Clinical Implications for Design of In-House Specialty Pharmacies

The demand for in-house specialty pharmacies in large healthcare facilities is on the rise. Health systems are realizing (more) the benefits these pharmacies offer to their employees and patients. As these pharmacies are expected to facilitate seamless clinical support and education, provide external distribution (which inherently brings challenges), and offer integrated technology, conventional design is facing an evolution. With this evolution, we see opportunity for improving employee workflow and increasing the quality of patient care.

Seamless Support–

Specialty pharmacies provide seamless support through education and training. Pharmacy staff are trained in specialty drugs, and when combined with access to the patients EMR, can provide tailored guidance and counseling regarding disease management. Proper private consult areas ensure this support is successful. Design considerations must prioritize this need for privacy and education into consideration. Private consult areas facilitate a “safe” environment for patients to engage in sensitive (and private) conversations they may otherwise avoid in a public setting. Additionally, pharmacists are better able to ensure proper patient/provider interaction, enhancing the patient’s experience.

Distribution–

Access to specialty medications can be challenging for vulnerable populations. Factors including unreliable transportation and highly expensive prescription medication have yielded poor compliance among this group. In-house pharmacies that provide financial and logistical support for at-risk populations help significantly close this gap. Pharmacy-to-door delivery eliminates logistical challenges. Governmental programs, such as 340B, provide financial relief for patients lacking means to purchase costly drugs.

During the design process, planning should include ample square footage for packaging and preparation workflow. Stringent guidelines, such as temperature control and UV exposure, warrant a dedicated space. Proper packaging is essential to ensure the integrity of the drugs are not compromised.

Integrated Technology–

In-house specialty pharmacies, clinical staff, and patients all benefit from integrated information systems.  All pharmacy and care team members have access to the same comprehensive patient history and individualized care regimen. The proliferation of web-based applications enables quicker patient discharge with a continuation of recovery at home with 24/7 monitorization re medication side effects (and early intervention when needed).  Web-based applications also allow for on-going physician-patient interaction through video observation and discussion. Hospital and pharmacy design should include dedicated space for private video interaction and adequate workspace to support remote patient monitoring.

Quality patient care is aided through intentional design and collaboration.  Specialty pharmacies are integral to quality care, patient compliance, and satisfaction. Specialty pharmacies have a unique role and footprint in a hospital setting. Efficient design of these spaces has a direct impact on their success. Thoughtfully planned pharmacy design has the potential to reduce hospital re-admissions, decrease medication abandonment rates, and improve coordination of care. And, these outcomes are desirable to everyone–design team, patients, and providers.