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 professional issues during its 55th annual session, including roles for pharmacy technicians, requirements for machine-readable coding, and regulation of dietary supplements. The session held June 1 and 3 in San Diego, was conducted in conjunction with the Societys Summer Meeting 2003.
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 and forums, and five fraternal delegates representing the federal services.
The House approved the following professional policies, which originated from the committees indicated:
Commission on Therapeutics
Sale and Manufacture of Dietary Supplements Containing Ephedrine Alkaloids: To support a ban on the manufacture and sale of dietary supplements containing ephedrine alkaloids because (1) ephedrine alkaloids pose a significant risk of illness and injury, (2) changes in product labeling are not adequate to protect the public from these dangers, (3) the use of these products represents significant expenditures for a health-related remedy of unsubstantiated value, and (4) other safe and effective interventions are available for all common uses of these products.
Executive Committee, Section of Home, Ambulatory, and Chronic Care Practitioners
Continuity of Care: To recognize that continuity of patient care is a vital requirement in the appropriate use of medications; further, to strongly encourage pharmacists to assume professional responsibility for ensuring the continuity of pharmaceutical care as patients move from one setting to another (e.g., ambulatory care to inpatient care to home care); further, to encourage the development of strategies to address the gaps in continuity of pharmaceutical care.
Council on Administrative Affairs
Machine-Readable Coding and Related Technology: 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 electronically verified before they are administered to patients in health systems; further, to urge the Food and Drug Administration, other regulatory agencies, contracting entities, and others to mandate that pharmaceutical manufacturers place standardized machine-readable coding, which includes National Drug Code, lot number, and expiration date, on all manufacturers unit dose, unit of use, and injectable drug packaging; further, to strongly encourage health systems to adopt machine-readable coding and point-of-care technology to (1) improve the accuracy of medication administration and documentation, (2) improve efficiencies within the medication-use process, and (3) improve patient safety; these systems should be planned, implemented, and managed with pharmacist involvement and should be in all areas of the health system where drugs are used. (Replaces policy 0204)
Unit Dose Packaging Availability: To advocate that pharmaceutical manufacturers provide all medications used in health systems in unit dose packages; further, to urge the Food and Drug Administration to support this goal in the interest of public health and patient safety.
Technician-Checking-Technician Programs: To advocate technician-checking-technician programs (with appropriate quality control measures) in order to permit redirection of pharmacist resources to patient care activities; further, to advocate state board of pharmacy approval of these programs.
Council on Educational Affairs
Skills Needed to Provide Interdisciplinary and Interprofessional Patient Care: To encourage colleges of pharmacy and other health professions schools to focus on the need to teach students the skills necessary for working with other health care professionals to provide patient care; further, to encourage the American Council on Pharmaceutical Education to include standards for teaching the provision of interprofessional patient care throughout the curriculum; further, to encourage and support pharmacists collaboration with other health professionals in the development of purposeful, deliberative interprofessional practice models. (Note: Interdisciplinary refers to communication between disciplines within a profession; interprofessional refers to communication across the health care professions.) (Replaces policy 9914)
Interdisciplinary and Interprofessional Instruction on Performance Improvement and Patient Safety: To urge colleges of pharmacy and other health professions schools to include instruction, in an interdisciplinary and interprofessional fashion, on the principles of performance improvement and patient safety and train students in how to apply these principles in practice. (Note: Interdisciplinary refers to communication between disciplines within a profession; interprofessional refers to communication across the health care professions.) (Replaces policy 0208)
Patient-Centered Care: To encourage that the principles of patient-centered care be integrated throughout the college of pharmacy curriculum.
Cultural Competence: To foster cultural competence among pharmacy students, residents, and practitioners and within health systems for the purpose of achieving optimal therapeutic outcomes in diverse patient populations.
Practice Sites for Colleges of Pharmacy: To encourage practitioner input in pharmacy education; further, to encourage that institutional and health-system environments be used as sites for experiential training of pharmacy students; further, to encourage colleges of pharmacy and health systems to define and develop appropriate organizational relationships that permit a balance of patient care and service, as well as educational and research objectives, in a mutually beneficial manner; further, to include the administrative interests of both the health system and the college of pharmacy in defining these organizational relationships to ensure compatibility of institutional (i.e., health system or university) and departmental (i.e., pharmacy department and department in the college) objectives; further, to encourage pharmacists and pharmacy leaders to recognize that part of their professional responsibility is the development of new pharmacy practitioners. (Replaces policy 9810)
Biological Drugs: 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; further, to facilitate education of pharmacists about the proper use of biologic therapies. (Replaces policy 0017)
Council on Legal and Public Affairs
Medicare Prescription Drug Benefit: To strongly advocate a fully funded prescription drug program for eligible Medicare beneficiaries that maintains the continuity of patient care and ensures the best use of medications (fully funded means the federal government will make adequate funds available to fully cover the Medicare programs share of prescription drug program costs; eligible means that the federal government may establish criteria by which Medicare beneficiaries qualify for the prescription drug program); further, to recommend that the program should at a minimum contain the following: (1) appropriate product reimbursement, (2) appropriate coverage and payment for patient care services provided by pharmacists, and (3) open access that allows any willing provider to participate.
Role of Licensing, Credentialing, and Privileging in Collaborative Drug Therapy Management: To recognize licensure of pharmacists as the only state-imposed legal requirement necessary for pharmacists engaged in providing collaborative drug therapy management services; 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; any additional training or credentials required of pharmacists engaging in these practices should be determined by the local practice site; further, to stipulate that privileging should be conducted by an oversight body of the practice site. (Note: Privileging is the process by which an oversight body of a health care organization or other appropriate provider body, having reviewed an individual health care providers credentials and performance and found them satisfactory, authorizes that individual to perform a specific scope of patient care services within that setting.) (Replaces policy 0219)
Drug Product Shortages: To strongly encourage the Food and Drug Administration to consider, in its definition of medically necessary drug products, the impact of medication-use factors, taking into account that if an unfamiliar product is introduced in a clinical setting because the customary product is unavailable, there is increased risk to patient safety; further, to support government-sponsored incentives for manufacturers to maintain an adequate supply of medically necessary pharmaceutical products; further, to advocate laws and regulations that would (1) require pharmaceutical manufacturers to notify the appropriate government body at least 12 months in advance of voluntarily discontinuing a medically necessary product, (2) provide effective sanctions for manufacturers that do not comply with this mandate, and (3) require prompt public disclosure of a notification to voluntarily discontinue a medically necessary product; further, to encourage the appropriate government body to seek the cooperation of manufacturers in maintaining the supply of a medically necessary product after being informed of a voluntary decision to discontinue that product. (Replaces policy 0221)
Re-importation of Pharmaceuticals: To oppose re-importation of pharmaceuticals except in cases where the Food and Drug Administration determines it would be necessary for the health and welfare of United States citizens.
Integrity of Drug Products in the U.S. Supply Chain: To encourage the Food and Drug Administration (FDA) to take the steps necessary to ensure that (1) all drug products entering the country are thoroughly inspected and tested to establish that they have not been adulterated or misbranded and (2) patients will not receive improperly labeled and packaged, deteriorated, outdated, counterfeit, or non-FDA-approved drug products; further, to encourage the Food and Drug Administration to develop and implement regulations to: 1) restrict or prohibit licensed drug distributors (drug wholesalers, repackagers and manufacturers) from purchasing legend drugs from unlicensed entities, 2) to accurately document at any given point in the distribution chain the original source of drugs and chain of custody from the manufacturer to the pharmacy, further; to urge Congress to provide adequate funding or authority to impose user fees to accomplish these objectives. (Replaces policy 8609)
Regulation 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 that state governments mandate certification by the Pharmacy Technician Certification Board (PTCB) of all 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 and the protection of public health and safety; 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 policy 0224)
Licensure for Pharmacy Graduates of Foreign Schools: To support state licensure eligibility of a pharmacist who has graduated from a pharmacy program accredited by the American Council on Pharmaceutical Education (ACPE) or accredited by an ACPE-recognized accreditation program.
Regulation of Dietary Supplements: To advocate a change in the Dietary Supplement Health Education Act such that dietary supplements shall at a minimum meet the same legal requirements as nonprescription drug products; further, to support the routine reporting and monitoring of product defects and adverse effects associated with dietary supplements through the FDA, MedWatch and United States Pharmacopeia reporting programs. (Replaces policy 9818)
Public Funding for Pharmacy Residency Training: To support legislation and regulation that ensures public funding for accredited 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. (Replaces policy 9811)
Council on Professional Affairs
Complementary or Alternative Substances: To recognize that patients may choose to use dietary supplements and complementary or alternative substances; further, to recognize that when providing patient care, pharmacists need to be aware of all substances a patient is using, including dietary supplements and complementary or alternative substances; further, to support the principle that pharmacists should be informed about dietary supplements and complementary or alternative substances and capable of providing sound advice to patients about their use; further, to support the principle that pharmacists recommendations about the use of dietary supplements and complementary or alternative substances should be based on sound scientific evidence of safety and efficacy; further, to support the principle that sound research on the safety and efficacy of dietary supplements and complementary or alternative substances is required for pharmacists to perform this function, and to advocate that the Food and Drug Administration take an active role in encouraging such research. (Replaces policy 9817)
Expression of Therapeutic Purpose of Prescribing: To advocate that the prescriber provide or pharmacists have immediate access to the intended therapeutic purpose of prescribed medications in order to ensure safe and effective medication use. (Replaces policy 9708)
Pain Management: To advocate fully informed patient and caregiver participation in pain management decisions as an integral aspect of patient care; further, to advocate that pharmacists actively participate in the development and implementation of health-system pain management policies and protocols; further, to support the participation of pharmacists in pain management, which is a multidisciplinary, collaborative process for selecting appropriate drug therapies, educating patients, monitoring patients, and continually assessing outcomes of therapy; further, to encourage the education of pharmacists, pharmacy students, and other health care providers regarding the principles of pain management. (Replaces policy 9815)
Pharmacist Support for Dying Patients: To support the position that care for dying patients is part of the continuum of 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 patient care needs, especially the quality-of-life needs, of dying patients of all ages; further, to support research on the needs of dying patients; further, 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. (Replaces policies 9814 and 9816)
ASHP Statement on the Role of Health-System Pharmacists in Emergency Preparedness
ASHP Statement on the Pharmacists Role in the Care of Patients with HIV Infection
ASHP Statement on the Pharmacists Role in Substance Abuse Prevention, Education, and Assistance
House of Delegates Resolution
Pharmacy Drug Theft: To support the development of policies and guidelines for health system pharmacists designed to deter drug product theft and thereby enhance both the integrity of the drug distribution chain and the safety of the workplace; further, to encourage the development of systems that limit the diversion and abuse potential of medications including high-cost drugs and controlled substances and thereby reduce the likelihood that these products will be targets of theft.
The House of Delegates offered 19 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, ambulatory care clinics, 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.