The Cure for Resource Headaches? Central Pharmacy Services 

Episode Highlights

Describe the challenges you’re facing around technician labor shortages.

Dave Young: We're really struggling right now. We currently have four full-time pharmacy technician openings, and we routinely run in the neighborhood of 10 or more vacant per diem tech positions. These vacancies put a lot of pressure on our entire staff. It also has a lot of cost implications, especially from an overtime standpoint.

When we talk with colleagues in other Philadelphia area hospitals, it's something that everybody's dealing with. It’s been a challenge for quite a long time. There just are not a lot of viable candidates out there for the positions that are open.

Matt Baldwin: I definitely echo Dave’s sentiments about technician labor. It's getting hard to try to put a finger as to why we're having so many technician labor shortages. I know that this isn't just an Ohio and Pennsylvania problem; I know it's everywhere.

During the pandemic, we were blessed because we did not have a lot of turnover. More recently, as the pandemic has started to wind down, our turnover has increased. Obviously we look at wage analysis and tried to implement some initiatives to see if that would help.

Also, complicating matters somewhat, technicians are required to register with the Ohio Board of Pharmacy, which puts them into three tier categories: trainee, registered pharmacy technician, or certified pharmacy technician. Each registration has different roles and responsibilities they are allowed to complete. That’s made us rethink how we onboard technicians to manage for these designations, for instance, when looking for certified pharmacy technicians for IV room operations.

How has the technician labor shortage strained your medication distribution processes?

Dave Young: First, we have an older campus with space limitations on nursing units that prevent us from fully utilizing automated medication dispensing machines. We also don’t have a pneumatic tube system. So we rely on a 24-hour cart fill process filled by our robot. All of our first doses – anything outside of the cart fill process – are manually delivered to patient care areas, which is a huge labor issue. That’s our biggest daily struggle: getting doses to patients in a timely manner.

Second, even with our current robot, we need someone to run it across multiple shifts. We have staff devoted to packaging and to checking doses. We have staff devoted to monitoring robot inventory and to optimizing the robot. Being down all of those technician positions, even with the automation that we currently have, is a significant challenge.

Matt Baldwin: At Aultman, we have a lot of automation systems – the robot, carousels, and unit-based cabinets. The labor issues have forced us to look at our pain points and then figure out a way to optimize the technology.

For instance, we looked at missing dose requests we get from nurses. We addressed that by using our electronic medical record to alert nurses where they can find medications. Now nurses spend less time looking for them.

Also, my team has done a great job at evaluating how many meds are being tubed, and then optimizing the medication supply in each cabinet. Both of those changes required a lot of thought from pharmacy and required nurse education.

Does your executive team understand how these labor challenges are impacting pharmacy operations?

Matt Baldwin: Prior to taking on my role as a system director, it was more difficult to deliver that messaging to leaders. Now, I actually sit in with the leadership team, with the CEOs from the different hospitals, and can present those challenges to them.

We’re due for a refresh on our pharmacy automation systems, with plans for a new XR2 dispensing system, new carousels, and new XT cabinets. Having to present that, obviously, was not fun, given the financial climate. But I believe they see the value of advanced technology, that it has become the standard and has allowed us to maximize what pharmacy can do for the health system, especially in adding another hospital to the group in Aultman Alliance. And that's definitely been beneficial for me, at least to tell that story.

Dave Young: What Matt said certainly resonates for us as well. I'm fortunate to be in a position where our VP and our senior leadership team are very involved. They are open to feedback and to receiving information.

My approach is to keep everybody in the loop and share the data, so there are no surprises for them. That includes sharing the pain points we’re experiencing, but also having a discussion around options and potential solutions.

Our capital pipeline process is pretty painful every year. And we’re not in a financial position where we get what we need, let alone what we want. It comes down to a persistent approach and making the case consistently over time, so that when the opportunity comes, it’s not new information for anyone, and is just a matter of pulling the trigger on it.

How did the as-a-service model change the discussion with executive leadership?

Dave Young:

Not having that large capital investment certainly made the XR2 more feasible for us and probably sped up the timeline more than it would have otherwise. While absorbing the XR2 on the operational budget wasn't an easy pill to swallow, compared to what pharmacy operations would have looked like if we had gone back to a manual process, it made it a much easier sell to leadership.

Matt Baldwin: My VP and I shared two options with our leadership. The first option was building on our automation vision with XR2 as a service being a central hub supplying other facilities. The second was, what if we went backward and undid our existing automation? How would we supply these other facilities? What would the cost impact be in terms of additional FTEs? In terms of potential medication errors? How would this affect our health system? Showing that whole story to leadership, it became clear to them what the benefits to patients would be.

What do you see as the lasting impact from your as-a-service approach to pharmacy technology?

Matt Baldwin: By increasing efficiencies with XR2, optimizing processes, reducing packaging requirements – all of that will allow us to reallocate resources to patient programs. Our pharmacists can move to patient care units, we can enhance our med histories initiatives, and we can expand our meds to beds services.

From a system-level perspective, the vision is to supply medications to other facilities, and to standardize pharmacy services so that patients have the same care experience everywhere throughout the Aultman system.

Dave Young: At this stage, we’re still in the mode of projecting what the XR2 as a service means for us. How much can we advance from the pressure cooker of where we are today in dealing with all of the open positions, to how we can use the efficiencies gained to reallocate staff. That’s one of the exciting things that lies ahead for us, leading back into that realm of providing value-added services and delivering on what we’re capable of doing to enhance patient care.

DISCLAIMER

The Future of Pharmacy Podcast is produced and distributed by Pharmacy Podcast Network. The views and opinions expressed in this podcast are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.