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 MeetingOctober 14, 2017Presenters: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 familyTo 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 ObjectivesDescribe 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 PHARMACYAccess to CareReimburse-ment RatesMedically UnderservedAffordable Care ActAccountable Care OrganizationMedical Home ModelMedicaid ExpansionCollaborative PracticeProvider StatusThe pharmacy profession is under pressure to change.AccessAffordable Care ActMergersCollaborationsReimbursementsStar RatingsAccess to CareReimbursement RatesMedically UnderservedAffordable Care ActAccountable Care OrganizationMedical Home modelMedicaid expansionCollaborative practiceProvider status
6 Emerging Pharmacy Technician Roles and Responsibilities Medication reconciliationMedication therapy managementImmunizationIndigent care prescription programsSterile & non-sterile compoundingClinical technicians (e.g., chronic care, appt. scheduling, medication adherence, smoking cessation, vital signs measurements, data management, etc.)Tech-check-techPoint of Care TestingPrescription clarificationQuality assurance and quality improvement initiativesOTC CounselingCommunity outreach programsDUE/ADR monitoringInformaticsPurchasingMedication safety initiativesTelepharmacyRefill counseling screeningPrescription transfersBoard of PharmacyEducation/EducatorDetermine 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 growingIn 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 pharmacistsIn 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 familyTo 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 RequirementsMultistate Pharmacy Jurisprudence Exam (MPJE)North American Pharmacist Licensure Exam (NAPLEX)ACPE Accredited Pharmacy School
9 PHARMACY TECHNICIAN ENTRY Pharmacy technicians do not experience the same linear path into the professionThere is no national educational requirementPharmacy board regulations vary among 50 states + D.C.45 states regulate pharmacy technicians23 states include national certification in their regulationsBasic 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 regulations57 varieties of tomatoes
11 State Regulations Vary Widely 45 states and DC regulate pharmacy technicians24 states include national certification in regulations3 states accept only the PTCE for national certification19 states require a background check22 states require CE10 states have a pharmacy technician serving on the state Board of Pharmacy5 states do not regulate pharmacy techniciansMany states have pending legislation or regulations2017 NABP Survey of Pharmacy LawRegulatory Oversight of Pharmacy Technicians45 States and Washington DC regulate pharmacy techniciansAlabama, 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, Wyoming24 States and Washington DC include national certification in their regulationsArizona, 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 Technician4 States require and/or accept only the PTCB Exam in their statesLouisiana, North Dakota, Wyoming. recognizes only PTCB’s Pharmacy Technician Certification Exam.19 States require a background checkAlabama, Arkansas, California, District of Columbia, Georgia, Idaho, Indiana, Louisiana, Maine, Maryland, Mississippi, Missouri, New Jersey, Ohio, Oregon, Tennessee, Texas, Utah, West Virginia, Wyoming22 States require continuing educationAlabama, 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, Wyoming10 States have a pharmacy technician serving on their Board of PharmacyArizona, Massachusetts, Michigan, Montana, North Dakota, Oregon, Texas, Utah, Washington, WyomingHowever…5 States do not regulate pharmacy techniciansColorado, Hawaii, New York, Pennsylvania, Wisconsin15 States have pending legislation, regulation or board discussionsPharmacy Technician Certification BoardUpdated: 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 PTCEExCPTState examProgrammatically accreditedNon accreditedCommunity basedHospital basedRegistrationLicensureCertificationBoard RegulationEmployer TrainingBoard Approved ExamFormal Education
13 GOING IN THE SAME DIRECTION 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 TechniciansAmerican Society of Health-System Pharmacists. ASHP statement on the roles of pharmacy technicians. Am J Health-Syst Pharm. 2016; 73:928–30.
14 PHARMACY TECHNICIAN ADVANCED ROLES/RESPONSIBILITIES Usually requires additional:ExperienceEducationTrainingCompetencies (including analytical and problem-solving skills)CertificationCompetence AssessmentSupervision of pharmacistsState Board of Pharmacy approvalCareer laddersLiability issuesPharmacist resistance
15 ADVANCED ROLES IN COMMUNITY PHARMACY PRACTICE CLINICAL SUPPORT TECHNICIANPatient screening for counseling and servicesAppointment schedulingRefill remindersMedication historyDevice training and vital sign measurementPoint of care testingPatient outcomes dataVaccine administrationPATIENT ASSISTANCE PROGRAMTECHNICIANPatient identification for servicesAppointment schedulingPatient application completion, tracking and follow-upInterprofessional teamBilling and payment monitoringICD-10 codingMay 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 WashingtonOther roles/responsibilities include:Community outreach programsRefill counseling screeningBoard of Pharmacy seatIndigent care prescription programs
16 ADVANCED ROLES IN COMMUNITY PHARMACY PRACTICE MANAGEMENT OR SUPERVISIONSupervision of other pharmacy techniciansDevelopment of position descriptionsDevelopment of policies and proceduresSchedulingPersonnel evaluationsEducation and trainingProjects managementTECH-CHECK-TECH (TCT)Perform final verification on a product for which prospective drug utilization review had been previously performed by a pharmacistPerform 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 minimumlevel 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 todirect 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 systematicreview, 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.
17 ADVANCED ROLES IN INSTITUTIONAL/HEALTH-SYSTEM PHARMACY PRACTICE INVESTIGATIONAL DRUGS TECHNICIANManage drug and supply inventories and tracking expiration datesMonitor for study protocol, regulatory and policies complianceDatabase managementCoordinate sponsor visitsPersonnel orientation and trainingSPECIALTY MEDICATION TECHNICIANObtain patient home medication regimensRefill managementMedication adherence monitoringPrior-authorization managementPatient assistance program managementInventory managementInsurance reconciliationMailing/shipment managementOther Advanced Institutional Role/Responsibilities include:DUE/ADR MonitoringMedication safety initiativesMedication therapy management, including assistance with pharmacokinetic dosingTech check Tech
18 ADVANCED ROLES IN INSTITUTIONAL/HEALTH-SYSTEM PHARMACY PRACTICE CONTROLLED SUBSTANCE SURVEILLANCE TECHNICIANMaintain controlled substances recordsConduct auditsPrepare and distribute utilization and related reportsServe on interdisciplinary monitoring teamsMEDICATION RECONCILIATION TECHNICIANObtains patient prior-to-admission medication list from variety of sourcesCompiles discharge medication lists and corresponding SNF admission listsCommunicates with patients, caregivers and other health care professionalsCommunicates and documents activitiesAssists 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 reconciliationAccurate medication list at admission-accurate list at dischargeMed rec: Sen et al. Am J Health-Syst Pharm. 2014;71(1):51-6.Smith et al. Hosp Pharm. 2013;48(2):112-9.
19 ADVANCED ROLES IN TECHNOLOGY AUTOMATION/IT TECHNICIANConfiguration, testing, device rollout, troubleshootingBar coding and scanningMaintenance of medication automation formulary databasesDevelopment of rules/alertsQuality assurance auditsStaff development and trainingSpecial projectsTELEPHARMACY TECHNICIANPharmacy technician at remote siteProcesses and/or dispenses prescriptions (may be home-based)Facilitates videoconferencing between pharmacist & patientCompletes medication transactionsMay use automated drug dispensing systemsGenerates reportsAutomation technician:Collaborates with pharmacy and other health care informatacists on data management methodsNeeds to understand:IT systems/technologyPharmacy/medical terminologyInventory/procurementClinical environmentCommunications—oral and writtenTelepharmacy technicianSaves pharmacies that might otherwise close downIncreases access to medicationsIncreases access to patient counselingRelieves pharmacists in rural hospitals due to lack of health care professionalsFriesner et al. J AM Pharm Assoc. 2011;51:Yam et al. J Am Pharm Assoc. 2009;49:Image:
20 ADVANCED ROLES IN QUALITY ASSURANCE AND MEDICATION SAFETY DOCUMENTATIONMedication errorsMedication adverse eventsDrug utilization evaluationDrug recall coordinationRESEARCHPatient satisfactionREGULATORY COMPLIANCEMedication recall coordinationMaintaining staff competency databasePerforming auditsPharmacy staff educationPHARMACY ACCREDITATION PREPARATIONWorks 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 ChangeParadigm Shift
22 The Way ForwardElevate standards within the profession to meet the demands of the growing healthcare systemImprove patient care, outcomes & accessSupport evolving roles & scope of practiceAdvocacy efforts with legislators, pharmacy associations and other stakeholdersProvide platform to advance pharmacy techniciansTechnicians must have education, training and credentials to advance with the pharmacy workforce
23 SummaryPharmacy 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 LicenseDeveloping 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 TechnicianEducationEntry-level knowledge, skills, abilitiesCertification/recertificationState laws and regulationsAdvanced practiceOther
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 transfersAnticoagulation dosage adjustment and medication reconciliationPrescription clarification and tech-check-tech in community pharmaciesChronic care clinic medication history and influenza vaccine administrationB: 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 prescriptionsPerform the final tech-check-tech program verification in both health-system and community settingsWork 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 ReferencesGlowczewski 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.pdfASHP 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 ReferencesLaubenstein D. Specialized Roles for Pharmacy Technicians. Pharmacy Purchasing and Products. April Vol. 13 No. 4:18Friesner et al. Expanding the role of pharmacy technicians. J AM Pharm Assoc. 2011;51:Yam, et.al. Expanding the role of pharmacy technicians. J Am Pharm Assoc. 2009;49:Sen, et.al. 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 AlliancesPharmacy Technician Certification Board (PTCB)