You’ve been there. You go to the pharmacy to drop off your prescription. You start by waiting in line to give the technician your prescription. Once you hand it off, he tells you it will be, say, twenty minutes until the medication is ready to be picked up. You roam the store and come back in twenty minutes to find that your prescription is not ready. Naturally, you’re a little perturbed. Ever wondered why it isn’t ready?
When you drop off a prescription, it goes through multiple stages before it is sent to the register to be picked up by the customer. Once the pharmacy obtains the new prescription, the patient’s name, date of birth, address, phone number, allergy information, and insurance information all have to be verified and updated if necessary. The prescription is then scanned into the computer so that an electronic copy can be made. The technician then has to manually input the data from the prescription. Once this happens, it is sent to the pharmacist, or in this case, the bottleneck. A bottleneck occurs when the limited capacity of a process causes work to pile up or become unevenly distributed in the flow of a process. Unless your pharmacist is Superman, he is going to be a bottleneck of the prescription filling process. With several technicians inputting medications, there is bound to be a pile of work at the pharmacist’s station, since the typical ratio of technicians to pharmacists is 4 to 1.
The pharmacist must perform a function called “Four Point”. This is where he checks to make sure that the technician input all of the information correctly and verifies that the doctor wrote for an appropriate therapy. At this point, insurance often plays a role in the delay of filling your “script”, another bottleneck, of course. Insurance problems go back to the technicians, for troubleshooting. Once problems are resolved, the work is sent out to technicians who actually count your medication. Ever seen a technician starving? It happens. Starving occurs when the activities in a stage must stop because there is no work. Technicians cannot count the medication until the pharmacist gives the o.k. to do so. Since the pharmacist is the bottleneck in the whole operation, he starves the technicians of work. Once the technician counts the medication, it is set on racks in front of the pharmacist. This part of the process is called “Visual Verification”. The pharmacist checks each medication to ensure that the correct drug and the correct quantity has been dispensed. Again, there is one pharmacist per four technicians. There tends to be a pile in front of the pharmacist at this point. Blocking may occur at this point. Blocking occurs when the activities in a stage must stop because there is no place to deposit the item just completed. Often, there is no room to put the basket or tote that contains the medication in front of the pharmacist. Sometimes, it comes to the point where the pharmacist is so backed up that there are no totes available. When no totes are available, the technicians cannot carry on with work and count more medications, or your medication. Once the pharmacist ensures that the medication is correct, it is bagged.
The prescription must be checked in multiple ways at this stage. If the prescription is new to the patient, it has to be bagged separately and differently than if the prescription is a refill. If the prescription costs more than a certain amount, say $50, the bagger indicates that the medicine must be paid for at the pharmacy and cannot be taken to another register in the store. Finally, the prescription is taken to the area for pick up. Now imagine a pharmacy that fills 700 prescriptions daily. An average pharmacy is open 12 hours. Your pharmacy is filling 58.3 prescriptions per hour. There are four technicians to do the labor, which amounts to 14.5 prescriptions each, per hour. A pharmacist checks all 58.3 prescriptions each hour. Of course we want to be certain that the pharmacist has done his job and we obtain the correct medication and are consulted and treated in a respectful manner. Pharmacies have found ways to install processes that ensure a smooth flow of work between the technicians and pharmacists. However, pharmacists are humans, not machines, and they have a major responsibility and liability towards each patient’s health. We trust that they spend the appropriate amount of time reviewing our health history, the therapy suggested by the doctor and the implications it may have for us. Now, are you still mad?