Should technicians run the pharmacy computer?

March 21, 2005

Supposedly technicians are not allowed to screen for drug therapy problems, but isn't that exactly what they're doing when they routinely zip past a blizzard of DUR alerts?

Many big employers want technicians, not pharmacists, to run the pharmacy computer. The most-often stated reason is that this frees up R.Ph.s to answer customers' questions, speak on the phone with doctors' offices, and so on.

Apparently many big employers do not attach much significance to drug utilization review, or DUR, alerts that frequently pop up on computer screens. By letting technicians run the computer, R.Ph.s no longer have the opportunity to review these warnings, contraindications, high-/low-dose alerts, drug interactions, etc.

The fact that so many employers encourage techs to run the computer demonstrates to me that they view the device as mainly a data-entry tool for processing prescriptions, rather than a medical tool for ensuring that all Rxs are screened for drug therapy problems.

I bet most pharmacists have wondered which warnings techs are ignoring. In my experience, only a small percent of warnings require changing anything about the Rxs; so, statistically, the pharmacy staff finds little danger in having a relaxed attitude toward the endless number of warnings that pop up. But surely we are also overriding some very important warnings.

If the big employers are sued, they can claim that the pharmacist was negligent in overlooking the warnings on the computer screen. Thus corporate executives can blame the pharmacist, rather than admit that staffing levels determined by the company don't allow the R.Ph. enough "warm bodies" in the pharmacy to ensure that all Rxs are filled with maximum care.

I used to work with a technician who would occasionally ask me to look at a warning. She seemed proud of herself for being conscientious enough to ask; yet, she summoned me in a totally random manner. She seemed to have no idea which warnings were serious and which were unlikely to result in significant harm.

I suspect that she, like many techs, overrode the vast majority of warnings but, feeling guilty, wanted to assuage her discomfort by asking me to check some alerts.

So it is not surprising that some pharmacists insist on controlling the computer themselves. However, in very busy pharmacies with several terminals, it is almost impossible to prohibit the technicians from running the computer. High Rx volume often requires substantial use of computers by technicians.

I used to work for a chain that required pharmacists to review drug interactions by typing in their secret password before proceeding. The screen would lock until a valid R.Ph. password was entered. This meant the technician had to interrupt the pharmacist to look at a DUR alert. The pharmacists had to examine the potential interaction and then enter the password if they determined the interaction was unlikely to result in significant harm.

Some other chains' computer systems do not require the R.Ph.'s secret password to proceed. Many pharmacists have told me that they are scared to death that a technician would bypass critical drug interaction warnings, creating the potential for a lawsuit.

With dangerously inadequate staffing in too many pharmacies, R.Ph.s don't welcome frequent interruptions. In many such cases, techs become reluctant to interrupt the pharmacist and simply override warnings. As a result, the big employers are placing our license (and the corporation itself) at risk in order to fill Rxs quickly. Many pharmacists feel that employers will continue in this manner until the cost of settlements from lawsuits exceeds the cost of adequate staffing in the pharmacy.

Let me be perfectly clear that I do not mean to denigrate technicians. Technicians provide invaluable assistance to pharmacists. My concern is simply whether they're capable of determining the significance of highly complex warnings when R.Ph.s themselves are often uncertain of their practical significance.