Expunging Board of Pharmacy Disciplinary Actions.

Boards of pharmacy have the authority to discipline licensees whose actions fall short of practice standards. Disciplinary action may include license suspension, revocation, practice restrictions, fines and reprimands. Once discipline is levied against a board of pharmacy licensee, it is usually part of the licensee's permanent record. At least four states have created a pathway for individuals to seek expungement of previous disciplinary actions levied by a board of pharmacy. These states have variations on what violations may be expunged and when. Given the evolving approach to the regulation of pharmacists, more states may want to consider expungement pathways in the years ahead.

The Basis for Elimination of the Jurisprudence Examination as a Condition of Pharmacist Licensure in Idaho.

Some national pharmacy associations have recently joined in advocacy for a more portable pharmacist license. One impediment to accomplishing this is the state-specific nature of the pharmacy jurisprudence examination, leading to calls for the exploration of alternatives to, or outright elimination of, such examinations. This manuscript reviews the rationale for the elimination of the pharmacy jurisprudence examination in Idaho. The Idaho Board of Pharmacy reviewed the absence of similar jurisprudence examinations in other health professions, the role schools of pharmacy and employers play in preparing pharmacists for lawful practice, and how the adoption of a "standard of care" regulatory model changed thinking about the need for a jurisprudence examination. Idaho eliminated the examination in 2018, and no evidence demonstrating a public safety impact has yet materialized, while the number of Idaho licensed pharmacists has grown at a higher rate than its border states. State boards of pharmacy are in a position to decide whether keeping the pharmacy jurisprudence examination is necessary, and this manuscript reviews key considerations for other states.

Pathways to pharmacist prescriptive authority: Do decentralized models for expanded prescribing work?

Scope of practice decisions, such as granting pharmacists independent prescriptive authority, are governed at the state level and are often contentious debates. Five states - Florida (FL), New Mexico (NM), Colorado (CO), Idaho (ID), and Oregon (OR) -- have created structures that can theoretically expand independent prescriptive authority through decentralized approaches rather than needing the legislature to approve each drug that pharmacists may prescribe. These approaches have the potential advantage of allowing the states to expand independent pharmacist prescriptive authority to address public health needs more quickly. Four distinct models have been identified from most to least restrictive in practice: 1) medical veto; 2) interdisciplinary committee; 3) board of pharmacy; and 4) pharmacist-determined. These models have generally focused on postdiagnostic and preventive care by pharmacists. In terms of enabling broad pharmacist prescribing, only two of these models have demonstrated success: board of pharmacy and pharmacist-determined. Pharmacy and public health stakeholders considering similar legislation in their own states should consider the success of these decentralized models prior to enacting legislation.

Time and motion study of pharmacist prescribing of oral hormonal contraceptives in Oregon community pharmacies.

OBJECTIVES: The aim of this time and motion study was to evaluate the procedural time and steps of performing an oral hormonal contraceptive pharmacist prescribing service in an Oregon community pharmacy. METHODS: A standardized patient seeking oral hormonal contraception visited 13 community pharmacies throughout February 2018 in the tri-county Portland, Oregon, metropolitan area for pharmacist-prescribed hormonal contraception services for a total of 26 patient encounters. An observer was present at each encounter to record the time for each step and the total encounter time. Each pharmacist was asked to perform assessment procedures and prescribing for each of 2 standardized patient presentations: in cohort 1 (n = 13), the pharmacist's assessment resulted in a hormonal contraception prescription written; in cohort 2 (n = 13), pharmacist's assessment detected contraindications and resulted in a medical referral to another health care prescriber. RESULTS: The average total patient time from arrival at the pharmacy to the generation of either a written prescription for hormonal contraception or referral to another health care provider was 17.9 and 14.1 minutes, respectively. Without accounting for documentation or dispensing the prescription, the average total pharmacist time to perform the service and issue a prescription, or refer the patient, was 7.8 and 5.4 minutes, respectively. CONCLUSION: The results indicate that the pharmacist prescribing service for oral hormonal contraception requires a modest amount of pharmacist time. Incorporation of practice into regular workflow appears to have an impact similar to other clinical services, such as immunizations and point-of-care testing. The patient time spent with the pharmacist was similar to other health care provider visits.

Are advanced practice pharmacist designations really advanced?

Four states have created advanced practice pharmacist designations in state law: advanced practice pharmacist (California), clinical pharmacist practitioner (Montana and North Carolina), and pharmacist clinician (New Mexico). To attain an advanced pharmacist designation, states typically require a fee and set a minimum education requirement either through continuing pharmacy education (CPE) or through attainment of a national certification or completion of a residency. Once attained, pharmacists may practice with additional scope of practice authorities, namely the ability to order and interpret drug therapy-related tests, and initiate or adjust/modify medications under a collaborative practice agreement (CPA). Uptake of advanced practice pharmacist designations has been light (range: 0.35%-9.8%). The additional scope of practice authority is on par with, and in some instances more restrictive than, other states with fewer barriers to entry. As such, the excitement surrounding advanced pharmacist designations may be disproportionate to the actual scope of practice gains when compared to other existing state laws.

Pharmacist and Technician Perceptions of Tech-Check-Tech in Community Pharmacy Practice Settings.

OBJECTIVE: Tech-check-tech (TCT) is a practice model in which pharmacy technicians with advanced training can perform final verification of prescriptions that have been previously reviewed for appropriateness by a pharmacist. Few states have adopted TCT in part because of the common view that this model is controversial among members of the profession. This article aims to summarize the existing research on pharmacist and technician perceptions of community pharmacy-based TCT. DATA SOURCES: A literature review was conducted using MEDLINE (January 1990 to August 2016) and Google Scholar (January 1990 to August 2016) using the terms "tech* and check," "tech-check-tech," "checking technician," and "accuracy checking tech*." DATA SYNTHESIS: Of the 7 studies identified we found general agreement among both pharmacists and technicians that TCT in community pharmacy settings can be safely performed. This agreement persisted in studies of theoretical TCT models and in studies assessing participants in actual community-based TCT models. Pharmacists who had previously worked with a checking technician were generally more favorable toward TCT. CONCLUSION: Both pharmacists and technicians in community pharmacy settings generally perceived TCT to be safe, in both theoretical surveys and in surveys following actual TCT demonstration projects. These perceptions of safety align well with the actual outcomes achieved from community pharmacy TCT studies.

Expanded pharmacy technician roles: Accepting verbal prescriptions and communicating prescription transfers.

As the role of the clinical pharmacist continues to develop and advance, it is critical to ensure pharmacists can operate in a practice environment and workflow that supports the full deployment of their clinical skills. When pharmacy technician roles are optimized, patient safety can be enhanced and pharmacists may dedicate more time to advanced clinical services. Currently, 17 states allow technicians to accept verbal prescriptions called in by a prescriber or prescriber's agent, or transfer a prescription order from one pharmacy to another. States that allow these activities generally put few legal limitations on them, and instead defer to the professional judgment of the supervising pharmacist whether to delegate these tasks or not. These activities were more likely to be seen in states that require technicians to be registered and certified, and in states that have accountability mechanisms (e.g., discipline authority) in place for technicians. There is little evidence to suggest these tasks cannot be performed safely and accurately by appropriately trained technicians, and the track record of success with these tasks spans four decades in some states. Pharmacists can adopt strong practice policies and procedures to mitigate the risk of harm from verbal orders, such as instituting read-back/spell-back techniques, or requiring the indication for each phoned-in medication, among other strategies. Pharmacists may also exercise discretion in deciding to whom to delegate these tasks. As the legal environment becomes more permissive, we foresee investment in more robust education and training of technicians to cover these activities. Thus, with the adoption of robust practice policies and procedures, delegation of verbal orders and prescription transfers can be safe and effective, remove undue stress on pharmacists, and potentially free up pharmacist time for higher-order clinical care.