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April 9, 2020

Important Wins on the Advocacy Front in the Fight Against COVID-19

Dear Colleagues,

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

AS THE IMPACT OF THE COVID-19 PANDEMIC CONTINUES TO ESCALATE ACROSS THE COUNTRY, there is increased urgency to ensure that frontline pharmacists, pharmacy technicians, and our healthcare partners have the medications and equipment they need to successfully treat their patients. ASHP continues to spearhead multiple advocacy efforts that support your ability to provide the best care possible for those in need.

Mitigating shortages of critical medications like propofol, fentanyl, midazolam, paralytics, and others remains a high priority. We continue to engage with relevant federal agencies to improve access to medications. I am pleased to report that the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA) have taken critical actions in direct response to ASHP’s advocacy efforts.

ASHP, in coordination with the American Medical Association, the American Hospital Association, the Association for Clinical Oncology, and the American Society of Anesthesiologists, sent a letter last week to the DEA requesting an immediate increase in the annual production quota allocations for Schedule II controlled substances. This would enable manufacturers and 503B outsourcing facilities to increase the supply of opioids critical to the care of COVID-19 patients on ventilators. As a direct result of this collaborative advocacy effort, the DEA announced yesterday that it is taking immediate actions to address this critical issue. These actions include increasing the annual production quota for controlled substances, including fentanyl, morphine, and hydromorphone, that are used for the treatment of mechanically ventilated COVID-19 patients, and increasing the amount of ketamine, diazepam, and other controlled substances that can be imported into the United States.

We also sent a letter to the FDA advocating for regulatory flexibility in compounding drugs in shortage and compounding in hospitals. ASHP’s advocacy efforts, including significant staff engagement on the issue, directly triggered the FDA to clarify existing compounding guidance, including the removal of the one-mile radius requirement for hospitals compounding medications. FDA’s quick action to reduce regulatory hurdles for health systems is an important step to help clarify compounding guidance during this crisis.

ASHP will continue to advocate for additional compounding flexibility, including the expansion of FDA’s drug shortage list to include products ASHP has identified as in shortage. We will also continue to seek 503B outsourcing facility flexibility, particularly for hospital-owned or affiliated 503B operations, to help ensure they can meet hospitals’ medication needs.

Yesterday, we were pleased to see that the Department of Health and Human Services (HHS) authorized pharmacists to order and administer COVID-19 tests pursuant to the Public Readiness and Emergency Preparedness (PREP) Act. The authorization is responsive to the joint COVID-19 recommendations we created with other national organizations. While this authorization does not address pharmacist reimbursement, we are encouraged to see HHS providing pharmacists with a greater role in supporting the COVID-19 response, and we continue to work on that issue.

We also continue to actively advocate for Congress to recognize pharmacists as providers in the Medicare program to further support the COVID-19 response and beyond. Yesterday, ASHP and 11 other national organizations sent a letter requesting that Congress immediately support legislation that would establish pharmacists as providers in Medicare Part B on an emergency basis to provide COVID-19 and flu testing. This authority is an important step in being able to rapidly expand access to testing across our country to support the national response to this crisis. We also see this as a step toward expanded recognition of pharmacists by payers, including Medicare.

Finally, ASHP is also working with our members and other stakeholders to gain access to medications from the Strategic National Stockpile (SNS). Most recently, we joined with several organizations to request that FEMA immediately release all available quantities of a number of critical drugs from the SNS to the New York and New Jersey Departments of Health to address urgent patient care needs. We are also working to support other state affiliates and members across the country with these important requests.

ASHP and its government relations team will continue to work tirelessly with our collaborating partners to ensure that U.S. regulatory authorities are responding to the current needs of pharmacists and healthcare providers.

While our collective attention is on the needs of frontline practitioners, I wanted to take an opportunity to highlight some positive news about the newest members of our profession. ASHP’s 2020 Residency Match concluded this week, and I want to congratulate the 5,269 future pharmacists who matched with 2,551 PGY1 and PGY2 pharmacy residency programs across the country. This number represents a 46% increase in the number of available positions over the past five years – a remarkable rate of growth. I am pleased that our accredited residency programs have demonstrated an outstanding commitment to training during the pandemic. While managing multiple critical priorities, these programs continued to interview applicants virtually. This undoubtedly will be a unique time during which to begin a residency program regardless of its focus. ASHP is committed to ensuring that these young practitioners and their programs have the needed resources to successfully conduct critically important resident training this year and beyond.

In the same vein, please know that ASHP stands ready to offer you and your healthcare colleagues that same level of steadfast support. In addition to advocating to give you access to critical medications, ASHP continues to update and create new resources and tools that can be found on our COVID-19 Resource Center. We have also opened access to many evidence-based online resources and tools on, making them widely available to all pharmacists and the broader healthcare community.

Over the last few weeks, I have heard countless stories from members and others about the challenges they are facing, but I’ve also heard many stories of hope and heroism. I, and David Chen, ASHP assistant vice president for Pharmacy Leadership and Planning, have listened in on calls from pharmacy leaders at major health systems in New York City, the pandemic’s current epicenter. We are incredibly impressed by how these leaders have shared their information and experiences and how they support each other and their frontline staff. This is a tremendous example of how peer-to-peer connection and communication can aid in the pandemic response. Their experiences and willingness to share their stories will undoubtedly help others in responding to COVID-19 in facilities across the country. We applaud them for these efforts.

Please also know that ASHP is here to support your well-being, which should remain a priority for all healthcare personnel during this challenging time. Please make sure that you are taking care of yourself and your family.

“ASHP has our backs.” These are the words of a member who recently reached out to us. This really resonated with me, and I can assure you that we will continue to work across all fronts, leveraging our talented staff, our valued partners, and our amazing members to provide you with the information, connections, and resources you need today and in the future.

Thank you for everything you do for your patients and the profession.



September 23, 2011

Cleveland Clinic Hospitals Lead Way on Quality-of-Care Measures

STARTING IN OCTOBER 2012, Medicare will reimburse hospitals based on quality-of-care measures, including how closely hospitals follow best clinical practices and how satisfied patients are with their care. “All institutions now have a heightened awareness of the need to perform better because of Medicare’s pay-for-performance reimbursement that’s coming,” said Michael Hoying, R.Ph., M.S., director of pharmacy for Fairview-Lutheran Hospitals, part of the Cleveland Clinic Hospital System. A New Opportunity for Pharmacists  Among the factors that Medicare will consider in its incentive calculus will be drug-related process-of-care measures for patients with congestive heart failure (CHF)—specifically, the percentage of patients with CHF evaluated for left ventricular systolic (LVS) function and the percent of CHF patients with LVS dysfunction who received an ACE inhibitor or an AR blocker. A year ago, Fairview-Lutheran’s respective scores for this patient population hovered around 93 percent and 86 percent, both below national averages.

Michael Hoying, R.Ph., M.S.

Hoying recognized an opportunity for pharmacists to improve the scores and reach organizational goals of 100 percent compliance. “The pharmacy was not consistently involved with heart failure measures, and we saw that we could do a better job of identifying patients who needed their CHF core measures reviewed.”

In August 2010, Fairview-Lutheran’s night-shift pharmacist began a nightly review of a computer-generated data pool, looking for all patients admitted to the hospital that day with a primary or secondary diagnosis of CHF. For patients with CHF whose most recent echocardiograms showed ejection fractions of less than 40 percent and who had received either an ACE inhibitor or AR blocker, the treatment is documented in the electronic medical record (EMR).For those who had not received drug therapy, the pharmacist checks the EMR to determine if there are valid reasons for why it has not been ordered. If none are found, the patient’s record moves to a follow-up list. Patients for whom a new echocardiogram had been ordered are also placed on the follow-up list.The next morning, a pharmacist reviews the follow-up list and obtains either a medication order for appropriate treatment or documentation of a medication variance. A cardiology nurse practitioner who is part of the daily clinical staff coordinates the final resolution to ensure that the core measures have been met.

“Where we faltered in the past was documenting why an ACE inhibitor wasn’t on board,” said Hoying. “That’s where the pharmacists have really filled a role and made sure that there’s either a good reason why the therapy wasn’t ordered, or have tracked down the physician to get the order if there’s no reason why the patient shouldn’t be receiving the drug.”

Over the next few months, the number of CHF patients screened monthly quadrupled. Fairview-Lutheran reached—and has maintained—100 percent compliance with core CHF measures by the last quarter of 2010.

“At first, managing the list was a little overwhelming,” noted Erin Barnett, Pharm.D., clinical specialist II at Fairview-Lutheran, “but soon we were able to easily integrate the new procedures.”

Connecting Patients and Pharmacists

Last March, Hoying turned to another factor that will weigh heavily in the Medicare incentive calculations: the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey. HCAHPS is the first national, standardized, publicly reported survey of patients’ perceptions of their hospital care. The results will count for 30 percent of the Medicare reimbursement score. For the two survey questions about how well patients were informed about new medicines during their stay, Fairview-Lutheran scored poorly.

Hoying initiated a pilot program on one 36-bed unit that increased the number of direct encounters between pharmacists and patients. The goal: improving communications about new drugs.

Prior to pharmacist involvement, overall communication about medications for the unit ranked in the 17th percentile among comparably sized hospitals. For describing what a new medicine was for, it ranked in the 55th percentile, and for describing possible side effects, it ranked near the bottom, in the 2nd percentile.

By the second quarter of 2011, the unit had jumped to the 96th percentile for overall communication about medications, and to the 99th and 90th percentiles, respectively, for the other two measures.

“We’ve had a huge impact,” said Hoying. “I plan to use the data to make the case for greater resources and to start a residency program, which would allow us to expand our coverage to other units.” He’s already added two pharmacists to his staff.

“The story at Fairview-Lutheran demonstrates how pharmacists can really improve patient outcomes as well as their hospital’s ranking,” said David Chen, R.Ph., M.B.A., director of ASHP’s Pharmacy Practice Sections and Section of Pharmacy Practice Managers. “This shows how much they can make a difference.”

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March 28, 2011

Gazing into the Crystal Ball

Filed under: Feature Stories — Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , — editor @ 6:00 pm

Illustrated by Matt Sweitzer ©2011 ASHP

AS PHARMACY PRACTICE EVOLVES from a profession that primarily supervises medication distribution to one that provides services such as medication therapy management and disease prevention, one of the main questions that remains unanswered is, “how long will this transformation take?”

Although no one can predict how fast it will happen or what path it will take, practice model change is being driven by economic realities, safety and quality concerns, political influences, and pharmacists who desire to be more involved in the care of patients in their institutions.

David Chen, ASHP’s director of pharmacy practice sections, said that despite the fact that pharmacists provide direct patient care in many practice settings across the country, services offered and distribution are uneven.

“We know that outcomes are better for patients when there is pharmacist involvement, but now we have to support pharmacy practice leaders in determining the most effective way to implement pharmacy, technicians, and technology in their settings,” he said.

Although each hospital and health system will need to tailor practice models to meet its own goals, the consensus is that there is ample opportunity for pharmacists to shape the future of their profession. Many have already begun to seize the day.

Work Flow and Collaboration

Pharmacists’ success in providing direct patient care hinges on their ability to collaborate with other health professionals. As part of its patient-centered practice model, the University of Wisconsin Hospital and Clinics has decentralized its pharmacy staff. Every pharmacist is assigned to a unit or group of patients for which he or she provides medication order review, pharmacokinetic dosing, medication reconciliation, and medication education.

“This model forges relationships between pharmacists and physicians and establishes trust between pharmacists and medical staff,” said Steve Rough, M.S., B.S.Pharm, director of pharmacy. “Medical staff comes to trust that we are consistently going to optimize what is best for the patient’s care in the process of making our recommendations.”

Rough added that demonstrating value and accountability ensures continued pharmacist involvement in multidisciplinary teams. “When we need buy-in for integrating pharmacists into a new care team or service, we prepare a succinct business case demonstrating the value proposition for the hospital,” he said. “Then, once we add additional pharmacist resources to the budget, we document and present the promised outcomes.”


Technology has been a boon to pharmacists by increasing patient medication safety and enabling pharmacists to delegate task-oriented work to highly trained pharmacy technicians. Automation such as robotic dispensing cabinets frees up pharmacists’ time, while analytics enhance clinical decisions.

Christopher R. Fortier, Pharm.D., manager of pharmacy support and services and clinical assistant professor in the Department of Pharmacy Services at the Medical University of South Carolina, Charleston, notes the increasing importance of mobile technology in the hospital setting.

“Remote and mobile technologies such as iPads, tablets, and smart phones enable us to take information with us to the patient’s bedside,” said Fortier. “We’re not stuck behind a desktop computer, and with real-time information at hand, we don’t have to go to five different places to get information and provide care to patients.”

Barbara Giacomelli, Pharm.D., M.B.A., director of pharmacy at Shore Memorial Hospital in Vineland, N.J., believes pharmacists are well suited to take leadership roles in developing technology for use in practice models.

“We can partner with medical staff in developing rules and setting up order entry screens to be user-friendly and provide the correct levels of alerts,” she said.

Informatics is an expanding field in which pharmacists will find plenty of opportunity, Giacomelli added. “Most of the people I have spoken with have developed into an informatics role by having a strong interest in it,” she said. “However, if you don’t have a pharmacist who understands it, you’ll have to recruit for it. There are limited resources out there, but this specialization is in demand, and the demand will only increase with time.”

Pharmacist Education

If new pharmacy practice models are to take hold, it is critical that pharmacy students and residents are prepared for the hands-on work in direct patient care that awaits them. At the University of Colorado in Aurora, students and residents work together with pharmacists. Residents assist with consultations, particularly with respect to chronic disease states such as hypertension, dyslipidemia, and diabetes. Students assist with data collection and medication reconciliation to the extent allowed by law.

“While students can’t practice independently, they are licensed interns and can certainly provide a significant amount of help in providing clinical patient care under the guidance of pharmacists,” said Joseph Saseen, Pharm.D., FCCP, BCPS, professor at the University of Colorado Schools of Pharmacy and Medicine, Aurora. “They can do more than just shadow. “Students must be supervised, but collecting data, providing medication reconciliation, interpreting patient care data, and drafting clinical recommendations are all valuable roles that can be filled by students.”

According to Rough, of the University of Wisconsin Hospital and Clinics, residents offer an excellent return on investment, particularly when it comes to the aforementioned technology.

“We have 16 pharmacy residents on board, and everything we do involves them,” he said. “The complexity of drug preparation and distribution technology oversight has increased drastically over the last five years. Overseeing pharmacy operations is now seen as a patient care role, and we are currently developing residents with expertise in that area.”

Evolving Technician Roles

Pharmacy technicians with the appropriate education, training, and credentials stand poised to take on more responsibility and perform tasks that were once solely the domain of pharmacists. By dispensing medications, taking prescriptions over the phone, and documenting patients’ medication information for pharmacist review, technicians free up pharmacists’ time for direct patient care.

“When you talk about staffing and resources, you have to ask where you get the most value out of each of the key participants,” said Brian T. Marden, Pharm.D., director of pharmacy at Maine Medical Center in Portland. “Clearly, a pharmacist’s best value is direct patient care, but unfortunately, in many systems that does not happen because a lot of pharmacists are still doing things that well-trained technicians could do easily and safely.”

According to Marden, pharmacists have to be prepared to let go of traditional nonclinical roles, and pharmacy leaders should create the technician infrastructure to allow for it.

“One strategy that has proven to be very effective for Maine Medical Center was the decision two years ago to hire the necessary staff to decentralize our pharmacy technicians,” he said, adding that the decision “created a sense of pride amongst our technicians that they were truly having a positive impact on patient care, right on the front lines.”

Education is of the utmost importance, not only for getting value from pharmacy technicians but also for maintaining adequate staffing, Rough believes. He speaks from experience.

“We had problems with tech turnover,” Rough said. “When we went to Human Resources, we learned that during exit interviews, the techs said that the job was not professional enough, and that they didn’t feel adequately trained for the work we were demanding of them.

“So, we made a business case for expanding technician training, showing how it was an investment in patient care,” he said. Now the University of Wisconsin system offers a nine-month ASHP-accredited pharmacy technician program.

“If you are looking for ways that pharmacists can take care of a larger population without adding more staff, the key is technician education,” Rough added.

Learning From Best Practices

The future of pharmacy depends on making the most of the resources you have, said ASHP’S Chen. “There aren’t unlimited resources, so the question comes back to, What is the most effective way to deploy allocated staff and technology? We can learn from best practices in the field, and, while recognizing that every hospital will be at a different point in the process and every state has different laws, working together, we can determine the best direction for the profession.”

Editor’s Note

In 2009, ASHP and the ASHP Foundation launched the Pharmacy Practice Model Initiative (PPMI), with the goal of developing new practice models that support the most effective use of pharmacists as direct patient care providers. Last November, thought leaders throughout hospital and health- system pharmacy came together at the PPMI Summit in Dallas to take stock of the Initiative’s progress, discuss challenges and opportunities in pharmacy, and reach consensus on next steps. In the above article, InterSections talks with some of the key leaders who attended the Summit to get their thoughts on what the future of the profession might hold.

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September 28, 2010

The Complicated World of REMS

Filed under: Feature Stories — Tags: , , , , , , , , , , , , , , , — editor @ 12:09 pm

James M. Hoffman, Pharm.D., M.S., BCPS, medication outcomes and safety officer at St. Jude Children’s Research Hospital in Memphis.

IN 2007, with the passage of the Food and Drug Administration (FDA) Amendments Act, the FDA was granted new authority to require a Risk Evaluation and Mitigation Strategy (REMS) to ensure that the benefits of a drug outweigh its risks. An REMS, which can be required at the time a drug is approved and/or once it has gone to market, has been instituted for a number of drugs. Some REMS requirements are more complicated than others; however, REMS programs have one thing in common: They all affect pharmacists.

A Broad Spectrum

The depth of pharmacist involvement in implementing REMS plans depends on each REMS. Fortunately, the majority of REMS plans are fairly cut-and-dry.

“When you look at the list of drugs for REMS, the most common REMS is a medication guide,” said James M. Hoffman, Pharm.D., M.S., BCPS, medica- tion outcomes and safety officer at St. Jude Children’s Research Hospital in Memphis. That sounds simple enough, but the challenge lies in the language: Medication guides tend to stress toxic- ity and risks.

To help patients understand both the potential positive and negative actions of a drug, St. Jude creates and distributes its own patient education materials to give out along with the FDA-required medication guides.

“Some med guides can concern patients, so we put a lot of effort into our patient education materials to make sure patients receive a balanced message,” Hoffman said.

The requirement to distribute medication guides and patient education materials appears, at first glance, to be fairly straightforward. However, the REMS requirements for some drugs, such as erythropoiesis-stimulating agents (ESAs), are a lot more complicated and can become burdensome, said David Chen, M.B.A., ASHP’s director of Pharmacy Practice Sections.

“The ESA REMS requires a paper system. Pharmacists need to collect agreements from the patients and physicians, verify that the physician has had a conversation with the patient about the drug, and maintain records in case there is an audit,” Chen said. “If a patient shows up without the right paperwork, it can take a while to track down the physician and get him or her to fax it over. This represents time away from other patient care.”

Chen added that such require- ments cast pharmacists into the role of enforcer, a role that is not reimbursed or compensated. “ASHP supports the FDA’s authority and intent, which is safety, but the question is, ‘How do we find the balance?’” he said. “It’s easy to say that it only takes six to 10 minutes to counsel a patient and comply with the REMS, but if a pharmacist has to do that several times a day, it adds up.”

JoAnn Stubbings, R.Ph., MHCA

An Uncertain Future

REMS requirements put forth by the FDA are not standardized, and there are more on the way. In June, drug manufacturers proposed a new REMS for long-acting and extended-release opioids, a plan that required prescriber and patient education with an eye toward reining in misuse of the drugs. In late July, an FDA advisory committee voted against the REMS, saying it didn’t go far enough.

Although the FDA scrapped the ideas of prescriber accreditation and patient registration programs, and it will be up to the drug manufacturers to offer the required training, that does not mean that other REMSs for other drugs will not require prescriber certification.

Indeed, the FDA has said that if the current REMS is not effective in curtailing the problems stemming from inappropriate use of long-acting and extended-release opioids, the agency may take further steps.

According to JoAnn Stubbings, R.Ph., MHCA, clinical assistant professor, pharmacy practice, and manager, research and public policy, University of Illinois at Chicago College of Pharmacy, the uncertainty surrounding future REMS plans is precisely why it is necessary to have a system in place to implement them as they are released.

“The company gives you what needs to be done, and they have the forms you need to fill out on paper or online,” said Stubbings, “but you still have to incorporate that into your own health care system.”

Creating an REMS Task Force

The University of Illinois Medical Center takes a two-pronged approach to handling REMS. First, a specialty pharmacy task force consisting of several key clinicians and administrators meets regularly. When there is a new REMS, a pharmacist whose specialty is affected by the plan will give a presentation and discuss what has to be done to meet the requirements.

“I strongly recommend that any medical center with an outpatient pharmacy have a task force like this,” said Stubbings. “Once you start investing in REMS and coping with issues of specialty pharmacy, you can get a handle on the business end of it. It has taken us two years, and we’re still learning.”

Second, the medical center develops policies and procedures for each REMS. The center began doing so when a pharmacist in the pulmonary clinic wrote an REMS management policy that covers how the drug needs to be monitored and includes a checklist for prescribers.

When it comes to REMS plans that require certification, Stubbings feels that all pharmacies that can meet the requirements should be certified. “There should be an ‘any willing pharmacy provision,’” she said. “Right now, if a provider is able, the manufacturer may still choose not to certify. They make arrangements with specialty pharmacies as a business decision. I don’t think academic medical centers and other providers should be cut out of the loop.”

Overall, it is important to remember that REMSs are put into place to protect patient safety, she added. “The intent is good. In some cases, it is possible to lose sight of that, because some REMSs have become such a burden, but we should remember that some drugs would not have been approved without it.”

Hoffman agrees. “Obviously, we are seeing an increased workload and complexity in medication use from REMS, and there is no arguing that the extra work is not compensated,” he said. “But there is no one better than a pharmacist to handle the challenges. We have an opportunity to step up and take ownership.”

ASHP: A Voice for Pharmacists

ASHP has been working with the FDA and providing a voice for pharmacists as REMS federal policy takes shape. Over the past year, ASHP has testified before the FDA and submitted written comments, attended meetings with FDA officials, and provided input for meetings covering REMS for opioids and the challenges associated with the development and implementation of REMSs.

To learn more about ASHP’s efforts to advocate for pharmacists regarding REMSs, click here.

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April 9, 2010

Blazing a New Trail for Pharmacy

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TWENTY-FIVE YEARS after the influential Hilton Head conference, ASHP and the ASHP Foundation are once again embarking on a groundbreaking national effort to guide the future of hospital and health-system practice.

The Pharmacy Practice Model Initiative (PPMI), officially launched in 2009, will revisit the hard consensus-building work of Hilton Head and other ASHP-hosted legacy conferences as pharmacists in all practice settings debate what the future of the profession should look like.

“National health care reform, constantly evolving technologies, massive amounts of new drugs entering the market every year, scientific breakthroughs… All of these and more are demanding that we, as pharmacists, really step up and begin to own the medication-use policies and procedures within our institutions,” said ASHP president Lynnae Mahaney, M.B.A., FASHP, chief of pharmacy services at the William S. Middleton Memorial Veterans Hospital in Madison, Wis.

Expectations Versus Actual Opportunities

“We’re in an environment where there is national concern about the future state of health care,” said David Chen, R.Ph., M.B.A., director of ASHP Pharmacy Practice Sections. “Additionally, we’re seeing growing demand for enhanced pharmacy services and increasing pressure to integrate technology advances. We really need a self-critical analysis of the state of pharmacy practice.”

Although the Hilton Head conference and other ones like it successfully laid the groundwork for the all-Pharm.D. degree and many of the professional opportunities that pharmacists now enjoy, there is much more to achieve, according to Doug Scheckelhoff, M.S., ASHP vice president of professional development.

“Hilton Head was focused on the clinical profession of pharmacy and the types of training needed to get there,” Scheckelhoff said. “It was really pivotal in setting a clear direction. The PPMI will be just as important, but in a different way.”

A joint project of ASHP and the ASHP Foundation, the PPMI will comprise three components: an invitational summit this fall, a campaign to promote change, and demonstration projects funded by Foundation grants. At press time, McKesson Corporation had signed on as a Leadership-Level sponsor of the Initiative, and Omnicell, Inc. and CareFusion had signed on as Gold-Level sponsors.

An Unsettling Trend

The Initiative reflects a powerful movement within ASHP’s membership. The need for a new practice paradigm has surfaced again and again during the past several years in ASHP’s policymaking Councils and membership Sections, as well as during strategic planning for the Society’s Leadership Agenda.

“We’ve been monitoring a trend in which professionals other than pharmacists are taking roles that have traditionally been pharmacists’ roles, both by design and by direct competition,” Chen said, adding that the movement is troubling because pharmacists have the knowledge and skills to conduct direct patient care and medication management.

“We need to put our stake in the ground and become the recognized experts among our medical peers on drug therapy and medication-use processes,” he said. “We also have to start taking into consideration external influences that we don’t directly control but that will ultimately affect our opportunities.” 

The issue is particularly stark when one considers the scientific breakthroughs happening today, according to Karl Gumpper, R.Ph., BCPS, director of ASHP’s Section of Pharmacy Informatics and Technology. The Section recently published a Vision Statement on Technology-Enabled Practice, acknowledging many of the challenges and opportunities that lie ahead for pharmacists.

“Medication management eventually will move toward genetics and genomics,” Gumpper noted. “All of that science will go into dosing and even picking a medication. There is no one more qualified than pharmacists to do that job.”

Finding the Right Balance

Ultimately, the best pharmacy practice models are those that find optimal balance, matching the work to the skills of the individual and using automation and technology wherever possible to improve safety and efficiency, according to Scheckelhoff. “What are technicians capable of doing and what should they be doing?” he asked. “How can we use technology to improve our processes? And how can pharmacists directly impact the care of patients?”

Scheckelhoff noted the disparities that currently exist among pharmacy services at different types of hospitals and health systems across the country. ASHP’s National Survey has repeatedly shown that “innovator hospitals” offer high levels of pharmacy services. In contrast, less progressive hospitals still provide the same kinds of  services that they provided 30 to 40 years ago.

“We need to look for ways to close that gap,” Scheckelhoff said. “Our patients need it, and they deserve it.” ASHP created a website just for the Initiative and is encouraging members to disseminate their thoughts on the best practice models via ASHPConnect discussion boards.

The first major activity will be a multidisciplinary invitational summit this fall that will focus on developing a framework of pharmacy practice that takes into consideration the internal and external factors that will affect patient care in the future.

From there, a synopsis of proceedings will help members do their own critical analysis about what types of pharmacy services they are offering. This process will, in turn, drive the development of new practice models.

“To actually change our practice models, we will need leadership at every level of pharmacy…from the pharmacy director, to the clinician at the bedside, to the technician,” said Daniel J. Cobaugh, Pharm.D., FAACT, DABAT, the Foundation’s senior director for research and operations. “It won’t be easy, and it will take time and commitment, but we all need to be engaged in this exciting process.”

Summit Dates Announced
To kick off the PPMIMI, ASHP will host an invitational consensus conference Nov. 7-9, 2010, in Dallas. The conference will bring together thought leaders throughout hospital and health-system pharmacy to reach consensus on optimal practice models.

For more information on ASHP’s Pharmacy Practice Model Inititiave, go to

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