White Paper on Pharmacy Technicians 2002: Needed Changes Can No Longer Wait

Am J Health Syst Pharm. 2003;60(1)

Introduction

The counting and pouring now often alleged to be the pharmacist's chief occupation will in time be done by technicians and eventually by automation. The pharmacist of tomorrow will function by reason of what he knows, increasing the efficiency and safety of drug therapy and working as a specialist in his own right. It is in this direction that pharmaceutical education must evolve without delay.

-- Linwood F. Tice, D.Sc.
Dean, Philadelphia College of Pharmacy and Science (1966) ^[1]

Health care and the profession of pharmacy have changed enormously since Dr. Tice articulated this vision more than 35 years ago. The role of the pharmacy technician has likewise undergone substantial change. Technicians have increased in number. They may access a wide array of training opportunities, some of which are formal academic programs that have earned national accreditation. Technicians may now seek voluntary national certification as a means to demonstrate their knowledge and skills. State boards of pharmacy are increasingly recognizing technicians in their pharmacy practice acts.

Nonetheless, Dr. Tice's vision remains unrealized. Although pharmacy technicians are employed in all pharmacy practice settings, their qualifications, knowledge, and responsibilities are markedly diverse. Their scope of practice has not been sufficiently examined. Basic competencies have not been articulated. Standards for technician training programs are not widely adopted. Board regulations governing technicians vary substantially from state to state.

Is there a way to bring greater uniformity in technician competencies, education, training, and regulation while ensuring that the technician work force remains sufficiently diverse to meet the needs and expectations of a broad range of practice settings? This is the question that continues to face the profession of pharmacy today as it seeks to fulfill its mission to help people make the best use of medications.

The purpose of this paper is to set forth the issues that must be resolved to promote the development of a strong and competent pharmacy technician work force. Helping pharmacists to fulfill their potential as providers of pharmaceutical care would be one of many positive outcomes of such a development. The paper begins with a description of the evolution of the role of pharmacy technicians and of their status in the work force today. The next section sets forth a rationale for building a strong pharmacy technician work force. The paper then turns to three issues that are key to realizing the pharmacy technician's potential: (1) education and training, (2) accreditation of training institutions and programs, and (3) certification. Issues relating to state regulation of pharmacy technicians are then discussed. The paper concludes with a call to action and a summary of major issues to be resolved.

Many of the issues discussed in this report were originally detailed in a white paper developed by the American Pharmaceutical Association (APhA) and the American Socity of Health-System Pharmacists (ASHP), which was published in 1996.^[2] For this reason, this paper focuses primarily on events that have occurred since that time. Other sources used in the preparation of this paper include Institute of Medicine (IOM) reports,^[3,4] a report to the U.S. Congress on the pharmacy work force,^[5] and input from professional associations representing pharmacists and technicians as well as from educators, regulators, and consumers.

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Cite this: White Paper on Pharmacy Technicians 2002: Needed Changes Can No Longer Wait - Medscape - Jan 01, 2003.

Sidebar: Appendix - Policy Statements of National Associations

The following statements are published with the permission of the respective organizations and were accurate as of March 2002, with the exception of (d), which was accurate as of June 2002.

The American Association of Colleges of Pharmacy
The American Association of Pharmacy Technicians
The American Pharmaceutical Association
The American Society of Health-System Pharmacists
The National Association of Chain Drug Stores
The National Community Pharmacists Association
The National Pharmacy Technician Association
The Pharmacy Technicians Educators Council

www.aacp.org/Docs/AACPFuntions/AboutAACP/4308_CumulativePolicies,1980-2001.pdf

Policies On Supportive Personnel

AACP supports inclusion in the professional pharmacy curriculum of didactic and experiential material related to the supervision and management of supportive personnel in pharmacy practices. (Source: Professional Affairs Committee, 1990)
Training for technicians in pharmacy must be based on competencies derived from tasks that are deemed appropriate by the profession and currently performed by technical personnel. (Source: Professional Affairs Committee, 1989)
Pharmacy schools should offer their assistance to supportive personnel training programs to assure that programs meet appropriate educational objectives. (Source: Professional Affairs
Training for supportive personnel in pharmacy must be based on sound educational principles with clearly established competency objectives. (Source: Professional Affairs Committee, 1987)

www.pharmacytechnician.com/

Preamble

Pharmacy Technicians are healthcare professionals who assist pharmacists in providing the best possible care for patients. The principles of this code, which apply to pharmacy technicians working in any and all settings, are based on the application and support of the moral obligations that guide the pharmacy profession in relationships with patients, healthcare professionals and society.

Principles

A pharmacy technician's first consideration is to ensure the health and safety of the patient, and to use knowledge and skills to the best of his/her ability in serving patients.
A pharmacy technician supports and promotes honesty and integrity in the profession, which includes a duty to observe the law, maintain the highest moral and ethical conduct at all times and uphold the ethical principles of the profession.
A pharmacy technician assists and supports the pharmacists in the safe and efficacious and cost effective distribution of health services and healthcare resources.
A pharmacy technician respects and values the abilities of pharmacists, colleagues and other healthcare professionals.
A pharmacy technician maintains competency in his/her practice and continually enhances his/her professional knowledge and expertise.
A pharmacy technician respects and supports the patient's individuality, dignity, and confidentiality.
A pharmacy technician respects the confidentiality of a patient's records and discloses pertinent information only with proper authorization.
A pharmacy technician never assists in dispensing, promoting or distribution of medication or medical devices that are not of good quality or do not meet the standards required by law.
A pharmacy technician does not engage in any activity that will discredit the profession, and will expose, without fear or favor, illegal or unethical conduct of the profession.
A pharmacy technician associates with and engages in the support of organizations, which promote the profession of pharmacy through the utilization and enhancement of pharmacy technicians.

www.aphanet.org

APhA supports the use of automation for prescription preparation and supports technical and personnel assistance for performing administrative duties and facilitating pharmacist's provision of pharmaceutical care.

The American Pharmaceutical Association supports the pharmacists' authority to control the distribution process and personnel involved and the responsibility for all completed medication orders regardless of practice setting.
(J Am Pharm Assoc. NS36:396. June 1996)

APhA recognizes, for the purpose of these policies, the following definitions:
1. Licensure: The process by which an agency of government grants permission to an individual to engage in a given occupation upon finding that the applicant has attained the minimal degree of competency necessary to ensure that the public health, safety, and welfare will be reasonably well protected. Within pharmacy, a pharmacist is licensed by a State Board of Pharmacy.
2. Registration: The process of making a list or being enrolled in an existing list.
APhA supports the role of the State Boards of Pharmacy in protecting the public in its interaction with the profession, including the Boards' oversight of pharmacy technicians, through their control of pharmacists and pharmacy licenses.
In States where the Board of Pharmacy chooses to exercise some direct oversight of technicians, APhA recommends a registration system.
APhA reaffirms its opposition to licensure of pharmacy technicians by statute or regulation.
(J Am Pharm Assoc. NS36:396. June 1996)

The committee recommends that APhA endorse the use of properly supervised supportive personnel in pharmacy practice as a positive step toward improving the quality and quantity of pharmaceutical services provided by the profession.
(J Am Pharm Assoc. NS11:277. May 1971)

The committee would be opposed to any assumption of the pharmacist's professional functions by sub-professionals or technicians. There is a need to determine exactly what these functions are and the relative position of the pharmacy intern. Under no circumstance should a sub-professional program in pharmacy create an individual such as the former "qualified assistant" still practicing in some states.
(J Am Pharm Assoc. NS6:332. June 1966)

www.ashp.org
See also www.ashp.org/public/hq/ (accessed 2002 Apr 4).
See also www.ashp.org/public/hq/policy/2001PolicyPositions.pdf (accessed 2002 Apr 4).

Credentialing of pharmacy technicians

Source: Council on Legal and Public Affairs To advocate and support registration of pharmacy technicians by state boards of pharmacy (registration is the process of making a list or being enrolled in an existing list; registration should be used to help safeguard the public by interstate and intrastate tracking of the technician work force and preventing individuals with documented problems from serving as pharmacy technicians); further,To advocate and support mandatory certification of all current pharmacy technicians and new hires within one year of date of employment (certification is the process by which a nongovernmental agency or association grants recognition to an individual who has met certain predetermined qualifications specified by that agency or association); further,To advocate the adoption of uniform standards for the education and training of all pharmacy technicians to ensure competency; further,To oppose state licensure of pharmacy technicians (licensure is the process by which an agency of government grants permission to an individual to engage in a given occupation upon a finding that the applicant has attained the minimal degree of competency necessary to ensure that the public health, safety, and welfare will be reasonably well protected); further,To advocate that licensed pharmacists should be held accountable for the quality of pharmacy services provided and the actions of pharmacy technicians under their charge.

0212

Source: Council on Educational Affairs

To support the goal that technicians entering the pharmacy work force have completed an accredited program of training; further,

To encourage expansion of accredited pharmacy technician training programs.

Image of and career opportunities for pharmacy technicians

Source: Council on Educational Affairs To promote the image of pharmacy technicians as valuable contributors to health care delivery; further,To develop and disseminate information about career opportunities that enhance the recruitment and retention of qualified pharmacy technicians.

0209

Source: Council on Educational Affairs

To collaborate with appropriate professional and academic organizations in fostering adequate education on substance abuse and chemical dependency at all levels of pharmacy education (i.e., schools of pharmacy, residency programs, and continuing-education providers); further,

To support federal, state, and local initiatives that promote pharmacy education on substance abuse and chemical dependency; further,

To advocate the incorporation of education on substance abuse and chemical dependency into the accreditation standards for Doctor of Pharmacy degree programs and pharmacy technician training programs.

Opposition to creation of "pharmacist assistant" category of licensed pharmacy personnel

Source: House of Delegates To reaffirm the following statement in the "White Paper on Pharmacy Technicians" (April 1996) endorsed by ASHP and the American Pharmaceutical Association:"Although there is a compelling need for pharmacists to expand the purview of their professional practice, there is also a need for pharmacists to maintain control over all aspects of drug product handling in the patient care arena, including dispensing and compounding. No other discipline is as well qualified to ensure public safety in this important aspect of health care."Further,To note that some interest groups in pharmacy have advocated for the creation of a new category of licensed personnel called "Pharmacist Assistant" that would have (a) less education and training than pharmacists and (b) independent legal authority to perform many of the functions that are currently restricted to licensed pharmacists; further,To support the optimal use of well trained, certified pharmacy technicians under the supervision of licensed pharmacists; further,To oppose the creation of a category of licensed personnel in pharmacy such as "Pharmacist Assistant" that would have legal authority to perform independently those professional pharmacy functions that are currently restricted to licensed pharmacists.

8610

Source: Council on Legal and Public Affairs

To work toward the removal of legislative and regulatory barriers preventing pharmacists from delegating certain technical activities to other trained personnel.

This policy was reviewed in 1997 by the Council on Legal and Public Affairs and by the Board of Directors and was found to still be appropriate.

www.nacds.org

Issue Brief -- Pharmacy Technicians (Issued October 2001; updated April 2002)

Registration, training and certification of pharmacy support personnel (pharmacy technicians) and maximizing the duties that such pharmacy technicians can perform.

Allowing pharmacy technicians to be utilized to the fullest extent possible without any ratio will:

Enhance pharmacists availability to counsel patients and to confer with other health professionals;
improve overall service to patients;
ease workload and improve professional satisfaction for pharmacists; and,
enhance efficiency and improve resources available for meeting the increased prescription volume and addressing the pharmacist shortages.

Certification should be voluntary and not mandatory.
"Certification" exams should be effective tools for evaluating pharmacy technicians at the various pharmacy practice sites, such as community retail pharmacies, hospital pharmacies, and other practice settings.
If pharmacy technicians decide to be certified they should be permitted to perform expanded duties and responsibilities.
Pharmacy technicians, even if not certified, should be permitted to do routine nonjudgmental dispensing functions including, but not limited to, handling nonjudgmental third party and other payment issues, offering the patient the availability of the pharmacist for counseling, placing telephone calls to prescribers for refill requests, taking phone calls from prescribers' offices authorizing refill prescriptions, and preparing prescriptions for pharmacist's final review.

Boards of Pharmacy should allow for employer-based pharmacy technician training programs and examination pursuant to a Pharmacy Technician Training Manual.
Boards of Pharmacy should recognize that employer-based technician training programs prepare technicians to work in their own particular practice setting, and that technician training programs should be designed to teach competencies relevant to the particular practice setting.
Chain pharmacy technician training programs and examinations should receive Board approval.

Continue to permit an unlimited number of technicians and allow each practice setting to determine their optimal ratio.
Allow technicians to perform non-judgmental tasks . . . those duties that do not require the expertise of a pharmacist.
Allow technician training tailored to the pharmacy and to the company operations and standards.
Allow certification to remain voluntary.
Allow certified pharmacy technicians to perform additional duties and responsibilities commensurate with their competencies.
Approve employer based training and examination pharmacy technician programs and recognize the importance of practice site specific training and examination programs such as community pharmacy based programs.
Recognize the NACDS pharmacy technician training and examination program for certification of pharmacy technicians.

www.ncpanet.org

NCPA supports the use of pharmacy technicians in community pharmacies to enhance the pharmacist's role in the provision of quality pharmacist care. NCPA believes the proper training and supervision of technicians by the pharmacist is critical to the health and safety of patients.

Technician Support and Technology: Recognizing the current environment of regional shortages of pharmacists and the projected increase in prescription volume due to potential Medicare prescription drug benefit coverage and an aging population, NCPA recommends enhancing patient care and addressing manpower issues through the more efficient utilization of technician support and technology. NCPA strongly opposes the creation of any category of supportive personnel, which is not under the direct supervision of a licensed pharmacist.

www.pharmacytechnician.org/

Medication Errors: NPTA feels that the use of highly trained, educated and certified pharmacy technicians in the pharmacy profession will assist in efficiently and effectively reducing the occurrence of medication errors.

Technician Liability: NPTA feels that with the emergence of national technician certification, producing increased roles and responsibilities, the issue of technician liability will become an evermore-present factor. Currently, NPTA does not have a position statement on technician liability.

Technician Education and Training: NPTA fully supports formalized education and training programs at institutions of higher education. NPTA feels strongly that at some point, pharmacy technicians should be required to obtain a degree/certificate to be allowed to practice as a pharmacy technician. At this point, NPTA does not have a position statement on whether this degree should be aone or two year degree, when this policy should be implemented, or an appropriate approach for those already practicing. The requirement of formal education for pharmacy technicians, which is not present in most states, will be an integral part of the advancement of pharmacy practice, patient safety and a more efficient/effective health-care system.

National Certification: NPTA fully supports legislated requirements of certification by pharmacy technicians across the United States. National Certification is an appropriate and effective first step towards the educational and training goals for pharmacy technicians of the future.

Continuing Education: NPTA strongly believes that an independent organization should be setup to accredit and monitor providers of pharmacy technician level continuing education programs. NPTA feels that while certified pharmacy technicians should be allowed to utilize ACPE CE Programs, that no organization (local, state or national) should make ACPE programs a requirement, since currently all ACPE programs are designed at the pharmacist's level.

www.rxptec.org/

PTEC strongly recommends that all pharmacy education and programs seek ASHP accreditation.

PTEC strongly recommends that all pharmacy technician-training programs have a minimum of 600 contact hours, in accordance with ASHP accreditation standards.

In the short term, PTEC will:

Work with AACP to design and implement programs which would provide step-wise technician training curriculum credits which could be used towards pharmacist training and education.
Advocate a PTEC representative attend AACP board meetings, and invite AACP officers to attend PTEC board meetings.

PTEC advocates that:

Within 5 years, all technician-training programs have a minimum of 600 contact hours; and
Within 10 years, all technician-training programs evolve into 2-year associate degree programs.

PTEC recognizes the need for, and supports the development and introduction of, appropriate credentials for pharmacy technicians, including at the specialty level.

PTEC will work with AACP to design and implement programs which would provide step-wise technician-training curriculum credits that could be used towards pharmacist training and education.

The PTEC recommended pharmacy technology program content is published on its website: www.rxptec.org/rptpc.html

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White Paper on Pharmacy Technicians 2002: Needed Changes Can No Longer Wait

Introduction

References

Authors and Disclosures

Authors and Disclosures

Appendix

Sidebar: Appendix - Policy Statements of National Associations

Source: Council on Educational Affairs To promote the image of pharmacy technicians as valuable contributors to health care delivery; further,To develop and disseminate information about career opportunities that enhance the recruitment and retention of qualified pharmacy technicians.

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