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Gatekeepers to Customer Care: Pharmacy Technicians in Expanded Roles

Gatekeepers to Customer Care: Pharmacy Technicians in Expanded Roles

Momentum continues to build toward the integration of pharmacists into the overall healthcare team, recognized (and reimbursed) for their clinical knowledge and patient care. But more time on patient care leaves less time for the myriad tasks necessary to prepare, dispense and get paid for medications. This turns the spotlight to pharmacists’ own indispensable team members – pharmacy technicians.

Ed Vess, R.Ph., senior manager of Pharmacy Services and Solutions at QS/1, said good pharmacy technicians are worth their weight in gold, and he wants to see them get the recognition they deserve. “QS/1’s more progressive and profitable pharmacies use technicians to the fullest extent possible,” he said. “They take on time-intensive tasks so the pharmacists can focus on clinical decisions and patient counseling.” His recognition of technicians’ value and potential exists across pharmacy types. The American Society of Health-System Pharmacists launched a new Pharmacy Technician Forum whose executive committee will advise on ways to meet technicians’ professional needs and elevate their roles.

What Pharmacy Techs Can Do

Expanded duties fall on a spectrum from administrative to clinical and depend on the technician’s training and interests, state regulations and individual pharmacist’s needs. Vess said some technicians excel in technical areas. They can be assigned responsibility for tasks such as keeping up-to-date on the store’s pharmacy management software and then training other team members. Technicians with people skills, like a knack for remembering names and other personal details, can be invaluable in a role that enhances customer rapport and loyalty.

Across settings, technicians are performing tasks as varied as patient data collection, insurance resolution, appointment scheduling, marketing, point-of-care testing, sterile and non-sterile compounding and the offsite duties of telepharmacy. Some highly trained clinical technicians review referrals and run reports to triage patients for follow up or perform tasks known as tech-check-tech (usually limited to restocking automated dispensing machines and preparing unit-dose batches but sometimes includes reviewing the work of other technicians).1 One review found that about a third of states allow technicians to take verbal prescriptions or transfer prescriptions, likelier when the state requires registration, certification or disciplinary mechanisms for technicians. Most of these states leave details of how these tasks are delegated to the supervising pharmacist’s judgment rather than to legal specifications.2

Pharmacy Tech Initiatives at the State Level

The issue of expanding technician roles was brought to the Iowa Pharmacy Association by independent pharmacy owners examining what was keeping them from more clinically focused practices, despite higher standards for both pharmacist and technician training. A task force determined that pharmacists’ time was constrained by continued high levels of dispensing work. Their solution was a proposal to allow tech-check-tech.3

In 2016, the Idaho State Board of Pharmacy sought to enlarge the list of tasks that pharmacists can delegate to technicians. This included tech-check-tech, accepting verbal prescriptions, transferring prescriptions, performing remote data entry and immunizations. The board found that pharmacists generally support the expansion when technicians are properly trained, and they were pleased to learn that liability insurers typically acknowledge no increased risk. Technicians themselves reported excitement at the prospect of a career ladder.4

Long at the forefront of expanded technician roles is North Dakota’s Board of Pharmacy. It believes that as pharmacy evolves to serve new healthcare needs, the profession needs technicians to expand their capabilities. Recent initiatives focused on revisions to their administrative code to let pharmacy technicians assess the need for consultation with a patient refilling a prescription. North Dakota chooses certification as the best way to serve the public, hiring pharmacists and technician coworkers, and it has sought a model of baseline knowledge that allows portability from state to state.5

Pharmacy Tech Certification

Like North Dakota, Canada has embraced uniformity in pharmacy technician preparation, but the conversation continues on the U.S. national level. Some stakeholders call for mandatory certification, saying consumers erroneously believe pharmacy technicians have formal education and training, when in reality, regulations vary widely by state regarding prior education, continuing professional education, background checks and registration, licensure and pharmacist-to-technician ratios. Recent initiatives on certification include a 2017 conference hosted by the Pharmacy Technician Certification Board that explored national consensus on entry-level requirements, advanced technician practice, state regulations and standardization models like those of Canada and North Dakota. A task force of the National Association of Boards of Pharmacy recommended that the Pharmacy Technician Certification Board (PTCB) institute more stringent qualifications for its certification exam: completion of an accredited pharmacy technician education and training program and a high school diploma or GED.

An alternate viewpoint elevates the discretion of pharmacists to decide who does what in their pharmacies, just as physicians do. This approach seeks to avoid legal limits that could keep pharmacists from delegating otherwise reasonable tasks. Vess said, “The role of the pharmacy technician should be tailored to individual needs. Certification says they’re all equal, but people’s needs vary.” These differing needs include locales where finding a certified technician is difficult, prohibitive costs for start-up pharmacies and disadvantages for technicians who live in areas where salaries cannot match their investment in formal certification. Although Idaho requires certification for new technicians, it embraced the pharmacist-led approach to job delegation in recent initiatives, acknowledging the importance of individual capabilities, comfort levels and risk mitigation policies.6 Iowa decided the assignment of tasks should ultimately rest with the supervising pharmacist even when the technician has completed related training.7 Additionally, many stakeholders point out that large chain drugstores might use mandated technician certification to replace pharmacist jobs.

Getting Comfortable with New Roles

Regardless of regulations, evolutions in the pharmacy profession will continue. Allowing technicians to work to the pharmacy’s best advantage does not require delegating tasks at the clinical end of the spectrum. Vess advocates that pharmacists push out of their comfort zone of handling paper prescriptions and claims processing themselves, only passing off label printing and pill counting to technicians. He said technicians should handle order entry, claims adjudication, including rejects and reporting tasks – basically any of the time-consuming dispensing functions that take away from face-to-face patient interaction. “Technicians should be employed to remove any barriers that prevent pharmacists from spending more time with their patients,” Vess said.

The Iowa Board of Pharmacy found that while technicians embraced their new role, pharmacists did not always provide the clinical patient care made possible by technicians’ new duties, illustrating the need for changes in pharmacists’ mindset and workflow to make the best use of what is sometimes unpredictable extra time.8 When technicians are trusted with time-intensive dispensing tasks, pharmacists can focus on clinical duties, such as counseling, immunizing and in-depth medication therapy management. These role expansions will require strong pharmacist-pharmacy technician working relationships built on mutual respect and communication. The result is more and better patient care, which is the foundation of independent pharmacy.

Sources:

1 Page, Michael R., Pharm.D., R.Ph. Tech-check-tech programs: What pharmacists need to know. Pharmacy Times. June 10, 2015. Web. 14 Feb. 2018. www.pharmacytimes.com/news/tech-check-tech-programs-what-pharmacists-need-to-know

2, 7 Frost, T., & Adams, A. (2017). Expanded pharmacy technician roles: Accepting verbal prescriptions and communicating prescription transfers [Abstract]. Research in Social & Administrative Pharmacy, 13(6), 1191-1195. Web. 14 Feb. 2018. www.ncbi.nlm.nih.gov/pubmed/27923641

3, 8 Eid, Deeb, Pharm.D., R.Ph. State Roundup: Iowa Initiative Advances Pharmacy Technician Roles in the Community Setting. Feb. 27, 2017. Web. 14 Feb. 2018. www.ptcb.org/about-ptcb/news-room/whats-new-at-ptcb/2017/02/27/state-roundup-iowa-initiative-advances-pharmacy-technician-roles-in-the-community-setting#.Wkz0NlWnGUk

4 Eid, Deeb, Pharm.D., R.Ph. State Roundup: Alex Adams Discusses Idaho’s Proposed Rules to Expand Technician Roles. Nov. 21, 2016. Web. 14 Feb. 2018. www.ptcb.org/about-ptcb/news-room/whats-new-at-ptcb/2016/11/21/state-roundup-alex-adams-discusses-idaho’s-proposed-rules-to-expand-technician-roles#.Wkz2mlWnGUk

5 Skenyon, Caitlin, Pharm.D. State Roundup: North Dakota’s Move toward Expanding Pharmacy Technician Roles at the Counter. May 16, 2017. Web. 14 Feb. 2018. www.ptcb.org/about-ptcb/news-room/whats-new-at-ptcb/2017/05/16/state-roundup-north-dakota’s-move-toward-expanding-pharmacy-technician-roles-at-the-counter#.Wkzw4lWnGUk

6 Adams, A. (2018). Advancing technician practice: Deliberations of a regulatory board [Abstract]. Research in Social & Administrative Pharmacy, 14(1), 1-5. Web. 14 Feb. 2018. www.ncbi.nlm.nih.gov/pubmed/28245969

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