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1 Towrd uniform stndrds for phrmcy technicins: Summry of the 2017 Phrmcy Technicin Stkeholder Consensus Conference Am J Helth-Syst Phrm. 2017; 74: e Willim A. Zellmer, B.S.Phrm., M.P.H., Phrmcy Foresight Consulting, Bethesd, MD. Everett B. McAllister, B.S.Phrm., M.P.A., Phrmcy Technicin Certifiction Bord, Wshington, DC. Jnet A. Silvester, Phrm.D., M.B.A., FASHP, Americn Society of Helth- System, Bethesd, MD. Peter H. Vlsses, Phrm.D., D.Sc. (Hon), FCCP, Accredittion Council for Phrmcy Eduction, Chicgo, IL. Address correspondence to Mr. McAllister (emcllister@ptcb.org). Keywords: consensus conference, phrmcy technicin certifiction, phrmcy technicin eduction, stte regultion of phrmcy technicins, uniform ntionl stndrds for phrmcy technicins This rticle will pper in the September 1, 2017, issue of AJHP. Copyright 2017, Americn Society of Helth-System, Inc. All rights reserved /17/0000-0e377. DOI /jhp In pursuit of pth towrd resolving unsettled issues relted to phrmcy technicins, the Phrmcy Technicin Certifiction Bord (PTCB) sponsored stkeholder consensus conference on Februry 14 16, 2017, in Irving, Texs. Plnned in collbortion with the Accredittion Council for Phrmcy Eduction (ACPE) nd the Americn Society of Helth-System (ASHP) nd under the guidnce of n dvisory committee representing ll mjor brnches of phrmcy, this invittionl event yielded importnt recommendtions concerning the definition, eduction, b entry-level requirements, dvnced prctice, certifiction, nd regultion of phrmcy technicins. The 89 invited prticipnts in the conference (eappendix A, vilble t included phrmcists nd technicins from vrious types of prctice nd eductionl settings, phrmcy ssocition executives, regultors, nd representtives of the generl public. Approximtely 350 individuls prticipted remotely in the plenry sessions of the conference through Web link. c Design of the conference In consulttion with the dvisory committee, the conference plnners estblished objectives for the event (sidebr), designed preconference survey tht ws sent to phrmcy opinion leders nd conference prticipnts, estblished the event gend, selected spekers, identified invitees, nd recommended redings for prticipnt review in dvnce of the event. (Some key redings re cited here. 1-4 ) Individuls engged in plnning nd conducting the conference re listed in eappendix B, vilble t The progrm consisted of 5 plenry sessions (ech focused on seprte fcets of the conference objectives), 3 work-group sessions (during which conferees divided into 4 groups to discuss specific issues nd drft relted recommendtions), nd finl session for polling of conference ttendees on level of greement or disgreement with recommendtions from the work groups. Conference opening Everett B. McAllister, chief executive officer nd executive director of PTCB, reviewed the objectives of the conference nd referred to the struggles bords of phrmcy, technicin eductors, nd employers fce... prtly becuse we don t hve good creer pln for technicins. He dded, The time hs come to identify relistic nd chievble pthwys for technicins tht support mediction sfety nd protect our ptients. Commenting on PTCB s decision to suspend implementtion of its 2020 ccredited-eduction requirement for Conference Objectives The im of the conference ws to explore consensus on 1. The necessity of public confidence in phrmcy s process for ensuring the competency of phrmcy technicins. 2. An optiml level of bsic ( generlist ) knowledge, skills, nd bilities tht phrmcy technicins should hve regrdless of prctice site. 3. An optiml definition of entrylevel (generlist) phrmcy technicin prctice with respect to () leglly recognized scope of prctice, (b) eductionl requirements, (c) trining requirements, (d) certifiction requirements, nd (e) stte bord of phrmcy registrtion or licensure. 4. The desirbility nd fesibility of developing process for recognizing competencies of phrmcy technicins beyond entry-level prctice. 5. The desirbility nd fesibility of minimizing vribility mong the sttes in the definition nd regultion of phrmcy technicins. 6. The entities tht potentilly could tke responsibility for ny chnges in phrmcy s process for ensuring the competency of phrmcy technicins. e377

2 Conference Advisory Committee Json Ausili, Phrm.D. Director, Phrmcy Affirs Ntionl Assocition of Chin Drug Stores Mlcolm Broussrd, B.S. Louisin Bord of Phrmcy Al Crter, Phrm.D., M.S. Senior Director, Phrmcy Regultory Affirs CVS Helth Chrles E. Dniels, B.S.Phrm., Ph.D. Phrmcist-In-Chief nd Associte Den University of Cliforni Sn Diego Kenneth Mrk Ey, B.S.Phrm. Vice President of Opertions CARE Phrmcies Coopertive Dine Hlvorson, RPhTech, CPhT Led Phrmcy Technicin Vibr Hospitl Frgo Phrmcy Technicin Member North Dkot Stte Bord of Phrmcy Timothy R. Koch, B.S.Phrm., P.D., C.H.C. Senior Director, Phrmcy Prctice Complince Wlmrt Corporte Office Jnet M. Liles, M.S., CPhT Phrmcy Technicin Eductors Council Scott A. Meyers, B.S.Phrm., M.S., FASHP Executive Vice President Illinois Council of Helth-System Mtthew Osterhus, B.S.Phrm. Coowner Osterhus Phrmcy Jon Roth, B.S., M.S., FAPhA, FASHP Chief Executive Officer Cliforni Assocition Steve Rough, B.S.Phrm., M.S., FASHP Director of Phrmcy University of Wisconsin, Mdison School of Phrmcy Rfel Senz, Phrm.D., M.S., FASHP Administrtor, Phrmcy Services University of Virgini Helth System helthcre system, the profession, nd ptients. (The full text of Moné s remrks is published in AJHP. 6 ) Christopher Jerry, hed of the Emily Jerry Foundtion, spoke from the public perspective nd drew on the personl trgedy of hving lost young dughter to ftl compoundtechnicins seeking PTCB certifiction, 5 McAllister sid tht the results of the conference will help determine future plns for PTCB progrm chnges. Frming key issues Two spekers frmed the key issues of the conference from seprte perspectives those of the phrmcy profession nd the public. The first perspective ws provided by Michel A. Moné, vice president t Crdinl Helth, president of the Ohio Bord of Phrmcy, nd member of the ACPE bord of directors. Moné sid, must fcilitte the dvncement of phrmcy technicins... further enbling phrmcists to chieve their rightful plce s helthcre providers. Commenting on the profession s obligtion to ssure the public of the competency of technicins, Moné remrked, The process of providing the public with... gurntees of trustworthiness lredy exists in the form of the ccredittion, eduction, exmintion, nd licensure model tht is pplied to phrmcists. He concluded, Our chrge t this conference is to come to consensus [on wht the public expects], how to meet those expecttions, nd wht we must implement in order to deliver the vlue we promise to the KEY POINTS A ntionl consensus conference engged ll sectors of phrmcy in identifying points of greement regrding entry-level requirements for phrmcy technicins. Stte vribility in the regultion of phrmcy technicins poses risks for ptients nd the profession of phrmcy. Conferees were polled on their extent of greement or disgreement with 59 sttements relted to unsettled phrmcy technicin issues. Conferees greed tht tsk nlysis should be the bsis for ccredited technicin eduction, technicin certifiction, nd stte regultion of technicins. Conferees recommended the cretion of brod colition to pursue the recommendtions of the conference. Optimizing the contributions of technicins in phrmcy prctice ws the theme of tlks by Michel A. Moné (left), speking from the perspective of the phrmcy profession, nd Christopher Jerry, speking from the public-interest perspective. e378

3 ing error by phrmcy technicin. Commenting on the history of phrmcy-relted mediction errors, Jerry sid tht opportunities for such errors re likely to increse given the risks ssocited with new medictions nd the expnded use of medictions. Jerry sid tht lthough the public expects ll helthcre workers to be well educted, this bsic expecttion is not being met in the cse of phrmcy technicins. He ws criticl of the fct tht there re no uniform stte requirements for ensuring the competency of technicins, which he ttributed in prt to lck of public wreness bout the scope of technicin responsibilities. Jerry sid tht uniformly trined, competent phrmcy technicins would free up phrmcists to provide more ptient consulttions, which re proven to reduce mediction errors. Insights from preconference surveys Willim A. Zellmer, consultnt who helped pln the conference, summrized the results of the preconference surveys. The opinion-leder survey showed strong greement, cross ll sectors of phrmcy, with 7 sttements; these sttements were considered foundtionl precepts for the conference (sidebr). The 9 survey items tht hd substntil vribility in level of greement mong sectors of phrmcy were tken into ccount when plnning the gend of the conference. Zellmer sid tht the comments mny respondents mde to supplement their nswers to the survey suggest tht there is room for finding common ground on unsettled technicin issues. Snpshots of the phrmcy technicin workforce Updted PTCB job nlysis. The director of certifiction progrms t PTCB, Levi Boren, discussed PTCB s 2016 technicin job nlysis, which will be used in guiding test content nd requirements for the Certified Phrmcy Technicin credentil. More thn 44,000 phrmcy technicins nswered 1 of 2 surveys in the job nlysis, which ssessed how frequently specific tsks re performed nd probed the importnce of specific knowledge, skills, bilities, nd other chrcteristics (KSAOs) in performing the work of technicins. Bsed on the job nlysis, questions in future editions of the Phrmcy Technicin Certifiction Exmintion will be distributed cross 4 domins: medictions (40%), ptient sfety nd qulity ssurnce (26%), order entry nd processing (21%), nd federl requirements (13%). (The cur- Everett B. McAllister (t the lectern) moderted the pnel discussion on snpshots of the phrmcy technicin workforce. Seted (left to right) re Levi Boren, Willim Schimmel, Jnet Silvester, nd Json Ausili. Foundtionl Precepts for the Conference,b 1. Phrmcy supportive personnel encompss different types of workers, rnging from individuls with clericl duties to individuls (phrmcy technicins) who ssist phrmcists with their professionl responsibilities. c 2. The profession of phrmcy hs n obligtion to mke certin tht phrmcy technicins re educted nd regulted in mnner tht ensures public sfety. 3. In the interest of public sfety, stte bords of phrmcy hve n obligtion to regulte the scope of prctice of phrmcy technicins. 4. In the interest of public sfety, stte bords of phrmcy hve n obligtion to estblish the minimum qulifictions of phrmcy technicins. d 5. In the interest of public sfety, stte bords of phrmcy hve n obligtion to define the nture of licensed-phrmcist oversight of phrmcy technicins. e 6. There re generlist (entry-level) knowledge, skills, nd bilities tht ll phrmcy technicins should hve, regrdless of prctice site. f 7. Additionl certifiction progrms should be developed to llow phrmcy technicins to demonstrte competence beyond entry level. Bsed on preconference survey of phrmcy opinion leders. Recipients of this survey were selected by member orgniztions of the Joint Commission of Phrmcy Prctitioners. b There ws t lest 90% greement with these 7 items mong respondents (except s noted in footnotes c f) in the following phrmcy sectors: independent phrmcies (42 respondents), chin drugstores (38), hospitl phrmcies (128), eductionl institutions (90), regultory gencies (29), nd phrmcy ssocition stff (24). c 89% of respondents from chin drugstores greed with this item. d 87% of respondents from ssocitions greed with this item. e 84% of respondents from chin drugstores greed with this item. f 83% of respondents from ssocitions greed with this item. e379

4 rent exm hs 9 domins.) The new exm will focus only on core KSAOs relevnt to entry-level prctice in both of the lrgest sectors of phrmcy community/retil nd hospitl/ helth-system prctice. PTCB will nlyze the job nlysis results to ssess the pproprite precertifiction eductionl requirements. Boren sid tht PTCB intends to develop future certifiction progrms in dvnced community phrmcy prctice nd sterile compounding. Trends in technicin eduction. ASHP s vice president of ccredittion services, Jnet A. Silvester, pointed out tht there is no single defined pth for n individul to prepre to become phrmcy technicin, nd there is no uniform ntionl eductionl requirement. Most phrmcy technicins hve received primrily on-thejob trining. This is in shrp contrst to the eductionl requirements for comprble helthcre occuptions (e.g., clinicl lbortory technicin, 2 4 yers of eduction; dentl ssistnt, 1 2 yers; physicl therpy ssistnt, 2 yers). Accredited distnce-eduction progrms for phrmcy technicins re incresing ccess to stndrdsbsed eduction. The ccredittion stndrd ws recently mended for flexibility relted to the number of experientil sites nd the phrmcy compounding requirement. The 271 ccredited progrms re estimted to represent bout one fourth of phrmcy technicin eduction progrms. Accredited progrms grdute pproximtely 18,000 technicins per yer; bsed on 2016 ASHP survey, these progrms pper to hve cpcity to expnd enrollment by 60%. Technicin eduction by chin drugstores. The director of phrmcy ffirs for the Ntionl Assocition of Chin Drug Stores (NACDS), Json Ausili, reported on smll survey of NACDS members. Among the 24 respondents, 3 sid they used primrily n ccredited progrm for educting technicins, 12 used primrily stndrdized nonccredited on-the-job trining, nd 9 provided on-the-job trining (no stndrdiztion indicted). Sixteen respondents indicted tht the number of cndidtes for technicin positions ws insufficient to meet their business needs. With respect to the turnover rte mong technicins, 10 respondents sid it ws nonissue; 9, mngeble issue; nd 5, excessive. Fifteen respondents sid tht their needs were not being met with respect to hiring educted technicins. Optiml requirements for entry-level prctice Optiml requirements for phrmcy technicins in entry-level prctice ws ddressed by (left to right) Tim Koch, Rfel Senz, nd Mtt Osterhus. Three spekers from different sectors of phrmcy ddressed the question, Wht knowledge, skills, nd bilities must be chieved by individuls who wish to be credentiled s phrmcy technicin for entry-level prctice? The gols in the ccredittion stndrds for phrmcy technicin eduction were point of reference for their remrks. 7 Timothy R. Koch, senior director of phrmcy prctice complince for Wlmrt, explined tht his compny hs 2 types of technicin eduction progrms: 1 designed specificlly to stisfy its business needs (160 hours didctic, 80 hours experientil, 3.5 hours simulted skills development) nd nother ccredited by ASHP ACPE (minimum of 160 hours didctic, 80 hours simulted skills development, 160 hours experientil eduction, nd 200 hours llocted mong didctic, simulted, nd experientil eduction). The didctic portion of both progrms is the sme. The ccredited progrm, which is used to meet requirements in 2 sttes, mndtes eduction in sterile compounding, which is not relevnt to the compny s current or future retil phrmcy opertions, ccording to Koch. He sid tht the requirements for the ccredited progrm hve helped the compny improve its shorter, primry progrm. Becuse of the certifiction success rte of grdutes of the shorter progrm, it hs not been fesible to justify ccredited eduction for ll technicins. Koch voiced support for stndrdiztion of entrylevel eduction for technicins but not t the level required in the current ccredittion stndrds. He supported technicin certifiction but expressed doubt bout the necessity of the full scope of knowledge, skills, nd bilities currently covered in the certifiction exm. He sid tht registrtion or licensure of technicins should bsolutely be required. Rfel Senz, dministrtor of phrmcy services t the University of Virgini Helth System, bsed his remrks on the belief tht the vlue of phrmcists lies primrily in their bility nd time spent in direct ptient cre, touching ptients, ptient eduction, nd ensuring better ptient outcomes. From the perspective of e380

5 phrmcy prctice leder who wnts to free up phrmcists for ptient cre, Senz outlined technicin knowledge nd skills in must hve nd like to hve ctegories. Noting tht it is common for phrmcy technicins to move from one sector of prctice to nother, he rgued tht fundmentl concepts in the compounding of nonsterile, sterile, nd chemotherpy/ hzrdous products should be included in entry-level eduction. Senz sid he believes the vrious sectors of prctice re not fr prt in their thinking bout single entry-level stndrd for phrmcy technicin eduction, certifiction, nd registrtion. Mtthew Osterhus, phrmcist nd owner of n independent phrmcy in smll community in Iow, sid tht personl nd interpersonl skills of phrmcy technicins re very importnt in his prctice setting. Other vitl skills include professionl knowledge nd the processing nd hndling of mediction orders. Not required for entry-level prctice in his setting re eduction in ntomy, physiology, nd phrmcology nd understnding of issues in the profession, nontrditionl roles, emerging therpies, nd sterile nd nonsterile compounding. Osterhus believes tht tech-checktech, mediction reconcilition, ssistnce with mediction therpy mngement, nd compounding should be considered dvnced technicin prctice. He stted tht vribility in the needs mong prctice sites must be considered when estblishing stndrds for technicin eduction. Osterhus indicted support for certifiction nd stte registrtion for entry-level prctice; he suggested tht dd-on credentils should be developed for compounding nd hndling durble medicl equipment. regultory ffirs for CVS Helth, discussed the rnge of prctice settings (nd the relted vriety of technicin responsibilities) in his compny: retil stores (dispensing), specilty phrmcies (dispensing nd collbortion with phrmcists nd ptients on clinicl issues), home infusion (compounding), nd mil order (centrl processing nd dispensing). Potentil dvnced responsibilities for technicins in lrge corporte phrmcy environments include tech-check-tech, ccepting orl orders, trnsferring prescriptions, remote order processing, point-of-cre testing, nd vccine dministrtion. Crter sid there would be immense vlue in greter uniformity mong the sttes in how they ddress technicin issues. He sked the udience to consider whether the time will come when technicins hve uthority to perform whtever tsks phrmcists delegte to them. Dn Luce, ntionl director of phrmcy ffirs for Wlgreens, discussed potentil dvnced roles for phrmcy technicins bsed on his perspectives s chin drugstore executive nd former bord of phrmcy member. He stted tht mny experienced technicins re cpble of performing dvnced roles in phrmcy deprtment mngement, using brcode technology for product verifiction, triging phrmcistdministered services, dministering vccines, nd mnging cll centers nd centrlized dispensing opertions. Luce sid tht fers bout potentil phrmcist job loss nd compromised sfety stemming from n incresed technicin-to-phrmcist rtio hve proved to be unfounded in sttes where rtios hve incresed. He suggested tht it my be necessry to estblish eduction nd credentiling requirements for dvnced-prctice technicins to ddress concerns tht regultors or legisltors re likely to hve bout expnding technicins scope of prctice. Advnced roles would help with creer development mong technicins nd llow phrmcists to focus to greter extent on ptient cre. He sked rhetoriclly if phrmcy will be redy to llow phrmcists to delegte ny nonjudgmentl tsk to technicins nd, if tht is done, who will hold libility for the technicins work. Steve Rough, director of phrmcy t University of Wisconsin Helth, described the 700-hour ccredited technicin eduction progrm t his helth system. The helth system s 4-level creer ldder for technicins is designed to foster professionl commitment nd provide incresed compenstion s individuls tke on more responsibility. Trining is provided for technicins who desire to dvnce to higher level. Rough dvocted (1) ccredited eduction, certifiction, nd licensure for ll technicins, (2) certifiction s prerequisite for dvnced prctice, (3) mintennce of entry-level certifiction fter moving into dvnced prctice, nd (4) development of credentils (ccredited Advnced phrmcy technicin prctice Four spekers discussed dvnced phrmcy technicin prctice, including whether relted stndrds nd credentils should be developed. Al Crter, senior director of phrmcy Left to right, Al Crter, Dn Luce, Steve Rough, nd Anthony Pudlo spoke on opportunities relted to dvnced technicin prctice. e381

6 eduction nd certifiction) for dvnced roles. He suggested tht some supportive positions in phrmcy tht do not involve hndling medictions could be given title other thn technicin (e.g., phrmcy clerk ) in the interest of moving towrd consensus. Anthony Pudlo, vice president of professionl ffirs for the Iow Phrmcy Assocition, described the demonstrtion project in his stte to ssess tech-check-tech (more ppropritely designted s technicin product verifiction ) in the community phrmcy prescription dispensing process. Thus fr in the reserch, there hs been no difference in error rte compred with bseline, nd greter phrmcist time hs been devoted to ptient cre ctivities. Community phrmcists in Iow, through multiple venues, re experiencing incresed opportunities for pyment for ptient cre services, nd they will require more time for providing such services, which wrrnts n expnsion of technicin product verifiction. Becuse of the success of the demonstrtion project, legisltion will be pursued to expnd phrmcy technicin product verifiction to include community phrmcy prctice in Iow. Models for moving forwrd Susn Jmes, director of competence progrms for the Ontrio College of ( registering nd regulting body for phrmcy), ws Peter Vlsses (t the lectern) moderted the pnel discussion on models for moving forwrd on phrmcy technicin issues. The spekers were (left to right) Susn Jmes, Dine Hlvorson, Mlcolm Broussrd, nd Alex Adms. the led speker on pnel showcsing how certin provinces or sttes hve dvnced their requirements for phrmcy technicins. As the result of process tht begn round 2005, phrmcy technicins in Ontrio now must complete ntionlly ccredited eduction progrm (minimum of 940 hours) nd pss ntionl entry-toprctice exmintion. 8,9 Phrmcy technicins ( title restricted to registered individuls) re ble to perform ll technicl spects of product preprtion nd drug distribution, including independent checking of the finl product for relese to the ptient; they re held ccountble s utonomous helth professionls. Technicins re not llowed to provide therpeutic or clinicl services tht re within the scope of the phrmcist. Phrmcies in Cnd re estimted to employ bout 8 times s mny phrmcy ssistnts s phrmcy technicins; there re no stndrds for phrmcy ssistnts. Phrmcy technicins cn check nd mnge the work of phrmcy ssistnts. Dine Hlvorson, led phrmcy technicin t Vibr Hospitl, Frgo, nd member of the North Dkot Stte Bord of Phrmcy, sid tht it ws through the ledership of phrmcy technicins tht her stte ws ble to chieve mndtory ccredited eduction nd mndtory PTCB certifiction for registered technicins. The stte is pursuing n expnsion of technicin roles relted to the screening nd dispensing of prescription refills. She urged the Ntionl Assocition of Bords of Phrmcy to include explicit stndrds for phrmcy technicin scope of prctice, eduction, nd certifiction in its model stte phrmcy ct. Bsed on North Dkot s experience, Hlvorson sid tht in order to move towrd uniform ntionl stndrds, phrmcy technicins should be n ctive prt of the chnge process, nd there should be shrp focus on ptient sfety. Mlcolm Broussrd, executive director of the Louisin Bord of Phrmcy, noted tht his stte will require (effective Jnury 2018) ccredited eduction nd PTCB certifiction for registrtion s phrmcy technicin. He suggested tht the wy forwrd, ntionlly, will depend on the nswers to 3 questions: (1) Wht phrmcy tsks should be restricted to phrmcists? (2) Wht phrmcy tsks should be restricted to phrmcists or technicins? nd (3) Should the stndrds for technicin eduction cover the gmut of technicin roles or should distinction be mde between entry-level tsks nd dvnced tsks? Broussrd sid tht phrmcy should hve only 1 ccredittion process for technicin eduction nd only 1 certifiction process. Alex Adms, executive director, Idho Stte Bord of Phrmcy, discussed his stte s recent expnsion of the scope of prctice for certified technicins. In mking its chnges, Idho considered evidence tht 44% of phrmcists time ws spent on tsks tht could be delegted to competent technicins. Tsks tht phrmcists re permitted to delegte to certified technicins (in some cses requiring specil trining) re in 2 ctegories: mediction dispensing support (ccept orl prescriptions, clrify technicl elements of prescriptions, trnsfer prescriptions, serch the prescription drug monitoring progrm dtbse, nd perform finl verifiction of filled prescriptions tht hve undergone drug-use review by phrmcist) nd e382

7 technicl support for phrmcist clinicl services (dminister vccines, dminister simple [Clinicl Lbortory Improvement Amendment-wived] clinicl tests, conduct bsic physicl ssessments, nd conduct mediction histories). Consensus recommendtions Four work groups involving ll invited conferees met in 3 sessions throughout the conference to formulte recommendtions on issues relted to phrmcy technicins. Ech group hd blnced representtion from ll sectors of phrmcy nd ws led by fcilittor recorder tem. The topic ssignments were the sme for ll groups. After the lst work group session, the fcilittor recorder tems met with other conference stff to consolidte nd prepre recommendtions for polling. At the finl plenry session, prticipnts indicted their level of greement or disgreement with 59 recommendtions creted by the work groups. Using Web-bsed ppliction, polling ws conducted on 4-point scle: strongly gree, gree, disgree, or strongly disgree. d,e The polling results re presented in Tbles 1 7. f Defining phrmcy technicins. Most conferees greed with the need to crete legl definition of phrmcy technicins (Tble 1, items 1.1 nd 1.2) nd to restrict the use of tht occuptionl title to those who hve met specified qulifictions (item 1.3). In considertion of 2 lterntive pproches for technicin tsk nlyses (s the bsis for ntionl stndrds), there ws greter support for n inclusive ll-settings ssessment (item 1.4) versus seprte ssessments for different sectors of prctice (item 1.5). Eduction of phrmcy technicins. Most conferees greed tht ntionl stndrds should guide technicin eduction (Tble 2, item 2.1) nd tht technicin eduction progrms should be ccredited (item 2.4). There ws further greement tht the ntionl stndrds should focus on the outcomes of eduction, llowing certin degree of progrmmtic flexibility in how those outcomes re chieved (item 2.5). Entry-level knowledge, skills, nd bilities. Conferees voted on the specific knowledge, skills, nd bilities tht should be chieved by those who wish to be credentiled s phrmcy technicin for entry-level prctice (Tble 3). These domins pply to eduction nd to competency ssessment (certifiction) of phrmcy technicins. All of the 18 res polled received mjority greement, but bout one third of conferees disgreed with 2 res demonstrte understnding of nontrditionl roles (item 3.5) nd billing (item 3.12). Certifiction of phrmcy technicins. There ws strong support for requiring ntionl certifiction of technicins hed of stte bord of phrmcy registrtion or licensure (Tble 4, item 4.1), nd there ws cler disgreement tht this should be done without specified eductionl requirement (item 4.2). Mintennce of ntionl certifiction s requirement for continued registrtion or licensure ws supported (item 4.3). Stte lws nd regultions on phrmcy technicins. Nerly ll conferees greed tht vribility in stte regultions regrding technicins should be minimized (Tble 5, item 5.1) nd tht technicin prctice should be under the purview of the phrmcist (item 5.5). Most conferees greed tht ntionl stndrds should not prevent sttes from innovting nd expnding technicins scope of Tble 1. Defining Phrmcy Technicins: Results of Conference Polling Issue 1.1 The profession of phrmcy should develop contemporry definition of entry-level phrmcy technicins tht differentites them from other phrmcy supportive personnel. 1.2 Stte bords of phrmcy should dopt stndrdized terminology tht defines different ctegories of phrmcy supportive personnel nd their ssocited scope of work. 1.3 Stte bords of phrmcy should protect the title of phrmcy technicin, ensuring tht only those tht hve completed required eduction my use the title. 1.4 A ntionl tsk nlysis should be used to inform the development of ntionl stndrds, in n objective nd dt-driven mnner, relted to the competencies/credentils of entry-level phrmcy technicins. 1.5 A seprte tsk nlysis of phrmcy technicins should be conducted within different phrmcy prctice sectors to develop cross-wlk process for determintion of common core competencies. % Respondents Agree Agree Disgree Disgree The number of respondents for polling items rnged from 65 to 75. For some items, percentges do not totl 100% becuse of rounding. e383

8 Tble 2. Phrmcy Technicin Eduction: Results of Conference Polling Issue 2.1 The profession of phrmcy should move urgently towrds the development nd doption of ntionl stndrds for phrmcy technicin eduction. 2.2 The profession of phrmcy should set trget for implementtion of the ntionl stndrd for phrmcy technicin eduction t 3 to 5 yers fter doption of the stndrd. 2.3 Technicin eduction progrms should be bsed on ntionl stndrds, be foundtionl cross ll prctice settings, nd provide room for innovtion nd flexibility. 2.4 Technicin eduction progrms should be ccredited nd bsed on defensible stndrds developed using stkeholder input, tking into ccount diversity of prctice environments. 2.5 In the development of ntionl stndrds for technicin eduction, there should be focus on outcomes nd flexibility in terms of process. 2.6 The number of required eduction hours for phrmcy technicins should be determined bsed upon the defined entry-level core knowledge, skills, nd bilities. 2.7 The entrustble professionl ctivities tht cn be performed by n entry-level phrmcy technicin fter completion of stndrdized eduction progrm should be defined. 2.8 Employees seeking the entry-level phrmcy technicin designtion should be required to complete ntionlly ccredited eduction progrm. (See lso item 4.2.) 2.9 Employees seeking the entry-level phrmcy technicin designtion should be considered technicins-in-trining during the period of completion of eduction nd certifiction, ll of which must be completed in less thn 2 yers. % Respondents Agree Agree Disgree Disgree The number of respondents for polling items rnged from 65 to 75. For some items, percentges do not totl 100% becuse of rounding. prctice beyond estblished entry-level stndrds in the interest of improving ptient sfety nd cre (item 5.3). Advnced phrmcy technicin prctice. Conferees generlly greed tht the profession of phrmcy s immedite priority, with respect to technicin issues, should be development of stndrds relted to entry-level eduction (Tble 6, item 6.2) nd tht dvnced roles for technicins (nd relted eduction nd credentils) will evolve over time (items 6.3 nd 6.4). Moving forwrd on phrmcy technicin issues. All prticipnts in the polling greed tht the conference plnners should estblish colition of stkeholders to pursue the consensus recommendtions from the conference (Tble 7, item 7.5). Most conferees greed tht prticipnts in this stkeholder event hve responsibility to work towrd chieving the consensus recommendtions (item 7.7). Conference wrp-up The following 5 conferees offered brief reflections on the conference: Anthony Provenzno (vice president, phrmcy complince nd government ffirs, Albertsons Compnies), Lis Schwrtz (senior director, professionl ffirs, Ntionl Community Assocition), Chrles Dniels (phrmcist-in-chief nd ssocite den, University of Cliforni Sn Diego), Jnet Liles (executive director, Phrmcy Technicin Eductors Council), nd Crmen Ctizone (executive director, Ntionl Assocition of Bords of Phrmcy). They commented on the event s vlue in cndidly exploring unsettled issues nd reching conceptul greement on importnt chnges tht should be pursued relting to the eduction, certifiction, nd registrtion or licensure of phrmcy technicins. They emphsized the urgency of building on this stkeholder consensus event nd not llowing momentum to diminish. Representtives of the conference plnning orgniztions Everett B. McAllister, Jnet A. Silvester, nd Peter H. Vlsses (ACPE executive director) thnked the prticipnts for their constructive enggement nd expressed commitment to mrshling forces for pursuing the chnges identified t the conference in the interest of ptient sfety nd phrmcy s service to the public. e384

9 Tble 3. Required Knowledge, Skills, nd Abilities of Entry-Level Phrmcy Technicins: Results of Conference Polling Issue % Respondents Agree Agree Disgree 3.1 Personl nd interprofessionl knowledge nd skills Professionl knowledge nd skills Clcultions Bsic phrmcology Demonstrte understnding of nontrditionl roles Processing orders Ptient nd mediction sfety Understnding sterile nd non-sterile compounding Mediction use process Screen prescriptions for completion nd ccurcy, but not crossing the line into clinicl topics such s drug interctions, dosge rnges, etc Informtion technology in generl nd in the context of mediction sfety elements Disgree Billing Qulity principles Regultory Mintennce of confidentility Ability to reconstitute nd compound simple non-sterile preprtions using USP s definitions Proper hndling of hzrdous drugs Inventory mngement The number of respondents for polling items rnged from 65 to 75. For some items, percentges do not totl 100% becuse of rounding. Tble 4. Certifiction of Phrmcy Technicins: Results of Conference Polling Issue 4.1 Stte bords of phrmcy should require new phrmcy technicins to obtin ntionl certifiction for registrtion or licensure. 4.2 Entry-level phrmcy technicins should be required to complete ntionl phrmcy technicin certifiction progrm, without specified eduction requirement. (See lso item 2.8.) 4.3 Stte bords of phrmcy should require phrmcy technicins to mintin ntionl certifiction for continued registrtion or licensure. 4.4 PTCB should initite converstions with bords of phrmcy regrding the recent updtes in the PTCB exm blueprint, i.e., the decresed number of domins from nine to four, nd the modifiction in the level of emphsis on sterile compounding. 4.5 Stte bords of phrmcy should provide system to recognize experienced phrmcy technicins while not compromising the bsic competencies required of certified phrmcy technicin. % Respondents Agree Agree Disgree Disgree The number of respondents for polling items rnged from 65 to 75. For some items, percentges do not totl 100% becuse of rounding. e385

10 Tble 5. Stte Lws nd Regultions on Phrmcy Technicins: Results of Conference Polling Issue 5.1 The vribility of stte regultions regrding phrmcy technicins should be minimized, while mintining the required stndrds to ensure ptient sfety. 5.2 The level of urgency for chieving stte-to-stte consistency in regultion of phrmcy technicins scope of prctice, eduction, certifiction, nd licensure or regultion is high. 5.3 Ntionl stndrds should not prevent sttes from innovting nd expnding technicins scope of prctice beyond estblished entry-level stndrds in the interest of improving ptient sfety nd cre. 5.4 Evolution of stte-level lws nd regultions regrding phrmcy technicins should be founded on ensuring ptient/public sfety. 5.5 Ntionl stndrds should be frmed in the context of phrmcy technicin prctice being under the purview of the phrmcist. 5.6 Stte bords of phrmcy should require phrmcy technicins to be licensed bsed on specific criteri including ccountbility nd dministrtive libility. 5.7 Registrtion should be required for ll individuls who embrk upon their initil entry into the profession of phrmcy. 5.8 Stte bords of phrmcy should require tht phrmcy technicins complete continuing eduction or other professionl development ctivities for continued registrtion or licensure. 5.9 Stte bords of phrmcy should include phrmcy technicin on the bord. % Respondents Agree Agree Disgree Disgree The number of respondents for polling items rnged from 65 to 75. For some items, percentges do not totl 100% becuse of rounding. Tble 6. Advnced Phrmcy Technicin Prctice: Results of Conference Polling Issue 6.1 The phrmcy profession should clerly rticulte nd communicte the vision for dvnced phrmcy technicin prctice nd disseminte the vision to pproprite stkeholders. 6.2 The phrmcy profession should mintin focus nd energy towrd developing entry-level stndrds for technicin eduction, with the expecttion tht dvnced-level competencies will evolve over time. 6.3 Bridging progrms should be developed nd offered to build competencies of phrmcy technicins who re currently in the workforce nd who would like to dvnce their skills. 6.4 Specific dvnced-level eductionl progrmming for phrmcy technicins is needed, vilble, nd will continue to evolve s needs within the profession re identified (e.g., sterile compounding, controlled substnces, risk mngement, qulity ssurnce, informtics). 6.5 In developing stndrds for dvnced phrmcy technicins, the phrmcy profession must recognize tht there re technicins currently prcticing t this level nd cknowledge the pproprite pthwy for their continued development. 6.6 The profession of phrmcy should develop credentils for technicins who perform dvnced roles beyond entry-level prctice. % Respondents Agree Agree Disgree Disgree The number of respondents for polling items rnged from 65 to 75. For some items, percentges do not totl 100% becuse of rounding. e386

11 Tble 7. Moving Forwrd on Phrmcy Technicin Issues: Results of Conference Polling Issue 7.1 The profession of phrmcy must be trnsprent in its messge bout phrmcy technicins, communicting the priority of public/ptient sfety, tking ownership of identified issues, ssuming commitment to chnge, ensuring ccountbility, nd reinforcing the positive contributions of phrmcy technicins to chieving optiml mediction use. 7.2 The profession of phrmcy should develop communictions pln to disseminte its vision for phrmcy technicins nd chieve buy-in from ll stkeholders (e.g., phrmcists, phrmcy technicins, legisltive nd regultory bodies, employers, pyers, public, etc.). 7.3 The profession of phrmcy should dvocte for the removl of phrmcistto-technicin rtios bsed on existing evidence. 7.4 Encourge phrmcy technicin inclusion, representtion, nd membership in professionl phrmcy orgniztions (t stte nd ntionl levels). 7.5 The conference plnners should estblish colition with brod representtion to tke forth the recommendtions from the Phrmcy Technicin Stkeholder Consensus Conference. 7.6 The Joint Commission of Phrmcy Prctitioners should tke responsibility for ensuring pproprite priority nd ccountbility in follow-up of conference recommendtions, possibly collborting with orgniztions such s the Council on Credentiling in Phrmcy, the Institute for Sfe Mediction Prctices, nd the Ntionl Conference of Stte Legisltors. 7.7 All prticipnts in the Phrmcy Technicin Stkeholder Consensus Conference hve responsibility to work towrd chieving the consensus recommendtions from the conference. % Respondents Agree Agree Disgree Disgree The number of respondents for polling items rnged from 65 to 75. For some items, percentges do not totl 100% becuse of rounding. Lrry Wgenknecht, chief executive officer of the Michign Assocition nd chir of the PTCB bord of governors, lluded to numerous previous ttempts to build ntionl consensus on stndrds for phrmcy technicins nd sked, Wht will be different this time? His nswer: We now hve different understnding of where we need to be s profession nd the importnt role tht well-qulified phrmcy technicins must ply in helping us rech tht plce. He declred tht PTCB is committed to collborting with the full rnge of stkeholders to chieve uniform ntionwide stndrds for phrmcy technicins. Disclosures Mr. Zellmer provides contrctul services for the Americn Society of Helth-System (ASHP), serves on the AJHP Editoril Bord, nd consulted on the plnning of the Phrmcy Technicin Stkeholder Consensus Conference. Mr. McAllister is employed by the Phrmcy Technicin Certifiction Bord (PTCB). Dr. Silvester is employed by ASHP. Dr. Vlsses is employed by the Accredittion Council for Phrmcy Eduction (ACPE). The PTCB certifies phrmcy technicins nd provided finncil support for the 2017 Phrmcy Technicin Stkeholder Consensus Conference. ASHP provides continuing eduction for phrmcy technicins, is n owner of PTCB, nd holds permnent set on the PTCB bord of directors. ASHP nd ACPE jointly sponsor the Phrmcy Technicin Accredittion Commission, which is the ccrediting review commitee for phrmcy technicin eduction progrms. Additionl informtion This rticle will lso pper s Web publiction of the Journl of the Americn Assocition. ACPE nd ASHP jointly sponsor the Phrmcy Technicin Accredittion Commission, which is the ccrediting review committee for phrmcy technicin eduction progrms. b The term phrmcy technicin eduction is used in this report to encompss the full bredth of cdemic, simulted experientil, nd prctice-setting experientil eduction of phrmcy technicins. c Web prticipnts could sk questions or mke comments in writing during the discussion portion of plenry sessions; they did not vote in the polling process t the end of the conference. d Individuls who were involved in plnning or stffing the conference were excluded from the polling. e The 2 ttendees from NACDS excused themselves from the polling. f There ws no predetermined definition of consensus relted to level of greement on polling items. The conference orgnizers will be guided by the overll polling results in plnning how to pursue uniform stndrds for phrmcy technicins. e387

12 References 1. Council on Credentiling in Phrmcy. Phrmcy technicin credentiling frmework, August Files/CCP%20technicin%20frmework_08-09.pdf (ccessed 2017 Jn 3). 2. Council on Credentiling in Phrmcy. Frmework for credentiling in phrmcy prctice, www. phrmcycredentiling.org/contemporry_phrmcy_prctice.pdf (ccessed 2017 Jn 3). 3. Ntionl Assocition of Bords of Phrmcy. Report of the Tsk Force on Phrmcy Technicin Eduction nd Trining Progrms, uplods/2016/07/tf-phrmtecheduc.pdf (ccessed 2017 Jn 3). 4. Phrmcy Technicin Certifiction Bord. Technicin regultory snpshot (interctive mp) (December 31, 2016). phrmcy-technicins/cphts-stteregultory-mp (ccessed 2017 Mr 1). 5. Humphrey L. PTCB suspends implementtion of ccredited eduction requirement originlly plnned for 2020 (Jnury 23, 2017). www. ptcb.org/bout-ptcb/news-room/ news-lnding/2017/01/23/ptcb-suspends-implementtion-of-ccredited-eduction-requirement-originlly-plnned-for-2020#.wmmhyhirlrc (ccessed 2017 Feb 1). 6. Moné M. Optimizing the contributions of technicins in phrmcy prctice interest of the phrmcy profession. Am J Helth-Syst Phrm. 2017; 74: In Press. 7. Americn Society of Helth-System, Accredittion Council for Phrmcy Eduction. Accredittion stndrds for phrmcy technicin eduction nd trining progrms, menu/technicins/technicin-accredittion/accredittion-stndrdsfor-phrmcy-technicin-eduction. spx (ccessed 2016 Dec 28). 8. Ontrio College of. Register s phrmcy technicin. www. ocpinfo.com/registrtion/registertechnicin (ccessed 2017 Jn 3). 9. Cndin Council for Accredittion of Phrmcy Progrms. Stndrds for ccredittion of phrmcy technicin progrms in Cnd, revised August c/wp-content/uplods/2016/01/ Technicin-Stds-2014.pdf (ccessed 2017 Jn 3). e388

13 DATA SUPPLEMENT eappendix A Invited prticipnts of the Phrmcy Technicin Stkeholder Consensus Conference Alex J. Adms, Phrm.D., M.P.H. Idho Stte Bord of Phrmcy Nncy Alvrez, Phrm.D., BCPS President-elect Americn Assocition Dniel Ashby, B.S.Phrm., M.S., FASHP Chief Phrmcy Officer The Johns Hopkins Helth System Json Ausili, Phrm.D. Director, Phrmcy Affirs Ntionl Assocition of Chin Drug Stores Cynthi Boyle, Phrm.D., FAPhA AACP Immedite Pst President Professor nd Chir, Deprtment of Phrmcy Prctice nd Administrtion University of Mrylnd Estern Shore School of Phrmcy nd Helth Professions Lynette Brdley-Bker, RPh, Ph.D. Vice President of Public Affirs nd Enggement Americn Assocition of Colleges of Phrmcy Dvid Bright, Phrm.D., BCACP President, PTCB Certifiction Council Associte Professor Ferris Stte University Mlcolm Broussrd, B.S. Louisin Bord of Phrmcy Kren Brouwere, CPhT Phrmcy Procurement Technicin Deprtment of Veterns Affirs Mike Brownlee, Phrm.D., M.S., FASHP Chief Phrmcy Officer University of Iow Helth Cre Phil Brummond, Phrm.D., M.S. Director of Phrmcy Froedtert nd the Medicl College of Wisconsin Brbr Burch, Ed.D. Provost Emeritus Western Kentucky University Pul Bush, Phrm.D., M.B.A., BCPS, FASHP Chief Phrmcy Officer Duke University Hospitl Donnie Clhoun, B.Phrm., FACA, FACVP Chief Executive Officer nd Executive Vice President Americn College of Apothecries Liz Crdello, RPh Senior Director, Corporte Allinces Americn Assocition Al Crter, Phrm.D., M.S. Senior Director, Phrmcy Regultory Affirs CVS Helth Crmen Ctizone, RPh, M.S., D.Ph. Ntionl Assocition of Bords of Phrmcy Adm Chesler, Phrm.D. Director, Regultory Affirs Crdinl Helth Ulric Chung, Ph.D. Chief Executive Officer Americn Bord of Industril Hygiene Justin Coyle, Phrm.D. Senior Director, Phrmcy Opertions Wlgreens Chrles Dniels, B.S.Phrm., Ph.D. Phrmcist-In-Chief nd Associte Den University of Cliforni Sn Diego Shne Desselle, Ph.D. Professor Touro University John Diem, CPhT, RPT Director, Phrmcy Technicin Progrms Ornge Technicl College Andrew Funk, Phrm.D. Iow Bord of Phrmcy MSgt Robert George, USAF, CPhT Senior Enlisted Leder, Deprtment of Defense Phrmcy Trining Medicl Eduction nd Trining Cmpus Lis Gersem, Phrm.D. President, Americn Society of Helth- System Director of Phrmcy United Hospitl, prt of Allin Helth Sherrill Giddens, CTE Creer nd Technology Eduction Specilist Medicl Eduction nd Trining Cmpus Hrold Godwin, RPh, M.S. Chir, Bord of Phrmcy Specilties, nd Professor Emeritus University of Knss School of Phrmcy Steven Gry, Phrm.D., J.D. Ntionl Phrmcy Professionl Affirs Leder Kiser Permnente Curtis Hs, Phrm.D. Director of Phrmcy University of Rochester Medicl Center Dine Hlvorson, RPhTech, CPhT Led Phrmcy Tecchnicin Vibr Hospitl Member, North Dkot Stte Bord of Phrmcy Mrk Hrdy, Phrm.D. North Dkot Stte Bord of Phrmcy Rndy Hitchens, B.Phrm., M.B.A. Executive Vice President Indin Allince Donn Horn, RPh, D.Ph. Director, Ptient Sfety Community Phrmcy Institute for Sfe Mediction Prctices Scott Jcobson, B.S.Phrm. Vice President, Phrmcy Opertions Rite Aid Corportion Susn Jmes, B.Sc.O.T., M.P.A. Director, Competence Progrms Ontrio College of Christopher Jerry President nd Chief Executive Officer The Emily Jerry Foundtion Sm Johnson, Phrm.D. Director, Helth Policy nd Interprofessionl Affirs Americn College of Clinicl Phrmcy Mike Johnston, CPhT Chief Executive Officer Ntionl Phrmcy Technicin Assocition Donn Kisse, CPhT Phrmcy Conversion Mnger, Thrifty White Phrmcy Chirperson, Northlnd Assocition of Phrmcy Technicins Timothy R. Koch, B.S.Phrm., P.D., CHC Senior Director, Phrmcy Prctice Complince Wlmrt Corporte Office Hrold Kornfuhrer, RPh Contrct Led Surveyor Americn Society of Helth-System e389

14 DATA SUPPLEMENT Desi Kotis, Phrm.D., FASHP Phrmcy Director Northwestern Medicine Brin Krmer, RPh, M.B.A. President nd Chief Informtion Officer Forum Extended Cre Services Din Kwn, Phrm.D. Scientific Liison United Sttes Phrmcopeil Convention Brbr Lcher, B.S., RPhT, CPhT Associte Professor nd Assistnt Progrm Director North Dkot Stte College of Science Anne LVnce, CPhT Phrmcy Technicin Progrm Director Delgdo Community College Brin Lwson, Phrm.D. Director, Professionl Affirs Bord of Phrmcy Specilties Donld Letendre, Phrm.D. Den nd Professor University of Iow Jnet Liles, M.S., CPhT Phrmcy Technicin Eductors Council Deepti Lohrikr, J.D. Director, Federl nd Stte Public Policy Ntionl Assocition of Chin Drug Stores Pul Lott, RPh Region 4 Director Americn Society of Consultnt Owner LLW Consulting Dn Luce, B.S.Phrm., M.B.A., FAPhA Ntionl Director, Phrmcy Affirs Wlgreens Lis McCrtney, M.Ed., CPhT, PhTR Deprtment Chir, Phrmcy Technicin Progrm Austin Community College-Estview Cmpus LuGin Mendez-Hrper, Phrm.D. Member of Accredittion Council for Phrmcy Eduction Bord of Directors Director of Professionl Prctices Prime Therpeutics Tom Menighn, B.S.Phrm., M.B.A., Sc.D. Executive Vice President nd Chief Executive Officer Americn Assocition Scott Meyers, RPh, M.S., FASHP Executive Vice President Illinois Council of Helth-System Michel A. Moné, B.S.Phrm., J.D., FAPhA Vice President, Associte Generl Counsel Regultory Crdinl Helth Judy Neville, CPhT, NE-CPhT, B.L.S. President Americn Assocition of Phrmcy Technicins Director of Phrmcy Technicin Eduction University of Nebrsk Medicl Center College of Phrmcy Meliss Orteg, Phrm.D., M.S. Director, Peditrics nd Phrmcy Opertions Tufts Medicl Center Mtthew Osterhus, B.S.Phrm., FAPhA, FASCP Owner nd Phrmcist Osterhus Phrmcy Tony Plmer, D.B.A. Director, New Opertions LLW Consulting Sidney Phillips, Phrm.D., M.B.A. President Texs Society of Helth-System Rico Powell, CPhT Phrmcy Automtions Anlyst LeBonheur Childrens Hospitl Anthony Provenzno, Phrm.D. Vice President, Phrmcy Complince nd Government Affirs Albertsons Compnies Anthony Pudlo, Phrm.D., M.B.A., BCACP Vice President, Professionl Affirs Iow Phrmcy Assocition MAJ Todd Reeder, Phrm.D. Army Service Led Medicl Eduction nd Trining Cmpus Steve Rough, B.S.Phrm., M.S., FASHP Director of Phrmcy University of Wisconsin Helth Sheri Roumell, B.S., CPhT, RPh Progrm Director, Csper College Contrct Led Surveyor, ASHP Rfel Senz, Phrm.D., M.S., FASHP Administrtor, Phrmcy Services University of Virgini Helth System Cthy Schuster, RPhT CCAPP Coordintor Phrmcy Technicin Progrms Cndin Council for Accredittion of Phrmcy Progrms Lis Schwrtz, Phrm.D. Senior Director, Professionl Affirs Ntionl Community Assocition RADM Pmel Schweitzer, Phrm.D., BCACP Chief Phrmcy Officer, USPHS Centers for Medicre nd Medicid Services Amr Shrm, M.P.H., CPhT 340B Progrm Coordintor UC Sn Diego Helth April Shughnessy, RPh, CAE Deputy to the Chief Executive Officer Acdemy of Mnged Cre Phrmcy Mrk Sinnett, Phrm.D. Director, Clinicl nd Eductionl Phrmcy Services Montefiore Medicl Center John Smith, Ph.D. Director, Curriculum nd Instruction Est Sn Gbriel Vlley ROP Anne Sodergren Assistnt Executive Officer Cliforni Stte Bord of Phrmcy Elliott Sogol, Ph.D., RPh, FAPhA Vice President, Professionl Reltions Phrmcy Qulity Solutions Brooke Stokely, B.S., CPhT President, Phrmcy Technicin Eductors Council Phrmcy Technology Progrm Director nd Externship Coordintor Southestern Institute Ksey Thompson, Phrm.D., M.S., M.B.A. Chief Operting Officer Americn Society of Helth-System Tim Tucker, Phrm.D. Owner nd Phrmcist City Drug Compny Lrry Wgenknecht, RPh, FMPA, FAPhA Chief Executive Officer Michign Assocition Donn Wll, Phrm.D. Clinicl Phrmcist Indin University Hospitl e390