By Annette M. Boyle
FALLS CHURCH, VA — After saving $22 million in Phase One, the Navy Pharmacy Financial Improvement Program has expanded from establishing target inventory levels to refining stock levels based on demand and availability — resulting in another $13.5 million in savings.
The Navy spends about $500 million each year on inventory for direct care.
Earlier this year, the program produced a new Standard Operating Procedures manual which codified best clinical practices across all Navy pharmacies and produced additional benefits for pharmacy staff and patients.
“Initially, we asked sites to set inventory levels they thought they needed, and we evaluated how well they moved toward their own goal. After the first year, they gained an understanding of the interplay of inventory levels, finances and patient needs and we saw an additional 29% reduction in inventory,” said Capt. Edward C. Norton, MSC, pharmacy specialty leader for U.S. Navy Bureau of Medicine and Surgery.
Pharmacies in the continental United States now keep less than a 30-day supply of medications on hand, while those overseas maintain an inventory of up to 45 days, to allow for additional shipping time.
“These numbers are averages, as pharmacies will have just a few days on hand for fast moving items and have well in excess of 30 to 45 days of infrequently used but critical life-saving medications,” Norton told U.S. Medicine.
Pharmacies that run short of medications generally can place an order by 4 p.m. and expect it to be shipped the following day. In addition, each pharmacy can receive as many as three drop shipments per month, enabling them to receive drugs and supplies later the same day.
Branding Navy Medicine
The Pharmacy Financial Improvement program proved so effective in managing inventory to meet critical needs while reducing costs that program leadership set their sights on broader processes — standardizing key clinical processes.
The team first reviewed processes at pharmacies across Navy facilities and identified best practices.
“We thought that if all pharmacies followed the best practices, it would improve patient experience and safety,” Norton said. “We have a mobile patient population, and we want to make it as seamless as possible for our people to move between facilities. We’re branding Navy medicine much like McDonald’s. It’s about creating expectations of experience.”
Previously, Navy policy stated that “Navy pharmacies may transfer prescriptions from other sites,” but some chose not to, said Norton. So if, for example, a patient moved from California to Maryland, the California pharmacy might have said there was no problem with transferring prescriptions, yet the patient might arrive in Maryland to find that the pharmacy there did not accept transfers. The new standards mandate that all pharmacies accept prescription transfers.
Patients also might have encountered difficulty picking up prescriptions because of differences in how pharmacists used the DRX [dispensing] system.
“Some pharmacists saw the system as an administrative program and checked as completed when the prescription was filled, not when it was picked up. If the patient actually went elsewhere to pick up the medications, the system would show that they were already dispensed and the patient couldn’t get them,” Norton noted. The SOP clarified when the record should be marked as complete, giving patients more options for pick-up.Safety Improved
Reducing variation in other processes reduced risk for patients.
“Quite often, a pharmacist would pull medication out of the bag and review with the patient what it is, what it’s for and how to take it,” Norton pointed out. “That’s not just about educating the patient; it’s also a way for pharmacists to do one last check. If it’s not done, it introduces the possibility of errors ranging at the low end of risk from not giving a patient all their medications to, at the high end, giving the wrong directions or commingling two patients’ medications.”
With the new SOPs, all pharmacists perform the medication review “show and tell” the same way with patients, he noted.
In reviewing processes to identify best practices, the team found that some pharmacists would ask patients whether they were pregnant or lactating and some would look through a database for the information. One medical treatment facility (MTF) had a sign that asked patients to disclose to a pharmacy staff whether they were pregnant or lactating.
“We found that having the sign made it easier for pharmacy staff to bring up the subject. With the sign, the patient is prepared to be asked and realizes that it is important information that the pharmacist needs to know. We realized that if it were done across Navy medicine, it would support patient safety,” Norton said.
The new manual also gives pharmacy staff a tangible, consistent resource wherever they are.
“Anyone new to the Navy pharmacy community can go to the SOP and research what to do. It’s like following a cookbook,” he suggested.
The SOP lays out the division of tasks within the pharmacy. As a result, less training is required when pharmacy staff transfer.
“In some places technicians were expected to perform a little beyond the scope of their training, while at others, the pharmacists felt stifled. Now, all staff can be fairly confident that their duties will be the same at each facility,” Norton added.
Easing Joint Commission Review
As part of developing the manual, the team cross-walked Joint Commission accreditation standards with specific pharmacy processes. If the Joint Commission said “Organization has a way to store medications safely,” the SOPs spelled out what that means specifically for outpatient pharmacies, nursing facilities and hospitals.
“When the Joint Commission comes in, if they see four pharmacies following four different procedures, they know that one of them is better than the others. If they go from facility to facility and see that everyone follows the same Navy standard, that makes it easier for the pharmacy staff at each medical treatment facility,” Norton explained.
While the rollout of the new procedures is nearly complete, a few items may roll over into Fiscal Year 2014. Next year, the team will go out to sites to verify that they are following the SOPs and look at “front-end” or customer interaction metrics such as patient satisfaction, percentage enrolled and receiving prescriptions at Navy facilities, and medical adherence statistics.
So far, the response has been favorable, Norton said, “The recurring comment is that it’s great to have the SOP, guidance on how senior leadership wants us to do this. It helps to have an overarching Navy position to refer to whether questions come from local leadership or the Joint Commission.”
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