A Review of the Evidence on Its Safety and Benefits

Alex J. Adams; Steven J. Martin; Samuel F. Stolpe


Am J Health Syst Pharm. 2011;68(19):1824-1833. 

In This Article

The Role of TCT in the Drug Distribution Process

From the time a medication is ordered for a patient until it is dispensed to its ultimate user, there are a series of steps that require varying levels of technical and clinical expertise. Tasks related to order entry and production do not typically require specialized clinical knowledge, judgment, and skill and are thus routinely delegated to pharmacy technicians. The work activities of technicians include but are not limited to developing patient profiles, adjudicating insurance claims, assembling and packaging prescriptions, maintaining inventory, and operating automated dispensing machines.

Pharmacists traditionally have had sole responsibility for performing a "final verification" of the assembled product. The pharmacist generally reviews the patient's profile to evaluate the appropriateness of each medication's prescribed dose, the route of administration, and the frequency and duration of use given the patient's unique characteristics, combination of diseases, and concurrent medication regimen. The pharmacist's review also involves screening for drug interactions, contraindications, allergies, and gaps in therapy, among other factors. Prospective drug-use reviews (DURs) require a specialized knowledge of pharmacology, pharmacokinetics, and pharmacotherapeutics, as well as the ability to recognize and resolve drug-related problems.

Institutional pharmacies using TCT have permitted pharmacy technicians to perform final verification on refill orders—a task previously performed only by a pharmacist. In institutional settings, the drug distribution system is usually arranged so that the minimum number of doses needed by the patient is dispensed until the next regularly scheduled cycle of medication distribution. Thus, standing orders are regenerated with each regular distribution period for the duration specified by the prescriber. Because licensed pharmacists have already performed a prospective DUR for each of these regenerated prescription orders, verifying an assembled product against the order is a technical function that does not require clinical judgment. Institutional practices using TCT have layers of safety built in that further reduce the likelihood of dispensing errors. Most institutions dispense medications in unit dose packaging. Bar-code scanning is becoming more prevalent in U.S. hospitals as a tool for ensuring safe medication dispensing and administration, and its use has been shown to reduce medication errors, especially when used in tandem with electronic medication administration records.[16] Unit dose medications are dispensed to licensed health professionals, not directly to patients, allowing an additional check before administration. TCT thus reduces the need for pharmacists to perform technical functions, allowing their redeployment to the provision of clinical services.


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