California gives pharm techs more responsibility
California gives pharm techs more responsibility
Move frees up pharmacists for pt care
Specially trained pharmacy technicians in California may soon be employed in general acute care hospitals to check medication cassettes and the work of other technicians, thus freeing pharmacists to expand their patient care role. A regulation allowing the change took effect January 5, 2007.
Approval of the regulation was based on research conducted several years ago by Cedars-Sinai Medical Center and the University of California, San Francisco School of Pharmacy. The study, conducted at Cedars-Sinai and Long Beach Memorial Medical Center, demonstrated the safety of having specially-trained technicians check the work of other technicians to prevent medication errors.1 A second study, completed in 2006, demonstrated the impact of pharmacists on preventing medication errors during the time they would otherwise have been performing non-discretionary tasks.
"A number of studies have demonstrated the value of pharmacists in reducing adverse drug events in the hospital setting," said principal investigator Rita Shane, Pharm.D., director of pharmacy services at Cedars-Sinai. "One study showed that hospitals with pharmacists in patient care areas had a 45% decrease in medication errors overall and a 94% decrease in medication errors that adversely impacted patient outcomes. This regulation will have a significant positive impact on the practice of pharmacy in California by enabling pharmacists to spend more time in direct patient care activities designed to improve medication safety. Hopefully this will assist other states who are considering allowing technicians to check medication cassettes as well."
The 2002 study report, published in the American Journal of Health-System Pharmacists, noted that California required that unit dose medication cassettes filled by pharmacy technicians must be checked by a pharmacist. It said pharmacists spent one hour a day checking the cassettes, time that competed with the increasing demand to provide clinical services and become more involved in medication safety initiatives, in addition to dealing with the increased complexity of hospitalized patients and the shortage of pharmacists.
Waiver allowed study
The study was conducted under a waiver of regulations approved by the California State Board of Pharmacy. Shane says it should be emphasized that the process of filling and checking unit dose medication cassettes is preceded by pharmacist review and verification of all medication orders. The pharmacist evaluates the appropriateness of the medication, dose, dosage form, route of administration, and frequency in the order and screens for drug allergies, drug-drug interactions, and contraindications. A pharmacist also is responsible for dispensing any initial medication doses needed before the regularly scheduled unit dose cart distribution.
Pharmacy technicians don't evaluate the accuracy and appropriateness of medication orders. Rather, they perform manipulative and nondiscretionary functions only under pharmacist supervision. When filling a medication cassette with unit dose medications, a technician reads a list of medications (fill list) previously verified by a pharmacist, removes the unit dose medication from stock, and places it in a patient's cassette or medication drawer. Next, a "checker" verifies the filled cassette against the fill list to minimize the possibility of errors before the medications are sent to the nursing areas.
"It should be noted that nurses also check the medication when removing it from a patient's cassette and confirm it with the medication administration record (also reviewed and approved by a pharmacist) before administering the medication to the patient...," Shane wrote. "Thus, a medication is triple-checked before it is administered to a patient."
With study accuracy rates over 99%, Shane said the study's results appeared to support the ability of well-trained technicians to accurately check unit dose medications. In fact, she said, there was a higher accuracy rate for technicians than for pharmacists.
"The expansion of the technician's role has been shown to increase pharmacists' productivity," Shane said. "We estimated that pharmacists at each institution spent approximately one hour per day per pharmacist checking unit dose medication cassettes before the program was implemented. In this experimental program, the pharmacists were able to use this additional time to expand clinical services and respond to drug therapy-related requests from physicians, such as dosing recommendations."
Shane tells Drug Formulary Review there was considerable opposition to the idea as the study got underway, but that with the pharmacist shortage, it's important that pharmacists spend their time on patient care instead of on work that could be performed by trained technicians.
Standards sought in Ohio
Meanwhile, in Ohio there have been calls for bills to establish standards for pharmacy technicians following the February 2006 death of a two-year-old girl who received an overdose of a saline solution while being treated in a hospital. A technician at Cleveland's Rainbow Babies and Children's Hospital allegedly prepared the girl's chemotherapy treatment with a 23% saline solution instead of the typical mix of less than 1%. The mistake wasn't caught by the technician's supervising pharmacist, who resigned and faced a state Board of Pharmacy disciplinary hearing. Pharmacy technicians in the state are not regulated and the board has no power to discipline them. Lawmakers said there should be a requirement that technicians complete a two-year training program or internship, pass a state or national exam, and be licensed through the state pharmacy board.
Reference
- Ambrose, Peter J.; Saya, Frank G.; Lovett, Larry T, et al. Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes. American Journal of Health-System Pharmacy. 2002; 59(12):1183-1188.
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