South Carolina Society of Health-System Pharmacists Position Statement on Pharmacy Technicians

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1 South Carolina Society of Health-System Pharmacists Position Statement on Pharmacy Technicians The safety and health of the citizens of South Carolina are vital concerns for all pharmacists. Without appropriate measures to ensure that all of our state s Pharmacy Technicians are adequately trained, educated, and certified, public health is at risk. Therefore, the South Carolina Society of Health-System Pharmacists (SCSHP) believes that, at minimum, accredited training programs, national certification, and appropriate training should be required of all practicing pharmacy technicians in the state of South Carolina. SCSHP believes that Uniform pharmacy technician competency standards are a vital patient safety issue that must be implemented in order to protect the public from harm. A pharmacy technician program that meets stringent standards and requires a rigorous evaluation process serves to provide better patient care and leads to reduction in medication errors. Accredited training programs prevent such errors while developing consistent practices across the nation. National accreditation will ensure that the training programs meet the criteria set out by the South Carolina Board of Pharmacy and that the training programs undergo accreditation visits and scheduled re-accreditation. Pharmacist-to-technicians ratios should be determined on the local level, based upon the acuity of care, breath of service, quality improvement processes, and historical data, rather than being universally applied. SCSHP will work with our fellow pharmacists and pharmacy technicians, with other professional organizations, the general public, and the state legislature to develop the appropriate educational and competency requirements for pharmacy technicians. This is vital for the protection and the health of the citizens of South Carolina. Therefore, we believe that the following essential components of pharmacy technician education, certification and experience should be implemented in South Carolina: Establish a single category of Certified Pharmacy Technician recognized and supported by the laws and regulations of the state of South Carolina. Require that ALL Certified Pharmacy Technicians have completed education and training as required by the state of South Carolina laws and regulations. Education and training is to include completion of an accredited certification program, successful passing grade of a nationally recognized certification examination and completion of at least 2000 hours of supervised experience. All persons entering the workforce as a pharmacy technician, on or after July 1, 2012, shall have completed an American Society of Health-System Pharmacists (ASHP) accredited pharmacy technician program, or another nationally recognized and

2 accredited education and training program as approved by the South Carolina Board of Pharmacy. Mandatory certification by the Pharmacy Technician Certification Board (PTCB) or another nationally accredited certification program, as approved by the South Carolina Board of Pharmacy, shall be a prerequisite for any pharmacy technician to engage in the full scope of responsibilities authorized by the Board of Pharmacy. Any pharmacy technician employed prior to the July 1, 2012 date shall complete an accredited training program or attained certification through the PTCB or another Board-approved accredited certification examination. Additionally, the technician shall have a minimum of 2000 hours of full-time equivalent experience as a pharmacy technician, under the supervision of a licensed pharmacist, before they are eligible for the title of Certified Pharmacy Technician. The pharmacist-to-technicians ratios should be determined on the local level on the basis of acuity of care, breath of service, quality improvement processes, and historical data instead of specific ratios.

3 Background: The objective of the overall pharmacy function in hospitals and health-systems is to support sound patient care through the safe, evidence-based, cost beneficial use of prescription medications. Hospitals and health systems require that pharmacists and pharmacy technicians possess and maintain sound credentials, attesting to their competence in handling the tasks assigned to them. Medication use is a prominent therapy for patients and it is inherently complex and dangerous. All pharmacists and pharmacy technicians are responsible for error prevention, patient safety, and patient outcomes related to medication therapy. 1 Numerous reports over the past year have been done by Good Morning America, 20/20, CBS and WorldNews highlighting the tragic and deadly results of medication errors committed by both pharmacists and pharmacy technicians. 2-5 The U.S. Centers for Disease Control and Prevention estimates common medical errors cost the nation $4.5 billion a year. The U.S. Centers for Medicare and Medicaid Services has said it will not longer pay hospitals for a number of so-called never events and complications arising from preventable medical errors. On August 22, 2008, South Carolina s Medicaid program announced it will stop paying hospitals for medical errors and the complications they cause. In July 2008, The American Society of Health-System Pharmacists, along with the American Society of Health-System Pharmacists Research and Education Foundation, the Institute for Safe Medication Practices, the United States Pharmacopoeia, the Infusion Nurses Society, the National Patient Safety Foundation and the Joint Commission, convened an expert panel to examine the issue of death or serious injury resulting from errors with intravenous medications. Health care safety experts and researchers have documented an unacceptably high incidence of harm and death from medical errors in general, most notably in the Quality Chasm series of reports from the Institute of Medicine (IOM). These and other studies characterize medical errors as a pervasive symptom of the current health care system's inability to deliver care safely and effectively. Medication errors account for a significant proportion of these events and frequently cause patient harm and sometimes death. Errors associated with the use of parenteral medications are more likely to result in serious patient injury or death. 6 The problems associated with inappropriate medication use have received broad publicity in recent years. To Err is Human: Building a Safer Health System has drawn attention to medical errors. 7 The February 2008 USA Today series, detailing errors that occurred as a result of actions of a pharmacy technician, highlights the need to ensure adequate and standardized requirements for pharmacy technicians in South Carolina. As we increase the number of technicians that a single pharmacist supervises, we increase the role of technicians in patient care. This affects patient safety, which makes the appropriate training of pharmacy technicians essential. A positive outcome of developing a strong and competent pharmacy technician workforce is found in the collaborative opportunities between a pharmacist and a pharmacy technician. However, there is still a marked diversity in the requirements for entry into the pharmacy technician work force. This diversity is seen in the disparate education and training

4 requirements, the basic knowledge and skills brought to the workplace, and the functions a pharmacy technician can be expected to perform. With the national shortage of pharmacists and with the increasing numbers of prescriptions to dispense, pharmacists have less time to counsel patients. To combat this increasing workload and the myriad responsibilities, pharmacy technicians are becoming increasingly vital to the successful utilization of our current pharmacist workforce. By developing and promoting appropriately trained and certified pharmacy technicians, we allow pharmacists to spend more time with patients. Clearly, technicians are instrumental to the advancement of pharmacy care. The absence of national training standards and the resulting variations in program content, length, and quality are barriers to the development of a strong technician work force. 8 In South Carolina, ASHP accredits six state technical college pharmacy technician training programs, along with the training programs of the national pharmacy chain drug stores CVS and Walgreens. Currently, recognition of ASHP accreditation is set by policy of the Board of Pharmacy and is not in state statute. On November 14, 2007, the South Carolina Technical College System, at the request of the South Carolina Board of Pharmacy, presented their Pharmacy Technician Certification and Training Update. The Technical College System is proposing a 22 credit-hour certificate program that could be completed in as few as two semesters. This curriculum parallels that of current certificate programs that are already ASHP accredited. The target audience for the proposed program is retail pharmacy technicians, who are seeking first-time employment or who already have experience in the field. This program will allow all 16 state technical colleges to offer pharmacy technician training, which would then help to counteract the certified pharmacy technician shortage in all areas of South Carolina. SCSHP believes that a technician program that meets stringent standards and requires a rigorous evaluation process results in better patient care and a reduction in medication errors. Such accredited training programs can help prevent errors, while developing consistent practices across the nation that will lead to a healthier and encourage the appropriate use of prescription medication. Patient safety and quality of care will improve, and access to appropriate patient care by pharmacists will increase if all technicians are mandated to complete an ASHP-accredited pharmacy technician training program and be certified by the PTCB. SCSHP believes that the best and most effective way to develop a qualified pharmacy technician workforce is to develop and advocate for the enactment of state legislation that ensures an appropriately trained and certified technician workforce. 9 By doing so, we will enable pharmacists to meet the medication management needs of patients as we strive to continue to protect the public health of South Carolina. SCSHP is proud to be a supporting and active member of the SC Node in association with the SCHA. The SC Node was originally created in December of 2005 in response to the Institute for Healthcare Improvement's (IHI) 100,000 Lives Campaign. The intent of the Node is to promote collaborative relationships among SC hospitals and healthcare-related entities. The Node continued its work to support, facilitate and promote collaboration of its supporting members as the original 100,000 Lives Campaign came to a close and the IHI 5 Million Lives Campaign began. The SC Node has been effective in bringing together those responsible for providing quality healthcare in SC through educational forums and programs, mentor hospital designation and sharing of ideas, and focusing on common objectives. The

5 Node members have decided to continue working together after the 5 Million Lives Campaign comes to an end to improve the safety and quality of healthcare in South Carolina. 10 Current South Carolina Law on Pharmacy Technicians The South Carolina Board of Pharmacy recognizes two types of pharmacy technician: Registered Technician The only legal requirement is to complete the registration paperwork required by the Board of Pharmacy and pay the $40 registration fee. This technician can begin filling prescriptions immediately under the direct supervision of a licensed pharmacist. State Certified Technician A state certified technician must: A registered pharmacy technician has: No age requirements No educational requirements No training requirements No background check a. Complete a Board of Pharmacy approved technician course; b. Document a high school diploma or the equivalent; c. Pass the national Pharmacy Technician Certification Board exam or a Board of Pharmacy approved exam and maintain current certification; d. Work for one thousand (1000) hours under the supervision of a licensed pharmacist as a technician; and e. Fulfill continuing education requirements as provided for in Section (G) of the South Carolina Pharmacy Act. A state certified pharmacy technician is allowed the following expanded duties: Receive and initiate verbal telephone orders; Conduct one time prescription transfers; Check a technician's refill of medications, if the medication is to be administered by a licensed health care professional in an institutional setting; and Check a technician's repackaging of medications from bulk to unit dose in an institutional setting. As of September 28, 2008, there are 4320 technicians registered with the Board of Pharmacy, of which 2374 (55%) are state certified.

6 Supervision One pharmacist may not supervise more than three pharmacy technicians at a time; as of June 30, 2006, at least two of these three technicians must be state-certified. If a pharmacist supervises less than three pharmacy technicians, the technicians are not required to be statecertified. Pharmacy technicians do not include personnel in the prescription area performing only clerical functions, including data entry up to the point of dispensing. Comparison with Cosmetology and Barbers Currently, if we compare the required education and training of those who in cosmetology or as barbers, we find that there are more requirements in training and education than for a registered pharmacy technician. Cosmetology: SECTION Qualifications for licensure; cosmetologist; esthetician; nail technician. (A) A license as a cosmetologist must be issued by the board to a person who: (1) is at least sixteen years of age and possesses at least a tenth grade education or the equivalent as established by tests used in the public schools or tests approved by the board; (2) has completed at least one thousand five hundred hours in classes in cosmetology in a reliable school approved by the board or is a registered master hair care specialist pursuant to Chapter 7 who has satisfied educational requirements established by the board in regulation; and (3) has passed the examination prescribed by the board and pays the required fee. (B) A license as an esthetician must be issued by the board to a person who: (1) is at least sixteen years of age and possesses at least a tenth grade education or the equivalent as established by tests used in the public schools or tests approved by the board; (2) has completed at least four hundred fifty hours in classes in skin care in a reliable school approved by the board or comparable training approved by the board; and (3) has passed the examination prescribed by the board and pays the required fee. (C) A license as a nail technician must be issued by the board to a person who: (1) is at least sixteen years of age and possesses at least a tenth grade education or the equivalent as established by tests used in the public schools or tests approved by the board; (2) has completed at least three hundred hours in classes in a reliable nail technician school approved by the board or comparable training approved by the board; and (3) has passed the examination prescribed by the board and pays the required fee Barbers: Regulation Barber Students, Applications, Permits, Training, Progress Reports, and Examinations A) Students training fulltime in a school or college shall be on a five (5) day week basis, eight (8) hours per day, for a minimum of forty (40) weeks; or, students training fulltime under the personal supervision of a qualified registered barber shall be eight (8) hours per day on a forty (40) hour a week basis for forty-eight (48) weeks.

7 (B) Students shall have received a written student permit issued by the Board. (C) Each student training under the personal supervision of a registered barber will be required to obtain the same textbooks taught by barber school or college and be given at least one (1) hour of study per day. (D) Student training part-time in a school or college shall be on a twenty (20) hour a week basis for forty (40) weeks; students training part-time under the personal supervision of a qualified registered barber shall be on a twenty (20) hour a week basis for forty-eight (48) weeks. References 1. American Society of Health-System Pharmacists. ASHP Long-Range Vision for the Pharmacy Work Force in Hospitals and Health Systems. Am J Health-Syst Pharm 2007; 64: Dennis Quaid Recounts Twins Drug Ordeal Medical Errors Costing U.S. Billions Drug Errors hurt 1 in 15 hospitalized kids Rx for errors: Drug error killed their little girl American Society of Health-System Pharmacists. White Paper on Pharmacy Technicians 2002: Needed changes can no longer wait. Am J Health-Syst Pharm 2003; 60: Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academy Press; American Society of Health-System Pharmacists South Carolina Society of Health-System Pharmacists and American Society of Health-System Pharmacists. Letters to members of the South Carolina Senate and House of Representatives. April SC Node 5 Million Lives Campaign (5MLives@phts.com).