Cure coming for Naval Hospital's pharmacy's lengthy wait times

Wait times would often be four or five hours.

Every time Bernie Fleming goes to pick up his prescriptions at Naval Hospital Bremerton's pharmacy, he is sure to bring a book or a newspaper to entertain himself.

"There was always a wait, but no one had a problem with that since it was maybe an hour so," he said. "Now, someone walks in there and thinks they're going to be there for an hour, but then you end up being there four or five hours."

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Fleming has been getting his medications at the pharmacy for the last five years, ever since he became eligible for TRICARE for Life. He served more than 20 years in the military, jumping around between the Air National Guard, the Army and the Navy.

At the pharmacy's peak busy times, the wait can even creep up to six hours, whether you're waiting to pick up an over-the-counter medication or a controlled substance, like narcotic painkillers. The waiting area on most afternoons is packed, with people sitting in almost all of the lobby's chairs, just idling the time away by reading, watching television or even napping.

At that point, Fleming said, you have to calculate what's worth more — your time or your money.

"You might be there to get a $10 pharmacy prescription, but by the time you're done, you've put in more than the minimum wage into it," he said.

But those long wait times might soon come to end.

The hospital is in the midst of upgrading the pharmacy's counter to add five additional windows to serve patients. Once the $4.4 million project is completed this spring, it will almost double the pharmacy's current capacity, bringing the total number of windows to 12.

Hospital Corpsman Third Class Kyle Fields retrieves medications from the shelves as he fills prescriptions in the pharmacy at Naval Hospital Bremerton. (Photo: MEEGAN M. REID / KITSAP SUN)

"This has been years in the making," said Cmdr. Christopher Keith, director of clinical support services. "We've always recognized that we've had long wait times for our beneficiaries so we wanted to find ways to improve on efficiency."

On an average day, Keith estimated the pharmacy serves 300 patients. That averages out to the pharmacy filling some 2,400 prescriptions.

The construction should be completed sometime in March, at which time the pharmacy will begin serving patients at all 12 windows.

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This main pharmacy will be closed on Saturday to finish a large portion of the needed construction for the new windows. Both the pharmacy and the annex will be closed Sunday and Monday (a federal holiday). Normal operating hours for both locations will resume on Tuesday.

Behind the scenes, the construction inside the pharmacy has impacted the staff's workflow, which is a contributing factor to the long work times, said Lt. Cmdr. Dean Kang, pharmacy department head.

"It's definitely not been the ideal work environment," Kang said.

A large portion of the workspace in the middle of the pharmacy is blocked off as a part of the construction zone, inhibiting the flow of traffic from one side of the pharmacy to the other. The islands, where pharmacy technicians and pharmacists count and fill prescriptions, are pushed off to two sides in between the construction area, leaving only a few feet of work space and a narrow pathway between the two.

Renovations to the Naval Hospital Bremerton pharmacy will add windows to the facility. Additional pharmacists and technicians are also being hired. (Photo: MEEGAN M. REID / KITSAP SUN)

Despite the challenges, Kang said it's still better than the alternative — to entirely shut down the pharmacy during the renovation process and move its services into a trailer in the parking lot.

In addition to the new windows, the hospital is in the process of hiring more staff for the pharmacy, including 14 additional pharmacy technicians and three to six pharmacists.

"With more people, we can better devote that time to making sure that the prescriptions are appropriately safe and dispensed and that patients are taken care of," Kang said.

In September, Naval Hospital Bremerton was one of the first military hospitals in the country to test out the Department of Defense's new electronic health records system, MHS Genesis, which has also been a factor in the lengthy wait times.

"We're a pilot sight, and one of the things we've been tasked to do is identify some of the issues with implementing the new electronic system," Keith said. "And that's no different than anywhere else you would go that's implementing new technology."

While the hospital has been adjusting to the new system and working out some of the kinks, Kang said it's been a bit of an encumbrance to the prescription-filling process.

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"Under the old system, it was more on the pharmacist to do some checks, and now the system does it for us," Keith said. "So people will come up, they all wonder, what are they doing? I just see someone sitting at the desk. Well, they're focused on the computer screen. There's a lot going on behind the system when you check in as a patient to request medications."

Kang said pharmacists are also responsible for checking a variety of factors when someone brings in a prescription, including checking on whether the medication was entered into Genesis correctly or if any new medications might have a drug interaction with ones they're currently taking.

"If there's any discrepancy anywhere along the way, that becomes a hard stop," Keith said. "We have to make sure it's not a patient safety-related problem and then we have to work back and find out how we got there."

Fleming said he's noticed a difference since the new health care record system rolled out last fall.

"It' slowed down the whole process," Fleming said. "With Genesis and the remodel going on at the same time, it's like two strikes.

But in the end, it should be all worth it, Keith said.

"Once it goes live at all (Department of Defense) facilities, it's going to be a really useful, positive thing," Keith said.

After the system is instituted across the board, patient information will be accessible by providers at any military health facility across the country.

The hospital is considering other avenues to cut down wait times.

Keith said the other options on the table include instituting a system where the hospital can send a text message to alert someone when their medication is ready for pickup, adding the possibility of allowing patients call in new prescriptions to initiate the process over the phone, or giving patients the option to decide if they want to wait or come back within 10 days to pick up their prescriptions.

"These are things that still have to go through the evaluative process, but they are things we're considering as methods to help the wait times," Keith said.

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Once construction is complete and the new windows are opened with additional staff, Fleming said he's looking forward to a quicker stop to pick up his medications.

"The people behind the desk are really nice and I have no complaints about them, but gee whiz, it's just become so long," Fleming said. "I'm appreciative of their service and the free medication, and it's been real rough, but I understand that it's going to be better when it's done."