Advanced Roles for Pharmacy Technicians: PPMI Update and

Pharmacy Technician Law Review

John B. Hertig, PharmD, MS, CPPSAssociate Director

Assistant Clinical Professor of Pharmacy PracticeCenter for Medication Safety Advancement

Purdue University College of PharmacyIndianapolis, IN

September 19th, 2014

Disclosure Statement

• None of the presenters have actual or potential conflicts of interest in relation to this presentation

Learning Objectives

• Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana

• Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles

• List at least two examples of advance pharmacy technician roles in various practice settings

Learning Objectives

• Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana

• Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles

• List at least two examples of advance pharmacy technician roles in various practice settings

First Things First

• Audience response: how many of you have heard of the ASHP Pharmacy Practice Model Initiative?

Why Change?

• Professions must continually assess their practice to determine whether expertise is being maximized• Healthcare reform• Increased emphasis on quality and safety• Social and economic influences

• Pharmacy practice changes• Doctor of Pharmacy degree• Residency training

Why Change?• More patients, increased demand

• Payment tied to performance• Move away from fee-for-service payments

• Challenge to US health care system to improve quality and cost effective care

• Meanwhile…pharmacists recognized as:• drug therapy experts• medication use process experts

• Better Care!

AJHP 2009;66:713

Impact

• All these factors have combined to drive critical discussions regarding change within the health-system pharmacy profession

• Where do we go from here…?

What is our professional future?!

Our Future. Now.

The Purpose of the PPMI• Describes how pharmacy department resources are deployed to provide care

• One size does not fit all• Does include:

• How pharmacists practice and provide care to patients

• How technicians are involved to support care• Use of automation/technology in the medication use system

AJHP 2010;67:542

PPMI = Practice Advancement

Considerations for All of Us• “The capacity of 1”

• How much can we do with limited resources?• Where do our priorities lie?

• Ensuring we practice at “the top of our license”• Ensuring the best care across ALL practice settings• Hospital, ambulatory, long-term care, community, and

so on…• Teamwork is essential!

Where is Indiana?

PPMI in Indiana• Indiana Pharmacy Practice Model Taskforce

• Indiana Society for Health-System Pharmacists• Steering group for hospital practice model change • 13 members

• Step 1 : focus on completion of Hospital Self-Assessment (HSA)• Provides current practice data for Indiana• Allows for identification and dissemination of

advanced and “lagging” pharmacy practices

ASHP Foundation Grant• Step 2: identify practice priorities

and begin implementation• Grant awarded in February 2013• Workshop held May 23rd 2013

• 50 attendees from across Indiana• Established consensus opportunities and priorities• Helped develop a state affiliate strategic plan for advancing

pharmacy practice• Workshop results communicated

• Task force: steering group responsible for implementation

PPMI Impact: Advancing the Pharmacy Technician

ASHP Technician Initiative

To develop an educated, trained, certified, and registered pharmacy technician workforce in every state in order to improve medication use safety and expand access to the patient care services of pharmacists. Our hope is to achieve this mission through a partnership between ASHP and state affiliates, with a mutual goal of advocating...

*ISHP Board voted unanimously to join in November 2013

Going to the Source

New Pharmacy Technician Law

SEA 233 Overview• Changes pharmacy technician “registration” to licensure

• Formally establishes a technician license in the statute• Began July 1, 2014

• Requires high school diploma or graduate equivalency degree

• Outlines requirement for minimum standards that all employer-based training programs must meet• Developed by Board of Pharmacy by July 1, 2015• All programs must be resubmitted for approval with newly

developed standards

• All technicians licensed prior to July 1, 2015 are “grand-fathered” into old requirements

“Unless someone like you cares a whole lot, nothing is going to get better. It’s not.”

- Dr. Seuss

Learning Objectives

• Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana

• Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles

• List at least two examples of advance pharmacy technician roles in various practice settings

Pharmacy Technician Education and National Certification

Melynda Ludwick, BS., RPh

Program Director

IU Health Pharmacy Technician Program

Methodist Hospital, Indianapolis

Pharmacy Technician Education• Traditional pharmacy technician training was on the job

• ASHP began accrediting Pharmacy Technician education programs in 1983

• IU Health’s Pharmacy Technician Program began and was initially accredited in 1999

• Today: 258 ASHP accredited programs

ASHP-Accredited* Pharmacy Technician Training Programs

*PTAC will begin accrediting in 2015Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP

Number and Type of ASHP-Accredited *Pharmacy Technician Programs

*PTAC will begin accrediting in 2015

Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP

Why is Education Important?

• Pharmacists are “working at the top of their license”

• Pharmacy technicians are taking on more job responsibilities including more clinical functions

• Pharmacy technician job growth from 2012 to 2022 is expected to be 20% according to the Bureau of Labor Statistics

http://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm

National Certification• Two types of national certification recognized by the Indiana Board of Pharmacy• ExCPT : National Healthcare Association• PTCE : Pharmacy Technician Certification Board

• PTCB • Established in 1995 by APhA; ASHP; IL Council of

Health-System Pharmacists and MI Pharmacists Assoc.; NABP joined in 2001

• In 2006, PTCB became accredited by The National Commission for Certifying Agencies (NCCA)

PTCB Exam ContentUpdated PTCE Effective November 1, 2013

 

Knowledge Domains Domain Description % of PTCE Content

1 Pharmacology for Technicians 13.75

2 Pharmacy Law and Regulations 12.50

3 Sterile and Non-sterile Compounding 8.75

4 Medication Safety 12.50

5 Pharmacy Quality Assurance 7.50

6Medication Order Entry and Fill

Process 17.50

7 Pharmacy Inventory Management 8.75

8 Pharmacy Billing and Reimbursement 8.75

9Pharmacy Information Systems

Usage and Application 10.00

Requirements for Taking Exam

• Criminal background check required in 2014• Note: Any felony conviction, drug or pharmacy-related

violations, or State Board of Pharmacy action taken against license or registration must be reported at the occurrence and at the time of recertification to the PTCB

• ASHP-accredited pharmacy technician education required by 2020

Postponed to an undetermined date - personal communication

Ultimate Goal • A well-qualified and trained workforce

• Improved patient safety

• Standard knowledge base in technician workforce

• Trained technician workforce can assume more pharmacy-based technical tasks

• Less turnover in pharmacy technician positionsSlide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP

Activities of Pharmacy TechniciansTr

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Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP

Learning Objectives

• Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana

• Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles

• List at least two examples of advance pharmacy technician roles in various practice settings

Advanced Roles for a Pharmacy Technician

Liz Swan, CPhT

Order Set Specialist

Investigational Drug Technician

IU Health Pharmacy

Indianapolis

Shaping a pharmacy technician advanced role

One Step at a Time…Evolution of an Order

Set1.) Request Received2.) Regimen Verified3.) Order Set Drafted4.) OncPOG Review5.) Final Draft Created6.) Sent to Pharmacist for

Review7.) Physician Review and

Signature8.) Submitted to Informatics

Pharmacist for PCO Build9.) Pharmacy and Physician

Validate Build10.) Order Set Posted to IU

Health Intranet and Activated in PCO

It Takes a Village• 12 is the magic number

• 8 Pharmacists• 2 Physicians• 1 Nurse• 1 Certified Pharmacy Technician

• 12 is the number of people who review an order set before it is built in Powerchart Oncology

Advanced Roles for a Pharmacy Technician

Andy Galligan, CPhT

Distribution System Supervisor

Community Health Network

Indianapolis

Medication Reconciliation TechnicianWhat is medication reconciliation?As defined by The Joint Commission:

Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking

1) Develop a list of current medications.

2) Develop a list of medications to be prescribed.

3) Compare the medications on the two lists.

4) Make clinical decisions based on the comparison.

5) Communicate the new list to appropriate caregivers and to the patient.

The Patient Interview• Courtesy is KEY (knock before entering)• Privacy- DO NOT discuss a patients medications in

front of family/visitors without the patient’s permission• SMILE

• Make eye contact• Introduce yourself• Let the patient know what you are there to do• End with “Is there anything else I can do for you… I have the time!”

• Remember you may be the only “face of pharmacy” this patient/family sees-you’ve got to be on your game at all times

• What is a medication? According to the patient?

The Patient Interview• Allergies- This may be the most important information on

the medication list• “Do you have any allergies to medications?”• “What happens when you take this medication?”• “Do you have any allergies to latex?”• “Do you have any allergies to IV contrast dye?”• “Do you have any allergies to food?”

• Patients Preferred Pharmacy

• Include all the medications (OTCs, etc)

The Patient Interview• Barriers to Obtaining an Accurate Medication List• “I take a pink pill for my heart.”

• “My doctor just changed my medications around and I don’t know what I am taking.”

• “My wife always takes care of my medications.”

• “Here is my pill box-this is what I take everyday.”

• Patient does not speak English

A technician safety success story• Safety Success Story

• CHN technician discovered a loading dose of vancomycin was ordered on a patient in the hospital

• From “digging a little deeper” the technician discovered that patient was already receiving vancomycin via home health care

• Loading dose of vancomycin was not given and dose was adjusted

• Avoided excessive vancomycin dose

Medication Assistance Program

A new pharmacy technician position to help patients navigate the process of obtaining “free” drug through manufacturers and other various resources

Red Tape

Patient

AccessTo

Medication

Medication Assistance TechnicianStep 1: Patients in need of help are given the contact information of Medication Assistance Technician

Step 2: Technician evaluates which drugs are eligible for reduced pricing (or free)

Step 3: Technician works with the manufacturer and/or navigates existing federal or state programs to provide the drug to the patient free of charge

Medication Assistance Technician• As of May 1, 2014 the Medication Assistance program

saved Community Health Network patients 2 million dollars since inception

• Since May 1, 2014 – Community Health Network has saved an additional 1 million dollars resulting in total savings of 3 million dollars

Medication Assistance Technician• The program is growing….

• Technician dedicated to chemotherapy drugs in on-site Cancer Clinic

• Recently hired 2 more technicians to accommodate the growing number of patients taking

advantage of the program

Advanced Roles for a Pharmacy Technician

Amanda High, CPhT

Senior Pharmacy Technician

Walgreen’s Onsite Pharmacy

Fort Wayne

The Bedside Pharmacy Technician• The tools for the bedside technician

• Small shopping cart on wheels• A clip board• A cell phone• Smile and Hello

• Walgreen’s “girl” at the hospital• Often face of pharmacy - questions for the pharmacy• Accepting refill requests

• Workflow• List of patients for discharge• Rx written by prescriber?• Patient visit• Anticipated discharge time

• What is a medication? According to the patient?

The Bedside Pharmacy Technician• Patient Visit

• Smile and greet• Availability and convenience of DC Rx

• Challenges to DC Rx Prescriptions• Lack of insurance• Language barriers

• The process• Patient interaction• Helping patients• Make a wish foundation - Hawaii

ID Discharge

Rx Fill

Bedside Delivery

The Bedside Pharmacy Technician

Advanced Roles for Pharmacy Technicians

• Breakout Groups (at your tables)

• Discuss an advanced role for a pharmacy technician you have seen or have implemented in your pharmacy

• Can the role be expanded (either in scope or in number of technicians performing it)

Questions?

Advanced Roles for Pharmacy Technicians: PPMI Update and

Pharmacy Technician Law Review

September 19th, 2014