Pharmacies

Transforming Pharmacy Workflow and Setting Priorities

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Performance-driven workflow builds pharmacy value and helps patients live healthier lives.

In most pharmacies, the dispensing process begins when patients call in medication refills or hand off prescriptions from their physician. In this scenario, workflow is patient-driven with pharmacists and staff reacting and responding according to patient demands as the day unfolds.

Naturally, some parts of the week or seasons of the year are busier than others, creating volume fluctuations. Consequently, traditional dispense-driven workflow makes it difficult to pre-schedule clinical medication therapy management (MTM) services and to carve out time for business-related tasks such as running reports and analyzing data.

In contrast, an enhanced approach — performance-driven workflow — sets the stage for dramatic increases in pharmacy efficiencies. Performance-driven workflow empowers the pharmacy owner or manager to drive and control daily prescription volume, establish staff responsibilities, schedule MTM services and other pharmacy tasks, and devote time to business reports.

Here’s how to create this level of pharmacy workflow efficiency.

Build from a solid foundation
Medication synchronization, which coordinates all of a patient’s chronic medications to be filled at the same time each month, sets the groundwork for performance-driven workflow. The process enables improved management of medication inventory and staffing. Further, interactions with patients lead to more meaningful outcomes while reducing duplications in processes saves time and expense.

It’s been the most valuable program for patients and staff that I’ve ever implemented at my two pharmacies in Moundsville and Sistersville, West Virginia.1

We started medication synchronization in 2013 at Moundsville, which fills about 9,000 prescriptions per month and now has 930 patients enrolled in the program. Likewise, we started synchronization in 2015 at Sistersville, which fills about 3,800 prescriptions monthly and has 360 patients enrolled. In both cases, the number of prescriptions processed through synchronization is between 57 and 59 percent of total prescription volume.

Industry-wide, patients enrolled in medication synchronization are over 2.5 times more likely to be adherent to their medications and 21 percent less likely to discontinue drug therapy.2

Synchronization also helps in the following ways:

  • Reducing incoming phone calls. Whether a pharmacy has staff answer the phone or relies on an interactive voice response system, it takes time and resources to handle refill requests, which make up the bulk of prescription volume. Synchronization allows the pharmacy to know when prescriptions need to be filled so staff can work proactively to fill them in advance without the patient needing to make a call.
  • Minimizing patients’ wait time. With synchronization, the only patients waiting in-store for medications are those who have new prescriptions. Refills are handled separately through the synchronization process.
  • Decreasing accesses to patient profiles. Synchronization consolidates dispensing — and associated patient look-ups — to once a month, as opposed to disjointed accesses three or four times per month for unsynchronized patients.
  • Producing complete medication orders. By its once-monthly nature, synchronization reduces the incidence of on-order and partial medication fills.
  • Speeding up patient checkouts. Enrolled patients don’t have to wait at point-of-sale terminals multiple times per month, as they would without synchronization. That moves along the checkout process for in-store patients and leverages staff efficiency.
  • Scaling back deliveries or mailings. Again, medications go out once per month rather than multiple times.
  • Opening up opportunities for MTM. Time not spent on dispensing can be devoted to MTM services like comprehensive medication reviews and targeted interventions, and expanding these clinical offerings to a higher percentage of patients. In the process, pharmacies can improve patient understanding of medications and disease states, ramp up drug adherence, and identify potential drug interactions and duplicate therapies.3

Think in terms of separate processes
At our pharmacies, we’ve established distinct primary and synchronization workflows. The former serves patients waiting in the pharmacy for their prescriptions while the latter assists those who have enrolled in our synchronization program. This structure allows us to assign designated processes, tasks and responsibilities to each pharmacist and technician.

What’s more, it improves our ability to schedule staff. We set aside two consistent days of the week for processing synchronization prescriptions and we schedule a full staff on those days. On other days, we utilize about 30 percent of the staff we would use on a synchronization day and have them work on tasks such as will-call checking, handling durable medical equipment (DME) processes, sending thank-you cards and running financial reports.

Review and remodel
Pharmacies just starting out with synchronization may have just 50 to 75 patients enrolled in the program, accounting for only 5 or 10 percent of prescription volume. Aim to expand by 10 percent quarterly, with a longer-term milestone of at least 30 percent of prescription volume, at which point major efficiencies in workflow will become evident.

Combining synchronization and MTM services creates tremendous value for the pharmacy. First, patients benefit from identification of omissions in therapy and as high-risk medications are flagged they are converted to safer alternatives. From a business perspective, enrolling a patient in synchronization adds the potential to fill 20 more prescriptions per year.4 And the MTM process may help identify chances to offer immunizations and DME.

Further, while pharmacies share many similarities in day-to-day operations, the methods of completing processes vary considerably. Thoughtful review of strengths and weaknesses will reveal unique opportunities to become more effective. Pharmacy owners and managers should take a step back and watch their teams work to discover possible causes for inefficiency.

For instance:

  • Are staff responsibilities clearly delineated or do they overlap?
  • Are the right staff members working on the right processes?
  • Are administrative and inventory tasks handled on the pharmacy’s slowest days?
  • Are staff members (e.g., processing and counting technicians) working in a space that’s too cramped?
  • Are they communicating well with one another?
  • Do they encounter too many interruptions (e.g., incoming calls)?
  • Are they competing for resources such as phones and printers?

Overall, consider how synchronization would address any current pharmacy workflow challenges while meeting the needs of patients. Also keep in mind that any selected solution must be “trainable” to the team and sustainable over time.

Training should include explanation of not only how to complete new processes, but why.

Monitor and expand the program
Performance reports from platforms such as EQuIPPTM will begin to reflect the number of patients enrolled in synchronization. As enrollment increases, so will performance scores. Log on to the performance platforms at least once a week to track synchronization progress and check for new MTM case assignments. At our pharmacies, we sign on every Monday so that we can plan accordingly for the rest of the week by scheduling time to complete MTMs.

A pharmacy with an established workflow strategy should target achievement of Top 20 Percent, as measured by EQuIPP, in adherence quality measures. That’s not easy, but becomes progressively more realistic with a sizable number of patients enrolled in synchronization. Pharmacy teams with the right training stand ready to offer adherence solutions such as compliance packaging and medication delivery.5 They also strive to complete at least 80 percent of MTM cases.

Finally, pharmacies should approach workflow initiatives with an eye toward identifying and addressing a more holistic set of patient needs such as recommending immunizations and DME services. Performance-driven workflow creates new opportunities for expanding services that boost the bottom line and help patients live healthier lives.

References
1. How medication synchronization makes a difference. http://www.knowledgedriven.com/articles/pharmacies/how-medication-synchronization-makes-a-difference.aspx#.WHjhwrGZOCQ
2. National Community Pharmacists Association. Community pharmacies forming an adherence network. http://ncpa.co/uploads/Arkansas-One-Pager.pdf
3. Ten best practices for success in medication therapy management. http://www.knowledgedriven.com/articles/pharmacies/10-best-practices-for-success-in-medication-therapy-management.aspx#.WHkQIrGZOCQ
4. National Community Pharmacists Association. Patients benefit from pharmacy-provided medication synchronization programs. http://www.ncpanet.org/newsroom/news-releases/2014/01/15/patients-benefit-from-pharmacy-provided-medication-synchronization-programs
5. Strategies for improving medication adherence. http://www.knowledgedriven.com/articles/pharmacies/strategies-for-improving-medication-adherence.aspx#.WHkpwbGZOCQ
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