Redefining Pharmacists' Roles Nonphysician prescribing) compounding) and AIDS prevention are among topics to be discussed by the APhA House ofDelegates. by Sara Martin
E
xpanding, redefining, and asserting pharmacists' roles is an underlying theme of the policy recommendations to be discussed by the 1992 American Pharmaceutical Association (APhA) House of Delegates at its 139th Annual Meeting and Exposition. This year's House will consider 31 proposed Association policies. Many of them assert pharmacists' professional prerogatives or seek to expand pharmacy practice. They include recommendations that APhA: • Support a requirement that the desired therapeutic outcome of a medication be stated on prescription orders. • Support granting of prescribing authority to health care professionals competent to do so, as long as pharmacists are responsible for choosing the drug or device to be used in a patient's therapy. • Affirm that compounding prescription orders is an essential part of health care that is a prerogative of the pharmacist. • Oppose mandatory HIV testing of pharmacists and affirm pharmacists' responsibilities in HIV-infection control. The proposed policies are the recommendations of APhA's four policy committees--educational, professional, public, and scientific affairs. The committees met last fall to discuss issues sent to them by APhA members. The committees' recommendations are considered by the APhA reference committees, which will hold open hearings at the APhA 1992 Annual Meeting. The reports of the reference committees are then considered by the House of Delegates, which will vote to adopt, revise, reject, or refer the recommendations back to the appropriate policy committee or the Board of Trustees. Vol. NS32, No.2 February 1992/151
New Pharmacist Responsibilities Several proposed Association policies outline new responsibilities for pharmacists. Among them are proposals by the APhA Policy Committee on Professional Affairs concerning nonphysician prescriptive authority. According to the committee, the changing health care environment has caused health care professionals, such as nurses, physician assistants, and pharmacists, to seek the authority to prescribe medication. Physicians in particular have opposed granting such authority to other health professions. The committee said it believes that the controversy over nonphysician prescribing has resulted from an outdated definition of prescribing and that prescribing should be defined in a new way. Rather than being viewed as a single action-the writing of an order for a specific drug therapy-prescribing should be regarded as a process that begins at the time the patient presents a health problem and ends when "a maximum therapeutic outcome has been achieved for that patient. " When viewed as a process rather than a single action, said the committee, it becomes clear that various health care professionals can have input into prescribing. Perhaps more important, this new view of prescribing would allow pharmacists to become more actively involved in what pharmacists do best-selecting specific medications and/ or devices to be used in a patient's therapy and managing their effective use. With this in mind, the committee recommended policies that call for APhA to: • Support granting prescribing authority to competent health care professionals, provided that the pharmacist be AMERICAN PHARMACY
responsible for choosing the drug or device to be used in the patient's therapy. Following up on this recommendation, the committee also recommended that APhA adopt a policy that calls for all prescription orders to list the therapeutic intent as well as the medication and dosage (for example, "captopril to treat high blood pressure").
Reaffirming Current Roles
During the Annual Meeting, APhA ~ House of Delegates adopt policies that guide Association activities.
Other proposed policies reaffirm pharmacists' roles as experts in drug therapy and as vital members of the health care team. One example is a recommendation by the APhA Policy Committee on Professional Affairs that the Association strongly reaffirm compounding as the pharmacist's prerogative. Pharmacists' compounding has recently been targeted by the Food and Drug Administration, which is seeking to limit the boundaries of professional compounding. While the committee recognized that there may be inap-
Official 1992 Policy Committee Recommendations Policy Committee on Educational Affairs Members: Holly L. Mason, chairman, Betty H. Dennis, vice chairman, David C. Gammon, Sheri Huebner, Betty Jane Nichol, Mark Stiling, Steve Timmerman. The Policy Committee on Educational Affairs considered and recommended to the House of Delegates two matters of policy: (A) "Cross Discipline Accreditation of Continuing Education" and (B) "Balanced Education for Pharmacists." In addition the committee considered one other matter, for which the committee determined it would not recommend policy to the House of Delegates. In regard to subject (C) "Review of the Final Report of the Task Force on Pharmacy Education," the committee opted, in lieu of recommending policy, to transmit its suggestions for nonpolicy-re1ated actions directly to the APhA Board of Trustees for consideration. A. CrosS-Discipline Accreditation of Continuing Education The committee recommends that the Association adopt the following policies: 1. APhA supports the acceptance, for pharmacy continuing education credit, of relevant, quality programs offered by other health-related continuing education providers. 2. APhA supports the acceptance of relevant programs
AMERICAN PHARMACY
offered by American Council on Pharmaceutical Education (ACPE)-approved providers to meet continuing education requirements in other health disciplines.
B. Balanced Education for Pharmacists The committee recommends that the Association adopt the following policies: 1. APhA encourages schools and colleges of pharmacy to ensure the provision of a balanced general education, in order to graduate educated citizens and competent health care professionals. 2. APhA supports development of admission processes by schools and colleges of pharmacy, which assure that students possess qualities necessary to become educated citizens and competent health care professionals. 3. APhA supports adoption, by schools and colleges of pharmacy, of educational outcomes and competencies fOf the genera} education component of the curriculum which contribute to the development of educated citizens and competent health care professionals. C. The Final Report of the Task Force on Pharmacy Education (APhA, 1984). The committee recommends that the Association adopt no policy.
February 1992/152 VoL NS32, No.2
propriate uses of compounding, it said it fears that government involvement could impose new requirements and restrictions on pharmacists that would interfere with pharmacists' professional prerogatives. The committee asserted that compounding is, and always has been, part of the pharmacy profession, and therefore recommended that APhA adopt a policy affirming that: compounding pursuant to or in anticipation of a prescription or diagnostic preparation order is an essential part of health care, which is the prerogative of the pharmacist.
In a separate memorandum to the APhA Board of Trustees, the committee recommended that the Board appoint a working group on compounding to investigate and develop recommendations on such issues as what defines compounding, the role of regulatory agencies in compounding, and the challenges to compounding. Another example of pharmacists asserting their roles in pharmaceutical care is the professional affairs committee's
Policy Committee on Professional Affairs Members: Donald G. Floriddia, chairman, Arlene A. Flynn, vice chairman, John Eddy, Bruce Field, Christopher J. Forst, Kem Krueger, Holly Whitcomb. The Policy Committee on Professional Affairs considered and recommended to the House of Delegates four matters of policy: (A) "The Pharmacist's Role in Therapeutic Outcomes," (B) "Nonphysician Prescriptive Authority," (C) "Compounding Activities of Pharmacists," and (D) "Cognitive Services with New Health Technologies." In regard to subject (C), the committee also transmitted its suggestions for nonpolicy-related actions directly to the APhA Board of Trustees for consideration. A. The Pharmacist's Role in Therapeutic Outcomes The committee recommends that the Association adopt the following policies: 1. APhA affirms that achieving optimal therapeutic outcomes for each patient is the shared responsibility of the health care team. . 2. APhA believes that a primary responsibility of the pharmacist in achieving optimal therapeutic outcomes is to take an active role in the development and implementation of a therapeutic plan for each patient. B. Nonpbysician Prescriptive Authority The committee recommends that the Association adopt the following policies: 1. APhA supports a requirement for a statement of
Vol. NS32, No.2 February 1992/153
recommendation that a primary responsibility of pharmacists in achieving optimal therapeutic outcomes be to "take an active role in the development and implementation of a therapeutic plan for each patient. " Discussing a related topic, the APhA Policy Committee on Public Affairs noted that in order to achieve APhA's mission for pharmacy-achieving optimal therapeutic outcomes for patients-all aspects of a patient's care must be coordinated. The committee stated that the best communication occurs when patient, pharmacist, and physician share information face-to-face and ensure understanding through effective feedback. To reaffirm pharmacists' belief in the importance of such interaction, the committee recommended policies that call for APhA to: • Support practice environments and distribution systems that enhance the pharmacist-patient relationship. • Encourage those responsible for practice environments without direct patient-pharmacist contact to use methods to enhance communication, face-to-face interaction, and pharmaceutical care.
desired therapeutic outcome on the order for drug therapy to maximize patient benefit from pharmaceutical care. 2. APhA supports granting, to health care professionals competent to do so, prescribing authority for desired therapeutic outcomes, provided that the pharmacist be responsible for choosing the drug or device to be used in the patient's therapy. 3. APhA rescinds its 1976 policy which opposes granting independent drug prescribing authority to physician assistants and nurse practitioners.
c.
Compounding Activities of Pharmacists The committee recommends that the Association adopt the following policy: 1. APhA affirms that compounding pursuant to or in anticipation of a prescription or diagnostic preparation order is an essential part of health care which is the prerogative of the pharmacist.
D. Pharmaceutical Care and the Provision of Cognitive Services with New Health Technologies The committee recommends that the Association adopt the following policies: 1. APhA supports the utilization of new health technologies to enhance the pharmacist's ability to provide pharmaceutical care. 2. APhA believes that the use of new health technologies should not replace the pharmacist-patient relationship. 3. APhA emphasizes that maximizing patient benefit
AMERICAN PHARMACY
• Recognize the value of pharmacists' cognitive services and support the dissemination of information regarding the value of these services.
Mandatory AIDS Testing Perhaps the most controversial issue the APhA House of Delegates will consider is a recommendation by the APhA Policy Committee on Public Affairs that APhA oppose mandatory testing of pharmacists for HIV. Although there are no known cases in which a pharmacist has transmitted HN through professional practice, the profession must consider this issue in the current climate of public concern over HN transmission by health professionals. At the end of 1990, 5,815 health care professionals were reported by the Centers for Disease Control (CDC) to have AIDS . Another 46,520 have tested positive for HIV and could conceivably transmit the virus. The CDC estimates that between 13 and 128 Americans have contracted the virus from health care professionals.
from new health technologies depends upon the pharmacist-patient relationship. 4. APhA affirms that the utilization of new health technologies by pharmacists shall not compromise the patient's right to confidentiality.
At least two professional health care associations have policy on HIV testing. The American Medical Association has policy that supports testing of health professionals for HN in appropriate situations. The American Nurses Association does not support mandatory testing, but encourages voluntary testing. During its deliberations, the APhA Policy Committee on Public Affairs discussed the difficult balance between the rights of patients and the privacy of health professionals. They concluded that APhA policy should address pharmacists' responsibility to (1) follow practice precautions to prevent HIV transmission and (2) educate the public on the minute risk of an HN-positive pharmacist transmitting the disease to a patient in the course of professional practice. The committee proposed policies that call for APhA to: • Oppose mandatory HIV testing, but support voluntary testing of those pharmacists who are involved in high-risk procedures. • Assert that pharmacy personnel maintain current knowledge of infection control.
4. APhA should provide necessary information and materials for pharmacy students and pharmacists to carry out this role in disseminating public health information.
A. The Role of Pharmacists in
B. Pharmaceutical Care and Medication Distribution Systems The committee recommends that the Association adopt the follOWing policies: 1. APhA endorses the concept of "pharmaceutical care." 2. APhA supports practice environments and distribution systems which enhance the pharmacist-patient relationship. 3. APhA encourages those responsible for practice environments without direct patient-pharmacist contact to use methods to enhance communication, face-to-face interaction, and pharmaceutical care. 4. APhA recognizes the value of pharmacists' cognitive services and supports the dissemination of information regarding the value of these services.
Public Health Awareness The committee recommends that the Association adopt the following policies: 1. APhA recognizes the unique role and accessibility of pharmacists in public health. 2. APhA encourages pharmacists to provide services, education, and information on public health issues. 3. APhA encourages health organizations and institutions, including colleges of pharmacy, to develop appropriate public health programs for pharmacists and pharmacy students.
c. Pharmacy Practice Precautions Related to HIV Infection The committee recommends that the Association adopt the following policies: 1. APhA opposes mandatory. HIV testing of pharmacists. The Association supports voluntary HIV testing of pharmacists who are involved in invasive procedures or other professional activities that may place patients at risk. 2. APhA believes that all pharmacy personnel should maintain knowledge of infection control through regular
Policy Committee on Public Affairs Members: Neil M. Abel, chairman, Debra W. Nichol, vice chairman, Kathleen D. Blake, Lisa C. Cox, Michael A. Pavlovich, Steven T. Simenson, Dereck Terry. The Policy Committee on Public Affairs considered and recommended to the House of Delegates three matters of policy: (A) "The Role of Pharmacists in Public Health Awareness," (B) "Pharmaceutical Care and Medication Distribution Systems," and (C) "Pharmacy Practice Precautions Related to HN Infection."
AMERICAN PHARMACY
Feb ruary 1992/154 Vol. NS32, No .2
• Encourage employers to develop policies and procedures on infection control. • Assert that HN-infected pharmacy personnel should be given "confidential consultation and reasonable accommodation." Encourage professional support networks and other outreach programs for HN-infected individuals.
Other Proposed Policies The House of Delegates will also consider policies that call for APhA to: • Support granting pharmacists continuing education credit for completing relevant education programs offered by other health-related professions. • Support the pharmacist's role in selecting appropriate drug packaging and recognize the value of unit-of-use
review of current scientific information and guidelines. Health establishments and organizations should assist in providing such education. 3. APhA encourages employers to develop policies and procedures regarding infection control, and the need for disclosure based on scientific knowledge and guidelines from appropriate organizations. 4. APhA believes that confidential consultation and reasonable accommodation should be provided to infected pharmacy personnel concerning their profeSSional activities. Pharmacy personnel should not participate in procedures that pose a risk for pharmacy personnel-to-patient transmission of infection. 5. APhA encourages profeSSional support networks and other outreach efforts to develop programs for HN-positive health care professionals.
Policy Committee on Scientific Affairs Members: Steven H. Zlotnick, chairman, Mario F. Sylvestri, vice chairman, Todd A. Edgar, John P. Juergens, Anna C. .Kowblansky, 1. Douglas Ried,Mary Walbridge. The Policy Committee on Scientific Affairs considered and recommended to the House of Delegates one matter of policy: (A) "Drug Product Packaging." In addition, the committee considered two other matters for which the committee determined it would not recommend policy to the.House of Delegates. Regarding (B) "State-Level Restriction on Medication Use and Patient Care" and (C) "The
VoL NS32, No. 2 February 1992/155
packaging, while opposing its exclusive use. • Support the use of new health technologies-such as computerized patient information-to enhance the pharmacist's ability to provide pharmaceutical care, but assert that such technology should not interfere with the patient-pharmacist relationship. • Recognize the unique role and accessibility of the pharmacist in public health and encourage pharmacists to provide services, education, and information on public health issues. • Encourage schools and colleges of pharmacy to ensure that students receive a balanced general education that provides the skills necessary to be educated citizens and competent health care professionals. Sara Martin is associate editor, American Pharmacy.
Pharmacist's Role in Drug Development," the committee opted, in lieu of recommending policy, to transmit its suggestions for nonpolicy-related actions directly to the APhA Board of Trustees for consideration. A. Drug Product Packaging
The committee recommends that the Association adopt the following policies: 1. APhA supports the role of the pharmacist to select appropriate drug product packaging. 2. APhA recognizes the potential value of unit-of-use packaging to enhance pharmaceutical care, but opposes its exclusive use. 3. APhA encourages the pharmaceutical industry to perform compatibility and stability testing of drug products in officially approved patient use containers to assist pharmacist selection of appropriate drug product packaging.
B. State-Level Restrictions on Medication Use and Patient Care The c01nmittee recommends that the Association adopt no policy.
c. The Pharmacist's Role in Drug Development The committee ..recommends that the Association adopt no policy.
AMERICAN PHARMACY
E
xpanding, redefining, and asserting pharmacists' roles is an underlying theme of the policy recommendations to be discussed by the 1992 American Pharmaceutical Association (APhA) House of Delegates at its 139th Annual Meeting and Exposition. This year's House will consider 31 proposed Association policies. Many of them assert pharmacists' professional prerogatives or seek to expand pharmacy practice. They include recommendations that APhA: • Support a requirement that the desired therapeutic outcome of a medication be stated on prescription orders. • Support granting of prescribing authority to health care professionals competent to do so, as long as pharmacists are responsible for choosing the drug or device to be used in a patient's therapy. • Affirm that compounding prescription orders is an essential part of health care that is a prerogative of the pharmacist. • Oppose mandatory HIV testing of pharmacists and affirm pharmacists' responsibilities in HIV-infection control. The proposed policies are the recommendations of APhA's four policy committees--educational, professional, public, and scientific affairs. The committees met last fall to discuss issues sent to them by APhA members. The committees' recommendations are considered by the APhA reference committees, which will hold open hearings at the APhA 1992 Annual Meeting. The reports of the reference committees are then considered by the House of Delegates, which will vote to adopt, revise, reject, or refer the recommendations back to the appropriate policy committee or the Board of Trustees. Vol. NS32, No.2 February 1992/151
New Pharmacist Responsibilities Several proposed Association policies outline new responsibilities for pharmacists. Among them are proposals by the APhA Policy Committee on Professional Affairs concerning nonphysician prescriptive authority. According to the committee, the changing health care environment has caused health care professionals, such as nurses, physician assistants, and pharmacists, to seek the authority to prescribe medication. Physicians in particular have opposed granting such authority to other health professions. The committee said it believes that the controversy over nonphysician prescribing has resulted from an outdated definition of prescribing and that prescribing should be defined in a new way. Rather than being viewed as a single action-the writing of an order for a specific drug therapy-prescribing should be regarded as a process that begins at the time the patient presents a health problem and ends when "a maximum therapeutic outcome has been achieved for that patient. " When viewed as a process rather than a single action, said the committee, it becomes clear that various health care professionals can have input into prescribing. Perhaps more important, this new view of prescribing would allow pharmacists to become more actively involved in what pharmacists do best-selecting specific medications and/ or devices to be used in a patient's therapy and managing their effective use. With this in mind, the committee recommended policies that call for APhA to: • Support granting prescribing authority to competent health care professionals, provided that the pharmacist be AMERICAN PHARMACY
responsible for choosing the drug or device to be used in the patient's therapy. Following up on this recommendation, the committee also recommended that APhA adopt a policy that calls for all prescription orders to list the therapeutic intent as well as the medication and dosage (for example, "captopril to treat high blood pressure").
Reaffirming Current Roles
During the Annual Meeting, APhA ~ House of Delegates adopt policies that guide Association activities.
Other proposed policies reaffirm pharmacists' roles as experts in drug therapy and as vital members of the health care team. One example is a recommendation by the APhA Policy Committee on Professional Affairs that the Association strongly reaffirm compounding as the pharmacist's prerogative. Pharmacists' compounding has recently been targeted by the Food and Drug Administration, which is seeking to limit the boundaries of professional compounding. While the committee recognized that there may be inap-
Official 1992 Policy Committee Recommendations Policy Committee on Educational Affairs Members: Holly L. Mason, chairman, Betty H. Dennis, vice chairman, David C. Gammon, Sheri Huebner, Betty Jane Nichol, Mark Stiling, Steve Timmerman. The Policy Committee on Educational Affairs considered and recommended to the House of Delegates two matters of policy: (A) "Cross Discipline Accreditation of Continuing Education" and (B) "Balanced Education for Pharmacists." In addition the committee considered one other matter, for which the committee determined it would not recommend policy to the House of Delegates. In regard to subject (C) "Review of the Final Report of the Task Force on Pharmacy Education," the committee opted, in lieu of recommending policy, to transmit its suggestions for nonpolicy-re1ated actions directly to the APhA Board of Trustees for consideration. A. CrosS-Discipline Accreditation of Continuing Education The committee recommends that the Association adopt the following policies: 1. APhA supports the acceptance, for pharmacy continuing education credit, of relevant, quality programs offered by other health-related continuing education providers. 2. APhA supports the acceptance of relevant programs
AMERICAN PHARMACY
offered by American Council on Pharmaceutical Education (ACPE)-approved providers to meet continuing education requirements in other health disciplines.
B. Balanced Education for Pharmacists The committee recommends that the Association adopt the following policies: 1. APhA encourages schools and colleges of pharmacy to ensure the provision of a balanced general education, in order to graduate educated citizens and competent health care professionals. 2. APhA supports development of admission processes by schools and colleges of pharmacy, which assure that students possess qualities necessary to become educated citizens and competent health care professionals. 3. APhA supports adoption, by schools and colleges of pharmacy, of educational outcomes and competencies fOf the genera} education component of the curriculum which contribute to the development of educated citizens and competent health care professionals. C. The Final Report of the Task Force on Pharmacy Education (APhA, 1984). The committee recommends that the Association adopt no policy.
February 1992/152 VoL NS32, No.2
propriate uses of compounding, it said it fears that government involvement could impose new requirements and restrictions on pharmacists that would interfere with pharmacists' professional prerogatives. The committee asserted that compounding is, and always has been, part of the pharmacy profession, and therefore recommended that APhA adopt a policy affirming that: compounding pursuant to or in anticipation of a prescription or diagnostic preparation order is an essential part of health care, which is the prerogative of the pharmacist.
In a separate memorandum to the APhA Board of Trustees, the committee recommended that the Board appoint a working group on compounding to investigate and develop recommendations on such issues as what defines compounding, the role of regulatory agencies in compounding, and the challenges to compounding. Another example of pharmacists asserting their roles in pharmaceutical care is the professional affairs committee's
Policy Committee on Professional Affairs Members: Donald G. Floriddia, chairman, Arlene A. Flynn, vice chairman, John Eddy, Bruce Field, Christopher J. Forst, Kem Krueger, Holly Whitcomb. The Policy Committee on Professional Affairs considered and recommended to the House of Delegates four matters of policy: (A) "The Pharmacist's Role in Therapeutic Outcomes," (B) "Nonphysician Prescriptive Authority," (C) "Compounding Activities of Pharmacists," and (D) "Cognitive Services with New Health Technologies." In regard to subject (C), the committee also transmitted its suggestions for nonpolicy-related actions directly to the APhA Board of Trustees for consideration. A. The Pharmacist's Role in Therapeutic Outcomes The committee recommends that the Association adopt the following policies: 1. APhA affirms that achieving optimal therapeutic outcomes for each patient is the shared responsibility of the health care team. . 2. APhA believes that a primary responsibility of the pharmacist in achieving optimal therapeutic outcomes is to take an active role in the development and implementation of a therapeutic plan for each patient. B. Nonpbysician Prescriptive Authority The committee recommends that the Association adopt the following policies: 1. APhA supports a requirement for a statement of
Vol. NS32, No.2 February 1992/153
recommendation that a primary responsibility of pharmacists in achieving optimal therapeutic outcomes be to "take an active role in the development and implementation of a therapeutic plan for each patient. " Discussing a related topic, the APhA Policy Committee on Public Affairs noted that in order to achieve APhA's mission for pharmacy-achieving optimal therapeutic outcomes for patients-all aspects of a patient's care must be coordinated. The committee stated that the best communication occurs when patient, pharmacist, and physician share information face-to-face and ensure understanding through effective feedback. To reaffirm pharmacists' belief in the importance of such interaction, the committee recommended policies that call for APhA to: • Support practice environments and distribution systems that enhance the pharmacist-patient relationship. • Encourage those responsible for practice environments without direct patient-pharmacist contact to use methods to enhance communication, face-to-face interaction, and pharmaceutical care.
desired therapeutic outcome on the order for drug therapy to maximize patient benefit from pharmaceutical care. 2. APhA supports granting, to health care professionals competent to do so, prescribing authority for desired therapeutic outcomes, provided that the pharmacist be responsible for choosing the drug or device to be used in the patient's therapy. 3. APhA rescinds its 1976 policy which opposes granting independent drug prescribing authority to physician assistants and nurse practitioners.
c.
Compounding Activities of Pharmacists The committee recommends that the Association adopt the following policy: 1. APhA affirms that compounding pursuant to or in anticipation of a prescription or diagnostic preparation order is an essential part of health care which is the prerogative of the pharmacist.
D. Pharmaceutical Care and the Provision of Cognitive Services with New Health Technologies The committee recommends that the Association adopt the following policies: 1. APhA supports the utilization of new health technologies to enhance the pharmacist's ability to provide pharmaceutical care. 2. APhA believes that the use of new health technologies should not replace the pharmacist-patient relationship. 3. APhA emphasizes that maximizing patient benefit
AMERICAN PHARMACY
• Recognize the value of pharmacists' cognitive services and support the dissemination of information regarding the value of these services.
Mandatory AIDS Testing Perhaps the most controversial issue the APhA House of Delegates will consider is a recommendation by the APhA Policy Committee on Public Affairs that APhA oppose mandatory testing of pharmacists for HIV. Although there are no known cases in which a pharmacist has transmitted HN through professional practice, the profession must consider this issue in the current climate of public concern over HN transmission by health professionals. At the end of 1990, 5,815 health care professionals were reported by the Centers for Disease Control (CDC) to have AIDS . Another 46,520 have tested positive for HIV and could conceivably transmit the virus. The CDC estimates that between 13 and 128 Americans have contracted the virus from health care professionals.
from new health technologies depends upon the pharmacist-patient relationship. 4. APhA affirms that the utilization of new health technologies by pharmacists shall not compromise the patient's right to confidentiality.
At least two professional health care associations have policy on HIV testing. The American Medical Association has policy that supports testing of health professionals for HN in appropriate situations. The American Nurses Association does not support mandatory testing, but encourages voluntary testing. During its deliberations, the APhA Policy Committee on Public Affairs discussed the difficult balance between the rights of patients and the privacy of health professionals. They concluded that APhA policy should address pharmacists' responsibility to (1) follow practice precautions to prevent HIV transmission and (2) educate the public on the minute risk of an HN-positive pharmacist transmitting the disease to a patient in the course of professional practice. The committee proposed policies that call for APhA to: • Oppose mandatory HIV testing, but support voluntary testing of those pharmacists who are involved in high-risk procedures. • Assert that pharmacy personnel maintain current knowledge of infection control.
4. APhA should provide necessary information and materials for pharmacy students and pharmacists to carry out this role in disseminating public health information.
A. The Role of Pharmacists in
B. Pharmaceutical Care and Medication Distribution Systems The committee recommends that the Association adopt the follOWing policies: 1. APhA endorses the concept of "pharmaceutical care." 2. APhA supports practice environments and distribution systems which enhance the pharmacist-patient relationship. 3. APhA encourages those responsible for practice environments without direct patient-pharmacist contact to use methods to enhance communication, face-to-face interaction, and pharmaceutical care. 4. APhA recognizes the value of pharmacists' cognitive services and supports the dissemination of information regarding the value of these services.
Public Health Awareness The committee recommends that the Association adopt the following policies: 1. APhA recognizes the unique role and accessibility of pharmacists in public health. 2. APhA encourages pharmacists to provide services, education, and information on public health issues. 3. APhA encourages health organizations and institutions, including colleges of pharmacy, to develop appropriate public health programs for pharmacists and pharmacy students.
c. Pharmacy Practice Precautions Related to HIV Infection The committee recommends that the Association adopt the following policies: 1. APhA opposes mandatory. HIV testing of pharmacists. The Association supports voluntary HIV testing of pharmacists who are involved in invasive procedures or other professional activities that may place patients at risk. 2. APhA believes that all pharmacy personnel should maintain knowledge of infection control through regular
Policy Committee on Public Affairs Members: Neil M. Abel, chairman, Debra W. Nichol, vice chairman, Kathleen D. Blake, Lisa C. Cox, Michael A. Pavlovich, Steven T. Simenson, Dereck Terry. The Policy Committee on Public Affairs considered and recommended to the House of Delegates three matters of policy: (A) "The Role of Pharmacists in Public Health Awareness," (B) "Pharmaceutical Care and Medication Distribution Systems," and (C) "Pharmacy Practice Precautions Related to HN Infection."
AMERICAN PHARMACY
Feb ruary 1992/154 Vol. NS32, No .2
• Encourage employers to develop policies and procedures on infection control. • Assert that HN-infected pharmacy personnel should be given "confidential consultation and reasonable accommodation." Encourage professional support networks and other outreach programs for HN-infected individuals.
Other Proposed Policies The House of Delegates will also consider policies that call for APhA to: • Support granting pharmacists continuing education credit for completing relevant education programs offered by other health-related professions. • Support the pharmacist's role in selecting appropriate drug packaging and recognize the value of unit-of-use
review of current scientific information and guidelines. Health establishments and organizations should assist in providing such education. 3. APhA encourages employers to develop policies and procedures regarding infection control, and the need for disclosure based on scientific knowledge and guidelines from appropriate organizations. 4. APhA believes that confidential consultation and reasonable accommodation should be provided to infected pharmacy personnel concerning their profeSSional activities. Pharmacy personnel should not participate in procedures that pose a risk for pharmacy personnel-to-patient transmission of infection. 5. APhA encourages profeSSional support networks and other outreach efforts to develop programs for HN-positive health care professionals.
Policy Committee on Scientific Affairs Members: Steven H. Zlotnick, chairman, Mario F. Sylvestri, vice chairman, Todd A. Edgar, John P. Juergens, Anna C. .Kowblansky, 1. Douglas Ried,Mary Walbridge. The Policy Committee on Scientific Affairs considered and recommended to the House of Delegates one matter of policy: (A) "Drug Product Packaging." In addition, the committee considered two other matters for which the committee determined it would not recommend policy to the.House of Delegates. Regarding (B) "State-Level Restriction on Medication Use and Patient Care" and (C) "The
VoL NS32, No. 2 February 1992/155
packaging, while opposing its exclusive use. • Support the use of new health technologies-such as computerized patient information-to enhance the pharmacist's ability to provide pharmaceutical care, but assert that such technology should not interfere with the patient-pharmacist relationship. • Recognize the unique role and accessibility of the pharmacist in public health and encourage pharmacists to provide services, education, and information on public health issues. • Encourage schools and colleges of pharmacy to ensure that students receive a balanced general education that provides the skills necessary to be educated citizens and competent health care professionals. Sara Martin is associate editor, American Pharmacy.
Pharmacist's Role in Drug Development," the committee opted, in lieu of recommending policy, to transmit its suggestions for nonpolicy-related actions directly to the APhA Board of Trustees for consideration. A. Drug Product Packaging
The committee recommends that the Association adopt the following policies: 1. APhA supports the role of the pharmacist to select appropriate drug product packaging. 2. APhA recognizes the potential value of unit-of-use packaging to enhance pharmaceutical care, but opposes its exclusive use. 3. APhA encourages the pharmaceutical industry to perform compatibility and stability testing of drug products in officially approved patient use containers to assist pharmacist selection of appropriate drug product packaging.
B. State-Level Restrictions on Medication Use and Patient Care The c01nmittee recommends that the Association adopt no policy.
c. The Pharmacist's Role in Drug Development The committee ..recommends that the Association adopt no policy.
AMERICAN PHARMACY
