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March 27, 2017

ASHP’s 75th Anniversary: Celebrating the Past, Creating the Future

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

ASHP TURNS 75 THIS YEAR, and we have a yearlong campaign filled with surprises and exciting events for our members to celebrate this significant milestone. The last 75 years have been marked by so many ASHP-led advances in pharmacy practice, including: the creation of postgraduate residency training, clinical pharmacy, enhanced recognition of pharmacists as vital members of the interprofessional team, the largest gathering of pharmacists in the world — the ASHP Midyear Clinical Meeting — and so many more.

Although much has been accomplished over the last 75 years, our focus remains on the future, and ensuring that more and more people have access to the direct patient care services of pharmacists. Therefore, the theme of our yearlong celebration is Celebrating the Past, Creating the Future.

The founders of ASHP were visionaries who understood and learned from the past but realized that pharmacists must transform their practices. They worked hard to create a practice future designed to dramatically improve the care of their patients. These leaders included legends such as Gloria Niemeyer Francke, ASHP’s first CEO; Harvey A.K. Whitney, ASHP’s first president; and Donald Francke, ASHP’s second president; and, of course, Joseph A. Oddis, ASHP’s CEO for over 37 years. These are just a few of the great leaders who realized very early that pharmacists must do so much more than dispense drugs, and that ASHP should be the organization that makes it happen on behalf of patients.

Prior to the 1920s, hospital pharmacy was not a strong, well-organized component of the profession. In 1936, a subsection of hospital pharmacists in APhA was formed and, for the first time, hospital pharmacists had a voice on the national pharmacy stage. In 1942, the American Society of Hospital Pharmacists was formed with 153 charter members who worked exclusively in hospital settings.

Today ASHP has nearly 45,000 members who treat patients in every healthcare setting, including in ambulatory clinics, hospitals, and throughout the entire continuum of patient care. ASHP members are involved in all facets of pharmacy practice and include inpatient pharmacists, ambulatory care pharmacists, clinical specialists and scientists, informatics experts, practice managers, student pharmacists, residents, new practitioners, pharmacy technicians, and others.

We owe our success to our dedicated members, which is why we would like you to help us celebrate our diamond anniversary. We have a number of special activities scheduled throughout the year, culminating in a grand finale celebration at the Midyear Clinical Meeting in Orlando in December. We also are planning significant activities for key ASHP events including the Summer Meetings in June, the Preceptors Conference in August, Policy Week in September, and the Leaders Conference in October.

Thank you so much for being a member of ASHP, and for everything you do for your patients. With your help, we can continue to improve patient care and support you in your professional endeavors.

Please join us in celebrating this important anniversary — and stay tuned for more details as we roll out our 75th anniversary celebration.

Sincerely,

Paul

February 27, 2017

ASHP Continues Working on Solutions to Rising Drug Prices

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

RISING DRUG PRICES have affected virtually every segment of healthcare. From consumers to hospitals to third-party payers, all have been forced to make difficult decisions regarding healthcare choices. Patients and ASHP members’ organizations are feeling the impact of escalating drug prices, as is the entire healthcare system. ASHP is well aware of this alarming trend and is diligently working with a wide array of stakeholders and bipartisan policymakers to explore practical and sustainable solutions.

This problem is about public health and the downstream effects that high drug costs have on the health of patients and the ability of our healthcare institutions to care for them. For example, we know that when patients face higher costs they are more likely to not fill their prescriptions and may even ration their medications. Nonadherence often leads to more expensive therapies or hospital stays due to complications resulting from untreated or undertreated conditions. Payers have also had to make difficult choices in the face of spiraling drug costs, including challenging formulary decisions. Hospitals and health systems may be forced to make difficult decisions to offset rapidly rising drug costs.

Even generic drugs widely used to manage the cost burden on individual patients and our hospitals and clinics are now experiencing dramatic price increases. Instead of a robust marketplace flush with competition that drives prices lower, sometimes there appears to be little or no competition, resulting in a single company producing a generic product. Without competition, manufacturers can raise their prices as high as the market will bear. In 2016, a study commissioned by the American Hospital Association and the Federation of American Hospitals noted that drug spending increased 8.5% in 2015, while inflation increased only 0.7%. This trend cannot be sustained. The study provided an example of one hospital where “the price increases for just four common drugs, which ranged between 479 and 1,261 percent, cost the same amount as the salaries of 55 full-time nurses.” Unfortunately, while this may be an extreme example, the typical drug price increases in a hospital or health system place a heavy burden on the healthcare team and its organization to ensure their patients have access to medication therapies.

In 2016, ASHP joined the Steering Committee of the Campaign for Sustainable Rx Pricing (CSRxP), a coalition consisting of physicians, consumers, payers, hospitals, health systems, and patient advocacy groups. We believe that CSRxP, as a coalition of nationally prominent organizations, has the best chance of effecting change at the national level regarding drug price increases. With ASHP’s input, CSRxP developed a policy platform that seeks to address this problem through market-based solutions, focusing particularly on competition, value, and transparency. ASHP and other members of the Steering Committee have begun conducting joint meetings with congressional staff to discuss bipartisan policy solutions. CSRxP has also been implementing an ongoing media strategy to call attention to drug pricing and place this issue on the national agenda.

Efforts to address the problem through legislation are already underway. For example, S. 297 and H.R. 749 would require the Food and Drug Administration (FDA) to expedite approval of an Abbreviated New Drug Application (ANDA) when a drug is in short supply or little or no competition exists. Another bill, S. 124, would prohibit brand companies from paying generic manufacturers to delay introduction of a generic version, otherwise known as “pay for delay.” ASHP believes these are steps in the right direction, but more can and should be done to promote competition and limit marketplace manipulation through pay-for-delay or restricted distribution.

Also under consideration in Congress is legislation (S. 92, S. 183) that would allow drugs to be imported from other countries, such as Canada, where prices are significantly lower. This approach, however, is not one that ASHP supports, due to safety concerns over the origin of the drug and the disconnect of the pharmacist-patient relationship. Another policy option would be to allow the government to negotiate drug prices directly with manufacturers for drugs covered by Medicare Part D. However, this legislation (S. 348, H.R. 242, S. 41) does not have bipartisan support.

Finally, the Prescription Drug User Fee Act (PDUFA) is up for reauthorization this year and may serve as a legislative vehicle to address this problem. This reauthorization is considered must-pass legislation, and we have already begun discussions with key congressional staff about the policy goals of CSRxP and their potential fit within PDUFA.

ASHP remains an active leader in CSRxP and will continue pushing for solutions to the problem of rising prescription drug prices. As the only national pharmacy organization on the Steering Committee, we will continue to work collaboratively with our partners to provide the perspective of our members and to help ensure that affordable medications are accessible to those who need them.

Thank you for all that you do on behalf of your patients and for being members of ASHP.

Paul

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January 13, 2017

Provider Status Bill Reintroduced in Senate with Strong Bipartisan Support

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

IT IS WITH GREAT PLEASURE that I can announce that on Thursday evening, Senators Charles Grassley (R-Iowa), Robert Casey (D-Pa.), and Sherrod Brown (D-Ohio), along with 24 other original co-sponsors, reintroduced the Pharmacy and Medically Underserved Areas Enhancement Act (S. 109). This legislation is the same as last year’s provider status bill, with the exception of the new bill number, S. 109. This is significant not only because of the quick timing of the reintroduction, but also because of the high number of Senators who have signed on as original co-sponsors. The Patient Access to Pharmacists’ Care Coalition (PAPCC), in which ASHP serves on the steering committee, set a goal late last year of introducing the new bill in 2017 with 20 co-sponsors. We are pleased to see that this goal was not only met but exceeded.

On the House side we expect reintroduction soon. Our lead sponsor to the House bill, Rep. Brett Guthrie (R-Ky.), has been leading the charge and will reintroduce the bill with the same bill number as last Congress, H.R. 592. Again, the language will be same as last year. We expect the House bill to be reintroduced with approximately 90 co-sponsors.

We are greatly encouraged to see the momentum from last session carry over to the new 115th Congress, and we remain steadfast in our commitment to passing this important legislation. As a lead member of the PAPCC, ASHP will be working diligently to help facilitate passage of the legislation, most likely as part of a larger Medicare package later this year. In fact, early discussions between the PAPCC and key congressional staff are already occurring, as we seek to position the legislation to be a part of a larger Medicare bill.

I will continue to update you on the progress on provider status as new developments arise. Thank you so much for being a member of ASHP. It’s because of you that we are the premier organization in pharmacy.

Sincerely,

Paul

RADM Pam Schweitzer: Climbing Every Mountain

RADM Schweitzer hikes along the Sierra Crest just below the summit of Mt. Whitney, the highest peak in the contiguous United States.

THE INSPIRATIONAL SONG “Climb Every Mountain” from the well-loved movie “The Sound of Music” could be Rear Admiral (RADM) Pamela M. Schweitzer’s theme song — both literally and figuratively. RADM Schweitzer is a mountain climber both in real life and in the profession of pharmacy.

In 2014, RADM Schweitzer became the first woman ever appointed to the Chief Professional Officer (CPO) post with the United States Public Health Service (USPHS). In this role, she provides leadership and coordination of USPHS pharmacy programs and professional affairs for the Office of the Surgeon General and the Department of Health and Human Services.

Reaching this pinnacle is only one step in her long and impressive upward career climb. RADM Schweitzer received a B.A. in Biological Sciences from California State University Fullerton and earned her Pharm.D. from the University of California San Francisco School of Pharmacy. Her career has been long and distinguished, including leadership roles with the Indian Health Service and Veterans Administration. She has received numerous awards and honors, most recently ASHP’s William A. Zellmer Lecture Award, which recognizes exceptional leadership in advancing healthcare-related public policy.

Mentorship and support from colleagues have played an important role throughout RADM Schweitzer’s career. “I didn’t want to be considered for the job originally,” she said, referring to the CPO position. But her mentors encouraged her and gave her the confidence to apply. “What I didn’t originally realize about the position was how important it was to other women,” she said.

Support for Women Pharmacists

After RADM Schweitzer accepted the CPO position, she could see the challenges that other women pharmacists were facing. Frequently, junior officers would come to her for guidance about balancing career and family. To address these issues, she started a women’s leadership support group, which includes more than 110 commissioned core officers, mainly pharmacists.

RADM  Pamela M. Schweitzer

The group discusses numerous topics, particularly those related to work-life balance, including career decisions as they relate to balancing work and family, the importance of support, and leadership/management challenges. “Family first,” RADM Schweitzer often tells members of the group. “Learn to be smarter about where you put your energy. Where is your passion? If it’s your kids, do that! You learn leadership skills even by volunteering in your community.”

The support group also teaches women in leadership roles how to compartmentalize. “When you’re at work, you work,” explained RADM Schweitzer. “At home, you focus on family. Don’t let work brew in the back of your head. Turn it off.”

There are multiple support groups now located in different time zones. They usually meet once a month and periodically have special sessions on specific topics. One of the speakers at a recent meeting was RADM Schweitzer’s grown daughter, who spoke about what it was like to be the child of a mother with a professional career.

Meaningful Mentorship

RADM Schweitzer credits her mentors with much of her success. “I learned a lot about how to maneuver through a bureaucracy, best approaches to take in solving problems, and other soft skills needed when working with the C-suite,” she said. “Men tended to take me under their wing, giving really good advice — for instance, not showing facial expressions when in meetings or negotiating.”

RADM Schweitzer holds leadership support groups to encourage junior officers to use strategic thinking to solve problems.

RADM Schweitzer routinely spends her evenings mentoring women who are strategic thinkers, which positions them to be the next generation of leaders. “Strategic thinking is the most important skill that people need to learn in order to be a leader,” she said. “I tend to help people with the soft skills used in dealing with people and problems, or helping them understand the big picture of what they are trying to achieve. I also help to give them confidence and reinforce when they are on the right track. I use Myers-Briggs techniques all the time.”

She also mentors junior officers and admires how “they want to learn to make things happen.” RADM Schweitzer gives them projects and works collaboratively with them. “It helps them get off the ground, it helps to connect them, and it becomes obvious who the good ones are.”

RADM Schweitzer is happiest when she is challenged, which inspires her to challenge others. “People want to feel included and part of something that is making an impact,” she said, which is why RADM Schweitzer asks junior officers to help with simple projects and encourages them to participate in workgroups.  “I like to get [projects] off the ground, then train other people that I can pass the project off to. That’s another good way to mentor people.”

On the Up and Up

As a seasoned mountain climber, RADM Schweitzer sees many analogies between mountain climbing and pharmacy leadership. “Climbs take a lot of training,” said RADM Schweitzer. “You look at the mountain and it looks absolutely impossible, unachievable, unattainable — like the scope of a project. But one step at a time, staying focused on the mission and you get there. You may have to stop and adapt, or adjust what you are doing, but you keep going and you don’t give up.”

RADM Schweitzer on the summit of Mt. Rainier.

She has climbed Mt. Rainier, Mt. Kilimanjaro, and many other geologic giants. She noted that scaling Mt. Rainier was particularly rough, requiring the use of ropes to cross glacial ravines. “You’re going up, and people along the way are dropping … but you just keep going. Something inside keeps pushing you,” said RADM Schweitzer. That push, she noted, is what is needed to attain leadership positions as well.

One of the secrets to RADM Schweitzer’s success is keeping things in perspective and looking at the bigger picture. She admits that always doing the right thing can be difficult. Early in her career, she used to avoid people she didn’t get along with, but she eventually realized that wasn’t productive. RADM Schweitzer learned to turn conflicts into something constructive. “I needed to see the world from their view and figure out what they wanted. I needed to be strategic,” she said.

Ask Women to Lead

When it comes to being promoted into leadership roles, RADM Schweitzer encourages women to speak up and ask for what they want. In her experience, women are less likely than men to speak up in group settings, unless the group is comprised primarily of women.

Women in leadership positions can help other women by asking them to contribute in meetings and giving them kudos when they make a good point. “Women need that encouragement more than men do,” said RADM Schweitzer. “I help by calling on them, saying ‘Hey, what do you think? I’d like to hear your thoughts.’ It makes a difference.”

A look at RADM Schweitzer’s career makes it clear that with inner drive, support from mentors, and strategic thinking, women can climb to the top.

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November 16, 2016

ASHP’s Role with the New Congress and Administration

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

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

AS ANOTHER ELECTION SEASON comes to a close and we look ahead to the new administration and the 115th Congress in 2017, ASHP is again positioning itself as a credible resource to policymakers on issues impacting the profession of pharmacy and public health. While elections create change among those in government, ASHP’s public policy priorities remain the same: advancing provider status legislation, protecting the 340B program, and working with both sides of the aisle and with the administration to address the growing problem of skyrocketing drug prices and their impact on our patients and the healthcare system.

Over the last few years ASHP has increased its presence in Washington by spearheading legislative efforts aimed at curbing drug shortages and ensuring safer compounding practices. These are issues that impact all Americans regardless of political affiliation, and ASHP input was instrumental in developing policy solutions.

The new landscape on Capitol Hill and at the White House is an opportunity for ASHP to forge new partnerships, educate new stakeholders, and highlight ASHP’s expertise in public health issues. Healthcare legislation will once again be back on the agenda, and issues related to Medicare and Medicaid are likely to be in play. As we look ahead to advancing provider status, 2017 may provide legislative vehicles that could include pharmacists as providers in the Medicare program.

ASHP remains committed to working with the new administration and the new Congress to address our public policy goals. Currently we are planning outreach efforts to the Trump transition team and will begin educating the freshman congressional class on how ASHP members improve the health and wellness of their patients by ensuring safe and effective medication use and advancing healthcare. Although change in Washington is inevitable, ASHP stands firm on its commitment to its members and the public at large.

We look forward to continuing to engage you and represent your professional interests in 2017 and beyond. Thanks so much for being a member of ASHP, and for everything you do for your patients.

Sincerely,
Paul

October 19, 2016

Code Sepsis Initiative Leads to Fast Response, Better Survival

ON THE SIXTEENTH DAY of his hospitalization at Wake Forest Baptist Health (WFBH) in Winston-Salem, N.C., a 50-year-old man admitted for serious injuries from a car wreck was in trouble. His oxygen needs increased markedly, his fever spiked, and his heart rate rose as his blood pressure fell.

Clinicians suspected sepsis. At 1:30 p.m., they called a Code Sepsis, setting in motion a carefully orchestrated response by a team of physicians, nurses, pharmacists, and other clinical staff.

The patient’s physician requested antibiotics. The pharmacist reviewed the patient’s medical record and ordered piperacillin/tazobactam and vancomycin, which were sent by pneumatic tube to the nursing station. The nurse administered the drugs. The entire sequence, from recognition of sepsis to antibiotic delivery, took 19 minutes.

After careful monitoring and adjustments to his antibiotic regimen, the patient gradually improved and was discharged, sepsis-free, to a rehabilitation facility.

Reversing High Sepsis Mortality Rates
That was in the spring of 2013. A year earlier — before the hospital’s Code Sepsis initiative was fully established — this fast, focused choreography that brought antimicrobial therapy to bear against a lethal infection would not have happened. The outcomes for the patient might not have been as bright either.

Severe sepsis and septic shock are associated with a mortality rate of 25% and higher. Since each hour of delay is associated with a measurable increase in mortality, speed in initiating antibiotic therapy is critical.

James R. Beardsley, Pharm. D., BCPS

James R. Beardsley, Pharm. D., BCPS

“This case exemplifies the efficiency of the Code Sepsis process. More people who develop sepsis survive here, because we get them appropriate care quickly,” said James R. Beardsley, Pharm.D., BCPS, Manager of Graduate and Postgraduate Education in the WFBH Department of Pharmacy and one of the Code Sepsis developers.

Bringing Clinical Resources to the Bedside
Modeled after code responses to cardiac arrest or stroke, Code Sepsis got its start at WFBH in late 2011, when data showed that the sepsis-related mortality index (the observed death rate divided by the expected death rate) at the 885-bed tertiary academic hospital was twice the average for the 10 top-performing members of the University HealthSystem Consortium (UHC).

At that time, the mean elapsed time from the arrival of a rapid response nurse to antibiotic administration for patients with sepsis was 6.6 hours, and only 5.4% of these patients received antibiotics within one hour. Something had to change.

Margaret Currie-Coyoy, M.B.A., P.M.P.

Margaret Currie-Coyoy, M.B.A., P.M.P.

The medical center’s leadership assembled a multidisciplinary task force to figure out a way to get antibiotics to patients within 60 minutes after sepsis is suspected and to reduce sepsis-related mortality.

“We sought to bring valuable clinical resources to the bedside to ensure optimal treatment for each patient” and to remove barriers to rapid drug delivery, according to Margaret Currie-Coyoy, M.B.A., P.M.P., Associate Director of Performance Improvement at WFBH.

The solution is a single-minded focus on identifying sepsis patients more reliably and quickly providing them with definitive care. Under the plan, once sepsis is suspected, the bedside nurse activates the hospital’s emergency-response system, which generates a text page to all Code Sepsis team members.

Pharmacists Play Critical Role in New Protocol
As part of their responsibilities in a Code Sepsis situation to ensure timely administration of antibiotics, pharmacists assumed the somewhat unconventional role of timekeeper: If the pharmacy has not received an antibiotic order within 15 minutes of the Code Sepsis alert, the pharmacist calls the nursing unit to make sure the essential chain of events remains intact and that a drug order, if still needed, is forthcoming.

In addition, a protocol was developed that allows pharmacists to select antibiotics for Code Sepsis patients when prescribers are busy with other critical aspects of patient care.

“I may know what antibiotics I want to prescribe, but I’m so busy putting in a central line or intubating the patient that I can’t place the order,” said Catherine M. Jones, M.D., M.S., who was the Associate Chief Medical Officer at WFBM during Code Sepsis development and early implementation. She is now a Professor of Clinical Medicine at the University of Missouri Health Sciences Center.

Code Sepsis was implemented in noncritical care areas in April 2012 and then rolled out incrementally to surgical ICUs, the emergency department, coronary care units, and, finally, to medical intensive care units in August 2013.

The impact was dramatic: In noncritical care areas, the mean time from the arrival of a rapid-response nurse on the unit to antibiotic administration dropped to 51 minutes — nearly six hours less than the previous mark of 396 minutes.

In the ICUs, that time plummeted from 427 minutes to 31 minutes. The sepsis-related mortality index dropped by more than half from 1.65 to 0.8 (which translates to more than 200 lives saved annually), placing the hospital among the 10 top-performing UHC institutions.

Dr. Jones said that working on Code Sepsis gave her a better understanding of what’s involved with filling a medication order. “I had very little insight into all the work needed to get a drug order from the pharmacy to the floor. It just seemed to magically appear,” she said. “So many things can interrupt the process, and often physicians just don’t think about that. Code Sepsis gave my colleagues and me an appreciation for all that goes into the process and getting antibiotics to patients in under an hour.”

Dr. Beardsley emphasized that collaboration across disciplines was vital to the program’s success. “Without multidisciplinary cooperation, this wouldn’t have worked. It’s that simple,” he said. “We’re talking about patients’ lives, not some theoretical quality improvement initiative. When you present it that way, people are more likely to jump on board.”

–By Steve Frandzel

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