Fred M. Eckel, RPh, MS; Pharmacy Times Editor-in-Chief
Should well-trained pharmacy technicians assume more responsibility for nonjudgmental activities in the pharmacy?
Expanding the role of the pharmacy technician is a very emotional issue. Does giving the well-trained pharmacy technician independent responsibility for nonjudgmental activities free up the pharmacist for an expanded role? Or will it simply allow managers to replace some pharmacist positions with lower-salaried pharmacy technicians?
For me, these are the 2 sides of the story that revolve around the issue of why we should or should not expand the role of the pharmacy technician. Perhaps complicating this decision, most recently, is the growing oversupply of pharmacists. Although I do not believe we should let the need to assure jobs for pharmacists determine the appropriate pharmacy technician role, this trend does factor into it for many pharmacists with whom I interact.
Most of those who are promoting an expanded pharmacy technician role are basing their position on using well-trained pharmacy technicians who have completed an accredited pharmacy technician training program and passed a validated examination, such as the Pharmacy Technician Certification Board (PTCB) exam. Such a requirement should assure everyone that these technicians have achieved a common skill set. Too many pharmacists— using their experience working with technicians trained on the job—suggest that technicians are not qualified to accept expanded responsibilities, however. Having formal training requirements and passing a validated examination should ensure less technician variability and a minimum competency. Yet some oppose a formal training requirement for technicians because it may require a higher salary for technicians and make recruitment more difficult.
Another argument I hear against an expanded role is the perception from pharmacists that they would end up with more liability. Of course, anyone can be included in a lawsuit. I believe that an expanded role will make the pharmacy technician both accountable as well as responsible for their own actions, thus not increasing pharmacist liability and maybe even reducing it.
The other reason I have heard voiced against an expanded role is concern about patient safety. Using technicians to perform roles previously performed by pharmacists is not as safe for the patients, these opponents suggest. Even when presented with studies that show that technicians perform certain tasks as safely or safer than pharmacists, they often reject the evidence and hold onto their view.
Recently, the Board of Pharmacy in North Carolina, where I reside, passed a rule that allows an expanded role in acute care settings for pharmacy technicians who have completed an Associate Degree in Pharmacy Technology and have passed the PTCB exam. Although I supported this rule, I thought a similar opportunity to use these pharmacy technicians in other practice settings should be allowed. It became clear, however, that I was in the minority. When I suggested that refilling a prescription is a nonjudgmental activity—just like checking drugs in a unit-dose cart or a floor-based cabinet in a hospital, it was clear that I was really in the minority.
The judgmental decision about the appropriateness of using a particular drug for a patient is made when the original prescription is filled. The refilling process is not judgmental, but simply requires accuracy, which I think could be handled by a well-trained technician—with a recheck by another well-trained technician, rather than a pharmacist. Such a practice model would then give the pharmacist more time to counsel patients. Based on my recent experience, however, it may be a long time before such a practice model becomes operational in community pharmacy.
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Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.