Tech-Check-Tech (TCT): Challenges and Opportunities

1. Tech-Check-Tech (TCT):Challenges and Opportunities Maryland Pharmacists Association Mid-Year Meeting Annapolis, Maryland February 18, 2018

2. Disclosures Drs. Cynthia Boyle, Kayla McFeely, and Kristopher Rusinko have no relevant financial relationships with a commercial interest pertaining to the content of this presentation.

3. Objectives At the end of this presentation, the participant should be able to: 1. Describe at least 3 recent advances/initiatives for pharmacy technician education/training 2. Describe the Maryland Society of Health-System Pharmacy (MSHP) Acute Care TCT process and proposal highlights presented to the Maryland Board of Pharmacy

4. Objectives (continued) 3. Describe the successes and challenges of an optimized community pharmacy care model that enhances the role of qualified pharmacy technicians in order to reinvest pharmacists’ time to provide patient care services 4. Discuss steps, scope, and limitations for possible Tech-Check-Tech in Maryland

5. Format Introductions/Background TCT in Health-systems Optimizing Care in Community Pharmacy Facilitated Discussion- Challenges and Opportunities for TCT in Maryland (Audience Input for Maryland Stakeholders’ Conference)

6. Objective #1: Describe at least 3 recent advances/initiatives for pharmacy technician education/training. Cynthia J. Boyle, PharmD, FAPhA Professor, University of Maryland School of Pharmacy MPhA Past President

7. Poll the Participants State boards of pharmacy should require new pharmacy technicians to obtain national certification for registration or licensure (75/15/5/5) Bridging programs should be developed and offered to build competencies of pharmacy technicians who are currently in the workforce and would like to advance their skills (56/40/3/1) Planners should establish a coalition with broad representation for the recommendations from the PTSCC (77/23/0/0) Zellmer WA, McAllister EB, Silvester JA, Vlasses PH. Toward uniform standards for pharmacy technicians: summary of the 2017 pharmacy technician stakeholder consensus conference. JAPhA 57(2017)e1-e14.

8. Education Perspective Quality in Pharmacy Technician education/training programs Program Accreditation Pharmacy Technician Accreditation Regulation of Pharmacy Technicians Role of academic institutions in education, training, and certification of Pharmacy Technicians Collaborations Mobley Smith MA, Boyle CJ, Keresztes JM, Liles J, Garrelts MacLean L, McAllister EB, Silvester J, Williams NT, Bradley-Baker LR. Advancing the Pharmacy Profession Together through Pharmacy Technician and Pharmacy Education Partnerships. Report of the 2013-14 Professional Affairs Standing Committee. Am J Pharm Educ. 2014; 78(10): Article S22.

9. “The ability of pharmacists to successfully fulfill patient care provider roles depends on how well pharmacy technicians are prepared to function in their roles a pharmacy supportive personnel.”

10. 2017 PTCB-ASHP-ACPEConsensus Conferences All pharmacy sectors were engaged including pre-conference poll of JCPP member organizations. State variability in regulations poses risks for patients and the profession. Task analysis should be basis for accredited technician education, technician certification, and state regulations. Participants recognized generalist knowledge/skills/abilities regardless of practice and need for additional programs beyond entry-level (advanced).

11. Pharmacy Technican News PTCB- founded in 1995 by APhA, ASHP, Illinois Council of Health-System Pharmacists, and Michigan Pharmacists Association, and joined by NABP in 2001. PTCB advocates for a single national standard for pharmacy technician certification, recognized and supported by the profession. PTCB advances medication safety by certifying technicians who are qualified to support pharmacists and patient care teams in all practice settings. New PTCB Executive Director William Schimmel www.ptcb.org

12. Jan. 11, 2018 PTCB News Release:Exam and Education Changes • Exam Content Domains (9 to 4) from 2016 Job Analysis, Entry Credential • Med Safety/Patient Care Focus • Education- PTCB or equivalent experience • Effective Jan. 1, 2020 • 90-Day Comment Period Staff Sgt Mary Johnson PTCB CPhT of the Year 2017

13. Active Learning The statement which best describes the outcomes of the Pharmacy Technician Stakeholders Consensus Conference (PTSCC) is: By 2020, all pharmacy technicians should be licensed. By 2020, all pharmacy technicians may qualify for certification by PTCB courses or experience. By 2020, all states should enact comparable technician regulations. By 2020, all schools/colleges should offer technician education/training.

14. Tech-Check-Tech (TCT) MSHP Workgroup Kristopher Rusinko Pharm. D., MBA, M. Ed. Director of Operations Johns Hopkins Health System

15. Objective #2 Describe the Maryland Society of Health-System Pharmacy (MSHP) Acute Care Tech-Check-Tech (TCT) process and proposal highlights presented to the Maryland Board of Pharmacy

16. TCT - Background • Specially trained and validated pharmacy technicians (VPT) verify accuracy of medications filled by another technician • No clinical judgment required • Studies demonstrate technicians are at least as accurate as pharmacists • Barcode scanning technology provides a safeguard against dispensing the wrong medication • Reallocation of pharmacist time to patient care tasks

17. Board Approval - Institutional Setting 23 states allow TCT

18. Board Approval - Community Setting 7 states allow TCT

19. Workgroup Process Overview University of Wisconsin Health and University of Iowa Health Conference Calls UW Health/ Pharmacy Examination Board Toolkit Conversations with other states (student project) Retreats and small work groups to update documents and discuss roles of VPTs

20. Roles of VPT Proposed to Maryland BOP • Bar code scanning required • Automated Dispensing Cabinet (ADC) filling • Batch dose preparations • Code box/tray filling • Unit dose prep from bulk bottles

21. Handout Review • Appendix A – Lit Summary • Appendix B – Cover Letter Variance Request • Appendix C – Variance Request form • Appendix D – Sample Policy • Appendix E/F – Additional samples • Appendix G – Practical Training Checklist • Appendix H – Competency Assessment Checklist • Appendix I – TCT Overview for Technicians • Appendix J – TCT Training and Self Learning Packet • Appendix K – Written Examination • Appendix L – Skill Validation Process Guidance • Appendix M – Initial Validation Error Log Form • Appendix N – Quality Assurance Process Guidance

22. Handout Review (cont.) • Appendix O – Quality Assurance Error Log Sheet • Appendix P – Variance Report to Board • Appendix Q - Artificial Error Log • Appendix R – Examples of Artificial Errors • Appendix S – Cart Fill Artificial Error Examples • Appendix T – Tech Initial Validation Log • Appendix U – QA Monitor Report to Board • Appendix V – TCT Implementation Checklist

23. Current Situation • Pilot sites identified • Proposed to MDBOP 9/20/17 • MDBOP created a work group of its members to review • Setting where applicable • Training and requirements • Activities authorized • Tracking and reporting

24. Active Learning Which of the following have been proposed as items to be checked in an acute care setting TCT Program: Product verification prior to restocking Automated Dispensing Cabinet (ADC) Batch dosing preparation for loading into ADCs Code tray/box filling Drawing up oral doses from manufacturer bulk bottles of liquid medications All of the above

25. Objective #3: Describe the successes and challenges of an optimized care model in the community pharmacy setting Kayla M. McFeely, PharmD Executive Fellow National Association of Chain Drug Stores

26. Innovation in Pharmacy “Change is a common thread that runs through all businesses regardless of size, industry and age. Our world is changing fast and organizations must change quickly, too. Organizations that handle change well thrive, whilst those that do not may struggle to survive.”

27. Optimizing CareEnhances the role of qualified pharmacy technicians in order to reinvest pharmacists’ time to provide patient care services Improve patient access and healthcare outcomes Utilize full potential of clinical expertise of pharmacists and the skills of technicians Iowa, Wisconsin, Tennessee

28. NACDS Optimizing Care Projects: Chain and Independent Pharmacy Participation

29. Current Status 1. Iowa • Transition to dissemination phase • Sharing their experiences and insights • Webinar series – upcoming 2. Wisconsin • Concluding data collection • Data analyses upcoming 3. Tennessee • Recruitment • Baseline data collection 4. Qualitative analyses – all 3 projects

30. Optimizing Care Myths De-bunkedCourtesy of the Tennessee Pharmacists Association Courtesy and Property of the TN Pharmacists Association Courtesy and Property of the TN Pharmacists Association

31. Patient Safety Iowa Optimizing Care Pilot – Phase 1

32. Pre-implementation Phase Implementation Phase Challenges • Board of pharmacy approval • Recruitment of pharmacies • IT remodeling • Separate distinction for checking technicians • Workflow redesign plan • Perceptions and myths • Technician verification process – time consuming • Want to verify more technicians – coverage • Staff turnover • Takes time to adapt to new responsibilities • Perceptions and myths

33. RPh time spent dispensing • 67.3% to 48.58% (p=0.004) Successes: Time Reinvestment Decrease • RPh time spent patient-care activities • 15.9% to 35.08% (p=0.002) Increase Increase Iowa Optimizing Care Pilot – Phase 1

34. Successes: Areas of Impact • Increased number of services provided • Identifying drug therapy problems • Immunizations, and non-immunization injections • MTM services – disease management, adherence monitoring, med sync, compliance packaging • Potential for further advancements • TN pilot – CPA engagement • Preventative services, point of care testing, more

35. Successes: Qualitative Data

36. Final Thoughts • Pharmacy technicians may be able to perform final product verification at least as accurately as pharmacists • Pharmacists may spend more time providing clinical services when the optimizing care model is utilized • Value of RPh discretion and clinical judgement preserved • Essential: quality assurance/improvement, and patient safety

37. Acknowledgements Iowa Pharmacy Association Pharmacy Society of Wisconsin Tennessee Pharmacists Association 1st Pharmacy Services Aurora Boscobel Caves Comprehensive Wellness Community Pharmacy Fnd Crawford’s Costco East TN Discount Froedtert Hartig Drug Hayat Hy-Vee Kroger Main at Locust McKesson Medicap Mercy Family Pharmacy NuCara Pulaski Publix Perkin’s Shopko Surgoinsville Target Telligen Terry’s Thrifty White Towncrest UW Health Walgreens Wester Drug

38. Active Learning True or False: An optimizing care model has the potential to advance patient care in community pharmacies.

39. Objective #4: Discuss steps, scope, and limitations for possible Tech-Check-Tech in Maryland. Input for Maryland Stakeholders’ Conference Open Discussion- All Participants

40. Emily Jerry Foundationhttps://emilyjerryfoundation.org/