1. Instructor: Milan Topalov

2. Instructor Credentials Education: St. John’s University, Jamaica, N.Y. : Bachelor Degree in Chemistry cum laude. Awarded 1997. Curriculum included organic synthesis, functional group analysis, and other chemical theory study. St. John’s University, Jamaica, N.Y.: Pharm.D in Pharmacy, cum laude. Awarded in 2006. Curriculum included required NYS pharmacy study: pharmacology, pharmacokinetics, therapeutics, pharmacy law. Professional Licensure: NYS licensed Pharmacist (RPH): licensed October 2006

3. Employment History: New York Presbyterian Hospital at Columbia / Cornell 622 W. 168 th Street, New York, N.Y. 10032 Title: Pharmacist Duties as Pharmacist: medication review and order entry, drug information consultation for MD and RN supervision of pharmacy personnel IV admixture preparation Omnicell and Pyxis experience Held: January 2008- Present. Flushing Hospital Medical Center, Flushing NY Title: Pharmacy Intern. Held between December 2002-October, 2006 Title: Pharmacist. Held between October 2006-December 2007 Duties as Pharmacist: medication review and order entry, drug information consultation for MD and RN supervision of pharmacy personnel IV, TPN, and chemotherapy admixture preparation (limited experience)

4. Definition of Pharmacy Technician A pharmacy technician is an individual who is trained to perform certain tasks related to providing pharmacy services to patients in an institutional setting and customers in a community setting. A pharmacy technician is an important part of the pharmacy team who directly assists the pharmacist in the provision of pharmaceutical related care. The expanding role of the pharmacy technician has enabled the pharmacist to spend more time in providing clinical services to patients.

5. Duties performed by a pharmacy technician The duties performed by a pharmacy technician vary according to the state that the technician is employed. Technicians in most states can: Provide purchaser services and place orders for medications to suppliers. Physically fill and handle automated dispensing cabinets (i.e pyxis and omnicell) Assist in Inventory management. Count, pour and label medications for patients Pre pack medications from manufacturer’s packaging to institutional packaging.

6. Duties performed by a pharmacy technician (continued) In NY state a pharmacy technician is allowed to accept written prescriptions presented to the pharmacy by patients and gather patient specific information. A pharmacy technician is allowed to key personal prescription data into a computerized system; however a licensed pharmacist must initial and approve the entries. A pharmacy technician is allowed to handle issues dealing with pharmacy third party payers.

7. Duties that a pharmacy technician can’t provide. In all states, a pharmacy technician can not provide counseling to patients or provide drug information to other health care professionals (i.e MD’s and RN’s). A pharmacy technician can not accept oral orders for prescriptions from health care providers authorized to prescribe drugs (MD, NP, PA) In some states, a pharmacy technician is not permitted to compound medications like creams, ointments, and parenteral agents. All these duties are the responsibilities of the pharmacist or a pharmacy intern. In general, any issue that involves professional judgment requires the pharmacist. Performing these duties can leave you open to legal liability.

8. Patient’s Bill of Rights act of 2005 Typically displaced in every hospital in America Provides a framework to what every patient is entitled to by the nation’s healthcare system Provides for the five rights of medication administration Right Patient Right Route Right Medication Right Time Right Strength See page 37-38 in your textbook

9. Pharmacist Counseling Omnibus Budget Reconciliation Act of 1990 requires the pharmacist to counsel all medicaid patients when: A new patient is added to the pharmacy A new Rx for an existing patient When a change is made to an existing medication that a patient is taking. When flagged by a DUR (drug utilization review) When requested by a patient These counseling points should be covered at the discretion of the pharmacist: Drug, dosage form, special precautions, side effects, proper storage, action to be taken in the event of a missed dose These rights have now been extended to all patients not just medicaid patients.

10. Requirements to be a pharmacy technician 18 years of age High school diploma or GED No felony convinction The above requirements will allow you to be able to take the PTCE which is the Pharmacy Technician Certification Board’s (PTCB) exam The above requirements will allow you to be able to take the ExCPT which is given by Institute for the Certification of Pharmacy Technicians (ICPT). The website for the PTCB is www.ptcb.orgwww.ptcb.org The website for the ICPT is www.nationaltechexam.orgwww.nationaltechexam.org

11. Certification versus Licensing: difference between a pharmacy technician and a pharmacist A license is granted to a pharmacist by the state in which he/she is employed. A certification is granted by a nongovernmental agency that indicates an individual has obtain a certain level of competency in the field in which the certification is granted. States and employers recognize these agencies and often attach highest priority to these individuals possessing certification Many states require these certifications to allow individuals to be registered as pharmacy technicians. Some employers require these certifications for consideration in employment.

12. The Pharmacist: background information A pharmacist is an individual licensed to dispense, compound, and provide drug related advise on medications. A pharmacists can work in a community/retail setting, hospital or institutional setting or in the pharmaceutical setting for drug companies like Pfizer or Sanofi Aventis. Opportunities in these areas exist for the pharmacy technician as well. To be a pharmacist requires: Six years of study in a college of pharmacy to include organic chemistry, physiology, pharmacology and therapeutics among other course work 9 months of internship (part of six year program) Graduation from the program with a PharmD. degree Passage of the NAPLEX exam Passage of the Jurisprudence (Pharmacy Law)exam for the state in which applicant wishes to practice. Registration with the state in which the applicant wishes to practice. 45 CE credits every 3 years to be able to renew registration. License is permanent unless its revoked for professional misconduct.

13. Pharmacy Technicians in the hospital setting Duties includes: ordering of medications from suppliers, filling orders, labeling medications, unit dosing, filling of ADC with legend drugs and controlled substances. At New York Presbyterian/Columbia University Medical Center. Pharmacy technicians are paid between $39,000 to $42,000 per year not including overtime. Pharmacy technicians are 1199 union members. Pharmacy technicians receive 4 weeks paid vacation/year, 12 paid sick days/year, 8 paid holidays/year, and 4 personal days/year. In addition, full time technicians are eligible for a union pension, life insurance, full medical and dental coverage. Pharmacy technician receive good pay for their efforts. PTCB certification is required at NYP

14. With great rewards come great responsibilities A pharmacy technician is a rewarding career and can open the doors to other opportunities. However, with these benefits comes responsibilities. You will be entrusted with people’s medications and you will be handling medications that are controlled substances in the United States (i.e Narcotics like Vicodin®, Percocet®, Xanax®, and stimulants like Concerta® and mixed amphetamines like Adderall ® etc) In some states you will be allowed to compound parenteral products. Mistakes can be costly and can leave you open to legal liabilities.

15. Legal Cases involving Pharmacy Technicians (and Pharmacists) “Rx for errors: Drug error killed their little girl” Article reported in US Today in February, 2008 about 2 year old Emily Jerry in a cleveland ohio hospital. http://emilyjerryfoundation.org/emilys-story/ https://www.youtube.com/watch?v=iru56ZO9tKc

16. Emily Jerry’s Case 2 year old girl was diagnosed with a curable tumor in the abdominal region of her body in 2005. The “cure” became the curse. A pharmacy technician had prepared Emily’s chemotherapy medication using 23.4% solution of sodium chloride instead of the normal 0.9% sodium chloride solution. The pharmacist who was supervising the technician had also missed the error. The baby received the chemotherapy agent and within a few hours was on life support. She died on March 1, 2006. In August 2006, an Ohio grand jury indicted the pharmacist on charges of reckless homicide and involuntary manslaughter "in the death of Emily Jerry.“ Unlike the pharmacist, the pharmacy technician did not face disciplinary charges; however she no longer works at the hospital and now holds a non pharmacy related job at CVS. Congressman, Rep. Steven LaTourette, R-Ohio. introduced Emily’s Act into congress which would mandate certain educational requirements for all pharmacy technicians and provide for restrict legal penalties for misconduct.

17. Legal Cases “Inside a pharmacy where a fatal error occurred” USA Today article published in 2008. Case concerned a 46 year old man with a prescription for methadone in 2001. He had the prescription filled at a walgreens in Florida. He received his prescription and began taking his medication which is a pain killer. Within a day he was found dead in the shower by his wife. An autopsy performed determined the cause of death as a methadone overdose. A legal case was brought against the Jacksonville, Florida walgreens. The plaintiff team determined the cause as a pharmacy technician who keyed the directions for use incorrectly and the pharmacist who was too busy to catch the error. The case was settled out of court.

18. Other cases of Pharmacy errors https://www.youtube.com/watch?v=tPt6ANGnK7s Https://www.youtube.com/watch?v=6JWstD9ov6o https://www.youtube.com/watch?v=G52rBOQwNc8 https://www.youtube.com/watch?v=vxrkQOQLSU8 https://www.youtube.com/watch?v=XEbf9bliOus https://www.youtube.com/watch?v=Gmy2ZR0anLc

19. Pharmacy Technician Certification Board PTCB’s examination, called PTCE (Pharmacy Technician Certification Exam) PTCB is the pharmacy technician certification board, which began in 1995 under the organization of the American Pharmacist Association, American Society of Health System Pharmacist, the illinois Council of Health System Pharmacist, and the Michigan Pharmacist Association. Provides a nationally recognized standard for pharmacy technicians

20. Pharmacy Technician Certification Exam The PTCB’s exam that test and certifies a candidate’s competency as a pharmacy technician To qualify to take the exam you must be: 18 years of age or older Possess a high school diploma or GED ( a foreign diploma equivalent may apply)at a minimum No felony convictions dealing with drugs (misdemeanors also) or misconduct as defined by the NABP Once you pass the exam you may use the acronym CPhT after your name Certification is valid for 2 years at which time renewal is required

21. Competency areas test by the exam: Assisting the Pharmacist in serving patients (66%) Maintain medication and inventory control system (22%) Participation in the administration and management of pharmacy practice (12%) As of November 2013, the competency areas have been slightly modified; however on balance most of the previous material remains the same Visit this page for more detailsthis page

22. To renew a certification you must pay a fee and take 20 hours of CE Credit The Structure of the Exam 90 questions 10 questions are polling questions that do not count towards your score and are meant to gauge questions difficulty in reference to future exams Time to complete: 1 hr. 50 min (with some extra time to complete a tutorial and exit survey) The Results Pass/fail score is reported to you immediately on the test terminal Numerical score and certificate is mailed to your home

23. Application process Apply online: PTCB application herePTCB application here The PTCB will ask you to set up an account Once your application is approved you must pay the application fee of $129 You will receive an authorization to test notification to schedule an exam date and time. You must schedule a date and time within 90 days

24. What is bring with you to the test? You Government issued photo ID (driver’s license) Candidates who don’t bring ID forfeit all fees and will not be permitted to test A erasable scratch board will be provided Handheld and on computer calculators are provided All personal property (include cell phone) will be secured at lockers at the test site Exam offered year round

25. How is the exam graded? Uses the modified Angoff method Panel Experts estimate the difficulty in each question and estimate the percentage of pharmacy technician that can answer the question correctly. More difficult questions are weighted more heavily to the overall score. Each exam is the compared to other exams so that several exams of slightly fluctuating difficulties can be scaled relative to each other. This is called Statistical Equating (SE) Grading is from 1,000 to 1,600 passing is 1,400

26. For more information please view the PCTB website for their guidebookPCTB website

27. Retake policy Candidates are allowed four attempts to pass the PTCE Candidates must apply and pay for each attempt Candidates who are unsuccessful at passing the PTCE must wait 60 days from the most recent attempt to apply for the second and third attempts, and 6 months for the final attempt. After four attempts, candidates will need to petition PTCB in writing for additional attempts. Petitions will only be considered and approved by PTCB based on a showing of reasonable cause or compelling circumstances supporting another examination attempt.

28. Conclusions You as a pharmacy technician have a wonderful career opportunity. You also have a great deal of responsibility. It is your right to receive adequate supervision by your pharmacist. Be proactive and protect yourself. Education is an important part of everyone’s career path. Make it a part of yours. Good Luck