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2017 RDC PROCEEDINGS MINUTESSeptember 23, 2017

Collated Minutes from Region 1-5

ATTENDANCE :Region 1 Diablo, Golden Gate, North Coast, Quatra, Touro, UCSF, PTEL

BOD: Jeannette Hanni, Elaine Law, Nicole Nguyen, Loriann DeMartiniDiablo: Lucian Cheng, Grace Ng, Natalie Fan, Keith Yoshizuka, Lester Wong, Alfonso Becerra, Johnny Wong, Donald Kishi, Linda Kan HueyGolden Gate: Bonnie Fabian, Andrew DeLaunay, Johnny Rau, Philip Kong, Michael Trillanes, Janet Kwon, Sylvia Stofella, Andy Wong, Mackenzie ClarkNorth Coast: Robyn RichardQuatra: Connie Ha, Helen Park, Sandra Bardas, Betty Lee, Jenny Hong, Carol LeeTouro: Mylien Hoang, UCSF: Alexi KimuraPTEL: Tom Harper, Richard Nunez

Region 2 Central Valley, CNSU, Pacific, Sac Valley, SierraBOD: Jennifer Cashman, Jim Walsh, Norm foxCentral Valley: Andrea Hinton, Yvonne My-Y Mai, Greg Matsumura, William YeeCNU: Nelson Chu, Pacific: Emily Hou, Brandon LeSac Valley: Grant Lackey, Jennifer Lackey, Karen Azama-Kihara, Norman Ashcraft, Maria D. SerpaSierra: Shelly Hilliard, Bethanne Carpenter, Travis Pham, Gillian Pineda, Other Region delegates/alternates: Rachael Ortiz(PTEL), Edlen Wong (Diablo), Anh Do (Diablo) & Judy Tran (north Coast)Non-Delegates: Michael Yadao, Harlin Husted & Olutosin Falade

Region 3 Golden Empire, San Fernando Valley, Southern California, CHSUBOD: Annett Arakelian, Mirta Millares, Daniel DongGolden Empire: Jerry FujiwaraSan Fernando Valley: Robert Small, Nogie DemirjianSouthern CA: Kathleen Besinque, Megan Besinque, Mei Wong, John sang, Joanna Lee, Sarah Mc BaneCHSU:Other Region delegates/alternates: Steve Thompson(SB/LB) & Kenn Horowitz (Past President)

Region 4 San Gabriel Valley, Inland, KGI, Loma Linda, Western U, USCBOD: Kethen So, Gary Besinque, Donna Fitzgerald

SGV: Jason Chen, Fred Mock, Leslie Berina, Nancy Quon, Selina SoohooInland: Kristine Parbuoni, Bill Templeman, Steve GrayKGI: Junel TagayunaLLU: Christian Gaoiran, Rena SackettWestern U: Hong Kong Tran, Angineh Moradi Masihi, Allison Lee, Hou Su ChienUSC: Sandy On, Kara OnouyeNon-Delegates: Pamela Ng & Jane Liu (SGV)

Region 5 Chapman University, Orange County, San Diego, South Bay-Long Beach, UCSD BOD: Vicky Ferraresi, Marcie Lepkowsky, Pauline ChanChapman University: Jaylene Lu, Christopher Vu, Orange County: Jack Chen, Marty Torres, Jack Chen, Dennis Andrew, Robert Stein, Douglas MonroeSan Diego: Jennifer Floyd, Rebecca Kandilian, Nightingale Meyou, Hoangmy NguyenSB/LB: Rosalin Preechakul, Tim Chou, Cindy Odegard, Angela (Na Hyun) LeeUCSD: Lucy Chen, Allison Cid

PROPOSALSProposal A.1: Pharmacy Tech Training

Region1 Region 2 Region 3 Region 4 Region 5Discussion GG: does this

include editing 2016-04? (as noted in the situation #7)-quatra: 2012-09 is also in proposals D to be re-affirmed.

-will PTCB increase the cost of tech licensure costs

SC – opposed to specialized certification of techs; doesn’t even exist for Rxs. Could create a “cottage industry” for tech specialization. This is “duplication.” Also this policy is “self-serving” as there is potential monetary benefit for CSHP in promoting this is CSHP will also offer this certification. Stated this should not be “Undisclosed” in the proposal …recommends that CSHP “disclose” that it makes monetary gains from the PTCB. SC suggests that the PTCB exam is NOT an adequate measure of tech expertise.

Suggestion to add language re: compensation.

Delegates want there to be some grandfathering for experienced technicians.

Why can’t technicians vote or hold office in CSHP?

We are hypocritical by wanting them on the BOP but limiting their power within CSHP.

Defined in Bylaws; this can be changed. Consider submitting a Recommendation at the HOD.

Recommendations Combine A.1 and D.7 Would have to oppose D.7 first? Addressed multiple levels of

Region 3 is Opposed to this entire policy. Recommends deletion of this policy.

4. Supports that all pharmacy technicians,” – kind of not consistent w/5; i.e., should take out “all” from this section…

Consensus for edits to A1:

The California Society of Health-System

technicians, separated into advanced practice technician level, standardization (see attachment 1 for amending language) Attachment:

but this may not work if we intend to open up qualifying training programs.

Pharmacists:

1. Recognizes that pharmacy technicians have many different roles in a variety of health care settings, with varying levels of responsibility and complexity, from those suitable for technicians just entering the workforce to advanced or specialized roles that require additional education, training, experience, and competence and compensation.

2. Recognizes there is a need for specialized certification of pharmacy technicians who perform activities involving higher than normal degrees of complexity and risk. Any pharmacy technician in an area of pharmacy practice

designated for specialty or advanced certification must have the appropriate certifications successfully completed prior to practicing in that specialty area.

3. Recognizes that differing roles for pharmacy technicians will require advanced education and training beyond that of an entry-level technician. Education and training requirements must reflect the responsibilities that technicians will have in their daily activities. Ongoing competence assessment must be a component of advanced or specialized technician roles.

4. Supports that all pharmacy technicians, from entry-level to specialty-trained

technicians, complete a pharmacy technician training program accredited by ASHP and the Accreditation Council for Pharmacy Education (ACPE) through the Pharmacy Technician Accreditation Commission (PTAC) as a requirement for earning PTCB certification or equivalent certification. A process should exist allowing for a grandfathering process.

5. Supports that pharmacy technicians have either be PTCB or equivalent certificationed as a prerequisite to licensure by the California Board of Pharmacy and maintain their certification through mandated continuing education and

recertification.

Proposes to delete: 2012-09 Technician Regulations 2013-10 Technician Accreditation 2013-31 Qualifications of Pharmacy Technicians in Advanced Roles

Follow Up

Legal ClarificationRDC Vote Approved with

proposed changes.

Approves

BOD Action

Proposal A.2: Career Opportunities for Pharmacy Technicians

Region1 Region 2 Region 3 Region 4 Region 5Discussion Discussion on why there

are so few technicians involved in CSHP. (Touched on discussion points per A1.)

Review of why we have professional policy (to clarify CSHP opinion on topics). Discussed SB716 as an example—CSHP has no policy on composition of BOP, CPhA does. To be discussed further per the Resolution submitted.

Delegates were unclear about “living wage”.Prefer to address compensation/salary.

Recommendations quatra: strike #4, “supports pharmacy technician career advancement opportunities and compensation models that are

Recommendation of edits to A2:

California Society of Health-System Pharmacists:

1. Promotes pharmacy

commensurate with training and education” – Attachment:

technicians as valuable contributors to healthcare delivery.

2. Develops and disseminates information about career opportunities that enhances the recruitment and retention of qualified pharmacy technicians.

3. Supports pharmacy technician career advancement opportunities and salary, commensurate with training and education.

4. Encourages compensation models for pharmacy technicians that provide higher than the living wage.

Follow Up

Legal Clarification

RDC Vote Approved with proposed changes.

Approves No changes, support

BOD Action

Proposal A.3: Pharmacy InternRegion1 Region 2 Region 3 Region 4 Region 5

Discussion GG: Change language #1, “supports changes in state practice…that is equivalent to a pharmacist scope of practice under supervision” – GG is stating they should be supervised in the sense of being “overseen” like a new grad -- REJECTED

Strike out “changes” in #1?

What is meant by “support changes to state practice acts?” This would require action by CSHP to support changes that may not exist or may not be in line with CSHP position/policy.

1. “Supports changes in California and other state practice acts and regulations…2. “Supports and promotes the exploration of”, instead of “Explore and promote”

Discussion that CA does not need to deal with the practice act in other states. The proposed change deletes “advocates for changes”; this proposal states “Supports changes”.We already have law in CA that allows students to do almost everything a pharmacist can do under their supervision.

RecommendationsStrike out entire #1 (since pharmacist intern already defined) –ACCEPTED

Include information regarding educating pharmacists on the roles of interns and their scope of practice (per CA State BOP). There may be other factors determining the roles and duties

Recommendation is to delete bullet #1 pertaining to other states.

2013-18 Role of Intern Pharmacists

The California Society of Health-System Pharmacists:

1. To advocate for

(i.e. employer specific).

Supports changes in state practice acts and regulations that would define a scope of practice for intern pharmacists that is not limited to that of a pharmacy technician.

2. Eexplores and promotes new staffing models that foster expanded roles for intern pharmacists, providing quality work and patient experiences that build upon their knowledge and help them develop as future pharmacists.

Follow Up Board to do: Need to verify if no existing ASHP policy and add to situation if none exists


proposed changes.

OK, support

BOD Action

Proposal B.1: Leadership DevelopmentRegion1 Region 2 Region 3 Region 4 Region 5

Discussion CSHP has two professional policies entitled Pharmacists Involvement in Student Pharmacist Education, 2012-07 (Proposal D) and 2014-61.

Recommendations Quatra: reformat policy to make more readable (see attachment 2); move bottom statement to the top

Attachment:

4. Reaffirms that residency programs post-graduate training programs should develop leadership skills through mentoring, training, and leadership opportunities;

Region 3 recommends: Change wording in item #3…use “SUPPORT” rather than “REAFFIRM”

Proposes to delete CSHP Policies: 2015-67 Statement on Leadership as a Professional Obligation (which accepts the ASHP Statement on Leadership as a Professional Obligation)2014-61 Pharmacists Involvement in Student Pharmacist Education [will keep 2012-07]

OK with proposal B1 but needs formatting clean up as follows:

The California Society of Health-System Pharmacists: (CSHP)

1. sSupports collaboration with

healthcare organization leadership to foster opportunities, allocate time, and provide resources for pharmacy practitioners to move into leadership roles;


2. Encourages leaders to seek out and mentor pharmacy practitioners in developing administrative, managerial, and leadership skills;

3. Encourages pharmacy practitioners to obtain the skills necessary to pursue administrative, managerial, and leadership roles;

4. Encourages colleges of pharmacy and CSHP chapters to collaborate in fostering student leadership skills

through development of co-curricular leadership opportunities, leadership conferences, and other leadership promotion programs;

5. Reaffirms that residency programs should develop leadership skills through mentoring, training, and leadership opportunities;

6. Fosters leadership skills for pharmacists to use on a daily basis in their roles as leaders in patient care.

The California Society of Health-System Pharmacists (CSHP) supports providing a leadership development program for its members. [ this is Policy 2015-43]

CSHP will: 1. Select a leadership development program

that fits the needs of its members, 2. Aid in the selection of members for the program, and 3. Provide a grant for partial reimbursement for the selected attendees.

7. CSHP is committed to providing leadership development programs for its members.

Follow Up


proposed changes.

Approved with proposed changes.

OK

BOD Action

Proposal B.2: Inter professional EducationRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Discussion on role of technicians.

Recommendations capitalize “S” in systems in title

OK; [but fix this: The California Society of Health-System Pharmacists:]

If include technicians, this becomes:Bullet 2. Supports inter-professional education, mentorship and professional developments for student pharmacists and technicians, residents, pharmacists and technicians.

Follow Up

Legal ClarificationRDC Vote Support, no

changeApproves OK, Support

BOD Action

Proposal B.3: Cultural CompetencyRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Is there cultural diversity in our profession that we should address?

Policy does not need to have background and references….makes it overly lengthy and not in same format as other CSHP policy. Make the policy format more consistent across all policies.Final policy should be JUST bullet points #1, 2, and 3…eliminate all other wording.

Long discussion on use of ethnically. Ethnicity should have no role and sometimes cannot be controlled. Is there any evidence it improves care? Consensus is to delete it.

The STP has situation language in the Target and Proposal. Need to cite Policy 2015-09 in the Situation (and not the Target). Need to move preamble and references from the Proposal to the Situation.

Recommendations Intro is wordy? Move to background?

Add #4 in regards to recruiting diverse cultures in our profession – need to be cognizant of prop 209

Region 3 recommends:1 – delete background and references2 – Policy should consist of #1, 2, and 3 ONLY.

Therefore, rewrite the STP so that the proposal is only the proposal.

PROPOSAL:

Combine the ASHP policy with the CSHP Professional Policy to make it complete with the ASHP study references:

The United States is rapidly becoming a more diverse nation. Culture influences a patient’s belief and behavior toward health and illness. Cultural competence can significantly affect clinical outcomes. Research has shown that overlooking cultural beliefs may lead to negative health consequences.1 According to the National Center for Cultural Competency, there are numerous examples of benefits derived from the impact of cultural competence on quality and effectiveness of care in relation to health outcomes and well-being.2 Further, pharmacists can contribute to providing “culturally congruent care,” which can be described as “a process of effective interaction

between the provider and client levels” of healthcare that encourages provider cultural competence while recognizing that "[p]atients and families bring their own values, perceptions, and expectations to healthcare encounters which also influence the creation or destruction of cultural congruence.”3 The Report of the ASHP Ad Hoc Committee on Ethnic Diversity and Cultural Competence and the ASHP Statement on Racial and Ethnic Disparities in Health Care4 support ways to raise awareness of the importance of cultural competence in the provision of patient care so that optimal therapeutic outcomes are achieved in diverse populations.

The California Society of Health-System

Pharmacists:

1. Promotes the development of cultural competency of educators, practitioners, residents, students, and technicians;

2. Supports the education of providers on the importance of providing culturally congruent care to achieve quality care and patient engagement;

3. Fosters awareness of the impact that an ethnically and a culturally diverse workforce has on improving health care quality.

References: 1. Administration on Aging. Achieving cultural competence. A guidebook for providers

of services to older Americans and their families. Available at: http://archive.org/details/achievingcultura00admi (accessed October17, 2013)2 .Goode TD, Dunne MC, Bronheim SM. The evidence base for cultural and linguistic competency in health care. The Commonwealth Fund; 2006. http://www.commonwealthfund.org/usr_doc/Goode_evidencebasecultlinguisticcomp_962.pdf (accessed October 17, 2013)3. Schim SM, Doorenbos AZ. A Three-dimensional Model of Cultural Congruence: Framework for Intervention. JSoc Work End Life Palliat Care. 2010; 6:256–70.4. Report of the ASHP Ad hoc committee on ethnic diversity and cultural competence. Am J Health-Syst Pharm.2005; 1924-30

Follow Up


proposed changes.

Approves OK

BOD Action

Proposal B.4: Timely Board of Pharmacy LicensingRegion1 Region 2 Region 3 Region 4 Region 5

Discussion All are in agreement that there are delays inherent in every step of the licensing process in CA. Our policy should reflect this. BOP is the rate-limiting step, not NABP. This is not a problem in other states. Need to reflect this in bullet (4).

Delegates questioned the need to state pharmacist category of licensure.

Recommendations Quatra: reformat verbiage to standards of other (see attachment

Region 3 proposes:1. a change in the wording of the last statement in this policy

Timely release of results must receive emphasisReorder and enumerate thus:

Suggestion for change (including formatting):

#3) – last statement should be divided into two sections – NABP does not get involved into licensure of pharmacists –

Attachment:

to the following:.“The CSHP supports that the CA BOP streamline the licensure process and improve the timeliness of application approval.”2. Strike out completely the first statement of the current policy:“All applicants for pharmacist licensure in California should meet the same minimum competency standards irrespective of category of licensure.”

1. Update CSHP policy 2012-10 to emphasize…

2. California Society of Health-System Pharmacists advocates that the California Board of Pharmacy collaborate

3. Adopt the following as CSHP Professional Policy:

#2012-10: Pharmacist Licensure

The California Society of Health System Pharmacists:

1. Affirms that All applicants for pharmacist licensure in California should meet the same minimum competency standards irrespective of category of licensure.

2. Supports that The California State Board of Pharmacy should maintain its competency standards for licensure;

3. Acknowledges that The North American Pharmacist Licensure Examination (NAPLEX), combined with a California Practice Standard and Jurisprudence Examination (CPJE), is appropriate to test for

basic competencies essential for entry-level pharmacist practice if the examinations include, but are not limited to, testing for pharmacy principles and standards in:

a. Patient consultation skills;

b. Application of clinical knowledge in a variety of patient care settings;

c. Sterile and non-sterile compounding;

d. Drug distribution; and

e. Medication safety.

1. California Society of Health-System Pharmacists advocates that the California Board of Pharmacy collaborate with the National Association of Boards of Pharmacy (NABP) and third-party vendors to

streamline the licensure process through standardization to improve the timeliness of application approval.

Follow Up

Legal ClarificationRDC Vote Approved as

amendedApproves

BOD Action

Proposal C.1: Promotion of Off-Label UsesRegion1 Region 2 Region 3 Region 4 Region 5

Discussion No discussionRecommendations

Follow Up


changesApproves Support OK

BOD Action

Proposal C.2: Home IV TherapyRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Discussion around need to reimburse for patient and caregiver education.

Recommendations #3 change to “…sufficient information and time…to the patient.”

Region 3 recommends the addition of one more statement to the policy (a #4):“Encourages health-systems and providers to ensure that transitions of care in the home care environment include patient and care giver education”

Bullet (3) contains a lot of items; suggest these become bullet points a, b, c, etc.

Home Intravenous Therapy


1. Supports the continuation of a home intravenous therapy benefit under federal, state, and private health insurance plans.

2. Supports expansion of the home infusion benefit under Medicare, and Medicaid Medi-Cal and other health plans at an appropriate level of reimbursement for

pharmacists’ patient care services provided, and which includes including patient and caregiver education, medications, supplies, and equipment to provide optimal therapy for patients.

3.Encourages health-systems and providers to ensure that transitions of care into the homecare environment includes sufficient information and sufficient time for the home infusion pharmacy to provide:

a.Coordination with other healthcare providers nursing care

b. intravenous therapy c. medicationsd. ancillary supplies and equipmente. education to the patient in an optimal and timely manner.

Follow Up


amended.Approves OK

BOD Action

Proposal C.3: Tobacco Products and Electronic Nicotine DevicesRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Discussion centered on the concept that many pharmacies are part of a larger retail space/organization due to changing business models (e.g., CostCo, WalMart, etc) and it we cannot dictate to the larger corporation

This policy adds electronic nicotine devices to existing policy.

Significant discussion on smoking marijuana. Consensus is that this policy pertains to tobacco and that in order to create a separate policy to deal with marijuana smoking at meetings and events, a Recommendation can be submitted at the HOD.

Recommendations Quatra: see attachment #4Why give examples of ENDs? – deleteRevise: #1: “supports smoke-free, tobacco-free, and electronic nicotine delivery systems (ENDs) free

1. Supports environments that are smoke-free, tobacco-free, and electronic nicotine delivery systems (ENDs)-free, including CSHP sponsored meetings and events.

Region 3 recommends:1. Change statement #3 as follows (for clarity):“Promotes pharmacists as providers of tobacco cessation counseling and medication therapy management”2. Delete the following from statement #4 of policy: “..and all

1. [We have] concerns RE vape products that do not contain nicotine, but do pollute2. also Para 6 (which has been deleted) deserves restoration. ADD IT BACK!

This group felt the naming of ENDs was distracting and not necessary. Recommend they be deleted.

The California Society of Health-System Pharmacists: recognizes the public health hazards and economic burden of tobacco use and

environments, including at CSHP sponsored meetings and events”

Add (ENDs) to all bullet points

Attachments:

*Delete the examples in the statement and include as a footnote instead – to ensure the END-free statement is clear (eg. vaporizers, vap pens, hookah pens and electronic cigarettes and pipes)-

establishments that contain a pharmacy”

therefore:

1. Supports smoke-free, tobacco-free, and electronic nicotine delivery systems (ENDs) (eg. vaporizers, vap pens, hookah pens and electronic cigarettes and pipes)-free environments, including CSHP sponsored meetings and events.

Etc.Follow Up


proposed changes.

BOD Action

Proposal C.4: Physician Aid-in-DyingRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Why does this need to go back to the HOD? This is being reaffirmed with no changes.

Recommendations Recommendation for BOD: Title change to something less emotionally-charged (e.g. End of Life Options). . Term ASHP is using “Medical Aid in Dying.”

Include document “Recommendation of the Joint Council Taskforce on ASHP Positions on Assisted Suicide” (November 17, 2016) in the Background materials for CSHP STP.

There is no change here. Should it be withdrawn versus STP clearly state that we are reaffirming existing policy #2016-08. [Suggest remove “Approve as amended from the Proposal , add in the Policy number and change from italic to regular print.]

Follow Up


changesSupport OK

BOD Action

Proposal C.5: Safety of Epidural Steroid InjectionsRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Should this be a stand-alone policy or embedded in the Sterile Compounding policy?

Discussion centered on why are we just focusing on one type of medication administration in this policy? And, is there not already a CSHP policy that deals with the larger issue of sterile preparation?

Most is done in doctors’ officeInvolvement is very vague—rarely a pharmacist is involvedQuestion whether we need this policy.

Recommendations Quatra: delete in #3 “supports…with epidural steroid injections.” (delete end of sentence since pharmacists shouldn’t be involved in decision making of whether they are medically necessary or not) Attachment:

Region #3 recommends:1. Return this policy to the BOD…someone needs to re-review current CSHP policy to see if we already have something that covers sterile compounding (a broader policy)

Recommend delete bullet (3).

Epidural Steroid Injections

The California Society of Health-System Pharmacists: 1. Supports the efforts of the California State Board of Pharmacy, the United States Food and Drug Administration, and the United States Pharmacopeia to ensure the safety, potency, and efficacy of sterile compounded

medications.

2. Encourages healthcare providers to inform patients about the significant risks and potential lack of efficacy of epidural steroid injections, request their informed consent, and inform patients of alternative therapies and their risks and benefits.

3. Supports pharmacist involvement in the medication-use process associated with epidural steroid injections when such injections are medically necessary.

Follow Up Board to do: Follow up with an ASHP delegate why “medically necessary” was included in their ASHP policy

Legal Clarification

RDC Vote Approved as amended

OK

BOD Action

Proposal C.6: Controlled Substance DiversionRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Quatra: wordsmith to streamline. See Attachment #5;

-Quatra rationale: Importance of delineating difference in appropriate pain management vs. diversion vs abuse

-#4: deleted since policy 2012-06 addresses rehab programs

Group discussion on amendment aboveDiscussion for #1, what does “legitimate pain issues” mean? Now it’s more of a statement/ background – delete? – need to include something about pharmacists participating in pain medication

This policy from ASHP addresses drug diversion and patient access.CSHP has existing policy, 2014-38 The Role of the Pharmacist in Substance Abuse and Drug Diversion. This proposal recommends to make some changes to it.Rehabilitation of pharmacists does not belong to this policy. 2012-06, Recovering Pharmacy Professionals is being reviewed as Proposal D4 with no recommendation for substantive change.

managementDiscussion for #2, what does “Asserts” mean? Change to “Recognizes that pharmacists….”

2014-29 already address pharmacist role in pain management

Recommendations Region 1 recommendations:Accept Quatra proposal (attachment #5), with amendment:Delete #1#2: Change to “Recognizes that pharmacists….”

Region 3 recommends:1. Delete a portion of statement #1 to read:“That pharmacists have the unique knowledge, skills, and responsibilities in substance abuse and drug diversion prevention and education.”Portion deleted is: ‘….for pharmacists assuming an important role..”2. That BOD look into whether there is a policy around naloxone…pharmacists should be able to

Consider adding APP and CCM pharmacists to be able to, e.g., prescribe buprenorphine to fill the acute care gap in NorCal

Recommendation:Adding a new bullet (1) regarding treating pain.Delete original bullet (4) about pharmacist rehabilitation.

Suggested changes to existing policy 2014-38:

#2014-38: The Role of the Pharmacist in Substance Abuse and Drug Diversion

The California Society of Health-System Pharmacists endorses the ASHP Statement on the Pharmacist’s

provide… Role in Substance Abuse Prevention, Education, and Assistance:

1. Recognize the importance of balancing efforts to address legitimate pain issues and patient care.

2. That pharmacists have the unique knowledge, skills, and responsibilities for pharmacists assuming an important role in substance abuse and drug diversion prevention and education.

1. That pharmacists should be working collaboratively with other health professionals are actively involved in the identification and mitigation of substance abuse and diversion within

health-systems.

4. That pharmacists, as health care providers, should be actively involved in reducing the negative effects that substance abuse has on society, health-systems, and the pharmacy profession.

4. Rehabilitation programs for pharmacists and other health-system employees whose mental or physical impairments are caused by substance abuse.

[Suggest that the language in the statement before bullet (1) be changed to new bullet (1) for a total of (5) bullets:

1. Endorses the ASHP Statement on the Pharmacist’s Role in

Substance Abuse Prevention, Education, and Assistance.

Follow Up


proposed changes.

Approves

BOD Action

Proposal C.7: Therapeutic Indication in CDSRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Discussion on this policy focused on eliminating a lot of the detail in the policy…too much detail and too specific; policy should be more stream-lined.

The CA legislature has tried and failed to pass law mandating indications on Rx labels.There are regulations in some settings requiring it, e.g. in SNFs. JC Home Health standards mandate that clinicians must know why a patient is taking a particular medication.

Recommendations Quatra: formatting change. “CSHP Supports…”(Attachment #5)

Region 3 recommends:1. Delete statements #1-4 of the current policy. 2. Adopt new statement (highlighted below) which should be incorporated into the first statement in this policy (which will now be the entire policy) as follows:“California Society of Health-System Pharmacists supports the development of clinical decision support (CDS) systems that are proven to

Fix: Pahrmacists. Change to: 4.5.

Support CDS systems to include the purpose of the medication indications on the prescription label and/or include the indication on the hospital order

2013-42, Clinical Decision Support Systems


1.Supports the development of clinical decision support (CDS) systems that are proven to improve medication-use outcomes and that include the following capabilities:

2.The use of alerts, notifications, and

improve medication-use outcomes and support CDS systems to include medication indications on the prescription order.”

summary data views provided to the appropriate people at the appropriate times in clinical workflows, based on:a. a rich set of

patient-specific data,

b. standardized, evidence-based medication-use best practices, and

c. identifiable patterns in medication-use data in the electronic health record;

3.Audit trails of all CDS alerts, notifications, and follow-up activity;

4.Structured clinical documentation functionality linked to individual CDS alerts and notifications; and

5.Highly accessible and detailed management reporting capabilities that facilitate assessment of the quality and completeness of CDS

responses and the effects of CDS on patient outcomes.

6.Support CDS systems to include medication indications on the prescription medication orders and prescriptions.

Follow Up


amended.Approves

BOD Action

Proposal C.8: TelepharmacyRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Quatra: #1, Statement was need to establish what telepharmacy was and that it shouldn’t replace standards of care where pharmacists are available.

Discussion from group:#1 this is more background, “supports the use of telepharmacy…” – okay with this changeWhat is the definition of “remote areas” – what about “prison system”? – original language was “medically underserved areas”; should we advocate if we

Discussion focused on again eliminating too much detail and specifics.

The delegates were very concerned that this proposal is not ready for approval.Issues include:Definition of Telepharmacy (is it only remotely approving orders?)What about patients who frequently cross state lines?Tele-pharmacy not co-located with the main medical center/facility should be familiar with the facility’s operations and guidelines.

want to devote resources to this if it is an important issue, need to decide which issues to use “advocate”The statement “remotely” does not mean “remote areas”#1 “Supports the use of telepharmacy…to medically underserved areas…”Delete #1 from proposalOpposition to Quatra’s proposal since #1 talks about the use of telepharmacy and not the regulation.

Can #4 and #6 be combined? #4 is for companies that have state line services, #6 addresses state agencies

Recommendations Accept Quatra proposal (attachment #6), with amendment to Delete #1#4: “Encourages the board of pharmacy to adopt…”#6k “…outcome measures” (fix typo)

Attachment:

Strike 1, 2, and 3

Change G under bullet 4 as follows:G. Service arrangements across cross state and international borders;

Region 3 recommends:1. Delete A thru J and all current statement #4.2. Delete current statement #13. Delete current statement #34. In current statement #2 – use “Support” rather than “Advocate”New policy would now read as follows:1. “Supports that telepharmacy be applied to suitable functions of pharmacy operations and patient care to improve patient outcomes, expand access to healthcare, and enhance patient safety.

2. Further advocates that boards of pharmacy adopt compatible regulations that enable the use of U.S.-based telepharmacy services within and across state lines for appropriate

Recommendation to defer this proposal

[Note:How does this relate to CSHP Policy 2016-10, Internet Pharmacy Practice which was not considered in the STP? The BOD needs to look at this. I believe these concerns will be addressed if we consolidate these two policies.]

practice settings and that further research be conducted to establish best practices for telepharmacy.

Follow Up

Legal ClarificationRDC Vote Approves as

amended.OK

BOD Action

Proposal C.9: Automated Preparation and Dispensing Tech for Sterile PrepsRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations Quatra: #2 “…

technicians BE included…”#3: Delete “ and to encourage them to establish expectation of adoption by health systems”

Discussion:Why did ASHP include the end of #3?Quatra deleted because the statement encouraged more regulation vs. ability to self-policing – should be included to make aspirational vs if unable to regulate then inability to continue operating (people don’t want more regulation, people thinking about the

Did not like the last phrase in bullet (3). Recommend it be deleted.

Automated Preparation and Dispensing Technology for Sterile Preparations


1. Supports the use of health information technology (HIT) and other patient-care technologies for preparing and dispensing sterile preparations that improves the safety and reliability of the medication use process.

2. Supports pharmacists and pharmacy technicians as included in key decision roles of a

new compounding regs)

Adding to #2 about educating about the VALUE

Straw poll of the group:Delete end of #3 vs. keeping it in – group in favor of deleting end of statement

Attachment:

multidisciplinary team in the planning, selection, implementation, and maintenance of automated systems to facilitate preparation and dispensing of sterile preparations.

3.Encourages the education of patient safety advocacy groups and regulatory agencies on the capabilities and benefits of automation and technology for preparing and dispensing compounded sterile preparations, and to encourage them to establish expectation of adoption by health systems.

Follow Up


proposed changes.

Approves Support OK

BOD Action

Proposal D.1: Sports PharmacyRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations No changes.

Follow Up


changesApproves Support OK

BOD Action

Proposal D.2: Computerized Prescriber Order EntryRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations Amend as follows: 2.

Such orders are part of a single, shared database that is integrated with the pharmacy information systems, electronic healthcare record, and other key information system components…

No changes.

Follow Up


changesApproves Support

BOD Action

Proposal D.3: Non-Pharmacist and Prescriber DispensingRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations Supports the

passage and enforcement of legislative and regulatory controls establishing the requirements for non-pharmacist and prescriber dispensing.

Discussion: what is purpose of passage / enforcement?

No changes.

Follow Up


changesSupport OK

BOD Action

Proposal D.4: Recovering Pharmacy ProfessionalsRegion1 Region 2 Region 3 Region 4 Region 5

Discussion There was a question as to why this includes mental illness, but that is how the program is described in statute.

Recommendations CSHP eEncouragesAdvocates that the California State Board of Pharmacy to also include pharmacy technicians in the State of California’s Pharmacist Recovery Program.

OK with change as proposed. (See discussion of Proposal C.6)

Follow Up


changesSupport OK

BOD Action

Proposal D.5: Pharmacist Involvement in Student Pharmacist EducationRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Discussion to include CSHP in bullet (6).

Recommendations Quatra: Change #1 to “…development of student pharmacists” (to be consistent) – agreed by the group

GG: #1, delete “pharmacy leaders” – opposed given that pharmacy leaders could be non-pharmacists#2: change “competency” to “goals” – opposed, since competencies is a common term used in job setting and academia#6: change “ASHP” to “published

). Other edits as follows.

The California Society of Health-System Pharmacists supports high standards and innovation in the practice of pharmacy. Therefore, … such programs. The California Society of Health-system Pharmacists encourages:

1.Pharmacists and pharmacy leaders to recognize that part of their professional responsibility is the development of new pharmacy practitioners.

guidelines” – not to be limited to just ASHP – opposed since ASHP guidelines are referenced in CMS and regulatory bodies when hospitals are surveyed; don’t need to give examples for every clinical guidelines

This is in the oath of a pharmacist.

2.Pharmacist’s’ participation in the training and education of student pharmacists through involvement with independent internship programs and/or with School of Pharmacy sponsored practice-based experience programs. The achievement of predetermined competencies should be the primary objective of all such programs

3.Schools of pharmacy to define and develop appropriate organizational relationships that permit a balance of patient care and professional and

community service4. Schools of

Pharmacy to collaborate with pharmacy organizations on the development of standards to enhance the quality of experiential education and pharmacy precepting pharmacist preceptor.

5. The provision of tools, education, and other resources to develop preceptor skills.

6.All educators use ASHP and CSHP guidelines, statements and profession policies as an integral part of the educational process.

Follow Up

Legal Clarification

RDC Vote Region 1 will only accept Quatra amendments

Approves Support OK

BOD Action

Proposal D.6: Productivity Measurement SystemsRegion1 Region 2 Region 3 Region 4 Region 5

Discussion -Administrators depend on productivity metrics-If we oppose productivity measurement systems as a whole, we can’t come up with our own metrics or create our own benchmark system; then discussion that we are opposing “standardized format” not the concept of us creating our own-This policy as previously written was more “widget counting”-is there are CSHP statement or stance on appropriate benchmark, like a

Why was “health system” removed?

Why was the second paragraph deleted. Keep last sentence?

Discussion about problems and issues with benchmarking.Everyone agreed number of orders is not a good benchmark and that we need new ones.We can’t just oppose this but to support developing measures that capture all pharmacist activities, including quality and outcomes

guiding document?

GG amendment, add #2 “supports quality measurements to evaluate performance with the goal of optimizing patient care” – opposed

Recommendations Reject this proposal and create a new proposal or make a recommendation in regards to “performance management systems” – look at quality organizations and other standards of care – how do we measure value? To make more a positive statement

Recommend to

We thought more could be added…E.g., CSHP recognizes that not every healthcare setting is exactly the same. As such, a standardized metric to quantify productivity is unrealistic. For this and other like-minded reasons, CSHP opposes…

Recommendation is to not approve this proposal and that the BOD be charged with working to develop measures to capture all pharmacist activities. Marty and Mimi will bring a Recommendation to the HOD.

delete.

Follow Up

Legal ClarificationRDC Vote SupportBOD Action

Proposal D.7: Technician RegulationsRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations Recommend to

delete, combined as above

Add the following:3. Encourage practice sites to only accept technician students from ASHP-accredited schools or schools in candidate status.

Change wording to:The California Society of Health-System Pharmacists:

1. Supports efforts by the pharmacy profession through regulatory and/or legislative changes that broaden the scope of practice for pharmacy technicians.

2. We support the following model with respect to pharmacy technicians:

a. Development and adoption of uniform state laws and regulations regarding pharmacy technicians;b. completion of an ASHP accredited pharmacy technician training program as a

2b. Mandatory Encourages completion of an ASHP accredited pharmacy technician training program…2c. Mandatory certification by a single nationally validated, psychometrically …

Make sure this is consistent with Proposal A.1

prerequisite to pharmacy technician certification; andc. certification by a single nationally validated, psychometrically sound examination approved by the state board of pharmacy as a prerequisite to the state board of pharmacy granting the technician permission to engage in the full scope of responsibilities authorized by the state.

Follow Up

Legal ClarificationRDC VoteBOD Action

Proposal D.8: Repackaging of Pharmaceuticals for DistributionRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations Keep the current

language…i.e., opposed to the addition of, “and the Food and Drug Administration guidelines and regulations.”

Concern that mentioning FDA may have unintended consequences, but after reassurance the group is OK with no changes.

Follow Up


changesApproves Support

BOD Action

Proposal D.9: Safe Handling of Cytotoxic and Hazardous DrugsRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations NIOSH, USP and

CHA be spelled out

Upon Slocal, state and Federal national laws, and regulations, and the best practices and guidelines from nationally recognized organizations such as ASHP, NIOSH, USP and CHA.,.

Minor change recommended for the last sentence:1. change to “and/or”Now reads: “State and Federal laws and regulations and the best practices and/or guidelines from nationally recognized organizations such as ASHP, NIOSH, USP and CHA.”

Add California BoP to the list (such as ASHP, NIOSH, USP and CHA)

Only format change – no content change.

Follow Up


Proposal D.10: Nuclear PharmacyRegion1 Region 2 Region 3 Region 4 Region 5

Discussion Does style change require approval by the HOD (should be REAFFIRM)?

Region 3 recommends that the wording in this policy be consistent throughout and consistent with any other policy which refers to the area of practice.1. Check to make consistent wording “nuclear pharmacy” vs “radiopharmaceuticals” etc….what is legal terminology?? What is consistent with other policy?

Recommendations Support, no changes

No change

Follow Up

Legal ClarificationRDC Vote OKBOD Action

Proposal D.11: Increased Security Features on Controlled Substances Prescription FormRegion1 Region 2 Region 3 Region 4 Region 5

DiscussionRecommendations For rationale,

change CPhA to CSHP.

Region 3 recommends two wording changes1. For Statement # 2:“Supports accountability regulations that require controlled substance prescription form printers to inform law enforcement if their products are stolen or the company identity is stolen.”2. For statement #3 (add development…):“Encourages the development and use of real-time electronic verification methods.

Modify as follows: 3. Encourages the development of real-time electronic transmission and verification methods.

No change

Follow Up

Legal ClarificationRDC Vote ApprovesBOD Action

Resolution A: Changing the Composition of the Board of Pharmacy and Pending Legislation-Authored By: Kathy Besinque and Daniel Kudryashov

Region1 Region 2 Region 3 Region 4 Region 5Discussion Sac valley: wants

to amend to “…a majority membership of licensed pharmacists and a pharmacy technician to ensure public safety” (does this mean there will be more than one pharmacy technician in the future)Vs. Another amendment to delete second statement, why need to talk about majority?Vs. Opposition of resolution (majority)

Sunset review

Discussion around overall support for adding a technician member

Proposed: CSHP supports the inclusion of one pharmacy technicians on the Board of Pharmacy to represent thetechnician workforce.

Discussion around pharmacist majority vs pharmacy majority

Region 3

1. all three chapters and the delegates in attendance (with the exception of 3) expressed support for the resolution. The sentiment was against the current version of the bill and Support for the original intent.

2. agrees that clarification of the language on this resolution can be made. Language will reflect that pharmacists must be the majority of BOP. Kathy B will work on the current language to make that point more clearly.

Reviewed how the bill got to its current form as well as the current and potentially changed composition of the BOP. Discussion of taking the bill back to its original language (add a technician, but not a public member).

Ferraresi, described her conversation with Senator Hill (Chairman of Senate B, P and ED Committee) who stated that there is no way an additional licensee would be added to the BOP without adding another public member. He was adamant that the Supreme Court case

2021 may make this moot: Move towards more public vs. licensed members

Opposed to resolution because Need data/evidence to show if the loss of pharmacist majority actually patient safety was compromised?BOP usually votes along lines of conservative vs. liberal issues

Majority also want to see this debated on the HOD floor

did apply and that the composition of all boards will be assessed when they are due for Sunset Review.

There was discussion questioning if a majority of pharmacists on the BOP ensures public safety. What is the evidence?

Some questioned if we need the policy at this point. Can it be changed?Yes, it can be amended, or withdrawn by the authors if it was felt it was not needed or if they wanted the BOD to further develop it.

Recommendations Proposed: CSHP supports that the majority of the Board of Pharmacy is comprised of a

RDC consensus supported the 1st sentence, but did not support the 2nd sentence of the proposal.

It was suggested that it could be amended to state:

CSHP supports the inclusion of

pharmacy technician and licensed Pharmacists.

pharmacy technicians on the Board of Pharmacy to represent the technician workforce.CSHP supports the composition of the Board of Pharmacy to be constituted by a majority membership of licensed pharmacists and technicians to insure public safety.

To make the proposed policy consistent with CSHP formatting, change it to:


1. Supports the inclusion of pharmacy technicians on the Board of Pharmacy to represent the technician

workforce.

2. Supports the composition of the Board of Pharmacy to be constituted by a majority membership of licensed pharmacists to insure ensure public safety.

The SBLB Chapter will consider the above.

Follow Up


Other Items of DiscussionRegion 1 New Business from Golden Gate:

“Safe and Effective Use of Medications in Pediatric and Neonatal Patients”

Is there ASHP policy about standardized concentrations for oral medications in pediatrics?

Submit as a resolution to be acted on by the HOD

Region 2Region 3 FOR CSHP STAFF:

1. Send a copy of the entire Seminar schedule to all delegates.2. For HOD: Don’t have the CCTF reports at the HOD. Suggest to videotape each CCTF report for viewing.

Region 4Region 5 Suggestion to create an orientation packet for new members. More comprehensive than the welcome materials.

Make this an ongoing process to encourage involvement for new members. Make an invitation.

Also, when member transfer, inform the chapter so they can welcome them, introduce at board meetings, etc. Share the orientation packet at regional chapter presidents meeting for consistency.

Regional chapter presidents meeting – how often? Do more webinars in between formal meetings.

Advocacy – opportunity on Legislative Day and at the PAC reception at Seminar. These are the two times to wow legislators. Should to focus on this. We would have better attendance at both events. Need to advertise and promote donations to PAC more heavily.

Meeting ReviewRegion 1Region 2 - Reminder email

- Map / directions- Food was great!

Region 3Region 4 Went efficiently; food was great! Start at 9 or 9:30 next time?Region 5 Well done!

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