Introduction
An increasing need exists for pharmacists to trust the knowl-edge and training of pharmacy technicians. Educational stan-dards are required to ensure that technicians have the skills to perform their work and that once in the workforce they maintain this knowledge and skill level by participating in continuing education and upgrading. There is also a clear and present need to ensure pub-lic safety. Regulation, standards of pharmacy technician prac-tice, competencies required to practice and registration will support the goal of public pro-tection.
History of the profession The practice of pharmacy has been around for hundreds of years. But it wasn’t until the mid-20th century that “phar-macy support personnel” began to be used. The first document-ed use of pharmacy support personnel was in the United States military in 1947.1Various titles have been used for people in this role—pharmacy assis-tant, pharmacy aide, helper, clerk, pharmacy specialist—and duties varied by work site, but largely consisted of counting
medication, and cashier and inventory duties.
In the late 1960s and early 1970s, the need for standardized training and responsibilities became apparent. American Society of Health-System Phar-macists (ASHP) and American Association of Colleges of Pharmacy (AACP) responded by officially endorsing pharma-cy technicians. In Canada, the first pharmacy assistant educa-tional programs were offered in Ontario at Humber College and St. Clair College. In 1976, the Canadian Society of Hospital Pharmacists (CSHP) published a statement defining the functions of pharmacists and non-pharmacist personnel.
In 1979, the American Association of Pharmacy Tech-nicians (AAPT) was founded, followed by the Canadian Association of Pharmacy Technicians (CAPT) in 1983. Establishing professional associ-ations to represent pharmacy technicians represented a step toward self-definition and tech-nicians becoming responsible for their own profession.
Throughout the 1980s and 1990s, various definitions and statements on training, duties and responsibilities of
pharma-cy technicians were published by numerous organizations. Certification became available nationally in the U.S. in 1995. In Canada, certification followed closely behind, in Ontario in 1996 and in Alberta in 2001. Evolution of the tech’s role The responsibilities of today’s pharmacy technicians are a far cry from what they were 20 or 30 years ago. According to an article written by ISMP (Institute for Safe Medication Practices),2the number of drugs on the market has grown 500 per cent in the last decade— there are more than 17,000 names for pharmaceuticals marketed in North America. During this same time period, drug regimens have become more complex. With the advent of easily obtainable electronic information, consumers are much more knowledgeable about medications and are being encouraged to take more responsibility for their health. These factors contribute to the increasing need for direct phar-macist intervention in patient care. Further intensifying the issue is a pharmacist shortage. As a result, pharmacy techni-cians have assumed more duties
Instructions
1. After carefully reading this lesson, study each question and select the one answer you believe to be correct. Circle the appropriate letter on the attached reply card. 2. Complete the card and
mail, or fax Mayra Ramos at (416) 764-3937. 3. Your reply card will be
marked and you will be advised of your results in a letter from Tech Talk. 4. To pass this lesson, a grade
of 70% (7 out of 10) is required. If you pass, you will receive 1 CEU.
Please allow 6-8 weeks for notification of score.
Please note: Tech Talk CE is not accredited by the Canadian Council for Continuing Education in Pharmacy (CCCEP).
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Pharmacy technician
regulation and certification
Statement of objectives
Upon completion of this lesson, the pharmacy technician should be able to: 1. Describe the differences between certification and regulation.
2. Explain the standards of practice and how they relate to competencies.
3. Describe the benefits of accrediting pharmacy technician educational programs.
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FOR TECHNICIANS
Tech Talk CE is Canada’s first national ongoing continuing education correspondence pro-gram specifically designed for technicians. It's brought to you by the publishers of Pharmacy Practice, who have been producing CE lessons for pharmacists for the past 10 years. Tech Talk CE is gene-rously sponsored by Novo-pharm. A lesson will appear in each issue of Tech Talk, which appears bimonthly in Pharmacy Practice (January, March, May, July, September, November).March/April 2005
that traditionally were per-formed by pharmacists.
Technical duties can vary along a continuum of super-vised (over the shoulder) rou-tine duties such as counting and pouring, answering the telephone and basic customer service to independent respon-sibilities such as teaching, managing or performing qual-ity control functions. Duties performed by pharmacy tech-nicians are largely employer-driven based on policies and requirements defined within the workplace. “Additional fac-tors may include variation of training, experience or qualifi-cations among technicians, views of pharmacists with regard to how technicians should be employed, and vari-ation in regulvari-ations set by licensing bodies.”3
As regulatory and profes-sional organizations have endeavoured to define the functions and responsibilities of pharmacy technicians, edu-cational institutions have also worked to maintain curricu-lum that would keep pace with expanding technician duties. Courses including sterile prod-uct training, computer order entry and database skills, tech-nological advancements and innovations and others have been added. Many pharmacy technicians are moving into non-traditional roles within pharmacy that include: super-vision and management of other pharmacy personnel, inventory procurement, home care, diabetes educator, com-pounding specialist, clinical
positions to support home par-enteral therapy, HIV pro-grams and ICU (to name a few). As the duties and respon-sibilities of technicians in-crease, there is a need to estab-lish standards of practice and the competencies required to meet those standards. Certification
The objective of certification is to identify the basic qualifi-cations for practice that would give employers assurance that a pharmacy technician meets a specific educational stan-dard.3Certification is defined as the process by which a non-governmental agency or asso-ciation grants recognition to an individual who has met cer-tain predetermined qualifica-tions specified by that agency or association.4
In Canada, technician cer-tification is voluntary, but some employers may require in-house certification. Currently, there are two organizations that offer certification assess-ments for pharmacy techni-cians: Ontario College of Pharmacists (OCP) and Phar-macy Technician Certification Board of Alberta (PTCB Alberta).
Both organizations offer a theory component only. At this time, to write the Ontario examination, the applicant must be a resident of Ontario and be a graduate of a recog-nized pharmacy technician program (or provide evidence of 3,500 hours of practical experience). To recertify, 600 work hours as a pharmacy
technician every three years is required (plus a fee). The Alberta exam is open to appli-cants from across Canada, provided that the applicant is a graduate of a recognized pharmacy technician pro-gram. To recertify on an annu-al basis, evidence of 10 hours of continuing education is required (plus a fee). PTCB Alberta has plans to adopt a practical competency-based assessment sometime in 2005. Standards & Competencies A standard may be defined as any definite rule, principle or measure established by auth-ority.5 Standards of practice for pharmacy technicians would define the minimum qualification of knowledge and skills required to practice or perform as a pharmacy technician.
Competencies are groups of skills, behaviours (attitudes) or knowledge that are applied as performance standards to a particular job or profession rather than to an individual employee. There are two types of competencies: knowledge and skills/behaviours, that are distinguished by how they can be measured. A “knowledge competency” can be mea-sured by an objective test or question. A skill/behaviour (or attitude) must be demonstrat-ed or observdemonstrat-ed.6To be compe-tent is to be adequately or well qualified to perform a task. It is synonymous with ability. A person gains competency through education, training, experience or natural abilities.
Performance
Performance is the accom-plishment of a task in accor-dance with a set standard of completeness and accuracy. While a person may have the skills or knowledge (competen-cy) to perform a task, it does not mean he or she will have the desire (attitude) to do so correctly (performance). In other words, competencies give a person the ability to per-form, while attitudes give a person the desire to perform.6
Only OCP, CAPT, Alberta have defined competencies for the pharmacy technician. CAPT Manitoba is consider-ing adoptconsider-ing them.
Accreditating Technician Training Programs
Standardization of pharmacy technician practice cannot be accomplished without stan-dardized training programs. Defined competencies for the pharmacy technician are a useful tool in assisting educa-tional institutions to set objec-tives for their curriculum.
In Canada, there is cur-rently no objective third party organization that accredits pharmacy technician educa-tional programs naeduca-tionally. Both OCP and PTCB Alberta evaluate programs upon de-mand, but are not in a position to accredit them. The Phar-macy Technician Educators of Canada (PTEC) are in discus-sion with the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) regarding inclusion of pharma-cy technician educational pro-grams under its mandate. Jurisdictional Scan
Not all provinces have a CAPT chapter, the only national body representing Pharmacy Technicians at this time. The provinces with a CAPT chapter are:
• Nova Scotia
• Ontario (Windsor/District; London & District; Sudbury & District CE Coordinator: Margaret Woodruff B.Sc.Phm., MBA Professor, Pharmacy Technician Program Humber College, Etobicoke, ON Author:
Diane Reeder, BA, CPhT, President, CAPT Alberta Technical Manager, Outpatient Pharmacy Services, Calgary Health Region
Clinical Editor:
Lu-Ann Murdoch, B.Sc.Phm. Reviewer:
Debbie Benjamin, CPhT York Central Hospital in Richmond Hill, Director, Membership Services for CAPT 11 Northgate Dr. Bradford, ON
For information about CE marking, please contact Mayra Ramos at (416) 764-3879 or fax (416) 764-3937 or email [email protected]. All other inquiries about Tech Talk CE should be directed to Laurie Jennings at (416) 764-3917 or laurie.jennings@pharmacygroup. rogers.com.
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• Manitoba (www.captmanitoba.ca) • Saskatchewan (captsask@ yahoo.com) • Alberta (www.captalberta. org) Each province/territory is at a different stage with respect to certification and regulation of pharmacy technicians. Since not all provinces have a formal organization represent-ing pharmacy technicians, information about the occupa-tion is often difficult to obtain. In 2001, Canadian Pharma-cists Association (CPhA) con-ducted an environmental scan of pharmacy technicians, which represents the most comprehensive information available at this time.8The fol-lowing is a short summary of known initiatives in each province.B.C. has prepared docu-ments defining standards for pharmacy technician verifica-tion of sterile and non-sterile products and for delegation of technical functions to pharma-cy technicians.
CAPT Alberta, in conjunc-tion with PTCB Alberta, has defined policy statements that include Standards of Practice, Competencies, Code of Ethics, Entry to Practice and Rationale for Self-Regulation. They plan to approach the Minister of Health and Well-ness in 2005 to seek profession-al status and to establish a reg-ulatory body to govern the practice of pharmacy techni-cians in Alberta.
The Saskatchewan Phar-maceutical Society (SPhA) rec-ognizes pharmacy technicians in its regulations and its by-laws. Formal training of tech-nicians is required but may include on-the-job training.8
CAPT Manitoba has made recommendations to the Manitoba Pharmaceutical Association that pharmacy technicians be recognized in the Manitoba Pharmaceutical Act as a separate and identifi-able professional group,
with-out distinction between phar-macy technicians in communi-ty and hospital practice. Currently, legislation recog-nizes certified hospital phar-macy technicians.
OCP administers the vol-untary certification program in Ontario and has plans for a future voluntary registration for pharmacy technicians. CAPT is involved with the establishment of the certifica-tion program.
The New Brunswick Pharmaceutical Society is waiting for a national initiative to recognize pharmacy techni-cians in law.8
Nova Scotia supports the idea of a voluntary certifica-tion program, with expan-sion as necessary as the pro-gram grows.8
The Newfoundland Phar-maceutical Association is preparing to develop regula-tions outlining the role of phar-macy technicians.10
No information is avail-able about certification or regulation for Quebec, Prince Edward Island and the Yukon, Northwest, Nunavut Territories.8
The Future of Regulation Recognizing pharmacy techni-cians as separate and distinct healthcare professionals and regulation, is being considered as a solution to concerns of public safety as a result of the increasing use of pharmacy technicians. Regulations are principles, rules or laws that are designed to control or gov-ern conduct. “Public Pro-tection” is the primary pur-pose of regulation. It ensures public protection by requiring all members of a profession to have minimum levels of com-petence (skills, knowledge and attitudes). Regulation also requires that anyone perform-ing the duties of a particular profession must remain com-petent (by upgrading or taking refresher courses as required) and determines who may use
a professional title (e.g., phar-macist, dentists, nurse, etc.). Only those individuals who have satisfied the educational and registration requirements of a profession can represent themselves to the public as members of that profession.10
The provinces of Canada are constitutionally responsible for the administration and delivery of healthcare ser-vices.11Therefore, regulation of health professions is exclu-sively within provincial/terri-torial jurisdiction. Following recognition and the establish-ment of a provincial regulato-ry body representing a particu-lar profession, regulations are created. The government pro-duces legislation that empow-ers regulatory bodies to estab-lish and maintain appropriate registration, continuing com-petence and ethical, technical and clinical standards, to which all members of the pro-fession must adhere to ensure protection of the public. Regulations take effect only after government has ap-proved them. Some ways that public protection is achieved is by establishing minimum re-quirements to become a spe-cific health professional (entry to practice) and by requiring that minimum ethical, techni-cal and clinitechni-cal standards of practice are maintained. Mini-mum standards are enforced through programs such as con-tinuing education. Investi-gations (sometimes leading to discipline) and incapacity assessments may become nec-essary when minimum stan-dards are not met.12There are no provisions to regulate pro-fessions nationally. However, most established professions have mechanisms to promote voluntary cooperation be-tween provinces.
Registration
To practice as a member of a regulated profession, an indi-vidual must be registered with the appropriate governing
body and must maintain a licence issued by that body. A register or roster is a list of qualified people. To qualify for the register, a system would need to be in place to assess skills and knowledge (compe-tencies). To maintain one’s registration, evidence of prac-tical experience and continu-ing education must be pro-duced on a periodic basis. Liability
Regulation brings with it accountability. Currently in Canada, pharmacists are ulti-mately responsible for all tasks carried out by pharmacy nicians. When pharmacy tech-nicians become recognized as a separate and distinct health-care profession, legal responsi-bility will follow. The pharma-cy technician would assume liability, similar to the pharma-cist. What this means, practi-cally speaking, is that a techni-cian would bear responsibility for any duties performed and potentially could be sued for negligence in the event of a medication error. This issue would need further study fol-lowing regulation of pharma-cy technicians.
Conclusion
There are many challenges ahead if pharmacy techni-cians are to become recog-nized as regulated health pro-fessionals. Minimum standards of knowledge (education) and skills (training) must be estab-lished for technicians. Entry to practice must include formal education and successful com-pletion of a standardized examination of knowledge and skills. Certification is a vital step to personal assurance of knowledge and skills. Continuing education is a vital component to maintain one’s competence. Through mem-bership and active participa-tion in our professional associ-ation, CAPT, we are meeting one of the defining criteria of a health care professional.13
1. Certification is
a. The minimum qualification of knowledge and skills required to practice or per-form as a pharmacy techni-cian
b. The process by which a nongovernmental agency or association grants recogni-tion to an individual who has met certain predetermined qualifications specified by that agency or association c A continuum of fully super-vised routine duties
d The establishment of stan-dards of practice and compe-tencies required to meet those standards
2. Competency
a. Plus attitude equals perfor-mance
b. Is the state or quality of being adequately or well qualified to perform a task c. Is a group of skills, behav-iours (attitudes) or knowledge that are identified as perfor-mance standards for a partic-ular job or profession d. All of the above 3. Regulation is necessary a. And is the same thing as registration
b. To ensure public protection by requiring all members of a profession to practice safely, competently and ethically c. To determine the level of competence of a technician d. To ensure the job market remains viable
4. Standardization of practice requirements
a. Will only apply to pharmacy technicians who work in hos-pitals
b. Cannot be accomplished since pharmacy technicians work in so many different fields
c. Defines the minimum quali-fication of knowledge and skills required to practice or perform the duties of a phar-macy technician
d. Can only be accomplished through continuing education 5. CAPT
a.. Represents the occupation of pharmacy technicians b. Was established in 1983 in Toronto
c. Is the Canadian Asso-ciation of Pharmacy Tech-nicians
d. All of the above
6. Registration is neces-sary
a. To assist in the provision of public protection from unethi-cal or unscrupulous practi-tioners
b. To ensure unionized staff are recognized for the hours they have worked
c. To provide continuing edu-cational opportunities in phar-macy
d. As part of an in-house qual-ity assurance program 7. Training programs for phar-macy technicians are cur-rently
a. Accredited in Canada by the Canadian Council for Accreditation of Pharmacy Programs
b. Accredited by the Phar-macy Technician Certification Board
c. Not accredited in Canada d. Offering standardized pro-grams of study across Canada
8. The role of a pharmacy technician can be described as
a. Simple – anyone who walks and breathes can do it b. Constantly changing;
ex-panding to include duties for-merly performed by pharma-cists
c. Supervised by a pharma-cist, therefore, no one should worry about patient safety d. Completely lacking in responsibility or accountabili-ty to the tasks performed 9. Regulation and registration of pharmacy technicians a. Will automatically follow recognition of pharmacy technicians as a profession b. Require standards of prac-tice and establishment of competencies to support them
c. Does not require ongoing continuing education to main-tain competencies
d. Is equivalent to certification 10 Legal liability may become an issue for pharmacy tech-nicians because
a. Part of becoming a “profes-sional” involves taking re-sponsibility for your actions b. Medication errors are in the public spotlight
c. The welfare of the patient must come first
d. All of the above
Q U E S T I O N S
CE4
Establishment of a local chap-ter will provide local and provincial advocacy for certifi-cation and regulation.
Voluntarily becoming cer-tified, maintaining high prac-tice standards, attending con-tinuing education sessions and maintaining membership in CAPT lends credibility to the assertion that pharmacy tech-nicians should be recognized as a distinct group of regulated health care professionals. Bibliography
1 From a presentation given by Rock Folkman, Chairperson, Pharmacy Technician Program, Red Deer College to the CAPT Alberta Annual Conference,
September 2000.
2 Institute for Safe Medication Practices. A Call to Action: Elim-inate Handwritten Prescriptions Within 3 Years! 2000. http:// www.ismp.org/MSAarticles/Wh itepaper.html
3 McGregor K, Millin B, Aro S, Samuelson A. An Information Paper on the Role of the Pharmacy Technician. CJHP 2001; Vol. 54, No. 4:293-6. 4 American Society of
Health-System Pharmacists. 0412 UNI-FORM STATE LAWS AND REGULATIONS REGARD-ING PHARMACY TECHNI-CIANS Source: Council on Legal and Public Affairs), 2004. http://www.ashp.org/About
ASHP/PolicyGovernance/poli-cypositions.pdf
5 Merriam-Webster Online Diction-ary. http://www.m-w. com/ 6 NC Department of Health and
Human Services. Managing Em-ployee Workplans, Definition of “Competencies,” 2002. http:// www.dhhs.state.nc.us/humanre- sources/workplan/competen-cies_definition.html 7 Clark, D. Introduction to Competencies, 1999. http:// www.nwlink.com/~donclark/ hrd/case/compet1.html 8 MacInnis M, Power B, Cooper J.
Environmental Scan of Phar-macy Technicians. Canadian Pharmacists Association, 2001 http://www.pharmacists.ca/con-tent/hcp/Resource_Centre/Pra
ctice_Resources/pdf/pharma-cy_technicians.pdf
9 McLeod C. NPhA and Ministry of Health Pair up to Regulate Techs. Tech Talk, 2003. 10 Maxston BE. Understanding
the Health Professions Act, A Practical Guide for Colleges, their Members and Healthcare Stakeholders, 2003.
11 Canada Health Act Overview. http://www.hc-sc.gc.ca/ eng-lish/media/releases/2002/hea lth_act/overview.htm 12 CAPT Alberta. President’s
Message. The “C.A.P.T.”Sule, 2004.
13 CAPT-Manitoba. President’s Message. Keystone CAPT, 2004. http://www.captmanito-ba.ca/newsletters/CAPTNews Dec04.pdf
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Business name Email address Address (Business)
City Province
Postal Code Business telephone
Please help ensure this program continues to be useful to you by answering these questions.
1. Do you now feel more informed about pharmacy technician regulation and certification ?
❑ Yes ❑ No
2. Was the information in this lesson relevant to you as a technician? ❑ Yes ❑ No
3. Will you be able to incorporate the information from
this lesson into your job as a technician? ❑ Yes ❑ No ❑ N/A
4. Was the information in this lesson... ❑ Too basic ❑ Appropriate ❑ Too difficult
5. How satisfied overall are you with this lesson? ❑ Very ❑ Somewhat ❑ Not at all
6. What topic would you like to see covered in a future issue?
Pharmacy technician regulation and certification
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Type of practice
❑ Hospital ❑ Full-time technician
❑ Retail (independent) ❑ Part-time technician
❑ Retail (chain) ❑ Other (specify)
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MARCH/APRIL 2005
Are you a certified technician? ❑ Yes ❑ No
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