Optimizing your pharmacy dispensing system

Making the most of your computer system is one of the easiest, no-cost ways you can improve your workflow, save time, and reduce the chance for errors. Even if you've done it in the past, but it's been a while, it's a good idea to take another look and see what updates are available.

Computer systems are not stagnant, 'set it and forget it' systems, but rather are constantly being updated and improved upon, so if you're not capitalizing on that you're missing out.

I still remember doing a rotation at a site that had a system capable of barcode scanning and product checking that included a picture of the product but had not set up any of that, so were still using the old-school method of putting the stock bottle in the bin and bringing the whole thing to the pharmacist.

What a waste. Don't do that! At least max out your existing system, and if it still doesn't have what you want then go shopping for another one. Don't settle for mediocrity when it comes to something so central to your daily operations.

Of note, I will be referring to QS/1 a lot because it's what we have and thus what I'm familiar with, but your dispensing system should have similar features (even if they're called something different).

OK, now on to my list of top things to review in your system:

Check Your Sig Codes

Sig codes can be a big source of errors, but they don't have to be. Most systems I've worked with have had hundreds of sig codes added, yet we regularly use less than 30 or 40. That leaves the others to cause confusion and increase the risk for errors.

I once saw a med error because "PRNCON" defaulted to "as needed for constipation," but "PRN CON" defaulted to "as needed for congestion." I don't have to finish that story for you to guess what happened.

Part of the issue is allowing too many people to add sig codes (the example above apparently was added by billing staff that didn't even work there anymore).

Like a hospital P and T committee, your pharmacy should have a group (even if less formal) that will give feedback on sig codes. Access to edit, delete, or add sig codes should only be given to the manager or owner.

Be careful, though, deleting the codes: in many systems, that means any other previous prescription that used it will now not convert to the associated directions. A good place to start might be to delete codes that have not been used in over a year (since those prescriptions would be expired anyway and wouldn't be at risk of being filled).

Other tips with sig codes:

  • Be sure all aspects of the directions are there. Route of administration is frequently left out ("by mouth," "under the skin," etc.).

  • In line with ISMP and AAP recommendations, eliminate the use of tablespoon and teaspoon. All liquid measurements should be in mL.

  • Avoid provider-specific codes ("SMITH" = "Take 1-2 tabs every 6-8 hours", because 'that's what Dr. Smith writes for').

  • Check for patient-friendly language (under the skin vs. subcutaneously, etc.).

NPLEX Reporting

In most systems the NPLEX database, used to report CMEA transactions, can be integrated with the point of sale system. Instead of manually logging into NPLEX and entering all of the customer's info from their ID, you can just scan it in the POS, it pre-populates the info, then submits it to NPLEX.

When I got to my current pharmacy this was an easy win. I turned the feature on for maybe $20-30 a month and saved a ton of time at the register. Enrolling was a one-page form, a signature, and a fax back.

Automated PDMP Reporting

Similar to NPLEX, you shouldn't be manually reporting to your state PDMP. Get signed up for the auto reporting. If your software vendor doesn't have automated NPLEX or PDMP, you should probably shop for a new vendor. Both of these are no-brainers that will save you time everyday.

I enrolled us for about $20 per month and haven't touched the PDMP ever since (other than checking it, of course, before filling controls).

Automated Price Updates

AWP can change rapidly and when it does you could be missing out on revenue by submitting a price lower than what the insurance company would reimburse you for. They are happy to pay your price, of course, but you lose revenue. Having the AWP update automatically once daily can help prevent this problem.

Delivery Methods

It's probably called something slightly different in every system, but these are the things that mark your prescription as Waiting, Pickup, etc. It's a good idea, if you have programs like home delivery, mail order, Meds to Beds, adherence packaging, or even a nursing home contract, to use those delivery methods to mark the prescriptions for their ultimate destination.

Combine that with bins to sort them all out and now you've got an efficient system to maximize your staff time. It also makes it easy to run reports and see how you're doing with each of those programs.

Security Settings Standardization

I'm still shocked to see pharmacies that have inadvertently given technicians (and pharmacists) access to features they should not have access to in the computer system. Even mistakenly giving your technician access to verify a prescription or do the final product check, a pharmacist-only function (in most states), is a great way to land yourself in front of the board and maybe in court.

Here's how you handle this: