The Pharmaceutical Journal Vol 267 No 7155 p10-11
July 7, 2001

Self-checking — what do you think?

The consultation period on developing standard operating procedures for the dispensing process has just drawn to a close. One specific issue planned for discussion by the Council of the Royal Pharmaceutical Society in August, from its guidance document on standard operating procedures, is self-checking by non-pharmacists. Zoë Gross investigates

On-line survey is here
Your replies will be submitted to the Council in time for their deliberations in October 2001

The Council of the Royal Pharmaceutical Society has agreed to review its policy on self-checking by non-pharmacists. Its current view is that a trained technician can check the accuracy of what another technician has assembled provided every prescription has been assessed by a pharmacist at some point in the dispensing process.

Self-checking of dispensed items by non-pharmacists is currently not recommended in the Council’s guidance on standard operating procedures for dispensing (PJ, 5 May, p616). Section 5(v) of the guidance document, which covers the checking procedure following the assembly and labelling of prescribed medicines, also states that wherever possible the check should be undertaken by a second person.

However, anecdotal evidence suggests that appropriately trained pharmacy technicians in hospitals may be as competent as pharmacists in accuracy checking in the dispensing process. Also, by delegating this task to technicians, pharmacists will have more time to carry out other roles, such as medicines management, and provide a better service to patients.

In August, the Council is to discuss whether to change its current policy to allow a trained technician to self-check in the dispensing process provided an assessment of the prescription has been carried out at some stage by a pharmacist.

Self-checking by non-pharmacists was among the topics from the guidance document discussed by the Practice Committee earlier this week. Following the Council meeting in August, the final version of the document will be considered again by the Practice Committee.

Training courses for technicians

Accuracy checking is not covered by the current Business and Technology Education Council and Scottish/National Vocational Qualifications Level 3 qualifications for pharmacy technicians. However, some hospital technicians are being additionally trained in accuracy checking providing they have obtained a level 3 NVQ or F-NVQ qualification, or equivalent, in pharmacy services first.

Most hospital regions now have accredited checking technician development programmes for hospital technicians. The London Pharmacy Education and Training Accredited Checking Technician scheme enables technicians to carry out the final check on dispensed items and complies with recommendations made by the Royal Pharmaceutical Society. In the scheme it is currently advised that all prescriptions are clinically checked first by a pharmacist and the accredited technician checks the work of other people. Before the scheme is implemented locally it has to be approved by the chief executive within an individual Trust.

The London Pharmacy Education and Training scheme was originally based on a programme developed by the South Thames region and there are now similar schemes across England which are based on the London scheme. Currently there are over 300 accredited technicians working in many different hospitals in the London region.

In Wales the Welsh Centre for Postgraduate Pharmaceutical Education (WCPPE) has a remit that covers both hospital and community pharmacists and support staff. The Accredited Checking Technician scheme covers both hospital and community technicians. The Welsh scheme involves a two-day training course after which the technician returns to the dispensary to collect evidence of competence in the work place, which includes compiling a record of 1,000 prescriptions that he or she has personally checked and regular reviews by a site supervisor or tutor. On completion, technicians have to undertake a test that involves checking the accuracy of 20 dispensed items against several prescriptions, followed by a two-week probationary period during which items the technician has checked are double checked at random by either a pharmacist or an accredited checking technician.

The London scheme is similar. Also, both schemes are limited to the dispensary and both involve checking technicians having to be reaccredited after two years.

Nationally agreed programme

Lesley Morgan, pharmacy support staff education and training co-ordinator, Wales, told The Journal that a sub-group of the NHS Pharmacy Education and Development Committee was working on a nationally agreed programme for checking technicians. She also commented that the whole process of technicians carrying out the final check was dependent on standard operating procedures being in place and that this was a requirement for the sites where the technicians were working before they started the programme.

Andrew Burr, Council member, told The Journal on 29 June that in his opinion the Council’s current policy was “one of the things we are going to give up”. In his community pharmacy he has a hospital technician working for him who has been trained in accuracy checking. “I think that my technician is more accurate at the dispensing process than I am because I am not doing this job day in, day out,” he said. It was a better use of resources to use a highly trained technician. Mr Burr said that he would routinely encourage such a procedure. Although the dispensing process needed to be “inherently safe”, there was a need to delegate some of the tasks in the dispensary if non-pharmacists were to self-check.

Was treatment prescribed appropriate for patient?

The role of the pharmacist was to make the decision about whether or not the drug treatment being prescribed was appropriate for the person receiving it. “Outside that, dispensing is a technical process,” he said. Trained support staff should be paid to undertake the traditional roles of pharmacists and failing to do this would cause the profession to wither away. “The one thing that will stop this profession moving forward is the large amount of time pharmacists spend printing out labels on computers.”

Mr Burr suggested that a standard operating procedure involving a trained technician self-checking should be in place whereby the pharmacist checked the prescription at the beginning of the dispensing process, which should be documented, and therefore did not need to see it again.

Bob Rihal, community pharmacist and chairman of Lambeth, Southwark and Lewisham LPC, had a less positive view and felt that self-checking by a non-pharmacist was a fundamental worry.

Mr Rihal said that one of the factors involved with non-pharmacists self-checking was the issue of corporate and individual liability and he thought that his colleagues would be concerned about this. Accuracy checking by a non-pharmacist “negates the process of having a four-year degree programme”, he said. “That’s what your training is for.” However, he would ideally like to see something happen so that pharmacists could have time to perform other tasks. There was a need to “look at the methodology for self-checking tasks”, he said.

He suggested that a non-pharmacist could self-check a prescription for a drug such as amoxicillin for which complex counselling was not needed, as long as a pharmacist assessed the prescription at some stage in the process. He said that “pharmacists must carry out a pharmaceutical assessment” and suggested that this could be at the beginning of the process when looking at patient medication records. However, even if the pharmacist assessed every prescription there would still be a flaw in the process in that if an error was made by a self-checking technician that was beyond the pharmacist’s assessment, the responsibility would still be with the pharmacist.

However, there would have to be “robust peer checking” and a second technician would be needed to check the first, he said. Nevertheless having a second technician to check the first raised the issue of cost again.

Technicians skilled in labelling drugs

Helen Remington, Council member, said that the Royal Pharmaceutical Society’s policy on accuracy checking made a distinction between pharmacists and non-pharmacists.

She went on to say that technicians were as skilled as pharmacists in the process of typing a label and checking it, but were not as good as a pharmacist in terms of checking dose safety and making the right choice for the patient. She said that the process of self-checking by non-pharmacists needed evaluating in context and that accredited training for technicians was needed.

Looking at what happens on hospital wards, she commented that nurses use original packs, from drug trolleys, without labels. As the move was being made towards having individual patient drug lockers, the question should be raised of whether anything was actually different.

Ward-based technicians were already starting to appear and a technician working on a ward was always under the supervision of a pharmacist. As long as the technician could see that the pharmacist had signed to indicate that the drug was appropriate and safe, a trained technician could then do the necessary label changes if the dose was changed. Likewise, if a doctor had adjusted a dose.

Mrs Remington said that by skill mixing some parts of the process may not need to be included in the four-year pharmacy degree course.

Self-checking repeat prescriptions

Noel Dixon, community pharmacist, Dixon and Hall, County Durham, is training a technician in-house aiming towards the technician self-checking. Technicians could be used to self-check repeat prescriptions, he said. Doing this would reduce pharmacists’ workload and make them more accessible for advising patients.

He said that self-checking by non-pharmacists needed to be done properly and that pharmacists needed to maintain responsibility. If they did not, standards would suffer, he said. In a letter to The Journal this week, Mr Dixon makes reference to delegating routine tasks to competent members of staff (see p15).

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Zoë Gross is on the staff of The Pharmaceutical Journal