6.1 Introduction
Although the terms are used interchangeably, pharmacy technicians and assistants are different roles. However, there is a significant amount of overlap in duties and responsibilities. The roles often vary, depending on the size and number of staff members and amount of patient interactions. Pharmacy technicians are more actively involved in the compounding and filling of prescriptions, whilst assistants perform these duties under the supervision of a registered pharmacy professional.
Pharmacy assistants are usually associated with executing the administrative and clerical tasks in a pharmacy. They are responsible for maintaining patient records, interacting with patients, labelling medication dispensations and answering calls, as well as collecting and processing payments. In addition, they are in charge of monitoring stocks and ordering new supplies. In certain cases, they may also reβill prescriptions or count pills, under the supervision of the pharmacist.
Pharmacies are required to maintain records for every transaction that involves the supply of prescription medicine. Although this may be difficult in busy pharmacies, it is a good idea to maintain records for all sales of medicines, including OTC medication. The supervising pharmacist is responsible for the modification of records or the addition of information and under his guidance, the assistant will execute the required steps.
As assistant, you will not be required to make decisions or review medication, but you will be able to help the pharmacist access the relevant information. EHR stands for Electronic Health Records and these records are sometimes accessed by pharmacists, in order to review patient information. The pharmacist may need to access EHR records in order to make decisions related to drug interactions, allergy statuses and so on. Whilst assistants will not be involved in the decision making process, they will be able to assist in the retrieval of relevant records.
Hospital pharmacies (and sometimes community pharmacies) deal with emergency care. In such cases, the pharmacy may have no information regarding the patient. The Summary Care Records (SCR) help the pharmacy team to gain access to patient information by providing significant health information regarding the patient.
FACT
Statistics indicate that a person visits a pharmacy 14 times a year on an average, out of which 11 times is for health related concerns.
Source: england.nhs.uk
6.2 Duties and Responsibilities of a Pharmacy Assistant
Pharmacy assistants are responsible for handling clerical and organisational functions in a pharmacy. They may also assist a pharmacy technician or pharmacist to prepare medication or dispense drug preparations. Pharmacy assistants usually work at pharmacy counters and interact with patients, customers and caregivers on the telephone, as well as face to face.
They may direct the patient to a colleague or co-worker, or prepare drug dispensations under the supervision of the pharmacist. There is a significant level of overlap between the job profiles of a pharmacy technician and a pharmacy assistant, but assistants are typically required to execute administrative and clerical tasks. It is a good idea for pharmacy assistants to be familiar with drug and medication dispensations, as well as prescription interpretations.
The pharmacy assistant will also be expected to be actively involved in the upkeep and maintenance of the pharmacy and this will include the stocking of shelves, updating computerised stocks and keeping the premises neat and clean. They will also be expected to deliver medication to patients (especially in a hospital setting), as well as accepting payment, processing cash transactions and printing out bills.
Pharmacy assistants should also be familiar with insurance providers and following up with them for coverage.
To summarise, the primary responsibilities of a pharmacy assistant will typically include:-
-Establish, update and maintain patient profiles
-Preparation of insurance claim forms
-Filling and organising prescriptions and counting pills
-Monitor stocks and take inventory of prescription and OTC drugs
-Maintenance, operation and upkeep of pharmacy equipment and supplies
-Process payments and operate the cash register
-Labelling of dispensed medications
-Accurate record keeping of prescriptions and patient information
Pharmacy assistants do not usually require a formal qualification (unlike pharmacy technicians) and may receive on the job training. However, efficient pharmacy assistants can play a crucial role in freeing up time for pharmacists and technicians to perform their job roles. Employers prefer candidates who possess (at the minimum) a high school diploma and computer skills, as well as a disposition to work well in a team environment and to demonstrate a customer oriented approach.
Successful pharmacy assistants are generally found to be responsible, friendly, organised and dedicated. Pharmacy assistants sometimes compound prescriptions under the direct supervision of technicians or pharmacists - they are usually not expected to fill or transfer prescriptions.
6.3 How to maintain Patient Records in a Pharmacy
Pharmacies are expected to maintain the records of patients, in order to ensure quality, consistency and continuity of healthcare. Well maintained records also help the pharmacist to respond to any questions regarding the patient's medication regimen. Pharmacy Patient Medical Records (PMR systems) are commonly used for maintaining patient records in pharmacies in the UK. In general, however, the requirements governing PMR systems are similar to HER and other record maintenance systems. Pharmacy professionals and workers (please keep in mind that patient records are usually entered and updated by assistants) should ensure that they enter patient data in accordance with the Data Protection Act and professional standards stipulated by the GPC (General Pharmaceutical Council), as well as governance frameworks.
As a pharmacy assistant or a member of the pharmacy team, you may find the following recommendations useful, with respect to records:-
-Pharmacy professionals should store, access and share patient information in records, in accordance with legal confidentiality and information requirements.
-You should be able to take responsibility for the accuracy of information stored in patient records.
- Pharmacy workers should obtain consent, if information in patient records needs to be shared.
- In the case of mentally ill patients, the consent should be obtained from an authorised caregiver.
-Obtain permission to view for different periods of care or during transition of care, if you need to access national care records for the patient.
Ideally, the patient medical records help to integrate pharmaceutical care into the healthcare systems. Patient records will ideally contain information regarding the patient and the medication/prescriptions. The information will help the pharmacist or the pharmacy technician to refill prescriptions and retrieve older prescriptions, in order to ensure positive patient outcomes. Pharmacy record maintenance also helps to guard against manipulation and misuse of patient information.
In addition, patient information also serves to create a legitimate audit trail. In this case, the information in the trail is meant to assist in the construction of a prescription order. The information also helps during filling subsequent orders belonging to the same prescription. Nowadays, most pharmacies use an automated, computerised record keeping system, but it may be helpful to maintain an auxiliary system in case the former becomes inoperative - resulting in loss of information. One of the primary objectives of maintaining patient pharmaceutical records is to ensure that the pharmacist is able to review patient information in a consistent manner.
A patient record should contain the following minimum information:-
-Patient's full name and address
-A serial number should be assigned to each new prescription
-The date of drug dispensations (including refills and repeat orders), as well as stop dates
-The identification of the pharmacist or technician who filled the prescription
-The name (generic and brand), strength, dosage and quantity of drug dispensed
-Any instructions related to refilling, issued by the prescribing authority
-Name, address and GMC registration number of the GP or physician who prescribed the drug
-Comprehensive details regarding directions for use of the drug
-Details of any patient allergies or reactions to the drug prescribed. If there is no allergy, there cord should indicate as such
Patient pharmaceutical records should also indicate any special medication status. This could include statuses such as on hold/discontinued, self-administration, restrictions, special times for consumption and controlled substances. Accurate and updated patient records in pharmacies help the pharmacist to identify potential drug interactions, reactions and therapeutic duplication.
The information also helps to pinpoint improper or risky usage of drugs. Any modification to a patient record must contain the name of the pharmacy professional or prescriber who has initiated the modification. Similarly, any changes to prescriptions, including changes in dose, directions for use, quantity etc, must be entered in the patient record. The changed record and the original record must be stored, for reference.
Prescription records are usually maintained for a period of two years. This is why the pharmacy assistant should be particularly vigilant, when entering data in a patient record. As assistant, you may not be directly involved in drug dispensations and modifications (these functions will be performed by the pharmacist or the pharmacy technician), but you may be responsible for recording information in the computer system.
The pharmacy record is extremely important for indicating the responsible pharmacist at any given date and time. The audit trail of patient medication and prescription information is particularly important, as this practice improves accountability in cases of errors or incidents. Pharmacy records may be stored in writing or electronically, or both. Most pharmacies use computerised systems, although hard copies of some documents like prescriptions may be stored. Relevant information may be entered in pharmacy records, as long as it is in keeping with professional and legal requirements.
A typical patient medical record should contain the following pharmaceutical information:-
-Currently prescribed drugs, mode of transmission (oral, transdermal, inhalation and so on), frequency, dosage and formulations.
-Over the counter drugs, such as herbal or natural remedies.
-Adverse drug reactions, nature and duration of reactions.
-Information regarding adherence to therapy (please be aware that this information may be intentionally or unintentionally inaccurate).
-The pharmacy workers should also ensure that the GP has provided information regarding drug prescriptions (this list should be up to date), adverse reactions and last prescription date for the drug order.
-UK Pharmacy record requirements
Pharmacy records in the UK must meet the following requirements (please bear in mind that as assistant, you may be in charge of entering information and storing records):-
The assistant, pharmacist or technician must personally make entries in the pharmacy record. Do not allow any third person to access or enter information. If the supervising pharmacist was absent from the pharmacy at the time of entering the record, this information should be reflected in the record.
The records should be available for inspection and should be backed up in case of system breakdowns. Do not enter any information, unless you have been authorised to do so by the pharmacist or the technician. If you have any doubts, refrain from entering or modifying information until you have discussed the matter with your supervisor. The audit trail should be able to clearly identify the date on which records were created or modified, the name of the responsible pharmacist, as well as original records.
Activity
Estimated time 10-15 minutes
Take 10 minutes to read the following questions and make notes on your thoughts:-
As a pharmacy assistant, how can you contribute to improved and efficient record keeping? Under what circumstances should you consider consulting your supervisor for guidance?
6.4 Pharmacy Systems used for storage of EHR
EHR stands for Electronic Health Record and these records are used as resources for creation of pharmacy records.
Pharmacy record systems could include one of the following:-
-Patient Medical Record systems (typically used in community pharmacies)
-GP systems and primary care record systems
-National and local systems used to evaluate pharmacy data
-National Summary Care Service
Pharmacies may use one or more of these systems, in order to manage patient information. The system is chosen based on the kind of information available. The underlying objective is to ensure that the pharmacist has all of the relevant information required to make decisions. Pharmacy assistants should exercise care and caution when entering patient information, as this will play a crucial role in decision making processes at a later stage.
Please note that when a patient presents a prescription at a pharmacy, it involves the supply of medication -and this automatically implies the creation of a record. However, if the patient requires other assistance or products (such as smoking cessation information, contraceptives and so on), you may have to obtain consent from the patient before entering a record. If you need to access pharmacy records, you have to take prior permission of the supervising pharmacist or technician.
Pharmaceutical staff members should make it a point to access patient records and information, for provision of pharmaceutical services only. The information must not be misused or shared without due authorisation or legal consent. All of your actions and services should be in the best interests of the patient. A competent adult does not require representation by another adult. In case of any doubts, please contact the patient directly. It is also good to be alert and report any discrepancies or errors to your supervisor. If you are authorised to do so, please correct any erroneous information as soon as possible (if you have the correct information available to you).
It is common to complete routine tasks, such as selling over the counter medication or providing refills, without amending or accessing pharmacy records. However, it is always a good idea to keep records updated and accurate, as this helps to provide documentation of medical care in case of problems or court cases.
In many pharmacies, the patient may be able to view the record along with the pharmacy professional, in order to enable mutual participation during patient counselling sessions. The pharmacist may ask the assistant to retrieve the appropriate records before the patient arrives, in order to review them beforehand. It is not necessary to access EHR records before every pharmaceutical transaction.
However, EHR information may be used by a pharmacy under certain circumstances:-
The pharmacist may wish to review previous medication history (especially if the patient has been discharged from the hospital), allergy status and contra-indications. Again, the supervising pharmacist will perform the review, but may request the assistant to access the EHR records. EHR information may help support healthcare. For minor ailments, the pharmacist may wish to review medication information, to confirm compatibility of OTC drugs with other medication. EHR information may also be useful when supplying medication for emergency requests or out of hours, at the behest of the patient.
Patient identified errors
In case the patient identified errors in the medical record, you may need to correct the information after verification of the new information or cross-checking with the GP. The records should be closed and stored in a safe and secure manner, after the counselling. Patient data may sometimes have to be shared with other healthcare professionals - and prior consent from the patient is necessary, in order to do this. However, pharmacy professionals may need to balance the need for conβidentiality with the requirement of continuity of care.
As pharmacy assistant, you will not be required to make such decisions, but once the pharmacist decides, you may need to email or share the patient data as required. Under NHS regulations, patients need to be informed about what data is stored in pharmacies. It may be a good idea to provide each patient with a printed information sheet. You can also explain the information to them verbally. EHR and pharmacy records should be destroyed or deleted in accordance with NHS regulations regarding maintenance of medical records.
Activity
Estimated time 10-15 minutes
Read through the following questions and write a few sentences on each.
When will a pharmacist wish to review EHR records? Is it compulsory to review EHR records for every prescription?
6.5 Summary Care System
The SCS or Summary Care System contains information regarding allergies, adverse reactions and prescriptions. SCR records also contain additional information, such as significant medical history. The Summary Care Records are particularly useful for emergency and out of hours care, as pharmacists are able to review important health information at a glance, for patients for whom they may hold no information
at all.
For example
A patient from a different part of the UK may be involved in a car accident and it may be necessary to provide emergency care. Summary Care Records are particularly useful for hospital pharmacies, in order to perform medicine reconciliation for emergency patients. The patient has the right to waive the “permission to view clause, in case he wishes his information to available for access.
The pharmacist who has a legitimate relationship (LR) with the patient is allowed access to the patient's Summary Care Records, at all times. The “permission to view” will then be accessible to all branches of the pharmacy. As pharmacy assistant, you will be responsible for record retrieval and it is a good idea to be familiar with the different systems and terminology associated with patient information records.
Note: In Wales and Scotland, different health record systems apply. In Wales, the Individual Heath Record system is used, whilst the Emergency Care Summary Records are used in Scotland. NHS regulations are not applicable in Wales. Accurate pharmaceutical patient records help to reduce prescription errors and the consequent increase of risks to the patient. In addition to prescription errors, medical records are also helpful in identifying drug related clinical symptoms, which may arise as a result of drug therapy. A comprehensive medical
record will contain details of all previous and current drugs prescribed to the patient. In addition, it will contain details of adverse or allergic reactions. Pharmacy records should also contain details of over the counter medication and herbal alternatives.
For example
Poor documentation of hypersensitivity reactions may result in the unnecessary avoidance of drugs. The pharmacist then does not have access to adequate information, in order to make decisions that maximise patient outcomes. As pharmacy assistant, you will not be required to review pharmaceutical information and make decisions. However, accurate and meticulous record maintenance (which you will be responsible for) can help the pharmacist(s), to a significant extent. In fact, studies indicate that pharmacy team workers are better at recording medication histories, compared to nurses and even most physicians. Well maintained pharmacy patient records are useful in the larger context, by helping to reduce medical costs, reducing wastage and medication errors.
MODULE SUMMARY
The Pharmacy team consists of the pharmacist(s), pharmacy technicians, assistants and counter assistants. The number of staff will depend on the size of the pharmacy and the number of patient interactions during a day. The distribution of duties and responsibilities will depend on the volume of business handled in a day. Pharmacy assistants will be expected to execute administrative and clerical duties, within a pharmacy setting. The primary responsibilities include answering the telephone, interaction with patients, maintaining and updating pharmacy patient records and communicating with insurance providers.
Additional duties could also include counting pills, labelling bottles, stocking shelves and filling repeat prescriptions under the supervision of the pharmacist. Pharmacy patient records are extremely important, in order to maintain consistency, quality and continuity of care. They are also important for court cases or legal proceedings in negligence cases. Pharmacy assistants are usually expected to enter patient information and update records. They should perform this task with the utmost care and vigilance, because errors in information may result in far-reaching consequences.
Any modifications or changes to prescriptions must be done so under the supervision of the pharmacist or technician, or any registered professional. In such cases, it is important to save the original as well as the modified prescription. If you need to correct a record and you have access to the relevant information, it is a good idea to incorporate the correction(s), without delay. Whilst the pharmacist or technician will review prescriptions and monitor allergic reactions, drug interactions and so on, it is the duty of the assistant to ensure that pharmacy records are updated regularly.
Summary Care Records or SCR include significant patient details and health information. They are particularly useful for emergency care and out of hours treatment. For example, the pharmacy may have no information regarding an unconscious patient who has been involved in a car accident. They can access Summary Care Records and review important information, in order to perform medication reconciliation.
The patient has the right to provide or refuse consent for “permission to view”. Pharmacies may also develop an LR or Legitimate Relationship with the patient. In such cases, all branches of the pharmacy have the right to access the SCR and patient information.
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