Is pharmacy destined to repeat history?

Every time I turn around someone is talking about the need for change in pharmacy practice. That’s a good thing. In fact, it’s a great thing. I’ve discussed my thoughts in detail on this site before so I don’t feel the need to rehash everything I’ve said. Suffice it to say there is a buzz in the air.

I read an interesting article this morning at the ASHP Intersections website about the expanding role of technicians in pharmacy practice. While the article focuses a bit too heavily on the need for providing better education for technicians to fill this new role, it does make one thing perfectly clear: “As Pharmacists expand their roles and carve out new niches in an era of health care reform, they are counting more and more on highly skilled pharmacy technicians to take on added responsibility.” Well said.

Now that we all agree on what’s needed from our technicians, how do you propose we get there? It’s clear that ASHP believes in advocacy along with pharmacy technician certification as the answer. Sounds great, in a global sense, but what model allows technicians to assume more responsibility in the physical pharmacy, thus allowing pharmacists the freedom to move to the patient bedside to perform more clinically relevant duties?

The answer isn’t as complex as many would think. Along with a heavy dose of regulatory bureaucracy, healthcare will need to make use of all sorts of automation and technology. And along with that technology the Boards of Pharmacy in representative states will need to begin thinking outside the box.

Simple plan, right? Not so fast buckaroo. Remember when automated dispensing cabinets entered the pharmacy world? Everyone thought that pharmacists would be out of a job. Boy, were they wrong. How about when the Baker Cell arrived on the retail scene? Pharmacists thought their practice environment would improve. Bzzt, wrong again. How about when robotics were introduced? I remember when the facility I was working in went through a robot installation. It was supposed to handle the cart fill and make life easy. What a joke that turned out to be. I think in created more work than it eliminated.

Ok, so why did all these wonderful new technologies fail to make pharmacists more “clinical”? No one wants to hear the truth, but I’m going to tell you anyway. The simple truth is we (collective we) didn’t take the time to adjust our thinking and change the core of what we do. I’ve been scolded by pharmacists for suggesting that 80%, or more, of the work done in the central pharmacy of an acute care hospitals could be handled by a combination of good technicians and technology. Am I wrong?

Think about it. Technicians already do a bulk of the dispensing. Most of the time pharmacists are simply there to wave their hand over the final product like some Jedi Drug Master. We don’t need Jedi Drug Masters to ensure proper medication dispensing. What we need are Jedi Pharmacists protecting the patients at the point of contact, intercepting medication management issues before they become a problem, helping the medical team decide on the best course of therapy to ensure effective treatment, working to improve medication outcomes, driving down resistance with judicious use of antimicrobials, saving the healthcare system billions by advocating cost conscious medication use and avoiding adverse drug events, doing research, etc. Quite simply, pharmacists need to get out of the pharmacy and create a better healthcare system in the image chosen by the profession not by someone else.

History’s a bugger, and it’s always in the rearview mirror challenging us. The trick is not letting it sneak up on you, again.

5 thoughts on “Is pharmacy destined to repeat history?”

  1. Gosh, I can’t agree with you more. I was just explaining to someone today that as a Tech in the hospital I worked at, i did 80 % of the things the Pharmacists did. This wasn’t because I was such a great tech, but because the Pharmacists are so limited by the walls of the system. Ferrari’s are under utilized when they’re only allowed to drive around the block…agree? Same thing. They can rev, chirp their tires, look pretty and go the speed limit, but can’t you do that in a Honda Accord too? What do you do though Jerry? You have the Physician/Nurse model….How about increasing the education requirements/responsibilities of techs, so they get some physiology/anatomy/intro to pharmacology etc.. Allow tech-check-tech combined with automated filling technology to take over dispensing duties? I know this isn’t a super new idea, but it seems like a solution that could get pharmacists more involved in the things that they are/were trained to do. Ferrari’s operate best on the open road.

  2. What to do indeed, Aaron. That is a question for the ages. There is no easy solution, only ideas. I’d like to see significant changes in both acute care and the “retail” segment of pharmacy, but that’ll take some serious convincing because there’s a lot of politics and money involved in what I propose.

    And about the Ferrari…I’d say more like a VM bus; classic, old and tired, but still clung to by many.

  3. I think, the reason we, pharmacists, dont want to let go of dispencing duties is a fear for a out job security, we dont want to loose our place in the pharmacy before we establish ourselves on a new territory, on the hospital floor.

  4. Hi Zina – I think you have a good point. With that said there’s nothing to prevent us from becoming obsolete long before we create a viable alternative at the rate we’re going. We, as a profession, have been talking about establishing ourselves “on the floor” for 20 years and haven’t been successful. In fact, we’ve gone backward a couple of times during that span. I remember when satellites and pharmacists on the floor were all the rage. Then budgets got tight and everyone was pulled back into a centralized model. If we had truly established ourselves “on the floor” things would have played out differently. Now we’re starting to creep out onto the floors again with no change in practices model…thin ice. Of course this is only my opinion and worth nothing more than the paper it’s written on.

    Thanks for stopping by

Leave a Comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.