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6/29/2016
Press Release

ASHP House of Delegates Approves Professional Policies 2016

During the 68th annual session of its House of Delegates in Baltimore earlier this month, the ASHP House of Delegates approved a professional policy calling on Congress to ban direct-to-consumer (DTC) advertising of prescription drugs and medication-containing devices.

Delegates also approved policies supporting efforts by manufacturers and the Food and Drug Administration (FDA) to protect healthcare workers from exposure to hazardous drugs, expanded authority for the FDA to regulate the dissemination of information about off-label uses of medications, and the development and promotion of best practices for preventing drug diversion and reducing the incidence of controlled substance abuse.

ASHP’s House of Delegates is the ultimate authority over the organization’s stance on important professional issues related to pharmacy practice and societal medication use. The House of Delegates meets annually at the ASHP Summer Meetings and virtually in March and November.

In calling for a ban on DTC advertising, the House of Delegates shifted away from a policy of opposing DTC ads unless they meet certain criteria and instead adopted a policy calling for an outright ban on DTC advertising of prescription drugs and medication-containing devices. The new position by ASHP supersedes a policy that was first adopted in 1997.

The House also approved the following professional policies:
 
Stewardship of Drugs with Potential for Abuse
To advocate for the inclusion of a clinically appropriate indication of use, the intended duration, and the goals of therapy when prescribing drugs with potential for abuse; further, to encourage pharmacists to engage in interprofessional efforts to promote the appropriate, but judicious, use of drugs with the potential for abuse, including education, monitoring, assessment of clinical progress, and discontinuation of therapy or dose reduction, where appropriate; further, to advocate that pharmacists lead efforts to prevent inappropriate use of drugs with potential for abuse, including engaging in strategies to detect and address patterns of use in patient populations at increased risk for adverse outcomes; further, to facilitate the development of best practices for prescription drug monitoring programs and drug take-back disposal programs for drugs with potential for abuse.

Appropriate Use of Antipsychotic Drug Therapies

To advocate for the documentation of appropriate indication and goals of therapy to promote the judicious use of antipsychotic drugs and reduce the potential for harm; further, to support the participation of pharmacists in the management of antipsychotic drug use, which is an interprofessional, collaborative process for selecting appropriate drug therapies, educating patients or their caregivers, monitoring patients, continually assessing outcomes of therapy, and identifying opportunities for discontinuation or dose adjustment; further, to advocate that pharmacists lead efforts to prevent inappropriate use of antipsychotic drugs, including engaging in strategies to detect and address patterns of use in patient populations at increased risk for adverse outcomes.

Safety of Epidural Steroid Injections
To encourage healthcare providers to 1) inform patients about the significant risks and potential lack of efficacy of epidural steroid injections, 2) request their informed consent, and 3) inform patients of alternative therapies and their risks and benefits; further, to recommend pharmacist involvement in the medication-use process associated with epidural steroid injections when such injections are medically necessary.
 
Drug Dosing in Renal Replacement Therapy
To encourage research on the pharmacokinetics and pharmacodynamics of drug dosing in renal replacement therapy; further, to support development and use of standardized models of assessment of the pharmacokinetics and pharmacodynamics of drug dosing in renal replacement therapy; further, to collaborate with stakeholders in enhancing aggregation and publication of data on the pharmacokinetics and pharmacodynamics of drug dosing in renal replacement therapy.

Use of Methadone to Treat Pain
To acknowledge that methadone has a role in pain management and that its pharmacologic properties present unique risks to patients; further, to oppose the payer-driven use of methadone as a preferred treatment option for pain; further, to advocate that pain management experts, payers, and manufacturers collaborate to provide educational programs for healthcare professionals on treating pain with opioids, including the proper place in therapy for methadone; further, to advocate that all facilities that dispense methadone, including addiction treatment programs, participate in state prescription drug monitoring programs.

Therapeutic Indication in Clinical Decision Support Systems

To advocate that healthcare organizations optimize use of clinical decision support systems by including the appropriate indication for medications.

Pharmacy Technician Training and Certification

To advocate that Pharmacy Technician Certification Board (PTCB) certification be required for all pharmacy technicians; further, to advocate that all pharmacy technicians maintain PTCB certification; further, to support the position that by the year 2020, the completion of a pharmacy technician training program accredited by ASHP and the Accreditation Council for Pharmacy Education (ACPE) be required to obtain PTCB certification for all new pharmacy technicians; further, to foster expansion of ASHP-ACPE accredited pharmacy technician training programs. (Replaces ASHP policy 1519)

Career Opportunities for Pharmacy Technicians

To promote pharmacy technicians as valuable contributors to healthcare delivery; further, to develop and disseminate information about career opportunities that enhances the recruitment and retention of qualified pharmacy technicians; further, to support pharmacy technician career advancement opportunities, commensurate with training and education; further, to encourage compensation models for pharmacy technicians that provide a living wage. (Replaces ASHP policy 0211)

Developing Leadership Competencies
To work with healthcare organization leadership to foster opportunities, allocate time, and provide resources for pharmacy practitioners to move into leadership roles; further, to encourage leaders to seek out and mentor pharmacy practitioners in developing administrative, managerial, and leadership skills; further, to encourage pharmacy practitioners to obtain the skills necessary to pursue administrative, managerial, and leadership roles; further, to encourage colleges of pharmacy and ASHP state affiliates to collaborate in fostering student leadership skills through development of co-curricular leadership opportunities, leadership conferences, and other leadership promotion programs; further, to reaffirm that residency programs should develop leadership skills through mentoring, training, and leadership opportunities; further, to foster leadership skills for pharmacists to use on a daily basis in their roles as leaders in patient care. (Replaces ASHP policy 1518)

Interprofessional Education and Training
To support interprofessional education as a component of didactic and experiential education in Doctor of Pharmacy degree programs; further, to support interprofessional education, mentorship, and professional development for student pharmacists, residents, and pharmacists; further, to encourage and support pharmacists’ collaboration with other health professionals and healthcare executives in the development of interprofessional, team-based, patient-centered care models; further, to foster documentation and dissemination of outcomes achieved as a result of interprofessional education of healthcare professionals.  (Replaces ASHP policy 1014)

Cultural Competency
To foster the ongoing development of cultural competency within the pharmacy workforce; further, to educate healthcare providers on the importance of providing culturally congruent care to achieve quality care and patient engagement. (Replaces ASHP policy 1414)

Controlled Substance Diversion and Patient Access
To enhance awareness by pharmacy personnel, healthcare providers, and the public of drug diversion and abuse of controlled substances; further, to advocate that the pharmacy profession lead collaborative efforts to reduce the incidence of controlled substance abuse; further, to advocate that pharmacists lead collaborative efforts by organizations of healthcare professionals, patient advocacy organizations, and regulatory authorities to develop and promote best practices for preventing drug diversion and appropriately using controlled substances to optimize and ensure patient access and therapeutic outcomes; further, to advocate that the Drug Enforcement Administration and other regulatory authorities interpret and enforce laws, rules, and regulations to support patient access to appropriate therapies, minimize burdens on pharmacy practice, and provide reasonable safeguards against fraud, misuse, abuse, and diversion of controlled substances; further, to advocate establishment of programs to support patients and personnel with substance abuse and dependency issues.

Protecting Workers from Exposure to Hazardous Drugs

To advocate that pharmaceutical manufacturers eliminate surface contamination on packages and vials of hazardous drugs; further, to inform pharmacists and other personnel of the potential presence of surface contamination on the packages and vials of hazardous drugs; further, to advocate that the FDA require standardized labeling and package design for hazardous drugs that would alert handlers to the potential presence of surface contamination; further, to encourage healthcare organizations, wholesalers, and other trading partners in the drug supply chain to adhere to published standards and regulations, such as ASHP guidelines and United States Pharmacopeia Chapter <800>, to protect workers from undue exposure to hazardous drugs. (Replaces ASHP policy 0618)

Patient Experience
To encourage pharmacists to evaluate their practice settings for opportunities to improve the experience patients have with healthcare services and with the outcomes of their drug therapy; further, to educate pharmacists and pharmacy personnel about the relationship between patient experience and outcomes; further, to develop or adopt tools 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 in efforts to engage patients and improve their experience; further, to facilitate a dialogue with and encourage education of patient experience database vendors to include the value of pharmacists and pharmacy services in the patient experience. (Replaces ASHP policy 0104)

Automated Preparation and Dispensing Technology for Sterile Preparations
To advocate that health systems adopt automation and information technology for preparing and dispensing compounded sterile preparations when such adoption is (1) planned, implemented, and managed with pharmacists’ involvement; (2) implemented with adequate resources to promote successful development and maintenance; and (3) supported by policies and procedures that ensure the safety, effectiveness, and efficiency of the medication-use process; further, to educate patient safety advocacy groups and regulatory agencies on the capabilities and benefits of automation and technology for preparing and dispensing compounded sterile preparations, and to encourage them to establish expectation of adoption by health systems; further, to foster further research, development, and publication of best practices regarding automation and information technology for preparing and dispensing sterile preparations.

Integrated Approach for the Pharmacy Enterprise

To advocate that pharmacy department leaders promote an integrated approach for all pharmacy personnel involved in the medication-use process; further, to advocate a high level of coordination of all components of the pharmacy enterprise across the continuum of care for the purpose of optimizing (1) medication-use safety, (2) quality, (3) outcomes, and (4) drug therapy. (Replaces ASHP policy 0619)

Preventing Exposure to Allergens
To advocate for pharmacy participation in the collection, assessment, and documentation of a complete list of allergens pertinent to medication therapy, including food, excipients, medications, devices, and supplies, for the purpose of clinical decision-making; further, to advocate that vendors of medication-related databases incorporate and maintain information about medication-related allergens and cross-sensitivities; further, to advocate that pharmacists actively review allergens pertinent to medication therapy and minimize patient and healthcare worker exposure to known allergens, as feasible; further, to encourage education of pharmacy personnel on medication-related allergens.

Promotion of Off-Label Uses
To advocate for authority for the FDA to regulate the promotion and dissemination of information about off-label uses of medications and medication-containing devices by manufacturers and their representatives; further, to advocate that such off-label promotion and marketing be limited to the FDA-regulated dissemination of unbiased, truthful, and scientifically accurate information based on peer-reviewed literature not included in the New Drug Approval process. (Replaces ASHP policy 1120)

Timely Board of Pharmacy Licensing
To advocate that the National Association of Boards of Pharmacy (NABP) collaborate with boards of pharmacy to streamline the licensure process through standardization and improve the timeliness of application approval; further, to advocate that NABP collaborate with boards of pharmacy and third-party vendors to streamline the licensure transfer or reciprocity process; further, to advocate that boards of pharmacy grant licensed pharmacists in good standing temporary licensure, permitting them to engage in practice, while their application for licensure transfer or reciprocity is being processed. (Replaces ASHP policy 0612)

Inclusion of Drug Product Shortages in State Price-gouging Laws
To urge state attorneys general to consider including shortages of lifesaving drug products within the definition of events that trigger application of state price-gouging laws.

Home Intravenous Therapy
To support the continuation of a home intravenous therapy benefit under federal and private health insurance plans and expansion of the home infusion benefit under Medicare at an appropriate level of reimbursement for pharmacists’ patient care services provided, medications, supplies, and equipment. (Replaces ASHP policy 0414)

Ban on Direct-to-Consumer Advertising for Prescription Drugs and Medication-Containing Devices
To advocate that Congress ban direct-to-consumer advertising for prescription drugs and medication-containing devices. (Replaces ASHP policy 1119)

The House of Delegates consists of 163 voting state delegates (a minimum of two from each state, the District of Columbia, and Puerto Rico), members of the Board of Directors, past presidents of ASHP, chairs of the organization’s sections and forums, and five delegates representing the federal services. 
 
About ASHP
ASHP represents pharmacists who serve as patient care providers in acute and ambulatory settings. The organization’s more than 43,000 members include pharmacists, student pharmacists, and pharmacy technicians. For over 70 years, ASHP has been at the forefront of efforts to improve medication use and enhance patient safety. For more information about the wide array of ASHP activities and the many ways in which pharmacists advance healthcare, visit ASHP’s website, www.ashp.org, or its consumer website, www.SafeMedication.com.
 
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