Ready or Not, the Future of Pharmacy Design Starts Now

By Paul Langland and Doug McCurry originally published in Medical Construction & Design:

Ready or Not

The future of pharmacy design starts now

We've learned a thing or two, not the least of which is that over the past two years, pharmacists have played an important role in the gap created by overworked healthcare providers, limited physician appointments and overcrowded emergency rooms. Pharmacists have even been heralded by some as the forgotten heroic frontline workers during this period. Healthcare leaders and federal and state lawmakers guide how pharmacy is practiced in the U.S. and will continue to study and manage changes, going forward.

Retail vs. hospital-based pharmacies

In the not-so-distant past, pharmacists were restricted from discussing matters related to a patient's care, allowed only to fill a doctors' prescriptions in drugstore pharmacies. Now, however, pharmacists advise patients on safe use of prescriptions, conduct health and wellness screenings, provide immunizations, oversee medications prescribed and deliver advice on healthy lifestyles. Thus, the pharmacist's influence over patient health has expanded.

With that in mind, it's interesting to note that in the 1950s, fewer than 4 out of 10 hospitals had the services of a full-time pharmacist. Today, the U.S. Bureau of Labor Statistics reports that 27% of practicing pharmacists are hospital-based across the country's 6,100 acute care hospitals.

Though patients are accustomed to meeting pharmacists across the drugstore counter, many pharmacists are at work in the clinical setting, behind the scenes as an essential part of every hospital's professional staff. Some hospitals have added a retail pharmacy inside their inpatient and outpatient facilities for the convenience of both patients and staff.

This pharmacy was designed to serve as both a compounding pharmacy with secure and physical separations and an added retail pharmacy, accessible by patients and outside caregivers in tandem with their doctor visits to the center.

Pharmacy design regulations

While local regulations can vary state to state, Joint Commission accreditation sought by hospitals in the U.S. includes pharmacy compliance with USP 797 regulations, and anticipates adoption of USP 800 in the future. What is USP? Two centuries ago, in 1820, United States Pharmacopeia was formed by a group of 11 physicians who took action to protect patients from harm due to inconsistently formulated medicines. Now, the USP has earned trust throughout the health care world by its continued stewardship to improve patient care quality through oversight of medicines, supplements and foods.

USP 797, already part of the USP code, establishes the safe environment for preparing patient-specific medications in a sterile environment that protects the medications all the way to their administering. The environment is required to be designed so it eliminates the potential for a drug's contamination and thereby, activity devising it must be separated physically from the rest of other pharmacy activities.

Buffer and ante areas must be provided and separated with proper airflow. A chemo hood/isolator can be installed in a room with positive pressure. Air quality is required to be tested in these spaces every six months.

USP 800 was written later, to protect hospital and other staff members from exposure to hazardous drugs by specifically outlining how they should be handled. Hazardous drug storage, compounding, dispensing, disposal and surface cleaning are all addressed with this new, but unadopted statute, heretofore.

Both the latest USP 797 and USP 800 pharmacy standards are under appeal, but their relevance has been widely recognized and implemented. Pending results of the appeals, USP 800 is now considered informational; neither USP 797 nor USP 800 is expected to be legally enforced until the appeals have been satisfied. Nevertheless, designing and building to their guidelines is advisable under any circum- stances in pharmacy development.

New hospital construction projects should be planned for compliance of both statutes to realize the benefits of safety, which the rules are intended to achieve. Hospitals with existing pharmacies facing extensive physical plant revisions to comply admittedly face cost implications, which bear no benefit in revenue increases but also will realize the benefit of safety measures.

Built-in shelves, stocked with over-the-counter products, face the retail pharmacy registers and are bathed in natural light from the window wall at the end of the space.

Tale of two pharmacies

There are other important considerations in pharmacy design programming, which can be illustrated through two very different specific cases. One project completed in 2019, in a central Georgia hospital, revealed no directions or clues in the public wayfinding system for the pharmacy's location. This hospital's pharmacy was programmed only for inpatient hospital operations with drugs to be used in operating rooms, infusion space and patient bedside care.

In this project, the presence of a high volume of hazardous drugs was considered too high a public security risk, so the designers planned this pharmacy to be located in a campus setting, which was well-isolated from the public.

In another project, an outpatient cancer center located in south-central Alabama, completed at about the same time, the pharmacy was designed to serve as both a compounding pharmacy, with secure and physical separations, and an added retail pharmacy, accessible by patients and outside caregivers in tandem with their doctor visits to the center. In this case, the goal was to provide patient convenience and full-service care, so high visibility of the pharmacy location was a key part of the program.

Consequently, the pharmacy was visible to all visitors, located contiguously to the outpatient center's expansive entrance. Abundant space for the pharmacist to work was important as was the feel of openness and access to the pharmacist, when needed for patient consultations. The dual purpose made necessary a separate space for mixing and compounding chemotherapy drugs, along with a space for transportation to the infusion space on the second floor.

In each case, security was one of the highest priorities in the pharmacy's design. Clear sightlines throughout the department were important, as well. Provisions for specific equipment related to pharmacy practice, including Omnicell, benches, pneumatic tube systems, refrigeration and airflow and pressurization control systems are a few of the considerations during planning.

Pharmacy design is more complex, nuanced and technical than it might appear, particularly for those pharmacies located on healthcare campuses. Because pharmacies are unique and are a subspecialty within the healthcare realm, with their own set of distinctive regulations, engaging experienced pharmacy designers and contractors is important for a smooth design and construction process.

Paul Langland, AlA, and Doug McCurry, AlA, are partners with TRO Jung| Brannen. They both are located in the firm's Birmingham, Alabama office.