MPA | Pharmacy News

By Jesse Hogue, Pharm.D., pharmacy education coordinator, Bronson Methodist Hospital, Kalamazoo, MSHP immediate past-president 

The American Society of Health-System Pharmacists (ASHP) convened its 69th Session of the House of Delegates in Minneapolis during their summer meeting in June. In the course of the two House sessions, delegates considered 28 policy recommendations, one new business item and one resolution. Delegates also received board and committee reports and considered a variety of other society business items. Of the 28 policy recommendations, 15 were amended, one was referred back to the Council on Pharmacy Management for further study and 12 were approved as submitted by the Councils, including five approvals for policy discontinuations. Delegates voted to refer the resolution on ‘FDA Criteria for Specialty Drug Products Available through Restricted Drug Distribution’ for further study by the Council on Public Policy, the new business item was referred to the Council on Pharmacy Practice and delegates presented 42 recommendations to ASHP for review and action.

As you may remember from my preview article, your elected delegates this year were Gary Blake, Mike Ruffing, Paul Walker and myself, Jesse Hogue. Gary, unfortunately, was ‘Joint Commissioned’ so we appreciate Lynette Moser and Nancy MacDonald’s willingness to substitute at the House of Delegates sessions. I am proud to say that we participated in several formal caucuses and informal meetings to discuss the policy recommendations and were fully engaged in the process. I would like to take a moment to update MSHP members regarding what happened with the key policy recommendations I presented in the preview article. You can find the details of all the policies approved by the 2017 House of Delegates, along with several other documents that might be of interest here

Any Willing Provider Status for Pharmacists and Pharmacies. This policy was of particular interest considering MSHP’s focus this year on “Gearing Up” for advanced practice. It turns out, however, that this issue was far more complicated than we initially surmised. We had considerable discussion about risks/benefits, transparency and possible impacts on quality, access, cost and choice depending on the use criteria healthcare plans and payors may develop for these services. The House ended up agreeing on a significant amendment to the policy recommendation in an attempt to address these issues, but the ASHP Board recommended in their review of amendments between House sessions that the policy recommendation and its amendment be referred back to the Council on Pharmacy Management for further study. The delegates accepted this suggestion, given that it is a very complex issue and there are existing ASHP policies that would enable staff to advocate on the topic while a more specific policy on any willing provider legislation and regulation is developed. 

Ready-to-Administer Packaging for Hazardous Drug Products Intended for Home Use. I thought this policy was of interest to MSHP members because we increasingly see hazardous medications brought into the hospital as ‘patient supplied’ medications, and we continue to get more actively involved in transitions of care. I was pleased to see support for this policy at the House of Delegates and that it was amended to make it an even stronger policy statement. The delegates recognized that advocacy to the manufacturers would not be successful, so clauses were added encouraging ASHP to advocate that regulators have the authority to impose requirements on manufacturers to provide these hazardous medications intended for home use in ready-to-administer packaging, and that those products be labeled with appropriate warnings. 

Collaborative Drug Therapy Management. If you recall from the preview article, we had some concerns with this policy recommendation. While mostly favorable, and in line with our MSHP theme, we were worried that the recommended use of drug therapy management protocols would actually narrow the scope of our practice in Michigan. I am happy to report that we were successful in having this policy amended before it was accepted by the House of Delegates. The name was also changed to Collaborative Practice to better reflect the amended language, which essentially replaced ‘collaborative drug therapy management protocols’ with phrases including the terms ‘providers’ and ‘collaborative practice.’ As I noted in my Board article this month, one of ASHP’s current areas of focus is on expanding pharmacists’ authority and privileges at the state level in an effort to pave the way for federal expansion. This policy supports those efforts nicely, encouraging advocacy for key laws and regulations such as ones that would allow pharmacists to prescribe and transmit prescriptions electronically. 

Pharmacist Participation in Medical Aid in Dying. As anticipated, this policy recommendation drew a significant amount of discussion on ASHP Connect and in the caucuses and meetings leading up to the House sessions. I am relieved to report that having those forums for discussion in place allowed us to carry on most of the debate and deliberation outside of the formal House sessions, allowing the House sessions to proceed efficiently. 

To refresh your memory, two years ago the ASHP House of Delegates approved a policy opposing pharmacists’ participation in capital punishment, affirming that we, as healthcare providers dedicated to achieving optimal health outcomes and preserving life, should not participate in capital punishment. A recommendation was made after that to evaluate the ASHP position of neutrality on health professional participation in assisted suicide, and subsequently the ASHP Committee on Resolutions proposed a policy amendment strengthening that policy to one of opposition for consideration at the 2016 House. The House voted to refer the motion for further study, and the ASHP Board convened the Council of Pharmacy Management, Council on Pharmacy Practice and the Council on Public Policy as a Joint Council Task Force to study and consider the issue. The Task Force noted in their rationale that many healthcare professionals and organizations (including the American Medical Association, the American College of Physicians and the American Nurses Association) hold that death is not an acceptable therapeutic goal. Others, however (such as the American Academy of Hospice and Palliative Medicine and the American Psychological Association) have a neutral position, with the view that medical aid in dying has as its goal the relief of suffering through a compassionately hastened death while recognizing the risks of such a practice. They also noted that “medical aid in dying” is the currently accepted terminology, rather than “assisted suicide.” 

After researching and discussing the issue, the Task Force proposed a position of studied neutrality on whether pharmacists should participate in medical aid in dying. They defined studied neutrality as “the careful or premeditated practice of being neutral in a dispute … to foster a respectful culture among people of diverse views and to guide action that does not afford material advantage to a [particular] group.”1 The Task Force cited a desire to promote patient autonomy and access to care and to protect pharmacists’ professional integrity and comity as the rationale for this stance. The recommended policy also reaffirmed that a pharmacist’s decision to participate is one of individual conscience, and that participation or refusal to participate should not result in retribution, which was similar to the existing ASHP policy. While some delegates supported an amendment for ASHP to take an opposition stance, in the end the proposed policy passed as written, with the new ASHP Policy 1704 superseding ASHP Policy 9915. 

I again encourage you to review all the new policies on the ASHP website, since this summary only scratches the surface of this year’s House of Delegates activities. On behalf of my fellow delegates, thank you for allowing us to serve as your delegates this year! 


References:
1. Johnstone M-J. Organization Position Statements and the Stance of “Studied Neutrality” on Euthanasia in Palliative Care. J Pain Symp Manag. 2012; 44:896-907.

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