36E77618R0055-006.pdf

5.0 APPENDIX

APPENDIX 5-2

PG 18-12 – PHARMACY SERVICES DESIGN GUIDE JANUARY, 2018

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APPENDIX 5-3

5.0 APPENDIX

TABLE OF CONTENTS

5.1 SITE VISITS 5-5

5.1.1 Introduction 5-5

5.1.2 Jesse Brown VAMC, Chicago, Illinois 5-7

5.1.3 Edward Hines Jr. VAMC CMOP, Hines, Illinois 5-16

5.1.4 University of Chicago Medical Center, Chicago, Illinois 5-20

5.1.5 Elmhurst Memorial Hospital, Elmhurst, Illinois 5-28

5.1.6 Rush University Medical Center 5-38

5.1.7 Orlando VAMC, Orlando, Florida 5-44

5.1.8 James Haley VAMC, Tampa, Florida 5-56

5.1.9 Malcom Randall VAMC, Gainesville, Florida 5-68

5.1.10 Washington DC VAMC, Washington, DC 5-78

5.2 STORAGE STUDY 5-87

5.2.1 Jesse Brown VAMC Storage Survey 5-88

5.2.2 Orlando VAMC Storage Survey 5-89

5.2.3 Orlando VAMC Storage Survey 5-90

5.2.4 Tampa VAMC Storage Survey 5-91

5.2.5 Gainesville VAMC Storage Survey 5-92

5.2.6 UCMC Storage Survey 5-93

5.2.7 UCMC Storage Survey 5-94

5.2.8 Elmhurst VAMC Storage Survey 5-95

5.2.9 Rush VAMC Storage Survey 5-96

5.2.10 Washington DC VAMC Storage Survey 5-97

APPENDIX 5-4

5.3 TEST FITS 5-99

5.3.1 Consult Room 5-100

5.3.2 Phonebank, Telepharmacy 5-101

5.3.3 Storage, Prosthetics and Supplies 5-102

5.3.4 Filling/Assembly, Shelving Storage 5-103

5.3.5 Work Area, Sterile Compounding 5-104

5.3.6 Storage, Sterile Compounding 5-105

5.3.7 Workstation, Clinical Pharmacy Teaching Coordinator 5-106

5.3.8 Workstation, Intern/Student 5-107

5.3.9 Workroom, Resident 5-108

5.3.10 Pharmacy Cache 5-109

APPENDIX 5-5

5.1 Site Visits

5.1.1 Introduction

As a beginning step to updating the Space Criteria and Design Guide for the Pharmacy chapter, the team embarked on two site visits to conduct post occupancy evaluations of existing pharmacies. In order to gain an understanding of the way the VA currently operates, the team toured multiple VA-operated pharmacies in addition to several State-operated Veteran Homes across the country. In addition, the team toured a number of private pharmacies to see a variety of solutions and work flows. The group also focused on adjacencies of spaces, finishes, and architectural details. The analysis was intended to be a learning experience for the design team which would translate into modifications, additions, or deletions from the existing chapter criteria and design guide.

APPENDIX 5-6

APPENDIX 5-7

JESSE BROWN VAMC

Location Chicago, Illinois

Total Area 240,000 SF

Floors 8

Beds 200

Pharmacy Size Not Available

Construction Cost $82,000,000

Opening Date May 2008 Outpatient Pharmacy renovated 2011

Owner Veterans Health Administration

Architect/Engineer SOM/Ellerbe Becket

5.1.2 Jesse Brown VAMC, Chicago, Illinois

Figure 5.1 Aerial of Jesse Brown VAMC

APPENDIX 5-8

Figure 5.2 Main Concourse in Jesse Brown VAMC

Medical Center Overview The Jesse Brown VA Medical Center consists of a 200-bed acute care facility and four community based outpatient clinics (CBOCs). Jesse Brown VAMC provides care to approximately 62,000 enrolled veterans who reside in the City of Chicago and Cook County, Illinois, and in four counties in northwestern Indiana. In FY10, the medical center had over 8100 inpatient admissions and 560,000 outpatient visits. A budget of over $355 million supports approximately 2,000 full-time equivalent staff, including 200+ physicians and 450 nurses, with 500+ volunteers providing service and care at Jesse Brown VAMC and CBOCs.

In May 2008, the medical center opened its new inpatient bed tower pavilion, which includes seven surgical suites, cystology, intensive care, inpatient dialysis, an outpatient surgical center and a chapel. The medical center’s strategic priority is the “heart of the Veterans Community” and as Provider of Choice for veterans in the Chicago area. JBVAMC established

APPENDIX 5-9

Figure 5.3 Entrance Lobby in Jesse Brown VAMC a “We Are Here” outreach campaign to inform veterans about the health care benefits they have earned through their service to our country and the specific services available to them at Jesse Brown VA Medical Center.

Formerly known as the West Side VA Medical Center, the facility was renamed in 2004 for the Honorable Jesse Brown, who served as Secretary for Veterans Affairs from 1993 to 1997.

Pharmacy Overview Pharmacy services are spread throughout the medical center to best serve the facility at the necessary points of access. Pharmacy services are divided into 5 separate locations: Outpatient, Inpatient, DDTC, Drug Cache, and OR Satellite.

The outpatient Pharmacy is located on the 1st floor, which provides it easy access to and from the loading dock. The space is large enough that it is able to handle inpatient discharge prescriptions as well, to help alleviate space constraints in the inpatient Pharmacy. The move for discharge from inpatient to the outpatient Pharmacy was critical to provide enough room

APPENDIX 5-10

to support the use of robotics, which are now used heavily for discharge prescriptions. Locating the outpatient Pharmacy on the first floor also makes it convenient for pick-up by vets. As the medical center is located conveniently to public transit, the system does not need to contract out any pharmaceutical work to external pharmacies. The Just-In-Time delivery service used means that the Pharmacy currently has no need for a medications carousel. Noted space constraints include those in the waiting area where urgent care patients often contribute to crowding, and the space necessary to keep various drugs segregated per regulating while they are awaiting disposal. Space for staff lockers and personal storage is also an issue.

The inpatient Pharmacy is located on the 3rd level within the bed tower, and is much smaller than the outpatient Pharmacy. It typically supports 130 patients (200 maximum) at any given time. It has two clean rooms with an ante room, each with two hoods, which were built according to best practices in 2007. As a result, few to no alterations are anticipated to be necessary once updated standards are adopted. There is a pick-up window for nurses near the clean room which allows the compounding pharmacist to remain in the clean room area at all times. The inpatient Pharmacy also includes a narcotics vault, an oncology research workstation, and a pick-up window that can be used for after-hours outpatient pick-up services. Although space is limited, it is used effectively and the Pharmacy benefits by sharing discharge services with the outpatient Pharmacy. However, the inpatient and outpatient services each have their own receiving processes and area, which does occupy valuable space within the inpatient Pharmacy.

The DDTC (drug dependence treatment center) Pharmacy resides on the second floor and supports the medical center’s methadone program.

The room has enough space to prepare and administer pick-up and take-home doses of methadone. The workstation near the large pick-up window assures that patients can watch their dosage being prepared before it is administered.

The drug cache occupies two rooms on the second floor of the medical center. The entrance has a two-step security system requiring both a key and a code for entry, although a code may be entered without the key in an emergency (however an alarm will sound). The rooms have ample space for the cache and are therefore also used for overflow storage, including several overflow refrigerators and storage for flu vaccines.

The OR satellite Pharmacy can be used as contingency space, if needed, by the other Pharmacy services. However, the satellite was not observed

APPENDIX 5-11

APPENDIX 5-12

R

(CUBICLE)

(CUBICLE)

FEC

FEC

WALL

GUARD

WALL

GUARD

WALL

GUARD

WALL

GUARD

FEC

WALL

GUARD

WALL

GUARD

CLEAN STORAGE

ALCOVE

1266A

WHEELCHAIR

STORAGE

1249A

MAIN

ENTRANCE

CORRIDOR

CHAIR

STATION

CUBICLES

1259A

HALLWAY

TEMPORARY

NURSES

STATION

PATIENT

WAITING

AREA

PATIENT

TEMPORARY

SOILED

UTILITY

CLEAN

STORAGE

(WET)

CLEAN

STORAGE

NURSE

MANAGER

SOCIAL

WORKER

CHAIR STATION

CUBICLES

STAFF

TOILET

LOCKERS

1264A

CONFERENCE

LUNCH RM

BIO-MED REPAIR

EXIST SHAFT

MECH RM

WATER TREATMENT

STORAGE

(DRY)

CHIEF

PHYSICIAN

Outpatient Pharmacy Plan

Legend:

Outpatient

Circulation

Clean Room Inpatient Staff Area Support

Receiving/breakdown Bulk storage Automation Pick-up window Call center

Waiting space: can become overcrowded with urgent care patients Consulting stations Staff coats hung here on wall as they do not fit in lockers

1 6

Key Notes / Photo Locations:

Figure 5.4 Jesse Brown VAMC Outpatient Pharmacy Floor Plan on this site visit, as the program is covered by the VA Surgical Services Design Guide.

APPENDIX 5-13

Figure 5.5 Jesse Brown VAMC Outpatient Photo taken at note position #3

Figure 5.6 Jesse Brown VAMC Outpatient Photo taken at note position #5

Figure 5.7 Jesse Brown VAMC Outpatient Photo taken at note position #8

Figure 5.8 Jesse Brown VAMC Outpatient Photo taken at note position #5

APPENDIX 5-14

Inpatient Pharmacy Plan

Legend:

Outpatient

Circulation

Clean Room Inpatient Staff Area Support

Compounding pharmacist and pick-up window Inpatient pick-up window Pyxis restocking Research Oncology

Main work area Receiving

1 5

Key Notes:

Figure 5.9 Jesse Brown VAMC Inpatient Pharmacy Floor Plan

APPENDIX 5-15

Figure 5.10 Jesse Brown VAMC Inpatient Photo taken at note position #1

Figure 5.11 Jesse Brown VAMC Inpatient Photo taken at note position #3

Figure 5.12 Jesse Brown VAMC Inpatient Photo taken at note position #5

Figure 5.13 Jesse Brown VAMC Inpatient Photo taken at note position #6

APPENDIX 5-16

HINES CMOP

Location Hines, Illinois

Total Area ~115,000 SF Currently not all area is in use

Floors 1

Beds N/A for CMOP

Pharmacy Size ~115,000 SF

Construction Cost Not Available

Project Cost Not Available

Opening Date 1995

Owner Veterans Health Administration

Architect/Engineer Not Available

5.1.3 Edward Hines Jr. VAMC CMOP, Hines, Illinois

Figure 5.14 Aerial of Edward Hines Jr. VAMC

APPENDIX 5-17

Figure 5.15 Front facade of Edward Hines VAMC

Overview Edward Hines, Jr. VA Hospital, located 12 miles west of downtown Chicago on a 147-acre campus, offers primary, extended and specialty care and serves as a tertiary care referral center for VISN 12. Specialized clinical programs include Blind Rehabilitation, Spinal Cord Injury, Neurosurgery, Radiation Therapy and Cardiovascular Surgery. The hospital also serves as the VISN 12 southern tier hub for pathology, radiology, radiation therapy, human resource management and fiscal services.

Hines VAH currently operates 471 beds and six community based outpatient clinics in Elgin, Kankakee, Oak Lawn, Aurora, LaSalle, and Joliet. Over 600,000 patient visits occurred in fiscal year 2010 providing care to over 54,000 veterans, primarily from Cook, DuPage and Will counties. In FY 2010 the budget for Hines was over $510 million.

APPENDIX 5-18

Figure 5.16 Robotic picking in Hines CMOP

CMOP Overview The Central Mail Order Pharmacy located near the Hines campus is one of six such facilities in the country, which in aggregate handle about 85% of all outpatient prescriptions for the VA. Since 2006 the CMOP facilities have comprised their own organization separate from the purview of the VA hospitals. They are funded by payments from the hospitals and operate at a cost of about $1.63 per prescription. The hospitals typically handle their own discharge prescriptions before the prescription is automatically transferred to the CMOP system. The CMOPs process close to 90 million prescriptions a year. At the Hines CMOP specifically, the facility processes roughly 120,000 prescriptions every day, and has a turn-around rate of 48 hours.

The current workflow for the Hines CMOP, including the administrative area, occupies only about half of the total area of the building. The current system was installed in 1995 and has undergone numerous updates and

APPENDIX 5-19

upgrades in the intervening years to add more capacity and functionality.

There are several components to the system, which includes robotic picking for medications that can be ordered in the correct doses for prescription filling, a dispensing area for filling bottles with individual pills, a line of stations for pharmacist verification of each prescription, and a line of stations for packaging and preparing each package for shipment.

Once the material is packed, it is stored on carts until it can be picked up by a contracted consolidator and sorted for shipping. The CMOP does not handle shipping itself. As no compounding or IV prep is done at the facility, there are no clean rooms. However, there are several mechanical hoods for handling of some specific medications.

An entire replacement system is currently planned for the empty space in the CMOP warehouse. As a result, the CMOP expects to be able to handle any future increases in demand easily, and is not space-constrained.

Figure 5.17 Current assembly line at Hines CMOP

APPENDIX 5-20

UNIVERSITY OF CHICAGO MEDICAL CENTER - CENTER FOR CARE AND

DISCOVERY

Location Chicago, Illinois

Total Area 1.2 Million SF

Floors 10

Beds 240

Pharmacy Size 6,600 SF

Project Cost $700 Million

Construction Cost $470 Million

Opening Date February 2013

Owner University of Chicago Medicine

Architect/Owner Rafael Vinoly/CannonDesign

5.1.4 University of Chicago Medical Center, Chicago, Illinois

Figure 5.18 Aerial of University of Chicago Medical Center

APPENDIX 5-21

Figure 5.19 Main Entry of University of Chicago Medical Center

Overview The University of Chicago Medicine is an academic medical center based on the campus of the University of Chicago. The not-for-profit corporation offers the full range of specialty and primary care services for adults and children that includes the Center for Care and Discovery.

The new hospital is a 10-story “hospital for the future” that serves as the new core of the campus of the University of Chicago Medicine. The Center for Care and Discovery provides a home for complex specialty care with a focus on cancer, gastrointestinal disease, neuroscience, advanced surgery and high-technology medical imaging.

It has the internal capacity to rapidly and economically adjust to changes in technology and medicine, and to the facility needs, for decades to come.

At 1.2 million square feet, the hospital is one of the largest buildings on the University of Chicago campus, changing the skyline of the South Side of Chicago. It occupies the north end of two city blocks, along the south side of 57th Street between Cottage Grove and Drexel Avenues. Each floor

APPENDIX 5-22

provides 100,000 square feet of space.

The architects created flexibility and adaptability by designing the entire hospital structure on a grid system. The grid is organized into 85 modular cubes that repeat on each floor. At 31 feet wide by 18 feet high, these large cubes, or “bays,” can be re-purposed over time to accommodate technological advancements and changing needs. For example, one bay can enclose two patient rooms, one operating room or one interventional procedure room–without changing the basic framework of the building.

The hospital’s innovative design also extends to its public spaces. The main lobby is located on the 7th level and is referred to as the “Sky Lobby.” The space has floor–to–ceiling glass walls, filling the space with natural light and providing panoramic views of the campus and downtown Chicago. The Sky Lobby houses central reception, family waiting areas, a chapel, the gift shop, dining areas and other public spaces. The ground level of the new hospital, open to the public, enhances the street-scape and includes cafés and other retail businesses.

The new hospital contains 240 single-occupancy inpatient rooms including 52 intensive care beds; space for 28 operating rooms with leading-edge technology; and an integrated diagnostic and interventional platform including cardiac, gastrointestinal, neurological and vascular services.

The building also has two floors of expansion space that could be used for additional patient care units as well as future leading-edge, technology-based interventional or surgical suites.

Figure 5.20 Lobby at UCMC Center for Care and Discovery

APPENDIX 5-23

Pharmacy Overview The project team visited three separate Pharmacy spaces at University of Chicago: the inpatient Pharmacy in the Center for Care and Discovery, the inpatient Pharmacy within the Comer Children’s Pediatric Hospital, and the outpatient Pharmacy near the main lobby.

The Comer Children’s Pediatric Pharmacy currently serves as the main inpatient Pharmacy to support all of the beds on the medical center campus. However, as there are additional beds planned, it is anticipated that the Center for Care and Discovery Pharmacy will play a larger role in supporting the inpatient population in the future. The Comer Pharmacy includes several clean rooms as well as a compounding robot, though staff find that the robot provides the maximum benefit if it can be employed to do a single task. The clean rooms and compounding robot together provide sufficient capacity for most of the medical center’s current needs.

The Center for Care and Discovery Pharmacy has three additional medication carousels, staff and administrative space, an investigational drug service space, and a built-in narcotics vault. There are three additional clean rooms in this Pharmacy which all share an Ante room, however these rooms are currently only used as contingency and overflow space for the Comer Pharmacy clean rooms, and their capacity is anticipated to be needed once the hospital grows to accommodate an additional several hundred inpatient beds. This Pharmacy was originally planned to include picking robotics, however the hospital ultimately opted to utilize the medication carousels instead.

APPENDIX 5-24

Inpatient Pharmacy Plan

Figure 5.21 Floor Plan of UCMC Center for Care and Discovery Pharmacy

LOCKERS

331 SF

STAFF TLT

65 SF

CORR

343 SF

MULTI-PURPOSE ROOM

367 SF

STAFF LOUNGE

247 SF

OFFICE

131 SF

OFFICE

84 SF

OFFICE

86 SF

OFFICE

84 SF

CHEMO

COMPOUNDING

198 SF

GENE THERAPY

COUMPOUNDING

89 SF

STAT IV

86 SF

ANTE

155 SF

IDS

721 SF

CORR

388 SF

EVS

111 SF

MANUAL

WORKSTATIONS

279 SF

MAIN

WORKROOM

1639 SF

NARCOTICS

STOR

159 SF

PACKAGING

199 SF

COPY

84 SF

Legend:

Outpatient

Circulation

Clean Room Inpatient Staff Area Support

These clean rooms are used as contingency or overflow spaces primarily Three meds carousels in main workroom Admin spaces arranged in ring around work area

Work area tight and doubles as receiving and storage Narcotic vault with automated medication dispensing as additional secured storage

1 4

Key Notes:

APPENDIX 5-25

Figure 5.22 UCMC Inpatient Note position #1

Figure 5.24 UCMC Inpatient Note position #5

Figure 5.23 UCMC Inpatient Note position #2

APPENDIX 5-26

Outpatient Pharmacy Plan

Figure 5.25 Floor Plan of UCMC Outpatient Pharmacy

377600 Internal Corridor

377600

Internal Corridor

1574B 377625

Mammography

378500

Clean Workroom

380777

Internal Corridor

1002A 373214 Argo Tea

Reception

Family Resource Library

Security Desk

Reception

Office 234 1013

370300 Office

370300 Office

Internal Corridor

377625

GenRad - X-Ray

1574A 377625

Internal Corridor

1574E 377625

Internal Corridor

1574D 377625

Mammography

377625

Public Lobby Seating

1204A 378500 Office

378500

Internal Corridor

390777

Public Corridor 1,190

380777

Internal Corridor

1STF

390777 Stairway

Public Corridor

1403A 390777

Public Corridor

390777

Public Corridor

377600

Internal Corridor

Internal Corridor

1STD

390777 Stairway

1651CO1

373540

Voice/Data

Public Corridor

1STA

390777 Stairway

378101

Reception

1108A 380777

Internal Corridor

Office

380777

Reception

1STE

390777 Stairway

380777 Office

1EL1

373540

Electrical

Non-Public Elevator

Non-Public Elevator

Public Corridor

Valet

Office

Office

Work/Copy

Office

Kitchenette

Consult Room

Sub-Waiting

Office

Office

Conference Room

Elevator

Public Elevator

Public Corridor

Public Elevator

Public Elevator

Public Elevator

373275

Trash Room

377600

Private RR

377600

Locker Room

378500

Exam Room

378500

Exam Room

1218A 378500

Central Storage

378500

Exam Room

378500

Exam Room

378500

Exam Room

378500

Medical Records

378500

Soiled Workroom

378500

Treatment, General

378500

Exam Room

378500

Treatment, VFI

378500

Exam Room

378500 Phototherapy

378500

Phototherapy

378500 Office

378500

Patient Toilet

378500

Treatment, VFI

Office

378500

Work Area, Resident

378500

Patient Toilet

378500

Exam Room

378500

Exam Room

377620 Staff RR

377620 Office

377607 Office

1561A 377620

Internal Corridor

377620 Office

377620 Staff RR

377620 Office

1577A 377625

Patient Toilet

390777

Public RR

390777

Public RR

1115A 373214

Merchandising Service

378500

Internal Corridor

1018A 390777

Public Corridor

Stairway

1109-S3 380777 Office

1109-N1 380777 Office

1109-N2 380777 Office

1109-S4 380777 Office

1108-S3 380777 Office

1108-N1 378101 Office

1108-N2 378100 Office

1108-S4 380777 Office

1108-S5 380777 Office

1108-N3 378100 Office

1109-S1 380777 Office

1109-S2 380777 Office

1108-S1 380777 Office

1108-S2 380777 Office

1115-N1 378101 Office

1109-E1 380777

Work/Copy

1109A 380777

Internal Corridor

380777

Internal Corridor

1005A 378020

Conf Supply

Supply

Argo Tea

Office 51 Office

Office

Sub-Waiting

Internal Corridor

Closet

1574A2 377625

Changing Area

1574A1 377625

Changing Area

A75

External 72,464.91

A: EXTERNAL, NON-EMPLOYEE

A: EXTERNAL, NON-EMPLOYEE

A: QUASHIE, ANGELA D.

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: ASEVES, FRANK

A: RAGO, JAMES

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: HARRIS, SHARON

A: HUGHES, ROSALIE

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

A: DUNCAN, EDNAA: MASON, PATRICIA

A: UNOCCUPIED, VACANTA: UNOCCUPIED, VACANT

A: RYAN, DENAE

A: UNOCCUPIED, VACANTA: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANTA: UNOCCUPIED, VACANT

A: UNOCCUPIED, VACANT

PUBLIC CORRIDOR

4397 SF

PUBLIC CORRIDOR

224 SF

OFFICE

90 SF

OFFICE

141 SF

WHEELCHAIR

STOR

166 SF

ORDER

PROCESSING

312 SF

SUPPLIES

291 SF

DISPENSING

300 SF

WAITING

359 SF

TELCOM

154 SF

Legend:

Outpatient

Circulation

Clean Room Inpatient Staff Area Support

ScriptPro automation is primary tool for outpatient Pharmacy services High density storage Outpatient filling

Key Notes:

APPENDIX 5-27

Figure 5.26 UCMC Outpatient Note position #1 west

Figure 5.27 UCMC Outpatient Note position #1 east

Figure 5.28 UCMC Outpatient Note position #3

APPENDIX 5-28

ELMHURST MEMORIAL HOSPITAL

Location Elmhurst, Illinois

Total Area 866,000 SF

Floors 6

Beds 259

Pharmacy Size 4,000 SF

Project Cost $450 Million

Construction Cost $320 Million

Opening Date June 2011

Owner Elmhurst Memorial Care

Architect/Engineer Albert Kahn Associates/Pratt Design Studio

5.1.5 Elmhurst Memorial Hospital, Elmhurst, Illinois

Figure 5.29 Aerial of Elmhurst Memorial Hospital

APPENDIX 5-29

Figure 5.30 Main Entry of Elmhurst Memorial Hospital

Overview Elmhurst Memorial Healthcare recently took the opportunity not only to replace an outdated, landlocked hospital building, but also to redefine the way they treat patients.

When the system set out to build a replacement facility, it established five main goals for the new building: clinical quality, safety, market growth, financial performance and patient satisfaction. Central to these is the patient experience; throughout the planning process, the health system asked, “How do you put the patient at the center, and make that stick?”

To answer this question, the system worked extensively with health care consulting firm Hammes Company, Brookfield, Wis., to research, map and optimize the patient experience. It also joined the Planetree network, an organization based in Derby, Conn., that promotes patient-centered care, including the idea that physical environments can enhance healing, health and well-being. Planetree’s principles for safe, effective, high-quality care that nurture the body, mind and spirit clearly are evident in the newly opened Elmhurst Memorial Hospital facility, which was designed by Albert Kahn Associates Inc., Detroit, and Pratt Design Studio, Chicago.

APPENDIX 5-30

The red brick Prairie-style building is adorned with bands of precast concrete molded in the design of a Planetree leaf, a motif used throughout the hospital in tribute to the patient-centered model of care.

Gardens and outdoor seating areas span the front of the building. A water feature is installed just inside the main entrance to provide a serene entry sequence for patients and visitors. Oversized windows fill the first-floor, public concourse with natural light. A number of amenities are located along the concourse, including a flower shop, wellness boutique, Starbucks, Pharmacy and the hospital’s café.

A health education center is available to the public in keeping with the Planetree belief that access to health information can empower people to participate in their own care. The back of this library opens to the physician lounge, giving doctors easy access to research materials.

A nondenominational chapel with a second-story balcony is adjacent to both the emergency department (ED) on the first floor and the intensive care unit on the second floor. Family members and friends of patients in these critical care areas can access the chapel without having to travel far from the patient bedside.

Each room has a computer work station with an articulating arm that allows caregivers to position the monitor where it can be seen easily by the patient. A stool is provided in every room so caregivers can sit down while speaking with patients.

To save hospital staff the time spent fetching extra seats for visitors, a folding chair is stored in a cabinet in the family zone of each patient room.

A small table with leaves that fold down for easy storage can be rolled out from beneath a counter on the footwall to give family and visitors a place to work, share a meal or play games with a patient. The idea that families, friends and loved ones are vital to the healing process is important to the Planetree approach. At the far corner of each room, the walls meet in a smooth curve rather than a sharp point, a gesture that has surprising impact on making the room more comfortable.

Integrated, ceiling-mounted patient lifts are installed in each room for staff and patient safety. Large bathrooms include roll-in showers sized to enable staff members to assist patients with bathing. The toilet is positioned away from the corner of each bathroom, providing room for two caregivers, one on each side, to help a patient sit or stand. Fold-down grab bars are installed on either side of the toilet to allow patients to

APPENDIX 5-31

help themselves. A recessed cabinet in the wall of each bathroom stores bedpans and other commonly used items.

The project team followed the 90/5 rule in designing the hospital. This rule, which originated in the aerospace industry, states that 90 percent of supplies should be stored within five seconds of where they are needed.

Nurse servers in each patient room keep supplies close at hand.

Like the patient rooms, the ED exam rooms are private, each with a private bathroom. Two doors lead into each exam room; the staff work area is on one side of the exam rooms and the waiting area is on the other, to reduce noise and chaos.

A six-bed pediatric inpatient unit is located next to the ED on the hospital’s first floor. The rooms here look into a children’s garden filled with fanciful blown-glass globes.

Figure 5.31 Lobby of Elmhurst Memorial Hospital

APPENDIX 5-32

Model of Care The Planetree Model of Care has been highlighted as a holistic philosophy of care that resonates with every department in the facility, including the Pharmacy.

The hospital is considered a destination care center for community providers. Facility management related that local physicians and surgeons have a choice in their admitting and privileges and surgical case blocks with competition from other area hospitals and surgical centers. Many of the physicians are choosing to operate at Elmhurst and the facility has seen an uptick in procedures related to this. The hospital also has an established partnership with Northwestern University’s Interventional Radiology program.

Because of the Planetree related design, there seems to be a large amount of underutilized public space. Facility staff mentioned that this space was a circulation factor and much of it was not in the program when designed but is part of the Planetree philosophy to provide open, non-restrictive spaces without pinch-points and generous lobby areas for visitors.

Pharmacy Overview The Pharmacy at Elmhurst handles inpatient medications, chemotherapy for their adjacent cancer clinic, some home health care, and employee outpatient prescriptions. Inpatient discharge prescriptions are not a service provided. All Pharmacy services are located in one area in the basement of the main hospital building. During an initial planning phase, the Pharmacy was located near the ICU and OR suite on Level 2. Eventually, planning adjustments were made to co-locate all critical care units, and Pharmacy was left with limited space on Level 2. By moving the program to the basement, they were able to maximize the space that could be made available to the Pharmacy. This also located the Pharmacy to be convenient to the loading dock for daily deliveries.

The Pharmacy group consists of 65 staff members for a total of 45 FTEs. They collectively handle 285 beds which are typically at 70-75% occupancy. Staff are cross-trained to be able to work in both the inpatient and employee outpatient services. Some pharmacists are “roving” on the bed floors with a laptop which takes the place of having any satellite Pharmacy spaces beyond what is located in the basement. There are also two Pyxis stations located in each 25-bed unit. The stations are refilled manually across all three shifts, with a focus on refilling the OR-located

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Pyxis machines on the overnight shift to minimize disruption during peak hours.

Although the Pharmacy group considered robotics, they ultimately decided to utilize two medication carousels to automate their process for the inpatient Pharmacy. There are also three pneumatic tube stations within the Pharmacy, with one station for a dedicated tube system which is used exclusively for chemotherapy being sent to the cancer clinic. By isolating the chemotherapy drugs on their own system, the team minimizes risk associated with a container bursting while in transit.

The carousels put out a report for restocking and a delivery is received daily. As a result, the inpatient Pharmacy space is uncluttered and organized, which a large portion of all drug storage occurring within the carousels. Oncology drugs, however, are not handled through the carousel and are therefore restocked manually. There is also a separate room for receiving, breakdown, and additional storage. Due to the packaging and storage needs of some specific medications, the staff would prefer this space to be larger. Although the space has a high ceiling, the tops of shelves are too high to be practically usable on a regular basis. If overflow space is needed, the staff use the Home Health Care space, which also is used for storing the emergency drug cache.

The clean rooms are built for best practices and therefore the group anticipates that few changes will be necessary for USP 800. However, the group expressed dissatisfaction with the current clean-room layout, which employs a shared ante room for both clean rooms. The preference was to have two separate ante rooms to keep the IV clean room workflow completely separate from the chemo compounding workflow. The clean rooms both have pass-through cabinets and refrigerators.

The project team noted the generally de-cluttered feel of the Pharmacy, the quality of which was made more pleasant by the indirect lighting installed in the main workspaces of both the inpatient and employee outpatient services.