The Pharmacy Technician in Long-Term Care Pharmacy
A fairly unique setting in the pharmacy world can be found in long-term care pharmacy. This article is to introduce you to long-term care pharmacy and the possibilities for pharmacy technicians.
First of all, we need to define what long-term care is. Very simply, long-term care is a service provided to people who can no longer care for themselves. This can be a physical, mental or emotional need. Perhaps the most common and well known is elderly people who become unable to live alone at home safely. However, this also includes individuals who have serious mental disabilities or illnesses, as well as those who are too sick to return home after a hospital stay, but no longer need to be in the hospital. Here are a few examples of long-term care facilities:
Nursing Home: As mentioned before, this is typically a home for those who have lost the ability, either physically or mentally, to remain at home because of their age. The typical nursing home is a skilled nursing facility, which means the facility is licensed with the state and is staffed with registered nurses as well as licensed practical nurses (LPNs) and certified nurse aids (CNAs). These homes are usually for those who can no longer perform most or any activities of daily living (ADLs). An activity of daily living is exactly what it sounds like; the things we do every day such as dressing, brushing teeth and other hygiene, and eating. Therefore, the nurses and assistants in the home help the residents with these activities.
Assisted Living: There is a much broader range of residents in an assisted living facility. Again, these are mostly for older people but many of them are able to complete most or all ADLs still. Some people choose to enter an assisted living facility because they don’t want to live alone or they may just need help with preparing food or taking medications. Many assisted living facilities do not have nurses in the facility at all times and have a minimal healthcare staff. Residents can stay at this type of facility until their needs are more than can be provided and they must move to a nursing home where a higher level of care is available.
Hospice Care: Hospice refers to the care a patient receives after they are determined to be terminally ill and throughout the process of dying. This care usually involves not only the patient but also the whole family and covers physical, emotional and mental needs. This care can be provided in the patient’s home but it is also common that a hospice nurse or doctor sees the patient at a nursing home. Some hospice companies have a facility where patients can stay during their terminal illness.
Rehab Facilities: This group also covers a wide range of facilities but it is generally a place where people can go when they no longer need hospital level care but still need supervised recovery time. There is usually a staff of registered nurses, therapists and doctors employed here. For example, after breaking a hip, once a patient is stabilized in the hospital they can leave but it is unlikely they could care for themselves at home. Therefore, they go to a rehab facility where they are retrained in ADLs and allowed to heal while being cared for by professionals. The length of stay is generally much shorter then at a nursing home or assisted living. Another type of rehab facility helps those with drug or alcohol addiction problems. Patients are admitted and are supervised and treated until they are free of addiction and able to function in society.
Specialized Youth Care Facilities: Also known commonly as “group homes,” these facilities offer care to younger people for a variety of reasons. Children or teenagers with special needs who cannot be cared for in the home could stay at this sort of residence. Also, teenagers with mental disabilities or illnesses that cannot be helped or kept safe at home often live in a place like this. For example, there are homes for teenage girls with eating disorders where they can be supervised more closely and treated medically at the same time by healthcare professionals.
The long-term care pharmacy exists to provide medications and other services to these types of facilities. In general, these pharmacies are “closed door”, which means they are not open to the public like a retail or an outpatient pharmacy is. Similar to the retail setting, the pharmacy is separate from the actual care facility, unlike a hospital inpatient pharmacy.
A prescription is received and fulfilled in a unique way at this type of pharmacy. Here is an example of how one long-term care pharmacy processes an order. A prescription can be called in or sent by fax from the nurse or doctor at the care facility, from the doctor’s office, or the hospital. Once the order is received it is reviewed by a group of pharmacy technicians who look for problems and make sure the patient information is in the computer system and updated. Next, it is sent to a department of pharmacy technicians that type the order into the computer system. From there it is checked by a pharmacist, and if everything is correct, sent to another department to be filled. Pharmacy technicians fill the prescription and give it to a pharmacist to be checked for accuracy. Once it is checked, it is sent to another department to be sorted by facility and then packaged and sent to drivers to be delivered.
Obviously, there is a wide range of job duties at this type of pharmacy. The first group of pharmacy technicians to see an order, often called intake or triage, become experts on patient set up, including insurance or Medicare and Medicaid programs. They are on the phone a large part of the day, either calling for billing issues or speaking with the facilities to get more information if needed or to clarify orders. Even though the pharmacy is closed to the public, these technicians require good customer service skills as they spend a large part of their time on the phone with nurses, doctors, insurance companies, etc. They also must have a basic but comprehensive knowledge of medications, as they need to know how to discuss costs and billing problems, and be able to adjust as necessary to insurance requirements.
The prescription is then entered into the computer system by a pharmacy technician. While this group is rarely on the phone, they also need to know billing procedures and have a good knowledge of medications as they are interpreting the prescription. They need to know laws regarding controlled substances and be able to identify doctors. Above all, they must be accurate. This is definitely a desk job as the day is spent entering orders into the computer.
The next group of pharmacy technicians actually fills the prescription. Keep in mind that in this type of pharmacy, it is very rare that a prescription is done all at once, as in retail. For example, in a retail setting, a prescription comes in, is entered in the computer, filled, checked and returned to the patient in a matter of minutes. The same person may complete all these tasks in order. In a long-term care pharmacy, orders come in constantly, are sorted before they are printed and then filled as groups of similar medications. This allows for much greater volume of prescriptions to be filled much faster. For example, an order for a patient may come in with prescriptions for several different tablets, a liquid medication, an I.V. medication and a controlled substance. These would be entered into the computer together but then sent to different stations in the pharmacy to be filled. The liquid medication would be sorted with other liquids, the controlled substance with other controls, etc. They would then be checked by a pharmacist and re-sorted to the correct facility after being sent to the packaging area. Technicians in this area are generally on their feet a majority of the time as they are sorting, gathering, labeling, compounding and other tasks that generally require movement. Technicians could be further separated into departments including one that packages month supplies for a home, or only fills I.V. medications.
After being checked by a pharmacist, the last step for the medication is to be sorted by facility and then packaged for delivery. A pharmacy technician could complete this step but it can be delegated to non-technician personnel, as there is no direct handling of medications. The prepared and labeled medications are simply sorted and bagged then placed for delivery drivers to pick up and take to the various destinations.
Is long-term care pharmacy for you? There are a lot of things to consider. The biggest difference in this pharmacy is the lack of public exposure. The orders come in by phone and fax so you are never face to face with patients. This is considered by most to be a definite advantage to the job but if you enjoy the variety of constant patient interaction this may not be a good choice for you. Also, every pharmacy is different but many times dress code is relaxed because there is no public exposure. Professionalism is definitely stressed no matter what pharmacy you work in but tennis shoes and jeans may be acceptable depending on your site.
Again, while the focus must remain on work, the atmosphere is generally more relaxed when compared to other pharmacy situations. Most retail pharmacies have a counter but beyond that, are open to the public. Many patients who drop off prescriptions are not feeling well and the pharmacy is the last of possibly several stops they have to make. Plus, at the end of waiting for what feels like a very long time to them, they are required to pay you, which makes everyone unhappy. This can make for some intense and often unpleasant encounters, even when you are offering the best customer service possible. Many customers will also urge you to work faster as they are waiting for their prescription, and may do so in a very unpleasant way. This can create a high-pressure environment in the pharmacy, which can last all day if the pharmacy is busy. There is still pressure at a long-term care pharmacy. Many orders need to be delivered as soon as possible and there can still be unpleasant customers on the phone. There can be very busy days where breaks are skipped and there is barely time for bathroom breaks. However, the difference is the lack of exposure. Once the phone is hung up, you can focus and complete the work without anyone watching or urging you on. It is possible to prioritize workflow without offending a customer who may have been there sooner. And on days where there is less work, breaks are usually mandatory and can be taken without a crowd of customers glaring at you for leaving the pharmacy. Conversation between coworkers, while again, needs to maintain professional standards, are possible and can help to relieve stress and encourage productivity and work enjoyment.
On a side note, many people love and work in the retail environment throughout their career. Customers can also be wonderful people whom you can build relationships with and come to look forward to seeing regularly. Especially if you get a good group of coworkers, the retail experience can be full of satisfaction. However, from experience and word of mouth, these situations are usually the exception.
Another unique opportunity offered by the long-term care pharmacy is variation in work opportunity. As discussed, there can be a big difference between the jobs of two different pharmacy techs that work at the same pharmacy. If you prefer moving around throughout the day and do not care for customer service, a job filling prescriptions would fit you well. However, if you prefer a desk and computer situation, you might want to try for the spot entering orders into the computer. Depending on the size of the pharmacy, there may be quite a few different situations, each with different requirements, pay, and probably hours that you could try for. If the pharmacy is very small and services only a few facilities, there will likely be only a few employees and you might be required to learn each of these tasks and actually follow an order from start to finish. However, if you work for a larger operation, you could not only try for one position initially, you could try another one eventually, if the first is not what you wanted. Another consideration in a large pharmacy is that there are often enough pharmacy technicians in a department to need a manager, which could be yet another job opportunity if you prefer. The “I.V.” department offers a setting much more like a hospital where patients are often followed throughout therapy and compounding intravenous medications in a sterile environment is required.
Overall, long term care pharmacy is a unique and often preferred place to work. It offers a variety of employment options for pharmacy technicians in a field that can be very stressful in other situations. Additionally it provides educational situations and positions for advancement that might not be available elsewhere. Technicians in this type of pharmacy cover a vast range of duties including insurance billing, customer service, data entry, identifying and filling all types of oral and controlled medications, intravenous medication and oral medication compounding and more. If you don’t know of one already, investigate in your area; you may be surprised to find a long-term care pharmacy opportunity nearby.