ASHP House of Delegates Takes Action on Broad Range of Professional Issues
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 and forums, and five fraternal delegates representing the federal services.
The House approved the following professional policies, which originated from the following ASHP councils:
Council on Administrative Affairs
Scope and Hours of Pharmacy Services: To support the principle that all patients should have 24-hour access to a pharmacist responsible for their care. To advocate alternative methods of pharmacist review of medication orders (such as remote review) before drug administration when onsite pharmacist review is not available; further, to support the use of remote medication order review systems that communicate pharmacist approval of orders electronically to the hospital’s automated medication distribution system; further, to promote the importance of pharmacist access to pertinent patient information, regardless of proximity to patient. (Replaces policy 9706).
Standardization, Automation, and Expansion of Manufacturer-Sponsored Patient-Assistance Programs: To advocate standardization of application criteria, processes, and forms for manufacturer-sponsored patient-assistance programs (PAP); further, to advocate the automation of PAP application processes through computerized programs, including Web-based models; further, to advocate expansion of PAPs to include high-cost drugs used in inpatient settings.
Electronic Information Systems: To advocate the use of electronic information systems, with appropriate security controls, that enable the integration of patient-specific data that are accessible in all components of a health system; further, to urge computer software vendors and pharmaceutical suppliers to provide standards for definition, collection, coding, and exchange of clinical data used in the medication-use process; further, to pursue formal and informal liaisons with appropriate health care associations to ensure that the interests of patient care and safety in the medication-use process are fully represented in the standardization, integration, and implementation of electronic information systems; further, to strongly encourage health-system administrators, regulatory bodies, and other appropriate groups to provide health-system pharmacists with full access to patient-specific clinical data. (Replaces policy 9909).
Workload Monitoring and Reporting: To advocate the development and implementation of a pharmacy workload monitoring system that analyzes the impact of pharmacy services on patient outcomes; further, to define pharmacy workload as all activities related to providing pharmacy patient care services; further, to continue communications with health-system administrators, consulting firms, and professional associations on the value of pharmacists’ services and on the use of valid and reliable data to assess pharmacy workload and staffing effectiveness; further, to encourage practitioners and vendors to develop and use a standard protocol for collecting and reporting pharmacy workload data and patient outcomes; further, to advocate to health-system administrators, consulting firms, and vendors of performance-measurement services firms the use of comprehensive pharmacy workload and staffing effectiveness measurements. (Replaces policy 9907).
Documentation of Pharmacist Patient Care Services: To encourage the documentation of pharmacist patient care services in order to validate their impact on patient outcomes and total cost of care. (Replaces policy 9910).
Council on Educational Affairs
Continuing Professional Development: To endorse the concept of continuing professional development (CPD), which involves personal self-appraisal, educational plan development, plan implementation, documentation, and evaluation; further, to strongly encourage the development of a variety of mechanisms and tools that pharmacists can use to assess their CPD needs; further, to support the efforts of individual pharmacists to understand CPD (including the fact that various options are available for self-assessment) and to implement CPD; further, to collaborate with other pharmacy organizations in the development of effective strategies for piloting the implementation of CPD; further, to strongly support objective assessment of the outcomes of implementation of CPD; further, to encourage colleges of pharmacy and accredited pharmacy residency programs to teach the principles, concepts, and skills of CPD.
Cultural Diversity among Health Care Providers: To foster awareness of the cultural diversity of health care providers; further, to foster recognition of the impact that cultural diversity of health care providers may have on the medication-use process; further, to develop pharmacy practitioners’, technicians’, pharmacy students’, and educators’ cultural competencies.
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; further, to recommend that the program should at a minimum contain the following: (1) appropriate product reimbursement based on transparency of drug costs, (2) payment for indirect costs and practice expenses related to the provision of pharmacy services, based on a study of those costs, (3) appropriate coverage and payment for patient care services provided by pharmacists, and (4) open access to the pharmacy provider of the patient’s choice. (Note: Fully funded means the federal government will make adequate funds available to fully cover the Medicare program’s share of prescription drug program costs; eligible means the federal government may establish criteria by which Medicare beneficiaries qualify for the prescription drug program.) (Replaces policy 0317).
Compounding by Health Professionals: To advocate the adoption, in all applicable state laws and regulations governing health care practice, of the intent of the requirements and the outcomes for patient safety as described in United States Pharmacopeia Chapter 797 (“Pharmaceutical Compounding—Sterile Preparations”).
Uniform State Laws and Regulations Regarding Pharmacy Technicians: To advocate that pharmacy move toward the following model with respect to technicians as the optimal approach to protecting public health and safety: (1) development and adoption of uniform state laws and regulations regarding pharmacy technicians, (2) mandatory completion of a nationally accredited standardized program of education and training as a prerequisite to pharmacy technician certification, and (3) mandatory certification by the Pharmacy Technician Certification Board (or another comparable nationally validated, psychometrically sound certification program approved by the state board of pharmacy) as a prerequisite to the state board of pharmacy granting the technician permission to engage in the full scope of responsibilities authorized by the state; further, to advocate registration of pharmacy technicians by state boards of pharmacy; further, to advocate, with respect to certification, as an interim measure until the optimal model is fully implemented, that individuals be required either (1) to have completed a nationally accredited standardized program of education and training or (2) to have at least one year of full-time equivalent experience as pharmacy technicians before they are eligible to become certified; further, to advocate that licensed pharmacists be held accountable for the quality of pharmacy services provided and the actions of pharmacy technicians under their charge. (Note: 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. 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.) (Replaces policy 0322).
Importation of Pharmaceuticals: To advocate for the continuation and application of laws and regulations enforced by the Food and Drug Administration and state boards of pharmacy with respect to the importation of pharmaceuticals in order to: a) maintain the integrity of the pharmaceutical supply chain and avoid the introduction of counterfeit products into the United States, b) provide for continued patient access to pharmacist review of all medications and preserve the patient-pharmacist-prescriber relationship, and, c) provide adequate patient counseling and education, particularly to patients taking multiple high-risk medications; further, to urge the FDA and state boards of pharmacy to vigorously enforce federal and state laws in relation to importation of pharmaceuticals by individuals, distributors (including wholesalers) and pharmacies that bypass a safe and secure regulatory framework. (Replaces policy 0320).
Home Intravenous Therapy Benefit: To support the continuation of a home intravenous therapy benefit under federal and private health insurance plans, and expand the home infusion benefit under Medicare Part B at an appropriate level of reimbursement for pharmacists’ patient care services, medications, supplies, and equipment. (Replaces policy 9004).
Council on Professional Affairs
Pharmaceutical Counterfeiting: To foster increased pharmacist and public awareness of drug product counterfeiting; further, to encourage pharmacists to purchase and handle medications in ways that enhance the transparency and integrity of the drug product supply chain; further, to encourage pharmacists to identify instances of drug product counterfeiting and to respond by assisting the patient in receiving appropriate treatment and monitoring, documenting patient outcomes, and notifying the patient, prescriber, and appropriate state and federal regulatory bodies (e.g., the Food and Drug Administration’s MedWatch system); further, to provide consumers and health professionals with information on how to avoid counterfeit drug products and how to recognize, respond to, and report encounters with suspicious drug products; further, to foster research and education on the extent, methods, and impact of drug product counterfeiting and on strategies for preventing and responding to drug product counterfeiting.
Ready-to-Use Packaging for All Settings: To advocate that pharmaceutical manufacturers provide all medications used in ambulatory care settings in unit-of-use packages; further, to urge the Food and Drug Administration to support this goal; further, to encourage pharmacists to adopt unit-of-use packaging for dispensing prescription medications to ambulatory patients; further, to support continued research on the safety benefits and patient adherence associated with unit-of-use packaging and other dispensing technologies. (Note: A unit-of-use package is a container-closure system designed to hold a specific quantity of a drug product for a specific use and intended to be dispensed to a patient without any modification except for the addition of appropriate labeling.)
ASHP Statement on the Use of Dietary Supplements: To approve the ASHP Statement on the Use of Dietary Supplements. (Replaces policies 0223, 0304, and 0324).
Delegates approved for referral to the Board of Directors two New Business items, including measures calling for enhanced professionalism among pharmacy practitioners and greater awareness of health care treatment disparities among racial and ethnic minorities.
The House of Delegates offered 15 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 ASHP’s Web site, www.ashp.org.