Advanced Roles for Pharmacy Technicians: PPMI Update and Pharmacy Technician Law Review

1. Advanced Roles for Pharmacy Technicians: PPMI Update and Pharmacy Technician Law Review John B. Hertig, PharmD, MS, CPPSAssociate DirectorAssistant Clinical Professor of Pharmacy PracticeCenter for Medication Safety AdvancementPurdue University College of PharmacyIndianapolis, IN September 19th, 2014

2. Disclosure Statement • None of the presenters have actual or potential conflicts of interest in relation to this presentation

3. Learning Objectives • Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana • Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles • List at least two examples of advance pharmacy technician roles in various practice settings

4. Learning Objectives • Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana • Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles • List at least two examples of advance pharmacy technician roles in various practice settings

5. First Things First • Audience response: how many of you have heard of the ASHP Pharmacy Practice Model Initiative?

6. Why Change? • Professions must continually assess their practice to determine whether expertise is being maximized • Healthcare reform • Increased emphasis on quality and safety • Social and economic influences • Pharmacy practice changes • Doctor of Pharmacy degree • Residency training

7. Why Change? • More patients, increased demand • Payment tied to performance • Move away from fee-for-service payments • Challenge to US health care system to improve quality and cost effective care • Meanwhile…pharmacists recognized as: • drug therapy experts • medication use process experts • Better Care! AJHP 2009;66:713

8. Impact • All these factors have combined to drive critical discussions regarding change within the health-system pharmacy profession • Where do we go from here…? What is our professional future?!

9. Our Future. Now.

11. The Purpose of the PPMI • Describes how pharmacy department resources are deployed to provide care • One size does not fit all • Does include: • How pharmacists practice and provide care to patients • How technicians are involved to support care • Use of automation/technology in the medication use system AJHP 2010;67:542

12. PPMI = Practice Advancement

13. Considerations for All of Us • “The capacity of 1” • How much can we do with limited resources? • Where do our priorities lie? • Ensuring we practice at “the top of our license” • Ensuring the best care across ALL practice settings • Hospital, ambulatory, long-term care, community, and so on… • Teamwork is essential!

14. Where is Indiana?

15. PPMI in Indiana • Indiana Pharmacy Practice Model Taskforce • Indiana Society for Health-System Pharmacists • Steering group for hospital practice model change • 13 members • Step 1 : focus on completion of Hospital Self-Assessment (HSA) • Provides current practice data for Indiana • Allows for identification and dissemination of advanced and “lagging” pharmacy practices

16. ASHP Foundation Grant • Step 2: identify practice priorities and begin implementation • Grant awarded in February 2013 • Workshop held May 23rd 2013 • 50 attendees from across Indiana • Established consensus opportunities and priorities • Helped develop a state affiliate strategic plan for advancing pharmacy practice • Workshop results communicated • Task force: steering group responsible for implementation

18. PPMI Impact: Advancing the Pharmacy Technician

19. ASHP Technician Initiative To develop an educated, trained, certified, and registered pharmacy technician workforce in every state in order to improve medication use safety and expand access to the patient care services of pharmacists. Our hope is to achieve this mission through a partnership between ASHP and state affiliates, with a mutual goal of advocating... *ISHP Board voted unanimously to join in November 2013

20. Going to the Source

22. New Pharmacy Technician Law

23. SEA 233 Overview • Changes pharmacy technician “registration” to licensure • Formally establishes a technician license in the statute • Began July 1, 2014 • Requires high school diploma or graduate equivalency degree • Outlines requirement for minimum standards that all employer-based training programs must meet • Developed by Board of Pharmacy by July 1, 2015 • All programs must be resubmitted for approval with newly developed standards • All technicians licensed prior to July 1, 2015 are “grand-fathered” into old requirements

25. “Unless someone like you cares a whole lot, nothing is going to get better. It’s not.” - Dr. Seuss

26. Learning Objectives • Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana • Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles • List at least two examples of advance pharmacy technician roles in various practice settings

27. Melynda Ludwick, BS., RPh Program Director IU Health Pharmacy Technician Program Methodist Hospital, Indianapolis Pharmacy Technician Education and National Certification

28. Pharmacy Technician Education • Traditional pharmacy technician training was on the job • ASHP began accrediting Pharmacy Technician education programs in 1983 • IU Health’s Pharmacy Technician Program began and was initially accredited in 1999 • Today: 258 ASHP accredited programs

29. ASHP-Accredited* Pharmacy Technician Training Programs Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP *PTAC will begin accrediting in 2015

30. Number and Type of ASHP-Accredited *Pharmacy Technician Programs *PTAC will begin accrediting in 2015 Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP

32. Why is Education Important? • Pharmacists are “working at the top of their license” • Pharmacy technicians are taking on more job responsibilities including more clinical functions • Pharmacy technician job growth from 2012 to 2022 is expected to be 20% according to the Bureau of Labor Statistics http://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm

33. National Certification • Two types of national certification recognized by the Indiana Board of Pharmacy • ExCPT : National Healthcare Association • PTCE : Pharmacy Technician Certification Board • PTCB • Established in 1995 by APhA; ASHP; IL Council of Health-System Pharmacists and MI Pharmacists Assoc.; NABP joined in 2001 • In 2006, PTCB became accredited by The National Commission for Certifying Agencies (NCCA)

34. PTCB Exam Content

35. Requirements for Taking Exam • Criminal background check required in 2014 • Note: Any felony conviction, drug or pharmacy-related violations, or State Board of Pharmacy action taken against license or registration must be reported at the occurrence and at the time of recertification to the PTCB • ASHP-accredited pharmacy technician education required by 2020 Postponed to an undetermined date - personal communication

36. Ultimate Goal • A well-qualified and trained workforce • Improved patient safety • Standard knowledge base in technician workforce • Trained technician workforce can assume more pharmacy-based technical tasks • Less turnover in pharmacy technician positions Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP

37. Activities of Pharmacy Technicians Traditional functions Non-traditional functions Slide Courtesy of Erika L. Thomas, M.B.A., B.S.Pharm. ASHP

38. Learning Objectives • Describe recent proposed legislation on the licensing of pharmacy technicians in the State of Indiana • Discuss environmental factors and other practice forces that are highlighting the need for advanced pharmacy technician roles • List at least two examples of advance pharmacy technician roles in various practice settings

39. Advanced Roles for a Pharmacy Technician Liz Swan, CPhT Order Set Specialist Investigational Drug Technician IU Health Pharmacy Indianapolis

40. Shaping a pharmacy technician advanced role

41. Evolution of an Order Set 1.) Request Received 2.) Regimen Verified 3.) Order Set Drafted 4.) OncPOG Review 5.) Final Draft Created 6.) Sent to Pharmacist for Review 7.) Physician Review and Signature 8.) Submitted to Informatics Pharmacist for PCO Build 9.) Pharmacy and Physician Validate Build 10.) Order Set Posted to IU Health Intranet and Activated in PCO One Step at a Time…

43. 12 is the magic number 8 Pharmacists 2 Physicians 1 Nurse 1 Certified Pharmacy Technician 12 is the number of people who review an order set before it is built in Powerchart Oncology It Takes a Village

44. Advanced Roles for a Pharmacy Technician Andy Galligan, CPhT Distribution System Supervisor Community Health Network Indianapolis

45. Medication Reconciliation Technician What is medication reconciliation? As defined by The Joint Commission: Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking 1) Develop a list of current medications. 2) Develop a list of medications to be prescribed. 3) Compare the medications on the two lists. 4) Make clinical decisions based on the comparison. 5) Communicate the new list to appropriate caregivers and to the patient.

46. The Patient Interview • Courtesy is KEY (knock before entering) • Privacy- DO NOT discuss a patients medications in front of family/visitors without the patient’s permission • SMILE • Make eye contact • Introduce yourself • Let the patient know what you are there to do • End with “Is there anything else I can do for you… I have the time!” • Remember you may be the only “face of pharmacy” this patient/family sees-you’ve got to be on your game at all times • What is a medication? According to the patient?

47. The Patient Interview • Allergies- This may be the most important information on the medication list • “Do you have any allergies to medications?” • “What happens when you take this medication?” • “Do you have any allergies to latex?” • “Do you have any allergies to IV contrast dye?” • “Do you have any allergies to food?” • Patients Preferred Pharmacy • Include all the medications (OTCs, etc)

48. The Patient Interview • Barriers to Obtaining an Accurate Medication List • “I take a pink pill for my heart.” • “My doctor just changed my medications around and I don’t know what I am taking.” • “My wife always takes care of my medications.” • “Here is my pill box-this is what I take everyday.” • Patient does not speak English

49. A technician safety success story • Safety Success Story • CHN technician discovered a loading dose of vancomycin was ordered on a patient in the hospital • From “digging a little deeper” the technician discovered that patient was already receiving vancomycin via home health care • Loading dose of vancomycin was not given and dose was adjusted • Avoided excessive vancomycin dose

50. Medication Assistance Program A new pharmacy technician position to help patients navigate the process of obtaining “free” drug through manufacturers and other various resources Red Tape Access To Medication Patient