1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 11: Laboratory and Pharmacy Services

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists History of the Profession –Late 1800s, early 1900s: establishment of first clinical labs –World War I: technicians took on pathologists’ & bacteriologists’ duties –1928: Board of Registry (BOR) created by ASCP –Graduates of BOR exam known as “medical technologists” –1933: American Society for Clinical Laboratory Science (ASCLS) formed –1973: National Accrediting Agency for Clinical Laboratory Sciences (NAACLS) formed –Name changed to “clinical laboratory technologists” recently

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) Education –Bachelor’s in medical technology or a life science is standard –Associate’s degree required by CLIA for advanced lab personnel –Programs offered by universities & hospitals –Academic classes & clinical experience (3+1 or 4 + 1 program) –Master’s & doctoral programs available –215 accredited programs

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) Course Work –Anatomy & physiology –Immunology –Microbiology –Statistics –Hematology –Chemistry –Urinalysis –Quality assurance & improvement –Safety & government regulations & standards –Communication & teamwork skills –Ethics & professionalism –Educational techniques –Research design & practice –Laboratory operations

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) Licensure, Registration, and Certification –Licensure or registration Required by some states Requires bachelor’s degree & passing exam –Certification Optional, but advantageous General & specialized Offered by several organizations

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) General Duties –Prepare specimens, perform tests on them, & interpret results –Use complex instruments & equipment –Check for accuracy –Ensure proper function of equipment –Monitor lab process for quality control –Train subordinates in new techniques –Design & develop research experiments

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) Specialties –Clinical chemistry –Microbiology –Blood bank –Immunology –Cytotechnology –Molecular biology

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) Personal Characteristics –Responsible –Reliable –Thorough –Accurate –Good problem-solving skills –Capable of working well under pressure –Able to focus on complex tests –Communication skills –Capable of working independently

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) Employment Opportunities and Trends –>172,000 jobs –Most jobs in hospitals –14% growth from 2008 to 2018 –Growth due to: More tests required for growing population Development of new tests

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technologists (cont’d) Professional Organization: ASCLS –Represents all lab personnel –Advocates for lab occupations –Monitors legislation –Acts as liaison to Congress & federal & state agencies –Emphasizes standards setting, continuing education, & personal & professional development –Membership benefits: online courses, workshops, conferences, national meeting, etc.

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians History of the Profession –Emerged in the 1960s –Developed due to: New technologies, need for new tests Need to free up medical technologists Increasing popularity of 2-year community & junior colleges 1966: Allied Health Personnel Training Act—provided funding –1969: educational programs guidelines published & first exam –1973: entry-level competencies approved

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians (cont’d) Education –Most have either: Associate’s degree from community or junior college Certificate from hospital, vocational or technical school, or military –A few are trained on the job –CLIA requires associate’s degree for advanced lab personnel –196 accredited programs

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians (cont’d) Course Work –Laboratory methodologies –Specimen collection, processing, & analysis –Use of lab results in diagnosis & treatment –Communications –Quality assessment –Lab safety & regulations –Information processing –Ethical & professional conduct –Professional development

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians (cont’d) Licensure, Registration, and Certification –Licensure or registration Required in some states Requirements vary by state –Certification Optional, but advantageous Offered by several organizations

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians (cont’d) Work Responsibilities –Collect & prepare specimens for testing –Conduct & monitor tests –Analyze results of tests –Record findings on computer or paper –Report problems to supervisor –Care for instruments & equipment –Cross-match blood –Care for specimens –Train new employees

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians (cont’d) Personal Characteristics –Accuracy –Good judgment –Analytical skills –Responsibility –Precision –Eye for detail –Ability to work independently –Ability to work under time pressure –Teamwork skills –Communication skills

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians (cont’d) Employment Opportunities and Trends –Rapid growth: 14% between 2008 & 2018 –Setting distribution: 45% in hospitals 15% in medical & diagnostic labs 14% in physician’s offices 8% in educational services

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Laboratory Technicians (cont’d) Professional Organization: AMT –Nationally & internationally recognized certification program –Includes clinical laboratory technicians & technologists & others –Promotes personal & professional growth & leadership skills –Benefits: Continuing education opportunities Annual convention State society meetings & seminars Professional journal Online programs & career center

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Assistants History of the Profession –Emerged in 1950s due to shortage of medical technologists –State medical associations promoted training programs –1960s & 1970s: development of educational & certification standards –1962: development of a model training program –1963: first certified laboratory assistants graduated –1967: exam made a requirement for certification –1973: ASMT approved entry-level competencies

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Assistants (cont’d) Education –HS diploma or equivalent required –Many are trained on the job –Some complete formal training program –Only a few accredited programs –Programs: Last about 18 months Lead to a certificate Some combine training with phlebotomist & EKG training Include both course work & practical experience

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Assistants (cont’d) Course Work –Laboratory assistant skills –Introduction to health care –Medical terminology –Laboratory administrative skills –Anatomy & physiology –Medical laboratory safety –Phlebotomy –Computer applications –Interpersonal & communication skills

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Assistants (cont’d) Licensure, Registration, and Certification –Licensure or registration required in some states –Certification Certified Medical Laboratory Assistant (CMLA) credential Some programs prepare student for phlebotomist certification Optional, but advantageous –No professional organization for this occupation

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Assistants (cont’d) Work Responsibilities –Collect & label samples –Set up routine tests –Prepare materials for analysis –Perform low- to moderate- complexity tests –Maintain storage system for specimens –Deliver samples for testing –Recognize & report errors –Maintain equipment & supplies –Enter patient data into computer –Answer phones –Process test orders –Report results –Do billing

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Assistants (cont’d) Personal Characteristics –Strong organizational skills –Eye for detail –Ability to work both independently & as part of a team –Interpersonal & communication skills –Ability to work well under time pressure –Ability to work quickly & accurately

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Laboratory Assistants (cont’d) Employment Opportunities and Trends –Shortage of personnel due to: Competition for qualified staff Lower compensation for lab work compared to other fields –Increased opportunities due to: Aging baby boomers Low awareness of lab occupations

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists History of the Profession –Colonial America: doctors, apothecaries, & wholesale druggists –Before Civil War: apothecaries trained by apprenticeship –1821: first professional association & first college of pharmacy –After Civil War Pharmacy education shifted to state universities Albert B. Prescott: shifted focus to academic study State boards began licensing pharmacists –1900: pharmacy school association formed (later called AACP) –1920s: AACP adopted basic curriculum

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists (cont’d) Education –PharmD degree required –116 accredited programs –Entrance to program requires: At least 2 years of undergraduate work Most programs require PCAT –Programs usually last 4 years –“0-6” programs, for high school student applicants –Residency programs following graduation increasingly required –MS & PhD degrees available

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists (cont’d) Course Work –Pharmaceutical chemistry –Pharmacology –Business management –Pharmacy practice –A clinical component

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists (cont’d) Licensure –Required in all states –Requires PharmD & passing several exams: All states: North American Pharmacists Licensure Exam (NAPLEX) Most states: Multistate Pharmacy Jurisprudence Exam (MPJE)

30. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists (cont’d) Work Responsibilities –Receive prescriptions & fill them –Monitor work of technicians –Counsel patients –Confer with physicians & other health care professionals –Maintain confidential medication records –Plan, monitor, & evaluate drug treatment plans –Complete third-party insurance forms –Run a business

31. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists (cont’d) Personal Characteristics –Organizational skills –Eye for detail –Conscientiousness –Reliability –Strong analytical & problem-solving skills –Good judgment & common sense –Good communication & interpersonal skills –Good teamwork skills

32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists (cont’d) Employment Opportunities and Trends –Rapid growth: 17% between 2008 & 2018 –Factors prompting growth: Increased demand for prescription drugs due to population growth New drugs becoming available –Setting distribution: 65% in community pharmacies 22% in hospitals

33. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacists (cont’d) Professional Organization: NPhA –One of several professional associations for pharmacists –Represents interests of minority pharmacists –Works to advance standards of pharmaceutical care –Works to stimulate interest in pharmacy as a career –Benefits: Annual convention Regional meetings Continuing education Networking

34. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians History of the Profession –Began with training program by U.S. Army in mid-1940s –1940s to 1960s: establishment of a formal system of training –1975: American Society of Health-System Pharmacists (ASHP) established –1982: accreditation standards established –1983: ASHP began accrediting programs –1990s: national certification program & model curriculum developed

35. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians (cont’d) Education –Some trained on the job –Most complete formal training –Accredited programs must: Provide at least 600 hours of training over 15 or more weeks Cover topics stipulated in model curriculum Develop individualized training plan for each student Require extensive lab experience Offer an internship or externship in at least two settings –HS diploma or equivalent required by some states

36. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians (cont’d) Course Work –Introduction to pharmacy –Medical terminology –Pharmacology –Pharmacy math –Commercial pharmacy practice –Hospital pharmacy practice –Pharmacy law & ethics –Computer applications –Psychology –Speech or interpersonal communications

37. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians (cont’d) Certification –Required in some states, optional in most –Offered by several organizations –Requires passing a national exam –Recertification required every 2 years via continuing education

38. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians (cont’d) Work Responsibilities –Accept a written prescription –Review info on prescriptions for accuracy –Prepare prescriptions –Prepare prescription labels –Choose proper containers & label them –Price & file prescriptions –Perform administrative tasks

39. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians (cont’d) Personal Characteristics –Responsibility –Eye for detail –Organizational skills –Customer service skills –Friendly, professional attitude –Good teamwork skills –Ability to work independently

40. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians (cont’d) Employment Opportunities and Trends –Rapid growth: 31% between 2008 & 2018 –Factors prompting growth: Increased demand for prescription drugs due to population growth Pharmacy technicians taking on new roles –Setting distribution: 73% in retail pharmacies 18% in hospitals

41. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Pharmacy Technicians (cont’d) Professional Organizations –American Association of Pharmacy Technicians (AAPT) Represents interests of members to public & health care organizations Helps technicians update their skills Provides continuing education programs, a national convention, & a career center –National Pharmacy Technician Association (NPTA) Promotes professional development Advocates for the profession Conducts industry-related research