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Approval & Planning of Tech - Check - Tech

Gayle Mayer, RPh, BPharm
Director of Pharmacy
Spencer Hospital
Spencer, Iowa

The Iowa Board of Pharmacy gave final approval to Chapter 40 rules “Tech-check-Tech” of the Iowa Administrative Code on November 9, 2011. These rules (657.40.1)1 “allow the Board to authorize a hospital pharmacy or a pharmacy providing pharmaceutical services to a patient in a long term care facility to participate in a Tech-check-Tech program. The purpose of the Tech-check-Tech program is to authorize certified pharmacy technicians to review the work of other certified pharmacy technicians in connection with the filling of floor stock including automated medication distribution systems (AMDS) and unit dose dispensing systems for institutionalized patients whose orders have previously been reviewed and approved by a licensed pharmacist, for the purpose of redirecting and optimizing pharmacist patient care services. Implementation of a tech-check-tech program is not intended to reduce pharmacist staffing levels, but is intended to increase the availability of the pharmacist for involvement in cognitive and patient care activities.”

Spencer Hospital is a 99 bed acute care facility in NW Iowa, with

  • Two - twenty bed Medical/Surgical floors
  • A sixteen bed inpatient Mental Health unit
  • A six bed Intensive Care unit (soon to be expanded to eleven beds, with the construction of a new six bed unit with five additional step down beds)
  • Emergency Department
  • Two Dialysis units (one on site and one in Spirit Lake, Iowa)
  • Radiation Oncology and Medical Oncology units
  • Obstetrics
  • Surgery Center
  • Ambulance Service
  • Two family practice clinics located in Milford and Sioux Center, Iowa

We have both a central pharmacy and a pharmacy located in our Abben Cancer Center. Both pharmacies have complete797 suites. The Medical Oncology pharmacy (built in 2010) is staffed Monday to Friday, while our central pharmacy (built in 2008) is staffed twelve hours/day weekdays and ten hours/day weekends. Spencer Hospital has remote pharmacist coverage (and a pharmacist on call) to provide pharmaceutical services 24 hours a day.

As I followed the development of the rules following the legislative authorization, I realized that this was a program that would be ideal for Spencer Hospital to fulfill requirements in both the medication distribution process and in the opportunities to expand clinical pharmacy services.

  • We have a large enough staff (seven pharmacists and seven certified technicians) to provide flexibility and personnel to team with each other and effectively implement a Tech-check-Tech program.
  • The open layout of the central pharmacy is conducive to active communication with the technicians and oversight by pharmacists, even if not involved directly in a medication distribution process.
  • We also provide a wide scope of services, which gives us opportunity for clinical pharmacy involvement and expansion.

Early in 2011, my initial approach was to involve our pharmacists in discussion regarding their feelings towards developing a Tech-check-Tech program at Spencer Hospital. We discussed technician competencies (our technicians average 8 years experience) and if as a pharmacist staff we wished to be involved in further training, educating, and supporting our technicians. Input and ideas were shared on the potential for pharmacists to offer increased clinical services. (One pharmacist is on the floor each day to offer clinical services – this is rotated with all pharmacists.) I was encouraged by the attitude of the pharmacists and willingness to proceed with the potential Tech-check-Tech program for Spencer Hospital.

I next visited with my technicians, outlining both the direction national pharmacy groups (PTCB and ASHP) were taking for ideas of technician services, and with the drafts of the rules that Iowa was proposing. The entire group of technicians actively embraced the potential to further their careers, add to their responsibilities and be more actively involved in serving our patients as a member of the Spencer Hospital Pharmacy team. We included discussion of potential career ladders – including conversations about also taking on Medication Reconciliation and Allergy reviews with our patient admits.

Then it was time to talk to administration – our organizational structure has pharmacy reporting to a Vice President of Operations. After giving him an overview of both state and national direction for potential increased roles for pharmacy technicians, I outlined a potential plan for Spencer Hospital, indicating that both our pharmacists and technicians were on board with these ideas. The initial reaction was positive, and after further discussion we decided to move forward with a site specific proposal to the Board of Pharmacy. Administratively, this provided Spencer Hospital with the initiatives to maximize the use of our existing staff to increase pharmacy services to our patients, nurses, and medical staff with the most effective use of our payroll dollars.

Iowa Board of Pharmacy approval of site-specific Tech-check-Tech is required at least 90 days prior to implementing your program. I did begin gathering preliminary data and drafting plans in June of 2011, with a goal of being ready to present our proposal as soon as the Board would vote to approve the rules. We worked together as a department to envision how the process might work, discussed ideas for training and evaluations, considered ideas for clinical expansion, and addressed any concerns as a group.

My submitted proposal included the business plan, training plan, filler and checker competency evaluations, on going evaluations, current and proposed expanded pharmacist clinical services, examples of daily, weekly, monthly recaps and reports, including trends.

The Chapter 40 rules did receive final approval on November 9, 2011 - and I was on the agenda for November 10, 2011 having previously submitted a site specific business plan for implementation of a Tech-check-Tech at Spencer Hospital prior to the Board Meeting.

Spencer Hospital did receive approval to implement Tech-check-Tech – with implementation allowed 90 days after approval– or in February 2012. As first in the state, I did volunteer to submit quarterly reports on our implementation and progress, which the Board agreed would be beneficial.

In my next column, I will further outline the components of the training and implementation we used. That will be followed with results and areas we have modified as we learn during the active process.

Reference
https://www.legis.iowa.gov/IowaLaw/AdminCode/ruleDocs.aspx?pubDate=11-16- 2011&agency=657&chapter=40

Helpful Links
PTCB – Pharmacy Technician Certification Board
http://www.ptcb.org/AM/Template.cfm?Section=CREST_Summit&Template=/CM/HTMLDisplay.cfm&ContentID=4156

ASHP PPMI - American Society of Health-Systems Pharmacists Pharmacy Practice Model Initiative
http://www.ashp.org/ppmi

CREST
https://www.ptcb.org/AM/Template.cfm?Section=C_R_E_S_T_Initiative&Template=/CM/HTMLDisplay.cfm&ContentID=4734

Hospital Web Site
http://www.spencerhospital.org

Gayle Mayer Contact Info
Director of Pharmacy
SpencerHospital
1200 First Avenue East
Spencer, Iowa 51301
Phone 712-264-6391
Fax 712-264-6670
gmayer@spencerhospital.org

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