Pharmacists, Interns, and Ancillary Personnel by wan12683

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									Pharmacists, Interns, and
  Ancillary Personnel


            PharP 582, Spring
            2005
Definitions
   Practitioner – person duly authorized by law to
    prescribe drugs or devices
   Pharmacist – person duly licensed by Board to
    engage in the practice of pharmacy
   Dispense – interpretation of order, and selection,
    measuring, compounding, labeling or packaging
    necessary to prepare for delivery
   Administer – direct application of a drug or device
    by injection, inhalation, ingestion or any other
    means, to body of patient or research subject
    Practice of Pharmacy
   Interpreting prescription orders
   Compounding, dispensing, labeling, administering and
    distributing of drugs and devices
   Monitoring of drug therapy and use
   Initiating or modifying drug therapy in accordance with
    written protocols approved for his or her practice by a
    practitioner authorized to prescribe
   Participating in DUR and drug product selection
   Proper and safe storage, distribution, record keeping
   Providing of information on legend drugs … therapeutic
    values, hazards, and uses
MONITORING OF THERAPY – WAC
246-863-110
   Collecting and reviewing patient drug histories
   Measuring and reviewing routine patient vital signs including,
    but not limited to, pulse, temperature, blood pressure, and
    respiration.
   Ordering and evaluating the results of laboratory tests
    relating to drug therapy
    –   blood chemistries and cell counts
    –   drug levels in blood, urine, tissue or other body fluids
    –   culture and sensitivity tests
    –   when performed in accordance with policies and procedures or
        protocols applicable to the practice setting,
    –   which have been developed by the pharmacist and prescribing
        practitioners
    –   which include appropriate mechanisms for reporting to the
        prescriber monitoring activities and results.
It is unlawful to practice without a
license.
                       Criminal charges filed against
                        Shahid Shiekh, a registered
                        counselor from Bellevue
                       Gave hundreds of flu shots,
                        although he is not a nurse,
                        physician, or pharmacist
                       Charged with using outdated
                        flu vaccine from the 2002
                        formula.
Pharmacists’ responsibilities that
may not be delegated
   Receipt of a verbal Rx          Providing patient
   Consultation with the pt         information as required
   Consultation with Dr.            by WAC 246-869-120
   Extemporaneous                  Signing of documents or
    compounding of the Rx            registry books
   Interpretation of data in       Professional
    the patient record               communications with
   Ultimate responsibility          other health care
    for verification of the Rx       professionals
Pharmacists License
   18 years of age
   Good moral and professional character; not
    impaired by use of alcohol, drugs or controlled
    substances or by mental or physical disability
   Bachelors or Doctor of Pharmacy from accredited
    school or college
   Met internship requirements
   Passed examinations (NAPLEX, MPJE)
   Completion of 7 hours of HIV/AIDS education
   License may be renewed subject to completion of
    continuing professional education requirements
    and timely payment of fees
Board may refuse to issue license to an
otherwise qualified applicant who …

   Has engaged in fraud, misrepresentation or
    deceit in procuring a license
   Has violated laws relating to drugs, controlled
    substances, cosmetics, or non prescription
    drugs, or the rules of the Board of Pharmacy,
    or has been convicted of a felony.
Fees for Pharmacist’s License
   Original license -- $130
   Annual renewal fee -- $135
   Renewals occur on the pharmacist’s birthday
    –   Initial licenses issued within 90 days of the birthday do not
        expire until the following year
   Late renewal penalty -- $67.50
    –   Note; between the time the license expires and the renewal
        fee and late penalty fee are received by the Board, the
        pharmacist is not eligible to practice pharmacy.
    –   Renewal fees may be paid up to 90 days prior to the expiration
        of the license
Interns

   Student enrolled in accredited college of
    pharmacy
   Making timely progress towards graduation
   Engages in practice of pharmacy under
    supervision of a licensed pharmacist preceptor
    –   Notifies Board prior to starting at site
    –   Preceptor oversight
    –   May be supervised by non-preceptor RPh in the temporary
        absence of preceptor
    –   Submits final report within 30 days after finishing at site, and at
        least 30 days prior to taking licensure exam
   Timely pays the $20 annual fee for an intern permit
Preceptors

   Actively practicing in a Class “A” pharmacy.
   Been in active practice for at least 12 months
    prior to becoming a preceptor
   Completion of a Board-approved preceptor
    training program every 5 years
   Supervise only one intern at any given time
Required internship hours

   1,500 hours prior to licensing
   Earned after completing the first term in a
    pharmacy program
   1,200 hours credit given for clinical
    experiences during the PharmD program
   Board will document hours in excess of 1,500
    for reporting to other states with larger
    requirements
RCW 18.64A – Pharmacy
Assistants
   Pharmacist defined in this section but not intern
   Ancillary personnel
    –   Technicians
    –   Assistants
   Training programs for pharmacy technicians
   Duties of technicians and assistants
   Limitations
   Disciplinary actions
   Pharmacy Application to use Ancillary Personnel
   Pharmacy or pharmacist responsible
Ancillary Personnel -- Duties

   Technicians
    –   Assist in performing manipulative, nondiscretionary functions
        associated with the practice of pharmacy
    –   Under supervision of a licensed pharmacist
   Assistants
    –   Typing, filing, refiling, bookkeeping, pricing, stocking,delivery,
        nonprofessional phone inquiries,documentation of third party
        reimbursements
    –   May not enter data into the computer system
Pharmacy Technician Training

   Education and training required for technicians,
    as established by Board rules
   Licensed pharmacist shall supervise training of
    technicians
   Training to consist of instruction and/or
    practical training
   May include requirements for completion of
    examinations
Pharmacist-to-technician ratios
specified in the statute
   1:1 is standard
   Institutional practice
    –   Hospitals (70.41); Mental health institutions (71.12);
        Residential Habitation Centers (71A.20); Nursing homes
        (74.42)
    –   Inpatient medication preparation, 1:3
    –   Outpatient medication preparation, 1:1
   Board may modify ratio by rule
    –   Pharmacy desiring higher ratio must submit a utilization plan
    –   Board may approve pilot projects
Board of Pharmacy Rules:
WAC 246-901– Ancillary Personnel
   “Consultation”
    –   Between pharmacist and patient, agent, or provider in which
        pharmacist uses professional judgment to provide advice
        about drug therapy
   “Verification” by pharmacist
    –   Review of order
    –   Examination of profile
    –   Approved order, taking into account pertinent drug and
        disease information to assure correctness of the drug order for
        a specific patient.
    –   Must generate audit trail that identifies pharmacist
   “Immediate Supervision”
    –   Visual or physical proximity to a licensed pharmacist to assure
        patient safety.
Only pharmacists, interns, and
technicians may …

   Enter a new medication order into the
    pharmacy computer system
   Retrieve the drug product to fill a prescription
Technician Education and Training
   Education or training required
    –   Formal academic program
    –   On-the-job training
    –   High school diploma or G.E.D. required to enter training
   Application submitted to Board
   Completion of certifying exam may be required
   Foreign applicants have special requirements
   Special training requirements
    –   Unit dose checking: must demonstrate 99% accuracy in
        checking medications
    –   IV Admixtures: 100% accuracy for a sample of preparations
IV admixtures

   Technicians may prepare IV admixtures
   Licensed pharmacist must check each
    parenteral drug prepared by technician
   Interns may not check technician-prepared
    admixtures
Unit-dose Checking (Tech-Check-
Tech)

   May check unit doses of another technician or
    intern in institutional settings
   No more than 48 hour supply may be included
    in the checked cassettes
   Meds must check the drug before
    administration
   Interns may check technician-prepared unit
    dose medications
Pharmacy Assistants may …

   Perform all duties not reserved to pharmacists
    or technicians
   Package and label drugs for subsequent use
   Count, pour, and label for individual
    prescriptions
   Replace the container on the shelf (but not
    retrieve it from the shelf)
   Must be under general supervision of a
    pharmacist
Pharmacy Assistant Registration

   No formal training, age, or educational
    requirements
   Apply to board on registration forms provided
   Maintain current mailing address with board
   Renew every two years on birth date
   No individual fee; included in pharmacy
    utilization fee
   No limit on ratio of pharmacists to assistants
Identification of ancillary personnel

   If working in the pharmacy and having contact
    with patients;
   Must wear badges or tags clearly identifying
    them as technicians or assistants
Utilization Plan

   Manner in which technicians will be utilized
    –   Job description
    –   Task analyses
    –   Number of positions
   Specialized functions
    –   Criteria for selection of technicians for specialized functions
    –   Methods of training
   Assistants
    –   Job title or function of each assistant
Pharmacist-to-technician ratios

   Standard ratio
    –   1:3 pharmacist:technician ratio set by board rule for each
        licensed pharmacy
    –   Pharmacist supervising must be actively practicing pharmacy
        (not the CEO in the office)
   Inpatient pharmacies
    –   Ratio may include pharmacists outside of the central pharmacy
   Pharmacy services plan
    –   May use more than 3:1 techs to pharmacists subject to board-
        approved plan
Access to pharmacies restricted …

   Differential hours
   Lay person may not converse with a
    pharmacist who is compounding a prescription
   Prescription department must be located so
    that public won’t have free access to area
    where drugs, etc., are stored, compounded, or
    dispensed.
Licensure Examinations

   NAPLEX
    –   North American Pharmacy Licensure Examination
    –   All 50 states now use NAPLEX
            CA after January 2004
    –   Normally, may take in your home state and transfer
        scores to other states at same time
            FL accepts score transfers after January 2005
   Pre-NAPLEX available on NABP web site
    –   $50 per attempt
    –   Maximum of 3 attempts
Law Exams

   All states require some form of law exam for
    licensure and many prepare their own exam
    –   Idaho
    –   California
   MPJE
    –   Multistate Pharmacy Jurisprudence Exam
    –   Computer adaptive covering both federal and state
        law
    –   Take once for each state you wish to be licensed in
    –   AK, AZ, HI, MT, NV, OR, WA, WY use MPJE
License Transfer

   If already licensed by examination in one state,
    may transfer license to another state without
    retaking NAPLEX
    –   NABP has electronic system for transferring license
        information to the new state
    –   Somewhat more expensive than retaking NAPLEX
   Most states, including WA, won’t allow transfer
    of a “transferred” license – must maintain at
    least one license by examination
Federal pharmacists

   Indian Health Service, PHS, armed forces, VA
   Must be licensed in at least one state or
    territory
   Do not need to be licensed in the state where
    stationed
   Cannot practice part-time outside of the
    installation unless licensed in that state
Roles requiring special training or
experience

   “Qualified by education, training, or
    experience”
    –   Directors of hospital pharmacies
    –   Pharmacists-in-charge of home IV therapy
        pharmacies
   Nuclear pharmacists
    –   6 months of on-the-job training under supervision of
        qualified nuclear pharmacist in a licensed nuclear
        pharmacy
    –   Completion of a nuclear pharmacy training program
        in an accredited college of pharmacy
Miscellaneous requirements
   Criminal background checks required for providers of
    services to children or vulnerable adults
   Pharmacists required to report
    –   Child abuse or neglect
    –   Abuse of vulnerable adults
   Social Security Numbers are required to be submitted
    to DOH to obtain a license
   The pharmacist’s current license (or photocopy) must
    be displayed to the public in each pharmacy in which
    he or she is practicing.

								
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