Medicine and Health Sciences Commons^™

Pharmacist Pilot Project To Reduce Hypoglycemic Events On Internal Medicine Unit, Carly Barnes, Pamela Levine

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

No abstract provided.

Medication And Pharmacy-Related Outcomes As Part Of The Seniors At Risk For Falls After Emergency Room Visit (Safer) Project, Hyesoo Chae, Sharon Leigh, Colleen M Casey

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

The United States is comprised of an aging population; adults over the age of 85 are the fastest-growing age group in the United States and will reach approximately 9 million in 2030.1 25% of patients ≥ 65 years old in the United States report falling each year.1 There are over 3 million emergency department visits related to falls in the United States, totaling approximately 50 billion dollars in total medical expenditures.2 Falls are a major threat for older adults as they can lead to increased risk of further injury, loss of independence, decreased mobility, and premature death.1,2 Despite numerous …

Evaluation Of Specialty Pharmacy Productivity Metrics To Create An Updated Standardized Productivity Tool, Linda Huynh, Adam Saulles, Amber Franck

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• The number of specialty pharmacy medications has increased and is only projected to grow as more medications are approved for complex, chronic disease states 1,2 • Specialty medications are associated with high costs, high risks, and high complexity requiring extensive time and efforts to make medications safe and affordable for patients. • Much of this health system based specialty pharmacy’s productivity has been measured using a weighted scoring system for new vs. refill prescriptions. • With updated specialty pharmacy accreditation standards, stricter payer requirements, and shifting limited distribution medication complexities, there is a substantial focus on quality, clinical …

Evaluation Of Provider Adherence To Antibiotic Selection Following The Implementation Of Antimicrobial Stewardship Committee Recommendations For The Empiric Treatment Of Hospitalized Adults With Urinary Tract Infections, James E. Watkins, Alyssa B Christensen, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Urinary tract infections (UTIs) are one of the most common indications for prescribing antibiotics in the inpatient setting. • Recent literature suggests that not all patients are prescribed empiric antibiotics that are adherent to Infectious Diseases Society of America (IDSA) guidelines. • Arguably the most positive, predictable impact on provider adherence to guideline-based treatment regimens is achieved when evidence-based recommendations are made easily accessible. • The causative organism at the time of diagnosis and initiation of antibiotic therapy for a UTI is generally unknown: patients are often prescribed broad-spectrum therapy that may be unnecessary. • Inappropriate treatment of …

Evaluation Of Surgical Antibiotic Prophylaxis Compliance At A Large, Tertiary Medical Center, Meagan Greckel, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Surgical site infections (SSIs) are a significant cause of morbidity, prolonged hospitalization, and mortality. •Studies estimate SSIs contribute to nearly one million additional inpatient days per year and SSI mortality rate has been estimated to be 3%. •Additionally, SSIs in the US alone have an annual cost of approximately $3.5 billion. •A prior quality improvement project performed at a large, tertiary medical center in 2018-2019 identified that consistent adherence to the system surgical antibiotic prophylaxis (SAP) guideline and institutional antibiogram for antibiotic selection was an area for improvement. •This was particularly evident in hysterectomy and colorectal surgeries; therefore, …

Fixed Dose Prothrombin Complex Concentrate Versus Weight-Based Dose For Warfarin Reversal, Peter Martsin, Bryce Winn

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

•4 Factor Prothrombin Complex Concentrate (4F-PCC) reverses anticoagulation of warfarin with weight-based dosing criteria supplied by manufacturer. INR must be processed before 4F-PCC is prepared. This regimen provides additional cost and delay of treatment to the patient as well as cost to the hospital and pharmacy department. •Fixed dose regimens of 4F-PCC have been described in literature1,2-4as having similar performance in achieving target INR compared to weight-based dosing, and can potentially have a decreased rate of thromboembolic events (TEE) compared to weight-based dosing, although large randomized-control trials on the comparison have not been conducted. •Fixed dosing of 4F-PCC is …

Evaluate Opioid Prescribing Trends For Elderplace, A Program For All-Inclusive Care For The Elderly (Pace), Jacqueline Figueras, Loann Wong, Sharon Leigh

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Providence ElderPlace in Oregon is the fifth-largest PACE program in the country that offers wraparound nursing home-eligible medical and social services to over 1600 community-dwelling seniors who are medically frail with complex medication regimens. • Many elderly patients suffer from chronic nonmalignant pain which may affect their function and quality of life. • The Centers for Disease Control and Prevention (CDC) reports a 7.7% increase in drug overdoses and opioid deaths in the aging population from 2013 to 2014. • In 2015-2016 elderly adults obtained an annual average of 774 Morphine Milligram Equivalents (MME) of outpatient prescriptions for …

Financial Impact Of A Regional Antimicrobial Stewardship Cost Saving Initiative In A Large Integrated Health Care System, Van Nguyen, Colton Taylor, Alyssa B Christensen, Brent Footer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Since 2017, antimicrobial stewardship is a Centers for Medicare & Medicaid Services (CMS) and The Joint Commission (TJC) requirement for all acute care hospitals, critical access hospitals, and nursing care centers. •Given the current evidence supporting the utilization of extended-infusion beta-lactams, the system transitioned all its acute care facilities within the region to extended-infusion piperacillin/tazobactam (TZP) in March 2016 •According to Bauer et al, the median length of stay and hospital costs were significantly less for patients admitted to the ICU who received extended-infusion cefepime for bacteremia and/or pneumonia

Purpose

The purpose of this study was to evaluate …

Review Of Prophylactic Anticoagulation Strategies And Outcomes For Covid-19 Patients (Research In Progress), Caleb Galindo, Pamela Levine, Melanie Geer

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

In March of 2020, the World Health Organization (WHO) declared the spread of COVID-19 a global pandemic. •Though largely considered a respiratory disease, research continues to demonstrate additional impacts of COVID-19 on other organ systems.2, 3 •A key characteristic of COVID-19 is marked inflammation leading to hypercoagulability.2, 3, 6 •Infected patients are at a higher risk of developing thromboembolic events (VTE and stroke) compared to healthy adults. 2, 3, 6 •Some clinicians have trialed varying anticoagulation strategies for patients with COVID-19 based on coagulation parameters such as D-dimer.4, 5, 6 •Multiple expert groups have released preliminary guidance on anticoagulation …

Health Disparities In Black, Latinx, And Native Populations Compared To Caucasians: A Retrospective Descriptive-Analysis Of Care Focused On Hypertensive Emergency, Non-St Segment Elevation Myocardial Infarction (Nstemi), And Cerebrovascular Accident (Cva)., Jonathan Aguilar Roa, Evon Anukam

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Health disparity is a sum of differences in healthcare seen in underserved populations of the United States. 1 • Differences include incidence, prevalence, mortality, burden of disease, and other adverse health conditions • According to ASHP, health disparities continue to be a major public health problem confronting the U.S. health care systems. 2 • Evidence suggests that health disparities can be in part due to differences in the quality of care for different racial and ethnic groups. 2 • All the different disparity factors have been shown to lead to different health outcomes that do not favor Black, …

Evaluation And Implementation Of A New Phenobarbital Protocol For Alcohol Withdrawal Management In The Emergency Department, Sarah J. Kim, Sara Clark, Joshua L. Floyd

Providence Pharmacy PGY1 Program at Providence Portland and Providence St. Vincent Medical Centers 2021

Background

• Alcohol withdrawal syndrome can lead to substantial health care costs and mortality. • Although historically benzodiazepines (BZDs) are considered the mainstay treatment for alcohol withdrawal, some studies have shown that phenobarbital may be the safer and preferred alternative option. • Advantages of phenobarbital are its mechanism of action, more predictable pharmacokinetics, and greater therapeutic index. • A prospective study by Rosenson et al. 2012 found that a single 10 mg/kg IV dose of phenobarbital versus standardized lorazepam protocol resulted in decreased ICU admissions (8% vs. 25%). • A retrospective study by Tidewell et al. 2018 demonstrated shorter hospital …