Malmstrom pharmacy keeps missile force, community healthy

  • Published
  • By John Turner
  • 341st Missile Wing Public Affairs
MALMSTROM AIR FORCE BASE, Mont. --  It is 9 a.m. on a Tuesday and the pharmacy is already bustling with activity. A steady line of customers are queuing at the service windows to receive their medications. Scanners beep as technicians quickly fill and label vials of pills, package them in brown paper bags, and ready them to be sent out. Telephones are ringing steadily.

Located near the main entrance to the Malmstrom Air Force Base Clinic, the pharmacy serves upwards of 13,000 beneficiaries including active-duty members, their dependents and retirees. It also manages pharmaceuticals for doctors, physicians and nurses within the clinic.

"We fulfill the promise of keeping pharmacy services at a low cost to beneficiaries," said Capt. Arnaldo Figueroa, 341st Medical Support Squadron pharmacy flight commander.

To achieve this, the pharmacy is budgeted up to $3.9 million annually, the largest budget within the 341st Medical Group, yet is considered a small pharmacy. The staff has two pharmacists--Figueroa and Capt. Julie Carpenter--and six pharmacy technicians, three of whom are civilians.

Their primary mission is to keep Airmen who work in the nuclear enterprise healthy so they can stay on task, and to care for families while Airmen are away on duty in the missile complex, Figueroa said.

"It's our job to look out for those guys," he said. "If they get sick and come see the doctor, we give them medication so they get better and can go back to work."

The pharmacy fills between 7,800 and 9,500 prescriptions monthly. This works out to approximately 400 orders a day, although demands fluctuate throughout the year. Prescription refills--usually between 100 and 200 orders each day--account for much of the workload. On this particular morning, technicians will process 215 refills before noon.

"Sometimes it feels hectic after the holidays or a long weekend," said Tech. Sgt. Shontell Nelson, 341st MDSS pharmacy flight chief. "Other than that, we have a pretty steady flow."

Technicians need to have good people skills for this job, she said.

"We interact a lot with people, whether it is in person or on the phone," Nelson said. "You have to be a people person."

The workload is eased by an automated dispenser that fills bottles with the correct number of pills from pre-loaded cells, thereby saving time from hand counting, and by a new controlled substances vault installed in October that perpetually inventories stock as it is dispensed and replaced. Additionally, an automated cabinet is projected to arrive soon that files completed orders in baskets and guides technicians directly to the correct one via blinking lights and sounds.

"It's built for safety," Figueroa said, explaining that the cabinet prevents giving out the wrong medications to a customer.

In total, the pharmacy currently stocks approximately 400 different medications in its formulary, and the inventory is expanded as space allows. If the pharmacy does not have a medication in stock, the staff will refer patients to a mail-order pharmacy where the items are available at a low cost.

"We have the responsibility to ensure that pharmaceuticals are administered directly, effectively and safely," Figueroa said. This includes watching out for signs of drug misuse or abuse.

The pharmacists also provide limited clinical services. Figueroa and Carpenter manage anti-coagulant therapy for patients who, for example, are at risk for a stroke. They also manage medication therapy, including gum and patches, for the 341st MDG's tobacco cessation program.

"My favorite part (of the job) is talking to the patients and explaining their therapies to them and what they can expect," said Carpenter.

In addition to conferring with doctors and patients, Carpenter is responsible for helping monitor the business of the pharmacy including spending and best practices. She also suggests items that can be added to the formulary to better serve the Malmstrom community.

Because the pharmacy is so busy, workers there are given a lot of responsibility. That doesn't mean that there aren't checks and balances for ensuring inventory isn't lost.

The vault custodian is responsible for conducting daily inventories and resolving any discrepancies. Figueroa then verifies the inventory and signs off on it. In addition, a monthly inventory is conducted by a disinterested party from outside the pharmacy who is appointed by the 341st MDG commander.

"We trust that everybody will do the right thing and not take a tablet, put it in their pocket and walk home," Figueroa said. "But we also have a way to determine that everything is being done correctly, that there are no discrepancies in the system, and if there is a discrepancy, that discrepancy is solved in a timely manner.

"To work in the pharmacy, you have to have a high level of integrity," he said.