Pharmacy Practice
Joey Sweeney, PharmD, BCPS
The American Society of Health-System Pharmacists (ASHP) recently published its Practice Advancement Initiative (PAI) 2030, which looks forward to the coming decade and changes to pharmacy practice within both acute and ambulatory settings of health systems. The PAI evolved from ASHP’s Pharmacy Practice Model Initiative (PPMI), a guide published in 2010 on the future of pharmacy practice within health systems.
The past decade of the PPMI/PAI forecasted and saw the rise of new practices in transitions of care. At patient admission, pharmacy staff often perform medication histories and review medications ordered against this history. At discharge, pharmacy staff compare the medication history, the inpatient medications ordered, and the medications ordered at discharge.
These two tasks alone have resulted in reductions in medication errors across the continuum of care that went uncorrected prior to the publication of the PPMI/PAI.
A paradigm shift?
As we consider the PAI 2030 document, it is important to realize that many of its recommendations may result in similar paradigm shifts to medication error reductions and quality of life improvements for patients. As the past decade has illustrated, allowing pharmacy practice to evolve is of paramount importance to our patients and the profession at large.
PAI 2030 was not created in a vacuum. ASHP organized an advisory panel comprising 15 members and compelled it to discuss PAI during a strategic planning event. Next, the group collected feedback during town hall meetings over the summer of 2019 and during a public comment period. Finally, the ASHP Board of Directors approved the PAI.
Five domains
At the start of the process, there were 172 initial recommendations, which were refined until the board approved a final list of 59 recommendations in the last step. These 59 recommendations are divided into five domains:
- Patient-centered care
- Pharmacist role, education, and training
- Technology and data science
- Pharmacy technician role, education, and training
- Leadership in medication use and safety
Each of these five domains is further broken down into practice-focused, organization-focused, and profession-focused subdomains.
Patient-centered care
In the practice-focused subdomain of patient-centered care, the theme is collaboration. Collaboration among pharmacy staff and other stakeholders in patient care aims to create seamless transitions of care. This means pharmacy staff should collaborate with patients, their families, and other caregivers. Documentation of pharmacy services rendered should be available to other caregivers within the health care team and not limited to a pharmacy silo. This also means patients should have access to a pharmacist in all care settings.
The organization-focused subdomain recommends that pharmacy staff in all care settings should have access to an integrated health care record for each patient. In addition, health systems should provide 24/7 pharmacy services to all patients they serve, including small/rural hospitals. Innovative support models (likely remote services) are encouraged.
Pharmacist role, education, and training
The practice-focused subdomain of pharmacist role, education, and training encourages individualized professional development, with an emphasis on prescribing. It also encourages participation in emergency response (Code 4/Code Blue) teams.
The organization-focused subdomain encourages residency training as a minimum credential for new pharmacists. It encourages pharmacy leaders to require credentialing, privileging, and board certifying to ensure pharmacists have appropriate competency in their scope(s) of practice.
The profession-focused subdomain encourages training that includes competence in health care finance. In addition, pharmacists should be held accountable for outcomes and population health. Ambulatory care pharmacists who are credentialed should be viewed as primary care providers. Finally, a more robust licensure should be championed by the profession.
Technology and data science
The practice-focused subdomain of technology and data science recommends that all pharmacists use technology to provide the best care. This requires training throughout the pharmacist’s entire career in analytics, automation, and other applications of technology. Pharmacy leaders should develop and implement new technologies to aid in risk assessment, performance metrics, identification of at-risk patients and their medication regimens, and business management.
The organization-focused subdomain encourages virtual care to extend services and offer better continuity of care across transitions. In addition, sufficient resources (financial and technical) are required to monitor patient care and pharmacist performance. One specific tactical recommendation is to use technology to ensure safe sterile product compounding.
The profession-focused subdomain compels pharmacies to use high reliability principles (similar to what other high-risk environments use, such as aviation and surgery). It also encourages the use of artificial intelligence in the prescribing, order review, and monitoring stages of the medication use pipeline.
Pharmacy technician role, education, and training
The practice-focused subdomain states that technicians should assume advanced roles in all practice settings with responsibility for all technical and supporting activities of pharmacy care. This would allow pharmacists currently supporting these tasks to be available for more advanced care opportunities.
The organization-focused subdomain encourages pharmacy technicians to complete an accredited training program and subsequent certification by the Pharmacy Technician Certification Board. Pharmacy leaders should create career paths and roles that allow technicians to devote their talent to the practice areas stated above.
Leadership in medication use and safety
The practice-focused subdomain encourages pharmacists to advance pharmacogenomic opportunities to enhance or implement personalized medication treatment. It also states that pharmacists should be involved as leaders in medication stewardship activities at all political levels: local, state, and national.
The organization-focused subdomain has a wide array of recommendations for leadership within a health system. The pharmacy department should be accountable for financial stewardship while providing up-to-date, evidence-based care. Burnout should be prevented by considering and supporting the well-being and resiliency of staff. Equity, diversity, and inclusion should be a priority at all levels of the department—technical, clinical, and leadership roles.
The governance structure of a health-system pharmacy should be headed by a pharmacy executive leader with a reporting structure similar to that of other executive leadership (i.e., having pharmacy leaders report to an individual who has expertise within pharmacy, instead of an unrelated clinical executive leader).
The profession-focused subdomain outlines how pharmacists should be involved to ensure pharmacy services are appropriately valued and paid for by impacting change at the state and federal regulatory levels. By being involved in defining national quality indicators and accountability measures, pharmacists will impact legislative and regulatory policy development that improves health outcomes for individuals and populations. Being involved with interprofessional organizations is also required to effect these changes.
A robust document for change
The PAI 2030 is a robust document that sets a strategic tone for the direction of health-system pharmacy over the next decade. Its recommendations were created via the combined wisdom of the pharmacist crowd approach. As such, the document is filled with consensus-derived directions the profession will move toward.
This past decade has seen a huge amount of progress in the practice of pharmacy guided by ASHP’s PPMI/PAI documents. The next decade will continue to see the progression of more advanced pharmacy services that will be guided by PAI 2030. Put on your sunglasses—the future looks bright!