Changes in Pharmacy

[What_the?]

Not sure if anyone's following along with the proposed changes in legislation for Pharmacy Technicians, but there is a big change underway in the field of Pharmacy and noone seems to know about it. Every single person gets their prescriptions from the Pharmacy, so these changes really are relevant to everyone, so please do take a moment to read this.

I am a practicing community pharmacist, and currently trying to figure out what's going on in terms of this new proposed licensing of pharmacy technicians initiative. Yes, that's right... even as a pharmacist I have no idea what's going on because the people pushing this legislation out are being super elusive about what is going to happen. They're leaving everyone in the dark trying to push this through, and we in the Pharmacy profession barely have a clue about what's going on, let alone the general public who's healthcare will be changing very soon.

First off, some background information. There are 2 main types of people behind the counter in the pharmacy. Pharmacists, and Pharmacy Technicians.

Pharmacists have a minimum of 5 years post secondary education plus several clinical rotations in the community and hospital settings. They are educated on things like Pharmacology, Therapeutics, Biomolecular Pharmaceutical Chemistry, Pharmacokinetics, Toxicology, Anatomy, Physiology, so on and so forth. They are familiar with medical conditions and what goes wrong in your body, what medication is used to treat it and why, what the differences between drugs used are at a chemical level, how the medicine works with your body at a molecular level to provide it's effect, etc.

Technicians currently are trained through a 6 month program through colleges like VCC, MTI, etc. And in some cases do not have any schooling, but are instead just trained on the job.

Normally, Technicians are restricted to the technical components of dispensing (i.e. counting, taking in a prescription, dealing with inventory, billing, etc), and the Pharmacist would deal with clinical issues, drug interactions, recommendations to patients and physicians, answering questions, taking verbal prescriptions from physicians and discussing treatment, etc.

Under the current model, every prescription no matter who types or counts it must be final checked by the pharmacist before it is released. This is not as simple as making sure it's the right pill in the bottle. Along with that, the medication profile must be checked to determine whether or not there are any interactions, therapeutic duplications, other problems etc. For example seeing a patient on multiple blood pressure medicines which can cause hypokalemia may prompt us to check with the patient about blood tests for potassium levels, or if we see a patient who's dose of an antidiabetic medication is increasing, we would be prompted to look into other medication that could affect glucose levels, or talk to them about lifestyle changes etc.

The new proposal is looking to license pharmacy technicians so they would be able to make the final check and release the medication without the Pharmacist seeing what is going out. They would also be allowed to take verbal prescriptions from a physician with limited Pharmacology and therapeutics knowledge which may impair their ability to cross-check what the doctor is prescribing with what is appropriate treatment for that condition. (This is something that I and all Pharmacists do in our heads every time we see or receive a prescription. I can tell just by looking or hearing it what a prescription "should" be used for, and what it shouldn't. Often times we catch mistakes or slips of the mind of doctors this way)

The new rules are looking at making technicians go through a challenge exam, then a licensing exam to get a license, or go through an 8 month course and an exam, then get a license. However, the big problem is although they would have a license which should make them liable for their actions, the stupid part is that the Pharmacist is apparently still liable for the things that the technicians do. So even if the Pharmacist didn't even see what went out because that is "legally" acceptable, if the technician makes a mistake, the Pharmacist for whatever reason is still liable?? <-- I'm still trying to get this cleared up by the College of Pharmacists, but this is my understanding as of now.

Anyways, this seems like a huge cost reduction strategy by the big corporations and the government hospitals to save a quick buck. However, by doing so, they have compromised patient care. I am not opposed to an increase in responsibility of technicians, but what they are proposing is waaay too big of a jump in my opinion.

The point of this whole writeup is to educate everyone on what's currently happening. It has not been totally finalized yet so there is still time to voice your opinion. Ultimately, you are still paying the same for your prescriptions, but soon they could be checked by a Technician rather than a Pharmacist. If you had a grandparent just released from a hospital post heart attack, and they were discharged with 6 different new heart medications and blood thinners... would you be comfortable with a VCC or other community college trained technician looking over those prescriptions? Knowing that they may not know what an appropriate duration of blood-thinning medication would be for a patient who had a bare-metal stent put in their heart, vs. a drug eluting stent. (For the record, I always ask my post-MI patients what type of stent they received to cross-check). Or they may not know whether or not the beta-blocker chosen by the physician has intrinsic sympathomimetic activity or not, or even what that means, or whether that beta blocker is a pure or mixed alpha/beta blocker, and whether it is selective or not. You may wonder why it matters, but for a delicate post-heart attack patient, it does.

Chances are this legislation is still going to go through, and there's nothing we can do. But at least everyone should be aware of what's going on, and try to look for the best pharmacy care possible. Some chains who are big on cost-savings will probably try to load up on certified technicians to save costs. I wouldn't touch those places with a 10 foot pole, since they clearly favor cost-savings over your pharmacy care.

Here's an article about this particular topic from the Vancouver Sun. It might be a little bit confusing when you read it, but it's the same sort of idea.

http://www.vancouversun.com/opinion/...490/story.html

Please feel free to ask any questions and share your thoughts. Hopefully some people who weren't aware about these new changes are now aware and can inform their friends and family too.

[truth]

Great informative read coming from a pharmacist's POV. With just being a few months away from being licensed I can understand the feeling of uncertainty and being protective over our role. From what I've seen, some techs don't even ask if the patient has any questions for new medications going out, which is unsettling. The people who benefit from this the most are the big chains, the same people who are pushing for this program. The chains who are going to jump on these are the same ones that offer large incentives for transferring over prescriptions (which is another topic all on its own).

With what I've read about the qualifications and the short program they need to complete, it is nowhere near the amount of education needed to identify problems with medications. Also, the fact that pharmacists are still liable is bullshit, it defeats the whole purpose of giving the techs more responsibility and liability.

Unfortunately, for most of the younger population without chronic diseases, this issue is completely invisible to them since a good portion of them are not exactly sure what the role of a pharmacist is.

The idea behind this all is that the pharmacist gets more free time to spend with patients and doing more clinical type work, but I have the feeling the big chains won't be spending too much money developing those programs and I hope I'm wrong about that. My opinion is that they should make it a rule to allocate a certain number of hours for pharmacists to be out of the dispensary and do clinical work off site so we don't get the shaft.

Anyways just a few quick thoughts while I procrastinate...

[kitsune]

Speaking from a technicians pov..
I dont feel comfortable with the opposed legislation as it puts a burden..
I mean, comparing 5 years to 6 months is not enough.
Our pharmacy is letting us push through prescriptions on pharmanet but i always get a pharmacist to look over it or print the screen out for them.
Many pharmacists on the board of the college are opposed as it makes them liable for our actions which is completely understandable as we are linked under the pharmacists name.. But as mentioned, its the corporates that are pushing it forward.
Pharmacists wages vs. Technicians.. You do the math
i wouldnt do it unless they tripled my wages since its a huge liability :d
soooo.. Itd just be better to have pharmacists look over the profiles.
I only know what pharmanet tells me an even they sometimes miss things.

Hopefully.. Enough pharmacists intervene so the college will have a board meeting and hopefully doesnt pass.
After all.. Pharmaceutical field is about our patients health and well being~
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[What_the?]

Thanks for chiming in truth/kitsune... I agree that this is a total money-saving incentive for the companies to push this out which puts us all in a bad spot. Although they claim to allow pharmacists to focus on patient care and clinical things, realistically speaking, the workload will become even heavier once they start reducing the number of pharmacists in the pharmacy, and that ultimately will compromise clinical functions anyhow. I have the luxury of working in a pharmacy that has a good amount of pharmacists on at all time, and overlap during the day. I spend lots of time with my patients, answering questions, doing consults, etc. Some pharmacy chains are known to be better in terms of staffing, so hopefully they won't change, and I will continue to work for them and provide my cognitive functions which is the best part of my job I think. I forsee certain other chains who are known to have minimal pharmacist hours, no overlap, and poor working conditions to try to take advantage of this to reduce their costs and increase their gain further... ultimately screwing everyone who works there and deals with them.

As i mentioned before, I am not against an increased role for pharmacy technicians. When the idea first came out, I thought the new role would allow for technicians to help in checking refill prescriptions and such in a limited capacity because those ones would have previously been screened, etc. I supported the idea originally, because this kind of an expanded role would help with workflow in the pharmacy and would indeed allow for me to spend more time with my patients. I also thought that the technician would carry a license and liability insurance and would solely be held liable for the medications they check. However, as I learned more about what they were proposing, it seemed to step further and further away from what I imagined. There was no limit to what a technician could check, and taking verbals from physicians was thrown in, and to top it all off, we were still being held liable?? I am hoping that they will work on the bylaw and adjust the scope of practice a little, but i am doubtful.

I support the idea of pharmacy technicians being able to advance their careers and pay with higher certification because it's ridiculous how in some grocery chains the cashiers up front scanning barcodes and weighing vegetables get paid more than the technicians dealing with people's health and lives with me every day. A good technician makes my job so much easier and less stressful, and i would be totally hooped without the awesome support staff that I have at my current workplace. Most of the technicians that I've spoken to share the same hesitations about this whole thing, and understand that this whole uproar is not directed towards them, but instead to the stupid lawmakers and the people who are looking after the pocketbooks of the corporations.

[fliptuner]

DO NOT WANT!!!

This completely undermines the pharmacists as a whole profession. The college is compromising health for cost. If they allow pharm. techs to challenge the exam, hell, why not just give them licenses once they pass, so they (and the company) can be liable when there's a conflict. The pharmacist shouldn't be liable if they're not even checking what's going out.

[twitchyzero]

interesting..i always knew techs was trying to expand their scope of practice but didnt know the liability would still be on the pharmacist.

Realistically I dont think they will have full liability unless a college (regulatory body) is started for its own profession.

and interestingly enough, there are parallels of expansion on scope of practice happening in medicine with the physician assistants down in the us and in dentistry with dental hygienists...though the latter they have their own regulatory body but with limitations (patients must have seen dentist in the last 12 months and cannot administer local anasthetics without a doctor on site)

IMO 6 months tech training is way too short to expand on such scope of practice...it should be 18 months to even grasp some of the medical concepts.

[Mugen EvOlutioN]

tats a long read lol

[fliptuner]

So I was out for breakfast w/ a friend who's a pharmacist for a big grocery chain. Apparently, the techs all took their tests on Monday and might be dispesing as soon as October.

WTF?

You would think the public would have been made aware of this a looooong time ago.

[vafanculo]

Just a question derived from a point you made. Say I go to a pharmacist with my multiple prescriptions given from my doctor. As you stated sometimes you catch a few errors. What happens next? From a patients pov, the doctors precription would override the pharmacists knowledge, no?
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[fliptuner]

The pharmacist is PROFFESIONALLY TRAINED FOR YEARS IN UNIVERSITY to catch conflicting prescriptions and would probably confer with the prescribing doctor before processing/dispensing the meds.

That's why I have such an issue with techs attempting to do this job.

[What_the?]

Vafanculo, good question! Errors happen all the time, and when they do happen, we will contact the physician to correct the error/ get clarification. When a doctor prescribes something, the pharmacist (being a completely separate profession) has to do their due diligence to protect the patient. This includes refusing to fill certain prescriptions until further clarification or a change is made, or if it is just plain old dangerous and neither doctor nor patient listens, the pharmacist does indeed have the right to refuse to fill it based on their judgement.

Of course, the majority of the time, I will point out the mistake to the patient, let them know what it normally is, or why I am concerned, and they are usually grateful that I caught it and have no problem with waiting until the problem is resolved to pick up their medication. When I contact the physician, they're usually pretty good about resolving the issue and more often than not it is due to a slip of the mind or that they were not aware that another doctor prescribed XX drug and they can't go together, or the patient has some sort of allergy they may not be aware of etc.

I have had one incidence where there was a very old school patient where they brought in a prescription and an interaction was present. I explained the issue and offered to contact the physician to address the problem, but the physician was off, so it would have to wait until the next day... but the patient basically said "oh if the doctor prescribes it, it must be right! Why would he prescribe it otherwise?? Why are you questioning it? Just give me whatever's on that prescription" He made a huge fuss, while undermining our profession/knowledge... but still rather than just giving it to him to get him out of our hair, I refused to fill it... he got pissed... but i told him i swear to god you're at a high risk of a massive, possibly life-threatening bleed if you don't listen... He took the prescription back from me, not before I stamped it with my pharmacy stamp (if he tried to fill it at any other pharmacy they would call me to see what's going on before filling it), and said he'd go tell his doctor tomorrow... next day he comes back, and lo and behold... he was prescribed something else instead...

There is tons of back and forth faxing and calling to physicians that happens all the time at the pharmacy. It often is unnoticed because you only see your final prescription... but I talk to so many physicians on a daily basis that I can recognize their voices when they call in... and alot of the ones in my area know me as well...

Fliptuner: and yes, this whole thing is happening very soon... and I really have no clue why the public and us for that matter have been left in the dark for the most part... As i stated in my original post, it seems way too shady, and honestly if it was made public, I think it would be pretty obvious how it's really just a cash grab for companies... There'd probably be some big public outcry if the general public realized they're going to start having 8 month college trained technicians checking their prescriptions instead of someone with 5 years of university training because of cost...

Even some physicians that i've talked to and have asked me about this have expressed some concern over it. Usually over transcribing accuracy of their verbal prescriptions and being able to ask a quick question about the medicine while prescribing it as well... It would seem like a bother to have them give half of their verbal prescription, then ask a question about the medicine, only to have them put on hold again so the technician can grab a pharmacist, and then have them start all over again...

[Nocardia]

Wow, actually an intelligent conversation on revscene


From a hospital pharmacy perspective, techs already do tech-check-tech and its crucial for cost containment as well as expanding their role. Tech's in the hospital are compensated for the increased responsibility but they are still limited to only technical functions. Pharmacists check every script as it comes but we are fortunate enough to also have nurses check the meds prior to giving it to the patient.

Problems still arise with giving out wrong drugs, its a fact of life no matter who checks the physical drug. Its the pharmacist who ensures that the drug they receive is actually safe by using their knowledge.

Anyways, by having techs do the technical function, it allows me to do clinical work and actually be proactive in catching drug problems before the patient get their meds.

There is plenty of evidence (especially in the ICU world) that for every dollar spent on clinical pharmacy, we save ~$6. Anyways, I am not overly familiar with the community technician proposal but I figure this may be a place to hijack your post and note that Clinical Pharmacists are also pushing for an expanded role in the hospital setting to have prescribing authority. Most patients I talk to are extremely in favor of this and thought it already happened

Anyways, continue the discussion, that was purely an FYI.

I am curious who you people are though If you want to pm me, tell me your name, I may know you!

[R5x]

Good topic.
Lots of changes to pharmacy coming up: 1) Technician regulations and 2) The end of the current interim agreement between pharmacies and the government (Pharmacare). The former will change the practice of pharmacy; while the latter will likely determine the future of pharmacy in terms of employment and the continued existence of some pharmacies (probably needs another thread for that discussion).

Regarding technician regulations, I'm pretty sure the reason why this huge change is moving so quickly and so quietly is because it would likely face heavy opposition if everything was fully disclosed. There are really only a couple parties that stand to benefit from these changes; and you can be sure that patients are NOT one of them. The people supporting this change include our very own College of Pharmacists (which ironically is there to PROTECT the public) and also of course the major chain pharmacies out there.

The College of Pharmacists will be the governing body for the new regulated technicians and they stand to gain A LOT of money from yearly licensing fees from the new regulated technicians once they complete their course and become certified. The number of pharmacy technicians vastly outnumber pharmacists in the province and this is a potential (new) influx of cash for the College. I'm sure there may be other reasons why they're pushing for this change, but it's pretty obvious that money is one very large reason.

Major chain pharmacies also stand to gain from this initiative since staff wages are probably one of the biggest expenses for them. Pharmacists earn pretty decent wages, therefore the company's way of cost-cutting will be to hire regulated technicians instead. Why have multiple pharmacists on staff when you can just have one pharmacist and 1 regulated technician to do the "same" work for much less? To chain pharmacies, this will be a no-brainer and I'm sure the bigwigs in headoffice/accounting have already worked the #'s out in terms of savings to the company. Clinical services and patient care? They don't care about that. Money comes from the # of Rx's filled, and until there is a reimbursement model set up for our cognitive services (clinics, patient counselling, medication reviews, etc.) no time or money will be funneled there.

The real irony of the situation is that even IF the new regulated technicians have not received adequate training in their courses after 8 months or whatever, the burden will fall on the existing pharmacists to help "train" them on the job. Pharmacists will essentially be training their own replacements. This entire initiative has nothing to do with patient care, which is why it's so upsetting to pharmacists that are trying their best to improve the lives of patients.

[twitchyzero]

^ sounds like they'll be cutting the floater pharmacists from the big chains then? ironic because the province's only pharmacy school is expanding their admission intake by almost 50% in the fall 2011 for those that are not aware yet.

[What_the?]

Hey Kb08, are you a member of the UBC Pharmacy Facebook group? there's currently a discussion going on over there, and there are some people who are opposed to the fight against regulation because they think it'll be great for cognitive services for pharmacists... Can you post what you posted here up over there? I think they may not be aware of the reality of the situation since they are new grads and haven't started working yet. But your post illustrates the reality of it perfectly

[Jermyzy]

What I don't understand, is if the tech has power to take verbal prescriptions and to check certain prescriptions, why the pharmacist is still liable for it...

Originally Posted by What_the?

Hey Kb08, are you a member of the UBC Pharmacy Facebook group? there's currently a discussion going on over there, and there are some people who are opposed to the fight against regulation because they think it'll be great for cognitive services for pharmacists... Can you post what you posted here up over there? I think they may not be aware of the reality of the situation since they are new grads and haven't started working yet. But your post illustrates the reality of it perfectly

Yeah...they'll have lots of time to perform cognitive services...since there won't be any job openings for them when they graduate

[truth]

Thanks for bringing this topic up in the FB group. For students who want to practice pharmacy in the ideal world - the wool has been pulled over their eyes. It's time for them to realize how difficult it really is and things aren't the way they teach us in school. The sad truth is, money is always the driving factor in the eyes of head office.

[What_the?]

Originally Posted by Jermyzy

What I don't understand, is if the tech has power to take verbal prescriptions and to check certain prescriptions, why the pharmacist is still liable for it...

I know! somewhere the logic fell through on that one...

Originally Posted by Jermyzy

Yeah...they'll have lots of time to perform cognitive services...since there won't be any job openings for them when they graduate

well said... well said... hahaha you can indeed only practice cognitive services if you have a job to practice it at...

[dmo]

this is such a huge topic lol. Here I am procrastinating to study for my pharmacokinetic exam tomorrow and I see this thread. hahaha i'll definitely chime in sometime after I'm done.

but another huge issue to discuss in another thread: Ontario...0_o

[What_the?]

^ohhhh man... don't even get me started on ontario... hahaha

[gen5accordv6]

I heard that its pretty hard now to get a full time job for a licensed pharmacist. I guess big corporations are tigthing their hirings already?!

[What_the?]

i'm not completely sure about that... i'd imagine the new grads may have a bit more difficulty finding a job in their dream spot, but i'm sure they'd be able to find a job... ultimately it's just a matter of where... they may have to work out of town or for a different company than they hoped for, but i guess sacrifices must be made in these times

[truth]

Definitely not as open as I thought it'd be, so much has changed even in just the past year with the number of new grads companies are hiring. Many of the big chains reserve spots for students who have worked for them in the past. Things will open up if you wait, it's just the matter of being willing to take the risk waiting or take the offer that's in front of you.

[gen5accordv6]

Talking about cost cut, not sure about other pharmacies, but i know most Choppers now only have 1 pharmacist in attendance.

Just curious, where do you guys look for job postings? My friend has been looking for a full time for more than few months now.

[achiam]

Originally Posted by What_the?

The new proposal is looking to license pharmacy technicians so they would be able to make the final check and release the medication without the Pharmacist seeing what is going out.

Are you kidding me?! No offence to techs but I have worked with some "certified" techs I wouldn't trust to wash my car -- I would trust the Pharm student techs much more!