Pharmacy Waiting: Some Proposals for Improvements

Bailiwick Express noted the issues with the waiting at the hospital pharmacy

"When one politician joined the lengthy hospital pharmacy queue last week, she was confronted with a scene she described as “chaos”… someone crying and begging for help, staff being abused, individuals being turned away empty-handed."

The Government website attempts to address these issues but it raises other issues:

https://blog.gov.je/2023/10/24/hospital-pharmacy-questions-answered/

"Why not open 2 hatches (one for drop off, one for collection)?: When we have capacity, we aim to have two pharmacy assistants at the hatches; we have listened to patients comments."

Why is there not capacity when queues are endemic? Surely that needs extra staff as a matter of urgency.

There are two waiting areas that are now fitted with pharmacy screens which notifies patients when their medicine is ready at the counter for them. The waiting rooms can be found outside of Pharmacy and a larger more comfortable are in the Outpatients waiting room, approx. 15m away.

The problem is that when a prescription is ready one has to go to the queue.

There are several ways in which matters can be improved. 

Firstly, matters could be improved at times when the queue is long by opening two hatches, which would mean two people could be seen at once. Supermarkets do this all the time. When someone at a counter notes that a single counter is not enough, they press a button and someone goes to another counter, and immediately halves the queue and waiting times. One the queue is manageable a hatch can be closed again.

Second, the screens should function more like those in Customers and Local Services. When someone is available to see a client, the screen indicates that, and they go to the person behind the desk which is free to see them. They can see their place in the queue but when it is their time, they do not then have to join a queue. Obviously if someone doesn't come in that slot, they get shifted down, but as they know they are going to be seen, most people stay around sitting. Sitting in this way is surely of major importance in a hospital setting where some people may be unable to stand for any length of time. Currently the system tells the patient - their prescription is now ready - please join the queue which completely nullifies the "larger more comfortable" waiting area for sitting.

Thirdly, especially for repeat prescriptions when these are necessary, Boots the Chemist operates a system whereby a text is sent saying the prescription is ready. This could be charged to the patient but would be low cost rather that the proposed solution of going away and ringing to see if the prescription is ready. Not only does that clog up the hospital switchboards, the cost of waiting on the telephone to the patient (who again joins a queue) is vastly more inefficient than a text based system

An interesting study - "Studying the Efficiency of Waiting Time in Outpatient Pharmacy" (2020) also makes some other recommendations. It notes the following issues with a pharmacy they studied:

"First, the pharmacy serves all outpatient clinics and the average waiting time for the patients is between 90 to 120 minutes. Second, prescriptions are written manually by doctors which might cause some difficulties to the pharmacists. The number of medicines prescribed is between 1500 to 1800 per day. Third, the size and layout of the pharmacy does not contribute to the number of prescriptions being prepared and the number of patients. Finally, a whole pharmacy storage is dedicated to the unclaimed prescriptions."

And it also quotes the World Health Organization (WHO) which said: “The extent to which healthcare services provided to individuals and patient populations improve desired health outcomes. In order to achieve this, health care must be safe, effective, timely, efficient, equitable and people-centered.”

They suggest the following improvements, based on logistical and statistical studies:

"Results showed that by proposing automated waiting system with automated prescriptions, where doctors can send prescriptions over an online system; this will enhance communication between doctor and pharmacist, save time and effort, as well as will increase the efficiency of the service"

They also note that dispensing prescriptions can be eased by two windows by using "patient categorization, where not all types of patients are served from the same window. By categorizing each type of patient in a need base, for example, special needs and low immunity patients require more time since the pharmacists needs to explain thoroughly the prescription, so they will have special privacy window, and the refill patient service should be by itself since its fast and they can request the refill over phone and/or online. This as well will reduce the unclaimed prescriptions due to the short waiting time, and since most of the unclaimed prescriptions were due to the long waiting time."

https://www.sciencedirect.com/science/article/pii/S2215016120301321