1. N ARCOTIC T ECHNICIAN W ORKFLOW P ROJECT W EEK 2 Pam Lyons PharmD Candidate 2014 University of Pittsburgh Pharmacotherapy Scholar Program

2. W ORK A CTIVITIES ActivityTime Spent (percentage) Dispensing Poll124 minutes (34.3%) Cassette Exchange67 minutes (18.5%) CII order -Organizing order -Generating PO -Putting away order 40 minutes (11.05%) Trouble Shooting35 minutes (9.67%) Organizing -Paperwork -The room 24 minutes (6.63%) Dispensing 1 time orders -DEA forms -Items to prepack -Patient specific 1 st doses 19 minutes (5.25%)

3. W ORK A CTIVITIES ActivityTime Spent (percentage) Polling cabinets16 minutes (4.4%) Open transaction resolution10 minutes (2.76%) Preparing for cassette exchange -Census verification 8 minutes (2.21%) Talking6 minutes (1.66%) Expiring one medication order6 minutes (1.66%) Ordering CIII-V6 minutes (1.66%) Waiting for PharmD to finish with NarcStation 1 minute (0.6%)

4. T ROUBLE S HOOTING B REAKDOWN Questions about ordering a product (6) Looking for items Biohazard binder (2), carts (2), bags (2) Questions about if a medication was in stock (5) People asking for medications to be sent to the floor (4) Paperwork questions (3) Issues with low fentanyl drip stock (3) Determining what to do with extra boxes (2) Determining if a medication would fit in the cabinet (1) Dealing with a medication found on the floor (1) Questions about returns (1) Trying to adjust the thermostat (1) Resolving dispensing error (1) Question about an order from yesterday (1)

5. D ATA

6. A REAS FOR I MPROVEMENT

7. P APERWORK /B ENCHMARKING HospitalPaperworkDurationPaperwork Destroyed PUH (McKessen) Confirmed -DEA 222, POs, Order forms, weekly Narc Station audit -Open transactions, pulling reports, narcotic unloaded/expired sheets -Anesthesia reports Onsite 2 years then off site 5 more yrs Stock out reports ShadysideTBD Mercy (McKessen/Manual) Deliver sheets (confirmed)Onsite 2 months then off for 7 years None MageePulling reports, delivery reports after 1 week Daily, weekly ect. Inventory reports DEA 222, POs, Order forms, weekly Narc Station audit Onsite 2 years then off site for 5 more years Open transactions, pulling reports, narcotic unloaded/expired sheets Kept until transaction is closed – then destroy (should be w/in 24 hrs) Anesthesia reportsTBD – kept onsite 1 month POs, order forms, anesthesia sheets, pulling reports ( confirmed) Onsite 1 years then off site for 2 more years DEA 222Onsite 2 years then shredded DEA 222, POs, order forms7 years Delivery reports1 week Yearly inventory report7 years

8. R ECORD K EEPING R EQUIREMENTS DEA Section VI “All records related to controlled substances must be maintained and be available for inspection for a minimum of two years.” PA Code Section 27.18(b)(5) “In an institution, Schedule II controlled substances which the pharmacy dispensed and which were ultimately received by the patient shall be recorded and the record kept for 2 years.”

9. O BSERVATIONS Largest areas for improvement Cassette exchange, trouble shooting, open transactions MANY interruptions in work flow Questions, comments, people coming in and out A specific minute only labeled as “trouble shooting” if she stopped working Many more interruptions “Critical Low” feature may help tech fill future stock outs before the poll  less interruptions First half hour wasted

10. P ROPOSED S OLUTIONS Dispensing Critical low feature will allow tech to fill stock outs before the poll and avoid interruptions Interruptions/Trouble shooting Have specified time for narcotic pharmacist to be in the room (ex: during tech’s lunch, cassette exchange) Cassette exchange Divide narc tech’s 3 units among 3 other technicians OR Start the exchange at 6AM Start the poll earlier Have the tech start at 5 - 5:30AM Cut out cassette exchange so poll could start at 6AM This would decrease calls from units, stock outs, interruptions Have a dedicated narc delivery tech Would decrease open transactions resolution time Prevent calls from units when delivery techs don’t take the narcotics

11. F OLLOW - UP T ASKS Dispensing Activate the “critical low” feature Have narc tech fill critical lows before starting the poll Law Determine record keeping for CIII-IV drugs Paperwork Continue confirming benchmarking data All categories Continue collecting data from narcotic technicians on different days Implement a set time for narcotic pharmacist to be in the room