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6/19/2001
Press Release

ASHP House of Delegates Pushes for New Vision of Pharmacy Practice

The House of Delegates of the American Society of Health-System Pharmacists (ASHP) took action on a broad range of professional issues during its 53rd annual session, including technician education, machine-readable coding for single-unit drug product packaging, and restricted distribution systems. The session, held June 4 and 6 in Los Angeles, was conducted in conjunction with the Society’s Annual Meeting 2001.

The House of Delegates, ASHP’s chief policy-making body, consists of 163 voting state delegates (a minimum of two from each state, the District of Columbia and Puerto Rico). Voting delegates also include members of the Board of Directors, past presidents of ASHP, chairs of the Society’s sections of clinical specialists and home care practitioners, two student delegates, and five fraternal delegates representing the federal services.

Policy Actions

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

Board of Directors

Delegates approved measures amending the Society’s bylaws to grant sole authority to the Board of Directors to establish the dues rate for active members, revising the Society’s mission statement and creating a vision statement for the Society that offers a look into an optimal future for health-system pharmacy practice.

Council on Administrative Affairs

Pharmacy Benefits for the Uninsured: To support the principle that all patients have the right to receive care from pharmacists; further, to declare that health-system pharmacists should play a leadership role in ensuring access to pharmacists’ services for indigent or low-income patients who lack insurance coverage and for patients who are underinsured; further, to advocate better collaboration among health systems, community health centers, state and county health departments, and the federal Health Resources and Services Administration (HRSA) in identifying and addressing the needs of indigent and low-income patients who lack insurance coverage and of patients who are underinsured.

Medication Formulary System Management: To declare that decisions on the management of a medication formulary system (1) should be based on clinical, ethical, legal, social, philosophical, quality-of-life, safety, and pharmacoeconomic factors that result in optimal patient care, and (2) 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. (Replaces policy 9803.)

Gene Therapy: To declare that health-system decisions on the selection, use, and management of gene therapy agents should be based on the same principles as a medication formulary system in that (1) decisions are based on clinical, ethical, legal, social, philosophical, quality-of-life, safety, and pharmacoeconomic factors that result in optimal patient care and (2) such decisions must include the active and direct involvement of physicians, pharmacists, and other appropriate health care professionals.

Patient Satisfaction: To encourage pharmacists to establish mechanisms within their practice settings that measure the level of satisfaction patients have with pharmacy services and with the outcomes of their drug therapy; further, to construct such mechanisms in a manner that will (1) provide a system for monitoring trends in the quality of pharmacy services to patients, (2) increase recognition of the value of pharmacy services, and (3) provide a basis for making improvements in the process and outcomes of pharmacy services; further, to facilitate a dialogue with and education of national patient satisfaction database vendors on the role and value of clinical pharmacy services.

Computerized Prescriber Order Entry: To advocate the use of computerized entry of medication orders or prescriptions by the prescriber when (1) it is planned, implemented, and managed with pharmacists’ involvement, (2) such orders are part of a single, shared database that is fully integrated with the pharmacy information system and other key information system components, especially the patient’s medication administration record, (3) such computerized order entry improves the safety, efficiency, and accuracy of the medication-use process, and (4) it includes 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. (Replaces policy 9806.)

Machine-readable coding: To declare that the identity of all medications should be verifiable through machine-readable coding technology and to support the goal that all medications be verified before they are administered to patients in the inpatient setting; further, to urge the Food and Drug Administration to mandate that standardized machine-readable coding be placed on all manufacturers’ single-unit drug packaging to (1) ensure the accuracy of medication administration, (2) improve efficiencies within the medication-use process, and (3) improve overall public health and patient safety.

Council on Educational Affairs

Nonaccredited Pharmacy Degree Programs: To support the position that every educational program that offers a pharmacy degree must be accredited by the American Council on Pharmaceutical Education (ACPE), regardless of licensure status of students enrolled.

Nontraditional Pharm.D. Accessibility: To encourage colleges of pharmacy to continue to develop innovative ACPE-accredited programs that meet the professional advancement needs of practitioners, using distance learning and other advanced technologies where appropriate; further, to identify and publicize mechanisms available to baccalaureate-degree pharmacists for overcoming barriers to the attainment of the Pharm.D. degree.

Training for Pharmacy Technicians Working in Health Systems: To support the goal that technicians working in health systems have completed a uniform, standards-based program of training or have attained comparable skills through work experience.

Professional Socialization: To encourage pharmacists to serve as mentors to students, residents, and colleagues in a manner that fosters the adoption of: high professional aspirations for pharmacy practice, high personal standards of integrity and competence, a commitment to serve humanity, habits of analytical thinking and ethical reasoning, and a commitment to lifelong learning.

Professional Development as a Retention Tool: To recognize that pharmacy department staff development is an essential component of staff recruitment and retention as well as quality of work life; further, to recognize that staff development encompasses more than formal inservice or external programs and includes informal learning among colleagues, mentoring, and other types of learning; further, to strongly encourage pharmacy directors and health-system administrators to support staff development programs as an important benefit that aids in recruiting and retaining qualified practitioners; further, to assist pharmacy directors with staff development initiatives by providing a variety of educational programs, services, and resource materials. (Replaces policy 8706)

Council on Legal and Public Affairs

Credentialing of Pharmacy Technicians: To advocate and support registration of pharmacy technicians by state boards of pharmacy (registration is the process of making a list or being enrolled in an existing list; registration should be used to help safeguard the public through interstate and intrastate tracking of the technician work force and preventing individuals with documented problems from serving as pharmacy technicians); further, to advocate and support certification of pharmacy technicians (certification is the process by which a nongovernmental agency or association grants recognition to an individual who has met certain predetermined qualifications specified by that agency or association); further, to advocate the adoption of uniform standards for the education and training of all pharmacy technicians to ensure competency; further, to oppose state licensure of pharmacy technicians (licensure is the process by which an agency of government grants permission to an individual to engage in a given occupation upon a finding that the applicant has attained the minimal degree of competency necessary to ensure that the public health, safety, and welfare will be reasonably well protected); further, to advocate that licensed pharmacists should be held accountable for the quality of pharmacy services provided and the work of pharmacy technicians under their charge. (Replaces policies 9704 and 9912.)

Restricted Distribution Systems: To reiterate support for the current system of drug distribution in which prescribers and pharmacists exercise their professional responsibilities on behalf of patients; further, to acknowledge that there may be limited circumstances in which constraints on the traditional drug distribution mechanism may be appropriate if the following principles are met: (1) the requirements do not interfere with the continuity of care for the patient; (2) the requirements preserve the pharmacist-patient relationship; (3) the requirements are based on scientific evidence fully disclosed and evaluated by physicians, pharmacists, and others; (4) there is scientific consensus that the requirements are necessary and represent the least restrictive means to achieve safe and effective patient care; (5) the cost of the product and any associated product or services are identified for purposes of reimbursement, mechanisms are provided to compensate providers for special services, and duplicative costs are avoided; (6) all requirements are stated in functional, objective terms so that any provider who meets the criteria may participate in the care of patients; and (7) the requirements do not interfere with the professional practice of pharmacists, physicians, and others; further, to strongly encourage pharmaceutical manufacturers and the Food and Drug Administration to consult with practicing pharmacists when they contemplate the establishment of a restricted distribution system for a drug product. (Replaces policy 9104.)

Product Reimbursement and Pharmacist Compensation: To pursue, in collaboration with public and private payers, the development of improved methods of reimbursing pharmacies for the cost of drug products dispensed and associated overhead; further, to pursue, with federal and state health-benefit programs and other third-party payers, the development of a standard mechanism for compensation of pharmacists for patient care services and compounding and dispensing services; further, to pursue changes in federal, state, and third-party payment programs to (1) define pharmacists as providers of patient care and (2) 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. (Replaces policy 0004.)

Patient Adherence Programs as Part of Health Insurance Coverage: To support the pharmacist’s role in patient medication adherence programs that are part of health insurance plans; further, to support those programs that (1) maintain the direct patient—pharmacist relationship; (2) are based on the pharmacist’s knowledge of the patient’s medical history, indication for the prescribed medication, and expected therapeutic outcome; (3) use a communication method desired by the patient; (4) are consistent with federal and state regulations for patient confidentiality; and (5) are consistent with ASHP policy on confidentiality of patient health care information.

Council on Organizational Affairs

Bylaws Definition of the Term "State": To amend the ASHP Bylaws, Article 10 Section 1.2, by adding the phrase "…and Puerto Rico." (Proposal A)

Increasing Number of State Delegates in the House: To amend the ASHP bylaws, Articles 7.1 and 7.1.1.1, to increase the number of allowable state delegates in the ASHP House of Delegates to 163 to accommodate the addition of two delegates to represent ASHP active members in Puerto Rico. (Proposal B)

Periodic Reexamination of ASHP’s Organizational Structure and Governing Process: To assign to the Board of Directors responsibility for ensuring that ASHP has a mechanism for examining periodically the organizational structure and governing processes of ASHP. (Replaces policy 8811.)

State Affiliate Membership and ASHP Appointments: To give consideration to ASHP members who also hold membership in their state affiliate when making appointments to ASHP councils, committees, commissions, and other appointed bodies. (Replaces policy 8412.)

Council on Professional Affairs

Institutional Review Boards: To support mandatory training on human-subject protections and research bioethics for members of institutional review boards (IRBs), principal investigators, and all others involved in clinical research; further, to advocate that institutional review boards include a pharmacist as a voting member.

New Business

Delegates approved for referral to the Board of Directors four New Business items, including a motion advocating health-system pharmacy leadership in the safe storage and labeling for neuromuscular blocking agents. A motion commending Sen. Timothy Johnson (D-S.D.), sponsor of the Medicare Pharmacists Services Coverage Act of 2001, was also approved, as well as a motion commending Brian L. Kaatz, Pharm.D., for his efforts in educating Sen. Johnson about the patient care role of pharmacists. The fourth New Business motion called for increasing the visibility of candidates for ASHP elected office.

Recommendations

The House of Delegates offered 23 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, which has a long history of medication error prevention efforts, believes that the mission of pharmacists is to help people make the best use of medicines. 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.