We are going to wind up this series with the last workflow you need to understand – Order Fulfillment. Just like with any good manufacturer orders must be received in an efficient manner. With the acute care pharmacy this can through a pneumatic tube system, hand delivered (STAT orders) , fax, or through electronic means. Once the order is received, the pharmacy now needs to enter the order and start the process of preparing the order for the patient.
Once again before we go into details about the process; let’s take a look at the overall flow.
All orders start at the Order Entry position. This area is a general office application where the order is entered into the system. The patient records are updated, medication interactions are checked, and billing is set up. Order entry is responsible for reviewing and distributing all prescription orders. Order Entry is the “hub of the wheel” and from this starting point the order flows to the next process depending on the type of medication that is needed
If the order contains frequently used medications the next step is the Unit Dose / Picking Station. This station contains approximately 95% of the most frequently administered drugs. These are the High-volume medications and they are packaged in single dose form. This station is set up for quick and efficient picking because unnecessary steps and movement leads to a loss of time and a decrease in productivity.
If the patient needs a compounded medication the order will be set to Compounding. In the compounding area “wet” materials such as topical, ointments, creams, and other liquids are mixed.
The order may contain narcotics. These medicines are kept in the Controlled Substance Vault. This is a monitored area for the storage of narcotics and regulated medications. This area should remain secure at all times using locked doors and locked cabinets. Alternate solutions utilize ADM’s or other automated machines for dispensing the medication.
Lastly, if the order is for an IV delivered solution, the order will be sent to the Sterile area. This area of the pharmacy is one of the technical and regulated areas. There are regulations, such as USP 797, that determine how this area functions, but that is for another post. There are three areas the make up the sterile prep area.
Gowning – This is the least sterile of the area. It is used for the loading of supplies and it s a prep area before entering the sterile areas
Ante Room – The ante room is a ‘Semi” sterile area. It is used as staging area for sterile prep and chemo prep
Sterile Areas – The sterile area has a positive airflow to deduce airborne particulates. There are two sections one for Sterile Prep and one are for Chemo Prep
How would this workflow look in real life?
Very rarely is an order just one medication. So it is possible that order entry will send requests to several areas. Once the order is completed with all needed medication requests, the order will be checked by a pharmacist and only then will the order be complete. Now the medication can be loaded and sent to the patient via the distribution flows we discussed in the first part of this series.
Over the last three posts we have looked at the acute care pharmacy workflow. This fundamental foundation will be solid footing on which you can build. I am not going to tell you that this is all you need to be a pharmacy expert. This kind of expertise can take years to learn, but with this basic knowledge you can begin the learning experience and deliver appropriate solutions to your clients.