Is There More to this than Counting Pills? A Review Of the Practice of Pharmacy and Its Different Settings A Knowledge Based Course

The Texas Tech University HSC- School of Pharmacy is accredited by The Accreditation Council For Pharmaceutical Education (ACPE) as a provider of continuing Pharmaceutical Education. Course Administered By: J&D Educational Services, Inc PO Box 130909 The Woodlands, Texas 77393-0909 Voice: 1-866-747-5545 Fax: 1-936-321-9295 www.jdeducation.com Is There More to this than Counting Pills? A Review Of the Practice of Pharmacy and Its Different Settings A Knowledge Based Course By Jeff Blackburn, C.Ph.T., MBA Healthcare Administration ACPE No. 0096-9999-15-086-H04-T Release Date: 08/31/2015 Expiration Date: 08/31/2018 Total number of pharmacy continuing education hours: 6 hours (0.6 CEU s) Course Cost: Average time to Complete: Course Value: Reading: Final Exam: Completion Requirements: $14.00 (to be paid at time of testing) Approximately Six hours including testing Six Contact Hours 47 Pages 40 Questions Answer 70% of questions correctly, Evaluation i

J & D Educational Services October 17, 2015 PTCB RE-CERTIFICATION CHANGES On February 27 th The Pharmacy Technician Certification Board (PTCB) announced significant certification program changes. Some of the changes are concerning required CE or re-certification. A summary of those changes is on the following page. More information is available at the PTCB website (www.ptcb.org). If you have questions or if we can be of any additional service, please give me a call at our toll free customer service number: 866-747-5545. Thank you for choosing J&D for your CE requirements. Carl IMPORTANT NOTE FROM PTCB You Ask, We Answer Your Question: "I am entering my CE hours online to recertify, but the total is wrong. Why?" PTCB's Answer: If your CE hours do not seem to add up in your application to recertify, you may have selected incorrect 'types' for your CEs. Under 'CE Program Details' there are three CE types in the menu to choose from: 1) Seminars, Workshops, and Conferences: The vast majority of CE hours are this type. Choose it for online CE courses and activities, recorded presentations, or webinars, as well as live conferences, seminars, workshops, or other educational programs that contain primarily pharmacy-related subject matter. This is also the type for home study courses. This includes all courses in this package. ii

PTCB Announces Certification Program Changes by PTCB Staff Feb 27, 2013 WASHINGTON, DC The Pharmacy Technician Certification Board (PTCB) announces future changes to the PTCB Certification Program. The new changes will advance pharmacy technician qualifications by elevating PTCB s standards for national certification and recertification. During the next seven years, PTCB will phase in the changes, including mandatory background checks, accredited education requirements, and changes in acceptable continuing education (CE) programs for recertification. PTCB is elevating our certification requirements in order to meet the demands of the evolving healthcare system, said PTCB Executive Director and CEO Everett B. McAllister, MPA, RPh. We have made bold decisions on what will be required for candidates to become certified pharmacy technicians (CPhTs). Our Board of Governors is sharply focused on ensuring that the PTCB Program prepares CPhTs for the integral roles they play in supporting pharmacists in all practice settings. PTCB s requirements have remained largely unchanged since the organization s founding in 1995. The PTCB Board of Governors decided that new candidates for PTCB certification will be required to complete criminal background checks, beginning in, or around, 2014. Many employers already require background checks as a condition of employment, and PTCB plans to collaborate with stakeholders to synchronize with the existing systems. As part of the 20 hours of CE required for recertification, individual CPhTs will need to complete one hour of medication safety CE, effective in 2014, in addition to the one hour of law CE already required. By 2015, PTCB will require all 20 recertification CE hours to be pharmacy technician-specific. Many existing CE offerings already fit this definition. The allowable CE hours from college courses will be reduced from 15 to 10 by 2016, and allowable in-service hours will be phased out by 2018. By 2020, PTCB will require candidates for initial PTCB certification to successfully complete an American Society of Health-System Pharmacists (ASHP)-accredited education program. ASHPaccredited programs include didactic course work and practical experience, thereby providing well-rounded training for technicians. For additional information visit www.ptcb.org iii

Extremely Urgent Notice! Changes to CE Monitoring That Will Affect Your CE Beginning May 1, 2012! CPE Monitor is a national collaborative effort by the National Association of Boards of Pharmacy (NABP) and the Accreditation Council for Pharmacy Education (ACPE) to provide an electronic system for state pharmacy boards and other licensing agencies to track and authenticate CE units completed by pharmacist and pharmacy technicians. This will eliminate the need for the random audits now being done. Most state boards have committed to this program beginning year and many others have shown a strong interest. It is expected that all 50 states will soon become a part of this program due to the savings they will experience in time and money. As an ACPE approved provider of CE for Certified Pharmacy Technicians, J&D Educational Services, in association with Texas Tech University School of Pharmacy, will be participating in this program. How does this benefit me? After you have registered to participate in this program J&D will electronically transmit the results for each course you successfully complete to CPE Monitor where they will be stored in a highly secure environment. This information will be available only to your appropriate licensing agency and to you. J&D will continue to maintain your records and issue you printed credits as we have always done. What does it cost? There is no cost to you to participate in this program. Don t wait! Technicians are strongly urged to obtain their NABP e-profile ID now to ensure their e-profile is properly set up. If you choose not to enroll in e-profile you will continue to get your credits as before. However, beginning 5-1-2012 we will not be authorized to use ACPE logo or ACPE number on your statements of credit. Don t Wait! It only takes a few minutes. www.nabp.net/programs/cpe-monitor/ After you have reached the site choose CPE Monitor Log in If you are registered at jdeducation.com, enter your e-profile ID and your date of birth in your personal info. Be sure to email your e-profile ID and your date of birth to carl@jdeducation.com using e-profile ID in the subject line. Please include your name and a contact phone number. Important Note: Your requirements for re-certification with your state board and PTCB have not changed. You will still be required to re-certify or re-register as you have always done. iv

Please Read Carefully Re-certification Procedures and Requirements Re-certification procedures and requirements are determined by the Pharmacy Technician Certification Board (PTCB) and/or your state board and change from time to time. It is highly advisable that you review these procedures and requirements on a periodic basis. You may do this on line at the PTCB website (www.ptcb.org). If you are certified or registered with your state board of pharmacy or other agency, you should contact that agency for re-certification procedures and requirements. J & D Educational Services, Inc. does not send the results of your CE to PTCB. PTCB requires that all certified pharmacy technicians complete the re-certification process and provide them with all requested information. J & D will provide you with a Statement of Credit for all courses you have successfully completed. It is highly recommended you keep a copy of the CE statement provided at the completion of each course. This is your proof that you completed the necessary requirements and have received credit for the course. Additional information is available on our website (www.jdeducation.com). LEGAL The material contained in this book is owned and administered by J & D Educational Services, Inc. and is protected under U.S. and international copyright laws. The content of the continuing education courses provided within this book are developed by licensed and certified professionals. All courses are approved by the Accreditation Council for Pharmaceutical Education (ACPE) and meet all requirements of the Pharmacy Technician Certification Board (PTCB) as outlined for continuing education. J & D EDUCATIONAL SERVICES, Inc ASSUMES NO RESPONSIBILITY OR LIABILITY AS A RESULT OF INACCURATE INFORMATION CONTAINED IN THESE COURSES. J & D EDUCATIONAL SERVICES, Inc. DOES NOT EDIT THE COURSES FOR CONTENT. THE INFORMATION CONTAINED IN THESE COURSES IS SELECTED AND PREPARED BY VARIOUS AUTHORS. ALL RECOMMENDATIONS OR SUGGESTIONS FOR THE USE OF DRUGS, DEVICES OR TECHNIQUES REFLECT THEIR OPINIONS. NO RESPONSIBILITY OR LIABILITY IN PROVIDING THIS INFORMATION IS ASSUMED BY J& D EDUCATIONAL SERVICES, Inc. v

Frequently Asked Questions: 1) What if I fail the final exam? To receive CE credit, the technician must work through the manual and self-assessment questions and pass a final exam with a score of 70% or better. If you do not pass, we will return your graded exam and ask you to try again at no charge. 2) What date is placed on my certificate? The date that your final exam arrives in our office. We can use the postmark date if it is legible. You may fax your completed answer sheet to us if necessary to meet your deadline. On line testing is available with instant results. Visit our website (www.jdeducation.com) for details. 3) How long should it take me to complete a course? One contact hour (0.1 CEU) is offered for each 50-60 minutes of organized activity pertinent to pharmacy practice. A four contact hour course, for example, should take approximately four hours to complete. 4) Can I take the same course twice? Please do not submit an exam for a course you have already successfully completed. Your board will not allow credit for a course you have submitted for a prior renewal. 5) Will you return my corrected answer sheet to me? We return your corrected answer sheet to you because we know that reviewing your mistakes is part of the learning process. PTCB requires that you keep your statement of credit in your file for one year. Some states require that the statements be available for review at anytime during the renewal cycle. 6) Do you send a receipt? We will send an itemized receipt with your order. 7) Do you send my results to PTCB? We cannot send your results to PTCB. PTCB requires that each individual technician complete the re-certification process. We will provide you with Statements of Credit for each course you successfully complete. Thank you for choosing J & D Educational Services for your CE requirements! vi

Thank you...... for ordering your continuing education from J & D Educational Services, Inc.. We would like to make completing your course as pleasant as possible and will gladly assist you in any way we can. Please don t hesitate to call if we can help. First: Please locate the course and an answer sheet. All answer sheets are the same and can be used for any course. They are located in the back of your courses. Second: The purpose of the final exam is to guide your reading to the most important points in the course. It is also proof to your Board that you have, in fact, read the material. In order to earn your statement of credit, please: 1) Read the material in the course. 2) On the exam itself, circle the correct one answer that most completely and fully answers the question. 3) Transfer your answers from the exam to the answer sheet. You may use a soft lead pencil or black pen and fill the appropriate space completely. 4) Mail only the completed answer sheet and the corresponding evaluation. The evaluation is required by ACPE before we can issue your statement of credit. You may fax your answer sheets and evaluations if you wish. If you wish your results to be faxed back, you must clearly state your request along with a return fax number. It is not necessary to mail your answer sheets if you use the fax. 5) As a precaution against loss, please make and keep a copy of the answer sheets on which you marked your answers until you receive your statement of credit. 6) Your original test will be graded and returned to you along with a statement of credit. PTCB requires that a copy of your statement of credit be retained by you for audit. J & D Educational Services does not keep copies of your answer sheets on file and cannot replace it if lost. We do keep a record of your grade and will furnish you with a copy of your statement of credit if requested. Last: Please allow several days for your answer sheet to arrive at our office. It takes longer than you think often up to four or five working days from the East Coast. Within two working days we will correct the answer sheet and hand it and your statement of credit to the mail carrier to return to you. Thank you again for ordering your continuing education for J & D Educational Services. If you have any questions, don t hesitate to call us toll free at 1-866-747-5545. vii

J&D Educational Service Intended Audience The intended audience for this course is Certified Pharmacy Technicians. Assessment Strategy Government/Regulatory Requirement the Pharmacy Technician Certification Board requires that Certified Pharmacy Technicians complete 20 hours of continuing education that is specific to pharmacy technicians. Current Gap A recent draft of the Long-Range Vision for the Pharmacy Work Force by the ASHP s Council on Education and Work-Force Development described the pharmacy technician of the future with the following role classifications: generalist working in inpatient, ambulatory, chronic, and home care; focused practitioners working in specialty settings; advanced practitioners collecting clinical data for pharmacist evaluation; and managerial roles. Each of these roles would require basic education and training in an accredited pharmacy technician training program. Each role would require national certification by the Pharmacy Technician Certification Board (PTCB) as soon as possible after completion of the educational program. While the role of the pharmacist is becoming more and more about patient care and the void they are leaving behind is being filled more and more by pharmacy technicians. This void is not only functional and administrative work, but also advanced practitioner work that requires a certain amount of professional judgment about when to alert the supervising pharmacist. As the career of the pharmacy technician moves into more advanced roles, it is important that they have an understanding of the different positions and practice settings that may be open to them both now and in the future. This course will review the different pharmacy practice settings as well as the different roles technicians currently hold and may in the future. OBJECTIVES Describe the pharmacy practice and the tasks and functions defined by the ASHP s Model Curriculum. Discuss the current and future advanced roles available to the certified pharmacy technician. List and describe some of the community based pharmacy practice settings. List and describe some of the institutional based pharmacy practice settings. 1

Table of Contents I. Introduction II. III. IV. The Practice of Pharmacy Pharmacy Technicians Functions and Tasks The Future of the Pharmacy Technician V. Community Based VI. VII. Institutional Based Conclusion 2

INTRODUCTION A 2002 white paper on pharmacy technicians provided a comprehensive analysis of historical developments, drivers for change, work-force issues, and the education, training, certification, and regulation of pharmacy technicians. 1 The paper called for a profession-wide vision for pharmacy technicians, identified the key issues that needed to be addressed, and described the needed action. An increasing number of state boards of pharmacy, recognizing the integral role of pharmacy technicians, have revised practice regulations to allow a broadening of their responsibilities and regulation of pharmacy technicians has increased significantly over the past 15 years. In 1993, only 12 states regulated pharmacy technicians. At present, 39 states regulate pharmacy technicians through licensure, certification, or registration. It is estimated that there are over 280,000 technicians regulated by state boards of pharmacy. The majority of states require some level of training or education that must be completed by a pharmacy technician; 29 of the 39 states that regulate pharmacy technicians have mandated training requirements. The majority of these training programs must be reviewed, or approved by the state board of pharmacy. As a part of their regulation of technicians, 14 boards of pharmacy have examination requirements that must be completed. An overview of the state regulation of pharmacy technicians is provided in NABP's annual Survey of Pharmacy Law. 2 Pharmacy technicians work in a wide variety of practice settings, including community pharmacies, hospitals, the military, home health care, long-term care, prescription mail-order facilities, managed healthcare facilities, and educational/training programs. The role of a pharmacy technician has evolved to assist the pharmacist in almost all types of practice settings with completing the technical aspects of dispensing prescriptions such as computer entry, labeling, medication preparation, record keeping, insurance form completion, and maintenance of an appropriate supply of medications in the pharmacy. The pharmacy technician is accountable to the supervising pharmacist who, in turn, is legally responsible through state licensure for the care and safety of patients served by the pharmacy. Pharmacy technicians are a critical part of the pharmacy work force, and the ever-increasing complexity of practice requires the increased utilization of qualified competent technical personnel. The following synopsis of the practice is provided to give readers an understanding of the vital role that they play in the delivery of pharmacy services. We will first look the history of the pharmacy practice, then at the general tasks performed by pharmacy technicians and finally we will explore some of the different practice settings from a general perspective. Some of the practices described in this course do not give specific technician duties, but offer a flavor of the practice type, keeping in mind that technicians are vital to almost all forms of pharmacy practice. 1 White Paper on Pharmacy Technicians 2002: Needed Changes Can no Longer Wait Am J Health-Syst Pharm. 2003;60:37 51; www.ashp.org/s_ashp/docs/files/tech_whitepaper.pdf; Accessed 6/15/2009. 2 Survey of Pharmacy Law; National Association of Boards of Pharmacy;www.nabp.net; Accessed December 30, 2008. 3

The Practice of Pharmacy The mission of the profession of pharmacy is to improve public health through ensuring safe, effective, and appropriate use of medications. Contemporary pharmacy practice reflects an evolving paradigm from one in which the pharmacist primarily supervises medication distribution and counsels patients, to a more expanded and team-based clinical role providing patient-centered medication therapy management, health improvement, and disease prevention services. The Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy (NABP) defines the practice of pharmacy as follows: The Practice of Pharmacy means the interpretation, evaluation, and implementation of Medical Orders; the Dispensing of Prescription Drug Orders; participation in Drug and Device selection; Drug Administration; Drug Regimen Review; the Practice of Telepharmacy within and across state lines; Drug or Drug-related research; the provision of Patient Counseling; the provision of those acts or services necessary to provide Pharmacist Care in all areas of patient care, including Primary Care and Collaborative Pharmacy Practice; and the responsibility for Compounding and Labeling of Drugs and Devices (except Labeling by a Manufacturer, Repackager, or Distributor of Non-Prescription Drugs and commercially packaged Legend Drugs and Devices), proper and safe storage of Drugs and Devices, and maintenance of required records. The practice of pharmacy also includes continually optimizing patient safety and quality of services through effective use of emerging technologies and competency-based training. 3 Tasks and Functions of Pharmacy Technicians In its Model Act, NABP defines pharmacy technicians as personnel registered with the Board who may, under the supervision of the pharmacist, assist in the pharmacy and perform such functions as assisting in the dispensing process; processing of medical coverage claims; stocking of medications; cashiering but excluding drug regimen review; clinical conflict resolution; prescriber contact concerning prescription drug order clarification or therapy modification; patient counseling; dispensing process validation; prescription transfer; and receipt of new prescription drug orders. There has been recurring collaborative initiatives to analyze and document the work activities of pharmacy technicians. Some of these studies have been accomplished at the same time as an evaluation of professional activities of pharmacists, e.g., the Scope of Pharmacy Practice Project (1992 1994) mentioned above. 4, The most recent practice analysis for pharmacy technicians was completed in 2005. It identified new responsibilities performed by CPhTs, including the handling and processing of restricted, investigational, and chemotherapy drugs; working in mail-order pharmacy settings; and increased involvement in third-party payment. New knowledge areas identified in the practice analysis included knowledge of error prevention strategies for data entry, cultural diversity, third-party payment, and pharmacy benefit management companies. The practice analysis indicated that CPhTs spend about 66 percent of their time assisting the pharmacist in serving patients, 22 percent maintaining medication and inventory control systems, and 12 percent participating in pharmacy practice 3 Model State Pharmacy Act and Model Rules of the National Boards of Pharmacy; National Association of boards of Pharmacy; www.nabp.net; August 2008; Accessed: December 30, 2014. 4 Summary of the Final Report of the Scope of Pharmacy Practice Project Am J Hosp Pharm. 1994;51:2179 82 4

management and administration. This distribution of the workday is similar across community, health-system, and other work settings. Community-based CPhTs are most frequently involved in assisting with outpatient prescription dispensing, purchasing and inventory control, and billing. For health-system CPhTs, assisting in inpatient medication dispensing, preparing intravenous admixtures, and prepackaging and repackaging are the primary responsibilities. CPhTs are taking on additional, more advanced responsibilities, including those more traditionally performed by a pharmacist. In community settings, there has been growth in the extent to which pharmacy technicians are contacting prescribers for clarification of prescriptions and participating in quality assurance activities. Skilled technicians are now playing an important role in improving patient safety and medication-error strategies. Technician roles include medication order entry, multiple-point checking, screening medication orders for dangerous medical abbreviations, physically separating look-alike medications and sound-alike medication names, and assisting the pharmacist in monitoring patient outcomes by collecting patient-specific data. Many CPhTs now have expanded supervisory responsibilities, including order-entry verification, preparation and packaging of medications produced by other technicians, and preparing prescription and medication orders for final approval by a pharmacist, as allowed by law. Additional practice management tasks include collecting productivity information, performing billing and accounting functions, performing or contributing to employee evaluations, and participating in the establishment, implementation, and monitoring of policies and procedures. There have been a number of significant positive developments affecting pharmacy technicians in the past ten to fifteen years including the establishment of certification boards, the development of the Model Curriculum for pharmacy technician training 5, an expansion in the number of accredited training programs, and greater regulatory recognition of pharmacy technicians in state pharmacy practice acts. Pharmacy technician education and training requirements vary among states and employers; there is, however, a trend toward more formalized technician training, either through an academic training program or on the job. The Model Curriculum provides a starting point for identifying core competencies for pharmacy technicians and a framework for training pharmacy technicians for all practice settings and geographic locations. The goal statements of the Model Curriculum are listed below. 1. Assist the pharmacist in collecting, organizing, and evaluating information for direct patient care, medication. 2. Receive and screen prescription/medication orders for completeness and authenticity. 3. Prepare medication for distribution. 4. Verify the measurements, preparation, and/or packaging of medication produced by other 5 American Society of Health-System Pharmacists. Model Curriculum for Pharmacy Technician Training2nd Edition. American Society of Health-System Pharmacists;www.ashp.org/Import/MEMBERCENTER/Technicians/Training/ModelCurriculum.aspx. Bethesda, MD. 2001; Accessed February 13, 2009. 5

technicians. 5. Distribute Medications. 6. Assist the pharmacist in the administration of immunizations. 7. Assist the pharmacist in the identification of patients. 8. Initiate, verify, assist in the adjudication of and collect payment and/or initiate billing for pharmacy services and goods. 9. Purchase pharmaceuticals, devices, and supplies according to an established purchasing program. 10. Control the inventory of medications, equipment, and devices according to an established plan. 11. Assist the pharmacist in monitoring the practice site and/or service area for compliance with federal, state, and local laws; regulations; and professional standards. 12. Maintain pharmacy equipment and facilities. 13. Assist the pharmacist in preparing, storing, and distributing investigational medication products. 14. Assist the pharmacist in the monitoring of medication therapy. 15. Participate in the pharmacy department s process for preventing medication misadventures. 16. Take personal responsibility for assisting the pharmacist in improving direct patient care. 17. Demonstrate ethical conduct in all job-related activities. 18. Maintain an image appropriate for the profession of pharmacy. 19. Resolve conflicts through negotiation. 20. Understand the principles for managing change. 21. Appreciate the need to adapt direct patient care to meet the needs of diversity. 22. Appreciate the benefits of active involvement in local, state, and national technician and other pharmacy organizations. 23. Appreciate the value of obtaining technician certification. 6

24. Understand the importance of and resources for staying current with changes in pharmacy practice. 25. Communicate clearly when speaking or writing. 26. Maximize work efficiency through the use of technology. 27. Efficiently solve problems commonly encountered in one s own work. 28. Display a caring attitude toward patients in all aspects of job responsibilities. 29. Maintain confidentiality of patient and proprietary business information. 30. Understand direct patient care delivery systems in multiple practice settings. 31. Efficiently manage one s work whether preformed alone or as part of a team. 32. Function effectively as a member of the health care team. 33. Balance obligations to one s self, relationships, and work in a way that minimizes stress. 34. Understand the use and side effects of prescription and nonprescription medications used to treat common disease states. 35. Assist the pharmacist in assuring the quality of all pharmaceutical services. Several national pharmacy organizations have adopted policies calling for nationally standardized education and training for pharmacy technicians. The development of guidelines and standards to regulate the qualifications of individuals who work as pharmacy technicians will ultimately reduce the variation in pharmacy technician qualifications and deployment across the country. The Future of the Pharmacy Technician Now that we have outlined the traditional tasks and functions of the pharmacy technician, it is time to discuss both future and current roles that are becoming available to pharmacy technicians. Technicians will find positions available in a number of practice settings. As you continue to develop expertise in your profession, you should continue to be alert for opportunities for advancement. Keep a log documenting all aspects of your education, training, certifications, and job responsibilities in preparation for any opportunity that arises. Continue to explore all related horizons to find that perfect position that will open the door to a fulfilling career. This section discusses some of the professional duties technicians are performing now or may be performing in the future. The future is in your hands as you begin your journey toward the 7

career goals that are of interest to you. Keep an open mind as you explore this exciting profession because the possibilities are endless. Don t be deterred if someone tells you that pharmacy technicians do not perform that role in a particular facility. Be prepared to demonstrate your abilities and desire to be a part of the team. Pharmacy Technician Educator A practice setting that employs many technicians may require a technician educator in the pharmacy setting to assist with orientation and training of new employees. If this position does not yet exist and you see a need for it in your practice setting, you can begin by offering to train new hires. Outline a formal procedure for this process and document your training activities. Request feedback from technicians you have trained and document this. Many technicians do not like to be bothered by training others and consider it a nuisance. If there is new equipment or new software brought into the practice setting, ask to be trained on it first and assist in the training of others. If your site accepts students for clinical rotation, offer to be the preceptor, and set up a documented training plan. When you have amassed enough documentation for your training activities, approach the supervisor with your request for creation of a new position. Be prepared to promote yourself by discussing your knowledge, ability to convey that knowledge, the respect you have earned as a professional, your communication skills, and your desire to be of service. Pharmacy Technician Supervisor The role of a technician supervisor is different from that of an educator, although in some settings the positions may be combined. The technician supervisor usually has the ultimate responsibility for managing all the technicians employed in the facility. This would include recruiting, interviewing, screening, and hiring new employees. The supervisor must be totally familiar with the workflow so that adequate help can be scheduled and adjustments in personnel can be made quickly to accommodate work load. Technicians must be cross trained in all areas to facilitate workload changes. Although one or more technicians may be designated for inventory control, it would ultimately be the responsibility of the supervisor to ensure competent inventory management. Technician attendance issues, poor work habits, and disagreements among employee would be addressed by the technician supervisor. Generally, this position would also involve a great deal of administrative paperwork responsibilities, and often some business management courses would be helpful. The technician supervisor usually reports to the pharmacy manager and must have a good working relationship with management. If this is a position of interest, acquire a copy of the job description and requirements for your facility and be certain that you meet all the requirements. Pharmacy Warehouse Supervisor A large hospital facility will require a pharmacy warehouse separate from the hospital warehouse facility so that medications can be more closely monitored. There may be an opportunity for a qualified technician to assume the role of pharmacy warehouse supervisor. This position would require good computer skills, proficiency in using the ordering system, and great organizational 8

skills. A systematic approach to receiving orders, accurately stocking the shelves, and distributing medication to other areas is essential. Adequate procedures for the handling of controlled drugs will prevent the chaos that accompanies discrepancies. This person would be responsible for handling expired drugs and drug recalls. Clinical Coordinator for Pharmacy Technician Program Pharmacy technician education programs are becoming increasingly prevalent across the country and the need for more competent, educated technicians in the workforce is recognized. Education can be a very rewarding pathway to a fulfilling career as a professional. A logical next step up the career ladder for a technician educator would be a position as a clinical coordinator for a formal education program. Classroom instruction about extemporaneous compounding and handling sterile products may be the responsibility of the clinical coordinator. Supervising laboratory experiences to prepare students for actual experiential time in a pharmacy setting is an important responsibility of the clinical coordinator. Maintaining an inventory of laboratory supplies and placing equipment and supply orders would also be duties of the coordinator. Teaching other classes in the curriculum might be included in the job description, depending on the expertise and credentials of the technician. The coordinator also serves as a liaison with experiential practice sites and cultivates a relationship with possible preceptors, assisting in their understanding of the important role they play in the education and training of the student. The coordinator meets with the students for discussions about their goals and decides on the practice settings that would be the most productive for the training of each individual student. A booklet is prepared for each student and each clinical rotation. The competencies required of the student will vary depending on whether the setting is inpatient or outpatient. Contained in the booklet will be daily logs to document hours worked by the student and a brief description by the student of the work day. Each student should also fill out an evaluation of the site and the preceptor. For the preceptor there will be a checklist of competencies to be mastered by the student during the rotation, and an evaluation form for the affective behaviors observed in the student. The clinical coordinator will make regular visits to each site on a predetermined schedule and meet briefly with the preceptor and the student to assess the learning and deal with any concerns. Any serious concerns should be directed to the program director for assessment and resolution. Often the clinical coordinator will also facilitate preparation for job interviews, assist in resume writing, and help the technician supervisor place students for employment after they complete the educational program. This position requires great organizational skills, outstanding clinical skills, and ability to teach effectively, and good communication skills to develop effective relationships with experiential sites. Director of Pharmacy Technician Program The director of a formal education program is ultimately responsible for the quality and viability of the program. Program directors often have an associate s or bachelor s degree, and in some cases may have a master s degree and/or may be a pharmacist. In some cases the program director is responsible for developing and implementing every aspect of the program, but often 9

some of the core courses are already in place and provide a foundation for pharmacy technicianspecific courses. Investigational Drug Pharmacy Technician Some large hospitals systems are very involved in investigational drug studies and have a department devoted to record-keeping and dispensing of investigational drugs. Skilled technicians are vital to this important aspect of the pharmacy profession. Each study drug has hundreds of protocols outlining everything from the specifications for the patients admitted to the study to the way the drug is labeled and dispensed to patients. The technician is responsible for documenting the many protocols used to validate the study. Confidentiality and accurate documentation are important because the pharmacy personnel may be the only ones who know which patients are taking the actual drug and which are taking placebos in the case of a doubleblind study. An ability to read and understand the protocols enables the technician to set up the proper documentation for the various phases of the studies. Exact records of medications must be kept, and any medication not used by a patient must be retrieved because it is not an FDA approved drug. All of these tasks are performed under the supervision of a pharmacist, but the technician has great responsibilities in a rewarding and professional setting. Refill Triage Pharmacy Technician In a busy physician s office, the phone rings incessantly and the fax machine continually prints requests from pharmacies for refill authorizations. The office personnel are busy taking care of patients and their immediate needs. A pharmacy technician can be invaluable, especially in a multi-physician office, to organize and triage the requests so that patients can receive their medications in a timely manner. The technician documents all the information from the phone request, along with the call back number and the pharmacy name. The patient charts are then retrieved and the refill request is checked against the documentation in the chart. The technician should learn the established protocols for refill authorization for patients and note when the patient was last seen in the office. The prescription refills to be called into the pharmacies should be written up on the appropriate form. A similar procedure is followed for requests that are faxed to the office. The prepared forms are placed along with the patient chart in the appropriate place for the prescribers to sign off on the refills. The authorizations can then be faxed back to the pharmacy and the designated person can return the calls for the phoned-in requests. The charts can then be filed. To be qualified for this position, a technician must have good organizational skills, be fluent in medical terminology and experienced in reading patient charts, and able to communicate well with the prescribers and work cooperatively with the other office personnel. A strong background in pharmacology, emphasizing brand and generic names and drug uses, will help the technician check the chart for similar drugs that have been prescribed and others that may have been discontinued. If a fast-paced physician s office appeals to you as a possible place to work, prepare yourself educationally, decide whether your personality type fits with this type of work, and contact some physicians and let them know what you are capable of doing for them. Medication Reconciliation Pharmacy Technician 10

The Joint Commission Accrediting Healthcare Organizations (JCAHO) has mandated that all patient medications go through a verification process each time the patient is moved from one facility to another or from one unit to another. The medication reconciliation process is designed to prevent duplication of medication ordered by different physicians or by the same physician at different times. When a patient first enters a healthcare facility, an accurate listing of all medications the patient is currently taking is compiled with information from the patient or a caregiver. This list is compared with the physician admission orders to check for any duplications or discrepancies. The professional judgment of the technician is invaluable at this step and aids in the decision to alert the pharmacist about a medication concern. Discrepancies are then evaluated by a pharmacy using knowledge-based professional judgment to decide whether a medication adjustment is within the pharmacist s scope and standards of practice, or whether a consultation with the physician is required to resolve the issue. Any changes in the physician s orders are documented, and the reconciliation form should become a part of the patient s chart. This form should follow the patients each time they are moved to another unit in the facility and continue with them if they are transferred to another facility or discharged to home. Each of these steps should be documented according to a previously designed set of protocols established by the institution involved. The institution should have an official reconciliation form to be utilized and guidelines for the qualifications of the staff members allowed to participate in this process. A staff education process should be put into place for all staff involved in this process. In some institutions, this process may be performed by the nursing staff or by pharmacists. This is a process that requires a considerable commitment of time to be effective. An educated pharmacy technician has more knowledge about pharmacology and a better understanding of the medication process, especially concerning brand and generic drug names, drug classes, adverse effects, and interactions, than the nursing staff. A competent pharmacy technician understands the scope of practice and standards of practice, and how they relate to the professional judgment of a technician. A competent, educated and certified pharmacy technician is trained to exercise professional judgment of a technician to alert the pharmacist to any discrepancies that require evaluation by the pharmacist. If this position interest you, prepare yourself by excelling in your educational requirements, demonstrating your skills as a staff technician, building a sense of trust with the pharmacists, and consistently proving your professionalism. Then you must make a formal request to train for this position. Quality Assurance Technician Medication safety has become a major benchmark for pharmacies everywhere. The technician who is involved with the day-to-day functions performed in the pharmacy is in the best position to observe system problems that may be contributing to medication errors. A quality assurance technician should be familiar with all the established protocols for procedures performed in the pharmacy. These protocols should be evaluated regularly and adapted as needed. The technician in this role should be constantly alert for potential problems that may cause a medication error or a breach of aseptic technique. Documentation of any errors that have occurred and the plan to prevent the error from recurring, along with special training session to reinforce skills and education sessions to refresh the memory, would be parts of the role. 11

COMMUNITY BASED CARE Community Pharmacy Practice Community pharmacy is the practice setting that the public primarily envisions when pharmacy practice is discussed. The provision of medication for ambulatory patients is the primary responsibility of community pharmacy practitioners and the volume will increase as a result of an aging population and the trend toward managing more acute conditions and acute exacerbations of chronic conditions in the ambulatory environment. The complexity and sophistication of the medications used in the ambulatory setting, coupled with the increasing number of ambulatory patients, suggests that pharmacists in community pharmacies will become an even more essential access point for acquisition of healthcare services. This trend will continue despite the fact that an increasing number of patients receive their medications and medication information from an institutional or health system-affiliated pharmacy or a pharmacy that is located within an organized primary care medical practice. Community pharmacy is a diverse, dynamic and constantly changing practice environment. First and foremost, community pharmacy is a practice environment that requires good people skills and excellent communication, because the pharmacy personnel deal with patients on a daily basis. Most people visit the community pharmacy more than any other health care setting. Pharmacy technicians play a vital role in this practice setting by assisting the pharmacist in preparing prescriptions, collecting information from patients, and performing several other important functions (many discussed in the goal statements of the Model Curriculum outlined earlier). The number of prescriptions being filled has increased dramatically over the last few years and is only expected to keep rising. One of the reasons for this rise is the aging of the population. People are living longer and as people age, their medication requirements increase. In addition to the aging population, advances in medicine have led to the ability of physicians to treat more disease states in an outpatient setting. These factors, along with the fact that more and more prescription drugs become available each year and more and more patients have access to prescription insurance has allowed for more prescription to be processed in the community pharmacy practice. Because of the rapid growth in the number of prescriptions each year, the community pharmacy environment needs to be open to change and ready to adapt to the challenges of the increased need. One constant change is the role of technology in the processing of prescriptions. Almost all community pharmacies utilize computers to some degree in the prescription filling process. Besides keeping a computerized patient profile, computers in the pharmacy can be used to screen phone calls, accept refill orders, scan prescriptions to prevent errors, and computers are being used to count the units of medication, fill the container, and label the vial or bottle. Computers are also used to alert the pharmacist to drug interactions and transmit insurance information to a patient s insurance company. Many pharmacies utilize e-prescribing technology, where a prescription can be generated at the prescriber s office and electronically transmitted directly into the processing computer at the local pharmacy, eliminating the need to enter information off a paper prescription. 12

With prescription volume increasing and the shortage of pharmacist worsening, the role of the pharmacy technician has increased in the community pharmacy practice. Pharmacist are expanding their role as patient care providers and incorporating more patient-care activities into their daily practice. With the increasing complexity of drug regimens, pharmacists need to be spending more time with the patients, counseling and educating them on their disease states and medication therapy. With these increased tasks, technicians perform many of the technical functions in support of the pharmacist. By allowing pharmacist to spend more time with the patients, receiving care and information, the technician can help them get the most benefit from their therapy. Independent Pharmacies Independent pharmacies consist of one to four stores owned and operated by an individual pharmacist or group of individuals. They vary greatly in size, volume of prescription, and services. A benefit of working for an independent pharmacy is that a technician will usually have direct access to the owner or main decision maker. Also, independent pharmacies are more likely to specialize in one area of pharmacy, such as surgical supplies or home infusion therapy. These specialty areas can offer exciting and diverse opportunities for pharmacy technicians. The technician s responsibilities vary according to the type of pharmacy and the services offered. In a full-service pharmacy the technician may be required to function in all departments of the store depending on the size of the store, the number of employees, and the prescription volume of the pharmacy. Inventory control is an important duty that technicians routinely perform. It is vitally important that an adequate stock of medications be available in the pharmacy so that patients can receive their treatment in a timely manner. There are various ways to control inventory, but most pharmacies use a computerized method. Prioritizing phone calls helps the pharmacist concentrate on patient-care concerns by directing calls that do not truly require the pharmacist s attention to other employees or having the technician respond to questions when possible. Technicians may take refill phone orders from patients. A new prescription from a doctor must be transferred to the pharmacist. A refill order from the doctor may be accepted by the technician if there is no change in the medication strength or directions. Receiving and verifying prescriptions requires the expertise of a competent technician. Chain Pharmacies Chain pharmacies also vary in size, volume, and services and can be differentiated one from another based on the setting in which they are housed. Chain drugstores are the most common, and although these stores sell mostly traditional drugstore merchandise, many of them carry a large variety of products. Chain drugstores can be regional, where they only operate stores in one geographic area, or national, with stores spread out all over the country. Chain pharmacies generally have standard operating procedures that apply to all pharmacies in the system. On-the-job training, technician responsibilities, and general employee regulations are usually described during an orientation period and are often documented in a policy and procedure book and/or employee handbook. Many of the retail technician s responsibilities will 13