Advanced Roles for Pharmacy
Technicians: PPMI Update and
Pharmacy Technician Law Review
John B. Hertig, PharmD, MS, CPPS
Associate Director
Assistant Clinical Professor of Pharmacy Practice
Center for Medication Safety Advancement
Purdue University College of Pharmacy
Indianapolis, 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 healthsystem 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 2015
Slide 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 Content
Updated 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
6
Medication Order Entry and Fill
Process
17.50
7
Pharmacy Inventory Management
8.75
8
Pharmacy Billing and Reimbursement
8.75
9
Pharmacy 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
Postponed to an undetermined date - personal communication
• ASHP-accredited pharmacy technician education
required by 2020
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 positions
Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP
Non-traditional
functions
Traditional
functions
Activities of Pharmacy Technicians
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
Set
1.) Request Received
2.) Regimen Verified
3.) Order Set Drafted
4.) OncPOG Review
5.) Final Draft Created
6.) Sent to Pharmacist for
Review
7.) Physician Review and
Signature
8.) Submitted to Informatics
Pharmacist for PCO Build
9.) Pharmacy and Physician
Validate Build
10.) 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 Technician
What 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
Access
To
Medication
Medication Assistance Technician
Step 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
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