Objective: Medication errors contribute to a significant number of fatal and nonfatal adverse medical events each year. Many actions, from both a policy and innovation standpoint, have been taken to reduce medication errors in the inpatient setting; yet, these actions often target larger urban hospitals. Rural hospitals face many more challenges in implementing these changes due to fewer resources and lower patient volumes. Our article discusses the implementation and results of a telepharmacy demonstration implemented between the University of California Davis Health System and six rural hospitals. Materials and Methods: A retrospective chart review obtained baseline medication errors for comparison with the prospective review of medication orders through telepharmacy. Medication orders from rural hospitals were transmitted via fax to the University of California Davis Pharmacy for after-hours review. If a medication required afterhours removal from the pharmacy, it was requested that video verification by a telepharmacist be used to verify that the correct medication was removed from the pharmacy. Results: Baseline findings from the retrospective chart review indicated that 30.0% of patients had one or more medication errors and that these errors occurred in 7.2% of the medication orders. None of these errors were found to have resulted in harm to the patients. During the telepharmacy demonstration, 2,378 medication orders were screened from 504 independent order review requests. In total, 58 (19.2%) patients had one or more medication errors. The errors from the telepharmacy demonstration represented potential errors that were identified through telepharmacy medication review. Conclusions: Telepharmacy represents a potential alternative to around-the-clock on-site pharmacist medication review for rural hospitals.

is increased hematoma expansion in patients with delayed or incomplete INR reversal prior to transfer. Methods: Retrospective 32 month single-center review of patients with warfarin-associated intracranial hemorrhage, INR 1.4 or greater upon tertiary center arrival, and treated per an institution-approved warfarin reversal protocol. Patients were excluded from the study if transitioned to palliative care in the first 24 hours or if direct radiologist comparison between images was not available or if surgical intervention was performed that disallowed assessment of hematoma expansion. The presence or absence of hematoma expansion was documented by the radiologist at time of the study. Results: 53 patients met study criteria. 18 patients (34%) transferred from smaller hospitals. 50% of transferred patients had hematoma expansion compared to 11% admitted directly through our hospital emergency department (p=0.002). Average study age was 75. Initial INR did not correlate with incidence of hematoma expansion (mean INR 3.5, no hematoma expansion, INR mean 3.5, with hematoma expansion, p=0.94). Patient variables were analyzed for confounders between the group that was transferred and those that were directly admitted and no differences were noted in baseline INR, gender, bleed location (extra vs intra-axial), and surgical interventions, however the transfer arm was younger (p=0.018). Conclusions:Study suggests delayed INR reversal for hospital transfers leads to significantly higher incidence of hematoma expansion. Expediting INR reversal may limit hematoma expansion and neurologic injury in patients with warfarinassociated intracranial hemorrhage.