Medicine and Health Sciences Commons^™

Pd-1 And Pd-L1 Inhibitors: A Single Center Medication Assistance Program (Map) Experience, Sarah Tu, Shuntao Cai

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

PD-1 and PD-L1 Inhibitors: A Single Center Medication Assistance Program (MAP) Experience

Sarah Tu, PharmD and Shuntao Cai, PharmD, BCOP

Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA

Background: PD-1 and PD-LI inhibitors are a large component of the growing immuno-oncology field and every year there are increasing studies investigating potential indications for these agents. This IRB approved retrospective chart review examines patients in the Medication Assistance Program (MAP) within a large tertiary medical center who are on PD-1 and PD-L1 medications due to financial barriers and/or non-FDA approved regimens (unlabeled indications). This study seeks to evaluate …

Evaluating Outcomes Of Medication-Related Interventions From The “Seniors At Risk For Falls After Emergency Room Visit” (Safer) Pilot Project, Ling J. Zhan, Sharon Leigh, Mary E. Kuebrich, Clara Mikhaeil, Kevin Hom, Colleen M. Casey

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Primary Author: Ling J. Zhan, PharmD

Co-Authors: Sharon Leigh, PharmD BCPS, Mary Beth Kuebrich, MS, AGPCNP-BC, Clara Mikhaeil, PharmD, BCPS, Colleen M. Casey, PhD, ANP-BC

Location: Providence Health & Services, Portland, Oregon

Title: Evaluating outcomes of medication-related interventions from the “Seniors At risk for Falls after Emergency Room visit” (SAFER) pilot project

Purpose: Falls are the leading cause of injury in older adults, resulting in decreased mobility, loss of independence, and increased health care costs. Even a single fall puts an older adult at higher risk for future falls. Despite numerous studies showing evidence that multifactorial fall risk interventions are …

Safe Opioid Prescribing At Discharge, Taylor Goodman, Elva Van Devender, Luetta Jones, Courtney Barber

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Safe Opioid Prescribing at Discharge Taylor Goodman, PharmD; Elva Van Devender, PharmD; Luetta Jones, PharmD; Courtney Barber

Background/Purpose: The opioid epidemic has led to devastating consequences, especially in Oregon, with an average of five Oregonians dying each week from opioid overdose. Opioid prescriptions at discharge are correlated with future continued opioid use. United States providers prescribe more opioids both inpatient and at discharge than other countries, and Oregon providers wrote more opioid prescriptions per person than the national average. Oversupplying prescription opioids can lead to reservoirs of unused medication, creating opportunities for non-medical use and overdose. Pharmacy interventions have …

Evaluating The Utility Of Cyp2c19 Genetic Testing For P2y12 Inhibitor Prescribing Within An Inpatient Setting, Thomas E. Maslo, Carolynn Null

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Thomas Maslo, PharmD, PGY-1 Pharmacy Resident

Carolynn Null, PharmD

Providence Portland Medical Center, Portland, Oregon

Evaluating the utility of CYP2C19 genetic testing for P2Y12 inhibitor prescribing within an inpatient setting

The emergence of pharmacogenomics offers the opportunity to practice precision medicine across health care. In patients presenting with acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) is routinely prescribed for 12 months. DAPT consists of a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) plus aspirin. Of the P2Y12 inhibitors, clopidogrel is uniquely impacted by CYP2C19 status. About 30% of the North American population carry at …

Evaluation Of A Two-Way, Hipaa-Compliant Text-Messaging Platform In A Health System Specialty Pharmacy, Dj Clark, Adam Saulles, Tara Berkson

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

PDJ Clark, PharmD, PGY1 Pharmacy Practice Resident
Adam Saulles, PharmD, CSP, BCACP; Tara Berkson, PharmD, BCACP

Providence Health and Services, Portland, Oregon

Evaluation of a two-way, HIPAA-compliant text-messaging platform in a health system specialty pharmacy

Specialty medications, including those used to treat Multiple Sclerosis (MS), represent a growing proportion of prescription drug expenditures in the United States. MS is a chronic, progressive condition that requires maintenance therapy with disease-modifying medications. Many patients with MS rely on specialty pharmacies to obtain, dispense, and perform the necessary monitoring for these complex medication regimens. A study performed in 2017 by Munsell et al, …

Implementing A Simplified Targeted Feedback Method To Reduce Fluoroquinolone Prescriptions In Emergency Departments, Minh Le, Alyssa Christensen, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Minh Le, PharmD

Alyssa Christensen, PharmD, BCIDP, Brent Footer, PharmD, BCPS

Providence Health System, Oregon

Implementing a simplified targeted feedback method to reduce fluoroquinolone prescriptions in emergency departments

Background: The CDC has proclaimed antibiotic resistance to be one of the biggest public health challenges of our time. Although fluoroquinolones (FQs) are among the most widely prescribed antibiotics in the ambulatory setting, there have been recent efforts to reduce their usage due to mounting concerns regarding their safety profile and resistance patterns. Provider audit-and-feedback has been shown to be among the most effective antimicrobial stewardship interventions, but the auditing process …

Implementation And Evaluation Of Pulmonary Arterial Hypertension Clinical Program And Pharmacist Education At A Health-System Specialty Pharmacy, Timothy Cao, Adam Saulles, Tara Berkson

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Timothy Cao, PharmD, PGY-1 Pharmacy Resident

Preceptors: Adam Saulles, PharmD, CSP, BCACP and Tara Berkson, PharmD, BCACP

Providence Health and Services, Portland, Oregon

Implementation and evaluation of pulmonary arterial hypertension clinical program and pharmacist education at a health-system specialty pharmacy

Pulmonary Arterial Hypertension (PAH) is a progressive, debilitating, and costly disease, often resulting in poor prognosis when treatment is inadequate. With an exponential growth of specialty therapies, clinical pharmacists in specialty pharmacies are well-equipped to play an integral role in improving patient care outcomes and reducing overall healthcare costs. By incorporating a PAH-specific clinical program as part of the specialty …

Standardizing Specialty Pharmacist Follow-Up Frequency In Patients Prescribed Inflammatory Disease-Modifying Therapies, Rochelle Castrillo, Linda Huynh, Tara Berkson, Adam Saulles

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2020

Submission Category Specialty Pharmacy

Purpose Specialty medications for inflammatory conditions have demonstrated decreased effectiveness, safety, and quality of life, largely attributable to inadequate medication adherence. Furthermore, with poorer health outcomes, patients face greater healthcare costs associated with exacerbations, flares, and hospitalizations. Monitoring for non-adherence, side effects, and health status changes is essential for patients diagnosed with inflammatory conditions. The benefit of a standardized pharmacist clinical follow-up assessment is currently lacking in specialty pharmacy literature. This study will implement a standardized pharmacist follow-up frequency guide and determine its clinical value and utility for patient safety and therapeutic goals in newly established …

Education Of Heparin Per Pharmacy Guidelines To Increase Compliance, Safety, And Pharmacists’ Management Of Heparin Infusions, Christopher Truong, Braxton Mehl

Providence Pharmacy PGY1 Program at Providence Medford 2020

Presentation Title: Education of heparin per pharmacy guidelines to increase compliance, safety, and pharmacists’ management of heparin infusions

Authors: Christopher Truong, PharmD and Braxton Mehl, PharmD, BCCCP

Facility: Providence Medford Medical Center

Background: Element of Performance 4 of The Joint Commission’s National Patient Safety Goal 03.05.01 requires that hospitals have a written policy that addresses the need for baseline and ongoing laboratory tests to monitor and adjust anticoagulant therapy. Our hospital has a written Anticoagulation Management General Operating Policy for heparin orders managed through nursing or pharmacy. Currently, most heparin orders are nurse-managed and have resulted in lab and dosing …

Empowering Caregivers To Recognize, Support, And Treat Opioid Use Disorder: An Interdisciplinary Assessment Of Knowledge, Attitudes, And Comfort Level Pre And Post-Education, Annette Sprankle, Mika Michaels

Providence Pharmacy PGY1 Program at Providence Medford 2020

Author: Annette Sprankle, PGY1 Pharmacy Resident, PMMC

Title: Empowering caregivers to recognize, support, and treat opioid use disorder: an interdisciplinary assessment of knowledge, attitudes, and comfort level pre and post-education

Background: Substance use disorder affects approximately one in every four hospitalized patients. These patients are often treated for the admitting medical issue without addressing their substance use disorder. A hospital admission provides an opportunity to connect patients to the medical system. Evidence demonstrates that starting medication-assisted treatment in the hospital reduces the risk of overdose upon discharge, rate of hospital readmission, length of stay, and hospital expenditures.

Purpose: The purpose …

Incorporating A Clinical Pharmacist In An Outpatient Palliative Care Team, Crystal Rim, Sharon Leigh, Linda Desitter, Mary Grant, Dana Nguyen

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2020

Title: Incorporating a clinical pharmacist in an outpatient palliative care team

Crystal Rim, PharmD; Sharon Leigh, PharmD, BCPS; Linda De Sitter MD, MPH; Mary Grant, ANP; Dana Nguyen, PharmD

Palliative care is a growing field in medicine that focuses on delivering care that improves quality of life for patients with serious illnesses. Often, the goals of palliative care differ from traditional goals of medicine. Currently, there is limited data demonstrating the integration of pharmacists in the palliative care setting. The purpose of this quality improvement is to evaluate the clinical pharmacist’s role within an outpatient palliative care team when performing …

Evaluation Of Transitional Care Interventions From A Decentralized Clinical Pharmacist In A Small Inpatient Geriatric Psychiatry Unit, Nathan Wong, Michael Brown

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2020

Evaluation of Transitional Care Interventions from a Decentralized Clinical Pharmacist in a Small Inpatient Geriatric Psychiatry Unit

Nathan Wong, PharmD; Michael Brown, RPh, BCPS, BCPP

Background: Transitioning between healthcare settings increases the risk for medication errors. A systematic review of 26 studies comparing various medication reconciliation interventions demonstrated consistent reductions in adverse drug events. Intensive pharmacist involvement and focus on high risk populations were the most successful. ¹ Geriatric and behavioral health populations are especially vulnerable with polypharmacy and cognitive impairment often complicating the picture. Providence Milwaukie Hospital (PMH) houses a small unit tailored to provide mental health care …

Impact Of Academic Detailing On Clinical Pharmacy Specialist Involvement In Medication Assisted, Lindsey M. Bartos, Kristin A. Tallman, Dara L. Johnson

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Title: Impact of academic detailing on clinical pharmacy specialist involvement in medication assisted treatment for opioid use disorder in a primary care setting

Lindsey Bartos, PharmD; Kristin Tallman, PharmD, BCPS, BCACP; Dara Johnson, PharmD, BCPP, BCACP

Introduction: Opioid prescribing and opioid overdose deaths have increased steadily since the 1990s, reaching a 6-fold increase between 1999 and 2017. The opioid crisis, as it became known, was declared a public health emergency in 2017. In 2018 alone, an estimated two million people had a diagnosed opioid use disorder (OUD). The use of medication-assisted treatment (MAT) for OUD reduces the use …

Impact Of Pharmacist-Led Appointments For Hypertension Management In A Primary Care Setting: A Retrospective Analysis, Anne Marie Thibodeaux, Christine Doran, Ben Rosati

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Impact of pharmacist-led appointments for hypertension management in a primary care setting: a retrospective analysis

Introduction: High blood pressure is a major risk factor for heart disease and stroke, two of the leading causes of death for Americans.1 Evidence supports the idea that pharmacist-led hypertension management can result in overall blood pressure reduction; however, it remains unclear whether pharmacist-led initiatives can also improve performance metrics.2-5

Research question: Can pharmacist-led appointments for blood pressure management positively impact hypertension metrics?

Study design: Retrospective chart review

Methods: Primary outcome data was measured via metric inventory, defined as percentage of …

Clinical Pharmacist-Led Intervention To Improve Statin Metric For Secondary Prevention At Providence Medical Group – Southern Oregon Region, Chloe Nguyen, Judy Wong, Karen White

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Clinical Pharmacist-Led Intervention to Improve Statin Metric for Secondary Prevention at Providence Medical Group – Southern Oregon Region

Chloe Nguyen, PharmD, Judy Wong, PharmD, BCACP, and Karen White, PharmD, BCACP

Background: Currently, there is a gap in meeting the statin metric at Providence Medical Group in Southern Oregon Region. The purpose of this project is to identify intervention strategies to improve statin metric for secondary prevention among patients with clinical atherosclerotic cardiovascular disease (ASCVD).

Methods: This quality improvement project was approved by the system’s Institutional Review Board. Patients at least 18 years of age with diagnosis of clinical ASCVD not …

Effect Of A Pharmacist-Led Antimicrobial Stewardship (Ams) Program On Outpatient Fluoroquinolone Prescribing In The Elderly, Katie Larue, Chelsea Mannebach, Bonnie Jiron

Providence Pharmacy PGY2 Program at Providence Medical Group 2020

Title: Effect of a pharmacist-led antimicrobial stewardship (AMS) program on outpatient fluoroquinolone prescribing in the elderly

Authors: LaRue, Katie PharmD; Mannebach, Chelsea PharmD, BCPS, BCACP; Jiron, Bonnie, PharmD, BCACP

Introduction: The Center for Disease Control and Prevention, the Society of Infectious Diseases Pharmacists, and American Pharmacists Association recognize the need for outpatient AMS programs and the important role pharmacists play in appropriate prescribing. Fluoroquinolones (FQ) pose many risks, highlighted by U.S Food and Drug Administration safety warnings, including aortic dissection, hypoglycemia, mental health side effects, and tendonitis, along with the risk of Clostridium difficile infections, particularly in …

Pharmacists Improve Door To Needle Times In The Emergency Department, Kevin Phan, Megan Degener

Books, Presentations, Posters, Etc.

No abstract provided.

Impact Of Prevnar (Pcv13) Vaccine Recommendations In Pediatric And Immunocompetent Adults 65 Years And Older: What Are The Benefits And Risks?, James E. Watkins, Anne Marie Thibodeaux, John C. Darnell

Articles, Abstracts, and Reports

Background:

2000: PCV7 becomes the first FDA approved pneumococcal vaccine for pediatrics
2010: PCV13 recommended in pediatrics
2014: PCV13 recommended in immunocompetent adults 65+
2018: CDC looked at data since 2014 recommendation
2019: PCV13 now shared clinical decision-making

Long-Term Safety And Efficacy Of Subcutaneous Pasireotide In Patients With Cushing's Disease: Interim Results From A Long-Term Real-World Evidence Study., Luca Manetti, Timo Deutschbein, Jochen Schopohl, Kevin C J Yuen, Michael Roughton, Ulrike Kriemler-Krahn, Libuse Tauchmanova, Ricardo Maamari, Carla Giordano

Articles, Abstracts, and Reports

PURPOSE: Clinical trials have demonstrated the favorable efficacy/safety profile of pasireotide in patients with Cushing's disease (CD). We report interim long-term results of an ongoing real-world evidence study of subcutaneous pasireotide in patients with CD.

METHODS: Adults with CD receiving pasireotide, initiated before (prior-use) or at study entry (new-use), were monitored for ≤ 3 years during a multicenter observational study ( http://clinicaltrials.gov identifier NCT02310269). Primary objective was to assess long-term safety of pasireotide alone or with other CD therapies.

RESULTS: At the time of this interim analysis, 127 patients had received pasireotide (new-use, n = 31; prior-use, n = 96). …

A Screening Tool To Identify Qualified Pharmacy Residency Candidates., Daniel Hu, Danny Veenhouwer, Julie Mccoy, Dominick A Caselnova

Articles, Abstracts, and Reports

No abstract provided.

Comparative Effectiveness Of Drugs Used To Constrict The Patent Ductus Arteriosus: A Secondary Analysis Of The Pda-Tolerate Trial (Nct01958320)., Melissa Liebowitz, Joseph Kaempf, Omer Erdeve, Ali Bulbul, Stellan Håkansson, Johanna Lindqvist, Aijaz Farooqi, Anup Katheria, Jason Sauberan, Jaideep Singh, Kelly Nelson, Andrea Wickremasinghe, Lawrence Dong, Denise C Hassinger, Susan W Aucott, Madoka Hayashi, Anne Marie Heuchan, William A Carey, Matthew Derrick, Ilene Sue Wolf, Amy Kimball, Meera Sankar, Tina Leone, Jorge Perez, Arturo Serize, Ronald I Clyman

Articles, Abstracts, and Reports

OBJECTIVE: To evaluate the effectiveness of drugs used to constrict patent ductus arteriosus (PDA) in newborns < 28 weeks.

METHODS: We performed a secondary analysis of the multi-center PDA-TOLERATE trial (NCT01958320). Infants with moderate-to-large PDAs were randomized 1:1 at 8.1 ± 2.1 days to either Drug treatment (n = 104) or Conservative management (n = 98). Drug treatments were assigned by center rather than within center (acetaminophen: 5 centers, 27 infants; ibuprofen: 7 centers, 38 infants; indomethacin: 7 centers, 39 infants).

RESULTS: Indomethacin produced the greatest constriction (compared with spontaneous constriction during Conservative management): RR (95% CI) = 3.21 (2.05-5.01)), followed by ibuprofen …

Worsening Choreoathetosis In Huntington's Disease With Fluoxetine, Lisdexamfetamine, And Melatonin: A Case Report., Clayton J Hamilton, Tysen K Timmer, Robert C Munjal, Fernando Cardozo-Pelaez, Ian R Mcgrane

Articles, Abstracts, and Reports

Cognitive, affective, and sleep disturbances can be found in patients with Huntington's disease (HD), and medications used to treat these HD-related sequela can also impact HD-related movement disorders. We present the case of a 52-year-old Caucasian man with previously undiagnosed HD who exhibited significant choreoathetoid movements that improved with discontinuation of fluoxetine and lisdexamfetamine upon hospital admission. Following diagnosis of HD through genetic testing, he was administered 5mg of oral melatonin on two consecutive evenings, which resulted in worsening choreoathetosis. We calculated Naranjo adverse event scores of 5, 5, and 2 for fluoxetine, lisdexamfetamine, and melatonin, respectively, based on our …

The Hospital Antimicrobial Use Process: From Beginning To End., William R Truong, Jason Yamaki

Articles, Abstracts, and Reports

Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at …