In June I was fortunate to represent Vermont as a delegate to the ASHP Summer meeting in Rosemount, IL. I have attended many ASHP meetings but this was my first opportunity to take part in the delegate’s conference. Though not required, I attended the regional delegate’s conference in Baltimore in early May and was therefore well prepared for the June meeting.

The meetings for delegates included an open forum, primer, two caucuses and two House of Delegates meetings. The meetings were well run and completed on time or early. My understanding is that this is quite unusual as there are often one or more controversial issues that extend the schedule. In this case there was good consensus.

When I first entered the delegates meeting I saw tags on the tables designating every state. In general the setup was alphabetical and I expected to find the Vermont table at the back of the room. Instead they had the Vermont table front and center in the second row immediately behind the ASHP board of directors.

The meeting was concentrated on resolutions to give the ASHP leadership and committees’ direction in areas of advocacy, program development, education and other issues. More detail can be found on the ASHP website.

Some of the issues discussed included:
   - Encourage medication safety instruction in pharmacy education

   - Increase the number of ASHP accredited pharmacy residency training programs and positions.

   - Advocate for continued Pharmacist leadership of the Pharmacy Department

   - Promote/define the pharmacist's role in:
        * Health Care Information Systems
        * Providing care for an aging population
        * Antimicrobial stewardship and infection prevention and control

   - Advocate for better requirements for handling of pharmaceutical waste

   - Public policy direction on:
        * Pharmaceutical product and supply chain integrity
        * Reporting of medication errors
        * Collaborative drug therapy management
        * Interstate pharmacy practice

- Therapeutic policy recommendations on safe use of heparin with neonatal patients

I saw how the policies and recommendations created through the House of Delegates shape the direction of ASHP and Health System Pharmacy. Through active participation I saw how it is possible to influence and improve this direction.

On the second meeting of the House of Delegates I did introduce one recommendation to ASHP. This recommendation is reflective on my informatics specialty and recent work with the government and others on e-prescribing standards and legislation. I recommended that ASHP advocate for the government's finalization of e-prescribing standards (drug nomenclature and coded SIG) as well as the certification of ambulatory pharmacy computer systems. The goal would be to eliminate the manual transcription that occurs in e-prescribing with the goal that the electronic standards reach all the way to the patient.

In addition to being a delegate I joined the ASHP government affairs staff in giving a presentation on the economic stimulus package and healthcare reform. My presentation was on the HITECH Act and the health information technology provisions of the stimulus act. The presentation was very timely and somewhat stressful as one hour before the presentation the HHS ONC policy committee released their first definition of "meaningful use" of health information technology. This definition became a significant part of the presentation as it will drive the direction of health IT projects and health IT spending for the next five years.

I thank VtSHP for allowing me to represent Vermont at the summer meeting. I highly recommend this experience to others. This experience has shown me that it is truly possible for an individual to significantly impact the direction of ASHP and the profession. Vermont has been a leader in healthcare reform and it is possible for Vermont Pharmacists to impact this healthcare transformation as well.

Kevin Marvin, RPh, MS, FASHP, FHIMSS

Kevin is an independent pharmacy informatics consultant and resides in Burlington, VT.

I was privileged to represent Vermont as a delegate for the ASHP Summer meeting in Rosemont, IL. It was my first major meeting since becoming a pharmacist, and as a first time delegate the whole process was very interesting and informative. The ASHP House of Delegates establishes the professional policies of the organization. As a delegate you vote on the ASHP policies and can bring up new recommendations on current pharmacy and healthcare issues that you would like to see addressed in the House of Delegates and brought to the board. I was not prepared to initiate any new proposals, but still was able to listen to fellow delegates and vote on the key issues at hand. As a House, after some amending and editing, we passed nine policies.

At the ASHP summer meeting the new board members and the new president were elected into office. It was exciting to be only a few rows away from the past and current presidents of ASHP who are so committed and involved to our pharmacy profession.

It was a busy week filled with meetings, continuing education, and also some time for site seeing. I was able to take away information from the educational sessions as well as the delegate meetings to use in my clinical practice. As an ASHP member there are opportunities for each person to become involved and make a difference, be it locally, regionally, or nationally. After attending the ASHP Summer meeting I could truly see how changes can be made. It was a great opportunity to network with other pharmacists from across the United States, compare experiences, and share ideas to consider in our own clinical practices. It’s a good feeling to see all those involved and the motivation that comes from participating in the meetings.

I was able to attend the Night-on-the-Town and visit downtown Chicago. I was fortunate to meet some new friends and fellow delegates and eat at the famous Gino’s East and go up 94 floors at the nearby John Hancock Observatory. It was a great experience and lots of fun.

I thank VtSHP for the opportunity to represent Vermont and would gladly accept a chance to attend as a delegate again in the future. I enjoyed the experience and would highly recommend it to others, if given the opportunity.

Michele Havens, Pharm.D
Clinical Pharmacist at Rutland Regional Medical Center in Vermont

Albany College of Pharmacy and Health Sciences is pleased to offer the Annual Medication Errors Symposium on Wednesday, August 12, 2009.

Click here to learn more and/or register.

Survey results released by The American Society of Health-System Pharmacists (ASHP) revealed the effects of publicity around Michael Jackson’s alleged prescription drug misuse. More than 200 pharmacists who work in home, ambulatory, and chronic care practices responded to the survey conducted on July 1, 2009.

Learn more including recommendations

ASHP recently called on members of the House of Representatives to include pharmacists in health care reform proposals. In a statement for a House Energy and Commerce committee hearing, ASHP called on representatives to:

* Include pharmacists’ medication management services in public health programs, including Medicare,
* Restore Medicare Graduate Medical Education funding for postgraduate year-two pharmacy residency programs, and
* Make pharmacists eligible for loan forgiveness programs under the National Health Service Corps.

ASHP recently expressed its support for the Access to Frontline Health Care Act of 2009, a bill that would provide for loan repayment for pharmacy graduates’ in exchange for a commitment to practice in underserved areas.

The legislation is an important first step forward in addressing pharmacy workforce challenges, the Society noted in a letter to the bill’s sponsor, Rep. Bruce Braley, (D-Iowa).

Support Letter: Access to Frontline Health Care Act

ASHP’s push for priority funding for the dissemination and translation of the findings of comparative effectiveness research (CER) was embraced by the committee charged by the federal government with coordinating research efforts.

The report of the Federal Coordinating Council for Comparative Effectiveness included several of ASHP’s recommendations, including the use of information technology and other decision-support technologies to make CER findings available at the point of care. Evaluations of models of care, such as medication therapy management by pharmacists that have the potential to improve the quality and efficiency of patient care, were also recommended.

The Society’s recommendations were also influential in CER recommendations issued this week by the Institute of Medicine (IOM). The IOM, which issued more than 100 priority areas for CER, recommended that the U.S. Department of Health and Human Services compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others. Nearly one half of the IOM’s CER recommendations are concerned with drug therapy, which could positively impact pharmacists’ ability to provide patient care.

The number of pharmacy jobs in the United States is expected to grow by 22 percent between 2006 and 2016, according to the Bureau of Labor Statistics (BLS). The mean pay for all pharmacists, according to the BLS is $104,260. For hospital pharmacists it's $103,480. These figures make pharmacy an attractive field for workers looking for better job security, particularly in the recession. Fortunately, there are now approximately 112 pharmacy degree programs throughout the United States ready to provide prospective pharmacists with the education they need. The estimated average for pharmacy degree programs is between three and four years for students who have already taken necessary core classes in math and science. Those core classes can add an additional two years to any program. However, many degree programs are now offering accelerated courses of study, condensing a four year program into 36 months. Many schools are also offering flexible schedules and classes online to better accommodate students who already have jobs and families. For example Creighton University offers Internet-based courses that include video recorded lectures and coordinate exam times for both distance and local students. Distance students are then also allowed to travel to campus for several weeks each summer to complete lab work needed for their course load. Such flexible programs will be necessary in coming years as several factors continue to contribute to the rising demand for pharmacists. The most commonly-cited of these factors is the aging population that is expected to require more prescription drugs. However, experts predict President Obama's healthcare reform initiative will also expand the role of pharmacists. Under the administration's proposed reforms, healthcare will become more team-based in hospitals, long-term care facilities, and nursing homes. As part of that team, pharmacists may fulfill a number of roles, such as providing immunizations and performing blood monitoring for patients taking blood thinners.

An FDA advisory panel has voted to recommend that the agency ban acetaminophen/oxycodone (Percocet) and acetaminophen/hydrocodone (Vicodin) because of the risk of liver damage. The panel noted that many patients who take Percocet and Vicodin often develop tolerance after taking the drugs for an extended length of time, but the acetaminophen present in both drugs has been known to cause liver damage. To reduce accidents from overdosing on acetaminophen, the committee also voted to recommend that the FDA reduce the highest allowed dose of acetaminophen in over-the-counter (OTC) medications, to 325 mg from 500 mg. Additionally, the committee voted against limiting the number of pills allowed in each bottle, which panel members said could hurt rural and poorer patients. However, most panel members agreed that consumers needed to be better educated about the risks of popular medications.

A recent review of the expansion of the global pharmacy workforce, designed to aid the efforts of the International Pharmaceutical Federation working group, included an analysis of 48 peer and 21 non-peer reviewed articles published between January 1998 and February 2008. Following the review, researchers Nicola Hawthorne and Claire Anderson of the division of Social Research in Medicines and Health for the University of Nottingham School of Pharmacy found that the global pharmacy workforce was composed of increasing numbers of females working fewer hours. They also found that distribution of pharmacists tended to be uneven between urban and rural areas as well as in more-developed and less-developed countries and the private and public sectors. Pharmacy graduates demonstrated a preference for completing necessary training near where they studied as undergraduates, which researchers concluded may be an important factor in recruiting pharmacists to rural areas. International awareness and support for certification, registration, and regulation in the pharmacy sector has increased, as has support for the accreditation of training courses. The most common contributing factors for increased demand and awareness of pharmacy programs included increased feminization, clinical governance measures, complexity of medication therapy, and increased prescriptions. Despite these gains, the researchers found that continued increases in recruitment and retention remain necessary. They also cautioned; however, that these efforts must be undertaken in a coordinated way. Additionally, they concluded that further research is necessary to investigate such possible trends as decreasing demand for postgraduate training; job satisfaction; and the impact of pharmacy technicians.

Experienced pharmacists or recently-graduated pharmacy students who are looking to become hospital pharmacists need to develop several key skill sets, says Prof. Ray Fitzpatrick, clinical director of Pharmacy at Wolverhampton Hospital. According to Fitzpatrick, hospital pharmacists are spending more and more time out of the dispensary, working as part of a clinical team. This change allows them to review and check prescriptions clinically as well as providing important insight to a variety of patient care scenarios. For this reason, Fitzpatrick recommends hospital pharmacists actively pursue additional clinical training as they develop their careers. By doing so, hospital pharmacists gain invaluable knowledge in therapeutics and prescriptions. In fact, Fitzpatrick maintains, pharmacists often provide access to clinical information not available to many junior doctors, particularly those pharmacists who are able to specialize within their facility. In addition to developing clinical skills, hospital pharmacists must also be excellent communicators. It is this ability that will allow them to deal with patients who are extremely sick as well as working with a range of healthcare professionals effectively to improve patient care and reduce adverse events.

The FDA has received reports of adverse events associated with patients receiving the incorrect starter kits for lamotrigine (Lamictal) or with patients administering the product incorrectly. Reported adverse events included sensations of fuzziness and buzzing in the head and Stevens-Johnson Syndrome. In order to prevent adverse events associated with lamotrigine medication errors, the FDA has made several recommendations for pharmacists. First, pharmacists should ask patients which medications they are taking to ensure the correct lamotrigine starter kit is administered. Second, pharmacists who receive a prescription that only specifies a color for the lamotrigine kit should verify that the prescriber has selected the correct dosage. Third, pharmacists should ensure patients know how to take pills in their starter pack correctly. Patients should be advised specifically that their dosage will increase from week to week. Finally, patients should be warned that they should contact their prescriber immediately if a rash appears, because this could be a sign of a serious adverse reaction.

Hospitals that want to reduce surgical site infections (SSIs) should consider a combination of education and performance data, along with accountability, to promote SSI prevention, Canadian researchers say. Their analysis included interviews with seven surgical division heads and 11 quality improvement or infection prevention managers at seven hospitals. The professionals were asked about awareness and accountability of SSI prevention and recommendations to promote compliance with current strategies. Although most sites were aware of guidelines and had organized SSI-prevention measures, few had reviewed or implemented their own strategies. Some barriers to following SSI prevention recommendations included passive educational strategies, lack of clinician accountability, and a lack of performance data. Standard orders and organizational support of teamwork may help improve SSI infection control adherence, the researchers conclude.

The Accreditation Council of Pharmacy Education has awarded "candidate status" to Union University's School of Pharmacy. As such, all students graduating from the school, which is located in West Tennessee, will be afforded "the same rights and privileges as graduates of an accredited program," says founding dean Sheila Mitchell. The program is expected to become fully accredited when the first class graduates. Union's first class in the School of Pharmacy finished its first year of studies in May 2009 and a second class in the four-year program is scheduled to begin coursework in the fall.

The 2006 Institute of Medicine report that cited 1.5 million people are harmed annually by medication errors takes into account not only the incorrect administration of medication, but also the failure to prescribe or administer medication. Technology can solve a majority of the problems linked to medication errors by reducing variation and ensuring compliance. Some of the main reasons errors occur include nurse and pharmacy staffing shortages, high patient acuity, illegible handwriting and medication distribution process problems. Barcodes and radio-frequency identification are the mainstays of medication administration improvements among hospitals, but these solutions are vulnerable to error as well, especially if wireless networks go down or laptop batteries fail. To ensure problems are caught early, hospitals must examine room size and the weight of computer devices, ensure metrics are defined beforehand, staff is trained and continues to train throughout implementation, compliance is policed and medication administration begins at order entry and ends at the bedside.

A new anesthesia cart from San Francisco-based McKesson Corp. dispenses medications entirely via touch screen, enabling users to find drugs with only two touches and without having to search by drug names. Anesthesia-Rx also tracks patient charges and inventory, offers enough capacity so the average pharmacy only needs to restock once a day, and includes an optional syringe label printer. Clarion Hospital in Clarion, Pa., and Shore Memorial Hospital in Somers Point, N.J., underwent beta testing of Anesthesia-Rx.

Selective serotonin reuptake inhibitor (SSRI) antidepressants do not pose a greater risk of bleeding than non-SSRI antidepressants following coronary artery bypass graft (CABG) surgery, according to a recent study led by Beth Israel Deaconess Medical Center Dr. Dae Hyun Kim. The study, published in the American Journal of Cardiology, included 1,076 CABG patients who took an SSRI antidepressant and 304 who took a non-SSRI antidepressant. Of patients who took SSRI antidepressants, 6.4 percent experienced a bleeding event compared to 7.2 percent of those in the non-SSRI group. Researchers also observed similar levels of in-hospital mortality: 3.1 percent in the SSRI group and 2.3 percent in the non-SSRI group.