Transforming pharmacy technicians for the future

I support the use of pharmacy technicians in many roles inside acute care pharmacies. I believe that they are a valuable tool and, when properly utilized, pharmacy technicians can not only improve pharmacy operations and patient safety, but can also give pharmacists freedom to focus on clinical duties and patient care.

This is why I found a recent article in Pharmacy Practice News so interesting. The article describes a program at Inova Alexandria Hospital in Alexandria, Virginia where the department of pharmacy has developed a system to educate their technicians for expanded roles.

The program outlined in the article is quite extensive and involved. Why would Inova Alexandria Hospital undertake such a task? It’s simple really. As stated in the article: “The implementation of automation means expanded roles for technicians. Automation promotes safety and accuracy, and when used properly, it can save valuable time, freeing up technicians to work in other areas of patient care and enabling pharmacists to act as direct care providers. The American Society of Health-System Pharmacists’ (ASHP) Pharmacy Practice Model Initiative cites technicians as a cornerstone of the future of pharmacy practice and recommends increased educational requirements for technicians in the future.” I couldn’t agree more.

The program consists of monthly sessions targeted at educating technicians about medications and disease states. It is designed to promote interactive discussion and teamwork, and appears to have paid off in spades for Inova. According to the article, “The benefits of the technician education forum are numerous. Technicians have become more engaged and accountable for their work and have reported an increased job satisfaction. Furthermore, teaching technicians about correct dosing and safety allows them to become a second set of eyes for pharmacists. Technicians present concerns or questions during daily activities based on topics and concepts previously presented.”

The article presents examples of how to present clinical information to technicians, and even includes a chart for tips on starting a technician education program of your own. It’s a great article and I encourage everyone involved in pharmacy to take a few minutes to read it.

The future of pharmacy remains uncertain, but it is clear that technicians are an underutilized commodity in acute care pharmacy. Expanding the role of pharmacy technicians can only improve pharmacy practice and serve as a springboard to launch pharmacist into more patient centric activities.

cross-posted at Talyst.com

Improving medication safety with accurate medication lists and education [article]

Here’s an interesting article in the October 2012 issue of Joint Commission Journal on Quality and Safety. The article looks at the impact of pharmacy involvement in the medication reconciliation process. In this “study” pharmacy was involved in ensuring an accurate medication list as well as following up with patients after discharge to “enhance patient safety”.

Overall the results appear positive: improved accuracy of pre-admission medication lists, reduction in medication errors, reduction in 30- and 60-day readmission, and reduction in ADEs associated with readmission and ED visits.

I only have two minor complaints about the article. First, the data is old. It’s good information, but the impact is diluted by the fact that it was collected nearly 2 years ago. And second, you have to have a subscription to read the entire article, or be willing to shell out $20 to download the full text. Information like this should be open access.

Teaching Medication Adherence in US Colleges and Schools of Pharmacy [article]

An article in the American Journal of Pharmaceutical Education takes a look at “the nature and extent of medication adherence education in US colleges and schools of pharmacy”. Surprise, the authors found that “Intermediate and advanced concepts in medication adherence, such as conducting interventions, are not adequately covered in pharmacy curriculums”. Disappointing outcome as medication adherence is one of those areas where I think pharmacists could make a significant impact in not only healthcare outcomes, but reducing costs associated with patient care as well.

The authors used a combination of surveys to gather information: “(1) a national Web-based survey of faculty members at colleges and schools of pharmacy, (2) a national Web-based survey of student chapters of 2 national pharmacy organizations, Phi Delta Chi (PDC) and the National Community Pharmacists Association (NCPA), and (3) conference calls with a convenience sample of pharmacy preceptors and faculty members.”  While the study isn’t exactly comprehensive, I think it may be representative of what’s really going on in pharmacy schools these days. Let’s face it, the focus is on “clinical” activities of which medication adherence is often overlooked.

I won’t bore you with the details as the full text of the article is available for free at the journal’s website. What I will say is that it appears that pharmacy schools teach medication adherence, but fail to dig deep enough or allow students to participate in a meaningful manner when given an opportunity to become involved. This is similar to my experience in pharmacy school. The only place I was really exposed to medication adherence was during a six week internal med rotation. Other than that the subject was only covered in passing.

(10.5688/ajpe76579)

Bibliography

I have seen the end of operational pharmacists in long term care (#LTC)

I spent Saturday, Sunday and Monday in Baltimore, MD at the ASHP Summer Meeting (#ashpsm). I was there for work, and didn’t have an opportunity to participate in any of the sessions. I did however get the opportunity to visit a large long term care pharmacy called Remedi SeniorCare just outside the city. This particular pharmacy is using Paxit robots to handle the dispensing needs for well over 10,000 long term care beds throughout the area.

I am not a fan of robots in general, but I couldn’t help but be impressed with Paxit. The design is groundbreaking, genius and game changing for long-term care pharmacists. My initial impressions were’t exactly flattering, but after watching it run for the better part of an hour, and listening to the owner talk about it, my opinion changed.

During part of the conversation our tour guide said that the company was able to “lay off five pharmacists” after getting the Paxit machines up and running. My gut reaction was one of anger. Who the heck do they think they are to get rid of pharmacists in a pharmacy! After all, I’m a pharmacist and no machine can replace me. Right? Wrong. Paxit does a fine job of replacing pharmacists in their traditional dispensing role. And it doesn’t make mistakes, it doesn’t get tired, it doesn’t whine about working conditions, it doesn’t show up late or call in sick, it doesn’t need benefits, etc, etc. No, the Paxit robot makes perfect sense in this environment both from a business standpoint as well as a safety standpoint; they’ve been filling prescriptions with Paxit for three years and it hasn’t committed a single dispensing error. I wish I had had such a safety record when I was still a real pharmacist.

After my initial reaction I realized that the fault lies with ourselves, i.e. pharmacy practice itself. It’s our own fault. We’ve created a system where we can be replaced by a machine under the right circumstances. Anyone that’s been in pharmacy for any length of time could have told you this was coming, but we haven’t done anything to stop it. And by stop it I mean change our practice. I worked in an LTC pharmacy for nearly two years. It’s brain-numbing work. There’s very little need for a highly trained clinician in an LTC pharmacy. You certainly don’t need a highly trained clinician to check bingo cards or make sure all the right pills are in a med drawer. If you think you do, then you’re wrong. Dead wrong.

Listen up all you pharmacists stuck behind the counter in retail pharmacies or sitting in the “main pharmacy” in a hospital dutifully counting meds as they go out the door. Continuing down the current path of pharmacy distribution is like putting a gun to the head of your pharmacy career. It’s only a matter of time before you’re obsolete, and it won’t be anyone’s fault but your own. It won’t matter for me as the change is probably still 20 years away, but for those of you just starting a new career “in pharmacy”, you should be looking over your shoulder.

Pharmacy technician program standards draft from ASHP now available for comment

This was part of my ASHP NewsLink today - A draft of the updated, revised “Accreditation Standards for Pharmacy Technician Education and Training Programs” [from ASHP] is now available for comment until September 28. After this date, another draft will be developed and made available for one more round of comments.

According to the document “the role of the pharmacy technician is evolving and varies according to state and setting. This role description draws on the one developed by the Pharmacy Technician Educators Council (PTEC)”, and the standards have been developed to:

  • protect the public,
  • serve as a guide for pharmacy technician education and training program development,
  • provide criteria for the evaluation of new and established programs, and
  • promote continuous improvement of established programs.

You can see the actual document here.

Kind of cool, except for the fact that the comment period is open until September followed by another round of comments. At this rate we should have a nice set of standards by the end of… uh…hmm, 2013? Woohoo! Light speed ahead.

Article: A pharmacist-led information technology intervention for medication errors (PINCER)

From a recent article in The Lancet (The Lancet, Volume 379, Issue 9823, Pages 1310 – 1319, 7 April 2012)

Kind of man versus machine study. Actually, it was more like man plus machine versus machine alone.

The control group practices therefore used simple feedback; after collection of data at baseline, control practices received computerised feedback for patients identified as at risk from potentially hazardous prescripting and inadequate blood-test monitoring of medicines plus brief written educational materials explaining the importance of each type of error. Practices were asked to introduce changes they considered necessary within 12 weeks after the collection of data at baseline. Intervention practices received simple feedback plus a pharmacist-led information technology complex intervention (PINCER) lasting 12 weeks.”
Continue reading Article: A pharmacist-led information technology intervention for medication errors (PINCER)

ASHP Summer Meeting 2012 full of pharmacy informatics stuff

I attended the ASHP Summer Meeting last year in Denver, CO for the first time ever. The Summer Meeting was much smaller than the infamous Midyear Meeting, but I must say that there were some great informatics sessions. You can read about my experience last year here:

Well, it looks like the 2012 Summer Meeting is primed and ready to offer just as much interesting informatics stuff this year. The meeting takes place in Baltimore, Maryland June 9-13, 2012. Hope to see you there.
Continue reading ASHP Summer Meeting 2012 full of pharmacy informatics stuff

Effect of med reconciliation on med cost after hospital D/C [article]

The Annals of Pharmacotherapy March 20121

BACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs.

OBJECTIVE: To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

METHODS: A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included.

RESULTS: Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10).

CONCLUSIONS: Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.

Based on the exchange rate mentioned in the study (EUR 1 = USD 1.3443) the six month savings associated with medication reconciliation was about $75 U.S. per patient after factoring in labor. Not exactly earth shattering, but nothing to turn your back on either. At least there’s a positive ROI.

I would have liked to have seen the authors take the study one step further by linking the medication reconciliation savings back to hospitalization readmission and/or effect on the patient’s lifestyle/activity. Once in a while optimizing a patient’s therapy might mean trading a more expensive drug for ease of use or improved patient compliance.

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  1. Karapinar-Çarkit F, Borgsteede SD, Zoer J, Egberts TC, van den Bemt PM, van Tulder M.Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. Ann Pharmacother. 2012 Mar;46(3):329-38. Epub 2012 Mar 6. PubMed PMID: 22395255.

Physician dispensing, that’s some bad mojo right there

Physician dispensing is a hot topic for several reasons. And while I’m not opposed to the use of medication kiosks to dispense medications to patients, I believe that their use must be carefully defined and continuously monitored. As I said in a post in September 2010Under the right set of circumstances, and with thoughtful implementation, kiosks could free up pharmacists to spend more time with patients in emergency departments and urgent care clinics across the country. After all, don’t pharmacists argue for more clinical face time with patients and less association with the physical medication dispensing process? That’s what I’ve been hearing from pharmacists for years.” The key part of that quote is “under the right set of circumstances”. You cannot remove the pharmacist form the medication use process. It would be a mistake to do so, and I believe ultimately would lead to increased patient risk. I’ve worked in retail, long-term care, home infusion and acute care pharmacy, and let’s face it, physicians struggle at times to get things right. That’s why God made pharmacists. While I’m not naive enough to think that a pharmacist has to speak to each and every patient about every medication they use each time they receive it, I do think there should be some oversight of the process; regardless of the method of distribution.
Continue reading Physician dispensing, that’s some bad mojo right there

We’re asking the wrong questions

thoughtful_monkeyA couple of weeks ago I spent the morning with a friend of mine. He also happens to be a pharmacist and the director of a pharmacy IT group for a medium-sized healthcare system. As one might imagine we have similar interests, which means we spend most of our time together talking about pharmacy; where we’ve been, where we’re going, how to make it better, and so on. We both think that pharmacy is moving at a glacial pace when it comes to making important changes and any real change will likely occur long after we’re both retired.

One thing that occurred to us during the conversation was that we always seem to ask the same questions, which always results in the same answers.

  • How do make a process faster [to free up pharmacist’s time]?
  • How do we make a process more efficient [to free up pharmacist’s time]?
  • How do we make a process better [to free up pharmacist’s time]?
  • Etcetera

Continue reading We’re asking the wrong questions