Pharmacy and Pharmaceutical Sciences Commons^™

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 …

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 …

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 …

Antibiotic Durations For Skin And Soft Tissue Infections In Pediatric Urgent Care Clinics, Megan Hamner, Amanda Nedved, Holly Austin, Donna Wyly, Alaina N. Burns, Diana King, Brian R. Lee, Rana El Feghaly

Posters

Background: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. However, most antibiotic stewardship programs have mainly focused on the latter. Children seen in the ambulatory setting for SSTIs often receive >7 days of antibiotics, although current society guidelines recommend 5-7 days for most diagnoses.


Objective: To determine the baseline percentage of patients receiving antibiotic prescriptions for >7 days for SSTIs in urgent care clinics (UCC)s of a pediatric health system and to evaluate factors that influence providers towards longer durations.


Design/Methods: We built a …

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 …

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 …

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 …

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 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 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, …

Development And Evaluation Of A Diabetes Themed Escape Room For Students Completing An Ambulatory Care Advanced Pharmacy Practice Experience, Katherine Frances Brown

Undergraduate Honors Thesis Collection

Introduction: Escape rooms are a novel form of entertainment that have become increasingly popular in the United States. The idea of an escape room has great potential for educational purposes as well. In professional healthcare schooling, they have been used to supplement what students learn in the classroom. Interactive learning through the use of an escape room has been studied in the setting of pharmacy students completing their third year of traditional didactic learning. As of yet, there is no published literature that analyzes the use of escape rooms in the Advanced Pharmacy Practice Experience (APPE) setting.

Objectives: The primary …

Introduction To Leadership Development Using The "Five Practices" Framework In A Co-Curricular Pharmacy Student-Development Program, Sumyya Wase, Melinda E. Lull

Pharmacy Faculty/Staff Publications

Introduction and leadership framework: With the increased expectation that pharmacy education should prepare students to become pharmacy leaders, schools of pharmacy are struggling to find ways to incorporate leadership topics. One way to incorporate content is to build co-curricular programs that introduce and practice leadership frameworks. The co-curricular program described in this study introduces leadership content using Kouzes and Posner's Student Leadership Challenge. Educational context and methods: Students were offered three workshops developed around the Five Practices framework. Each workshop provided background knowledge before engaging in self-reflection, discussion, and application activities. Students participated in a pre−/post-series assessment of leadership practices, …

Maximize Use Of Library Electronic Resources To Help Students Achieve Better Board Examination Scores Through Libguides And Collaboration With A Pharmacy Educational Specialist, Wendy Wu, Karen Gessler

Library Scholarly Publications

Background

The library subscribes to many e-textbooks and Q-bank tools to facilitate pharmacy students’ preparation of North American Pharmacist Licensure Examination (NAPLEX). Because these resources are included in various subscription packages, making them discoverable and easily accessible are important to make best use of library resources. This poster will discuss how to promote NAPLEX resources using LibGuides and deliver the specially designed quiz assignments to the students at the point of preparation and the collaboration between a librarian and pharmacy educational specialist.

Description

Resources the library subscribes for NAPLEX preparation were selected, organized, and displayed based on faculty recommendation, students' …

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 …

The Effects Of Dexmedetomidine On Preventing/Decreasing Severity Of Delirium When Given To Surgical Intensive Care Unit Patients: A Systematic Review Of Randomized Control Trials, Lindsey Hettish

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The purpose of this systematic review was to integrate research evidence from studies published from 2010 to 2020 on the relationship between administration of dexmedetomidine and severity/prevalence of postprocedural delirium in patients in the surgical intensive care unit. In this review, clinical trial studies were recovered by searching the MEDLINE Complete and PubMed databases and utilizing MeSH terminology search. The MeSH terms utilized to search for applicable articles on PubMed included: “intensive care units” or “critical care” or “critical care nursing”, and “delirium”, “dexmedetomidine”, and “surgical procedures, operative”. On MEDLINE Complete, the search terms utilized were “ICU or intensive care …

Compounded Gabapentin For Felines: Associated Metabolic Processes And Analysis Of Potency, Johnny Altwal

Student Scholar Symposium Abstracts and Posters

Pharmaceutical compounding provides pharmacists and clinicians the opportunity to create unique drug formulations that are better suited to a specific patient’s needs. This is especially prevalent in veterinary medicine where clinicians treat a variety of maladies in a large number of species, thereby requiring unique formulations to more easily deliver drugs to animals. Several examples of compounded veterinary formulations with sub-therapeutic potencies have been published, but none examine compounded gabapentin. Gabapentin is frequently compounded into an oral suspension for veterinary use from tablets or capsules for the purpose of pain management in felines and other small animals. The project’s goals …

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.

Computational Design Of Β-Fluorinated Morphine Derivatives For Ph-Specific Binding, Nayiri Alexander, Makena Augenstein, Angelina Sorensen, Matthew Gartner

Student Scholar Symposium Abstracts and Posters

Opioids such as morphine are important pain-relieving drugs but also carry a risk of harmful side effects including addiction. Morphine is active in both healthy and inflamed tissue, however, decreasing the pKa of the biochemically-active amine group can promote selective binding in the more acidic conditions of inflamed tissue and reduce harmful side effects associated with opioids. Herein, we explore the impact of fluorination on the pKa of fluoromorphine derivatives to identify which will bind selectively in inflamed tissue. Theoretical pKa values are determined at the M06-2X(SMD)/aug-cc-pVDZ level of theory to calculate the ΔGaq" …

Multimodal Pain Control In Common Neonatal Surgeries: Post-Operative Pain Protocol Reduces Opiate Exposure And Side Effects, Jamesia Donato, Nefertari Terrill-Jones, Ashley K. Sherman, Warren Teachout, Stephanie Prince, Alexandra Oschman, Daphne Reavey, Darian Younger, Tamorah R. Lewis

Posters

Background: Opioids are the primary post-operative (post-op) analgesic in neonates. Side effects include hypotension, apnea and ileus. Previous studies show IV acetaminophen decreases opiate need in specific populations including cleft palate repair, cardiac surgery. The effect of IV acetaminophen as part of a post-op pain algorithm is not known in common neonatal surgical procedures.


Objective: To determine if (a) a post-op pain algorithm including IV acetaminophen and (b) IV acetaminophen exposure reduces cumulative opioid requirements in neonates undergoing common surgeries in the NICU.


Design/Methods: This is a retrospective cohort study comparing cumulative post-operative opiate exposure between infants with common surgeries …

Pde4 Inhibition: A Novel Therapeutic Strategy In Liver Fibrosis., Mohamed Elnagdy

Electronic Theses and Dissertations

Background: Liver fibrosis is accumulation of extracellular matrix (ECM) proteins due to chronic liver injury. Chronic hepatic damage can occur due to multiple causes including, alcohol, non-alcoholic steatohepatitis and chronic viral hepatitis. Liver fibrosis is a critical problem worldwide due to the extremely high incidence of alcohol associated liver damage and chronic viral hepatitis. Moreover, there is no FDA approved therapy for liver fibrosis. Activation and transdifferentiation of quiecent hepatic stellate cells (HSCs) to myofibroblasts (MFBs) is the main event contributing to liver fibrosis. This process involves two phases, the initiation and the perpetuation phases. Hepatocyte injury and inflammatory response …