MSHP Director’s Forum 2018 - cdn.ymaws.coms_forum_2018.pdf · MSHP Director’s Forum 2018 #MASHP18 9 Pharmacy Technicians With Credentials ASHP national survey of pharmacy practice

MSHP Director’s Forum 2018 #MASHP18

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MSHP Director’s Forum 2018Welcome and Introductions

Ross Thompson, MS, RPh, FASHP, FMSHP, Vice President and Chief Pharmacy Officer, Tufts Medical Center

Christopher Fortier, PharmD, FASHP, Chief Pharmacy Officer, Massachusetts General Hospital

Supporting the Pharmacy Technician Workforce:

Education, Training and Development

Paul W. Bush, PharmD, MBA, BCPS, FASHP

President

American Society of Health System Pharmacists

Chief Pharmacy Officer

Duke University Hospital


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Learning ObjectivesAt the completion of this activity, the pharmacist and pharmacy technician will be able to:

• Describe the current and emerging roles of pharmacy technicians

• Identify workforce requirements and current status• Understand new requirements for accredited technician

education• Discuss solutions to the workforce shortage• Describe a health system approach to pharmacy

technician development


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What Benefits will Pharmacy Technician Members Receive?

• Free subscription access to PharmacyTechCE.org, which offers 40hrs of T-designated CE to meet requirements of PTCB certification, including law and medication safety

• A dedicated website landing page and resource centers, visit www.ashp.org/technicians

• Member-only access to technician-specific web resources and webinars

• Digital access to the world’s premier pharmacy journal, AJHP

• Membership to any or all ASHP Sections

• Specialized email Newslinks

• A dedicated technician network on ASHP Connect

• Exclusive member discounts on ASHP meeting registrations, publications and other products

• An established social media identity

• Other benefits and services as recommended by pharmacy technicians

Advancing the Role of Pharmacy Technicians


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Emerging Pharmacy Technician Roles and Responsibilities

• Prescription clarification

• Quality assurance and quality improvement initiatives

• ACA Marketplace Certified Application Counselors

• CMS-CMMI Grant Projects (Innovations Center)

• Community outreach programs

• DUE/ADR monitoring

• Informatics

• Medication safety initiatives

• Telepharmacy

• Medication reconciliation• Medication therapy

management• Immunization• Indigent care prescription

programs• Sterile & non-sterile

compounding• Clinical technicians (e.g.,

chronic care, appt. scheduling, medication adherence, smoking cessation, vital signs measurements, data management, etc.)

• Prior authorization• Tech-check-tech

Activities of Pharmacy Technicians

6%

6%

8%

11%

11%

18%

18%

28%

38%

61%

62%

76%

81%

85%

91%

95%

94%

98%

0% 20% 40% 60% 80% 100%

Dispensing with remote video supervision

Screening of medical records for MRPs

Facilitating Transitions of Care

Medication assistance program mgmt

Order entry (for pharmacist verification)

Medication reconciliation (obtaining list)

Tech-check-tech

Technician supervising other technicians

IT system management

Controlled substance system mgmt

Compounding chemotherapy preps

Quality Assurance act/unit inspections

Billing

Compounding sterile preps

Packaging activities

Purchasing

Replenishing unit dose carts

Restocking floor stock and/or ADCs

% Hospitals with technicians performing activity 2014

Trad

itio

nal

fun

ctio

ns

No

n-t

rad

itio

nal

fun

ctio

ns

Source: 2014 ASHP National Survey of Hospitals


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6%

8%

11%

18%

18%

6%

5%

11%

28%

38%

2%

5%

8%

12%

15%

10%

9%

25%

29%

42%

0% 20% 40% 60% 80% 100%

Dispensing with remote video supervision

Facilitating Transitions of Care

Medication assistance program mgmt

Medication reconciliation (obtaining list)

Tech-check-tech

Screening of medical records for MRPs

Preparation of clinical monitoring information

Order entry (for pharmacist verification)

Technician supervising other technicians

IT system management

% Hospitals with technicians performing activity

KEY:2011:

2014:

Are

as o

f d

ecl

ine

Are

as o

f gr

ow

th

Expansion of Non-traditional Activities

ASHP national survey of pharmacy practice in hospital settings - 2014


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Polling Question

What are the issues and opportunities for pharmacy technicians and the workforce in Massachusetts?

EDUCATION AND TRAINING


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Pharmacy Technician

Training, Competency, Practice (CCP preferred state)

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Accre

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Work as a

Pharmacy Technician Exit

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Council on Credentialing in PharmacyPharmacy Technician Credentialing Framework Aug 09

http://www.pharmacycredentialing.org/Files/CCP%20technician%20framework_08-09.pdf

Pharmacy TechnicianAccreditation Commission (PTAC)

• Formed through ASHP/ACPE collaboration

• ACPE Board approved ASHP standards, guidelines, and procedures for PTAC

• PTAC recommendations require approval of both ASHP and ACPE Boards

• First PTAC recommendations to ASHP and ACPE boards for accreditation actions occurred June 2015


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Ultimate Goal of ASHP-ACPE Collaboration

• A better qualified and trained workforce

• Improved patient safety

• Greater consistency in technician workforce

• Accreditation standards updated as needed to stay consistent with expanding roles and responsibilities of technicians

• Greater ability to delegate technical tasks from pharmacists

• Less turnover in pharmacy technician positions

ASHP/ACPE-Accredited Pharmacy Technician Training Programs

-50

0

50

100

150

200

250

300 274Note – estimated 200 – 1000 non-accredited programs exist


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Pharmacy Technicians With Credentials

ASHP national survey of pharmacy practice in hospital settings - 2015

PTCBCertification

Completed a ASHP/ACPE-accredited Technician

Training Program

Staffed beds % %<50 73.7 19.350-99 75.8 19.3100-199 82.8 19.2200-299 74.5 27.0300-399 72.6 12.5400-599 84.3 18.3600 74.3 9.0

All hospitals – 2015 77.5 17.5All hospitals – 2014 71.2 14.9All hospitals – 2013 70.9 14.2All hospitals – 2012 67.5 13.6All hospitals – 2011 65.8 11.1

By The Numbers

Employment increase is 9% faster than average for all occupations

• 74% (275,000) of technicians are PTCB certified

• Increased demand for prescription medications will lead to more demand for pharmacy services

U.S. Bureau of Labor Statistics, May 2016 http://www.bls.gov/oes/current/oes292052.htm

2016, Median Pay $14.86 hr / $30,920 yr

2016, Number of Jobs 398,390

Job Outlook, 2016-2026 9% growth

Employment Change, 2016-26 35,855


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• Approximately 100 attendees – state boards of pharmacy,

– employers,

– educators,

– accreditors,

– national, state and international pharmacy associations,

– Pharmacists,

– technicians and the

– public


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ObjectivesThe objectives conference was to develop consensus in the following areas:

• The necessity of public confidence in pharmacy’s process for ensuring the competency of pharmacy technicians.

• The entry-level (“generalist”) knowledge, skills, and abilities that all pharmacy technicians must have regardless of practice site.

• The definition of entry-level (“generalist”) pharmacy technician practice with respect to (a) legally recognized scope of practice; (b) educational requirements; (c) training requirements; (d) certification requirements; and (e) state board of pharmacy registration or licensure.

• The desirability and feasibility of developing a process for recognizing competencies of pharmacy technicians beyond entry-level.

• The desirability and feasibility of minimizing variability among the states in the definition and regulation of pharmacy technicians.

Recommendations • Technician education and training programs should be based on

national standards, be foundational across all practice settings and provide room for innovation and flexibility. (96)

• Employee seeking the entry-level pharmacy technician designation are required to complete a nationally accredited education and training program. (84)

• The employee will be considered a technician-in-training during the period of completion of education, training and certification, all of which must be completed in less than 2 years. (88)

• The profession should move urgently towards the development and adoption of national standards for pharmacy technician education and training. (95)

• The pharmacy profession should clearly articulate and communicate the vision for advanced pharmacy technician practice and disseminate the vision to appropriate stakeholders. (97)


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A SOLUTION FOR THE PHARMACY TECHNICIAN SHORTAGE

Distance Education

• Bringing the availability and affordability of accredited pharmacy technician education and training anywhere

• Simulation and distance education

• Accredited - Therapeutic Research Center

Game Changer

http://www.bing.com/images/search?q=Distance+Education+Courses&view=detailv2&&id=1FF820CED766C25E0405E36AD24DB4974CCEEBE7&selectedIndex=10&ccid=quXVufdR&simid=608000278656385141&thid=OIP.Maae5d5b9f751fad95f8745abc985a067o0


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Pharmacy Technician Shortage?

• Technician workforce demand commonly exceeds supply

• Shortage must be addressed so we can achieve our aspirations to improve care of patients

• Possible solutions

– Health system - technical school/community college partnerships

– Health system (employer-based) program

Health System Technician Training

• Curriculum– Didactic by distance education

– Simulation

– Experiential

• Length - approximately 3 months

• Class size – 10 to 15

• Resources – Course leader

– Experiential preceptors

– Classroom


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PHARMACY TECHNICIAN PROFESSIONAL DEVELOPMENT


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All Rights Reserved, Duke Medicine 2007

Pharmacy Technician Professional Development Committee

Technician Thursday ConferenceJune 23, 2016 2:00 to 2:30 Room Location: TBA

“THE STATE OF THE UNION – Pharmacy Technicians Then and Now…

What’s Next”

Jacquelyn Curtis, CPhTPharmacy Technician Supervisor

Duke Regional Hospital

DUHS Pharmacy Technician

Engagement and Satisfaction

Assessment


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Post-test Questions

What percentage of technicians working in all hospitals surveyed

in 2015 completed an ASHP/ACPE accredited Technician Training

Program.a. < 20%

b. 20-30%

c. 30-40%

d. >40%

Answer = a

Post-test Questions

What are actionable solutions to the pharmacy technician

shortage?a. Commit to educating, training and developing the technician

workforce.

b. Support and participate in community college/technical school

technician training programs.

c. Implement an accredited health system-based program.

d. a, b and c

Answer = d


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Advancing the Role of Pharmacy Technicians:

Education, Training and Development

MSHP Annual Meeting 2018Development of an ASHP-ACPE Accredited Technician

Training Program

mmPharmDJanet M Kozakiewicz MS, PharmD, FASHPDirector of Pharmacy ServicesYale New Haven Hospital New Haven, CT


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Learning Objectives

1. Discuss the elements of a successful return on investment proforma for a pharmacy technician training program

2. Identify novel strategies for tuition reimbursement

3. Understand how to utilize a pharmacy technician training program to accelerate the PAI imitative at your organization

4. Describe various leadership roles for pharmacy technicians within health systems

Yale New Haven Health At a Glance

Yale New Haven Health System• Yale New Haven Hospital (YNHH)

• Bridgeport Hospital

• Greenwich Hospital

• Lawrence + Memorial Hospital

• Westerly Hospital

• 2,563 Licensed Beds

• Yale New Haven Hospital• 1500 Bed Academic Medical Center

• Primary teaching hospital of Yale School of Medicine

• 5,000 medical staff members

• System physician foundation: Northeast Medical Group (NEMG)

• 835 providers


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AWOT Analysis

US Pharmacy Technician Employment and Wages

(2) Annual wages have been calculated by multiplying the hourly mean wage by a "year-round, full-time" hours figure of 2,080 hours; for those occupations where there is not an hourly wage published, the annual wage has been directly calculated from the reported survey data.(3) The relative standard error (RSE) is a measure of the reliability of a survey statistic. The smaller the relative standard error, the more precise the estimate.

Source: US Department of Labor Statistics, Occupational Employment and Wages, May 2015, Pharmacy Technicians


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2015

2016



• Source: US Department of Labor Statistics, Occupational Employment and Wages, May 2015, Pharmacy Technicians

(9) The location quotient is the ratio of the area concentration of occupational employment to the national average concentration. A location quotient greater than one indicates the occupation has a higher share of employment than average, and a location quotient less than one indicates the occupation is less prevalent in the area than average.


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Peer ASHP Accredited Programs Within Academic Medical Centers

YNHH Cleveland Clinic Indiana Univ. Health UW Health

Program Established 2017 2010 1999 2012

Program Duration 20 weeks 15 weeks 9 months, F/T days 18 weeks

Tuition $3,350 $1,500 $1,335 for IU employees$2,479 for non-employees

$0 employees / paid for training$3,400 for non-employees

Additional fees Books, Parking, Uniforms

Registration fee Application, Books, Scrubs,Training license, PTCB Exam

Yes

Graduation Rate 87.5% 75% none

Financial impact Cost avoidanceTuition

Cost avoidance Use as an on-boarding and retention tool

Key findings from other programs

Recruiting students isbiggest challenge; went to on-line evening program to attract & accommodate current employeesnew state laws require certification;

Upon completion of the program eligible students receive up to 28 hours of credit towards an Associates of Science degree in Pharmacy Technology from Vincennes University


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Creating a Business Case

Creating a Business Case• ASHP’s Practice Advancement Initiative (PAI) acknowledges the

importance of pharmacy technician and the strong need to develop uniform standards for training and education

• ASHP advocates that all pharmacy technicians complete an ASHP Accredited Technician Training Program as a requirement for attaining certification

• The expanding role of the pharmacy technician has created a demand for highly qualified technicians

• Create a safe transition plan for technicians to move from operations to other growth opportunities

• US Department of Labor Statistics for CT show more jobs than qualified applicants


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Writing a Business Plan

1. Create a factual overview of the situation

oWe have a problem with hiring qualified pharmacy techniciansoRegional and state labor statistics

oVacancy rate

o Time to hire

oThe educational and onboarding time for current recruits is 3-6 months oActual hours spent recruiting

oActual time covering for open shifts


1. Describe the complication – the problem that unsettles the situation

oAs a result we spend a lot of time on training our new hiresoQuantify the cost of training a new employee

o 3-6 months at $xx.xx/hr

oQuantify the cost of covering a vacant positiono 3-6 months of overtime at $xx.xx/hour to cover vacated shift

o 3-6 months of a person training at $xx.xx/hour

oQuantity the cost/amount of time your recruiting department spends on pharmacy technician sourcing and recruiting


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3. What's the question that you are trying to answer?

o What's wrong with our current hiring process?oWe are recruiting candidates from retail pharmacy which is not adequately

meeting our needs

oRetail pharmacy candidates require 3-6 months to train as an hospital based pharmacy technician


4. Provide a viable answer to your question and a viable solution to the complication.

oThe best way to hire qualified pharmacy technicians is to start our own technician training program.oWe will be able to hire from this candidate pool that has trained in all areas of our

organization

oWe will be able to cut down on orientation and training time and save on labor expense in the pharmacy.

oWe can reallocate valuable HR sourcing and recruiting time to other areas


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Income / Profit and Loss Statement

o Measures revenue and expenses during a specified period of time.

o Looks at all sources of revenue and subtracts all expenses related to the revenue.

oEnables finance to evaluate your ability to manage and use your resources.

Income/ Profit and Loss Statement


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Income/ Profit and Loss Statement

Overcoming Barriers

oState Law regarding technician students handling medicationsoApplied for a State of Connecticut waiver

o Students are required to apply for a Pharmacy Technician Registration

oCreate a process for 1:1 direct in-process supervision by a Technician Preceptor

o Technicians who are precepting cannot be performing duties require simultaneously perform job functions

oAll work require a final pharmacist check

o The total number of students paired with a pharmacist must not exceed existing pharmacist to technician ratios

o Students are NOT allowed to participate in the preparation of sterile and non sterile compounded medications

oCompeting programs at local community colleges and technical schools


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Results –Year One

Assessment Question

The elements of a successful business plan for a pharmacy technician training program include the following:

a. SWOT Analysis

b. Understanding Department of Labor (DOL) statistics for your geographic area

c. Developing an income/Profit and Loss Statement

d. All of the above


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Assessment Question

The elements of a successful business plan for a pharmacy technician training program include the following:

a. SWOT Analysis

b. Understanding Department of Labor (DOL) statistics for your geographic area

c. Developing an income/Profit and Loss Statement

d. All of the above

Program Sustainability

Planning for sustainability needs to begin on day 1

oDevelop a quality improvement plan o Student and preceptor surveys

o Student attrition rates

oBuilding and strengthening organizational capacityoPlan for growth

oMarketing/Exploring partnerships oHospital

oCommunity

oIdentifying new funding streams and diversifying sources of funding

oFocused student recruitment and tuition funding


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Strategies for Student Recruitment / Funding

Providing viable reimbursement options• Tuition Reimbursement

• Eligible employees who enroll in the program

• Workforce Alliance/US Department of Labor • Must meet certain income guidelines • Reimburses up to $4,000/student

• Retention Bonus for those hired from the program • Must meet all qualifications for graduation from the program• Paid out in three installments equal to the tuition• Must commit to two years of employment in central operations

• Tuition Forgiveness (TF)• TF was developed to provide direct tuition payments to accredited educational programs (up to

$4,200 on behalf of full time employees and $3,000 on behalf of part time employees).

• Continuous Readiness-Exploring other student funding options

Strategies for Student Recruitment / Funding

Sourcing of Candidates

Existing Hospital Employees

Area High Schools

• Graduates

• Off campus classroom

External Placement Services

• State of CT Department of Labor

• Work reentry program/Adult Ed

Other

Funding Sources

Employee Tuition Reimbursement

State of CT Department of Labor

• Up to 4,000/eligible candidate

• Includes books/supplies

State of CT Department of Labor

• Up to 4,000/eligible candidate

• Includes books/supplies

Retention Bonus

• Equivalent to the total cost of tuition with a 2 year sign on bonus in Central Operations


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Internal Marketing Strategies

Screen Savers

Hospital Sourcing Specialists

oMarket program to unqualified job applicants o YNHH requires Pharmacy Technician

experience

o Sourcing results from other searches

oNursing PSA

oRadiology

o Laboratory

oMonthly Hospital Bulletin advertisement

External Marketing Strategies

Area Public High SchoolsoWork with guidance counselors

oOff campus classroom

oAdult education

oCareer events

oPizza - Open House

Career Job FairsoAttend all career fairs

oGet names, addresses and telephone numbers

o Invite prospective students on site for a presentation and refreshments

o Interactive video tour


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External Marketing Strategies

Social Mediao Facebook

o Linkedin

oCreate a student blog

o Interactive video tour

Student Alumni AmbassadorsoUse graduates to reach out to

recruits in area high schools

oPosting fliers and ads

oHost recruiting sessions of their own

oProvide Pizza and career adviceo Dressing for success

o Resume evaluations

Assessment Question

Strategies for program sustainability include the following:

a. Tuition reimbursement and forgiveness programs

b. Internal and external marketing

c. Hope and a prayer

d. A and B

e. All of the above


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Assessment Question

Strategies for program sustainability include the following:

a. Tuition reimbursement and forgiveness programs

b. Internal and external marketing

c. Hope and a prayer

d. A and B

e. All of the above

Long-term Value


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Long-term Value

oDecrease training hours

oDecrease time to hire

oGraduation RatesoPTCB Pass Rates

oEmployment Opportunities

Long-term Value – Training Time

0 50 100 150 200 250

Training Program Hires

External Hires

Training By Hours

IV Room Adult Decentralized Carousel

60%

30%

30%


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Long-Term Value – Time to Hire

0

20

40

2015 2016 2017

Number of Requisitions

Number of Requisitions

Linear (Number of Requisitions)

25

75

125

2015 2016 2017

Time to Start

Time to Start

Linear (Time to Start)

Average number of days to start = 91

Average number of requisitions/year = 33

Long-term Value – Time to Hire

0

20

40

60

80

100

External Candidates Technician Training Program Candidates

Days to Start

85% Reduction


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Long-term Value – Student Achievement

Class Matriculated Students/Total Enrolled

PTCB Pass Rate Graduation Rate

September 2016 3/3 100% (3/3) 100%

January 2017

8/10 75% (6/8) 75%

September 2017 4/5 75% (3/4) 75%

November 2017 5/5 100% (5/5) 100%

February2018

6/6 Pending Pending

Total 29 87.5%National Pass Rate 58%

Rolling Admissions

Advancing the Role of the Pharmacy Technician

Pharmacy Technician

• Nursing• Radiology• Respiratory• Business• Culinary Arts

Current State


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• Ambulatory Care• Prior Authorizations

• Automation Technology• Quality Improvement

• Medication Reconciliation• Best Practice Medication Histories• Patient Centered Medical Home

• Education and Training• Lead Technician Training Program• Lead staff ongoing education and training

• Specialty Pharmacy• Pharmacy Liaison

• Purchasing• Buyers• 340B Specialists


Pharmacy School

Pharmacy Technician

Future State


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Assessment Question

Advanced roles for pharmacy technicians include some of the following:

a. Medication Reconciliation

b. Education and Training

c. Specialty Pharmacy

d. Purchasing

e. All of the above

Assessment Question

Advanced roles for pharmacy technicians include some of the following:

a. Medication Reconciliation

b. Education and Training

c. Specialty Pharmacy

d. Purchasing

e. All of the above


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Key Takeaways

oThere is a need for highly trained pharmacy technicians oNew areas of expanded responsibility include Medication Histories, Chemo-

therapy/Immune-therapy Preparation, Specialty Pharmacy Liaison, 340B specialist

oDeveloping a business plan for an ASHP Accredited Pharmacy Technician Training Program is a viable solution to meet your technician needs oA return on investment may exist in your organization based on tracking of training

time and overtime to cover vacant shifts

oDeveloping a sustainability plan is key to a successful program o This includes internal and external marketing, tuition funding options, and hospital

tuition reimbursement

oRetaining qualified technicians requires distinct opportunities for advancement

Questions


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Career Ladders andInnovative Roles for

Technician Specialization

Moderated Discussion

Statement of disclosure

• None of the speakers in this session have conflicts of interest to disclose


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Innovative Roles for Technician Specialization - Medication

Reconciliation

Keith Preston, MS, RPh

Administrative Director of Pharmacy

Berkshire Health Systems

Rational / Motivation

• Internal data demonstrated ongoing poor medication reconciliation completion for admissions through the ED.

• In addition, data indicated significant error rate for those that were completed.

• Nurses are struggling in the present workflow scenario. • Is a dedicated resource required to perform this

function adequately?• Financial impact of dedicating pharmacists in the role

was not feasible. • Would trained med rec technicians be the proper

resource?


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Process for Developing

• Six Sigma Performance Improvement Plan• Pharmacists

• Pharmacy Technicians

• Nursing

• Physicians

• Performance Improvement

• Goal was to improve/optimize performance compared to present state.

Launching the Program

• Technician pilot designed including education plan.

• Pilot data demonstrated significantly improved completion rate and reduction in errors.

• Used staffing to demand model to optimize/determine staffing hours.

• Two shifts seven days per week. (2.8 FTE including relief)• 0930 – 1800

• 1730 – 0200

• Staff recruited; Education plan refined.


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Challenges with Implementing

• Need for technicians to navigate two EHRs.

• Training for staff relief coverage.

Benefits this Yielded

• Medication Reconciliation completion rate reached highest levels since inception.

• Error rate reduced. • Patient history more complete for all members of the

health care team with noted improvement in patient care and time savings on subsequent visits and admissions.

• For the first time all member's of the health care team realized the well known benefits of a robust Medication Reconciliation program.

• Scope expanded when clinic and population health leadership requested a med rec technician to serve as an educator and mentor in their setting.


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Innovative Roles for Technician Specialization -

Narcotic Diversion Audit Technician

Joy Vreeland

Director, Inpatient Pharmacy

Boston Medical Center

Objectives

• Describe the role of a Narcotic Audit Technician

• Understand the rationale for development of this role

• Review the challenges encountered with implementation

• Discuss future expansion plans for the Narcotic Audit Technician role


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Program Description

• Narcotic diversion monitoring audits are performed by 2 pharmacy technicians.• 16hr Pharmacy Student Intern• 40hr Certified Pharmacy Technician

• Boston EMS and Boston Med Flight audits reconcile narcotics dispensed against trip sheets and controlled substance waste records

• Each anesthesia provider is audited for 100% of their transactions for a 24hr period at least once, and usually 2-3 times per year

• Nursing High Users audits are performed based on RxAuditorreports. All nurses who are more than 3 Std Dev above the mean are audited

• Open ADM discrepancies, undocumented waste reports, and unreconciled dispense reports are reviewed/investigated daily


• Prior to the inception of this position, an internal audit of narcotic diversion monitoring evaluated hospital practice vs policy and ASHP guidelines • Nurse Managers were responsible for performing high user audits on

their floors and reporting audit results to the Director of Pharmacy. Compliance rates were between 50%-75% in any given month.

• Pharmacy’s process for EMS narcotic reconciliation was inconsistent, and Med Flight reconciliation was outsourced

• Daily open discrepancies were referred to nurse managers to resolve without support for the investigation and follow up was often delayed

• Pharmacy, Nursing, HR, and Risk reviewed the internal audit findings and acknowledged that procedural gaps and inconsistencies could lead to risk for diversion events.

• There was consensus that dedicated resources would be required to improve the diversion prevention program and close these gaps.


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Development and Implementation

• Creating the position• Consideration was given to the skill level needed: RN, RPh, or a CPhT• Ultimately, given that clinical decision making was not required, a technician was the

most economical skill set to perform the work• A job description was developed based on the desired components of the Diversion

Monitoring Program• Funding was sourced by combining a part-time nursing and part-time pharmacy

vacancy

• Recruiting the right person• Good understanding of the narcotic policies and ADS procedures• Strong interpersonal skills to collaborate with Nursing leaders• Attention to detail, ability to analyze data and detect abnormal patterns in utilization• Inquisitive mind-set

• Training• Introduction to eMAR, EPIC reporting, Pyxis reporting• Developed a template for recording audit findings, and a monthly summary template• Frequent meetings with nurse managers and pharmacy managers to dissect incidents• Diversion articles (Hospital Pharmacy series, ASHP Diversion Prevention Guidelines)

Challenges with Implementation

• Learning curves:• performing chart audits in EMR • understanding the data in the RxAuditor reports • using Excel efficiently

• Change in perception that Diversion monitoring is now a Pharmacy job • Refined monthly summary reports to maintain nurse managers focus on

pertinent audit trends on their floors• Developed a nurse champion partnership to review monthly summary issues

• Expectation that audits would find lots of diversion right away • Large number of audits each month is time consuming

• Expansion to RxAuditor 360 software should significantly streamline audits

• Reporting tools are limited in what they can show and they provide a monthly snapshot. Data over time is needed to detect trends

• Nurse managers needed more training to look for behavioral red flags associated with diversion that cannot be seen in a paper audit


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Benefits

• Improved compliance with controlled substance policies

• Frees up manager time

• Decreased labor costs (eliminated consultant hours)

• Improved quality, consistency & objectivity of audits• Increased reporting of drug incidents • Nurse managers willingly participate in investigations “for cause” • Reliable documentation when investigation results in HR action

• Flexibility for nurse managers to solicit audits as needed for suspicious activity related to narcotics

• Confirmation of audit findings is a two way collaboration

Future direction

• As the program enters it’s second year, further development of the nurse champion partnership will continue

• Present an annual report to the Medication Quality and Safety Committee depicting trends

• Targeted educational programs based on observations and incidents reports• Nursing education around witnessing waste • Anesthesia provider education around temporary patients

• Improvement in utilization of all available RxAuditor reports to look for less obvious signals (besides high users)

• Cross-train additional staff to cover in the event of a leave of absence or vacancy

• MedFlight auditing procedures are undergoing revisions since ADS machines were installed on the bases that connect electronically to our main vault


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Implementing a Technician Career

Ladder

David Mangan

Director, Clinical Pharmacy Programs

St. Elizabeth’s Medical Center

Rationale / Motivation

• Job Descriptions did not meet practice standards or CMR

• Recruitment/Retention/Engagement

• No current path to hire Pharmacy Interns or Tech Trainees

• 2 rounds of acquisitions in the past year that quadrupled the network

• Aspiration for Pharmacy Technicians to own the supply chain


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• Supported by Leadership from Steward HR and Unions

• Pharmacy led, HR was consultative

• Engaged employee unions in commissioned workgroups

• Compared existing titles, 64 different JD’s and streamlined them to 5.

Pharmacy Technician Career Ladder (proposed)Responsibility PT-trainee PT-I PT-II PT-III Tech Lead

Required licensure Pharmacy Tech Trainee or Technician Registration

Pharmacy Technician Registration and Nationally Accredited Certification OR Pharmacy Intern Registration

Pay grade Grade -1 grade Grade +1 Grade +2 Grade + 3

Fills medication orders X X X X X

Operates Pyxis X X X X X

Delivers medications to floors X X X X X

Answers phones X X X X X

Participates in training of new employees X X X X

Handles federal controlled substances X X X X

Performs sterile compounding X X X X

Performs non-sterile compounding X X X X

Intermediate skill sets; hazardous compounding, basic purchasing, decentralized services, med rec, ADC(inventory optimization, adding users), 1 minor KPI

X X X

Assists in revising training materials X X X

Advanced skill sets; ( Advanced Purchasing, ADC building or advanced troubleshooting, high risk compounding, 2 major KPI)

X X

Establishes/Maintains training materials X X

Charge role for a scheduled area X X

Performs validation of training X

Performs complex individual tasks; scheduling, narcotic surveillance, etc.

X

Performs managerial tasks as needed; hiring, evaluating, corrective action Not applicable, managerial position

Maximum time an individual can stay at this step 6m N/A N/A N/A N/A


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Features of Career Ladder

• 5 step Pharmacy Technician ladder; Trainee, I, II, III, Lead

• Permanent employment requires:• Pharmacy Technician Certification• Ability to perform sterile compounding

• Registered Pharmacy Techs and Pharm Tech Trainees must become certified within 6 months.

• Defined responsibility for training for all levels• Intermediate skill proficiency required for Level II advancement

• Advanced skill proficiency required for Level III advancement

• Lead Pharmacy Techs can fulfill any responsibility, schedule, build ADM’s, etc.

• Requirement for major/minor Key Performance Indicators or Key Process Improvements

Process for Maintaining

• During investigation, all employees were forecasted into redefined career ladder

• Skills based checklists makes the path for advancement clear

• Checklists then applied back to existing staff


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Challenges with Implementing

• Design must be scalable for 39 hospitals in 9 states ranging from 8 beds to over 700. ~435 Technician FTE’s total

• State requirements; Ohio does not have certification

• Advancement based on proficiency vs seniority upon implementation?

• Standardizing performance expectations across sites

• Implementation off budget cycle

• Pleasant surprise: Labor unions were responsive and a true partner

What Benefits did this Yield

• 40% of our staff were eligible for promotion

• Increased engagement

• Improve quality of service

• Technicians on a trajectory to lead cleanroom operations

• Recruitment and Retention TBD


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Development, Progression & Successes of a Pharmacy Technician Career Ladder

Jean Beach, CPhT

Pharmacy Supervisor

Julie Lanza, CPhT

Beth Israel Deaconess Medical Center


• Reduce current turnover rate for pharmacy technicians

• Create new opportunities for existing employees

• Create a model to attract new employees

• Implementing a Career Ladder meant having a system that can grow to benefit individuals, department and medical center.


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Supported by Human Resources, Compensation & Workforce Development:

• Conducted a market analysis to use as a tool for comparison of our current pharmacy technician salary to other Medical centers in area

• Compiled a comprehensive list of responsibilities performed by pharmacy technicians in the current model.

• Developed a new extensive training program and educational competencies

• Constructed a new multi-level career ladder based on the complexity and skill level of each function

Career Ladder Structured Around Five Levels

Focusing on the following elements:

Training

Specialty

Leadership

Communication

Problem Solving

Responsibility

Skill


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Technician I

• Monitor Inventory & stock reports for ADM

• Refill ADM

• Repackaging of bulk into unit dose

• Charges & Credits

• Code Carts & Emergency boxes to Nursing areas

• Patient Specific Meds

• Expiration Date Checking

Technician II

*In addition to all tasks required by Tech I

• Sterile Products

• Neonatal IV preparation

• Hazardous Medication Preparation

• Chemotherapy Medication Preparation


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Technician III

*In addition to all tasks required by Tech I & Tech II

• High Risk Medication Preparation

• Pharmacy Inventory

• Pharmacy/Anesthesia responsibility

• Off Site Locations

• Is an effective trainer

• QA Documentation

• Active in Professional Organization

• Problem Solving

Technician IV

*In addition to all tasks required by Tech I, Tech II & Tech III

• Works with Lead Tech to develop & maintain training materials

• Problem Solving

• Committee Involvement

• Core trainer in specialty area

• Able to rotate thru 2 or more specialty areas

• Advanced QA projects

• Assist with Policy & Procedures development


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Lead Technician*In addition to all tasks required by Tech I, Tech II, Tech III & Tech IV

• Schedule coordination for Technicians an Interns• Training coordination for Technicians and Interns• Maintains Sterile Products UAP <797> QA Measures (Sterile

Products Lead)• QA of ADM in OR (OR Lead)• Regular Participation on Pharmacy Practice Council• Develop any P&P pertinent to technicians and associated

areas • Maintain skills by staffing in all areas• Teach USP <797> classes in accordance to standards (Sterile

Products Lead)• Present or Coordinate CE activity

Maintenance

• Existing Technicians were evaluated on an individual basis to be placed in either Tech I, Tech II or Tech III positions.

• Technicians interested in applying for Tech IV or Lead Tech positions applied on a separate basis and went through an interview process with members of Pharmacy Administration


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Evaluation

• Following advancement, involvement and/or completion of required tasks must be demonstrated annually at performance review.

• Failure to comply with the requirements and standards set in each level will result in re-assignment into one level below with a commensurate in pay

Statistics on Advancement for First 24 Months

• 18 pharmacy technicians have advanced one step• 3 pharmacy technicians have advanced two steps• 4 pharmacy technicians have advanced three steps

44.78 FTE at time of implementation

25 achieved advancement = 55% of staff took advantageof new opportunities presented to them


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Benefits and Successes• The need for pharmacy technicians is projected to rise 9%*

over the next 10 years. This will expand the importance and requirements in the pharmacy technician career path – this career ladder will allow us to “grow with the times” in all areas of pharmacy. (9% was projected rate in 2014 – has now increased to 12% by 2026)

• Creating new avenues for advancement and education has increased employment levels with highly skilled technicians and has reduced our turnover rate by 30% in the 24 months since implementation

• Increased job satisfaction due to personal growth and continued opportunities will allow our pharmacy technicians to deliver the highest quality of care to our patents on a daily basis

Technology-check-Technician: Leveraging Our Superheroes and the Power of Technology

Erin Taylor Pharm.D. Assistant Director, Acute Care Pharmacy Services

Baystate Health

Caryn Belisle RPh, MBA Director of Pharmacy Compliance, Quality and Safety

Brigham and Women’s Hospital


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Objectives

1. Discuss the need to explore a technology check technician pilot in the hospital pharmacy distribution process

2. Explain the process of obtaining a waiver from the Massachusetts Board of Pharmacy

3. Describe the scope, methods and preliminary outcome metrics of a technology check technician pilot

Background

• Increasing demand for clinical pharmacy services in the institutional setting

• Financial strain of non-profit hospitals to “do more with less”

• More of a need to leverage technology and eliminate duplicative and wasteful processes

• Survey to members of the Massachusetts Society of Health System Pharmacists interested in “Technology Check Tech”• N=18 • 100% use barcode scanning at the time they replenish ADM at their institution• 94% use barcode scanning at the time of dose administration (BCMA) at their

institution• 94% displayed interested in using Technology-Check-Tech if it were an option


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Question 1:

According to Massachusetts CMR 8.04 Certified Pharmacy Technicians cannot:

A. Perform drug utilization review

B. Contact prescribers concerning prescription drug order clarification or therapy modification

C. Provide patient counseling

D. Perform dispensing process validation

E. All of the above

Question 1: Answer

According to Massachusetts CMR 8.04 Certified Pharmacy Technicians cannot:

A. Perform drug utilization review

B. Contact prescribers concerning prescription drug order clarification or therapy modification

C. Provide patient counseling

D. Perform dispensing process validation

E. All of the above


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Background

• With Carousel and ADM barcode verification at all steps, visual verification does not add value to the process

• Inventory management versus “dispensing process validation” to a patient specific prescription

• Opportunity for the inpatient pharmacy department to improve its workflow by allowing for more timely deliveries of medications to the ADMs on the inpatient units

• Reallocate pharmacists that were otherwise dedicated to validating the ADM inventory to perform timely Drug Utilization Reviews (DURs), medication order verification, clinical appropriateness assessments, and medication reconciliation upon admission and discharge

• Also supports a financial benefit to the patient as by receiving the right medication at the right time could assist with an overall decrease the length of stay

Waiver with the MA Board of Pharmacy

• Petition for a Waiver for the Provisions of 247 CMR Licensure of a Pharmacy or Pharmacy Department• Explain compelling public interest that would be served

• Explain why adherence to regulations are impractical or burdensome

• Statement of the policies and procedures of proposal and safeguards to protect the public health, welfare and safety

• Paperwork submitted by each entity requesting waiver

• Presentation at Board of Pharmacy meeting to review waiver


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Our Journey….

June 2016: BoP Proposal

Presentation –CMR 8.04 changes

October 2016: Advisory

Committee Review

January 2017: BoP reviews

CMR 8.00 w/o wording changes

February 2017: Status update meeting with

Dave Sencabaugh

(BoP)

April 2017:

Proposal submitted to

Dave Sencabaugh

(BoP)

September 2017:

BoPpresentation

scheduled (9/7/17)

November 2017:

Formal waiver approval granted

Approval and next steps

• Approval formally granted on 11/1/17, and expires 12/31/18 • Interim update to board expected

(7 months of data)

• BMC & BWH: program implemented Jan 2018


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Question 2:

Some of the proposed benefits of a Technology-check-tech program include:

A. Reallocation of Pharmacists to clinical/patient-centered tasks

B. More timely delivery of medications

C. Reduced costs associated with missing medications

D. All of the above

Question 2: Answer

Some of the proposed benefits of a Technology-check-tech program include:

A. Reallocation of Pharmacists to clinical/patient-centered tasks

B. More timely delivery of medications

C. Reduced costs associated with missing medications

D. All of the above


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Supporting Data

• NABP 2015 Survey of Pharmacy Law breaks down Tech-Check-Tech (Technician checks Technician) regulations in the institutional setting and the community setting.• 15 states that allow Tech-Check-Tech in the institutional setting (CA, CO, ID, KS, KY,

MI, MT, NC, ND, NH, OR, SC, TX, UT, WA)

• Michigan currently supports Technology-Check-Technician processes when automated dispensing machines (ADM) and bedside barcode scanning verification are used • Maximizing technology to support medication dispensing validations has been

demonstrated to be more accurate than pharmacist validations (0.7% error rate vs. 0% error rate, p = 0.008; Wang BNT, et al)

• Leveraging technology allowed for over 1400 hours of Pharmacist time to be reallocated to other clinical activities

Wang BNT, Brummond P, Stevenson JG. Comparison of barcode scanning by pharmacy technicians and pharmacists’ visual checks for final product verification. Am J Health Syst Pharm. 2016;73:69-75.

Scope of Pilot

• In Scope• Any medication dispensed from the carousel (electronic inventory management

system) with a barcode verification

• Medication is scanned upon replenishment to ADM by a CPhT

• Barcode medication administration at bedside

• Out of Scope

• Schedule II-V medications

• Patient-specific medications dispensed per patient order from the pharmacy

• Patient-specific compounded products per patient order from the pharmacy


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Methods

Medication

Validation

Scanning Points

Methods (Video Examples)

LOADING MEDICATION INTO CAROUSEL WITH SCAN VALIDATION:

https://www.youtube.com/watch?v=7r3EEpOz2CM

DISPENSING MEDICATION FROM CAROUSEL:

http://www.youtube.com/watch?v=OSuna23ze5U

DISPENING MEDICATION TO ADC FROM CAROUSEL:

http://www.youtube.com/watch?v=-AtydCD5j3E

https://www.youtube.com/watch?v=7r3EEpOz2CM

https://urldefense.proofpoint.com/v2/url?u=http-3A__www.youtube.com_watch-3Fv-3DOSuna23ze5U&d=DwMCaQ&c=BLF1codk7grETTA02F6JwR5DiXMTPyNdcZpbXT_1iEc&r=oBjFOa7WS41_OMQIFWWK0yfdGhfBNYHuJ4LFgayawAk&m=c3oznQtK2sOquReOA2CtVeeY2jeRqzpd_10Ke5vKr4U&s=rp4NByPIyqLPnnF6-YsGfEDbfqmoUuBkSvzdAJzel3g&e=

http://www.youtube.com/watch?v=-AtydCD5j3E


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Incorrect Scans = Hard Stop

Methods

Baystate Medical Center• 1 year pilot using barcode verification at receiving, loading, removing

and restocking

• Training of CPhTs• 2 weeks minimum (80 hours)

• Trainer must be lead tech or supervisor

• Training will be outlined and documented in orientation/training document

• Implement monthly audits conducted by clinical pharmacists

Brigham and Women’s• 1 year pilot using barcode verification at

receiving, loading, removing and restocking

• Tracking restocks through “exception report” (tracks if the expected restock quantity in ADM did not occur)

• Training of CPhTs• 2 weeks minimum (80 hrs)• Trainer must be at BWH 2+ years• Training, communication and tracking done by an

on-line education system

• Implement monthly audits – PGY2 residency project


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Outcome Metrics

•Mirror published data methods (Wang, et al; Poon et al)

•MONTHLY AUDITS:•Medication scan compliance rates• Inventory audits of pharmacy dispensing processes •Medication-related events

Wang BNT, Brummond P, Stevenson JG. Comparison of barcode scanning by pharmacy technicians and pharmacists’ visual checks for final product verification. Am J Health Syst Pharm. 2016;73:69-75.

Poon et al, Medication Dispensing Errors and Potential Adverse Drug Events before and after Implementing Bar Code Technology in the Pharmacy. Ann Intern Med. 2006;145:426-434.

Baystate Outcome Metrics

• ADM Scan Rates• Jan-Mar: Average 93%

• Bedside Barcode Scan Rates • Jan – Mar: Average 90%

• Monthly Audit by RPh• Feb/Mar = 100%, no inaccuracies identified during audit

• SRS events – trend pre/post• Missing/delayed doses significantly reduced, no increases in wrong drug/dose)


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BWH Outcome Metrics

• ADM Scan Rates• Jan-Mar: Average 98%

• Bedside Barcode Scan Rates • Jan – Mar: Average 95%

314

206

No Error(s) Errors

Total PRE BATCH restock errors

BWH Outcome Metrics


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Wrong Drug0%

Wrong Dose1%

Wrong Quantity

98%

Wrong Dosage Form

0% Expired1%

ERROR TYPE: PRE-BATCH

Wrong Drug Wrong Dose Wrong Quantity

Wrong Dosage Form Expired

BWH Outcome Metrics

BWH Outcome Metrics

446

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No errors Errors

Total POST BATCH restock errors


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Wrong Drug2%Wrong Dose

0%Wrong

Quantity…

Wrong Dosage Form

0%

Exp…

ERROR TYPE: POST BATCH

Wrong Drug Wrong Dose Wrong Quantity

Wrong Dosage Form Expired

BWH Outcome Metrics

Reallocation of Resources

Baystate Medical Center• Schedule adjustments to create 3 hours

of clinical time M-F for care team RPhs

• Controlled substance auditing processes implemented

• Additional daystay order verification/prep support

Brigham and Women’s• (1) Pharmacist cover inpatient units that

don’t require rounding (L&D)

• Use a COOP to do the manual verification of all medications out of scope (warehouse/refrigerated medications)


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Gaps/Lessons Learned

• Ensure training and orientation highlights expected process

• Establish expectations for WHAT is being visually checked versus barcodevalidated

• Expiration dating isn’t tracked/identified through barcode scanning

• Only need to scan “one” item → Establish workflow to manage loose packages vs. full UD card

Question 3:

Understanding gaps in leveraging technology is critical. Some solutions to managing these gaps include:

A. Do not allow “loose” UD packages to be stocked in carousel

B. Limit technician resources to 2-3 individuals that you trust

C. Establish a process for managing “loose” UD packages

D. Outline visual checks versus barcode validations in dispensing process

E. C and D only


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Question 3: Answer

Understanding gaps in leveraging technology is critical. Some solutions to managing these gaps include:

A. Do not allow “loose” UD packages to be stocked in carousel

B. Limit technician resources to 2-3 individuals that you trust

C. Establish a process for managing “loose” UD packages

D. Outline visual checks versus barcode validations in dispensing process

E. C and D only

Summary

• Reallocation of personnel to direct patient-care activities

• Leverage technology to minimize redundancies

• Ensure patient safety is a priority

** Dispensing inventory from the carousel to replenish the ADM is NOT the final step in the medication

administration process **


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From the Horses’ Mouth!

• “The carousel pull and ADC fill process is much faster now…” Melodie, CPhT (Baystate)

• “We feel more aware of what is going on and more in control of the process…” Tiffany, CPhT (Baystate)

• “Our Pharmacists can spend more time with their patients….” Brendan, CPhT (Baystate)

• “Pharmacy technicians feel like they have a higher purpose within the department than just to deliver medications…” Pablo, CPhT (BWH)


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Idea Exchange and Wrap-Up

• Reflect on where we should concentrate our technician advancement efforts within our respective organizations

Thank you!

• Please join us in the Grand Ballroom South • 330pm Cocktail Reception

• 4-6pm Reverse Expo• Will have assigned table – vendors will come to you!

Documents

MSHP Director’s Forum 2018 - cdn.ymaws.coms_forum_2018.pdf · MSHP Director’s Forum 2018 #MASHP18 9 Pharmacy Technicians With Credentials ASHP national survey of pharmacy practice