Design Manual. workflow design & project planning. medical casework Goelst International, LLC

Transcription

1 Pharmacy Design Manual workflow design & project planning medical casework 2009 Goelst International, LLC

2 Sustainable by design Goelst International, LLC

3 CONTENTS Pharmacy Design Manual 04 Learning Objectives 05 Primary Pharmacy Function 07 Distribution and Workflow 09 Pharmacy Personnel 10 Benefitting from Goelst Modular Medical Casework 12 Pharmacy Work Areas 12 Order Entry/Review 14 Unit Dose Picking/Dispensing 16 IV Admixture 18 USP Compounding/Packaging 22 Bulk and Active Storage 24 Controlled Substance Vault 26 STAT Dispensing 28 Technician s Workstation 30 Pharmacist Office 32 Secretary/Reception 34 Break Room/Staff Lounge 36 Conference/Drug Information Center 38 Satellite Pharmacy 40 Outpatient Pharmacy 42 Square Footage Calculation 43 Block Diagram 44 Preliminary Plan 45 Schematic Plan 46 Future Trends 47 Pharmacy Terms 48 Pharmacy Graphical Overview 50 Pharmacy Product Spotlight 52 Basic Information Sheet workflow design & project planning

4 Pharmacy Design Manual OBJECTIVES 0 Learning Objectives Be comfortable in the pharmacy environment Know the 3 primary services of a pharmacy Understand the role of each of the pharmacy work areas Know the relationship between the pharmacy and all other hospital departments and the important role that the pharmacy plays Know the key personnel Who are the key players within the hospital and pharmacy staff What is the pharmacy personnel chain of command Who should you make initial contact with and, in the event that you are unable to do so, who is your next best option Understand the pharmacy workflow Understand the flow of materials throughout individual pharmacy work areas and how to best optimize that individual area s workflow Know the two main types of pharmacies and how they differ Understand the function of each work environment and why certain work environments are located where they are Be able to identify distribution systems Understand the interrelationship of pharmacy departments and their individual responsibilities concerning medication distribution Understand the pros and cons of available distribution systems Consider future trends of distribution including automation, robotics, and pneumatic tube systems Be able to fill out the Basic Information sheet Provide the facility s initial needs assessment Establish design requirements for the specific work areas to be built Calculate square footage of rooms and consider hardware, machinery, and additional design constraints including structural impediments Sustainable by design. Goelst USA, LLC phone (336) fax (336)

5 Pharmacy Design Manual FUNCTION Primary Function of a Pharmacy 0 The main objective of the hospital pharmacy is to provide prescription medications, intravenous doses, an all related substances to both inpatients and outpatients of the healthcare facility at the request of the physicians. Preliminary distribution efforts of medicines include receiving, packaging and compounding of various substances are completed within the pharmacy. Research based pharmaceutical substances, developed for clinical studies, may also be managed by the hospital pharmacy staff. Other responsibilities of the pharmacy include, managing inventory, providing security of controlled substances, keeping of drug distribution records, providing cost analysis, and the management and updating of patient prescription records. Primary services of the pharmacy fall under the following categories: 1. Procurement and organization of patient prescriptions 2. Facility wide medication distribution 3. Patient consultation and clinical research More and more pharmacies are dedicated to the continuing education of their staff. Conferencing as well as pharmacy research initiatives are integral to the growth and development of successful pharmacy personnel. The role of the pharmacist is becoming increasingly more dynamic in the fields of healthcare. In addition to dispensing medications, pharmacists are now taking a more direct role in patient care. Once a prescription is received by the pharmacist from the physician the task of fulfilling the medicinal requirements may vary greatly. Medicines are typically prepared and dispensed in one of two locations: 1. Central Pharmacy - Location of primary storage, packaging and compounding 2. Satellite Pharmacy - High traffic area capable of dispensing general use drugs Medications are delivered via patient care units by a variety of personnel. Doctors, nurses, and orderly assistants may all be responsible for trafficking medications. Increasingly prevalent modern forms of distribution include the use of automated vending and pneumatic tube systems to supply high traffic areas such as emergency rooms and intensive care units. The use of automated machinery provides pre-stocked pharmaceuticals to be delivered almost immediately after the initial request by the physician. Sustainable by design.

6 Pharmacy Design Manual TYPES OF PHARMACIES 0 Types of Pharmacies Centralized & Decentralized Centralized Prescription orders are processed by the pharmacist and are sent to the nurse station/ patient care unit, to be administered by the nursing staff. Decentralized The pharmacy department distributes medications at the nurse station via controlled automation systems for 24/7 availability by the nursing staff. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

7 Pharmacy Design Manual DISTRIBUTION Process of Distribution 0 The initial prescription requested by the attending physician is commonly referred to as the STAT ORDER. STAT denotes a severe urgency and is administered almost immediately. This initial order or first dose is rapidly filled when received by the pharmacist. Next preparations begin to continually provide doses to the patient at regular intervals. The process of stocking an ample supply of the required medication at the patient unit may vary greatly depending on the size and organization of the facility. The following descriptions are the most common processes of distribution used by hospital pharmacies. Standard Floor Stocking A predetermined quantity of medicine is stored in the patient care unit to be administered by the nurse at designated intervals. To prevent depletion, the pharmacy is responsible for restocking this patient care unit on a regular basis. At this point, management of the medicine and patient record keeping become the responsibilities of the nurse. This process is not widely used due to a lack of security, the probability for mistakes and its overall inefficiency. Single Dose Drawer Exchange Individual packaged doses are prepared in either the central or satellite pharmacy. The single dose is then placed inside of a secure drawer along with all the patient s required medications for a 12 to 24 hour period. Multiple drawers are loaded into cart shelving and delivered to the patient care unit for the nurses. The emptied carts are then switched out and replenished. The drawers are now refilled to begin the process over. Multiple Integration Process The most common process of distribution is a hybrid of both floor stocking and the single does drawer/cart exchange. In this scenario, the specialized medications, which are less frequently administered, are transported via the mobile carts. The high volume medications such as pain relievers, gastrointestinal drugs, and cough suppressants are stored using the standard floor stocking system. Additional Systems I.V. medication or intravenous fluids are predominantly used in the hospital to administer drugs directly into the patient s vein. Preparation of such speciality pharmaceuticals are done under a tissue culture hood within a sterile prep room inside of the pharmacy. This mixture of sterile fluid and medication is then delivered by the pharmacist to the patient care unit in a sterile container, typically a glass bottle or plastic bag. Sustainable by design.

8 Pharmacy Design Manual FLOW CHART 0 In-Patient Pharmacy Workflow Movement of Materials From Wholesaler to Order Entry Supplies are received directly from the wholesaler, by the pharmacy staff in the receiving area. Items are then broken down and sent to distribution via bulk storage or sent directly to packaging where bar coding and organization takes place. Next medicines are subdivided and sent to unit dose order processing, the IV preparation room, or prepared for automated distribution methods. From Loading Dock Administration & Purchasing Bulk /Active Storage Compounding Recieving Break Down Packaging Unit Dose Station Order Entry Processing Sterile IV Prep Automation Autamation & Exchange Systems Distribution of Medication upon receipt of Doctor s Prescription The doctor s prescription is received by the order entry staff. Next the pharmacist categorizes the medicine as IV, oral dose, or special treatment. The prescription order is then electronically processed and labeled by Order Entry technicians before being sent to the appropriate patient care location after review of the order by a supervisor. Doctor writes R X IV Prep USP-797 Sterile Prep Room Outpatient Pharmacy Drawer Exchange Order Entry Processing Oral Medications Unit Dose Distribution Labeling & Order Review Automation/ Pnuematic Tube Systems Patient Care Unit Special Treatments Floor Stocking Systems Sustainable by design. Goelst USA, LLC phone (336) fax (336)

9 Pharmacy Design Manual PHARMACY PERSONNEL Pharmacy Personnel 0 Director of Pharmacy The Pharmacy Director is a registered pharmacist typically holding a B.S., M.S. or M. B. A in pharmacology or some other advanced degree. The Director of Pharmacy is responsible for the total management of the pharmacy staff and facilities. The Director also oversees administrative, distributive, technical, and clinical operations. The Director of Pharmacy is also responsible for observing policy issues including strict adherence to local and federal regulatory commissions. The role of the pharmacist is continually expanding within the healthcare environment. The director may also interact with personnel from other departments in addition to overseeing direct patient care responsibilities. Assistant Director The responsibility of the Assistant Director may vary from organization to organization. The assistant can aid with the management of staff and facilities as well as administrative duties including dealing with drug representatives and distributors. Assistant Directors may only be present at larger pharmacy facilities. However the size of a pharmacy and its staff may not be directly proportional to the size of the hospital. Pharmacist The pharmacist is also a licensed healthcare provider and is responsible for overseeing the daily operations of the pharmacy. The pharmacist s role in patient care includes providing accurate dosage of medications and individual consultations. The pharmacist may work together with the nursing staff in addition to reviewing the performance of technicians and other subordinate personnel. The pharmacist is concerned with specific area functions and will be primarily interested in optimizing workflow, space management issues, and improving productivity within the overall facility. Technician Pharmacy technicians may receive a varying amount of certified training. Under supervision and direction from the Director of Pharmacy and staff pharmacists, the technician performs routine duties including IV preparation, unit dose sorting, inventory organization, packaging and compounding. Tasks completed by technicians are always reviewed by a certified pharmacist. Clerical Staff Clerical staff in the pharmacy department are responsible for a variety of administrative duties. Clerical personnel complete word processing, data entry, reception, inventory, and medication procurement tasks. Sustainable by design.

10 Pharmacy Design Manual ADVANTAGES 10 Benefitting from Goelst Modular Medical Casework As with most functional environments, no two pharmacy facilities will be the same. Staffing, technical considerations, and frequency of patient turnover all affect pharmacy size and workflow requirements. It is important to understand how the Goelst product and service process are engineered to provide custom solutions for all pharmacy design needs. The following points outline both the technical and financial advantages of designing with Goelst within the pharmacy and other healthcare facilities. Technical Advantages of Goelst Casework The prominent aspect of Goelst casework is how drastically it differs from the fixed millwork cabinetry traditionally found in healthcare facilities. The adaptability of Goelst workplace configurations suit the constantly evolving needs of innovative work environments in ways that are simply unachievable by use of the millwork alternative. The complete Goelst design process centers on the product s modular capabilities. In addition, the durable Goelst casework construction reinforces its potential uses within a variety of different institutional applications. The following list of technical advantages discusses how Goelst is designed to change in order to meet the expanding needs for space and workflow optimization while meeting rigorous physical standards: Goelst casework is 100% moveable, changeable, reconfigurable and repairable. Modular construction allows for field repair and replacement of individual parts should the need arise, thereby increasing the life and versatility of the product. Goelst is engineered to provide multiple design reconfigurations. Modular construction adapts with the technology, personnel, and spatial needs of each facility. The highest quality European engineered hardware combined with durable construction materials create a lasting functional product suitable for institutional use. All product materials and design efforts including component hardware engineering are specifically catered to meet the high demands of healthcare work spaces. Goelst casework products are held together by high-quality metal systems resulting in joinery that is multiple times stronger than conventional millwork furniture. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

11 Pharmacy Design Manual ADVANTAGES 11 Additional Advantages Goelst s product inventory consists of over 75,000 standard line items enabling any design solution to meet application specific needs and custom configurations. Casework and accessories are designed to meet standards including engineering that complies with the latest USP 797 regulations for pharmacy infection control. Financial Advantages of Goelst Casework Both the engineering aspects and quality of construction materials contribute to the longevity of Goelst casework. However, it is the economic life cycle cost, extended warranty and vast reconfiguration options that provide the significant return on the customer s investment. Specific financial benefits of installing Goelst product include: Modular capabilities decrease the costly churn-rate for new casework that is often associated with the use of millwork furniture during healthcare expansion. Goelst installs in half the time of millwork carpentry and maintenance of the modular components is completed within minutes with the use of a single screwdriver. Traditional millwork is fixed to the building structure making change impossible. The reconfiguration of Goelst maximizes the customer s casework purchase. There are no hidden costs resulting from prolonged installation schedules or unforeseen maintenance that is largely characteristic of the millwork alternative. Compared to the 39+ year depreciation rate for millwork, the freestanding Goelst casework will rapidly depreciate in only 7 years. This is becoming increasingly important to for profit healthcare institutions. The 10-year, all-inclusive warranty, including on-site service ensures unsurpassed performance of the physical product supported by dedicated customer service. Regardless of initial up-front costs, the sustainable dynamics of Goelst casework ensure that it will pay for itself long before millwork or other casework providers. Sustainable by design.

12 ORDER ENTRY/REVIEW 12 Order Entry/Review The order entry area is the primary receiving and communications area for the entire pharmacy. It is often the most central and open location of the pharmacy. It is found in close proximity to entrances and exits and requires multiple computer workstations. The order entry pharmacist is responsible for reviewing and distributing all written prescription orders. The workers in this area may depend on multiple communication technologies. Orders may be ed, faxed or transmitted via pneumatic tube systems. Once orders are received by the pharmacist, they must be cross-referenced with the patient care folder and all medication dosage history must be documented. Prescriptions are typically archived at the order entry station which requires significant storage space. Goelst Modular Medical Casework Application Larger order entry areas may be designed using the modular G-Wall system including the use of cantilevered worktops and shelves. Smaller areas may be configured using transaction counters, worktables, or assorted casegoods. The final design of the pharmacy order entry area must allow for: An optimal use of available workspace including future reconfiguration efforts. Comprehensive electrical wiring including power, telephone, and data lines. Additional space for the upgrade and expansion of computer hardware. Goelst casework products may include: Both 11 series sitting height and 14 series standing height base cabinets. The order entry area must accommodate storage and organizational requirements. Cantilevered worktops that accommodate multiple computer workstations and keyboard trays. Adjustable height worktables may also be used as workstations. Cantilevered shelving and/or 18 series overhead cabinets that provide storage for file folders, procedural manuals, reference books, and technical literature. 24 series transaction countertops that allow for pass-through communication between interdepartmental pharmacy personnel. Illumination hardware including 80.3 series task lighting and light valances series Slatwall components for increased organization of work tools and files..additional office accessories may include series lightweight tack panels. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

13 ORDER ENTRY/REVIEW Plan view of Order Entry/Review Stations The order entry/review workstation will range in size from 100 to 280 square feet based on the volume of patient care, number of employees, and computer hardware needs ' - 8" 15" - 10" 29' Sustainable by design.

14 UNIT DOSE PICKING/DISPENSING 14 Unit Dose Picking/Dispensing In an effort to maximize productivity, high-volume pharmacy medications are prepackaged in single dose form. The administration of individual unit doses ensures accuracy and prevents unnecessary waste of medications. The need to sort and dispense unit-dose medications as efficiently as possible has lead to the development of ergonomically configured picking stations. The repetitive physical actions performed by the technician within the unit dose picking station, must be kept to a minimum. All extra steps taken and unnecessary movement leads to substantial loses of time and a decrease in overall departmental productivity. Ergonomic characteristics of successful unit dose stations reduce medications to an arm s length in distance. The majority of picking takes place at standing height. Computer data entry is typically performed at a sitting height work top. The average horseshoe shaped picking station will contain gravity fed medication bins. These stations contain approximately 95% of the most frequently administered drugs. Automated Dispensing Carousels Hospitals with larger operating budgets may incorporate automated dispensing robots and carousels in the unit dose picking area. These automated vertical shelving units rotate within the picking area to dispense medication doses at the touch of a button. Goelst Modular Medical Casework Application The size and orientation of the picking station will vary depending on the size of each facility and the volume of medications regularly distributed. Functional requirements of individual stations also vary depending on available personnel and organization of the hospital. The casework application must be adaptable to suit these various needs. Factors of successful unit dose casework configurations include: Practical size of picking station and number of technicians required to fill orders. Quantity of multiple picking stations and their proximity to the order entry area. Distribution access including cart exchange method and pneumatic tube systems. Integration of computer hardware and wiring of data and communication terminals. Goelst casework products may include: 20 series G-Wall consisting of both radiused and straight walls. Use of additional cantilevered shelving and worktops also provide efficient use of available space. 14 series base cabinets with gravity fed drawers as well as angled cantilevered shelves with plastic storage bins to provide optimal use of vertical wall space. Cantilevered work surfaces as well as centrally located 26 series adjustable height worktables to provide space for computer workstations as well clerical duties. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

15 UNIT DOSE PICKING/DISPENSING Automated Station 15 Plan Views of Unit Dose Picking Stations Unit dose picking stations will vary in size and configuration based on the size of the hospital and layout of the pharmacy. The quantity of picking stations and total square footage depends on the volume of patients and the quantity of drugs in the pharmacy. Unit Dose Picking Station areas range in size from square feet. Robot-Rx - A centralized, distribution system that automates the drug dispensing process using bar-code scanning technology Vertical Carousel - automated vertical shelving units rotate within the picking area to dispense medication doses at the touch of a button. 12' - 4" 11' - 5.5" 5' 17' - 4" 29' - 0.5" Sustainable by design.

16 IV ADMIXTURE 16 IV Admixture The IV Admixture chamber or Clean Room should be designed to be the most sterile environment in the pharmacy. Work done within the IV Admixture room consists of the sterile mixture and preparation of medications suspended within intravenous fluids and syringe doses. The size and number of required personnel within the IV Admixture is dependent on the volume of IV s prepared and level of risk that must be complied to. All IV Admixture rooms must retain an airtight seal that when compromised engages a positive air pressure vacuum that prevents contamination from airborne microbes. Inside of the clean room, medications are introduced into sterile IV solutions underneath a Laminar Hood. The Laminar Hood distributes filtered air downward through the prep area. Additional positive air filters are strategically placed within the clean and anterooms. The classification of IV Admixture room will vary based on the number and effectiveness of sterile filter locations. Inside of the adjacent Anteroom should be adequate storage space for fluids and medications. The anteroom is also were gowning, hand washing, and clerical work takes place. Multiple computer workstations positioned on cantilevered worktops must also be located within the anteroom. Goelst Modular Medical Casework Application The use of standard Goelst product including G-Wall and specialty cabinetry will effectively satisfy all infection control requirements. G-Wall product is also reconfigurable. Design of the entire IV Admixture area should consist of 20 series modular G-Wall. Base cabinetry may consist of 14 series open drawer trays to allow for storage. Both adjustable height and sloped shelving may be used for additional storage. Adequate space must be provided for refrigeration units and multiple fume hoods. Goelst casework products may include: 25 series cantilevered worktops constructed of chemically resistant Trespa resin. 16 IVS Tambour Door Cabinet to enable pass-trough capabilities of medications. 20 SHD G-Wall panels with sliding acrylic windows to provide sterile pass-through. 80 DSD Double Swinging Doors to create sterile, hands-free entrances/exits. 80 SOS illuminated soffits prevent contamination of empty space above cabinets. 21 series lockers and wardrobes will provide sterile storage of work gowns etc. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

17 IV ADMIXTURE Plan View of an IV Admixture Room An average IV Admixture room configuration consisting of sterile compounding, IV and Chemo prep, distribution/order entry, an anteroom and changing area will require a minimum of 800 square feet. 17 Vertical Laminar Hood Horizontal Laminar Hood Horizontal Laminar Hood CHEMO PREP STERILE IV ROOM 26' - 8" (-) Negative Airflow (+) Positive Airflow (+) Positive Airflow (+) Positive Airflow ANTEROOM Double Swinging Doors 15' - 10" Tambour Door Pass-Throughs ADDITIONAL IV SUPPLIES GOWNING 29' Sustainable by design.

18 USP USP 797 What is USP 797? In each sate, the state pharmacy boards are defining the infection control regulatory standards for hospitals. The extent of each state s USP 797 requirements may vary. USP 797 compliant IV Admixture rooms will soon become standard and are currently requested by the Pharmacy Director and hospital administration to ensure the regulatory viability of their pharmacy and healthcare facility well into the future. Establishing USP 797 Regulations USP 797 is an extensive regulation that establishes a number of specific pharmacy classifications and sterile procedural requirements. It outlines various means of prevention for the accidental transmission of disease and bacterial infections. Specific policies describe sterilization methods of medications in an effort to protect both hospital patients and pharmacy staff. These guidelines have been mandated by the Unites States Pharmacopeia (USP), not for profit, public health organization. It applies to any pharmacy that manufactures, stores, or administers compounded sterile preparations or CSP doses. Such doses include IV s prepared from non-sterile ingredients, syringe doses with suspended medication and topical anti-biotics. Most hospital pharmacies will fit this description. Additional details concerning USP 797 compliance are as follows: JCAHO has been defining USP 797 since July 1, Efforts to comply with USP 797 guidelines should begin immediately before they become mandatory in To begin with, accurately asses the needs of your healthcare facility by interviewing the Director of Pharmacy, Director of Engineering, and various administrators. With the aid of the Pharmacy Directory, identify in the pharmacy where sterile compounding is done and procedural requirements that will need to be provided for. Create a USP 797 compliant analysis document to illustrate how Goelst product will effectively satisfy all such requirements within individual pharmacy areas. Create an action plan that describes how to consider specific design elements. Ensure successful integration of ISO Level-7, standard air-quality filtration systems. Depending on proximity to IV clean rooms, air treatment systems may also be required in the anteroom, Chemo prep area, compounding and order entry areas. Daily sanitation requirements including floor moping and the wiping down of all casework and walls is also included within USP 797 compliant rooms.. Hand washing and sterile gowning are also required for USP 797 compliant rooms. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

19 USP 797 Laminar Flow Hood 19 Stat IV Transom Panel Pick Station Laminar Flow Hoods Sterile Prep Chem. Hood IV Storage Bulk Storage Pass Thru Unit Chemo Prep Pick Station USP 797. This regulation exists in an effort to prevent contamination of supplies and from putting hospital patients at risk. Fume hoods, anteroom areas, pass-through units, and airflow vents all need to be carefully positioned within the pharmacy to be USP 797 compliant. Note: Sterile preparation areas will utilize (+) positive air pressure, or a downward flow of air. Chemo preparation areas will utilize the opposite, (-) negative air pressure or upward flow of air. AIRFLOW DIAGRAM Filtered Air & (+) Air Pressure Area Unfiltered Air & ( ) Air Pressure Area HEPA filter AIRFLOW DIAGRAM Filtered Air & (+) Air Pressure Area Unfiltered Air & ( ) Air Pressure Area Sustainable by design.

20 COMPOUNDING/PACKAGING 20 Compounding/Packaging In the compounding area of the pharmacy wet materials such as topical medications, ointments, creams, lotions and other liquids are mixed and stored, typically by a pharmacist or technician. Medications are either divided into single unit doses or repackaged and placed in storage. Located either adjacent to or in the same location as the compounding area will be a smaller work space reserved for packaging and labeling of both unit dose and bulk medications. Technicians are typically responsible for such duties and will utilize special packaging machines. The Purchasing area, where bulk medications are initially received from shipping, is also positioned close or adjacent to the packaging and compounding areas. Close proximity to purchasing enables technicians to quickly sort medications that will be funneled through compounding and packaging. Packaging is completed on an as needed basis and in smaller healthcare facilities there will be no need for two separate areas. Packaging and Labeling Machines Automated packaging machinery allows technicians to simultaneously sort, bar code label, and package individual unit doses and secondary items for bulk storage and picking. Individually labeled, high-volume drugs may be dispensed by robotic systems. Further USP regulations will soon be required for the packaging/compounding areas. In an effort to decrease mis-dispensing of medications to the wrong patients, USP mandates will include standardized barcoding for explicit organization of all unit dose medications. Also compounding areas may soon move towards clean room standards similar, to IV prep/storage, including sliding glass doors and air filtration systems. Goelst Modular Medical Casework Application Freestanding G-Wall frames may be used to configure both compounding and packaging areas. Refrigeration units and plumbing systems including sinks and faucets must be integrated for the wet compounding station. Ideally compounding/packaging will also be in close proximity to the order entry area and bulk storage areas. Mobile tables, significant storage space, and room for computer hardware and packaging machines must all be considered within a compounding/packaging design. Both areas should utilize cantilevered worktops and cantilevered overhead shelving. Goelst casework products may include: 25 series cantilevered worktops constructed of chemically resistant Trespa resin. 20 series G-Wall consisting of both radiused and straight walls. Use of 14 WMS sinks will require 20 CTS support brackets and 20 OMR mounting rails. 14 series standing height base cabinets including moisture resistant HPL worktops. 14 SNK base cabinets should be specified for all sink applications. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

21 COMPOUNDING/PACKAGING Automated Station 21 Plan Views of Compounding/Packaging Areas Since these two areas are typically combined, the overall size of the compounding and packaging areas will range from square feet. Med-Pak - creates individually labeled, unit dose packages that work in conjunction with centralized, robotic picking systems 23' - 10" 26' - 8" 15' - 10" PURCHASING COMPOUNDING & PACKAGING Sustainable by design.

22 BULK & ACTIVE STORAGE 22 Bulk & Active Storage Bulk storage is a large area of the pharmacy designated for the storing of boxed material, packaged medication and IV supplies in bulk quantities. Daily deliveries are sent to bulk storage via purchasing/receiving or directly from the loading dock until accessed by pharmacy personnel. As a result of the dust and debris generated from breakdown of boxes and freight, bulk storage is situated far away from sterile processing areas. The smaller, active storage area is typically situated adjacent to bulk storage but in closer proximity to picking and packaging/compounding stations which require frequent restocking. Here supplies and materials are further broken down and organized into smaller more accessible quantities. Less frequently administered drugs may also be stored here in ready-to-use individual unit doses. High Density Mobile Storage Bulk Storage is also an ideal area to integrate mobile shelving units. Smaller hospitals may be to unable accommodate storage without further maximizing available floor space. Mobile Cart Storage Mobile cart storage and distribution methods vary greatly between hospitals. Depending on size, there may be a large network of cart exchange systems in place. Some facilities may rely only on mobile carts. Other hospitals may be responsible for transporting large volumes of medication off site to various healthcare institutions. Goelst Modular Medical Casework Application Modular shelving will be predominantly used within all pharmacy storage areas. Shelving units may consist of a variety of configurations based on the size, format and quantities of various stored materials. Additional design considerations may include: Proximity of storage areas to one another and to receiving and processing areas. Storage areas may include computer workstations for labeling, printing, and filing. Cantilevered worksurfaces used for completing paperwork may also be required. Aisle ways within storage areas as well as throughout the entire pharmacy floor plan must provide sufficient space for the movement of mobile exchange carts. Also an area for the storage of mobile carts while not in use may also be required. Goelst casework products may include: 20 series G-Wall including radiused walls, straight walls and cantilevered shelving. 25 series cantilevered worktops to provide computer and clerical workstations. 16 series tall cabinets with open adjustable shelving, sloped shelving and drawers. 14 series standing height base cabinets with multiple open and gravity fed drawers. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

23 BULK & ACTIVE STORAGE 12' - 10" 23 26' - 7" BULK STORAGE Plan Views of Bulk/Active Areas The size of storage areas will vary based on volume of patient care and size of the pharmacy. Bulk storage areas range from 200 to 400 square feet. Active storage areas should be no larger than 250 square feet. If either storage area is too small or too large they become ineffective. Shelf dimensions should range from 24 to 48 in width. ACTIVE STORAGE 18' - 4" 7' - 5" Sustainable by design.

24 CONTROLLED SUBSTANCE VAULT 24 Controlled Substance Vault In the central pharmacy, there should be a specific area or closed room reserved for the storage of narcotics and government regulated medications. This area should remain secure at all times using locked doors and locked cabinets or a physical vault. The vault should be located in a low traffic area yet remain highly visible for security purposes. Secured Automated Dispensing Pyxis automated dispensing units enable tracking and documentation of controlled substances while streamlining the distribution process. The use of free standing, secure dispensing machines should be used in conjunction with secure locked doors. Goelst Modular Medical Casework Application G-Wall modular configurations with both cantilevered shelving and worktops are suitable for controlled substance vault design. The use of any cabinets or drawers should include either double or single security locks. Any transport devices either automated or the use of mobile dose exchange carts should also remain secure. Goelst casework products may include: 25 series cantilevered worktops and 20 series cantilevered adjustable shelving. 22 series drawer cabinets are ideal for storage of smaller unit dose medications. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

25 CONTROLLED SUBSTANCE VAULT Automated Station 25 Plan View of a Controlled Substance Storage Room Depending the size of the hospital and methods of security the controlled substance storage room will range in size from 200 to 240 square feet. Controlled Substance Towers - Secured vending enclosers with regulated computer access dispense labeled unit dose narcotics 13' - 7" 5' - 4" 7' - 6" Sustainable by design.

26 STAT DISPENSING 26 STAT Dispensing STAT orders require a rapid work flow and distribution process. STAT orders are filled and dispensed immediately and delivered independently to patent care units. STAT drugs are not distributed during regularly scheduled floor delivery. The STAT picking station is set apart from the larger unit dose station so that work flows remains independent. STAT stations will stock a majority of high-volume drugs in unit dose quantities. Goelst Modular Medical Casework Application A similar configuration to the larger Unit Dose Station may be implemented for a STAT dispensing area. G-Wall units equipped with cantilevered shelves and worktops along with multiple drug storage bins will provide optimal use of distribution work space. Goelst casework products may include: 20 series G-Wall consisting of both radiused and straight walls. Use of additional cantilevered shelving and worktops also provide efficient use of available space. 14 series base cabinets with gravity fed drawers as well as angled cantilevered shelves with plastic storage bins both provide optimal use of vertical wall space.. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

27 STAT DISPENSING Plan View of a STAT Dispensing Station An independent STAT dispensing station will range in size from 50 to 125 square feet. A smaller STAT dispensing station reserved for IV medications may also be located in the sterile IV Admixture room ' - 3" 10' - 6" 4' - 6" Sustainable by design.

28 TECHNICIANS WORKSTATION 28 Technicians Workstation A series of small computer workstations or offices, for use by technicians, should be designated within the pharmacy floor plan. These workstations serve a variety of functions. Technicians may be provided independent personal space to file and sort paperwork, use computers for communication and data entry, be involved with telephone conferencing, and to read technical literature and research documents. Goelst Modular Medical Casework Application Modular components used for workstation configurations may include G-Wall, cantilevered shelving and a variety of overhead and/or base cabinets. Key issues to address within this area include flexibility of space and the integration of computer and communications hardware. Use of modular wiring will also be comprehensive within this area. Goelst casework products may include: 20 series G-Wall consisting of optional partitions to maintain privacy. Use of additional cantilevered shelving and worktops to provide flexible use of space. 14 series base cabinets with adjustable shelves to store computer hardware. 18 series overhead cabinets with mail slots/shelving for storage of files and manuals. 80 series modular wiring components including grommet holes and task lighting. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

29 TECHNICIANS WORKSTATION Plan View of a Technician s Workstation Depending on quantity of mid-level personnel and available computer technology the technicians workstation will range in size from 75 to 125 square feet ' - 10" 14' - 10" Sustainable by design.

30 PHARMACIST S OFFICE 30 Pharmacist s Office The Director of Pharmacy is assured to have his/her own private office. Additional offices may be reserved for the Assistant Director and supervising Pharmacists. Maintaining confidentiality and privacy is critical within these areas. Administrative as well as commercial meetings with pharmaceutical representatives may occur in the office area. Aside from implementing standard office design conventions it is important to consider future reconfiguration possibilities. G-Wall structures, base and overhead cabinets, and additional casegoods may be used in conjunction with product from other functional areas to satisfy reconfiguration and expansion efforts of the facility, in the future. Goelst Modular Medical Casework Application Largely reflecting both personal taste and specific facility requirements, office areas will utilize a variety of cabinet and worksurface configurations. Goelst casework products may include: 20 series G-Wall consisting of cantilevered 25 series worktops. A variety of 11 series sitting height base cabinets and 16 series tall cabinets may be used to provide adequate storage for both folder filing and additional items. 80 series modular wiring components including grommet holes and task lighting. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

31 PHARMACIST S OFFICE Plan View of a typical Pharmacist s Office The office of the Director ranges between square feet depending on individual needs. The Assistants offices average 100 square feet depending on available space ' - 4" 13' - 11" Sustainable by design.

32 SECRETARY/RECEPTION 32 Secretary/Reception The initial area of the pharmacy will be reserved for reception personnel and equipment. Secretaries and other clerks in this area may have offices in close proximity to administrators and directors. The reception area should be located at the front of the pharmacy to prevent foot traffic from entering the medical distribution and clinical areas. It is required that accreditations, memberships, licenses and other certifications be displayed to the public in this area. Waiting rooms may also be located close to this area. Goelst Modular Medical Casework Application Aesthetics of casework configurations as well as function are important aspects of a successful reception area. Reception personnel must remain organized and efficient while also acting as the initial contact for people entering and existing the pharmacy. Goelst casework products may include: Multiple 11 series file drawer cabinets for archival storage of paperwork. 18 series open overhead cabinets with multiple mail slots to provide additional storage and organization of paper, files, and technical manuals. Corner and peninsula shaped 25 series worktops for computer accommodation series lightweight tack panels to display documents and/or public notices. 80 series Slatwall Accessories to provide reconfigurable organization for office items. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

33 SECRETARY/RECEPTION Plan View of a Secretary/Reception Area A secretary/reception area will range in size from 50 to 200 square feet. The volume of traffic for reception is dependent on the number of patent consultations and outpatient services offered by the hospital pharmacy ' - 11" 8' - 6" 5' Sustainable by design.

34 BREAK ROOM/STAFF LOUNGE 34 Break Room/Staff Lounge It is customary to locate a separate break room or lounge area for pharmacy personnel to allow for coffee and meal breaks. It is important to provide a pharmacy break area to cater to the needs of 2nd and 3rd shifts. Personnel should always remain in close proximity to distribution areas to quickly complete STAT orders during emergencies. Goelst Modular Medical Casework Application Break room configurations must allow space for major and minor appliances including refrigerators, ovens, microwaves, and kitchen supplies. Design must include integration of electrical components as well as plumbing apparatuses including at least one sink. Goelst casework products may include: 14 series standing height base cabinets including moisture resistant HPL worktops. 14 SNK base cabinets should be specified for all sink applications. 26 series circular and/or rectangular dining tables. Chairs and additional seating are typically outsourced by Goelst if requested by the end user. 17 series mail slot cabinets may also be used to provide mail and personal storage series lightweight tack panels to display documents and/or public notices. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

35 BREAK ROOM/STAFF LOUNGE Plan View of a Break Room/Staff Lounge A break room/staff lounge will range in size from 75 to 225 square feet depending on the appliances and equipment needed as well as the number of employees per shift. 35 7' 3' 14' 15' Sustainable by design.

36 CONFERENCE/DRUG INFORMATION 36 Conference/Drug Information In order to ensure both the longevity and professional capabilities of the pharmacy personnel a large conferencing/research area is typically provided as home for the continuing education of current issues and developments on Pharmacology. In addition administrators may hold meetings in the pharmacy conference room which remains set apart from the rest of the healthcare facility. Goelst Modular Medical Casework Application Shelving and other modular products that are reconfigurable will allow for future change as the functions and services of the pharmacy evolve over time. Modular shelving will be needed to accommodate research manuals and multiple periodicals. Space for a computer and/or digital projector may be required as well as a narrow wall-mounted cabinet to enclose a white marker board. A large table with available seating is also required. Goelst casework products may include: Multiple 16 series open tall cabinets equipped with adjustable shelving for storage. Multiple 11 series file drawer cabinets for archival storage of paperwork. 80 series modular wiring including task lights to illuminate reading/writing surfaces. 26 series circular and/or rectangular dining tables. Chairs and additional seating are typically outsourced by Goelst if requested by the end user.. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

37 CONFERENCE/DRUG INFORMATION Plan View of a Conference/Drug Information Center An average conference area will range in size from 150 to 225 square feet depending on quantity of personnel employed and available floorspace ' - 10" 12' - 7" Sustainable by design.

38 SATELLITE PHARMACY 38 Satellite Pharmacy Remote satellite pharmacies my be located anywhere within a hospital but are typically positioned in close proximity to acute patient care departments including emergency rooms and operating rooms. The satellite pharmacy is independently stocked, operated, and supervised by the official pharmacy department. By positioning one or more satellites, the overall networking and distribution efforts of the pharmacy become significantly more streamlined and effective. By locating satellite pharmacies directly on patient care floors the pharmacist is allowed far greater involvement in clinical patient care and drug treatment observation. This trend of direct patient contact by the pharmacist is rapidly becoming the new standard in pharmaceutical care. Decentralized patient care floors with individual satellite pharmacies may include pediatric, oncology, or separate hospital wings found in larger facilities. Goelst Modular Medical Casework Application Size and scale of satellite pharmacies may vary depending on necessity but all basic functions should remain fundamentally similar. There should be a small unit dose picking station, computer and label printer, telecommunication hardware, refrigerated cold storage and wet sink area. Depending on facility requirements, a satellite pharmacy may also be equipped with a small laminar flow hood for sterile preparation procedures. Depending on size of the hospital mobile cart distribution networks may be in place that include the satellite. In such a case, ample space must be designated for cart storage. In response to innovation in pharmacy care, the services and functional requirements of the satellite work area may need to change over time. Similar reconfigurable casework configurations as found in the main pharmacy may be designed for a satellite. Goelst casework products may include: Multiple 16 series open tall cabinets equipped with adjustable sloped shelving. 18 series overhead cabinets with sloped shelves and/or mailslots for filing. 11 series sitting height cabinets to accommodate storage and filing requirements. 14 series base cabinets with gravity fed drawers as well as angled cantilevered shelves with plastic storage bins to provide optimal use of vertical wall space. 80 series modular wiring including task lights to illuminate reading/writing surfaces. 25 series cantilevered worktops constructed of chemically resistant Trespa resin. 26 series circular and/or rectangular conference tables will be required in the patient consultation rooms. Additional seating is typically outsourced by Goelst. Sustainable by design. Goelst USA, LLC phone (336) fax (336)

39 SATELLITE PHARMACY Plan View of a Typical satellite Pharmacy An average satellite pharmacy area will range in size from 125 to 275 square feet depending on the size of the hospital and volume of patient care ' 5' 8' -11" Sustainable by design.