How To Master Pharmacy Workflow

Category: Pharmacy Advances Written by Dr. Charles Shively / November 7, 2014

The Carolina Apothecary folks in Rockingham County, NC have mastered pharmacy workflow. Located near the North Carolina-Virginia border, this operation (one of three sister companies owned by Arnold Britt since 1971) and its efficient pharmacy workflow design is absolutely amazing.

This operation started with 5 individuals in 1971 filling 75 prescriptions per day. Visualize today's pharmacy workflow challenges in an operation with these daily elements...completed in less than 600 square feet with a drive-thru:

- Up to 1100 prescriptions filled daily (9-8 M-F, 9-6 Saturday, 9-11AM Sunday)
- 3-4 pharmacists working at any time (Mondays and Fridays are the busiest)
- 8 experienced pharmacy technicians
- An additional minimum of 2 technicians dedicated to prescriptions for delivery
- 4 customer service specialists (every call-in is answered by a human being)
- 5 delivery drivers (these drivers service 15 counties along the NC-Virginia border)
- 4 account billing staff professionals for credit accounts

And who is overseeing this action, centrally located? Regina, the RxMedic ADS robot.

Can pharmacy workflow be an art form?


The Carolina Apothecary pharmacy workflow, designed by Melissa Cross (Pharmacy Operations Manager) and Nathan "Nate" Hemberg, (Pharmacist-in-Charge), demonstrates how efficiency can exist in such a busy operation. Frankly, they can write the "pharmacy workflow book" for other pharmacy owners with high volumes should they wish to do so. During my visit to this Reidsville, NC shop, it became immediately apparent that every staff member enjoys the opportunity to work together as a team. Perhaps because the pharmacy technicians choose their daily stations of effort? When standing within 2 foot of your nearby associate in this operation (almost elbow to elbow) it is obvious these folks enjoy each other!

The layout of the pharmacy is like somewhat like a trapezoid...4 sided square with the front counter containing 3 angled portions. Prescription dropoff (one station) occurs on the right end of the front counter (as you look at the pharmacy area) with subsequent processing activities (entry verification by a pharmacist and insurance issue adjudication...almost always needed these dedicated pharmacy technicians) before being sent to Regina, their RxMedic ADS robot or the dedicated pharmacy technicians which are responsible for any manual counting and subsequent labeling and packaging of all prescriptions filled (either by Regina or manual count). To assist these pharmacy technicians, each receipt/prescription has an identification of whether or not the prescription was counted by Regina or manually completed and where its final pickup destination is to occur (in-store or via delivery). Carolina Apothecary uses QS1 software (since 1985).These counting/packaging activities occur on a workbench on the right side of the front counter. All prescription components (receipts, original prescriptions, filled prescription vials) are always transferred throughout the pharmacy to the various locations in color-coded baskets (waiting, later pickup, delivery, long term/assisted living care, etc.).

A Sophisticated Computer Workstation/Telephone Network

How many computer stations does your pharmacy have? Carolina Apothecary has at least fourteen (14)...15 with the RxMedic ADS)...stationed every 3 foot throughout their bench workspace. As one views the pharmacy layout standing in front of the pharmacy area, the front angled counter is approximately 28 foot long with an adjacent right side counting/packaging area some 6 foot long (separated by one of two entrances into the secured pharmacy area). The Customer Service area at the rear left of the pharmacy has an 8 foot bench adjacent to the drive thru behind the necessary inventory shelves surrounding Regina. At the left end of the front angled counter is the prescription pickup and counseling area with 3 cash registers (one dedicated to the adjacent drive-thru window). The drive-thru area is separated from the front angled counter by the second secured entry door to the pharmacy area.

I observed at least 6 telephones in use at any one time during my visit...customer service at the Carolina Apothecary is priority # 1.

Inventory and its Control

With the filling of 1100 prescriptions a day, inventory and its storage/control can be substantial. This operation...once again within the approximate 600 sq. ft. floorspace...has also over 600 linear feet of inventory shelving with no vacant space. No more than 8 steps are required to access meds not filled by Regina. I noted not a single odd-placed or improperly angled bottle. These folks are organized! The RxMedic ADS in this operation has responsibility to house and deliver the fast movers including C ll's and high volume controlled substances. Currently they have Regina set up with 12-16 supercells and 210 or so regular cells. Every cell location is used on the 256 cell RxMedic ADS unit.

Daily med counts filled by Regina are captured and sent via an e-mail, after day close, to Nate, the PIC, with the number of top 5 regular meds and any controlled substances noted. The e-mail also contains previous day fillings as a comparison. During daily activities, when replenishment of any medication is required, an additional report is generated by the RxMedic ADS system for inventory control. This allows any pharmacy to avoid a separate manually documented notebook, by NDC with lot number, quantity added, on each date and by whom with pharmacist witness, as required by some Boards of Pharmacy (as in my shop in South Carolina). Any replenishment of CII's is overseen by one of the pharmacists.

Narcotics and controlled substances either manually counted or filled by the RxMedic ADS are double counted by the appropriate pharmacist or staff as mandated by most Boards of Pharmacy. Nate (PIC) offered to me that Regina continues to never miscount or misfill and supports accuracy discussions of any miscount question by a customer/patient. Due to each event being captured with a visual in-the-bottle picture presented on the RxMedic ADS computer workscreen, the on-screen final drug fill and count verification step eliminates misfills or miscounts.

Best Pharmacy Workflow Practices Observed

With each pharmacy operation I visit, I find what I like to think of as "best practices". Carolina Apothecary confirmed several practices I have seen (in-part) with other locations:
- Ensure all staff is cross-trained to accurately complete each step of any process
- Define different station locations for the various daily filling/packaging activities
- Allow your staff to choose their daily area of activity
- Answer every telephone call with a human being
- Establish computer stations offering no more than 3 steps to access
- Separate for processing those prescriptions with insurance challenges
- Use color-coded baskets to move individual prescriptions throughout the pharmacy
- Have "being organized" as an operational mandate
- Allow your staff to name the RxMedic ADS robot (as the pharmacy technician
nicknamed "Boo-Boo" did for the Carolina Apothecary).

With the efficiency in workflow this pharmacy operation has achieved, give Melissa or Nate a call and discuss their successes. The pharmacy workflow, operational success and acceptance/utilization of pharmacy automation equipment has allowed them to explore other new revenue opportunities which are forthcoming. Visit them at or at 726 South Scales Street, downtown Reidsville, NC. Telephone: 336-349-8221.

Should you visit, don't forget to say "hi" to Regina. I understand she thinks she lives in a environment that allows her to mentally sing "Oh Happy Days...Oh Happy Days...".

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Thank for sharing!

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