The Pharmaceutical Journal Vol 264 No 7101 p930-931
June 17, 2000 Forum

IPPE/EFAHP

Extending the role of hospital pharmacy technicians

Opening the meeting, the chairman, Mr Tim Delaney (head of pharmacy, Adelaide and Meath hospital, Dublin) told the audience that the conference had been fully subscribed, demonstrating the interest that existed for further information and discussion about extending the role of hospital pharmacy technicians.

The role of the pharmaceutical technician in Ireland

Ms Yvonne Sheehan (senior technician, Adelaide and Meath hospital, Dublin) said that the first pharmacy technician training course had only been introduced into Ireland in 1985. The course consisted of a two-year, part-time diploma course which was divided into three sections requiring day release to Trinity College Dublin and work experience. The course primarily focused on the training required by community pharmacy technicians. It was planned to introduce additional material of relevance to hospital pharmacy technicians in the future. A hospital pharmacy technician grade had first been established in 1988. As clinical pharmacy developed, pharmaceutical technicians had been introduced as support staff. The senior pharmacy technician grade had been introduced in 1994. There was, however, considerable variation in technician roles in different hospitals in Ireland. There were currently 87 basic grade technicians and 26 senior technicians employed in Ireland and 50 per cent of these posts were based in the five Dublin hospitals. In the Adelaide and Meath hospital, a large teaching hospital in Dublin, extended roles for pharmacy technicians included providing a service in a satellite pharmacy in the operating theatres, and participating in outpatient clinics managing patients maintained on clozapine and warfarin therapy.

Yvonne Sheehan: day release

Pharmacist-free dispensary

Mr Darren Leech (chief technician, William Harvey hospital, Ashford, Kent) described a system involving a "pharmacist free dispensary".
The system required that prescription charts, nurses and patients remained on the wards. Ward staff accessed pharmacy services by bleeping ward-based pharmacy teams. These teams screened newly written prescriptions, resolved pharmaceutical problems and prioritised workload before sending requests for supply to the dispensary. The pharmacy teams consisted of a clinical pharmacist, a clinical technician and a pharmacy assistant. An accredited pharmacy technician checking system operated in the dispensary to enable items screened by the pharmacists on the ward to be dispensed and checked by pharmacy technicians. Since its introduction the new system had become very popular with hospital staff and patients.

Clinical trials management

Ms Jo Gresty (senior pharmacy technician, Queens Medical Centre, Nottingham) described the pharmacy technician's role in clinical trial management.
Because of a growing number of clinical trials involving the pharmacy service at her hospital and the requirement to comply with good clinical practice and international clinical harmony guidelines, the pharmacy team co-ordinating clinical trials in 2000 would comprise a part-time pharmacist, a full-time technician, and a part-time assistant with additional clerical support.
The role of the pharmacy technician in clinical trials included:

• Checking dispensed clinical trial supplies
• Checking drug accountability receipts
• Checking supplies made
• Checking returns
• Maintaining clinical trial records
• Responding to requests and information received in connection with clinical trials
• Providing guidance and support for other pharmacy staff
• Meeting the clinical research assistant from the pharmaceutical manufacturer sponsoring the trial

Technical input had improved the efficiency and effectiveness of the pharmacy department's involvement in clinical trials and had enabled the hospital to attract more clinical trial business. The number of clinical trials had risen to 73 studies in 1999 and the original technician involved in this service had moved to the pharmaceutical industry as a clinical research assistant.

Procurement

Ms Doreen Clark (principal pharmacy technician, Tayside University Hospitals trust, Dundee) described technician managed pharmacy procurement in Scotland.
In Scotland, there was a three-tier system for procurement of pharmaceuticals which involved national, zonal and local contracting with suppliers.
In Tayside, pharmacy technicians were responsible for managing area procurement, local contract negotiation, management of a wholesale dealing service involving storage and distribution activities, representing Tayside at national and zonal levels, local storage and distribution to wards, and ward order assembly in partnership with a pharmaceutical wholesaler. Many of these responsibilities had been previously held by pharmacists.

Aseptic dispensing

Mr Steve Bales (pharmacy services projects manager, Baxter Healthcare) outlined extended roles for pharmacy technicians in the aseptic dispensing units within Baxter Healthcare Ltd.
Baxter Healthcare currently operated three licensed pharmacy compounding units in the United Kingdom in the Christie hospital, Manchester, Kingston hospital, Surrey, and Mount Vernon hospital, Middlesex. The units were run as joint ventures with the host hospitals, providing compounded antibiotics, and chemotherapy for use within the hospital as well as a range of compounded batch and patient-specific items to hospitals and home care patients throughout the UK. Baxter also operated industry-based compounding units in Thetford and Dublin and in other locations worldwide.
A new computer system for controlling all aspects of the aseptic dispensing process from inventory control and prescription receipt through to final checking and invoicing was described. The development of the system had involved a detailed review of the entire process, including a thorough risk assessment of the order processing steps. The resulting system had a strong emphasis on quality assurance and minimisation of the potential for human error.
The design of the software supported the implementation of extended roles for pharmacy technicians working in the Baxter units. Such roles included screening of prescriptions and final release checking of compounded items. Ultimately, Baxter's reliance on pharmacists to perform these tasks exclusively would be reduced, resulting in greater flexibility of staff and increased opportunities for the scope of the technician role to be increased.

Quality control

Ms Claire Noble (head of quality control, Clinovia Ltd) provided details of a quality control service provided by pharmacy technicians. Clinovia was a home health care company that provided patient-specific, aseptically prepared medicines and services to home care patients. The licensed aseptic compounding unit was based in the companies main facility in Harlow, Essex. In 1995, there had been an in-house production team managed by two pharmacists and an external quality control service provided by a pharmacy department in a local NHS hospital, again managed by a pharmacist. In 1998, one of the production managers had left and a number of issues had been identified following an inspection by a medicines inspector. This caused the company to make changes to the organisational structure: two experienced technicians had been appointed to the posts of head of production and head of QC, both managed by the compounding services manager, who was a pharmacist. The company had also discontinued its external contract for quality control services provided by the NHS hospital and built its own quality control laboratory in its facility in Harlow. The current role of head of quality control was managing the environmental monitoring system, setting and monitoring technical standards, approving and monitoring suppliers, validating systems and personnel, and recommending and influencing corrective actions. The head of QC and head of production, who were both technicians, were now the named individuals on the specials manufacturing licence approved by the Medicines Control Agency.

Claire Noble: head of QC

Medicines management

The role of the technician in medicines management and clinical governance was presented by Ms Kate Appleby (chief technician, Southern Derbyshire acute hospitals trust). She said that the post of medicines management technician had been created in response to clinical governance and controls assurance initiatives relating to management of medicines in the trust.
A number of health care groups were involved in prescribing, storing, preparing, supplying and administering medicines. It was important routinely to examine all these processes and ensure the required level of quality was maintained and to identify ways in which processes could be improved. The responsibilities of the medicines management post included:

• Acting as secretary of the medicines management subcommittee for the trust (which produced policies and procedures for medicines and reviews reports of medication errors each month) and performing regular audits on medicines usage throughout the trust
• Acting as a member of the trust's clinical audit group
• Acting as a member of the trust's clinical governance working group
• Acting as a member of the trust's clinical negligence scheme for trusts steering group

Hospice care

Ms Jeanette Parry (principal technician, Trinity hospice, Clapham, London) described the technician's role in hospice care. She reminded the audience of the overall objective of palliative care, which was to achieve the best quality of life for patients and their families.
The pharmacy technician co-ordinated all pharmaceutical activities in the hospice and this involved the provision of a specialist service for the terminally ill. The technician was required to be totally responsible for:

• Managing the pharmacy department
• Ordering and supplying of medicines, including Controlled Drugs
• Providing a clinical pharmacy service
• Visiting wards
• Attending multidisciplinary ward rounds
• Monitoring and endorsing prescriptions
• Alerting prescribers to drug interactions and inappropriate therapy
• Providing a wound management service (grading wounds and advising on dressings)

Training

Pharmacy technician training in Scotland was reviewed by Ms Lynn Leitch (principal technician, Lothian pharmacy practice unit, Lothian University Hospitals trust). She said that technician education and training in Scotland had evolved over the past decade as a direct response to national initiatives resulting in changes in pharmacy practice. In 1990, the only qualification available had been the knowledge-based national certificate in pharmaceutical sciences (SCOTVEC).
The first advanced qualification for technicians had been developed and introduced in 1991 in the form of a higher national certificate in pharmaceutical sciences (SCOTVEC). The course had been designed to provide the skills and knowledge to support the development of senior and chief pharmacy technicians. It had not been until 1997 that competency-based qualifications had been made available with the implementation of the "SVQ pharmacy services level 3", and procedures for pharmacy technician dispensary checking course.
Joint appointments between pharmacy practice and academia had successfully been in place in Scotland for three years, providing support for the development of education and training initiatives. National task teams utilising specialist expertise had led to the development of three new competency-based qualifications, covering chemotherapy for cancer care, operational management of a an aseptic dispensing facility within a pharmacy department, and procedures for aseptic checking technicians.
The HNC was due for revalidation in 2001, providing the opportunity to review and modify the existing qualifications to ensure they retained relevancy to pharmacy practice. Future developments to facilitate further expansion of the technician's role included identification of the need for a higher national diploma in pharmaceutical services or a professional development qualification.
Ms Sarah Goodson (principal technician, technician development, Guy's and St Thomas's Hospitals, London) described education and training for technicians in the South Thames region, where, in recent years, there had been several education and training developments for technicians. One of these, an accreditation scheme for technician final checking of dispensed items, had been successfully completed by over 300 technicians in South Thames. The scheme had been adopted in North Thames, Anglia, the South West regions and Wales. There was also an accreditation scheme for technician counselling to facilitate the extended roles of technicians in clinical areas and discharge planning.
Initiatives for the future included:

• An accreditation scheme for technician final release of aseptically dispensed products
• Introduction of a three-tier approach to training in aseptic services (novice, competent, expert), which would ensure that there were sufficient staff trained in these areas
• Establishing the role of clinical technicians looking at areas of innovative practice and developing courses to support and underpin these roles