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Monitoring, QA, and Value from Tech Check Tech

Written by Gayle Mayer

A Tech Check Tech (TCT) program requires continuous monitoring and evaluation of each technician to ensure continued competency and safety of the patients. Errors and variances are identified and compiled in a bi-weekly report to comply with our house wide quality measures. If a variance is identified or an event arises a detailed analysis occurs and follow up education is provided. These events our documented on our “Technician QA Monitoring” sheet and all events receive “real time” review.

Specific evaluation of the TCT program incorporates three measures which are documented daily:

Filling: Errors that occur during the filling process can be identified by either a Checking Technician or pharmacist but the staff pharmacist is ultimately responsible for technician oversight. The pharmacist reviews the error with the certified pharmacy technician(s) and procedures are reviewed to minimize the risk of repeating the error.
Checking: Pharmacists periodically review by the work checked by the technician(s). This includes identification and documentation of all errors not corrected by the checking technician. If an error is identified, the pharmacist reviews the error with the certified pharmacy technician(s) and procedures are reviewed to minimize the risk of repeating the error.
Review of errors: Errors can also be identified by health care professionals, a patient or other individuals following product release by the checking technician or pharmacist. The staff pharmacist on duty at the time of the error, evaluates and reviews the incident with the pharmacy technicians involved in the process and procedures are reviewed to minimize the risk of repeating the error.

Benchmarks for the program are identified by compilation and evaluation of the Technician QA Monitoring program. Bi-weekly reports are evaluated and additionally, cumulative misfills plus total error recaps/trending are monitored. Errors rates are standardized by computing number of misfills per hours worked. This information is used to evaluate ongoing competencies, identify possible system modifications, provide data for continuing site specific education, and to establish need for any retraining of the technician. Because of the ease of recording on the daily sheets, it was decided to make both filling monitoring and checking monitoring an ongoing daily process. Therefore, pharmacists capture all steps of the process for all technicians who participate in the program.

Retraining will occur if a technician has an error rate which does not meet our established baseline rate of 99.800%. Error rate “outliers” will be determined by an excessive error rate in filling or checking over two consecutive bi-weekly periods or if the technician’s cumulative error rate significantly exceeds the average cumulative error rate of technicians as a whole. During the retraining period (not less than two bi-weekly periods) a technician’s work will be checked by a pharmacist and the technician will not be allowed to check other technicians work. Retraining will consist of a repeat competency evaluation in the area or areas in which excessive errors have occurred and the potential repeat of didactic modules as deemed appropriate. The Pharmacist in Charge, with the input of staff pharmacists, will determine which sections of the competency evaluations and training modules must be repeated. Upon completion of the re-training the technician will again submit the written competency evaluation form.

How do some of the Spencer Hospital actual numbers look?
Our 14-week rolling filling rate has moved from 99.953% (August 20111) to 99.965% (March 2012) to 99.979% (December 2012). Our target rate is 99.8; we are surpassing that goal and have seen a continual increase in that rate.

Our 14-week rolling checking rate is 99.999%. In our 12 months of evaluating and live TCT – there has been only 5 items missed by this tech check process. Four of these items never left pharmacy control as the error was identified and corrected at the automated dispensing cabinet fill during the restock. The fifth item was a bar code issue that has since been resolved.

The implementation of a Tech Check Tech (TCT) program should result in the redirection of pharmacists time from distributive tasks to cognitive and patient care activities. Spencer Hospital Pharmacy documents these clinical activities in our “Pharmacy Clinical Tracking”(which includes tracking of our pharmaceutical care workload, therapeutic indicators, and information and education review.)Our pharmacy “clinical workload” numbers have shown a steady increase, Year to date fiscal 2013 is showing a 13.6% increase in pharmacy clinical interventions per patient day in comparison to fiscal year 2012.

In addition to increased daily pharmacy clinical interventions, some services the pharmacy has been able to expand or add include:

  • Weekly mental health teaching in our inpatient Mental Health Unit
  • Weekly cardio-pulmonary teaching for our outpatient Rehab department
  • Increased involvement in inpatient diabetic monitoring and instituting a new inpatient program
  • Participation in outpatient diabetic classes and health fairs
  • Initiated an Antibiotic Stewardship program
  • Reworking our Intravenous Nutrition program
  • Implementing pharmacy supported medication reconciliation – utilizing our advanced technicians with a didactic and hands-on training program

Items Of Note

Recognition: Not only can pharmacy clinically reach more patients, we have also more opportunity to work with other departments on interdisciplinary activities. This has increased recognition for pharmacy services throughout the hospital – from administration to medical staff to nursing to ancillary departments.

Technician work flow: Technicians state they are satisfied on improvement in their workflow. What we had not considered was how much time they had spent waiting for a pharmacist to check their work. Now the technicians team up with each other to efficiently check each other’s work. There has been less pharmacist interruptions and job satisfaction for both the pharmacists and the techs.

Medication Reconciliation: We have observed increased accuracy on nurse entered medication reconciliation - just with rolling out a pharmacy “supported” service in the implementation stages. We continue to focus on a final model using our certified technicians– it’s a moving target.

Advanced Technician Job Description and Career Ladder: With the success of TCT, our technicians are currently involved in implementing pharmacy supported medication reconciliation. Consequently we have moved even one step further, creating a new job description for “Advanced Certified Pharmacy Technician” which includes both TCT and medication reconciliation. This does include a new, higher pay scale for those technicians.

1. Program data collection began in August 2011, Board approval received in November 2011, implementation In March 2012

Hospital Web Site

Gayle Mayer Contact Info
Director of Pharmacy
Spencer Hospital
1200 First Avenue East
Spencer, Iowa 51301
Phone 712-264-6391
Fax 712-264-6670