TEAM BASED CARE - IPJ - The official journal of FIP

THE FUTURE OF PHARMACY

INTERNATIONAL PHARMACY JOURNAL

More t h a n t hr e e d e c a d e s of p e e r r e v i e w r e s e a r c h co nﬁ r m s t h e s a f e t y a n d a c c u r a c y of TCT. In a s y s t e m a t i c r e v i e w, a ut h o r s fo u n d 1 1 s t u d i e s t h a t e x a m i n e d t h e a c c u r a c y of TCT comp a r e d t o p h a r m a c i s t - p r o v i d e d ﬁn a l v e r i ﬁ c a t i o n , a n d fo u n d t h a t TCT sy s t e m s a r e at le a s t a s a c c u r a t e a s t r a d i t i o n a l TZTUFNTJOXIJDIQIBSNBDJTUTWFSJGZPSEFST WT 4 One re p r e s e nt a t i v e s t u d y wa s co n d u c t e d by St a f f o r d in a 7 0 0 - b e d t e r t i a r y c a r e in s t i t u t i o n . 5 The f a c i l i t y us e d a n en v e l o p e - b a s e d uni t d o s e di s t r i b u t i o n s y s t e m a n d fo r t h e s t u d y, in v e s t i g a t o r s r a n d o m l y a n d co v e r t l y int r o - EVDFEFSSPSTJOUPPGUIFFOWFMPQFTJOPSEFSUPEFUFS- m i n e t h e e r r o r - d e t e c t i o n r a t e of p h a r m a c i s t s a n d p h a r m a c y t e c h n i c i a n s . Pha r m a c y t e c h n i c i a n s p e r f o r m e d ﬁn a l v e r i ﬁ c a - t i o n o n t h e e n v e l o p e s a n d d o c u m e nt e d a ny e r r o r s . W it h o u t co r r e c t i n g t h e e r r o r s , t e c h n i c i a n s t h e n p a s s e d t h e e n v e l o p e s o nt o p h a r m a c i s t s a n d ha d t h e m p e r f o r m ﬁn a l v e r i ﬁ c a t i o n a s we ll . Over a 5 - w e e k p e r i o d , b ot h p h a r m a c i s t s a n d t e c h n i c i a n s v e r i ﬁ e d a s a m p l e of 15 , 25 2 e n v e l o p e s . The a ut h o r r e p o r t e d t h e e r r o r d e t e c t i o n r a t e of t h e TCT sy s t e m e xc e e d e d t h a t of USBEJUJPOBMTZTUFNT WT Q 1FSIBQTPOF r e a s o n why t e c h n i c i a n s p e r f o r m a s a c c u r a t e l y a s p h a r m a - c i s t s is t h e lo s s of “ b a c k g r o u n d n o i s e ” m e a n i n g t e c h n i c i a n s a r e a b l e t o la s e r fo c u s o n en s u r i n g t h e dr u g t h a t is b e i n g di s p e n s e d is t h e s a m e a s t h a t o n t h e o r d e r, a n d t h e y d o s o wit h o u t t h e p h o n e c a ll s a n d ot h e r di s t r a c t i o n s p h a r m a c i s t s t r a d i t i o n a l l y f a c e a s t h e y c a r r y o ut t h e i r da i l y a c t i v i t i e s .

Publi s h e d lit e r a t u r e o n TCT als o de m o n s t r a t e s a n imp a c t o n p h a r m a c i s t s ’ c li n i c a l a c t i v i t i e s . Pha r m a c i s t s p r a c t i c i n g in t h e s e s y s t e m s g a i n e d a ny w h e r e f r o m 1 ho ur of p h a r m a - c i s t t im e p e r da y t o 1 0 h o u r s of a d d i t i o n a l p h a r m a c i s t t im e p e r m o nt h . The s e g a i n s p r o v e d sig n i ﬁ c a nt . In on e in s t a n c e , in v e s t i g a t o r s n ot e d t h a t p h a r m a c i s t s lib e r a t e d fo r a mo r e cli n i c a l l y - o r i e nt e d r o l e in a TCT sy s t e m p r e v e nt e d mi s h a p s t h a t ha d t h e p ot e nt i a l t o c a u s e sig n i ﬁ c a nt m o r b i d i t y a n d e v e n d e a t h .3

As wit h a ll b o d i e s of e v i d e n c e , TCT is ce r t a i n l y n ot wit h o u t lim i t a t i o n s . Whi l e m a n y of t h e lim i t a t i o n s – s t u d y dur a t i o n , fo r e x a m p l e – ma y b e we a k n e s s e s in s t u d y d e s i g n , t h e y d o n ot n e c e s s a r i l y t r a n s l a t e t o p r a c t i c a l dif f e r e n c e in r e a l wo r l d sit u a t i o n s . Most TCT pro g r a m s , a s di s c u s s e d p r e v i o u s l y, h a v e p e r p e t u a l qu a l i t y a s s u r a n c e m e c h a n i s m s b ui l t int o t h e d e s i g n t o en s u r e t e c h n i c i a n s a r e a l w a y s co g n i z a nt t h a t t h e i r wo r k m a y b e a u d i t e d fo r a c c u r a c y. More o v e r, s o m e s t a t e s h a v e d e c a d e s of e x p e r i e n c e a ll o w i n g TCT in t h e h o s p i t a l s e t t i n g s , a n d B o a r d s of Pha r m a c y m a i nt a i n o v e r s i g ht of t h e p r o c e s s . No re p o r t s of b r e a k d o w n in s a f e t y of TCT sy s t e m s o r s t a t e s p e r m a n e nt l y s c r a p p i n g l e g i s l a t i o n o r r e g u l a t i o n s t h a t p e r m i t TCT wer e fo u n d in a lit e r a t u r e r e v i e w.

Over a l l , e v i d e n c e sh o w s TCT is s a f e a n d a c c u r a t e , a n d le a d s t o g a i n s in p h a r m a c i s t t im e fo r cli n i c a l s e r v i c e s . TCT als o le a d s t o c a r e e r d e v e l o p m e nt p a t h w a y s a n d jo b s a t i s f a c- t i o n fo r p h a r m a c y t e c h n i c i a n s . D e s p i t e t h e e v i d e n c e b a s e , o nl y a lim i t e d num b e r of U.S . St a t e s cur r e nt l y p e r m i t s o m e fo r m of TCT. Most of t h e o p p o s i t i o n t o TCT his t o r i c a l l y h a s

The b e n e ﬁ t of cli n i c a l p h a r m a c y s e r v i c e s is b e c o m i n g in c r e a s i n g l y c l e a r. In a sur v e y of 1 , 3 9 1 h o s p i t a l s , B o n d a n d co ll e a g u e s r e p o r t e d t h a t cli n i c a l p h a r m a c i s t s t a f ﬁ n g m a y b e a ke y t o r e d u c i n g m e d i c a t i o n e r r o r s a n d a s s o c i a t e d co n s e - q u e n c e s su c h a s in c r e a s e d l e n g t h of s t a y, m o r t a l i t y, dr u g co s t s , a n d o v e r a l l h e a l t h c a r e co s t s . 2 Pha r m a c y t e c h n i c i a n s t a f ﬁ n g s e e m e d t o en a b l e e nh a n c e d p h a r m a c y c a r e ; t h e a ut h o r s sug g e s t e d , “Havin g [p h a r m a c y t e c h n i c i a n s] p e r f o r m m o r e di s p e n s i n g f un c t i o n s sh o u l d e nh a n c e t h e a b i l i t y of ma n y dir e c t o r s t o in c r e a s e c li n i c a l p h a r m a c i s t s t a f ﬁ n g a n d im p l e m e nt o r e x p a n d c li n i c a l p h a r m a c y s e r v i c e s .” 2

This ce r t a i n l y is n ot a ne w p e r s p e c t i v e . Thoug ht le a d e r s h a v e , fo r d e c a d e s , c a ll e d fo r a n enh a n c e d p h a r m a c y t e c h n i c i a n r o l e t o en a b l e p h a r m a c i s t s t o t a k e o n m o r e dir e c t p a t i e nt c a r e s e r v i c e s . One s y s t e m t h a t a im s t o lib e r a t e p h a r m a c i s t s f r o m n o n - j u d g m e nt a l t a s k s a s s o c i a t e d wit h di s p e n s i n g is k n o w n a s “ t e c h - c h e c k - t e c h ” (TCT), a n d is in c r e a s i n g l y co m i n g int o us e in t h e Unit e d St a t e s .

Case Study: “Tech-Check-Tech” in the United States TCT is p e r h a p s unf o r t u n a t e l y n a m e d , b e c a u s e it imm e d i a t e l y co n j u r e s up im a g e s of a s y s t e m t h a t is t e c h n i c i a n - d r i v e n , t o t h e e xc l u s i o n of p h a r m a c i s t s . The t r u t h is t h a t t h e o v e r a r c h - i n g go a l of TCT is to en s u r e a d e q u a t e a v a i l a b i l i t y of p h a r - m a c i s t s fo r cli n i c a l s e r v i c e s , a n d is lim i t e d t o ve r y sp e c i ﬁ c c ir c u m s t a n c e s . 3 In ge n e r a l , TCT is onl y a p e r m i s s i b l e p r a c t i c e in ho s p i t a l s e t t i n g s in t h e Unit e d St a t e s , n ot co m m u n i t y p h a r m a c y o r a mb u l a t o r y p r a c t i c e sit e s . This is in p a r t du e t o t h e s a f e t y v a l v e s p r e s e nt in h o s p i t a l s e t t i n g s : uni t d o s e p a c k a g i n g , b a r c o d e s c a n n i n g , a n d m e d i c a t i o n a dm i n i s t r a - t i o n by a li c e n s e d h e a l t h p r of e s s i o n a l (e . g . , a nur s e ) whi c h a ll o w s a ﬁn a l in d e p e n d e nt c h e c k p r i o r t o a me d i c a t i o n b e i n g a dm i n i s t e r e d t o a p at i e nt . More o v e r, t e c h n i c i a n s c a n o nl y p e r f o r m ﬁn a l v e r i ﬁ c a t i o n fo r r e ﬁ l l s , m e a n i n g e a c h p r e s c r i p - t i o n o r d e r h a s b e e n v e r i ﬁ e d fo r s a f e t y a n d a p p r o p r i a t e n e s s by a ph a r m a c i s t ; t h u s t e c h n i c i a n s a r e o nl y v e r i f y i n g t h a t t h e p a t i e nt is r e c e i v i n g t h e co r r e c t dr u g , d o s e , a n d qu a nt i t y fo r a pr e v i o u s l y r e v i e w e d o r d e r. Sin c e t h e m a j o r i t y of m e d i c a t i o n e r r o r s o c c u r dur i n g t h e p r e s c r i b i n g o r a dm i n i s t r a t i o n p h a s e s , n ot di s p e n s i n g , r e - d i r e c t i n g p h a r m a c i s t t im e t o t h e fo r m e r co n c e p t u a l l y h o l d s p r o m i s e t o imp r o v e p a t i e nt c a r e . 3

U.S . St a t e s t h a t a ll o w TCT all re q u i r e sp e c i a l a n d a d v a n c e d t r a i n i n g fo r t e c h n i c i a n s t o a s s u m e in c r e a s e d r e s p o n s i b i l i t y fo r ﬁn a l v e r i ﬁ c a t i o n of r e ﬁ l l s . 3 The y of t e n r e q u i r e a min i m u m a m o u nt of wo r k e x p e r i e n c e a s a t e c h n i c i a n , ( ge n e r a l l y si x m o nt h s t o a ye a r ) , di d a c t i c co u r s e w o r k , a n d a n e x p e r i e nt i a l p r o g r a m wh e r e b y t e c h n i c i a n s p e r f o r m ﬁn a l v e r i ﬁ c a t i o n a n d mu s t a c h i e v e a min i m u m a c c u r a c y r a t e in or d e r t o b e c o m e a “ t e c h - c h e c k e r.” Robus t qu a l i t y a s s u r a n c e p r o g r a m s a r e a l s o a co r n e r s t o n e of TCT sy s t e m s . Pha r m a c i s t s mu s t p e r i o d i c a l l y a u d i t a ce r t a i n num b e r of do s e s t h a t ha v e b e e n v e r i ﬁ e d by a t e c h - c h e c k e r t o en s u r e a min i m u m a c c u r a c y l e v e l is m e t . Techn i c i a n s wh o d o n ot m e e t min i m u m t hr e s h o l d s c a n lo s e t h e i r t e c h - c h e c k e r s t a t u s .

Fluidbook : Solution de catalogues interactifs et brochures en ligne