Chemotherapy Daycare Pharmacy Workflow and Workspace Assessment

Issue
The Chemotherapy Daycare (CDC) Pharmacy of Princess Margaret Hospital approached the Healthcare Human Factors Team for an assessment of their workflow and workspace.  The impetus for this assessment was rooted in the growing need to accommodate more chemotherapy patients in the CDC via an alternate day patient booking model and therefore to improve the efficiency of the pharmacy within its limited space.  The objectives of this assessment were: 1) to identify issues of safety and efficiency, and 2) to recommend practical solutions for improving the efficiency and safety of the unit’s workflow and workspace.

Methods
Semi-structured interviews were conducted with stakeholders to understand the work processes and unit issues and to provide a context for observations.  Observations of pharmacists and pharmacy technicians performing their regular duties were conducted to capture workflow involved in preparing different chemotherapy treatments.  Pharmacy staff was asked for their opinion on certain unit issues and to explain actions when applicable.  A visual record was kept by capturing photographs and measuring physical dimensions of the workspace. Artifacts such as sample tracking sheets, labels, and standard order forms were also collected.

Results
Observations and interviews identified several issues related to safety and efficiency. Some of the most significant issues were related to congested layout, lack of standardization in the workflow for dispensing chemotherapy treatments in preparation, inefficient use of available storage space and undesirable work postures. Recommendations for these issues included modifications to the layout, conducting a standardized clean-up (often called a 5S evaluation) and implementing ergonomic adjustments to workstations.