Danny McNally, Pharmacy Process Improvement Manager, at Day Lewis Pharmacy discuss the group’s journey to a hub and spoke model of pharmacy dispensing, covering everything from their approach to what they have learnt along the way.
“At Day Lewis our teams put patients first and we want to deliver the best healthcare services for them. Business growth for us is defined by the impact we make on people’s lives. We want to grow our patient base and then do more with those patients to improve their health for the better and even save lives.
We knew that to make more time for more face-to-face patient care, dispensing efficiency was important. We’d already used technology to automate the production of MDS trays and we knew the next step was an efficient solution for the dispensing of repeat original pack prescriptions.
As a business we spent significant time exploring different ways of achieving this, including hub and spoke and the various models that exist. We concluded that due to the scale of our business and our ambitions we would ultimately need one central hub with large-scale automation to meet our needs.
However, we also realised two very important things. Firstly, we needed a software solution that would ensure seamless communication between our stores and the hub so that teams in store had full visibility and control. Secondly, the way we managed this change would be crucial. We knew going with a ‘big bang’ approach and turning everything on, everywhere, all at once, would be a real risk to successful adoption of this new way of working.
Based on this we decided to manage the change in small steps. Stage one has involved partnering with Centred Solutions and using their FLOWRx software to put in place a tote to spoke model. We’ve done this as we believed the biggest change for the pharmacy teams would be sending dispensing ‘offsite’ and so we wanted them to become acclimatised to that.
This simplified model of hub and spoke dispensing is an option for all pharmacies. The process starts with the pharmacist in the store who does the clinical and accuracy check in the PMR up front. Patient orders are then transmitted to the ‘hub’ using the FLOWRx software.
At the warehouse, staff ‘batch pick’ medication required for specific patients and pack it into ‘patient specific totes’ containing loose medication for up to 30 different patients. These are delivered back to the pharmacy where staff scan the tote barcode to display in FLOWRx the medication included in that tote and any items that need to be picked locally in store and added to it. The software then guides dispensers through the dispensing process using barcode technology as an additional safety net.
The dispenser selects medication from the tote and scans the medication barcode. FLOWRx matches that medication to a patient and automatically prints a patient label, which is scanned before the medication is assigned to a patient specific basket. Once all medication in the tote has been scanned into the patient specific baskets, the dispenser begins packing by scanning a basket barcode to print the patient bag label. Medication in the basket is then scanned into the bag which gets a final scan to confirm it is complete before being scanned into the PMR.
The pharmacist will only get involved if an anomaly arises in the dispensing process. For example. a short expiry date or medication placed in the wrong patient basket halts the dispensing process for that patient until it has been checked and cleared by a pharmacist.
We rolled out this dispensing process to nine of our pharmacies. Training was initially done by the team at Centred Solutions but now we have created a team of Change Champions to embed good practice. What we have achieved so far is a whole new level of accuracy when it comes to patient prescriptions. The barcode scanning functionality of FLOWRx coupled with the end to end audit trail of every patient order helps us to ensure the right dose and the right medication is dispensed to the right patient.
Time is saved in pharmacy as staff are now putting away less stock on the shelves because they are assembling and dispensing directly from the tote. Our pharmacists also work smarter. There is a specific point in their day which is dedicated to checking for repeat original pack prescriptions and after that the pharmacist is not required in the process unless there is an anomaly. This concentrated approach is a far more efficient way of working as it means the pharmacist isn’t spending the entire day checking medication. We currently send around 70% of our repeat prescriptions through the hub.
We’re now in the process of rolling out phase two which involves using our Knapp automated packing line along with the FLOWRx software. This means medication is delivered back to the store bagged and labelled ready to dispense. The FLOWRx technology sends orders to the hub and it is also used to process the bagged medication back in the store along with any exceptions not fulfilled by the hub. Staff are now familiar with the technology which is crucial as part of the change management process.
We’ve rolled out successfully to our pilot sites and our next step is to have two “centres of excellence” pharmacy stores in each of our 17 regions. They will be our best practice sites that other stores in the region can turn to as we roll out this new way of dispensing to our whole estate.”
A view from Regional Senior Manager, Charlotte Sharp: “Kingsbridge Pharmacy in Devon were one of the first pharmacies in the group to use the FLOWRx solution and they have adapted to it really well. The branch dispenses around 12,000 items and its located next door to a GP surgery. The first couple of weeks using it was all about changing the dispensing mindset within the pharmacy and they have done that brilliantly to make it work for them. The team are fully on board and they have been vital in providing feedback so that we learn and improve moving forward. I think improved patient safety is one of the benefits to using a solution like this. Because of the amount of times the team scan the medication in the process I would be surprised if patient safety hasn’t improved since we started using it, that includes near misses and dispensing errors. Anything that doesn’t follow the normal dispensing path for FLOWRx is put into quarantine and can’t be processed further until it has been checked by a pharmacist or ACT.”
A view from Sue Porter ACT at Kingsbridge Store: “The team like it and we are looking forward to the next step when the medication starts arriving back to the store in bags because we think that will be easier still. We’ve definitely saved time in putting away stock orders. When the orders arrive it’s a great feeling to simply put the ones marked original pack dispensing to one side and to know we don’t need to put everything in them away as we now dispense directly from those totes. Sending offsite has also meant a quicker turnaround for patients. Prescriptions sent through FLOWRx are now ready to dispense to the patient within 24 hours, whereas when we were dispensing from the branch it would be 48 hours before the prescription was ready to collect.