Rehabilitation Hospital of the Pacific (REHAB), a 70-bed, acute medical rehabilitation facility, is the only inpatient rehabilitation hospital in the Pacific Rim and treats over 6,500 patients a year at the main facility and its three outpatient clinics. The hospital specializes in treating patients who have had strokes, brain or spinal cord injuries, or other serious injuries or illnesses.

REHAB is currently undergoing extensive facility-wide renovations that began in the fall of 2011 and are expected to be completed by the spring of 2015. One of our goals was to improve the proximity between pharmacy and nursing, so the pharmacy was relocated from the first-floor lobby area and is now adjacent to the second-floor nursing unit. The renovation of the pharmacy and the second-floor nursing unit was completed in June 2013.

The new pharmacy is a total of 420 square feet, plus a 54-square-foot office for the pharmacy manager. It is staffed by two pharmacists (including the manager) and two technicians and operates from 9:30 am to 6 pm, Monday to Saturday. A total of six profiled ADCs, each with six-drawer auxiliary units, service three nursing units. More than 95% of required medications are stored in the ADCs. The pharmacy relies heavily on ready-to-use IV products, as we do not have IV admixture services.

Prior to our renovation we utilized a stand-alone pharmacy computer system and paper orders were sent to the pharmacy where the pharmacist entered them into the pharmacy computer, which interfaced with our profiled ADCs and an administrative management software program for patient admission, transfer, and discharge (ADT). A fully integrated CPOE system was implemented in March 2013, during our renovation. 

Given the efficiency of the current medication dispensing process, the limited physical area in the new pharmacy was less of an issue. Since there is a need for extensive countertop space, large and bulky items are stored in the pharmacy with open casework of various depth and adjustable shelves. 

The daily pharmacy workflow revolves heavily around ADCs. The pharmacist begins the process by reviewing and printing out the orders. The technician then checks the orders  on the ADC console for correct order information and to ensure medication is available in the designated ADC on the patient units. The console is adjacent to the pharmacist’s desk to ensure easy patient/order verification. This process of checking medication availability in the designated ADC may seem cumbersome, but it is necessary to ensure the efficiency of the nursing workflow.

Here the technician pulls medications for the morning ADC fill and for reloads throughout the day as additional patient orders are received. Moving the pharmacy to a patient unit within close proximity of the nursing stations has allowed us to better service the hospital and improve interaction with the medical staff. 

One of the most significant new features of our renovation is a two-way pharmacy window with a built-in microphone. The new window provides safety and security while facilitating clinicians’ access to the pharmacy staff. The air-tight cleanroom pass-through adjacent to the two-way pharmacy window allows staff to quickly access medications from the pharmacy in emergent situations. The new pharmacy design not only improves workflow, but, perhaps more importantly, brings pharmacy closer to clinical staff and patients.

Jacqueline (Jackie) Bogan, RPh, received her BS in pharmacy from the University of Michigan in 1975. She has been the pharmacy manager at REHAB since 1987. Jackie’s professional interests include rehabilitation medicine, infectious disease, cardiology, medication error prevention, and pharmaceutical waste management.