medsafetyonline

A forum for caregivers and pharmacy professionals concerned with patient and provider safety.

Competency

Ensuring Drug Specific Competency for Infusion Center Clinicians

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As with any occupation, there’s a lot to know in order to become a competent and proficient professional. Healthcare is no different. Based on your specific discipline, be it pharmacy, nursing, or physician, there are skills and tasks that are essential to the successful completion of your responsibilities.

For infusion center clinicians, the most essential information is undoubtedly in-depth drug knowledge. That includes knowledge of: drug preparation, drug administration, patient response(s) to drugs, and what to do in the event of an adverse patient reaction. In an article published in the British Journal of Clinical Pharmacology[1], Jeffrey K. Aronson explains the following (as it relates to medication errors):

Errors are first broken down into two separate categories:

1. Mistakes
2. Skill-based errors

Mistakes are then divided into two categories:

1. Knowledge based errors
2. Rule-based errors

Skill-based errors are divided into two categories as well:

1. Action based errors (slips)
2. Memory based errors (lapses)

What does this mean to the infusion center clinician?

To prevent both rule-based and action-based errors, we recommend utilizing RxTOOLKIT’s RxWORKFLOW for IV Safety™. These user-friendly drug specific monographs provide interactive reference, tools, and training, right where every clinician really needs them, at the point of care. Within each drug specific monograph, the “rules” for drug preparation and administration are presented in an easy to follow format that guides the clinician through a safe and consistent process.

RxWORKFLOW for IV Safety also helps to prevent “slips” by providing drug specific on-the-spot tools that assist in preparation or administration (RxQuickCALC™, RxCALC™, and RxDoseCHECK™). These tools are always what you need for that specific drug and include step-by-step instructions, tapering tables, and automated calculations helping clinicians to avoid an action based error.

So how do you address Knowledge and Memory Based Errors?

Let’s start with Knowledge Based Errors.

RxTOOLKIT provides a Drug Specific Competency Tracking Program in our popular LMS platform, RxTOOLKIT eLEARNING. Drug Specific Competency Tracking is an ongoing program that was built specifically for training, certification, and tracking of drug knowledge. The program provides drug specific courses with interactive assignments and competency exams. Clinicians can retake the courses periodically whenever their certification expires (as determined by your organization). This program enables clinicians (and their managers) to verify that their drug knowledge is complete and up to date.

To help with Memory Based Errors, which the author describes as “lapses”, we return to the point of care, right inside every RxWORKFLOW for IV Safety monograph, where clinicians find an Integrated Competency Check. Integrated Competency Checks—quick drug specific pop-up quizzes, including instant feedback, help to ensure your staff is familiar with both a drug and related dosing parameters. The quizzes act as a quick refresher, helping to confirm comprehension of the “rules” and increasing caregiver confidence.

RxTOOLKIT’s goal is to provide the infusion center clinician a single source of standardized reference, tools, and training. We can help any center to establish standardization in practice and staff training and ensure their positive patient outcomes.

For more information about these two awesome tools, RxWORKFLOW for IV Safety and Drug Specific Competency Tracking, check out these short videos, contact us, or visit RxTOOLKIT.com.

 

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723196/pdf/bcp0067-0599.pdf

Pharmacy Technicians: The Invisible Asset

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If you have ever had a prescription filled in a pharmacy, received an IV infusion in a hospital, or received a medication in a nursing home, you have received services from a pharmacy technician. Who are these people? How are they trained?

The answer to these questions is both complex and inconsistent but can be summarized in one phrase, “it depends.” This post will provide some background about my own experience with pharmacy technicians, explore the current regulatory landscape, and provide some suggestions for how we can move forward.

Pharmacist Mate — NEC HM-8242

One of my first positions as a pharmacist was as a pharmacy officer at the US Naval Hospital in Philadelphia. That job caused me to fall in love with both the Navy and Philadelphia, as well as, to develop a special appreciation for pharmacy technicians. The Navy Enlisted Classification (NEC) for a pharmacy technician is NEC HM-8242. The pharmacy technicians are trained first as hospital corpsman and then they attend a 12-week course at the joint Medical Education and Training Campus (METC) in San Antonio, Texas. That’s 26-weeks total in military style training, 8‑hour days, 5 days a week.

Naval pharmacy technicians perform the same type of tasks in naval hospitals as civilian pharmacy technicians. Among those duties are dispensing, sterile compounding, non-sterile compounding, automated dispensing cabinet management, and purchasing. Besides the work that they do in naval hospitals, they also serve “independent duty”. Independent duty involves work on naval war ships. These individuals can also be deployed to FMF (fleet marine force) to serve in combat areas.

After the intense training and military service, these healthcare professionals know their job and they do it well. Many of the pharmacy technicians that I knew went on to become pharmacists after leaving the Navy, one even later reentered the Navy and became the service chief for all naval pharmacists.

This experience provided me awareness and appreciation for the intensity of the training provided, the required skill sets, and the complex nature of the job of pharmacy technician.

Hospital Pharmacy Technicians

After my tour in the Navy, I spent the bulk of my career as a practicing hospital pharmacist, with many pharmacy technicians working under my supervision.

Typically, there is not a single dose of a medication in any hospital pharmacy that does not pass through the hands of at least one pharmacy technician prior to administration. They are extremely valuable team members but very few patients ever realize the complexities and importance of their role.

The Corner Drug Store

Pharmacy technicians also play an important role in retail pharmacy. They work “behind the counter” assisting pharmacists in the preparation and dispensing of medications. Retail pharmacy technicians must also learn about insurance plans, co-pays, and the use of generic medications so they are equipped to handle patient questions.

What do the Regulations Say?

Pharmacy technician certification or registration is controlled at the state level and not the federal level. As you can imagine, states are all over the board at this time, but that is changing.

The chart below shows the number of certified pharmacy technicians per 100,000 people in each state. The states with the orange bars are the states that have no regulations regarding pharmacy technicians. It’s easy to see that in states working to recognize this valuable resource and establish minimum standards of competency, the ratio of CPhT’s to the population rises dramatically.

The good news is that virtually every state in looking at legislation to regulate pharmacy technicians and the number of states regulating pharmacy technician training has increased steadily over the last 10 years.

While many states do not specifically define the duties of pharmacy technicians, some states mandate pharmacy technician to pharmacist work ratios. Common ratios are 2 to 1 or 3 to 1, meaning 2 technicians to 1 pharmacist in the workplace.

Unfortunately still, in most states (including my home state of Pennsylvania), licensure is not required. Registration is not required. There is no minimum skill proficiency required. Training is often provided on the job with no organized standards (though many organizations establish their own set of requirements which can vary widely).

In Ohio in 2005, there was no registration or licensure of pharmacy technicians. That changed in February of 2006. Only after Emily Jerry’s tragic death, through the formation of the Emily Jerry Foundation, and by the perseverance of her dad, Emily’s Law was passed–requiring certification, background checks, and minimum standards of practice for pharmacy technicians.

I guess that it’s human nature to only react after there is a tragedy. Do we really need to wait for a tragedy like this to happen in all of the states that still currently have no standards of practice? I sure hope not!

As you can imagine, the various requirements and differences across state lines creates confusion, inconsistency, and problems for both organizations and pharmacy technicians.

PTCB

The Pharmacy Technician Certification Board provides a nationally recognized exam to measure competency for pharmacy technicians. Once a technician achieves certification, they, like practicing pharmacists, must also obtain continuing educations credits to keep their skills up to date and relevant. Pharmacy technicians that have received certification from PTCB are required to complete 20 hours of continuing educations every 2 years.

Certification (CPhT) is achieved by passing a nation exam administered by PTCB. The exam covers a wide variety of subject matter, all of which would be included in the daily tasks of a pharmacy technician.

RxTOOLKIT in Action

We, at RxTOOLKIT, see the lack of standardization and training for pharmacy technicians as a significant patient safety issue and have made the decision to act.

RxTOOLKIT eLEARNING™ was developed in direct response to these observations. Our mission is to provide specialized online training with both clinical and operational focus to increase safety, expand competency, boost confidence, and ensure successful patient outcomes.

RxTOOLKIT eLEARNING™ has also recently partnered with TRC Healthcare (Authors of Pharmacist’s Letter and Pharmacy Technician’s Letter) in advancement of Pharmacy Technicians University (PTU). This online competency‐based curriculum provides all of the tools and information needed to prepare techs for the job and the national certification exam. Pharmacy Technicians University meets or exceeds requirements for technician training in all 50 states and Washington, D.C.

Our goal is to increase the pool of qualified pharmacy technicians as all states move toward certification. We do this for all the reasons I’ve articulated in this post. It is a complex and extremely important job and we need qualified pharmacy technicians!

Want to get involved?

Are you a pharmacy technician or a pharmacist that knows a really awesome tech? We invite you to share your story for publication on this blog! Please submit post ideas to: info@rxtoolkit.com.

Please make a generous donation to the Emily Jerry Foundation.

Tell someone you know about Pharmacy Technician’s University, a portion of proceeds from the sale of these courses is donated to the Emily Jerry Foundation.

For more information about RxTOOLKIT eLEARNING™ please contact elearning@rxtoolkit.com or visit RxTOOLKITeLEARNING.com.

 

The Vital Role of Pharmacy Technicians — Chris Jerry, of the Emily Jerry Foundation

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The following post was written by Chris Jerry of the Emily Jerry Foundation. Chris tragically lost his daughter as a result of a preventable medical error made by a pharmacy technician. We are grateful to Chris for his courage in sharing his story as well as for the work he is doing to bring light to this important issue.

Before the loss of my beautiful daughter, Emily, to a tragic preventable medication error in 2006, like most people, I had no knowledge of the vital role that all pharmacy technicians play with respect to safe pharmacy practice. Shortly after Emily’s death, I decided to establish the Emily Jerry Foundation (EJF), in an effort to create awareness about preventable medical errors as well as to be an active part of the overall solution in preventing them.

I reached out to my friend Michael Cohen, from the Institute for Safe Medication Practices (ISMP), to help explain the overall function and responsibilities of a pharmacy technician. Michael imparted some words of wisdom by sharing an analogy that really hit home with me, one that I will never forget.

He said, “Chris, always think of pharmacy technicians as being the “team” and the supervising pharmacists as being the “coaches” in any pharmacy setting.” He went on to say, “What coaches wouldn’t want to have the best trained and most qualified team to ensure a successful and victorious season?” He then explained, that a truly “victorious season” in any pharmacy setting, can be equated to having no medication errors that actually reach a patient receiving care. That simple analogy made sense to me back then and still resonates with me today.

Due to the fact that pharmacy is really the only modality in healthcare that truly works in the background, especially in hospital pharmacy, like most people, I was naturally clueless as to the overall scope of practice that pharmacy technicians have in modern day pharmacy. For example, I had no idea that in virtually every one of our nation’s hospitals, pharmacy technicians have the important responsibility of compounding nearly ALL IV (intravenous) medications, which go directly into patient’s circulatory systems.

In addition, most states have little or no requirements in regards to pharmacy technician training or certification. On the EJF website, we have created an interactive National Pharmacy Technician Initiative and Scorecard, so you can see exactly how your state ranks.

I was absolutely horrified to learn that my little girl had died from a sterile IV compounding error, made on the part of a pharmacy technician, who did not have the proper training or core competency to know the difference between a standard bag of saline with 0.9% sodium chloride, versus hypertonic saline, which has a concentration of 23.4% sodium chloride.

Technically, my daughter tragically died as a result of being overdosed on hypertonic saline.

However, as Emily’s Dad, I feel as though what actually caused her death was a lack of understanding regarding the true importance and vital role that pharmacy technicians play on the clinical “team”, helping to ensure the best and safest possible outcome for each and every patient receiving healthcare.

This is precisely the reason why I feel so strongly that pharmacy technician training is a matter of life and death for all of us! As every single one of us will receive healthcare at some time over the course of our lifetimes.

Above all else, well trained, competent, and reliable pharmacy technicians can drastically reduce any facility’s overall medication error rate. We must fully support technician training and certification, and never ever forget the vital role that technicians play; there are countless lives at stake!

 

For more information about Chris Jerry and the Emily Jerry Foundation please visit: https://emilyjerryfoundation.org/

For more information on Pharmacy Technicians University or to enroll please contact elearning@rxtoolkit.com or visit https://rxtoolkitelearning.com/ptu/

Minimizing Risk with Standardized IV Care for the Infusion Center

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In recent years there has been a plethora of new infusion and injection therapies flooding the healthcare market. These new therapies are giving patients with chronic illnesses a broader range of treatment options and providing them the opportunity to live their lives with fewer debilitating chronic symptoms.

As an Infusion Center Nurse Manager, with over 25 years of nursing experience, I find the surge of new treatment options to be mind blowing. I still remember when new drugs seemed to take years in development. They would go through a lengthy approval process, including clinical trials, before a new therapy would be released to market and finally become available for patients.

Currently, the speed at which new infusion/injection drugs are approved, gives nurses little time to research and learn the important care points of preparation, administration, patient response to therapy, and patient assessment.

In addition, the days of learning nursing from our more seasoned nurses, thru tradition, and one-on-one training are dwindling fast. We are all out there on the front lines learning together. This makes the availability of reliable evidence based resources more important than ever.

RxTOOLKIT’s RxWORKFLOW™ for IV Safety is answering the call for those concise care points we nurses need in order to provide evidence based care safely and efficiently for our patients.

I have found RxWORKFLOW™ for IV Safety to be convenient and easy to use, providing the information nurses need, right when they need it! It prepares us to provide patients the best quality care:

  • Evidence based processes with quick links to resources ensure the information is credible, reliable, and up-to-date
  • Step-by-step instructions (including recommendations for all equipment needed) help me to prepare and administer the latest infusion/injection therapies
  • Pop-up Competency Checks provide the ability to check my knowledge anytime. It is a great learning tool and a quick refresher that help me reinforce and retain what I learn
  • Having fast access to trustworthy and comprehensive information gives me confidence that I will do it right for my patients
  • Pop-up calculators ensure that calculations are done correctly and fall within accepted parameters for the drug

Before RxWORKFLOW™ for IV Safety, my nursing colleagues and I adopted fragmented processes to provide safe patient care:

  • Finding the time to research reliable information and learn the administration and preparation for IV medications was always challenging
  • We would carry index cards and pocket notes to help remember the key care points for many IV medications prescribed for patients
  • Keeping a paper binder up to date with all the requirements for each drug regimen was a constant struggle
  • We often sought the help of a colleague with experience in preparing and administering a drug that was new to us
  • Those of us not confident with math skills (myself included!) would often track down another nurse to double check any drug calculations

These fragmented, inconsistent processes lead to wasted time, distractions, and exponentially increased the risk for medication errors.

Many of the highest risk medications are delivered by IV infusion. In fact, 61 percent of the most serious and life-threatening potential adverse drug events are IV drug related.1 IV administration often results in the most serious outcomes of medication errors.2

The development of evidence based practices and standards of care are vital for successful outcomes in outpatient infusion centers. Training staff and keeping them up-to-date on the established guidelines is also imperative for success. RxWORKFLOW™ for IV Safety provides assurance that I have the right information and that I can provide proper training to maintain safety and quality care for my nurses and patients.

Please contact info@RxTOOLKIT.com or visit IVSafety.RxTOOLKIT.com for more information.

[1–2]: http://www.hqinstitute.org/highriskmed (sdpsc_safe_administration_of_high-risk_iv_medication.pdf):[1] Communication with D.W. Bates, M.D., M.Sc. of Brigham & Women’s Hospital in Boston, October, 2001. [2] Hicks, RW, Cousins, DD, Williams, RL. (2003). Summary of Information Submitted to MEDMARX® in the Year 2002. The Quest for Quality. Rockville, MD: USP Center for the Advancement of Patient Safety.

RxTOOLKIT® and TRC Healthcare Announce Partnership to Expand Availability of Best-in-Class Online Pharmacy Technician Training Program

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Pharmacy Technician University (PTU) now included in RxTOOLKIT’s eLEARNING™ division offerings, portion of proceeds donated to the Emily Jerry Foundation.

[Ephrata, PA April 2018—] RxTOOLKIT eLEARNING™ has partnered with TRC Healthcare (Authors of Pharmacist’s Letter and Pharmacy Technician’s Letter) to make TRC’s Pharmacy Technicians University™ (PTU) available to its clients. PTU’s online competency-based curriculum provides the tools and information needed to prepare techs for employment, as well the national technician certification exam.

Today, pharmacy technicians are increasingly important members of the pharmacy team. Skilled pharmacy technicians are critical for the economic and efficient function of a pharmacy. However, training requirements for pharmacy technicians change often and are becoming more complex, creating a shortage of qualified pharmacy technicians.

“Training and certification ensure that pharmacy technicians have the core competencies required to safely perform the full scope of practice as well as the right attitude for advancing success. Expanding the reach of high-quality technician training is important to improving the overall quality of patient care and medication safety,” said Chuck DiTrapano, President of RxTOOLKIT.

Pharmacy Technicians University takes the headache out of technician training and compliance with convenient, cost-effective, online training including real-world scenarios and rich media content. Most importantly, trained, competent, and reliable techs can drastically reduce any facility’s overall medication error rate.

“RxTOOLKIT has chosen to donate a portion of proceeds from PTU subscriptions to the Emily Jerry Foundation, in memory of Emily Jerry, a two-year-old girl who lost her life due to a medication error made by a hospital pharmacy,” said DiTrapano,

“We want to remind healthcare workers that there is an Emily in everything we do. The better we know our job, and the more engaged we are, the more likely we are to prevent her story from being repeated.”

Pharmacy Technicians University offers:

  • PTU Advanced Training Program: (126 hours)
    • Includes the 83 hours from PTU 101 plus 43 additional hours of specialized training (including sterile product preparation) and prepares candidates to take the national certification exam.*
  • PTU Advanced Training Program: (160 hours)
    • Includes the 126 hours from the PTU Advanced Training Program plus 34 additional required preceptor hours, to be completed with either a self or employer coordinated externship.*

Program Benefits Include:

  • Achievable hourly and practice-model specific courses
  • Continuous updates with changes to state laws and regulations
  • Relevant, enriched content to engage students, including:
    • Realistic context support for active learning and problem solving with real-world scenarios
    • Development of observational and critical thinking skills across multiple learning modalities (videos, audios, interactive modules, learning games, and didactic content)
    • Charts, guides and other reference tools useful for long after training is complete

Please contact eLEARNING@RxTOOLKIT.com or visit RxTOOLKITeLEARNING.com for more information or individual purchase.

[TRC® Healthcare, Pharmacy Technicians University™, and PTU 101™ are trademarks of Therapeutic Research Center. Copyright © 2018 Therapeutic Research Center (TRC) All Rights Reserved. / RxTOOLKIT® and RxTOOLKIT eLEARNING™ are trademarks of HMMRx Inc. Copyright © 2018 RxTOOLKIT, HMMRx Inc. All Rights Reserved.]

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If you would like more information, please contact Chuck DiTrapano at 1–888-RXTLKIT (798‑5548) or chuckditrapano@rxtoolkit.com.