The question of whether extended roles for hospital pharmacy technicians could be developed in order to help hospital pharmacy departments provide new services while reducing the number of hospital pharmacists was addressed at a meeting organised by the Independent Panel for Pharmaceutical Education in London on November 5
Opening the meeting, the chairman, Dr DAVID COUSINS (chief pharmacist, Southern Derbyshire Acute Hospitals trust) said that now was the best of times and the worst of times for hospital pharmacy services. On the one hand there had never been so many opportunities and invitations for pharmacy services to take on new and exciting roles. But, on the other hand, the supply of hospitals pharmacists, and to some extent pharmacy technicians, had not been as poor for 30 years. Dr Cousins said that opportunities had come about through staffing, workload and quality changes in hospitals.
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David Cousins: the best and worst of times |
Workload changes had resulted from the reduction in the length of hospital stays, increased day surgery rates and reductions in waiting lists, all of which had produced significant increases in clinical workload.
Quality changes had come about from greater awareness of general practitioners' and patients' complaints about the provision of medicines and medicines information from hospitals, high-profile medication error cases, medicines inspector reports and the Government's initiative on clinical governance.
Dr Cousins went on to say that hospital pharmacy was not the only hospital service that was faced with these dilemmas. Medical, nursing, pathology and operating theatre services also faced similar staff shortages and were examining their systems and skill mix to resolve the difficulties.
He told the audience, which was mainly comprised of pharmacy technicians, that the conference had been organised to examine extended roles for hospital pharmacy technicians that could be developed in order to help hospital pharmacy departments provide new services while the number of hospital pharmacist posts was reducing. He added that there would be greater use of technicians in managerial and clinical roles in the future.
Dr Cousins suggested that European models of hospital pharmacy service provision could be worth considering since these had always operated with fewer pharmacists and recognised that pharmacy technicians had a major role to play.
Ms TRUDY GERRITSMA (drug distribution and logistics manager, Isala Clinics, Zwolle, the Netherlands) outlined the role of the hospital pharmacy technician in the Netherlands.
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Trudy Gerritsma: extra training in hospital practice |
Ms Gerritsma explained that it took three years to become a pharmacy technician in the Netherlands. During their education, technicians learned how to perform tasks independently and how to take responsibility for daily routine tasks. Much attention was paid to communication skills, drug information, health care and hygiene, preparation and dispensing of drugs, and pharmacy automation. Twenty per cent of a technician's training was in hospital practice.
Once qualified, technicians could work in hospital or community pharmacy, but a job in hospital generally entailed extra study in one of three specialties: drug production, hospital pharmacy practice and pharmacotherapy. Ms Gerritsma said that most Dutch hospitals required their technicians to follow the course on hospital pharmacy practice. She added that the terms of employment were better for technicians working in a hospital rather than a community pharmacy.
Ms SAM PASS (ward pharmacy technician, Northern General hospital, Sheffield) described the role of the ward pharmacy technician at her hospital. She explained that, at the Northern General, skill mix changes had been implemented in the main pharmacy which had resulted in the provision of a competency-based training package for pharmacy assistants to enable them to be used for dispensing procedures and ward top-up duties. This had freed pharmacy technicians to work on wards with the clinical pharmacists and nursing staff in co-ordinating the total medicines management process.
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Sam Pass: savings of ££41,000 |
Ward technicians also had to have good interpersonal skills, computer competency and the ability to work as part of a team, said Ms Pass.
She told the audience that the introduction of a ward pharmacy technician on her ward had resulted in savings of nearly £41,000 in 1998. Thus, ward technicians could have a dramatic impact on reducing financial burden, she said.
The effect of the allocation of a clinical pharmacy technician to a urology ward was outlined by Ms DEEPA RANIGA (chief technician, Leicester General hospital). She explained that increasing workloads and increasing demands on pharmacists' time had led her hospital to determine if clinical pharmacy functions could be performed by an experienced pharmacy technician. The urology ward had been chosen to determine this because of its fast turnover of patients, many of whom had been admitted for minor surgical procedures requiring little alteration in drug therapy.
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Deepa Raniga: gaining clinical knowledge |
The benefits of the clinical technician role included increased job satisfaction for the pharmacist and the technician as the pharmacist now had time to attend ward rounds which he did not have before and the technician was gaining clinical knowledge. There was also increased interaction between patients and the pharmacy service.
In future, said Ms Raniga, it was hoped that the technician would be able to attend pre-assessment clinics to take drug histories, to increase their patient counselling role and to become involved in teaching nurses and junior medical staff.
Given the right training, hospital pharmacy technicians were capable of dealing with most drug information queries and of knowing when to refer inquirers to the drug information pharmacist, Ms VIBHA TELI (principal technician, drug information and clinical trials, Royal Brompton hospital, London) said.
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Vibha Teli: know when to refer |
Ms Teli said that the skills required to be a drug information technician were knowing the available sources of drug information, good communication and telephone messaging skills, an ability to keep good documentation, and knowing when to refer queries to a pharmacist. The sort of queries that a technician could competently answer related to administration and dosages, adverse effects, availability and supply, identification of foreign drugs, drug interactions, and intravenous incompatibilities. All of this information was well-documented so a technician could competently give it out, she said.
Ms CAROLINE KELLY (electronic discharge project technician, Neath General hospital, West Glamorgan) described her role in her hospital's electronic discharge system.
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Caroline Kelly: challenging role |
Ms Kelly said that, on the whole, it had been an innovative and challenging role for her which had called on all her problem solving skills. She hoped that the system, which was currently funded by the Welsh Office, would become permanent once evaluation had shown the scheme to be a benefit.
Mr PAUL COUCHMAN (chief pharmacy technician, Derbyshire Royal infirmary) described the work of a pharmacy technician in providing a satellite aseptic dispensing service.
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Paul Couchman: new opportunities |
The IPPE
The IPPE is an independent company which has been offering education programmes for several years in some European countries and, recently, in the United Kingdom. It does not focus exclusively on hospital pharmacy practice, but has a broad pharmaceutical approach.
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The electronic discharge project was not funded by the Welsh Office. The project was funded by Iechyd Morgannwyg Health.