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 Medication History Technician (Mht) Expansion At A Large Tertiary Medical Center, Sarah Auer, Rochelle Castrillo, Tony Lucchi

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2021

Background

• The yearly joint commission National Patient Safety Goals for 2020 and 2021 stress the importance of using medications safely which includes an emphasis on medication reconciliation and decreasing medication discrepancies. 1,2 o Pharmacy Medication History Technicians (MHTs) work as an integral part of the medication reconciliation process to gather complete medication histories o The goal of medication reconciliation is to decrease medication discrepancies  decreased medication related adverse events  improve patient outcomes • Pharmacist run medication reconciliation programs have shown decreased medication errors by over 80% when compared to standard medication reconciliation performed by nurses or other …

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 …

Traditional Herb Or Drug Of Abuse? A Case Of Severe Kratomwithdrawal, Nicholas Pettit, Benjamin Pedroja, Bradford Glavan

Providence Portland Medical Center Internal Medicine 2021

Introduction

Kratom (Mitragynaspeciosa) is an herb native to Southeast Asia with opioid and stimulant-like properties that is commonly used to achieve a legal recreational high. •Kratom purchase and consumption is legal in most U.S. states. •Cases of acute toxicity and withdrawal have been increasing over the past decade.

Case Presentation

Pre-hospital course •Well adjusted 38 y.o. male presented with respiratory arrest requiring intubation by EMS in the field. •Found to have pinpoint pupils and bradypnea that was minimally responsive to naloxone. ICU course •Transferred to ICU and quickly extubated. •12 hours after arrival the patient became tachycardiac, tachypneic, and developed …

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 …

Impact Of Pharmacist Led Provider Education On Outpatient Copd Management, Erica Dominguez, Ben Rosati, Trevor Laursen

Providence Pharmacy PGY2 Program at Providence Medical Group 2021

Purpose

To evaluate the efficacy of provider education on adherence to guideline directed therapy in outpatient chronic obstructive pulmonary disease (COPD) management in South Oregon PMG clinics.

Background

• COPD is the third most common cause of death in the US • The CDC reports costs attributable to COPD in 2010 were $32.1 billion projected to have increased to $49 billion by 2020 • Direct healthcare costs include detection, prevention, physician office visits, hospitalizations, home care, and medications hospitalizations accounting for about 45 50% of these direct costs • Clinical burden of uncontrolled COPD has been shown to impact quality …

Assessing The Effect Of An Electronic Health Record Order Entry Guideline On Duration Of Outpatientantimicrobial Therapy Prescribed For Uncomplicated Urinary Tract Infections, Kasey Rubin, Chelsea Houshour, Christine Doran

Providence Pharmacy PGY2 Program at Providence Medical Group 2021

Background

• Fifty percent of antibiotics prescribed in the outpatient setting are unnecessary1. •Outside of unnecessary prescribing, the antibiotics chosen can be incorrect with an inappropriate duration of therapy1. •It has been estimated that resistant infections affect nearly 3 million Americans annually and are the cause of 35,000 deaths each year with added costs up to $33.2 billion dollars1. •The Centers for Disease Control (CDC) recommends that outpatient antimicrobial stewardship programs identify “high priority conditions.” •Examples of high priority conditions include acute respiratory infections, urinary tract infections (UTI)and skin and soft tissue infections (SSTI).2 •Antibiotics are not associated with a …

An Evaluation Of The Use Of Tranexamic Acid In The Treatment Of Bradykinin-Mediated Angioedema In The Emergency Department, Sarah Yb Kim, Carol Keller

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2021

Background

Bradykinin mediated angioedema is an overarching term that includes idiopathic angioedema, angiotensin converting enzyme inhibitor (ACEi) induced angioedema and hereditary angioedema (HAE). •This is an emergent condition that must be treated with the utmost urgency due to the fatal outcomes associated with the rapid constriction of the throat. •Bradykinin mediated angioedema is treated differently from histamine associated angioedema due to its resistance to corticosteroids and antihistamines. •HAE and ACEi induced angioedema are treated similarly but there is a lack of unanimity in the first line pharmacologic treatment. •Current treatment options include fresh frozen plasma, bradykinin-2 receptor antagonists, plasma-kallikrein inhibitors …

Evaluation Of Clinical Pharmacist Management Trends For Depression, Adam Olesen, Kelsie Fiss, Judy Wong

Providence Pharmacy PGY2 Program at Providence Medical Group 2021

Background

• Depression affects almost 10 of Americans over 18 years old 1 • Per the Centers for Disease and Control Prevention, the 2020 COVID 19 pandemic has led to an increase in adults struggling with mental health 1 • There is currently a shortage of mental health prescribers, with over half of all counties within the United States not having a single psychiatrist 2 • Southern Oregon also has a shortage of mental health prescribers, resulting in longer wait times for care • Evidence demonstrates that depression managed by pharmacists in the primary care setting led to increased follow …

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 …

Optimizing The Role Of Clinical Pharmacy Services In Transitions Of Care, Dj Clark, Clara Mikhaeil, Karen White

Providence Pharmacy PGY2 Program at Providence Medical Group 2021

Purpose

Health & Services The purpose of this project is to improve clinical outcomes in patients transitioning from inpatient to outpatient care by optimizing the process that primary care pharmacists use to perform comprehensive medication reviews.

Background

• Transitions of care from the inpatient to outpatient setting is an area of great opportunity for improving patient outcomes. • One prospective cohort study found that 20% of patients discharged from the hospital to home experienced an adverse event within 3 weeks of discharge. Of these adverse events, 66% were medication related.1 • Another observational study found that 14% of patients had …

Impact Of The Geriatric Mini-Fellowship On Prescribing Patterns Of The Primary Care Providers, Amy Zahn, Sharon Leigh

Providence Pharmacy PGY1 Program at Providence Milwaukie and Providence Newberg Medical Centers 2021

Background

• Geriatric patients are likely to experience adverse drug events related to high-risk medication use. Polypharmacy is also common and has a significant impact on the health of older adults. •The American Geriatric Society Beers Criteria lists potentially inappropriate medications for older adults.1 •Current literature suggests that Implementing interventions and deprescribing practices have a role in reducing costly hospitalizations. •STOPP (Screening Tool of Older People’s Prescriptions) was designed to address polypharmacy.2 •Medication review and follow-up services for older, polypharmacy patients lowered medication-related costs.3 •Projections suggest there is an insufficient supply of geriatrician services.4 •Per person personal health care spending …

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 …