The things we might take for granted during “routine” pharmacy operations contribute greatly to the quality of care delivery and to patient outcomes. One example is the mere handoff of prescriptions to patients. Variability in handoffs might make the difference between a patient who is adherent or not.
Chui and Stone examine a concept called ‘information chaos’ that occurs during prescription handoffs.1 They state that a significant number of prescriptions are dispensed from high-volume pharmacies with multiple pharmacists working in one pharmacy, including a growing number of part-time or floating/relief pharmacists who may have a limited relationship with or knowledge of the patient. Thus, one pharmacist may accept a prescription, another may verify its accuracy, while yet another may counsel the patient (if counseling occurs). When there is a problem such as missing or confusing information about the prescription or the patient requires clarification, that problem must be addressed by the pharmacist prior to the medication being dispensed. They add that handoffs frequently occur in a haphazard fashion. Given the frequency of these transitions in health care, and lapses and errors in communication, handoffs have been identified as a key area for improvement in reducing medical errors and patient harm. Consequences of information chaos include increased mental workload, which can precipitate problematic prescriptions “falling between the cracks.” This can ultimately impact patient care and pharmacist quality of work life. The resultant information hazards can distract pharmacists from their primary work of assessing prescriptions and educating patients. To that end, we are reminded by some momentous research conducted a while back demonstrating the results of a simple workflow redesign that that had the same pharmacy personnel receiving and handing off the prescription, while other personnel prepared the medication and contributed to other operational functions.2 This relatively simply redesign helped ensure that patients received counseling and mitigated the prospects of information chaos.
Pharmacy managers have to consider workflow in a number of contexts. One is to facilitate communication and lessen chaos, while also clarifying the roles of pharmacy personnel in general and on a particular shift. This reduces their confusion and improves their satisfaction while also minimizing risks and maximizing patient safety.
Additional information about Operations Management and Ensuring Quality in Pharmacy Operations can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.
1Chui MA, Stone JA. Exploring information chaos in community pharmacy handoffs. Res Social Adm Pharm. 2014;10:195-203.
2Schommer JC, Wiederholt JB. A field investigation of participant and environment effects on pharmacist-patient communication in community pharmacies. Med Care. 1995;33:567-584.