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Space & Service: The Impact of Architecture on Patient Care

Dec 01, 2008

DeeAnn Wedemeyer-Oleson, Pharm.D., director of pharmacy for Guthrie County Hospital, Guthrie Center, Iowa, couldn’t be more thrilled with her new, spacious pharmacy.

With ample drug storage and a patient education room, the space is a complete departure from the hospital’s first makeshift pharmacy, a dark, windowless drug closet too small for a desk. Wedemeyer-Oleson, whose former office actually occupied a tiny hospital chapel after she was hired as the institution’s first staff pharmacist, jokes that she competed for office space with God, and won.

“This is the first time that there has even been space built intentionally for a pharmacy” in the 56-year-old, 25-bed facility, she said. “Before, we felt that we were busting at the seams. We were all on top of each other. Now, we each have our own workspaces, and we enjoy coming to work everyday.”

Guthrie County’s ground-level pharmacy is just one example of a growing trend in pharmacy architecture toward larger space, better light, more visibility, and room for patient education. Hospitals and health systems across the country are moving their pharmacies out of closets or up from basements to increase space for medication therapy management and patient counseling.

“Pharmacists will only be utilized to their potential if they are available to consult with medical and nursing staff,” Wedemeyer-Oleson said, adding that pharmacists should also be close to their patients. “For us, this is extremely important because our pharmacists constantly work with Guthrie’s admission medication history and discharge medication education services. Our pharmacists and pharmacy students frequently talk with patients in their rooms throughout the day, so it is most convenient for us to have the pharmacy on the nursing floor.”

There are other factors driving what three ASHP members described as one of the largest building booms in U.S. history in the Handbook of Institutional Pharmacy Practice.[1]

The need to replace aging 1970s hospitals, the growing number of elderly, and the introduction of new technologies will fuel hospital construction spending of up to $20 billion a year by the end of 2010, according to authors Kenneth N. Barker, FASHP ; Elizabeth A. Flynn, Ph.D.; and David A. Kvancz.

Better pharmacy design can help increase effectiveness in care delivery, improve patient safety, and lower staff stress, according to the authors.

Room to Work More Effectively

While Wedemeyer-Oleson struggled with a pharmacy in a closet, Bonnie Pitt, M.A.S., director of pharmacy at Frederick Memorial Hospital, Frederick, Md., had to work in the dark confines of a basement-level pharmacy.

That is, until this year.

“We have windows!” Pitt said about the hospital’s new third-floor pharmacy.

Prior to the renovation, Pitt’s staff of 42 pharmacists and technicians (15 of whom work on any given shift) endured cramped quarters in the small basement pharmacy that hadn’t seen significant renovations in two decades.

“We just kept smashing into things,” she said. “There were noises and distractions. You couldn’t hear yourself think.”

 For Pitt and her staff, the move to a 3,300-square-foot pharmacy on the third floor means that pharmacy staff members are now more accessible to patients, nurses, and other healthcare providers.

“The new pharmacy keeps us more connected to patients and prescribers,” she said. “You can just run over and talk to someone or look at a chart at a nursing unit.”

When Wedemeyer-Oleson worked on the redesign of her hospital’s pharmacy, she ensured adequate space for staff to carry out drug distribution and clinical and administrative duties.

“I listed every single function staff carries out under those categories and thought, ‘When my pharmacy technicians arrive in the morning, what is the first thing they do?’ ”

Wedemeyer-Oleson also considered efficiency in the staff ’s workflow; planned space for future processes, such as barcode medication administration; and allotted adequate drug storage space.

 At Frederick Memorial Hospital, the differences in the old and new spaces highlight the importance of pharmacy size and location.

 “When you work in a well-lit space, you can spread out your work and not have people on top of you while phones are ringing off the hook. We are now serving patients better,” Pitt said.

The hospital pharmacy at the National Institutes of Health (NIH) Clinical Center, the nation’s largest hospital solely focused primarily on clinical research, relocated to new digs in 2005, according to Robert DeChristoforo, FASHP , interim chief of the pharmacy department.

NIH hadn’t relocated its pharmacy from an isolating closet or basement, but the first-floor pharmacy was far from perfect. Gone is cramped space and outdated utilities, as staff members enjoy bigger, brighter space, improved ventilation, upgraded technology and space set aside for exciting, new additions, such as a robot.

“Although the staff was thrilled with the new space, ironically their new concern was the additional walking needed to accomplish the same tasks as in the past,” DeChristoforo said, laughing.

[1] Handbook of Institutional Pharmacy Practice, “Facility Planning and Design,” 2006, 4th ed., pp 519-541.

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