Campus Pharmacy: Fly on the Wall

Date: Monday, January 30th, 2023

Observer: Sammy Robens-Paradise, Note Taker: Sammy Robens-Paradise

Time: 14:00-15:30

The Space:

• The Campus Pharmacy uses Kroll, available from Telus Health
• They are short on space, mostly because they need a lot of storage in the pharmacy for documents which they must keep for six years
• There is limited counter space available due to various tooling and labelling equipment
• Medication is stored in mostly open medicine cupboards behind the counter
• Behind the counter and in the workspace, there is anti-fatigue matting and a raised floor.

Software & Process:

• Kroll operates on 6 computers and monitors in the pharmacy. No computer is tied to a particular individual. People hop from computer to computer quickly, meaning that users need to be able to quickly log in to a particular computer under the correct authorization. Kroll does this by allowing staff members to use only an initial and a password to log in. Some staff members were observed to have passwords that consisted only of numbers and were less than 6 characters. While this is a clear security vulnerability, what it suggests is that being able to quickly access the system is a key requirement for staff members. It is also common to see multiple instances of the software open at once. Each tab corresponds to a particular staff member.
• Staff members seem to be satisfied with Kroll as a product, particularly with their customer support. From a product standpoint, it is clear that customer service and easily accessible support are key to a design solution. This is not surprising and is in keeping with Don Norman’s principles of good design.
• As an important regulatory requirement, the pharmacist on duty is responsible for granting permissions to any staff members that are currently on shift at the beginning of the pharmacist’s work day. If there is a change in the pharmacist on duty, then the other staff members must be granted permission from the new pharmacist. This is because pharmacy technicians, assistants and cashiers can only work under the supervision of a pharmacist. So the consequence of this is that if there is no pharmacist available, the system must not be available. It is also necessary for pharmacists to sign off on all prescriptions and approve them before they can be given to patients.
• Searching for patients: When staff search for patients they often search for my student number which helps them quickly identify patients. This can be done because Kroll has the ability to add a field to a user that is a custom identifier and is searchable. If they can’t search by student number they search by last name, date of birth and then finally first name. All patients are asked to confirm their date of birth whether it is in person or over the phone. This is necessary, especially when a patient is using their student card as their identification. When it comes to processes when a prescription comes in via the front desk as a walk-in or via fax, the information is entered into Kroll and added to a queue of prescriptions to fill. Each prescription is associated with a prescription basket to keep all of the medication alongside documentation. When a prescription is filled it is placed on the counter for the pharmacist who is working to sign off. When the pharmacist signs off on the prescription, it is placed in a basket on the floor by the pharmacist and a call is placed to the patient to let them know that their prescription is ready for pickup. The prescription is placed on a shelf below the pickup desk. See an image of the setup below:

Demographic:

General Ratio of New Versus Repeat Prescriptions on a particular day:

As we can see, on a particular day the pharmacy does about 2 to 3 times as many new prescriptions relative to refill prescriptions. Based on the estimate provided by the head pharmacist, Kiran Patel, roughly 80% of their prescriptions are new, and only 20% repeat. This is in near completely opposite to the general trends of typical pharmacies which do about 75% in repeat prescriptions and only 25% in new prescriptions.

---