mrm.pharmacist.com R6... · Web viewThis resolution encourages public education on naloxone and...

Region 6 Midyear Regional MeetingSt. Louis, Missouri

October 12-14, 2018

Proposed Resolutions

Proposing APhA-ASP ChapterPolicy Numb

er

Page Numb

erHarding University R6.1 2Southwestern Oklahoma State University R6.2 4St. Louis College of Pharmacy R6.3 5Texas A&M R6.4 7Texas Southern University R6.5 8Texas Tech University R6.6 10University of Arkansas for Medical Sciences R6.7 12University of Houston R6.8 15University of the Incarnate Word R6.9 16University of Kansas R6.10 18University of Louisiana Monroe R6.11 20University of Missouri-Kansas City R6.12 23University of North Texas R6.13 25University of Oklahoma R6.14 28University of Texas at Austin R6.15 30University of Texas at Tyler R6.16 32Xavier University R6.17 34

APhA Academy of Student Pharmacists Region 6 Midyear Regional Meeting 2018

R6.1

Proposing APhA-ASP Chapter: Harding University

Proposed Resolution Title/Topic: Naloxone Education Protocol

Proposed wording: APhA-ASP reaffirms Resolutions 2014.2 and 2015.4 and encourages pharmacies to work in tandem with local first responders to provide naloxone and training for using the naloxone to first responders, as well as lay persons who are interested in possessing naloxone. This training should include, but is not limited to: recognizing an overdose, responding to an overdose, and administering naloxone.

Background Statement:Naloxone can currently be dispensed as an OTC product in all 50 states in some form or fashion. This gives pharmacists the opportunity to dispense naloxone to first responders as well as lay persons such as friends and family members of people who are at risk for an overdose. Pharmacists may be the only chance for these lay persons to receive training that can increase the chances of survival from an overdose (Giglio 4-5). Currently, New Mexico and New York require a training of some sorts to be completed by the lay person before they can purchase naloxone, unless they receive a prescription for it, but training is optional in all other states.

First responders may have received some education regarding naloxone in their training, but this information is too valuable to not be sure. This could involve a pharmacist speaking directly to groups of first responders, or teaching someone else, who will then present the information to their peers.

This resolution would require active effort from pharmacists to both learn the information needed and to train a lay person, which could be difficult for busy pharmacies. The training could take place in a CE format, and both interns and pharmacists could be involved in this training to reduce the load.

Giglio, Rebecca E., Li, Guohua. and DiMaggio, Charles J. “Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis.” Injury Epidemiology, 22 May 2015. p 3-4

Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes X No___

If yes, please provide the number and title of the adopted resolution(s) as well as your rationale for the addition of this Proposed Resolution:

Resolution 2014.2: Dispensing and Administering Medications in Life-Threatening Situations

The above resolution mentions naloxone administration in a blanket statement supporting the laws that have already been passed. Simply that pharmacists should be able to dispense naloxone, as well as a few

2


other drugs such as Epi-Pens. This suggested resolution would encourage pharmacists to operate at a greater capacity within their licenses by providing specific education to a small group of the patient population.

Resolution 2015.4: Increased Access to Opioid Reversal Agents

This resolution encourages public education on naloxone and supports legislation that increase access to naloxone. The proposed resolution takes this a step further in a specific direction by encouraging a partnership between pharmacists and their local first responders in order to better educate the public. The opioid epidemic is a huge public health problem. As medication experts and the most accessible health professionals, pharmacists should be doing everything that they can to distribute this knowledge.

Author of Proposed Resolution: James Jackson

Author Phone Number: 870-450-1553

Author Email Address: [email protected]

3


R6.2

Proposing APhA-ASP Chapter: Southwestern Oklahoma State University

Proposed Resolution Title/Topic: PBM Education

Proposed wording: APhA-ASP supports the efforts of the state and national APhA organizations to provide talking points to pharmacists and student pharmacists about the activities of PBMs.

Background Statement:Our proposal is meant to be more of an educational stance supported by APhA-ASP. While many pharmacists have awareness of PBM activities, it is important to make sure that all pharmacists and student pharmacists are correct in their understanding about important specific points concerning PBMs. As not every state is equal in the amount of assistance that pharmacists receive regarding education about PBMs, it is our goal through this resolution that APhA-ASP supports the efforts of the state and national APhA organizations to provide talking points to pharmacists and student pharmacists about the activities of PBMs. We hope that by having specific points clarified, we as pharmacists and student pharmacists can stand as a consensus to provide information to insurance commissioners and the public when questions arise.

We hope that by coming from an education angle, our proposal will be a supportive resolution concerning PBMs in addition to other PBM resolutions.

Pros: • All pharmacists and student pharmacists will gain a linear understanding of PBMs, and will be able to have a collective voice as public awareness of PBMs grow.• Greater understanding of the processes will give more pharmacists and student pharmacists a voice when legislation involving PBMs arise. • Greater understanding of the PBM processes may also allow for a better appreciation for actual cost savings and improved outcomes for patients.

Cons:• Not all states are equal in their efforts to provide education about PBM topics to pharmacists and student pharmacists.

Are there any adopted resolutions currently on the books related to this Proposed Resolution? Yes ___ No X


Author of Proposed Resolution: Jordyn Richey

Author Phone Number: (580) 623-0280

4



Proposing APhA-ASP Chapter: St. Louis College of Pharmacy

Proposed Resolution Title/Topic: Patient Care

Proposed wording: APhA-ASP encourages pharmacists and student pharmacists to take advantage of educational resources that teach basic sign language so pharmacists and student pharmacists can better serve patients who are deaf or hearing impaired. These educational resources should be included as required learning for all accredited pharmacy institutions.

Background Statement:The deaf community is an underserved population in the healthcare field who often receive an inadequate level of accommodation when engaging with health care professionals. In a study review by the Journal of Preventing Chronic Disease, researchers concluded “Deaf sign language users continue to experience inequities accessing health care, health information, health research, and health-related careers, which limits their ability to achieve optimal health for themselves, their families, and their communities.” (1) Deaf patients often site having a negative experience when dealing with health care professionals. As noted in the Journal of Internal Medicine, “Fear, mistrust, and frustration were prominent in participants' descriptions of health care encounters. Positive experiences were characterized by the presence of medically experienced certified interpreters, health care practitioners with sign language skills, and practitioners who made an effort to improve communication.” (2)

Having a pharmacist that the hearing impaired patient can discuss basic information and questions with could go a long way in ensuring their experience is a positive one and they feel comfortable admitting when they fail to understand. An improvement in communication could reduce the risk of complications that may lead to a harmful outcome for the patient and improve the overall experience. There is a basic set of sign language words and phrases that providers can learn to better serve hearing impaired patients without having a translator immediately on hand. These include phrases such as “where does it hurt,” “on a scale from one to ten how bad does it hurt,” “do you think this medicine is helping,” etc. One alternative solution to this proposal would be to use some variant of a speech-to-text device in order to allow the patient to read what the pharmacist is saying. While this would be an improvement over not having the device, an often overlooked problem is that “Communicating through spoken or written English poses many challenges to deaf people, as there is no written form of basic sign language (BSL), and it differs from English in grammar and syntax.”(3) Another important factor in having deaf patients read from text is “(a)lthough not a reflection of their intelligence, Conrad’s (1977b) seminal research noted that the average reading age of deaf adults is that of a nine-year-old.”(4) Due to the fundamental differences between BSL and spoken language, a deaf patient who has a high health literacy may still have trouble understanding the provider and may misinterpret the written text. Therefore, it would be a wise investment to educate pharmacists and student pharmacists with a few basic sign language skills in order to help improve communication between deaf or hearing impaired patients and their pharmacists.

5


(1): Barnett S, McKee M, Smith SR, Pearson TA. Deaf Sign Language Users, Health Inequities, and Public Health: Opportunity for Social Justice. Preventing Chronic Disease. 2011;8(2):A45.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3073438/

(2): Steinberg AG, Barnett S, Meador HE, Wiggins EA, Zazove P. Health Care System Accessibility: Experiences and Perceptions of Deaf People. Journal of General Internal Medicine. 2006;21(3):260-266.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1828091/

(3): Kyle JG, Woll B (1985) Sign Language: The Study of Deaf People and their Language. Cambridge: Cambridge University Press.

(4): CONRAD, R. (1977), LIP READING BY DEAF AND HEARING CHILDREN. British Journal of Educational ‐Psychology, 47: 60-65.



Author of Proposed Resolution: Alexander Muller



6

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1828091/



R6.4

Proposing APhA-ASP Chapter: Texas A&M Irma Lerma Rangel College of Pharmacy

Proposed Resolution Title/Topic: Closed Care Areas within Community Pharmacies

Proposed wording: APhA-ASP supports legislation requiring newly built and redesigned community pharmacies, that wish to provide clinical services, to have a screening room incorporated into the design of the building.

Background Statement:As the field of pharmacy is continuing to evolve and we are advocating for recognition as providers, it is also important to change the public perception of pharmacy. The addition of an enclosed screening area will not only enhance patient privacy but create a more clinical environment for pharmacists to care for patients. Pharmacists will have a designated area specifically for one-on-one patient care, versus providing immunizations in a chair while a crowd of people are watching as they wait in line. This reserved area will also be critical for the potential services pharmacists will be providing in the future such as strep and influenza throat swabs, as well as medication therapy management.

Due to extensive costs of building renovations, this legislation would only be applicable to pharmacies undergoing construction along with newly constructed pharmacies. The proposed screening area would not require a significant amount of space within the pharmacy. A minimum area of 7x7 feet would sufficiently provide private space for immunizations, patient counseling, and other pharmacy services. This area may also serve as a storage space for items used to provide such services including vaccines and syringes, in addition to other items in the pharmacy such as documentation.

In order for pharmacists to optimize patient care within communities, they need the proper facilities to do so. Ultimately, having a closed screening area implemented within pharmacies will reduce patient and provider anxiety when providing services, as well as transform community pharmacies into more professional places of patient care.



Author of Proposed Resolution: Jaylon Cole

Author Phone Number: 2149267702


7


R6.5

Proposing APhA-ASP Chapter: Texas Southern University College of Pharmacy

Proposed Resolution Title/Topic: Improving Pharmacist’s Working Hours

Proposed wording: APhA-ASP recommends scheduling pharmacists a minimum of twelve hours between two consecutive shifts.

Background Statement:Many pharmacists in a retail setting often work long hours without any breaks during a shift. Some stores require one to be more attentative due to a higher store volume. It involves a lot of focus and fast response times on necessary tasks, such as, reviewing medications as accurately as possible on top of a high workload. It demands a lot of multitasking and increased productivity levels. However, when a person does not get sufficient sleep, it can lead to serious cognitive impairments. Thus, allowing room for medication errors, slower response time, and a decline in performance.

On certain days a pharmacist could have a closing shift and be required to open the next day. For example, one can be scheduled to close at midnight but have to be at the store at eight the next morning. Not all pharmacists reside near the store they work at and can have long commutes which may allow one to sleep for a maximum amount of five hours. This results in them being sleep deprived since the average amount a person needs to sleep at night is around six to eight hours. This in turn can also prevent medication errors and increase productivity levels. Therefore, a policy should be implemented to allow a minimum time of twelve hours between two consecutive shifts.

References:1. Dai, Xi-Jian et al. “Plasticity and Susceptibility of Brain Morphometry Alterations to Insufficient

Sleep.” Frontiers in Psychiatry 9 (2018): 266. PMC. Web. 13 Sept. 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030367/

2. Institute of Medicine (US) Committee on the Work Environment for Nurses and Patient Safety; Page A, editor. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington (DC): National Academies Press (US); 2004. Appendix C, Work Hour Regulation in Safety-Sensitive Industries. Available from: https://www.ncbi.nlm.nih.gov/books/NBK216189/



Author of Proposed Resolution: Kathy Hsieh, Uzma Munawar

8



Author Phone Number: 832-788-3365, 281-839-5118

Author Email Address: [email protected], [email protected]

9


R6.6

Proposing APhA-ASP Chapter: Texas Tech University Health Sciences Center School of Pharmacy

Proposed Resolution Title/Topic: Collaboration of Clinical Pharmacists and the FDA on Therapy Modification Transition

Proposed wording: APhA-ASP encourages clinical pharmacists to collaborate with the U.S. Food and Drug Administration on providing recommendations to clinicians on therapy management and substitutions for successful transition during potential drug shortages.

Background Statement:Between 2001 and 2011, the amount of drug shortages across the nation increased exponentially. In 2011, there was a peak value of 215 shortages over the fiscal year, leading to patient care issues due to the following: substituting to unsafe therapies, delaying of therapy and medication errors.1 Additionally, the labor costs associated with managing drug shortages is nearly $216 million annually.2 Since then, the FDA has improved its practices and regulations to work with manufacturers to receive earlier notices on potential drug shortages using electronic data tracking and trend setting systems. As a result, the number of drug shortages has steadily decreased over the past half-decade through these implementations. As low as the amount of drug shortages may be, patient care will continue to be possibly jeopardized without the implementation of an established system that accounts for maintenance medications.

The International Society for Pharmaceutical Engineering stated that the lack of a quality system that complies with FDA regulations and internal procedures and specifications was the most common cause for drug shortages among sterile products. Indeed, it further stated that manufacturing companies that implemented information technology or established redundancy in the supply chain were not as likely to manage drug shortages as opposed to companies that implemented reforms to improve the drug production lines.3 Because manufacturing problems are often the cause of drug shortages or recalls, the pharmacist’s role in modifying patient therapy becomes essential in determining either equivalent or alternative treatment.1

Fortunately, action has been taken by pharmacies to manage drug shortages. Most notably, around 25% of hospital pharmacy directors have added at least one full-time position to manage drug shortages. Looking ahead, it is important to inform patients on how the drug shortages affect them by reporting the drug shortages and by reaching out to patients who are affected by the drug shortages too.2

To ease the transition of patient care for clinicians, we believe that setting a collaboration between clinical pharmacists with the FDA on providing recommendations for therapy modification for future potential drug shortages.1 As of now, the FDA does employ licensed pharmacists to advise on therapy changes and management on a local basis, however, no team has been implemented internally with the intention of easing the transition for patients taking drugs that will potentially be on a national shortage.

10


1. Ventola CL. The drug shortage crisis in the United States: causes, impact, and management

strategies. P T. 2011;36(11):740-57.2. Kaakeh, R., Sweet, B. V., Reilly, C., Bush, C., DeLoach, S., Higgins, B. et al. Impact of drug shortages

on U.S. health systems. American Journal of Health-System Pharmacy. 2011 October;68 (19):1811-1819. http://www.ajhp.org/content/68/19/1811.short?sso-checked=true

3. Orlovich DS, Kelly RJ. Drug shortages in the U.S. a balanced perspective. https://www.apsf.org/article/drug-shortages-in-the-u-s-%C2%AD-a-balanced-perspective/

4. Logan, J., Bish, T., Rowe, E. Case Study about utilizing a drug shortage task force in a hospital → http://www.ashpmedia.org/pai/docs/casestudy_logan.pdf



Author of Proposed Resolution: Ervin Lopez and Parsa Famili Author Phone Number: (713) 478 – 2462

Author Email Address: None provided

11


R6.7

Proposing APhA-ASP Chapter: University of Arkansas for Medical Sciences

Proposed Resolution Title/Topic: National Standard for Computer Drug Interaction Database

Proposed wording: APhA-ASP supports a national drug interaction software database to be in the public domain for all pharmacies to access in order for the patient’s new and previously prescribed medication interactions to be accurately and quickly assessed for the clinical judgement of a health care provider.

Background Statement:Drug interaction programs can only effectively perform their role when all information about a patient’s current medication regimen are known and updated potential drug interactions are available. Recent reports that have come out, specifically in Chicago, showed that 52% of pharmacies included in the study dispensed medications without mentioning a potentially harmful interaction to the patient. Developing and implementing a national standard for computer drug interaction data would more effectively allow pharmacists to become aware of potential drug interactions and better care for patients. Such a program could be developed via a competitive bidding process by software developing companies with sponsorship and oversight provided by the FDA. Through this partnership the FDA could be used to help initially fund. Then the software developer would be responsible for maintenance.

Pros: -Implements a national standard for Drug Interaction computer programs.-Standardizes a ranking system on the severity of drug interactions.-Health Care Providers would be more efficient with their time.-Prevents notification fatigue.-Decreases risk of potential harm by drug interaction data errors being presented to the pharmacist.-Increases in patient-centered care and safety (especially in the face of growing poly-drug therapy and access to multiple prescribers).-Better transition of care services.-More streamlined collaboration between medical professionals.

Cons: -Cost of developing programs.-Drug interaction computer programs are not standardized.-Community, hospital, and government health care computer systems may vary widely in their advice to a pharmacist on interactions between the same two drugs.-Potential communication barriers between physician and pharmacist.-Need updates/revisions as new clinical data comes out.

References:Long, R., King, K., & Roe, S. (2016, December 15th). Pharmacies miss half of drug combinations.

12


http://www.chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-pharmacy-met-20161214-story.html

Long, R. & Roe, S. (2017, January 24th). New plan aims to protect Illinois pharmacy customers from dangerous drug interactions.http://www.chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-illinois-pharmacies-rauner-met-20170124-story.html

Moura, C.S., Prado, N.M., Belo, N.O. et al. Int J Clin Pharm (2012) 34: 547. Evaluation of drug–drug interaction screening software combined with pharmacist interventionhttps://doi.org/10.1007/s11096-012-9642-2



Resolution 2010.3 E-Prescribing and Computerized Prescriber Order Entry (CPOE) Systems

1. APhA-ASP encourages the use of e-prescribing and Computerized Prescriber Order Entry (CPOE) systems that improve patient care.2. APhA-ASP encourages the development of standardized and interoperable e-prescribing and CPOE systems that reduce medication errors, ensure secure transmission of prescriptions and patient information, and improve workflow for prescribers and pharmacy personnel.3. APhA-ASP encourages pharmacists, student pharmacists, pharmacy associations, and boards of pharmacy, in collaboration with prescribers, to take an active role in the development, regulation, and integration of e-prescribing and CPOE systems. APhA-ASP also encourages these stakeholders to take part in studies that continually evaluate and improve the safety and security of e-prescribing and CPOE systems.4. APhA-ASP encourages that state and federal regulatory agencies update regulations to allow for the transmission of controlled substance (CII – CV) prescriptions through e-prescribing and CPOE systems.5. APhA-ASP supports e-prescribing and CPOE systems that are cost-effective and do not place a disproportionate financial burden on pharmacies. 6. APhA-ASP encourages the development of education and training programs to enhance prescriber, pharmacist and all other users understanding of e-prescribing and CPOE systems.

The proposed resolution offers a reasonable and implementable option to further reduce medication errors and improve workflow for prescribers and pharmacy personnel by introducing a standardized drug interaction database. Having a standard drug interaction will also increase the safety and security of e-prescribing. This database would also promote collaboration between prescribers, pharmacists, and other users.

13

https://doi.org/10.1007/s11096-012-9642-2

http://www.chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-illinois-pharmacies-rauner-met-20170124-story.html

http://www.chicagotribune.com/news/watchdog/druginteractions/ct-drug-interactions-illinois-pharmacies-rauner-met-20170124-story.html




2004.6 Information Technology

APhA-ASP encourages all pharmacy practice sites to provide immediate access to the Internet, Web-based applications, and other forms of information technology that enhance patient care.

A national drug interaction software database would be included under this resolution.

Author of Proposed Resolution: Ashlyn Tedder Ward, Philip Deer

Author Phone Number: (479) 857-6325, (501) 944-9403

Author Email Address: [email protected], [email protected]

14


R6.8

Proposing APhA-ASP Chapter: University of Houston College of Pharmacy

Proposed Resolution Title/Topic: Adapting To A Growing Online Patient Base

Proposed wording: APhA-ASP encourages the implementation of higher standards regarding counseling and drug information over medications received by patients who primarily use online pharmacies.

Background Statement:In recent years, the popularity of online pharmacy has significantly grown as seen by Amazon’s recent acquisition of the online pharmacy PillPack. PillPack provides a pharmacy service aimed towards giving their patients a efficent and convenient method of receiving medicaition. Based on the website, PillPack currently provides a 24 hour support via online, email, and phone with the option to speak with a pharmacist. While the emergence of online pharmacies provide a new level of convenience and on demand services, the lack of face to face interaction between patients and pharmacist could lead to misunderstandings and lack of necessary knowledge regarding the medications patients receive. This stance aims to provide a uniform patient education delivery system to all patients who receive medications through online pharmacys in order to ensure the same level of patient outcomes seen in traditional settings.

Resources:1. PillPack Service Model:https://www.pillpack.com/service

2. Amazon’s Acquisition of PillPack: https://www.pharmacytimes.com/news/amazon-enters-the-pharmacy-world-with-acquisition-of-pillpack--



Author of Proposed Resolution: Harshil Patel



15

https://www.pharmacytimes.com/news/amazon-enters-the-pharmacy-world-with-acquisition-of-pillpack--

https://www.pharmacytimes.com/news/amazon-enters-the-pharmacy-world-with-acquisition-of-pillpack--

https://www.pillpack.com/service


16


R 6.9

Proposing APhA-ASP Chapter: University of the Incarnate Word

Proposed Resolution Title/Topic: Physician-Pharmacist Prescribing Process

Proposed wording: APhA-ASP proposes the change in the prescribing process where clinicians prescribe a specific non-control drug class based on the diagnosis, while the pharmacist determines which medication to use within the chosen drug class. The pharmacist will determine the dose and the most cost-effective drug for the patient based on the patient’s medication history, background, and APhA Pharmacy Patient Care Process which includes collect, assess, plan, implement, follow up: monitor and evaluate, making the prescribing process a more team-based approach. Chronic disease state, excluding opioid prescriptions, will be the focus of this prescribing change.

Background Statement:Prescribers and Pharmacists are both experts in their respected fields. Pharmacists focus on pharmacology and therapeutics for all drug classes all four years of school. Currently, the clinicians prescribe medications without any other knowledge of other medication or other patient factors. The Pharmacist then makes any change to the medications based on patient factors, but only with physician approval. According to the study “A comparison of medical and pharmacy students' knowledge and skills of pharmacology and pharmacotherapy” published in the British Journal of Clinical Pharmacology in September of 2014, pharmacy students had better knowledge of basic pharmacology than medical students whereas medical students had better skills than pharmacy students in writing prescriptions. The two groups of students had similar knowledge of applied pharmacology. This study and the focuses of each profession show that pharmacists and physicians can work together in the prescribing process to prescribe the best drug therapy for each individual patient and avoid any potential medication errors. This new prescribing process would really accentuate a team-based care approach. Some states allow pharmacist some prescribing power. For example, according to an article published by the Journal of the American Pharmacist Association in September of 2016, select Oregon pharmacists were trained to prescribe hormonal contraceptives. The study showed results over the course of 12 months with a survey sent at 6-months and at the end of the cycle to evaluate pharmacist-patient outcomes. “At both 6 and 12 months, almost one-half of all pharmacists were billing insurance for the visit, and the average visit took less than 30 minutes. The top 3 motivators for providing HC did not change over time and included increasing access, reducing unintended pregnancy, and increasing pharmacist scope of practice” (APhA 2016). The overall outcome of this study caused an increase in pharmacist prescribing hormonal contraceptives across the state. The results also show that patient “wait time” is efficient with the given activities conducted during the visit. The only downfall to this might be that the physicians would be losing part of their prescribing duties. Based on the article “Pharmacist and physician views on collaborative practice” in the Canadian Pharmacist Journal, both physicians and pharmacists agree that they would like more collaborative practice agreements in place, but for different reasons. Physicians would like pharmacists to have more collaborative practice agreements for insurance approvals and increased counselling. Pharmacists would like to have more collaborative practice agreements to assist with identifying and managing patients’ drug related problems. Overall, prescribers don’t agree with pharmacists on the roles of pharmacists in collaborative practice agreements. However,

17


allowing pharmacist to help in the prescribing process is a small price to pay for a more patient centered prescribing experience that will benefit each patient.

Resources:Hilmer SN, Seale JP, Carroll PR. A comparison of medical and pharmacy students knowledge and skills of pharmacology and pharmacotherapy. British Journal of Clinical Pharmacology. 2015;79(6):1028-1029. doi:10.1111/bcp.12560. Rodriguez MI, Biel FM, Swartz JJ, Anderson L, Edelman AB. Pharmacists’ experience with prescribing hormonal contraception in Oregon. Journal Of The American Pharmacists Association: Japha. September 2018. doi:10.1016/j.japh.2018.06.020Kelly DV, Bishop L, Young S, Hawboldt J, Phillips L, Keough TM. Pharmacist and physician views on collaborative practice. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 2013;146(4):218-226. doi:10.1177/1715163513492642.



1977.5 - Pharmacist Prescribing: APhA-ASP supports the concept of the pharmacist's active role in the selection of the therapeutic agent.

This resolution just states that the pharmacist should have a more active role in the selection of a therapeutic agent. It does not complete define what the new prescribing process would be or how it would work.

1994.8 - Pharmacist Prescribing Authority: APhA-ASP supports the formation of a Task Force to study the costs and benefits of a) allocating to the pharmacist the authority to prescribe; b) allocating to the pharmacist the authority to approve refills in defined situations; and c) assisting in patient utilization of therapeutic agents and devices.

This resolution is inactive and tried to create a task force to test the benefits of giving pharmacists prescribing rights in certain situations. Our resolution is not giving pharmacist prescribing rights but more allowing them to assist in the process of prescribing to ensure the right medication for each person is being prescribed the first time.

Author of Proposed Resolution: Cassidy Heath



18


R6.10

Proposing APhA-ASP Chapter: University of Kansas School of Pharmacy

Proposed Resolution Title/Topic: Universal Drug Take Back

Proposed wording: APhA-ASP encourages all community Pharmacies to become authorized collectors of unused pharmaceutical products and controlled substances by administering mail-back programs and/or maintaining collection receptacles in accordance with DEA regulations.

Background Statement:

While many pharmacies are already registered with the DEA to allow them to take back unused prescriptions and there are frequent drug take events in many communities, a vast amount of pharmacies are currently not able to accept the very medicine that was dispensed from that location weeks, months or years earlier. The dangers of having old or unused medication at home is incredibly high, even more so with controlled substances including opioid medications. Potentially even more common is patients holding on to left over medication that have been switched or stopped. This increases the risk of patients taking the wrong dose or even wrong medication all together. Often it is challenging to dispose of old medications, drug take back days can be few and far between. Encouraging all pharmacies to be drug take back locations would be the most efficient and easily accessible location for patients to dispose of old or unused medication. The largest benefit would be to drastically decrease the potential for medication misuse and controlled substance diversion. It will be the easiest solution for the patient and can be under close supervision of a Pharmacist.

Hindrances include a possible increase in liability for the pharmacy and increased opportunity for drug diversion by employees handling the drug take back. Although there shouldn’t be any significant increase due to the current practices where controlled substances are already being handled by pharmacy staff and already at high risk for diversion. Pharmacies that dispense controlled substances are an inherently high crime and theft target due to the known presence of those controlled substances irrespective of whether they choose to be a take back location or not. These risks are currently mitigated by keeping them in safes or locked containers, having camera and security systems, and ensuring secure facilities with drop down gates or securely locked doors. Having additional controlled substances would add minimal, if any liability to the pharmacy.

The implementation is not as challenging as one may think, even though each individually pharmacy has to register with the DEA. Though they would be responsible for the costs associated with implementing and operating their program. These costs can be fairly insignificant, for example there is no additional cost to modify the DEA registration to become an authorized collector. The primary cost would be installing a collection receptacle in accordance with DEA regulations that must be “1) Be securely fastened to a permanent structure so that it cannot be removed; (2) Be a securely locked, substantially constructed container with a permanent outer container and a removable inner liner as specified in § 1317.60 of this chapter; (3) The outer container shall include a small opening that allows contents to be added to the inner liner, but does not allow removal of the inner liner’s contents; (4) The outer container shall prominently display a sign indicating that only Schedule II–V controlled and non-controlled

19


substances, if a collector chooses to comingle substances, are acceptable substances (Schedule I controlled substances, controlled substances that are not lawfully possessed by the ultimate user, and other illicit or dangerous substances are not permitted)” (§ 1317.75). In contrast, after the initial investment there are not significant costs on top of normal operating expenses. Just as in clinical practice a Pharmacist may recommend therapy if it’s benefit outweighs the risk, the risks and costs of implementing this system are far outweighed by the prospective gains of reducing the amount of unwanted and unused medications in the communities across the US.

Many chain pharmacies are already starting to adopt this process as they see the benefits of pulling unused medications out of the pathways of diversion, and offer a more convenient experience for the end user who is more likely to fill at their pharmacy. Walgreens and CVS have both started programs that will place drug take back containers at some of their locations.

Sources: Disposal of Controlled Substances, 79 Fed. Reg. 174. (September 9, 2014). Federal Register: The Daily Journal of the United States. Web. 5 September 2018.

Disposal, 21 C.F.R § 1317 2014.

LaVito, A. (2018, April 26). Drugstores are making it easier to empty your medicine cabinet. Retrieved September 24, 2018, from https://www.cnbc.com/2018/04/15/cvs-and-walgreens-add-units-to-get-rid-of-painkillers-other-medicines.html



2012.3 Proper Medication Disposal and Drug Take-Back Programs

This resolution includes developing legislation for pharmacies to take back drugs as well as developing proper guidelines to do and even encouraging Pharmacists and Student Pharmacists to be sources of information on proper disposal of unused medications. This proposal encourages every pharmacy to become a drug take back location if allowable as current legislation already allows most, if not all pharmacies to do so. This is a similar but different recommendation, much more focused on the call of action rather than development of legislation or guidelines.

Author of Proposed Resolution: Nathan Jones



20

https://www.cnbc.com/2018/04/15/cvs-and-walgreens-add-units-to-get-rid-of-painkillers-other-medicines.html

https://www.cnbc.com/2018/04/15/cvs-and-walgreens-add-units-to-get-rid-of-painkillers-other-medicines.html


21


R6.11

Proposing APhA-ASP Chapter: University of Louisiana Monroe College of Pharmacy

Proposed Resolution Title/Topic: Sports Medicine

Proposed wording: APhA-ASP encourages schools and colleges of pharmacy to offer general education providing an adequate level of training in sports medicine and doping prevention.

Background Statement:Athletes need specialized treatment plans for preventive care measures and sports-related injuries. While opportunities to work with professional athletes are few, there are still other opportunities for involvement in sports that would allow pharmacist to use their skills. This could be done by helping patients through community pharmacies and by serving college students. There is an increased level of participation in sports and exercise from the average person to an elite athlete. This increased participation in exercise also leads to an increase in the consumption of various dietary supplements, which could lead to health complications and other issues. With a deeper comprehension of the use of supplements, appropriate drug use for athletes, and doping; pharmacist could play a key role in sports medicine. The field is wide open, and people do not necessarily know what they need until someone shows their value. This is similar to when pharmacist created a role for themselves in the 1960’s with the beginning of clinical pharmacy (Ambrose,2008).

The use of medications, dietary supplements, and other performance-enhancing substances is widespread and can be challenging for an individual to keep up with (Awaisu, et al.,2015). Pharmacist can assist athletes by providing information about supplements concerning safety, efficacy, drug-drug interactions, and any possible physiological changes that may occur. Dietary supplements have also been found to contain substances that are banned or mislabeled. These substances can cause health problems and can be deceptively labeled as “botanical extracts”, for example. Some dietary supplements contain androgenic steroids and other ergogenic substances which may not appear on the label but are a banned substance (Cohn, et al.,2016). Along with health complications, these substances not found on the label can be an issue if it is banned from the competitors league and they get penalized for it. Eventually these suppliers do get caught and the medication is pulled from the market, but this can take time and damage can be done by then. Pharmacist do not have any education to handle a situation like this and what kind of effect a potential doping substance could have on their patient. With the proper training and existing knowledge of how drugs act, indicating each substances potential for performance enhancement would progress well (Awasiu, et al.,2015). Counseling patients on dietary supplements that are banned, contaminated, or seem suspicious would be an appropriate thing to do.

In competitive sports, doping is the use of banned athletic performance-enhancing drugs by athletic competitors. During the 2000 Olympic Games in Sydney, Australia, a young Romanian gymnast with cold like symptoms had won a gold medal. An extraordinary performance and accomplishment meant nothing after she was stripped of her gold medal for testing positive for the banned substance pseudoephedrine, which was given to her by the team physician for those cold like symptoms. Pseudoephedrine was banned by the International Olympic Committee (IOC) at that time for being a stimulant but was not banned

22


universally for sports-governing organizations (Ambrose, 2008). Since there is no universal list of banned substances, having to navigate through various banned substance databases can be troublesome. Pharmacist are in a position to where they could take responsibility and help athletes throughout various sports and various leagues by keeping up with this information. Support for pharmacist to take this role has also been shown, stated in a study by Ahmed Awaisu, “The International Pharmaceutical Federation (FIP), had previously recognized pharmacists’ role in the fight against doping in sports with a statement that recommended that pharmacists should be updated with the contents of the World Anti-Doping Agency (WADA) Code and should provide information to athletes to help recognize the substances on that list (Awasiu,et.,2015)”. This would go along well with the treatment for sports-related conditions and injuries by having the knowledge what pharmacological therapy options should not be considered.

Pharmacist are the easiest accessible primary healthcare provider and with the proper education/training we can help comprehend sport-related drug decisions, while making the field of sports medicine safer for patients. Pharmacist should know common risk factors and prevention of sports-related injuries and be able to effectively counsel and help manage these injuries with appropriate pharmacological treatment. Having an understanding and ability to find necessary information regarding common performance-enhancing products and dietary supplements can have a major impact on this special population of patients. This also provides an opportunity to play a big role in doping prevention and ensuring the safety and rational use of drugs among athletes.

References:Awaisu, A., Mottram, D., Rahhal, A., Alemrayat, B., Ahmed, A., Stuart, M., & Khalifa, S. (2015, October 25). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678744/

On the team: Pharmacists work with athletes in professional sports. (n.d.). Retrieved from https://www.pharmacist.com/article/team-pharmacists-work-athletes-professional-sports?is_sso_called=1

Ambrose, P. J. (2008, February 15). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254248/

Cohen, P. A., Avula, B., Venhuis, B., Travis, J. C., Wang, Y., & Khan, I. A. (2016, April 07). Pharmaceutical doses of the banned stimulant oxilofrine found in dietary supplements sold in the USA. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/dta.1976



Author of Proposed Resolution: Bhavesh Patel

23

https://www.pharmacist.com/article/team-pharmacists-work-athletes-professional-sports?is_sso_called=1





24


R6.12

Proposing APhA-ASP Chapter: University of Missouri-Kansas City School of Pharmacy

Proposed Resolution Title/Topic: Opioid Education and Disposal

Proposed wording: APhA-ASP recommends mandatory inclusion of opioid educational pamphlets and point of care disposal solutions with every newly dispensed opioid prescription.

Background Statement:Every year, millions of Americans are prescribed opioid medications for the management of acute

and chronic pain. Most opiates are Schedule II drugs, meaning they have a high potential for physical and psychological abuse. The United States is undeniably going through an opioid crisis right now. According to the United States Center for Disease Control (CDC), more than 630,000 people have died from drug overdose in the United States since 1999, with nearly ⅔ of cases involving opioids. Majority of these deaths are tied to overuse of prescription medications including natural and synthetic opioids that are routinely prescribed by physicians. For this reason, it is critically important for pharmacists, who are at the forefront of dispensing, to provide educational materials to patients on the proper use of opioid medications.

In a study review by the Journal of the American Medical Association (JAMA), researchers found that a large majority of prescription opioid medications go unused, unlocked, and undisposed of. In one study, 67-92% of patients who filled their opioid prescriptions reported excess medication. In addition, studies showed very low rates of anticipated or actual disposal. With excess medication, there is an increased risk of diversion and misuse of opioid medications. In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that ⅔ of teens who misused pain relievers retrieved them from unused prescriptions from family and friends. For this reason, it is important that pharmacies provide point of care resources for patients to dispose of opioid medications.

Currently, pharmacists recommend that patients dispose of their opioid medications at annual Drug Take-Back events or via the septic system. However, immediate disposal of opioid medications is the key to prevent drug diversion and plumbers do not recommend the latter. However, there are drug disposal solutions that are cheap and can be dispensed at the point of care. This past year, Walmart became the first national pharmacy chain to provide free opioid disposal packets in partnership with DisposeRx. DisposeRx provides powder packets that, when combined with water, chemically and physically sequester medications and render them unusable. In combination with increased patient education on opioid medications and providing point of care methods to dispose of opiates, the pharmacy profession can work towards combating the opioid epidemic.

“Opioid Overdose: Understanding the Epidemic.” Centers for Disease Control and Prevention. 30 August 2017. URL: https://www.cdc.gov/drugoverdose/epidemic/index.html (Accessed: 9/13/18).

Bicket, Mark C, et al. “Unused Prescription Opioids After Surgery.” JAMA, American Medical Association. 1 November 2017. https://jamanetwork.com/journals/jamasurgery/article-abstract/2644905 (Accessed: 9/13/18).

25


Volk, Katherine. “Rise in Prescription Drug Misuse and Abuse Impacting Teens.” Substance Abuse and Mental Health Services Administration. 2014. https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/teen-prescription-drug-misuse-abuse (Accessed 9/13/18).

“Solving the Problem of Drug Disposal.” DisposeRx™ - Solving the Problem of Drug Disposal. 2017-2018. https://disposerx.com/ (Accessed 9/13/18).



Authors of Proposed Resolution: Anna Hughes, Elizabeth Breeden, William Molenaar

Author Phone Number: 636-795-6709 (AH), 913-302-2642 (EB), 417-350-6086 (WM)

Author Email Address: [email protected] (AH), [email protected] (EB), [email protected] (WM)

26

mailto:[email protected]




R6.13

Proposing APhA-ASP Chapter: University of North Texas Science Center System College of Pharmacy

Proposed Resolution Title/Topic: Identifying Burnout Related Patient Safety Hazards

Proposed wording:APhA-ASP recommends that employers of pharmacists, pharmacy interns, and pharmacy technicians:

1. Have all pharmacy personnel be clinically assessed for stress-related job burnout on an annual basis.

2. Have pharmacy personnel be clinically assessed for stress-related job burnout each time they are involved in a medication error as a part of a root cause analysis (RCA).

3. Implement measures to identify when stress-related job burnout in the workplace is caused by working conditions-related issues.

Background Statement:

As our profession begins to gain more acknowledgement for its value in healthcare, we must address our clinical and non-clinical errors more progressively. This is a critical point in time where our role in healthcare is changing rapidly, and if we continue to give ourselves increased expectations in the form of non-dispensing services while disregarding burnout within our profession, our quality of care will suffer.3 The National Institute for Occupational Safety and Health estimates that 25% to 40% of U.S. workers suffer from stress-related job burnout, and according to a pharmacy-centered study on burnout, 70% of surveyed pharmacists experienced job overload.8 Burnout is listed under the ICD-10 Code Z730.0 as a state of vital exhaustion.4 It can lead to chronic fatigue, emotional distress, insomnia, and gastrointestinal problems.3 This is critical because unwell pharmacists have been found to make significantly more serious errors than pharmacists who practice in good condition. 5 In fact, The World Health Organization identified overworked/fatigued professionals as a major factor causing medication errors worldwide.6

With such a prevalent phenomenon impacting our profession, preventative measures must be put in place to ensure patient safety. The proposed resolution not only calls for routine assessments of burnout, but also for assessments to be done in non-punitive investigations that identify the root cause of every mistake made in a practice setting. Root cause analysis (RCA) is a popular retrospective method of analyzing errors in healthcare and coming to conclusions that do not put blame on one single person involved.7 Most medication errors result in minimal patient harm, but we must learn from every mistake to prevent tragic outcomes in the future.2 In identifying burnout as a possible cause for mistakes, pharmacy personnel and employers can look forward in a more accurate manner in creating healthy working conditions.

Once an individual is found to have burnout, the cause of the condition must be addressed so that the person can heal and other individuals won’t have the same experience. Traditionally burnout has been regarded as an issue stemming from the individual, but there is growing evidence that burnout is tied to poor working conditions. Causes of burnout include, but are not limited to, staffing inadequacy, high workload, and long periods of continuous effort and concentration. 3 Employers should identify when burnout is a product of working conditions in order to improve patient safety. Incentives for them not only include preventing tragic outcomes for patients that can lead to increased legal scrutiny, but also preventing tragic outcomes for those they employ. Not only is burnout associated with poor intermediate outcomes such as high job turnover and chronic diseases, it can even lead to final outcomes such as suicide.1,3 As our roles expand, we may be more likely experience role overload and increased stress.3 If employers wish to capitalize on our expertise and clinical value it must be in a sustainable manner, otherwise our newfound roles in healthcare may be met with poor results and disappointment.

27


References:1.El-Ibiary SY, Yam L, Lee KC. Assessment of Burnout and Associated Risk Factors Among

Pharmacy Practice Faculty in the United States. American Journal of Pharmaceutical Education. 2017;81(4):75. doi:10.5688/ajpe81475.1261. Accessed September 14, 2018.

2.Degnan D. To prevent errors, first define the problem [Internet]. Pharmacy Today. APhA; 2018 [cited 2018Sep26]

Available from: https://www.pharmacytoday.org/article/S1042-0991(18)30149-X/fulltext

3.Gaither CA. ORGANIZATIONAL STRUCTURE AND BEHAVIOR. In: Zgarrick DP, Alston GL, Moczygemba LR, Desselle SP. eds. Pharmacy Management: Essentials for All Practice Settings, 4e New York, NY: McGraw-Hill; . http://accesspharmacy.mhmedical.com.proxy.hsc.unt.edu/content.aspx?bookid=1850&sectionid=12824 2018Sep25]. Available from: https://www.pharmacytoday.org/article/S1042-0991(18)30149-X/fulltext

4.ICD-10 Version:2015 [Internet]. World Health Organization. World Health Organization; Available from: http://apps.who.int/classifications/icd10/browse/2015/en#/Z73.0

5.Niven K, Ciborowska N. The hidden dangers of attending work while unwell: A survey study of presenteeism among pharmacists. International Journal of Stress Management [Internet]. 2015May [cited 2018Sep13];22(2):207–21. Available from: https://www.researchgate.net/publication/276087317_The_Hidden_Dangers_of_Attending_Work_While_Unwell_A_Survey_Study_of_Presenteeism_Among_Pharmacists

6.Payne R, Slight S, Franklin BD, Avery AJ. Medication errors. Geneva: World Health Organization; 2016.

7. Plake KS, Schafermeyer KW, McCarthy RL. McCarthys introduction to health care delivery: a primer for pharmacists. Burlington, MA: Jones & Bartlett Learning; 2017.

8.Varkey A. Promoting resiliency: Recognizing and preventing burnout [Internet]. APhA News. The American Pharmacist Association; 2018 [cited 2018Sep14]. Available from: https://www.pharmacist.com/article/promoting-resiliency-recognizing-and-preventing-burnout



28

https://www.researchgate.net/publication/276087317_The_Hidden_Dangers_of_Attending_Work_While_Unwell_A_Survey_Study_of_Presenteeism_Among_Pharmacists

https://www.researchgate.net/publication/276087317_The_Hidden_Dangers_of_Attending_Work_While_Unwell_A_Survey_Study_of_Presenteeism_Among_Pharmacists


1998.12 - Working ConditionsAPhA-ASP recognizes that patient safety is compromised by poor working conditions and strongly encourages the immediate implementation of systems that improve these conditions.

The proposed resolution works in conjunction with this resolution by building modes to identify poor working conditions. This addition takes into account that APhA-ASP already encourages the improvement of poor working conditions for the sake of patient safety, and it addresses the timely issue of burnout prevalence affecting our profession nationally. It is necessary to add this on alongside Resolution 1998.12 in order to address burnout and identify where there may be poor working conditions that put patient safety in jeopardy.

Author of Proposed Resolution: Ellias Hishmeh



29


R6.14

Proposing APhA-ASP Chapter: University of Oklahoma College of Pharmacy

Proposed Resolution Title/Topic: Mental Health Patient Care Project

Proposed wording: APhA-ASP encourages chapters to make mental health a patient care project to promote awareness within the respective campuses and communities.

Background Statement:As society becomes more aware of the existence of mental health illnesses and more accepting of those who have such diseases, it is important for healthcare providers to become actively involved in educating the public of and treating the patients with mental health problems. Pharmacists play an exceptionally important role as they are the most accessible healthcare providers. Because of this, it is essential for the pharmacy student to receive practice and experience in this subject while in school.

All APhA-ASP chapters should establish a patient care project for mental health. A major goal of this organization is to reach out and meet the healthcare needs of our respective communities. According to the National Alliance on Mental Illness, approximately 1 in 5 Americans suffers from a mental health issue within a given year and estimates that 26% of homeless individuals staying in a shelter suffers from a severe mental illness. It is our job as healthcare providers to provide preventative options to the public through education and helpful tools for mental health disorders, such as anxiety and depression.

It is understandable that this may be an unreasonable goal because of cost issues, however, there are many national organizations that APhA-ASP could partner with to aid in the funding of this project. The National Alliance on Mental Illness, The National Institute of Mental Health, Active Minds, or The American Foundation for Suicide Prevention are examples of such organizations that target mental health education.

In conclusion, the topic of mental health is becoming more discussed and acknowledged in American society and it is imperative that pharmacists become part of the movement. To better prepare the student for involvement in this, APhA-ASP should establish a patient care project that focuses on mental health disorders or on the equivalent importance that mental health is to physical health.

References and Resources:1. “NAMI.” Mental Health by the Numbers, NAMI: National Alliance on Mental Illness, 2018,

www.nami.org/Learn-More/Mental-Health-By-the-Numbers.2. “NIMH » Home.” National Institute of Mental Health, U.S. Department of Health and Human Services, 2018,

www.nimh.nih.gov/index.shtml3. “Changing the Conversation about Mental Health.” Active Minds, 2018, www.activeminds.org/.4. “Home.” Lifeline, 2018, suicidepreventionlifeline.org/.


30

http://www.activeminds.org/

http://www.nimh.nih.gov/index.shtml

http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers



2017.3 - Efforts to Reduce Mental Health Stigma addresses the need for more awareness and training on the subject but does not specifically endorse/encourage the formation of a patient care project.

Author of Proposed Resolution: Laura Blanchard and Brandy K. SmithAuthor Phone Number: 405-213-7223 and 405-618-9947

Author Email Address: [email protected] and [email protected]

31



R6.15

Proposing APhA-ASP Chapter: University of Texas at Austin

Proposed Resolution Title/Topic: Prior Authorization Standardization

Proposed wording: APhA-ASP supports standardization of prior authorization across all insurance companies and federal insurance agencies to streamline and increase efficiency.

Background Statement:Prior authorization (PA) is a cost-saving measure that is used by insurers that requires health care providers to comply with coverage and payment rules before specific services are provided to patients. PA emerged from the well-meaning, cost-saving process of utilization review. They are typically used to reduce expenditures, unnecessary utilization, and improper payments. It is now a requirement for a growing list of pharmaceuticals, medical equipment, and services to receive a review by an insurer before the services can be obtained by the patient. From the patient’s perspective, it can add hours to days for them to get their medication. For the healthcare professionals, it is often a frustrating and inefficient process. It can require constant back and forth with insurers to demonstrate the clinical necessity and to satisfy prior authorization guidelines that vary between payers. It is now estimated that the PA process costs the healthcare system $21 to $31 billion annually due to overwhelming administrative burdens and delays in healthcare delivery. One of the major reasons services or medications may be denied is because the payers don’t have the information needed for approval by the time they have to make an initial decision. Ultimately, the payers are dependent upon which data the providers supply. In a period of medical advancement, where new medications and procedures have reached enormous prices, insurance companies are trying to maintain cost-effective treatment by requiring prior authorization for many of these costly advancements. Insurance companies are facing increasing amounts of pressure to decrease or stagnant health care costs, further driving the demand for prior authorization. Prior authorization programs are used to steer patients away from using higher-cost drugs or procedures without proper need. Although this may lower prescription spending, it could be at the expense of patient safety. An AMA survey reported that 90 percent of providers reported treatment delays because of prior authorization wait times and providers spend an average of 16 hours per week completing drug access requests. To make the situation more challenging, payers are consistently adding new authorization requirements. To ease the administrative burden and improve care delivery to patients, developing one standard form for submitting a prior authorization request is needed. This form should be easily accessible and fit within the normal workflow. A single, automated prior authorization set of requirements can potentially yield as much as $6.7 billion per year in savings. In addition, developing uniform rules across payers for a given medical condition and treatment option would be helpful so that healthcare professionals are not being asked to provide different information by

32


different payers. The healthcare industry must work together to find the balance between the administrative load while delivering high quality, cost-effective care. All stakeholders must be brought to the table in order to lower the administrative burden for healthcare professionals. A streamlined and standard prior authorization process across all insurers, both private and public, would improve efficiency and promote a higher standard of care.

Clowers A, King K. MEDICARE: CMS Should Take Actions to Continue Prior Authorization Efforts to Reduce Spending. GAO Reports [serial online]. May 21, 2018;i. Available from: MAS Ultra - School Edition, Ipswich, MA. Accessed September 14, 2018.

The Cost of Prior Authorization: Insurance reform required, say docs. Receivables Report For America's Health Care Financial Managers [serial online]. June 2018;33(6):1. Available from: Advanced Placement Source, Ipswich, MA. Accessed September 14, 2018.

American Medical Association. Standardization of Prior Authorization Process for Medical Services: White Paper. Chicago, IL: American Medical Association. 2011.

American Medical Association. 2016 AMA Prior Authorization Physician Survey [Internet]. AMA; 2016 [cited 2018 Sep 28]. Available from: https://www.ama-assn.org/sites/default/files/media-browser/public/government/advocacy/2016-pa-survey-results.pdf

HealthPayerIntelligence. How Payers Can Streamline Prior Authorization for Prescriptions [Internet]. HealthPayerIntelligence. 2017 [cited 2018 Sep 28]. Available from: https://healthpayerintelligence.com/news/how-payers-can-streamline-prior-authorization-for-prescriptions

Optimizing the Preauthorization Process [Internet]. Maximizing Reimbursement Starts with Patient Access | HFMA. [cited 2018 Sep 28]. Available from: http://www.hfma.org/Leadership/Preauthorization/



Author of Proposed Resolution: Kristen Curry

Author Phone Number: 6785768623


33


R6.16

Proposing APhA-ASP Chapter: Ben and Maytee Fisch College of Pharmacy- University of Texas at Tyler

Proposed Resolution Title/Topic: Patient Care

Proposed wording: 1. APhA to support state and federal legislation to increase patient access to

epinephrine auto injectors through a physician protocol. 2. APhA encourage pharmacists and student pharmacists to provide public

education about epinephrine auto injection, including proper administration in situations of anaphylaxis.

Background Statement:There have been many times where patients were unable to pick up their

prescription of epinephrine either due to a hold up in the insurance (FARE, 1991), or in a situation where the patient was waiting for their prescriber to authorize more refills on the medication. With the refill authorization situation sometimes, the clinics are closed during the weekend and holiday which deprives the patient of having lifesaving medication. In some instances when the situation occurred, the patient was going to be out of town, and a place where they couldn't have a prescription to be picked up such as a cruise, vacation, or other travel event that limited access to the medication.

In order to alleviate some of these situations, as well as give access of life-saving epinephrine to those who might encounter an anaphylactic situation, epinephrine should be dispensed similar to Narcan, under a protocol system that was written by a physician (Texas Medical Association, 2016). In this situation the patient would not need to have another prescription, if they were waiting for the position to approve more refills, or they could get the cheapest generic alternative that was available on cash or discount (Soule, 2018). This proposal is to give the patients more access to epinephrine at a much faster rate, especially when they're anticipating a situation in which anaphylaxis could be involved.

It would be the duty of the pharmacist to document, and at their professional discretion, dispense the epinephrine under the protocol of the physician. the medications might not also be dispensed to individual patients but can also be used for other authorized entities such as schools, daycare facilities, restaurants, caps, colleges, amusement parks, and other sites where business owners might want to keep epinephrine in stock for their clients in case of an emergency (Adams, 2016).

“Insurance Appeal Information for High Epinephrine Cost / Denial of Coverage.” Food Allergy Research & Education, FARE, 1991, www.foodallergy.org/insurance-appeal-information-high-epinephrine-cost-denial-coverage.

34

http://www.foodallergy.org/insurance-appeal-information-high-epinephrine-cost-denial-coverage

http://www.foodallergy.org/insurance-appeal-information-high-epinephrine-cost-denial-coverage


“Standing Order Allows Pharmacists to Prescribe Naloxone.” Texmed, 11 Oct. 2016, www.texmed.org/Template.aspx?id=36693.

Adams, Alex J. “Pharmacist Prescriptive Authority for Epinephrine Auto-Injectors in Idaho.” INNOVATIONS in Pharmacy, vol. 7, no. 3, 2016, doi:10.24926/iip.v7i3.457.

Soule, Alexander. “Walgreens to Stock EpiPen Alternative.” Connecticut Post, Connecticut Post, 6 Sept. 2018, www.ctpost.com/business/article/Walgreens-to-stock-EpiPen-alternative-13209090.php.



2014.2 – Dispensing and Administering Medications in Life-Threatening SituationsPharmacists can dispense and administer in life threatening situation without doctor’s prescription. In conjunction, this proposal does support the administration, however only in life threatening situation but we want to broaden the access of care to situations including anaphylaxis.

Author of Proposed Resolution: Minh Van ; Naina Kishore ; Michael Garner

Author Phone Number: (832-614-6413) ; (903-646-1905) ; (512-797-1371)

Author Email Address: [email protected] ; [email protected] ; [email protected]

35

http://www.ctpost.com/business/article/Walgreens-to-stock-EpiPen-alternative-13209090.php

http://www.ctpost.com/business/article/Walgreens-to-stock-EpiPen-alternative-13209090.php

http://www.texmed.org/Template.aspx?id=36693


R6.17

Proposing APhA-ASP Chapter: Xavier University

Proposed Resolution Title/Topic: Pre-Pharmacy Undergraduate Student Membership Price Reduction

Proposed wording: APhA-ASP encourages a reduction in price of the membership dues for pre-pharmacy undergraduate students.

Background Statement:In effort to increase pre-pharmacy undergraduate participation in APhA-ASP, the membership dues for these students need to be reduced. The national dues, which are $45 for all student members according to chapter 2 of the APhA-ASP Membership Toolkit, in addition to the local dues are expensive for students, and this price turns a plethora of potential members away. Moreover, pre-pharmacy students may not benefit from all the resources that APhA has to offer their pharmacy students. Pre-pharmacy students do not have a need for the discounted textbooks offered by APhA, and they are limited when able to participate in health fairs because they are not able to do health screenings. A reduction in membership dues can lead to an increase in pre-pharmacy undergraduate membership, which leads to students seeing the value of APhA sooner and more exposure into the field of pharmacy; moreover, early exposure to the organization can increase member retention as students proceed to and matriculate through their respective pharmacy programs, which will greatly benefit APhA-ASP in the long run.

APhA-ASP [Internet]. APhA-ASP Membership Toolkit, [cited 28th September 2018] Available from: www.pharmacist.com/sites/default/files/audience/17502%20-%20MVP%20Toolkit%20Edits_Final.pdf.



Author of Proposed Resolution: Bobby LeDuff



36

mrm.pharmacist.com R6... · Web viewThis resolution encourages public education on naloxone and...

Documents

Transcript of mrm.pharmacist.com R6... · Web viewThis resolution encourages public education on naloxone and...