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In the complex and vital world of healthcare, various roles contribute to the smooth functioning of medical facilities. Two such roles often confused are Pharmacy Technicians and Pharmacist Assistants. While their titles may sound similar, the responsibilities and qualifications associated with these positions are distinct. In this article, we will delve into the differences between a Pharmacy Tech and a Pharmacist Assistant, shedding light on the unique contributions each makes to the healthcare system.

Defining Roles

Pharmacy Technician

Pharmacy Technicians play a crucial role in supporting pharmacists in their daily tasks. They are trained professionals responsible for handling medication dispensing, managing inventory, and interacting with both customers and healthcare professionals. Pharmacy Technicians work under the direct supervision of a licensed pharmacist.

To become a Pharmacy Technician, individuals typically undergo formal education and training programs, which may include classroom instruction and hands-on experience. Certification requirements vary by location, but many pharmacy technicians opt for certification to enhance their skills and marketability.

Pharmacist Assistant

Pharmacist Assistants, on the other hand, focus on administrative and clerical tasks within a pharmacy setting. Their responsibilities may include managing phone calls, organizing inventory, and handling customer queries. Pharmacist Assistants work closely with both pharmacists and pharmacy technicians but do not engage in tasks directly related to medication dispensing.

Unlike Pharmacy Technicians, Pharmacist Assistants may not require formal education or certification. Many individuals in this role learn on the job, gaining experience in administrative tasks and customer service within a pharmacy environment.

Key Differences

• Educational Requirements: One of the primary distinctions between Pharmacy Technicians and Pharmacist Assistants lies in their educational backgrounds. Pharmacy Technicians typically undergo formal training programs that cover pharmaceutical calculations, medication dispensing procedures, and ethical considerations. In contrast, Pharmacist Assistants may enter the field with a high school diploma and receive on-the-job training.
• Scope of Responsibilities: Pharmacy Technicians are directly involved in the medication dispensing process. They work with pharmacists to ensure prescriptions are accurately filled, provide information to patients about medication usage, and maintain detailed records. Pharmacist Assistants, on the other hand, focus on administrative tasks such as handling phone calls, managing inventory, and ensuring the smooth operation of the pharmacy.
• Supervision and Collaboration: Pharmacy Technicians work under the direct supervision of a licensed pharmacist. Their tasks are often more technical and require a deep understanding of medications and dosage calculations. In contrast, Pharmacist Assistants work alongside both pharmacists and pharmacy technicians, providing crucial support in administrative functions.
• Certification and Regulation: Many regions have specific certification requirements for Pharmacy Technicians, emphasizing the importance of formal education and standardized training. Pharmacist Assistants, while valued for their contributions, may not be subject to the same certification regulations. This distinction highlights the specialized knowledge and skills associated with the Pharmacy Technician role.

Learn more about working as a pharmacy technician.

Is a Pharmacy Tech the Same as a Pharmacist Assistant?

While the titles “Pharmacy Technician” and “Pharmacist Assistant” may sound similar, the roles they play within a healthcare setting are distinct. Pharmacy Technicians undergo formal education and training, often earning certifications, to handle the technical aspects of medication dispensing. On the other hand, Pharmacist Assistants focus on administrative tasks, providing essential support to ensure the efficient operation of the pharmacy.

Understanding these differences is crucial for individuals considering a career in the pharmaceutical field and for those seeking clarity when interacting with healthcare professionals. Both Pharmacy Technicians and Pharmacist Assistants contribute significantly to the overall functioning of a pharmacy, playing integral roles in patient care and safety.

The field of pharmacy technology is undergoing significant transformations, mirroring the dynamic changes in the healthcare landscape. Pharmacy technicians, once considered as support staff, are now integral members of the healthcare team, playing a vital role in ensuring the safe and efficient delivery of medications. In this article, we’ll explore the evolving role of pharmacy technicians, highlighting current trends and the plethora of opportunities that await those considering a career in this field.

The Shifting Landscape of Pharmacy Technicians

Traditionally, pharmacy technicians were primarily responsible for tasks such as medication dispensing and inventory management. However, with the advancement of healthcare practices, the role of pharmacy technicians has expanded to encompass a wider array of responsibilities. Today, pharmacy technicians are increasingly involved in patient care, medication therapy management, and even preventive health initiatives.

Educational Requirements for Pharmacy Technicians

To meet the demands of this evolving profession, educational programs for pharmacy technicians have adapted accordingly. Many aspiring pharmacy technicians pursue formal education and training programs that cover a range of subjects, including pharmacology, pharmacy law and ethics, medication safety, and practical skills such as prescription processing and compounding.

Most pharmacy technician programs are designed to prepare students for the Pharmacy Technician Certification Exam (PTCE) or similar certification exams. Attaining certification is a key step toward professional recognition and enhanced career opportunities.

Technological Integration in Pharmacy Settings

Technology is playing a pivotal role in shaping the modern pharmacy landscape, and pharmacy technicians are at the forefront of these advancements. Automated dispensing systems, electronic health records (EHRs), and telepharmacy services are becoming increasingly prevalent. Pharmacy technicians must not only be proficient in utilizing these technologies but also contribute to their effective implementation for improved patient outcomes.

Expanded Responsibilities and Specializations

Pharmacy technicians are now taking on expanded roles, with some specializing in areas such as compounding, sterile product preparation, or medication therapy management. This diversification allows pharmacy technicians to carve out niche roles within the healthcare system, contributing to specialized patient care and fostering career growth.

Opportunities for Career Advancement

The evolving role of pharmacy technicians opens up diverse career paths and opportunities for advancement. Beyond traditional retail and hospital settings, pharmacy technicians may find opportunities in long-term care facilities, specialty pharmacies, and even in roles that involve collaborating with healthcare providers to optimize medication regimens.

Megan Bosa, CPhT

Megan Bosa, CPhT has been a certified pharmacy tech for the past 3 years, with extensive experience in a hospital pharmacy. She lives in the Midwest and is an avid marathon runner.

Pharmacy folks, like many others, turn to social media to express frustration with their job. One of the more common photos posted these days shows a prescription with a plea for help from the public to interpret the name of a prescription item … "what in the world is the name of this drug?" Answers may range from humorous to slightly off-color, but the overall consensus is that sometimes it's hard to be 100% sure. What is clear, however, is that handwriting and other factors often contribute to confusion around drug names that look and sound similar. These drugs are also known as "look-alike, sound-alike" medication pairs (LASA). When confusing labels are paired with a high stress work environment with many distractions, errors are bound to occur.

RELATED: 10 Errors of Computer-Generated Prescriptions You Should Be Aware Of

A study completed by the Food and Drug Administration (FDA) evaluated common causes of errors related to medication. This study found the most common type of fatal medication error was improper dose (41%), and the second most common type of error was related to wrong drug and wrong route of medication (16% each). It is clear that labeling is an important part of medication safety. How can pharmacy technicians play a role in reducing the risk of medication errors and minimize patient harm, particularly involving drug names?

The Prescription Label: It All Starts Here

The pharmacy technician is often the first staff member to receive and interpret the prescription label, and can pause the process if any information is missing or includes an error. For example, although not all states require the prescriber to list the purpose the patient is taking a medication (also known as the "indication"), inclusion of this information can serve as a "red flag" if the wrong medication has been chosen. Sometimes this information may simply be vague, such as "Take <blood pressure medication> for heart health", but other times the indication may be completely incorrect, such as "Take <cholesterol medication> for infection." These types of inconsistencies may require the pharmacist or another staff member to call the prescriber's office to clarify the prescription. If possible, the technician should also refer to the patient's medical record to confirm the prescription diagnosis matches a health condition included in the patient's chart. Any inconsistencies should be discussed with the supervising pharmacist immediately.

Safety Must Always Come First

Unfortunately, not all prescribers or their nursing staff may want to receive these types of calls, but patient health and safety must come first. If the pharmacy staff member does speak to a provider or team member to clarify the prescription, it is also good practice to confirm that the label contains both the brand name (trade name) and generic (nonproprietary) name for the medication. Errors can also happen due to poor handwriting, use of abbreviations, memory lapse, rushed work environment, and/or large formularies from which to choose therapies. Attempts should also be made to minimize the use of verbal and telephone orders which are more difficult to verify should confusion occur. Written orders allow for the pharmacy team to verify the order at the time of dispensing, and in future situations should questions arise.

An additional strategy technicians can employ is to become aware of some common examples of medications that have similar names. Examples are published each year by the Institute for Safe Medication Practices (ISMP) and include the following:

• Acetaminophen and acetaZOLAMIDE
• Hydralazine and Hydroxyzine
• amantadine and amiodarone
• buPROPion and busPIRone
• CeleXA and ZyPREXA
• clonazePAM and cloZAPine
• cloNIDine and clonazePAM

Some of the examples listed above also demonstrate a risk management technique known as "tall man" lettering (also known as mixed-case), i.e. changing the appearance of look-alike product names to bring attention to spelling dissimilarities. Other options for drug labeling including boldface or color differences. Some pharmacy dispensing software systems are even configured such that the screen prevents look-alike drug names from appearing in consecutive order. Very creative!

Other Strategies to Reduce Errors

Pharmacy technicians can also help reduce medication errors related to drug names by working to create an organized medication storage environment. For example, technicians can place "eye-catching" labels on storage bins and store medications that could potentially be mixed up in different areas of the pharmacy. Some software programs may incorporate bar code technology to confirm the correct product has been chosen for each prescription. In addition, technicians can also ask their supervising pharmacist to counsel patients who are taking medications with problematic drug names. The pharmacist can also provide written information to further reduce errors that could occur after the correct medication is dispensed and taken home with the customer. As a team, the pharmacist and technician can help get the right medication to the right patient and reduce medication errors.

Dr. Michelle Lamb

Dr. Michelle Lamb currently works full-time as a Senior Care/Geriatric Pharmacy Consultant based out of Tulsa, OK. She is the Founder of LTC Pharmacist Connection, a forum of over 3500 current and future LTC consultants and dispensing pharmacists. She is also the CEO/Owner of Foxglove Pharmacy Consulting. Dr. Lamb provides inspection services and medication therapy management for nursing homes, assisted living facilities, and group homes in the GREAT state of Oklahoma. This role allows her to promote safe medication use by residents in long-term care settings focusing upon reducing the use of anti-psychotic medications.

Pharmacy technicians are taking on progressively expanding roles in the healthcare arena, and a need exists in the market for both new and experienced individuals. The healthcare system continues to become increasingly large and complex. There are many opportunities for pharmacy technicians, especially in a hospital setting. Read on to discover what pharmacy technicians can expect from a position in this sector.

The Initial Journey

Wuen Hernandez, a fourth-year pharmacy student (Class of 2021) from the University of Houston College of Pharmacy, has been working as a pharmacy technician in a large academic medical center. His interest in pharmacy was sparked when he enrolled in his high school's pharmacy technician preparatory class. This class was designed to teach high school students basic pharmacology, pharmacy mathematics, and pharmacy law. The main goal of this program was to allow graduating seniors to take the PTCB exam and hopefully obtain a job as a pharmacy technician post-graduation. As an incentive, the school offered to cover examination fees. Growing up, Hernandez always knew he wanted to work in the healthcare field, so this was an amazing opportunity that he couldn't miss.

The Transition

After five years of working retail chain pharmacy, Hernandez got tired of being overworked with minimal pay. There was always a constant push for more work, but with less help. He knew that he wanted to make a transition to find another job. He wanted to explore other fields of pharmacy – specifically, hospital pharmacy. A requirement for hospital inpatient pharmacy is having an IV certification, as it is a vital skill to serve acute care patients. He then enrolled in a pharmacy technician intravenous (IV) compounding certification class offered by a local company in Houston, TX. There are many organizations that offer this type of certification, which usually consists of a 2-day course with didactic and some practical applications.

Hernandez obtained his IV certification after completing the required training and started to apply for hospital pharmacy jobs, eventually finding employment at a tertiary hospital in the Texas Medical Center. By this time, he was getting ready to start pharmacy school and was not too sure which route in pharmacy he wanted to pursue. As a result, he kept both pharmacy technician jobs (in the hospital and in the retail chain). It is a good start to keep your options open by being in two settings if you have the time to dedicate and your manager is willing to work with your schedule. In addition, pharmacy technicians in retail sometimes get paid more than their hospital counterparts.

Onboarding Process and Job Duties

The hospital onboarding process requires the technician to complete various modules prior to receiving on-the-job training. Hernandez received a month-long training where he was able to shadow other pharmacy technicians to learn the daily workflow.

Hospital pharmacies have various roles for pharmacy technicians compared to retail pharmacies. During one shift, a pharmacy technician could be scheduled to do IVs, be the front technician to assist the pharmacy staff with first/cart fill doses, deliver medications, or prepare the oral syringe batch/pre-package medications. Other duties include preparing hazardous medication such as chemotherapy, preparing crash carts, RSI kits, and tackle boxes.

Hernandez’s hospital was big enough to have an operating room (OR) surgical satellite pharmacy where a pharmacist and pharmacy technician were staffed 24/7 to prepare any urgent/emergency (STAT) IV medication or deliver any medication needed in the OR. All hospitals have a central pharmacy where the main operations run from, but not all have satellite pharmacies, such as OR or intensive care units, as it takes more manpower and resources.

Key Takeaways

In many community hospitals, which comprise about 85% of all hospitals, resources are limited, so you learn to wear many different hats as a pharmacy technician. The evening team is responsible for pulling medications from the robotic inventory machine called MedCarousel for delivery/refill to all automatic dispensing units such as Pyxis. Again, depending on the size of the hospital and financial standpoint, different technologies exist due to capital costs. In general, when there is more automation, it helps to reduce some of the manual work. For example, with the robotic inventory carousel, it provides another level of protection in terms of retrieving the right medications with bar code scanning and reducing manual memorization of medications' locations.

When working at a hospital pharmacy you're working directly with a larger team, including doctors, nurses, respiratory therapists, speech therapists, and pharmacists, which is very different from a retail pharmacy. Except for a few unique pharmacy technician duties, inpatient pharmacy does not usually deal with patients directly since their main job is to handle medications, stock them on the units, and work with nurses and pharmacists to take care of their requests. The hospital pharmacy technician job can be exciting for people who enjoy working with healthcare professionals and embrace a fast-paced environment with many growth opportunities.

Phuoc Anne Nguyen, PharmD, MS, BCPS

Phuoc Anne Nguyen is a passionate pharmacy leader who wants to enhance the pharmacy profession and financial literacy. She has had a wide range of experiences including community independent pharmacy, clinical pharmacy, hospital pharmacy leadership, and academia.

Technology in healthcare is always moving forward. From personal health monitoring to medical tests, technology is here to improve our lives. In medicine and healthcare, digital technology brings more effective solutions for issues happening in any part of the continuum of care.

An excellent example to cite is the introduction of electronic prescribing (e-prescribing) to prevent medication errors secondary to misinterpretation of handwritten prescriptions. E-prescribing is the process of transmitting prescriptions electronically from the prescriber (e.g., doctor, nurse practitioner, etc.) to the pharmacy. It is one of the instructions a provider can send through the computerized provider order entry (CPOE) system. However, research shows that e-prescribing is associated with new errors - both in inpatient and outpatient settings.

A study found out that over one-in-ten e-prescription errors were seen in an outpatient pharmacy chain located in three states. The researchers also noted that a third of the errors could potentially cause harm to the patients.

RELATED: 3 Ways Pharmacy Technicians Are Vital for Patient Care

What Are the Errors Associated With E-Prescribing?

E-prescribing offers an improvement in patient safety over paper-based systems. A good example is alerting clinicians of drug interactions. Although it has been beneficial in many ways, there are still errors associated with e-prescribing. This is why as a pharmacy technician, you must be aware of the following to minimize dispensing a medication prescribed with errors.

1. Missed Allergy

Identifying a patient's allergies is a part of medical history-taking. According to research, the highest error rate in e-prescribing is the failure to enter a patient's allergy information.

2. Medication Name

In a computerized system, you need to choose a medication from a list. Errors such as selecting Augmentin Duo instead of Augmentin Duo Forte would result in prescribing the wrong medication.

3. Dose and Quantity

The wrong dose entered means you could either give a higher or lower dose of the medication than what was prescribed. This error is very risky for the patient.

On the other hand, the quantity and type of unit are required for the provider to enter. If they are unaware, it will lead to guessing what information to enter.

4. Administration Time

Changing the default times for the patient's medication intake is necessary, but failure to do it is common. Let's take Furosemide 40mg PO taken twice daily. If it is prescribed at default times of 0800 and 2000, the patient will take it in the morning and evening. However, the correct time of the second dose intake is midday (1200) to lessen the disruption of sleep.

5. Frequency

A provider may have selected the wrong frequency from the CPOE menu. For example, a doctor prescribed Lisinopril 5mg PO daily in the morning. But, the suggested time of the day is in the evening because patients must take this blood pressure-lowering medication at nighttime to avoid the risk of falls.

6. Medication Omissions

Patients prescribed with new medications must have an updated file. Medication omissions happen when the prescriber did not add the new drug to the patient's electronic medication chart.

7. Qualifier Omission

Let's say you have a 76-year-old patient with a groin candida infection who was given Clotrimazole (1%) cream topical three times a day. A qualifier omission occurs when the prescription does not have an instruction for the anti-fungal cream on where it should be applied. In this case, there must be an added text, "to the groin area," for it to be administered properly.

8. Conflicting Information

Incorrect instruction may occur due to the provider's inability to make changes when the computerized system inserts auto-populated information into the prescription. Another possible reason could be that the automated system carried over the information incorrectly from prior prescriptions.

9. Refill Errors

Old refill prescriptions used as a template may generate incorrect information.

10. Transcription Errors

CPOE systems and pharmacy systems are not integrated. This forces a pharmacist or pharmacy technician to print the prescription or memorize the information to enter the data into the pharmacy system.

Recognizing E-Prescribing Errors is Important For Patient Safety

Despite the benefits of e-prescribing, such as improved efficiency between the pharmacy staff and providers, we cannot take the fact that errors are still occurring. Medication errors could potentially harm patients and that is a public health concern. Therefore, one of the pharmacy technician's critical roles as part of the pharmacy staff is to recognize and capture prescription errors before they reach the patient.

Karen Alinas

Karen Alinas is a professional writer living in Canada. She works closely with B2C businesses and has a background in healthcare. She specializes in family health as well as career and personal development types of content.

The sounds of the pharmacy ring loud and clear. Spatulas counting tablets by fives, the ring of the drive-through bell, pill bottles returned to shelves, and (of course) the phone. The DARN phone, it NEVER stops! Pharmacy technicians must balance customer needs, dispensing duties, inventory management, and their own mental health. Often the sound of the phone ringing seems like just enough to fry that last nerve. Even the renowned "super tech" may struggle to stay sane while managing so many roles, and just when you feel caught up the pharmacist hollers to answer the phone. OUCH! It's time to make an important choice – do you tell the pharmacist you are busy, answer the phone and lose track of which refill you were processing, or perhaps (in a not so subtle but effective move) throw the phone into the returns bin and find a new line of work?

High Expectations and Strong Emotions

Providing excellent customer service during a pandemic is not easy! Extra phone calls related to COVID testing or hand sanitizer may cause stress levels to soar. The Centers for Disease Control offer some tips to help healthcare personnel cope and stay resilient. These suggestions include the following:

1. Communicate openly with colleagues about job stress, and work together to find solutions.

2. Remember everyone is in an unusual situation with limited resources.

3. Realize there are work factors that you have no control over.

4. Recognize that you are providing a crucial role in fighting the pandemic and doing the best you can with what you have available.

Overwhelmed technicians may also communicate with their pharmacist about ways to reduce the stress associated with the busy environment, including rotation of job roles and assignment of job responsibilities, such as answering the phone. Hopefully, the pharmacist will listen and respond.

RELATED: Crunching Numbers: How Pharmacy Techs Can Keep It All Straight

Slowing Down During Operation Warp Speed

Although it is a reasonable first effort, communication strategies may ultimately have little effect on the business of retail pharmacy. The overwhelmed pharmacy technician can also reach for coping strategies that can be done anytime, and which will support their mental health. Here are some simple ideas for staying calm while the script count never slows. First, consider designating a one-minute mental break at the top of each hour. This could look like taking a series of deep breaths, or a simple exercise such as leaning over and touching your toes. Another option could be each time you look out a window and see a cloud, wait a few moments until you see the cloud move before resuming activities. These brief moments of calm may sound silly or unnecessary, but a few seconds to periodically perform self-care can lower stress.

But That Phone Is Still Ringing!

Despite improved communication with the pharmacist and stealing a moment to slow your heart rate and thoughts, ultimately the pharmacy work environment is shaped by the duties that are required by the pharmacist. This is particularly true for the tasks that can only be completed by a pharmacist, and they are responsible for everything that happens in the pharmacy! It may appear as though they are simply staring at a screen or answering questions about the latest drug to be featured in a commercial. However, their responsibilities include double-checking all prescriptions before it is sold to a patient, ensuring all prescriptions are legal and valid, adhering to all state and federal regulations, keeping accurate records, and paying close attention to detail. Unlike a pharmacy technician, there is no higher-level professional to check the pharmacist's work, and mistakes can have grave consequences.

Although it isn't necessarily noticed by technicians or customers, pharmacists may perform their final check with a series of "rights" while verifying the prescription: it is critical that the right dose of the right drug reaches the right patient at the right time via the right route. Unfortunately, the truth is that from the pharmacist perspective, the ringing phone represents an interruption to this thought process, which could result in having to restart the verification. If the pharm tech is able to answer (and screen!) all phone calls that do not directly require the pharmacist knowledge, then the pharmacist is able to focus on those activities that do require the additional clinical knowledge and resources that were obtained through a doctorate level of education. Other tasks that may be required to be completed by a pharmacist include inventory of controlled drugs and supervising or training of student interns and other personnel.

RELATED: What is the Difference Between a Pharmacy Technician and a Pharmacist?

But Does Team Work Make the Dream Work?

The hard truth is sometimes it does, and sometimes it doesn't. The pharmacist and pharm tech can accomplish the most when working together – like how the right hand helps the left. But when it comes down to it…it's probably the hand of the pharmacy technician that answers most calls. Take a deep breath…you got this!

Dr. Michelle Lamb

Dr. Michelle Lamb currently works full-time as a Senior Care/Geriatric Pharmacy Consultant based out of Tulsa, OK. She is the Founder of LTC Pharmacist Connection, a forum of over 3500 current and future LTC consultants and dispensing pharmacists. She is also the CEO/Owner of Foxglove Pharmacy Consulting. Dr. Lamb provides inspection services and medication therapy management for nursing homes, assisted living facilities, and group homes in the GREAT state of Oklahoma. This role allows her to promote safe medication use by residents in long-term care settings focusing upon reducing the use of anti-psychotic medications.

Pharmacy technicians are counting machines! OK, not literally counting machines (which some stores are actually lucky enough to have), but they do count a variety of items throughout the day. How many customers were in the drive-through before opening? How many refills in the queue? And perhaps the most important…how many minutes until closing time? Counting counts for so much, and there are certain reminders that are worth revisiting, starting at the beginning…with zero.

Zero In On This Idea

Believe it or not, there are many ways to express the number zero! The British use the term "naught" but in the United States other options include aught, cipher, goose egg, nil, nothing, zilch, and zip. However one chooses to describe zero around the world, pharmacy personnel must honor the concept of "leading" and "trailing" zeroes. A leading zero is a zero preceding a decimal point, such as Risperdal 0.5 mg PO daily. Leading zeroes must always be used when writing prescriptions for quantities of drugs that are fractions of a unit to avoid dosing confusion. For example, if the prescription above is written without the leading zero, i.e. Risperdal .5 mg PO daily, the result may be a tenfold dosing error! Pharmacy technicians that encounter a prescription written incorrectly should notify their supervisor of the need to clarify the drug strength.

On the other side of this concept is a "trailing" zero. A trailing zero refers to a zero that follows a decimal point, such as Clonidine 1.0 mg PO TID. Using a zero after a decimal point can also result in a tenfold dosing error if the decimal point is illegible or not noticed. For this reason, the Joint Commission on the Accreditation of Hospitals has included trailing zeroes on their official "Do Not Use" list.

Other Number Confusion – Where to Start?

Another topic in pharmacy where confusion may come up are with starter packs. A starter pack refers to a unique manufacturing package size for medication regimens with quantities that may increase during the first few days or weeks of use. Examples of starter packs include the following regimens:

• Chantix (Varenicline): The patient should take one 0.5 mg tablet PO for 3 days, then one 0.5 mg tablet PO BID for 4 days. Continued treatment is 1 mg PO BID. The dose is started slowly to reduce adverse effects with varenicline, including strange dreams and trouble sleeping.
• Namenda (Memantine):
  • Week 1 (day 1-7): The patient should take one 5 mg tablet PO daily for 7 days.
  • Week 2 (day 8-14): The patient should take one 10 mg tablet per day for 7 days.
  • Week 3 (day 15-21): The patient should take one 15 mg tablet per day for 7 days.
  • Week 4 (day 22-28): The patient should take one 20 mg tablet per day for 7 days.
  • The maintenance dose is 20 mg per day. Each tablet strength is a different color, and starting with lower doses reduces the risk of side effects such as headache and sleepiness.
• Xarelto (Rivaroxaban): This starter pack is designed for the first 30 day supply. The patient should take 15 mg PO BID for 21 days, then the dose is reduced to 20 mg PO daily. Higher doses are given at the start of treatment when the patient is most vulnerable to a clotting event such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Lamictal (Lamotrigine): This medication has not one, but THREE different types of starter kits, each based upon other medications taken by the patient. The starter kits help minimize drug interactions, including life-threatening rashes.
  • Blue starter kit: for patients taking valproate
  • Green starter kit: for patients taking carbamazepine, phenytoin, phenobarbital, or primidone
  • Orange starter kit: for patients NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate

Take extra precaution when entering prescriptions for starter kits and ensure that you pick the right packaging and kit choice, and confirm the patient has received counseling from the pharmacist on how to use these kits to prevent errors related to patients who do not take these items as prescribed.

RELATED: 3 Ways Pharmacy Technicians Are Vital for Patient Care

Billing and Other Considerations

A final consideration when entering and filling prescriptions are errors related to the package size itself and how these items are billed to insurance. Stock bottles often come in quantities of 90 or 100, but there are some exceptions. Tizanidine products, for example, often contain 150 tablets per stock bottle (not 100) which can increase the risk of error when pouring an entire bottle into a vial. Other examples include testosterone gel packets supplied in boxes of 30 packets but billed for a quantity of 150 grams, and birth control packets which may have 21, 28, or 91 tablets.

The bottom line is take your time and focus on the details!

Dr. Michelle Lamb

Dr. Michelle Lamb currently works full-time as a Senior Care/Geriatric Pharmacy Consultant based out of Tulsa, OK. She is the Founder of LTC Pharmacist Connection, a forum of over 3500 current and future LTC consultants and dispensing pharmacists. She is also the CEO/Owner of Foxglove Pharmacy Consulting. Dr. Lamb provides inspection services and medication therapy management for nursing homes, assisted living facilities, and group homes in the GREAT state of Oklahoma. This role allows her to promote safe medication use by residents in long-term care settings focusing upon reducing the use of anti-psychotic medications.

Let's face it, folks, no matter how you look at it 2020 has been a tough year. Much about the pandemic is unknown and may remain that way for quite some time, but one certainty is the impact that wearing a mask and social distancing can have upon transmission of COVID-19. What is less clear is the impact masks and physical separation have on effective communication within the pharmacy. Keep reading for some real-world tips to improve these situations.

The pharmacy environment is a bustling and often stressful workplace, and in current times customers may be in an even bigger hurry to grab their medications and hit the road. Despite this, it remains important for the pharmacy technician to communicate with patients and customers in a clear and precise manner even while wearing a mask and social distancing. Being mindful of certain tips and tricks can help reduce communication errors, clarify nonverbal messages, and avoid facial irritation or "maskne" caused by long shifts wearing a mask.

RELATED: Working as a Pharmacy Technician

"Excuse Me, But What Did You Just Say?"

Since masks can muffle sound, and speech becomes quieter with distance, it is tougher than ever for pharmacy technicians to effectively relay prescription or health information to customers. For example, technicians providing price quotes to customers for a medication or co-pay may use the word "fifteen" as in, "Your new prescription has a $15 co-pay." This amount may be misheard as "fifty" instead, which would certainly cause some stress for all involved. One tip when sharing numerical information with a customer is to use multiple ways to state a quantity, such as "That will be fifteen dollars, one-five" or "Your prescription's instructions read forty units of insulin, four-zero." Pharmacy technicians can further improve communication by facing the customer directly, speaking louder and slower, and moving to a quiet counseling area if possible.

The Eyebrows Tell a Story

Masks affect our ability to see each other's facial expressions and can impact our understanding of what we are hearing. On the other hand, thoughtful use of hand gestures and body language can send a strong message of customer service and empathy. For example, pharmacy technicians should aim to relax their shoulders (not always easy), try not to cross their arms in front of their body, and nod to acknowledge listening and understanding of pharmacy customer concerns. In addition, eyebrows tell the story! Raised eyebrows imply happiness, pinched eyebrows can mean sadness, and "V" shaped eyebrows often connote anger or frustration. In addition to careful nonverbal communication, the pharmacy team should consider removing physical barriers that could impede the travel of sound or block customer view, such as over the counter (OTC) item displays or other signage. The Hearing, Speech, and Deaf Center even provides options for making or purchasing clear masks, an excellent option for team members working with deaf or hard of hearing customers who may rely on lip-reading.

2020 and Beyond…What's Next?

Some jobs just aren't meant for working from home, and most pharmacy personnel will not have the option to work in pajamas and forgo makeup or deodorant for a day. If working retail during a pandemic wasn't stressful enough, now pharmacy technicians must also deal with a certain type of acne associated with facial coverings, affectionately known as "maskne." That's right, there's even a nickname for this condition brought to us by 2020. This type of skin outbreak is actually called "acne mechanica," and it is caused by pores that become blocked by sweat, makeup, dirt, or oil. Before the pandemic, this condition was commonly found among athletes who were required to wear sports gear with helmets or straps, or on the armpits of patients using crutches.

These days, the friction of wearing a mask for long periods of time can clog pores, and the mask itself can lead to increased humidity and further exacerbate outbreaks. Strategies to help reduce the risk or severity of acne associated with wearing a mask include washing cloth masks daily and replacing disposable masks often. If an outbreak should occur, it is not uncommon to scrub excessively or too hard, which can actually worsen an outbreak. Instead, it is recommended to wash with a gentle facial cleanser and avoid products that are overly drying. Lotions that contain hyaluronic acid can also help keep skin moist, and products containing ceramides may provide a healthy protective barrier between the mask and the skin.

Don't forget to give your face a rest and remove your mask when it’s safe to do so, such as while driving or at home, unless taking care of a loved one and needing to take precautions. Take care of your face, and yourself! We can do this together.

Dr. Michelle Lamb

Dr. Michelle Lamb currently works full-time as a Senior Care/Geriatric Pharmacy Consultant based out of Tulsa, OK. She is the Founder of LTC Pharmacist Connection, a forum of over 3500 current and future LTC consultants and dispensing pharmacists. She is also the CEO/Owner of Foxglove Pharmacy Consulting. Dr. Lamb provides inspection services and medication therapy management for nursing homes, assisted living facilities, and group homes in the GREAT state of Oklahoma. This role allows her to promote safe medication use by residents in long-term care settings focusing upon reducing the use of anti-psychotic medications.

Without the help of pharmacy technicians, patient care would be compromised and the pharmacy profession would crumble. This may sound like a bold statement, but the vital importance of pharmacy technicians can't be understated. Read on to find out why pharmacy techs are needed more than ever.

1. Pharmacy Techs Save Lives With Their Compounding Expertise

Nowadays, pharmacy technicians are mainly the ones who compound medications for patients, especially IV medications. They have the dexterity and adaptability in this working environment. They are mostly on their feet while they are working in the IV room. Due to the critical nature of the drugs, they must be made in a sterile environment and per protocol for certain drugs.

For example, with the COVID-19 pandemic, technicians prepare a novel COVID-19 medication, named Remdesivir, and it has short stability; hence, they have to communicate with both the nurse and pharmacist before making it. Some technicians work to make specialized hazardous medications, such as chemotherapy agents. These medications can be toxic if accidentally spilled on the preparer or incorrectly made, as it could harm or delay recovery. Many precautions are taken to avoid accidents from occurring in this arena. In addition, these medications tend to be high cost, upwards of thousands of dollars per vial, which require extra attention to avoid waste. Oftentimes, most patients know the nurses that administer the medications or the doctor that they see but may not think about other critical staff members who are behind the scenes. Hence, it is important to know that we have pharmacy technicians to thank and recognize for making it possible to get medications to patients.

2. Pharmacy Techs Prevent Medication Errors by Retrieving Appropriate Medication History

One of the advanced pharmacy tech roles is a medication history pharmacy technician in a hospital setting. When patients arrive at a hospital, most patients are either incoherent or unprepared to provide their full medical and medication history to the healthcare team. In addition, there are circumstances where doctors and nurses don't have time to take a full, complete medication history. This could lead to medication errors, delays in care, or adverse health outcomes from inappropriate treatment due to lack of information.

A medication history pharmacy technician is a dedicated healthcare team member who takes the necessary time to talk with the patient and their family members to retrieve an accurate medication history. Patients may be upset with a pharmacy technician if they have to repeat themselves if they have already talked to a nurse or a doctor. However, for one's safety, it is worth the effort – especially if the technician deems the information to be incomplete. Sometimes, a call to the patient's home pharmacy may be needed to retrieve the information, as the patient may not recall the actual dose or name of the medication, or it may have been entered incorrectly.

By getting the medication history right at admission, it will help with the discharge process of going home as well, where doctors can either safely resume home medications or change them depending on the patient’s therapy. When healthcare records are not shared between the health system institutions, doctor's office, and pharmacy, it is paramount to get a complete medication history to provide effective care. Having a medication history technician in the Emergency Department (ED) is a crucial decision to prevent medication errors and improve patient safety.

3. Pharmacy Techs Ensure Medications Are Available Despite Supply Chain Disruptions

Another advanced pharmacy tech role is the inventory specialist, who manages the purchasing of the medications. Due to natural disasters and other unforeseen circumstances, medication supply may be limited, which impacts patient care and the ways doctors treat patients.

For example, with Hurricane Maria, 80 manufacturing industries were located in Puerto Rico, which disrupted chain supply to hospitals in the US. In 2018, during the flu season, basic IV fluid such as sodium chloride was in short supply. In these situations, the inventory specialists collaborate with pharmacy leadership and the healthcare team to alleviate the stress on patient care. When a commercial product becomes unavailable, it falls back on pharmacy technicians to compound these items in bulk, which creates extra stress as it is an additional workload to their already hectic workflow. The inventory specialist serves as an important gatekeeper for inventory management and acts as a leader in the drug supply chain to ensure patients get their medications when they are needed.

Being a pharmacy technician is a very stimulating and challenging, yet rewarding role. Overall, pharmacy technicians are the lifelines to the industry of the pharmacy, as they help pharmacists to practice at the top of their profession. Without pharmacy technicians, patients would suffer by not having their treatment when they need it. The bottom line is that pharmacy technicians play a vital role in delivering effective care while maintaining patient safety. Let's recognize them each day and not just on #RxTechDay!

Phuoc Anne Nguyen, PharmD, MS, BCPS

Phuoc Anne Nguyen is a passionate pharmacy leader who wants to enhance the pharmacy profession and financial literacy. She has had a wide range of experiences including community independent pharmacy, clinical pharmacy, hospital pharmacy leadership, and academia.

Yes. Pharmacy technicians are trained to prepare, package, mix, and distribute medications, among other duties. Dispensing a drug, according to the North Carolina Public Health department, means to prepare and package a prescribed medication in a container and label the container with information that is required by state or federal law. Dispensing also includes the process of filling or refilling drug containers with prescribed medications for use by patients.

How Pharm Techs Dispense Medications

The process of dispensing medications to a patient is a detailed one that involves checks and double-checks by the pharmacist and the pharmacy technician. The first step is to enter the prescription information into the computer system (tech) including the patient name, prescribing doctor's information, medication, dose, and instructions to the patient as well as the number of medications. Most pharmacy management systems will automatically check the new medication order against any previous orders to identify contraindications or adverse drug-to-drug interactions. This information is then verified by a pharmacist, including the appropriateness of the medication for the patient.

RELATED: Pharmacy Technician vs Pharmacist

The technician or the pharmacy management system creates a label for the order and secures it to the container. The pharmacy technician then fills the container with the prescribed quantity of the medication and the pharmacist verifies the medication in the container. Medication information sheets are also printed for each dispensed medication.

What About Medication Counseling?

When the patient presents to purchase the medication, a pharmacy technician may conduct the sale of the medication, although that is not required in most states. If the medication is new to the patient, or even if it's a refill, the pharmacist will provide counseling to patients regarding the specific medication. Pharmacy technicians are not trained nor certified to provide medication counseling or information that is not pre-printed by the pharmacy management system.

Phuoc Anne Nguyen, PharmD, MS, BCPS

Phuoc Anne Nguyen is a passionate pharmacy leader who wants to enhance the pharmacy profession and financial literacy. She has had a wide range of experiences including community independent pharmacy, clinical pharmacy, hospital pharmacy leadership, and academia.