Comparing the accuracy of medication order verification between pharmacists and a tech check tech model: A prospective randomised observational study

Design and Implementation of Tech-Check-Tech Programs in North Dakota Pharmacies

Background: Tech-check-tech (TCT) programs in pharmacies are beneficial in facilitating a transition from fee for service dispensing tasks to advanced patient care, but they are underutilized. Objective: To describe the design, implementation, and evaluation of a transferable TCT program in several North Dakota pharmacies, with the goal of facilitating future efforts in other states. Methods: We developed a universal TCT implementation toolkit, recruited 6 pharmacies to implement it, developed an educational program for the pharmacies, and worked with the pharmacies over a year to assess success of the program. Pre- and post-implementation surveys assessed pharmacist and technician responses in regards to program effectiveness. Four outcomes were measured, and included pharmacist's time savings, descriptive comments on changes in workflow, incidence of errors and near misses, and barriers to implementation. Results: The implementation of TCT was unanimously perceived as successful and increasing efficiency in the post-site surveys completed by pharmacists. All 13 technicians who participated in the post-survey indicated the methods and materials used for training were sufficient and appropriate. The most commonly cited barrier to implementation of TCT stated by technicians was incorporating TCT into their current workflow. No dispensing errors which resulted in patient impact occurred throughout the duration of this study. Conclusions: A TCT implementation template provided a successful framework for TCT in various pharmacy settings and can serve as a model for other pharmacy settings, states, or regions.

Extending COVID-19 Pharmacy Technician Duties: Impact on Safety and Pharmacist Jobs

Background: The 2019 coronavirus pandemic (COVID-19) led to an expanded scope of practice for pharmacy technicians. As the pandemic wanes, state governments are faced with the decision of whether or not to make permanent the authority of pharmacy technicians to perform extended duties. Objective: Determine the impacts on patient safety and job market demands preadoption and postadoption of Idaho's expanded technician duties in 2017 as a natural experiment for expanded technician duties. Methods: Data from the National Practitioner Data Bank (NPDB) is used to explore patient safety outcomes in Idaho preadoption and postadoption and as compared with its border states. Data from Pharmacy Demand Reports is used to compare job postings in Idaho and its border state, and National Association of Boards of Pharmacy census data are used to compare growth in the number of pharmacists and technicians in Idaho and its border states over time. Results: For Idaho pharmacists, the average number of disciplinary actions reported against both pharmacists and technicians dropped after implementation of expanded technician duties. Idaho also had a lower rate of discipline for pharmacists and technicians than its border states. Idaho had the third highest job postings for pharmacists and the second highest for technicians among its border states. Idaho also had the largest growth in the number of licensed pharmacists and technicians of the observed states in the study period. Conclusion: Available statewide data from Idaho as compared with its border states suggests that expanded technician duties did not adversely impact patient safety outcomes or the pharmacist job market. Additional states may wish to expand pharmacy technician duties in the years ahead.

Exploring the role of medical imaging assistants in Australian medical imaging departments: A mixed-methods study

INTRODUCTION

Allied health assistants are support staff who assist medical imaging professionals in their clinical and non-clinical role. Assistants can improve efficiency of medical imaging services; however, little is known about the specific tasks they perform.

METHOD

A two-phase explanatory, sequential mixed-methods study design comprising a time motion survey and qualitative interviews was conducted across three health services in Victoria, Australia. Participants were medical imaging assistants supporting medical imaging professionals. Participants recorded tasks completed on a time motion proforma across two working days. Time spent on tasks was categorised into patient related and non-patient related tasks. Semi-structured interviews were conducted to explore assistants' perspectives about tasks, their roles and any responsibilities. Time motion data was descriptively analysed. Qualitative data were audiotaped, transcribed verbatim and analysed using the framework analysis method. Quantitative and qualitative findings were integrated using data triangulation.

RESULTS

Four medical imaging assistants participated, providing 4170 min of time motion data and 138 min of interview data. Integration of time motion and interview data revealed the medical imaging assistant role is predominantly non-patient facing; autonomous and critical to workflow; diverse and requires flexibility; has the potential to expand into a more patient-facing role.

CONCLUSIONS

Medical imaging assistants make significant contributions to workflow management. Their role is predominantly non-patient facing but there appear opportunities for the clinical role to expand. Realizing these opportunities will require careful consideration of the challenges and benefits of extending their scope of practice.

Pharmacy Technician Efficacies and Workforce Planning: A Consensus Building Study on Expanded Pharmacy Technician Roles

The expansion of pharmacy technician scope of practice in recent years, though remaining somewhat contentious, has afforded multiple opportunities for pharmacy technicians to provide additional assistance within the pharmacy. However, much of the research examining this growth has focused on specific tasks, which were determined by either the researchers themselves or the respective state boards of pharmacy. This study aimed to gain a better understanding of what expanded tasks pharmacists believe technicians should have an increased role in performing. A consensus-building research methodology was used to survey practicing pharmacists to determine which tasks those pharmacists believed technicians should take an increased role in performing. This study used modified Delphi techniques to build consensus among panels of both hospital and community pharmacists regarding 20 setting-specific technician tasks. Results of our study indicated that both hospital and community pharmacists believed technicians should have an increased involvement in performing tasks which are more related to the operations of the pharmacy rather than tasks which are more clinical in nature. This finding illustrates a belief among a segment of pharmacists that expanded roles for technicians should do more to alleviate the managerial and operational burden placed on pharmacists, potentially allowing pharmacists to take on increased clinical roles.

The Academy Is Well Positioned to Offer Pharmacy Technician Training Programs

Schools and colleges of pharmacy are optimally positioned to train the entire pharmacy team, including pharmacists and pharmacy support personnel, because they can provide comprehensive workforce development, utilize established faculty expertise, harness existing infrastructure, afford opportunities for intraprofessional education, and support institutional growth and reputability. As the emphasis of training shifts towards team-based approaches and expanded responsibilities, ensuring the existing and future pharmacy workforce is equipped to serve their communities becomes increasingly important. Thus, schools and colleges of pharmacy should consider offering a pharmacy technician training program to meet the needs of their community and the profession.

Reducing medication errors for adults in hospital settings

BACKGROUND

Medication errors are preventable events that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional or patient. Medication errors in hospitalised adults may cause harm, additional costs, and even death.

OBJECTIVES

To determine the effectiveness of interventions to reduce medication errors in adults in hospital settings.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, five other databases and two trials registers on 16 January 2020.  SELECTION CRITERIA: We included randomised controlled trials (RCTs) and interrupted time series (ITS) studies investigating interventions aimed at reducing medication errors in hospitalised adults, compared with usual care or other interventions. Outcome measures included adverse drug events (ADEs), potential ADEs, preventable ADEs, medication errors, mortality, morbidity, length of stay, quality of life and identified/solved discrepancies. We included any hospital setting, such as inpatient care units, outpatient care settings, and accident and emergency departments.

DATA COLLECTION AND ANALYSIS

We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. Where necessary, we extracted and reanalysed ITS study data using piecewise linear regression, corrected for autocorrelation and seasonality, where possible.  MAIN RESULTS: We included 65 studies: 51 RCTs and 14 ITS studies, involving 110,875 participants. About half of trials gave rise to 'some concerns' for risk of bias during the randomisation process and one-third lacked blinding of outcome assessment. Most ITS studies presented low risk of bias. Most studies came from high-income countries or high-resource settings. Medication reconciliation -the process of comparing a patient's medication orders to the medications that the patient has been taking- was the most common type of intervention studied. Electronic prescribing systems, barcoding for correct administering of medications, organisational changes, feedback on medication errors, education of professionals and improved medication dispensing systems were other interventions studied. Medication reconciliation Low-certainty evidence suggests that medication reconciliation (MR) versus no-MR may reduce medication errors (odds ratio [OR] 0.55, 95% confidence interval (CI) 0.17 to 1.74; 3 studies; n=379). Compared to no-MR, MR probably reduces ADEs (OR 0.38, 95%CI 0.18 to 0.80; 3 studies, n=1336 ; moderate-certainty evidence), but has little to no effect on length of stay (mean difference (MD) -0.30 days, 95%CI -1.93 to 1.33 days; 3 studies, n=527) and quality of life (MD -1.51, 95%CI -10.04 to 7.02; 1 study, n=131).  Low-certainty evidence suggests that, compared to MR by other professionals, MR by pharmacists may reduce medication errors (OR 0.21, 95%CI 0.09 to 0.48; 8 studies, n=2648) and may increase ADEs (OR 1.34, 95%CI 0.73 to 2.44; 3 studies, n=2873). Compared to MR by other professionals, MR by pharmacists may have little to no effect on length of stay (MD -0.25, 95%CI -1.05 to 0.56; 6 studies, 3983). Moderate-certainty evidence shows that this intervention probably has little to no effect on mortality during hospitalisation (risk ratio (RR) 0.99, 95%CI 0.57 to 1.7; 2 studies, n=1000), and on readmissions at one month (RR 0.93, 95%CI 0.76 to 1.14; 2 studies, n=997); and low-certainty evidence suggests that the intervention may have little to no effect on quality of life (MD 0.00, 95%CI -14.09 to 14.09; 1 study, n=724).  Low-certainty evidence suggests that database-assisted MR conducted by pharmacists, versus unassisted MR conducted by pharmacists, may reduce potential ADEs (OR 0.26, 95%CI 0.10 to 0.64; 2 studies, n=3326), and may have no effect on length of stay (MD 1.00, 95%CI -0.17 to 2.17; 1 study, n=311).  Low-certainty evidence suggests that MR performed by trained pharmacist technicians, versus pharmacists, may have little to no difference on length of stay (MD -0.30, 95%CI -2.12 to 1.52; 1 study, n=183). However, the CI is compatible with important beneficial and detrimental effects. Low-certainty evidence suggests that MR before admission may increase the identification of discrepancies compared with MR after admission (MD 1.27, 95%CI 0.46 to 2.08; 1 study, n=307). However, the CI is compatible with important beneficial and detrimental effects. Moderate-certainty evidence shows that multimodal interventions probably increase discrepancy resolutions compared to usual care (RR 2.14, 95%CI 1.81 to 2.53; 1 study, n=487). Computerised physician order entry (CPOE)/clinical decision support systems (CDSS) Moderate-certainty evidence shows that CPOE/CDSS probably reduce medication errors compared to paper-based systems (OR 0.74, 95%CI 0.31 to 1.79; 2 studies, n=88).  Moderate-certainty evidence shows that, compared with standard CPOE/CDSS, improved CPOE/CDSS probably reduce medication errors (OR 0.85, 95%CI 0.74 to 0.97; 2 studies, n=630). Low-certainty evidence suggests that prioritised alerts provided by CPOE/CDSS may prevent ADEs compared to non-prioritised (inconsequential) alerts (MD 1.98, 95%CI 1.65 to 2.31; 1 study; participant numbers unavailable). Barcode identification of participants/medications Low-certainty evidence suggests that barcoding may reduce medication errors (OR 0.69, 95%CI 0.59 to 0.79; 2 studies, n=50,545). Reduced working hours Low-certainty evidence suggests that reduced working hours may reduce serious medication errors (RR 0.83, 95%CI 0.63 to 1.09; 1 study, n=634). However, the CI is compatible with important beneficial and detrimental effects. Feedback on prescribing errors Low-certainty evidence suggests that feedback on prescribing errors may reduce medication errors (OR 0.47, 95%CI 0.33 to 0.67; 4 studies, n=384). Dispensing system Low-certainty evidence suggests that dispensing systems in surgical wards may reduce medication errors (OR 0.61, 95%CI 0.47 to 0.79; 2 studies, n=1775).

AUTHORS' CONCLUSIONS

Low- to moderate-certainty evidence suggests that, compared to usual care, medication reconciliation, CPOE/CDSS, barcoding, feedback and dispensing systems in surgical wards may reduce medication errors and ADEs. However, the results are imprecise for some outcomes related to medication reconciliation and CPOE/CDSS. The evidence for other interventions is very uncertain. Powered and methodologically sound studies are needed to address the identified evidence gaps. Innovative, synergistic strategies -including those that involve patients- should also be evaluated.

Community pharmacist perceptions of increased technician responsibility

BACKGROUND

Pharmacists have struggled to find time to spend on clinical tasks. As such, regulatory steps have been taken by some states to expand the scope of practice for community pharmacy technicians.

OBJECTIVE

The objective of this study was to determine what settings and characteristics predict pharmacists' comfort levels with technicians giving or receiving verbal prescriptions, performing nonclinical medication therapy management tasks, administering vaccinations, and verifying prescriptions.

METHODS

This study employed a national Internet-based survey of community pharmacists using a health care marketing research panel. The Consolidated Framework for Implementation Research (CFIR) was used as a theoretical basis for inquiry, particularly the CFIR domains of "outer setting," "inner setting," and "individual characteristics." As the outcome variable of this study, the respondents were asked to report their comfort levels with technicians performing the 4 advanced tasks. Four multivariable linear regression models identified statistically significant predictors of pharmacists' comfort with each task. Repeated measures analysis of variance (ANOVA) was used to compare the pharmacists' comfort levels among tasks.

RESULTS

For all 4 tasks, pharmacists who believed that technicians had the ability to complete each task were more comfortable with technicians completing those tasks. In addition, pharmacists with perceptions of stronger technician interest in advanced tasks were found to be more comfortable with technicians taking on more responsibility for all tasks except vaccine administration. Repeated measures ANOVA found that pharmacists' comfort levels differed on all 4 tasks.

CONCLUSION

This study found that the CFIR domains of inner setting (pharmacy location) and individual characteristics (perceptions of technicians and pharmacist education) affect pharmacists' level of comfort with technicians taking on additional responsibilities, but outer setting variables such as regulations do not. This suggests that pharmacist characteristics may affect the expansion of technician task responsibilities, no matter what state regulations allow.

Community Pharmacists Roles During the COVID-19 Pandemic

The aim of this paper is to review the roles that community pharmacists in the United States (US) can play to support public health measures during the current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic (COVID-19). Community pharmacists in the US are highly visible and accessible to the public and have long been regarded as a source for immunization services as well as other public health activities. In the US, the scope of pharmacy practice continues to expand and incorporate various health services on a state-by-state level. For the purposes of this article, a PubMed literature search was undertaken to identify published articles on SARS-CoV-2, COVID-19, pharmacist- and pharmacy-based immunization and other public health care activities in the US in order to identify and discuss roles that community pharmacists can play during this pandemic including as vaccinators, screeners and testers. In conclusion, community pharmacists are knowledgeable and capable providers of public health services and are easily accessible and well regarded by the public. The incorporation of community pharmacists into this nation's COVID-19 pandemic response plan can help aid recovery efforts in the US.

Practice-enhancing publications about the medication-use process in 2018

PURPOSE

This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2018 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following steps: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness toward daily practice change.

SUMMARY

A PubMed search was conducted in February 2019 for articles published in calendar year 2018 using targeted Medical Subject Headings (MeSH) keywords, targeted non-MeSH keywords, and the table of contents of selected pharmacy journals, providing a total of 43,977 articles. A thorough review identified 62 potentially significant articles: 9 for prescribing/transcribing, 12 for dispensing, 13 for administration, and 28 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation.

CONCLUSION

It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing recent impactful contributions to the MUP literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of significant published studies can assist in changing practice at the institutional level.

Practice, Skill Mix, and Education: The Evolving Role of Pharmacy Technicians in Great Britain

Pharmacy technicians’ roles are rapidly evolving in Great Britain (GB) as they undertake more extended activities with increased autonomy across the different pharmacy sectors. This paper compares the GB pharmacy regulator initial education and training standards recently introduced (2017) with the qualifications currently used in practice and discusses whether future qualifications will be ‘fit for purpose’. In this context, knowledge, skills, and competence are reviewed to assess whether they will meet the expectations and underpin the evolving pharmacy technician role as integral to healthcare provision. Based on drivers, policy change, and the changing GB healthcare landscape, effectiveness of skill mix is analysed to establish whether this is being optimised to support person-centred pharmacy in response to the challenges and pressures faced within the NHS. On this basis and given there is a limited evidence base, this review has highlighted a need for larger scale research to reassure the pharmacy and wider healthcare professions, and the public, that the evolving pharmacy technician role presents no increased risk to patient safety and contributes significantly to releasing pharmacists time for person-centred clinical activities.

Pharmacists ascribing value of technician certification using an organizational behavior framework

PURPOSE

To gather rich details about the value of technician certification from diverse groups of pharmacists of various practice settings and levels of experience.

METHODS

Focus groups of pharmacists were conducted using a semistructured interview guide in 4 states (California, Idaho, Tennessee, and Washington) varying in pharmacy technician scope of practice, regulation, and education and/or training environment. Participant pharmacists came from health-system, clinic, and community pharmacy environments. The focus groups took the unique approach of an organizational behavior perspective to contextualize technician readiness for practice change and employer fit. The sessions were audio-recorded and transcribed verbatim. Rapid-based qualitative analysis was used to code the data, with summary templates completed by 2 of the researchers for each of the 4 sessions.

RESULTS

There were a total of 33 focus group participants, including 13 male and 20 female pharmacists ranging in age from 27 to 68 years. The 4 major themes yielded by the data were (1) impact of certification, (2) context of certification, (3) organizational culture considerations, and (4) future credentialing. Certification was deemed to have a greater impact on technician maturation, professional socialization, and career commitment than on actual job skills, even while job knowledge was also deemed to be enhanced. In fact, the certification process was also deemed beneficial in that it meshes with on-the-job training. Participants indicated preferences for technician certification examinations to incorporate more content in "soft skills" and also for development of more specialty and/or differentiated certification products.

CONCLUSION

Pharmacists from 4 states saw value in certification but agreed that certification is but one component of readying technicians for future practice. Suggestions for furthering the value of certification were shared.

Exploring employer perceptions of pharmacy technician certification in the community pharmacy setting

BACKGROUND

With the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers.

OBJECTIVES

The aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs).

METHODS

Using a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory.

RESULTS

Employers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management).

CONCLUSIONS

New emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification.

Accuracy checking of dispensed medications by a pharmacy technician: a hospital case study

Medication order accuracy checking is an integral and time-consuming component of the current Australian pharmacist's role. However, the pharmacy profession internationally has moved towards separating the checking task into two parts: a clinical check performed by the registered pharmacist and a technical accuracy check delegated to an appropriately trained pharmacy technician. This case study demonstrates that in an Australian hospital pharmacy context, appropriately trained pharmacy technicians have the potential to be more proficient and time efficient than pharmacists when undertaking accuracy checking of dispensed medications.

A meta-analysis of pharmacists and pharmacy technicians' accuracy checking proficiency

BACKGROUND

Delegating the accuracy checking task to appropriately trained pharmacy technicians is desirable in all pharmacy settings, however it requires rigorous evidence prior to implementation to ensure safety. The delegation of accuracy checking has a twofold benefit, it frees time for pharmacists to undertake clinical activities and creates an advanced scope role for pharmacy technicians. Institutions also experience economic benefits when tasks can be reallocated to a lower-cost workforce.

OBJECTIVE

To perform a meta-analysis of pharmacist and technician accuracy rates when completing the final accuracy check on a prepared item.

METHODS

A systematic literature search was conducted to identify articles that reported the accuracy rates for the final check on prepared items. PubMed, EMBASE, CINAHL, Scopus, and Web of Science were used to retrieve articles. No limit was placed on publication year or item type. Once identified, data were extracted regarding study characteristics and accuracy rates. A meta-analysis was conducted using a random effects model.

RESULTS

Twelve articles were located which reported that 96.23-99.78% of items were accurately checked by pharmacists, and 98.25-99.95% of items were accurately checked by pharmacy technicians. The meta-analysis calculated the pharmacist accuracy rate for 216402 items to be 99.27% (95% CI: 98.77-99.64) and 99.72% (95% CI: 98.60-99.81) for 563296 items for pharmacy technicians. The difference between the two groups was statistically significant at a level of p < 0.0001.

CONCLUSIONS

Pharmacy technicians demonstrated a higher level of accuracy, and a lower variation in accuracy rates reported between studies. Improving checking accuracy and pharmacist availability for other clinical tasks is desirable for workforce efficiency and patient safety. These empirical accuracy rates of pharmacy technicians performing accuracy checking could be used by legislative and regulatory bodies to supplement necessary policy changes that improve the safety of the dispensing process.

Pharmacy-led ward-based education reduces pharmaceutical waste and saves money

OBJECTIVES

To measure the effectiveness of pharmacy-led ward-based education sessions for pharmaceutical waste.

METHODS

A pharmacy technician delivery pharmaceutical waste education in 2017. To measure the impact, results from pharmaceutical wastage audits from 2016 and 2018 were compared.

KEY FINDINGS

Pharmacy-led ward-based education reduces pharmaceutical waste and saves money. It was calculated that the cost of medication wastage was reduced by $1715.67 in the audit period, extrapolating to an annual saving of $44 607.45.

CONCLUSIONS

The findings highlighted the importance of pharmacy technicians and provided evidence for an advanced scope pharmacy technician ward role to reduce pharmaceutical wastage.