Pharmacy Technician Career Environments

1. Pharmacy Technician Career Environments • Retail Pharmacy • Retail pharmacy, also know as community based pharmacy or community pharmacy, is a very common environment in which pharmacy technicians are employed. These pharmacies provide prescription services and an outlet for the sales of commonly purchased good and services. • Retail pharmacies consists of independent pharmacies and chain pharmacies. • In general, the major benefit of retail pharmacies is accessibility. Often the patient will go to see the pharmacist at a retail store first before seeking medical attention for which they may have limited access to or no insurance to help cover the costs.

2. Independent Pharmacy • Owned as a sole proprietorship by one or a few owners. • Provide prescription filling along with other ancillary services (surgical supplies, vitamins, hallmark®) • Often provide personal services • Major benefit: familiarity of the pharmacists with the customers • Disadvantage: may not have the pricing power of larger chain stores.

3. Chain Drug Stores • National franchises like Walgreen’s, CVS, Rite Aid, and Duane Reade (east coast) have many stores around the US and/or in a regional area • Offer convenience with many stores operating 24/7 • Major advantages: pricing power, convenience, and accessibility. • Disadvantages: lack of personalized service between pharmacist and patient.

4. Retail Staff • Supervising pharmacist: a full time pharmacist who is in charge of the legal and administrative aspect of the pharmacy • Store Manager: a person, who may or may not be a pharmacist, that is in charge of the operation of the store in general • Typically the store is divided into front end and back end. • Front end deals with OTC issues and other non medication issues a customer may have • Back end contains the pharmacy • Stores the legend medications • Stores other restricted meds and higher priced devices • Blood glucose strips, blood pressure monitors, Plan B, and products that contain pseudoephedrine. • Combat Methamphetamine epidemic act of 2005 requires removal of pseudoephedrine products from the public area

5. Regulatory Agencies • State Boards of Pharmacy regulates the practice of pharmacy which in NYS are contained in the education law of the board of regents article 137, the public health law article 33 for controlled substances, and the NYSRR title 10 among others. SBOP conducts inspections of pharmacy facilities. • Centers for Medicare and Medicaid Services: CMS regulates the federal programs of Medicare and Medicaid along others. CMS conducts inspections to ensure compliance with federal regulations. • Third Party Payers: Third party insurance companies also may conduct inspects of pharmacy establishments to determine if contractual agreements are kept between insurance payer and the pharmacy.

6. Summary of Retail Pharmacy Technicians • Handling Deliveries • Inventory management • Record keeping • Stock rotation and others • Enter prescriptions in the patient’s medical profile • Create and maintain patient profiles to include: • Name, address, DOB, contact information • Medical allergies • Food allergies • Medical history (pertinent to medication use) • Current medications and herbals that patient is taking • One area where technician can offer advise is in the use of medical devices like blood pressure monitors, glucose testing equipment, etc. • Communicate with physician’s or their agents to obtain refill authorizations • In some states, compounding of solutions, suspensions, creams and ointments • Handling insurance issues to obtain pharmacy reimbursement

7. Health System Pharmacy • Pharmacy setting where patients reside at the facility where the pharmacy is located • Includes acute care hospitals • Long term care facilities-provides skilled nursing services to patients in need of long term rehabilitative services • Hospices-facilities that provide end of life palliative care to terminally ill patients. • Nursing Homes-facilities that provide skilled nursing care to elderly people who can no longer care for themselves due to chronic illness • Correctional Facilities-prisons

8. Hospital Staff • Includes pharmacists, nurses, physical therapists, respiratory therapists, nutritionists, etc • DO- doctor of osteopathy is a medical doctor that can practice conventional medicine and tends to use musculoskeletal manipulation to assist the patient. • MD- doctor of medicine who practices conventional medicine. • Physician Assistant- a licensed individual who is trained to work with and under the supervision of a physician in the care of patients. • Nurse Practitioner- a licensed individual who has rights similar to a physician assistant • RN- a licensed individual who is trained to provide and administer medical therapy (including medications) to patients under the order of a DO or MD • LPN- similar to an RN, however, works under the supervision of an RN. • Certified Nursing Assistant- CNA works under the supervision of an RN; however medication administration is not allowed

9. Regulatory Agencies in the Hospital • Joint Commission on the Accreditation of Healthcare Organizations • Called Joint Commission or JCAHO for short • Provides accreditation to hospitals, Long term care facilities and other organizations • Site inspections conducted every three years • Passing of site inspections required for accreditation • Accreditation required for CMS funding by the government

10. State Board of Pharmacy • State board of pharmacy typically monitors community pharmacies; but in the hospital setting monitors the staff in the hospital and not the department as a whole.

11. State Health Departments • State health departments directly governs hospitals, including the pharmacy department. • Directly charters a hospital and grants its privilege to operate in the state.

12. Medication Dispensing System • Floor Stock Distribution. A system where a compliment of medication inventory is keep at the nursing station. System is prone to diversion and is not used anymore in most hospitals, except in cases of ADC. • Cart Fill System: A system where a given supply of medication (24-72 hours)is dispensed to a patient via a locked cassette located in a centralized physical cassette • Unit Dose System/Prepackaging : A system where bulk medications are pre packaged into individual packets where the contents of such packets are a single unit of use. i.e A bulk container of 100 phenobarbital tablets in 100 individual blister packets of a single tablet. • Extremely cost efficient • Can be used in the Floor Stock System and/or the Cart Fill system

13. Summary of the Pharmacy Technician’s Duties in the Health System Pharmacies • Data collection (information on drug turnover and usage) • Survey and inspections (nursing station inspection) • Education (training new technicians) • Maintenance (restock of omnicell and pyxis, monitoring and replacement of crash cart items) • Dispensing/inventory management

14. Filling patient’s medication cassettes • Repackaging medications • Compounding oral solutions, creams, and suspensions • Compounding, in some states, IV parenteral drug products after being USP 797 training • Restocking and maintaining institutional crash carts • Nursing Station inspections