Pharmacy workflow on life support

By | February 2, 2010

A friend from Talyst stopped by the pharmacy and spent the greater part of Monday afternoon and Tuesday morning taking a look at what it means to work in an acute care hospital pharmacy. We have several pieces of Talyst automation and technology in our pharmacy and he was interested in how we used it and how it fit into the general scheme of things. As we roamed the pharmacy, I began describing our Pyxis system, how we handle our replenishment, how we put our order away, how we package bulk medications, how we barcode syringes, how we handle an IV batch, how we handle infusions for our smart pumps, and so on and so forth ad infinitum. It was a good exercise for me as it often improves my understanding of something when I try to explain it to someone else.

As we walked around the pharmacy and I began explaining how things worked I noticed that I frequently had to move to another location in the pharmacy to make better use of a visual aid to explain myself. Sounds benign enough until I realized that the movement created a disjointed and often times awkward workflow. I was all over the place.

Basically, the workflow that we initially designed prior to installing the carousels had gone out the window in favor of a haphazard method of making sure that things get accomplished in the pharmacy. Some call it organized chaos, but I’m not too sure about that. Chaotic? Yes. Organized? Uh, well, not so much.

The initial workflow design called for drugs entering the pharmacy to be identified, barcoded and added to the AutoPharm, Pharmacy and Pyxis systems prior to making their way to the carousels for storage. In reality, newly received medications that are not in the system are discovered during the restocking process. Therefore, our workflow is centralized at the carousels themselves, not at the back of the pharmacy as originally thought.

This isn’t the only area that appears to have gone sideways from the original plan. Several areas in the pharmacy have morphed into something completely different than originally designed. The unfortunate result is a very inefficient workflow with poor communication secondary to groups of people working in silos; not good.

So, I took some time and did what every red-blooded American does when something like this happens: I got a Diet Pepsi and started surfing the internet in search of answers. I ran out of Diet Pepsi without finding a decent solution to my problem. I used every trick in find-anything-you-want-on-the-internet bag of tricks and came up empty handed. Apparently people don’t publish this information openly on the internet. I realize that every pharmacy workflow will be different, but don’t you think there would be some general guidelines out there somewhere? Yeah, me too.

Anyone have any suggestions? Anyone? Bueller? Bueller? Bueller?

11 thoughts on “Pharmacy workflow on life support

  1. Rob Fahrni

    Wow, I think it’s time for you to take the bull by the horns, as they say, create a workflow, and publish it.

    Right?

  2. Jerry Fahrni Post author

    I suppose that would work. The biggest problem is I don’t really know how to design a good workflow; never had to do it. That’s what started the search in the first place. Retail pharmacies do it all the time, but apparently hospital pharmacies don’t. Go figure.

  3. carlac

    Hmmm, sounds like your “friend from talyst” should be able to point you toward some workflows. Just sayin’

  4. Jerry Fahrni Post author

    We talked a little about future possibilities and Rx Innovate a bit. Workflows are tough because of all the differences among healthcare systems. Know what I’m sayin’?

  5. Rob Fahrni

    Well, based on what happened during your tour you must have some idea of how it should change, right? Start there and iterate. Work with folks at all levels in the process, it should turn up some interesting ideas.

  6. Jerry Fahrni Post author

    Good idea, already started looking at it. Know any “easy” ways to create a computer generated 3D model?

  7. pillguy

    Jerry you have to go back to the root of the problem. Most likely your issues surround the roles each person plays in daily operations, how they move through the pharmacy, and the original design. Most of the time we just “make room” for automation somewhere in the Inpatient Pharmacy. Ambulatory environments seem to do a much better job of attending the workflow issue, so you might look at some of the busier outpatient pharmacies to get some ideas.

    Order Entry, Order Verification, faxing, phone calls, clinical duties, restocking, inventory management with ADCs, receiving, product preparation and storage, product checking and packaging for sending to floors. I am sure you can think of a few more.

    Get a CAD drawing of the pharmacy space, and if you have the electronic means start putting your equipment and people in places. FIgure out how to get things to flow without breaks in the process. I have done this a number of times in the ambulatory arena, but have yet to attempt it for inpatient. You the man!

  8. Jerry Fahrni Post author

    Hey pillguy, it’s been a while. I agree with your assessment completely. I think one of our biggest issues in our pharmacy is a couple of poor decisions during reconstructions. We’ve created some bottlenecks in the department.

    I like your recommendation about a CAD program. I’ve already been roaming the pharmacy trying to figure out what will work and what won’t. It’s not as easy as I thought it would be, that’s for certain.

    Thanks for the thought. Talk with you soon.

  9. Rob Fahrni

    Get the CAD drawing. I know a guy that can get you a copy of Visio, you can import the CAD drawing as a background, complete with layer support (at least I hope you still can), then annotate it to your hearts content.

  10. Dave Bateman

    Jerry,
    I design hospital pharmacies. My primary job is to work with you and establish the optimal workflow with the system you have or plan to have. There is a relatively small group of people across the country that specialize in pharmacy design.
    I am based in the Chicago area and have 23 years experience. If you want someone local, I know a number of people that may be able to help you. We all have references upon request.
    I was researching a design I am doing for a college pharmacy class room when I came across your post.

  11. Jerry Fahrni Post author

    Hi Dave,

    Thanks for the information, but I no longer have a need. That post is pretty old and I haven’t worked in a hospital pharmacy in quite sometime. One thing I can say with confidence is that the design of most hospital pharmacies is pretty bad. I see a lot of funky stuff during my travels.

    Jerry

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