Presenters The Laws, The Survey and Other Things M A R Y L A N D B O A R D O F P H A R M A C Y 4 2 0 1 P A T T E R S O N A V E N U E B A L T I M O R E, M A R Y L A N D 2 1 2 1 5 LaVerne G. Naesea, MSW Executive Director Maryland Board of Pharmacy David H. Jones, PD, FASCP Board Commissioner ( 4 1 0 ) 7 6 4-4 7 5 5 Neither Speaker has any conflict of interest Objectives 2015 Maryland Legislative Sessions Summary To review recent changes in Maryland State Legislation relevant to Pharmacy practice. To discuss initial findings from the Pharmacist- Pharmacy Technician Working Conditions Survey. To collaborate on developing plans for future action. 1
Overview The Progress of a Bill First Chamber Second Chamber Review of Legislative Process Review of Board s Process Communicating Board Positions to Annapolis Legislation Statistics Review of Legislation Conclusion Cross Over The Board of Pharmacy s Process Communicating Board Positions to Annapolis The Legislative and Regulations Unit tracks approximately 2,300 bills in each legislative session. Those bills are presented to the Board s Executive and Legislative Committees for comment. Once positions are determined, the Legislative/Regulations unit assist the Board in presenting their positions in Annapolis. POSITION PAPER 1. Support or Oppose (with or without amendments) 2. Testify at the hearing COMMITTEE LETTER 1. Letter of Support, Opposition, Education (with or without amendments) 2. No testimony offered 2
Statistics for the 2015 Session Bills tracked- 35 2015 Legislative Session Positions taken-19 Passed- 12 Failed-7 Passed or Failed in agreement with Board s position-16 SB 1/HB 591 Health Occupations - Pharmacists - Refills of Prescriptions During State of Emergency SB 14/ HB 748- Health Occupations - Board of Pharmacy - Pharmacist Rehabilitation Committee - Definition Allows a pharmacist in Maryland to refill a prescription for an individual who has been impacted by a declared State of Emergency in any of the 50 states, not just a declared State of Emergency in Maryland and increases the maximum quantity that may be dispensed under a prescription refill from a 14-day to a 30-day. Amends the definition of a "Pharmacist Rehabilitation Committee from a group consisting of a majority of pharmacists, to a group that is comprised of at least one pharmacist. SUPPORT SUPPORT 3
HB 58 Health Occupations Members of Boards & Advisory Committees Prohibition against Concurrent Service SB 69/HB 181 State Board of Pharmacy - Sterile Compounding - Compliance by Nonresident Pharmacies and Repeal of Permit Requirement Prohibits a member of a health occupations board, or a member of an advisory committee of a health occupations board, from serving concurrently on the board or advisory committee and as an elected member of a professional association that represents the interests of the individuals regulated by the health occupations board. JOINT LETTER OF SUPPORT Repeals Subtitle 4A of the Maryland Pharmacy Act that requires all sterile compounding facilities (including pharmacies, and physician, dentist and podiatrist offices) to acquire a separate permit, pay associated fees and meet other criteria in order to operate in Maryland. SUPPORT SB 198/HB 580 Health Care Disparities, Cultural & Linguistic Competency, and Health Literacy - CE SB 346/ HB 657 Pharmacists Scope of Practice - Revisions Requires the Office of Minority Health and Health Disparities to provide to health occupations boards a list of recommended CE; requiring each board to post a list on the board s Web site, provide information about CE to health care professionals and advertise the availability of CE in newsletters and media. OPPOSE, but then SUPPORT AS AMENDED Expands the pharmacist s ability to administer prescription drugs beyond vaccinations, authorizes pharmacists as participants in drug therapy management, to prescribe self-administered medications that do not require a diagnosis or to treat urgent conditions. SUPPORT WITH AMENDMENTS with only the administration piece 4
SB 347/HB 716 Health Occupations Prescriber-Pharmacist Agreements and Therapy Management Contracts Adds a new definition of Authorized Prescriber that includes licensed dentists, licensed podiatrists, certified nurse midwives, and certified nurse practitioners, to Subtitle 6A Therapy Management Contracts of the Maryland Pharmacy Act. SUPPORT WITH AMENDMENTS with physicians, podiatrists & advanced practice nurses SB 516/ HB 745 Public Health Overdose Response Program Authorizes advanced practice nurses, licensed physicians, pharmacists, or employees or volunteers appropriately supervised, to conduct overdose prevention educational training programs. Authorizes a pharmacist to dispense naloxone in accordance with a drug therapy management contract. Provides immunity to any individual, licensed physicians, advanced nurse practice nurses who administers naloxone to an individual who is, or in good faith is believed to be, experiencing an opioid overdose. SUPPORT WITH AMENDMENTS - add pharmacists to immunity clause SB 757 Public Health Drug Overdose Prevention 2016 Authorizes advanced practice nurses, licensed physicians, pharmacists, or employees or volunteers appropriately supervised, to conduct overdose prevention educational training programs. Authorizes health care practitioners with prescribing authority to prescribe naloxone to patients. LETTER OF SUPPORT with only disclosure sections.(remainder in HB 745/SB 516) It s important to know what bills failed in 2015 because they may come back next session. Look for: Pharmacist Provider Status Specialty Drugs Biosimilars ImmuNet reporting requirements for all health care providers 5
2016 It s important to know what bills failed in 2015 because they may come back next session. Look for: Pharmacist Provider Status Specialty Drugs Biosimilars ImmuNet reporting requirements for all health care providers Working Together To Protect Maryland Pharmacy Patients C O N T A C T T H E B O A R D O F P H A R M A C Y F I R S T!! E X I S T I N G L A W S C O N F L I C T I N G L A W S C O N F L I C T I N G L A N G U A G E E A R L Y I D E N T I F I C A T I O N O F O P P O S I T I O N E A R L Y I D E N T I F I C A T I O N O F S U P P O R T A V O I D A M E N D M E N T R E M E M B E R : B I L L D R A F T E R S M A Y N O T C O M P L E T E L Y U N D E R S T A N D T H E M A R Y L A N D P H A R M A C Y A C T O R R E L A T E D F E D E R A L A N D S T A T E L A W S A N D R E G U L A T I O N S For More Information Anna D. Jeffers, Esq. Legislation and Regulations Manager anna.jeffers@maryland.gov Pharmacist-Pharmacy Technician Working Conditions Survey 410-764-4794 W O R K I N G C O N D I T I O N S W O R K G R O U P P H A R M A C Y P R A C T I C E C O M M I T T E E Maryland Board of Pharmacy 6
Survey Overview Preliminary Statistics Conducted from October 2014 to January 2015 Survey time frame was initially set to one month but was expanded to 132 days to receive optimal feedback Goal: Assess working conditions as they could relate to public safety 3475 total responses with 2575 complete responses 74% full completion rate 63% responses were pharmacists 37% responses were technicians Over half of responses (54%)were from chain drug store settings Other practice settings Hospital/ health system - 25% Independent pharmacy 11% Chain pharmacy 53% Compounding pharmacy 1% Mail order pharmacy - 2% Not specified - 8% Hours and Volumes Supervision Hours worked weekly Less than 16 9% 17 to 31 14% 32 to 40-56% More than 40 21% Prescriptions filled: (70% of total responses) 101 to 300 daily: 52% 301 to 600 daily: 18% Pharmacist to technician ratio 1:1 = 15% 1:2 or 1:3 = 35% 1:4, 1:5, or 1:6 = 18% More than 1:6 = 5% None = 17% 7
Medication Errors Information Not Available Top three medication errors: Wrong directions Wrong quantity Wrong strength Most medication errors are caught before dispensing (91%) Top three potential causes of medication errors: Staff shortage High prescription volume Stress Most skipped questions: Question 11: If you are working more than 6 hours in a shift, do you have scheduled breaks throughout the day? (1,839 skipped) If yes, are you able to take it most days? If yes, is there another pharmacist available during your break? Question 27: Which of the following are potential causes of medication errors that you have made? (1,234 skipped) Areas of Concern Areas of Least Concern Interruptions/distractions make it difficult for staff to work accurately 77% of responses agreed or strongly agreed with this statement Having enough staff to handle the prescription/order workload 67% of responses sometimes, rarely or never have enough staff There is enough staff on duty to allow time for all personnel to take breaks during their shifts 66% of responses sometimes, rarely or never have enough staff Feeling rushed when filling prescriptions 58% of responses most of the time or always feel rushed Optimal Pharmacist to Pharmacy Technician Ratio Prescription Volume = Need higher ratio? Stress = Need lower ratio? When a medication error occurs, we try to figure out what problems/processes in the work process led to the error 79% of responses agreed or strongly agreed with this statement Staff feels comfortable asking questions when they have a concern 73% of responses agreed or strongly agreed with this statement We encourage patients to talk to their pharmacists about their medications 67% of responses agreed or strongly agreed with this statement The way we do things reflects a strong focus on patient safety 66% of responses agreed or strongly agreed with this statement 8
Areas of Conflicting Information Impact of Survey Responses There is enough staff on duty to allow time for all personnel to take breaks during their shifts 66% of responses sometimes, rarely or never have enough staff. However question 11- If you are working more than 6 hours in a shift, do you have scheduled breaks? 71% answered yes and that they were able to take it most days and 66% answered yes to another pharmacist being available during their break *Note- that question 11 was also the most skipped question, so results may be skewed* Initial survey responses have provided insight regarding which working conditions may need to be addressed before others Areas for additional focus: Hours worked Ability to take breaks Medication errors Pharmacist to Pharmacy Technician ratio Recommendations for Follow Up? Thank You Second survey Being designed Plan to finalize after this meeting Target: Out to all pharmacists in July One month response time Increase the number of completed responses Legislation vs. regulation vs. education To be determined Occam s Razor according to Dr. Gregory House The simplest explanation is almost always that somebody screwed up! House, MD Any Final Questions? Other: Let s Talk 9