1. Tech-Check-Tech (TCT): Challenges and Opportunities
Maryland Pharmacists Association Mid-Year Meeting
Annapolis, Maryland
February 18, 2018

2. Disclosures
Drs. Cynthia Boyle, Kayla McFeely, and Kristopher Rusinko have no relevant financial relationships with a commercial interest pertaining to the content of this presentation.

3. Objectives
At the end of this presentation, the participant should be able to:
1. Describe at least 3 recent advances/initiatives for pharmacy technician education/training
2. Describe the Maryland Society of Health-System Pharmacy (MSHP) Acute Care TCT process and proposal highlights presented to the Maryland Board of Pharmacy

4. Objectives (continued)
3. Describe the successes and challenges of an optimized community pharmacy care model that enhances the role of qualified pharmacy technicians in order to reinvest pharmacists’ time to provide patient care services
4. Discuss steps, scope, and limitations for possible Tech-Check-Tech in Maryland

5. Format Introductions/Background TCT in Health-systems
Optimizing Care in Community Pharmacy
Facilitated Discussion- Challenges and Opportunities for TCT in Maryland (Audience Input for Maryland Stakeholders’ Conference)

6. Objective #1: Describe at least 3 recent advances/initiatives for pharmacy technician education/training.
Cynthia J. Boyle, PharmD, FAPhA
Professor, University of Maryland School of Pharmacy
MPhA Past President

7. Poll the Participants
State boards of pharmacy should require new pharmacy technicians to obtain national certification for registration or licensure (75/15/5/5)
Bridging programs should be developed and offered to build competencies of pharmacy technicians who are currently in the workforce and would like to advance their skills (56/40/3/1)
Planners should establish a coalition with broad representation for the recommendations from the PTSCC (77/23/0/0)
Zellmer WA, McAllister EB, Silvester JA, Vlasses PH. Toward uniform standards for pharmacy technicians: summary of the 2017 pharmacy technician stakeholder consensus conference. JAPhA 57(2017)e1-e14.

8. Education Perspective
Quality in Pharmacy Technician education/training programs
Program Accreditation
Pharmacy Technician Accreditation
Regulation of Pharmacy Technicians
Role of academic institutions in education, training, and certification of Pharmacy Technicians
Collaborations
Mobley Smith MA, Boyle CJ, Keresztes JM, Liles J, Garrelts MacLean L, McAllister EB, Silvester J, Williams NT, Bradley-Baker LR. Advancing the Pharmacy Profession Together through Pharmacy Technician and Pharmacy Education Partnerships. Report of the Professional Affairs Standing Committee. Am J Pharm Educ. 2014; 78(10): Article S22.

9. “The ability of pharmacists to successfully fulfill patient care provider roles depends on how well pharmacy technicians are prepared to function in their roles a pharmacy supportive personnel.”

10. 2017 PTCB-ASHP-ACPE Consensus Conferences
All pharmacy sectors were engaged including pre-conference poll of JCPP member organizations.
State variability in regulations poses risks for patients and the profession.
Task analysis should be basis for accredited technician education, technician certification, and state regulations.
Participants recognized generalist knowledge/skills/abilities regardless of practice and need for additional programs beyond entry-level (advanced).

11. Pharmacy Technican News
PTCB- founded in 1995 by APhA, ASHP, Illinois Council of Health-System Pharmacists, and Michigan Pharmacists Association, and joined by NABP in 2001.
PTCB advocates for a single national standard for pharmacy technician certification, recognized and supported by the profession.
PTCB advances medication safety by certifying technicians who are qualified to support pharmacists and patient care teams in all practice settings.
New PTCB Executive Director William Schimmel

12. Jan. 11, 2018 PTCB News Release: Exam and Education Changes
Exam Content Domains (9 to 4) from 2016 Job Analysis, Entry Credential
Med Safety/Patient Care Focus
Education- PTCB or equivalent experience
Effective Jan. 1, 2020
90-Day Comment Period
Staff Sgt Mary Johnson
PTCB CPhT of the Year 2017

13. Active Learning
The statement which best describes the outcomes of the Pharmacy Technician Stakeholders Consensus Conference (PTSCC) is:
By 2020, all pharmacy technicians should be licensed.
By 2020, all pharmacy technicians may qualify for certification by PTCB courses or experience.
By 2020, all states should enact comparable technician regulations.
By 2020, all schools/colleges should offer technician education/training.

14. Tech-Check-Tech (TCT) MSHP Workgroup
Kristopher Rusinko Pharm. D., MBA, M. Ed.
Director of Operations
Johns Hopkins Health System

15. Objective #2
Describe the Maryland Society of Health-System Pharmacy (MSHP) Acute Care Tech-Check-Tech (TCT) process and proposal highlights presented to the Maryland Board of Pharmacy

16. TCT - Background
Specially trained and validated pharmacy technicians (VPT) verify accuracy of medications filled by another technician
No clinical judgment required
Studies demonstrate technicians are at least as accurate as pharmacists
Barcode scanning technology provides a safeguard against dispensing the wrong medication
Reallocation of pharmacist time to patient care tasks

17. Board Approval - Institutional Setting
23 states allow TCT

18. Board Approval - Community Setting
7 states allow TCT

19. Workgroup Process Overview
University of Wisconsin Health and University of Iowa Health Conference Calls
UW Health/ Pharmacy Examination Board Toolkit
Conversations with other states (student project)
Retreats and small work groups to update documents and discuss roles of VPTs

20. Roles of VPT Proposed to Maryland BOP
Bar code scanning required
Automated Dispensing Cabinet (ADC) filling
Batch dose preparations
Code box/tray filling
Unit dose prep from bulk bottles

21. Handout Review Appendix A – Lit Summary
Appendix B – Cover Letter Variance Request
Appendix C – Variance Request form
Appendix D – Sample Policy
Appendix E/F – Additional samples
Appendix G – Practical Training Checklist
Appendix H – Competency Assessment Checklist
Appendix I – TCT Overview for Technicians
Appendix J – TCT Training and Self Learning Packet
Appendix K – Written Examination
Appendix L – Skill Validation Process Guidance
Appendix M – Initial Validation Error Log Form
Appendix N – Quality Assurance Process Guidance

22. Handout Review (cont.) Appendix O – Quality Assurance Error Log Sheet
Appendix T – Tech Initial Validation Log
Appendix U – QA Monitor Report to Board
Appendix V – TCT Implementation Checklist
Appendix O – Quality Assurance Error Log Sheet
Appendix P – Variance Report to Board
Appendix Q - Artificial Error Log
Appendix R – Examples of Artificial Errors
Appendix S – Cart Fill Artificial Error Examples

23. Current Situation Pilot sites identified Proposed to MDBOP 9/20/17
MDBOP created a work group of its members to review
Setting where applicable
Training and requirements
Activities authorized
Tracking and reporting
Lifebridge, Medstar, JHBMC and JHH Peds

24. Active Learning
Which of the following have been proposed as items to be checked in an acute care setting TCT Program:
Product verification prior to restocking Automated Dispensing Cabinet (ADC)
Batch dosing preparation for loading into ADCs
Code tray/box filling
Drawing up oral doses from manufacturer bulk bottles of liquid medications
All of the above

25. National Association of Chain Drug Stores
Objective #3: Describe the successes and challenges of an optimized care model in the community pharmacy setting
Kayla M. McFeely, PharmD
Executive Fellow
National Association of Chain Drug Stores

26. Innovation in Pharmacy
“Change is a common thread that runs through all businesses regardless of size, industry and age. Our world is changing fast and organizations must change quickly, too. Organizations that handle change well thrive, whilst those that do not may struggle to survive.”
The “why”
Quick intro about the dynamic industry and the necessity of improved patient care. Brief intro regarding how optimizing care is one strategy to afford pharmacies the opportunity to further provide better quality and efficient care to patients.
*Omit if others go over their time*

27. Optimizing Care Enhances the role of qualified pharmacy technicians in order to reinvest pharmacists’ time to provide patient care services
Improve patient access and healthcare outcomes
Utilize full potential of clinical expertise of pharmacists and the skills of technicians
Iowa, Wisconsin, Tennessee
Definition and goals.
Optimizing care is the model, and technician product verification is an action within the model.

28. NACDS Optimizing Care Projects: Chain and Independent Pharmacy Participation
Will verbally state the Iowa evolution from participation in Phase 1, to Phase 3 participation which is shown on the slide.
FYI – IA includes the final phase of the project, but I can verbally state that it began with independent pharmacies.

29. Current Status 1. Iowa 2. Wisconsin 3. Tennessee
Transition to dissemination phase
Sharing their experiences and insights
Webinar series – upcoming
2. Wisconsin
Concluding data collection
Data analyses upcoming
3. Tennessee
Recruitment
Baseline data collection
4. Qualitative analyses – all 3 projects

30. Optimizing Care Myths De-bunked Courtesy of the Tennessee Pharmacists Association
Courtesy and Property of the TN Pharmacists Association
Courtesy and Property of the TN Pharmacists Association

31. RPh-Checked (Baseline)
Patient Safety
RPh-Checked (Baseline)
Technician-Checked
(Pilot )
Total
5,565
5,950
Wrong Drug 1
Wrong Strength 2
Safety Cap Error 8 19
Wrong # 3
Other Error 4
Total Errors 15 33
Accuracy Rate
99.73%*
99.445%*
*not significantly different
Published on the web:
Iowa Optimizing Care Pilot – Phase 1

32. Pre-implementation Phase
Challenges
Pre-implementation Phase
Implementation Phase
Board of pharmacy approval
Recruitment of pharmacies
IT remodeling
Separate distinction for checking technicians
Workflow redesign plan
Perceptions and myths
Technician verification process – time consuming
Want to verify more technicians – coverage
Staff turnover
Takes time to adapt to new responsibilities
Perceptions and myths
Time consuming especially for small volume stores
Now that the stage is set regarding definitions, goals, and background on the projects, transition to challenges and successes seen thus far

33. Successes: Time Reinvestment
RPh time spent dispensing
67.3% to 48.58% (p=0.004)
Decrease
This is available on the web:
RPh time spent patient-care activities
15.9% to 35.08% (p=0.002)
Increase
Increase
Iowa Optimizing Care Pilot – Phase 1

34. Successes: Areas of Impact
Increased number of services provided
Identifying drug therapy problems
Immunizations, and non-immunization injections
MTM services – disease management, adherence monitoring, med sync, compliance packaging
Potential for further advancements
TN pilot – CPA engagement
Preventative services, point of care testing, more

35. Successes: Qualitative Data
“Instead of having baskets pile up every time I was busy performing other tasks, I now know that my verification technician will get it done.”
“By allowing me to thoroughly check a patient's medication list and perform drug utilization reviews prior to any medication being filled in the pharmacy, I am able to provide better outcomes to patients while spending more time with each individual patient. ”
“Overall, things are going really well and I have noticed a significant reduction in my stress level and my co-workers' stress.”
“Patients don't have to wait to be counseled or receive immunizations. Patients receive the care they deserve while spending less time sitting in the pharmacy waiting area.”
“After performing double checks of the verification technician's initial checks, the results for me have been abundantly clear: She does just as good of job at checking prescriptions as me or any pharmacist does.”
“Freeing up our pharmacists' time has allowed us to grow clinically.”
From IA report testimonials.

36. Final Thoughts
Pharmacy technicians may be able to perform final product verification at least as accurately as pharmacists
Pharmacists may spend more time providing clinical services when the optimizing care model is utilized
Value of RPh discretion and clinical judgement preserved
Essential: quality assurance/improvement, and patient safety
Workflow design may be different for each store
Need buy-in at all levels for success

37. Acknowledgements Iowa Pharmacy Association
1st Pharmacy Services
Medicap
Aurora
Mercy Family Pharmacy
Iowa Pharmacy Association
Boscobel
NuCara
Caves
Pulaski
Comprehensive Wellness
Publix
Community Pharmacy Fnd
Perkin’s
Pharmacy Society of Wisconsin
Crawford’s
Shopko
Costco
Surgoinsville
East TN Discount
Target
Froedtert
Telligen
Hartig Drug
Terry’s
Tennessee Pharmacists Association
Hayat
Thrifty White
Hy-Vee
Towncrest
Kroger
UW Health
Main at Locust
Walgreens
McKesson
Wester Drug

38. Active Learning True or False:
An optimizing care model has the potential to advance patient care in community pharmacies.

39. Objective #4: Discuss steps, scope, and limitations for possible Tech-Check-Tech in Maryland.
Input for Maryland Stakeholders’ Conference
Open Discussion- All Participants

40. Emily Jerry Foundation https://emilyjerryfoundation.org/