“To Prefill or Not to Prefill, That Is the Question”

Posted on April 27, 2016

By Jason Spencer, Implementation Specialist

Before joining ARxIUM, I spent a fair amount of time in the underbelly of the long term care world. Fifteen years to be exact. Fifteen years of learning the ins and outs of the old FDS: from navigating the flow of batches, troubleshooting the heat rollers while burning fingers and changing cutter blades all the way to training staff, building canisters from spare parts … and yes, filling canisters.

It has long been a belief and ritual of many customers to take the time prior to dispensing a batch (big or small) and load up the medication list to see which canisters are ‘low’ or possess a lesser have than need. Thus, in turn giving the operator a sort of peace of mind that their following batch will run fluidly, without any unexpected canister interruptions and therefore, eliminating downtime.   This can be true in a perfect world, but in a world of a hectic pharmacy environment, with many users, batches and timelines to meet, this isn’t always the case.

In my experience, this whole notion of eliminating down time is one of the most important factors when running a successful, good flowing pharmacy with high volume productivity out of a FastPak device. I understand this, I’ve been there. But, the more experience I got utilizing the FDS and working closely with many of its users, the more I learned that not all things appear as they seem. And by this, I am referring to the almighty running inventory count that is updated each time a technician fills a canister using our fool-proof method of the replenishment station.  Now, this is where things can go awry. Not because of the accuracy of the scale and scanner, but because of the many other factors involved when it comes to relying on humans that use technology.  We can get lazy, distracted, rushed, etc. all with the good intention of attempting to meet a workflow deadline.

This is where my argument starts to take shape. Assuming that not all canister counts are 100% accurate, due to the aforementioned possibilities, or straight up ‘short cuts’ used by seasoned pharmacy veterans waiting to start their long weekend with thirty minutes left of run time remaining on a twenty-minute shift, the time crunch is on. It has been witnessed many times that either a bottle was scanned for verification but not put on the scale (the scan and dump), or something I’m not proud of myself but guilty of, the straight up dump and continue. It’s not part of the properly trained protocol but it does happen, albeit on a rare occasion. However, the fact that these do occur whether we like them or not, leads us back to not always having a 100% accurate running inventory of every medication in every canister in a FastPak device at all times.

Where am I going with all of this? Well, I’m just trying to paint the picture of a realistic high-volume-pharmacy environment scenario, where we have to assume that canister counts are at the very least, slightly off.  It is because of this that my argument has always been to not prefill any canisters and to fill them as they become empty during a live batch. A canister is only going to stop the flow for one of two reasons; it has become jammed or it is actually empty, and a jammed canister cannot be accounted for when prefilling. When filling the canisters as they actually run empty, we are only experiencing the amount of down time it takes that particular operator to follow the procedures and fill the canister. Whereas, if we follow the notion of prefilling saves us ‘down time’ during the batch, how do we account for the time lost when we take the time to look at our med list, choose a ‘low count’ medication on the list, update med, wait for carousel, only to find that “gasp,” the canister is full because our inventory is not correct. Fill them as they come up during live dispensing and you will experience a realistic and understandable representation of down time. That is unless the operator stops on their way to the shelf to discuss their upcoming long weekend.

In conclusion, I’m sure there are some scenarios and battles that I may not have personally encountered as a customer, but I am fairly confident that I’ve experienced most of them. So, with that being said, it is my belief that the habit of not prefilling will in the long run create less down time than the act of habitually prefilling, and hey, isn’t down time something we are all trying to eliminate?

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