The Profession of Pharmacy

The Profession of Pharmacy

• Pharmacy involves dispensing and preparing drugs, and providing drug-related information
• Aspects include interpreting prescriptions, compounding, labeling, dispensing, drug selection, and utilization reviews
• Pharmaceutical care is vital for total health care
• Pharmacists and technicians enhance patients' lives by preventing and curing diseases
• All pharmacy personnel should provide truthful, accurate information to minimize patient risk
• Equal care should be given to everyone, regardless of race, religion, social status, sex, orientation, age, or health
• Respect should be shown to the wishes of patients who refuse treatments, and to the dignity of patients with diminished competence

The Pharmacist

• In 2012, pharmacy schools had over 61,000 students, with more women than men
• Pharmacy college enrollment has increased since 1984
• In 1992, pharmacy colleges started awarding the Doctor of Pharmacy (PharmD) instead of the Bachelor of Pharmacy (BS Pharm)
• A PharmD requires two years of undergraduate and four years of graduate study
• Either PharmD or BS Pharm degrees enable graduates to take the state board of pharmacy licensure exam
• State boards of pharmacy are overseen by the National Association of Boards of Pharmacy (NABP)
• The website for NABP is https://nabp.pharmacy/

The Role of the Pharmacist

• Pharmacists are trained in pharmaceutical sciences and must be licensed by their state's BOP
• Pharmacy practice has become more specialized in the last 25 years
• Specialties include:
  • Ambulatory care
  • Pharmacy administration
  • Drug information
  • Community practice
  • Geriatrics
  • Industry
  • Managed care
  • Long-term care
  • Home health care
  • Oncology
  • Pediatrics
  • Psychiatric pharmacy
  • Nuclear pharmacy
  • Nutritional support

The Pharmacy Technician

• Degree options include certificate, diploma, and associate's degree programs
• A certificate program takes less than a year and teaches retail/clinical skills, requiring a high school diploma
• A diploma program is a year-long and focuses on foundational knowledge and skill application; no prior health background is required
• A two-year associate degree covers:
  • Pharmacy administration and professional aspects
  • Medical terminology
  • Pharmaceutical calculations
  • Anatomy
  • Pathophysiology
  • Pharmacology
  • Drug distribution systems
  • IV admixture procedures
  • Medication packaging techniques
  • Customer relations
  • Healthcare delivery systems
  • Current issues
  • Training includes externships

Role of the Pharmacy Technician

• Pharmacists supervise technicians and are accountable for their performance
• Technicians assist pharmacists with tasks not requiring professional judgment
• The role and number of pharmacy technicians are increasing
• Technicians perform clerical and technical tasks
• Training and certification expand their role, allowing pharmacists to focus on tasks requiring professional judgement
• All duties performed are nondiscretionary

Expanding Roles and Responsibilities of Technicians

• Technicians are involved in:
  • Prescription preparation
  • Dispensing
  • Purchasing
  • Inventory control
  • Billing
  • Filling unit-dose carts
  • IV solutions compounding
  • Labeling
  • Filling prescriptions
  • Reviewing insurance
  • Repackaging products
• Employers include:
  • Hospitals
  • Medical centers
  • Teaching facilities
  • Outpatient clinics
  • Urgent care centers
  • HMOs
  • Retail and wholesale pharmacies
• Hospital technicians assist with:
  • Inpatient medication dispensing
  • IV admixtures
  • Compounding nonsterile preparations
  • Repackaging
  • Purchasing
  • Billing

Obtaining Experience

• Colleges offer externships as short-term student work programs
• Experiential sites include community pharmacies, hospitals, or other institutional pharmacy
• Students are assigned to an experienced practitioner called the preceptor, who provides instruction and supervision
• The best externships use American Society of Health-System Pharmacists (ASHP) objectives to instruct students and evaluate various skills

Areas of Assessment during Externships

• Communication
• Dispensing
• Documentation
• Error prevention
• Inventory
• Quality control
• Storage
• Drug product control
• Work ethic
• Billing and insurance skills are assessed in community pharmacies
• Community dispensing and retail practice skills are assessed in ambulatory pharmacies
• Medication orders and unit-dose cart filling skills are assessed in institutional pharmacies
• Students can arrange externships independently through pharmacists and facilities if the college does not offer externships

Internships

• Internships are official, paid or unpaid, entry-level positions for trained/semi-trained individuals
• Internships are competitive and require job applications
• Unofficial, part-time internships are also available in retail, hospital, nursing assistant, volunteer, or maintenance positions
• They provide solid pharmacy experience and networking opportunities for employment

Certification Exam Preparation

• State requirements differ for pharmacy technician registration, licensure, and certification
• Most states require or prefer national certification for licensure and practice
• Companies and hospitals are increasingly requiring national certification to improve efficiency and safety and to meet accreditation standards

ASHP’s Model Curriculum

• Includes standards for accredited pharmacy technician education and training
• Requires at least 600 hours including:
  • 360+ hours of hands-on practice site experience
  • 160 hours of classroom work
  • 80 hours of laboratory training
• The NABP task force recommends state boards of pharmacy register/license technicians, which requires standardized education and training guidelines

Obtaining Certification

• Pharmacy technicians can choose to become certified
• Certification is obtained via a standardized national exam
• There are two national examination options:
  • Pharmacy Technician Certification Exam (PTCE)
  • Exam for the Certification of Pharmacy Technicians (ExCPT)
• Certification is valuable and increasingly required by states

The Pharmacy Technician Certification Exam (PTCE)

• Prepared by the Pharmacy Technician Certification Board (PTCB)
• It tests competency in basic functions
• The exam blueprint was revised in 2013
• The content is organized into nine general knowledge areas:
  • Pharmacology for Technicians (13.75%)
  • Pharmacy Law and Regulations (12.5%)
  • Sterile and Nonsterile Compounding (8.75%)
  • Medication Safety (12.5%)
  • Pharmacy Quality Assurance (7.5%)
  • Medication Order Entry and Fill Process (17.5%)
  • Pharmacy Inventory Management (8.75%)
  • Pharmacy Billing and Reimbursement (8.75%)
  • Pharmacy Information Systems Usage and Application (10%)

PTCE Exam Details

• Consists of 90 multiple-choice questions with 10 non-scored questions for statistical purposes
• A minimum score of 650 (out of 900) is required to pass
• Passing the exam allows use of the CPhT designation
• Exams are available online or via phone across the country, including military test centers
• As of 2017, high school students within 60 days of graduation can take the PTCE
• Proof of high school completion is required for PTCB certification

National Healthcareer Association’s ExCPT Exam

• It's also recognized by many states, it's required for certification with the NHA Pharmacy Technician Certification Program
• The computerized exam is overseen by the ICPT, part of the NHA
• The ExCPT is offered at test centers across United States, and is also available for scheduling online at www.nhanow.com
• It contains 120 questions, 100 scored and 20 pretest, divided into:
  • Regulations and Pharmacy Duties
  • Drugs and Drug Therapy
  • Dispensing Process

ExCPT Exam Content Breakdown

• 52% focuses on dispensing of medications
• 25% relates to pharmacy regulations and technician duties
• 23% relates to drugs and drug products
• Dispensing Process section elements:
  • Prescription information
  • Preparing and dispensing prescriptions
  • Pharmacy calculations
  • Sterile products
  • Unit doses
  • Repackaging
• Regulations and Pharmacy Duties include:
  • General technician duties
  • Controlled substances
  • Federal and state law
  • Federal/state/agency rules
• Drugs and Drug Therapy encompasses:
  • Drug classification
  • Frequently prescribed medications
  • Dosage forms
  • Brand and generic drug names

Comparing the PTCE and EXCPT

• The National Commission accredits both for Certifying Agencies(NCCA)
• Candidates must be at least 18 years of age for both exams
• The PTCE is generally more expensive
• Both exams are equally challenging with different structures
• The ExCPT focuses on community retail pharmacy
• The PTCE aligns with the ASHP, requires background checks, and is accepted in all 50 states
• Some states require the PTCE and is also favored by hospitals and institutional pharmacies
• Both assess similar competencies and are multiple-choice, lasting 2 hours in duration
• For both exams, pharmacy technicians complete 20 continuing education credits within 2 years to remain certified, including one unit of law topics
• Recertification is the same for both exams
• PTCE retake wait time is 90 days; ExCPT is 30 days
• Both offer online practice exams at similar costs
• The PTCE is endorsed by the NABP.
• The NCPA endorses the ExCPT.

Choosing an Exam

• Determine which organization is recognized by the BOP in your state
• The PTCE is more widely recognized due to its longer existence
• Certification assures employers of safe and effective work with medications, prescriptions, and pharmacists
• Either exam can improve employment and promotion chances

Maintaining Certification

• Certification is valid for two years
• After this initial period, certification requires renewal and fulfillment of 20 continuing education credits

Continuing Education

• Technicians continually update their knowledge of new information and regulations after formal training
• The traditional roles of pharmacist and tech are ever changing, creating new functions
• A commitment to continue education is essential
• Pharmacy technicians need a specialized body of knowledge, including knowledge of:
  • Pharmacy practice settings
  • Medications
  • Adverse effects
  • Drug interactions
• They regularly assist patients, provide information to patients, specifically geriatric patients, and oversee nutritional supplements

Lifelong Learning

• It has become part of the philosophy of professional education
• Review daily pharmacy literature, journals, and newsletter
• CE classes, seminars, and workshops enhance pharmacy knowledge
• Continuing education units (CEUs) are required to maintain certification
• Apps such as Medscape aid in staying current

Continuing Education Requirements

• To be eligible for recertification every two years, certified pharmacy technicians must obtain 20 contact hours of pharmacy-related continuing education
• At least 1 contact hour must be in pharmacy law, accomplished through an educational meeting
• CEUs can be obtained through:
  • The American Association of Pharmacy Technicians (AAPTs)
  • Other agencies
  • Educational institutions
  • Online resources
• CEUs are awarded for participation in professional seminars and workshops

The Pharmacy's Role

• Pharmacies are responsible within the communities served
• The public trusts that pharmacists and drugs are sound and safe
• Standards of performance include:
  • Staff training
  • Compliance
  • Maintenance of standards
• Opinions can vary among the roles that pharmacists and pharmacies can play
• Some Job duties for technicians increase with knowledge, skills, and training
• Salaries may increase
• Some pharmacies allow technicians to enter prescription order information on computers
• Pharmacists emphasize:
  • Patient counseling
  • Medical staff consultations

Providing Services to the Community

• Pharmacies maintain high standards of medication dispensing
• Giving accurate information and fair prices are necessary to run a pharmacy
• Compounding is less common and often requires compassion when treating patients
• Routine duties include:
  • Regularly treating all customers with dignity and respect
  • Participating in community outreach
  • Conducting health fairs
  • Organizing fundraisers
• Overall, the goal is heightened community awareness of assistance programs

Responsibility to Those Being Served

• Developing methods for standardization and control of medicinal agents is vital
• Pharmacists often perform physical and chemical analysis
• When pharmacists delegate analysis to staff, they need to understand the basic principles of analysis
• An analytical method is justified after it is proved to be valid, accurate, and selective
• Drug control methods include:
  • Analytical testing
  • Process control
  • Statistical analysis
  • Documentation
  • Audits
• Drug control provides:
  • Knowledge
  • Understanding
  • Judgments
  • Procedures
  • Skills
  • Ethical standards

Control of the Drug-Use Process

• Multiple institutions jointly involved in manufacturing, repackaging, and relabeling of drugs fall under government regulation via the federal Food, Drug, and Cosmetic Act
• Control of quality is essential in the formulation, manufacture, and distribution of pharmaceutical products
• Its purpose is to provide desired features of purity, potency, and stability, all of which must be maintained in a quality control unit.
• Unit functions include auditing the control system, and overall product quality

Quality Control

• It must be built into the manufacturing process
• It must be organized effort of all individuals involved in the production of meds
• Encompasses:
  • Formulation
  • Compounding
  • Dispensing
  • Packaging
  • Purchasing
  • Storage
  • Distribution
• Is pharmacy department responsibility for auditing
• The unit reports to Director of Pharmacy Services with authority of approving, rejecting, and reprocessing policies

The Profession Today

• A PharmD degree is now required in most states
• After two to four years of undergraduate coursework, students take the Pharmacy College Admissions Test (PCAT), before the 4 year program
• Courses include anatomy, biology, chemistry, and physics
• PharmD students complete rotations in clinical and pharmaceutical facilities
• Pharmacists need to pass the NABP examination
• Additionally, they need to have excellent communication skills

Technicians Today

• They are skilled in many different areas
• Some states require them to receive additional education and on-the-job training
• There are still no nationally standardized requirements for positions
• Community Pharmacies:
  • Maintain patient medications and histories
  • Prepare and compound specialized
  • Manage inventory
  • Billing with third-party insurance
• Hospitals and Inpatient clinics:
  • Dispense parental meds
  • Supply floor stock
  • Inventory
  • Transcribing information

Specialty Roles for Technicians

• Include work in:
  • Long-term care
  • Nuclear pharmacies
  • Insurance companies
  • Call centers
• Specialty certifications are available, the technician must have knowledge in:
  • Pharmacy laws and regulations
  • Pharmacology
  • Compounding
  • Inventory
  • Billing
  • Medication safety
  • Technologies
• Additional work:
  • Anticoagulation services
  • Pharmacokinetics
  • Review of lab results
  • Determine the concentration of drugs

Pharmacy Associations

• American Association of Colleges of Pharmacy (AACP): Represents 129 pharmacy colleges in the United States
• American Association of Pharmaceutical Scientists (AAPS): Represents pharmaceutical scientists employed in academia, industry, government, and research institutions
• American Association of Pharmacy Technicians (AAPT): Represents pharmacy technicians and promotes certification

Professional Societies

• American College of Clinical Pharmacy (ACCP): A professional society that provides resources for clinical pharmacists
• Accreditation Council for Pharmacy Education (ACPE): The accrediting agency for pharmacy education programs

Pharmacists Associations

• American Pharmacists Association (APhA): The largest pharmacy organization
• American Society of Health-System Pharmacists (ASHP): Represents pharmacists in hospitals, HMOs, etc.

The ASHP Curriculum

• ASHP consists of the following categories
  • Personal and interpersonal knowledge and skills
  • Foundational professional knowledge and skills
  • Medications-handling and Processing
  • Compounding(sterile and non-sterile)
  • Billing
  • Patient safety
  • Safety
  • Technology

Additional Associations

• National Pharmacy Technician Association (NPTA): Largest pharmacy technician organization
• Pharmacy Technician Certification Board (PTCB): Publishes the PTCE
• Pharmacy Technician Educators Council (PTEC): Prepares people for careers as pharmacy technicians
• United States Pharmacopeia (USP): Sets standards for drug products

Code of Ethics

• Promotes respect and fair treatment for all patients.
• The following values show a code of ethics:
  • Health and safety of each patient to be of primary consideration
  • Form a professional relationship with each patient
  • Honor the autonomy, values, and dignity of each patient
  • Respect and protect the patient’s right of confidentiality

Maintaining Ethical Standards

• Meeting patient needs
• Preserving high professional standards
• Improving professional knowledge
• Cooperating with other healthcare professionals
• Contributing to the health care system
• Avoiding promotion drugs
• Being fair and reasonable with amounts charge for services

Pharmacy Technician Job Market

• There are good job opportunities are expected for full-time and part-time pharmacy technicians that have the knowledge
• There will be more need as the aging population increases and new medications are being created.