Learning Outcomes
After completing this chapter, you will be able to
Compare and contrast the responsibilities of pharmacy technicians and pharmacists.
Outline the differences among licensure, certification, and registration.
Describe the advantages of formal training for pharmacy technicians.
Describe the differences between the ambulatory and institutional pharmacy practice settings.
List two specific examples each of ambulatory and institutional pharmacy practice settings.
Describe at least six characteristics of a professional.
List five tasks that pharmacy technicians perform in various pharmacy settings.
Describe the concept of pharmaceutical care.
Define medication therapy management.
Explain why the use of outpatient pharmacy and medical services is increasing.
Key Terms
| accreditation | The process of granting recognition or vouching for compliance with established criteria (usually in refererence to recognition of an institution or program) |
| certification | The process of granting recognition or vouching for compliance with established criteria (usually in refererence to recognition of an institution or program) |
Pharmacy Training and Education
Pharmacy Benefit Managers and Managed Care
Expansion of Technician Responsibilities Pharmaceutical Care and Medication Therapy Management Increasing Impact of Technology Increasing Use of Outpatient Services |
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The pharmacy profession has roots dating back thousands of years and is based on the sciences of mathematics, chemistry, and medicine. Knowledge from these sciences is applied to the development and study of drugs and their actions (pharmacology); the understanding of how drugs are absorbed, distributed, metabolized, and eliminated by the body (pharmacokinetics); and the preparation and dispensing of drugs (pharmaceutics).
The primary responsibility of any employee in the pharmacy profession is to ensure that patients receive optimal drug therapy to maintain or restore their health. To achieve this goal, pharmacy personnel in hospitals, community pharmacies, and other health care settings perform a variety of duties designed to deliver the correct drug in the correct amount to the right patient at all times and in a timely manner. These duties include ordering medications from suppliers, evaluating the appropriateness of each medication based on patient-specific information, distributing medications to patients, and monitoring patients while they are taking medications. Pharmacists are assisted by pharmacy technicians in several capacities to fulfill these obligations.
Pharmacists and pharmacy technicians must be honest and ethical and protect the rights and privacy of patients. To establish and maintain a profession consistent with these goals, state boards of pharmacy enforce pharmacy laws and regulations and require pharmacists to meet minimum education and experience standards. Most state boards of pharmacy also require that pharmacy technicians be registered or certified.
The purpose of this chapter is to describe pharmacy training and education, licensure and certification, aspects of professionalism, various settings in which pharmacy technicians practice, and how technician responsibilities are expanding. It emphasizes the differences between the duties and responsibilities of pharmacy technicians and pharmacists and introduces pharmacy technician competency expectations.
Pharmacy Training and Education
A profession is an occupation or vocation that requires advanced training in a liberal art or science. Pharmacy is a profession in which pharmacists are trained in the pharmaceutical sciences. Technicians are individuals who are skilled in the practical or mechanical aspects of a profession. Pharmacy technicians assist pharmacists by performing the routine, day-to-day functions that do not require the judgment of a pharmacist. Although technicians may be capable of functioning efficiently and safely without supervision, pharmacists are ultimately responsible for the technicians’ activities and performance. The assistance of pharmacy technicians allows pharmacists more time to engage in activities that require professional judgment. Such assistance includes activities such as repackaging medications and maintaining medication inventory. Educating patients about their medications and suggesting medication alternatives to physicians require a pharmacist’s judgment and are not to be performed by pharmacy technicians. Legally, pharmacists are held liable for the performance of technicians and must oversee and approve the technicians’ work.
Pharmacists are ultimately responsible for the technicians’ activities and performance and are legally held liable for the technicians’ work.
Pharmacy Technicians
Pharmacy technicians assist pharmacists by completing tasks that do not require the professional judgment of a pharmacist and that can be reviewed for accuracy by a pharmacist. In this way, pharmacy technicians give pharmacists more time to concentrate on clinical services, such as patient consultation and education, physician collaboration, disease and medication management, and other clinical activities.
The Pharmacy Technician Certification Board (PTCB) is a national certification program that administers a nationally accredited pharmacy technician certification examination. The PTCB defines pharmacy technicians as
individuals working in a pharmacy, who, under the supervision of a licensed pharmacist, assist in pharmacy activities not requiring the professional judgment of a pharmacist. The pharmacy technician is accountable to the supervising pharmacist, who is legally responsible by virtue of state licensure for the care and safety of patients served by the pharmacy. The pharmacy technician performs activities as the result of having certain knowledge and skills.1
Training prerequisites for pharmacy technicians vary from state to state and from employer to employer, but most employers require pharmacy technicians to have at least a high school diploma. As the level of responsibility for pharmacy technicians increases, so does the amount of required training or experience. Many employers have established criteria to classify technicians on the basis of their training or experience. For example, a hospital pharmacy technician 1 (PT-1) may be a newly hired technician responsible only for filling automated medication dispensing cabinets (e.g., PyxisR MedStationTM medication management systems). A pharmacy technician 2 (PT-2) in that same hospital may have five years’ job experience and be able to fill automated medication dispensing cabinets, as well as charge and credit patient accounts, compound (mix) intravenous (IV) solutions, and inventory narcotics.
Similar classifications may exist in community pharmacies. There, a PT-1 might receive prescriptions as patients leave them to be filled and check out patients at the cash register when they are ready to pay, whereas a PT-2 may be able to enter data in computerized patient profiles, fill and label prescriptions, and review patient insurance information.
Training prerequisites for pharmacy technicians vary from state to state and from employer to employer.
The work that pharmacy technicians perform is becoming more and more demanding. Some states allow technicians to check the work of other technicians (tech-check-tech) under the supervision of a pharmacist. Because most pharmacy practice settings rely heavily on computers and automated technology, technicians frequently are responsible for the day-to-day operations and upkeep of these systems. Computerized narcotic inventory control is one example of a technology that requires a high degree of computer skill, and the preparation and compounding of IV and sterile products is an example of a technician duty that demands a high level of proficiency and competence.
Patient safety is a top priority for all pharmacists and pharmacy technicians. Technicians often perform the first step in dispensing medication to patients. As such, they must be sure that they choose the right drug in the right dose to give to the right patient by the right route at the right time. Technicians may be responsible for preparation of drugs that must be reconstituted, mixed, or otherwise prepared before administration, and they must be sure that no errors occur in this process. Technicians often enter patient information into a computer profile for later verification by a pharmacist. Errors made in any of the steps to get the correct medication to the correct patient can carry through and cause potentially fatal errors. Technicians play a key role in minimizing the risk of such errors happening.
Patient safety is a top priority for pharmacists and pharmacy technicians. Technicians must be sure to choose the right drug, the right dose, and the right route and must check to make sure that no errors have been made in the drug preparation. Check your work!
Technicians may be trained on the job or by completing a formal program, such as a certificate of completion or associate degree program at a community or technical college.
On-the-Job Training. In some states, employers offer on-the-job training to technicians. Technicians are trained to perform tasks that are specific to the job or position for which they were hired. Usually, technicians are taught only those skills needed to perform the particular job. For example, a technician may be trained on the job to fill prescriptions or automated medication dispensing cabinets, compound IV solutions or medications, or enter prescription information into a computer database. When this type of training is very informal, a pharmacist or technician who is familiar with the job often instructs the trainee. In more structured training situations, the trainee participates in a training course developed by the employer.
Some practice sites offer training courses that consist of classroom teaching combined with hands-on experience that may last from a week to six months. In addition to covering general pharmacy topics, such as aseptic (sterile) technique, pharmaceutical calculations, technician responsibilities, and pharmacy rules and regulations, these courses may cover job-related issues such as patient confidentiality, organizational policies and procedures, and employee responsibilities.
Formal Programs. Community and technical college programs are broader in scope than on-the-job training. These programs are more rigorous and take from six to twenty-four months to complete. They cover the technical duties related to pharmacy, as well as such topics as medical terminology, pharmaceutical calculations, drug distribution systems, IV admixture procedures, and medication packaging techniques. In these programs, student technicians gain skills, knowledge, and experience by attending classes and completing clerkships (educational training in actual practice settings such as local hospitals or community pharmacies). After completion of many of these programs, students earn associate degrees or pharmacy technician certificates. Most programs offer full-time, part-time, and night classes, as well as financial assistance to those individuals who qualify. Some are available as online distance learning programs.
Pharmacists
Pharmacists are professionals who have had advanced training in the pharmaceutical sciences.
When filling prescriptions or medication orders, pharmacists depend on their education, experience, and professional judgment to determine whether the prescription is appropriate for each patient. Often, answers are not black and white, so they rely on their education, experience, and judgment to make the best decision. They are obliged to verify that the medication is appropriate for a patient’s condition, that the dosage is correct, that the patient is not allergic to the drug, and that the prescribed medication will not interact with other medications the patient is taking. They must also educate the patient on how to take the medication properly and alert the patient to possible side effects of the drug. Pharmacists perform these functions every time a prescription or medication order is filled.
In all states, pharmacists must be licensed by the state’s board of pharmacy before they can practice pharmacy and must follow the board of pharmacy regulations as they practice. Licensed pharmacists supervise the activities of technicians and are held accountable for the technicians’ performance.
Pharmacists are required to earn a college or university degree in pharmacy to take the licensing examination offered by their state boards of pharmacy. To be qualified for enrollment in a college pharmacy degree program, students must have completed a minimum of two years of college course work that includes prerequisite classes for pharmacy school. While earning a pharmacy degree, would-be pharmacists learn how to use medical information to evaluate health care-related situations safely and effectively.
The first professional college degree that pharmacists graduating today usually earn is a doctor of pharmacy (PharmD), although some older pharmacists may hold a bachelor of science (BS) in pharmacy. Some schools of pharmacy have also developed “external PharmD” programs for pharmacists with BS degrees who wish to earn a PharmD Using advanced communication technology such as videoconferencing and the Internet, pharmacists can take classes from a school of pharmacy located any distance away, continue to work a full-time job, and maintain their family lives while fulfilling the requirements of a PharmD degree. Pharmacists who choose this option are often those who have several years of experience working as pharmacists and desire to advance their education but have other obligations that make it impractical for them to return to college full-time.
Many pharmacists have also completed oneor two-year postgraduate training programs called residencies. Residencies provide the opportunity to gain clinical experience, usually in hospital, ambulatory, or community settings, after earning a degree. Fellowships, usually two to three years long, also provide postgraduate training but focus on pharmacy research rather than clinical pharmacy practice.
Licensure and Certification
Before learning about licensure and certification for pharmacy technicians and pharmacists, it is important to know some key terminology. The American Society of Health-System Pharmacists (ASHP) Task Force on Technical Personnel in Pharmacy has provided these definitions:
Accreditation—The process of granting recognition or vouching for conformance with established criteria (usually refers to recognition of an institution).2
Certification—A voluntary process by which a nongovernmental agency or association grants recognition to an individual who has met certain predetermined qualifications specified by that agency or association. This recognition demonstrates to the public that the certified individual has achieved a certain level of knowledge, skill, or experience.2
Credentialing—The process by which an organization or institution obtains, verifies, and assesses a pharmacist’s qualifications to provide patient care.2,3
Licensure—The process by which an agency of government grants permission to an individual to engage in a given occupation upon finding that the applicant has attained the minimal degree of competency necessary to ensure that the public health, safety, and welfare will be reasonably well protected.2
Registration—The process of making a list or being enrolled in an existing list. Registration of pharmacy technicians by state boards may be required to legally carry out some functions.4
Pharmacy Technicians
Successful completion of an accredited pharmacy technician program or certification examination helps assure pharmacy employers and patients that pharmacy technicians have met a predefined set of standards and possess an established set of skills and knowledge. Some states and employers may require one or the other, but even if they don’t, pharmacy technicians who are certified or who have completed an accredited training program may have an advantage in terms of job responsibilities, salary, and seniority over technicians who are not certified or who have not completed such a program.
Pharmacy Technician Certification. In 1994, several professional organizations, including the ASHP, the American Pharmaceutical Association (APhA, now known as the American Pharmacists Association), the American Association of Colleges of Pharmacy (AACP), and the National Association of Boards of Pharmacy (NABP), completed a joint endeavor named the Scope of Pharmacy Practice Project. The objective of the project was to perform a validated task analysis of the functions, responsibilities, and tasks of pharmacists and technicians. This analysis documented what pharmacy technicians actually do and what knowledge they need to effectively perform those tasks.
Participants in the Scope of Pharmacy Practice Project identified the need for a national technician recognition program to replace the various state programs that then existed. In 1995, APhA, ASHP, the Illinois Council of Hospital Pharmacists (ICHP, now known as the Illinois Council of Health System Pharmacists), and the Michigan Pharmacists Association (MPA) established the Pharmacy Technician Certification Board (PTCB). The PTCB was created to develop a voluntary national pharmacy technician certification program.5
Some states require registration of pharmacy technicians, whereas other states require certification; still others are considering the matter. There is no national requirement for certification at this time. However, a 2007 consumer survey conducted by the PTCB revealed that 73% of the public believes that “pharmacy technicians are required by law to be trained and certified before they can help prepare prescriptions.” Most consumers (91%) felt that employers should hire only certified pharmacy technicians.6 Given this strong public opinion, it may be only a matter of time before certification is mandated by law.
Most consumers believe that all pharmacy technicians have been trained and certified before they are allowe to prepare prescriptions.
Technicians who wish to become certified may take the national Pharmacy Technician Certification Examination (PTCE) offered by the PTCB. The first such examination was held in 1995. To take the examination, candidates must have earned a high school diploma or a graduate equivalency diploma (GED or foreign diploma) and submit the appropriate application form, fee, and supporting documents. Candidates are not eligible if they have been convicted of a drugor pharmacyrelated felony, or have had any felony convictions any time during the five years before applying for the PTCE.
The PTCE is a two-hour, closed-book, computerbased examination consisting of eighty multiple-choice questions plus an additional ten non-scored questions. The non-scored questions are pretest questions and are not used in calculating the candidate’s score, but provide information for possible use on future examinations. Each question has four possible answers from which to choose, with only one being the best, or correct, answer. The score is based on the number of correctly answered questions.
The questions are written to assess the knowledge and skills that are deemed necessary to perform the work of pharmacy technicians. The exam divides these activities into three function areas:
I. Assisting the pharmacist in serving patients, including activities related to dispensing prescriptions, distributing medications, and collecting and organizing information
II. Maintaining medication and inventory control systems pertaining to activities related to purchasing medications and supplies, controlling inventory, and storing, preparing, and distributing medications according to policies and procedures
III. Participating in the administration and management of pharmacy practice, including administrative activities that deal with such issues as operations, human resources, facilities and equipment, and information systems
Of the scored questions on the examination, 66% of the examination tests the candidate on topics in function area I, 22% on topics in function area II, and the remaining 12% on topics in function area III. Candidates who pass the exam may use the designation CPhT (certified pharmacy technician) after their names.
To maintain the certification, technicians must recertify every two years by completing at least twenty hours of continuing education. A maximum of ten hours may be earned at the technician’s workplace under the direct supervision of a pharmacist. These hours must be special assignments or training; regular work hours do not apply. At least one hour of continuing education must be related to pharmacy law. Several references are available to assist candidates preparing for the examination. Refer to the PTCB Web site to verify current eligibility requirements and test specifics (www.ptcb.org).
In 2005, the Institute for the Certification of Pharmacy Technicians (ICPT) also began offering a national certification examination, called the Exam for the Certification of Pharmacy Technicians (ExCPT). It is offered in an on-demand, computer-based format; pharmacy technicians may take the examination at any time at any one of over 600 supervised test centers throughout the United States. After completing the ExCPT, and before leaving the testing center, technicians are immediately given the examination results.
Eligibility requirements to take the ExCPT are similar to those of the PTCE. The ExCPT is a two-hour test with 110 multiple-choice questions (of which 10 are not counted in the score) examination. Questions are categorized into three areas:
1. Regulations and Technician Duties (25% of the examination), which includes questions about technician duties and general information, controlled substances, and other laws and regulations
2. Drugs and Therapy (23% of the examination), which contains questions about drug classification and most frequently prescribed medications
3. Dispensing Process (52% of the examination), which relates to areas such as prescription information, preparing/dispensing prescriptions, calculations, sterile products, and unit dose and repackaging
