Dynamic Process

 Dynamic Process Analysis

Prescription Fulfillment Dynamic Process - Patient Prescription (Outbound logistics)

Star Pharmacy receives 4 different types of prescriptions, in-person prescription paper, where the patient or a relative of the patient comes in and gives the prescription paper from the doctor’s office to the pharmacist. If it is a new patient, the doctor inputs all the patient profile information such as name, date of birth, drug name, phone number, drug interactions, drug allergies, previous medications taken, and insurance coverage. If he or she is not a new patient, the patient file should already exist, the pharmacist will only need to verify if all the information is correct on paper and on the electronic prescription and select it in the system. If there are any issues with insurance billing or coverage, the pharmacist calls the insurance, resolves the issue, and bills the insurance. If insurance was still rejected, the pharmacist will call back the patient, let him or her know that his or her insurance is rejected, and proceed to proceed without insurance or cancel the prescription. Once the insurance is checked, the pharmacist can move on to ordering the drug if the drug is not in stock and if the drug is in stock, he or she will allow the pharmacy technician to fill the prescription along with the printed label. The second type of prescription are electronic prescriptions sent through the escripts software that allows the pharmacist to receive error-free prescriptions from the doctor or prescriber. The third type of prescription is a fax prescription, where the doctors fax the prescription directly to the pharmacy fax machine and the pharmacist can proceed from there. The fourth type of prescription is call prescription, where doctors call the pharmacy and ask for the prescription drug along with the drug name, strength (mg), the number of pills or if liquid (how much is required), or if a pen or injection (how many pens), RX number, doctor’s office name, doctors name, doctor phone number, along with the patient profile information (name, DOB, phone number, address). For controlled medications, the pharmacist will abide by the rules and regulations which varies depending on the type (Schedule I, II, III, IV, or V) such as verifying prescriber, documenting prescriptions, informing the Drug Enforcement Administration if prescriber fails to deliver electronic prescription on time...etc. After insurance approval, the pharmacist will print labels and the pharmacy technician will fill the prescription. The filling prescription process includes verifying name, date of birth, drug name, and quantity of pills on the printed label with the paperwork, printing extra labels if necessary for large size medications that don’t fit into one bottle to be put in two or three separate bottles (1/2 and 2/2). Then, the pharmacy technician will take the correct medication with matching NDC # from the shelf, count and fill based on prescribed quantity in a separate bottle. An exception is that control medications are counted twice because they are medications that cause physical and mental dependence, hence, are regulated and classified by the DEA, Drug Enforcement Administration, with restrictions on filling and refilling. Another exception is that some medications such as medicated ointments, or pens do not require to be filled into another bottle. The last exception is that brand name drugs, usually that have “®” on them, do not need to be counted or put in a separate bottle, they can be given in the same bottle. For example, Synthroid is a brand name drug, it does not need to be opened or put in a separate bottle when filling. Hazardous drugs are counted in a separate tray and gloves are disposed of after filling and the paperwork is filled. Prior to printing the patient receipt and label, the pharmacist sometimes calls the patient phone number to confirm whether they want it delivered or will pick up physically in-store. Then, the pharmacist scans the items and updates that the medications were filled on the Computer RX information system through the WinRX software and will print the patient receipt and label.  The printed label for the prescription will say “delivery” or “pickup”. There are some meds, called as needed medications, cough medicine, don’t need every month. Sometimes a patient does not need the medication anymore or is discontinued by the doctor will be shown as an Inactive status on WinRX software.

Cross Functional Swimlane Flowchart - Dynamic Process

Dynamic Process Map

Prescription Deliveries

Star Pharmacy offers medication delivery to customers if the patient is not there or the patient wants it delivered. The pharmacy technician scans the patient meds on the Computer RX system. Sometimes there is a payment, you can use the payment card that is on file, or you can charge to the patient’s account. Once the payment is made, it is already recorded in the system and will print the delivery ticket. Once the delivery ticket is printed, it is already in the system and will save a store copy receipt as a reference or as a record-keeping. Then, the patient meds are packaged together or separately depending on where it is going (patient home, healthcare facility, or nursing home). All the items that go to one healthcare facility are packaged into one big box and all the packages that go to one specific nursing home are all packaged into one big box. The packages that are delivered to individual patient homes are put in separate boxes to be delivered separately. Finally, the delivery driver will come to pick up all the packages and deliver them to those specific locations.

In-store pickup

With in-store pickup, the customer can make payment through the WinScan software and will use this tool, Verifone pin pad payment terminal, for credit card transactions and the pharmacy technician will take care of cash transactions through the use of the cash register. Sometimes customers will come into the store with the medication and inform the pharmacist that he or she does not need this medication anymore or is sometimes discontinued by the doctor. For example, there are some meds, called as needed medications, such as cough medicine, where patients do not need supply every month. In this case, the pharmacist will cancel the prescription and it will be under inactive status. Regardless of whether there was payment or none at all, the customer must still sign using the Verifone pin pad as signature of verification showing that the customer received the prescription as a record keeping system, so that if the Board of Pharmacy or other higher authorities would like to check for signature to verify that the customer received the prescription, they would be able to see it.

The transactional data including signatures are saved forever in the system as a record in case the Board of Pharmacy or other higher authorities would like to verify or check. In addition, pharmacists can check if the patient received the current medications, and also can check in the future if that same patient had got that medication already in the past.

WinScan Software

WinScan is a pharmacy POS system that integrates front end sales and pharmacy operations by the Computer RX information system (OTC inventory is added only on WinScan such as tylenol, advil, cough medicine & drops, noor vitamins, 21st century vitamins, hygienic products - toothpaste, soaps, ointments, lotion, PPE such as hand sanitizer, wet wipes, clorox disinfectant spray, gloves, N95 masks...etc. Patient prescription deliveries are carried out through WinScan as well.