By Alexander Jenkins, PharmD, MS, and Stephen Eckel, PharmD, MHA, BPCS
The University of North Carolina Hospitals and Clinics (UNCH) Central Outpatient Pharmacy is a retail pharmacy designed to facilitate direct patient interactions for all dispensed prescriptions (approximately 240 every day). The Outpatient Pharmacy is staffed by up to six pharmacists at one time to maximize the pharmacist-patient interactions of profile review, medication reconciliation, and patient counseling. However, pharmacists still struggled to balance the provision of comprehensive pharmacy care with patient throughput.
Despite efforts to increase pharmacist availability through a low prescription-to-pharmacist ratio and to streamline medication dispensation by implementation of technology solutions, patients continued to experience significant wait times because pharmacists are often slowed by technical dispensing functions. Therefore, it was decided that conducting a workflow analysis was essential to demonstrate opportunities for improved pharmacist efficiency in the dispensation process.
Performing Workflow Analysis
The UNCH Outpatient Pharmacy workflow was evaluated by characterizing the sequential steps of the medication dispensation process and determining the level of pharmacist involvement. Results of the assessment were then used to describe how much pharmacist time was dedicated to value added (to the patient) activities, non-value added activities, and non-value added but essential activities (eg, necessary for regulatory compliance). Examples of value added activities include medication reconciliation and medication therapy management (MTM). (See Table 1.)
Because initial pharmacist-patient engagement did not begin until after the patient had been entered into the queuing system, this analysis only took into consideration the actions of the pharmacist between initial patient interaction and patient check out. Based on observation, it was revealed that the Outpatient Pharmacy dispensing process included eight sequential process steps (see Figure 1).
In general, a significant amount of variability was observed in pharmacist behavior throughout the dispensation process. However, it was found that pharmacists were heavily involved in almost all process steps, including technical dispensing activities, which were considered non-value added activities. Our analysis of the Outpatient Pharmacy workflow model demonstrated a need for increased pharmacist-patient interactions, which add value to the patient.
Lastly, we were able to quantify the potential gain in pharmacist efficiency through the use of theoretical modeling that incorporated specific workflow enhancements. By incrementally applying these theoretical workflow modifications, we determined how non-value added activities could be minimized.
Use of Theoretical Modeling
Creating theoretical models is a valuable tool for establishing future goals to increase efficiency in pharmacist workflow. Application of theoretical concepts enables pharmacy managers to target specific steps in the dispensation process for performance improvement initiatives.
Theoretical modeling can be used to maximize the use of pharmacist time by systematically applying process changes to reduce non-value added activities. Examples of process changes include defining larger roles for pharmacy technicians in technical dispensing functions (ie, counting, prescription entry, transcribing prescriptions over the phone, etc), adding cashiers to the workflow, and utilizing pharmacy students/interns for patient counseling. These are just a few examples of how managers can apply theoretical concepts to demonstrate opportunities for improved use of pharmacist time. As every retail pharmacy has a unique workflow, theoretical modeling is a useful tool for strategic planning and identifying future performance improvement projects.
Conducting a workflow analysis of the UNCH Central Outpatient Pharmacy demonstrated opportunities to increase pharmacist efficiency during medication dispensation by reducing involvement in non-value added activities. Observational data revealed significant pharmacist involvement in technical dispensing activities that could be shifted to pharmacy technician responsibilities.
Overall, there was a need to improve workflow by facilitating increased pharmacist-patient interactions. This need was further demonstrated by applying theoretical concepts to determine the potential gain for optimizing the use of pharmacist time. The potential benefits derived from redirecting pharmacist work toward direct patient interactions include improved workflow efficiency, opportunities for MTM, reduced salary cost per dispensed prescription, and improved quality of patient care.
Alexander T. Jenkins, PharmD, MS, the Medication Safety Officer at WakeMed Health & Hospitals, received his MS in health-system pharmacy from the University of North Carolina at Chapel Hill. He also earned a doctor of pharmacy from the University of North Carolina.
Stephen F. Eckel, PharmD, MHA, BPCS, is an assistant director of pharmacy at the University of North Carolina Hospitals and is Residency Program Director for the 2-year health-system pharmacy administration residency program.
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