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9/5/2000
Press Release

ASHP House of Delegates Takes Action on Broad Range of Professional Issues

The House of Delegates of the American Society of Health-System Pharmacists (ASHP) considered a number of vital pharmacy issues at its 52nd annual session, including mandatory reporting of medical errors, compensation for pharmacist services, pharmacist credentialing, online and Internet pharmacy issues, pharmacists’ role in immunization, and solutions to ongoing drug shortages. The session, held June 5 and 7 in Philadelphia, was conducted in conjunction with the Society’s Annual Meeting 2000.

The House of Delegates, ASHP’s chief policy-making body, consists of 161 voting state delegates (a minimum of two from each state and the District of Columbia). Voting delegates also include the members of the Board of Directors, past presidents of ASHP, and two student delegates.

Policy Actions

The House approved the following professional policies, which originated from either the ASHP Board of Directors, ASHP councils, or House of Delegates, as noted:

hod2000-2.jpgBoard of Directors

ASHP Statement on Reporting Medical Errors

Council on Administrative Affairs

Pharmacy Work Force: To encourage pharmacy managers to work in collaboration with physicians, nurses, and health-system administrators to outline key pharmacist services that are essential to patient care and to establish strategies within their practice setting that address pharmacist staffing shortages; further, to factor into such strategies legal requirements and professional standards of practice.

Drug Shortages: To declare that pharmaceutical manufacturers, distributors, group purchasing organizations, and regulatory bodies, when making decisions that may create drug product shortages, should strive to prevent those decisions from compromising the quality and safety of patient care.

Financial Management Skills (replaces ASHP policy 8301): To foster the systematic and ongoing development of management skills for all health-system pharmacists in the areas of (a) health-system economics, (b) business plan development, (c) financial analysis, (d) pharmacoeconomic analysis, (e) diversified pharmacy services, and (f) compensation for pharmaceutical care; further, to encourage schools of pharmacy to incorporate these management areas in students’ course work and clerkships; further, to integrate these management areas into the practice management requirements in the ASHP Standard for Residency in Pharmacy Practice (with an Emphasis on Pharmaceutical Care).

Compensation for Pharmacists’ Services (replaces ASHP policy 9308): To pursue the development of a standard mechanism for compensation of pharmacists for patient care services by federal and state programs and other third-party payers; hod2000-3.jpgfurther, to pursue changes in federal, state, and third-party programs to (a) define pharmacists as providers of patient care and (b) issue provider numbers to pharmacists that allow them to bill for patient care services; further, to assist pharmacists in their efforts to attain provider status and receive compensation for patient care services.

Council on Educational Affairs

Residency Training for Pharmacists Who Provide Direct Patient Care: To recognize that optimal direct patient care by a pharmacist requires the development of clinical judgment, which can be acquired only through experience and reflection on that experience; further, to establish as a goal that pharmacists who provide direct patient care should have completed an ASHP-accredited residency or have attained comparable skills through practice experience.

Pharmacist Credentialing: To support the position that credentialing is a voluntary professional activity distinct and separate from the licensing process; further, to endorse the goals and the standards-based approach to credentialing being pursued by the Council on Credentialing in Pharmacy (CCP); further, to support the position that all widely accepted postlicensure pharmacy credentialing programs must meet quality standards that are being established by CCP.

Certified Pharmacy Technicians: To support the concept of health systems requiring the pharmacy technicians they employ to be certified by the Pharmacy Technician Certification Board.

Council on Legal and Public Affairs

New and Emerging Pharmacy Systems: To support the use of new and emerging medication ordering and distribution systems (e.g., via the World Wide Web) when such systems (a) provide the elements of pharmaceutical care, (b) ensure that patients will not receive improperly labeled and packaged, deteriorated, outdated, counterfeit, or non-FDA-approved drug products, (c) provide appropriate relationships between an authorized prescriber and patient, (d) enhance the continuity of patient care, and (e) support the pharmacist’s role as a patient care advocate.

Online Pharmacy and Internet Prescribing: To support collaborative efforts of the Food and Drug Administration, the National Association of Boards of Pharmacy, and the Federation of State Medical Boards, as stated in the Principles of Understanding on the Sale of Drugs on the Internet, to regulate prescribing and dispensing of medications via the Internet; further, to support legislation or regulation that requires pharmacy World Wide Web sites to list the states in which the pharmacy and pharmacists are licensed, and, if prescribing services are offered, requires that the sites (a) ensure that a legitimate patient-prescriber relationship exists (consistent with professional practice standards) and (b) list the states in which the prescribers are licensed; further, to support the concept of voluntary accreditation of pharmacy Web sites and appropriate consumer education about the risks and benefits of using Internet pharmacies; further, to support the principle that any medication distribution or drug therapy management system must provide timely access to, and interaction with, appropriate professional pharmacist patient care services.

Dispensing by Nonpharmacists and Nonprescribers: To reaffirm the position that all medication dispensing functions must be performed by, or under the supervision of, a pharmacist; further, to reaffirm the position that any relationships that are established between a pharmacist and other individuals in order to carry out the dispensing function should preserve the role of the pharmacist in (a) maintaining appropriate patient protection and safety, (b) complying with regulatory and legal requirements, and (c) providing individualized patient care.

Statutory Protection for Medication-Error Reporting: To collaborate with other health care providers, professions, and stakeholders to advocate and support federal legislative and regulatory initiatives that provide liability protection for the reporting of actual and potential medication errors by individuals and health care providers; further, to seek federal liability protection for medication-error reporting that is similar in concept to that which applies to reporting safety incidents and accidents in the aviation industry.

FDA’s Public Health Mission (replaces ASHP policy 9606): To support the Food and Drug Administration’s public health mission of ensuring the safety and effectiveness of drugs, biologics, and medical devices through risk assessment, appropriate product approval, labeling approval, manufacturing oversight, and consultation with health professionals, while deferring to state regulation and professional self-regulation on matters related to the use of drugs, biologics, and medical devices; further, to support the allocation of sufficient federal resources to allow FDA to meet its defined public health mission; further, to support the appointment of practicing pharmacists to FDA advisory committees as one mechanism of ensuring that decisions made by the agency incorporate the unique knowledge of the profession of pharmacy for the further benefit of the patient; further, to support an ongoing dialogue between FDA and ASHP for the purpose of exploring ways to advocate the best use of FDA-regulated products by consumers and health care professionals.

Patient’s Right to Choose (replaces ASHP policy 9406): To support the right of the patient or his or her representative as allowed under state law to develop, implement, and make informed decisions regarding his or her plan of care; further, to acknowledge that the patient’s rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment; further, to support the right of the patient in accord with state law to (a) formulate advance directives and (b) have health care practitioners who comply with those directives.

Prudent Purchasing of Pharmaceuticals (combines ASHP policies 9003 and 9105 into a single policy): To support existing laws and legitimate practices that allow organized health care settings to purchase drug products and related supplies at prices that minimize health care costs; further, to support the principle of prudent purchase of pharmaceutical products and related supplies by public and private entities using appropriate professional practices to achieve that end; further, to encourage government support of existing local professional activities (e.g., drug-use review, formulary systems, pharmacy and therapeutics committees, and patient counseling) already practiced in organized health care settings that are methods of promoting quality and cost-effective pharmaceutical care for patients.

Council on Professional Affairs

Internet and Telepharmacy: To encourage pharmacists to assume a leadership role in their health systems with respect to strategic planning for, and implementation of, Internet and telehealth technology and services; further, to advocate the inclusion of Internet and telepharmacy issues and applications in school of pharmacy curricula.

Pharmacogenomics: To encourage pharmacists to take a leadership role in the therapeutic applications of pharmacogenomics; further, to advocate the inclusion of pharmacogenomics and its application to therapeutic decision-making in school of pharmacy curricula.

Biologic Therapies: To encourage pharmacists to take a leadership role in their health systems for all aspects of the proper use of biologic therapies, including preparation, storage, control, distribution, administration procedures, safe handling, and therapeutic applications.

Inline Filters: To support the principle that pharmacists be involved in the development of policies in their practice settings on the use of inline filtration for intravenous administration of fluids, nutrients, and medications.

Pharmacists’ Role in Immunization (replaces ASHP policy 9113): To affirm that pharmacists have a role in promoting, providing, and administering proper immunization to patients and employees in all organized health care settings; further, to encourage pharmacists to seek opportunities for involvement in disease prevention through community immunization programs; further, to advocate the inclusion of the pharmacist’s role in immunization in school of pharmacy curricula.

Drug Names, Labeling, and Packaging Associated with Medication Errors (replaces ASHP policy 9007): To urge drug manufacturers and FDA to involve practicing pharmacists, nurses, and physicians in decisions about drug names, labeling, and packaging to help eliminate (a) look-alike and sound-alike drug names, and (b) labeling and packaging characteristics that contribute to medication errors; further, to inform pharmacists and others, as appropriate, about specific drug names, labeling, and packaging that have documented association with medication errors.

Medication Errors and Risk Management (replaces ASHP policy 8614): To urge that pharmacists be included in health care organizations’ risk management processes for the purpose of (a) assessing medication-use systems for vulnerabilities to medication errors, (b) implementing medication-error prevention strategies, and (c) reviewing occurrences of medication errors and developing corrective actions.

Investigational Use of Drugs (replaces ASHP policy 8616): To reaffirm that pharmacists should be included in the management of drug products used in the conduct of clinical research; further, to urge pharmacists to develop formal liaison relationships between institutional review boards and pharmacy and therapeutics committees in the management and conduct of clinical drug research studies.

House of Delegates Resolution

Opposition to the Creation of a Pharmacist Assistant Category of Licensed Pharmacy Personnel: To reaffirm the following statement in the "White Paper on Pharmacy Technicians" (April 1996) endorsed by ASHP and the American Pharmaceutical Association: ‘Although there is a compelling need for pharmacists to expand the purview of their professional practice, there is also a need for pharmacists to maintain control over all aspects of drug product handling in the patient care arena, including dispensing and compounding. No other discipline is as well qualified to ensure public safety in this important aspect of health care’; further, to note that some interest groups in pharmacy have advocated for the creation of a new category of licensed personnel called "Pharmacist Assistant" that would have (a) less education and training than pharmacists, and (b) independent legal authority to perform many of the functions that are currently restricted to licensed pharmacists; further, to support the optimal use of well-trained, certified pharmacy technicians under the supervision of licensed pharmacists; further, to oppose the creation of a category of licensed personnel in pharmacy such as "Pharmacist Assistant" that would have legal authority to perform independently those professional pharmacy functions that are currently restricted to licensed pharmacists.

New Business

Delegates approved for referral to the Board of Directors two New Business items, including a motion dealing with member representation in the House and one dealing with the ethics of genetic research.

Other Business

Delegates also approved twotwo measures proposed by the Board of Directors dealing with ASHP operations and governance, including an annual membership dues increase from $155 to $195 and, changing the fiscal year to begin June 1, and an amendment to governing documents that would give voting rights in the House to the five fraternal delegates who represent members in the federal services, and to the chairs of the executive committees of the two ASHP sections. The amendment now goes to ASHP active members in a mail ballot for final approval.

Recommendations

The House of Delegates offered 24 recommendations for review by the Board of Directors and referral to appropriate ASHP bodies for study during the coming year. As part of its sunset review process, the House also discontinued 10 existing policies.

ASHP is the 30,000-member national professional association that represents pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care, and other components of health care systems. ASHP, which has a long history of medication-error prevention, believes that the mission of pharmacists is to help people make the best use of medications. Assisting pharmacists in fulfilling this mission is ASHP’s primary objective. The Society has extensive publishing and educational programs designed to help members improve their delivery of pharmaceutical care, and it is the national accrediting organization for pharmacy residency and pharmacy technician training programs.