Advancing the Role of Advancing the Role of Pharmacy Pharmacy TechniciansTechnicians

Radhika Pisupati, Pharm.D., BCPSRadhika Pisupati, Pharm.D., BCPS

Lynette Richards, Pharm.D., BCPSLynette Richards, Pharm.D., BCPS

St. Joseph’s Healthcare SystemSt. Joseph’s Healthcare System

Conflicts of InterestConflicts of Interest

We do not have a vested interest in or We do not have a vested interest in or affiliation with any corporate organization affiliation with any corporate organization offering financial support or granting offering financial support or granting monies for this continuing education monies for this continuing education activity, or any affiliation with an activity, or any affiliation with an organization whose philosophy could organization whose philosophy could potentially bias our presentation.potentially bias our presentation.

ObjectivesObjectives

Describe the ASHP Pharmacy Practice Describe the ASHP Pharmacy Practice Model Initiative recommendation on Model Initiative recommendation on pharmacy technician practicepharmacy technician practiceIdentify reasons to expand role of Identify reasons to expand role of pharmacy technicians within the healthcare pharmacy technicians within the healthcare systemsystemDescribe expanded roles of pharmacy Describe expanded roles of pharmacy technicians technicians Identify barriers to pharmacy technician role Identify barriers to pharmacy technician role expansionexpansion

Question?Question?

With the adoption of the latest healthcare With the adoption of the latest healthcare reform, pharmacists and pharmacy reform, pharmacists and pharmacy technicians will be legislatively limited to technicians will be legislatively limited to dispensing roles.dispensing roles.

True or FalseTrue or False

Question?Question?

With the adoption of the latest healthcare With the adoption of the latest healthcare reform, pharmacists and pharmacy reform, pharmacists and pharmacy technicians will be legislatively limited to technicians will be legislatively limited to dispensing roles.dispensing roles.

True or True or FalseFalse

ASHP Pharmacy Practice Model ASHP Pharmacy Practice Model InitiativeInitiative11

Group of healthcare leaders convened in 2010 Group of healthcare leaders convened in 2010 to optimize the future of pharmacy practice to optimize the future of pharmacy practice – Goals Goals

Advance the health and well-being of patients Advance the health and well-being of patients

Develop and disseminate optimal pharmacy practice modelsDevelop and disseminate optimal pharmacy practice models

Effectively use pharmacists as direct patient care Effectively use pharmacists as direct patient care providers by optimizing pharmacy technician rolesproviders by optimizing pharmacy technician roles and and technologytechnology

– Tools for implementationTools for implementationHospital self assessmentHospital self assessment

C-suite resourcesC-suite resources

ASHP Pharmacy Practice Model ASHP Pharmacy Practice Model InitiativeInitiative22

Healthcare systems must considerHealthcare systems must consider– System accountabilitySystem accountability

Fiscal responsibilityFiscal responsibilityResource deploymentResource deploymentIncreased demand Increased demand Performance improvement measuresPerformance improvement measuresPatient safety Patient safety Data collectionData collection

– Call for restructuring patient care managementCall for restructuring patient care management– BarriersBarriers

Staff development and trainingStaff development and trainingTechnologyTechnologySystem cultureSystem culture

Have you completed PPMI self-assessment Have you completed PPMI self-assessment tool?tool?

Figure 1. PPMI HAS Completion by State. ASHP 2015

ASHP PPMI Self-Assessment ToolASHP PPMI Self-Assessment Tool

– All distributive functions that do not require pharmacist judgmentAll distributive functions that do not require pharmacist judgment– Medication history (MH) collectionMedication history (MH) collection– Medication allergy verificationMedication allergy verification– ““Tech-check-tech” (TCT)Tech-check-tech” (TCT)– Sterile compoundingSterile compounding– Clinical monitoring compilation Clinical monitoring compilation – Inventory managementInventory management– Medication assistance programMedication assistance program– Quality improvement programsQuality improvement programs– Information technologyInformation technology– Supervisory role/lead techniciansSupervisory role/lead technicians– Board certificationBoard certification

Benefits of Advanced RolesBenefits of Advanced Roles

Increased pharmacist mobility and patient Increased pharmacist mobility and patient profile reviewprofile review

Increase employee satisfactionIncrease employee satisfaction

Increased nursing satisfaction and Increased nursing satisfaction and multidisciplinary relationshipsmultidisciplinary relationships

Improved turn around timesImproved turn around times

Decreased medication costsDecreased medication costs

Decreased medication errorsDecreased medication errors

BarriersBarriers

Lack of standardized regulations and Lack of standardized regulations and trainingtraining

Diversity of requirements for entry into the Diversity of requirements for entry into the workforceworkforce

Administration (C-Suite)Administration (C-Suite)

IncentiveIncentive

BarriersBarriers

Lack of standardized Lack of standardized regulations and trainingregulations and trainingDiversity of requirements for entry into the Diversity of requirements for entry into the workforceworkforce

Administration (C-Suite)Administration (C-Suite)

IncentiveIncentive

Tri-State Area Pharmacy Tri-State Area Pharmacy Technician RegulationsTechnician Regulations

StateState RegulatedRegulated Registration Registration with the with the Board of Board of PharmacyPharmacy

Documented Documented continuing continuing education/ education/ training req.training req.

National National certification certification req.req.

ConnecticutConnecticut YesYes YesYes YesYes YesYes

New JerseyNew Jersey YesYes YesYes No, unless No, unless certified certified (PTCB/ExCPT)(PTCB/ExCPT)

NoNo

New YorkNew York No No No No No, unless No, unless certified certified (PTCB/ExCPT)(PTCB/ExCPT)

NoNo

Best Practices in Advanced Technician Best Practices in Advanced Technician RolesRoles

Tech-Check-Tech Tech-Check-Tech 4,54,5

Several studies published on TCTSeveral studies published on TCT

Comparable accuracy Comparable accuracy

Improved clinical outcomesImproved clinical outcomes

Memorial Hermann Southeast Hospital (TX)Memorial Hermann Southeast Hospital (TX)– Medication cart fillMedication cart fill– Floor stock medication refillFloor stock medication refill

Patient care areaPatient care area

Automated dispensing deviceAutomated dispensing device

– Patient specific orders previously reviewed and Patient specific orders previously reviewed and approved by a pharmacistapproved by a pharmacist

Information TechnologyInformation Technology66

Collaborate with pharmacist informaticist Collaborate with pharmacist informaticist

Manage automation and technology systemsManage automation and technology systems

Develop and implement end-user educationDevelop and implement end-user education

Stay updated on newest technologyStay updated on newest technology

Ensure appropriate and accurate charges Ensure appropriate and accurate charges billingbilling

Compile and analyze data reportsCompile and analyze data reports

Supervisory Role/Lead Supervisory Role/Lead TechnicianTechnician

Duke University Health SystemDuke University Health System– HiringHiring

– Orientation/trainingOrientation/training

– Performance appraisalsPerformance appraisals

– Work distributionWork distribution

– Inventory ordering and managementInventory ordering and management

– Cost containmentCost containment

– Performance improvement and quality assurancePerformance improvement and quality assurance

– Clinical coordinator for affiliated programs and Clinical coordinator for affiliated programs and schoolsschools

Compounding Compounding PreparationPreparation– Sterile IV compounds Sterile IV compounds – ChemotherapyChemotherapy– Neonatal/Pediatric oral and IV syringesNeonatal/Pediatric oral and IV syringes

TrainingTraining– Aseptic techniqueAseptic technique– USP 797 complianceUSP 797 compliance– Calculations Calculations – Additional institution specific requirement(s)Additional institution specific requirement(s)

Certification Certification

ASHP-APhA Medication Management in ASHP-APhA Medication Management in Care Transitions Best Practices (MMCT)Care Transitions Best Practices (MMCT)77

Developed to ascertain best practices of transitions of Developed to ascertain best practices of transitions of care by pharmacists and Pharmacy Technicianscare by pharmacists and Pharmacy Technicians

Winning programsWinning programs– Einstein Healthcare NetworkEinstein Healthcare Network– Froedtert HospitalFroedtert Hospital– Hennepin County Medical CenterHennepin County Medical Center– Johns Hopkins MedicineJohns Hopkins Medicine– Mission HospitalsMission Hospitals– University of Pittsburgh School of PharmacyUniversity of Pittsburgh School of Pharmacy– University of Utah Hospitals and ClinicsUniversity of Utah Hospitals and Clinics

Cassano, A. ASHP-APhA Medication Management in Care Transitions Best Practices. Rep. American Society of Health-System Pharmacists and American Pharmacists Association, Feb. 2013.

Programs with Pharmacy Programs with Pharmacy Technicians InvolvementTechnicians Involvement

Winning programsWinning programs– Einstein Healthcare NetworkEinstein Healthcare Network– Froedtert HospitalFroedtert Hospital– Hennepin County Medical CenterHennepin County Medical Center

– Johns Hopkins MedicineJohns Hopkins Medicine– Mission HospitalsMission Hospitals– University of Pittsburgh School of PharmacyUniversity of Pittsburgh School of Pharmacy

– University of Utah Hospitals and ClinicsUniversity of Utah Hospitals and Clinics

Cassano, A. ASHP-APhA Medication Management in Care Transitions Best Practices. Rep. American Society of Health-System Pharmacists and American Pharmacists Association, Feb. 2013.

Pharmacy Technician Role

Einstein • ‘APPLE’ Role – Ambulatory Pharmacy Patient Liaison Empowerment

• Attend discharge rounds, interview patients and assess medication needs

• Facilitate discharge prescriptions• Triage and screen patients that require pharmacist intervention

Froedtert Discharge prescription processing, insurance verification, adjudication, prior authorization, filling and delivery

Johns Hopkins

Discharge prescription processing, insurance verification and claim adjudication, referrals to patient assistance program

Mission • Make initial contact with patients at discharge. • Make follow up arrangements with providers.• Three follow up phone calls after discharge (72 h, 1 week of first

refill, after 1st visit with PCP)• Alert pharmacist regarding medication discrepancies

University of Utah

Partner with pharmacists for discharge, thrombosis referrals, clinic services, transplantation care and MTM services

Einstein Healthcare NetworkEinstein Healthcare Network

Cassano, A. ASHP-APhA Medication Management in Care Transitions Best Practices. Rep. American Society of Health-System Pharmacists and American Pharmacists Association, Feb. 2013.

Rx Team Model: ResultsRx Team Model: Results

Pharmacy technicians rolePharmacy technicians role– Emergency department pharmacy technicians from several Emergency department pharmacy technicians from several

hospitals received praise at ASHP Midyear 2013 for 96% hospitals received praise at ASHP Midyear 2013 for 96% accuracyaccuracy

– The Hospital of Central Connecticut (THOCC) Pharmacy The Hospital of Central Connecticut (THOCC) Pharmacy technician and pharmacist collaborationtechnician and pharmacist collaboration

– 25,000 ED medication reconciliations from late 2012 to late 2013 25,000 ED medication reconciliations from late 2012 to late 2013 with documentation showing 96% accuracywith documentation showing 96% accuracy

– Other ED health care providers showed 66% accuracyOther ED health care providers showed 66% accuracy

Cooper University Hospital Cooper University Hospital Camden, NJ; Monday-Friday from 7:00 am- 3:30 pmPatient interviewed by pharmacy technician within 72 hours of admissionInformation collected• List of all home medications• Outpatient pharmacy information • Healthcare provider information

Home medications verified by contacting• Outpatient pharmacy• Physician’s office• Long term care facility/skilled nursing facility

Pharmacists identified and resolved any noted medication reconciliation discrepancies

Sen S, et al. Am J Health-Syst Pharm. 2014; 71(1): 51-56.

Cooper University HospitalCooper University Hospital

Desired technician skillsDesired technician skills– Strong communicationStrong communication– Attention to detailAttention to detail– Self-motivationSelf-motivation– Hospital work experience Hospital work experience – Retail pharmacy Retail pharmacy

experience contributed to experience contributed to strong communication strong communication skills and increased skills and increased knowledge of commonly knowledge of commonly prescribed medications prescribed medications

Training processTraining process– One-on-one supervision One-on-one supervision

by pharmacy technician by pharmacy technician mentormentor

– Orientation to medication Orientation to medication reconciliation process and reconciliation process and EHR computer trainingEHR computer training

– Instruction on patient Instruction on patient interview techniquesinterview techniques

– Role observationRole observation

Sen S, et al. Am J Health-Syst Pharm. 2014; 71(1): 51-56.

Cooper University Hospital Cooper University Hospital

PerspectivesPerspectives• Technicians – improved job satisfactionTechnicians – improved job satisfaction

• Pharmacists focused on the integration and connection Pharmacists focused on the integration and connection between a hospital stay and patient’s care as an outpatient between a hospital stay and patient’s care as an outpatient

• Program bridged care between the inpatient and outpatient Program bridged care between the inpatient and outpatient realms of pharmacy and physician services realms of pharmacy and physician services

• Physicians were able to focus on patient care rather than Physicians were able to focus on patient care rather than time-consuming medication history process and time-consuming medication history process and appreciated the time savedappreciated the time saved

• Program enhanced patients’ experiences by improving the Program enhanced patients’ experiences by improving the quality of bedside carequality of bedside care

Sen S, et al. Am J Health-Syst Pharm. 2014; 71(1): 51-56.

Morton Plant Hospital Morton Plant Hospital

Clearwater, FLClearwater, FL

Patients > 18 years old admitted directly Patients > 18 years old admitted directly from ED between 1:00pm and 9:30 pm and from ED between 1:00pm and 9:30 pm and taking at least 3 medications were includedtaking at least 3 medications were included

Two certified pharmacy technicians hired Two certified pharmacy technicians hired for processfor process

Previous process: ED nurses collected Previous process: ED nurses collected medication history medication history

Hart C, et al. P&T. 2015; 40(1): 56-61.

Morton Plant Hospital Morton Plant Hospital

Training processTraining process• On-site training by PGY1 pharmacy practice On-site training by PGY1 pharmacy practice

resident over 2 weeksresident over 2 weeks• Medication history process: patient interview, Medication history process: patient interview,

checklist utilization, reviewing and updating checklist utilization, reviewing and updating old records, and contacting patient’s pharmacyold records, and contacting patient’s pharmacy

• Trained to document allergy information and Trained to document allergy information and last dose taken of each medication last dose taken of each medication

• Trained on computer software Trained on computer software

Hart C, et al. P&T. 2015; 40(1): 56-61.

Morton Plant Hospital Morton Plant Hospital

Hart C, et al. P&T. 2015; 40(1): 56-61.

Morton Plant Hospital Morton Plant Hospital

Hart C, et al. P&T. 2015; 40(1): 56-61.

Medication HistoryMedication History

MH Collection and allergy verification pilot at MH Collection and allergy verification pilot at SJRMC (emergency department)SJRMC (emergency department)– TrainingTraining

Discussed importance of initiativeDiscussed importance of initiative

Required to complete MH related continuing educationRequired to complete MH related continuing education

Verbally instructed on patient interview processVerbally instructed on patient interview process

Technician observed pharmacist perform interview processTechnician observed pharmacist perform interview process

Technician assessed performing patient interviewTechnician assessed performing patient interview

Obtain translator certificationObtain translator certification

– ImplementationImplementationMH collection in ED by technicianMH collection in ED by technician

Medication list verified by technician and pharmacistMedication list verified by technician and pharmacist

ResultsResults

Results Results Percent Error Rate of Pharmacy Technicians

versus Non-Pharmacy Personnel

15%

65%

0%

10%

20%

30%

40%

50%

60%

70%

Pharmacy Technicians Non-Pharmacy Personnel

RRR=77%ARR=50%

p<0.001

Medication History at SJHSMedication History at SJHS

MH Collection and allergy verification at MH Collection and allergy verification at SJRMC (emergency department)SJRMC (emergency department)– Future directionFuture direction

Implementation of pharmacy technician MH Implementation of pharmacy technician MH program in SJRMC-EDprogram in SJRMC-ED

Continuous quality assurance and improvementContinuous quality assurance and improvement

Routine training and educationRoutine training and education

Optimize current software utilizationOptimize current software utilization

Technician RolesTechnician Roles

OR TechnicianOR Technician– Procedural complianceProcedural compliance

Clinical TechnicianClinical Technician– Data collection for trials, MUEsData collection for trials, MUEs– Unit inspections/off site inspectionsUnit inspections/off site inspections– Sample medicationsSample medications– Patient assistance programPatient assistance program– Aseptic technique testingAseptic technique testing

Technician RolesTechnician Roles

Automated Dispensing Cabinet (ADC)Automated Dispensing Cabinet (ADC)– Optimize inventory in ADCsOptimize inventory in ADCs– Drug diversion surveillanceDrug diversion surveillance– Troubleshoot failures/other problems with Troubleshoot failures/other problems with

ADCsADCs

InformaticsInformatics

Inventory ManagementInventory Management

ASHP PPMI Self-Assessment Tool: ASHP PPMI Self-Assessment Tool: SJHS ExperienceSJHS Experience

Most distributive functions that do not require Most distributive functions that do not require pharmacist judgmentpharmacist judgment√ √ Medication history (MH) collectionMedication history (MH) collection–Medication allergy verificationMedication allergy verification–““Tech-check-tech” (TCT)Tech-check-tech” (TCT)√ √ Sterile compoundingSterile compounding√ √ Clinical monitoring compilation Clinical monitoring compilation √ √ Inventory managementInventory management√ √ Medication assistance programMedication assistance program√ √ Quality improvement programsQuality improvement programs√ √ Information technologyInformation technology√ √ Supervisory role/lead techniciansSupervisory role/lead technicians√ √ Board certificationBoard certification

Question?Question?

All of the following are avenues for All of the following are avenues for pharmacy technician role advancement pharmacy technician role advancement except?except?

A.A. Inventory managementInventory management

B.B. Procedural compliance initiativesProcedural compliance initiatives

C.C. Quality improvement initiativesQuality improvement initiatives

D.D. Medication order verificationMedication order verification

Questions?Questions?

ReferencesReferences1. "Pharmacy Practice Model Summit: Executive Summary." AJHP 68 (2011): 1079-085. Web. Aug. 2015.

<http://www.ajhp.org/content/68/12/1079.full.pdf+html>.

2. Wellikson, Larry. "Healthcare Imperative for Practice Model Change." PPMI. Aug. 2015. PPMI: Pharmacy Practice Model Initiative. Web. Aug. 2015. < <http://www.ashp.org/DocLibrary/PPMI/PPMI-Opening-Session.aspx>.>.

3. “PPMI Hospital Self-Assessment Worksheet.” PPMI. Aug. 2015. PPMI: Pharmacy Practice Model Initiative. Web. Aug 2015 <http://www.ppmiassessment.org/docs/assessment_questions.pdf >.

4. Samuel, Rachel. Liem, Aily. “Tech-Check-Tech Program Implementation and Operational Impact.” TSHP. March. 2012. Web. Aug. 2015. <http://www.tshp.org/uploads/12-023_Samuel_Liem_TechCheckTech.pdf>.

5. Page, Michael. “Tech-Check-Tech Programs: What Pharmacists Need to Know” Pharmacy Times: published online. June 2015. Web. Aug. 2015. <http://www.pharmacytimes.com/news/tech-check-tech-programs-what-pharmacists-need-to-know>.

6. “ASHP Statement on the pharmacy technician’s role in pharmacy informatics.” 2013. Web. Sept. 2015. <http://www.ashp.org/doclibrary/bestpractices/autoitstptrolepharminform.aspx>.

7. Cassano, A. “ASHP-APhA Medication Management in Care Transitions Best Practices.” Feb. 2013. Web. Aug. 2015. <http://media.pharmacist.com/practice/ASHP_APhA_MedicationManagementinCareTransitionsBestPracticesReport2_2013.pdf >.