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Training and Implementation of Tech-Check-Tech in a Hospital Setting

Gayle Mayer
Director of Pharmacy
Spencer Hospital
Spencer, Iowa

Iowa Law now allows implementation of the Tech-check-Tech (TCT) site specific programs 90 days after program approval is received from the Board of Pharmacy. Although our preparations and planning had extended for several months, the actual staff training took our institution the full 90 days required. The lessons themselves were completed quickly, but just the logistics of having the minimum number of opportunities for each of the technicians to complete the hands on evaluations during a mass implementation took a while. As we continue to add new technicians to the program, this process will be much easier because the whole staff will not be training/needing specific repetitions at the same time.

Our didactic training started with four lessons and accompanying quizzes that were prepared by me. The lessons were prepared in a PowerPoint format which then were loaded into our hospital on line training system- HealthStream©. As a result, technicians were able to read the lessons and take quizzes at their own pace. These four lessons consisted of:

  • Math Review
  • Dosage Forms and Routes of Administration
  • Prevention, Identification, and Classification of Med Errors
  • Tech-check-Tech Program Rules Review

The state rules require minimum education on the prevention, identification, and classification of medication errors. My pharmacists and I just believed the additional three lessons were appropriate, so they were added to the program.

The technicians also had to read 3 articles from “Pharmacy Technicians Letter” and then take three short quizzes via HealthSteam© on the content of each. We selected:

  • “Look-Alike, Sound Alike Medications”
  • “Medical Errors”
  • “How to respond to Medical Errors”

I believe that I had covered most relevant areas – new content plus a review of material a certified technician would be expected to know. I believe the quizzes were appropriately challenging as the group of six technicians took an average 1.46 attempts per quiz to pass.

When each technician completed these education units they were allowed to begin the hands on evaluations. The first requirement was a series of evaluations on their “filling accuracy rates.” Because we are not a large hospital, each technician is required to achieve 100% on each of the fill batches to record a passing score. (5)

The “Filler Technician Competency Evaluation” consisted of:

  • Basic technician orientation completed (and met description of required experience)
  • Completing the 7 specialized and advanced lessons for TCT
  • Competency Evaluations @100% in 7 different areas, from 2 to 10 batches checked
  • Sign off and date that the tech may fill in the TcT program
  • Section for notes on suspension or revocation, and for retraining and reinstatement

A “Checker Technician Competency Evaluation” requires completion of the above, plus an equal number of batches of the same medications checked @ 100% accuracy.

Note: I found limited resources for a target rate of errors. The number I did find at that time, and again now, is 99.8% accuracy for checking. (1) (2) (4) At Spencer Hospital we have selected that number for our ongoing and overall filling accuracy target as well as our checking accuracy target rate.

I requested and received approval from the State for TCT program in the following areas:

  • AMDS (OmniCell®)
  • Patient Specific Bar Coded Unit Dose (pass thru units)
  • Anesthesia Stock
  • Crash Cart Stock
  • Ambulance Kits
  • Surgical Stock
  • Dialysis Stock
  • Clinic Stock

Our institution did evaluate technician filling rates in each of these areas, although the intent was to just “activate” the TCT for the AMDS area as the program was rolled out. I wanted to see how well the program actually worked before expanding its scope to the other areas. We have since added our Ambulance supplies under TCT. We activated bedside bar code medication administration facility wide in May 2012. We are jointly monitoring this with nursing – and as soon as we feel comfortable with the end users, override rates, etc. – we will expand our TCT to the units where we have “Pass thru Medications.”

To monitor our quality for TCT, we developed a “Technician QA Daily Monitoring Sheet.” While it sounds burdensome, in practice it takes only a few seconds to record who filled and who checked in what areas. This sheet also allows me to capture some dose counts on medications that do not process through our regular software.

Any error is recorded:

  • Wrong drug
  • Wrong dosage form
  • Wrong strength
  • Wrong count
  • Wrong label/paperwork
  • Wrong tag
  • Wrong patient
  • Wrong unit/OmniCell
  • Outdated

If any error occurs in filling or checking, a pharmacist must re-verify, and discuss the error with the technician/s. We document this discussion so we can prevent any future occurrence if possible.

To monitor how the program is working, I am using spreadsheets to record data on a bi-weekly basis. The published evidence demonstrates that pharmacy technicians can perform as accurately as pharmacists, perhaps more accurately, in the final verification of unit dose orders in institutional settings. (3) We have definitely seen an improvement in our filling rates since we began monitoring to gather information in anticipation of presenting our proposal to the Board of Pharmacy. Improvement has continued after implementation. (6) A summary of this data is attached.

The final article in this series will cover additional information on our monitoring, “lessons learned” and some overall comments on this TCT program and some duties we still want to expand/add with our technicians.

Hospital Web Site

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

(5) 99.8% would be 2 errors per 500 doses, some of our batches are not that large, hence the 100% requirement
(6) attachment of SH TcT stats