Melissa Furman, PharmD
Clinical Pharmacist
Inova Alexandria Hospital
Alexandria, Virginia
 
Change can be positive, change can be challenging, and change can require a shift in roles. We all are experiencing an empowering phase of pharmacy practice, but this time is especially exciting for pharmacy technicians. It brings accountability to technicians, as well as opportunities for them to seize a larger and a more direct role in improving patient safety.

Change is inevitable in the health care field and it seems as if we are seeing it occur more quickly recently, especially with the rapid development and implementation of technology. The implementation of automation means expanded roles for technicians. Automation promotes safety and accuracy, and when used properly, it can save valuable time, freeing up technicians to work in other areas of patient care and enabling pharmacists to act as direct care providers. The American Society of Health-System Pharmacists’ (ASHP) Pharmacy Practice Model Initiative cites technicians as a cornerstone of the future of pharmacy practice and recommends increased educational requirements for technicians in the future. To meet these goals and to prepare technicians for these expanded roles, education is essential, but how do we best teach technicians and what are the real-world benefits afforded?

Last year, Inova Alexandria Hospital’s Pharmacy Department began a journey to answer these critical questions. After returning from the ASHP 2011 Summer Meeting, I was asked to give 2 educational presentations summarizing key points gleaned from the conference—one for our pharmacists and another for pharmacy technicians. The technicians had many questions and the presentation quickly transformed into an interactive discussion. This experience revealed that not only is there a need for technicians to know this information, but also there is a desire to learn, and these types of presentations could be beneficial as a scheduled program. The team brainstormed initial ideas for creative programming and surveyed the technicians for topics of interest. A 6-month framework of presentations was created, and thus our pharmacy technician education forum was born.

Each month we teach interactive sessions designed specifically for technicians, covering 2 to 3 drugs or a single disease state. Each presentation consists of approximately 20 minutes of material and there are an additional 10 minutes built in so that technicians are free to ask questions at any point to help facilitate discussion. During each learning session, our technicians are given a pretest and post-test to assess their knowledge and quantify what they have learned in order to give them a chance to think critically, work together, and reinforce each lesson from the presentations. Presentations specifically are focused on what technicians need to know—everything from basic drug information, to side effects, to sterile IV compounding, to recognizing a standard dose versus a toxic dose, and even to knowing simplistic mechanisms of action—with a special emphasis on safety and the technician’s role as it relates to a drug or disease state. The presentation strategies used to engage technicians include keeping it simple and short, asking questions, giving out prizes, and using case studies (Tables 1 and 2).

Table 1. Tips for Starting Technician Education Programs
Keep it simple and short.
Use a language technicians understand and make sure presentations are no more than 40 minutes.
Keep technicians engaged.
Ask questions, encourage attendees to ask questions, give “pop quizzes,” provide snacks and rewards for participation.
Use simplistic patient cases to make your points (Case Studies).
Show technicians how the information they are learning fits into the patient care in their job.
Avoid the use of medical jargon.
Don’t overwhelm them with terms they don’t understand; if you do use a medical term, also define that word in layman’s terms.
Plan out your session 3 to 6 months at a time but always remain flexible.
If there is a change in the department or protocol, these technician education sessions are an efficient and effective way to ensure technicians understand the changes.
Have fun! Give out candy and prizes, use humor and visuals in the presentation. Don’t be afraid to make attendees laugh. It keeps them from getting overwhelmed and keeps them engaged.
Table 2. How Best To Use Case Studies

Case 1

ID, DOB 6/1/1944, weight 154 lb, with paresthesia and dysarthria lasting for 150 minutes, is brought to the emergency department for suspected acute ischemic stroke. Is ID eligible for tPA? What dose and at which rate of tPA should ID receive?

Why would this be confusing for a technician?

  • Medical jargon is used.
  • Extraneous information is provided.
  • It is challenging to extract needed information.

The goal is to teach technicians about drug information using patient case examples, rather than teaching patient assessment.

Case 2

Ima Droopie, a 68-year-old man who weighs 70 kg, has numbness in right arm, facial drooping, and slurred speech. Symptoms begin at 10:00 am, and at 12:30 pm, Ima arrives at the ED. Ima appears to be having an “acute ischemic stroke” (stroke caused by a blood clot). Is he a candidate for tissue plasminogen activator (tPA) (alteplase)? If so, what dose should he receive and how fast should the rate be?

Why is this presentation more suited for educating technicians?

  • The information is presented clearly.
  • Only the necessary information is provided.
  • Weight is provided in kilograms, which facilitates calculations.
  • The patient is described in a language technicians can understand.
  • Humor is used.

 

The benefits of the technician education forum are numerous. Technicians have become more engaged and accountable for their work and have reported an increased job satisfaction. Furthermore, teaching technicians about correct dosing and safety allows them to become a second set of eyes for pharmacists. Technicians present concerns or questions during daily activities based on topics and concepts previously presented.

Based on these educational sessions, technicians even have helped to prevent medication errors by stopping incorrect orders before the drug ever leaves the shelf. For example, the agent dabigatran (Pradaxa, Boehringer Ingelheim) was reviewed during one of the sessions. Technicians learned key points about this anticoagulant, including that capsules should not be crushed or opened due to the potential for serious adverse effects. A few months later, a pharmacy technician was completing medication reconciliation in the emergency department. During a patient interview, he discovered the patient was opening the dabigatran capsules and swallowing the powder. That technician notified pharmacy and the patient’s physician immediately. A pharmacist educated the patient regarding proper administration of dabigatran, preventing potential harm.

It is evident that these programs promote teamwork. In addition to pharmacists educating technicians, technicians also are encouraged to teach one another through the questions posed during the educational sessions. Moreover, some of the technicians have volunteered to lead peer-to-peer presentations.

As a result of these educational programs, technicians have become more engaged and involved in their work and now provide another set of eyes to improve medication safety. The programs also have provided pharmacists new opportunities for leadership and an avenue to help close the gap between themselves and technicians by raising the bar based on technicians’ newfound drug information knowledge base. Furthermore, our pharmacy technician education programs keep technicians engaged, help us with medication safety, and prepare our technicians for the future of pharmacy practice.

With time, dedication, and a little creativity, any hospital pharmacy department can start a pharmacy technician education forum. If you have questions or need some advice, please feel free to contact me at Marissa.Furman@inova.org.