ASHP House of Delegates Moves Forward on Pressing Practice Issues
The House of Delegates, ASHPs 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 Societys sections of clinical specialists and home care practitioners, two student delegates, and five fraternal delegates representing the federal services.
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 Societys bylaws to specifically permit the use of electronically transmitted ballots and systems for ASHP elections for President-elect and Board of Directors, granting voting representation in the House of Delegates for the chairs of ASHP member Sections and Forums, and approved the ASHP Statement on the Role of Health-System Pharmacists in Emergency Preparedness.
Council on Administrative Affairs
Staffing for Safe and Effective Patient Care: To encourage pharmacy managers to work in collaboration with physicians, nurses, health-system administrators, and others to outline key pharmacist services that are essential to safe and effective patient care; further, to encourage pharmacy managers to be innovative in their approach and to factor into their thinking legal requirements, accreditation standards, professional standards of practice, and the resources and technology available in individual settings; further, to support the following principles:
- Sufficient qualified staff must exist to ensure safe and effective patient care;
- During periods of staff shortages, pharmacists must exert leadership in directing resources to services that are the most essential to safe and effective patient care;
- Within their own organizations pharmacists should develop contingency plans to be implemented in the event of insufficient staff actions that will preserve services that are the most essential to safe and effective patient care and will, as necessary, curtail other services; and
- Among the essential services for safe and effective patient care is pharmacist review of new medication orders before the administration of first doses; in settings where patient acuity requires that reviews of new medication orders be conducted at any hour and similar medication-use decisions be made at any hour, there must be 24-hour access to a pharmacist (Replaces policy 0001.)
Performance Improvement: To encourage pharmacists to establish performance improvement processes within their practice settings that measure both operational and patient outcomes; further, to encourage pharmacists to use contemporary performance improvement techniques and methods for ongoing improvement in their services; further, to support pharmacists in their development and implementation of performance-improvement processes. (Replaces policy 9808.)
Pharmacists Role in Electronic Patient Information and Prescribing Systems: To strongly advocate key decision roles of pharmacists in the planning, selection, implementation, and maintenance of electronic patient information systems (including computerized prescriber order-entry systems) to facilitate clinical decision support, data analysis, and education of users for the purpose of ensuring the safe and effective use of medications. (Replaces policy 9807.)
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 health systems; further, to urge the Food and Drug Administration (FDA) to mandate that standardized machine-readable coding, including lot numbers and expiration dates, be placed on all manufacturers' single-unit drug packaging to (1) improve the accuracy of medication administration, (2) improve efficiencies within the medication-use process, and (3) improve overall public health and patient safety. (Replaces policies 0106 and 9906.)
Pharmacists in Managed Care Settings: To assume a leadership role as a membership organization in meeting the unique needs of pharmacists practicing in managed care settings (e.g., health maintenance organizations, preferred-provider organizations, pharmacy benefit management companies, and independent practice associations). (Replaces policy 8801.)
Reimbursement for Unlabeled Uses of FDA-Approved Drug Products: To support third-party reimbursement for FDA-approved drug products appropriately prescribed for unlabeled uses. (Replaces policy 9001.)
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 educate pharmacists about those methods; 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 educate and assist pharmacists in their efforts to attain provider status and receive compensation for patient care services. (Replaces policy 0115.)
Council on Educational Affairs
Medication Safety in Curricula for Health Practitioners: To urge that the curricula of colleges of pharmacy and other health profession schools include instruction, in an interdisciplinary fashion, about the principles of performance improvement and patient safety and train students how to apply these principles in practice.
Substance Abuse and Chemical Dependency: To collaborate with appropriate professional and academic organizations in fostering adequate education on substance abuse and chemical dependency at all levels of pharmacy education (i.e., schools of pharmacy, residency programs, and continuing-education providers); further, to support federal, state, and local initiatives that promote pharmacy education on substance abuse and chemical dependency; further, to advocate the incorporation of education on substance abuse and chemical dependency into the accreditation standards for Doctor of Pharmacy degree programs and pharmacy technician training programs.
Health Literacy: To encourage the development of educational programs for pharmacy students, residents, and practitioners on assessing the level of general literacy and health literacy of patients; further, to encourage pharmacists, when communicating medication information to patients, to use techniques that take into account the patient's level of general literacy and health literacy; further, to seek opportunities to support research on health literacy as it relates to the appropriate use of medicines.
Image of and Career Opportunities for Pharmacy Technicians: To promote the image of pharmacy technicians as valuable contributors to health care delivery; further, to develop and disseminate information about career opportunities that enhance the recruitment and retention of qualified pharmacy technicians.
Pharmacy Technician Training: To support the goal that technicians entering the pharmacy work force have completed an accredited program of training; further, to encourage expansion of accredited pharmacy technician training programs. (Replaces policy 0109.)
Pharmacists Role in Immunization and Vaccines: To affirm that pharmacists have a role in promoting and administering proper immunizations to patients and employees in all 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; further, to strongly encourage pharmacists to use available opportunities and materials to educate at-risk patients their caregivers, parents, guardians, and health care providers about the importance of immunizations. (Replaces policies 0019 and 0111.)
Image of and Career Opportunities for Health-System Pharmacists: To expand the public information program promoting the professional image of health-system pharmacists to the general public, public policymakers, other health care professionals, and health-system decision-makers; further, to provide ASHP informational and recruitment materials identifying opportunities for pharmacy careers in health systems. (Replaces policy 9710.)
Educational Program Resources for Affiliated State Societies: To assist ASHP-affiliated state societies with information about potential educational program resources. (Replaces policy 8802.)
Residency Programs: To strongly advocate that all pharmacy residency programs become accredited as a means of ensuring and conveying program quality. (Replaces policy 8715.)
"P.D." (Pharmacy Doctor) Designation for Pharmacists: To oppose the use of "P.D." or any other designation that implies an academically conferred degree where none exists. (Replaces policy 8308.)
Council on Legal and Public Affairs
Pharmacist Work- Force Recruitment and Retention: To support federal and state incentive programs for new pharmacy graduates to practice in underserved areas; further, to provide information and educational programming on strategies used by employers for successful recruitment and retention of pharmacists and pharmacy technicians; further, to conduct regular surveys on trends in the health-system pharmacy work force, including retention rates for pharmacists and pharmacy technicians.
Requirements for Engaging in Collaborative Drug Therapy Management: To recognize licensure of pharmacists as the only state imposed legal requirement for pharmacists engaged in activities involving collaborative drug therapy management; further, to support the current practice of pharmacists and prescribers negotiating and establishing collaborative drug therapy management agreements in which the pharmacist receives delegated authority; further, to support the use of privileging processes in those practice environments where explicit privileging is required to receive delegated authority; additional training or credentialing required of the pharmacist engaging in these practices are determined by the local practice site.
Intermediate Category of Drugs: To support, with appropriate changes in federal statutes and regulations, the establishment of an intermediate category of drug products that do not require a prescription but are available only from pharmacists and licensed health care professionals who are authorized to prescribe medications; further,
To base such support on the following facts:
- Some drug products that are potential candidates for switching from prescription-only to nonprescription status raise concerns about patient safety as nonprescription products; these products could be better controlled, monitored, and evaluated by making them available only from pharmacists and licensed health care professionals who are authorized to prescribe medications; and
- Pharmacists have the education, training, and expertise to help patients make appropriate therapeutic decisions associated with the use of such drug products; further,
To support that the regulatory system for this intermediate category of drug products contain the following features:
- Drug products appropriate for this intermediate category would be identified through the advice of pharmacists, physicians, and other licensed health professionals who are authorized to prescribe medications, on the basis of the medical conditions to be treated and potential adverse effects (as indicated in FDA-approved labeling);
- Pharmacists would be able to provide drugs in this intermediate category directly to patients without a prescription, on the basis of appropriate assessment and professional consultation;
- Licensed health professionals who currently have prescribing authority would continue to have the ability to prescribe medications in this intermediate category; and
- Data from postmarketing surveillance, epidemiologic studies, and adverse-drug-reaction reporting would be collected to help determine a drug product's eventual movement to nonprescription status, return to prescription-only status, or continuation in the intermediate category. (Replaces policy 8511.)
Drug Product Shortages: To strongly encourage FDA to revise its definition of "medically necessary" drug products to cover both single-source and multisource products; further, to strongly encourage FDA to require pharmaceutical manufacturers that are single-source manufacturers of a particular drug product or have a preponderant market share of a multisource product to provide adequate notice of not less than six months to the agency that they plan to discontinue or significantly reduce the manufacture of the product; further, to strongly encourage FDA to become more assertive in assuring that drug manufacturers maintain adequate supplies of drug products that the agency deems medically necessary.
Greater Access to Less Expensive Generic Drugs: To support legislation and regulations that promote greater patient access to less expensive generic drug products.
Federal Research on Dietary Supplement Labeling: To advocate federal support for research on the adequacy of dietary supplement labeling to ensure the safe use of these products; further, to advocate that such research assess the potential need for (1) more information in the labeling of dietary supplements about adverse effects, interactions with medications, and safe and effective use, and (2) increased reporting of adverse reactions to dietary supplements to FDA.
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 by 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 mandatory certification of all current pharmacy technicians and new hires within one year of date of employment (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 actions of pharmacy technicians under their charge. (Replaces policies 0007 and 0113.)
Compounding versus Manufacturing: To support the principle that compounding, when done to meet anticipatory patient needs, is part of the practice of pharmacy and is not manufacturing; further, to foster educational efforts relating to pharmacy compounding in health systems. (Replaces policy 9107.)
Council on Organizational Affairs
Proxy/Absentee Balloting: To oppose the development of proxy/absentee balloting programs for the ASHP House of Delegates. (Replaces policy 8215.)
Council on Professional Affairs
Pharmacists Responsibility for Patient Safety: To affirm that individual pharmacists have a professional responsibility to ensure patient safety through the use of proven interventions and best practices; further, to affirm that employee performance measurement and evaluation systems should incorporate measures that support and encourage a focus on patient safety by pharmacists.
Appropriate Dosing of Medications in Patient Populations with Unique Needs: To advocate reforms in medication-use systems, including electronic systems, and health care provider education and training that facilitate optimal patient-specific dosing in populations of patients (e.g., pediatrics, geriatrics) with altered pharmacokinetics and pharmacodynamics.
Clinical Investigation of Drugs Used in Elderly and Pediatric Patients: To advocate increased enrollment of pediatric and geriatric patients in clinical trials of new medications; further, to encourage pharmacodynamic and pharmacokinetic research in geriatric and pediatric patients to facilitate the safe and effective use of medications in these patient populations. (Replaces policy 8711.)
Institutional Review Boards and Investigational Use of Drugs: To support mandatory education and 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 IRBs include pharmacists as voting members; further, to advocate that IRBs inform pharmacy of all approved clinical research involving drugs within the hospital or health-system; further, to advocate that pharmacists should act as liaisons between IRBs and pharmacy and therapeutics committees in the management and conduct of clinical drug research studies; further, to strongly support pharmacists' management of drug products used in clinical research. (Replaces policies 0119 and 0022.)
Pharmaceutical Waste: To work closely with regulatory bodies and appropriate organizations to develop standards that address pharmaceutical hazardous waste as defined in the Resource Conservation and Recovery Act, for the purpose of simplifying the disposal of these substances in health systems; further, to encourage pharmaceutical manufacturers and the Environmental Protection Agency to provide guidance and assistance to health systems in their pharmaceutical waste-destruction and waste-recycling efforts; further, to promote awareness of pharmaceutical waste regulations within health systems; further to encourage pharmaceutical manufacturers to streamline packaging of drug products to reduce waste materials. (Replaces policy 9110.)
Pharmacists Role in Drug Procurement, Distribution, Surveillance,and Control: To affirm the pharmacist's expertise and responsibility in the procurement, distribution, surveillance, and control of all drugs used within health systems; further, to encourage the Joint Commission on Accreditation of Healthcare Organizations, other accreditation bodies, and governmental entities to enhance patient safety by supporting the pharmacist's role in drug procurement, distribution, surveillance, and control. (Replaces policy 9908.)
Electronic Health and Business Technology and Services: To encourage pharmacists to assume a leadership role in their health systems with respect to strategic planning for and implementation of electronic health and business technology and services; further, to advocate the inclusion of electronic health and business technology, and telepharmacy issues and applications in pharmacy school curricula. (Replaces policy 0015.)
ASHP Statement on the Pharmacists Role in Hospice and Palliative Care: (see attachment)
Delegates approved for referral to the Board of Directors one New Business item which calls for an ASHP-sponsored consensus development conference on the role of emerging technologies in redefining pharmacy practice models, including the medication-use process, in health systems.
The House of Delegates offered 20 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 professional practice, and it is the national accrediting organization for pharmacy residency and pharmacy technician training programs. For more information, visit ASHPs Web site, www.ashp.org.