Category: Professional Posters
Purpose: The 2015 National Association of Boards of Pharmacy identified fifteen states with approved regulations that remove the requirement for pharmacist visual verification in an institutional setting. Michigan passed regulation to support technology-check-technician processes when automated dispensing machines (ADMs) and bedside barcode scanning verification are used. A 2016 study by Wang and colleagues demonstrated technology to be more accurate than pharmacist validations, and when leveraged, allowed for reallocation of over 1400 hours of Pharmacist time. Massachusetts regulations do not allow certified pharmacy technicians to perform dispensing process validations. Given these advantages, we explored introducing a technology-check-technician program in Massachusetts.
Methods: Two academic, tertiary medical centers partnered to pilot changes to pharmacy regulations governing pharmacy technician responsibilities related to dispensing process validation in Massachusetts. In order to better establish the ideal process, we worked with members of the ASHP government relations team and referenced the 2015 National Association of Boards of Pharmacy (NABP) survey of pharmacy law data to appreciate the various scopes of pharmacy technician regulations. A literature review was helpful to understand the pros and cons of different approaches, and primarily focused on workflows that leveraged technology to replace the visual verification step in the dispensing process. A survey was distributed to institutional members of the Massachusetts Society of Health System Pharmacists (MSHP) gathering information on the type of technology used at each site, scanning compliance rates, and interest in pursuing a technology-check-technician program. Choosing a strategy that utilized barcode validation technology, the two medical centers collaborated on a proposal to pilot a technology-check-technician process. In order to proceed with the pilot, we needed to obtain a waiver from the Massachusetts Board of Registration in Pharmacy that would outline the scope and workflow, as well as the data to be collected related to quality and safety outcomes and technician employee training. The results of this pilot would help determine next steps in making formal changes to the technician regulations in Massachusetts.
Results: The MSHP survey captured data from eighteen facilities, identifying comprehensive use of barcode scanning at the time of ADM replenishment and at the bedside at the time of dose administration, as well as strong interest in pursuing a technology-check-technician process. The waiver proposal was presented to the Massachusetts Board of Registration in Pharmacy and approved for a twelve month pilot. Our technology-check-technician process begins when a medication is removed from the pharmacy’s electronic inventory management system for dispensing to an ADM. The scope included medications dispensed from the electronic inventory management system for ADM inventory replenishment, excluding schedule II through V and patient-specific (including compounded) medications. Monthly audits were conducted to track accuracy and scanning compliance, and trend errors at the point of dispensing from the electronic inventory and after loading into the ADM. The data demonstrated continued compliance with scanning processes and no trends suggesting patient safety risks. Following pilot completion, the data was presented to the Massachusetts Board of Registration in Pharmacy and we gained waiver approval to continue our process. Since that time, the Board of Pharmacy approved an advisory that allows other acute care institutions in the state to mirror our technology-check-technician process.
Conclusion: At the onset of our journey we utilized various resources to best understand the ideal workflow that was not only supported by literature, but was also progressive to capture practice advancement initiative concepts. Partnering with members of the Board of Registration in Pharmacy helped us understand our options for implementing change and any potential barriers to our proposal. Having the opportunity to collaborate across organizations helped demonstrate the positive impact of these practice changes at different organizations.