Score one for common sense

August 6, 2008 at 10:24 pm | Posted in pharmacy | 1 Comment

Today, and for the next several days, I’m working at another giant chain. Well, not so much that the chain is giant, as that everything about the chain is humongous. Except the prescription volume, which is about average, 300-400 prescriptions/day. But it felt like half that much.

The computer system is a weird hybrid of UNIX, windows and barcoding, and is a little clunky, especially the part the techs deal with most. The pharmacist side of the system is much more streamlined, and the workflow is extremely well-thought-out. Also the shelves are arranged entirely by the alphabet, regardless of dosage form or brand vs generic, which is actually the most efficient way to organize them.

Old school pharmacy dogma mandates that products be separated by dosage form. In other words, lotions and creams in one section, eyedrops and eardrops in another, elixirs and syrups someplace else, and pills and capsules in the middle. Some places even have a special section for birth control pills. The other thing you frequently find in an old school setup is for brand and generic drugs to be placed next to each other, with the location determined alphabetically by one or the other. So you have to know the generic name and all the various brand names of each drug in order to find it.

The point of this seems mostly to make things as unfriendly and disorienting as possible for part-time staff and floaters. The regular staff will always be more efficient, because they know where everything is. –Although the argument used is that it’s “safer” for patients, in that it prevents dosage form mixups. But consider: the most harmful error you can make in this regard is to substitute eardrops for eyedrops (due to pH and tonicity differences), yet the “old school” setup still places the otic and ophthalmic versions of each drug right next to each other. So that argument doesn’t even support the thing it’s used to justify. There’s actually no evidence at all to support it. On the contrary, most studies of workflow efficiency support the strictly alphabetical setup, with at most a small section of fast-movers.

At various times, people have tried to tell me that, a) state pharmacy laws require it, b) Joint Commission mandates it, and c) pharmacy professional societies have it as a standard of practice. None of these things are true. Believe me, I checked.

There is no law, regulation or professional standard that requires the separation of dosage forms. And it’s far more efficient to sort strictly by alphabet. Especially when turnover is high among technical staff, and the frequent presence of floating professional staff is a reality. And yet, most pharmacists react to this idea as though you threatened to kidnap their children.

So I was very happy to note that this pharmacy had sorted their shelves exactly as I’d have done. If nothing else, it enabled me to help the techs more effectively when the workload started to bog them down. Because this pharmacy could run on a quarter of my time as a pharmacist, and what they really needed was an extra tech.