I like to review data related to pharmacy operations analytically. In doing that, I have uncovered some instances in which analytics can illuminate a problem, but not provide a solution for it. One such problem reminds me of an experience from the “good old days” when I was a Director of Pharmacy.
Back in those days, we were running what was then known as a unit-dose drug distribution cart-exchange system, in which a cart served a particular population of patient rooms/beds, and each room/bed (actually the patient therein) was represented by a drawer in that cart.
There were duplicates of each cart: one being used by caregivers on the patient care units, and another in the pharmacy being filled, checked and prepared for delivery. Every day we would bring a “newly filled” cart up to the patient care area, and return the “used” cart for refilling.
My purpose in bringing this up is not to weigh the merits of the cart-exchange system, but rather to talk about what I learned from this experience about scheduling pharmacy work.
You see, we did our cart fill during the day. We would start the process about 8 a.m. for a delivery at the change-of-shift about 3 p.m., every 24 hours. It was convenient for us (though not necessarily for nursing), and we didn’t have to pay shift differential to get it done.
By the time the 9 a.m. med pass came around the next morning, our cart supplies were pretty well picked over, and we had a swell of missing med requests to deal with starting around 8 a.m. The phones rang off the hook, and we were constantly running med supplies up to the unit.
Additionally, because we were filling during times of significant new order activity, we were constantly having to update the cart fills as new orders came in between filling, checking and delivery.
I was young then (about 29 actually), so I wasn't smart enough to think about whether this made sense; it "just was".
For reasons unrelated to any serious analysis, I wound up in a position where I had the opportunity to move cart fill to the night shift and move the delivery to around 7 a.m. (at the change of night and day shifts for nurses - they worked in three shifts back then). To everyone's amazement, this almost completely eliminated the missing meds problem for the 9 a.m. med pass. The phones didn’t get busier until later in the day, and my day shift could focus entirely on managing order changes. It may be worth mentioning that this was well before CPOE so those orders were a lot of work.
This caused me to look into why this had made such a change in our work patterns, and I came to realize that the 9 a.m. med pass was by far the busiest med pass of the day (our QD, BID, TID, and QID med schedules all had 9 a.m. doses) and providing a new supply of meds just before this med pass significantly reduced missing meds. Of course, we still had missing meds later in the day, but the demand was smaller then, and the number we had to run up to the floor was substantially reduced.
It also turned out that moving the cart fill to the night shift meant that filling those carts occurred during a time when the pace of order changes was at its absolute lowest so we didn’t have much in the way of cart updates before delivery, and the delivered carts were far more accurate and complete.
I won’t say that it solved all of our operational problems, but I will say that our mornings were generally quieter and easier to manage.
Now that our distribution methods have changed to include the use of automated dispensing cabinets, we refill cabinets rather than exchanging carts. The analyses I am doing points to some of the same problems; specifically, refill processes that are organized and scheduled during or after the busiest med passes of the day. Might moving those refill processes have an effect on the number of urgent refill trips taken during the day?
What do you think? Please let me know!
As always, the ideas expressed herein are my own, and not necessarily those of ASHP or of my employer, BD.
Dennis A. Tribble, Pharm.D., FASHP
Ormond Beach, FL
datdoc@aol.com