Hospital pharmacies play a vital role in delivering quality healthcare services to patients. In fact, as pharmacists become more involved in direct clinical care, their interventions have been shown to help reduce the occurrence of adverse drug events, improve medication adherence, and shorten hospital stays.
When a strong workflow is in place, it shows. On the other hand, an inefficient pharmacy workflow can significantly impact patient care, leading to delays, errors, and decreased satisfaction. If things aren’t in sync, it can cost you time, revenue, and even patients.
Creating a well-designed workflow takes effort and commitment from the entire team, but with the right strategies in place, your hospital pharmacy can achieve optimal efficiency.
The Benefits of Hospital Pharmacy Workflow
Having an efficient workflow that is well thought out and documented helps the entire health system. It enhances patient safety and outcomes, reduces medication errors, improves operational efficiency, and increases overall staff satisfaction.
Everyone in the pharmacy knows exactly what tasks they should execute and the timeline for doing them. When the staff know what’s expected, they have the freedom to perform at their best, which leads to an overall sense of well-being.
Understanding the Natural Rhythms of a Hospital
Hospital pharmacies have different needs than stand-alone pharmacies. For example, there’s a flow around a doctor’s morning rounds and discharging patients that will impact the timing of filling daily medications. Surgery schedules or nurses’ needs could bump up against tasks in your daily workflow. Or the timing of a drug delivery could compete with internal resources, putting conflicting demands on your technicians or pharmacists.
While every health system is unique and requires a more tailored approach to improving workflow, efficiency can be optimized by setting up processes and designing a system that fits within the natural rhythms of your organization. That way you are getting things done in a timely fashion instead of getting them done just in time.
The Ideal Hospital Pharmacy Workflow
An ideal workflow optimizes time, space, and personnel. Setting up the space with a linear flow and clear stages creates well-defined systems that work regardless of the individual who’s on duty.
The space should allow room for the process to run smoothly and the staff to fulfill their tasks without interruption. You want to have defined checkpoints with clear documentation all the way through until the final check area when the pharmacist gives their approval and it can be moved into the delivery cycle.
All roles and responsibilities should be clearly defined, and tasks should be assigned to team members accordingly. Up-to-date training and continuing education help ensure your staff sharpens their skills, and cross-training your staff with specializations in different areas can equip them with multiple skill sets.
It’s important to involve key stakeholders such as pharmacists, pharmacy technicians, buyers, and pharmacy management. Engaging these team members allows for a comprehensive understanding of the current overall hospital workflow and fosters collaboration to address potential challenges and implement improvements effectively.
Gathering insights from procedural areas, like the Cardiac Cath Lab or Radiology department, is crucial to align the pharmacy workflow with patient care needs and expectations.
Steps to Optimize Hospital Pharmacy Workflow:
Observe the Current Process
Begin by carefully observing the existing pharmacy workflow to identify areas that require improvement. This assessment should include workflow mapping, identifying bottlenecks, and analyzing potential inefficiencies.
Do rounds with your team members to find out how things are working – or not working – and if there are any additional resources needed. Workflows are so dependent upon size, space, and design. So, it’s important to determine your key processes, time frames, and areas that you’re servicing.
Clearly Define New Processes and Priorities
Based on your observations, clearly define new processes, roles, and responsibilities. Establish priorities to ensure that tasks are allocated efficiently, and everyone understands their role in the workflow. Ideally, you’re looking for quick segmented processes that can get things done in a timely fashion.
Know what your schedule looks like and create a timeframe for when things will happen, what the deadlines are, and who is responsible. For example, a change of shift report should explain what still needs to be done and who’s responsible for doing it. Demands will change. Defined workflows help to account for staff that can and will need to step away from their regular tasks to quickly fill and deliver stat medications.
Maintain Clear Communication
Once those new processes and systems are created, they need to be communicated to everyone involved, from the internal team to other departments in the hospital that will be affected.
Communicate the Plan and Designate Responsibilities: Clearly communicate the new processes and designate responsibilities to the team. This fosters accountability and ensures everyone is aligned with the workflow changes.
Develop Communication Plans Throughout the Hospital: Establish effective communication channels within the pharmacy and across the entire hospital system. This includes determining who to contact in case of medication shortages or other urgent issues.
Measure Your Success
Set specific goals and metrics to measure the success of your optimized workflow. Regularly track and evaluate key performance indicators, such as turnaround time, medication error rates, and staff productivity. Additionally, develop mechanisms to identify and address inefficiencies and errors promptly.
Identify Common Workflow Mistakes
Look for common pitfalls in the workflow, such as bottlenecks, lack of readily available resources, or multiple tasks going on in a tight space. Then implement strategies to address these issues and ensure smooth operations.
For example, if you’ve drawn up oral liquids, like a specific dose of cough syrup, but the system is staged poorly, it may take you twice as long to fill the order. You have to draw it up, label it, and stage it for the pharmacist, which means you need syringes and other items nearby, as well as a sink where you can wash your hands. And if the printer is in a different area than the workflow, getting the label involves more time and effort than it should.
Harmonize Pharmacy Workflow with Hospital Floor Operations
Analyze the workflow within the pharmacy and align it with the processes happening on the hospital floor.
Foster collaboration and open communication between the pharmacy and other departments to improve coordination and patient care. If pharmacists are decentralized to the floors, make sure they have the proper tools at the right time and that there are clearly defined communication channels for them to reach the team.
Talk to nursing and understand how their work is happening so that things flow more easily. And set up processes for procedural areas so that when they need something urgently, they know exactly who to call and who is responsible for delivering the item or medication.
Account for Inpatient vs. Outpatient Needs
Recognize the unique workflow requirements for inpatient and outpatient settings. Tailor the workflow to accommodate these differences and ensure seamless transitions for patients in each place.
An efficient workflow for, say, an outpatient infusion center requires advance preparation, so you have enough lead time to supply the drugs in a timely manner and minimize the patient infusion time to increase patient throughput. Outpatient departments are critical service areas, and ineffective processes can result in delays and complaints. This may result in doctors sending patients elsewhere and lead to lost revenue.
Explore strategies and tools that can optimize hospital pharmacy workflow. Automation technologies, like automated dispensing cabinets, are one of the primary ways that drugs are delivered in a hospital. They can enhance efficiency by reducing manual tasks and streamlining the medication management processes. But there’s a timing sequence to consider.
If you’re filling the machine while nurses are pulling from it, you’re fighting against the team. It’s not only about understanding when you need to supply the machines. It’s also knowing how many times a day you need to supply them.
A key component of efficiency, here, is getting things done ahead of time. The timing plays into the greater good of care.
Prepare for One-off Needs
Develop contingency plans for unexpected situations or urgent needs that may disrupt scheduled tasks. Depending on the size of your institution and the workload of your team, you may want to create a separate workflow capacity for things that pop up in addition to the production line doing the regularly scheduled tasks.
No matter how you design it, make sure the contingency plan is clearly defined, prioritized, and communicated. Otherwise, one unexpected task can create a bottleneck and throw everything else off schedule. Having a plan in place ensures that routine operations continue smoothly without compromising patient care.
Manage Shortages Effectively
Hospitals are a 24/7 operation, and drug shortages can have a significant impact on both workloads and patient care. Workflow gets held up, and scheduled tasks can’t be completed because you’re waiting on one or two missing items.
Establish a dedicated holding area to track missing items, their expected arrival, and responsible personnel. And create a robust system for managing shortages, including clear protocols for change of shift and communication. That way the rest of the process doesn’t stop, and you know what’s still outstanding.
Regularly Review and Update Processes
Continuously review and evaluate the effectiveness of your newly optimized hospital pharmacy workflow. Seek feedback from staff and department heads, monitor evolving healthcare and pharmacy trends, and make necessary adjustments to ensure the workflow remains efficient and aligned with your current needs.
About the Author
Dana Fox, Pharm. D., Director of Quality and Compliance
Dr. Dana Fox joined CompleteRx in 2003 and is the Director of Quality and Compliance. In his role, Dana oversees the compliance assessments and solutions and the quality improvement solutions – such as pharmacy implementations and processes changes – to meet the needs of hospitals and pharmacists across the country.
Dana previously served as Director of Pharmacy for a health system in Atlanta, Georgia and has over 22 years of experience in hospital pharmacy management and operations including operational and process improvements, implementation of automation, 340B, pharmaceutical purchasing and medication safety.
Dana received his Pharm.D. from University of Illinois at Chicago and completed a two-year health system pharmacy administration degree at University of Wisconsin Health. He has completed Six Sigma Green Belt training with Purdue University.