Knowing What I Don’t Know

With the equinox just around the corner I’ve been in spring-cleaning mode for the last several weeks. This weekend I committed to purging some of the file boxes I have in storage at home. While browsing the contents of one box, I came across some text books from my pharmacy technician school days. My first thought was, “Why have I kept these books all these years?” But instead of putting them into the garbage pile, I got curious about their contents. One of the texts was titled “Introduction to Intravenous Admixtures: Aseptic Technique Training Manual”. As I dusted it off and opened to the title page I noted the text was on its 5^th edition published in 1995. In the first chapter, just following the introductory definition of aseptic technique and points outlining the advantages of an I.V. additive system, was a section about the need for skilled pharmacy technicians. The textbook described how the role of the pharmacy technician had expanded to meet the need for skilled personnel to prepare sterile medication dosage forms. Now, two decades later, compounding sterile preparations is an activity that pharmacy technicians are uniquely qualified to perform.

As a scrolled through the pages, I saw much of what you’d expect in a sterile compounding textbook from 20 years ago. Then I came to a page that caused me to pause and reflect. The first two points of a check list for the technician to use to prepare for sterile compounding were:

1. “Remove nail polish and all makeup”
2. “Remove all jewelry (rings, watch, earrings, bracelets).”

In my day job as a Practice Leader with Alberta Health Services, much of my work is currently focused on the application of the National Association of Pharmacy Regulatory Authorities’ (NAPRA) suite of model standards for pharmacy compounding. The standards were created in response to evolving practice and to ensure the safety of patients who receive sterile preparations compounded by pharmacy professionals. For many pharmacy technicians and pharmacies, implementing the new model standards is a work-in-progress and includes changes to the conduct of pharmacy personnel entering controlled compounding areas. I was surprised that these two preparation concepts regarding makeup and jewelry currently being implemented as part of the new standards were the same as what I was taught as a student more than 20 years ago. At some point between then and now I adopted new thinking into my practice about the minimum requirements for preparing myself for sterile compounding.

One of the reasons we complete continuing education is so that we don’t lag behind the fast-paced changes we face in healthcare – it is important for our growth as professionals. What we don’t always consider is that continuing education also helps us to maintain the knowledge and skills that allows us to practice as competent professionals. Practice experience is a great way to maintain knowledge and skills but it’s usually limited to what we’ve done before. That may not always be based on best practice and current evidence. Being competent in practice cannot be achieved just by working as a pharmacy technician and fulfilling the annual CEU requirements. There is a component of professional self-responsibility that we can achieve through reflection and proactively identifying the competency areas we may need to a little refresher in.

As the saying goes, it’s hard to know what you don’t know. But what’s worse than not knowing something is thinking we know more than we actually do. Even after 20 years of practice, realizing there is always something new I can learn is what makes me a better pharmacy technician. These days it seems this is a realization I have on a weekly basis. That doesn’t mean I’m incompetent – it means I understand my strengths and limitations and have committed to improving through life-long learning. When I evaluate my current knowledge and skill and identify something I don’t know, I can seek more information to improve my competence in that area. While sterile compounding has been a part of my practice, it has not been an area of focus for me in recent years. Being thrust back into that practice area with full force I realize that if I had taken the time to deliberately evaluate my knowledge about sterile compounding, and completed continuing education on that topic, even when my practice wasn’t focused in that area, perhaps I wouldn’t have been so surprised by the realization that my recent practice has not reflected what I learned all that time ago.

Do you have a plan for how you maintain your competence? Do you think self-evaluation can help improve the quality of your practice? Share your thoughts by commenting below.

About the author: Since receiving her pharmacy technician diploma in 1998, Teresa Hennessey has practiced in front-line and leadership roles in both community and hospital pharmacies. Teresa is dedicated to helping pharmacy technician practice evolve and will share her ideas and opinions on this topic with whomever will listen.