Pharmacy and Pharmaceutical Sciences Commons^™

Post-Discharge Transitions Of Care Pharmacists Follow-Up Impact On Patient Care, Lesly Rapado, Sara Panella, Elaina Rosario, Emilie Collongette, Faaria Quadri, Beatriz Jimenez-Cadilla, Amanda Gronniger

Nursing & Health Sciences Research Journal

Introduction: This quality improvement project assessed the impact of a newly implemented transitions of care (TOC) pharmacist service at a large health system. The service involves a comprehensive review of recently discharged value-based care individuals, including chart review and, when necessary, telephonic follow-up by the pharmacist 3-6 days post-discharge.

Methods: This retrospective evaluation compared two groups: pre-implementation (September 1st, 2023 - January 30th, 2024) and post- implementation (March 1st, 2024 - July 30th, 2024) of TOC pharmacist service, focused on patient evaluations 3-6 days post-discharge. The primary outcome was a composite of 30-day re-hospitalization rates including urgent care, emergency department, …

Impact Of Multimodal Analgesia In Comparison To Conventional Analgesia In Coronary Artery Bypass Graft Patient With Implementation Of An Enhanced Recovery After Surgery Order-Set, Rhoda Musyoka, Radhan Gopalani, Maura Falli, Maria Ruiz, Cathleen Charles, Yanija Zhang, Esty Trimino, Laura Dominguez Vasquez, Tom Nguyen

Nursing & Health Sciences Research Journal

Background: An Enhanced Recovery After Surgery (ERAS) pilot program was implemented for coronary artery bypass graft (CABG) procedures under a single cardiothoracic surgeon in May 2024 across two community hospitals. We assessed the impact of multimodal analgesia facilitated through the ERAS CABG order-set compared to the non-ERAS (conventional) CABG order-set.

Methods: This study was an Institutional Review Board-approved, multi-site, retrospective chart review of participants admitted to two community hospitals for a CABG procedure from June 2024 to January 2025. Participants who utilized the preand post-ERAS or the pre- and post-conventional CABG order-sets were included. The primary outcome was the opioid …

Assessment Of Stroke Priority Status On Door-To-Reversal Time And Outcomes In Anticoagulant Associated Intracranial Hemorrhage, Kayla Mitzel, Jonathan Kline, Thomas J. Wolfel, Erika Dittmar, Nina Cruz, Felipe De Los Rios La Rosa, Heidi Clarke

Nursing & Health Sciences Research Journal

Background: The emergent reversal of anticoagulation in the setting of intracranial hemorrhage (ICH) is critical, and it is essential that comprehensive stroke centers adhere to the American Heart Association (AHA) metrics for door-to-reversal within the designated 90 minutes. The objective of this review is to evaluate individuals classified as stroke alert priority 1 and non-stroke alert and compare AHA metrics for door-to-reversal times and clinical outcomes when diagnosed with ICH.

Methods: Single-center observational, retrospective review that compared stroke alert priority 1 individuals to non-stroke alert individuals who were diagnosed with an ICH and taking an anticoagulant prior to admission. The …

Evaluating Perceptions Of Clinical Sports Pharmacists: Insights From An Orthopedic Clinic Survey, Brandon K. Welch, Sara Panella, Michael Swartzon, Eli Friedman, Samantha Cossin

Nursing & Health Sciences Research Journal

Introduction: Athletes have unique pharmaceutical needs due to injury risk, supplement use, and anti-doping regulations. Despite this, pharmacists remain underutilized in sports medicine. This quality improvement project evaluated clinician and staff perceptions of clinical sports pharmacists at Baptist Health, a large healthcare system in South Florida.

Methods: A 12-question REDCap survey was distributed to 19 staff and clinicians— including physicians, athletic trainers, and medical assistants—across five Baptist Health Orthopedic and Sports Medicine clinics. Responses were measured using a Likert scale and analyzed using descriptive statistics and thematic analysis.

Results: The survey achieved a 100% response rate. Most participants had over …

How Low Can We Go: Evaluation Of A Pharmacist-Led Weight Loss Management Program, Kelly Rubi, Elaina Rosario, Sara Panella, Jacqualine Igwe, Maria Pulido, Faaria Quadri

Nursing & Health Sciences Research Journal

Background: Obesity is a major health challenge that is associated with several health risks, including diabetes and hypertension. The purpose of this project was to evaluate the impact of clinical pharmacists on the therapy optimization of GLP-1 receptor agonists (GLP-1RAs) in a weight management program. Methods: This project evaluated a quality improvement initiative through a retrospective chart review that included patients who were treated with semaglutide or liraglutide between October 2022 and July 2023, with body mass indices (BMI) of 27 kg/m2 or greater with at least one weight-related comorbidity or a BMI greater than or equal to 30 kg/m2. …

Impact Of An Interdisciplinary Team On Patients Seen At A Heart Failure Clinic, Nilda Pelegrino, Faaria Quadri, Elaina Rosario, Jacqualine Igwe, Sandra Chaparro, Lourdes Labrada, Sara Panella, Maria Pulido, Stephen Breazeale, Zhenwei Zhang

Nursing & Health Sciences Research Journal

Background: Heart failure is a complex clinical syndrome that requires the involvement of interdisciplinary teams to address patient needs and optimize therapy. Interdisciplinary teams, including physicians, advanced practice practitioners, and pharmacists, play a crucial role in implementing guideline-directed medical therapy and addressing barriers to self-care that ultimately improve patients’ overall survival. This study assessed the impact of an interdisciplinary team on patients’ heart failure outcomes compared to patients solely managed by clinical cardiologists. Methods: This was a single-center retrospective chart review study of Baptist Health patients seen at the heart failure clinic. The study compared patients seen by an interdisciplinary …

Navigating Copay Adjustment Programs In Specialty Pharmacy, Farah Barada, Sarah Fillman, Angelica Berni, Samuel Casey Yokum

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Many patients rely on copay cards from manufacturers to help pay for prescriptions, especially for specialty and brand name medications which often result in higher out of pocket expenses. Historically, copay card savings were applied to the patient’s out of pocket expense and/or deductible to help the patient save money on their prescription and benefit plan responsibilities. In some cases, this added up to thousands of dollars in savings. However, in 2018, many Pharmacy Benefit Managers (PBMs) and insurance plans began utilizing copay adjustment programs known as “copay accumulators” and “copay maximizers” as forms of utilization management. These programs are …

Assessment Of A Pharmacist-Led Antibiotic Time-Out For Transition Of Iv Vancomycin To Oral Linezolid, Mary S. Vogel, Jefferson Cua, Erika Dittmar, Timothy Gauthier, Kelsey N. Williams

Nursing & Health Sciences Research Journal

Introduction: Intravenous (IV) vancomycin requires therapeutic drug monitoring and line placement and may prolong hospital stay. Linezolid requires less monitoring, is orally bioavailable, and may expedite transitions of care. This study assessed the impact of a pharmacist-led antibiotic timeout for the transition from IV vancomycin to oral linezolid. Methods: This single-center, quasi-experimental study included admitted adult patients receiving IV vancomycin for over 48 hours. Patients receiving vasopressors, of immunocompromised status, or with specific antibiotic indications were excluded. The primary outcome was the pharmacist intervention acceptance rate. Secondary outcomes included median hospital length of stay, median antibiotic treatment days, and incidence …

Optimizing Empiric Vancomycin Use In Febrile Neutropenia Patients, Nicole Tadros, Erika Dittmar, Radhan B. Gopalani

Nursing & Health Sciences Research Journal

Introduction: National guidelines do not support routine empiric vancomycin use in the initial management of febrile neutropenia (FN) and only recommend it in patients with specific clinical indications. This bi-phasic quality improvement project aimed to evaluate current vancomycin use in FN and improve compliance with a guideline-driven algorithm (GDA) to ensure appropriate prescribing and therapy duration in a community hospital.

Methods: Phase I was a retrospective review of charts of adults receiving empiric vancomycin therapy for FN at a community hospital. Phase II was a prospective review of charts of patients with FN, who received pharmacist-led interventions, to improve de-escalation …

Pharmacists’ Role In The Management Of Patients Receiving Dual Or Triple Antithrombotic Therapy, Laura Neubauer, Radhan Gopalani, Kristen De Almeida

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Purpose: Patients on dual and triple antithrombotic therapy present the therapeutic dilemma of mitigating bleed risk while sustaining antithrombotic efficacy. Lack of literature and variability in existing published guidance potentiates inconsistent management of these patients. Furthermore, suboptimal dosing of direct oral anticoagulants is relatively common. One study reported as high as 43% of patients receive higher and 13% receive lower than clinically indicated doses. These findings were associated with a significantly increased risk of major bleeding and incidence of stroke, thus highlighting the importance of selecting an ideal regimen. The purpose of this project is to highlight pharmacists’ role in …

Optimizing Empiric Vancomycin Use In Febrile Neutropenia Patients, Nicole Tadros, Erika Dittmar, Radhan Gopalani

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Introduction: Febrile neutropenia (FN) is a complication of chemotherapy resulting in a temperature 100.4⁰F or greater plus an absolute neutrophil count (ANC) below 500 cells/mm³ or an ANC below 1000 cells/mm³ and expected to decrease below 500 cells/mm³ within 48 hours. Timely administration of broad-spectrum antimicrobial therapy is a cornerstone for the initial management of FN. However, prolonged empiric antimicrobial treatment can lead to resistance and toxicity. National guidelines and published literature do not support vancomycin as a routine part of empiric antimicrobial regimens in FN; it is only recommended in patients with specific clinical indications. This …

Evaluation Of Antiplatelet-Related Bleeding Events In A Community Hospital, Frank C. Moreno Exposito, Heidi Clarke, Erika Dittmar

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Background:Bleeding rate among patients who take high-dose aspirin is approximately 1.92% with an expected 2-3 fold increase after a second antiplatelet is added. Similarly, the addition of an anticoagulant to single or dual antiplatelet therapy results in increased bleeding rates of approximately 13.9% and 15.7% respectively. The concomitant use of antiplatelets and anticoagulants has become a common practice due to the high incidence of clinical conditions for which these agents are used. Hence, reversal of antithrombotic agents is often needed during major bleeding events or invasive procedures. However, the use of antiplatelet reversal is still under-utilized, and its efficacy …

Evaluation Of An Elevated Vte Thromboprophylaxis Guideline For Critically Ill Patients Infected With Covid-19, Tony Nguyen, Heidi Clarke

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Retrospective studies and systematic-review meta-analysis have shown an association in inducing a prothrombotic state in patients infected with COVID-19. The risk of VTE are compounded in the critically ill. Current practices at Baptist Hospital of Miami (BHM) is to routinely order standard prophylactic dosed chemical thromboprophylaxis for all patients infected with COVID-19. In August 2020 an anticoagulation guidance document was approved to tailor anticoagulation dosing for critically ill COVID-19 patients. At risk patients were based on clinical and laboratory markers such as D-dimer, CRP, and ferritin. Following implementation, our analysis show a statistically significant reduction in the number of treatment …

Evaluation And Optimization Of Medication Related Fall Risk At A Community Hospital, Giselle Chahili, Thomas Wolfel, Heidi Clarke, Erika Dittmar

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Background: Falls occur commonly in older adults at a rate of 3-5 per 1000 beds in healthcare settings. They can results in increased length of stay, morbidity and mortality, and healthcare costs. Some risk factors include older age, environmental hazards and medications. Currently at BHM, patient’s risk for falling is assessed based on Morse Fall Scale (MFS), which does include drugs as part of its assessment. The purpose of this project is to integrate medication risk evaluation into our current fall assessment.

Methodology: single-centered, retrospective, IRB-reviewed quality improvement project at BHM. We included patients over age 18 who fell with …

Optimization Of Albumin 5% Use In A Community Hospital, Robyn Feldman, Stephanie Palma, Erika Dittmar, Heidi Clarke

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Background: The debate surrounding the use of crystalloids versus colloids remains a source of controversy due to limited and conflicting evidence. Emerging data favors the use of crystalloids over colloids in addition to cost benefits. Baptist Hospital of Miami (BHM) has evidence-based guidance for albumin 5%, but it is unclear the degree of appropriate usage. The purpose of this study is to assess the prescribing practices of albumin 5% at BHM and optimize appropriate use through pharmacy driven interventions.

Methodology: A single-center, IRB-reviewed, bi-phasic study was conducted within a community hospital. In phase I, a retrospective chart review of patients …

Retrospective Review Of Anticoagulation Regimens Used For The Prevention Of Venous Thromboembolisms In Critically Ill Patients Infected With Sars-Cov-2, Tony Nguyen, Heidi Clarke

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No abstract provided.

Impact Of Ketorolac On Opioid Consumption After Open Heart Surgery, Laura Neubauer, Radhan Gopalani, Kristen De Almeida, Andrea Marr-Peralto

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No abstract provided.

Evaluation Of Albumin 5% Prescribing Patterns In Adult Hospitalized Patients, Robyn Feldman, Nicole Tadros, Heidi Clarke, Erika Dittmar

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No abstract provided.

Evaluating The Association Between Vasopressin Use And In-Hospital Mortality In Patients With Septic Shock, Michael Pasqualicchio, Heidi Clarke, Jonathan Kline, Payal Patel

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No abstract provided.

Evaluation Of Incidence Of Thrombosis And Bleeding In Medical Floor Covid-19 Patients At A Community Hospital, Giselle Chahili, Frank C. Moreno Exposito, Heidi Clarke, Erika Dittmar

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No abstract provided.

Impact Of A Pharmacist-Driven Methicillin-Resistant Staphylococcus Aureus Nasal Swab Protocol On The De-Escalation Of Empiric Vancomycin In The Setting Of Community Acquired Pneumonia, Grether Hernandez Gama, Winifred Pardo, Wilbert Fuerte, James Adefisoye

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No abstract provided.

Effect Of Epoetin Alfa-Epbx Versus Epoetin Alfa On Hemoglobin Levels In Myelodysplastic Syndromes, Chemotherapy Induced Anemia, And Chronic Kidney Disease, Gabrielle Dubruille, Sigal Nadulek, Anderson Mabour

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No abstract provided.

Optimization Of Drug-Drug Interaction Alerts In An Effort To Reduce Pharmacist Alert Fatigue In A Hospital System, Jose Ojeda, Kristina Lee, Claudia Chang, Frances Ordieres Gonzalez, Aman Rai

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Background/Purpose:

A drug-drug interaction (DDI) occurs when one medication affects either the pharmacokinetics or pharmacodynamics of another medication. DDIs can result in preventable adverse drug events (ADEs), which can cause harm to patients. A clinical decision support (CDS) system is a health information technology system that assists with clinical decision-making tasks. CDS systems are capable of reducing the frequency of preventable ADEs. However, studies have demonstrated that only around 10% of the alerts fired by CDS systems are applicable in all the circumstances they fire, which can lead to clinician alert fatigue. Alert fatigue occurs when both important and non-important …

Risk Of Acute Kidney Injury In Patients Receiving Vancomycin And Piperacillin-Tazobactam Compared To Vancomycin And Cefepime, Viktoria Andonova

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No abstract provided.

Etomidate Use In Septic Patients Requiring Rapid Sequence Intubation, Elizabeth Osmon, Nishika Patel

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No abstract provided.

Calcitonin Prescribing Criteria For The Management Of Hypercalcemia In A Community Hospital, Jessica Hernandez, Radhan Gopalani, Heidi Clarke, Joyce Lee, Alyssa Donadio

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Purpose/Background: Hypercalcemia is a clinical condition in which serum calcium levels exceed the upper limit of normal (>10.5 mg/dL). The most common causes of hypercalcemia are primary hyperparathyroidism and malignancy, however, it can also be caused by vitamin D intoxication, endocrine disorders, and immobilization due to an increase in bone resorption. First-line treatment of hypercalcemia includes hydration with intravenous (IV) normal saline and IV bisphosphonates. Calcitonin (Miacalcin®) is a synthetic hormone with a rapid onset of action and used intramuscularly (IM) or subcutaneously (SQ) as a second-line treatment in the management of hypercalcemia, specifically in severe and in symptomatic …

Evaluating The Association Between Vasopressin Use And In-Hospital Mortality In Patients With Septic Shock, Michael Pasqualicchio, Heidi Clarke, Jonathan Kline, Payal Patel

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Purpose/Background: The Surviving Sepsis Campaign recommends norepinephrine as the first-line vasopressor in patients with septic shock to maintain a mean arterial pressure (MAP) of at least 65 mmHg. The guideline also makes a weak recommendation (2B) to use vasopressin as an adjuvant therapy to raise MAP to goal or to reduce the norepinephrine rate required to maintain the goal MAP. The recommendation is based on conflicting results of the VASST trial that showed no significant difference in 28-day all-cause mortality between patients managed with norepinephrine alone compared to norepinephrine and vasopressin. However, in subgroup analysis, the VASST trial showed mortality …

Evaluation Of Clinical Outcomes Of 4-Factor Prothrombin Complex Concentrate Versus Andexanet Alfa In The Treatment Of Intracerebral Hemorrhage, Eduardo Guizan Corrales, Radhan Gopalani, Heidi Clarke, Jonatha Kline, Felipe De Los Rios La Rosa, Thomas Wolfel

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Purpose: Oral anticoagulants account for up to 20% of intracerebral hemorrhages (ICH) with one-year mortality estimated as high as 54%. Several studies have examined the use of 4-Factor prothrombin complex concentrate (4F-PCC) and andexanet alfa in the treatment of factor Xa associated ICH. High cost burden, lack of clinical outcomes, and risk of thromboembolic events continues to be a major dilemma behind product selection at many healthcare systems. The purpose of this project is to compare clinical outcomes between 4F-PCC and andexanet alfa in the management of patients with ICH secondary to apixaban and rivaroxaban at Baptist Hospital of Miami …

Transition From Fixed-Dosing To Symptom-Triggered Management Of Alcohol Withdrawal Syndrome In The Intensive Care Unit Of A Community Hospital, Marianela Robainas, Heidi Clarke, Claudia Chang, Frances Ordieres Gonzalez, Lorenzo Porras Jr.

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Background/Purpose: In the United States, 2 to 7% of heavy alcohol users admitted to the hospital for general medical care will develop severe alcohol withdrawal (AW) requiring treatment. The most dangerous complications of AW are delirium tremens and seizures. Benzodiazepines (BZD) are considered first-line therapy, with varying modality options available to providers. Fixed-dosing has historically been used to manage AW. However, studies suggest that symptom-triggered therapy (STT) can decrease length of stay and BZD duration of therapy. The purpose of this study was to evaluate the current fixed-dose protocol and outline the transition to STT in the intensive care unit …

Review Of Adjunctive Midodrine To Facilitate Weaning Intravenous Vasopressors In Critically Ill Patients, Claudia Martin Diaz, Heidi Clarke, Payal Patel, Radhan Gopalani, Stephanie Palma

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Background/Purpose: Intravenous (IV) vasopressor agents are mainstay therapy for the management of refractory hypotension in critically ill patients in the intensive care unit (ICU). Patients remain in the ICU for vasopressor administration and monitoring which results in increased length of stay (LOS). Midodrine is an oral alpha-1 adrenergic agonist that causes vasoconstriction and increased blood pressure. It is commonly utilized off-label as an adjunctive therapy to help wean off vasopressors and decrease ICU LOS. Although midodrine offers many benefits, a study by Rizvi, et al stated that inappropriate continuation at hospital discharge resulted in a 1.6-fold higher risk of 1-year …