Recently I became aware of a new practice model to improve patient access to quality and efficient care, with the objective of advancing pharmacy in the broader healthcare setting. The pilot project is titled “Advancing community pharmacy quality: leveraging tech-check-tech (TCT) to expand patient care services in community pharmacies,” and is being conducted by the National Association of Chain Drug Stores, in partnership with the Pharmacy Society of Wisconsin.1
In retail pharmacy today, after the initial pharmacist verification, interpretation, and drug utilization review, pharmacy technicians process and prepare prescriptions under the direct supervision of a pharmacist. The final verification of the completed prescription is a pharmacist’s duty, and takes place before the prescription is provided to the patient. Under this proposed pilot program, trained and validated pharmacy technicians complete the final check of a prescription filled by another technician.
Technicians in the program must be certified by the Pharmacy Technician Certification Board, or have completed 1500 hours of work as a technician in the past 3 years. This pilot pharmacy technician verification project will be implemented in a variety of community practices across Wisconsin. The program will also assess the impact on patient safety measures and pharmacist care services. The stated purpose of the TCT program is not to reduce pharmacist staffing, but rather to facilitate pharmacists’ provision of patient care services.
Pilot Program Details
The 2-year pilot program seems well-designed, and is accepting independent, chain, and health system pharmacy applications. The program should launch in early 2017, pending Institutional Review Board approval. The technicians must complete a didactic and experiential training program related to TCT. Furthermore, they must demonstrate and maintain competency throughout the pilot program, and adhere to program reporting requirements.
Pharmacists must be physically located on the premises (ie, no telepharmacy). The pharmacist must perform all prescription transcription accuracy checks and clinical reviews; maintain a quality improvement program; keep records on the accuracy of the pilot; and provide patient consultation in accordance with state law. Prescriptions that need further scrutiny and pharmacist oversight, such as compounded prescriptions or Schedule II Controlled Substances, are excluded from the TCT program.
Hospital TCT Programs
Nine states currently allow TCTs in hospitals, with laws defining the TCT process, and another 6 states are considering a pilot program to evaluate the implementation of TCT.2 The programs have existed in hospitals because institutional practices using TCTs have layers of safety built in that reduce the likelihood of dispensing errors. These safeguards include dispensing drugs in unit dose packaging, barcode scanning to ensure safe medication dispensing and administration, and using electronic medication administration records.
Several states specify that an allowable institutional setting for TCT must have a licensed health professional to provide additional, independent verification before medication administration. Hospital-based TCT programs are often limited to final verification on refill orders, not new orders. Hospital-based TCT programs may be limited to technicians checking the work of other technicians when refilling automated drug-dispensing machines on hospital floors, and when filling unit dose batches of prescription refills that were previously pharmacist-approved.
Results from 11 studies in hospitals indicate that technicians’ accuracy in performing final dispensing checks is comparable to pharmacists’ accuracy (99.6% vs 99.3%, respectively). Pharmacists in TCT programs report a time savings ranging from 10 hours monthly to 1 hour daily, allowing for additional time for clinical services.
Retail Pharmacy Implications
Additional time to perform necessary clinical services will be essential if the pharmacist’s clinical role is to expand beyond administering immunizations. This added time could help address one of the practice limitations of insufficient time available that leads to low medication therapy management completion rates. This time could also be used to provide screening and patient engagement activities, including those covered in a recent article on the role of the pharmacist in diabetes screenings.3
There is constant pressure on retail pharmacy profitability as payers lower reimbursement rates. Beyond reducing the cost of goods for pharmaceuticals with improved purchasing, lowering your labor costs is a key strategy in maintaining a profitable pharmacy department. It will be interesting to monitor the success of this pilot initiative to see whether retail TCT is a future opportunity for controlling operating costs and freeing up pharmacist time without any adverse impact on prescription dispensing accuracy.
- Pharmacy Society of Wisconsin. Advancing community pharmacy quality: leveraging tech-check-tech (TCT) to expand patient care services in community pharmacies. May 25, 2016. http://dsps.wi.gov/Documents/Board%20Services/Agenda%20Materials/Pharmacy/2016/20160525_PHM_Additional_Material.pdf. Accessed November 22, 2016.
- Adams AJ, Martin SJ, Stolpe SF. "Tech-check-tech": a review of the evidence on its safety and benefits. Am J Health Syst Pharm. 2011;68:1824-1833.
- Dietz DJ. Diabetes screenings: a future opportunity for pharmacists? Inside Patient Care. October 2016. http://insidepatientcare.com/issues/2016/october-2016-vol-4-no-10/446-diabetes-screenings-a-future-opportunity-for-pharmacists. Accessed November 22, 2016.