Appropriate Supervision of Pharmacy Assistants

The regulation of pharmacy technicians was driven by changing roles in pharmacy. The pharmacy practice environment was growing in complexity due to increasing demands on the provision of patient care and health services. There was a need to ensure that patients continued to be protected throughout the shift in responsibilities between pharmacists and pharmacy technicians. The result was a framework that kept pace with modern pharmacy practice; ensuring pharmacy technicians were qualified and appropriately assessed. As a practicing pharmacy technician I was, and continue to be, fully supportive of the regulation of pharmacy technicians. I’m lucky that I am able to practice autonomously and to full scope as a pharmacy technician, but I realize that many of my peers aren’t so lucky. A recent experience with our current pharmacy practice model as a patient helped me to realize some of its flaws. It is based upon there still being a place for unregulated pharmacy personnel, often referred to as pharmacy assistants. This is a model driven by the business aspects of pharmacy, but as a healthcare profession, we must be careful that we don’t allow potentially unsafe situations by the inappropriate utilization of pharmacy assistants.

Recently, my three year old daughter experienced an infection following an insect bite. That meant a new antibiotic prescription, so off I went to our community pharmacy to get the medication. I was greeted at the drop-off counter by a new pharmacy assistant, who I’ll call Henry. Henry was working that day with Mary, one of the regular staff pharmacists who I knew well. They were the only two pharmacy staff working at the pharmacy on this particular day. When accepting the prescription Henry was pleasant and knew all the right questions to ask to confirm my daughter’s health information. He also asked her current weight and even confirmed that she had a skin infection. He also checked that the medication was in stock before I walked away from the counter and waited for the prescription to be prepared. When I returned to the pharmacy after a short wait, Mary met me at the pick-up counter with the labeled medication bottle in hand. We had a short counselling session and I asked for oral syringes so that I could unit-dose the medication to send along to my daughter’s daycare. While Mary obtained the syringes for me, Henry took the bottle to reconstitute the oral suspension since it had not yet been done. I watched as Henry measured the water and added it to the bottle. This happened while Mary was at the opposite side of the pharmacy trying to affix tip caps to the oral syringes I had requested. Mary returned, Henry passed the bottle to her, she placed it into a bag with the syringes and I was on my way.

Even though the scenario was a fairly standard prescription filling experience, and quite positive, I couldn’t help feel uneasy about it. Henry did all the right things and I was impressed with my interactions with him, so much so, that I asked him what his background was. He told me that he was brand-new to pharmacy. He recently completed a degree and was thinking about going back to pharmacy school, so he applied for the open pharmacy assistant position to learn more about working in the field. Henry had not had any formal pharmacy training, but his aptitude and successful on-the-job training were very evident. Despite this, I’m not certain that this scenario demonstrates appropriate pharmacy practice in action. As unregulated pharmacy employees, pharmacy assistants like Henry, must be directly supervised. According to Alberta regulations, this means that the pharmacy technician or pharmacist who is providing the supervision must “be able to observe and promptly intervene and stop or change the actions of the individual who is under supervision”. I believe Mary failed to properly supervise Henry’s reconstitution of the oral antibiotic and ultimately confirm the integrity of the final product. Additionally, section 20.7 of the Standards of Practice for Pharmacy and Pharmacy Technicians outlines the activities that an unregulated employee engaged in providing a drug may perform, such as entering the prescription into the computer, selecting the drug from stock, and filling it. While Mary was in the pharmacy and potentially listening to the conversation Henry and I had, it was not appropriate for him to gather the patient and health information needed to fill my daughter’s prescription.

The utilization of pharmacy assistants in practice may be necessary in some situations but it should only be done when it’s in patients’ best interests. The tasks pharmacy assistants perform must be within clearly defined limits with identifiable outcomes, and there must be sufficient training and supervision so that the pharmacy assistant can perform the tasks safely and within standards. Pharmacy assistants cannot be used as replacements for pharmacy technicians. When appropriately utilized, pharmacy assistants, help with, or perform certain pharmacy tasks that do not require the expertise or authorization of a pharmacy technician. One could argue that this also means a pharmacy assistant should never be working in a pharmacy where there is no pharmacy technician employed. Recently, the largest publicly funded health system in the UK, the National Health Service, reported that extensive substitution of registered nurses with unskilled support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. You can read about that here. If we don’t change direction now and eliminate inappropriate practices, like the one I experienced, we risk the same thing happening within pharmacy.

Do you agree? How do you think we can appropriately utilize pharmacy assistants while ensuring pharmacy technicians and pharmacists are able to practice to full scope? Share your thoughts in the comments below.