Tip of the Week: Minimizing Pharmacy Workflow Interruptions

Wouldn’t it be nice to have all day to perform the tasks one sets out to do during their work day and not be interrupted by anyone at anytime? Can you imagine how much work you could get done? Can you imagine the stress reduction?

Well, those sorts of conditions are rarely, if ever, applicable for anyone’s job. In fact, so-called interruptions are a large part of pharmacists’ jobs and involve a considerable amount of their communication activities. However, workflow and job descriptions can be designed to minimize the impact of these disruptions and even leverage them to promote higher quality of work while minimizing their deleterious impact on work life.

Reddy et al examined the interruptions that occur for pharmacists in the community setting.¹ One of the many interesting aspects of the study is that for study participants (interviewees), the researchers did not define what an interruption was. Instead, the researchers informed participants merely that the study was to investigate how pharmacy personnel work and communicate with one another.

For the purposes of coding and analysis, the researchers defined an interruption as a break in the many tasks a pharmacist performs while the pharmacist is engaged in any activity related to dispensing medications, such as order transcription, pill counting, filling, labeling, verification, and counseling. The study found an average of 7 to 13 interruptions per hour across 6 different pharmacies.

They characterized the interruptions across 5 domains:

• Patients (43%, walking up to the counter, calling in refills)
• Technicians (25%, interrupting a pharmacist due to a task required that they are unauthorized to complete, having difficulty with a prior authorization, or talking with the pharmacist about a non-work matter)
• Self-initiated (17%, calling a prescriber's office to seek needed information, initiating a non-work conversation, pausing in anticipation of an interruption)
• Technology (8%, phone ringing, attending to drug utilization review alerts on the computer, store loudspeaker announcements)
• Second pharmacist (5%, having a question about dosage or similar question and leaving a shift that requires handoff of information to current/upcoming shift of employees)

All of these might sound similar and indeed are part of the pharmacist’s job, per se, but they come as interruptions to workflow. These issues require the pharmacist to divert their attention away from a current task onto a different one, then back to the task they were initially working on. This demands cognitive load and can lead to errors and to burnout.

The researchers noted workflow redesign factors modeled after the Systems Engineering for the Improvement of Patient Safety (SEIPS) model. Additionally, there is the need to educate patients on the complexity of processing prescriptions; improved technology for notification of patients regarding the status of their prescriptions; better call-management systems for triage; provision of an interface to aid decisions for interruptions based on a cost-benefit assessment of the potential interruption; system modification to reduce error alerts; training technicians to differentiate between urgent and non-urgent needs for interruption; and various spacing improvements, including even color-coded zones to indicate certain areas in which interruptions are basically impermissible.

Pharmacy managers do not have to simply live with interruptions. They are and will likely remain for quite some time to be a consistent and persistent part of the job. But certain changes can be made to operations that minimize these interruptions, reduce errors, and facilitate greater quality of work life.

Additional information about Operations Management can be found in Pharmacy Management: Essentials for All Practice Settings, 5e.

¹Reddy A, Ebebe E, Rivera JA. Interruptions in community pharmacies: Frequency, sources and mitigation strategies. Res Social Adm Pharm. 2019;15(10):1243-1250.

About the Author

Shane P. Desselle, RPh, PhD, FAPhA, is a professor of Social/Behavioral Pharmacy at Touro University California.