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9/18/2002

Home Care Pharmacy Relies on Clinical Pharmacy Technicians

Kate Traynor

Qualified pharmacy technicians at a home infusion pharmacy in Portland, Ore., can leave intravenous (i.v.) admixture duties behind and pursue a clinically oriented career track.

Providence Home and Community Services began using clinical pharmacy technicians about two years ago and now employs three of the specialist technicians, said Pharmacy Services Manager Milo Haas. He said the program was developed because of "a need to have additional support work done for our clinical pharmacists."

The home infusion pharmacy is part of Providence Health System, a 20-hospital network that serves patients in Alaska, Washington, Oregon, and California. Fifteen pharmacists and 15–20 pharmacy technicians work at Haas's facility, which serves about 650 patients in Oregon and southwest Washington.

Haas described the pharmacy's business as "high-volume, subspecialty work" consisting mostly of preparing and monitoring the use of invasive drug therapies.

"We're managing patients for what you call continuum of care," Haas said. "The acute crisis is over, and our goal here is to keep [the patients] stabilized" throughout a course of i.v. therapy that can last weeks or even a lifetime.

Because Providence Home and Community Services is accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as a home care provider, each patient is treated as specified in a detailed care plan—a task that involves the clinical pharmacy technicians.

"We ask the technician to gather essential clinical data," Haas said. Information collected by the clinical pharmacy technicians can include a patient's medication history, physical data, and laboratory test results. The technicians also record the type of catheter in place in the patient so that treatment can be delivered effectively.

Haas noted that all of the pharmacy technicians at Providence have been certified by the Pharmacy Technician Certification Board. Only after three years' work in Providence's pharmacy, however, do the technicians become eligible for advancement to the position of clinical technician. All technicians must also pass an inhouse competency assessment of their i.v. admixture preparation technique, although clinical technicians are not placed on the pharmacy's routine schedule for preparing admixtures.

At Providence, clinical pharmacy technicians are responsible for telephoning patients and recording their answers to a series of questions about the outcomes of the medication regimen. Haas said that the questions are designed to elicit information specifically required by JCAHO as part of care planning and monitoring.

If a patient's response to any question indicates that there may be a problem, the technician turns the call over to a clinical pharmacist, who decides whether action should be taken.

Under Oregon's pharmacy practice laws, Haas said, "judgment or professional advice is restricted to a clinical pharmacist." Haas said the pharmacy staff operates under a "working agreement" to keep the clinical technicians' duties within their legal scope of practice. "The technicians clearly know they report to and are supervised by a registered pharmacist," Haas said.

In some situations, the responsibility for telephoning patients to obtain clinical data automatically falls to a pharmacist, not a clinical pharmacy technician. Total parenteral nutrition (TPN) therapy is one such situation. When a patient is receiving TPN therapy, Haas said, the pharmacy found that "it was better for the pharmacist to talk with the patient because of the specially guided therapy." He said pain-management therapy is another area in which a pharmacist may be better suited than a technician for obtaining information from patients.

Clinical pharmacy technicians also interact with caregivers outside of the pharmacy, Haas said.

"We work with 38 subcontracted home health agencies around our geographic area," he noted, adding that JCAHO and Medicare require that the agencies share some of their documentation with Providence. The clinical pharmacy technicians obtain outcomes reports and patient-assessment information from the contractors and send them patient information obtained by Providence.

Haas said he encourages other home health agencies to explore the use of clinical pharmacy technicians. He suggested that the duties of clinical technicians be targeted toward improving areas related to JCAHO accreditation requirements, such as charting data and assessing patient outcomes.

Haas acknowledged that some pharmacists may be reluctant to embrace the use of clinical pharmacy technicians because of worries over scope-of-practice issues. But, Haas emphasized, "the final decision can still be done by the pharmacist, and much of the preliminary work can be done by the technician."