ASHP’s Practice Advancement Initiative Aims for National Impact with New Recommendations

Pharmacy professionals with the Practice Advancement Initiative (PAI) 2030 have been working to identify changes in health care, and predict where they may lead.¹ A program of the American Society of Health-System Pharmacists (ASHP), PAI 2030 has instituted 59 recommendations to promote optimal, safe, and effective medication use, expand pharmacist and technician roles, and implement the latest technologies. ^1,2

According to ASHP, recommendations are intentionally aspirational rather than prescriptive, so practitioners can customize implementation plans for their situation and update as conditions evolve.¹ Members of the PAI 2030 advisory board shared the recommendations’ highlights, during the ASHP 54th Midyear Clinical Meeting & Exhibition in Las Vegas.²

Five domains have been identified: patient-centered care; pharmacist role, education, and training; technology and data science; pharmacy role, education and training; and leadership in medication use and safety. Under each domain, actions are recommended in patient-, organization-, and profession-focused subdomains.²

Patient-centered care²

Presented by Meghan D. Swarthout, PharmD, MBA, BCPS, the patient-centered care domain focused on the themes of engagement with patients, families, and caregivers; continuum of care; innovative 24/7 models; lead medication education; and documentation and information transparency.

Patient advocacy of the past has moved to include patients and caregivers in health care decision-making, Swarthout said. “How are we finding and using the voice of the patient?” she asked.

PAI 2030 recommends that pharmacy professionals engage in Patient and Family Advisory Councils (PFACs) by introducing PFAC members to pharmacy services, and involving them in pharmacy projects and committees. The initiative also recommends:

• Mapping out patient workflows across the continuum, including medication reconciliation and pharmacist handoffs.
• Expanding use of telehealth services to provide patient access to a pharmacist.
• Pharmacist participation and leadership in ethics committees, patient education workgroups, and external partnership assessments.

Pharmacist role, education, and training²

Swarthout also shared the themes of the pharmacist role, education, and training domain. They include: a continuing professional development plan; pharmacist prescribing; credentialing and privileging; board certification; behavioral, and mental health skills, and training; ambulatory pharmacists as primary care providers; and national or multistate licensure.

According to Swarthout, pharmacy professionals should work to elevate the status of pharmacists among health care peers. Applying that notion to practice could include:

• Assess the institutional process and political landscape for credentialing and privileging.
• Engage in government affairs by establishing relationships, and meeting regularly with your organization’s government affairs team, and create an advocacy strategic plan.
• Build continuous professional development into performance review activities.
• Revise job descriptions and requirements.
• Establish training in mental health first aid and behavioral health.

Technology and data science²

Heath technology will continue to have a significant impact on pharmacy, according to presenter Joseph Lassiter, PharmD, MS, BCPS, CPHIMS. However, he said information technology needs to work across state lines, between health systems, and between professions.

“Interoperability is key,” said Lassiter. “All of these systems need to talk to each other.”

Among the PAI 2030 recommendations for technology and data science:³

• The pharmacy workforce should be competent in health information technology, including analytics, automation, and clinical applications, with ongoing education and training at all stages of career development.
• Pharmacy should establish standards for the application of artificial intelligence in the various steps of the medication-use process: prescribing, reviewing mediation orders, and assessing medication-use patterns in populations.
• Virtual pharmacy services should be deployed to optimize operational and clinical services, extending patient care services and enhancing continuity of care. This includes telepharmacy.

“Telepharmacy can better assist patients who lack access to care,” Lassiter added. “What an exciting time to be a part of health system pharmacy practice.”

Pharmacy technician role, education and training²

“We are the smallest domain,” quipped presenter Julie F. Lanza, CPhT, CSPT.

PAI 2030 is calling for pharmacy technicians participation is advanced roles for all practice settings. The 6 recommendations for this domain focus on advocacy and organizational support for advancing the role of these professionals. Lanza said this role is no longer a job, but a career, and one that calls for more education, training, and certification.

“It’s all going to be trial-and-error when you put technicians in advanced roles, if you don’t already have them there,” said Lanza. “The way to support and watch this be successful for technicians is recognition of competencies.”

Lanza cited the success pharmacies have had with technicians administering vaccinations. “Technicians providing vaccinations free up copious amounts of time for pharmacists,” she said.

One challenge for advancing the role of pharmacy technicians is that every state has different criteria and opportunities. “There should be some kind of career path or career ladder, but there should be uniform education for entry-level technicians,” said Lanza.

To that end, PAI 2030 recommends:³

• Pharmacy technicians should have complete responsibility for advanced technical and supporting activities. These may include order fulfillment, regulatory compliance, diversion prevention, patient assistance program, and other responsibilities.
• Health systems should require technicians to be certified by the Pharmacy Technician Certification Board.
• A scope of practice including core competencies should be developed and defined for pharmacy technicians in acute-care and ambulatory-care settings.

Leadership in medication use and safety²

PAI 2030 supports pharmacist-led pharmacogenomic and medication stewardship at local, state, and national levels.³ That leadership should support staff well-being and resiliency, and interprofessional innovation centers, as well as diversity, equity, and inclusion.

According to presenter, John S. Clark, PharmD, MS, BCPS, FASHP, recommendations for leadership in medication use and safety includes policy influence for patients and population health, and developing opportunities for interdisciplinary problem solving around patient care.

Other PAI 2030 recommendations include:³

• Pharmacy practice leaders should ensure evidence-based medication use by continually analyzing and reporting use patterns and outcomes.
• Health systems should have a pharmacy executive leader with a reporting structure consistent with other executive leaders, to oversee and influence enterprise-wide decision making related to mediation use and technology.
• Pharmacy should partner with interprofessional organization to define and delineate practice advances into state and federal laws and regulations to optimize patient care.

The moderator for the session—entitled “Generating National Impact with the Practice Advancement Initiative (PAI) 2030”—was Eric M. Maroyka, PharmD, BCPS.

REFERENCES

• About PAI 2030. ASHP website. https://www.ashp.org/Pharmacy-Practice/PAI/About-PAI-2030. Accessed December 12, 2019.
• Maroyka E, Swarthout M, Lassiter J, Lanza J, Clark J. Generating National Impact with the Practice Advancement Initiative (PAI) 2030. Presented at: ASHP (American Society of Health-System Pharmacists) 54th Midyear Clinical Meeting & Exhibition; Las Vegas, Nevada: December 8, 2019.
• PAI 2030 Recommendations. ASHP website. https://www.ashp.org/Pharmacy-Practice/PAI/PAI-Recommendations. Accessed December 16, 2019.