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We Support Pennsylvania House Bill 770!

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“An ounce of prevention is worth a pound of cure.”

B. Franklin

On April 9, 2019 my colleagues and I from the Pennsylvania Society of Health System Pharmacists (PSHP) will be attending a meeting with Pennsylvania State Representative Tony DeLuca. Representative DeLuca, along with 12 other co-sponsors, have sponsored House Bill 770 into the General Assembly of Pennsylvania.

This bill, when passed and signed into legislation, will amend the Pharmacy Act to “further provide for definitions; and providing for pharmacy technician and pharmacy technician registration, qualifications and supervision”. Pennsylvania is currently one of only four states that do not provide Board of Pharmacy oversight of pharmacy technicians through registration or licensure.

In 2006, Ohio was one of those states without any oversight of pharmacy technicians. In February of that year, a tragic error committed by a pharmacy technician and not caught by a pharmacist resulted in the death of 2‑year-old Emily Jerry. Once Emily’s dad, Chris, understood the cause of Emily’s death, he took it upon himself to change the law in Ohio. Emily’s Law was passed in December 2008 and went into effect on April 8, 2009.

As with any change in law and/or regulations, there are voices on both sides of the argument. House Bill 770 is no exception. On one hand, it seems so logical. Why would you not want to regulate and demand standards of practice for individuals who prepare medications? On the other hand, there are economic issues that come with regulations and competency.

The answer, in my opinion lies with Ben Franklin. Prevention in healthcare typically leads to a better quality of life and can at the same time provide cost savings for patients and providers alike. It’s why we do things like vaccinate and perform cancer screenings. There are so many benefits to pharmacy technician training, but the most important one is that trained, competent, and reliable techs can drastically reduce any facility’s overall medication error rate.

When Pennsylvania adopts House Bill 770, my home state will take a step forward to prevent a tragedy like Emily’s from ever happening again. This makes Emily’s short time on this earth all the more meaningful and it is absolutely worth the continued fight!

Pennsylvania residents please call or write your representatives and ask them to support this bill!

About the bill:

Who is my Pennsylvania Legislator?:

 

Photo Credit: Governor Tom Wolf, The Pennsylvania State Capitol in Fall, November 4, 2015, Harrisburg, PA used under Attribution 2.0 Generic (CC BY 2.0) source: https://flic.kr/p/AH98zR

Technology, Technicians, Action!

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This post was updated on 02–06–19

The profession of pharmacy has certainly evolved in the years since my graduation and licensure. Significant improvements to patient care and an increase in quality outcomes are evident to any long-term observer of the profession. But this progress has revealed a major vulnerability. My goals are to bring this deficiency to light and to do something about it.

In addition to being the president and founder of RxTOOLKIT.com, I was formerly the operations manager of a large (700 bed) hospital. The pharmacy department there was fortunate to have the latest technology and a state of the art facility. They even provided a PGY 1 residency program and acted as a practice site for six different local schools of pharmacy.

As I interacted with students and residents, two things became apparent:

  • They are much better prepared for the clinical challenges of the profession than I was at that stage of my career
  • Most have little or no interest in operational jobs like mine (focused on dispensing and distribution)

Both observations make sense when you see the expanded role pharmacy is taking into so many different areas. In most hospitals now there are many different specialized areas in the pharmacy: clinical specialists, oncology specialists, and anticoagulant specialists.

Those clinical positions are the most sought after by recent graduates and the ones they are most prepared to do. But I wonder, “In the future, who is going to take care of dispensing and distribution?”

I ask that question often and the answer that I usually receive is, “These jobs will be done by technology and technicians.”

My reaction is two-fold, “You really don’t understand the limitations of the existing technologies” and “Where are we going to find these technicians?”

 

Technology

As I mentioned, the hospital where I formerly worked had the very latest in pharmacy technologies, including state of the art robotics. I am absolutely a strong proponent for technology and my company RxTOOLKIT, offers many technologically based solutions.

Frequently, technologies are singular components in a larger workflow involving many moving parts.

As an example, let’s look at preparing a NICU stock solution and then repackaging the solution into individual syringes. Normally the following separate silos of technology are utilized:

  • Printer Application: Print the stock solution label capturing lot numbers / expiration dates
  • Barcode Verification Application: Barcode verify ingredients in preparation
  • Follow Established Procedure: Paper or electronic, centrally stored for reference
  • Printer Application: Print syringe labels for repackaging the stock solution dose into a syringe
  • Electronic or Paper Storage: Logging all of this in a book or online for regulatory compliance and quality control

Often times, these individual technology silos can be extremely expensive, severely limiting their practical use in smaller hospitals.

And I caution, that technology alone is not the answer. I have yet to see a technology that can be a substitute for understanding workflow and a well designed process. And even the best technology won’t work without well-trained people and an established process. Check out RxWORKFLOW™: Integrating Technology, Process, and Competency or visit ivsafety.rxtoolkit.com for more on this topic.

RxTOOLKIT advocates for smarter solutions that incorporate technology with process and competency. We work hard to make the solutions we offer accessible and affordable.

 

Technicians

I drive a car. Before I could get behind the wheel, I had to prove my competency with both a written and observational exam.

I get my hair cut at a local barber. My barber has a framed license hanging on the wall proving her competency at cutting hair.

If I were admitted to a hospital in the United States, a pharmacy technician would almost certainly prepare any drugs given to me. Would there be a license I could point to that would demonstrate their competency? In almost every state in the country the answer is NO! Only 16 states currently require licensure as of this post, please see this post and the interactive map on the Emily Jerry Foundation’s site for more information.

Most hospitals do have an internal training program or may require technicians to pass a national certification exam. But there is no consistent, enforceable, governmental mandate. Who is responsible if something goes wrong? The pharmacist is the one who is accountable for what happens and is typically the only one with a license to loose.

How prepared are they for this responsibility? The answer: not particularly! Especially when education is moving further away from the skills required to supervise and perform operational tasks.

The extreme case of what can go wrong is former pharmacist Eric Cropp. The pharmacy technician’s error—missed by Eric—resulted in the death of two-year-old Emily Jerry. It also resulted in the loss of license, his career, and ultimately his freedom. Eric was the second victim in this medication error.

The pharmacy technician is a complex, sensitive, and extremely important job! We need to treat it as such.

 

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.

We have become advocates for national pharmacy tech certification and are also lobbying for hospital pharmacy technician certification on a state-by-state level.

We have partnered with the Emily Jerry Foundation and Eric Cropp to help educate both the profession and the public about the changes that need to come.

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.

Only after Emily Jerry’s tragic death, did the State of Ohio pass Emily’s Law requiring certification, background checks, and proven competency for pharmacy technicians. We don’t think it should take another senseless death to motivate change—We want Emily’s to be the last innocent life lost! If we can help prevent losing ONE MORE LIFE, isn’t it worth all of the ideas, energy, and passion we can muster?

 

Want to join the Zero Movement?

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 directly to the Emily Jerry Foundation.

Contact us if you are interested in volunteer opportunities.

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

Pharmacy Technician Certification — Christina Martin, PharmD, MS

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I began my pharmacy career in 2003 as a pharmacy technician for Weis Markets in Lancaster County, PA. My parents encouraged me to work in a pharmacy before I committed to six years of college.

What has always surprised me is the amount of previous experience and/or education required to be a pharmacy technician in Pennsylvania. In a modern period when states require hairdressers to be registered and tax accountants to be certified and licensed, it is amazing that pharmacy technicians can be hired without any credentials!

Eight states currently have no regulation of pharmacy technicians, which means that a sixteen-year-old without a high school diploma could be filling a patient’s prescription for injectable anticoagulants.

Ninety-six percent of all medications involve a pharmacy technician somewhere in the dispensing process.

The misconception is that all pharmacy technicians are certified; this thought is held by 73 percent of Americans.

As medication regimens become more complex and cost-conscious insurers rely on pharmacists to provide direct patient-care and medication therapy management, pharmacy technicians will continue to be called upon in-keeping pharmacy operations running smoothly. The number of pharmacy technician roles is anticipated to increase 31 percent by 2018 as a response to the redeployment of pharmacists and technicians need to fulfill distributive roles that do not require clinical judgment. The Pharmacy Technician Certification Board suggests that pharmacy technicians with formal education or training, previous work experience, and national certification will be specifically sought after to meet those demands.

My interest in pharmacy technician education and development was heightened during my pharmacy residency years at the University of Kansas Hospital. As a PGY1 resident, I had the opportunity to take a Health Policy course while working towards my Master’s degree in Pharmacy Practice Management.  We were tasked with identifying a “health care issue” and writing a proposal to address (fix) the issue.

I was aware of Emily Jerry’s story and wanted to create awareness of the need to train, register, and certify/license pharmacy technicians in all states. Registration allows the state to track and monitor who is designated as a pharmacy technician. Certification and licensure show that the technician has the pre-education through completion of an accredited pharmacy technician training program and passed an extensive competency exam. Requiring regulatory requirements will help ensure that a pharmacy technician has baseline knowledge of the job requirements.

In 2011, Pennsylvania proposed legislation that addressed not only the registration, certification and licensure standards, but also a minimum age and education requirement for technicians. Unfortunately, the proposed legislation died early in discussion.

In my lifetime, I hope to see resurgence in both the interest and importance of regulating pharmacy technicians. The uniform credentialing standards will promote health, safety and wellness in our patients!

What do you think?

Christina Martin, PharmD, MS

Practitioners on the Defensive

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In the article titled: “Current approaches to punitive action for medication errors by boards of pharmacy”, the authors point out that most boards of pharmacy invoke punitive action against pharmacists involved in medication errors. Most states do not have specific rules or regulations that stipulate errors as actual violations and most determinations are made on a case-by-case basis.

Questions we are asking are:

  1. How many pharmacists are aware of this?
  2. How many pharmacists know the rules for their state?
  3. Do these rules apply to other healthcare professionals?
  4. What obligation does the hospital or other healthcare institution have in doing everything possible to create a safe work environment?
  5. If there is technology that would have prevented the error or minimized the potential for the error and it was not in place, does that responsibility then go to the hospital/institution?

A link to the article originally published on The National Center for Biotechnology Information site: Current approaches to punitive action for medication errors by boards of pharmacy.

Current approaches to punitive action for medication errors by boards of pharmacy. Holdsworth M, Wittstrom K, Yeitrakis T. Ann Pharmacother. 2013 Apr;47(4):475–81. doi: 10.1345/aph.1R668. Epub 2013 Apr 2. [Read more…] about Practitioners on the Defensive