As long as pharmacists have been dispensing medications, pharmacy technicians have been assisting in the medication delivery process, and as the profession of pharmacy evolves, so too must the roles and responsibilities of pharmacy technicians. To create an environment where pharmacists are consistently able to practice to the top of their license requires the development of technician roles that are capable of supporting pharmacy’s clinical efforts. Technician roles must be driven by standardized education and training along with pharmacy’s commitment to develop effective pharmacy technician programs.
Pharmacy Technician Landscape
More than 380,000 pharmacy technicians are employed in the US, with 16% of those working in a hospital setting.1 While 44 states currently regulate pharmacy technicians through registration, certification requirements, training requirements, ratios, or licensure, these regulations vary widely, ranging from no requirements at all, to a high school diploma, to requiring accredited education and/or national certification (see Figure 1).2
National pharmacy organizations have supported the role of pharmacy technicians for decades. Over the last five years, national pharmacy organizations have increasingly focused on promoting technician training, education, certification, and regulatory oversight. The Council for Credentialing in Pharmacy and the National Association of Boards of Pharmacy, among others, have designated task forces to build consensus on these issues. In 2010, the ASHP Pharmacy Practice Model Initiative Summit made a number of recommendations, including that technicians should be assigned to distributive functions not requiring clinical judgment, such as compounding sterile preparations and filling automated dispensing cabinets (ADCs), and advocated the development of opportunities for technician specializations. Summit participants agreed that for their recommendations to be met, uniform national standards should be required for the education, training, certification, and regulatory oversight of pharmacy technicians.3 Additionally, in early 2011, the Pharmacy Technician Certification Board’s (PTCB) C.R.E.S.T. Initiative Summit presented a national survey of pharmacists and technicians that indicated overwhelming support for national standards for training, education, certification, and regulatory oversight of pharmacy technicians.4
Technician Education, Training, and Certification
Unlike technical roles in many other professions, there is presently no national standard for pharmacy technician education and training. This makes the hiring process challenging for employers, as there are often vast differences in the education and training that job applicants have received. Thirty-three states require training of pharmacy technicians, with many states requiring training through a board of pharmacy–approved training program, encompassing associate’s degree programs, sufficient training to pass a competency exam, or on-the-job training.2 ASHP is the only programmatic accreditation body for pharmacy technician programs, which are usually vocational/technical, community college programs, or employer-based; however, the number of programs that earn and maintain the ASHP accreditation is growing. Key aspects of ASHP’s accreditation are the hours required and the experiential learning required in its curriculum.5
Nationally accredited certification examinations document competency for pharmacy technicians in all areas of pharmacy practice. Eighteen states require national certification to work as a pharmacy technician, and additional states require passing a state-approved certification exam.2 Also, employers may opt to require certification prior to employment through one of two national certification examinations: PTCB’s Pharmacy Technician Certification Examination and the National Healthcareer Association’s (NHA) ExCPT Pharmacy Technician Certification Exam. Since 1995, more than 440,000 pharmacy technicians have been certified by PTCB, and as of 2009, another 5,100 were certified by the NHA.6,7
Expanding Roles for Technicians
Technician involvement in current pharmacy practice encompasses any medication- or pharmacy-related roles or responsibilities that do not require the clinical judgment of a pharmacist. According to the C.R.E.S.T. Summit proceedings, most commonly technicians are involved in purchasing and inventory maintenance, data input, billing and insurance, assisting in prescription dispensing, pre- and re-packaging, compounding sterile and nonsterile products, and leadership or supervisory roles.4 The ideal technician roles enable pharmacists to devote additional time to direct patient care. Thus, it is important to continually look for opportunities to expand technician responsibilities or even create new roles for technicians that permit pharmacists to then work to the top of their license.
Medication Safety and Quality Assurance
Direct patient care and decision making requiring clinical judgment to prevent or treat medication errors is clearly the responsibility of the pharmacist, but the detective work and documentation required to support a strong medication safety and quality assurance program does not have to be. Reviewing and investigating reports, documenting missing factual information, and collating the associated data can become the responsibility of a medication safety technician, and implementing such positions can lead to timely research and documentation.8 Technicians also can perform smart infusion pump, ADC, and narcotic vault audits to ensure quality measures are being met. Similarly, pharmacy technicians can assist in increasing a pharmacy’s ability to comply with regulations, such as USP Chapter <797>.9 Expanded responsibilities in this area could include training new employees and conducting competency assessments.
At least 10 states permit tech-check-tech (TCT) programs, and technicians in areas of the federal pharmacy sector have been operating in a TCT model for many years.2 In most cases, pilot programs are required prior to extending the practice statewide, and often the final rules limit TCT to institutional settings and final checks on refills. Additional requirements of most TCT programs include advanced education and training, along with ongoing quality assurance measures. In a 2011 meta-analysis of TCT programs, 11 studies reported that the accuracy of a pharmacy technician’s final dispensing check is comparable to that of a pharmacist’s.10 With advances in technology assisting in dispensing verification, TCT programs continue to evolve, and additional states are exploring or revisiting the concept.11
Drug Shortage Management
Purchasing medications and maintaining inventory is not a new role for technicians, but the recent surge of drug shortages has elevated these responsibilities to a new level. The number and acuity of drug shortages affects all health care practitioners; the time technicians spend managing drug shortages is comparable to that of pharmacists (8 hours per week vs 9 hours per week, respectively).12 Shortages continue to require substantial staff time to identify products on shortage, secure medications, track inventory levels, alert practitioners, and disseminate new protocols. Making the logistical management of drug shortages a natural extension of technician duties will free up pharmacist time to manage the clinical issues that result from these shortages.
Leadership and Supervision
Career ladders or tiered advancement programs for technicians often have lead technicians or technician supervisors at the top rung; however, not everyone is a natural leader or supervisor. It is vital to define roles for technician supervisors and to provide leadership training, just as would be provided for a pharmacist supervisor. If your department does not have formalized supervisory positions for technicians, leadership opportunities can be created in other ways. Consider appointing technicians to department- or hospital-wide committees, and encourage technicians to take on significant leadership roles in projects, such as redesigning processes. Certified technicians can be key to the success of various projects, and should also be afforded the opportunity to author articles detailing such projects.
With the advent of medication reconciliation regulations, health systems have developed creative ways to comply, and many hospitals have used these new regulations as an opportunity to utilize the skills of well-trained pharmacy technicians. Although clinical medication reconciliation responsibilities must be performed by pharmacists, in most states pharmacy technicians can research and document patient medication histories; support physicians, nurses, and pharmacists in program facilitation; assist with the logistics of patient medication transfer; and provide translation assistance services for patients who are not fluent in english.
The high turnover rate of pharmacy technicians—currently close to 13%—can hinder any attempts to expand technician roles and responsibilities.13 The following strategies can help to increase retention and fill the void of experienced pharmacy technicians:
Pharmacy technicians continue to play a vital role within the pharmacy department. Implementing programs to expand the professional opportunities available to experienced, committed, and growth-oriented pharmacy technicians can help elevate their role while adding value to your pharmacy department and institution.
Angela T. Cassano, PharmD, BCPS, has held positions as a clinical pharmacist in pediatrics, Clinical Assistant Director, and Assistant Health System Director of Quality Assurance and Drug Safety. In 2005, she founded Pharmfusion Consulting, which focuses on quality and regulatory assurance, medication safety and technology, clinical programs, and operations solutions. Angela is also employed as a consultant to PTCB.
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