Tech-Check-Tech Programs: What Pharmacists Need to Know

Pharmacy technicians with special certifications are taking on expanded roles in medication delivery. Although most of these responsibilities relate to restocking automated dispensing machines, some programs enable technicians to perform refill verification, and they are also getting involved in medication reconciliation and transitions of care programs.¹

Enhanced workflow models for pharmacies that involve expanded technician responsibilities are under consideration. These expanded technician tasks may allow pharmacists to spend more time on patient-centered activities.² To assume these roles, technicians must have certain certifications and complete routine tests.³

In some hospital pharmacies, new technician roles include drug order entry, checking the work of other technicians, and even dispensing certain medications, though the latter task is usually limited to refills of a limited set of medications.

In some institutions, expanded roles for technicians have enabled the pharmacy to increase productivity and reduce medication errors while providing more time for clinical activities performed by pharmacists.⁴

Tech-check-tech (TCT) programs are authorized by pharmacy boards in at least 9 states. A metaanalysis of 11 studies published since 1978 shows that technicians have comparable accuracy to pharmacists in performing final checks when restocking automated medication dispensing systems.⁵

For instance, the University of Wisconsin Hospital and Clinics implemented a TCT program and recorded a >99.8% accuracy rate for technicians filling unit-dose medication cassettes.⁶

Other pilot programs at Cedars-Sinai Medical Center and Long Beach Memorial Medical Center compared pharmacists with trained, certified pharmacy technicians (CPTs) on checking unit-dose cassettes. The accuracy rates of the CPTs were comparable to those of the pharmacists, and all involved parties met the 99.8% accuracy standard required by California law for a CPT’s ability to fill cassettes.⁷

By some definitions, TCT programs are limited to restocking automated dispensing machines and preparation of unit-dose batches.⁷ However, these programs may include other responsibilities.

For instance, in some programs, technicians photograph the label, diluents, fluid, syringe, and other components used in intravenous preparation, rather than receiving them from a supervising pharmacist. These images are then viewed by a pharmacist in final product verification step, eliminating the need for a pharmacist to be physically present during preparation.⁸

Advanced technician roles may also include taking medication histories. In a recent study, dedicated medication history verification by pharmacy technicians in an emergency department resulted in fewer errors among inpatient medication regimens than the same activity performed by a physician team tasked with taking medication history alongside other responsibilities.⁹

TCT programs are generally limited to the institutional setting and require advanced education and training requirements. These programs are also contingent on ongoing quality assurance tests.⁵ However, TCT programs involving automatic robotic prescription-filling machines have been explored in some independent community pharmacies.¹⁰

A new set of TCT rules were adopted by the Texas State Board of Pharmacy in March 2010. These programs are limited to hospitals with clinical pharmacy programs, and they enable specially licensed pharmacy technicians to check the other work of another technician in filling floor stock or unit-dose distribution systems. Importantly, medications in these systems must have been previously approved by a pharmacist.¹¹

A separate set of expanded TCT rules also approved by the Texas pharmacy board in March 2010 enables technicians in rural hospitals to perform most pharmacist duties without a pharmacist being present. These responsibilities include¹¹:

· Medication order entry

· Preparing, packaging, and labeling prescription medication, with verification performed at bedside by a licensed nurse

· Filling medication carts and restocking automated medication supply systems

In these cases, a pharmacist must be accessible at all times to answer questions, including by phone, and a nurse or pharmacist must be available remotely to verify the activities of the pharmacy technician.¹¹

Some TCT programs in hospitals enable specially trained pharmacy technicians in tightly circumscribed practice situations to perform order verification on medication refills.¹²

In some countries, notably New Zealand, technicians who have taken online classes to achieve “Level 5” status can dispense prescriptions under the supervision of a pharmacist, and even counsel patients on the use of a medication. Similarly, in Wisconsin, some specially licensed technicians may perform the final check on certain medications before they are dispensed.¹³

Some critics view TCT programs as decreasing demand for pharmacists. Acknowledging these concerns, some legislation in the United States specifically states that TCT program implementation may not be used as means to reduce pharmacy staff. Rather, TCT programs are intended to help enable pharmacists spend more time on clinical services and patient-centered activities.¹²

Some pharmacists view TCT programs as an important step toward improving patient safety and working conditions for pharmacists.¹³ But with more pharmacy school openings, falling reimbursement rates, changing health care coverage models, and a trend toward automation across many industries, other pharmacists worry TCT programs are a step in the wrong direction for the profession.

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References

1. Anderegg SV, Wilkinson ST, Couldry RJ, Grauer DW, Howser E. Effects of a hospitalwide pharmacy practice model change on readmission and return to emergency department rates. Am J Health Syst Pharm. 2014;71(17):1469-1479.

2. Jenkins A, Eckel SF. Analyzing methods for improved management of workflow in an outpatient pharmacy setting. Am J Health Syst Pharm. 2012;69(11):966-971.

3. Friesner DL, Scott DM. Identifying characteristics that allow pharmacy technicians to assume unconventional roles in the pharmacy. J Am Pharm Assoc. 2010;50(6):686-697.

4. Kalman MK, Witkowski DE, Ogawa GS. Increasing pharmacy productivity by expanding the role of pharmacy technicians. Am J Hosp Pharm. 1992;49(1):84-89.

5. Adams AJ, Martin SJ, Stolpe SF. "Tech-check-tech": a review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68(19):1824-1833.

6. Reed M, Thomley S, Ludwig B, Rough S. Experience with a "tech-check-tech" program in an academic medical center. Am J Health Syst Pharm. 2011;68(19):1820-1823.

7. Ambrose PJ, Saya FG, Lovett LT, Tan S, Adams DW, Shane R. Evaluating the accuracy of technicians and pharmacists in checking unit dose medication cassettes. Am J Health Syst Pharm. 2002;59(12):1183-1188.

8. O'Neal BC, Worden JC, Couldry RJ. Telepharmacy and bar-code technology in an I.V. chemotherapy admixture area. Am J Health Syst Pharm. 2009;66(13):1211-1217.

9. Cater SW, Luzum M, Serra AE, et al. A prospective cohort study of medication reconciliation using pharmacy technicians in the emergency department to reduce medication errors among admitted patients. J Emerg Med. 2015;48(2):230-238.

10. Walsh KE, Chui MA, Kieser MA, Williams SM, Sutter SL, Sutter JG. Exploring the impact of an automated prescription-filling device on community pharmacy technician workflow. J Am Pharm Assoc (2011;51(5):613-618.

11. Benz A, Sanchez N. Regulating Pharmacy Technicians. http://www.tshp.org/uploads/12-028_Benz_Sanchez_TSBPTechUpdate.pdf. Accessed June 2015.

12. Gabay M. Tech Check Tech: An Overview. Hosp Pharm. 2012;47(6):444-445.

13. Watterson TL. Optimizing Patient Care: Tech-Check-Tech Initiative. http://c.ymcdn.com/sites/www.papharmacists.com/resource/resmgr/Foundation_posters/Taylor_Watterson.pdf. Accessed June 2015.