It’s two o’clock in the morning when your phone rings. It’s the on-call hospital administrator at your facility. A natural disaster has struck, and your hospital must remain fully operational for the next 72-96 hours with limited external resources. The 96-hour emergency management plan at your hospital is being activated, and a media press conference is set to take place at 5:00 a.m. The next question you hear is, “Do we have enough medications on hand to provide care to our patients for the next 3-4 days?” As the pharmacy director, which medications will you prioritize as the most medically necessary?

While this scenario might seem like something out of a blockbuster movie, you may have already faced it or addressed a similar question during your triennial accreditation survey preparation. At the core of this situation is the crucial question: Is the medication list in your emergency playbook robust enough to meet the challenge, or will it leave you scrambling?

If you haven’t created an essential medications list before, or are looking to revisit your current one, it’s important to start by defining your scope. According to the World Health Organization (WHO), essential medications are those that satisfy the priority health care needs of a population. Your scope consists of two main components: the setting you are covering and the types of medications you are including.

First, determine what your setting needs to plan for. Then, define which medications are essential for your patients. This should reflect the disease prevalence and public health relevance within your patient population, including common conditions, infrequent but possible scenarios, and rare but potential disease states. Both the identification of disease states and the selection of necessary medications should be approached in a multidisciplinary fashion, leveraging the expertise of specialists in each area to pinpoint the truly essential medications.

When creating a disease state-specific medication list, it’s helpful to identify primary and secondary alternatives when possible. For organizations that serve as centralized hubs within a larger health system, it might be most feasible to set a minimum reorder point at 7-8 days for each medication based on system-wide use. This strategy ensures the larger hub can maintain control over product availability during challenging times. However, given the diversity of your patients and the “rare or potential disease states,” this approach can lead to substantial costs and high levels of waste on seldom used but essential products.

For smaller or leaner facilities, establishing reduced reorder points for secondary agents or even a non-stocking status for infrequent secondary agents, when the primary medication is readily available, can help reduce carrying costs. This approach does require closer attention to stock levels to ensure availability and a commitment to daily ordering.

Regardless of the facility size, partnering with vendors to identify replacement product programs and collaborating with other hospitals in the area to understand each location’s stock can help cut costs and reduce waste.

Lastly, establishing a follow-up procedure to ensure the medications on your emergency list remain in stock is essential. If your automation or inventory management system allows you to set standard stock products in both decentralized and centralized inventory, you can align your inventory reports with cycle counts to ensure products are always replaced after expiration and never inadvertently removed.

For hospitals in regions where emergencies are more common, whether year-round or seasonally, consider creating more frequent automated dashboards to alert your buyer of stock issues. Additionally, revisiting your day’s supply based on current patient usage or embedding the emergency medication evaluation within the formulary approval process can help maintain the stability of your list as treatments and needs evolve.

Steps to Consider When Creating an Essential Medication List for Your 96-Hour Emergency Management Plan:

1. Form a multidisciplinary team.
   1. Include representatives from pharmacy, clinical departments, administration, inventory management, and key disaster management members.
   2. Ensure involvement of specialists for different disease states to get a comprehensive perspective.
2. Define essential medications.
   1. Prioritize medications based on disease prevalence, public health relevance, and patient needs within your specific setting. Identify primary medications and establish secondary alternatives for each condition.
   2. Validate the list with input from specialists and clinical teams to ensure completeness and accuracy.
3. Develop inventory management protocols.
   1. Set minimum reorder points based on medication use patterns. For centralized hubs, establish a minimum reorder point at 7-8 days for each medication. For smaller or leaner facilities, consider reduced reorder points or non-stocking status for infrequent secondary agents.
   2. Use automation and inventory management systems to track stock levels and align reports with cycle counts.
   3. Create automated dashboards to alert buyers of stock issues, especially in regions prone to emergencies.
4. Collaborate with vendors and other local hospitals.
   1. Collaborate with nearby hospitals to create a network of transparency and cost reduction by sharing information on high-cost, low-utilization medications.
   2. Work with vendors to identify product replacement programs or consignment opportunities to reduce costs and ensure supply.
   3. Explore options for emergency restocking and rapid replenishment.
5. Create a plan for ongoing monitoring and continuous improvement.
   1. Schedule regular reviews of the essential medication list to update it based on changing patient needs and treatment protocols. Revisit day’s supply based on current patient usage and embed the emergency medication evaluation within the formulary approval process.
   2. Maintain communication with clinical teams, administration, and other stakeholders to ensure the list remains relevant and effective.

Seven out of 10 pharmacies are understaffed¹. When a pharmacy is understaffed, every aspect of the business suffers: employees become overburdened, lines are longer, and customer service deteriorates, resulting in patient and employee churn.

Does this situation sound familiar?

Fortunately, there's a more sustainable solution than the continuous cycle of hiring and training staff – and you’re already familiar with it. Digital transformation, the adoption of online and integrated technology, can bridge the gaps created by staffing shortages to streamline workflows, enhance efficiency, and increase staff capacity.

While the concept sounds nebulous and overwhelming, we’ve identified the most impactful technologies to help you get started on your journey toward modernization.

No. 1: Streamline Transactions with Digital, Self-Service Payments

As a consumer, you use your phone to pay for goods and services nearly daily. From curbside pickup to third-party delivery apps, 82% of Americans use digital payments regularly².

However, pharmacies and healthcare have been slow to adopt self-service payments due to regulatory concerns. But as dedicated healthcare payment providers have entered the space, it's now an area ripe for transformation and efficiency gains.

When payments are required to be made at the counter, patients arrive surprised by Rx prices, fumbling with payment methods, and asking pharmacists to update billing information, resulting in lengthy and frustrating transactions. At the most critical point in the patient's journey, the pharmacist is spending more time with the patient on operational activity rather than clinical engagement. No wonder pharmacies are the second most common place where Americans spend the most time waiting in lines ³. 

Providing digital, self-service patient payments via text or email offers patients convenience while saving pharmacy staff time and effort⁴. Patients can pay how they want, when they want, and where they want, while pharmacists can focus on the core elements of their job. When patients arrive to pick up their prescriptions, pharmacists can verify their identity, see proof of payment with a QR code from the patient, collect the necessary signatures, and offer counseling with little to no billing support required.

Instead of a 10-minute wait time and an ineffective interaction at the register, the pharmacist and patient benefit from shorter, yet more effective interactions.

No 2.: Eliminate Manual Processes with a Mobile Point of Sale (POS) System

Is your staff wasting time using pen and paper? You're not alone. 71% of providers still use manual processes for collecting payments, signatures, and identification⁵. This pulls pharmacists and technicians away from their core duties, increases the likelihood of errors, and compromises security.

Manual pen and paper processes are most common during mobile transactions, like meds to beds or curbside pickup, because most point of sale (POS) systems have been reliant on on-premise, hardware-based solutions. But advancements in cloud computing and mobile devices have enabled technology providers to offer mobile, cloud-based systems that work on tablets and laptops without bulky servers. 

With a mobile POS that’s integrated with your pharmacy management system (PMS), staff can capture all necessary patient and payment information as the transaction is being conducted⁶. This enables revenue-driving programs like meds to beds, drive-thru, curbside pickup, and line busting without adding extra workload for your staff. No more frustrating tasks like tracking down signatures with paper, spending hours uploading and scanning, or worrying about accuracy and compliance. 

No. 3: Quickly Locate Prescriptions with an Automated Will Call System

In 2021, over 6.5 billion prescriptions were dispensed in the U.S.⁷ With 66,000 pharmacies in the U.S. that year, we can roughly estimate that each pharmacy handled an average of 98,000 prescriptions annually⁸. 

Think about how long it takes for your staff to find a patient's prescription during pickup. Even if it only takes a minute, that's 98,000 minutes—or 1,633 hours (about 2 months)—wasted each year.

An effective, low-cost way to reduce this time is through an automated will call system. These systems use lights and/or sounds to help pharmacists quickly locate prescription bags. When dispensing a prescription, the pharmacist scans the prescription and bag before hanging it on the rack or in the refrigerator. When the patient arrives, the bag lights up or makes a noise, allowing staff to locate it instantly, reducing wait times from 10-30 minutes down to seconds.

While pharmacy automated will-call systems aren’t necessarily new, a lighted will-call system that integrates into the point of sale (POS) is. This helps streamline vendors and applications leveraged by pharmacy staff for greater efficiency.

Reclaim Time to Achieve More with Less

Imagine a pharmacy where your team can focus on what truly matters while experiencing more manageable workloads. Alleviating staffing shortages and providing better patient and employee experiences starts with technology. By doing the work now to modernize your most time-consuming processes, your staff, patients, and bottom line will benefit for years to come. 

Self-service payments, mobile POS systems, and automated will call systems are just the beginning. What innovative solutions will you explore next? 

Resources

1. Untapped opportunities for health system pharmacies | McKinsey (mckinsey.com)
2. New trends in US consumer digital payments |McKinsey (mckinsey.com)
3. Consumer Survey: The State of Waiting in Line (2023) | Waitwhile
4. Pharmacy Payments Pain Points: How to Avoid Them | Emporos
5. 2024 Trends in Healthcare Payments Annual Report | J.P. Morgan (jpmorgan.com)
6. mPOS: A Patient-Centered Solution | Emporos
7. Total drug prescriptions dispensed U.S. 2009-2022 | Statista (statista.com) 
8. U.S. National Pharmacy Market Summary | IQVIA (onekeydata.com) 

In a previous article, I covered 5 key things that hospital pharmacy leaders need to know about medication safety [SEE: '5 Things You Need to Know NOW About Medication Safety']. Now, we need to put this into action. In this article, I’ll touch on 4 things to jump start medication safety at your organization!

1. Review and share reported medication errors. I have a colleague whose career in medication safety started when she was asked to categorize medication errors as part of a modified work assignment (she was a hospital pharmacist back then) while she was transitioning back from maternity leave. She was only asked to categorize the errors but as she read through them, she started asking the question, ‘What are we doing about these errors?’ That was the impetus for the creation of a dedicated medication safety role at her organization. I cannot emphasize enough the power of these reported errors when they are reviewed AND SHARED! Bring awareness to what is happening to both those on the front line as well as leaders above you who can influence and prioritize resources to projects that will reduce the risk of medication errors.
2. Utilize the Institute for Safety Medication Practices (ISMP) Newsletters. As a hospital pharmacist many moons ago, I was fortunate enough to be part of an organization that shared the ISMP newsletters with staff. It was eye-opening (and scary!) to read about medication errors that occurred at other organizations. It can also be overwhelming to realize how much risk exists! That said, don’t try to boil the ocean. Instead, identify one or two items each quarter (or even each year) that you want to address for your pharmacy or hospital and just focus on that. While some recommendations may require a heavy lift (e.g., a system enhancement to the organization’s electronic health record), others could be easier to implement and lead to small but quick wins.
3. Assign small medication safety related projects to interested staff. As a pharmacy leader, remember that you do not have to do everything. Instead, as medication safety related projects arrise, leverage the talent, expertise, and interest from your staff. This is a win-win-win all the way around. The hospital or pharmacy benefits from the project, the employee is engaged and feels valued for being able to contribute in a unique way, and the manager gets something they has been meaning to address off their plate.  Standardizing a process (example: a process for unit dosing medications), creating a quick reference card/table (example: creating a laminated table of where certain medications can be infused based on unit), or redesigning an automated dispensing cabinet matrix drawer or tower to optimize efficiency of refills AND minimize look alike errors, are all very ‘doable’ by staff, with guidance.
4. Hire a dedicated medication safety officer!  I strongly believe that every medical center needs a dedicated medication safety officer to set the medication safety vision, identify opportunities to improve the medication-use process, and lead efforts and initiatives to prevent medication errors. This simply cannot be another hat that a manager or director wears in addition to a multitude of other responsibilities on their plate. In a later article, I’ll provide insight into what to look for in a medication safety officer.

Children's National Hospital Division of Pharmacy boosted its pharmacy operational efficiency by merging datasets across its workflow platforms into a central data repository, from which many co-variables were then accounted for. With aggregated workload data from 180+ employees across 10,000 shifts, they implemented user-friendly dashboards, ensuring accuracy through collaboration. 

The result? Major operational and clinical improvements, highlighting the power of data integration and automation in healthcare. This signals a bright future for efficiency with advancements in automation, predictive AI, and data analytics, poised to revolutionize pharmacy operations and patient care. Upon implementation, one of the Operations Manager voiced being “empowered to track, trend, and share employee metrics during their monthly 1on1s with their direct reports especially now being able to account for differences in workload in different shifts, days, and whether training or not”.

^{Fig 1: Lifecycle of medication in the hospital. Each stage of the medication lifecycle has different disconnected technology platforms with different datasets needed to be merged into a data warehouse.}

Healthcare organizations face a data explosion, with the sector generating a significant share of global data. Despite this, healthcare lags in data utilization due to privacy concerns and disjointed systems. Children’s National Hospital, like many others, operates various disconnected platforms, hindering data analysis and workflow understanding. Manual data handling strains resources, urging the need for automated solutions. To enhance efficiency and patient care, hospitals are turning to digital health strategies, integrating analytics platforms. Children’s National Hospital aimed to streamline pharmacy data management through automation, addressing staffing challenges and burnout. This report outlines the implementation process and key insights gained.

Setting the Stage: Navigating Pharmacy Innovation

Children’s National Hospital, recognized as a top-ranking facility in neonatal intensive care and overall pediatric care by U.S. News & World Report, prioritizes pediatric well-being. With a dedicated team of over 180 professionals, patient safety remains paramount. To improve medication management, the hospital sought modernization. Recognizing the inefficiency of Excel, which consumed 25 hours monthly and incurred extra costs, the pharmacy initiated a digital analytics pilot. Technical hurdles and data inaccuracies necessitated a transition to streamline medication lifecycle management.

The Blueprint for Pharmacy Efficiency

To meet diverse data reporting needs like daily huddle, Department of Health DOH on-demand, and C-suite reporting, an integrated platform was sought. Preceding tool development, similar organizations were studied for best practices. Some of those studied included a rural Maryland hospital analytics-driven approach with reduced spending on acetaminophen by 78%, a multihospital system in Central NC using clinical analytics to monitor high-risk medications, and a large multihospital and clinical system in South Florida streamlining its formulary after acquiring more hospitals and clinics to its network.

Critical platforms were integrated in phase I, with less critical ones and financial data slated for phase II. Real-time reporting measures encompassed dose preparation and verification efficiency, shift efficiency, dispenses to outside clinics, and controlled substance dispenses. Validation involved collaborative efforts between the Division of Pharmacy Services team and the analytics platform provider's Director of Healthcare Consulting and Implementation.

Powering Pharmacy Performance

Post-implementation, the platform analyzed eight real-time datasets, covering over 180 employees and 10,000 shifts, providing comprehensive insights into operational and clinical efficiency. Access to real-time dashboards centralized data from the entire medication lifecycle, allowing for streamlined measurement of performance indicators. Integration of previously siloed platforms enhanced leadership's visibility into employee efficiency, resulting in a 75.5% reduction in open shift hours. The dashboards facilitated accurate staff probation decisions and reduced manual data entry, freeing up 25 hours monthly in bandwidth. Phase II integration included census and capacity data, enabling predictive staffing level assessments with <5% variance to actual.

Navigating Challenges Learned in Pharmacy Automation

The Division of Pharmacy at Children's National learned key lessons in automating and integrating data tracking and would like to share for others considering adopting new data and analytics platforms. They include:

• Buy-in: Securing support from leadership and frontline staff is crucial, emphasizing increased efficiency and improved outcomes.
• Time: Phase 1 took over 300 hours across 6-8 months, requiring adequate bandwidth and avoiding peak busy seasons.
• Technological: Managing IT governance, including HIPAA compliance, and addressing cybersecurity concerns with the IT department are essential. Renegotiating contracts with existing vendors may be necessary.
• Project staff-mix: Some staff lacked a blend of clinical and technical expertise, hindering effective integration and tailoring of the analytics software. Avoid using a non-clinical project manager and rather utilize a pharmacist with both clinical and technical knowledge to facilitate quicker implementation.

The Future of Data Automation in Healthcare

Automating data analysis fits the future of healthcare, aligning with digital health trends. Recent advancements include vaccine management and sterile automated compounding. Predictive analytics and AI are increasingly vital in diagnosis, treatment, and regulation. Predictive AI can enhance pharmacy efficiency by forecasting drug demand and managing medications. Integration with Cerner EHR aims to bolster analytical trends, identify cost-saving opportunities, and improve safety reporting.

Conclusion

Implementing a unified data platform improved pharmacy efficiency and real-time reporting at Children’s National Hospital. Integrating clinical and operational data is crucial for hospital effectiveness. As healthcare automation advances, digital analytics platforms are vital for capturing and enhancing clinical performance.

We urge other healthcare systems to merge data and share results to maximize efficiency and outcomes.

Long Grove Pharmaceuticals, an experienced and innovative pharmaceutical company specializing in complex generics and proprietary 505(b)(2)s, leverages its heritage of success through in-house research and development from parent company Capstone Development Services. Long Grove distinguishes itself in the generic pharmaceutical market with innovative approaches encompassing People, Products, and Processes. This includes in-house R&D for differentiated generics supported by Capstone, dedicated supply chains to introduce new supply to the U.S. market, and a seasoned leadership team fostering collaborative partnerships with customers and suppliers. Differentiated generics are delivered through proprietary products developed via the 505(b)(2) pathway, aided by rapid approvals and process efficiencies. Supply chain continuity and reliable partnerships further reinforce Long Grove's commitment to providing novel solutions to the healthcare sector.

The issue of drug shortages is an enduring problem, dating back to the early 1920s with the first traceable shortage being insulin. National tracking of drug shortages began in 2001, highlighting the persistent nature of this challenge. Despite over a century worth of awareness and opportunity, patients and healthcare providers continue to grapple with drug shortages. Although the idea of “drug shortages” is not exclusive to certain regions or facility type, each healthcare entity navigates these overlapping challenges in its own unique way, reflecting the widespread but varied impact of this ongoing issue.

We started the first quarter of 2024 by breaking historical records, reaching an all-time high of 323 active drug shortages, with nearly half being generic sterile injectable (GSI) medications. The challenges in patient care due to interruptions in GSI availability, coupled with financial implications, are significant. It's estimated that hospitals collectively spend upwards of $600 million per year managing drug shortages. This includes direct costs associated with more expensive, non-preferred products, increased labor costs due to alternative preparation requirements, higher operational carrying costs from increased standard stock amounts, and perhaps most frustratingly, waste once the shortage is resolved.

While no product interruption is ideal, some are more understandable than others. These include manufacturing delays due to equipment maintenance or repair, precautionary batch failures due to suspected quality control issues, or natural disasters. On the flip side, shortages caused by single-source producers dominating the market, significant violations leading to an FDA Form 483, or a diluted product margin resulting in negative value-added situations across multiple manufacturers are less palatable within a fragile system responsible for the health of a nation.

More recently, in response to these concerns, the U.S. Department of Health and Human Services (HHS) released a jointly sponsored white paper titled "Policy Considerations to Prevent Drug Shortages and Mitigate Supply Chain Vulnerabilities in the United States." In this white paper, HHS emphasized the importance of developing and implementing a collaborative, shared accountability model for drug shortage prevention. This model consists of two key components: the Manufacturer Resiliency Assessment Program (MRAP) and the Hospital Resilient Supply Program (HRSP).

The combined program aims to enhance market transparency for GSIs, promote volume-based purchase decisions with a sustainability focus rather than a "race-to-the-bottom" approach, and improve reliability by incentivizing investments in supply chain resilience and diversification. This includes initiatives such as expanding domestic manufacturing and production of key ingredients. However, there's also the potential for hospitals to face penalties under this framework.

Although an official statute has not yet been enacted into law, this is a critical issue. Institutions should take this opportunity to thoughtfully develop and refine clear processes and policies for managing drug shortages at the local level. The following factors should be considered when constructing your inventory management plans during a shortage and preparing to understand your financial position throughout.

Important discussion points to consider when developing your drug shortage management process:

• Work closely with your external pharmacy procurement stakeholders. Vendors such as drug manufacturers, wholesalers, and Group Purchasing Organizations (GPOs) can be invaluable partners. Each partner has the potential to add significant value to your organization.
• Internally, build relationships with key stakeholders across all care areas that may be impacted by a drug shortage. This ensures you understand who can be involved in developing a detailed mitigation plan.
• Determine the appropriate level of inventory for your facility and establish protocols for adjusting standard stock amounts during a shortage. This is a crucial component of financial stewardship during a shortage. Avoid panic-buying all available products in every dose and size to prevent product wastage and tighter constraints caused by a bullwhip effect.
• Conduct frequent huddles with purchasing team members to maintain a consistent understanding of product availability in the market. Daily structured huddles, even if brief, are ideal. Provide broader communication on a weekly basis to all pharmacy leadership for situational awareness, with meaningful escalation as needed. For larger Integrated Delivery Networks (IDNs), establish a system-level committee to review new, active, and pending mitigation plans.
• Organize a response process for activating a drug shortage plan and proactively plan mitigation strategies when monitoring indicates a potential shortage. Start discussions early with key pharmacy staff and select providers to determine preferred treatment alternatives. Do not assume that a pending shortage will be automatically communicated to the relevant stakeholders.
• Leverage your informatics and automation technologies to alert and guide providers to the shortage mitigation strategy, ensuring that any available product is reserved for patients who need it most.
• Identify ways to stretch your current supply to benefit as many patients as possible. Strategies include reducing automated dispensing cabinet PARs, strategically planning compounding for products that contain more than one dose, and shifting inventory from low-use to high-use areas. Work with key internal stakeholders to ensure changes are made with full awareness, for instance in the previous examples, ensure billing units do not result in overcharging during batch preparation of doses or that a PAR reduction does not interfere with urgent response protocols.
• Finally, revisit partnerships and how they can support you during drug shortages. Partners such as wholesalers, GPOs, and manufacturers can collaborate on plans to purchase short-dated products that would otherwise be wasted or enroll in commitment programs that ensure sustainable product availability through predictable and consistent volume needs. Both approaches can reduce your financial burden during shortages, with commitment programs offering proactive shortage prevention; understanding that these programs are most impactful prior to a shortage occurring. 

What is psychological safety? Psychological safety is a shared belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes. In a psychologically safe environment, people feel comfortable in asking a question, raising a concern, providing feedback, and contributing to a discussion without fear of negative consequences.

Why have a psychologically safe environment? There are many benefits to creating a psychologically safe environment in a pharmacy including increased workforce engagement and motivation, increased safety culture, and decreased patient harm. Interestingly enough, psychological safety is embraced by other industries such as the technology industry for its ability to drive innovation.

How can I create a psychologically safe environment in my pharmacy?

1. Share errors. Start daily huddles and team meetings with a safety story. Keep things simple, short, and sweet. Rotate who shares each day. Recognize and reward people for speaking up and sharing errors and close calls. This is also great opportunity to share what has been done to address past errors. As a leader, practice active listening as things shared could be future process improvement projects!
2. Thank people for sharing their opinions – even when you may disagree! In a psychological safety training exercise I attended, we were asked to discuss as a group what it would "feel" like in a psychologically safe environment of which we thought everything would be rosy with hearts and rainbows. Our instructor shared that psychological safety can feel uncomfortable. We were all dumbfounded. The instructor went on to explain that as a leader, you may not be used to someone disagreeing with you which will feel uncomfortable. Fight the urge to defend your position and just remember that everyone brings a unique perspective.
3. Model vulnerability. As leaders, we feel like we should have all the answers, fix all the problems, and be absolutely perfect all the time. Leaders are humans too. There is no shame in asking for help which may take the form of delegation, collaboration, or even having motivated team members take on a stretch project. Additionally, admitting to the team your mistakes and shortcomings shows vulnerability, builds trust, and sends a message that everyone makes mistakes but we can all learn from it.

The pharmacy supply chain is extremely complex, and the stakes are high for healthcare organizations. It falls on the shoulders of health system and hospital pharmacy leaders, along with their teams, to not only prepare and dispense drugs accurately and safely, but also manage all the processes and requirements related to drug products from procurement through point of use.

Discover the challenges keeping health system and pharmacy leaders up at night, and how U.S. health systems and hospitals are addressing them through supply chain management optimization.

Soaring drug prices are putting the squeeze on pharmacies, but you have the power to resist the trend. Advanced analytics can help your pharmacy loosen hyperinflation’s grip.

From 2022 to 2023, drug prices surged by 15.2%, on average, on top of an 11.2% increase the previous year, significantly outpacing inflation. This past year’s increase constitutes an average difference of $590 per drug, putting big pressure on providers nationwide.

The increases are especially bad news for rural hospitals, where over 600 facilities, or 3 in 10, were at risk of closure in 2023 due to financial instability.

Mitigating the impact of rising costs is an industry priority: 71% of hospital pharmacy participants recently stated that streamlining pharmacy purchasing and procurement was an essential priority for them this year. 

The good news is they can do just that.

Where’s the opportunity?

There’s plenty of opportunity among the 40,000 to 60,000 NDC prices hospitals must evaluate daily, given nearly 2,500 preferred NDCs and eight NDC options per therapeutic group.

Most hospitals have been managing this supply chain with low-tech tools like Excel. Many also rely on traditional siloed GPO tools, wholesale portals, and TPA software. Despite pharmacies’ best efforts, this fragmentation hampers data-driven decision-making, creating gaps, deficiencies, and waste.

Traditional procurement approaches also prioritize compliance over financial performance, missing potential improvements in fiscal optimization and sustainability. Even hospitals using newer analytics focus mostly on inventory tracking and supplier consolidation.

Cost-reduction reality

Pharmacy supply chain teams need more. In my view, they need integrated analytics created specifically to optimize spending through blended prices, real-time cost pricing data, and clear visibility into potential savings.

Hospital executives generally understand this need and intend to address it. More than half say data-driven improvements in supply chain management can improve margins by at least 1% to 3%, according to a Sage Growth Partners Survey. The challenge, however, has been creating the right solution.

Fortunately, some hospital systems are adopting purpose-built innovations that surface potential cost savings and elevate the highest-potential opportunities to the top of an integrated dashboard.

These solutions provide transparency around all available drug options to ensure a hospital system gets the best prices and is fully stocked with the drugs it needs. From 2023 to 2024, there was a significant increase in the adoption of new software technologies to help combat purchasing problems, with 25% of respondents turning away from their wholesaler tools compared to 8% the previous year.

Millions of dollars recouped

We looked at 140 hospitals using state-of-the-art purchasing-optimization technology and workflows developed by pharmacists. These leaders saved $27 million in 2023 through real-time data-driven recommendations for better purchasing options. The recommendations considered preferred NDCs, GPO compliance, availability, and WAC, GPO, and 340B ratios.

For the pharmacy professional, a useful real-time purchasing-optimization dashboard provides three simple workflows:

• A direct savings workflow that flags overcharges and recommends lower-priced options for identical products and hard-dollar ROI.
• A cost avoidance workflow that flags 340B insights, contract management opportunities, and impending price increases, preventing overcharges before they happen.
• An oversight workflow that monitors spending, shortages, and GPO compliance.

Relief is in reach

Now, any hospital system can have a bird’s-eye perspective of these workflows in their organization, viewing similar sites in “groups” and facilitating standardized buying practices where applicable. Buyers can dive deeper into any recommended change with a simple click.

Developing such a system doesn’t have to be a major IT undertaking. It’s more about gathering primary data: a wholesaler account list, a 12-month inventory history, 340B covered entity status, and GPO’s preferred NDC list. Standard templates help pharmacy departments connect to major wholesalers.

As a hospital pharmacy, there’s not a lot you can do to prevent drug prices from rising. But you can do more to find the best available price for every purchase. Analytics, dashboards, and the data you already have point the way. 

Medication Safety is one of those terms that can be woven into anything related to medications.  Adverse event from an anticoagulant? Medication safety. Sterile compounding? Medication safety. Regulatory compliance? Medication safety. Medication administration? Medication safety. REMS? Medication Safety. Electronic order sets? Medication safety. The list can go on and on and on and rightfully so since safety plays a role throughout the entire medication use process.  While many medication safety officers do juggle one or several of these responsibilities, at the heart of any medication safety program is reducing the risk of medication errors and patient harm.  Here are 5 things you need to know NOW about medication safety.

1. Safety culture makes ALL the difference. Safety culture is one of those weird intangible concepts that is difficult to explain or put your finger on but has such a profound effect on how situations can unfold.  I’ve given many lectures on safety culture, and I always like to start by painting a picture of a busy pharmacy and looking at how a scenario could unfold in different safety cultures. In a strong safety culture, an error is caught before leaving the pharmacy and a system fix is later put in place to prevent that error from happening again. In a lower safety culture, an error reaches the patient who subsequently goes into cardiac arrest resulting in an overhead call for a code blue.  Again, hard to put your finger on exactly what it is, but has a profound effect.  I can go into many technical aspects of safety culture, but I’ll spare you the details. The key takeaway is that it all starts with psychological safety or how comfortable everyone is with speaking up, disagreeing openly, or asking questions without fear of negative repercussions. In a later article, I’ll provide more specific tips on how to build psychological safety at your pharmacy.

    

2. Saying (and repeating) “BE MORE CAREFUL!” does NOT make a safer system. Instead, higher leverage strategies are needed to prevent errors.  The Institute for Safe Medication Practices has an infographic entitled the ‘hierarchy of effectiveness of risk-reduction strategies’ that displays low, medium, and high-leverage strategies.  Low-leverage strategies, such as educational programs and telling someone to “Be more careful!”, focus on human reliability. As humans are fallible and to err is human, we simply cannot educate ourselves to safety.  Medium-leverage strategies are a step above and include redundancies and alerts but may need reinforcement and periodic updating. High-leverage strategies, such as forcing functions, computerization, and automation, may take longer to implement, but is most effective because it can eliminate the risk of errors altogether. So, if you find yourself saying “BE MORE CAREFUL!” over and over again, pause, check yourself, and ask ‘What higher leverage strategies can we put in place to prevent this error from happening again?’

    

3. Learn from events that happen outside your organization. There is something called normalcy bias when errors occur at outside organizations where people think ‘That won’t happen here.’  But guess what? It can and it will.  Don’t rely on solely on reported medication errors at your organization!  Look proactively at events that happened at other organizations and learn from them.  Identify gaps internally based on the shared event and work to close those gaps before the same error occurs at your organization.

    

4. Every healthcare institution needs a dedicated medication safety leader. The American Society for Health-System Pharmacy (ASHP) has a white paper on the need for a dedicated medication safety leader that I highly encourage all pharmacy directors to read. Medication safety simply cannot be another hat one wears as a pharmacy manager or director who is also managing budgets, monitoring financial performance, implementing cost-saving measures, addressing regulatory concerns, maintaining a competent and engaged staff, and more!  A medication safety leader sets the medication safety vision, identifies opportunities to improve the medication-use process, and leads efforts and initiatives to prevent medication errors. Advocate for a dedicated medication safety leader at your institution and use patient safety stories to drive home the need.

    

5. You are not alone!  I meet a variety of people in medication safety.  Those who juggle multiple responsibilities where medications safety is just one of the many balls they need to keep up in the air.  Those who have a dedicated role in medication safety but feel like they are carrying the weight of the world on their shoulders.  Those who are new to medication safety and don’t know where to start. One thing that I say to everyone in medication safety is ‘You are not alone!’ There are a ton of resources out there (e.g. ASHP Medication Safety Resource Center and the Institute for Safety Medication Practices newsletters and self-assessment tools) that you can and should leverage.  You can also connect with others in medication safety via forums such as the Medication Safety Officers Society (MSOS) or ASHP Connect for Medication Safety. I also highly encourage joining state or national professional organizations that have a medication safety group to have a network of other medication safety professionals you can lean on and learn from!