By Beth Richter, Pharmacist Consultant

Carousels are ubiquitous in the health system pharmacy space.  Often times, the pharmacy staff will pick more than 85% of all doses from a carousel.  Carousels are the primary engines that drive medication distribution and workflow; pharmacy technicians spend hours in front of a carousel each day.  Their day is divided into buckets of activity: receiving the day’s orders from the wholesaler, processing cart-fills, cabinet-fills, and returns from the floors while staying on top of the STAT and first dose orders that filter in throughout the day.  It’s important to consider why optimizing your carousel(s) will make long-lasting efficiency improvements for all functions performed.

Optimization is a dynamic process.  Prescribing patterns and medication utilization patterns change over time.  Continued re-organization of the carousel is needed and will benefit patient care goals of the pharmacy.  ARxIUM recommends performing a full carousel optimization project annually.

Depending on the carousel software vendor utilized at a given Health System pharmacy, the user may or may not have a specified report for this purpose.   ARxIUM provides a “Carousel Optimization Report” for users of our RxWorks Pro carousel software.  This report gives the user all the information necessary to effectively reconfigure medications to achieve optimal picking and put-away efficiency.

Items are sorted by usage velocity with corresponding cumulative percentage of doses outlined so the operator can easily assess the top 20% of fast and slow movers.  Initially, focus on moving these products to gain the biggest efficiency boost.  Fast movers should all be grouped in a starburst pattern arms-length distance from where the user is interacting with the picking screen and barcode scanner.  Put the fastest movers in the 2-3 shelves in this area.

Conversely, align the slowest 20% 180 degrees away from the fastest movers.  Internally, carousels have an oval-shaped shelf configuration.  Placing the slow movers 180 degrees away from the fast movers will allow for the least amount of carousel rotation during pick and put-away processing.  Less carousel rotation equals less waiting which equals increased efficiency!  Picking and put-away efficiency will improve because item dispense velocity correlates to item purchase velocity.

Once the top and bottom 20% have been optimized, cast the net further to 40% and beyond in order to make certain that the full carousel is optimized.  Do not get discouraged with this task.  This will take some time.  Set a goal to tackle 10 items per day.  Remember that optimization is on-going; you’re never really “done”.

While performing the analysis of the carousel optimization report, filter the report by Shelf number and Position number.  Look to make sure that there are no sound-alike, look-alike medications that are assigned next to each other in the carousel.  Pay close attention to IR and ER versions of the same medication or IV and PO versions of the same medications.  If you find examples of this, move these products away from each other to limit the possibility of a miss-pick or incorrect loading of the wrong medication into the wrong pocket during receiving or returning products from the floor.

Ultimately, the carousel optimization report is designed to help redesign carousel items to minimize labor by increasing workflow efficiency.  Use this report annually to make the technician’s time in front of the carousel as productive as possible. Would it be beneficial if you could shave 15 minutes or more off of your receiving time each day?  Would your technicians be able to start delivering those cabinet refills faster if the picking process were faster?  Pharmacy is an environment of high production.  Using the tools available to improve efficiency will ultimately improve patient care.

Watch for my next article on this topic where I will discuss the use of this same Carousel Optimization Report to help drive improvements in carousel medication inventory levels.