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March 26, 2020

Update on ASHP Resources and Efforts to Help Combat COVID-19

Dear Colleagues,

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

I WANT TO CONTINUE TO UPDATE YOU on our most recent efforts on your behalf to face the rapidly evolving impact of the COVID-19 pandemic.

New COVID-19 Resources for All

ASHP continues to work to create up-to-date, evidence-based tools and provide the most current resources that you can trust to support your work on the front lines of patient care.

ASHP, through the leadership of our drug information staff in AHFS, created an evidence table to help practitioners better understand current approaches related to the proposed treatment and care of patients with COVID-19. ASHP’s Assessment of Evidence for COVID-19-Related Treatments also includes an assessment of the evidence around supportive treatments and selected chronic medications that may be used in this population.

This resource provides a concise summary – for pharmacists, physicians, and other health professionals – of published studies related to the use of hydroxychloroquine, azithromycin, and remdesivir and other antivirals in the treatment of people with COVID-19. We are updating this document regularly as new evidence becomes available.

We have made this valuable resource available for free to everyone, both domestically and internationally. We encourage you to share it with anyone who you believe would benefit from it, including your colleagues in medicine, nursing, state and local government, and others.

Earlier this week, we published our newest resource, supporting the stewardship of off-label treatments for COVID-19. Inappropriate prescribing can lead to an inadequate supply of medications for those who need them most. Stockpiling and hoarding may also create or exacerbate shortages. This resource was created to support the interprofessional care team as it makes decisions about the off-label use of medications for confirmed or suspected COVID-19 cases, allowing clinicians to weigh supporting evidence, risks, and potential benefits.

Yesterday we issued a joint statement with the American Medical Association and the American Pharmacists Association addressing the inappropriate ordering, prescribing, or dispensing of medications to treat COVID-19. The statement cautions about the lack of strong evidence for the off-label use of medications for COVID-19 as well as stockpiling medications, and opposes the prophylactic prescribing of medications currently identified as potential treatments for COVID-19.

You can find the full text of the joint statement, tools, and many other resources on ASHP’s COVID-19 Resource Center, which is updated frequently with the latest information and news. Our resources, along with many other practice and educational tools on ashp.org, are now open access and available to all healthcare professionals. We encourage you to share these materials with anyone who may need them in your network and community. 

Personal Protective Equipment Survey

ASHP is closely monitoring personal protective equipment (PPE) shortages that we know are affecting many of our members and other healthcare providers. We are conducting a bi-weekly survey to obtain an updated status of supplies and the availability of medical masks, including surgical masks, N-95 respirators, or mask alternatives currently being used in healthcare settings.

According to the results of our first survey, 15% of respondents indicated either a major or moderate disruption in the availability of medical masks, and over half indicated their vendor is allocating supplies of PPE. ASHP has been in contact with The Joint Commission, United States Pharmacopeia, and other experts and stakeholders to call attention to the critical nature of some PPE supplies and to develop guidance for compounding pharmacies. The United States Pharmacopeia Compounding Expert Committee has developed recommendations in response to shortages of garb and PPE for sterile compounding.

The second ASHP PPE survey is currently in the field, and we will continue to update you on the results.

ASHP Connect Community

Last week ASHP launched the COVID-19 Connect Community. ASHP members — and any healthcare provider — can use this resource to ask questions, receive answers, share experiences, post resources, receive updates, and learn best practices to support your patients and each other. We will also post updates about new resources, guidance documents, news, and announcements to this community. I encourage you to join your healthcare colleagues in the new ASHP Connect Community.

ASHP Advocacy Efforts

Finally, I’m pleased to share with you that several of ASHP’s recommendations to mitigate the risks that drug shortages pose to patients and the healthcare system were included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act that Congress voted to advance yesterday. The legislation, passed unanimously in the Senate, includes five key drug shortages provisions, including:

  1. Prioritizing reviews of drug applications, including expediting inspections and reviews for abbreviated new drug applications
  2. Mandatory manufacturer reporting of some drug shortage information that is currently voluntary
  3. Expansion of current manufacturer reporting requirements to include interruptions or disruptions of a drug’s active pharmaceutical ingredient’s availability
  4. Requiring manufacturers to develop risk management and redundancy plans for their supply chains
  5. Including medical devices in shortage reporting requirements during a public health emergency

While the CARES Act provides significant resources to assist hospitals in responding to COVID-19, unfortunately, pharmacist provider status in Medicare, which is language that we have been working to include, is not in this legislation. Please know that we will continue to actively advocate for Congress to recognize pharmacists as providers in the Medicare program, including and beyond the current pandemic.

ASHP is here to support you in every way we can during this public health emergency. We will continue to bring you new and updated resources to meet your evolving needs and advocate on your behalf. Thank you for being a member of ASHP and for everything that you are doing for your patients and our profession during this pandemic.

Sincerely,

Paul

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

 

March 13, 2020

Residency Match Day 2020

Filed under: From the CEO — Tags: , , , , — jmilford @ 4:09 pm

Dear Colleagues,

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

CONGRATULATIONS TO ALL WHO MATCHED during Phase I of the 2020 ASHP Residency Match! All of your hard work and dedication have led you to this very important moment in your pharmacy career. Your residency will strengthen your leadership and interprofessional skills, broaden your clinical knowledge base, and prepare you to contribute as essential members of the patient care team across all settings.

If you did not match in Match Phase I, we encourage you to participate in Match Phase II, as there are still a number of unfilled positions at exceptional programs all across the country. Take advantage of ASHP’s Residency Guide: Preparation for Phase II of the Match, created by members of the ASHP New Practitioners Forum, as you prepare for the next phase.

ASHP is proud of the countless residents who have participated in the ASHP Residency Match program over the last 40-plus years and the hundreds of programs that are a part of our nearly 60-year history of accrediting pharmacy residency programs. Residency training is very important to improving patient care, advancing pharmacy practice, and developing the future leaders of our profession.

We are excited about the continued growth and success of residency programs. This year, there were 4,923 positions matched, and 404 positions representing 327 programs remain to be filled in Match Phase II.

Over the last five years, PGY1 residency positions have grown by 27% and PGY2 positions by 56%. Specifically, PGY2 programs in ambulatory care residencies grew by 85%, infectious disease residencies by 66%, and critical care residencies by 34%. Expansive growth also occurred in emergency medicine residencies, which grew by 141%, and in pain management and palliative care residencies, which increased by 145%. The growth that we are seeing is encouraging as we seek to support the increasing demand for pharmacists with advanced training to fill medication expert roles on the patient care team and as we work to close the gap overall between residencies and residents.

As new PGY1 and PGY2 residents, you can anticipate a rewarding year ahead filled with many challenges and even more opportunities for personal and professional growth. ASHP is here to support your success at every step, as your professional home. ASHP offers a variety of resources tailored for residents, such as the Career Transitions Resource Center and the ASHP Foundation’s Essentials of Practice-Based Research for Pharmacists. Please plan to continue to read and contribute to AJHP Residents Editionan exceptional peer-reviewed platform dedicated to pharmacy residents. Also, make sure to stay involved in the ASHP New Practitioners Forum, which provides career guidance, clinician well-being and resilience resources, and opportunities for volunteer leadership.

On behalf of ASHP, congratulations once again! We are very proud of your accomplishments and wish you the best of luck throughout your residency training.

Sincerely,

Paul

 

March 12, 2020

ASHP Update on Activities During and in Response to the COVID-19 Pandemic

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

THE COVID-19 PANDEMIC is taking a major toll on people in the United States and around the world. The pandemic is taxing our entire healthcare system and public health apparatus and has or will affect all of our daily lives. ASHP wants you to know that we are here for you as you work on the front lines of patient care to help ensure your healthcare organizations are ready and that your patients get the best care possible. We understand that you and your loved ones may be at risk and the difficulty that this presents as you work to serve your communities and care for your patients during this crisis. We also know that the risks of drug shortages present major challenges in the care of your patients. ASHP and our colleagues at the University of Utah will continue to work to keep the ASHP Drug Shortages Resource Center updated, and we will continue to advocate on your behalf through continued outreach to policymakers as you stand ready to fight this public health emergency.

Last week, we developed two white papers detailing recommendations for federal and state policymakers to address the outbreak. Today, we also sent a letter to Vice President Mike Pence urging the Administration to take immediate steps to maximize pharmacist engagement in COVID-19 preparedness and response efforts. We also asked that decisive action by the Centers for Medicare & Medicaid Services be taken to remove barriers to pharmacists’ patient care services.

ASHP also developed a COVID-19 Resource Center, and we are continually updating it with new resources from various sources, including ASHP.

Due to the current COVID-19 developments, the “Safe, Effective, and Accessible High-Quality Medicines as a Matter of National Security” summit, originally planned for next week, will be postponed. We will be working with the other co-conveners, including the American Hospital Association, American Medical Association, and United States Pharmacopeia, to reschedule this important event in the coming months to continue to drive solution-focused recommendations that address global pharmaceutical manufacturing as a national security priority.

In addition, I would like you to know what we are doing to protect our staff, members and volunteers, and everyone we interact with at ASHP headquarters in Bethesda, Maryland. This includes preparing the organization for a scenario that could include closing our offices. However, we also recognize the need to be able to continue to serve our members even if our physical offices must be closed. We are prepared to run the organization remotely so that we can continue to work on your behalf and provide the tools and resources you need to care for your patients and yourselves.

Furthermore, I would like you to know that ASHP is also assessing all of our upcoming member events on a daily basis. The ASHP Regional Delegates Conferences that are taking place at the end of April in cities around the country are being planned to be held virtually if necessary.

In regard to the ASHP Summer Meetings that are scheduled to take place in Seattle in early June, it is too early to make a final decision. However, we will be fully prepared to make that difficult decision if there is any risk whatsoever to our participants. Safety comes first, no exceptions.

During this crisis, ASHP will remain focused on how we can best assist you, our members, and work at the local, state, and federal levels to be a partner in bringing this unfortunate public health crisis to an end. If you need our assistance, please don’t hesitate to contact ASHP. Please also continue to look to ASHP for up-to-date information and resources on the COVID-19 crisis. We will get through this difficult time together, and be stronger as a profession, citizens, and as a country and global community. In the meantime, ASHP will do everything we can to support you and the patients you serve.

Thank you for everything you do, and please know that we are here for you during this very difficult time.

Sincerely,

Paul

 

March 6, 2020

Pharmacist-led Initiative Cuts Post-Operative Opioid Use

Pharmacists at Riverside discuss patient pain control in daily interdisciplinary rounds with providers, nurses, and therapists.

PHARMACISTS AT RIVERSIDE HEALTH SYSTEM in Newport News, Va., are at the helm of an innovative paradigm shift in post-operative pain management. Historically, most joint replacement patients who sought to eliminate post-operative pain presumed opioids would be the cornerstone their pain control strategy. In 2017, Riverside’s pharmacy team rolled out a new  initiative aimed at reducing the amount of opioids prescribed for post-operative pain. The results have been nothing short of remarkable.

Multiple pain interventions

According to Cynthia Williams, Pharm.D., B.S., FASHP, two essential elements make the opioid reduction initiative a success: managing patient expectations regarding post-operative pain and provider use of multimodal analgesia (MMA).

“Unlike opioid-based regimens, MMA relies on non-opioid treatments, such as acetaminophen, non-steroidal anti-inflammatory drugs, neuropathic pain medications, and muscle relaxants, thus reducing the use of opioids,” Dr. Williams said. She is vice president and chief pharmacy officer at Riverside Health System and led the initiative along with a multidisciplinary team.

Cynthia Williams, Pharm.D., B.S., FASHP

Riverside’s “Joint University”

Dr. Williams, an ASHP member for over 20 years, said the efforts to change how Riverside’s total joint replacement patients think about post-operative pain begins well in advance of the procedure during conversations between patients and providers, and through group education sessions known as the “Joint University.”

“Joint University is our structured program that gives joint replacement patients, their caregivers, and families a chance to learn about all of the aspects and steps of total joint replacement surgery, from the pre-operative period to post-discharge home health care,” explained Dr. Williams.

While the Joint University was in place before this opioid reduction initiative was rolled out, Ms. Williams and her colleagues revised the educational materials to emphasize the need to balance post-operative pain control with safety and physical recovery.

The educational materials are reviewed with a nurse, who explains to patients that eliminating post-operative pain is unrealistic, may slow recovery, and place patients at risk of misuse and complications. “Chipping away at the commonly held patient expectation that there should be no pain post-operatively has been challenging, but the educational initiative has been effective,” said Dr. Williams.

Pharmacists take the lead

While addressing patient expectations, the Riverside team has also been encouraging providers to use MMA regimens, explained Katherine Koehl, Pharm.D., system director of clinical pharmacy services at Riverside Health System, and an ASHP member since 2006.

She said pharmacists have played a key role in achieving this shift in practice, through presentations at grand rounds, at provider retreats, and in one-on-one discussions with physicians, she noted. Pharmacists have also helped revise order sets to “make it easier for providers to do the right thing, which is to use fewer opioids,” Dr. Koehl said.

“Physicians can still order opioids, but the revised order sets for total joint replacement now default to include MMA components and require providers to take additional steps to prescribe opioids,” said Dr. Koehl. We’ve driven clinical practice by how we built our order sets, she added, pointing to a 95% adoption rate of MMA for total joint replacement surgeries.

Juanita Baer, Pharm.D.

Morning rounds

Ensuring joint replacement surgery patients are managed with MMA is a priority for Juanita Baer, Pharm.D., who is Riverside Health System’s surgical team lead for pharmacy.

“When I do my morning rounds, if a patient has high levels of pain, I’ll glance down at their chart and make sure that if they are receiving an opioid, they’re also being given multimodal components when appropriate, because pain medications work much better together than individually,” Dr. Baer said.

Indeed, she said having multiple components in place has led to less opioid use and is helping patients progress more rapidly in their physical therapy and through to discharge and rehabilitation. “By combining several different classes of drugs, we can find that individual optimal pain level where the patient is comfortable enough to sleep, while also being able to stand up safely and participate in physical therapy,” she said.

Expanding the program

Since the initial effort on elective total joints, Riverside has moved the focus to Enhanced Recovery After Surgery (ERAS) implementation in several specialty areas, including total colectomy and neurosurgery. One of the components of ERAS is the minimization of opioids, with a focus on multimodal pain management.

In early 2019, Riverside embarked on rapid performance improvement focused on ERAS implementation in colectomy surgery. “During the process, which included provider engagement from anesthesia and surgeons, the focus was placed on opioid-sparing treatment by utilizing multimodal pain management pre-operatively, the use of surgical blocks during the procedure, and the continuation of scheduled non-opioid medications post-operatively,” said Dr. Williams.

Katherine Koehl, Pharm.D.

Based on chart review, patients were successfully managed on limited or no opioid therapy and reported management pain levels. When opioids were needed for break-through pain, the oral route was utilized, which is a component of ERAS pathways, she added.

Leveraging the success of colorectal ERAS implementation, a neurosurgery project was launched in Summer 2019 and is showing early success, noted Dr. Williams.

Optimizing pain management

While there is now near-complete adoption of MMA regimens in Riverside’s total joint replacement, colectomy, and neurosurgery patient populations, Dr. Koehl said there was some initial resistance.

Perhaps the greatest reluctance, which was seen among both providers and patients, was that acetaminophen was thought of as a “low-value pain medication,” despite the evidence showing “it can be very powerful,” said Dr. Koehl. Some nurses were also initially apprehensive about spending more time administering the multiple medications included in an MMA regimen.

However, with education from pharmacists, providers and nurses ultimately placed the welfare of patients and others affected by the opioid epidemic over any hesitation, said Dr. Koehl.

“At the end of the day, we all want to minimize exposure to opioids and prevent large quantities of these drugs from getting into the community, and optimizing post-operative pain management is one way we have achieved this,” she said.

 

By David Wild

 

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