Wednesday, August 1, 2007

Pharmacy Eutopia

I've been thinking about this for some time now. If you could create the perfect retail pharmacy, what would it be like? I'm going to talk about changes I would love to see in our pharmacy that would make everyone's lives a lot easier.

First of all, the first thing I would want in my dream pharmacy is a receptionist (or 2) to handle all the phone calls. I can deal with long lines at the registers. I can deal with customers asking questions all day. One thing I cannot handle is the GODDAMN PHONE ringing all day long. It never stops! Every time I need time to think in order to solve some problem or look up the answer to some question, the phone rings 20 times. It's never an important phone call by the way. It's never something that actually requires a pharmacist. Most of the time, I go rushing to the phone to find that it's simply someone looking to refill a prescription. Listen people... there's a refill line. It's really easy. You just punch in your prescription number, and the computer will tell you whether you have any refills available or not, and if you do, it will tell you what time you can pick it up. You don't neeed a pharmacist for that, so quit calling me with your prescription numbers.

These receptionists should be pharmacy technicians that simply screen phone calls. They could work in their own little office-like area. Whenever a call goes to the pharmacy, it would ring in that office first. The tech will answer it and determine whether it is truly something that a pharmacist must deal with. Insurance problems, refills, simple questions about whether there is something called in for a customer or not can all be solved without a pharmacist ever hearing a ringing phone. These techs could also handle all the refill requests to doctor's offices as well as prior authorization requests. The only time a phone call goes through to the pharmacy is if it is a doctor's office calling in a script, a pharmacy requesting a transfer, or a customer with a question about medication that can only be answered by a pharmacist. I figure this would cut down the call volume by 80%. Wouldn't it be lovely to not hear the phone ring all day???

Now, let me focus on the work flow. Many pharmacists like to have technicians inputting and filling scripts while the pharmacist just checks them at the end. Personally, I prefer it when a pharmacist enters the scripts into the computer. I apologize to pharmacy technicians, but I simply don't trust you imputting scripts. It's just that I know there are a million little DUR screens, and you can't possibly call me over to check on every single one of them, so there are some you simply have to ignore. I do the same thing. However, I'm trained to know which DUR screens I can ignore. In addition, I know which ones are serious interactions that don't necessarily register in the computer as a serious interaction. A lot of therapeutic duplications slip right by the DUR software. For example, today an insurance company called me asking me why we filled both lovastatin and simvastatin for a patient on the same day. The answer: It didn't present as a serious DUR warning screen, so the tech just blew right by it. When I type a script, I can also check that our Vicodin cash customers aren't filling their scripts 20 days too early.

I do think technicians are very very capable and essential employees in a pharmacy. However, they have no incentive to be as thorough as a pharmacist. Afterall, if something goes wrong, the blame falls on the pharmacist. For that reason, I'd at least like a pharmacist to see all the warnings our software kicks out (note- I'm talking about new scripts here. My receptionist techs are more than able to fill refill scripts because any interaction has presumably already been checked by a pharmacist). Without the other phone call distractions, the pharmacist entering scripts should be able to call doctors any time a script needs clarification or when there is an interaction the doctor needs to know about.

Technicians would take care of all the filling duties. That means, they'd organize the labels off the printer, pull the drug from the shelves, fill the script, then place it in an area for the pharmacist to check. This would probably take 2 technicians. One would organize the labels and pull the drugs. The other would fill and set them up to be checked.

So keeping track here... we have 2 technicians handling phone calls and 2 handling filling. One pharmacist is typing prescriptions and 1 pharmacist is checking scripts. 4 techs to 2 pharmacists. We're still within that nice 2:1 tech to pharmacist ratio (can be 3:1 if one is nationally certified).

Moving to the front counter (register/drop-off area). You technically just need 2 clerks to work here. All they have to be able to do is pull the script from the bin and ring it up. Not too difficult. It's also not too difficult to get the necessary information on new scripts. No matter how busy your pharmacy is, you should only need 2 people ringing out customers. Any problems that might arise at checkout can be resolved by the 3rd pharmacist. This pharmacist will answer any customer questions, provide medication counseling, help customers choose OTC drugs, and generally handle any problems that arise at the register. This pharmacist will kind of be like a free-safety in football, surveying the pharmacy and going where he is needed at that particular time.

So, if you're scoring at home.... that's 3 pharmacists, 4 technicians, and 2 clerks for a 6:3 non-pharmacist to pharmacist ratio. Not bad. The pharmacists and technicians would rotate positions either on a daily basis or every couple of hours as to not get stuck doing one thing for too long.

This example is from my pharmacy which fills roughly 2800 scripts per week. Obviously slower stores would have fewer pharmacists and technicians to work with. However, the lower volume would probably still allow this to work. You would just need to combine a few jobs. Furthermore, I'm only talking about having that full staff during the 9 to 5:30 regular doctor's office business hours. Before 9 and after 5:30, you could decrease staff.

Now that I think about it... this actually isn't entirely unfeasible. You would need 4 good, experienced technicians though, which can be very hard to come by. If I couldn't have all this though, I'd just love to have that receptionist tech to handle the phone calls. I hate the phone with a white hot blinding fury.


Anonymous said...

I agree. Get the phones ringing in another room. Get me out of DIRECT view of customers too. It would be nice if the tech/receptionist would be able to type "new rx on line 1" or "transfer on line 2" and it would pop up on your computer. I work for WAG and the pharmacist is at the end of the counter, closest to the cash registers. If my outwindow tech or cashier is helping somebody else out, who do they look at? Me! Now, I don't mind ringing people up from time to time, but there has to be a better way to get the RPh out of direct view of the customer. BTW my phones ring NONSTOP. We fill about 3500 rxs/week. Most of the time, the techs are busy dealing with other BS calls, that I have to get the phone out of frustration of listening to them and they are things that can be answered by the tech.

greensunflower said...

This sounds much like my well staffed critical care unit. One nurse to break other nurses, or help handle difficult/really critical patients and a "tech" who basically covers our ass with stuff nurses shouldnt be paid $45/hr to do.

Sometimes this doesnt work out of course, and we are left finding pumps and restocking syringes, but most of the time it works out.

More evidence all my favorite pharmacists need to move to my hospital.

jess said...

In addition to your exemplary vision for the perfect pharmacy, the main section of the store should have only OTC and durable medical goods. Nothing else - no groceries, greeting cards, toys, ice cream, cameras, or any of that other crap. I did a clerkship in a compounding pharmacy that was similar to this; it was very nice. The customers that came in seemed to have a totally different attitude towards us than the attitude I saw when I did a summer internship at Rite Aid.

Pharmacy Mike said...

Good call on getting rid of the groceries and other crap. I'm sick of explaining to people I don't know where the batteries are.

Anonymous said...

>Before 9
>After 5.30

frankly, if I ever own a pharmacy those are the only hours I would be open. If doctors office's and every other business can close before 9, and shut doors at 5, i'm closing at that time to. No sundays either. Just because mrs. so and so needs her medication doesn't mean I can't be entitled to reasonable working hours and a life. This is one of the problems with pharmacies, this expectation to be open and available all the time. Every other healthcare profession isn't available for the hours pharmacists are (and still get paid more)