Why should pharmacies develop work standards for pharmacy technicians? What is a work standard?

By: Erica Ellis, Application Consultant

As an Industrial Engineer, I have a unique perspective on how work is done in a pharmacy.  Whether it is inpatient, outpatient, long-term care, mail order, etc. each pharmacy has specific processes that must be completed by both pharmacists and technicians in order to deliver medications to its patients. Many of the pharmacies I work with are searching for ways to make their processes safer and more efficient for their employees and patients.

One of the areas that pharmacies frequently overlook in the search for improvement is the area of Standard Work.  Standard Work is an agreed upon set of work procedures that effectively combines people, materials, and machines to maintain quality, efficiency, safety, and predictability. Work is described precisely in terms of cycle time, work in process, sequence, time, layout, and the inventory needed to conduct the activity. Standard work begins as an improvement baseline and evolves into a reliable method. It establishes the best activities and sequence steps to maximize performance and minimize waste.¹

The concept of Standard Work has three major applications that pharmacy personnel can use to justify its implementation:

1. Reduction of errors / Easily identifying source of errors
2. Decreased training time for new technicians
3. Creation of baseline metrics for future process improvements

In the pharmacy world, we often focus on errors.  They are the most costly and the most dangerous to our patients.

Many pharmacies do have Standard Operating Procedures or policies about work methods for their staff. These documents are generally written to a broad audience and do not contain detailed work methods for standardizing how work is performed amongst the different people assigned the job.

For example, on a recent visit to a pharmacy I observed the process used by technicians to fill Multi-Dose Blister cards (commonly referred to as Bingo cards) for a long-term care facility.  There were three technicians assigned the task of prefilling cards for dispensing.

• Technician A began by creating labels and attaching them to the cards, finding the stock bottles, then dispensing the tablets into the cards and sealing.
• Technician B found the stock bottles, filled the cards and sealed, then printed the labels and attached to the cards.
• Technician C found the stock bottles, printed the labels, filled and sealed the cards, then attached the labels.

What the pharmacy manager needs to ask in this situation is “what is the best and safest way to perform this task?”, then ensuring the technicians are properly trained in the specific tasks in a way to reduce the possibility of errors and increase the efficiency of the task.  Work standards dictate each step in the process, for example:

1. Find stock bottle for product order and obtain sufficient quantity to fulfill the order.
2. Take stock bottle(s) to work area and produce labels.
3. Attach labels to empty cards.
4. Fill blister cards using appropriate technique to prevent cross-contamination and seal.
5. Place finished batch in pharmacist check queue for verification.

By implementing a standardized process for technicians, the pharmacist can more easily identify the step where an error occurred because each technician is performing the same operations in the same order using the same method.

This leads into training time for the technicians and pharmacists.  When work standards are used, there is one consistent process that each person needs to follow.  The work standard is a written description of how a process should be done.  It guides the consistent execution of tasks and the documented activity enables trainers to more easily train the workers on the given task. Workers also have references for future questions about specific tasks they are to perform.

Finally, by establishing such standards and confirming each technician is following these standards, the pharmacy manager can then begin to look further into different process improvements in the pharmacy built upon the baseline metrics that can come out of work standards. This includes areas of inventory management, sequence, and turn-around time.

Every pharmacy manager is looking for ways to improve. Implementing Work Standards could be one step to take to move towards future improvements.

1. Standard Work for the Shopfloor. (2002). New York: Productivity Press.