At Day Lewis we knew that to make more time for more face-to-face patient care, dispensing efficiency was important. We’d already used technology to automate the production of MDS trays and we knew the next step was an efficient solution for the dispensing of repeat original pack prescriptions.

We spent significant time exploring different ways of achieving this, including hub and spoke and the various models that exist. We concluded that due to the scale of our business and our ambitions we would ultimately need one central hub with large-scale automation to meet our needs.

However, we also realised two very important things. Firstly, we needed a software solution that would ensure seamless communication between our stores and the hub so that teams in store had full visibility and control. Secondly, the way we managed this change would be crucial. We knew going with a ‘big bang’ approach and turning everything on, everywhere, all at once, would be a real risk to successful adoption of this new way of working.

 

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Based on this we decided to manage the change in small steps. Stage one has involved partnering with Centred Solutions and using its ‘FLOWRx’ software to put in place a tote to spoke model. We’ve done this as we believed the biggest change for the pharmacy teams would be sending dispensing ‘offsite’ and so we wanted them to become acclimatised to that.

This simplified model of hub and spoke dispensing is an option for all pharmacies. The process starts with the pharmacist in the store who does the clinical and accuracy check in the PMR up front. Patient orders are then transmitted to the ‘hub’ using the software.

At the warehouse, staff ‘batch pick’ medication required for specific patients and pack it into ‘patient specific totes’ containing loose medication for up to 30 different patients.

 

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These are delivered back to the pharmacy where staff scan the tote barcode to display the medication included in that tote and any items that need to be picked locally in store and added to it. The software then guides dispensers through the dispensing process using barcode technology as an additional safety net.

The dispenser selects medication from the tote and scans the medication barcode and matches that medication to a patient and automatically prints a patient label, which is scanned before the medication is assigned to a patient specific basket. 

Once all medication in the tote has been scanned into the patient specific baskets, the dispenser begins packing by scanning a basket barcode to print the patient bag label. Medication in the basket is then scanned into the bag which gets a final scan to confirm it is complete before being scanned into the PMR. 

 

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The pharmacist will only get involved if an anomaly arises in the dispensing process. For example. a short expiry date or medication placed in the wrong patient basket halts the dispensing process for that patient until it has been checked and cleared by a pharmacist.

We rolled out this dispensing process to nine of our pharmacies. Training was initially done by the Centred Solutions team but now we have created a team of Change Champions to embed good practice.

What we have achieved so far is a whole new level of accuracy when it comes to patient prescriptions. The barcode scanning functionality coupled with the end to end audit trail of every patient order helps us to ensure the right dose and the right medication is dispensed to the right patient.

 

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Time is saved in pharmacy as staff are now putting away less stock on the shelves because they are assembling and dispensing directly from the tote. Our pharmacists also work smarter.

There is a specific point in their day which is dedicated to checking for repeat original pack prescriptions and after that the pharmacist is not required in the process unless there is an anomaly.

This concentrated approach is a far more efficient way of working as it means the pharmacist isn’t spending the entire day checking medication. We currently send around 70% of our repeat prescriptions through the hub.

We’ve rolled out successfully to our pilot sites and our next step is to have two ‘centres of excellence’ pharmacy stores in each of our 17 regions. They will be our best practice sites that other stores in the region can turn to as we roll out this new way of dispensing to our whole estate.

Danny McNally is pharmacy process improvement manager at Day Lewis Pharmacy