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Call for Entries: 2016 Best Practice Award

President's Message
Strengthen Your Chances of Success with Soft Skills

by Jen Phillips, PharmD, BCPS, ICHP President; co-written with Sheron Chen, PharmD, Assistant Professor of Clinical Sciences, Roosevelt University College of Pharmacy

Directly Speaking
Letters I Hate and Love to Sign!

by Scott A. Meyers, Executive Vice President

Leadership Profile
Barb Limburg-Mancini, BS Pharm, PharmD

Board of Pharmacy Update
Highlights from the March 2016 Meeting

by Scott A. Meyers, Executive Vice President

1 minor violation during the same visit	$100 fine
2 minor violations during the same visit	$250 fine
3 minor violations during the same visit	$500 fine

Government Affairs Report
The Fun Has Begun

by Jim Owen and Scott A. Meyers

SB2515 PBM Regulation

HR0944 Study e-prescribing discontinuation/stop orders

HR1018 Urge Congress to ban Direct-to-Consumer Advertising

HB3627 Immunization expansion for pharmacists

HB5540 Dispensing naloxone without a prescription

HB5591 PBM Regulation

HB5809 Pharmacist prescribed hormonal contraceptives

SB2498 Technical change to pharmacy practice act

SB3336 Establishes a pharmacy quality assurance program for error reporting

HB4936 Technical change to pharmacy practice act

HB6180 Establishes a pharmacy quality assurance program for error reporting

Professional Affairs
Strategy for dealing with fomepizole shortage: revisiting the use of alcohol as an antidote

by Katherine V. Zych, PharmD, BCPS, PGY2 Drug Information Resident, UIC College of Pharmacy; Anthony M. Burda, BS.Pharm, DABAT, Illinois Poison Center; Carol DesLauriers, PharmD, DABAT, Illinois Poison Center

Educational Affairs
2016 Spring Meeting Poster Abstracts

EDITOR’S NOTE: For a detailed list of all posters as presented at the 2016 Spring Meeting, please refer to the Spring Meeting Syllabus, pages 14-16. Poster numbers as presented at the meeting are in parenthesis below. For Platform Presentations, please refer to the Spring Meeting Syllabus, page 10. All research was to have results and conclusions by the time of presentation. This may not be reflected in the posted abstracts below.

PLATFORM PRESENTATIONS

1. Reducing adverse drug event risks for geriatric patients by optimizing prescribing for selected medication records
2. Economic impact of major adverse drug events using hospital chargemaster data in 2014-2015

ORIGINAL

1. Sacubitril; Losartan the next treatment for heart failure?
2. The role of tenofovir in preexposure prophylaxis of herpes simplex virus type 2: a systematic review
3. Calcium and Vitamin D co-supplementation in Gestational Diabetes Mellitus
4. Oral lorazepam for seizure prophylaxis in adult patients treated with high dose intravenous busulfan before hematopoietic stem cell transplantation: A retrospective study
5. Evaluation of a Protocol used to Screen and Control Glycemic Levels Following Total Orthopedic Knee and Hip Surgeries
6. Analysis of Risk Factors and Antipsychotic Usage Patterns Associated with Terminal Delirium in a Veteran Inpatient Hospice Population
7. Redesigning PGY1 Pharmacy Residency Interview Structure
8. Impact of pharmacists within a multidisciplinary team on chronic obstructive pulmonary disease (COPD) readmission rates
9. Efficacy, nephrotoxicity, and incidence of Clostridium difficile infection with broad spectrum antibiotic regimens in patients with nosocomial pneumonia
10. Evaluation of fall risk in dementia patients on an atypical antipsychotic in the VA population
11. Digoxin and Time to Cardiac-Related Hospitalizations: A Retrospective Cohort Study
12. A Performance Improvement Approach to Implementing a Pharmacist-led Medication Education Program in a Community Hospital
13. Evaluation of a Pilot Benzodiazepine Taper Clinic in Veterans with Concurrent Opioid Use

ENCORE

1. Implementation of decentralized pharmacy technicians to improve medication delivery and nursing satisfaction
2. Global Initiatives to Streamline Pharmacy Education and Workforce Development
3. Antifungal prophylaxis consideration in patients being treated with blinatumomab for Philadelphia chromosome-negative relapsed or refractory b-cell acute lymphoblastic leukemia: a case report
4. Differences in Clostridium difficile infection outcomes between guideline concordant and discordant therapy

STUDENT

1. Assessment of healthcare needs of elderly patients in rural communities of central Illinois
2. Effectiveness of Pharmacy Practice Model Initiative Competency
3. Desmopressin (DDAVP) Dose Changes Post Discharge in Pediatric Patients with Diabetes Insipidus Receiving Oral DDAVP Compounded from Nasal Spray Inpatient
4. Retrospective analysis of osteoporosis risk factors among the Chinese population
5. Comparison of oral morphine equivalent doses vs. PHQ9 scores in a family practice setting
6. Phytopharmacological evaluation of chamomile (Matricaria recutita L.) for indirect modulation of the endocannabinoid system
7. Comparison of Pharmacist and Physician Attitudes and Knowledge of Pain Management

ICHP Poster Presentations – Platform Presentation #1

Category: Original - Research Complete

Title: Reducing adverse drug event risks for geriatric patients by optimizing prescribing for selected medication records

Purpose:  To improve the age-appropriate prescribing for selected medications in patients over 65 years old, to decrease the potential for adverse drug reactions (ADRs). 

Methods: This trial was conducted at a 600+ bed level ¹ trauma center in Peoria, IL, which utilizes an electronic health record (EHR) with pre-selected or default medication doses and frequencies. To reduce potential ADRs associated with medication prescribing, seven medications (amitriptyline, cyclobenzaprine, diphenhydramine (oral and intravenous), glimepiride, glipizide, and glyburide were identified. These medications were selected because, their default doses and/or frequencies in the EHR did not adhere to age-appropriate guidelines as described by BEERs. The BEERs list, published in 1991, described the development of a consensus list of medicines considered to be inappropriate for geriatric patients and is endorsed by The American Geriatrics Society. It includes medications that should be avoided, and medications that should be used with extra caution, either in all elderly or in certain populations.¹ Changes in doses and or frequencies were made based on recommendations from the BEERs criteria and the geriatric dosing provided in Lexi-Comp.² EHR reports were obtained for two six month periods, baseline and follow up. The follow up period began two months after changes were implemented to ensure full integration. The percentage of medication orders within the geriatric appropriate dose and/or frequency targets were measured for both the baseline and follow up periods.  

Results: Positive changes in physician prescribing habits were seen in four out of seven medications, including cyclobenzaprine, diphenhydramine (both oral and intravenous), glimepiride and glipizide. The baseline percentage of orders within the target dose range compared to the follow up period were cyclobenzaprine (39.1% vs 61.1%), diphenhydramine oral (39.2% vs 49.4%), diphenhydramine intravenous (55.2% vs 57.4%), glimepiride (19.6%  vs 21.9%), and glipizide orders (14.1% vs 21.5%).  

References
1. American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2015 Oct 8. doi: 10.1111/jgs.13702. [Epub ahead of print].
2. Lexi-Comp. Accessed August 2014.

Conclusion:  Improved compliance was achieved with physician ordering of medications (cyclobenzaprine, oral and intravenous diphenhydramine, glimepiride and glipizide) for patients over 65 years old by adjusting the default dose and or frequency, using evidence based criteria.  Although not specifically measured in this initiative, it is concluded that the risk of ADEs were reduced by adjusting the EHR default doses and frequencies for these selected medications.

Submitting Author: Amy B. Maxfield, BS Pharm

Submitting Organization: OSF SFMC

Authors: Amy B. Maxfield, BS Pharm; Heather M. Harper, PharmD, BCPS

ICHP Poster Presentations – Platform Presentation #2
Winner: Best Platform Presentation 2016

Category: Original - Research Complete

Title: Economic impact of major adverse drug events using hospital chargemaster data in 2014-2015

Purpose: Patient-specific adverse drug events (ADEs) have been previously associated with respective increases in hospitalization costs and length of stay. Literature determining the economic impact of ADEs is relatively outdated, driving health system administrators to apply an inflation factor to previously published figures in the processes to evaluate current cost avoidance of ADE prevention. The purpose of this study is to determine the economic impact of major ADEs on patient hospitalization costs and length of stay (LOS), in present time.

Methods: This study has been approved by the University of Chicago Institutional Review Board. ADEs were identified using both voluntary event reporting data and ICD-9 codes for patients admitted to the University of Chicago Medicine during the time period of April 2014 and May 2015. Case patients experienced a major ADE (as classified as “E” or higher on The National Coordination Council for Medication Errors Reporting and Prevention [NCC-MERP] Index for Categorizing Medication Errors).   Controls matched by admission during study time period, classification by diagnosis related group, age (±2 years), and sex of each case were included. Using eSimon (Algonquin, IL), a hospital cost accounting system, total cost of hospitalization and length of stay were determined for both cases and controls. All analyses were performed using a two-sample Wilcoxon rank-sum (Mann-Whitney) test in STATA (College Station, TX).

Results: Of a total of 416 patients who experienced major ADEs evaluated for inclusion in the study, 242 were matched with controls for analysis. The drug classes primarily accounting for studied major ADEs include chemotherapy (38%), corticosteroids (14%) and opioids (11%). Mean cost of hospitalization between patients who experienced a major ADE and those who did not differed significantly ($38,239.31 vs. $47,138.04, p=0.0440), as well as in mean LOS (8.03 vs. 9.92 days, p=0.005).

Conclusion: This study determined total cost of hospitalization and LOS remains significantly higher for patients experiencing major ADEs than those who did not.

Submitting Author: Bryan C. McCarthy Jr., PharmD, MS, BCPS

Submitting Organization: University of Chicago Medicine

Authors: Bryan C. McCarthy Jr., PharmD, MS, BCPS; Tara P. Driscoll, PharmD; Kristin A. Tuiskula, PharmD; Andrew M. Davis, MD, MPH

ICHP Poster Presentations – Original #1
(presented as Poster #14)

Category: Original - Research Complete

Title: Sacubitril; Losartan the next treatment for heart failure?

Purpose: Congestive heart failure (CHF) is a leading cause of morbidity and mortality for which there are few recent improvements in treatment. Over one million US patients on optimized drug therapy are hospitalized each year. Identification of neurohormonal mechanisms that do not overlap with existing therapies are needed. The enzyme Neprilysin impairs endogenous vasoactive compounds, including natriuretic peptide leading to diuresis, natriuresis, and vasodilation. Sacubitril, a neprilysin inhibitor in combination with valsartan is the first of these treatments to show morbidity and mortality benefit compared to enalapril, as reported in the PARADIGM-HF trial. The purpose of this study is to analyze the safety and efficacy data available on sacubitril; valsartan (SV) and to determine if there is a role for the drug in the clinical treatment of CHF.

Methods: A systematic review of the databases PubMed, MedLine, and EMBASE was performed up to December of 2015. The following keywords were used: heart failure, neprilysin, ACE inhibitors, ARB, sacubitril, vasopeptidise inhibitor, PARADIGM-HF. Inclusion criteria included: 1) adult patients with NYHA class II-IV HF with ejection fraction <40% 2) treatment with SV 3) direct comparison to recommended treatment with an ACE-I 4) inclusion of morbidity, mortality, and safety outcomes 5) CEBM level of evidence 2b or greater. Only one randomized control trial met all specified inclusion criteria. It was therefore decided to include retrospective analyses of this trial due to the novelty of this subject. Two secondary analyses were identified as relevant and included in safety and efficacy analysis.

Results: The use of SV compared to enalapril in the treatment of HF was found to significantly reduce the risk of death (17% vs. 19.8% NNT 36) from any cause and (13.3% vs. 16.5% NNT 31) from cardiovascular causes, and time to first hospitalization for CHF (12.8% vs. 15.6% NNT 36). Safety data for SV found patients experiencing significantly less angioedema, renal impairment, or adverse events leading to discontinuation compared to enalapril. However a significant (18% vs. 12%; NNH 17) increase in hypotension was found for patients on SV compared to enalapril. Secondary analysis revealed that the mortality benefit for SV is primarily related to a modification in the risk for sudden death or to worsening heart failure. This benefit was comparable amongst patients of all ages, except for the very oldest in the outcome of CV death and the composite outcome of CV death and heart failure hospitalizations.

Conclusion: More research is needed before clinicians should use SV for the treatment of heart failure, despite the positive outcomes of the PARADIGM-HF trial. The morbidity and mortality benefits found may not generalize to the population at large in the setting of the trial’s limitations. The most concerning of these being that there is only a single RCT comprised majorly of clinically stable white males to support the use of SV over ACE-I. The authors also chose to compare the maximum recommended dose of the ARB component of SV to a low-dose of enalapirl, making it possible that the clinical benefits found were due to greater RAAS inhibition. Additionally, 12% of patients dropped out of the active run-in period due to side effects making it likely that the rates of adverse reactions reported, including angioedema, are lower than would be expected in practice. Moreover, the authors chose to omit findings from pre-clinical trials that demonstrated an increase in CSF beta-amyloid protein for patients receiving SV. For these reasons it is difficult to justify the significant cost associated with SV, which is approximately 100x that of enalapril, until further safety and efficacy analysis can be completed.

Submitting Author: Michael Fotis, RPh

Submitting Organization: Northwestern University Feinberg School of Medicine

Authors: Tara Marcus PA-S2, Master of Medical Sciences Candidate; Michael Fotis, RPh

ICHP Poster Presentations – Original #2
(presented as Poster #1)

Category: Original - Research Complete

Title: The role of tenofovir in preexposure prophylaxis of herpes simplex virus type 2: a systematic review

Purpose: Herpes simplex virus type 2 (HSV-2) is among the most common sexually transmitted infections, affecting approximately 417 million sexually active adults worldwide [1]. HSV-2 is the leading cause of genital ulcers, and is associated with pain, itching, negative social stigma and increased risk for HIV-1 [2]. Preventative measures include barrier methods, abstinence, and chronic antiviral suppressive therapy for HSV-2 positive patients. There is not a vaccination or medication for preexposure prophylaxis (PrEP) for HSV-2. The purpose of this study is to assess the efficacy of the nucleotide reverse-transcriptase inhibitor, tenofovir, in the preexposure prophylaxis of HSV-2.

Methods: Data sources included PubMed, Cochrane Library and Embase between 1966-2015. Search terms included, “ tenofovir prevention herpes simplex virus type 2”. A total of 222 articles resulted. Inclusion criteria were set as randomized controlled trials with human participants conducted over the last 5 years, which yielded 2 studies. The dominant reason for exclusion was non-human participants. The main outcome measured is HSV-2 seroconversion.

Results: In one study, the incidence rate of HSV-2 was 10.2 cases per 100 person years with pericoital application of tenofovir gel, compared to incidence rate of HSV-2 of 21.0 cases per 100 person-years with placebo gel, NNP = 9.8 [3]. A second study resulted in an incidence rate of HSV-2 of 5.6 cases per 100 person years with oral tenofovir-based PrEP, compared to 7.7 cases per 100 person years with placebo, NNP = 37.1 [4].

References
1. Looker, K.J., et al., Global and Regional Estimates of Prevalent and Incident Herpes Simplex Virus Type 1 Infections in 2012. PLoS One, 2015. 10(10): p. e0140765.
2. Tan, D., Potential role of tenofovir vaginal gel for reduction of risk of herpes simplex virus in females. Int J Womens Health, 2012. 4: p. 341-50.
3. Abdool Karim, S.S., et al., Tenofovir Gel for the Prevention of Herpes Simplex Virus Type 2 Infection. N Engl J Med, 2015. 373(6): p. 530-9.
4. Celum, C., et al., Daily oral tenofovir and emtricitabine-tenofovir preexposure prophylaxis reduces herpes simplex virus type 2 acquisition among heterosexual HIV-1-uninfected men and women: a subgroup analysis of a randomized trial. Ann Intern Med, 2014. 161(1): p. 11-9.

Conclusion: Tenofovir-based therapy significantly reduced HSV-2 seroconversion in two double-blinded, randomized controlled trials. Periocoital tenofovir gel resulted in a 51% absolute decrease in HSV-2 seroconversion, while oral tenofovir-based therapy resulted in a 30% absolute decrease in HSV-2 seroconversion, suggesting that topical therapy is more effective in preventing HSV-2 seroconversion compared to oral therapy, although future studies comparing topical and oral tenofovir therapy for PrEP of HSV-2 are needed. Limitations of the studies are: neither study was originally designed to assess the effect of tenofovir on HSV-2 acquisition thus randomization at study enrollment was not stratified by HSV-2 status; the studies do not use the same formulation of tenofovir and neither study assesses the timing of HSV-2 acquisition in relation to plasma tenofovir levels; given the current cost of oral tenofovir, this may be a very costly option; widespread and long-term use of tenofovir may lead to increased viral resistance. This systematic review suggests that there is a potential role of tenofovir to prevent HSV-2 acquisition, which could reduce genital ulcers, pain, social stigma and HIV risk associated with HSV-2.

Submitting Author: Michael Fotis, RPh

Submitting Organization: Northwestern University Feinberg School of Medicine

Authors: Julia Silver PA-S2, Master of Medical Sciences Candidate; Michael Fotis, RPh

ICHP Poster Presentations – Original #3
(presented as Poster #13)

Category: Original - Research Complete

Title: Calcium and Vitamin D co-supplementation in Gestational Diabetes Mellitus

Explain the strengths and the limitations of the clinical data supporting the use of supplementation of calcium and vitamin D during pregnancy to improve maternal outcomes in patients with gestational diabetes.

Purpose: The purpose of this poster is to examine if vitamin D and calcium co-supplementation is an effective intervention during pregnancy to improve maternal outcomes in patients with gestational diabetes (GDM). Diabetes is a significant cause of morbidity and mortality in the US, and an important economic burden. The CDC estimates up to 9.2% of pregnancies are affected by GDM. Available studies examining the relationship between Vitamin D deficiency and insufficiency in patients with GDM and associated maternal outcomes are inconsistent in their findings. Although the mechanism of effect is unclear there a few studies of Vitamin D and calcium co-supplementation reporting promising results.  

Methods: A systematic review was conducted using EMBASE, PubMed, and MedLine databases between October and December 2015. Search terms included: Calcium, Vitamin D, and Gestational Diabetes. Studies written in English were included in this review. Studies that did not examine gestational diabetes or did not examine co-supplementation of calcium and vitamin D were excluded. Under these inclusion and exclusion criteria a total of 2 eligible studies were identified. The studies were CEBM level of evidence 1b.

Results: Karamali in a randomized placebo controlled trial of 60 patients found that Vitamin D and calcium co-supplementation in women with GDM decreased the rates of many maternal and neonatal outcomes. There was a significant reduction in cesarean rates from 63% to 23% the number needed to treat (NNT) estimated as 2.5, and for maternal hospitalization from 13% to 0 (NNT=7). For neonatal hyperbilirubinemia the NNT=2.7, neonatal hospitalization was reduced from 57% to 20% (NNT = 2.7), and macrosomia NNT = 3. 

Asemi in a randomized placebo controlled trial of 56 patients found statistically significant improvement in laboratory values for fasting plasma glucose, serum insulin, HOMA-R, LDL cholesterol, total cholesterol: HDL cholesterol, HDL cholesterol, GSH, and MDA. Clinical outcomes were not measured in this trial. 

Both studies had the same intervention length of 6 weeks with 1,000mg of calcium carbonate daily over 6 weeks, and 50,000U of Vitamin D₃ two times during the intervention, once at baseline and once on day 21 of the intervention.

Conclusion: The two RCTs examined in this systematic review found co-supplementation with calcium and vitamin D improved maternal laboratory results and improved maternal outcomes. There are limitations to note: studies are small, both were conducted in Iran and may lack external validity, only a single small trial measured clinical outcomes where maternal outcomes were secondary outcomes and may not have been appropriately powered to detect differences. Further well-designed, high powered, randomized controlled trials investigating the impact on maternal and fetal outcomes are necessary to determine a clinical effect. If a positive effect is established, future studies can focus on the optimal amount of supplementation and the timing during pregnancy. While the studies did not report adverse events, one separate study has determined that a 300,000 intramuscular dose of Vitamin D is safe and efficacious in pregnant women, and the National Institute of Health recommends 1,000mg of calcium carbonate daily for pregnant and lactating women. Furthermore, with possible similarities in the pathophysiology of GDM and diabetes, and the risk of progression from GDM to Type 2 DM, the effects of co-supplementation in diabetes mellitus could also be explored.

Submitting Author: Michael Fotis, RPh

Submitting Organization: Northwestern University Feinberg School of Medicine

Authors: Christina Hill PA-S2, Master of Medical Sciences Candidate; Michael Fotis, RPh

ICHP Poster Presentations – Original #4
(presented as Poster #17)

Category: Original - Research in Progress

Title: Oral lorazepam for seizure prophylaxis in adult patients treated with high dose intravenous busulfan before hematopoietic stem cell transplantation: A retrospective study

Purpose: To determine the efficacy of oral lorazepam in preventing seizures in adult patients receiving high dose intravenous busulfan prior to allogeneic hematopoietic stem cell transplant (HSCT). 

Methods: This is a single center study conducted at Rush University Medical Center (RUMC) located in Chicago, Illinois.
• This retrospective study was approved by the Institutional Review Board prior to data collection.
• A stem cell transplant database was used to identify patients who have received allogeneic HSCTs from January 1, 2009 to March 31, 2015.
• Patients were included if they were ≥ 18 years old, received intravenous high dose busulfan, received oral lorazepam for seizure prophylaxis.

· Patients were excluded only if they received concomitant phenytoin.

• RUMC's electronic medical record system and the stem cell transplant database will be used to collect the following: age, sex, race, underlying malignancy, type of transplant, conditioning regimen, dates of busulfan administration,  fever during busulfan administration.
• Medication charts were reviewed for past medical history of seizures, illegal drug use, AIDS, and CNS malignant disease involvement at or during diagnosis.
• The primary endpoint is the occurrence of seizures from the start of busulfan until 72 hours following the completion of busulfan.
• Per RUMC policy, patients receive oral lorazepam 0.5 mg every 6 hours starting 24 hours prior to busulfan administration and continuing for 48 hours after the completion of busulfan.
• Categorical variables will be analyzed using Chi square or Fischer's Exact test. 

Results: Research in progress 

Conclusions:  Research in progress

Submitting Author: Monica Timmerman, PharmD candidate

Submitting Organization: Midwestern University Chicago College of Pharmacy and Rush University Medical Center

Authors: Monica Timmerman, PharmD candidate; Lisa M. DiGrazia, PharmD, BCPS, BCOP; Amanda N. Seddon, PharmD, BCPS, BCOP; Annette Gilchrist, PhD

ICHP Poster Presentations – Original #5
(presented as Poster #4)

Category: Original - Research in Progress

Title: Evaluation of a Protocol used to Screen and Control Glycemic Levels Following Total Orthopedic Knee and Hip Surgeries

Purpose: Perioperative hyperglycemia can affect a patient’s recovery following orthopedic surgery by increasing the risk of complications including infection and by increasing patient length of stay.  Currently, our institution does not have a standardized glucose management protocol for this patient population. The objective of this study is to implement a protocol that can effectively manage patient’s glucose levels post-operatively and decrease the rate of post-op infections in patients who have undergone a total orthopedic knee or hip surgery. 

Methods: Patients undergoing elective orthopedic knee or hip surgery will first have Hemoglobin A1c labs drawn during preadmission testing. Patients with an A1c <8 will undergo surgery as planned while patient with an A1c >8 will be referred to their primary care physician to help manage their glucose levels. Their surgery will be postponed until the patient can provide documented glucose logs demonstrating glucose control and management over a 4 week period.  Once patients undergo surgery their glucose level will be managed by a P&T approved protocol using a sliding scale or basal plus correction method of insulin administration. Both non-diabetic and diabetic patient’s glucose will be managed by this protocol. This study will compare the management of patient glucose levels prior to and after the initiation of the protocol. The primary outcome of the study is the rate of post-operative infection. Secondary outcomes include the average glucose on post-operative days 0, 1, 2, and 3. Other outcomes include nursing satisfaction and number of patients who are found to have new onset diabetes.  

Results: Research in Progress 

Conclusions: Research in Progress

Submitting Author: Patrick D. Hammond, PharmD

Submitting Organization: Presence St. Joseph Medical Center

Authors: Patrick D. Hammond, PharmD; Rishita Shah, PharmD

ICHP Poster Presentations – Original #6
(presented as Poster #2)

Category: Original - Research in Progress

Title: Analysis of Risk Factors and Antipsychotic Usage Patterns Associated with Terminal Delirium in a Veteran Inpatient Hospice Population

Purpose:  The purpose of this study is to (1) Identify risk factors for terminal delirium in a VA inpatient hospice population (2) Assess usage patterns of antipsychotics in terminal delirium (3) Describe nursing assessment, non-pharmacological and pharmacological interventions, and documentation of terminal delirium 

Methods:  This is a retrospective case-control study of patients who expired in the Edward Hines, Jr. VA Hospital Community Living Center (CLC) under the treating specialty “NH hospice” during the period of October 1, 2013 to September 30, 2015. Cases are defined as patients who were treated with antipsychotics for terminal delirium within the last two weeks of life. Controls are defined as patients who were not treated with antipsychotics for terminal delirium within the last two weeks of life.  All patients enrolled under the treating specialty “NH Hospice” will be evaluated with the exclusion of living hospice patients and patients discharged to receive home hospice care prior to death. Patients’ medical records will be reviewed from two weeks prior to death until the recorded death date during which the following will be assessed from the medical record as available: age, terminal diagnosis, time interval cancer diagnosis and death, war era, comorbid conditions, prescribed antipsychotic medications, other medications potentially contributing to delirium, documentation for antipsychotic use, non-pharmacological interventions, and date of death.  

Results: Research in progress 

Conclusions: Research in progress

Submitting Author: Emily Ellsworth, PharmD

Submitting Organization: Edward Hines, Jr. VA Hospital

Authors: Emily Ellsworth, PharmD; Kevin Bacigalupo, PharmD, BCPS; Kavita Palla, PharmD, BCPS; Seema Limaye, MD; Margaret Walkosz, ACHPN, GNP-BC; Sandra Szczecinski, BSN; Katie Suda, PharmD, MS

ICHP Poster Presentations – Original #7
(presented as Poster #8)

Category: Original - Research in Progress

Title: Redesigning PGY1 Pharmacy Residency Interview Structure

Purpose: The structure of our PGY1 residency interview day was redesigned to increase objectivity in candidate evaluations and exposure of candidates to the activities in our department while decreasing the preceptor time commitment.  

Methods: In 2015 the PGY1 recruitment team incorporated multiple mini interviews (MMI), interdisciplinary rounds and a departmental activity in the interview days for PGY1 residency candidates for the 2015 recruitment season. Each multiple mini interview assessed specific qualities deemed to be essential in pharmacy residency training and utilized standardized evaluation tools. In 2016, the interview day was again restructured to adjust the time candidates spend rounding, eliminated one of the MMIs and implemented a one-on-one discussion session with the candidates and a current resident. Following the interviews, candidates were sent an electronic survey to evaluate their satisfaction with the interview day and the new structure. Descriptive statistics were used to describe the survey results from 2015 and survey results from 2016 are pending. Preceptor time for interview days in 2015 and 2016 will be compared with the amount of time required of preceptors in previous years.  

Results: In 2015 a total of 72 candidates were interviewed and 49 completed the post-interview survey. The activities that left the highest positive impression during the interview day were the introduction section, departmental activity and traditional interview sessions. The majority of candidates (84%) stated that the interview day increased their desire to pursue residency training at University of Chicago and felt that time was adequately appropriated between activities. Preceptor time for candidate interviews decreased by 72% (600 hours vs 168 hours) and from 7.1 hours per candidate to 2.3 hours per candidate. With the new structure, the number of candidates per day was increased allowing us to decrease the number of interview days by 36%. Results from 2016 are in progress.  

Conclusion: The restructuring of the interview day in 2015 provided resident a positive impression of our residency program while requiring fewer preceptor hours dedicated to interviewing. These results will be compared and new conclusions drawn off of the research conducted on the 2016 interview cycle.

Submitting Author: Hailey P. Soni PharmD

Submitting Organization: University of Chicago

Authors: Hailey P. Soni PharmD; Shannon Rotolo, PharmD; Mary Kate Miller, PharmD; Jennifer Austin Szwak, PharmD

ICHP Poster Presentations – Original #8
(presented as Poster #6)

Category: Original - Research in Progress

Title: Impact of pharmacists within a multidisciplinary team on chronic obstructive pulmonary disease (COPD) readmission rates

Purpose: In FY2015, the Centers for Medicare and Medicaid Services (CMS) expanded the existing algorithm accounting for readmission of patients to include those admitted for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The Medicare Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for excess early readmissions of patients with AECOPD. Currently, the penalty is in place for all-cause 30 day readmissions. The purpose of this study is to evaluate the impact of pharmacists within a multidisciplinary team on chronic obstructive pulmonary disease (COPD) readmission rates. 

Methods: Patients were identified at admission to University of Chicago Medicine using an algorithm that identified documented COPD.  On admission, a medication history was performed by a pharmacist or student pharmacist during which five COPD-focused questions were asked to each patient. The patients were then seen by the pulmonary advanced practice nurse (APN).  After being seen by the APN, the pharmacy department provided inhaler education utilizing the teach-to-goal (TTG) method. Once the patient was discharged, a follow up appointment was scheduled within approximately seven to ten days with the pulmonary APN.  During this follow up appointment, the pharmacy department provided further inhaler education using TTG. The primary endpoint of this study was COPD readmission in 30 days. The secondary endpoints were to show an increase in completed medication histories and an improvement in patients’ inhaler techniques using the TTG method. COPD readmission rates were determined by reporting from the hospital’s quality department. Improvement in patients’ inhaler techniques was evaluated through a systematic scoring system which allowed for the comparison of initial and final inpatient technique scores. 

Results: Research in progress. Preliminary data collection comparing scores before TTG session and after TTG session in the inpatient setting shows the average increase in TTG score was 4.9 points for the MDI inhaler (percentage change 20.3%). For the tiotropium inhaler, the average increase in the TTG score was 6 (percentage change of 20%). 

Conclusions: Research in progress

Submitting Author: Leigh A. Moffett, PharmD, BCPS

Submitting Organization: University of Chicago Medicine

Authors: Leigh A. Moffett, PharmD, BCPS; Jennifer Szwak, PharmD, BCPS

ICHP Poster Presentations – Original #9
(presented as Poster #3)

Category: Original - Research in Progress

Title: Efficacy, nephrotoxicity, and incidence of Clostridium difficile infection with broad spectrum antibiotic regimens in patients with nosocomial pneumonia

Purpose: Identify the difference in efficacy, nephrotoxicity, and incidence of Clostridium difficile infection between vancomycin plus piperacillin-tazobactam and vancomycin plus cefepime (with or without metronidazole) in patients with nosocomial pneumonia. Vancomycin plus piperacillin-tazobactam is a broad-spectrum antibiotic regimen chosen as empiric therapy for a multitude of infections. Recent data suggest that this combination may increase the risk of nephrotoxicity when compared to vancomycin alone, or when compared to vancomycin plus an alternative beta-lactam antibiotic, such as cefepime. Recently, as a result of these studies and due to recommendations by pharmacy, prescribing at Edward Hines, Jr. VA Hospital has begun to shift from using vancomycin plus piperacillin-tazobactam to a regimen of vancomycin plus cefepime with or without metronidazole for anaerobic coverage. This regimen has been chosen for many infections, but most commonly for the nosocomial pneumonias: hospital-acquired pneumonia (HAP), healthcare-associated pneumonia (HCAP), and ventilator-associated pneumonia (VAP). This change in prescribing practices raises many important questions. First, in terms of aspiration pneumonia and VAP, what is the difference in efficacy between vancomycin plus piperacillin-tazobactam and vancomycin plus cefepime plus metronidazole? Additionally, in terms of nosocomial pneumonia without mention of aspiration, what is the difference in efficacy between vancomycin plus piperacillin-tazobactam and vancomycin plus cefepime? Finally, what is the difference in the rates of nephrotoxicity and Clostridium difficile infection associated with these regimens?

Methods: This study has been approved by the Institutional Review Board (IRB). This study is a retrospective, electronic chart review of patients with nosocomial pneumonia. Eligible patients for screening will be identified with active orders of piperacillin-tazobactam plus vancomycin, cefepime plus vancomycin, or cefepime plus vancomycin plus metronidazole. Inclusion criteria for the study include male and female patients ≥ 18 years of age with a clinical diagnosis of nosocomial pneumonia, who had a baseline serum creatinine obtained within 24 hours of admission, and who received one of these broad-spectrum antibiotic regimens for at least 48 hours. Patients will be excluded if they are receiving chronic dialysis or have a diagnosis of end stage renal disease. The primary outcome being evaluated is clinical efficacy of antibiotic regimens, which is reflected as improvement in two of the following three clinical symptoms (fever, leukocytosis/leukopenia, purulent secretions) at 48 hours. A secondary endpoint will be the incidence of Clostridium difficile infection, which is reflected as a positive Clostridium difficile toxin B PCR test with diarrhea (three or more unformed stools passed in 24 hours) or histopathological findings of pseudomembranous colitis within 14 days of starting antibiotics. An additional secondary endpoint of acute kidney injury, defined as an increase in serum creatinine ≥50% from baseline, an increase in serum creatinine of ≥0.5 mg/dL, or a urine output <0.5mL/kg per hour for >6 hours, will also be evaluated. Data collection will include demographics, classification/etiology of pneumonia, temperature, WBC count, blood pressure, pulse, sputum production, clinical improvement, use of broad-spectrum antibiotic regimens, number of days on oral or IV antibiotics in the previous 14 days, concomitant use of nephrotoxic drugs, and documented adverse drug reactions to antibiotics.

Results: Research in progress. 

Conclusions: Research in progress.

Submitting Author: Kaitlyn B. Kalata, PharmD

Submitting Organization: Edward Hines, Jr. VA Hospital

Authors: Kaitlyn B. Kalata, PharmD; Sue Kim, PharmD, BCPS; Ursula C. Patel, PharmD, BCPS, AQ-ID; Raymond Byrne, PharmD, BCPS

ICHP Poster Presentations – Original #10
Winner: Best Original Poster Presentation 2016
(presented as Poster #16)

Category: Original - Research in Progress

Title: Evaluation of fall risk in dementia patients on an atypical antipsychotic in the VA population

Purpose: Antipsychotics are widely used as off-label treatment for behavioral symptoms in dementia patients. It is recognized that antipsychotics can increase the risk for falls in the elderly population. When used in dementia patients, this risk is further increased, since dementia itself is an independent risk factor for falls. A study on the use of antipsychotics in the Veterans Affairs (VA) Community Living Centers (CLC) found that veterans residing in the dementia special care units were more likely to receive an antipsychotic, more commonly atypical antipsychotics. The purpose of this study is to determine whether atypical antipsychotics increase fall risk in dementia patients.

Methods: This study was approved by the Institutional Review Board. This study will be a retrospective cohort study comparing two groups in the VA population: dementia patients receiving atypical antipsychotics versus dementia patients not receiving atypical antipsychotics. The primary endpoint is the difference in the incidence of falls between the two cohort groups. The secondary endpoints are the differences in the incidence of falls between subtypes of dementia, different atypical antipsychotics, and different fall risk as defined by the Morse Scale. Primary endpoint will be analyzed using unpaired t-test, while secondary endpoints will be analyzed through descriptive analysis. The following data will be collected: age, gender, number of other Fall Risk Increasing Drugs (FRIDs), comorbid conditions that can also increase fall risk, subtype of Dementia, type of atypical antipsychotics, fall risk as defined by Morse Scale, and the documented fall. Each patient’s chart will be reviewed from admission and up to 6 months, or patient’s discharge, or patient's death whichever is the earliest to determine if a documented fall has occurred during that time. Determining fall risk in the dementia population receiving atypical antipsychotics can help prevent inappropriate prescribing of these agents for treatment of behavioral symptoms, leading to decreased fall risk. 

Results: Research in Progress

Conclusions: Research in Progress

Submitting Author: Lianna Serbas, PharmD, PGY1 Pharmacy Resident

Submitting Organization: Captain James A. Lovell FHCC

Authors: Lianna Serbas, PharmD; Yinka Alaka, PharmD

ICHP Poster Presentations – Original #11
(presented as Poster #15)

Category: Original - Research in Progress

Title: Digoxin and Time to Cardiac-Related Hospitalizations: A Retrospective Cohort Study

Purpose: The purpose of this study is to evaluate the safety of digoxin therapy in patients with atrial fibrillation with and without heart failure. The time to first cardiac-related hospitalization will be documented comparing patients with atrial fibrillation with and without digoxin therapy. Additionally, the safety of digoxin will be further analyzed by evaluating the length of digoxin therapy prior to first cardiac-related hospitalization and digoxin serum concentrations. Finally, a sub-group analysis of patients with and without heart failure will be conducted to determine if concomitant heart failure has any impact. 

Methods: This study is a retrospective cohort study with two groups of patients: patients with atrial fibrillation receiving digoxin therapy and patients with atrial fibrillation not receiving digoxin therapy. Cardiac event is defined as any of the following: cardiac arrhythmia, acute myocardial infarction, unstable angina, cardiac arrest, hypertensive urgency/emergency, and cardioembolic stroke. Patients included in the study are those who are 18 years of age and older, with one or more inpatient admission with a primary discharge diagnosis of atrial fibrillation or two or more outpatient, nonemergency department encounters for atrial fibrillation. Patients must also have at least one primary care or cardiology clinic visit. The following data will be collected for each patient: initial diagnosis of atrial fibrillation, patient age and gender, past medical history, start date of digoxin therapy, concurrent medications, date of initial hospitalization with a cardiac primary admission diagnosis, primary admission diagnosis, length of hospitalization, admission to ICU or general acute medicine floor, serum digoxin level, admission renal function, troponin, potassium, magnesium, and most recent height and weight. The data collected will be used to assess the time to first hospitalization in patients with atrial fibrillation with or without digoxin therapy. The time to initial hospitalization will be reported in number of days since atrial fibrillation diagnosis, and will be analyzed using a Cox proportional hazards regression. The secondary endpoints for continuous variables will be reported as percentages, means, and standard deviations, and assessed using a student t-test. 

Results: Research in Progress 

Conclusions: Research in Progress

Submitting Author: Stephanie Dwyer, PharmD, PGY1 Pharmacy Resident

Submitting Organization: Captain James A. Lovell Federal Health Care Center

Authors: Stephanie Dwyer, PharmD; Sherri Stoecklein, PharmD, BCPS

ICHP Poster Presentations – Original #12
(presented as Poster #7)

Category: Original - Research in Progress

Title: A Performance Improvement Approach to Implementing a Pharmacist-led Medication Education Program in a Community Hospital

Purpose:  The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a standardized questionnaire that has become an important indicator of the patient’s view of perceived care. The study site was underperforming in the medication-related survey questions: “How often did hospital staff tell you what the medication was for?” and “How often did hospital staff describe possible side effects in a way you could understand?”.  The Pharmacy Department wanted to implement an intervention to improve patient satisfaction in this domain.  The purpose of the study was to determine the impact of a pharmacist-led medication education program on the medication-related HCAHPS scores. 

Methods:  The study was conducted at a small community hospital from July to December 2015.  All pharmacists and student pharmacists received competency and training to ensure uniformity in the medication education sessions. Patients from two medical-surgical units were targeted to receive medication counseling by a pharmacist or student pharmacist with priority given to those with heart failure, on an oral anticoagulant or receiving 6 or more medications. Nursing home patients and patients with altered mental status were excluded from receiving the intervention.  At the end of the month, data was reviewed and changes were made to the process to improve to the target goal of five counseling sessions per day. The primary outcome was change from baseline on medication-related HCAHPS scores.  A secondary outcome was number of documented counseling sessions performed, tracked on a daily basis on a department quality improvement board and trended monthly.   

Results: The 2015 HCAHPS results regarding the question about explaining medication indications improved by 8% and the scores regarding the question about side effects improved by 36% when comparing the pre and post implementation of the medication education service.  392 patients were counseled as part of the pharmacist-led medication education program with an average of 65 sessions performed per month.   

Conclusion: As shown in the study, pharmacist medication counseling can make an impact on the medication-related HCAHPS scores.  Medication education is an important aspect of patient communication in the inpatient setting and the launching of this service enhanced patient understanding of the indications and side effects of their medications as measured by these scores.

Submitting Author: Stacy Thomas Scaria, PharmD

Submitting Organization: Tenet Healthcare - Westlake Hospital

Authors: Stacy Thomas Scaria, PharmD; Deanna McMahon Horner, PharmD, BCPS; Dusica Jovic Szczybura, PharmD; Charlene Hope, PharmD, MS, BCPS

ICHP Poster Presentations – Original #13
(presented as Poster #5)

Category: Original - Research in Progress

Title: Evaluation of a Pilot Benzodiazepine Taper Clinic in Veterans with Concurrent Opioid Use

Purpose: Opioid pain relievers are implicated in nearly 17,000 overdose deaths in the United States. This is over a 100% increase in rates over the first decade of this century. Thirty-one percent of these deaths involved the concurrent use of benzodiazepine sedatives.  In late 2013, the Department of Veterans Affairs (VA) launched the Opioid Safety Initiative to reduce the use of opioids among veterans. While the initiative drew attention to clinical considerations regarding the risk of co-administration, a recent medication use evaluation concluded that over 700 Veterans had active outpatient prescriptions for both a benzodiazepine and an opioid at a single VA facility. As a result, a pilot benzodiazepine taper clinic will be implemented at Edward Hines, Jr. VA Hospital in January 2016 in collaboration with the Hines Primary Care and Mental Health Providers to reduce the number of veterans on high dose benzodiazepines and concurrent opioid therapy.  An order set for the treatment of insomnia will also be created and integrated into the electronic medical record system in February 2016 at Edward Hines, Jr. VA Hospital to promote and facilitate the use of non-benzodiazepine evidence-based treatment of insomnia. The primary purpose of this quality assurance and quality improvement project is to evaluate potential benefits and barriers to implementing a multidisciplinary benzodiazepine taper clinic at Edward Hines, Jr. VA Hospital.  

Methods: The project will assess the reduction in high dose benzodiazepines for the pilot clinic patients. The magnitude and time to dose reduction(s) will be evaluated. High dose benzodiazepines will be defined as total daily doses of temazepam >20 mg, diazepam >10 mg, clonazepam >1 mg, lorazepam >2 mg, and alprazolam >1 mg. Patients receiving opioids for cancer pain, patients receiving a benzodiazepine for back spasms in spinal cord patients, hospice patients, and patients with severe mental health disorders (i.e. bipolar disorder, psychosis) will be excluded.  Time spent in preparation for clinic visits, patient contact hours, and time spent for follow up will be logged. Self-reported patient compliance with treatment plans and patient clinic cancellations will be recorded. Additionally, the project will track the use of the newly implemented order set for the treatment of insomnia.  

Results:  Research in Progress  

Conclusion: Research in Progress

Submitting Author: Julie Bucek Cabrera, PharmD, PGY1 Pharmacy Practice Resident

Submitting Organization: Edward Hines Jr., VA Hospital

Authors: Julie Bucek Cabrera, PharmD; Julie Stein, PharmD, VHA-CM; Sue Kim, PharmD, BCPS

ICHP Poster Presentations – Encore #1
Winner: Best Encore Poster Presentation 2016
(presented as Poster #20)

Category: Encore

Title: Implementation of decentralized pharmacy technicians to improve medication delivery and nursing satisfaction

Purpose: To assess the impact decentralized pharmacy technicians (DPTs) can have on the medication delivery process and on nursing satisfaction with the pharmacy service

Methods: A two-week prospective study on one general medicine floor and two intensive care units was conducted between September and October 2015. One decentralized pharmacy technician was assigned to each of these locations Monday through Friday from 9:00 am to 5:30 pm to improve medication availability through timely communication with nursing staff regarding medication procurement issues. Each study floor served as its own control in that data pertinent to the study outcomes was collected in a two-week period preceding the intervention period. The number of medication requests sent to the central pharmacy and the number of medications that required physical pick-up by nurses during the intervention period and the control period were recorded. Nursing satisfaction was surveyed prior to the intervention period and immediately following the intervention period. 

Results: Nursing workflow interruptions due to medication retrieval were decreased by 74%. Post-intervention, mean scores for each nursing satisfaction survey question were significantly higher than the pre-intervention period survey (P < 0.01 for all five questions). Electronic medication requests sent to central pharmacy did not decrease significantly, 463 and 453 requests were sent during the pre-intervention and intervention periods respectively. 

Conclusion: The decentralized pharmacy technician model significantly reduced nursing workflow interruptions and improved nursing satisfaction.

Submitting Author: Whitnee Caldwell, PharmD

Submitting Organization: Northwestern Memorial Hospital

Authors: Whitnee Caldwell, PharmD; Bryan Shaw, PharmD; Fuwang Xu, PharmD; Noelle Chapman, PharmD; Ana Fernandez, CPhT

ICHP Poster Presentations – Encore #2
(presented as Poster #9)

Category: Encore

Title: Global Initiatives to Streamline Pharmacy Education and Workforce Development

Purpose:  The FIP Education Initiatives and Pharmacy Education Taskforce developed the Global Competency Framework and the Global Quality Assurance Framework for pharmacy leadership organizations to provide strategic mapping tools for pharmacy education and workforce development. The main purpose of this study is to share educational tools that impact the pharmacy profession and empower educators, leaders, and practitioners to streamline competencies.

Methods:  The educational experts describe national and global initiatives to best streamline Competencies for pharmacy education. Specifically, the experts highlight programs for pharmacy education and workforce development that have been successfully implemented and assessed to assure the quality of pharmacy education on the global level.

Results: A panel of experts of educators, regulators, and practitioners highlight the structure, process, and outcomes of global collaborations to improve the quality of pharmacy education. Specifically, the panel shares the results of a “SWOT” Analysis - Strengths, Weaknesses, Opportunities, and Threats - of streamlining pharmacy educational competencies. The panel also shares examples of pharmacy education and workforce development initiatives that were implemented to continuously improve the quality of pharmacy professional development programs. In addition, the presenters describe collaborations between national and international agencies and opportunities for future scientific contributions.

Conclusions: Global initiatives will enhance the quality of education for pharmacy students and practitioners and ultimately improve pharmacy practice.

Submitting Author: Abby A. Kahaleh, BPharm, MS, PhD, MPH

Submitting Organization: Roosevelt University College of Pharmacy

Authors: Abby A. Kahaleh, BPharm, MS, PhD, MPH; Mike Rouse, BPharm; Ian Bates, PhD-FIP; Andreia Bruno, PhD

ICHP Poster Presentations – Encore #3
(presented as Poster #18)

Category: Encore

Title: Antifungal prophylaxis consideration in patients being treated with blinatumomab for Philadelphia chromosome-negative relapsed or refractory b-cell acute lymphoblastic leukemia: a case report

Purpose: The purpose of this case is to illustrate why antifungal prophylaxis should be considered for patients being treated with blinatumomab for Philadelphia chromosome-negative relapsed or refractory B-cell acute lymphoblastic leukemia (ALL). Based on the National Comprehensive Cancer Network (NCCN) guidelines, consideration of antibacterial, antiviral, and antifungal prophylaxis should be considered for ALL patients being treated with chemotherapy. In this case, AL, a 24-year-old female, upon first diagnosis of B-cell acute lymphoblastic leukemia, was initiated on induction chemotherapy with Cancer and Leukemia Group B (CALGB) 10403 protocol. After four cycles, a bone marrow biopsy was performed and her results were consistent with remission. Two months later, during a routine follow-up visit, AL was noted to have worsening pancytopenia. Her bone marrow biopsy results were consistent with relapsed B-cell ALL involving 80% of the marrow space. The patient was then admitted to the hospital to begin re-induction therapy with newly approved blinatumomab. Blinatumomab is a novel agent that activates T cells by binding to both CD19 expressed on B cells and CD3 expressed on T cells, which results in lysis of the CD19 cells. It is recommended that the first 9 days of the first cycle be administered in the hospital to monitor for cytokine release syndrome (CRS). In addition to CRS, other side effects include neurological toxicities, infections, and elevated liver enzymes. As part of her supportive care regimen, AL continued acyclovir for antiviral prophylaxis and was initiated on levofloxacin for antibacterial prophylaxis. Due to patient’s pancytopenia, antifungal prophylaxis with an azole antifungal was considered, but due to concern for elevated liver enzymes reported with both blinatumomab and azole antifungals, antifungal prophylaxis was held.  AL received the first 9 days of blinatumomab induction therapy inpatient as recommended to monitor for CRS. AL tolerated treatment without any issues and was discharged from the hospital to continue the remainder of blinatumomab therapy at home. One month after the initial induction of blinatumomab, AL was admitted to the emergency department with abdominal pain and headache. AL was afebrile upon admission and blood cultures were obtained. Blood culture results revealed growth of budding yeasts, which was later identified as candida krusei. AL began treatment with micafungin and blinatumomab therapy was discontinued. An infectious disease (ID) team was consulted and due to persistently positive cultures for budding yeast, AL’s central line was removed. Cultures of the line were negative. In addition, a transesophageal echocardiogram was obtained, which was negative for valvular vegetation. After five days of failed treatment with micafungin, persistent fever and now newly hypotensive, AL was transitioned to liposomal amphotericin and flucytosine per ID’s recommendations and also transferred to the medical intensive care unit (MICU) for sepsis. The following day, AL went into respiratory distress and was intubated. Two days after, liposomal amphotericin and flucytosine was discontinued and voriconazole was initiated.  Cultures remained positive for 13 days with fungemia. Given the progressive decline in her condition and poor prognosis, she expired 21 days from when she was transferred to the MICU.  As with any new cancer drug, supportive care treatment is not well defined. Although more experience is needed to draw a definitive conclusion, the purpose of this case report is to share our experience and generate discussion about the need for antifungal prophylaxis, and if so which antifungal agent, in patients receiving blinatumomab therapy. 

Methods: N/A

Results: N/A

Conclusion: N/A

Submitting Author: Margaret Lee, PharmD Candidate

Submitting Organization: Midwestern University Chicago College of Pharmacy

Authors: Margaret Lee, PharmD Candidate; Lisa M. DiGrazia, PharmD, BCPS, BCOP; Amanda N. Seddon, PharmD, BCPS, BCOPr

ICHP Poster Presentations – Encore #4
(listed in Syllabus as Poster #19)

Category: Encore

Title: Differences in Clostridium difficile infection outcomes between guideline concordant and discordant therapy

Poster not presented.

ICHP Poster Presentations – Student #1
(presented as Poster #22)

Category: Student - Research Complete

Title: Assessment of healthcare needs of elderly patients in rural communities of central Illinois

Purpose: To complete an assessment of elderly care to reduce costs, increase quality and access to medical care among patients living in rural Illinois counties.

Methods: A literature review was conducted by the researchers to assess the quality, cost, and access to care among elderly living in rural Illinois. A Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis was conducted to evaluate the feasibility of the project. Search engines, including PubMed and Medline were used for the most currents findings, using relevant subject headings. Comprehensive search strategies were used within the intrinsic limits of each resource. The results were reviewed to select literature for inclusion criteria.

Results: Results of the literature reviews revealed 40 sources from which 17 were utilized. National statistics showed that 20% of the US population lives in rural America, but only 15% of nurses, 12% of pharmacists, and 9% of physicians practice in rural settings. Currently, lack of access to healthcare providers for rural patients has been reported to be the biggest barrier, 31 % were lacking transportation and 37 percent missed their appointments due to transportation issues. Medicare Advantage plan has a high star rating, which is in line for bonus payments from Centers for Medicare and Medicaid Services (CMS). These bonus payments reflect reward for good performance, improved patient outcomes, and health care savings by the plan. In Illinois, Peoria county consists of 187,000 residents, which is the target county in this study. Research indicates that rural elderly residents are more likely to go without needed care. This increases their total out-of-pocket medical costs due to future hospital or specialty care (40% versus 33% of urban patient healthcare costs). This proposal would provide patients with personalized healthcare in the comfort of their own home. The healthcare professional team can provide educational programs at local city centers. These interprofessional teams offer general medical needs, such as blood glucose screenings, medication therapy reviews, and patient counseling.

Conclusions: Interprofessional teams, composed of physicians, pharmacists, nurses and social workers will provide care to elderly patients to reduce costs, increase quality, and improve access to healthcare services. This proposed model will reduce out-of-pocket cost for patients in Peoria by eliminating unnecessary direct and indirect medical costs. This model will optimize individual health care, improve quality of life for patients by providing care at home, and increase patient adherence. Ultimately, providing home care will enhance access to healthcare services amongst elderly patients in Peoria.

Submitting Author: Katarzyna Plis, PharmD Candidate

Submitting Organization: Roosevelt University College of Pharmacy

Authors: Katarzyna Plis, PharmD Candidate; Danielle Cilano, PharmD Candidate; Sarah Bay, PharmD Candidate; Rimple Patel, PharmD Candidate; Abby Kahaleh, BPharm, MS, PhD, MPH

ICHP Poster Presentations – Student #2
(presented as Poster #21)

Category: Student - Research Complete

Title: Effectiveness of Pharmacy Practice Model Initiative Competency

Purpose: The Pharmacy Practice Model Initiative (PPMI) is a national initiative started by the American Society of Health-Systems Pharmacists (ASHP) in 2008 to encourage the most effective use of pharmacists allowing for overall advancement in patient care. PPMI is currently referred to as the Pharmacy Advancement Initiative (PAI) by ASHP; this change was made after the conclusion of the study.

With regards to pharmacy education, there is a lack of literature discussing PPMI/PAI.  Such literature would be beneficial for schools of pharmacy in order to assess the best approach to teaching students regarding PPMI. Education of pharmacy students regarding PPMI and the professional goals of advancing patient care can impact healthcare reform and encourage them to advocate for patient care at all stages in their career.

In 2013, Pharmacy Practice Model Initiative (PPMI) components were incorporated into Southern Illinois University Edwardsville School of Pharmacy's curriculum. Students partook in an educational activity to learn more about PPMI during their Advanced Pharmacy Practice Experience (APPE) preparatory course in their 3^rd year. Additionally, a competency requirement on PPMI was developed for students to complete during their Hospital APPE. This study’s primary objective is to determine the effect of the PPMI competency on students’ understanding and discussion of PPMI during their Hospital APPE. The expected outcome was that the mean score for the total number of students would be a 6 or above (indicating an average to moderate understanding of PPMI).

Methods: A survey of SIUE preceptors who taught hospital APPE rotations was determined to be the most practical approach to obtaining the necessary information regarding student knowledge base of PPMI. A survey was created consisting of primarily short answer questions and yes/no options. The 20 question survey collected the following information: hospital and preceptor demographics, staffing model, staff training, automation/technology systems, pharmacy involvement in PPMI initiatives, and student understanding and discussion of PPMI during the rotation. For the questions regarding student understanding of PPMI, preceptors were asked to rank student knowledge from 0 to 10 (0 indicating did not meet expectations and 10 indicating exceeded expectations). The scoring of students was based on the discussion of PPMI knowledge and was not based on whether or not changes to the institution were implemented.

Inclusion criteria were: Illinois or Missouri SIUE preceptors, taught ≥ 6 hospital APPE students for the academic school year, and agreed to the interview.  Exclusion criteria included: those who did not respond or complete the interview. Only one preceptor was selected from each hospital site. Seven preceptors were selected based on the criteria that were eligible to partake in the survey and were subsequently contacted. Preceptors who taught from May 2013-May 2014 were selected to participate.

Results: Six out of the seven preceptors contacted responded and completed the interview. All preceptors interviewed answered every question on the survey. When asked about the average baseline knowledge of their SIUE Hospital APPE rotation students with regards to PPMI on a numerical scale, the responses ranged from 4 to 8.5 (mean ± S.D., 6.4±1.65).When asked about the impact of PPMI within the hospital after discussion with SIUE APPE hospital students, 5 out of 6 preceptors stated that no changes were made based on these discussions. One preceptor noted that three specific ideas for implementing the goals of PPMI were initiated by SIUE APPE students during their hospital rotation. These ideas included: technicians checking the work of other technicians (tech-check-tech), pharmacists managing insulin titrations until physician champion is set, and medication reconciliation done by pharmacy technicians. Another preceptor stated that since there were no changes implemented after student discussions within the 2013-2014 school year, the site decided to adjust the discussion of PPMI to include students filling out the ASHP hospital PPMI survey which allows hospitals to see how well they are doing in terms of implementing PPMI goals.

Conclusions: Based on the study results, the PPMI competency met the expected outcomes of the study. The study showed that the majority of students had an average to moderate understanding of PPMI according to their preceptors. One significant limitation to the study is the number of preceptors interviewed.  Future directions could include performing the study with a larger sample size, studying the long term impact of student discussion on PAI a few years after the rotations, and surveying alumni to see how/if the competency impacted their own practice of pharmacy.

Submitting Author: Saba Mohiuddin, PharmD candidate

Submitting Organization: Southern Illinois University Edwardsville School of Pharmacy

Authors: Saba Mohiuddin, PharmD candidate; Lisa Lubsch, PharmD, AE-C; Jinyang Fan, PharmD, BCPS

ICHP Poster Presentations – Student #3
(presented as Poster #24)

Category: Student - Research in Progress

Title: Desmopressin (DDAVP) Dose Changes Post Discharge in Pediatric Patients with Diabetes Insipidus Receiving Oral DDAVP Compounded from Nasal Spray Inpatient

Purpose:  The purpose of this study is to evaluate desmopressin (DDAVP) dose changes among diabetes insipidus (DI) pediatric patients receiving oral DDAVP solution formulated using DDAVP nasal spray.  DDAVP is not commercially available as an oral liquid in the United States.¹ This is problematic for pediatric patients unable to swallow whole tablets.  Consequently, many caregivers must resort to extemporaneously compounding a DDAVP solution prior to immediate use.  Comparing the effect of both formulations, oral tablets and solution compounded from tablets, on decreasing urine volume and increasing urine osmolality have produced equivalent results.² However, many institutions utilize a compounding recipe that uses desmopressin nasal spray to produce an oral solution that has a 30 day shelf life.³ Following the inpatient administration of this formulation, however, the Pediatric Endocrinology service at the University of Chicago observed that preadmission desmopressin doses were no longer adequate post discharge.

Methods:  This single center retrospective study evaluated the medical records of pediatric patients who received DDAVP oral solution compounded from DDAVP nasal spray. The observation period took place between January 1, 2013 and August 7, 2015. Only patients who received oral desmopressin before admission and after discharge were included in the study. Additionally, a two-month refill history of oral desmopressin tablets with instructions for extemporaneous compounding before and after discharge was required. Patients undergoing neurosurgical procedures and displaying acute renal impairment were excluded.  Doses were then tabulated and analyzed using descriptive statistics. 

Results: Research in Progress 

References
1. Desmopressin.  Micromedex 2.0. Truven Health Analytics, Inc.  Greenwood Village, CO.  Available at: http://www.micromedexsolutions.com.  Accessed December 20, 2015.
2. Argenti D, Ireland D, & Heald DL. A pharmacokinetic and pharmacodynamics comparison of desmopressin administered as whole, chewed, and crushed tablets, and as an oral solution. J Urol. 2001;165(5):1446-51.
3. Michigan Pediatric Safety Collaboration to Standardize Compounded Oral Liquids. University of Michigan College of Pharmacy. Available at: http://www.mipedscompounds.org.  Accessed December 21, 2015. 

Conclusions:  Research in Progress

Submitting Author: Gennaro Anthony Paolella, BS Pharmacy Student

Submitting Organization: University of Chicago

Authors: Gennaro Anthony Paolella, BS Pharmacy Student; Shannon Rotolo, PharmD, BCPS

ICHP Poster Presentations – Student #4
Winner: Best Student Poster Presentation 2016
(presented as Poster #12)

Category: Student - Research in Progress

Title: Retrospective analysis of osteoporosis risk factors among the Chinese population

Purpose:  Assess effects of weight, cigarette smoking, and alcohol intake, on bone mineral density, measured as T-score, among the Chinese population in Chicago’s Chinatown neighborhood. -Determine if length of stay in the US has any impact on BMD.

Methods: A retrospective analysis will be conducted using data collected at Midwest Asian Health Association (MAHA) in Chicago’s Chinatown neighborhood from August 2013 to August 2015. Data from 200 participants will be reviewed. MAHA, located in Chicago, is a community-based, non-profit 501 (c)(3) organization that provides community outreach education, screenings, immunizations and linkage to care in collaboration with community-based organizations, health care providers and academic institutions to reduce health disparities for the Asian population. The majority of the health fair attendees lack or have limited health insurance.  For the last two years, pharmacy school students from Chicago State University College of Pharmacy have partnered with MAHA to offer free bone mineral density screening during MAHA’s monthly health fair.  During these events, MAHA collected demographic information of each participant as part of their record keeping in order to properly assess the participants’ risk of osteoporosis. These demographic information include age, sex, height weight, social and family history. Bone health-bone density screenings were offered to men and women aged 20 years and older using the Lunar AchilllesTMQuantitative Ultrasound System provided by the College of Pharmacy at Chicago State University. All participants signed a consent form to be part of the health screenings.  Descriptive analysis will be used to report demographic and fracture risk factors. A correlation analysis will be used to describe the relationship between length of stay in the US, weight, smoking status, and alcohol consumption and BMD.  

Results:  Research in Progress 

Conclusion: Research in Progress

Submitting Author: Anna Aidonis, PharmD candidate

Submitting Organization: Chicago State University College of Pharmacy

Authors: Anna Aidonis, PharmD candidate; Cindy Leslie A. Roberson, PharmD, BCACP; Hemangini Shah, PharmD Candidate

ICHP Poster Presentations – Student #5
(presented as Poster #23)

Category: Student - Research in Progress

Title: Comparison of oral morphine equivalent doses vs. PHQ9 scores in a family practice setting

Purpose: Determine if a pharmacist is able to decrease opioid use without worsening PHQ9 scores. 

Methods: This retrospective chart review evaluates a sample size of 271 patients receiving pain management by a pharmacist in a family practice setting in southern Illinois. The primary outcome is to determine if decreasing oral morphine equivalent doses increases PHQ9 scores. Opioid use (measured by the oral morphine dose) and depression (measured by PHQ9 scores) were calculated for each patient visit and compared over a two year time frame.  

Results: Research in Progress 

Conclusions: Research in Progress

Submitting Author: Lauren Ashley Kirkpatrick, PharmD candidate

Submitting Organization: Southern Illinois University Edwardsville

Authors: Lauren Ashley Kirkpatrick, PharmD candidate; Chris Herndon, PharmD, BCPS, CPE, FASHP

ICHP Poster Presentations – Student #6
(presented as Poster #11)

Category: Student - Research in Progress

Title: Phytopharmacological evaluation of chamomile (Matricaria recutita L.) for indirect modulation of the endocannabinoid system

Purpose: German chamomile (Matricaria recutita L.) has been known to be a useful antidepressant and anxiolytic in humans. Clinical trials demonstrate the role of the endocannabinoid system in modulating emotional homeostasis. The objective of our research was to identify compounds in chamomile that indirectly modulate the endocannabinoid system through inhibition of the endocannabinoid catabolizing  enzymes, fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL). The identification of compound(s) interacting with the endocannabinoid system will provide lead compounds with therapeutic potential against various mood disorders. 

Methods: A bioassay-guided fractionation approach was adopted. Whereas chamomile powder was initially extracted with methanol followed by fractionation with hexane, chloroform, ethyl acetate, and methanol. All fractions were fingerprinted using high performance liquid chromatography.   The fractions were evaluated for FAAH inhibition using an in vitro microplate assay. In the initial screening, the hexane showed the highest activity. The fraction was further subjected to bioassay-guided chromatography until a pure active compound was isolated and identified. All fractions were also evaluated for inhibition of the MAGL enzyme. 

Results: Research in progress. Throughout our experiments, we were able to identify one active compound, linoleic acid. Our current and future research aim at identifying the remainder of compounds and their evaluation in animal models. 

Conclusions: Though our research is still in progress, our experiments demonstrate a procedure that can be replicated for any other herbs of interest. We are still in an early phase of our chamomile project, and many active compounds are yet to be isolated and identified. However, we were able to reliably demonstrate FAAH and MAGL inhibition activity, which show that chamomile has a role in modulating the endocannabinoid system and supports its use as an herbal dietary supplement for depression and anxiety.

Submitting Author: Kristine Manlimos, PharmD Candidate

Organization: Chicago State University College of Pharmacy

Authors: Kristine Manlimos, PharmD Candidate; Nidhi Patel, PharmD Candidate; Ehab Abourashed, MS, PhD; Abir El-Alfy, MS, PhD, PharmD Candidate

ICHP Poster Presentations – Student #7
(listed in Syllabus as Poster #10)

Category: Student - Research in Progress

Title: Comparison of Pharmacist and Physician Attitudes and Knowledge of Pain Management

Poster not presented.

 

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