The introduction of a checking technician programme in community pharmacy and its impact on pharmacist activities

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.

Experiences of pharmacy staff during the introduction of the checking technician role in New Zealand

Objectives

To investigate the experiences of the participants in a study introducing a Pharmacy Accuracy Checking Technician (PACT) role, and specifically their perceptions of any advantages and disadvantages.

Methods

Self-administered surveys were distributed during the introduction of a checking technician role in eight community and four hospital pharmacy sites. Surveys were conducted at three time points; at baseline, at mid-point and a final data collection. Questions covered staff perceptions on; technicians’ ability to take on this role, impact on workflow, impact on pharmacists’ time spent with patients and any perceived advantages or disadvantages.

Key findings

Three hundred and fifty-five responses were received from participants. There was significant support for the introduction of this new role, and the greatest advantage identified was an increase in time available to pharmacists to increase potential clinical activities. Many staff felt that this role could easily fit into their current workplace and workflow with minor adjustments. There was a perception that this new role would increase safety and decrease errors as a result of the separation of clinical and checking tasks. Respondents identified a need for more technicians; however, conversely concern was expressed of a negative impact on the number of pharmacists’ jobs.

Conclusions

Despite the disruption caused by the training process, the respondents believed this new role to be beneficial to both staff and patients, and that the new model would allow for increased error identification and enhanced safety.

Facilitating integration of regulated pharmacy technicians into community pharmacy practice in Ontario: Results of an exploratory study

Background

The integration of regulated pharmacy technicians (RPTs) into community pharmacy practice was intended to relieve pharmacists of certain technical duties to facilitate greater provision of direct patient care services, commensurate with expanded scope of practice. There is scant data available regarding the success, value and impact of RPT integration, either in Canada or in other jurisdictions.

Methods

Pharmacists and RPTs working in community practices were interviewed. Qualitative data were categorized using an iterative coding process to identify themes related to barriers and facilitators to integrating and optimizing the role of the RPT in community practice in Ontario.

Results

A total of 16 RPTs and 12 pharmacists were interviewed from community sites in Ontario. Strategies for facilitating successful integration of RPTs into daily workflow were identified, based on 4 major themes: environmental factors, interpersonal factors, professional identity formation and innovative use of delegation.

Interpretation

Integration of RPTs into community practice is complex and requires careful management, planning, training and follow-up to ensure attainment of objectives. Simply hiring RPTs and placing them into existing workflow patterns is generally not a successful implementation strategy.

Conclusions

Implementation strategies identified through this study can provide employers, managers, pharmacists and RPTs with opportunities to enhance RPT integration and optimize the role of both pharmacists and RPTs in community practice.

Pharmacist and Technician Perceptions of Tech-Check-Tech in Community Pharmacy Practice Settings

Objective:

Tech-check-tech (TCT) is a practice model in which pharmacy technicians with advanced training can perform final verification of prescriptions that have been previously reviewed for appropriateness by a pharmacist. Few states have adopted TCT in part because of the common view that this model is controversial among members of the profession. This article aims to summarize the existing research on pharmacist and technician perceptions of community pharmacy–based TCT.

Data Sources:

A literature review was conducted using MEDLINE (January 1990 to August 2016) and Google Scholar (January 1990 to August 2016) using the terms “tech* and check,” “tech-check-tech,” “checking technician,” and “accuracy checking tech*.”

Data Synthesis:

Of the 7 studies identified we found general agreement among both pharmacists and technicians that TCT in community pharmacy settings can be safely performed. This agreement persisted in studies of theoretical TCT models and in studies assessing participants in actual community-based TCT models. Pharmacists who had previously worked with a checking technician were generally more favorable toward TCT.

Conclusion:

Both pharmacists and technicians in community pharmacy settings generally perceived TCT to be safe, in both theoretical surveys and in surveys following actual TCT demonstration projects. These perceptions of safety align well with the actual outcomes achieved from community pharmacy TCT studies.

Tech-Check-Tech in Community Pharmacy Practice Settings

Objective: The benefit of a tech-check-tech (TCT) practice model in institutional settings has been well documented. To date, few studies have explored TCT beyond institutional settings. This article summarizes the existing evidence in community pharmacy–based TCT research with respect to dispensing accuracy and pharmacist time devoted to direct patient care. Data Sources: A literature review was conducted using MEDLINE (January 1990 to August 2016), Google Scholar (January 1990 to August 2016), and EMBASE (January 1990 to August 2016) using the terms “tech* and check,” “tech-check-tech,” “checking technician,” and “accuracy checking tech*”. Bibliographies were reviewed to identify additional relevant literature. Study Selection and Data Extraction: Studies were included if they analyzed TCT and were conducted in a community pharmacy practice site, inclusive of chain, independent, mass merchant, supermarket, and mail order pharmacies. Studies were excluded if the TCT practice model was conducted in an institutional or long-term care setting. Survey data on theoretical models of TCT in community pharmacy practice settings were also excluded. Data Synthesis: Over the past 14 years, 4 studies were identified indicating TCT has been performed safely and effectively in community settings. The studies demonstrate that trained community technicians perform as accurately as pharmacists and that TCT increased the amount of pharmacist time devoted to clinical activities. In the 2 studies that reported accuracy rates, pharmacy technicians performed at least as accurately as pharmacists (99.445 vs 99.73%, P = .484; 99.95 vs 99.74, P < .05). Furthermore, 3 of the studies reported gains in pharmacist time, with increases between 9.1% and 19.18% of pharmacist time for consultative services. Conclusions: The present studies demonstrate that TCT can be safe and effective in community pharmacy practice settings, with results similar to those found in institutional settings. It is anticipated more states will explore TCT in community settings in the years ahead as a strategy to improve patient care.

Support staff in community pharmacy: who are they and what do they want?

Objective

To collect information on different categories of support staff, their deployment in community pharmacy, their levels of experience and qualifications, and their opinions on a number of topical issues, such as training and regulation.

Method

Two ‘snapshot’ surveys, one of community pharmacists, another of support staff employed by them. Three focus groups with support staff.

Setting

The surveys were conducted in community pharmacies in two primary care trusts (PCTs) in England. Two focus groups were conducted in one of the PCTs with respondents who had taken part in the survey; a third took place in a third PCT during the design phase.

Key findings

Medicines counter assistants (MCAs) formed the largest category of support staff (56%); 21% were dispensing assistants (DAs); 17% were pharmacy technicians (PTs). All community pharmacies employed at least one (60%), and often more than one MCA, but 20% had no DAs and 40% operated without a PT. Nearly all (93%) support staff were women, and about one-third worked part-time. More mature (40+ years) staff commonly only held an MCA qualification and were often not keen on further training. Younger staff held higher qualifications and were interested in further training and career progression. The majority of all categories of staff showed high levels of job satisfaction and loyalty to their employer. Most held positive views towards the regulation of support staff. Poor salaries were identified as potential barriers to further training and regulation, and pharmacists identified problems recruiting support staff.

Conclusion

Many different categories of support staff are employed in community pharmacies, although some operated without DAs or a PT. Support staff were generally satisfied with their jobs, but increasing requirements for formal qualifications and regulation of support staff, if not accompanied by adequate recognition and remuneration, may worsen recruitment problems.

Governance and the pharmaceutical workforce in England

A key component of a commitment to patient safety is ensuring the fitness to practice of health professionals. This article uses the changing landscape of the regulation of the pharmaceutical workforce and the extended roles and responsibilities of pharmacy practitioners in England to explore the challenges for governance within contemporary pharmacy practice, and consider the powers and structures necessary for effective regulation. In England, it is recognised that the approach of the national regulatory body for pharmacy should be consistent with that of the regulators of other health professions, and focus on assuring the competence and performance of practitioners. Pharmacy employers will have complementary adjunct responsibilities. Attention is being concentrated on ensuring the continuing fitness to practice of health professionals, with regular revalidation certain to become a requirement for all. Particular challenges arise in the effective regulation of advanced practitioners, and in ensuring the continuing competence of prescribing practitioners, who in England may come from a range of health disciplines, including pharmacy, and practice in a variety of settings and circumstances. A separate professional register is to be established for pharmacy technicians, whereupon they will also have to demonstrate continuing competence to practice, and be subject to regulation in the same way as pharmacists. Significant change is also planned in the professional control of community pharmacies. In future the law will require a "responsible pharmacist" to be identified for each community pharmacy, rather than insisting on a pharmacist always being present to supervise the dispensing and sale of medicines.