Hospital Pharmacist
Vol 11 No 5 p208-210
May 2004

Association of Pharmacy Technicians United Kingdom annual conference

Get involved in delivering holistic health care

Moving technicians away from the dispensary and on to the wards improves patient care and makes financial sense, according to Alison Woods, senior technician and Mike Scott, chief pharmacist of the United Hospitals Trust, Northern Ireland. Miss Woods and Dr Scott explained to delegates the workings of a pilot ward-based integrated medicines management scheme in place at their trust.

On the five wards (three at the Antrim Area Hospital, one at Whiteabbey Hospital and one at Mid-Ulster Hospital) where the scheme is up and running, technicians undertake much of the day-to-day medicines management from patient admission to discharge and beyond. For example, they assess patient’s own drugs on admission, manage their storage (including arranging the destruction of inappropriate drugs, where patient consent has been given) and reassess them on discharge. As well as assessing PODs, technicians contribute to compiling a drug history by finding out information about the drugs the patient is taking (including OTC preparations) from any community pharmacists routinely used by the patient (after obtaining consent).

Information is then transferred to a Kardex, which technicians review to arrange the supply of any non-stock items needed. They record the technical interventions they make, referring clinical issues to the pharmacist.

During a patient’s stay, technicians educate them about how to use devices such as inhalers. If a patient is transferred to another ward (especially those where the medicines management service has not yet been rolled-out), the technician takes responsibility for transferring non-stock medications and PODs to the new ward.

When the patient is to be discharged, the technician checks the discharge prescription (which is prepared by a pharmacist under a local protocol) against the Kardex and other in-patient records for technical errors (eg, inconsistencies), with the pharmacist performing the clinical check. The technician promotes patient safety across the primary and secondary care interface by forwarding information about the patient’s drug treatment to their GP and, where appropriate, their community pharmacist on the day of discharge.

Analysis of the medicines management scheme has shown that it reduces the average length of hospital stay, the admission rate, and drug wastage, all of which bring cost savings. There has also been a statistically significant improvement in the appropriateness of medicines being taken by patients (as analysed by researchers at Queens University Belfast). Nurses, pharmacists and junior doctors benefit because the scheme frees some of their time and the technicians themselves value their extended role and the challenges it brings. Assistant technical officers and students also benefit from their increased responsibilities within the dispensary.

Issues that need to be resolved include re-engineering services to provide cover at weekends and evenings and for holidays. The deskilling of nursing staff and junior doctors about drug issues is also something that needs to be borne in mind, Miss Woods and Dr Scott added.

Future plans include rolling out the service to all wards at Antrim Area Hospital and to other hospitals in Northern Ireland. Self-administration schemes are also under consideration, as are plans to put up notices in GP practices asking patients to bring in their medicines if they are admitted to hospital. Using hand-held digital devices for recording interventions and following up patients at medicines management clinics in the community are also initiatives that are under development at the trust.

Other extended roles

Pharmacy technicians could play an important part in delivering services to patients with cystic fibrosis, according to Rhona Fair, paediatric directorate pharmacist at The Royal Hospitals, Belfast. The setting up of multidisciplinary teams is in its infancy, Ms Fair explained, and there are potential roles for technicians to deliver ward-based medicines management services, encourage compliance (especially because patients with cystic fibrosis receive complex treatments for long periods of time using expensive drugs). Technicians could also lead studies on improving central intravenous additive services to these patients, she said.

Children with kidney disease could also benefit from having pharmacy technicians as part of the team delivering their care, according to Anne Burns, senior paediatric clinical pharmacist, also at The Royal Hospitals, Belfast. The National Renal Workforce Planning Group 2002 includes an implementation schedule for technicians to become involved in the renal pharmacy service to children by 2006–08, she added.

Technicians’ perceptions about electronic prescribing

Perceptions of how electronic prescribing technology has and will change the role of pharmacy technicians was the subject of a poster presentation by Ann Mold, senior pharmacy technician for education and training at the Sunderland Royal Hospital (part of the Sunderland NHS Trust pharmacy service) that won the award for best poster, sponsored by Baxter Healthcare.

Mrs Mold prepared questionnaires and gave them to eight technicians, one pharmacist and one student assistant technical office, asking for their views on electronic prescribing, which was being rolled out at the hospital. Staff were asked to list any positive or negative effects they thought the introduction of electronic prescribing had brought to the role of pharmacy technicians and to state whether they thought patient care had benefited. They were also asked what roles technicians should undertake if electronic prescribing and other technology reduced their dispensing role and what training they would need to do these.

Of the eight technicians, six could see no benefits, with the other two citing more time for ward work as a benefit. Reduced responsibility and taking longer to perform tasks were the main negative effects technicians listed. The pharmacist saw more legible orders to work from as a positive effect and the fact that electronic prescribing introduced (yet) another system that staff needed to know how to use, as negative. All ten respondents thought that patient care benefited. Extending their roles on wards and in medicines information, anticoagulant and preassessment clinics and management were cited by all ten staff as work technicians should undertake given that technology has made the dispensing process more of a “factory production line”.

Publish, network, share ideas, and take responsibility

Pharmacy technicians should publish their work and subject it to peer review, “to provide a robust evidence base that others can use and apply” said Norman Morrow, chief pharmacist at the Department of Health, Social Services and Public Safety in Northern Ireland. Focusing on the impact and outcomes of service developments is the way to draw in new resources and direct new practice to benefit patients. He cited the technician/pharmacist-led medicines management programme at the United Hospitals Trust (set out on p208 opposite) as a prime example of a practice development that has provided evidence of its benefits to patients and NHS staff.

Dr Morrow also explained to delegates that “opportunity comes with responsibility and with responsibility comes accountability”. This theme was echoed by Mark Koziol from the Pharmacy Insurance Agency who cited greater responsibility and, for example, the increasingly litigious nature of society as reasons why technicians should consider taking out professional indemnity insurance. In saying this, Mr Koziol drew on the independent advice given to the APTUK from lawyers at health care law firm, Capsticks, who conclude that, although the risk of technicians being sued for negligence or prosecuted under the criminal law is small, there is still a risk that this could happen. Relying on an employer’s insurance will not always be best for the technician — for example they might want to claim that their training is inadequate or there might be an issue as to who their employer is (eg, for locum staff), Mr Koziol added.

Technicians were urged by Kate McClelland, President of the Pharmaceutical Society of Northern Ireland and Tanya Creaner, conference organiser, from Knockbracken Healthcare Park, to take back best practice to their work place, share new information, make contacts and network. That way, practices that work can be introduced more easily and time is not lost introducing those that do not, they said.

Agenda for Change profiles for technicians agreed

Agreement has now been reached with the national Job Evaluation Working Party on pharmacy technician job profiles. The announcement was made by Darren Leech, APTUK president. Five national profiles can now be used at Agenda for Change early implementer sites for the job matching of individual job descriptions (or families of job descriptions), he said. They cover the core areas of pharmacy technician practice in the NHS, including dispensary and patient services, clinical services, stores and distribution and technical services. Technicians whose jobs cannot, or do not, match these national profiles will need to fill in a job analysis questionnaire, which will then be evaluated and scored by trained job analysts.

The profiles represent an overall basic pay range for pharmacy technicians of between £13,226 and £34,417. “Entry level pharmacy technicians” (roughly equivalent to MTO1) will be in band 3, with “chief pharmacy technicians” (roughly equivalent to an MTO5) in band 7. “Pharmacy technicians”, “pharmacy technicians — higher level” and “pharmacy technician — specialist team leader” are in bands 4, 5 and 6 respectively. Unsocial hours payments and recruitment and retention premium payments remain under discussion, Mr Leech added. In addition, draft profiles for student pharmacy technicians and for technicians working in primary care have yet to be received (those for primary care technicians are expected shortly). Although the APTUK does not represent assistant technical officers, Mr Leech explained that the association had been asked to look at their profiles before their release, and had done so.

Also speaking at the conference was Tess Fenn, chief pharmacy technician for education at Guy’s and St Thomas’ Hospital, London, one of the 12 early implementer trusts. She explained that one of the roles of staff such as herself at early implementer sites is to give feedback to other trusts on the Agenda for Change process, from job evaluation through to assimilation. One of the recommendations she made was for staff to train as “job matchers” if they are given the opportunity. She also advised technicians to ensure that their job descriptions and person specifications are up to date and give a clear description of the job they do. They should not, however, be written or altered just to fit in with “Agenda for Change language”, she added.

Changes made to APTUK

Opening an office and appointing a paid professional membership co-ordinator was among the resolutions passed by APTUK members at their annual general meeting at the conference. It was also agreed that changes would be made to membership categories so that, by 2007 (when registration becomes compulsory), only registered technicians will be allowed as full members of the association.

The line-up of the associations’ officers has also altered — Victoria Harman, Peterborough Hospitals NHS Trust, retired as the association’s honorary treasurer. That position is now filled by Nicola Allsopp. A full list of the APTUK officers is set out in the panel below.