Hospital Pharmacist
Vol 11 No 3 p112-114
March 2004

Consultation on code of ethics for technicians

By Debbie Andalo

Pharmacy technicians are being invited to comment on a draft code of ethics as the next step towards professional regulation and registration. The code, which is out for consultation until the first week in May, has been drawn up by the Royal Pharmaceutical Society and the Association of Pharmacy Technicians UK (APTUK) — the organisation which represents pharmacy technicians.

The code covers a technician’s professional responsibilities in a variety of roles in the workplace. It also considers competency and continuing professional development and issues around patient confidentiality. The document is based on the existing code of ethics for pharmacists and the code of conduct which already applies to the 2,000 members of the APTUK. Once finally approved by the council of the Society, in late summer at the earliest, the code will apply from January 2005 to coincide with the introduction of the profession’s voluntary register which will become a mandatory register in 2007.

The code is a watershed for pharmacy technicians because for the first time a system will exist to ban a technician from practising if they are incompetent or have broken the law. Currently, if a technician breaches the association’s code they can be banned from membership but not from practice.

The President of APTUK Darren Leech said: “This proposed code of ethics is not significantly different from the association’s own code of conduct which we have had for some time. The only difference is that it is going to be mandatory — if it is breached it will stop a technician from practising which is something we have been campaigning for, for over 50 years.” He is confident that the draft code will not require major changes. He said: “The association has been heavily involved in drafting the proposals and we hope there will not be too much needed in the way of redrafting. I do not expect significant changes but then we are not infallible.”

David Pruce, director of practice and quality improvement at the Society said it was important that technicians have a set of standards which are explicit and which they are expected to meet. He added: “I hope we do not have to change the draft code much because we have based it on the pharmacists’ one. They are not incongruent and should be okay together.”

The Guild of Healthcare Pharmacists has welcomed the decision to give technicians their own professional code of ethics. The guild’s outgoing president Robert McArtney said: “I think it is an excellent idea to have a code of ethics which represents the best parts of the pharmacist’s code — we did not want to see a pharmacist’s code just imposed on technicians. It is important that the pharmacist and technician codes should complement and not contradict each other.”

He predicted a professional code of ethics would give pharmacy technicians greater security and clear lines of duties and responsibilities which do not necessarily exist at the moment. He added: “It gives them a sense of where, as a group, they are heading and a delineation of what to expect and not to expect of them.”

Patient safety

Patient safety is at the heart of the draft code, whether the technician works in the hospital or community sectors or has a managerial role. Patients have a right to take part in decisions which affect their treatment which technicians should recognise and also ensure that patient information to help them reach those decisions can be easily understood. Technicians have a duty to keep their professional development up to date and that it is evidence based. Personal and professional behaviour, which does not bring the profession into disrepute or undermines public confidence, is also highlighted.

The code is divided into two main parts — key responsibilities for all technicians and standards of professional performance which in turn cover personal responsibilities, professional competence and confidentiality.

The draft code points out that technicians have a professional duty to protect patients and the public but must also ensure that their own work procedures are safe and effective. They are also reminded that they must only ever work within the limits of their own knowledge or expertise. If necessary they should seek advice either from a pharmacist, or, “other authority” if they work in primary care and do not have direct access to a pharmacist.

Another fundamental aspect of the code is that technicians are responsible for their own actions and must only accept work which they are skilled to carry out. They must also ensure they have access to facilities, equipment and materials necessary for them to work to the required acceptable standards.

If they need to delegate work it must be to individuals who are competent to perform the tasks. Technicians should make a commitment to continuing professional development and ensure that they have professional indemnity.

Technicians also have a duty, under the draft code, to report to their supervising pharmacist or other appropriate authority any suspected adverse drug reactions or interactions so that steps to protect the patient can be taken. If a technician finds that their religious or personal belief ever prevents them from providing a service they must never criticise the patient but instead refer the patient to either another technician or pharmacist for care.

Whistle blowing is also expected under the proposed code. If they believe a fellow technician or pharmacist is putting the public at risk they must inform the Society. If they believe a patient has received sub-standard care or service, even if they did not provide it themselves, they must be able to explain what happened or seek advice from a pharmacist or other authority.

Technician managers

The code lays down specific responsibilities for pharmacy technician managers, or those in Scotland, who may have part ownership in a pharmacy. They must keep up to date records of pharmacists and services they are expected to maintain. A pharmacist should also be identifiable and accountable for all pharmacy services provided by non-pharmacists. Technician managers, or part owners, also have the responsibility of organising indemnity cover for themselves and staff under their control. Quality control is also their responsibility, as they must ensure that the quality of medicines or pharmaceutical ingredients, their supply and source are “reputable”. It is expected that medicines are bought from licensed wholesalers, from the manufacturers or through a central purchasing system. Records of medicines obtained from other sources, which should include steps taken to ensure efficacy and safety, must also be made.

Managers have a responsibility to tell staff the duties expected of them and they should be given clear instructions which minimise risk. They must also make sure that there are adequate support staff in the work place and that information about pharmacy practice and services are easily available to all staff including locums and temporary staff.

They must make sure that all their staff understand the importance of continuing professional development and are competent in speaking English. Other responsibilities include providing working conditions which enable staff to work to acceptable professional standards and having a complaints’ procedure in place and a system to deal with incidents which threaten patient or public health.

Managers should also inform the Society if they are concerned about a colleague’s professional competence and write to the society about any pharmacy ownership changes.

Pharmacy technicians who supervise student pharmacy technicians are also the focus of the draft code. They must be confident that any student they assess is competent and understands and complies with the key responsibilities of the code. Offering students a range of experiences and the necessary training to meet the needs of their S/NVQ studies is also essential as well as appropriate supervision, particularly when they are in contact with the public. The technicians also have a responsibility to review student progress and offer constructive comments and honest assessment, although students should also be encouraged to carry out their own appraisal, the code recommends.

Professional competence

Professional competence is a key part of the code, which stipulates: “The public, profession and the NHS expect pharmacy technicians to develop their professional performance to provide a high level of care to patients.” Technicians have a duty to review their skills and knowledge and audit what they have done so that they can provide evidence that they are up to date. They must do this every year. If a patient needs advice or information concerning a medicine which the technician is unsure about, they must refer to either a pharmacist or another appropriate professional. Technicians also have a duty to be aware of potential drug reactions and interactions and how they should respond if these occur.

Patients and the public have a right to confidentiality, according to the draft code. Technicians must respect that right and protect confidentiality — which applies to personal details, prescribed and non-prescribed medication — in the course of their work. Confidentiality must also be protected when information is thrown away, stored, transmitted or received. Any confidential information must only be disclosed with the consent of the individual, the draft code points out.

However, there are exceptions which include occasions where the patient’s age or health means they are incapable of giving consent or if there is a danger to the patient, public health or safety. A further exception is where there is a legal obligation to pass on information or there is a request from a judge, Coroner, Crown Prosecution Service or Procurator Fiscal.

Technicians can also pass on confidential information to the NHS fraud investigators or the police, provided the request is made in writing and the details are needed to prevent a serious crime. Information about adolescents should not normally be disclosed to their parents, the code points out.

The code extends confidentiality to colleague’s prescribing practices. They are not allowed to pass on information which identifies a prescriber or their practice without written consent from the individual. Confidential information in the pharmacy is restricted to those who require it and who are personally governed by confidentiality. Computer systems should include encryption, and access to manual and computer systems, that include confidential information, should be controlled to reduce risk of breaches of confidentiality, says the draft code.

Mr Leech urged all technicians to take the time to read the draft code and to contribute to the consultation. He said: “We are in the middle of a consultation exercise and I do not want to draw attention to any particular part of the code. But I would say to technicians that it is important to read the paper and to consider its contents thoroughly. I think the whole document is important because technicians are going to have to abide by it and the consultation is their chance to influence it.”