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Module One

The Pharmacy Technician and Pharmacy Settings

Table of Contents

1. The Pharmacy Technician


A. Personal Standards of a Pharmacy Technician (p 2)
B. Duties of a Pharmacy Technician (p 3)
i. Tasks Performed (p 3)
ii. Assisting the Pharmacist with Medical Data
(p 4)
iii.Skilled Areas (p 4)
iv. Switching Gears (p 5)
C. Pharmacy Technician Certification Board (PTCB)
Knowledge Statements for the National Examination
i. Assisting the Pharmacist in Serving Patients
(p 6)
ii. Maintaining Medication and Inventory
Control Systems (p 9)
iii. Participating in the Administration and
Management of Pharmacy Practice (p 10)
D. Certification (p 13)
E. Sample Questions (p 15)

2. Pharmacy Settings
A. Retail (p 16)
B. Institutional (p 17)
C. Long Term Care (p 18)
D. Other (p 19)
E. Sample Questions (p 20)

3. Answer Key for Sample Questions (p 21)

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1. The Pharmacy Technician

A pharmacy technician in health care is an individual who is given a


basic level of training designed to help them perform specific tasks in
a pharmacy. A pharmacy technician is under the direct supervision of
the pharmacist.

A. Personal Standards

The personal standards of every pharmacy technician should be:

! Professional Behavior
! Neat Appearance
! Dependability
! Trustworthiness
! Patient Confidentiality

Remember:

# Competence is knowing your scope of practice, what you can and can
not do.

# Negligence is failing to do something that should or must be done.

# Confidentiality is the requirement of health care providers to keep all


patient information private.

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B. Duties of a Pharmacy Technician

i. Tasks Performed

# Receiving Prescriptions: Whether from a patient or a healthcare


provider, make sure the prescription contains all of the necessary
information for dispensing.

# Data Entry of Patient Information: Inputting patient information into the


computer is actually very important. One must be very accurate in
adding new patients, new medications, correct insurance information, the
correct medication, dosage, and directions for use.

# Filling Prescriptions: Always check the National Drug Code (NDC)


number when filling a prescription to make sure you are entering the
correct drug.

# Packaging Medications: Make sure to package medications in


appropriate containers. Example: If you package 30 small tablets, use a
small dram vial, not a large one.

# Inventory Control: Performing inventory control is extremely important


in every pharmacy. We will talk about how to control inventory and save
your pharmacy money while maintaining the ability to serve the
customer/patient.

# Ordering Drugs: Only order what you need, bulk ordering can mean an
over stock. Check quantities before ordering drugs or supplies for the
pharmacy.

# Record Keeping: How long should you keep records on prescriptions,


whether hard copies, controlled substance records, or wholesale receipts?
Where are records kept? (Hard Copy This is the term used in a pharmacy
meaning original prescription order.)

# Use of Sterile Technique for IV Additives: Who do we want to protect?

# Compounding: Do you know how to follow a recipe when cooking?


Compounding is a lot like following a recipe very carefully.

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ii. Assisting the Pharmacist with Medical Data

Pharmacy technicians should be able to assist the pharmacist with medical


data associated with the pharmacys monitoring outcome programs. The
types of monitoring outcome programs for patients are:

# Blood Pressure

# Bone Density

# Cholesterol

# Blood Glucose

# Respiratory Functions

# Immunizations

iii. Skilled Areas for Technicians

# Math and Problem Solving: Used for mark-ups in the pharmacy,


calculating dosage forms, chemotherapy, compounding, and even in
calculating the hours you work.

# Language and Terminology: Knowing some basic medical terminology


is important if, for example, a prescriber orders a medication for blood
pressure and writes B/P on the prescription. You will have to
transcribe B/P to blood pressure for the patient to understand what
this medication is for.

# Computer Skills: You will need computer skills to perform tasks like
data entry and inventory control. Learning the computer programs in
your pharmacy is very important.

# Interpersonal / Communication Skills: These skills are very important as


you will interact with patients/customers, supervisor, co-workers,
physicians, nurses and others. You must be able to communicate,
cooperate, and work effectively as part of a team.

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iv. Switching Gears, A Day in the Life of a Pharmacy Technician

You are a pharmacy technician in a retail pharmacy that fills 250


prescriptions per day, does chemotherapy for a physicians office, and does
compounding on occasion. The pharmacy has 1 pharmacist, 2 technicians
who are also certified compression-hose fitters, and 1 clerk. Both pharmacy
technicians are experienced in all settings of pharmacy. One technician calls
in sick, so today you are the only technician on the job.

You are currently filling several prescriptions for a waiting customer. The
telephone rings for the pharmacist, but he is on another line. The clerk takes
a short break to go to the restroom. The phone rings again, a customer is
calling to see if she has any refills left on her prescription. Another customer
arrives at the counter and hands you a prescription for a compound, one of
those you cant fill ahead of time.

Now you have 2 calls holding and 2 customers waiting for prescriptions.
What do you do? Scream? NO!

The pharmacist takes the first call and is given a chemotherapy order. Now
stay calm. Go back to the second call and check the refill for the customer
on the phone. Keep filling the prescriptions for the waiting customer.
Tell the new customer since this is a compound it will be filled within 24
hours and you will call when its ready. The clerk is back now. The
pharmacist hands you a chemo order to prepare. A customer comes in with a
prescription for a compression stocking. You know this takes about 20
minutes to do. Now you can scream.

Ask yourself... do you really want to be a pharmacy technician? Yes, you


do. Actually this is one of my typical days as a technician. The reward of a
pharmacy technician is helping patients and having them smile and thank
you for your service. Remember the pharmacist is counseling patients,
checking your work, taking phone calls, filling prescriptions and screaming
inside too.

Once you have that little CPhT behind your name the customer will notice
this. They will ask you questions about their drugs, and recommendations
for Over the Counter drugs. You are not authorized to give them this kind of
information and you must refer them to the pharmacist.

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C. Pharmacy Technician Certification Board (PTCB)
Knowledge Statements for the National Exam

The knowledge base required to perform activities associated with


each function of the pharmacy technician are:

i. Assisting the Pharmacist in Serving Patients

1. Knowledge of federal, state, and/or practice site regulations, codes of


ethics, and standards pertaining to the practice of pharmacy.
2. Knowledge of pharmaceutical, medical, and legal developments
which impact on the practice of pharmacy.
3. Knowledge of state-specific prescription transfer regulations.
4. Knowledge of pharmaceutical and medical abbreviations and
terminology.
5. Knowledge of generic and brand names of pharmaceuticals.
6. Knowledge of therapeutic equivalence.
7. Knowledge of epidemiology.
8. Knowledge of risk factors for disease.
9. Knowledge of anatomy and physiology.
10. Knowledge of signs and symptoms of disease states.
11. Knowledge of standard and abnormal laboratory values.
12. Knowledge of drug interactions (such as drug-disease, drug-drug,
drug-laboratory, drug-nutrient).
13. Knowledge of strengths/dose, dosage forms, physical appearance,
routes of administration, and duration of drug therapy.
14. Knowledge of effects of patients age (for example, neonates,
geriatrics) on drug and non-drug therapy.
15. Knowledge of drug information sources including printed and
electronic reference materials.
16. Knowledge of pharmacology (for example, mechanism of action).
17. Knowledge of common and severe side or adverse effects, allergies,
and therapeutic contraindications associated with medications.
18. Knowledge of drug indications.
19. Knowledge of relative role of drug and non-drug therapy (for
example, herbal remedies, lifestyle modification, smoking cessation).
20. Knowledge of practice site policies and procedures regarding
prescriptions or medication orders.

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21. Knowledge of information to be obtained from patient/patients
representative (for example, demographic information, allergy, third-
party information).
22. Knowledge of required prescription order refill information.
23. Knowledge of formula to verify the validity of a prescribers DEA
number.
24. Knowledge of techniques for detecting forged or altered prescriptions.
25. Knowledge of techniques for detecting prescription errors (for
example, abnormal doses, early refill, incorrect quantity, incorrect
patient ID #, incorrect drug).
26. Knowledge of effects of patients disabilities (for example, visual,
physical) on drug and non-drug therapy.
27. Knowledge of techniques, equipment, and supplies for drug
administration (for example, insulin syringes and IV tubing).
28. Knowledge of non-prescription (over-the-counter [OTC])
formulations.
29. Knowledge of monitoring and screening equipment (for example,
blood pressure cuffs, glucose monitors).
30. Knowledge of medical and surgical appliances and devices (for
example, ostomies, orthopedic devices, pumps).
31. Knowledge of proper storage conditions.
32. Knowledge of automated dispensing technology.
33. Knowledge of packaging requirements.
34. Knowledge of NDC number components.
35. Knowledge of purpose for lot numbers and expiration dates.
36. Knowledge of information for prescription or medication order labels.
37. Knowledge of requirements regarding auxiliary labels.
38. Knowledge of requirements regarding patient package inserts.
39. Knowledge of special directions and precautions for patient/patients
representative regarding preparation and use of medications.
40. Knowledge of techniques for assessing patients compliance with
prescription or medication order.
41. Knowledge of action to be taken in the event of a missed dose.
42. Knowledge of requirements for mailing medications.
43. Knowledge of delivery systems for distributing medications (for
example, pneumatic tube, robotics).
44. Knowledge of requirements for dispensing controlled substances.
45. Knowledge of requirements for dispensing investigational drugs.
46. Knowledge of record-keeping requirements for medication
dispensing.

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47. Knowledge of automatic stop orders.
48. Knowledge of restricted medication orders.
49. Knowledge of quality improvement methods (for example, matching
NDC number, double-counting narcotics).
50. Knowledge of pharmacy calculations (for example, algebra, ratio and
proportions, metric conversions, IV drip rates, IV admixture
calculations).
51. Knowledge of measurement systems (for example, metric and
avoirdupois).
52. Knowledge of drug stability.
53. Knowledge of physical and chemical incompatibilities.
54. Knowledge of equipment calibration techniques.
55. Knowledge of procedures to prepare IV admixtures.
56. Knowledge of procedures to prepare chemotherapy.
57. Knowledge of procedures to prepare total parenteral nutrition (TPN)
solutions.
58. Knowledge of procedures to prepare reconstituted injectable and non-
injectable medications.
59. Knowledge of specialized procedures to prepare injectable
medications (for example, epidurals and patient controlled analgesic
[PCA] cassettes).
60. Knowledge of procedures to prepare radiopharmaceuticals.
61. Knowledge of procedures to prepare oral dosage forms (for example,
tablets, capsules, liquids) in unit-dose or nonunit-dose packaging.
62. Knowledge of procedures to compound sterile non-injectable products
(for example, eye drops).
63. Knowledge of procedures to compound non-sterile products (for
example, ointments, mixtures, liquids, emulsions).
64. Knowledge of procedures to prepare ready-to-dispense multidose
packages (for example, ophthalmics, otics, inhalers, topicals,
transdermals).
65. Knowledge of aseptic techniques (for example, laminar flow hood,
filters).
66. Knowledge of infection control procedures.
67. Knowledge of requirements for handling hazardous products and
disposing of hazardous waste.
68. Knowledge of documentation requirements for controlled substances,
investigational drugs, and hazardous wastes.
69. Knowledge of pharmacy-related computer software for documenting
the dispensing of prescriptions or medication orders.

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70. Knowledge of manual systems for documenting the dispensing of
prescriptions or medication orders.
71. Knowledge of customer service principles.
72. Knowledge of communication techniques.
73. Knowledge of confidentiality requirements.
74. Knowledge of cash handling procedures.
75. Knowledge of reimbursement policies and plans.
76. Knowledge of legal requirements for pharmacist counseling of
patient/patients representative.

ii. Maintaining Medication and Inventory Control Systems

1. Knowledge of drug product laws and regulations and professional


standards related to obtaining medication supplies, durable medical
equipment, and products (for example, Food, Drug and Cosmetic Act;
Controlled Substances Act; Prescription Drug Marketing Act; USP-
NF; NRC standards).
2. Knowledge of pharmaceutical industry procedures for obtaining
pharmaceuticals.
3. Knowledge of purchasing policies, procedures, and practices.
4. Knowledge of dosage forms.
5. Knowledge of formulary or approved stock list.
6. Knowledge of par and reorder levels and drug usage.
7. Knowledge of inventory receiving process.
8. Knowledge of bioavailability standards (for example, generic
substitutes).
9. Knowledge of the use of DEA controlled substance ordering forms.
10. Knowledge of regulatory requirements regarding record-keeping for
repackaged products, recalled products, and refunded products.
11. Knowledge of policies, procedures, and practices for inventory
systems.
12. Knowledge of products used in packaging and repackaging (for
example, child-resistant caps and light-protective unit-dose
packaging).
13. Knowledge of risk management opportunities (for example, dress
code, personal protective equipment [PPE], needle recapping).
14. Knowledge of the FDAs classifications of recalls.
15. Knowledge of systems to identify and return expired and unsellable
products.

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16. Knowledge of rules and regulations for the removal and disposal of
products.
17. Knowledge of legal and regulatory requirements and professional
standards governing operations of pharmacies (for example,
prepackaging, difference between compounding and manufacturing).
18. Knowledge of legal and regulatory requirements and professional
standards (for example, FDA, DEA, state board of pharmacy,
JCAHO) for preparing, labeling, dispensing, distributing, and
administering medications.
19. Knowledge of medication distribution and control systems
requirements for the use of medications in various practice settings
(for example, automated dispensing systems, bar coding, nursing
stations, crash carts).
20. Knowledge of preparation, storage requirements, and documentation
for medications compounded in anticipation of prescriptions or
medication orders.
21. Knowledge of repackaging, storage requirements, and documentation
for finished dosage forms prepared in anticipation of prescriptions or
medication orders.
22. Knowledge of policies, procedures, and practices regarding storage
and handling of hazardous materials and wastes (for example,
Materials Safety Data Sheet [MSDS]).
23. Knowledge of medication distribution and control systems
requirements for controlled substances, investigational drugs, and
hazardous materials and wastes.
24. Knowledge of the written, oral, and electronic communication
channels necessary to ensure appropriate follow-up and problem
resolution (for example, product recalls, supplier shorts).
25. Knowledge of quality assurance policies, procedures, and practices for
medication and inventory control systems.

iii. Participating in the Administration and Management of Pharmacy


Practice

1. Knowledge of the practice settings mission, goals and objectives,


organizational structure, and policies and procedures.
2. Knowledge of lines of communication throughout the organization
3. Knowledge of principles of resource allocation (for example,
scheduling, cross training, work flow).

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4. Knowledge of productivity, efficiency, and customer satisfaction
measures.
5. Knowledge of written, oral, and electronic communication systems.
6. Knowledge of required operational licenses and certificates.
7. Knowledge of roles and responsibilities of pharmacists, pharmacy
technicians, and other pharmacy employees.
8. Knowledge of legal and regulatory requirements for personnel,
facilities, equipment, and supplies (for example, space requirements,
prescription file storage, cleanliness, reference materials, storage of
radiopharmaceuticals).
9. Knowledge of professional standards (for example, JCAHO) for
personnel, facilities, equipment, and supplies.
10. Knowledge of quality improvement standards and guidelines.
11. Knowledge of state board of pharmacy regulations.
12. Knowledge of storage requirements and expiration dates for
equipment and supplies (for example, first-aid items, fire
extinguishers).
13. Knowledge of storage and handling requirements for hazardous
substances (for example, chemotherapeutics, radiopharmaceuticals).
14. Knowledge of hazardous waste disposal requirements.
15. Knowledge of procedures for the treatment of exposure to hazardous
substances (for example, eyewash).
16. Knowledge of security systems for the protection of employees,
customers, and property.
17. Knowledge of laminar flow hood maintenance requirements.
18. Knowledge of infection control policies and procedures.
19. Knowledge of sanitation requirements (for example, hand washing,
cleaning counting trays, countertop, and equipment).
20. Knowledge of equipment calibration and maintenance procedures.
21. Knowledge of supply procurement procedures.
22. Knowledge of technology used in the preparation, delivery, and
administration of medications (for example, robotics, Baker cells,
automated TPN equipment, Pyxis, infusion pumps).
23. Knowledge of purpose and function of pharmacy equipment.
24. Knowledge of documentation requirements for routine sanitation,
maintenance, and equipment calibration.
25. Knowledge of the Americans with Disabilities Act requirements (for
example, physical accessibility).

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26. Knowledge of manual and computer-based systems for storing,
retrieving, and using pharmacy-related pharmacy information (for
example, drug interactions, patient profiles, generating labels).
27. Knowledge of security procedures related to data integrity, security,
and confidentiality.
28. Knowledge of downtime emergency policies and procedures.
29. Knowledge of backup and archiving procedures for stored data and
documentation.
30. Knowledge of legal requirements regarding archiving.
31. Knowledge of third-party reimbursement systems.
32. Knowledge of healthcare reimbursement systems (for example, home
health, respiratory medications, eligibility and reimbursement).
33. Knowledge of billing and accounting policies and procedures.
34. Knowledge of information sources used to obtain data in a quality
improvement system (for example, the patients chart, patient profile,
computerized information systems, medication administration record).
35. Knowledge of procedures to document occurrences such as
medication errors, adverse effects, and product integrity (for example,
FDA Med Watch Program).
36. Knowledge of staff training techniques.
37. Knowledge of employee performance evaluation techniques.
38. Knowledge of employee performance feedback techniques.

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D. Certification

A certificate is a legal proof or document certifying that an individual


meets certain standards provided by a neutral professional
organization.

The Pharmacy Technician Certification Board (PTCB) offers a National


Examination to become a Certified Pharmacy Technician (CPhT). This
examination tests your knowledge in areas of assisting the pharmacist in
serving patients, medication distribution, and inventory control systems for
pharmacy operations.

# Requirements for taking the PTCB exam:

Must have a high school diploma or GED.


Have never been convicted of a felony.

# Scoring the Examination:

Must have a score of at least 650 on the exam:


(Scoring systems range from 300-900).
The exam contains 140 multiple choice questions. You will be
graded on 125 of the 140. There are 15 questions on the exam that
will not be graded. These 15 questions are used to test the exams
effectiveness for future versions of the PTCB Exam.
Given 3 hours to complete.
Contact PTCB if you have any special requests for disability
reasons.

# Certification must be renewed every two years.

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# During the 2 year period between recertification you are required to
receive 20 hours of continuing education on such topics as:

Medication Distribution and Inventory Control Systems


Pharmacy Administration and Management
Pharmacy Calculations
Programs specific to Pharmacy Technicians
Interpersonal Skills
Pharmacology / Drug Therapy
Pharmacy Law
o At least one contact hour of pharmacy law is required every
two years.

Important Notes:

# Programs relating to patient counseling, recommending drugs, or any


other function outside the scope of practice for pharmacy technicians
are not acceptable.

# All continuing education documents you receive should be kept


together in case you are audited by PTCB.

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E. Sample Questions

1. What should be checked when filling a prescription to make sure you are
entering the correct drug into the computer?
a. Inventory
b. NDC number
c. Manufacturer
d. Dosage

2. When is math accuracy important in a pharmacy?


a. Performing pharmacy mark-ups
b. Calculating chemotherapy dosage
c. Compounding a prescription
d. All of the above

3. A _______ is a legal proof or document showing that an individual meets


certain standards provided by a neutral professional organization.
a. Certificate
b. Diploma
c. License
d. Continuing education

4. Who offers the National Pharmacy Technician Exam?


a. APhA
b. NPhA
c. PTCB
d. NCPA

5. How many hours of continuing education is needed every 2 years to


renew your pharmacy technician certification?
a. 5
b. 10
c. 15
d. 20

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2. Pharmacy Settings

A. Retail Settings

Pharmacy retail settings provide prescriptions for the general public.


Approximately two thirds of all prescriptions dispensed are filled in this type
of setting. Retail pharmacies are also called community, independent, chain,
food store, and mass merchandiser pharmacies.

In a retail setting, prescriptions are brought into the pharmacy by the


customer, or faxed, telephoned, or mailed in by the prescriber. A
prescription computer program is used for the process of filling medications
for the public by the pharmacy technician and pharmacist.

Retail pharmacists conduct programs for disease state management where


they counsel patients about their disease state and medications.

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B. Institutional Settings

Institutional pharmacies dispense drugs for patients in a hospital or nursing


home. In this setting medications are dispensed from the inpatient (main)
centralized pharmacy or from a (satellite) decentralized pharmacy within the
hospital. The coronary care unit, pediatric unit, and the operating room are
just a few examples of decentralized (satellite) pharmacies.

In institutional settings, medications are transcribed from a medication order


form completed by the prescriber and transferred onto a medication
administration record (MAR). The MAR is then sent to the pharmacy for
dispensing. All medications dispensed in this setting are packaged in a unit
dose system: one single drug, for one patient, for one time of day.

The unit dose is prepared and filled by pharmacy technicians, checked by the
pharmacist, and then put into a medication cart where each patient has their
own drawer with his or her name, room and bed number. Drawers in a
medication cart are filled every 24 hours.

Some hospitals have automated dispensing systems such as the Baker Cells
or the Pyxis Supply Stations. Cart-filling robots are also used for assisting
the filling of prescriptions in the inpatient pharmacy. Other orders that may
come in during the day or night will be filled and sent to the floor or unit by
dumb waiters, pneumatic tubes, or hand delivered as needed.

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C. Long Term Care (LTC)

LTC pharmacies dispense medications in a unit dose form, putting


medications in a medication cart and then delivering it to the nursing home.
In an assisted living home, the medication is packaged in a single dose card
called a bubble pack and is for one patient, with one drug, for one time of
day, for one month. Another system is the customized safety-sealed pill cup
calendar card with the patients name, medication names, and time to take.
This system has all the medication in one single cup for one time of day for
one patient.

The difference between the two facilities is that in a nursing home a


registered nurse will distribute the prescribed medication to the patients
whereas in an assisted living home a trained medication aid administers the
medication to the patients.

Long Term Care (LTC) pharmacies dispense medication to facilities such as


nursing homes or assisted living homes where patients are no longer able to
take care of themselves at home. The pharmacy will deliver or mail the
medications to such facility.

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D. Other Pharmacy Settings

Mail Order Pharmacies: Mail order pharmacies serve the


general public and they send medications by mail or other delivery
method. Prescriptions take about 24-48 hours to fill and mail to the
customer. This type of pharmacy is appropriate for ordering
maintenance drugs for medical conditions like diabetes, high blood
pressure, and thyroid because the cost of the medication is cheaper.
However, if a patient is given an antibiotic or pain medication
prescription that needs to be taken right away, this setting would
not be appropriate.

Home Infusion and Compounding Pharmacies: These


pharmacies are primarily used for the dispensing of intravenous
medications for patients who need IV medication in their homes.
They prepare admixtures, chemotherapy, total parenteral nutrition
(TPN), and provide infusion pumps. A registered nurse will deliver
the medication and administer it to the patient.

Nuclear Pharmacies: This pharmacy setting prepares nuclear


medications mainly for patients x-ray testing. In addition to the
PTCB certification, a separate certification is required for
pharmacy technicians to prepare nuclear medications.

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E. Sample Questions

1. What type of pharmacy setting fills prescriptions for the general public?
a. Mail order
b. Institutional
c. Retail
d. a and c

2. What is a decentralized pharmacy?


a. Wholesale pharmacy
b. Nursing home pharmacy
c. Satellite pharmacy
d. Long term care pharmacy

3. What type of pharmacy prepares and dispenses intravenous medications


and TPNs for patients who receive their medications at home?
a. Nuclear
b. Home infusion
c. Mail order
d. Hospital

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3. Answer Key for Sample Questions

1. E. 2. E.

1. b 1. d
2. d 2. c
3. a 3. b
4. c
5. d

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