News
made use of disposable supplies and equipment whenever possible. Mehta said Emory staff was trained in “donning and doffing” personal protective equipment (PPE), and a team member observed the process each time it was performed in the unit. “Removing the PPE properly was the key to preventing contamination,” Mehta said. But he noted that “some complacence” among staff in the donning and doffing of PPE was observed over time and had to be addressed. According to Emory’s website, hospital staff were trained to use face masks and goggles when caring for the Ebola virus–infected patients but instead used powered air-purifying respirators even though the virus is not transmitted in the air. The hospital stated that this equipment was used because it is more comfortable to wear for long periods than a mask and goggles. A small laboratory was quickly built for the isolation unit, which Mehta said was convenient but not a necessity and helped to ensure that Emory’s regular laboratory services weren’t interrupted for Ebola virus–related work. A disadvantage to the dedicated lab, he said, was that only “a very limited testing panel” was available to clinicians. Laboratory testing for both patients revealed “very marked electrolyte abnormalities,” including hypokalemia, hypocalcemia, hyponatremia, and nutritional deficiencies, Mehta said. He said the ability to provide “highlevel nursing and supportive care” around the clock to the patients likely had a “significant impact” on survival. Both patients were discharged from the hospital in mid-August. Emory has since cared for a third humanitarian worker with EVD who was evacuated from West Africa. The hospital’s website states that being prepared for and receiving such patients will be the “new normal” at Emory. A fourth patient received treatment for EVD in the biocontainment unit at the Nebraska Medical Center in Omaha
after being evacuated from Liberia in early September. He was released from the hospital in late September. At presstime, a patient who had been exposed to the virus was being monitored in isolation at the National Institutes of Health’s Clinical Center in Bethesda, Maryland.
Also at presstime, the first patient to be diagnosed with EVD while in the United States was being treated at Texas Health Presbyterian Hospital Dallas. —Kate Traynor DOI 10.2146/news140073
Winckler shares views on pharmacy’s rules of the road
F
or pharmacy practice in today’s evolving healthcare landscape, both the journey and the destination matter, says Susan C. Winckler, managing partner of Leavitt Partners in Washington, D.C., and the presenter of the 2014 William A. Zellmer Lecture. The destination Winckler referred to is a healthcare system that rewards outcomes instead of paying on the basis of the volume of care received. “The emergence of value-based payments presents a new situation, a situation where we must find that right balance at the intersection of policy and professional responsibility,” Winckler said. At that intersection, she said, “the right patient receives the right drug at the right time but with it understood that we’re empowered to make that medication work—to lower their cholesterol, treat their depression; to someday reduce the symptoms and progress of Alzheimer’s disease.” The Zellmer Lecture has been presented annually since 2010 by a pharmacist who has demonstrated exceptional leadership in national healthcare policy to improve the safety and effectiveness of medication use.
The lecture, delivered during ASHP’s annual Policy Week to a crowd of pharmacists from across the nation, gives the presenters the opportunity to express their personal views on the interface between public policy and pharmacy practice. Winckler, former chief executive officer of the Food and Drug Law Institute and former FDA chief of staff, has a long history of service and leadership in public policy at the national level. During her September 16 remarks in Bethesda, Maryland, Winckler said the journey to value-based care requires pharmacists to follow the profession’s “rules of the road” while making individual decisions about the best way to reach the destination.
Photo courtesy of Mig Dooley Photography
Continued from page 1823
Susan C. Winckler
Am J Health-Syst Pharm—Vol 71 Nov 1, 2014
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“Public policy is the road, the rules, and the environment. Professional responsibility is how we operate within it,” she said. Specific healthcare goals may be accomplished through policy in combination with professional judgment, but how the two are balanced affects the ability to meet those goals. For example, Winckler asked, if a hospital wants to implement an antimicrobial stewardship program, “is that need best met by pursuing an amendment to state law to require that a pharmacist provide such services?” Or, she asked, is the “preferred route” a group effort at the hospital level that maximizes the contributions of each member of the healthcare team? Winckler said state regulation of pharmacy practice often differs from rules that govern other healthcare professions. “In defining the pharmacist’s scope of practice, our profession has chosen a very detailed, step-by-step structure that can be quite restrictive,” while state medical practice acts are generally shorter and provide physicians “wide discretion in how best to care for their patients,” she said. A glance at guidance from regulatory boards that govern pharmacy and medicine bears out Winckler’s assertion. The Federation of State Medical Boards’ Medical Practice Acts: A Guide to the Essentials of a Modern Medical Practice Act is a 35-page document whose recommendations assist states in the updating of their medical practice acts. The Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy, in contrast, is a 280-page document that contains specific language to include in pharmacy practice acts. “In a nutshell, state medical practice acts define the practice of medicine as everything that the physician would like to do to care for the patient,” including the incorporation of new technologies and medical advances into patient care, Winckler said. Pharmacy practice acts, instead, generally encourage pharmacists to practice within their comfort zone.
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“We know our role, where to turn, where to hit the gas,” Winckler said. She said neither approach to crafting or changing a practice act is right or wrong. But if the pharmacy profession wants to change state practice acts, individual pharmacists must participate in making public policy. Winckler said pharmacy’s process for “lifelong learning” illustrates an emphasis on professional responsibility that enhances pharmacists’ ability to meet patients’ needs without relying heavily on proscriptive public policy. “While most state regulators require a designated number of continuing pharmacy education units, the form of those specific credits is somewhat less proscribed. This is where we have a responsibility to engage in securing education that advances our practices and what is most important for us” to respond to patient care challenges, she said.
Winckler concluded her remarks by challenging Policy Week attendees to find the right balance between public policy “guardrails” and professional responsibilities that empower pharmacists. Winckler’s remarks will appear in full in a future issue of AJHP. The lecture series is supported by the ASHP Foundation’s William A. Zellmer Lecture Fund. Zellmer retired from ASHP in 2009 after nearly 40 years with the organization, including serving as chief of what is now ASHP’s Office of Policy, Planning and Communications. Zellmer wrote many essays on key issues affecting pharmacy practice, including numerous editorials in AJHP written during and after his tenure as editor of the journal. —Kate Traynor DOI 10.2146/news140074
Pharmacist supporter Ron Anderson dies at 68
R
on J. Anderson, M.D., a 2003 recipient of the ASHP Board of Directors Award of Honor and a director-at-large for the ASHP Foundation in 2005–09, died of cancer on September 11. He was 68 years old. For 29 years, Anderson served as the president and chief executive officer (CEO) of Dallas County’s Parkland Health & Hospital System, one of the nation’s largest public teaching hospitals. He was elected to the Institute of Medicine (IOM) in 1987. In 2004, three years after IOM released the report Crossing the Quality Chasm: A New Health System for the 21st Century, Anderson served on the committee that planned the Crossing the Quality Chasm Summit. He was named by Modern Physician magazine as among the 50 most powerful
Am J Health-Syst Pharm—Vol 71 Nov 1, 2014
physician executives for five consecutive years, starting in 2005. Throughout his years as a physician and executive, Anderson maintained the pharmacist license he obtained in 1969 after graduation from the Southwestern Oklahoma State University School of Pharmacy in Weatherford. He worked as a pharmacist on weekends and in the summers during his first two years in medical school. The ASHP Board of Directors accorded Anderson its Award of Honor in recognition of his support of pharmacists’ role in ensuring that patients receive optimal benefits from their medications. ASHP CEO Paul W. Abramowitz said, “I met Dr. Anderson shortly after he became Parkland’s CEO. He was a leader who early on publicly supported the role
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
made use of disposable supplies and equipment whenever possible. Mehta said Emory staff was trained in “donning and doffing” personal protective equipment (PPE), and a team member observed the process each time it was performed in the unit. “Removing the PPE properly was the key to preventing contamination,” Mehta said. But he noted that “some complacence” among staff in the donning and doffing of PPE was observed over time and had to be addressed. According to Emory’s website, hospital staff were trained to use face masks and goggles when caring for the Ebola virus–infected patients but instead used powered air-purifying respirators even though the virus is not transmitted in the air. The hospital stated that this equipment was used because it is more comfortable to wear for long periods than a mask and goggles. A small laboratory was quickly built for the isolation unit, which Mehta said was convenient but not a necessity and helped to ensure that Emory’s regular laboratory services weren’t interrupted for Ebola virus–related work. A disadvantage to the dedicated lab, he said, was that only “a very limited testing panel” was available to clinicians. Laboratory testing for both patients revealed “very marked electrolyte abnormalities,” including hypokalemia, hypocalcemia, hyponatremia, and nutritional deficiencies, Mehta said. He said the ability to provide “highlevel nursing and supportive care” around the clock to the patients likely had a “significant impact” on survival. Both patients were discharged from the hospital in mid-August. Emory has since cared for a third humanitarian worker with EVD who was evacuated from West Africa. The hospital’s website states that being prepared for and receiving such patients will be the “new normal” at Emory. A fourth patient received treatment for EVD in the biocontainment unit at the Nebraska Medical Center in Omaha
after being evacuated from Liberia in early September. He was released from the hospital in late September. At presstime, a patient who had been exposed to the virus was being monitored in isolation at the National Institutes of Health’s Clinical Center in Bethesda, Maryland.
Also at presstime, the first patient to be diagnosed with EVD while in the United States was being treated at Texas Health Presbyterian Hospital Dallas. —Kate Traynor DOI 10.2146/news140073
Winckler shares views on pharmacy’s rules of the road
F
or pharmacy practice in today’s evolving healthcare landscape, both the journey and the destination matter, says Susan C. Winckler, managing partner of Leavitt Partners in Washington, D.C., and the presenter of the 2014 William A. Zellmer Lecture. The destination Winckler referred to is a healthcare system that rewards outcomes instead of paying on the basis of the volume of care received. “The emergence of value-based payments presents a new situation, a situation where we must find that right balance at the intersection of policy and professional responsibility,” Winckler said. At that intersection, she said, “the right patient receives the right drug at the right time but with it understood that we’re empowered to make that medication work—to lower their cholesterol, treat their depression; to someday reduce the symptoms and progress of Alzheimer’s disease.” The Zellmer Lecture has been presented annually since 2010 by a pharmacist who has demonstrated exceptional leadership in national healthcare policy to improve the safety and effectiveness of medication use.
The lecture, delivered during ASHP’s annual Policy Week to a crowd of pharmacists from across the nation, gives the presenters the opportunity to express their personal views on the interface between public policy and pharmacy practice. Winckler, former chief executive officer of the Food and Drug Law Institute and former FDA chief of staff, has a long history of service and leadership in public policy at the national level. During her September 16 remarks in Bethesda, Maryland, Winckler said the journey to value-based care requires pharmacists to follow the profession’s “rules of the road” while making individual decisions about the best way to reach the destination.
Photo courtesy of Mig Dooley Photography
Continued from page 1823
Susan C. Winckler
Am J Health-Syst Pharm—Vol 71 Nov 1, 2014
1827
News
“Public policy is the road, the rules, and the environment. Professional responsibility is how we operate within it,” she said. Specific healthcare goals may be accomplished through policy in combination with professional judgment, but how the two are balanced affects the ability to meet those goals. For example, Winckler asked, if a hospital wants to implement an antimicrobial stewardship program, “is that need best met by pursuing an amendment to state law to require that a pharmacist provide such services?” Or, she asked, is the “preferred route” a group effort at the hospital level that maximizes the contributions of each member of the healthcare team? Winckler said state regulation of pharmacy practice often differs from rules that govern other healthcare professions. “In defining the pharmacist’s scope of practice, our profession has chosen a very detailed, step-by-step structure that can be quite restrictive,” while state medical practice acts are generally shorter and provide physicians “wide discretion in how best to care for their patients,” she said. A glance at guidance from regulatory boards that govern pharmacy and medicine bears out Winckler’s assertion. The Federation of State Medical Boards’ Medical Practice Acts: A Guide to the Essentials of a Modern Medical Practice Act is a 35-page document whose recommendations assist states in the updating of their medical practice acts. The Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy, in contrast, is a 280-page document that contains specific language to include in pharmacy practice acts. “In a nutshell, state medical practice acts define the practice of medicine as everything that the physician would like to do to care for the patient,” including the incorporation of new technologies and medical advances into patient care, Winckler said. Pharmacy practice acts, instead, generally encourage pharmacists to practice within their comfort zone.
1828
“We know our role, where to turn, where to hit the gas,” Winckler said. She said neither approach to crafting or changing a practice act is right or wrong. But if the pharmacy profession wants to change state practice acts, individual pharmacists must participate in making public policy. Winckler said pharmacy’s process for “lifelong learning” illustrates an emphasis on professional responsibility that enhances pharmacists’ ability to meet patients’ needs without relying heavily on proscriptive public policy. “While most state regulators require a designated number of continuing pharmacy education units, the form of those specific credits is somewhat less proscribed. This is where we have a responsibility to engage in securing education that advances our practices and what is most important for us” to respond to patient care challenges, she said.
Winckler concluded her remarks by challenging Policy Week attendees to find the right balance between public policy “guardrails” and professional responsibilities that empower pharmacists. Winckler’s remarks will appear in full in a future issue of AJHP. The lecture series is supported by the ASHP Foundation’s William A. Zellmer Lecture Fund. Zellmer retired from ASHP in 2009 after nearly 40 years with the organization, including serving as chief of what is now ASHP’s Office of Policy, Planning and Communications. Zellmer wrote many essays on key issues affecting pharmacy practice, including numerous editorials in AJHP written during and after his tenure as editor of the journal. —Kate Traynor DOI 10.2146/news140074
Pharmacist supporter Ron Anderson dies at 68
R
on J. Anderson, M.D., a 2003 recipient of the ASHP Board of Directors Award of Honor and a director-at-large for the ASHP Foundation in 2005–09, died of cancer on September 11. He was 68 years old. For 29 years, Anderson served as the president and chief executive officer (CEO) of Dallas County’s Parkland Health & Hospital System, one of the nation’s largest public teaching hospitals. He was elected to the Institute of Medicine (IOM) in 1987. In 2004, three years after IOM released the report Crossing the Quality Chasm: A New Health System for the 21st Century, Anderson served on the committee that planned the Crossing the Quality Chasm Summit. He was named by Modern Physician magazine as among the 50 most powerful
Am J Health-Syst Pharm—Vol 71 Nov 1, 2014
physician executives for five consecutive years, starting in 2005. Throughout his years as a physician and executive, Anderson maintained the pharmacist license he obtained in 1969 after graduation from the Southwestern Oklahoma State University School of Pharmacy in Weatherford. He worked as a pharmacist on weekends and in the summers during his first two years in medical school. The ASHP Board of Directors accorded Anderson its Award of Honor in recognition of his support of pharmacists’ role in ensuring that patients receive optimal benefits from their medications. ASHP CEO Paul W. Abramowitz said, “I met Dr. Anderson shortly after he became Parkland’s CEO. He was a leader who early on publicly supported the role
Copyright of American Journal of Health-System Pharmacy is the property of American Society of Health System Pharmacists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
