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9/6/2000
Press Release

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

ASHP

The American Society of Health-System Pharmacists (ASHP) House of Delegates considered a variety of pharmacy issues at its 49th annual session, including pharmaceutical care for dying patients; conscientious objection to the provision of drugs used in morally, religiously, or ethically troubling therapies; pharmacist participation in collaborative drug therapy management; and the necessity to take a greater leadership role in preventing medication misadventures. The session, held June 1 and 3 in Baltimore, Md., was conducted in conjunction with the Society’s Annual Meeting ’98.

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. Five fraternal delegates, representing ASHP members in the federal services, round out the composition of the House. 

POLICY ACTIONS 

The House approved the policy recommendations noted below, which originated from the ASHP councils noted, and discontinued several older policies as a part of a sunset review process. A complete list of the discontinued policies is available from the ASHP Public Information Division at (301) 657- 3000, ext. 1203. 

Council on Administrative Affairs 

  • Medication Formulary System Management. To declare that decisions on the management of a medication formulary system (a) should be based on clinical, quality-of-life, and pharmacoeconomic factors that result in optimal patient care and (b) must include the active and direct involvement of physicians, pharmacists, and other appropriate health care professionals; further, to declare that decisions on the management of a medication formulary system should not be based solely on economic factors.  
  • Multidisciplinary Action Plans for Patient Care. To support pharmacists as integral participants in the development of multidisciplinary action plans for patient care (care MAPs), disease- management plans, and health-management plans.  
  • Medication Misadventures. To affirm that pharmacists must assume a leadership role in preventing, investigating, and eliminating medication misadventures across the continuum of care.  
  • Electronic Entry of Medication Orders. To support, as the preferred method of prescribing, direct electronic entry of medication orders or prescriptions by the prescriber, with provisions for the pharmacist to review and verify the order’s appropriateness before medication administration, except in those instances when review would cause a medically unacceptable delay.  
  • Patient Information Systems. To affirm that, because of their unique expertise and value in patient care, pharmacists must have a leadership role in the planning, selection, implementation, maintenance, and enhancement of electronic information systems used within a health system; further, to affirm that pharmacists must contribute to the design of patient information systems, including involvement in decisions on the functions, logic, and rules related to medication use.  
  • Defining and Measuring the Quality of Clinical Services. To encourage pharmacists to establish a quality improvement process within their practice settings that measures both operational and patient outcomes.

Council on Educational Affairs 

  • Position on the Entry-Level Doctor of Pharmacy Degree. To reaffirm the official policy of ASHP to support the Doctor of Pharmacy degree as the single entry-level degree for professional pharmacy practice; further, to strongly encourage the development of viable and widely available external and nontraditional Doctor of Pharmacy Degree programs; further, to be an active participant in the American Council on Pharmaceutical Education (ACPE) process for the revision of accreditation standards for entry-level education in pharmacy; further, to provide the ACPE with appropriate documents and background materials in order to demonstrate the ASHP position and support for ACPE’s intent on this important issue; further, to actively monitor the long-range impact that the single entry-level degree will have on residency education, availability of experiential training sites, graduate education, continuing education programs, and the resulting health-system pharmacist applicant pool.  
  • Relationship Between Practice Sites and Educational Institutions. To reaffirm ASHP’s commitment to practitioner input in undergraduate professional education and to restate the importance of the institutional and health-system environments as sites for undergraduate training; further, to define and develop appropriate methods of organizational relationships between health systems and colleges of pharmacy that permit a balance of patient care and service, as well as educational and research objectives of both institutions in a mutually beneficial manner; further, to include the administrative interests of both the health system and the college in defining these organizational relationships to assure compatibility of institutional (i.e., health system or university) and departmental (e.g., pharmacy department and department in the college) objectives; further, to develop appropriate support materials to assist pharmacists in developing cost analyses and other materials required to justify active participation of a health system in undergraduate pharmacy education.

Council on Legal and Public Affairs 

  • Public Funding for Pharmacy Residency Training. To support legislation and regulation that ensures public funding for pharmacy residency programs consistent with the needs of the public and the profession; further, to oppose legislation or regulation involving reimbursement levels for graduate medical education that adversely affects pharmacy residencies at a rate disproportionate to other residency programs.  
  • Collaborative Drug Therapy Management. To pursue the development of federal and state legislative and regulatory provisions that authorize collaborative drug therapy management by the pharmacist as a component of pharmaceutical care; further, to actively support affiliated state societies in the pursuit of state-level collaborative drug therapy management authority for pharmacists.  
  • Regulation of Automated Drug Distribution Systems. To work with the Drug Enforcement Administration and other agencies to seek regulatory and policy changes to accommodate automated drug distribution in health systems.

Council on Professional Affairs 

  • Educating Pharmacists to Provide Appropriate Support for Dying Patients. To provide education to pharmacists on caring for dying patients, including education on clinical, managerial, professional, and legal issues; further, to urge the inclusion of such topics in the curricula of colleges of pharmacy.  
  • Pain Management. To advocate for fully informed patient and caregiver participation in pain management decisions as an integral aspect of pharmaceutical care; further, to support any advancements in treatment that result in improved control of pain, especially relief of chronic intractable pain; further, to work with other health care organizations in fostering improved pain management; further, to increase ASHP’s efforts in offering educational programs on contemporary pain management therapies and techniques.  
  • Appropriate Pharmacy Support for Dying Patients. To support the position that care for dying patients is part of the continuum of pharmaceutical care that pharmacists should provide to patients; further, to support the position that pharmacists have a professional obligation to work in a collaborative and compassionate manner with patients, family members, caregivers, and other professionals to help fulfill the pharmaceutical care needs -- especially the quality-of-life needs -- of dying patients of all ages; further, to support research on the needs of dying patients.  
  • Pharmacists as Source of Information About Dietary Supplements and Alternative or Complementary Substances. To support the principle that pharmacists should be informed about dietary supplements and alternative or complementary substances and capable of providing sound advice to patients about their use; further, to support the principle that pharmacists and pharmacies should foster public confidence that they are accessible sources of available authoritative information about dietary supplements and alternative or complementary substances; further, to support the principle that pharmacists’ recommendations about the use of dietary supplements and alternative or complementary substances should be based on scientific evidence of safety and efficacy.  
  • Regulation of Complementary and Alternative Substances. To support Food and Drug Administration (FDA) regulatory authority over complementary and alternative substances for which claims -- even indirect and general claims -- are made by manufacturers or distributors about their usefulness in preventing and treating disease; further, to support the principle that complementary and alternative substances not having proven efficacy but having no appreciable toxicity should be allowed to be marketed (but not as drugs or biologics) with labeling that clearly states their lack of proven efficacy; further, to support the routine reporting and monitoring of product defects and adverse effects associated with complementary and alternative substances through the FDA MedWatch and United States Pharmacopeia reporting programs.  
  • Role of Pharmacists and Business Leaders in Health Care Services and Policies. To support the principle that business leaders and health professionals must share responsibility and accountability for providing optimal health care services to patients; further, to support the principle that business leaders should expect practicing pharmacists to formulate policies that affect the prerogative of pharmacists to make optimal care decisions on behalf of patients.  
  • Medication Administration by Pharmacists. To support the position that the administration of medicines is part of the routine scope of pharmacy practices; further, to support the position that pharmacists who administer medicines should be skilled to do so; further, to support the position that pharmacists should be participants in establishing procedures in their own work settings with respect to the administration of medicines (by anyone) and monitoring the outcomes of medication administration.  
  • ASHP Statements. The House of Delegates approved the following new ASHP Statements (an ASHP Statement is a category of professional policy defined as “a declaration and explanation of basic philosophy or principle”): ASHP Statement on the Pharmacist's Role in Clinical Pharmacokinetic Monitoring; ASHP Statement on the Pharmacist's Role in Infection Control; and ASHP Statement on the Pharmacist's Role in Substance Abuse Prevention, Education, and Assistance. For copies of these statements, contact the ASHP Public Information Division at (301) 657-3000, ext. 1203.

RESOLUTIONS 

Delegates approved the following two new Resolutions: 

  • Collaborative Drug Therapy Management Activities. To support the participation of pharmacists in collaborative drug therapy management, which is defined as a multidisciplinary process for selecting appropriate drug therapies, educating patients, monitoring patients, and continually assessing outcomes of therapy; further, to recognize that pharmacists participate in collaborative drug therapy management for a patient who has a confirmed diagnosis by an authorized prescriber; further, to recognize that the activities of a pharmacist in collaborative drug therapy management may include, but not be limited to, initiating, modifying, and monitoring a patient’s drug therapy; ordering and performing laboratory and related tests; assessing patient response to therapy; counseling and educating a patient on medications; and administering medications.  
  • Conscientious Objection by Pharmacists to Morally, Religiously, or Ethically Troubling Therapies. ASHP recognizes a pharmacist’s right to conscientious objection to morally, religiously, or ethically troubling therapies and supports the establishment of systems that protect the patient’s right to obtain legally prescribed and medically indicated treatments while reasonably accommodating the pharmacist’s right of conscientious objection.

NEW BUSINESS 

Delegates approved for referral to the Board of Directors two New Business items dealing with professional issues, including collaboration with health care and consumer associations to build support on professional issues for ASHP policy, and development of a professional policy on patient confidentiality. 

RECOMMENDATIONS 

The House of Delegates also offered 17 Recommendations for review by the Board of Directors and referral to appropriate ASHP bodies for study during the coming year. 

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 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.