10/08/09: Forward Thinking Pharmacy Design Boosts Patient Safety, Efficiency and Aesthetics

A new hospital pharmacy design, for the Santa Barbara Cottage Hospital, has many goals, but the number one goal, from the beginning, was always clear: patient safety. The director of the pharmacy, Allan Cohen, PhD --- who signs all of his emails with the phrase “Patient Safety is Contagious – Pass It On!” --- and the Assistant Director, Sergio Castro, made sure that patient safety played a central role in the myriad decisions made in the planning and design process for the new pharmacy. 

Also playing an important role in the process was a forward-looking hospital facilities planning department --- headed by Ronald Biscaro, with Scott Allen as Project Manager --- that wanted the best and latest thinking in pharmacy planning.

So it was that the pharmacy design firm of Bernstein & Associates, Architects, based in New York, was hired to work with the pharmacy and facilities planning departments, to create the best and most forward-thinking pharmacy design possible.

Patient safety considerations, as mentioned, played a central role in the planning of the pharmacy. One way that patient safety was addressed was through the extensive use of pharmacy automation equipment. Put simply, pharmacy automation dramatically decreases the potential for human error in the selection and delivery of medication. Pharmacy automation equipment utilized in the design included: MedCarousel by Mckesson in the central work area; pneumatic tube stations by Swisslog; IV Stations by Devon Robotics in the central work area; PillPick System by Swisslog in robot area; NarcStation units in the Narcotics Area by McKesson; BoxPicker by Swisslog in the central work area; CytoCare Robot by Devon Robotics in the hazardous compounding room, and a RxMedic Robot by RxMedic Systems in the employee pharmacy.

Another way that patient safety was addressed was through a logical arrangement of pharmacy areas and zones. This was accomplished through a methodical and comprehensive planning process for the pharmacy. The process started with adjacency diagrams, flow diagrams, room lists, equipment lists, and overall goals. These initial pharmacy planning diagrams and lists, were then converted by the architect into a space program and initial design concepts for client review. As schemes were produced, they were refined incorporating input from facilities, the pharmacy department, equipment manufacturers, and engineers. Underlying this process was the goal of making a clear and logical pharmacy plan to facilitate logical flow of materials and staff, to again minimize the potential for errors in order entry, flow and delivery.

Perhaps most important in addressing both patient safety as well as staff safety, was the creation of separate rooms for compounding sterile products: one room for non-hazardous compounding, and one room for hazardous compounding. Access to these rooms is strictly controlled through an anteroom. All three of these rooms are designed to meet cleanroom standards, including high levels of air purity, directional air flow, and 100% heap filtered exhaust of the hazardous compounding room. In this way, the risk of transmission of infection through pharmaceutical products is greatly reduced. Additionally, by segregating the hazardous compounding room, and designing it with negative airflow into the room and 100% heap-filtered exhaust, a safer environment is also created for the staff working in this space.

In some ways a by-product of the focus on safety, is the resulting design which maximizes the efficiency of the flow of materials as well as staff. Flow of materials, as well as flow of personnel, were taken into account, to produce the most logical and efficient pharmacy plan, in order to take advantage of every square foot of space made available for the project, as well as to maximize the efficiency of the plan to save as much staff time and travel as possible. The extensive use of pharmacy automation equipment also creates a logical and time-efficient environment for producing and delivering pharmaceuticals throughout the hospital.

An important consideration in the project was the aesthetics of the pharmacy environment. The facility design started with a concept of transparency --- the opportunity for staff to see through one room to another (and often another after that) to increase communication, the sense of a team environment, and in general an open, modern environment. The main passages through the pharmacy are only partly by walls, but also distinguished through changes in lighting, finish and color to distinguish passage from functional space. On the subject of lighting, various types of energy efficient lighting are used throughout, with different types appropriate to function used in work areas vs. offices vs. conference and lounge spaces. Finally, bringing the concepts of safety, efficiency and aesthetics together, the central cleanroom spaces for sterile compounding --- anteroom, non-hazardous compounding and hazardous compounding --- are distinguished from the rest of the pharmacy through the use of color and a distinctive but relevant shape for the windows into these rooms, anchoring the notion of a carefully thought-out, forward-looking pharmacy playing a central role in furthering patient safety within the hospital environment as a whole.

"Bernstein and Associates had the vision we needed to create a hospital pharmacy that combined architecture, engineering, art and education to establish a model for intelligent design, " explains Dr. Allan Cohen, the SBCH Pharmacy Director. "This pharmacy will be one that meets our needs now and for years into the future".

About Santa Barbara Cottage Hospital:

Founded in 1888, this 408-bed acute care teaching hospital – the largest of its kind between Los Angeles and the San Francisco Bay area – is committed to patient safety and providing the highest quality health care to the growing communities of greater Santa Barbara.  For more information about Santa Barbara Cottage Hospital, see www.cottagehealthsystem.org.

About Bernstein & Associates, Architects:

Bernstein & Associates, Architects specializes in pharmacy design, including the architectural design, engineering design and construction of USP 797-compliant pharmacies. Since the introduction of USP 797, Bernstein & Associates, Architects has been on the forefront of USP 797-compliant architectural design. The firm's principal, William N. Bernstein, AIA, has written extensively on USP 797. Over the past five years, Bernstein & Associates, Architects has designed twenty USP 797-compliant pharmacies, a number of which have been featured in architectural and healthcare publications.  For more information about pharmacy design, including USP 797 compliant design, see www.bernarch.com.