I’ve lived in New Jersey all my life. When I was growing up, I remember driving down to Florida with my family. It would take several days. And it was fun, seeing all the different cities and interesting points along the way. In fact, one of things that amazed me the most, was the sale of fireworks.
I didn’t remember the exact rules in New Jersey. I remembered you could set off sprinklers and small firecrackers. But you couldn’t ignite Roman Candles. And you definitely couldn’t buy or sell any fireworks in New Jersey. Which I thought was sort of strange that you could use them in New Jersey, but you had to go out of state to obtain them.
I was rather amused as we drove further south that we saw these little shacks selling fireworks. These pop-up places were open structures that sat off major highways. They were adorned with flags and signs urging everyone to stop and buy fireworks. And they did. People, in cars and trucks, lined up for miles to buy fireworks at these places.
I hate the mentality that every state makes their own rules. For example, look what’s happening with COVID and the pandemic. And I’ll try not to get too political.
One state mandates masks, another one doesn’t. One state quarantines its people, another state is open for business. One state limits large gatherings, another state allows them with no restrictions. One state vaccinates one way, another state vaccinates another way. Every state a different set of rules. It’s absurd!
Even in my hospitals, there was no consistency between how departments handled various situations. Now my hospital’s administration department and/or my human resources department might have disagreed with this statement. They might have claimed that they’ve implemented policies and procedures so that every department acts consistently with one another.
However, nothing could be further from the truth! I mean seriously did they believe that every department, every nursing floor, every area acted in the same way? By definition, each area is different. So why were they expected to operate in a similar manner?
Passing The Survey
My hospital had many regulatory agencies come and inspect them. One of the most important and perhaps most frightening inspections was performed by a regulatory group known as the Joint Commission on Accreditation of Healthcare Organizations or JCAHO (pronounced jay-co). The agency wanted to be known as “The Joint Commission” or “TJC”. But everyone still called them “JCAHO”.
A JCAHO inspection was conducted by three or four surveyors over a four or five day period The best satisfactory survey resulted in an accreditation for a three year period. Other satisfactory and non-satisfactory levels were also possible.
It was an extremely stressful event. In conducting the inspection, the JCAHO surveyors inspected the entire hospital. It seemed that they had free rein to go wherever they wanted and look at whatever they wanted. In addition, every department, every nursing floor, every patient and non-patient area had its own criteria standards that the area had to comply with in order for the facility to obtain a satisfactory three year accreditation.
Furthermore, the final accreditation level for the facility was based on every department’s ability to deliver a satisfactory survey in their own individual area. Even one bad departmental inspection could lower the scores. This, in turn, could result in the entire facility receiving a less than satisfactory accreditation.
Thus, the JCAHO inspection invoked fear into many departmental managers. After all, no one wanted their department to do poorly on their area’s survey. Because this might drag down the entire facility’s scores and result in a non-satisfactory survey for the entire hospital.
Imagine if the entire facility performed satisfactory, but because of a single department’s poor inspection that it lowered the accreditation rating. Therefore, the hospital would receive a a lower accreditation or even a non-satisfactory accreditation simply because of one department’s poor survey.
Think of the repercussions. First of all, every department that did well would “hate” that one department that performed poorly. The entire facility might be subject to re-inspection, not just the poorly surveyed area. Thus, extra tasks and responsibilities would be inflicted on not only the non-satisfactory area, but on the entire hospital.
The facility’s morale would go down and the stress level would go up. There would be no celebrations or special activities because the entire focus would be obtaining a future satisfactory accreditation.
Finally, it might be hinted, subtly suggested, or downright stated, that people would lose their jobs if things didn’t improve next time.
Changing The Survey
The JCAHO survey inspection has changed throughout the years. Originally the surveyor came to each individual department. The surveyor would take a quick tour of the area and then meet with its manager in their office. There, the surveyor would ask questions or request documents from the manager.
Several years ago, the inspection procedure changed. The surveyor no longer wanted to meet with the manager of the department. Instead the surveyor wanted to speak solely with the staff. After all, a manager could “tell” they surveyor anything. But to actually find out about the department’s procedures— the surveyor simply watched and spoke with the staff.
Preparing My Department
I was always a numbers person. I kept the best data in the hospital. My expense reports were in real time— something no other department could claim. In fact, the Chief Financial Officer of my hospital once said that my pharmacy kept better, up-to-minute, expense reports that his finance department.
In addition, I was well educated in many Microsoft Office programs, particularly Microsoft Excel and Microsoft Powerpoint. Quite often my expense reports and drug usage reports were immersed with appealing charts and graphs.
Furthermore, I was very good at working with my staff and teaching them any essential materials. I made it fun. I made a game out of it. I would walk around the department asking staff members JCAHO questions. And they were rewarded with cookies, candy, and pens (pens were like gold) for correct or even incorrect answers.
After several months of preparation, I knew my staff was ready for the JCAHO surveyor’s questions.
I knew other departments did not have the same resources or expertise that I had. Yet, the hospital set their expectations. And without providing any direct assistance, hoped that each department would somehow achieve the hospital’s goals.
I’m baffled by this logic. It’s sort of reminiscent of the COVID crisis. The hospital mandates its goals and tells each department where it would like to be. The hospital then sits back and expects each department, with no assistance whatsoever, to implement procedures and reach the goals.
Some departments were successful and passed their part of the survey. Some departments failed but miraculously passed their part of the survey. And other departments just failed miserably.
Praising Pharmacy Technicians
I’ve always been an advocate for the pharmacy technician. Regardless of the place of business (hospital pharmacy, independent retail pharmacy, supermarket pharmacy, chain store pharmacy, etc.) every pharmacy wanted the best, most educated, most highly skilled, most experienced, most dedicated pharmacy technician that ever existed. It’s a shame that these same pharmacies wanted to pay their pharmacy technicians at or below minimum wage.
I have a friend who was a pharmacist for a supermarket chain. At certain times, he was allowed one pharmacy technician to assist him in the prescription department. This, however, was based strictly on workload numbers. In fact, it was based on the previous week’s workload numbers.
So if he had had high workload numbers last week, he would have been entitled to a pharmacy technician this week. If he had had low workload numbers last week, then he would not have been allowed a pharmacy technician this week.
I don’t understand the logic. Why would any place of business use last week’s numbers to determine how busy it is this week? That’s ridiculous! I’m sorry but it’s downright idiotic to base this week’s help on last week’s numbers.
But the thing I found most illogical was the supermarket’s definition of what constituted a pharmacy technician. The supermarket felt that anyone, a produce employee, a meat worker, or even a cashier could serve as a pharmacy technician if one was needed.
Now I knew that various states have licensing, education, and certification requirements when it comes to pharmacy technicians. And I knew that these so-called supermarket pharmacy technicians (from other areas) couldn’t fill prescriptions or enter patient information into the computer. But they could operate the register or answer the phone (provided they handed it to the pharmacist).
I’m sure these workers were nice people. I’m sure they were skilled in their non-pharmacy departments. However, in my opinion, they just didn’t measure up to the level of expertise or experience that a trained pharmacy technician has.
So why were they used? Because this satisfied the supermarket’s policy of providing a pharmacy technician when the previous week’s workload numbers justified it.
Establishing Uniform Guidelines
Just like the departments in my hospital, when it comes to pharmacy technicians— there’s no consistency. Every state does things differently. There’s no uniform standard for pharmacy technicians across the United States.
I feel that all states should have basic minimum guidelines in place when it comes to pharmacy technicians. These topics include:
- Board review- there should be some state governing body to provide rules and oversee pharmacy technicians.
- Licensing or registration- those individuals that work as pharmacy technicians should be licensed or registered with the state.
- Training- individuals should have some kind of formalized training to work as a pharmacy technician within that state.
- Certification- although this still remains an option, more and more places require certification to work or move up within the organization.
As stated, these guidelines are my opinion of what a state’s requirements should be. But that is currently not what is happening across the U.S. All states are different. Some share all of my guidelines. Some share a few of my guidelines. And some share none of my guidelines.
With all the inconsistencies from state to state, it’s no wonder that the pharmacy technician profession is not taken seriously.
In closing, imagine bringing a prescription to a local pharmacy to be filled. The prescription is for oneself, or a spouse, or a sick child.
There is a pharmacist who oversees the prescription department. In addition, many times there is a pharmacy technician present as well.
If it were up to me, I wouldn’t want some unregulated, unlicensed, uneducated, and even uncertified pharmacy technician filling a prescription for myself, my spouse, or my sick child.
But because of their lenient guidelines, many states permit this to happen.
Daniel Shifrin, R.P., M.S. is a recently retired pharmacist who enjoys sharing his insights about hospital pharmacy. He is proud to own one of the largest collections of Pharmacy Stamp First Day Covers.