Pharmacy technicians are operational experts, and as such, should be entrusted to own process improvement opportunities. Strategies for engaging technicians in process improvements include providing routine access to data tools, developing analytic skillsets, and granting authority to act on their conclusions. Supporting and encouraging this approach affords technicians deeper insight into the impact of their work as they can translate their personal observations from involvement with workflows into evidence-based insight gleaned from data.
Traditionally, the process of data retrieval and analysis has been primarily reserved for supervisors, who may not have consistent bandwidth to support efforts for timely data driven insights. Shifting these responsibilities to the frontline technicians permits timely investigations and prompt responses to operational opportunities.
At the University of Iowa Stead Family Children’s Hospital (SFCH), a 189-bed facility, senior technicians have access to an electronic dashboard that displays medication dispenses. The dashboard (see the FIGURE) shows total and average dispense volumes for specified time frames based on medication, dispensing pharmacy, patient location, dispense code, and dispense type (eg, first dose, cart fill, redispense). The data that feeds into the dashboard can also be exported for further analysis.
We share the following experiences to illustrate how technicians can utilize data from a medication dispensing dashboard to advance operations.
Inventory Layout Improvements
Ideal pharmacy medication storage minimizes unneeded or excessive movement by technicians. To optimize medication storage, higher usage medications or “fast movers” should be stored proximal to where medications are staged. As clinical practices evolve, inventory layout should also evolve as part of operational optimization—dispensing data can be used to streamline this growth.
SFCH senior technicians worked on a Lean process improvement project to reduce excess movement by the staging technician. In our facility, ready-to-use (RTU) medication bags are stored on a shelf behind a medication carousel, which requires the stager to walk back and forth regularly to obtain the products. Following analysis based on one year of dispensing data and space constraints, we moved the top five most utilized RTU products to a storage location at the staging counter. This change is estimated to reduce the staging technician’s movement by 51 hours per year.
SFCH has a section of “fast mover” injectable vials that are stored near the pass-through to the buffer room. Periodically, senior technicians will assess the dispensing volume of sterile products and adjust this inventory accordingly. Recently, meropenem vials were replaced, which correlates with antimicrobial stewardship efforts to decrease inappropriate broad-spectrum antibiotic usage.
ADC Inventory Optimization
Due to daily interactions with automated dispensing cabinets (ADCs), technicians develop a keen sense of medication usage patterns. Often, technicians recognize the inefficiencies of unoptimized ADC inventory as they make frequent deliveries to restock select medications or dispose of the same medications that consistently expire.
At SFCH, such feedback is relayed to senior technicians who review the dispensing dashboard for a medication’s total dispenses, average dispenses, and the average number of products needed to complete a dispense. If the data indicates an inventory adjustment is reasonable, they submit a proposal for managerial approval. With data in hand, managers can make more timely decisions.
This proactive, frontline-driven practice can augment an institution’s existing infrastructure for periodic review of ADC inventory. If the infrastructure for regular reviews does not exist, this process can serve as a starting point for ADC inventory optimization.
With product batching, select medications are repackaged or compounded in advance at standard doses to support a more efficient dispensing model. Inventory levels for batched products should be dynamic and reflect evolving patient needs. Dashboard data can help identify trends to determine if or when an inventory adjustment is required.
The value of adaptation is exemplified through SFCH’s use of a standard epoprostenol inhalation; a batch supply of up to nine syringes is routinely maintained. Product utilization can fluctuate significantly based on patient acuity in the neonatal and pediatric intensive care units. After receiving team feedback, the senior technician utilizes this data to trend dispensing volumes over the previous week and confers with pharmacists to determine if patients’ needs will continue. Then, the senior technicians independently determine if epoprostenol batching volume should be increased and by how much in order to avoid inventory stock outs and urgent compounding.
Conversely, there are instances where inventory adjustments are not warranted. Technician input is just as valuable in determining when inventory change is necessary as when it is not. When the pharmacy team felt that promethazine intravenous piggybacks should be batched, senior technicians were able to immediately access data from the dashboard to ascertain that the dispense volumes and the 7-day expiration did not justify batching, further supporting the idea that access to dashboards yields prompt, fact-based decisions.
Odd Stock vs Routine Inventory
On occasion, hospitals may rely on an adjoining facility to supply medications that are infrequently dispensed to its own population. Data from a dashboard can reveal if this is the best approach for specific medications as usage volume fluctuates.
The SFCH pediatric pharmacy relies on the adjoined adult hospital, the University of Iowa Hospital and Clinics, to supply medications that are infrequently dispensed to pediatric patients. These are temporarily stored in the SFCH pharmacy as “odd stock” to be used as needed. The current process for obtaining these odd stock medications requires an SFCH pharmacy technician to walk 0.7 miles roundtrip to the adult hospital pharmacy. While the retrieval process of such medications will vary by facility, these campaigns can waste technician resources. To address this, the technician team notes consistent or increased usage of any odd stock medication, alerting the senior technicians when appropriate. The senior technicians then evaluate the dispensing volumes and consult with pharmacists to determine if usage reflects a permanent or temporary change in clinical practice. If an addition to routine inventory is deemed warranted, justifiable proposals are submitted for manager consideration.
During the operational huddle, dispensing volumes from the previous day (eg, total, per shift, cart fill, first doses, total chemotherapy compounds) can be shared with technicians to reflect on and generate discussion. When dispense volumes do not corroborate with team sentiment, managers are able to more precisely inquire about which events and workflows are not captured by the data. These in-depth conversations with complementing metrics help convert the team’s subjective feelings into tangible and objective insight that provides increased clarity to management, who may not be savvy to every event in the pharmacy. As dispense volumes and sentiment are trended, management may approve a temporary increase in staffing. In our experience, visibility to this data heightened the technicians’ sense of ownership of operations. In turn, this increase in clarity as to their quantifiable contributions to patient care also increased technicians’ job satisfaction.
By evolving the type and distribution of responsibilities within a pharmacy team, individuals are empowered to tackle new challenges and provide new avenues for adding value to patient care. Since working with the dispensing dashboard, SFCH senior technicians report an increased sense of ownership for the pharmacy’s operations. As a result of the data insights, they report feeling more connected to their work and are empowered to make effective decisions to benefit the team and their patients. These sentiments have steadily dispersed throughout the entire technician team as their involvement results in timelier responses. Dashboards with data analytics are a key tool for enabling frontline technicians to act on data-based insight, ultimately leading to a more dynamic and engaged workforce.
Jessica Boesen, BA, CPhT, is a senior pharmacy technician for the University of Iowa Stead Family Children’s Hospital in Iowa City, Iowa.
Taylor Evans, BA, MS, is a senior pharmacy technician for the University of Iowa Stead Family Children’s Hospital in Iowa City, Iowa.
Camryn Froerer, PharmD, MS, BCPS, is an adult pharmacy operations manager for the University of Iowa Hospitals & Clinics in Iowa City, Iowa. He earned his doctor of pharmacy degree from the University of Utah College of Pharmacy and completed his MS in pharmacy administration at the University of Utah while completing a combined PGY1/PGY2 in Health-System Pharmacy Administration at the University of Utah Health.
Felix Lam, PharmD, MBA, BCPS, is the pediatric pharmacy operations manager for the University of Iowa Hospitals & Clinics in Iowa City, Iowa. He earned his doctor of pharmacy from the University of North Carolina Eshelman School of Pharmacy and his MBA with an emphasis on health care management from the Johns Hopkins Carey Business School while completing a combined PGY1/PGY2 in health-system pharmacy administration at The Johns Hopkins Hospital.
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