The ASHP Midyear 2018 Clinical Meeting & Exhibition
The annual meeting of the American Society of Health-System Pharmacists (ASHP) was held from Dec. 2 to 6 in Anaheim, California, and attracted more than 20,000 participants from around the world, including pharmacy specialists, technicians, and other health care professionals. The conference featured educational sessions covering the newest trends in pharmaceutical research and providing insight into effective and safe medication use.
During an educational session, Matthew Malachowski, Pharm.D., of the University of Alabama at Birmingham Health System, provided insight into specialty pharmacy services. He acknowledged that health systems with embedded retail and specialty pharmacy services are uniquely equipped and organized to remove friction between the patient and the treatment they need and increase the chances of successful patient outcomes.
“Specialty pharmacy agents and the disease states they treat are exceedingly complex, with numerous barriers to optimal patient outcomes, including administrative friction between the patient and the treatments they need. By effectively employing the unique skills of a variety of health care professionals and support staff, these patients can safely and effectively navigate their plan of care from diagnosis to treatment to improved quality of life and decreased system utilization,” Malachowski said. “It is only through effective communication, documentation, and standardized care processes that this technical expertise can be truly brought to bear.”
Malachowski suggests that a care team should not be afraid to come together and discuss roles and responsibilities, professional skills, processes, and preferred routes of communication for patient health information.
“Where possible, utilize an electronic medical record, which allows the entire care team to embed and retrieve health information and follows the patient through transitions of care,” Malachowski said. “When correctly utilized, pharmacy services can improve patient safety, operational efficiency, and institutional revenue.”
During the conference, the ASHP announced updated national guidelines outlining best practices for responding to drug shortages. These guidelines were established for health care teams to develop policies and procedures to reduce the impact of drug shortages on quality of care.
According to Michael Ganio, Pharm.D., director of Pharmacy Practice and Quality at ASHP, drug shortages continue to be problematic for the health care system. Ganio suggests that the best approach to managing shortages is to have a process in place for recognizing shortages and developing strategies to manage the shortages. Strategies include purchasing and inventory management practices, interprofessional collaboration on clinical restrictions and alternatives, and effective communication to ensure that all health care personnel have timely information about specific shortages.
“Clinicians should know that the management of drug shortages requires an interprofessional effort. Pharmacists and pharmacy departments are able to mitigate the impact of shortages in many cases; however, there are times when prescribers, nurses, and other health care personnel will have to make clinical decisions based on which drugs are available,” Ganio said. “Clinicians should understand that the entire health system is working to manage the shortage, everyone from pharmacists and pharmacy technicians to medication safety officers and clinical informaticists.”
Ganio notes that clinicians should also understand that alternatives to drug products that are in shortage may look different or come in a different form than what they are used to. Medication errors can occur during shortages because of these differences, so clinicians should pay close attention to communication they receive about these products.
“Prescribers should make sure they are familiar with therapeutic alternatives, including dose conversions between similar products (e.g., converting between injectable opioids). Prescribers should also pay attention to restrictions on drugs that are in short supply, as the use may be limited to specific patient populations or clinical situations,” Ganio said. “Many health care disciplines are affected by shortages. A collaborative approach is necessary to limit the clinical impact on patients and reduce the risk of medication errors associated with drug shortages. The ASHP website includes an up-to-date database of all drugs in short supply, the ASHP Guidelines on Managing Drug Product Shortages, drug shortage statistics, and suggestions on managing specific critical shortages.”
The ASHP also announced during the conference updated guidelines outlining best practices for handling hazardous drugs. According to Ganio, the ASHP guidelines on handling hazardous drugs describe a comprehensive strategy to mitigate the risk of hazardous drug exposure during all risk points. The recommendations outline processes like waste disposal and environmental monitoring programs. They also include physical protections, such as personal protective equipment (gloves, gowns, and masks) and containment engineering controls (compounding hoods and rooms).
“The risks of hazardous drug exposure have been well established for several decades. Many studies have detected hazardous drugs in the urine of health care workers, including those with low expectation of exposure. Clinicians should be aware that they can be exposed through inhalation, accidental injection, ingestion of contaminated food or beverages, ingestion through mouth contact with contaminated hands, or absorption through the skin,” Ganio explained. “It’s important for clinicians to fully understand the risks of the medications they are working with, and that there are many examples of hazardous drugs that are not classified as chemotherapy. Clinicians can reduce their exposure risk by using proper personal protective equipment and by storing and handling hazardous drugs according to these guidelines.”
According to Ganio, by following these updated recommendations, health care leaders and health care personnel can reduce their exposure and prevent health-related complications of hazardous drug exposure.
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