ExCPT

The exam repeatedly asks whether a task may be performed by a technician. The rule of thumb: technicians handle tasks that are technical, mechanical, or clerical and can be checked; pharmacists handle anything requiring professional judgment. When a question describes a patient asking "Should I take this?", "Is this safe with my other medicine?", or "Which cold medicine should I buy?", the correct technician action is to refer the patient to the pharmacist.

Tasksbyrole

Technician(underpharmacistsupervision)	PharmacistOnly
Receivewritten faxed andelectronicprescriptions;checkthem , ,	Acceptnewverbal(oral)prescriptionsfromaprescriber(inmost
forcompleteness	states)
Collectandupdatepatientprofileinformation:demographics ,	Performprospectivedrugutilizationreview(DUR)anddecidehow
allergies conditions insurance , ,	toresolvealerts
Enterprescriptionsandsubmitclaims;resolvebillingrejections	InterpretDURalertsforinteractions duplications allergies and , , ,
	dosingproblemsandcontactprescribersabouttherapy
Requestrefillauthorizationsfromprescribers Select count measure reconstitute(perpolicy) package and , , , , , labelmedications	Counselpatientsonuse sideeffects andinteractions; 1 , , recommendOTCproducts Performfinalverificationofeveryprescriptionbeforerelease

Tasksbyrole(Continued)

Technician(underpharmacistsupervision)	PharmacistOnly
Compound sterile and non-sterile preparations following	Verifycompoundedpreparationsandapprovecompounding
procedures	records
Order receive stock androtateinventory;pullexpiredand , , ,	Makeclinicaldecisionsontherapeuticsubstitution emergency ,
recalledproducts	supplies andwhethertodispense ,
CollectmedicationhistoriesandscheduleMTMappointments	Conductthecomprehensivemedicationreviewandcreatethe
	actionplan
Offerthepatienttheopportunitytospeakwiththepharmacist	Administervaccines(trainedtechniciansmayadministercertain
	vaccinesonlywherestatelawallows)
Transferprescriptionsonlywherestatelawpermitstechnicians	Transferprescriptions(moststates) includingcontrolled ,
todoso	substancetransfers

A technician may offer counseling ("Do you have any questions for the pharmacist?") and document the patient's response, but may never provide the counseling. Under OBRA '90, the offer to counsel is required for Medicaid patients, and most states extend it to all patients.

Final Verification Before Release

Final verification is the pharmacist's check of the finished prescription against the original order and the entered data before it reaches the patient. The pharmacist confirms the right patient, drug, strength, dosage form, quantity, directions, prescriber, and label, and compares the product with the NDC on the stock bottle (or a scanned image and barcode record). Technicians support this checkpoint by keeping the original prescription, stock bottle, label, and filled product together in the same basket, scanning the product barcode, and never bagging, delivering, or releasing a prescription that has not been verified. If the pharmacist finds an error, the prescription goes back to the step where the error occurred and is corrected and checked again.

Pharmacy Security

Pharmacy security protects three things: medications (especially controlled substances) from theft and diversion, patient information from unauthorized access, and staff and patients during emergencies. Technicians are expected to follow each safeguard and report any lapse immediately to the pharmacist.

Area	RequiredPractices
Accesstothepharmacy	Onlyauthorizedpersonnelbehindthecounter;visitorsandvendorsescortedandlogged;thepharmacy
	islocked(orgated)whenevernopharmacistispresent;alarmsystemsandcamerasmonitored
Keys codes andbadges , ,	Issuedonlytoauthorizedstaffandneversharedorlent;alarmcodesandpasswordsareindividual;
	codeschangedandkeysorbadgescollectedwhenanemployeeleaves;lostkeysreportedatonce
Controlledsubstances	Stored in a securely locked substantially constructed cabinet or safe or dispersed throughout non- , ,
	controlledstockasfederalrulespermit(staterulesmaybestricter);accesslimited;perpetualinventory
	forScheduleIIwherestatelaworpolicyrequiresit;theftorsignificantlossreportedtotheDEA(DEA
	Form106)
Automatedsystems	Individual biometric or password log-ins for ADCs and robots; overrides and discrepancies reviewed and
	resolvedpromptly
Protectedhealth	Monitorsangledawayfromthepublicorfittedwithprivacyscreens;automaticscreenlocksandlogging
information(PHI)	offwhenleavingaworkstation;minimumnecessaryaccess;labelsandpaperworkfacedown;PHIwaste
	shreddedorplacedinlockedshredbins;conversationskepttoaprivatecounselingarea
Personalidentifying	Creditcardnumbers SocialSecuritynumbers anddriver'slicensedataneverwrittendown repeated , , ,
information	aloud orstoredoutsidesecuresystems ,

Emergency Protocols and Phone Lists

Every pharmacy keeps written emergency procedures and a posted emergency phone list. Technicians must know where both are and follow them without improvising.

Robberyorthreat					Powerorrefrigeratorfailure
Complyanddonotresist;activatethe					Keeprefrigeratorandfreezerdoors
silentalarmonlywhensafe;note					closed;recordthetimeand
descriptions;callpoliceafterthe					temperatures;moveproductstoa
personleaves;preservethescene;the					workingunitorapprovedcooler;
pharmacistreportscontrolled					quarantineaffectedproductsuntilthe
substancelossestotheDEAandthe					manufacturerconfirmsstability .
board .

Follow the posted evacuation route; secure controlled substances only if it is safe; account for all staff; never re- enter until cleared.

A typical emergency phone list includes 911 and the local police, the pharmacist-in-charge and managers, the alarm company, refrigeration repair, the drug wholesaler, the state board of pharmacy, the local DEA diversion office, building maintenance, and the Poison Control Center (1-800-222-1222).