The Tech Letter, Issue #001 -- Tech-Check-Tech (TCT) Programs

In this first issue of the Tech Letter, I will be discussing Pharmacy Technician Tech-Check-Tech programs. First of all, what are they? Why are they used and why are they becoming more popular? Which states currently have them in place?

Hospital and critical care pharmacists are being called upon to do more and more, and as they are in high demand, many institutions are now utilizing pharmacy technician tech-check-tech programs. Quite simply, this is where a pharmacy technician prepares and administers certain medications, but before anything is given to a patient, another, certified pharmacy technician checks their work for accuracy of medication and dosage. The ultimate goal of pharmacy technician tech-check-tech-programs is to free up the pharmacist to do other work.

Currently, tech-check-tech (TCT) programs are available in a limited number of states. Washington and Minnesota have had TCT programs for almost 15 years, and Kansas, Kentucky, California and Texas have recently followed suit. A TCT program must be approved by the individual state's Board of Pharmacy. Recent data, showing the efficacy of these programs, is allowing more states to favorably consider adding such programs. A 2006 study found that there was only one error in over 1,600 preparations. In short, there is a need, and TCT programs work.

One concern over TCT programs has been in the medications themselves. Tech-check-tech programs are not designed for all medications. First and foremost, they are only for medications administered by automated dispensing cabinets (ADCs). They may not be used for narcotics, nor may they be used for first dose administrations, which must be given by a licensed pharmacist. The programs are regulated, which has alleviated the fears of some critics.

TCT programs are administered in the hospitals in which they are used. Programs are open to pharmacy interns with 6 months of unit dose filling experience, and to certified pharmacy technicians with one year of dose filling experience. The TCT training module includes a didactic lecture or self-training packet, as well as one-on-one training, where the candidate observes a pharmacist checking dose batches. Once a candidate is validated, he or she undergoes quarterly quality assurance audits for the first year, and then bi-annual audits thereafter. These audits are done by the pharmacist, who must report any errors. During the training, the pharmacist will introduce faulty dosages, which the trainee is expected to find and remove. These are rigorous programs, which ensure that the validated technicians are able to ensure the safety of their patients.

If the goal of a pharmacist is to improve patient care, then it is important that he or she be freed up to do so. TCT programs have been proven effective in attaining this goal. When technicians, who are highly trained in dosage control, can assume responsibilities of preparing certain medications for ADCs, the pharmacist is allowed to focus on other responsibilities. As the medications are double-checked, the TCT accuracy is 99.89%, versus 99.52% for pharmacists. TCT programs free up pharmacists and improve accuracy.

As pharmacists' need for time have increased, pharmacy technician tech-check-tech programs were born and have evolved. TCT programs, administered by trained and validated technicians, have a very low error rate, and generally lead to improved patient care. As the national need increases, I expect more states to approve TCT programs.

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David Shedd

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