Toward uniform standards for pharmacy technicians: Summary of the 2017 Pharmacy Technician Stakeholder Consensus Conference

A national consensus conference engaged all sectors of pharmacy in identifying points of agreement regarding entry-level requirements for pharmacy technicians. State variability in the regulation of pharmacy technicians poses risks for patients and the profession of pharmacy. Conferees were polled on their extent of agreement or disagreement with 59 statements related to unsettled pharmacy technician issues. Conferees agreed that a task analysis should be the basis for accredited technician education, technician certification, and state regulation of technicians. Conferees recommended the creation of a broad coalition to pursue the recommendations of the conference. In pursuit of a path toward resolving unsettled issues related to pharmacy technicians, the Pharmacy Technician Certification Board (PTCB) sponsored a stakeholder consensus conference on February 14–16, 2017, in Irving, Texas. Planned in collaboration with the Accreditation Council for Pharmacy Education (ACPE) and the American Society of Health-System Pharmacists (ASHP)a and under the guidance of an advisory committee representing all major branches of pharmacy, this invitational event yielded important recommendations concerning the definition, education,b entry-level requirements, advanced practice, certification, and regulation of pharmacy technicians. The 89 invited participants in the conference (eAppendix A, available at www.ajhp.org) included pharmacists and technicians from various types of practice and educational settings, pharmacy association executives, regulators, and representatives of the general public. Approximately 350 individuals participated remotely in the plenary sessions of the conference through a Web link.c In consultation with the advisory committee, the conference planners established objectives for the event (sidebar), designed a preconference survey that was sent to pharmacy opinion leaders and conference participants, established the event agenda, selected speakers, identified invitees, and recommended readings for participant review in advance of the event. (Some key readings are cited here.1–4) Individuals engaged in planning and conducting the conference are listed in eAppendix B, available at www.ajhp.org. The program consisted of 5 plenary sessions (each focused on separate facets of the conference objectives), 3 work-group sessions (during which conferees divided into 4 groups to discuss specific issues and draft related recommendations), and a final session for polling of conference attendees on level of agreement or disagreement with recommendations from the work groups. Everett B. McAllister, chief executive officer and executive director of PTCB, reviewed the objectives of the conference and referred to “the struggles boards of pharmacy, technician educators, and employers face … partly because we don’t have a good career plan for technicians.” He added, “The time has come to identify realistic and achievable pathways for technicians that support medication safety and protect our patients.” Commenting on PTCB’s decision to suspend implementation of its 2020 accredited-education requirement for technicians seeking PTCB certification,5 McAllister said that the results of the conference will help determine future plans for PTCB program changes. The aim of the conference was to explore consensus on The necessity of public confidence in pharmacy’s process for ensuring the competency of pharmacy technicians. An optimal level of basic (“generalist”) knowledge, skills, and abilities that pharmacy technicians should have regardless of practice site. An optimal definition of entry-level (generalist) pharmacy technician practice with respect to (a) legally recognized scope of practice, (b) educational requirements, (c) training requirements, (d) certification requirements, and (e) state board of pharmacy registration or licensure. The desirability and feasibility of developing a process for recognizing competencies of pharmacy technicians beyond entry-level practice. The desirability and feasibility of minimizing variability among the states in the definition and regulation of pharmacy technicians. The entities that potentially could take responsibility for any changes in pharmacy’s process for ensuring the competency of pharmacy technicians. Jason Ausili, Pharm.D. Director, Pharmacy Affairs National Association of Chain Drug Stores Malcolm Broussard, B.S. Executive Director Louisiana Board of Pharmacy Al Carter, Pharm.D., M.S. Senior Director, Pharmacy Regulatory Affairs CVS Health Charles E. Daniels, B.S.Pharm., Ph.D. Pharmacist-In-Chief and Associate Dean University of California San Diego Kenneth Mark Ey, B.S.Pharm. Vice President of Operations CARE Pharmacies Cooperative Diane Halvorson, RPhTech, CPhT Lead Pharmacy Technician Vibra Hospital Fargo Pharmacy Technician Member North Dakota State Board of Pharmacy Timothy R. Koch, B.S.Pharm., P.D., C.H.C. Senior Director, Pharmacy Practice Compliance Walmart Corporate Office Janet M. Liles, M.S., CPhT Executive Director Pharmacy Technician Educators Council Scott A. Meyers, B.S.Pharm., M.S., FASHP Executive Vice President Illinois Council of Health-System Pharmacists Matthew Osterhaus, B.S.Pharm. Coowner Osterhaus Pharmacy Jon Roth, B.S., M.S., FAPhA, FASHP Chief Executive Officer California Pharmacists Association Steve Rough, B.S.Pharm., M.S., FASHP Director of Pharmacy University of Wisconsin, Madison School of Pharmacy Rafael Saenz, Pharm.D., M.S., FASHP Administrator, Pharmacy Services University of Virginia Health System Two speakers framed the key issues of the conference from separate perspectives—those of the pharmacy profession and the public. The first perspective was provided by Michael A. Moné, a vice president at Cardinal Health, president of the Ohio Board of Pharmacy, and a member of the ACPE board of directors. Moné said, “Pharmacists must facilitate the advancement of pharmacy technicians … further enabling pharmacists to achieve their rightful place as healthcare providers.” Commenting on the profession’s obligation to assure the public of the competency of technicians, Moné remarked, “The process of providing the public with … guarantees of trustworthiness already exists in the form of the accreditation, education, examination, and licensure model” that is applied to pharmacists. He concluded, “Our charge at this conference is to come to consensus [on what the public expects], how to meet those expectations, and what we must implement in order to deliver the value we promise to the healthcare system, the profession, and patients.” (The full text of Moné’s remarks is published in AJHP.6) “Optimizing the contributions of technicians in pharmacy practice” was the theme of talks by Michael A. Moné (left), speaking from the perspective of the pharmacy profession, and Christopher Jerry, speaking from the public-interest perspective. Christopher Jerry, head of the Emily Jerry Foundation, spoke from the public perspective and drew on the personal tragedy of having lost a young daughter to a fatal compounding error by a pharmacy technician. Commenting on the history of pharmacy-related medication errors, Jerry said that opportunities for such errors are likely to increase given the risks associated with new medications and the expanded use of medications. Jerry said that although the public expects all healthcare workers to be well educated, this basic expectation is not being met in the case of pharmacy technicians. He was critical of the fact that there are no uniform state requirements for ensuring the competency of technicians, which he attributed in part to a lack of public awareness about the scope of technician responsibilities. Jerry said that uniformly trained, competent pharmacy technicians would free up pharmacists to provide more patient consultations, which are proven to reduce medication errors. William A. Zellmer, a consultant who helped plan the conference, summarized the results of the preconference surveys. The opinion-leader survey showed strong agreement, across all sectors of pharmacy, with 7 statements; these statements were considered “foundational precepts” for the conference (sidebar). The 9 survey items that had substantial variability in level of agreement among sectors of pharmacy were taken into account when planning the agenda of the conference. Zellmer said that the comments many respondents made to supplement their answers to the survey suggest that there is room for finding common ground on unsettled technician issues. Updated PTCB job analysis. The director of certification programs at PTCB, Levi Boren, discussed PTCB’s 2016 technician job analysis, which will be used in guiding test content and requirements for the Certified Pharmacy Technician credential. More than 44,000 pharmacy technicians answered 1 of 2 surveys in the job analysis, which assessed how frequently specific tasks are performed and probed the importance of specific knowledge, skills, abilities, and other characteristics (KSAOs) in performing the work of technicians. Everett B. McAllister (at the lectern) moderated the panel discussion on snapshots of the pharmacy technician workforce. Seated (left to right) are Levi Boren, William Schimmel, Janet Silvester, and Jason Ausili. Pharmacy supportive personnel encompass different types of workers, ranging from individuals with clerical duties to individuals (pharmacy technicians) who assist pharmacists with their professional responsibilities.c The profession of pharmacy has an obligation to make certain that pharmacy technicians are educated and regulated in a manner that ensures public safety. In the interest of public safety, state boards of pharmacy have an obligation to regulate the scope of practice of pharmacy technicians. In the interest of public safety, state boards of pharmacy have an obligation to establish the minimum qualifications of pharmacy technicians.d In the interest of public safety, state boards of pharmacy have an obligation to define the nature of licensed-pharmacist oversight of pharmacy technicians.e There are “generalist” (entry-level) knowledge, skills, and abilities that all pharmacy technicians should have, regardless of practice site.f Additional certification programs should be developed to allow pharmacy technicians to demonstrate competence beyond entry level. aBased on a preconference survey of pharmacy opinion leaders. Recipients of this survey were selected by member organizations of the Joint Commission of Pharmacy Practitioners. bThere was at least 90% agreement with these 7 items among respondents (except as noted in footnotes c–f) in the following pharmacy sectors: independent pharmacies (42 respondents), chain drugstores (38), hospital pharmacies (128), educational institutions (90), regulatory agencies (29), and pharmacy association staff (24). c89% of respondents from chain drugstores agreed with this item. d87% of respondents from associations agreed with this item. e84% of respondents from chain drugstores agreed with this item. f83% of respondents from associations agreed with this item. Based on the job analysis, questions in future editions of the Pharmacy Technician Certification Examination will be distributed across 4 domains: medications (40%), patient safety and quality assurance (26%), order entry and processing (21%), and federal requirements (13%). (The current exam has 9 domains.) The new exam will focus only on core KSAOs relevant to entry-level practice in both of the largest sectors of pharmacy—community/retail and hospital/health-system practice. PTCB will analyze the job analysis results to assess the appropriate precertification educational requirements. Boren said that PTCB intends to develop future certification programs in advanced community pharmacy practice and sterile compounding. Trends in technician education. ASHP’s vice president of accreditation services, Janet A. Silvester, pointed out that there is no single defined path for an individual to prepare to become a pharmacy technician, and there is no uniform national educational requirement. Most pharmacy technicians have received primarily on-the-job training. This is in sharp contrast to the educational requirements for comparable healthcare occupations (e.g., clinical laboratory technician, 2–4 years of education; dental assistant, 1–2 years; physical therapy assistant, 2 years). Accredited distance-education programs for pharmacy technicians are increasing access to standards-based education. The accreditation standard was recently amended for flexibility related to the number of experiential sites and the pharmacy compounding requirement. The 271 accredited programs are estimated to represent about one fourth of pharmacy technician Accredited programs technicians on a 2016 these programs to have to by Technician by chain The director of pharmacy for the National Association of Chain Drug Stores Jason Ausili, on a survey of the 3 said used primarily an accredited program for technicians, used primarily on-the-job and 9 provided on-the-job training respondents that the number of for technician was to meet their respect to the among technicians, respondents said was a a and respondents said that their were not being met with respect to educated technicians. requirements for pharmacy technicians in entry-level practice” was by (left to right) Koch, Rafael Saenz, and speakers from different sectors of pharmacy the knowledge, skills, and abilities must be by individuals who to be as a pharmacy technician for entry-level The in the accreditation for pharmacy technician were a of for their Timothy R. Koch, director of pharmacy practice for that has 2 types of technician 1 designed to its and accredited by of experiential education, and among and experiential The of both programs is the The accredited which is used to meet requirements in 2 in sterile which is not relevant to the current or future pharmacy to He said that the requirements for the accredited program have helped the its of the certification of of the has not to accredited for all technicians. support for of entry-level for technicians not at the level in the current accreditation He technician certification about the necessity of the full scope of knowledge, skills, and abilities in the certification He said that registration or licensure of technicians should be Rafael Saenz, of pharmacy at the University of Virginia Health remarks on the that the value of pharmacists primarily in their and time in patient patient education, and ensuring patient the perspective of a pharmacy practice who to free up pharmacists for patient technician and in and to that is common for pharmacy technicians to from one of practice to he that in the compounding of and should be included in entry-level education. said he the various sectors of practice are not in their about a single entry-level standard for pharmacy technician education, certification, and Matthew Osterhaus, and of an independent pharmacy in a community in said that personal and of pharmacy technicians are important in practice professional and the processing and of medication for entry-level practice in are in and and of issues in the profession, and sterile and compounding. Osterhaus that medication with medication therapy and compounding should be considered advanced technician practice. He that variability in the among practice sites must be considered when for technician education. Osterhaus support for certification and state registration for entry-level he that should be developed for compounding and speakers discussed advanced pharmacy technician practice, related and should be Al Carter, director of pharmacy regulatory for CVS Health, discussed the of practice the related of technician in pharmacies and collaboration with pharmacists and patients on clinical and order processing and advanced for technicians in pharmacy order and said there would be value in among the states in how technician issues. He the to the time will come when technicians have to tasks pharmacists to national director of pharmacy for discussed advanced for pharmacy technicians on as a chain executive and board of pharmacy He that many technicians are of performing advanced in pharmacy for services, and and said that about job and safety from an have to be in states have He that be to establish and requirements for technicians to that or are likely to have about scope of practice. would help with career among technicians and allow pharmacists to focus to a extent on patient He pharmacy will be to allow pharmacists to any task to technicians that is who will for the to Al Carter, Steve Rough, and spoke on related to advanced technician Steve Rough, director of pharmacy at University of Health, the accredited technician program at The career for technicians is designed to professional and provide as individuals take on more is provided for technicians who to advance to a level. accredited education, certification, and licensure for all technicians, certification as a for advanced practice, of entry-level certification into advanced practice, and of and for advanced He that supportive in pharmacy that not medications could be given a other than (e.g., in the interest of toward vice president of professional for the Pharmacy the in state to assess as in the community pharmacy in the there has no in error with and time has to patient pharmacists in through are opportunities for for patient services, and will more time for providing such services, which an of technician of the of the will be to pharmacy technician to community pharmacy practice in director of competence programs for the of Pharmacists and for was the on a panel how certain or states have advanced their requirements for pharmacy technicians. the of a process that pharmacy technicians in must a accredited program of and a national Pharmacy technicians to are to all of and independent of the final for to the are as are not to provide or clinical that are the scope of the Pharmacies in are estimated to about as many pharmacy as pharmacy there are no for pharmacy Pharmacy technicians and the work of pharmacy (at the lectern) moderated the panel discussion on for on pharmacy technician The speakers were (left to right) Diane Halvorson, Malcolm Broussard, and Diane Halvorson, pharmacy technician at Vibra and a member of the North Dakota State Board of Pharmacy, said that was through the of pharmacy technicians that state was to achieve accredited and PTCB certification for technicians. The state is an of technician related to the and of the National Association of of Pharmacy to for pharmacy technician scope of practice, education, and certification in its state pharmacy Based on North said that in order to toward uniform national pharmacy technicians should be an part of the and there should be sharp focus on patient safety. Malcolm Broussard, executive director of the Louisiana Board of Pharmacy, noted that state will accredited and PTCB certification for registration as a pharmacy technician. He that the will on the answers to 3 pharmacy tasks should be to pharmacy tasks should be to pharmacists or and the for technician the of technician or should a be made entry-level tasks and advanced said that pharmacy should have only 1 accreditation process for technician and only 1 certification executive State Board of Pharmacy, discussed of the scope of practice for technicians. In its considered that of time was on tasks that could be to competent technicians. that pharmacists are to to technicians are in 2 medication support of the program and final of that have review by a and support for clinical clinical basic physical and medication work groups all invited conferees met in 3 sessions the conference to recommendations on issues related to pharmacy technicians. had from all sectors of pharmacy and was by a The were the for all groups. the work the met with other conference staff to and prepare recommendations for the final plenary participants their level of agreement or disagreement with 59 recommendations by the work groups. a polling was on a or The polling results are in Pharmacy of The number of respondents for polling items from to not because of Pharmacy of The number of respondents for polling items from to not because of pharmacy technicians. Most conferees agreed with the to a definition of pharmacy technicians items and and to the use of that to those who have met qualifications In of 2 for technician task the basis for national there was support for an separate for different sectors of practice Education of pharmacy technicians. Most conferees agreed that national should technician and that technician programs should be accredited There was further agreement that the national should focus on the of education, a certain of flexibility in how those are Pharmacy Technician of The number of respondents for polling items from to not because of Pharmacy Technician of The number of respondents for polling items from to not because of knowledge, skills, and Conferees on the specific knowledge, skills, and abilities that should be by those who to be as a pharmacy technician for entry-level practice to and to competency of pharmacy technicians. of the polled received agreement, about one of conferees with 2 of and and of Pharmacy of The number of respondents for polling items from to not because of and of Pharmacy of The number of respondents for polling items from to not because of Certification of pharmacy technicians. There was strong support for national certification of technicians of state board of pharmacy registration or licensure and there was disagreement that this should be a educational requirement of national certification as a requirement for registration or licensure was Certification of Pharmacy of The number of respondents for polling items from to not because of Certification of Pharmacy of The number of respondents for polling items from to not because of State and on pharmacy technicians. all conferees agreed that variability in state regarding technicians should be and that technician practice should be under the of the Most conferees agreed that national should not states from and scope of practice beyond established entry-level in the interest of patient safety and State and on Pharmacy of The number of respondents for polling items from to not because of State and on Pharmacy of The number of respondents for polling items from to not because of pharmacy technician practice. Conferees agreed that the profession of pharmacy’s with respect to technician should be of related to entry-level and that advanced for technicians related and will time and Pharmacy Technician of The number of respondents for polling items from to not because of Pharmacy Technician of The number of respondents for polling items from to not because of on Pharmacy Technician of The number of respondents for polling items from to not because of on Pharmacy Technician of The number of respondents for polling items from to not because of on pharmacy technician issues. participants in the polling agreed that the conference planners should establish a coalition of to pursue the consensus recommendations from the conference Most conferees agreed that participants in this stakeholder event have a responsibility to work toward the consensus recommendations The following 5 conferees on the pharmacy and professional National Pharmacists Charles and University of California San Janet Pharmacy Technician Educators and National Association of of on the value in unsettled issues and agreement on important changes that should be to the education, certification, and registration or licensure of pharmacy technicians. the of on this stakeholder consensus event and not to of the conference planning B. McAllister, Janet A. Silvester, and executive the participants for their and to for the changes identified at the conference in the interest of patient safety and pharmacy’s to the public. chief executive officer of the Pharmacists Association and of the PTCB board of to to national consensus on for pharmacy technicians and will be different this have a different of we to be as a profession and the important that pharmacy technicians must in that He that PTCB is to with the full of to achieve uniform for pharmacy technicians. Zellmer for the American Society of Health-System Pharmacists on the and on the planning of the Pharmacy Technician McAllister is by the Pharmacy Technician Certification Board is by is by the Accreditation Council for Pharmacy Education The PTCB pharmacy technicians and provided support for the Pharmacy Technician for pharmacy technicians, is an of PTCB, and a on the PTCB board of directors. and ACPE the Pharmacy Technician Accreditation which is the review for pharmacy technician This will as a Web of the of the American Pharmacists