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Authors: Samuel Ubanyionwu, PharmD, BCPS; Stacy Carson, PharmD, BCPS, FISMP; 

Chris Urbanski, BSPharm, MS, FASHP; Madeline Camejo, PharmD, MS; Devlin Smith, PharmD, MS

SAG: Operations & Automation; Workgroup: Get IT Done

Pharmacy technicians are critical members within a health system pharmacy team. They perform many functions that support the medication-use process and overall patient care such as medication inventory management, compounding sterile products, fulfillment of medication orders, billing, patient medication history reviews, and the performance of many other clinical and administrative functions.¹

Several factors have created a national staffing shortage of pharmacy technicians including the Covid-19 pandemic, highly stressful work environments, low salaries, and unclear or unavailable promotional career ladders.^1,2 A recent ASHP survey reported pharmacy technician turnover rates of at least 21% in 2021 by a majority of pharmacy administrators, with 10% noting they had lost 41% or more of their technicians.³

As staffing shortages put a strain on the ability for pharmacy departments to maintain the current level of care, health systems must be creative and use alternative technology solutions to cover tasks and work. These alternatives have a direct impact on pharmacy operations, budget/spend, and patient care. This leads to reassignment of duties to pharmacy technicians in advanced roles, outsourcing aspects of medication preparation, hiring agency/third party staff, use of overtime, and the assignment of technician duties to pharmacists.

Several strategies have been implemented by pharmacy departments to address pharmacy staffing shortages:

Centralized Automated Dispensing Cabinet (ADC) Refills

A health system creates a centralized distribution center staffed by pharmacy technicians and pharmacists for ADC refills. Centralization of resources and functions may create operational efficiencies at the facility level (e.g., improving medication inventory, standardization of NDCs, drug purchasing, and reducing drug waste). This model allows for shared medication inventory across a health system with fewer staff required to do this work.

Regional/Outsourced Parenteral Nutrition (PN) Compounding Model

A regional model utilizes a core team of pharmacy technicians and pharmacists to prepare and compound patient-specific PNs.⁴ This allows one main site to set up and maintain the compounder each day versus multiple sites. An outsourced model utilizes a third-party vendor to compound and deliver PNs to sites.

Artificial Intelligence (AI)

AI has the potential to transform pharmacy operations and improve patient outcomes. AI in pharmacy can help with staffing shortages by automating routine tasks and creating more efficient workflows that free up the pharmacist and technicians to focus on more complex tasks. There are several AI strategies being investigated in the pharmacy space^5,6:

• Medication Management – AI can help assist pharmacists manage medication orders, prioritizing and reducing medication errors.
• Predictive Analytics – AI can analyze patient data to make predictions about disease progression, medication effectiveness and treatment outcomes.
• Inventory Management – AI can help pharmacies optimize inventory levels, reducing waste and ensuring that critical levels are always in stock.

Medication Delivery Robots

Delivery robots may help pharmacies streamline their operations by automating the delivery process (e.g., first doses and stat priority orders). Delivery robots can be leveraged to help reduce the need for manual labor and help free up staff time and resources, allowing your technicians to focus on other important tasks.   

Centralized / Remote Pharmacy Order Verification

Centralized or remote pharmacy order verification refers to a process in which medication orders are reviewed and verified by dedicated pharmacist staff focusing primarily on this task in order to gain economies of scale.⁷ This model provides flexibility to allow coverage within a single facility or across an enterprise for proactive staffing as well as reactive staffing during unexpected staff shortages. Critical access hospitals are excellent candidates for this model when they do not provide 24-hour pharmacist coverage.

Overall, the extent to which technology may be leveraged to assist with mitigating pharmacy staffing shortages has not yet been fully adopted or developed. Existing strategies such as centralization of ADC refill/compounding models, delivery robots, and remote order verification provide an improved level of efficiency although they are only partially adopted due to varying differences among health system operations strategies. Truly transformative technologies, such as those involving artificial intelligence, provide a promising look into what the future of pharmacy may hold. Pharmacy leaders managing staff shortages should identify potential areas of technologic opportunity within their system’s operational workflows to best align staff and automation where each can provide their maximum value to patient care. 

REFERENCES

1. George M. Pharmacy technician shortage causes strain in hospital and retail pharmacies. The State News. 2023 Feb 10. Accessed Mar 17, 2023.  https://statenews.com/article/2023/02/pharmacy-technician-shortage-causes-strain-in-hospital-and-retail-pharmacies?ct=content_open&cv=cbox_latest#:~:text=A%20national%20staffing%20shortage%20of,virus%20in%20a%20healthcare%20setting.
2.  Hennessy M. Pharmacy Technician Shortage is Critical.  Pharmacy Times. 2022 Nov 1. Accessed Mar 17, 2023. https://www.pharmacytimes.com/view/pharmacy-technician-shortage-is-critical
3. Pharmacy technician shortage survey findings executive summary. American Society of Health-System Pharmacy. March 2020. Accessed Mar 17, 2023. https://www.ashp.org/-/media/assets/pharmacy-technician/docs/Technician-Shortage-Survey-Exec-Summary.pdf
4. Bracero D, Pagan LC, Rowe A, Cassano AT. Centralized insourcing of sterile compounding: One multihospital health system’s journey. Am J Health-Syst Pharm. 2022 Jul 22;79(15):1281-1289.
5. Schutz N, Olsen CA, McLaughlin AJ, et al. ASHP statement on the use of artificial intelligence in pharmacy. Am J Health Syst Pharm. 2020;77(23):2015-2018.
6. Cech, Laura. “Sepsis-Detection AI Has the Potential To Prevent Thousands of Deaths.” Hub.jhu.edu July 2021. https://hub.jhu.edu/2022/07/21/artificial-intelligence-sepsisdetection/
7. ASHP Expert Panel on Remote Medication Order Processing, Thompson B, Conrad G, et al. ASHP guidelines on remote medication order processing. Am J Health Syst Pharm. 2010;67(8):672-677.