[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/Improving+services+cutting+costs/2909490/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 :p
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...

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 :lol

[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?]

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...


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

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]

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!

[SiRV]

In Denmark in the 1990s, regulatory changes were made to transfer several functions of community pharmacists to pharmacy technicians by creating a brand new career called "pharmaconomists". Danish community pharmacists never came to terms with these regulatory changes and they did not stop this professional crisis.(1). What happened since then?
• Community pharmacists largely replaced by pharmacy technicians (pharmaconomists)
• Pharmaconomists perform almost all the functions of pharmacists including counselling
• Only 15% of pharmacy graduates are employed in community pharmacies.
• The average pharmacist: pharmacy technician ratio is 1.8 : 13.2.
• Pharmacies allowed to operate without the presence of a pharmacist(2).
• Very few developments for the role of community pharmacists for the last 20 years, so community pharmacists still trying to define their identity, dealing with issues about third-party paid cognitive services, while pharmaceutical care is still not evident in practice(3).

Similar things are happening here in Canada. A brand new job called 'Regulated Pharmacy Technician' is created. The difference is that the pharmacy technician program in Denmark is 3 years long whereas the accredited regulated pharmacy technician program in B.C. is 8 months long.

The College of Pharmacists of B.C. (CPBC) has proposed to transfer most of pharmacists' dispensing responsibilities to regulated pharmacy technicians. The extended scope of practice for regulated pharmacy technicians include final checks and the receipt of verbal orders (For detailed information, go to www.cpacbc.com). An 8-month program is not adequate for this extended scope of practice for regulated pharmacy technicians. In comparison, the length of certified pharmacy technician programs in U.S.A. is usually longer than the one in B.C.. American pharmacy technicians also must pass a national exam to be certified. Yet, certified pharmacy technicians are not allowed to perform final checks in any of the states and not allowed to receive verbal Rxs in many states.

The transfer of final checks and the receipt of verbal orders particularly concerns many community pharmacists in two areas:

1) Liability issues: The CPBC states that pharmacists are still responsible for ensuring the appropriateness of the Rxs and providing consultation. How well can a pharmacist ensure the appropriateness when Rxs are received, processed, prepared and final-checked by pharmacy technicians? Even if regulated pharmacy technicians carry their own liability insurance, customers will sue you for technicians' errors because you are THE PHARMACIST, supervising pharmacy technicians. By the way, do you know that it can cost you up to $30,000 just to prove that you are not liable when you are sued?
2) Public safety issues: What would you want if you are a customer? Your Rx being checked twice (while processing and doing the final check) by a pharmacist with 5 years of university education or your Rx being processed and checked by a regulated pharmacy technician with 8 months of training? The CPBC, whose mandate is to protect the public, is actually putting the public at risk.
What are the implications for the future of community pharmacists?

Job Loss There are some pharmacists who believe that this regulation will free up a pharmacist's time for more counselling and clinical services. Since there are very few 3rd party paid cognitive services available, pharmacies will not keep their pharmacists to provide free or almost free cognitive/clinical services.

Further deterioration of working conditions Pharmacists who manage to keep their job will see the deterioration of their working conditions. Since there will be few employment opportunities available, you will end up accepting whatever your employer demands. Wage rollbacks, no breaks, long commutes to work, floating between stores, mean bosses and co-workers might be some of thing you have to put up with just to keep your job.

Conflict of Interest The CPBC predicts after regulation of pharmacy technicians starts:
"Pharmacists would be the minority in a "College of Pharmacy" (White Paper on Pharmacy Technicians by CPBC (http://www.bcpharmacists.org/library/A-About_Us/A-8_Key_Initiatives/5072-White_Paper_Ptech.pdf))

Currently, there are 4,000 pharmacists (2,800 community pharmacists) and about 12,000 pharmacy technicians in B.C.. The CPBC decided to regulate pharmacy technicians for their own gains (revenue increase), but they are in a 'conflict of interest' position. How can an organization represent two groups of people who will constantly have conflicts over responsibilities, employment, etc.? The CPBC has been trying very hard to reach out to pharmacy technicians to make them interested in becoming regulated for the past several years. Isn't it obvious to you whom the CPBC will listen to when a conflict arises?

What can you do to protect your career and the health of the public?
Chain drug stores currently dominate regulatory bodies (e.g. CPBC) and national and provincial pharmacy organizations (e.g. BCPhA). This is posing a serious threat to the careers of community pharmacists. BCPhA is no longer an advocacy group for pharmacists. It is rather a trade organization that acts in the best interest of chain drug stores. The job market is also dominated by chain drug stores. Currently, 80% of community pharmacists are employed by chain pharmacy. All these problems tell us one thing. Community pharmacists urgently need an advocacy organization that represents their real voice. Without pharmacists joining forces, there will be no future for community pharmacists. Taking responsibility and proactive steps for your career is the only way to protect your career and ensure the public safety. Otherwise, your career will continue to be shaped and directed by corporate interests with little input from you. Petition letters have been sent to the board members of the CPBC, the Health Services Minister, some MLAs, the dean of the faculty of pharmaceutical sciences of UBC. UBC pharmacy students also sent a petition letter to the CPBC (go to www.cpacbc.ca for details).

We, Community Pharmacists Association, welcome advances and innovations in pharmacy practice. However, our responsibility of ensuring the safety and efficacy of medications at the dispensary should not be left in the hands of regulated pharmacy technicians with 8 months of training.


References
(1) Pharmacy World and Science, Vol. 23, No. 4, August 2001.
(2) C P J / R P C • N ov e m b e r / D e c e m b e r 2 0 0 6 • Vo l 3 9 , N o 6, Pg. 54
(3) Journal of Clinical Pharmacy and Therapeutics, Vol. 28, Issue 4, 311-318, August 2003
.

[kitsune]

Hey revsceners!

There's a petition against the regulation of pharmacy technicians..
If anyone feels strongly about this issue, please sign and let your friends/colleagues.. etc know.
http://www.gopetition.com/online/34742.html

Also for the pharmacists, the CPACBC is trying to hold a special general meeting regarding this issue. Please sign your consent and send the form to the group.
I believe they need at least 10% of the pharmacists. Please support!

[kitsune]

bump!
Read about the current situation and sign the petition guys~
Spread the word to everyone~

[xzman]

I am well aware of this situation from both perspectives. one of my best friends is a pharmacist (has been for 15 years) and supports the idea. i think the misconception is that people think the techs will be doing the pharmacists job overnight. obviously no pharmacist in their right mind will hand over prescription sign offs to a tech if they're fresh out of school etc. the pharmacist is the one who is ultimately responsible for the actions of the techs so on that note, will not proceed with assigning the duties unless they are comfortable in doing so. just because the regulated techs have the ability or authority to perform the new task doesn't mean they automatically entitled to do so.

[xzman]

if i am not mistaken - i very well could be on this part. pharmacists although are in university for five years, the first two are general sciences upon which they apply into pharmacy. at that point it's two years of schooling then a one year clinical. pharm techs under the new government regulations have a minimum 8 month course and have to pass the government regulatory exam before they can become a regulated tech and possibly assume any further responsibilities. any current certified tech must take the regulatory exam (and bridging courses if necessary) as well if they want the government license. it's not just handed to them. personally i believe all techs should at least be certified - i know of a couple non-certified techs and like one of the other comments, wouldn't trust them to wash my car let alone handle a prescription.

[R5x]

I am well aware of this situation from both perspectives. one of my best friends is a pharmacist (has been for 15 years) and supports the idea. i think the misconception is that people think the techs will be doing the pharmacists job overnight. obviously no pharmacist in their right mind will hand over prescription sign offs to a tech if they're fresh out of school etc. the pharmacist is the one who is ultimately responsible for the actions of the techs so on that note, will not proceed with assigning the duties unless they are comfortable in doing so. just because the regulated techs have the ability or authority to perform the new task doesn't mean they automatically entitled to do so.

It's not a matter of whether or not a PHARMACIST will allow a tech to check prescriptions overnight. It's what the EMPLOYER will force/allow a regulated tech to do, and when they will be expected to do it. The point we are arguing is that the employer will force the responsibility onto the regulated tech simply because that's why they were hired in the first place. An easy way to force the responsibility onto them is that the company will replace the hours of a pharmacist with a regulated tech. So now you have one pharmacist, one (or more) regulated techs and other non-regulated techs. The sheer volume of Rxs to be checked will already dictate that the regulated tech will have to check the Rxs to prevent workflow disruption. The fact that regulated techs will likely be paid more than regular techs ensures that they will be expected to perform their new duties. No employer in their right mind would pay MORE for a regulated tech if they're not getting MORE out of them. No employer would be that stupid.

Even IF you are correct and the changeover does not occur immediately, the point is that it WILL occur. If not now, then what happens 5-10 years from now when there are more regulated techs? The bottomline is that eventually pharmacists can/will be replaced once this initiative is passed. I didn't go to pharmacy school to be replaced within 5-10 years.

if i am not mistaken - i very well could be on this part. pharmacists although are in university for five years, the first two are general sciences upon which they apply into pharmacy. at that point it's two years of schooling then a one year clinical. pharm techs under the new government regulations have a minimum 8 month course and have to pass the government regulatory exam before they can become a regulated tech and possibly assume any further responsibilities. any current certified tech must take the regulatory exam (and bridging courses if necessary) as well if they want the government license. it's not just handed to them. personally i believe all techs should at least be certified - i know of a couple non-certified techs and like one of the other comments, wouldn't trust them to wash my car let alone handle a prescription.

Pharmacy is a total of 5 years in university. The first year is general sciences. The 2nd year is a mix of anat, phyl, bioc + pharmacy courses. The last 3 years are all pharmacy courses.
As far as 'clinical', that is present for the latter 3 years when we take pharmacy courses exclusively (therapeutics, labs, clerkships, etc.).
When we're done the curriculum, we have licensing exams (which is what I'm currently studying for now).

I have no beef against techs being certified. What I have a beef with is the scope of practice they are allowed to work within once they are certified. There IS a role for certified techs. But that role should not include the final check for Rxs, which should always remain with a pharmacist who is trained for this.
I haven't read the wording for the responsibility for a while, but from what I previously understood, the pharmacist will not LEGALLY be responsible for errors for Rxs that were prepared by a regulated tech. But even still, there is an 'assumed' responsibility by the public already that if there's a mistake, the pharmacist is the one in charge and the one to blame. No pharmacist in their right mind would say: "I didn't do it, the tech did it. Go bug them about it...." So really, the pharmacist is fucked either way.

[xzman]

I have no beef against techs being certified. What I have a beef with is the scope of practice they are allowed to work within once they are certified. There IS a role for certified techs. But that role should not include the final check for Rxs, which should always remain with a pharmacist who is trained for this.
I haven't read the wording for the responsibility for a while, but from what I previously understood, the pharmacist will not LEGALLY be responsible for errors for Rxs that were prepared by a regulated tech. But even still, there is an 'assumed' responsibility by the public already that if there's a mistake, the pharmacist is the one in charge and the one to blame. No pharmacist in their right mind would say: "I didn't do it, the tech did it. Go bug them about it...." So really, the pharmacist is fucked either way.

i am not disputing that a tech should not have final responsibility in checking scripts because yes, that would be insane and possibly put the publics health at risk. but i do agree with their scope being widened - as long as they have the credentials to back it - in their horizons of responsibilities being broadened. all colleges offering pharm tech programs are under review in their accreditation to see if they are in line with the possible changes as new standards have to be met. i personally don't think any pharmacy will put a noob in charge of final script checks and i would trust that any pharmacist that bore witness to such practice would immediately raise a concern to have a more qualified person step in, including themself

[Nocardia]

I wanted to revive this thread to see if anyone is actually out there and still interested in the discussions.
In dec. 2009 the CSHP (basically the society for hospital pharmacists - MUCH different than community pharmacists) will begin the long journey to try and have hospital pharmacists prescribe medications in the hospital. Its not something that occurs overnight or over a year or 2, but the process is underway...more likely 5-10 years but its a start.

I also wanted to note that there are more and more pharmacist who undergo an extra year called "residency" in order to enhance their clinical knowledge so it is technically a 6 year program and is almost becoming a requirement for any new pharmacist in the hospital setting.

Thoughts? Concerns?

[LanEvoMR]

Most of the time pharmacists know a hell of a lot more about medications than doctors do. As a health professional I totally agree with the movement towards hospital pharmacists being able to prescribe medications. Doctors would still be doing what they are trained to do: diagnosing.

[TripleSoul]

1 year science and then 4 more years seems a bit overkill to be working in the community IMO. If they started teaching you therapeutics and had labs since day 1 (leaving a lot of the BS courses), I think it can be shortened by a bit.

But since we are training pharmacists 5+ yrs, its fair to give them more responsibility. The only problem is reimbursement. New initiatives like medication management is now being tested by the government across the province.

In the hospital, a residency is definitely helpful and will help you in your career as a clinical pharmacist. My thoughts is that prescribing authority would be a great idea. However, it would take a long time, if ever for that to be implemented. There will be changes for sure, but you can only speculate at this point.

[What_the?]

Looks like we may have our first round of certified technicians checking your prescriptions coming out starting April 2011 or so.

One of the technicians that I work with is currently finishing her "certified technician upgrading courses"... However at times she'll ask me questions like "what are the differences between these two drugs? or what is this used for?" I try to teach her as much as I can, since she'll have lives in her hand soon, but of course she's not expected to know everything out there. It's difficult to assess therapeutic appropriateness of a prescription if you're not familiar with the usual dosing for a particular condition, or if you don't really know what the drug is for... *sigh*

Some things I did at work today to earn my pay for the day:

-looked at a prescription for 120mg of Nifedipine XL daily and thought "weird... the dose is so high.." The computer doesn't catch this... My "what the heck" radar caught this...

-same thing with an unreasonably low starting dose for a new heart medication for a patient... "what the heck? so low... must... call... doctor..."

-seemingly healthy lady came in with a prescription for high dose levaquin (antibiotic)... "what the heck" radar goes off as i'm looking at it... so I go talk to the lady... After asking about her situation, learn that her GP has been trying to treat her chest infection with multiple antibiotics and some antifungals with no luck... based on the fact she's using it for a treatment resistant infection, and judgement, even though dose was at the upper end of the spectrum I would consider it reasonable... selection of this particular antibiotic was reasonable, being a strong respiratory fluoroquinolone... continue filling prescription...

-got a call from a gentleman who didn't understand the side effects of one of his heart medications, and swore it was dropping his blood sugars making him feel light headed and dizzy... I told him that medication masks the symptoms of hypoglycemia, but doesn't really drop his blood sugars... his dizziness was more likely a result of a drop in blood pressure which this medication can cause... Asked if he should be continuing his medication, and i explained to him this medication normally can be used to slow the heart, and to drop blood pressure... but because he's previously had a heart attack, in his case he's on it for mortality reduction... I explained some of the findings of clinical trials to him, whereby patients post heart attack on this medication would have a better chance of long term survival than those not on it... Clarified the situation with the patient who then proceeded to bug me for a free "healthy eating for diabetes" book...

-explained a drug interaction between dronaderone and clarithromycin to a doctor who wasn't aware that one existed... Dr. wanted to switch to amoxicillin instead... based on the condition the patient was in, I prompted the physician "what about some amoxi-clav instead since the infection doesn't seem so good? might be a better choice than amoxicillin... " (amoxi-clav has an extra component in it to fight against bacterial resistance, and usually used for more problematic infections such as this one)... Dr. switched Rx to amoxi-clav.

And these are only the things that come to mind for today... not to mention the countless times I have to remind people not to take their crestor with milk products, or why you can't eat grapefruits and have your viagra at the same time....

Next time you have a health/drug related question, if you've never tried before, I would recommend you visiting or calling your local pharmacist. Get to know them, see what they do, see what they know, ask for a recommendation... You may be surprised what's hiding in there when you pick their brains... Come talk to us before they try to replace us with robots! If you can find a pharmacist that's willing to take the time to talk to you and answer your questions, you should try to develop a good relationship with them. You'd be surprised how many people they remember. I know I remember the majority of people who come to my store regularly... I have had patients come see me each year for allergies, saying "oh, we had a discussion about my daughter's allergies last year, and this is the situation now... what should we do now?" We talked, made some changes to the strategy this year, and sent her on her way...

I realize I'm ranting now... time to stop

[Inaii]

I'm curious about something, how do you tell if the person is a pharmacist or a pharm tech? It would say on their name tag correct? The reason I ask is one of the gentleman working at the Shoppers by my work (which is where I currently fill my prescriptions if I'm not near Old Orchard) simply handed me my prescription and didn't explain anything to me. This was one I had never taken before and wasn't sure if it would react with other medication I was on (I always read the piece of paper it comes with, but honestly, sometimes I don't know if my medication is in there or not). Is this something a pharm tech would do? Or was it a case of a pharmacist who simply was too busy/didn't care?

Sorry for interrupting the discussion, but I figured this would be a good place to ask since you're already discussing them taking on new responsibilities (fyi I believe this was back in September).

[What_the?]

Hey Inaii,

Usually a nametag would distinguish the two types of people. At Safeway however, they try to make it a bit more obvious. Only Pharmacists wear White labcoats, whereas technicians wear red labcoats. So it's pretty easy to tell for them.

At Shoppers it's a little tougher because i don't think they are too strict with their dress code. For the most part, the person wearing the white labcoat is the pharmacist, and the technicians at Shoppers usually don't wear a labcoat at all. The exception would be Pharmacy Interns. So if they're students, they may still wear a labcoat, but if they're in their earlier years of study they may not know enough to counsel you yet.

If you were just sent off without counselling, usually it would be a pharm tech who can't counsel, and just sends you off. They may not have known it was new for you, or you may be right and they may have been busy.

Legally it's their duty to make sure everyone taking a new medication gets proper counselling and the opportunity to talk about questions or concerns. If you feel like your pharmacy is more concerned with putting out your drugs and getting you to pay and leave as opposed to actually being concerned about your health and well-being, then I highly recommend you switch to a new pharmacy. It is true, some pharmacists are jaded and don't care, but there are also just as many that will go above and beyond to make sure their patients are ok. A good test would be to just go to a pharmacy near you and ask a reasonable health question that takes more than one word to respond to. If the pharmacist takes the time and effort to talk to you and explain things to you, you know they're a keeper. If they give you short answers and try to brush you off, then maybe not.

You may think you're young, and don't have many medical problems, so it doesn't matter... but that's not true. The drugs you get are the same everywhere, and the money you pay is about the same... so why not get the best care possible?

Here's an example that happened to me at work TODAY actually:

Young girl in her twenties came in for some medication for a Urinary Tract Infection. She says she gets them quite often, but I still like to talk to my patients anyways. I start telling her about all the usual things with the antibiotic, and ask about her symptoms. I tell her that this antibiotic is ok for normal UTIs, but to watch out for fever and for any signs of pain in her back, as that can be a sign that the infection has spread to her kidneys. If so, this would not be useful. She then pauses and tells me "oh... actually I do have pain in my back"... I tell her to show me where, and she points to right where her kidneys would be. I tell her she should go to a doctor right away, and she asks if she could just take this anyways. I explain the mechanism of the drug to her, and that there's very poor tissue penetration with the drug. It collects in the bladder, and works downwards, not upwards at the kidney. She tells me she may not be able to go in to see a doctor today because she has class. I tell her that the inflammation from a kidney infection can cause damage to her kidneys which is baaad. I tell her i'll call across the street and see if the doctor there will take her in to see her quickly because i know them on a professional basis, and if it's urgent they'll usually help me out. I call twice, but they weren't open yet. She understood the severity of the situation at least, and said she wouldn't take the antibiotics right now from me, and go make sure she sees a doctor instead. I tell her to make sure she does that, and then she goes on her way.

So in this situation, all the work filling the prescription, and time spent explaining things to the patient, and the phone calls I made for her didn't even end up with a sale since I told her not to take it. But as a health professional, this intervention made my day because I know I made a difference for her and may have potentially saved her from IV antibiotics in the hospital and kidney damage. This is what your ideal pharmacy experience should be like. If you can't trust your pharmacist to have your back, then you need to go elsewhere. I'd gladly tell my patients not to pick up their meds even after I go through all the work filling it if it is inappropriate, whereas there may be other places who want to rack up the numbers and may not be so happy if you change your mind after all the work is done.

Good luck finding a pharmacy that works for you Inaii! Posting this actually reminds me that I have to follow up tomorrow and call my UTI patient to make sure she actually did end up seeing a doctor!

[Inaii]

Thanks for the reply What_the? :) The pharmacy I usually go to, the pharmacists there are amazing. I've been going there for years simply because the two of them are always so helpful and even if they're busy if I have questions they take the time to explain everything.

It's nice to know there are pharmacists like you who actually care about the patients :D

[littledog]

Hey Inaii,
Here's an example that happened to me at work TODAY actually:

Young girl in her twenties came in for some medication for a Urinary Tract Infection. She says she gets them quite often, but I still like to talk to my patients anyways. I start telling her about all the usual things with the antibiotic, and ask about her symptoms. I tell her that this antibiotic is ok for normal UTIs, but to watch out for fever and for any signs of pain in her back, as that can be a sign that the infection has spread to her kidneys. If so, this would not be useful. She then pauses and tells me "oh... actually I do have pain in my back"... I tell her to show me where, and she points to right where her kidneys would be. I tell her she should go to a doctor right away, and she asks if she could just take this anyways. I explain the mechanism of the drug to her, and that there's very poor tissue penetration with the drug. It collects in the bladder, and works downwards, not upwards at the kidney. She tells me she may not be able to go in to see a doctor today because she has class. I tell her that the inflammation from a kidney infection can cause damage to her kidneys which is baaad. I tell her i'll call across the street and see if the doctor there will take her in to see her quickly because i know them on a professional basis, and if it's urgent they'll usually help me out. I call twice, but they weren't open yet. She understood the severity of the situation at least, and said she wouldn't take the antibiotics right now from me, and go make sure she sees a doctor instead. I tell her to make sure she does that, and then she goes on her way.


Lemme guess...a Nitrofurantoin was prescribed?

And the doctor is ...older?

[Nocardia]

Hey Inaii,

Usually a nametag would distinguish the two types of people. At Safeway however, they try to make it a bit more obvious. Only Pharmacists wear White labcoats, whereas technicians wear red labcoats. So it's pretty easy to tell for them.


Its good to know there are advocates for pharmacy hanging around RS and the community in general

[Okami]

bumping this thread..

so i applied to UBC Pharmacy this year and got rejected at the interview stage.. they was informed later that my interview sucked XD but grades and everything fine.. so i know if i improve my interview i should be able to get in.

ive been working in a pharmacy for 4 years now and after the rejection i really started thinking whether or not pharmacy was even the right choice..

i love the pharmacy environment but what i'm afraid of is if ill even have a job when i graduate..

with those regulated techs (which i think equates to less demand for pharmacists) i feel there will be less job available.. on top of that UBC increased enrollment so competition (for jobs later) will be even greater..

i have decided i don't want to be a pharmacist's bitch the rest of my life to getting regulated is out of the question.

right now i'm really considering nursing.. the entrance requirements are pretty similar and from what i've seen during my volunteer shifts (@hospital), it seems like something i would enjoy doing..

so for those of you in the loop do you think the profession will level out in 5-7 years time or should i gamble with nursing (i don't even know the job prospects of them.. but everyone says they are good)

thank you for reading

[SiRV]

I'll Chime in here.

Pharmacists jobs are few and far in between now (for the lower mainland at least). For the first time in many many years, the community pharmacists salary has taken a significant pay-cut across the board in the lower mainland. Shoppers, and LD to be specific from what I've heard have lowered wages by 2 to 4 dollars hourly (translating to 4-8k / year, so .. pretty much a bump from ~78k down to 68-70k/year range. Job opportunities outside lower mainland however are still doing quite healthy and paying quite well. Quite a few of my classmates have signed positions for well over 100k/year for jobs on the island or in northern parts of BC.

Job futures on the other hand.... it's looking grim like many other professions (and health care professionals in general). Due to the huge surge in enrollment this year, in addition to the new regulations added into the field (regulated techs etc.), I can see the need for pharmacists decreasing significantly.

I hear the trend has also extended into medicine as well, with people going to med school, finishing residency in something like internal medicine and even a fellowship in some specialized field only to finish and realize that there are no jobs in their specialty, and going back to work as a general internist.. locum.

For nursing, I have quite a few friends who are in the nursing field and many of them being recent grads have discussed with me their struggles in finding work. Generally what I hear from them is that a lot of nursing grads are now waiting 3-4 months before employment for a casual position pops up. Few people will get full time permanent positions, but they are few and far in between, usually luck of the draw. In general though, with the advancing age of the population still looming up on us, and not many changes that I know of (is there an increasing role of LPN/Care aides vs RN's comparable to whats going on with regulated technicians and pharmacists?) it still does not look horribly bad yet... but who knows, things could change in an instant.

[Okami]

thanks for your input

i believe there will be changes similar to the regulated techs and pharmacists

on the canadian nurses association i found this PDF

http://www.cna-nurses.ca/CNA/documents/pdf/publications/Toward-2020-e.pdf

it sounds good and all but i bet the one for pharmacy sounded good as well (promising more time to do clinical stuff because of the regulated techs)

2 points in the article caught my eye..

-there will be incentive programs to lure men into the field
-70% of nurses in all categories will have access to full time position.

apparently to deal with the "shortage" of nurses they are going to give existing nurses more hours instead of increasing enrollment

im taking this with a grain of salt though as money is always the driving factor..

[Jermyzy]

Yeah job market for pharmacists is crappy now. I used to work for save-on-foods. They were cutting pharmacist's hours and wanted me to go back to a floating position, so I ended up quitting and now I work for an independent pharmacy now. Better hours/pay/work conditions :)

sirvfung - are you sure about the wage cuts? usually when one company does this, the rest will follow suit

okami - not confirmed, but I've heard from people in the field that there are less job opportunites for RN now as they are hiring more LPN instead.