Restructuring pharmacy services to reduce expenses without eliminating services

The manner in which pharmaceutical services in a 719-bed teaching institution were restructured to reduce expenses without eliminating services is described. Before the department was restructured, the labor-intensive nature of the drug distribution system and high personnel costs hindered the introduction of upgraded services. Drugs were dispensed from a central pharmacy and 14 pharmacy satellites located throughout the hospital campus. A traditional floor stock system was used in the critical-care units, the operating suites, and the pediatric facility; i.v. admixture services were provided to only two patient-care units. Under a three-year strategic plan, the organizational structure of the department was changed to regroup existing functions and to give more autonomy to the managers. The 12 small pharmacy satellites in the main hospital building were replaced by two larger and more efficiently designed satellites. An automated medication order entry system with bar-code-reading capabilities was installed; automation was also used to increase the efficiency of the nutritional support and oncology services and to create an online file of all statistical, fiscal, and purchasing records. Fax machines that were installed on five critical-care units and the oncology unit decreased turnaround time for new medication orders. These changes enabled the department to eliminate 17 positions while adding 5 clinical pharmacist specialist positions and 6 technician group leader positions. By integrating automation technology with controlled downsizing and restructuring of drug distribution services, the department was able to reduce expenses while improving existing pharmaceutical services.