Hospital Pharmacist
Vol 11 No 2 p62-65
February 2004

US technician roles and registration requirements

By Gareth Jones, MRPharmS

Pharmacy technicians in the UK are moving towards compulsory registration by 2007, and it is interesting to note that the same issue is under consideration for their American counterparts. The American Council for Pharmacy Education (ACPE) has just completed a consultation exercise on the education, training and registration of pharmacy technicians. This widespread consultation exercise has been undertaken throughout 2003 to gather information and suggestions on the way to move forward, and closed at the ASHP meeting in December 2003. Its recommendations are expected during 2004.

There are thought to be at least 250,000 people working as pharmacy technicians in the US, and about 20 per cent of them are in hospital practice. This number is expected to increase by 36 per cent between 2000 and 2010. Over 140,000 have met the requirements of the Pharmacy Technician Certification Board (PTCB). Therefore, almost half of pharmacy technicians in the US do not have a nationally recognised credential.

Registration and training

The entry degree for pharmacists in the US is a doctorate of pharmacy. Peter Vlasses, executive director, ACPE, commented on the changes in pharmacy education levels over the years. As levels of training for pharmacists have changed, that given to technicians should also be reviewed. He asked if the US should adopt a national standards and a quality assurance programme for technician training. In 1988, a consensus conference identified the need for consistent titles, uniform definitions, defined duties, standardised training and education, and modernisation of regulations. In 1995 PTCB was developed to provide the first nationally recognised certification for pharmacy technicians. In 2002 a pharmacy technician summit was held and a request made that ACPE initiate discussion on the possible development of national standards and accreditation.

The current definition of a pharmacy technician is, “An individual working in a pharmacy setting, under the supervision of a licensed pharmacist, assisting in pharmacy activities that do not require the professional judgement of a pharmacist.” That definition is being reviewed, along with the training, education and registration of pharmacy technicians.

Michael Rouse, assistant executive director, international and professional affairs, ACPE, asked why the current system needed to be reviewed. It was, he said, because pharmacy technicians are playing an ever increasing role in delivery of pharmacy services. It is vital to safeguard the public, and therefore sufficient education and training of all personnel delivering pharmacy services should be in place. The goal of pharmacy is to promote public health through the safe use of medicines, and pharmacy technicians are a vital part of the pharmacy team. He said that they are trying to address future needs, and look at what technicians are likely to be doing in the future.

Issues that they are tackling, with a view to ensuring better preparation and use of pharmacy technicians, include:

· Pharmacist workforce shortage
· Momentum for pharmaceutical care, and why we have not been able to move as fast in terms of implementation
· Safe medicine use

Mr Rousse said that ACPE was mainly interested in looking at education and training. Before doing this, he said, it is important to look at the definition of a pharmacy technician, establish whether different grades of pharmacy technician are required, and match the roles and responsibilities for these levels.

Survey

A survey of technician registration and education has shown that there is a wide range of requirements, and there is a need for some standardisation. Examples of disparities in requirements for technicians are presented in Panel 1.

Pharmacy technician training programmes ranged in duration from 540–2,145 hours. The average course length was 1,110 hours. A review was made of other courses being offered at technical colleges. There was less variation in the length of courses for dental technician, veterinary technician and medical assistant training. Mr Rousse questioned why there was so much variation for pharmacy technicians.

Examples were presented of different levels of technician practice. In some US states, technicians are allowed to check the dispensing of another technician, in lieu of an accuracy check by a pharmacist. However, only 20 states allow a technician to transcribe a verbal order from a doctor.

A survey had been sent by ACPE to organisations in other countries to find out about education and registration of pharmacy technicians around the world. From a small response, it was found that 56 per cent of countries use the designation “pharmacy technician”, 75 per cent register or licence pharmacy technicians and 61 per cent have minimum requirements for education or training. Formal or institution training was more common than on-the-job training. Ninety per cent used support staff in pharmacy. Further information is available from: www.acpe-accredit.org

Innovative roles

Technicians roles have developed a lot in the last ten years, as pharmacists take on new work which leaves opportunities to be filled said Jan Kereztes, pharmacy technician programme coordinator, South Suburban College, Illinois. Pharmacy technicians in the UK are probably familiar with most of the innovative roles performed by US technicians, as similar roles are already being undertaken in the UK.

However, one role that is not needed in the UK is the pharmacy benefits manager. This is a role that some US technicians are undertaking, and involves assessing requests from pharmacies about whether a prescribed drug can be reimbursed on a patient’s medical insurance scheme. Dr Kereztes described another emerging role: working in the operating theatre, preparing drugs for administration.

It was also hoped that technicians may be able to take on roles in nursing homes administering oral medication. There is a shortage of nurses in the US, and pharmacy technician training would prepare them well for this role.

Innovative practice

An example of innovative practice where pharmacy technicians work semi-independently in remote locations with audio and video links to the pharmacist was presented by Kenneth Strangberg, pharmacy technician programme director, North Dakota State College of Science. North Dakota is a large and sparsely populated state, with many small communities. An example of this is the town of Beach, which has a population of 1,116. Doctors travel to Beach from the nearest main town of Dickinson, which is 60 miles away. When prescribed medicines, patients previously needed to make a 120 mile round trip to collect their drugs from the pharmacy.

As it was not commercially viable for a pharmacist to run a shop in such a small town, an exception was made in the state laws to allow the setting-up of a new pharmacy, with the drugs dispensed by a pharmacy technician. When a prescription is presented at the pharmacy, the technician scans it, and the image is visible to the pharmacist 60 miles away in Dickinson. The technician dispenses the drug and generates a label, and this is viewed by the pharmacist on a video link. Having checked the prescription, the pharmacist then counsels the patient using the video and audio link.

The pharmacy has between 25 and 50 prescriptions per day, but the service is of significant benefit to the local community who now do not have to travel to collect their prescriptions. This arrangement is only permitted at certain remote locations, and the technician must be state registered, have at least one years’ experience and their technician education must have been at a state approved institution. Pharmacists are restricted to controlling no more than four remote sites.