With the imminent year 2000 shortfall in preregistration trainees it is time for pharmacy to utilise the skills of pharmacy technicians appropriately in order to give pharmacists the time and support to provide high standard pharmaceutical care. Making best use of pharmacists and their support staff will add value to the services provided by pharmacy by raising the profile of the pharmacist in the health care system.1
In recent years a number of hospitals have recognised that pharmacy technicians can be given the responsibility of extending their role by performing accuracy checks on dispensed items. Such technicians are termed "checking technicians". Training schemes for them have been either in-house or regional as in the South Thames region.2
At a recent West Midlands regional study day on checking technicians ideas were put forward to the chief pharmacists recommending that the region should establish an accredited scheme for checking technicians that would promote uniformity across the region and allow technicians to move from one hospital to another without need for retraining. The West Midlands chief pharmacists agreed to the recommendations and set up a working group of pharmacists and technicians to develop a training package.
Training was the key element for the introduction of the checking scheme. Because technicians did not routinely undertake the checking role, the change in practice required training that would enable individuals to obtain the necessary skills to take on this extended role. It was felt that the underpinning knowledge should be provided by an external educational establishment to promote uniformity and that the qualification should be formalised by being accredited by an awarding body, such as BTEC Edexcel.
A template for checking technicians had already been written at the University Hospital Birmingham NHS trust, so it was decided to adopt part of this package for the regional scheme.
The checking technician qualification forms a module of the current HNC course in pharmaceutical science offered by Matthew Boulton College, Birmingham. This is accredited by BTEC Edexcel and the checking technician unit runs as a stand-alone module. The college course provides the underpinning knowledge needed for the award and comprises two study days totalling 12 hours of taught knowledge.
It covers the following topics
The requirements that pharmacy technicians must satisfy before entering the programme are that they should:
The work-based programme is designed to ensure that each technician satisfies two key criteria. They have to be able to detect mistakes and to check accurately under pressure.
Ability to detect mistakes Candidate are required to check a minimum of 50 items that have previously been checked by an assessor nominated by the senior pharmacy manager of the department where the work is being undertaken. Nominated assessors have to be pharmacists of grade C or higher and have to have at least three months' experience in the department where the assessment is undertaken. Previously accredited checking technicians can also be assessors after having practised as checking technicians in the department for a minimum of three months. The 50 items have to be checked over a period of not less than one month and not more than three months. Between 25 per cent and 30 per cent of the items chosen for checking should involve serious dispensing mistakes.
Checking under pressure It is important to assess the candidate's ability to check accurately under pressure with the usual dispensary distractions. A minimum of 200 items must be checked in this way with subsequent checking by the assessor before release from the dispensary.
The minimum number of 200 was chosen to cater for both small and large hospitals, but can be expanded if desired. This part of the workplace assessment must take place over a minimum period of one month but not more than three months. A diary approved by the accrediting body has to be used for logging items checked in the workplace.
Failure by a candidate being assessed to detect a serious dispensing mistake is not acceptable. Assessors are required personally and confidentially to report failures to the senior pharmacy manager of the department. The senior pharmacy manager will discuss the matter with the candidate to find out why the error was not detected and whether there were any extenuating circumstances.
If it is felt to be appropriate for the candidate to continue to pursue accreditation then he or she must restart the component of the competencies in which the failure occurred.
It was decided that once competence to check had been accredited to a candidate there would be no need for reassessment: it would be the individual's responsibility to ensure that standards were maintained.
The author acknowledges the help and support given by University Hospital Birmingham NHS trust and the West Midlands checking technician working group.
Ann Perrett is senior pharmacy technician for service development at the University Hospital Birmingham NHS trust and a member of the West Midlands checking technician working group