This story is often reflected in general life, at home and in business, with pharmacies being no exception. Pharmacists are busy people, often coping under restrictive conditions, and have little time to evaluate their working environment, never mind make improvements. However, these improvements are the short cuts and ultimately pharmacists, their staff and, more importantly, their customers can all benefit from a well planned and thought out dispensary layout.
As a healthcare professional, you are tasked with making professional decisions in what can sometimes be challenging situations. Furthermore, as the responsible pharmacist you will have to ensure the safe and effective running of the pharmacy even during periods of absence whilst bearing in mind the seven principles of the Code of Ethics:
1. Make the care of patients your first concern.
2. Exercise your professional judgment in the interests of patients and the public.
3. Show respect for others.
4. Encourage patients to participate in decisions about their care.
5. Develop your professional knowledge and competence.
6. Be honest and trustworthy.
7. Take responsibility for your working practices.
It is also important to remember that your primary concern must be the care of your patients, yet as the responsible pharmacist you must establish, maintain and review pharmacy procedures that ensure that medicinal products are:
- Sold by retail;
- Supplied in circumstances corresponding to retail sale;
- Delivered outside the pharmacy;
- Disposed of in a safe and effective manner.
With so much to consider it’s not difficult to understand why some of our pharmacies are falling behind when it comes to implementing improvements and yet the rewards for successfully taking the short cuts are numerous.
Improving dispensary design
The design of the dispensing environment has been long been a subject for debate and improvement. In 2007 the National Patient Safety Agency published a booklet entitled ‘Design for patient safety (A guide to the design of the dispensing environment)’ which used information, experience and feedback gathered over two years with the clear objective of improving patient safety through dispensary design and layout.
The information was correlated by a team of pharmacists and a pharmacy technician with combined experience in community, primary care, hospital and academic pharmacy. Added to this was a wealth of experience gained from a number of stakeholders including individual healthcare professionals, professional and commercial organisations, patients, carers, and patient organisations. Research trips were undertaken to a number of community and hospital pharmacies that had been identified as using design effectively to support innovative practice. The result was a design guide applying the principles of human factors, lean principles and customer services to the dispensing environment.
Many of the recommendations are centered upon the clinical workflow, which aims to make dispensing safer by means of improving organisation and defining clear steps in the standard operations. At the heart of this lies the medicine storage and dispensing work surfaces.
Considering that dispensaries come in all shapes and sizes it is important to choose a system of storing medicines that is flexible whilst leaving enough space for dispensing and clinical workflow to run smoothly. Of course there are many different types of pharmacy shelving available from traditional style flat wooden shelving, to the latest robotic systems.
Robots deliver excellent pharmacy automation providing improved efficiency, increased productivity and greater accuracy. They never grow tired, get sick or take holidays but, whilst the prices are lower than when robots were first introduced to the pharmacy world, they are still expensive and perhaps more suited to hospitals and the very largest community pharmacies. It’s also worth considering when you choose the robot route the additional works that are needed in your pharmacy and dispensary to accommodate it. These machines are not simply ‘plug and play’. Many pharmacists have also reminded me that ‘split packs’ and bottles are still an obstacle to overcome for the robots.
Traditional style flat pharmacy shelving often made from melamine faced chipboard is very flexible in that a good shopfitter can make shelves fit any size or shape and they are probably the best economical option available although sometimes bespoke joinery can turn out to be fairly expensive. Often between six and eight inches in depth, flat shelves don’t offer a high stock density needed in a small space and can also present a number of problems in terms of operations and efficiency.
A great number of pharmacies with flat shelves that I have visited are aware of the extra time it takes to keep piles of medicines neat and tidy. Auditing stock numbers also becomes protracted if the pharmacist is constantly removing front facings to enable them to count unseen stock behind, particularly at eye level or higher. A further point of note is that the shelving, in much the same way as an automated system, is very inflexible once installed and cannot be easily changed to adapt to any future changes in practice or workflow.
Pull out shelves, or drawers, are not a new idea. The concept which is tried and tested has been widely available for around thirty years now in various different forms and offer the pharmacist probably the best option in terms of stock density, flexibility, providing an efficient dispensary environment and cost.
Stock density is important in many ways to the pharmacist as not only a means of holding as much stock as possible in the smallest space but it invariably improves the clinical workflow in the dispensary. If pharmacy staff can reduce the distance walked in the course of their dispensing operations imagine how much time and energy is saved at the end of a busy day. Reducing staff fatigue is a key factor in minimising dispensing errors as well as providing improved working conditions. There is of course the added bonus of more space being made available for retailing or consultation rooms.
The flexible option
Flexibility is becoming increasingly important in today’s pharmacies where extra services and continuous improvement in standard operations can add to efficiency and profitability. Pull out shelves and the associated drawers and ancillary items offered by the best systems mean that a pharmacist can create a working environment that suits them and their workflow.
Most systems locate the various items into sturdy steel slotted posts which mean that the constituent parts can be moved at a later date if needed. This can facilitate many improvements from a major change in workflow to simply changing a drawer to a more easily usable height or position. The latest systems available offer an extensive range of equipment designed to aid the design of the dispensary. Pull out shelves in various sizes, drawers, integrated work surfaces and accessories that are all fully interchangeable to provide the pharmacist with the flexibility to design safer and efficient dispensing operations.
The individual shelves hold a great deal of stock but it’s easily identified and medicines can be easily retrieved which contributes to minimising dispensing errors. An additional feature of pull out shelving is that they are often sloping which allows the stock to slide to the front when the front facing is removed, ensuring ‘first in, first out’. In most cases these systems are also simple to build and can be installed by anyone with average DIY skills rather than expert shopfitting services which can add considerable sums to the final bill.
There is a further pull out shelf system commonly known as the ‘continental drawer system’, which is a closed system where the medicines can’t be seen until the drawers are open. Like the open system these offer high stock densities and are arguably more attractive but they are certainly more expensive and very inflexible in that once installed it is very difficult to move them.
Steve Turner of Medishelve