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April 3, 2020

ASHP Update on COVID-19

Dear Colleagues,

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

WEDNESDAY EVENING I had the opportunity to participate on a director of pharmacy roundtable call with members of the New York State Council of Health-System Pharmacists. On the call, the current situation on the ground and lessons learned regarding the COVID-19 pandemic were shared by New York City pharmacy leaders. These individuals and their teams are true healthcare heroes. They are dealing with patient care situations that are beyond compare. Patient care needs have required an increase of propofol, fentanyl, and midazolam utilization by 400-600% in the past 14 days as they manage the demands of the intensive care unit and ventilated patients. One healthcare system shared that three weeks ago, it had 18 COVID-19 positive patients. As of Wednesday, they had 1,100.

We have all watched and listened to reports from New York, New Jersey, and other COVID-19 epicenters responding to this national pandemic. Listening firsthand to the heroic efforts of pharmacists on the front lines underscores the urgent need to proactively provide data to our health system, local, state, and national leaders on the pharmacy staff resources and drug supply needed to meet the needs of our COVID-19 patients. These extraordinary times will require remarkable coordination and responsiveness among our industry partners and government agencies.

ASHP has put the full weight of our advocacy efforts toward resolving these issues. This week, ASHP and the American Hospital Association, the American Medical Association, the Association of Clinical Oncology, and the American Society of Anesthesiologists, sent a letter to the Drug Enforcement Administration (DEA) requesting an immediate increase in controlled substances (CII) annual production quota allocations to manufacturers and 503B outsourcing facilities to increase the supply of opioids critical to COVID-19 patients on ventilators. ASHP’s letter notes the tightening CII supply and the need to increase production of fentanyl, hydromorphone, and other supportive CIIs as quickly as possible to avoid exacerbating existing shortages. ASHP will continue to work with the DEA, the Food and Drug Administration, manufacturers, and distributors to provide hospitals with the CIIs and other medications that are in short supply and critically needed to treat patients during the COVID-19 response.

Yesterday we sent a letter to Vice President Mike Pence, imploring him to encourage agencies to coordinate their efforts to increase manufacturing capacity for critical medications, including opioids, sedatives, and paralytics, to the greatest extent possible.

A colleague in New York expressed that a “tsunami” of drug shortages is coming as more hospitals and health systems struggle to manage the exponential rise in patient load. It is ASHP’s number-one priority to keep this issue at the forefront of public attention, and we will activate all of our partners and resources to help ensure you have the medications your patients need.

Launch of New Free Service: ASHP CareerPharm Rapid Connect

ASHP has been working on many fronts to assist you, our members, and all healthcare professionals to combat the COVID-19 pandemic. We continue to create new resources to support your valuable work on the front lines of patient care.

As the impact of the pandemic escalates, we are hearing from healthcare organizations nationwide that pharmacy departments are struggling to keep pace with the demands of the growing COVID-19 patient population. In response, I am pleased to share that ASHP has quickly developed and launched a new free service, ASHP CareerPharm Rapid Connect, to help healthcare organizations connect with pharmacists who can provide critical services including surge support with temporary onsite staffing, remote medication order review, remote clinical pharmacy specialist services, and other staffing needs. ASHP’s CareerPharm Rapid Connect also will help organizations connect with pharmacy technicians. We hope this free service will provide opportunities for hospitals, health systems, and others to fill a growing demand for pharmacy personnel during this urgent time of need.

PPE Shortages

In addition to the troubling issue of drug shortages related to COVID-19 patient care, ASHP members and other healthcare providers continue to face shortages of personal protective equipment (PPE). As I noted in last week’s blog, we are continuously surveying our members to understand the real-time impact of this issue. According to our most recent survey results, 58% of respondents whose organizations perform sterile compounding reported the need to reuse masks, and 42% reported a major or moderate disruption in the availability of medical masks. This is a substantial increase from the first survey, where 15% of respondents indicated disruptions in their supplies. We will continue to survey this situation and provide you with updates in the weeks ahead.

Given the data, ASHP is advocating for increased production and supply of PPE to ensure pharmacy personnel and other healthcare providers have adequate protection from exposure. We also continue to advance ASHP’s policymaker recommendations that address shortages of PPE for pharmacists and drug shortages to Congress, HHS, and the Vice President’s COVID-19 Task Force. Over 5,000 ASHP members have contacted their members of Congress to share those recommendations. If you haven’t yet, please consider reaching out to your members of Congress to ensure your concerns are heard.

We also created a dedicated section on ASHP’s COVID-19 Resource Center with the latest sterile compounding and PPE guidance and health policy statements. Resources include additional tools that ASHP created to support your needs as well as guidance from others, including the United States Pharmacopeia Compounding Expert Committee’s recommendations in response to shortages of garb and PPE for sterile compounding.

In addition, we continue to work on creating tools and resources to protect and assist you, our members, and all healthcare professionals as you work on the front lines of patient care. Today, we released our newest recommendations for pharmacists and pharmacy technicians on ways to prevent exposure to COVID-19 while in the workplace as well as recommendations on how to protect your family and friends to reduce exposure at home. Given the rapidly evolving guidance and recommendations supporting this effort, we will be updating these materials regularly.

Extending the Reach and Impact of the ASHP Community

ASHP supports our members by serving as a professional home and facilitating a sense of community. During this challenging time, we’ve expanded that community to include and support the interprofessional teams that are working together to treat patients in the face of unprecedented challenges.

In this spirit, you may recall that a few weeks ago, we opened access to our evidence-based online resources and tools on ashp.org, making them widely available to all pharmacists and the broader healthcare community. It gives us great satisfaction to know that members and non-members alike are using and sharing many of our important COVID-19 resources. More than 32,000 professionals have taken advantage of our free offering of ASHP’s Critical Care Pharmacy Specialty Review Course, Practice Exam, and Core Therapeutic Modules package, including more than 24,000 who are not currently ASHP members.

ASHP will continuously offer credible, trusted resources and share best practices, advice, and experiences from those on the front lines across the country. We recently launched a daily COVID-19 podcast on our @ASHPOfficial podcast channel with episodes featuring ASHP members and pharmacy practice leaders who discuss the evolving clinical, operational, and leadership challenges surrounding the COVID-19 pandemic. In the latest podcast episode, nationally recognized drug shortage expert Erin R. Fox and ASHP experts share the most recent information on drug shortages related to COVID-19 and the impact the recent relief bill passed by federal legislators will have on managing the supply chain. I encourage you to subscribe to @ASHPOfficial to receive this free, timely content.

As a reminder, we also recently established a COVID-19 Connect Community that ASHP members — and all healthcare providers — can use to ask questions, receive answers, share experiences, post resources, receive updates, and learn best practices related to COVID-19. Since it was launched less than two weeks ago, this active community has grown to more than 51,000 members and has generated nearly 500 discussions. It’s a wealth of real-time, real-life information. Please join and participate if you haven’t already.

Summer Meetings

Finally, I’d like to address our decision announced earlier this week to cancel the Summer Meetings in June. Our top priority is the safety of our meeting participants and staff, and supporting your patients’ needs. We are working on a plan to deliver many of the important activities from the Summer Meetings virtually, including educational programming and the House of Delegates. We’ll share the details as they become available.

In the meantime, please take care of yourself and your families. Be assured that we will continue to work tirelessly on your behalf. Thank you for everything you do for your patients and the profession.

Sincerely,

Paul

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

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