CHPPC Module 26, Section 2: Batching Tactics
MODULE 26: QUEUE COMMAND: TIME-TRIAGE FOR VERIFICATION UNDER FIRE

Section 26.2: Batching Tactics: Similar Orders, Same Med/Concentration, Unit Runs

From Serial Processing to Parallel Power: The Art of Efficient Workflow in the Verification Queue.

SECTION 26.2

Batching Tactics

Learning the high-performance techniques that elite pharmacists use to manage volume, reduce errors, and stay sane.

26.2.1 The “Why”: Defeating the Enemy of Efficiency

After you have triaged your queue and cleared the immediate life-threats (the STATs and high-risk orders), you are left with the core of your workload: a large, amorphous blob of routine orders. The amateur approach is to simply work from top to bottom. The professional approach is to work smarter, not harder. The single greatest enemy of efficiency and safety in knowledge work is “task-switching.” Every time your brain has to switch from one type of task to another—from evaluating a potassium level to calculating a pediatric antibiotic dose, from reviewing a blood pressure medication to interpreting a heparin protocol—it pays a cognitive tax. It takes time and mental energy to load the “software” for the new task. When you are switching tasks with every single order, you are paying this tax dozens or hundreds of times a day, leading to mental fatigue, decreased speed, and an increased risk of error.

Batching is the tactical antidote to task-switching. It is the simple but profound strategy of grouping similar tasks together and executing them in a focused burst. By doing so, you load the relevant “mental software” only once. You become a temporary, hyper-focused expert on that one task, allowing you to move with a speed and accuracy that is impossible with a serial processing approach. You minimize the cognitive tax, conserve your mental energy for more complex problems, and dramatically increase your throughput.

This section will teach you the three primary batching tactics used by elite hospital pharmacists: batching by medication/class, batching by patient unit (“unit runs”), and batching by order type. Mastering these techniques will transform your workflow from a chaotic reaction to a structured, professional, and highly efficient practice.

26.2.2 The Analogy: From a Home Cook to a Restaurant Chef’s “Mise en Place”

A Deep Dive into the Analogy

Think about the process of cooking a complex meal. The amateur Home Cook often works in a linear, serial-processing fashion. To make a stir-fry, they might: 1. Get out one carrot, wash it, peel it, chop it, and put it in a bowl. 2. Get out one bell pepper, wash it, chop it, and add it to the bowl. 3. Get out the chicken, cut it up, and brown it. 4. Then, they start making the sauce. This approach is slow and inefficient because they are constantly switching tasks and tools—from peeling to chopping to searing.

The professional Restaurant Chef works in a completely different, parallel-processed universe built on the philosophy of “mise en place”—a French term meaning “everything in its place.” Before the first dinner order ever arrives, the chef performs a masterclass in batching:

  • They don’t chop one carrot; they take out five pounds of carrots and spend 30 minutes dicing every carrot they will need for the entire night’s service. This is batching by medication.
  • They don’t make one serving of sauce; they make a two-gallon batch that will last all night. This is batching by concentration.
  • They fully prep every ingredient for a specific station. The grill station has its perfectly portioned steaks, the sauté station has its finely minced garlic. This is batching by unit run.

When an order finally comes in, the chef is not cooking; they are assembling. They are grabbing handfuls of their pre-batched ingredients and executing the final steps with incredible speed and precision. The verification queue is your kitchen. This section will teach you how to set up your “mise en place” to handle the dinner rush with the efficiency of a Michelin-starred chef.

Masterclass Part 1: Batching by Medication or Therapeutic Class

This is the most intuitive and often the most powerful batching technique. The principle is simple: instead of verifying one order for Drug A, then one for Drug B, then another for Drug A, you filter your queue to show you all the pending orders for Drug A and verify them in a single, focused burst. This keeps your “mental software” for that specific drug loaded, dramatically increasing speed and safety.

The “Electrolyte Run”: A Classic Batching Tactic

Electrolyte replacements (potassium, magnesium, phosphate) are some of the most common orders in any hospital. They are also ripe for error (wrong rate, wrong concentration). Performing a periodic “Electrolyte Run” is a highly effective tactic.

The Step-by-Step Process:
  1. Filter your verification queue to show only orders for “potassium,” “magnesium,” and “phosphate.”
  2. Start with potassium. Open the first order for IV potassium chloride.
  3. Perform your standard check:
    • Check the Lab: What is the patient’s current potassium level? Does it justify the dose?
    • Check Renal Function: Is the patient’s creatinine stable?
    • Check the Dose, Rate, and Concentration: Is it a standard concentration (e.g., 20mEq/100mL)? Is the infusion rate safe (e.g., not to exceed 10mEq/hr on a peripheral line)?
    • Check Concurrent Meds: Is the patient also on an ACE-inhibitor, spironolactone, or other potassium-sparing drugs?
  4. Verify the order. Then, without closing your “potassium software” in your brain, move to the very next potassium order on your filtered list and repeat. You will find that by the third or fourth order, your speed will have doubled because you are not re-thinking the fundamentals each time.
  5. Once all potassium orders are clear, switch your mental software to magnesium and repeat the process for all pending magnesium orders. Then do the same for phosphate.

Other High-Yield Medication-Based Batches

Batch Type Description & Rationale Key Verification Checklist for the Batch
The Anticoagulation Power Hour Group all your routine anticoagulation orders together. This includes new orders for enoxaparin, dose adjustments for warfarin, and follow-up lab reviews. This is a high-risk, high-reward batch. By focusing solely on anticoagulation, you are less likely to miss a critical detail.
  • Correct indication (prophylaxis vs. treatment)?
  • Dose appropriate for weight and renal function?
  • Baseline platelets (for enoxaparin)? Baseline INR (for warfarin)?
  • Any planned procedures that would require holding?
  • Any interacting medications (especially antibiotics with warfarin)?
The Antibiotic Stewardship Sweep Filter your queue for all new antibiotic orders. This allows you to approach verification from a stewardship mindset, looking for opportunities to optimize therapy across multiple patients at once.
  • Indication documented?
  • Allergies checked?
  • Appropriate spectrum of activity for the likely indication?
  • Renal/hepatic dose adjustments needed?
  • Is it a restricted antimicrobial requiring approval?
  • Is it a candidate for IV-to-PO conversion?
The Pain Med Pass Batch verify all new and modified orders for opioids and other analgesics. This allows you to focus on the unique risks associated with pain management, such as respiratory depression and duplicate therapy.
  • Is the patient opioid-naive? If so, is this a safe starting dose?
  • Correct dose conversion if switching from another opioid?
  • Is there therapeutic duplication (e.g., a scheduled long-acting opioid AND a frequent PRN short-acting one)?
  • Is there a bowel regimen ordered to prevent constipation?
  • Is naloxone readily available?

Masterclass Part 2: Batching by Patient Unit (“Unit Runs”)

This is a more advanced, but incredibly powerful, batching strategy. Instead of focusing on a specific drug across the whole hospital, you focus on a specific location and verify all the routine orders for that unit. This tactic transforms you from a remote order processor into an integrated, unit-based clinical pharmacist.

The Step-by-Step Guide to a “Unit Run”
  1. Select a Unit: Choose one of the nursing units you are assigned to (e.g., “6-North Med/Surg”).
  2. Filter Your Queue: Filter your entire verification queue to show only orders for patients located on “6-North.”
  3. Work Patient by Patient: Instead of jumping between patients, pick the first patient on your filtered list, Mr. Smith in 601. Open his chart. Now, verify all of the pending orders for Mr. Smith. You might verify his lisinopril, his sliding scale insulin, and his PRN Tylenol all in one go.
  4. Move to the Next Patient: Once Mr. Smith’s queue is clear, move to the next patient on 6-North, Mrs. Jones in 602, and repeat the process. Continue until the queue for that entire unit is clear.
  5. Reset and Repeat: Clear your filter and select a new unit to focus on.

The Synergistic Power of the Unit Run

This method is powerful because it creates clinical and operational synergy that is impossible with other batching methods.

Benefit Explanation & Example
Enhanced Clinical Context When you verify three orders for one patient at the same time, you are forced to see the bigger picture. You are not just verifying a blood pressure med; you are verifying it for a patient whose potassium you just saw is 5.5 and whose creatinine you just noticed is climbing. This allows you to catch context-dependent errors you would otherwise miss.
Bundled Interventions While working up Mr. Smith’s three orders, you might notice a fourth problem: a drug interaction or a missed dose of a home medication. Because you are already “in his chart,” you can address all issues at once. This allows you to contact the provider with a single, efficient message (“For Mr. Smith, I recommend we adjust X, hold Y, and add Z”) instead of three separate, annoying interruptions.
Operational Efficiency When you finish your “run” for 6-North, you will have a stack of medications that all need to be delivered to the same place. This allows you and your technicians to batch the delivery process, saving immense time and effort compared to sending one medication at a time to 20 different units.
Builds Unit Expertise For the 30-60 minutes you are focused on 6-North, you become the absolute expert on those patients. If a nurse calls from that unit with a question, you don’t have to re-open the chart; the patient’s story is already fresh in your mind. This allows you to answer questions and solve problems with incredible speed.

Masterclass Part 3: Building a Hybrid System That Works for You

You do not have to choose only one batching method. The most effective pharmacists create a hybrid system that adapts to the rhythm of their day. The goal is to have a default “game plan” for your shift that incorporates blocks of focused, batched work.

The Cardinal Rule: Triage First, Batch Second

Batching is a strategy for managing your routine workload. It should only be implemented AFTER you have scanned your entire queue and cleared all STAT and high-risk orders using the prioritization framework from Section 26.1. Never let your desire to complete a “batch” prevent you from responding immediately to a new emergency that appears on your radar.

A Sample Shift Workflow Using Hybrid Batching

This is a sample schedule for a day-shift pharmacist. Note how it moves between different types of focused work.

Time Block Activity Rationale
07:00 – 07:30 Initial Triage & Handoff Review First, clear all overnight STATs and high-risk orders. Review handoff from the night shift pharmacist to identify any pending issues or “ticking time bombs.”
07:30 – 09:00 First Unit Run (ICU/High-Acuity) Focus on your sickest patients first. Batching by the ICU allows you to get a handle on your most complex patients before morning rounds begin.
09:00 – 10:30 Post-Rounds Order Rush & Triage Morning rounds will generate a flood of new orders. This is a time for rapid triage, focusing on clearing STATs and NOWs as they appear. Batching is less feasible during this chaotic period.
10:30 – 12:00 The “Kinetics & Lab Review” Batch Most morning labs are back by now. This is the perfect time to filter your queue for all patients requiring pharmacokinetic monitoring (vancomycin, etc.) or who have had critical lab changes.
12:00 – 13:00 The “Electrolyte Run” A classic, high-yield batch to clear out the common potassium and magnesium orders that have accumulated.
13:00 – 15:00 Afternoon Unit Runs (Med/Surg Floors) The pace often slows in the afternoon. This is a great time to perform focused unit runs on your medical-surgical floors, looking for IV-to-PO conversions and other optimization opportunities.
15:00 – End of Shift Discharge Batch & Handoff Prep Focus on verifying complex discharge prescriptions and preparing a clean, concise handoff for the evening shift pharmacist.