Pharmacy Technician Schools

Most hospital pharmacies are divided into different areas to ensure efficiency. Depending on the size of the facility, there is at least one pharmacy technician working in each area throughout the day. Routine tasks are created for each area and it is the responsibility of the technician to complete these tasks as they relate to their position. Position names change from facility to facility but there are similar tasks used at every hospital. Details may vary per hospital.

Unit Dose: The unit dose area consists of the pharmacy’s oral, topical, ophthalmic, otic and respiratory medications. There are phones for technicians to triage calls and pharmacists to answer clinical questions. Computers are used in this area to look up patient medication profiles to troubleshoot missing doses. Tube stations are used to transfer STAT medications to various nursing units. As pharmacists enter orders they are filled by techs and either sorted for delivery or sent via tube station.

Pharmacy technicians working in the unit dose also prepare carts which contain a 24 hour supply of each patient’s medication that will be delivered to nursing units at a specified time. Each cart is divided first by unit then by unit room number. A daily report listing each drug ordered for every patient located in the hospital is used to prepare each cart and is checked by pharmacists before delivery. In addition to the daily cart fill, rounds (often called “runs”) are sorted and delivered to the nursing units hourly. Medications taken on rounds are separate from the 24 hour cart fill and usually include enough doses to cover until the fill is delivered.

Receiving: The receiving area is where all medication orders from vendors are delivered. It can also be the site of code cart transfer. Technicians working in this area receive medication orders and compare them to invoices to ensure accuracy. Medication is sorted by area and put away. Department requisitions are filled and picked up through the receiving area. Technicians working in this area work closely with the pharmacy buyer to maintain stocking needs

Automated Dispensing Cabinets (ADC) have a server management system that controls all individual ADC’s within the hospital usually via TCP/IP. The server manages users that are allowed to access the specific ADC(s), the restricted formulary (inventory of medications) found in each ADC, interface linking with the pharmacy information software system, inventory paper report configurations, clinical alert mechanisms, and many more controls that are beyond the scope of this article. There are mainly two top-level configurations of an ADC that are termed ‘profile’ or ‘non-profile.’ Profile ADCs only allow the user to access the medications in the ADC in the nursing unit if there is an active order within the pharmacy information software system written by a prescriber. Otherwise, the medication cannot be pulled unless it is on the hospital’s override list – a list of critical medications that users could be allowed to retrieve only under urgent circumstances. Only certain prescribers will have ‘override’ privileges. Non-profile ADCs allow any medication to be pulled without an active order. These ADC types are usually located in surgical, operating room, and other outpatient areas.

The ADC server will routinely print automatic reports to inform the pharmacy on ADC status practices in the hospital. These reports are used by pharmacy management, staff pharmacists, and pharmacy technicians. Pharmacy technicians will most likely be using the low volume reports generated from the ADC. These reports detail any bins that have a low volume of medications. The low volumes are a configuration setting within the server for each bin that sets a threshold number. If the quantity in the bin falls below the threshold, the item will appear on the next report scheduled to print in the pharmacy. Pharmacy technicians use the report to know which medications that they have to restock. It could be a big report depending on the quantity of ADCs in the hospital, the frequency of medication usage, and space limitations in the ADC. It is the pharmacy technicians job to verify that every bin in each drawer for the ADC is stocked appropriately in order to ensure that medications are available for the nursing units when needed. Pharmacy technicians are also assigned to load new medications configured for bins, and unload expired or unused medications that will no longer be needed in the ADCs. Managing the ADC system by pharmacy technicians could be a full time job depending on the amount of ADCs in the hospital. Regardless, pharmacy technicians serve important roles in this type of medication distribution as they do in cartfills, and those that excel in managing ADCs could potentially move on to new career opportunities by serving as analysts, ADC field technicians, and consultants for other hospitals or for vendors that design ADC products.

Next…robots in the pharmacy.

Lets focus on unit based cabinets, also known as automatic dispensing cabinets (ADC). Most hospitals have at least one ADC depending on the volume of medications the dispensed, the hospital services provided to the community, the urgency of critical medications, and the hours of operation of the pharmacy. Hospitals usually have two mechanisms of medication dispensing: from the pharmacy or from ADCs. As discussed in the previous article on cartfills, medications are sent by the tubing system, delivered by the pharmacy technicians during hourly runs, or delivered by cartfills for future 24 hour usage. However, if the specific nursing houses an ADC and the medications are found in the ADC, then there would be no need to send the medication from pharmacy or cartfills. This is why ADCs are great solutions for hospitals to utilize. ADCs do have to be configured properly by knowledgeable administrators in order to ensure optimal usage and safety, otherwise the risks and errors associated with improper configurations will outweigh the benefits.

An automatic dispensing cabinet is a storage device that manages medication dispensing for a nursing unit. They could vary in size, and appear as a big shelf with many locked drawers that could only be opened by the software system that operates the machine for users that have accounts. They are strategically placed by the hospital and pharmacy management in an area where routine and critical medications are needed without having the nurse travel to the main pharmacy to retrieve the medication; the pharmacy staff do not have to deliver these items to the nursing unit. Needless to say, they save a lot of time for both pharmacy and nursing, which only benefit the patient when medications are on hand without much delay.

These devices are similar to automatic teller machines (ATM’s) where people could simply go to an ATM and retrieve their cash whenever needed without having to go inside a brick and mortar bank, or wait to retrieve their funds during bank business hours – ATM’s resemble standalone banks. They are simply very convenient and most places enjoy the technology. Similar to an ATM, the ADC is available as somewhat of a standalone pharmacy that is available around the clock whether the pharmacy is open or closed to only certain licensed healthcare providers such as registered nurses, physicians, surgeons, and of course pharmacists. They have certain limitations such as a limited inventory of medications depending on the space available for the the device. ADC’s are purposely configured for each specific nursing with a restricted list of medications that include critical medications that may be needed for urgencies, and routine medications that are always used around the clock without the need to waste time waiting for pharmacy for deliveries.

ADC’s house many drawers, with each drawer having different types of containers or bins that may include: (1) open bins where many medications could be found in the ‘open’ and separated by plastic dividers, (2) closed bins covered by plastic or metal lids for clear separation of medications from other types, and (3) locked bins or carousels strictly for narcotic medications to prevent diversionary practices and better accountability. Open bins are usually assigned to non-narcotic medications that are given routinely to facilitate ease of retrieval and quick selection such as over-the-counter medications, inhalers, topical(creams, ointments, etc), eye/ear/nose drops, and many other products. Closed bins are designated usually for injectables syringes and vials that may have closely related products elsewhere in the drawers so as to avoid confusion. It is commonly good practice to put all drugs that look alike or sound alike in separate closed bin drawers, in addition to separating them into different drawers of the ADC to prevent the healthcare providers from mistakenly choosing the wrong product. Locked bins and carousels are mainly reserved for narcotic medications to prevent diversion in compliance with regulatory agencies and hospital policies.

To be continued…

Many pharmacies utilize cartfill dispensing of medications. Cartfill supplies are medications loaded from the pharmacy into carts to provide a 24 hour supply of medications for all patients that are admitted (or have a bed) into a hospital. Cartfills may be separated by hospital floors, hospital services, or other means. Each cartfill contains a matrix of drawers where each drawer corresponds to one patient. Each drawer contains medications ordered for the patient for a 24 hour duration. Usually one or two pharmacy technicians are assigned specifically to fill each drawer with all of the correct medications. You could imagine this is a daunting and burdensome task.

Pharmacy technicians use a cartfill paper report which is a practically a checklist  of all medications ordered for the patient. The cartfill report will print during specific times of the day, and the pharmacy technician(s) are expected to retrieve this report from the printer and begin loading the drawers with the medications listed. The reports are configured to be printed manually by the technicians or automatically by the pharmacy systems software depending on the type of software being used by the pharmacy.  These reports are printed hours ahead of time before the cartfills are scheduled to be delivered in order to give the pharmacy technicians enough time to stock a 24 hour supply of medications for each patient in the hospital.  This could be time-consuming, and the pharmacist themselves will have to check each medication before having it delivered.  Updated cartfill reports are also printed later in the day which reveal additions, deletions, or modifications to the current patient’s medication orders. After every drawer is loaded correctly, a pharmacist will use the same cartfill report to verify the accuracy of the pharmacy technician’s work.  This goes on daily for each cartfill. When the pharmacist signs off on the readiness of the cartfills, they are delivered to each nursing unit to be stored in the patient’s medication storage area.

When cartfills are returned to the pharmacy by the nursing unit, they are sometimes filled with returned medications.  The pharmacy technician will have to credit back  the cost of the order to the patient’s medication account if  it was charged.  Then, the item is stored back into inventory assuming the medication has not been used and has not expired.  Medication returns occur because the orders may have been discontinued by the physician, or if the patient was discharged (went home) from the hospital after the cartfill list was printed and prior to the cartfills being sent to the nursing unit.

To be continued on the next post…Automatic Dispensing Cabinets

As described in a previous article, hospital pharmacy operations could be complex and cumbersome depending on how pharmacy processes are designed. This post will focus on the roles of the pharmacy technician in the ‘unit dose’ area of a pharmacy.

Most hospital pharmacies could be divided into two segments: the unit dose area and the intravenous compounding area. Each of these two segments could be further divided into sub-segments depending on the services provided from the hospital. Pharmacy technicians serve very important roles in each segment of these operations.

Unit Dose: The unit dose area contains medications that are usually ready to be dispensed and are easily prepared for delivery to patients. The definition of unit dose is ‘one dose’ to the patient. Hospital pharmacies usually dispense ‘one dose’ at a time when initially ordered, and then a subsequent 24 hour supply of unit doses per patient for the entire hospital. Examples of unit dose medications include tablets, capsules, sublinguals, lozenges, oral liquids, patches, ear/eye/nose drops, inhalers, topical products (lotions, creams, emulsions, ointments) used on the skin, shampoos, certain injectable solutions and many more. These products are usually already prepared from the manufacturer, although certain solutions and topical products could be made or ‘compounded’ in the pharmacy. Much like in retail or outpatient pharmacies, pharmacy technicians assigned in this area use the orders that have been verified by pharmacists and retrieve the correct medication from the pharmacy area where the products are stocked. Products could be stocked within shelving bins or refrigerators. Pharmacy operations could be overwhelming with the volume of orders, the abundance of different medications that exist, as well as certain medications that could cause confusion (medications that look and sound alike). Therefore, it is critical for pharmacy technicians to correctly select the product that is ordered for the patient, and label it appropriately so that the pharmacist could easily check the product prior to delivery.

Upon a pharmacists verification, the pharmacy technician will deliver the product to the nurse depending on the urgency. If the medication is ‘stat’ or urgent, the pharmacy technician will use the pneumatic tube system to deliver the medication or directly walk to the nursing unit. the pneumatic tube system is an internal delivery system within a hospital. It is similar to a subway system, except each ‘nursing unit’ is similar to a subway stop, and each ‘tube’ is similar to a train. Pharmacy technicians could load the medication (with the exception of medications that are not to be shaken, and those that are stored in fragile containers) inside of a tube (which is usually a plastic vessel with cushioning) and send it off from the pharmacy tube station. The tube station has a touch button panel adjacent to a directory of codes that correspond to the nursing delivery unit. Pharmacy technicians will use the directory to find the code of the nursing unit to send off the tube.

If the medication orders are not urgent, medication swill be stored in a bin or basket to be sent during the next batch delivery. Batch deliveries are usually done each hour during the daytime due to sheer volume. As the name suggests, these types of deliveries are ‘batches’ of medications that are due in the hospital that are not urgent at the moment, but are due within the next few hours. In summary, for orders that print for dispensing, after a pharmacists verification, it is then routed for urgent deliver or for later batch delivery depending on the due date of the medication.

To be continued on the next post…Cartfills

You are on your way to becoming a great pharmacy technician if you are responsible, great at multitasking, and are able to manage your time efficiently. Additionally, with the added qualities below, you will be propelled into a successful career.

Problem Solver. Challenges arise every day in the pharmacy. What should you do when your customer has no refills for a critical medication? How will you compound (mix) a medication to a standard concentration using a nonstandard concentration using some fundamental arithmetic? What do you do when automated reports of orders that have to be processed for patients do not print? These are just a few examples of issues that may occur on any given day. Pharmacy technicians must be able to troubleshoot well and use their intuition to solve unexpected problems. Adding this skill to your repertoire will lift your performance rating from average to just good, and you will be quickly recognized by your peers and management.

Initiative. If there is a task that you can do which falls outside of your job description – be like Mike and just do it! If you have an idea that will have a positive outcome in the pharmacy, share it to others or to management. If your coworker is running behind on a task and you are caught up, offer your assistance. Going above and beyond your own duties will be noticed by others and those that you help. It even looks really good on your performance appraisals which could have a direct impact on your pay increase. Great pharmacy technicians do not wait for someone to tell them what to do or lie in wait trying to figure out what has to be completed – they simply just do it.

Smile. Pharmacy technicians serve hundreds of people each day. This requires pleasant demeanor and avoidance of negative feelings and attitudes. Smiles, whether seen or heard, really are contagious. Avoid any grumbling and whispers of complaint as they are also contagious to peers and staff members. Anyone could complain about tough situations, but very few could handle it professionally and smile. The few that could smile under pressure will are always be remembered by others.

Eagerness to Learn. Every great pharmacy technician becomes a sponge to absorb new information in order to continually evolve their skills and knowledge. Whenever an opportunity to learn something new arises, take the initiative to seize it before others do. Continuing education is not just a requirement for recertification, but an opportunity to be learn something new and evolve into a more knowledgeable technician.

With the introduction of new technologies in software, server management, database systems, and hardware innovations in the past decade, hospital pharmacy operations have been improved from vendors who build such products geared towards streamlining many of the time-consuming workflow processes of medication dispensing. In the not too distant past, many pharmacies held patient medication records on paper or paper cards for storage in file cabinets and bins; this kind of record keeping seems unheard of with the growing prevalence of smartphones, tablets, and laptops. You could imagine the burden of sifting through hundreds to thousands of files within file cabinets to retrieve a patient’s medication record given the volume of the patients that routinely come in and out of a hospital each day. Hospital pharmacy operations are significantly different from retail pharmacy operations, especially when it comes to the steps required to process a medication between preparation steps and delivery to the patient.

Understanding the role of the pharmacy technician in a hospital requires a fundamental knowledge of basic hospital pharmacy operations. In short, pharmacies store medications that will be ordered by prescribers, and deliver them to nurses for proper administration to patients. The process isn’t as simple as written here because of the existence of different measures involved that are dependent on the due date of a medication, the stability (shelf-life) of the medication, and policies of the medication in question for the hospital. Unlike retail pharmacies (or outpatient pharmacies), hospital pharmacies do not dispense a thirty day supply, sixty day supply of medications, or what have you for the patient to pick up and go home. Usually pharmacies dispense as much as needed for a 24 hour day due to the fact that the patient’s medication may change, the medication may expire (eg. injectable medications), or if the patient is expected to be discharged (sent home) soon. There isn’t much sense in preparing a month’s supply of medication for a patient that could be discharged the next day or within the week, or if the medication has a short shelf-life.

Also unlike retail pharmacies, hospital pharmacists carry many different formulations of medications that include injectables, oral liquids, tablets, capsules, creams, lotions, ointments, emulsions, gels, eye/ear/nose drops, inhalers, nasal sprays, sublinguals, buccals, intravenous solutions, patches, and many more. Injectable medications could further be divided into different categories based on the site of administration such as intravenous, intramuscular, subcutaneous, intra-articular, intra-dermal, etc. Many injectables have to be further diluted in a larger volume of fluid for proper administration to a patient.

There are numerous classes of medications such as antihypertensives, antipsychotics, proton-pump inhibitors, narcotics, chemotherapeutics, investigational, and many more. Each medication has their own clinical information and usage guidelines from the manufacturer for proper dosages, adverse effects, drug interactions with other drugs/food/labs/allergies, contraindications, stability, compatibility with solutions, etc. Some even have regulatory oversight on proper usage such as narcotics and hazardous medications. Even more, the hospital may also determine how certain medications are to be processed and ordered, and could hold restrictions on which prescribers are permitted to order these medications.

As you could see, the amount of information and work required to operate a hospital pharmacy could seem overwhelming. Today’s hospital pharmacies require pharmacists AND pharmacy technicians to be versed in the proper dispensing of medications within the limits of regulatory and hospital policies in order to operate an efficient pharmacy operation.

Anyone interested in working as a Pharmacy Technician should pursue it.   However, there are some caveats to know before moving forward with this career option.  Some pharmacy technicians, or ‘techs’ will be underperforming, more will be average, many will be good, but very few will be great techs.  Below are some distinctive qualities found in the very few:

Responsibility. There are many pieces that factor in to running a successful pharmacy. Having responsible personnel is one of them. In most pharmacy settings, pharmacy technicians will be assigned to work in a certain area of the pharmacy each day. Every technician has their specific list of tasks to complete each day in order for the pharmacy to function properly. It is the pharmacy technician’s responsibility to complete their assigned tasks in order for the pharmacy to run like a well-oiled machine.  Taking responsibility and ownership is an important characteristic of a great pharmacy technician.

Multitasking. It is an absolute must that pharmacy technicians be able to multitask. Hospital pharmacy tasks may include triaging phone calls, attending to various scenarios at the window, filling orders, and preparing for hourly runs.  Each hour and day may change depending on the circumstances and volume of orders being processed in the pharmacy, and the technicians should be able to quickly adapt to meet the demands these changing scenarios.  In a retail pharmacy setting, you may be processing prescriptions from customers, answering phone calls, calling insurance companies, and filling prescriptions in one sitting – therefore, the ability to multitask as well as perform each of the tasks properly without error is extremely crucial.

Efficiency. Let us not forget that pharmacy technicians are in the position of customer service by helping others in the community. Whether techs are working at the neighborhood retail pharmacy or the largest hospital in the city, customers and patients are waiting and expecting great service.  Everybody has their bad days, and most people will react negatively during stressful work situations.  But those that put on a smile each day without murmuring complaints regardless of the circumstances are the ones that will stand out and will be remembered by their peers, supervisors, and most importantly their customers/patients.  Reminding yourself to always put yourselves in the ‘shoes’ of the customer will help.