Pharmacists Taking a More Active Role in Patient Care

An Expert Interview With Douglas Scheckelhoff, MS, RPh, FASHP

Rod Franklin

June 24, 2011

June 24, 2011 (Denver, Colorado) — Editor's note: The role of technicians who assist licensed pharmacists in hospitals is evolving. Part of this is because of the perceived need for licensed pharmacists to spend less time on perfunctory duties and more time in direct patient care.

Workplace responsibilities and the processes by which pharmacy technicians are educated and certified were among the topics discussed at last year's American Society of Health System Pharmacists (ASHP) Practice Model Summit meeting in Dallas, Texas. Recommendations from the summit were revisited at the ASHP 2011 Summer Meeting and Exhibition, which was held June 11 to 15.

Medscape Medical News interviewed Douglas Scheckelhoff, MS, RPh, FASHP, and ASHP's vice president of professional development, about the professional development of pharmacy technicians and the role that is envisioned for them within an idealized hospital pharmacy practice model.

Medscape: Have licensed pharmacists traditionally occupied themselves with drug distribution activities that could just as easily be handled by a pharmacy technician?

Mr. Scheckelhoff: Historically, pharmacists have been very involved with drug distribution activities, but over the last 10 to 15 years, there has been a shift from drug distribution to greater pharmacist involvement in patient care types of activities. We believe that shift needs to continue, and pharmacists should be spending the majority of their time in direct patient care activities. Pharmacists should, however, still have oversight responsibility over drug distribution.

We also see a growing number of new activities that are not as traditional [for technicians]. Those may include things like collecting medication lists from patients as part of a medication reconciliation process, or being more involved in [information technology] and automated systems related to medication preparation and dispensing to ensure that the automation is functioning properly. Technicians are also, in some cases, performing chart reviews to identify allergies that may not be well recorded in the electronic health record. Others are collecting laboratory data that can then be used by the pharmacist and followed-up when there are lab values that are outside of the normal range.

Another activity that is less traditional is that of technicians checking technicians' work, or "tech-check-tech" programs. When we've analyzed what technicians do overall, only about 8% of their time is spent on these nontraditional activities.

Medscape: Is distribution the only area in which the role of the pharmacy technician can be safely expanded?

Mr. Scheckelhoff: Generally speaking, technician roles can, many times, be expanded to those that don't require the professional (clinical) judgment of a pharmacist. Often technicians can very effectively extend the reach of what the pharmacist can do by helping with the collection of data or information that the pharmacist can then utilize in interacting with the patient or healthcare providers in making sure that the patient is getting the best possible care.

Medscape: Should the core competencies for technicians working in hospital pharmacies be defined differently than for those working elsewhere?

Mr. Scheckelhoff: Historically, the profession has viewed pharmacy technicians as having a single core set of competencies, regardless of setting. That has been true in terms of accredited training programs and the core curriculum that is used as the basis for training program accreditation. Whether the technician is going to work in a chain drug store or in a hospital, he or she still has that same set of core competencies. Some people consider either an accredited training program or the PTCB (Pharmacy Technician Certification Board) exam as being more geared toward a hospital or more geared toward a community pharmacy setting, but the reality is they're based on a task analysis that includes activities from across the various practice settings.

Medscape: Do quality standards applied in the various learning environments for pharmacy technicians suffer from a lack of uniformity?

Mr. Scheckelhoff: There really should be a single standard for pharmacy technician education and training. Our belief is that the programmatic accreditation process provided by the ASHP serves this purpose. There is a core curriculum that is the focus of that accreditation standard, and we feel that all technicians achieving this level of standardization and uniformity would benefit the overall competence of pharmacy technicians. This way, a minimum set of pharmacy technician competencies would be established, regardless of work setting.

Medscape: Have pharmacy technicians been allowed to take the Pharmacy Technician Certification Board exam without having first completed an accredited training program?

Mr. Scheckelhoff: Our most recent survey showed that 78% of technicians who work in hospitals and health systems are trained on the job. They have not been through an accredited training program or other type of structured training program. The fact that they are trained on the job lends itself to a great deal of variability, including the length of time that they are in training and what topics and issues are covered.

Our position is that technicians should go through an accredited training program, then become certified through the PTCB, and finally be registered by their respective (state) board of pharmacy — and in that sequence.

Medscape: Does the ASHP endorse the optional certification exam offered by the Institute for the Certification of Pharmacy Technicians?

Mr. Scheckelhoff: The ASHP's position for many years has been that there should be one single standard for pharmacy technician certification. That should be the Pharmacy Technician Certification Board or PTCB examination. We believe the PTCB has established an excellent process, with a psychometrically sound examination that's based on a well-performed task analysis.

As a matter of disclosure, the ASHP was involved in the formation of the PTCB back in 1995 and has continued to be part of their governing board. In our view, having multiple certification exams based on different task analyses and criteria would not serve the needs of pharmacy technicians.

Medscape: What is the ideal role that state boards of pharmacy should play in the pharmacy technician vetting process?

Mr. Scheckelhoff: State boards of pharmacy or, in some cases, the state legislature should establish standards for pharmacy technician education and training, certification, and registration. Currently, state requirements vary greatly. In some states, there are no requirements for technicians. Other states may define loosely what the education requirements are, and then require PTCB certification. Other states have a very well-defined education and training requirement, but no requirement for certification.

Generally, the pharmacy boards are not equipped to inspect and validate the quality of technician training programs. That's why there are accreditation processes.

Our current position is that technicians should be registered with boards of pharmacy. There was a recommendation that came out of our summit on whether we should change our official position to that of recommending licensure, as opposed to registration. Licensure would require that the technician demonstrate competence to be able to work in that position.

Mr. Scheckelhoff has disclosed no relevant financial relationships.

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