Consolidated materials...2016-04: The Roles of the Pharmacy Technician CSHP recognizes that highly trained and skilled pharmacy technicians working in advanced roles regularly perform

HOUSE OF DELEGATES 2017 Consolidated materials

TABLE OF CONTENTS

SERIAL NUMBER

HEADING PAGE NO.

1. House of Delegates 2017 Agenda-------------------------------------------------------------------------- 42. Delegate Roster------------------------------------------------------------------------------------------------- 63. Proposals for the House of Delegates--------------------------------------------------------------------- 10

Proposal A: Pharmacy Technicians and Interns----------------------------------------- 10 A.1: Pharmacy Tech Training ----------------------------------------------------------------------------- 12 A.2: Career Opportunities for Pharmacy Technicians----------------------------------------------- 16 A.3: Pharmacy Intern--------------------------------------------------------------------------------------- 20

Proposal B: Leadership and Professional Development---------------------------------------- 23 B.1: Leadership Development--------------------------------------------------------------------------- 25 B.2: Inter professional Education----------------------------------------------------------------------- 31 B.3: Cultural Competency-------------------------------------------------------------------------------- 34 B.4: Timely Board of Pharmacy Licensing------------------------------------------------------------ 38

Proposal C: Pharmacy Therapeutics and Distribution-------------------------------- 43 C.1: Promotion of Off-Label Uses---------------------------------------------------------------------- 45 C.2: Home IV Therapy-------------------------------------------------------------------------------------- 49 C.3: Tobacco Products and Electronic Nicotine Devices------------------------------------------- 52 C.5: Safety of Epidural Steroid Injections------------------------------------------------------------- 55 C.6: Controlled Substance Diversion------------------------------------------------------------------- 58 C.7: Therapeutic Indication in CDS--------------------------------------------------------------------- 62 C.9: Automated Preparation and Dispensing Tech for Sterile Preps--------------------------- 66

Proposal D: Review 5 years older CSHP Professional policies---------------------- 69 D.1: Sports Pharmacy-------------------------------------------------------------------------------------- 71 D.2: Computerized Prescriber Order Entry----------------------------------------------------------- 74 D.3: Non-Pharmacist and Prescriber Dispensing---------------------------------------------------- 77 D.4: Recovering Pharmacy Professionals-------------------------------------------------------------- 79 D.5: Pharmacist Involvement in Student Pharmacist Education---------------------------------- 81 D.6: Productivity Measurement Systems--------------------------------------------------------------- 84 D.7: Technician Regulations-------------------------------------------------------------------------------- 87 D.8: Repackaging of Pharmaceuticals for Distribution----------------------------------------------- 91 D.9: Safe Handling of Cytotoxic and Hazardous Drugs----------------------------------------------- 93 D.10: Nuclear Pharmacy------------------------------------------------------------------------------------- 95 D.11: Increased Security Features on Controlled Substances Prescription Form------------- 97

Proposal E: 2018 Committee on Nominations and Leadership development---- 100 4. Resolutions

101 Resolution-A: Change to the composition of the California Board of Pharmacy: Pending legislation SB 716-------------------------------------------------- Resolution-B: Mandatory Labeling of the Presence of Natural Rubber Latex in

Medications-------------------------------------------------------------------- 109

Resolution-C: Preventing Exposure to Allergens in Medications--------------------- 111

114 Resolution-D: Excipients in Medications--------------------------------------------------- Resolution-E: Safe and Effective Use of Medications in Pediatric and

Neonatal Patients------------------------------------------------------------- 117

5. Rules of Procedure to the House of Delegates---------------------------------------------------------- 120

CSHP Bylaws------------------------------------------------------------------------------------------------- CSHP Professional Policy Catalog Yr 2012-2016---------------------------------------------------- CHSP Policy Development Process--------------------------------------------------------------------- CSHP Stragtegic Priorities 2017-2021----------------------------------------------------------------- HOD Forms--------------------------------------------------------------------------------------------------- STP- Decision Making for Effective Action----------------------------------------------------------- STP Template----------------------------------------------------------------------------------------------- Delegate Orientation Presentation-------------------------------------------------------------------- 2017 Election Slate----------------------------------------------------------------------------------------- Committee Council and Task Force (CCTF’s) Reports---------------------------------------------- House of Delegates 2016 Report-----------------------------------------------------------------------

6. How to participate in the House of Delegates---------------------------------------------------------- 123

7. Summary of RRobert's RRules of OOrder---------------------------------------------------------------------- 131

8. Links to other supporting materials---------------------------------------------------------------------------- 134

A g e n d a H o u s e o f D e l e g a t e s O c t o b e r 2 9 , 2 0 1 7 P a g e | 4

AGENDA FOR THE 2017 CSHP HOUSE OF DELEGATES (HOD) Concorde A, Paris Hotel, Las Vegas, Nevada

Sunday, October 29, 2017 10:00AM to 12:30PM

I. Call to Order (Hanni, Chair HOD)

II. Roll Call and Quorum (Hanni, Chair HOD/ DeMartini CEO)

III. Introductions (Hanni, Chair HOD)A. Head tableB. Board of DirectorsC. Honored GuestsD. Parliamentarian

IV Approval of Minutes from 2016 House of Delegates (Hanni, Chair HOD)

V Reports (Hanni, Chair HOD) A. Blue Ribbon Committee (William Yee)B. 2017 Committee on Nominations (Tran-Pugh)

VI Proposals

Proposal A: Pharmacy Technicians and Interns

A.1: Pharmacy Tech Training

A.2: Career Opportunities for Pharmacy Technicians

A.3: Pharmacy Intern

Proposal B: Leadership and Professional Development

B.1: Leadership Development

B.2: Inter professional Education

B.3: Cultural Competency

B.4: Timely Board of Pharmacy Licensing

Proposal C: Pharmacy Therapeutics and Distribution

C.1: Promotion of Off-Label Uses

C.2: Home IV Therapy

C.3: Tobacco Products and Electronic Nicotine Devices

C.5: Safety of Epidural Steroid Injections

C.6: Controlled Substance Diversion

C.7: Therapeutic Indication in CDS

C.9: Automated Preparation and Dispensing Tech for Sterile Preps

A g e n d a H o u s e o f D e l e g a t e s O c t o b e r 2 9 , 2 0 1 7 P a g e | 5

Proposal D: Review 5 years older CSHP Professional policies

D.1: Sports Pharmacy

D.2: Computerized Prescriber Order Entry

D.3: Non-Pharmacist and Prescriber Dispensing

D.4: Recovering Pharmacy Professionals

D.5: Pharmacist Involvement in Student Pharmacist Education

D.6: Productivity Measurement Systems

D.7: Technician Regulations

D.8: Repackaging of Pharmaceuticals for Distribution

D.9: Safe Handling of Cytotoxic and Hazardous Drugs

D.10: Nuclear Pharmacy

D.11: Increased Security Features on Controlled Substances Prescription Form

Proposal E: 2018 Committee on Nominations and Leadership development

VII Resolutions

Resolution-A: Change to the composition of the California Board of Pharmacy: Pending legislation SB 716

Resolution-B: Mandatory Labeling of the Presence of Natural Rubber Latex in Medications

Resolution-C: Preventing Exposure to Allergens in Medications

Resolution-D: Excipients in Medications Resolution-E: Safe and Effective Use of Medications in Pediatric and

Neonatal Patients

VIII New Business

IX Delegate Recommendations

X Inauguration A. Chairperson of the BoardB. President

XI Recognition of Outgoing Directors and Officers

XII Announcements

XIII Adjournment

Page | 6 2017 HOUSE OF DELEGATES-ROSTER

2017 HOUSE OF DELEGATES DELEGATE ROSTER AS OF 10/3/2017

Officers and Directors:

Jeannette Hanni, Chair of the House Victoria Ferraresi, President Daniel Dong, President-Elect Kethen So, Chair of the Board Pauline Chan, Treasurer Loriann DeMartini CEO, Secretary

Annet Arakelian, Director Donna Fitzgerald, Technician Director Elaine Law, Director Gary Besinque, Director Jennifer M Cashman, Director Jim Walsh, Director Marcie Lepkowsky, Director Mirta Millares, Director Nicole Y. Nguyen, Director Norman Fox, Director

Past Presidents Delegates:

Alan Endo (San Gabriel Valley) Brian Hodgkins (Inland) Christine M. Antczak (Central Valley) David Adler (San Diego) Donald Kishi (Diablo) Eric Herfindal (Golden Gate) Fran Hopkins (Southern California) Frank Saya (San Gabriel Valley) Glenn Yokoyama (Golden Gate) Jay P. Rho (Southern California) Julie Lenhart (Diablo) Kenneth Horowitz (South Bay/Long Beach) Kenneth Reifman (San Diego) Kenneth Schell (San Diego) Mary Ann Sullivan (Golden Gate)

Nancy Korman (Golden Gate) Norman Ashcraft (Sacramento Valley) Paul LeSage (North Coast) Patricia New (Quatra County) Peter Solyom (San Diego) Robert Ignoffo(Golden Gate) Robert Miller (San Diego) Robert Mowers (Sacramento Valley) Sam Shimomura (Orange County) Scott Takahashi (San Gabriel Valley) Stacey Raff (Golden Gate) Steve Litsey (Southern California) Steven Gray (Inland) Terry Hashimoto (San Fernando Valley) Virginia White (Sacramento Valley) William Yee (Central Valley)

Parliamentarian:

Maria D. Serpa


Affiliate/Student Chapter Delegate Alternate Delegate California Northstate University (1) Que Huynh Nelson Chu

Chapman University (1) Jaylene Lu Christopher Vu

Central Valley (3) Andrea Hinton Yvonne My-Y Mai Stephanie Ham

Greg Matsumura

CHSU (1) Kc Yovino Hayley (Shuman) Madson Olutosin Falade Jankhna Yadav Giovauna Alberre

Diablo (9) Lester Wong Grace Ng Natalie Fan Johnny W Wong Alfonso Becerra Keith Yoshizuka Lucian Cheng Edlen Wong Yolanda Dickey

May Wapniarski Linda Kan Huey Anh Do Frank Choy Derek Dwinell

Golden Empire (2) Elliott Asarch Jerry Fujiwara

Jim Caras

Golden Gate (7) Bonnie Fabian Michael Trillanes Johnny Rau Sylvia Stofella Andrew Delaunay Philip Kong Janet Kwon

Bao Dao Andy Wong Mackenzie Clark

Inland (4) Bill Templeman Guy Ito Dale Timothy Kristine Parbuoni

Sarah Hur

KGI (1) Junel Tagayuna Zainab Hameed

Loma Linda Student Chapter (2) Christian Gaoiran Rena Sackett

Chi Hau

North Coast (2) Ken Chee Robyn Richard

Kirsten Balano Judy Tran

Orange County (5) Cham Nguyen Marty Torres Robert Stein Dennis Andrew Ancheta

Anne Tran-Pugh Douglas Monroe


Jack Chen Pacific Student Chapter (2) Emily Hou

Brandon Le Quatra Country (6) Connie Ha

Helen Park Lawrence Troxell Sandra Bardas Jennifer Pham Betty Lee

Carol Lee Jenny Hong

Sacramento Valley (5) Praveen Reehal Michael Gonzales Jason Bandy Grant Lackey Jennifer Lackey

Karen Azama-Kihara

San Diego (5) Hoangmy Nguyen Therese Clark Jennifer Flyod Rebecca Kandilian Nightingale Meyou

San Fernando Valley (3) Vahe Apelian Robert Small Nogie Demirjian

San Gabriel Valley (5) Grace Chen Fred Mock Jason Chen Leslie Berina John Shin

Nancy Quon Selina Soohoo

Sierra (3) Shelly Hilliard Bethanne Carpenter Travis Pham

Gillian Pineda

South Bay/Long Beach (5) Steven Thompson Angela Lee Tim Chou Rosalin Preechakul Cindy Odegard

Lisa Gunther Lum

Southern California (7) Mei Wong John sang Trinh Nguyen Joanna Lee Britt Christensen Megan Besinque Kathleen Besinque

Hector Delgado Jen Leung Willie Quan

Touro University Student Chapter (2) Tatiana Ouabo Mylien Hoang

Brienna Andrews Cindy Nguyen

UCSD Student Chapter (2) Lucy Chen Allison Cid

John (Byungho)Wang


UCSF Student Chapter (2) Alexi Kimura Jasper Hai

Carol Ou Brian Ma

USC Student Chapter (2) Sandy On Kara Onouye

Allison Hy Devin Panlasigui

Western University Student Chapter (2) Hong Kong Tran Angineh Moradi Masihi

Hou Su Chien Allison Lee

PTEL (2) Tom Harper Richard Nunez

Rachael Ortiz

CPhA (2) Vinson Lee Ethan Huynh

Total Delegates: 138

CALIFORNIA SOCIETY OF HEALTH-SYSTEM PHARMACISTS PROPOSAL IN STP FORMAT

Proposal A P a g e | 10

PROPOSAL A

PROPOSAL: Proposals Related to Technicians and Interns

SUBMITTED BY: Board of Directors

DATE SUBMITTED: October 2, 2014

SITUATION:

1. CSHP professional policies are developed from recommendations (from the House of Delegates),resolutions (from members) and from the work of committees and task forces.

2. The Board of Directors also reviews ASHP policies & other guidance documents for consideration asCSHP Professional Policy.

3. During this process, CSHP’s professional policy catalogue is checked for policies relating to the topicunder review.

4. The large number of proposals thus created lends itself to grouping by topic to facilitateconsideration by the House of Delegates.

TARGET:

1. CSHP provides resources to its members, their patients and the public per the 2017 Strategic Plan.

2. CSHP develops professional policy in congruence with other professional organizations, but adoptspolicy as an independent professional society.

3. CSHP’s professional policies accurately reflect current practice and professional standards.

PROPOSAL:

To adopt as CSHP professional policy:

Proposal A - Proposals Related to Technicians and Interns

• A1:

To Delete CSHP policies: 2012-09 “Technician Regulations”, 2013-10 “TechnicianAccreditation” and 2013-31 “Qualifications of Pharmacy Technicians in Advanced Roles”

To Adopt CSHP policy, Statement on the Roles of Pharmacy Technicians

• A2 :

To Adopt CSHP Policy, Career Opportunities for Pharmacy Technicians


Proposal A P a g e | 11

PROPOSAL A

• A3:

To Adopt the modified CSHP Policy 2013-18, Pharmacy Intern Positions

CSHP BOARD ACTIONS: The CSHP Board of Directors has approved these proposals for consideration by the 2017 House of Delegates


P r o p o s a l A . 1 P a g e | 12

PROPOSAL A.1

PROPOSAL: Pharmacy technician training and certification


DATE: October 4, 2017

SITUATION:

1. CSHP Professional Policy #2015-04 directs CSHP to adopt ASHP policies and other guidancedocuments as CSHP Professional Policy

2. Adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all officialStatements in the current edition of the Best Practices for Health-System Pharmacy of the ASHP,

except when such policies differ substantially from CSHP policy.

3. Endorse the use of ASHP Position Statements, Guidelines, and Technical AssistanceBulletins by its members in their practice settings.

4. CSHP will review all ASHP Policy Positions by 2020 for possible adoption as CSHP ProfessionalPolicy.

5. CSHP has policy 2012-09 on Technician Regulations.

6. CSHP has policy 2013-10: Technician AccreditationSource: HOD 1983(Note: This is former policy #8303 approved by the HOD in 1983; reaffirmed by the HOD in 1992 aspolicy #9218; reaffirmed by the HOD in 1997 as policy #9703; modified and reaffirmed by the HODin 1998 as policy #9808; modified and reaffirmed by the HOD in 2003 as policy #2003-12;reaffirmed by the HOD in 2008 as policy #2008-10; and reaffirmed by the HOD in 2013 as policy#2013-10.)

To endorse the ASHP technician training program accreditation process and to inform programadministrators in California of the accreditation program and encourage them to seekaccreditation of their programs (www.ashp.org/technician).

7. CSHP has policy 2016-04: The Roles of the Pharmacy Technician

CSHP recognizes that highly trained and skilled pharmacy technicians working in advanced rolesregularly perform complex and critical medication-use procedures, and that a safe and effective

http://www.ashp.org/technician


P r o p o s a l A . 1 P a g e | 13

PROPOSAL A.1

medication-use process depends significantly on the skills, knowledge, and competency of those pharmacy technicians to perform those tasks;

CSHP reaffirms that all pharmacy technicians should complete an ASHP-accredited pharmacy technician training program, pass a psychometrically valid certification exam and be licensed by state boards of pharmacy;

CSHP supports that pharmacy technicians working in advanced roles should have additional training and should demonstrate ongoing competencies specific to the tasks to be performed;

CSHP recommends that the expansion of pharmacy technician duties into advanced roles should include consideration of potential risk to patients and that ongoing quality assurance metrics should be established to assure patient safety.

8. The 2016 ASHP House of Delegates approved ASHP policy 1609, Pharmacy Technician Training andCertification.

1609PHARMACY TECHNICIAN TRAINING AND CERTIFICATIONSource: Council on Education and Workforce DevelopmentTo advocate that Pharmacy Technician Certification Board (PTCB) certification be required for allpharmacy technicians; further,

To advocate that all pharmacy technicians maintain PTCB certification; further,

To support the position that by the year 2020, the completion of a pharmacy technician trainingprogram accredited by ASHP and the Accreditation Council for Pharmacy Education (ACPE) berequired to obtain PTCB certification for all new pharmacy technicians; further,

To foster expansion of ASHP-ACPE accredited pharmacy technician training programs.

This policy supersedes ASHP policy 1519.

RationaleThe partnership between ASHP and the Accreditation Council for Pharmacy Education (ACPE) toaccredit pharmacy technician training programs could be an important inflection point leading toprofession-wide support for uniform education, training, and credentialing of pharmacytechnicians. Such broad support may stimulate more uniform state statutes and regulationsregarding pharmacy technicians. The requirement that pharmacy technicians be graduates ofASHP-ACPE accredited training programs to be certified by the Pharmacy Technician CertificationBoard (PTCB) mirrors the profession’s approach to the education (first) and licensure (second) ofpharmacists. Consistent with this model, PTCB will, in 2020, require that an individual sitting forthe pharmacy technician certification examination be a graduate of an ASHP-ACPE accredited


P r o p o s a l A . 1 P a g e | 14

PROPOSAL A.1

training program. Although programs currently accredited by ASHP will be granted the joint accreditation, the anticipated increase in demand for enrollment in ASHP-ACPE accredited training programs will require an expansion of the number and distribution of such programs.

9. ASHP policy #1537 states: ASHP Statement on the Role of the Pharmacy Technician.

TARGET:

1. CSHP provides resources to its members, their patients, and the public per the 2017-2021 StrategicPriorities and Goals.


3. CSHP has professional polices 2012-09 Technician Regulations, 2013-10 Technician Accreditation,2013-31 Qualifications of Pharmacy Technicians in Advanced Roles which could be replaced with theStatement on the Roles of Pharmacy Technicians.

PROPOSAL:

1. Replace CSHP policy 2012-09, 2013-10, and 2013-31 with the following ASHP policy.

2. Adopt the following as CSHP professional policy,

Statement on the Roles of Pharmacy Technicians

The California Society of Health-System Pharmacists:

1. recognizes that pharmacy technicians have many different roles in a variety of health caresettings, with varying levels of responsibility and complexity, from those suitable fortechnicians just entering the workforce to advanced or specialized roles that require additionaleducation, training, experience, and competence and compensation.

2. recognizes there is a need for specialized certification of pharmacy technicians who performactivities involving higher than normal degrees of complexity and risk. Any pharmacy technicianin an area of pharmacy practice designated for specialty or advanced certification must havethe appropriate certifications successfully completed prior to practicing in that specialty area.

3. recognizes that differing roles for pharmacy technicians will require advanced education andtraining beyond that of an entry-level technician. Education and training requirements must


P r o p o s a l A . 1 P a g e | 15

PROPOSAL A.1

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 AccreditationCouncil for Pharmacy Education (ACPE) through the Pharmacy Technician AccreditationCommission (PTAC) as a requirement for earning PTCB certification or equivalent certification.A process should be developed to allow for grandfathering of qualified technicians.

5. supports that pharmacy technicians have eitherbe PTCB or equivalent certificationed as aprerequisite to licensure by the California Board of Pharmacy and maintain their certificationthrough mandated continuing education and recertification.

RESOURCES REQUIRED FOR PROPOSED ACTION(S)

Financial: Minimal CEO time: Minimal Staff time: Minimal

CSHP BOARD ACTION: The CSHP Board of Directors approved this proposal on October 3, 2017 for consideration by the 2017 House of Delegates

ACTION:

☐ Bylaws update☐ Rules and Procedures of the House of Delegates☐ Update Administrative Policy catalog☒ Update Professional Policy catalog☐ Staff Procedural manual☐ CCTF’s volunteer hand book☐ Minutes only☐ Any other (please state)

HOD ACTION:


Proposal A.2 P a g e | 16

PROPOSAL A.2

PROPOSAL: To adopt ASHP Policy 1610 Career Opportunities for Pharmacy Technicians



SITUATION:

1. CSHP Professional Policy #2015-04 directs CSHP to adopt ASHP policies and other guidancedocuments as CSHP Professional Policy.

2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all officialStatements in the current edition of the Best Practices for Health-System Pharmacy of theASHP, except when such policies differ substantially from CSHP policy.

3. To endorse the use of ASHP Position Statements, Guidelines, and Technical AssistanceBulletins by its members in their practice settings.


5. CSHP has policy 2012-09 on Technician Regulations.

6. CSHP has policy 2016-04 on Statement on the Roles of Pharmacy Technicians.

7. The 2016 ASHP House of Delegates approved ASHP Policy 1610, Career Opportunities forPharmacy Technicians.

1610 CAREER OPPORTUNITIES FOR PHARMACY TECHNICIANS Source: Council on Education and Workforce Development To promote pharmacy technicians as valuable contributors to healthcare delivery; further,

To develop and disseminate information about career opportunities that enhances the recruitment and retention of qualified pharmacy technicians; further,

To support pharmacy technician career advancement opportunities, commensurate with training and education; further,



PROPOSAL A.2

To encourage compensation models for pharmacy technicians that provide a living wage.


Rationale As the responsibilities of pharmacy technicians expand and their role as a vital member of the

healthcare team is recognized, it is imperative that pharmacy technicians be well trained and competent to perform those responsibilities. Pharmacists cannot achieve their goals for quality patient care without the support of competent pharmacy technicians. To support pharmacists, it is important that pharmacy technician positions be viewed as a career option and not just a job. As such, pharmacy technicians should be given opportunities for life-long advancement and should be compensated a living wage to ensure that being a pharmacy technician is a viable career option. (For the purposes of this policy, a living wage is defined as one sufficient to provide the basic things, such as food and shelter, needed to live an acceptable life.1)

The median annual salary of pharmacy technicians in the U.S., $29,320 in 2012, falls short by approximately $5,000 per year of the median annual salaries for other health technologists and technicians.2 Pharmacy technicians do not earn as much as dental hygienists ($71,530) or radiologic technologists ($56,760).3 If a wage and benefits, commensurate with skills and responsibility, were paid to pharmacy technicians, the pharmacy profession could expect a better return on employee investment and reduced turnover rates. Improving wages and benefits would encourage workers to make a career of being a pharmacy technician and reinforce their vital role on the healthcare team.

References: 1 Merriam-Webster online (http://www.merriam-webster.com/dictionary/living wage). 2 Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-2015 Edition, Pharmacy Technicians. http://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm (accessed 2015 Jul 23). 3 US News and World Report. Best Health Care Jobs 2015, Pharmacy Technician: Salary. http://money.usnews.com/careers/best-jobs/pharmacy-technician/salary (accessed 2015 September 8).

TARGET:



http://www.merriam-webster.com/dictionary/living%20wage

http://www.bls.gov/ooh/healthcare/pharmacy-technicians.htm

http://money.usnews.com/careers/best-jobs/pharmacy-technician/salary



PROPOSAL A.2

3. CSHP has a professional policy that addresses career opportunities for pharmacy technicians.

PROPOSAL:

1. Adopt the following as CSHP Professional Policy:CAREER OPPORTUNITIES FOR PHARMACY TECHNICIANS


1. promotes pharmacy technicians as valuable contributors to healthcare delivery.

2. develops and disseminates information about career opportunities that enhances therecruitment and retention of qualified pharmacy technicians.

3. supports pharmacy technician career advancement opportunities and compensation modelsthat are, commensurate with training and education.

4. Encourages compensation models for pharmacy technicians that provide a living wage.



CSHP BOARD ACTION: The CSHP Board of Directors approved this proposal on October 3, 2017 as amended for consideration by the 2017 House of Delegates

ACTION:

☐ Bylaws update☐ Rules and Procedures of the House of Delegates☐ Update Administrative Policy catalog☒ Update Professional Policy catalog☐ Staff Procedural manual☐ CCTF’s volunteer hand book☐ Minutes only



PROPOSAL A.2

☐ Any other (please state)

HOD ACTION:



PROPOSAL A.3

PROPOSAL: Pharmacy Intern Positions



SITUATION:


2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all officialStatements in the current edition of the Best Practices for Health-System Pharmacy of the ASHP,




5. CSHP has policy 2013-18 Role of Intern Pharmacists.

#2013-18: Role of Intern Pharmacists

To advocate for changes in state practice acts and regulations that would define a scope ofpractice for intern pharmacists that is not limited to that of a pharmacy technician; further

To explore and promote new staffing models that foster expanded roles for intern pharmacists,providing work experiences that build upon their knowledge and help them develop as futurepharmacists.

6. The 2017 CPhA House of Delegates amended the Pharmacy Intern Positions policy, as follows:

Pharmacy Intern Positions

The California Pharmacists Association supports reasonable intern pharmacist ratios asdetermined by the supervising pharmacist.



PROPOSAL A.3

The California Pharmacists Association supports all pharmacists and pharmacies providing as many intern opportunities as possible, both paid and volunteer, at their place of practice so that intern pharmacists are afforded quality training experiences.

Background

The committee recommends updates to simplify and update language.

7. The California Board of Pharmacy states the following:

4114. Intern Pharmacist: Activities Permitted(a) An intern pharmacist may perform all functions of a pharmacist at the discretion of andunder the direct supervision and control of a pharmacist whose license is in goodstanding with the board.(b) A pharmacist may not supervise more than two intern pharmacists at any one time.

TARGET:



3. CSHP has an updated professional policy 2013-18, in agreement with CPhA PharmacyIntern Positions policy.

PROPOSAL:

1. Update CSHP policy 2013-18 to emphasize the need for a quality patient focus experience.

2. Adopt the following as CSHP Professional Policy:

#2013-18: Role of Intern Pharmacists


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



PROPOSAL A.3

2.1. explores 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.




ACTION:


HOD ACTION:


Proposal B P a g e | 23

PROPOSAL B

PROPOSAL: Proposals Related to Leadership and Professional Development



SITUATION:





TARGET:




PROPOSAL:


Proposal B – Leadership and Professional Development

• B1:

To Adopt the modified CSHP policy #2015-43, Leadership Development

• B2:

To Adopt the modified CSHP Policy #2014-58, Inter-professional Education and Training

• B3:


Proposal B P a g e | 24

PROPOSAL B

To Adopt the modified CSHP Policy #2015-09, Cultural Competency and Cultural Diversity



Proposal B.1 P a g e | 25

PROPOSAL B.1

PROPOSAL: Leadership Development



SITUATION:






5. CSHP has policy 2015-43 Leadership Development, 2015-67 Statement on Leadership as aProfessional Obligation, and policy 2014-61 Pharmacist Involvement in Student PharmacistEducation.

#2015-43: Leadership Development

The California Society of Health-System Pharmacists (CSHP) supports providing a leadershipdevelopment program for its members.

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, and3. Provide a grant for partial reimbursement for the selected attendees.

The individuals who complete this leadership development program will be required to serve in CSHP either as an elected officer or through the various committees for a minimum of two years and provide continuing education on the topic.



PROPOSAL B.1

#2015-67: Statement on Leadership as a Professional Obligation

CSHP approves the ASHP Statement on Leadership as a Professional Obligation. Full text of the statement is available at: http://www.aacp.org/governance/SIGS/leadershipdevelopment/Documents/Statements%20on%20Leadership %20Development%20in%20Pharmacy.pdf

#2014-61: Pharmacists Involvement in Student Pharmacist Education The California Society of Health-Systems Pharmacists:

1. Supports high standards and innovation in the practice of pharmacy. Therefore,pharmacists are encouraged to participate in the training and education of studentpharmacists through involvement with independent internship programs and/or withSchool of Pharmacy sponsored practice-based experience programs. The achievementof predetermined competencies, as well as the growth of the student as a professionalthrough the development of professional values such as integrity, ethics, leadership, andgiving back to the community should be the primary objectives of all such programs.

2. Supports structured requirements, goals, and objectives for pharmacy internshipexperiences, in alignment with requirements for introductory and advanced pharmacypractice experiences.

3. Promotes new staffing models that foster expanded roles for pharmacy interns,providing work experiences that build upon their knowledge and help them develop asfuture pharmacists.

4. Encourages pharmacists to serve as mentors to students, residents, and colleagues in amanner that fosters the adoption of:A. High professional standards of pharmacy practice,B. High personal standards of integrity and competence,C. A commitment to serve humanity,D. Analytical thinking and ethical reasoning,E. A commitment to continuing professional developmentF. Personal leadership skills.

6. The 2016 ASHP House of Delegates replaced ASHP policy 1518.

1611Developing Leadership Competencies



PROPOSAL B.1

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

To encourage leaders to seek out and mentor pharmacy practitioners in developing administrative, managerial, and leadership skills; further,

To encourage pharmacy practitioners to obtain the skills necessary to pursue administrative, managerial, and leadership roles; further,

To encourage colleges of pharmacy and ASHP state affiliates to collaborate in fostering student leadership skills through development of co-curricular leadership opportunities, leadership conferences, and other leadership promotion programs; further,

To reaffirm that residency programs should develop leadership skills through mentoring, training, and leadership opportunities; further,

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

Rationale

In their 2013 report, White and Enright anticipated a high rate in turnover of pharmacy directors and middle managers over the coming decade. Healthcare organizations must address this ongoing challenge if there are to be a sufficient number of new directors and managers to fill those positions. Factors that may contribute to a shortage of potential new leaders and managers include:

• New graduates frequently accept clinical positions or positions in drug distribution. Aftera few years, they may have a desire to assume managerial positions in health-systempharmacies, but training programs may not be convenient for them, and they may nothave the resources to obtain training.

• Health-system pharmacy management positions do not turnover often. Prospectivemanagers view those positions as unavailable for the near future, so there is littleincentive to obtain training to be ready to move into those positions.

• Job satisfaction among pharmacy managers appears low to prospective managers.• Frequent turnover in organizational administrative positions (above pharmacy) is

frustrating to pharmacy directors, because they continually need to inform newadministrators about the organization’s medication-use strengths and weaknesses andthe pharmacy department’s roles, strategic plans, and priorities for sustaining quality andmaking improvements. In those turnover circumstances, diligently achieved pharmacyservice improvements can sometimes be eroded and reversed. The ensuing frustrationcan induce pharmacy directors to depart voluntarily from management positions andmake those positions unattractive to others.



PROPOSAL B.1

• Flattening of organizational structures in healthcare organizations has eliminatednumerous managerial positions in pharmacies, leaving fewer pharmacists to serve asmentors for prospective managers. Without positive role models, it is difficult forpharmacists to gain good management experience.

• Pharmacy management positions that combine clinical and management responsibilitiessometimes allow little time for clinical work.

• Many pharmacists, even those in managerial positions, have no training in personneladministration. Skills such as conflict resolution and negotiation are rarely taught inpharmacy curricula but are very important in leadership positions.

• In some healthcare organizations, managers receive raises predicated on overallorganizational or departmental performance. However, the compensation of some staffmay be based on individual performance. These differing bases can lead to instances inwhich the compensation of those supervised is higher than that of their managers. Whenthat occurs, it can be a disincentive to individuals considering management positions.

Leadership and managerial potential in today’s student pharmacists and new graduates is as high as it has ever been, but more effort is needed to nurture that potential and develop leadership and management skills in practice. Colleges of pharmacy, state associations, residency programs, and practitioners themselves need to foster the development of leadership and management skills. ASHP can help foster leadership competencies at all levels of practice through actions such as providing education about leadership and management roles, developing Web-based resources, and facilitating networking among leaders, managers, and those aspiring to such roles.

Leadership continues to be a critical area for development, as leadership is a necessary competency in the provision of patient care. There are multiple avenues available to pharmacists for leadership development and ASHP should take the lead in fostering this effort.

TARGET:



3. CSHP has an updated professional policy 2015-43 that addresses LeadershipDevelopment, 2015-67 that supports ASHP’s Statement on Leadership as a ProfessionalObligation and policy 2014-61 that encourages pharmacists to serve as mentors tostudents, residents, and colleagues, in agreement with ASHP Policy 1611.

PROPOSAL:



PROPOSAL B.1

1. Update CSHP policy 2015-43 to incorporate the language and sentiment of policy 2015-67 andthe mentorship component of policy 2014-61.

2. Delete CSHP Policy 2015-67 and 2014-61.

3. Update policy 2015-43 to align with ASHP policy 1611.


The California Society of Health-System Pharmacists (CSHP) supports collaboration with healthcare organization leadership to foster opportunities, allocate time, and provide resources for pharmacy practitioners to move into leadership roles;


1. supports 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 developingadministrative, 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 studentleadership skills through development of co-curricular leadership opportunities, leadershipconferences, and other leadership promotion programs;

1. Reaffirms 5. support that residency programs should develop leadership skills throughmentoring, training, and leadership opportunities;

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

The California Society of Health-System Pharmacists (CSHP) supports providing a leadership development program for its members.

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



PROPOSAL B.1

3. Provide a grant for partial reimbursement for the selected attendees.

7. CSHP iIs committed to providing a leadership development programs for its members. TheIndividuals who complete this selected leadership development programs will be expected to serve in CSHP either as an elected officer or through the various committees for a minimum of two years and provide continuing education on the topic.




ACTION:


HOD ACTION:



PROPOSAL B.2

PROPOSAL: To amend CSHP Policy #2014-58 Inter-professional Education in Support of Team-Based Care Models.



SITUATION:

1. CSHP Professional Policy #2015-04 directs CSHP to adopt ASHP policies & other guidancedocuments as CSHP Professional Policy.

2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins and all official Statementsin the current edition of the Best Practices for Health-System Pharmacy of the ASHP, exceptwhen such policies differ substantially from CSHP policy.

3. To endorse the use of ASHP Position Statements, Guidelines and Technical Assistance Bulletinsby its members in their practice settings.


5. The 2016 ASHP House of Delegates approved ASHP Policy 1612 which states:

1612 Interprofessional Education and Training

Source: Council on Education and Workforce Development To support interprofessional education as a component of didactic and experiential education in Doctor of Pharmacy degree programs; further,

To support interprofessional education, mentorship, and as a part of professional development for pharmacy practitioners, student pharmacists, residents, and pharmacists. including collaboration with other disciplines to facilitate and promote programs that support this goal.; further,

To encourage and support pharmacists’ collaboration with other health professionals and healthcare executives in the development of interprofessional, team-based, patient-centered care models; further,

To foster documentation and dissemination of outcomes achieved as a result of interprofessional education of healthcare professionals.



6. CSHP has Policy #2014-58: Inter-professional Education in Support of Team-Based Care Models.

7. The content of CSHP Policy #2014-58 could be amended so that item #2 models ASHP policylanguage.

TARGET:

1. CSHP provides resources to its members, their patients, and the public per the 2017-2021Strategic Priorities and Goals.

2. CSHP develops professional policy in congruence with other professional organizations, butadopts policy as an independent professional society.

3. CSHP has professional policy on Inter-professional Education and Training.

PROPOSAL:

1. Modify CSHP Policy #2014-58: Inter-professional Education in Support of Team-Based CareModels Inter-professional Education and Training which states the California Society of Health-System Pharmacists encourages and supports pharmacists’ collaboration with other healthprofessionals and health care executives in the development of team-based, patient-centered caremodels. Toward that end,


1. supports inter-professional education as a component of didactic and experiential education inDoctor of Pharmacy degree programs.

2. supports inter-professional education, mentorship and as a part of professional developmentfor pharmacy practitioners, student pharmacists, student technicians residents, andpharmacists and technicians. including collaboration with other disciplines to facilitate andpromote programs that support this goal.

3. encourages and supports pharmacists’ collaboration with other health professionals andhealthcare executives in the development of inter-professional, team-based, patient-centeredcare models.

3 4. encourages documentation and dissemination of outcomes achieved as a result of inter-professional education of healthcare professionals.


Financial: Minimal



PROPOSAL B.2

CEO time: Minimal Staff time: Minimal


ACTION:


HOD ACTION:



PROPOSAL B.3

PROPOSAL: Cultural Competency



SITUATION:

1. CSHP Professional Policy #2015-04 directs CSHP to adopt ASHP policies andother guidance documents as CSHP Professional Policy

2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and allofficial Statements in the current edition of the Best Practices for Health-SystemPharmacy of the ASHP, except when such policies differ substantially from CSHPpolicy.

3. To endorse the use of ASHP Position Statements, Guidelines, and TechnicalAssistance Bulletins by its members in their practice settings.

4. CSHP will review all ASHP Policy Positions by 2020 for possible adoption asCSHP Professional Policy.

5. CSHP has policy #2015-09: Cultural Competency and Cultural Diversity approved by the HOD in2015.

6. ASHP has 2016 policy position #1613 Cultural Competency.

1613 Cultural Competency Source: ASHP’s Council on Education and Workforce Development

To foster the ongoing development of cultural competency within the pharmacy workforce; further, To educate healthcare providers on the importance of providing culturally congruent care to achieve quality care and patient engagement.

Rationale The United States is rapidly becoming a more diverse nation. Culture influences a patient’s



PROPOSAL B.3

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.

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 forIntervention. 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-SystPharm.2005; 1924-30.

TARGET:

1. CSHP provides resources to its members, their patients, and the public per the 2017-2021 Strategic Priorities and Goals.

2. CSHP develops professional policy in congruence with other professional organizations,but adopts policy as an independent professional society.



PROPOSAL B.3

3. CSHP has a professional policy that addresses cultural competency, 2015-09: CulturalCompetency and Cultural Diversity:

#2015-09: Cultural Competency and Cultural Diversity Source: HOD 2015 (Note: This is policy replaces #2010-09 approved by the HOD in 2015; approved by the HOD in 2015 as policy #2015-09.)


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 toachieve quality care and patient engagement;

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

PROPOSAL:

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


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 toachieve quality care and patient engagement;

3. fosters awareness of the impact that an ethnically aand culturally diverse workforce has onimproving 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.



PROPOSAL B.3

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 forIntervention. 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-SystPharm. 2005; 1924-30




ACTION:


HOD ACTION:



PROPOSAL B.4

PROPOSAL: Pharmacist Licensure



SITUATION:






5. CSHP has policy 2012-10 Pharmacist Licensure

#2012-10: Pharmacist Licensure

All applicants for pharmacist licensure in California should meet the same minimum competencystandards irrespective of category of licensure.

The California State Board of Pharmacy should maintain its competency standards for licensure;

The North American Pharmacist Licensure Examination (NAPLEX), combined witha California Practice Standard and Jurisprudence Examination (CPJE), is appropriate to test forbasic competencies essential for entry-level pharmacist practice if the examinations include, butare not limited to, testing for pharmacy principles and standards in:

1. Patient consultation skills;2. Application of clinical knowledge in a variety of patient care settings;3. Sterile and non-sterile compounding;4. Drug distribution; and5. Medication safety.



PROPOSAL B.4

6. The 2016 ASHP House of Delegates replaced ASHP policy 0612 Streamlined Licensure Reciprocitywith a new title, Timely Board of Pharmacy Licensing:

1621TIMELY BOARD OF PHARMACY LICENSING

To advocate that the National Association of Boards of Pharmacy (NABP) collaborate with boardsof pharmacy to streamline the licensure process through standardization and improve thetimeliness of application approval; further,

To advocate that NABP collaborate with boards of pharmacy and third-party vendors tostreamline the licensure transfer or reciprocity process; further,

To advocate that boards of pharmacy, grant licensed pharmacists in good standing temporarylicensure, permitting them to engage in practice, while their application for licensure transfer orreciprocity is being processed.

Rationale

Pharmacists sometimes face challenges from delays in obtaining licensure by transfer orreciprocity when moving their practice from one jurisdiction to another. Such delay may be due tothe need for boards to review pharmacists’ licensure records in all jurisdictions in which they arelicensed, administer a state pharmacy law exam, complete a criminal background check, and, insome cases, schedule an interview with the board. To address these challenges, boards ofpharmacy should allow pharmacists in good standing to immediately practice in a differentjurisdiction when they change employment or enter a residency program. Granting pharmacists, atemporary license for a period of up to six months while the board completes its review wouldhelp meet workforce demands while continuing to safeguard the public health. In some cases,pharmacists who are unable to obtain a license in a timely manner are unable to fully use theskills in which they have been trained. Without a license, the pharmacist may temporarily have tofunction as a technician or perform other tasks. For pharmacists participating in residencyprograms outside their jurisdiction of licensure, several months of their residency program canelapse before they receive licensure transfer or reciprocity. Upon completion of a year-longresidency program, many residents move to another jurisdiction to practice and have to start thetransfer or reciprocity process again.

Members in several states have reporting that in recent years boards of pharmacy have been slowto issue pharmacy licenses. This delay is especially problematic for pharmacy residents fromanother jurisdiction who rely on boards to grant them a license prior to performing in a clinicalcapacity. Given that the licensing period can take several months, this delay has presented aproblem for pharmacy residents who have a limited timeframe to successfully complete their



PROPOSAL B.4

duties, typically one year. In some cases, state boards are urging residents to obtain a pharmacy technician license; however, this is inappropriate given the expertise and education residents have and the level of practice they’re expected to engage in. Given its national scope, NABP is well-positioned to explore a broad solution to this problem rather than the current, incremental, state-by-state approach.

7. California State Board of Pharmacy does not allow for license transfer or reciprocity. 8. Per business and professional code 4200.2 California Practice Standards and Jurisprudence

Examination for Pharmacists; Required Inclusions.

When developing the California Practice Standards and Jurisprudence Examination for Pharmacists, the board shall include all of the following: (a) Examination items to demonstrate the candidate's proficiency in patient communication skills. (b) Aspects of contemporary standards of practice for pharmacists in California, including, but not limited to, the provision of pharmacist care and the application of clinical knowledge to typical pharmacy practice situations that are not evaluated by the North American Pharmacy Licensure Examination.

9. Per business and professional code 4200.3 Examination Process to be Reviewed Regularly;

Required Standards; the board may terminate its use of North American Pharmacy Licensure Examination and use board developed written and practical examination.

(a) The examination process shall be regularly reviewed pursuant to Section 139. (b) The examination process shall meet the standards and guidelines set forth in the Standards for Educational and Psychological Testing and the Federal Uniform Guidelines for Employee Selection Procedures. The board shall work with the Office of Professional Examination Services of the department or with an equivalent organization who shall certify at minimum once every five years that the examination process meets these national testing standards. If the department determines that the examination process fails to meet these standards, the board shall terminate its use of the North American Pharmacy Licensure Examination and shall use only the written and practical examination developed by the board.

TARGET:



PROPOSAL B.4



3. CSHP has an updated professional policy that addresses pharmacist licensure, which includescollaboration with NABP, who oversees the NAPLEX, in agreement with ASHP Policy 1621.

PROPOSAL:

1. Update CSHP policy 2012-10 to emphasize collaboration with boards of pharmacy and third-partyvendors to streamline the licensure process and improve timeliness of application approval.


#2012-10: Pharmacist Licensure


All applicants for pharmacist licensure in California should meet the same minimm competency standards irrespective of category of licensure.

1. supports that Tthe California State Board of Pharmacy should maintain its competencystandards for licensure.;

2. the North American Pharmacist Licensure Examination (NAPLEX), combined witha California Practice Standard and Jurisprudence Examination (CPJE), is appropriate to testfor basic competencies essential for entry-level pharmacist practice if the examinationsinclude, but are not limited to, testing for pharmacy principles and standards in:

a. 1. patient consultation skills;b. 2. application of clinical knowledge in a variety of patient care settings;c. 3. sterile and non-sterile compounding;d. 4. drug distribution; ande. 5. medication safety.

3. California Society of Health-System Pharmacists Advocates that the California Board of Pharmacycollaborate with the National Association of Boards of Pharmacy (NABP) and third-party vendors to streamlines the licensure process through standardization and improve the timeliness of application approval.



PROPOSAL B.4




ACTION:


HOD ACTION:


Proposal C P a g e | 43

PROPOSAL C

PROPOSAL: Proposals Related to Pharmacy Therapeutics and Distribution



SITUATION:





TARGET:




PROPOSAL:


Proposal C – Pharmacy Therapeutics and Distribution

ADOPT:

• C1:

To Adopt the modified CSHP policy #2014-51, Off-Label Use of Medication

• C2:


Proposal C P a g e | 44

PROPOSAL C

To Adopt the newly created CSHP Policy, Home Intravenous Therapy

• C3:

To Adopt the modified CSHP Policy #2013-13, Efforts to Discourage the Use of TobaccoProducts

• C6:

To Adopt the modified CSHP Policy #2014-38, “The Role of the Pharmacist in SubstanceAbuse and Drug Diversion”

• C7:

To Adopt the modified CSHP Policy #2013-42, “Clinical Decision Support Systems”

• C9:

To Adopt newly created CSHP Policy, “Automated Preparation and DispensingTechnology for Sterile Preparations”

DELETE:

• C5:

To delete CSHP Policy, “Safety of Epidural Steroid Injections”

WITHDRAWN:

Proposals withdrawn from consideration by the House of Delegates:

• Proposal C4, “Physician Aid-in-Dying” – no change to current Policy

• Proposal C8, “Regulation of Telepharmacy Services” – send to 2018 COPA for review andconsolidation with 2016-10 “Internet: Pharmacy Practice”



Proposal C.1 P a g e | 45

PROPOSAL C.1

PROPOSAL: Off-Label Use of Medication



SITUATION:






5. CSHP has policy 2014-51 Off-Label Use of Medication

#2014-51: Off-Label Use of Medication


1. Supports the practice of prescribing medications for off-label uses that are documented inthe medical literature in a system that:a) Maintains patient access to pharmacist review of all medications.b) Protects the pharmacist’s right of refusal of an off-label use of a medication.c) Preserves the patient-pharmacist-prescriber relationship.d) Provides adequate patient counseling and education, particularly to patients taking

medications for off-label use.e) Recognizes the prescriber’s responsibility in assuring the appropriate and safe use of all

medications; andf) Encourages evidence-based decision making and prescribing.



PROPOSAL C.1

2. Opposes efforts to restrict the off-label use of medication when the usage is medicallyappropriate, evidence-based and in the patient’s best interest

3. Recognizes the authority of the Food and Drug Administration to regulate and restrict thepromotion and dissemination of information about off-label uses of medications bymanufacturers.

4. Supports that such promotion and dissemination of off-label use by a manufacturer bepermitted if manufacturers submit a supplemental new drug application for new use within areasonable time after initial dissemination of information about off- label uses.

6. The 2016 ASHP House of Delegates replaced ASHP policy 1120 Regulation of Off-Label Promotionand Marketing with new policy 1620 with a new title, the addition of medication-containingdevices and manufacturer representatives, and a revision to the paragraph on the promotion ofoff-label uses:

1620PROMOTION OF OFF-LABEL USES

To advocate for authority for the Food and Drug Administration (FDA) to regulate the promotionand dissemination of information about off-label uses of medications and medication-containingdevices by manufacturers and their representatives; further,

To advocate that such off-label promotion and marketing be limited to the FDA-regulateddissemination of unbiased, truthful, and scientifically accurate information based on peer-reviewed literature not included in the New Drug Approval process.

RationaleCongress is considering significant changes in the way drugs are developed, approved, andmarketed in the United States. A provision in the House-passed 21st Century Cures bill (H.R. 6)would allow pharmaceutical manufacturers to promote off-label uses of their products toclinicians. This change has raised concerns about the accuracy and sources of such information.Sources of such information, if unreliable, could put patient safety at risk. Despite these concernsabout promotion of off-label uses by manufacturers, ASHP has suggested an amendment thatwould require Food and Drug Administration (FDA) oversight of such promotion and requirepromotional materials to be unbiased, truthful, scientifically accurate, and based upon peer-reviewed literature not included in the approved labeling of the drug. Materials would thereforerequire approval by the proper authority (FDA), meet certain requirements, and be truthful andscientifically accurate.

7. Status Update of H.R. 6



PROPOSAL C.1

H.R. 6 passed through the House and was sent to the Senate Committee on Health, Education, Labor, and Pensions on July 13, 2015 where it remains.

TARGET:



3. CSHP has an updated professional policy that addresses off-label use of medication, which includesmodifications to include text within ASHP Policy 1620.

PROPOSAL:

1. Update CSHP policy 2014-51 to harmonize paragraph 4 with ASHP Policy 1620 on promotion of off-label use of medication while retaining paragraphs 1-3 in CSHP policy 2014-51.


#2014-51: Off-Label Use of Medication


1. supports the practice of prescribing medications for off-label uses that are documented inthe medical literature in a system that:

a. maintains patient access to pharmacist review of all medications.b. protects the pharmacist’s right of refusal of an off-label use of a medication.c. preserves the patient-pharmacist-prescriber relationship.d. provides adequate patient counseling and education, particularly to patients taking

medications for off-label use.e. recognizes the prescriber’s responsibility in assuring the appropriate and safe use of all

medications; andf. encourages evidence-based decision making and prescribing.

2. opposes efforts to restrict the off-label use of medication when the usage is medicallyappropriate, evidence-based and in the patient’s best interest



PROPOSAL C.1

3. supports the authority of the Food and Drug Administration (FDA) to regulate thepromotion and dissemination of information about off-label uses of medications andmedication-containing devices by manufacturers and their representatives.

4. supports that such off label promotion and marketing be limited to the FDA-regulateddissemination of unbiased, truthful, and scientifically accurate information based on peer-reviewed literature not included in the New Drug Approval process. off-label use by amanufacturer be permitted if manufacturers submit a supplemental new drug applicationfor new use within a reasonable time after initial dissemination of information about off- label uses.




ACTION:


HOD ACTION:



PROPOSAL C.2

PROPOSAL: Home Intravenous Therapy



SITUATION:


2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all official Statementsin the current edition of the Best Practices for Health-System Pharmacy of the ASHP, exceptwhen such policies differ substantially from CSHP policy.

3. To endorse the use of ASHP Position Statements, Guidelines, and Technical Assistance Bulletins byits members in their practice settings.


5. CSHP does not have a policy on Home Intravenous Therapy.

6. ASHP has 2016 policy 1623 Home Intravenous Therapy that supersedes ASHP policy 0414:

1623HOME INTRAVENOUS THERAPY

To support the continuation of a home intravenous therapy benefit under federal and private health insurance plans and expansion of the home infusion benefit under Medicare at an appropriate level of reimbursement for pharmacists’ patient care services provided, medications, supplies, and equipment.

Rationale The Medicare Modernization Act of 2003 created an outpatient prescription drug benefit for Medicare beneficiaries, Medicare Part D. The new benefit provided prescription drug coverage for Medicare beneficiaries by private health plans and pharmacy benefit managers (PBMs). Although the law requires certain basic coverage packages across the plan continuum, it provides no coverage for services and supplies used in home infusion. The result is that the drug products used in home infusion may be covered, but the supplies (e.g., IV bags, tubing) and services related to providing and administering the drug products are not.



PROPOSAL C.2

Over the years, efforts have been made to address this gap by moving coverage for the drug products from Part D to Part B, and including supplies and services within that coverage. Initially, this effort resulted in federal legislation to move home infusion coverage from Part D to Part B; however, projected costs to the Medicare program have prevented Congress from passing the legislation. ASHP supports continuation of a home intravenous therapy benefit under federal and private health insurance plans and expanding the home infusion benefit under Medicare to include supplies and services related to providing and administering the therapy.

7. Occasionally, home intravenous therapy patients are discharged from a hospital with insufficienttime for the home infusion pharmacy to coordinate and provide nursing care, intravenoussolutions, medications, ancillary supplies, and equipment to the patient’s location prior to the timeof the next dose. This failure in the transition of care process may result in preventable adverseevents.

TARGET:



3. CSHP has a professional policy that addresses home intravenous therapy and supports thecontinuation of a home intravenous therapy benefit under federal, state, and private healthinsurance plans. This policy should also support expansion of the home infusion benefit underMedicare and Medicaid at an appropriate level of reimbursement for pharmacists’ patient careservices provided, medications, supplies, and equipment to provide optimal therapy for patients.

PROPOSAL:


Home Intravenous Therapy


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



PROPOSAL C.2

2. supports expansion of the home infusion benefit under Medicare and Medi-cCalid andother health plans at an appropriate level of reimbursement for pharmacists’ patientcare services including patient and caregiver education, provided, and which includesmedications, supplies, and equipment to provide optimal therapy for patients.

3. encourages health-systems and providers to ensure that transitions of care into thehomecare environment includes sufficient information and sufficient time for the homeinfusion pharmacy to provide the following in an optimal and timely manner:

a. coordination with other healthcare providers nursing careb. intravenous therapyc. medicationsd. ancillary supplies and equipmentee. education

3. nursing care, intravenous therapy, medications, ancillary supplies, and equipment tothe patient in an optimal and timely manner.




ACTION:


HOD ACTION:



PROPOSAL: To Amend CSHP Policy #2013-13: Efforts to Discourage the Use of Tobacco Products.



SITUATION:

1. CSHP Professional Policy #2015-04 directs CSHP to adopt ASHP policies & other guidancedocuments as CSHP Professional Policy.

2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins and all official Statementsin the current edition of the Best Practices for Health-System Pharmacy of the ASHP, exceptwhen such policies differ substantially from CSHP policy.

3. To endorse the use of ASHP Position Statements, Guidelines and Technical Assistance Bulletinsby its members in their practice settings.



1625 Tobacco, Tobacco Products, and Electronic Nicotine Delivery Systems

Source: Council on Therapeutics

To discourage the use, distribution, and sale of tobacco, tobacco products, and electronic nicotine delivery systems (e.g., vaporizers, vape pens, hookah pens, and electronic cigarettes and pipes) in and by pharmacies; further,

To advocate for tobacco-free environments in hospitals and health systems; further,

To seek, within the bounds of public law and policy, to eliminate the use and distribution of tobacco, tobacco products, and electronic nicotine delivery systems in meeting rooms and corridors at ASHP-sponsored events; further,

To promote the role of pharmacists in tobacco-cessation counseling and medication therapy management; further,

To join with other interested organizations in statements and expressions of opposition to the use of tobacco, tobacco products, and electronic nicotine delivery systems.


6. CSHP has Policy #2013-13: Efforts to Discourage the Use of Tobacco Products



PROPOSAL C.3

7. The content of CSHP Policy #2013-13 could be amended to reflect ASHP Policy 1625 Tobacco,Tobacco Products, and Electronic Nicotine Delivery Systems

TARGET:

1. CSHP provides resources to its members, their patients and the public per the 2017-2021Strategic Priorities and Goals.

2. CSHP develops professional policy in congruence with other professional organizations, butadopts policy as an independent professional society.

3. CSHP has professional policy on tobacco, tobacco products, and electronic nicotine deliverysystems.

PROPOSAL:

1. Amend CSHP Policy #2013-13 Efforts to Discourage the Use of Tobacco Products to state:

#2013-13: Efforts to Discourage the Use of Tobacco Products Source: HOD 1989 (Note: This is former policy #8907 approved by the HOD in 1989; modified and reaffirmed by the HOD in 1995 as policy #9506; modified and reaffirmed by the HOD in 2000 and combined with policy #9604 as policy #2000-05; modified and reaffirmed by the HOD in 2005 as policy #2005-06; modified and reaffirmed by the HOD in 2009 as policy #2009-08; modified and reaffirmed by the HOD in 2013 as policy #2013-13.)


recognizes the public health hazards and economic burden of tobacco use and therefore:

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

2. CSHP functions and meetings are shall be smoke-free, tobacco-free, and e-cigarette-free.2. encourages its members to participate in educational efforts to discourage tobacco useand encourages pharmacists who educate patients on tobacco cessation to obtain trainingas tobacco cessation educators.3. promotes the role of pharmacists in tobacco cessation counseling and smoking cessations

medication therapy management.



4. supports the elimination of the sale of tobacco products and ENDs from all CaliforniaPharmacies and all establishments that contain a pharmacy.6. CSHP urges employers, trust funds and local, state and federal governments to limitparticipation in private or government-sponsored programs (340B, Medicare, Medicaid,etc.) to pharmacies in establishments that do not sell tobacco products.

57. CSHP jjoins with other interested organizations in statements and expressions ofopposition to the use of tobacco, tobacco products, and electronic nicotine deliverysystems.will join in statements and positions of opposition to the use of tobacco andtobacco products.

8. CSHP endorses the concept of the “Great American Smokeout.”

6. supports patient accessibility to multiple tobacco cessation therapies




ACTION:


HOD ACTION:



PROPOSAL C.5

PROPOSAL:

SUBMITTED BY:

DATE:

Safety of Epidural Steroid Injections Board

of Directors

October 19, 2017

SITUATION:






5. ASHP has policy 1605 Safety of Epidural Steroid Injections.

1605Safety of Epidural Steroid Injections

To encourage healthcare providers to 1) inform patients about the significant risks and potentiallack of efficacy of epidural steroid injections, 2) request their informed consent, and 3) informpatients of alternative therapies and their risks and benefits; further,

To recommend pharmacist involvement in the medication-use process associated with epiduralsteroid injections when such injections are medically necessary.

6. CSHP does not have a professional policy on safety of epidural steroid injections.

TARGET:




PROPOSAL C.5


3. CSHP has a professional policy that addresses safety of epidural steroid injections.

In 2012, New England Compounding Center (NECC) dispensed non-sterile methylprednisoloneepidural injections that killed 64 people and sickened 800 more. NECC failed to follow regulationsspecific to the compounding of injectable medication. Since then,

Federal regulations enforced by the FDA and state regulations enforced by boards of pharmacyhave been implemented nationwide regarding sterile compounding by pharmacies. Regulationshave also been implemented that require some pharmacies to be registered with the FDA asoutsourcing facilities that must adhere to FDA GMPs. The California State Board of Pharmacyenacted new sterile compounding regulations in 2016 that are enforceable and closely mirror theversion of USP 797 in force at that time. All of these sterile compounding regulations have theirbasis in USP 797 and other USP standards.

ASHP RationaleUse of epidural steroid injections to treat low back pain is increasing, despite not being a labeledindication and sparse literature confirming the safety and efficacy of the treatment. These drugs, inthis route of administration, have narrow therapeutic indices, and there are quality assuranceissues related to the compounding of the preparations used in epidural injections. The safety ofepidural steroid injections has been referred to in the FDA Safe Use Initiative (SUI), in which 13stakeholders were involved in assessing evidence of neurological complications of injections.Several recommended practices resulted, including a controversial preference for nonparticulatesteroid injections for use in cervical transforaminal injections. In addition to the concerns aboutparticulates in the injections, there are very significant safety concerns due to the proximity ofintrathecal, epidural, and subdural spaces and how the injections are administered. Skillfultechnique is required to appropriately administer these drugs. Radiographic contrast is often usedto guide the needle to injection sites. Improper technique can cause vasospasm and stroke, which isnot related to particulates in the injection.

In April 2014, the FDA released a drug safety communication stating that rare and seriousneurological effects can result from epidural steroid injections. The safety communication notedthat “the effectiveness and safety of epidural administration of corticosteroids have not beenestablished, and FDA has not approved corticosteroids for this use” and recommended thathealthcare providers “discuss with patients the benefits and risks of epidural corticosteroidinjections and other possible treatments.” ASHP concurs with those recommendations andencourages use of an informed consent process in addition to other institutional protocols,including pharmacist involvement in the medication-use process when such injections are medicallynecessary, to promote the safe use of epidural steroid injections.

PROPOSAL:



PROPOSAL C.5


Epidural Steroid Injections


1. Supports the efforts of the California State Board of Pharmacy, the United States Food andDrug 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 potentiallack of efficacy of epidural steroid injections, request their informed consent, and informpatients of alternative therapies and their risks and benefits.

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


Financial: Minimal EVP time: Minimal Staff time: Minimal

CSHP BOARD ACTION: The Board of Directors on October 3, 2017 recommended not to adopt ASHP Policy 1605- Safety of Epidural Steroid Injections.

ACTION:


HOD ACTION:



PROPOSAL C.6

PROPOSAL: Controlled Substance Diversion and Patient Access



SITUATION:

1. CSHP Professional Policy #2015-04 directs CSHP to adopt ASHP policies andother guidance documents as CSHP Professional Policy

2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and allofficial Statements in the current edition of the Best Practices for Health-SystemPharmacy of the ASHP, except when such policies differ substantially from CSHPpolicy.

3. To endorse the use of ASHP Position Statements, Guidelines, and TechnicalAssistance Bulletins by its members in their practice settings.

4. CSHP will review all ASHP Policy Positions by 2020 for possible adoption asCSHP Professional Policy.

5. CSHP has policy #2014-38: The Role of the Pharmacist in Substance Abuse and Drug Diversion.

6. ASHP has 2016 policy position 1614 Controlled Substance Diversion and Patient Access.

1614 Controlled Substance Diversion and Patient Access Source: Council on Pharmacy Management To enhance awareness by pharmacy personnel, healthcare providers, and the public of drug diversion and abuse of controlled substances; further, to advocate that the pharmacy profession lead collaborative efforts to reduce the incidence of controlled substance abuse; further, To advocate that pharmacists lead collaborative efforts by organizations of healthcare professionals, patient advocacy organizations, and regulatory authorities to develop and promote best practices for preventing drug diversion and appropriately using controlled substances to optimize and ensure patient access and therapeutic outcomes; further, To advocate that the Drug Enforcement Administration and other regulatory authorities interpret and enforce laws, rules, and regulations to support patient access to appropriate therapies, minimize burdens on pharmacy practice, and provide reasonable safeguards against fraud, misuse, abuse, and diversion of controlled substances; further, To advocate establishment of programs to support patients and personnel with substance abuse and dependency issues.



PROPOSAL C.6

Reference: ASHP Guidelines on Preventing Diversion of Controlled Substances Philip W. Brummond, David F. Chen, William W. Churchill, John S. Clark, Kevin R. Dillon, Doina Dumitru, Lynn Eschenbacher, Toni Fera, Christopher R. Fortier, Kristine K. Gullickson, Kristen Jurakovich, Stan Kent, Jennifer Keonavong, Christine Marchese, Tricia Meyer, Lee B. Murdaugh, Richard K. Ogden, Brian C. O’Neal, Steve Rough, Rafael Saenz and Jacob S. SmithAmerican Journal of Health-System Pharmacy March 2017, 74 (5) 325-348; DOI:https://doi.org/10.2146/ajhp160919

TARGET:


2. CSHP develops professional policy in congruence with other professional organizations,but adopts policy as an independent professional society.

3. CSHP has a professional policy that addresses drug diversion, policy #2014-38: The Roleof the Pharmacist in Substance Abuse and Drug Diversion:

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

The California Society of Health-System Pharmacists endorses the ASHP Statement on the Pharmacist’s Role in Substance Abuse Prevention, Education, and Assistance:

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

2. That pharmacists should be actively involved in the identification and mitigation ofsubstance abuse and diversion within health-systems.

3. That pharmacists, as health care providers, should be actively involved in reducing thenegative effects that substance abuse has on society, health-systems, and the pharmacyprofession.

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



PROPOSAL C.6

PROPOSAL:

While the CSHP policy states that pharmacists “should be actively involved…within health-systems.” The position should be made clear that “the pharmacy profession lead collaborative efforts to reduce the incidence of controlled substance abuse”- from ASHP policy 1614 above.

Per ASHP Guidelines on Preventing Diversion of Controlled Substances: Those responsible for their CSDPP should be familiar with local and state requirements and work collaboratively to minimize risk to the organization and ensure public safety.

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

Source: HOD 2014


endorses the ASHP Statement on the Pharmacist’s Role in Substance Abuse Prevention, Education, and Assistance:

1. endorses the ASHP Statement on the Pharmacist’s Role in Substance Abuse Prevention,Education, and Assistance.

2. recognizes the importance of balancing efforts to address legitimate pain issues and patientcare.

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

2.4. recognizes tThat 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.

5. recognizes tThat pharmacists, as health care providers, should be actively involved in reducingthe negative effects that substance abuse has on society, health-systems, and the pharmacyprofession.

3.6. recognizes that pharmacists play an active role in harm reduction by furnishing opioid antogonist products.

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



PROPOSAL C.6




ACTION:


HOD ACTION:



PROPOSAL C.7

PROPOSAL: Therapeutic Indication in Clinical Decision Support Systems



SITUATION:


2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all official Statementsin the current edition of the Best Practices for Health-System Pharmacy of the ASHP, exceptwhen such policies differ substantially from CSHP policy.



5. CSHP has policy #2013-42 Clinical Decision Support Systems#2013-42: Clinical Decision Support Systems

CSHP supports the development of clinical decision support (CDS) systems that are proven toimprove medication-use outcomes and that include the following capabilities:

1. Alerts, notifications, and summary data views provided to the appropriate people at theappropriate times in clinical workflows, based on:

a. a rich set of patient-specific data,b. standardized, evidence-based medication-use best practices, andc. identifiable patterns in medication-use data in the electronic health record;

2. Audit trails of all CDS alerts, notifications, and follow-up activity;3. Structured clinical documentation functionality linked to individual CDS alerts and

notifications; and4. 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. The 2016 ASHP House of Delegates approved ASHP policy 1608, Therapeutic Indication in ClinicalDecision Support systems.



PROPOSAL C.7

1608 - THERAPEUTIC INDICATION IN CLINICAL DECISION SUPPORT SYSTEMS Several well-known studies have demonstrated reductions in wrong-patient errors and adverse events with the inclusion of indication on the prescription order. In 2010, Equale1 described the accuracy of indication information in electronic health records (EHRs). Galanter2 focused on preventing wrong-patient medication errors with the use of indication-based prescribing. Indication-based alerts resulted in an interception rate of 0.25 interceptions per 1000 alerts. One investigator conducted a trial of inpatient indication-based prescribing using computerized provider order entry (CPOE) with medications commonly used off-label.3 In a 60-day trial documenting indications in the CPOE system for lansoprazole, intravenous immune globulin, and recombinant Factor VII, the accurate diagnosis rates after validation by a clinician were 9, 16, and 24 percent, respectively. In a study in the Joint Commission Journal on Quality and Patient Safety, investigators tracked a total of 140,755 medications filled by pharmacy technicians over a seven-month period in an academic institution. A total of 5,075 (3.6%) contained errors, and 1,059 contained an error that was not detected by the hospital pharmacist. Just over 23 percent of the undetected errors were potential adverse drug events.4 Addressing these errors can have a large public health impact. Off-label prescription medication use without strong scientific evidence has also been associated with increased rates of adverse drug events, according to an article in JAMA Internal Medicine.5 The authors suggested that use of the electronic health record (EHR) and proper documentation of therapeutic indication can help improve surveillance and safety and decrease risk.

In several countries, including Canada and Spain, the EHR includes indication as part of comprehensive documentation. ASHP first developed official policy on the importance of pharmacists’ access to indications in 1993. In 1996, the National Coordinating Council for Medication Error Reporting and Prevention recommended including the purpose of prescription orders because of concerns about safety, unless considered inappropriate by the prescribers. In 1999, the Institute for Safe Medication Practices recommended including the purpose of prescribing on all written orders. In 2004, the National Association of Boards of Pharmacy (NABP) approved a resolution encouraging national and state medical associations to support legislative and regulatory efforts to require prescribers to include indications for all oral, written, and electronically transmitted prescriptions. In 2012, the United States Pharmacopeia made amendments to the standards for prescription container labeling to include “purpose-for-use” language. In 2015, the National Council of Prescription Drug Plans drafted language to recommend diagnosis and SNOMED indication be sent with any prescription.

A project funded by the National Institutes of Health (NIH) project in collaboration with the Agency for Healthcare Research and Quality is underway to assess, evaluate, and make recommendations on optimal communication of the purpose of prescribing. The goal of the project is to improve prescribing safety by redesigning CPOE to incorporate the medication indication into the prescription order. ASHP is a primary partner in this initiative, and almost 100 organizations have already joined the effort. Three phased goals are expected from this project. Phase one consists of a series of webinars. Phase two consists of the development of a white paper that outlines and specifies best practices and ideas obtained from the workgroups and webinars. Finally, phase three consists of the creation of simulated models of ideal systems that



PROPOSAL C.7

can reduce harm and increase efficiency. This project will focus on six domains: medication error prevention and mitigation, facilitating patient education, promoting prescribing drugs of choice, enhanced team communication, organizing the medication list for medication reconciliation, and enabling comparative outcomes research.

References: 1Eguale T, Winslade N, Hanley JA et al. Enhancing pharmacosurveillance with systematic collection of treatment indication in electronic prescribing. Drug Saf 2010; 33: 559-67. 2Galanter W, Falck S, Burns M, et al. Indication-based prescribing prevents wrong-patient medication errors in computerized provider order entry (CPOE). J Am Med Inform Assoc. 2013;20:477–81. 3Walton SM, Galanter WL, Rosencranz H, et al. A trial of inpatient indication based prescribing during computerized order entry with medications used off-label. Appl Clin Inf. 2011;2:94–103. 4Cina JL, Gandhi TK, Churchill W, et al. How many hospital pharmacy medication dispensing errors go undetected? Joint Commission Journal on Quality and Patient Safety 2006; 32:73-80. 5Eguale T, Buckeridge DL, Verma A, et al. Association of off-label drug use and adverse drug events in an adult population. JAMA Internal Medicine 2016; 176:55-63. doi:10.1001/jamainternmed.2015.6058.

7. The Joint Commission Advanced Certification in Heart Failure requires the indication for use fordischarge medications in the care transitions record that is transmitted to the next level of careprovider.

TARGET:

1. CSHP provides resources to its members, their patients, and the public per the 2015-2018 StrategicPlan and the 2016-2019 Strategic Priorities and Goals.


3. CSHP does not have an updated professional policy that addresses therapeutic indications in clinicaldecision support systems.

PROPOSAL:

1. Update CSHP policy 2013-42 to include support for the inclusion of therapeutic indication on theprescription order.




PROPOSAL C.7

The California Society of Health-System Pharmacists: 1. supports the development of clinical decision support (CDS) systems that are proven to improvemedication-use outcomes and that include the following capabilities:

a. the use of aAlerts, notifications, and summary data views provided to the appropriatepeople at the appropriate times in clinical workflows, based on:

a.i. a rich set of patient-specific data,b.ii. standardized, evidence-based medication-use best practices, andc.iii. identifiable patterns in medication-use data in the electronic health record;

b. aAudit trails of all CDS alerts, notifications, and follow-up activity;c. sStructured clinical documentation functionality linked to individual CDS alerts and

notifications; andd. hHighly accessible and detailed management reporting capabilities that facilitate

assessment of the quality and completeness of CDS responses and the effects of CDS onpatient outcomes.

d.e. sSupport CDS systems to include medication indications on the prescription order




ACTION:


HOD ACTION:



PROPOSAL C.9

PROPOSAL: Automated Preparation and Dispensing Technology for Sterile Preparations



SITUATION:


2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins, and all official Statementsin the current edition of the Best Practices for Health-System Pharmacy of the ASHP, except whensuch policies differ substantially from CSHP policy.

3. To endorse the use of ASHP Position Statements, Guidelines, and Technical Assistance Bulletins byits members in their practice settings.


5. CSHP does not have a policy on Automated Preparation and Dispensing Technology for SterilePreparations.

6. ASHP has 2016 policy position 1617 Automated Preparation and Dispensing Technology forSterile Preparations:

1617 Automated Preparation and Dispensing Technology for Sterile Preparations

To advocate that health systems adopt automation and information technology for preparing and dispensing compounded sterile preparations when such adoption is (1) planned, implemented, and managed with pharmacists’ involvement; (2) implemented with adequate resources to promote successful development and maintenance; and (3) supported by policies and procedures that ensure the safety, effectiveness, and efficiency of the medication-use process; further,

To educate 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; further,

To foster further research, development, and publication of best practices regarding automation and information technology for preparing and dispensing sterile preparations.



PROPOSAL C.9

Rationale Adoption of automation and information technology for preparing and dispensing sterile

preparations is increasing but not evenly distributed among healthcare organizations. A 2014 ASHP survey showed that 40-60% of larger health systems used automated IV compounding technology in compounding nutrition support preparations. Less than 20% of all health systems surveyed employed barcode verification in their IV medication preparation process. A 2013 survey found that less than 10% of all health systems surveyed used drug workflow software to manage IV drug preparation, verification, and dispensing.

The reasons for these disparate rates of adoption are numerous. Each institution has a different break-even point of investment versus return, and challenges of implementation can be daunting. Some organizations have implemented automated compounding technology only to withdraw it later. The probability of successful adoption of automation and information technology for preparing and dispensing sterile preparations is increased when it is planned, implemented, and managed with pharmacists’ involvement and when adequate resources (including time) are planned for and provided not only to develop but also to maintain the technologies. Upfront costs and ongoing investments need to be clear from the start. Use of such technology also requires well-crafted policies and procedures to ensure the safety, effectiveness, and efficiency of the medication-use process. Research, development, and publication of best practices regarding automation and information technology for preparing and dispensing sterile preparations will require efforts not only from vendors but also from those who have experience with the process.

Adoption of such technology will also be accelerated if patient safety advocacy groups and regulatory agencies understand and appreciate the technology’s value and establish an expectation of adoption among healthcare organizations.

TARGET:

1. CSHP provides resources to its members, their patients, and the public per the 2017-2021Strategic Priorities and Goals.


3. CSHP has a professional policy that addresses the use of technology and automated systems:#2014-19: Interoperability, Standardization and Use of Health Information and Other Patient- CareTechnologies. This does not specifically address sterile preparations.

PROPOSAL:

Adopt the following as CSHP Professional Policy:



PROPOSAL C.9

Automated Preparation and Dispensing Technology for Sterile Preparations


1. supports the use of health information technology (HIT) and other patient-caretechnologies for preparing and dispensing sterile preparations that improves the safetyand reliability of the medication use process.

2. supports pharmacists and pharmacy technicians as be included in key decision roles ofa multidisciplinary team in the planning, selection, implementation, and maintenanceof automated systems to facilitate preparation and dispensing of sterile preparations.

3. encourages the education of patient safety advocacy groups and regulatory agencieson the capabilities and benefits of automation and technology for preparing anddispensing compounded sterile preparations, and to encourage them to establishexpectation of adoption by health systems.




ACTION:


HOD ACTION:


2017 Professional Policy Review Proposal D Page 69

PROPOSAL D

PROPOSAL: To reaffirm, modify and reaffirm, or delete CSHP professional policies which are five (5) years or older


DATE: 10/2/17

DESCRIPTION OF CURRENT SITUATION:

1. CSHP Professional Policies have been catalogued since 1980.2. One of the duties of Board of Directors is to review any professional policy that is 5 years old or

older. For this review, each professional policy that is five years old was reviewed forapplicability and current relevance and recommendations to reaffirm, modify and reaffirm, ordelete were outlined.

3. While analyzing professional policies, ASHP’s professional policy catalogue was checked for anypolicies that relate to the topic.

DESCRIPTION OF DESIRED SITUATION:

1. A mechanism exists to periodically review CSHP policies for their continued relevance andapplicability (CSHP Board of Directors action is generally guided by existing policy.)

2. CSHP’s professional policies accurately reflect current practice and professional standards.3. The annual review process of professional policy is continued as an opportunity for CSHP to

reflect the most current and contemporary positions on pharmacy practice and organizationalguidelines for our members.

PROPOSED ACTIONS:

1. The following CSHP professional policies be reaffirmed as CSHP professional policy.a. Proposal D1 - 2012-02, Sports Pharmacyb. Proposal D2 - 2012-04, Computerized Prescriber Order Entry

2. The following CSHP professional polices to be modified & reaffirm as CSHP professional policy.a. Proposal D3 - 2012-05, Non-Pharmacist and Prescriber Dispensingb. Proposal D4 - 2012-06, Recovering Pharmacy Professionals (grammatical change)c. Proposal D5 - 2012-07, Pharmacist Involvement in Student Pharmacist Educationd. Proposal D6 - 2012-08, Productivity Measurement Systemse. Proposal D7 - 2012-09, Technician Regulations (Proposal A recommends deletion of this

policy)f. Proposal D8 - 2012-12, Repackaging of Pharmaceuticals for Distribution


2017 Professional Policy Review Proposal D Page 70

PROPOSAL D

g. Proposal D9 – 2012-13, Safe Handling of Cytotoxic and Hazardous Drugs as CSHPProfessional Policy

h. Proposal D10 – 2012-14, Nuclear Pharmacy (format change)i. Proposal D11 – 2012 – 15, Increased Security Features on Controlled Substance

Prescription Form (format change)

3. The following CSHP professional policies be deleted as CSHP professional policy - none

CSHP BOARD ACTIONS: The CSHP Board of Directors has approved these proposals for consideration by the 2017 House of Delegates.


P a g e | 71 Proposal D.1

PROPOSAL D.1

2017 REVIEW OF CSHP PROFESSIONAL POLICIES 5 YEARS AND OLDER

PROPOSAL: To reaffirm, modify and reaffirm, or delete CSHP professional policies that are five (5) years or older



SITUATION 1. CSHP Professional Policies have been catalogued since 1980.2. One of the duties of Board of Directors is to review any professional policy that is 5 years old or older. For this review, each professional

policy that is five years old was reviewed for applicability and current relevance and recommendations to reaffirm, modify, and reaffirm, ordelete were outlined.

3. While analyzing professional policies, ASHP’s professional policy catalogue was checked for any policies that relate to the topic.

TARGET 1. A mechanism exists to review periodically CSHP policies for their continued relevance and applicability (CSHP Board of Directors action is

generally guided by existing policy.)2. CSHP’s professional policies accurately reflect current practice and professional standards.3. The annual review process of professional policy is continued as an opportunity for CSHP to reflect the most current and contemporary

positions on pharmacy practice and organizational guidelines for our members.

PROPOSAL 1. Reaffirm 2012-02, Sports Pharmacy

Policy #: 2012-02 Policy name: Sports Pharmacy

Assigned to: Jeannette Hanni Recommended Action: Reaffirm; Delete; Modify & Reaffirm

Current Policy Wording

#2012-02: Sports Pharmacy

CALIFORNIA SOCIETY OF HEALTH-SYSTEM PHARMACISTS

Proposal D.1 P a g e | 72

Source: HOD 2007

(Note: This is former policy #2007-02 approved by the HOD in 2007; modified and reaffirmed by the HOD in 2012 as policy #2012-02.)


1. encourages safe and healthy participation in competitive sport and exercising.

2. supports the pharmacist’s role in promoting safe and proper use of medications and nutritional supplementsand recognizes the unique medication needs of athletes.

3. encourages the general public to seek health professional advice related to medications and nutritionalsupplements promoted for sports performance or used to maintain health.

4. supports the efforts of organizations to educate and enforce drug testing to discourage the use of bannedand/or harmful performance-enhancing substances.

develops collaborative efforts with health and sport organizations in order to educate athletes and othersregarding the safe and most effective legitimate use of medications.

5. supports public and professional education campaigns in discouraging the use of banned and/or harmfulperformance-enhancing substances.

6. encourages members to offer consultation to athletes about the potential harm of using banned performance-enhancing substances.

7. encourages schools of pharmacy to develop education programs for students and pharmacists that address thesafe use of medication recognizing the unique needs of athletes.

If Modify & Reaffirm, Recommended Wording

Reaffirm as written



Rationale for Recommendation

CSHP BOARD ACTIONS: Approved on October 3, 2017 to be considered by the House of Delegates.

ACTION:


HOD ACTION:


P r o p o s a l D . 2 P a g e | 74

PROPOSAL D.2











PROPOSAL 1. Modify & Reaffirm 2012-04, Computerized Prescriber Order Entry

Policy #: 2012-04 Policy name: Computerized Prescriber Order Entry

Assigned to: Jeannette Hanni Recommended Action: ☐Reaffirm; Delete; ☒Modify & Reaffirm


Page 75 of 3

P r o p o s a l D . 2 P a g e | 75


#2012-04: Computerized Prescriber Order Entry (CPOE)

Source: HOD 2007

(Note: This is former policy #2007-04 approved by the HOD in 2007; reaffirmed by the HOD in 2012 as policy #2012-04.)

The California Society of Health-System Pharmacists advocates for and supports the use of computerized entry of medication orders or prescriptions when:

1. it is planned, implemented, and managed with pharmacists’ involvement.

2. such orders are part of a single, shared database that is integrated with the pharmacy informationsystems, electronic health record, and other key information system components such as the patient’smedication administration record.

3. such computerized order entry improves the safety, efficiency, and accuracy of the medication-useprocess.

4. such computerized order entry includes clinical decision support systems.

5. it includes provisions for the pharmacist to review and verify the order’s appropriateness beforemedication administration, except in those instances when review would cause a medicallyunacceptable delay.

If Modify & Reaffirm,

Recommended Wording

Modify & Reaffirm


Page 76 of 3

P r o p o s a l D . 2 P a g e | 76


CSHP BOARD ACTIONS: Approved on October 3, 2017 for considerestion by the House of Delegates.

ACTION:

Bylaws update

Rules and Procedures of the House of Delegates

Update Administrative Policy catalog update

☒ Update Professional Policy catalog

Staff Procedural manual

CCTF’s volunteer hand book

Minutes only

Any other (please state)

HOD ACTION:



PROPOSAL D.3











PROPOSAL 1. Modify & Reaffirm 2012-05, Non-Pharmacist and Prescriber Dispensing

Policy #: 2012-05 Policy name: Non-Pharmacist and Prescriber Dispensing

Assigned to: Pauline Chan Recommended Action: ☐Reaffirm; Delete; ☒Modify & Reaffirm


Source: HOD 1985



CSHP BOARD ACTIONS: Approved as amended on October 3, 2017 to be considered by the House of Delegates

ACTION:


HOD ACTION:

(Note: This is former policy #8501 approved by the HOD in 1985; reaffirmed by the HOD in 1992 as policy #9222; reaffirmed by the HOD in 1997 as policy #9704; reaffirmed by the HOD in 2002 as policy #2002-03; reaffirmed by the HOD in 2007 as policy #2007-05; modified and reaffirmed by the HOD in 2012 as #2012-04.)


1. supports the passage and enforcement of legislative and regulatory controls establishing the requirements fornon-pharmacist and prescriber dispensing.

If Modify & Reaffirm, Recommended

Wording

Modify & reaffirm as herebelow:


1. supports the passage and enforcement of- legislative and regulatory controls establishing the requirements fornon-pharmacist and prescriber dispensing




PROPOSAL D.4











PROPOSAL 1. Modify & Reaffirm 2012-06, Recovering Pharmacy Professionals

Policy #: 2012-06 Policy name: Recovering Pharmacy Professionals

Assigned to: Kethen So Recommended Action: Reaffirm; Delete; Modify & Reaffirm

Current Policy The California Society of Health-System Pharmacists



Wording 1. Encourages members to support and participate in the State of California’s Pharmacist Recovery Program, which identifies and rehabilitates pharmacists and pharmacy interns with impairment due to the misuse and abuse ofdangerous drugs and substances or due to mental illness.

2. CSHP encourages the California State Board of Pharmacy to also include pharmacy technicians in the State ofCalifornia’s Pharmacist Recovery Program.


Recommended Wording

The California Society of Health-System Pharmacists

1. eEncourages members to support and participate in the State of California’s Pharmacist Recovery Program,which identifies and rehabilitates pharmacists and pharmacy interns with impairment due to the misuse and abuse of dangerous drugs and substances or due to mental illness.

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


Grammatical change only The current policy language reflects the current state of the State of California’s Pharmacy Recovery Program: http://www.pharmacy.ca.gov/licensees/personal/pharmacist_recovery.shtml. Support the concept to expand the program to allow pharmacy technicians to participate as there are over 72,000 registered CA technicians.

CSHP BOARD ACTIONS: Approved on October 3, 2017 to be considered at the House of Delegates.

ACTION: ☐ Bylaws update☐ Rules and Procedures of the House of Delegates☐ Update Administrative Policy catalog☒ Update Professional Policy catalog☐ Staff Procedural manual☐ CCTF’s volunteer hand book☐ Minutes only☐ Any other (please state)

HOD ACTION:

http://www.pharmacy.ca.gov/licensees/personal/pharmacist_recovery.shtml


P r o p o s a l D . 5 P a g e | 81

PROPOSAL D.5











PROPOSAL 1. Modify and Reaffirm 2012-07, Pharmacist Involvement in Student Pharmacist Education

Policy #: 2012-07 Policy name: Pharmacist Involvement in Student Pharmacist Education

Assigned to: Dan Dong Recommended Action: Reaffirm; Delete; ☒Modify & Reaffirm

#2012-07: Pharmacists Involvement in Student Pharmacist Education



Current Policy Wording Source: HOD 1984

(Note: This is former policy #8409 approved by the HOD in 1984; reaffirmed by the HOD in 1992 as policy #9221; modified and reaffirmed by the HOD in 1997 as policy #9713; modified and reaffirmed by the HOD in 2002 as policy #2002-08; reaffirmed by the HOD in 2007 as policy #2007-07; modified and reaffirmed by the HOD in 2012 as policy #2012-07.)

The California Society of Health-System Pharmacists supports high standards and innovation in the practice of pharmacy. Therefore, pharmacists are encouraged to participate 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


Recommended Wording

The California Society of Health-System Pharmacists supports high standards and innovation in the practice of pharmacy. Therefore, pharmacists are encouraged to participate 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


1. encourages pharmacists and pharmacy leaders to recognize that part of their professional responsibility isthe development of student pharmacists.

2. encourages pharmacist’s participation in the training and education of student pharmacists throughinvolvement 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. encourages schools of pharmacy to define and develop appropriate organizational relationships thatpermit a balance of patient care and professional and community service

4. encourages schools of Pharmacy to collaborate with pharmacy organizations on the development ofstandards to enhance the quality of experiential education and pharmacists preceptor.

5. supports the provision of tools, education, and other resources to develop preceptor skills.6. encourages all educators use ASHP guidelines, statements and profession policies as an integral part of the

educational process.




This policy refers to encouraging more pharmacist participation in helping to precept and educate student pharmacists. There were many components that appeared missing in the existing policy statement. Most of these changes were excerpted from existing ASHP Policy. CPhA was reviewed as well.

CSHP BOARD ACTIONS: Approved as amended on October 3, 2017 to be considered for the House of Delegates.

ACTION:

☐ Bylaws update☐ Rules and Procedures of the House of Delegates☐ Update Administrative Policy catalog☒ Update Professional Policy catalog☐ Staff Procedural manual☐ CCTF’s volunteer hand book☐Minutes only☐ Any other (please state)

HOD ACTION:



PROPOSAL D.6

2017 REVIEW OF CSHP PROFESSIONAL POLICIES 5 YEARS AND OLDER PROPOSAL: To reaffirm, modify and reaffirm, or delete CSHP professional policies that are five (5) years or older



SITUATION 1. CSHP Professional Policies have been catalogued since 1980. 2. One of the duties of Board of Directors is to review any professional policy that is 5 years old or older. For this review, each professional

policy that is five years old was reviewed for applicability and current relevance and recommendations to reaffirm, modify, and reaffirm, or delete were outlined.

3. While analyzing professional policies, ASHP’s professional policy catalogue was checked for any policies that relate to the topic. TARGET

1. A mechanism exists to review periodically CSHP policies for their continued relevance and applicability (CSHP Board of Directors action is generally guided by existing policy.)

2. CSHP’s professional policies accurately reflect current practice and professional standards. 3. The annual review process of professional policy is continued as an opportunity for CSHP to reflect the most current and contemporary

positions on pharmacy practice and organizational guidelines for our members. PROPOSAL

1. Modify and Reaffirm 2012-08, Productivity Measurement Systems

Policy #: 2012-08 Policy name: Productivity Measurement Systems

Assigned to: Pauline Chan Recommended Action: Reaffirm; Delete; Modify & Reaffirm

Current Policy

Wording

#2012-08: Productivity Measurement Systems



Source: HOD 1983 (Note: This is former policy #8302 approved by the HOD in 1983; reaffirmed by the HOD in 1992 as policy #9217; modified and reaffirmed by the HOD in 1997 as policy #9714; modified and reaffirmed by the HOD in 2002 as policy #2002-09; modified and reaffirmed by the HOD in 2007 as policy #2007-08; reaffirmed by the HOD in 2012 as policy #2012-08.)

Productivity monitoring in health-system pharmacies is difficult due to the broad number of services provided by a given pharmacy department. The included services that are not easily captured in productivity measurements, such as patient care activities, or are not provided by all institutions. Therefore, not: CSHP opposes the development of a standardized format and definitions for creating a productivity measurement system for health-system pharmacies in California.


Wording

Productivity monitoring in health-system pharmacies developed during the 80’s of the last century is difficult due to the broad number of services provided by a given pharmacy department. The included services not easily captured in productivity measurements, such as patient care activities, or services that are not provided by all institutions.


1. oOpposes the development of a standardized format and definitions for creating a productivity measurementsystem for health-system pharmacies in California.However, CSHP recognizes these tools have since evolved into new benchmarking and indicators that may be ofvalue to use, particularly in demonstrating pharmacist’s value in providing direct patient care and participating inteam care. To support expansion of pharmacist roles, it is vital pharmacists understand how these tools are used.CSHP supports effective use of workload and productivity monitoring tools in health system pharmacies, includingcritiquing and refining existing tools to improve effectiveness.


I think this is a topic that HOD may be interested. Particularly in the era of value-based reimbursement. Pharmacists need to be proactive in understanding performance measurement, how to evaluate existing tools (vendor created) and advocate for use of more effective tools to measure workload, productivity, and performance.

CSHP BOARD ACTIONS: Approved as amended on October 3, 2017 to be considered for the House of Delegates.



ACTION:

☐ Bylaws update ☐ Rules and Procedures of the House of Delegates ☐ Update Administrative Policy catalog ☒ Update Professional Policy catalog ☐ Staff Procedural manual ☐ CCTF’s volunteer hand book ☐ Minutes only ☐ Any other (please state)

HOD ACTION:



PROPOSAL D.7











PROPOSAL 1. Modify & Reaffirm 2012-09, Technician Regulations

Policy #: 2012-09 Policy name: Technician Regulations






1. Supports efforts by the pharmacy profession through regulatory and/or legislative changes that broaden the

scope of practice for pharmacy technicians.

2. CSHP advocates that the profession of pharmacy move toward the following model with respect to pharmacy technicians as an approach to protecting public health and safety:

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

pharmacy technician certification; and c. Mandatory 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.

3. To continue to advocate licensure of pharmacy technicians by the state board of pharmacy.

4. To advocate as an interim measure (until the optimal model is fully implemented) that individuals be required

either

a. to have completed an ASHP accredited pharmacy technician training program or b. to have at least one year of equivalent experience as a pharmacy technician before they are eligible to

become licensed.


Recommended Wording

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. Encourages that the profession of pharmacy move toward the following model with respect to pharmacy technicians as an approach to protecting public health and safety:

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

pharmacy technician certification; and c. Mandatory 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.



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

a. development and adoption of uniform state laws and regulations regarding pharmacytechnicians;

b. completion of an accredited pharmacy technician training program as a prerequisite to pharmacytechnician certification; and

c. certification by a single nationally validated, psychometrically sound examination approved by thestate 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.

3. encourage practice sites to only accept technician students from ASHP-accredited schools or schools incandidate status.

3. To continue to advocate licensure of pharmacy technicians by the state board of pharmacy.

4. To advocate as an interim measure (until the optimal model is fully implemented) that individuals be requiredeither

a. to have completed an ASHP accredited pharmacy technician training program orb. to have at least one year of equivalent experience as a pharmacy technician before they are eligible to

become licensed.


Currently, the CA Board of Pharmacy recognizes two nationally recognized examination as a prerequisite to obtain a pharmacy technician license (PTCB and ExCPT). Since this policy speaks to the development of regulatory and legislative changes that are related to technician practice, the specific language related to the technician licensure becomes too specific. The policy statement should be broad in general. Recommend to remove items #7 and #8.

CSHP BOARD ACTIONS: Approved on October 3, 2017 for consideration by the House of Delegates

ACTION:

☐ Bylaws update☐ Rules and Procedures of the House of Delegates☐ Update Administrative Policy catalog☒ Update Professional Policy catalog



☐ Staff Procedural manual ☐ CCTF’s volunteer hand book ☐ Minutes only ☐ Any other (please state)

HOD ACTION:



PROPOSAL D.8











1. Modify and Reaffirm 2012-12, Repackaging of Pharmaceuticals for Distribution

Policy #: 2012--12 Policy name: Repackaging of Pharmaceuticals for Distribution

Assigned to: Dan Dong Recommended Action: Reaffirm; Delete; ☒Modify & Reaffirm

#2012-12: Repackaging of Pharmaceuticals for Distribution




(Note: This is former policy #8609 approved by the HOD in 1986; reaffirmed by the HOD in 1992 as policy #9227; reaffirmed by the HOD in 1997 as policy #9709; reaffirmed by the HOD in 2002 as policy #2002-05; modified and reaffirmed by the HOD in 2007 as policy #2007-12; reaffirmed by the HOD in 2012 as policy #2012-12.)

The California Society of Health-System Pharmacists supports the practice of pharmacies performing bulk repackaging of pharmaceuticals for distribution outside the facility in which that pharmacy is located or licensed in accordance with California Board of Pharmacy regulations.


Recommended Wording


1. supports the practice of pharmacies performing bulk repackaging of pharmaceuticals for distribution outside thefacility in which that pharmacy is located or licensed in accordance with California Board of Pharmacy regulationsand the Food and Drug Administration guidelines and regulations.


Repackaging may fall under the FDA as well as the BOP.

CSHP BOARD ACTIONS: Approved on October 3, 2017 for HOD consideration.

ACTION:


HOD ACTION:



PROPOSAL D.9











1. Modify & Reaffirm 2012-13, Safe Handling of Cytotoxic and Hazardous Drugs as CSHP professional policy.

Policy #: 2012-13 Policy name: Safe Handling of Cytotoxic and Hazardous Drugs

Assigned to: Pauline Chan Recommended Action: Reaffirm; Delete; ☒Modify & Reaffirm

Current Policy

Source: HOD 1984



Wording (Note: This is former policy #8408 approved by the HOD 1984; modified and reaffirmed by the HOD in 1992 as policy #9220; modified and reaffirmed in 1997 as policy #9712; reaffirmed by the HOD in 2002 as policy #2002-07; modified and reaffirmed by the HOD in 2007 as policy #2007-13; reaffirmed by the HOD in 2012 as policy #2012-13.)

The California Society of Health-System Pharmacists recommends that each hospital, health-system, other patient care facility or environment where cytotoxic or hazardous drugs are handled, stored or administered establish a set of guidelines on the safe handling of chemotherapeutic cytotoxic and hazardous drugs based upon the best practices of State, federal and ASHP guidelines.


Wording


1. recommends that each hospital, health-system, other patient care facility or environment where cytotoxic orhazardous drugs are handled, stored or administered establish guidelines on the safe handling ofchemotherapeutic, cytotoxic and hazardous drugs based upon State and Federal laws and regulations and thebest practices and/or guidelines from nationally recognized organizations. such as ASHP, NIOSH, USP and CHA.

CSHP BOARD ACTIONS: Approved as amended on October 3, 2017

ACTION:

� Bylaws update � Rules and Procedures of the House of Delegates � Administrative Policy catalog update ☒ Update Professional Policy catalog� Staff Procedural manual � CCTF’s volunteer hand book � Minutes only � Any other (please state)

HOD ACTION:



PROPOSAL D.10











1. Reaffirm 2012-14, Nuclear Pharmacy

Policy #: 2012-14 Policy name: Nuclear Pharmacy



To adopt CSHP Professional Policy on “Nuclear Pharmacy” as follows:



The California Society of Health-System Pharmacists supports that the responsibility for the preparation and distribution of radiopharmaceuticals for human and veterinary use shall be delegated only to specially trained pharmacists, as defined by the Board of Pharmacy, in the area of nuclear pharmacy.


Recommended Wording

To adopt CSHP Professional Policy on “Nuclear Pharmacy” as follows:


1. sSupports that the responsibility for the preparation and distribution of radiopharmaceuticals for humanand veterinary use shall be delegated only to specially trained pharmacists, as defined by the Board ofPharmacy, in the area of nuclear pharmacy.


For consistent style of the policy format.

CSHP BOARD ACTIONS: The BOD approved this STP on October 3, 2017 for considering at the House of Delegates 2017.

ACTION:

� Bylaws update � Rules and Procedures of the House of Delegates � Administrative Policy catalog update � Professional Policy catalog update � Staff Procedural manual � CCTF’s volunteer hand book � Minutes only � Any other (please state)

HOD ACTION:



PROPOSAL D.11











PROPOSAL 1. Modify & Reaffirm 2012-15, Increased Security Features on Controlled Substances Prescription Form

Policy #: 2012-15 Policy name: Increased Security Features on Controlled Substances Prescription Form

Assigned to: Dan Dong Recommended Action: ☐Reaffirm; Delete; ☒Modify &Reaffirm

#2012-15: Increased Security Features on Controlled Substances Prescription Form




The California Society of Health-System Pharmacists supports standardization of the controlled substance prescription security forms and improving the security feature requirements on those forms.

CSHP also supports accountability regulations that require controlled substance prescription form printers to inform law enforcement if their products are stolen or their company’s identity is stolen.

CSHP encourages the development of real-time electronic verification methods.


Recommended Wording


1. supports standardization of the controlled substance prescription security forms andimproving the security feature requirements on those forms.

2. supports accountability regulations that require controlled substance prescription formprinters to inform law enforcement if their products are stolen or their company identity isstolen.

3. encourages the development and use of real-time electronic verification methods.


Same wording as current CPhA professional policy on this issue. No change needed in this area.

CSHP BOARD ACTIONS: Approved as amended on October 3, 2017 for consideration by the House of Delegates

ACTION:

� Bylaws update � Rules and Procedures of the House of Delegates � Update Administrative Policy catalog



☒ Update Professional Policy catalog � Staff Procedural manual � CCTF’s volunteer hand book � Minutes only � Any other (please state)

HOD ACTION:


Proposal E P a g e | 100

PROPOSAL: Proposed 2018 CSHP Committee on Nominations and Leadership development


DATE SUBMITTED: September 28, 2017

SITUATION:

1. CSHP Bylaws requires the Chair, House of Delegates appoint a Committee on Nominations(CON) to develop the CSHP slate of candidates for CSHP office.

2. The CSHP CON shall be composed of CSHP members as outlined by the CSHP Bylaws.3. The CSHP CON shall be approved by the House of Delegates and Board of Directors.

TARGET:

1. CSHP is a member-centric organization.2. CSHP provides members with opportunities for professional growth.

PROPOSAL:

Below are the proposed members for the 2018 CSHP Committee on Nominations and Leadership development:

1. Martin Iyoya (Diablo) – Chair2. Nancy Korman (Golden Gate)3. Kirsten Balano (North Coast)4. Maria Serpa (Sacramento Valley)5. Bob Miller (San Diego)6. Kenn Horowitz (South Bay/Long Beach)7. Jay Rho (Southern California)

CSHP Board Action: Approved on Sept 27, 2017 to be submitted to the House of Delegate 2017

HOD Action:

PROPOSAL E.1

1314 H Street, Suite 200 Sacramento, CA 95814-‐1930

(916) 447-‐1033/ FAX (916) 447-‐2396E-‐mail: [email protected]

CSHP:Shared:CSHP Cloud Drive:HOD (HOUSE OF DELEGATES):2014 HOD:2014 HOD Forms:HOD- Resolution Form.doc

Date:

RESOLUTION

(May be submitted by any two Active Members and must be received by the Secretary or Chair of the House of Delegates no later than close of business

INTRODUCED BY: (1)

(2) (Names -‐ please print) (Signatures)

(Chapter or Division Represented, if applicable)

DATE:

SUBJECT:

DESCRIPTION OF CURRENT SITUATION: (Describe problem/concern/issue. Include history and background, facts, opinions, feelings about the situation)

1.

2.

3.

DESCRIPTION OF DESIRED SITUATION (Outcome, e.g. goals, objectives, targets to be met, how desired situation relates to strategic plan)

1.

2.

PROPOSED ACTION(S): (Include cost analysis and who should address the issue (Board, specific committee, specific individual(s)?.))

1.

2.


Financial: EVP time:

Staff time:

(Please use reverse side if more room is needed)

$??(Impact on budget.) If it will cost money, how do you propose it be funded?

Have you asked the EVP (or other staff members who will be affected) for input on how this proposal will impact their time?

See pages to follow

July 25, 2017

Kathleen Besinque Kathleen Hill BesinqueDigitally signed by Kathleen Hill Besinque DN: cn=Kathleen Hill Besinque, o, ou, [email protected], c=US Date: 2017.07.25 11:14:41 -07'00'

Daniel Kudryashov

representing the SCSHP Chapter and SBLB Chapter

July 25, 2017Change to the composition of the California Board of Pharmacy: Pending legislation SB 716

SB 716 as originally introduced proposed the addition of a pharmacy technician to the Board of Pharmacy. The bill was subsequently amended to increase the number of public members to the BOP and thereby eliminated the pharmacist majority on the board

Maintaining the pharmacist majority on the Board of Pharmacy is important to insure regulatory decisions are made by individuals with the expertise and perspective to insure public safety

Two local chapters have sent letters of opposition to CSHP detailing reasons for concern. CSHP does not have professional policy on the composition of the BOP and this issue is significant enough to warrant formal consideration by the HOD.

Return SB 716 to the original language, adding a technician member only

The Board of Pharmacy, like all similar regulatory boards in California should have a majority of professional (pharmacist) members. until a discussion at the 2017 House of Delegates for discussion and debate.

Introduce professional policy (see following page)

00minimal

7/25/2017

Page 101

Description of current situation: (continued): 4. Concerns of our local chapters related to this legislation include: loss of pharmacist majority on theCA BoP, putting public safety at risk if regulatory decisions are made by individuals lacking appropriateexpertise and perspective (public members); discordance in categorization of technicians as having thesame role on the BOP as pharmacists given they are not considered active members of CSHP, and lack ofclarity in messaging delivered from CSHP main offices to the general membership.

5. Additionally, SB 716 will not resolve the anti-trust concerns (NC Board of Examiners v FTC) stated as areason for adding a public member to the CA BoP.

6. We do not oppose a technician serving on the BOP- we are opposed to the amended bill altering themajority membership on the BOP.

Proposed Actions (continued): New Professional Policy:

CSHP supports the inclusion of 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 to insure public safety.

.. ,,,

July 13, 2017

South Bay / Long Beach Society of Health System Pharmacists (SBLBSHP) [email protected]

California Society of Health-System Pharmacists (CSHP) 1314 H Street, Suite 200 Sacramento, CA 95814

Dear Loriann DeMartini, CSHP CEO, CSHP Board of Directors, and CSHP Government Affairs Advisory Committee:

The SBLBSHP Board of Directors is highly concerned with the existing language of CSHP

sponsored Senate Bill 716 (Hernandez) and believes the bill in its current form does not

align with the best interests of health-system pharmacists in the state of California.

Existing California law establishes the California Board of Pharmacy (the Board) composed of seven (7) pharmacists and six (6) members of the public. In its current form, SB 716 will add one (1) pharmacy technician member and one (1) additional member of the public to the Board. TheCSHP-sponsored legislation will bring the overall Board member count to fifteen (15),effectively eliminating the existing pharmacist majority.

We are strong proponents of advancing the profession of pharmacy, including by expanding the scope of practice of pharmacy technicians. We do agree with the original intent of this bill. However, passage of SB 716 in its current form will be a dis-service to the profession. Via the virtue of their advanced training, first-hand pharmacy experience, knowledge of the complex healthcare field and having the patients' best interests in mind, pharmacists are the bestpositioned individuals to serve and protect the public as members of the Board. Loss of pharmacist majority will not only expose all California pharmacists to unfair regulatory risk, but will also compromise patient safety. In addition, passage of SB 716 in its current form will signal a shameful sign of weakness in demonstrating that pharmacists cannot be trusted to act in their patients' best interests nor to regulate their own profession.

Ten other states have added pharmacy technician members on their respective pharmacy boards. We applaud this movement. However, not one of these states has sacrificed its pharmacist majority on the pharmacy regulatory board in the process of adding a pharmacy technician member (see table below).

Page 103

.. •

Comparison of Pharmacy State Regulatory Board Compositions in States with a Pharmacy Technician Member on the Board

State Pharmacist Technician Public and RPh: Total Members Members Other Members Members Ratio

Arizona 6 1 2 6 : 9

Massachusetts 8 1 4 Up to 9:13

Michigan 6 1 4 6:11

Montana 4 1 2 4:7

North Dakota 5 1 1 5:7

Oregon 5 2 2 5:9

Texas 7 1 3 7:11

Utah 5 1 1 5:7

Washington 10 1 4 10:15

Wyoming 6 1 2 6:9

California (current) 7 0 6 7:13

California (proposed) 7 1 7 7:15

The California Board of Pharmacy already has one of the most unfavorable pharmacist to nonpharmacist member ratios in the nation. We urge CSHP to avoid worsening the situation by eliminating pharmacist majority altogether. In its current form, SB 716 does not represent the interests of health-system pharmacists and neither does it protect the patients they serve. We

urge you to seek immediate amendment of the bill. We request a provision calling for replacement of one (1) of the Board public members with one (1) pharmacy technician, leaving total membership count at 13. If it is not possible to amend the bill in this way, we urge you to pull the bill. Any costs already spent on promoting the bill are sunk costs and should not be considered in decision-making.

We are respectfully bringing up our concerns with you first, before communicating our opposition to Dr. Ed Hernandez and other elected officials. We hope that our CSHP leadership will listen to the voice of its membership. In the words of Andy Stanley, "leaders who don't listen, will eventually be surrounded by people who have nothing to say."

Daniel Ku ryashov, PharmD, BCPS, PMP, CSSBB, CPHQ SBLBSHP Legal Affairs Chair

.. •

CC: SBLBSHP Board of Directors, Delegates and Elected Chairs Matt Kamada Angela Lee Tim Chou Billie Gomes Rosalin Preechakul Steve Thompson Cindy Odegard Lisa Lum Lauren Epperson Mirta Millares Dan Bauman Angela Jeong Joanne Lin Leslie Tanaka Scott Harada Jenny Wan Cindy La Pauline Phan Julie La Yasmin Yap-Mariano Helena Lau Jennifer Fong JR Flores Eunice Lee

. --�

. - . . '

�

July 10, 2017

California Society of Health-Systems Pharmacists

Southern California Chapter

Attn: CSHP Board of Directors

In keeping with the goal of a cooperative relationship between CSHP chapter affiliates and

CSHP, we the Southern California Chapter of CSHP are requesting CSHP support for the position

of our affiliate that the Board of Pharmacy should be comprised of a majority of registered

pharmacists.

The Board and members at large present at the May and June meetings of the SCSHP Board of

Directors believe this position is fundamental to ensuring the ongoing professional practice of

pharmacy.

Although we see the valuable role pharmacy technicians play in our mission, we do not see

pharmacy technicians as equivalent to pharmacists in their role as members of the California

State Board of Pharmacy.

We further believe that CSHP should propose a substantive change to SB-716 as in its current

form before the Assembly Business and Professions Committee, it provides a Board

composition of only 7 of 15 registered pharmacist members.

We look forward to a formal CSHP response regarding this matter.

Sincerely,

SCSHP Board of Directors, 2017

July 17, 2017

California Society of Health-Systems Pharmacists Southern California Chapter

Topic: SCSHP opposition to SB 716

Dear SCSHP members,

CSHP’s key sponsored legislation this year, SB-716 (Hernandez) - “California State Board of Pharmacy: Pharmacy Technician Member”, is currently being considered by the California Assembly, and would add two members to the California State Board of Pharmacy: 1 pharmacy technician plus 1 public member.

If the bill passes, pharmacists will lose their majority position on the California State Board of Pharmacy.

Initially, CSHP sponsored this bill to add 1 pharmacy technician to the Board of Pharmacy, however the bill has been amended to add a public member in addition to a pharmacy technician. Once the bill was amended to add another public member, and pharmacists no longer had a majority on the Board, CPhA, CRA (California Retailers Association) and NACDS (National Association of Chain Drug Stores) issued a statement of opposition to SB 716, and sent it to the CSHP leadership and to their legislators. CSHP still supports the amended bill, despite its potential impact on pharmacists.

Current board structure (13 members) Proposed board structure (15 members)

7 pharmacists 6 public members

7 pharmacists 7 public members 1 technician member

The SCSHP Board of Directors has discussed SB 716 during our last two board meetings, and on 7/12/17, voted unanimously to oppose SB 716. The board feels that due to their advanced training, first-hand pharmacy experience, knowledge of the complex healthcare field and having the patients’ best interests in mind, pharmacists are the best-positioned individuals to serve and protect the public as members of the Board. Loss of pharmacist majority will not only expose all California pharmacists to unfair regulatory risk, but will also compromise patient safety.

For reference: here is the composition of other professional boards in California:

CA Nursing Board 8 members 5 RNs, 3 public

CA Medical Board 15 members 8 MDs, 7 Public

CA Dental Board 11 members 6 DDSs, 5 Public

Here is the chart from the SBLB letter showing the composition of Boards of Pharmacy from other states:

Comparison of Pharmacy State Regulatory Board Compositions in States with a Pharmacy Technician Member on the Board

State Pharmacist Members

Technician Members

Public and Other Members

RPh : Total Members Ratio

Arizona 6 1 2 6 : 9

Massachusetts 8 1 4 Up to 9:13

Michigan 6 1 4 6:11

Montana 4 1 2 4:7

North Dakota 5 1 1 5:7

Oregon 5 2 2 5:9

Texas 7 1 3 7:11

Utah 5 1 1 5:7

Washington 10 1 4 10:15

Wyoming 6 1 2 6:9

California (current) 7 0 6 7:13

California (proposed) 7 1 7 7:15

Our board has contacted the CSHP leadership, expressing our concerns that the amended bill puts the pharmacist members of the Board of Pharmacy in the minority. Here is the text of our letter:

The SCSHP Board of Directors is also aware that other affiliate chapters have expressed the same concern. One example is this letter from the Board of Directors of the South Bay/Long Beach Affiliate Chapter, below.

Members of the SCSHP Board noted that some of the information disseminated regarding SB 716 is potentially confusing, and we want to make sure our members are aware of the implications of SB 716. If you share in our concerns, we urgently encourage you to contact CSHP’s CEO and Board ofDirectors to let them know that you do not support SB 716 and request they petition Senator EdHernandez to withdraw the bill.

Sincerely,

XKathleen Besinque

President, SCSHP

On behalf of the SCSHP Board of Directors, 2017

CSHP

PROPOSED RESOLUTION

Introduced by: Ciindy Hespe

Jason Bandy

Paul Sabatini

X Jason �hdv

Date: September 29. 2017

Subject: Mandatory Labeling of the Presence of Natural Rubber Latex in Medications

Description of Current Situation:

1. CSHP Professional Policy 2015-04 directs CSHP to adopt ASHP policies and other guidance

documents as CSHP Professional policy

2. To adopt as CSHP policy all ASHP Policy Positions, Guidelines, Bulletins and all official Statements

in the current edition of the Best Practices for Health-System Pharmacy of the ASHP, except

when such policies differ substantially from CSHP policy.

3. To endorse the use of ASHP Position Statements, Guidelines and Technical Assistance Bulletins

by its members in their practice settings.

4. CSHP will review all ASHP Policy Positions by 2020 for possible adoption as CSHP Professional

Policy.

5. CSHP does not have a policy with respect to latex in medications.

6. The CDC estimates that 1-6% of the general population has latex allergy and specific patient

populations are at higher risk

7. ASHP Policy 0501 Mandatory Labeling of the Presence of Latex was adopted in 2005 and

reaffirmed in 2014 by the ASHP Council on Pharmacy Practice:

0501

RESOLUTION B

Page 109

Target:

MANDATORY LABELING OF THE PRESENCE OF LATEX

Source: Section of Inpatient Care Practitioners

To urge the Food and Drug Administration to mandate that manufacturers of

medications and medication-device combination products include labeling information

on whether any component of the product, including its packaging, contains natural

rubber latex.

1. CSHP provides resources to its members, their patients, and the public per the 2017-2021

Strategic Priorities and Goals.

2. CSHP develops professional policy in congruence with other professional organizations, but

adopts policy as an independent professional society

3. CSHP provides professional policy that addresses natural rubber latex in medications.

Proposal:


Mandatory Labeling of the Presence of Latex

To urge the Food and Drug Administration to mandate that manufacturers of medications

and medication-device combination products include labeling information on whether any

component of the product, including its packaging, contains natural rubber latex.

Rationale:

Patients may be exposed to potentially life-threatening allergens including natural rubber latex

in items encountered in the medication-use process (i.e., medications, devices, and supplies).

Pharmacy involvement in collection, assessment, and documentation of a complete list of

allergens, including natural rubber latex, pertinent to the medication-use process would assist

in clinical decision-making. Pharmacists should also minimize patient and healthcare worker

exposure to known allergens by limiting or banning the use of latex gloves in pharmacies and

striving for latex-safe medication formularies.

Resources Required for Proposed Action(s): Financial: Minimal CEO time: Minimal Staff time: Minimal

CSHP Board Action: The Board of Directors reviewed this proposal on October 3, 2017 and recommends approval of this resolution.

CSHP

PROPOSED RESOLUTION

Introduced by: Cindy Hespe

Jason Bandy

Paul Sabatini

X ��===--=-Jason Bandy

{.,/


subject: Preventing Exposure to Allergens in Medications










Policy.

5. CSHP does not have a policy with respect to allergens in medications.


PREVENTING EXPOSURE TO ALLERGENS

Source: Council on Pharmacy Practice

RESOLUTION C

Page 111

Target:

To advocate for pharmacy participation in the collection, assessment, and documentation of

a complete list of allergens pertinent to medication therapy, including food, excipients,

medications, devices, and supplies, for the purpose of clinical decision-making; further,

To advocate that vendors of medication-related databases incorporate and maintain

information about medication-related allergens and cross-sensitivities; further,

To advocate that pharmacists actively review allergens pertinent to medication therapy and

minimize patient and healthcare worker exposure to known allergens, as feasible; further,

To encourage education of pharmacy personnel on medication-related allergens.

ASHP Rationale:

In 2005, ASHP adopted policy 0501, Mandatory Labeling of the Presence of Latex, and in

2008 adopted policy 0808, Excipients in Drug Products (now ASHP policy 1528). The

common theme in these policies is that patients may be exposed to potentially life

threatening allergens in items encountered in the medication-use process (i.e., natural

rubber latex, drugs, drug product excipients, devices, and supplies). Pharmacy involvement

in collection, assessment, and documentation of a complete list of allergens pertinent to the

medication-use process, including food, excipients, medications, devices, and supplies,

would assist in clinical decision-making. Pharmacists should also minimize patient and

healthcare worker exposure to known allergens, for example by limiting or banning the use

of latex gloves in pharmacies and striving for latex-safe medication formularies. Although

allergy information is becoming more readily accessible though the electronic health record

and clinical decision support systems, some well-known cross-sensitivities are good

candidates to be included in medication-related databases.

l. CSHP provides resources to its members, their patients, and the public per the 2017-2021

Strategic Priorities and Goals.

2. CSHP develops professional policy in congruence with other professional organizations, but

adopts policy as an independent professional society

3. CSHP provides professional policy that addresses allergens in medications including natural

rubber latex.

Proposal:


Preventing Exposure to Allergens

1. To urge adi.•ocate for_pharmacy participation in the collection, assessment, and

documentation of a complete list of allergens pertinent to medication therapy, including

food, natural rubber latex, excipients, medications, devices, and supplies, for the purpose of

clinical decision-making; further,

2. To encourage advocate that vendors of medication-related databases incorporate and

maintain information about medication-related allergens and cross-sensitivities; further,

3. To recommend that all ad,,ocate that pharmacists actively review allergens pertinent to

medication therapy and minimize patient and healthcare worker exposure to known

allergens, as feasible; further,

4. To encourage education of pharmacy personnel on medication-related allergens.

Resources Required for Proposed Action(s): Financial: Minimal

CEO time: Minimal

Staff time: Minimal

CSHP Board Action: The Board of Directors reviewed this proposal on October 3, 2017 and recommends

approval of this resolution.

CSHP

PROPOSED RESOLUTION

Introduced by: Cindy Hespe

Jason Bandy

Paul Sabatini


Subject: Excipients in Medications










Policy.

5. CSHP does not have a policy with respect to excipients in medications.

6. ASHP Professional Policy was adopted in 2015:

1528 EXCIPIENTS IN DRUG PRODUCTS

Source: Council on Pharmacy Practice

,,

RESOLUTION D

Page 114

Target:

To advocate that manufacturers remove unnecessary, potentially allergenic excipients

from all drug products; further,

To advocate that manufacturers declare the name and derivative source of all excipients

in drug products on the official label; further,

To advocate that vendors of medication-related databases incorporate information

about excipients; further,

To foster education on the allergenicity of excipients and documentation in the patient

medical record of allergic reactions to excipients.

ASHP Rationale:

Excipients are intended to be inactive ingredients that assist in delivering a

pharmaceutically elegant medication. In some patients, however, excipients cause

allergic responses or aggravate medical conditions. Examples include patients with

celiac disease reacting to gluten in a drug product or pediatric patients with a red-dye

allergy reacting to a suspension containing red dye. Inclusion of excipients in drug

product labeling, including their derivative source (the botanical, animal, or other source

from which the excipient is originally derived), would allow substitution of nonallergenic

alternative, but in many cases patients may not be aware of the allergy or it may not be

documented in the patient medical record. Manufacturers are therefore encouraged to

avoid putting allergenic excipients (e.g., red or yellow dye, gluten) in drug products

when possible.

Education of manufacturers, pharmacists and other healthcare professionals, and patients regarding the allergenicity of excipients will be required. Medicationrelated databases will need to be configured to include information about drug product excipients, and electronic health record systems will need to permit documentation of allergies and medical conditions related to excipients.


2. CSHP develops professional policy in congruence with other professional organizations, but adopts policy as an independent professional society

3. CSHP provides professional policy that addresses excipients in medications.

Proposal:


Excipients in Medication Products

1. To support the adi;ocate that maR1:.1fact1:.1rers removal of e unnecessary, potentially

allergenic excipients from all medications; further,

2. To encourage ad-.•ocate t-hat manufacturers to declare the name and derivative source

of all excipients in medications on the official label� further,

3. To strongly encourage adi;ocate that vendors of medication-related databases

incorporate information about excipients; further,

4. To foster education on the allergenicity of excipients and documentation in the patient

medical record of allergic reactions to excipients.

Resources Required for Proposed Action(s):

Financial: Minimal CEO time: Minimal Stafftime: Minimal

CSHP Board Action: The Board of Directors reviewed this proposal on October 3, 2017 and

recommends approval of this resolution.

(Names - Please Print)

(Chapter or Division Represented, if applicable)

SUBJECT: Safe and Effective Use of Medications in Pediatric and Neonatal Patients

DESCRIPTION OF CURRENT SITUATION:

(Describe problem/concern/issue. Include history and background,facts, opinions,feelings about the

situation)

1. CSHP has policy 2013-35: Medication Use in Geriatric Patients

CSHP supports medication therapy management to provide safe and effective drug therapy for geriatric patients

in addition to supporting the development, refinement, and validation of medication use criteria that considerdrug-disease and patient-specific factors for these patients.

However, there are not any recommendations for pediatric and neonatal patients.

2. ASHP has Medication Therapy and Patient Care: Specific Practice Area Position 0912: Safe and Effective Use of

Heparin in Neonatal Patients

ASHP supports the development and use of nationally standardized concentrations of heparin when used for

maintenance and flush of peripheral and central venous lines in neonatal patients as well as advocates that

hospitals and health systems use manufacturer-prepackaged heparin flush products to improve the safe use of

heparin in neonatal patients.

3. ASHP has Medication Therapy and Patient Care: Specific Practice Area Guidelines Providing Pediatric

Pharmaceutical Services in Organized Health Care Systems

ASHP supports that pharmacy services should be provided with sufficient physical facilities, personnel, and

equipment to meet the pharmaceutical care needs of the pediatric population. This includes orientation andtraining programs for pharmacists providing services to pediatric patients emphasizing dosage calculations,

dosage-form selection appropriate to patient's age and condition, and specialized drug preparation andtechniques.

4. Organizations such as the American Academy of Pediatrics (AAP), the Institute for Safe Medication Practices

(ISMP), The Joint Commission, and the Pediatric Pharmacy Advocacy Group (PPAG) have provided policystatements, position papers, and safety bulletins to advise and promote a culture of pediatric patient safety.

These organizations encourage all individuals and institutions caring for these vulnerable populations to becognizant of the challenges to provide safe and effective medication therapy due to limited availability of

published literature and clinical trials, limited FDA-approved for use drugs in pediatric patients, different and

changing pharmacokinetic parameters, lack of pediatric formulations, dosage forms, and guidelines, andmedication dosing based on body weight, body surface area, and patient age. The pediatric population (including

Page 119

Rules of Procedure of the HOD

RULES OF PROCEDURE FOR THE CSHP HOUSE OF DELEGATES PURSUANT TO ARTICLE VIII, OF THE BYLAWS OF

CSHP AS AMENDED JANUARY 2017

ARTICLE I ESTABLISHMENT OF REGULATIONS

The House of Delegates shall be governed by the Society's Bylaws and by Regulations adopted by a majority of votes cast at a regularly called meeting.

ARTICLE II SEATING OF DELEGATES

After the session of the House of Delegates has been called to order, the Secretary shall recognize and enroll the duly certified delegates who shall then compose the House of Delegates.

Any elected delegate or alternate delegate who appears at the meeting of the House of Delegates Session to be recognized and enrolled as a delegate of the House shall remain a delegate of the House until such time as s/he is replaced. The place of a recognized and enrolled delegate will not be taken by any other person, except that at the commencement of each meeting, the House may, by majority vote, recognize and enroll an alternate delegate who shall then remain a delegate (in place of the replaced delegate).

ARTICLE III ATTENDANCE AT MEETINGS

All meetings of the House of Delegates shall be open unless the House of Delegates votes to go into executive session. When in executive session the following only shall be admitted to the room in which the meeting is held: voting delegates, officers of the House of Delegates, and the parliamentarian.

ARTICLE IV OPEN FORUM

An Open Forum is an open hearing for all members. The Open Forum shall be conducted in conjunction with any House of Delegates session to provide a forum for members to express their opinions on matters of concern to them and on matters to be considered by the House of Delegates. The Open Forum shall be scheduled to be completed prior to the deadline for submission of new business

The Chairperson of the House of Delegates shall preside at the Open Forum and may request assistance from members of the Board of Directors and Committee, Council and Task Force (CCTF) Chairpersons.

Page 120


ARTICLE V PRIVILEGE OF THE FLOOR

The privilege of the floor during a meeting of the House of Delegates may be extended to any members of the California Society of Health-System Pharmacists. In addition, the House of Delegates, by a majority vote or common consent, may grant the privilege of the floor to other persons attending the meeting.

ARTICLE VI OFFICERS

The Chairperson of the House of Delegates shall preside at all meetings. The Chairperson shall be elected as described in Section 2 of Article VI of the Bylaws. The Secretary of the Society shall serve as Secretary of the House of Delegates and shall keep a roster of its members and shall keep and be custodian of its minutes and records.

ARTICLE VII COMMITTEES

There shall be a Committee on Nominations appointed annually by the Chairperson of the House of Delegates.

ARTICLE VIII RULES OF ORDER The House of Delegates shall be governed by the latest edition of Roberts Rules of Order when they are not in conflict with the Bylaws of the California Society of Health- System Pharmacists or with the Rules of Procedure for the CSHP House of Delegates.

ARTICLE IX ORDER OF BUSINESS

The following shall be the suggested order of business unless otherwise determined: 1. Call to Order2. Roll call of delegates3. Reports of officers4. Recommendations of delegates5. Recognition of councils, committees and task forces6. Report of the Committee on Nominations7. Unfinished business8. New business9. Election of the Chairperson of the House10. Installation of the Chairperson of the House and President.11. Adjournment

ARTICLE X ACTION ON REPORTS AND RECOMMENDATIONS

At least one author or author’s representative of the proposal, resolution or recommendation should be present at the Open Forum to speak on the issue.

This shall not preclude consideration, debate and reference to an appropriate body within the Society by the Delegates of proposals, resolutions, or recommendations that are presented to the House of Delegates from other sources.


ARTICLE XI INTRODUCTION OF NEW BUSINESS

Any matter to be presented as new business shall be presented to the Chairperson of the House on the proper form in writing or other method determined by the Board of Directors no later than 5:00 p.m. on the day before the meeting in which new business is on the agenda, except when presented by the Board of Directors or the chairperson of any council or committee authorized to report to the House of Delegates. If any such matter will include the offering of a motion, the method of submission required by this rule shall state explicitly the motion to be offered.

ARTICLE XII MOTIONS AND RESOLUTIONS

All motions and resolutions shall receive for adoption the majority of votes cast. Secret ballots shall not be permitted in voting.

Resolutions submitted to the California Society of Health-System Pharmacists for consideration by the House of Delegates will be handled in the following manner:

1. The Board of Directors will consider all proposed resolutions.

a. Proposed resolutions must be presented to the Board of Directors onthe proper form in writing or other method determined by the Boardof Directors thirty (30) days prior to the House of Delegatessession to allow time for preparation andpresentation.

b. Proposed resolutions submitted after a specific date will be consideredat the next House of Delegates session, except as provided in “c”below.

c. Resolutions that, because of the emergent nature of their content orintent require immediate action, may be processed provided thatapproval of a majority of the members of the Board of Directors isobtained.

2. Resolutions submitted to the Board of Directors must bear the signature of atleast two active members of the Society.

3. All resolutions not voluntarily withdrawn by the originators shall be presentedand acted upon at the meeting of the House of Delegates and shall besubmitted to the delegates with a recommendation for action from the Boardof Directors as follows:

a. Recommend adoption.b. Not recommend adoption.c. Recommend referral to a committee for further study, ord. Present with no recommendation.


ARTICLE XIII NOMINATIONS

All nominations for office will be made by the Committee on Nominations, or as otherwise provided in Sections 3 and 4 of Article VI of the Bylaws.

ARTICLE XIV AMENDMENTS

Every proposal to amend the Rules of Procedure for the CSHP House of Delegates shall be submitted in writing at least 30 days prior to the Regional Delegates Conference and may be enacted upon at the annual meeting, when upon receiving a majority of votes cast, it shall become a part of these regulations.

HOD- How to participate.doc

TIPS ON HOW TO MAXIMIZE YOUR PARTICIPATION IN THE CSHP HOUSE OF DELEGATES

I. To assist you in understanding the roles and responsibilities of delegates and theCalifornia Society of Health-System Pharmacists House of Delegates, please review theCSHP Bylaws and the Rules of Procedure for the CSHP House of Delegates, especially thefollowing sections:

A. Bylaws

(1) Article V--Meetings of the Society(2) Article VI--Directors(3) Article VII--Officers(4) Article VIII--House of Delegates(5) Article XVII--Parliamentary Procedure

B. Rules of Procedure for the House of Delegates

(1) Article V--Privilege of the Floor(2) Article X--Action on Reports and Recommendations(3) Article XI--Introduction of New Business(4) Article XII--Motions and Resolutions

II. Addressing the House

A. See Article II, V and VIII, Rules of Procedure for the HouseB. Go to a microphone and wait to be recognized by the Chairperson.C. State your name and the name of the regional chapter you represent. State

your business or question.

III. Introduction of Items for Consideration

A. Resolutions--see Rules of Procedure for the House, Article XII

(1) A resolution can be submitted by any two active members of CSHP. Youdon't have to be a delegate. Resolutions for modifications to the Bylaws,although usually introduced by the Board of Directors, may be introducedby any two active members (see Bylaws, Article XVIII).

(2) Requirements:a. Must be written.b. Two active members' signatures must be on the resolution.

c. Must be received by the Secretary of the House (the CSHP chiefexecutive officer) 30 days in advance of the meeting of the House.

(3) The Board of Directors will review and make a recommendation to theHouse on the proposed resolution.

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(4) The resolution will be read at the meeting of the House by theChairperson of the CSHP Board of Directors. Further discussion canoccur at the meeting of the House.

(5) The resolution will be read at the meeting of the House and the Board ofDirectors' position presented at this time. The Board may recommend anyof the following positions:

- adopt- not to adopt- referral to an appropriate council or- committee for further study- present without a recommendation

(6) Following discussion, a voice vote will be taken.

B. Recommendations (see Article X of the Rules of Procedure for the House)

(1) Recommendations may be made during the meeting of the House.

(2) A recommendation can be made by a delegate (as an individual) or onbehalf of a delegation.

(3) The recommendation must be submitted by the delegate in writing to theChairperson or Secretary (Chief Executive Officer) of the Houseimmediately after (s)he makes the recommendation. This is based solelyon the need for accuracy of the minutes and to ensure clarity of therecommendation.

(4) Since the presentation of a recommendation is simply a request bya delegate for the Board of Directors to address an issue, need,problem, etc., during the coming year, no discussion, debate or votetakes place.

C. New Business (see Article XI of the Rules of Procedure for the House)D.

(1) Any delegate may submit an item(s) of new business.

(2) Items must be submitted in writing to the Chairperson or the Secretary ofthe House in writing no later than 5:00 p.m. on the day before the meeting of theHouse.

(3) During the meeting of the House, the Chairperson will call for thepresentation of items new business. At that time, the delegate who submitted theitem of new business (or a representative of the individuals/delegation whosubmitted the item) will read the motion and background to the motion.

(4) The motion must be seconded, or no further action on it takes


place.

(5) If the motion is seconded, the floor is open for discussion/debate.

(6) A voice vote is taken on the motion.

IV. VOTING

As a delegate, you will be asked to vote on a number of items during the course of themeeting. The major items for which a vote will be necessary include ratification of thereport of the Committee on Nominations, approval of the appointees to the Committee onNominations for the next year, proposals from the Board (includes policy proposals fromcouncils, committees and task forces), new business, and resolutions.

A. Ratification of the Report of the Committee on Nominations (themeeting of the House.)

(1) This report will be presented at the meeting of the House bythe chairperson of the Nominating Committee.

(2) A second is required.


B. Approval of new Committee on Nominations (themeeting of the House.)

(1) The Chairperson of the House of Delegates will present theproposed Committee on Nominations appointments forratification.

(2) A second is required.


C. Officers' Reports

(1) President and Treasurer

a. Each of these officers will present a report on his/her year.b. Each report will be followed by a request for a motion to accept

the report and a second to such motion.c. Following discussion, a voice vote will be taken.

(2) Chief Executive Officer


This report is for the delegates' information and no vote is taken. However, questions and discussion are in order at the conclusion of the report.

CI. Action on Proposals -- (see Article X of the Rules of Procedure for the House)

(1) Proposals before the House of Delegates will be summarized by theChairperson of the Board of Directors at the first meeting of the House.

(2) No discussion of the report or vote will occur at this time. Clarification anddiscussion should take place at the Open Forum.

(3) Policy proposals will be reintroduced during the meeting of the House.The Chairperson of the Board of Directors will move for adoption. Nosecond is required. The floor will be open for discussion/debate.

(4) A voice vote will be taken on each proposal presented.

CII. Action on Resolutions -- (meeting of the House)(see Article XII of the Rules of Procedure for the House)

(1) Resolutions before the House of Delegates will be presented by theChairperson of the Board of Directors (acting as the Committee onResolutions) along with the Board’s recommended position, at the meetingof the House.

(2) No discussion of the report or vote will occur at this time. Clarification anddiscussion should take place at the Open Forum.

(3) Resolutions will be reintroduced during the meeting of the House. TheChairperson of the Board of Directors will move as recommended by theCommittee on Resolutions (Board). No second is required. The floor will beopen for discussion/debate.

(4) A voice vote will be taken on each resolution presented.

V. Amendments

A delegate can request that a resolution or policy proposal be amended. Some basicrules:

A. A motion to amend is a motion to modify. At the time the motion to amendis made, background should also be provided.

B. The amendment must be germane to the original motion and may take the form ofan insertion or addition; a deletion of wording; or a substitution. Any insertion,addition or substitution must be explicitly worded. It would be helpful if thepresenter provided the Chairperson of the House with a written version of theamendment.

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C. The amendment, once moved and seconded, is open fordiscussion/debate followed by a vote.

D. Following a vote on the amendment, a vote on the entire amended motion will betaken.

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CALIFORNIA SOCIETY OF HEALTH-SYSTEM PHARMACISTS HOUSE OF DELEGATES

UNDERSTANDING THE DIFFERENCE BETWEEN POLICY PROPOSALS,

RESOLUTIONS, NEW BUSINESS ITEMS, AND RECOMMENDATIONS

POLICY PROPOSALS Many of the proposals that come before the House of Delegates and ultimately result in new CSHP policy originate from council, committee and task force deliberations and are forwarded to the House of Delegates for action by the Board of Directors. CSHP councils, committees and task forces are appointed by the president with approval of the Board of Directors to fulfill specific charges and pursue activities based on the strategic plan.

RESOLUTIONS An avenue for individual members to introduce proposals for adopting or changing policy is through the resolution process. This process is especially good for addressing emerging issues that were not considered by the Board or councils, committees or task forces during the year. It can also be used as an “appeal” to the House of Delegates to act on proposals that are rejected by the Board. It requires only two active members (they don’t have to be delegates) to initiate the resolution process.

To be acted on at the House of Delegates, resolutions must be submitted in writing (in STP format) to the chair of the House or the secretary of the House (CEO) at least 30 days before the House convenes. This allows time for resolutions to be distributed to all delegates in advance of the House of Delegates meeting so that they may be duly considered by delegates and regional chapter members. The Board of Directors will also consider each resolution and submit it to the House with a recommended course of action, although the House’s action is on the resolution itself. The House may adopt, amend, reject, or refer the resolution. If a resolution is passed with amendments that have financial implications, the resolution is referred to the Board for review and possible modification.

ITEMS OF NEW BUSINESS New business items may be submitted only by delegates, (a non-delegate member of CSHP may request a delegate to introduce the measure on his/her behalf, or may request the House's permission to submit an item of new business). Any matter to be presented as new business must be presented to the Chairperson or Secretary of the House, in writing (in STP format), no later than 5:00 p.m. on the day before the meeting of the House of Delegates.

RECOMMENDATIONS Recommendations constitute the simplest and most direct way for a delegate to identify topics for further review and policy development by CSHP. At the designated point in the House agenda, any delegate is entitled to present a recommendation by simply approaching a microphone and voicing it. To help achieve the desired outcome,


recommendations should make clear what the recommender is requesting. A written copy of the recommendation (in STP format) should also be presented to the Chairperson for the record. Recommendations do not require a second, are not debatable, and are received without a vote. Thus, no recommendation can be voted down or dismissed by the House. All recommendations are considered by the Board of Directors for action or referral to an appropriate CSHP body - a council, committee or task force- for consideration. The outcome of each recommendation is reported both to the originator and to the House.

IN SUMMARY:

POLICY PROPOSALS 1. Originate with councils, committees, task forces or the Board of Directors and will be

presented to the House by the Board of Directors.2. Will be voted on by the House of Delegates.

RESOLUTIONS 1. May be submitted by any two active members.2. Must be submitted in writing 30 days in advance of the meeting.3. Shall be presented in STP format.4. Will be duly considered and presented to the House of Delegates with a

recommendation for action from the Board of Directors.5. Will be voted on by the House of Delegates.

ITEMS OF NEW BUSINESS 1. May be submitted by any delegate.2. Must be submitted no later than 5:00 p.m. the day before the meeting of the House

of Delegates.3. Shall be presented in STP format.4. Will be duly considered by the Board of Directors and presented to the House of Delegates

with a recommendation for action from the Board of Directors.5. Will be voted on by the House of Delegates.

RECOMMENDATIONS 1. May only be presented by delegates.2. Shall be presented in STP format.3. Will not be voted on by the House, but rather, considered by the Board of Directors for

action or referral to a CSHP council, committee or task force for consideration.

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Summary of Robert’s Rules of Order P a g e | 131

Robert's Rules of Order - Summary Version

Introduction to Robert’s Rules of Order

What Is Parliamentary Procedure? It is a set of rules for conduct at meetings that allows everyone to be heard and to make decisions without confusion.

Why is Parliamentary Procedure Important? Because it's a time tested method of conducting business at meetings and public gatherings. It can be adapted to fit the needs of any organization. Today, Robert's Rules of Order newly revised is the basic handbook of operation for most clubs, organizations and other groups. So it's important that everyone know these basic rules!

The method used by members to express themselves is in the form of moving motions. A motion is a proposal that the entire membership take action or a stand on an issue. Individual members can:

1. Call to order.2. Second motions.3. Debate motions.4. Vote on motions.

There are four Basic Types of Motions:

1. Main Motions: The purpose of a main motion is to introduce items to the membershipfor their consideration. They cannot be made when any other motion is on the floor,and yield to privileged, subsidiary, and incidental motions.

2. Subsidiary Motions: Their purpose is to change or affect how a main motion is handled,and is voted on before a main motion.

3. Privileged Motions: Their purpose is to bring up items that are urgent about special orimportant matters unrelated to pending business.

4. Incidental Motions: Their purpose is to provide a means of questioning procedureconcerning other motions and must be considered before the other motion.

How are Motions Presented?

1. Obtaining the floora. Wait until the last speaker has finished.b. Rise and address the Chairman by saying, "Mr. Chairman, or Mr. President."c. Wait until the Chairman recognizes you.

2. Make Your Motion


a. Speak in a clear and concise manner.b. Always state a motion affirmatively. Say, "I move that we ..." rather than, "I

move that we do not ..."c. Avoid personalities and stay on your subject.

3. Wait for Someone to Second Your Motion4. Another member will second your motion or the Chairman will call for a second.5. If there is no second to your motion it is lost.6. The Chairman States Your Motion

a. The Chairman will say, "it has been moved and seconded that we ..." Thusplacing your motion before the membership for consideration and action.

b. The membership then either debates your motion, or may move directly to avote.

c. Once your motion is presented to the membership by the chairman it becomes"assembly property", and cannot be changed by you without the consent of themembers.

7. Expanding on Your Motiona. The time for you to speak in favor of your motion is at this point in time, rather

than at the time you present it.b. The mover is always allowed to speak first.c. All comments and debate must be directed to the chairman.d. Keep to the time limit for speaking that has been established.e. The mover may speak again only after other speakers are finished, unless called

upon by the Chairman.8. Putting the Question to the Membership

a. The Chairman asks, "Are you ready to vote on the question?"b. If there is no more discussion, a vote is taken.c. On a motion to move the previous question may be adapted.

Voting on a Motion:

The method of vote on any motion depends on the situation and the by-laws of policy of your organization. There are five methods used to vote by most organizations, they are:

1. By Voice -- The Chairman asks those in favor to say, "aye", those opposed to say"no". Any member may move for a exact count.

2. By Roll Call -- Each member answers "yes" or "no" as his name is called. Thismethod is used when a record of each person's vote is required.

3. By General Consent -- When a motion is not likely to be opposed, the Chairmansays, "if there is no objection ..." The membership shows agreement by theirsilence, however if one member says, "I object," the item must be put to a vote.

4. By Division -- This is a slight verification of a voice vote. It does not require acount unless the chairman so desires. Members raise their hands or stand.

5. By Ballot -- Members write their vote on a slip of paper, this method is usedwhen secrecy is desired.


There are two other motions that are commonly used that relate to voting.

1. Motion to Table -- This motion is often used in the attempt to "kill" a motion. The optionis always present, however, to "take from the table", for reconsideration by themembership.

2. Motion to Postpone Indefinitely -- This is often used as a means of parliamentarystrategy and allows opponents of motion to test their strength without an actual votebeing taken. Also, debate is once again open on the main motion.

Parliamentary Procedure is the best way to get things done at your meetings. But, it will only work if you use it properly.

1. Allow motions that are in order.2. Have members obtain the floor properly.3. Speak clearly and concisely.4. Obey the rules of debate.

Most importantly, BE COURTEOUS.

For Fair and Orderly Meetings & Conventions

Provides common rules and procedures for deliberation and debate in order to place the whole membership on the same footing and speaking the same language. The conduct of ALL business is controlled by the general will of the whole membership - the right of the deliberate majority to decide. Complementary is the right of at least a strong minority to require the majority to be deliberate - to act according to its considered judgment AFTER a full and fair "working through" of the issues involved. Robert's Rules provides for constructive and democratic meetings, to help, not hinder, the business of the assembly. Under no circumstances should "undue strictness" be allowed to intimidate members or limit full participation.

The fundamental right of deliberative assemblies requires all questions to be thoroughly discussed before taking action!

The assembly rules - they have the final say on everything!

Silence means consent!

• Obtain the floor (the right to speak) by being the first to stand when the personspeaking has finished; state Mr/Madam Chairman. Raising your hand meansnothing, and standing while another has the floor is out of order! Must berecognized by the Chair before speaking!

• Debate cannot begin until the Chair has stated the motion or resolution andasked "are you ready for the question?" If no one rises, the chair calls for thevote!

• Before the motion is stated by the Chair (the question) members may suggest


modification of the motion; the mover can modify as he pleases, or even withdraw the motion without consent of the seconder; if mover modifies, the seconder can withdraw the second.

• The "immediately pending question" is the last question stated by the Chair!Motion/Resolution - Amendment - Motion to Postpone

• The member moving the "immediately pending question" is entitled topreference to the floor!

• No member can speak twice to the same issue until everyone else wishing tospeak has spoken to it once!

• All remarks must be directed to the Chair. Remarks must be courteous inlanguage and deportment - avoid all personalities, never allude to others byname or to motives!

• The agenda and all committee reports are merely recommendations! Whenpresented to the assembly and the question is stated, debate begins andchanges occur!

The Rules

• Point of Privilege: Pertains to noise, personal comfort, etc. - may interrupt only ifnecessary!

• Parliamentary Inquiry: Inquire as to the correct motion - to accomplish a desiredresult, or raise a point of order

• Point of Information: Generally applies to information desired from the speaker:"I should like to ask the (speaker) a question."

• Orders of the Day (Agenda): A call to adhere to the agenda (a deviation from theagenda requires Suspending the Rules)

• Point of Order: Infraction of the rules, or improper decorum in speaking. Mustbe raised immediately after the error is made

• Main Motion: Brings new business (the next item on the agenda) before theassembly

• Divide the Question: Divides a motion into two or more separate motions (mustbe able to stand on their own)

• Consider by Paragraph: Adoption of paper is held until all paragraphs aredebated and amended and entire paper is satisfactory; after all paragraphs areconsidered, the entire paper is then open to amendment, and paragraphs maybe further amended. Any Preamble cannot be considered until debate on thebody of the paper has ceased.

• Amend: Inserting or striking out words or paragraphs, or substituting wholeparagraphs or resolutions

• Withdraw/Modify Motion: Applies only after question is stated; mover canaccept an amendment without obtaining the floor

• Commit /Refer/Recommit to Committee: State the committee to receive thequestion or resolution; if no committee exists includes size of committee desiredand method of selecting the members (election or appointment).

• Extend Debate: Applies only to the immediately pending question; extends until


a certain time or for a certain period of time • Limit Debate: Closing debate at a certain time, or limiting to a certain period of

time• Postpone to a Certain Time: State the time the motion or agenda item will be

resumed• Object to Consideration: Objection must be stated before discussion or another

motion is stated• Lay on the Table: Temporarily suspends further consideration/action on pending

question; may be made after motion to close debate has carried or is pending• Take from the Table: Resumes consideration of item previously "laid on the

table" - state the motion to take from the table


• Reconsider: Can be made only by one on the prevailing side who has changedposition or view

• Postpone Indefinitely: Kills the question/resolution for this session - exception:the motion to reconsider can be made this session

• Previous Question: Closes debate if successful - may be moved to "CloseDebate" if preferred

• Informal Consideration: Move that the assembly go into "Committee of theWhole" - informal debate as if in committee; this committee may limit numberor length of speeches or close debate by other means by a 2/3 vote. All votes,however, are formal.

• Appeal Decision of the Chair: Appeal for the assembly to decide - must be madebefore other business is resumed; NOT debatable if relates to decorum, violationof rules or order of business

• Suspend the Rules: Allows a violation of the assembly's own rules (exceptConstitution); the object of the suspension must be specified

Taken from: http://www.robertsrules.org/

http://www.robertsrules.org/

Robert’s Rules of Order Chart of Motion P a g e | 137

ROBERTS RULES CHEAT SHEET

To: You say: Interrupt Speaker

Second Needed

Debatable Amendable Vote Needed

Adjourn "I move that we adjourn" No Yes No No Majority Recess "I move that we recess until…" No Yes No Yes Majority Complain about noise, room temp., etc.

"Point of privilege" Yes No No No Chair Decides

Suspend further consideration of something

"I move that we table it" No Yes No No Majority

End debate "I move the previous question" No Yes No No 2/3 Postpone consideration of something

"I move we postpone this matter until…"

No Yes Yes Yes Majority

Amend a motion "I move that this motion be amended by…"

No Yes Yes Yes Majority

Introduce business (a primary motion)

"I move that…" No Yes Yes Yes Majority

The above listed motions and points are listed in established order of precedence. When any one of them is pending, you may not introduce another that is listed below, but you may introduce another that is listed above it.

To: You say: Interrupt Speaker

Second Needed

Debatable Amendable Vote Needed

Object to procedure or personal affront

"Point of order" Yes No No No Chair decides

Request information "Point of information" Yes No No No None Ask for vote by actual count to verify voice vote

"I call for a division of the house" Must be done before new motion

No No No None unless someone objects

Object to considering some undiplomatic or improper matter

"I object to consideration of this question"

Yes No No No 2/3

Take up matter previously tabled

"I move we take from the table…" Yes Yes No No Majority

Reconsider something already disposed of

"I move we now (or later) reconsider our action relative to…"

Yes Yes Only if original motion was debatable

No Majority

Consider something out of its scheduled order

"I move we suspend the rules and consider…"

No Yes No No 2/3

Vote on a ruling by the Chair "I appeal the Chair’s decision" Yes Yes Yes No Majority The motions, points and proposals listed above have no established order of preference; any of them may be introduced at any time except when meeting is considering one of the top three matters listed from the first chart (Motion to Adjourn, Recess or Point of Privilege).

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Links to other supporting materials

The other additional materials listed here below are available on CSHP wensite at the following link: http://www.cshp.org/page/2017_HOD_Materials

Additional Materials:

CSHP Bylaws

CSHP Professional Policy Catalog Yr 2012-2016

CHSP Policy Development Process

CSHP Stragtegic Priorities 2017-2021

HOD Forms

STP- Decision Making for Effective Action

STP Template

Delegate Orientation Presentation

2017 Election Slate

Committee Council and Task Force (CCTF’s) Reports

House of Delegates 2016 Report

http://www.cshp.org/page/2017_HOD_Materials