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Advancing the Roles for Pharmacy Technicians in an Evolving Health Care Environment (Part 1): Maine Pharmacy Association and Maine Society of Health-System.

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Presentation on theme: "Advancing the Roles for Pharmacy Technicians in an Evolving Health Care Environment (Part 1): Maine Pharmacy Association and Maine Society of Health-System."— Presentation transcript:

1 Advancing the Roles for Pharmacy Technicians in an Evolving Health Care Environment (Part 1):
Maine Pharmacy Association and Maine Society of Health-System Pharmacists Sesquicentennial Anniversary Meeting October 14, 2017 Presenters: Miriam A. Mobley Smith, PharmD, FASHP

2 CPE Information and Disclosures
Miriam A. Mobley Smith is employed by the Pharmacy Technician Certification Board. She “declare(s) no conflicts of interest, real or apparent, and no other financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.”

3 A competent pharmacy technician workforce will be fundamental to advancing the patient care role of pharmacists in the FUTURE. Response to 20/20 shows we still have a long way to go with the rest of the pharmacy family To meet societal needs for safe and optimal medication therapy management, the profession must set the direction for quality and consistency in pharmacy technician roles, educational preparation, credentialing and regulation.

4 Learning Objectives Describe the evolving national health care landscape and how it serves as the framework for pharmacy technician role/responsibilities expansion. Describe examples of expanded roles and responsibilities for pharmacy technicians and how they may provide opportunities for patient care services advancement, patient safety initiatives enhancement, and pharmacist/pharmacy technician job satisfaction. Explain how state pharmacy regulatory variations in pharmacy technician education, training, certification and licensure may support or suppress advanced roles creation for pharmacy technicians. Contrast and compare possible pharmacy technician education, training, and certification requirements to assume advanced roles and responsibilities.

5 Transitions of the Profession
PHARMACY Access to Care Reimburse-ment Rates Medically Underserved Affordable Care Act Accountable Care Organization Medical Home Model Medicaid Expansion Collaborative Practice Provider Status The pharmacy profession is under pressure to change. Access Affordable Care Act Mergers Collaborations Reimbursements Star Ratings Access to Care Reimbursement Rates Medically Underserved Affordable Care Act Accountable Care Organization Medical Home model Medicaid expansion Collaborative practice Provider status

6 Emerging Pharmacy Technician Roles and Responsibilities
Medication reconciliation Medication therapy management Immunization Indigent care prescription programs Sterile & non-sterile compounding Clinical technicians (e.g., chronic care, appt. scheduling, medication adherence, smoking cessation, vital signs measurements, data management, etc.) Tech-check-tech Point of Care Testing Prescription clarification Quality assurance and quality improvement initiatives OTC Counseling Community outreach programs DUE/ADR monitoring Informatics Purchasing Medication safety initiatives Telepharmacy Refill counseling screening Prescription transfers Board of Pharmacy Education/Educator Determine the difference between clinical and technical roles/responsibilities. We all want provider status to allow pharmacists to be reimbursed by insurance -Increasing pharmacist access to public increases care. -Telepharmacy is allowing pharmacist access to rural areas, pharmacists are rounding as part of the clinical team -Immunization percentage of the public has increased significantly since pharmacists started giving shots -Pharmacists are doing increased clinical tasks, Flu testing, strep testing pilots, MTM growing In order for this to happen, all non-clinical tasks must be delegated -Iowa piloting Tech-check-tech, successful with pharmacists doing more clinical tasks and = or less errors/Idaho less errors than pharmacists In order to delegate, to keep our patients safe, we need to have a standard minimally competent technican. Provider status recognition for pharmacists will provide increasing opportunities for roles & responsibilities delegation -technicians also serve as members of boards of pharmacy and board of pharmacy field inspectors -teachers/educators

7 Increased demand for prescription medications and interprofessional team-based care will lead to more demand for pharmacy services and advanced roles for pharmacists and technicians. Advanced roles require moving technicians from unskilled labor to certification for protection of patient safety. Response to 20/20 shows we still have a long way to go with the rest of the pharmacy family To meet societal needs for safe and optimal medication therapy management, the profession must set the direction for quality and consistency in pharmacy technician roles, educational preparation, credentialing and regulation. Pharmacy Times,

8 Pharmacists Entry into the Profession
State Board Requirements Multistate Pharmacy Jurisprudence Exam (MPJE) North American Pharmacist Licensure Exam (NAPLEX) ACPE Accredited Pharmacy School

Pharmacy technicians do not experience the same linear path into the profession There is no national educational requirement Pharmacy board regulations vary among 50 states + D.C. 45 states regulate pharmacy technicians 23 states include national certification in their regulations Basic stats

10 What do this ketchup bottle and the current U. S
What do this ketchup bottle and the current U.S. pharmacy state board regulations on pharmacy technician education and certification have in common? 50 different sets of regulations 57 varieties of tomatoes

11 State Regulations Vary Widely
45 states and DC regulate pharmacy technicians 24 states include national certification in regulations 3 states accept only the PTCE for national certification 19 states require a background check 22 states require CE 10 states have a pharmacy technician serving on the state Board of Pharmacy 5 states do not regulate pharmacy technicians Many states have pending legislation or regulations 2017 NABP Survey of Pharmacy Law Regulatory Oversight of Pharmacy Technicians 45 States and Washington DC regulate pharmacy technicians Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wyoming 24 States and Washington DC include national certification in their regulations Arizona, California, Connecticut, District of Columbia, Idaho, Illinois, Iowa, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nebraska (4/16), New Mexico, North Dakota, Oregon, South Carolina, South Dakota, Texas, Utah, Washington, West Virginia, Wyoming. Note: Ohio for Qualified Pharmacy Technician 4 States require and/or accept only the PTCB Exam in their states Louisiana, North Dakota, Wyoming. recognizes only PTCB’s Pharmacy Technician Certification Exam. 19 States require a background check Alabama, Arkansas, California, District of Columbia, Georgia, Idaho, Indiana, Louisiana, Maine, Maryland, Mississippi, Missouri, New Jersey, Ohio, Oregon, Tennessee, Texas, Utah, West Virginia, Wyoming 22 States require continuing education Alabama, Alaska, Arizona, District of Columbia, Florida, Idaho, Illinois, Kansas, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Mexico, North Dakota, Oregon, South Carolina, Texas, Utah, Virginia, Washington, Wyoming 10 States have a pharmacy technician serving on their Board of Pharmacy Arizona, Massachusetts, Michigan, Montana, North Dakota, Oregon, Texas, Utah, Washington, Wyoming However… 5 States do not regulate pharmacy technicians Colorado, Hawaii, New York, Pennsylvania, Wisconsin 15 States have pending legislation, regulation or board discussions Pharmacy Technician Certification Board Updated: May 26, 2016 *This data, based on research performed by PTCB, is for PTCB’s internal use only.

12 Various Points of Entry for Pharmacy Technicians
PTCE ExCPT State exam Programmatically accredited Non accredited Community based Hospital based Registration Licensure Certification Board Regulation Employer Training Board Approved Exam Formal Education

Well-educated and highly skilled pharmacy technicians have important roles and responsibilities in the pharmacy enterprise. Safe and effective medication-use process depends significantly on the skills, knowledge, and competency of those pharmacy technicians. To properly fill these roles, pharmacy technicians require standardized education, training, and competency assessment. Pharmacists’ ability to redistribute their focus to more clinical and patient-centered activities is dependent upon pharmacy technicians utilization in key roles within the medication-use system. Moving toward Provider Status: The education, training, and certification of pharmacy technicians as well as the accreditation of pharmacy technician education/training programs have progressed greatly, yet there continues to be a lack of consistency and standardization of these elements due to many issues and influencing factors. There is a need to establish national standards for the education, training and certification of pharmacy technicians to provide the optimal deployment of the pharmacy workforce tomeet the health care demands and delivery of quality health care services to the public. The pharmacy profession has an obligation to ensure that pharmacy technicians are subject to rigorous standards—standards that are required of pharmacists and other health care professionals in order to provide the highest quality health care to improve patient outcomes and protect the public’s health. ASHP Statement on the Role of the Pharmacy Technicians American Society of Health-System Pharmacists. ASHP statement on the roles of pharmacy technicians. Am J Health-Syst Pharm. 2016; 73:928–30.

Usually requires additional: Experience Education Training Competencies (including analytical and problem-solving skills) Certification Competence Assessment Supervision of pharmacists State Board of Pharmacy approval Career ladders Liability issues Pharmacist resistance

CLINICAL SUPPORT TECHNICIAN Patient screening for counseling and services Appointment scheduling Refill reminders Medication history Device training and vital sign measurement Point of care testing Patient outcomes data Vaccine administration PATIENT ASSISTANCE PROGRAM TECHNICIAN Patient identification for services Appointment scheduling Patient application completion, tracking and follow-up Interprofessional team Billing and payment monitoring ICD-10 coding May also assist in chronic care activities, medication adherence assessment, smoking cessation, taking vital signs, and data management. Point of care testing is best described as a quick and simple lab test which can be performed in the pharmacy (e.g. A1C, Cholesterol, Liver/Kidney function, Hep C, group A strep, influenza and others. Technicians are immunizing in Idaho and Washington Other roles/responsibilities include: Community outreach programs Refill counseling screening Board of Pharmacy seat Indigent care prescription programs

MANAGEMENT OR SUPERVISION Supervision of other pharmacy technicians Development of position descriptions Development of policies and procedures Scheduling Personnel evaluations Education and training Projects management TECH-CHECK-TECH (TCT) Perform final verification on a product for which prospective drug utilization review had been previously performed by a pharmacist Perform final verification for medications under the control of an ordering prescriber such as those in an automated dispensing system. TCT: In community pharmacy for at least 14 yrs discussions on community pharmacy TCT are under way in at least Arizona, Idaho, Iowa, South Dakota, and Wisconsin. A key question will be what education and training tech-checkers should have. The studies as stated here required technicians to be nationally certified, have a minimum level of practice experience (2000hrs +), complete advanced didactic training (training modules), and successfully complete a validation period prior to participating in a TCT model. Pharmacy technicians statistically outperformed pharmacists in 6 of the 11 studies reviewed. Moreover, these studies demonstrate that pharmacists were able to devote more time to direct patient care services, with a range of 10 hours per month to 1 hour per day. Additional institutional TCT studies have been published since the aforementioned systematic review, all with similar results. These newer TCT publications have reported even greater pharmacist time savings, ranging from 50 hours per month to 5.75 hours per day.

INVESTIGATIONAL DRUGS TECHNICIAN Manage drug and supply inventories and tracking expiration dates Monitor for study protocol, regulatory and policies compliance Database management Coordinate sponsor visits Personnel orientation and training SPECIALTY MEDICATION TECHNICIAN Obtain patient home medication regimens Refill management Medication adherence monitoring Prior-authorization management Patient assistance program management Inventory management Insurance reconciliation Mailing/shipment management Other Advanced Institutional Role/Responsibilities include: DUE/ADR Monitoring Medication safety initiatives Medication therapy management, including assistance with pharmacokinetic dosing Tech check Tech

CONTROLLED SUBSTANCE SURVEILLANCE TECHNICIAN Maintain controlled substances records Conduct audits Prepare and distribute utilization and related reports Serve on interdisciplinary monitoring teams MEDICATION RECONCILIATION TECHNICIAN Obtains patient prior-to-admission medication list from variety of sources Compiles discharge medication lists and corresponding SNF admission lists Communicates with patients, caregivers and other health care professionals Communicates and documents activities Assists the pharmacist in collecting, collating, maintaining, and auditing records of controlled substance utilization within the organization. May involve procurement, dispensing, distribution, and administration of controlled substances. Patient medication lists from patient, family, caregiver, outpatient pharmacies, physician offices, dialysis centers, skilled nursing facilities (SNFs) for pharmacist review and reconciliation Accurate medication list at admission-accurate list at discharge Med rec: Sen et al. Am J Health-Syst Pharm. 2014;71(1):51-6. Smith et al. Hosp Pharm. 2013;48(2):112-9.

AUTOMATION/IT TECHNICIAN Configuration, testing, device rollout, troubleshooting Bar coding and scanning Maintenance of medication automation formulary databases Development of rules/alerts Quality assurance audits Staff development and training Special projects TELEPHARMACY TECHNICIAN Pharmacy technician at remote site Processes and/or dispenses prescriptions (may be home-based) Facilitates videoconferencing between pharmacist & patient Completes medication transactions May use automated drug dispensing systems Generates reports Automation technician: Collaborates with pharmacy and other health care informatacists on data management methods Needs to understand: IT systems/technology Pharmacy/medical terminology Inventory/procurement Clinical environment Communications—oral and written Telepharmacy technician Saves pharmacies that might otherwise close down Increases access to medications Increases access to patient counseling Relieves pharmacists in rural hospitals due to lack of health care professionals Friesner et al. J AM Pharm Assoc. 2011;51: Yam et al. J Am Pharm Assoc. 2009;49: Image:

DOCUMENTATION Medication errors Medication adverse events Drug utilization evaluation Drug recall coordination RESEARCH Patient satisfaction REGULATORY COMPLIANCE Medication recall coordination Maintaining staff competency database Performing audits Pharmacy staff education PHARMACY ACCREDITATION PREPARATION Works closely with pharmacists and other health care team members to ensure compliance to regulatory and legal standards.

21 How Will Technology Drive Roles?
As technology continues to expand, how will the roles that I described continue to evolve? The profession should drive this… Incremental Change Paradigm Shift

22 The Way Forward Elevate standards within the profession to meet the demands of the growing healthcare system Improve patient care, outcomes & access Support evolving roles & scope of practice Advocacy efforts with legislators, pharmacy associations and other stakeholders Provide platform to advance pharmacy technicians Technicians must have education, training and credentials to advance with the pharmacy workforce

23 Summary Pharmacy technician roles are evolving as pharmacist scope of practice is expanding. Regulatory variations for pharmacy technicians may support or suppress advanced roles creation. Future role changes and expectations for pharmacy technicians can be anticipated. Pharmacy technicians should be educated, enabled, and empowered to assume advanced roles to improve patient care and foster medication safety.

24 Practicing at Top Of Our License!!!
Summary about how they are the leaders of pharmacy, the voice of their states, and can help drive Pharmacists to the top of their License Developing advanced roles for pharmacy technicians frees pharmacists to focus on clinical pursuits and improves patient care. Moreover, encouraging technician career advancement improves job satisfaction for technicians. Uniformly, technicians in specialty roles demonstrate pride in their work, enjoy the challenges of their unique positions, and appreciate the ability to assist patients, other health care providers, and the public.

25 Discussion on Key Issues
Pharmacy Technician Education Entry-level knowledge, skills, abilities Certification/recertification State laws and regulations Advanced practice Other

26 Self-Assessment Question #1
Which of the following statements are true? The lack of uniform national standards for pharmacy technician education, training, and certification enhances roles and responsibilities advancement. Pharmacy technician roles and responsibilities have advanced as a result of expanded direct patient care role for pharmacists. The elevation of education, training and certification requirements for pharmacy technicians has been eagerly adopted across all pharmacy practice sectors. Pharmacy technician education and training requirements for entry-level practice roles are equivalent to those for advanced practice roles. B-There are numerous examples of how pharmacy technician roles and responsibilities have advanced across the country as a result of expanded roles for pharmacists and more specific identification/delegation of clinical vs. technical roles/responsibilities across pharmacy settings.

27 Self-Assessment Question #2
Which of the following are not emerging roles and responsibilities for pharmacy technicians? Patient counseling for OTC medication and prescription drug transfers Anticoagulation dosage adjustment and medication reconciliation Prescription clarification and tech-check-tech in community pharmacies Chronic care clinic medication history and influenza vaccine administration B: technicians are assuming all the other roles in states such as Illinois (prescription clarification), Iowa and others (tech-check-tech), Idaho (vaccine administration), Utah (OTC counseling) several states (chronic care clinic medication), Maine/Idaho/South Carolina (prescription transfers). Technicians do not assume clinical roles such as medication dosage adjustment.

28 Self-Assessment Question #3
Which of the following statements are true? Medication reconciliation technicians may compile discharge medication lists for skilled nursing home patient admissions. Patient assistance technicians must be familiar with ICD-10 coding. Tech-check-tech programs are conducted in both community and health-system pharmacy settings. All of the above. D-All of the above are true.

29 Self-Assessment Question #4
A “registered certified” pharmacy technician may be authorized to serve in which of the advanced roles as compared to a “registered” pharmacy technician? Accept new oral medication prescriptions Perform the final tech-check-tech program verification in both health-system and community settings Work remotely, including remote order entry, in a telepharmacy practice setting or home-based setting. All of the above. D-All of the above are true.

30 References Glowczewski J. Advanced Pharmacy Technician Practice Model Case Study South Pointe Hospital Warrensville Heights, Ohio A Cleveland Clinic Hospital Technician-Initiated Medication Histories in the Emergency Department. 9 New Ways Pharmacy Technician Roles Are Changinghttp:// Mihalopoulos C, Powers MF. Roles for Pharmacy Technicians in Community Pharmacy Practice Accreditation. J Pharm Technol 2013;29: Desselle S, Holmes ER National Pharmacy Technician Workforce Study Sponsored by: Pharmacy Technician Accreditation Commission (PTAC), Pharmacy Technician Certification Board (PTCB), and Pharmacy Workforce Center (PWC) . Report Pharmacy Technician Workforce Survey.pdf ASHP Statement on the Pharmacy Technician’s Role in Pharmacy Informatics Am J Health-Syst Pharm. 2014; 71: Knoer et al. A review of American pharmacy: education, training, technology, and practice. Journal of Pharmaceutical Health Care and Sciences (2016) 2:32 DOI /s  

31 References Laubenstein D. Specialized Roles for Pharmacy Technicians. Pharmacy Purchasing and Products. April Vol. 13 No. 4:18 Friesner et al. Expanding the role of pharmacy technicians. J AM Pharm Assoc. 2011;51: Yam, Expanding the role of pharmacy technicians. J Am Pharm Assoc. 2009;49: Sen, Exploring the role of hospital pharmacy technicians and assistants to enhance the delivery of patient centered care. Am J Health-Syst Pharm. 2014;71(1):51-6. Smith et al. Pharmacy impact on medication reconcilliation in the medical intensive care unit. Hosp Pharm. 2013;48(2):112-9.

32 Thank you. Miriam A. Mobley Smith, PharmD, FASHP
Director of Strategic Alliances Pharmacy Technician Certification Board (PTCB)

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