Inpatient Pharmacy at Cancer Institute

Background and Challenges

A leading cancer treatment centers with 78 exam rooms and 86 infusion chairs, sees nearly 135,000 adult exam visits each year across 13 different disease centers. In addition to their association with Harvard Medical School, they are known for their dedication to patient satisfaction and world-class providers.

Aligned with the institute’s mission, the pharmacy organization strives for an environment with quality, safety, and operational effectiveness. The inpatient pharmacy clinics handle an increasing annual volume of approximately 200,000 dispenses across chemotherapies, pre-meds, and other types of drugs.

Faced with an annual growth rate of 12% in infusion demand, the inpatient pharmacy clinics performed at an average turnaround time (time between order entry and order dispense) that contributed to a long time-to-dispense (time between infusion appointment and order dispense) and extensive wait times for the patients, as well as nursing concerns regarding resource availability and patient safety.

Tools & Methodologies

The inpatient pharmacy asked Tefen to help it improve its operations. Tefen completed a diagnostic to identify the issues that impacted the performance of the inpatient pharmacy clinics. These issues included:

• Pharmacy orders were processed on a "first-come, first-served" basis, regardless of the appointment time
• Pharmacists could not start processing an order until after the patient was seated in the infusion chair and seen by the nurse
• Communication between pharmacy and nursing staff was unclear with regards to expectations of service levels
• Staffing levels within the pharmacy were misaligned with demand fluctuations, resulting in a shortage of staff during peak hours

Outcomes and Results

Tefen and the pharmacy leadership collaboratively developed the work plan to address five key work-streams:

• Order Prioritization: Ensure Pharmacy team is processing the orders in the sequence that contributes to reducing the overall patient wait time
• Pre-Planning: Ensure Pharmacy is efficiently ready for the next day’s operation by utilizing its downtimes to perform pre-planning activities
• Staffing Model: Develop tool that enables Pharmacy Management Team to determine the optimal working shifts that address the fluctuations in demand while maximizing the coverage in the clinics
• Process Improvement: Identify areas for improvement and develop/enhance processes in order to increase efficiencies and working effectiveness
• Order Initiation: Enable Pharmacy to start its processes earlier and work in parallel with the nurses with the goal of reducing the wait time for the patient Performance Excellence

Delivered Within 3 months, the inpatient pharmacy clinics were able to improve their workflow and create a more efficient environment. The institute experienced the following results:

• Reduction in turnaround time by an average of 35%
• Reduction in time-to-dispense by an average of 20%
• Alignment of resource allocation with demand fluctuation
• Improvement in communication between pharmacy and nursing
• Increase patient and staff satisfaction