Nebraska Medicine Sets Up Central Fill

Nebraska Medicine is a health center pharmacy leader – implementing a scripClip-integrated Central Fill solution to streamline the process of dispensing and packaging prescriptions, while alleviating the burden on outpatient pharmacy staff and affording more time to spend with patients. They have plenty of room to grow, but it wasn’t always this way…

The Opportunity

Nebraska Medicine’s main pharmacy location, located in the Durham Outpatient Center in Omaha, underwent a 5,000-square-foot expansion in 2018. Prior to the remodel, they were essentially tripping over each other to process roughly 800 prescriptions per day with a “messy, almost antiquated way of numerical bin management,” as Chris Zaleski, PharmD, Pharmacy Supervisor, HUB Pharmacy – Centralized Services, at Nebraska Medicine, put it.


They implemented scripClip as part of the renovation, and it was a game changer – doing away with the need for numerical or alphabetical organization by illuminating orders anywhere in the will-call area. Now, they fill around 1,300 prescriptions daily, and save approximately one minute searching for each one at five point-of-sale workstations, on top of return-to-stock time savings.


“When you’re finding 400 [patient orders] a day, that’s a lot of minutes,” Zaleski said. “It was a night-and-day difference.”


Still, between influx prescriptions and sustained surge in mail order spurred by COVID, they reached capacity across their three pharmacy locations.


In the Durham Outpatient Center alone, they have 14 outpatient pharmacists and up to 22 technicians on any given day, as well as meds-to-beds, specialty, investigational and inpatient pharmacy teams working elsewhere in the hospital. Without enough workspace for everyone that needs to be there every day, they’ve even set up desks in an overflow room on another floor for prescription pre-verification.


“Every employee was so busy … [and] that really takes away from the time you can spend with patients to discuss a disease state or their medications,” said Amanda Haynie, Pharmacy Supervisor, HUB Pharmacy – Pharmacy Fulfillment, at Nebraska Medicine. “[And] when there’s a big line, patients are also more hesitant to ask questions because people are waiting; they’re less likely to stay for that consultation.”


The team knew they needed to find a way to improve collaboration, do more volume for outpatient pickup and home delivery with the same number of people, and free up pharmacy teams to spend more time on patient care.

The Solution

Nebraska Medicine formed several decision-making committees and sought guidance from McKesson Enterprise on their High-Volume Services, now Sanitas® Pharmacy Control System, and a few other large health system pharmacies before implementing Central Fill. Estimating they could bring 75% of their prescriptions from Durham Outpatient Center, Bellevue and Lauritzen Outpatient Center pharmacy locations into a centralized “HUB Pharmacy” operation, they kept coming back to some key questions, Haynie illustrated: “How do we get prescriptions sorted, how do we get them back to the retail pharmacies, and how do we check them in?”

 

Those discussions made it clear they’d want to incorporate scripClip into Central Fill. “We can maintain the front-end system we have, maintain patient safety [with two-factor name and date-of-birth authentication] and streamline the process,” Haynie explained. “[Outpatient pharmacy staff will] scan the tote into the McKesson Enterprise system and into scripClip, and then just hang the bags. I don’t know that it could be any easier than that!”

 

The HUB Pharmacy went a step further than many Central Fill facilities by adopting a centralized services model. Teams doing pre-verification, order entry, call center, specialty pharmacy, management, medication access coordination, and 340B and third-party analysis, plus dispensing, verification, packing and shipment or delivery, will work together under one roof. The fulfillment area, which the team has dubbed the ‘automation room,’ consists of two robotic machines and a conveyor system.

 

“We pulled all the busywork out of the satellite retail pharmacies so the pharmacists there can really focus on the patient that’s in front of them and improve the patient experience tenfold,” Zaleski said. For Nebraska Medicine, it all comes back to their brand promise of Serious medicine. Extraordinary care.

Nebraska Medicine HUB Pharmacy

The Payoff

The HUB Pharmacy prescription automation room will be fully operational by the end of the 2022. They’ll have the capacity to process 2,000 prescriptions per day with eight full-time employees, compared to the 1,400/day they were previously doing with 10 people. In other words, they’ll be able to fill 250 Rx/hour vs. 100 Rx/hour – a 150% increase in output, with 20% less human capital. Roughly half of prescriptions will go back to the outpatient and specialty pharmacies (in scripClips), and the other half will be delivered by mail or courier.


Still, Nebraska Medicine isn’t cutting staff; instead, they’re focusing on providing more one-on-one consultation and clinical care.
“By reducing the time retail staff has to spend on filling, checking and packaging prescriptions, we can add more assistance to clinics and expand access to patient care,” Haynie said.


They also built the HUB facility with room to grow – to dispense and deliver more prescriptions, and service additional outpatient pharmacies. There’s open space to add more workstations, a track capable of filling 2x the number of prescriptions they’ll do immediately (4,000 vs. 2,000), and room to add more automated technology down the line.

5 Takeaways

Nebraska Medicine’s HUB Pharmacy offers a few tips for other multi-location pharmacies considering centralization:

  1. If fulfilling mail orders is part of your operation, implement a shipping solution before building out your Central Fill facility. (They use Global Ship™ through LogiCor.)

  2. Likewise, if you can centralize services, make those changes first. Nebraska Medicine started its centralized services model – bringing together management, pre-verification, call center and other functions under one roof – in August to build camaraderie and work out some kinks before taking Central Fill live in December 2022.

  3. Think through the end-to-end workflows and streamline as much as possible by integrating smart solutions like will-call automation, which can reduce rework, save invaluable time both in Central Fill and at the retail pharmacy, and increase staff and patient confidence in “right-patient, right-prescription” accuracy. (Hello, scripClip!)

  4. Ask a lot of questions and keep lines of communication with the team and all partners open, so you continue to learn what’s working and what’s not working. “You can feel like you’re 100% prepared, but until you’re actually in there, on the front lines – that’s where you’re going to notice the opportunities,” Zaleski humbly said.

  5. Set yourselves up to grow – into more space, doing more volume, with more staff and technology, etc., because patient demand isn’t slowing down.

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