Uh, should a pharmacy tech really be allow to mix meds?

  1. Error that killed a baby.
    Baby's death spotlights safety risks linked to computerized systems

    And what happen in my city a few months back: pharmacy tech decided to skip autoclaving all together and contaminated TPN with serratia marcescens, killing 19.





    I've never taken a pharmacy tech course. I do know that some pharmacy's will hire people with no formal education and provide on the job training. I also know that you are not required to obtain a pharmacy tech degree/diploma/certificate to take the certification exam; as long as you have a highschool diploma and pay the fee you can take the test.

    Until the serratia outbreak I though the only thing pharm. techs did was deliver meds.
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    12 Comments

  3. by   Nurse_Diane
    Prior to becoming, and RN, I was a pharmacy tech for 3 1/2 years (inpt setting).

    We didn't "mix" per se.

    for instance, if the order was for 50cc IVP with 20 mEq of KCl, we did the following:

    Placed the IV bag (NS) and a syringe with the right amt of KCl in it, with the empty vial of KCl, next to the bag.
    The RPh would always check it and then mix it...

    The error was tragic, that you were referring to. I don't know the solution. Really.
  4. by   Esme12
    Quote from Diane-RN in Michigan
    Prior to becoming, and RN, I was a pharmacy tech for 3 1/2 years (inpt setting).

    We didn't "mix" per se.

    for instance, if the order was for 50cc IVP with 20 mEq of KCl, we did the following:

    Placed the IV bag (NS) and a syringe with the right amt of KCl in it, with the empty vial of KCl, next to the bag.
    The RPh would always check it and then mix it...

    The error was tragic, that you were referring to. I don't know the solution. Really.
    Even that bothers me. How does the RPh know that's the right syringe with the right amount of KCL. He didn't withdrawl it up from the vial. I too didn't realize that the high school kids with a 60 hour course handled these meds until a few years ago and I have to say.....makes me nervous they have such access to handle such dangerours meds and make such tragic "UNWITING MISTAKES".

    I don't know the answer either....
  5. by   wtbcrna
    Pharmacy technicians mixing drugs is very safe, and it isn't so much that it is who is mixing the medications but where IMO. The pharmacy is a controlled environment devoid of direct patient in a much cleaner environment than is available to nurses on the floor. I don't think it would make a difference if it was a pharmacist or someone else mixing the medications in the pharmacy errors are going to happen eventually.
  6. by   honeykrown
    My husband is a pharmacist and he is trying to advocate for pharmacy tech education in CC (although he is a new grad and did a rotation at a CC). He said most of the education available for pharm techs are at for profit school charging crazy amount for a $10 job. That is why most of them just apply to CVS because without the degree you still get hired so why waste $25000 going to Xtech. Not to say there arent pharm tech courses in CC

    Although i asked him this question and he said they are allowed because they do on the job training
    Last edit by honeykrown on Jul 3, '11 : Reason: More info
  7. by   Picklefreak
    I was a pharmacy tech for quite a while before I was a nurse. We mixed iv's and showed the Dph what we had added to it and they signed off. At first we were only able to do single ad-mixture iv's, but that was eventually relaxed. Some facilities allowed their techs to do TPNs and even chemo with extra training.

    I suppose that the Dph cannot be 100% certain that what the tech says she added was what she actually added. Of course, I can't be 100% certain that our nurse techs are always using proper technique when they take vitals or that they are accurately reporting intake and output. At some point, you just have to trust people to do their jobs.

    I do support more formalized education for pharmacy techs, however. On the job training is not enough, IMO.
  8. by   leslie :-D
    should a nursing student be able to administer high risk meds?
    the answer is 'of course!'...with responsible and appropriate training and supervision...
    same w/pharmacy techs.

    leslie
  9. by   LuckyinKY
    I have also worked as a pharmacy technician. I worked at Walgreens where everything was so automated it would be hard to make mistakes, there were multiple checks in place. I hate that people pay so much to train as a pharmacy tech. Many pharmacies will pay for their technicians to train and earn their certification.

    I did not work at all with IV solutions but would mix suspensions. You have very specific directions of how many mL of water to add to the bottle. Hospitals usually require their pharmacy technicians to have certification and so many years of experience, along with additional training for more complicated compounds and IV mixtures.

    In reading the link about the IV overdose, the pharmacist should have checked the order before ti was prepared. Where I worked, the technician would enter the prescription or order and it was sent to the pharmacist for error checking. The program we used also would check for errors .
    Last edit by LuckyinKY on Jul 3, '11
  10. by   Tait
    Bad things happen. We hear about them on occassion. It doesn't mean an entire population, hundreds, thousands of people, need to be punsished who perhaps do a better job than the professionals paid more money.

    I will never condemn additional training and education as a bad thing, but in the end each person is individually responsible for their actions.

    What I am wondering on that story is it says the tech "entered" the wrong dosage information, so this really isn't about the tech physically mixing that bag, but that a lot of fail-safes between the order and the patient were missed.
  11. by   MunoRN
    I didn't realize that either until I read this story about a med error:

    "The error happened on a Sunday morning, with typical weekend staffing. Eric (Pharmacist) was busy and had taken no breaks and had not eaten any meals during his shift. Routine maintenance had been performed on the computer the night before, and the pharmacy system was not available until mid-morning. The labels for IV admixtures, which typically printed around 7 a.m., printed later that morning, causing a delay in preparing solutions. Eric received a call to dispense Emily’s chemotherapy right away, although it was not needed until hours later (unknown by Eric at the time). After the technician mixed the solution, he felt rushed to check the chemotherapy, which was among many other solutions, vials, and syringes in a very small, crowded checking area. Eric saw an empty 250 mL bag of 0.9% sodium chloride near the bag of chemotherapy and assumed the technician had used it to prepare the base solution."

    That seems like an extremely error prone system and I'm not really sure how the Pharmacist can be sure what they are "checking".

    The Pharmacist in this story spent 6 months in Jail and lost his license.
    Last edit by MunoRN on Jul 3, '11
  12. by   Nurse_Diane
    If the Pharmacy techs didn't do most of the physical work, we'd need a lot more Pharmacists.

    Healthcare costs are already high enough...
  13. by   Lahryn04
    Diane in Michigan- im hoping IVP meant IV Piggyback and not IV push in this instance!! Right? :-)
  14. by   RTtoBe2011
    uh, why shouldn't they be? it's a physical task they've been trained and are paid to do. Or are we saying that because a few techs--or even all techs occasionally--make mistakes, no techs should be allowed mix meds? If that's the case we'd better just give up on healthcare all together because we all make errors and we can all negatively affect a patient.

    i personally make IV admixtures, neonate TPNs and chemos as a technician. more education is never bad but I think a better solution to these types of errors by techs is continuous process improvement. especially in this case. it was obviously a human error compounded by multiple process failures that turned what was essentially a typo into a tragic, unnecessary death.

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