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UBC Theses and Dissertations

Hospital pharmacy simulation : a study of the inpatient dispensary Harris, Henry David Leslie 1972

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HOSPITAL PHARMACY SIMULATION: A STUDY OF THE INPATIENT DISPENSARY by HENRY DAVID LESLIE HARRIS (B.Sc., U.B.C, I967) A Thesis Submitted i n Partial Fulfillment of the Requirements for the Degree of Master of Business Administration in the Faculty of Commerce and Business' Administration We accept this thesis as conforming to the required standard. THE UNIVERSITY OF BRITISH COLUMBIA MAY - 1972 In p r e s e n t i n g t h i s t h e s i s in p a r t i a l f u l f i l m e n t o f the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e fo r reference and s tudy. I f u r t h e r agree tha t pe rmiss ion for e x t e n s i v e copying o f t h i s t h e s i s fo r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e s . I t i s understood that copying o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l ga in s h a l l not be a l lowed wi thout my w r i t t e n p e r m i s s i o n . H.D.L. HARRIS Department of Commerce and Business Administration The U n i v e r s i t y o f B r i t i s h Columbia Vancouver 8, Canada Date May» 1972 i i ABSTRACT The objective of this research i s to develop a simulation model as an aid i n planning hospital operations. The hospital pharmacy i s selected as an appropriate area f o r study. An extensive systems analysis of pharmacy functions i s undertaken. A simulation model of the inpatient dispensary operations i s developed using the IBM General Purpose Simula-ti o n System. This model allows experimentation with dispensary work-load, operations, and manpower schedule. S t a t i s t i c s are provided on service to the patient, work-load d i s t r i b u t i o n , and manpower u t i l i z a t i o n . Variation i n pharmacist a v a i l a b i l i t y and type of prescription entering the dispensary allows optimization of operations. Several experiments are conducted to i l l u s t r a t e the model concept and experiment p o s s i b i l i t i e s . I t i s concluded that the model i s a valuable planning tool for the hospital pharmacy administrator and can be extended to simulate operations i n other areas of the pharmacy. ill ACKNOWLEDGEMENT The author i s Indebted to Professor D.H. Uyeno of the Faculty of Commerce and Business Administration, University of B r i t i s h Columbia, for his invaluable guidance and encouragement i n the development of this thesis. He Is also g r a t e f u l f o r the assistance and cooperation provided by Mr. J. Dancey and his s t a f f at the Vancouver General Hospital Pharmacy. This work has been p a r t i a l l y supported by a University of B r i t i s h Columbia Research Grant. The author would also l i k e to thank his wife, Badojka, f o r her help i n preparing data for this thesis, and f o r her encouragement these past two years. i v BIOGRAPHICAL NOTE Henry David L e s l i e Harris: Born March 19, 19^6, i n the Shetland Is., Scotland. Emigrated to Canada i n 1957. Graduated from the University of B r i t i s h Columbia in I967 with a B.Sc. degree i n Mathematics and Computer Science. Worked as a computer programmer and systems analyst for B.C. Hydro and Power Authority. Married in 1970. Presently on leave of absence from B.C. Hydro to obtain an MBA Degree at the University of B r i t i s h Columbia. V TABLE OF CONTENTS CHAPTER PAGE I. INTRODUCTION 1 1.1 General 1 1.2 Thesis Defined k I I . SYSTEMS IDENTIFICATION 7 2.1 Role of the Hospital Pharmacy 7 2.1.1 Inpatient Dispensary 8 2.1.2 Outpatient Dispensary 13 2.1.3 Solution Preparation Ik 2.1.4 Bulk Manufacturing 15 2.1.5 Ward Stock Replenishment 15 2.1.6 Inventory Control 16 2.1.7 Other 18 2.2 Literature Review 19 2.2.1 Hospital Pharmacy Work-load Studies . . 21 2.2.2 Drug D i s t r i b u t i o n Systems 23 2.2.3 Drug Inventory Studies . 23 2.2.4 Other General Applications . 25 2.3 Simulation Techniques 27 I I I . SYSTEMS ANALYSIS 32 3.1 Inpatient Dispensary 3k 3.1.1 Work-Flows 3k 3.1.2 Work-load kk 3.2 Narcotics and Controlled Drugs 51 3.3 Ward Stock 55 3.k Solutions 58 3.5 Outpatient Dispensary 62 3.6 Inventory Control 65 3.7 Summary . . . . . . . 71 v l CHAPTER PAGE IV. MODEL DEVELOPMENT 76 4.1 Model Description 76 4.1.1 Receive Inpatient Prescriptions . . . 78 4.1.2 F i l i n g New Direct Doctor Forms . . . . 81 4.1.3 E d i t i n g New Direct Doctor Forms . . . 81 4.1.4 Query Prescriptions 83 4.1.5 Label Typing 86 4.1.6 Dispensing 92 4.1.7 Return Work 95 4.1.8 Serve Counter 97 4.1.9 Interruptions 97 4.1.10 Control 100 4.2 Model Validation 103 V. CONCLUSIONS . . . . . . 113 5.1 Some Simulation Results 113 5.1.1 Test 1 - Test 3 114 5.1.2 Test 4 117 5.1.3 Test 5 117 5.1.4 Test 6 118 5.1.5 Test 7 118 5.1.6 Test 8 . . . . 118 5.2 Summary of Approach 119 5.2.1 Model Concept 119 5.2.2 Some Analysis Results 123 5.2.3 Areas f o r Future Study 125 BIBLIOGRAPHY 127 APPENDICES: A Regression Equations . . 131 B Vancouver General Hospital Organization Chart 132 C Prescription Regulations 133 D Sample Formulary Drug C l a s s i f i c a t i o n . . 134 E Program L i s t i n g 137 F Computer Output From Model Validation . 150 G Computer Output From Tests 1-8 . . . . . 170 v i i LIST OF TABLES TABLE PAGE 3.1 Dispensary Daily Work-load 48 3.2 Dispensary Weekly Work-load 49 3.3 Number of Prescriptions per,Form 50 3.4 Source of Pre s c r i p t i o n Work-load i n the Inpatient Dispensary 50 3.5 Sources of Inpatient Narcotic and Controlled Drug Orders 55 3.6 Ward Stock Data 59 3.7 Solutions Data 61 3.8 Hospital Area Served by Solutions 62 3.9 Number of Outpatient Prescriptions per Form . 63 3.10 Outpatient Pr e s c r i p t i o n Volumes 64 3.11 D i s t r i b u t i o n of Orders by Formulary Code . . . 68 4.1 Comparison of Actual vs. Simulated Time Parameters 105 4.2 Comparison of Actual vs. Simulated P r e s c r i p t i o n Totals 107 4.3 V a l i d a t i o n of Manpower U t i l i z a t i o n 108 4.4 Simulated Prescription Time in the Inpatient Dispensary . 110 4.5 Other Dispensary S t a t i s t i c s . I l l 5.1 Summary of Experiments 116 v l l i LIST OF FIGURES FIGURE PAGE 2.1 T r a d i t i o n a l Drug D i s t r i b u t i o n System 9 2.2 Revised Drug D i s t r i b u t i o n System 11 2.3 General Diagram of a Hospital Pharmacy's Environment 20 2.4 Black Box Model 29 2.5 P r e s c r i p t i o n E d i t i n g Operation 30 3.1 Floor Plan of VGH Pharmacy 33 3.2 Black Box Model of Inpatient Dispensary . . . 35 3.3 New Personal Prescriptions Work-flow . . . . . 37 3.4 R e f i l l Personal Prescriptions Work-flow . . . 38 3.5 New Direct Doctor Prescriptions Work-flow . . 40 3.6 R e f i l l D i r e c t Doctor Prescriptions Work-flow . 42, 3.7 Inpatient Dispensary Operations 45 3.8 Cumulative % Di s t r i b u t i o n s of Dispensary Work-load 46 3.9 Narcotic Drugs Work-flow . 52 3.10 Controlled Drugs Work-flow 53 3.11 Ward Stock Work-flow 57 3.12 Solutions Work-flow 60 3.13 Pharmaceutical Purchasing and Receiving Work-flow . . 66 4.1 Inpatient Dispensary Functions 77 4.2 Receive Inpatient Prescriptions 80 4.3 F i l i n g New Direct Doctor,Forms 82 4.4 E d i t i n g New Direct Doctor Forms 84 FIGURE PAGE 4.5 D i s t r i b u t i o n of Edit i n g Time for New Direct Doctor Forms 85 4.6 Query Prescription Routine 87 4.7 D i s t r i b u t i o n of Phone C a l l Time 88 4.8 Label Typing Routine 89 4.9 D i s t r i b u t i o n of Label Typing Time f o r the Inpatient Dispensary 91 4.10 Dispensing Routine 93 4.11 D i s t r i b u t i o n of Dispensing Time in the Inpatient Dispensary 9^ 4.12 Return Work Routine 96 4.13 Serve Counter Routine 98 4.14 D i s t r i b u t i o n of Time Spent with Staff at Inpatient Dispensary Counter . . . 99 4.15 Phone C a l l Interrupt Routine 101 4.16 Sample Inpatient Dispensary Work Schedule . . . . 102 4.17 D i s t r i b u t i o n of Pharmacist Work A r r i v a l s i n Inpatient Dispensary . . 106 CHAPTER I INTRODUCTION 1 . 1 General Sophistication i n techniques as well as more e f f i c i e n t cure processes have helped make health care one of the more r a p i d l y expanding public services. In Canada, health and s o c i a l welfare expenditures reached 9 . 9 per cent of the 1969 gross national product.^" i n B r i t i s h Columbia, health and s o c i a l services absorbed 3 1 . 9 per cent of I 9 5 9 / I 9 6 O p r o v i n c i a l government expendi-tures, while in 1 9 7 1 / 1 9 7 2 i t i s estimated that this t o t a l w i l l r i s e to 3 8 . 1 per cent. In f a c t , health expenditures are growing more r a p i d l y than most other forms of personal consumption. When private industry i s faced with the equivalent prospect of growth and implementation of new technology, management must spend much time in forecasting expected costs, resource requirements, r e s u l t s , and the l i k e . Planning becomes c r i t i c a l , and any tools that can help managers in this task are g r a t e f u l l y accepted. Thus, private industry has developed an extensive inventory of Dominion Bureau of S t a t i s t i c s , Canada Year Book. 1 9 7 0 - 7 1 , P. 3 9 2 . 2Province of B r i t i s h Columbia, Budget Speech, February, 1 9 7 1 . 2 planning tools. In the l a s t ten years, health service administrators have begun to apply some of these techniques to help them solve their current administration problems and to plan for future growth needs. The f i e l d of management science provides several powerful tools that have been successfully applied i n non-health areas. One of these techniques i s simulation. I t requires that the analyst abstract the e s s e n t i a l properties of a r e a l system. These properties are then combined i n a way that allows the user to investigate complicated i n t e r -actions that would otherwise be extremely d i f f i c u l t to study by mathematical or work study techniques. This simulation process w i l l be described more f u l l y i n a l a t e r chapter. However, i t i s important to note that i t has already been applied extensively to the analysis of health sersrices. Fetter and Thompson (1964) used simulation to develop approaches to problems i n the design and u t i l i z a -tion of hospital f a c i l i t i e s . They experimented with models of a maternity s u i t e , outpatient c l i n i c , and a s u r g i c a l p a v i l i o n . Simulation of emergency ambulance services has been described by Savas (1969). Drew and Swerling (I968) have simulated c y b e r a i l operation in h o s p i t a l s — a n automated system for transporting materials within hospitals such as meals, l i n e n , trash, mail, paperwork and drugs. The Research Triangle I n s t i t u t e in North Carolina has used simulation extensively in mental health planning (F.D. Kennedy, et a l . , 3 1970) , i n the development of a community health service model (P.D. Kennedy, 1967), and In forecasting hospital manpower demands (Horvitz and Hallan, I 9 6 9 ) . The varied nature of these applications i l l u s t r a t e s the magnitude of health service planning. For example, the h o s p i t a l administrator must consider areas such as s t a f f i n g , financing, b u i l d i n g services; inventory control, purchasing, transportation, and food services. Coordination of these a c t i v i t i e s becomes more c r i t i c a l when the hospital depends on funds which are provided by the public, and apportioned by government. Not only must services be maintained at as high a l e v e l as possible, but any i n e f f i c i e n c e s or inade-quate patient treatment are subject to c r i t i c i s m by the p u b l i c . Thus, the hospital administrator must plan f o r a l l contingencies, obtain s u f f i c i e n t financing, and ensure that hospital s t a f f s are able to provide the best service possible. I t i s not s u r p r i s i n g , therefore, that the complexity of s o c i a l , technical, and administrative problems facing health services today, i s being analyzed very c l o s e l y . Sophisticated management techniques such as simulation appear to o f f e r some assistance i n the coordination and planning of various a c t i v i t i e s . 4 1.2 Thesis Defined It has been proposed that planning i n health services i s e s s e n t i a l , and that various techniques can be applied to advantage i n this f i e l d . Hospitals provide the greatest opportunity f o r study because of their d i v e r s i t y of operations and their complexity. Many hosp i t a l departments, such as Purchasing or the Pathology Laboratory, operate as s p e c i a l i z e d units, receiving s p e c i f i c patients or work requests, and carrying out independent operations. Others provide a more generalized service function, working clo s e l y with other departments, and r e -f l e c t i n g changes in work flows i n the t o t a l hospital system. Examples of these might be the Pharmacy or D i e t e t i c depart-ments. In f a c t , there are so many components or subsystems making up a t o t a l hospital environment that any systems analysis or h o s p i t a l simulation i s a major undertaking i n i t s e l f . This i s r e f l e c t e d i n the choice of simulation applications to date. The few examples, previously c i t e d , covered well-defined, s p e c i a l i z e d areas. This thesis has s i m i l a r l y been limited to the study of one p a r t i c u l a r area of a hospital, the pharmacy. Hospital pharmacy operation w i l l be analyzed with respect to work flow, services provided, communications with other hospital departments, and other general functions. A simulation model w i l l be developed to provide a planning 5 t o o l for future operation analysis and work-load changes. I t i s hoped that r e s u l t s of this study w i l l be of benefit in h ospital planning, and w i l l provide information suitable for incorporation into a more general hospital model. The h o s p i t a l pharmacy i s an ideal one f o r study for several reasons. F i r s t , a pharmacy has high paper flow. Furthermore, extensive records are kept £o meet l e g a l r e -quirements, and to provide patient protection. Thus a large data base i s available that can provide accurate information on operating volumes and other service charac-t e r i s t i c s . Secondly, the h o s p i t a l pharmacy has well-defined functions. I t i s e s s e n t i a l l y a s t a f f service department. This implies that an operational unit exists which looks a f t e r inputs (requests) and provides outputs (pharma-ceu t i c a l s ) to various l i n e departments in the ho s p i t a l . Thus the pharmacy workload depends d i r e c t l y on the size of the hospital and the type of functions i t performs. Standards and procedures are created to ensure accuracy i n handling drugs, and pharmacy employees are assigned s p e c i f i c duties and r e s p o n s i b i l i t i e s . With such a well-defined work flow and job assignment, the model builders' task i s a less complex one. F i n a l l y , the pharmacy i s a r e l a t i v e l y important cost center in the operations of a ho s p i t a l . Drugs are expensive and, as such, create inventory problems that must 6 be solved in order to keep pharmacy and patient costs as low as possible. Pharmacists are highly s k i l l e d personnel and command r e l a t i v e l y high s a l a r i e s . The equipment needed to maintain pharmacy standards and to provide a wide range of services to the h o s p i t a l can i t s e l f be a f a i r l y large expense. Thus the e f f i c i e n t operation of a hospital pharmacy i s important not only from the point of view of supplying high-quality services, but also to keep ho s p i t a l operating costs within a reasonable range. 7 CHAPTER II SYSTEMS IDENTIFICATION 2.1 Role of the Hospital Pharmacy A hospital pharmacy has been defined as that depart-ment of the hospital where the procurement, preservation* storagecompounding; manufacturing, packaging, controlling, assaying, dispensing, and distribution of medications to hospitalized and ambulatory patients are performed by pro-fessionally competent and legally qualified pharmacists.^" This is similar to the responsibility that a community pharmacy has, but there are several important differences. The hospital pharmacy must operate in conjunction with other departments of the hospital and is subject to the general authority and planning of the hospital admini-stration. Another major difference Is the addition of the nurse to the drug flow cycle. Nearly a l l medications in a hospital are administered by professional nurses so that the drug order flow becomes: physician-pharmacist-nurse-patient. The hospital pharmacy operates on a non-profit basis and emphasis is placed on providing the best service to •'•Remington's Pharmaceutical Sciences. 13th Edition. Mack Publishing Company, 19o5f P. 1700. 8 patients at as low a cost as possible. The h o s p i t a l pharmacist, therefore, does not have to concern himself with store promotion and p r o f i t motives but, rather, must operate i n conjunction with the many services that a h o s p i t a l needs. Thus, the hospital pharmacy r e f l e c t s the medical and organizational conditions in i t s environment. I t must provide highly s p e c i a l i z e d services and must also work cl o s e l y with many other medical s p e c i a l i s t s in an e f f o r t to provide a t o t a l hospital service and good patient care. A b r i e f summary of some of the functions of a h o s p i t a l pharmacy w i l l . i l l u s t r a t e the type of work that i t does, and how i t contributes to the general hospital work flow and attempts to f u l f i l l i t s service function. 2.1.1 Inpatient Dispensary Most people are f a m i l i a r with the dispensing opera-tions c a r r i e d out by community pharmacists. A doctor writes out a p r e s c r i p t i o n for his patient. When presented with this document, the pharmacist interprets i t s contents, types a l a b e l containing patient and drug information, and packages the drug for the patient. The pharmacist also spends some time i n s t r u c t i n g the patient on the correct use of the drug, whether cert a i n symptoms can be expected, and providing other professional guidance that w i l l allow the 9 patient to get the most benefit from the prescribed drug. T r a d i t i o n a l l y , prescriptions for hospital patients have been looked a f t e r by the nurse, once the physician has provided instructions on i n d i v i d u a l patient charts. Thus, the pharmacist has generally directed most queries to the nurse o r i g i n a t i n g the p r e s c r i p t i o n . With this type of d i s t r i b u t i o n system in a h o s p i t a l , pharmacist communications with physicians have been greatly reduced, and the inpatient dispensary function has become one of f i l l i n g p r e s c r i p t i o n s , rather than providing an important informational service f o r which the pharmacist i s well q u a l i f i e d . This t r a d i t i o n a l approach i s i l l u s t r a t e d in Figure 2.1. 7' Physician's Order to p r e s c r i p t i o n patient form  Pharmacy Dispensary FIGURE 2.1 T r a d i t i o n a l Drug D i s t r i b u t i o n System As well as l i m i t i n g the effectiveness of the pharmacy services this t r a d i t i o n a l d i s t r i b u t i o n method has allowed s i g n i f i c a n t margin for error i n the transcription of drug orders to the p r e s c r i p t i o n form. One source states that I Patient Charting; — * ~ * T r a n s c r i b e d JMUr.se a d m i n i s t e r s by nurse d r u g to 10 between 6 to 14 per cent of medication administrations involve some deviation from the physician's order, whether i t be i n terms of drug or dosage ordered, or of the time of administration indicated. With these problems i n mind, most hospitals are now moving towards a c l i n i c a l approach to pharmacy services. In this case, the pharmacist becomes more involved with patient care a c t i v i t i e s , in some cases making rounds with physicians and providing drug information as needed. Access to patient charts also enables the h o s p i t a l pharmacist to provide a valuable information service to the doctor. By checking for possible drug interactions and being f a m i l i a r with the many types of drugs a v a i l a b l e , the pharmacist i s able to assume the r o l e of professional consultant and give opinions on drug effectiveness, as well as information on the a v a i l -able dosage strengths and forms of a p a r t i c u l a r product. Dissemination of drug information begins to play a more important r o l e i n a hospital pharmacy's operations. The dispensing pharmacist can also query the contents of a p r e s c r i p t i o n both from the point of view of accuracy, as well as e f f e c t on the patient. Thus the drug flow i n hospitals i s evolving more to that shown in Figure 2.2. ^G.R. Sprague and M.E.. Ludwlg, "Hospital Pharmacy Systems," Hospitals. J.A.H.A.. October 16, 1970, Vol. 44, P. 56. 11 Physicians Orders _ _ _ ^ J Patient Charting Nurse Administers Drug to Patient Pharmacy Dispensary! Interprets order, patient p r o f i l e , drug information, dose preparation FIGURE 2.2 Revised Drug D i s t r i b u t i o n System Naturally, with this type of c l i n i c a l environment, the pharmacist i s assuming a larger work-load. Prescriptions d i r e c t from the doctor must be edited. A patient f i l e must be kept up-to-date to allow the pharmacist to check for drug interactions and the l i k e . This increasing work-load has led to many studies on the actual operations undertaken i n the hospital pharmacy. In a recent a r t i c l e , the American Society of Hospital Pharmacists stated that, Studies have indicated that many of the tasks performed in today's modern hospital pharmacy could be delegated to supportive personnel under the supervision of a pharmacist.... If the hospital pharmacist could be freed to a greater extent from performing routine tasks...he would be able to d i r e c t more of his attention to pro-f e s s i o n a l tasks only, thereby expanding 12 professional pharmacy service in the interest of patient care.3 Pharmacy aides are now being used extensively by the larger hospitals to take care of the non-professional tasks in the dispensary. Any attempt to model a dispensary must, there-fore, consider the allocation of professional and non-professional tasks to appropriate personnel. Recent development in drug distribution systems has also affected hospital dispensary operations. Concepts such as unit-dose packaging and unit-dose dispensing have become popular. A unit dose is usually defined as any quantity of 4 a drug to be administered to a patient at one time. Each dose of medication is individually packaged and labeled either by the pharmaceutical manufacturer or the pharmacist.^ These unit doses must be dispensed from the pharmacy to the nursing stations, and the dispensing system can either be centralized, where unit-doses are dispensed from a central ^"Statement on Supportive Personnel in Hospital Pharmacy," ASHP, October 26-27, 1970, American Journal of ' Hospital Pharmacy, Vol. 28, July 1971, P. 516* ^C.O. Thompson, et a l . , "Pharmaceutical Communications in the C l i n i c a l Environment," American Journal of Hospital  Pharmacy. Vol. 27, April 1970, p. 281. ^Examples of unit doses are: tablets and capsules in strip packs, pr e f i l l e d syringes, and oral liquids in indi-vidual dose bottles. ^Canadian Society of Hospital Pharmacists, "Guidelines for Single Unit Packaging of Pharmaceuticals in Canada, August, 1971," Canadian Journal of Hospital Pharmacy. September-October, 1971, P. 184. 13 pharmacy, or decentralized, where small pharmacy units are d i s t r i b u t e d throughout the h o s p i t a l . In most cases, unit doses are d i s t r i b u t e d using a compartmentized cabinet, one compartment for each patient. I t becomes the pharmacy's duty to prepare these cabinets usually just before drugs must be dispensed. Thus, a greater part of the drug administration work-load i s sh i f t e d to the pharmacy and the nurse can concentrate on other nursing duties. As well as r e l i e v i n g the nurse of some of her work-load, this system can lead to greater accuracy i n drug administration, and well as e f f i c i e n c i e s in the preparation of drug doses. In summary, the major r o l e of the pharmacists i n the inpatient dispensary i s to dispense drugs according to pr e s c r i p t i o n and to disseminate information on pharmaceuticals and their use. As the name suggests, the prescriptions that are f i l l e d w i l l normally be for hospital inpatients, although a part-time service may be provided for hospital s t a f f members. 2.1.2 Outpatient Dispensary Most hospitals have a s i g n i f i c a n t number of out-patients requiring p r e s c r i p t i o n service. A s p e c i a l outpatient pharmacy w i l l usually e x i s t to take care of these outpatient prescriptions and to provide other special r o l e s . T r a d i t i o n a l l y , i t w i l l provide a service to welfare patients i n conjunction with welfare assistance programs, and i t w i l l also provide a 14 p r e s c r i p t i o n - f i l l i n g service for hospital c l i n i c s . Special i n v e s t i g a t i o n a l drugs are sometimes prescribed to out-patients, and since these drugs are not usually available in community pharmacies, the hospital pharmacy department must be able to f i l l these prescriptions. Thus, the outpatient dispensary's r o l e i s a l i m i t e d , but s p e c i a l i z e d one. In some cases, this dispensary w i l l be located in a d i f f e r e n t area of the h o s p i t a l , c l o s e r to out-patient c l i n i c s and the l i k e . I t i s usually quite small with only one or two pharmacists on duty. 2.1.3 Solution Preparation The pharmacy department in a large hospital w i l l usually have s p e c i f i c pharmacists and technicians assigned to prepare bulk solutions and s t e r i l e products. This requires a highly-trained s t a f f as well as a s i g n i f i c a n t amount of equipment. Normally, a s p e c i a l solutions room w i l l e x i s t where preparation of s t e r i l e products for i n j e c t i o n , eye-drops, intravenous solutions and the l i k e can be prepared to exacting s p e c i f i c a t i o n s . Work-flow for this department w i l l usually be on a pre-scheduled basis with regular orders being received from s p e c i f i c wards during the work week. S i g n i f i c a n t savings to the hospital can thus be achieved by the bulk preparation of these solution products. In addition to preparing s t e r i l e solutions, this 15 area of the pharmacy also packages them. Thus, i t operates a s i g n i f i c a n t amount of b o t t l e cleaning and s t e r i l i z i n g equipment, such as autoclaves, i n conjunction with i t s t o t a l solutions work-load, 2.1.4 Bulk Manufacturing In some cases, s p e c i a l compounds are required by physicians which are not commercially av a i l a b l e . The pharmacy w i l l thus have a well-equipped laboratory to prepare these compounds. Sometimes, these requests can be f i l l e d by pharmacists working in the dispensary. Usually, however, the s p e c i a l manufacturing area i s staffed with pharmacists and technicians to provide this service. 2.1.5 Ward Stock Replenishment Most hospitals keep s u f f i c i e n t stocks of often used drugs or emergency supplies on hand in s p e c i f i c ward statio n s . These must be replenished on a regular basis, and the pharmacy w i l l usually receive r e q u i s i t i o n s f o r these ward stock items according to a predetermined schedule. Pharmacy aides are normally assigned the task of f i l l i n g these orders. This involves such work as pre-packaging tablets and capsules, l a b e l i n g containers, and keeping records. This i s again a bulk supply service to the major wards i n the h o s p i t a l . 16 2.1.6 Inventory Control A hospital pharmacy generally l i m i t s the number of brands and types of drugs i t stocks by using a formulary system. The formulary groups drugs by various categories and provides information on drug formulas, dosages, and possible effects of the drug on patients. This information i s made available by the American Hospital Formulary Service, and through i t s use the hospital can s e l e c t an inventory of drugs most appropriate f o r the type of service i t provides. A copy of the hospital formulary i s provided to prescribing doctors so that the doctor can cooperate with the pharmacy i n using the s p e c i a l l y selected drugs. The formulary i s normally updated on a yearly basis to incor-porate newly-developed and, perhaps, more e f f e c t i v e drugs. Thus, the formulary system i s important to the pharmacy i n c o n t r o l l i n g drug inventory. There are many other d e t a i l s that a f f e c t the problem of inventory c o n t r o l . Physicians can request that s p e c i a l drugs be kept on hand for i n v e s t i g a t i o n a l purposes. Narcotics and controlled drugs must be s t r i c t l y regulated and safely stored to protect against i l l e g i t i m a t e uses. Night cabinets, containing emergency supplies f o r use when the pharmacy i s closed, e x i s t throughout the hospital and must be kept stocked and up-to-date. Refrigeration i s 17 necessary for various drug types. In f a c t , most pharma-c e u t i c a l supplies deteriorate with time and lose their potency. Therefore, s t r i c t compliance with expiry dates must be followed to provide hospital patients with maximum protection? drug inventories must be reviewed p e r i o d i c a l l y to ensure that a l l these r e s t r i c t i o n s are met. The various areas requiring pharmaceutical supplies, such as the dispensary, ward stations, outpatient dispensary and others previously mentioned, must be kept well-stocked by the pharmacy s t a f f . Because of the small size of pharma-c e u t i c a l s , storage space i s generally not a problem. However, much time must be spent in administrative work as records must be kept on specialized and r e s t r i c t e d drugs, short l i s t s must be prepared for low-stocked items, and drug orders placed with wholesale or manufacturing firms. In many cases, drugs are ordered by tender, so that the pharmacist i n charge of drug ordering must spend some time seeing sales representatives from various drug manufacturing or wholesale firms. However, the hospital pharmacy does not usually get too involved in the drug purchasing cycle. Once a r e q u i s i t i o n has been prepared, the hospital purchasing department generally looks a f t e r such paper work as i s necessary. Thus, inventory control i s v i t a l to the e f f i c i e n t operation of a hospital pharmacy as this department must provide a service to physicians and patients as well as try to keep drug costs as low as possible. 18 2.1.7 Other The ho s p i t a l pharmacy has numerous other functions. For example, tra i n i n g i s an important duty of most large hospitals. New graduates or pharmacy interns must be given job experience and trained in the various duties of the pharmacist i n the h o s p i t a l . Continuing education f o r the pharmacist i s important as he must keep abreast of new drug information. He meets with other medical representatives i n the hospital and takes part in research a c t i v i t i e s . Pharmacists sometimes give lectures on drugs to nurses and, perhaps, prepare drug information b u l l e t i n s . Administrative duties are important as the pharmacy is usually a separate cost center i n the hos p i t a l . The chief pharmacist must control the operation of his depart-ment, e s t a b l i s h p o l i c i e s and procedures, handle personnel r e l a t i o n s , and plan for future budgets and resources needed to maintain an e f f i c i e n t pharmacy service. He must also represent his department at committee meetings and various hos p i t a l administration tasks. The physical drug d i s t r i b u t i o n system being used i n a hospital d i r e c t l y a f f e c t s the operations of the pharmacy. Use of pneumatic tubes and messengers must be coordinated. Much of the d i s t r i b u t i o n e f f i c i e n c y depends on the location of the pharmacy i n the hos p i t a l . Communication and record-keeping problems can become so large that computers can be successfully used to reduce some of the work-load. There 19 are several commercially available computer information systems available to h o s p i t a l s , and the majority of these consider the pharmacy as one of the Important information and cost centers.'' Figure 2 . 3 summarizes the general work flows that a hospital pharmacy deals with, and gives some idea of communications with other departments of the h o s p i t a l . 2 . 2 L i terature Review Several excellent journals e x i s t which r e g u l a r l y cover a l l aspects of h o s p i t a l pharmacy operations. Subject matter can range from an in-depth analysis of the chemical composition of p a r t i c u l a r drugs, to statements on current l e g a l requirements on drug dispensing, to various admini-s t r a t i v e problems confronting the hospital pharmacist. I t i s r e l a t i v e l y rare to f i n d an a r t i c l e , or book fo r that matter, dealing with the application of management science techniques to pharmacy operations. However, some l i t e r a t u r e relevant to t h i s thesis has been reviewed and i s summarized below. 7THIS (Total Hospital Information System), a computer based information system available from Medelco Inc., 2 0 0 E. Irving Park Road, Wood Dale, I l l i n o i s , 60191. 20 FIGURE 2.3 GENERAL DIAGRAM OF A HOSPITAL PHARMACY'S ENVIRONMENT 4 ItOSPiTflJ. T>£fT. 4 ftPMl>J I S T K f l T i O i J coo?!!?-C O M r A i J l l T S 21 2 . 2 . 1 Hospital Pharmacy Work-load Studies Some work has been done on the analysis of hospital pharmacy work-loads. Didier (I965) conducted a study of the pharmacy i n St. Joseph Mercy Hospital (Ann Arbor, Michigan), in order to determine the cause and e f f e c t of pharmacy work-load v a r i a t i o n s . Analysis r e s u l t s were depicted i n the form of t o t a l work-load graphs, and s i g n i -f i c a n t cost reductions were proposed by changing s t a f f i n g schedules and requirements. In conjunction with this work-load analysis the author also conducted time studies on the basic pharmacist operations, such as pre s c r i p t i o n e d i t i n g , l a b e l typing, and dispensing. These are extremely useful i n simulating the hospital dispensary operations. Barker et a l . (1972) did an in-depth study of the work of pharmacists in f i v e small hospitals using the techniques such as work sampling, continuous observations, and photography. As well as providing a de t a i l e d breakdown of the types of Jobs done by the pharmacist, the report provided data on the d i s t r i b u t i o n of work time between these a c t i v i t i e s . This study has implications and usefulness other than determining the p o t e n t i a l use of a u x i l i a r i e s or non-professional s t a f f in the pharmacy. A breakdown, such as these authors provide, i s extremely valuable i n v e r i f y i n g the accuracy of a pharmacy model. Turnbull et a l . (1965) also studied trends i n the u t i l i z a t i o n of pharmacists and attempted to define the 22 pharmacy manpower required for each one hundred beds in a hospital. Bias ingsana et a l . (I969) did time and motion studies of the use of single unit packaged drugs. Neubrecht and Emmanuel (I97I) surveyed the utilization and attitudes of pharmacy technicians. With this literature, available, the functions and manpower requirements of a hospital pharmacy are well docu-mented. However, the only literature found using management science techniques to predict.manpower requirements was an ar t i c l e by Liebman et a l . (1970). Using queuing theory, they attempted to produce a schedule for outpatient pharmacist requirements based on prescription arrival rates, and with the objective of minimizing patient waiting time. Their schedule also had the restriction that no more man-hours could be used than were presently being allocated. They developed estimates of the expected waiting time as a function of the arrival rate per pharmacist. However, rather than attempt to measure this arrival rate and allocate the appro-priate manpower, the authors scheduled pharmacists according to the number of prescriptions waiting for service, or queue length. Prescription arrivals were found to be Poisson, and the number of prescriptions per patient were estimated by a geometric distribution. It was also concluded that service time was a random variable but d i f f i c u l t to f i t to a pro-bability distribution because of the variety, of types of prescriptions and occurrence of batch service. 23 2.2.2 Drug; D i s t r i b u t i o n Systems This area i s perhaps the most thoroughly covered by current l i t e r a t u r e . With the use of unit dose packaging more f l e x i b i l i t y has evolved in the drug d i s t r i b u t i o n cycle. Durant (I968) describes how University Hospital in Wisconsin developed i t s medication d i s t r i b u t i o n system and indicates the various problems associated with the decen t r a l i z a t i o n of pharmaceutical services. Mehi (1968) also presents guide-l i n e s on drug d i s t r i b u t i o n methods, while the American Society of Hospital Pharmacists (I965) went so f a r as to review the types of systems in use and present guidelines for evaluation of various d i s t r i b u t i o n systems f o r p a r t i c u l a r hospitals. However, applying costing techniques to the choice of a l t e r n a t i v e d i s t r i b u t i o n systems has not been considered in most cases. Schnell and Hammel (1971) did compare unit dose costs under various d i s t r i b u t i o n systems, but such examples are d i f f i c u l t to f i n d . Most hospitals have t h e i r own peculiar d i s t r i b u t i o n problems and generalized methods are d i f f i c u l t to apply. 2.2.3 Drug Inventory Studies Inventory control i s one area where successful application of theory i s abundant. However, the health-service f i e l d has not made much use of s c i e n t i f i c inventory 24 control methods. D'Ambola ( I 9 6 9 ) suggests the use of sampling techniques to maintain accurate records of cur-rent drug inventory. This method was also suggested by Chmielewski ( 1 9 6 4 ) . Webb ( 1 9 ? 0 ) studied various methods of inventory control at St. Louis State Hospital and applied s c i e n t i f i c inventory techniques to recommend a fixed order quantity system. Drug purchasing i s another important facet of inven-tory control. Jones ( I 9 7 0 ) studied feasible methods of purchasing drugs at Penrose State Hospital (Colorado) and recommended that purchasing be centralized i n the hospital purchasing deparment. Motta ( 1 9 6 4 , I 9 6 5 ) also covered various problems in developing an integrated drug purchasing system. I t i s i n t e r e s t i n g to note why so few successful applications of inventory management theory can be found since simple hand models can be e f f e c t i v e in c a l c u l a t i n g economic order quantities and reorder, points. Perhaps one of the main reasons i s that hospitals carry a large number of d i f f e r e n t drugs. Maintaining accurate usage and on-hand records f o r each p a r t i c u l a r drug would, therefore, be a time-consuming task and the hospital pharmacy usually does not have s u f f i c i e n t funds or manpower resources to warrant such an inventory control system. There i s no doubt that s c i e n t i f i c inventory control works best when a computerized record of each drug i s a v a i l a b l e . I t i s then ; a simple 25 matter to obtain up-to-date reoords and s t a t i s t i c s to help control drug inventory. Very few hospitals can afford the type of integrated computer system necessary, but when computer power i s a v a i l a b l e , the v a r i e t y of f e a s i b l e applications in the pharmacy is impressive. A r t i c l e s , such as those by Evans and Howe (1971), and Eckel and L a t i o l a i s (1965)» v e r i f y t h i s . In f a c t , some hospitals, such as the Ottawa C i v i c Hospital (Smythe, et a l . 1 9 6 8 ) , have actually used computers to produce their hospital formulary, which i s e s s e n t i a l l y a master l i s t of drugs avail a b l e i n the pharmacy inventory. Analysis of drug costs, however, i s r e l a t i v e l y scarce. Muller et a l . (I967) attempted an analysis of i n -patient drug costs. Paul (I967) studied various costs associated with the preparation of solutions in hospitals. On the whole, the costing of hospital pharmacy services should be a r e l a t i v e l y simple task, as most costs are d i f f e r e n t i a b l e and concrete. 2 . 2 . 4 Other General Applications Naylor and Tester ( 197D applied stepwise regression in an attempt to analyze hospital pharmacy costs. They were able to predict two v a r i a b l e s : (1) raw drug cost per day, and (2) t o t a l pharmacy costs per patient day. They showed that the type of drug d i s t r i b u t i o n system used by the hospital i s an important contributor to pharmacy costs. The 26 actual predictor equations have been summarized in Appendix A. The application of simulation to the hospital phar-macy area has not been found in the l i t e r a t u r e , although Lapp (I969, 1970) has studied pharmacy operations in d e t a i l and proposed a possible simulation. Many of his ideas have been found relevant to this thesis. His approach i s to consider the pharmacy as a supply or service department i n the h o s p i t a l . He attempts to define how this area could be modelled along the l i n e s of a general support function. This approach requires a "black box" model where detailed operations are not simulated, but inputs are related to outputs in an appropriate manner through extensive use of p r o b a b i l i t y d i s t r i b u t i o n s . In summary, the l i t e r a t u r e available describes most of the operations of a hospital pharmacy. L i t t l e e f f o r t has been made to abstract the basic pharmacy functions and r e l a t e them in a simulation model. .Perhaps the c l o s e s t approximation was the Liebman study, but even then, the v a r i e t y of dispensing operations that could be performed made i t d i f f i c u l t to successfully predict service times. Appli-cation of other techniques would be a d i f f i c u l t task because of the variety of functions that are performed, sometimes i n d i f f e r e n t sequence, and sometimes with d i f f e r e n t p r i o r i t i e s . It would appear that a simulation model offers the most f l e x i b l e approach as i t would allow approximation of current operations, permit the incorporation of d e t a i l e d 2? modeling with more general estimations, and s t i l l allow modifications and experimentation. The information found in the l i t e r a t u r e could also be consolidated and used to model the various functions in the pharmacy. 2.3 Simulation Techniques Simulation can be defined as the use of models to analyze r e a l world s i t u a t i o n s . These models have taken many forms. The armed forces have used large maps and movable pieces to simulate war a c t i v i t i e s and test various st r a t e g i e s . E l e c t r i c a l c i r c u i t s have been used in analogue computers to simulate r e l a t i o n s h i p s in a r e a l world system. Simultaneous measurements are often possible in many parts of the analogue model by using e l e c t r i c pulse recorders. Thus this type of model allows the user to experiment and te s t the system's reaction to changes i n one or more inputs or r e l a t i o n s h i p s . However, the more recent development of d i g i t a l computers has allowed the experimenter to b u i l d more complex models. Using symbolic computer languages, a simulation model can be b u i l t that includes many mathematical and l o g i c a l r e l a t i o n s h i p s . With the use of generalized simula-tion languages, the task of b u i l d i n g a model i s much easier and can be completed in less time. Thus, the cost-effectiveness of simulation becomes more a t t r a c t i v e and has resulted in the increased application of this technique. 28 The complete process of simulation involves several tasks: systems analysis, d e f i n i t i o n of objectives, .model build i n g , and experimentation. Of these, perhaps the most d i f f i c u l t and complex i s that of model building. The model must r e f l e c t the basic attributes that the investigator wishes to study. I t can range from a detailed operation analysis to a more general r e l a t i o n s h i p of inputs to outputs. In many cases, a system i s so complex that an i n d i v i d u a l operation simulation would be a monumental task. Thus, most models w i l l include some generalizations or estimates of r e l a t i o n s h i p s . In order to b u i l d a s a t i s f a c t o r y model, the inves-tigator must become f a m i l i a r with the system. This usually involves a learning process. I t i s not unusual for several models to be developed, each successive one r e f l e c t i n g a better understanding of the operation of the system and eliminating unnecessary d e t a i l s . The more general form of model has been described as a "black box" (Lapp, I969). Inputs arrive at predetermined i n t e r v a l s and are transformed into outputs by the r e l a t i o n -ships contained in the black box. In this case, the contents of the black box are not of i n t e r e s t , only the e f f e c t of input changes on outputs. As long as the t r a n s i t i o n Is achieved in a way that r e f l e c t s actual system behavior, the model can be considered accurate. An example of this type of model i s shown i n Figure 2 .4. 29 w Black Box y = w + 2x FIGURE 2.4 "Black Box" Model v y The black box model would be appropriate for a very general type of simulation, and requires very l i t t l e under-standing of how a system operates. At the other extreme i s the modeling of actual opera-tions. To b u i l d this d etailed model, the investigator must c a r e f u l l y study each r e l a t i o n s h i p and type of work under-taken in the system. Operations would then be modeled on a one-for-one basis. An example of such a model i s shown i n Figure 2 .5. Using operation modeling f o r a complex system can r e s u l t in a complicated simulation. Usually the time incre-ment in the model must be very small in order to allow inclusion of each operation. Simulation of a large time span may take a large amount of computer time so that costs become p r o h i b i t i v e . Also,the investigator becomes involved in too much d e t a i l and may lose sight of the basic functions req u i r i n g study. F i n a l l y , the detailed operation model usually proves d i f f i c u l t to change unless i t has been b u i l t on a modular basis. I f operation changes are to be studied, 30 the computer program w i l l generally require some refinements, Thus, operation modeling i s suitable for only a li m i t e d number of systems. E d i t P rescription Phone doctor or nurse Correct Prescription Information yes Place Ready For Label Typing  FIGURE 2.5 Prescription Editing Operation In most cases, the investigator w i l l formulate'a model that i s a compromise between these two extremes. This has been ca l l e d a functional flow model by Lapp (I969). Each function, which can consist of one or more operations, is modeled, and transactions or types of work are passed through 31 these function modules. Examples of functions in the hospital pharmacy include dispensing, manufacturing, and inventory c o n t r o l . In most cases, only the important operations w i l l be included i n each function module, with others being simulated by sampling from p r o b a b i l i t y d i s t r i b u t i o n s . Generally, each function w i l l have several parameters asso-ciated with i t which can e a s i l y be changed to analyze various system configurations. For example, one parameter in the dispensary function might be the number of pharmacists on duty. In a l l cases, however, i t i s important not to lose sight of the main purpose of simulation: to provide the opportunity to generate 8nd test alternative forms of the system under study. D e f i n i t i o n of the basic requirements of the simulation model w i l l enable the investigator to deter-mine the d e t a i l necessary, and the type of output required. The simulation must provide s u f f i c i e n t output s t a t i s t i c s so that the investigator can examine the e f f e c t of the various r e l a t i o n s h i p s and values included in the model. ####### 32 CHAPTER III SYSTEMS ANALYSIS It i s important to understand how a system operates before formulating a simulation model. A d e t a i l e d systems analysis was therefore undertaken of the various functions of the Vancouver General Hospital Pharmacy. The r e s u l t s are summarized i n t h i s chapter. The Vancouver General i s an acute care hospital con-taining about 1,664 beds. The average length of stay of patients i s approximately 12.3 days. An estimated 3.1 per cent of hospital expenditures are f o r drugs, or approximately $1.84 per patient day."1* The hospital i s c e n t r a l l y located i n the Greater Vancouver area. The organization chart, shown in Appendix B, gives some in d i c a t i o n of the many components of such a large h o s p i t a l . The main pharmacy i s located i n the basement of the l a r g e s t p a v i l i o n . Prescriptions and other supplies are trans-ported to the various wards by pneumatic tube or by messenger. The outpatient pharmacy i s located i n a differ'eftt^buII&I-Sg. The main pharmacy includes areas f o r dispensing, manufacturing, pre-packaging, preparing solutions, and storage of pharma-c e u t i c a l s . The actual layout i s shown In Figure 3»1» iDominlon Bureau of S t a t i s t i c s , Canada Year Book. 1970-71. PP. 362-366. 33 FIGURE 3.1 Floor Plan of Vancouver General Hospital Pharmacy WA£j> srocc T > R « . S O L U T i O M S ROOM ^ P U b J I S I N J O T T O SCftk£ } 34 Most of the major work-flows have been Included in the following analysis. A description of the more important pharmacy s t a f f functions i s also provided. The summary at the end of t h i s chapter w i l l outline the conclusions reached on the f e a s i b i l i t y of a pharmacy simulation, and describe the approach taken i n this thesis. 3.1 Inpatient Dispensary This area provides services to the hospital every day of the week. The scheduled open hours are as follows: Monday - Saturday: 8:30 a.m. to 6:00 p.m. Sunday and Holidays: 9:00 a.m. to 5'00 p.m. Using a black box model, the inpatient dispensary work-flows would appear as i n Figure 3»2. This dispensary i s the major Information disseminating area and receives phone c a l l s from nurses and doctors. Also, since the pharmacists in t h i s area deal with the hospital p r e s c r i p t i o n work-load 9 most of the queries or requests for more pr e s c r i p t i o n i n f o r -mation w i l l originate from here. 3.1.1 Work-Flows New personal prescriptions originate from the ward nurses. Normally, they w i l l request drugs for an i n d i v i d u a l patient. More than one p r e s c r i p t i o n can be included on eaoh form. The nurse must provide a l l the required dispensing information: date, ward, name of drug, strength, doct., . FIGURE 3.2 Inpatient Dispensary Work-Flow us*/ T>,Zecr D O C T O R 8^  / — -* (SitoKT u s r ) / opev^ fvnotvjs — icxbiil -hyping 36 name, and her own signature. The pharmacist does not generally have to supply dosage instructions as the nurse w i l l have these on the doctor°s orders sheet from which she obtained information f o r the order, A more de t a i l e d work-flow for these forms i s shown In Figure 3.3» R e f i l l personal prescriptions are also requested by the nurse. However, i n this case, only the patient's name and ward i s supplied along with the container from the o r i g i n a l p r e s c r i p t i o n . The pharmacist has only to dispense the drug. Label typing i s required f o r r e f i l l s when the o r i g i n a l container i s not supplied, ( i . e . , when i t has been broken i n t r a n s i t , or i s i n general not reusable). A d e t a i l e d work-flow f o r these r e f i l l personal prescriptions i s shown in Figure 3.4, D i r e c t doctor prescriptions have recently been introduced i n the Vancouver General Hospital but are only being used on a l i m i t e d number of ward. However, i t i s l i k e l y in the near future that t h e i r use w i l l become more widespread. Their consideration i n a simulation model Is, therefore, important as an analysis of changes i n work-loads can be undertaken by increasing the volume being looked aft e r i n the dispensary. Direct doctor prescriptions have a s l i g h t l y d i f f e r e n t work-flow than do the personal prescriptions. Drug orders are written on doctor's order sheets along with prescribed x-rays, lab t e s t s , and various other treatments and 37 FIGURE 3.3 New Personal Prescriptions Work-flow Medication order written by doctor (or v i a nurse) on patient chart. ... Transcription of order to medication card and .patient's Kardex  ' • V Medication order transferred by nurse to presc r i p t i o n form  Tube mess or efnger INPATIENT DISPENSARY 4 Prescription form covered by pharmacist with respect to: (1) i l l e g i b l e handwriting (2) drug, dosage and queried or/and corrected Pharmacist—Typist types labels j for prescriptions \ Prescription form f i l e d by building 1 Label a f f i x e d to container and .prescription f i l l e d by-pharmacist Tube or messenger R.N. Nursing s t a t i o n FIGURE 3o4 R e f i l l Personal Prescriptions Work-flow Medication order previously written by-doctor (or via nurse) on _doctor°s order page  A. Nurse receives confirmation from doctor to repeat medications  4 Nurse transcribes r e f i l l order to prescription form l i s t i n g otaly patient name and ward, and sends with original container  Tube or messenger INPATIENT DISPENSARY Original container and prescription form checked by pharmacist  y Label typed i f necessary Prescription form f i l e d under r e f i l l s Order r e f i l l e d by pharmacist Tube or messenger V R.N. Nursing s t a t i o n 39 i n s t r u c t i o n s . Instead of the nurse transcribing the prescriptions to a separate form, a copy of the entire doctor's order sheet i s sent to the pharmacy. The phar-macist must then e d i t these and determine i f new prescrip-tions are required. He also has access to a patient f i l e containing a l l previous doctor's order sheets, and can check the medication history of the patient and look for possible drug i n t e r a c t i o n s . In t h i s way, the new d i r e c t doctor prescriptions require more of the parmacist's time, but he i s also able to provide a more complete service. Some of the doctor's order forms sent to the pharmacy w i l l not require any new pres c r i p t i o n s . In these cases, the form i s simply placed in the patient's f i l e . For those r e q u i r i n g a new p r e s c r i p t i o n , the e d i t i n g pharmacist under-l i n e s the required drug, and l a b e l typing and dispensing i s performed i n the same way as for new personal prescriptions. Figure 3.5 outlines the main steps i n this work-flow. R e f i l l d i r e c t doctor prescriptions are requested on a s p e c i a l form and originate from wards which use the doctor's order sheets previously described. In this case, the p r e s c r i p t i o n i s transcribed by the nurse. Unlike personal r e f i l l s , no o r i g i n a l containers are returned. Therefore, the order must contain the f u l l information requirements f o r the p r e s c r i p t i o n . These r e f i l l prescriptions are generally not edited as thoroughly as the new d i r e c t doctor requests, but the pharmacist w i l l r e f e r to the patient's f i l e i f he 40 FIGURE 3 „ 5 Mew Direct Doctor Prescriptions Work-flow Medication written by doctor (or. v i a .nurse), on doctor's order page Duplicate of doctor's order page removed by nurse  Tube or INPATIENT Transcription of order to medica-tion card and Kardex messenger DISPENSARY V Order page and previous pages edited by pharmacist with respect tos 1) Medications available as ward stock (marked (W/S) 2) Drugs to be dispensed by pharmacist underlined 3 ) Incorrectly prescribed medications — i l l e g i b l e handwriting, drug, dosage 4) Potential drug, laboratory interactions Pharmacist contacts nurse or doctor to advise and c l a r i f y  Pharmacist-typist types labels f o r medications to be dispensed  Labels attached to doctor's order page V Doc tor's order page f i l e d by patient name i Label attached to container and order i s f i l l e d by pharmacist Tufce or Messenger R.N. Nursing Station Doctor's order page again edited and marked."filled" beside medications dispensed  41 notices something out of the ordinary. Figure 3.6 d e t a i l s the r e f i l l d i r e c t doctor work-flow. Staff members requiring prescriptions can come to the dispensary counter during open hours. However, t h e i r prescriptions are only f i l l e d during c e r t a i n hours of the day. At present, any s t a f f prescriptions brought to the dispensary before twelve noon are f i l l e d and made availa b l e between 2:00 p.m. and 4:00 p.m., otherwise they w i l l not be ready u n t i l the following day. A pharmacy aide looks a f t e r d i s t r i b u t i o n of these prescriptions to s t a f f members and c o l l e c t s any necessary charges. New prescriptions and r e -f i l l s are looked a f t e r i n much the same way as f o r the personal p r e s c r i p t i o n s . However, s t a f f prescriptions w i l l interrupt the normal dispensary work-flow as a pharmacist must go to the counter, check the pre s c r i p t i o n to see i f the drug i s avai l a b l e i n the hospital formulary, and provide instructions to the s t a f f member. Another major task i n the operations of the inpatient dispensary i s looking a f t e r the phone c a l l s that originate from doctors and nurses. Often, some time must be spent providing information. Some of the phone c a l l s are f o r s p e c i f i c people i n the dispensary so that normal work patterns must be interrupted. This information dissemination process occurs randomly throughout the day. Also i n conjunction with editing the various types of p r e s c r i p t i o n s , the pharmacist w i l l have to phone doctors 42 FIGURE 3.6 R e f i l l D i r e c t Doctor Prescriptions Work-flow Medication order previously written by doctor (or v i a nurse) on doctor's order page  i "Nurse receives confirmation from doctor to repeat medications  Transcribed by nurse on r e f i l l order form J Tube or Messenger INPATIENT DISPENSARY V R e f i l l order page and previous doctor's order pages edited by pharmacist with respect to* 1) Incorrectly prescribed medications— i l l e g i b l e w r i t i n g , drug dosage 2) Automatic stop order d r u g s — r e q u i r e new order from doctor 3) P o t e n t i a l drug t o x i c i t y 4) Ward stock (mark W/S) Pharmacist contacts nurse or doctor to advise or c l a r i f y I Pharmacist types labels f o r medications 1 Pharmacist attaches labels to r e f i l l order page  1 R e f i l l page and previous order pages again edited  Label a f f i x e d to container and order i s f i l l e d by pharmacist R e f i l l page f i l e d under r e f i l l s Tube . or . Messenger \J  B.N. Nursing Station 43 and nurses to obtain c l a r i f i c a t i o n on c e r t a i n orders, or to advise on possible drug i n t e r a c t i o n s . This work w i l l generally take place as the pharmacist deals with each pre-s c r i p t i o n . The pharmacists in the dispensary also perform several other miscellaneous tasks. During the course of dispensing operations, i f a p a r t i c u l a r drug i s found to be low stocked, i t i s entered on a l i s t c a l l e d the "short l i s t . " Each day th i s short l i s t i s reviewed by the pharmacist i n charge of drug ordering, and r e q u i s i t i o n s for more stock are sent to the purchasing department. Investigational drugs also require s p e c i a l operations. Usually, one pharmacist i s i n charge of t h i s group of drugs and he must maintain d e t a i l e d f i l e s on p r e s c r i p t i o n informa-tion and the amount of each drug i n stock. Requests f o r i n v e s t i g a t i o n a l drug Information must go to t h i s pharmacist, and orders for add i t i o n a l stock w i l l also be i n i t i a t e d by him. Some prescriptions require p r i o r i t y handling. These "sp e c i a l s " can eit h e r a r r i v e by tube or messenger. Often a nurse w i l l bring an order to the dispensary and wait u n t i l i t i s f i l l e d . Thus, the pharmacist tends to f i l l these prescriptions as soon as possible, usually interrupting current work. The inpatient dispensary also has a pharmacy aide on duty from Monday to Friday. She performs such tasks as: 44 looking a f t e r the tube station,, sorting prescriptions as they a r r i v e , matching r e f i l l s with containers, obtaining patient f i l e s for d i r e c t doctor prescriptions, pre-packaging and l a b e l i n g narcotics and controlled drugs, and other routine housekeeping tasks. Thus, the various dispensary tasks can be grouped as shown In Figure 3 » 7 . Manpower needs are important in the e f f i c i e n t operation of the dispensary, and work can be assigned to pharmacists or to pharmacy aides. P r i o r i t y jobs and other interruptions have an e f f e c t on the work-flow and turn-around time f o r pr e s c r i p t i o n dispensing. Any simulation model must, therefore, consider job a r r i v a l s , manpower a v a i l a b i l i t y , job assignment, and p r i o r i t y or preempting tasks. 3.1.2 Work-load The graph shown in Figure 3o8 i l l u s t r a t e s the a r r i v a l d i s t r i b u t i o n s f o r the major types of work i n the inpatient dispensary. The data was gathered on a day considered repre-sentative of the operations of this area. I t can be seen that the inpatient prescriptions continue to ar r i v e before and aft e r the dispensary i s closed. In f a c t , i t was found that the d a i l y volume of these pre-s c r i p t i o n s spread over three major time sectors as follows: TIME #HOURS ' % OF TOTAL 6 pm - 8 am 14 28 8 am -12 pm ^ 37 12 pm - 6 pm 6 35 ^5 FIGURE 3.7 Inpatient Dispensary Operations V N ) O R < PitftCilKf > £ X > i T i ( ^ 6 - M £ A / P u t t e r D O C T O R P 6 ? J C £ i P r u > s S . P£oUlt>l i \ j5- I N f b £ r t f * T i O i v l Serv ice C O U I V J T E ^ . < < oPe^nnoiJ^. PttWg' OVu-S P f t ^ c C v P n c x ^ P K*ORIT< PceetnPr 46 47 Staff prescriptions did not s t a r t a r r i v i n g u n t i l 9 a.m., and 71 per cent of the t o t a l f o r the day arrived before twelve noon. This i s s i g n i f i c a n t i n that because of the schedule set up for f i l l i n g these prescriptions, the remaining 29 per cent would not be available u n t i l the following day. Phone c a l l s arrived randomly throughout the d i s -pensary open hours. Queries generated by p r e s c r i p t i o n errors were also handled over the phone so that there was a flow of outgoing phone c a l l s as well as incoming. The volume of incoming has been estimated at 228 per week based on a t y p i c a l work day. Prescription volumes were co l l e c t e d for several weeks to provide the s t a t i s t i c s shown in Table J.l and Table 3.2. These indicate that approximately 2,387 prescriptions are f i l l e d each week. This includes s t a f f prescriptions but not narcotics and controlled drug orders which w i l l be covered l a t e r . I t must be noted that the s t a f f p r e s c r i p t i o n service i s not offered on Saturdays and Sundays thus reducing the p r e s c r i p t i o n volume. S i m i l a r l y , Sunday pr e s c r i p t i o n volume i s approximately 75 P©r cent of that found i n other week days. Also of Interest was the number of prescriptions on each form entering the dispensary. Table 3*3 summarizes the data gathered. These w i l l be important In any simulation of dispensary ttfork-flows. The task of sort i n g work as i t 48 TABLE 3.1 DISPENSARY DAILY WORK-LOAD Average Rx by Day of Week Type Mon. Tue, Wed. Thur, F r l . Sat. Sun, l,New personal 157.8 Rx 210.4 214,2 212.8 220,2 228 220.3 2 , R e f i l l pers 0Rx 81 .5 65 .5 79 81 .5 81 77 59 3.New Direct Doctor Rx 21 26 11 15 17 10 15 4 . R e f i l l D i r . Doctor Rx 8 12,5 9 12 5.5 10.5 12 Inpatient 317.8 243.8 Average 320.9 318.2 3 H . 8 328.7 331.5 5 . S t a f f Rx (include r e f i l l s ) 46.3 41.3 45.2 36.4 45.3 Day Avge. 367.2 369.5 357.0 365.1 376.8 317.8 243.8 Daily S t a t i s t i c s Mon. - Sat. Sun, Avspo S 0D 0 Avge. i S.D. l.New Personal Rx 216.7 19.2 157.8 22.2 2 . R e f i l l pers. Rx 77.6 9.2 59.3 5.5 3.New Dire c t 17.6 Doctor Rx 17.6 9.9 9.9 4 . R e f i l l D i r . . Doctor Rx 9.6 3.8 8.0 3 .2 Inpatient 242.7 Average 321.5 5.New Sta f f Rx 33.9 10 .7 6 . R e f i l l Staff Rx 8 0 4 2,9 Staff Avge. 42,8 TABLE 3.2 DISPENSARY WEEKLY WORK-LOAD Weekly S t a t i s t i c s Inpatient Rx: (Mon.-Sun.) # 1. New Personal 1463.7 2. R e f i l l Personal 524.5 3. New Dir e c t Doctors 115 4. R e f i l l D i r e c t Doctors 69o 5 Tot a l : 2172.2 S t a f f Rx: (Mon.-Fri.) 5. New S t a f f Rx 169.5 6. R e f i l l S t a f f Rx 45.0 Totals 214.5 Phone C a l l s i n : (Mon.-Sun.) (estimated from t y p i c a l day) Total = 34 x 6.7 = 227.8 50 a r r i v e s i n the dispensary i s dependent on the number of forms, while e d i t i n g , typing, and dispensing operations depend on the number of prescri p t i o n s . TABLE 3.3 NUMBER OF PRESCRIPTIONS PER FORM % of Forms with #Rx Type of Form 1 2 3 4 5 or more New Personal 89.7 7.4 2.1 .7 .1 R e f i l l Personal 70.8 17.1 7.3 3.7 1.1 New Dire c t Doctor 87.0 11.7 1.3 -R e f i l l Dir.Doctor 66.3 18.7 6.3 8.7 -Staff 84.7 13.7 1.6 « , — F i n a l l y , ' Table 3.4 summarizes the areas served by the inpatient dispensary, . I t i can be seen that most of the major pr e s c r i p t i o n work--load originates from two p a v i l i o n s , Heather and Centennial. TABLE 3.4 SOURCE OF PRESCRIPTION WORK-LOAD IN THE INPATIENT DISPENSARY Source Area % Heather P a v i l i o n 46.0 Centennial P a v i l i o n 31.^ Health Center f o r Children 8.4 Fairview P a v i l i o n 4.3 Willow P a v i l i o n 2.6 Temporary Annex 2.6 Intensive Care Unit I d Emergency .8 Heather Annex «6 Other 2.2 l O O o O 51 3.2 Narcotics and Controlled Drugs Narcotics and controlled drugs require special handling and security measures as can be seen from the government regulations included in Appendix C. In the Vancouver General, a narcotics control clerk is respon-sible for dispensing these drugs on week-days. On weekends and holidays9 the pharmacists in the dispensary assume this duty. Narcotic drugs require the strictest security measures. The work-flow is illustrated in Figure 3 . 9 . Orders must be brought to the pharmacy and returned to appropriate wards by messenger. Special control forms must be signed by various personnel handling narcotic orders. These drugs are dispensed in the morning according to a fixed schedule. For example, at 10:30 a.m., orders from the Centennial Pavilion are f i l l e d . At 12:30 p.m., other major pavilion orders are f i l l e d . Thus, the work of the control clerk is evenly scheduled, and other ac t i v i t i e s rarely interrupt the dis-pensing operation. Controlled drugs require much the same work as narcotic drugs, although with less emphasis on security. Orders can arrive at any time, and controlled drugs may be shipped by pneumatic tube or messenger. Figure 3»10 shows the controlled drug work-flow0 52 FIGURE 3 ,9 Narcotic Drugs Work-flow RN completes form for narcotic drugs  I Form co-signed by .... building supervisor NARCOTICS Messenger only AND CONTROLLED DRUGS AREA Requisition f i l l e d and drug record sheet completed listings ward, pharmacist (aide), drug, strength, units of issue, dats.  Narcotics placed in brown bag with drug record affixed to bag  Messenger . only j Nursing Station I Delivery copy signed .by...... messenger  Checked by RN Receiving copy signed and returned to pharmacy  Filed by Pharmacy aide JZ Tube 53 FIGURE 3 . 1 0 Controlled Drugs Work-flow RN completes form for controlled drugs  Co-signed by head nurse"f Tube NARCOTICS or messenger AND CONTROLLED DRUGS AREA Requisition f i l l e d and drug record sheet completed l i s t i n g ward, pharmacist (aide), drug, strength, units of issue, date. (Delivery copy remains in pharmacy). Drugs and sheet placed in interdepartmental envelope Filed by pharmacy aide Tube or messenger Tube or messenger Checked by RN Receiving copy signed and returned to the.- . pharmacy  54 Orders for narcotics or controlled drugs are trans-cribed onto three-part forms. These are used as a security-measure to make certain that the drugs ordered, dispensed, shipped, and received,all correspond. Each form must contain the originating ward, date, drug name, drug strength, amount, and the signature of the person dispensing the drug. Narcotic orders are placed in individual brown bags with the control form attached to the outside. Controlled drugs are usually placed in an interdepartmental envelope» Narcotic and controlled drugs are prepackaged in units of ten or twenty-five capsules or tablets. The pharmacy aide in the inpatient dispensary normally makes sure that a sufficient supply of these drugs have been prepackaged. The narcotic control clerk also keeps an exact count of the number of drug capsules that are in stock. After the morning dispensing work, the individual drug inventory f i l e s are updated. Thus, the purchase of additional narcotic or controlled drugs can be initiated whenever stock levels are seen to be relatively low. A study of February drug usage found that a total of 736 narcotic orders were f i l l e d , while 854 controlled drug orders were dispensed. These figures do not include the narcotic and controlled drugs which were dispensed by the outpatient dispensary. Table 3°5 outlines the major sources of inpatient narcotic and controlled drug orders. 55 Thus, narcotic and controlled drug dispensing is a relatively segregated operation. Only on weekends and holidays w i l l i t affect the operation of the inpatient dispensary. TABLE 3,5 SOURCES OF IMPATIENT NARCOTIC AND CONTROLLED DRUG ORDERS AREA Narcotics i Heather Pavilion Centennial Pavilion Willow Pavilion Fairview Pavilion Other Controlled: Heather Pavilion Centennial Pavilion Willow Pavilion Fairview Pavilion Other 3.3 Ward Stock 42.0 39.5 A^ge« 2.5 Order/Day 3<>7 = 35 12,3 100.0 33.0 40.9 9.1 Avge. - 6.8 Order/Day 10.2 = 40 100.0 This Is essentially a self-contained area of the hospital pharmacy. It has ^.ts own staff and responsibi-l i t i e s , and operates according to a well-defined work schedule. Orders are received and f i l l e d from 8:30 a.m. to 12 noon on Monday to Saturday. The ward stock area is not open for special ordering as is the dispensary, hut some miscellaneous orders w i l l be f i l l e d If they are brought and returned by messenger or ward personnel. 56 The majority of ward stock orders are handled in the following way. Each hospital ward keeps a stock of often used drugs or pharmaceuticals such as aspirin, anti-biotics, cold cream, soap, rubbing alcohol, and other pre-parations. Additional supplies are requisitioned from the pharmacy ward stock area using a special order booklet. This l i s t s the majority of pharmaceuticals available on a ward stock basis, and provides ordering space for each day of the month. Each ward simply has to mark down the quantity of a drug required under the appropriate day column. Two types of booklets are in use? one for general wards (yellow), and another for the area technicians (blue). The latter has an abbreviated ward stock l i s t . Individual requisition slips are also available for special orders or for hospital areas which do not require an extensive ward stock service. Thus, the work-flow for ward stock requisitions is as shown in Figure 3.11. Pre-scheduled ward stock orders arrive in the morning via the pneumatic tube in the dispensary, or by messenger. Some of these ward stock pharmaceuticals can be quite bulky so special transportation arrangements are available. The supplies requested in each booklet are gathered by the pharmacy ward stock personnel and placed in special carts. These are then picked up b^ the hospital transportation service and delivered to appropriate hospital wards. This pickup service is only available during the mornings, and is FIGURE 3.11 Ward Stock Work-flow RN or nurse aide enters. items in ward stock book Tube WARD or Messenger (a.m.) STOCK AREA Requisition f i l l e d by pharmacy aides and book signed  1 Ward stock and requisition book returned V Transporation Service 1 Nursing Station 58 scheduled for the main hospital pavilions. Thus, the ward stock area must f i l l requisitions in order to be ready for this delivery service. The ward stock area is mainly staffed by pharmacy aides. They perform most of the order f i l l i n g . During the afternoon, most of the work Involves pre-packaging ward stock, stocking shelves, and some manufacturing. Several pharmacists are also on duty in this area. They supervise operations and perform specialized tasks such as manufac-turing, production control, and raw material inventory control. Table 3»6 summarizes the data collected for February. The 927 dally orders can easily be handled by this area since a l l drugs are pre-packaged and pre--labelled. 3.4 Solutions Again, this is a self-contained area of the pharmacy which has i t s own particular work-flow as shown in Figure 3 . 1 2 . It is staffed by technicians who perform the various functions of solution preparation, s t e r i l i z e and clean bottles, and do other miscellaneous tasks related to the preparation of sterile solutions. Requisitions for IV (intravenous) and topical solutions are f i l l e d each morning from Monday to Saturday in much the same manner as for ward stock. Some orders are f i l l e d on Sunday, but not on a regular basis. Solutions 59 TABLE 3.6 WARD STOCK DATA Pavilion Yellow Book Orders Blue Book Orders Misc.Orders Avcre/day Avge/book Avge/day Avge/book Avge/day Heather 165 7.2 13^ 9«0 73 Centennial 111 9.2 121 10.1 59 Fairview 35 8.0 19 9.5 6 Willow 39 6.5 - - 6 Health Center 30 for Children 7.5 36 6 8 Other 60 20.0 _ 20 440 8.5 310 6.6 172 A l l Orders Avge/day % of Total Orders Heather 372 41 Centennial 291 29.3 Fairview 60 7.0 Willow ^5 5.8 Health Center for Children 74 6.3 Other 80 10.6 927 100.0 FIGURE 3.12 Solutions Work-flow RN (night shift) enters items on solutions requisition form  Tube or SOLUTIONS Messenger AREA 1 Requisition f i l l e d and sheet signed by technicians  V Solutions and delivery sheet placed in ward cart  Transportation Service Y Nursing Stations 61 are ordered on special forms which l i s t the various products available. Each form can request more than one type of solution as shown in Table 3.7. A l l orders are in terms of "number of bottles." TABLE 3.7 SOLUTIONS DATA # of Solution Types Requested per form  1 - 2 3 - 4 5 -10 >10 # of Bottles Requested /form 1 - 5 6 -10 11 -20 21 -30 31 -50 >50 Percentage 27 51.5 19 2,5 100,0 2,8 27 27 24.4 16.2 2.6 100,0 On an average week approximately 3»600 bottles of IV or topical solutions are supplied to various hospital wards. These are shipped by the hospital transportation 62 department on the same schedule and in the same way as ward stock* Table 3»8 illustrates the major areas served by this pharmacy service, TABLE 3,8 HOSPITAL AREA SERVED BY SOLUTIONS Area % of Forms Heather Pavilion 35.8 Centennial Pavilion 17,4 Willow Pavilion 14.5 Fairview Pavilion 10,6 Health Center for Children 11.7 Intensive Care Unit 6,7 Heather Annex 2.2 Other 1.1 lOOoO 3.5 Outpatient Dispensary In the Vancouver General Hospital, the outpatient dispensary is situated in a different building from the main pharmacy. It is open on Monday to Friday from 9*30 a.m. to 4s30 p.m. It operates in the same way as a community pharmacy except that cash is not collected for prescriptions. Pre-scriptions are brought to the service counter by patients. The pharmacists then f i l l these using the same procedures as for staff prescriptions in the inpatient dispensary. 63 Each prescription form may request more than one drug as shown in Table 3.9. The pharmacists must edit these forms, type a l a t e l for each prescription, and dispense the drugs. R e f i l l s are also available, and when the original container Is sup-plied, no label need be typed. Dispensing operations usually take longer than in the inpatient dispensary as each prescrip-tion requires an accurate dosage count, TABLE 3,9 NUMBER OF OUTPATIENT PRESCRIPTIONS per form #Rx/Form % of Forms 1 62,0 2 24,1 3 8.9 4 3.6 5 .7 >5 .7 10.0*0 There are seldom interruptions in this area so that prescription f i l l i n g is a very efficient operation. Table 3.10 summarizes a representative week°s prescription work-load, Tftd to three pharmacists are on duty throughout the week. Since this dispensary has Its own stock of pharma-ceuticals, inventory control is Important, Additional supplies are obtained from the main pharmacy either by one 64 TABLE 3.10 OUTPATIENT PRESCRIPTION VOLUMES New R e f i l l s Controlled Drugs Total Monday 180 36 29 245 Tuesday 229 43 29 301 Wednesday 188 45 13 246 Thursday 237 31 20 288 Friday 196 3^ 6 236 Total /week: 19030 189 97 1,316 Avge/day: 206 38 19 263 of the pharmacists in this area, or by one of the pharmacy aides in the main pharmacy. Record-keeping is also impor-tant. Each prescription must be numbered and f i l e d since patients are not charged for the prescriptions, and the pharmacy may want to determine the volumes and costs of drugs dispensed on welfare, and to various hospital c l i n i c s . The outpatient dispensary has approximately the same work-load pattern as indicated In the Liebman (1970) study. The busiest hours are in the morning and some after-noons when special clinics are held in the hospital. A large portion of the prescriptions are dispensed to patients from the B.C. Cancer Institute. Thus, the outpatient dis-pensary work volume is related to the number of hospital c l i n i c s being held on a particular day. 65 3.6 Inventory Control Some of the work required to maintain pharmaceutical Inventories has already been mentioned. Any drug that is reaching a low stock point is entered on a "short l i s t . " It is d i f f i c u l t to determine the exact rule for reordering these drugs. Perhaps the best explanation is that from experience, the senior pharmacist in charge of drug inventory, or pharma-cists in specific areas, know approximately how much of a drug is used each week. When i t is seen that l i t t l e more than a week's supply is l e f t , the drug is placed on the short l i s t and enters the purchasing cycle. A l l pharmaceuticals are purchased by the pharmacy through the hospital Purchasing Department. A stock card is kept for each item in inventory. This is pulled and sent with each drug requisition and provides information to the Pur-chasing Department such as quantity required, drug price, and drug vendor. Supplies from the vendor are sent to the hospital Receiving Department which, in turn, routes them to the pharmacy. Figure 3.13 provides a generalized work-flow of the drug-purchasing-receiving cycle. Pharmaceutical Inventory control is a d i f f i c u l t concept to introduce into a hospital pharmacy simulation. There are more than three thousand different pharmaceutical supplies stocked by the hospital. Each has different usage, cost, strength, and size. In fact, It has been stated by LaPP (1969) that more than f i f t y thousand parameter values 66 FIGURE 3.13 Pharmaceutical Purchasing end Receiving Work-flow PHARMACY Pharmacist or aide enters item on "short-list" 3 L Senior pharmacist transcribes to stock card for product? date amount, unit of issue, cost.  Checked by pharmacist or aide I V PURCHASING - RECEIVING Preparation of purchase order delivered and checked 7i Local warehouse or wholesale outlet 67 would have to be collected to accurately define a hospital pharmacy's total drug inventory. Such a task would be impossible for this thesis, but would probably be feasible where a computerized inventory system is in use. A simulation model would at best only be able to contain general drug categories. One method of grouping drugs for this purpose would be to use the major categories defined in the hospital drug formulary. An example of a formulary is Included in Appendix D. The data in Table 3.11 has been compiled by using a selected subset of drugs Issued from various main pharmacy areas during a typical week. The pharmacy inventory problem is further complicated by the fact that pharmaceuticals are stored in various areas of the hospital. Each ward has a large supply of items. Emergency and night boxes require specific drugs, and the outpatient dispensary has i t s own inventory of pharmaceu-t i c a l s . Thus, any attempt to study inventory usage must consider the requirements of these areas as well as the general flow of prescriptions and other works. However, there is room for experimentation with simple inventory control models. The basic requirement of these models is estimation of ordering and storage costs. In the Vancouver General, ordering costs would have to be compiled from various factorsJ the time spent on inventory control and preparing drug requisitions, the effort required by the Purchasing Department in ordering and receiving 68 TABLE 3.11 DISTRIBUTION OF ORDERS BY FORMULARY CODE Drug Inpatient. Narc/Cont. Ward . Solu- Outpatient Code Dispensary Drugs Stock tions Dispensary 04 2.66 3.40 08 17c 10 - 7.80 10 1.05 - -12 2.32 - .16 16 .21 - -20 3.36 - 1.17 not 24 4.77 3.74 28 20.40 96.59 12.60 analyzed 36 .63 — 3.21 100.00 40 9«20 6.15 44 .28 -- -48 1.54 - .15 52 3.93 .95 6.14 56 6.52 2.46 12.00 60 .07 - — 64 .02 -68 8.40 - .44 72 .21 - -76 .14 - — 78 .02 - — 80 .70 - — 84 9.25 - 38.80 86 .56 - . .61 88 4.70 3.63 92 1„96 — 100,00 100.00 lOOoOO 100.00 69 drugs 9 the time necessary to store drugs, and miscellaneous record-keeping tasks e Webb (19?0) calculated a cost per order of $ 6 . 7 2 in his particular hospital. Storage costs must be calculated from storage space requirements, the cost of having cash tied up in inventory, and the cost of obso-lescence and spoilage. This is usually calculated as a percentage of the value of a drug--12 per cent per year in Webb's study. The simplest inventory control model is composed of the following equations! Drug cost per = ka + ca +chQ time period Q 2 Economic Order = Q = / 2 k a ' Quantity (units) V ch Average inventory (units) = B * Q/2 Reorder point = Q/a (time period) wheret k = ordering cost a = drug usage per time period (units) c = cost per unit of drug h = storage cost {% of inventory value per time period) Q = economic order quantity (units) B = safety stock to avoid stock-outs (units) Ordering Q units of a drug every Q/a time periods w i l l minimize the average cost of drug inventory. This is known as a fixed order quantity system. Many variations on this model are possible. For example, availability of 70 quantity discounts w i l l affect the order quantity, average inventory, and reorder points. However, i t is only the purpose here to il l u s t r a t e the type of analysis that can be undertaken. Consideration of pharmaceutical inventory would in i t s e l f be a suitable thesis topic. Perhaps . the best area to experiment with inventory models is in the use of narcotics and controlled drugs. Here accurate usage figures are available as well as in-stock volumes and purchase quantities. The average cost of inventory deter-mined by the economic order quantity could be compared with current costs. In this way, experiments could be attempted with several drugs to see If costs could be reduced. The safety stock provides an easy method of analyzing the effectiveness of inventory control procedures. Normally, this w i l l be composed of two factorss enough units to allow for the lead time between the ordering and receipt of drugs , (usually daily usage times the number of days lead time), and a buffer stock to allow for variances in drug usage or re-order lead times. The buffer stock could be placed in.a brown envelops and a record kept of when i t was necessary to use these drugs. In this way, a check would be available on the usage and safety stock levels for a particular drug. Naturally, the buffer stock should be replaced with each order to ensure that the drugs do not become obsolete. The advantages of inventory control procedures are, therefore, twofold: (1) drugs can be procured in the most 71 economical order quantity and a l l cost factors are con-sidered, and (2) the purchasing and inventory control personnel need only devote attention to drug items that are giving problems. Establishment of automatic drug re-ordering procedures would eliminate most of the frequent stock level checks. 3 .7 Summary With this overview of the major pharmacy functions in the Vancouver General, i t is now possible to determine the fe a s i b i l i t y of simulation. From a hospital administration, viewpoint, i t would be desirable to incorporate a l l of the features mentioned in a simulation model. Unfortunately, there are so many complexities and variables involved that a simulation of the complete pharmacy and drug distribution system would only be feasible as a "black box" model. Using this approach i t could, perhaps, be shown how a drug distribution system could affect the hospital's drug , cost per patient day. However, a model of this type would require a high level of abstraction and would be next to useless from the point of view of pharmacy planning. In fact, i t could be said that a "black box" model is not really necessary. The regression equations provided by Naylor and Tester (1971) would give the same type of information. Only in the case where the pharmacy "black box" model was to be incorporated in a larger hospital model, much like that 72 proposed by Lapp (1969), would i t be of any major advantage to simulate pharmacy operations in this way. Therefore, i f the "black box" model is ruled out for the purposes of this thesis, this leaves the more informative functional flow simulation approach. The major functions of the pharmacy have been described here and information pro-vided on the types of xvork done, the hospital areas served, and the work processing flow. It has become increasingly apparent that there are three major concepts that can be studied in the pharmacy? inventory control, manpower schedu-ling, and drug distribution. As has been mentioned, the major problem concerning inventory is the amount of data collection necessary. The proposed grouping by formulary code would be feasible. However, i t would be d i f f i c u l t to study anything other than drug usage. Placing three thousand or more pharmaceuticals into twenty-five categories obviously presents some problems in estimating costs, order quantities, and reorder points. Thus, simulation of inventory problems would have to be at a very high level and again would not be of much benefit in planning pharmacy operations. The most attractive areas for simulation are, therefore, those of manpower planning and drug distribution. Emphasis could be placed on providing the best service possible to the patient or to the various areas of the hospital. This is the approach taken in the simulation model presented in this thesis. 73 Simulation can be most effectively used where there are many interacting events occurring on a relatively random basis. Many of the pharmacy areas described in this chapter perform well scheduled functions and have a stable work-flow pattern. Incorporation of these areas could not be justified in a functional flow model. The narcotics and controlled drugs works requires only one person for three to four hours each day. The volume of drug requests remains f a i r l y constant and, more important, other work rarely interrupts the normal dispensing work-flow. It would be a simple task to estimate the,effect of volume changes or new procedures on the work of the narcotics control clerk. Furthermore, i t is not l i k e l y that i t w i l l be necessary to study new distribution methods for these drugs because of the need for s t r i c t security controls. Thus, a simulation of the narcotics and controlled drugs dispensing functions would not be very valuable. The ward stock and solutions areas were not modeled for similar reasons. F i r s t , their work-load is pre-scheduled and remains f a i r l y constant throughout the week. Orders can be f i l l e d during the mornings, while afternoons are spent on miscellaneous tasks. Secondly, most of the pharmaceuticals requested from these areas have already been prepared and pre-packaged. Changes in order volume w i l l have l i t t l e effect on the work-load of personnel since the major function is simply . to collect these drugs. Thus, simulation of the ward stock 7^ or solutions dispensing functions would not be very informative. Also, i t would be d i f f i c u l t to model the various other tasks such as pre-packaging, manufacturing, and "housekeeping" since they are not directly related to the number of orders f i l l e d , nor are they necessarily undertaken at specific times. It would, therefore, require an extensive work study.' to analyze a l l of the operations of these areas and l i t t l e benefit would accrue from a simulation. Thus, i t is proposed that rather than incorporate a l l of the pharmacy areas in a functional flow simulation model, only dispensary operations w i l l be studied and, in particular, those of the inpatient dispensary. As has been mentioned, the outpatient dispensary only concerns i t s e l f with f i l l i n g one type of prescription, and rarely has any interrupting events. Therefore, i t can be viewed as a subset of the i n -patient dispensary work, much like that required to f i l l staff prescriptions, although on a much larger scale. The techniques used to build an inpatient dispensary model can, therefore, be applied to the outpatient dispensary to study manpower sche-duling and service to the patient. The inpatient dispensary is the heart of the hospital pharmacy. From four to five pharmacists each day are required to staff this area, more than f i f t y per cent of the pharmacist work force. Five types of prescriptions must be dispensed, each requiring a slightly different service. Interruptions are frequent since this area provides most of the drug 75 information to the rest of the hospital. Prescriptions must be f i l l e d as received so that the type of drug requested, and complexity of dispensing, can have both a direct and indirect effect on the efficiency of service provided to the hospital patient. Priority requests occur and must be com-pleted as soon as possible, usually interrupting or replacing normal work-flows. A staff counter must be serviced, again interrupting dispensing operations. Thus, the patient dispensary has a dynamic work-flow and various operations occurring at random,, c r i t e r i a that can best be studied using a simulation model. Once a model of the inpatient dispensary Is available, many different types of experiments can be undertaken. Changes in prescription volumes can be analyzed for their effect on manpower utilization and dispensary efficiency. It is planned to convert many of the hospital wards to direct doctor pre-scriptions. These require extensive editing by the pharmacist. The simulation model could, therefore, be used to plan a man-power schedule to best handle this increase in work-load. The effect of having more than one typewriter available could be studied. Similarly, the use of pharmacy aides to type labels could be analyzed for the changes i t would make in pharmacist u t i l i z a t i o n . Finally, not every hospital has such extensive pharmacy services as the Vancouver General. However, most w i l l have an inpatient dispensary and the model described in the following chapters can easily be adapted to simulate this area of any hospital. 76 CHAPTER IV MODEL DEVELOPMENT 4.1 Model Description The model described here Is concerned with the opera-tions of the inpatient dispensary. It w i l l allow analysis of manpower scheduling 9 dispensary work-load, and service to the patient. The simulation model uses the IBM General Purpose Simulation System (GPSS). Figure 4.1 provides a general flowchart of dispensary operations. The major functions that w i l l be included in the model are shown, as well as their linkages. The model w i l l route transactions (prescriptions) through specific function modules to simulate the operations carried out on different types of work. A manpower schedule w i l l be set up specifying when a pharmacist or aide is available. Thus by changing the working hours and number of workers available, the model can be used as a planning tool to study the dispensary work-load. Each function w i l l have access to a subset of the available man-power. Thus "dispensing" can only use pharmacists, while "receiving work" can be taken care of by pharmacy aides or pharmacists, depending on avai l a b i l i t y . Experimentation by changing these manpower subsets would also be possible. For example, assigning a pharmacy aide to f u l l time typing duties could be analyzed for i t s effect on pharmacist u t i l i z a t i o n and prescription service time. 77 FIGURE 4.1 Inpatient Dispensary Functions COO :\JTH^  wo St VftUl> - t > -V WORK. 1 78 A control transaction w i l l be used to assign manpower avai l a b i l i t y , determine when " o dispensary is open or closed, and change the arrival frequency of prescriptions. Also, interrupt transactions w i l l be used to simulate phone calls and preempt workers from regular vrork routines. The model characteristics can be defined in GPSS ter-minology. Transactions are prescriptions, phone c a l l s , and other miscellaneous work. F a c i l i t i e s are the pharmacists and pharmacy aides, as well as the phone and staff counter. Storages are used to collect data on the number of prescrip-tions in the dispensary, and to control the use of the type-writer. Thus, i f the maximum contents of the typewriter storage is one, only one prescription label can be typed at a time. Changing this maximum w i l l allow analysis of the situation in which more than one typewriter is available. The stat i s t i c s automatically collected by GPSS for f a c i l i t i e s and storages are quite extensive. TaMes w i l l also be used to collect prescription information, and to provide graphs on dispensary work-load distribution. The GPSS program l i s t i n g is included in Appendix E. Each major dis-pensary function w i l l now be examined in deta i l . 4.1.1 Becelve Inpatient Prescriptions Most of the inpatient dispensary work arrives by pneumatic tube. It is the duty of the pharmacy aide to empty each tube and sort the prescriptions. R e f i l l prescriptions 79 must be matched with returned containers. New direct doctor prescriptions forms must be set aside until they can be matched with patient f i l e s . When these prescriptions have been sorted by the pharmacy aide, a l l except the new direct doctor prescriptions must be set beside the typewriter for label typing or checking by the pharmacist. Figure 4.2 outlines this receiving function. When the pharmacy aide is not on duty, the pharmacists must perform this work. Messengers can also bring work, but the receiving function w i l l consider the pneumatic tube and messenger stations as one transport station. It has been estimated that this sorting work takes 20 - 10 seconds per form. As indicated in the previous chapter, each form can contain more than one pre-scription but this does.not have any effect on the sorting time. The time estimate used i s , therefore, an average of a l l the various operations required to attend the transport station: sort forms, match with containers, empty tubes, return tubes, and place forms by the typewriter. The pharmacy aide must also look after tubes arriving with controlled drugs, ward stock, and solution orders. However, only work performed by the inpatient dispensary pharmacists is included in this receiving function. Thus, changes in inpatient dis-pensary work-load and schedules can be analyzed directly. 80 ciwvK.'\cr©c.isTics. FIGURE 4.2 RECEIVE INPATIENT PRESCRIPTIONS r E ^ P T Y •nSAwsnjp.T _ — SPi-lT O r f Or 3< OKI f ^ R H Pi'if'etOSfve-Y U F O 81 4.1.2 F i l i n g New Direct Doctor Forms This is usually done by the pharmacy aide. However, the model has been set up to allow a pharmacist to perform this duty i f no pharmacy aides are available. Such an occasion might occur on weekends, or after 4s30 p.m. each day (according to current schedules). F i l i n g involves two phases. F i r s t , when new direct doctor forms arrive in the dispensary, they must be matched with patient f i l e s of previous forms. Thus, when the phar-macist is editing these new forms he can refer to previous prescriptions and check for drug interaction and the lik e . Secondly, when editing and label typing operations have been completed for new direct doctor prescriptions, the forms are no longer needed and must be f i l e d in the patient folders. Figure 4.3 flowcharts the f i l i n g logic. The f i l i n g operation, i t s e l f , was found to vary from 10 to 40 seconds depending on various factors. An average of 20 seconds is used in the model. 4.1.3 Editing New Direct Doctor Forms As has been mentioned, this involves checking i f any prescriptions are needed and underlining each drug that must be dispensed. The pharmacist also can check for possible drug interactions or medication errors. 82 FIGURE 4*3 FILING NEW DIRECT v  -Ti t t t 83 After a form has been edited, i t can follow several possible routes. F i r s t , i f a prescription is required but there is a possible interaction, prescription or medication error, the pharmacist must phone the doctor or ward and query the prescription. When this is corrected, or there is no query, the form is placed by the typewriter for label typing. More than one prescription may be required for each form (see Table 3 . 3 ) , and this w i l l affect label typing volume. Also, in many cases, there are no prescriptions required so that the only work remaining is the r e - f i l i n g of the direct doctor form in the appropriate patient folder. Ee-filing is also necessary once labels have been typed. The r e - f i l i n g operation has been initiated in this editing module since most of the work is done by the pharmacy aide and w i l l not affect the time that a prescription is in the dispensary. Figure 4.4 flowcharts editing operations. Editing time was found to be distributed as shown in Figure 4.5. However, this time includes only the most general editing operations. Present dispensary work-load prevents the pharmacists from checking extensively for interactions and the li k e . If a pharmacist were to thoroughly edit each form i t would take considerably longer. 4.1.4 Query Prescriptions Prescription forms must sometimes be queried because of incorrect medication instructions and il l e g i b l e handwriting. This involves phoning the doctor or nurse who originates the 84 TfiSiA-*TSr FIGURE 4 a4 EDITING NEW DIRECT DOCTOR FORMS 1 f SPun" O^F r «a M E T R I C CO 86 form. Often, when the pharmacists are busy, these prescrip-tions w i l l be held until someone has time to make the phone ca l l s . Also, they cannot be corrected until the phone is free? thus, a special routine has been provided in the model to simulate this query function. Figure 4 . 6 flowcharts this function. Prescriptions are queued until, a pharmacist is free and the phone is not busy. The query time is estimated by the distribution of phone c a l l time provided in Figure 4 . 7 . Queries can originate from direct doctor form editing, or from the pharmacist typing prescription labels. 4.1 . 5 Label Typing The Vancouver General uses a procedure to speed up label typing. In the morning, the busiest period of the day, one pharmacist w i l l look after a l l prescription interpreting and label typing. The labels for the large volume of pre-scriptions which have collected overnight can then be dealt with e f f i c i e n t l y . Figure 4 . 8 flowcharts the label typing function. If the typewriter is in use, then the model w i l l not look for a free pharmacist but w i l l queue prescriptions for the pharmacist already at the typewriter. In this way, a full-time pharmacist can be simulated when prescriptions volume warrants. \ \ FIGURE 4,6 QUERY PRESCRIPTION ROUTINE f\fo V METRIC 89 T l M t Z X Z *1 90 The label typing function can also route invalid prescriptions to the query function. Normally, the pharma-c i s t interpreting prescriptions for labels w i l l have problems with handwriting, unclear instructions, or misspelled drug names. These prescriptions w i l l be laid aside until someone has time to query the contents. Thus the model transfers invalid prescriptions to the query function, and once a query is made, these prescriptions are re-routed for label typing. Figure 4 .9 provides a distribution of label typing time. The mean time found was 37.8 seconds. Didier (1969) estimated label typing time at .81 minutes, but i t is concluded that the difference in typing time (10 seconds) per label can be a t t r i -buted to the use of a full-time typist during the busy hours of the day. A n operation such as that required in the out-patient dispensary, where labels must be typed as prescriptions arrive, would require the longer label-typing time. The label typing function also deals with r e f i l l pre-scriptions. Thus, labels are not required for personal or staff prescription r e f i l l s , and the model w i l l bypass the label typing function when reusable containers are available. However, r e f i l l direct doctor prescriptions always require label typing since containers are not returned. Thus, the label typing function performs editing, typing, and re-routing of invalid prescriptions. Once this function is completed, prescriptions are available for dispensing. 92 4 . 1 . 6 Dispensing Figure 4 . 1 0 flowcharts the dispensing function. This is only one major operation since a l l of the editing and label typing have been previously completed. Since more than one pharmacist can be dispensing at the same, time, each prescrip-tion is assigned the f i r s t available pharmacist. If none are available, then the prescription must wait. Once prescrip-tions have passed through this dispensing function, they are sent to a routine which simulates the work of returning the drug via the transport station. Figure 4 . 1 1 illustrates the distribution of dispensing time. With a mean of 7 9 . 7 seconds, this compares favorably with the 1 . 1 3 minutes found by Didier ( 1 9 6 9 ) . Actual dispensing operations cover a wide range of times for several reasons. Due to the large volume of pre-scriptions handled in a day, the pharmacy has implemented various procedures in an attempt to be as efficient as possible. Pharmacists can dispense an approximate number of dosages, rather than have to make a tedious and time-consuming count of the total individual drug dosages placed in each container (when more than the dispensed dosages are required, nurses can order a prescription r e f i l l ; where too many dosages are supplied, unused drugs can be returned to the pharmacy i f practical). Since a dosage count is not required, the pharmacist can then almost simultaneously f i l l two prescrip-tions requiring the same drug. Dispensing time in these cases can be as low as 10 seconds. FIGURE 4 o10 DISPENSING ROUTINE foe. FIGURE 4.11 K i t fej Iii-! f ^ ^ ^ i H u - j i i l l l i l l 95 One of the exceptions to the above procedure is the staff prescriptions. These require dosage counts and pro-cedures similar to those carried out in a community pharmacy. Dispensing time w i l l , therefore, take longer on average for staff prescriptions than for inpatient prescrip-tions. Approximately 6 per cent of the prescriptions studied required compounding. Of this total, 83 per cent were for solutions and the remaining 17 per cent were for ointments and creams. These require additional time to prepare, sometimes up to 8 minutes. This compounding time is reflected in the graph in Figure 4.11. 4.1.7 Return Work When a prescription has been f i l l e d , i t must be returned to the originating ward. 'This is usually done using the pneumatic tube. The containers must be placed in a tube and the destination dialed on the tube routing control. Some pre-scriptions must be sent by messenger. These are usually for wards not connected to the tube transportation system, or prescriptions in breakable or large containers. Figure 4.12 flowcharts this return function. Normally, the pharmacy aide w i l l do this work, but when she is not on duty, the dispensary pharmacists must return the prescriptions. The model considers both tube and messenger stations as one transport station as was done in the "receive" functions. The 96 FIGURE 4 o l 2 RETURN WORK ROUTINE v i > | COM-EC-T ?rPrn<.r\cs 9 7 time allocated to each prescription in this function averages 20 seconds. 4.1.8 Serve Counter Figure 4 . 1 3 flowcharts the procedure required to serve staff who bring prescriptions to the dispensary counter. Normally, any pharmacist who is free w i l l look after this task. However, i f none are free, then a pharmacist must interrupt what he is doing to perform this function. There are three possible routes for staff prescriptions to take. If the hospital does not have the required drug, the employee must be directed to a community pharmacy. If i t is after 12 noon, then prescriptions w i l l be f i l e d for tomorrow's work. Otherwise, the prescription is placed by the typewriter for label typing. After the "serve counter" function is per-formed and the prescription is ready for label typing, the procedure used for inpatient prescriptions w i l l be followed. Figure 4.14 illustrates the distribution of time required to look after the counter. On average this was found to take 3 0 seconds, although a majority of the times were 20 seconds or less. This counter time function could also be used in an outpatient dispensary model. 4 . 1 . 9 Interruptions Most of the interruptions in the dispensary are caused by the staff prescriptions, or phone call s . Other interrup-tions occur but these are d i f f i c u l t to incorporate in a model. 98 FIGURE 4.13 SERVE COUNTER ROUTINE •CAT . Ho V IX'TY 100 Phone calls are mostly of a business nature and can be answered by any pharmacist on duty. However, some personal calls do occur and must be answered by a specific pharmacist. Figure 4 . 1 5 flowcharts the logic used to simulate these phone c a l l interruptions. The time distribution in Figure 4 . 7 was used to approximate the length of each phone c a l l . 4 . 1 . 1 0 Control A manpower schedule matrix is used in the model to control the ava i l a b i l i t y of each pharmacist and pharmacy aide. Figure 4 . 1 6 illustrates how this is done. Each worker is assigned an identification number which is used to assign a work schedule and to specify the GPSS f a c i l i t y associated with this person. Entries in this matrix are in terms of quarter hours. A control transaction is generated every 15 minutes and checks to see i f any worker is scheduled to start work, have a coffee break, go to lunch, or f i n i s h work at that point in time. If any of these breaks are scheduled, the worker w i l l be made unavailable for use in the dispensary until the next control transaction is generated. Another matrix is used to assign subsets of workers to dispensary duty for different days of the week. Thus, i f more than one day is to be simulated, different work schedules can be set up for specific days;^ 1 0 1 PHASHftC/iT Pi-roue PIGUEE 4 . 1 5 PHONE CALL INTERRUPT ROUTINE 7 P&svwpr f i r f e &>-<! METRIC 103 It can be seen that i t is a simple matter to change the manpower schedule in the dispensary. More pharmacists can be assigned, or part-time pharmacists can be scheduled on duty at any time of the day. The model as shown in Appendix E only simulates ten hours of each day. The dispensary is only open between the hours of 8800 a.m. and 6s00 p.m. although prescriptions continue to arrive during closed hours. It was found that 28 per cent of prescription forms are waiting when the dispensary opens in the morning. For simulation efficiency, therefore, the f i r s t transaction allowed into the dispensary w i l l generate 28 per cent of the expected daily work-load. Other control transactions are used in the model to make available the phone, staff counter, and typewriter. In other words, they are used to control when the dispensary is open and staffed by pharmacists. Also, a control transaction is generated each hour to reset prescription ar r i v a l rates. As was shown in Chapter III, most of the dispensary work arrives before noon, and the mean arr i v a l rates must be changed to account for this (see Figure 3.8). 4.2 Model Validation As can be seen in Table 3ol» the heaviest work-load in the inpatient dispensary occurs on week-days. Since each week day is similar,only one day w i l l be simulated in the model verification and analysis that folloxTS. 104 The various time parameters used in the model were simulated using GPSS functions. The simulated d i s t r i b u t i o n s for each operation were shown on the previous graphs. If the time parameters are normalized, then a paired comparison of actual and simulated means can be undertaken. This i s shown in Table 4.1. Since the computed t value of .33 i s less than ^ 4 9 . 0 5 =2.7764, i t can be concluded that there i s no systematic difference between the actual and simulated mean times. Using these time d i s t r i b u t i o n s and an average of 265 p r e s c r i p t i o n forms per day, the model was run to simulate one day's operation. Four d i f f e r e n t validations were run using d i f f e r e n t sequences of random numbers. The number of prescrip-tions on each form was d i s t r i b u t e d as in Table 3«3» The man-power schedule was as shown i n Figure 4.16. The output from these va l i d a t i o n s i s provided i n Appendix F. The f i r s t important data requiring v e r i f i c a t i o n i s the d i s t r i b u t i o n of the dispensary work-load. A l l work requiring handling by pharmacists was tabulated as i t arrived according to the hour of day. The r e s u l t i n g d i s t r i b u t i o n i s shown in the computer output. Comparison with the actual d i s t r i b u t i o n of work r e s u l t s i n the graph in Figure 4.17. From this i t can be v e r i f i e d that the model i s exhibiting the work a r r i v a l c h a r a c t e r i s t i c s found in actual studies. Table 4.2 provides a comparison of the totals of each type of p r e s c r i p t i o n simulated versus the range found in actual studies. This also v e r i f i e s that a t y p i c a l p r e s c r i p t i o n mix was generated by the model. TABLE 4.1 COMPARISON OP ACTUAL VERSUS SIMULATED TIME PARAMETERS MEAN TIMES NORMALIZED TYPE A c t u a l S i m u l a t e d Ac t u a l S i m u l a t e d D i f f e r e n c e ( D i f f - d ) ^ E d i t i n g 35.0 37.6 1.0 1.07 -.07 .006084 Phone 61.6 58.2 1.0 .95 +.05 .001764 T y p i n g 37.8 39.9 1.0 1.05 -.05 .003364 D i s -p e n s i n g 79.7 77.7 1.0 .97 +.03 .000484 S t a f f C o unter 30.8 30.7 1.0 1.00 .00 .0 244.9 244.1 5.0 5«04 -.04 .011696 2 = -.04 = -.008 5 S 2= ( D i f f - 5 ) 2 = .011696 = .002924 M-l 4 s = / . 002924" = .0541 t = .008 J5~ = .017888 = .33 .0541 .0541 kk8.05 = 2.7764 107 TABLE 4 . 2 COMPARISON OF ACTUAL AND SIMULATED PRESCRIPTION TOTALS Type of Prescription . Actual (Week day). Low Average High 1 Simulated 2 3 4 New Personal 192 2 1 ? 2 5 5 248 .234 250 254 R e f i l l Pers. 59 78 89 82 88 92 82 New Direct Doctor 5 18 32 14 13 16 15 R e f i l l Direct Doctor 3 10 14 6 10 9 7 Staff 8 42 56 20 23 28 32 Special 1 3 6 4 5 8 6 Total 282 368 452 374 373 4 0 3 396 The model estimated that the typewriter is in use from 3 2 . 6 per cent to 3 6 . 8 per cent of the time. Obviously, this depends on the type of prescription mix as well as volume since r e f i l l personal prescriptions do not usually require new labels. A study found that the typewriter was in use 41 per cent of the time from 8$30 a.m. to 6 $00 p.m. Since pharmacists are not on duty until 8 s 3 0 a.m., this percentage can be inter-polated to cover the 10 hours that the model was in operation. This gives 3 8 . 9 per cent which is considered accurate for the purposes of this validation. The manpower util i z a t i o n statistics provided can also be compared with data obtained f r o _ t actual work studies. 108 Table 4.3 compares figures obtained from the four validation runs T T l t h actual studies. Since the model has been set up to select pharmacists on a random basis, the dispensary work-load has been evenly distributed. Therefore, direct comparison of pharmacist utilization is not possible. However, estimates of the total hours worked on the specified jobs compare favorably. TABLE 4o3 V A L I D A T I O N O F M A N P O W E R U T I L I Z A T I O N Worker (Work) # Hours available Actual U t i l i z . # Hours on work! S I M U . LA T E D U T I L : [ Z A T I O N # Hours on work 1 2 3 4 Avgen Pharmacy Aide: (Trans. 7 39.2 : 2.74 39.7 32.9 38.0 38.8 37.5 2.62 Stn.+filing) Pharmacists; (Editing & typing + j Dispensing + i i Staff + Phone) i #3 . 7 65.1 58.3 61.6 66.6 62.9 4.4 #4 7 59.2 54.2 £5.4 64.7 57.4 60.4 4.2 #5 . 7 59.2 53.8 61.7 64.5 59.8 4.2 #6 1.5 ) 16.2 17.0 26.2 22.2 20.4 .3 Total . 22.5 13.3 13.1 The utilization figures provided by the model are based on the time a pharmacist is available for work (that is 7 hours out of an 8-hour s h i f t ) . The total u t i l i z a t i o n figures indicate the number of hours worked in a 10-hour simulation period. It is in-teresting to compare these u t i l i z a t i o n figures with those found in 109 other hospitals. For example9 the study by Barker et a l . (1972) found that pharmacists in eight hospitals spent from 32.4 per cent to 59.2 per cent of their time on productive a c t i v i t i e s , or activities similar to those indicated in Table 4.3o This corresponds to 2.3 hours to 5 hours a day. It can be seen that the results obtained in the Vancouver General and from the simulation model compare favorably with these figures. In fact, i t can be concluded that an ideal u t i l i z a t i o n figure for pharmacists in the model is 60 per cent. Statistics produced by various experiments can thus be compared with this u t i l i z a t i o n . It is d i f f i c u l t to collect statistics on the time each prescription type is in the dispensary. The prescription form is discarded once a label is typed, so each prescription would have to be timed individually. This proved too large and time-consuming a task for the purposes of this thesis. However, some comments can be made on the accuracy of the results produced by the simulation model. Table 4.4 sum-marizes the results from, the four validation runs. It is to be expected that prescriptions are in the dispensary for longer than an hour since there is a heavy work-load in the mornings. The average of 74 minutes can, therefore, be considered normal. New direct doctor prescriptions averaged 102 minutes reflecting the extra time required for editing these forms. Similarly, the staff prescriptions averaged 105 minutes. This reflects the special schedule set up for 110 f i l l i n g these prescriptions. Finally, the average time for specials was 8 minutes. Actual studies found that these took from 3 to 10 minutes, depending on the availability of pharmacists. TABLE 4.4 SIMULATED PRESCRIPTION TIME IN THE INPATIENT DISPENSARY Rx Type 1 SIMULATED MEAN . Time (Min.) 2 3 4 Avge, New Personal 72.5 59.6 68.2 69.6 67.5 R e f i l l Personal 88.3 80.5 80.7 86.0 83.9 New Direct Doctor 95o5 116.0 111.2 85.7 102.1 R e f i l l Direct Doctor 72.5 51.5 68.9 83.4 69.1 Staff 109.6 94.1 106.6 108.7 104.8 Special 5.0 5.4 8.5 14.3 8.3 A l l Prescriptions 78.1 67.7 74.2 76.2 74.1 The model also provides other statistics which explain Ttfhy prescriptions are in the dispensary for more than an hour. These are summarized in Table 4.5. It can be seen that the major factor is the waiting time for label typing. Since only one typewriter is available and usually only two pharmacists are available, this is to be expected. Finally, graphs of work completion are provided by the model. These, in general, r e f l e c t the avai l a b i l i t y of personnel I l l and work-load arrivals. For example, three pharmacists are available from 10§00 a.m. and work completions build up until lunch time. Refer to the output in Appendix F for examples of these graphs. TABLE 4.5 OTHER DISPENSARY STATISTICS SIMULATED (MIN.) 1 2 2 4 Avge. Label typings Avge. waiting time 58.9 55.9 60.2 57.3 58.1 Avge.# of Rx waiting 30 28 33 31 30 Dispensings Avge. waiting time 32.2 30.8 33.1 33.7 32.4 Avge.# of Rx waiting 12 9 11 14 11 Direct Doctor Form Editings Avge. waiting time 8.3 17.2 5.1 15.7 11.6 #Rx in dispensary: Average 48 41 49 50 47 Maximum 128 127 138 124 129 Thus, the model has been validated for the data used in Its construction. The next step, validation against a different subset of data, w i l l be discussed in the next chapter. The output from the model provides the data required for analysis of manpower ut i l i z a t i o n , work-load distribution and service to the user. The latter is indicated by the time a prescription is In the dispensary. Comparison of experiment 112 r e s u l t s w i t h the s t a t i s t i c s o btained from the v a l i d a t i o n runs w i l l a l l o w the a n a l y s t to measure the e f f e c t s of changing schedules, work volumes, and procedures. In t h i s way, s i m u l a t i o n of d i s p e n s a r y o p e r a t i o n s can be used to prepare f o r f u t u r e requirements. 113 CHAPTER V CONCLUSIONS 5»1 Some Simulation Results Up to this point the simulation model has been shown to f i t the subset of data collected in the systems analysis of the inpatient dispensary. However, a model cannot be considered completely validated unless i t can produce results that compare with data that have not been applied to con-struct the model. Recently, the Vancouver General Hospital Pharmacy started to use direct doctor forms for a l l prescrip-tions originating from the Heather Pavilion. Since 46 per cent of the prescription work-load comes from this area, the simulation model should show the problems that can arise. The model results can then be verified against the actual experience in the dispensary when this new system was im-plementedo Also, a few other experiments w i l l be described here to help show how the simulation model can be used. It is not the purpose of this thesis to optimize dispensary operations. Rather, i t is to show how planning can be enhanced through the use of simulation. A l l computer output associated -with the tests that follow have been Included in Appendix G. 114 5.1.1 Test 1 - Test 3 The input to the model was changed to r e f l e c t the use of more d i r e c t doctor forms. This involved changing the number of forms per day from 265 to 430, 264 of which were d i r e c t doctor forms. Approximately 69 per cent of these forms did not require any prescriptions. In f a c t , the t o t a l new d i r e c t doctor forms each day corresponds with the t o t a l number of patients i n the Heather P a v i l i o n . Thus, estimation of dispensary work-load i s a r e l a t i v e l y simple matter, and use of d i r e c t doctor forms can e a s i l y be analyzed f o r other h o s p i t a l areas. The breakdown of the type of forms entering the d i s -pensary then changed as shown belowt Form Type Before Now New Personal 7^.6$ 24.8$ R e f i l l Personal 16.4$ 5.6$ New Direct Doctor 7.0$ 64.5$ R e f i l l D i r e c t Doctor 2.0$ 5.1$ The volume of s t a f f prescriptions was d i s t r i b u t e d as previously shown. A l l other parameters and times remained the same9 and the manpower schedule was not revised. Test 1 r e f l e c t s what would happen to the dispensary operations i f previous procedures and s t a f f i n g were used. The pharmacist u t i l i z a t i o n has r i s e n to more than 80 per cent. By any standards this i s extremely high and would be d i f f i c u l t 115 to maintain* Also note that the pharmacy aide is even busier with a 91 per cent uti l i z a t i o n . This l s 9 in effects what actually occurred in the dispensary. A l l pertinent data are summarized in Table 5.1. The next step was to schedule an additional pharmacist from 8s30 a.m. to 12:00 p.m. This was defined as Test 2. It can be seen that pharmacist utilization did decrease con-siderably, and also of significance, the average time that a prescription is in the dispensary was reduced by 21 minutes. Pharmacy aide utilization was s t i l l much too high, however, and the relatively high uti l i z a t i o n of pharmacists resulted from performing some of the pharmacy aide duties. Finally, Test 3 eliminated the need for f i l i n g new direct doctor forms. As shown in Table 5 . I 9 the pharmacist utilization was reduced to an average of 64.6 per cent, and the pharmacy aide utilization became 54 per cent. This latter figure can be attributed to sorting the Increased number of forms entering the dispensary. The average prescription time in the dispensary has now been reduced to 57 minutes mainly as a result of having the extra pharmacist on duty in the mornings. Test 3» therefore, presents a feasible work-schedule to deal with the increased number of direct doctor forms. It w i l l also produce a much better service to hospital patients since the average prescription time in the dispensary hasv> been reduced by 17 minutes. Thus, the scheduling of an TABLE 5.1 SUMMARY OP EXPERIMENTS T E S T S Manpower V a l i d o _ Utilization {%) % Avge. 1_ 2L-Pharmacy Aide #1 Pharmacist #3 #4 #5 #6 #7 A l l Pharmacists 37c5 62.9 60.4 58,8 20.4 91o0 80.8 85.8 83.0 39.0 59.2 80.6 84.6 69ol 81o0 71.8 37.7 56.2 70c0 54.0 64.? 64.3 61.8 41.8 78.5 64.6 41, 65c 63< 66, 29. 7 7 1 3 2 77.8 65.4 39.8 78.9 76.9 74.6 35.5 82.6 76.5 43.0 59.7 66.5 60.3 61.0 73.6 64.0 42, 62, 56, 55. 1 7 7 2 47.8 74.4 58.2 8 45« 59 c 58 c 55 = 67« 75< 62, 9 5 7 9 2 1 5 Hours Used 13.3 18.2 18.3 17.0 17.1. 20.0 20.2 19.0 19 0 Rx Time in Disp.(MIn.) 61 New Personal 67 109 92 44 80 83 54 32 R e f i l l Pers. 84 119 97 48 86 91 67 58 33 New Direct Dr. 102 148 114 83 117 156 124 99 93 R e f i l l Dlr.Dr. 69 99 84 47 83 98 66 55 31 Staff 105 117 112 64 134 123 99 47 "Special 0 8 58 12 8 5 12 8 3 3 A l l Prescrip. 74 119 98 57 96 111 83 68 50 Avge*Waitlng Time (Min.)% For Dir.Dr. editing 12 31 20 20 14 43 42 30 60 For typing 58 11 23 84 74 69 64 34 For Dispensing . 32 41 32 36 56 21 0 4 Avge.# of Rx Waitingi In Disp. 47 64 56 31 60 45 33 20 For DD edit. • - 15 9 9 6 19 17 12 9 For typing 30 18 30 17 46 41 38 31 17 For Dispensing 11 19 8 8 8 15 4 0 0 ^Present Situation in Dispensary H H ON 117 additional pharmacist i n the mornings and the elimination of f i l i n g operations is what could have been derived from the model. This i s exactly what occurred i n the Vancouver General Hospital Pharmacy. Thuss i t can be surmised that the simula-tion model exhibits the characteristics of the inpatient dispensary and is valid providing a l l functions remain as modeled. 5.1.2 Test k The f i r s t three tests assumed that only one pharmacist at a time would be editing direct doctor forms. This was essentially a full-time task unless interrupted by other higher priority work. Test k considered that up to two phar-macists could be used but on a random basis and not necessarily full-time. The model indicated that this was not particularly desirable as the entire prescription-filling process was dis-rupted and the average prescription time in the dispensary increased by 39 minutes. 5.1.3 Test 5 The present direct doctor form time considers only the most elementary of editing requirements. L i t t l e or no time is available for a more thorough edit where the pharmacist could conduct an extensive check for possible drug interactions. Therefore, Test 5 illustrates what could happen i f the average editing time was increased from 37 seconds to 72 seconds0 As can be seen in Table 5.1, this added approximately 3 hours of 118 pharmacist time, and average u t i l i z a t i o n was up to 76.5 Per cent. Obviously, this extra e d i t i n g time could not be handled e a s i l y by the present s t a f f i n g arrangement (as i n Figure 4.16 plus a pharmacist from 8*30 to 12s00 noon). 5.1.4 Test 6 This attempts to f i n d a solution f o r the problem i n Test 5. The part-time pharmacist scheduled to s t a r t at 4*30 p.m. i n the dispensary was changed to a f u l l - t i m e pharmacist s t a r t i n g at 10t15 a.m. (See Appendix G). The r e s u l t s are shown i n Table 5.1. The pharmacist u t i l i z a t i o n decreased to 64 per cent and the pr e s c r i p t i o n time in the dispensary was reduced by 28 minutes, 5.1.5 Test 7 1 Keeping the same schedule as in Test 6, this analyzed the e f f e c t of eliminating s t a f f prescriptions from the inpatient dispensary work. As can be seen from Table 5»1» the pharmacist u t i l i z a t i o n Improved, as did the time a pre s c r i p t i o n i s in the dispensary. The increased a v a i l a b i l i t y of pharmacists and reduction in interruption also reduced pre s c r i p t i o n waiting time for a l l of the major dispensary functions. 5.1.6 Test 8 It can be seen that the major part of a pr e s c r i p t i o n time i n the dispensary i s spent waiting f o r l a b e l typing. 119 Since only one typewriter is available, this suggests an experiment with two to see i f dispensary.operations can be improved. Table 5«1 summarizes the results of having up to two pharmacists typing labels. Pharmacist uti l i z a t i o n stayed approximately the same, but prescription time in the dispensary was greatly improved. The time for new direct doctor prescrip-tions remained f a i r l y high since only one pharmacist at a time was allowed to edit these forms. Thus, the waiting time for editing (60 minutes) is where the major time difference occurs, 5»2 Summary of Approach 5.2.1 Model Concept As has been shown, the simulation model presented here is extremely useful for planning dispensary operations and manpower scheduling. Many different types of analysis can be undertaken. Although only direct doctor prescriptions have been illustrated, the model could be slightly modified to simulate various unit dose distribution requirements. Unit dose dis-pensing is not used in the Vancouver General. However, various studies (Chiu and Kabat, I 9 6 9 ) have found that there can be up to a 270 per cent increase in pharmacy work-load when unit dose distribution methods are applied. Obviously, such a drug distribution system w i l l require additional staff. The model would be beneficial in planning schedules as well as determining the number of pharmacists required to maintain the pharmacy's standard of service 0 120 As has "been mentioned, data from the outpatient d i s -pensary could e a s i l y be Incorporated into the model. I t might also be useful to determine the e f f e c t of dealing with s t a f f prescriptions in this dispensary since they obviously a f f e c t the operations of the inpatient dispensary. Thus, i t i s concluded that the model concept presented in this thesis i s the most useful one from the point of view of pharmacy planning. However, i t would also be of benefit to construct a more general "black box M model. Many of the pharmacy areas such as Ward Stock and Solutions have a r e l a t i v e l y simple work-flow. Some time studies and analysis would be necessary to e s t a b l i s h d i r e c t relationships between work volume, manpower u t i l i z a t i o n , and service times.. These could then be incorporated into a "black bos" model. I t would be necessary to generalize the inpatient dispensary operations i n order to be useful i n a model of this type. Most of the relationships would have to be defined i n terms of p r o b a b i l i t y d i s t r i b u t i o n s . The simulation model described here would be extremely useful i n determining these d i s t r i b u t i o n s . Data could be c o l l e c t e d at various areas or f o r s p e c i f i c p r e s c r i p t i o n types and frequency tables produced l i k e those shown in Appendix G. The existence of a fun c t i o n a l flow simulation model, therefore, s i m p l i f i e s the work of constructing a "black box" model. A more general simulation model would have to include the concepts i l l u s t r a t e d i n the functional flow model. 121 Manpower planning i s important in the pharmacy as well as in the h o s p i t a l . Thus, some provision must be made to allow f o r experimentation with various combinations of professional and a u x i l l i a r y workers, and assignment of d i f f e r e n t duties and work areas. A general model should r e f l e c t the drug d i s t r i b u t i o n system used i n a hospital and i t s e f f e c t on pharmacy work-load and costs. I t would have to be as f l e x i b l e and modular as possible to allow d i f f e r e n t mixes of ward stock, personal p r e s c r i p t i o n s , d i r e c t physicians orders, unit dose dispensing, and any other possible methods. Also, there must be some means of measuring the e f f i c i e n c y of pharmacy services. As,in the functional flow model, t h i s could be the average time required to service a pr e s c r i p t i o n . However, a better method would be to use the cost of pharmacy service. For example, this would be more . b e n e f i c i a l when measuring the effects of unit dose dispensing. Other factors should be included in a "black box" model that have been ignored i n the functional flow model. The f i r s t i s pharmaceutical inventory. As shown i n Figure 2 . 3 S this i s what tie s a l l of the d i f f e r e n t areas of a pharmacy together. In f a c t , the general model I t s e l f could be looked at as an inventory model since the major components are ordering,manufacturing, and d i s t r i b u t i n g drugs. However, as has been pointed out, there are many d i f f i c u l t problems to overcome in order to model drus inventory e f f e c t i v e l y . 122 L a s t l y 9 costs would have to play a major r o l e in a "black bos" model. They could be used f o r v a l i d a t i o n purposes and to measure and optimize pharmacy performance. Costs were not included in the functional flow model since drug inventory was not considered. As can be surmised, there are two possible routes to take i n developing a pharmacy simulation model. The f i r s t i s the functional flow approach. This considers detailed phar-macy operations and provides an accurate picture of the environ-ment within the pharmacy. The second i s to abstract the pharmacy operations into a "black box" model. In so doing, most of the c h a r a c t e r i s t i c s of the pharmacy can no longer be observed. While both approaches have their own merit, the funct i o n a l flow concept was the most useful f o r the purposes of this t h e s i s 0 I t Is also concluded that the a v a i l a b i l i t y of a functional flow model makes the work of constructing a general model much easier. The analyst merely has to continue s i m p l i f y i n g the detailed model while maintaining the appropriate re l a t i o n s h i p s and r e s u l t s . I t might even be postulated that a funct i o n a l flow model of each of the pharmacy areas should be constructed before an attempt i s made to b u i l d a general model. Often, a det a i l e d analysis and simulation provides excellent insights Into how various parts of a system i n t e r a c t . 123 5.2.2 Some Analysis Results Although inpatient dispensary operations have not been optimized, several conclusions can be made as a result of the systems analysis. F i r s t of a l l , the staff prescrip-tions appear to disrupt normal dispensary operations quite significantly. Test 7 indicated that the average prescription time could be reduced by 15 minutes i f staff prescriptions were eliminated. There are several alternatives to f i l l i n g staff pre-scriptions in the inpatient dispensary. The service could be discontinued. This would be inconvenient for staff members, but the increased efficiency in the inpatient dispensary must be considered. A second alternative might be to f i l l staff prescriptions at the outpatient dispensary. Although the outpatient pharmacist already has a heavy work-load, the dis-pensing requirements for staff prescriptions more closely parallel those in the outpatient dispensary. It would, therefore, be useful to simulate outpatient dispensary opera-tions in the same way as was done in the inpatient dispensary 9 and see how the addition of staff prescriptions affects the daily work-load and efficiency. The fact that cash must be collected for staff pre-scriptions also complicates operations elsewhere In the dispensary." The narcotics clerk must be available between 2;00 p.m. and 4s00 p.m. to distribute f i l l e d staff prescrip-tions. This interferes with the recording work that must be 124 done on dispensed narcotics and controlled drugs. If s t a f f prescriptions could be eliminated from the inpatient dispensary, the narcotics cleric would be able to use the ad d i t i o n a l time to advantage In such areas as inventory control and miscellaneous analysis projects,, The l i m i t e d open hours f o r the inpatient dispensary r e s u l t s in an unevenly d i s t r i b u t e d work-load. From 60 to 70 per cent of the d a i l y work arrives in the inpatient dispensary before 1*00 p.m. I t was observed that the a v a i l -a b i l i t y of only one typewriter slowed the flow of prescrip-tions considerably. Thus, i t might be worthwhile to experiment with more than one typewriter i n the dispensary. Test 8 indicated that some improvement i s possible. Perhaps, even the a v a i l a b i l i t y of an extra typewriter for the f i r s t three hours in the morning could r e s u l t in an improved p r e s c r i p t i o n turn-around time. This could be analyzed by using the simula-t i o n model. In summary, improvements in dispensary operation may be possible by simple changes in work schedules or a v a i l -a b i l i t y of equipment such as the typewriter. It i s d i f f i c u l t to make these changes without having some idea of the consequences or r e s u l t s that may be achieved. The simulation model can, therefore, be used to analyze various configurations without disturbing present operations. 1 2 5 5 . 2 . 3 Areas for Future Study I t has been shown that simulation can be b e n e f i c i a l In planning pharmacy operations. Similar simulation techniques could be applied to the other areas of the pharmacy. The outpatient dispensary i s , perhaps, the ea s i e s t to adapt to the model formulation presented here. Analysis of work a r r i v a l patterns and dispensing operations would be necessary. However, i t Is f e l t that most of the time d i s t r i b u t i o n s presented In this thesis could be used d i r e c t l y . The greatest r e s t r i c t i o n found In attempting to simulate inpatient dispensary operations was the lack of pertinent data. Much time had to be spent on systems analysis and data c o l l e c -t i o n . Therefore, an important consideration i n future research i s the amount of time necessary to c o l l e c t appropriate data. In f a c t , i t would be b e n e f i c i a l to study the work of the pharmacy i n d e t a i l and attempt to formulate simple data c o l l e c -t i o n procedures. These would be useful to the pharmacy s t a f f as there are various times when p a r t i c u l a r data would be b e n e f i c i a l in making po l i c y decisions. The problem of pharmaceutical inventory control i s one which provides s i g n i f i c a n t research p o t e n t i a l . Application of s c i e n t i f i c techniques or simple models can be of benefit to the hospital pharmacy. I d e n t i f i c a t i o n of ordering, shortage, and storage costs could be immediately applied to the narcotics and controlled drug inventory problems. 126 A more general model could be of benefit i f i t included a l l the areas of the pharmacy. Much time would also be necessary to examine in more detail the pharmacy interfaces with other hospital departments. Correlation of hospital occupancy with prescription orders, for example, would provide a means of estimating future pharmacy work-loads. The magnitude of data collection problems in the pharmacy, as well as in the hospital, makes simulation a time-consuming task. The approach taken in this thesis i s , perhaps, the best way to start. When various functional flow models or modules are available, they can be generalized and combined to obtain a more useful model from the hospital administrators point of view. 1 2 7 BIBLIOGRAPHY American Society of Hospital Pharmacists. 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Hospitals JAHA, Vol. 4 4 , Oct. 16, 1970, pp. 5 6 - 6 3 . 130 Thompson, C O . , e t a l . " P h a r m a c e u t i c a l Communications i n the C l i n i c a l Environment.," American J o u r n a l o f  H o s p i t a l Pharmacy, V o l . 27, A p r i l 1970, PP. 277-294. T u r n b u l l , R.T. , and G r o v e r , C B . " C u r r e n t Trends i n the U t i l i z a t i o n o f H o s p i t a l Pharmacy P e r s o n n e l . " American J o u r n a l o f H o s p i t a l Pharmacy, V o l . 22, 1965, PP. 597-605. Uyeno, D.H. A S t r a t e g y f o r D e t e r m i n i n g A c t i v i t y Sampling .• D e n s i t y . T h e s i s s u b m i t t e d f o r Master of S c i e n c e i n E n g i n e e r i n g , U n i v e r s i t y o f Washington, 1967. Wagner, H.M. P r i n c i p l e s o f O p e r a t i o n s R e s e a r c h . P r e n t i c e -H a l l , I n c . , New J e r s e y , I 9 6 9 . Webb, B. A Study o f Pharmacy I n v e n t o r y C o n t r o l a t S t . L o u i s  S t a t e H o s p i t a l . R e p o r t as p a r t o f Degree o f M a s t e r of H o s p i t a l A d m i n i s t r a t i o n , B a y l o r U n i v e r s i t y , August 1970. APPENDIX-A REGRESSION EQUATIONS •Sfr •S'-K-ifr ~*r •»!• 131 REGRESSION EQUATIONS PREDICTING HOSPITAL PHARMACY COSTS (NAYLOR AMD TESTER. 1971) NON-PROFIT TEACHING HOSi'ITALS (1) Raw Drug C o s t p e r P a t i e n t Day (RDC) (a) Independent V a r i a b l e s ; R = Number a s s i g n e d to d r u g d i s t r i b u t i o n system 1 = Ward s t o c k + i n d i v i d u a l Rx 2 = Brewer system + ward s t o c k + i n d i v . Rx. 3 = Ward s t o c k + i n d i v D Rx + u n i t dose on 10$ or l e s s beds i n h o s p i t a l 4 = Ward s t o c k + i n d i v Q Rx + u n i t dose on 10-75$ o f beds i n h o s p i t a l 5 = U n i t dose on 75-100$ o f beds i n h o s p i t a l S = $ m e d i c a l beds T = Bed s i z e U = Average l e n g t h o f s t a y V = $ s u r g i c a l beds W = Number o f d i f f e r e n t m e d i c a l r e s i d e n c i e s X = Amount of time p h a r m a c i s t spends on a d v e r s e d r u g r e a c t i o n s programs ( $ ) . (b) Equation8 RDC = .81906 + .27475R + .03383S + .OOI36T + 0OII57U - 0O3679V - . 0 3 0 1 7 W - 1.34752X (2) T o t a l Pharmacy C o s t per P a t i e n t Day (TPC) (a) Independent V a r i a b l e s ; P = Number o f f u l l - t i m e p h a r m a c i s t s R = As p r e v i o u s l y d e f i n e d U = Average l e n g t h o f s t a y V = Amount of time p h a r m a c i s t spends on extemporaneous compounding ($) W = Amount of time p h a r m a c i s t spends on p r e - p a c k a g i n g ($) X = Amount o f time p h a r m a c i s t spends on s t e r i l e manuf.($) Y = Amount o f time p h a r m a c i s t spends on t e a c h i n g ($) (b) Eq u a t i o n s T P C = .48827 + 0O925IP + .37545R + .03544U + 1 . 4 8 5 2 4 V + .73859W - .74125X - . 2 9 9 I O Y APPENDIX B VANCOUVER GENERAL HOSPITAL ORGANIZATION CHART ~t.r-o DIRECTOR OF NURSING Miss M . L . Richmond FUNCTIONS ng Service Nursing Education Nursing In-Service Education Nursing Supplies & E quipmcn* ASSISTANT D IRECTOR NURSING E D U C A T I O N / / rs . D. Logan * T i E_ W C q U V ' l : R G l U l t:J< A D M I N I S T R A T I V E O R W N I Z A T I O N C H A R T 11 o s r B O A R D O F T R U S T E E S E X E C U T I V E D I R E C T O R K . R . Weaver D I R E C T O R ADMIN. S. P E R S O N N E L S E R V . J . Roberts Public Relat ions Data Centre PersonneI Employee Health Unit Employee Agreements Management Engineering Training Programmes I ASSISTANT D I R E C T O R P E R S O N N E L S E R V I C E S G.D . St orey Safety & Security Job Ana lys is D I R E C T O R M E D I C A L S E R V I C E S Dr. C . Key FUNCTIONS Admitt ing Medica I Records Intensive Care Unit Post Anaes. Recovery Emergency Opei ol ing Rooms Anacsthesio logy Temporary Annex Renol Unit Phot ogrophy ASSISTANT D I R E C T O R M E D I C A L S E R V I C E S J . C . Ettner ASSISTANT D IRECTOR M E D I C A L S E R V I C E S FUNCTIONS Pathology Card iology E lectroenccphologrophy Rod i ol ogy Plr/s ica 1 Mod ic ine Sociu l Sciv ice Pharmacy O . P . D . - Adults O . P . D . - H . C . C . D I R E C T O R M A T E R I E L M A N A G E M E N T L . V . Truitt FUNCTIONS Purchasing & Stores Centra I Supply Laundry • Printing Transportation ' Communications Service Administrative Research Forms Analyst D i e t e t i c s ASSISTANT D I R E C T O R M A T E R I E L M A N A G E M E N T R.W. Davidson MEDICAL DIRECTOR Dr. L . E . Ronla Medical Staff L ia ison Quality of Care & Ut i l izat ion Health Services Development House Staff Medical Legal Health Agenc ies L ia ison Catastrophe Plan ADMINISTRATIVE RESIDENT DIRECTOR P L A N K I N G & BUILDING M.M. WalLor FUNCTIONS Current Planning Space A llocat ion Future Development Major Renovations Piont Maintenance Building Services Women's Auxi l iar ies Telephones M E D I C A L BOARD Sec. Dr. L.E . Ronla C L I N I C A L D E P T S . M E D I C A L S T A F F I. D I R E C T O R F I N A N C E R . S . Fletcher FUNCTIONS Finance Control Account ing Parking Forms Committee E N G I N E E R P H Y S I C A L P L A N T E .R. Corpcntcr ASSISTANT D IRECTOR F I N A N C E G.W. Dawson BUILDINGS ro Mav l'?70 APPENDIX G. • PRESCRIPTION REGULATIONS ^ ; -x ;•! .-.I > H C\ :> .7^1 !'••' n 1. L A S C L A S S I R C . V I i O N ' " o d c i n e . l . e m e . ' . ' . l . j t,tV t \ i . . : V i n e . j N c r c o l i c P - i f o r a t i o n ( A l s o k n o w n a s O r : ! P r o s c r i p t i o n N ' ; i t " c u i i r - ) \VC - . \ i i h C o d e i n e ye '.. ,- \P'Demerol, e t c . C o ' t ' f o l l o d D r u g ' E x s . - . p l e s : S e c o n a l , P h e n o b a r b , ; D e x e d r i n e , D e x a m y l , T u i a a l , j e t c . , e t c . j C o n t r o l l e d D r u g P r o p o r o t i o n s ; E x a m p l e s : A m p h u g v J - S A , B e p -• l e t e , \ r n e s o c , H o n n a t o l , N e u -W . r a i c . n t i i i , e t c e t c . O l h « ; t P r e s c r i p t i o n D r u g s D E S C R I P I"ION M l s t r r t i g l i l i t ; , - ~ o i i c d r u g s . \ ! l s t r a i g h t i i . i r . ' . i l i c d r u g ? ' o r - - • . i . n . i p o i ! ! " ! . - - f o r p : ; : \ ! l i t e r a l u s e -\ l l n a r c o t i c c o m p o u n d s c o n -t a i r . i n s » • • > - » l b . ' . ' , o n e n a r c o t i c I . ' . a i v . - o i i c c o m p o u n d s c o n -t a i i ' i i - : ^ ' e s s t h a n t w o o t h e r n o n - / . u - o o t i c i n g r e d i e n t s . A c o m b i n a t i o n f o r o t h e r t h a n p a r o n t o r a l u s e , • . - o n t a i n i n g o n e ( o n l y ) n a r c o t i c d r u g a n d t w o ( o r i i i o r e ) n o n n a r c o t i c d r u g s i n t h e r a p e u t i c d o s e . r*RF.SC . !?i i J I I O H Ri-:outRr.Ms >:rs U ' r i K . v . j > r > - . • t • r i p ( i o n .- ' ; v d i c r > d _ _ J n | - i b \ p h ) i o i a a . i l f i j . ' t u t o r v . ' : ( » r i r , p r y »..H-,>:CM-.. S t r a i g h t a m p h e t a m i n e s , b a r b i -t u r a t e s o r m e t h a i n p h e t a m i n e s . C o m b i n a t i o n s c o n t a i n i n g m o r e t h a n o n e c o n t r o l l e d d r u g . A c o m b i n a t i o n c o n t a i n i n g o n e ( o n l y ) c o n t r o l l e d d r u g a n d o n e ( o r m o r e ) o t h e r i n g r e d i e n t s ) . A l l d r u g s l i s t e d i n S c h e d u l e A , P a r t I o f t h e P h a r m a c y A c t o f B . C . ( w h i c h c o n t a i n s a l l d r u g s i n S c h e d u l e F o f t h e F o o d a n d D r u g s A c t o f C a n a -d a p l u s a n u m b e r o f o t h e r s ) . W r i t t e n o r v e r b a l p r e s c r i p t i o n b y , : • s i c h ' n , d e n t i s t o r v e t e r -i n a r y s u r g e o n . V e r b a l p r e -s c r i i ' i i o n s m u s t b e d i r e c t f r o m p r e s c r i b c r t o p h a r m a c i s t a n d m o y n o t b e r e c e i v e d f r o m a n u r s e o r a n y o t h e r p e r s o n . A l l v e r b a l p r e s c r i p t i o n s r e -d u c e d t o w r i t i n g b y p h a r m a c i s t s h o w i n g : • N a m e a n d a d d e r ' s o f p a t i e n t . • N a m e , q u a n t i t y . ' . n i l f o r m o f r l r u g ( s ) . • N a m e o f p r e s c r i b c r . • D a t e a n i l p r e s c r i p t i o n n u m -b e r . • I n i t i a l s o f d i s p e n s i n g p h a r -m a c i s t . • N u m b e r o f r e f i l l s ( i f a n y ) n u t h o r i z e d . A s y n o p s i s o f f o d e i n l o . ' i d p r o v i n c i a l l a w s a n d r e g u l a t i o n * i . - 7 ' ' r ' l i r ' ' l t h e d i s l r i b u t i o n n f d r u t j s b y p r e ' . c r i p t i o n i n E r i t i ' . h L o l i m i b i - ) . R E P E A T S N o r e p e a t s a l l o w e d . M l " r e - o r d e r s ' " m u M b e n e w w r i t t e n p r e s c r i p t i o n s . N o r e p e a t s a l l o w e d . A l l " r e - o r d e r s " , w r i t t e n o r v e r -b a l , m u s t b e n e w p r e s c r i p t i o n s . N o r e p e a t s a l l o w e d i f o r i g -i n a l p r e s c r i p t i o n i s v e r b a l . I f w r i t t e n , t h e o r i g i n a l p r e s c r i p -t i o n m a y b e r e p e a t e d i f t h e p r e s c r i b c r h a s i n d i c a t e d i n w r i t i n g t h e n u m b e r a n d f r e -q u e n c y o f r e p e a t s . D a t e a n d q u a n t i t y o f r e f i l l a n d p h a r m a c i s t ' s i n i t i a l s m u s t b e r e c o r d e d o n o r i g i n a l p r e s c r i p -t i o n . R e p e a t s m a y b e a u t h o r i z e d o n o r i g i n a l p r e s c r i p t i o n w h e t h e r w r i t t e n o r v e r b a l , b u t a u t h o r i z a -t i o n m u s t b e f o r a s p e c i f i c q u a n t i t y ; e . g . " R e p e n t t h r e e t i m e s " ; " R e p e a t f o r t w o m o n t h s " ; ( w h e r e a s p e c i f i c d o s a g e i s g i v e n ) . " R e p e a t P U N " i s N O T a n a c c e p t a b l e a u t h o r i t y f o r t e f i l l i n g n p r e -s c r i p t i o n . D a l e a n d q u a n t i t y o f r e f i l l a n d p h a r m a c i s t ' s i n i t i a l s m u s t b e r e c o r d e d o n o r i g i n a l p r e s c r i p -t i o n . R E C O R D I N G P I L I N G M l p r e s c r i p t i o n s r> - f b - d i n n a r c o t i c r e g i s t e r ? s r i i n i t i a l l e d t h e r e i n b y a p h a r m a c i s t . R e g -i s t e r m u s t b o k e p t ' i r :.{ ; ' e « M t v . o v e a r s - . N o e n t r y r e q u i r e d i n n a r c o t i c r e g i s t e r . A l l p r e s c r i p t i o n s r e c o r d e d i n n a r c o t i c r e g i s t e r a n d i n i -t i a l l e d t h e r e i n b y a p h a r m a -c i s t . R e g i s t e r m u s t b e k e p t f o r a t l e a s t t w o y e a r s . N o e n t r y r e q u i r e d i n n a r c o t i c -r e g i s t e r . N o r e c o r d i n g r e q u i r e d . A l l p r e s c r i p t i o n s , w h e t h e r i n w r i t i r . g f r o m t h e p r e s c r i b c r o r a s . i v : c O i d i > ' i b y t h e p h a r m a c i s t , o n a s c p c r . j l e f i l e i n s e q u e n c e a s t o - l a t e a n d n u m b e r . N a r -c o t i > s , c o n t r o l l e d d r u g s a n d p r e ; . - - a . ' i n n s o f e i t h e r m a y b e o n t h e s a m e f i l e . T h e f i l e m u s t b e k e p t f o r a t l e a s ! ^ j w f y e a r s . A l l p r e * f i l e f o r l i n e d . ' a V3 APPENDIX D SAMPLE FORMULARY DRUG CLASSIFICATION C O IM 'V E N T S 4:00 ANTIKiSTA/vUNE DRUGS 8:00 ANTI-iNTECTIVE AGENTS 8:04 Amebacides 8:08 Anthelmintics 8:12 Antibiotics 8:16 Aniitubercular Agenls 8:20 Plasrnodicides ' 8:24 Sulfonamides 8:28 Trepon^micides 8:32 Trichomonacides 8:36 Urinary Germicides 8:40 Other Anti-lnfectives ' 10:00 ANTINEOPLASTIC AGENTS 12:00 AUTONOMIC DRUGS 12:04 Parasympathomimetic (Cholinergic) Agents- " -12:08 Parasympatholytic (Cholinergic Blocking) Agent 12:12 Sympathomimetic (Adrenergic) Agents 12:16 Sympatholytic (Adrenergic Blocking) Agents 12:20 Skeie-ial Muscle Relaxants 16:00 BLOOD DERIVATIVES 20:00 GLOOD FORMATION AND COAGULATION ^ 20:04 Antianemia Drugs 20:04:04 Iron Preparations 20:04:03 Liver and Stomach Preparations •20:12 Coagulants and Anticoagulants» 20:12:04 Anticoagulants 20:12:08 Antiheparin Agents 20:12:12 Coagulants 20:12:16 Hemostatics s 24:00 CARDIOVASCULAR DRUGS 24:04 Cardiac Drugs . 24:04:04 Digitalis type ' 24:04:03 Antiarrhythmic 24:04:12 Autonomic 24:08 Hypotensive Agents . • 24:12 Vasodilating Agents 24:12:04 Coronary 24:12:0S Peripheral 24:16 Sclerosing Agents 23:00 CENTRAL N E R V O U S SYSTEA\ DRUGS _ 3-S^G-'.-Gertefa!- Anesthet ics 2S:03 Ar .a loes ics a;-,ci Ant ipyre t i cs 2S:10 Na icot ic Antagon is ts 28:12 Ant i convu lsants 2S: 16 Psychotherapeut ic Agen t s 28 :16 :04 Ant idepressants 28 :16 :08 Tranqui l izers 28 :16 :12 Other Psychotherapeut ic Agen ts 28:20 Respiratory and Cerebra l St imulants 28:24 Sec3 l i ves and Hypnot ics 36:00 D IAGNOST IC A G E N T S 36.04 Adrenocor t i ca l Insufficiency 36:08 A m y l o i d o s i s 36 :12 B lood V o l u m e 36 :16 Brucel losis 36 :20 Chanc ro id 36 :24 C i rcu la t ion T ime 36:28 Diphther ia • 36:32 Fungi 36 :36 Gastr ic Funct ion 36:40 K idney Funct ion . ' 36:44 Liver Funct ion .36:48 L y m p h o g r a n u l o m a V e n e r e u m .- -36:52 Murnps 36 :56 Myas then i a G ra v i s 36 :60 M y x e d e m a 36:64 Pheochromocy toma 36:66 Pituitary Funct ion 36:68 ' Roen tgenography 36:72 Scarlet Fever 36 :76 .Sweating 36 :80 Tr ichinosis 36:84 Tuberculos is 36:88 Ur ine Contents 40 :00 ELECTROLYTIC, CALOR IC , A N D WATER B A L A N C E 40:04 A c i d i f y i n g A g e n t s 40 :08 A l k a l i n i z i n g A g e n t s 40 :12 Replacement Solut ions 40 :16 Sod ium-Remov ing Resins 40 :18 Potass ium-Removing Resins 40 :20 Calor ic A g e n t s 40:24 Salt and Sugar Substitutes 40:28 Diuretics 40:32 Ant id iu re t i cs - . . 44:00 ENZYMES 42 :00 EXPECTORANTS A N D C O U G H PREPARAT IONS 52 :00 EYE, EAR, NOSE A N D THROAT P R E P A R A T I O N 52:04 Anii-mfcrcrrvcs" 52:04:04 Ant ib iot ics 52 :04:03 Su l fonamides 52:04.12 Misce l l aneous Ant i- lnfect ives 52 :08 Ant i- lnf larnmatory Agen ts 52 :16 Local Anesthet ics 52 :20 Miot ics ' 52:24 Mydr iat ics 52 :28 Mouth Washes and Garg les 52 :32 Vasoconstrictors 52 :36 Unclassif ied Agen ts 56:00 GASTROINTEST INAL DRUGS 56 :04 Antac ids and Adsorben ts 56 :08 Ant id ia r rhea Agen ts 56 :12 Cathartics 56 :16 Digestants 56 :20 Emetics and Ant iemet ics 56 :20:04 Emetics 56:20:08 Ant iemet ics 56 :24 Lipotropic Agen ts 60:00 G O L D C O M P O U N D S 64:00 H E A V Y METAL A N T A G O N I S T S 63:00 H O R M O N E S A N D SYNTHETIC SUBSTITUTES 68:04 Cort icosteroids , 68 :08 And rogens -68:12 Chor ionic Gonado t rop in 68 :16 Estrogens ' 68 :18 A n d r o g e n Estrogen Comb ina t i ons 68 :20 Insulins and. Ant id iabe t i c Agen t s 68 :24 Parathyroid 68 :28 Pituitary 68 :32 Proges logens 68 :36 Thyro id and An t i t hy ro id 7 2 : 0 0 L O C A L ANESTHETICS 7 6 : 0 0 O X Y T O C I C S 7 8 : 0 0 RAD IOACT IVE A G E N T S SO:CO SF.RUMS, TOXOIDS , A N D VACC INES 80:04 Scrums 80:03 Toxoids 60:12 Vaccines 8-5:00 SKIN A N D M U C O U S M E M B R A N E PREPARATIONS 8-4:04 Ant i- lnfec l ives 84:04:04 Ant ibiot ics 84 :04 :08 Fungicides 84 :04 :12 Scabicides and Pedicul ic ides 84 :04 :16 Misce l laneous Local Ant i- lnfecf ives 84 :06 Anti-Inf lammatory Agents 84:08 Ant iprur i t i cs and Local Anesthet ics 84 :12 As l r ingents 84 :16 Ce l l St imulants and Prol iferants 84 :20 Delergents 84 :24 Emol l ients , Demulcents and Protectants 84 :24 :04 Basic Lotions and Liniments 84 :24 :08 Basic Oi ls and Other Solvents 84 :24 :12 Basic Ointments and Protectants 84 :24 :16 Basic Powders and Demulcents 84 :28 Keratolyt ic Agents . 84 :32 Kera top las ty Agents 84 :36 Misce l l aneous Agents 86 :00 SPASMOLYT IC AGENTS 88:00 V I T A M I N S 88 :04 V i t amin A - . • 88 :08 B V i t amins 88 :10 V i t amin B Complex 88 :12 V i t am in C 88 :16 V i t amin D 88 :20 V i l a m i n E 88 :28 V i t amin K Act iv i ty 88 :28 Mu l t i v i t am in Preparations 92 :00 UNCLASSIFIED AGENTS 92:04 An t igou t Agents 92 :08 Irrigation Solutions 92 :12 Misce l laneous APPENDIX E PROGRAM LISTING ' I v v \ *• > A A A A A AAA A A \ A A A A /. A A A A A >• A \ X ,X X X A A A A A A A A A A A A A A A X A A A A A A A A A A A A A A .* A A A A A X X X A A X X X X X X -S ;v'-. 7 7P''17 UN !~VERSfrY OF R C COMPUTING CENTRE' MTSUN192) ' * - ** * * * * * * * * * * * *-;c THIS JO P. SUBMITTED T I- R. 0 UGH FRONT DESK R EADE R * * * * * * * * * * * * * * * * * * ><cJG HHLK I r \ S I ONO M W A S : 1. 7 :JT} : \ 3 HI N MA_Y 0_l / 7 2 'JScK " H D L H" ~S 1 G N E ii ~ ON AT~ i f : 55:" 27 CN MCN MAY 01/72 LIST LESFIL+*SOURCE* \ 1 SIMULATE I ^  3 ******** TIMER UNIT: 1= 20 SEC * 4 * * :|: * * * * * * * * * * * * * * -J: * * * * * * * * _ _ . . . . . - -6 1. MATRIX H, 10, 5 MANPOWER' SCHEDULING 7 2 MATRIX H,15,6 RX TOTALS BY DAY P, 3 MATRIX H,R,7 "" "MANPOWER ASSIGNMENT BY DAY - A 9 PHONE EOU 100, F l'"> COUNT EOU 1 02 , F 11 r A Y EOU 2 8, H 12 BAY TO EOU 29, H 1 3 ODRX FQU 3 0, H f 14 HO UR EQ U 3 1, H 1.5 ME AM EQU 3 2, H • > 16 SAVID EQ U 3 3,H 17 CHOUR EQU 34, H < * IB' ' DD EOT EQU 3.5, H '1Q EI LID EQ U 3 6 , H 20 RE FNC EQU 3 7, H 21 LEAIO EQU 38, H 1 > ?2 ' QTRTO EQU 3 c, H i ' a • MEANS FQU t\ 1, H • ' STFRF FQU 4 3 , H ?5 . TO IMP. EQ U 4 4,H 26 AV EB EQU 4 6, H - - . • - - •• 2? , AVEC EQU 47,H. L 2 8 IMP TO EQU 4 8,H 2<3 NOSTF EQU 53, H 30 PER PH. EQU 5 4 , H c 31 NP EPS EQ U 1, T 32 R P E R S EQU • "2,T " ' ' "~ "•' 33 ME ViDD EQU 3 , T . . . 34 RE FDD EQ U 4 ,T " 35 STAFF EQU 5,T 36 SPECL EQU 6,T j 37 3 8 AL L RX * EQU 7,T : 39 TYP EW STORAGE-. 2 ONLY 2 TYPEWRITER AVAILABLE 40 ODEDT' STORAGE 1 1 PHARM EDITING AT.A TIME \ 41 * MATRIX 3 CONTAINS TOTALS AND ID'S OF WORKERS ASSIGNED 42 * TO EACH AREA IN THE PHARMACY •. \ 1 43 * C0L1=INPATIENT DISPENSARY CAY <MON=1,,SUN = 7 ) 44 * ' ROW l=#PA«St 2=PA . I DL ,3=?A IDH, 4=«PH 1S,5=PH I DL,6 = PH IDH," y 45 * 7=TYP 1ST PH IOL, 8=TYPIST PH IDH 4 6 IN IT I A L MH3 (1,1 ), 1/MH3< 2, 1 ) , 1/:MH3( 3, 1 ), 1 47 INITIAL • MH3(4,1) ,4/yH3(5,U ,3/MH3 (6 ,1 ! ,6 > 4-3 IN IT I AL MH3<7, 1 ),.3/MH3( 8, 1 ) , 6 o o IN I T I A L MH3( 1-3 ,1-5 ) , 1/ WH3(4, 1-5 ) , 4/MH3 ( 5, 1-5 ) , 3 IN J'TIAL MH.3 ( 6 ,1- 5 ) , 6 /VH 3 ( 7 , 1- 5 )' , 3 /MH3'( 8 ,1 -5 ) , 6 51 INITIAL MP3( 1, 6 ), 1/MH3( 2-3, 6 ) , 2/MH3( 4, 6 ) , 2 5 2 INITIAL MH3 ( 5 , 6 ) , 7/ fH.3 ( 6 , 6 ) , 8 /MH3 ( 7 ,6 ) , 7/M H3 ( 8 , 6 ) , 8 5 INITIAL 138 MH3 ( 1-3,7), C/MH3<4 ,7 ) ,.?/MH3 (5,7) ,9/MH3 (6, 7 ) , 10 IN IT 1 Al MII3( 7,7) , Q/MH2( B ,71,10 5^  * MATPTX C. 0 NT A I N S SCFEITJI F FOR ID'S SET LIP ABOVE. CONTENTS ARE IN * Tf-RMS OF 1/4 HOURS ( IE ft J 00 AM=3 2 > : ROW// = ID * r.n [J! .1 = S T ART , ?. = 1ST CO F F F F , 3= [. UN C H, 4= 2 N 0 COFFEE, 5= FINISH IN IT TAL MIIK 1,1), 32/MH1 ( 1 ,2) ,40/MHl ( 1 ,3) ,50/MHl( 1 ,4) ,60 IN IT I A L "hl(l,?),6/+ 6C IN I T I A L MHH? ,1 ) ,32 /f-'Hl ( 2 ,2 ) ,40/MHl (2 ,3 ! ,5 0/MH1f 2,4 ) ,60 6 1 IN I TIAL MHI ( ?,5),64 6 2 . IN IT IAL MFi (3 , 1 ) ,34/Mhl ( 3 , 2 ) , 4 2/MHI. ( 3, 3 ), 50/Mil K 3,4) ,61 . ft 3 INITIAL MHK 3 ,5 ) ,66 IN IT I AL M HI ( 4, 1 ) , 34/MH1( 4,2) ,-4 2/MH 1(4,3) , 5 2/MHK 4,4) , 61 6 5 I'M I TI AL MH1 (4,5) ,66 66 IN I T I A L MH1 ( 5 , 1 ) ,4 1/M-ll ( 5,21 , 99/MH1 (5,3) , 5 2 / M H1 ( 5 ,4 ) ,63 6 7 J N I T T A L MHH 5, 5), 72 6P INITIAL •VH1 ( 6 ,1 ) ,66/ NH1 (6 ,2 ) , 99/MH1 Kb ,3 ) ,99/ MW1 ( 6, 4 ) , 99-INITIAL MH1 ( 6,5) ,72 7^ ' IM T T I A L MH1 ( 7, 1 ), 34/MH1 (7 , 2 ) , 4 2/MHK 7, 3 ) , 50/MH 1( 7, 4) , 61 71 INI TI A1. MH1(7,51,66 7? IN IT I AL MiH1 ( 8, 1 ) , 41/MH1 ( 8 , 2 ) , 99/MH 1 ( 8 , 3) , 52/MM 1 ( 8,4) , 63 7 3 INITIAL MH1 ( 3 ,5 ) ,7.2 74 IN ITTAL MH1(9,1.) ,36/MHl(9,2) ,42/MHl (9,3) ,50/MH1(9,4),60 , 75 IN IT I AL MH1(9,5 ), 68 7 6 .INITIAL MH1 ( 10 , i) ,36/BH1(10,2 ) ,43/MHl (10,3),5 2/MH1(10,4),61 77 IN IT IAL MH1 ( 10, .5) ,68 7 a ' * 7 9 INITf AL XH£MEAN, 100 an IN IT.I AL • X H^M EAN S , 100 . 8 1 INITIAL XH4N0STF ,010/XH$PERPh,050 8 2 INITIAL" XHSI NPTO,430 r^ v •- IN IT IAL X Hm E FN C, 200 "~ REFILLS WI TH NO C ONT A I NE R *)'• INITIAL XHSDOBX ,100 %. OF NEW OD RX REQUIRING NO RX 9 5 IN IT IAL XHAOHOUR,3 1/XHSHOUR,7 START AT 8 AM R6 INITIAL XF$STFRF,2I0 % OF STAFF RX THAT ARE REFILLS 37 * * * * * * **** * 3> .->******« ' 8 8 IN I T IA L XH SQTRTO,0 8 9 IN IT IAL XHSCAY, i/XH$CAYTO,0 9C INITIAL XH20-XH2 5 ,0 91 INITIAL ..MH2( l-.15t.l-6) ,0_ JJSEO TO COLLECT RX TOTALS 92 >!:*:;: 9 3 .1 VARI A 81. E MHl{*fl,3)+Kl OET 2ND QHCUR OF LUNCH 94 2 FV AR I AIM E P7+((<P8-P7)*RN6 + 50G)/1000) GET ID# ' 95 C M I N F VA RI ABLE < N 1 + 1.1 /3 CONVERT TIME TO MINUTES ' °6 CR F.R X VAR IABL E P 5- 1 ; 97 DY PI. 1 VARIABLE XF*0AYT0+1 GET DAY£(INIT AT ZERO) 98 CI FF VARIABLE P fi- P 7 99 - SUNHY-FVART ABLE (XH$INPTO*75+50)/100 GET SUNDAY TOTAL*752) ; START FVARI ABLE ( <XHST0INP*2 8)+50> /100 28? OF DAY TOTAL 101 • AVE 2 FV AR I ABLE 7200/((XH$TGINP*37)/1C) 8AM-12PM= 37? 1. 02 AVF3 FVARTABLE lC800/( <XH$TOINP*2 5)/10) 12PM-6PM = 35% ;10 3 * * * * :;: * 1 o 4 NPFRS TABLE VSCMIN, 20, 20, 15 NEW P ER S R X 105 R P F P S TA BL E V$CM.I N,20 ,20 , 15 REFILL PERS RX 1^6 NEWDD TABLE V *C M T N , 20 , 2 O't 15 NE W DO R X 1^ 7 REFPn T A B1. F VSCMIN, 20, 20, 15 REFILL DO RX 1 r; a ' STAFF TA R L E VSCMIN,20,2G,15 STAFF RX SPEOl T A BL F V SCM IN , 20 , 20, 1 5 SPEC I AI.'S V o AL IJ-'.X TABLE VT.CMIN,20 ,20 , 15 TIME RX IS IN 01 SP EN SAR Y ( M I N 5 111 WARP V TABLE X H $1-10 UR ,8,1 ,1 2 WORK ARRIVAL D IS T R I RUT I ON/ HR 1 1 ? W L E AV T ABL E X F<;HOUR , 8, 1 , 12 , WORK COMPLETE D I STR IB/HOUR 1 13 * * 4 4>' 4 3 1 4 F >' P C N F! 1N C T 10 N R M 8 , C 2 4 1 1 5 0 , 'V. | , . ] 04/. 2 2? /. 3 , .3 55 / .4 , . 5 0 9 / .5,.69/.6,.915/.7,1.2/.75,1.38 1 16 . 8, 1 .6 / .84, ] . 8 3/.8 8,2. 12/.9,2. 3/.9?, 2. 52/. 94,2. 81 /. 95 ,2.99/.96 ,3.2 ] 3 7 0 ; . 97 ,3. 5/. °3 ,3.9/ . 99 ,4. 6/ , 995,.5 . 3/ .99 GFTMNi FUNCTION XH.$.,HGUR,E4 8, 6.2/.999,7/.9997,8 RX ARRIVAL RATE V--- 7, 100/11, XH*AVEP/17,XH*AVEC /99, 100 12 0 STFf-'N FUNCTION XH$H0UP,D5 STAFF RX ARRIVAL RATE 121 8 , 1 ^ 0 / 1 ] , 2 1 / 1 2 , 9 9 / 1 2 , 3 0 / 9 9 , 1 9 0 12? STPTM EH NOTION RN4,C6 DEAL WITH STAFF AT COUNTER 1 2 3 0 ,1 /.6 40,2 /. 860,3 /.92° ,4/.989 ,5/.999 ,6 1 2 4 PHfiOl. FUNCTION RN4,C7 TIME FOR PHONE CALL 0 , 1 / . 1 70 , 2 / «. 600 , 3 / . 800 , 4/ . 9 40 , 6 / . 9 7 G , 12/. 999,24 126 FOIT FUNCTION RN5,C4 TIME TO EDIT DD RX 127 0,2/.=00,4/.800,5/.9^9,8 12 3 OSPTM FUNCTION R N 5 , C 9 DISP ENSING TIME 12° 0 , 1 /. 1 0 0,2/. 2 C C , 3 /. 500,4/. 750 ,5/'. 870 ,6/.930 ,7/.980 ,14/.9 99, 20 1 3" T Y P F M i-ij N C T TON R N 7,04 TYPE OF FORM 131 . 24 7,1 /.3 03,2 /.9 4 8,3/ . 999 ,4 13? QUERY' FUNCTION RN4,02 QUERY RX CONTENTS? 133 . 9 69,0/.999, 1 134 * 1 3 ^  AM YR X FUNCTION RN3,02 ANY RX CN NEW DD 1 3 6 .690,0/ .999, 1 137 * 133 TYPFL FUNCTION RN5,C5 TYPE LABEL 1 39 0,1/.300,2/.790,3/.980,4/.999,5 140 NMRXS FUNCTION P2,E5 GET #PX/FORM 14 1 1 , FNSNMRK l/2,FNiN.vRX2/3,FNSNMRX3/4",FN$NMRX4/5 ,FN$NMRX5 14? NMRX1 FUNCTION RN2,05 Ol . 89 6, 1 /.9 70, 2/o 991 , 3/. 99 8 ,4/. 999 , 5 K M R X 2 F U N 0 T 10 N P. N 2 , D 5 I L r;, . 707 ,1 /.878 ,27 .951 ,3/.988 ,4/.999, 5 146 NMRX3 FUNCTION PN2,D3 14 7 .S69,l/.986,2/.°99,3 143 . NMR X4 FUNO TICN RN2 ,04 149 : .662, 1/.849, 2/.912, 3/. 999,4 1 50 ,\MRX5 FUNOTION RN4, D3 151 . 846, 1/. 9 83, 21. 999 ,3 lO? • 4 4 4 4 44 4 4 4 **>i 4 4 4 4 4 4 4 4 4 4 4 44 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 1 ^ 3 * C CNTROL SIMUL A T I 0 N LENGTH 8> CAT A COLL ECTI0 N * * * * * * * * * * * * * * 154 #** * 4 * * 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 44 44 4 4 44 4 4 4 4 44 155 GENERAT E , , 1, 1 INI TI AL IZATION TX - ONLY ONE 156 UN LIST 157 TEST E X H W A Y, K 7 , I I I 1 IS IT SUNDAY? , 1 58 SAVE VALUE' "" "TOINP,V''!.SUNDY,H GETTOT FOR SUNDAY 1 5 9 TRANSFER ,1112 16 0 I I I 1 SAV LVALUE TO IMP •, XHS INPTG ,H • 161 I I 12 SAVFVALUE AVER,V$AVE2 ,H M FAN ARR TV AL RATE 8AM-12PM 162 SAVE VALUE A VEC , V* A VE3 ,H M E A N ARRIVAL RATE 12? M-6 PM 1 63 UNLINK TOMOR,S T F4B,A LL L " TERMINATE '• 165 4 4 4 4 4 166 GENER AT E 1800 END OF ONE DAY(10 HOURS) 6 ' lie. 17 1 172 LOGIC R SAVE VALUE UNLINK TEST GE SAVFVALUE TR ANS FER TTRST DA.YTO+ , K l ,H T CMOR,ST F4B, ALL XH.T.DAY, K7 , LLLO CAY, K 3., H , LLL1 ~E N A BL E~STOT~~OF~~RX ADD TC TOTAL DAYS SIMULATED TEST CAY-fi (1 -MCN 7= SUN ) SET DAY=1(MONDAY) 1 4 0 7 4 7 7 , B A 81. 8? 8 3 • 8 4 _ So 8 7 8 8 CO L L U"-* G E T 1.LL1 J J J1 ' j j J2 S AVFV A 1.11 r AVf-RAT-F A R R TFST i-SA VF'VAI. UF TP ANSFFR . 5 A V FV AI.IJ E D Ay + , Kl , l-l IVAL RATES FOR RX X H$RAY , K7. J.JJ 1 TCI NP ,VT>SUNDY ,H , .JJ.) 2 T C I NP, X H$ I.NPTO, H APO TO DAY n RASED CN TCTAL/OAY IS IT SUNDAY? GET T CT FDR SUNDAY SAVE VALUE SAVEVALUE TF KM., NAT F * * * * * * * :': * * * * * * * ** * CONTROL GENE RAT * * * * A * * * * * * * * * * * * ARRIVAL PATE ARRIVAL RATE AVER ,V<KAVE2 »H MEAN AVEC,VSAVE3,H MEAN 1 ********* E CYCLE ;': * * * * * * * * * * * * * * * * * * * * * * * * * * ••' * * * * * * ********* 8AM-12PM 12PM-6PM CCC1 CCC2 GENERATE TEST f - F SAVE VALUE TRANSFER SAV EV ALU F SAVE VALUE 180, , 1 X F : $ H 0 U R , K 1 8 , C C C 1 H O U R , K8 , H ,0X02 H C U R +, K 1 , H M E A N , F N $ G E T M I \ ,H 1 HOUR 6 PM? SET TO 8 AM 9 1 SAVEV AL l.l E MEANS,FN$STFMN , H 92 TERMINATE 0 3 * * * * * * * * * * * * * * * * * * * * * * 9 4 * MANPOWER S CHE GUI.. ING ************************************** 05 * CYCLE * 96 *********************** c-7 98 99 2 0 P' 20 r 20 2 000 1 GENERATE SAVE VALUE. TEST GE SAVEV A LU E TRANSFER SAVEVALUF 4 5,,!. QTRTO+ , Kl ,H XH$OHOUR,K72,CQQl 0 h OU R , K 3 2, H ,0004 QH0UR+,Kl,H 1/4 HOUR 6 PM? SET TO 8 AM a * 0QQ4 SPLIT 1 ,TESPA 20 8 SPL IT 1 ,TESPH SPLI T TX * S TO TEST WORK HOURS 206 • SPLIT 1 ,TES EQ TX TO T EST EQUIP AVAIL . 207 QQ0 6 TERMINATE 20 8 * 2 C9 * TEST FOR WORKER AVAILABLE HOURS ?. 10 * * * I NP A TI F N T DI S P E N S A R Y * * * 211 TES PA AS S I GN 7,MH3( 1,X H$D AY ) HP. AIDES ON DUTY 212 ASSIGN 8 ,MH3 (2 ,XH$DAY ) START ID TES GO GATE LP. SCHED 214 LOGIC S S CHE D ' 215 TE SO TE ST GE XHf'QHQUR, MH1 (*8,1 ) , TES1 START 216 TEST NE XHSOHOUR ,MH1( *8 , 2 ) , TE S 1 1ST COFFEE 217 TEST NE- XH$QHCUR, MH1 ( *3 ,3) ,TES1 ^ LUNCH-1ST QHOUR 2 1 8 ' SAVE VALUE " 2 2,VI ,H " GET 2ND QHOUR F O R LUNCH , 2 1 Q TEST NE XHJOHOUR, XH22,TES 1 LUNCH-2ND QHOUR 220 TE ST NE XMT- QH OU R » MH1 ( *8 ,4 ) , T E S1 2ND COFFEE ?2T TEST L XHSQHOUR , MM 1 ( * 8 , 5) , TE SI STOP 222 FAVAIL *3 223 TRANSFER , TES2 2 24' TES 1. FU M AV AI L * 8,CO,, , C O , , C 0 ,225 TE S2 ASSIGN- 3 + .K1 GET NEXT ID ' 2 26 LOOP 7 , TESO .2 2 7 LOGIC R SCHED MAKE AVAIL NEXT TEST 2?8 TERMINATE O TESPH ASS IGN 7 ,MH3(4,XHSDAY) fiPHARM ON DUTY Wo ASSIGN 8,MH3(5,XH$CAY) 'GET START ID 231 TRANSFER , TESGO 232 * 141 •? -i t 234. 2 3 ? 2 3 6 -> -< i\ TE S !2>'0 TP SI A T E S 1 B T E S 1 C T E S 1 D * SET TF S2A T E S 2 3 TE S2C TE ST I TEST GE TFST L FA VA I L SA VA T(. T F S T GE _ F U N ' U ' A I 1. T R A N S F F R FA VA T I. TR A N S F F R T F S T G E T F S T L "TRANSFER F l. .1N A V A I L S U N A V A I L EDNA VA 11. SW I T C H E S TE ST L TEST GE TEST L L O G I C R TR ANS'FER TE ST GE T E S T L K 3 4 , T E S 1 D K7 ?, T E S 1C , TES1_B ,7cC, ,C"G~ XE ' M 1 A Y , K 7 , T F S 1 C MON-SAT? XII T-QHOUR , X Hf.QHOU R, PHONE TYPE W X E * n AY ,_K6 C O U N T Y C O Y , T E S 2 A COUNT , T E S 2 A X E $0 HOU R , JKHjfcQHCiUR^ ttFSTA " PHONE,CO, , , CC, , C 0 TYPE W COUNT,CO, , , C 0 , , c n C ALL CW RX A R R I V A L S XH$ 0A Y ,K 7 , T E S 2 C MQN-S AT? K 3 6 , T E S 1 0 K6 3 ,TFS 1 D SATJ.IRJDAY OR SUNDAY? 'NO ST AF'E""SERV I C E A V A I L A B L E " " S T A F F S E R V I C E A V A I L A B L E T E S T FOR SUNDAY OPEN HOURS 9A M - 5 P M T R A N S F E R T E S 2 D L O G I C S T E S 2 E T E R M I N A T E * * * * * * * * * * * * * * * * * * G E N E R A T E P R F S C R * * * ** * * ***** * * * * * y H vO HOUR , XHSOHOUR, OPEN ,TES 2E XH"5QHOUR , X H f>Q HOUR , , TF.S?~B OPEN K 3 2 , T E S 2 D K7 2 , TES 2D K 3 6 , T ES2 D K6 8 , T E S 2 D OPEN D I S P E N S A R Y D I S P OPEN? HOUR S? CLOSE D I S P E N S A R Y * * ******* IPT IONS * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ******** * * * * * ** * * * * * * P R E S C R I P T I O N T R A N S A C T I O N P A R A M E T E R S : P I - M I S C E L L A N F O L S P2 - P R E S C R I P T I O N T Y P E : 1=NP,2=RP,3=NDD,4=RDD,5= ° 3 - I F =1 THEN PX W I L L BE Q U E R I E D P 4 - USED TC A S S I G N WORKFR ID S T A F F * * S R ^ T T J R M * * P6 - I F NOT = 0 , THEN ** p 7 _ M I S C E L L A N E O U S ** p,q _ My S C E L LAN EOUS * * P 9 - M I S C E L L A N F O L S * * D io- o FTURN A D D R E S S FROM RX IS A ' S P E C I A L ' S E L E C T WORKER ROUTINE T~, THEN NEW DD PX HAS ALREADY BEEN E D I T E D ** pi2- USED TO D E T E R M I N E I F NEW DD FORM HAS ANY RX * * * * * * * * * * * * * * * * * * * * G E N E R A T E X H £ M E A N, FNSEXPON GATE LP OPEN ***HOLD TX I F D I S P E N S A R Y IS CLOSED GATE LR A S S I G N L O G I C S P L I T S F TRST,GGGO 5 , VS START F IR ST * 5 ,GGGO ^ T ^ T F -r^RTTTx -"F N ^ T T A Y T , sTTTf""OpF * * * OF E X P E C T E D T O T A L FOR CAY * * * D I S A B L E S P L I T U N T I L ME XT DAY GET S T A R T £ O F RX 29% GGGO A S S I G N 2 , F N $T Y PF M GET RX TYPE A S S I G N 5 ,FN?.NMRXS L I N K I N P D S , F I F 0,A A A A A #RX/FORM 7q? GE ME RATE AS S 1 GM AS S I G N 4 3 0 , F N * EXPON 2 ,K 1 5 , K 1 • S P E C I A L ' RX 1 RX ON ' S P E C I A L ' FORM 2 c 3 2 9 A Q ; : 301, 3C ' 3 0 3 _3G'', 30 5~ 30 6 10 7 30 P 3 0" J 1 r _ 3 T i 31 2 313 •314 31 5 _3_16_ 317 31 P 31° • 3 2 <"'. 321 322 A S S I G N 0,K1 P R I O R I T Y 2 LI NK I N'PDS,I.IEO, '-AAA A y. * >'c :;. 4 4 s; 4 * 4 4 4 * >: * •:• 4 4 * * * * * * * * * * * * * 4 4 4 * * * • * ROUT I N F TO AGO C U NT !•" OR PHONE 0. AI L S * ** TO TI I F [ NP AT I FN T 0 I SP LN SARY _ _ *_ * 4 * 4 * 4 I' * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 * * ' SPFO. I A L ' GENER AT E OA TE FV AS S I ON AS S I G N _ _T° A N S F E R **" BUS I N 4 7 , F N S E X P O N , 135 PHONE 7,MH3( 5,XH<?;DAY) 8 ,MH3 (6 ,XHSCAY ) . XH f,PER PH , , PHG1 F I R S T TM AT 8:45 WATT U N T I L PHCNF A V A I L A B L E GET TO RANGE FOR PH ARM PH 0 1 PH 02 SS PHONE TP A N S F E R TEST F A S SI G N GATF FV C ALL ** SBR ,GETWR,10 P 4 , K 9 9 9 , P H 0 2 4 ,V2 * 4 , P H 0 3 GET F R E E PHAP.M NONE? GET RANDOM PHARM AVA IL A B L E ? OA TF NU T ABUL ATE S E I Z F PR FEMPT MS AVE VALUE An VANCE PHONE,PH03 WARR V PHONE *4 2 + , V S D Y P L l , 6 , K l , H F NSPHOCL PHONE IN U S E ? ADD TO WORK A R R I V A L S / H O U R PREEMPT WORKER ADD TO PHONE C A L L S FOR DAY PHONE CALL T I M E R E L E A S E PHONF RETURN *4 TA B U L A T E W L E A V PH03 T E R M I N A T E * * * * 4 4 4 •;• * * * 4 * * * 4 4 * * 4 -;< * 4 * * * 4 4 * 4 * * * * * * ** ROUTINE TO ACCOUNT FOR A R R I V A L GF * ADD TO WORK COMPLETIONS/HOUR 4 4 S T A F P P R E S C R I P T I O N S * 4 4 4 4 4 * 4 4 * 4 4 * 4 4 * 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 32 5 GFN ER ATE XH* M E A N S , F N $F X P 0 N ,90 F I R S T IN AT 8:30 AM 3 26 GATE FV COUNT COUNTER OPEN? 227 QUEUE S T A F F WAIT 328 AS S IGN 7,MH3( 5, XHSDAY) GET ID RANGE 32 9 ASS ION 8 , MH3 (6 , XHSDAY) FOR PHARM 3 30 STF 1 TRAN S F E R SBR , GET WR ,10 ANY A V A I L A B L E AND FREE 331 TEST E P 4 , K 9 9 9 , STF 2 NO: ^32 S E L E O T F V 4 ,*7 , * 8 , , ,STF1A GET F I R S T PHARM A V A I L A B L E r 3 3 3 TRANSFER , STF 2 •a "3 4 ST F l A ADVANCE 3 NO-WAIT 33 5 TP- A N S F E R ,STF1 2 36 4 23 7 STF? PREEMPT 4 4 3 3° SE I Z E COUNT 3 3° DE PART S T A F F 3 4 " TABULAT F W ARRV- ADD TO WORK A R R I V A L S / H O U R 3^ 1 ADVANC E F N S S T F T M DFAL WITH S T A F F AT COUNTER 342 *3 / . O TP ANSFER . X H & N Q S T F , , S T F 4 I S DRUG I N FOR M U L A R Y ? 3 4 J 344 AS S I G N 2 , K 5 S T A F F RX 34 5 AS S I ON 5 , FN $NMRXS GET #RX/FORM 346 S p L T T *5 ,STF4 A 34 7 S T F 4 R E L E A S E COUNT RETURN 4 4 C7 T A B U L A T E W LEA V ADD T C WORK COMPLETIONS/HOUR TERM INATE 3 51 4 3 5 2 STF 4A. T C S T GF XH'EHOUR ,K12 , S T F 4 B I 3 5 '* 3 5r^ 356 3^7 " 6 n 3 61 • 3 6 ? 363 _3 6 i 3 6 5"" 366 ? 6 7 3 6 8 3.AQ _37C_ 37 1 3 7? 37 3 •3 74 3 75 37 6 37 7 3 78 37 9 " 380 3 81 _3 8_?_ 0^ 3 8 6 386 387 38 8 ~ 3~8 "" 390 3 91 392 ,393 394 LT NK S T F 4 R A S S I G N AS S I ON T A B U L A T E N A R K E N T ER L I N K :) * * * *i * * •;• * * :'• 4 * * * I N P A T I E N T H I S P * * * i,: i. ^  * * * * * * 4 4 * * * A- * * ** * * * * >•- i-. if * 4 * * * 4 ~*""R~X~ S H R T T N G * * * 4 * « * if if * 4 A * * * A A A A A ASS I G N A S S I G N C O U N T FV TP S T G T C-'iOR, F I FO 3 , F N 't« Q II FRY 6 , K 0 W A R R V QUERY RX CONTENTS? NOT ' S P E C I A L ' ADD TO WORK APR IV AL S / HO UR ADD TO T Y P I N G WORK IN OS P ' TYPE , ' F T F O ,RPB"B"B'"" *************** E NS AR Y M 0DUL E **** ** ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *  * * *' * * * * 7 TR ANSFER TEST E TR AN SF F R IN P I A S S I G N ASS I ON TR AN S F F R -> , MH3 (2. , XH$CAY ) 8 , M H 3 ( 3 , XHSDAY) l , * 7 , * f i f i t KQ , I NP1 c~n> ri r c x i.m GET ID FOR P. A I D E ANY P A I D E A V A I L A B L E SBR", GET WR , 10 P 4 , K 9 9 9 , I M P 3 , TNP2 1 N r c. !,MU3(5,XHSDAY) 3 , M H 3 ( 6 , X H$ D A Y) BR . 0 F T W R . 1 0 TEST E I N P 2 ADVANCE T R A N S F E R I N P 3 S E I Z E ADVANCE l l | 1 - I I , l\ I I -4' U I S BR , GET W.R ,1 0 P'4,K 999~, I MP 3 1 5 , A A A A. 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I N P 5 T A S S I G N 4 , X H 3 D D E D T Y E S : G E T H I S . I D F O R T X 4 3 7 G A T E F N V * 4 , I N P 5 C ' A 3 s * I N P 5 A A S S I G N 7 , M H 3 ( 5 , X H & D A Y ) L V A 4 0 A S S I G N 8 , M H 3 ( 6 , X H S D A Y ) ' 4 4 1 T P A N S F F R S B R , G E T W R , 1 0 T R Y T O G E T P H A R M UL ? , T E S T E P 4 , K 9 9 9 , I N P 5 B • a A D V A N C E 3 N O N E - W A I T G A T E S E . D D E D T , I N P 5 T 4 4 5 T R A N S F E R , I N P 5 T R Y A G A I N 4 ^ 6 I N P 5 B S A V E V A L U E D D E D T , * 4 , H S A V E I D O F E D I T I N G P H A R M & 4 4 7 I M P 5 C S E I Z E * A 4 4 8 E N T E R D D E D T ' 4 4 9 ' T A B U L A T E W A R R V A D D T O W O R K ARRIVALS/HOUR. 4 5 0 U M L I N K D D E D T , I N P 5 , K 1 A L L O W N E X T T X F O R E D I T I N G 4 5 1 ' A D V A N C E F N . S E D I T E D I T T I M E 4 5 2 ' S P L I T 1 , 1 N P 6 A G R E A T E R E - F I L E D D T X V 4 5 2 T E S T G P 1 2 , K 0 , N O R E Q A N Y R X R E Q U I R E D ? 4 5 4 * 4 5 5 S P L I T V S C R E R X , I N P 6 G C R E A T E R X T X ' S 4 5 6 R E L E A S E ' * 4 4 5 7 L E A V E D D E D T 4 5 8 T A B U L A T E ' W L F A V , 4 5 9 I N P 6 G A S S I G N 3 t F N S Q U E R Y Q U E R Y R X ? . 4 6 0 E N T E R I N D S P " 4 6 1 T A B U L A T E W A R R V 4 6 ? 4 6 3 T E S T L E P 3 , K 0 , R X Q U E Q U E R Y R X ? A 6 4 L I N K T Y P E , F I F O , R G B B R ; - 4 6 5 * * * N 0 D R U G * * 4 6 6 NO R E Q S A V E V A L U E 2 3 + , K 1 , H T O T A L D D N O F I L L S T O D A Y 4 6 7 T A B U L A T E W L E A V A D D T O W O R K C O M P L E T I O N S / H O U R A f P L E A V E D D E D T 0 , R E L E A S E T E R M I N A T E * 4 4 7 1 * 4 7 2 ' I N P 6 A . A S S I G N 1 1 , K 1 S E T A L R E A D Y E D I T E D S W I T C H 4 7 8 4 7 4 4 7 5 ^ 4 7 6 4 7 7 Q o 4 8 o 4 8 ? 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R , G F T W R , 1 0 P 4 , K 9 9 9 , 1 N P 3 4 I 5 , I N P 3 2 _G_FT P H A R M F O R " " Q U E R Y " ' " T R Y T O G E T P H A R M N O M E - W A I T G A T E N U S E I Z E S E I Z E D E P A R T MS A V E V A L U E AD V A N C E P E O N E , I N P 3 3 * 4 P H O N E 0 U E R Y 2 + , V * D Y PI.. 1 , 6 , K 1 , H F N S P H O C L A D D T O P H O N E C A L L S F O R D A Y P H O N E Q U E R Y R E L E A S E R E L E A S E A S S I G N T E S T G L I N K I M P 3 5 L I N K P F O N E * 4 3 , K O P 6 , K 0 , I M P 3 5 T Y P E , L I F O T P E G B B T Y P E , E I F 0 , B B B 8 8 S E T O F F Q U E R Y G O T Y P E • S P E C I A L * 4 ^ 7 " 4 9 8 4 9 C ) 5 0 1 _JQ2_ cr 5 0 5 5 0 6 --5 0 7 " 5 0 8 * * * * * * $ * * * * * * * * * * if * * * * L A B E L T Y P I N G * * * * * * * * * * * * **=;:•:< * * * * * B B B R B G A T E S F T Y P E W , 8 B B B 0 B B B 8 X A S S I G N 4 , X H $ S A V I D G A T E F M V * 4 , I N P l l A N Y P H A R M A L R E A D Y T Y P I N G ? Y E S : G E T H I S I D F O R T X I S H E S T I L L A V A I L A B L E ? B B B B O A S S T G N A S S I G N ' T R A N S F E R T E S T E A D V A N C E 7 , M H 3 ( 7 , X H $ D A Y ) 8 , M H 3 ( 8 , X H S O A Y ) S E R , G E T W P . , 1 0 P 4 , K 9 9 9 , I N P 1 0 3 G E T P H A R M F O R T R Y T O G E T P H A R M N O N E - W A I T " 5 0 9 5 l o , 5 1 1 5 1 2 ^ 1 3 5 i 4 -5-1-5-5 11 . 5 1 7 5 1 3 ^ 5 1 9 5_2_i_ ' 5 2 1 5 2 2 5 2 3 5 2 4 o 2 5 5 2 6 I N P 1 0 I N P 1 1 G A T E S E T R A N S F E R S A V E V A L U E S B I Z E U N L I N K T Y P E W , B B B B X , B S B B 8 S A V I D , P 4 , H * 4 T Y P E , B B B B B , K 1 ~ P 3 , K G , I N P 1 6 -1 * 4 , R X Q U E P 2 , K 2 , I N P 2 0  " P 2 , K 5 , I N P 1 7 . X H S S T F R F , , I N P 2 0 T Y P E W F N S T Y P E L T Y P E W * 4 S A V E P H A R M I D G E T N E X T R X F O R T Y P I N G ' 5 2 7 " 5 ? R 5 3 1 * * * N O I N P I 6 " T E S i T G A D V A N C E R F I E A S E T R A N S F E R Q U E R Y * * * T E S T N E " Q U E R Y R X ? MI SC. E D I T T I M E R E F I L L P E R S R X ? I N P 1 7 I M P 1 8 T E S T E T R A N S F E R E N T E R A D V A N C E L E A V E R E L E A S E R E F I L L S T A F F R X ? G E T T Y P E W R I T E R L A B E L T Y P I N G I N P 1 9 T F S T L I N K L I N K I N P 2 0 T R A N S F E R P 6 , K 0 , I N P 1 9 D I S P N , L I F O , C C C C C D I S P N , F I F O , C C C C C . X H $ R E F N C , I N P 1 8 , I M P 1 7 • S P E C I A L « N O C O N T A I N E R ? 146 5 " ^ * * ;': * * :| * * * * * * * * * * * * * * ? 3 4 * D I S P E N S I N G OF R X * * * * :•; * * * >; * * * * * * * * * * * * * * 5 3 * CC.CCC ASS IGN 7 , M!I3 ( 5 , XH.tC AY ) GET PHARM 5 ^ 7 ASSIGN 8 ,MH3 ( 6 , XFHDAY) FOP D I S P E N S I N G TR .ANS F f- R S PR , GETWR, 10 TRY TO GET PHARM TF S T F P 4 , K 9 9 9 , I N P 4 ] 5 4 " A 0 V A N C F 3 NONE - WAIT 5 4 1 C / 0 TR ANS FFR , c c c c c T U / 54 <' IMP 4 1 S F I 7 F * 4 5 4 4 . UNLINK D IS P M , C C C C C , K 1 GET NEXT PX FOR D I S P E N S I N G "546* AH VANGF. F Nf>DS PT M BIS PENS ING TI M E 5^6 R E L E A S E *4 5 4 7 TEST G P 6 , K D 7 I N P 4 2 ADD TO L E A V E - D I S P E N S A R Y WORK 548 LI NK L E A V E , L I F O , L F A D S ' S P E C I A L ' INP42 L INK L E A V E , F I F O , L E A D S 5 5 3 * * 3; * * * -.!; * * * * * A * * * * * * * * * * * * * * 551 * L E A V E O I S P E N S A P V ROUTINE * 552 * * * * * * * * * * * * * * * * * * * * * 5 5 0 LEADS GATE LS L E A V E ,1 E A l ANYONE ALREADY RETURNING WORK 5 5 4 ASS IGN 4 , X H S L E A ID Y E S : GET H I S ID FOR TX 55 5 GATE F NV * 4 , L E A 5 5 56 * 557 LE A l ASSIGN 7 , M H 3 ( 2 , X H $ D AY ) GET ID FOR 55R A S S I G N 8 ,MH3 (3 ,XH£OAY ) P A IDE 5 5 9 COUNT FV 1 , * 7 , * 8 ANY A V A I L A B L E ? 560 TEST G P 1 , K 0 , L E A 2 561 TRANSFER S8R ,GETWR ,1 0 Y E S : TRY AND GET ONE 562 TEST E P 4 , K 9 9 9 , L E A 4 TR ANS FER , LE A3 J 4 LEA 2 A S S I G N 7 , M H 3 ( 5 , X H $ D A Y ) GET ID FOR PHARM 5 65 AS S IGN 8 , M H 3 ( 6 , X hi $ D A Y ) 566 TRANSFER S B R , G ET WR , 10 TRY TO GET PHARM. 567 TEST E P 4 , K 9 9 9 , L E A 4 563 L E A3 ADVANCE NONE: WAIT 569 TRANSFER , LE A l S70 571 LEA4 S A V E V A L U E L EA ID , * 4 , H STORE WORKER ID 5 72 LEA 5 S E I Z E *4 573 LOGIC S LEAVE WORK IN PROCESS 5 7 4 LEA6 UNLINK L E A V E , L E A 8 , K 1 , , , L E A 7 GET WORK UNTIL ALL RX SENT 57^ ADVANCE 1 RETURN T I ME 576 TRANS FER , LEA6 ANY MORE READY 577 * * ALL S E N T * * 578 LEA 7 UNLINK L E A V E ,L E A D S , K l ALLOW NEXT TX TO L E A V E 579 REL EAS E * 4 5 30 LOGIC R LEAVE WORK F I N I S H E D 581 LEA 3 ADVANCE 1 RETURN T IME 5 82 * * C O L L E C T S T A T I S T I C S * * 5 83 TFST G P6 , K 0 , T A B O T 5 84 TABULATE S P E C L ' S P E C I A L ' 585 TRANSFER , TABOK 5 86 TABOT TABULATE *2 T IME IM D ISPENSARY BY RX TYPE ^87 TABOK M SAVEVALUE ? + , V 6 D Y P L 1 , P 2 , K 1 , H ADD TO TYPE TOTAL FOR DAY c-88 TABULATE ALLRX RX TIME IN D I S P E N S A R Y - A L L ~)9 TABULATE WLFAV ADD TC WORK C C M P L ET IONS/ HO U R " ^ 0 L FAV E INDSP " • 5Q1 ' TERMINATE 5 e/? * * * -:= * * * -'• * ••• * * * * * * * * * * * * * * * * * * * * * * * * * ~ * * * * * * * * * * * * * * * 147 5 9 8 5 °4 ••;<-> 7 Q o " 6 0 " 6 0 1 6 n ? 6 0 3 _ 6 0 4 ~ 6 0 5 6 0 6 6 " 7 6 0 S 6 0 9 _6L°_ 6 1 1 6 1 2 6 1 3 - 6 1 V 6 1 5 6 1 7 i S D K p. n I T T KF T O s F 1 . f C T Ay A 1 1 . A R.L E W 0 R K F R I N R ANG E G T V F N BV P 7 - P 8 , A Mi) P L A G E T 0 I N P 4 . P 1 . 0 + I I S T M F R E T U R N A C T R E S S GETWP G A T E LR 1 . 0 G T C S ' A S S I G N " " " " A S S TON G E T 1 G A T E FV G A T F N U AS S I G N G F T 2 L O G I C R SFLWR S_ELWR___ " 9 , V ? 3 , V S D I F F * 9 , G E T 3 * 9 , G E T 3 4 , * o S F L W R C O N T R O L O N E T X A T A T I M E G E T R A N D O M W O R K E R I D G E T W O R K E R S T O T R Y A V A I L A R L E N O T I N U S E ? S T O R E I D R E T U R N G E T R A N S F E R T E S T 0 A S S I G N T E S T - L A S S I G N P , 1 0 , 1 P 3 , K G , C E T 4 1 - , K .1 P 9 , P 3 , G E T 3 1 9 + , K l T O B L O C K P I 0 + 1 F I N I S H E D A L L P O S S I B L E I D ' S ? R E D U C E ii O F T R I E S L E F T R E A C H E D T O P R A N G E ? G E T N E X T U P T R A N S F E R , 0 E T 1 G E T 3 1 A S S I G N 9 , * 7 T R A N S F E R , G E T 1 G E T 4 A S S I G N 4 , K 9 9 9 T R A N S F F R , G E T 2 G E T L O W R A N G E N O N E F O U N D : P 4 - D U M M Y V A L U E L I S T S T A R T R E P O R T E J E C T 3 « • * e • • c * . D I S P E N S A R Y A N A L Y S I S . . . a o • 9 o o o o • • • o © « o o « 0 • 0 0 •» 9 0 « 0 8 Q 1 1 -.V -.V 9' 0 1 S P E N S A R Y ( R O W ( C O L M A N P O W E R S C H E D U L E M A T R I X : # = I D O F W O R K E R ) H = U S E D T O I D E N T I F Y S T A R T , S T O P £ B R E A K T I M E S ) 3.2 1 3 F 1 4 ' 1 5 I S H E S T A R T 1 S T L U N C H 2 N D F I N -T I M E C O F F E E C O F F E E T I M -R 1 6 1 7 H M S T I T L E ! I I 1 I 1 , ( E N T R I E S I N M A T R I X A R E I N T E R M S O F U G E 1 / 4 H O U R S ) 1 8 3 .9 2 0 2 1 • 2 2 2 3 s*j S P A C E 2 M A N P O W E R A S S I G N M E N T B Y D A Y ( C C D H M S F A C T I T L E S P A C F T I T L E 3 , ( R O W 1 - 3 " = P . A I D E S ; R O W 4 - 8 = P H A R M A C I S T S ) U T I L I Z A T I O N O F M A N P O W E R , P H O N E & ' S T A F F C O U N T E R 2 4 2 5 2 6 2 7 - 2 3 2 9 E J E C T • T Y P E W R I T E R : 1 0 T E X T N U M B E R A V A I L A B L E - # S $ T Y P E W , 8 / X X X X X X # A V E R A G E U T I -L I Z A T I O N = « $ $ T Y P E W , 4 / 2 R X X X X . X # 2 ! 1 0 T E X T T O T A L L A B E L S T Y P E D = # S $ T Y P E W , 5 / X X X X X X # A V E R A G E T I M -E / L A B E L = # S $ T Y P E W , 6 / X X X X , X X « ( 1 / 3 M I N ) 3 ° 6' 3 4 3 8 1 0 T E X T X . X X -H ( 3. / 3 M I N ) 1 0 T E X T S O A C E * P R E S O R T P T T C N S : ""]. 0 T E X T A V E R A G E W A I T I N G T I M E F O R . L A B E L T Y P I N G = # C H $ T Y P E » 3 / X X X — A V E R A G E N U M B E R O F R X W A I T I N G = # C H $ T Y P E , 5 / X X X X X # 2 A V E R A G E N U M B E R O F R X I N D I S P E N S A R Y =/,' S i I N D S P , 3 / X X X X X t; 7 6 1 o Tf; XT " MAXIMUM NUMBER OF RX IN D I S P E N S A R Y = #S S. IN DSP »8 / X X XX X# ' / I S 1 0 TFXT AVERAGE S T A F F W A I T I N G T I M E AT COUNTER ~UQ U S T A F F , 7 / X X X -1 . XX* ( 2 /3-1 IN ) .'. O ] r ' TEXT AVERAGF T I M E SPENT WITH S T A F F AT COUNTER = //F SG0UNT.4/-X X X . X X •y { 1 /? MJ_NJ 1 0 TEXT AVERAGE RX W A I T I N G T I M E FOR D I S P E N S I N G = # C H $ D I S P N , 3 / X -•'+4 XXX. xy- ( 1/3MTN) 1 o TFX T AVERAGE NUMBER OF RX WA I T I N G FOR D I S P E N S I N G =f'CH$DISP-46 N , 5 / X X X X X // 4 7 * 4 £ i o TFXT AVERAGE W A I T I N G T I M E FOP. DD RX E D I T I N G = # C H $ D 0 E D T » 3 / X -4 q ^0 R 1 XXX.XX * ( 1/3MIN ) 10 TFXT TCTAL RX O U E R I F C =#G$QUERY,4/XXXXX# 52 1 0 TEXT AVERAGE W A I T I N G TIME FOR QUERY =# 0$ QUERY ,7 / XXX .X X # (1 / -3 MI N) 54 SPACE 2 55 P R E S C R I P T I O N T I M E IN I N P A T I E N T D I S P E N S A R Y 56 " 5 7 5 <q * R X T Y P F NUMBER AVE TIME ( M I N ) S.D. ( M I N ) FO PM AT I -7/T 1, T 2 , T 3 , T 4 5" SPACE 2 60 TAB T T T I. E , TIME I N D I S P E N S A R Y FOR A L L P R E S C R I P T I O N S . ( M I N ) 61 TAB I N C L U D E T 7 / 2 , 3, 4, 1 0 , 1 1 , 1 2 , 13 62 E J E C T " 6 3 OR APH T P t A L L R X 6 A OR I G I N 5 1, 10 65 X , 2 , 3 , 2 0 , 1 , 1 5 D r 30 Y ST AT EM,FNT 0 , 5 , 10, 5 1 , 2 4 , * * * * * * * * * * * * * * * * * * * * * * * 6 3 30 STA TF ME NT 2 , 2 4 , * D I S T R I B U T I O N OF T I M E * 69 30 STATEMENT 3 , 2 4 , * A P R E S C R I P T I O N I S I N * 70 30 STATEMENT 4 , 2 4 , * THE D I S P E N S A R Y * 71 30 STA TEMFNT ^ *•'* j 1 , i'c ;)* 'V ^x. jj< *J,£ j'* 72 1 ST AT EM ENT 2 5,4,35 OF 73 1 STATEMENT 2 6 ,4 ,RX 74 20 STATEMENT 5 4 , 1 5 , T I M E IN MINUTES 75 EN DOR APH 76 E J F O T 77 GR APH TP,WAPRV 7 8 0°. I G I N 5 1,10 79 X , 2 , 3 , 8 , 1 , 1 1 80 y 0 , 5 , 1 0 , 5 o J. 30 STATEMENT 1 , 2 3 , * * * * * * * * * * * * * * * * * * * * * * * 8 2 30 STATEMENT 2 , 2 3 ^ D I S T R I B U T I O N OF WORK * 83 30 ST AT EM EM T 3 , 2 3 , * AR R I VA L S BY H 0 UR 0 F * 84 8 5 30 30 S T AT E '•' F NT STA TEMEMT 4 , 2 3 , * DAY * 86 1 ST AT EM FNT 2 5, 4, % OF F.7 1 STATEMENT 2 6 , 4 , WORK 8° 20 STATEMENT 54 , 23 ,HOUR OF D A Y ( 8 A M TO 6PM) 8" EN DGR AP H 90 E J E C T "1 , GRAPH TP,WLEAV y OR I 0 I N 5 1,10 ^$3 ; X , 2 , 3 , 8 , 1 , 1 1 94 1 Y 0 , 5 , 1 0 , 5 95 30 ST AT E ME NT ] ,?"} ,* * * * * * * * * * * * * * * * * * * * * * * _ . . .. . - IkSL O A ?0 S T A T C M F N T ? ,23 , *0 I STR I B UTI 0N OF WORK * 07I 30 STATEMENT 3 , 2 3 , * C O M P L E T I O N BY HOUR * c ? J 30 STATEMENT 4 ,23 , * OF DAY * o-? 30 STATEMENT j r- n 3 S T A T E M E NT 2 5,4, ^  0 F /~V . 1 STATL'MFN'T 2 6,4, WORK ? . 20 STATEMENT 54,23,HOUR OF D A Y ( 8 A M TO 6PM) - 103 SNOOP. APH 104. E J E C T . ^ 1 n 5' * 106 '*** MATRIX OF C A I L Y WORK TOTALS '_107 ' * _ NEW PERS R E F I L L PERS NEW DD RX R E E OP RX STAF-108 F ' PUO.NE C A L L S " . • 1 C"< HMS T I T L E 2 , * * . 110 SPACE 3 ^ 1 1 ) TAP T I T L E • , A R R I V A L AND LEA V E D I S P E N S A R Y D I S T R I B U T I O N S > 11? TAB IN C L U D E T SW AR.RV -T $>W L E AV / 1 , 2 , 3» 4 , 10 » 1 1 , 1 2 , 13 m E J E C T 114 STO T I T L E ,STORAGES USED IN MODEL 1.16 S P A C E 2 116 C HA TITLE- , D I S P E N S A R Y WORK C H A I N S 117 S P A C E 2 113 BLO T I T L E ,BLOCK COUNTS 110 END 'ND OF F I L E o APPENDIX F COMPUTER OUTPUT FROM MODEL VALIDATION 1 5 9 . D I S P E N S A R Y :\r-! A L. Y S T S * * 0 TS p E \' S AR Y MA'MPO •J'"? -OHM'UJLE V A Tf' l M: (POM << = TD cr WC'JK ER ) ( CO I. * = L S F B TC I u r,\. T j f-Y S T A R T , S T O » 8 EREAi< T J ^  i- S START 1ST L UN 0! ?N 0 E I N I S H TI « c 1 COFFEE i 1 C O F F E E T E i {I: ,V T P T t S IN :v A T R I X 1 ARE IN 1 T F P F S CF -1 OF I 1/4 HOURS) i I HAL r w n f * o MA jr< I X I ROW/COLUMN 1 2 "A 4 1 3 2 4 0 50 6 0 6 4 o 4 r 5 0 6 0 6 4 3 3 4 4 2 5 0 6 1 6 6 4 34 42 5 2 6 1 6 6 5 4 1 99 5 2 6 3 7 2 6 6 6 9 9 QC ' 9° 72 7 34 42 50 6 1 b 6 8 4 1 9 9 5 2 63 7 2 36 4 ? 50 6 0 6 8 1 0 36 4 3 5 2 61 • 1. O ** MANPOWER ASSIGNMENT f}Y D A Y I C O L ) (ROW 1.-3 = P. A I D E S ; ROW 4-8 ^ P H A R M A C I S T S ) HAL FNOR C MAT R I X 3 ROW /COLUMN 1 t .j 1 1 I 1 -i I l -> 1 ] ] I l , ~ 1 1 1 J, 1 1 4 4 4 / , - I 4 4 5 3 3 •2 c • 6 6 A, 7 3 .j 3 3. 6 6 n 6 U T I L I Z A T I O N OF MAMPO , j F R, PHONE £ STA'-F COUNTER :A.C ] L ITY NUMBER f= NT R I E S R T F 33 4 26 9 2 9 0" 2 5 4 4 29" AVERAGE T IME/TRAN 2 . l o o 2.463 2 .64 2 2 . 6 7 2 1.759 5 . 2 2 7 l . i ' O • A V C RAGE U T I L I Z A T I O N DURING-TDTAL A V A I L . U N A V A I L . TIME TIM'- TIME TTTW 4 5 6. ,3 79 , 4 1 4 0 2 4 , 1 27 ToTT .39 7 . 6 5 1 ; 54 2 . 59 2 . 1 5 2 .134 . 0 1 3 T^rRcr . nnr-. 0 0 0 .^00 . onn . 0-0 .* . v i. o C U F 6 PH C NE COUNT VAiiPfrnoK) 1 T Y D P U R FT bR : KLMBFR AVMT 1 /MM. n = 1 A V E R A G P U T I L I 7 A T I Q M -r- 3 4 . TOTAL LA BEL S TYPED •-: •>-'•:•• • AVE RAG F T I LAB EL = 2 . 00 ( 1/3M IN ) AVERAGE WA I T IMG T I IE • FOE LMM. L T Y P I N G = 176. 76( 1 / 3 f / I M ) A V E R A 0 F M l ' i R F R OF RX W A I T I N G 30 PR E S C ; ! PT TOMS: AV B OA 0 E NUMBER CF RX T;N« B I S p F N S A BY = A X I M U M NUN REE 0 i- I-. X IN D I S P E NS ARY = 128 AV F R A Q P S T A FF W A [T TM 0 T I M E AT C 0 LN T ER . 0 3 ( 1 / 3 M • N) AVER AGF T I M E SP F N T W I TH S T A F F AT COUNTER = 1 . 1 0 ( 1/3MIN) AVERAGE RX WAIT ING T IMF FOR D I S P E N S IN G = <= 6. 5 ( 1 / 3 >v I N ) AVERAGE NUMBER OF RX W A I T I N G FO R 0 IS P ENS ING = 12 AVERAGE W A I T ING T IMP FOP CO R X E D I T I N G = 2 5. < 0 ( 1 /8MI N) TOTAL RX Q U E R I E D = 12 AV ERAGE W A I T I N G T IME FOR OUER Y = 3.7 5( 1/3MIN) P R E S C R I P T I C N T I>VE IN T b PAT IE NT D I S P E M S A R V RX TYPE NLMBE R AVE TI M E ( MI N ) S . 0. ( M IN > N P E R S 248 7 2 . 4 5 9 51 .987 F P E R S 82 8 8 . 341 51 .875 NEWOO 9 5 . 5 0 0 7 3 .12 5 R EF DD 72 .5 00 50 .062 S T A F F 20 10 9 . 5 9 9 22 .3 75 S P E C L 4 5 .00 0 2 .160 A L L R X 374 7 8.06 9 5 2 .7 50 T I M E IN D I S P E N S A R Y FOR A L L P f- h S OR IP T ION S ( M IM ) E N T R I E S IN T A B L E M r A r\ ARCUM FNT STANDARD DEVI AT ION ' 374 7 8. C6 9 52 .750 U P P E R OBSE R V E E P ER CENT CUMUL ATI VE L I M I T F R F G L E NCY OF TCTAI. PERCENT AGE 20 8 7 2^.26 2 3.2 40 3 6 9.6 2 60 10 2 .67 3 5 . 5 80 3 4 c n Q 4 4 . 6 ] 00 7 2 1 9 . 2 5 6 3.9 120 3 9 1 0 . 4 2 74 .3 1 4 0 49 1 3 . 1 0 8 7. 4 1 60 3 6 9.62 9 7 . 0 180 6 1 . 6 0 9 8 . 6 200 3 .80 9 9 . 4 2 20 2 .53 1 0 0 . 0 R E M A I N I N G EREOUEN C I E S AR E A L L Z FRO 1 5 2 V/VUiPfYftok) 1 A A A A A A A A A A 4 4 4 4 4 A 4 4 4 4 4 4 4 A * 0 [ S I R I R L T I C N O F T I r ' F * * * A P R F S C R T P T I O N I S I N * . * 1 T O P 0 1 S P P N S . A R Y ' * A A A A A 4 A A A A A A A A A A A A A A A A A A A * * 4 0 * * 3 5 * * V 4 4 3 0 4 * % O F 4 R X 2 5 4 A A A A A A A 2 0 * * * A A A A A A A A 44 A A 44 A 4 4 4 1 5 4 4* 4 4 * A 4 44 * 44 4 4 44 A 4 4 4 4 4 4 >:•• 4 4 44 4 4 1 0 * 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 A 4 4 4 4 A4 * A A 4 4 A A A 4 4 -4 4 4 4 4 4 4 4 4 4 4 44 4 4 4 4 4 4 * 4 4 4 4 4.4 4* 4 4 4 4 4 4 c * 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 A 4 4 A 4 4 4 4 4 4 4 A A A A A 4 4 4 4 4 4 4 4 4 4 4 A A 4 4 4 4 4A •A 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 A • 4 4 0 * * * A * * * * * * * 4 * 4 * * * * A * s; * A 4 *4 * * 4 4 A * * * * A * * 4 * * A * 4 4 4 A A * A * A A * A * * * * * AAA A 4 :'. 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0 1 6 0 1 8 0 2 0 0 2 2 0 2 4 0 2 6 C T I M F IN MTMjTFS rO A 4 4 4 4 ••••• 4 •-• A 4 4 * 4 4 4 4 4 4 4 4 A 4 * 4 4 - C I S T R IbUT ION OF WORK * * 4 A R P I V A 1. S FY 110 0 R 0 F 4 * 4 CAY * A 4 4 4 4 4 A A 4 4 4 4 s! A 4 A ?l A A A A A A A A 4 4 4 0 4 * 4 * 35 * 4 4 4 4 3 0 4 4 4 * 4 4 4 . 4 4 A 4 4 WORK 25 A 4 4 4 4 * 4 4 * 4 4 4 2 0 * 4 4 4 4 A 4 4 4 * 4 4 4 4 4 1 5 * 4 4 4 4 4 A. A 4 4 4 A A 4 4 A A 4. 4 4 4 4 4 4 4 4 1 0 4 4 4 4 4 4 4 A 4 4 . 4 4 A 4 A 4 A A 4 4 4 A * A 4 4 4 4 4 4 4 4 4 4 4 4 4 A A 4 4 4 A A A 4 4 4 4 4 A A c 4 4 4 A A A A A * 4 4 4 4 4 4 4 4 A 4 4 A A A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 * 4 4 4 4 0 4 4 4 4 4 4 4 4 -! 4 4 4 4 4 A 4 4 A 4 4 4 4 4 4 4 A 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 A A 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 A A 8 9 10 11 12 13 1.4 15 16 17 18 HOUR OF DA\( c A M TO 6 P M ) 154-t p 4 4 * A * 4 4 .;: :' ': 4 * |c 4 * :'• A '- .'- * A :'-* *c i s T r ; [«.UT ITM np WORK * * * C 0 R l'> t. F T I C !\ P Y F C! i R * * 4 D F Pi AY 4 4- 4 4 * 4 4A j; 4 4 4 4 4 4 4 4 4 4 4 4 4 * * * 4 c 4 4 4 4 4 0 4 4 4 4 3 5 * 4 4 4 4 3 0 4 4 4 4 % 0 F * WORK 2 5 * 4 4 4 4 2 0 4 4 4 4 4 4 44 4 4 4 4 * 4 4 4 A * 4 4 4 4 4 1 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 • 4 4 4 4 4 4 4 4 4 4 * 4 4 1 0 4 4 4 4 4 4 4 4 4 4 * 4 4 * 4 4 4 4 4 4 4 A 4 * * * 44 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 * 44 4 4 4 * 5 4 4 4 4 4 4 4 4 4, * 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * * 4 4 4 4 4 '! : 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 44 4 4 4 4 4 4 4 4 4 4 4 4 4 4 44 4 4 4 4 4 4 * * 4 4 0 44 44 4 * * * 4 ; 4' 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 =1:4 4 4 * 3 9 10 11 12 ] 3 1.4 15 16 17 18 HCUS OF CAY (8 AN' TO 6 PM ) .01 SPENS.ARY ANAI.YS IS \7tt l~lPrVTlOKJ 2 155. 0 I S F E N S A P Y ( P 0 W ( CO L MANPOWER S O EOU I E M A T R I X : ^ = 10 OF WGRKFR) ' _ _ T V ' u S E f r f f T I D E N T I F Y S~TAR T» STOP f. BREAK f l f ' E S ) S TART T I M E 1 ST CO F F E E LUNCH 2 NO C 0 F F E; F IN I S H TI ME I E N T J l J ES IN'.. M A T R I X ARE I N TERMS OF V OF 1/4 HOURS) HAL FW ORB MATRIX ROW' /COLUMN 1 ? 6 7 8 9 10 1 1 3 2 32 34 34 .4 1 66 4 1 36 36 2 4 0 40 4? 4 2 99 9 9 4 2 9 9 4 2 4 3 3 5 C 5 0 50 5 2 T f 99 50 5 2 5 0 52 6 0 6 0 6 1 _hl_ 6 3 9 9 6 1 6.3 6 0 61 64 64 66 66_ "72 7 2 6 6 72 6 8 '63 ** MANPOWER ASSIGNMENT BY C A Y ( C C L ) {ROW 1-3 =P. AICES-; ROW 4-8 = P HARM AC I STS ') HAL FWORD MATRIX _ 3 ROW/COLUMN 1 2 4 1 1 • 1 i. I i 2 1 ] 1 I 1 3 1 1 1 1 4 4 4 4 4 4 5 3 3 3 3 3 6 6 6 6 6 6 7 3 3 3 3 3 s 6 6 6 6 6 U T I L I Z A T I O N CF MANPOWER,PHONE £ S T A F F COUNTER -AVERAGE U T I L I Z A T I O N D U R I N G -F A C I L I T Y NUMBER AV ERAGE TOT AL AVA IL . UNAVA I L . C U EN TRIE S T I N E / T R A N TIME T I ME T I M F c 1 2 31. 1 .80 9 ' .2 32 . 3 2 9 . 0 0 5 3 2 9 6 2 .50 6 .4 12 . 5 8 3 . 0 1 1 4 35 ] 2 . 4 J 0 . 4 6 9 . 65 4 .03 3 5 2 3 3 2 . 4 A 2 . 37 7' .53 8 . 0 0 3 6 8 2 1 .43 7 .0 2 5 • . 1 7 0 .00 0 PhON E 4 1 2 . 5 1 2 .0 57 .06 0 . 00 0 . CCLNT 30 1 . 7 9 9 . 0 2 9 . 03 1 . 00 0 T Y P p K i R I T E R : i X U M R P R A V A I L A B L E = 1 A V E R A C F U T I L I Z A T I O N = 3 ? . 6 ? " T O T A L L A B E L S ' T Y P F O = 3 '''• 4 A V E R A G E T I M E / L A B E L = 1 . 9 2 ( 1 / 3 0 K A V E R A G E W A I T I N G T I M E F O R I . A B E L T Y P I N G - 1 6 7 . 9 6 ( 1 / 3 y I N ) A V E R A G E N U M B E R C F R Y W A I T I N C = 2 R P R E S C R I P T I O N S : AVFRAGE NUMBER O F R X I N D I S P E N S A R Y = 4 1 M A X I M U M N U M B E R O F P X I N 0 I S P E N S * R Y = 1 2 7 A V E R A G E S T A F F W A I T I N G T I M E A T C O U N T E R •= . C C < ] / 3 M I N ) AVERAGE T I M E S P E N T W I T H S T A F F A T C O U N T E R = 1 . 7 9 1 1 / 3 M I N ) A V E R A G E R X W A I T I N G T I M E F O R D I S P E N S I N G = 9 2 . 4 ( 1 / 3 M I N ) A V E R A G E N U M B E R C F R X W A I T I N G F O R D I S P E N S I N G = 9 A V E R A G E W A I T I N G T I M E F O R D D R X E D I T I N G = E l . 5 9 ( 1 / 3 V I N ) T O T A L R X Q U E R I E D = 1 4 A V E R A G E W A I T I N G T I M E F O R Q U E R Y = 2 . 7 . 8 5 ( 1 / 3 M I N ) P R E S C R I F T I C N T I V E I N I N P A T I E N T D I S P E N S A R Y P X T Y P E N U M B E R A V E T I M E ( M I N ) S n ( M I N ) N P F R S 2 3 4 5 9 . 5 6 3 4 6 . 8 7 5 R P E R S 8 8 8 0 . 5 1 1 5 0 . 3 1 2 N E W D D • 1 3 1 1 6 . 0 0 0 6 0 . 1 P 7 P E E 0 0 1 0 5 i 5 0 0 4 5 . 6 2 5 S T A F F 2 3 5 4 . 1 3 0 2 2 . 3 1 2 S P E C L 5 3 9 9 4 . 0 5 7 A L L ' R X 3 7 3 6 7 . 6 6 4 4 9 . 5 0 0 T I M E I N D I S P E N S A R Y F O R A L L P R E S C R I - P T I O N S ( M T N ) E N T R I E S I N T A B L E M F A iN A R G U M E N T S T A N O A R 0 D E V I A T I O N 3 7 3 6 7 . 6 6 4 4 Q « 5 0 0 U P P E R O B S E R V E D P E R . C E N T C U M U L A T I \ / E L I M 'I T F R E Q U E N C Y O F T O T A L P E R C E N T A G E 2 0 9 1 ? 4 . ^ 9 2 4 . 3 4 0 3 5 5 . 3 8 3 3 . 7 6 0 4 9 1 3 . 1 3 4 6 . 9 8 0 5 2 1 2 . 5 4 6 0 . 8 1 0 0 3 9 . 1 ° . 4 5 7 1 . 3 1 2 0 6 n 1 3 . 4 0 8 4 . 7 1 4 0 2 1 5 . 6 3 9 0 . 3 1 6 0 2 6 6 . 5 7 9 7 . 3 1 8 0 c 1 . 6 0 9 8 . 9 2 0 0 3 . 8 0 9 9 . 7 2 2 0 ' 1 . 2 6 1 0 0 . 0 R E M A I N I N G E R E Q U E N C I E S A R E A L L Z E R O t:; 0 * 4 4 4 4 :'• 4 4 4 =J •: 4 4 4 A 4 4 4 4 4 4 * a * D I S T R I B U T I O N OF TIME * 4 * A PRESCR I P T I O N I S IN * 4 * THE D I S P E N S A R Y * 4 :> 4 4 A A A 4 A A A A 4 * 4 A A A 4 A * 4 4 4 4 <i_5 4 * * AC 4 * 3 5 * * 4 4 30 A A * % OF * R X 2 5 * 4 4 * 4 4 * 4 4 4 4 20 * 4 4 4 4 4 . 4 4 4 4 . 4 4 4 4 15 4 4 4 4 4 4 4 4 4 4 A 4 * 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 10 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 A' 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 5 4 ' ~4 4 4 4 4 4 4 4 4 4 4 4 4 4 ' 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 A A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 ' 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 a 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 A A 4 4 4 4 4 4 4 A 4 A A A 4 A A A A 4 - 4 4 4 : ' ' 2 0 4 0 " 60 * BO 1 0 0 1 2 0 14 0* " 1 A O 1 8 > " 200 2 20 240 26 TIME I l \ M M J T E S v'i'tuipn-Tvo^ Z 1 5 8 5 Q * A 4 * A A 4 >: 4 * 3i >: >> A -: s> * * * * * * *ni STP IP l_T T C N CF w e n K * A * APR I VALS P . Y h!R!Ji- DF * * >'•' CAY A ,;; .;. 4 * A * 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 & A 4 . 5 . . * ; A 4 A A AO * A A A A 3 5 * A 4 A A A A A A A A A A A A A A A % OF * ** WORK 2 5 * ** A A A A A A A A A A A A 2G A A A A A 4 A A A A A A A • A A 15 A A A A A A A A A A A A A A A A A A A A A A A 10 A A A A A A A A A A A A . A A A A A A A A A A A A A A A A A A A A A 4 4 4 A A A A A A A A A 4 4 4 4 4 A 5 A A A A A A A A A A A 4 4 4 4 4 4 A A A A A A A A 4 4 A A A A A A 4 4 4 A A A A A A A A 4 4 4 4 4 4 • 4 4 A 4 4 4 A A A A A 4 A A A A 4 4 4 4 4 4 4 4 4 4 4 A A A A A 4 4 4- 4 4*. 4 4 4 4 4 4 4 4 4 4 0 A A A A A A * * 4 4 * 4 4 4 * * 4 4 4 4 4 4 4 4 4 •••• 4 A A 4 A A A A A A A A A A A A A A A A A A A A A A A 4 A A A A A A 8 9 10 1 1 12 1 3 14 15 16 17 18 HCLJi; CF CAY (RAM TO 6 F M ) K ( 1 4 i| :,' s| 4 >! :| -I- -', :, * •! 4 4 4 4 4 4 4 * A * * l ) I S TR I '•• I. ' ' I f N O F v . Q P K * * * COM! L f T ICK Pi Y HOUR * * 4 F, F RAY 4 A A A 4 A A A A A A A A A A A 4 A A A A A A A A 4 5 •:< _ _ _ _ _ _ A A A A A G * * A A A 3 5 * A •A A A 30 * A A A % OF * WORK 2 5 * A A A A 2C * A A A A A 4 4 4=:= 4 4 4 4 4 1 5 A 4 4 4 4 A 4 4 A A A 4 A A 4 4 4 A 4 4 4 4 A A 4 4 A 4 4 4 4 4 4 4 4 1 0 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4:4 A A 4 4 A 4 4 4 4 4 4 4 4 • 4 4 A 4 4 4 4 =: 4 4-4 4 4 A A A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 A A 4 ' 4 4 4 4 4 4 4 4 4 4 4 4 A 4 A 4 4 4 A 4 4 A 4 4 4 A 4 4 4 4 4 A 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 -4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 0 A A A A A A A A A A A A A * A A A A A 4 4 4 * * 4 4 A 4 4 * 4 A A 4 4 4 4 4 A 4 * 4 4 4 4 4 A A A : ; . 4 4 4 4 A A 4 4 4 S 9 i o 1 1 12 1 3 14 1 5 16 17 1« HOUR OF DAY. 8AM 70 6 F " ) 160 \//in-iD/VT~io(\j 3 * * D I S P E N S A R Y M A N P O W E R S C H E O U L E O A TP I X : ( R (>> = j n 'OF W O R K E R ! ) ( co 1. r- L S E 0 '10 I D F M T ' T FY~s~f A R T , S ' Y O P " ~ h ~{?E A K ' " T T M r-s i S T A R T I S T L 0 N 0 H 2 0 D F I N I S H T I N E C H E F F E C O F E F E T I M E I I I I ! J E M R I F S TN MATRIX \RE IN TERMS CF / { _ _QFi.M_TOUjRS.) HAL F W O R D W A T p f x 1 . R O W / C O L U M N 1 2 2 4 5 1 3 2 4 0 5 0 6 0 6 4 2 2 2 4 0 5 0 6 0 6 4 3 4 4 2 5 0 6 1 6^ _ 4 3 4 4_? 11 ^ L _ . 6 6_ " 5 4 1 5 5 5 2 6 3 72 6 6 6 . 9 0 9 9 9 9 7 2 7 3 4 4 2 5 0 6 1 6 6 8 4 1 9 9 5 2 6 3 7 2 9 3 6 4 2 5 0 6 0 6 8 1 0 3 6 4 3 5 2 6 1 6 8 * * M A N P O W E R A S S I G N M E N T B Y D A Y ( C O L 5 ( R O W 1 - 3 = P . A I D E S ; R O W 4 - 3 = P H A R M A C I S T S ) H A L F W E R D M A T R I X —1 R O W / C O L U M N 1 3 4 1 1 1 1 i 1 2 1 1 1 1 1 3 1 1 1 i 1 4 L • 4 L 4. 4 5 3 3 3 6 6 6 6 6 6 7 0/ 3 •2 3 3 O 6 6 A 6 6 U T I L I Z A T I O N C F M A N P O W E R . P H O N F € S T A F F C O L N T E R F A C I I . I T Y N U M B E R E N T R I E S A V F R A G F T I N ' E / T RA N - A V E R A 0 E T C T A L T I M E U T I L I Z A T I O N C U R I N G -A V A I L . U N A V A I L . C U T I E T TM E S I i. 2 4 4 2 . 0 1 2 . 2 7 2 . 3 6 0 . 0 2 0 3 3 0 3 2 . 5 6 7 . 4 2 2 . 6 1 6 . ^ 0 1 4 3 2 1 2 . 5 6 3 . 4 5 7 . 6 4 7 . 0 1 2 c 3 6 5 2 . 1 4 2 . 4 3 4 . 6 1 7 . 0 0 7 6 3 6 1 . 9 7 2 . 0 3 9 . 2 6 8 . C C O P H C N E 3 2 3 . 1 2 5 . 0 5 5 . 0 5 8 . 0 C 0 C O U N T 4 1 1 0 5 8 5 . 0 3 6 . 0 3 3 . 0 0 0 I YP! IVN 1 1 ! r. NUMpi .< A V A rrr AI. L A BE AVE R A f> E AVERAGE ) |. A H |.|- :- 1 A V P R A C ! " L S I Y P i" I • = 3 2 5 A V E R A G F W A I T ! N G T F M E f r R |_ A B E L T Y P IM G N U M B E R O F R X »AAI T I N G = 3 3 VYIl i i '/E'l l u M 16.1 H i l l 7 AT I rr T I M E / L A B I : I. - 1 8 0 . 7 1( 1/ ? 7 I N I hi ) P R F S C R I P T I C N S : A V E R A G E N U M B E R OF RX I N D I S P E N S A R Y = , 4 9 MAX I'MUM N U M B E R O F R X I N D I S P E N S A R Y = 1 3 8 A V E R A G E S T A F F W A I T I N G T I M E AT C C U N T E P = . 0 4 (1. / 3 M IN ) AVE R A C- F T I M E S P E N T V. I TH S T A F F A T C O U N T E R = 1 . 8 8 < ] / 3 M I N ) A V F R A G E R X W A I T I N G T I ME F O R CISPEIVS ING = 9 9 . 2 ( .1 / 3 M IN ) A V E R A G E N U M B E R O F R X W A I T I N G F O R D I S P E N S I N G = 1 1 A V E R A G E WAI T I N C T I M E F C R DD RX• E D I T I N G = 1 5 . 3 3 ( 1 / 3 M IN) T CT AL RX QU ER I E C = g A V E R A G E W A I T I N G T I M E F O R Q U E R Y = . 0 0 { 1 / 3 M T M ) PR ES CR I P T ION T I M E I N I N P A T I E N T D I S P E N S A R Y RX T Y P E N U M B E R A V E T IM £ (M IN ) S.D.( M I N ) N P E R S 2 5 0 6 8 . 1 5 9 5 4 . 9 3 7 R P E R S 9 2 ' 8 0 . 7 5 0 5 2 . 3 7 5 N E W D D 1 6 1 1 1 . 1 8 7 5 8 . 8 7 5 R E F D D 9 6 8 . 8 8 8 4 9 . 9 3 7 S T A F F 2 8 1 0 6 . 5 7 1 1 7 . 8 1 2 SPECI- 8 8 . 5 0 0 6 . 4 3 3 A L L R x 4 0 3 7 4 . 2 4 3 5 4 . 4 3 7 T I ME I N 01 SP E N S A R Y F CR A L L . P R E SC R I PT 1 0 NS ( R I N ) E N T R I E S IN T A B L E 403 M E A N A R G U M E N T 7 4 . 2 4 3 . S T A N D A R D D E V I A T I O N 5 4 . 4 3 7 U P P E R O B S E R V E D P E R C E N T C U M U L AT I V E L I M.I T F R E Q U E N C Y "OF " T O T A L P E R C E N T A G E . 20 123 30 o 52 30 . 5 40 19 4.73. 3 5.2 60 1 9 4.71 3 9. 9 8 0 2 3 5 .70 4 5.6 100 ' 4 9 3. 2. 1 5 5 7,8 .1 20 7 5 1 8 . 6 1 7 6. 4 1 4 0 4 3 10 .66 8 7 . 0 1 6 0 45 I 1.16 9 8.2 180 5 1.2 4 o c C. ZO 0 r .00 99 .5 2 20 2 .49 _ 1 0 0 . 0 R E M A I N I N G F RE Q U E N C I ES A R E . A L L Z E R O -VVtuDA^ '.a.xJ 3 162 >: •'/ * * * •> * * * * * * * * # * # * * * * H I S T P T O U T J C M O F T I M E * * - A P s t S O - 1 I P T I C M I S I N * * * T H E D I S 0 F N S A R Y * * -f * * =: * *.-; i * * * * * * * * -;• 6 5 * * 3 5 * if if 3 0 * ** ** * * % OF if * R X 2 5 * if.lt * if if if if * * * 2 0 * * * * i f * if if if if if * if if. * if * if -!-1 5 if if * if if if * * * if * if. if * * * if if * * 10 * if if * * if if if * if if if if if is if if if if if i f * if if if if i f * if * if if if if if * * * ** if if if if if if 5 * * * if * * if * " ' " i f * ' * * if ii if if if if i: if if if if if if if i? if if if if if * if . i if- * i f if * t--'f if if if if if if if if * if if if if if * * if if if if if if if if if * if if if if ** if if if if 0 •Jf if if if if if if If * * if if if if * s|: if if if if if if if if if if. if if if if if if if if if * if if if if A if if if if if if if if if if * * if >f if if ii if if if if if 20 4 0 60 80 1 0 0 1 2 0 1 4 0 160 180 2 0 0 220 2^0 26 T I M E If^ M NOTES 8 0 4 5 4 0 3 5 7 0 * A * A A A * A A A A A A A * A * * A : ' . A A A A 4 =: =; -> * -'• 4 * * * * * 0 I S TR 115 L T I T \' 0 F W0 R K * * A R R I V A L S RY HOUR OF * CAY * A A * A 4 A A 4; * A A A A A A A A A 4 A A A A 1 6 3 . A ••;< A A % OF A A * WORK 2 5 A A A A A A A A A A A A A A A 20 A A A A A A A A A A A A A A A 15 A A A A A A A A A A A A A A A A A A A A A A A A A 10 A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 5 A A A A A 4 A A A A A A A A A ' A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 4 A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 0 A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 4 A A A A A A A A A A A A A A A A A A A A A A * A A A A A A 10 11 13 14 15 16 1 7 18 HOUR CF CAY { 8 A M TO 6PM ) K o A >• >: A * 4 4 4 4 4 4 « 4 4 4 ::• * * * * M S I P 1PLT I C N O F W O R K * * * C f i H P L L - T I O N B Y H O U R * * P, F DAv * * -5 * * 4 A A A A A A A A A A A A A A A A A A 4 5 * A A 4 4 - c * _ A A A 3 5 A A A A A 3 0 * A A A % OF * WORK 2 5 * A A A 4_ 2Q~*" A A 4 4 4 4 A 4 4 4 4 A 4 4 A 4 1 5 A 4 4 4 4 A * 4 4 4 A. 4 4 44 A 4 4 44 A A A 4 4 4 4 4 4 10 A A A 4 4 4 4 A 4 A A A A A 4 4 4 4 4 4 A A A A A 4 4 44 4 4 A A A A A 4 4 4 4 A 4 A 4 A A A A A A 4 44 4 4 4 * 4 4 4 4 5 A A A A A A A 4 4 4 4 4 4 4 4 4 4 4 4 A A A A A A A 4 A 4 4 4 4 4 4 4 4 4 4 A 4 A A A A A A 4 A A 4 A A 4 4 4 4 4 4 A 4 A A A A A A A 4 A A A A A A 4 4 4 4 A A 4 4 A A A A A 4 4 A 4 A A 4 4 A A • 4 4 4 4 4 4 0 A A A A A A A A A 4 A A A A A A A A 4 A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 g 10 1 1 12 13 14 1 5 ~16 17 18 HOUR OF D A M 8 AM TO 6 P y) . D I S PFNS ARY A N A L Y S I S 1 6 5 ** D I S P E N S A R Y MANPOWER SOP'-DULE MATF I X : ( R O K 'I- = I'D DF V.'CRK F P ) (COL * = USED TO I D E N T I F Y START V STOP f. BREAK TI MPS ) START 1ST LUNCH 2ND F I N I S H 'TI ME ) COFFEE 1 l C O F F E E 1 T I M E 1 ( E N T R I E S IN MATRIX 1 A P. E I N 1 T E P v- S CF H OF 1 1/4 FOURS) 1 1 HAL FWCRC M A TR IX .1 RO W/CCLUMN 1 2 3 4 c 1 3 2 40 ^ 0 6 0 64 2 3 2 4 0 5 0 6 0 6 4 3 3 4 4 2 6 0 61 6 6 A 34 4 2 5 2 6 1 6 6 5 41 09 5 2 6 3 7 2 6 66 9 9 9 0 9 9 72 7 2 4 42 5 0 6 I 6 6 3 ' 4 1 9 9 52 6 3 72 0 3 6 4 2 5 0 6 0 6 3 10 36 43 5 ? 6 1 6 8 ** MANPOWER ASSIGNMENT BY CAY (COL ) (ROW 1-3 = P.A I DES5 ROW 4- B = P H A R M A C I STS ) HALFWCPD MATRIX 3 PCW/CCLUMN 1 2 -1 4 5 1 1 1 1 1 1 2 I 1 1 1 1 -3 3 1 I r " 4 4 4 4 4 5 3 3 ^, 3 6 6 6 6 6 6 7 3 3 3 3 3 6 6 6 6 6 U T I L I Z A T I O N OF MANPOWER,PHONE £ S T A F F CO IN T E R -AVERAGE U T I L I Z A T I O N DOR IN G-F A C I L I T Y NUMBER AVERAGE TOTAL A V A I L . !JNAVAIL. C E N T R I E S T I N E / T R A N T I M E TIME TT'-iE 1 2 3 4 2 . 09 3 .2 72 .388 . 0 0 ] 3 36 3 2 . 3 1 6 . 4 6 7 . 6 6 6 . i " ' 0 4 25 9 - 2 . 8 1 4 .404 . 574 . r 0 9 34 7 2. 34 8 .4 52 . 64 5 . "M"* 3 6 3 4 1 . 76 4 . 0 3 3 . 2 2 2 . 0 0 0 PH ONE 2 8 3.96 4 .06 1 .06 4 0 0 0 0 COUNT 51 1. 80 3 .051 . 0 5 3 . 0 1 0 0 T Y P E V. K [ T r- •• : N U M 3 F R A V M I A B I . F = 1 A V ' R A C E L T I ! 1 7 A T I C M = . 3 6 . * ^ T O T A L L A 8 R . S T Y P E D = ^ ? 7 A V E R A r r T 1 M F / I A i ' F I . « 2 . r 2 ( I / 3 ' ' I N ] A V E R A G E W A T T I N G U N ' " F F . K I . A R E L T Y P I N G = 1 7 1 . 7 8 ( 1 / 3 - 1 1 ' - ! ) A V F R A (•'. F M U >\ B F R 0 F R X l>, A I T I N G = 3 1 F R E S C R I P T I C N S : A V E R A G E N U M B E R G F R X I N B I S P E N S A P Y r v l M A X I M U M N U M B E R O F R X I N D I S P E N S A R Y = 1 2 4 A V E R A G E S T A F F W A T T I N G T I M E A T C O U N T E R = . 8 8 ( 1 / - ''• I M ) A W A f J T T T M i T T P E N T W T I M S T A F E A T G G U N T E P = 1 . 8 0 ( 1 / 3 R T O ) A V E R A G E R X W A I T I N G T I M E F O R 0 I S F E N S I N G - 1 0 1 . 2 ( 1 / 3 M I N ) A V E R A G E N U M B E R O F R X W A I T I N G F O R D I S P E N S I N G = 1* A V E R A G E W A I T I N G T I M E F O R D D R X E D I T I N G = 4 7 . 2 5 ( i / 3 M I N ) T O T A L ' R X Q U E R I E D = 7 A V E R A G E W A I T I N G T I M E F O P Q U E R Y = . 0 0 ( 1 / 3 M I N ) P R E S C R I P T I O N T I M E I N I N P A T I E N T D I S P E N S A R Y R X T Y P E N U M B E R A V E T I M E ( M T M ) S . D . ( M I N ) N P E R S 2 5 4 6 9 . 5 8 6 4 7 . 8 1 2 -R P E P . S 8 2 8 6 . 0 3 6 4 7 . 7 5 0 N E W O D 1 5 8 5 . 7 3 3 6 0 . 8 7 5 R E F D D 7 8 3 . 4 2 8 5 6 . 6 8 7 S T A F F 3 2 . 1 0 8 . 7 5 0 2 2 . 3 7 5 S P E C L 6 1 4 . 3 3 3 1 0 . 0 5 0 A L L R.X 3 9 6 7 6 . 1 7 6 4 3 . 8 7 5 T I M E I N D I S P E N S A R Y F O R A L L P R E S C R I P T I O N S ( M I N ) E N T R I E S I N T A B L E M E A N A R G U M E N T S T A N D A R D O F - V I A T I C N 3 0 6 7 6 . 1 7 6 4 8 . 8 7 5 U P P E R O B S E R V E D P E R C E N T C U M U L A T I V E L I M I T F R E Q U E N C V O F T O T A L P E R C E N T A G E 2 0 9 0 2 2 . 7 2 2 2 . 7 4 0 2 2 5 . 8 0 2 8 . 5 6 0 2 6 6 . 5 6 3 5 . I 8 0 2 5 • 6 . 3 1 4 1 . 4 1 0 0 8 4 2 1 . 2 1 6 2 . 6 1 2 . 0 6 1 ' 1 5 . 4 0 7 8 . 0 1 4 0 6 6 1 6 . 6 6 9 4 . 6 1 6 0 1 3 2 . 2 8 9 7 . 9 1 8 0 5 1 . 2 6 9 0 . 2 2 0 0 2 . 5 0 9 9 . 7 2 2 0 1 . 2 5 . 1 0 0 . o R E M A I N I N G F R E Q U E N C I E S A R E A L L Z E R C . _ y ^ i T > ^ i O N j _ _ f t i6? 5 {) ;•: i if * if i. if if if * i- it i: if if if :•- if if if if if if if if * • •'< 0 IS T 0 [RUT TON OF TIME * * * A PRESCR I n T T O M I S IM * * THE D I S P E N S A R Y * * i, if if * i, * * if i, if i. i/ i, if if if if if if if if if * if 4 ^  * * * 4 0 * * ii if if 3 5 -^ if 3C * if * if Y~OF * RX 25 * if " i f if if if if if if ** 2 0 if if * if * if if i f * i.: if if * i f * '* * * ' if if if i f * * * * * 15 if * * if * * i;. if * • if * * ** * * * * * * * ** * * i f * * ** ** if * if * * . if if " ** " i f i f " '""if if 1.0 if if i f * ** ** if * if * * * if if ** if i f * i f * ** * * if * * if if * * if if if i f * * * if if * * if if * * 5 if if * ' '* * if * * * if if if if **' if if if * * . * * * * i f * * * ** if ** * * * * if ** ** if if i f * * * * * * if * * * * * * if if * if * if ** ** if * * * * * . * if i f * i f * * if 0 * * * * * * if * * * * * * * * if -'f :'f * * * * ''f if * * if -'f * * if * * ****** * * * * * * * * * * * * * * * * * * * * * * * * * • 20" " 4 0' " 60. ' 80 100 120 1 4 0 ' 1 6 0 ' 180 200 ' 2 ?0" 240 26 T I M E IN MINUTES R ^ 4 v - 4 * A 4 4 4 ^ i >1 4 4 4 4 4 4 4 4 4 A * * n i S T P i R i . T i C N r.r WORK -* A R R I V A L S N V H O L " . DF * * C AY * 4 4 A A ;|; * 4. 4 * 4 4 4 4 4: 4: .]: 4 +• 4 A C * 4 4~ * 4 3 5 * 4 4 4 4 3 0 * 4 4 4 '2 O F 4 WCR K 2 5 4 4 4 4 4 4 4 4 4 4 4 4 4 ' 4 4 2 0 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 1 5 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 : 4 4: 4: 4 4 4= 4 4 4 " 4 4 4 4 4: 4 1 0 4 4 4 4 4 4 4 4 4 4 4 *. >:.- 4 4= 4 4-- 4 4 4 4 4: 4 4: 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4: 4= 4 5 4 4 4 4 4 4 4 4 4 4; 4 4- 4= 4= 4 4:4 4 4 4 .4 * 4 4 4 4 4= 4; 4 4 4 4= 4 : 4 4; 4< 4 4= 4 4 4 4 4= 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4: 4= 4 4 4 4 4 4 4 4:4 4 4 4 4 0 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4= 4 4 4:4 4 4 4 4 4 4 4 4 4 4 4 4= 4 4 4- * 8 9 1 0 1 1 12 13 1 4 1 5 1 6 17 I S H C U R OF C A Y ( B A N T O 6FM ) /i'iXipft'fiow 4 169_ n * * •:• s- A * * * A -J •: * * •; * A * * A A * 4 * i1 L S T'•: I n f i r \' C F OOP K A * * C O M P Ll.-TICN R Y H O U R * * R F R A Y * A -J; A A A A A A A A A A A A A A A A A A A A A 4 5 * _ _ A A A A 4 0 * A A A 3 5 * A A A A 30 * A A A % OF * WCRK 2 5 * A A A A 2C * A A • A A A A A A ' A A 15 A A A A * A A A A A A A A A A A A 4 A A A A A A A '" A A A A A A A A I P A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 4 A * A A A A A A A A A "A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A- A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 4 =!= 4 A A A A A A A A A A * * A A ~'f A A A A A A A A A A A A A A A A A A A A A A AAA A 3 9 10 11 12 13 14 15 16 17 18 HOUR OF C A Y ( 8 A M TO 6PM) AFPENDIX G COMPUTER OUTPUT PROM TESTS 1-8 ** D I S P E N S A R Y MANPOWER SCH E D U L E M A T R I X : (ROW tt = ID OF WORK ER 5 (COL ft = USED TO I D E N T I F Y START ,ST OP £ BREAK" T I M E S ) START 1ST LUNCH 2ND F I N I SH TIME I C O F F E E i I C O F F E E i T IME I ( E N T R I E S IN MATRIX 1 ARE I N 1 TERMS OF # CF I 1/4 HOURS) 1 l H A LF WORD MA T R I X 1 ROW/COLUMN 1 2 4 5 1 32 40 50 60 64 2 32 4 0 5 0 60 6 4 3 34 4 2 50 6 1 66 4 34 4 2 52 6 1 ' 6 6 5 41 9 0 52 6 3 72 6 66 9 9 9 9 9 9 72 7 34 4 2 50 61 66 3 41 99 5 2 63 7 2 9 36 42 50 60 6 3 10 36 4 3 52 61 68 ** MANPOWER ASSIGNMENT BY D A Y ( C O L ) "V* (ROW 1-3 = P . A I D E S ; ROW 4-8 = P H A R M A C I S T S ) HALFWCRD MATRIX 3 ROW/COLUMN 1 2 3 4 5 1 1 1 1 1 1 2 1 1 1 1 1 3 1 1 1. 1 1 4 4 4 4 4 4 5 3 3 3 - i 3 6 6 .6 6 6 6 7 3 3 3 3 3 8 6 6 6 6 6 UT IL IZ AT ION OF MANPOWER, PHONE £ S T A F F COUNTER -A V E R A G E U T I L I Z A T I ON DUR ING-F A C I L I T Y NUMBER AVERAGE TOTAL A V A I L . U N A V A I L . CURR E N T R I E S . T I M E / T R A N TIME TI ME TI ME STA 1 584 2. 104 .6 8 2 . 9 1 0 . 1 5 0 N •> 4 0 4 2. 53 2 . 5 6 8 .80 8 . 0 0 7 N 4 45 8 2 . 3 8 2 . 6 0 6 .858 . 0 1 4 N c 4 0 3 2. 60 0 .5 82 .83 0 . 0 0 3 6 72 1. 50 0 .0 59 .3 9 9 . 0 0 0 PH C NE 36 4 . 1 9 4 .0 8 3 .0 8.8 . 0 0 0 COUNT 4 2 1. 42 8 .033 .03 5 .000 f r S T ± 1?1 TYPE ITER : MUMPER A V A I L A B L E = 1 AVERAGE U T I L I Z A T I O N = 3 9 . 4 % TOTAL L A B E L S T Y P E D •= 3 5 2 AVERAGE T I M E / L A B E L = 2 . 0 K 1 / 3 K I N ) AVERAGE W A I T I N G TIME FOR L A B E L T Y P I N G = 10 3 .8 7( 1 / 3M IN ) AVERAGE NUMBER OF RX WAITING = 18 P R E S C R I P T I O N S : AVERAGE NUMBER OF RX IN D I S P E N S A R Y = 64 MAXIMUM NUMBER OF RX IN D I S P E N S A R Y = 1 7 0 AVERAGE S T A F F W A ITING TI M E AT COUNTER =• .'16 <1/3M IN ) AVERAGE T I M E SPENT WITH S T A F F AT COUNTER = 1 . 4 2 ( 1 / 3 M I N ) AVERAGE RX W A I T I N G TIME FOR D I S P E N S I N G = 1 3 1 . 9 ( 1 / 3 M I N ) AVERAGE NUMBER OF RX W A I T I N G FOR D I S P E N S I N G = 1 9 AVERAGE WAITING TIME FOR DD RX E D I T I N G = 9 5 . 6 9 ( 1 / 3 M I N ) T CT AL RX Q U E R I E D = 9 AVERAGE W A I T I N G T I M E FOR QUERY = . 0 0 ( 1 / 3 M I N ) P R E S C R I P T I O N TIME IN I N P A T I E N T D I S P E N S A R Y RX TYPE NUMBER AVE T I M E ( M I N ) S . D . ( M I N ) M P E R S 119 1.09. 193 5 0 . 812 R P F P S 25 1 1 8 . 7 5 9 4 5 . 5 0 0 N E W D D 106 1 4 7 . 5 6 6 7 1 . 5 0 0 _ R E F _ 0 D _ 87 9 9 . 3 2 1 5 3 . 8 7 5 T f A F F - 33 1 1 6 . 7 8 7 2 9 . 8 75 S P E C L 4 5 8 . 2 5 0 . 4 6 . 3 1 2 A L L R X 3 7 4 1 1 8 . 5 3 7 5 9 . 5GG TIME IN D I S P E N S A R Y FOR A L L P RE SC RI PT I ONS ( M I N ) E N T R I E S IN T A B L E . MEAN ARGUMENT STANDARD D E V I A T I O N 3 7 4 1 1 8 . 5 3 7 5 9 . 5 0 0 U P PER OBSERVED PER CENT C U M U L A T I V E L I M I T FREQUENCY OF TOTAL PERCENTAGE 20 3 6 9.62 9.6 40 12 3 . 2 0 1 2 . 8 60 23 6. 14 1 8 . 9 80 22 5.88 2 4 . 8 100 5 1.33 2 6 . 2 120 7 2 1 9 . 2 5 4 5 . 4 1 4 0 £5 2 2 . 7 2 6 8 . 1 160 _ J - _ 1 2i^A 7_1 1 8 0 70 18 . 7 1 . 89". 8 .200 2 6 6.95 96 .7 2 20 1 .26 9 7.0 2 4 0 0 .00 9 7 . 0 2 6 0 9 2 . 4 0 9 9 . 4 2 8 0 0 .OO 9 9 ^ 4 OVERFLOW 2 .53 1 0 0 . 0 AVERAGE V A L U E OF OVERFLGW 2 1 2 . 5 0 T e&T _L 172 5 0 * * * * * * * * * * * * 4 A * * A * * 4 * 4 A A A * * D I S T R I B U T I O N O F T I M E * * * A PR ESCR IPT ION I S IN * * * THE D I S P E N S A R Y * ' A A A A A A A A A A A A* A A * A A A A * A A A * _ 4 5 * 4~ A A A 4 0 * A A' A A 35 * A * A * 3 0 * 4 * A RX 25 * A A A 4 4 A 4 4 20 A A 4 4 4 4 4 4 A 4 4 4 4 4 4 A 4 4 4 4 * 4 4 A 4 4 4 4 4 4 15 * 4 * 4 4 4 4 A 4 4 4 4 4 4 A 4 4 4 4 4 4 A 4 4 4 4 4 4 * 4 4 4 4 4 4 10 A 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 5 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 * * 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 A A A A A *A A *A A A A A A AA A A A AA * ****A A A A A 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 20 40 60 30 ICO 120 140 160 180 200 2 20 240 2 60 T I M E IN N I NUT ES - f V v r 1 7 3 5 Q * * * A A A A A A A A A A A * * A A A A A A A A * *D I S TR I R I T I C fx OP WORK * * * A R R I V A L S SY HOUR OF * * CAY * A A A A A A A A A A * * * * * * * * * * * * * * 4 5 * A A A A 4 0 * A A A 35 * A A A A 30 * * A A % OF * WORK 2 5 * A A A A 20 * A * * * A * * A A * 1 5 A * * A * * * * A * * * * A A A A * A A * ** A * * * 10 A * * * A A A ** ** A A * * * * * ** * * ** A ** * * A * A * * A ** A ** ** ** ** * * ** ** A A A * * * * * * ** ** ** ** 5 A A A A * A A A * ** * A * * * * ** ** A A A * * * * * * ** A A A A A A A * A * A A A * * * * A A A * A * ** * * * * ** A * * * * A * ** ** * * ** * * * * ** A * A * * * * * * ** * * * A ** ** ** 0 A A A A A A A A 4 * * * A * * * 4 A * A A A * * A A A A A A A A A A A A A A A A A A * A A A * * * * * * * * * * * * * * 8 9 10 1 1 12 13 14 15 16 17 18 HOUR OF D A X SAM TO 6PM) 5 0 * A A A A A A A A A A A A A A A A A A A A A A A * *0 ISTR IBUT IOM OF WORK * * * C O M P L E T I O N BY HOUR * 4 * OF DAY * * A * A A A A A A A A A A A A A A A A A A A * A 4 5 4 * * * * 4 0 * 4 * 4 3 5 * * 4 * 3 0 * * * * OF * A A WORK 25 * A A * A A * A A 4 A A A A 20 A 4 * A A * A A * A A 4 A A 15 A A A A A A 4 4 A A A A A 4 4 A A A A A A A 4 4 A A A A A 4 4 4 4 10 A A A A 4 * A 4 A 4 4 A A A A A ** A * 4 4 A A A A * A A A A 4 4 A A A A * A A A A A A 4 4 4 4 A A A * A A A A * A * 4 4 4 4 5 A A A A A A A A A * A 4 4 4 * A A A A A A A * A 4 A A 4 4 4 4 4 A A A A A A A A A 4 4 4 4 4 4 4 4 A A A A A A * A A A A 4 4 4 4 4 4 4 4 4 A A 4 A A A A A A A A A 4 4 4 4 4 4 4 4 Q 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * * 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 * 4 * 4 * * * 4 4 * * * * 4 * * * 8 9 10 11 12 13 14 15 16 17 1 8 HOUR OF DAY{ 8AM TO 6PM) .175__. © D I S iP Lj N S A K Y Aj\j A L. Y ^ I S 09 o o • ftoo o « o e « o « « o » « o 0 0 0 0 . * » • 0 0 0 * « 0 0 »<• o o o a o • • » • « e * * * D I S P E N S A R Y M A N P O W E R S C H E D U L E M A T R I X : ( R O W if = I D C F W C R K E R ) ~ ( C O L ~it = U S E D T 0 " I D E N T I F Y ~ S T A R ~ f , S T 0 ~ P " ' & B R E A K T T N E S ) S T A R T 1 S T L U N C H 2 N D F I N I S H T I M E C O F F E E C O F F E E T I M E 1 1 I i I ( E N T R I E S _ VN M A T R I X _A_R E I N T E R M S O F # O F 1 / 4 H O U R S J H A L F W O R C M A T R " IX" ~ 1 " * R O W / C O L U M N 1 2 3 4 5 1 3 2 4 0 5 0 6 0 - 6 4 2 2 2 4 0 5 0 6 0 6 4 3 3 4 4 2 . 5 0 6 1 6 6 4 3 4 4 2 5 2 6 1 6 6 5" " 4 1 9 9 5 2 6 3 7 2 6 6 6 9 9 9 9 9 9 7 2 7 3 4 4 2 5 0 5 0 5 0 8 4 1 9 . 9 5 2 6 3 7 2 9 3 6 4 2 5 0 6 0 6 8 1 0 3 6 4 3 5 2 6 1 6 8 * * M A N P O W E R A S S I G N M E N T B Y C A Y ( C O L ) { R O W 1 - 3 = P . ' A I O E S ; R O W 4 - 8 = P H A R M A C I S T S ) H A L F W C R D M A T R I X 3 R O W / C O L U M N 1 2 3 4 5 1 1 1 1 1 1 2 1 1 2- 1 1 1 3 1 I 1 1 4 5 5 5 5 5 5 3 3 3 3 3 6 7 7 7 7 7 7 3 3 3 3 3 8 7 7 7 7 7 UT.IL IZ * T ION C F M A N P O W E R , P H O N E S S T A F F C O U N T E R ' - A V E R A G E U T I L I Z A T I O N DURING-F A C I L I T Y N U M B E R A V E R A G E T O T A L A V A I L . U N A V A I L . C U R f -E N T R I E S T I M E / T R A M T I M E T I M E T I M E ST/> 1 6 1 8 1 . 8 4 9 . 6 3 4 . 8 4 6 . 1 4 1 f 3 3 1 3 2 0 8 0 1 . 4 8 7 . 6 9 1 . 0 0 9 4 2 7 • 2 . 4 1 6 . 5 7 3 . 8 1 0 . 0 1 8 |\ 5 4 0 6 2 . 2 4 6 . 5 C 6 . 7 1 8 . 0 1 2 6 6 2 1 . 6 4 5 . 0 5 6 . 3 7 7 . 0 0 0 7 1 0 8 3. 5 3 7 . 2 1 2 . 5 6 2 . 0 0 1 r P H G N E 3 5 3 . 0 8 5 . 0 5 9 . 0 6 3 . 0 0 0 COUNT 4 2 1 . 6 4 2 . 0 3 8 . 0 4 0 . 0 0 0 Te-T £ 176 Y Y P E W R I T E R : N U M B E R A V A I L A B L F = 1 A V E R A G E U T I L I Z A T I O N = . 3 8 . 1 3 T O T A L L A B E L S T Y P E D = 3 4 9 A V E R A G E T I M E / L A B E L = 1 . 9 6 ( 1 / 3 M I N ) A V E R A G E W A I T I N G T I M E F O R L A B E L T Y P I N G = 1 5 7 . 3 6 ( 1 / 3 M I N ) A V E R A G E N U M B E R O F R X W A I T I N G = 3 0 P R E S C R I P T I O N S : A V E R A G E N U M B E R O F R X I N D I S P E N S A R Y = 5 6 M A X I M U M N U M R E R O F R X I N D I S P E N S A R Y = 1 5 3 A V E R A G E _ S T A F F W A I T I N G T I M E A T _ C O U N T E R _= _ . G 9 J 1 / 3 M I N ) " A V E R A G E T I M E S P E N T W I T H ' S T A F F A T C O U N T E R = ' I .~6 4 < 1 / 3 M * I N ) A V E R A G E R X W A I T I N G T I M E F O R D I S P E N S I N G = 1 2 3 . 3 ( 1 / 3 M I N ) A V E R A G E N U M B E R O F R X W A I T I N G F O R D I S P E N S I N G = 8 A V E R A G E W A I T I N G T I M E F O R D D R X E D I T I N G = 6 0 . 1 4 ( 1 / 3 M I N ) T O T A L R X Q U E R I E D = 1 0 A V E R A G E W A I T I N G T I M E F O R Q U E R Y = . 0 0 ( 1 / 3 M I N ) P R E S C R I P T I O N T I M E I N I N P A T I E N T D I S P E N S A R Y R X T Y P E N U M B E R A V E T I M E ( M I N ) S . D . ( M I N ) N P E R S 1 1 9 9 2 . 4 2 0 4 3 . 3 1 2 R P E R S 2 5 9 7 . 0 3 9 3 6 . 7 5 0 N E W D D 1 0 6 1 1 4 . 4 1 . 5 4 7 . 1 2 5 R E F 0 D 8 7 8 4 . 3 3 3 5 1 . 8 1 2 S T A F F 3 3 1 1 2 . 3 6 3 2 1 . 0 6 2 S P E C L 4 1 2 . 2 5 0 6 . 1 2 8 A L L R X 3 7 4 9 7 . 9 8 3 4 6 . 9 3 7 T I M E I N D I S P E N S A R Y F O R A L L P R E S C R I P T I O N S ( M I N ) E N T R I E S I N T A B L E 3 7 4 U P P E R L I M I T 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0 _ 1 _ 6 0 _ 1 8 0 2 0 0 2 2 0 . 2 4 0 M E A N A R G U M E N T O B S E R V E D F R E Q U E N C Y 5 0 2 2 5 7 . 9 3 3 P E R C E N T O F T O T A L 1 3 . 3 6 5 . 8 8 1 1 0 7 4 8 8 7 2 4 1 1 3 0 2 1 . 2 6 2 . 6 7 1 9 . 7 8 2 3 . 5 2 1 9 . 2 5 3 . 4 7 . 0 0 . 5 3 . 2 6 S T A N D A R D D E V I A T I O N 4 6 . 9 3 7 C U M U L A T I V E P E R C E N T A G E 1 3 . 3 1 9 . 2 1 9 . 5 2 2 . 1 4 1 . 9 6 5 . 5 8 4 . 7 9 5 . 7 9 9 . 1 9 9 . 1 9 9 . 7 1 0 0 , 0 R E M A I N I N G F R E Q U E N C I E S A R E A L L Z E R O % OF * RX 25 * * T t ^ i 2 l? 7 50 * * * * * * * * * * * * * * * * * * * * * * * * * * * n i S T R I B U T I O N OF TI M F * * * A P R E S C R I P T I O N I S IN * * * THE 01 SPENSAP. Y * * * * * * * * * * * * * * * * * * * * * * * * * * 4 5 * _ _ " * * * * 4 0 * * * * * 3 5 * * * • * ' * 3 0 * * * * * ** * ** * ** 2 0 * * * * ' ** * .* ** * ** * * ** * ** ** ** * ** * * ** 15 * ** * * * * * ** ** ** * ** ** * * ** * ** ** ** ** * ** ** * * ** 10 * ** ** ** ** ** * ** ** ** ** ** * ** ** ** ** ** * ** ** ** ** ** * ** ** * * ** ** 5 * ** * * ** * * ** ** * ** * * ** ** ** ** * ** ** ** ** * * * * ** * ** * * ** ** * * ** ** ** * ** ** ** ** ** ** ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ' 20 4 0 60 80 1 0 0 1 2 0 1 4 0 1 6 0 180 200 220 240 26( TI M E IN MINUTES T E S T Z 178 S O * ; ! L * * * >:' * * * * * * : ; : * •• * * * * * * * * * * D I S T R I D L T I G N OF WORK * * * A R R I V A L S BY HOUR OF * * » CAY * 45 ; ; * 40 * * * 3 5 * * 30 * * * % OF * WORK 2 5 * * ** 2 0 * ** * ** * * * * ** * * * * * * * * * * * * * * ** ** ** * ** ** ** 10 * ** * * ** ** ** * ** ** ** ** ** ** * ** ** ** ** ** * ** ** ** ** ** ** * ** ** ** ** **• ** ** 5 * *.* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * jjc * * * * * * * * * * * * * * * * * * * * * ** ** ** ** ** ** ** ** ** ** # ** ** ** ** ** ** ** ** ** ** 0 * * * * * * * * * * * * * * * * ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 8 9 10 11 12 13 14 15 16 17 18 HOUR OF OAV (8AM TO 6PM) re-£-r 2 179 5Q A A A A A A A A A A A A A A A A A A A A A A * A * ^ D I S T R I B U T I O N OF WORK * * * C O M P L E T I O N BY HOUR * * * OF DAY * * * * * * * * A A A A A A A A A A A A A * A * A 4 5 * A A A A 4 0 * A A A * 3 5 * A A A A 3 0 * * A * ITOF * WORK 25 * A A * A A A 2 0 A A * A A A A A A A A A A A A A A 15 A A * A A A A A A A A A A A A A * A A A A A A A ** A A A A A A A ft A 10 * A A A * A A A A A A A A A A A A A A A A A * A A A A A ft A A A A A A A A A * A A A * A A A * A A * * A A A A 5 A A A A A A A A * A A A A A * A A A A A A A A A A A A A A A A A * * • A A A * A A A A A A A A * A * A A A A A A A A A A A ft* A A A * A A A A A A A A A A A A * * A A * A A A A A A A A A A A * * A A A ft* 0 A A A * A A A A A * A A A A A * A A A A A A * 4 A A A A A A A A * A A A A A A * A A A * A A A A A A A A A A * * A A A A 8 9 10 1 1 12 1 3 14 15 16 17 18 HOUR CF C AY { 8AM TO 6PM) 180 . D I S P E N S A R Y A N A L Y S I S 4 ** D I S P E N S A R Y MANPOWER SCHEDULE M A T R I X : (ROW H = ID OF WORKER) (COL # = US ED TO I DENT I FY START ,STOP _ BREAK TI ME S) START 1 ST LUNCH 2ND F I N I S H T I M E I COFFEE I 1 C O F F E E t TI ME I ( E N T R I E S IN M A T R I X 1 ARE IN 1 TERMS OF H OF 1 1/4 HOURS) I 1 "HALEU CRD M A T R I X 1 ROW/COLUMN 1 2 3 4 5 1 32 4 0 50 6 0 64 2 32 4 0 50 60 64 _ 34 42 i 50 6 1 66 4 34 42 52 61 66 41 99 52 63 72 6 66 99 99 99 7 2 7 34 42 50 50 50 8 41 9 9 52 6 3 72 9 36 42 50 6 0 68 10 36 4 3 52 61 68 ** MANPOWER A S S I G N M E N T BY D A Y ( C O L ) (ROW 1-3 = P . A I D E S ; ROW 4-6 i ^ P H A R M A C I S T S ) HALFWORD M A T R I X 3 ROW/COLUMN 1 2 3 4 5 1 1 1 1 • 1 1 2 1 1 1 1 1 3 1 1 1 1 1 4 5 5 5 5 5 5 3 3 3 3 3 6 7 7 7 7 7 . 7 3 3 3 3 3 8 7 7 7 7 7 U T I L I Z A T I O N CF MANPOWER,PHCNE £ S T A F F COUNTER - A V E R A G E U T I L I Z A T I O N D U R I N G -F A C I L I T Y •1 4 5 6 7 PHCNE COUNT NUMBER E N T R I E S_ 7 5 6 371 3 6 8 36 5 7 7 169 4 4 4 2 AV ERAGE TI ME/TRA N . 90 2 2 .210 2 . 2 0 6 2 .139 1.467 3 . 1 8 3 2 . 8 1 8 1 . 5 0 0 TOTAL T I M E . 3 7 8 . 4 5 5 . 4 5 1 .4 35 .062 . 2 9 8 ,0 6 8 .034 A V A I L T I ME . 54 0 . 6 4 7 . 64 3 . 6 1 8 .43 8 _._78 5_ . 0'72_ .03 6 U N A V A I L . T I M E . 0 0 1 n n ~j . 0 0 0 . 0 0 6 . . 0 0 0 .000 -TCST 3 181 T Y P E W R I T E R : NUMBER A V A I L A B L E = 1 AVERAGE U T I L I Z A T I O N = 40 . 1 £ TOTAL L A B E L S TYPED = 3 5 5 AVERAGE T I M E / L A B E L = 2 . 0 3 U / 3 M I N ) AVERAGE WAITING T I M E FOR L A B E L T Y P I N G = 9 5.061 1/3M IN ) AVERAGE NUMBER OF RX W A I T I N G = 17 P R E S C R I P T I O N S : AVERAGE NUMBER OF RX IN D I S P E N S A R Y = 31 MAXIMUM NUMBER OF RX IN D I S P E N S A R Y = 123 ^ AVE R_AG_E_STA FF W A I T I N G TIME__AT_CCUNT ER = _ .0_9_(]._/3M IN ) """AVERAGE TI M E S PENT WITH STAFF AT COUNTER =""" lV5 CTi / 3 M I N )""" A VERAGE RX W A I T I N G T I N E FOR D I S P E N S I N G = 6 8 . 2 ( 1 / 3 M I N ) AVERAGE NUMBER OF RX W A I T I N G FOR D I S P E N S I N G = 8 AVERAGE W A I T I N G T I M E FOR CD RX E D I T I N G = 6 1 . 37 ( 1 / 3M IN ) TOTAL RX Q U E R I E D = 12 AVERAGE W A I T I N G T I M E FOR QUERY = 6 . 2 5 ( 1/3M IN ) P R E S C R I P T I O N TIME IN I N P A T I E N T D I S P E N S A R Y RX T Y P E NUMBER AVE T I M E ( M I N ) S.D.{MIN) _N_PERSj 121 4 3 . 566 3 5 . 8 1 2 E P E R S 25 4 8 . 5 1 9 4 0 . 0 0 0 NEWDD 1 0 8 8 2 . 7 6 8 4 9 . 9 3 7 REEDD 88 4 7.011 3J?_.06 2_ S T A F F 32 6 3 . 8 7 5 22~37~5 S P E C L 4 8.000 4 . 0 8 2 A L L R X 378 5 7 . 367 4 3 . 7 5 0 TIME I N D I S P E N S A R Y FOR A L L PRESCRI PT IONS ( V IN ) E N T R I E S IN T A B L E MEAN ARGUMENT STANDARD D E V I A T I O N 3 7 8 5 7 . 3 6 7 4 3 . 7 5 0 UPPER OBSERVED PER CENT CUMUL AT IV E L IM IT FREQUENCY OF TOTAL P E R C E N T A G E 20 1 2 2 3 2.27 3 2 . 2 4 0 38 1 0.05 4 2 . 3 60 4 7 1 2 . 4 3 5 4 . 7 80 4 4 11 .64 6 6 . 4 100 4 0 1 0 . 5 8 7 6 . 9 1 20 . 52 1 3 . 7 5 9 0 . 7 1 4 0 2 8 7 . 4 0 9 8 . 1 1 60 7 1.8 5 1 0 0 . 0 REMAINfNG" F R E Q U E N C I E S ARE ALL ZERO 3 182 5 0 * * * * * * * * * * * * * * * * *- * * * * * * A A * - * D I S T R I B U T I O N OF TIME * * * A P R E S C R I P I I C N IS IN * * * THE D I S P E N S A R Y * A A A A A A A A * A A * A A * A * A A A * * A A A _4 5 * A A A 4 0 * A A A A 3 5 * A ** A ** 3 0 A ** A ** A ** A ** % OF A ft* RX 25 A ** A ** A ** A ** A ** 2 0 A ** A ** A ** A A A A ** ' 15 A ** A ** A * A ** A A * ** ** A ** ** ** ** 10 A * * * * ** ** ** ** A ** * * ** ** ** ** A ** * * A * ** ** ** A ** * * ** ** ** A * ** * ** * * * * * * ** ** ** 5 A * * * * ** * A ** * * ** A ** * * ** * * ** ** ** A ** * * * * A * ** * * ** A * * ** A * ** * * ** A ** * * ** ** ** ** * * * * 0 * * * * * * * * * * * A * * * A * * A * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 20 4 0 6 0 8 0 ICO 120 140 1 6 0 1 8 0 2 0 0 2 20 2 40 2 6 0 TIME I N MINUTES * 3 0 * * f e s r 3, 183 5Q * * * * * * * * * * * * * * * * * * * * * * * * * *D ISTR I8UT ICN OF WORK * * * ARRIVALS BY HOUR OF * * * CAY * if * * * * * * * * * * * * * * * * * * * * * * * A 5 * ...... _ * * AO * * * 3 5 * % OF WORK 25 * it ** 20 * * * * ** * * ** * * * * 15 * ** ** * * * * * * * ** ** ** * * * * ** * * * * * * * * * 10 * * * * * ** ** * * * * * * * * * ** ** ** ** ** * * * * * * * * * ** ** * * * * * ** ** ** ** ** 5 ** ** *:* ** ** ** ** * * * * * * * * * ** ** ** ** ** ** ** ** * ** ** * * * * ** ** ** ** ** ** IT"" ** ** ** ** ** ** ** * * * * * * * ** * * * * * * ** ** ** * if * * * * 0 ****** * * * ***** * * * * * * * if if if * * * * * * * * * * * * * * * * * * * * ********** * * * * * * 8 9 10 11 12 13 14 15 16 17 18 HOUR OF C AY ( 8 AM TO 6PM) r _ S T 3 l 8/4 50 * >:• * * * >: * * * * * * * * * * * * * * * * * * * *DI S T R I B U T I C N OF WORK * * * COM P L E T I O N BY HOUR * * * OF DAY * * * * * * * * ft ft ft * * ft * * * * * * * ft ft ft ft 4 5 * _ ; . . ft ft ft * 40 * ft ft * 3 5 * ft ft 30 * * * % OF * WORK 2 5 * ft ft * * 20 * ft ft ft * A f t * ft ft * * * ftft ft* 1 5 ft ft ft ft* * ftft A A * * ft ft ft A A * * * ftft ft A * * ft* * ft ft- ft A * * * * 10 ft ft ft A A * * ft* ft ft ft- ft ft- ft ft ft* * ft ft ft ft- * * ft* * A f t ft A * * * * *ft * * * ft ft ft A * * * * * * * * 5 * ft* ft* ft* A * * * ft* * * * * * * * ft * ft ft ft* * * * * ft * * * * * * * * * * ft ft ft ft ft A * * * * * * * * * * * * * * * * * * ft A * * * . * * * A * * 4 * * * * * ft ft ft ft * ftft * * * * * A * * ** ft* ftft 0 ft ft ft ft ft ft ft ft ft ft 4 ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft ft * ft ft ft ft ft ft ft * ft 3 9 10 1 1 12 13 14 15 16 17 18 HOUR OF DA Y{8AM TO 6FM) . 135 * D I S ^ N S A R Y A N A \ L Y S I S « * O » * » » * « « » O # « O » « O O « O O » O » « * « » « « O « O O O » « O « « « O O « « O « « "I* * * D I S P E N S A R Y M A N P O W E R S C H E D U L E M A T R I X : (ROW # = _ I D O F W O R K E R ) ' ( C O L ' U "= U S ED T 6 ~ I D E N T I FY S T A R T , S T O P £ B R E A K T I M E S ) S T A R T r 1 S T L U N C H 2 N D F I N I S H T I M E C O F F E E C O F F E E T I M E i I 1 I I ( E N T R I E S I N M A T R I X A R E I N T E R M S OF # O F 1/4 H O U R S )  H A L F W C R D M A T R I X 1. R O W / C O L U M N 1 . 2 3 4 5 1 3 2 4 0 5 0 6 0 6 4 2- 3 2 4 0 5 0 6 0 6 4 3 3 4 4 2 5 0 6 1 6 6 4 3 4 4 2 5 2 6 1 _ 6 6 5 4 l 9 9 5 2 6 3 7 2 6 6 6 9 9 9 9 9 9 7 2 7 3 4 4 2 5 0 5 0 5 0 8 4 1 9 9 5 2 6 3 7 2 9 3 6 4 2 5 0 6 0 6 8 1 0 3 6 4 3 5 2 6 1 6 8 * * M A N P O W E R A S S I G N M E N T B Y D A Y ( C O L ) * {ROW 1 - 3 = P . A I D E S ; ROW 4-8 = P H A R M A C I S T S ) H A L F WORD M A T R I X 3 R O W / C O L U M N 1 2 3 4 5 1 1 1 1 1 1 2 1 1 I 1 1 3 1 1 1 1 1 4 5 5 5 5 5 5 3 3 3 3 3_ 6 7 7 7 7 7 7 3 3 3 3 3 8 7 7 7 7 7 U T I L I Z A T I O N CF MANPOWER,PHONE £ S T A F F C O U N T E R - A V E R A G E U T I L I Z A T I O N D U R I N G -F A C I L I T Y N U M B E R A V E R A G E T O T A L A V A I L . . U N A V A I L . C U R F E N T R I E S T I M E / T R A M T I M E T I M E T I M E S T ; .1 8 8 8 . 5 9 3 . 2 9 2 . 4 1 7 . 0 0 1 r 2 3 9 1 2 . 1 3 0 . 4 6 2 . 6 5 7 . 0 0 7 h 4 3 3 0 2 . 4 3 0 . 4 4 5 . 6 3 1 . 0 1 1 b 5 3 7 0 2 . 2 8 3 . 4 6 9 . 6 6 3 . 0 1 6 6 7 3 1 . 0 8 2 . 0 4 3 . 2 9 2 . 0 0 0 _ 7 2 1 7 2 . 4 5 1 . 2 5 5 . 7 7 8 ^ 0 0 5 f P H C N E 3 9 3 . 6 9 2 . 0 7 9 . 0 8 4 . 0 0 0 C O U N T 4 2 1 . 5 7 1 . 0 3 6 . 0 3 8 . 0 0 0 T Y P E W R IT E R : N U M B E R A V A I L A B L E - = T O T A L L A B E L S T Y P E D = A V E R A G E W A I T I N G T I M E A V E R A G E N U M B E R OF RX 1 A V E R A G E 3 5 5 A V E R A G F FOR L A B E L T Y P I N G W A I T I N G = 4 6 1 8 6 -U T I L I Z A T I O N = 3 8 . 3 % T I M E / L A B E L = 1 . 9 4 I 1 / 3 M I N ) = 2 5 2 . 1 5 ( 1 / 3 M I N ) P R E S C R I P T I O N S : A V E R A G E N U M B E R O F RX I N D I S P E N S A R Y = 5 7 M A X I M U M N U M B E R OF R X I N D I S P E N S A R Y = 1 1 7 A V E R A G E S T A F F W A I T I N G T I M E AT C O U N T E R . 3 8 ( 1 / 3 M I N ) A V E R A G E T I M E S P E N T W I T H S T A F F A T C O U N T E R = 1 . 5 7 Q / 3 M I N ) A V E R A G E RX W A I T I N G T I M E F C R D I S P E N S I N G = 1 0 7 . 7 * 1 / 3 M I N ) A V E R A G E N U M B E R OF R X W A I T I N G F O R D I S P E N S I N G = 8 A V E R A G E W A I T I N G T I M E F O R DD RX E D I T I N G = 4 1 . 5 3 ( 1 / 3 MI N ) T O T A L R X Q U E R I E D = 9 A V E R A G E W A I T I N G T I M E FOR Q U E R Y . 0 0 ( 1 / 3 M I N ) P R E S C R I P T I O N T I M E I N I N P A T I E N T D I S P E N S A R Y RX T Y P E N P F R S P P E P 8 N E W D D R E F D D N U M B E R 121 2 5 1 0 7 8 3 A V E T I M E ( M I N ) 7 9 . 5 9 5 8 6 . 3 5 9 1 1 7 . 1 3 0 8 3 . 3 2 9 S T A F F S P E C L A L L RX 3 4 4 3 7 9 1 3 4 . 8 2 3 4 . 5 0 0 9 5 . 6 6 7 S . D . ( M I N ) 5 3 . 1 2 5 5 5 . 5 0 0 5 3 . 7 5 0 _54_._7_50_ 3 9 . 0 0 0 1 . 7 3 0 5 6 . 6 2 5 T I M E I N D I S P E N S A R Y F O R A L L P R E S C R I P T 10 NS ( M IN ) E N T R I E S I N T A B L E M E A N A R G U M E N T S T A N D A R D D E V I A T I O N 3 7 9 9 5 . 6 6 7 5 6 . 6 2 5 U P P E R O B S E R V E D P E R C E N T C U M U L A T I V E L I M I T F R E Q U E N C Y O F T O T A L P E R C E N T A G E 2 0 6 7 1 7 . 6 7 1 7 . 6 4 0 2 3 7 . 3 8 2 5 . 0 6 0 2 8 7 . 3 8 ' 3 2 . 4 3 0 2 2 5 . 8 0 3 3 . 2 1 0 0 2 8 7 . 3 3 4 5 . 6 1 2 0 3 0 7 . 9 1 5 3 . 5 1 4 0 7 8 2 0 . 5 3 7 4 . 1 1 6 0 5 0 1 3 . 1 9 8 7 . 3 1 8 0 4 1 1 0 . 3 1 9 8 . 1 2 0 0 6 1 . 5 8 9 9 . 7 2 2 0 1 . 2 6 1 0 0 . 0 R E M A I N I N G F R E Q U E N C I E S A R E A L L Z E R O Tlfj^-r .4- 1 8 ? 5 0 * * * * A * * A A A A A A A AAA A A A * A AAA * * D I S T R I B U T I O N O F T I M E * * * A PR E S C K I P T T O N I S IN * * * T H E D I S P E N S A R Y * A A A A A * A A A A A A A A A A A A A ft ft A A A 45 * . _ A A A ft 4 0 * A . _ f t ' A A 35 * A A _____ . _ * 30 * A * ft % O F * . RX 25 * A A A ft 2 0 * ** A * * ft A A A ftft ftft A A A A A 1 5 A A A A f t ft ft A A f t A A f t A A A A A A A ftft ftft A A f t A * ft* 1 0 * * * * * * * ** ft ftft ' ** * * ft* * ftft \ ' ** ** ** * ftft ftft ftft A * * A A * * * * * * ft* ** ** ** ** ** ** ** 5 ft ftft ftft ftft A * * * ft* * * * * * * * ftft * * A * * * * * A * * * A * * * * ft* ** ft* * * ** ** ** ** ** *~ * * * * * * * * * * * * ftT;< * * * * * ** ** ** ** ** ** ** ** ** ** 0 * **************************************** *ft * ** *ft * * ft * ft * ** * ft * * * * ft * * * * 20 40 60 80 100 120 140 160 180 200 220 240 260 T I M E I N M I N U T E S 5S OF WORK 5 0 45 V * 4 * 4 * 4 * * * A 3 5 * * A * A A A A A A A A * A * A A A A A A A A A A *D ISTP IOUTICN OF WORK * * ARRIVALS BY HOUR OF * A DAY • * A A A A A A A A A A A A A A A A A A A A A A * 188 4 0 A A 3 0 * A A A ~*T A A A 25 A 4 4 A 4 4 2 0 * 4 4 A 4 4 A 4 A A 4 4 4 4 A A f t 4 4 . 15 A 4 4 4 4 if 4 4 4 4 4 4 if 4 4 4 4 4 4 if 4 4 4 4 4 4 4 4 4 ' 4 * 4 4 4 4 1 0 A 4 * 4 4 4 4 4 4 4 ft 4 A A 4 4 4 4 if 4 A 4 4 4 4 4 4 4 4 A 4 4 4 4 ftft 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 5 A 4 4 4 4 A ft- 4 4 4 4 . 4 4 4 4 A 4 4 4 4 ft 4 4 4 4 4 4 4 ft 4 4 4 4 4 4 4 A 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 ft4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 A A A 4 A * A A A A * A A A A A A A A A A A A A A A A A * A A A * A A A * A A A A * A A A A ft ft A A A A 4 4 4 4 4 4 4 4 8 9 10 1 1 12 1 3 14 15 16 17 18 HOUR OF C A Y ( 8 AM TO 6PM) % O F * W C R K 2 5 * * ' T V w 4 189 - _.. s o * * * * * * * * * * * * * * * * * * * * * * * * * D I S T R I f i U T I C N QF WORK * * * C O M P L E T I O N B Y H O U R * * * OF D A Y * * * * * * * * * * * * * * * * * * * * * * * * * 4 5 * _ _ _ _ _ . * A C * * * 3 5 * * . 3 0 * * 2 0 * * * * ** * * * * ** ** 1 5 * ** * ** ** * * * ** * ** * * ** -* ** ** ** ** 1 0 * ** ** .** ** * ** * * * * ** ** * ** * * * * ** ** ** * ** ** ** ** ** ** ** * * * * * * * * ** ** ** ** 5 * * * * * * * * * ** * * * * ** * * * * * * * * * ** ** ** ** ** ** * ** ** * * * * ** ** ** ** ** ** * * * * * * * * * ** * * ** ** ** ** * * * * * * * * * ** * * * * ** ** ** 0 ** ** ********** * * * * * * ** * * ******* * * * ** * * * * * * * * ******** ** * * * * * * 8 9 1 0 1 1 1 2 1 3 1 A 1 5 1 6 1 7 1 8 H O U R O F C A Y { 8 A M T O 6 P M ) . O l S P E N S A R Y A N A L Y S I S . 190 * * D I S P E N S A R Y M A N P O W E R S C H E D U L E M A T R I X : (ROW U = ID O F W O R K E R ) ( C O L # = U S E D TO I D E N T I F Y S T A R T , S T O P £ B R E A K T I M E S ) S T A R T 1 ST L U N C H 2 N D F I N I S H T I M E 1 C O F F E E 1 1 C O F F E E T I M E 1 ( E N T R I E S I N 1 M A T R I X A R E I N 1 T E R M S OF H OF 1 1 / 4 ' H O U R S ) 1 H A L F W C R D M A T R I X 1 R O W / C O L U M N 1 2 3 4 5 1 3 2 4 0 5 0 6 0 6 4 2 3 2 4 0 5 0 6 0 6 4 3 3 4 4 2 5 0 6 1 6 6 4 3 4 4 2 5 2 6 1 6 6 c 4 1 9 9 5 2 6 3 7 2 6 6 6 9 9 9 9 9 9 7 2 7 3 4 4 2 5 0 5 0 5 0 8 4 1 9 9 5 2 6 3 7 2 3 6 4 2 5 0 6 0 6 8 1 0 3 6 4 3 5 2 6 1 6 8 * * M A N P O W E R A S S I G N M E N T B Y D A Y { C O L ) ( ROW 1 - 3 = P . A I D E S ; ROW 4 - 8 = P H A R M A C I S T S ) H A L F W O R D M A T R I X 3 R O W / C O L U M N 1 2 3 4 5 1 1 i 1 1 1 2 1 1 1 1 1 1 1 1 1 1 4 5 5 5 5 5 3 3 3 3 3 6 7 7 7 7 7 7 3 3 3 3 3 8 7 7 7 7 7 U T I L I Z A T I O N C F M A N P O W E R , P H O N E 5 S T A F F C O U N T E R < - A V E R A G E U T I L I Z A T I C N D U R I N G -F A C I L I T Y N U M B E R AV E R A G E T O T A L A V A IL . U N A V A I L C U R ! E N T R I E S T I M E / T R A N T I M E T I ME T I ME S T 1 9 0 7 . 5 5 4 . 2 7 9 . 3 9 8 . 0 0 1 •2 3 7 3 2 . 6 7 2 . 5 5 3 . 7 8 9 . 0 0 1 4 3 7 4 2 . 6 3 1 . 5 4 6 . 7 6 9 . 0 2 5 1 5 3 7 7 2 . 5 2 2 . 5 2 8 . 7 4 6 . 0 2 0 ft 6 3 1 . 5 2 3 . 0 5 3 . 3 5 5 . 0 0 0 7 1 6 5 3 . 5 1 5 . 3 2 2 . 8 2 6 . 0 1 8 P H C N E 3 8 3 . 2 3 6 . 0 6 8 . 0 7 1 . 0 0 0 C O U N T 4 2 1 . 5 2 3 . 0 3 5 . 0 3 7 . 0 0 0 f l r ^ T - 1 9 1 T Y P E W R I T E R : N U M B E R A V A I L A B L E = 1 A V E R A G E U T I L I Z A T I O N = 3 7 . 9 ? TOT At L A B E L S T Y P E D = 3 4 5 A V E R A G E T I M E / L A B E L - 1 . 9 8 ( 1 / 3 M I N ) A V E R A G E W A I T I N G T I M E FOR L A B E L T Y P I N G - 2 2 1 . 4 3 1 1 / 3 M , I N ) A V E R A G E N U M B E R OF RX W A I T I N G = 4 1 P R E S C R I P T I O N S : A V E R A G E N U M B E R O F RX IN D I S P E N S A R Y = 6 0 M A X I M U M N U M B E R O F R X I N D I S P E N S A R Y = 1 1 5 A V E R A G E S T A F F W A I T I N G T I M E AT C O U N T E R . = . 0 9 ( 1 / 3 M I N ) A V E R A G E T I M E S P E N T W I T H S T A F F A T C O U N T E R = 1 . 5 2 Q / 3 M I N ) A V E R A G E RX W A I T I N G T I M E F C R D I S P E N S I N G = 1 6 8 . 3( 1 / 3 M IN ) A V E R A G E N U M B E R OF R X W A I T I N G F O R D I S P E N S I N G = 1 5 A V E R A G E W A I T I N G T I M E F C R DD RX E D I T I N G = 1 3 0 . 8 9 . 1 / 3 M I N ) T O T A L R X O U E R I ED = 9 A V E R A G E W A I T I N G T I M E FOR Q U E R Y = . 0 0 I 1 / 3 M I N ) P R E S C R I P T I O N T I M E I N I N P A T I E N T D I S P E N S A R Y RX T Y P E N U M B E R A V E T IME(MIN) S . D . ( M I N ) N P E R S 1 1 9 8 3 . 2 6 8 5 4 . 8 1 2 R ' P ERS 2 5 9 1 . 0 3 9 6 0 . 5 6 2 N E W D O 1 0 6 ' 1 5 6 . 3 3 0 7 3 . 0 0 0 R F E D 0 8 1 9 8 . 2 4 6 _ 5 2 _ . 3 1 2 _ S T A F F 3 2 1 2 3 . 3 7 5 4~4.3~75 S P E C L 4 1 2 . 0 0 0 1 0 . 7 0 7 A L L R X 3 6 7 1 1 0 . 9 2 6 6 7 . 3 7 5 T I M E I N D I S P E N S A R Y F O R A L L P R E S C R I PT I O N S (M IN ) E N T R I E S I N T A B L E M E A N A R G U M E N T S T A N D A R D D E V I A T I O N 3 6 7 1 1 0 . 9 2 6 6 7 . 3 7 5 U P P E R O B S E R V E D P E R C E N T C U M U L A T I V E L I M I T F R E Q U E N C Y OF T O T A L P E R C E N T A G E 2 0 3 8 1 0 . 3 5 1 0 . 3 4 0 3 6 9 . 8 0 2 C U 1 6 0 1 3 - 3 . 5 4 2 3 . 7 8 0 4 5 1 2 . 2 6 3 5 . 9 1 0 0 3 5 9 . 5 3 4 5 . 5 1 2 0 5 6 1 5 . 2 5 6 0 . 7 1.40 2 0 5 . 4 4 6 6 . 2 1_6_0 2 4 6 ^ 5 3 7 2 ._7 1 8 0 4 0 1 0 . 8 9 ' 8 3 . 6 2 0 0 2 7 7 . 3 5 9 1 . 0 2 2 0 5 1 . 3 6 9 2 . 3 2 4 0 1 2 3 . 2 6 9 5 . 6 2 6 0 1 3 3 . 5 4 9 9 . 1 2 8 0 3 . 8 1 1 0 0 . 0 R E M A I N I N G F R E Q U E N C I E S A R E A L L Z E R O -TG^r < .192 5 C * >;< * * * * if if if if if if if if if if if if if if if if if if if * * D I S T R I B U T I O N ( IF T I M E * * * A P R E S C R I P T I C M I S I N * * * T H E D I S P E N S A R Y * * * * * * * * * * * * * * * if * * * * * * if if if if 4 5 * "if * * 4 0 * * if if * 3 5 * * 3 0 * R X 2 5 * * * 2 0 - * " 1 5 ** ** if* ** *if if* ** 1 0 ** ** if if * if if ** ** ** if* ** * if if * * ** ** if* ** * * ** ** ** if * ** ** * ** if* ** if if ** ** ** ** 5 * * * * * * i> ** * * ** ** ** if* ** if* * * ** * * ** ** ** if* * ** * * * * * * * * if* ** ** if* ** ** ** ** if if ** *if ** * * ** ** ** ** ** if* * ** if * * * ** if* ** ** if if *if ** if* if* 0 * * * if if * * if if if if* * * if if * if if if if if*. * * if # * * * ********** if if * * if if if if * * if if * if * if **********: 2 0 4 0 6 0 3 0 1 0 0 1 2 0 1 4 0 1 6 0 1 8 0 2 0 0 2 2 0 2 4 0 2 6 0 T I M E I N M I N U T E S rt-'vT _r 193 5 0 * * * * 4 .' * * * * * * * 4 * * 4 4 4 4 4 4 4 4 4 * D I S T R I R U T I C N OF WORK * 4 4 A R R I V A L S B Y H O U R OF * 4 4 C A Y * ft 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 _* . _ .. „ " * 4 4 4 4 0 * 4 4 4 4 3 5 * 4 4 4 3 0 * 4 4 4 % O F * WORK 2 5 * 4 4 4 4 2 0 4 4 . 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 1 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 1 0 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4: 4 4 4 4 4 4 4 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 ft 4 4 4 4 4 4 4 4 4 4 4 4 4 . ft 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1.8 H O U R O F D A V . 8 A M TO 6 P M ) s o * * * * * * * * * ** * * * * * * * * * * * * * * * D I S T R I R U T I O N D F W O R K * * * C O M P L E T I O N B Y H O U R * * * O F D A Y * 4 * 4 4 * * * 4 * * * * * 4 * * * * * * * * * * 45 * .... * 4 4 4 0 * 4 4 4 4 3 5 * 4 4 4 3 0 * 4 4 • 4 ~%~QF * W O R K 2 5 * 4 4 , 4 4  _____ 4 4 4 4 4 4 4 4 1 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4-' 4 4 4 4 4 4 4 4 4 4 4 4 4 4 1 0 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4c 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4=4 4 4 4 4 4 4 5 4 4 4 . 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 = 4 4 4 4 4 4 4 4 4 • 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 4 4 4 4 4 44= 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4= 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 8 9 1 0 1 1 1 2 .1.3 1 4 1 5 1 6 1 7 1 8 H O U R GF C A Y ( 8 A M T O 6 P M ) . . . 1 9 5 - . . . • • T E ^ T • D I S P E N S A R Y A N A L Y S I S 0 0 0 0 6 0 4 0 4 0 0 « 0 0 « a 0 0 0 0 <* <* 0 0 • • • 0 0 * * D I S P E N S A R Y M A N P O W E R S C H E D U L E M A T R I X : ( R O W # = I D C F W O R K E R ) ( C O L # = U S E D T O I D E N T I F Y S T A R T ,STOP £ B R E A K T I M E S ) S T A R T 1 S T L U N C H 2 N D • F I N I SH T I M E I C O F F E E i 1 C O F F E E 1 T I M E 1 ( E N T R I E S I N M A T R I X 1 A R E I N ! T E R M S O F n O F 1 1 / 4 H O U R S 1 ) 1 H A L F W O R D M A T R I X 1 R O W / C O L U M N .1 2 -3 4 5 1 3 2 4 0 5 0 6 0 6 4 2 3 2 . 4 0 5 0 6 0 6 4 3 3 A 4 2 5 0 6 1 6 6 4 3 A 4 2 5 2 6 1 6 6 5 4 1 " 9 9 5 2 6 3 7 2 6 A l 9 9 5 0 6 3 7 2 7 3 A 4 2 5 0 5 0 5 0 3 A l 9 9 5 2 6 3 7 2 9 3 6 4 2 5 0 6 0 6 8 1 Q 3 6 4 3 5 2 6 1 6 3 * * M A N P O W E R A S S I G N M E N T B Y D A Y { C O L ) T { R O W 1 - 3 = P . A I D E S ; R O W 4 - 8 ^ P H A R M A C I S T S ) H A L FW O R D M A T R I X 3 P C W / C O L U M N 1 2 3 4 5 1 1 1 1 1 1 2 1 1 1 1 1 3 1 1 1 1 1 A 5 5 5 5 5 5 3 3 3 3 6 7 7 7 7 7 7 3 3 3 3 3 8 7 7 7 7 7 U T I L I Z A T I O N O F MANPOWER. PHONE S S T A F F C O U N T E R F A C I L I T Y N U M B E R E N T R I E S - A V E R A G E U T I L I Z A T I O N D U R I N G -A V E R A G E T O T A L A V A I L . U N A V A I L . T I N E / T R A N T I M E T I M E T I M E 1 3 4 c 6 7 "PHONE" C C U N T 8 7 2 2 5 7 3 2 0 3 1 4 2 9 7 1 6 0 3 8 4 2 . 6 2 3 2 . 9 2 9 2 . 6 6 5 2 . 4 2 3 2 . 6 2 2 3 , 1 2 5 3 . 2 3 6 1 . 4 5 2 . 3 0 2 , 4 1 8 , 4 7 3 . 4 2 2 . 4 3 2 . 0 6 8 . 0 3 3 . 5 9 7 . 6 6 5 . 6 0 3 . 6 1 0 . 0 7 1 . 0 3 5 . 0 0 1 . 0 0 0 . 0 2 5 . 0 0 1 . 0 1 3 ^qo_i_ .060 . 0 0 0 . _ . T e s r k 196 T Y P E U R I T E R : N U M B E R A V A I L A B L E = ' 1 A V E R A G F U T I L I Z A T I C M = 3 8 . 6 . T O T A L L A B E L S T Y P E D - 3 5 5 A V E R A G E T I M E / L A B E L = 1 . 9 6 ( 1 / 3 M I N ) A V E R A G E W A I T I N G T I M E F O R L A B E L T Y P I N G = 2 0 8 . 4 7 ( 1 / 3 M I N ) A V E R A G E N U M B E R O F R X W A I T I N G = 2 8 P R E S O R T P T I E N S : A V E R A G E N U M B E R O F R X I N D I S P E N S A R Y - 4 5 M A X I M U M N U M B E R . O F R X I N D I S P E N S A R Y = 1 1 3 A V E R A G E S T A F F _WA I T I N G T I M E _ A T _ _ C 0 U N J E R = __p9_( 1 / 3 M I N ) A V E R A G E T I M E S P E N T W I T H S T A F F A Y C O U N T E R " = 1 . 4 5 T T / 3 M I N ) A V E R A G E R X W A I T I N G T I M E F O R D I S P E N S I N G = 6 3 . 6 . 1 / 3 M I N ) A V E R A G E N U M B E R O F R X W A I T I N G F O R D I S P E N S I N G = 4 A V E R A G E W A I T I N G T I M E F O R C D R X E D I T I N G - 1 2 5 . 6 2 (1 / 3 M I N ) T O T A L R X Q U E R I E D - 9 A V E R A G E W A I T I N G T I M E F O R Q U E R Y = . C 0 . 1 / 3 M I N ) P P E S C R I P R I O N T I M E I N I N P A T I E N T D I S P E N S A R Y R X T Y P E N U M B E R A V E T I M E ( M I N ) S . D . ( M I N ) N P E R S 1 2 1 6 1 . 3 3 3 4 4 . 0 0 0 R P E R S • 2 5 6 6 . 8 3 9 4 6 . 1 8 7 N F W D D ' 1 0 6 1 2 3 . 6 0 3 6 5 . 6 8 7 R E F D D 8 6 6 6 . 5 8 1 5 2 . 6 8 7 S T A F F ' 3 4 9 9 . 0 0 0 • 2 8 . 4 3 7 S P E C L ' 4 7 . 5 0 0 5 . 0 6 2 A L L R X 3 7 6 8 3 . 2 8 9 5 8 . 6 8 7 T I M E I N D I S P E N S A R Y F O R A L L P R E S C R I P T I O N S ( M I N ) E N T R I E S I N T A B L E M F A N A R G U M E N T S T A N D A R D D E V I A T I O N 3 7 6 8 3 . 2 8 9 5 8 . 6 8 7 U P P E R O B S E R V E D P E R C E N T C U M U L A T I V E L I M I T F R E Q U E N C Y O F T O T A L P E R C E N T A G E 2 0 9 2 2 4 . 4 6 2 4 . 4 4 0 2 4 6 . 3 8 3 0 . 8 6 0 1 6 4 . 2 5 3 5 . 1 • 8 0 3 3 8 . 7 7 4 3 . 8 1 0 0 7 7 2 0 . 4 7 6 4 . 3 1 2 0 3 0 7 . 9 7 7 2 . 3 1 4 0 3 0 7 . 9 7 8 0 . 3 1 6 0 2 3 6 . 1 1 8 6 . 4 1 8 0 2 6 6 . 9 1 9 3 . 3 2 0 0 2 2 5 . 8 5 9 9 . 2 2 2 0 2 . 5 3 9 9 . 7 2 4 0 1 . 2 6 1 0 0 . 0 R E M A I N I N G F R E Q U E N C I E S A R E A L L Z E R O TeCr 4. 197 5 0 * 4 * * * * * * * * * 4 * * 4 4 4 4 4 4 4 4 4 4 4 * * D I S T R I B U T I O N O F T I M E * * A P R E S C R I P T I O N I S I N * * * T H E D I S P E N S A R Y * 4 44 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 _4_5_ * 4 4 4 4 40 * 4 4 4 4 3 5 * 4 4 4 4 3 0 * * 4 4 4 2 5 * 4 4 4 4 A 4 4 4 4 4 A 4 20 4 4 4 4 4 4 4 4 4 4 4 4 4 4* 4 4 4 4 4 4 4 4 4 4 1 5 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 10 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 5 4 A4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4= 4 4 4 4 4 4 4 4 4 4 4 4 4 4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 0 4 4 4 4 4 4 4 4 A4 * 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 A 4 4 4 4 4 4 4 4 4 4 4 4 4 A A A 4 4 20 40 60 8 0 100 120 140 160 180 200 2 20 240 2 60 T I M E I N M I N U T E S Tfc'-sr t- 198 5 * *** * *** * * * * * * * * * * * * * * * * * * D I S T R T B U T I C N OF WORK * * * A R R I V A L S BY HOUR OF * * * DAY * * *********************** A S * * AO * * 3 5 * * 3G * * WORK 2 5 * 20 * * * ** ** * ** * * * * * * * ** 15 * * * * * * * * * * *:* ** * ** * * * * ** * ** * * * * ** * ** * * * * .** 10 ** * * * * *• * * ** * * * * ** * ** * * * * ** * ** ** ** * * ** * * * * * * * ** ** ** 5 * ** * * * * * * ** ** ** * ** * * * * * * ** * * ** ** ** ** * , ** * * * * * * * * * * ** ** ** ** * ** * * * * ** ** ** ** * * * * * * ** * * * * ** * * * * ** ** ** ** 0 **** ** **** *** * * * ** ****** * * * *** ** * * * * ** ***** ** ************ * * * 8 9 10 11 12 13 1A 15 16 17 18 HOUR OF DA Y( 8AM TO 6PM) % O F W O R K 2 5 * * ft ft 5 0 * * ft ft ft ft* * * * * * * >;.* ft* ft* * * * * * * ' * D IS T R [ B U T T 0 N OF WORK * * * C O M P L E T I O N B Y H O U R * *• ft O F D A Y * * * ft * * * * * * * ft A A A * * * * * A * * * ft 4 5 * _ A " " - - - " " ' ' ' * A A 4 0 * A A ' * * 3 5 * * A A A 3 0 * * * 2 0 * A * A * A f t A A 1 5 A * * A A A A ft A A * A ft* • * A * A A ft A * * ft * * A A ** A f t A * * ft A A * * * A f t 1 0 * * * A f t A A * * ft* • A ftft A A . * * * A * * * * A ft* * A ftft * ft ft* * ft* ft ft * ft- A f t * A * * A A A * * ft * * * * & A A 5 ft A * * * ft ft- ftft ftft A * * * A ft ft A A ft A ** * * * * * * A * * * * A A A A ft A A * ft* ft* ft* ft* _ * * ft* A A * A A A * * * ftft ** ** * * * * * ft-ft A A A * A A A A A f t A f t A f t ft A * * * f t 0 ft ft ft ft * * * ft * ft * * * * * ft * * A ft * ft ft ft * * * « * * * * * ft * * * * * * * * * * * * * * * * * * * * * * * * * * 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 H O U R O F C A Y . 8 A M T O 6 P M ) . D I S P C N S A R Y A N A L Y S I S 200 D I S P E N S A R Y { ROW ( C O L M A N P O W E R S C H E D U L E M A T R I X : # = ID OF W O R K E R ) # = U S E D T O I D E N T I FY~"~START , S T O P £ C R E A K T I M E S ) S T A R T T I M E 1 S T C O F F E E ."JNCH 2ND C O F F E E F I N I S H T I ME J J N T R I E S I N M A T R I X A R E H A L F WCRD M A T R I X R O W / C O L U M N 1 2 3 4 I N T E R M S OF # O F 1/4 H O U R S ) 5 6 7 8 9 1 0 1 1 3 2 32 3 4 4 1 4 1 3 4 41 3 6 3 6 2 4 0 4 0 4 2 4 2 9 9 9 9 4 2 9 9 4 2 4 3 3 50 50 50 5 2 5 2 50 50 52 50 52 4 6 0 6 0 6 1 A L 6 3 6 3 5 0 6 3 6 0 6 1 5 6 4 6 4 6 6 _ 6 6 _ 72 72 50 72 6 3 6 8 * * M A N P O W E R A S S I G N M E N T B Y D A Y ( C O L ) (ROW 1-3 = P . A I D E S ; ROW 4 - 8 = P H A R M A C I S T S ) H A L F WORD M A T R I X 3 R O W / C O L U M N 1 2 3 4 5 1 1 1 1 1 1 2 1 1 1 1 1 3 1 1 1 1 1 4 5 5 5 5 5 3 3 3 3 3 6 7 7 7 7 7 7 3 3 3 3 3 3 7 7 7 7 7 U T I L I Z A T I O N OF M A N P O W E R , P H G N E £ S T A F F C O U N T E R - A V E R A G E U T I L I Z A T I O N D U R I N G -F A C I L I T Y N U M B E R AV E R A G E T O T A L A V A I L . U N A V A I L . CURE E N T R I E S T I M E / T R A M T I M E T I ME T I ME ST. ' 1 889 .59 9 .296 . 42 1 . 00 3 i. 287 2 .780 .443 .627 .012 r 4 251 2. 856 . 39 8 . 567 .001 5 29 2 2.390 .387 .55 2 . 003 6 232 2.616 .33 7 .47 8 .00 7 7 133 2. 770 . 281 . 744 . 003 r P H C N E 44 2.836 .070 .07 4 .000 Ti5<3T 7 201 T Y P E W R I T E R : N U M B E R A V A I L A B L E = 1 A V E R A G E U T I L I Z A T I O N = 3 5 . 9 ? T O T A L L A B E L S T Y P E D = . 3 2 5 A V E R A G E T I M E / L A B E L = 1 . 9 9 { ] . / 3 M I N ) A V E R A G E W A I T I N G T I M E F O R L A B E L T Y P I N G = 1 9 1 . 3 2 ( 1 / 3 M I N ) A V E R A G E N U M B E R C F R X W A I T I N G = 3 1 P R E S C R I P T I O N S : A V E R A G E N U M B E R O F R X I N D I S P E N S A R Y = 3 3 M A X I M U M N U M B E R O F R X I N D I S P E N S A R Y = 8 7 A V E R A G E _ S T A F F W A I T I N C _ Jl M E_ A T _ C 0 U N T E R = . 0 ( 1 / 3 M I N ) . A V E R A G E " T Y M E " " S P E N T " W I T H " S T A F Y " A T " " " C O U N T E R " ' ='" " Y 6 " ' ( 1 / 3 M I N " ) A V E R A G E R X W A I T I N G T I M E F O R D I S P E N S I N G = . 0 I 1 / 3 M I N ) A V E R A G E N U M B E R O F . R X W A I T I N G F O R D I S P E N S I N G = A V E R A G E W A I T I N G T I M E F O R D D R X E D I T I N G = 9 0 . 5 9 U / 3 M I N ) T O T A L R X Q U E R I E D = 8 A V E R A G E W A I T I N G T I M E F O R Q U E R Y = 3 . 7 5 1 1 / 3 M I N ) P R E S C R I P T I O N T I M E I N I N P A T I E N T D I S P E N S A R Y R X T Y P E N U M B E R A V E T I M E ( M I N ) S . D . ( M I N ) N P F P. S 1 2 0 5 4 . 2 9 1 3 8 . 1 2 5 R P E R S 2 5 5 7 . 6 3 9 3 7 . 0 0 0 N E W D O 1 0 8 9 9 . 4 6 2 5 3 . 8 7 5 R E F D D 8 8 5 4 . 7 6 1 4 1 . 5 6 2 S T A F F 3 3 . 0 0 0 1 . 0 0 0 S P E C L 3 4 4 6 8 . 3 8 9 4 9 . 1 2 5 A L L R X T I M E I N D I S P E N S A R Y F O R A L L P R E S C R I P T I O N S ( M I N ) E N T R I E S I N T A B L E M E A N A R G U M E N T S T A N D A R D D E V I A T I O N 3 4 4 6 8 . 3 8 9 4 9 . 1 2 5 U P P E R O B S E R V E D P E R C E N T C U M U L A T I V E L I M I T F R E Q U E N C Y O F T O T A L P E R C E N T A G E 2 0 9 9 2 8 . 7 7 2 8 . 7 4 0 2 2 6 . 3 9 3 5 . 1 6 0 2 5 7 . 2 6 4 2 . 4 8 0 3 3 9 . 5 9 5 2 . 0 1 0 0 8 7 2 5 . 2 9 7 7 . 3 1 2 0 2 3 6 . 6 8 8 4 . 0 1 4 0 2 3 6 . 6 8 9 0 . 6 1 6 0 2 5 7 . 2 6 9 7 . 9 1 8 0 6 1 . 7 4 9 9 . 7 2 0 0 1 . 2 9 1 0 0 . 0 R E M A I N I N G F R E Q U E N C I E S A R E A L L Z E R O ' T V S T .. 7 202. 5Q * * * * * * * * * * * * * * * * * * * * * * * * * * •* D I S T R I B U T I O N O F T I M E * * * A P R E S C R I P T I O N I S IM * . * • * T H E D I S P E N S A R Y * * * * * * * * * * * * * * * * * * * * * * * * * * A 5_ * * * * * AO * * * * 3 5 * * * * * 3 0 * * * ** * * * % ~ 0 F * R X 2 5 * * * * * * * * • * * . * * * * * * ** ** * ** ** _G - — xx_ * ** ** * ** ' ** * ** ** * ** ** 1 5 * * * * * * ** ** * ** ** * * * * * 1 0 * * * * * * ** ** ** * ** ** ** ** ** * * * * * * * * * * * * * * * * * . 5 * * * * * * * * * * * * * * * * * * ** ** ** ** ** ' ** ** ** * ** ** ** ** ** ** ** ** * * * **~ * * 12* * * * * * * * * * ** ** ** ** ** ** ** ** ** 0 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 2 0 A O 6 0 8 0 1 0 0 1 2 0 1 A 0 1 6 0 1 8 0 2 0 0 2 2 0 2 A 0 2 6 0 T I M E IN M I N U T E S % OF * WORK 25 * TfcfST 7 203 5 o * >: * * * * * * * * * * * * * * * * * * * * * * * * D I $ T R I B U T . I C N O F W O R K * • * * A R R I V A L S B Y H O U R O F * * * C A Y * * * * * * * * * * * * * * * * * ******* * 4 5 * _ _ . ... ' * * * * 40 * * * * 3 5 * * * * * 30 * * * ' * 20 * * * * * * * * * * * 1 5 * * * * * * * * ** * * ** ** * ** * * ** ** * ** ** * * * * * ** ** * * ** 10 * * * * * * ** ** ** * * * * ** * ** ** * * ** * ** * * ** ** ** * ** * * ** * * * * ** ** 5 * ** * * * * * * ** ** ** * * ** ** * ** ** ** * * ** * * ** * * ** ** * * * ** ** * * ** * * ** ** ** **' * ** * * ** ** ** ** ** ** * * ** * ** ** ** ** * * ** ** ** ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 3 9 10 11 12 1 3 14 15 16 17 18 H O U R O F D A Y ! S A M T O 6PM) T t F S r / 204 5 Q * * * * * * * * * if if if if if if if if if if if- if if if if * 0 I S T R I B U T 1 0 N 0 F WORK * * * C O M P L E T I O N B Y H O U R * * * O F D A Y * * * * * * if if if. if if if if if if if if * if if if if if if if 4 5 * * - — 4 0 * * if if 3 5 * if * 30 * % O F * WORK 2 5 * if 2 0 * * * * ** ** 1 5 * * * * * ** * ** * * ** ** ** ** * * * * ** * * ** ** ** 1 0 * * * ** ** ** * ** * * *.* ** ** ** *. * * * * * * ** ** ** * * * * * * * ' ** * * ** if ** ** ** ** * * - ** ** 5 if ** **, ** ** ** ** ** ** if * * * * * * ** ** * * ** ** ** ** if ** ** ** * * ** * * ** ** ** ** if ** ** ** ** ** ** ** ** ** ** * ** ** ** ** ** ** ** * * ** ** 0 ****** if* if * * if if if * * * * * * * * * * * * * * * * * if * * * * ********* * * * * * * * * * * * * * * * 8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 , 1 8 H O U R O F C A Y ( 8 A M T O 6 P M ) i o o r * • _ <• w « * o «• « _«e« _ ti " , D I S P i T N S A R Y A N AI Y S 1S . 205 ** HI s P F:\SA r'Y MANPOWER SCR E RULE M A T R I X : , (ROW 'l = 10 OF WORKER) (COL « = USED TO I D E N T I F Y ~ S t A P Y , S TO P ~ Y B R E A T Y Y M E S ) START 1ST LUNCH 2ND F I N I S H TT-'F COFFEE C O F F F - TTMF ! I ! I I ( E N T R I E S IN MA TR I X APE I N T F * M S OF f OF 3 /A HOURS) H A l . F W O R P M A T R I X 1 ROW/COLUMN 3 2 3 . 4 5 1 3 2 40 5 0 6 0 64 2 3 2 40 5 0 6 0 64 3 34 42 5 0 6 1 66 4 34 4 2 52 ; (:>1 66_ 5 4 1 9 0 5 2 6 3" ' 6 41 9 9 5 0 6 3 7 2 7 34 42 5 0 5 0 50 8 41 9 9 5 2 6 3 7 2 9 36 4 2 5 0 '60' 6 8 10 36 43 52 6 1 68 ft* M A N F O K E » A S S I G N M E N T B Y C A Y ( 0 0 1 ) (ROW 1-3 = P . A l C E S ; R O W 4-8 = P H A R M A C I S T S ) HALF WORD MA TR I X 3 ROW/COLUMN 3. 2 2 4 " 5 1 1 1 1 1 1 2 1 1 1 1 1 3 1 1 • .1 1 1 4 ' 5 5 5 5 5 R 3 3 3 3 3 6~ 7~ ' 7 7 7 7"" 7 3 3 3 3 3 8 7 - 7 7 . 7 7 U T I L I Z A T I O N CF M A N P O W E R » P l - C N E f. S T A F F COUNTER -AVERAGE UTI L I Z ATI CN DURTi F A C I L TTY NUMBER /V ERAG F. T O T A L AVA IL . UNAVA I L E N T R I F S T I M E / T R A N T I ME T I ME T I M E 1. 3 5 5 .67 9 .2 22 . 4 5 9 . 00 3 1 25 9 2 . 9 1 8 ' .4 19 .59 5 . 0 0 9 4 2^5 2. 5* 2 . 4 1 6 .5 87 . 01 6 5 2 9 2 2 . 4 3 4 .394 K E; C e — * . 0 1 1 c 31 '3 2.71 5, .472 . 67 2 .00 5 7 18 1 2. 8 1 7 . 2 8 3 . 75 3 .001 PHCNE' 4'- • 3 .00 0 . 0 7 3 .07 7 . OCO COUNT 4 2 1.452 .033 .03 5 .000 T e s - r g 206 TY'-f V M l [.•• : M ! - ' \ ! ' R A V AI I. A R I r = 2 W I"; P A G F UT II. I Z AT T CM = 1 9 . b% T F T AL I A R PI, S T Y P F D = 34R A V E R A G F. T I ^ E / L A B E L « 2 . 0 3 ( 1 /3M. IN ) A V E P A G F W A I T I M G T TM F FOR L A B E L T Y P I N G = 1 0 3 . 1 5 ( 1 / 3M I N ) A V F R A G F N U M B E R E F R X V» A I T T N G = 17 P R E S C ' - T ° T T O M S : A V E R A G E N U M B E R O F R X I N 0 I S P E N S A R Y = 2 0 M A X I M U M N U M B E R O F R X I N D I S P E N S A R Y 7 9 A V E R ' \ C F _ S T A F J F W A I T J N G T I M F _ A T C O U N T E R = _ _ _ . 0 7 ( 1 / 3 M I N ) A V E P A G F ~ T I M E S P F N T "W T " T H " _ S T A F F " A T " C O U N T E R " = " T . V 5 ( 1 / 3 M T N T A V E R A G E R X W A I T I N G T I N F F O R D I S P E N S I N G = 1 1 . 7 { 1 / 3 M I N ) A V E R A G E N U M B E R O F R X W A I T I N G F O R D I S P E N S I N G = A V E R A G E W A I T I N G T I M E F C R D D R X E D I T I N G = 1 8 0 . 2 1 . 1 / 3 M I N ) T O T A L R X Q U E R I E D = 11 A V E R A G E W A I T I N G T I M E F O R Q U E R Y = & . 8 1 ( 1 / 3 M I N ) P R E S C R I P T I O N T I M F I N , I N P A T I E N T D I S P F N S A P Y RX T Y P E N U M B E R A V E T I M E ( M I N ) S . D . ( M I N ) M P E R S _ 1 1 9 2 1 . 6 3 8 2 3 . 0 6 2 Rp'r 'R S 2 5 3 2 . 5 1 9 2 1 . 6 8 7 N T WOO 1 0 6 9 3 . 0 9 4 5 0 . 4 3 7 R E F O n • 8 8 3 1 . 1 1 3 _.___?A0_ S T A F F 3 2 4 7 . 1 2 . 5 1 6 . 0 6 2 S P E C L 4 3 . 2 5 H 1 . 2 5 7 A L L R X 3 7 4 5 0 . 0 1 3 4 2 . 3 1 2 . T I M E I N 0 1 S P E N S A R Y F O R A L L P R E S C R I P T I O N S ( M I N ) E N T R I E S I N T A B L E M E A N A R G U M E N T S T A N D A R D D E V I A T I O N 3 7 4 5 0 . 0 1 3 4 2 . 8 1 2 U P P E R O B S E R V E D P E R C E N T O U M U L A T I V E L I M I T F R E Q U E N C Y O F T O T A L P E R C E N T A G E 2 0 1 1 7 3 1 . 2 8 3 1 . 2 4 0 C 1 1 3 . 6 3 4 4 . 9 6 0 5 7 2 5 . 9 3 7 0 . 8 8 0 3 7 9 . 8 9 8 0 . 7 1 0 0 8 2 . 1 3 8 2 . 8 1 2 0 2 8 7 . 4 8 9 0 . 3 1. 4 0 1 4 3 . 7 4 9 4 . 1 1 6 0 1 9 5 . 0 8 Q 9 . 1 1 8 0 3 . 8 0 1 0 0 . 0 R E M A I N I N G F R E Q U E N C I E S A R E A L L Z E R O 5 o * » :;. * * * * * * * * * •} :'c i: * * * * 01 S T R I 0 L T I 0 M O F T T F * * A P R E S C P I P T f 00 I S I i'-i * * T ! | F • 0 I S P F N S A R Y * * ;l: * * * * * * >- * * * * * 5'- * * * * * * * * 4 5 * * * * 4 0 * * * * 3 5 * * * * 30 * * * * * * * * ** •5 O F - * * * R X 25 * .** * * * * * ** * * * ' ** * * * * * * * * * * 2 0 if A- ** * * * ' ** * ** * * * * * ** * ** * * 1 5 * * * i: * ' * * * ** * , ** ** ** ** * * * * ** ' * * * * ' 10 * * ** * * * ** ** ** * * * * * * * * * * * * * * * * * * * * * ** * * * * ** ** 5 ** * *' * * ** ' ' ** ** * * * * * * * * * * * * * * * * * * * * * * * * * * * * *.* * * * * * * * * * * * * * * ** * * ** ** ** ** ** ** 0 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ****** * * ***** * 20 4 0' 6 0 ' 8 C 1 0 0 1 2 0 1 4 0 1 6 0 I S O 200 2 2 0 2 4 0 2 6 0 T I MF IN NT NOTES TlfSr 9 208 * * >: * * * * * * >: * * * * * * * * • * D J 5 TR I BL'T [CM CP WORK * * A R P I V / L C BY HOUR QF * * •;• n A Y * * * * * * ;;t * * * * * :je * * :|: * * * * * * * A 0 * 2 5 * *. * -3 3 * ? O F * WORK 2 5 -•:= 2 0 * 3 5 * * * * * * * * * * * * * * * * ** ** ] 0 * * * *>:< * ** * * * * * * * * ** * ** * * * =!-* * * * * ** * * * * * *' * * * * * * * * * ** * * * * A * * * * '-'A * * * * ** * * * * * * * * ** * * 0 ?:>*;;: * * * «>'f * * * >:• * * * * s;. -i »; * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * a 9 1 0 11 12 1 3 14 15 16 17 1 8 H O U R OF D A Y ( 8 A M TO 6 P M ) * >: * * * * ** * * * * 5> * * * * * * "0 [ S TR IB I; TI r M OF WORK * * C C M P L F T I O O FY 00OR * * * i ]F PAY * •S- * * * * :;• * * * * * * if if :|- * * * * * * * « * T&r <k 2 0 9 * * A 0 * -!= 30 * X OF * WORK 2 5 * 20 -15 * ** ** * * * ** * ** * * * * * * ** * ** ** ** * * * * * * * ** * * * * * * * * * * :|; * * * --I: * * * * ;|: * ** * if if* ** if* ** if if * if * * * if if if if if if if if 5 * if* if* ** if if if* if* ** if ** if* if* *if if* if* if* ** *if * * * * * * * * * * * if * * if if if . if if if if * if~f ifT- *1< ** *~* *if ** ** * ** ** ** if* **. ** ** ** ** 0 * if if * if if * * * ******** * * if if * * if * * * * * * * * * * * * * * it * * * * * * * * * * * * * * * **** * * 8 9 3.0 1. 1 12 1 3 14 15 16 17 18 HOUR OF C AY ( 8 AM TO 6P?<n 

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