Contributors: Alex Adams, Pharm.D., Brian Hille and Samantha Thompson, CPhT
The problem: pharmacists need time to counsel patients
Research continues to show that when pharmacists spend more time with patients, better patient outcomes can be achieved.1 But if more time with patients leads to better outcomes, why aren’t more pharmacists doing it?
Unfortunately, most pharmacists don’t have enough time to devote to patients because they have too many other tasks to perform — such as taking verbal prescriptions, verifying prescriptions, immunizing patients and transferring prescriptions to and from other pharmacies. These tasks often transpire concurrently, which can potentially divert pharmacists’ attention away from safely completing their work, not to mention putting significant strain on workflow.
A recent time allocation study by the University of Pittsburgh School of Pharmacy found that between 21 and 41% of pharmacists’ work could be completed by minimally-qualified and advanced-practice pharmacy technicians, respectively.1 Alex Adams, Pharm.D., former executive director of the Idaho State Board of Pharmacy recalls when the Idaho Board reviewed their data on a pharmacist’s workday, finding that a significant amount of their time was spent completing duties that technicians could safely and comfortably perform. These are duties that do not require the clinical judgment that a pharmacist brings to the healthcare team.
“Our board [determined that] if pharmacists are spending a substantial fraction of their day doing technician duties, that means patients are not getting the full benefit of what pharmacists can be providing; they’re not getting the clinical or patient care services that pharmacists are well-qualified and capable of performing,” says Adams.
The Idaho Board reviewed what other state boards of pharmacy were permitting technicians to do, as well as their track records of safety. Overwhelmingly, decades worth of available data examining technicians performing such tasks as taking verbal prescriptions, transferring prescriptions, and performing “tech-check-tech” duties, among others, demonstrated that there often were no statistically significant differences in accuracy or error-detection rates between pharmacists and technicians.
If pharmacy technicians had been successfully performing these other tasks, why hadn’t they been given the opportunity to administer immunizations?
“We didn’t have any states to look to [for technicians giving immunizations], but we did have other healthcare professions we could draw from,” explains Adams.
In the medical model, a physician often delegates tasks to their appropriately trained support personnel, so the question became: “If [physicians] can delegate immunizing to medical assistants, why can’t [pharmacists] have their appropriately trained support personnel administer vaccines?”
With the exception of technician-administered immunizations, many studies have confirmed that other advanced duties can be performed safely and effectively by pharmacy technicians.
Additionally, data shows that advancing technician roles does not come at the cost of pharmacist jobs.
“I think when you look at the objective data, it’s very hard to argue with from a safety standpoint, and it allows pharmacists to practice at the top of their education and training,” says Adams.
To help ease concerns and give pharmacists the ability to supervise, a key component of the Idaho regulation is that these tasks can only be performed under the delegation of a pharmacist. This is important because pharmacists are in the best position to understand the capabilities of their support staff.
Empowering pharmacy technicians to administer immunizations not only amplifies their role on the team, but also elevates the pharmacist’s role and leads to greater patient care. However, technicians need the skills required to perform these tasks, so Idaho began a training program.
The Idaho Board of Pharmacy granted a waiver to Washington State University (WSU) to develop and implement a technician-oriented immunization training that met the requirements of the board of pharmacy.
WSU partnered with Albertsons Companies in Boise, Idaho, to train the first 30 pharmacy technicians in the U.S. to administer vaccines.
Albertsons Companies was also the first to implement pharmacist-provided oral contraceptive consultations and prescriptions in both Oregon and California.
“[Albertsons is] a proponent of advancing and fully utilizing the capabilities of technicians,” says Brian Hille, vice president of specialty and wellness services for Albertsons Companies. Being the first to participate gave Albertsons the opportunity to “align very closely with the policy changes and to put best practices in place to be prepared to roll this out in other states as they adopt their own changes.”
The initial round of training resulted in a nearly 100% conversion rate, with only one tech opting out of immunizing after receiving training due to having a low comfort level with the task.
“Any time you have the ability to use somebody else to do tasks within the pharmacy that could traditionally only be done by a pharmacist, it allows for a lot more flexibility in workflow,” says Hille. “As there are opportunities to advance the profession, we’re going to move our technicians in that direction because it makes sense to our business and it makes sense for the profession.”
Samantha Thompson, CPhT, a former technician for Safeway Pharmacy in Coeur d’Alene, Idaho, was in this first group of pharmacy technicians trained to give immunizations and became the first pharmacy technician in the country to administer a vaccine to a patient.
With the support of her pharmacists during her time at Safeway, she provided a large number of flu shots over several seasons. Samantha believed the design of her pharmacy promoted more direct patient dialog. “Safeway has an entire waiting room and private rooms to give vaccines, which allows technicians to step out from behind the counter and away from the phone and other customers, [to] engage more directly with patients.”
Thompson has been a technician since 1986 and welcomed the opportunity to advance her skillset. Like many experienced techs, she has longed for additional responsibilities and growth.
“Having the opportunity to get more training, more education, and more involved in the entire pharmacy process was great,” she says.
This sentiment is one that both Adams and Hille hopes will help to advance the entire profession. Both believe over time these tasks will become expectations, following a similar path forged by pharmacists that began immunizing in the 1990s.
The ability to perform these new skills is exciting and novel within the profession, but Thompson found that patients were surprised these tasks weren’t always performed by technicians.
What the future holds
As the results of technician immunization become available, many hope that other jurisdictions will see the success of permissive technician practice and work to model Idaho’s legislation.
“[Other jurisdictions] don’t have to set sail for an unknown destination. There are plenty of studies out there that are published on these tasks with the exception of technician immunization, but the good news is technician-administered vaccines is currently being studied, and the results are forthcoming,” says Adams.
As more technicians across Idaho acquire the advanced training to practice at the top of their license, both technician and pharmacist practice will continue to increase in scope, making way for continual improvements in patient care and healthcare delivery. The ability of technicians to do more has already led to greater patient engagement.
Holding national certification as a condition of being able to perform these tasks has also been a catalyst for some longtime practicing technicians to move forward with earning the “CPhT” credential.
As all of these pieces come together, the improvements in efficiency, the impact to care, and the demonstrated safety of technicians performing these duties will provide a strong case for adoption of similar regulations across other states, and perhaps even help to finally standardize technician practice nationwide.
Elevating and improving the pharmacy workforce in its entirety will be great for the field of pharmacy and patients alike. As Brian Hille says, “It’s a fun time to be practicing pharmacy right now. Having technicians playing a bigger role that will allow pharmacists to do things like prescribing is going to be really important. It will make us successful.”
References:
1 Berenbrok, L., Carroll, J., Coley, K., McGivney, M., (2018). Pharmacy Technician Role Expansion: An Evidence-based Position Paper [white paper]. Retrieved March 19, 2019 from https://www.nacds.org/pdfs/pharmacy/2018/techinician-talkingpoints.pdf.
2Adams, A., Martin, S., Stolpe, S. (2011) “Tech-check-tech”: A review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68(19):1824-1833.
3McKeirnan, Kimberly C. et al. (2018). Training pharmacy technicians to administer immunizations. Journal of the American Pharmacists Association. Volume 58 , Issue 2 , 174 - 178.e1.