CALIFORNIA SOCIETY OF HEALTH-SYSTEM PHARMACY 2015 REVIEW OF CSHP ADMINISTRATIVE POLICIES 5 YEARS AND OLDER

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1 2015 REVIEW OF CSHP ADMINISTRATIVE POLICIES 5 YEARS AND OLDER The following CSHP administrative policies are to be reaffirmed, deleted, or modified and reaffirmed as indicated. Policy #: Assigned to: Marty Torres, Claire Action: Delete Spahn, Gollapudi Shankar : Pharmacist Certification, Credentials, and the Credentialing Process Source: HOD 2000 (Note: This is former policy # approved by the HOD in 2000; reaffirmed by the HOD in 2005 as policy # ; reaffirmed by the HOD in 2010 as policy # ) CSHP supports: 1. The approach being proposed by the Council on Credentialing in Pharmacy (CCP), which includes: a. The systematic development and implementation of standards for certification, credentials, and credentialing processes in the pharmacy profession. b. The systematic development and implementation of nationwide, profession-wide systems for certification and credentials. c. The development of a systematic approach to determining the need for current and future certifications and credentials for pharmacy practice based on the needs of the public, health care system and pharmacy profession. d. The development and implementation or adoption of a nationwide, profession-wide credentialing system for pharmacy practice. e. To work in collaboration with other members of the health care system in the achievement of a-d. 2. The concept of requiring periodic re-certification for advanced practice roles. 3. The treatment of certification, credentials, credentialing, and payment for pharmacists services as separate issues. 4. The concept of requiring accreditation of pharmacy certifying and credentialing organization(s). 5. The development of a time-limited mechanism to recognize practitioners certified under the current BPS, CCG and DSM systems, if they are actively practicing in their area(s) of certification during the development of a nationwide, profession-wide certification program. 1. Council on Credentialing in Pharmacy. Guiding principles for post-licensure credentialing of pharmacists [2011]. Files/GuidingPrinciplesPharmacistCredentialing.pdf 2. Credentialing and privileging of pharmacists: A resource paper from the Council on Credentialing in Pharmacy Council on Credentialing in Pharmacy Am J Health-Syst Pharm. 2014; 71: ,

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3 Page 3 of 24 Policy #: Assigned to: Marty Torres, Donna Action: Reaffirm Luong : Collective Bargaining Source: HOD 1989 (Note: This is former policy #8906 approved by the HOD in 1989; reaffirmed by the HOD in 1995 as policy #9502; reaffirmed by the HOD in 2000 as policy # ; modified and reaffirmed by the HOD in 2005 as policy # ; reaffirmed by the HOD in 2010 as policy # ) CSHP is a professional organization committed to upholding the standards of practice in the profession of pharmacy. CSHP remains separate and apart from any collective bargaining entity. It appears the intent of this policy is to state that CSHP is neutral regarding collective bargaining in general, as such, this policy is current and no change is needed.

4 Page 4 of 24 Policy #: Assigned to: Betty Jue, Fred Action: Reaffirm Shackelford : ASHP Policies Source: HOD 1987 (Note: This is former policy #8711 approved by the HOD in 1987; reaffirmed by the HOD in 1993 as policy #9324; reaffirmed by the HOD in 1998 as policy #9807; modified and reaffirmed by the HOD in 2000 as policy # ; modified and reaffirmed by the HOD in 2005 as policy # ; modified and reaffirmed by the HOD in 2010 as policy # ) To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins and all official Statements in the current edition of the Best Practices for Health-System Pharmacy of the ASHP, except when such policies differ substantially from CSHP policy. To endorse the use of ASHP Position Statements, Guidelines and Technical Assistance Bulletins by its members in their practice settings. This policy is still current and reflects the CSHP strategic plan.

5 Page 5 of 24 Policy #: Assigned to: William Alger, Donna Action: Reaffirm Luong : Pharmacist License Renewal Source: BOD 1993 (Note: This is former policy #9302 approved by the HOD in 1993; modified and reaffirmed by the HOD in 1998 as policy #9810; modified and reaffirmed by the HOD in 2000 as policy # ; modified and reaffirmed by the HOD in 2005 as policy # ; modified and reaffirmed by the HOD in 2010 as policy # ) CSHP opposes the use of examinations for the purpose of pharmacist license renewal, notwithstanding Board of Pharmacy Disciplinary Action. No similar policy from ASHP or CPHA could be found. ASHP policies (1111 & 1014) provide general recommendations regarding CE and Training but this CSHP policy is more specific to its intent regarding opposition to the use of examinations.

6 Page 6 of 24 Policy #: Assigned to: Marty Torres, Action: Reaffirm Suzanne Shea, Douglas Barcon : Pharmacists Scope of Practice: Efforts to Restrict Source: HOD 2000 (Note: This is former policy # approved by the HOD in 2000; modified and reaffirmed by the HOD in 2005 as policy # ; modified and reaffirmed by the HOD in 2010 as policy # ) CSHP opposes efforts that restrict pharmacists scope of practice or limit the pharmacists role in the medication use process. Examples of such efforts include, but are not limited to, legislation or regulations and/or policies and procedures that: 1. In the area of prescribing: a. Rescind or limit pharmacists scope of practice in any patient care setting. 2. In the area of dispensing, preparation and distribution: a. Restrict pharmacists ability to provide specialty medications to patients by implementing limited distribution systems for selected products. b. Restrict pharmacists ability to substitute generic medications. c. Restrict pharmacists ability to use formularies or physician-approved therapeutic substitutions. d. Restrict pharmacists use of professional judgment. 3. In the area of medication administration: a. Eliminate the requirement for pharmacist verification of the medication orders prior to administration to patients. b. Restrict the pharmacists ability to administer immunizations. 4. In the area of patient monitoring of medication effects: a. Restrict the pharmacists ability to provide patient education on the safe use of medications. b. Restrict the pharmacists ability to properly monitor medications to assure safe use and minimize adverse effects. c. Restrict pharmacists ability to provide therapeutic drug monitoring or other monitoring services. 5. In the area of medication process oversight and responsibility a. Restrict the pharmacists responsibility for the medication use process. This policy is still current in today s pharmacy practice environment regarding efforts to restrict pharmacist scope of practice. However, SB-493 does incorporate a restrictive element by not grandfathering pharmacists who have more than five-years of clinical pharmacy experience in collaborative practice, such as in a hospital or ambulatory care clinic and do not have a residency or a

7 Page 7 of 24 certification. SB-493 favors new pharmacy school graduates who have minimal experience but have a residency and a certification over those pharmacists who have hands-on experience.

8 Page 8 of 24 Policy #: Assigned to: Claire Spahn, William Action: Reaffirm Alger : Funding, Expertise and Oversight of Pharmacy Practice Source: HOD 2005 (Note: This is former policy # approved by the HOD in 2005; reaffirmed by the HOD in 2010 as policy # ) 1. CSHP advocates appropriate oversight of pharmacy practice (including nontraditional practice) and the pharmaceutical supply chain by the state board of pharmacy and other state and federal agencies whose mission it is to protect the public health; further 2. CSHP advocates adequate representation on the state board of pharmacy and related state and federal agencies by pharmacists who are knowledgeable about hospitals and health systems to ensure appropriate oversight of hospitals and health-system pharmacy practice; further 3. CSHP advocates adequate funding for the state board of pharmacy and related state and federal agencies to ensure the effective oversight and regulation of pharmacy practice and the pharmaceutical supply chain. Recommend no change as it is already essentially the same as ASHP policy (0518)

9 Page 9 of 24 Policy #: Assigned to: Suzanne Shea, Action: Reaffirm Gollapudi Shankar : Conscientious Objection by Pharmacists to Morally, Religiously, or Ethically Troubling Therapies Source: HOD 1993 (Note: This is former policy #9316 approved by the HOD in 1993; reaffirmed by the HOD in 1998 as policy #9802; modified and reaffirmed by the HOD in 2003 as policy # ; modified and reaffirmed by the HOD in 2005 as policy # ; reaffirmed by the HOD in 2010 as policy # ) 1. CSHP recognizes a pharmacist s right to conscientious objection to morally, religiously or ethically troubling therapies; and 2. CSHP supports the development of systems to allow pharmacists to invoke the right to conscientiously object to morally, religiously or ethically troubling therapies, while ensuring the patient s right to obtain, in a timely manner, legally prescribed and/or medically indicated therapies. Policy is current. No changes recommended.

10 Page 10 of 24 Policy #: Assigned to: Betty Jue, Gollapudi Action: Delete Shankar : Diversity in Health Care and Pharmacy Source: HOD 2005 (Note: This is former policy # approved by the HOD in 2005; reaffirmed by the HOD in 2010 as policy # ) CSHP endorses programs, systems, and communications that: 1. Improve health-care outcomes through diversity initiatives; 2. Foster awareness of the impact of diversity in all its forms among health care providers by providing educational programs on evidence-based cultural issues and disparities; 3. Recognize the impact of health care provider diversity on the medication-use process; and 4. Develop and promote the weaving/embedding of diversity issues into many of CSHP s educational programs and articles. CSHP Professional Policy # directs CSHP to adopt ASHP policies and other guidance documents as CSHP Professional Policy: To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all official Statements in the current edition of the Best Practices for Health-System Pharmacy of the ASHP, except when such policies differ substantially from CSHP policy. In 2014, ASHP combined its cultural competence (ASHP #0314) and cultural diversity (#0409) policies into one which closely resembled CSHP s With these changes, COPA felt that the ASHP policy position do not differ substantially from CSHP s, hence the recommendation to delete CSHP policy and adoption of ASHP s policy.

11 Page 11 of 24 Policy #: Assigned to: Douglas Barcon, Action: Reaffirm Marty Torres : Importation of Pharmaceuticals Source: HOD 2005 (Note: This is former policy # approved by the HOD in 2005; reaffirmed by the HOD in 2010 as policy # ) To advocate for the continuation and application of laws and regulations enforced by the Food and Drug Administration and state boards of pharmacy with respect to the importation of pharmaceuticals in order to 1. maintain the integrity of the pharmaceutical supply chain and avoid the introduction of counterfeit products into the United States; 2. provide for continued patient access to pharmacist review of all medications and preserve the patient-pharmacist-prescriber relationship; and 3. provide adequate patient counseling and education, particularly to patients taking multiple highrisk medications; further, To urge the FDA and state boards of pharmacy to vigorously enforce federal and state laws in relation to importation of pharmaceuticals by individuals, distributors (including wholesalers), and pharmacies that bypass a safe and secure regulatory framework. CSHP supports greater affordability and access to needed medications in the United States. It is our opinion that any program that seriously attempts to reign in rising drug costs MUST involve pharmacists. CSHP encourages exploration and research into mechanisms that can be implemented to assure that all of the safeguards needed are feasible to assist our nation in continuing the drug importation debate. Until such research is performed, and safeguards are assured and in place, CSHP advocates for the continuation and application of laws and regulations enforced by the Food and Drug Administration and state boards of pharmacy with respect to the importation of pharmaceuticals in the United States and urges the FDA and state boards of pharmacy to vigorously enforce federal and state laws in relation to importation of pharmaceuticals by individuals, distributors (including wholesalers), and pharmacies that bypass a safe and secure regulatory framework.

12 Page 12 of 24 This policy is still current in today s regulatory and pharmacy practice environments.

13 Page 13 of 24 Policy #: Assigned to: William Alger, Betty Action: Modify & Reaffirm Jue : Redistribution of Unused Medications Source: HOD 2005 (Note: This is former policy # approved by the HOD in 2005; reaffirmed by the HOD in 2010 as policy # ) CSHP supports the concept of redistribution of previously dispensed, unused medications provided that adequate safeguards are in place. CSHP supports the concept of redistribution of previously dispensed, unused medications provided that adequate safeguards are in place and it is in compliance with Federal and State regulations. The State has regulation in place on this subject. CA Pharmacy Law Book -- Division 116 Surplus medication Collection and Distribution, Chapter 2 Health Facilities Regs , , , , , , , , and

14 Page 14 of 24 Policy #: Assigned to: Gollapudi Shankar, Action: Modify & Reaffirm Jasmine Reber : Use of Patient Identifiers at Time of Outpatient Prescription Dispensing Source: HOD 2010 CSHP supports accurate dispensing procedures to reduce medication errors for patients in the outpatient setting that include the use of at least two-identifiers ensuring patient identification at the time of prescription dispensing. CSHP supports accurate dispensing procedures to reduce medication errors for patients in the outpatient setting that include the use of at least two-identifiers ensuring patient identification at the time of prescription dispensing to the patient or the patient s agent within the current scope of state and federal regulations. Many patients are chronically ill and prescription dispensing often involve family members, long-term facility personnel, etc.

15 Page 15 of 24 Policy #: Assigned to: Fred Shackelford, Action: Modify & Reaffirm Jasmine Reber : Gifts to Pharmacists and Pharmacy Personnel from Industry Source: HOD 1991 (Note: This is former policy #9108 approved by the HOD in 1991; reaffirmed by the HOD in 1996 as policy #9601; reaffirmed by the HOD in 2001 as policy # ; reaffirmed by the HOD in 2006 as policy # ; modified and reaffirmed by the HOD in 2010 as policy # ) Pharmacists and pharmacy personnel should not solicit or accept gifts from industry that might influence or appear to influence objectivity, independence, or fairness in clinical and professional judgment. Pharmacists and pharmacy personnel may accept educational items only that do not have value outside of her or his professional responsibilities. Providing items for health care professionals use that do not advance disease or treatment education even if they are practice-related items of minimal value (such as pens, note pads, mugs and similar reminder items with company or product logos) may foster misperceptions that company interactions with health care professionals are not based on informing them about medical and scientific issues. Such non-educational items should not be offered to health care professionals or members of their staff, even if they are accompanied by patient or physician educational materials. Pharmacists and pharmacy personnel should not solicit or accept gifts from industry that might influence or appear to influence objectivity, independence, or fairness in clinical and professional judgment. Pharmacists and pharmacy personnel should not benefit personally from transactions outside from educational purposes from industries or suppliers even on the behalf of a business. These include, but are not limited to gifts, meals, entertainment, and grants. Pharmacists and pharmacy personnel may accept educational items only that do not have value outside of her or his professional responsibilities. Providing items for health care professionals use that do not advance disease or treatment education even if they are practice-related items of minimal value (such as pens, note pads, mugs and similar reminder items with company or product logos) may foster misperceptions that company interactions with health care professionals are not based on informing them about medical and scientific issues. Such non-educational items should not be offered to health care professionals or members of their staff, even if they are accompanied by patient or physician educational materials. Gifts include non-tangible items such as special events, items of value, etc., and are not appropriate for personal benefit.

16 Page 16 of 24 Policy #: Assigned to: Donna Luong, Action: Modify & Reaffirm Douglas Barcon : Assisting California Schools of Pharmacy Assess Healthcare and Manpower Demands Source: HOD 2010 The California Society of Health-System Pharmacists shall seek an active role in assisting California schools of pharmacy and proposed schools of pharmacy to assess current and future healthcare demands, and manpower needs. The California Society of Health-System Pharmacists shall seek an active role in assisting California schools of pharmacy and proposed schools of pharmacy to assess current and future healthcare demands, and manpower needs. CSHP: 1. Advocates for high quality pharmacist education by new and proposed accredited schools of pharmacy. 2. Supports that new and current schools of pharmacy must provide and maintain sufficient highquality IPPE and APPE experiential sites for their students enrolled in their doctor of pharmacy programs. 3. Supports that proposed schools of pharmacy must secure sufficient high-quality IPPE and APPE experiential sites for their potential doctor of pharmacy candidates prior to admission of the inaugural class and grant of accreditation. 4. Supports the expansion of pharmacy schools and enrollment in existing or new colleges of pharmacy only when well-designed projections demonstrate that such expansion is necessary to maintain a sufficient and balanced pharmacist workforce in California. 5. Supports the expansion of post-graduate pharmacy training programs such as PGY1 residency programs in California. The Sherman Antitrust Act prohibits interference with free trade, such as the opening of new schools of pharmacy regardless of need. Only the market can determine the number of pharmacists needed in California regardless of tuition costs and the ability of pharmacy students to secure financing for their education and ability for future repayment of student loans. Overall quality of pharmacy education is related to the quality of the education provided in IPPE and APPE experiential programs. Without sufficient high-quality experiential sites, the quality of education provided to pharmacy school students suffers, and this in turn impacts the student upon graduation and their ability practice pharmacy at a doctor of pharmacy level. ASHP has policy 1108 Quality of Pharmacy Education and Expansion of Colleges of Pharmacy and policy 1201 Preceptor Skills and Abilities. This policy differs substantially from these ASHP policies.

17 Page 17 of 24 Policy #: Assigned to: Claire Spahn, Action: Reaffirm Jasmine Reber : Uniformity of Controlled Medications for Federal and State Classifications Source: HOD 2010 The California Society of Health-System Pharmacists supports uniformity for controlled medications between federal and state classifications. We agree with retaining the above wording but wonder whether we should also address classifications that may conflict and whether to defer to federal law or to the more stringent of the 2 (state vs. federal) classifications in such a case? For example, Paregoric (tincture of opium is a CII in California, but a CIII federally) Also, our committee s STP on medical marijuana supports changing its classification to schedule II, although it is schedule I federally

18 Page 18 of 24 Policy #: Assigned to: Suzanne Shea, Fred Action: Reaffirm Shackelford : Sales Tax Exemption on Prescribed Medications and Medical Equipment Source: HOD 2010 The California Society of Health-Systems Pharmacists supports the exemption of sales tax on prescribed purchases of medications, medical supplies, equipment, and devices. This policy is still current. No changes needed.

19 Page 19 of 24 Policy #: Assigned to: Jasmine Reber, Action: Reaffirm Claire Spahn : Requiring the Purpose of a Prescribed Medication on the Label Source: HOD 2010 The California Society of Health-System Pharmacists supports requiring that the purpose of a prescribed medication be included on all prescriptions, and that the purpose of the medication be included on the medication label. In recognition of a patient s right to privacy, CSHP supports allowing patients to opt out of having the purpose printed on the label upon request. We agree with keeping the current wording; our rationale: the Board of Pharmacy surveyed consumers/patients regarding this issue please see results in the linked report below

20 Page 20 of 24 Policy #: Assigned to: Suzanne Shea, Fred Action: Delete Shackelford : Third Party Insurance Cards Source: HOD 2010 The California Society of Health-System Pharmacists supports: 1. The uniformity of content for all third party insurance cards; 2. Third party payers to provide information on patient identification cards to facilitate efficient claims processing, including adoption of a standardized system of identifying numbers for members and their dependents. Policy is still current. Policy deleted by HOD in November 2014.

21 Page 21 of 24 Policy #: Assigned to: William Alger, Donna Action: Modify & Reaffirm Luong : Pharmacy Staff Training to Identify Victims of Abuse, Neglect, or Domestic Violence Source: HOD 2010 The California Society of Health-System Pharmacists supports the education and training of pharmacy staff to recognize patients who may be victims of child and elder abuse or neglect, or domestic violence and refer them to appropriate local programs. The California Society of Health-System Pharmacists supports the education and training of pharmacy staff to recognize patients who may be victims of child and elder abuse or neglect, or domestic violence/abuse and refer them to appropriate local programs. No similar ASHP policies and it would appear that CSHP is taking the lead in this area. Recommend no change as this CSHP policy is clear and succinct while not being too prescriptive.

22 Page 22 of 24 Policy #: Assigned to: Douglas Barcon, Action: Modify & Reaffirm Betty Jue : Emergency Preparedness and Response Source: HOD 2006 (Note: This is former policy # approved by the HOD in 2006; modified and reaffirmed by the HOD in 2010 as policy # ) CSHP supports the participation of pharmacists in the development and execution of federal, state and local emergency preparedness and response guidelines by: 1. Involving pharmacists and pharmacy staff in the planning and execution of pharmaceutical distribution and medication management of patients during disasters. 2. Classifying pharmacists as First Responder Health Workers if they choose to seek this designation. 3. Assisting public health officers in relaying health information to the community. 4. Encouraging all pharmacists to obtain and maintain competency in basic cardiac life support; and 5. Encouraging all pharmacists and pharmacy staff to volunteer in advance of a disaster. 6. Encouraging pharmacists and pharmacy staff to register as a State of California Disaster Health Care Volunteer. 7. Recommending the California Office of Emergency Services to allow licensed pharmacists to cross emergency lines to render services. CSHP supports the participation of pharmacists in the development and execution of federal, state and local emergency preparedness and response guidelines to: A. Prevent or minimize repercussions and effects of a disaster upon an institution, community, and individuals. 1. CSHP strongly encourages pharmacists becoming well informed about the local history of and potential for natural disasters and industrial accidents, as well as the threat of terrorist attacks with WMD, including potential agents that could be used and the related diagnostic and treatment issues. 2. CSHP supports pharmacist assistance to public health officers in relaying health information to the community. 3. CSHP encourages pharmacists and pharmacy technicians to consider volunteering in advance of a disaster.

23 Page 23 of CSHP encourages pharmacist and pharmacy technician involvement in community based emergency response teams, i.e., Community Emergency Response Team (CERT) 5. CSHP adopt ASHP Statement on the Role of Health-System Pharmacists in Emergency Preparedness: B. Utilize their skills and training to provide safe medication usage, medication distribution, and victim safety from initial response through recovery stemming from a disaster or emergency situation 1. CSHP encourages pharmacists to consider volunteering to assist in (a) distributing emergency supplies of pharmaceuticals, (b) dispensing and administering medications and immunizations, and (c) managing the drug therapy of individual victims. 2. CSHP supports a recommendation to the California Office of Emergency Services to allow licensed pharmacists to cross emergency lines to render services. C. Train and prepare pharmacy staff to respond effectively to disasters and emergency crises from initial response through demobilization. 1. CSHP supports classifying pharmacists as First Responder Health Workers if they choose to seek this designation. 2. CSHP encourages pharmacists and pharmacy technicians to register as a State of California Disaster Health Care Volunteer. 3. CSHP encourages all pharmacists and pharmacy technicians to develop and maintain first-aid skills and complete and maintain basic cardiac life support (BCLS) certification. 4. CSHP encourages pharmacists to be trained and knowledgeable of the FEMA National Incident Management System, at least, through IS-200 level for healthcare professionals. 5. CSHP supports pharmacist involvement in the planning and execution of pharmaceutical distribution and medication management of patients during disasters. D. Identify essential resources needed for disaster relief and recovery and assist in facilitating appropriate conservation, distribution, and utilization. 1. CSHP strongly encourages pharmacists and pharmacy staff becoming well informed of local and institutional plans for emergency preparedness, especially those related to the distribution, control, and use of pharmaceuticals.

24 Page 24 of CSHP strongly discourages individuals from developing personal stockpiles of pharmaceuticals for use in the event of chemical, biological, or nuclear terrorism without regard to local emergency preparedness plans designed to meet the needs of the whole community. : In order for a pharmacist to function in an emergency or disaster incident, he or she must understand the standard terminology used by responders and incident command staff, how the incident management system works, and where they fit into the response team. Without such a statement in the policy, pharmacists may not be able to participate in emergency preparedness and disasters as described in this policy. ASHP Statement on the Role of Health-System Pharmacists in Emergency Preparedness