The tech-check-tech model to improve clinical practice

pharm_logo2Earlier this year the American Journal of Health-System Pharmacy published “A vision statement by the ASHP Section of Pharmacy Informatics and Technology”. 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: “Pharmacy 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.” The article goes on to say that pharmacy is using “an obsolete practice model”. 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, I believe a model that supports the movement of pharmacists to the patient bedside should include the use of pharmacy technicians to help bear the burden that keeps pharmacists tied to the physical pharmacy. The idea was quite a topic of discussion when I was in pharmacy school, 1993-1997.

Tucked away in the deepest, darkest corner of the California Code of Regulations there is a section (Title 16, Division 17, Article 11, Section 1793.8 –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.


§ 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 between pharmacy technicians, 99.89%, and that of pharmacists, 99.52%.  This basically means that technicans did a better job. 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 that 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 I’ve worked in here in the Central Valley, only one currently uses a tech-check-tech model. And even they don’t use it to its logical potential.

So tell me pharmacy world, why haven’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 tasks in a hospital pharmacy certainly hasn’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 colleague’s work. Accuracy and safety can be further enhanced by the use of advances in barcoding technology from companies like Talyst. 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 help you get there.

13 thoughts on “The tech-check-tech model to improve clinical practice”

  1. Talyst has worked with a couple of different state pharmacy boards to get tech check tech approved. Remind me and I can hook you up with Dr. Gary Johnson at Talyst User Group to give you the details on the which states and the P&Ps we used to get approval. With pick to light and scanning – this can save tremendous pharmacy time and effort.

  2. The tech-check-tech option is one of the easiest ways I can think of to free up pharmacists. It just doesn’t make sense not to pursue it, especially with all the technology available to us. We need to change infrastructure and the thinking behind it. Thanks for the offer Carla. I look forward to it. See you in Vegas.

  3. Let’s talk Jerry. I’m looking at the Minnesota regs. Let’s chat about California and what Talyst can do to help facilitate this process.

  4. Hello I live in Burlington, MA and we want to start tech check tech percedures, I was hoping if you can give me some advice about that and I am looking forward for this become true. Thank Roza Senior Pharmacy Thech.

  5. Hi Roza,

    It’s difficult to say exactly what should be done as the state laws vary quite a bit when it comes to tech-check-tech. I recommend that you do two things before anything else. First: contact your state board of pharmacy and find out what’s required for your facility to make use of tech-check-tech. Second: contact ASHP and find out how they can help. There are some great groups inside ASHP that can give you some guidance. Good luck.


  6. Hi Jerry,

    I know this and some of your other articles on the topic are a 1-2 years old, but I am just now becoming aware of the existence of the tech-check tech. I am a Pharm tech, and my facility is now talking about using TCT’s, so I am very interested in having that privilege. Like I said, 2 weeks ago I didn’t even know of the existence of TCT’s. I plan on doing research on the requirements to become one. I wonder if there will be additional state-governed/regulated training and licensure, or if it will be mostly the responsibility of the facility to assure competency and experience? Do you have any updated knowledge on this, or any recommendations on where to seek that info?

    I also read your “Unforeseen barrier” article on TCT’s, which talked about automated-packaged medicines. I wanted to make a point: at my hospital, the pharamcist reviews/checks the refilling of the cansiters, and signs that they did so, and once the unit dose pills come out of the machine, the pharmacist also checks that one and only one pill is in each package (although I think techs should be allowed to do this part). So, those meds have already been reviewed and documented as checked by an RPh. Would that not qualify them for later use/checking by a tech and TCT?

    One last point for now, which I haven’t yet heard anyone else mention explicitly: another main benefit that I first think of with having the TCT (depending on what their other responsibilities/duties are during their shift), is that stat orders, lost doses, and new orders will get to the nursing units much faster.

    I work evening shift in inpatient at a 325-bed hospital (soon to be 450-bed), and while I don’t think I could rightly say we work with a bare-bones staff, if the hospital is full or the acuity is high, we are VERY busy. For the bulk of the evening, we have one IV tech, one unit-dose tech, and 3 pharmacists (2 on weekends/holidays). We also have a medication reconciliation tech, but he/she has little-to-nothing to do with the acute care the others are providing. At worst, especailly when we are trying to get our meal breaks in, unit dose meds sit on the counter for an hour before they are checked/sent to the nursing floor. If we had a TCT with a primary responsibility of checking the unit-dose tech, it would drastically reduce that amount of time, which would benefit the nurses and pharmacy staff alike. I assume most if not all IV-mixing would still have to be checked by an RPh.

  7. Hi Brian,

    I am a proponent of TCT. Always have been. I fully support using technicians, and pharmacists, at the top of their licence. It make sense if you think about it for more than 10 seconds. Using technicians to their full potential gives pharmacists an opportunity to do other things, like focus on patient care.

    I find the laws that limit its use archaic and pharmacists that think it’s unsafe silly. The advantages offered by TCT are numerous, and the downsides minimal; in my opinion anyway. I regards to what qualifies certain duties for TCT and others not, you’d have to look at your specific state board of pharmacy laws. Your assumption about utilizing a high-speed packager (canister reference) is valid, but depends on the boards interpretation. In California you’d get dinged because the laws in our state are screwed up. If you read my “Unforeseen barrier” post then you’d know what I mean.

    I would encourage you to pursue TCT to its full potential, whatever that may be. I believe technicians, when use appropriately, can go a long way in improving the profession of pharmacy and getting us to that new practice model everyone keeps talking about. Good luck.


  8. does anyone know how many states currently have TCT program? better yet what % of hospitals across the country are having TCT program?

  9. I don’t have that information, Thuy. You may check with ASHP. They may be able to help you.

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