WORKING AS A PHARMACY TECHNICIAN IN EUROPE

PT in the hospital pharmacy

My name is Klára Bendová and I work as a pharmaceutical technician (FA) in a hospital pharmacy (IKEM Prague). Hospital pharmacies make up a minority of the total number of pharmacies in the Czech Republic, but they employ a relatively large number of pharmaceutical technicians. Our pharmacy has six main departments and twenty-two pharmaceutical technicians. Each of the technicians is assigned to their core department, but substitutability works to cover the needs of all departments, which proved very important during the Covid-19 pandemic.

Start in the morning

My day starts at the Public Medications Department, which is my main area of operation. Even before the pharmacy opens, we start receiving new goods, to which part of the team devotes all day. Other colleagues provide, for example, replenishment of medicines for prescription and free sales. One or two colleagues are engaged in ‘over the counter’sales and consulting with customers.

A day in the laboratory

Some days I come to the Department of Drug Preparation (a laboratory), where we produce medicines for our outpatients and for patients in the hospital ward. These are, for example, special medicines for transplant patients, but also common ointments and drops or intravenous nutrition (AIO). I also participate in the preparation and packaging of medicines intended for clinics and hospital outpatient clinics. Here we are working with a positive list that contains the priority drugs used in our hospital. These medicines, as well as medical supplies and devices, are selected in a tender or auction organized by the Central Purchasing Department of our hospital. In the middle of the working day, I go to lunch to the hospital canteen. Our typical patient (post-transplant patient) uses many different drugs, so even before the nationwide introduction of electronic prescriptions, we used our own system, where the patient’s medication is prepared prior to them coming to the pharmacy to collect it. This unique system speeds up shipping, shortens patient waiting times and allows more time for individual counseling. The system is completely anonymized and was created by the hospital's IT department. Of course, patients still have the opportunity to choose another pharmacy where they can pick up their medication but our patients are often seriously chronically ill and their treatment requires special medication and approach so they choose our pharmacy where they are sure that their medicine is available.

Storage and refilling

We have a limited storage space, so we have to deal with refilling supplies all day long; a reconstruction and expansion are already planned. The pharmacy's range of goods for the public includes medicines, food supplements and individual medicines prepared in our laboratory, which are very popular with our clients and give our pharmacy sort of exclusivity.
Dispensing and sale of medical devices and aids to the public is provided by another department where some of my colleagues work. There are three pharmaceutical technicians working in this particular department.

Serving patients and colleagues

My core department is designed to be used by general public and my favorite activity of the working day is ‘over the counter sales (without a prescription). In addition to sales and consultations, my scope of work also includes placing orders with suppliers, communication with sales representatives, administration of advertising campaigns, receipt and sorting of goods. We have the opportunity to determine the range of free sale products by ourselves; my favorite domain is homeopathy. In addition to our patients and local people from the area, a large part of our customers are IKEM employees, of whom there are about 1,700. I am happy when customers return and often give us positive feedback.

Seminars and conferences

As for our continuing education, we organize internal seminars, which we sometimes prepare ourselves for our colleagues. Other times, we invite experts or sales representatives to introduce us to the latest developments in their field. Once a year, we attend a national conference, where pharmaceutical technicians have their section. We also provide internships for future PTs and participate in internships for pharmacy students from the Czech Republic and abroad. Our hospital specializes in cardiology and cardiac surgery, transplantation, diabetology and hepatogastroenterology. It is by and large a top and one of a kind hospital in our country, so it is used by a great number of patients and there is a lot of work throughout the day. Therefore, we must exercise caution and pay attention to each of our activities, because the work of other colleagues and experts often depends on it. We are all used to working together, regardless of job position; each and every member of our team is important! Within the scope of our responsibilities, we also communicate with other healthcare professionals and nurses of our hospital.

The scope of work of PT in IKEM is very similar in all pharmacies in the Czech Republic, regardless of the size and type of pharmacy. The number of PTs in individual pharmacies varies. There are pharmacies where there are dozens of them and pharmacies where there is only one. Some activities are carried out by the PT independently, other times he or she works closely with a pharmacist who has a higher education and thus competencies. PT is not authorized to dispense prescription drugs. The vast majority of medical supplies and aids stores operate exclusively by the PT.

For all PTs in the Czech Republic, it is necessary to know the news from the field of healthcare and pharmacy business. We can attend various conferences and seminars or train under the supervision of the Ministry of Health in various specializations.

PHARMACY TECHNICIANS IN EUROPE / DENMARK

I work as a pharmaconomist –Danish pharmacy technician – in central Copenhagen at a medium sized community pharmacy with ca. 10 employees. Community pharmacies in Denmark are privately owned, where the government grants license to run a pharmacy at chosen location and that proprietor pharmacist can open up to 7 pharmacy branch stores, within 75 km radius of the licensed pharmacy. My pharmacy has an extra store and I work three days a week at one pharmacy, one day at the other and every second Saturday. On average I work 37 hours a week. Opening hours are 9.00-17.30 on weekdays, 9.30-13.30 Saturday and Sunday closed.

My day starts 15-30 minutes before the pharmacy opens. The staff gathers to a morning briefing, where we discuss the work plan of the day and activities that has to fit into the daily work such as meetings with business partners, vaccinations etc.

I then stock shelves. I am responsible for logistics, but our wholesaler manages our inventory through software that estimates what products we need. My task is more to cooperate with the wholesaler, who I have daily contact with. I survey our products to optimize the stock to best match the customer’s preferences. In addition, I manage inventory of controlled substances and run checks of expiry dates every month. We also have a KLS robot in one pharmacy, which needs supervision sometimes to run smoothly.

When I work behind the counter, I handle the patient and their prescription immediately. More often than not, the prescriptions are electronic and therefore accessible from the nationwide prescription server. The pharmaconomist receive the prescription, does pharmaceutical control, gathers the drug, barcode controls it, dispenses it, and counsels the patient on the use of the medicine. All is done independently and under individual responsibility. Though a pharmacist must be available for queries by the pharmaconomist.

Other days I work with supplying medicine to patients who have reduced mobility. The medicine is packed for each patient and given to our delivery man, who works every weekday. We also supply medicine to elderly care facilities. Each of the elderly care residents has an account with us and I manage these accounts. When I work with the medicine supply I speak with quite a few patients, heath care personnel and doctors.

In addition to my work at the counter and the medicine supply, I also do pharmaceutical control of pharmaconomist students. A student can handle a patients prescription, gather the medicine, council and dispense the medicine, but must have their actions checked by a trained pharmaconomist. This is similar to the pharmaceutical control of pharmacy technicians done by pharmacists in many other countries. I control the students steps and councils them to improve their handling of the medicine and the patient.

As a relatively new health care service, I am certified to give vaccinations. My pharmacy is one of 16 in Denmark which has started to provide travel vaccinations. Patients book a consultation, where we go through their travel plans and the risk associated with the destination. I cross check with the national registry for vaccinations’ recommendations for their destination. After the patient has been informed of side effect and agrees, I administer the vaccination.

PHARMACY TECHNICIAN IN EUROPE / GERMANY

Hello, my name is Hanna and I work since seven years in a community pharmacy in north Germany. It is my second pharmacy I work for and I like it here, the colleagues are nice and my employer is a good lady to work for.

We are four Pharmacy Technicians, two pharmacists and two Pharmacy Commercial Assistants in the Pharmacy.

I work four or five days and 35 hours a week from 8 am to 6.30 pm. I get 2000.00 € before Tax, 33 days holiday and work sometimes also on Saturdays, but we are only open until 1 pm on Saturdays. I live nearby, I`m married and have two kids.

Normally my day in the Pharmacy starts with getting the goods, pills and everything ready ( we have an overnight delivery ) and help our Pharmacy Commercial Assistant to get the stock in the shelf´s and drawers.

My main activity in the Pharmacy is to serve the customers and patients, deliver their prescription, give them advises and check their medication. The prescription will be later checked by the pharmacist, mostly in the evening. If some complications or interactions with the medication or the OTC occur, I`ll check with the pharmacist right away. Most of the patients have a customer card, so we can check the medication and the OTC for their wellbeing every time.

Since we have no dermatologist nearby, we have very few ointments and cremes to compound, so I`m not very often in the laboratory. Sometimes I have to do some capsules for babies or small kids.

I like my job and the contact with the patients, well most of them anyway.

Most of my PT colleagues also work in a community pharmacy and very few in a hospital pharmacy, in the industry or the PT schools. I`m a member of the Union – ADEXA die Apothekengewerkschaft – to get information and help if I have some problems with my work, fortunately I did not need the union so far.

My name is Tara Hayden and I am a Senior Pharmacy Technician. Currently I am employed in two part-time senior positions; splitting my week between the School of Pharmacy and Bimolecular Sciences in RCSI University of Medicine and Health Sciences in Dublin and St Luke’s General Hospital, Carlow/ Kilkenny. I am also a committee member of the National Association of Hospital Pharmacy Technicians of Ireland (NAHPT). The aims of the NAHPT are: to increase awareness of Hospital Pharmacy Technicians’ value and role throughout the health services sector, to enhance professionalism through communication, continuing education, and networking, to increase credibility through involvement with other professional organisations in the field and to build and maintain alliances with other related members of the health services sector. We represent our members at meetings and conferences and hold a seat on the committee of the European Association of Pharmacy Technicians (EAPT). We also work with course providers in reviewing and developing Pharmacy Technician courses with competencies suitable to hospital pharmacy services.

RCSI – Senior Pharmacy Technician Role

I have been working in RCSI University of Medicine and Health Sciences in Dublin since September 2020. This position is the first of its kind within a University setting in Ireland. My role and responsibilities include contributing to the design, development and delivery of the school’s educational programme. I provide support to the educators within the Pharmacy Practice labs. These labs are known as ‘Patient Centred Care Labs’ and provide students on the Masters of Pharmacy programme the opportunity to perfect their dispensing, communication and counselling skills. Students put theory from their lectures into practice within these labs. I have the responsibility of ensuring that the labs are adequately supported both from a practical and educational stance, in order for students to learn and reach their competency goals within the labs. This enables students to develop their skills throughout the course in order to be competent and professional pharmacists once qualified. I began working in this position at the height of the Covid-19 pandemic, and while challenging, I have thrived on the novel experiences and brought with me, my vast knowledge from community and hospital pharmacy settings. The level of practical knowledge I have gained across diverse pharmacy settings adds to the benefit of the students at RCSI.

On Tuesday, my commute starts at 7:20am. I arrive in Dublin and start the prep for the morning lab. Due to Covid-19, social distancing has become a key health and safety priority and the impact that this has had on class sizes means that labs have half the quantity of students than normal. The students have been split into two groups and these labs are then run throughout the day in order to facilitate students and ensure health and safety guidelines are adhered to. Today, 2nd Year MPharm students are in a lab that covers the topic of the central nervous system. Prior to the lab commencing students were emailed a prescription for a patient who had recently been discharged from a psychiatric hospital. The following medications were prescribed: 28 x Olanzapine 10mg one daily and 28 x Zopiclone 7.5mg one nocte (night). Each student accesses their online handbook via Moodletm on their laptop and must complete this during the lab. During the lab the students must demonstrate validation of each prescription to ensure it meets the legal requirements, is clinically appropriate for the patient and dispense the items from the mock pharmacy where they have access to a large variety of prescription medicines. Students get to simulate prescription dispensing and counselling and I act as a facilitator in order for them to do this. They get hands on experience of ‘real world’ training in a controlled environment.

The Calgary Cambridge model of communication is taught on the programme and students are expected to apply this model when in the pharmacy practice labs. This model looks at the process of the consultation from initiating the session, gathering information, providing structure to the consultation, building a relationship, giving information by explanation and planning, and closing the session. When errors occur on a prescription, students are required to simulate a phone call with the prescriber; this is where I, as an educator use role-play in order for the student to communicate effectively with the prescriber. The same applies for when the student has to communicate with their patient about the medication prescribed, providing information of any side effects, cover key points in counselling and any other lifestyle advice for their patient. Some sample questions students may also have to answer include: Is the prescription legal? Under which scheme will you dispense the items and why? What is the legal classification of the product? Finally, I assess the communication skills demonstrated by each student and provide feedback to each at the end of their session. It's a very rewarding position and a great privilege to be involved in the education of our future Pharmacists. Pharmacy Technicians possess a vast amount of knowledge from a practical perspective and therefore, can add to the quality of education within pharmacy practice labs in a University setting. St. Luke’s General Hospital Carlow/Kilkenny – Senior Pharmacy Technician Role

As a Senior Purchasing Technician at the St Luke’s Hospital Carlow/Kilkenny

I have been employed in St Luke’s Hospital Carlow/Kilkenny for almost nine years. I am a Senior Purchasing Technician and my role involves managing the inventory of drugs and adhering to HSE budgets for the pharmacy department where pricing and contracts for products are considered. I am responsible for procurement of pharmaceuticals across a broad range, some of which include: Hepatitis C medication; monoclonal antibodies; IV fluids and controlled drugs. I ensure that the hospital is stocked with the required products and that levels are appropriate for the patients being treated, as well as maintaining good stock control whereby the hospital has adequate stock but is not over stocked. I purchase from a wide variety of pharmaceutical wholesalers as well as smaller independent pharmaceutical companies. Who we purchase from is reviewed and updated as the demands of our patient cohort change. Additionally, I provide cover as a Ward Based Technician as well as Technician cover in a satellite pharmacy in St Dympna’s Hospital in Carlow town. More recently, I have been offering my services within the Covid-19 Vaccination Hubs as they are required. This involves working extra hours and weekends in order to get as many people vaccinated as possible.

Friday is an early start for me, I arrive at 7:00 a.m. and meet two colleagues, also Pharmacy Technicians, at the main door of the Covid Vaccination Hub in Kilkenny. We have to pass through security and go to the changing rooms to get changed into our scrubs. The work starts with cleaning and disinfecting the working areas, monitoring the fridge temperature, stock count and check for each brand of vaccine, expiry date check, consumables check e.g. syringes, needles, antiseptic swabs and so on. The staff from the previous day have the communication board complete with the number of appointments and brand of vaccine. We have 849 patients receiving the Pfizer vaccine today. My colleague starts preparing reconstitution trays which include alcohol swabs, needles, syringes etc. We manage the workload through great team work and preparation, something that comes naturally to us.

The clinic today is administering the Pfizer vaccine which means the day will be very busy. The Pfizer vaccine, as opposed to the other Covid-19 vaccines, requires reconstitution. I start by scanning the vaccine vials through the HSE software system. Each vial of sodium chloride 0.9% and each Covid-19 vaccine is scanned. This generates labels which include the expiry time of the vaccine. Diluted vaccines can be stored between 2° and 30° but must be used within six hours following dilution. We divide ourselves into four separate work stations. Station one is responsible for drawing up 1.8ml of sodium chloride 0.9% (NaCl) and this will then be double checked by a second person. Station two is responsible for the reconstitution of the vaccine. This requires gently inverting the vial ten times, adding in the 1.8ml of NaCl and then inverting the diluted solution ten more times. Then, 1.8ml of air is slowly removed from the vial to equalise the pressure. It must not be shaken and care must be given when inspecting the solution for visible particles. (If any particles are present it must be discarded). Station three is the drawing up station. The needle is inserted at 45° with the eye pointed upwards. Six doses of 0.3ml are drawn into separate syringes and are left aside for their final volume check at station four which is done by the Pharmacist who joins our team at 8am. He attaches the labels which I previously generated to each syringe. The vaccinator will ensure the syringe is within the expiry time limit before administering. We rotate stations on numerous occasions throughout the day. This helps us to avoid becoming complacent and helps with keeping our attention span focused. Due to the large number of appointments scheduled for today I issue 40 vials in total. It’s all hands on deck and there is a real sense of community spirit. The patients start arriving at 8:15a.m. and there is a real buzz in the air. It has been a long road to get to here but finally there is a light at the end of the tunnel and it is fantastic to be a part of it.

I am scheduled to be back in the hospital for the rest of the day so I make my way across the city. When I arrive in the pharmacy department I change into separate scrubs and grab a quick coffee. The deliveries have arrived so we gather together as a team to put them away making sure to scan all the QR codes to ensure compliance with the Falsified Medicines Directive. After, I settle into the purchasing desk. I have designed an extensive purchasing schedule which breaks down our usage of stock and the frequency of orders into weekly/fortnightly/monthly orders. I work on the scheduled list of orders for Fridays. I send them to the wholesalers and scan the to-follow board for any items that are currently in short supply. Thankfully everything is available today! The afternoon requisitions start to flow in from the wards. Each ward has two set list collections every day at 11a.m. and 2p.m. These are checked and dispensed as appropriate in the pharmacy department. I grab the lists from the surgical ward that I cover. There are some items that need to be clinically checked such as anticoagulants. I inform the ward Pharmacist that there are two checks required for two separate patients taking Apixaban 2.5mg and Dabigatran 150mg respectively. She will check both and come back to me later to let me know if these are clinically suitable and whether or not I can send the stock. There is also a request for a Prolia® (Denosumab) 60mg sub-cut injection. As this is a six monthly injection I need to determine whether it is actually due to be administered. I check what Community Pharmacy the patient regularly attends and access the Primary Care Reimbursement Service online portal to check the date the patient last received the injection. As it was dispensed four months ago it is not due to be given again so I contact the ward to inform them. I also update the ward Pharmacist. She will inform the team of doctors caring for the patient and ensure the medication is removed from the inpatient Kardex®. She also informs me that the anticoagulants are fine to send. I dispense these to the patient’s files and leave the labelled medication out to be double checked before sending them to the ward. Due to my early start this morning I can finish early, so ensuring that the workload in the department is under control I make my way to the changing area and head home for the weekend.

As you can see, both positions are very diverse but extremely rewarding in their own way. They are both very fulfilling and allow for a positive contribution to society. No two days are ever the same and I love the variation in my week.

Online pharmacies growing rapidly

The turnover of Norwegian online pharmacies is increasing from day to day, particularly at the Farmasiet online pharmacy. Pharmacy technician and customer advisor Hege M. Winther Thomsen believes that Farmasiet is perceived as being a great complement to physical pharmacies and other online pharmacies.

By: Kristin Rosmo

The online pharmacy, Farmasiet (formerly Komplett Apotek), doubled its turnover in 2020 compared to the previous year. This pharmacy now had around 40 employees, including 15 pharmacy technicians and around 15 pharmacists. They are constantly having to hire new employees to keep up with the demand for buying medication and other pharmacy products online.

Pharmacy technician Hege M. Winther Thomsen has spent the last three years working as a customer advisor at Farmasiet where she and five other pharmacy technicians and a pharmacist run the Customer Services Centre. "We are in contact with our customers via chats, phone calls and e-mails. Just like in physical pharmacies, we provide advice for customers about choosing products and using them correctly. We also get a lot of technical questions, such as requests for help with registering customer profiles or general help about shopping online. This has been particularly noticeable during the Coronavirus pandemic. More people than ever have a preference for purchasing prescription medication online. Not all older people are equally confident about that, so we help them to get started," says Ms Winther Thomsen.

From rags to riches

Farmasiet’s CEO, Hans Kristian Furuseth, feels that he is helping to create a new fairytale success story. "We are a small, Norwegian-owned company that has entered into competition with the three large, foreign-owned pharmacy chains in Norway. And we're doing pretty well. It's very motivating. Last year we doubled our turnover compared to 2019, ending up with a turnover of NOK 330 million. Our goal is to reach one billion by 2023," says Mr. Furuseth.

However, such growth comes at a price. The pharmacy had a NOK 100 million deficit last year. However, Mr. Furuseth has clear plans as regards the pharmacy’s strategy going forward. "Firstly we will invest in customer experience, then we will invest in growth. We will then focus on profitability,” he says. He believes that around 2-3% of sales in the pharmacy market are now taking place online, and he estimates that Farmasiet has just over 1% of the pharmacy market.

Dependent on purchasing experiences

Furuseth has been the CEO of Farmasiet since 2019. He was previously the head of Zalando in the Nordic countries and the UK. One important experience he has brought with him from there is the importance of the actual buying experience in an online store.

A good buying experience is a characteristic that will also apply to Farmasiet and the prices charged will be one aspect of this. "We have significantly lower prices for non-prescription medication and other merchandise than those charged by our competitors. We are also working to create a new and better pharmacy experience than the sort of experience that people might have in physical pharmacies. For example, a good website, good prescription information, discretion, available and competent customer service, as well as fast and affordable/free delivery. Eventually we will also offer some pharmacy services, such as advice on starting to take medication," he says.

However, Farmasiet’s chat and phone service has been closed for a while during the new year. "In connection with the outbreak of the mutant virus, we experienced a heavy, unforeseen increase in demand for prescription products. In order to deal with this influx of orders, we had to close down our chat and phone service for a while so that we could supply medication as quickly as possible," says Mr. Furuseth.

Mr. Furuseth has not answered Farmasilivet’s questions about what this might mean for customers' buying experiences, but he says that they are satisfied that most customers who contact Farmasiet receive a reply within one day, despite the huge demand. He also points out that the solution would otherwise be to employ more people in order to ensure satisfactory operations as they continue to grow.

Customers from north to south

Pharmacy technician and customer advisor Hege Winther Thomsen is an important piece in the puzzle that will help to achieve a good buying experience at Farmasiet. Her working days mainly involve wearing a headset and working in front of a screen at the Customer Services Centre. Her working hours are from eight to four, Monday to Friday, as well as some Sundays. She already has 19 years of experience from working at three physical pharmacies in Sandefjord and Larvik.

She thinks that the main difference is the working hours and the fact that all customer contact takes place without meeting the customers in person. "Another difference is that I have contact with more customers at the same time and that they come from all over our elongated country. It’s great to be able to meet a wider range of the population. I have also noticed that a lot of people ask more direct questions openly here in our online pharmacy than they would in a physical pharmacy. Maybe they feel less restricted when they don't meet me face-to-face or don't risk meeting their neighbours. But of course I sometimes miss having regular customers who would stop by their local pharmacy for a little chat "every Friday morning." We don't have those customers here," says the experienced pharmacy technician.

Must keep up-to-date professionally

Ms Winther Thomsen feels she is fully able to use her education as a customer advisor at Farmasiet and feels that she has a great responsibility to keep up-to-date professionally. "We comply with a competence plan that has been drawn up by our pharmacy manager and this includes attending e-learning courses. There is also a lot to learn about in respect of the many skin product ranges we sell," she says.

She has noticed that some physical pharmacies are a bit sceptical about Farmasiet, which is only involved in online trading. "We are aiming primarily to operate as a complement to physical pharmacies and other online pharmacies. Even though we're competitors, I do not look on other pharmacies as being enemies. I prefer to think that all pharmacies – both physical and online – provide opportunities for customers to choose whichever pharmacy and solutions are most suitable for them,” she points out.

Increased knowledge about prescription drugs from online pharmacies

The results of this autumn’s Apotekbarometer (the Pharmacy Barometer), a representative survey conducted by Kantar on behalf of the Norwegian Pharmacy Association, show that the population's knowledge about the options available for buying prescription drugs from Norwegian online pharmacies has increased from 49% to 58% in less than six months.

Jostein Soldal, Head of Communications at the Norwegian Pharmacy Association, says that there are small variations with regard to gender and age, but that there has been a significant increase in knowledge among those who state that they use prescription drugs regularly. "With the exception of increased knowledge, our surveys have shown fairly small changes in respect of online pharmacies in recent years," he says.

Elderly people are underrepresented

The Pharmacy Barometer shows that of the 58% of knowledgeable respondents, 11% stated that they had purchased prescription medication from an online pharmacy. The percentage of the population over the age of 60 is underrepresented. "This has remained pretty much the same since our the previous two surveys. When we ask the full spectrum of respondents, about one third state that it is quite or very likely that they will take advantage of the opportunity to purchase medication from an online pharmacy. The younger the respondents, the higher the percentage,” he explains.

Mr. Soldal stresses that the Pharmacy Barometer is based on self-reported information, and does not necessarily say anything about the actual state of the market. Farmasiet proves this, because their sales of prescription medication to the over 55s will soon be highest and this customer group will be the fastest growing market with the greatest increases. “The ordering habits of older people in respect of prescription medication has undoubtedly changed a lot as a result of the coronavirus. It will not be long before seniors will be leading the way in respect of online purchases of pharmacy goods,” Mr. Furuseth believes.

Turnover growth for more online pharmacies

According to the Norwegian Medicines Agency, there are 16 approved online pharmacies in Norway. In addition to the online pharmacies of Norway’s three major pharmacy chains and Farmasiet, these consist of online services provided by independent pharmacies. Farmasiet is the only pharmacy operating solely online.

Pharmacist Tore Jakob Meltevik at the independent Danmarksplass Pharmacy in Bergen has been running their online pharmacy, iapoteket.no, since June 2017. Between 2019 and 2020 this online pharmacy had an increase in turnover amounting to almost 40%. "At the same time, our online competition is increasing. The market is very price sensitive, and the margins are small. When major players operate with such low prices, it can be difficult for smaller pharmacies like us to be economically viable. Not many of us can afford to lose tens of millions each year in order to drive up turnover," says Mr. Meltevik.

Large pharmacies also experiencing increases

All three of Norway’s main pharmacy chains are also experiencing an increase in their online pharmacy sales. "We have noticed that boots.no is receiving more hits and that our customers are buying more. We acquired a lot of new online customers last year and almost doubled our turnover for the year as a whole. In our marketing we have focused on the fact that online shopping is a good option for many, especially during a pandemic," says Communications Manager at Boots Norway, Anne Margrethe Aldin Thune.

The pandemic has boosted the turnover of Apotek 1’s online pharmacy. "During the second half of last year, sales on apotek1.no increased by 75% compared to the previous year. At the same time, we also noticed an increase in sales from our physical pharmacies during the same period," says Silje Ensrud, Head of Communications at Apotek 1.

The turnover of vitusapotek.no has also followed the same trend. "Last year, our Click & Collect turnover increased by 200%, and our home delivery service increased by 80% compared to the previous year," says Tonje Kinn, Head of Communications at NMD.

Farmasiet

• Established as an online pharmacy in 2015, with prescription medication sales starting in 2016.
• Changed its name from Komplett apotek to Farmasiet in 2019, when they were no longer part of the Komplett Group.
• Owned 50/50 by the Norwegian-owned companies Verdane and Canica.
• Has warehouses and own pharmacy outlets in Sandefjord and Vestby. Moved everything to Vestby in 2021.
• Uses Alliance Healthcare as a wholesaler.
• Has around 40 employees.
• Turnover in 2020 was around NOK 320 million.
• Is required to have a physical pharmacy outlet as well as an online pharmacy. In 2019, the pharmacy outlet had two customer visits, and none in 2020.

Norway’s first filling robot for chemotherapy drugs is hard at work at the Hospital Pharmacy Production Unit at the Norwegian Radium Hospital. The Italian donna has been given the name Monte Bella, and according to reports she is capable, beautiful and a little strict.

By: Kristin Rosmo

As we exit the elevator on the seventh floor we are greeted by an orange, spiral-shaped “person” on the expansive white wall in front of us. The head of Hospital Pharmacy Production Unit at the Norwegian Radium Hospital, Lise Raanes Rødøy, enthuses over the brand new artwork by Farnoosh Shahamatdar. “The idea is to illustrate that, here, humans, science and technology work closely together,” she explains, before opening the door to the bright and attractive premises that her unit moved into at the start of the year.

Profitability and production

We are currently in the new OCCI building at the Norwegian Radium Hospital. OCCI, or Oslo Cancer Cluster Innovasjonspark, is a research-based industry cluster for biomedical cancer diagnostics and treatment. The unit’s main task is the production of chemotherapy drugs and antibodies used to treat patients with cancer at the Norwegian Radium Hospital and Oslo University Hospital. Often, the patients have to undergo highly specialised courses of treatment. “We create many special treatment doses with various excipients and we produce around 26,000 treatment doses each year,” says Raanes Rødøy.

At the moment, the unit is also participating in around 60 clinical studies involving the preparation of substances for trial treatment; chemotherapy drugs, antibodies and vaccines. The department employs 12 pharmacy technicians, ten pharmacists and two operators.

In connection with the decision to relocate the production unit from the basement of the Hospital Pharmacy to the new premises in the OCCI building, the Hospital Pharmacy's board decided to procure a chemotherapy drugs robot for the unit. Following an extensive, international tendering process for the contract – which was worth millions – a robot known as Apoteca Chemo, manufactured by the Italian company Loccioni, was selected. “The procurement agreement also includes an option to purchase a further two robots of the same type. If you break it down, the technical investment is not the largest single cost. When we look at the profitability of the project, we also need to consider the fact that personnel resources in connection with a tendering process of this nature and implementation total around double the technical cost. Our aim is for all our investments to be profitable within eight years,” explains Bente Hayes, project owner and operations manager for the Hospital Pharmacies.

The Italian robot was quickly named Monte Bella

“The choice of named was obvious. The Norwegian Radium Hospital is located in an area known as Montebello in the westernmost part of Oslo. High up on the seventh floor it almost feels as though you are in the mountains, or on the ‘monte’ as the Italians would say. Seeing as the robot is Italian, and stunning to boot, it was obvious that she should be called ‘Monte Bella’. When she is being especially good, we refer to her simply as ‘Bella’,” adds unit manager Raanes Rødøy.

The result of the contract with the Italian company materialised last spring, when Monte Bella soared into the premises. “She could not very well take the elevator up. At 1.4 tonnes she is a rather hefty lady, and in order to get her into place we needed to construct special scaffolding and remove the façade. It was spectacular, but the whole process was very smooth,” recounts Kristoffer Olavesen, advisor to the Hospital Pharmacy and project engineer for the Monte Bella project.

Monte Bella is Norway’s first filling robot for chemotherapy drugs. She does have a robot colleague in Copenhagen that has been producing chemotherapy drugs for many years. The robot signorina relies heavily on collaboration with human colleagues in order to be able to do what is expected of her. Two such colleagues are pharmacy technicians and superusers Irene Ovland and Torhild Sandboe Sauro.

Superusers with solid experience

“It is wonderfully exciting to be a part of something that is completely new here in Norway. It is quite simply a bit of an honour. I never really thought that I would ever get an opportunity like this, and I feel honoured that I am trusted to be a superuser on this project,” says Sandboe Sauro.

Four years ago, having spent 26 years working in the same pharmacy in Strømmen, Sandboe Sauro began looking for change and new challenges, and she certainly got her wish. Fellow superuser Ovland has been working at the Hospital Pharmacy’s production unit for 14 years. “I have many years’ experience of preparing chemotherapy drugs, but doing it with the help of a robot is completely new to me. It is great to see what technology is capable of, and I am very impressed by Monte Bella’s performance,” she says.

Both superusers recently turned 50 and feel that it is great to have been given the opportunity to learn something completely new at a mature age.

A beautiful and clever colleague

Last autumn was all about ensuring that Monte Bella met all the relevant quality requirements before she was allowed to commence regular production, “The autumn was spent on installing data, technical checks and validating the production process. The validation has also involved testing the purity of the production chamber itself and ensuring that the robot complies with GMP (Good Manufacturing Practice) standards. We had to burn the midnight oil quite a bit, but Monte Bella passed all the tests,” confirms the project engineer.

Olavesen has been heading up the validation work together with an Italian engineer. The staff received training on how to use Monte Bella around the new year, during which period the Italian project manager was available. “Learning how to use the robot has been both exciting and challenging. The Italian project manager who has been in charge of training is a very good teacher and easy to understand. Most of the training has been conducted in English,” he says.

The two superusers gush shamelessly about their new colleague, who they have become fond of despite the fact that she can be a little strict from time to time. “Monte Bella does not accept errors. She alerts us by making beeping noises,” explains Ovland.

The unit’s new addition is nevertheless capable of recognising all substances by measuring the height and weight of the vials. To make absolutely sure that the substance is correct, she also uses image recognition technology. In order for the weight parameter to be correct, the density of all the substances is also recorded in the database. She also knows when the first vial injection was made, how long the vial may be used once opened and how much of the substance remains inside. “Once she has finished she presents the results to us and asks us to check, for example, that all dry components have been dissolved properly. She performs all these operations with the most feminine and elegant flair,” says Sandboe Sauro.

HSE and patient safety improvements

It looks set to be a busy year for Monte Bella. The unit produces around 100 chemotherapy bags each day. “We estimate that Monte Bella will initially be capable of shouldering around 20 per cent of the unit’s total production. This figure will increase gradually to reach our target of 60 per cent automation. In order to achieve this we rely on the new regional ordering system which forms part of the digital renewal project for the South-Eastern Norway Regional Health Authority. We believe that this will be in place by 2017. By then we will have reached our target,” concludes unit manager Raanes Rødøy.

She believes that the expensive investment will pay off over time. In addition, the investment is important to patient safety, HSE and the prevention of operator strain injuries. “My experience so far is that work positions have improved and the strain has been reduced. I spent many years working on manual production in an isolator and I have developed strain injuries to my neck and shoulders as a result. Now, I spend only a minimum of time sitting down and my work positions are completely different. I also get some relief when it comes to certain operations such as the filling of syringes,” says Ovland.

No need to fear for jobs

This winter the Norwegian dailies have been running a series of articles focusing on how, in the future, robots will be able to both improve and obfuscate our professional and our personal lives. In an article in Aftenposten, Infuture partner Camilla Tepfers asks the burning question: ‘As robots become increasingly intelligent, isn’t there a risk that they might take over our jobs?”. Not necessarily, according to Tepfers. She believes that robots complement humans by taking on work where human resources are insufficient, working side by side with us to relieve some of the strain associated with, for example, heavy lifting or dangerous or demanding operations. These views are reflected by the superusers at the Hospital Pharmacy Production Unit at the Norwegian Radium Hospital. “Monte Bella will not make us redundant. We will always need pharmacy technicians to operator her, together with a pharmacist. She has been a positive addition to our workplace and she has enabled us to look at our profession in a completely new light. We are ready to work in partnership with technology,” says Sandboe Sauro, carefully and confidently executing Monte Bella’s shut-down procedure on this February day.

PHARMACY TECHNICIANS IN EUROPE / PORTUGAL

Working as a PT in a hospital pharmacy on the Algarve

My name is Pedro Fidalgo and I am the Senior Technician Specialist and Pharmacy Coordinator at Centro Hospitalar Universitário do Algarve, which is composed of 4 Hospitals (Hospital de Faro – 666 beds, Hospital de Portimão – 319 beds, Centro de Medicina Física e Reabilitação do Sul – 21 beds and Hospital Terras do Infante in Lagos – 40 beds) located in Algarve, the southernmost part of Portugal. The Hospital Pharmacy is open 365 days a year from 8 am to 10 pm. Our team is composed by 39 Superior Pharmacy Technicians and we have the following functional areas: Warehouse, receiving and checking orders, Stock Management, Repackaging and fractioning of medicines, Daily Individual Distribution in Unit Doses, Traditional Distribution, Distribution for Replenishment of Leveled Stocks, Pharmacy Laboratory with Non Sterile Production, Sterile Production of Intravenous Mixtures for Premature Infants and Adults and Preparation of Cytotoxic Drugs, Quality Control, Monitoring and Training, Teaching and Research. Our department's mission is to provide the best health care, with high levels of competence, excellence and accuracy, encouraging pre- and post-graduate training and research, always respecting the principle of humanization and promoting the pride and sense of belonging of all professionals.

In the 2023 Action Plan prepared by the Superior Pharmacy Technicians, we mention that the Hospital Pharmacy has the mission of integrating, in its fullness, the multidisciplinary health team, fulfilling its exercise integrated in a new concept – “Pharmaceutical Care” – which aims to promote the improvement of patients' quality of life. Hospital Pharmacy carries out its activity through the Pharmaceutical Services, a department with scientific, technical and management autonomy, responding to the hospital administration, for the results of its exercise. The progress of health sciences and technologies creates for the Hospital Pharmacy, a greater need for an integrated multidisciplinary action that involves professionals with different curriculum formations, specific and differentiated.

The Pharmaceutical Services work to improve their performance, developing efforts to achieve excellence in their area of activity.

It is expected that in the medium term, the Pharmaceutical Services will be able to apply for a Certification Project, which will imply, both at a logistical and structural level, profound changes that aim to respond to the new demands resulting from the evolution in the treatments of patients and the need to make the department more effective and efficient.

The Pharmaceutical Services are responsible for:

• Ensure and assume technical responsibility for the acquisition, reception, storage, conservation and control of medicines, thus allowing coverage of the needs of all the hospital departments;
• Establish effective and safe medication dispensing systems;
• Preparing medications for inpatients, day hospital, external consultation and outpatients (which are not available in normal street pharmacies, or with authorization for hand over, e.g. (Parenteral nutrition, eye drops, pediatric oral solutions, medication papers and other manipulated);
• Participate in Technical Committees, through which there is the possibility of reaffirming their contribution to improving the quality of services provided to the patient;
• Establish a drug information system for users and healthcare professionals;
• Carry out educational activities about the medicine, targetting to healthcare professionals and healthcare users;
• Develop research in an independent way and in collaboration with other departments/services;
• Planning of reserach on the correct use of medicines;
• Collaboration in curricular and observation placements.

I will describe some Production and Activity Indicators described in the 2022 Activities Report, which has as economic indicator, an expenditure on medicines of € 64,000,000. In the Indicator Management and Coordination Processes of the Hospital de Faro, I was involved in 1.321 processes, the Indicator of Invoices Prepared at Hospital de Faro was 9.514, the Indicator Production of Cytotoxics was 15.835 Intravenous Bags, 7.188 Boluses, 2.248 Elastomeric Pumps and 858 of other preparations in Hospital de Faro. The Indicator Sterile Preparations: production of Parenteral Nutrition, Eye drops, Vaccines and other injectable preparations at Hospital de Faro was 1.856 Parenteral Nutrition for Adults, 811 Parenteral Nutrition for Pediatrics, 596 Parenteral Nutrition for Pediatrics for Lipids and 313 for other preparations. The Vaccine Preparations Indicator against SARS-CoV-2 in Hospital de Faro and Portimão was 2.081. Indicator number of Non Sterile Preparations was 5.029. The Indicator for the Total number of Repackaged Drugs was 2.020.114 units. The Indicator for the total number of Requisitions and total number of dispensed items was 29.451 requisitions, corresponding to 145.965 dispensed medications. The Leveled Stocks Replacement Indicator corresponded to a total of 77.865 medicines replaced. The Indicator of Total Patients and medication prepared through the Unitary Dose Distribution System corresponded to 227.947 patients and 1.854.982 medication prepared. We attended 222 training actions and we had 6 university students from the Pharmacy Degree for Placement.

One of the strategic objectives for the year 2023 was to ensure an effective and prompt implementation of quality control. In this regard, meetings began in the last quarter of the year with the aim of obtaining certification for the service. Another strategic objective for the year 2023 was to update some equipment that could improve performance and reinforce inspection activities to verify compliance with legal and regulatory requirements for the operation of the distribution sectors. New automated level replacement devices (ATHOS) were purchased to replace the previous ones (PYXIS) that were already obsolete. Regarding the remaining requests (Kardex and repackaging and restowage equipament) funding was obtained for 2023 and was already open an application call for equipment providers.

The objectives presented for the year 2023, with medium-term development targets, are dependent on the necessary Human Resources and financial availability.

In Slovenia, the profession of a pharmacy technician has a long tradition. The secondary school for the education of t pharmacy technicians was founded in 1946 in Ljubljana and continues to operate to this day.

Anyone who has completed a nine-year primary school can choose the profession of a pharmacy technician. Secondary education lasts four years, where students learn more about the profession itself. After completing secondary school, where they have acquired sufficient theoretical and practical knowledge in the field of pharmacy, they have to complete six months of practical training or internship.

After completing the internship, which most future pharmacy technicians complete in a pharmacy, a professional exam follows. Successful completion of the professional exam is a condition for independent work in a pharmacy and entry into the register of healthcare providers and healthcare workers.

In Slovenia, pharmacy technicians work in many areas.

Most of pharmacy technicians are employed in public, private and hospital pharmacies and specialized stores. They advise visitors on a healthy lifestyle and the correct use of over-the-counter medicines, medical devices and care products. In pharmacies and other areas of work, the pharmacy technician and the pharmacist are a well-coordinated team, where they mutually cooperate with each other.

Many of them are also employed in the pharmaceutical industry and galenic laboratories, where they participate in the production of medicines.

In control and analytical laboratories, pharmacy technicians perform chemical, physical and microbiological analyses that ensure the quality and stability of medicines.

In wholesale pharmacies, they participates in the supply of medicines and other products to other pharmacies, specialized stores and medical institutions.

They can also get a job in related professions, for example in the chemical or cosmetic industry.

Due to the pace of life dictated by today's times, the profession of a pharmacy technician is very dynamic. The charm of our profession is the daily challenges we face. In order to perform our profession well, it is necessary to get additional education and keep up with the times, because only in this manner are pharmacy technicians successful and competent members of the pharmaceutical profession.