Module One
The
Pharmacy Technician and Pharmacy Settings
Table
of Contents
1. The Pharmacy Technician
A. Personal Standards of a Pharmacy
Technician
B. Duties of a Pharmacy Technician
i.
Tasks
Performed
ii.
Assisting
the Pharmacist with Medical Data
iii.
Skilled
Areas
iv.
Switching
Gears
C. Pharmacy Technician Certification
Board (PTCB) Knowledge Statements for
the National Examination
i.
Assisting the Pharmacist in Serving Patients
ii.
Maintaining Medication and Inventory Control Systems
iii.
Participating in the Administration and Management
of Pharmacy Practice
D. Certification
E. Sample Questions
2. Pharmacy Settings
A. Retail
B. Institutional
C. Long Term Care
D. Other
E. Sample Questions
3. Answer Key for
Sample Questions
1. The Pharmacy
Technician
A pharmacy technician
in health care is an individual who is given a basic level of training designed
to help them perform specific tasks in a pharmacy. A pharmacy technician is under the direct
supervision of the pharmacist.
A. Personal
Standards
The personal standards of
every pharmacy technician should be:
Professional
Behavior
Neat
Appearance
Dependability
Trustworthiness
Patient
Confidentiality
Remember:
Competence
is knowing your scope of practice, what you can and can not do.
Negligence
is failing to do something that should or must be done.
Confidentiality
is the requirement of health care providers to keep all patient information
private.
B. Duties of a Pharmacy Technician
i. Tasks Performed
Receiving
Prescriptions: Whether from a patient or a healthcare
provider, make sure the prescription contains all of the necessary information
for dispensing.
Data
Entry of Patient Information: Inputting patient information into the computer
is actually very important. One must be
very accurate in adding new patients, new medications, correct insurance
information, the correct medication, dosage, and directions for use.
Filling
Prescriptions: Always check the National Drug Code (NDC) number
when filling a prescription to make sure you are entering the correct drug.
Packaging
Medications: Make sure to package medications in
appropriate containers. Example: If you package 30 small tablets, use a small
dram vial, not a large one.
Inventory
Control: Performing inventory control is extremely
important in every pharmacy. We will talk about how to control inventory and
save your pharmacy money while maintaining the ability to serve the
customer/patient.
Ordering
Drugs: Only order what you need, bulk ordering can
mean an over stock. Check quantities
before ordering drugs or supplies for the pharmacy.
Record
Keeping: How long should you keep records on
prescriptions, whether hard copies, controlled substance records, or
wholesale receipts? Where are records kept? (Hard
Copy – This is the term used in a pharmacy meaning “original prescription
order.”)
Use
of Sterile Technique for IV Additives: Who do we want to protect?
Compounding: Do you know
how to follow a recipe when cooking? Compounding is a lot like following a
recipe very carefully.
ii. Assisting
the Pharmacist with Medical Data
Pharmacy technicians should
be able to assist the pharmacist with medical data associated with the
pharmacy’s monitoring outcome programs.
The types of monitoring outcome programs for patients are:
·
Blood Pressure
·
Bone Density
·
Cholesterol
·
Blood Glucose
·
Respiratory
Functions
·
Immunizations
iii. Skilled
Areas for Technicians
Math
and Problem Solving: Used for mark-ups in the pharmacy, calculating
dosage forms, chemotherapy, compounding, and even in calculating the hours you
work.
Language
and Terminology: Knowing some basic medical terminology is
important if, for example, a prescriber orders a medication for blood pressure
and writes “B/P” on the prescription.
You will have to transcribe “B/P” to “blood pressure” for the patient to
understand what this medication is for.
Computer
Skills: You will need computer skills to perform
tasks like data entry and inventory control.
Learning the computer programs in your pharmacy is very important.
Interpersonal
/ Communication Skills: These skills are very important as you will
interact with patients/customers, supervisor, co-workers, physicians, nurses
and others. You must be able to communicate, cooperate, and work effectively as
part of a team.
iv.
Switching
Gears, A Day in the Life of a Pharmacy Technician
You
are a pharmacy technician in a retail pharmacy that fills 250 prescriptions per
day, does chemotherapy for a physician’s office, and does compounding on
occasion. The pharmacy has 1 pharmacist, 2 technicians who are also certified
compression-hose fitters, and 1 clerk. Both pharmacy technicians are
experienced in all settings of pharmacy. One
technician calls in sick, so today you are the only technician on the job.
You
are currently filling several prescriptions for a waiting customer. The telephone rings for the pharmacist, but
he is on another line. The clerk takes a short break to go to the restroom. The phone rings again, a customer is calling
to see if she has any refills left on her prescription. Another customer
arrives at the counter and hands you a prescription for a compound, one of
those you can’t fill ahead of time.
Now
you have 2 calls holding and 2 customers waiting for prescriptions. What do you
do? Scream? NO!
The
pharmacist takes the first call and is given a chemotherapy order. Now stay
calm. Go back to the second call and
check the refill for the customer on the phone.
Keep filling the prescriptions for the waiting customer.
Tell
the new customer since this is a compound it will be filled within 24 hours and
you will call when it’s ready. The clerk
is back now. The pharmacist hands you a
chemo order to prepare. A customer comes in with a prescription for a
compression stocking. You know this takes about 20 minutes to do. Now you can scream…….
Ask
yourself... do you really want to be a pharmacy technician? Yes, you do.
Actually this is one of my typical days as a technician. The reward of a
pharmacy technician is helping patients and having them smile and thank you for
your service. Remember the pharmacist is
counseling patients, checking your work, taking phone calls, filling
prescriptions and screaming inside too.
Once
you have that little CPhT behind your name the customer will notice this. They will ask you questions about their
drugs, and recommendations for Over the Counter drugs. You are not authorized to give them this kind
of information and you must refer them to the pharmacist.
C. Pharmacy
Technician Certification Board (PTCB)
Knowledge Statements for the National
Exam
The knowledge base required
to perform activities associated with each function of the pharmacy technician
are:
i. Assisting the Pharmacist in Serving
Patients
1. Knowledge of federal,
state, and/or practice site regulations, codes of ethics, and standards
pertaining to the practice of pharmacy.
2. Knowledge of
pharmaceutical, medical, and legal developments which impact on the practice of
pharmacy.
3. Knowledge of state-specific
prescription transfer regulations.
4. Knowledge of pharmaceutical
and medical abbreviations and terminology.
5. Knowledge of generic and
brand names of pharmaceuticals.
6. Knowledge of therapeutic
equivalence.
7. Knowledge of epidemiology.
8. Knowledge of risk factors
for disease.
9. Knowledge of anatomy and
physiology.
10. Knowledge of signs and
symptoms of disease states.
11. Knowledge of standard and
abnormal laboratory values.
12. Knowledge of drug
interactions (such as drug-disease, drug-drug, drug-laboratory, drug-nutrient).
13. Knowledge of
strengths/dose, dosage forms, physical appearance, routes of administration,
and duration of drug therapy.
14. Knowledge of effects of
patient’s age (for example, neonates, geriatrics) on drug and non-drug therapy.
15. Knowledge of drug
information sources including printed and electronic reference materials.
16. Knowledge of pharmacology
(for example, mechanism of action).
17. Knowledge of common and
severe side or adverse effects, allergies, and therapeutic contraindications
associated with medications.
18. Knowledge of drug
indications.
19. Knowledge of relative role
of drug and non-drug therapy (for example, herbal remedies, lifestyle
modification, smoking cessation).
20. Knowledge of practice site
policies and procedures regarding prescriptions or medication orders.
21. Knowledge of information to
be obtained from patient/patient’s representative (for example, demographic
information, allergy, third-party information).
22. Knowledge of required
prescription order refill information.
23. Knowledge of formula to
verify the validity of a prescriber’s DEA number.
24. Knowledge of techniques for
detecting forged or altered prescriptions.
25. Knowledge of techniques for
detecting prescription errors (for example, abnormal doses, early refill,
incorrect quantity, incorrect patient ID #, incorrect drug).
26. Knowledge of effects of
patient’s disabilities (for example, visual, physical) on drug and non-drug
therapy.
27. Knowledge of techniques,
equipment, and supplies for drug administration (for example, insulin syringes
and IV tubing).
28. Knowledge of
non-prescription (over-the-counter [OTC]) formulations.
29. Knowledge of monitoring and
screening equipment (for example, blood pressure cuffs, glucose monitors).
30. Knowledge of medical and
surgical appliances and devices (for example, ostomies, orthopedic devices,
pumps).
31. Knowledge of proper storage
conditions.
32. Knowledge of automated
dispensing technology.
33. Knowledge of packaging
requirements.
34. Knowledge of NDC number
components.
35. Knowledge of purpose for
lot numbers and expiration dates.
36. Knowledge of information
for prescription or medication order labels.
37. Knowledge of requirements
regarding auxiliary labels.
38. Knowledge of requirements
regarding patient package inserts.
39. Knowledge of special
directions and precautions for patient/patient’s representative regarding
preparation and use of medications.
40. Knowledge of techniques for
assessing patient’s compliance with prescription or medication order.
41. Knowledge of action to be
taken in the event of a missed dose.
42. Knowledge of requirements
for mailing medications.
43. Knowledge of delivery
systems for distributing medications (for example, pneumatic tube, robotics).
44. Knowledge of requirements
for dispensing controlled substances.
45. Knowledge of requirements
for dispensing investigational drugs.
46. Knowledge of record-keeping
requirements for medication dispensing.
47. Knowledge of automatic stop
orders.
48. Knowledge of restricted
medication orders.
49. Knowledge of quality
improvement methods (for example, matching NDC number, double-counting
narcotics).
50. Knowledge of pharmacy
calculations (for example, algebra, ratio and proportions, metric conversions,
IV drip rates, IV admixture calculations).
51. Knowledge of measurement
systems (for example, metric and avoirdupois).
52. Knowledge of drug stability.
53. Knowledge of physical and
chemical incompatibilities.
54. Knowledge of equipment
calibration techniques.
55. Knowledge of procedures to
prepare IV admixtures.
56. Knowledge of procedures to
prepare chemotherapy.
57. Knowledge of procedures to
prepare total parenteral nutrition (TPN) solutions.
58. Knowledge of procedures to
prepare reconstituted injectable and non-injectable medications.
59. Knowledge of specialized
procedures to prepare injectable medications (for example, epidurals and
patient controlled analgesic [PCA] cassettes).
60. Knowledge of procedures to
prepare radiopharmaceuticals.
61. Knowledge of procedures to
prepare oral dosage forms (for example, tablets, capsules, liquids) in
unit-dose or non–unit-dose packaging.
62. Knowledge of procedures to
compound sterile non-injectable products (for example, eye drops).
63. Knowledge of procedures to
compound non-sterile products (for example, ointments, mixtures, liquids,
emulsions).
64. Knowledge of procedures to
prepare ready-to-dispense multidose packages (for example, ophthalmics, otics,
inhalers, topicals, transdermals).
65. Knowledge of aseptic
techniques (for example, laminar flow hood, filters).
66. Knowledge of infection
control procedures.
67. Knowledge of requirements
for handling hazardous products and disposing of hazardous waste.
68. Knowledge of documentation
requirements for controlled substances, investigational drugs, and hazardous
wastes.
69. Knowledge of
pharmacy-related computer software for documenting the dispensing of
prescriptions or medication orders.
70. Knowledge of manual systems
for documenting the dispensing of prescriptions or medication orders.
71. Knowledge of customer
service principles.
72. Knowledge of communication
techniques.
73. Knowledge of
confidentiality requirements.
74. Knowledge of cash handling
procedures.
75. Knowledge of reimbursement
policies and plans.
76. Knowledge of legal
requirements for pharmacist counseling of patient/patient’s representative.
ii. Maintaining
Medication and Inventory Control Systems
1. Knowledge of drug product
laws and regulations and professional standards related to obtaining medication
supplies, durable medical equipment, and products (for example, Food, Drug and
Cosmetic Act; Controlled Substances Act; Prescription Drug Marketing Act;
USP-NF; NRC standards).
2. Knowledge of pharmaceutical
industry procedures for obtaining pharmaceuticals.
3. Knowledge of purchasing
policies, procedures, and practices.
4. Knowledge of dosage forms.
5. Knowledge of formulary or
approved stock list.
6. Knowledge of par and
reorder levels and drug usage.
7. Knowledge of inventory
receiving process.
8. Knowledge of
bioavailability standards (for example, generic substitutes).
9. Knowledge of the use of DEA
controlled substance ordering forms.
10. Knowledge of regulatory
requirements regarding record-keeping for repackaged products, recalled
products, and refunded products.
11. Knowledge of policies,
procedures, and practices for inventory systems.
12. Knowledge of products used
in packaging and repackaging (for example, child-resistant caps and
light-protective unit-dose packaging).
13. Knowledge of risk
management opportunities (for example, dress code, personal protective
equipment [PPE], needle recapping).
14. Knowledge of the FDA’s
classifications of recalls.
15. Knowledge of systems to
identify and return expired and unsellable products.
16. Knowledge of rules and
regulations for the removal and disposal of products.
17. Knowledge of legal and
regulatory requirements and professional standards governing operations of
pharmacies (for example, prepackaging, difference between compounding and manufacturing).
18. Knowledge of legal and
regulatory requirements and professional standards (for example, FDA, DEA,
state board of pharmacy, JCAHO) for preparing, labeling, dispensing,
distributing, and administering medications.
19. Knowledge of medication
distribution and control systems requirements for the use of medications in
various practice settings (for example, automated dispensing systems, bar
coding, nursing stations, crash carts).
20. Knowledge of preparation,
storage requirements, and documentation for medications compounded in
anticipation of prescriptions or medication orders.
21. Knowledge of repackaging,
storage requirements, and documentation for finished dosage forms prepared in
anticipation of prescriptions or medication orders.
22. Knowledge of policies,
procedures, and practices regarding storage and handling of hazardous materials
and wastes (for example, Materials Safety Data Sheet [MSDS]).
23. Knowledge of medication
distribution and control systems requirements for controlled substances,
investigational drugs, and hazardous materials and wastes.
24. Knowledge of the written,
oral, and electronic communication channels necessary to ensure appropriate
follow-up and problem resolution (for example, product recalls, supplier
shorts).
25. Knowledge of quality assurance
policies, procedures, and practices for medication and inventory control
systems.
iii.
Participating in the Administration and Management of Pharmacy Practice
1. Knowledge of the practice
setting’s mission, goals and objectives, organizational structure, and policies
and procedures.
2. Knowledge of lines of
communication throughout the organization
3. Knowledge of principles of
resource allocation (for example, scheduling, cross training, work flow).
4. Knowledge of productivity,
efficiency, and customer satisfaction measures.
5. Knowledge of written, oral,
and electronic communication systems.
6. Knowledge of required
operational licenses and certificates.
7. Knowledge of roles and
responsibilities of pharmacists, pharmacy technicians, and other pharmacy
employees.
8. Knowledge of legal and
regulatory requirements for personnel, facilities, equipment, and supplies (for
example, space requirements, prescription file storage, cleanliness, reference
materials, storage of radiopharmaceuticals).
9. Knowledge of professional
standards (for example, JCAHO) for personnel, facilities, equipment, and
supplies.
10. Knowledge of quality
improvement standards and guidelines.
11. Knowledge of state board of
pharmacy regulations.
12. Knowledge of storage
requirements and expiration dates for equipment and supplies (for example,
first-aid items, fire extinguishers).
13. Knowledge of storage and
handling requirements for hazardous substances (for example, chemotherapeutics,
radiopharmaceuticals).
14. Knowledge of hazardous
waste disposal requirements.
15. Knowledge of procedures for
the treatment of exposure to hazardous substances (for example, eyewash).
16. Knowledge of security
systems for the protection of employees, customers, and property.
17. Knowledge of laminar flow
hood maintenance requirements.
18. Knowledge of infection
control policies and procedures.
19. Knowledge of sanitation
requirements (for example, hand washing, cleaning counting trays, countertop,
and equipment).
20. Knowledge of equipment
calibration and maintenance procedures.
21. Knowledge of supply
procurement procedures.
22. Knowledge of technology
used in the preparation, delivery, and administration of medications (for
example, robotics, Baker cells, automated TPN equipment, Pyxis, infusion
pumps).
23. Knowledge of purpose and
function of pharmacy equipment.
24. Knowledge of documentation
requirements for routine sanitation, maintenance, and equipment calibration.
25. Knowledge of the Americans
with Disabilities Act requirements (for example, physical accessibility).
26. Knowledge of manual and
computer-based systems for storing, retrieving, and using pharmacy-related
pharmacy information (for example, drug interactions, patient profiles,
generating labels).
27. Knowledge of security
procedures related to data integrity, security, and confidentiality.
28. Knowledge of downtime
emergency policies and procedures.
29. Knowledge of backup and
archiving procedures for stored data and documentation.
30. Knowledge of legal
requirements regarding archiving.
31. Knowledge of third-party
reimbursement systems.
32. Knowledge of healthcare
reimbursement systems (for example, home health, respiratory medications,
eligibility and reimbursement).
33. Knowledge of billing and
accounting policies and procedures.
34. Knowledge of information
sources used to obtain data in a quality improvement system (for example, the
patient’s chart, patient profile, computerized information systems, medication
administration record).
35. Knowledge of procedures to
document occurrences such as medication errors, adverse effects, and product
integrity (for example, FDA Med Watch Program).
36. Knowledge of staff training
techniques.
37. Knowledge of employee
performance evaluation techniques.
38. Knowledge of employee
performance feedback techniques.
D. Certification
A
certificate is a legal proof or document certifying that an individual meets
certain standards provided by a neutral professional organization.
The Pharmacy Technician
Certification Board (PTCB) offers a National Examination to become a Certified
Pharmacy Technician (CPhT). This examination tests your knowledge in areas of
assisting the pharmacist in serving patients, medication distribution, and
inventory control systems for pharmacy operations.
Requirements
for taking the PTCB exam:
·
Must have a high
school diploma or GED.
·
Have never been
convicted of a felony.
Scoring
the Examination:
·
Must have a score
of at least 650 on the exam:
(Scoring systems range from 300-900).
·
The exam contains
140 multiple choice questions. You will be graded on 125 of the 140. There are
15 questions on the exam that will not be graded. These 15 questions are used
to test the exam’s effectiveness for future versions of the PTCB Exam.
·
Given 3 hours to
complete.
·
Contact PTCB if
you have any special requests for disability reasons.
Certification must be renewed every two years.
During the 2 year period between recertification you
are required to receive 20 hours of continuing education on such topics as:
·
Medication
Distribution and Inventory Control Systems
·
Pharmacy
Administration and Management
·
Pharmacy
Calculations
·
Programs specific
to Pharmacy Technicians
·
Interpersonal
Skills
·
Pharmacology /
Drug Therapy
·
Pharmacy Law
o
At least one
contact hour of pharmacy law is required every two years.
Important Notes:
Programs
relating to patient counseling, recommending drugs, or any other function
outside the scope of practice for pharmacy technicians are not acceptable.
All
continuing education documents you receive should be kept together in case you
are audited by PTCB.
E. Sample
Questions
1. What should be checked when filling a
prescription to make sure you are
entering the correct drug into the
computer?
a. Inventory
b. NDC number
c. Manufacturer
d. Dosage
2. When is math accuracy important in a
pharmacy?
a. Performing
pharmacy mark-ups
b. Calculating
chemotherapy dosage
c. Compounding a
prescription
d. All of the above
3. A _______ is a legal proof or document
showing that an individual meets
certain standards provided by a neutral
professional organization.
a. Certificate
b. Diploma
c. License
d. Continuing education
4. Who offers the National Pharmacy Technician
Exam?
a. APhA
b. NPhA
c. PTCB
d. NCPA
5. How many hours of continuing education is
needed every 2 years to
renew your pharmacy technician
certification?
a. 5
b. 10
c. 15
d. 20
2. Pharmacy
Settings
A. Retail
Settings
Pharmacy retail settings
provide prescriptions for the general public. Approximately two thirds of all
prescriptions dispensed are filled in this type of setting. Retail pharmacies are also called community,
independent, chain, food store, and mass merchandiser pharmacies.
In a retail setting,
prescriptions are brought into the pharmacy by the customer, or faxed,
telephoned, or mailed in by the prescriber.
A prescription computer program is used for the process of filling
medications for the public by the pharmacy technician and pharmacist.
Retail pharmacists conduct
programs for disease state management where they counsel patients about their
disease state and medications.
B. Institutional Settings
Institutional pharmacies
dispense drugs for patients in a hospital or nursing home. In this setting
medications are dispensed from the inpatient (main) centralized pharmacy or
from a (satellite) decentralized pharmacy within the hospital. The coronary care unit, pediatric unit, and
the operating room are just a few examples of decentralized (satellite)
pharmacies.
In institutional settings,
medications are transcribed from a medication order form completed by the
prescriber and transferred onto a medication administration record (MAR). The MAR is then sent to the pharmacy for
dispensing. All medications dispensed in
this setting are packaged in a unit dose system: one single drug, for one
patient, for one time of day.
The unit dose is prepared and
filled by pharmacy technicians, checked by the pharmacist, and then put into a
medication cart where each patient has their own drawer with his or her name,
room and bed number. Drawers in a
medication cart are filled every 24 hours.
Some hospitals have automated
dispensing systems such as the Baker Cells or the Pyxis Supply Stations.
Cart-filling robots are also used for assisting the filling of prescriptions in
the inpatient pharmacy. Other orders that may come in during the day or night
will be filled and sent to the floor or unit by dumb waiters, pneumatic tubes,
or hand delivered as needed.
C. Long Term Care
(LTC)
LTC pharmacies dispense medications in a unit dose form,
putting medications in a medication cart and then delivering it to the nursing
home. In an assisted living home, the medication is packaged in a single dose
card called a “bubble pack” and is for one patient, with one drug, for one
time of day, for one month. Another system is the customized safety-sealed
pill cup calendar card with the patient’s name, medication names, and time
to take. This system has all the medication
in one single cup for one time of day for one patient.
The difference between the
two facilities is that in a nursing home a registered nurse will distribute the
prescribed medication to the patients whereas in an assisted living home a
trained medication aid administers the medication to the patients.
Long Term Care (LTC)
pharmacies dispense medication to facilities such as nursing homes or assisted
living homes where patients are no longer able to take care of themselves at
home. The pharmacy will deliver or mail the medications to such facility.
D. Other
Pharmacy Settings
·
Mail Order Pharmacies: Mail order pharmacies serve the general
public and they send medications by mail or other delivery method.
Prescriptions take about 24-48 hours to fill and mail to the customer. This
type of pharmacy is appropriate for ordering maintenance drugs for medical
conditions like diabetes, high blood pressure, and thyroid because the cost of
the medication is cheaper. However, if a patient is given an antibiotic or pain
medication prescription that needs to be taken right away, this setting would
not be appropriate.
·
Home Infusion and Compounding Pharmacies: These
pharmacies are primarily used for the dispensing of intravenous medications for
patients who need IV medication in their homes. They prepare admixtures,
chemotherapy, total parenteral nutrition (TPN), and provide infusion pumps. A
registered nurse will deliver the medication and administer it to the patient.
·
Nuclear Pharmacies: This pharmacy setting prepares nuclear medications
mainly for patient’s x-ray testing. In addition to the PTCB certification, a
separate certification is required for pharmacy technicians to prepare nuclear
medications.
E. Sample
Questions
1. What type of pharmacy setting fills
prescriptions for the general public?
a. Mail order
b. Institutional
c. Retail
d. a and c
2. What is a decentralized pharmacy?
a. Wholesale
pharmacy
b. Nursing home
pharmacy
c. Satellite
pharmacy
d. Long term care
pharmacy
3. What type of pharmacy prepares and dispenses
intravenous medications
and TPN’s for patients who receive their
medications at home?
a. Nuclear
b. Home infusion
c. Mail order
d. Hospital