"Tech-check-tech": a review of the evidence on its safety and benefits.

OBJECTIVE: The published evidence on state-authorized programs permitting final verification of medication orders by pharmacy technicians, including the programs' impact on pharmacist work hours and clinical activities, is reviewed.

SUMMARY: Some form of "tech-check-tech" (TCT)--the checking of a technician's order-filling accuracy by another technician rather than a pharmacist--is authorized for use by pharmacies in at least nine states. The results of 11 studies published since 1978 indicate that technicians' accuracy in performing final dispensing checks is very comparable to pharmacists' accuracy (mean ± S.D., 99.6% ± 0.55% versus 99.3% ± 0.68%, respectively). In 6 of those studies, significant differences in accuracy or error detection rates favoring TCT were reported (p < 0.05), although published TCT studies to date have had important limitations. In states with active or pilot TCT programs, pharmacists surveyed have reported that the practice has yielded time savings (estimates range from 10 hours per month to 1 hour per day), enabling them to spend more time providing clinical services. States permitting TCT programs require technicians to complete special training before assuming TCT duties, which are generally limited to restocking automated dispensing machines and filling unit dose batches of refills in hospitals and other institutional settings.

CONCLUSION: The published evidence demonstrates that pharmacy technicians can perform as accurately as pharmacists, perhaps more accurately, in the final verification of unit dose orders in institutional settings. Current TCT programs have fairly consistent elements, including the limitation of TCT to institutional settings, advanced education and training requirements for pharmacy technicians, and ongoing quality assurance.