Download The Texas Tech University – HSC- School of Pharmacy is accredited

The Texas Tech University – HSC- School of Pharmacy is accredited by The Accreditation
Council For Pharmaceutical Education (ACPE) as a provider of continuing
Pharmaceutical Education.
Course Administered By:
J&D Educational Services, Inc
PO Box 130909
The Woodlands, Texas 77393-0909
Voice: 1-866-747-5545
Fax: 1-936-321-9295
www.jdeducation.com
“Is There More to this than Counting Pills?”
A Review Of the Practice of Pharmacy and Its Different Settings
A Knowledge Based Course
By
Jeff Blackburn, C.Ph.T., MBA – Healthcare Administration
ACPE No. 0096-9999-15-086-H04-T
Release Date: 08/31/2015
Expiration Date: 12/31/2017
Total number of pharmacy continuing education hours: 6 hours (0.6 CEU’s)
Course Cost:
$14.00 (to be paid at time of testing)
Average time to Complete:
Approximately Six hours including testing
Course Value:
Six Contact Hours
Reading:
47 Pages
Final Exam:
40 Questions
Completion Requirements:
Answer 70% of questions correctly, Evaluation
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J & D Educational Services
September 11, 2016
PTCB RE-CERTIFICATION CHANGES
On February 27th The Pharmacy Technician Certification Board (PTCB) announced
significant certification program changes. Some of the changes are concerning
required CE or re-certification. A summary of those changes is on the following
page. More information is available at the PTCB website (www.ptcb.org).
If you have questions or if we can be of any additional service, please give me a
call at our toll free customer service number: 866-747-5545.
Thank you for choosing J&D for your CE requirements.
Carl
IMPORTANT NOTE FROM PTCB
You Ask, We Answer
Your Question: "I am entering my CE hours online to recertify, but the total is wrong.
Why?"
PTCB's Answer: If your CE hours do not seem to add up in your application to recertify,
you may have selected incorrect 'types' for your CEs. Under 'CE Program Details' there
are three CE types in the menu to choose from:
1) Seminars, Workshops, and Conferences: The vast majority of CE
hours are this type. Choose it for online CE courses and activities,
recorded presentations, or webinars, as well as live conferences,
seminars, workshops, or other educational programs that contain
primarily pharmacy-related subject matter. This is also the type for
home study courses. This includes all courses in this package.
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PTCB Announces Certification Program Changes
by PTCB Staff | Feb 27, 2013
WASHINGTON, DC — The Pharmacy Technician Certification Board (PTCB) announces
future changes to the PTCB Certification Program. The new changes will advance pharmacy
technician qualifications by elevating PTCB’s standards for national certification and
recertification. During the next seven years, PTCB will phase in the changes, including
mandatory background checks, accredited education requirements, and changes in acceptable
continuing education (CE) programs for recertification.
“PTCB is elevating our certification requirements in order to meet the demands of the evolving
healthcare system,” said PTCB Executive Director and CEO Everett B. McAllister, MPA, RPh.
“We have made bold decisions on what will be required for candidates to become certified
pharmacy technicians (CPhTs). Our Board of Governors is sharply focused on ensuring that the
PTCB Program prepares CPhTs for the integral roles they play in supporting pharmacists in all
practice settings.” PTCB’s requirements have remained largely unchanged since the
organization’s founding in 1995.
The PTCB Board of Governors decided that new candidates for PTCB certification will be
required to complete criminal background checks, beginning in, or around, 2014. Many
employers already require background checks as a condition of employment, and PTCB plans to
collaborate with stakeholders to synchronize with the existing systems.
As part of the 20 hours of CE required for recertification, individual CPhTs will
need to complete one hour of medication safety CE, effective in 2014, in addition
to the one hour of law CE already required. By 2015, PTCB will require all 20
recertification CE hours to be pharmacy technician-specific. Many existing CE
offerings already fit this definition. The allowable CE hours from college courses
will be reduced from 15 to 10 by 2016, and allowable in-service hours will be
phased out by 2018.
By 2020, PTCB will require candidates for initial PTCB certification to successfully complete an
American Society of Health-System Pharmacists (ASHP)-accredited education program. ASHPaccredited programs include didactic course work and practical experience, thereby providing
well-rounded training for technicians.
For additional information visit www.ptcb.org
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Extremely Urgent Notice!
Changes to CE Monitoring That Will Affect Your CE Beginning May 1, 2012!
CPE Monitor is a national collaborative effort by the National Association of Boards of
Pharmacy (NABP) and the Accreditation Council for Pharmacy Education (ACPE) to provide an
electronic system for state pharmacy boards and other licensing agencies to track and
authenticate CE units completed by pharmacist and pharmacy technicians. This will eliminate
the need for the random audits now being done. Most state boards have committed to this
program beginning year and many others have shown a strong interest. It is expected that all 50
states will soon become a part of this program due to the savings they will experience in time and
money. As an ACPE approved provider of CE for Certified Pharmacy Technicians, J&D
Educational Services, in association with Texas Tech University School of Pharmacy, will be
participating in this program.
How does this benefit me?
After you have registered to participate in this program J&D will electronically transmit the
results for each course you successfully complete to CPE Monitor where they will be stored in a
highly secure environment. This information will be available only to your appropriate licensing
agency and to you. J&D will continue to maintain your records and issue you printed credits as
we have always done.
What does it cost?
There is no cost to you to participate in this program.
Don’t wait!
Technicians are strongly urged to obtain their NABP e-profile ID now to ensure their e-Profile is
properly set up. If you choose not to enroll in e-profile you will continue to get your credits as
before. However, beginning 5-1-2012 we will not be authorized to use ACPE logo or ACPE
number on your statements of credit. Don’t Wait! It only takes a few minutes.
www.nabp.net/programs/cpe-monitor/
After you have reached the site choose “CPE Monitor Log in”
If you are registered at jdeducation.com, enter your e-Profile ID and your date of birth in your
personal info.
Be sure to email your e-Profile ID and your date of birth to [email protected] using
“e-profile ID” in the subject line. Please include your name and a contact phone number.
Important Note: Your requirements for re-certification with your state board and PTCB
have not changed. You will still be required to re-certify or re-register as you have always
done.
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Please Read Carefully
Re-certification Procedures and Requirements
Re-certification procedures and requirements are determined by the Pharmacy Technician
Certification Board (PTCB) and/or your state board and change from time to time. It is highly
advisable that you review these procedures and requirements on a periodic basis. You may do
this on line at the PTCB website (www.ptcb.org). If you are certified or registered with your
state board of pharmacy or other agency, you should contact that agency for re-certification
procedures and requirements.
J & D Educational Services, Inc. does not send the results of your CE to PTCB. PTCB requires
that all certified pharmacy technicians complete the re-certification process and provide them
with all requested information. J & D will provide you with a Statement of Credit for all
courses you have successfully completed.
It is highly recommended you keep a copy of the CE statement provided at the completion of
each course. This is your proof that you completed the necessary requirements and have received
credit for the course. Additional information is available on our website (www.jdeducation.com).
LEGAL
The material contained in this book is owned and administered by J & D Educational Services,
Inc. and is protected under U.S. and international copyright laws. The content of the continuing
education courses provided within this book are developed by licensed and certified
professionals. All courses are approved by the Accreditation Council for Pharmaceutical
Education (ACPE) and meet all requirements of the Pharmacy
Technician Certification Board (PTCB) as outlined for continuing education.
J & D EDUCATIONAL SERVICES, Inc ASSUMES NO RESPONSIBILITY OR
LIABILITY AS A RESULT OF INACCURATE INFORMATION CONTAINED IN
THESE COURSES. J & D EDUCATIONAL SERVICES, Inc. DOES NOT EDIT THE
COURSES FOR CONTENT.
THE INFORMATION CONTAINED IN THESE COURSES IS SELECTED AND
PREPARED BY VARIOUS AUTHORS. ALL RECOMMENDATIONS OR
SUGGESTIONS FOR THE USE OF DRUGS, DEVICES OR TECHNIQUES REFLECT
THEIR OPINIONS. NO RESPONSIBILITY OR LIABILITY IN PROVIDING THIS
INFORMATION IS ASSUMED BY J& D EDUCATIONAL SERVICES, Inc.
v
Frequently Asked Questions:
1) What if I fail the final exam?
To receive CE credit, the technician must work through the manual and self-assessment
questions and pass a final exam with a score of 70% or better. If you do not pass, we will return
your graded exam and ask you to try again at no charge.
2) What date is placed on my certificate?
The date that your final exam arrives in our office. We can use the postmark date if it is
legible. You may fax your completed answer sheet to us if necessary to meet your deadline. On
line testing is available with instant results. Visit our website (www.jdeducation.com) for
details.
3) How long should it take me to complete a course?
One contact hour (0.1 CEU) is offered for each 50 - 60 minutes of organized activity pertinent to
pharmacy practice. A four contact hour course, for example, should take approximately four
hours to complete.
4) Can I take the same course twice?
Please do not submit an exam for a course you have already successfully completed. Your board
will not allow credit for a course you have submitted for a prior renewal.
5) Will you return my corrected answer sheet to me?
We return your corrected answer sheet to you because we know that reviewing your mistakes is
part of the learning process. PTCB requires that you keep your statement of credit in your file
for one year. Some states require that the statements be available for review at anytime during
the renewal cycle.
6) Do you send a receipt?
We will send an itemized receipt with your order.
7) Do you send my results to PTCB?
We cannot send your results to PTCB. PTCB requires that each individual technician
complete the re-certification process. We will provide you with Statements of Credit for each
course you successfully complete.
Thank you for choosing J & D Educational Services for your CE requirements!
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Thank you . . .
. . . for ordering your continuing education from J & D Educational Services, Inc.. We
would like to make completing your course as pleasant as possible and will gladly assist you in
any way we can. Please don’t hesitate to call if we can help.
First: Please locate the course and an answer sheet. All answer sheets are the same and can be
used for any course. They are located in the back of your courses.
Second: The purpose of the final exam is to guide your reading to the most important points in
the course. It is also proof to your Board that you have, in fact, read the material. In order to
earn your statement of credit, please:
1) Read the material in the course.
2) On the exam itself, circle the correct one answer that most completely and fully answers the
question.
3) Transfer your answers from the exam to the answer sheet. You may use a soft lead pencil or
black pen and fill the appropriate space completely.
4) Mail only the completed answer sheet and the corresponding evaluation. The evaluation is
required by ACPE before we can issue your statement of credit. You may fax your
answer sheets and evaluations if you wish. If you wish your results to be faxed back, you
must clearly state your request along with a return fax number. It is not necessary to
mail your answer sheets if you use the fax.
5) As a precaution against loss, please make and keep a copy of the answer sheets on which you
marked your answers until you receive your statement of credit.
6) Your original test will be graded and returned to you along with a statement of credit.
PTCB requires that a copy of your statement of credit be retained by you for audit. J
& D Educational Services does not keep copies of your answer sheets on file and cannot
replace it if lost. We do keep a record of your grade and will furnish you with a copy of
your statement of credit if requested.
Last: Please allow several days for your answer sheet to arrive at our office. It takes longer
than you think – often up to four or five working days from the East Coast. Within two working
days we will correct the answer sheet and hand it and your statement of credit to the mail carrier
to return to you.
Thank you again for ordering your continuing education for J & D Educational Services. If you
have any questions, don’t hesitate to call us toll free at 1-866-747-5545.
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Pharmacy Practice Settings
Intended Audience
The intended audience for this course is Certified Pharmacy Technicians.
Assessment Strategy
Government/Regulatory Requirement – the Pharmacy Technician Certification Board requires
that Certified Pharmacy Technicians complete 20 hours of continuing education that is specific
to pharmacy technicians.
Current Gap
A recent draft of the Long-Range Vision for the Pharmacy Work Force by the ASHP’s Council
on Education and Work-Force Development described the pharmacy technician of the future
with the following role classifications: generalist working in inpatient, ambulatory, chronic, and
home care; focused practitioners working in specialty settings; advanced practitioners collecting
clinical data for pharmacist evaluation; and managerial roles. Each of these roles would require
basic education and training in an accredited pharmacy technician training program. Each role
would require national certification by the Pharmacy Technician Certification Board (PTCB) as
soon as possible after completion of the educational program.
While the role of the pharmacist is becoming more and more about patient care and the void they
are leaving behind is being filled more and more by pharmacy technicians. This void is not only
functional and administrative work, but also advanced practitioner work that requires a certain
amount of professional judgment about when to alert the supervising pharmacist.
As the career of the pharmacy technician moves into more advanced roles, it is important that
they have an understanding of the different positions and practice settings that may be open to
them both now and in the future. This course will review the different pharmacy practice
settings as well as the different roles technicians currently hold and may in the future.
OBJECTIVES

Describe the pharmacy practice and the tasks and functions defined by the ASHP’s
Model Curriculum.

Discuss the current and future advanced roles available to the certified pharmacy
technician.

List and describe some of the community based pharmacy practice settings.

List and describe some of the institutional based pharmacy practice settings.
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Table of Contents
I.
Introduction
II.
The Practice of Pharmacy
III.
Pharmacy Technicians Functions and Tasks
IV.
The Future of the Pharmacy Technician
V.
Community Based Pharmacy Practice Settings
VI.
Institutional Based Pharmacy Practice Settings
VII.
Conclusion
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INTRODUCTION
A 2002 white paper on pharmacy technicians provided a comprehensive analysis of historical
developments, drivers for change, work-force issues, and the education, training, certification,
and regulation of pharmacy technicians. 1 The paper called for a profession-wide vision for
pharmacy technicians, identified the key issues that needed to be addressed, and described the
needed action.
An increasing number of state boards of pharmacy, recognizing the integral role of pharmacy
technicians, have revised practice regulations to allow a broadening of their responsibilities and
regulation of pharmacy technicians has increased significantly over the past 15 years. In 1993,
only 12 states regulated pharmacy technicians. At present, 39 states regulate pharmacy
technicians through licensure, certification, or registration. It is estimated that there are over
280,000 technicians regulated by state boards of pharmacy. The majority of states require some
level of training or education that must be completed by a pharmacy technician; 29 of the 39
states that regulate pharmacy technicians have mandated training requirements. The majority of
these training programs must be reviewed, or approved by the state board of pharmacy. As a part
of their regulation of technicians, 14 boards of pharmacy have examination requirements that
must be completed. An overview of the state regulation of pharmacy technicians is provided in
NABP's annual Survey of Pharmacy Law.2
Pharmacy technicians work in a wide variety of practice settings, including community
pharmacies, hospitals, the military, home health care, long-term care, prescription mail-order
facilities, managed healthcare facilities, and educational/training programs. The role of a
pharmacy technician has evolved to assist the pharmacist in almost all types of practice settings
with completing the technical aspects of dispensing prescriptions such as computer entry,
labeling, medication preparation, record keeping, insurance form completion, and maintenance
of an appropriate supply of medications in the pharmacy. The pharmacy technician is
accountable to the supervising pharmacist who, in turn, is legally responsible—through state
licensure—for the care and safety of patients served by the pharmacy. Pharmacy technicians are
a critical part of the pharmacy work force, and the ever-increasing complexity of practice
requires the increased utilization of qualified competent technical personnel.
The following synopsis of the practice is provided to give readers an understanding of the vital
role that they play in the delivery of pharmacy services. We will first look the history of the
pharmacy practice, then at the general tasks performed by pharmacy technicians and finally we
will explore some of the different practice settings from a general perspective. Some of the
practices described in this course do not give specific technician duties, but offer a “flavor” of
the practice type, keeping in mind that technicians are vital to almost all forms of pharmacy
practice.
1 White Paper on Pharmacy Technicians 2002: Needed Changes Can no Longer Wait Am J Health-Syst Pharm. 2003;60:37–51;
www.ashp.org/s_ashp/docs/files/Tech_WhitePaper.pdf; Accessed 6/15/2009.
2 Survey of Pharmacy Law; National Association of Boards of Pharmacy; www.nabp.net; Accessed December 30, 2008.
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The Practice of Pharmacy
The mission of the profession of pharmacy is to improve public health through ensuring safe,
effective, and appropriate use of medications. Contemporary pharmacy practice reflects an
evolving paradigm from one in which the pharmacist primarily supervises medication
distribution and counsels patients, to a more expanded and team-based clinical role providing
patient-centered medication therapy management, health improvement, and disease prevention
services.
The Model State Pharmacy Act and Model Rules of the National Association of Boards of
Pharmacy (NABP) defines the practice of pharmacy as follows:
The “Practice of Pharmacy” means the interpretation, evaluation, and implementation of Medical
Orders; the Dispensing of Prescription Drug Orders; participation in Drug and Device selection;
Drug Administration; Drug Regimen Review; the Practice of Telepharmacy within and across
state lines; Drug or Drug-related research; the provision of Patient Counseling; the provision of
those acts or services necessary to provide Pharmacist Care in all areas of patient care, including
Primary Care and Collaborative Pharmacy Practice; and the responsibility for Compounding and
Labeling of Drugs and Devices (except Labeling by a Manufacturer, Repackager, or Distributor
of Non-Prescription Drugs and commercially packaged Legend Drugs and Devices), proper and
safe storage of Drugs and Devices, and maintenance of required records. The practice of
pharmacy also includes continually optimizing patient safety and quality of services through
effective use of emerging technologies and competency-based training. 3
Tasks and Functions of Pharmacy Technicians
In its Model Act, NABP defines pharmacy technicians as “personnel registered with the Board
who may, under the supervision of the pharmacist, assist in the pharmacy and perform such
functions as assisting in the dispensing process; processing of medical coverage claims; stocking
of medications; cashiering but excluding drug regimen review; clinical conflict resolution;
prescriber contact concerning prescription drug order clarification or therapy modification;
patient counseling; dispensing process validation; prescription transfer; and receipt of new
prescription drug orders. There has been recurring collaborative initiatives to analyze and
document the work activities of pharmacy technicians. Some of these studies have been
accomplished at the same time as an evaluation of professional activities of pharmacists, e.g., the
Scope of Pharmacy Practice Project (1992–1994) mentioned above. 4, The most recent practice
analysis for pharmacy technicians was completed in 2005. It identified new responsibilities
performed by CPhTs, including the handling and processing of restricted, investigational, and
chemotherapy drugs; working in mail-order pharmacy settings; and increased involvement in
third-party payment. New knowledge areas identified in the practice analysis included
knowledge of error prevention strategies for data entry, cultural diversity, third-party payment,
and pharmacy benefit management companies. The practice analysis indicated that CPhTs spend
about 66 percent of their time assisting the pharmacist in serving patients, 22 percent maintaining
medication and inventory control systems, and 12 percent participating in pharmacy practice
3 Model State Pharmacy Act and Model Rules of the National Boards of Pharmacy; National Association of boards of Pharmacy;
www.nabp.net; August 2008; Accessed: December 30, 2014.
4 Summary of the Final Report of the Scope of Pharmacy Practice Project Am J Hosp Pharm. 1994;51:2179–82
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management and administration. This distribution of the workday is similar across community,
health-system, and other work settings. Community-based CPhTs are most frequently involved
in assisting with outpatient prescription dispensing, purchasing and inventory control, and
billing. For health-system CPhTs, assisting in inpatient medication dispensing, preparing
intravenous admixtures, and prepackaging and repackaging are the primary responsibilities.
CPhTs are taking on additional, more advanced responsibilities, including those more
traditionally performed by a pharmacist. In community settings, there has been growth in the
extent to which pharmacy technicians are contacting prescribers for clarification of prescriptions
and participating in quality assurance activities. Skilled technicians are now playing an important
role in improving patient safety and medication-error strategies. Technician roles include
medication order entry, multiple-point checking, screening medication orders for dangerous
medical abbreviations, physically separating look-alike medications and sound-alike medication
names, and assisting the pharmacist in monitoring patient outcomes by collecting patient-specific
data. Many CPhTs now have expanded supervisory responsibilities, including order-entry
verification, preparation and packaging of medications produced by other technicians, and
preparing prescription and medication orders for final approval by a pharmacist, as allowed by
law. Additional practice management tasks include collecting productivity information,
performing billing and accounting functions, performing or contributing to employee
evaluations, and participating in the establishment, implementation, and monitoring of policies
and procedures.
There have been a number of significant positive developments affecting pharmacy technicians
in the past ten to fifteen years including the establishment of certification boards, the
development of the Model Curriculum for pharmacy technician training 5, an expansion in the
number of accredited training programs, and greater regulatory recognition of pharmacy
technicians in state pharmacy practice acts. Pharmacy technician education and training
requirements vary among states and employers; there is, however, a trend toward more
formalized technician training, either through an academic training program or on the job. The
Model Curriculum provides a starting point for identifying core competencies for pharmacy
technicians and a framework for training pharmacy technicians for all practice settings and
geographic locations.
The goal statements of the Model Curriculum are listed below.
1. Assist the pharmacist in collecting, organizing, and evaluating information for direct
patient care, medication.
2. Receive and screen prescription/medication orders for completeness and authenticity.
3. Prepare medication for distribution.
4. Verify the measurements, preparation, and/or packaging of medication produced by other
5 American Society of Health-System Pharmacists. Model Curriculum for Pharmacy Technician Training2nd
Edition. American Society of Health-System
Pharmacists;www.ashp.org/Import/MEMBERCENTER/Technicians/Training/ModelCurriculum.aspx. Bethesda, MD.
2001; Accessed February 13, 2009.
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technicians.
5. Distribute Medications.
6. Assist the pharmacist in the administration of immunizations.
7. Assist the pharmacist in the identification of patients.
8. Initiate, verify, assist in the adjudication of and collect payment and/or initiate billing for
pharmacy services and goods.
9. Purchase pharmaceuticals, devices, and supplies according to an established purchasing
program.
10. Control the inventory of medications, equipment, and devices according to an established
plan.
11. Assist the pharmacist in monitoring the practice site and/or service area for compliance
with federal, state, and local laws; regulations; and professional standards.
12. Maintain pharmacy equipment and facilities.
13. Assist the pharmacist in preparing, storing, and distributing investigational medication
products.
14. Assist the pharmacist in the monitoring of medication therapy.
15. Participate in the pharmacy department’s process for preventing medication
misadventures.
16. Take personal responsibility for assisting the pharmacist in improving direct patient care.
17. Demonstrate ethical conduct in all job-related activities.
18. Maintain an image appropriate for the profession of pharmacy.
19. Resolve conflicts through negotiation.
20. Understand the principles for managing change.
21. Appreciate the need to adapt direct patient care to meet the needs of diversity.
22. Appreciate the benefits of active involvement in local, state, and national technician and
other pharmacy organizations.
23. Appreciate the value of obtaining technician certification.
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24. Understand the importance of and resources for staying current with changes in pharmacy
practice.
25. Communicate clearly when speaking or writing.
26. Maximize work efficiency through the use of technology.
27. Efficiently solve problems commonly encountered in one’s own work.
28. Display a caring attitude toward patients in all aspects of job responsibilities.
29. Maintain confidentiality of patient and proprietary business information.
30. Understand direct patient care delivery systems in multiple practice settings.
31. Efficiently manage one’s work whether preformed alone or as part of a team.
32. Function effectively as a member of the health care team.
33. Balance obligations to one’s self, relationships, and work in a way that minimizes stress.
34. Understand the use and side effects of prescription and nonprescription medications used
to treat common disease states.
35. Assist the pharmacist in assuring the quality of all pharmaceutical services.
Several national pharmacy organizations have adopted policies calling for nationally
standardized education and training for pharmacy technicians. The development of guidelines
and standards to regulate the qualifications of individuals who work as pharmacy technicians
will ultimately reduce the variation in pharmacy technician qualifications and deployment across
the country.
The Future of the Pharmacy Technician
Now that we have outlined the traditional tasks and functions of the pharmacy technician, it is
time to discuss both future and current roles that are becoming available to pharmacy
technicians. Technicians will find positions available in a number of practice settings. As you
continue to develop expertise in your profession, you should continue to be alert for
opportunities for advancement. Keep a log documenting all aspects of your education, training,
certifications, and job responsibilities in preparation for any opportunity that arises. Continue to
explore all related horizons to find that perfect position that will open the door to a fulfilling
career.
This section discusses some of the professional duties technicians are performing now or may be
performing in the future. The future is in your hands as you begin your journey toward the
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career goals that are of interest to you. Keep an open mind as you explore this exciting
profession because the possibilities are endless.
Don’t be deterred if someone tells you that pharmacy technicians do not perform that role in a
particular facility. Be prepared to demonstrate your abilities and desire to be a part of the team.
Pharmacy Technician Educator
A practice setting that employs many technicians may require a technician educator in the
pharmacy setting to assist with orientation and training of new employees. If this position does
not yet exist and you see a need for it in your practice setting, you can begin by offering to train
new hires. Outline a formal procedure for this process and document your training activities.
Request feedback from technicians you have trained and document this. Many technicians do
not like to be bothered by training others and consider it a nuisance. If there is new equipment or
new software brought into the practice setting, ask to be trained on it first and assist in the
training of others. If your site accepts students for clinical rotation, offer to be the preceptor, and
set up a documented training plan. When you have amassed enough documentation for your
training activities, approach the supervisor with your request for creation of a new position. Be
prepared to promote yourself by discussing your knowledge, ability to convey that knowledge,
the respect you have earned as a professional, your communication skills, and your desire to be
of service.
Pharmacy Technician Supervisor
The role of a technician supervisor is different from that of an educator, although in some
settings the positions may be combined. The technician supervisor usually has the ultimate
responsibility for managing all the technicians employed in the facility. This would include
recruiting, interviewing, screening, and hiring new employees. The supervisor must be totally
familiar with the workflow so that adequate help can be scheduled and adjustments in personnel
can be made quickly to accommodate work load. Technicians must be cross trained in all areas
to facilitate workload changes. Although one or more technicians may be designated for
inventory control, it would ultimately be the responsibility of the supervisor to ensure competent
inventory management. Technician attendance issues, poor work habits, and disagreements
among employee would be addressed by the technician supervisor. Generally, this position
would also involve a great deal of administrative paperwork responsibilities, and often some
business management courses would be helpful. The technician supervisor usually reports to the
pharmacy manager and must have a good working relationship with management. If this is a
position of interest, acquire a copy of the job description and requirements for your facility and
be certain that you meet all the requirements.
Pharmacy Warehouse Supervisor
A large hospital facility will require a pharmacy warehouse separate from the hospital warehouse
facility so that medications can be more closely monitored. There may be an opportunity for a
qualified technician to assume the role of pharmacy warehouse supervisor. This position would
require good computer skills, proficiency in using the ordering system, and great organizational
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skills. A systematic approach to receiving orders, accurately stocking the shelves, and
distributing medication to other areas is essential. Adequate procedures for the handling of
controlled drugs will prevent the chaos that accompanies discrepancies. This person would be
responsible for handling expired drugs and drug recalls.
Clinical Coordinator for Pharmacy Technician Program
Pharmacy technician education programs are becoming increasingly prevalent across the country
and the need for more competent, educated technicians in the workforce is recognized.
Education can be a very rewarding pathway to a fulfilling career as a professional. A logical
next step up the career ladder for a technician educator would be a position as a clinical
coordinator for a formal education program. Classroom instruction about extemporaneous
compounding and handling sterile products may be the responsibility of the clinical coordinator.
Supervising laboratory experiences to prepare students for actual experiential time in a pharmacy
setting is an important responsibility of the clinical coordinator. Maintaining an inventory of
laboratory supplies and placing equipment and supply orders would also be duties of the
coordinator. Teaching other classes in the curriculum might be included in the job description,
depending on the expertise and credentials of the technician.
The coordinator also serves as a liaison with experiential practice sites and cultivates a
relationship with possible preceptors, assisting in their understanding of the important role they
play in the education and training of the student. The coordinator meets with the students for
discussions about their goals and decides on the practice settings that would be the most
productive for the training of each individual student. A booklet is prepared for each student and
each clinical rotation. The competencies required of the student will vary depending on whether
the setting is inpatient or outpatient. Contained in the booklet will be daily logs to document
hours worked by the student and a brief description by the student of the work day. Each student
should also fill out an evaluation of the site and the preceptor. For the preceptor there will be a
checklist of competencies to be mastered by the student during the rotation, and an evaluation
form for the affective behaviors observed in the student.
The clinical coordinator will make regular visits to each site on a predetermined schedule and
meet briefly with the preceptor and the student to assess the learning and deal with any concerns.
Any serious concerns should be directed to the program director for assessment and resolution.
Often the clinical coordinator will also facilitate preparation for job interviews, assist in resume
writing, and help the technician supervisor place students for employment after they complete
the educational program. This position requires great organizational skills, outstanding clinical
skills, and ability to teach effectively, and good communication skills to develop effective
relationships with experiential sites.
Director of Pharmacy Technician Program
The director of a formal education program is ultimately responsible for the quality and viability
of the program. Program directors often have an associate’s or bachelor’s degree, and in some
cases may have a master’s degree and/or may be a pharmacist. In some cases the program
director is responsible for developing and implementing every aspect of the program, but often
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some of the core courses are already in place and provide a foundation for pharmacy technicianspecific courses.
Investigational Drug Pharmacy Technician
Some large hospitals systems are very involved in investigational drug studies and have a
department devoted to record-keeping and dispensing of investigational drugs. Skilled
technicians are vital to this important aspect of the pharmacy profession. Each study drug has
hundreds of protocols outlining everything from the specifications for the patients admitted to
the study to the way the drug is labeled and dispensed to patients. The technician is responsible
for documenting the many protocols used to validate the study. Confidentiality and accurate
documentation are important because the pharmacy personnel may be the only ones who know
which patients are taking the actual drug and which are taking placebos in the case of a doubleblind study. An ability to read and understand the protocols enables the technician to set up the
proper documentation for the various phases of the studies. Exact records of medications must
be kept, and any medication not used by a patient must be retrieved because it is not an FDA
approved drug. All of these tasks are performed under the supervision of a pharmacist, but the
technician has great responsibilities in a rewarding and professional setting.
Refill Triage Pharmacy Technician
In a busy physician’s office, the phone rings incessantly and the fax machine continually prints
requests from pharmacies for refill authorizations. The office personnel are busy taking care of
patients and their immediate needs. A pharmacy technician can be invaluable, especially in a
multi-physician office, to organize and triage the requests so that patients can receive their
medications in a timely manner. The technician documents all the information from the phone
request, along with the call back number and the pharmacy name. The patient charts are then
retrieved and the refill request is checked against the documentation in the chart. The technician
should learn the established protocols for refill authorization for patients and note when the
patient was last seen in the office. The prescription refills to be called into the pharmacies
should be written up on the appropriate form. A similar procedure is followed for requests that
are faxed to the office. The prepared forms are placed along with the patient chart in the
appropriate place for the prescribers to sign off on the refills. The authorizations can then be
faxed back to the pharmacy and the designated person can return the calls for the phoned-in
requests. The charts can then be filed. To be qualified for this position, a technician must have
good organizational skills, be fluent in medical terminology and experienced in reading patient
charts, and able to communicate well with the prescribers and work cooperatively with the other
office personnel. A strong background in pharmacology, emphasizing brand and generic names
and drug uses, will help the technician check the chart for similar drugs that have been
prescribed and others that may have been discontinued. If a fast-paced physician’s office
appeals to you as a possible place to work, prepare yourself educationally, decide whether your
personality type fits with this type of work, and contact some physicians and let them know what
you are capable of doing for them.
Medication Reconciliation Pharmacy Technician
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The Joint Commission Accrediting Healthcare Organizations (JCAHO) has mandated that all
patient medications go through a verification process each time the patient is moved from one
facility to another or from one unit to another. The medication reconciliation process is designed
to prevent duplication of medication ordered by different physicians or by the same physician at
different times.
When a patient first enters a healthcare facility, an accurate listing of all medications the patient
is currently taking is compiled with information from the patient or a caregiver. This list is
compared with the physician admission orders to check for any duplications or discrepancies.
The professional judgment of the technician is invaluable at this step and aids in the decision to
alert the pharmacist about a medication concern. Discrepancies are then evaluated by a
pharmacy using knowledge-based professional judgment to decide whether a medication
adjustment is within the pharmacist’s scope and standards of practice, or whether a consultation
with the physician is required to resolve the issue. Any changes in the physician’s orders are
documented, and the reconciliation form should become a part of the patient’s chart. This form
should follow the patients each time they are moved to another unit in the facility and continue
with them if they are transferred to another facility or discharged to home.
Each of these steps should be documented according to a previously designed set of protocols
established by the institution involved. The institution should have an official reconciliation
form to be utilized and guidelines for the qualifications of the staff members allowed to
participate in this process. A staff education process should be put into place for all staff
involved in this process. In some institutions, this process may be performed by the nursing staff
or by pharmacists. This is a process that requires a considerable commitment of time to be
effective. An educated pharmacy technician has more knowledge about pharmacology and a
better understanding of the medication process, especially concerning brand and generic drug
names, drug classes, adverse effects, and interactions, than the nursing staff. A competent
pharmacy technician understands the scope of practice and standards of practice, and how they
relate to the professional judgment of a technician. A competent, educated and certified
pharmacy technician is trained to exercise professional judgment of a technician to alert the
pharmacist to any discrepancies that require evaluation by the pharmacist. If this position
interest you, prepare yourself by excelling in your educational requirements, demonstrating your
skills as a staff technician, building a sense of trust with the pharmacists, and consistently
proving your professionalism. Then you must make a formal request to train for this position.
Quality Assurance Technician
Medication safety has become a major benchmark for pharmacies everywhere. The technician
who is involved with the day-to-day functions performed in the pharmacy is in the best position
to observe system problems that may be contributing to medication errors. A quality assurance
technician should be familiar with all the established protocols for procedures performed in the
pharmacy. These protocols should be evaluated regularly and adapted as needed. The technician
in this role should be constantly alert for potential problems that may cause a medication error or
a breach of aseptic technique. Documentation of any errors that have occurred and the plan to
prevent the error from recurring, along with special training session to reinforce skills and
education sessions to refresh the memory, would be parts of the role.
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COMMUNITY BASED CARE
Community Pharmacy Practice
Community pharmacy is the practice setting that the public primarily envisions when pharmacy
practice is discussed. The provision of medication for ambulatory patients is the primary
responsibility of community pharmacy practitioners and the volume will increase as a result of
an aging population and the trend toward managing more acute conditions and acute
exacerbations of chronic conditions in the ambulatory environment. The complexity and
sophistication of the medications used in the ambulatory setting, coupled with the increasing
number of ambulatory patients, suggests that pharmacists in community pharmacies will become
an even more essential access point for acquisition of healthcare services. This trend will
continue despite the fact that an increasing number of patients receive their medications and
medication information from an institutional or health system-affiliated pharmacy or a pharmacy
that is located within an organized primary care medical practice.
Community pharmacy is a diverse, dynamic and constantly changing practice environment. First
and foremost, community pharmacy is a practice environment that requires good people skills
and excellent communication, because the pharmacy personnel deal with patients on a daily
basis. Most people visit the community pharmacy more than any other health care setting.
Pharmacy technicians play a vital role in this practice setting by assisting the pharmacist in
preparing prescriptions, collecting information from patients, and performing several other
important functions (many discussed in the goal statements of the Model Curriculum outlined
earlier).
The number of prescriptions being filled has increased dramatically over the last few years and is
only expected to keep rising. One of the reasons for this rise is the aging of the population.
People are living longer and as people age, their medication requirements increase. In addition
to the aging population, advances in medicine have led to the ability of physicians to treat more
disease states in an outpatient setting. These factors, along with the fact that more and more
prescription drugs become available each year and more and more patients have access to
prescription insurance has allowed for more prescription to be processed in the community
pharmacy practice.
Because of the rapid growth in the number of prescriptions each year, the community pharmacy
environment needs to be open to change and ready to adapt to the challenges of the increased
need. One constant change is the role of technology in the processing of prescriptions. Almost
all community pharmacies utilize computers to some degree in the prescription filling process.
Besides keeping a computerized patient profile, computers in the pharmacy can be used to screen
phone calls, accept refill orders, scan prescriptions to prevent errors, and computers are being
used to count the units of medication, fill the container, and label the vial or bottle. Computers
are also used to alert the pharmacist to drug interactions and transmit insurance information to a
patient’s insurance company. Many pharmacies utilize e-prescribing technology, where a
prescription can be generated at the prescriber’s office and electronically transmitted directly into
the processing computer at the local pharmacy, eliminating the need to enter information off a
paper prescription.
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With prescription volume increasing and the shortage of pharmacist worsening, the role of the
pharmacy technician has increased in the community pharmacy practice. Pharmacist are
expanding their role as patient care providers and incorporating more patient-care activities into
their daily practice. With the increasing complexity of drug regimens, pharmacists need to be
spending more time with the patients, counseling and educating them on their disease states and
medication therapy. With these increased tasks, technicians perform many of the technical
functions in support of the pharmacist. By allowing pharmacist to spend more time with the
patients, receiving care and information, the technician can help them get the most benefit from
their therapy.
Independent Pharmacies
Independent pharmacies consist of one to four stores owned and operated by an individual
pharmacist or group of individuals. They vary greatly in size, volume of prescription, and
services. A benefit of working for an independent pharmacy is that a technician will usually
have direct access to the owner or main decision maker. Also, independent pharmacies are more
likely to specialize in one area of pharmacy, such as surgical supplies or home infusion therapy.
These specialty areas can offer exciting and diverse opportunities for pharmacy technicians.
The technician’s responsibilities vary according to the type of pharmacy and the services offered.
In a full-service pharmacy the technician may be required to function in all departments of the
store depending on the size of the store, the number of employees, and the prescription volume
of the pharmacy. Inventory control is an important duty that technicians routinely perform. It is
vitally important that an adequate stock of medications be available in the pharmacy so that
patients can receive their treatment in a timely manner. There are various ways to control
inventory, but most pharmacies use a computerized method. Prioritizing phone calls helps the
pharmacist concentrate on patient-care concerns by directing calls that do not truly require the
pharmacist’s attention to other employees or having the technician respond to questions when
possible. Technicians may take refill phone orders from patients. A new prescription from a
doctor must be transferred to the pharmacist. A refill order from the doctor may be accepted by
the technician if there is no change in the medication strength or directions.
Receiving and verifying prescriptions requires the expertise of a competent technician.
Chain Pharmacies
Chain pharmacies also vary in size, volume, and services and can be differentiated one from
another based on the setting in which they are housed. Chain drugstores are the most common,
and although these stores sell mostly traditional drugstore merchandise, many of them carry a
large variety of products. Chain drugstores can be regional, where they only operate stores in
one geographic area, or national, with stores spread out all over the country.
Chain pharmacies generally have standard operating procedures that apply to all pharmacies in
the system. On-the-job training, technician responsibilities, and general employee regulations
are usually described during an orientation period and are often documented in a policy and
procedure book and/or employee handbook. Many of the retail technician’s responsibilities will
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be the same as, or similar to, those expected of a technician in an independently owned retail
pharmacy. Large chain pharmacies will often have a higher prescription volume and may have
many more employees. There may be several pharmacists and many technicians depending on
the location and size of the pharmacy. Some of these pharmacies may be open 24 hours and
technicians may always work the same shift or take turns rotating through the morning, evening,
and overnight shifts. Communication among the technicians and the pharmacists is vitally
important to ensure the smooth operation of the pharmacy department. There may be one or
more lead technicians to assist in training and scheduling, but everyone must work together in a
professional manner to ensure excellent pharmaceutical care for patients.
In addition to chain drugstores, chain pharmacies can be located in supermarkets, and again, be
regional or national in scope. The primary goal of these retail outlets is to generate sales of their
traditional product lines, primarily groceries and related items.
Other types of stores that sometime house chain pharmacies are mass merchandisers like Target,
Costco, and Kmart. These retail outlets’ primary goals are generating traditional retail sales and
not pharmacy business. Mass merchants have entered the pharmacy market in a more serious
fashion, primarily to attract new types of customers to their stores and grow the sales of their
traditional products. Many have entered this market with the pharmacy department being a “loss
leader,” meaning they are willing to lose money in this department because losses are more than
offset by sales to these customers in other departments.
Surgical Supply/Durable Medical Equipment (DME)
The third most prevalent form of home health care is home equipment management services, also
referred to as home medical equipment (HME) services or durable medical equipment (DME)
services. Home equipment management services can be defined as the selection, delivery, setup,
and maintenance of equipment and the education of the patient in the use of the equipment – all
performed in the patient’s place of residence.
Some community pharmacies provide surgical supplies to patients in their community. This
would include durable medical equipment such as knee braces, neck collars, hospital beds, canes,
walkers, commodes, and other products. A pharmacy specializing in durable medical equipment
will have a pharmacist and specialty trained staff to assist patients in choosing the best products,
fitting patients for products like braces and other orthotic supplies, and obtaining proper
reimbursement from insurance providers for these services.
Long-Term Care
Community pharmacies can also provide medications to long-term care facilities in addition to
providing prescription processing services to the community. Some long-term care facilities,
like nursing homes, have their own pharmacies in the building, but many, because of their size or
budget, may not. In these cases the facilities use pharmacies that generally prepare the orders on
a daily basis for the inpatients and deliver the medications to the facility. This type of setting
combines both inpatient and outpatient services into one environment.
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Long-term care pharmacies sometimes service nursing homes in a state or regional area. They
employ drivers or delivery persons to distribute the medications daily to the homes that have
contracted with them for services. Pharmacy technicians are a vital link in the timely provision
of these services. Orders from the homes are usually faxed to the pharmacy in the morning.
Generally they are in the form of inpatient medication orders. There may be a pool of data entry
technicians who type the medication orders into the computer to produce labels for the
medications. These technicians must be well versed in interpreting medication orders and
accurately entering them in the computer.
Long-term care pharmacies also carry many nursing-home supplies, including IV tubing,
catheters, colostomy supplies, and other convalescent needs. Technicians must familiarize
themselves with all of the ancillary supplies to ensure that the correct items will be sent.
Periodically during the day, the data entry department will run all the labels entered in a given
time period. At this point, one or more pharmacists will check the labels produced against the
original medication orders received. The labels will be verified by the pharmacist or returned to
data entry for any corrections needed.
Once the labels are verified, they are passed on to the filing technicians, who begin to fill them in
a manner appropriate for the facility being served. Many facilities utilize a system in which a
30-day supply of each medication is sealed in a blister pack (often called a “bingo card”). Each
individual dose of medication can be punched out of its compartment and administered to the
patient. The technician is responsible for placing the medications into the pockets in the card,
heat-sealing the card, and placing the correct label on the card. This process may also be
accomplished by automation if it is available. High-volume products are often sealed in cards
ahead of time and placed in a storage area for easy retrieval when needed. These products are
required to meet all the regulations for repackaging of drugs.
Repackaged products must have correct expiration dates, lot numbers, and brand or
generic name, and be entered into a logbook and verified by a pharmacist.
When the medication orders are filled, they are placed in a central checking area to be verified by
the pharmacist. For any compounds ordered, the labels go to the compounding area, where a
technician is assigned to process them. The compounding process is supervised by a pharmacist.
IV medications will be processed by the IV technician and checked by the pharmacist. Homes
with a pediatric population may need medications packaged as unit dose oral liquids. Controlled
drugs are usually kept in a controlled room with a pharmacist and one or more technicians
assigned to work in the room. Controlled drugs sent to nursing homes are packaged in secure
containers to prevent drug diversion. At a prearranged time all medications must be filled,
checked by the pharmacist, and packed for delivery to each individual home. The technician
may be the person who packs the delivery boxes and checks to determine that all ordered items
are in the box. The homes usually contract with the pharmacy for all items ordered daily to be
received by the end of the day, so it is important that no item be left out. If a nursing-home
patient missies a dose of medication because it is unavailable, that would be considered a
medication error from the home.
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Depending on the size of the pharmacy, inventory control may be the responsibility of one or
several technicians. Often there is a lead technician or technician supervisor responsible for
interviewing, hiring, scheduling, and general technician supervision. Many nursing homes use a
medication cart system involving the exchange of medication carts every seven days or some
other prearranged schedule. In this case, there may be an “exchange technician” who delivers
the filled medication carts to the nursing home and returns the empty carts.
Medication carts are filled by technicians using unit dose medications. Many medications are
available in unit dose packaging, but if an ordered medication is not available in a unit dose, the
technician will package the correct quantity either manually or using a unit dose packaging
machine.
Long-term care pharmacies often serve hundreds of nursing homes and fill thousands of order
each day. The technicians’ knowledge of medications, convalescent supplies, and the policies
and procedures of the facility is crucial for ensuring the smooth operation of the pharmacy and
the provision of good pharmaceutical care to the many patients they serve. A position in a longterm care pharmacy can provide a fulfilling opportunity to work in a fast-paced setting where
there are many opportunities for advancement learning.
Home Infusion
Similar to long-term care provision, some pharmacies provide home care organization with
parenteral medications. These products are prepared in the community pharmacy and then
delivered or shipped to the patient’s home, where a skilled nurse will administer the medication.
The role of the technician is more varied and more progressive in home infusion therapy than
almost any type of pharmacy. It can be both challenging and provide the opportunity for job
changes or advancement. Pharmacy technicians have knowledge and skills that can adapt to
other job functions and responsibilities in home infusion pharmacy practice.
The traditional and key role of the technician in home infusion therapy is in the preparation of
sterile products under the supervision of a pharmacist. Some states have more stringent
requirements for technicians supervision by a pharmacist in outpatient and home settings (e.g., a
pharmacist must be physically present within eyesight of the technician at all times) than in a
hospital pharmacy. In some expanded health systems, there may be a retail or outpatient
pharmacy, institutional pharmacy or hospital pharmacy, and clinic or satellite pharmacies in
addition to the home infusion pharmacy, making the technician’s role more varied and possibly
including duties and responsibilities in these other areas as well. Other roles for pharmacy
technicians in home infusion therapy include:
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Equipment management technician
Patient service representative
Purchasing agent or manager
Warehouse supervisor
Billing clerk/case manager
Home infusion delivery representative
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Home infusion pharmacies are increasing in number with the spiraling cost of inpatient services
and the limits on inpatient coverage by insurance companies. Terminally ill patients also often
choose to remain in the home, given the availability of hospice services. A technician’s
responsibilities often include packing IV medications and medical supplies for shipping or
transport to the patient’s home. However, the primary responsibility will be accurate IV
admixture using the strictest aseptic technique in a cleanroom. Broth test should be performed
periodically6, IV bags sent into a patients home may be kept for several days to a week before
use, so any break in aseptic technique that could allow the growth of organism would be critical
for an already compromised patient. Home infusion pharmacies offer many opportunities for
advancement into administrative roles for qualified technicians desiring this type of position.
Educational requirements for home infusion technicians would be the same as for inpatient
hospital technicians, with a strong emphasis on sterile products.
Specialty Compounding Services
Because every patient has different needs, customized, compounded medications are a vital part
of quality medical care. The basis of the profession of pharmacy has always been the patient–
physician–pharmacist relationship. Through this relationship, patient needs are determined by a
physician, who chooses a treatment regimen that may include a compounded medication.
Physicians prescribe compounded medications for many reasons including the following
situations:
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When needed medications are discontinued by or generally unavailable from
pharmaceutical companies, often because the medications are no longer profitable to
manufacture,
When the patient is allergic to certain preservatives, dyes, or binders in off-the-shelf
medications,
When treatment requires tailored dosage strengths for patients with unique needs (e.g.,
infants),
When a pharmacist can combine several medications the patient is taking to increase
compliance,
When the patient cannot ingest the medication in its commercially available form and a
pharmacist can prepare the medication in cream, liquid, or other, more easily used form,
When medications require flavor additives to make them more palatable for some
patients, most often children.
For those people with unique health needs that cannot be met by commercially available
manufactured prescription medicines, compounded medications prescribed or ordered by
physicians can be prepared safely by trained compounding pharmacists. Compounding is in even
greater demand for treating animals because of their greater diversity in size and therapeutic
needs and the relatively narrow selection, flavors, and dosages of medicines that are
manufactured by pharmaceutical companies.
6 A test to assess operators ability to maintain the sterility of materials during the preparation of aseptically prepared injectable dose forms, in
order to ensure that minimal bioburden is introduced. http://www.civas.co.uk/universalbroth/Universal-Operator-Broth-Test-Version9Dec2005.pdf
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Many pharmacists have unique knowledge and skills in pharmaceutical compounding, having
studied chemical compatibilities and been trained to prepare alternate dosage forms.
Accreditation standards for professional degree programs in pharmacy require instruction in
compounding pharmaceutical ingredients and so all pharmacists have foundational knowledge
and skills in this area. Some pharmacists, however, have elected to focus their practice in this
area and have additional experience, education, and training.
In 2004, the Pharmacy Compounding Accreditation Board (PCAB) was established by eight
national pharmacy organizations. This was an important development impacting the practice of
pharmacy compounding because it established a national standard of best practices for
compounding pharmacies. PCAB accreditation is a voluntary process focused on maximizing the
quality of pharmacy compounding and reducing risk of patient harm. PCAB accreditation has
been recognized by the American Medical Association and the American Pharmacists
Association as a way to identify compounding pharmacies that meet high quality standards.
Many community and/or compounding pharmacies across the country specialize in compounding
pharmaceutical products that are not readily available in a particular dosage form or in the dose
necessary for the patient. Compounded pharmaceutical products can take the form of oral
suspensions or solutions, intravenous admixtures, capsules, topical preparations, or even the
unusual, like lollipops. Compounding services are an important part of many community
pharmacy services. They are especially useful in special patient populations such as children and
veterinary practices. Many times children will suffer from illnesses that can be treated only with
adult medications. In these cases, the medications may only be available as a tablet or capsule or
only in a dosage that would far exceed what would be recommended for a child. The medication
needs to be diluted into a child-appropriate dose and possibly into a dosage form that can be
taken by a child who cannot swallow tablets or capsules. In these situations, the pharmacist
would prepare a solution or suspension by grinding the available tablets into a powder, adding an
appropriate amount of water or other diluents, and then flavoring the preparation to make to
palatable. This is just one example of how pharmacist use compounding services to improve the
care offered to patients.
Veterinary practices also use compounding services on a routine basis. Many veterinarians use
human medications to treat their animals. The doses or dosage forms they need are not
commercially available. They will then go to a community pharmacy that specializes in
compounding veterinary products and use their services to get what they need.
A pharmacy technician offers many types of services to the compounding pharmacist. A
technician may be involved in almost any step in the process, from gathering necessary
ingredients to be incorporated, to mixing the products together under the supervision of the
pharmacist. Some of the skills necessary to participate in compounding services are meticulous
attention to detail, knowing how to properly use equipment necessary to weigh and measure wet
and dry ingredients, and knowledge of the metric and apothecary system for weights and
measures (extemporaneous compounding). Although extemporaneous compounding may be part
of a technician’s duties in any of the practice settings, it is extremely important in a practice that
specializes in compounding medications.
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Although basic compounding skills should be part of every technician’s education and training,
additional compounding techniques can be learned by receiving on-the-job training or
completing a compounding certificate program.
Mail-Service Pharmacy
Some patients receive their medications—especially refills for medications used for chronic
medical conditions—from mail-service pharmacies, which are used by some health plans,
prescription benefit management companies (PBMs), large pharmacy chains, and Internet
pharmacy providers to reduce costs associated with the supply of medications and provide the
convenience of home delivery of medications. Patients typically order their medications via
telephone, fax, e-mail, or the Internet. Once a prescription order is transmitted to the mail-service
pharmacy, patients usually receive their prescription within a week to ten days. Large numbers of
pharmacists and pharmacy technicians are employed at mail-service pharmacies, but many of the
processes use high-volume automated dispensing technologies. Some mail-service pharmacies
provide medication management services for individual or population-based patients.
The lack of one-on-one contact with a pharmacist and the delay in receiving medication are the
main reasons people do not use mail-order pharmacies.
Mail-order pharmacies are becoming more prevalent because many insurance companies are
mandating the use of mail-order for maintenance drugs, and some patients appreciate the
convenience of receiving their medications through the mail. It is especially helpful for patients
who live in rural areas and are unable to drive to a pharmacy.
Technician positions are delineated into the various functions required to process prescriptions in
a mail-order practice. Often there is a complete department of technicians responsible for
answering phones and either transferring the call to a pharmacist or, if it is a refill order,
recording the order and sending it to data entry to begin processing. The data-entry technicians
receive the mail, the refill orders that have been called into the order line, and the new
prescriptions that have been called in to the pharmacists. The prescriptions are evaluated for
completeness and if there are any concerns about content, dose or legibility, the prescription in
question is sent to the phone area where a pharmacist completes the evaluation process and calls
the prescriber for clarification if necessary. The phone-clarification area is staffed by
pharmacists and technicians. The technicians call prescribers for refill authorization and missing
prescriber identification, and a pharmacist is available if other medication verification is
necessary.
When the prescription information is complete and accurate, the data-entry technicians process
them and produce labels and paper work for each prescription. The technicians who prepare the
label for the medications continue the prescription processing and send the completed
prescriptions and paper work to a pharmacist for a final check and transfer to the packaging and
shipping area. This process must be completed in a timely manner so that patients can receive
their medications promptly. To ensure an efficient process, technicians also perform inventory
control, handle insurance processing, and help to stock and maintain the automated machines
involved in the dispensing. All technicians work under the direct supervision of pharmacists;
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however, there may also be a technician supervisor to handle scheduling and other technician
issues.
Internet Pharmacy
Since about the year 2000, a growing number of Internet pharmacies have been established
worldwide. Many of these pharmacies are similar to community pharmacies, and in fact, many
of them are actually are operated by “brick-and-mortar” community pharmacies, that serve
consumers online and those that walk in their door. The primary difference is the method by
which the medications are requested and received. Some customers consider this to be a more
convenient and private method rather than traveling to a community drugstore where another
customer might overhear about the drugs that they take. Internet pharmacies (also known as
Online Pharmacies) are also recommended to some patients by their physicians if they are
homebound.
While most Internet pharmacies sell prescription drugs and require a valid prescription, some
Internet pharmacies sell prescription drugs without requiring a prescription. Many customers
order drugs from such pharmacies to avoid the “inconvenience” of visiting a doctor or to obtain
medications which their doctors were unwilling to prescribe. However, this practice has been
criticized as potentially dangerous, especially by those who feel that only doctors can reliably
assess contraindications, risk/benefit ratios, and an individual’s overall suitability for use of a
medication. There also have been reports of such pharmacies dispensing substandard products.
Of particular concern with internet pharmacies is the ease with which people, youth in particular,
can obtain controlled substances via the internet without a prescription issued by a
doctor/practitioner who has an established doctor-patient relationship. There are many instances
where a practitioner issues a prescription, brokered by an internet server, for a controlled
substance to a “patient” s/he has never met. In the United States, in order for a prescription for a
controlled substance to be valid, it must be issued for a legitimate medical purpose by a licensed
practitioner acting in the course of legitimate doctor-patient relationship. The filling pharmacy
has a corresponding responsibility to ensure that the prescription is valid. Often, individual state
laws outline what defines a valid doctor-patient relationship.
Canada is home to dozens of licensed Internet pharmacies, many of which sell their lower-cost
prescription drugs to U.S. consumers, who pay one of the world’s highest drug prices. In recent
years, many consumers in the U.S. and in other countries with high drug costs, have turned to
licensed Internet pharmacies in India, Israel, and the UK, which often have even lower prices
than in Canada.
In the United States, there has been a push to legalize importation of medications from Canada
and other countries, in order to reduce consumer costs. While in most cases importation of
prescription medications violates Food and Drug Administration (FDA) regulations and federal
laws, enforcement is generally targeted at international drug suppliers, rather than consumers.
There is no known case of any U.S. citizen buying Canadian drugs for personal use with a
prescription, who has ever been changed by authorities.
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A relative newcomer to the scene of pharmacy practice setting, as a technician, before accepting
a position, you should be certain that the pharmacy has a valid license and is operating legally in
the states it serves. The technician’s duties can vary from gathering data into a patient’s profile,
counting and labeling medications, and packaging the order for delivery to the patient. The
technician should be supervised by a licensed pharmacist who can verify that the prescriptions
are legitimate orders prescribed by licensed physicians.
INSTITUTION-BASED CARE
The policies and procedures in the acute care or long-term care institutional settings are
analogous to but slightly different from those depicted for ambulatory settings. In these settings
there is often active participation by pharmacists in the medication selection decision as part of
the medical care team. This collaboration precedes the generation of the medication orders,
which are interpreted and processed by other pharmacists to ensure accurate medication selection
and the development of monitoring plans to assure that optimal outcomes—including patient
safety—are achieved. Pharmacists in the medication distribution process have a responsibility
for the training and supervision of pharmacy technicians, efficient use of information technology,
and application of management skills that allow for patient priorities to be set in daily practice
activities. In addition to collaborating with other health professionals in the medication selection
process and monitoring drug distribution, pharmacists have responsibilities to assure that patients
receive the safest and best therapy possible, are educated about their medications, and are
provided strategies to enhance their compliance with medication regimens. Pharmacists provide
consultation and recommendations to physicians, nurses, physician assistants, and other
healthcare professionals regarding approved and off-label indications, dosing and administration
guidelines, drug interactions, chemical incompatibilities, therapeutic drug-monitoring approaches
to avoid toxicity and maximize effectiveness, adverse-effect monitoring and prevention, and
avoidance of therapeutic duplication as the result of polypharmacy 7. Dosing might have to be
adjusted according to the patient's age, disease, renal function, or hepatic function. In a hospital a
variety of routes of administration may be available including intravenous, intramuscular,
subcutaneous, irrigation, nasogastric tube, oral, or targeted therapies. When this scope of
pharmacy services is present, the pharmacist becomes a critical contributor to direct patient care
through interactions with providers on decision-making processes for drug regimens, formulary
issues, and optimal drug therapies to meet the needs of the individual patient.
Hospital Pharmacy Practice Setting
Many factors influence the type of activities for the pharmacist in a hospital setting. Some of
these factors include: the size of the hospital, the services provided by the hospital (e.g.,
pediatrics, oncology, transplant, trauma center), academic affiliations with the hospital, the
presence of pharmacy residency programs, geographic location, affiliated health insurance
programs, related ambulatory clinics, the level of deployment of pharmacy technicians and the
extent of integration of information systems and technology such as robotics, automated
dispensing, and computerized physician order entry (CPOE).
7 Polypharmacy is the use of four or more medications by a patient, generally adults aged over 65 years.
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The nature of acute care requires that pharmacists in this setting have a broad knowledge base in
parenteral medications, intravenous fluid and nutritional therapy, chemistry, physiology, and
pathophysiology. Pharmacists are involved in determining chemical compatibilities, infusion
rates, and sequencing of multiple medications that may need to be infused intravenously into a
patient. Additionally, pharmacists interpret a wide array of laboratory and imaging tests to
monitoring drug therapy. Patients in hospitals receive a high number of medications, and have
frequently changing medical conditions that increase the opportunity for drug interactions and
adverse side effects. The pharmacists must always be reviewing medications to help assure the
best outcomes for the patient. Recent advances in informatics facilitate more efficient access to
drug information, lab information, and patient data so that all pharmacists provide drug
information to a variety of healthcare practitioners.
Hospital pharmacy technicians perform a broad range of clinical, technical, and clerical tasks
necessary to the efficient operation of a hospital pharmacy. They enable the licensed
pharmacists to concentrate on professional functions, such as providing medical staff and
patients with clinical information and guidance. The principal responsibility of technicians is to
prepare, package, and distribute medications prescribed by physicians for hospitalized patients.
Medication orders are written by physicians and other licensed practitioners on the patient’s
medical record. Copies of these orders are sent either manually or electronically from all the
patient care units to the pharmacy. After pharmacists review the orders for appropriateness and
perform clinical interventions when applicable, the medical order is processed and technicians
assist in preparing the medications for dispensing.
The most common method used by technicians for preparing and distributing prescribed
medications is known as “unit-dose-distribution.” Each day, technicians assist in assembling a
complete 24-hour supply of medications for every hospital patient. Individual, patient-specific
doses of each drug are separately packaged and labeled. All of these unit doses are then placed
in the patient’s medication cassette either manually or by robotic and automated systems that
technicians must be trained to utilize. Many commonly used medications are prepackaged in
unit-dose form by drug manufacturers so that technicians need only select the right package.
When prepackaged unit doses are not available, supervised technicians must measure or count
the prescribed amount of bulk containers and create the packaging with the use of a unit-dose
packaging machine. Many hospitals are utilizing bar-coded medications for electronic
medication dispensing and patient safety checking. Technicians often assist the pharmacists with
this newly added packaging necessity.
When unit doses are to be administered by the injection route, technicians may assist the
pharmacist in the transfer of the medication from vials and ampoules, using aseptic techniques,
to the proper dispensing container. In addition, the technician may assess in the preparation of
IV admixtures, adding drugs or nutrients (IV additives) to commercially prepared or
compounded intravenous solutions. Pharmaceutical calculations must be accurate and checked
by a pharmacist, and extreme care must be taken to ensure sterile condition and aseptic
techniques.
Inventory control is another responsibility for some pharmacy technicians. Technicians keep
track of medications and other supplies and prepare orders for additional quantities when stock
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diminishes. They also receive incoming supplies; reconcile invoices against quantities ordered,
received, and billed; and put supplies into the appropriate secured storage areas.
Additional duties performed by pharmacy technicians may include delivering drugs and
pharmaceutical supplies to nursing stations (either manually or by utilizing a hospital-wide
pneumatic tube transport system); refilling emergency crash cart medications; maintaining
automated dispensing and robotic machines; keeping pharmacy work areas well-stocked, clean
and orderly; and responding to telephone questions or requests from other hospital personnel.
The hospital pharmacy technician’s increasing role, responsibilities, and employment
requirements may vary not only from hospital to hospital, depending on the pharmacy
department’s scope of service, but from state to state, as state boards of pharmacy regulations
governing the practice of pharmacy are different.
Due to a current nationwide shortage of pharmacists, along with an increasing need for clinical
pharmacists on multidisciplinary hospital care teams to ensure good patient outcomes, the need
and reliance for well-trained, skilled and competent technicians will increase.
Hospice Pharmacy Practice Setting
Hospices range from small rural organizations to very large hospices. Regardless of the
organization's structure, a large part of the care they provide, and a significant cost, is
medication-centered. Pharmacists practicing in this setting help to ensure that medications are
appropriately selected and that management of symptoms is balanced with cost–effectiveness.
ASHP has published a statement on the Pharmacist's Role in Hospice and Palliative Care, which
outlines service issues that should be addressed, including: (i) assessing the appropriateness of
medication orders and ensuring the timely provision of effective medications for symptom
control; (ii) counseling and educating the hospice team about medication therapy; (iii) ensuring
that patients and caregivers understand and follow the directions provided with medications; (iv)
providing efficient mechanisms for extemporaneous compounding of nonstandard dosage forms;
(v) addressing financial concerns; (vi) ensuring safe and legal disposal of all medications after
death; and (vii) establishing and maintaining effective communication with regulatory and
licensing agencies. Hospice programs are varied in their structure and hospice pharmacy practice
models have evolved to complement these programs. Models include: (a) hospice-employed
pharmacist; (b) contracted consultant pharmacist or pharmacist group; (c) pharmacy benefits
manager (PBM) with or without in-house or contracted clinical pharmacist services; (d) central
dispensing pharmacy with PBM and clinical support that services hospices regionally or
nationally; (e) selected pharmacies that generally dispense on a contract basis to a local hospice;
and (f) community pharmacies that dispense to hospice patients usually on contract with the
hospice. Compounded medications often constitute a significant element of the pharmacy
services provided because of the need to individualize dosages and/or dosage forms for
terminally ill patients.
The purpose of a hospice pharmacy is to provide medications and pharmaceutical care to the
hospice patients to enhance the quality of his or her remaining life. Hospice patients are
terminally ill with one or more of the following diagnosis:
• Cancer
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• AIDS
• Alzheimer’s disease
• Congestive heart failure
• Other terminal illnesses
The only element that differentiates a hospice pharmacy from other areas of pharmacy practice is
its inventory. The inventory in a hospice pharmacy is limited and specialized. It does not include
all of the medications used for the treatment of diseases. The hospice pharmacy stock includes
more types of dosage forms of medication, such as injectables and suppositories, for terminally
ill patients who cannot take oral medications. Examples of these drugs include:
• Narcotic and non-narcotic analgesics
• Anti-nauseates
• Laxatives
• Anti-anxiety medications
• IV fusions for pain therapy, hydration therapy, ect.
Advantages
Hospice pharmacy offers the following advantages:
• One-on-one, comforting patient care treating the person, not the disease.
• Emphasis on quality of the remaining life of the patient.
• Twenty-four-hour help and support.
• Follow-up with the patient’s family after the patient’s death.
Disadvantages
The disadvantages of hospice pharmacy include:
• Limitations exist concerning what Medicare covers for hospice patients.
• Money is wasted on medications that are left unused after a patient’s death, and which, by law,
cannot be repackaged for use by others.
Staff
The staff of a hospice pharmacy includes:
• Licensed and specialized pharmacists
• Pharmacy technicians
• Administrative personnel
• Drivers who deliver medications
The Role of Pharmacy Technicians
Pharmacy technicians in hospice pharmacy are responsible for:
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• Filling and packaging prescriptions intended to provide utmost patient comfort, including
intravenous therapies.
• Providing pain- and symptom-management information.
• Providing drug information and education.
Nuclear Pharmacy Practice Setting
Nuclear pharmacy was the first recognized area of specialty practice within pharmacy. Nuclear
pharmacists seek to improve and promote the public health through the safe and effective use of
radioactive drugs for diagnosis and therapy. A nuclear pharmacist, as a member of the nuclear
medicine team, specializes in the procurement, compounding, quality-control testing, dispensing,
distribution, and monitoring of radiopharmaceuticals. In addition, the nuclear pharmacist
provides consultation regarding health and safety issues, as well as the use of nonradioactive
drugs and patient care. Working with radioactive isotopes as part of a compounding process
demands specialized training, with requirements set in part by the Nuclear Regulatory
Commission. This product-focused training has tended to link this area of practice with the
compounded product rather than a clinical service. Nuclear pharmacy practice largely occurs in
two areas—within free standing radio-pharmacies or within hospital settings. Nuclear pharmacy
and nuclear medicine practice are inter-professional areas of practice involving technologists
(who acquire the images), occasionally chemists, physicists, nurses, pharmacists, and physicians.
Nuclear pharmacy is a specialty area that focuses on the compounding and dispensing of
radioactive materials for use in nuclear medicine procedures. Compounding of radioactive
materials is done behind leaded glass shields and with leaded glass syringes. The material is
contained in lead containers. A technician’s responsibilities in a nuclear pharmacy may include
generating computer labels for radiopharmaceuticals, managing inventory and documenting
records for radioactive materials, repackaging and labeling unit dose from bulk containers,
compounding and properly measuring and packaging radiopharmaceuticals, and performing and
documenting quality control tests. All of these functions are performed under the direct
supervision of a nuclear pharmacist after the technician completes intense education and training.
Education and training should be in addition to the course work required for hospital pharmacy
technicians. A comprehensive nuclear pharmacy technician certificate should be completed.
Education must include additional regulatory requirements for working with radioactive
materials, radiopharmaceutical medical terminology, abbreviations, symbols, brand and generic
names, and diagnostic and therapeutic uses of radioactive drugs. Extensive training in dose
calculations for radiopharmaceuticals and closely supervised compounding techniques should be
completed before compounding for patient use. A site-specific understanding of functions that
require the professional judgment of a pharmacist, and any state or federal regulations affecting
technicians’ responsibilities should be clearly understood. There are a relatively small number of
technicians practicing in this specialty, but the number of nuclear pharmacies is growing and
opportunities are available in nearly every state.
A Nuclear Pharmacy Technician (NPT) is a pharmacy technician who has received specialized
training and education in the nuclear pharmacy practice setting. An NPT works under the direct
supervision of a licensed nuclear pharmacist and performs many pharmacy-related functions.
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Each state Board of Pharmacy has exact definitions of a pharmacy technician. Each state may,
or may not, have definitions applicable to a Nuclear Pharmacy Technician.
Military Pharmacy
Military pharmacy is an entirely different working environment due to the fact that technicians
perform most duties that in a civilian sector would be illegal. State laws of Technician patient
counseling and medication checking by a pharmacist do not apply.
The pharmacists working in the military sector can deploy their services at short notice anywhere
in the world to provide medical support to the Armed Forces in war, during conflict or during
peacekeeping operations worldwide.
In Peacetime
The Pharmacist Officer’s main roles are in the distribution of medical supplies to support current
operations and overseas units; the provision of pharmaceutical care within service hospital units
working alongside their civilian colleagues; and in the provision of pharmacy support to General
Practitioners at primacy care level.
During Conflict
In the medical logistic role, the pharmacist is responsible for timely distribution of drugs,
dressings and medical equipment in general to all units in the theatre of operations. In Field
Hospitals, they provide pharmacy support and advice to the Commanding Officer. Depending
on the number of pharmacists deployed at any one time, any one pharmacist could be required to
provide advice to other unit commanders on all pharmaceutical matters including storage,
distribution, security and the prescribing, dispensing and supply of drugs. As commissioned
officers, they also undertake military duties as required by the Commanding Officer and will be
expected to develop their leadership and management skills.
NON-TRADITIONAL PHARMACY PRACTICE SETTINGS
A growing number of pharmacists are practicing in what could be referred to as “nontraditional”
practice roles or settings. Pharmacists in such roles contribute directly to patient care (at the
individual patient and population levels) and may have direct interactions with patients and
healthcare professionals, but not necessarily face-to-face. Pharmacists are also involved in
providing care to animals. Veterinary pharmacists receive special training in veterinary
pharmacology and therapeutics and must be proficient at compounding, which is a key service
for animal patients. The complete spectrum of nontraditional pharmacist roles cannot be
provided in this paper, but a few examples are given below.
While we do not specifically show the role of the pharmacy technician in these settings, it is
important that you have at least some familiarity with them. Technicians are vital to almost all
types of pharmacy practice settings and history teaches us that we will continue to grow our roles
in both traditional and non-traditional ways.
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Veterinary Pharmacy
Veterinary pharmacies may fall in the category of hospital pharmacy or retail pharmacy.
Veterinary pharmacies stock different varieties and different strengths of medications to fulfill
the pharmaceutical needs of animals. Because the needs of animals as well as the regulations on
veterinary medicine are very different from those related to people, veterinary pharmacy is often
kept separate from regular pharmacies.
A veterinary pharmacist can make a valuable contribution to the welfare of animals by supplying
a professional service to pet owners. Pharmacists are closely involved in the supply of animal
medicines and the dispensing of veterinary prescriptions. Pharmacists in rural settings are often
involved in helping the farming industry by supplying medicines for farm livestock.
Pediatric Pharmacy Practice
The pediatric patient population spans the years from birth through adolescence, presenting a
unique challenge with regard to drug therapy administration and monitoring. Unlike adults,
dosing is most commonly based on body weight, and pharmacokinetic variables are standardized
relative to weight and/or body surface area. Since physical growth and organ system maturation
are dynamic processes throughout the aging continuum, frequent individual dosing calculations
and adjustments are necessary, particularly in infants. Pediatric disease states, such as cystic
fibrosis can further impact pharmacotherapy due to differences in pharmacokinetics seen in this
particular subset of patients. Pediatric patients are under-represented in clinical trials, resulting
in an inadequate evidence base on which to make individualized therapeutic decisions. Most
commercially-available drugs are not formulated for use in infants and children. In addition, the
pediatric patient population poses a higher risk for medication errors. Pediatric patients are three
times more likely to suffer from a medication error; and a relatively small magnitude of error, as
compared to adults, may result in more serious consequences, especially in the youngest, most
vulnerable patients. Pediatric patients frequently experience adverse drug reactions similar to
adults, but adverse reactions in the pediatric population may be harder to recognize or be of
greater or lesser intensity. Adverse drug events occurred in 11 percent of admissions to
children's hospitals. Pediatric pharmacists have specialized knowledge of the age-related
differences that impact on medication regimens, are able to recognize the need of the individual
patient, and then make the needed adjustments to ensure safe and effective medication use in
infants, children and adolescents. Pediatric pharmacists possess a broad knowledge of treatment
of the various diseases that are common in childhood, such as otitis media, as well as those
diseases that are relatively rare, but more serious, such as cystic fibrosis. These pharmacists,
who have often completed one or more years of post-graduate residency training, have been
shown to be effective in decreasing preventable adverse drug events.
Geriatric Pharmacy Practice
Elderly patients are unique in that they possess an altered metabolic capacity for medications due
to, for example, increased body fat and water, decreased muscle mass, decreased cardiac output
and perfusion, decreased protein binding, reduced liver function, and reduced physiologic
reserve—all of which lead to unique medication selection and dosing requirements compared to
younger adults. As a result of concomitant disease states, multiple medications are often
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prescribed for elderly patients by a variety of providers. They also often require additional
assistance to understand how to take their medications to avoid possible adverse drug effects.
Lack of mobility, vision/hearing difficulties, and possible altered mental status may further
hamper proper use of medications by the elderly. There is a shortage of healthcare professionals
trained in geriatric pharmacotherapy and seniors older than 75 years of age are under-represented
in clinical trials, resulting in a poor evidence base on which to make individualized therapeutic
decisions. As the number of elderly patients continues to increase, the contribution of the
pharmacist to quality, long-term medication management will require dramatic expansion. Some
state boards of pharmacy (e.g., Florida) instituted a requirement for pharmacists to complete
special certificate programs in the area of geriatrics/long-term care consulting. Since the area of
geriatric pharmacotherapy is highly specialized, in 1997 the American Society of Consultant
Pharmacists (ASCP) founded the Commission for Certification in Geriatric Pharmacy (CCGP),
which now awards the Certified Geriatric Pharmacist (CGP) credential
.
As the proportion of elderly patients in society has increased, so has the demand for long-term
care. The term long-term care (LTC) encompasses pharmacy practice in skilled nursing facilities,
intermediate-care facilities, assisted-living facilities, psychiatric centers, rehabilitation centers,
and sub-acute care settings. Pharmacists practice in these areas as consultants, preparers,
dispensers, and/or in-house reviewers of patients' medication regimens. Consultant pharmacists
play a crucial role in LTC settings as a result of federal mandates in 1974 requiring pharmacistconducted drug regimen reviews at least monthly for all residents of skilled nursing facilities.
This requirement was extended to intermediate care facilities in 1987. Beginning with statutory
requirements in 1990, pharmacists have an expanded essential role in ensuring the proper use of
psychoactive medications and ensuring resident's drug regimens are optimized (i.e., eliminating
excessive dose and duration, duplicate therapy, inadequate monitoring, unsubstantiated
indications for use, and continued use in the presence of adverse consequences indicating the
dose should be reduced or discontinued). In 1999, the “Beers Criteria” was added to the drug
therapy guidelines for nursing facility residents to ensure avoidance of certain medications that
are inappropriate or potentially inappropriate for use in seniors. Pharmacists have also expanded
the provision of clinical services to patients in Adult Congregate Living Facilities.
Nutrition Support Pharmacy
Nutrition support pharmacy addresses the care of patients who receive specialized nutrition
support, including parenteral and enteral nutrition. Nutrition support pharmacists have
responsibility for promoting maintenance and/or restoration of optimal nutritional status and
designing and modifying treatment according to the needs of the individual patient. Nutrition
support pharmacists have responsibility for direct patient care and often function as members of
an interprofessional nutrition support team.
Oncology Support Pharmacy
Oncology pharmacists provide specialized care to patients with cancer. Specialists recommend,
design, implement, monitor and modify pharmacotherapeutic plans to optimize outcomes in
patients with malignant diseases. This includes the supportive care needed to minimize side
effects from the oncology treatments and the disease. Oncology agents require specialized
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handling and preparation, and the patients require frequent monitoring to achieve the desired
outcome. Pharmacists play a key role in assuring the safety and optimum care of these patients.
Oncology pharmacists may practice in hospitals or ambulatory oncology clinics, or a
combination of both. Many oncology agents are now infused in ambulatory infusion centers.
Psychiatric Pharmacy
Psychiatric pharmacy addresses the care of patients with psychiatric-related illnesses. As a
member of an inter-professional treatment team, the psychiatric pharmacy specialist is often
responsible for optimizing drug treatment and patient care by conducting such activities as
monitoring patient response, patient assessment, recognizing drug-induced problems, and
recommending appropriate treatment plans.
Managed care organizations
A pharmacist in a managed care practice provides a markedly different type of professional
activity, and as a result, additional competencies are required. For a pharmacist working in this
environment, patients are monitored as a population database and pharmacist care is directed
through database review and querying. Economic and clinical outcomes are weighed against, and
with each other, to make appropriate decisions for a “population” of patients. Pharmacists
practicing in managed care organizations, including health plans and PBMs, are responsible for a
broad range of clinical, quality-oriented drug management services. The role of a pharmacist in
a managed care organization is often stratified into seven different areas of activity: (1) drug
distribution and dispensing; (2) patient safety; (3) clinical program development; (4)
communication with patients, prescribers and pharmacists; (5) drug benefit design; (6) business
management; and (7) cost management.
Drug distribution within a managed care model has embraced many pharmacy roles. Service
providers in this type of setting are encouraged to collaborate in the provision of health care
through an inter-professional approach. Patient management is based on provider group
interactions that address all aspects of individualized patient care. This inter-professional team
includes but is not limited to the physician, nurse, physician's assistant, nurse practitioner,
pharmacist, nutritionist, medical assistant, and benefits manager. A pharmacist in this
environment has the benefit of direct and immediate contact with not only the primary healthcare
provider, but also the rest of the healthcare team. This kind of one-on-one contact among health
professionals often leads to more patient-centered health care and efficient MTM services. Also,
within this type of environment, the pharmacist has access to pharmacy claims data, which
allows for large numbers of patients to be reviewed. Since many of these models have an
integrated dispensing pharmacy program, the patient-care team can monitor medication
adherence and utilization.
Patient Care Call Centers
Call center pharmacists provide patient and prescriber education, patient counseling, drug
information, and customer service, as well as drug utilization review, health management and
formulary management. Pharmacists in call centers interact with patients telephonically to
promote effective drug therapy. Call center pharmacists are primarily employed in health
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maintenance organizations (HMOs), PBMs, and health plans, but may also be found in other
environments. These pharmacists make calls to and receive calls from patients to optimize
medication therapy. Some calls focus on medication adherence reminders; others are to obtain
information about adverse medication events; and some calls focus on patients' questions about
treatment. Some call center pharmacists focus on specific disease states, such as anticoagulation,
hypertension, or diabetes. In the disease-specific model, pharmacists manage the medication
therapy for one disease. Another model places a patient's total medication therapy under the
direction of one call center pharmacist. In this model, pharmacists manage full patients' drug
regimens and are able to suggest changes and make referrals to other healthcare professionals to
ensure positive patient outcomes. Call centers may provide services for specific member
populations, for example, MTM services for Medicare Part D beneficiaries.
Pharmacist information technology specialist
The rapid development of technology and the impact technology can have on patient care have
led to the emergence of the pharmacist information technology specialist or pharmacy
“informatics” specialist. These individuals are in high demand especially in large health systems.
Initiatives such as CPOE, bar coding, dispensing software development, automated medication
dispensing machines, programmed infusion devices, and systems maintenance require both a
clinical and technical knowledge to be implemented effectively and to reduce errors.
CONCLUSION
The evolutions in health care and pharmacy practice are presenting many new opportunities for
pharmacy technicians to perform functions and provide services not considered as traditional
roles. A clear vision for pharmacy practice has been articulated. New roles and responsibilities
for pharmacy technicians will assist pharmacists to achieve this vision. As pharmacists evolve
their practice to meet the healthcare needs of society related to medication use and
pharmacotherapy, individual practitioners seek to expand the scope of services they offer to
provide high quality, relevant care to patients. Education, training, and licensing processes to
underpin practice are competency-based. New professional services have been introduced and an
expanded range of post-licensure credentials, education, and training have been created to assure
the contemporary competence of all practitioners and to support their continuing professional
development and career progression. Accreditation and psychometrically sound examinations
have been developed to provide consistency and quality assurance in the education, training, and
credentialing of both pharmacists and pharmacy technicians. The profession of pharmacy is
working to achieve a pervasive model and standard of care determined only by the needs of
patients and populations. The Council on Credentialing in Pharmacy hopes that the material
presented herein, including the framework for credentialing in pharmacy practice, will allow
audiences to gain a better understanding of where pharmacy is today and what future pharmacy
practice will look like.
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FINAL EXAM
Exam Purpose: The purpose of this exam is to make sure that that the reader has read the
material. The questions are straightforward and not designed to be “tricky” in any way. If
you find any of the questions to be unclear, please contact J&D Educational Services, so
that they may make the author aware of any ambiguities.
Choose the best answer from the choices given.
1. Which of the following is NOT part of the “practice of pharmacy”?
a. Drug regimen review
b. The dispensing of prescription drug orders
c. Delivering to patient’s home
d. Participation in drug and device selection
2. The most recent analysis for pharmacy technicians, completed in 2005, showed CPhTs
spend ___ percent of their time assisting the pharmacist in serving patients.
a. 66
b. 22
c. 44
d. 12
3. Pharmacy technician education and training requirements vary among states and
employers; there is, however, a trend toward more formalized technician training.
a. True
b. False
4. The Model Curriculum provides a starting point for identifying core competencies for
pharmacy technicians in certain practice settings.
a. True
b. False
5. Which of the following is part of the Model Curriculum for pharmacy technicians?
a. Understand the principles for managing change
b. Appreciate the value of obtaining technician certifications
c. Display a caring attitude toward patients in all aspects of job responsibilities
d. All of the above
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FINAL EXAM
6. ________________ is a technician who assists with orientation and training of new
employees.
a. Pharmacy Technician Educator
b. Pharmacy Technician Supervisor
c. Pharmacy Warehouse Supervisor
d. Clinical Coordinator for Pharmacy Technician Program
7. ____________________ requires good computer skills, proficiency in using the ordering
system, and great organizational skills.
a. Pharmacy Technician Educator
b. Pharmacy Technician Supervisor
c. Pharmacy Warehouse Supervisor
d. Clinical Coordinator for Pharmacy Technician Program
8. _________________ usually has the ultimate responsibility for managing all the
technicians employed in the facility.
a. Pharmacy Technician Educator
b. Pharmacy Technician Supervisor
c. Pharmacy Warehouse Supervisor
d. Clinical Coordinator for Pharmacy Technician Program
9. The technician is responsible for documenting the many protocols used to validate the
study in which position?
a. Pharmacy Technician Educator
b. Investigational Drug Pharmacy Technician
c. Pharmacy Warehouse Supervisor
d. Refill Triage Pharmacy Technician
10. The technician in this role should be constantly alert for potential problems that may
cause a medication error or a breach of aseptic technique.
a. Quality Assurance Technician
b. Pharmacy Technician Supervisor
c. Pharmacy Warehouse Supervisor
d. Clinical Coordinator for Pharmacy Technician Program
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FINAL EXAM
11. This technician should learn the established protocols for refill authorization for patients
and note when the patient was last seen.
a. Pharmacy Technician Educator
b. Pharmacy Technician Supervisor
c. Refill Triage Pharmacy Technician
d. Clinical Coordinator for Pharmacy Technician Program
12. ____________________ is the practice setting that the public primarily envisions when
pharmacy practice is discussed.
a. Home infusion
b. Long-term care
c. Specialty compounding
d. Community pharmacy
13. First and foremost, community pharmacy is a practice environment that requires good
people skills and excellent communication.
a. True
b. False
14. The number of prescriptions being filled has decreased dramatically over the last few
years.
a. True
b. False
15. ______________ pharmacies consist of one to four stores owned and operated by an
individual pharmacist or group of individuals.
a. Chain
b. Home infusion
c. Independent
d. Hospital
16. ________________ pharmacies generally have standard operating procedures that apply
to all pharmacies in the system.
a. Chain
b. Home infusion
c. Independent
d. Hospital
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FINAL EXAM
17. ____________________ is the third most prevalent form of home health care.
a. Chain
b. Home infusion
c. Independent
d. Home equipment management services
18. Long-term care pharmacies also carry:
a. IV tubing
b. Catheters
c. Colostomy supplies
d. All of the above.
19. Many facilities utilize a system in which a 30-day supply of each medication is sealed in
a blister pack; often called ___________________.
a. Monthly cards
b. Supply cards
c. Bingo cards
d. Deck of cards
20. Repacked products do not need lot numbers.
a. True
b. False
21. A _______________ is a pharmacy technician in a long-term care practice who delivers
the filled medication carts to the nursing home and returns the empty carts.
a. Exchange technician
b. Cart technician
c. Medication technician
d. None of the above
22. The role of the technician is more varied and more progressive in home infusion therapy
than almost any type of pharmacy.
a. True
b. False
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J&D Educational Services
Pharmacy Practice Settings
FINAL EXAM
23. The primary responsibility of the Home Infusion pharmacy technician is:
a. Packing IV medications and medical supplies
b. Transport to a patient’s home
c. Accurate IV admixture using the strictest aseptic technique in a cleanroom
d. None of the above.
24. Physicians prescribe compounded medications for the following situations:
a. When the patient is allergic to certain preservatives, dyes, or binders in off-theshelf medications.
b. When treatment requires tailored dosage strengths for patients with unique needs.
c. When medications require flavor additives to make them more palatable for some
patients, most often children
d. All of the above.
25. Compounding is in less demand for treating animals.
a. True
b. False
26. Accreditation standards for professional degree programs in pharmacy require instruction
in compounding pharmaceutical ingredients and so all pharmacists have foundational
knowledge and skills in this area.
a. True
b. False
27. Compounded pharmaceutical products can take the form of:
a. Oral suspensions and solutions
b. Capsules
c. Lollipops
d. All of the above
28. Mail-order pharmacies are becoming more prevalent because:
a. Of the one-on-one contact with a pharmacist
b. The delay in receiving medications
c. Many insurance companies are mandating the use of mail-order for maintenance
drugs.
d. All of the above
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J&D Educational Services
Pharmacy Practice Settings
FINAL EXAM
29. While most Internet pharmacies sell prescription drugs and require a valid prescription,
some Internet pharmacies sell prescription drugs without requiring a prescription.
a. True
b. False
30. Dosing might have to be adjusted according to the patient’s:
a. Age
b. Disease
c. Both A and B
d. None of the above
31. Hospital pharmacy technicians perform a broad range of _________ tasks.
a. Clinical
b. Technical
c. Clerical
d. All of the above
32. Technicians that keep track of medication and other supplies and prepare orders for
additional quantities when stock diminishes; also receive incoming supplies and reconcile
invoices are performing ____________________.
a. Aseptic technique
b. Inventory control
c. Technology training
d. Patient education
33. The purpose of a hospice pharmacy is to provide medications and pharmaceutical care to
hospice patients to ensure they have a long and healthy life.
a. True
b. False
34. The only element that differentiates a hospice pharmacy from other areas of pharmacy
practice is its inventory
a. True
b. False
35. Nuclear pharmacy was the first recognized area of specialty practice within pharmacy.
a. True
b. False
36
J&D Educational Services
Pharmacy Practice Settings
FINAL EXAM
36. Military pharmacy is an entirely different working environment due to the fact that:
a. The technician must be an officer in the service
b. Technicians are not allowed in the pharmacy
c. Technicians perform most duties that in a civilian sector would be illegal
d. All of the above
37. Veterinary pharmacies may fall in the category of:
a. Hospital pharmacy
b. Retail pharmacy
c. Both A and B
d. None of the above
38. Adverse drug events occurred in ___ percent of admissions to children’s hospitals.
a. 4
b. 11
c. 15
d. 26
39. In ____, the “Beers Criteria” was added to the drug therapy guidelines for nursing facility
residents to ensure avoidance of certain medications that are inappropriate or potentially
inappropriate for use in seniors.
a. 2014
b. 1990
c. 1984
d. 1999
40. A pharmacist in a managed care practice provides a markedly different type of
professional activity, and as a result, additional competencies are required.
a. True
b. False
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