Pharmacy and Pharmaceutical Sciences Commons^™

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 …

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, …

Clinical Impact Of An Hiv Specialist Pharmacist Collaborative Practice Agreement: A 1-Year Retrospective Review Of Interventions, Rebekah Bartholomew, Geoffrey L'Heureux, Brent Footer

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

Title: Clinical Impact of an HIV Specialist Pharmacist Collaborative Practice Agreement: a 1-year Retrospective Review of Interventions

Purpose/Background:

HIV continues to be one of the most complex disease states for patients and providers to manage. With new medications and guidelines being routinely updated, ensuring that patients are on optimal anti-retroviral therapy (ART) throughout their lives can be difficult. Previous studies on pharmacist-led HIV services have shown that utilizing a pharmacist to manage ART is beneficial. The purpose of this study is to add to that body of evidence by analyzing the clinical impact of a nascent collaborative practice agreement for …

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 …

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 …

Development And Implementation Of Take-Home Naloxone Kit For Patients Admitted To The Emergency Department Of A Large Tertiary Care Hospital, Myung Seon (Amy) Song, Pamela Levine, Katharine F. Marshall, Chelsea Harmon

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

Title: Development and implementation of take-home naloxone kit for patients admitted to the emergency department of a large tertiary care hospital

Authors: Myung Seon (Amy) Song, PharmD; Pamela Levine, PharmD, BCPS; Katharine F. Marshall, MD; Chelsea Harmon, PharmD Candidate 2020

Background/Purpose: In 2017, the United States Department of Health and Human Services (HHS) declared the opioid epidemic as a public health emergency as more than 70,000 people died from drug overdoses. Approximately 75% percent of unintentional opioid-overdose deaths occurred outside of a medical setting. In order to combat the opioid crisis, the US Surgeon General urged prescribers and pharmacists …

Impact Of Real-Time Antimicrobial Stewardship Team Intervention Versus Conventional Microbiology Reporting On Time To Appropriate Antimicrobial Therapy In Patients With Enterobacterales Bacteremia, Scott C. King, Alyssa B Christensen, Brent Footer, Timothy G. Shan, Kim Health, Ivor Thomas, Margaret Oethinger

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

Scott C. King

Alyssa B. Christensen, Brent W. Footer, Timothy G. Shan, Kim Health, Ivor Thomas, and Margret Oethinger

Impact of real-time antimicrobial stewardship team intervention versus conventional microbiology reporting on time to appropriate antimicrobial therapy in patients with Enterobacterales bacteremia.

Introduction:

The benefit of rapid laboratory speciation combined with real time antimicrobial stewardship team (AMT) interventions has been shown to improve patient outcomes and decrease hospital costs. The Providence Oregon region conducts direct from blood culture matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) identification, which results in decreased time to organism identification. The MALDI-TOF identification has allowed the AMT …

Evaluation Of Late-Onset Sepsis Antibiotic Utilization And Revision Of Empiric Late-Onset Sepsis Antibiotic Prescribing Guidelines, Alex Creevan, Sara Clark, Anavice Jimenez, Michael Garcia

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

Alex Creevan, PharmD

Michael Garcia, PharmD, Angela Roberti, PharmD, Sara Clark, PharmD, Anavice Jimenez, PharmD Candidate

Providence St. Joseph Health, Portland, OR

Evaluation of late-onset sepsis antibiotic utilization and revision of empiric late-onset sepsis antibiotic prescribing guidelines

Neonatal late-onset sepsis (LOS) is commonly defined as an infection occurring after the first 72 hours of life. Late onset sepsis is a common complication of prolonged admission to the neonatal intensive care unit (NICU) and is a major cause of morbidity and mortality. Due to risks associated with LOS, empiric antibiotics can be inappropriately prescribed, which may lead to multi-drug resistant bacteria, …

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 …

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 …

Pharmacoeconomic Impact Of Patient-Centric Oncology Service Model, Kasey Rubin, Samuel Jacobson, Shannon Buxell

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

Kasey Rubin PharmD.

Samuel Jacobson PharmD. BCOP, Shannon Buxell PharmD.

Providence Health & Services, Portland Oregon

Pharmacoeconomic impact of patient-centric oncology service model

Providence Health & Services recently embedded ambulatory oncology pharmacists into the ambulatory oncology clinic setting. The overall purpose of this retrospective study is to quantify the financial benefits of ambulatory oncology pharmacists as well as quantify patient-centric factors through utilization of an onsite specialty pharmacy. This study was submitted and approved by Institutional Review Board. Electronic health records of patients who visited the ambulatory oncology clinic will be retrospectively reviewed over two time periods: 12 months preceding …

Impact Of Clinical Pharmacist Medication Review Upon Enrollment In A Program For All-Inclusive Care Of The Elderly (Pace), Adam Olesen, Kristen Wendell

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

Impact of clinical pharmacist medication review upon enrollment in a Program of All-Inclusive Care for the Elderly (PACE)

Adam Olesen, PharmD, PGY1 Resident
Kristen Wendell, PharmD, BCGP

Providence Elderplace Oregon

Learning Objective:

Describe the interventions and recommendations made by a pharmacist upon enrollment of a new participant at a PACE facility.

Abstract:

Pharmacists have been proven to be beneficial in the transitions of care for high-risk patients with multiple morbidities, such as the reduction of both polypharmacy and thirty-day readmission rates. The objective of this study is to quantify and characterize the total number and type of interventions and recommendations …

Evaluation Of Surgical Antibiotic Prophylaxis At A Large, Tertiary Medical Center, Emily Fox, Brent Footer, Angel Mendez

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

Emily Fox, PharmD, PGY-1 Pharmacy Resident

Brent Footer, PharmD, BCPS; Angel Mendez, Pharmacy Student

Providence Portland Medical Center, Portland, Oregon

Evaluation of surgical antibiotic prophylaxis at a large, tertiary medical center

Surgical site infections (SSI) are a significant cause of morbidity, prolonged hospitalization, and mortality. The cost of a single SSI is estimated to be upward of $25,000 and increases a patient’s length of hospital stay by ~10 days. Our institution has identified inappropriate or less than optimal antimicrobial prophylaxis as a potential contributor in several recent SSI cases. Current literature on this topic has found that there may be …

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 …

Evaluation Of Guideline-Directed Medication Therapy For Heart Failure With Reduced Ejection Fraction Patients At Discharge On 30-Day Readmission Rates At Two Tertiary Healthcare Centers, Jacqueline Hesse, Yan Xu, Meri Slavica, James E. Watkins, Alan Rankin, Joshua Remick

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

Evaluation of Guideline-Directed Medication Therapy for Heart Failure with Reduced Ejection Fraction Patients at Discharge on 30-Day Readmission Rates at Two Tertiary Healthcare Centers

Principal Investigator: Jacqueline Hesse, Pharm.D.

Preceptors: Yan Xu, Pharm.D., BCPS, BCCP; Meri Slavica, Ph.D., BCPS

Pharmacy Student: James Watkins, 2020 Pharm.D. Candidate

Sub-Investigators: Alan Rankin, MD; Joshua Remick, MD

Background:

Heart failure with reduced ejection fraction (HFrEF) is a chronic, progressive disease leading to symptoms such as dyspnea, cough, edema, fatigue, and exercise intolerance. The use of anangiotensin converting enzyme inhibitor (ACEi), angiotensin II receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) in combination with an …

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 …

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 …

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 …