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Technician Tutorial:
The Ins and Outs of Pharmacy Inventory
A patients most basic expectation for service at a pharmacy is that prescribed medications are in stock.
This is one reason its so important to ensure your pharmacy has the medications your patients need,
when they need them. Inventory is one of the most frequently performed tasks in a pharmacy, whether in
a community or hospital setting. In fact, after dispensing, managing and maintaining inventory is the
pharmacy technicians biggest role. This can offer great rewards for a job well done. On the other hand,
ignoring inventory poses great risks. Just a glance can reveal pharmacies that have well-managed
inventories and those that have neglected this vital job. This PL Technician Tutorial reviews the ins and
outs of pharmacy inventory.
Youre working on a refill: a 90-day supply of metoprolol extended-release 100 mg tabs for
Mary Bingham. Mrs. Bingham called in for this and said shell be in tomorrow afternoon to pick
it up. You are surprised when the computer alerts you there are only 80 tablets remaining in
stock. You check the shelf, and the computer is correct. Youre glad to have caught this issue,
because the pharmacy dispenses a lot of this medication. Fortunately, Mrs. Bingham isnt in the
pharmacy waiting for her prescription.
Besides having meds available, for what other reasons are managing and maintaining
pharmacy inventory important?
Pharmacy inventory itself is costly. While keeping adequate inventory in stock is a necessary
requirement to serve patients, keeping too much in stock can be financially detrimental. Both too little
inventory (below the pre-determined reorder point or par level) and too much inventory (reorder
quantities that cause you to exceed desired stock-on-hand) are directly related to poor inventory
practices.
In addition, there is an actual dollar cost associated with the space for storing inventory in the pharmacy.
Plus, space in a pharmacy is a valuable resource for other reasons. Good work takes place in an orderly
environment. A disorderly environment can lead to mistakes and a breakdown in efficiency. When vital
space such as countertops and shelving are used for long-term storage of inventory, workflow can be
impeded.
You wonder if there was somehow a mix-up with the reorder point for the metoprolol tabs, or the
reorder quantity needed to maintain the appropriate amount of stock-on-hand. Normally, you
keep up to 500 tabs of these tabs on the shelf, and reorder when you drop below 300 tabs. As
you are thinking about this short supply of metoprolol in your pharmacy, you notice there are
several unopened bottles of tranexamic acid tablets sitting on the counter. You know this med is
not frequently dispensed and its very expensive, so you make a mental note to mention this to the
pharmacist.
Inventory measurement can be contracted or done in-house. There are several companies that specialize
in inventory measurement. Some pharmacies choose to use their own crew to do inventory. The method
and frequency of inventory measurement is not as important as having a policy that governs how it is
done. Following the policy gives the pharmacy a dependable method of knowing its inventory value.
Inventory levels and ratios such as the inventory value as a percentage of annual sales may be somewhat
similar in most pharmacies. However, differences in business approaches, work methods, and types of
patients will affect these numbers for your pharmacy specifically.
Business agreements govern discount rates, payment agreements, and return privileges between the
pharmacy and its supplier.
The wholesaler or warehouse offers an array of services other than supplying merchandise. The most
important of these is to take inventory back. The agreement between the supplier and the pharmacy
contains a set of rules governing all aspects of returning goods. Pharmacies need a way to sell goods back
to the wholesaler when too much stock is delivered, the wrong item is received, medications go out of
date, merchandise has stopped selling, etc. This inventory becomes unusable as it begins to expire in the
store. (Remember that if only a month and year are designated for the expiration date, the drug expires on
the last day of the month.)
The downside of too much inventory is not only financial. Issues with clutter or not moving stock
appropriately are also important considerations. The warehouse or wholesale operation can shift
merchandise from a location where it is not being used to one where it will be used, but only if the
pharmacy returns the product to the warehouse.
Some pharmacy companies choose to use a returned goods company in addition to their principal
wholesaler. These companies specialize in returns of out of date or close date merchandise that the
main wholesaler doesnt accept. The payment from these companies is lower than the usual wholesale
value, but they offer an easy way to dispose of product that is no longer saleable. These one box return
companies also handle Schedule II controlled substances including the required DEA 222 transfer forms
(in U.S.).
What are some tools and strategies for ordering and maintaining inventory?
While community pharmacies will order medications based on what is purchased in the store, hospital
pharmacies will order what is needed from a list of drugs known as the hospitals formulary. The
formulary is usually determined by a group of health care professionals and administrators (the Pharmacy
and Therapeutics or P and T committee), balancing effectiveness of the medications with factors such
as cost and safety.
All staff should know their assignments and work to keep appropriate levels of useful inventory in stock.
Fortunately, pharmacies also have good tools to help with this, such as shelf labeling, automated
reordering, and automatic substitution.
Shelf labeling is a manual technique of inventory management. Labels are used to mark a shelf place for
each product. The label provides the name/strength/size of the medication, NDC (U.S.) or DIN (Canada),
reorder number, bar code, size, etc. These labels help when its time to reorder stock manually, such as
when a med drops below its predetermined par level or reorder point. Generating a reorder in a well-
labeled pharmacy can be done easily using a portable data terminal device to scan labels and adjust order
quantities. By placing a label on the shelf for all products in the pharmacy, shortages can also be quickly
identified. Creating new labels can also be very helpful. If the store has to wait for the warehouse or
wholesaler to send labels, much of the impact of labeling is lost. Diligence and patience are required to
keep a store well-labeled, but the benefit to inventory levels, and ultimately to patients, is well worth the
effort.
Automatic reordering is a feature most pharmacies already have, though many may not use it. Most
computer systems allow reorder points and stock-on-hand values to be set for each medication, which is
referred to as a point of sale inventory system. Prior to generating an order, the system can list all
products that need to be replenished. A purchase order is then created and sent to the supplier. In more
advanced systems, the software determines inventory level through usage, then orders the merchandise
without any interaction from the pharmacy staff. Even with these automated systems, though, it is a good
idea to review each order to make sure the items and quantities are appropriate. If unusually high or low
amounts in the order catch your attention, take a look at your target inventory and actual inventory to see
if everything makes sense.
Most suppliers offer the option of automatic substitution to minimize out of stocks. This feature gives
the warehouse permission to send another size or brand if they are out of stock, or if a more economical
preparation becomes available. Chain pharmacies often have suppliers provide drugs from the same
manufacturer to all stores in the area. This way, patients will receive a familiar-looking medication
regardless of the location where they had it filled.
Here is a list of other tasks to help with maintaining and managing inventory:
Perform inventory tasks each day. Make sure you know the deadline by which an order must be placed
in order to be received in the pharmacy by the next delivery day.
Dont wait until products are out of stock to maintain your inventory. Pay extra attention to fast
movers, meds that are very commonly dispensed such as atorvastatin, furosemide, and metoprolol. It
can lead to patient dissatisfaction if these are out of stock, and also have significant financial impact for
the pharmacy.
In the community setting, avoid ordering new and expensive meds until a patient brings in a
prescription. Verify the cost with the patient beforehand, and dont open the container or label it until
the patient has paid. This way the drug can be returned to the supplier if necessary. In the hospital
setting, the need to stock new meds will be determined by the formulary. However, circumstances may
arise where a patient needs a new and expensive med that is not on formulary. If this is the case, a
pharmacist or administrator will typically be able to advise about how much of the drug to order, and at
what point any excess should be returned.
Keep reasonable but not excessive amounts of non-income products such as bags, labels, and vials in
stock. Like excess inventory of drug products, these can tie up cash flow and space.
Mark products that are set to expire soon with a colored sticker or some other identifier so they can be
used first and removed from the shelves for return to the supplier at the appropriate time. In some
situations, such as for medication trays for code carts in the hospital setting, you will want to avoid
stocking medications that will expire soon (e.g., within the next three months). The reason is that the
carts will be stocked throughout the hospital, and monitoring and exchanging them within a short period
of time due to expired meds is not an efficient use of time. Make sure you are aware of these types of
rules in your pharmacy.
Fortunately, you are able to manually add metoprolol extended-release 100 mg tabs to your
order that will be delivered to your pharmacy tomorrow. The order is usually delivered early
and gets checked in right away.
Keep in mind that controlled substances may be delivered in a separate order from noncontrolled
substances. These may need to be checked in by the pharmacist and the paperwork must be filed
separately from other pharmacy invoices.
Make sure drug products are placed in the appropriate area for storage: shelves, locked cabinet,
refrigerator, or freezer. If you are unsure of proper storage, check with the pharmacist or look at the
package or product labeling, under the How Supplied or Storage and Stability section. Make sure
refrigerators and freezers are working properly to avoid wasting supplies of drugs that require
refrigeration or freezing, such as vaccines. When stocking new meds in the pharmacy, pay attention to
the potential for mix-ups to be caused by look-alike, sound-alike drug names. Use shelf tags, bins, etc to
separate these products to prevent dispensing errors.
Be sure to rotate stock when unpacking new orders so packages with shortest expiration get used up first.
Place new product behind, not in front of, whats already on the shelf. Also, mark open stock bottles to
avoid having multiple open bottles of the same product on the shelf.
The return process should take place at regular intervals. This will ensure there are not huge stacks of
unprocessed returns or multiple piles of return goods cluttering up the pharmacy. It is important to
process returns on a consistent basis. This ensures the most credit for returns while freeing up inventory
dollars to order the most needed items for your patients.
You find out from the pharmacist that the bottles of unopened tranexamic acid tablets sitting on
the counter were pulled from the shelves for return to the wholesaler. You place these in the
designated area, knowing that returns will be processed within the next couple of days.
How is the inventory of controlled substances different from inventory for nonscheduled
drugs?
In the U.S., inventory of controlled substances has specific requirements mandated by the Drug
Enforcement Agency (DEA). The DEA requires that a controlled substance inventory (Schedule II-V) be
done when a pharmacy first opens, then once every two years. This record needs to be kept in an easily
accessible place for at least two years, in case of inspection. The record must contain the pharmacys
name, address, and DEA number and must be signed by the person who does the inventory. State boards
of pharmacy also have requirements for inventory of controlled substances. An example of this would be
perpetual inventory of Schedule II-V substances reported to the board of pharmacy twice a month. Both
state boards of pharmacy and pharmacy policy may dictate other procedures involving controlled
substances, such as the method for filing paperwork associated with the ordering of controlled substances,
storage of controlled substances, etc.
In the U.S., remember that the ordering of Schedule II controlled substances requires a special order form
(DEA form 222) that is available as either a paper triplicate or electronically. When C-IIs have passed
their expiration date, DEA Form 41 must be completed and destruction of the expired drugs must be
witnessed.
Rules regarding inventory of controlled substances are similar in Canada. For example, controlled
substances may need to be counted quarterly to make sure there are no major discrepancies.
Discrepancies may need to be reported to Health Canada, depending on the drug involved.
In the hospital setting, unused unit doses can usually be returned to stock. However, storage conditions
on patient care units may determine whether or not injectables can be returned to stock. For example, if a
vaccine that requires refrigeration is found on a countertop in a med room or unused and in a med return
bin, you should check with the pharmacist about what to do with the dose. It may need to be discarded, or
if room temperature storage for a period of time is allowable per the manufacturer or other guidance, it
may be able to be redispensed to another patient. The same is true for IV piggybacks such as antibiotics
and for IV infusions or fluids such as heparin drips, insulin drips, and maintenance fluids (e.g., normal
saline 1000 mL with potassium chloride 20 mEq).
One way to reduce unused medications in the hospital setting is to avoid delivering duplicate supplies.
For example, if a nurse reorders a medication, you can look into the reason for the reorder. Many
reorders are appropriate, such as when a medication ordered as a continuous infusion runs out (e.g.,
amiodarone, heparin, insulin) or when a bulk med is empty (e.g., inhalers, insulin vials, ointments).
However, if a reorder seems too soon, its a good idea to cover your bases and make sure the nurse is
looking in the correct location for the med, such as for meds that are refrigerated. Also, make sure the
patient wasnt transferred and his or her meds were delivered to the old location. If you do redispense a
med in response to a reorder and find that the patient already has an adequate supply on the patient care
unit, simply return the redispensed med to stock.
When Ms. Bingham comes in to pick up her metoprolol the next day, she brings with her an unused
Z-Pak that was prescribed for her husband about two weeks ago. She asks if it can be returned.
You tell her there is a chance, since it is in the original package and has not been used. However,
you ask the pharmacist to speak with her and confirm whether or not a return can be made.
Project Leader in preparation of this PL Technician Tutorial: Stacy A. Hester, R.Ph., BCPS, Assistant
Editor
Cite this document as follows: PL Technician Tutorial, The Ins and Outs of Pharmacy Inventory. Pharmacists
Letter/Pharmacy Technicians Letter. August 2015.
Chuck Upton is a 57-year-old male who comes in to your pharmacy with a new prescription for
dexlansoprazole 30 mg capsules, take one by mouth once daily. He is a new patient, so you hand
him your standard form for new patients to fill out, which will include information about his
allergies, medical history, and insurance coverage.
Meanwhile, you notice three other people have come to the drop-off window, and things seem to be
getting busy. The next patient has a list of ten refills she needs, so you ask her if she will be waiting
to pick them up. She says, oh no, I know this will take some time, so Ill be back tomorrow
afternoon. You go ahead and put Mr. Uptons Rx before hers. Mr. Upton has taken a seat and
will be waiting for his Rx to be filled today. Hes okay with the 20 minute wait time.
What are some general practices I can use to improve the environment in my pharmacy?
As a rule, the pharmacy should always be kept both clean and organized. This may be easier said than
done, especially when the workload in the pharmacy is at its peak. Still, as they say, an ounce of prevention
is worth a pound of cure.
Always take the time to place medications and other pharmacy supplies in their proper storage
locations. This helps ensure that correct medications will be chosen from pharmacy shelves for filling
prescriptions. It also helps keep the dispensing process efficient, so you dont have to spend time searching
for the correct supplies (e.g., bags, labels, lids, vials) when you need them. In addition, placing meds and
supplies in their proper storage locations ensures that items stored in their proper places arent hidden by
other items that are inappropriately stacked or stored in places they dont belong.
Be consistent about removing unnecessary items from the different locations in the pharmacy. For
example, cleaning out discontinued or unclaimed meds from the will-call area (or removing discontinued
meds from a patient care unit in the hospital) and returning them to stock on a regular basis will help keep
the will-call area organized, improving efficiency and patient safety. Errors that can be avoided by keeping
the will-call area neat and up-to-date include giving meds to the wrong patient. Another example is placing
meds that are soon to expire in a designated area to be returned. This can help prevent dispensing of meds
that are expired or too close to expiration to be dispensed.
Keep in mind regulatory agencies in the U.S., such as state boards of pharmacy, mandate standards of
cleanliness, such as keeping food and beverages out of refrigerators and freezers meant for medication
storage. Place your food and beverages only in areas designated for food and beverages. Also, be sure to
keep personal items such as purses and backpacks off of pharmacy floors and counters and in designated
areas such as cubbies, lockers, or break rooms.
Define areas of activity and what functions should be performed in each area. Some of the areas of activity
might include prescription drop-off, computer order entry, compounding, and prescription pick-up.
Technicians can be assigned responsibility for the specific areas. Then technicians can be cross-trained to
work in different areas. Defining areas of activity in the pharmacy can reduce chaos, and allow technicians
to focus on one task from start to finish instead of bouncing from one task to another. Note that if you work
in a hospital setting, the different areas within the pharmacy may be far more different from each other than
those within a community pharmacy. Special competencies may be required for technicians to work in areas
of the hospital pharmacy such as the IV room.
Assigning technicians to different areas can also help prevent bottlenecking in the pharmacy. For example,
if only two technicians are working and both are at prescription drop-off, with no one assigned to the area
for filling prescriptions, the queue at the pick-up window will be out of control with patients waiting for
their filled prescriptions!
Monitor areas of activity to make sure work is not backing up anywhere and that problems are getting
handled in a timely manner. For example, if you see that a technician in an area other than yours is very
busy and you are having a lag in your work, you might ask if you can step in and cover for a few minutes so
that tech can troubleshoot on whatever is holding him or her up.
You start entering Mr. Uptons information into the computer. He has an allergy to sulfa drugs
(rash), and he has been taking acetaminophen for headaches and OTC omeprazole for upset
stomach. He doesnt list any other medical conditions or Rx meds that he has been using. You
look over his prescription to make sure all the necessary info is included: drug, dosage form,
strength, route, directions, number of refills, etc. The information is all there, so you are ready to
enter it in to the computer.
Be on time for work. When folks come late to work, this can really throw a wrench in the workflow. No
one likes to start out the day being behind. Besides, tardiness is unprofessional, a poor example for
coworkers, and a possible stimulus for disciplinary action. Make sure your breaks are scheduled at
appropriate times of day (those that arent the busiest), coordinated appropriately with your coworkers, and
that you return from your breaks on time.
Once your pharmacy is clean and organized and areas of activity are established, it is important that the
work patterns in each area are defined and followed. Work patterns mean that each technician is trained to
perform the same work similarly, so the work is both efficient and safety checks are incorporated
consistently.
Work patterns can be defined for functions such as gathering patient information, selecting medications from
pharmacy shelves, returning medications to stock, and so on. For example, the work pattern for choosing
meds from pharmacy shelves may involve a number of double checks as well as the use of shelf tags for
information about alternate storage locations for look-alike, sound-alike meds. Work patterns may also
incorporate customer service as a priority. Some examples include acknowledging patients as they approach
the pharmacy counter, promptly answering the telephone, and informing patients ASAP about any problems
regarding the filling of their prescriptions. Here is a very basic example of a work pattern for incoming
prescriptions:
Acknowledge the patient
Gather patient information including date-of-birth, medication history, diseases/conditions, allergies,
insurance coverage
Screen the patients prescription for omissions
Prioritize work, such as incoming prescriptions. Not all prescriptions much be filled ASAP, nor do all
prescriptions need to be filled at once. Try to find out when each prescription needs to be ready and make a
note on the prescription to inform other pharmacy staff. Then work on in-store prescriptions (or stat
orders in the hospital pharmacy) first. Fill in the gaps and lulls in your workload with prescriptions that
arent as pressing such as those that you know wont be picked up for a day or two (or in the hospital, those
that will go out on a scheduled delivery). Some work may be saved or scheduled for a time of day when you
know you will be less busy.
Have a system in place to handle problem prescriptions such as insurance rejects, out-of-stocks, refill
requests, etc. These can be separated from normal workflow with the use of a special system such as color-
coded baskets. A technician can be assigned to work on these problems and follow up on them as necessary,
rather than multiple technicians dealing with them individually and interrupting their assigned workflows.
This technician will also need to notify patients of any issues with their prescriptions, whether they are in-
store or planning to pick up the prescription at a later date.
Keep the lines of communication open. For example, communicate with your coworkers as soon as
possible about any problems that you anticipate will affect workflow. Some examples of these types of
problems include meds that are out of stock, special order meds, a large incoming order, a malfunctioning
automatic dispensing machine, and a third-party payor computer thats down. When you communicate
about these problems in a timely fashion, others may be able to help mitigate the problem, such as by
providing an extra set of hands, notifying patients of delays, etc. Remember that work is all business and all
about the patients. Dont let any kind of personal friction with coworkers impede professional
communication.
Also communicate with patients about any problems having to do with their prescriptions. This type of
customer service is very important and can help prevent unwanted outcomes such as frustration or
inconvenience for patients as well as delays or interruptions in their drug therapy. In the hospital setting,
nurses will appreciate being kept abreast of problems with their patients orders that might lead to delays.
An example of this might be a med that is especially labor intensive to prepare or the need for an order to be
clarified by the pharmacist with a prescriber prior to dispensing.
Be sure to minimize distractions when you are on duty in the pharmacy. Avoid excessive chatter about
personal business, personal phone calls, text messaging, internet surfing, etc. Stay focused and on-task when
youre working to help reduce the chance of errors and disturbances to workflow. Use your break times to
attend to personal matters and socialize.
Mr. Uptons Rx is rejected by his insurance because it will require prior authorization. Mr. Upton
needs to try a generic form of this type of stomach medicine before his insurance will pay for
dexlansoprazole, which is not available as a generic and is more expensive. Mr. Uptons Rx goes
to another tech assigned to work on third-party rejections. You hear the technician tell Mr. Upton
that his Rx is going to take longer than expected because there are issues with his insurance.
Mr. Upton says he would be glad to come pick up his Rx first thing in the morning. Your coworker
thanks him for his patience and assures him that his med will be waiting for him when he arrives
tomorrow.
Cite this document as follows: PL Technician Training Tutorial, Optimizing Pharmacy Workflow. Pharmacists
Letter/Pharmacy Technicians Letter. October 2013.
Casey Sanchez is a 25-year-old female patient who comes into your pharmacy with an Rx for
doxycycline 100 mg PO BID x 21 days. She tells you she just moved into town and is a graduate
student in English literature at the local university. You suspect she has never had a prescription
filled at your place before. You double check this on the computer, and you do not find Casey
Sanchez.
What is my role, as a technician, in gathering patient information?
In the community pharmacy setting, technicians are likely to have the most face time with patients. This
opens up opportunities for asking patients questions and gathering info that is needed for making patient
profiles and keeping them current. Name, address, and date of birth are three pieces of information that
you likely gather for all patients, for identification. But beyond these basics, you can gather and maintain
patient information that will help prevent problems with drug therapies.
In the hospital setting, nursing staff will usually be responsible for entering most patient information into
the computer. However, pharmacy technicians may play a role, such as with entering medication lists
through medication reconciliation programs.
on. Plus, folks seem to be getting more and more creative with the spelling of names. They arent always
spelled like they sound.
Make sure you have the correct middle initial, as well as suffix such as Jr, Sr, II, III, or IV. This can help
prevent mix-ups between patients who have the exact same first and last names.
Keep phone numbers and insurance information up to date as well. Some computer systems allow you to
look patients up by phone number. And having current insurance info will prevent issues with billing.
You ask Casey Sanchez to verify the correct spelling of her name, as well as her address, phone
number, and date of birth. She spells her name with a K instead of a C (Kasey instead of
Casey). You enter the name correctly into the computer, and you make a note on the Rx of the
correct spelling. You also note in the computer that Kasey is a female.
Allergies. Medication should not be dispensed (except in very rare circumstances such as emergencies) until
a patients allergies are documented. Dont just ask for medication allergies. Other allergies that you should
document include vaccines, supplements, food, dyes, and other substances such as latex. In addition, ask for
the specific reaction the patient had to the substance to which he or she is allergic, as well as when the
reaction took place. This info can help the pharmacist make decisions (sometimes along with the prescriber)
about whether or not a drug therapy is appropriate.
Consider a situation where a patient who reports an allergy to the antibiotic penicillin is prescribed the
antibiotic cephalexin for an infection. In general, patients who are allergic to penicillin can also have
reactions with cephalosporin antibiotics such as cephalexin. If the patient reports a reaction such as
stomach ache with penicillin, the pharmacist is likely to go ahead and dispense the cephalexin. Stomach
ache is not generally a true allergic reaction. On the other hand, if the patient reports shortness of breath
with penicillin, which is a serious allergic reaction, the pharmacist is likely to take additional steps to decide
whether or not cephalexin will be safe for the patient.
Here are a few more examples of why good allergy info is important:
Patients with certain allergic reactions to eggs should in most cases only receive flu vaccine from allergy
specialists.
People with severe latex allergy might have trouble if medications in vials with natural rubber stoppers
are dispensed.
Patients with gluten sensitivity (celiac disease) can become very sick if they take medications that
contain gluten.
If a patient has had a serious allergic reaction to a vaccine in the past, he or she should not receive that
vaccine again.
You ask Kasey if she has any allergies. She responds that she is allergic to codeine, peanuts, and
strawberries. When you ask for specific reactions and when they happened, she tells you that she
has nausea with codeine, which happened about one year ago, and breathing problems and hives
with both strawberries and peanuts, which happened when she was a kid.
Medication lists. A comprehensive medication list is also important. This can help prevent any issues such
as duplicate therapy, incorrect dosing intervals or schedules, use of medications that are no longer needed,
and drug-drug interactions. A medication list should not be limited to Rx meds only. Meds such as over-
the-counter products, and supplements such as vitamins and herbals should also be included. Also include
meds that are used on an as-needed basis and meds that are used topically such as creams, patches, eye
drops, and inhalers. These can be easy to forget.
Vaccines that a patient has received should be included on a med list. This can help pharmacists recommend
appropriate vaccines for patients who have missed them or who are due for another dose.
You ask Kasey if she takes any medications. She says that she does not take any other Rx
medications, but that she does occasionally take acetaminophen, ibuprofen, and OTC omeprazole.
Medical conditions or disease states. Adding conditions or disease states to patient profiles can be key for
helping the pharmacist really fine tune drug therapy. For example, kidney disease or renal failure is a factor
for dosing many drugs. Doses will often need to be reduced because the body doesnt get rid of certain
drugs as quickly when the kidneys arent working well. An example of a drug thats cleared by the
kidneys is the antibiotic trimethoprim-sulfamethoxazole. Clearance by the liver is another way the body gets
rid of drugs. Doses of some drugs may need to be reduced for patients with liver disease or failure. This can
be true for products with acetaminophen, opioids, and a handful of others.
Pregnancy may not be thought of as a condition, per se, but its important to include on a patient profile.
Some drugs, such as ACE inhibitors (e.g., enalapril, lisinopril) should never be used in pregnancy. Some
antibiotics such as quinolones (e.g., ciprofloxacin, levofloxacin) and trimethoprim-sulfamethoxazole should
be avoided at certain times during pregnancy. Its also good for the pharmacist to know if a patient is
pregnant when helping with selection of an appropriate OTC product. Likewise, if a patient is breastfeeding,
this can be included in the patient profile. Drugs can pass to the baby through breast milk, so knowledge
that a patient is breastfeeding can affect drug selection.
You might be surprised to know that conditions such as glaucoma (high pressure in the eye) and myasthenia
gravis (chronic muscle weakness) can affect drug selection. Certain drugs can worsen these conditions, so
its important for the pharmacist to be aware of them. For example, the antibiotic telithromycin should not
be used by patients who have myasthenia gravis.
Other common disease states that should be included on patient profiles include diabetes (specify type 1 or
type 2), hypertension (high blood pressure), hypercholesterolemia (high cholesterol), asthma, heart failure,
any type of cancer, etc.
You ask Kasey if she currently has any medical conditions and she tells you that she has acid reflux
and tension headaches but she doesnt take any Rx meds for either condition, just the OTC meds
that she already mentioned.
Height and weight. Having a patients current weight is key, especially for children. Childrens bodies and
organs are still developing and dont yet function just like adults. Drug dosing for babies and kids is usually
based on weight, such as milligrams per kilogram per dose (mg/kg/dose) or milligrams per kilogram per day
(mg/kg/day). Since these patients weights change over time, be sure to always ask for the current weight.
Note that 1 kilogram (kg) is equal to 2.2 pounds (lbs). These units are easy to mix up. Here are some
example conversions:
Mrs. Simms baby son Carlisle weighs 14 lbs. How many kg does he weigh?
Mr. Browns baby daughter Samantha weighs 6.7 kg. How many lbs does she weigh?
How many kg do you weigh? How many lbs do you weigh? Keep this in mind if you need a quick
comparison to help you remember the conversion.
Always double check your calculations and computer entries. It doesnt hurt to glance at the patient either,
just to make sure the weight makes sense. For example, if you mistakenly enter the value of 10.5 into a
field with a unit of kg instead of lbs, the corresponding field with a unit of lbs might automatically populate
with 23.1. Just looking at the child might help you realize the mistake.
A patients height is necessary for calculating doses of some drugs such as some intravenous antibiotics and
chemotherapy. This is most applicable in the hospital setting. Keep in mind that 1 inch is equal to 2.54 cm.
Lifestyle. Having some information about a patients lifestyle is important for drug therapy and also for
helping the pharmacist encourage improvements and healthy behaviors. Lifestyle info that you can include
on a patient profile includes:
Consumption of certain foods and beverages. For example, alcohol can interact with meds that cause
sedation (such as some pain killers) or with metronidazole (which can increase side effects). Grapefruit
can interact with some meds and cause their blood levels to increase.
Cigarette smoking, which can affect how drugs are broken down by the body
Marijuana use, now legal in some states and in Canada, which may interact with some medications
Of all the patient information you collect, lifestyle information might be the most sensitive for patients. Stay
matter of fact and nonjudgmental in your tone. If youre uncomfortable, ask your pharmacist for guidance.
Kasey tells you she is 54 and weighs about 140 lbs. You enter these values into the correct fields
in the computer so that the units match up. Kasey is an occasional smoker and drinks alcohol
occasionally as well. You thank her for her patience and for the information she has provided, and
tell her it will be about 30 minutes before her Rx is ready. Kasey thanks you, and says she
appreciates you asking for her information. She has never had anyone collect this info from her
before in a pharmacy, and it helps her feel confident that she will be well taken care of now and
when she needs other medications in the future.
What else should I consider about gathering patient info and maintaining patient profiles?
Make sure you are familiar with your computer system so you know where to enter and how to access
patient information. Also, its important to know where to enter and how to access additional info such as
unusual allergies, notes regarding correspondence, and so on, that cannot be entered in any other field.
Remember that patient information of any kind must never be shared with individuals who are not involved
in a patients care and that patient information should never be accessed unless its necessary for the
patients care. Never share patient info with friends, family, or even coworkers unless its directly related to
pharmacy business.
Keep in mind that patients are likely to appreciate privacy and discretion when they are sharing very
personal information. You can help optimize this. Be conscious of the volume of your voice and use a more
private consultation area in the pharmacy when possible.
Cite this document as follows: PL Technician Training Tutorial, Patient Profiles 101. Pharmacists
Letter/Pharmacy Technicians Letter. March 2013.
Technician Tutorial:
Certification and CE Requirements
Education, training, and certification help technicians demonstrate knowledge and skills, and their
ability to meet pharmacy practice standards. New state requirements are bringing up questions about
registration, certification, and licensure of pharmacy technicians. For example, the death of a toddler
in Ohio resulting from a hospital pharmacy technicians error not caught by the pharmacist led to the
passage of Emilys Law. Although the pharmacist was also held responsible, new requirements
were put in place for Ohio pharmacy technicians to maximize patient safety and ensure appropriate
pharmacy technician training.
This tutorial explains what technician certification means, how to become certified, and how to
maintain certification. It also reviews technician continuing education (CE) requirements and other
professional development opportunities for technicians. Each state will have different requirements
for its technicians. Use the Technicians CE & Training Organizer to find out requirements in your
state and keep track of your completion of required courses.
What are differences between registration, certification, and licensure for technicians?
States may require technicians to be registered, certified, or licensed. Some states dont require
anything of pharmacy technicians no registration, no licensure, and no certification. Other states use
different terms to describe technician requirements. For example, in Oklahoma, technicians are not
considered registered, but are given a permit.
Nearly one-half of states include certification in their regulations. Certification is defined as the
process by which a nongovernmental organization recognizes an individual who meets predetermined
qualifications specified by that organization. Technicians can become certified by taking a national
certification exam, or by meeting state certification requirements. National certification by exam
through the Pharmacy Technician Certification Board (PTCB) or the National Healthcareer
Association (NHA) recognizes technicians who have the education, knowledge, and training to
efficiently assist pharmacists in the safe and accurate preparation and dispensing of medications and
the provision of quality patient care and service. Some states require that technicians take one of the
national certification examinations to get state certification, registration, or licensure. However, other
states grant state certification by recognizing on-the-job training or a diploma, certificate, or
associates degree program from a community college or technical school. State certification may also
be granted through completion of training approved by the state pharmacy board or pharmacy
accreditor (e.g., the American Society of Health-System Pharmacists and Accreditation Council for
Pharmacy Education [ASHP-ACPE]) as an alternative to taking a national examination. The number
of states requiring either national or state certification is expected to increase due to patient safety
concerns. Theres even a push for standardization of technician training, education, certification
requirements, and regulation among all states. Check the Technicians CE & Training Organizer
for certification requirements in your state.
Licensure is required for technicians in some states, including Arizona, California, and Utah.
Licensure is defined as the process by which permission is granted to an individual to practice their
occupation after it is determined that the individual has the minimum level of competency to practice
safely. Licensure may require registration plus certification by exam and/or completion of education
and training. Keep in mind, some states use the terms licensure and registration interchangeably.
Check the Technicians CE & Training Organizer to see if licensure is an option in your state.
PTCB is a non-profit organization governed by five pharmacy organizations, including the American
Pharmacists Association (APhA), American Society of Health-System Pharmacists (ASHP), Illinois
Council of Health-System Pharmacists (ICHP), Michigan Pharmacists Association (MPA), and the
National Association of Boards of Pharmacy (NABP). The PTCE is vetted by NABP, which
performed a psychometric audit of the PTCE in 2001 and determined that the PTCE is
psychometrically sound, defensible, and valid. Since its inception in 1995, PTCB has certified over
600,000 pharmacy technicians through the examination.
The ExCPT exam is administered by NHA and is endorsed by the National Association of Chain Drug
Stores (NACDS) and the National Community Pharmacists Association (NCPA). The NHA is one of
the largest national health certification providers in the U.S. Established in 1989, the NHA provides
national credentials and an information support network to allied healthcare professionals, educators,
and the health care industry.
What is the NCCA? What does this mean for a certification exam?
The National Commission for Certifying Agencies (NCCA) reviews and accredits certification
programs that assess professional competency. Meeting NCCA criteria means, among other things,
that the certification program uses fair and valid tests, defines the professionals level of responsibility,
and requires continued proficiency. The PTCBs certification program and the NHA certification
process are accredited by NCCA.
states with no board-approved national certification exam requirements. Alternatively, in some states,
there are other avenues for pursuing state certification, such as on-the-job training or completing an
educational program.
Before pursuing national certification in any state, check with your employer or pharmacist supervisor
about specific requirements or certifications that may be recognized within your organization. Use the
Technicians CE & Training Organizer to check your states requirements, see which exams are
board-recognized in your state, and watch for future changes in your state.
The ExCPT exam is taken on a computer at a PSI Testing Center. There are over 600 test sites
nationwide. See www.psiexams.com or call 800-211-2754 for testing locations.
The ExCPT exam can be taken continuously. You can apply at www.nhanow.com. After submitting
your application, youll receive your confirmation to test. Youll be able to schedule your exam
within 24 to 48 hours. Call 800-211-2754 to register to take the exam at a PSI location of your choice.
Or go to www.psiexams.com to locate a nearby test center.
The ExCPT consists of 120 questions, including 20 pre-test questions. A quarter of the exam covers
regulations and technician duties. About another quarter covers medications and drug therapy (e.g.,
drug classes, dosage forms, common side effects, interactions, and indications). The remaining
questions cover the dispensing process, including calculations and IV preparation.
Our Pharmacy Technicians University program is an online, interactive educational course designed to
prepare enrollees to pass any pharmacy technician certification exam. It also helps enrollees learn
what it takes to become a safe, efficient, and overall great pharmacy technician. The course allows
users to go through the content at their own pace. Plus, there are pacing questions, case studies,
educational games, and more to help cement the concepts to memory, as well as keep the experience
fresh and enjoyable. You can get additional information by going to the Pharmacy Technicians
University website.
Make sure you understand what actions technicians are allowed to do in your state and the renewal
requirements in your state. If you perform an action that is considered outside the scope of practice for
technicians in your state, or fail to renew your registration, certification, or licensure as your state
requires, you could be fined or lose your ability to practice.
Even if it is not required by your state, it is a good idea to maintain your certification because you may
move to a state that requires it, or your state law may change. If your ExCPT or PTCB certification
lapses for more than 12 months, you will need to sit for the exam again to be certified. Check the
Technicians CE & Training Organizer for information on your state or certifying boards renewal
period and renewal requirements.
Technicians certified by ExCPT need to obtain 20 hours of CE every two years. At least one hour
must be in pharmacy law. Similar to PTCB, the NHA also allows special projects and college courses
to count toward your certification hours. All of the proof of your completed CE must be submitted to
NHA in time for your recertification (renewal). The online form can be accessed here:
http://www.nhanow.com/pharmacy-technician/recertification.aspx.
Bear in mind, states can have their own continuing education requirements that may be different from
those required to maintain certification. For example, a state may require a certain number of live
CE hours (e.g., CE delivered by live lecture or teleconference). They might also require that a certain
number of hours cover designated topics such as pharmacy law or medication errors. For example, in
South Carolina technicians need four hours of live CE annually. See our Technicians CE & Training
Organizer for answers about exactly what, if any, CE is required in your state. You can also find
the appropriate Pharmacy Technicians Letter CE course to meet any state requirement, including live
CE requirements.
In some states, the CE must be approved by the board or by ACPE. Consider doing only ACPE-
approved CE programs to ensure the programs are acceptable in your state(s). For example, Louisiana
specifies that ten hours must be ACPE approved.
Your state might require tech-specific CE. Some CE is specifically designed for technicians. These
programs have an ACPE code number with the letter T (as opposed to P for pharmacists) at the
end of the code. Regardless of your states requirements, try to choose tech-specific programs because
their breadth, scope, and subject matter are geared specifically to technicians. Technicians can rest
assured that Pharmacy Technicians Letter CE meets ACPE requirements, is specifically designed for
technicians, and will meet PTCB, NHA, and state CE requirements.
in the event of an audit. PTCB and NHA require that you upload credits online, or mail/fax copies of
your completed CE for recertification. Some states require that documentation be kept up to five
years. Technicians should print and keep their Pharmacy Technicians Letter CE statements of credit
as proof of completed CEs.
You also need to report CE credits through a national system, called CPE Monitor, if you want to earn
any of your CE from an ACPE-accredited provider. CPE Monitor is a national, collaborative effort by
National Association of Boards of Pharmacy (NABP) and the Accreditation Council for Pharmacy
Education (ACPE) to provide an electronic system for pharmacists and pharmacy technicians to track
their completed continuing pharmacy education (CPE) credits. To enroll, go to your Technicians CE
& Training Organizer.
Obtaining additional training may be helpful in expanding your responsibilities. For example, the
National Pharmacy Technician Association (NPTA) offers certificate programs in Sterile Products or
Compounding that combine home study and experience-based learning to help technicians further
specialize. See www.pharmacytechnician.org for more information on these certificate programs.
Phone: 209-472-2240
Email: ce@pletter.com
http://www.trchealthcare.com
Phone: 800-363-8012
http://www.ptcb.org
Submit contact request: https://ptcb.zendesk.com/hc/en-us/requests/new
Phone: 800-499-9092
Fax: 913-661-6291
Email: info@nhanow.com
http://www.nhanow.com
Cite this document as follows: Technician Tutorial, Certification and CE Requirements. Pharmacists
Letter/Pharmacy Technicians Letter. April 2017.
Roles Find ways techs can help prompt pharmacists to speak to patients about
for MTM throughout the dispensing process, such as identifying eligible patients at
Pharmacy Staff drop-off or flagging completed prescriptions.
Encourage techs and other pharmacy staff to use the 30-second pitch and other
More. . .
Copyright 2014 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~
www.PharmacyTechniciansLetter.com
(PL Detail-Document #300801: Page 3 of 9)
Billing Apply for a National Provider Identifier (NPI) number in order to bill for
and MTM services covered under Medicare Part D
Reimbursement (https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart)
Determine your fees. These may be negotiable with some payers and you will
need to establish pricing for self-paying patients.
Check with third party payers about how to bill for pharmacists services, such
as what services are covered, what billing codes must be used (e.g., CPT, ICD),
and where to submit the claims.
If you are contracted with an online MTM platform, make sure all staff complete
any necessary training and understand all documentation and billing
requirements.
Delegate billing to pharmacy staff when possible.
MTM Setting It Up
Workflow Develop a systematic process for providing MTM. For targeted interventions,
build steps into your existing workflow if possible (i.e., identification of a
problem, discussion with the patient, contacting the prescriber if necessary for
interventions and/or to let him/her know that a medication review has been
completed, and following up with the patient). Map it out with a flow chart.
Consider having a point person who can lead the implementation of patient
care services.
Find out the capabilities of your available technology such as collecting data,
identifying eligible patients, guiding the pharmacist through the MTM interaction,
and generating patient education materials.
Schedule appointments for CMRs during pharmacist overlap or off-peak times
if possible. Consider whether telephone-based services are an option.
Create a system for timely follow-up with patients and/or providers, such as with
computer reminders or a binder divided by day of the month. Involve your entire
pharmacy staff in follow-up to ensure that patient and provider recommendations
are accepted and effective, to evaluate med changes and ensure problems are
resolved, and identify new concerns.
Credentialing Determine if third party payers require special training or credentialing for
and pharmacists who provide MTM
Education Consider training such as the certificate course for MTM that is available through
the American Pharmacists Association (APhA).
Stay up-to-date with evidence-based recommendations and guidelines
Consider mechanisms for quality assurance like staff training, peer-review of
clinical notes, etc.
Drug Therapy
Formulary/Drug Comparison (includes dosage comparison charts, drug class
comparison charts, device comparison charts, and a template letter for sending
to prescribers to request drug switches)
Potentially Harmful Drugs in the Elderly: Beers List
STARTing and STOPPing Medications in the Elderly
Clinical Guidelines: Selection, Use, and Implications for Healthcare
Lab Monitoring for Common Medications
Liver Function Test Scheduling
Improving Patient Safety: Medication Reconciliation Basics
Appropriate Use of Oral Anticoagulants
More. . .
Copyright 2014 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~
www.PharmacyTechniciansLetter.com
(PL Detail-Document #300801: Page 6 of 9)
More. . .
Copyright 2014 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~
www.PharmacyTechniciansLetter.com
(PL Detail-Document #300801: Page 7 of 9)
Definitions
Comprehensive medication review (CMR): According to the Centers for Medicare and Medicaid
Services (CMS), MTM includes an interactive person-to-person or telehealth consultation performed by a
pharmacist or other qualified provider and an individualized, written summary in CMS standardized
format. The summary includes a personalized medication action plan and medication list. CMR involves
the systematic process of collecting patient-specific information, assessing medication therapies to
identify medication-related problems, developing a prioritized list of medication-related problems, and
creating a plan to resolve them with the patient, caregiver, and/or prescriber. Some examples of
recommendations that might result from CMR include a need for additional drug therapy, identification of
an unnecessary drug therapy, identification of a drug dose that is too high or too low, availability of a
more effective drug, identification of an adverse drug reaction, and identification of medication adherence
issues. Also referred to as a comprehensive medication therapy review (MTR). The American
Pharmacists Association (APhA) defines comprehensive MTR as a process where the pharmacist collects
patient-specific information including all current medications including prescription and nonprescription
products, herbals, and other dietary supplements. The pharmacist assesses the regimen to identify any
medication-related problems, prioritizes problems, and then works with the patient and/or prescriber to
create a plan to resolve any problems.
Medication action plan (MAP): This is a document the patient receives at the end of an MTM visit. It
should be a simple guide, written in patient-friendly language, for patients to keep track of their meds and
health concerns, what they need to do to address those concerns, and associated actions that already have
been taken.
Medication therapy management (MTM): In addition to being described as a broad range of patient-
centered services provided by pharmacists, MTM is also described more specifically by a framework
consisting of five core elements: a medication therapy review (MTR), a personal medication record
(PMR), a medication-related action plan (MAP), intervention and/or referral, and documentation and
follow-up. This model is based on a set of standards adopted by APhA/NACDS (National Association of
Chain Drug Stores), which can be found at
http://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf.
Personal medication record or list (PMR or PML): Another document the patient receives at the end
of an MTM visit. The PMR includes patient information (e.g., allergies, medication-related problems,
demographic information) and a comprehensive list of all meds (Rx, OTC, herbals, dietary supplements)
along with doses, reason for use, instructions for use, start/stop date, and prescriber, in patient-friendly
language. Patients should be encouraged to keep this list updated and share it with all other health care
providers, and pharmacists may do so as well, to promote continuity of care.
Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other
necessary or appropriate sources prior to making clinical judgments based on the content of this document. Our
editors have researched the information with input from experts, government agencies, and national organizations.
Information and internet links in this article were current as of the date of publication.
More. . .
Copyright 2014 by Therapeutic Research Center
3120 W. March Lane, Stockton, CA 95219 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.PharmacistsLetter.com ~ www.PrescribersLetter.com ~
www.PharmacyTechniciansLetter.com
(PL Detail-Document #300801: Page 9 of 9)