Scope of practice for Pharmacy Techs

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    I'm a nurse in the state of Maryland. There's been an on-ging debate - situation regarding utilizing a pharmacy tech in the hospital. The pharmacy tech, who was grandfathered in by the pharmacist, has a key to the pharmacy, is physicially in the pharmacy when the pharmacist is not in the pharmacy, (sometimes in another building, sometimes not at the hospital at all), inventories/fills the pyxis with meds when again, the pharmacist is not there to verify the medications.

    My understanding of COMAR Regs state the tech cannot be in the pharmacy without the pharmacist being in there, nor can the tech dispense any medications without oversight from the pharmacist.

    These practices have been long and on going, and are obviously for pharmacist conveinence as we are such a small hospital you cannot justify needing a tech to assist. As a manager of an acute unit, I've tried many times to tactfully and then directly with both the tech and the pharmacist address these on going practices. Most recently we've had "saves" due to the vigilence of the nursing staff, when the the wrong med or doseage was placed in the pyxis by the tech. Most recent was this morning, when the tech came into put the correct medication in the bin....and the pharmacist is not even here.

    We have protocols in the event of an emergency as well as for persons entering the pharmacy. The problem is, the pharmacist has not only allowed but has encouraged the tech, giving the tech a false sense of security. This has gone up to the corporate compliance level, but I feel confident, I will have to lodge a formal complaint against the two of them with their licensing board before there will be any lasting change in behavior.

    Can anyone tell me if I am right/wrong, about my understanding of the regs and the scope of practice for a pharmacy tech? How are techs utilized in other facilites as far as scope of practice.

    Thank you!!!
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  4. 11 Comments so far...

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    I am a certified pharmacy tech and just got accepted to nursing school; and that is a big concern, the pharmacist is supposed to check every drug that leaves the pharmacy rather it be for the pyxis machine or patient. We were never allowed in the pharmacy when the pharmacist was not present. i worked mainly night shift and would have to leave when they took a break etc. is there a pharmacy manager you can go to? my first step would be to talk to your unit supervisor then the pharmacy. that is not a safe practice, i know that not only techs make mistakes but the more eyes that see the drugs the less likely a mistake is made.
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    No experience with this, but I totally agree with what you state in your post, particularly since there are numerous mistakes being caught by the nursing staff. The pharmacist needs to wake up. Sounds to me like he is getting too close to retirement. Even if there weren't regulations addressing this, (which I am sure there must be), the hospital is placing itself at risk by allowing this to continue. Find it hard to believe that hospital risk management has not acted.
    firstaiddave908 likes this.
  7. 0
    Quote from caliotter3
    No experience with this, but I totally agree with what you state in your post, particularly since there are numerous mistakes being caught by the nursing staff. The pharmacist needs to wake up. Sounds to me like he is getting too close to retirement. Even if there weren't regulations addressing this, (which I am sure there must be), the hospital is placing itself at risk by allowing this to continue. Find it hard to believe that hospital risk management has not acted.
    these are the folk you need to talk to!
  8. 0
    I am a certified pharmacy tech in WI. I just graduated from nursing school and understand that we all make mistakes. HOWEVER, your concerns should be taken seriously by the pharmacist as well as the hospital. There should be no situation that the tech should be left alone in the pharmacy....does the pharmacist realize that if anything should happen, he can be held responsible simply due to the fact that he is pharmacist on duty? Also, no medications should be leaving without verification by the pharmacist?
    This concerns me due to the fact that there are mistakes made everyday concerning medications. They should always be checked and then double checked to make sure that everything is correct.
    Working in a pharmacy during nursing school was one of the best choices that I ever made. But I couldn't imagine being put in that position like the tech you are talking about. I would voice your concerns.....speaking out is gonna save someone's life.
  9. 0
    Thank you so much guys for your responses so far. In answer to your questions, the Pharmacist "doesn't have to work" meaning he is doing us a favor because he doesn't need the $...and Risk Management is a totally different issue. Our Risk manager is the CEO....and very non-confrontational....and is the person who brought the pharmacist on board here. In fact, the Risk Manager pretty much listens/does/believes what the pharmacist says. I'm the Unit Manager, Nurse Leadership has been dealing with this for a long time, and my boss, the DON is just as outspoken about it as I am, but again, its the only the CEO who can force any issue.....As for the tech....the tech was a CNA who has been given a false sense of security in "you can do that"...and truly isn't intelligent enough to research or understand the regs for scope of practice. They just go on "the pharmacist says...." So you can see how shaky/dangerous a situation this is.

    I'm just covering my bases to see if I'm interpreting Maryland's COMAR correctly so I can cover my own but. Looking forward to any other assistance/suggestions.
  10. 0
    I would continue to put your concerns in writing, if nothing else, so that you are on written record for when the stuff hits the fan. And an "atta girl/boy" to your observant and knowledgeable nurses for catching the pharmacy mistakes.
  11. 1
    well, what would happen if you refused any and all meds that the tech prepared and brought to the floor?
    Because, that seems to me to be the legally appropriate action, if you knowingly participate in this doesnt that mean you accept it?.....since risk management is of no help, try the law firm that is retained to protect the hospital.....good luck
    roser13 likes this.
  12. 1
    Morte took the words right out of my mouth...no matter how small your hospital, there is bound to be a corporate attorney somewhere. If anyone is going to take your concerns seriously, it would be the attorney.

    Unbelievable story in so many ways.
    morte likes this.
  13. 2
    I am a pharmacy technician and just graduated from nursing school. I dont know about your state specifically but in Texas everything you are describing is completely and utterly ILLEGAL. Its not just unsafe its downright against pharmacy law. The Pharmacist must be present in the pharmacy when a technician is there and the pharmacist must check every medication that leaves the pharmacy whether it is directly dispensed for the patient or loaded into an automated dispensing device. The tech is allowed to load the automated dispensing device without the pharmacist being physically present but the pharmacist must check those medications against a list of inventory being filled in that machine before the medications leave the pharmacy.

    I think a PP was right when they said that if an eror was made you could potentially be held liable by knowingly participating. I'd be sure to document each and every attempt you have made to right the situation and I would also contact the Maryland State Board of Pharmacy. If the Board becomes involved then it wont matter if your CEO and the Pharmacist dont care...they'll be forced to comply or the pharmacy will risk losing its license to dispense medications. I also wouldnt be suprised if that pharmacist didnt lose his license for allowing that. If you go to the Maryland Board of Pharmacy website and click "contact us" there is a link to email regarding "complaints against a pharmacist, technician, or pharmacy." If you email them I'd be sure to mention all the individuals (by name) that you have gone to trying to get this problem solved. I'd also include a list of errors made by the pharmacy that your staff have caught.

    This is just a huge safety issue and I cannot believe no one is taking it seriously!
    morte and Jarnaes like this.


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