ASHP InterSections ASHP InterSections

October 29, 2014

Can Volunteering for a Political Campaign Help Your Patients?

Filed under: Current Issue,Feature Stories,Provider Status,Students — Kathy Biesecker @ 5:06 pm
Kathryn Schultz and Sen. Al Franken take a moment to pose for a picture.

Kathryn Schultz and Sen. Al Franken take a moment to pose for a picture.

THE EXPERIENCE THAT KATHRYN R. SCHULTZ, Pharm.D., MPH, FASHP, has had in the advocacy realm proves the old adage that all politics is local.

The ASHP past president and current director of pharmacy for St. Croix Regional Medical Center in St. Croix Falls, Wisc., has been actively involved in advocating on behalf of pharmacists and pharmacy for more than 10 years. She has participated in many of ASHP’s Legislative Days and took those opportunities to speak with Sen. Al Franken (D-Minn.), Sen. Amy Klobuchar (D-Minn.), and Rep. Betty McCollum (D-Minn.), and their staffs both in Washington, D.C., and at their offices in her home state of Minnesota.

Most recently, Schultz volunteered for Sen. Al Franken’s reelection campaign. For Franken, Schultz worked the phones to reach out to voters, talk about the importance of going to the polls, and discuss where the senator stands on various issues.

“I like the phone bank, in particular, because the campaign staff members really prepare you well. Although I’m well-versed in healthcare, I need a little help in discussing other public issues,” Schultz said. “It’s good because you don’t feel like you need to be a political expert on everything, and though I’m not comfortable knocking on doors, I do like talking to people.”

The phone bank enables Schultz to reach as many people as possible, which she feels is crucial to Franken’s reelection. “In the last election, he only won by 312 votes after a protracted recount, so the focus has been on making sure people know that their votes are really important.”

Relying on Your Knowledge and Training

Schultz feels it’s paramount that pharmacists stay abreast of what their senators and representatives are doing that can affect the profession and to speak out on pharmacy’s behalf. Given the current status of H.R. 4190 and ASHP’s focused advocacy to achieve provider status, Schultz thinks it’s more important than ever for pharmacists to get involved in politics at the local level.

I’m really happy to be doing something that can positively affect pharmacy and patient care in this country.

Schultz acknowledges that reaching out to elected officials and getting involved in the campaigns of pharmacy-friendly candidates may seem intimidating. However, she reminds pharmacists to trust in their knowledge and training.

“I was concerned that my meetings with the senator and his staff would be very formal and that they might be skeptical of what I had to say about pharmacists’ critical role in patient care. But they weren’t,” Schultz said. “They really respect that pharmacists are medication experts, and they look to us for important information.”

Schultz believes that all pharmacists can bring better awareness about patients’ medication needs to their elected officials. “You know the issues that affect pharmacy and patient care better than they do. And, with ASHP behind you to provide any information you may need, you have all the necessary tools at your disposal. Don’t be shy!”

Building rapport is also essential to achieving a productive give-and-take, according to Schultz.

“I look at the process as a relationship: First, you provide the necessary information that your elected officials need. Then, you can ask them if they will support measures to improve pharmacy practice and patient care.”

Getting Behind a Pharmacy-Friendly Candidate

Knowing the issues and interacting with senators and representatives regularly on behalf of the profession make it easier to get out there and campaign, Schultz noted. She volunteered for the Franken campaign in part because of his past involvement in proposing legislation to help pharmacists manage the challenges of sterile compounding.

Kathryn Schultz joins Franken campaign organizer Patrick Chilton to call potential voters with information about Franken’s stance on healthcare and other issues.

Along with Sens. Tom Harkin (D-Iowa), Lamar Alexander (R-Tenn.), and Pat Roberts (R-Kan.), Franken introduced S. 959 in 2013, the Pharmaceutical Compounding Quality and Accountability Act. This legislation was designed to create a new category of producer called “compounding manufacturer” that must register with and be inspected by the Food and Drug Administration.

According to Schultz, although pharmacists and pharmacy students may worry that political involvement may negatively affect their jobs or careers, in reality, it may actually help.

“I like to think of this kind of activism as a way to differentiate yourself from the herd. For me, it shows that I truly care about macro issues in pharmacy, that I’m not one-dimensional, and that I am active in my community.”

Schultz stresses the importance of involvement for pharmacy students, in particular.

“You’ll be in your career for 20 or 30 years, so it behooves you to do whatever you can to try to help your legislators understand the pharmacy issues that will help achieve better patient care—such as provider status—and to make the changes that will help,” she said. “What Congress does will affect your professional future.”

Overall, Schultz said that she wouldn’t trade her political experiences and time spent volunteering regardless of the outcome of the election.

“With so many people to help you and to give you the tools that you need, it’s easy and it’s actually fun. I’ve met people I never would have met otherwise, people with whom I share common goals and political views. I’m really happy to be doing something that can positively affect pharmacy and patient care in this country.”

–By Terri D’Arrigo


October 21, 2014

The Ebola Outbreak: ASHP’s Actions

Filed under: Current Issue,Emergency Preparedness,From the CEO — jmilford @ 12:38 pm
Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

I WOULD FIRST LIKE TO SAY that our hearts go out to the patients, families, and healthcare workers who have been stricken by the Ebola virus. These cases of Ebola infection have, of course, raised questions and concerns regarding America’s preparedness—and that of the rest of the world—to contain this outbreak.

Pharmacists practicing in hospitals and clinics are playing a key role in developing and implementing infection control procedures, and working as integral members of the team in managing patients. We realize that many of you would like to have more information regarding not only the outbreak and progress being made with potential treatment and prevention, but also best practices in managing these patients and preventing transmission of the virus. We want you to know that ASHP is here to help.

Since the first case of Ebola in the United States was reported, ASHP has been working with the federal government and other organizations to help manage this public health situation and to get reliable information out to our members.

ASHP will be featuring updated information in our daily e-mail news service–the ASHP Daily Briefing–and featuring news stories in our weekly ASHP NewsLink that goes out every Monday evening.

We have also launched an Ebola resource center on the ASHP website that will be constantly updated with the latest information, and we have created an ASHP Connect Community for members to post questions and share best practices about Ebola preparedness and response. We will also compile insights and best practices shared on the Ebola ASHP Connect Community and post that information to the web resource center.

ASHP and our members have always been on the forefront of addressing the most pressing issues facing our healthcare system, and the current concerns related to Ebola are no exception. Much of the best information available comes from peers sharing what they have learned. ASHP, through our ASHP Connect Member Communities, social media channels (Facebook, Twitter, LinkedIn, and YouTube), original news, and our interactive website have made the platforms available to facilitate that sharing of information.

Please let us know if we can do anything further to assist you in your efforts to address Ebola. Thank you so much for everything you do to care for your patients, and to help ensure that pharmacists are playing leading roles in addressing the most important public health issues facing our nation.



October 16, 2014

Ebola Cases Bring Practical and Clinical Challenges

Filed under: Calendar Event,Clinical,Current Issue,Feature Stories,Managers,Uncategorized — Kathy Biesecker @ 12:53 pm

ebola virusCARING FOR THE FIRST TWO EBOLA virus–infected humanitarian workers in the United States required high-level clinical services for the patients as well as practical strategies to deal with fears among hospital staff and the local community.

For hospital staff, twice-daily “town hall” meetings were initially held to ensure that people who weren’t part of the Ebola virus disease (EVD) treatment team were “more comfortable” with the presence of the patients, said Aneesh Mehta, associate chief of infectious diseases at Emory University Hospital in Atlanta.

“The members of the team knew what we were doing, but not everyone at the hospital did,” said Mehta on September 8 at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting in Washington, D.C.

Mehta said the hospital sent out regular e-mail updates to staff about the Ebola virus–infected patients and also informed all patients at the hospital about its decision to treat the humanitarian workers.

The hospital also had to respond to concerns within the local community.

For example, in early August, as Emory was receiving the two patients, Internet reports stated that the hospital planned to flush the patients’ liquid waste down the toilet to undergo standard sewage processing.

That, in turn, set off fears among area residents that their water supply would be contaminated by the Ebola virus. Comments on the hospital’s blog included one by a resident who claimed to be so “terrified” about the safety of the water that her health was suffering.

Ultimately, Mehta said, “local and civil authorities requested that no untreated [Ebola virus–containing] patient waste enter the municipal waste stream.” To comply with the request, liquid waste from the patients was disinfected with bleach or a detergent before being flushed.

Mehta also said Emory had to deal with “surprises in shipping” when some hospital staff refused to come to the isolation unit to pick up samples, and local couriers at one point “refused to touch” any containers labeled for transport to the Centers for Disease Control and Prevention (CDC), which is located about a mile from Emory.

It’s not surprising for people to be frightened by the Ebola virus. About half of those reported to be infected during the current outbreak in West Africa have died so far; uncontrolled bleeding has been portrayed as a symptom of EVD; and there is no approved vaccine or drug therapy for the disease.

ASHP has developed an Ebola resource center on its website to update members on the latest information and provide critical resources concerning this public health crisis. ASHP officials are working closely with federal officials and stakeholders, and are monitoring the response of the U.S. Centers for Disease Control and Prevention and other federal agencies.

ASHP has developed an Ebola resource center on its website to update members on the latest information and provide critical resources concerning this ongoing public health crisis.

The United States classifies the Ebola virus and other hemorrhagic viruses as level A “select agents” that pose a risk to national security—the highest threat level. Level A select agents can be easily transmitted from person to person, result in high death rates and a potentially major public health threat, may cause public panic and social disruption, and require special action for public health preparedness.

CDC in September released interim guidance about how the select agent regulations apply to activities associated with the diagnosis and care of patients with suspected or confirmed Ebola virus infection.

According to CDC, any hospital that follows the agency’s infection control recommendations and can isolate a patient in a private room can safely care for Ebola virus–infected patients.

In clinical settings, CDC specifically recommends that hospitals “implement standard, contact, and droplet precautions” while caring for these patients.

CDC’s website contains several documents related to EVD preparedness, including a detailed hospital checklist. According to CDC, the checklist contains “practical and specific suggestions to ensure your hospital is able to detect possible EVD cases, protect your employees, and respond appropriately.”

“I think, at the very least, every institution needs to go through the checklist,” said Deanne E. Tabb, infectious diseases clinical pharmacist at Columbus Regional Healthcare System in Columbus, Georgia. Tabb said the document is being reviewed by her hospital’s infectious diseases and infection-control staff as part of their preparedness efforts.

“I think we’re always prepared for any infectious disease influx that comes our way,” Tabb noted.

Removing the Personal Protective Equipment (PPE) properly was the key to preventing contamination.

She recommended that hospitals be aware that CDC’s recommendations include droplet precautions in addition to the standard and contact precautions that hospitals routinely follow to prevent disease transmission.

Emory’s Ebola virus–infected patients were housed in the hospital’s serious communicable diseases isolation unit, but Mehta said such a resource “is not necessary to take care of patients with Ebola.”

“We have it, so we used it to make it easier for our processes,” Mehta said. He said the team had “dedicated medical equipment” for the isolation unit and made use of disposable supplies and equipment whenever possible.

Mehta said Emory staff was trained in “donning and doffing” personal protective equipment (PPE), and a team member observed the process each time it was performed in the unit.

“Removing the PPE properly was the key to preventing contamination,” Mehta said. But he noted that “some complacence” among staff in the donning and doffing of PPE was observed over time and had to be addressed.

According to Emory’s website, hospital staff were trained to use face masks and goggles when caring for the Ebola virus–infected patients but instead used powered air-purifying respirators even though the virus is not transmitted in the air. The hospital stated that this equipment was used because it is more comfortable to wear for long periods than a mask and goggles.

A small laboratory was quickly built for the isolation unit, which Mehta said was convenient but not a necessity and helped to ensure that Emory’s regular laboratory services weren’t interrupted for Ebola virus–related work.

A disadvantage to the dedicated lab, he said, was that only “a very limited testing panel” was available to clinicians.

Laboratory testing for both patients revealed “very marked electrolyte abnormalities,” including hypokalemia, hypocalcemia, hyponatremia, and nutritional deficiencies, Mehta said.

He said the ability to provide “high-level nursing and supportive care” around the clock to the patients likely had a “significant impact” on survival. Both patients were discharged from the hospital in mid-August.

Emory has since cared for a third humanitarian worker with EVD who was evacuated from West Africa. The hospital’s website states that being prepared for and receiving such patients will be the “new normal” at Emory.

A fourth patient received treatment for EVD in the biocontainment unit at the Nebraska Medical Center in Omaha after being evacuated from Liberia in early September. He was released from the hospital in late September.

At presstime, a patient who had been exposed to the virus was being monitored in isolation at the National Institutes of Health’s Clinical Center in Bethesda, Maryland.

Also at presstime, the first patient to be diagnosed with EVD while in the United States was being treated at Texas Health Presbyterian Hospital Dallas.

–by Kate Traynor, reprinted with permission from AJHP (Nov. 1, 2014; volume 71, pages 1822-1823, 1827)

Editor’s Note: ASHP recently launched an Ebola resource center, which features the latest information and resources on this public health crisis. ASHP is also working closely with federal officials and stakeholders, and is monitoring the response of the CDC and other federal agencies to the Ebola outbreak.

October 8, 2014

Making the Case for H.R. 4190 with the Cleveland Clinic C-Suite

Cleveland Clinic

Large healthcare systems like the Cleveland Clinic can often wield substantial political clout on important patient care issues like provider status.

THE IMPORTANCE OF H.R. 4190 and reimbursement for pharmacy services in outpatient clinics is clear to pharmacists. But, understandably, other healthcare providers and members of the C-suite may be unaware of its potential benefit for the entire healthcare system.

Yet I believe that interdisciplinary support, as well as support from hospital systems themselves, is a critical element in ensuring that H.R. 4190 becomes law. That’s why I, along with my colleagues, set out to convince the Cleveland Clinic’s executive leadership to support the bill. The process took about eight months, but I think the time and effort will pay off.

Leveraging the Political Muscle of Large Healthcare Systems

Several years ago, I learned first-hand about the substantial political power wielded by large hospitals—and the even greater influence of hospital coalitions—when I was involved in a national effort to add language to the FDA Safety and Innovation Act, which became law in July 2012.

The change we advocated and, which ultimately succeeded, allows multi-facility health systems to repackage and transfer shortage drugs within their networks but without having to register as repackagers. Avoiding that substantial bureaucratic and operational burden has been crucial for hospitals trying to manage acute drug shortages.

The political muscle of a national coalition of hospitals was instrumental in making that happen. Legislators pay attention to hospitals. Every congressional district has one, and large flagship systems employ thousands of constituents… all of whom are potential voters.

A similar coalition is important for the future of H.R. 4190. But before we could join such a coalition, we had to gain buy-in from the leaders of our own institution. That meant demonstrating convincingly why provider status for pharmacists will benefit not only the pharmacy department, but the entire Cleveland Clinic and its patients.

Making the Case

Of course, we couldn’t simply walk in to the C-suite and expect them to take our word for it. We painstakingly gathered and organized sufficient information to support our case, including data from recent independent studies about the impact of expanding clinical pharmacy roles.

Then I arranged a meeting with three key decision makers: the chair of the Cleveland Clinic Medicine Institute, who is in charge of our clinic system; the chief government and community relations officer; and my boss, the chief of medical operations.

Accompanying me was one of our pharmacists, a clinical specialist in ambulatory care who works closely with physicians to care for patients requiring careful medication management for disease states such as hypertension, diabetes, and hyperlipidemia. The high level of credibility she had earned among physicians added another dimension to our argument.

Scott Knoer, M.S., Pharm.D., FASHP

With the help of a PowerPoint presentation, I illustrated some of the many benefits—general and specific—that would accrue from provider status. For example: For every 10 patient visits to a clinical pharmacists, 8.2 physician/prescriber visits are avoided, with a resulting cost savings per patient projected at nearly $700.

I also emphasized that what we’re proposing for pharmacists in ambulatory care is the same thing we’ve been doing for years on hospital units, where pharmacists routinely round with physicians and are members of interdisciplinary teams.

We succeeded, and the Clinic’s leadership gave the green light for our government relations professionals to reach out to their counterparts at other health systems and to Brian Meyer, ASHP’s director of legislative affairs, to begin the process of building a coalition of health systems to push our legislative agenda in Congress.

What Can You Do?

The success we had in gathering the might of a world-renowned hospital system behind ASHP’s efforts to enact H.R. 4190 is not an exception. Anyone who is in a management position can do what we’ve done.

First, I suggest getting to know your hospital’s government affairs professional. Start a dialogue… maybe take them to lunch. Meanwhile, begin to educate your boss about how provider status for pharmacists can reduce costs and improve patient outcomes. Build your case, gather data, and educate decision makers about what pharmacists can do across the continuum of care.

But the ability to enact provider status doesn’t end at the C-suite. Staff pharmacists can do their part by solidifying relationships with physicians and proving their worth every day through collaborative patient care. Your professional expertise and ability to improve outcomes and reduce costs will show our non-pharmacy colleagues why our vision of an expanding clinical role for pharmacists in ambulatory settings is a critical step in the evolution of effective and efficient patient care.

 –By Scott Knoer, M.S., Pharm.D., FASHP, Chief Pharmacy Officer, Cleveland Clinic, Cleveland, Ohio



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