On The Cover
Johanna Taylor Katroscik, PharmD
Over the past year and a half, the COVID-19 pandemic has altered the lives of people across the globe. Pharmacists have worked to meet the increasing needs of their communities during this time, and they have been recognized as vital frontline health care workers. However, pharmacy technicians are often not given the same attention. With the PREP Act now granting technicians the authority to administer vaccines, the importance of their position and potential of expanding their roles are becoming increasingly visible.
William Schimmel, executive director and CEO of the Pharmacy Technician Certification Board (PTCB), stresses the importance of incorporating technicians into different positions and said the goal is to advance the efficiency of the pharmacy team as a whole. By allowing technicians to perform a range of advanced and specialty duties, pharmacists are freed up to focus more on direct care and clinical decisions.
However, there are still pharmacists who remain hesitant to relinquish some of their current duties, even ones that technicians could easily help perform and do not require clinical skills or judgment.
According to a 2021 JAPhA article by Kulczycki and colleagues, only 24% of pharmacists surveyed in 2018 agreed that technicians should be able to administer vaccines.
Perhaps some of the hesitation comes from pharmacists and technicians who have been practicing for years. New practitioners might offer a fresh perspective for moving the profession forward.
Ariel Clark, PharmD, who began her career as a technician, was employed at a community pharmacy last year when technicians were granted the authority to immunize under the PREP Act. She felt a great sense of relief knowing that technicians could help in this area, and it took some of the weight off her shoulders.
“What I would love to see—if I had a magic wand and could make any changes that I wanted—I would want to see all pharmacy technicians certified because it ensures that they are all practicing with the same knowledge base,” said Clark, who currently works for a community pharmacy as well as PTCB as their executive fellow. At PTCB, she supports efforts to expand pharmacy technician credentials.
“I would want pharmacies to support technicians in advanced pharmacy technician certifications and compensate them for their skills,” she said.
Clark believes that pharmacists can be advocates for technicians by helping them access resources they need to gain advanced training (see sidebar) and then giving them the opportunity to utilize their new skills.
“When I think about expanded roles of technicians, I think about giving them the responsibility of being able to do what they know how to do,” said Courtney Tigges, PharmD, a community pharmacy resident with Towncrest Pharmacy in Iowa City, IA.
Tigges believes that by doing this, pharmacists can spend more one-on-one time with patients.
Technicians immunizing in the community
Currently, the PREP Act gives technicians the authority to administer COVID-19 vaccines, ACIP-recommended childhood vaccines, COVID-19 tests, and COVID-19 therapeutics under certain conditions. While the PREP Act does not grant pharmacy technicians this authority beyond October 2024, it has been shown that technicians are willing and able to step up as important members of the pharmacy team.
Sara Dreyer, a certified pharmacy technician (CPhT) from Towncrest Pharmacy is one of these technicians who has been trained to give immunizations over the past year. ”It was bumpy at first, as all new things are, but once we got into a rhythm it became a really smooth process,” Dreyer said. While a little nervous initially, she was excited to be able to learn a new skill and help take some of the workload from pharmacists.
Randy McDonough, PharmD, co-owner of Towncrest Pharmacy, has been advocating for advanced technicians’ roles for several years in his home state of Iowa. He believes that part of pharmacy practice transformation is optimizing technician roles, which will allow pharmacists to be able to do more clinical work and help patients achieve better outcomes.
Finding technicians is becoming more and more difficult across the country, but when pharmacies support technicians, McDonough said they are investing in their practice. Giving technicians new opportunities, providing training and career paths, and paying them a good wage are all important factors in hiring and maintaining a technician workforce.
McDonough knows that transformation doesn’t happen overnight and recommends that pharmacies start with small and incremental changes. First, pharmacists need to reframe their mindset and think about how they can modify workflow in their pharmacy. The second step is to shift the focus of the technicians to be able to do more. The third step is working toward pharmacists being comfortable providing clinical management to patients.
None of these are new concepts; some pharmacies, like Towncrest Pharmacy, are already implementing them. At Towncrest, they believe that technicians are a vital part of the team. Towncrest Pharmacy also includes technicians as part of the team by incorporating tech-check-tech (TCT)—a process which allows technicians to check prescription refills—into their workflow.
As the profession continues to grow, pharmacists need to be ready to learn, grow, and adjust, as well.
Beyond vaccination in health-system settings
Technicians in health care systems also play important roles, and currently they may have more opportunities for expanded roles than technicians in community settings.
Miranda Peek, CPhT, is a pharmacy technician who works as a clinical manager for the inpatient pharmacy at Gundersen Health System in Wisconsin. Although she has not been able to administer immunizations, she is a firm believer in the value of pharmacy technicians and the importance of expanding their roles.
She has been working with Gundersen for approximately 17 years and recalls that when she first started, there were virtually no opportunities for technicians to advance their careers within the pharmacy. In her current position, she has been able to facilitate growth and now oversees 9 different advanced technician roles that include TCT, I.V. compliance, and medication history technicians. The technicians she supervises are not required to obtain additional certifications, but certification gives them a chance to move forward professionally. Peek said she hopes to help her staff advance both professionally and personally.
“I hope we can get to a place, as a profession, where our actions and regulations fully support the value technicians create for pharmacists and patients,” said Meghan Swarthout, PharmD, a clinical pharmacist and division director for The Johns Hopkins Hospital. She has been a big proponent of advanced technician roles for a number of years and has worked with PTCB to develop advanced pharmacy technician
certifications. Additionally, she works to support technicians as their roles continue to expand and is a firm believer that a living wage and personal well-being are important aspects of technicians’ professional growth. From her health-systems’ perspective, she has helped build technician ladders leading toward technician specialization.
She noted that the PTCB wanted to do everything they could to reduce barriers for technicians. One of the sayings that sticks with her is “a rising tide lifts all boats.” To Swarthout, the advancement of pharmacy technicians is the rising tide of the pharmacy profession.
What are the current requirements enabling technicians to administer vaccines?
- Technicians must be licensed or registered according to state requirements. If there are no state requirements, technician must have CPhT from PTCB or NHA.
- Technicians must complete an ACPE-approved practical training program that covers hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.
- Technicians must complete a minimum of 2 hours of ACPE-approved immunization-related CE during each state licensing period.
- Technicians must have current certificate in basic CPR.
- Pharmacists must be available at all times.
- Technicians may administer COVID-19 vaccines, influenza vaccines, and childhood immunizations to patients 3 years and older.
PREP Act basics
- PREP stands for Public Readiness and Emergency Preparedness.
- The PREP Act authorizes the Secretary of the Department of Health and Human Services to issue a declaration that provides immunity from liability to groups, businesses, or individuals who are involved in developing, manufacturing, testing, distributing, or administering products designed to be used as countermeasures against a public health threat (e.g., COVID-19 vaccines, tests, and therapeutics).
- The declaration under the PREP Act for Medical Countermeasures Against COVID-19 was issued in February 2020 and currently has 9 amendments detailing what is covered under the declaration.
- For a full list of training requirements and who and what is covered under the PREP Act, see APhA’s practice resource “Authority to Immunize during COVID-19” (aphanet.pharmacist.com/sites/default/files/audience/APhACOVIDAuthoritytoImmunize_0321_web.pdf).
How pharmacists can support technicians as they work to become immunizers or gain expanded roles
- For non-immunization roles, know what is and is not allowed based on specific state legislation.
- Be available and willing to answer questions and shadow technicians as they start using their new skills.
- Be an advocate in your state and pharmacy for expanded technician roles.
- Have an open mind and be flexible!