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Why Tech Training Matters and What’s the Real ROI?

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My essential core motivation comes from both an intense passion to improve the pharmacy profession and a deliberate intention to make the patients it serves safer.

I believe strongly that true patient safety in medication preparation and administration must include a well‐designed process incorporating innovative and affordable technology utilized by competent staff.

I also believe wholeheartedly that technology can only truly be effective when it is utilized by a competent and engaged caregiver.

I’ve recently noticed a number of trends in the field that have created a void in pharmacy education:

  • Pharmacists are trending toward a more clinical focus
  • Continuous advancements in technology effect the need to stay current
  • Industry developments and CE requirements effect the need to stay current (USP, state license boards, individual practice competency requirements)
  • Operations and dispensing are relying more on technicians and technology
  • Pharmacy technicians are positioned for increased responsibility
  • Pharmacists are positioned for increased liability (as pharmacy technicians assume more responsibility)
  • Recent errors are directly related to pharmacy technician performance:
    • Oregon: Technician prepared wrong drug – women died in ER
    • Indiana: Omnicell stocking error – heparin overdoses 6 babies, 3 NICU babies died
    • Ohio: Technician error in compounding IV solution for Chemo – 2 yr. old Emily Jerry died
    • California – Quaid twins given wrong heparin concentration due to restocking error
  • Pharmacy technician certification is currently not a requirement in the most states but there is a movement towards standardization
  • In most markets, there is currently no accessible or organized pool of certified experienced pharmacy technicians

Pharmacy techs have become an integral part of nearly every segment of every pharmacy in the country. And their responsibilities are growing.

Training and certification can ensure that pharmacy technicians have the core competencies required to safely perform the full scope of practice as well as the right attitude for success.

Most importantly, trained, competent, and reliable techs can drastically reduce any facility’s overall medication error rate.

So what’s the real ROI for tech training?

    • Trained techs are less likely to make errors, costing time and money
    • Trained techs are more likely to be team players critical for departmental success
    • Untrained techs can slow productivity causing delays in treatment or care
    • Untrained techs can lack professional skills or conduct
    • The process of hiring techs can be long, interim staff positions must be covered by others until filled adding stress to existing staff
    • Staff vacancies cost more in overtime paid and are hard to cover especially second and third shifts or holidays
    • It’s extremely hard to find qualified candidates:
      • Difficult to get “true” employment history
      • Hard to identify bad attitudes, laziness, troublemakers, or those with dependency issues before hire
      • A bad hire can cost a great deal of time and money to correct
    • An unprofessional hire can reflect poorly costing the whole department:
      • Techs often work independently and act as the pharmacy representative to other departments in the hospital
    • Techs have no time to waste on anything not vital in the context of doing their job, including education
    • Classroom training is expensive:
      • Pay for training
      • Backfill the staff vacancy on the floor
    • Classroom learning is less effective than competency training that is targeted, relevant, and directly helpful to the job at hand
    • Classroom training is often too broad in focus or happens ahead of time/out of context
      • Reinforcing training with on‐the‐job application and clinical context improves retention, makes them feel effective and capable of doing their jobs well
    • Ensuring training is focused and relevant shortens the training path and amount of hours spent — A shorter training path means fewer hours away from the job
    • Flexible online training that can be accessed any time, in any place, reduces time away from the job even further
    • Online training provides evidence‐based outcomes to measure staff competency and real skill sets more effectively than “seat time”
    • Relevant Integrated Competency training provided on the spot is the most effective way to train your staff

 

RxTOOLKIT eLEARNING™ was developed in direct response to these observations. Our mission is to provide specialized online training with both clinical and operational focus to increase safety, expand competency, boost confidence, and ensure success for all clinicians.

 

RxTOOLKIT eLEARNING™ has recently partnered with TRC Healthcare (Authors of Pharmacist’s Letter and Pharmacy Technician’s Letter in advancement of Pharmacy Technicians University (PTU). This online competency‐based curriculum provides all of the tools and information needed to prepare techs for the job and the national certification exam.

 

RxTOOLKIT eLEARNING™ also provides a Drug Specific Competency Tracking program. This ongoing educational program includes drug specific courses and provides certification and tracking with interactive assignments and competency exams.

 

For more information about RxTOOLKIT eLEARNING™ programs please contact elearning@rxtoolkit.com or visit RxTOOLKITeLEARNING.com.

In Support of the Second Victim

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It has been 8 years since I made the biggest mistake of my life. I was responsible for the death of a 2-year-old girl named Emily Jerry.

The emotional repercussions of this mistake still haunt me every single day—when I see the neighborhood kids playing, a commercial for the Children’s hospital, or a little blond blue eyed girl in line at the grocery with her mother. The tears well up in my eyes when I picture Emily, with all of her energy, riding her big wheel around the nurse’s station at the hospital where I worked. I can still picture her looking around with joy and discovery during the precious and altogether too short time that she graced this earth.

Personal / Professional Impact

I have been diagnosed with the medical emergency equivalent to post-traumatic stress disorder and have experienced a myriad of both psychological and physical symptoms.

The emotional impact of the error has affected both my professional and private life. I have experienced a full range of emotions: anger, fear, sadness, and shame. I have felt apprehension, panic, and disbelief. I have experienced loss of appetite and difficulty concentrating. I completely lost my self-confidence. I was terrified of being labeled as incompetent and careless by my peers, the general public, both Emily’s family and my own.

During the first few weeks following the incident, I felt isolated from my colleagues and the hospital—No one checked on me or offered support. I feared going to work. I experienced depression, guilt, humiliation, remorse, and frustration. I longed to reach out and try to make amends with Emily’s family.

The day I was dismissed from my employment at the hospital, I truthfully wanted to die. On the way home that day, I thought of turning the wheel into a bridge pylon and ending it all. I received a call from my mother at that very moment—it was the only thing that stopped me.

Even as time passed, all of these feelings stayed with me. I wasn’t equipped with the tools to process the intense and constant feelings. I suffered with insomnia, nightmares, flashbacks (even during the day), and continuing thoughts of suicide.

Every day seemed to drag on and on and I sunk into a deep depression. When I returned to work several months later, I felt so scared and incompetent that I could barely function.

Initially I didn’t think I would lose my license, let alone that the case would lead to criminal charges. I was wrong. In time, I lost my job, my license, and went to prison. I wondered how I would survive.

Healing

For years, I continued to suffer in silence.  In time I started to realize something needed to be done. As I began the process of personally healing from this terrible tragedy, I realized working towards prevention of these errors and helping others in the same or similar circumstances would become part of my own recovery. In my research as well as talking with others, I found an enormous lack of support for practitioners, who like me had become second victims in these unfortunate occurrences. Just as we take care of the patients and families affected by a medical error, we much also take care of the second victims.

Second Victim Awareness

In all of my personal and professional experience, I had never heard of a “second victim”. I was unaware that there were other health care providers that had gone through similar experiences. I eventually learned that following medical mistakes there is a documented increased risk for suicide. I learned about a nurse named Kimberly Hiatt, who took her own life following a medical error. It left me grieving that no one, including myself, had been there to support her.

I had an opportunity to meet Charles Denham, author of the article, The Five Rights of Second Victims, and Chairman of the Texas Medical Institute of Technology (TMIT). He maintains that second victims have five essential rights, represented by the acronym TRUST: Treatment that is fair and just, Respect, Understanding and Compassion, Supportive Care, Transparency and the Opportunity to Contribute.

When speaking with Charles, I learned not only that I was a second victim, but also that I wasn’t the only victim. He also believes that there is a third victim involved – the healthcare organization itself. The organization can include any professional involved in the patient’s care: from doctors and nurses all the way to the housekeeper or volunteer. The sustained “wound” that the organization feels can either be worsened or lessened based on the behavior of its leaders. Many professional leaders often feel conflicted loyalties to the patient, the healthcare system, and to their staff. In this way, they too, become victims of the error. When second victims are abandoned or ignored by their leaders, Charles believes the wound can infect the entire culture of the organization. When visiting my past employment, even after many years, you can still feel the hurt rippling throughout the organization. He suggests that by ensuring second victims are supported, the organization and its leaders can shoulder the outcome together and heal.

Industry Reaction

Not too long ago in pharmacy, we were encouraged to keep secrets about medication errors, trying in vain to maintain an image of perfection in the healthcare system.

As it stands, most of the medical profession tend to abandon, isolate, and punish the second victim. Both my research and personal experience has exposed a huge deficit in regards to the support of second victims. The healthcare profession cannot continue to blindly ignore this issue. They are currently failing to provide the fundamental and necessary resources.

Recommendations and Resources

The industry needs to provide accessible, effective, and long-term support that must be in place the before a traumatic event happens. Healthcare professionals and administrators need to promote widespread understanding of the second victim. Support initiatives need to be established and widely communicated. Education and discourse will help to lessen the stigma surrounding an error and increase the receptiveness of second victims to accept support.

In my opinion, one of the most important resources we can provide is a sense of community for second victims. By putting impacted caregivers in contact with others who have gone through similar situations, they realize that they are not alone. I now volunteer with the Institute for Safe Medication Practices (ISMP). I assist their second victim support programs and have also provided testimony for board hearings and criminal proceedings. I have seen first hand how many professionals, who initially felt isolated and defeated, can turn their lives around once they receive support.

I have started a support group in the Cleveland area for second victims. Through discussion, sharing of resources, and the establishment of a support system my hope is that we can create a safe and compassionate place for those in need. I have found a number of resources and organizations that were helpful in getting it started. Please visit our Resources page for more information.

Closing

Make no mistake; harmful events happen in all organizations, so leaders must be prepared. It is really not a question of if, but when. An emotional reaction to a medical mistake has the potential to lead leaders down a reactive and punitive pathway that can ripple negativity throughout the organization.

The industry must work to stop errors before they happen by increasing education and implementing technology and automation. Crisis management plans, that formally address the second victim, must be developed before they are needed. Health care workers must work to educate our peers and share these stories of caution—lessening the stigma surrounding a mistake and encouraging second victims to seek support. All facets of healthcare must work together, continuing to build the resources available for second victims, making them both accessible and highly visible within the system. All of us must remember to treat second victims as human beings who deserve respect and support.

My greatest hope is that by sharing my story and shining a bright light on this issue, it will serve as a catalyst for one the most important changes in healthcare—improved and long-term support of the second victim.

Feel free to leave a comment below, suggest additional resources, or contact me with any questions you may have. I can absolutely help to educate your staff and assist your organization in implementing a support system before a traumatic event happens. Contact me, I am available to speak to your group, either in person, or as part of an online program.

In My Own Words

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In February 2006, I reported to work in the early morning, at a primary pediatric hospital in Cleveland. I worked double shifts the previous two days, so I was tired when I arrived. The hospital’s computer system had been down for ten hours prior, so I knew I was in for a busy day. The hospital staff was in a state of panic. The phones were ringing off the hook. Nurses and doctors were calling in looking for their missing medications. By the time the computer system finally came back up, we were buried with labels printing from three different shifts. Our pharmacy was compact; the area where we made IVs was the size of a small closet and the checking area was a 4′ x 6′ table. Within an hour the table was filled and beginning to pile up. We were running out of bins to put the finished products so many were mixed together. I spent the next hour trying to check as fast as possible. I caught numerous errors that day, but I missed the most important: my technician had prepared a child’s chemotherapy base solution mix of sodium chloride 23 times more than what was ordered.

I asked the technician if the bag I was checking was sodium chloride, but didn’t confirm that it was 0.9%. I saw an empty bag of sodium chloride 0.9% on the table and thought that had been used to fill the empty via-flex bag. After checking the bag, the solution was combined with the ordered chemo agent, checked again, and sent to the floor to be administered. When the nurse administered the fatal dose of sodium chloride, it caused the child’s brain to swell sending her into a coma. Three days later, she died.

Her name was Emily. I live every day with the responsibility for her death.

I was later convicted of involuntary manslaughter. I received six months of jail time, six months of house arrest, 3 years of probation, a $5,000 fine, and 400 hours of community service. I also lost my license, career, reputation, and much of my confidence.

But the worst thing of all is living every day with the memory of that little girl whose life was cut short.

I accept my role in what happened, but I am filled with regret. I truly wish I could go back and check that solution more carefully. Though I could easily dwell in the past, I am sharing my story with the hope that we can all learn from my mistake.

Many factors led up to the medication error. They are common occurrences happening in hospitals and retail pharmacies across this country, every single day. If we are to avoid similar tragedies, they must be addressed.

One factor is that pharmacy technicians need better training. Most people don’t realize that techs are involved in approximately 96% of prescription compounding in pharmacies. According to the National Pharmacy Technician Association (NPTA), 92% of the US does not require technicians to have any formal training. The technician working for me had only a GED. She didn’t know a thing about the different concentrations of sodium chloride. One positive change that resulted from this tragedy is Emily’s Law. It requires that all techs undergo training and pass a competency exam in Ohio. NPTA and the Emily Jerry Foundation are currently working on an additional bill to institute Emily’s Law nationwide.

Another factor is having a bar-scanning system in place; my hospital did not. Almost every supermarket in the country utilizes this technology. Why not pharmacies? There are so many look-a-like and sound-a-like medications that come in small vials with tiny labels. Errors can easily be made. There are many bar-scanning systems currently on the market, which can act as a safety net. I truly wish one had been in place that day.

But this technology isn’t enough; pharmacists and technicians need better working conditions. Pharmacies are cramped and the workload is often heavy. Studies have shown that crowding and dim lighting often lead to mistakes. Additionally, interruptions, filling too many prescriptions, and long shifts frequently cause errors. Believe me, I and many pharmacists, have said a little prayer on their way home that an error didn’t slip by.

Finally, I wish I had been able to talk to the family directly when the error occurred. I wasn’t given the chance to personally say I was sorry. The hospital management met with the family and I was advised not to talk to them. There exists a culture of silence and bureaucracy and it must be changed.

Similar errors happen every day and people continue to talk about my error; but no one has yet addressed why the error occurred and how it could have been prevented. I want to be part of changing the current system. We need to figure out how we can be supported (not prosecuted) by our hospitals and institutions.

This is why Chuck and I developed medsafetyonline. We want to allow pharmacists, doctors, nurses, and other caregivers to be able to come together; to discuss their own experiences, and concerns, to find support, and lastly, but most importantly, to use what we learn to make the systems safer. We hope that by increasing dialog, improving pharmacy education, and advocating for automation and technology we can change the system for the better.

We hope you find support in this community. By coming together we will help others learn from our mistakes and hopefully create a positive change.

The Eric Cropp Story: Courage Under Fire

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Eric Cropp

Eric Cropp went to jail; he is a convicted felon.


What was Eric Cropp’s crime? ….he was human.

An error occurred that had tragic consequences to an innocent toddler and her family. It wasn’t that Eric even made the error; he failed to catch the error someone else made. When you hear his story, it is not hard to see how this error could have been made by anyone, especially under the circumstances of the day. He was under lots of pressure: overworked, understaffed, and with constant interruptions.


How did Eric pay for his crime?

Eric lost his job, his profession, his livelihood, his freedom, and he lives with the memory of a young girl whose life was cut short.


What has Eric chosen to do?

He could be bitter, sullen, depressed. All of which would be clearly understandable reactions to these events. Instead, Eric has chosen to speak to those of us who are still practicing. Those of us who, by placing a simple initial on a label, could easily do the same thing.

As a health care provider who regularly functions under similar circumstances, I know full well that “there but for the grace of God, go I”.

I can vividly remember near misses, that had I failed to catch, could have had devastating consequences to the patient. I believe most of us that practice has one or more of these events forever frozen into our memories.

I will never believe that Eric committed a crime…he made an error. But I do believe that there are crimes associated with this event.


The crimes as I see them are:

• Making a human error a criminal offense
• The loss of Eric’s license to practice his profession
• The failure of the people and organizations that could have helped and supported him
• The lack of automation and technology for dose preparation in so many hospitals…even today


Courage under fire

Despite the fact that Eric has paid dearly for his error, and despite the fact that the profession appears to have turned its back on him, Eric has decided to speak out to those of us who still practice. He is using his voice to help prevent anyone from harm in the future.

Eric has to stand up in front of all of us and say:

“I made an error and a toddler lost her life,
I want to prevent this from happening again”.

That takes courage and Eric is not short on courage.

Thanks Eric for not turning your back on us.