Ensuring adaptability and the capacity to accommodate future growth proved to be two of our defining goals in the recent pharmacy renovation at Jackson South Community Hospital, a 226-bed, acute-care facility located in South Miami-Dade County, Florida. In February 2011, Jackson South doubled its size through a major 157,000 square-foot expansion and renovation project, which included a new, state-of-the-art pharmacy, as well as construction of a USP <797>-compliant sterile cleanroom.

The Jackson South pharmacy department is staffed by both pharmacists and pharmacy technicians and is open 24 hours a day, 7 days a week. Our staff provides high-level clinical and distributive services to the facility, with decentralized clinical pharmacists assigned to several units. The primary services offered by the pharmacy include unit dose drug distribution; sterile products preparation, including chemotherapy; drug monitoring; pharmacokinetic consultation; patient education; and drug information and counseling. 


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Factors Driving the Renovation
Jackson South’s old pharmacy was an obvious candidate for renovation. At only 1000 square feet, the space was cramped and lacked the functionality and flexibility required of an efficient pharmacy. Our hospital had experienced recent growth, and in order to adequately provide for the needs of more patients the pharmacy had to grow concurrently. The old pharmacy’s insufficient size and suboptimal design created difficulty in providing high-quality and efficient patient care. In addition, to become compliant with USP General Chapter <797>, it would be necessary to build an IV cleanroom, and the renovation project offered the ideal time to complete this task. Finally, we wanted to design a modern, updated pharmacy that would be aesthetically pleasing to both staff and visitors.

Budget Constraints
At the beginning of the expansion project, each department involved in the overall hospital expansion, including the pharmacy, was allotted an individual budget within which it was required to plan all updates. Following our institution’s strict, facility-wide procurement policies, pharmacy solicited project bids from three vendors; the winning bids for both the pharmacy and the cleanroom were chosen based on superior quality of materials proposed, aesthetics, flexibility, and overall design based on our workflow, within a competitive price structure. 

However, during the planning phase, it soon became apparent that our allotted pharmacy budget would not be sufficient to fund the medication carousel technology we had planned to install as part of the new design. Because of the flexibility of the modular casework and fixtures we had chosen, however, we were able to remove the carousel element from the plan and revise the proposed pharmacy layout. The changes to the plan, while both practical and efficient, most importantly allowed for flexibility in the future, when funds will become available to purchase or lease the inventory carousels and the layout can be reconfigured to integrate the new technology into the pharmacy footprint.   

Renovation Partners
The pharmacy department collaborated with architectural, HVAC, electrical, and procurement firms, as well as contractors, all of which had experience designing and building or renovating hospitals and procuring the required health care equipment. Construction of the new IV cleanroom involved a number of components and teams of people, and required numerous inspections by various agencies—for example, the Dade County Building and Zoning Department, the Agency for Health Care Administration (AHCA), and the Board of Pharmacy—to ensure compliance with USP <797>. 

Planning Tips
The expansion and renovation project provided the hospital and pharmacy department with valuable insight into properly planning a project of this scope to realize the greatest benefits. 

• Involving staff from the outset of the project is critical, as they can offer unique insight into pharmacy processes and workflow, as well as provide design suggestions that will ultimately allow them to perform their jobs more safely and efficiently. For example, one staff suggestion we implemented was to incorporate a pass-through window in the main order processing area to increase visibility of pharmacy staff to other hospital personnel, such as nursing, as they approach the pharmacy. Keep in mind that as end users, staff members’ satisfaction with the final results of a renovation can affect the perception of the project’s success or failure.
• Work within your budget and research options carefully.  
• Avoid surprises by setting early deadlines for design work and manage the process to ensure the deadlines are met. 
• Ensure that your renovation partners are experts who can anticipate and resolve issues as they arise. 

Flexibility for the Future
The results of the pharmacy renovation project have exceeded our expectations. At more that 3000 square feet, the new pharmacy maximizes space and efficiency, and improves staff workflow and productivity. Equally as important, the pharmacy environment is aesthetically pleasing and has contributed to improved staff morale. The flexibility inherent in the design and choice of fixtures will allow the space to be easily reconfigured as needed in the future. We are extremely satisfied with the results, and are excited to witness how the new design will grow with the hospital and the community in the coming years.

Paul A. Eger, RPh, CPh, is director of pharmacy services at Jackson South Community Hospital and has been a pharmacy manager for more than 25 years. He received his BS in Pharmacy from Auburn University and has served in various capacities as an officer in several pharmacy organizations. Paul has experience renovating existing pharmacies and establishing new pharmacies in five facilities throughout his pharmacy career.