Earlier this year the American Journal of Health-System Pharmacy published â€œA vision statement by the ASHP Section of Pharmacy Informatics and Technologyâ€. The statement represents thoughts on the current state of pharmacy practice and contains a healthy dose of ideas on how technology can help support and improve pharmacy practice.
According to the statement: â€œPharmacy practice, especially practice within the acute care setting, is largely unchanged from what it was 30 years ago. While it can be asserted that new drugs have entered the market, more pharmacists spend some or all of their time in clinical practice, and, to some degree, new technologies have become available, too many pharmacists continue to practice in the acute care settings that provide roughly the same services, using the same practice model now, that they did in 1976.â€ The article goes on to say that pharmacy is using â€œan obsolete practice modelâ€. Unfortunately this is a sad, but ultimately true statement.
The alternative practice model presented in the article calls for pharmacists to move away from the physical pharmacy into a more robust, patient centered practice. It makes sense that the focus of the article is on the use of technolgy to accomplish this goal. With that said,Â I believe a model thatÂ supports the movement of pharmacists to the patient bedside should include the useÂ of pharmacy technicians to help bear the burdenÂ that keeps pharmacists tied to the physical pharmacy.Â The idea was quiteÂ a topic of discussion when I was in pharmacy school, 1993-1997.
Tucked awayÂ in the deepest, darkest corner of the California Code of Regulations there is a section (Title 16, Division 17, Article 11, Section 1793.8 â€“Technicians in Hospitals with Clinical Pharmacy Programs) that allows the use of pharmacy technicians to check the work of other pharmacy technicians under certain circumstances, i.e. tech-check-tech . Section 1793.8 is listed below.
BARCLAYS OFFICIAL CALIFORNIA CODE OF REGULATIONS
TITLE 16. PROFESSIONAL AND VOCATIONAL REGULATIONS
DIVISION 17. CALIFORNIA STATE BOARD OF PHARMACY
ARTICLE 11. ANCILLARY PERSONNEL
Â§ 1793.8. Technicians in Hospitals with Clinical Pharmacy Programs.
(a) A general acute care hospital, as defined in Health and Safety Code 1250(a), that has an ongoing clinical pharmacy program may allow pharmacy technicians to check the work of other pharmacy technicians in connection with the filling of floor and ward stock and unit dose distribution systems for patients admitted to the hospital whose orders have previously been reviewed and approved by a licensed pharmacist.
(1) This section shall only apply to acute care inpatient hospital pharmacy settings.
(2) Hospital pharmacies that have a technician checking technician program shall deploy pharmacists to the inpatient care setting to provide clinical services.
(b) Compounded or repackaged products must have been previously checked by a pharmacist and then may be used by the technician to fill unit dose distribution systems, and floor and ward stock.
(c) To ensure quality patient care and reduce medication errors, programs that use pharmacy technicians to check the work of other pharmacy technicians pursuant to this section must include the following components:
(1) The overall operation of the program shall be the responsibility of the pharmacist-in-charge.
(2) The program shall be under the direct supervision of a pharmacist and the parameters for the direct supervision shall be specified in the facility’s policies and procedures.
(3) The pharmacy technician who performs the checking function has received specialized and advanced training as prescribed in the policies and procedures of the facility.
(4) To ensure quality there shall be ongoing evaluation of programs that use pharmacy technicians to check the work of other pharmacy technicians.
The data to suppot tech-check-tech was published in the American Journal of Healthy-System Pharmacy in 2002. The study was conducted concurently at Cedars-Sinai Medical Center and Long Beach Memorial Medical Center between June 1998 and December 2001. The most interesting part of the study was the comparison of accuracy rate betweenÂ pharmacy technicians,Â 99.89%,Â and that of pharmacists, 99.52%.Â Â This basicallyÂ means that technicans did a better job.Â You may be asking yourself what the big deal is. Well, allowing technicians to check the work of other technicians frees up pharmacists to do what they were trained to do; perform clinical activities.
The above article goes on to say thatÂ pharmacists gained time for direct patient care and were able to expand clinical services during the study period. In addition, pharmacists at both facilities reported increased job satisfaction.
The tech-check-tech provision has been in effect since January 5, 2007. Even with all the data to support the idea, tech-check-tech has never really caught on in any significant way. Of the six hospitals that Iâ€™ve worked in here in the Central Valley, only one currently uses a tech-check-tech model. And even they donâ€™t use it to its logical potential.
So tell me pharmacy world, why havenâ€™t we taken the reins and developed this tool that is right in front of our faces? We all claim to want more time for clinical activities, but few take the time to do anything about it.
The use of technicians to perform many of the common tasksÂ in a hospital pharmacyÂ certainly hasnâ€™t been shown to endanger patients. In fact, the opposite may be true. At the very least technicians can do no worse than a pharmacist in verifying a colleagueâ€™s work. Accuracy and safety can be further enhanced by the use ofÂ advances in barcoding technology from companies like Talyst.Â Our most recent upgrade includes a feature that allows barcode verification during the “checking phase” of items pulled for Pyxis. Not only do the technicians scan the items when they are removed from our carousel, but we have the option to scan each item a second time as it is checked. Does that really require a pharmacist? Certainly not.
Pharmacists need to divorce themselves from the age old belief that they have to lay their eyes on each and every item dispensed from the pharmacy. Move to the bedside where you belong and let the technician helpÂ you get there.