Whenever visitors tour our pharmacy, one of the most common comments has to do with the level of our staffing. We typically have a minimum of 4 pharmacists working on any given day, with as many as 7 on select days. The use of extra pharmacists (what we call our slack resources) allows the flexibility to accomplish many ventures other “stripped down model” pharmacies cannot. This article will describe our workflow and the benefits it brings to a pharmacy practice.
Technician Driven
The most important part of our workflow is freeing the pharmacist to focus on the patient. This is accomplished by leveraging excellent technicians to do all data entry and filling processes. In our case, our pharmacy is involved in a pilot project allowing technicians that have received additional training to check refill orders without a pharmacist final verification of the product.
The Pharmacist Belongs on the Counter
Another important philosophy in our workflow is that the pharmacist needs to stay in the dispensing workflow. Even if the pharmacist is not doing the final verification step (for example, in the tech check tech pilot program above) the pharmacist is still reviewing the patient’s profile and clinical record in real-time. The pharmacist is tasked with creating and documenting interventions that need to be addressed with either the patient and / or the prescriber. By being on the counter, the pharmacist is accessible to gather information directly from the patient as needed to make clinical recommendations.
The pharmacist on the counter has one of the more difficult jobs in our practice. Their responsibilities include:
- Final Verification of the drug product (all prescriptions, or for new prescriptions if a tech-check-tech program is in place)
- Clinical profile review. Each patient’s records are reviewed any time a prescription is filled or a patient contacts the pharmacy with a concern or question.
- Identify issues that need to be addressed at the point of sale (compliance, high risk medication use etc) and flag these for follow-up with the patient
- Gather patient information specific to any issues identified
- Document the additional information gathered
- Schedule appropriate follow-up as required
- Contact the prescriber by phone or fax regarding any problem(s) identified as needed
This is a significant amount of work to put on one person, and when the pharmacy becomes busy, this pharmacist needs a resource to delegate work. This is our slack pharmacist.
The Slack Pharmacist
It is important to develop a workflow that leverages this person to maximize their impact. It would be inefficient to have this resource sitting and waiting for the hand-off from our prescription counter. Our slack pharmacist’s responsibilities also include medication reviews for our patients residing in nursing homes we service, and our assisted living community patients. They are also involved in vaccination programs and other clinical services like cholesterol screenings, site visits and our medication sync program.
Our slack pharmacists are located a few feet from our prescription counter, in semi-private cubicles. This workspace allows the slack pharmacist to work individually with a patient, and to have ready access to the clinical records system and many of the other tools they use (blood pressure cuff, Cholestec machine, immunization supplies, injection supplies, patient charts etc). This proximity means that the counter pharmacist can easily hand-off patient care activities, SOAP note completion, physician calls and faxes during a busy time on the counter.
Pharmacists Enable Care
If it isn’t obvious by now, our practice places a significant emphasis on the talents and capabilities of our pharmacists. What visitors notice immediately after they count the number of pharmacists at our practice is that every single pharmacist is quite busy. Taking care of patients is not possible if you don’t have the resources available, and simply filling prescriptions is not patient care. The pharmacist has excellent access to their patients, and they need to capture every encounter and make it count.