Pharmacist-Technician Ratios Require More Evaluation

Further research is needed to pinpoint a technician-to-pharmacist ratio that best ensures patient safety and quality care, commentary published in the November-December 2014 issue of the Journal of the American Pharmacists Association suggests.

A team of pharmacists from the University of Tennessee Health Science Center in Memphis became interested in the topic after the Florida State House of Representatives passed a bill in April 2013 that revised the pharmacy technician-to-pharmacist ratio from 3:1 to 6:1. In the Florida State Senate version of the bill, legislators considered increasing the ratio 6-fold without approval from the Florida Board of Pharmacy.

Although that legislation was not passed into law, the debate over pharmacy staffing ratios was renewed in the state’s 2014 legislative session. That year, the Florida House of Representatives’ bill amended by the Florida Senate did pass into law, which states that a pharmacist can supervise more than 1 technician only if the authorized under the guidelines set by the Florida Board of Pharmacy.

According to a previous study from the University of Arizona Tucson College of Pharmacy, increased pharmacist workload, prescription volume, and total pharmacy staffing are linked to significantly more dispensing of drugs with potential drug—drug interactions. Similarly, a nationwide survey of Certified Pharmacy Technicians (CPhTs) identified staffing issues as a major factor of medication-preparation errors.

The authors of the current commentary called attention to the significant implications such safety risks can have on patients, especially when the actions of pharmacy technicians under a pharmacist’s supervision go awry. For instance, they cited a well-known case in which an Ohio pharmacist served jail time and had his license revoked due to pharmacy technician misconduct.

In addition to patient safety risks, the researchers highlighted the dangers of drug diversion, noting that “unlimited staffing ratios decrease the level of supervision the pharmacist can provide to prevent and detect diversion.” The legal consequences of those errors have intensified concerns about increasing the technician-to-pharmacist ratio without sacrificing safety and quality standards, the authors said.

“As pharmacy practice evolves, pharmacists must continue to advocate for quality and safety while increasing efficiencies in the provision of health care,” the researchers wrote. “Pharmacists and leaders within the profession must continue to collaborate with legislators, focusing on safety and quality as the foundation for decisions affecting practice.”

In response to the political turmoil in Florida, the Tennessee Board of Pharmacy decided to address the issue in 2007. Prior to that year, the state’s technician-to-pharmacist ratio was 2:1, but had the potential to increase to 3:1 if at least 1 of the participating technicians was a CPhT. Today, the state’s ratio is 2:1 with potential for the pharmacist-in-charge to increase it to 4:1 based on public safety considerations and the addition of CPhTs.

“When addressing the issue of staffing ratios, the challenge is finding the balance between providing the pharmacist necessary operational and dispensing assistance while not overpowering the pharmacist with too many staff to supervise,” the authors concluded. “From investigating staffing ratios specific to different types of pharmacies to understanding the needs of different states, further research is warranted. Identifying risks and potential solutions related to staffing ratios and pharmacist workload could provide guidance to pharmacy corporations and government agencies to develop metrics to promote patient safety and operational efficiency.”