CPhT CONNECT™ Magazine - Jan/Feb 2021

Immunization Opportunities For Pharmacy Technicians Vaccines are one of the greatest, most cost-effective public health interventions. Despite the availability of safe and effec- tive vaccines to prevent a number of health conditions, many patients remain under- or unimmunized. To make an impact on public health, pharmacists have been able to provide immunizations to fulfill childhood and adult vaccination needs. As the scope of practice for pharmacists has turned to providing more clinical services to patients, the phar- macy profession has realized the added benefit of allowing pharmacy technicians to assist with providing immu- nizations. To provide technicians with appropriate education and training, an immunization training pilot program was developed in Idaho by Washington State University (WSU) to help present solutions to the ongoing challenges in health care delivery and access and disease prevention. An Idaho rule states, in part, that an immunizing pharmacist may delegate the technical task of administering an immunization to a technician under their supervision. Pharmacy technicians performing immunizations must have national certification, hold a basic life support certification, and have completed an approved education program on proper immunization tech- nique, similar to the program developed by WSU. Pharmacy technicians involved in this pilot program participated in a major difference was in the rate of detecting errors introduced by the investigators. This study showed that pharmacy tech- nicians were detecting errors in unit dose orders better than the pharmacists performing the verification. Overall, the study demonstrated that pharmacy technicians in an institutional setting perform TPV as accurately, or perhaps more accu- rately, than pharmacists while maintaining patient safety. If TPV is shown to be useful in institutional settings, how effective is it in a community setting? A pilot program was con- ducted in Iowa in seven community pharmacies to assess the effects of the TPV program on the rate of dispensing errors, impact on pharmacists’ activities, amount of patient care ser- vices provided, and reimbursement status of those services. The program demonstrated that technicians were accurate in checking refill prescriptions, while helping increase the amount of time pharmacists spent providing patient care services. Despite pharmacists spending more time on patient care services, there was no corresponding increase in reim- bursement for those services. Nonetheless, this pilot program shows that technicians are in the position to per - form advanced roles, including TPV. As of December 2020, 18 states allow technicians to perform TPV, though the extent to which it is allowed varies from state to state.

Point-Of-Care (Poc) Testing

Pharmacy technicians have been performing product verifica- tion in the United States since the late 1970s in health-system settings. Several studies and pilot programs demonstrate it is safe for pharmacy technicians to perform TPV. One tech-check- tech study required pharmacy technicians and pharmacists to verify the same sample. The purpose of a same-sam- ple study is to prevent one group from checking an easier or more difficult product than the other group and allow for con- sistency. Investigators introduced 510 errors into a sample of more than 15,000 envelopes over a 5-week period in a tertiary care institution and were asked to verify the same product. The accuracy rate of checking the samples was sim- ilar between pharmacists and pharmacy technicians, but the Technician Product Verification (TPV) POC testing is an increasingly popular service offered by community pharmacies. However, POC is sometimes met with barriers in workflow integration, including pharmacists’ lack of time to devote to this service. With proper education and training, pharmacy technicians can assist pharmacists in POC testing. One study showed that patients agreed or strongly agreed that POC test administration by CPhTs was valuable, and pharmacy personnel agreed that CPhTs performing POC testing was feasible, appropriate, and acceptable. Most importantly, technicians involved in the study not only embraced the project throughout implementa- tion but also showed their dedication by arriving to work early to ensure they were prepared for their scheduled patients. The study involved 32 community pharmacies in one regional division of a large community pharmacy chain in Tennessee. Twenty-nine CPhTs across 16 sites completed a training pro- gram and supported POC testing, while 16 similar sites in the same regional division did not have CPhT involvement. The training program included a home study portion covering POC testing device operation, sample collection, and qual- ity controls. Furthermore, live training provided technicians an opportunity to become comfortable with the analyzer, sample collection, and quality controls. The outcome showed that pharmacies that had CPhTs performing POC testing adminis- tered over 100 more tests than pharmacies not having CPhTs perform POC testing. Although limitations were reported with this pilot study, including a small sample size, it serves as a starting point for researchers, pharmacists, employers, and regulators to realize the value for pharmacy technicians to support POC testing. Additionally, it continues to follow the trend of delegating non-clinical tasks to technicians to free up pharmacist time to provide more direct patient care.

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