By Kirstin Grace-Simons (Madigan Army Medical Center)October 26, 2018
Editor's note: Madigan Works! is a new video series created especially for social media platforms to inform patients and the general public alike what goes on behind-the-scenes to make Madigan work. Each episode will have an accompanying article. Shining a light behind the window of the pharmacy is first.
JOINT BASE LEWIS-MCCHORD, Wash. -- Every day Madigan Army Medical Center's outpatient pharmacy alone sees an average of 800 patients and fills 2,000 to 3,000 prescriptions. Compare that to a couple hundred prescriptions for the average retail pharmacy and the scale of Madigan's pharmacy operation becomes clear.
Dan Gardner, the chief of ambulatory (commonly called outpatient) pharmacy, walked Col. Suzanne Scott, the deputy commanding officer, through the process of filling a prescription.
"Once your number is called, your pharmacy health care team goes into action. A lot of people don't realize this is a health care encounter just like an exam by your doctor is. Pharmacy is one of the most used and yet least understood aspects of health care," said Gardner.
When a patient steps up to the counter, a pharmacy technician greets the patient, takes his or her identification, and finds and reviews the prescriptions a provider has entered into the electronic health record system.
A pharmacist checks this new medication with the patient's other medications to make sure there are no interactions. The pharmacist reviews the diagnosis and the dose to ensure they are appropriate.
It also goes through an insurance screen, electronically, while the patient is standing at the window. That's new with MHS GENESIS, the Department of Defense's new electronic health record system. It provides another safety check and helps Madigan align better with Congressional mandates. Many people don't realize they have insurance, but that's what TRICARE is, much like insurance in the civilian world.
None of these reviews is to second guess the provider; they just bring the expertise of the pharmacy doctor into treatment and serve as a safety check.
Once these initial reviews are complete, the techs and pharmacist go about filling the prescriptions.
Some medications require refrigeration; some are considered controlled substances, so they are stored and counted separately. Some are in the automated systems, the "robots." There is some great technology assisting the pharmacy.
"But, of course, anything tech will have its hiccups and occasional downtime," said Gardner.
Some medications must be made or compounded onsite. That happens in the inpatient pharmacy. That's one of the reasons filling a patient's prescriptions can take some real time.
All of this is just for a new prescription. Refills are a separate part of the operation.
When a patient has a prescription that is already established, the patient calls the refill line, chooses where to pick up -- the drive thru or the walk-up window -- then give the pharmacy a few days to fill it. All medications in the refill section of the pharmacy are stored in automated vaults so they are easy to find when the patient comes to pick them up.
"Our process revolves around accuracy and patient safety -- making sure the right person gets the right medication," stressed Gardner.
A patient can also use the mail order option or go to a retail pharmacy. Those options will cost some money, but it may be well worth it to have the convenience of the mailbox or the neighborhood pharmacy.
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