Some pharmacists say ratios are unnecessary

Richard Fry, director of pharmacy affairs for the Academy of Managed Care Pharmacy in Alexandria, VA, says that while most state pharmacy boards have not proposed new regulations on technicians checking technicians, he’s not so sure they should.

He says Washington state is a good example of how best to handle the issue. There the state board is attempting to eliminate mandated ratios and let individual pharmacy directors set their own ratios based on need.

"I don’t see any significant movement anytime soon to a widespread tech-check tech process, and I would share some pharmacy directors’ concerns that increasing responsibilities of the technicians without the increased commitment to technology could spread the pharmacists too thin," Fry explains.

"Those two movements need to go hand in hand. I think we can move away from the mandated ratio, but we need regulation to address the use of new technologies to compensate for that.

"I think we still have a need for the dispensing pharmacist, for lack of a better term. That won’t or shouldn’t go away, at least on a regulatory basis and to back up the emphasis on error prevention. The accountability of the pharmacist part also won’t go away, and shouldn’t."

According to the National Association of Boards of Pharmacy’s 1996-1997 Survey of Pharmacy Law, more than a dozen states do ot require a ratio of pharmacists to technicians in ambulatory or institutional care settings. The majority of ratios that are mandated call for one or two techs per pharmacist, while three or four techs per pharmacist are allowed in just a few states. (See charts on technician certification, pp. 148-150.)

Although 19 states require some form of technician training, only four license technicians. Eleven states mandate registration, and five are in the process of developing a form of registration. Two states specifically certify technicians, and two more are developing those requirements.

Fewer than 10 states allow technicians to take called-in prescriptions from doctors, while the vast majority allow labeling, computer entry, and dispensing. About half of the states allow techs to call physicians for refill authorization, while most allow technicians to compound medications under a pharmacist’s supervision.

In Texas, new rules by the state pharmacy board require documentation of 40 hours of compounding training for technicians (20 for pharmacists) involved in the preparation of sterile pharmaceuticals.

That rule allowed institutions such as Presbyterian Hospital of Dallas to devise a systemwide competency assessment in the pharmacy. Initial areas covered included antineoplastic drug preparation, TPN preparation, solid-dose prepackaging, drug therapy assessments, medical emergencies, and even basic mathematic calculations, all by demonstration or by multiple-choice or written exams.

[For more details, contact Richard Fry, Director of Pharmacy Affairs, Academy of Managed Care Pharmacy, 1650 King St., Suite 402, Alexandria, VA 22314. Telephone: (703) 683-8416.]