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Innovative Technician Practices Debuting in Hospitals

Technicians at Wishard Health Services in Indianapolis are an integral part of the pharmacy team.

ASHP has long advocated that properly educated and trained pharmacy technicians take a more active role in drug-dispensing duties, thus freeing up pharmacists to spend more time on medication management and direct patient care.

“Highly skilled technicians are key players on a pharmacy team,” said Stan Kent, M.S., FASHP, ASHP president. “As we move forward with pharmacy practice model change, we must deploy our workforce in a way that optimizes pharmacists’ clinical capabilities.”

A number of pioneering pharmacy departments are leading the way with innovative technician services. One of them is at Mercy Hospital in Coon Rapids, Minn. In 2008, the pharmacy department instituted a tech-check-tech program, in which a certified pharmacy technician checks the accuracy of orders filled by another technician and provides final verification prior to patient administration.

“We have technicians checking other technicians for 75 to 80 percent of our medications,” said Brent Kosel, Pharm.D., M.S., pharmacy operations manager. “Our auditing data shows that technicians do just as good a job as pharmacists. The pharmacists are champions of this program because they can focus more on our patients’ clinical needs.”

Samantha Murray, CPhT

The last audit, which covered about 7,500 doses, resulted in a 99.8 percent accuracy rate, according to Kosel. For now, the technicians check doses for automated dispensers, while pharmacists still conduct the final review for high-risk and intravenous drugs. According to an article in the American Journal of Health-System Pharmacy, some form of “tech-check-tech” is authorized for use in at least nine states. The results of 11 studies published since 1978 indicate that technicians’ accuracy in performing final dispensing checks is comparable to pharmacists’ accuracy.

Fulfilling a Core Purpose
“I’ve found tech-check-tech to be a great way to extend my role and feel more accomplished and gratified in my work,” said Heather Burley, CPhT, an inpatient pharmacy technician at Mercy. “Our core purpose, especially in a hospital, is to assist the pharmacists in any way we can. This really gives us an opportunity to do that.”

Burley’s training involved a didactic component with a written test, followed by one-on-one, hands-on sessions with pharmacists and an extensive validation test. “We had to correctly check a total of 500 line items with a 99.8 percent accuracy rate,” she said.

In another initiative at Mercy, pharmacy technicians now review medication dose adjustments of bedtime medications in adults age 65 and older (such as benzodiazepines), which can increase a patient’s risk of falling. Such dose adjustments are frequently overlooked during the order verification process.

An evaluation of the pilot program found that “technicians are as capable as pharmacists in performing tasks not requiring clinical judgment (i.e., identifying bedtime medications in need for dose adjustments in certain patient populations).”

Dianna Gatto, Pharm.D., BCPS

Techs and Med Rec
At Good Samaritan Hospital in Puyallup, Wash., pharmacy technicians have pretty much taken over the medication-reconciliation process at admission. In too many cases, the medication lists at the time of a patient’s admission are inaccurate—a common story at hospitals across the country.

“We wanted to see how we could get a better list up front, because it’s not a primary focus of nursing and we don’t have enough pharmacists to obtain medication histories on all of our patients,” said Dianna Gatto, Pharm.D., BCPS, manager of pharmacy clinical services. “I thought we could train our technicians to do this.” So she did.

Gatto discovered that there was no precedent in the state for technicians doing reconciliations, so she went before the Washington State Board of Pharmacy to make her case. The board quickly granted permission.

After a month-long pilot program involving two technicians, the program rolled out in the emergency department (ED), which treats about 175 patients daily (20 percent of whom are admitted). Since the program’s debut, it has expanded significantly, with three technicians working daily to spend an overlapping 28 hours on medication reconciliation. Medication lists are obtained for ED patients and direct admissions. A pharmacist reviews each updated medication list before physician reconciliation.

Samantha Murray, CPhT, a pharmacy technician at Good Samaritan, enjoys the social aspect of medication reconciliation, which occupies most of her work day.

“I’m constantly dealing with patients, their families, doctors, nurses and retail pharmacies. It’s more hands-on than what I was doing before,” she said.

The work is also more challenging: “You have to be a people person because the last thing that people want to do when they’re in the ED and don’t feel well is talk about their
medications when they’ve already talked about them three or four times,” Murray said. “You have to meet them on their own level and make them feel comfortable enough to tell you what you need to know.”