2nd annual florida · 2018. 4. 3. · 2nd annual florida residency conference welcome to the second...

2ND ANNUAL FLORIDA

RESIDENCY CONFERENCE

May 9-10, 2013

University of Florida College of Pharmacy Gainesville, Florida

Sponsored by the FSHP Research and Education Foundation

2ND ANNUAL FLORIDA RESIDENCY CONFERENCE

Welcome to the Second Annual Florida Residency Conference. We are grateful to all in attendance and we are looking forward to another great conference full of high quality resident presentations, as well as some quality time with friends and colleagues. The Florida Residency Conference Steering Committee has been busy looking ahead to not only this conference but the future of the FRC.

Last year’s attendees at the first annual Florida Residency Conference provided the FRC Steering Committee with great feedback. One of the key changes to the conference this year is our Thursday night social event. Based on your feedback, we replaced the formal dinner with a Networking Reception at The Florida Museum of Natural History with a heavy hors d’oeuvres reception and a cash bar. You will have access to the museum’s exhibits and Butterfly Rainforest. We hope you join us for an evening of fun! We have also modified the layout of the program book and spread out the sessions to give attendees more space during the sessions as well as the breaks.

We are grateful to the FSHP Research and Education Foundation for their continued support of the Florida Residency Conference. This year the FSHP Research and Education Foundation provided funding for the new 2013 FRC Excellence in Research Award. The Excellence in Research Awards Program was created with the intent of recognizing pharmacy residents for their innovative contributions of original research relevant to health-system pharmacy practice during the calendar year preceding the FRC. The applications received were reviewed, and the top five finalists will be presenting their research during the conference as part of the competition. All five finalists are PGY-1 residents, and one of the finalists will receive the 2013 FRC Excellence in Research Award on Friday.

Congratulations to our five finalists:

Joseph Hong, Morton Plant Hospital

Kourtney Marsh, Orlando Health

Danielle Pierini, UF College of Pharmacy

Joseph Pardo, Lee Memorial Health System

Michael Verbosky, Tampa General Hospital

The FRC Steering Committee would like to thank the University of Florida College of Pharmacy Gainesville Campus for the use of their top-notch facilities, the Pharmacy Department of Shands for providing the parking vouchers for the conference attendees, and the FSHP Office Staff, Pam White and Tamekia Bennett, for their long hours and patience as we strive to make each conference better.


Report of the Florida Residency Conference Steering Committee In addition to preparing for the FRC 2013 conference, the FRC Steering Committee was charged with developing a formal FRC Committee structure as well as planning ahead for the impact residency training growth will have on future conferences. Highlights from those committee charges are highlighted below. Florida Residency Conference Steering Committee Structure The FRC Steering Committee has created and approved the FRC Officers and Ad Hoc Committee Members Responsibility and Elections procedure. The FRC Committee Structure is outlined below. Applications for all positions are available on the FSHP website with an application date of June 1 each year. FSHP Foundation Representative: appointed yearly by the FSHP Foundation Board of Directors. The representative will serve as a liaison between the FRC Steering Committee and the FSHP Foundation.

FRC Chair: will consist of a three (3) year term. The first year will be served as a FRC Chair Elect, the second year as the FRC Chair, and the third year as FRC Immediate Past Chair.

FRC Finance Liaison: FRC Finance Liaison will be responsible for oversight of the FRC budget, investigate scholarship opportunities and coordinate any fundraising efforts.

Pharmacy Resident Member: The Pharmacy Resident Member will be a second year pharmacy resident (PGY-2) and will serve one term. Pharmacy Resident member will work with FRC Chair and will be delegated responsibilities set forth by the FRC Chair.

AD HOC Members (4 to 6 members): Ad Hoc members will serve to support the FRC Chair, FRC Chair Elect, FRC Immediate Past Chair in their responsibilities in those positions. At least one Ad Hoc committee member will be from the same geographic location of the next FRC meeting.

Florida Residency Conference Future Planning Sub-Committee

In November 2012 a FRC Needs Assessment Planning Survey was sent via email to all preceptor attendees of FRC12 as well as additional Residency Program Directors in the state of Florida. 43 people completed the survey. 38% of the responses were completed by people who attended FRC in 2012. Highlights of the survey results included:

The top three geographic areas that were listed as desirable for future FRC meetings: 1. Central FL (Orlando) 2. North FL (Gainesville) 3. Tampa/St Pete area.

Finance was the primary reason why responders would not attend FRC in future years. In addition, more than 50% of responders said they would not want to pay higher rates that maybe necessary if the FRC moves from year to year.

Resident and preceptor attendance growth was estimated at about 9% for 2013 and roughly 20-25% within five years.

With the relatively small expected growth over in the next two years the FRC Steering Committee decided to hold the FRC13 and FRC14 in Gainesville. However, we have started exploring potential meeting sites in both the Tampa/St Petersburg and Orlando areas for future conferences to accommodate the anticipated growth.

2013 FLORIDA RESIDENCY CONFERENCE STEERING COMMITTEE

SUZANNE TURNER, PHARM.D., CHAIRPERSON 2013 Pharmacy Clinical Specialist-Education and Residency Coordinator

Lee Memorial Health System, Fort Myers, FL Phone: 239-343-2232 [email protected]

John Armitstead, MS, RPh, FASHP System Director of Pharmacy Lee Memorial Health System, Fort Myers, FL Phone: 239-343-6490 [email protected] Kara L. Birrer, Pharm.D., BCPS Clinical Pharmacist, Trauma/General Surgery Assistant Director, PGY-1 Pharmacy Residency Orlando Regional Medical Center, Orlando Health, Orlando, FL Phone: 321-841-2593 [email protected] Jason Brady, Pharm.D., BCPS Clinical Pharmacist, Emergency Medicine Director, PGY-1 Pharmacy Residency Program Orlando Regional Medical Center, Orlando Health, Orlando, FL Phone: 321-841-2597 [email protected] Tiffany Jagel, Pharm.D., CDE, BCPS, BCACP Clinical Pharmacy Specialist VA Gulf Coast Joint Ambulatory Center, Pensacola, FL Phone: 850-912-2359 [email protected] William Kernan, Pharm.D., BCPS Assistant Director, Department of Pharmacy Director, PGY-1 Pharmacy Residency Program Cleveland Clinic Florida, Weston, FL Phone: 954-689-5646 Email: [email protected] Jessica LaFosse, Pharm.D., BCPS Pharmacy Residency Coordinator Pharmacy Educator Learner, Input, Positivity, Developer, Includer Holmes Regional Medical Center, Melbourne, FL Phone: 321-434-7309 [email protected]

Carrie Lagasse, Pharm.D., BCPS Clinical Specialist, Clinical Resource Utilization Co-Director, PGY-1 Pharmacy Residency Shands at the University of Florida, Gainesville, FL Phone: 352-265-0111 ext 44032 [email protected] Mike Magee, MS, RPh, FASHP Director of Pharmacy St Joseph's Hospitals South Florida Baptist Hospital, Tampa, FL Phone: 813-870-4868 [email protected] Mark Ninno, Pharm.D. Pharmacy Implementation Manager VHA Performance Services, Orlando, FL Phone: 407-359-1128 [email protected] Christine Price, Pharm.D. Clinical Coordinator Director, PGY-1 Pharmacy Residency Program Morton Plant Mease Health Care, Clearwater, FL Phone: 727-462-7454 [email protected] William Terneus, Jr., Pharm.D., BCPS Pharmacy Clinical Manager Director, PGY-1 Pharmacy Residency Program Indian River Medical Center, Vero Beach, FL Phone: 772-567-4311 ext 3027 [email protected] Lisa Thames, Pharm.D., BCPS Chief, Pediatric Clinical Pharmacy Services Director, PGY-2 Pediatric Residency Program Shands Children's Hospital at UF, Gainesville, FL Phone: 352-265-0111 ext 45926 [email protected]

CONTINUING EDUCATION AND EVALUATIONS

The Florida Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of pharmacy continuing education. This program contains Knowledge Based CPE.

CE INSTRUCTIONS: Request for Continuing Education Forms: After successfully attending preferred sessions in their entirety, complete the Request for CE Form found in your Program Book and turn it in to verify attendance. Sessions are in 1.0 hour increments and CE will be awarded according to the completion of the presentation, partial credits are not acceptable. There is a maximum of 9.0 general credit hours. Complete your form as you attend the sessions to avoid mistakes. Forms should not be turned in until you are done with sessions. NABP eProfile IDs and month and date of your birth date are required, CE will not be issued without this information.

EVALUATION INSTRUCTIONS: Speaker Evaluations: Please complete an evaluation for each speaker and submit them to the session moderator immediately after each resident’s presentation. Also, complete the overall meeting evaluation form found in your Program Book and turn in with your Request for CE Form when you are done with sessions.

FSHP Designated Reviewer-Moderator Responsibilities Form: The session moderator is responsible for completing their portion of this form for each speaker during their session and submitting the completed forms to the designated FSHP representative at the completion of the session.

THURSDAY, MAY 9, 2013 General Session-Precepting for Excellence (1.0 hr) ACPE UAN 163-999-13-077-L04-P SESSION I Session Ia-Infectious Disease Part I (1.0 hr) ACPE UAN 163-999-13-078-L01-P

Session Ib-Ambulatory Care I (1.0 hr) ACPE UAN 163-999-13-079-L01-P

Session Ic- Critical Care Medicine Part I (1.0 hr) ACPE UAN 163-999-13-080-L04-P

Session Id-Internal Medicine Part I (1.0 hr) ACPE UAN 163-999-13-081-L01-P

Session Ie-Administration Part I/Med Safety Part I (1.0 hr) ACPE UAN 163-999-13-082-L05-P

Session If-Infectious Disease Part I (1.0 hr) ACPE UAN 163-999-13-083-L01-P

Session Ig-Ambulatory Care Part II (1.0 hr) ACPE UAN 163-999-13-084-L01-P

Session Ih-Critical Care Medicine Part II (1.0 hr) ACPE UAN 163-999-13-085-L04-P

Session Ii-Administration Part II (1.0 hr) ACPE UAN 163-999-13-086-L04-P

FRIDAY, MAY 10, 2013 SESSION II Session IIa-Internal Medicine Part II (1.0 hr) ACPE UAN 163-999-13-087-L01-P

Session IIb-Infectious Disease Part III (1.0 hr) ACPE UAN 163-999-13-088-L01-P

Session IIc- Infectious Disease Part IV (1.0 hr) ACPE UAN 163-999-13-089-L01-P

Session IId-Critical Care Medicine Part III (1.0 hr) ACPE UAN 163-999-13-090-L01-P

Session IIe-Ambulatory Care Part III (0.1 hr) ACPE UAN 163-999-13-091-L01-P

Session IIf- Ambulatory Care Part IV (1.0 hr) ACPE UAN 163-999-13-092-L01-P

Session IIg-Internal Medicine Part III (1.0 hr) ACPE UAN 163-999-13-093-L01-P

Session IIh-Infectious Disease Part V (1.0 hr) ACPE UAN 163-999-13-094-L01-P

Session IIi-Infectious Disease Part VI (1.0 hr) ACPE UAN 163-999-13-095-L01-P

Session IIj-Critical Care Medicine Part IV (1.0 hr) ACPE UAN 163-999-13-096-L01-P

Session IIk-Ambulatory Care Part V (1.0 hr) ACPE UAN 163-999-13-097-L01-P

Session IIl-Ambulatory Care Part VI/Pediatrics Part I (1.0 hr) ACPE UAN 163-999-13-098-L01-P

CONTINUING EDUCATION AND EVALUATIONS, CONT.

FRIDAY, MAY 9, 2013

SESSION III

Session IIIa-Critical Care Medicine Part V (1.0 hr) ACPE UAN 163-999-13-099-L01-P

Session IIIb-Pediatrics Part II (1.0 hr) ACPE UAN 163-999-13-100-L01-P

Session IIIc- Psychiatry Part I (1.0 hr) ACPE UAN 163-999-13-101-L01-P

Session IIId-Internal Medicine Part IV (1.0 hr) ACPE UAN 163-999-13-102-L01-P

Session IIIe-Ambulatory Care Part VII (1.0 hr) ACPE UAN 163-999-13-103-L01-P

Session IIIf- Community Pharmacy/Internal Medicine Part V (1.0 hr) ACPE UAN 163-999-13-104-L01-P

Session IIIg-Critical Care Medicine Part VI/Med Safety Part II (1.0 hr) ACPE UAN 163-999-13-105-L01-P

Session IIIh-Pediatrics Part III (1.0 hr) ACPE UAN 163-999-13-106-L01-P

Session IIIi-Transplantation (1.0 hr) ACPE UAN 163-999-13-107-L01-P

Session IIIj-Internal Medicine Part VI (1.0 hr) ACPE UAN 163-999-13-108-L01-P

Session IIIk-Ambulatory Care Part VIII (1.0 hr) ACPE UAN 163-999-13-109-L01-P

Session IIIl-Psychiatry Part II/Administration Part III (1.0 hr) ACPE UAN 163-999-13-110-L01-P

SESSION IV

Session IIIa-Oncology Part I (1.0 hr) ACPE UAN 163-999-13-111-L01-P

Session IIIb-Administration Part IV (1.0 hr) ACPE UAN 163-999-13-112-L04-P

Session IIIc-Med Safety Part III (1.0 hr) ACPE UAN 163-999-13-113-L05-P

Session IIId-Oncology Part II/Administration Part V (1.0 hr) ACPE UAN 163-999-13-114-L04-P

Session IIIe-Infectious Disease Part VII (1.0 hr) ACPE UAN 163-999-13-115-L01-P

Session IIIg-Oncology Part III (1.0 hr) ACPE UAN 163-999-13-116-L01-P

Session IIIh-Administration Part VI (1.0 hr) ACPE UAN 163-999-13-117-L04-P

Session IIIi-Med Safety Part IV (1.0 hr) ACPE UAN 163-999-13-118-L05-P

Session IIIk-Pharmacy Informatics/Infectious Disease Part VIII (1.0 hr) ACPE UAN 163-999-13-119-L01-P

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Conference Agenda All Sessions will be held at the University of Florida College of Pharmacy

THURSDAY MAY 9, 2013

12:00pm-1:45pm Registration HPNP Front Entrance Courtyard

1:00pm-1:20pm Moderators/Evaluators Meeting HPNP Auditorium

1:30pm-2:45pm Welcome FRC Steering Committee Report Opening Session

HPNP Auditorium

3:00pm-4:00pm Session I Concurrent Sessions

Rooms G103, G112, G114, G301, G312

CE Switch

4:10pm-5:10pm Session I (Continued) Rooms G103, G112, G114, G301

6:00pm- 9:00pm Networking Reception

Florida Museum of Natural History

FRIDAY MAY 10, 2013

7:30am-8:20am 7:30am

Registration Continental Breakfast

HPNP Front Entrance Courtyard HPNP Reception Hall

8:20am-9:20am Session II Concurrent Sessions

Rooms G103, G112, G114, G301, G312, G307

CE Switch

9:30am-10:30am Session II (Continued) Rooms G103, G112, G114, G301, G312, G307

10:30am-10:50am Refreshment Break HPNP Reception Hall

10:50am-11:50am Session III Concurrent Sessions

Rooms G103, G112, G114, G301, G312, G307

CE Switch

12:00pm-1:00pm Session III (Continued) Rooms G103, G112, G114, G301, G312, G307

See you next year at the 2014 Florida Residency Conference!

Tentative 2014 FRC Information Dates: May 8-9, 2014

Location: University of Florida College of Pharmacy, Gainesville, FL

1:00pm-1:15pm

1:15pm

1:00pm-2:00pm

Presentation: It’s YOUR Profession! Mike Magee, MS, RPh, FASHP

Director of Pharmacy St Joseph’s Hospitals

John Armitstead, MS, RPh, FASHP System Director of Pharmacy Lee Memorial Health System

FRC Excellence in Research Award Presentation FRC Steering Committee

Buffett Lunch

Room G101 **FOR RESIDENTS** *ATTEND PRIOR to LUNCH*

Room G101 All Attendees are Invited

HPNP Reception Hall

2:00pm-3:00pm Session IV Concurrent Sessions

Rooms G103, G112, G114, G301, G312

CE Switch

3:10pm-4:10pm Session IV (Continued)

Rooms G103, G114, G301, G312

4:10pm Program Evaluation and Adjourn

2013 Legend- Programs Represented

ACH All Children's HospitalBHMF Baptist Hospital of Miami, Miami, FloridaBHPF Baptist Hospital, Pensacola, Florida BMCS Bayfront Medical Center, St. Petersburg, FloridaBGMC Broward General Medical CenterBPVA Bay Pines VA Healthcare System, Bay Pines, FloridaCCFL Cleveland Clinic Florida, Weston, FloridaCSI Coram Specialty InfusionFHOF Florida Hospital, Orlando, FloridaFHCO Florida Hospital for Children, Orlando, FloridaFHOC Florida Hospital, Celebration, FloridaFMVA Fort Myers VA Outpatient Clinic, Fort Myers, FloridaHLMCC H. Lee Moffitt Cancer Center & Research InstituteHRMC Holmes Regional Medical Center, Melbourne, FloridaIRMC Indian River Medical Center, Vero Beach, FloridaJHVH James A. Haley Veterans Hospital, Tampa, FloridaLRMC Lakeland Regional Medical Center, Lakeland, FloridaLMHS Lee Memorial Health System, Fort Myers, Florida MCJF Mayo Clinic of Jacksonville, Jacksonville, FloridaMSP Medimix Specialty PharmacyMRHS Memorial Regional Hospital, Hollywood, FloridaMHMF Mercy Hospital, Hospital, FloridaMVMC Miami VA Healthcare System, Miami, FloridaMPHC Morton Plant Hospital, Clearwater, Florida FGVM North Florida/South Georgia Veterans Health System, Gainesville, FloridaNOVA NOVA Southeastern University College of Pharmacy, Fort Lauderdale-Davie, FloridaORHC Orlando Health, Orlando, FloridaOVAO Orlando VA Medical Center, Orlando, FloridaSMHS Sarasota Memorial Hospital, Sarasota, FloridaSUF Shands at the University of FloridaSJAX Shands Jacksonville Department of Pharmacy, Jacksonville, FloridaSMVM South Miami Hospital, Miami, FloridaSAHS St. Anthony's Hospital, St. Petersburg, FloridaSJHT St. Joseph's Hospital, Tampa, FloridaSVMC St. Vincent's Medical Center, Jacksonville, FloridaTGHT Tampa General Hospital, Tampa, FloridaUFCOP University of Florida College of PharmacyVAGC VA Gulfcoast Joint Ambulatory Care Center, Pensacola, FloridaWCHP WellCare Health Plans, Tampa, FloridaWFHC West Florida Healthcare, Pensacola, FloridaWPB West Palm Beach VA Medical Center WCHB Wolfson Children's Hospital/ Baptist Health, Jacksonville, Florida

**DESIGNATED CLASSIFICATIONS**

ADMINISTRATION—ADM

AMBULATORY CARE—AMB

CRITICAL CARE MEDICINE—CCM

COMMUNITY PHARMACY—CP

INFECTIOUS DISEASE—ID

INTERNAL MEDICINE—IM

MEDICATION SAFETY—MED

ONCOLOGY—ONC

PEDIATRICS—PED

PHARMACY INFORMATICS—PI

PSYCHOLOGY—PSY

TOXICOLOGY—TXP

Note: Abstracts were reproduced in the format in which they were received.

Thursday

May 9th, 2013

Room HPNP Auditorium G301 G103 G114 G312 G112 G307

Registration Noon1:00 - 1:20pm Preceptors/Moderators

introduction

Welcome -OpeningOpening Session

1:30 - 2:45 General Session/Preceptors

3:00 - 3:20

3:20 - 3:40 ID AM CARE CCM IM ADM3:40 - 4:00 MED

4:10 - 4:30 ID AM CARE CCM ADM

4:30 - 4:50

4:50- 5:10

6:00 - 9:00 Reception at Florida Mueseum of Natural History

ABSTRACT ARRANGEMENT BY DESIGNATED CLASSIFICATION2nd Annual Florida Residency Conference

Opening Session & Session I

Session I

CE Switch: 10 mins

1

Friday

May 10th, 2013

Room G301 G103 G114 G112 G312 G307

8:20 - 8:40

8:40 - 9:00 IM ID ID CCM AM AM

9:00 - 9:20

9:30 - 9:50 AM

9:50 - 10:10 IM ID ID CCM AM

10:10- 10:30 PED10:30 - 10:50

10:50 -11:10 CP

11:10 - 11:30 CCM PED PSY IM AM IM

11:30 - 11:50

12:00 - 12:20

12:20 - 12:40 MED PED TXP IM AM

12:40 - 1:00 ADM

1:00 - 2:00

2:00 - 2:20 ONC

2:20 - 2: 40 ADM MED ADM ID

2:40 - 3:00

3:10 - 3:30 PI

3:30 - 3:50 ONC ADM MED ID

3:50 - 4:10

PSY

ONC

CE Switch: 10 mins

CE Switch: 10 mins

Session III

Session II

ABSTRACT ARRANGEMENT BY DESIGNATED CLASSIFICATION

Refreshment BREAK

Box LUNCH

2nd Annual Florida Residency Conference

Session II, III, & IV

Session IV

CE Switch: 10 mins

1

Thursday

May 9th, 2013

HPNP Auditorium G301(90 people)

G103(70 people)

G114(72 people)

G312(60 people)

G112(38 people)

G307(40 people)

Registration Noon1:00 - 1:20pm Preceptors/Moderators

introduction

Welcome -OpeningOpening Session

1:30 - 2:45 General Session/Preceptors - - - -

3:00 - 3:20 Aaron Sango/SJAX Deniz Yavas/BPVA Courtney McKay/LRMC Marie A. Lafosse/MRHS **Michael Verbosky/TGHT**

3:20 - 3:40 **Joseph Pardo/LMHS** Pinal Patel/BPVA Ann McConnell/ORHC Jessica Saiz de la Mora/BHMF Luke Miller/SJAX

3:40 - 4:00 Corey Witenko/SJAX Joshua McWilliam/MVMC Matthew Bamber/ORHC **Joseph Hong/MPHC** Kristin Morabito/CCFL

CE Switch: 10 mins

4:10 - 4:30 Denise Kelley/SJAX Nicholas R. Bacon/MVMC Brittany Herring/MRHS Kristen Fischer/BPVA

4:30 - 4:50 Carmen Ward/WFHC **Danielle Pierini/UFCOP** Rachel O'Geen/SJAX Brooke Gabel/BPVA

4:50- 5:10 Heather Stamper/HRMC Rachael Carloni/SJAX Amy Wilds/MRHS Ellen Cvejanovich/BPVA

6:00 - 9:00 Reception at Florida Mueseum of Natural History

ABSTRACT ARRANGEMENT BY PRESENTER/PRACTICE SITE2nd Annual Florida Residency Conference

Opening Session & Session I

Note: The asterisks (**) signifies award Finalists of the Excellence Award

Session I

1

Friday

May 10th, 2013

G301 G103 G114 G112 G312 G307

8:20 - 8:40 Evgenia Prokopenko/WCHB Kristen Hillebrand/IRMC Ryan Mejia/SMHS Janet Arrazcaeta/SUF Ahmad Shehab/FHOC Adrienne DeBerry/SJAX

8:40 - 9:00 Whitney G. Bunion/WCHB Amanda Chao/ORHC Rusha Patel/SMHS Matthew Logan Wright/SUF Justin Davis/JHVH Jason Powell/UFCOP

9:00 - 9:20 Sara Dingwall/IRMC Martha Knoblich/SJHT Aileen Martinez/LMHS Jaela Dahl/JHVH Jennifer Gregory/FHOC Poe Aunggyi/CCFL

CE Switch: 10 mins

9:30 - 9:50 Dennis Ganyc/SMHS Rebekah Seale/SJHT Diane M. Gomes/SJAX Veronica Sherman/BHMF Kelly Anderson/FHOC Scott Cohen/FGVM

9:50 - 10:10 Olusola O. Apena/SUF Chad Cannon/SVMC Rebecca Gonzalez/LMHS Rochelle M. Forsyth/MCJF Jayme Lentz/VAGC Natalie Pike/WPB

10:10- 10:30 Ji Y. Lee/SUF Karen Reeves/MVMC Ashley Kelleher/BPVA Violeta Barac/FHOF Kendrick Murphy/VAGC **Kourtney Marsh/ORHC**

10:30 - 10:50

10:50 -11:10 Julie J. Lewandowski-Belfer/MCJF Tara Nygaard/SJHT Teresa Elsobky/IRMC Laura Trembath/BPVA Kim Tyanne Julien/FMVA Marjohn Armoon/MSP

11:10 - 11:30 Jose Valdes/BHPP Emi Onuki/WCHB Matthew Felser/MVMC Peter Richard Rabbath/JHVH Lindsey Bates/FMVA Janel Gordon/JHVH

11:30 - 11:50 Micaela Carroll/BGMC Jamie Caruthers/WCHB Katie Cich/UFCOP Phuoc Bui/LRMC Lindsay Jackson/FHOC Andrew Gatton/SJAX

CE Switch: 10 mins

12:00 - 12:20 Kristina Lee/SMVM Joanna Wrobel/WCHB Beatrice Adams/TGHT Mina Abdalla/MHMF Stacie Halmilton/OVAO Brian McKee/NOVA

12:20 - 12:40 Eleanor Bituin/WFHC Suzanna Bedy/ACH Chelsea Sammons/TGHT Stephanie Tears/LMHS Natasha Antonovich/OVAO Ashley Hillman/WCHB

12:40 - 1:00 Rebecca Nelson/HLMCC Juwon Yim/FHCO Harrison E. Saull/MCJF Nitha Kan Chou/SAHS Kristen Johnson /OVAO Pamela Tabor/WCHP

1:00 - 2:00

2:00 - 2:20 Andrea Velandia/ORHC Thomas Towers/IRMC Danielle M. Gingras/BPVA Kristy Nguyen/SMHS Wonhee So/SAHS

2:20 - 2: 40 Chungeun Joanne Lee/SJHT Joy Awoniyi/MVMC Crystal Parke/SVMC Lashawn Morton/OVAO Andrew Zaki/CSI

2:40 - 3:00 Brandon Wilds/SVMC Kristyn Mulqueen/FGVM Sylvia Stoffella/IRMC Christina Lee/SJHT Sloka Manvi/SJAX

CE Switch: 10 mins

3:10 - 3:30 Moe Shwin/BHMF Emily Dutton/TGHT Katherine Kamataris/SVMC Kenny Aristide/IRMC

3:30 - 3:50 Leigh Anna Soler/MCJF Derek Vuong/BMCS Heather C Murphy/SVMC Andrew Coelho/WCHP

3:50 - 4:10 Jamie Lee/LRMC Jocelyn Congdon/SJAX Margaret Swindler/FGVM Jessica Dabady/HRMC

4:10 - Program Evaluation & Adjourn

Session IV

Session III

ABSTRACT ARRANGEMENT BY PRESENTER/PRACTICE SITE2nd Annual Florida Residency Conference

Sessions II, III, & IV

Refreshment BREAK

Buffet LUNCH

Session II

1


Opening Session 1:30pm-2:45pm

Welcome & Announcements Suzanne Turner, Pharm.D. Chair, 2013 Florida Residence Conference Steering Committee Welcome from the University of Florida College of Pharmacy Michael McKenzie, Ph.D. Senior Associate Dean for Professional Affairs Department of Pharmacotherapy & Translational Research University of Florida College of Pharmacy, Gainesville, FL Florida Residency Conference Steering Committee Report Suzanne Turner, Pharm.D, FRC Chair 2013 William Terneus, Pharm.D., BCPS, FRC Chair-Elect 2013

Precepting for Excellence: Navigating Transitions, Continually Learning, Leading our Profession

Transitioning into the Preceptor Role Kelly Kasten, Pharm.D., BCPS, Clinical Pharmacist, Indian River Medical Center, Vero Beach, FL Upon completion of this activity, attendees should be able to: Recognize potential barriers when transitioning from learner to trainer and explain how to

overcome them Identify incremental steps for developing precepting skills Describe techniques for giving effective feedback to near peers

Mentoring Programs Antonia Zapantis, MS, Pharm.D., BCPS, Associate Professor, Pharmacy Practice, Residency Director, PGY2 Pharmacotherapy, Nova Southeastern University, Fort Lauderdale, FL Upon completion of this activity, attendees should be able to: Describe the components of a successful mentoring program Identify barriers preceptors may encounter while mentoring a resident Discuss strategies to implement reverse mentoring into rotation design Leadership Coaching and the Role of the Preceptor Rena Coll, Pharm.D., Medical Outcomes Specialist, Pfizer, Coral Springs, FL Upon completion of this activity, attendees should be able to: Recognize your role as a leader coming into an organization from residency training Describe the challenges of leading in a changing healthcare eco-system Review the current pharmacy leaderships concerns of today and the future

2ND ANNUAL FLORIDA RESIDENCY

CONFERENCE

Session I

May 9, 2013

3:00-4:00pm

ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM


Time: 3:00 - 3:20 Room: G301 Category: ID

EVALUATION OF A STEWARDSHIP APPROACH TO OPTIMIZE ANTIMICROBIAL THERAPY THROUGH USE OF A RAPID

MICROARRAY ASSAY ON BLOOD CULTURES POSITIVE WITH ENTEROCOCCUS SPECIES

Aaron Sango, Yvette McCarter, Jason Ferreira, Donald W. Johnson, Jr., Christopher A. Jankowski Shands Jacksonville Medical Center

Purpose/Background: Enterococci are a major cause of bloodstream infection in hospitalized patients and have limited antimicrobial treatment options due to many resistance mechanisms. Vancomycin-resistant enterococci are commonly isolated healthcare-associated multidrug-resistant pathogens. Newer molecular technologies have significantly shortened the time to enterococci isolate identification versus conventional methods. This study was designed to evaluate the impact of rapid organism identification and resistance detection by the Verigene® Gram-Positive Blood Culture (BC-GP) test on clinical and economic outcomes for patients with enterococcal bacteremia.

Methodology: A single-center pre-post quasi-experiment was performed to compare inpatients with documented enterococcal bacteremia from February 1, 2012 to September 30, 2012 (pre-BC-GP period) and October 1, 2013 to February 28, 2013 (post-BC-GP period). An infectious diseases and/or critical care pharmacist was contacted with results of the BC-GP; effective antibiotics and an infectious diseases consult were recommended. The primary outcome assessed time from blood culture draw to initiation of appropriate antimicrobial therapy before and after the BC-GP was implemented. Secondary outcome measures assessed the effects of the BC-GP on hospital length-of-stay, infection-related readmission, costs of antimicrobial therapy and hospital admission, rate of adverse effects related to antimicrobial therapy, and mortality.

Results/Conclusions: Results pending at time of abstract submission. Conclusion pending at time of abstract submission.

Presentation Objective: Describe the impact of rapid organism identification and resistance detection on the management of enterococcal bacteremia. Self Assessment: Within what timeframe can the BC-GP identify Enterococcus species and related resistance genes from time of blood culture positivity?


DAPTOMYCIN VERSUS VANCOMYCIN FOR METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BLOODSTREAM INFECTION

Joseph Pardo, Sandy Estrada, Kristin Quarterman, Rajendra Sharma, Suzanne Turner Lee Memorial Health System

Purpose/Background: Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are a significant burden on the healthcare system. Daptomycin is a lipopeptide antibiotic with activity against a wide range of gram positive organisms, including MRSA. Simple dosing regimens and low rates of adverse drug reactions may lead clinicians to utilize daptomycin in lieu of vancomycin, the historical standard of care for serious MRSA infections. The purpose of this study was to compare the outcomes of MRSA BSI in patients treated with either daptomycin or vancomycin.

Methodology: This was a multi-center, retrospective, matched-cohort study of patients treated with daptomycin or vancomycin for MRSA BSI between January 2010 and December 2012. Adult patients with at least one blood culture positive for MRSA and at least 72 hours of treatment with intravenous daptomycin or vancomycin were included. Exclusion criteria included receipt of more than two doses of other anti-MRSA pharmacotherapy, death within 72 hours of admission, polymicrobial bacteremia, need for renal replacement therapy at baseline and concomitant MRSA pneumonia. The primary outcome was infection-related length of hospital stay. Secondary endpoints included the occurrence of adverse drug reactions, microbiologic cure, in-hospital mortality and 30-day infection-related readmission.

Results/Conclusions: At the time of abstract submission, 68 unmatched cases of MRSA bacteremia occurring during 2012 were included in the study. Mean length of stay was 11 days and 14 days in those receiving vancomycin (n=36) and daptomycin (n=32), respectively.

Presentation Objective: Identify differences in clinical outcomes between patients receiving daptomycin or vancomycin for MRSA bloodstream infections. Self Assessment: What is the vancomycin MIC susceptibility breakpoint for MRSA?


EVALUATION OF EMPIRIC GRAM-NEGATIVE DOUBLE COVERAGE USED IN NON-CRITICALLY ILL HOSPITALIZED PATIENTS

DIAGNOSED WITH HEALTHCARE-ASSOCIATED PNEUMONIA Corey Witenko, Donald Johnson, Nadia Iwanyshyn, Jason Ferreira Shands

Jacksonville Medical Center

Purpose/Background: Healthcare-associated pneumonia (HCAP) is defined as pneumonia in patients admitted from the community but with recent exposure to the healthcare system. Current guidelines suggest the use of an anti-pseudomonal beta-lactam in combination with either an anti-pseudomonal fluoroquinolone or aminoglycoside, because patients have a higher risk of infection with multidrug-resistant pathogens such as Pseudomonas aeruginosa. There is limited literature on the benefits of empiric combination of Gram-negative agents in non-critically ill patients. The additional use of antimicrobials may increase risk of further resistance, side effects, and hospital cost . The primary objective of this study is to compare clinical outcomes of a single anti-pseudomonal beta -lactam versus combination therapy with the addition of an anti-pseudomonal fluoroquinolone or aminoglycoside.

Methodology: This study is an observational retrospective chart review of patients admitted to Shands Jacksonville Medical Center for treatment of HCAP. Patients are grouped depending on whether they received a single anti-pseudomonal beta-lactam antibiotic or combination with either an anti-pseudomonal fluoroquinolone or aminoglycoside. The primary endpoint is to determine if combination therapy leads to a decreased length of stay. Secondary endpoints include time to first dose of antibiotics, duration of therapy, escalation of therapy, rates of C. difficile infections, transfers to intensive care, and 30-day mortality.


Presentation Objective: Evaluate the impact of the empirical addition of an anti-pseudomonal fluoroquinolone or aminoglycoside to an anti-pseudomonal Î²-lactam in non-critically ill patients with HCAP. Self Assessment: What are potential risks of combination therapy for Gram-negative bacteria in HCAP?

Time: 3:00 - 3:20 Room: G103 Category: AM

USE OF SECURE E-MAIL MESSAGING FOR ANTICOAGULATION FOLLOW-UP

Deniz Yavas, Steven Totterdale, Rachel Pfaus Bay Pines VA Health Care System

Purpose/Background: To develop anticoagulation management via a secure e-mail messaging system (SM) as an alternative to telephone follow-ups.

Methodology: Patients enrolled in the Sarasota Anticoagulation Clinic were offered the option to do SM follow-up. Patients at a long-term care facility and those who have their INR measured on Friday are not eligible. Also, patients not responding to correspondence twice will be removed from SM monitoring and returned to telephone follow-up. Interested patients had to enroll in MyHealtheVet for access to SM. Patients will be sent assessment questions via SM by 3:00 PM the day their blood is drawn and will respond by the following morning. Upon receiving answers, pharmacists will reply with the anticoagulation plan. If the patient’s INR exceeds 5, no response is received, or clarification is needed, a telephone call will be made. Pharmacists will check 24 hours after sending the plan to ensure the message was read. If it was not, a telephone call will be made. Patients will be accepted into this clinic from November 2012-January 2013. Demographics of patients enrolled and number of visits completed in this clinic will be gathered through April 2013.


Presentation Objective: The advantages and disadvantages of using SM for anticoagulation follow-ups. Self Assessment: What are some factors to consider when establishing a SM clinic?




EVALUATION OF ADHERENCE MEASURES OF A PHARMACIST-MANAGED DIABETES TELEPHONE CLINIC: WEEKLY VERSUS

BIWEEKLY Pinal Patel, Hetal Bhatt-Chugani, William Lavinghousez Bay Pines VA Health Care

System

Purpose/Background: The purpose of this project is to evaluate the adherence of a weekly versus biweekly telephone-based pharmacist managed diabetes clinic.

Methodology: This project has been reviewed by the Bay Pines Veterans Affairs Healthcare System (BP VAHCS) Research and Development Committee and meets all criteria for quality assurance. A prospective chart review from October 1, 2012 to February 28, 2013 will be conducted at BP VAHCS. The chart review will access the outcomes of a pharmacist-managed telephone diabetes clinic. Diabetic patients currently enrolled in the BP VAHCS Pharm PACT telephone clinic with a hemoglobin A1C above 8%, who are on or requiring insulin therapy will be identified. Patients with an A1C of > 9% will initially be called weekly vs. those with an A1c of 8-9% will initially be called biweekly. Scheduled weekly versus biweekly telephone patients will be traced on a secured document. Adverse events, treatment adherence, and appointment adherence will be assessed. The BP VAHCS appointment management system will be reviewed over this time period to evaluate patient appointment compliance. All data will be maintained confidentially.


Presentation Objective: Evaluate adherence measures in weekly versus biweekly telephone appointments in a pharmacist managed diabetes telephone clinic. Self Assessment: What is one advantage of having a pharmacist-managed telephone clinic?


EVALUATION OF A NOVEL CARDIOVASCULAR RISK REDUCTION GROUP ON PATIENT'S 10YR GENERAL CARDIOVASCULAR RISK

Joshua McWilliam, Patricia Fernandez-Quevedo Miami VA Healthcare System

Purpose/Background: Within the Miami VA Healthcare System’s Patient-Aligned-Care-Team (PACT), a novel method for treating patients with multiple cardiovascular risk factors has been developed. Patients attend (are invited) to cardiovascular risk reduction group clinic appointments in which multiple patients are evaluated simultaneously by an interdisciplinary team of healthcare practitioners. The patients interact with each other and with the health care practitioners in order to obtain a better understanding of their disease states and medical treatments. The purpose of this evaluation is to assess the effect these group appointments have on the patient’s cardiovascular risk factors and overall 10 year cardiovascular disease risk.

Methodology: Patients who have been enrolled in the Miami VA PACT cardiovascular risk reduction group will be identified and their cardiovascular risk factors (blood pressure, lipid panel [LDL, HDL, Total Cholesterol], diabetes [HBA1C] and tobacco use) will be evaluated at intervals before and after initiation of group clinic appointments. Absolute and percent change to each individual risk factor will be measured and reported as will overall change in general cardiovascular disease risk as measured by the general cardiovascular disease calculator by The Framingham Heart Study.


Presentation Objective: Describe the value (or lack thereof) of a cardiovascular risk reduction group in reducing patient's cardiovascular risk factors. Self Assessment: What is the purpose of the cardiovascular risk reduction group?

Time: 3:00 - 3:20 Room: G114 Category: CCM

TIME TO BLOOD PRESSURE CONTROL PRIOR TO THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE ISCHEMIC STROKE:

COMPARISON OF LABETALOL, NICARDIPINE, AND HYDRALAZINE Courtney McKay, Brad Hall, Jennifer Cortes Lakeland Regional Medical Center

Purpose/Background: Elevated blood pressure is common in patients with acute ischemic stroke. Thrombolytic therapy is contraindicated in patients with a systolic blood pressure (SBP) greater than 185 mm Hg or diastolic blood pressure (DBP) greater than 110 mm Hg. Elevated blood pressure can lead to a delay in thrombolytic therapy which is associated with increased mortality. There is currently insufficient evidence to support the use of a particular antihypertensive agent in this setting. The aim of this study is to compare the effects of labetalol, nicardipine, or hydralazine on time to target blood pressure prior to alteplase administration in patients with acute ischemic stroke.

Methodology: A retrospective chart review was conducted to identify patients who had an elevated blood pressure (SBP >185 or DBP >110) and received labetalol, nicardipine, or hydralazine prior to intravenous alteplase therapy for ischemic stroke. Data collection included the following parameters: patient demographics, drug names, doses, and administration times of antihypertensive agents administered prior to alteplase, time of alteplase bolus, blood pressure and heart rate measurements, and baseline National Institute of Health Stroke Scale score. Data were then analyzed to compare time to target blood pressure (SBP

Results/Conclusions: Results pending at time of abstract submission Conclusion pending at time of abstract submission

Presentation Objective: Discuss the importance of timely blood pressure control prior to thrombolytic therapy for acute ischemic stroke. Self Assessment: Which antihypertensive agent was associated with the fastest time to blood pressure control in this study?


IS ADRENAL INSUFFICIENCY A COMMON PHENOMENON IN TRAUMA PATIENTS?

Ann McConnell, Brandon Hobbs, Xi Liu-Deryke, John Promes Orlando Health

Purpose/Background: Cortisol is important during periods of severe stress as it increases total body water distribution, enhances vascular tone and endothelial integrity, and potentiates the actions of catecholamines. As a normal response to severe infection, illness, surgery, burns, or trauma, circulating levels of cortisol may increase. However, when the normal response to stress is impaired, cortisol concentrations may be decreased as a result of dysfunction anywhere along the HPA axis and is known as adrenal insufficiency (AI). Random cortisol levels are most commonly used to diagnose AI. At Orlando Regional Medical Center (ORMC), adrenal insufficiency is defined as a random serum cortisol level

Methodology: A retrospective cohort study evaluating presence or absence of adrenal insufficiency in trauma patients at ORMC admitted from January 2011 to January 2012. Patients will be excluded for pregnancy, known infection, and known AI. Patients who fulfill inclusion criteria and with no exclusion criteria will be retained for data analysis. Demographic data including age, gender, race, and home medication use will be collected. Injury type, injury severity, cortisol concentrations, clinical data, laboratory data, and clinical interventions will be assessed.


Presentation Objective: Describe the incidence of adrenal insufficiency in a trauma population and identify any risk factors associated with adrenal insufficiency. Self Assessment: Adrenal insufficiency is defined as a random cortisol level less than ________ mcg/dl at Orlando Regional Medical Center.




EVALUATION OF EMERGENCY DEPARTMENT MANAGEMENT OF DIABETIC KETOACIDOSIS AND HYPERGLYCEMIC HYPEROSMOLAR

SYNDROME Matthew Bamber, Deba Rihani, Jason Brady Orlando Health

Purpose/Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening conditions that occur with uncontrolled or improperly managed diabetes mellitus. In 2009, the American Diabetes Association (ADA) developed a consensus statement containing recommendations for hyperglycemic crisis management. The purpose of this study is to evaluate the management of DKA and HHS compared to guideline recommendations to determine areas for improvement in current practices at our institution.

Methodology: Emergency Department (ED) patients ≥18 years of age who presented to Orlando Regional Medical Center classified as being positive for DKA/HHS as defined by consensus guideline were examined in this study. Data related to fluid repletion, insulin administration, electrolyte management, subcutaneous insulin transition, ED disposition, and ED length of stay were collected from admission through resolution of DKA/HHS and compared to consensus statement recommendations. Assessment of total insulin requirements, identification of causes of hyperglycemic crisis, and development of an ED specific protocol to enhance adherence to consensus recommendations was the ultimate intention of this study.


Presentation Objective: Determine areas for improvement to adherence of current DKA/HHS management guidelines of ED patients and create an ED specific protocol for more effective management. Self Assessment: What is the most common error occurring in DKA/HHS management?

Time: 3:00 - 3:20 Room: G312 Category: IM

EFFECTIVENESS OF THE CURRENT WEIGHT BASED HEPARIN PROTOCOL IN OBESE PATIENTS

Marie A. Lafosse, Simon Leung, Carla Hawkins-Locke, Madeline Camejo Memorial Regional Hospital

Purpose/Background: The 2012 American College of Chest Physician guidelines for prevention of thromboembolic disorders recommend the use of heparin based on patient weight. Thus, our hospital utilizes a heparin weight based protocol. A cap, however, is included in the dosing parameters. This study will evaluate whether or not obese patients achieve goal aPTT within 24 hours of initiating the protocol compared to non-obese patients.

Methodology: Patients 18 years and older receiving heparin therapy for a minimum of 24 hours from August 1, 2011 through February 1, 2012 were studied. Patients were excluded if therapy was utilized for acute coronary syndrome or interrupted within the initial 24 hours. Patients with incorrect use of the protocol were also excluded. Research analysis utilized descriptive statistics and an odds ratio with a 95 percent confidence interval.

Results/Conclusions: Of 118 patients identified, 74 were included and 44 were excluded per criteria. It was demonstrated that 73.3 percent of patients with a BMI less than 30 and 45 percent of patients with a BMI greater than or equal to 30 reached goal aPTT within 24 hours. Overall, there was no difference in achieving goal aPTT between non-obese and obese patients. Current heparin weight-based protocol has shown to be effective in both groups.

Presentation Objective: Describe the effectiveness of the heparin weight-based protocol in obese patients. Self Assessment: Recall two exclusion criteria and how these would affect patients reaching goal aPTT?


REDUCING INAPPROPRIATE PRESCRIBING OF PROTON PUMP INHIBITORS IN A COMMUNITY HOSPITAL

Jessica Saiz de la Mora, Radhan Gopalani, Heidi Clarke Baptist Hospital of Miami

Purpose/Background: Overuse of stress ulcer prophylaxis (SUP) is a widespread issue in hospitals throughout the country. The inappropriate use of SUP is associated with increased cost and risks. In addition, overutilization of proton pump inhibitors (PPIs) for SUP is a growing concern. Certain adverse events associated with SUP, such as community-acquired pneumonia, C. difficile infection, and fractures occur more frequently with PPIs than with H2-antagonists. Nevertheless, PPIs are the most commonly used medications for SUP in critical care and non-critical care settings. The purpose of this study is to optimize the use of pantoprazole in general medical-surgical units through pharmacist-driven implementation of hospital-approved guidelines.

Methodology: This prospective, IRB-approved study includes patients ≥ 18 years of age ordered pantoprazole 40 mg orally or intravenously on general medical-surgical units. Data collected includes patient demographics and pertinent laboratory values, diagnostic tests, and home medications. The primary outcome is to compare the number of pantoprazole doses dispensed over a three-month period prior to the study to the three-month period of the study. The secondary outcomes of this study are to assess the number of recommendations made and/or accepted, determine the rates of untoward GI symptoms in patients in which pantoprazole was discontinued, and measure associated cost savings.


Presentation Objective: Discuss the impact of a pharmacist-driven implementation of hospital-approved guidelines to curtail PPI use in a community hospital. Self Assessment: What are some adverse events associated with overuse of PPIs?


COLCHICINE VERSUS AMIODARONE FOR THE PREVENTION OF POSTOPERATIVE ATRIAL FIBRILLATION AFTER CARDIAC SURGERY

Joseph Hong, Christine Price, Joshua Rovin, Pamela Chapin, Colin Fitzgerrel, Michael Ruble Morton Plant Hospital Association

Purpose/Background: Post-operative atrial fibrillation (POAF) is a frequent complication after most types of cardiac surgeries with a 15-50% incidence following open-heart surgery. Despite ACC/AHA/ESC-supported evidence for use of oral beta-blockers or amiodarone as prophylaxis, POAF continues to be a significant complication. Given the increasing body of evidence which suggests inflammation plays a role in POAF induction, the impact of colchicine has been investigated for its efficacy in preventing POAF after open-heart surgery. The primary objective of this study is to compare the rates of POAF after CABG and valve surgery between patients on colchicine versus amiodarone for prophylaxis.

Methodology: This IRB-approved study is a pre-post study design comparing a historical control of patients on amiodarone for POAF prophylaxis to a prospective cohort group receiving the colchicine protocol for POAF prophylaxis. Patients meeting inclusion criteria will comprise of adult patients undergoing cardiac surgery for CABG or valve replacement, without contraindications to colchicine or amiodarone, and in normal sinus rhythm at the time of administration. Treatment with colchicine will start immediately after surgery. Matched controls for the amiodarone group will be collected systematically utilizing the Society of Thoracic Surgeon's Cardiac Surgery Database. Statistical analysis will be conducted using Chi-square or Fisher's exact tests for nominal data and student's t-tests for discrete and continuous data.


Presentation Objective: To compare the rates of POAF after cardiac surgery in patients receiving colchicine versus amiodarone prophylaxis. Self Assessment: Which pathophysiological mechanism does colchicine target in the prevention of POAF after cardiac surgery?


ABSTRACT REPRODUCTION FORM

Time: 3:00 - 3:20 Room: G112 Category: ADM

EVALUATING THE IMPACT OF PHARMACIST INTERACTIONS AND DIRECT PATIENT CARE SERVICES ON SATISFACTION SCORES

Michael Verbosky, Kara Jastemski, Maja Gift, Minh Duong, Kimberly Cohen-Pelosi Tampa General Hospital

Purpose/Background: As pharmacy transitions to a more patient centered profession, the pharmacist’s role in working directly with patients to improve the quality of care becomes essential. Few studies are published evaluating the impact of direct pharmacist to patient interactions in the hospital setting. The purpose of this project is to increase the pharmacist-patient interactions and to introduce pharmacy services to promote medication understanding and access.

Methodology: The pharmacist on the adult specialty surgery floor conducted patient visits upon admission and at discharge during the 2½ month quality improvement initiative. Pharmacy services provided included an admission medication assessment, direct access to a pharmacy service line, discharge counseling, and promotion of the onsite outpatient pharmacy. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores, outpatient pharmacy revenue, and service workflow measures are being evaluated.

Results/Conclusions: Of the 362 patients admitted to the pilot unit, 161 (44%) were seen on admission by the pharmacist. Admission patient interviews averaged 19 minutes for completion. Discrepancies were found on 36% of the admission medication reconciliations completed. Conclusion pending at time of abstract submission.

Presentation Objective: Describe how pharmacists can increase direct patient care interactions to provide and promote pharmacy services. Self Assessment: What areas of patient satisfaction, shown by HCAHPS scores, do pharmacists have the potential to impact through increased patient interaction?


PATIENT PERCEPTION OF MEDICATION COMMUNICATIONS IN THE HOSPITAL: THE ROLE OF THE PHARMACIST

Thanh Hogan, Ben Bato, Donald Floresca Shands Jacksonville Medical Center

Purpose/Background: Patient experience in the hospital has become an increasingly important measure of how well a healthcare system functions. While the patient’s experience has been documented for decades, there has never been a standardized method that allowed for comparisons between hospitals. In 2002, Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) co-developed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This survey includes 27 unique questions measuring eight dimensions from the patient’s perspective. Two of these questions specifically address medication communications while in the hospital. While other studies have demonstrated the benefit of pharmacist counseling during patient discharge in terms of readmission rates and emergency department visits, the potential benefit of pharmacist intervention during the patient’s hospital stay remains to be seen. Shands Jacksonville Department of Pharmacy has committed to emphasizing patient-centered medication education and using pharmacy personnel to counsel patients about their medication therapy. This study was designed to evaluate the impact of patient-centered education at an academic medical center in an effort to increase patient satisfaction and knowledge about their medications.

Methodology: This study is a pre/post analysis assessing patient perception of medication communications during hospitalization in an academic teaching hospital. A brief five question survey was administered to patients on general medical-surgical units before and after the pharmacy initiative to use pharmacy personnel including pharmacists, pharmacy residents, and pharmacy students to counsel patients about their medication therapy.


Presentation Objective: Identify the role of pharmacist driven patient-centered education in regards to medication therapy. Self Assessment: Poor patient-reported experiences have been associated with which of the following? a) Lower recovery rates b) Decreased compliance to medications after discharge c) Increased readmission rates d) All of the above

Time: 3:40 - 4:00 Room: G112 Category: MED

PHARMACIST IMPACT ON CONTRAST INDUCED NEPHROPATHY Kristin Morabito, William Kernan, Jamie Riskin, Darshika Patel Cleveland Clinic

Florida

Purpose/Background: Contrast induced nephropathy (CIN) is one of the most serious complications associated with administration of intravenous iodinated contrast. Screening patients for risk factors prior to administering IV contrast dye is crucial to prevention. A policy was established at our institution for pharmacist verification of all contrast orders. This retrospective analysis serves to assess the efficacy of the policy.

Methodology: This study is a retrospective, single-center, observational study approved by the IRB at CCF. The primary endpoint is to compare the number of patients that develop CIN before and after policy implementation. Secondary endpoints are to assess the compliance with the policy, and quantify the number of interventions pharmacists have made related to contrast orders during the study period. Patient data includes diagnosis of CIN and serum creatinine level prior to IV contrast administration. This study will compare pre-policy data, February - May 2011 vs. post policy data, February - May 2012.

Results/Conclusions: For the primary endpoint, 58 patients were assessed for CIN, for the pre-policy time point, and 349 for the post-policy time point. Zero patients were found to have CIN in the pre-policy group vs. ten in the post-policy group. For the secondary endpoint 2 Conclusion pending at time of abstract submission

Presentation Objective: Assess a new pharmacy policy, and pharmacist impact on decreasing the incidence of contrast induced nephropathy at our institution. Self Assessment: Are pharmacists complying with the policy to ensure safer administration of IV contrast?


CONFERENCE

Session I, cont.

May 9, 2013

4:10-5:10pm




EVALUATION OF AN ANTIMICROBIAL STEWARDSHIP APPROACH TO MINIMIZE OVERUSE OF ANTIBIOTICS IN PATIENTS WITH

ASYMPTOMATIC BACTERIURIA AT AN ACADEMIC TEACHING HOSPITAL

Denise Kelley, Patrick Aaronson, Elaine Poon, Yvette McCarter, Ben Bato, Christopher A. Jankowski Shands Jacksonville Medical Center

Purpose/Background: Asymptomatic bacteriuria (ASB) is a commonly occurring problem in hospital facilities that is often misdiagnosed and mistreated. Current guidelines discourage antimicrobial therapy for ASB unless the patient is pregnant or undergoing a urologic procedure. The unnecessary treatment of ASB has been associated with an increased incidence of adverse effects and development of antimicrobial resistance with no additional benefit on clinical outcomes. This study was designed to evaluate the impact of a multi-faceted educational initiative provided to physicians and pharmacists at an academic medical center in an effort to minimize inappropriate antimicrobial use in the setting of ASB.

Methodology: This study assessed the treatment of ASB through a pre/post educational initiative. Pocket urine antibiogram cards with ASB recommendations, educational in-services, and ASB awareness flyers were provided to the Emergency Medicine, Internal Medicine, and Hospitalist Medicine services. All patients with positive urine cultures (≥ 10^4 CFU/ml) collected between August-October (pre-education) and January-March (post-education) were assessed for antimicrobial treatment of ASB. Secondary endpoints included number of inappropriate antimicrobial days and Clostridium difficile infections within 30 days of treatment of ASB.


Presentation Objective: Describe the impact of an antimicrobial stewardship educational initiative on reducing the overtreatment of asymptomatic bacteriuria. Self Assessment: When is it appropriate to treat asymptomatic bacteriuria?


MEASURING THE IMPACT OF A MEDICATION SURVEILLANCE SYSTEM ON ANTIMICROBIAL DE-ESCALATION IN A COMMUNITY

HOSPITAL SETTING Carmen Ward, Ernie Cyr West Florida Healthcare

Purpose/Background: The use of the computerized pharmacy surveillance system Sentri7 has been utilized to streamline pharmaceutical antimicrobial management by alerting the pharmacist when patients meet certain criteria that may require an intervention by a pharmacist. These prompts notify pharmacists in real-time of potential opportunities for antimicrobial de-escalation in an effort to place patients on narrow spectrum antimicrobials, discontinue unnecessary therapy, or convert them to an oral dosage form if intravenous drug was previously being used. If the patient's antimicrobial therapy is ordered by a hospitalist, an automatic IV to PO protocol is in place where the pharmacist may independently determine a patient's eligibility for PO therapy. For all other cases of antimicrobial de-escalation, the physician is either contacted or a preprinted form is filled out by the pharmacist and left in the patient's chart for the physician's review. The primary objective of this study is to measure the clinical and pharmacoeconomic impact of computerized pharmacy surveillance on antimicrobial de-escalation.

Methodology: This is a single-center, open-label, randomized, and retrospective study. Data collection will be performed on patients who received more than 72 hours of antimicrobial therapy. A randomized and de-identified sample of 200 patients will be taken. Data will be collected from September 1, 2012 to November 31, 2012. The following data will be collected from Sentri7 monitoring parameters: age, sex, antimicrobial therapy orders, doses administered, cultures and sensitivities results, pharmacist interventions, and antimicrobial de-escalation.


Presentation Objective: Describe the utility of a pharmacy surveillance system for antimicrobial de-escalation. Self Assessment: What is a pharmacy surveillance system?

Time: 4:50- 5:10 Room: G301 Category: ID

MONITORING AND OPTIMIZING ANTIBIOTIC SELECTION IN COMMUNITY-ACQUIRED PNEUMONIA PATIENTS

Jessica LaFosse, Heather McCormick, Stephen Gilbert, Ted Heierman Holmes Regional Medical Center

Purpose/Background: It is best practice that admitted patients with a diagnosis of pneumonia receive antibiotic therapy consistent with current guidelines within twenty-four hours of arrival. The study purpose is to compare appropriateness of initial antibiotic selection and timing for patients admitted with a CAP diagnosis with pharmacist monitoring compared to usual care.

Methodology: The usual care group consists of patients diagnosed with CAP before the monitoring program. The data for this group will be retrieved from the health system's analytics system using dates from September 30, 2011 to January 26, 2012. In the comparator group, patient charts will be reviewed every 24 hours from October 1, 2012 until December 17, 2012 by a pharmacist. Patients will be included if they are diagnosed with CAP and over the age of eighteen. Immunocompromised and transfer patients will be excluded. The following data was recorded for each patient: admission date and time, antibiotic allergies, antibiotics administered within the first twenty four hours, antibiotic administration date and time, pseudomonas risk, comorbidities, and length of stay. Data will be used to compare the frequency of appropriate antibiotic selections between the two groups. This study obtained approval from the Ethics Committee.

Results/Conclusions: Pending at time of abstract submission.

Presentation Objective: Identify patients with community acquired pneumonia and recommend appropriate antibiotic regimen for treatment. Self Assessment: What is an appropriate antibiotic regimen for community-acquired-pneumonia?


EVALUATION OF AUTOMATIC CONVERSION FROM ROSUVASTATIN TO ATORVASTATIN IN AMBULATORY PATIENTS

Nicholas R. Bacon & Patricia Fernandez-Quevedo Miami VA Healthcare System

Purpose/Background: The Pharmacy and Therapeutics committee at the Miami VA Healthcare System approved an automatic conversion of patients receiving rosuvastatin to a predetermined dose of atorvastatin. It is of utmost importance to evaluate such programs to ensure there is not a decrease in efficacy of such regimens.

Methodology: All patients who were automatically converted from rosuvastatin to atorvastatin within the past year will be identified and evaluated for efficacy of their new medication regimen. Each patient will be evaluated for baseline serum cholesterol levels (prior to the automatic conversion) as well as a follow up lipid panel occurring at least 6 weeks post conversion. In addition, patients will be evaluated for changes in serum creatinine kinase and liver function tests. Analyses will be performed to determine if there is a significant difference between the two medication regimens.


Presentation Objective: Discuss the effectiveness of atorvastatin in patients previously treated with rosuvastatin. Self Assessment: What is the reported difference in potency between rosuvastatin and atorvastatin?




EVALUATION OF PHARMACY-DRIVEN MEDICATION RECONCILIATION AT THE UNIVERSITY OF FLORIDA & SHANDS

INTERNAL MEDICINE OUTPATIENT CLINIC THROUGH RETROSPECTIVE CHART REVIEW

Danielle Pierini, Katherine Vogel Anderson, Eric Rosenberg UF College of Pharmacy

Purpose/Background: Implementation of an effective medication reconciliation process can reduce errors and improve mediation use. Pharmacy service at the Shands Internal Medicine Outpatient Clinic has developed a novel medication reconciliation model involving telephoning a patient the day before his/her appointment scheduled with a resident physician. This study will evaluate pharmacy service’s roles in identifying opportunities for clinical intervention and providing drug therapy recommendations to the resident physicians.

Methodology: Investigators will perform a retrospective review of the health system’s electronic health record for all patients who were provided medication reconciliation by the pharmacy service over a six-month period. Data regarding recommendations made by pharmacy will be collected from pharmacy progress notes and categorized based on type of recommendation provided (e.g., drug-drug interaction, therapeutic duplication, indication for therapy). In order to assess whether recommendations have been accepted or declined by physicians, resident physician encounter notes will be reviewed. If recommendations were not accepted, the alternative plan formulated by the physician will be noted.


Presentation Objective: Describe the role of a clinical pharmacist in performing medication reconciliation services in an outpatient setting. Self Assessment: What was the most common category of drug therapy recommendations identified in this study?

Time: 4:50- 5:10 Room: G103 Category: AM

PREVENTION OF MEDICATION ERRORS THROUGH PHARMACY-BASED MEDICATION RECONCILIATION

Rachael Carloni, Bernadette Belgado, Marci DeLosSantos, Karen Malcolm, Stephanie McCormick, Jennifer Carrillo, Justin Tinsley Shands Jacksonville Medical

Center

Purpose/Background: Medication reconciliation upon inpatient admission has been proven to reduce medication errors and improve patient outcomes. This process is currently required by The Joint Commission and recommended by many other organizations, such as the Institute for Safe Medication Practices. Despite this, there are no clear recommendations about which healthcare providers should perform medication reconciliation. At Shands Jacksonville this is most often completed by nursing staff, but there has been a recent pharmacy initiative to supplement the process with pharmacy student involvement. The aim of this study is to evaluate the impact of pharmacy involvement in the medication reconciliation process.

Methodology: This is a retrospective evaluation including charity patients admitted to Shands Jacksonville for inpatient care between September 1, 2012 and January 15, 2013. Pharmacy medication reconciliation data collection forms will be evaluated to determine discrepancy rates compared to original medication reconciliation performed at the time of admission. The primary objective is to determine the frequency of discrepancies between medication reconciliation performed by pharmacy staff compared to other healthcare professionals. Secondary objectives include classification of discrepancy types identified, rates of discrepancy resolution, and identification of drug classes most commonly involved.


Presentation Objective: Describe the advantages of pharmacy involvement in the completion of medication reconciliation for hospitalized patients. Self Assessment: Which classification of medication discrepancy was identified most often?


IMPACT OF ACETAMINOPHEN IN REDUCING OPIOID USE POSTOPERATIVELY

Brittany Herring, Sheila Ader, Carla Hawkins, Madeline Camejo Memorial Regional Hospital

Purpose/Background: Opioids cause sedation, respiratory depression and reduced gastrointestinal motility. For this reason, physicians seek alternatives which reduce opioid use while maintaining a similar level of efficacy and analgesic effect. This study examines intravenous acetaminophen's impact on reducing opioid usage for postoperative pain in female hysterectomy patients.

Methodology: This is a retrospective study of surgical adult female patients who have undergone total abdominal hysterectomies. Group A received opioids without around the clock intravenous acetaminophen (January 1 through March 28, 2011). Group B was treated with intravenous acetaminophen and opioids (May 1 through July 16, 2012). The endpoints were to examine the impact of intravenous acetaminophen in reducing opioid use (average amount in morphine equivalents) within the first 48 hours and perioperatively.

Results/Conclusions: Postoperative intravenous acetaminophen showed a nonstatistically significant 34% reduction (p=0.2) in opioid use. In both groups, opioids were used more frequently in the recovery room than at any other time postoperatively. Intravenous acetaminophen reduced opioids 18% preoperatively, 11% intraoperatively and 16% perioperatively. While the results of this study cannot be conclusive, intravenous acetaminophen shows promise as a useful analgesic in surgical procedures. Additional research should be conducted to further investigate its role.

Presentation Objective: Describe intravenous acetaminophen's role in reducing opioid use in female hysterectomy patients for pain management. Self Assessment: In moderate to severe postoperative pain, the most effective medication regimens include a) Only opioids b) Only nonopioids c) Opioid and nonopioid combinations


USE OF N-ACETYLCYSTEINE THERAPY BEYOND THE 21-HOUR INTRAVENOUS PROTOCOL FOR ACETAMINOPHEN TOXICITY

Rachel O'Geen, Dawn Sollee, Jay Schauben, Thomas Kunisaki Shands Jacksonville Medical Center

Purpose/Background: Confusion exists among providers regarding proper utilization of the 21 hour intravenous (IV) protocol for N-Acetylcysteine (NAC) treatment of acetaminophen (APAP) overdose, especially when patients present outside the initial 8-10 hour window. Many practitioners assume the 21 hour protocol is sufficient in all cases of APAP overdose regardless of presentation. Currently, there are no studies evaluating use of this protocol for patients who are started on treatment beyond the FDA approved indications and any factors associated with extension of therapy.

Methodology: This is a non-interventional, retrospective chart review of APAP exposures handled by the Florida Poison Information Center Network (FPICN). Inclusion criteria includes any human exposure in the FPICN database coded with IV NAC as a therapy from 2/1/2004 to 6/30/2012, completion of the 21 hour IV NAC protocol, and documented APAP exposure based on serum levels or patient history. Exclusion criteria includes patients not completing 21 hours of therapy, known history of hepatic disease, co-ingestion of substances known to be hepatotoxic or affect coagulation, NAC administered orally prior to IV, administration error, non-toxic ingestion based on Rumack-Matthew treatment nomogram, patients lost to follow up or with insufficient data to determine outcome.


Presentation Objective: Describe the incidence of extending the 21-hour IV NAC protocol for APAP toxicity and factors contributing to extension. Self Assessment: What are the proposed endpoints for discontinuing NAC therapy for the treatment of APAP toxicity?



Time: 4:50- 5:10 Room: G114 Category: CCM

BLEEDING INCIDENCE WITH DIALYSIS PATIENTS ON TREATMENT DOSES OF ENOXAPARIN

Chad Edgar, Carla Hawkins-Locke, Madeline Camejo Memorial Regional Hospital

Purpose/Background: The drug manufacturer of enoxaparin recommends a dose adjustment for patients with a creatinine clearance at or below 30 mL/min. However, there is no recommendation for dosing in hemodialysis patients. Therefore, use of enoxaparin is discouraged in dialysis patients due to increased blood levels and the potential for bleeding.

Methodology: This study is a retrospective chart review conducted from 6/01/2008 to 8/31/2012. A review of the patient's medical records was performed to determine dialysis status and the presence of bleeding events. Only patients 18 years or older and on acute or chronic hemodialysis were included in the analysis. Patients with diagnosed bleeding disorders, pregnant/breast feeding patients and those on deep vein thrombosis (DVT) prophylaxis doses were excluded. All of the study subjects were evaluated for the presence of a bleeding event.

Results/Conclusions: Out of 69 patients included in the study, 9 bleeding events were found (13%). On average, patients with bleeding events were older (76.4 years old) when compared to all study participants (65.4 years old). In addition, the majority of patients with bleeding events were on 1-2 other anticoagulants/antithrombotics (77.7%). In this study, dialysis patients on treatment doses of enoxaparin showed a high incidence of bleeding, especially those over the age of 65 and on concomitant anticoagulants.

Presentation Objective: Describe the incidence of bleeding events in dialysis patients on treatment doses of enoxaparin. Self Assessment: What factors were found to be associated with a higher bleeding risk in dialysis patients?


REVISION OF THE NEW PATIENT ORIENTATION PROCESS FOR THE BAY PINES VETERAN'S AFFAIRS HEALTHCARE SYSTEM (VAHCS)

CONTINUED Kristen Fischer, Keri Justice Bay Pines VA Health Care System

Purpose/Background: A national Veteran’s Affairs initiative was recently launched to promote patient-centered care with an emphasis on interdisciplinary team collaboration. The purpose of this project is to streamline the new patient orientation process at the Bay Pines VA and outlying clinics by developing a consistent electronic version. Current new patient classes are conducted in a group setting with waived patient confidentially and employ an interdisciplinary team to deliver a varied message.

Methodology: Observation of the current process gathered the necessary information about specific content delivered. An interdisciplinary team has been working on a comprehensive script to provide an overview of pertinent information from each service. The goal is to make the content available to patients in a standardized digital format on the Bay Pines website, at computer terminals in the Patient Education Resource Center (PERC), through CCTV for inpatients, and on DVD. Having a consistent message and multiple points of distribution will improve orientation and make the process more efficient.

Results/Conclusions: The video script has been approved for production. Working as a patient-centric interdisciplinary team allowed for improvements in the new patient orientation process, including improved patient satisfaction, consistency of information, and increased access to information.

Presentation Objective: Describe the advantages of a standardized patient-centric orientation process as part of an interdisciplinary team approach. Self Assessment: What are the proposed advantages of the restructured patient orientation process? A. Enhance patient privacy and satisfaction B. Improve consistency and efficacy of information delivered C. Promote patient-centered care utilizing an interdisciplinary team


INITIATION OF PHARMACIST PHARMACOKINETIC PEER-REVIEW EVALUATION

Victoria Koenig, Robert Stewart Bay Pines VA Health Care System

Purpose/Background: The purpose of this project is to develop and implement a peer-review evaluation policy for pharmacists at BPVAHCS conducting vancomycin and aminoglycoside pharmacokinetic dosing.

Methodology: An evaluation form will be created for reviewers to assess the standardized performance indicators of vancomycin and aminoglycoside dosing. A peer-review committee (PRC) will be responsible for conducting the policies and procedures initiated. Five cases from each pharmacist will be reviewed quarterly (if available). Patient cases will be randomly identified from clinical notes completed by pharmacists through the VA computerized patient record system (CPRS). The PRC will determine who the most appropriate peer is to review a provider's case. After assessing the patient case, the reviewer will complete the standardized evaluation form and assign a level 1, 2 or 3 level of pharmacist-provided care. The PRC will examine peer-review reports, provide a confidential evaluation summary to the reviewed pharmacist, evaluate performance trends and compile a report to be distributed to the pharmacists and pharmacy administrators.


Presentation Objective: Describe how to develop and implement a pharmacokinetic peer-review evaluation for pharmacists Self Assessment: What differentiates peer review levels of 1, 2 and 3?

Time: 4:50- 5:10 Room: G112 Category: ADM

CENTRAL DATABASE TO ACCESS RESTRICTED-USE MEDICATION INFORMATION AT THE BAY PINES VETERANS AFFAIRS

HEALTHCARE SYSTEM Ellen Cvejanovich, John Hoeldtke Bay Pines VA Health Care System

Purpose/Background: The purpose of this project is to develop a central location to access information about medications determined by either Veterans Affairs National Formulary (VANF) or Bay Pines Veterans Affairs Healthcare System (BPVAHCS) to have restricted-use or contain criteria for use. The goal of the development of this central database is to standardize resources for the review of restricted medications.

Methodology: A database compiling information about restricted-use medications will be developed. This database will reference VANF criteria for use and drug monographs. The database will also compile BPVAHCS criteria for use and medication restrictions. This information will be obtained from the VANF and BPVAHCS P&T Committee minutes from 2007 to 2012. This database will be uploaded to the Bay Pines Public drive in the PBM folder. This database will be developed to allow for updating with new or revised medication use restrictions or criteria for use.


Presentation Objective: Describe the tools needed to develop a centralized database to provide access to local and national restricted-use medication information for a Veterans Affairs Healthcare Center. Self Assessment: Which of the following tools or references were utilized in the creation of this database? a.Microsoft Excel b.Veterans Affairs PBM National Criteria for use database c.Bay Pines VA P&T Committee minutes d.All of the above


CONFERENCE

Session II

May 10, 2013

8:20-9:20am




IMPACT OF DOSE-CAPPING OF UNFRACTIONATED HEPARIN ON TIME TO THERAPEUTIC ANTICOAGULATION: A RETROSPECTIVE

STUDY Mary Briand, Rachel Samples, Kelly Biastre Wolfson Children's Hospital/Baptist

Health System

Purpose/Background: Rapid achievement of therapeutic activated partial thromboplastin time (aPTT) and anticoagulation is important to a positive clinical outcome in patients receiving unfractionated heparin (UFH). The 2012 American College of Chest Physicians guidelines recommend weight adjusted heparin dosing for initial bolus and initial infusion rate for venous thromboembolism (VTE) therapy with no recommendation on specific weight to be used. This study evaluates the impact of maximum (dose-capped) initial bolus and the initial infusion rates for UFH on time to therapeutic anticoagulation in adult patients weighing greater than 145 kg (dose-capped weight per hospital protocol). This study also compares the final UFH infusion rates needed to achieve targeted aPTTs in patients weighing greater than 145 kg and patients weighing less than or equal to 145 kg.

Methodology: This IRB approved study includes two retrospective groups of hospitalized patients 18 years of age or older who received high-intensity UFH therapy. Information collected includes patient demographics, indication for anticoagulation, initial bolus and initial UFH infusion rate, time to therapeutic aPTT, final UFH infusion rate, and number of dose adjustments before therapeutic aPTT.

Results/Conclusions: Pending at time of abstract submission

Presentation Objective: List the potential complications of weight-based heparin dosing in patients who weigh more than 145 kg. Self Assessment: What are the complications of weight-based heparin dosing in patients who weigh more than 145kg?


OUTCOME OF PHARMACIST COUNSELING ON PATIENT SATISFACTION AND MEDICATION KNOWLEDGE: A PROSPECTIVE

STUDY Whitney Bunion, Marjorie Rochette-DeLucia, Beth Briand, Atinuke Ogunsan

Wolfson Children's Hospital/Baptist Health System

Purpose/Background: Pharmacists play a vital role in the improvement of appropriate medication use and in reducing medication errors among hospitalized patients. Medication counseling may help increase patient compliance and help to resolve medication related concerns for the patient. Many hospitals use a survey called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). This survey is used to assess patients' perspectives of their hospital stay including counseling about medication indications and side effects. The purpose of this study is to evaluate whether pharmacist counseling affects patient satisfaction and medication knowledge as measured by HCAHPS scores and evaluated by pharmacists administered survey post counseling.

Methodology: The study population will include adult patients (ages 18 years and up) on a medical-surgical unit. The intervention of the study will consist of counseling done by a pharmacist or a pharmacy student on the patient's medications. The participants who provide informed consent will fill out a pre- and post-survey regarding their medication knowledge. Patients will also be asked to complete the HCAHPS survey once receiving it in the mail.


Presentation Objective: Describe the patient-specific factors that may be affected by pharmacist counseling. Self Assessment: What do hospitals use to measure patient satisfaction?


DAILY PHARMACEUTICAL CARE INTERVENTIONS FOR CONGESTIVE HEART FAILURE PATIENTS IN A COMMUNITY HOSPITAL

Sara Dingwal,l Sylvia Stoffella, Kelly Kasten, William Terneus Indian River Medical Center

Purpose/Background: Congestive heart failure (CHF) is the leading cause of 30-day re-hospitalization of Medicare patients in the United States, with rates estimated at 23-27% nationally. New Medicare reimbursement strategy reduces payments for care of patients re-admitted within 30 days of discharge. Payments are also reduced when patient satisfaction surveys identify sub-optimal communication with healthcare providers. Healthcare systems are charged with identifying patient-centered care that satisfies both expectations.

Methodology: During December 2012 and January 2013, newly admitted patients with a primary diagnosis of CHF were identified using daily census reports. Eligible patients were interviewed by a pharmacist using a standardized questionnaire to assess baseline knowledge of CHF medications and to identify potential barriers to medication compliance. Patient-specific daily medication plans were created based upon the questionnaire results to address identified deficit(s) of knowledge and sources of potential medication non-compliance. During each day of the patients' hospitalization, a pharmacist or an APPE student pharmacist delivered daily medication education for approximately 10-15 minutes, including: daily topic (drug class) education, including brand/generic names, indication, instructions for use, and potential side effects. Any changes made to CHF medication regimens were discussed and patients were allowed to ask questions. Education and compliance tools were provided based on individuals' level of health literacy, comfort using technology, and CHF medication regimen.


Presentation Objective: Explore the effects of pharmacy-provided medication education on patient knowledge of CHF medications and barriers to medication compliance, as well as to determine the relative impact on 30-day re-hospitalization rates Self Assessment: What are two new measures that CMS is using to determine quality of care, and in turn, reimbursement rates?


IMPLEMENTATION OF A SEPSIS MANAGEMENT PROTOCOL AND EDUCATION PROGRAM IN A COMMUNITY HOSPITAL

William Terneus, Jr., Matthew Lambie, Charles Callahan, George Mitchell, Donald Sullivan Indian River Medical Center

Purpose/Background: Severe sepsis remains the primary cause of death in non-cardiac intensive care units nationwide, from 30-50 percent mortality. Between 2003-2007, severe sepsis hospitalizations increased by 71 percent to 710,000 admissions. In 2004, the Surviving Sepsis Campaign (SSC) introduced the first guidelines with a goal of reducing sepsis mortality by 25% over five years. Implementation of a guideline-based institutional sepsis program has been shown to improve survival.

Methodology: A multidisciplinary Sepsis Team developed a patient care protocol based upon SSC criteria. The Sepsis Management Protocol will be implemented hospital-wide. Part one will consist of a screening tool for early identification of sepsis. Patients meeting one of the following: recent procedure or antibiotics, or suspected or confirmed infection, and two of the following: temperature > 38°C or < 36°C, white blood cells > 12,000 or < 4,000, heart rate > 90, or respiratory rate > 20 will have labs drawn. The physician will be contacted for a lactate ≥ 4 mmol/L, systolic blood pressure < 90mmHg or > 40mmHg drop from baseline. For patients who meet SSC criteria, treatment will be accomplished in two steps: 1) a resuscitation bundle, completed within the first six hours, focused on fluid resuscitation and appropriate antibiotics, and 2) a management bundle, completed within the first 24 hours, focused on glucose control and corticosteroid use, among other measures. Education will be provided to all healthcare professionals involved prior to protocol initiation.


Presentation Objective: Describe the process of implementing a sepsis protocol in a community hospital. Self Assessment: Name one key component of successful implementation of a sepsis protocol.




EVALUATION OF VANCOMYCIN-INDUCED NEPHROTOXICITY (VIN) AND INSTITUTIONAL DOSING PROTOCOL

Amanda Chao, Brittany Fries, Shauna Jacobson Orlando Health

Purpose/Background: Vancomycin is a cornerstone antibiotic for the treatment of Gram-positive infections. Nephrotoxicity was common with the use of the old preparations due to toxic excipients, but VIN incidence significantly declined with the purified formulation. More recently, however, there has been an increase in the incidence of VIN. While the reason for this trend remains unclear, some explanations have been proposed, such as the use of higher doses to achieve higher goal trough levels, increased use of concomitant nephrotoxins, and uncertainty in dosing for obese patients. Regardless of the cause, VIN often leads to the use of costly or broader spectrum agents. An evaluation of VIN incidence, dosing practices, and identification of risk factors associated with VIN will be invaluable in optimizing clinical and stewardship activities of vancomycin.

Methodology: Retrospective chart review was performed in hospitalized patients ≥ 18 years of age receiving intravenous vancomycin for at least 72 hours. Data collected included patient demographics, laboratory results, concomitant nephrotoxic medications, vancomycin indication, dose, trough level(s), and duration. Patients with suspected VIN, defined as increase in SCr > 50% from baseline or a doubling of serum creatinine, were further evaluated for identifiable risk factors.


Presentation Objective: Describe risk factors and/or dosing practices that may predispose the patients to develop VIN. Self Assessment: What risk factor most associated with VIN was identified in this study?


IMPACT OF A PHARMACIST-DRIVEN ANTIMICROBIAL STEWARDSHIP PROGRAM FOR PATIENTS IN THE INTENSIVE CARE

UNIT ADMITTED WITH SEPSIS Martha Knoblich, Jennifer Schmeding, Han Truong St. Jospeh's Hospital

Purpose/Background: There is an increasing rate of resistance growing among pathogenic organisms and a delay in the development of new antibiotics. Consequently, the development of Antimicrobial Stewardship Programs (ASPs) to aid healthcare professionals in appropriate utilization of antibiotics has been strongly encouraged. St. Joseph's Hospital has recently implemented a review and feedback system which alerts pharmacists of potential inappropriate antibiotic use. The intent of this study was to review the effectiveness of this ASP.

Methodology: An IRB-approved, retrospective chart review conducted in the intensive care unit of St. Joseph's Hospital for patients admitted with a diagnosis of sepsis. Patients will be included if they are greater than 18 years of age and started on a broad-spectrum antibiotic regimen. Exclusion criteria include pregnancy, infections influenced by challenging source control, and immunocompromised patients. Data will be collected on days of therapy from admission date until antibiotic regimen is altered and until all antibiotic therapy is discontinued, the types of antibiotics administered, the quantity and type of pharmacist interventions and cost. The comparison of a before-ASP implementation group and an after-ASP implementation group will be used to evaluate the impact of the pharmacist-driven ASP.


Presentation Objective: Describe the impact a pharmacist-driven, review and feedback ASP may have on use of antibiotics and overall cost. Self Assessment: What are the potential responsibilities a clinical pharmacist can assume to assist with antimicrobial stewardship?


EVALUATION OF VANCOMYCIN DOSING WEIGHTS IN OBESE PATIENTS

Amy Stewart, Cassie Kostevicki, Jamie Kisgen Sarasota Memorial Hospital

Purpose/Background: Inappropriate dosing of vancomycin can lead to the development of antimicrobial resistance and therapeutic failure. For obese patients, the optimal dosing strategy to achieve therapeutic concentrations has not been well established. An evaluation of vancomycin dosing weights and a comparison of their predictive value to achieve therapeutic trough concentrations may provide evidence for the development of an optimal dosing strategy for this population.

Methodology: This IRB approved retrospective chart review was conducted to identify obese patients > 18 years of age who received vancomycin therapy for a minimum of 48 hours. Obesity was defined as having an actual body weight (ABW) > 150% of ideal body weight (IBW). Patients who had one steady state trough concentration drawn and had a creatinine clearance > 50mL/min were enrolled in the study. Data was collected for patient demographics, renal function, vancomycin dosing regimens, and trough concentrations. The total daily dose of regimens that achieved target concentrations of 10-20mcg/mL were analyzed as three weight-based groups (mg/kg) of ABW, IBW, and adjusted body weight (AdjBW). Statistical comparison of the predictive value for achieving target trough concentrations for each group was performed by the use of linear regression analysis.


Presentation Objective: Explain the Infectious Diseases Society of America's recommendation for dosing vancomycin in obese patients and discuss its limitations. Self Assessment: Which weight-based group had the greatest predictive value of achieving target trough concentrations?


RETROSPECTIVE ANALYSIS TO DETERMINE THE INCIDENCE OF ACUTE KIDNEY INJURY IN PATIENTS TREATED WITH PIPERACILLIN-

TAZOBACTAM, VANCOMYCIN OR THE COMBINATION Rusha Patel, Robyn Choe, Jamie Kisgen Sarasota Memorial Hospital

Purpose/Background: Acute kidney injury (AKI) is well documented in the literature as an adverse effect for vancomycin, whereas piperacillin-tazobactam is not commonly implicated. However, two recent studies indicate piperacillin-tazobactam may be associated with a higher incidence of AKI. The goal of this study was to determine if the use of vancomycin alone, piperacillin-tazobactam alone and/or the combination is associated with an increased risk of AKI at our institution.

Methodology: A single center, IRB approved, retrospective study was conducted in adult patients who received piperacillin-tazobactam, vancomycin or the combination for at least 48 hours. Patients with baseline renal dysfunction (serum creatinine greater than or equal to 2 mg/dl or currently receiving renal replacement therapy), receiving vasopressor agents within 48 hours of antibiotic administration, or patients on extended infusion piperacillin-tazobactam were excluded. The primary outcome was the incidence of AKI, defined as an increase in serum creatinine of greater than or equal to 0.5mg/dl or 50% from baseline after at least 48 hours of therapy. The secondary outcome was overall hospital mortality. One-way ANOVA will be used to determine significance of the primary outcome.


Presentation Objective: Determine the association between piperacillin-tazobactam and acute kidney injury. Self Assessment: Which group was associated with the highest rate of acute kidney injury in this study and was that found to be significant?




THE USE OF CEFTAROLINE FOSAMIL IN METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BACTEREMIA IN A COMMUNITY BASED

HOSPITAL SYSTEM: A RETROSPECTIVE CASE SERIES Aileen N. Martinez, Sandy Estrada, Amy Wecker Lee Memorial Health System

Purpose/Background: Ceftaroline is a new fifth-generation cephalosporin approved for the treatment of skin and soft tissue infections caused by MRSA and community-acquired pneumonia. Limited clinical data exists on the use of ceftaroline for MRSA bacteremia. The purpose of this study was to determine clinical and microbiologic outcomes of ceftaroline for the treatment of bacteremia caused by MRSA.

Methodology: A retrospective chart review was performed on every patient in LMHS who received ceftaroline for ≥5 days for the treatment of MRSA bacteremia. The primary end point was microbiologic cure, defined as negative blood cultures for MRSA at the end of therapy. Secondary outcomes were clinical cure rate defined as resolution of all signs and symptoms of infection including decreased white blood count and afebrile with a body temperature less than 38°C. Additional secondary outcomes included in-hospital mortality, hospital length of stay, antibiotic length of stay, 30 day readmission rate and adverse reactions including Clostridium dificile.

Results/Conclusions: Eight patients were included in the study. Preliminary results suggest that patients received ceftaroline for a median of 10 days (range 5-36 days). Microbiologic cure was achieved in 7 patients (87.5%), and clinical success occurred in 6 patients (75%). Our experience suggests that ceftaroline may be an acceptable option for MRSA bacteremia; however, larger studies should be performed before this antimicrobial is routinely used for this indication.

Presentation Objective: Determine clinical and microbiologic outcomes of ceftaroline for the treatment of bacteremia caused by methicillin-resistant staphylococcus aureus (MRSA). Self Assessment: Ceftaroline is FDA Approved for which indication? a) MRSA Bacteremia b) Skin soft tissue infections c) Community Acquired Pneumonia d) A & B e) B & C


EVALUATING THE SIGNIFICANCE OF DELAYING INTRAVENOUS LIPID THERAPY DURING THE FIRST WEEK OF HOSPITALIZATION IN

THE INTENSIVE CARE UNIT Janet Arrazcaeta, Stephen Lemon, Frederick Moore Shands at the University of

Florida

Purpose/Background: American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and the Society of Critical Care Medicine (SCCM) published guidelines in 2009 recommending against the use of intravenous (IV) lipids for parenteral nutrition (PN) within the first week of hospitalization in the critically ill. This grade D recommendation is controversial as it is based on the results of 2 small studies and did not evaluate glycemic control. This will be a retrospective analysis evaluating the incidence of new infections and glycemic control with receipt of IV lipids within the first week in the intensive care unit compared to withholding lipid therapy.

Methodology: A retrospective review will be conducted on adult patients who received PN with intravenous lipids from May 15, 2011, to May 1, 2012 and adults who received PN without intravenous lipids from May 15, 2012, to December 15, 2012. The primary outcome is incidence of infection any time after initiation of PN, or a positive culture at least 48 hours after hospitalization for patients on PN at home. Secondary outcomes will include all-cause inpatient mortality, incidence of hyperglycemia, ICU and total length of stay (LOS), duration of mechanical ventilation, health care expenditures.


Presentation Objective: Evaluate the significance in clinical outcomes associated with delaying intravenous lipid therapy within the first week of hospitalization in the intensive care unit (ICU). Self Assessment: What is the incidence of infections in patients who receive lipids within the first week of hospitalization?


SIMVASTATIN VERSUS PRAVASTATIN FOR THE PREVENTION OF VASOSPASM

Matthew Logan, Wright Darius Faison, Jennifer Bushwitz, Brian Hoh, Spiros Blackburn Shands at the University of Florida

Purpose/Background: Vasospasm, a complication of aneurysmal subarachnoid hemorrhage (aSAH), is a major cause of morbidity and mortality among patients who survive the initial hemorrhage. Nimodipine has been shown to confer a modest benefit in patient outcomes after aSAH, but it may not reduce the incidence of vasospasm. Simvastatin and pravastatin have been shown to decrease the incidence of radiographic vasospasm. Simvastatin was the statin of choice for this indication at our institution, but concerns from the FDA caused a shift in practice and pravastatin became the statin of choice for vasospasm prevention.

Methodology: Patients included in the study will be ≥18 years of age, have a new Fisher grade 3 or Modified Fisher grade 3-4 aSAH diagnosed by angiography, and will have received simvastatin or pravastatin for vasospasm prophylaxis. The incidence of angiographic vasospasm, clinical vasospasm, and vasospasm based on transcranial doppler criteria will be recorded. In addition, ICU length of stay, hospital length of stay, time to vasospasm, in-hospital mortality, and discharge disposition will be recorded. Comparisons among the two groups will be made.


Presentation Objective: Describe the role of statins in the prevention of vasospasm and make a comparison between pravastatin and simvastatin for this indication. Self Assessment: Which medications may prevent vasospasm after aSAH?


IMPACT OF DEXMEDETOMIDINE ON EARLY EXTUBATION FOLLOWING CARDIAC SURGERY IN A VETERAN POPULATION: A

RETROSPECTIVE ANALYSIS Jaela Dahl, Marc Pepin, Bradley Stein James A. Haley Veterans Hospital

Purpose/Background: Early extubation after cardiac surgery is associated with better patient outcomes, decreased length of stay, and reduced hospital costs. Historically following cardiac surgeries, our facility used an analgesia based sedation strategy with a fentanyl continuous infusion. While effective, this medication is known to cause respiratory depression, prolonged mechanical ventilation and hospitalization, cognitive impairment, constipation, and withdrawal after discontinuation. Dexmedetomidine is a new highly specific alpha-2 adrenoreceptor agonist approved for short term sedation, which the Cardiothoracic Surgery team started using routinely in 2009 to decrease post-operative intubation time. The purpose of this study is to evaluate if the use of dexmedetomidine in post-cardiac surgery sedation has increased the number of patients extubated within six hours compared to the historical use of fentanyl.

Methodology: This is a retrospective cohort study. Inclusion criteria are veterans' age 18 or older undergoing coronary artery bypass graft surgery and/or valve repair/replacement between January 1, 2005 and August 31, 2012. Data will be collected on patient demographics as well as preoperative, intraoperative, and postoperative variables associated with extubation timing. The primary outcome will be assessed by calculating the total intubation time from when the patient leaves the operating room and the documented extubation time. Patients will be excluded from the study for emergent surgery, crossover sedation, or perioperative variables that predispose them to a complicated post-operative course.

Results/Conclusions: Results pending at time of abstract submission.

Presentation Objective: Describe the rationale of dexmedetomidine for decreasing time to extubation in post-operative open heart patients. Self Assessment: Describe the variables collected in this study that can impact extubation timing in post-operative patients.




IMPROVING IMMUNIZATION RATES AMONG PATIENTS ENROLLED IN AN OUTPATIENT PHARMACIST-RUN CLINIC

Ahmad Shehab, Kimberly Finley Florida Hospital-Celebration Health

Purpose/Background: Influenza is a contagious disease which can be spread by coughing, sneezing, and/or nasal secretions. Common symptoms of influenza include: fever/chills, sore throat, cough, headache, muscle aches, fatigue, and runny/stuffy nose. Influenza affects 5-20% of the U.S. population and more than 200,000 people are hospitalized for flu-related complications yearly. This number can be greatly reduced by improving annual immunization rates. This project aims to increase immunization rates and assess barriers to receiving the annual influenza vaccine.

Methodology: This is an IRB-approved study that was conducted via voluntary anonymous survey. Patients enrolled in any of the Clinical Pharmacy Services (CPS) outpatient clinics were offered the influenza vaccine during the month of September and were asked to participate in a survey during their normal clinic visit. Surveys were completed anonymously and placed in a manila envelope. The survey assessed current vaccination status, expectation for receiving the influenza vaccination this year, planned location for vaccination, reasons for not receiving vaccination, reasons for receiving vaccination from CPS, and future willingness to receive the vaccine from CPS.

Results/Conclusions: 131 surveys were returned over the one month collection period. Results pending at time of abstract submission. Conclusion pending at time of abstract submission.

Presentation Objective: Describe a method to improve influenza immunization rates in the community. Self Assessment: What are some ways to improve influenza immunization rates in the community? Answer: Decrease cost, increase convenience, stress importance, and debunk any myths associated with the influenza vaccine.


INCIDENCE OF ANDROGEN DEFICIENCY IN PATIENTS RECEIVING LONG-TERM OPIOIDS FOR THE TREATMENT OF CHRONIC NON-

CANCER PAIN. Justin Davis, Julie McCutcheon, Jennifer Mauldin James A. Haley Veterans Hospital

Purpose/Background: Chronic non-cancer pain (CNCP) is a leading cause of disability for patients in the United States. Opioid-induced endocrinopathy may be one of the least diagnosed and underappreciated consequences in patients receiving long-term opioid therapy. Opioids suppress the hypothalamic-pituitary-gonadal axis which is responsible for the production and secretion of testosterone in men. Hypogonadism is associated with adverse sequelae including decreased libido, mood alterations, weight gain and fatigue. Current guidelines state there is insufficient evidence to support routine laboratory monitoring for opioid-induced endocrinopathy. This study aims to compare the incidence of hypogonadism in patients receiving opioids for chronic pain against patients not exposed to opioid therapy.

Methodology: This is a retrospective cohort study. A database will be queried to identify all male patients age 18 to 49 from July 1, 2011 to June 30, 2012 that received care at our institution. Eligible patients will be randomly selected for chart review to determine if a low testosterone level was recorded. Patients will be stratified for subgroup analysis by categorizing them based on the total daily dose (TDD) or morphine equivalents (ME) received during the study period. Relevant clinical and demographic data that may contribute to the development of hypogonadism will also be collected.


Presentation Objective: Describe the concern for the development of hypogonadism in patients receiving chronic opioid therapy and its clinical significance. Self Assessment: What risk factors should prompt evaluation for hypogonadism in a young male population?


RETROSPECTIVE COMPARISON OF TIME IN THERAPEUTIC RANGE UTILIZING 6 WEEK INTERNATIONAL NORMALIZED RATIO

MONITORING INTERVAL VS 4 WEEK INTERNATIONAL NORMALIZED RATIO MONITORING INTERVAL

Jennifer Gregory, Amber Beals Florida Hospital-Celebration Health

Purpose/Background: Less frequent INR monitoring may help decrease the amount of unnecessary warfarin dose changes, decrease overall medical costs, and limit the life inconvenience patients experience with monthly INR monitoring. While there has been research comparing the effectiveness and safety of 6 and 12 week INR monitoring, each study has its limitations, including exclusion of specific diagnoses or target INRs. This study will focus of the efficacy and safety of 6 week INR monitoring in a wider population without the exclusion criteria regarding diagnosis or target INR.

Methodology: A retrospective chart review will be conducted on all patients who were actively enrolled between April 1, 2012 and January 1, 2013 in an Anticoagulation Management Services. Using a standard data collection form, baseline characteristics will be collected for those patients who meet inclusion criteria. Time in therapeutic range will be separately calculated for each patient’s 4 and 6 week monitoring periods utilizing an electronic anticoagulation software system. In addition, extreme INRs (defined as INR ≤1.5 and ≥4), thromboembolic events (defined as an objectively verified symptomatic deep venous thrombosis, pulmonary embolism, or stroke) and major bleeding events (associated with hospitalization) will be reported.


Presentation Objective: As a clinician monitoring a stable patient’s INR, describe your comfort level in allowing patients to be monitored every 6 weeks vs the previous traditional 4 weeks. Self Assessment: What aspect of allowing patient’s INR to be monitored every 6 weeks vs every 4 weeks may lead to a thromboembolic or bleeding event?


IMPACT OF COLLABORATIVE CARE SERVICES FOR HIGH-RISK PATIENTS AFTER DISCHARGE FROM A LARGE URBAN ACADEMIC

MEDICAL CENTER Adrienne DeBerry, Billie Nguyen, Karen Malcolm, Ly Nguyen, Judella Haddad-

LaClÃ, Russell McKelvey, Julie Ferm Shands Jacksonville Medical Center

Purpose/Background: Healthcare providers have long been aware of the benefits of collaborative care practices. A high risk period for experiencing adverse drug events is the first few weeks following hospital discharge. Events such as changes in drug regimens, changes in disease state, and communication gaps between inpatient and outpatient providers may often accompany the discharge process and may negatively impact continuity of care. Novel approaches to the reduction of readmissions or emergency department visits in the 30 days following discharge should target these factors. This study aims to assess the impact of an interdisciplinary transition of care team on readmissions and emergency department visits in the 30 days following discharge.

Methodology: This study is a single-center, observational, prospective case series and pre-post study with a historical comparator group involving recently discharged patients referred to a transitional care team for intensive outpatient follow-up. Patients received medication therapy management sessions from pharmacists following discharge, home visits conducted by case management to further screen for barriers to medication access and outpatient care. Physician appointments were scheduled for patients within days of hospital discharge. Electronic medical records were utilized to obtain information regarding details of pharmacists, case management, and physician encounters in the 4 to 6 weeks following discharge. The number and type of medication-related problems uncovered in each pharmacist encounter and information regarding readmission or emergency room visits in the 30 days following discharge were also obtained from these records.


Presentation Objective: Describe the impact of a collaborative transition care team in reducing readmissions and/or emergency department visits in the 30-days following discharge. Self Assessment: What are some important considerations when implementing an effective transition of care service?



PHARMACIST IMPACT ON QUALITY OF DIABETES CARE Jason Powell, Karen Sando, Jim Taylor UF College of Pharmacy

Purpose/Background: The purpose of this study is to discover if there is a benefit in the utilization of clinical pharmacy services in the management of diabetes in meeting therapeutic goals and overall reduction in diabetes related hospitalizations and emergency room visits.

Methodology: Medical records were retrospectively reviewed for patients seen within the UF & Shands Community Health and Family medicine clinics between Jan 1, 2011 and Jan 1 2012 for a primary or secondary diagnosis of diabetes mellitus (250.xx). Patients meeting inclusion criteria will be placed in either the intervention group (those managed by pharmacy services plus physician) or control group (those managed by physician alone). Hemoglobin A1c, blood pressure, low density lipoprotein, number of all-cause hospitalizations and emergency department visits will be compared between groups. Attainment of treatment goals (Hemoglobin A1c, Blood Pressure, Low Density Lipoprotien) will be measured against national guideline standards for each group. Statistical analysis: Statistical differences in outcome measures will be compared by using the unpaired t-test. All data is expressed as mean ± SD. A two-tailed p value of less than 0.05 is considered statistically significant.


Presentation Objective: Understand the impact pharmacy intervention has in diabetes care. Self Assessment: How effective is pharmacist intervention in improving therapeutic outcomes and overall clinical outcomes in patients with diabetes?


PHARMACY INTERVENTION ON REDUCTION OF EARLY READMISSION RATES IN COPD PATIENTS

Poe Aunggyi; William Kernan; Martha Espinoza-Friedman; Antonia Zapantis; Cleveland Clinic Florida

Purpose/Background: Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in U.S. and worldwide. The Centers for Medicare and Medicaid Services has identified early rehospitalization of patients with COPD exacerbations as a performance measure. The primary objective of the study is to evaluate if COPD education by a pharmacist reduces thirty days readmission rates from COPD exacerbation. The secondary outcomes include improvements in medication compliance, vaccination adherence, symptom control and medication knowledge.

Methodology: This is a randomized, prospective study comparing outcomes of treatment and control groups. Subjects are identified by their COPD diagnosis in the electronic health record. The study includes patients who have been admitted for ≥ 24 hours with a history of COPD, new diagnosis of COPD, or exacerbation of COPD. Exclusion criteria are patients with co morbid conditions, which have greater clinical priority. After randomization, the intervention group receives extensive teaching from a pharmacist on safe and effective use of medication and successful management of COPD. The control group receives standard of care discharge counseling. Thirty days after discharge, patients are contacted via telephone to evaluate thirty-day readmission along with a verbal questionnaire to assess medication compliance, vaccination adherence, symptom control and medical knowledge.


Presentation Objective: Evaluate if pharmacy education reduces early hospital readmission rates in COPD patients Self Assessment: What are three cardinal symptoms of COPD exacerbation outlined in the GOLD guideline?


CONFERENCE

Session II, cont.

May 10, 2013

9:30-10:30am




IMPROVING THE MANAGEMENT OF HYPERKALEMIA IN A LARGE COMMUNITY HOSPITAL

Dennis Ganyc, Anit Legare, Agnes Kelly, Michelle Demus, Robyn Choe, Ashok Sastry Sarasota Memorial Hospital

Purpose/Background: Hyperkalemia is a life threatening emergency which may rapidly progress to cardiac arrest. Several areas for improvement in the management of hyperkalemia have been identified at our institution: delay in physician notification of critical potassium levels in a timely manner, underutilization of hyperkalemia order set, and inconsistent adherence to the treatment algorithm. A recent study has shown that rapid response team (RRT) involvement provided consistent and timely resolution of hyperkalemia. The objective of this study is to determine if multidisciplinary education, increased protocol awareness and RRT involvement will improve the management of hyperkalemia.

Methodology: This IRB approved study included two retrospective groups: pre-implementation (Jun - Sep 2012) and post-implementation (Jan - April 2013). Hospitalized patients ≥ 18 years of age with a serum potassium ≥ 6.3 mmol/L were included in this study. The primary endpoint was a comparison of patients in each group that showed a decrease in serum potassium level by 20% (for initial levels greater than 6.9mmol/L) or reached a target potassium level of 5.5 mmol/L or less within 6 hours from the critical alert level being reported. The secondary endpoints evaluated hospital length of stay and mortality between the two groups.

Results/Conclusions: Results pending at the time of abstract submission. Conclusion pending at the time of abstract submission.

Presentation Objective: Describe the principles of hyperkalemia management. Self Assessment: What are the first line agents for the management of hyperkalemia?


RESTRICTING THE USE OF INTRAVENOUS N-ACETYLCYSTEINE: AN ANALYSIS OF RESTRICTION ADHERENCE AND ITS EFFECT ON THE

RATE OF CONTRAST-INDUCED NEPHROPATHY Olusola O. Apen,a Karly L. Tommolino, James C. McAllister IV Shands at the

University of Florida

Purpose/Background: Contrast-induced nephropathy (CIN) occurs in 5-50% of patients after intravascular contrast administration. Common CIN prevention strategies include hydration and N-acetylcysteine (NAC); however, evidence describing the efficacy of NAC for the prevention of CIN is conflicting. At this institution, IV NAC for CIN prevention is restricted to high risk patients. The restriction is enforced via criteria-based questions within the order entry component of Epic, the electronic medical record, and relies on the verifying pharmacist to determine if criteria are met based on the answers selected. To date, no studies have evaluated the effectiveness of this strategy nor is there data describing the impact of such a restriction.

Methodology: A retrospective chart review was conducted to evaluate the effectiveness of the restriction enforcement strategy and compare the CIN rates in patients who received IV NAC before and after the restriction was implemented. Inclusion criteria are 18 years of age or older, receipt of IV NAC and intravascular contrast, and admission to an inpatient unit or the emergency department. The primary endpoint is the percentage of patients who received greater than one dose of IV NAC who were ineligible to do so. Secondary endpoints include provider and pharmacist compliance with the restriction and CIN incidence rates before and after restriction implementation.

Results/Conclusions: Pending at the time of submission Pending at the time of submission

Presentation Objective: Describe the efficacy of an IV N-acetylcysteine restriction enforcement strategy Self Assessment: What is the proposed mechanism of NAC to prevent CIN?

Time: 10:10- 10:30 Room: G301 Category: IM

CAUSES OF HOSPITAL READMISSION IN PATIENTS WITH HEART FAILURE WITH AND WITHOUT DISCHARGE INTERVENTION

Priya R. Parikh, Erin Jones, Garth Graham, Eric Rosenberg Shands at the University of Florida

Purpose/Background: There are approximately 5.7 million Americans diagnosed with heart failure, accounting for 1.1 million hospitalizations annually. An estimated 25 percent of patients diagnosed with heart failure are readmitted within 30 days, with patients on Medicare making up the majority. In October 2012, the Centers for Medicare and Medicaid Services implemented a reimbursement model reducing payment to hospitals whose readmission rates exceed the national average. To help develop effective strategies to reduce readmissions, this study will investigate the causes of readmission among patients with heart failure and seek insight into areas for improvement.

Methodology: English-speaking patients diagnosed with heart failure and readmitted within 30 days of discharge will be prospectively enrolled. Consenting patients and their healthcare providers will participate in a standard interview. An expert panel, consisting of two attending physicians and a clinical pharmacist, will convene to decide on the ultimate cause of readmission based on the data collected. The primary endpoint is to qualitatively describe the causes of readmission in this patient population.


Presentation Objective: Describe areas for strategy development to reduce readmissions among patients with heart failure Self Assessment: What was the most common cause of readmission identified in this study?


IMPACT OF A PHARMACIST DIRECTED ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE MANAGEMENT OF URINARY

TRACT INFECTIONS Rebekah Seale, Jennifer Moeller, Elizabeth Espinel St. Jospeh's Hospital

Purpose/Background: Antimicrobial stewardship programs (ASP) have become the means for optimizing antimicrobial therapy in healthcare settings. The high incidence of urinary tract infections (UTIs) and corresponding antibiotic utilization provides an opportunity for disease specific streamlining improvements at St. Joseph's Hospital. The objective of the study is to determine the impact of a pharmacist directed ASP on the management of UTIs.

Methodology: Institutional Review Board approval was obtained prior to a retrospective chart review. Adult patients with a complicated UTI in the pre and post education phases are eligible for inclusion. The education phase includes an education for clinical pharmacists at St. Joseph's Hospital reviewing IDSA guidelines for the treatment of UTIs in adults. The primary endpoint is defined as the streamlining of antimicrobial therapy based on documented cultures and sensitivities by a clinical pharmacist. The pharmacists' intervention to streamline an antimicrobial regimen for UTIs will be compared pre and post education to determine the impact of a pharmacist directed ASP on the management of UTIs.


Presentation Objective: Describe the impact of a pharmacist driven Antimicrobial Stewardship Program can have on streamlining therapy. Self Assessment: What are the roles of clinical pharmacists in assuring correct antimicrobial use for UTIs in hospitalized patients?




COMPARISON OF INTRAVENOUS TOBRAMYCIN DOSING METHODS USING THE AREA UNDER CONCENTRATION CURVE VERSUS TROUGH

MONITORING IN ADULT CYSTIC FIBROSIS PATIENTS Kevin Epps, Calvin Tucker,Vanessa Thomas, Harish Bhaskar, Ronni Wetmore,

Shauna Vaughn St. Vincent's Medical Center

Purpose/Background: Lung disease causes 85% of all mortality in patients diagnosed with Cystic Fibrosis (CF). Pseudomonas aeruginosa is a gram-negative aerobic bacterium commonly found in the sputum CF patients. Thus, the CF Foundation recommends the use of two anti-pseudomonas antibiotics, one being an aminoglycoside, for treatment of acute pulmonary exacerbations. Using once-daily dosing methods, target tobramycin trough levels of less than two mcg/ml are desired for suspected pulmonary infections. Recently, was proposed that the area under concentration curve (AUC) may be a better indicator of toxicity than measurement of trough and peak levels. The purpose of this study was to determine the outcomes of monitoring tobramycin using a goal AUC 80-120 mg.h/L.

Methodology: This retrospective cohort study evaluated adult CF patients admitted for acute pulmonary exacerbations. The trough monitoring group consisted of patients from September 2010 through February 2012. The AUC monitoring group included patients from September 10, 2012 through February 2013. All patients were dosed at 10 mg/kg/day intravenously. For patients in the AUC group, the levels were inputted into an AUC calculator and the dose was adjusted to obtain an AUC between 80-120 mg.h/L. The objectives of the study were to determine if AUC dosing had an effect on FEV1, nephrotoxicity, rate of hospital readmissions, number of days intubated, duration of therapy, reduction of cost of tobramycin, and number of days to next CF exacerbation.


Presentation Objective: Discuss CF Foundation recommendations for treatment of acute pulmonary exacerbations Self Assessment: What class is recommended to be a part of the two anti-pseudomonal therapies for cystic fibrosis patients? A) Cephalosporin B) Penicillin C) Aminoglycoside D) Fluroquinolones


ASSOCIATION BETWEEN READMISSIONS AND STREAMLINING ANTIBIOTIC SELECTION AFTER INITIATION OF

PIPERACILLIN/TAZOBACTAM IN THE EMERGENCY DEPARTMENT Karen Reeves and Eric Gomez Miami VA Healthcare System

Purpose/Background: Hospital readmissions are costly and patients who are admitted to the hospital are at risk for infections, electrolyte abnormalities, anemia, stress ulcers, and other comorbidities. At times, antibiotics selected in the emergency department are not streamlined after cultures and sensitivities return. Streamlining antibiotics selection prevents the development of antimicrobial resistance and reduces the likelihood that the patient will develop secondary infections from broad spectrum antibiotic use. Streamlining antibiotic use also minimizes adverse drug reactions and toxicity from excessive drug therapy and the unnecessary treatment of colonization.

Methodology: Medication orders for piperacillin/tazobactam started in the emergency department will be reviewed for a one year period. Patients who have readmissions to the Miami VA Healthcare System within 30 days will be identified. The antibiotic regimen prescribed at the first emergency department visit will be reviewed for: 1) appropriateness of regimen, 2) blood cultures collected before antibiotics administration, 3) antibiotics streamlined within 24 hours of gram stain, 4) antibiotics further streamlined within 24 hours of culture and sensitivity, 5) duplicate antibiotic therapy, and 6) relation of 30-day readmission to previous infection. If readmission was caused by reinfection, cultures will be reviewed to compare the resistance and presence of different bacterial strain.


Presentation Objective: Determine if streamlining piperacillin/tazobactam after gram stain and cultures complete prevents 30-day readmissions. Self Assessment: What types of infections are piperacillin/tazobactam used to treat in the emergency department? 1) Lower respiratory tract (community-acquired pneumonia, nosocomial pneumonia) 2) Uncomplicated and complicated skin and skin structures (including diabetic foot infections) 3) Gynecologic (endometritis, pelvic inflammatory disease) 4) Intra-abdominal infections (appendicitis with rupture/abscess, peritonitis) 5) Urinary tract infections 6) Bone and joint infections 7) Septicemia 8) Endocarditis 9) Cystic fibrosis exacerbations


BEYOND THE ANTIBIOGRAM: RATES OF NEPHROTOXICITY WITH BETA-LACTAM AND VANCOMYCIN COMBINATIONS TO DETERMINE

OPTIMAL EMPIRICAL ANTIMICROBIAL COVERAGE Amy Birch, Lori Dupree, Bethany Della Vecchia, Christopher A. Jankowski Shands


Purpose/Background: Hospital-acquired, drug-induced acute kidney injury (AKI) is associated with prolonged length of stay, increased hospital costs, and poor patient outcomes. The combination of an anti-psuedomonal beta-lactam with vancomycin is a common empiric antimicrobial treatment regimen for nosocomial infections. Recent literature associated a higher-rate of nephrotoxicity with the use of piperacillin-tazobactam when used in combination with vancomycin, compared to vancomycin therapy alone. The rate of nephrotoxicity with cefepime in combination with vancomycin is not well described in published literature.

Methodology: A retrospective medical record review was conducted for patients admitted to Shands Jacksonville Medical Center between January 21, 2012 and October 15, 2012, who received either vancomycin and piperacillin-tazobactam, or vancomycin and cefepime for more than 48 hours. The primary comparison was incidence of AKI, as defined by the Acute Kidney Injury Network (AKIN) criteria. Statistical analytic techniques will be used to control for potential sources of confounding. Secondary endpoints include time to AKI from initiation of combination therapy, and hospital length of stay.


Presentation Objective: Evaluate whether an empiric beta-lactam and vancomycin combination regimen may be favored based on incidence of AKI. Self Assessment: Is there an association between piperacillin-tazobactam and increased rates of AKI in patients also receiving vancomycin?


EVALUATION OF PHARMACIST CONSULTATION ON FEBRILE NEUTROPENIA TREATMENT AND ANTIMICROBIAL STEWARDSHIP

MEASURES IN A COMMUNITY BASED HOSPITAL Rebecca Gonzalez, Amy Skiff, Sandy Estrada, Suzanne Turner Lee Memorial Health

System

Purpose/Background: Evidence to show the impact of antimicrobial stewardship directed to immunocompromised patients who experience prolonged neutropenia and/or other infections are limited. This study aims to evaluate the appropriateness of febrile neutropenia (FN) treatment in medical oncology patients without routine pharmacist consultations, to that of a dedicated pharmacist participating in antimicrobial stewardship efforts to oncology inpatients at Lee Memorial Hospital (LMH). Secondarily, assess pharmacist opportunities to optimize patient care in antimicrobial prophylaxis and/or treatment of bacteremia, urinary tract infections, and pneumonia.

Methodology: A retrospective, Institutional Review Board-approved review of antimicrobial stewardship for oncology patients at least 18 years old admitted to the medical oncology unit at LMH with any of the above diagnoses. Baseline stewardship interventions will be identified through a retrospective chart review (September-November 2011) prior to pharmacist-hospitalist collaboration. These results will be compared to a second retrospective chart review (September-November 2012) for the above indications that were evaluated by the multidisciplinary team. Conformity of FN treatment without routine pharmacist collaboration, compared to treatment of FN with pharmacist consultation, as well as opportunities and impact of consultations regarding antimicrobial stewardship will be evaluated. Compliance of therapy will be determined based upon consistency with NCCN Guidelines for Prevention and Treatment of Cancer-Related Infections and IDSA Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Pharmacist consultations provided, communication method, overall acceptance, and consultation type will also be evaluated during the second chart review.


Presentation Objective: Determine the impact of a designated pharmacist performing antimicrobial stewardship on oncologic patient care outcomes, antimicrobial use and evaluation of conformity with approved indications and guidelines. Self Assessment: What pathogen should be the focus of initial empiric antimicrobial therapy for febrile neutropenia?




DEVELOPMENT AND IMPLEMENTATION OF AN ANTIMICROBIAL STEWARDSHIP NOTE TEMPLATE

Victoria Koenig, Victor Rozance Bay Pines VA Health Care System

Purpose/Background: The use of antibiotics in hospitalized patients has increased over the past several decades and problems with excessive and inappropriate use of antibiotics have been widely recognized. There are several potential consequences of inappropriate antimicrobial use including: toxicity, resistance, hospital-acquired infections, increased morbidity and mortality, prolonged hospital lengths of stay, and increased healthcare costs. Antimicrobial stewardship involves the prudent use of antibiotics through optimizing clinical outcomes while minimizing the unintended consequences of antimicrobial use. The purpose of this project is to develop a standardized note template for pharmacy antimicrobial stewardship recommendations at Bay Pines VAHCS that will increase efficiency of documentation and improve communication with providers.

Methodology: This project has been reviewed by the Bay Pines VAHCS Research and Development Committee and meets all criteria for quality assurance; therefore, it is exempt from review by an institutional review board. An antibiotic stewardship note template will be designed and implemented in the VA computerized patient record system (CPRS). This note template will include pertinent patient demographic information, assess risk for multidrug-resistant organisms, and assess appropriateness of current antibiotic selection.


Presentation Objective: Describe the process of developing an antimicrobial stewardship note template. Self Assessment: T/F: A clinical pharmacist with infectious disease training is a core member of the multidisciplinary antimicrobial stewardship team.


REVIEW OF ALBUMIN USE TO OPTIMIZE ITS USE IN A COMMUNITY HOSPITAL

Veronica Sherman, Heidi Clarke, Radhan Gopalani Baptist Hospital of Miami

Purpose/Background: Fluid resuscitation plays an integral role in the management of patients with intravascular volume depletion as it improves cardiac output and organ perfusion. The strategy for appropriate fluid resuscitation has been a topic of debate for decades, specifically regarding use of crystalloid versus colloid fluids. In response to this clinical dilemma, the University Hospital Consortium (UHC), comprised of experts on fluid resuscitation from institutions nation-wide, developed consensus guidelines for the use of albumin, nonprotein colloid (NPC), and crystalloid solutions. This study will evaluate albumin usage at a community hospital based on the UHC guidelines in order to develop recommendations to improve its appropriate use.

Methodology: A retrospective, randomized chart review of 75 patients prescribed albumin from May 2012 to July 2012 was performed. The appropriateness of albumin use was determined based on the UHC guidelines. Following the evaluation, a prospective convenience sample of patients admitted to the intensive care unit who are prescribed albumin will be reviewed by the primary investigator. If albumin is determined to be inappropriate, a recommendation will be made to the prescriber.


Presentation Objective: Identify and evaluate the trends of albumin over-utilization and establish a pharmacist's role in guiding its appropriate use. Self Assessment: According to the University Consortium Guidelines, albumin is the first line option for fluid resuscitation for which indication? Hypovolemia, non-hemorrhagic shock, plasmapharesis, traumatic brain injury.


TREATMENT OF WARFARIN-ASSOCIATED INTRACRANIAL HEMORRHAGE: AN EVALUATION OF 3-FACTOR PROTHROMBIN

COMPLEX CONCENTRATE VERSUS RECOMBINANT FACTOR VIIA Rochelle Forsyth, Jerah Nordeen, Alden Patel, Leah Ward, William D. Freeman

Mayo Clinic Florida

Purpose/Background: Warfarin-associated intracranial hemorrhage (wICH) can be a devastating outcome of therapy. Few studies have examined the use of prothrombin complex concentrate (PCC) versus recombinant factor VIIa (rFVIIa) in the treatment of wICH. Cost, hospital formulary, and physician preference remain the driving forces behind product selection at many institutions. The purpose of this study is to assess institutional protocol compliance and to compare the safety, efficacy, and cost of 3-factor PCC versus rFVIIa in the treatment of wICH.

Methodology: A single-center, retrospective chart review will be conducted of all patients admitted to the institution with wICH who received either PCC or rFVIIa for wICH between August 2008 and November 2012. The primary objective is to determine the time to INR normalization, as defined by an INR of less than 1.4. Secondary endpoints include the degree of hematoma expansion, intraoperative hemostasis, and the incidence of thromboembolic complications. Additionally, the drug cost between the two treatment options will be evaluated.


Presentation Objective: Recognize treatment options for rapid reversal of warfarin-associated intracranial hemorrhage and the risks and benefits associated with each therapy. Self Assessment: How does the use of PCC compare to rFVIIa in terms of safety and efficacy when used in warfarin-associated intracranial hemorrhages?

Time: 10:10- 10:30 Room: G112 Category: CCM

EPOETIN ALFA USE IN RENALLY IMPAIRED INTENSIVE CARE UNIT PATIENTS

Violeta Barac, Patricia Louzon Florida Hospital

Purpose/Background: Monitoring hemoglobin (Hgb) levels in patients with chronic kidney disease may decrease mortality rate as well as risk of adverse cardiovascular events. Hemoglobin >13 g/dl can result in cardiovascular events such as stroke. When adjusting therapy, Hgb rate of rise, rate of decline, erythropoiesis-stimulating agents (ESA) responsiveness and Hgb variability should be considered. This study will evaluate prescribing patterns and patient characteristics, and will assess frequency of achieving target Hgb levels to identify potential areas of improvement in epoetin alfa management.

Methodology: Patients ≥18 years of age that received at least three doses of epoetin alfa, had renal impairment (estimated creatinine clearance


Presentation Objective: Evaluate the utilization, prescribing patterns, and Hgb management of epoetin alfa while promoting more safe and efficient use at Florida Hospital. Self Assessment: What are the consequences of high Hgb that could be a result of inadequate epoetin alfa management?




EVALUATION OF AN AMBULATORY CLINIC'S OUTCOMES IN PATIENTS REQUIRING TEMPORARY INTERRUPTION OF WARFARIN

THERAPY FOR A PLANNED SURGICAL PROCEDURE Kelly Anderson, Elizabeth Clements Florida Hospital-Celebration Health

Purpose/Background: Each year approximately 250,000 patients on warfarin for prevention of thromboembolism require temporary interruption of therapy for a planned surgical procedure. Current studies providing good quality evidence of perioperative anticoagulation management are lacking. Thus, anticoagulation management services (AMS) sought to examine the safety and efficacy of â€œstandard of care" periprocedural anticoagulation management procedures in an already established pharmacist-run clinic. This study was designed to meet the following objectives: safety and efficacy of periprocedural anticoagulation management procedures including incidence of minor and major bleeding, thromboembolic events, or death, and the frequency in which physicians approve interruption of anticoagulation therapy recommendations made by AMS.

Methodology: This is an IRB approved prospective observational study enrolling eligible AMS patients who require temporary interruption of warfarin therapy for a planned surgical procedure prior to April 1st, 2013. AMS data collection will include the number of days warfarin will be held prior to and following the procedure, use of any bridging agent, and bleeding or thromboembolic events, or death. Safety and efficacy outcomes will be assessed for 30 days following the planned surgical procedure. The physician approval rate of anticoagulation management recommendations made by AMS will also be recorded.


Presentation Objective: Describe factors to consider when developing an anticoagulation management plan for a patient requiring temporary interruption of warfarin therapy for a planned surgical procedure. Self Assessment: Is the current standard of care safe and effective?


TRIMETHOPRIM-SULFAMETHOXAZOLE EXPOSURE AND HYPERKALEMIA IN ELDERLY VETERANS RECEIVING

SPIRONOLACTONE Jayme Lentz, Tiffany Jagel, Steven Schang VA Gulf Coast Joint Ambulatory Center

Purpose/Background: Hyperkalemia is a potentially life-threatening metabolic problem that could lead to serious conditions, such as conduction abnormalities, muscle weakness, paralysis, cardiac arrhythmias, or even death. It is estimated that up to one-third of heart failure patients on spironolactone have reported hyperkalemia while on therapy. The antibiotic trimethoprim has structural similarity to the potassium-sparing diuretic amiloride and similarly blocks the adenosine triphosphate-dependent sodium potassium pump in the collecting tubule, which could lead to hyperkalemia. The purpose of this study is to evaluate the potential for hyperkalemia in elderly Veterans receiving spironolactone and trimethoprim-sulfamethoxazole.

Methodology: Veterans at least 65 years of age and older during a five year time period who were taking continuous spironolactone and were initiated on trimethoprim-sulfamethoxazole will be identified by reviewing records at the VA Gulf Coast Veterans Health Care System. Veterans who have at least one baseline serum potassium level and at least one serum potassium level within seven days after administration of trimethoprim-sulfamethoxazole will be included in the retrospective, chart review study. Baseline serum potassium levels will be compared to serum potassium levels that were obtained after administration of trimethoprim-sulfamethoxazole to see if a statistically significant difference exists. In addition, the association of trimethoprim-sulfamethoxazole exposure and hyperkalemia will be analyzed among several pre-specified subgroups to identify potential risk factors in this population.


Presentation Objective: Determine the association of trimethoprim-sulfamethoxazole exposure and hyperkalemia in elderly Veterans receiving spironolactone. Self Assessment: True or False: Patients taking spironolactone and trimethoprim-sulfamethoxazole have an increased risk for developing hyperkalemia.

Time: 10:10- 10:30 Room: G312 Category: AM

SELF-TITRATION OF LONG-ACTING INSULIN: IDENTIFYING BARRIERS TO PATIENT ADHERENCE.

Kendrick Murphy, Katrina Fantaski VA Gulf Coast Joint Ambulatory Center

Purpose/Background: At the VA Gulf Coast Joint Ambulatory Care Center, many Veterans in the pharmacist-run diabetes clinic are managed via self-titration of long-acting insulin. Due to the pattern of nonadherence in the Veteran population, it is hypothesized that many Veterans are nonadherent to their self-titration regimens. The purpose of this study is to investigate Veteran’s adherence to self-titration of long-acting insulin and to identify barriers that may interfere with a Veteran’s ability to adhere to therapy.

Methodology: This study will be completed via retrospective chart reviews. Charts of Veterans included in this study will be reviewed to identify those who self-titrated long-acting insulin. Veterans who did not self-titrate or do not have a diagnosis of type 2 diabetes will be excluded. For Veterans with type 2 diabetes, who self-titrated long-acting insulin, investigators will review medical records for the following: age, gender, ethnicity, education level, service connection status, body mass index, hemoglobin A1c, approximate duration of diagnosis of diabetes, date self-titration started, type of insulin prescribed, starting dose of insulin, final dose of insulin, date self-titration stopped, reason(s) why self-titration stopped, self-reports of hypoglycemia, other antidiabetic medications, comorbidities, diagnosis of compliance problems, and other providers who are managing Veterans diabetes. Veterans will be divided into two groups: 1) Veterans who continued self-titration, and 2) Veterans who stopped or were unsuccessful with self-titration for any reason. The groups will be compared in order to identify any significant differences.


Presentation Objective: Identify barriers to adherence in patient's who self-titrate long-acting insulin. Self Assessment: Question: Which of the following are potential barriers to patient adherence? a. History of compliance problems b. Hypoglycemia c. Education level d. Age e. All of the above


EVALUATION OF VITAMIN D DEFICIENCY/INSUFFICIENCY IN VETERANS WITH MUSCLE-RELATED STATIN-INTOLERANCE

Scott Cohen, Jeremy Thoms North Florida/South Georgia Veterans Health System

Purpose/Background: Statins are the main lipid medications used to reduce cardiovascular morbidity and mortality. However, statins have been associated with a wide range of skeletal muscle complaints, ranging from myalgia and elevations of creatine kinase to rhabdomyolysis. Several recent studies have linked vitamin D deficiency with statin myopathy. One study evaluated the effect of vitamin D supplementation in statin-treated patients with myalgia and found that in patients whose vitamin D deficiency was corrected, 92% were able to be treated with statins and remain free of myalgia. The purpose of this retrospective review study is to evaluate the prevalence of vitamin D deficiency/insufficiency (in both numerical and categorical terms) in veterans with muscle-related statin-intolerance. We hypothesize that, on average, those patients with muscle-related statin-intolerance will have lower vitamin D levels.

Methodology: In this retrospective review, investigators will identify patients from the North Florida/South Georgia Veterans Health System with an observed allergy/adverse drug reaction to a statin from September 1, 2007 to August 31, 2012. Exclusion criteria include adverse drug reactions that are historical or are not determined to be muscle-related. Investigators will review patient's medical record for vitamin D level, specific statin, time relationship between vitamin D level and date of reaction, and interacting medications. Investigators will evaluate the prevalence of vitamin D deficiency or insufficiency in patients with muscle-related statin-intolerance.


Presentation Objective: Evaluate the prevalence of vitamin D deficiency/insufficiency in veterans with muscle-related statin-intolerance. Self Assessment: Based on 25-hydroxy-vitamin D level, how is vitamin D deficiency defined?



IMPLEMENTATION AND EVALUATION OF DIABETES MANAGEMENT VIA CLINICAL VIDEO TELEHEALTH

Natalie Pike, Cherylyn Beckey West Palm Beach VA Medical Center

Purpose/Background: Clinical Video Telehealth (CVT) is a form of telehealth using a real-time, clinical video and audio transmission that is used to virtually connect a healthcare professional and a patient. CVT has been shown to improve access to health care and can play a role in managing high-risk patients with chronic disease states such as diabetes. The purpose of this project is to describe and disseminate the results of this project and evaluate the value of this program via a patient satisfaction survey.

Methodology: In addition to describing the implementation of a CVT program, the process of starting a CVT program, a patient satisfaction survey will be administered at 6 months post enrollment for patients who actively participate in the CVT program. Patients may be referred to the CVT program via a CPRS consult, which will be restricted to providers in the diabetes specialty clinic. Patients to be considered will include patients who reside closer to a community based outpatient clinic (CBOC) rather than the main medical center with the following characteristics: • Prefer to visit CBOC’s • Without significant hearing or visual impairments • Clinically stable, unable to meet pre-specified target parameters for glucose control and that do not require extensive physical assessment. • Have a basic and reasonable understanding of their medication regimen and how to administer their medications. Data Collection: Patient demographics, patients distance from home to the WPB VA and from home to the CBOC they use, A1C at baseline and interval visits, Co-morbid conditions, Form of transportation used, travel reimbursement received, frequency of visits before and after CVT enrollment, and number of hospitalizations before and after CVT implementation.


Presentation Objective: Describe the process of implementing a Clinical Video Telehealth (CVT) program. Self Assessment: What was the main obstacle found in implementing the Diabetes Clinical Video Telehealth Clinic?

Time: 10:10- 10:30 Room: G307 Category: PED

EVALUATION OF DIABETIC KETOACIDOSIS TREATMENT AT ARNOLD PALMER HOSPITAL FOR CHILDREN

Kourtney Marsh, Jennifer Shenk, Susan Norman Orlando Health

Purpose/Background: Diabetic ketoacidosis (DKA) is the leading cause of death in children with diabetes mellitus. Published guidelines are consistent in their recommendations for the management of patients in diabetic ketoacidosis. Arnold Palmer Hospital for Children provides care to these patients, however there is no standardized protocol. An evaluation of the management of DKA at Arnold Palmer Hospital for Children may provide the information needed and rationale for creating and implementing a DKA protocol utilizing a two-bag method consisting of two fluid bags with identical electrolyte concentrations, but different dextrose concentrations.

Methodology: Hospitalized patients less than 18 years of age at Arnold Palmer Hospital that meet inclusion criteria for DKA will be retrospectively reviewed and enrolled. Information collected will include patient demographics, comorbidities, and pertinent labs and medications during hospitalization. Fluid therapy will be evaluated through collection of rate, duration, and fluid components. In addition, time required for pharmacy to verify fluids and for them to be started will be recorded. The insulin drip rate throughout therapy will be reviewed. Adverse outcomes related to DKA or insulin therapy will also be collected.


Presentation Objective: Describe the current management of diabetic ketoacidosis in pediatric patients. Self Assessment: What is the purpose of providing various dextrose concentrations in intravenous fluids during treatment of DKA in pediatric patients?


CONFERENCE

Session III

May 10, 2013

10:50-11:50am



Time: 10:50 -11:10 Room: G301 Category: CCM

SAFETY AND EFFICACY OF REPEATED DOSING HYPERTONIC SALINE FOR REFRACTORY INTRACRANIAL HYPERTENSION

Julie Lewandowski-Belfer, Daniel Jackson, Jerah Nordeen, Robert Darracott, Alden Patel, W. David Freeman Mayo Clinic Florida

Purpose/Background: To evaluate the safety and efficacy of repeated dosing of hypertonic saline (14.6% or 23.4%) in patients with elevated intracranial pressure and to evaluate a dose response comparison of 14.6% versus 23.4% saline. Bolus administration of hypertonic saline for reduction of intracranial pressure is well documented. Despite the benefits of hypertonic saline, no definitive recommendations regarding dose, frequency or concentration of hypertonic saline solution have been established for treating intracranial hypertension. Following a case report of ten doses of 23.4% saline administered over 48 hours, a protocol for the use of multiple doses of hypertonic saline was established for treatment of refractory intracranial hypertension at our institution.

Methodology: Observational, retrospective review from January 2008 through July 2012, evaluating the safety of repeated doses of 14.6% or 23.4% saline in patients age 18 or older for reduction of refractory intracranial hypertension. The primary objective is to evaluate the safety of repeated dosing of hypertonic saline assessed by documented adverse effects such as central pontine myelinolysis and MRI or CT changes. Secondary objectives include efficacy of repeated dose hypertonic saline and a dose response comparison between 14.6% and 23.4% saline.


Presentation Objective: Describe the safety and efficacy of the use of hypertonic saline for reduction of intracranial pressure. Self Assessment: What dose of hypertonic saline (in mEq) was used most commonly in this review?


STRESS ULCER PROPHYLAXIS UTILIZATION AND OPTIMIZATION IN THE INTENSIVE CARE UNIT

Jose Valdes, Fred Bourne Baptist Hospital

Purpose/Background: Critically ill patients are at risk for developing gastric ulcers which may lead to clinically significant bleeding. Antiulcer agents can reduce the risk of ulceration if the patient has one major risk factor (coagulopathy, ventilated >48 hours, GI ulcer/bleed within the past year, traumatic injury [brain, spinal cord, burn >35% BSA]) or two minor risk factors (Sepsis, ICU stay >1 week, occult GI bleeding >6 days, multiple trauma [excluding brain, spinal cord, burn >35% BSA], steroid therapy >250mg hydrocortisone or equivalent). While antiulcer agents are prescribed to critically ill patients to reduce the risk of ulceration, not all require prophylaxis. The purpose of the study is to evaluate the appropriate use of stress ulcer prophylaxis in patients admitted to intensive care units.

Methodology: A retrospective chart review will be performed on all patients admitted to the ICUs. Data collection includes: patient demographics, risk factors, antiulcer agent chosen, and use of home medications. Education using current guidelines and latest recommendations will be given to nursing and medical staff through group and individual in-services, pocket cards, and revising a daily nurse-rounding form. After education, a prospective chart review will be conducted to re-evaluate patients admitted to the ICUs.


Presentation Objective: Describe when stress ulcer prophylaxis is indicated in a critically ill patient. Self Assessment: Which of the following is not an indication for stress ulcer prophylaxis? A. Coagulopathy B. Mechanically ventilated >48 hours C. Sepsis D. Traumatic injury E. ICU stay >1 week AND steroid therapy >250 mg hydrocortisone


EVALUATION OF THE USE OF DEXMEDETOMIDINE IN CRITICALLY ILL PATIENTS IN THE CARDIOVASCULAR INTENSIVE CARE UNIT

Micaela Carroll, Robert Kraljevich, Aaron Trujillo, Jorge Garcia, Brent Anderson Broward General Medical Center

Purpose/Background: Propofol and dexmedetomidine are frequently prescribed to sedate postoperative patients in the cardiovascular intensive care unit (CVICU). The two drugs differ in many ways, including the mechanism of action, side effect profile, and cost. Dexmedetomidine costs considerably more than propofol and is being utilized with increased frequency; it is currently the top expenditure of the Broward Health Medical Center (BHMC) pharmacy department. The objective of this study is to optimize the use of dexmedetomidine at BHMC.

Methodology: Patients in the CVICU prescribed dexmedetomidine during the month of July 2012 were retrospectively reviewed. This review revealed prescribing patterns and offered insight with regards to duration of dexmedetomidine therapy, incidences of hypotension, and achievement of goal Richmond Agitation Sedation Scale (RASS) scores. This information is being used to create and implement a new sedation protocol. The protocol will be implemented to both cover overall sedation and to outline how and when to use dexmedetomidine in order to control costs and optimize therapy. After the protocol has been implemented, the use of dexmedetomidine in these patients and costs associated with their therapy will be compared to that of the historical controls.


Presentation Objective: Describe how dexmedetomidine is utilized in critically ill patients and streamline its use while still providing optimal patient care. Self Assessment: What was the most common adverse effect observed during therapy with dexmedetomidine?

Time: 10:50 -11:10 Room: G103 Category: PED

THERAPEUTIC DRUG MONITORING OF GENTAMICIN IN NEONATES: APPROPRIATENESS AND COST SAVINGS.

Tara Nygaard, Jenny Donald, Marisa Hill, Tim L'Hommedieu St. Jospeh's Hospital

Purpose/Background: Gentamicin monitoring for neonates on short course therapy is often inappropriate and costly. The purpose of this study is to decrease the number of inappropriate gentamicin levels drawn in neonates receiving short course gentamicin therapy.

Methodology: Institutional Review Board approval was obtained prior to a retrospective chart review at St. Joseph's Children's Hospital. Antibiotic naive neonates admitted to the neonatal intensive care unit (NICU) are eligible for inclusion. Initial peak and trough measurements will be assessed and deemed appropriate if urinary output is less than or equal to 2mL/kg/hr or gentamicin therapy is greater than six days. Data to be collected will include the following: demographic data, factors affecting gentamicin concentrations, gentamicin levels and timing, and lab-associated costs. An intervention to ensure appropriate gentamicin monitoring will be followed by a wash out period and post evaluation.


Presentation Objective: List the qualifications for omitting antibiotic therapeutic monitoring in neonates. Self Assessment: What role(s) can pharmacists play in reducing unnecessary monitoring in neonates?



Time: 11:10 - 11:30 Room: G103 Category: PED

EVALUATION OF VANCOMYCIN DOSING IN OVERWEIGHT AND OBESE PEDIATRIC PATIENTS: A RETROSPECTIVE STUDY IN A NON-

PROFIT, TERTIARY PEDIATRIC INSTITUTION Elisa Edwards, Katie Wassil Wolfson Children's Hospital/Baptist Health System

Purpose/Background: In patients receiving vancomycin therapy, it is important to achieve therapeutic trough concentrations to maintain efficacy. With the rise in the overweight and the obese populations, even among children, there is a need to evaluate vancomycin therapy in these populations. This study will assess the efficacy of typical vancomycin dosing in overweight and obese children. Traditional vancomycin dosing in overweight and obese pediatric patients will be compared to the non-overweight, non-obese group by looking at the dose and the time it took to reach therapeutic trough concentration.

Methodology: This IRB approved retrospective chart review of pediatric patients aged between 2 and 18 years old at the time of vancomycin treatment, receiving at least five doses of vancomycin will be identified. Information collected will include patient's sex, weight, height, body surface area (BSA), dose of vancomycin with serum trough concentrations with each intervention, and the time it took to achieve therapeutic concentration.


Presentation Objective: Assess the difference between the time to achieve therapeutic vancomycin trough concentration between overweight and obese children group and non-overweight, non-obese children group. Self Assessment: Choose a false statement regarding vancomycin. a. Glycopeptide antibiotic used to treat many gram positive bacterial infections b. The most current guidelines recommend serum trough levels to be within 5 - 10 mcg/mL c. Inhibits bacterial cell wall synthesis d. In children, the half-life is shorter compared to adults


INFLUENCE OF COMPUTERIZED PHYSICIAN ORDER ENTRY GUIDED DRUG SELECTION FOR THE TREATMENT OF COMMUNITY

ACQUIRED PNEUMONIA IN PEDIATRICS: A RETROSPECTIVE STUDY Jamie Caruthers, Marie Mavis, Nisha Patel Wolfson Children's Hospital/Baptist

Health System

Purpose/Background: A substantial amount of research exists showing that computerized physician order entry (CPOE) systems in adult hospitals reduce medication errors, length of stay, and cost. There is, however, less research regarding the impact of the use of CPOE in the pediatric population and the use of order sets within the CPOE system on community acquired pneumonia (CAP). The goal of this study is to compare physician ordering and treatment guideline adherence of pediatric patients hospitalized with CAP at WCH before and after CPOE implementation.

Methodology: Charts of patients between 3 months and 18 years of age with community acquired pneumonia will be retrospectively reviewed. Patients meeting appropriate inclusion and exclusion criteria will be assessed for the following: age, gender, weight, immunization status, suspected bacteria, use of CAP power plan, antibiotic agent and dose. Pre and post CPOE rates of appropriate antimicrobial selection, rates of CPOE power plan use, percentage of correct doses, and rates of antimicrobial selection for a specific age group will be recorded and evaluated.


Presentation Objective: List the advantages and disadvantages of CPOE implementation. Self Assessment: What are some advantages of CPOE implementation?

Time: 10:50 -11:10 Room: G114 Category: PSY

IMPLEMENTATION OF AN INDIGENT PATIENT PRESCRIPTION ASSISTANCE PROGRAM AFTER DISCHARGE AT AN INPATIENT

BEHAVIORAL HEALTH CENTER William Terneus Jr,. Mike Briante, Donald Sullivan Indian River Medical Center

Purpose/Background: The Indian River Medical Center (IRMC) provides an indigent patient assistance program through partnership with a local chain pharmacy to supply patients with their medications after discharge at no charge. The dispensing pharmacy charges the hospital the highest cost possible within their fee structure because the hospital is considered a cash customer. Patients discharged from the inpatient Behavioral Health Center (BHC) must be provided with a 30-day prescription which may be costly due to physicians prescribing newer agents. The purpose of this study is to develop a more cost-efficient program for the hospital without compromising the quality of patient care.

Methodology: 100 indigent patients and 100 non-indigent patients will have discharge medication reconciliation records reviewed for any antipsychotic, antidepressent or antianxiety medication that is prescribed as an outpatient. The outpatient indigent charges generated by the local community pharmacy for the time period of September 1, 2011 to August 31, 2012 for prescriptions written for BHC patients for psychotropic medications will be assessed as well. The pattern of prescriptions will be used to determine the list of drugs that would be potentially filled by an outpatient pharmacy. Various local pharmacies will be contacted to determine comparative prices for the drugs and the mechanism the hospital will be charged for the drugs.


Presentation Objective: Assess the importance of implementing a cost-efficient indigent patient prescription assistance program for indigent, mentally ill patients Self Assessment: What is the most commonly prescribed psychotropic medication?

Time: 11:10 - 11:30 Room: G114 Category: PSY

EVALUATION OF THE EFFECTIVENESS OF PALIPERIDONE INJECTION TREATMENT

Matthew Felser, Carmela Jean Miami VA Healthcare System

Purpose/Background: Paliperidone palmitate is the long-acting injectable form of paliperidone used once a month to treat schizophrenia. The objective is to identify the overall effectiveness of paliperidone injections as assessed by improvement or lack of improvement on the PANSS, MMSE, and/or GAF or the lack of effectiveness as indicated by its discontinuation in patients of the Miami VA Healthcare System.

Methodology: Data collection will be used to identify the number of Miami VA patients receiving paliperidone injections between January 1, 2012 and December 31, 2012. The Computerized Patient Record System (CPRS) will be reviewed to monitor for changes in the PANSS, MMSE, or GAF, if documented, as well as if a patient was discontinued from the medication due to lack of effectiveness or for any other reason. Also evaluated will be the gender, concurrent antipsychotics used while patients are receiving these injections, the number of previous 2nd-generation antipsychotics used prior to injection initiation, if paliperidone was discontinued during the timeframe under study, and if any metabolic or extrapyramidal adverse drug reactions occur after a patient begins receiving these injections.


Presentation Objective: Describe the effectiveness of long-acting paliperidone on the overall outcome of psychiatric patients in the VA setting. Self Assessment: What is the advantage of paliperidone injection compared to other second generation antipsychotics?




VARIABILITY IN ANTIDEPRESSANT PRESCRIBING AMONG PRIMARY CARE PHYSICIANS.

Katie Cich, Anzeela Schentrup UF College of Pharmacy

Purpose/Background: The use of antidepressant medications, over the past two decades, has grown to the point that they are now the third most commonly prescribed class of medications in the United States. Based on a recent study, 61.4% of patients for whom antidepressants were prescribed did not receive diagnosis for any psychiatric disorders during the course of a year. The purpose of this study is to review the trend in prescribing and management of antidepressant medications to patients with or without a psychiatric disorder and to describe variations in treatment among primary care physicians at University of Florida and Shands outpatient primary care clinics.

Methodology: Data was collected on all patients prescribed antidepressants > 18 years of age from January 2009 through December 2012 in University of Florida Physicians primary care practices. The frequency of which antidepressants were prescribed with no corresponding psychiatric diagnosis was identified and compared among primary care clinics.


Presentation Objective: Describe the current trend in antidepressant prescribing in primary care clinics. Self Assessment: What was the percentage of patients prescribed antidepressants with no corresponding psychiatric diagnosis?

Time: 10:50 -11:10 Room: G112 Category: IM

TPN STANDARDIZATION: A COST MINIMIZATION ANALYSIS Gail Krug, Peter Pasek Bay Pines VA Health Care System

Purpose/Background: The purpose of this project is to conduct a cost minimization analysis of current total parenteral nutrition (TPN) outsourcing service use versus standardized TPN mixtures. Currently, Bay Pines VAHCS uses Central Admixture Pharmacy Service, (CAPS) which delivers customized TPN. Clinimix offers several options of premixed solutions with varying compositions to choose from. Comparison of direct and indirect costs associated with both methods of TPN preparation will be conducted to examine weather standardization of TPN therapy would be beneficial to Bay Pines VA Health Care System (VAHCS).

Methodology: Direct and indirect costs of using CAPS and implementing the use of Clinimix will be compared. Direct costs include cost of solutions with electrolytes, delivery of the product, and cost of additional components such as fats and electrolytes as well as compounding materials needed for the use of Clinimix. This will be determined by reviewing cost data with the purchasing agent at Bay Pines VAHCS, CAPS representatives and drug representatives for Baxter. Indirect costs will include monetary estimates of differential workload associated with necessary manipulation of Clinimix preparations as well as differential time required for the verification of Clinimix orders and products. Monetary estimates will be derived by estimating average time spent on a particular task and average technician and pharmacist salaries.


Presentation Objective: Determine the most cost effective method of supplying TPN at Bay Pines Veterans Affairs Healthcare System. Self Assessment: Cost minimization analysis compares: a) Compares outcomes in terms of their utility b) Comparison of costs in monetary units c) Comparison of costs and outcomes d) Comparison of outcomes in quantitative non-monetary units


ASPIRIN USE AND INTRAOPERATIVE BLEEDING IN HIGH-RISK SURGERIES

Peter Richard Rabbath, Bradley Stein, Kristin St. John James A. Haley Veterans Hospital Purpose/Background: Continuing aspirin perioperatively in certain patients is now endorsed by the American College of Chest Physicians to prevent postoperative cardiac events. However, this puts patients at greater risk for intraoperative bleeding. There are few trials analyzing intraoperative bleeding and transfusion needs in this patient population. It is important to quantify intraoperative blood loss attributed to aspirin continuation so that surgeons and anesthetists can accurately anticipate and manage blood loss during high-risk surgeries. The purpose of this study is to assess whether continuing aspirin perioperatively significantly increases the amount of intraoperative blood transfusions as well as quantify intraoperative blood-loss.

Methodology: A retrospective cohort chart review will be conducted on patients who underwent the following surgeries from August 1st, 2005 to August 1st, 2012: cystoprostatectomy, radical retropubic prostatectomy, partial nephrectomy, radical nephrectomy, and total hip arthroplasty. The surgeries were chosen based on their high potential for bleeding and no requirement for intraoperative anticoagulant infusions. Data to be collected includes estimated blood loss (EBL), amount of blood transfused in units, age, aspirin use and dose, the use of intraoperative colloids, international normalized ratio (INR), and pre-operative hemoglobin levels. Estimated blood loss is calculated by the anesthesia team: the amount of blood vacuumed into a container plus the number of surgical lap sponges [times 80ml] plus the number of Ray-Tec sponges [times 15ml] minus the amount of irrigation used. The amount of estimated blood loss and blood transfused are found on the scanned anesthesia record. Although the amount of blood loss is an estimate, it is the standard practice at our facility for measuring this parameter. Identification of patients will be conducted through the Veterans Health Information Systems and Technology Architecture (VISTA) search via Current Procedural Terminology (CPT) codes.


Presentation Objective: Determine if patients who continue taking aspirin throughout the perioperative period require more intraoperative blood transfusions. Self Assessment: According to the American College of Chest Physicians, in which patients do they recommend the continuation of aspirin throughout surgery?


SEVERE HYPERGLYCEMIA: COMPARISON OF THE CLINICAL MANAGEMENT OUTCOMES

Phuoc Bui, Georgia Keriazes Lakeland Regional Medical Center

Purpose/Background: Inpatient hyperglycemia is associated with poor outcomes including increased length of stay, admission to the Intensive Care Unit, increased mortality, and increased hospital acquired infections. The American Association of Clinical Endocrinologists and the Endocrine Society Clinical Practice Guidelines recommend an insulin regimen in conjunction with blood glucose monitoring to maintain blood glucose in the range of 70 - 180 mg/dl for the management of general hyperglycemia in the non-critical care setting. The study assesses if an insulin regimen with basal insulin plus corrective scale insulin and appropriate monitoring is more effective than an alternative regimen in controlling blood glucose levels.

Methodology: Medical patients who have a critical blood glucose reading ≥400 mg/dL were identified and included in the study. Information collected includes: patient demographics; concurrent oral or IV glucocorticoids, TPN, tube feeding; proportion of managed blood glucose readings in the range of 70-180 mg/dL, and critical blood glucose readings ≥400 mg/dL and < 40 mg/dL; and approaches to hyperglycemia management. In addition, outcomes which include length of stay, transfers to the ICU, development of hospital acquired infection, and in-hospital mortality were collected.


Presentation Objective: Compare outcomes of the clinical management in two treatment groups of severe hyperglycemia with critical blood glucose ≥400 mg/dL in medical patients. Self Assessment: What was the most common approach to hyperglycemia management in this study?



Time: 10:50 -11:10 Room: G312 Category: AM

TESTOSTERONE USE AND IMPLEMENTATION OF PRESCRIBING TEMPLATE

Kim Tyanne Julien, John Hoeldtke Ft Myers VA Outpatient Clinic

Purpose/Background: Hypogonadism affects approximately 4 million males in the United States with its prevalence increasing with age. Low levels of serum testosterone are associated with diminished libido, erectile dysfunction, depression, anemia, reduced muscle mass and bone density. There are several FDA approved testosterone delivery systems. There is a large price disparity between the various testosterone delivery systems. Within our healthcare system, testosterone injections are formulary preferred. For patients who have a contraindication to testosterone injections, testosterone 1.62% topical gel is the second line agent. The purpose of this project is to create a testosterone prescribing and renewal template to facilitate proper formulary selection, ordering, for monitoring of testosterone products.

Methodology: A prescribing and renewal template will be developed for testosterone replacement therapy. The template will require the appropriate exams, labs and imaging to be completed before the initiation of testosterone replacement. Contraindications to testosterone injections will be recorded before requesting testosterone 1.62% topical gel. Regular monitoring and periodic review of testosterone level will be required to renew the prescription.


Presentation Objective: Describe the role of a clinical pharmacist in monitoring the appropriateness of prescribing topical testosterone. Self Assessment: What range is considered a low free testosterone level?


MEDICATION INDUCED VITAMIN B12 DEFICIENCY: EFFECTS OF METFORMIN AND PROTON PUMP INHIBITORS, ALONE AND

COMBINED Lindsey Bates, Sally Cushnie Ft Myers VA Outpatient Clinic

Purpose/Background: Vitamin B12 deficiency can cause anemia and neurologic dysfunction. The neurologic consequences cannot be reversed, and may result in significant morbidity. Metformin and proton pump inhibitors (PPIs), both widely used, have been associated with vitamin B12 deficiency. These medications are often used long-term, allowing for depletion of hepatic vitamin B12 stores. Data regarding the use of these medications and the decline in B12 levels remains limited and guidelines outlining monitoring and supplementation are lacking. The purpose of this project is to determine the effects on vitamin B12 levels in patients prescribed metformin and PPIs, both alone and when prescribed in combination. The results may aid in developing guidance for monitoring vitamin B12 levels and providing supplementation. This material is the result of work supported with resources and the use of facilities at the Bay Pines VA Healthcare System. The contents of this paper do not represent the views of the Department of Veterans Affairs or the United States Government.

Methodology: A retrospective chart review will be conducted on three groups of patients from the Lee County VA Healthcare Center. The groups will include: patients taking metformin, those taking a PPI, and those taking concomitant PPI and metformin. The number of patients deficient in vitamin B12, the frequency of monitoring for deficiencies and the number of patients receiving supplementation will be determined. The findings of this review may lead to educational opportunities regarding monitoring and supplementation in patients taking these medications.


Presentation Objective: Raise awareness about medication-induced vitamin B12 deficiency with the use of metformin and proton-pump inhibitors, and discuss potential monitoring and supplementation recommendations. Self Assessment: True or False? Patients taking both metformin and omeprazole tended to have lower vitamin B12 levels when compared to taking either drug alone?


EFFECT OF A QUALITY ASSURANCE INITIATIVE ON AN AMBULATORY CLINICAL PHARMACY SERVICES CLINIC Lindsay Jackson, Ruthan White Florida Hospital-Celebration Health

Purpose/Background: Error reporting is essential in continuous quality improvement (CQI) programs in all pharmacy practice settings. Barriers to reporting quality assurance (QA) issues include finding time to report and meet, having staff involved in reporting, reporting apprehensiveness, and accepting the online technology. Data regarding CQI programs in pharmacist-led ambulatory clinics is limited. The CQI program at a clinical pharmacy services clinic encourages staff to report QA issues; however, participation in reporting events is lacking. One explanation for under-reporting may include the accessibility of report forms. A new method of reporting QA issues was implemented to enhance visibility of forms. This study will evaluate the effectiveness of a new method for reporting QA issues based on the frequency of reporting before and after the process change. Secondarily, types of QA issues reported will be examined.

Methodology: Stacks of QA forms were placed in all work areas and a submission container was placed in a common location. Staff members were asked to complete and submit QA reports anonymously and voluntarily when quality-related events occurred. Data collected included total number of reports submitted monthly, type of incident reported, reporter’s job title, clinic location, and action taken as a result of each report.


Presentation Objective: Describe the effect of a quality assurance initiative on the ambulatory clinical pharmacy services clinic. Self Assessment: What was the most common type of quality assurance incident reported during the study period?

Time: 10:50 -11:10 Room: G307 Category: CP

EFFECTIVENESS OF COMPOUNDED BIOIDENTICAL HORMONE REPLACEMENT THERAPY IN REDUCING VASOMOTOR SYMPTOMS

AND QOL IN MENOPAUSAL WOMEN Marjohn Armoon, Nancy Hart, Steven Smith, Benjamin Epstein Medimix Specialty

Pharmacy

Purpose/Background: Bioidentical Hormone Replacement Therapy (BHRT) describes supplementation of a replacement hormone, whose molecular structure is identical to the hormone existing in the human body, and is often dispensed in compounding pharmacies for menopausal women experiencing symptoms of hormone deficiency. These hormones include: estradiol, estriol, progesterone, and testosterone. This study will evaluate the effectiveness of compounded BHRT in menopausal women with vasomotor symptoms and QOL, as well as the role of a clinical pharmacist in this setting.

Methodology: Peri or post-menopausal women ages 30 to 65 receiving BHRT at the pharmacy will be enrolled and followed over 12 weeks. Information collected includes two validated instruments, the Menopause Rating Scale (MRS) and Women's Health Questionnaire (WHQ) at baseline and 12 weeks and a satisfaction of care survey at 12 weeks, evaluating the level of care they received from their clinical pharmacist. Other information collected includes a hormonal symptom diary completed over 12 weeks, demographics, co-morbidities, concomitant medications, and past medications taken, if any, to relieve symptoms. The pharmacist will assess the patient via telephone communication at 2, 4, 8, and 12 weeks for any clinical changes. After the final assessment at 12 weeks, the MRS, WHQ, and satisfaction of care survey will be analyzed

Results/Conclusions: Results pending at time of abstract submission. Results pending at time of abstract submission.

Presentation Objective: Describe the role of a clinical pharmacist in a compounding pharmacy regarding the care of menopausal women with BHRT. Self Assessment: What are common concerns with hormone replacement that warrant a study of this nature?



PREVALENCE OF POTENTIALLY INAPPROPRIATE DRUG-DISEASE INTERACTIONS IN VETERANS AFFAIRS COMMUNITY LIVING CENTER RESIDENTS USING THE UPDATED BEERS CRITERIA

Kimberly Mattox, Lauren George, Janel Gordon James A. Haley Veterans Hospital

Purpose/Background: The primary aim is to assess the prevalence of, and factors associated with, potentially inappropriate medication-disease state combinations according to the 2012 Beers Criteria in Veterans who are ≥ 65 years old and residing in Veterans Affairs Community Living Centers (VA CLCs). This is a multi-site retrospective cohort study of VA CLC residents age ≥ 65 years old with a diagnosis of heart failure, dementia and/or cognitive impairment, history of falls or hip fractures, history of peptic ulcer disease and/or stage IV or V chronic kidney disease.

Methodology: The PI and co-investigators will use Veterans Health Information Systems and Technology Architecture (VISTA) to ascertain residents in the CLC on October 17, 2012. Then, the Computerized Patient Record System (CPRS) and/or MDS will be reviewed to identify those who are ≥ 65 years old who have one or more of the disease states of interest. The recorded age will be based on the age of the resident on October 17, 2012. For the residents meeting the inclusion and exclusion criteria, co-investigators will retrospectively record the following data: eGFR if the resident has stage IV or V chronic kidney disease, ejection fraction if the resident has heart failure, sex, race, Hispanic ethnicity, number of days since the most recent admission to the CLC, comorbidities, number of regularly scheduled, chronic medications, use of a proton pump inhibitor if the patient has peptic ulcer disease, and the potentially inappropriate medications in the drug-disease interactions of interest based on 2012 Beers Criteria.


Presentation Objective: Identify potentially interaction medications in elderly patients based on specific disease states using the most recent Beers Criteria List. Self Assessment: What are 3 medications potentially interacting medications for a 85 year old resident at the CLC with dementia and a history of falls?


EVALUATION OF THE CONTINUATION OF BETA-BLOCKERS PERIOPERATIVELY IN NON-CARDIAC SURGERY PATIENTS Andrew Gatton, Nadia Iwanyshyn, Paul Tan, Marci DeLosSantos Shands


Purpose/Background: Non-cardiac surgeries have been associated with post-operative complications, such as myocardial infarction (MI) and cardiac arrest. Beta-blockers have been studied in non-cardiac surgery patients during the perioperative period as a possible treatment to decrease post-operative complications. However, beta-blockers can cause detrimental effects, such as hypotension and bradycardia, making their use controversial. This study evaluates the post-operative cardiac outcomes of continuing beta-blockers during the perioperative period in non-cardiac surgery patients.

Methodology: This study is a retrospective chart review of patients on a beta-blocker at home who underwent a non-cardiac surgery. Patients were divided into two groups. One group was patients that received a beta-blocker on the day of surgery, post-operative day 1, and post-operative day 2. The second group was patients who did not receive a beta-blocker on all three days. The primary objective was to determine if continuation of beta-blockers during the perioperative period had an effect on a composite endpoint of post-operative cardiac complications (i.e., MI, cardiac arrhythmias, and ischemia) during index hospitalization. Secondary endpoints included post-operative MI, post-operative ischemia, post-operative cardiac arrhythmias, post-operative cardiac death, post-operative stroke, hypotension, bradycardia, length of stay, intensive care length of stay, and 30-day readmissions due to cardiac complications.


Presentation Objective: Describe the effects of the continuation of beta-blockers in the perioperative period for non-cardiac surgery patients. Self Assessment: What are the most common adverse effects of continuing beta-blockers perioperatively?


CONFERENCE

Session III, cont.

May 10, 2013

12:00-1:00pm




EVALUATING THE PHARMACIST ROLE IN THE EMERGENCY DEPARTMENT (ED)

Kristina Lee, Judy Tseng South Miami Hospital

Purpose/Background: The American Society of Health-System Pharmacists and current literature support the need for a pharmacist in the emergency department (ED). Responsibilities of the ED pharmacist include making therapeutic recommendations, providing drug information, monitoring labs, performing medication reconciliation, counseling patients and responding to codes. This IRB-approved study will describe the common services provided and interventions made by a pharmacist, evaluate the current medication reconciliation process and assess ED nursing staff perception of the pharmacist in the ED of a community-based hospital.

Methodology: A pharmacist was present in the ED for a consecutive two-week period in December 2012, and also for one weekday evening per week and one weekend afternoon per month from January to February 2013. The pharmacist provided services such as medication reconciliation, facilitation of stat medications, responding to drug information requests, and chart reviews. Each service provided or intervention made by the pharmacist was documented in the Quantifi program, which was then used to generate a summary report. The current medication reconciliation process in the ED was evaluated for accuracy and completeness using a random sample of medication reconciliation order forms for patients admitted to the hospital from the ED in October and November 2012. A survey was distributed to ED nurses over a four-week period to assess their perception of the pharmacist role in the ED.


Presentation Objective: Describe and evaluate the pharmacist role in the ED of a community-based hospital. Self Assessment: What was the most common service provided/intervention made by the pharmacist in this study?


EVALUATION OF PROTON PUMP INHIBITOR (PPI) USE OUTSIDE OF CRITICAL CARE IN A COMMUNITY HOSPITAL

Jaclyn Chessher, Ernie Cyr West Florida Healthcare

Purpose/Background: In 1999, the American Society of Health-System Pharmacists (ASHP) published evidence-based guidelines for stress ulcer prophylaxis (SUP) in the intensive care unit. Although ASHP guidelines give no recommendation for using PPIs in non-critical care settings, their use in preventing mucosal injury has become common practice. The purpose of this study is to evaluate the appropriateness of proton pump inhibitor use outside of the critical care.

Methodology: Patients greater than 18 years old admitted to non-critical care floors on PPIs were identified as possible candidates for retrospective review. Any patient with a documented diagnosis of gastro-intestinal reflux disease (GERD) or had an H2 receptor antagonist or PPI on their prior home medication list was excluded. Based on ASHP's stress ulcer prophylaxis guidelines as well the American College of Gastroenterology's guidelines for prevention of NSAID-related ulcer complication, patients were divided into possible categories for PPI use: stress ulcer prophylaxis candidates, NSAID-related ulcer prophylaxis candidates, or gastro-intestinal bleeding prophylaxis candidates. If patients fell into neither category, PPI use was deemed inappropriate.

Results/Conclusions: Results pending at time of submission. Review of data, thus far, shows 47% of patients did not meet criteria warranting anti-secretory therapy. Conclusion pending at time of abstract submission.

Presentation Objective: Evaluate the use of proton pump inhibitors in preventing mucosal injury in the hospital setting. Self Assessment: In this study, which class of drugs was identified as the largest risk factor for GI bleeding in hospitalized patients warranting proton pump inhibitor use?


SARGRAMOSTIM VS. FILGRASTIM FOR POST-INDUCTION CHEMOTHERAPY IN ACUTE MYELOID LEUKEMIA: A

RETROSPECTIVE ANALYSIS Rebecca J. Nelson; Timothy George; Viet Ho; Rod Quilitz, Yanina Pasikhova, Alan

F. List; Gene Wetzstein H. Lee Moffitt Cancer Center & Research Institute

Purpose/Background: Granulocyte-macrophage colony stimulating factor (GM-CSF), sargramostim (Leukine® ) and granulocyte colony stimulating factor (G-CSF), filgrastim (Neupogen ®) are used to limit myelosuppression in patients with Acute Myeloid Leukemia (AML) following post-induction chemotherapy. The additional immune stimulatory mechanisms of sargramostim suggest that it may offer additional protection against infections, compared to filgrastim. The purpose of this study is to evaluate both sargramostim and filgrastim, in post-induction AML patients, for prevalence of infections, length of hospital stay, neutrophil recovery and overall mortality.

Methodology: Approximately 160 electronic medical records from the hematology department database are being evaluated to identify newly diagnosed AML patients receiving induction chemotherapy, from January 2005 to October 2012, who received at least one dose of hematopoietic growth factor with either sargramostim (Arm A) or filgrastim (Arm B). This retrospective chart review excludes patients younger than 18 years of age, those who have received induction chemotherapy for relapsed disease, or those diagnosed with acute promyelocytic leukemia (APL or M3 AML). This study was approved by the University of South Florida Institutional Review Board.


Presentation Objective: Analyze and compare data on the prevalence of culture-documented bacterial or proven/probable fungal infections. The secondary objectives are to compare and analyze data on the length of hospital stay (LOS), time to neutrophil recovery, mortality during induction phase, as well as the prevalence of IDSA defined febrile neutropenia between the two treatment arms. Self Assessment: Filgrastim stimulates neutrophils, macrophages, and dendritic cells, which may theoretically broaden immune stimulatory mechanisms and lead to improved protection against infections. True/False


DOSING ANALYSIS OF A SIMPLIFIED HIGH DOSE MAGNESIUM SULFATE INFUSION PROTOCOL FOR STATUS ASTHMATICUS IN PICU

PATIENTS: A PROSPECTIVE PILOT STUDY Joanna Wrobel, Elisa Edwards, Sarah Katherine Wassil, Jose E Irazuzta Wolfson

Children's Hospital/Baptist Health System

Purpose/Background: In pediatric and adult studies, intravenous magnesium sulfate has been shown to significantly improve lung function. A continuous infusion is believed to achieve the desired therapeutic concentrations of 3 to 5 mg/dL. A previous study demonstrated attainment of these concentrations with a high-dose magnesium sulfate regimen, including a loading dose followed by a 4 hour continuous infusion, dosed on ideal body weight (IBW). The purpose of this study is to evaluate if a simplified dosing regimen, 50 mg/kg/hour for 5 hours, is tolerated and reaches the targeted blood levels for refractory status asthmaticus.

Methodology: In this prospective pilot study, patients between the ages of 2 and 21 years old will be enrolled from November 2012 to March 2013, consistent with the inclusion and exclusion criteria. The new dosing regimen is a 50 mg/kg/hour 5 hour magnesium sulfate infusion with dosing based on actual or ideal body weight depending on the child's body mass index (BMI) percentile. Patient data collected and analyzed will include patient demographics, vitals, 4 magnesium levels and respiratory function. Safety will be evaluated with the following adverse events: hypotension, nausea, vomiting, flushing, erythema, vision changes, electrocardiography (ECG) changes, somnolence/respiratory depression, depressed tendon reflexes, muscle weakness.


Presentation Objective: Identify the adverse events associated with supratherapeutic magnesium levels. Self Assessment: What are the adverse events associated with supratherapeutic magnesium blood levels?




DEVELOPMENT AND IMPLEMENTATION OF A PHARMACY PHARMACOKINETIC REVIEW SERVICE

Suzanna Bedy, Katie Namtu All Children's Hospital

Purpose/Background: Vancomycin and aminoglycosides often require pharmacokinetic calculations and therapeutic drug monitoring. This project will focus on implementing a pharmacokinetic review service in which staff pharmacists monitor orders and results for vancomycin and aminoglycoside levels. The primary endpoints are to determine the incidence of appropriate lab ordering and therapeutic serum drug concentrations pre- and post-implementation of the review service. A secondary endpoint is to measure the effectiveness of the pharmacokinetic training program.

Methodology: The review service will provide 24-hour coverage and will include inpatients except for the cystic fibrosis and NICU populations. Pharmacist training for the review service included a pre-test, presentation by the pharmacy resident, and post-test. After the review service has been enacted for one month, post-implementation prospective data will be collected to compare the incidence of appropriate lab ordering and therapeutic serum drug concentrations with pre-implementation retrospective data.

Results/Conclusions: Based on a preliminary retrospective data review, areas for pharmacist involvement include ensuring vancomycin and aminoglycoside levels are appropriately ordered and timed. Prospective data collection should determine whether or not pharmacists made an impact in this area and in increasing the incidence of therapeutic serum drug concentrations.

Presentation Objective: Discuss the importance of a pharmacist pharmacokinetic review/consult service. Self Assessment: What were areas for improvement based on retrospective data?


EVALUATION OF A NEW VANCOMYCIN DOSING SCHEME IN PEDIATRIC PATIENTS

Juwon Yim, Betsy Bickert Poon, Deborah Maka, Kristen Jones, Caitlin Crosley Florida Hospital for Children

Purpose/Background: Traditionally, vancomycin is initially dosed at 10 mg/kg/dose every 6 hours or 15-20 mg/kg/dose every 6-8 hours for serious infections in children. It has been a challenge to attain therapeutic vancomycin trough levels in a timely manner in children with normal renal function based on the traditional vancomycin dosing guidelines. As a result, a retrospective chart review was conducted at Florida Hospital for Children from 2009 to 2011 which established a new vancomycin dosing scheme approved by the medical staff. This follow-up study will evaluate the effectiveness of the new vancomycin dosing scheme in attaining goal therapeutic vancomycin concentrations.

Methodology: Pediatric patients whose vancomycin dosing was determined based on the new vancomycin dosing scheme and met the inclusion criteria will be enrolled in this prospective, observational study. The primary objective is to determine the percentage of patients who attain goal therapeutic vancomycin concentrations with their first dosing regimen. Safety of the new vancomycin dosing scheme will be assessed by evaluating the percentage of patients with initial trough concentrations in the potentially toxic range and number of patients who experience nephrotoxicity.


Presentation Objective: Describe the effectiveness and safety of a new vancomycin dosing scheme in achieving therapeutic trough concentrations in pediatric patients. Self Assessment: What age group of pediatric patients required the highest daily dose of vancomycin to achieve therapeutic vancomycin concentrations?

Time: 12:00 - 12:20 Room: G114 Category: TXP

ANALYSIS OF RISK FACTORS AND OUTCOMES FOR POLYOMAVIRUS INFECTION IN LUNG TRANSPLANT RECIPIENTS

Beatrice Adams, Angela Logan, Tarik Haddad, Mark Rolfe, Timothy Floreth Tampa General Hospital

Purpose/Background: BK virus (BKV) and JC (JCV) are polyomaviruses (PV) which cause asymptomatic infection during early childhood. PV reactivation typically progresses from viruria to viremia and could result in PVAN (polyomavirus associated nephropathy). Renal dysfunction is a late complication that occurs after lung transplant due to multi-factorial causes. Currently, there is limited literature describing polyomavirus infection in the cardiothoracic transplant population.

Methodology: Single-center, retrospective case-control study. Patients 18-75 years that received a lung transplant between July 2009 and August 2012 were included. Patients were matched based on indication, age, single vs. double lung, and sex. Additional information collected includes demographics, PV PCRs, tacrolimus levels, and SCr.

Results/Conclusions: One hundred fifty six patient were included for review and 12% (n=18) had PV detection, 6% (n=9) BKV, and 6% (n=9) JCV. All 18 patients had PV detection in the urine, 3% in the plasma. The SCr trended higher in the case group compared to the control (1.4 vs. 1.0; p=0.017). No significant differences were found in age, sex, FK levels, or rejection. Among the patients that developed viruria, 3% progressed to viremia which is a lower incidence compared to the renal transplant population that reports a 50% progression. Monitoring for PV reactivation may be warranted in lung transplant patients who have a late onset increase in SCr.

Presentation Objective: Evaluate the incidence, outcomes, and risk factors for polyomavirus reactivation and progression in lung transplant recipients. Self Assessment: What is the incidence of PV reactivation in the lung patients at TGH?


EVALUATION OF A TRANSPLANT MEDICATION EDUCATIONAL VIDEO ON TRANSPLANT RECIPIENT'S MEDICATION KNOWLEDGE

AND LEVEL OF COMFORT AT HOSPITAL DISCHARGE Chelsea Sammons; Christina Doligalski Tampa General Hospital

Purpose/Background: Medication education following organ transplantation is imperative for patient and graft survival. Various methods of education have been utilized however no standard of care exists. This study seeks to determine the impact of a medication educational video on patient knowledge and comfort level.

Methodology: This single-center, IRB-approved, prospective evaluation compares post-transplant medication knowledge and comfort via a written assessment tool between a standard-of-care cohort and an interventional cohort (standard education plus educational video); characteristics of high and low scorers will also be evaluated.

Results/Conclusions: During the standard-of-care cohort, 95 transplants occurred, including 73% male, 71% Caucasian and 52% kidney recipients. Sixty-two patients (65%) completed the assessment tool averaging a score of 80.9%. There were no statistically significant differences in scores based on gender, race, education level, or organ transplanted; however, lung recipients, African-Americans, and non-native English speakers trended towards lower scores. Increase in patient perceived medication knowledge and preparedness was correlated with higher scores. Questions evaluating side effects were most commonly missed; those evaluating drug interactions and administration were consistently answered correctly. Most (75%) preferred a combination of teaching methods. Over 90% responded that education with the pharmacist was either very or extremely helpful. Preliminary results show there is room for improvement in transplant medication education. Data analysis from the video group is ongoing.

Presentation Objective: Determine if baseline characteristics correlate with medication knowledge or level of comfort following transplant medication education. Self Assessment: What question topic is most commonly answered correctly? A. Side effects B. Indications C. Drug interactions D. Administration instructions E. C and D




COMPARISON OF ALEMTUZUMAB VERSUS ANTITHYMOCYTE GLOBULIN INDUCTION IN RENAL TRANSPLANTATION Harrison Saull, Cher Enderby, Thomas Gonwa Mayo Clinic Florida

Purpose/Background: Due to rejection risk with renal transplant, antibody induction therapy is employed in approximately 80% of patients as an adjunct to maintenance immunosuppression. Antibody induction therapy should be selected by a comprehensive assessment of immunologic risk, comorbidities, and financial burden. The purpose of this study is to evaluate compare the acute rejection rate at 1, 4, and 12 months post- renal transplant between alemtuzumab and antithymocyte globulin induction therapy in normal immunological risk patients. Secondary endpoints include: length of hospital stay following renal transplant, patient and graft survival, and cytomegalovirus and BK virus infection rate.

Methodology: A retrospective single-center cohort design evaluating acute rejection rate among normal immunological risk patients 18 years or older at the time of renal transplantation will be used. Based on institutional protocol, patients receiving alemtuzumab as an induction agent between April 2010 to September 2011 will be included. Patients who received antithymocyte globulin prior to April 2010 will be included in a number to match the alemtuzumab group. All patients must have received standard of care immunosuppressant therapy and rapid steroid taper. All biopsy specimens are graded for acute rejection by the Banff scheme by pathology.


Presentation Objective: Evaluate the acute rejection rates between alemtuzumab and antithymocyte immune globulin as induction therapy in renal transplantation. Self Assessment: What is the dosing regimen of alemtuzumab that is utilized for induction therapy ?


IMPACT OF A HOSPITALIST PHARMACIST IN A COMMUNITY HOSPITAL

Mina Abdalla, Estela Trimino, Janelle Berg Mercy Hospital, A Campus of Plantation Gen. Hosp

Purpose/Background: The collaboration between a pharmacist and a hospitalist is a novel approach to optimize patient care. Pharmacists have already proven to be invaluable in various setting such as critical care, emergency medicine and oncology. Our purpose was to evaluate the effectiveness of a pharmacist-hospitalist team approach to patient care in a non-teaching community hospital.

Methodology: A collaborative team was formed, consisting of a physician, 2 physician assistants and a pharmacist. The team rounded on internal medicine patients for 23 days. Interventions were documented, categorized and compared to hospital wide interventions (HWI). Workflow in central pharmacy was also analyzed.

Results/Conclusions: During the study period a total of 1845 interventions were documented, of which 621 were completed by the hospitalist pharmacist (33% of HWI) with an acceptance rate of 99%. There were 459 drug regimen modifications (43% of HWI), 78 antibiotic interventions (18% of HWI), 54 IV-to-PO conversions (21% of HWI), 27 renal dose adjustments (20% of HWI), and 3 lab tests avoided (100% of HWI). Average number of interventions was 27 per day for a total cost savings of $28,935. Number of outgoing pharmacy calls dropped from 12 to 2 calls per day. The hospitalist pharmacist provided additional benefit in core measure compliance, medication counseling, providing less expensive therapeutic alternatives and streamlining of admission and discharge medication reconciliation process. Collaboration between hospitalists and pharmacists improved patient care. The addition of a hospitalist pharmacist has shown to streamline the medication process, prevent delays of therapy and improve hospital work flow.

Presentation Objective: Demonstrate the impact of a hospitalist pharmacist in a community hospital. Self Assessment: The hospitalist pharmacist performed less than 25% of interventions in the institution.


IMPACT OF A PHARMACIST DRIVEN PROTOCOL ON THE MANAGEMENT OF HEPARIN-INDUCED THROMBOCYTOPENIA.

Stephanie Tears, Doug Peterson, Suzanne Turner, Scott Osborne Lee Memorial Health System

Purpose/Background: Heparin-induced thrombocytopenia (HIT) is an uncommon, however potentially life-threatening complication of anticoagulant therapy. Initial diagnosis of HIT can be accomplished using a 4-T test or a heparin-platelet factor 4 (H-PF4) assay. H-PF4 assays are sensitive but not specific resulting in frequent false positive results. A serotonin release assay (SRA) must be conducted to definitively confirm a diagnosis of HIT. An incorrect diagnosis of HIT can lead to more costly anticoagulant therapy and the documentation of a false allergy in the patient's permanent electronic medical record. A pharmacist facilitated HIT confirmation protocol was newly initiated in March 2012 at Lee Memorial Health System (LMHS). The purpose of this study was to compare anticoagulant therapy pre- protocol and post protocol implementation.

Methodology: This study is a retrospective chart review of LMHS patients. Cases will be defined as all patients with an order for a Heparin-PF4 antibody assay between the months of August-December of 2011 (pre-protocol) and October-December of 2012 (post- protocol implementation). Data will be obtained through patient charts and electronic medical records. The 4-T test will be calculated for each patient.


Presentation Objective: Determine if a pharmacist driven protocol improved the management of HIT by decreasing the number of patient days spent on non-heparin based anticoagulant therapy. Self Assessment: What is the most common anticoagulant used for the treatment of suspected heparin induced thrombocytopenia at LMHS?


EVALUATING THE IMPACT OF BASAL PLUS INSULIN ORDER SET ON INPATIENT GLYCEMIC CONTROL

Nitha Kan Chou, William Braun, Venkata Budharaju, Charles Guastella, Mary Catherine Lincoln, Carolyn Tete, Duangduan Geeratisoontorn, Margaret Myers,

Regina Shears-McCloud St. Anthony's Hospital

Purpose/Background: The basal plus insulin (BPI) order set incorporates the correctional insulin scale with a long- or intermediate-acting insulin. The primary objective of this study is to analyze the mean daily capillary blood glucose (CBG) after initiation of BPI order set compared to that of sliding scale insulin (SSI) order set. This study also compares the number of hypoglycemic events from the two order sets.

Methodology: The BPI order set will replace the SSI order set when St. Anthony's Hospital transitions to Computerized Physician Order Entry on February 26, 2013. Analysis of the SSI order set will use data from January 1, 2012 to December 31, 2012. Analysis of BPI order set will use data from February 26, 2013 onwards. The analysis will include hospitalized patients aged 18-80 years old with CBG readings between 140 mg/dL and 500mg/dL, or type 2 diabetes. Exclusion criteria are as follow: diabetic ketoacidosis, type 1 diabetes, clinically relevant hepatic disease, serum creatinine greater than or equal to 3.0 mg/dL, hemodialysis, acute kidney injury, pancreatic disease, pregnancy, or use of glucocorticoids. The following data will be collected: age, gender, body mass index, hemoglobin A1C, dietary status, and CBG readings on admission and after the initiation of each order set.


Presentation Objective: Describe the effects of the BPI order set on inpatient glycemic control. Self Assessment: What is the difference in mean daily CBG between the BPI and SSI order sets?




EFFICACY AND SAFETY EVALUATION OF VARDENAFIL TO SILDENAFIL CITRATE CONVERSION

Michael O. Chaffman, Stacie R. Hamilton, Zoralys M. Santiago Orlando VA Medical Center

Purpose/Background: Background/Purpose: Levitra (vardenafil) was identified as a product having a less expensive therapeutic alternative; a therapeutic conversion to sildenafil was performed.

Methodology: Methodology: A detailed dispensing report has been generated to identify patients previously taking vardenafil 20mg that are now taking sildenafil; the report captured 205 patients converted during the period of evaluation. A retrospective chart review will focus on incidence of sildenafil dose escalation post-conversion and progress note documentation which reflects drug efficacy/patient treatment satisfaction.

Results/Conclusions: Results: Results pending at time of abstract submission. Conclusions: Conclusion pending at time of abstract submission.

Presentation Objective: Determine global patient level of treatment satisfaction following the switch from high-dose vardenafil to standard-dose sildenafil citrate within a large VA Medical Center. Self Assessment: Were most patients stable on the 50 mg dose of sildenafil?


IMPACT OF NEW STATIN LABEL CHANGES REGARDING LIVER FUNCTION TEST MONITORING ON PRESCRIBING HABITS IN THE VA

POPULATION Natasha Antonovich, Kimberly Schnacky Orlando VA Medical Center

Purpose/Background: In February 2012 the Food and Drug Administration made several label changes to all statins, one being the removal of routine liver enzyme monitoring. This recommendation was based on evidence found by the National Lipid Association’s Liver Expert Panel and Statin Safety Task Force which stated irreversible liver damage is extremely rare and likely idiosyncratic. Rather it was more likely to prompt unnecessary discontinuation of a statin, putting the patient at an increased cardiovascular risk. Observing the change in continuation, discontinuation, and nonformulary request rates of statins in the VA population provides the opportunity to evaluate the pharmacist’s role in implementing labeling updates.

Methodology: This study involves retrospective and prospective components before and after a prescriber education session. Retrospective data will come from a medication usage evaluation completed by this research team. Prospective data will be compiled from chart reviews of patients with increased transaminase levels on a statin. The education session, presented by the investigators, will cover all label changes made to statins since June 2011 including the removal of routine liver enzyme monitoring. Chart reviews will include examining changes in LFTs and continuation, discontinuation, and nonformulary statin request rates.


Presentation Objective: Describe the impact of the clinical pharmacist implementing changes to liver enzyme monitoring in patients taking statins. Self Assessment: What benefits will patients and health systems gain by implementing this monitoring change?


RETROSPECTIVE REVIEW OF MANAGEMENT OF MALE PATIENTS AT HIGH RISK FOR OSTEOPOROSIS

Kristen M. Johnson, Laura VanScoik Orlando VA Medical Center

Purpose/Background: Osteoporosis is a skeletal disease characterized by compromised bone strength, leading to an increased risk for fracture. Early diagnosis of osteoporosis is crucial in order to initiate therapies to slow or possibly reverse the progression of the disease. The Office of the Inspector General has selected osteoporosis as one of the chronic disease management movement’s targeted disease states for clinical pharmacist specialists to identify, monitor, and treat. Osteoporosis screening recommendations are established for men as young as 50 years old with certain high-risk factors for developing osteoporosis, such as chronic glucocorticoid therapy and the use of androgen deprivation therapy. The purpose of this study is to determine if male patients on these high risk medications are being appropriately assessed and managed according to current clinical guidelines.

Methodology: The study team performed a retrospective chart review of male patients at high risk for developing osteoporosis due to glucocorticoid or androgen deprivation therapy (ADT). The study evaluated approximately 195 patients, separated into two study arms based on medication class. Data collected included patient’s risk factors, current treatment for osteoporosis, laboratory tests done to assess risk, and documented fractures after initiation of glucocorticoid or ADT.


Presentation Objective: Discuss appropriate identification, screening and management of male patients at high-risk for osteoporosis. Self Assessment: Should a 51 year old male patient who has been on leuprolide therapy for 14 months be assessed for osteoporosis risk?


COMPARISON OF ADHERENCE RATES BETWEEN CONVENTIONAL AND ATYPICAL LONG-ACTING ANTIPSYCHOTIC INJECTABLE

MEDICATIONS Brian McKee and Jose Rey Nova Southeastern University College of Pharmacy

Purpose/Background: Treatment of acute psychosis and remission of schizophrenia has consistently been achieved through antipsychotic therapy. However, the rate of medication nonadherence in patients with schizophrenia has proven to be problematic, with estimated nonadherence rates as high as 40-50%. Ninety-one percent of patients with schizophrenia who stopped taking oral medications for one week continued to abstain from psychotherapeutic treatment until relapse. In addition, patients with schizophrenia who decompensate secondary to nonadherence take longer to stabilize and often require adjustments to previously successful medication regimens. Long-acting injectable (LAI) antipsychotic medications have decreased medication nonadherence. The primary purpose of this study is to assess whether adherence rates are different for conventional LAI antipsychotic medications (haloperidol decanoate and fluphenazine decanoate) compared to the atypical LAI antipsychotic medication risperidone. Differences in psychiatric rehospitalizations between the LAI groups will be assessed as a secondary objective.

Methodology: Data collection is from an electronic medical record system and includes patient demographics, recent prescription data, office visits for LAI administration and any psychiatric hospitalizations. Patients above 18 years of age, on LAI antipsychotic medications between July 1, 2012 and December 31, 2012 with a diagnosis of schizophrenia will be included. Adherence will be determined based on percentages of received LAI medications during the specified time period. A Wilcoxan Mann Whitney test will be used to detect statistical differences between mean adherence rates for the different LAI antipsychotic medications.

Results/Conclusions: Pending at the time of abstract submission.

Presentation Objective: Determine if there is a difference in adherence rates for conventional vs. atypical LAI antipsychotic medications. Self Assessment: Risperidone is classified into which type of antipsychotic: conventional or atypical?



COMPARING THE USE OF ANTIPSYCHOTIC TO NO ANTIPSYCHOTIC FOR BEHAVIORAL DISTURBANCES IN DEMENTIA FOR SHORT-TERM

INPATIENT OUTCOMES Ashley Hillman, Naomi House Wolfson Children's Hospital/Baptist Health System

Purpose/Background: There are currently no medications that are FDA approved to treat behavioral and psychiatric symptoms of dementia (BPSD). The benefit of antipsychotics hasn't been clearly established and there may be an increased risk of cerebrovascular events and death. Despite these possible harms, they are still often prescribed for this purpose. Outcomes for outpatients and nursing home patients have been measured but no studies have been published researching outcomes in inpatient populations. The purpose of this study was to determine if antipsychotics decrease the use of as needed medications for agitation without increasing length of stay, medications for extrapyramidal symptoms (EPS) or 30 day readmissions while in an inpatient behavioral health unit.

Methodology: Patients' charts were retrospectively reviewed if they were 65 years of age and older, and had a dementia related diagnosis or prescribed FDA indicated dementia medications. Demographics, scheduled antipsychotic use, as needed medications for anxiety or agitation or EPS, length of stay and 30 day readmissions rates to the psychiatric units were collected. Groups who received scheduled antipsychotics were compared to groups who did not receive scheduled antipsychotics.

Results/Conclusions: Results pending at time of abstract submission Conclusion pending at time of abstract submission.

Presentation Objective: Describe the benefits or harms of scheduled antipsychotics for patients who are hospitalized for BPSD. Self Assessment: What is one harm to giving antipsychotics for BPSD?


IDENTIFICATION OF OPIOID OVERUTILIZATION TRENDS IN A MEDICARE POPULATION

Pamela Tabor, David Mostellar, Regina Mears, Angel Wolf WellCare Health Plans

Purpose/Background: Opioid overutilization is a growing health concern which may result in increased hospitalization and/or death due to overdose. Multiple guidelines determine a morphine equivalent dose (MED) of 120 mg/day or greater, over 90 days, as a threshold for patients who may be at risk for side effects or inappropriate overuse of opioid medications. However, having a high MED alone is not a sole indicator of overutilization risk. The number of physicians prescribing opioid medications and the number of pharmacies dispensing opioid medications also help identify opioid overutilizers. The purpose of this review is to determine if the number of opioid prescribing physicians or the number of opioid dispensing pharmacies led to a higher average MED. This review will also determine trends based on the type of physician specialty and classification of medications being prescribed.

Methodology: Medicare members enrolled within an MAPD (Medicare Advantage Prescription Drug plan) or PDP (Medicare Prescription Drug plan) who have a MED of 120 mg/day or greater for 90 consecutive days ending in October, November, or December 2012 will be included in this retrospective review. Medications meeting criteria as opioids are pulled from the CONSORT classification of opioid medications. Physician specialty will be retrieved from the National Provider Identifier (NPI) registry provided by the Center for Medicare and Medicaid Services (CMS) website. Pharmacy claims data utilized for this review includes prescription medication information, prescriber NPI, and dispensing pharmacy information.


Presentation Objective: Identify trends based on a Medicare population to improve identification of opioid overutilization. Self Assessment: What indicators are being utilized to identify members who are potential opioid overutilizers? a)Total morphine equivalent dose b)Number of prescribers c)Number of pharmacies d)All of the above


CONFERENCE

Session IV

May 10, 2013

2:00-3:00pm



Time: 2:00 - 2:20 Room: G301 Category: ONC

ASSESSMENT OF THE USE OF COLONY-STIMULATING FACTORS FOLLOWING INDUCTION CHEMOTHERAPY FOR NEWLY DIAGNOSED

ACUTE MYELOGENOUS LEUKEMIA Andrea Velandia, Melissa Butler, Rebecca Anderson, Jose Sarriera Orlando Health

Purpose/Background: Due to theoretical concerns for stimulation of leukemia cells, the routine use of colony-stimulating factors (CSF) following induction chemotherapy for newly diagnosed acute myelogenous leukemia (AML) is an area of controversy. Data is conflicting regarding effect on duration of neutropenia, use of antimicrobial therapy, and hospital length of stay (LOS) following early initiation of CSF. The purpose of this study is to evaluate time to neutrophil recovery following induction chemotherapy, effect of CSF on hospital LOS, number of anti-infective agents initiated and duration of therapy required, and impact of CSF use on day 14 bone marrow biopsy(BMBx) results.

Methodology: This is a retrospective review of newly diagnosed AML patients ≥ 18 years of age, who received induction chemotherapy with an anthracycline agent and cytarabine between October 2002 and October 2012. Based on common strategies for CSF use, patients will be divided into three groups: receiving CSF within 24-72 hours after completing induction, receiving CSF after a negative day 14 BMBx, and not receiving a CSF. Outcomes to be evaluated per treatment group include time to neutrophil recovery, LOS, incidence of febrile neutropenia, requirements for anti-infective therapy, impact on day 14 BMBx results, and cost of CSF compared to LOS.


Presentation Objective: Describe the influence of CSF on newly diagnosed AML patients undergoing induction chemotherapy. Self Assessment: Describe three common strategies for using CSF in AML patients upon completion of induction chemotherapy. a. Administer CSF after a negative day 14 BMBx b. No CSF utilization c. Administer CSF within 24-72 hours after completing induction

Time: 2:20 - 2: 40 Room: G301 Category: ONC

IMPACT OF PHARMACIST INTERVENTION IN THE MANAGEMENT OF BREAKTHROUGH CHEMOTHERAPY-INDUCED NAUSEA AND

VOMITING IN AN OUTPATIENT INFUSION CENTER Chungeun J. Lee, Saba Kareem, Kim Perez, Jennifer Showalter St. Jospeh's Hospital

Purpose/Background: Chemotherapy-induced nausea and vomiting (CINV) is recognized as one of the most distressing side effects of chemotherapy treatment. Studies have shown that a considerable number of patients receiving chemotherapy with optimal premedication continue to report breakthrough nausea and vomiting. This study will evaluate the impact of pharmacist intervention utilizing the developed survey and treatment algorithm in the management of breakthrough CINV.

Methodology: Adult patients of at least 18 years of age receiving moderately to highly emetogenic chemotherapy will be enrolled in this Institutional Review Board-approved prospective study in an outpatient infusion center. A validated survey and an antiemetic treatment algorithm developed from current practice guidelines will be utilized for evaluation. During the scheduled chemotherapy visit, patients will be provided with an informed consent form and survey, which will be completed post chemotherapy. The treatment algorithm will provide guidance to obtain appropriate pharmacological recommendations based on patient's responses to survey questions. The patients will follow the recommended treatment plan and complete a second survey to bring in at the next encounter. Data will be collected and outcomes will be evaluated in terms of the percent improvement of CINV after a pharmacist's intervention.


Presentation Objective: Describe the effect of a pharmacist intervention on breakthrough CINV to help improve patient care and quality of life. Self Assessment: Which antiemetic agent was recommended most often to prevent CINV for patients on a moderately emetogenic chemotherapy regimen?


EFFECT OF CAPPING SINGLE DOSE IV ONDANSETRON AT 16 MG FROM 32 MG IN MODERATE AND HIGHLY EMETOGENIC

CHEMOTHERAPY REGIMENS Brandon Wilds, Robin Bettman, Erica Stetz, Thomas Davis St. Vincent's Medical

Center

Purpose/Background: In June 2012, the 32 mg IV dose of ondansetron was removed from the prescribing information due to dose-related QT prolongation. This was due to the findings of a randomized, double-blind, four-period crossover study assessing the prolongation of the QTc interval in 58 patients receiving a single dose IV ondansetron of 8 mg or 32 mg. At St. Vincent's Medical Center - Riverside, the standard of care for moderate and highly emetogenic chemotherapy includes the use of the 5-HT3 antagonist ondansetron for pre-chemotherapy anti-nausea prophylaxis. It is hypothesized that the lower dose could impact patient care as more patients could potentially experience chemotherapy induced nausea and vomiting.

Methodology: A retrospective chart review of patients who received a moderate or highly emetogenic chemotherapy regimen and a single IV dose of either 16mg or 32mg of ondansetron from August 31, 2011 to March 31, 2013 will be conducted. The number of breakthrough anti-nausea medications, as defined by the National Comprehensive Cancer Network, used post-chemotherapy will be quantified to determine if there is a significant difference between treatment groups.


Presentation Objective: Explain the rationale for lowering the maximum single IV dose of ondansetron from 32mg to 16mg. Self Assessment: Which adverse effect caused by ondansetron led to the removal of the 32mg IV dose from the prescribing information?


FACILITATING THE USE OF COMMUNITY HOSPITAL PHARMACISTS IN THE IMPLEMENTATION OF A MEDICATION THERAPY

MANAGEMENT PROGRAM FOR EMPLOYEES OF A SELF-INSURED ORGANIZATION

Donald L. Sullivan, William Terneus Jr Indian River Medical Center

Purpose/Background: Medication therapy management services are dependent upon collaboration of healthcare professionals to optimize medication use in accordance with evidence-based practices. This service is a collaboration among a multidisciplinary team that strives to improve the quality of care and reduce overall cost to patients. These services can result in improved patient outcomes, reduce adverse drug events, improved mediation adherence, and reduce hospital admissions. Indian River Medical Center is a community hospital that is a self-insured institution that provides benefits for their employees and their dependent(s). The average annual cost in prescription medication makes up a significant component of the total health portfolio. The purpose of this program is to aid in relieving expenditures to the hospital and employees.

Methodology: This pilot project is a retrospective study of the pattern of medication prescribed for employees of Indian River Medical Center and their dependents. Data will be reviewed retrospectively under an IRB approved protocol. Phase I will review the overall medications utilized by physicians and the conformation to the health plan’s formulary. Phase II will review the patterns of medication use for individual patients and the potential for interventions due to less than optimal drug choice, drug interactions, potential for reduced clearance in compromised patients and cost.

Results/Conclusions: Results pending at time of abstract submission Results pending at time of abstract submission

Presentation Objective: Describe the role of a clinical pharmacist in improving patient outcomes through medication therapy management? Self Assessment: What was the most common error identified in this study that pharmacist can improve upon?



Time: 2:20 - 2: 40 Room: G103 Category: ADM

IMPLEMENTATION OF THE ASHP PHARMACY PRACTICE MODEL AT THE MIAMI VA HOSPITAL

Joy Awoniyi and Vivian Rios Miami VA Healthcare System

Purpose/Background: ASHP has identified five goals and measures for the implementation of the Pharmacy Practice Model throughout the nation. The goals and measures are that (1) pharmacist roles, practices and activities will improve medication use and optimize medication related outcomes, (2) pharmacy technicians will prepare and distribute medications and perform other functions that do not require a pharmacist’s professional judgment, (3) pharmacists and pharmacy technicians will have appropriate training and credentials for the activities performed within their scope of practice, (4) pharmacy departments utilize available automation and technology to improve patient safety and improve efficacy and (5) pharmacists will demonstrate leadership in exercising their responsibility for medication use systems and will be accountable for medication related patient outcomes. The objective of this project is to evaluate the Miami VA Healthcare System’s utilization of the pharmacy practice model as identified by these goals and measures.

Methodology: The ASHP Hospital Self-assessment worksheet will be completed by the pharmacy supervisory staff. The ASHP Hospital assessment tool will be used to evaluate the completed worksheets to determine the current status of the pharmacy and identify areas of deficiency. The deficient areas will be discussed with the director of pharmacy and ideas for improvement will be suggested.


Presentation Objective: Review and incorporate the five goals of the pharmacy practice model initiative into the Miami Veterans Affairs Healthcare System pharmacy. Self Assessment: Which of the five goals of the pharmacy practice model initiative as identified by ASHP was reported as the least implemented in the 2012 national survey?


DEVELOPMENT AND IMPLEMENTATION OF A LONGITUDINAL STUDENT LEARNING EXPERIENCE FACILITATED BY PHARMACY

RESIDENTS Kristyn Mulqueen, Laura Smoot, Denise Waddell North Florida/South Georgia

Veterans Health System

Purpose/Background: The Malcom Randall Veterans Affairs Medical Center (VAMC) in Gainesville, Florida serves as a clinical rotation site for many pharmacy students in their final professional year. Eighteen clinical pharmacists at the Malcom Randall VAMC serve as preceptors for Advanced Practice Pharmacy Experience (APPE) rotations, representing diverse fields of clinical pharmacy practice including ambulatory care, geriatrics, adult medicine, cardiology, hospice, oncology and surgery. Students rotating through the facility gain invaluable practical experience; however, didactic and interactive teaching components are often missing from these rotations, mainly because preceptors have difficulties finding time for such activities. Implementing weekly educational discussions facilitated by pharmacy residents would serve a dual purpose: to enhance the clinical learning of pharmacy students while simultaneously providing a venue for pharmacy residents to practice their teaching skills.

Methodology: Preceptors were given the opportunity to have their rotation students participate in the weekly “Student Education Clinic.” Participating preceptors added an insert to their syllabi which clarified the goals and expectations of the weekly student meetings. The resident coordinator arranged a topic schedule and coordinated communication between resident facilitators, students and preceptors regarding weekly assignments and feedback. Meeting facilitators were encouraged to provide pre-work assignments or reading materials to help the students prepare for the discussion.


Presentation Objective: Describe how the implementation of the Student Education Clinic benefited both pharmacy students and residents at the Malcom Randall Veterans Affairs Medical Center. Self Assessment: What types of “meeting themes” were utilized for Student Education Clinic? A) Topic Discussions B) Patient Case Presentations C) Student Mini-Lectures D) Landmark Trial Series E) All of the above


PERCENTAGE OF PAIN E-CONSULTS THAT RESULTED IN A THERAPY CHANGE

Danielle M. Gingras and Tracy L. Harvey Bay Pines VA Health Care System

Purpose/Background: The purpose of this evaluation is to evaluate the characteristics of recommendations made by a pharmacist through pain e-consults at Bay Pines VA Healthcare System (BPVAHCS), and the percentage (%) of consults which resulted in a change in therapy. Positive findings with pain e-consults will help in demonstrating the utility of pharmacists as providing services for managing chronic pain, as well as, measuring improved adherence to VA/DoD guidelines for chronic non-malignant pain.

Methodology: A retrospective chart review will be conducted at BPVAHCS to determine the % of patients whose pain regimen changed as a result of a pain e-consult completed by a pharmacist. The characteristics of those recommendations and their acceptance/rejection rate will then be categorized. Patients who had a pain e-consult between January 1, 2012 and March 31, 2012 will be identified for inclusion in the study. Criteria for exclusion include patients who received an e-consult but died before September 30, 2012. Included patient's charts will be reviewed for 6 months after completion of the consult in order to allow sufficient time for potential implementation of recommendations. Patient demographics, name and dose of pain medications, requesting practitioner, type of chronic pain, recommendation of pain e-consult, and consult outcome(s) will be recorded for all participants.


Presentation Objective: Explain the impact of pharmacist recommendations on pain management via the e-consult program. Self Assessment: What is the purpose of a pharmacist pain e-consult program?

Time: 2:20 - 2: 40 Room: G114 Category: MED

PHARMACISTS' RESPONSE TO DRUG-DRUG INTERACTION ALERTS: IMPACT ON ALERT FATIGUE AS A RESULT OF REDUCING NON-

CLINICALLY SIGNIFICANT INTERACTION WARNINGS Elizabeth Santiago, Brent Zussy, Dusko Klipa St. Vincent's Medical Center

Purpose/Background: Alert fatigue is experienced by clinical practitioners during the order entry process when an abundance of alerts are triggered that are not actionable. Alert fatigue has led to a concern of clinically significant alerts being ignored, thereby increasing adverse events. The purpose of this study is to reduce the number of non-actionable drug-drug interaction alerts viewed during the order entry process by re-categorization of severity levels, thereby decreasing alert fatigue and increasing safety.

Methodology: A retrospective review of drug-drug interaction alerts that were viewed during the pharmacists' order entry process before filtration, November 3rd 2012 through December 3rd 2012, and after filtration, January 4th 2013 through February 3rd 2013, was conducted. Re-categorization of the non-clinically significant drug-drug interactions, assessed by an expert panel, was performed in December 2012. Numerical data was analyzed to determine if there was a statistically significant difference in responses before and after re-categorization of the non-clinically significant drug-drug interaction alerts. In addition, the number of errors related to clinically significant drug-drug interaction alerts were reviewed to ensure there was not a significant increase secondary to re-categorization.


Presentation Objective: Discuss the impact re-categorization of non-actionable drug-drug interaction alerts viewed during the order entry process has on alert fatigue and patient safety. Self Assessment: What are the potential benefits of reducing the number of non-clinically significant drug-drug interaction alerts?




OUTCOMES OF PHARMACIST-PROVIDED DISCHARGE MEDICATION COUNSELING FOR PATIENTS WITH CONGESTIVE HEART FAILURE Sylvia Stoffella, William Terneus Jr., Kelly Kasten, Donald Sullivan Indian River

Medical Center

Purpose/Background: New expectations by Medicare include payment reductions based upon readmission rates and patient satisfaction scores, thus increasing the need to better educate patients prior to discharge. The primary objective is to evaluate pharmacy-provided discharge medication counseling in improving disease state and medication knowledge for patients with a primary diagnosis ofcongestive heart failure (CHF). Also, the investigator will assess how improving patient education through pharmacy-provided discharge medication counseling services will affect 30-day post-discharge readmission rates and the number of emergency department visits for our study population.

Methodology: Pharmacists will provide discharge medication counseling to patients with a primary diagnosis of CHF. Patients will be identified at admission and their knowledge of currently prescribed CHF medications will be assessed utilizing an admission medication assessment form. Afterwards, pharmacists or student pharmacists will educate the patient and assess the patient prior to discharge with a discharge medication assessment form. A scoring rubric will be used for both the admission and discharge medication assessment questions to determine if there was an improvement in heart failure medication knowledge through pharmacy-based medication counseling. This scoring rubric will evaluate medication specific learning and any deficits in medication knowledge that were corrected. HCAHPS Insight Press Ganey® scores will be evaluated to determine patient satisfaction. These scores are not patient specific, but only unit specific for the hospital. Patient demographics that will be collected include age, sex, previous or new diagnosis of CHF, ejection fraction (%), comorbid conditions, time during admission and discharge, medications, and the incidence of readmission rates and the number of emergency department visits within a 30-day post-discharge. Data will be reviewed retrospectively under an Institutional Review Board approved protocol.


Presentation Objective: Evaluate the role of pharmacy services providing disease state and medication education to patients admitted with a primary diagnosis of congestive heart failure Self Assessment: What are the most common resources patients utilize to answer their medication questions?


DEVELOPMENT AND ASSESSMENT OF A CHEMOTHERAPY PREPARATION CHECKLIST USING SIMULATIONS

Kristy Nguyen, Lisa Hymel, Sandra Prenosil, Pam Lewis Sarasota Memorial Hospital

Purpose/Background: The process of reviewing and preparing chemotherapy medications involves a complex and multi-step process that has the potential for serious or fatal consequences if not done correctly. At our institution, chemotherapy orders prepared are independently verified by a second pharmacist. The use of a tool such as a checklist has the potential to improve the process of verifying chemotherapy orders. The objective of this study is to assess whether the implementation of a chemotherapy checklist can decrease chemotherapy errors during simulation testing.

Methodology: This prospective, randomized, simulation-model pilot study was conducted at a large community hospital. A chemotherapy preparation checklist was developed to guide the pharmacists through the details of chemotherapy order review and preparation. In addition, our existing chemotherapy drug reference sheets were updated to include critical information as a guide for clinical considerations. Pharmacists participating in the simulation will be randomized to one of two groups: one using the chemotherapy checklist and chemotherapy updated drug reference sheets and the other using only the existing chemotherapy drug reference sheets. The simulation will consist of 20 cases, of which 18 have built-in errors and 2 will serve as controls. The reliability and validity of the chemotherapy checklist will be assessed based on simulation results.


Presentation Objective: Describe the rationale for using a checklist in chemotherapy preparation. Self Assessment: What are the key components of a chemotherapy checklist to guide the user?

Time: 2:20 - 2: 40 Room: G112 Category: ADM

EVALUATION OF PHARMACY WORK-FLOW EFFICIENCY FOR PATIENT RECEIVING CLOPIDOGREL

Lashawn S. Morton, Teresa Plotts, Wisener Young Orlando VA Medical Center

Purpose/Background: Clopidogrel is an antiplatelet agent indicated for specific patient populations with variable durations of therapies. Currently, clopidogrel is a restricted agent at the Orlando VA Medical Center and is approved or denied by pharmacy based upon defined criteria. Through the review of patient charts and completed restricted consults, the assessment and evaluation of the restricted-consult process will be the focal point of the project. Once the components of the process are identified, possible improvements in workflow for approval and monitoring of patients prescribed clopidogrel may be elucidated. This project will evaluate the current process and identify methods which can maximize pharmacy productivity.

Methodology: A drug utilization report was generated for clopidogrel prescriptions issued between April 1st, 2012 until April 30th, 2012. A random sample of approximately 80 patients were selected for inclusion in the medication use evaluation. Information collected included the status of consult placed, pharmacy completion time of consult, duration of therapy, baseline monitoring and follow-up monitoring.


Presentation Objective: Determine most efficient pharmacy work-flow for approval or denial of clopidogrel in regards to its status as a restricted medication. Self Assessment: Question: What was the most common process failure identified in this study? Answer: Pending results


IMPACT OF A CLINICAL PHARMACIST INPATIENT MEDICATION COUNSELING PROGRAM ON HCAHPS SCORES

Christina Lee, Timothy L'Hommedieu, Michael Everett St. Jospeh's Hospital

Purpose/Background: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized surveying instrument which measures patient perception of their hospital experience. The Centers for Medicare and Medicaid Services utilize HCAHPS scores as one of the metrics to determine financial reimbursement to hospitals. To improve HCAHPS scores in the communication about medications domain, the Department of Pharmacy at St. Joseph’s Hospital implemented a clinical pharmacist inpatient medication counseling program. The purpose of this study is to evaluate the impact of this program on HCAHPS scores in the communication about medications domain at St. Joseph’s Hospital.

Methodology: This study is a single-center, IRB-approved, retrospective study conducted at St. Joseph’s Hospital. One-on-one medication counseling will be provided to all patients who meet HCAHPS eligibility criteria and are admitted to any of three specified inpatient units within the hospital. The primary outcome of this study is to determine the impact of clinical pharmacist inpatient medication counseling on HCAHPS scores. This will be accomplished by comparing the hospital's post-intervention HCAHPS scores for the communication about medications domain to baseline scores prior to the program.


Presentation Objective: Describe the utility of a clinical pharmacist inpatient medication counseling program on HCAHPS scores. Self Assessment: What is the significance of HCAHPS scores meeting the national 50th percentile?


ABSTRACT REPRODUCTION FORM


IMPACT OF PHARMACISTS AND AN ID PHYSICIAN-DRIVEN ANTIMICROBIAL STEWARDSHIP PROGRAM IN A 395-BED, ACUTE

CARE, COMMUNITY HOSPITAL Wonhee So, Clinton Holder, William Braun,Charles Guastella, Angela Marquardt St.

Anthony's Hospital

Purpose/Background: An antimicrobial stewardship program (ASP) intends to achieve the most optimal clinical and economical outcomes with minimal adverse consequences of antimicrobial use. The primary objective of this study is to compare the magnitude of ASP at St. Anthony's Hospital (SAH) before and after July 9, 2012 with the addition of an infectious disease (ID) physician to the ASP team by looking at the number of interventions. The secondary objective is to evaluate the economical and clinical impact of the ASP.

Methodology: All hospitalized patients on whom antimicrobial therapy-related interventions were recorded by pharmacists during 2012 will be included. For pre-analysis of ASP without an ID physician on the team, data from January 1, 2012 to July 7, 2012 will be used. For post-analysis of ASP with an ID physician on the ASP team, data from July 9, 2012 to December 31, 2012 will be used. The following data will be collected: patient demographics, number of interventions, types of interventions, acceptance rates of interventions, and the rates of ID consults. In addition, cost for all antimicrobials purchased, duration of antimicrobial therapy, resistance rates, and the rates of Clostridium difficile will be collected.


Presentation Objective: Describe the main changes in ASP before and after the addition of an ID physician to the ASP team. Self Assessment: What is the percentage of the interventions that were made to cases with ID consults in this study?

Time: 2:20 - 2: 40 Room: G312 Category: ID

EVALUATING THE RISK OF BILIARY COMPLICATIONS IN HOME CARE PATIENTS RECEIVING INTRAVENOUS PUSH CEFTRIAXONE

Andrew Zaki Coram Specialty Infusion

Purpose/Background: Safety, simplicity of administration, and cost efficiency have always been important factors in drug therapy decision making. Because of these considerations, the use of intravenous push (IVP) antibiotics in the home care setting continues to be popular. At the same time, there is a desire to have more safety data on IVP ceftriaxone in home care patients. Some evidence suggests that ceftriaxone may lead to biliary complications such as increased bile viscosity (â€œbiliary sludgeâ € ) that may or may not lead to gallstones and/or acute pancreatitis. The purpose of this study is to add to the overall safety data of IVP ceftriaxone.

Methodology: A retrospective cohort study using 30 patient charts of Coram home care patients receiving intravenous push ceftriaxone will be conducted to assess for any statistically significant increases in amylase, lipase, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) in these patients. The study will analyze the adverse effects of biliary sludge resulting from the use of ceftriaxone, with respect to patient age and length of therapy.


Presentation Objective: Provide the reader with correlative data for the risk of biliary sludge when administering ceftriaxone by intravenous push. Self Assessment: Biliary sludge can eventually lead to what other manifestations?


IMPACT OF MDR GRAM POSITIVE DE-ESCALATION ON FREQUENCY OF APPROPRIATE ANTIBIOTIC UTILIZATION IN CRITICALLY ILL PATIENTS WITH MRSA NEGATIVE BRONCHOALVEOLAR LAVAGE,

BLOOD AND SURVEILLANCE CULTURE RESULTS Sloka Manvi, Christopher Jankowski, Mark Schreiber, Donald Johnson Shands


Purpose/Background: Bronchoalveolar lavage (BAL) has been demonstrated to be an accurate diagnostic technique for identifying ventilator associated pneumonia (VAP) bacteriology. Current recommendations endorse de-escalating initial antibiotic therapy based on results of lower respiratory tract cultures. Recent studies have postulated that active surveillance cultures (ASC) for MRSA have a high negative predictive value for MRSA colonization, which may predict patients with a high risk of MRSA VAP. Despite this objective evidence, physicians may be reluctant to discontinue empiric MRSA antimicrobial coverage (vancomycin/linezolid) for suspected VAP. The purpose of this study is to determine if early de-escalation of MDR Gram-positive therapy based on microbiological (BAL/ETA, blood cultures) and rapid molecular testing (MRSA ASC), leads to a reduction in the number of unnecessary antibiotic treatment days of vancomycin/linezolid in patients with clinical suspicion of VAP.

Methodology: This study is a pre/post education initiative analysis of early de-escalation of empiric MRSA antimicrobial therapy based on ASC and culture results. An observational retrospective chart review will be used to evaluate patients with clinically suspected VAP, MRSA negative surveillance cultures, negative BAL, and blood culture results. Appropriate antibiotic utilization will be evaluated by comparing the number of hours to vancomycin/linezolid discontinuation from initiation, in each study period. Secondary endpoints include hospital/ICU mortality and length of stay, duration of mechanical ventilation, subsequent occurrence of VAP, number of pharmacist interventions, and finally cost associated with the use of MRSA antimicrobial therapy.


Presentation Objective: Describe the role of education regarding early MDR gram positive de-escalation in the prevention of unnecessary antibiotic exposure in patients with clinically suspected VAP. Self Assessment: What is the utility of performing ASC for MRSA colonization?


CONFERENCE

Session IV, cont.

May 10, 2013

3:10-4:10pm




RETROSPECTIVE REVIEW OF CARBOPLATIN DOSING IN A COMMUNITY HOSPITAL

Moe Shwin, Anay Moscu, Radhan Gopalani Baptist Hospital of Miami

Purpose/Background: At present, there are no clear guidelines whether actual body weight (ABW), ideal body weight (IBW), or adjusted body weight (AdjBW) should be utilized in the Cockcroft-Gault (C-G) equation for carboplatin dose calculation in obese patients. The goal of this study is to determine an optimal weight descriptor for estimating glomerular filtration rate (GFR) to be utilized in carboplatin dose calculation via Calvert formula in obese patients.

Methodology: This is an IRB approved retrospective chart review. All patients ≥18 years of age who received at least one dose of carboplatin as monotherapy or as a part of combination chemotherapy regimen for solid tumor malignancies between June 2011 and July 2012 will be stratified into control (Normal body weight patients) or study (Obese patients) group. Carboplatin dose will be calculated using different weight descriptors in obese patients. The calculated carboplatin dose will be compared with the actual carboplatin dose administered to determine the difference in carboplatin dose in obese patients. To determine the difference in incidence of carboplatin dose limiting toxicities between control and study group, pre and post treatment platelet count, electrolytes level and serum creatinine will be collected and compared.


Presentation Objective: Demonstrate a difference in incidence of carboplatin associated toxicities between normal weight patients and obese patients. Self Assessment: What is the major dose limiting toxicity of carboplatin?


INCIDENCE OF SKELETAL-RELATED EVENTS IN PATIENTS WITH SOLID TUMORS RECEIVING ZOLEDRONIC ACID OR DENOSUMAB

FOR TREATMENT OF METASTATIC BONE DISEASE Leigh Anna Soler, Jessica Peterson, Nancy Elkhoury, Leah Ward Mayo Clinic

Florida

Purpose/Background: Metastatic bone disease is a common, clinically important complication of many types of solid tumors. Complications include pathologic fracture, spinal cord compression, and radiation or surgery to the bone. Collectively, these are referred to as skeletal-related events. Zoledronic acid and denosumab are two medications used to prevent skeletal-related events. Current practice guidelines do not recommend one agent over another. The aim of this investigation is to analyze rates of skeletal-related events at the study institution in patients receiving zoledronic acid or denosumab. Data will be used to determine if either agent should be selected as a preferred first line agent for prevention of skeletal-related events.

Methodology: Data will be collected from the electronic medical record of each patient. Patients with solid tumors with evidence of one or more bone metastases, age > 18 years, and an Eastern Cooperative Oncology Group performance status of 0, 1, or 2 will be included. Patients will be excluded for inadequate renal function or previous bisphosphonate use. The primary endpoint is the number of skeletal-related events. Secondary endpoints include rates of hypocalcemia, diagnosis of osteonecrosis of the jaw, and renal deterioration.


Presentation Objective: Describe the role of zoledronic acid and denosumab in preventing skeletal-related events. Self Assessment: On average, how often do patients with metastatic bone disease experience a skeletal-related event?


INCIDENCE OF NAUSEA AND VOMITING IN OBESE PATIENTS RECEIVING MODERATELY EMETOGENIC CHEMOTHERAPY

Jamie Lee, Georgia Keriazes, Angela Pearson Lakeland Regional Medical Center

Purpose/Background: The American Society of Clinical Oncology has released guidelines that recommend using actual body weight rather than an adjusted body weight when dosing chemotherapy in obese patients, especially when the goal is cure. Practice patterns demonstrate that up to 40% of obese patients receive limited chemotherapy doses that are not based on actual body weight, due to concerns for overdosing. There have been a number of studies evaluating toxicities, such as myelosuppression in obese patients receiving chemotherapy, but there is lack of significant data describing the incidence of chemotherapy induced nausea and vomiting in this population. Nausea and vomiting is known to be a dose dependent toxicity. This study will describe the baseline characteristics for obese patients receiving moderately emetogenic chemotherapy. The incidence of chemotherapy induced nausea and vomiting will be reported for obese patients receiving chemotherapy doses based on actual body weight versus an adjusted body weight.

Methodology: A retrospective chart review of obese patients receiving at least one dose of moderately emetogenic chemotherapy was conducted. Information collected included: age, gender, height, weight, BMI, BSA, creatinine, bilirubin, chemotherapy, dose, cancer type, predisposing factors contributing to nausea and vomiting, antiemetic and breakthrough medications.


Presentation Objective: Describe baseline characteristics, dosing weight strategies, and incidence of nausea and vomiting in obese patients receiving moderately emetogenic chemotherapy. Self Assessment: Does dosing weight strategy affect the incidence of chemotherapy induced nausea and vomiting in obese oncology patients receiving moderately emetogenic chemotherapy?


MEDS TO BEDS: PILOTING A PHARMACY INITIATED DISCHARGE PRESCRIPTION CONCIERGE SERVICE

Emily Dutton, Minh-Tri Duong, Maja Gift, Kimberly Cohen-Pelosi, Ramon Docobo, Leann Koontz, Angela Logan Tampa General Hospital

Purpose/Background: There is limited data evaluating the impact of a discharge prescription delivery service to the patient bedside. The purpose of this project is to evaluate the impact, feasibility, and possible barriers to implementing a pharmacy-run discharge medication concierge service.

Methodology: This 30-day quality improvement initiative included patients over 18 years of age admitted to the Adult Cardiology unit. Patients were offered a discharge delivery service and had discharge medications delivered if they chose to participate. Changes in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores and outpatient pharmacy revenue are being measured to evaluate impact. Service workflow measures, including time requirements, patient logistics, and resource barriers, are being evaluated for house wide implementation.

Results/Conclusions: Of 154 patients admitted to the pilot unit, 87% (n=134) were offered the service with 59% (n=79) electing to have discharge prescriptions delivered. Of those selecting the service, approximately half (n=46, 58%) had new medications prescribed. Deliveries were made to 72% (n=33) of those with discharge prescriptions. Outpatient pharmacy data shows a 10% increase in outpatient pharmacy utilization from the pilot unit. HCAHPS score analysis and further outpatient pharmacy data is pending. Review of data, thus far, shows that there is significant interest in a discharge prescription delivery service. The impact on HCAHPS scores and outpatient pharmacy profits are being evaluated.

Presentation Objective: Describe the impact, feasibility, and barriers to implementing a pharmacy-run discharge medication concierge service. Self Assessment: What are the potential benefits and barriers of a discharge prescription delivery service?




ADHERENCE TO TIMING, SELECTION, AND DURATION OF PROPHYLACTIC ANTIMICROBIAL AGENTS IN SURGICAL PATIENTS:

A PROCESS IMPROVEMENT PROJECT FOR BAYFRONT MEDICAL CENTER

Bao Tran Jackie Decrosta Anthony Spann Jennifer Miles Jeff Bush Bayfront Medical Center

Purpose/Background: The Surgical Care Improvement Project (SCIP) is sponsored by the Centers for Medicare & Medicaid Services (CMS) in collaboration with numerous national partners. The project focuses on the timing, selection, and duration of treatment with prophylactic antimicrobial agents, as well as additional measures surrounding patient safety and care during surgical procedures. Starting fiscal year 2013, hospital performance on seven of the SCIP measures will determine reimbursement rates from Medicare.

Methodology: Bayfront Medical Center pharmacy residents will retrospectively review 250 surgeries from August to October 2012 to assess antibiotic fallout rates at baseline. Patients are eligible for inclusion if 18 years or older. Pregnant patients will be excluded. Starting March 1, 2013, the residents will implement processes to decrease fallouts. The process improvement will include: 1) determine if procedures meet SCIP guideline criteria; 2) determine if scheduled prophylactic antibiotics are appropriate; 3) in-service pharmacists regarding appropriate scheduling of antibiotics; 4) designate “OnCall” antibiotic container for all antibiotics not stocked on floor McKessons; and 5) in-service pharmacy staff on new processes for “OnCall” antibiotic labels. Post implementation, 250 surgeries from March to May 2013 will be compared to baseline to assess antibiotic fallout rates. The primary outcome of the study is to ensure 100% compliance to the SCIP guidelines, focusing specifically on the timing, selection, and duration of prophylactic antibiotic agents.


Presentation Objective: Understand SCIP guidelines, identify compliance issues associated with SCIP , be able to develop new processes to improve SCIP compliance and be able to measure efficacy of the new process Self Assessment: What was the biggest challange during this process improvement project?


THE IMPACT OF PHARMACIST DRIVEN E-FORCSE EDUCATION ON PHYSICIAN CONTROLLED SUBSTANCE PRESCRIBING PRACTICES Jocelyn Congdon, Joseph Cammilleri, Natohya Mallory, Alan Halperin, Patrick

Aaronson Shands Jacksonville Medical Center

Purpose/Background: Prescription drug abuse continues to be a problem in the United States. Controlled substances have become increasingly popular and the epidemic of nonmedical use of these medications is on the rise. In order to combat this epidemic, statewide Prescription Drug Monitoring Programs (PDMP) have been developed and are fully operational in forty-two states. These programs allow prescribers, pharmacists, and select law enforcement personnel to track prescriptions dispensed for controlled substances. The PDMP in Florida, Electronic-Florida Online Reporting of Controlled Substances Evaluation Program (E-FORCSE) allows the tracking of schedule II, III, and IV medications. Although all controlled substances dispensed in the state of Florida are required to be reported to E-FORCSE, it is not mandatory for this information to be viewed prior to prescribing controlled substances. Since it is not mandatory to review E-FORCSE reports, the benefits of this program have yet to be fully determined. It is hypothesized that increased awareness and education about the benefits of E-FORCSE will decrease unnecessary controlled substance prescribing.

Methodology: Shands Jacksonville internal medicine residents’ controlled substance prescribing rates will be evaluated before and after clinical pharmacist intervention. The intervention provided will entail generation and analysis of E-FORCSE reports for patients seen by the internal medicine residents. Change in controlled substance prescribing rates will be evaluated for twenty six medical residents by looking at three month time periods exactly one year apart. Additionally, confidence in controlled substance prescribing will be evaluated with the use of a survey administered at the conclusion of the study.


Presentation Objective: Evaluate the effect of pharmacist driven E-FORCSE education on controlled substance prescribing rates and practices. Self Assessment: What is the purpose of E-FORCSE?


IMPACT OF PHARMACY TECHNICIAN ASSISTED MEDICATION RECONCILIATION IN THE EMERGENCY DEPARTMENT

Roma Merrick, Christina Gifford, Megan Keese, Elizabeth Santiago, Lauren Stafford St. Vincent's Medical Center

Purpose/Background: Obtaining an accurate and complete medication history is an integral part of The Joint Commission's mandated medication reconciliation process. Staffing a medication reconciliation pharmacy technician in the emergency department may increase patient safety. Pharmacy technicians might obtain a more complete and accurate medication history; thereby preventing a greater number of medication-related adverse drug events (ADEs). The purpose of this study is to determine the impact a medication reconciliation pharmacy technician may have on preventing adverse drug events in patients admitted through the emergency department.

Methodology: A retrospective chart review of patients admitted through the emergency department was conducted. Patients were excluded from this study if they reported taking no home medications or if they were not interviewed by a certified pharmacy technician during hospitalization. The primary endpoint was number of discrepancies related to admission medication histories. The discrepancies were considered markers of potential ADEs, as any deviation could potentially result in an ADE. Secondary endpoints included classification of drug associated with each discrepancy and time from admission to time of intervention by the pharmacy technician. Lastly, cost of avoidance was calculated using a reconciliation tracking tool.


Presentation Objective: Discuss the impact a pharmacy technician may have on medication reconciliation in the emergency department Self Assessment: True or False: In this study, a medication reconciliation pharmacy technician in the emergency department was shown to reduce number of discrepancies found in medication histories, versus those obtained by nurse or physician.


IMPACT OF AN INPATIENT PHARMACIST MANAGED WARFARIN SERVICE ON PATIENT SAFETY IN A COMMUNITY HOSPITAL SETTING

Sarah Hayes, Yasaman Homayouni, Kathleen Rottman, Elizabeth Santiago St. Vincent's Medical Center

Purpose/Background: Warfarin is considered a high- alert medication by The Joint Commission (TJC) because of patient safety risks including increased risk of bleeding. In 2008, St. Vincent's Medical Center- Riverside (SVMC-R) developed a physician managed anticoagulation protocol, however it's use was not mandatory. In 2012, pharmacists began managing all patients with a therapeutic warfarin order. The objective of this study is to evaluate the impact of the pharmacist managed warfarin service compared to physician managed warfarin dosing either by protocol or own management by assessing a composite rate of safety.

Methodology: A retrospective chart review of patients who received therapeutic warfarin doses during their inpatient stay from August 1, 2011 to July 31, 2012 (physician-managed group) and September 1, 2012 to February 28, 2013 (pharmacist-managed group) was conducted. Patients were included if they were greater than 18 years of age with a therapeutic warfarin order. The primary endpoint was a composite rate of safety of warfarin therapy complications.


Presentation Objective: Discuss the differences in the safety and effectiveness of warfarin therapy utilizing a pharmacist-managed dosing service compared to physician- managed. Self Assessment: How have studies demonstrated pharmacists' interventions impacted warfarin therapy management? A.Reduce the time to therapeutic INR during initiation of warfarin B. Reduce the incidence of supratherapeutic INR during warfarin titration C. Reduce the length and cost of hospital stay of patients receiving warfarin D. All of the above




FREQUENCY OF DOCUMENTED THERAPEUTIC FAILURES WITHIN THE ELECTRONIC MEDICAL RECORD OF A VETERANS AFFAIRS

HOSPITAL Margaret Swindler, Robert Svingos, Don Reeder North Florida/South Georgia

Veterans Health System

Purpose/Background: When a patient fails a medication, most clinicians will document the therapeutic failure in a progress note, but may overlook documenting the failure in a standardized location where all members of the medical team can easily look for this information. If a therapeutic failure isn't listed in a consistent location, another clinician could start a medication, not knowing that the patient may have tried it in the past without success. This study will look at whether therapeutic failures are being documented in the electronic medical record at the Malcolm Randall VA medical center, and if so, is there a description of the therapeutic failure.

Methodology: This is a retrospective chart review looking at patients aged 18-89 years old who were on select non-formulary medications due to a therapeutic failure from Jan 1, 2011 to Jan 1, 2012. The investigators will look at whether the therapeutic failure was documented in the ADR/Allergy tab of CPRS, and if so, was there a description of what the therapeutic failure was.


Presentation Objective: Determine the extent to which providers are documenting therapeutic failures in the medical record. Self Assessment: What is the importance of documenting therapeutic failures in the medical record?

Time: 3:10 - 3:30 Room: G312 Category: PI

DEVELOPMENT AND IMPLEMENTATION OF A COMPETENCY-BASED TRAINING PROGRAM FOR PHARMACISTS UTILIZING A NEW

COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) SYSTEM IN A COMMUNITY HOSPITAL

Kenny Aristide, Jon-Alan Ames, William Terneus Indian River Medical Center

Purpose/Background: On May 20, 2013, Paragon, a CPOE system designed by McKesson, will be implemented at the Indian River Medical Center (IRMC) as method to improve clinical workflow and reduce medication errors and adverse events. An ideal CPOE system is designed to support the efficiency of an institutions' medication use process. Appropriate training is a key factor to the successful implementation of a CPOE system. This project/training program will help ensure that current pharmacy staff and new staff members have the competency necessary to effectively navigate and use the new CPOE system.

Methodology: A brief, interactive CPOE competency-based training program with accompanying assessment examination is being developed and implemented. The training program includes assigned readings regarding the new CPOE system and details/instructions regarding processing medication orders. The training program will be available for access via online four weeks prior to the CPOE implementation date, May 20, 2013. Pharmacists are required to successfully complete four interactive test patient scenarios/medication orders and take an examination. A score of 90 percent or better is deemed as passing the competency examination. Also, a comprehensive electronic survey is being created to evaluate pharmacists' perception of readiness to utilize the new CPOE system.


Presentation Objective: Identify workflow changes in pharmacy practice after the implementation of a new CPOE system at a community hospital. Self Assessment: Following the implementation of a new CPOE system, what types of intervention are made by pharmacist?


EFFICACY OF HEPATITIS C TRIPLE THERAPY IN A GOVERNMENT SPONSORED HEALTHCARE POPULATION

Andrew Coelho, Deepak Singh WellCare Health Plans

Purpose/Background: Successful treatment of Hepatitis C is highly dependent upon adherence to a complex drug regimen along with associated medical visits. It is unsure if the stringent follow-up and monitoring that occurs during clinical trials is mimicked in the clinical setting. When a complicated dosing regimen is coupled with many adverse effects, adherence can be a major barrier to proper treatment. The primary outcome of this study is to evaluate the effectiveness of triple therapy (peginterferon alfa-2a/2b + ribavirin + an NS3/4A protease inhibitor) in clinical practice by evaluating sustained virological response (SVR) at 24-weeks post treatment. Secondary outcomes include discontinuation rates and non-adherence to drug regimen futility/stopping rules.

Methodology: Claims data was pulled to identify Medicare or Medicaid patients treated for Hepatitis C genotype 1 with peginterferon (PEG), ribavirin (RBV), and either boceprevir (BOC) or telaprevir (TVR) who started therapy between 10/1/11 and 2/29/12 for this retrospective review. Patient claims were confirmed to have genotype 1 via submitted laboratory data. HCV RNA values submitted to the plan during therapy were reviewed for primary and secondary outcomes. HCV RNA values at the end of therapy and 24-weeks post treatment were acquired and assessed for SVR. Patients who have comorbid HIV, have had a liver transplant, lost eligibility in insurance coverage, or patients whose laboratory data could not be obtained were excluded from this study.


Presentation Objective: Determine if the efficacy of triple therapy seen in clinical trials, which is highly dependent on medication adherence, corresponds to similar results in clinical practice. Self Assessment: Which is true regarding the new drug class that was recently developed for the treatment of Hepatitis C? a) This class is approved for use in Hepatitis C genotypes 1, 2, and 3 b) This class acts via inhibition of viral NS3/4A protease c) Drugs include boceprevir and telaprevir d) a and b e) b and c


IMPACT OF PHARMACIST ON PROPHYLACTIC ANTIMICROBIAL SELECTION FOR COLORECTAL SURGERY

Jessica Dabady, Ted Heierman, Jessica LaFosse, Heather McCormick Holmes Regional Medical Center

Purpose/Background: Development of a surgical site infection (SSI) is associated with increased morbidity and mortality following surgical procedures. However, when used appropriately, prophylactic antimicrobials may prevent the development of SSIs and improve patient outcomes. The primary objective of this study is to evaluate the frequency of appropriate prophylactic antibiotic selection and timing for colorectal surgery, between the standard care group and the pharmacist intervention group.

Methodology: The hospital's electronic medical record system will be used to retrospectively identify patients who have undergone colorectal surgery. Patients will be placed into one of two groups which will include the standard care (pre-implementation) group and the pharmacist intervention (post-implementation) group. Patient charts for the pre-implementation and post-implementation group will be reviewed from September 2011 to January 2012 and September 2012 to January 2013, respectively. Patients who are over the age of 18 and have undergone colorectal surgery will be included in this study. The following data will be collected for included patients: age, gender, allergies, baseline serum creatinine, antibiotic(s) used, start time of antibiotic prior to first incision, and time of last antibiotic dose post-surgery. The date of next hospital readmission and primary diagnosis will be collected, if applicable.


Presentation Objective: Assess the frequency of appropriate antibiotic selection and timing for colorectal surgery, between the standard care group and the pharmacist intervention group. Self Assessment: What was the most commonly used antibiotic regimen identified in this study?

2nd annual florida · 2018. 4. 3. · 2nd annual florida residency conference welcome to the second...

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