36E77619R0017-033.pdf

PG 18-9 – SPACE PLANNING CRITERIA January 2018

Ch 268: Pharmacy Service

CHAPTER 268: PHARMACY SERVICE

1 PURPOSE AND SCOPE ................................................................................ 268-2

2 DEFINITIONS ................................................................................................. 268-2

3 OPERATING RATIONALE AND BASIS OF CRITERIA ................................. 268-4

4 INPUT DATA QUESTIONS ........................................................................... 268-5

5 SPACE CRITERIA ......................................................................................... 268-7

6 PLANNING AND DESIGN CONSIDERATIONS ........................................... 268-16

7 FUNCTIONAL RELATIONSHIPS ................................................................. 268-19

8 FUNCTIONAL DIAGRAMS ........................................................................... 268-21

1 PURPOSE AND SCOPE

This document outlines Space Planning Criteria for Program Guide (PG) 18-9 Chapter 268: Pharmacy Service. It applies to all Inpatient and Outpatient Pharmacies developed as both new construction and renovation projects for the Department of Veterans Affairs

(VA).

The following VHA Handbooks and Directives have been reviewed as part of the development of this Space Criteria Chapter:

• 1108.01 Controlled Substances (Pharmacy Stock), dated November 16, 2010

• 1108.04 Investigational Drugs and Supplies, dated February 29, 2012

• 1108.05 Outpatient Pharmacy Services, revised August 1, 2016

• 1108.06 Inpatient Pharmacy Services, dated June 27, 2006

• 1108.07 Pharmacy General Requirements, dated April 17, 2008

• 1108.09 Pharmacy Education and Training, dated June 24, 2016

• 1108.11 Clinical Pharmacy Services, dated July 1, 2015

• 0730 Security and Law Enforcement, dated August 11, 2000

• 1047 All-Hazards Emergency Caches, dated December 30, 2014

2 DEFINITIONS

Pharmacy Definitions

A. Active Shelving: Quick-access storage shelving utilized for filling and assembling prescriptions in the Outpatient Pharmacy. Typically stocked with more common, fast-moving drugs, and medication supplies that are not handled by the automated filling robot.

B. All-Hazard Emergency Cache (Pharmacy Cache): A stockpile of pharmaceuticals and medical supplies for use in a disaster situation, to support patient care in the event of a significant incident related to natural disasters, catastrophes, or intentional attack.

C. Automated Dispensing Machine (ADM): Secure cabinets for storage and point-of-care dispensing of pharmaceuticals and supplies as part of a decentralized medication distribution system. Typically located within primary care clinics, nursing units, surgical suites, critical care units, emergency department, and long-term care departments.

Utilizes inventory management and distribution tracking software systems.

D. Automated Storage/Retrieval System (Carousel): Motorized vertical storage carousel for handling and tracking multiple medications within a minimal floor space, significantly reducing the need for static shelving or high-density movable storage units. Utilizes barcode scanning software for inventory management and distribution tracking.

E. Buffer Room: Controlled environment equipped to maintain specific temperature, humidity, and air pressure levels, while minimizing microbial contaminants and airborne particulate counts. High-efficiency particulate air (HEPA) filtration systems remove dust, microbes, particles, and vapors to maintain a specified ISO classification.

F. Compounded Sterile Preparations (CSP): Medications and other components that have been prepared, mixed, and assembled within a sterile environment. Products can include IV injections, eye drops, inhalers, irrigations, and other preparations.

G. Containment Primary Engineering Control (C-PEC): A ventilated device (commonly referred to as a ‘hood’) designed and operated to minimize worker and environmental exposures to hazardous drugs by controlling emissions of airborne contaminants through the use of full or partial enclosures, airflow capture velocities, air pressure relationships, and HEPA filtration.

H. Containment Secondary Engineering Control (C-SEC): Room with fixed walls in which the C-PEC is placed. Incorporates specific design and operational parameters required to contain the potential hazard within the compounding room.

I. Controlled Substances: Drugs and other substances listed in Title 21 Code of Federal Regulations (CFR) Part 1300, schedules I-V, that require additional security and handling measures, based on relative risk of abuse or harm.

J. Hazardous Drugs (HD): Drugs that have been proven to have dangerous effects to humans, requiring special handling/storage procedures, including the use of negative pressure rooms. Effects can include the potential to cause cancer, damage certain organs, or lead to birth defects in pregnant women.

K. Intravenous (IV): Pertaining to medications or solutions that are administered by injection into a vein.

L. Medication Consultation Services: Dedicated space for Clinical Pharmacists to consult with Patients regarding anti-coagulation treatments or medication management issues (i.e. Coumadin Clinic).

M. Oncology: The branch of medicine dealing with the physical, chemical, and biological properties of tumors, including study of their development, diagnosis, treatment, and prevention.

N. Pass-through: An enclosure with interlocking doors that is positioned between two spaces for the purpose of reducing particulate transfer while moving materials from one space to another. A pass-through serving negative pressure rooms needs to be equipped with sealed doors.

O. Primary Engineering Control (PEC): A room or device (commonly referred to as a ‘hood’) that provides an ISO class 5 environment for the exposure of critical sites when compounding sterile preparations, utilizing HEPA filtration and unidirectional airflow.

Some examples include laminar airflow workbenches (LAFW), biological safety cabinets (BSC), compounding aseptic isolators (CAI), and compounding aseptic containment isolators (CACI).

P. Robotics: Automated equipment and systems utilized for prescription filling, unit dose dispensing, medication storage and retrieval, and repackaging operations. Systems can be linked with remote Automated Dispensing Machines (ADM) for comprehensive inventory tracking and management capability.

Q. Satellite Pharmacy: Remote pharmacy space located within another department to support services with high volume or demand for pharmaceutical products, such as Surgical Services or Critical Care Units, or with specific medication needs, such as a Drug Dependency Unit.

R. Unit Dose: A dose of medication prepared in a single unit package, labelled for individual dispensing to patients.

General Definitions

S. Departmental Net to Gross (DNTG) Conversion Factor: A parameter, determined by the VA for each space planning criteria chapter, used to convert the programmed Net Square Foot (NSF) area to the Department Gross Square Foot (DGSF) area. The DNTG Conversion Factor for Pharmacy Service is 1.30.

T. Full-Time Equivalent (FTE): A staffing parameter equal to the amount of time assigned to one full time employee. It may be composed of several part-time employees whose total time commitment equals that of a full-time employee. One FTE equals 40 hours per week.

U. Functional Area (FA): The grouping of rooms and spaces based on their function within a clinical service or department. Typical Functional Areas include Patient Areas, Support Areas, Staff and Administrative Areas, and Education Areas.

V. Input Data Statements: A set of questions designed to elicit information about the healthcare project in order to create a Program for Design (PFD) based on the criteria parameters set forth in this document. Input Data Statements could be Mission related (based in the project’s Concept of Operations), and Workload or Staffing related (based on projections and data provided by the VHA or the VISN about the estimated model of operation). This information is processed through mathematical and logical operations in the VA Space and Equipment Planning system (SEPS).

W. Net Square Feet / Net Square Meters (NSF/NSM): The area of a room or space derived by multiplying measurements of the room or space taken from the inside surface of one wall to the inside surface of the opposite wall.

X. Program for Design (PFD): A project specific document consisting of an itemized listing of the spaces, rooms, and areas required for the proper operation of a specific service/department, and the corresponding net square foot area of each space, room, and area. The PFD is based on criteria set forth in this document and specific information from the Concept of Operations addressing the project’s mission, workload projections, and staffing levels authorized.

Y. SEPS (VA-SEPS): Acronym for Space and Equipment Planning System, a digital tool developed by the Department of Defense (DoD) and the Department of Veterans Affairs to generate a Program for Design (PFD) and an Equipment List for a VA healthcare project based on specific information entered in response to Input Data Questions. VA- SEPS incorporates the propositions set forth in this chapter as well as all chapters in VA’s Program Guide (PG) 18-9 (formerly Handbook 7610). VA-SEPS has been designed to aid healthcare planners in creating a space plan based on a standardized set of criteria parameters.

3 OPERATING RATIONALE AND BASIS OF CRITERIA

A. Workload Projections for specific VA Pharmacy projects are provided by the VA Central Office (VACO). The workload projections are generated by methodology based upon the expected veteran population in the respective market / service area.

Healthcare planners working on VA Medical Center, Hospital, or Satellite Outpatient Clinic projects will utilize and apply the workload criteria set forth herein for identified services and modalities to determine room requirements for each facility.

B. Space planning criteria have been developed on the basis of an understanding of the activities involved in the functional areas of the Pharmacy Service and its relationship with other services of a medical facility. These criteria are predicated on established and/or anticipated best practice standards, as adapted to provide environments supporting the highest quality health care for Veterans.

C. These criteria are subject to modification relative to development in the equipment, medical practice, vendor requirements, and subsequent planning and design. The selection of the size and type of the Pharmacy Service equipment is determined by VACO and upon Veterans Health Administration (VHA) anticipated medical needs.

4 INPUT DATA STATEMENTS

A. Input Data Statements

1. Is an Outpatient Pharmacy authorized? (M)

1.1. Is a combined Dispense/Consult Window configuration authorized? (M)

1.1.1. How many combined Dispense/Consult windows are authorized? (Misc)

1.2. Is a separate Dispensing and Consult Window configuration authorized? (M)

1.2.1. How many individual Dispensing windows are authorized? (Misc)

1.2.2. How many individual Consult windows are authorized? (Misc)

1.3. How many authorized Outpatient Filling/Assembly Pharmacist FTE at peak shift? (S)

1.4. How many authorized Outpatient Filling/Assembly Technician FTE at peak shift?

(S)

1.5. Is an automated filling robot authorized? (M)

1.6. How many authorized Outpatient Processing Pharmacist FTE at peak shift? (S)

1.7. How many authorized Outpatient Secured Dispensing Pharmacist FTE at peak shift? (S)

1.8. How many authorized Outpatient Secured Dispensing Technician FTE at peak shift? (S)

1.9. Is a Discharge Pharmacist service authorized? (M)

1.9.1. How many authorized Outpatient Discharge Pharmacist FTE at peak shift? (S)

1.10. Is an Outpatient Pharmacy Call Center authorized? (M)

1.10.1. How many authorized Outpatient Pharmacy Call Center Technician FTE at peak shift? (S)

1.11. How many authorized Outpatient Procurement Technician FTE at peak shift?

(S)

1.12. How many authorized Outpatient Pharmacy Supervisor FTE? (S)

1.13. Is an Outpatient Pharmacy Conference Room authorized? (Misc)

1.14. How many total authorized Outpatient Pharmacy FTE at peak shift? (S)

2. Is an Inpatient Pharmacy authorized? (M)

2.1. How many authorized Inpatient Filling/Assembly Technician FTE at peak shift?

(S)

2.2. How many authorized Inpatient Processing Pharmacist FTE at peak shift? (S)

2.3. How many Inpatient controlled substance secured storage safes are authorized?

(Misc)

2.4. Is the use of remote Automated Dispensing Machines authorized? (M)

2.5. Is the use of an Inpatient Automated Storage and Retrieval Carousel system authorized? (M)

2.5.1. How many individual Carousel units are authorized? (Misc)

2.6. How many unit-dose repackaging machines are authorized? (Misc)

2.7. Is an Inpatient Pharmacy Sterile Preparation Area authorized? (M)

2.7.1. How many non-hazardous drug PEC’s are authorized? (Misc)

2.8. Is Sterile Hazardous Drug Compounding authorized? (M)

2.8.1. How many hazardous drug C-PEC’s are authorized? (Misc)

2.9. How many authorized Inpatient Procurement Technician FTE at peak shift? (S)

2.10. Is the use of a pneumatic tube distribution system authorized? (M)

2.11. How many authorized Inpatient Pharmacy Supervisor FTE? (S)

2.12. Is an Inpatient Pharmacy Conference Room authorized? (M)

2.13. How many total authorized Inpatient Pharmacy FTE at peak shift? (S)

3. Is an Investigational Drug Service authorized? (M)

3.1. How many authorized Research Pharmacist FTE at peak shift? (S)

3.2. How many authorized Research Technician FTE at peak shift? (S)

4. Is a Medication Consultation Service authorized? (M)

4.1. How many authorized Medication Consultation Clinical Pharmacist FTE at peak shift? (S)

4.2. Is a Medication Consultation Tele-Pharmacy authorized? (M)

4.2.1. How many authorized Tele-Pharmacy Technician FTE at peak shift? (S)

5. Is a Pharmacy Service Administration area authorized? (M)

5.1. How many Associate/Assistant Chief FTE positions are authorized? (S)

5.2. How many Administrative Officer FTE positions are authorized? (S)

5.3. How many Program Support Assistant FTE positions are authorized? (S)

5.4. How many Clinical Pharmacy Supervisor FTE positions are authorized? (S)

5.5. How many Quality Management Pharmacist FTE positions are authorized? (S)

5.6. How many Informatics Pharmacist FTE positions are authorized? (S)

5.7. How many Pharmacoeconomist FTE positions are authorized? (S)

5.8. How many Pharmacy Service Clerical Support FTE positions are authorized?

(S)

5.9. Is a Pharmacy Service Administration Conference Room authorized? (M)

6. Is a Pharmacy Education Program authorized? (M)

6.1. How many authorized Intern FTE at peak shift? (S)

6.2. How many authorized Student FTE at peak shift? (S)

6.3. Is a Resident Program authorized? (M)

6.3.1. How many authorized Resident FTE at peak shift? (S)

7. Is an All-Hazard Emergency Response area authorized? (M)

5 SPACE CRITERIA

A. FA 1: OUTPATIENT PHARMACY PUBLIC AREA:

1. Waiting, General (WTG11) ........................................................ 240 NSF (22.3 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional 80 NSF for each [How many combined Dispense/Consult windows are authorized?] + [How many individual Dispensing windows are authorized?] + [How many individual Consult windows are authorized?] greater than three.

2. Toilet, Public (TNPG1) .................................................................. 60 NSF (5.6 NSM)

a. Provide two if [Is an Outpatient Pharmacy authorized?]

B. FA 2: OUTPATIENT PHARMACY WORK AREA:

1. Dispense / Consult Window (PHOW2) .................................... 500 NSF (46.5 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?] and [Is a combined Dispense/Consult Window configuration authorized?]

b. Provide an additional 100 NSF for each [How many combined Dispense/Consult windows are authorized?] greater than three.

Work area with secure transaction windows / pass-throughs for dispensing medication to patients, and for conducting general (non-confidential) consults with Pharmacists.

2. Dispensing Window (PHOW3) ................................................. 260 NSF (24.2 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?] and [Is a separate Dispensing and Consult Window configuration authorized?] and not [Is a combined Dispense/Consult Window configuration authorized?]

b. Provide an additional 100 NSF for each [How many individual Dispensing windows are authorized?] greater than one

Secure transaction window with pass-thru for dispensing medication to patients; not intended for patient consults.

3. Consult Window (PHOC1) ............................................................ 80 NSF (7.4 NSM)

a. Provide two if [Is an Outpatient Pharmacy authorized?] and [Is a separate Dispensing and Consult Window configuration authorized?] and not [Is a combined Dispense/Consult Window configuration authorized?]

b. Provide an additional one for each [How many individual Consult windows are authorized?] greater than two

Semi-private station located outside of secure Pharmacy perimeter for general (non-confidential) patient consults with Pharmacists; not intended for medication distribution; open configuration with no window or pass-through between patient and Pharmacist.

4. Consult Room, Pharmacy (PHOC2) ......................................... 120 NSF (11.2 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

Private space for confidential patient consults with Pharmacists.

5. Filling & Assembly Area, Outpatient (PHOF1) ........................ 800 NSF (74.3 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional 140 NSF for each [How many authorized Outpatient

Filling/Assembly Pharmacist FTE at peak shift?] + [How many authorized Outpatient Filling/Assembly Technician FTE at peak shift?] greater than four

Pharmacist / Technician work stations, and active shelving for storage of medications and prepackaged items required for filling of prescriptions.

6. Automated Filling / Storage, Outpatient (PHOF2) ................... 360 NSF (33.4 NSM)

a. Provide one if [Is an automated filling robot authorized?]

Space for automated filling robot, and for storage of bulk medications and supplies.

7. Processing Area, Outpatient (PHPA1) ......................................... 56 NSF (5.2 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional one for each [How many authorized Outpatient Processing

Pharmacist FTE at peak shift?] greater than one

Pharmacist workstation for initial receiving and validation of prescriptions, and for conducting phone consultations with providers. Can also accommodate Community Care coordination.

8. Secured Dispensing & Storage, Outpatient (PHOS1) ............. 380 NSF (35.3 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional 60 NSF for each [How many authorized Outpatient Secured

Dispensing Pharmacist FTE at peak shift?] + [How many authorized Outpatient Secured Dispensing Technician FTE at peak shift?] greater than three (maximum

500 NSF)

Restricted access work area for storing / processing narcotics and controlled substances. Includes space for packaging and holding mail-out prescriptions, handling returned mail, and for expired drug collection / disposal.

9. Mail Out Area (PHOM1) ............................................................... 100 NSF (9.3 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

Work space for packaging and shipping of filled prescriptions, and for processing returned mail.

10. Expired Drug Collection and Disposal (PHED1) ......................... 30 NSF (2.8 NSM)

Secured collection bins for expired / waste medications for return or disposal.

11. Discharge Pharmacist (PHDP1) ................................................... 56 NSF (5.2 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?] and [Is a Discharge Pharmacist service authorized?]

b. Provide an additional one for each [How many authorized Outpatient Discharge Pharmacist FTE at peak shift?] greater than one

Work area for provider coordination and processing of medications prior to patient being released from inpatient / emergency care.

12. Work Station, Call Center (PHCC1).............................................. 56 NSF (5.2 NSM)

a. Provide two if [Is an Outpatient Pharmacy authorized?] and [Is an Outpatient Pharmacy Call Center authorized?]

b. Provide an additional one for each [How many authorized Outpatient Pharmacy Call Center Technician FTE at peak shift?] greater than two

Space for Pharmacy Technicians to conduct phone consults with patients.

C. FA 3: OUTPATIENT PHARMACY SUPPORT AREA:

1. Inventory Receiving & Breakdown (PHRB1) ........................... 400 NSF (37.2 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

Space for receiving, verification, and breakdown of deliveries.

2. Workstation, Procurement (PHWP1) ........................................... 56 NSF (5.2 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional one for each [How many authorized Outpatient

Procurement Technician FTE at peak shift?] greater than one

Workstation for inventory control / stock management staff.

3. Storage, Prosthetics & Supplies (SRCS1) ................................. 100 NSF (9.3 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional 100 NSF if [How many authorized Outpatient

Filling/Assembly Pharmacist FTE at peak shift?] + [How many authorized Outpatient Filling/Assembly Technician FTE at peak shift?] is greater than six.

Storage for non-medicinal or bulky items and supplies required for filling of prescriptions.

D. FA 4: OUTPATIENT PHARMACY STAFF AND ADMINISTRATIVE AREA:

1. Office, Outpatient Supervisor (OFA09) ..................................... 100 NSF (9.3 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional one for each [How many authorized Outpatient Pharmacy

Supervisor FTE?] greater than one

2. Conference Room (CFR01) ...................................................... 240 NSF (22.3 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?] and [Is an Outpatient Pharmacy Conference Room authorized?]

3. Lounge, Staff (SSLG1) .............................................................. 140 NSF (13.0 NSM)

b. Provide an additional 15 NSF for each [How many total authorized Outpatient

Pharmacy FTE at peak shift?] greater than eight (maximum 260 NSF)

4. Lockers, Staff (LR001) .................................................................. 30 NSF (2.8 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional 8 NSF for every two [How many total authorized Outpatient

Pharmacy FTE at peak shift?] – [How many authorized Outpatient Pharmacy Supervisor FTE?] greater than eight

5. Toilet, Staff (TNPG1) ..................................................................... 60 NSF (5.6 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

b. Provide an additional one if [How many total authorized Outpatient Pharmacy

FTE at peak shift?] is greater than ten

6. Housekeeping Aides Closet (HAC) (JANC1) ............................... 60 NSF (5.6 NSM)

a. Provide one if [Is an Outpatient Pharmacy authorized?]

E. FA 5: INPATIENT PHARMACY WORK AREA:

1. Filling & Assembly Area, Inpatient (PHIF1) ............................. 540 NSF (50.2 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional 100 NSF for each [How many authorized Inpatient

Filling/Assembly Technician FTE at peak shift?] greater than four

Pharmacy Tech work area with access to carousel or shelving for filling orders and assembling medications for ADM restock.

2. Processing Area, Inpatient (PHPA1) ............................................ 56 NSF (5.2 NSM)

a. Provide two if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional one for each [How many authorized Inpatient Processing

Pharmacist FTE at peak shift?] greater than two

Pharmacist workstation for initial receiving/validation of medication orders and conducting phone consultations with providers.

3. Secured Dispensing & Storage, Inpatient (PHIS1) ................. 280 NSF (26.0 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional 60 NSF for each [How many Inpatient controlled substance secured storage safes are authorized?] greater than two (maximum 500 NSF)

Work area with secured access safes for storing and processing narcotics and controlled substances.

4. Work Area, ADM Management (PHAD1) ...................................... 56 NSF (5.2 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is the use of remote Automated Dispensing Machines authorized?]

Work area for management and oversight of remote automated dispensing machines.

5. Filling & Assembly Shelving, Inpatient (SRS01) ..................... 420 NSF (39.0 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and not [Is the use of an Inpatient Automated Storage and Retrieval Carousel system authorized?]

b. Provide an additional 100 NSF for each [How many authorized Inpatient Filling/Assembly Technician FTE at peak shift?] greater than four

Active shelving for storage of drugs and medication supplies required for filling orders; use when a facility does not incorporate a carousel storage and retrieval system.

6. Filling & Assembly Carousel, Inpatient (PHIF2) ...................... 280 NSF (26.0 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is the use of an Inpatient Automated Storage and Retrieval Carousel system authorized?]

b. Provide an additional 140 NSF for each [How many individual Carousel units are authorized?] greater than two

Automated storage and retrieval system for drugs and medication supplies required for filling orders. Space includes static shelving for overstock or bulky items that are not compatible with the carousel bins.

7. Repackaging Area (PHIR1) ....................................................... 400 NSF (37.2 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional 140 NSF if [How many unit-dose repackaging machines are authorized?] is greater than two

Work area and equipment for processing bulk medications into individual unit doses.

8. Expired Drug Collection & Disposal (PHED1) ............................. 30 NSF (2.8 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

Secured collection bins for expired / waste medications for return or disposal.

9. Restock Area, Crash Cart (PHRA1) ............................................. 40 NSF (3.7 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

Work space and storage area for crash cart replenishment and maintenance operations.

10. Non-Sterile Compounding (PHNS1) ............................................ 40 NSF (3.7 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

Work area for conducting Category 1 – non-sterile / simple compounding activities.

F. FA 6: INPATIENT PHARMACY STERILE PREPARATION AREA:

1. Sterile Non-Hazardous Drug Buffer Room (PHSC1) ............... 360 NSF (33.4 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is an Inpatient Pharmacy Sterile Preparation Area authorized?]

b. Provide an additional 120 NSF for each [How many non-hazardous drug PEC’s are authorized?] greater than three

Positive pressure buffer area / clean room for mixing, transferring, and assembling components of non-hazardous drug compounded sterile preparations.

2. Sterile Hazardous Drug Buffer Room (C-SEC) (PHHD1) ........ 360 NSF (33.4 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is Sterile Hazardous Drug Compounding authorized?]

b. Provide an additional 120 NSF for each [How many hazardous drug C-PEC’s are authorized?] greater than three

Negative pressure buffer area / clean room for mixing, transferring, and assembling components of hazardous drug compounded sterile preparations.

3. Storage, Sterile Compounding (PHSC2) ................................. 300 NSF (27.9 NSM)

a. Provide one for each [Sterile Non-Hazardous Drug Buffer Room (PHSC1)]

b. Provide an additional 100 NSF for each [How many non-hazardous drug PEC’s are authorized?] greater than three

Storage for sterile fluid bags and IV admixture materials and supplies.

4. Storage, Hazardous Drug (PHHD2) .......................................... 150 NSF (13.9 NSM)

a. Provide one for each [Sterile Hazardous Drug Buffer Room (C-SEC) (PHHD1)]

b. Provide an additional 40 NSF for each [How many hazardous drug C-PEC’s are authorized?] greater than three

Negative pressure space for unpacking and storage of hazardous drugs; connect by pass-through to the Sterile Hazardous Drug Buffer Room.

5. Work Area, Sterile Compounding (PHSC3) ................................. 56 NSF (5.2 NSM)

a. Provide one for each [Sterile Non-Hazardous Drug Buffer Room (PHSC1)] + [Sterile Hazardous Drug Buffer Room (C-SEC) (PHHD1)]

Non-sterile work area adjacent to Buffer Rooms and connected with a pass-through;

for support of both hazardous and non-hazardous compounded sterile preparation activities.

6. Anteroom, Sterile Compounding (PHAR1) .............................. 300 NSF (27.9 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is an Inpatient Pharmacy Sterile Preparation Area authorized?]

Transition area from non-sterile to positive or negative pressure buffer area; for scrubbing and garbing prior to entering Buffer Rooms.

7. Housekeeping, Sterile Compounding (PHJC1) ........................... 15 NSF (1.4 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is an Inpatient Pharmacy Sterile Preparation Area authorized?]

For storage of disposable cleaning supplies specifically for use in Sterile Compounding areas. Accessed through Sterile Compounding Anteroom, separate from general Pharmacy housekeeping supplies.

G. FA 7: INPATIENT PHARMACY SUPPORT AREA:

1. Inventory Receiving & Breakdown (PHRB1) ........................... 400 NSF (37.2 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

Space for receiving, verification, and breakdown of deliveries.

2. Workstation, Procurement (PHWP1) ........................................... 56 NSF (5.2 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional one for each [How many authorized Inpatient Procurement

Technician FTE at peak shift?] greater than one

Workstation for inventory control / stock management staff.

3. Pneumatic Tube Station (NT001) ................................................. 30 NSF (2.8 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is the use of a pneumatic tube distribution system authorized?]

Access station for connection to the facility pneumatic tube distribution system.

H. FA 8: INPATIENT PHARMACY STAFF AND ADMINISTRATIVE AREA:

1. Office, Inpatient Supervisor (OFA09) ........................................ 100 NSF (9.3 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional one for each [How many authorized Inpatient Pharmacy

Supervisor FTE?] greater than one

2. Conference Room (CFR01) ...................................................... 240 NSF (22.3 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?] and [Is an Inpatient Pharmacy Conference Room authorized?]

3. Lounge, Staff (SSLG1) .............................................................. 140 NSF (13.0 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional 15 NSF for each [How many total authorized Inpatient

Pharmacy FTE at peak shift?] greater than eight (maximum 260 NSF)

4. Lockers, Staff (LR001) .................................................................. 30 NSF (2.8 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional 8 NSF for every two [How many total authorized Inpatient

Pharmacy FTE at peak shift?] – [How many authorized Inpatient Pharmacy Supervisor FTE?] greater than eight

5. Toilet, Staff (TNPG1) ..................................................................... 60 NSF (5.6 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

b. Provide an additional one if [How many total authorized Inpatient Pharmacy FTE at peak shift?] is greater than ten

6. Housekeeping Aides Closet (HAC) (JANC1) ............................... 60 NSF (5.6 NSM)

a. Provide one if [Is an Inpatient Pharmacy authorized?]

I. FA 9: INVESTIGATIONAL DRUG SERVICES (IDS):

1. Work Room, IDS (PHID1) .......................................................... 300 NSF (27.9 NSM)

a. Provide one if [Is an Investigational Drug Service authorized?]

b. Provide an additional 60 NSF for each [How many authorized Research

Pharmacist FTE at peak shift?] + [How many authorized Research Technician FTE at peak shift?] greater than two

Work space for conducting investigational drug studies, including space for securable filing cabinets and refrigerator.

2. Storage, IDS Records (PHID2) ..................................................... 80 NSF (7.4 NSM)

a. Provide one if [Is an Investigational Drug Service authorized?]

b. Provide an additional 80 NSF if [How many authorized Research Pharmacist

FTE at peak shift?] + [How many authorized Research Technician FTE at peak shift?] is greater than five

J. FA 10: MEDICATION CONSULTATION SERVICES:

Dedicated space for Clinical Pharmacists to consult with Patients regarding anti-coagulation treatments or medication management issues (i.e. Coumadin Clinic).

1. Reception (RCP01) ....................................................................... 85 NSF (7.9 NSM)

a. Provide one if [Is a Medication Consultation Service authorized?]

2. Waiting Area (WTG03) .................................................................. 80 NSF (7.4 NSM)

a. Provide one if [Is a Medication Consultation Service authorized?]

b. Provide an additional 80 NSF for each [Office, Consult (OFA09)] greater than one

3. Office, Consult (OFA09) ............................................................. 100 NSF (9.3 NSM)

a. Provide one if [Is a Medication Consultation Service authorized?]

b. Provide an additional one for each [How many authorized Medication

Consultation Clinical Pharmacist FTE at peak shift?] greater than one

4. Work Station, Tele-Pharmacy (OFA07) ........................................ 56 NSF (5.2 NSM)

a. Provide two if [Is a Medication Consultation Service authorized?] and [Is a Medication Consultation Tele-Pharmacy authorized?]

b. Provide an additional one for each [How many authorized Tele-Pharmacy Technician FTE at peak shift?] greater than two

Space for Clinical Pharmacists to conduct phone consults with patients.

K. FA 11: PHARMACY SERVICE STAFF AND ADMINISTRATIVE AREA:

1. Office, Pharmacy Chief (OFA09) ................................................ 100 NSF (9.3 NSM)

a. Provide one if [Is a Pharmacy Service Administration area authorized?]

2. Office, Associate / Assistant Chief (OFA09) ............................. 100 NSF (9.3 NSM)

a. Provide one for each [How many Associate/Assistant Chief FTE positions are authorized?]

3. Admin. Assistant / Waiting Area (SEC01) ............................... 120 NSF (11.2 NSM)

a. Provide one if [Is a Pharmacy Service Administration area authorized?]

4. Office, Administrative Officer (OFA09) ...................................... 100 NSF (9.3 NSM)

a. Provide one for each [How many Administrative Officer FTE positions are authorized?]

5. Workstation, Program Support Assistant (OFA07) .................... 56 NSF (5.2 NSM)

a. Provide one for each [How many Program Support Assistant FTE positions are authorized?]

6. Office, Clinical Pharmacy Supervisor (OFA09) ......................... 100 NSF (9.3 NSM)

a. Provide one for each [How many Clinical Pharmacy Supervisor FTE positions are authorized?]

7. Office, Quality Management Pharmacist (OFA09) .................... 100 NSF (9.3 NSM)

a. Provide one for each [How many Quality Management Pharmacist FTE positions are authorized?]

8. Office, Informatics Pharmacist (OFA09).................................... 100 NSF (9.3 NSM)

a. Provide one for each [How many Informatics Pharmacist FTE positions are authorized?]

9. Office, Pharmacoeconomist (OFA09) ........................................ 100 NSF (9.3 NSM)

a. Provide one for each [How many Pharmacoeconomist FTE positions are authorized?]

10. Workstation, Clerical (OFA07) ..................................................... 56 NSF (5.2 NSM)

a. Provide one for each [How many Pharmacy Service Clerical Support FTE positions are authorized?]

11. Conference Room (CFR01) ...................................................... 240 NSF (22.3 NSM)

a. Provide one if [Is a Pharmacy Service Administration Conference Room authorized?]

12. Alcove, Refreshment Center (NCWD4) ........................................ 60 NSF (5.6 NSM)

a. Provide one if [Is a Pharmacy Service Administration area authorized?]

13. Toilet, Staff (TNPG1) ..................................................................... 60 NSF (5.6 NSM)

a. Provide one if [Is a Pharmacy Service Administration area authorized?]

14. Server Room (CMP02) ................................................................ 100 NSF (9.3 NSM)

a. Provide one if [Is a Pharmacy Service Administration area authorized?]

15. Copy/Admin. Storage (RPR01) ................................................. 120 NSF (11.2 NSM)

a. Provide one if [Is a Pharmacy Service Administration area authorized?]

L. FA 12: PHARMACY EDUCATION AREA:

1. Workstation, Clinical Pharmacy Teaching Coordinator (OFA07) .................................................... 56 NSF (5.2 NSM)

a. Provide one if [Is a Pharmacy Education Program authorized?]

2. Workstation, Intern / Student (OFA07) ........................................ 56 NSF (5.2 NSM)

a. Provide one for each [How many authorized Intern FTE at peak shift?] + [How many authorized Student FTE at peak shift]

3. Workroom, Resident (WKTM1) ................................................ 240 NSF (22.3 NSM)

a. Provide one if [Is a Resident Program authorized?]

b. Provide an additional 56 NSF for each [How many authorized Resident FTE at peak shift] greater than four (maximum 480 NSF)

M. FA 13: ALL-HAZARD EMERGENCY CACHE:

1. Pharmacy Cache (PHCH1) .................................................. 2,000 NSF (185.9 NSM)

a. Provide one if [Is an All-Hazard Emergency Response area authorized?]

Secured storage space for emergency medical supplies and pharmaceuticals. Actual NSF required for pharmaceutical portion of storage may vary by project - to be determined during planning process.

6 PLANNING AND DESIGN CONSIDERATIONS

A. For additional planning and design criteria, refer to the Department of Veterans Affairs (VA) Office of Construction & Facilities Management (CFM) Handbooks, Standards, Details, and Design Guides.

B. Departmental Net-to-Gross factor (DNTG) for Pharmacy Service is 1.30. This number when multiplied by the programmed net square foot (NSF) area determines the departmental gross square feet (DGSF).

C. While there are several core commonalities between Inpatient and Outpatient Pharmacy functions, there are also some fundamental differences regarding adjacency requirements, operational organization, and general work flow. As such, Inpatient and Outpatient Pharmacy services on a Medical Center campus are typically accommodated with one of three general configurations:

1. IP and OP pharmacies are completely separate, located in different parts of a building, or in different buildings altogether, with no physical connection between the spaces, and minimal or no shared support functions.

2. IP and OP pharmacies are located adjacent to one another, either vertically or horizontally. They still function as distinct services, but with the potential for sharing of some support functions.

3. IP and OP pharmacies are co-located within a contiguous building footprint or department perimeter. Operationally they still function as distinct services, but with increased potential for staff crossover and shared support functions.

D. Considerations for the location of the Outpatient Pharmacy should include spaces with broad visibility, ease of public access, and ability to support ambulatory care services, potentially near the main facility entrance or other high-traffic public amenities.

E. Inpatient Pharmacy does not require public access, but should be located to provide support for Surgical Suites, Critical Care Units, Emergency Department, and all Nursing Units. The need for direct adjacency is reduced by the implementation and distribution of automated dispensing machines (ADM), as well as utilization of a pneumatic tube distribution system. If a facility does not include a pneumatic tube, physical adjacency between the Inpatient Pharmacy, Emergency Department, and Surgical Suites becomes more significant.

F. Depending upon the departmental organization or physical space available within a facility, the Pharmacy Service Administration offices can be located adjacent to either the Inpatient or Outpatient Pharmacy, or can be in a separate location.

G. Refer to VA Directive 0730 Security and Law Enforcement for specific Pharmacy security considerations, including general department perimeter construction, dispensing window criteria, controlled substance storage, physical and electronic access control, and video monitoring requirements.

H. The Pharmacy Cache portion of the All Hazard Emergency Cache can be stored outside of the Pharmacy department perimeter, either incorporated into Logistics warehouse space, or another secured storage area with proper security/access control, and which is readily accessible in the event that cache activation is required.

The listed area of 2,000 NSF is a ‘placeholder’ value which can be adjusted for each individual project, based on the specific needs of the Facility.

I. Discharge Pharmacist functions are typically handled through the Outpatient Pharmacy, then transfer over to Inpatient Pharmacy staff for after-hours or weekend coverage.

J. Medication dispensing at the Outpatient Pharmacy must be conducted through a secure transaction window. This window can also be used for conducting general consults, while private consults can take place within the dedicated Consult Room.

If the Pharmacy prefers to conduct general consults face to face, with no barrier between the patient and Pharmacist, separate dedicated consult windows should be established just outside of the secure Pharmacy perimeter.

K. Use of a conveyor system between the Automated Filling Robot and the workstations in the Outpatient Filling and Assembly area may not have a significant impact on the quantity of space needed, but will greatly influence the configuration of that space, including general workflow and circulation patterns throughout the department. See PG 18-12 Pharmacy Services Design Guide for additional detail.

L. Medication Consultation Services (Coumadin / anti-coagulation / medication management) involve direct patient interaction, and are conducted outside of the secure Pharmacy perimeter. They can be adjacent to the Outpatient Pharmacy, or located closer to the ambulatory care clinic if space is available.

M. As an alternative to standard high-density movable storage shelving, the use of a carousel or automated storage and retrieval system can allow for significantly reduced square footage requirements, while also providing inventory management and tracking capabilities. Equipment costs should be weighed against the savings from reduced building area needs. Available space between the floor level of the Pharmacy and the underside of the roof/floor structure above can be a limiting factor, as growth in carousel capacity is primarily in the vertical direction. Increased structural floor loads must also be considered. Typical functions that benefit from carousel utilization are Inpatient Filling and Assembly areas, as well as bulk medication storage specifically for support of automated filling robots or repackaging processes.

N. Facilities that serve a significant Oncology mission may consider establishing a satellite location for a dedicated chemotherapy sterile compounding suite.

O. Departments or services requiring increased or specific medication needs can incorporate a Satellite Pharmacy location. The spaces dedicated to those functions are typically planned as part of the host department, not as part of Pharmacy Service. Refer to the PG 18-9 chapter for that specific service for additional information.

P. Facilities that may be performing frequent non-sterile hazardous drug compounding activities may consider including a dedicated containment hood directly within the Hazardous Drug Storage Room.

Q. The default Sterile Compounding Anteroom is sized to accommodate scrubbing/garbing activities, as well as access to two Buffer Rooms, a Hazardous Drug Storage Room, and the Sterile Compounding Housekeeping Closet. If the number of Buffer Rooms increases or decreases, the Anteroom size should be adjusted accordingly.

7 FUNCTIONAL RELATIONSHIPS

Relationship of Pharmacy Service to services listed below:

TABLE 1: OUTPATIENT PHARMACY FUNCTIONAL RELATIONSHIP MATRIX

SERVICES RELATIONSHIP REASON

Inpatient Pharmacy 1,2,3 A,B,J

Pharmacy Service Administration 1,2,3 A,I

Ambulatory Care 2 H,I

Canteen Service 2,3 H

Critical Care Unit 3 A

Drug Dependency Unit 2,3 A

Emergency Department 2 A,C,H

Laboratory 3 H

Logistics - Warehouse 2,3 A,B,J

Main Entrance - Lobby 1,2 H,I

Medication Consultation Services 2,3 A,G,H,I

Nutrition/Food Service 7

Patient Care Units - All 3 I

Prosthetics and Sensory Aids 3 A,B,H

Surgical Services 7

Legend:

Relationship:

1. Adjacent

2. Close / Same Floor

3. Close / Different Floor Acceptable

4. Satellite Location

5. Pneumatic Tube

6. Automatic Dispensing Machine

7. Limited Traffic

8. Separation Desirable

Reasons:

A. Common use of resources B. Accessibility of supplies C. Urgency of contact D. Noise or vibration E. Presence of odors or fumes F. Contamination hazard G. Sequence of work H. Patient convenience I. Frequent contact J. Need for security K. Closeness inappropriate

TABLE 2: INPATIENT PHARMACY FUNCTIONAL RELATIONSHIP MATRIX

SERVICES RELATIONSHIP REASON

Outpatient Pharmacy 1,2,3 A,B,J

Pharmacy Service Administration 1,2,3 A,I

Ambulatory Care 3,6 A,I

Canteen Service 7

Critical Care Unit 2,3,4,5,6 A,B,C

Drug Dependency Unit 2,3,4 A,I

Emergency Department 1,2,3,5,6 A,B,C

Laboratory 7

Logistics - Warehouse 2,3 A,B,J

Main Entrance - Lobby 7

Medication Consultation Services 3 A

Nutrition/Food Service 3 A

Patient Care Units - All 2,3,5,6 A,B,I

Prosthetics and Sensory Aids 3 A,B

Surgical Services 2,3,4,5,6 A,B,C

Legend:

Relationship:

1. Adjacent

2. Close / Same Floor

3. Close / Different Floor Acceptable

4. Satellite Location

5. Pneumatic Tube

6. Automatic Dispensing Machine

7. Limited Traffic

8. Separation Desirable

Reasons:

A. Common use of resources B. Accessibility of supplies C. Urgency of contact D. Noise or vibration E. Presence of odors or fumes F. Contamination hazard G. Sequence of work H. Patient convenience I. Frequent contact J. Need for security K. Closeness inappropriate

8 FUNCTIONAL DIAGRAMS

A. Outpatient Pharmacy

B. Inpatient Pharmacy