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March 18, 2020

Update on ASHP’s COVID-19 Response and Developments

Dear Colleagues,

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

I WANTED TO UPDATE YOU on our COVID-19 planning efforts, decisions we have made, various tools and resources we have made available, and advocacy and outreach efforts on your behalf.

Access to ASHP Resources for All

Earlier this week, ASHP opened access to our evidence-based online resources and tools on ashp.org, making them widely available to all pharmacists and healthcare professionals. Tools and resources that are now available include various Member Resource Centers (e.g., Emergency Preparedness, Geriatrics, Inpatient Care), relevant webinars and online programs (e.g., infectious diseases, disaster and mass casualty preparedness, and well-being and resilience), and select AJHP articles. Additionally, public access to AHFS Drug Information® is available for the next 60 days with the username “ahfs@ashp.org” and password “covid-19.”

ASHP Advocacy Efforts

I want to assure you that ASHP is working hard in Washington, D.C., to try to ensure the expertise of pharmacists is fully utilized and that healthcare providers are equipped to safely and effectively respond to the pandemic. We sent a letter to Vice President Mike Pence last week urging the administration to take immediate steps to maximize pharmacist engagement in COVID-19 preparedness and response efforts. We also continue to advance ASHP’s federal and state policymaker recommendations to address shortages of drugs and medical supplies, reimburse pharmacists for patient care services provided to Medicare and Medicaid beneficiaries, and provide resources for clinician readiness and resilience.

In addition, we have been working with several of the other national pharmacy professional organizations to develop joint recommendations that reflect our shared views on the optimal and expanded use of pharmacists during this crisis. This includes relaxing some state and federal requirements that currently limit the ability of pharmacists to maximize their contributions during this time of great need. We will share these recommendations when they become available.

Effect of Pandemic on Pharmacy Residents and Students

ASHP and our Accreditation Services team is monitoring and managing, to the extent possible, disruptions to residency training and accreditation activities as a result of COVID-19, and we will be flexible. Our primary goal is to minimize work disruptions while respecting public health guidance and the potentially harmful and disruptive effects of COVID-19 illness on healthcare systems, staff, residents, and patients. We are also concerned about the impact of canceled student experiential rotations on timely graduation, subsequent licensure, and ability to start a residency. We are monitoring this issue closely and will work to provide flexibility to help residents and programs. Updated information is being regularly posted to the Residency Program Director Connect Community.

You are likely aware that some pharmacy student experiential rotations are being canceled either by colleges of pharmacy or hospitals and health systems. We know, however, that many hospitals and health systems are successfully continuing to precept student pharmacists at this time, recognizing that they are valuable patient care providers and integral to their operations and patient care teams. I would like you to know that we are having ongoing discussions with the American Association of Colleges of Pharmacy and the Accreditation Council for Pharmacy Education, and we will keep you updated in the days to come on this issue.

Updates on ASHP Resources and Events

ASHP’s COVID-19 Resource Center is being updated regularly with new resources and tools from various sources, including ASHP. Our newest addition includes ASHP’s COVID-19 Pandemic Assessment Tool for Hospital and Health-System Pharmacy Departments, which is designed to assist in COVID-19 pandemic planning efforts in departments of pharmacy and to foster pharmacist involvement in preparedness at the institutional and community levels. The tool includes a detailed checklist to help with the development and implementation of preparedness plans.

Finally, with the country working to avoid gatherings and limit travel to slow the spread of the disease, I want to assure you that ASHP is also following suit to ensure the health and safety of our members and staff. We are canceling the face-to-face Regional Delegates Conferences scheduled for the end of April and moving to a virtual format instead. We will continue using the House of Delegates Community on ASHP Connect for member input. Any member is welcome to join that community, and we encourage you to do so. We will provide more information about these efforts in the weeks to come, as well as updates on all of our upcoming member events as we continue to assess them in light of this dynamic, evolving situation.

We have not yet made a decision about our Summer Meetings scheduled for June 6 – 10 in Seattle, but we are prepared to cancel if necessary and will make that decision as soon as we are able. We are actively preparing to offer our educational programming online and hold our House of Delegates virtually should we need to cancel the Summer Meetings.

In closing, please take care of yourself during these unprecedented times, as practicing self-care is a critical part of caring for your patients. Know that ASHP is here to help and stands ready to assist in any way that we can.

Thank you for being a member of ASHP and for everything that you do for your patients and our profession.

Sincerely,

Paul

 

July 1, 2013

Moving Closer to Achieving Our Vision

Abramowitz-PREFERRED-Featured

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

In the last 20 years, the ASHP House of Delegates has debated and passed important proposals like support for the entry-level Pharm.D., universal health insurance, mandatory reporting of medication errors and “just culture,” collaborative practice, and the implementation of health information technology.

In recent years, the ASHP House of Delegates has approved policies that set future goals for residency training for all practitioners in direct patient care roles; defined the role of pharmacist prescribing in interprofessional patient care; called on federal officials to take action on compounding, drug shortages, REMS, and meaningful use standards; and pushed for standardized education, certification, registration, and licensure requirements for pharmacy technicians.

These policies touch every facet of pharmacy practice and have a profound impact on medication use in this country. ASHP’s professional policies offer a vision for the future of the profession in which pharmacists are essential members of every health care team and where medication use is optimal, safe and effective for all people, all of the time.

Last month, the ASHP House of Delegates approved more than 20 new professional policies during its session at the 2013 Summer Meeting in Minneapolis. Along with passing measures that support training in team-based patient care for student pharmacists and residents and the reclassification of hydrocodone combination products under the Controlled Substances Act, delegates also took strong positions on compounding safely and achieving provider status for pharmacists.

These actions are emblematic of the leadership that ASHP has taken on key medication-use issues throughout its history. ASHP’s professional policies provide a solid foundation for the Society to pursue transformative solutions to the issues that affect our ability to care for our patients.

In particular, the newly approved policies on compounding by health care professionals and pharmacist recognition as health care providers highlight this principle.

Compounding

ASHP is actively engaged in federal efforts to close gaps in the regulatory oversight of pharmaceutical compounding activities. We’ve worked closely with members of Congress and congressional staff on legislation that we expect the Senate to vote on this month; namely, the Pharmaceutical Quality, Security, and Accountability Act. While this legislation addresses federal authority, our new policy focuses on the laws and regulations that govern traditional compounding that occurs in hospitals, clinics, and other areas within health systems. It advocates for the adoption of applicable standards of the United States Pharmacopeia by state legislatures and boards of pharmacy.

The laws and regulations governing compounding vary from state to state. It is essential for the safety of all patients that all pharmacies that compound medications, regardless of the setting, adhere to the very highest standards. A uniform standard will help to ensure that the medications our patients receive are safe and that they are not harmed by agents that are intended to help them.

Pharmacist Recognition as a Health Care Provider

Pharmacists are health care providers. You demonstrate that each day. But we have some work to do to fix antiquated federal and state laws that place unnecessary limits on patients having access to the care we provide.

Our new policy on pharmacist recognition as a health care provider makes a strong case for changing the status quo. It points to the pharmacist’s role as a medication expert who provides safe, accessible, high-quality, cost-effective care. The policy also highlights that, as health care providers, pharmacists improve access to patient care and bridge existing gaps in care.

Achieving recognition as providers for pharmacists is ASHP’s top advocacy priority. We are devoting substantial time and energy with our partner pharmacy organizations to push for changes in the Social Security Act that will recognize the valuable role we play in the health care system.

Please take a look at the summaries of these policies below, and review the other professional policies that were recently finalized by the ASHP House of Delegates:

Pharmacist Recognition as a Health Care Provider

To advocate for changes in federal (e.g., Social Security Act), state, and third-party payment programs to define pharmacists as health care providers; further, to affirm that pharmacists, as medication-use experts, provide safe, accessible, high-quality care that is cost effective, resulting in improved patient outcomes; further, to recognize that pharmacists, as health care providers, improve access to patient care and bridge existing gaps in health care; further, to collaborate with key stakeholders to describe the covered direct patient-care services provided by pharmacists; further, to pursue a standard mechanism for compensating pharmacists who provide these services.

Compounding by Health Professionals

To advocate that state laws and regulations that govern compounding by health professionals adopt the applicable standards of the United States Pharmacopeia.

___________________________

I also encourage you to spend some time thinking about what you envision for the future of practice and what is needed to bring us closer to that goal. Share your thoughts with me in the comments section of this column or by sending an email to ceo@ashp.org. Members serve as the catalyst for our policy initiatives. Your input can help bring us even closer to achieving the vision we have for patient care.

September 6, 2012

The Power of Policy: Pathways to the Future

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

SOMETIMES, WHEN PEOPLE THINK of the word “policy,” they think of “red tape,” bureaucracy, or an arduous process. However, when I think about the word policy, a different connotation comes to mind. I think about how much has changed in our profession since I first became an ASHP member 35 years ago, and I reflect upon the policies that helped to get us here.

Clinical pharmacy practice, the entry-level doctor of pharmacy degree, specialization, pharmacists providing direct patient care in clinics and other ambulatory settings, collaborative practice agreements, barcode medication administration, electronic clinical information systems, and so many more advancements in our profession started with just one thought: How can we do things better? And, that thought, driven by policy turned into action, ultimately led to change.

At the root of all professional advancements and change are the policies that guide us there.

Change in pharmacy practice does not just happen. It is carefully crafted, nurtured and re-evaluated over and over – even after success.

Today, ASHP stands strong as an organization adaptable and responsive to the changing needs of our patients as well as the changing demands within health care as whole. And, it is all because of you, our members. You make this happen. Through ASHP’s professional policy process, our members do not just play a significant role in bringing new and innovative ideas to the forefront of pharmacy practice; they are the catalysts for our efforts.

In June, there were several groundbreaking policies that came before the ASHP House of Delegates for debate that will make similar strides for pharmacy practice, including policies related to pharmacist prescribing, board certification, and licensing and training of pharmacy technicians. All of these were inspired by the recommendations of ASHP’s Pharmacy Practice Model Initiative (PPMI). I’d like to share some thoughts about them with you.

While these policies concern different aspects of practice, they have one thing in common: a shared vision for the future of the profession in which pharmacists are essential members of every health care team, helping our patients with our deep and extensive knowledge about all aspects of medication therapy.

The policies regarding pharmacist prescribing puts this activity in context of the pharmacist’s role on the interprofessional team and clearly states that prescribing is a complex function that requires pharmacists to have specific skills and competencies. The policy regarding board certification addresses the growing demand for board-certified pharmacists and sets a new expectation that pharmacists should become certified by the Board of Pharmacy Specialties (BPS) if they practice in a specialty in which BPS offers certification.

And the policies regarding pharmacy technicians take a strong stand on requiring licensure, as well as specialized training for advanced roles. These technician positions are an outgrowth of ASHP’s Pharmacy Technician Initiative and should serve to strengthen ASHP’s advocacy for standards for training, certification, and licensure.

These are just a few examples of the forward-thinking policies that ASHP members have conceptualized and that were brought before the House of Delegates. Although some of these concepts might seem far-reaching to some of us today, it is easy to imagine that these ideas will one day be part of routine practice, and that a new set of future-oriented policies to advance the profession for the betterment of patients will be brought before future ASHP Houses of Delegates. We look forward to working with our members and our state affiliates in creating a future in which these policies are the standard operating procedure.

Please take a look at these summaries, and review the professional policies that were recently finalized by the ASHP House of Delegates:

Prescribing:

A) Pharmacist Prescribing in Interprofessional Patient Care

Defines pharmacist prescribing as patient assessment and the selection, initiation, monitoring, adjustment, and discontinuation of medication therapy pursuant to diagnosis of a medical disease or condition; further, The policy also advocates that health care organizations establish credentialing and privileging processes to ensure competency.

B) Qualifications and Competencies Required to Prescribe Medications

Affirms that prescribing is a collaborative process that, if performed collaboratively, requires that competent, interdependent professionals complement each others’ strengths at each step. The policy also suggests the creation of prescribing standards that would apply to all prescribers, and encourages research on the effectiveness of educational processes currently available.

Board Certification:

Board Certification for Pharmacists

This policy, recommended by the ASHP Section of Clinical Specialists and Scientists, supports the principle that pharmacists practicing in formally recognized specialty areas should become BPS certified in that specialty. Among other things, the policy also calls for BPS to prioritize recognition of new specialties in areas that have a sufficient number of PGY2 residencies and existing training programs.

Pharmacy Technicians: 

A) Licensure of Pharmacy Technicians 

Advocates for licensure of pharmacy technicians by state boards of pharmacy, as well as the development of uniform state laws and regulations and mandatory completion of an ASHP-accredited training program as a prerequisite to licensure.

B) Qualifications of Pharmacy Technicians in Advanced Roles 

Advocates that beyond completing an ASHP-accredited training program, certification and licensure, pharmacy technicians working in advanced roles should have additional training and should be required to demonstrate competencies specific to these tasks.

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Once these new policies take root and grow to become the norm across health care and the nation, imagine their impact on the practice of pharmacy and how they will give us new tools to enhance patient care. Further, imagine all the future creative enhancements in the care delivery process that they will set in motion. Think back to some of the policies approved by our House of Delegates in the past and what they have led us to achieve.

Then, begin using these new policies to create the future.

March 28, 2012

The Next Frontier: Pharmacy and the Emerging Sciences

Filed under: Current Issue,Feature Stories — Tags: , , , , , — jmilford @ 5:20 pm

 

A pharmacist discovered the mistake, and it was a big one. Gone unnoticed, the error would have corrupted an entire clinical trial.

The detection occurred at the outset of a phase I gene therapy trial at The Cancer Institute of New Jersey (CINJ) in New Brunswick. Patients with carcinoma of the bladder were to receive a vaccine composed of a recombinant fowlpox virus expressing two proteins (TRI-COM and GM-CSF). The virus would be injected directly into the bladder. When the research team’s pharmacist reviewed the National Cancer Institute (NCI)-approved protocol, she realized that the normal saline solution used to dilute the vaccine was too acidic to support virus stability. Had the vaccine been administered, the results would have been meaningless.

The pharmacist alerted Susan Goodin, Pharm.D., BCOP, associate director of clinical trials and therapeutics at CINJ and professor of medicine at the University of Medicine & Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick. Dr. Goodin agreed with the evaluation and notified the research team and the NCI. Both were stunned. Eventually, a more suitable diluting agent was used.

“She caught the error before any of the 33 patients received the vaccine,” said Dr. Goodin. “We would have gotten to the end and said, ‘It doesn’t work,’ without ever knowing why.”

From Fatal Disease to a Cure

It is hard to imagine a more conspicuous example that establishes the value of pharmacists in research.

Pharmacists who are involved in emerging medical sciences research say the field requires patience and persistence.

Dr. Goodin and her vigilant colleague are part of a growing trend: pharmacists who are deeply involved in emerging medical sciences research, which include pharmacogenomics, gene therapy, biosimilar drug therapy and nanomedicine, among others. This is not a calling for individuals who thrive on instant gratification, because the payoff—if there is a payoff—usually doesn’t arrive for years, maybe decades, after the work commences, noted Dr. Goodin, who has been a researcher and clinical pharmacist for 20 years. But those rewards can be enormous.

“I truly believe that these kinds of trials will make some cancers chronic illnesses or possibly cure them,” said Dr. Goodin, who oversees all of the clinical trials at CINJ. “Gene therapy may be among the best opportunities for managing diseases like bladder cancer, pancreatic cancer and melanoma.” The team at CINJ is currently conducting a clinical trial of PANVAC, a vaccine for pancreatic cancer patients.

Individualizing Drug Therapy

Orly Vardeny, M.S., Pharm.D., conducts research on the pharmacogenomics of cardiovascular medications, insulin resistance and heart failure, and immune function and influenza vaccine response in patients with cardiovascular disease. Considered broadly, pharmacogenomics is the study of how variations in genetic composition affect a patient’s response to medication. The presence of specific genetic markers may allow a heretofore unreachable level of individualization and accuracy in drug therapy.

“Pharmacists who possess information about a patient’s genetic profile could provide prescribers with highly specific therapeutic recommendations,” said Dr. Vardeny, an associate professor of pharmacy at the University of Wisconsin in Madison.

Dr. Vardeny’s recent work includes a study of nondipping nocturnal blood pressure, which is characterized by disruptions in the normal circadian rhythm that leads to a lack of normal declines in blood pressure during sleep. The absence of a normal drop in blood pressure at night has been associated with heart failure, myocardial infarction and stroke, as well as sudden cardiac death.

The authors found that a genetic predisposition involving the sympathetic nervous system may play a role in abnormal blood pressure dipping patterns. “Determining who, from a genetic standpoint, is predisposed to nondipping, may enable us to target individuals who require more vigorous control of their blood pressure,” said Dr. Vardeny.

Asking the Important Questions

For Daniel Crona, Pharm.D., the attraction of research boils down to a simple idea: “I like asking important questions, formulating hypotheses and figuring out the answers. The end game for me is that my work may eventually save lives.”

Crona conducts clinical pharmacologic research, focusing on pharmacogenetics, in patients with genitourinary malignancies at the University of North Carolina (UNC) Eshelman School of Pharmacy, and is pursuing a Ph.D. in the UNC ESOP’s Division of Pharmacotherapy and Experimental Therapeutics.

He is part of a team seeking to discover genetic biomarkers that predict differences in survival and adverse event profiles among patients taking oral small molecule tyrosine kinase inhibitors (i.e. sorafenib) for metastatic kidney cancer. Their efforts may one day be used to identify patients who can benefit most from these agents by mitigating dangerous side effects, optimizing chemotherapy doses and improving overall survival.

“The thought that what I’m doing will potentially have a far-reaching impact on patient care is gratifying,” said Dr. Crona. “I wouldn’t give it up for the world.”

John M. Valgus, Pharm. D., BCOP, CPP

Among the prominent emerging sciences, pharmacogenomics is one of the only disciplines to have produced applications used in mainstream medicine, according to John M. Valgus, Pharm.D., BCOP, CPP, hematology/oncology clinical pharmacist practitioner at the University of North Carolina Hospitals and Clinics, and a clinical assistant professor at UNC Eshelman.

“Several specific pharmacogenomic tests are used beyond the context of a clinical trial and are generally covered by insurance,” said Dr. Valgus.

An example is genetic testing for the presence and activity of the enzyme thiopurine methyltransferase (TPMT) in patients scheduled to receive azathioprine or mercaptopurine. Patients with low TPMT activity are at increased risk of drug-induced bone marrow toxicity. The information has a direct impact on treatment decisions.

Closing the Knowledge Gap

Despite the emergence of pharmacogenomics as a practical diagnostic option, many practitioners know little about it, said Sandra Oh Clarke, R.Ph., senior director, certification development and CE liaison in the ASHP Office of Resources Development, and former director of ASHP’s Section of Clinical Specialists and Scientists.

“We have a big knowledge gap,” she said. “The information is out there. What we need is a way to communicate the value of pharmacogenomics to clinicians and bring the technology to the bedside.”

ASHP’s Section of Clinical Specialists and Scientists’ (SCSS) Advisory Group on Emerging Sciences evaluates and implements recommendations of the ASHP 2008 Task Force on Science and assesses potential policy issues related to the emerging sciences. The group is currently developing several major initiatives for members who are involved or interested in research, including a resource center on ASHP’s website and proposed CE programs at the 2012 Midyear Clinical Meeting.

“Emerging sciences will play a big part in the future of pharmacy practice,” said Dr. Valgus, who chairs ASHP’s advisory group. “Almost anyone who cares for patients, regardless of specialty, will eventually need to understand them, particularly pharmacogenomics.”

ASHP Summer Meeting & House of Delegates Meeting

Filed under: Calendar Event — Tags: , , , , , — jmilford @ 4:04 pm

September 22, 2011

Take Your ASHP Involvement to the Next Level

Filed under: ASHP News,InfoCentral — Tags: , , , — jmilford @ 2:58 pm

Are you passionate about building a strong future for health-system pharmacy?  Do you know someone else who is? Consider nominating yourself or a colleague for a position among ASHP’s elected leadership. 

ASHP’s president-elect and board members oversee the Society’s initiatives and programs, including professional policies, finances, and strategic planning. The officers are elected by active ASHP members and serve three-year terms. 

Responsibility for managing the activities of ASHP’s policy-making body falls to the chair of the House of Delegates. The chair is elected by the House and serves a one-year term.

Nominations for these positions must be submitted to the ASHP Committee on Nominations, via e-mail (ashpcon@ashp.org), fax (301-634-5825), or U.S. mail (Attention: Executive Office,) by February 1, 2012

 

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