Official Newsjournal of the Illinois Council of Health-System Pharmacists

ICHP KeePosted

December 2017

Volume 43 Issue 10

Print Entire Issue


President's Message








The GAS From Springfield

MarApr 2014 - PAC Raffle

KeePosted Info

Features

Call for Entries: 2014 Best Practice Award

Clinical Practice and Research Network Meeting

What I Learned During My Time with ICHP

Columns

President's Message

Directly Speaking

Educational Affairs

The GAS From Springfield

ICHPeople

Leadership Profile

Medication Safety Pearl

Board of Pharmacy Update

New Practitioners Network

College Connections

Mini-Health Fair at the Indo American Center

Volunteering with Care

APPE Preparation through SSHP Quarterly Journal Club Discussions

Second Annual Student and Pharmacist Mixer

More

Officers and Board of Directors

Welcome New Members!

ICHP Pharmacy Action Fund (PAC) Contributors

Upcoming Events

KeePosted Info




Illinois Council of Health-System Pharmacists
4055 North Perryville Road
Loves Park, IL 61111-8653
Phone: (815) 227-9292
Fax: (815) 227-9294
www.ichpnet.org

KeePosted
Official Newsjournal of the Illinois Council of Health-System Pharmacists

EDITOR
Jacob Gettig

ASSISTANT EDITOR
Jennifer Phillips

MANAGING EDITOR
Scott Meyers

ASSISTANT MANAGING EDITOR
Trish Wegner

DESIGN EDITOR
Amanda Wolff

ICHP Staff
EXECUTIVE VICE PRESIDENT

Scott Meyers

VICE PRESIDENT - PROFESSIONAL SERVICES
Trish Wegner

DIRECTOR OF OPERATIONS
Maggie Allen

INFORMATION SYSTEMS MANAGER
Heidi Sunday

CUSTOMER SERVICE AND
PHARMACY TECH TOPICS™ SPECIALIST

Jo Ann Haley

ACCOUNTANT
Jan Mark

COMMUNICATIONS MANAGER
Amanda Wolff

LEGISLATIVE CONSULTANT
Jim Owen

ICHP Mission Statement
Advancing Excellence in the Practice of Pharmacy

ICHP Vision Statement
ICHP dedicates itself to achieving a vision of pharmacy practice where:
  • Pharmacists are universally recognized as health care professionals and essential providers of health care services.
  • Patients are aware of the training, skills, and abilities of a pharmacist and the fundamental role that pharmacists play in optimizing medication therapy.
  • Formally educated, appropriately trained, and PTCB certified pharmacy technicians manage the medication distribution process with appropriate pharmacist oversight.
  • Pharmacists improve patient care and medication safety through the development of effective public policies by interacting and collaborating with patients, other health care professionals and their respective professional societies, government agencies, employers and other concerned parties.
  • Evidence-based practices are used to achieve safe and effective medication therapies.
  • There are an adequate number of qualified pharmacy leaders within the pharmacy profession.
  • Pharmacists take primary responsibility for educating pharmacy technicians, pharmacy students, pharmacist peers, other health professionals, and patients about appropriate medication use.

KeePosted Vision
As an integral publication of the Illinois Council of Health-System Pharmacists, the KeePosted newsjournal will reflect its mission and goals. In conjunction with those goals, KeePosted will provide timely information that meets the changing professional and personal needs of Illinois pharmacists and technicians, and maintain high publication standards.

KeePosted is an official publication of, and is copyrighted by, the Illinois Council of Health-System Pharmacists (ICHP). KeePosted is published 10 times a year. ICHP members received KeePosted as a member benefit. All articles published herein represent the opinions of the authors and do not reflect the policy of the ICHP or the authors’ institutions unless specified. Advertising inquiries can be directed to ICHP office at the address listed above. Image disclaimer: The image used in the Pharmacy Tech Topics™ advertisement is the property of © 2014 Thinkstock, a division of Getty Images.

Copyright © 2014, Illinois Council of Health-System Pharmacists. All rights reserved.




Features

Call for Entries: 2014 Best Practice Award

The objective of the Best Practice Award program is to encourage the development of innovative or creative pharmacy practice programs or innovative approaches to existing pharmacy practice challenges in health systems within the state of Illinois.

Applicants will be judged on their descriptions of programs and practices employed in their health system based on the following criteria:

  • Innovativeness / originality
  • Contribution to improving patient care
  • Contribution to institution and pharmacy practice
  • Scope of project
  • Quality of submission

If you have any questions related to the program please contact Trish Wegner at trishw@ichpnet.org.

Past winners include:

2013
Nicole Rabs, Pharm.D., Sarah M. Wieczorkiewicz, Pharm.D., BCPS, Michael Costello, PhD, and Ina Zamfirova, BA

“Development of a Urinary-Specific Antibiogram for Gram Negative Isolates: Impact of Patient Risk Factors on Susceptibility”

2012
Kathryn Schiavo, Pharm.D.; George Carro RPh, MS, BCO; Abigail Harper, PharmD, BCOP; Betty Fang, PharmD; Palak Nanavati, PharmD
“Outpatient Oncology Treatment Center Approach to Enhancing Continuity of Care Related to Dispensing Oral Chemotherapeutic Agents”

2011
Fatima Ali, PharmD; Sarah Wieczorkiewicz, PharmD, BCPS; Jill Cwik, PharmD; Robert Citronberg, MD, FACP, FIDSA
“Procalcitonin-Guided Duration of Antimicrobial Therapy for the Treatment of Lower Respiratory Tract Infections”

Online entry formhttp://www.ichpnet.org/professional_practice/best_practices/ 
Submission deadline: July 1, 2014

Eligibility
Applicants must be a member of ICHP practicing in a health system setting. More than one program can be submitted by a health system for consideration. Past submissions may be re-submitted if not previously given the award. Any new data should be included.

Instructions for preparing manuscript
Each entry for the Best Practice Award must include a manuscript prepared as a Word document, double-spaced using Times New Roman 12-pitch type. A header with the paper title and page number should appear on each page. The manuscript should not exceed 2000 words in length (not counting references), plus no more than a total of 6 supplemental graphics (tables, graphs, pictures, etc.) that are relevant to the program. Each picture, graph, figure, and table should be mentioned in the text and prepared as a separate document clearly labeled.

The manuscript should be organized as a descriptive report using the following headings:

  • Introduction, Purpose, and Goals of the program
  • Description of the program
  • Experience with and outcomes of the program
  • Discussion of innovative aspects of programs and achievement of goals
  • Conclusion

Format
Submissions will only be accepted via online submission form. The manuscript will be forwarded to a pre-defined set of reviewers. Please do not include the names of the authors or affiliations in the manuscript to preserve anonymity.

All applicants will be notified of their status within three weeks of the submission deadline. Should your program be chosen as the winner:

  • The program will be featured at the ICHP Annual Meeting. You will need to prepare a poster to present your program and/or give a verbal presentation. Guidelines will be sent to the winner.
  • You may be asked to electronically submit your manuscript to the ICHP KeePosted for publishing.
  • You will receive a complimentary registration to the ICHP Annual Meeting, recognition at the meeting and a monetary award distributed to your institution.

Non-winning submissions may also be considered for publication in the ICHP KeePosted, but your permission will be obtained beforehand.






Clinical Practice and Research Network Meeting
Transition Between Hospital and Nursing Home

It’s time for the next CPRN program. Based on requests from our previous CPRN meeting, the topic will be on transitioning between the hospital and nursing home. The location is conveniently located approximately 19 miles from both downtown Chicago and the western suburbs; easily accessible off of either I-294 or I-55.

Three excellent facilitators will tackle the issue of communication between the hospital and nursing home or rehab facility staffs.

Don’t miss out on this informational and networking opportunity, register now.

Please join us for a special CPRN meeting on April 17th. Discuss with other colleagues topics and issues affecting you in your practice of pharmacy today. Enjoy networking over dinner together. The atmosphere is relaxed and the food and fellowship are great.

We will then discuss issues related to transition of care/medication reconciliation.  

For those of you who do not live in Chicago or surrounding areas, we will make arrangements for you to dial in to the discussion. Please let me know if you are interested in dialing in by e-mailing me at trishw@ichpnet.org by April 10th. I will then give you the dialing instructions. We ask that those who live in the Chicago area come to the meeting location as it aids in better discussion.

Facilitators:

Nitika Agarwal, Pharm.D
Director of Pharmacy
Marianjoy Rehabilitation Hospital
Wheaton, IL

Rick Rondinelli, R.Ph.
President-CEO
In Touch Pharmaceuticals, Inc.
Valparaiso, IN  
(In Touch Pharmaceuticals is a long term care pharmacy for several facilities)

Rebecca Tomich, PharmD, CGP
Consultant Director
In Touch Pharmaceuticals
Valparaiso, IN

Location:

Adventist LaGrange Memorial Hospital
Dixon B Conference Rooms
5101 South Willow Springs Rd, La Grange, IL
(708) 245-9000
Click here for directions.

Parking: Free parking is available on the hospital campus.
 
Time: 6:00 pm - 8:30 pm - Dinner will be served.

Cost: Your credit card will be charged after the event. Cost will be under $30. Your credit card will be billed following the event but failure to attend with a confirmed reservation will incur the charge. (Note that parking is on your own, though you will receive discounted parking as stated above.)

Registration: Please register by 9 am April 14, 2014 here http://www.ichpnet.org/calendar/event.php?ce_id=364
Non-members are welcome to attend the CPRN meeting.

We look forward to another great discussion!
 
Trish Wegner, BS Pharm, Pharm.D., FASHP
TrishW@ichpnet.org 




What I Learned During My Time with ICHP

by Amanda Peerboom, 2014 PharmD candidate, Chicago State University College of Pharmacy

I really enjoyed the time I was able to spend with the staff of the Illinois Council of Health-System Pharmacists located in Loves Park, Illinois. Everyone I met and worked with was very friendly and welcomed me into the office. In the beginning, I was mainly doing a lot of reading of different documents and information to become more familiar with what ICHP does. 

The first main project that I worked on actually continued throughout the six weeks I spent there. I used the Illinois General Assembly website to search for bills that related to pharmacy and put them in a chart that was used to help follow those bills. My preceptor, Scott Meyers, used the more important bills to include in the Leg Day 101 presentations that were done at the pharmacy schools in Illinois. I was able to go along to most of the Legislative Day 101 presentations and visit most of the pharmacy schools in the Chicago area. 

This rotation also gave me a few writing opportunities. I was able to write two articles for KeePosted and an essay that was used for a Career Center email blast.

The other pharmacist that works in the office, Trish Wegner, showed me the process that is done in order for presentations to receive ACPE accreditation for continuing pharmacy education credit. I was able to practice going through the steps online and submit information that was needed for some presentations that sought CE accreditation. 

Recently there was an article in the Chicago Tribune that discussed what happened at an Illinois Board of Pharmacy meeting. I was given the opportunity to attend this meeting with Scott, and he told me that the meeting had more people attend than any previous board meeting he had attended, and it was a very interesting meeting because of the discussion about pharmacist involvement with medical marijuana that occurred during the visitor comment time. 

I was also given the opportunity to sit in on a dean’s advisory meeting, since Scott is on the advisory committee for most pharmacy schools in Illinois. It was very interesting to listen to the topics that were discussed during a meeting like this, and the advice the advisory team had for the school. 

Even though it was a bit intimidating, I was able to attend a Director’s dinner, which included the pharmacy directors of the Chicago area. It was nice to be able to meet them, have dinner with them, and casually discuss many topics. 

Scott Meyers was a great preceptor, and I am grateful I was able to have him as a preceptor. Again, I am glad I was given the opportunity to be able to spend those six weeks with such fun and friendly people at the ICHP office. I encourage students to take this rotation with Scott, because it is interesting to see what goes on behind the scenes. It is a great learning experience, shows you another side of pharmacy including what goes into planning events and everything else this organization does for health-system pharmacy. 




Columns

President's Message
Doing the Right Thing

by Mike Fotis, ICHP President

Pharmacists are particularly adept when it comes to figuring out the most efficient ways to do things. It seems like whenever I introduced a new policy or practice to my pharmacy department colleagues, there would be dozen of suggestions for a very efficient way to get this new job done. Most of these suggestions were offered before I was even close to finishing the introduction! It is so easy to start out with the intention to do the right thing and end up instead doing the most efficient thing. I think as pharmacists we need to be alert to this tendency and always keep our guard up. 

One way to protect against the tendency to do the most efficient thing is to build in a bias in favor of pushing the envelope rather than in favor of maintaining the status quo. After all, how safe is the status quo? Can we best secure our future by protecting the status quo, or instead by having a focus on protecting our patients? If our focus was to push the envelope to protect patients, would we have looked differently at recent healthcare initiatives such as the Risk Evaluation and Mitigation Strategies (REMS) developed by the FDA; at Medication Reconciliation Strategies promoted by The Joint Commission (TJC); or even medication teaching? The REMS program proposed by FDA was an opportunity for pharmacists to take the initiative to enhance medication safety and not intended to be just another bureaucratic obstacle to efficiency. Asking a patient to sign a register to verify they don’t want to speak to a pharmacist doesn’t achieve any goals to educate patients about their medications. Of course, time is often used to justify why certain processes were put into place. However, did we stop to consider the risk we were taking by not enhancing our responsibilities instead of substituting with processes aimed only at increasing efficiency? What did it cost us in terms of our future by maintaining the status quo? 

ASHP based the recent Pharmacy Practice Model Initiative (PPMI) around 7 basic goals. The first goal is “Every Patient Deserves a Pharmacist”, and the 7th and final goal is “The Pharmacist is First Responsible to the Patient”. Keeping these two goals in mind can go a long way toward guiding us to Do the Right Thing

Let’s apply this discussion to sterile manufacturing, which I define as using non-sterile products in the preparation of a medication to be delivered by injection. Our first question is often, “What is the stability of this preparation?” However, determining whether the preparation is stable or not does not mean we are doing the right thing. Using a medication that is intended for oral or topical patient administration to prepare a product for parenteral patient administration is about as far “off-label” as a medication use can be…unless we include a chemical in this compounded parenteral preparation that is not even approved for human consumption. In this case, the issue is far beyond that of simple off-label use. I think a REMS strategy that all of us should insist on is a process that begins with the assumption that all such medications are NOT on our formulary, whether we have determined if they can be used to compound a stable preparation or not. I believe that any proponent of adding a preparation for injection that starts with non-sterile compounds needs to present his/her rationale including evidence of efficacy and safety to the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee should determine if there is sufficient evidence to support adding this preparation to the formulary. As a final step, before we dispense such a product, we need to determine if the intended patient has a compelling indication to use this preparation. That is, have conservative measures and FDA approved treatments been tried and failed or are there contraindications for using FDA approved treatments in this patient before using the newly compounded preparation? After all, a pharmacist is first responsible to the patient, and I think any of the families of patients who developed central nervous system infections from contaminated compounded IV preparations would prefer that we take these measures very seriously. 

My final thought: What can students and pharmacy residents do? My suggestions: 1) Support ICHP in our efforts to push the envelope and to Do the Right Thing. 2) Choose your first job very carefully. It is so important to work at a site that is dedicated to pushing the envelope and believes that we are first responsible to our patients. It is true that these jobs are more demanding, but the cost of maintaining the status quo is too high. 3) Finally, learn about Practice Based Learning (PBL). Because after completing school or your residency, that is exactly what you should be doing. Work out your own plan for continuous professional development in conjunction with ICHP to be successful. 

Pushing the envelope involves risk, which is scary. Maintaining the status quo for the rest of your career is even scarier. 




Directly Speaking
All You Really Have To Do Is Ask!

by Scott A. Meyers, Executive Vice President

During a recent Strategic Planning Committee conference call, the group began discussing the different levels of member-engagement we experience here at ICHP. The group identified 5 levels of member engagement, and I’ll list them first together and then describe them individually. None of these terms are meant to be derogatory, and once you read each description, it should be clear how they came to be named.
  • Checkbook members
  • Users
  • Micro-engaged
  • Engaged
  • Leaders
Like most associations a significant percentage of members are what is called “Checkbook” members. This term is used across the association management field and again is not meant to be derogatory but merely describes those members who write their annual dues check and then that’s really all we see or hear from them each year. The term is actually a little dated because fewer and fewer members write checks, but the point is still the same. The “Checkbook” members may read KeePosted and access the website, but they don’t come to meetings or participate on committees. We hardly know they are there or if there is anything more we can do for them. “Checkbook” members are critically important when ICHP speaks with legislators and regulators and uses membership numbers to describe the organization.

The next group, called “Users”, use our products and services such as the Annual and Spring Meetings, the toolkits on the website and may participate in Legislative Day or local affiliate meetings. Again, participation is limited to using products and services and not on creating, reviewing or revising those products or services. “Users” are equally important because they bring traffic to our exhibit halls, fill seats in our educational sessions and hopefully take back information to their worksites to share with colleagues and hopefully improve patient care.

The third group are the “Micro-engaged”. These members respond to our surveys and may serve in an ad hoc position like poster reviewer, poster judge, article reviewer, or article editor but still don’t serve on a regular basis on any one committee or division. Their contributions are important, and these contributions are the first step on the true engagement ladder. The “Micro-engaged” are critical players for the Council as they take on tasks that might otherwise go unfinished or perhaps be the one-too-many task that burns out an “Engaged” volunteer. Plus the “Micro-engaged” bring special knowledge to the table from time to time that proves very useful to ICHP.

The “Engaged” member serves regularly as a member of a committee or division within ICHP. This includes the Divisions of Educational Affairs, Government Affairs, Marketing Affairs, Organizational Affairs or Professional Affairs or as a member of the New Practitioners Network, Strategic Planning, Annual Meeting Planning, Spring Meeting Planning or Technology Committees of ICHP. These members are a part of the broad spectrum of ICHP activities and are determined to participate all year long. The “Engaged” are the back bone of the Council’s activities!

The final level of membership engagement are the “Leaders”. These are the members of the Board of Directors, the Executive Boards of the Student Chapters, the Past Presidents, the ICHP Pharmacy Action Fund Board of Trustees, and the members of the ICHP Building Committee. These are members who have served for several years at the “Engaged” level and have decided not only to serve the organization but to help lead it forward as well. Without the “Leaders”, we don’t move forward; we don’t provide new products and services, and the utility of what we do provide quickly becomes outdated.

Take a minute and consider at what level of engagement you are currently, and then, where you would like to be. And when considering your level, remember that you should consider yourself at the highest level of your involvement within the past year. In other words, if you are currently on a division or committee, you are “Engaged” even though you may also consider yourself a “User” and “Micro-engaged” because you go to the Annual Meeting and may have taken on an ad hoc task within the past year. Or if you are not on a division or committee but have served in an ad hoc capacity in the last year, you are “Micro-engaged” even though you may also consider yourself a “User”.

Now, ask yourself if you would like to move up a level or more. If the answer is yes, all you have to do is ask! Send an email request to me at the ICHP office or if you know exactly what position or task you want to take on and you know who leads that effort, send them and email and ask to be added to whatever the group or task is. ICHP does not limit the number of members who may participate in most activities. And even if there is a limit because of the size of the task at hand, we very seldom reach that limit. That’s not to say that we are in drastic need of volunteers but rather, our philosophy is that there’s always room for one more.

But many of you are thinking, I like being a … “Checkbook” member, “User”, “Micro-engaged”, “Engaged”, or “Leader”, and I’m happy right where I am. Well, there’s another opportunity just for you. We want you to feel like “all you have to do is ask” a pharmacy colleague if they would like to move up to your level of engagement and join you in volunteering with the Council. In fact, this “ask” is even more important than someone asking to be a part of a committee or taking on a specific task. Asking to be a part of something can be very hard to do. When you ask to join an activity there is always the chance you’ll be rejected. But if a colleague invites you to join an organization or activity within an organization, the chances of rejection are diminished and the feeling of being wanted and needed is a great confidence builder. And yes, even the “Checkbook” members should invite their non-member colleagues to join the Council to become new “Checkbook” members to add to our numbers, share KeePosted and the website, and maybe move up the engagement ladder together. The “Buddy-System” has always been a great way to step out and explore.

Many hands make the load light, not to mention a lot more fun! So whether you are asking to join in or asking someone else to join you, all you really have to do is ask.





Educational Affairs
ICHP 2014 Spring Meeting Poster Abstracts

ENCORE
  1. Alendronate and Clostridium difficile infection: An unusual suspect identified by the FDA Adverse Event Reporting System
  2. The Effectiveness of a Pharmacist-run Patient Aligned Care Team (PACT) Telephone Clinic Managing Chronic Disease States and Therapeutic Monitoring at a Veterans Affairs Medical Center
  3. Pharmacists’ role in emergency airway responses
  4. Safety, effectiveness and cost analysis of rivaroxaban versus fondaparinux for thromboprophylaxis after joint replacement at an inpatient rehabilitation facility
  5. Intravenous batched medication waste management: a retrospective efficiency review
  6. Improvement of medication delivery through the use of decentralized pharmacy technicians

ORIGINAL
  1. Student Capstone Research Experience: A Five Year Perspective
  2. Prospective order review by Emergency Department (ED) pharmacists: Enhancing patient safety and aligning with regulatory compliance standards
  3. Evaluation of the accuracy and completeness of nurse driven admission medication histories after modifications to current practice
  4. Improving the Pharmacist Orientation Program at a Large Medical Center
  5. Impact of pharmacist led discharge counseling on 30-day readmissions and emergency department visits
  6. Pharmacist Involvement in the Medication Management of an Acute Care of Elderly (ACE) Unit
  7. Evaluation of an institution specific cellulitis antimicrobial guideline
  8. Pharmacist-led development of an interdisciplinary pain management team within a community hospital setting
  9. Clinical Outcomes in HIV+ Adults with K65R Mutation
  10. Evaluating the clinical impact of a computerized physician order entry (CPOE) sepsis bundle order set
  11. Characterization of Drug Shortages by Mining a Drug Information Service Database
  12. Nuts and bolts of building new service-lines: Blueprints for establishing an outpatient pharmacy
  13. Secondary Prevention Medication Prescription Filling Following an Acute Ischemic Stroke and the Relationship to Hospital Readmission Rates

STUDENT
  1. Evaluating Hospitalization Rates of Elderly Patients with Diabetes: An Observational Assessment Targeting Antidiabetic Medication Safety
  2. Achievement of A1C, Lipid, and Blood Pressure Goals in a Free Community Clinic
  3. Evaluating hospitalization rates of elderly patients with potential medication-induced geriatric syndromes: An observational assessment targeting safe prescribing practices
  4. Extended-infusion piperacillin-tazobactam vs. traditional dosing for improving patient outcomes
  5. Evaluating the impact of a follow-up telephone call program in recently discharged heart failure patients on 30 day readmission rates
  6. Illinois Prescribers’ Attitude on the Utility of Medical Marijuana

PLATFORM PRESENTATION
  1. Comparison of zolpidem to other drugs associated with falls in hospitalized patients
  2. Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Inpatient Treatment: A Retrospective Chart Review


ICHP Poster Presentations - Encore #1

Category: Encore

Title: Alendronate and Clostridium difficile infection: An unusual suspect identified by the FDA Adverse Event Reporting System

Purpose: Exposure to systemic antimicrobials is considered a major risk factor for Clostridium difficile infections (CDI). Recent data have shown possible associations between the risk of CDI and exposure to non-antimicrobial medications.

Methods: We performed a quantitative analysis of alendronate and adverse reactions of CDI in the FDA adverse event reporting system (FAERS) within the United States. All adverse event reports (AER) defined by the Medical Dictionary for Regulatory Activities (version 15.1) as “clostridium colitis” or “pseudomembranous colitis” between January 1999 and December 2011 were included. The proportional number of CDI reports associated with alendronate was determined using the information component (IC). The IC provides information on disproportionate reporting. A positive IC indicates a disproportionately high rate of reporting for a specific adverse event, and an IC >2 is considered to be a significant signal.

Results: During the study period, a total of 3,188,212 AER were submitted, 4,052 were of CDI. There were 18,854 total alendronate AER. The IC for alendronate reports and CDI in Q2 of 2010 was 4.86. The IC continued to be positive after this quarter indicating that the proportion of CDI reactions among alendronate reports was disproportionately high over this time period.

Conclusions: Whereas antimicrobial use is closely linked with CDI, the link between bisphosphonates and CDI is unusual. Bisphosphonates are minimally absorbed, antiresorptive agents with prolonged half-lives. Although agents of this class are used for osteoporosis, anti-infective properties have been identified. Further evaluation of the association between alendronate and Clostridium difficile is warranted.

Authors: Melinda M. Soriano, PharmD, BCPS Infectious Diseases Fellow**; Kevin W. McConeghy, PharmD, BCPS Infectious Diseases Fellow; Larry H. Danziger, PharmD, FIDSA Professor
University of Illinois at Chicago

**=submitting author; *=ICHP member


ICHP Poster Presentations - Encore #2

Category: Encore

Title: The Effectiveness of a Pharmacist-run Patient Aligned Care Team (PACT) Telephone Clinic Managing Chronic Disease States and Therapeutic Monitoring at a Veterans Affairs Medical Center

Purpose: The purpose of this study was to evaluate the effect of pharmacist-run telephone clinics managing type 2 Diabetes Mellitus (DM), hyperlipidemia (HL), and/or hypothyroidism.

Methods: This was a retrospective, electronic chart review of patients referred to the pharmacist-run telephone clinic from November 1, 2010 to July 1, 2011. Patients were > 18 years old, diagnosed with DM, HL, and/or hypothyroidism, and with > 50% interventions made by a pharmacist via telephone. The primary endpoints were changes in hemoglobin A1c (HgbA1c), low density lipoprotein (LDL), and thyroid stimulating hormone (TSH) from pre-intervention to post-intervention. Secondary endpoints included: adverse drug reactions, changes in total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), thyroid panel (Free T4, T3). Diabetic indices, diet and exercise counseling, average time followed in clinic, and appointment compliance were also evaluated.

Results: After telephone interventions made by a pharmacist, patients had a mean reduction in HgbA1c of 2.4% (p< 0.0002), LDL of 27.5 mg/dL (p < 0.0001), TSH of 16.4 uIU/mL, TC of 30.1 mg/dL, but no significant changes in TG, HDL, or Free T4 levels were noted. Majority of patients (82%) did not report any adverse effects with treatment, 78% were compliant with appointments, and 57% with medications. All the DM indices were addressed at least 50% of the time.

Conclusions: In majority of patients, statistically significant improvements in DM, HL, and hypothyroidism endpoints were seen. This study demonstrated that interventions by pharmacists in telephone clinics resulted in improved treatment of these disease states.

Authors: Tania George John, PharmD, BCACP**, Clinical Pharamacy Specialist Sindhu; Abraham, PharmD, BCPS, Clinical Pharmacy Specialist; Brett Geiger, PharmD, Associate Chief of Pharmacy, Clinical Services; Helen Kasimatis, PharmD, Clinical Pharmacy Specialist; Judith Toth, PharmD, CGP, CDE, Clinical Pharmacy Specialist
Jesse Brown VA Medical Center

**=submitting author; *=ICHP member



ICHP Poster Presentations - Encore #3

Category: Encore

Title: Pharmacists’ role in emergency airway responses

Purpose: The objective of this study is to assess the implementation of pharmacist participation in emergency airway responses at a large, academic, teaching hospital. This study evaluates pharmacists’ involvement and interventions during rapid sequence intubations, and the perceptions of other healthcare providers regarding pharmacists’ involvement.

Methods: The study was approved by the institutional review board. A pharmacy clinical surveillance system was utilized for documentation and data collection. Examples of documented parameters include: response time, arrival of pharmacist in comparison to respiratory care, whether anesthesia was alerted prior to pharmacy, time spent at the airway, pharmacist-driven interventions, and whether the intubation was deemed unsuccessful or progressed to a cardiac arrest. Additionally, specific interventions were documented on. A survey was also distributed to relevant healthcare providers to evaluate their perceptions of pharmacy participation.

Results: From August 14, 2013 to October 19, 2013, a total of 169 emergency airway responses occurred, 59 in which data was documented, collected, and analyzed. The majority of pharmacist response times were less than two minutes and the total duration of time spent at the intubation was generally five to fifteen minutes. Four interventions were documented and described. Survey results show that anesthesia generally agrees that “pharmacists are necessary members of the emergency airway response team”.

Conclusions: Pharmacists may be a valuable addition to airway response teams. They have opportunities to make interventions at airway responses such as a selection of agents used, dose-related recommendations and prevention of adverse drug events.

Authors: Gabriela Dimitrievski, PharmD, PGY1 Pharmacy Practice Resident1; Whitney Palecek, PharmD, PGY1 Pharmacy Practice Resident**1; Kimberly E. Levasseur-Franklin, PharmD, BCPS, Pharmacy Practice Coordinator/ICU Team Leader*1,2; Abbie Lyden, PharmD, BCPS, Clinical Pharmacist, Emergency Medicine1,3
1 - Northwestern Memorial Hospital; 2 - Midwestern University Chicago College of Pharmacy; 3 -Rosalind Franklin University of Medicine and Science

**=submitting author; *=ICHP member



ICHP Poster Presentations - Encore #4

Category: Encore

Title: Safety, effectiveness and cost analysis of rivaroxaban versus fondaparinux for thromboprophylaxis after joint replacement at an inpatient rehabilitation facility

Purpose: The purpose of this study is to compare safety, effectiveness, and cost of the new oral Factor Xa inhibitor rivaroxaban to fondaparinux, an injectable anticoagulant, for prevention of venous thromboembolism (VTE) after hip or knee arthroplasty within an inpatient rehabilitation facility (IRF). Rivaroxaban is the first available orally active anticoagulant that does not require dose monitoring.

Methods: The IRB approved this retrospective cohort study at a 128 bed IRF. Data was collected on the patient sample of convenience who were either status post total knee arthroplasty or total hip arthroplasty, admitted over a 24 month period (January 2011 to December 2012). All identified patients received either fondaparinux 2.5 mg subcutaneously or rivaroxaban 10 mg orally once daily. Primary effectiveness outcomes were composite of any deep venous thrombosis (DVT), non-fatal, symptomatic, objectively confirmed pulmonary embolism (PE); and all-cause mortality. Primary safety outcomes were any major or non-major bleeding events. Cost comparison was done by calculating acquisition cost of rivaroxaban dispensed and the equal number of fondaparinux doses.

Results: Analysis of 314 patient records (199 patients on rivaroxaban and 115 patients on fondaparinux) indicated no PE events during their IRF stay. No VTE occurred in the patients prescribed rivaroxaban compared to 0.87% in fondaparinux group. Major bleeding events occurred in 0.5% of patients prescribed rivaroxaban compared to 1.74% in fondaparinux group. Minor bleeding events occurred in 1% of patients prescribed rivaroxaban compared to 1.74% of patients in fondaparinux group. Direct acquisition cost comparison revealed savings of approximately 52% ($13,000) in the rivaroxaban group. Event related costs were not analyzed.

Conclusions: In this study rivaroxaban provided a safe and effective alternative to fondaparinux for prevention of VTE in post-operative patients undergoing rehabilitation at IRF. Use of rivaroxaban over fondaparinux resulted in significant cost savings in terms of drug acquisition costs. Rivaroxaban was also favorable compared to subcutaneous fondaparinux due to ease of drug administration.

Authors: Nitika Agarwal, PharmD, Director of Pharmacy**; Mary Mekheil, PharmD, Clinical Pharmacist; Nadia Tancredi, RPh, Clinical Pharmacist; Abhishek Reddy, DO, APM&R Resident; Noel Rao, MD, Medical Director
Marianjoy Rehabilitation Hospital

**=submitting author; *=ICHP member


ICHP Poster Presentations - Encore #5

Category: Encore

Title: Intravenous batched medication waste management: a retrospective efficiency review

Purpose: Batch production of IV medications, while contributing to efficiency, can potentially result in excessive medication waste. Efficient and accurate reporting along with timely monitoring of batch production waste allows adjustments in production to be made to ensure cost-effective operations. To improve upon our batch waste monitoring process, we undertook an analysis of a waste monitoring system that utilizes the EMR and batch production records.

Methods: The electronic medical record (EMR) and batch production records were utilized to calculate an anticipated waste level. Waste was defined as the difference between the total number of units manufactured and the total number of units charged to patients over a defined time period. Due to a large discrepancy between our current methods of batch waste monitoring as compared to the EMR method, it was decided to implement a one-month pilot study to validate the accuracy of this process.

Results: After assessing 19 batched medications, we stratified the top 5 with highest volume produced comparing the EMR method versus the pilot study. There was greater than 100% variance between both methods with all five medications reported.

Conclusions: The EMR method overestimated true waste when compared to the pilot study. There are many limitations to both methods presented such as human error and variance in medication expiration. Although the proposed EMR method did not capture the amount of medication waste, the study identified avenues for improvement to implement an efficient and accurate electronic medication waste monitoring system.

Authors: Rhynn J. Malloy, PharmD**; Brian Hoff, PharmD**; Michelle Loose, CPhT; Ana Fernandez, CPhT; Michael Postelnick, RPh, BCPS AQ ID*
Northwestern Memorial Hospital

**=submitting author; *=ICHP member



ICHP Poster Presentations - Encore #6

Category: Encore

Title: Improvement of medication delivery through the use of decentralized pharmacy technicians

Purpose: Previous literature demonstrates the link between uninterrupted nursing time and safe medication administration. Interruptions lead to clerical errors and unclear communication between nursing staff and pharmacy. To maximize efficiency, the use of decentralized pharmacy technicians was investigated.

Methods: This two week prospective study took place between 09/09/2013 and 09/20/2013. Two pharmacy students acting as decentralized pharmacy technicians were placed on a medicine floor. The control unit had similar baseline characteristics as the intervention unit. Medication requests for both units were recorded, as well as a pre and post intervention nursing satisfaction survey. The primary outcome was the number of medication requests (MRs). Secondary outcomes included the number of late doses and the nursing satisfaction with pharmacy.

Results: Medication requests on the intervention unit decreased compared to the control unit during the study period. During the last week of the study period, there were 4 MRs in the intervention unit compared to 34 in the control group (p=0.002, 95% CI [13.33-37.17]). In the intervention unit, the average number of late doses per patient decreased from 36 at baseline to 25 during the study. Finally, nursing satisfaction with pharmacy services improved by 32% during the intervention period.

Conclusions: The results suggest medication requests can be decreased by using decentralized pharmacy technicians. Beneficial results with respect to the timeliness of medication administration and nursing satisfaction with pharmacy services were also seen.

Authors: Brett James Pierce, PharmD, PGY1 Resident1*; Cynthia Herrera, PharmD, PGY1 Resident1; Mary Margaret Lenefsky, PharmD, PGY1 Resident1**; Puja Chandrakant Patel, PharmD Candidate 20142; Dipa Vijay Shah, PharmD Candidate 20142; Noelle RM Chapman, PharmD, BCPS, Pharmacy Manager*1; Michael John Postelnick, RPh, BCPS, AQID, Pharmacy Manager*1
1 - Northwestern Memorial Hospital; 2 - University of Illinois at Chicago College of Pharmacy


**=submitting author; *=ICHP member



ICHP Poster Presentations - Original #1

Category: Original

Title: Student Capstone Research Experience: A Five Year Perspective

Purpose: To provide a five year overview of student capstone projects focusing on the type of study design, origin of mentors and professional dissemination of the project information.

Methods: The capstone research experience consists of four components: the Advanced Pharmacy Practice Experience (APPE) Preparation class, a five week APPE rotation to complete the research under the guidance of a mentor, a written manuscript and a poster presentation. A log was kept from 2009 through 2013 on the type of study design for each project, practice site for the mentor and whether the capstone poster was presented at a professional meeting or if the written manuscript was published in a professional journal.

Results: Over the five years, 389 students completed the capstone experience. The study designs included: survey 149 (38%), retrospective chart review 129 (33%), business plan format 65 (17%), bench research 20 (5%) and other 26 (7%). A total of 223 (57%) students chose a faculty member as a mentor while 166 (43%) selected non-faculty mentors. There were 62 (15%) student posters presented at national meetings and 47 (12%) posters at state or regional meetings for a total of 109 (28%). To date, 6 (2%) of the capstone written manuscripts have been published in the literature.

Conclusions: The student capstone projects predominately use either a survey or retrospective chart review as a study design. Students slightly favor faculty over non-faculty as mentors. Over 20% of capstone projects have been presented at professionals meetings or published.

Authors: Cynthia Ann Wuller, BS Pharmacy, MS Pharmacy Admininstration, Clinical Professor, Capstone Coordinator**
St. Louis College of Pharmacy; Southern Illinois University Edwardsville

**=submitting author; *=ICHP member



ICHP Poster Presentations - Original #2

Category: Original

Title: Prospective order review by Emergency Department (ED) pharmacists: Enhancing patient safety and aligning with regulatory compliance standards

Purpose: To evaluate medication interventions when allowing for prospective order review by a pharmacist at a Level I trauma center ED in Central Illinois during a 2 week pilot.

Methods: A retrospective review of ED medication orders placed from November 11th-November 25th with pharmacist interventions will be performed. Baseline data of pharmacist interventions will be assessed with the auto-verify functionality on to compare intervention type and outcome obtained with auto-verify functionality off. Medication verification time by the pharmacist as well as administration time by the nurse will be measured to assess if prospective order review increases medication administration times.

Results: The 2 week pilot interventions were compared to baseline interventions which were gathered over 90 days. Pharmacist interventions per day were higher during the pilot period (20.2 vs 11.6). The number of critical/high pharmacist interventions per day was also higher during the pilot (11.4 vs 3.4). Time to order verification by the pharmacist was less than 2 minutes for the majority of orders (53%), followed by less than 5 minutes for 82% of orders and less than 10 minutes for 91% of all orders. Time to medication administration by nursing was greater than 15 minutes for the majority of orders (49%).

Conclusions: Pharmacist interventions increased when prospective order review was allowed. Time to medication administration was not adversely impacted by prospective pharmacist review.

Authors: Michaela M. Doss, PharmD, BCPS**; Justin Smith, PharmD; Heather Harper, PharmD, BCPS*
OSF Saint Francis Medical Center

**=submitting author; *=ICHP member



ICHP Poster Presentations - Original #3

Category: Original

Title: Evaluation of the accuracy and completeness of nurse driven admission medication histories after modifications to current practice

Purpose: Medication errors made during the admission and discharge process account for approximately 46% of all errors during a patient’s hospital stay. A baseline study at our institution also demonstrated the need for process improvement in admission medication histories (AMH). This study ultimately aims to reduce errors and omissions by utilizing a standardized process when obtaining the medication histories for newly admitted patients.

Methods: Research will be approved by the ethics committee and institutional review board for our institution. Baseline data was collected to evaluate current practice. This study will measure the effects of two distinct interventions focused on reducing the percentage of errors during AMH. The first intervention will be deletion of existing home medication histories from the electronic health record, therefore preventing the flow of incorrect data from previous admissions. The second intervention will be implementation of an algorithm and scripting for nurses to utilize when completing AMH. Patients will be randomly selected and each AMH reviewed for accuracy (no later than admission day one). This will involve follow-up and repeat AMH by a pharmacist using a standardized procedure. Data will be evaluated at each interval and data sets will be compared to baseline data.

Results: To be submitted

Conclusions: To be submitted

Authors: Andrea Elise O'Dell, PharmD, PGY-1**; Ashlie Kallal, PharmD, Medication Safety Coordinator*
Memorial Medical Center

**=submitting author; *=ICHP member



ICHP Poster Presentations - Original #4

Category: Original

Title: Improving the Pharmacist Orientation Program at a Large Medical Center

Purpose: The Pharmacy Department at Saint Francis Medical Center (SFMC) has seen many changes in the past five years, including a new pediatric pharmacy, an updated practice model, and increased staff and services. We recognized that our orientation model for new pharmacists had not adjusted to keep up with the changes. The purpose of this project is to develop an updated pharmacist orientation model that would allow for a better transition from training to practicing pharmacist at SFMC.

Methods: We surveyed two groups on various aspects of the orientation program: new pharmacists hired in the last 2 years and the pharmacists who served as pharmacist mentors in that same time frame. The initial survey allowed us to identify gaps in our orientation program. Organizational Development Personnel assisted in the development and implementation of a new pharmacist orientation program. As part of the new orientation program, a group of experienced pharmacists were selected to serve as peer sponsors for the new pharmacists. Training was provided to the peer sponsors prior to their involvement with the new pharmacists. The new program was instituted with five new pharmacists between July 2013 and January 2014. A follow-up survey will be distributed to these pharmacists and their peer sponsors in February 2014 to determine improvements realized and gaps still outstanding.

Results: We will analyze the follow-up survey to determine project success and the need for adjustments. All future new pharmacists will be surveyed for ongoing maintenance of the orientation program.

Conclusions: To be submitted

Authors: Jennifer C. Ellison, PharmD, BCPS PGY1 Pharmacy Residency Director, Drug Information Pharmacist**; Karin L. Terry, PharmD, Medication Safety Officer**
OSF Saint Francis Medical Center

**=submitting author; *=ICHP member



ICHP Poster Presentations - Original #5

Category: Original

Title: Impact of pharmacist led discharge counseling on 30-day readmissions and emergency department visits

Purpose: According to the New England Health Care Institute, medication non-adherence has shown to result in $100 billion per year in excess hospitalizations and it is estimated that along with non-adherence, suboptimal prescribing, and other factors could result in as much as $290 billion per year in avoidable medical spending. The primary objective of this study is to determine the impact of pharmacist discharge counseling on 30-day post-discharge hospital readmissions and emergency department (ED) visits.

Methods: A prospective, single center intervention study with a pharmacy discharge counseling service from 8 am to 4 pm on Monday through Friday. Inclusion criteria include age 55 years, being discharged by participating hospitalist group, started or already on a high risk medication as defined by the ISMP, and on 5 medications. Exclusion criteria include rejection of offer to counsel, discharge from inpatient rehabilitation, and discharge to place other than home. The pharmacist will review the patient’s medication list and collaborate with physicians to assess the appropriateness of medication regimen based on evidence based guidelines for patient specific disease states. Patient will receive counseling from a pharmacist prior to discharge and patient knowledge will be assessed using Agency for Healthcare Research & Quality’s discharge knowledge assessment tool. Data collected will include patient’s age, number of medications, high risk medications, readmissions, and DKAT score. A chart review will be conducted 30 days post discharge for readmissions and ED visits. The results will be compared to the current standard of care with discharge counseling by a nurse.

Results: To be submitted

Conclusions: To be submitted

Authors: Daljeet Kaur, PharmD, PGY-1 Pharmacy Resident**; Taylor Post, PharmD, BCPS, Clinical Pharmacist*
Presence Saint Joseph Medical Center

**=submitting author; *=ICHP member
 


ICHP Poster Presentations - Original #6

Category: Original

Title: Pharmacist Involvement in the Medication Management of an Acute Care of Elderly (ACE) Unit

Purpose: The inappropriate use of medications in the elderly population can lead to confusion, falls, and even delirium. This in turn puts their health at an increased risk as well as their mortality rate. A multi-disciplinary approach of elderly patient care in an Acute Care of Elderly (ACE) Unit will work to decrease adverse events, shorten the length of stay, and decrease mortality rates. A pharmacist will be an integral part of this team, overseeing the medication management of the patients as well as making interventions to reduce inappropriate medication dosing and polypharmacy. The primary expected outcome is that there will be an overall decrease in falls on the ACE unit.

Methods: A guideline will be set in place outlining potentially inappropriate medications and the appropriate therapeutic alternative based on BEERS criteria. The BEERS criteria are a guide of safer therapeutic alternatives for health professionals. Education of pharmacy and nursing staff on safe medication use in the elderly will be developed in conjunction with the geriatricians. After the guideline and education is in place, all patients in the ACE unit will be monitored prospectively for falls as well as interventions made by pharmacists.

Results: To be submitted

Conclusions: To be submitted

Authors: Katerina Anastasiou, PharmD, Pharmacy Resident**; Kimberly Janicek, PharmD, CPPS Clinical Pharmacy Manager*; Rashita Shah, PharmD, Clinical Pharmacist
Presence St. Joseph Medical Center

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Original #7

Category: Original

Title: Evaluation of an institution specific cellulitis antimicrobial guideline

Purpose: Cellulitis, a common skin and soft tissue infection, results in a significant amount of hospitalizations and office visits each year with occurrences increasing annually. Current guidelines provide empiric treatment but contain limited information on recommending initial antibiotic treatment according to infection severity. By assessing the current antibiotic prescribing practice at this institution and preparing an antimicrobial guideline, it may be possible to recommend a more appropriate initial cellulitis antibiotic regimen. The primary objective is to evaluate whether an institution specific cellulitis antimicrobial guideline will result in decreased length of stay.

Methods: Approved by the Institution Review Board, this study will be a single-center evaluation of outcomes both pre-and post-cellulitis antimicrobial guideline implementation. A list of patients diagnosed with cellulitis as designated by an ICD-9 code will be obtained from the institution’s Midas program. Patients from June to August 2013 will be evaluated prior to implementation of the guideline, as well as patients post-guideline implementation from January 2014 to March 2014. Electronic medical records will be utilized to determine patient demographics, length of stay, and initial antibiotic regimen. The guideline will be developed using the institution’s antibiogram and commonly suspected organisms, in addition to published guidelines and previously published studies. Both physicians and pharmacists at this institution will receive education on proper utilization of the guideline. A comparison of data between pre-and post-guideline implementation will be used to determine whether an institution specific cellulitis antimicrobial guideline has a positive effect on initial antibiotic regimen and length of stay.

Results: To be submitted

Conclusions: To be submitted

Authors: Sharlene Huang, PharmD, PGY-1 Pharmacy Practice Resident**; Katherine Allen, PharmD, BCPS, Clinical Pharmacist; Nicole Costa, PharmD, Clinical Pharmacist*
Presence Saint Joseph Medical Center

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Original #8

Category: Original

Title: Pharmacist-led development of an interdisciplinary pain management team within a community hospital setting

Purpose: Poor management of pain is linked to reduced quality of life and decreased patient satisfaction. In a community hospital setting, there is still a need to focus on adequate and appropriate utilization of analgesic therapy. The ideal approach to pain management in an inpatient setting includes the utilization of an interdisciplinary pain team. Currently, pharmacists have a limited role in most hospital pain management teams. The objective of this study is to determine if pharmacist participation in the development of a pain team can improve pain management therapy for patients resulting in better pain control and increased patient satisfaction.

Methods: The pain management pharmacist will work with other healthcare providers to assess and monitor patients while also identifying their existing pain therapy needs. To detect areas needing improvement, patient surveys, medical charts, and the hospital database will be used to collect information. Patient costs and length of stay will be determined using hospital bills, charges from the revenue center and cost department, and hospital-specific Medicare cost reports. Patients will undergo an initial pain assessment by the pharmacist to identify and evaluate the effectiveness of their current pain management therapy. The patients will also be followed by the pharmacist for the duration of their hospital stay and evaluated daily for proper utilization and effectiveness of therapy. The pharmacist will dose pain medication or suggest recommendations to improve current pain management for acute care patients to help facilitate the necessary interventions that will lead to improved patient outcomes.

Results: To be submitted

Conclusions: To be submitted

Authors: Sawsan Ikram, PharmD, PGY-1 Pharmacy practice resident**; Se Choi, PharmD, Pharmacy Director*; Barbara Walker, RN, Nurse manager, orthopedic unit
Presence St. Joseph Medical Center

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Original #9

Category: Original

Title: Clinical Outcomes in HIV+ Adults with K65R Mutation

Purpose: The K65R mutation is reported in HIV-infected individuals treated with tenofovir, limiting the use of other nucleoside reverse transcriptase inhibitors.  The purpose of this study is to determine virologic, immunologic, and treatment outcomes in patients who acquired K65R.

Methods: Single-site (Ruth M. Rothstein CORE Center), retrospective chart review.  Inclusion criteria included K65R mutation on HIV genotype, age =18 years, and receiving care at CORE.  Patient demographics, HIV genotype, regimen prescribed pre and post K65R development, HIV viral load, and CD4 counts were collected.

Results: 174 patients were identified, 134 qualified for inclusion, and 37 (28%) were lost to follow-up.  Demographics: 75% male, 69% African American, median age at time of HIV genotype 44 years. The most common regimen at time of HIV genotype was tenofovir/emtricitabine/efavirenz (63%). The median time on a tenofovir-containing regimen before K65R development was 24 months (IQR, 27 months). 125 patients began a salvage regimen and returned for at least one follow-up appointment, median time on salvage regimen was 29 months (IQR, 46.5 months), 92% achieved undetectable viral load at least once, and the median CD4 count increase was 150 cells/mL (IQR, 217 cells/mL). Patients receiving ≤2.5 vs. ≥3 active drugs were compared. Undetectable viral load was achieved in 87% (34/39) vs. 91% (78/86) in the two groups respectively, p-value = 0.551.  Mean changes in CD4 count from baseline were 156 vs. 168 cells/mm3 respectively, p-value = 0.747.

Conclusion:  Most patients with K65R responded to a salvage regimen and achieved undetectable viral load and an increase in CD4 count.  The most commonly prescribed salvage regimen in this population was zidovudine/lamivudine + boosted darunavir + raltegravir.  While there is a trend toward higher rates of achieving viral suppression and greater increases in CD4 count with a salvage regimen containing ≥3 active drugs, the results were not statistically significant.

Authors: David William Martin, PharmD, PGY-1 Pharmacy Practice Resident**1; Blake Max, PharmD, AAHIVE, Clinical Pharmacist*2
1 - John H. Stroger, Jr. Hospital of Cook County; 2 - Ruth M. Rothstein Core Center

**=submitting author; *=ICHP member



ICHP Poster Presentations - Original #10

Category: Original

Title: Evaluating the clinical impact of a computerized physician order entry (CPOE) sepsis bundle order set

Purpose: Sepsis accounts for approximately 10 percent of all intensive care unit admissions. The key to reducing sepsis mortality is early recognition of the onset of sepsis and prompt initiation of goal-directed therapy. The objective of this research is to evaluate the impact of an updated CPOE sepsis bundle order set reflective of best practice sepsis treatment on clinical outcomes in patients with severe sepsis.

Methods: Data will be collected pre-implementation of the evidence-based sepsis order set and post-implementation to allow a comparison of outcomes. Patients included in the study will be identified by a documented positive sepsis screen, indicating the presence of severe sepsis, or septic shock. Patient data will be collected from the electronic medical record and maintained without patient identifiers. Data collected will include: patient age, sex, source of infection, ICU length of stay, inpatient medications, time to receive and appropriateness of antibiotics, vital signs, serum lactate levels, complete blood count (CBC) values, and complete metabolic panel (CMP) values. Primary endpoints to be evaluated will be ICU length of stay and percentage of patients who met sepsis bundle treatment goals including serum lactate measurement within three hours, antibiotics given within three hours, cultures drawn before administration of antibiotics, fluid resuscitation bolus given, and central venous pressure (CVP) measurement within six hours.

Results: To be submitted

Conclusions: To be submitted

Authors: Lisa M. Deegan, PharmD, Pharmacy Resident**; Taylor J. Post, PharmD, BCPS, Clinical Pharmacist
Presence St. Joseph Medical Center

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Original #11

Category: Original

Title: Characterization of Drug Shortages by Mining a Drug Information Service Database

Purpose: Drug shortages are of increasing concern for policymakers, healthcare providers, and patients. It is crucial that healthcare institutions address drug shortage concerns to avoid compromising patient care. Multiple factors contribute to the frequency and severity of drug shortages, including raw material availability, manufacturer production, distribution mechanisms, business considerations, regulatory restrictions, clinical practice changes, and medical necessity. The volatility and dynamic interplay of these factors can lead to frequent changes in the supply and demand of medications. Therefore, it is necessary to utilize available data to characterize drug shortage trends.

Methods: The Drug Information Group at the University of Illinois at Chicago responds to queries from clients across the country and maintains this information in a database. This study mined the database from November 1, 2009 to November 1, 2012 using the search terms of “shortage,” “alternative” and “instead.” Entries were included if they were in regards to the shortage of a drug listed in the American Society of Health-System Pharmacists Drug Shortages Resource Center. Each entry was then categorized according to shortage agent including drug name, dosage form, medication class, and risk level. Specifics of the request and response were also collected including client geographic location, indication(s), and response to shortage. The compiled data were analyzed for trends in the above components to characterize drug shortages experienced by clients, as well as responses provided by the Drug Information Group.

Results: Drug shortage characterization remains under investigation, with data collection and evaluation currently being conducted.

Conclusions: Drug shortage characterization remains under investigation, with data collection and evaluation currently being conducted.

Authors: Aparna D. Reddy, PharmD, PGY2 Drug Information Resident**; Lara K. Ellinger, PharmD BCPS, Clinical Assistant Professor*
University of Illinois at Chicago

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Original #12

Category: Original

Title: Nuts and bolts of building new service-lines: Blueprints for establishing an outpatient pharmacy

Purpose: Currently, there are no guides that describe a generalized process for initiating new service lines in a healthcare institution. There are many studies presently showing the outcomes and benefits of various service lines, but there is nothing showing how to properly put these ideas into place. This research project is to develop guidelines addressing this process focusing on initiating an outpatient pharmacy to validate the process.

Methods: The project has outlined a step-by-step process starting from the development of the idea for the new service line to the final step of implementing the project in the institution. The process is comprised of 10 steps: identifying a need, identifying relevant personnel, developing a list of options, outlining the required investment, identifying outcomes, judging those outcomes, determining the value of the project, analyzing tradeoffs, creating acceptability, and finally, the implementation. The data collected included retrospective financial data of employee prescriptions as well as pricing of expected inventory. A pro forma was developed to support the guidelines presented.

Results: The final endpoint will be whether or not the process creates a successful initiation of an outpatient pharmacy in the studied institution.

Conclusions: The goal for the project is to encompass all aspects of the decision making process so that anyone who would like to initiate a service line can use these guidelines to start any type of service line in any institution with successful implementation of the project.

Authors: Mark D. Wadley, PharmD, Pharmacy Resident**; Se Choi, PharmD, Director of Pharmacy*
Presence St. Joseph Medical Center

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Original #13

Category: Original

Title: Secondary Prevention Medication Prescription Filling Following an Acute Ischemic Stroke and the Relationship to Hospital Readmission Rates

Purpose: Of the 795,000 who develop a stroke annually, 185,000 (23 percent) are recurrent strokes. Patients with high adherence to antihypertensive medications have been shown to suffer fewer non-fatal vascular events and have lower rates of stroke recurrence. Additionally, nonadherence to evidence-based secondary prevention therapies in patients with atherothrombosis was associated with an increase in mortality. The purpose of this study is to assess if medication pick-up following an acute ischemic stroke hospital discharge reduces hospital readmissions.

Methods: Prior to commencement, this study will be submitted to the institutional review board (IRB) for approval. This retrospective study will identify the discharge medications for acute stroke patients at my institution between April 1, 2012 through September 30, 2013. Medication adherence will be assessed via calling the patient’s home pharmacy and identifying if the patient retrieved their medications. Lastly, hospital readmission rates for the patients will be assessed. The primary objective of this study will be to evaluate if medication pick-up from an outpatient pharmacy is a predictor of ischemic stroke patient readmission. Chi-square testing will assess all nominal data and a student’s t-test will assess all continuous data.

Results: Results and conclusions to be presented at the ICHP Spring Meeting

Conclusions: Results and conclusions to be presented at the ICHP Spring Meeting

Authors: Ryan Szynkarek, PharmD, BCPS**; Jennifer Austin, PharmD, BCPS*; Olabisi Falana, PharmD, BCPS; James Brorson, MD

 

ICHP Poster Presentations - Student #1

Category: Student

Title: Evaluating Hospitalization Rates of Elderly Patients with Diabetes: An Observational Assessment Targeting Antidiabetic Medication Safety

Purpose: Diabetes mellitus (DM) is increasing in persons ≥65 and older. A recent study estimated that 100,000 emergent hospitalizations of patients ≥65 years of age are attributable to adverse drug events, with antidiabetic agents accounting for many of these admissions and readmissions. As a quality improvement pilot project, the authors evaluated hospitalization rates of elderly diabetic patients to assess the role pharmacist care can play in the therapeutic, safety and hospitalization outcomes in older adults at our institution.

Methods: The authors evaluated all elderly (≥65) emergency room visits, admissions, and re-admissions in an urban academic medical center for five consecutive weeks. Relevant components of diabetes care were assessed, including diabetes medication classes, and correlated with drug and patient outcomes.

Results: Fifty-six patients were evaluated (68% F, 59% AA, range 65-91 years of age). Emergency room visits, admissions and re-admissions were 62.5%, 37.5% and 7% respectively. Primary reasons for hospital visits were infection 32%, bone/muscle disorders 23% and cardiac conditions 11%. Diabetes management included: diet alone 14.3%, insulin 44.6%, oral agents 30.4% and combination therapy 10.7%. Severe hyperglycemia of ≥300mg/dL occurred in 9% (n=5), of which 3.5% (n=2) were admitted with ketoacidosis. Hypoglycemia occurred in 5.4% (n=3) emergency room visits (3.6% (n=2) confirmed), all patients were on insulin; 5.4% (n=3) experienced multiple hypoglycemic episodes during hospitalization course. 

Conclusion: Adverse drug events resulting in health care utilization are common in elderly diabetic patients. Pharmacist care can improve therapeutic and safety outcomes through enhanced patient- and provider-level interventions at our institution. 

Authors: Oksana Anna Kucher, PharmD candidate 2016**; Michael J. Koronkowski, PharmD, Clinical Assistant Professor, Geriatrics*
University of Illinois at Chicago

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Student #2

Category: Student

Title: Achievement of A1C, Lipid, and Blood Pressure Goals in a Free Community Clinic

Purpose: Lack of access to quality health care, including lack of access to proper drug therapy, places many patient populations at risk for poor health outcomes. Chronic diseases such as hypertension, diabetes and dyslipidemia can be difficult and costly to manage, and can lead to significant morbidity and mortality. The objectives of this research project are to compare the treatment options the patients at a free community clinic receive to what the guidelines recommend, and to observe if patients are able to reach their therapeutic goals. Methods: Patient charts were reviewed for those patients diagnosed with hypertension, diabetes, and dyslipidemia. Data regarding laboratory values and medications usage were collected during the chart review. The data was compared against the published guidelines for the management of each of the disease states to determine if patients have reached goals of treatment. Results: Only 30% of patients were able to reach their A1c goal of ≤ 7%. The blood pressure goal of ≤ 140/90 established by the new JNC 8 guideline was achieved in 70% of the patients, and 75% achieved an LDL of ≤ 100.  Seventy percent of patients were categorized as obese based on a BMI that was ≥ 30. Conclusion: Blood pressure and lipid control was obtained in the majority of patients, however diabetes control has been proven to be more difficult to achieve. Future research is needed to investigate the contributing factors for poor diabetes control. 

Methods: Patient charts will be reviewed for those patients diagnosed with hypertension, diabetes, and dyslipidemia. Data regarding laboratory values and medications used will be collected during the chart review. This data will be compared against the published guidelines for the management of each of the diseases to determine if patients have reached the clinically published goals for treatment. Expected Results: There will be lab results recorded for each patient chart along with the list of medications the patient is taking. This will be compared to what the guidelines recommend, and then evaluate if there are positive results for the lab values. Conclusion: The implications of this study can impact prescribing practices and potentially improve the outcomes of these diseases at the community free clinic.

Results: In progress

Conclusions: In progress

Authors: Amanda Peerboom, PharmD Candidate**; Elvira Becker, PharmD Candidate**; Yolanda Hardy, PharmD
Chicago State University

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Student #3

Category: Student

Title: Evaluating hospitalization rates of elderly patients with potential medication-induced geriatric syndromes: An observational assessment targeting safe prescribing practices

Purpose: Elderly patients (≥65) are at a 4-fold higher risk of drug-related hospitalizations. A recent study found over 25% of elderly hospitalizations related to adverse drug events. This study aims to evaluate hospitalization rates for medication-induced geriatric syndromes. The findings may identify expanded roles for pharmacists in medication management therapy to prevent unnecessary hospitalizations and improve health outcomes. 

Methods: A list of geriatric syndromes was determined and the 2012 American Geriatrics Society (AGS) Beers Criteria was utilized to screen patients for inclusion. Elderly patients (≥65) visiting the emergency room or those admitted to the medicine wards during December 2013 were evaluated. Patients with at least two pre-defined geriatric syndromes and at least one medication on the AGS Beers Criteria were included. Qualifying patients were further investigated for correlations between medication regimens and presenting symptoms. 
 
Results: A hundred and fifty-three patients were evaluated. Six patients met inclusion criteria and seven encounters were eligible for data analysis (4%). Of the seven encounters, 57% were strongly-correlating medication-induced geriatric syndromes and resulted in falls and confusion or dizziness; 71% were taking more than 10 different medications. The most commonly prescribed drugs on the AGS Beers Criteria were amiodarone, tramadol and meclizine. Upon review, 71% had medication lists with potentially severe drug interactions. (Research in progress.)

Conclusions: Medication-induced geriatric syndromes requiring hospitalizations may occur in elderly patients. Polypharmacy and prescribing of Beers Criteria medications were main contributors in these avoidable circumstances. Pharmacists advocating for appropriate use and minimizing medications may improve geriatric health outcomes. (Research in progress.)

Authors: Wendy Chen, PharmD Candidate 2017**; Alice Lee, PharmD Candidate 2014*; Michael J. Koronkowski, PharmD, Clinical Assistant Professor, Geriatrics*
University of Illinois at Chicago

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Student #4

Category: Student

Title: Extended-infusion piperacillin-tazobactam vs. traditional dosing for improving patient outcomes

Purpose: The use of extended-infusion piperacillin/tazobactam was implemented system-wide at Memorial Medical Center in Springfield, Illinois starting April 2013. It was thought that administering higher doses of piperacillin/tazobactam over an extended period of time would lead to improved patient outcomes due to the drug’s pharmacodynamic and pharmacokinetic properties. In addition, less frequent dosing with extended-infusion could potentially save in administrative costs. The objective of our current study is to compare the outcomes of patients who received traditional IV piperacillin/tazobactam with those who were given extended-infusion piperacillin/tazobactam as part of the change in protocol in 2013.

Methods: A retrospective analysis of data from the electronic database at Memorial Medical Center, Springfield, Illinois. The hospital switched form traditional IV administration to extended-infusion of piperacillin/tazobactam in April 2013. We are comparing the outcomes of patients who received traditional IV piperacillin/tazobactam between September 1st and November 30th of 2012 to patients who received extended-infusion piperacillin/tazobactam between September 1st and November 30th of 2013. We will compare outcomes which include death or discharge to hospice vs. discharge to home, long-term care, or a rehabilitation facility. Our collected data will also include age, sex, length of admission, duration of antibiotic therapy, adverse drug reactions, and indication for antibiotic therapy.

Results: In progress

Conclusions: In progress

Authors: Randall M. Patula, P3 Student**1; Zakarri K. Vinson, P3 Student**1; Julie A. Podlasek, Pharm.D., Antimicrobial Stewardship Coordinator**2
1  - Southern Illinois University Edwardsville; 2 - Memorial Medical Center

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Student #5

Category: Student

Title: Evaluating the impact of a follow-up telephone call program in recently discharged heart failure patients on 30 day readmission rates

Purpose: The objective of this research is to evaluate the impact of the implementation of a follow-up telephone call program for heart failure patients on 30-day readmission rates. The follow-up telephone program will allow an assessment of the patients’ understanding of heart failure and utilization of their medications. This is also an opportunity to provide additional patient education on medications, home monitoring, lifestyle changes, and when to seek additional help. The implementation of this program has the goal as well as the potential to help decrease readmission rates and improve quality of life for heart failure patients.

Methods: This study will involve patients with the diagnosis of heart failure who were recently discharged from Presence St. Joseph Medical Center. This study will compare data from 3 months before the implementation of this program to prospective post-implementation data to compare the rate of readmission due to heart failure. Subjects will be identified via a MIDAS report run daily to identify all patients discharged the day prior whom have a history of heart failure. During these telephone calls, pharmacists or students will review and counsel the patient on information such as weight monitoring, fluid restriction, low-sodium diet, exercise and social habits, symptoms of worsening heart failure, medication reconciliation, and confirmation of follow-up appointment with physician. Subjects will be de-identified and information will be stored in an Excel worksheet for review and analysis.

Results: In progress

Conclusions: In progress

Authors: Katherine Rushing, PharmD Candidate*1; Peter Stamatopoulos, PharmD Candidate*1; Michelle Wachtor, PharmD Candidate*1; *Jacob Backhoff, PharmD Candidate, Roosevelt University College of Pharmacy; Stefanie George, PharmD Candidate**1; Alexander Pak, PharmD Candidate*1; Lisa Deegan, PharmD, Pharmacy Resident*2; Sawsan Ikram, PharmD, Pharmacy Resident*2; Sharlene Huang, PharmD, Pharmacy Resident*2; Daljeet Kaur, PharmD, Pharmacy Resident*2; Katerina Anastasiou, PharmD, Pharmacy Resident*2; Mark Wadley, PharmD, Pharmacy Resident*2
1 - Roosevelt University College of Pharmacy; 2 - Presence St. Joseph Medical Center

**=submitting author; *=ICHP member

 

ICHP Poster Presentations - Student #6

Category: Student

Title: Illinois Prescribers’ Attitude on the Utility of Medical Marijuana

Purpose: In August of 2013, Illinois Governor Quinn signed House Bill 1, approving the Compassionate Use for Medical Cannabis Pilot Program. This program attempts to implement rules and regulations that will allow patients with certain debilitating conditions to legally obtain and use medical marijuana under Illinois state law. Our study aims to identify physicians’ knowledge and attitude toward the use of medical marijuana in hopes to guide future education and clinical policy regarding this practice.

Methods: An anonymous, electronic survey was distributed by email to members of the Illinois Association of Family Physicians (IAFP) in their scheduled monthly e-newsletter. The survey questions aimed to identify demographic information, the knowledge level of prescribers as it relates to the new marijuana law and prescribing guidelines, and their attitudes toward the new law.

Results: One hundred eleven IAFP members responded to the survey. Of these participants, 95% were aware that the bill had been signed. 49% were unlikely to prescribe marijuana and 58% of the participants did not feel comfortable prescribing marijuana. No correlation was found between the prescribers’ age or length of time in practice and the likelihood of prescribing marijuana.

Conclusions: In progress

Authors: Oliver Daniel Mills, Pharmacy Candidate**; Chris Herndon, PharmD*
Southern Illinois University Edwardsville

**=submitting author; *=ICHP member



ICHP Poster Presentations – Platform Presentation #1  

Category: Original

Title: Comparison of zolpidem to other drugs associated with falls in hospitalized patients

Purpose: Determine if zolpidem poses a higher risk of falls in hospitalized patient as compared to other medications commonly associated with patient falls.

Methods: Retrospective chart review of inpatient medical records of those patients recorded as having fallen during their hospitalization. Dates of data collection were from October 2012 to January 2013 (4 months). Data collection included select medications (i.e. zolpidem, antidepressants, antipsychotics, antihistamines, benzodiazepines, opioid analgesics) administered up to 24 hours prior to the fall, patients ages and gender. Patients on the pediatric units and in the Emergency Department were excluded. This study was approved by the local Investigational Review Board.

Results: There were 129 patient falls recorded on the hospital units being analyzed. At least one of the drugs associated with an increased fall risk was administered within 24 hours prior to the fall in 108 of the recorded falls. Although zolpidem was administered prior to 8.5% of the falls, opioids (50.4%), antidepressants (33.3%), lorazepam (24%) and antipsychotics (15.5%) were administered significantly more frequently.

Conclusions: Although zolpidem is a risk factor for patient falls in hospitalized patients, the incidence does not appear to be greater than with other medications associated with this hazard.

Authors: Edward C. Rainville, BSPharm, MSPharm, Clinical Pharmacy Manager**1; Daniel G. Ricci, PharmD, Graduate Student2
1 - OSF Saint Francis Medical Center; 2 - University of Wisconsin at Madison

**=submitting author; *=ICHP member

 

ICHP Poster Presentations – Platform Presentation #2  

Category: Original

Title: Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Inpatient Treatment: A Retrospective Chart Review

Purpose: To evaluate inpatient management of COPD exacerbations and adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendations.

Methods: A retrospective chart review was conducted in patients aged 18 to 89 years hospitalized for COPD exacerbation between the dates of April 1, 2013 and June 30, 2013. Subjects were excluded if they received antibiotic or systemic corticosteroid therapy for any reason other than a COPD exacerbation. Data collection for each subject included: smoking history, COPD medication therapy prior to admission and at hospital discharge, presence of cardinal symptoms of a COPD exacerbation at hospital admission, documentation of COPD Assessment Test (CAT) score, inpatient antibiotic and systemic corticosteroid regimens, vaccination screening and administration, time to hospital readmission, and reason for hospital readmission. Inpatient exacerbation treatment was evaluated for adherence to GOLD guideline recommendations.

Results: A total of 60 patients were included in this study. Antibiotics were used inappropriately in 58% of subjects (n=35). A variety of agents were given, of which levofloxacin was most common (n=42). Systemic corticosteroid regimens also varied widely, with total daily doses ranging from 10mg to 120mg. Short-acting bronchodilators, tiotropium, and oral corticosteroids were the most common medications initiated in the hospital that were continued upon discharge.

Conclusions: There is opportunity for improvement in antimicrobial stewardship in COPD exacerbations, specifically symptom-driven antibiotic use and antimicrobial selection. Oral corticosteroid regimens could also be optimized. It is difficult to assess appropriateness of COPD maintenance therapy due to lack of information about baseline disease severity.

Authors: Jennifer D. Arnoldi, PharmD, BCPS, Clinical Assistant Professor**; Mallory K. Klein, PharmD Candidate
Southern Illinois University Edwardsville School of Pharmacy

**=submitting author; *=ICHP member 









The GAS From Springfield
A very successful Legislative Day!

by Jim Owen and Scott Meyers

Wednesday morning, March 5th opened with snow blanketing the northern quarter of the state, but that only slightly dampened the impact of a highly successful and positive 8th Annual “Under the Dome” in Springfield. Late buses and slow going early on for the folks in the Chicago and Rockford areas gave way to countless legislator visits and productive conversations throughout the Capitol on Wednesday afternoon. The legislative reception that capped the day’s events that evening drew 21 legislators and several other friends of pharmacy from the Capitol. Approximately 350 ICHP and IPhA members from around the State attended the event!

During Legislative Day, attendees focused on four specific legislative issues, seeking support for pharmacist provided meningitis vaccinations for 10-13 year olds, stable funding for the Illinois Poison Center; and, encouraging defeat of a bill aimed at regulating the interchange of biosimilars and another that would make pseudoephedrine a prescription medication. Reception of our issues overall was strong, but we’ll have to wait and see as the legislative process continues through May. Below are summaries of the key bills ICHP is monitoring and lobbying on this session. There are many more pharmacy and health care legislative initiatives with lesser or unknown impact that we will add should they become critical issues.

Bill No. Sponsor Summary Status Position
SB1454 Delgado, D-Chicago Amends the Wholesale Drug Distribution Licensing Act. Provides that notwithstanding any other provision of law, a distributor licensed and regulated by the Department of Financial and Professional Regulation, and registered and regulated by the United States Drug Enforcement Administration, shall be exempt from the storage, reporting, ordering, record keeping and physical security control requirements for Schedule II controlled substances with regard to any material, compound, mixture or preparation containing Hydrocodone. These Controlled Substances shall be subject to the same requirements as those imposed for Schedule III controlled substances. Amends the Illinois Controlled Substances Act. Defines Prescription Monitoring Program Advisory Committee and electronic health record. Provides that Dihydrocodeinone (Hydrocodone) with one or more active, non-narcotic ingredients in regional therapeutic amounts is a Schedule III controlled substance, subject to the requirements for prescribing of Schedule III controlled substances with the exception that any prescription must be limited to no more than a 30-day supply with any continuation requiring a new prescription. Provides that prescribers may issue multiple prescriptions (3 sequential 30-day supplies) for Dihydrocodeinone (Hydrocodone), authorizing up to a 90-day supply. Provides that by January 1, 2018, all Electronic Health Records Systems should interface with the Prescription Monitoring Program application program interface to insure that all providers have access to specific patient records as they are treating the patient. Makes other changes. Passed Senate as Amended; Rules Committee in the House Neutral
SB1934 Munoz, D-Chicago Amends the Pharmacy Practice Act. Provides that a pharmacist may substitute a prescription biosimilar product for a prescribed biological product under certain circumstances. Provides that the Board shall adopt rules for compliance with these provisions. Assignments Oppose
SB2585 Kotowski, D- Park Ridge Amends the Illinois Public Aid Code and the Illinois Insurance Code. Requires the Department of Healthcare and Family Services and the Department of Insurance to jointly develop a uniform prior authorization form for prescription drug benefits on or before July 1, 2014. Provides that on and after January 1, 2015, or 6 months after the form is developed, whichever is later, every prescribing provider may use that uniform prior authorization form to request prior authorization for coverage of prescription drug benefits and every health care service plan shall accept that form as sufficient to request prior authorization for prescription drug benefits. Provides that on and after January 1, 2015, a health insurer that provides prescription drug benefits shall utilize and accept the prior authorization form when requiring prior authorization for prescription drug benefits; and that if a health care service plan fails to utilize or accept the prior authorization form, or fails to respond within 2 business days upon receipt of a completed prior authorization request from a prescribing provider, the prior authorization request shall be deemed to have been granted. Exempts certain providers. Sets forth certain criteria for the prior authorization form. Provides that "prescribing provider" includes a provider authorized to write a prescription as described in the Pharmacy Practice Act. Effective January 1, 2014. Human Services Committee Oppose
SB2674 Harmon, D- Oak Park Amends the State Finance Act. Adds the Poison Response Fund. Amends the Wireless Emergency Telephone Safety Act. Provides that human poison control centers constitute an enhancement to 9-1-1 services pursuant to federal law. Provides that for surcharges collected and remitted on or after July 1, 2013, $0.1275 per surcharge collected shall be deposited into the Wireless Carrier Reimbursement Fund on the last day of each month, $0.5825 per surcharge collected shall be deposited into the Wireless Service Emergency Fund, $0.02 per surcharge shall be deposited in the Poison Response Fund, and $0.01 per surcharge collected may be disbursed to the Illinois Commerce Commission for administrative costs. Requires the Auditor General to conduct an annual audit of the Poison Response Fund. Permits the Commission to require an annual report of income and expenditures from each human poison control center. Extends the date of repeal of the Act to July 1, 2018 (currently July 1, 2013). Creates the Poison Response Fund. Amends the Public Utilities Act. Extends the repeal of certain Sections relating to 9-1-1 system providers until July 1, 2016 (currently July 1, 2015). Effective immediately. 2nd Reading in the Senate Support
SB2941 Raoul, D-Chicago Amends the Criminal Identification Act. Authorizes the court to seal Class 4 felony convictions for possession with intent to manufacture or deliver cannabis without the defendant being required to successfully complete qualified probation under the Act. Authorizes the court to seal Class 3 felony convictions for possession with intent to manufacture or deliver cannabis without the defendant being required to obtain an authorization for sealing from the Prisoner Review Board.  This would blind potential employers who are required to do a background check on potential hires.  Effective immediately. Passed the Senate; Rules Committee in the House Oppose
SB3109 McGuire, D-Crest Hill Amends the Illinois Optometric Practice Act of 1987. Permits a licensed optometrist to prescribe Dihydrocodeinone (Hydrocodone) with one or more active, non-narcotic ingredients only in a quantity sufficient to provide treatment for up to 72 hours, and only if such formulations are reclassified as Schedule II by the U.S. Food and Drug Administration. 2nd Reading in the Senate Oppose
SB3277 Althoff, R-McHenry Amends the Pharmacy Practice Act. Adds the administration of the Meningococcal vaccine to patients 10 through 13 years of age to the definition of "practice of pharmacy". Licensed Activities Committee Support
SB3502 Koehler, D- Peoria Amends the Illinois Controlled Substances Act. Provides that substances containing ephedrine or pseudoephedrine, their salts or optical isomers, or salts of optical isomers, are Schedule III controlled substances and require a prescription. Criminal Law Committee Oppose
HB3638 Fine, D- Glenview Amends the Illinois Public Aid Code and the Illinois Insurance Code. Requires the Department of Healthcare and Family Services and the Department of Insurance to jointly develop a uniform prior authorization form for prescription drug benefits on or before July 1, 2014. Provides that on and after January 1, 2015, or 6 months after the form is developed, whichever is later, every prescribing provider may use that uniform prior authorization form to request prior authorization for coverage of prescription drug benefits and every health care service plan shall accept that form as sufficient to request prior authorization for prescription drug benefits. Provides that on and after January 1, 2015, a health insurer that provides prescription drug benefits shall utilize and accept the prior authorization form when requiring prior authorization for prescription drug benefits; and that if a health care service plan fails to utilize or accept the prior authorization form, or fails to respond within 2 business days upon receipt of a completed prior authorization request from a prescribing provider, the prior authorization request shall be deemed to have been granted. Exempts certain providers. Sets forth certain criteria for the prior authorization form. Provides that "prescribing provider" includes a provider authorized to write a prescription as described in the Pharmacy Practice Act. Effective January 1, 2014. 2nd Reading in the House Oppose
HB4230 Lilly, D-Chicago Amends the State Finance Act. Adds the Poison Response Fund. Amends the Wireless Emergency Telephone Safety Act. Provides that human poison control centers constitute an enhancement to 9-1-1 services pursuant to federal law. Provides that for surcharges collected and remitted on or after July 1, 2013, $0.1275 per surcharge collected shall be deposited into the Wireless Carrier Reimbursement Fund on the last day of each month, $0.5825 per surcharge collected shall be deposited into the Wireless Service Emergency Fund, $0.02 per surcharge shall be deposited in the Poison Response Fund, and $0.01 per surcharge collected may be disbursed to the Illinois Commerce Commission for administrative costs. Requires the Auditor General to conduct an annual audit of the Poison Response Fund. Permits the Commission to require an annual report of income and expenditures from each human poison control center. Extends the date of repeal of the Act to July 1, 2018 (currently July 1, 2013). Creates the Poison Response Fund. Amends the Public Utilities Act. Extends the repeal of certain Sections relating to 9-1-1 system providers until July 1, 2016 (currently July 1, 2015). Effective immediately. 2nd Reading in the House Support
HB4484 Reboletti, R-Addison Creates the Patient Transitions and Continuity of Care Act. Provides that whenever a patient is transferred from a hospital, nursing home, or assisted living facility the transferring hospital, nursing home, or assisted living facility shall provide the receiving hospital, nursing home, or assisted living facility with a form that lists certain specified information about the patient. Provides that the Illinois Department of Public Health shall develop and publish the form that is to be used by the transferring hospital, nursing home, or assisted living facility. Effective immediately. Rules Committee Support
HB4575 Lilly, D-Chicago Appropriates $1,331,100 from the General Revenue Fund to the Department of Public Health from the General Revenue Fund for grants to the Illinois Poison Center. Effective July 1, 2014. Rules Committee Support
HB4580 Lilly, D-Chicago Amends the Health Care Worker Background Check Act. Provides that the prohibition against a health care employer or long-term care facility hiring, employing, or retaining an individual in a position with duties involving direct care for clients, patients, or residents, or duties that involve or may involve contact with long-term care facility residents or access to the living quarters or the financial, medical, or personal records of residents, on account of the individual's conviction of committing or attempting to commit one or more of certain specified offenses shall be for a period of (i) 2 years following the date of conviction in the case of a conviction for a misdemeanor and (ii) 5 years following the date of conviction in the case of a conviction for a felony. Effective immediately. Rules Committee Neutral
HB5631 Gabel, D-Evanston Amends the Pharmacy Practice Act. Defines "bleeding disorder", "blood clotting product", and "established patient". Establishes certain requirements, standards of care, and business practices that pharmacies and pharmacists shall comply with when dispensing blood clotting products. Health Care Licenses Committee Oppose
HB5924 Zalewski, D-Riverside Amends the Illinois Vehicle Code. Provides that a person shall not drive or be in actual physical control of any vehicle within this State while there is any amount of a drug, substance, or compound in the person's breath, blood, or urine resulting from the use or consumption of a controlled substance listed in the Illinois Controlled Substances Act in excess of the prescribed amount in the person's prescription for the controlled substance. Judiciary Committee Oppose
HB5987 Phelps, D-Harrisburg Creates the Audits of Pharmacy Benefits Act. Imposes a number of requirements on audits of pharmacy services conducted pursuant to a contract entered into by the pharmacy and the auditing entity on behalf of a health carrier or a pharmacy benefits manager. Requires the entity conducting a pharmacy audit to deliver a preliminary audit report to the pharmacy and to give the pharmacy an opportunity to respond to the report prior to issuing a final audit report. Provides that the entity is also required to implement a process for appealing the findings of the final audit report, and further provides that if either party is unsatisfied with the appeal, that party may seek relief under the terms of the contract. Establishes a number of requirements that the auditing entity must follow when calculating the amounts and penalties that are to be recovered from the pharmacy based on the audit report, and prohibits the entity from receiving payment on any basis tied to the amount claimed or recovered from the pharmacy. Effective immediately. Rules Committee Oppose in current form

As you can see there are some important bills to watch and work on this legislative session. Please consider supporting the ICHP Pharmacy Action Fund with your contribution. This fund helps us get our message heard louder and stronger in Springfield.

If you have questions about these or any other bills, please contact us via email at jownenconsulting@aol.com or scottm@ichpnet.org, and we will do our best to help you better understand and advocate for pharmacy.




ICHPeople

Congratulations to Dr. Jennifer D'Souza on being chosen to participate in ASHP's Research and Education Foundation Research Boot Camp! Below is the official press release.

ICHP Member Selected to Participate in Research Skills Development Program
 
BETHESDA, Md. (March 21, 2014) - Jennifer D’Souza, Pharm.D., CDE, BC-ADM, has been selected to participate with five other pharmacists in the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation Research Boot Camp, a research skills development program composed of distance education, experiential education and research conduct components. Dr. D’Souza is also a member of the Illinois Council of Health-System Pharmacists.

The Research Boot Camp was created to foster the development of pharmacists’ practice-based research skills; to drive the advancement of translational research by providing clinicians with the expertise, tools and support to start a practice-based research program; and to enhance safe and effective medication use by promoting evidence-based decision making for individual patients and populations of patients. 

“I am very excited and honored to be accepted into the Boot Camp,” said Dr. D’Souza. “Clinical and educational research has always been a goal of mine as an academician, but the focus of the past nine years has been primarily on teaching, service to the university, and clinical responsibilities. I am interested in developing my research ideas into well-thought out projects. I am grateful for this opportunity to sharpen my skills in order to develop a sound methodology on how to answer practice-based research questions.”  

During the boot camp, participants will develop a research idea into a well-structured research plan to be executed following completion of robust distance and experiential education components. The boot camp’s experiential portion, which will take place May 21-23, gives the participants an opportunity to meet with three seasoned pharmacist investigators to discuss their planned research studies in depth. Participants’ sponsoring institutions provide seed support to individuals who successfully complete the Research Boot Camp to carry out their projects. 

More information about the Research Boot Camp can be found at www.ashpfoundation.org/bootcamp.  


About the Foundation
The ASHP Research and Education Foundation (www.ashpfoundation.org) was established in 1968 by the American Society of Health-System Pharmacists (www.ashp.org) as a nonprofit, tax-exempt organization. The mission of the Foundation is to improve the health and well-being of patients in hospitals and health systems through appropriate, safe and effective medication use. 

The Foundation provides leadership and conducts education and research activities that foster the coordination of interdisciplinary medication management leading to optimal patient outcomes. Emphasis is given to programs that will have a major impact on advancing pharmacy practice in hospitals and health systems, thereby improving public health.



Congratulations to Mary Ann Kliethermes whose book, Building a Successful Ambulatory Care Practice: A Complete Guide for Pharmacists, is published and available in the ASHP Store!















Congratulations to Megan Metzke who welcomed son, Drake Andrew Metzke, with her husband, Brian, on December 20, 2013.










Congratulations to Lisa (Lubsch) Bimpasis who welcomed son, Alexander Michael Bimpasis, with her husband, Nick, on February 13, 2014.












Leadership Profile
David Tjhio

Where did you go to pharmacy school?
Midwestern University, Chicago College of Pharmacy

Trace your professional history since graduation: where have you trained / worked, any special accomplishments?
After graduating from Midwestern with my BS in Pharmacy, I worked full time at Provena Mercy Center until I started my PharmD curriculum, during which time I still worked full time in 6 week stretches between rotations. Following graduation from Midwestern with my PharmD degree, I completed a pharmacy practice residency at Advocate Lutheran General Hospital. After my residency, I stayed on at Advocate to work on standardizing the nine hospital inpatient pharmacies onto a common pharmacy computer system, then worked my way up to being the System Manager of the Pharmacy Information Technology team for Advocate. I eventually moved on to my current position at Cerner Corporation where I am a Healthcare Executive. I also still staff at Advocate Trinity Hospital every other weekend.

Describe your current area of practice and practice setting.
I currently work in Healthcare IT for Cerner Corporation, which is based in Kansas City, MO. I work from home when I’m not traveling (I travel about 3-4 days/week). I work as a clinical consultant with our sales teams, primarily meeting with pharmacists, nurses, and other clinicians at various hospitals around the country to assess their current medication process workflow and to determine what solutions they need.

What initially motivated you to get involved, and what benefits do you see in being active in a professional association such as ICHP?
Initially I saw it as a way to get more professional exposure. Now I feel the biggest benefit for me is networking with other pharmacists around the state.

Is there an individual you admire or look up to, or a mentor that has influenced your career?
Janet Teeters was my residency director as well as our System Director of Pharmacy at Advocate Lutheran General Hospital. She was a great mentor for me during my residency and afterwards, and gave me the opportunity I needed to follow my career path in Pharmacy Informatics. I continue to interact with her in her current role at ASHP.

Do you have any special interests or hobbies outside of work?
I enjoy drinking and collecting wine, we have a wine cellar with over 200 bottles. I also enjoy racing in triathlons (primarily short course which include Sprint and Olympic Distances) and hope to one day complete a half Ironman triathlon. In addition, I enjoy live music and have really focused on the indie music scene over the last few years. Finally, I am a foodie and always look for great places to eat while I’m on the road for work. 

Do you have a favorite restaurant or food?
Next and Alinea both have some amazing fine dining and are definitely favorites for special occasions. Some of my everyday favorites however, are nearby in Logan Square including Revolution Brewing, Fat Rice, and Longman and Eagle.

What is your favorite place to vacation?
We really enjoy traveling outside of the country as it provides an opportunity to experience cultures and foods that are often very different from our daily experience here in the U.S. Some of our favorite destinations have been Brazil, Argentina, Uruguay, Bali, Cambodia, Vietnam, Thailand, and Lithuania.

What is the most interesting/unique fact about yourself that few people know?
I am colorblind (red-green colorblindness).

What 3 adjectives would people use to best describe you?
Funny, friendly, loyal




Medication Safety Pearl
Clinical Informatics and Medication Safety: Partnering for a Safer EMR

by Heather Harper, PharmD, BCPS and Karin Terry, PharmD, Clinical Informatics Pharmacist and Micro-Medication Safety Officer, OSF Saint Francis Medical Center, Peoria, IL

Electronic Medical Records (EMR) with Computerized Physician Order Entry (CPOE) have been recommended by safety organizations as a way to decrease medication errors. While many types of errors, such as illegible orders and transcription errors, are mitigated with these technologies, other types of errors that were not seen during the “paper chart era” have been uncovered.1 Some of these new error types generated include confusing order options and selection methods, problematic data presentations, and inappropriate text entries. Other unintended consequences from CPOE implementation have been identified such as unfavorable workflows, changes in communication practice and patterns, alert fatigue, changes in power structure, and overdependence on technology.2 Medication safety techniques that were previously utilized must be updated to be relevant in the electronic world.

OSF Saint Francis Medical Center (SFMC) is a 616 bed teaching affiliate of the University Of Illinois College Of Medicine at Peoria and is a part of the OSF Healthsystem. SFMC is a Level 1 Adult and Pediatric Trauma Center and tertiary care medical center. The computer system previous to 2010 was a partial EMR with pharmacist order entry. In this system, SFMC had facility-level control to make EMR changes. The Micro Medication Safety Officer led a committee of pharmacists and technicians who would review reported near miss events and evaluate the EMR for potential changes to prevent those events from recurring in the future. Examples of these changes include changing how the drug name appeared on the pick list and the drug label, adding indications to order entry, and adjusting dosing alerts for our pediatric population.

SFMC converted to an EMR with CPOE in 2010. Due to differences in EMR functionality, some of the customization to enhance patient safety in the prior EMR was lost. The new EMR was standardized across the OSF system, and updates to the EMR were only made after system agreement. Informatics resources were only available at the corporate level. Updates to the EMR after a reported medication near miss or event required a request to the corporate Informaticist, who would then get agreement from all facilities in the system prior to implementing the change in the EMR. At times, these requests were hindered by the lack of informatics expertise of those at the facility-level. Without that expertise, the system informatics personnel often performed multiple clarifications and modifications to meet the intent of the request.

SFMC recognized the need for a local informatics expert to facilitate these necessary updates in a more efficient manner. In October of 2012 a Clinical Informatics Pharmacist position was developed. The Clinical Informatics Pharmacist was tasked with coordinating the many change requests for updates to the EMR, providing ongoing EMR training to pharmacy staff, and collaborating with staff and leadership to develop workflow processes and technological solutions. Since that time, the role of the clinical informatics pharmacist has evolved and now includes membership on several safety committees at SFMC, including the Adverse Drug Event Committee, Pediatric Pharmacy Medication Safety Committee, and Drug Alert Work Group. Additionally, the Informaticist now reviews all reported medication events involving EMR and CPOE. The technical and clinical expertise of the Informaticist has allowed for more efficient resolution of medication safety issues in the EMR.

Prior to the informatics pharmacist position, the medication safety officer would have written a formal request for change. The request would go through multiple committees for approval at the facility-level before being sent through several committees at the system level. Once approved, the request would be routed to an analyst for implementation into the EMR. With the addition of the Clinical Informatics Pharmacist at SFMC, the request was able to be routed directly to the analyst for implementation. This was possible due to the specific information the informaticist provided the analyst.

One example of EMR updates facilitated by the clinical Informaticist involves the order entry of methotrexate oral tablets. The Adverse Drug Event Committee reviewed the ISMP 2014-2015 Targeted Medication Safety Best Practice for Hospitals Self-Assessment and recognized an opportunity for improvement regarding the dosing buttons with oral methotrexate. The default dose was blank, and the available dosing buttons included 2.5 mg, 5 mg, and 7.5 mg. The default frequency was “weekly”, and the available frequencies included daily, weekly, and twice weekly.

A usage report was run to determine if the dosing buttons matched the most commonly prescribed dose at SFMC and throughout the OSF system. It was determined that the doses were very patient specific and that the dosing buttons gave prescribers a false sense of security to choose one of the buttons. In some situations the prescriber chose 2.5 mg as the dose when the intention was to use the 2.5 mg tablet to get a larger dose. The frequencies used throughout the OSF system were also evaluated to determine if any of our patient populations required the “daily” or “twice daily” frequency buttons. There were very few times when these frequencies were used, and in each of these times, the orders were changed to “weekly” after pharmacist clarification. Based on the usage data, change requests were submitted to remove all dosing buttons and to only have a “weekly” frequency button. Both of these changes were able to be quickly and efficiently implemented with the combined efforts of the Medication Safety Officers and the Clinical Informatics Pharmacist.

Table 1:  Frequency of Dosages for Methotrexate

 

Table 2:  Frequency of Schedules for Methotrexate

 
Healthcare and Pharmacy practice continue to evolve. Constant updates to the EMR are required to keep pace with these changes in order to support, rather than hinder, clinical activities. The EMR should not be solely an IT project or a clinical project, but rather a collaboration of multiple disciplines. SFMC has recognized that this collaboration streamlines updates to the EMR and improves safety, efficiency, and coordination of patient care. We realize that not all facilities have the resources available for a dedicated Clinical Informatics Pharmacist. If resources are not available, we highly encourage developing a relationship between clinical and informatics personnel for work on enhancements to the EMR within patient care.


References:
  1. Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2006; 13(5): 547-556.
  2. Koppel R, Metlay JP, et al. Role of computerized physician order entry systems in facilitating medication errors (abstract).  JAMA. 2005; 293(10): 1197–1203. 




Board of Pharmacy Update
Highlights of the March Meeting

by Scott A. Meyers, Executive Vice President

The March 11th Board of Pharmacy Meeting was held at the James R. Thompson Center in downtown Chicago. These are the highlights of that meeting.

Pharmacy Practice Act Draft Rules – The process has taken longer than expected, but it is projected that the draft rules will be published in the Illinois Register sometime in the next 3-4 weeks. Once they are published, the public will have 45 days to provide written comments, and then the Department staff will review the comments and incorporate any changes they believe to be appropriate. Once that process is completed, the Department will submit the draft rules to the Joint Committee on Administrative Rules (JCAR is a bi-partisan committee of House and Senate members), and JCAR will have 45 more days to return the rules to the Department with recommended changes or approve them. Once approved by JCAR, the rules are in effect.

Medical Cannabis – Dr. Miriam Mobley-Smith reported on a meeting several Board members had with Division of Professional Regulation Director Jay Stewart concerning pharmacist involvement with dispensing medical cannabis in Illinois. Currently the rules are still in draft form and are being developed by the Illinois Departments of Agriculture, Public Health and Financial and Professional Regulation. Here are the key points identified in that meeting:
  • Pharmacists may be involved in the dispensing process of medical cannabis.
  • Pharmacies may not apply for or be medical cannabis dispensaries in Illinois.
  • Many sections on the application for a dispensary permit favor the knowledge and skills of pharmacists, relating to medical knowledge, product security, patient counseling and more.
  • The Department of Public Health will convene a Medical Cannabis Review Board, and one of the positions on the board is specifically identified as a pharmacist.
ICHP and other groups intend to file a comment on the draft Pharmacy Practice Act Rules that would prevent discipline to a pharmacist’s license under the Pharmacy Practice Act if they participate in the medical cannabis dispensing outside a pharmacy and are in full compliance with the Medical Cannabis Pilot Program Act statutes and rules.

FDA Compounding Oversight – Daniel Kelber, General Counsel for the Board, reported that the FDA is conducting another educational session for state Boards of Pharmacy and regulatory agencies on March 20-21, and he and Dr. Yash Amin will attend on behalf of the Department. The Department is looking for final rules from the FDA on compounding oversight and will be reporting back to the Board of Pharmacy in May.

NABP Annual Meeting – The Board will be well represented at the May 17-20 Annual Meeting in Phoenix with Phil Burgess, current Board Chair serving as a delegate and Miriam Mobley-Smith, current Vice Chair serving as an alternate delegate. In addition, Ron Weinert and Ned Milenkovich will be in attendance. Resolutions approved at this annual event often mold the direction of pharmacy practice across the country.

Meeting Dates for Fiscal Year 2015 – The Board of Pharmacy will continue to be held on the second Tuesday of the odd months throughout fiscal year 2015 (July 1, 2014-June 30, 2015); however, the November 2014 meeting will fall on Veterans Day and has been moved to November 18th.  

Legislative Update – This month was ICHP’s turn to present the legislative update to the Board. The information presented can be found in this issue in the GAS From Springfield column. The Board and numerous visitors were extremely appreciative of the update.

Controlled Substance Act Rules draft published and open for comments – New rules for the Illinois Controlled Substance Act were published in the March 7th Illinois Register and are open for public comment through April 20th. The March 7th Illinois Register can be accessed at http://www.cyberdriveillinois.com/departments/index/register/register_volume38_issue10.pdf with the draft rules found beginning on page 5705. Members are encouraged to review these changes and provide comments to the Department of Financial and Professional Regulation or to the ICHP office.

Next Board of Pharmacy Meeting – Is scheduled for Tuesday, May 11th at 10:30 AM on the 9th floor of the James R. Thompson Center in downtown Chicago. Pharmacists, pharmacy students and pharmacy technicians are welcome to attend the open portion of the meeting.




New Practitioners Network
What Does Provider Status Truly Mean?

by Kunal Desai, PharmD Candidate 2014, Chicago State University College of Pharmacy; reviewed by Rebecca Castner, PharmD, Assistant Professor of Pharmacy Practice at Chicago State University COP/Clinical Pharmacy Specialist, Ambulatory Care at Rush University Medical Center

I am sure many pharmacy students, pharmacists, and others who have a vested interest in pharmacy have heard that pharmacists may achieve provider status in the near future. It is not an easy task to define this new title of provider status that has been thrust into the media spotlight. The purpose of this article is to address some of the benefits and drawbacks of obtaining provider status for pharmacists in Illinois.

For the time being, pharmacists are not recognized as providers under the Social Security Act (SSA), but there are a myriad of other healthcare professionals that have been granted this status. The list of healthcare professionals includes, but is not limited to, physicians, certified nurse practitioners, physicians’ assistants, audiologists, clinical social workers, licensed clinical psychologists, and registered dieticians.1,2 This allows the aforementioned providers to bill insurance companies for services rendered to beneficiaries of Medicare Part B.1 With pharmacists not on this list, patients are forced to pay out of pocket for the pharmacy services that they provide. Services like education of proper medication use not only saves the patient money by averting frequent trips to their physician and admissions, but it also saves the state of Illinois money in healthcare costs directed at treating medication-related problems. According to the infographic from the National Alliance of State Pharmacy Associations (see table), the state of Illinois has spent around 14 billion dollars on medication-related problems. These problems, and much of their associated costs, could have potentially been avoided by utilization of a pharmacist’s expertise if patients had access to them through Medicare or private insurance, saving our state a significant amount of money at a time it is sorely needed to help balance the budget.3

Another benefit of provider status for pharmacists, specifically, is receipt of reimbursement for services provided. With the current healthcare model, many pharmacists find it difficult to obtain reimbursement for medication therapy management (MTM) services, which reduces the ability of pharmacists to make these services available to many patients, subsequently leading to poorer health outcomes. The Affordable Care Act (ACA) has allowed for the implementation of accountable care organizations (ACOs) and medical homes that will go hand in hand with pharmacists practicing with provider status. These new models reward providers for keeping costs down while improving patient outcomes.1,4

Another benefit of provider status is that pharmacists will have more opportunities to hold clinical positions because there will be more financially sustainable venues to practice these skills. With the new payment models of healthcare like ACOs and medical homes, there is an incentive for healthcare institutions to implement pharmacy services because this reduces risk and cost for all patient populations. Pharmacists may also gain increased job satisfaction due to the fact that they will be improving patient health through the education that they provide.1 The benefits of provider status for pharmacists are clear, but what about the drawbacks?  

Looking through the perspective of other healthcare professionals, provider status may be an act of encroachment on existing funds. One speculation is that other healthcare professionals may feel that the pool of money reimbursed by the state will get cut into by including pharmacists in the SSA.6 This may strain the interprofessional relationships between healthcare providers and pharmacists because other providers may see pharmacists as overstepping into their respective scope of practice. Another potential drawback would be the added paperwork that would need to be filed and increased administrative responsibility that could interfere with the efficient workflow a pharmacist is used to. In a study by Watkins et al., pharmacists working in an ambulatory oncology clinic found that completing MTM billing and documentation forms would hinder their overall efficiency.7 Some pharmacists may not be eager to expand their services if they are already overwhelmed by the amount of paperwork they are currently completing, but might be forced to do so in order to remain relevant in the ever-changing pharmacy landscape. However, while provider status means different things to different people, the positive impact it would have on our patients remains regardless of these potential drawbacks.1,2

The SB 493 bill was passed in California which granted provider status to pharmacists in California. This law allows pharmacists in California to administer drugs and biologics ordered by a physician (including injectables), furnish travel medications recommended by the CDC not requiring a diagnosis, and independently initiate and vaccinate patients 3 years of age and older. Although Illinois is far from California geographically, our ideals remain aligned with California with a hope that we, too, can pass a bill that will give us increased autonomy and reduce barriers related to providing our services to patients in our great state.5


 
 

References
  1. American Pharmacists Association. The pursuit of provider status: what pharmacists need to know. APhA provider status Q&A informational sheet. http://www.pharmacist.com/sites/default/files/files/Provider%20Status%20FactSheet_Final.pdf (Accessed 2014 Jan 16).
  2. Academy of Managed Care Pharmacy. Non-physician provider status for pharmacists. Where we stand on non-physician provider status for pharmacists. http://www.amcp.org/Sec.aspx?id=15415 (Accessed 2014 Jan 16).
  3. National Alliance of State Pharmacy Associations. Patient access to pharmacists’ patient care services: the key to improving medication use and lowering health care costs. 2013 state fact sheets. http://www.naspa.us/documents/facts/2013%20State%20Sheet%20Illinois.pdf (Accessed 2014 Jan 17).
  4. Centers for Medicare & Medicaid Services. Accountable care organizations (ACO). Baltimore, MD: Centers for Medicare & Medicaid Services, 2013. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/ACO/ (Accessed 2014 Jan 17).
  5. Yap, D. California provider status law effective January 1. American Pharmacists Association. http://www.pharmacist.com/california-provider-status-law-effective-january-1 (Accessed 2014 Jan 17). News.
  6. Doctors and Pharmacists Battle Over Scope of Practice. Medscape. Apr 05, 2012.
  7. Watkins JL, Landgraf A, Barnett CM, Michaud L. Evaluation of pharmacist-provided medication therapy management services in an oncology ambulatory setting. J Am Pharm Assoc (2003). 2012;52(2):170-4.




College Connections

Mini-Health Fair at the Indo American Center

by Zachary Stewart, P3, ICHP Philanthropy Chair, Midwestern University Chicago College of Pharmacy

The ICHP student chapter at Midwestern University Chicago College of Pharmacy had the opportunity to hold a mini-health fair at the Indo-American Center, a community center based in Chicago, Illinois. This event focused on the importance of medication adherence and diabetes education. The regular center attendees face various challenges in the healthcare system, some of which include language barriers (their main speaking language is Hindi) and lower health literacy. We believed that this population would greatly benefit from a mini-health fair that incorporated multiple healthcare disciplines to help them overcome these obstacles.

We set up four different booths at the event: a blood glucose screening booth, a medication review booth, an oral health booth supervised by a dentist, and a general diabetes education booth supervised by an osteopathic doctor. Each booth had translators for any patients who spoke Hindi. A total of 12 pharmacy students volunteered under the supervision of two pharmacists, along with two dental students and four medical students. Within three hours, we helped 22 patients.  This event provided patients with a unique experience because they had three different healthcare professionals together at the same event, all of who were aiming to raise medication adherence awareness. Patients also gained an in-depth understanding of diabetes from multi-disciplinary perspectives.

At our medication review booth, we created personal medication lists for all of our patients, to give them a guide as to when to take their medications. Our student pharmacist volunteers also investigated issues such as storage, proper timing of insulin injections, and fasting blood sugar goals for diabetic patients. Each patient came in with a unique issue with regard to medication education and adherence. One patient was actually using the same insulin bottle for the entire year; though she was adherent with taking her medications, she did not understand that her insulin may have been contaminated. Another patient had her blood glucose screened, resulting in a blood glucose number in the 300’s. When we investigated why this number was so high, the patient stated that she was not taking her diabetes medication because she did not notice any symptoms of hyperglycemia and no longer thought she needed to take them. One patient kept all four of her medications in one medication vial. 

We distributed surveys to assess current adherence and how well they perceived the event had gone; 14 surveys were completed. When asked, “Was it helpful to have a medication list created for you?” 13 out of 14 patients responded “very helpful”. Only 6 out of 14 patients thought they had been “very good” at taking their medications as directed in the last 30 days. All patients found the event to be “very useful” and all patients responded that they would be “very likely” to recommend the event to friends and family. Written comments included statements like “excellent service by students of Midwestern University” and “I will try to be better at taking my medications”.

Through this event, we were able to educate an underserved population about medication safety and adherence, and develop relationships between pharmacists and other healthcare professionals. It was a very rewarding experience to educate these patients and provide them with services they would not receive otherwise. Our student chapter looks forward to creating more inter-disciplinary events to better serve patients and continue to strengthen our relationships with other healthcare professionals.





Volunteering with Care

by Joanna Kasper, P-3, SSHP Philanthropy Chair, Rosalind Franklin University of Medicine and Science College of Pharmacy

Rosalind Franklin University’s ICHP student chapter has been committed since our beginning to pursue a variety of volunteer efforts. One of these opportunities includes our partnership with the newly accredited V-Care Hospice Services of Illinois, located in Northbrook. This organization is guided by a mission to provide personal, clinical, and technological excellence to people at the end of their life along with supportive services to family members and other loved ones. Patients are referred to hospice care when they are expected to live about 6 months or less and can no longer be helped with curative treatment. The care focuses on providing medical, psychological, and spiritual support to help them in the final phases of incurable disease so that they may live as comfortably as possible.1 Patients who utilize these services can be at a home, hospice center, hospital, or skilled nursing facility. This allows their last days to be surrounded by their loved ones.

Several of our students have started volunteering with the organization and have found it to be rewarding both as a future healthcare professional and in their personal lives. To begin this service, the students participated in several training modules that focused on activities such as patient care, the grieving process, and death and dying. They also participate in continuing education on topics such as the art of listening. One of the current volunteers, RaeAnn Hirschy (P3 student) said, “This has been a great experience to have as a pharmacy student. I feel that as healthcare providers, the focus is often on curative treatment. This opportunity allows exposure, and a way to help patients who are past the point of curative treatment and just need supportive care. I was able to build a relationship with the patient and able to tell the patient's mood, as well as if it was a good or bad day.”

The third year students as well as the ICHP-SSHP executive board have initiated this opportunity for members to advance service to the community while gaining valuable exposure to this specific patient population. Those who have participated are excited to continue their services with the organization and help expand the program to include first and second year students. “Working with hospice has allowed me to help those in need, while gaining a better understanding of this patient population that I will encounter as a pharmacist. These experiences will stay with me for a lifetime and I hope that more of my fellow students will be able to have these opportunities in the future,” said Jessica Zacher (P3 student). This has been a successful volunteer partnership that will hopefully expand in the future as V-Care Hospice of Illinois grows.

References: 
1) American Cancer Society. Hospice Care. 2013. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002868-pdf.pdf Accessed: February 26th 2014.




APPE Preparation through SSHP Quarterly Journal Club Discussions

by Kim Rusche P3, SSHP Journal Club Chair, Roosevelt University College of Pharmacy

With several pharmacy schools in the Chicagoland area, residencies and careers in pharmacy practice are becoming competitive and scarce. It is not enough for students to perform well academically, be active leaders in professional organizations, and participate in community outreach. It is just as crucial for pharmacy students to perform at their highest level during advanced pharmacy practice experiences (APPE) rotations. The majority of pharmacy programs have three years of didactic curriculum to prepare their students for APPE rotations. Roosevelt University College of Pharmacy’s unique three-year program gives students two years for the same preparation.  

Pharmacy students are held to high standards during rotations and are often judged on their ability to apply evidence-based medicine to clinical practice. It is a task that takes practice to perfect, and invovles selecting and analyzing proper journal articles, preparing a handout, and presenting the relevant information to professionals. Roosevelt University’s Student Society of Health-System Pharmacy (SSHP) believes that giving students additional practice in preparing and presenting journal clubs to clinical faculty provides our student members with an opportunity to improve their literature evaluation skills, clinical interpretation, statistical analysis, and presentation abilities to improve performance on their future APPE rotations.

Organizing a journal club event is fairly simple for any organization. To start, multiple research articles have to be selected from prominent peer-reviewed medical journals. Upon faculty advisor(s) approval, one article is selected and given to faculty and students along with journal club templates and examples, AMA citation guide, and a grading rubric. Students are asked to complete a one-page handout to present and be prepared for questions if they chose to participate in the event. Our goal is to simulate how a journal club presentation and discussion would take place on an APPE rotation.

During the actual event, students are grouped with clinical faculty members from Roosevelt University College of Pharmacy. Each student then presents a section of the article (introduction, methods, statistics, results, conclusions, and/or clinical relevance) and uses their handout as needed. Then comes the difficult part: the questions from faculty. We are incredibly lucky to have help from professionals that truly want to improve our skills. The faculty comes prepared, having read the article, taken notes, and developed a list of questions to test our knowledge of the study presented. The questions presented range from statistical questions, validity of the study, and how the outcome can be applied in practice. The majority of the time is spent in discussion, answering these questions when possible and discussing the importance of the study. This open discussion provides our students with knowledge on where they need to improve, what to look for in studies, what information to include in their journal club handout, how to critique the study, and much more. The faculty then takes each handout after the event and provides feedback to every student. This provides another opportunity for students to improve their journal club handouts before they present them again and on rotations.

Ultimately, journal club presentations continue throughout a pharmacist’s career as part of their continued lifelong learning, whether you are a student, resident or preceptor. Therefore, SSHP believes that giving our members an opportunity to practice before rotations begin will improve their knowledge and presentation abilities. When our members continue on to APPE rotations, they will be confident during journal club presentations, and be ready and prepared to answer questions from preceptors or part of the healthcare team. Our goal is for students to feel prepared for APPE rotations, and excel at journal clubs. We hope that this quarterly event will provide our students with the skills to impress preceptors and other professionals, to exceed on rotations and in their career.





Second Annual Student and Pharmacist Mixer

by Patrick Costello, PS3, University of Illinois at Chicago College of Pharmacy, Rockford Campus

As the second class to have the pleasure of attending the UIC Rockford College of Pharmacy, we have benefited greatly from the class ahead of us. Much like an older sibling, they have given us pearls of wisdom, been the guinea pigs, and set up many organizations and events. One such event was the ICHP Student and Pharmacist Mixer. In the fall of 2012, the first ever mixer took place without a hitch, with many area clinical pharmacists in attendance. This was a unique opportunity for our students to both network and learn more about the profession of pharmacy. 

The mixer was so successful that the ICHP E-Board decided that it should become an annual event. This meant that the pressure was on to have lightning strike twice, and required that the second annual mixer be a hit as well. After quite a bit of planning, the event was once again a success. The mixer was held on November 21, 2013 at the UIC Health Sciences Campus here in Rockford. In addition to the 65 students, over 20 pharmacists attended the mixer, ranging from infectious disease pharmacists, pediatric pharmacists, cardiac pharmacists, and even two residents. These health-system pharmacists came from all over the Rockford area, including Kishwaukee Community Hospital, Lehan Drugs, OSF Saint Anthony Hospital, Rockford Memorial Hospital, Swedish American Hospital, and ICHP.

The consensus on campus has been that both students and faculty really appreciated their opportunity to network with the pharmacists who attended the event. All classes learned something from the practitioners. One P1 even expressed how amazed she was at the different paths she could take after graduation. Similarly, P3 students appreciated getting to know their potential preceptors for their upcoming rotations during P4 year.

Events like this really help showcase the different directions that the profession of pharmacy can take someone after graduation. The motivation and advice given by the practicing pharmacists will serve the students as they soon enter the field, where hopefully they, too, can soon make an impact upon the profession. We hope to have a similar or even better turnout next year and really appreciate the support that is always given to us by our local pharmacists.
 
Furthermore, I hope that future classes here at the UIC Rockford campus learned from our class’ example and continue to grow, just as we did from our soon to be graduating P4s!




More

Officers and Board of Directors

MIKE FOTIS 
President 
michael.fotis@northwestern.edu 

TOM WESTERKAMP 
Immediate Past President
224-948-1528 
tom_westerkamp@baxter.com

LINDA FRED 
President-Elect
217-383-3253 
linda.fred@carle.com

GINGER ERTEL 
Treasurer 
660-342-5022 
gertel@msn.com 

CAROL HEUNISCH 
Secretary 
847-933-6811 
cheunisch@northshore.org

TRAVIS HUNERDOSSE 
Director, Educational Affairs 
thunerdo@nmh.org

JENNIFER ELLISON 
Director, Marketing Affairs
Jennifer.C.Ellison@osfhealthcare.org

DESI KOTIS 
Director, Professional Affairs
312-926-6961 
dkotis@nmh.org

KATHY KOMPERDA 
Director, Organizational Affairs 
630-515-6168 
kkompe@midwestern.edu

FRANK KOKAISL 
Director, Government Affairs
fkokaisl@amerisourcebergen.com

MIKE WEAVER 
Chairman, House of Delegates 
815-599-6113 
mweaver@fhn.org

ELIZABETH ENGEBRETSON 

Technician Representative 
815-756-1521x153346 
EEngebretson@northshore.org

DAVID TJHIO
 
Chairman, Committee on Technology 
816-885-4649 
david.tjhio@cerner.com

DIANA ISAACS
 
Chairman, New Practitioners Network 
disaacs@csu.edu

JACOB GETTIG 
Editor & Chairman, KeePosted Committee 
630-515-7324 fax: 630-515-6958 
jgetti@midwestern.edu 

JENNIFER PHILLIPS 
Assistant Editor, KeePosted 
630-515-7167 
jphillips@midwestern.edu 

KATHRYN SCHULTZ 
Regional Director North 
312-926-6961 
kathryn_schultz@rush.edu

JENNIFER ARNOLDI 
Regional Director Central 
jennifer.arnoldi@st-johns.org 

EMMA CARROLL 
President, Student Chapter
University of IL C.O.P. 
emmacarroll620@gmail.com 

JULIE BUCEK 
Student Chapter Liaison
University of IL C.O.P. 
bucek@uic.edu

NADIYAH CHAUDHARY 
President, Rockford Student Chapter 
University of IL C.O.P. 
nadi925@gmail.com

JANEY YU 
President, Student Chapter
Midwestern University C.O.P. 
janey.yu@mwumail.midwestern.edu

BERNICE MAN
 
President, Student Chapter 
Chicago State University C.O.P. 
bman@csu.edu 

TRAMAINE HARDIMON 
Student Representative 
Chicago State University C.O.P 
thardimo@csu.edu 

ZAK VINSON 
President, Student Chapter 
Southern Illinois University Edwardsville S.O.P
zvinson@siue.edu

ALEX MERSCH 

President, Student Chapter 
Roosevelt University C.O.P. 
amersch@mail.roosevelt.edu

JENNIFER AGUADO
 
President, Student Chapter 
Rosalind Franklin University C.O.P. 
jennifer.aguado@my.rfums.org 

SCOTT MEYERS 
Executive Vice President, ICHP Office 
815-227-9292 
scottm@ichpnet.org 


ICHP AFFILIATES 


PETE ANTONOPOULOS
 
President, Northern IL Society (NISHP)
1panton@gmail.com 

JULIA SCHIMMELPFENNIG 
President, Metro East Society (MESHP) 
jschimmelpfen@sebh.org 

MEGAN METZKE 
President, Sangamiss Society 
memiller8@yahoo.com

ED RAINVILLE
 
President, West Central Society (WSHP) 
309-655-7331x 
ed.c.rainville@osfhealthcare.org

Vacant Roles at Affiliates — 
President, Rock Valley Society; Southern IL Society; Sugar Creek Society; Regional Director, South

Welcome New Members!

ICHP color logofloat: none; margin-top: 0px; margin-bottom: 0px; margin-right: 0px; margin-left: 0px;
New Member Recruiter
Jeffry Ellis John Maxwell
Jessica Nacar
Brittany Huff
Kerri Eckerling Mike Fotis
D'Yana Conley
Crystal Ellison
Christine Jeng
Ozioma Nwaobia
Fadumo Mire
Yesol Kim
Coty Tunwar
Lila Ahmed
Marcella Wheatley Ina Henderson
L. Amulya Murthy
Michaela Smith
Lina Kishta
Olga Volozhina
Kimberly Scott
Magdalena Gacek
Samantha Plencner
Linh Do
Jontia Gentry
Sung Seo
Hanifath Lawani
Frederique Coulibaly
Sodiq Ogunnaike
ChungYun Kim
Allie Habhab
Michael Lewis
Gunny Chadha
Amanda Firmansyah
Hanh Nguyen
Greta Musaraj
Jennifer Ratliff
Joseph Gomes
GayleThompson
Carrie Sincak




ICHP Pharmacy Action Fund (PAC) Contributors

Names below reflect donations between April 1, 2013 and April 1, 2014. Giving categories reflect each person's cumulative donations since inception.

ADVOCACY ALLIANCE - $2500-$10000    
Edward Donnelly
Dave Hicks
Frank Kokaisl
Michael Novario


LINCOLN LEAGUE - $1000-$2499  
  
Scott Bergman
Kevin Colgan
Ginger Ertel
William McEvoy
Scott Meyers
Michael Rajski
Carrie Sincak
Michael Weaver
Patricia Wegner
Thomas Westerkamp
    

CAPITOL CLUB - $500-$999    
Rauf Dalal
Linda Fred
Ann Jankiewicz
Kathy Komperda
Despina Kotis
Mary Lynn Moody
UIC Student Chapter

    
GENERAL ASSEMBLY GUILD - $250-$499    
Margaret Allen
Michael Fotis
Janette Mark
Jennifer Phillips
Edward Rainville
Heidi Sunday

    
SPRINGFIELD SOCIETY - $100-$249    
Jennifer Arnoldi
John Esterly
Travis Hunerdosse
Carrie Vogler
Marie Williams
Cindy Wuller
William Wuller
    

GRASSROOTS GANG - $50-$99    
Susan Berg
Jennifer Ellison
Tory Gunderson
Glenna Hargreaves
Robert Hoy
Mike Koronkowski
Evanna Shopoff
Jerry Storm


CONTRIBUTOR - $1-$49    
John Chaney
Irvin Laubscher
Zakarri Vinson
Izabela Wozniak


Click here to make a donation to the PAC.




Upcoming Events

Regularly Scheduled

Visit the ICHP Calendar for the most up-to-date events!

Sunday, April 13
NPN Volunteer Opportunity: Lurie Ronald McDonald House
Chicago, IL

Thursday, April 17
Clinical Practice and Research Network
Adventist LaGrange Memorial Hospital | LaGrange, IL

Thursday, April 24
CPE Event! 2014 Nutritional Update CPE Program
Live Program: University of Illinois at Chicago College of Pharmacy | Chicago, IL
Live Broadcast: University of Illinois Chicago College of Pharmacy - Rockford Campus | Rockford, IL

Tuesday, May 6
NPN Cubs Game
Wrigley Field | Chicago, IL

Wednesday, May 7 at 12:00pm & Thursday, May 15 at 3:00pm
Champion Webinar: Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and post-discharge callbacks
LIVE Webinar

Tuesday, May 20
NISHP Meeting
Oakbrook Terrace, IL

Wednesday, May 28 (tentative date)
Pharmacy Directors Network Dinner
Location TBD

Tuesday, July 1
Deadline for submissions 2014 Best Practice Award

Thursday, September 11 - 13
ICHP 2014 Annual Meeting
Drury Lane | Oakbrook Terrace, IL







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