Pharmacy technician-administered immunizations: A five-year review

In October 2020, the U.S. Department of Health and Human Services (HHS) issued guidance authorizing trained pharmacy technicians in all states to administer immunizations. Given that this action is temporary, it will be necessary for states to adopt their own legislation or regulations to sustain these efforts beyond the coronavirus pandemic. At least 11 different immunization administration training programs have emerged for pharmacy technicians. An increasing number of publications have emerged on pharmacy technician immunization administration, demonstrating the ability to train technicians and have them safely administer immunizations in practice. Supervising pharmacists reported initial hesitancy but strong acceptance of delegating this task after experience in practice. States should look to expand and make permanent the authority of pharmacy technicians to ensure these benefits can continue to be realized after the HHS guidance expires.     

Community chain pharmacists’ perceptions of increased technicians’ involvement in the immunization process

BackgroundOver the past 2 decades, pharmacists have positioned immunization services as an important aspect of their expanding role in patient care.ObjectivesTo examine how community chain pharmacists view time spent on immunization, available in-store resources and barriers, and pharmacy technician involvement in the context of their views about the achievement of key National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice in their workplace.MethodsA representative, nationwide survey was administered electronically to chain community pharmacists over a 4-week period. Community pharmacists offering year-round immunization in retail chain, supermarket, and mass-merchant settings, randomly sampled from a database maintained by the American Pharmacists Association. We examined several sets of interrelated relationships regarding pharmacists’ perceived achievement of 3 key NVAC standards (assessment, recommendation and administration), time spent on the overall immunization process, the effectiveness of available in-store resources, immunization impediments, and the endorsement of increased technician involvement in community pharmacy-based immunization service (PBIS) delivery.ResultsA sample of 590 survey responses was obtained from 9717 e-mails delivered, with 489 deemed eligible (5% response rate). Sizeable numbers of pharmacists acknowledged that several activities integral to achieving optimal immunization levels were not being addressed. Although pharmacists accepted that appropriately trained pharmacy technicians should be able to ask (77%) and assess (66%) patients, only 24% agreed that technicians should be able to administer vaccine doses. Pharmacists satisfied with in-store immunization resources and technicians’ involvement were more likely to report achieving the 3 key NVAC standards. Paradoxically, how pharmacists viewed their immunization time expenditures was unrelated to whether they agreed that pharmacy technicians should have an expanded role in asking, assessing, or administering vaccines to their patients.ConclusionOverall, community pharmacies would likely better meet national immunization goals by achieving all 3 key NVAC standards and incorporating expanded roles for appropriately trained and supervised technicians in PBIS.     

Training pharmacy technicians to administer immunizations

Objectives

To evaluate the effectiveness of an immunization training program for pharmacy technicians on technicians' self-reported confidence, knowledge, and number of vaccines administered.

The role of pharmacy technicians in vaccination services: a scoping review

BackgroundA busy pharmacy workload may limit a pharmacist’s ability to meet the needs of vaccine-willing patients and also contribute to missed opportunities to engage with vaccine hesitant individuals. Opportunities for pharmacy technicians to support vaccination services may play a role in addressing increasing patient vaccination needs.PurposeThis research aims to review the role of pharmacy technicians in vaccination services that is supported by pharmacy practice research to date.MethodsIn compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols, systematic searches were performed in PubMed, Embase, International Pharmaceutical Abstracts, Scopus, and CINAHL. Articles published through June 2020, in French, English, and Spanish, were screened for eligibility. Two independent reviewers screened titles and abstracts for inclusion. Data extraction of included study methodologies and results was performed by one reviewer and verified by a second reviewer.ResultsA total of 656 records were identified through the search of published literature. Full-text screening of 145 records identified 14 articles for inclusion. Most articles evaluated emerging pharmacy technician roles in patient screening (n = 8, 53%) and vaccine administration (n = 5, 36%). Implementation of both emerging roles demonstrated positive patient outcomes (n = 10, 72%). Screening activities were complicated by the complexity of the role, as well as its potential to increase overall time spent on vaccination services. Pharmacists and technicians advocated for accredited vaccine administration training owing to consistent benefits in pharmacy workflow efficiency, pharmacist clinical time, and pharmacy technician job satisfaction.ConclusionThis review supports the effective deployment of pharmacy technicians in delivering vaccination services. Despite pharmacy technician vaccine administration roles being highly regulated, professional advocacy by pharmacists and technicians can use the advantageous training, workflow, and patient outcomes benefits presented in this review. Early adopters of professional practice advancements for pharmacy technician vaccine administration may expand vaccination service capacity efficiently and safely, thereby reaching more patients.     

Exploring employer perceptions of pharmacy technician certification in the community pharmacy setting

BackgroundWith the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers.ObjectivesThe aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs).MethodsUsing a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory.ResultsEmployers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management).ConclusionsNew emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification.     

Pharmacist-provided immunization compensation and recognition: White paper summarizing APhA/AMCP stakeholder meeting: American Pharmacists Association and Academy of Managed Care Pharmacy

ObjectivesTo identify the current challenges and opportunities in compensation and recognition for pharmacist-provided immunizations across the lifespan and to establish guiding principles for pharmacist-provided immunization compensation and recognition.Data sources22 stakeholders gathered on June 29, 2011, at the American Pharmacists Association (APhA) headquarters in Washington, DC, for a meeting on immunization compensation that was convened by APhA and the Academy of Managed Care Pharmacy. Participants included representatives from community pharmacy practices (chain, grocery, and independent), employers, national consumer health and advocacy organizations, national pharmacy and public health organizations, health plan representatives, pharmacy benefit managers, and health information technology, standards, and safety organizations. Key immunization leaders from TRICARE Management Activity, the Centers for Medicare & Medicaid Services, the National Vaccine Program Office of the Department of Health & Human Services, and the Centers for Disease Control and Prevention (CDC) also participated in the meeting.SummaryThe increased numbers of pharmacists providing vaccination services and the availability of pharmacist-provided immunizations to populations in need of vaccines has continued to increase. This has resulted in a rise in the percentage of patients who receive vaccines at pharmacies. Pharmacists are now working to leverage their ability to identify people with key risk factors (e.g., diabetes, heart disease or previous myocardial infarction), encourage them to receive their CDC-recommended vaccinations, and administer the required vaccine. Challenges and opportunities in compensation and recognition for pharmacist-provided immunizations across the adult lifespan persist. Variability in state practice acts, reimbursement and compensation processes and systems, and mechanisms for documentation of vaccine services create substantial differences in how pharmacist-provided immunizations are delivered throughout the United States.ConclusionPharmacist-provided immunizations are clinically sound, are cost effective, are readily accessible, and support our nation's public health goals. Pharmacists have demonstrated that patient vaccination rates have improved through expansion of pharmacist-provided immunizations. The profession should continue efforts to collaborate with other immunization stakeholders and expand a pharmacist scope of practice that is built around a uniform and recognized standard of immunization provision and that supports the provision of all CDC-recommended vaccines through pharmacy-provided immunizations.     

Comparing medication histories obtained by pharmacy technicians and nursing staff in the emergency department

BackgroundAn accurate medication history is crucial for maintaining continuity of care. There are numerous opportunities for discrepancies to occur, such as medication omissions, commissions, incorrect dosing, incorrect frequencies, or incorrect formulations. Medication discrepancies may prolong hospital length of stay, increase the number of future emergency department (ED) visits, and increase hospital readmissions. Numerous studies have established the advantages of utilizing pharmacy technicians to complete medication histories. This study aimed to compare the accuracy of obtaining medication histories through pharmacy technicians compared to nursing staff.ObjectiveTo compare the accuracy of obtaining medication histories through pharmacy technicians compared to nursing staff in the emergency department.MethodsThis was a single-center, retrospective, observational analysis of patients presenting to the ED between December 2018 through January 2019. A pharmacy technician received on-site training on how to properly obtain a medication history and performed medication histories on the days the pharmacy resident was present between 10:00 and 18:00. Medication histories were obtained by nurses on the days the pharmacy technician was not present. All study medication histories were reviewed for discrepancies by the pharmacy resident.ResultsMedication histories conducted by a pharmacy technician (n = 102) resulted in a greater number of accurate medication histories [96 (94.1%) versus 59 (57.8%); p < 0.01] when compared to those conducted by nurses (n = 102). A total of seven discrepancies were found in the pharmacy technician group compared to 131 in the nursing group (p < 0.01). There was also a statistically significant lower amount of high impact discrepancies in the pharmacy technician group compared to nursing (1 versus 15; p < 0.01).ConclusionsPharmacy technicians in the ED provided more accurate medication histories when compared to nursing staff, thereby reducing potential medication errors.     

Accuracy of medication histories collected by pharmacy technicians during hospital admission

Background

Transitioning activities that do not require clinical judgment from pharmacists to pharmacy technicians has been endorsed as a strategy to increase patient access to clinical pharmacy services. One role becoming increasingly common is using pharmacy technicians to collect the medication history within medication reconciliation processes.

Pilot testing a tool to determine the costs and time associated with community pharmacy-based administration of injectable naltrexone

BackgroundMedications for opioid use disorder (MOUD), including injectable naltrexone (IN), are part of evidence-based OUD treatments. MOUD access often is limited, especially in rural communities. When authorized to administer non-vaccination injections, pharmacists can increase IN accessibility. However, inadequate reimbursement for pharmacist-administered IN can hinder widespread adoption.ObjectivesTo pilot test a process to obtain a preliminary estimate of the total costs and time associated with community-pharmacist administered IN.MethodsA purposively-selected sample of key informants at community pharmacies administering IN were surveyed about time and cost for best practice IN activities. Respondents estimated the time to perform activities and average pharmacist/pharmacy technician hourly salary, which were used to calculate administration costs.ResultsThe approach to estimate time and costs was feasible. Administrative costs (mean = $93, range: $48-$164) and time (mean = 123 min., range: 63–220 min.) to administer IN varied widely. Pharmacists'/pharmacy technicians’ roles varied by pharmacy.ConclusionsPharmacists allocate significant time and resources to administer IN. Insufficient reimbursement may disincentivize pharmacy-involved OUD treatment and ultimately slow needed expansion of MOUD services. Increasing IN services requires engaging pharmacies to expand their practice through educational campaigns, along with a commitment to reimburse the cost of medications and related administration activities.     

Assessing pharmacy technician certification: A national survey comparing certified and noncertified pharmacy technicians

ObjectivesTo compare viewpoints of nationally certified and noncertified technicians and explore the perceived value of technician certification in the job performance domains of medication safety, skills and abilities, experience, engagement and satisfaction, and productivity.MethodsA cross-sectional survey of pharmacy technicians, from 6 states representing 4 regions of the United States, was conducted. Technician mailing lists were purchased from Boards of Pharmacy, and randomly selected technicians were sent survey invitations. Surveys were completed via Qualtrics and analyzed with the use of SAS.ResultsSix hundred seventy-six technicians (547 certified, 103 noncertified, and 26 previously certified) responded to the survey (9.4% response rate). Certified technicians reported significantly higher confidence rating for desire to take on new responsibilities (P < 0.01; Cohen d 0.45) and plans to remain in the pharmacy field (P = 0.01, Cohen d 0.35), lower rating for leaving the job in the next 12 months (P < 0.01; Cohen d 0.35), and perceived lower rate of medication errors (P < 0.01; Cohen d 0.35) compared with other technicians in the work setting. The majority of respondents stated confidence in performing the “final check” on another technician’s preparation of a new or refill medication if allowed. Both certified and noncertified technicians noted dissatisfaction with pay. The majority of respondents reported that they spent none of or less than 10% of their workday assisting pharmacists with medication therapy management (MTM) sessions, immunizations, or point-of-care tests; however, 71 respondents specifically described how they assist pharmacists with MTM.ConclusionResults from our survey sample indicate that certified technicians have a stronger organizational and career commitment and desire to take on new roles. A majority of respondents noted dissatisfaction with pay but feel a sense of pride in their work. Both groups were confident in their abilities needed for tech-check-tech product verification.     

Economic benefits of pharmacy technicians practicing at advanced scope: A systematic review

ObjectiveTo critically appraise the literature to determine the cost and time savings for institutions when pharmacy technicians practice in advanced scope roles.MethodsA systematic review was registered with Prospero and conducted in January 2019. Searches were conducted in Business Source Pro, CINAHL, EconLit, EMBASE, InformGlobal, Medline, ProQuest, PubMed, Scopus and Web of Science. Search terms included pharmacy technician/pharmacy assistant and cost or time or economic evaluation. After article selection in the web-based platform Covidence©, data was extracted, and a narrative review was performed.ResultsA total of 16 publications were eligible for inclusion in the review. Pharmacy technicians practicing at advanced scope led to both cost savings and time savings. Six studies reported a cost saving, six reported a time saving and four reported both time and cost savings. Annual savings ranged from AUD $4526 - $88,719.89, linked primarily to the difference in wages between pharmacists and pharmacy technicians. Studies that focused on time savings evaluated checking dispensed items, taking medication histories and entering chemotherapy orders; demonstrating savings of up to 5 min per task completed.Conclusion(s)Appropriately trained pharmacy technicians practicing at advanced scope have the potential to save time and reduce hospital costs. Identifying the cost saving opportunities from technicians acting in advance scope roles will provide incentives for hospitals to expand their technician workforce.