HOW DO WE DESCRIBE AN ETHICAL PERSON?

THE FOUNDATION OF ETHICS FOR PHARMACY TECHNICIANS

Pharmacy Technician Continuing Education Program Samford University

Amy E. Broeseker, R.N., Pharm.D., Ph.D. Professor

Department of Pharmaceutical, Social and Administrative Sciences McWhorter School of Pharmacy

Samford University

September 14, 2014

Learning Objectives:

A. Discuss the aspects of ethical people as outlined by the Character Counts! Coalition. B. Describe the stages of moral development and the ways that they apply to pharmacy. C. Discuss the various moral types or theories and relate them to the workplace.

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A. ASPECTS OF ETHICAL PEOPLE… CHARACTER COUNTS! COALITION

Michael Josephson (1942- ) founder of the Joseph and Edna Josephson Institute of Ethics Character traits: trustworthiness, respect, responsibility, fairness, caring, citizenship

When it is necessary to violate one character trait in order to honor another one, do the thing that you sincerely believe will be better in the long run, i.e., for the __________________ _____________.

www.charactercounts.org

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B. STAGES OF MORAL DEVELOPMENT

Lawrence Kohlberg (1927-1987) Kohlberg’s stages of moral development claimed that:

a. basic problem-solving strategies used by all people can be boiled down to six stages.

b. these six stages comprise a logical, developmental sequence such that ALL people progress

through a staircase process -- simple stages precede the more complex ones.

Level One: Preconventional Morality: rules are external to the self rather than internalized;

what is right is what one can get away with

Stage 1: Obedience or punishment orientation: An act is wrong only if I ______ __________.

the rightness or wrongness of an act depends on its consequences; obey authority to avoid punishment

Stage 2: Self-interest orientation: Let’s make a deal.

conforms to rules in order to gain rewards or satisfy personal objectives; some concern for others, but this is secondary to what is thought to benefit themselves

Level Two: Conventional Morality: strives to obey rules and social norms to win others’ approval

Stage 3: Social conformity orientation: Be considerate, nice, and kind.

primary objective is to be thought of as a good person; moral behavior pleases, helps, and is approved of by others

Stage 4: Law and order orientation: All are obligated to and protected by the law.

considers the perspectives of others; now, what is right is what conforms to the rules of authority; reason for conforming is not a fear of punishment, but a belief that rules and laws maintain a social order worth preserving

Level Three: Postconventional Morality: defines right and wrong in terms of broad principles

of justice that could conflict with laws or authority figures

Stage 5: Social contract orientation:

follow laws that promote human values and challenge rules that degrade them

Stage 6: Universal ethics orientation: Ideal moral reasoning.

a person defines right or wrong on principles of universal _____________________ that transcends any law or social contract that may conflict with them

www.usefulcharts.com/psychology/kohlberg-stages-of-moral-development.html

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C. MORAL TYPES OR THEORIES

1. Egoism

a. Generally: seeks to maximize the greatest good for him/herself; does not consider

other points of view

b. Advantages: tends to be a survivor; analytical and very aware of consequences and

implications of his/her decisions

c. Disadvantages: self-centered; makes productive, healthy relationships hard to maintain

and strengthen

2. 2. Conformism

a. Generally: when given an ethical dilemma, this person will consult with several

groups and will resolve the dilemma consistent with what those perceived values are; will avoid decisions or actions that conflict with the expectations of this person’s peer group

b. Advantages: always have ______________________ for ethical decisions

c. Disadvantages: interferes with individual judgment

3. 3. Deontology

a. Generally: Immanuel Kant; “deon” = duty; his famous ‘categorical imperative’

states that we should...

“Act only according to that maxim by which you can at the same time will that it should become a universal law.”

dilemmas are best resolved by following certain prescribed rules that are imposed by virtue of being human; does not consider the

consequences of fulfilling that duty in relation to self or others or how others may view the decision; when posed with a moral issue, this person will search for the overriding duty or obligation, and once found, will act in accordance to it

b. Advantages: offers clear answers in some situations; personal accountability helps

to keep one true to this standard

c. Disadvantages: may lose own perspective of right and wrong

4. Utilitarianism

a. Generally: Jeremy Bentham; will do that action which is in the best collective

interest of the most people; look for the best overall consequences without regard to oneself; “the greatest amount of happiness for the greatest number of people”

b. Advantages: accommodates as many people as possible; tends to maintain civil

harmony

c. Disadvantages: sacrifices continually made by a small group; what happens to

5. Divine Command

a. Generally: grounded in spiritual or religious teachings; acts without regard to

consequences to self or others, internal notions of right or wrong, duty, or what others think

b. Advantages: offers clear answers for those who follow this philosophy

c. Disadvantages: great diversity in beliefs across the religious spectrum due to various

interpretations; some people who operate in this realm are intolerant of others’ beliefs

6. Existentialism

a. Generally: always act in accordance with the purity of one’s own heart and soul,

regardless of the consequences; “to thine own self be true”; driven to act in keeping with the inner voice and internal notions of right and wrong

b. Advantages: stresses human autonomy and free will; encourages critical thinking

and reflection

c. Disadvantages: sometimes difficult to find that “inner purity” due to bias and

emotion; what if everyone did this?

7. Eclectic

a. Generally: combination of equally competing influences; relies on the best of

several theories

b. Advantages: gather information and deliberate about a decision; very reflective and

analytical

c. Disadvantages: decision making is often very _________________________

http://sevenpillarsinstitute.org/morality-101/moral-traditions

Wilkens S. Beyond Bumper Sticker Ethics: An Introduction to Theories of Right & Wrong. Downers Grove, IL: InterVarsity Press; 2005.

Legal Issues Faced By The Pharmacy Technician

Ronda H. Lacey, JD, RPH rhlacey@samford.edu

OBJECTIVES

 Identify and discuss the most common legal issues, questions and charges that the Alabama State Board of Pharmacy addresses dealing with pharmacy technicians.

 Interpret and restate the rules and responsibilities for the pharmacy technician in Alabama from 680-X-2.14: The Role of Pharmacy Technicians in Alabama.

 Interpret and discuss the new rule of the Alabama State Board of Pharmacy dealing with pharmacy access.

Alabama State Board of Pharmacy  Most frequent charges/challenges/problems

deal with:

 Registration renewal;  C.E. requirements

 Technician responsibilities (i.e. what you can and cannot do).

Registration/Renewal Requirements

 Must be 17 years of age or older.

 Fill out and submit the Alabama State Board of Pharmacy (ALBOP) approved registration form.  Pay the approved fee(s).

 Renewal is every other year (odd numbered years)  680-X-2.14

 Cannot obtain a registration/renewal if convicted of

a crime involving moral turpitude.

Moral Turpitude

 Think of this as meaning as an intentional act that is wrong (not accidental).

 For example:

 Shoplifting

 Theft of property/diversion of controlled substances

 Fraud

Reasons Stated for Failure to Renew Registration

 I forgot!

 I thought the pharmacist was supposed to take care of the renewal.

 I thought the district manager was supposed to take care of the renewal.

Reality

 It is your registration.  It is your job.

 You are the one that will not be able to go to work.

 You are the one that will not be paid.  You will have to pay a fine and or penalties.  If you were told someone was going to take care

of it for you – FOLLOW UP IN A TIMELY FASHION.

Reality  Will the pharmacist get in trouble?

 Yes!

 Will the district manager get in trouble?

 Maybe with the corporate office – but probably not ALBOP.

 Does ALBOP care who said they would pay the renewal fee for you?

Question

 How often does a pharmacy technician have to renew their registration with ALBOP? A. Each Year

B. Every other year/even numbered years C. Every other year/odd numbered years D. None of the above.

C.E. Requirements  3 hours of continuing education “annually”  1 of the 3 hours required MUST be live!  All of the hours can be obtained via a live

presentation.

 Even though you renewal every other year, you must obtain CE credits on an annual basis.

Reasons Stated for Failure to Obtain Annual CE Credit

 I forgot!

 I didn’t think it was a big deal.  I didn’t think I would be audited.

 The company didn’t provide any CE courses for me.

Reality

 Just like with the failure to renew your registration in a timely fashion, “YOU” are the one that will get in trouble.

 You will not only pay a fine and make up the hours you failed to get – YOU WILL HAVE TO TAKE ADDITIONAL CE COURSES.

Question

 How many continuing education credits does a pharmacy technician have to have to renew their registration with ALBOP? Select the best answer.

A. 6 CE credits

B. 6 CE credits/2 live hours C. 3 CE credits/1 live hour

Other Legal Issues  That is to say knowing what you can and

cannot legally do as a pharmacy technician.  Goes hand in hand with the 2nd_objective

dealing with The Role of Pharmacy Technicians in Alabama.

 Do you know where to find the legal responsibilities? Requirements?

680-X-2.14

 To some it seems like a silly rule, but you are required to wear a name tag while on duty!  Work under the immediate supervision of a

pharmacist.

 Not exceed pharmacist/technician work ratio.  Now let’s look at the “thou shall not rules”

Prohibited Acts

 Communicate, orally or in writing, any medical, therapeutic, clinical or drug information, or communicate any information recorded on a patient profile that requires professional judgment.

 Document the receipt of a controlled substance into inventory.

 Accept by oral communication a new prescription of any nature.  Prepare a copy of a prescription or read a prescription to another person.  Provide a prescription or medication to a patient without a pharmacist’s verification as to

the correctness of the prescription or medication. For the purpose of this rule, verification shall mean that the licensed pharmacist shall be aware of the patient profile, DUR, computer overrides and drug interactions as well as the correctness of the selected medication and labeling.

 Counsel a patient on medications or perform a drug utilization review.

 Perform any task that requires the professional judgment of a pharmacist.  Perform any task that is in violation of any federal, state or local pharmacy regulations.

Do You Know Why I Emphasized the Section Dealing with Controlled Substances and Counseling?

 We see these violation a lot!

 I know that you are trying to help your pharmacist and your patients.

 That you may have heard the pharmacist discuss a particular medication dozens of times.

 That you may not think signing in CS is a big deal – but it can open the door for possible diversion.

 The reality is that the Rules of the Alabama State Board of Pharmacy prohibits you from signing in controlled substances and counseling a patient!

Before You Shoot The Messenger  Remember

 I am here to help you not only navigate and understand Alabama Pharmacy rules and regulations but to also

 Help you become better at your jobs and  Be safe and compliant!

 I don’t want you to be charged with violating the rules.

Pharmacy Access

 680-X-2.11 Pharmacy Keys or other Controlled Access Device or method.

 General rule: ONLY a pharmacist can have the keys to the pharmacy.

 Exception allows owner to designate 1 unregistered person to have key.

 Supervising Pharmacist must agree  ALBOP must approve

 Rule does not allow Pharmacist to give the key to you.

A Few More Questions  May a pharmacy technician legally sign in the

controlled substances order?

a. True b. False

 A technician may legally counsel a patient on a medication.

a. True b. False

THANK YOU!

Ronda H. Lacey, JD, RPh rhlacey@samford.edu

Alabama Pharmacy Technicians

Requirements:

 Work under the direct supervision of a pharmacist licensed in Alabama;

 Be of seventeen (17) years of age or older;

 Submit a written pharmacy technician application to the Alabama State Board

of Pharmacy requesting a registration as a pharmacy technician, pay

appropriate registration fee, and receive registration certification BEFORE

working in a pharmacy;

 Obtain three (3) hours of continuing education with one (1) of the hours being

a“LIVE” credit hour. Technicians can receive CE credit for any continuing

education hour that is ACPE-T approved.

 An Alabama technician’s registration certificate MUST be displayed in the

pharmacy where the technician is working at all times.

 A technician MUST wear a nametag identifying them as such at all times.

 Perform only pharmacy functions NOT requiring professional judgment.

 Comply with ALL Federal Law, State Law, and Board of Pharmacy Rules.

 It is a rule that three (3) technicians, one (1) of which has certification by any

credentialing organization approved by the Board are sufficient in the

prescription area for each licensed pharmacist on duty.

A Technician Can:





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2. Count and pour

3. Place a label on the bottle.

Perform any task that that does not require the professional judgment of a pharmacist. The

pharmacist should make those tasks clear in order to adequately supervise any technician.

A Technician Cannot:

 Communicate, ORALLY or in WRITING any of the following information:

1. Medical, therapeutic, clinical or drug information;

2. ** Accept by oral communication a new prescription of ANY nature. It should be understood that a technician CAN NOT call a physician or have a discussion with his agent regarding a new prescription; receive OR transcribe an orally transmitted voice message left to a recording device for the pharmacist.

3. Prepare a copy of a prescription, or read a prescription to another person. 4. Counsel a patient on medications or perform a drug utilization review.

5. Provide a prescription or medication to a patient without a pharmacist’s verification as to the correctness of the prescription or medication. Verification shall mean that the licensed pharmacist shall be aware of the patient profile, DUR, computer

overrides and drug interactions as well as the correctness of the selected medication

and labeling.

6. Place CONTROLLED drugs into the pharmacy inventory.

680-X-2-.14 (4) In order to adequately protect the public health, technicians shall not: