36E77619R0017-019.pdf

Phase 1 – USP 800 Fort Meade Pharmacy Gap Assessment

Contract #36C26318C0003

Table of Contents

Section 1 Summary Statement and Project Team

Section 2 Pharmacy Site Assessments

A. First Level Outpatient Pharmacy B. Basement Inpatient Pharmacy

Appendix I Facility Internal Gap Assessment

Appendix II Programmatic Cost Estimate

USP800 Gap Assessment Fort Meade VAMC 5/30/18

Section 1

Phase 1 – USP 800 Pharmacy Assessment – Summary Statement

USP 797/800 describes practice and quality standards for handling hazardous drugs (HDs) to promote patient safety, worker safety, and environmental protection.

Handling HDs includes, but is not limited to, the receipt, storage, compounding, dispensing, administration and disposal of sterile and nonsterile products and preparations. The standards are rapidly evolving as states move into compliance with FDA and USP mandates.

The consulting team of National Facility Solutions (prime contractor), Stone Group Architects, BWBR and Dunham was engaged to provide a summary review of the hospital pharmacies at the Fort Meade - Black Hills VA Medical Center. This effort was two-phased; it began with a review of existing plans, details and specifications for each site. This was followed by a site visit to assess current conditions and identify compliance issues and deficiencies with proposed USP 800 regulations that will go into effect on December 1, 2019.

On March 20, 2018 the design team toured both pharmacy locations within the Fort Meade. The site visit included representatives from NFS, Stone Group Architects, VISN 23, and Fort Meade VA staff (Engineering, Maintenance, Pharmacy, and Industrial Hygiene & Safety). The visit began with a discussion of VA’s system wide goals for USP 800 compliance, a review of current hazardous drug protocols and a walk-through to review current state compliance. At each site, non-compliant USP 797/800 issues were identified and discussed with staff, and these are captured in the general pharmacy comments for each respective pharmacy.

A Gap Analysis produced by the Fort Meade - Black Hills VA Pharmacy staff is included as Appendix I (attached at the back of this report) and is intended to compliment the Design team’s review, which together comprise the entire Site Report.

The design team has included a cost estimate of anticipated construction costs associated with renovations required to bring these pharmacies in compliance with USP 797/800. This can be found in Appendix II of this document.

General Site Observations:

The Outpatient Pharmacy is located on the first level and is where all drugs are brought into the hospital and stored. The drugs enter the building through the first floor west door of the pharmacy, and are delivered by the pharmaceutical supplier in totes that are brought directly to the first level pharmacy. Since the Loading Dock/Receiving area does not receive Pharmacy deliveries, no provisions for USP 800 will be required in this area. Related to delivery of HDs, it was noted that HDs are going to start being segregated from non-HDs by their pharmaceutical supplier.

The areas in this analysis break down into three groups: the Outpatient Pharmacy located on the first level, the Inpatient Pharmacy in the basement, and the Chemo Hood room on the first level that is located in the chemotherapy treatment area.

Both pharmacies appear to be in decent condition. The Outpatient pharmacy went through a remodel in 2011, but they have since grown operations to capacity of their space. The Inpatient Pharmacy and the Chemo Hood room have gone through some upgrades to meet the minimum of 797. There was some discussion that with the wording changing in 797 that they may not be compliant at some point. Delivery, unpacking and storage areas will need to be designed to comply with USP797/800 requirements.

Outpatient Pharmacy – Level 1

HD ordering and management is similar to other VISN 23 pharmacies operations. A procurement tech orders HDs based on the medication orders received. Upon arrival at the Outpatient Pharmacy these HDs are checked in by a logistics tech and a procurement tech. Totes containing HDs are brought into the procurement office and stacked along the wall. This room is where the initial unpacking of all drugs takes place and lacks a dedicated handwashing sink. An area for PPE and spill containment kits were directly available.

As part of the breakout process, a narcotics tech separates out the class 1 narcotics and delivers these to the vault, which has restricted access.

The majority of the outpatient pharmacy area is carpet tile, while the receiving hall and procurement office has sheet vinyl flooring with a vinyl base. After numerous conversations within the VISN regarding best practice flooring finishes, we offer the following guidance on this topic:

While flooring material is not specifically addressed in USP 800, carpet is incompatible with HD handling best practices, and should be replaced with a material that provides a surface that is easier to clean and will minimize the concern for HD contamination. This finish selection would fit the requirements for durability and cleanability where cleaning agents are likely to be used, and also fits Facility Guidelines Institute (FGI) guidelines, Infection Control Risk Assessment (ICRA) best practices, and other licensing agencies (i.e. CMS, Dept. of Health) guidance for pharmacy design. Facilities infection control staff may have input on flooring selection to include weighing options of typical flooring materials such as resilient sheet flooring, VCT, LVT, or a MMA type product.

Regarding pressurization conditions, the general area of the pharmacy is currently in neutral to slightly positive pressure. Pharmacies must consider room pressurization when storing HDs1. Storing active pharmaceutical (APIs) of an HD in a negative pressure environment is required. Additionally, they must store any antineoplastic HD requiring manipulation in a negative pressure environment. Storage of other agents and dosage forms may be based on the facility’s AoR. Absent a current AoR, all current HD storage will need to be moved to a segregated HD storage area. The room must have a negative pressure between 0.01 to 0.03” wc, be vented to the outside, and have a least 12 air changes per hour. If determined to be acceptable within the facility’s current or future AoR, then the current HD storage practice may be acceptable within USP800 guidelines.

Inpatient Pharmacy – Basement

A pharmacy tech orders HDs based on the medication orders received from throughout the hospital. HDs that are received on 1st floor are packaged into totes and brought from the Outpatient pharmacy to the Inpatient pharmacy area. The HDs are stored in their container in the meds carousel. There is no separation from general traffic or other pharmacy products and limited designation on the floor for HDs vs non-HDs. There is a counter and handwashing sink as you enter the space for unpackaging. Additionally, there is a dedicated area for PPE and spill containment kits, which were both readily available if needed.

The inpatient pharmacy area, including this breakdown area, is furnished with welded seam sheet flooring and integral base. The general area of the pharmacy is believed to be in positive pressure. Walls appear to be epoxy paint and ceilings are 2x4 ceiling tiles.

There is a sterile non-HD Hood Room in this area also. This room did not include an ante room to pass through. Floor finishes are welded seam sheet flooring and integral base. Walls appear to be epoxy paint and ceilings are sealed 2x4 scrubbable ceiling tiles.

1 Antineoplastic HDs requiring manipulation other than counting or repackaging of final dosage forms and any HD API must be stored separately from non-HDs in a manner that prevents contamination and personnel exposure. Non-antineoplastic, reproductive risk only, and final dosage forms of antineoplastic HDs may be stored with other inventory if permitted by entity policy. See USP 800 Chapter 5.2

Chemo Hood – Level 1

The chemo hood room for sterile HD compounding is located within the chemotherapy area. The room is secure to only the pharmacy manager. Floor finishes are VCT with vinyl base. Walls appear to be epoxy paint and ceilings are sealed 2x2 scrubbable ceiling tiles. The chemo hood room does not include an ante room to pass through. There is a hand sink and an eye wash directly outside the room. Additionally, an area for PPE and spill containment kits is designated.

Based on discussions with the site, it was understood that the long-term plan is to centralize this room with other pharmacy. In the event of such a consolidation, this room could be used for training or backup.

Section 2

Phase 1 – USP 800 Pharmacy Assessment – Pharmacy Site Assessments

The following general comments apply to all or most of the facility we toured on March 20, 2018.

Site Visited: Fort Meade - Black Hills VA Health System – Lower Level Inpatient Pharmacy, First Level Outpatient Pharmacy and Chemo Hood

Observations:

• Both Pharmacies currently have limited access control devices at doorways. In the OP there is secure access at the exterior door to 191C. In the lower level inpatient pharmacy, there is card reader access in the corridor to the pharmacy.

Recommendations:

• A dedicated space within the receiving area should be created to provide bulk container receiving, and include space for inspection, PPE and spill kit storage, cleaning/disinfection supply storage and disposal unit. This area should also have suitable flooring (“smooth, impervious, free from cracks and crevices, and non-shedding”, i.e. a cleanable monolithic surface) and scrubbable wall surfaces.

• A hand wash sink should be in close proximity to this area.

• Pharmacy staff will need to establish USP 800 protocols for spills, containment, and returns when damaged HDs are received.

• Pharmacy staff will also need to establish USP 800 compliant protocols for delivery, distribution and administering of HDs and subsequent disposal.

• Generally, with all pharmacy groups, it was recognized that system wide standard operating procedures (SOP) will need to be defined and implemented.

• Relocate receiving to lower level through the loading dock and away from the front entrance.

• Combine the Chemo Prep, IV Prep, HD Storage, and an Ante room in a central location.

• A dedicated donning area for PPE directly inside the ante room with a demarcation line and PPE storage at all pharmacies is suggested as a best practice measure.

• A sink and eyewash are required in all ante rooms that is located at least one meter from the entrances to buffer rooms.

• Floor finishes within the ante room, positive and negative pressure buffer rooms should be monolithic with welded seams and provide an integral base.

• Wall finishes should be finished with a durable paint system that can withstand wipe downs and scrubbing associated with the facilities cleaning protocols.

• The ceilings within the ante and buffer rooms should be hard-lid (gypsum board) and should also have a durable paint finish that can withstand wipe downs and scrubbing associated with the facilities cleaning protocols.

Section 2-A

First Level Outpatient Pharmacy – Assessments

First Level – 191 Outpatient Pharmacy Existing Layout:

Summary:

• All HDs and non-HDs are unpackaged after delivery in the procurement office.

• Outpatient Pharmacy room does not have any compounding occurring on this floor.

• Drugs are sent downstairs for compounding and then back to this location in their packaging for outpatient distribution.

• The general area of the pharmacy is in slightly positive to neutral pressure.

HDs are required to be stored in a negative pressure environment or in final dose form within first layer of protection.

• Flooring in the Pharmacy is carpet with vinyl base.

• Receiving Hall and Procurement Office Floor is sheet vinyl with vinyl base, wall finishes are monolithic, verify paint is epoxy. Ceilings are 2x2 ceiling tile.

• Outpatient pharmacy contains spill kits and PPE for staff.

• Procurement office does not contain spill kits and PPE for staff.

• Procurement office does not have adequate hand sinks or an eye wash station and is not in negative pressure.

First Level – 191 Outpatient Pharmacy Proposed Layout:

Architectural Summary:

• Renovation work must be scheduled to minimize down time. Pharmacy may utilize couriers throughout to assist with compounding needs.

• Wall and ceilings should be gypsum board with an epoxy finish system that will allow wipe down and scrubbing per the facilities cleaning protocols.

• Receiving of all drugs to be in the basement for increased efficiency.

• No HD manipulation occurs in this pharmacy, so no HD storage is needed. If any manipulation of HDs is required, the recommendation would be to convert Office 191B to an HD storage room. Room would require negative pressure, hand sink, PPE, refrigerator and storage. Provide space for hood.

• In this gap analysis, the receiving of drugs was discussed as moving to the basement. If the SOP is determined to have the Outpatient Pharmacy order their own drugs and there will be any receiving that occurs in this area, the recommendation would be Office 191B to be used as HD receiving room.

HD Receiving Area (- / neutral for receiving of HD’s)

• Room pressure monitoring and recording system.

• Provide Donning/Doffing area directly inside room with PPE storage and waste collection.

• Provide handwashing sink in close proximity to room, probably in Hall 191C

• Provide negative or neutral HD receiving space with counter for breakdown of HD tubs.

Mechanical Summary:

Reference the above architectural sketches of the first floor outpatient pharmacy 191.

Based on our site assessment it was determined that HD storage is not required since there will be no HD drug manipulation or storage in this pharmacy. There is currently a dedicated HD refrigerator that will need to either be relocated into the new HD storage room in the outpatient pharmacy, or have all HD drugs removed and utilize refrigerator for non-HD drugs.

Since the proposed change removes all HD drugs from the outpatient pharmacy that are not in their final dose form and in double layer protection, there are no additional mechanical or plumbing changes to this space required to meet USP 800.

Electrical Summary:

Since the proposed change removes all HD drugs from the outpatient pharmacy that are not in their final dose form and in double layer protection, there are no additional electrical changes to this space required to meet USP 800.

During the site visit it was noticed that there is no security access from Hall 191C into the pharmacy. If the intent is to continue receiving shipments from the exterior door, then it is recommended to add a security badge reader to the door entering the pharmacy in Hall 191C.

Section 2-B

Basement Inpatient Pharmacy Phase 1 USP 800 Pharmacy – Assessments

Basement – B-30 Inpatient Pharmacy Existing Layout:

General:

• Welded seam floor and integral cove base, wall and ceiling finishes are monolithic; verify if paint is epoxy.

• Cardboard packaging present in B30 Pharmacy Unit Dose.

• Room does contain spill kits and PPE for staff.

• Hand wash was adjacent to entrance. Eyewash was not present.

• Additional storage rooms are used across the hall.

IV Prep (Sterile Buffer Room) (+)

• No room pressure monitoring and recording system present.

• Welded seam vinyl floor and integral cove base, wall and ceiling finishes are monolithic, verify if paint is epoxy.

Mechanical Summary:

Review of Certification Testing

Test Technology performed a full certification of the basement level BB-30 In-patient Pharmacy and Chemo Room located in the Oncology infusion area on December 04, 2017 with the following results:

Main Pharmacy Hood (IV Prep Sterile) Room Allowable Limit Measured Value Pass/Fail Particle Test (ISO 7) <352,000/ m3 1,053 m3 Pass Air Changes per Hour >30 AC/hr N/A N/A Room Pressurization >+0.02” w.c. +0.05 Pass

• All point-of-use laminar flow HEPA filters passed Leakage testing

Chemo Room (located in oncology infusion) Allowable Limit Measured Value Pass/Fail Particle Test (ISO 7) <352,000/ m3 5,732 m3 Pass Air Changes per Hour >30 AC/hr N/A N/A Room Pressurization -0.2” to -0.5” w.c. -0.3 Pass

• All point-of-use laminar flow HEPA filters passed leakage testing

The Chemo and IV Prep Room for hazardous drugs was found to be holding adequate room pressurization of -.13” w.c. There is one hood located in the chemo room being used for hazardous drug (Chemo) sterile compounding. There was no documentation provided that indicates that the current required air changes per hour (AC/hr) will meet USP 800 requirements of 30 AC/hr.

The Chemo room is located directly off the infusion room and does not contain an accessible eyewash, PPE gowning area, or hand wash sink. Additionally, there is no ante room/buffer space between the compounding room and an occupied patient area

The Sterile IV (Buffer) Room was found to be holding adequate room pressurization of +0.05” w.c.

All spaces above do not utilize room pressure monitors or recording. And it is required to have room pressurization and monitoring to meet USP 800 requirements.

Electrical Summary:

Chemo and Sterile IV (Buffer) Rooms were found to have the existing hoods connected to emergency power. The hospital has dual electrical service and full hospital generator backup. All lighting is flush mounted with gasketed with smooth lens covers for easy cleaning. Entry to the inpatient pharmacy has controlled and restricted access at all doors. Chemo Room has key lock doors for access control.

Basement – B-30 Inpatient Pharmacy Proposed Layout:

General

• Renovation work must be scheduled to minimize down time. Pharmacy may utilize couriers throughout to assist with compounding needs.

• Review storage needs for non-HD medications and supplies to consolidate overall space allocation to create dedicated HD delivery/breakout space and construction of new spaces described below.

• Provide a dedicated area for delivery and inspection. Breakout of HDs must occur in HD Receiving area with PPE, spill containment supplies and hand wash sink directly adjacent.

• Wall and ceilings should be gypsum board with a seamless, scrubbable surface that will allow wipe down and scrubbing per the facility cleaning protocols.

• Floors should be a cleanable monolithic surface.

• Receiving of all drugs to be in the basement, through the loading dock and sent directly to the pharmacy for increased efficiency.

• Relocate existing meds carousel.

After numerous conversations within the VISN regarding best practice flooring finishes, we offer the following guidance on this topic:

While flooring material is not specifically addressed in USP 800, it is generally agreed that carpet is incompatible with HD handling best practices, and if encountered in a general pharmacy space it should be replaced with a material that provides a surface that is easier to clean and will minimize the concern for HD contamination.

Depending on a facility’s Assessment of Risk (AoR), vinyl tile may be suitable as long as it meets standards for typical cleaning. Under ideal circumstances the pharmacy flooring would be a monolithic material with integral base. However, this is not explicitly required by USP800 so we suggest a material the meets standards for compatibility, durability and cleanability where cleaning agents are likely to be used, and also fits Facility Guidelines Institute (FGI) guidelines, Infection Control Risk Assessment (ICRA) best practices, and other licensing agencies (i.e. CMS, Dept. of Health) guidance for pharmacy design. Facilities infection control staff may have input on flooring selection to include weighing options of typical flooring materials such as resilient sheet flooring, VCT, LVT, or a MMA type product.

(New) Ante Room (+)

• Room pressure monitoring and recording system.

• Sink needs 1-meter separation from room entrance and entrance to Chemo

Prep buffer room.

• Donning/Doffing area (and adjacent PPE).

(New) IV Prep (Sterile) (+)

• Provide room for 6’ sterile non-HD Hood.

(New) Chemo Prep (HD) (-)

• Provide interlocked pass-through between HD Storage room and Chemo Prep.

• Room pressure monitoring and recording system.

• Provide room for 6’ sterile HD Hood and 4’ sterile HD Hood. Minimum 1-meter between hoods for less down time for staff and operational.

• Provide interlocked pass-through to pharmacy work area.

(New) HD Storage Room (-)

• Create negative pressure storage room (with monitoring) in close proximity to delivery/breakout space to minimize travel distances for transport of HDs.

• Provide covered/enclosed storage for HDs to minimize wipe down efforts.

• Provide refrigerator for HDs with low return behind for removal of particulate on coil.

• Provide handwashing sink either inside room or in close proximity to room.

• Provide pass thru windows to Chemo Prep room.

(New) HD Receiving Area (- / neutral for receiving of HD’s)

• Provide Donning/Doffing area directly inside room with PPE storage and waste collection.

• Provide handwashing sink in close proximity to room.

• Provide negative or neutral HD receiving space with counter for breakdown of

HD tubs.

Mechanical Summary:

Based on our assessment, a complete remodel of the existing inpatient pharmacy is being recommended to accommodate proper pharmacy compounding layout and flow to meet USP 800 requirements. Additionally, a new HD storage space will be installed to meet USP 800 requirements.

For the main in-patient pharmacy area, the proposed remodel will require a new ceiling grid be installed, and therefore new grilles and diffusers with new flex connections back to the existing ductwork. There may be additional ductwork and airflow requirements that will need to be determined during design. Additionally, there will need to be new thermostats and VAV boxes installed for proper zoning of the space. The air handler and all spaces served from the air handler will need to be test and balanced to insure proper air changes and air flow.

For the new compounding spaces provide the following to meet air distribution requirements.

• HEPA filters are required in the IV Prep, Ante, and Chemo Prep spaces.

HEPA filters should be located at the ceiling level and installed with provisions to allow for testing and recertification from inside the room. It is recommended to provide gasketed ceiling access doors where required.

• HEPA filter supply and return should be located to avoid areas of low or no air movement within the room. Supply air shall be located at the ceiling and return/exhaust air along the walls 6” from the floor. Ceiling mounted return/exhaust should not be used.

• HEPA filtration system shall be laminar.

• Provide an exhaust located adjacent to the compressor for each refrigerator located in the Chemo prep negative pressure clean room.

• Provide new automated pressure sensor and monitoring systems. Tie systems back to the BAS to allow for system monitoring and recording.

• Provide new sink and eyewash to Ante room. Locate a minimum of 1 meter from Chemo prep space.

• Provide ducted exhaust to the chemo prep hoods. Route exhaust ductwork up through roof (design engineer to determine best route). Insure new hood exhaust location is greater than 20ft from any outdoor air intakes.

Additionally, provide a dedicated air handler to serve the new compounding space.

This air handler unit could be located in one of basement mechanical rooms if space is available, design engineer to determine best location for this new unit. Unit will need to be sized to provide 30 AC/Hr to compounding rooms.

For the new HD storage space provide new diffusers to condition space with dedicated VAV box. A new dedicated exhaust fan needs to be provide for both the new non-sterile HD compounding hood and the room. These fans shall to be located on the roof with potential to route along outside wall and up to second story roof. A new chase exterior to route the ductwork in will need to be provided. The exhaust fans must maintain a minimum distance of no less than 20ft from adjacent outdoor air intakes. The exhaust fan serving the new HD storage room will need to maintain a negative pressure in the space at a rate of 12 AC/Hr. Provide optional room pressurization monitor if desired by staff or VA facilities. Provide a new wall hung sink with integral eyewash either within the HD storage room or adjacent and at least 1 meter from proposed non-sterile HD compounding hood.

Electrical Summary:

For the main in-patient pharmacy area, the remodel will require new walls and a new ceiling grid to be installed. New LED lighting and receptacles will need to be provided for the new layout.

Provide power to any new HVAC equipment. Power to be fed from nearest equipment branch panelboard. All power in the hospital is on emergency backup power and dual service. Modify the existing power layout to provide power for any new refrigerator locations. Provide gasketed and lensed LED lighting in the HD storage space. The exterior lens surface of lighting shall be smooth, mounted flush and sealed.

Provide new lighting and electrical outlets to the newly proposed compounding space. Provide gasketed and lensed LED lighting to Ante, Chemo prep, and IV prep.

The exterior lens surface of lighting shall be smooth, mounted flush and sealed.

Provide new electrical power to exhaust fans and refrigerators located within the new space.

Provide new security card access to in patient pharmacy along with security cameras at receiving door.

Appendix I

VA Fort Meade - Black Hills

Pharmacy Staff GAP Analysis USP 800 Assessment

Appendix II

VA Fort Meade - Black Hills MCC Programmatic Cost Estimate

USP 800 Assessment

Project #18.055

6009 Cottontail Trail

Madison, WI 53718 608 O

262.490.2744 C

www.middleton-cc.com

VAMC FORT MEADE

PHARMACY ASSESSMENT

Fort Meade, South Dakota

Programmatic Estimate April 29, 2018 Draft

Prepared For:

National Facility Solutions

220 Ramsey St.

Hastings, MN 55033 http://www.middleton-cc.com/

VAMC FORT MEADE

Pharmacy Assessment

Notes

NOTES REGARDING PREPARATION OF ESTIMATE

This estimate was prepared based on the following documents provided by National Facility Solutions

1. Programmatic Documents Received 4/26/18

2. Information regarding the project was also obtained via meetings, phone conversations, and email messages that clarified the project scope.

BIDDING PROCESS - MARKET CONDITIONS

This document is based on the measurement and pricing of quantities wherever information is provided and/or reasonable assumptions for other work not covered in the drawings or specifications, as stated within this document. Unit rates have been generated from current material/labor rates, historical production data, and discussions with relevant subcontractors and material suppliers. The unit rates reflect current bid costs in the area.

All unit rates relevant to subcontractor work include the subcontractors overhead and profit unless otherwise stated.

Pricing reflects probable construction costs obtainable in the Fort Meade South Dakota area on the bid date.

This estimate is a determination of fair market value for the construction of this project. It is not a prediction of low bid. Pricing assumes competitive bidding for every portion of the construction work for all subcontractors with a minimum of 3 bidders for all items of subcontracted work and a with a minimum of 3 bidders for a general contractor. Experience indicates that a fewer number of bidders may result in higher bids, conversely an increased number of bidders may result in more competitive bids.

Since Middleton Consulting has no control over the cost of labor, material, equipment, or over the contractor's method of determining prices, or over the competitive bidding or market conditions at the time of bid, this statement of probable construction cost is based on industry practice, professional experience and qualifications, and represents Middleton Consulting's best judgment as professional construction cost consultants familiar with the construction industry. However, Middleton Consulting cannot and does not guarantee that the proposals, bids, or the construction cost will not vary from opinions of probable cost prepared by them.

ASSUMED CONSTRUCTION PARAMETERS

The pricing is based on the following project parameters:

1. A construction start date of Summer 2018

2. No Phasing Requirements

3. The contract will be competitively bid to multiple contractors.

4. All contractors will be required to pay prevailing wages.

5 Work is assumed to be done during normal business, or trade hours 6 Estimate includes pricing as of April 2018.

Programmatic Estimate 04/29/2018

Draft

Pharmacy Assessment

Exclusions

EXCLUSIONS

The following are excluded from the cost of this estimate:

1. Professional Design Fees

2. Testing Fees

3. Owner Contingencies/Scope Changes

4. Construction Contingency

5. Cost Escalation Beyond a Start Date of Summer 2018

6. Finance and Legal Charges

7. Environmental Abatement Costs

8. Equipment (Owner Furnished/Installed)

9. Artwork

Programmatic Estimate

Pharmacy Assessment

COST SUMMARY

OUTPATIENT PHARMACY

INPATIENT PHARMACY $770,056

SUBTOTAL

TOTAL - ALL OPTIONS

Draft

Programmatic Estimate 04/29/2018

$844,083

$844,083

$74,028

BUILDING TOTAL

Outpatient

COST SUMMARY - OUTPATIENT PHARMACY

01000 GENERAL REQUIREMENTS $0

02000 EXISTING CONDITIONS $1,720

03000 CONCRETE $0

04000 MASONRY $0

05000 METALS $0

06000 WOODS, PLASTICS & COMPOSITES $0

07000 THERMAL & MOISTURE PROTECTION SYSTEM $852

08000 OPENINGS $0

09000 FINISHES $23,998

10000 SPECIALTIES $0

11000 EQUIPMENT $0

12000 FURNISHINGS $0

13000 SPECIAL CONSTRUCTION $0

14000 CONVEYING EQUIPMENT $0

21000 FIRE SUPPRESSION $5,836

22000 PLUMBING $0

23000 HEATING, VENTILATING & AIR CONDITIONING $2,117

26000 ELECTRICAL $5,932

27000 COMMUNICATIONS $0

28000 ELECTRONIC SAFETY AND SECURITY $0

31000 EARTHWORK $0

32000 EXTERIOR IMPROVEMENTS $0

33000 UTILITIES $0

SUBTOTAL $40,455

ESCALATION TO START OF CONSTRUCTION 2.0% $809

GENERAL CONDITIONS/BOND/INSURANCE 30.0% $12,379

CONTRACTOR'S FEES 15.0% $8,046

DESIGN CONTINGENCY 20.0% $12,338

TOTAL ESTIMATED BID $74,028

Programmatic Estimate

Project # 18.055

Inpatient Pharmacy

COST SUMMARY -INPATIENT PHARMACY

01000 GENERAL REQUIREMENTS $0

02000 EXISTING CONDITIONS $18,614

03000 CONCRETE $0

04000 MASONRY $0

05000 METALS $0

06000 WOODS, PLASTICS & COMPOSITES $2,662

07000 THERMAL & MOISTURE PROTECTION SYSTEM $2,147

08000 OPENINGS $16,067

09000 FINISHES $108,962

10000 SPECIALTIES $16,322

11000 EQUIPMENT $0

12000 FURNISHINGS $0

13000 SPECIAL CONSTRUCTION $0

14000 CONVEYING EQUIPMENT $0

21000 FIRE SUPPRESSION $7,991

22000 PLUMBING $17,027

23000 HEATING, VENTILATING & AIR CONDITIONING $172,002

26000 ELECTRICAL $76,300

27000 COMMUNICATIONS $23,032

28000 ELECTRONIC SAFETY AND SECURITY $14,587

31000 EARTHWORK $0

32000 EXTERIOR IMPROVEMENTS $0

33000 UTILITIES $0

SUBTOTAL $475,713

ESCALATION TO START OF CONSTRUCTION 2.0% $9,514

GENERAL CONDITIONS/BOND/INSURANCE 15.0% $72,784

CONTRACTOR'S FEES 15.0% $83,702

DESIGN CONTINGENCY 20.0% $128,343

TOTAL ESTIMATED BID $770,056

04/29/2018

FORT MEADE SOUTH DAKOTA

TOTAL COSTUNIT COSTUMQTYDESCRIPTION

Outpatient Pharmacy

Selective Demolition02100

Remove acoustical ceiling system 1,310 SQFT 1.31 1,720

TOTAL: Selective Demolition $1,720

Caulking & Sealants07800

Miscellaneous caulking & sealants 1,310 SQFT 0.65 852

TOTAL: Caulking & Sealants $852

Plaster & Gypsum Board09100

Gypsum Board Ceilings 1,310 SQFT 12.44 16,300

TOTAL: Plaster & Gypsum Board $16,300

Ceiling Finishes09400

Patch Walls 100 SQFT 15.47 1,547

TOTAL: Ceiling Finishes $1,547

Paints & Coatings09600

Prime & paint drywall walls, by roller, 3 coats- Epoxy- Water Based 1,561 SQFT 3.36 5,245

Misc Painting 1 LS 905.24 905

TOTAL: Paints & Coatings $6,150

Fire Sprinkler Equipment & Specialties21200

Reconfigure existing wet sprinkler system for renovation/buildout 1,310 SQFT 4.45 5,836

TOTAL: Fire Sprinkler Equipment & Specialties $5,836

Ventilation & Exhaust23200

Connect new duct to existing 1 EACH 273.02 273

Re-configure Ducts and Grilles in this area 1 EACH 1,844.16 1,844

TOTAL: Ventilation & Exhaust $2,117

Selective Demolition26100

Disconnect and remove interior light fixtures to 15' high, including supports & whips

24 EACH 43.70 1,049

TOTAL: Selective Demolition $1,049

Lighting26500

Light fixture, interior, including lamps, mounting hardware and connections -re-install

24 EACH 203.48 4,884

TOTAL: Lighting $4,884

$40,455 TOTAL: Outpatient Pharmacy

Inpatient Pharmacy

Building Demolition02300

Page 1 of 4Project #

04/29/2018

FORT MEADE SOUTH DAKOTA

TOTAL COSTUNIT COSTUMQTYDESCRIPTION

Gut building, commercial, medium demo 2,300 SQFT 8.09 18,614

TOTAL: Building Demolition $18,614

Rough Carpentry06200

Miscellaneous wood blocking & rough carpentry 2,300 SQFT 1.16 2,662

TOTAL: Rough Carpentry $2,662

THERMAL & MOISTURE PROTECTION07000

Patch roof at new exhaust fan 1 EA 1,227.09 1,227

TOTAL: THERMAL & MOISTURE PROTECTION $1,227

Caulking & Sealants07800

Miscellaneous caulking & sealants 2,300 SQFT 0.40 920

TOTAL: Caulking & Sealants $920

OPENINGS08000

HM frame-double 1 EACH 429.60 430

HM frame 5 EACH 384.60 1,923

SC wood door 7 EACH 555.64 3,889

Pair door auto open 1 EACH 5,200.00 5,200

Hardware set, single 5 EACH 925.02 4,625

TOTAL: OPENINGS $16,067

Plaster & Gypsum Board09100

Gypsum Board Ceilings 2,300 SQFT 14.51 33,379

3-5/8" 25 ga metal studs, 5/8" type x gypboard each side, 3" mineral fiber blanket insulation, full-height

1,939 SQFT 12.99 25,196

TOTAL: Plaster & Gypsum Board $58,575

Floor Finishes09200

Floor surface installation preparation 2,300 SQFT 1.13 2,604

Vinyl sheet vinyl flooring-New at rooms 2,300 SQFT 12.44 28,606

Premium for flash cove base at sheet vinyl flooring 635 LNFT 5.61 3,563

TOTAL: Floor Finishes $34,773

Ceiling Finishes09400

Patch exterior walls 200 SQFT 9.10 1,819

TOTAL: Ceiling Finishes $1,819

Paints & Coatings09600

Paint plaster/drywall 3 coats 7,756 SQFT 1.61 12,484

Misc Painting 1 LS 1,310.48 1,310

TOTAL: Paints & Coatings $13,795

Toilet Accessories10400

Paper towel dispenser, surface mounted 3 EACH 101.26 304

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TOTAL COSTUNIT COSTUMQTYDESCRIPTION

Hand sanitizer dispenser 3 EACH 91.26 274

TOTAL: Toilet Accessories $578

Wall & Door Protection10700

Corner guards, stainless steel, 48" high 22 EACH 207.51 4,565

Impact resistant wall covering, 4'-4" high in Corridor 840 SQFT 7.77 6,523

Bumper rail, Acrovyn 194 LNFT 24.00 4,656

TOTAL: Wall & Door Protection $15,745

Fire Sprinkler Equipment & Specialties21200

Reconfigure existing wet sprinkler system for renovation/buildout 2,300 SQFT 3.47 7,991

TOTAL: Fire Sprinkler Equipment & Specialties $7,991

Plumbing Fixtures22200

Lavatory, wall hung, hardwired sensor-op faucet 1 EACH 2,638.70 2,639

Sink, stainless steel, double basin, self supported,sensor-op faucet 2 EACH 3,951.80 7,904

Emergency eye/facewash, EEW, countertop 3 EACH 845.48 2,536

TOTAL: Plumbing Fixtures $13,079

Plumbing Equipment & Specialties22300

Thermostatic mixing valve - 1/2", point of use 3 EACH 335.02 1,005

TOTAL: Plumbing Equipment & Specialties $1,005

Domestic Water, Waste & Vent, & Storm Drainage Piping22400

Tie-In sanitary lines at new toilets/sinks 3 EA 981.20 2,944

TOTAL: Domestic Water, Waste & Vent, & Storm Drainage Piping $2,944

Ventilation & Exhaust23200

Ventilation,Heating and Exhaust-Including new AHU 2,300 SQFT 67.00 154,100

Exhaust fan, rooftop, w/curb, backdraft damper, 3/4 hp 1 EACH 1,742.08 1,742

Connect Refrigerator to exhaust 2 EACH 496.04 992

Provide connection for Fume Hood to Exhaust- Hoods by Owner 4 EACH 942.08 3,768

TOTAL: Ventilation & Exhaust $160,602

Temperature Controls23600

Negative air pressure monitoring device 4 EACH 1,600.00 6,400

TOTAL: Temperature Controls $6,400

Testing, Balancing, & Commissioning23700

Air testing and balancing 1 LSUM 5,000.00 5,000

TOTAL: Testing, Balancing, & Commissioning $5,000

Main Power Distribution26200

Service and distribution - Branch panelboards and associated feeders 2,300 SQFT 3.30 7,594

TOTAL: Main Power Distribution $7,594

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FORT MEADE SOUTH DAKOTA

TOTAL COSTUNIT COSTUMQTYDESCRIPTION

Emergency Power Distribution26300

Emergency Service and distribution -Feeders needed 2,300 SQFT 6.68 15,375

TOTAL: Emergency Power Distribution $15,375

Lighting26500

Lighting System - Light fixtures including installation and hook up 2,300 SQFT 11.30 25,996

Lighting System - Emergency and Exit Light fixtures including installation and hook up

2,300 SQFT 0.74 1,703

Lighting System - dual level, dimmed switching, occupancy sensors, time-based lighting control for exterior lighting

2,300 SQFT 1.59 3,658

Lighting System - Branch wiring installation 600 V, including 3/4" EMT conduit and

THWN wire, 20A

2,300 SQFT 2.27 5,212

TOTAL: Lighting $36,568

Branch Power Distribution & Devices26600

Branch Power - Miscellaneous receptacles and electrical equipment hook up 2,300 SQFT 4.02 9,250

Branch Power - Branch wiring installation 600 V, including 3/4" EMT conduit and

THWN wire, 20A

2,300 SQFT 2.27 5,212

TOTAL: Branch Power Distribution & Devices $14,462

Mechanical Equipment Connections & Feeders26700

Motors connection, disconnect switches and associated feeders 2,300 SQFT 1.00 2,301

TOTAL: Mechanical Equipment Connections & Feeders $2,301

Tele/Data Systems27200

Telecommunication/Data & Television System, complete 2,300 SQFT 5.64 12,965

TOTAL: Tele/Data Systems $12,965

Intercom & Public Address Systems27300

Public Address System, complete 2,300 SQFT 3.01 6,925

TOTAL: Intercom & Public Address Systems $6,925

Audio/Visual & Television System27600

Audio/visual System, rough-in only 2,300 SQFT 1.37 3,141

TOTAL: Audio/Visual & Television System $3,141

Fire Alarm Systems28200

Fire alarm System, complete 2,300 SQFT 2.57 5,911

TOTAL: Fire Alarm Systems $5,911

Intrusion Detection & Access Control Systems28300

Intrusion Detection System, complete 2,300 SQFT 3.77 8,675

TOTAL: Intrusion Detection & Access Control Systems $8,675

$475,714 TOTAL: Inpatient Pharmacy

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