What I Miss

Much has been written and discussed about the pharmacist experience through the COVID-19 pandemic. Our colleges and associations have had to pivot and adapt and step up to provide us guidance. Individual pharmacists, managers and companies have had to rush to develop new policies and guidelines to aid front line dispensary staff in providing service and staying safe.

I’m not going to add to the all the wonderful writing and teaching and learning that has come about since Covid hit our world.

Really, I only wish to share my own experience with looking after my patients.  When I am in a tough spot as a professional, when I find it hard to get up day after day and face the imposed changes of this unprecedented time, I find that I need to refocus on why I am there, and for me it always comes back to my patients and my team.

There are things that I just simply miss about the way I always practiced my profession and have been forced to change.

I miss being able to lean into the conversation with a patient, using my body language to convey empathy.

I miss my patients seeing my smile of welcome when they come in, my face now hidden behind a mask and a barrier.

I miss being able to give a patient a hug when they are diagnosed with a life changing condition or have lost a loved one.  Yes, I have hugged patients.

I miss analyzing patient interactions with how best to connect with patients rather than how best to distance in order to keep the patient, myself and my staff safe.

The constant re-evaluation of whether we are doing enough to protect our staff and whether we are providing the best care possible to our patients can be exhausting.  The constant change of protocol and daily briefings and updates allow for no escape from the focus on COVID.

However, I do remind myself that pharmacists across the world are facing unparalleled issues; some have lost patients to COVID and some have had to battle the virus themselves.  Much suffering and turmoil have spread across the globe, keeping pace with the virus that has forever changed us all. 

My small reflection and limited experience is perhaps sentimental, but maybe one day, if our “new normal” is but a memory, I will reread this and remember what it is about my everyday practice that I can be thankful for.

Leadership, where is it?

There’s lots of talk about lack of leadership in our profession; lack of leadership in our dispensaries, in our associations, in our regulatory bodies.  What is it we are looking for as pharmacists and what can we do about the “lack of leadership” we are feeling?

Leadership in not an innate “born with” quality, nor is it automatically a term we apply to those in positions of power or authority.   It is quite obvious that a position of power does not denote leadership.  Leaders inspire, they create unity, direction, common purpose, a sense of belonging.  It is a fortunate situation if those in positions of power are also leaders, but this often is not the case. 

As pharmacists we do not have to lament our lack of leadership, we all have the potential to lead.  Leadership is a skill that can be developed within ourselves.  Where there is a lack of leadership, we can step up and develop these skills to work for the betterment of our pharmacies and our profession.

Leadership starts in the dispensary with our teams first.  In developing leadership skills, this is the perfect place to start.  You do not have to be in a management position to be a leader.

Simon Sinek talks about the top 3 qualities of great leaders:

  1. Selflessness  Sometimes those new to a position of authority assume that in this position they should be served by those under them.  In fact, quite the opposite is true.  When you aspire to be a leader, you take on being responsible for those you lead.  A true leader will always work to bring out the best in people, to work with the individual talents and shortcomings of those they lead to help them be successful.  Indeed, great leaders put themselves last.  “You’re not a leader until you make it your job to look after others.”
  2. Empathy  Those we endeavor to lead come to their jobs with their own personalities, behaviours and temperament.  A strong leader needs to work with a wide diversity of personalities.  I honestly had no idea until I was in the thick of it how much of “managing” is really “managing people”.  Sinek’s second point that great leaders show empathy is bang on.  Being kind to those we work with and lead, avoiding gossip and instead being empathetic to an individual is almost counter-cultural in some dispensaries.  Yet a strong leader can model this for those on the team and make it a priority to redirect negativity and reinforce kindness and patience. 
  3. Grace under Fire  In a busy dispensary it is easy to place blame, to not assume the best intentions, to react rather than step back and take a breath.  Emanating grace under fire  is a key quality in any leader.  When everything around the team is chaotic, stressful, seeming to fall apart, the leader needs to be the essence of calm.  It is important the leader not get pulled into the mayhem and instead exert confidence and redirect the energy back to the common goal.  Providing support and direction in a reassuring manner is essential here. 

These qualities are by no means an exhaustive list, but they resonated with me as being qualities that all those looking for a leader would wish to see.  When looking for a leader, and not finding one, consider developing leadership skills yourself.  Leadership resources are easy to find.  There are many books, videos, podcasts, seminars, mentors and experts in the field to help develop such skills.  We all need strong leaders, and we need those around us to be willing to take the leap to be leaders themselves. 

It’s up to us

Practice change. Expanded scope. Clinical services. It seems that as pharmacists across the country gain additional authority, many still struggle with progressing their practice. Getting the prescription out the door is still the primary priority, engaging patients in optimizing drug therapy, chronic disease management and preventative care come second, and often not at all.

Pharmacists are perhaps the only health care professional that upon completion of their training are prepared to practice a profession and end up using only a fraction of their education to do their job.

I’ve heard pharmacy leaders express that our amazing pharmacy students will save the profession. They are primed for “expanded scope” and will ensure pharmacists do not become an irrelevant profession as more and more patients move to having Alexa order their drugs for delivery and get their “patient counselling” from google.

Is that a realistic expectation for the profession? Pharmacy students are struggling. If a new grad is lucky enough to get a job in the depressed market that exists in many parts of the country, what they face is joining a less than desirable practice or one where they hope they can effect some change, but within a very short time slide into apathy.

Inevitably when I present at a conference, I have many students come up afterwards and ask me how they can avoid the peril of apathy after getting into practice. They’ve seen many pharmacy students before them go through the seemingly inevitable slide and they are afraid of what their own future holds.

The problem however is really with us. It is with veteran pharmacists and pharmacy teams who are comfortable doing things “the way they have always been done.” It is almost impossible for a new grad joining a dispensary to change this.

Every dispensary has a “culture”. The culture is the way we interact with each other, the way we talk to patients, our work flow, what we accept and don’t accept, what we complain about, what we value, how we treat each other and what is generally acceptable and for sure what is NOT acceptable in that dispensary. When a new member enters a dispensary, it is an unexpressed expectation that they will fit in and “conform” to the current culture, regardless of what that culture is. A new grad may be asked to “add” some clinical stuff in, as almost a separate entity to the regular work flow, but the essential nature of the culture is not to change.

If the prevailing culture in dispensaries is not a proactive engagement of patients, utilizing the full scope of pharmacists expertise in improving patients quality of life, but instead in utilizing pharmacists as a “checking machine”, new grads will slowly be assimilated into the same role.

If real change is to happen, it will have to come from us. We cannot afford to remain dispensers of drug products and information. Drugs and information are to be had much more conveniently and cheaper than in our pharmacies. Third party payers, government and patients themselves are figuring this out. But our expertise in determining, with the patient, the “best drug therapy” for them ie: solving drug related problems, is a skill no other profession has.  We need to embrace it, or risk losing it altogether. 

Passing the Buck

A gentleman approached me just before I was about to step on stage at the last PXP Pharmacy Experience Pharmacie conference.  He shared with me an experience he had with his mother’s pharmacist.

His mother, a senior in her 80’s, needed a renewal of her ramipril so he went with her to the pharmacy to assist.  The pharmacist had a look at his mother’s file and said she would have to contact the doctor as there were no more refills. The gentleman, being in the know with the profession of pharmacy, advised her that this was not the case, the pharmacist indeed had the authority to extend the prescription if needed. The pharmacist insisted she must contact the doctor and refused to discuss it further.

While certainly there are times when referral to a physician is most appropriate rather than prescribing for continuity of care, what is highly disappointing in this case is that no assessment took place.  The pharmacist did not speak to the patient; no questions were asked, no discussion regarding her hypertension control, when her last appointment with her Dr. had been, does she home monitor, is she having any dizziness, etc.

I find this situation disappointing, but I also understand it is quite common.  As I’ve travelled across the country and had conversations with many pharmacists in community practice, management, academia and leadership positions, it seems a common trait for pharmacists to have difficulty making a clinical decision and taking responsibility for patient care.  The preference seems to be to defer decision making to another professional rather than take responsibility for the possible outcomes.   But what are the outcomes for the patient when our choice is to refuse care?  

Choosing not to provide care for a patient is a clinical decision in itself.  In this case, the outcome could be a gap in adherence or inappropriate accessing of emergency services or a walk-in clinic.   It is puzzling to me that many pharmacists seem to have a fear of causing harm by taking action, but do not feel a sense of responsibility towards the patient for the possible harm caused by inaction or delay of care. 

I have no doubt some will say that I must not have all the facts.  The pharmacist was likely under pressure, short of time, had many others waiting, etc.  We are all busy.  We all have patients waiting, phones ringing, billing issues and insane rules for paperwork.  Many of us, as we have heard, are feeling anxious, frustrated, worried, unsupported, jaded, disappointed and bitter.   But let’s look at this from the patient’s shoes.  A patient comes to a pharmacist requesting care, and the health professional turns her away; that’s the patient experience

Caring for the patient and taking responsibility for the decisions we make is a hallmark of being a health care professional.  If we want to be treated as professionals and not mere dispensers of drugs, we need to ensure we act like health professionals in every patient encounter.   Not taking action is not the solution to uncertainty and choosing not to care for a patient when it is within our competency and scope is a decision we are still responsible for.  There is simply no passing the buck or skirting the responsibility for care.  At some point it comes home to roost that if we are merely filling orders rather than caring for patients, we will continue on the path of being considered glorified technicians.

After speaking with this gentleman I stepped on stage and was heartened to see the engaged group of pharmacists who took the time out of their busy lives to attend an event meant to push pharmacy forward and make us all better professionals.  There was hope, not just fear,  brainstorming instead of stagnation, empathy replacing bitterness, and new energy in place of exhaustion.  We all face pressure, and pharmacy is in a tough place on many fronts;  I feel it every day when I walk into my dispensary.  But we must never forget to care for the patient, because without patients to serve there is no “pharmacist”.

The Ticking Clock

I attended my 25th pharmacy reunion this year and it seemed surreal to be celebrating 25 years of pharmacy practice.  Where has the time gone?? 

25 years doesn’t seem like so long ago, but the world has changed immensely in those years and it has caused me to think about whether we as pharmacists have kept up with the change.

When I graduated in 1994, there was no widely used public internet.  If we didn’t know something, we could not google it.  We had to look it up in a book, head to the library and search micro fiche, or call a drug company.  I had paper files for guideline updates and an overflowing paper copy of the CPS.  Information was not readily available nor easily accessed making it extremely valuable.  Consequently, pharmacists were valued for our ability to provide information to patients and colleagues regarding drug therapy.  Patients depended on us to give them information on their drugs, and physicians called us when they had a question.

Fast forward to today. We are now practicing in the information age.  Access to information is ubiquitous.  Being a source of information is no longer considered valuable as patients walk around with computers in their pockets and personalized drug information flows to them from many sources including third party insurance providers, APPs and websites.   Yet as pharmacists we have not really transformed pharmacy practice to keep up with what is valuable to today’s patients. 

Pharmacists are seen as providing a product plus information, because this is what patients experience when they walk through our doors.  The majority of Canadians interact with pharmacists when they are receiving a new medication; and we interact with them by providing information.  We call it counselling, but to the patient, it is information. 

Step into our patients’ shoes: how valuable are pharmacists to their quality of life?   What will keep patients coming into our pharmacies when they can receive their medications faster, cheaper and more conveniently by ordering them from their device and having it delivered to their door?  What will keep third party payers from requiring patients to only source prescriptions from these cheaper alternatives?

Pharmacists have an immense opportunity to demonstrate value to patients.  Study after study proves that we reduce health care costs and improve outcomes, but patients don’t seem to know this because they haven’t experienced it.  We practice reactively, responding to queries from patients or providing information when a product is dispensed.  What is needed is a shift to proactive engagement and assessment; an embracing of our role in chronic disease management.   Optimizing therapeutic outcomes and working with patients to improve drug therapy is what brings value.   

It takes proactive engagement because patients don’t know that they need us.  They don’t know if their blood pressure or blood glucose is at goal, that there are drug options that may optimize goals, have less side effects, are cheaper, or more convenient; that they could benefit from vascular risk reduction or that we can help them quit smoking.  I could go on and on about the immense opportunities for proactive intervention to improve a patient’s quality of life….but it takes a will to engage and renewed energy for patient care.  

The clock is ticking with innovative disruption rumbling in our near future.  We cannot allow negativity, financial pressures and government decisions to override the preservation of our profession, otherwise we may someday soon be hanging up our lab coats because it is too late.

Culture: The Missing Piece

When I graduated with my pharmacy degree all those many years ago, I came out trained to be a pharmacist.  Nowhere in my education was I taught how to be a leader.  Yet many pharmacists are thrust into the position of pharmacy manager or leader of the dispensary team and many more choose leadership as owners of their own practice.  When I started out as owner/manager six years ago I had no idea how to manage “people”, yet I soon discovered that productivity in the dispensary is at its highest when pharmacy teams work as a cohesive unit. I also quickly learned that being a leader is tough because it means managing a group of people, each with their own personality, history, experience, skills and challenges. 

Most often as managers/owners we focus on strategic planning, goals, getting “stuff” done, and sometimes cannot understand why our plans are not well implemented, why execution is lagging and negativity abounds.  Most often this is due to not understanding the power of culture.  Group culture is one of the most powerful forces on the planet, yet it is difficult to define.  We can sense when a strong group culture is present in successful businesses, championship teams, or philanthropic causes, and we sense when it is absent or toxic.  According to a Harvard study of over 200 companies, a strong culture increases net income 765% over 10 years. 

What is culture?  It is the tacit social order of an organization: It shapes attitudes and behaviors in wide-ranging and durable ways. Culture defines what is encouraged, discouraged, accepted, or rejected within a group.

Why is a strong common team culture important?  Because it correlates with levels of employee engagement and customer orientation; and both employee engagement and customer orientation correlate with productivity and profitability in business. 

If a team or business culture is properly aligned with staff’s values, drives, and needs, culture can unleash tremendous amounts of energy toward a shared purpose and foster a business’s capacity to thrive.  Cohesive culture allows creativity to flourish. Problem solving is innovative, identification of inefficiencies comes from the ground level as all team members strive to achieve common goals.  Leaving team or business culture to form on its own can confound strategic goals and lead to poor performance and dissatisfaction in employees which ultimately leads to unhappy patients/customers.  A pharmacy team culture that has been left to form on its own tends to be negative and staff’s internal dialogue can look something like this:


“That customer is difficult, I’m just going to put my head down and hope the other staff will take that prescription.”
“Why am I working so hard? He’s over there being so slow.”
“I don’t understand this. I’ll just leave it for the next shift.”
“I wonder if Pharmacy X is a better place to work?”

“I’m just going to use the washroom- but really I’m going to check my phone.”

Culture is not tangible, so how does it work?  We tend to think about it as a fixed trait, like DNA, some groups just have it and some don’t.   This however is not the case.  Team culture can be shaped and managed.  The first and most important step leaders can take to maximize the value of team culture and minimize its risks is examine and understand their business’s culture and assess its intended and unintended effects.  What is the implicit social order, the values, leadership style and team dynamics?  Once the culture is understood, leaders can work on shaping and changing team culture to align with the goals and strategies of the organization.  Successful change requires leaders themselves to align with the culture they wish to espouse.  Organizational conversation must underscore the change and so must organizational design.  As employees start to recognize that their leaders are talking about different business outcomes—for example patient care or innovation instead of revenue or quotas—they will begin to behave differently themselves, creating a positive feedback loop and ultimately meet and exceed the organizations goals. 

 “Leading with culture may be among the few sources of sustainable competitive advantage left to companies today.”  Harvard Business Review 

Resources:

  1. Start with Why: How Great Leaders Inspire Everyone to Take Action by Simon Sinek
  2. The Culture Code: The secrets of Highly Successful Groups  by Daniel Coyle
  3. The Culture Factor  Harvard Business Review.  HBR.org 
  4. Leader’s Eat Last: Why some teams pull together and others don’t.  by Simon Sinek.  Penguin 2014
  5. Corporate Culture and Performance  by James Heskett and Dr. John Kotter. Harvard Business School.

Where’s the Passion?

My oldest son entered his first year of university this year and it has been amazing to witness his excitement and passion for learning and the drive to achieve his goals.  It has me looking back at my own university days, over 20 years ago, and the ensuing years that have past.  What did I expect from working so hard to be a “pharmacist” all those years ago and where am I now?

I remember what it was like sitting in a lecture hall, in classes I enjoyed (admittedly medicinal chemistry may perhaps be excluded here!)  While it was incredibly hard work, I loved it!  I loved learning the newest drug studies and guidelines for disease management. I also remember those early years of pharmacy practice, fresh out of school, being so excited to get into the real world and apply my skills caring for patients.  Even 25 years ago we were talking about “Pharmaceutical Care” and “expanded scope of practice”.

It didn’t take long however before discouragement set in and I felt stuck in a rut of checking endless prescriptions.  I spent over ten years of my professional career mostly just “doing my job”, and I will admit, slowly drifting into apathy.  I did my job accurately, but I was not passionate about it. I also did the minimum amount of CEUs every year, never remembering the learning or applying it to practice.  One year I even had the College respond to my continuing education submission with the comment that it seemed “ lacking in thought ”  and rather “hastily put together”,  and they were right!  I wasn’t engaged, I had no passion for the practice or for continued learning.

I often complained I didn’t have the time to look after patients properly, however, when I did have time I did not extend myself to proactively engage patients.  I eventually asked myself the tough question:  If I was given the perfect circumstances, all the time I needed, the ideal practice setting…would I be able to do the job I wanted to?  Could I take responsibility for patients medication management, solve drug therapy problems, engage patients proactively rather than waiting to be asked questions?  I wasn’t sure.  I was so rusty from the many years of the prescription checking tread mill that I was hesitant and frankly afraid to step out of the role of just technically checking prescriptions.

I share this rather embarrassing segment of my career as I feel many pharmacists are stuck in their practices.  When I read comments on blogs and have discussions with colleagues at conferences, I hear the resounding theme that pharmacists, even just a few years out of school, have lost their passion for pharmacy practice.  There are numerous outside factors that contribute to this including corporate decisions, government cutbacks, drastic cuts in drug pricing, third party pressures, etc.  But I think we as a profession also need to acknowledge our own contributions to this state of the profession.  Apathy abounded even in the “good” years, in the years where pharmacists were being offered starting bonuses, had shift overlap and high wages.  It’s been decades of pharmacists not stepping into their role, merely talking about how important we are rather than demonstrating it in our pharmacies.

So now we face a time of crisis where artificial intelligence and automation can take over pharmacists role, and the drive towards cheaper, faster and more convenient drug access will radically disrupt traditional community pharmacy.

I don’t claim to have all the answers, or really any at all.  I continue to write and speak and engage colleagues because I’m just not ready to give up.  I’m not ready to retire my white coat and send my patients to the “Amazons” of the world.  Despite it being rather vulnerable to put myself out there in discussing pharmacy practice on a national platform, the dialogue is essential.

Where am I now?  In the ensuing years since that wake-up call I radically changed my practice, and eventually hired on support staff and pharmacists who have the same vision and passion and are willing to practice in an environment I am proud to have created.  Have I encouraged my son to pursue pharmacy as a career?  I will admit that in his earlier years I did, but as he got older and Engineering more suited his interest I was relieved.  I don’t know where pharmacy is headed, it isn’t looking good, but giving up for me is not an option.  I still need to find passion in my work, a reason to get out of bed in the morning, and that reason is the patients in our care and the development of my incredible team that looks after them.

Amazon->  Friend or Foe?

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I love my smart phone.  I can order dinner from my phone, I can schedule transportation from my phone, I book yoga classes and my kids haircuts from my phone, and I have already started doing my Christmas shopping, exclusively from my phone.

I know I am not alone here.  The dramatic rise in on-line commerce has risen at what could be seen as an alarming speed for industries that could be left behind.  The disruption felt in an increasing number of industries is not slowing down and pharmacy is starting to become one of those targets.

The trouble is that the perception of pharmacists is as providers of prescriptions. The value is in what the patient receives, which is a product.  Patients are always looking for the “what’s in it for me?”  If they can be offered speed and convenience (ie: order my prescriptions on my phone and have them delivered to my door) what’s stopping the vast and catastrophic wave of patients leaving their community pharmacies?
We cannot compete in speed, convenience, online platform, name recognition, familiarity with process or even price with monolithic companies such as Amazon.  When Amazon announced its purchase of Pillpack, the big three in the U.S (Walgreens, CVS and Rite-Aid) lost $11 billion dollars in value; the loss due to just the announcement.  What happens when Amazon actually starts filling prescription orders?

Will patients go for it?  Wall street analysts state 85% of insured Amazon Prime members are open to buying their drugs on the site.
The question we as pharmacists need to ask ourselves is, “Why should our patients come to our local pharmacies instead of ordering their prescriptions online?”

If our patients’ experience in our pharmacies is the provision of a product, then we will lose them.  If they interact with the pharmacist only when they receive a “new” prescription, and the pharmacist “counselling” entails giving them information and saying they can call them with any questions, again we will lose them.  Information is no longer a valuable commodity in the information age.  Our patients are walking around with Google in their pockets, and artificial intelligence today is just the tip of the oncoming iceberg.

As pharmacists we must demonstrate our value to patients through active engagement.  We cannot wait for patients to come to us with their questions.  It doesn’t matter how smart we are, or how many specialty certifications we have, or how many CEUs we attend if patients do not experience our care as actively impacting their quality of life.  Ultimately patients are asking, “What’s in it for me?”  With every interaction we can show patients the irreplaceable value of a face to face relationship with their pharmacist.  The value of the pharmacist is only realized when it is experienced.

If the ensuing disruption leads to pharmacists taking the lead in their own future and engaging patients to demonstrate the value of face to face care, then it will be a magnificent revolution.  If we do not embrace the disruption and choose to maintain the status quo, then we may very well end up with a lot of time on our hands to do our shopping from our phones.

Siri versus the Pharmacist:  Are We Relevant?

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A friend sent me a text the other day.  He went to his local pharmacy and was dispensed a drug he has never had before.  His text said, “Siri gave me better info than the pharmacist”

When I asked him to elaborate, he said the pharmacist never asked him anything about what he was taking the drug for, he simply read the directions off the label for him (which he could do himself) and mentioned a few possible side effects.  Ultimately, he felt the interaction was rushed and of no use to him.

I always find these situations rather embarrassing as a pharmacist, and they happen quite often.    Many of my friends and family across the country contact me for information regarding their health and their medications because they have had poor experiences and/or have no relationship with their local pharmacists.

Consider this typical pharmacy scenario.  A patient presents with a prescription for a repeat of their high blood pressure medication.  The technician at intake enters the prescription, sees nothing has changed and processes it.  On the back end, an assistant prepares the product, the pharmacist checks it and out it goes.  At the till the assistant asks, “Do you have any questions for the pharmacist today?”  The patient says no, thanks them and leaves.

This scenario happens over, and over again in our pharmacies every day.  For the majority of patients presenting to a pharmacy, they have minimal to no interaction with a pharmacist.

When do patients interact with a pharmacist?  Typically, when they get a new prescription.  What do patients usually receive in this interaction?  They are almost always provided with information, or what I call the “Top Five Points”.  What the drug is, how to take it, what side effects they could expect, when it might work and call if they have any questions.   Basically, patients see us as the providers of information. (Which I guess is marginally better than being seen as only a drug dispenser.)

The problem with this is that pharmacists simply spit out information that is easily found elsewhere.  This holds little value to patients.

Approximately 92 per cent of adults aged 18-39 now carry a computer in their pocket. Information is at our patients’ fingertips, it’s everywhere.  We are no longer the only source of drug information like we were 20 years ago.  People can look up the drugs on their prescription before they even get to you to fill it.  If our only interaction with a patient is to provide information (i.e. counselling), we will shortly be regarded as irrelevant.

If a patient takes a prescription to either your pharmacy or one of the four or five other pharmacies in your area and leaves with the exact same product and outcome, what is differentiating you from any other pharmacy?  This generation of young adults is favouring speed and convenience.  What’s more convenient than drive through, or a kiosk you can feed your Rx into and out comes a product, or an APP that will organize delivery of your drugs?  To the patient, there is no difference except increased convenience.  In both scenarios they do not have a meaningful interaction with a pharmacist.

In a time when pharmacists are pushing to advance forward on being reimbursed for services from third party payers and government, we must remember that these payers are ultimately patients too.  If they feel that a computer algorithm or robotic dispensing is cheaper and more convenient, and they have never seen the value of a pharmacist being involved in their care, then we may as well hang up our lab coats.

There are very few pharmacies that engage patients in shared decision making, chronic disease management and work to develop relationships with patients by following up with them on their drug therapy.  Yet, this is where pharmacists need to be.  This is what is irreplaceable.

Oh, but wait a second….  What about checking all those prescriptions?  We spend the majority of our time signing our name on the final check of prescriptions. Pharmacists are needed for that, right?  Nope. Registered technicians are much cheaper than pharmacists, so don’t count on being able to continue to sign your name for many hours a day and still be relevant.
“If we don’t like change, we will like irrelevance even less.” -General Eric Shinsek

Check this: Registered Technicians are Essential to Pharmacy Practice

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I recently hired another registered pharmacy technician into my practice.  It didn’t take long before she became an essential part of the team, and with her amazing communication skills, she’s become sought after by our patients.  When I asked her why she left her previous job in a community pharmacy, she disclosed that it was because the pharmacists there did not allow her to practice to her full scope. She could not do final check on prescriptions, could not counsel on devices nor perform many other tasks she was licensed to take responsibility for.  When she gave her notice, the pharmacy manager told her she understood why she was leaving and supported her in pursuing a job where she could practice to her full scope.

 

This was stunning to me.  It was hard to believe that rather than change their practice, the pharmacy manager chose to let a valuable employee leave.

 

This certainly isn’t an isolated incident.   I’ve presented continuing education sessions to registered technicians and have heard very similar reports about pharmacists not allowing them to practice at the “top” of their license.  Meaning, they were not allowed to do final check on prescriptions or unit dose packaging, they were not allowed to counsel on devices and some not even allowed to count out narcotic medications.

 

This seems entirely contrary to the goals of pharmacists who typically state they do not have enough time for clinical work and engaging patients in expanded scope services.

 

Pharmacists cannot possibly evolve into providing expanded scope services without accepting registered technicians for the full professionals they have now become.

 

Working to the fullest potential of their license is empowering for any profession. Technicians and pharmacists alike tend to have more job satisfaction when they are doing what they are trained to do, and job satisfaction is key to a successful pharmacy team.

 

Here are three key areas where pharmacy technicians are often under-utilized:

 

  • Final Check. There is no reason for pharmacists to do the final check on prescriptions.  The cognitive check and counseling of the patient can be done along with the initial assessment at intake.  Technicians carry their own malpractice insurance to take responsibility for the final sign off and dispense to the patient.  Pharmacists should also not be spending their time checking unit dose packaging or blister packs.  A cognitive assessment should be done by the pharmacist at regular intervals, such as quarterly, or when there is a change in therapy. This does not include having to check the final product or packaging.

 

  • Identifying expanded scope and billable services. My technicians really shine in this area.  They are continually identifying patients requiring pharmacist services, including those requiring injections, medication reviews, follow up and prescribing services.  They triage patients, set up appointments, and market these services to patients.

 

  • Teaching devices. Teaching a patient how to use a device such as an aerochamber or a blood glucose meter can be time consuming.  Utilizing the skills and expertise of registered technicians in device training is efficient but often underutilized in pharmacy practice.

 

Allowing all staff to work to their full potential, increases efficiency and job satisfaction as well as providing an excellence in patient care.