title: Design, implementation, and evaluation of a thrice-daily cartfill process.
abstract: OBJECTIVE
  Efficiencies achieved through a redesign of the central pharmacy cartfill process at a large academic medical center are reported.
  
  
  CONCLUSIONS
  In an initiative to expand clinical pharmacy services in a budget-neutral manner, pharmacists at the University of Wisconsin Hospital and Clinics (UWHC) led the transition from a once-daily to a thrice-daily medication cartfill model designed to better align pharmacy operations with patterns of medication ordering, delivery, and order discontinuation. A pre-post analysis demonstrated several benefits of the shift to thrice-daily cartfill, including a 32.7% decrease in the mean daily number of extemporaneously prepared oral doses. Overall, the new cartfill process resulted in reduction in lead times for three of four peak delivery periods, roughly a 55-65% reduction. During the postimplementation period, the frequency of requests for missing medication doses through the electronic medical record (EMR) system increased from 1.13% to 1.43%; however, this increase may have been the result of improved nurse adherence to EMR protocols for requests for missing medications.
  
  
  CONCLUSIONS
  Implementation of a thrice-daily cartfill process and ancillary changes at UWHC resulted in a 2.1% increase in cartfill doses dispensed, a 44.1% decrease in first doses dispensed, and a 42.9% decrease in the number of medications returned to the central pharmacy. This resulted in a reduction in waste within pharmacy operations and allowed for redeployment of two technician full-time equivalents to expand pharmacy services.
authors.affiliation: Korby Lathrop, M.S., Pharm.D., is Pharmacy Manager, Informatics and Automation, University of Kansas Hospital, Kansas City. Jim Lund, M.S., Pharm.D., is Pharmacy Manager, Inpatient Operations; Brad Ludwig, M.S., B.S.Pharm., is Assistant Director of Pharmacy; and Steve Rough, M.S., B.S.Pharm., FASHP, is Director of Pharmacy, University of Wisconsin Hospital and Clinics, Madison. klathrop@kumc.edu.
authors.forename: Korby
authors.initials: K
authors.lastname: Lathrop
authors.affiliation: Korby Lathrop, M.S., Pharm.D., is Pharmacy Manager, Informatics and Automation, University of Kansas Hospital, Kansas City. Jim Lund, M.S., Pharm.D., is Pharmacy Manager, Inpatient Operations; Brad Ludwig, M.S., B.S.Pharm., is Assistant Director of Pharmacy; and Steve Rough, M.S., B.S.Pharm., FASHP, is Director of Pharmacy, University of Wisconsin Hospital and Clinics, Madison.
authors.forename: Jim
authors.initials: J
authors.lastname: Lund
authors.affiliation: Korby Lathrop, M.S., Pharm.D., is Pharmacy Manager, Informatics and Automation, University of Kansas Hospital, Kansas City. Jim Lund, M.S., Pharm.D., is Pharmacy Manager, Inpatient Operations; Brad Ludwig, M.S., B.S.Pharm., is Assistant Director of Pharmacy; and Steve Rough, M.S., B.S.Pharm., FASHP, is Director of Pharmacy, University of Wisconsin Hospital and Clinics, Madison.
authors.forename: Brad
authors.initials: B
authors.lastname: Ludwig
authors.affiliation: Korby Lathrop, M.S., Pharm.D., is Pharmacy Manager, Informatics and Automation, University of Kansas Hospital, Kansas City. Jim Lund, M.S., Pharm.D., is Pharmacy Manager, Inpatient Operations; Brad Ludwig, M.S., B.S.Pharm., is Assistant Director of Pharmacy; and Steve Rough, M.S., B.S.Pharm., FASHP, is Director of Pharmacy, University of Wisconsin Hospital and Clinics, Madison.
authors.forename: Steve
authors.initials: S
authors.lastname: Rough
mesh_terms: D006284:Health Plan Implementation / Q000379:methods / Q000592:standards* / Q000639:trends; D006801:Humans; D008510:Medication Systems, Hospital / Q000592:standards* / Q000639:trends; D010595:Pharmacists / Q000592:standards* / Q000639:trends; D010607:Pharmacy Service, Hospital / Q000592:standards* / Q000639:trends; D015397:Program Evaluation / Q000379:methods / Q000592:standards* / Q000639:trends; D013997:Time Factors