Every workday I receive an Associations Now Daily News, a collection of articles from the American Society of Association Executives (ASAE). This morning, Friday, March 1, one of the articles caught my eye, “Help Your Attendees Make Friends – Not Contacts” and I found it especially timely. With the Spring Meeting coming soon, the article made me think about ICHP’s past years’ efforts to build more networking into the Annual Meeting and maybe in the future, the Spring Meeting. Unfortunately the Spring Meeting will be over when you read this but to that point, we don’t have a true networking session built into the meeting’s schedule anyway.

Samantha Whitehorne, the articles author, was stirred by an article she read on CNBC.com earlier in the week titled “If You Want to Be Successful, Don’t Network – Do This Instead”, which talked about doing more than just collecting business cards from others and it reminded her of a practice her first boss was dedicated to whenever she attended a meeting. The short version of that story was that her boss would not only collect business cards at meetings she attended, but she would make notes on that person’s card. Then after the meeting she would follow-up with the three people she felt most connected to during the meeting after a week or two. She made close friends and solid business contacts that way.

That’s a great lesson and a practice that anyone who wants to grow their network should aspire to emulate. But as I thought about our members, I remembered that we are pharmacists, pharmacy technicians, and pharmacy students. Maybe the new generations are changing our culture but for the most part, many of us tend to be introverts. How do you really connect with someone at a meeting that you don’t know at all, if you’re an introvert? Or if you’re a really clumsy or geeky extrovert?

So Samantha’s article reminded me of a lesson I learned nearly 28 years ago while working as the Assistant Director of Pharmacy at Sherman Hospital in Elgin. Sherman was big on staff development and I was lucky enough to be sent to a multi-week Dale Carnegie Management Seminar. The session on Communication spent a lot of time on “Asking the Right Questions.” The questions were aimed at getting to know a stranger without invading their personal space. Safe questions that would help you understand more about the individual you were working with, purchasing a product from, or just sitting next to on a long airplane flight.

I suspect that there are still Dale Carnegie courses out there, but I also assume they have changed a lot since 1991. So I hope I’m not infringing on copyrighted material but the instructors provide a system to remember the categories of safe questions to help you connect. The system, which is actually a picture, puts the categories in the order in which you should ask them. The picture is fairly vivid because I still remember most of it today. (I will admit, I still have my notes from that seminar and I found this section to make sure my memories were accurate.)

When you first meet a person - in any situation, but let’s focus on an ICHP networking event - you of course want to know their name. So the base of a picture you need to paint in your mind is a walnut name plate, like the one on your desk, providing you have one. (Yeah, like everybody has a walnut one. The only nameplate I ever got was a plastic one from LAG Drug Company [Look that one up Chicagoans!] when I graduated! So just bear with me and pretend we’re all Fortune 100 CEOs!)

On top of the nameplate, sits a house. The house represents questions about the person’s life like, “where do you live?”, “are you married?”, “do you have kids?”. Although in these days of personal privacy, I’m not sure these are that safe. But moving on, coming out of the chimney visualize a work glove. The work glove represents “Where do you work?”, and “What is your specific job?”. Chances are you may know these answers already if you’re speaking with a product or service vendor.

The work glove is holding an airplane. The airplane represents travel and questions like “Where was your last vacation?” or “Where would you travel to if you could go anywhere?”. Safe questions, sort of fun and while not necessarily why you are attending the networking event, they help lighten the discussion and don’t take much time. The next part of the picture is the final personal questions and they are represented by tennis rackets as the propellers on the airplane. Yes, some airplanes still use propellers but the tennis rackets represent hobbies or sports a person might enjoy. These questions are safe ones to use to get to know someone better or when you want to bug the snoring stranger in the next seat on a long flight.

Now back to the real purpose of tying this to the networking event and the final part of this picture you’re creating in your mind. As the plane flies through the sky, it is surrounded by pink light bulbs instead of clouds. Why pink? I have no idea and didn’t write that in the notes but probably so you won’t forget them.

The pink light bulbs represent ideas. Ideas from others to solve the problems you currently face on the topic of the table you selected or ideas you have that can solve the problems of those sitting with you.

Twenty-eight years later, and I remembered most of this without looking. Maybe because I use it often and because it has helped me get out of my shell a little more than I did before I knew it. But when I go to a meeting where I need to meet new people or when I find myself in a less than comfortable encounter with someone I don’t know, I lean on this and it works. What’s more, it has helped me make some friends that I can call or e-mail anytime that I wouldn’t have gotten to know without it.

So let me recap or in this case, repaint the picture succinctly:

I hope this helps and if you wake up some night from a crazy dream where King Kong is standing on your roof wearing work gloves, knocking airplanes with tennis racket propellers out of a sky full of pink light bulbs, you can blame me and ask yourself, where was the walnut nameplate? And actually, if you do, King Kong could represent asking the question, “Do you have any pets?” ■

President's Message
Spring Has Sprung

by Noelle Chapman, PharmD, BCPS, FASHP - ICHP President

I have always been prone to Spring Fever. The itch to clean out the drabness of winter, to refresh and reorganize, to step outside my comfort zone and go somewhere, or try something new. This year I’m taking this concept of renewal to a new level as I recently left my position at an organization I had been employed at for almost 18 years for a new opportunity.

Spring Cleaning

I was fortunate that I was not forced into a situation where I needed to find a new job or was unhappy in my situation. I know this was a luxury and allowed me to assess with my fa

mily what was most important and make choices. Approximately a year and a half ago I had the distinct pleasure to hear Michelle Obama speak at the ASHP Midyear Clinical Meeting opening session. (Incidentally, I got to meet her afterwards thanks to my friend and past ICHP President, Todd Karpinski!) The entirety of her authentic, interview style keynote was inspirational to me, however, there was one portion that planted a seed in my mind. An audience member submitted a question asking Mrs. Obama if she ever planned to run for president. Her answer was a strong no for several reasons including family, privacy and politics, but she also said this (and I’m paraphrasing). Sometimes you need to vacate your seat at the table to give others a chance to grow. This concept of providing space for new ideas and opportunity and actively giving up something you earned made me look at my own choices in a different light.

Approximately nine months after my Obama epiphany I was reading Think Like a Freak by Levitt and Dubner. The final chapter, “The Upside of Quitting” addresses the economic outlook for weighing fighting through something versus quitting. Generally speaking, quitting arouses negative connotations. My own upbringing has reinforced this (my mom often teases me that I “quit everything” and uses me giving up ballet at the age of 6 because I had extreme stage fright as an example. She’s joking. I think.) The reality is, however, that we all quit most things at some point. Whether it is sports or artistic activities or unhealthy relationships or jobs, there are many things we need to quit. In my experiences it isn’t knowing that we should walk away that is the issue. It's the actual letting go that we struggle with. There are many parts of my previous role I had a hard time letting go, but I realized that if I took the Kondo approach to my internal spring cleaning I would still be able to hold onto the things that spark joy for me.

Refresh and Renew

I have consistently been a believer in developing people. We all have something wonderful to give if we can only be allowed to see our strengths and determine our true interests. One of the leadership principles that I follow is surrounding myself with people who are better than me. David Ogilvy, the Father of Advertising, once said:

“If you always hire people who are smaller than you, we shall become a company of dwarfs. If, on the other hand, you always hire people who are bigger than you, we shall become a company of giants.”

I choose to surround myself with giants - professionally, personally and organizationally. I have been held up on the shoulders of people who have taught me, guided me, and challenged me. These giants taught me I had a voice and that if I used it effectively, people would listen. They guided me to the belief that what we are doing for pharmacy practice is good, but there is more to be done. They challenged me to stand up as a female leader to be an example. The support of the people around me is not only what made me realize I had to spread my wings but also was a large part of the reason I needed to. I owed it to them to take a new step and refresh how I want to make an impact.

Try Something New

In pharmacy practice there is very little black and white. We have to become comfortable in the gray zone in order to be effective. This is often a struggle with new learners who are learning to tie together all their didactic knowledge with reality. I have often given the advice to residents that they need to become comfortable with being uncomfortable, as this is where there is growth. This should not be a principle for only new learners, however. It is important for us all to evaluate the edges of our comfort in order for us to avoid being stagnant.

As I embark on this change I am reminded that a lot of practicing discomfort is managing emotions: facing your fears of potentially making a bad decision or not being good enough, reminding yourself that guilt is a wasted emotion, and caring so much that it can cloud your vision. Every year I force my residents to read Who Moved My Cheese? by Spencer Johnson. Despite having read it annually for the last half dozen years, this year, it took on new meaning and I was reminded that every end is a new beginning, particularly if you can work through the emotions of change and not let them control you. One of the ways I am attempting to do just that is by recognizing the areas of my life that are NOT changing. ICHP has been a touchstone for me in this process as I know my network here will keep feeding my roots as I embark on this new adventure.

This Spring I hope you get Spring Fever! Whether personally, professionally or organizationally - challenge yourself to do some spring cleaning, refresh your impact, and be a little uncomfortable. I can’t wait to hear how you grow! ■

Columns

March Board of Pharmacy Update
Highlights of the March 2019 Meeting

by Scott A. Meyers, Executive Vice President

The March 12th Meeting of the Board of Pharmacy was held at Thompson Center at Randolph and LaSalle in downtown Chicago. These are the highlights of that meeting.

New Department Leadership - Governor Pritzker has appointed Deborah Hagan as the new Secretary of the Department of Financial and Professional Regulation and Jessica Baer as the Director of the Division of Professional Regulation. Most of the staff have remained in their positions in the Department at this time.

NAPLEX and MPJE Remediation programs - A brief update was provided by pharmacy residents from Northwestern. The “PassNaplexNow” program has provided materials for review as an option for required remediation and Rx Prep will be following up with the residents in the near future regarding potential programming. At this point, the Board has not reviewed or approved any remediation programming.

Legislative Update – The update was provided by me and highlighted several dozen bills out of the 90+ ICHP is monitoring this session. A complete list of pharmacy and health care related bills may be found on the ICHP website in the Advocacy tab under Pharmacy Practice. In addition, a summary of the most important bills can be found in the Government Affairs Report in this issue of the KeePosted.

Public Comment Period – A brief discussion occurred of the pending USP Chapters 795 and 797, which are expected to be implemented in June of this year and Chapter 800, which is expected to be implemented in December of this year. Inspectors are currently enforcing compliance with 795 and 797 based on rules implemented late last year. Accrediting bodies however, are also enforcing compliance with USP 800 even though it is not yet required by State law.

Next Meeting – The next meeting of the Board is set for May 14th at 10:30 am in Springfield. This is a change from previous years when the March Meeting was normally held in Springfield. Check the IDFPR Website www.idfpr.com for exact location. Meetings of the Board of Pharmacy are open to the public and pharmacists, pharmacy technicians and pharmacy students are encouraged to attend.

Collaborative Pharmaceutical Task Force Deliberations (March 2019)
We're Getting Closer But No Votes Yet

by Scott A. Meyers, Executive Vice President

At the Collaborative Pharmaceutical Task Force March 12th meeting, the discussion began with a review of the grounds for discipline in the Act and Rules. There was substantial debate about the ability to enforce some of the points presented. For example, what types of advertising or soliciting that a pharmacist may be required to undertake could impact the health, safety and welfare of the patient? While requiring pharmacists to ask each patient if they have had the appropriate age-related immunizations when they pick-up prescriptions makes sound clinical sense, does the occasional announcement over the pharmacy PA system recommending customers stop by the pharmacy for their flu-shots have an impact on patient care? A concern was raised about another recommendation that requires “sufficient personnel to prevent fatigue, distraction, or other conditions that interfere with a pharmacist’s ability to practice with competency and safety” sounds reasonable except that “sufficient” is extremely subjective. The Task Force will continue to work on refining the recommendations related to Grounds for Discipline.

The Task Force discussed what tasks pharmacy technicians may carry out when the pharmacist is out of the office on a break. There was agreement that the pharmacy technicians could continue to work in the pharmacist’s absence and could deliver refilled prescriptions that the pharmacist had previously checked as long as the pharmacist felt that no additional counseling was needed. New prescriptions would not be dispensed that had not been checked by the pharmacist and there was significant disagreement related to dispensing new prescriptions that the pharmacist had checked. Counseling on all new prescriptions is required to be done by the pharmacist or pharmacy student when the pharmacist is present, however, mail-order pharmacy is only required to make a reasonable attempt to counsel the patient by telephone for new prescriptions. In addition, currently, pharmacies that deliver to the patient’s home are only required to provide counseling in a written format and a telephone number for questions for the pharmacist. These loopholes were criticized by more than one member of the Task Force. More discussion is expected on this topic.

The Task Force deliberated on the tasks a technician should or should not be allowed to undertake. Currently in the Pharmacy Practice Act and Controlled Substance Act, the following tasks may not be done by technicians:

· Patient counseling

· Drug regimen review

· Clinical conflict resolution

· Administration of immunizations

· Transfer of prescriptions

· Receiving of telephone orders for controlled

substances

Task Force Members agreed that the first three items listed were appropriate for exclusion, however there was lengthy discussion on the last three. Most of the Task Force felt that if technicians can receive telephone orders for non-controlled substances, why shouldn’t they be able to transfer the same? Concerns for receiving controlled substance prescriptions by telephone were based on the added opportunity for diversion and the reluctance to verify with the prescriber. Administration of immunizations seemed relatively reasonable as a task technicians could be trained to undertake but concerns were aired by the Medical Society representative over the expansion of the scope of practice. The Medical Society is opposed to any expansion of other professions’ scope of practice at this time. More discussion with a revised proposal for draft changes to the Practice Act will be discussed in April. ■

Collaborative Pharmaceutical Task Force Deliberations (April 2019)
Still Closer to Voting, but Different Opinions Appear

by Scott A. Meyers, Executive Vice Presiden

At the April 9th Collaborative Pharmaceutical Task Force meeting, the discussion began like it has several times before with a review of the grounds for discipline in the Act Rules. This time, there was limited debate with general agreement on the following major components:

Advertising or soliciting that may jeopardize the health, safety, or welfare of the patient including but not limited to, advertising or soliciting that:

Is false, fraudulent, deceptive, or misleading, or
Makes any claim regarding a professional service or product or the cost or price thereof which cannot be substantiated by the licensee, or
Requiring pharmacists to participate in such activities.

Failure to provide a working environment for all pharmacy personnel that protects the health, safety, and welfare of a patient which includes, but is not limited to:

Sufficient personnel to prevent fatigue, distraction, or other conditions that interfere with a pharmacist’s ability to practice with competency and safety or creates an environment that jeopardizes patient care
Appropriate opportunities for uninterrupted rest periods and meal breaks.
Adequate time for a pharmacist to complete professional duties and responsibilities including, but not limited to:

Drug regimen review
Immunizations
Counseling
Verification of the accuracy of a prescription; and
All other duties and responsibilities of a pharmacist as specified in the Pharmacy Practice Act Administrative Rules Part 1330.

Introducing external factors such as productivity or production quotas or other programs to the extent that they interfere with the ability to provide appropriate professional services to the public.
Incenting or inducing the transfer of a prescription absent professional rationale.
Anyone reporting violations of this section to the Department are specifically protected under the Illinois Whistle Blower Act (740 ILCS 174/15(b).

The Task Force discussed activities that could be conducted when the pharmacist is out of the pharmacy. The general consensus of the group was that dispensing of pharmacist-checked refilled prescriptions could occur along with the continued filling of all prescriptions up to the step of pharmacist final check. In addition, the pharmacist could require the patient or their agent to wait until they return for counseling on new prescriptions or specific refills. If the patient or their agent was unable to wait for counseling, pharmacist-checked prescriptions may be dispensed as long as the pharmacist attempts to contact the patient or agent by phone when they return. Revised language will be presented at the May meeting for (hopefully) final review.

The final discussion covered changes or clarifications to the role of the pharmacy technician. The proposal would now only prohibit technicians from participating in the following:

Patient counseling
Drug regimen review
Clinical conflict resolution

All pharmacy technicians would continue to be able to receive new prescriptions from prescriber offices by telephone, while certified pharmacy technicians would now be able to receive and provide transfers of prescriptions, administer immunizations, and receive controlled substance prescriptions from prescriber offices by telephone.

In addition, proposed language was generally accepted that would require that after January 1, 2022, all new pharmacy technicians shall complete an accredited education and training program approved by the Department. The ASHP/ACPE program will be cited as an example of an acceptable program. In addition, no technician may perform a function for which they have not been appropriately trained and that training documented.

While there was general consensus on all topics, the representative of the Illinois State Medical Society expressed concerns on several issues. ISMS is opposed to the expansion of the scope of practice of any health care professional and may be the dissenting vote on many of the Task Force’s final recommendations.

The next meeting of the Task Force will take place at 1:30 pm on Tuesday, May 14th in both Springfield and Chicago. Frontline pharmacists and pharmacy technicians are encouraged to attend to provide real-life experiences when discussing specific topics. The next meeting may produce votes on grounds for discipline, procedures for when the pharmacist is out of the pharmacy and expanding the roles of pharmacy technicians. Meeting location details will be posted on the Department website at www.idfpr.com/profs/Boards/PharmTaskForce.asp. ■

Government Affairs Report
Legislative Day, New Lobbyists and Lots of New Bills

by Scott A. Meyers, Executive Vice President

The “13th Annual Under the Dome” 2019 Illinois Pharmacy Legislative Day is under our belts and was an exciting success! Not only did it feature a raucous rally in the Capitol rotunda but ICHP shared a changing of the guard with all those in attendance. Retiring lobbyist and legislative consultant, Jim Owen, was thanked for his 18 years of service to ICHP with the presentation of a simple, but elegant Bulova watch.

Following that, Liz Brown-Reeves and Mitch Schaben (busy in the Capitol at the time) were introduced as ICHP’s new legislative consulting team and lobbyists from LBR Consulting in Springfield. Liz and Mitch have hit the ground running and are working to keep you and our Government Affairs team informed.

In addition to the “good-bye” and “hello”, Legislative Day attendees participated in the unveiling of House and Senate bills by Representative and House Majority Leader Greg Harris and Senator Andy Manar, which will begin to regulate Pharmacy Benefit Managers (PBMs) if passed. HB0465 and SB0562 - originally shells for the addition of future language - were amended on Monday and Tuesday of the week of Legislative Day, just in time to allow for the exciting rally. There were a variety of news outlets on hand and significant coverage across the State of this important issue. These bills are part of an extensive move by the Illinois General Assembly to rein in the fast-growing prices of prescription medications. Regardless of your practice setting, every member of ICHP should support these two bills.

As mentioned in the March Board of Pharmacy Update, ICHP is currently monitoring over 90 bills in this spring’s General Assembly session. There are many of those 90+ bills that are worthy of highlighting in this article and a complete list is available online at www.ichpnet.org/pharmacy_practice/advocacy/.

I encourage you to review each one and look to see if your legislators are a sponsor of any of them. Below are the most important bills at this time:

SB1135 – Harmon – Oak Park, D: Creates a process for Clinical Psychologists to obtain prescribing privileges. Sets requirements for education and training.

SB1220 & HB2338 – Jones: Chicago, D and Gabel: Evanston, D – Provides for the licensure of Naturopathic Physicians.

SB1250 – Murphy: Des Plaines, D – requires schools to allow students with pancreatic enzyme deficiencies to self-administer pancreatic enzyme replacement therapy in school.

SB1327 - Murphy: Des Plaines, D – Provides that medications prescribed to residents of facilities licensed under the Nursing Home Care Act are not subject to the 4-prescription limit under Medicaid.

SB1665 & HB2439 – Hastings: Frankfort, D and Mike McAuliffe, Chicago, R – Excludes licensed veterinarians from the reporting to the PMP unless they believe the person presenting an animal for treatment is fraudulently obtaining an opioid prescription.

SB1715 – Hastings: Frankfort, D - Amends the Pharmacy Practice Act to allow pharmacists to administer long-term anti-psychotic medications pursuant to a valid prescription upon completion of a training course.

SB1716 – Hastings: Frankfort, D – Amends the Public Aid Code to cover all FDA approved prescription medications that are recognized by a generally accepted standard medical reference as effective in the treatment of conditions specified in the most recent Diagnostic and Statistical Manual and Mental Disorders published by the American Psychiatric Association. These must be covered by both fee for service and managed care Medicaid programs.

SB1900 – Weaver: Peoria, R – Sets quantity limits on initial prescriptions for opioids. 7-days for all patients under 18 years of age, requires counseling of the parents or caregivers on the dangers of the opiate.

SB2094 – Glowiak: Western Springs, D – Amends the Safe Pharmaceutical Disposal Act to require any county or municipality to use its city hall, police department, or other facility to display a receptacle for unused pharmaceuticals.

HB0010 & HB0197– Flowers: Chicago, D – Amends the Pharmacy Practice Act by setting a limit of 10 prescription per hour, limiting the work-day of any pharmacist to 8-hours, requiring pharmacists to get one 30-minute lunch break and two 15-minute coffee breaks each shift, requiring a technician to be on duty whenever a pharmacist is and requiring 10 hours of technician duty for each 100 prescriptions filled in a pharmacy.

HB0053 - Flowers: Chicago, D –Requires drug manufacturers to provide price increase at least 60-days prior to implementation to State purchasers, insurance companies, PBMs, and the General Assembly.

HB0163 – Stuart: Collinsville, D – Requires pharmacies to report controlled substance sales to the PMP the day of the sale.

HB0272 – Harris: Chicago, D – Creates the Health Insurer Claims Assessment Act, assessing each health claim a 1% tax to be used to obtain federal matching funds for Medicaid.

HB0349 – Cassidy: Chicago, D – Creates the Drug and Sharps Stewardship Act, requiring manufacturers, distributors, and packagers to create stewardship programs for the products they make or distribute. Requires the placement of at least 5 take back kiosks in pharmacies per county and a minimum of 1 kiosk per 50,000 population.

HB0822 – Halpin: Rock Island, D – Allows schools to purchase and store glucagon on their premises and administer to students as needed.

HB1441 – Moeller: Elgin, D – Creates the Wholesale Importation of Prescription Drugs Act, allowing Illinois wholesalers to import medications from Canada.

HB1442 – Mussman: Schaumburg, D – Amends the Pharmacy Practice Act to allow pharmacists to prescribe hormonal contraceptives if properly trained.

HB2160 – Conroy: Villa Park, D – Amends the Illinois Insurance Code to require creation of a standardized prior authorization form and process.

HB2638 – Evans: Chicago, D – Amends the Controlled Substance Act and would require prescribers to offer a prescription for naloxone if specific morphine equivalents are prescribed, an opiate and benzodiazepine are prescribed together, or the patient has a history of prior overdose.

HB2702 – Rita: Blue Island, D – Revises the sunset date of the Pharmacy Practice Act by one year to December 31, 2021.

HB3192 – West: Rockford, D – Revises IDFPR’s Civil Administrative Code of Illinois and provides that certain health care professionals licensed by the Department who have applied to renew their licenses are presumed to be licensed until the application for renewal is approved or denied.

HB3232 – Evans: Chicago, D – Creates the Prescription Drug Repository Program Act which allows patients to donate unused medications that are in date and sealed in the original containers to participating pharmacies for redistribution to Illinois’ indigent population. Provides civil and criminal immunity to manufacturers and pharmacists who participate, but not pharmacies.

HB3300 – Manley: Romeoville, D – Amends the Veterinary Medicine and Surgery Act to place limits on the quantities of opiate medications veterinarians may dispense. Prescriptions filled in a pharmacy are not under the same restrictions.

HB3414 – Slaughter: Chicago, D – Creates the Prescription Drug Repository Pilot Program Act, which is similar to HB3232. The difference is the pilot program allows the Metropolitan Water Reclamation District to also collect medications and the Pilot Program ends in 2026.

HB3647 – Edly-Allen: Libertyville, D – Amends the Pharmacy Practice Act to require all pharmacies to offer medication take-back kiosks to their patients at no charge.

These bills are the most important bills we are monitoring but as you can see, do not come close to number the 90+ we are watching. For more details on each bill you may access the Illinois General Assembly website at www.ilga.gov and search it using these bill numbers. ■

ICHP Leadership Spotlight Interview - Alifiya F. Hyderi, PharmD
Leadership Profile

Leadership position in ICHP

As ICHP's Northern Regional Director-elect, I will be working with the affiliate presidents and champions of this region to address membership and activity needs. I will also be facilitating communication with Schools of Pharmacy located within this region.

Practice site
I am a Clinical Pharmacy Specialist and the PGY1 Pharmacy Residency Coordinator at RUSH University Medical Center in Chicago, Illinois. I work directly with the healthcare team to provide consistent patient care that ensures the appropriateness, effectiveness, and safety of patients’ medication use. I participate in daily team huddles that proactively address patients’ needs and problem solve how best to meet the needs of high-risk patients. In addition, I follow my passion of teaching and giving back to the profession by precepting pharmacy students and residents.

Tell us about a time where you made a difference in patient care/at work/with ICHP.
I am an advocate of patients actively participating in their own care. Early in my professional development, I realized that I can make a positive impact by empowering patients to make decisions and to instill a sense of control over their personal health. I once had an elderly patient who was unable to adhere to her medication regimen due to a combination of pill burden and the complexity of her regimen. I patiently went through the medication list and explained the indications for each of them in a way she could understand. We made a chart and organized medications that she can take in the morning, afternoon, and evening. I involved her in the decision-making process and addressed her questions and concerns. At the end of our conversation, I got a sense that she had a better understanding of her medication regimen. She also felt more confident in participating in her own self-care. A few months later, I met this same patient at the hospital cafeteria. I was surprised that she remembered me by my first name and was very appreciative of what I had done for her.

Tell us a story about how you selected pharmacy as your profession.
I was drawn to the pharmacy profession by seeing how accessible pharmacists are to people. When I was in high school, I remember going to a community pharmacy and being overwhelmed with the number of OTC products available. I went up to the pharmacy counter to consult the pharmacist. The pharmacist stepped out and walked with me to the aisle while asking me questions about my symptoms. Ultimately, he recommended a medication for my symptoms. He went a step beyond to explain how the product works, how I should take it, and what to do if my symptoms did not improve. In the years that followed, I learned more about the profession while shadowing pharmacists. I learned about the different opportunities that are available within the field and the ways pharmacists can provide care to patients. I also liked how pharmacy is a very respected profession.

Why did you join ICHP?
When I moved to Illinois from California I wanted to get involved and network with pharmacists in the Illinois community. A few of my colleagues were active members of ICHP and seeing their involvement in ICHP got me interested in this organization.

What makes ICHP great?
I think ICHP is resourceful. The organization provides countless opportunities for pharmacy students, pharmacy technicians, and pharmacists. Through my involvement in ICHP, I have been able to personally benefit from the networking, leadership, and continuing education sessions. ICHP provides a platform to grow professionally, share ideas with fellow members, and realize that together we can do a lot to advance our profession.

Who would you like to give special thanks to for making you who you are today in your career?
Special thanks to my family for their unconditional love and support! I would also like to thank Dr. Tien Ng and Dr. Angela Rosenblatt for being excellent mentors to me throughout pharmacy school. I would also like to acknowledge Dr. Hina Patel for her endless support during my pharmacy residency, Dr. Nora Flint for being a positive influence in my career, and Dr. Kathryn Schultz, who has inspired me to expand my leadership influence within and outside of the institution where I work. I really admire each of their personalities and their commitment to the pharmacy profession.

What advice do you have for a student?
Don’t hesitate to step out of your comfort zone.

What are your special interests/hobbies outside of work?
I enjoy working on DIY projects

What is your favorite restaurant or food?
I love Mediterranean and Indian cuisines, although I also love trying different cuisines.

What are 3 adjectives people use to describe you?
Determined, diligent, empathetic. ■

ICHP Leadership Spotlight Interview - Jared Sheley, PharmD
Leadership Profile

Leadership Position in ICHP
I serve as the President of the Metro East Affiliate of ICHP (Metro East Society of Health System Pharmacists or “MESHP”), where I am responsible for planning and carrying out local affiliate meetings and working directly with the ICHP Board on relevant activities. I re-initiated the MESHP as an active chapter in 2015 and have served as President since that time. I am also the Director-elect of the Southern Region, where I will represent Southern Illinois members on the ICHP Board of Directors.

Practice Site
I am a Clinical Assistant Professor at the Southern Illinois University Edwardsville School of Pharmacy, teaching in a variety of clinical courses. I am also a Clinical Pharmacy Specialist (Internal Medicine) at HSHS St. Elizabeth’s Hospital, where I round with the inpatient teaching service with the Saint Louis University Family Medicine Residency Program. I also regularly contribute to educational activities for the Family Medicine Residency program, as well as precept APPE students, pharmacy residents, and medical residents.

How did you know pharmacy was for you?
I decided to go into the pharmacy profession as a high school senior after contemplating several healthcare related professions and shadowing pharmacists in multiple practice settings. I was excited about the knowledge pharmacists had regarding how specific medications worked and how they contributed to enhancing patient care. Every time I make a significant clinical intervention at work, or instill important knowledge and skills in pharmacists-in-training or physicians that I know will have a positive impact on multiple patients in the future, I know I have selected the right career.

Tell us about a time when you had to fix a problem at work.
On several occasions, I have identified areas for improvement and subsequently developed and delivered formal education to pharmacists, physicians, and nursing staff to impact positive changes in patient care.

Why do you stay involved in ICHP?
ICHP is great because of the many amazing people who dedicate their time to continually improving this already great organization!

Why did you join ICHP?
I first joined ICHP as a student. After returning to Illinois following 2 years of residency training, I was encouraged by a few colleagues at SIUE to get more involved within ICHP and consider rejuvenating a local presence in the Metro East.

Do you have anyone you would like to thank?
Special thanks to everyone who contributed to my professional growth and for making me who I am today in my career. I don’t have one person to point out, but I have gained something from many, many people along the way – so thank you to ALL of you! Also to my wife for all of her support throughout my school, post-graduate training, and busy work life!

What advice do you have for a student?
Keep an open mind about your future and do not be afraid to change paths as you encounter new knowledge, experiences, or opportunities. Try to find a way to grow through every single experience.

Do you have any special interests or hobbies outside of work?
Spending time with family (especially with my recent addition of twin boys) and friends, being outdoors and active (hiking/camping/kayaking/recreational sports), and becoming a self-taught handyman.

Tell us something we may not know about you.
I was a state champion wrestler. ■

New Practitioners Network
Mentors Matter: Finding the Match to Make the Right Move

by Dalila Masic, PharmD PGY2 Critical Care Resident Loyola University Medical Center, Maywood, IL; Samantha Siepak, PharmD Candidate 2020 Midwestern University Chicago College of Pharmacy Downers Grove, IL; Megan Park Corsi, PharmD, MBA, DPLA Clinical Research Pharmacist The University of Chicago Medicine Chicago, IL

Creating a mentor-mentee relationship is a vital aspect of career development for students, residents, and experienced practitioners. Mentors are resources to point you in the right direction and to share in the excitement of your accomplishments. Additional benefits of a mentor include access to insider tips about your career field, insight into what has or has not worked for them, and connections to people that may benefit your future goals. Finding the right mentor takes time, attention, and effort to seek out the right intentional influence. Your mentor-mentee relationship should be with someone that you “click” with and who has your best interest at heart.

Finding a mentor may be a formal arrangement, an informal arrangement, or somewhere in between. A formal arrangement is usually more structured, with regular meetings and reviews of the mentee's progress. An informal arrangement may consist of a loose time frame for casual meetings, often per request of the mentee for each encounter. Regardless of an informal or formal arrangement, the mentor-mentee relationship is most effective when it is based on trust and open communication.

An ideal mentor is eager to share knowledge, provide honest feedback, and has time to foster the mentor-mentee relationship. Mentors get involved because they genuinely want to have a sincere interest in seeing their mentees succeed. It is important to differentiate between mentor and sponsor relationships. A sponsor is someone who advocates for you in their professional network. They connect you to opportunities that will advance your career and recommend you to others. It may feel as though a sponsor is working for you, in a sense, to get your name out there. Mentors serve as a sounding board, a support system, and provide insight into your developing goals and career path to assist in making decisions that will lead you to success. In short, mentors use their experience to teach you and offer their support to get you to where you want to be.

A mentor should embody the professional characteristics that you are working to achieve. However, you must first establish a clear understanding of what you are seeking from the mentor. Once you identify your motives, search for inspirational leaders around you and try to find a common a philosophy, passion, or project. A genuine shared connection will allow you to speak authentically about why you would like to establish a mentor-mentee relationship. This will help your potential mentor understand how you could engage in a mutually beneficial partnership. There are four key qualities to look for in a mentor: compatibility, contrast, expertise, and trust. Since a mentor is someone with whom you will be working closely, an essential element to a thriving relationship includes compatibility among personalities. If compatibility does not exist, the relationship may feel forced. Next, a mentor helps you step outside of your comfort zone and provides perspective. Having someone share how to look at things differently helps you gain clarity. Additionally, you want a mentor with enough experience to help you navigate through any challenge you may face, but that does not always mean someone with the most career experience. Expertise can take many forms and seeking a mentor with the expertise relevant to your success is advised. Finally, seek out a mentor who will challenge you to improve, is not afraid to ask tough questions, and will provide both positive and constructive feedback.

When reaching out to a person to request mentorship, it is important to prepare your thoughts. Articulate the challenge or opportunity you are facing and why you think he/she is the person who can help you. Then, identify something that you would like to learn or get perspective from the potential mentor by asking for a first meeting. After the meeting, ask if the mentor would be open to a similar meeting in the future and set a date. It will be surprising how quickly the relationship is able to develop. Mentors appreciate relationships that are worth the investment for which they are also receiving the benefit of knowing they are helping someone to achieve their goals.

Find a mentor that you trust and who genuinely wants to help you succeed. Honestly communicate your needs, wants, goals, and any plans that you already have in place. Do not be afraid when your mentor challenges you or puts you in an unfamiliar or uncomfortable place and recognize you will grow immensely when leaning into this discomfort. Your mentor wants you to step out of your comfort zone so that you can prove yourself, your abilities, and develop your confidence. ■

Professional Affairs
What are Position Statements and why does ICHP have them?

by Mary Lee, Director of Division of Organizational Affairs; Karin Terry, Director of Division of Professional Affairs

Hopefully you have seen the ICHP position statements that are under the Professional Practice Section of ICHPnet. If you have not, let us introduce them to you!

Why does ICHP have position statements?

The Illinois Council of Health-System Pharmacists (ICHP) develops position statements on pharmacy practice and health care policy. These position statements are intended to guide the practice of pharmacy by its members and clearly express to patients and decision makers the viewpoint of ICHP on important issues affecting the health of patients and their families in Illinois.

How does ICHP decide on topics for position statements?

Topics for position statements are identified and approved by the ICHP Executive Committee and then assigned to, drafted by, and approved by the appropriate ICHP division. The final approval of ICHP’s position statements is made by the ICHP Board of Directors before being posted on the ICHP website.

ICHP members may recommend the development of new position statements by submitting their suggestions to the ICHP office or any ICHP officer. That recommendation will be processed as described above.

What are examples of when I might consult the position statements?

When a new patient-specific challenge arises for which your facility does not have a policy or position.
When updating your facility-specific policies.
As a reference when preparing a presentation, in-service, etc.
As a reference when evaluating a specific service or practice at your facility.

How often are position statements updated?

The Division of Professional Affairs is responsible for regular periodic review and update of all position statements. With the current number of position statements and the usual review cycle, all position statements are reviewed at least once every 3 years. In the event of a significant change in pharmacy practice or regulations, a position statement will have an off-cycle review to allow for quicker updates.

Are ICHP position statements the same as the ASHP policy positions?

ICHP is the Illinois Affiliate of the American Society of Health System Pharmacists (ASHP). ASHP has also developed a variety of policy positions that may be useful to ICHP members. ICHP does not endorse every policy position of ASHP. For example, state and federal regulations may differ and this may require ICHP to have a different position than ASHP.

For questions or clarification regarding an ICHP position statement, please contact the ICHP office. ■

Professional Affairs
Call for Best Practice Award

Applications must be received by July 1st. Visit our website to apply online.

Program objectives and criteria
The objective of the program is to encourage the development of new, innovative 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

Eligibility

Applicants must be a member of ICHP for a minimum of 90 days prior to the submission deadline and practice in a health system setting. More than one program can be submitted by a health system for consideration.

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 as a continuing pharmacy education home study program.
You will receive a complimentary registration to the ICHP Annual Meeting, recognition at the meeting and a monetary award distributed to your institution.

For more information
Email Trish Wegner at TrishW@ichpnet.org or go to www.ichpnet.org/pharmacy_practice/professional_practice/best_practices/ ■

Educational Affairs
Implementing Anticoagulation Dosing Guidance and Drug-Drug Interaction Procedures

by By Cody C. Anderson, PharmD Long Term Care Consultant Pharmacist, Omnicare; Megan Grischeau, PharmD, BCACP VISN12 Clinical Pharmacist, Anticoagulation Hub – Midwest Region 2016-2019 Captain James A. Lovell Health Care Center PGY2 Ambulatory Care Residency Program Director Veterans Health Administration Integrated Service Network (VISN12)

Introduction

Anticoagulation management is a process that has largely been handled by pharmacists. Data has shown that a pharmacist-driven anticoagulation management is no less effective than physician-managed with improved patient satisfaction.^1-2 Significant consideration is needed when evaluating an anticoagulation regimen for safety and efficacy, including such factors as appropriate dosing, monitoring, and drug interactions. At the Captain James A. Lovell Federal Health Care Center (FHCC), processes for notification of warfarin drug-drug interactions and low molecular weight heparin (LMWH) dose rounding were standardized and implemented to maintain consistency across providers and to provide the safest care possible to the Veterans.

FHCC is a very unique organization, being the first and only combined Veterans Affairs (VA) and Department of Defense (DoD) facility. As a general statement, VA facilities serve only Veterans, while DoD facilities serve mainly active duty personnel, their dependents, and retirees. The process of merging two facilities into one has not been seamless. One barrier in particular is that both the VA and DoD utilize different computer systems; each with one system for electronic order entry by the provider and another for processing by the pharmacy. This means that medication orders entered through the VA systems will not cross over into the DoD computer system, and vice versa. In addition, some VA patients may have certain eligibilities, which require that they receive their medications through the DoD system, even if they are not receiving care from DoD providers. Unlike some private facilities where drug interaction alerts might seem customary, this joint VA/DoD venture has the aforementioned complicating factors to overcome. The following will describe the processes for enhancing patient safety through newly standardized processes.

Warfarin Drug-Drug Interaction Protocol

Warfarin has many drug-drug interactions, with some more likely to cause significant clinical interactions than others. Initiation or dosage adjustments of the medications in Table 1 were selected as being significant enough to warrant action.

Until recently, FHCC did not have a formal policy in place guiding inpatient and outpatient pharmacy on how to handle warfarin drug-drug interactions. At the FHCC, all warfarin is managed by clinical pharmacy specialists (CPS). Over the past two years, outpatient anticoagulation management responsibilities have shifted from the specific team’s CPS to a telephone based Centralized Anticoagulation Clinic (AC) model. Because the clinic may be staffed by different CPS on various days of the week, it was challenging for the outpatient pharmacy staff to identify which CPS to contact with specific concerns. For this reason, a Standard Operating Procedure (SOP) regarding the management of warfarin drug-drug interactions was necessary to improve patient safety.

This SOP applies to outpatient prescriptions dispensed by outpatient pharmacy, or outpatient prescriptions that are dispensed by inpatient pharmacy when the outpatient pharmacy is closed. The processing pharmacist or technician is responsible for identifying patients prescribed warfarin who received a new prescription or dosage adjustment of one of the aforementioned medications. If a patient receives VA care, the processing pharmacist will notify the AC CPS via a newly created email group with an encrypted message; or for DoD patients, the processing pharmacist will email the CPS directly as these patients were not included in the centralized model.

Clinical pharmacy specialists are responsible for monitoring the email account, evaluating critical drug interactions within one business day, and intervening as deemed appropriate. A few factors that the clinical pharmacist must take into consideration when evaluating a drug-drug interaction may include: length of therapy of the interacting drug, current or most recent INR, a patient’s risk for bleeding or thrombosis, and ability for patient follow-up monitoring. Interventions may include warfarin dosage adjustment, changing the follow-up appointment date, ordering labs, contacting the prescribing provider, or other interventions based on the CPS’s judgment. CPS ensure that a follow-up clinic, telephone, or lab appointment is scheduled and dates are relayed to the patient. Appropriate documentation of medication review and any needed interventions are completed in the patient’s electronic medical record.

Education was provided to the processing pharmacists and CPS upon implementation of the SOP and any questions they may have had were answered. The only question after training was knowing which pharmacist provider to email, and this was further clarified. In February 2018, this procedure was approved and posted to the pharmacy shared drive to allow for accessibility by all pharmacists. Continued follow-up from the anticoagulation clinic manager will be needed to ensure pharmacists implement and follow the procedures appropriately, including monitoring the VA email account and asking for feedback from the DoD CPS regarding ease of process.

With patient safety being a top priority, this was an area that necessitated change. Previously, processing pharmacists were not required to notify any CPS of potential warfarin drug-drug interactions. This process will greatly improve patient safety, as in the past the process relied on the patient to contact the clinic with medication changes.

LMWH Dosing Guidance

Outpatient dosing of LMWH can be challenging. A patient’s actual body weight is used to calculate the dose, either as a 1 mg/kg or 1.5 mg/kg dose for enoxaparin, and 150 units/kg or 200 units/kg for dalteparin.^4-5 However, given that LMWH syringes are only available in certain dosages with select syringes sizes having marked graduation, a patient’s dose will frequently need to be rounded up or down to reach the nearest syringe size. Some providers or institutions will instruct patients to “waste” part of a syringe to reach a specific dose, but this can lead to patients administering incorrect or inconsistent dosages. Relying on patients to waste the correct amount was identified as less ideal and offered an opportunity to standardize care and reduce the potential for medication errors. As seen in Tables 2 and 3, a provider can quickly and easily find the recommended dosage and available syringe strengths based on a patient’s calculated weight-based dose.

A provider may choose to round up or down based on the patient’s individual risk of bleeding or thrombosis. Table 4 provides situations in which a patient may be classified as a low or high bleed risk, and Table 5 classifies thrombotic risk based on specific indications and risk factors. The LMWH recommendations were not implemented as a protocol that must be followed, but created as a reference to help guide providers.

It is important to note that patients should have baseline labs performed when using either LMWH formulation, including a complete blood count and serum creatinine. Anti-Xa activity monitoring may also be recommended in specific situations such as extremes in body weight, renal impairment, pregnancy, or for patients receiving chronic use for venous thromboembolism (VTE) prophylaxis in the presence of a mechanical heart valve.^4-5,9

Conclusion

Since these processes were recently adopted, it is too soon to know their full impact. It can be difficult to change previous practice patterns, thus feedback from pharmacists and providers will be welcomed to maximize the efficacy and efficiency of the guidance and SOP. Time-in-therapeutic-range reports can be accessed in the VA data warehouse to potentially assess safety and efficacy of the process. However it is possible that some patients may not have an INR for four weeks following the drug interaction. At that time, the interacting drug may already be eliminated from the patient’s system and INR could have already returned to normal. Therefore, evaluation of the process may require generating reports of the above drug-drug interactions to assess if there was corresponding documentation in the patient’s medical record. Reassessment of the warfarin drug-drug interaction SOP may require re-education of pharmacy staff depending on activity of the CPS email group regarding interactions.

References
Young S, Bishop L, Twells L, et al. Comparison of pharmacist managed anticoagulation with usual medical care in a family medicine clinic. BMC Family Practice 2011;12:88.
Zhou S, Sheng X, Xiang Q, et al. Comparing the effectiveness of pharmacist-managed warfarin anticoagulation with other models: a systematic review and meta-analysis. J Clin Pharm Ther 2016;41:602-11.
Bungard T, Yakiwchuk E, Foisy M, et al. Drug interactions involving warfarin: practice tool and practical management tips. Can Pharmaceut J 2011;144(1):21-25.
Lovenox® [package insert]. Bridgewater, NJ: Sanofi-Aventis; October 2017.
Fragmin® [package insert]. New York, NY: Pfizer Inc; June 2017.
Douketis J, Spyropoulos A, Spencer F, et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (9th Edition). Chest 2012;141:326S-350S.
Lip GY, Frison L, Halperin J, et al. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol 2011 Jan 11;57(2):173-80.
Doherty J, Gluckman T, Hucker W, et al. 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with non valvular atrial fibrillation. J Am Coll Cardiol 2017 Feb 21;69(7):871-898.
Duhl A, Paidas M, Ural S, et al. Antithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes. AJOG Nov 2007;457:e1-57.e21.

Features

Looking For Some Leaders
How would you like to run for an ICHP Office?

by Scott A. Meyers, Executive Vice President

Every year, ICHP elects new members to its Board of Directors. As existing officers complete their terms, they often move up to higher offices or move on for a variety of reasons not the least being that they’ve completed the highest offices of President-Elect, President and Immediate Past President. So every year the ICHP Committee on Nominations searches for new leaders who are dedicated to “Advancing Excellence in Pharmacy!” to step up to carry on the business of the Council. That’s ICHP’s mission by the way.

This year is no exception. With Travis Hunerdosse completing his term as Immediate Past President and several other offices up for election, there are five offices that will need two candidates to run. While Board Members David Martin, Bernice Man and Kristine VanKuiken may opt to run for a second term as Directors of Educational Affairs, Marketing Affairs, and Technician Representative, respectively, we can’t be sure until they give us the thumbs up. And even if they do decide to run again, the Committee on Nominations will be seeking a second candidate to provide a choice for ICHP members.

Below is a list of the offices open for election in the fall of 2019. All the elected candidates will begin their term at the 2020 Annual Meeting, with the exception of the President-Elect, who assumes office immediately. So each new leader will have almost a year to train for their new job and be coached by our current Board Members. You don’t have to run that race unprepared!

President-Elect
Secretary-Elect
Director-Elect of the Division of Educational Affairs
Director-Elect of the Division of Marketing Affairs
Technician Representative-Elect
NPN Chair-Elect

If you are interested in running for an office or you would like to know more about an office before committing to run, you may contact Committee on Nominations Chair, Travis Hunerdosse at thunerdo@nm.org or Scott Meyers at scottm@ichpnet.org. We hope you are ready to help lead the way for ICHP and Pharmacy! ■

Legislative Day Highlights
Under the Dome #13 is Under our Belts

by Scott A. Meyers, Executive Vice President

The 13th Annual Illinois Pharmacy Legislative Day - “Under the Dome” is the well-known tagline - was a rousing success on March 13th! More than 400 attendees trekked to Springfield to meet with legislators and this year, rally in the Capitol Rotunda as Representative Greg Harris, D-Chicago and Senator Andy Manar, D-Springfield unveiled two identical bills to regulate PBMs (Pharmacy Benefit Managers)! On the Monday and Tuesday prior to Leg Day, both legislators introduced amendments to HB0465 and SB0652 that would begin to provide pharmacies and patients with significant protections from the predatory practices of PBMs! During the course of the day, more than 20 legislators were convinced to sign on as co-sponsors to one of these two pieces of legislation!

In addition, participants carried positions on two other pharmacy-related bills to their respective legislators, HB1441, a bill that would allow importation of medications from Canada and HB1442, a bill that would allow pharmacists to dispense hormonal contraceptives (pills, patches, and rings) through a standing order from the Illinois Department of Public Health. While there are more than 90 bills that ICHP and IPhA are monitoring, these four were selected for presentation during this important joint venture!

You can go to the ICHP website and Facebook page to see all the pictures of the days’ events - the registration process, lunch in the Howlett Building Hall of Flags, the orientation that prepared participants for the legislative meetings, the Rally in the Rotunda, and more. This annual undertaking, organized and orchestrated by ICHP and IPhA continues to build pharmacy’s presence and position in the State Capitol. With three articles: Board of Pharmacy Update, Government Affairs Report, and Collaborative Pharmaceutical Task Force Update in this issue of KeePosted alone, it should be clear that ICHP will continue to expand its legislative and regulatory advocacy efforts in Illinois on behalf of the pharmacy profession! You can help by establishing a relationship with your own legislators and planning to attend future “Under the Dome” events. It’s your profession, spend some time and effort on its behalf!

Enjoy this limited gallery of “Under the Dome” pics and go to the ICHP webpage or Facebook page to see the entire collection! ■

Student Chapter Video Contest 2019

For this year's student video contest, our student chapters were asked to submit a short video answering this question?

"What advocacy issue is most important to your chapter and why?"

Videos were posted on our social media platforms and votes were tallied by likes & Shares.

This year's winning chapter was: University of Illinois at Chicago College of Pharmacy - Chicago/Rockford

Check out all of the videos by visiting our social media pages and searching #ICHPAdvocacy

Champions Subcommittee
Be a Champion!

by Julie Downen, Chairperson of Champions Subcommittee

The ICHP CHAMPIONS program is a network of members from hospitals and health systems who serve as the “point person” or “Champion” for ICHP. Champions help to deliver services and information, assist with recruitment or retaining members, and connect ICHP to its members.

As a champion, there are several resources available, such as the monthly “Champion News Brief” update. Additional opportunities for Champions include involvement in committees or divisions, serving as a mentor for students, or providing feedback for future educational progams. In addition, Champions are recognized at ICHP events, such as at statewide meetings.

If you are pharmacist, pharmacy technician, or student pharmacist and are interested in volunteering to be a champion at your site, please contact:

Trish Wegner at trishw@ichpnet.org or Maggie Allen at maggiea@ichpnet.org. ■

ICHP/MSHP Spring Meeting
Poster Session Abstracts

Educational Affairs

2019 ICHP Spring Meeting Poster Abstracts
Please note: All research was to have results and conclusions by the time of presentation. These may not be reflected in the posted abstracts below.

PLATFORM PRESENTATIONS (Presented on Saturday, March 30, 2019)

Assessment of the Illinois Pharmacist’s Understanding of Palliative Care – Winner Best Platform Presentation

Exploration of Aztreonam in Combination with Avibactam or Vaborbactam for the Potential Treatment of Levofloxacin and/or Sulfamethoxazole-trimethoprim Resistant Strains of Stenotrophomonas Maltophilia Infections

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ORIGINAL RESEARCH POSTERS

On Site #1 - Operationalizing dispensing free naloxone out of a Level 1 Trauma Center Emergency Department (ED)

On Site #2 - Implementation of an enhanced recovery after surgery (ERAS) protocol in bariatric surgical patients to decrease post-operative nausea and vomiting: a retrospective chart review

On Site #3 - Impact of pharmacy process improvements within the emergency department on time to antibiotic administration and outcomes in patients with sepsis

On Site #38 - Value of pharmacy technician clinical support role in primary care

On Site #39 - Cost Savings Associated with a Therapeutic Conversion of Insulin Aspart to Insulin Lispro – Winner Best Original Poster

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ENCORE POSTERS

On Site #4 - The Financial Impact of Pharmacist Interventions in an Ambulatory Care Oncology Clinic Encore ICHP

On Site #5 - Student Pharmacist Driven Medication History Training Pilot Program Encore ICHP

On Site #6 - Assessing current gaps in practice and improving hospital adherence to ISMP’s Best Practice recommendations surrounding oral methotrexate use in non-cancer indications

On Site #7 - Impact of Team-Based Learning on Pharmacy Students’ Knowledge and Confidence in Searching Primary Literature Encore ICHP

On Site #40 - Comparing the efficacy of serum vancomycin concentrations of pharmacist-driven versus infectious disease physician-driven dosing of vancomycin – Winner Best Encore Poster

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STUDENT RESEARCH POSTERS

On Site #8 - Concurrent use of benzodiazepines and opioids: a drug utilization review based investigation in a community hospital

On Site #9 - A Retrospective, Single Center Study Evaluating COPD Management and Hospital Readmissions

On Site #10 - Does the Infusion Time of IVIG Matter in Kawasaki Disease?

On Site #11 – A comparison of renal outcomes among targeted immunotherapies – Canceled (Results and Conclusions were not available by the time of presentation)

On Site #12 - Analyzing the Role of Pharmacists in Overcoming Inadequate Documentation of Angiotensin Converting Enzyme Inhibitor Induced Drug Reactions in the Electronic Medical Record (Updated title)

On Site #41 - Nalbuphine as a Primary Parenteral Opioid for Acute Pain in a Large Community Hospital: A Retrospective Review.

On Site #42 - Dispense this, not that! Requirements for confident opioid dispensing

On Site #43 – A Retrospective, Single Center Study Evaluating Readmission Rates and Medications for Patients with Heart Failure with Preserved Ejection Fraction – Winner Best Student Poster

On Site #44 - Acute pain management for patients with an opioid dependence disorder receiving Suboxone, naltrexone or methadone

On Site #45 - Application of the Utah Bleeding Risk Score to LVAD Supported Patients at Advocate Christ Medical Center: A Retrospective Study (Updated title)

On Site #46 - Rocuronium versus succinylcholine in the traumatically injured brain: A prospective observational cohort (RVSTIB)

On Site #47 - Diluted single-syringe administration of adenosine for the rapid conversion of supraventricular tachycardia in the Emergency Department

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Spring Meeting Platform Presentations
Platform Presentation Abstracts

PLATFORM PRESENTATION ABSTRACTS

Platform Presentation – Student Research

Title: Assessment of the Illinois Pharmacist’s Understanding of Palliative Care – Winner Best Platform Presentation

Submitting Author: Blake Cornwell, PharmD Candidate

Authors: Blake Loran Cornwell, PharmD candidate, Southern Illinois University at Edwardsville School of Pharmacy; Katie Ronald, PharmD, BCPS, Professor, Pharmacy Practice, Southern Illinois University at Edwardsville School of Pharmacy.

Organization: Southern Illinois University at Edwardsville School of Pharmacy

Abstract

Purpose: The purpose of this palliative care survey was to assess Illinois pharmacists’ level of involvement and understanding related to palliative care.

Methods: The 22 question palliative care survey was distributed through Qualtrics after the IRB was approved. Once the survey was finalized an email was sent to the Illinois Pharmacists Association (IPhA) and the Illinois Council of Health-System Pharmacists (ICHP). These organizations then distributed the survey to their respective members. The email gave Illinois pharmacists an idea of what the research would be about and how it could benefit the pharmaceutical profession as a whole. Participants were able to access the survey through an anonymous link within the email. The survey was open to access from October 29, 2018 to November 30, 2018.

Results: A total of 152 responses were recorded with 131 of those participants completing the entire survey. The majority of pharmacists stated that they rarely (26.1%) or never (45.5%) engage in palliative care at their practice site. The majority of survey respondents selected that a goal of palliative care is improving quality of life (51.7%) and/or optimizing symptom management (43.6%) as opposed to halting the progress of life (2.6%) and/or doing whatever is necessary to keep patient alive (2.1%). When asked to rank objectives of palliative care respondents thought providing relief from pain and other distressing symptoms (30.9%) and enhancing patient’s quality of life (32.4%) were the most important palliative care objectives. When asked what challenge would make it the most difficult to educate patients about palliative care the 3 answers that made up the majority of responses were not enough time to discuss palliative care topics (37.3%), patients being unwilling to talk about palliative care topics (23.9%), and pharmacists’ lack of knowledge about palliative care topics (23.1%). Pharmacists were very interested in receiving additional education about pain management based on disease state (60.9%), symptom management based on disease state (53%), and mental health management for patient and family (45.1%). In addition to the topics listed above, most pharmacists were at least very interested or moderately interested in receiving additional education about communication with patient and family, spiritual needs, cultural beliefs re: death and dying, and legal aspects of patient care decisions.

Conclusions: The Illinois pharmacists who completed this survey displayed an understanding of the goals of palliative care and they believed enhancing quality of life as well as providing symptomatic relief was of the utmost importance for patients receiving palliative care. Despite multiple challenges making it difficult to educate patients about palliative care, pharmacists were willing to receive education about a plethora of palliative care topics to assist them in educating patients in the future. As the pharmacy profession progresses, the hope is that pharmacists will feel more comfortable discussing palliative care topics with patients and implementing palliative care management plans with other healthcare providers.

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Platform Presentation – Student Research

Title: Exploration of Aztreonam in Combination with Avibactam or Vaborbactam for the Potential Treatment of Levofloxacin and/or Sulfamethoxazole-trimethoprim Resistant Strains of Stenotrophomonas Maltophilia Infections

Submitting Author: Denise Lamm, PharmD Candidate

Authors: Denise Lamm, PharmD Candidate, Graduate Research Assistant, UIC College of Pharmacy; Mark Biagi, PharmD, Infectious Diseases Pharmacotherapy Fellow, UIC College of Pharmacy; Tiffany Wu, PharmD Candidate, Graduate Research Assistant, UIC College of Pharmacy; Kevin Meyer, PharmD Candidate, Graduate Research Assistant, UIC College of Pharmacy; Eric Wenzler, PharmD, Assistant Professor of Pharmacy Practice, UIC College of Pharmacy.

Organization: University of Illinois at Chicago College of Pharmacy

Abstract

Purpose: Given the widespread antibiotic resistance among Stenotrophomonas maltophilia and potential for toxicities and/or drug interactions to currently preferred agents, alternative therapies are needed. Aztreonam is the only β-lactam capable of avoiding hydrolysis by the L1 metallo-β-lactamase intrinsically expressed by S. maltophilia. Aztreonam remains susceptible to hydrolysis, however, by the L2 serine β-lactamase, thus making it ineffective for treating S. maltophilia. Combining aztreonam with a β-lactamase inhibitor with activity against L2 may restore aztreonam’s activity against S. maltophilia.

Methods: Thirty-seven S. maltophilia isolates resistant to levofloxacin and/or sulfamethoxazole-trimethoprim underwent MIC testing in triplicate by broth microdilution method according to CLSI guidelines. Modal MICs are reported and susceptibility interpretations were determined based on CLSI breakpoints for both levofloxacin and sulfamethoxazole-trimethoprim against S. maltophilia and Pseudomonas aeruginosa for aztreonam-based regimens. Time kill analyses for five isolates at standard inoculum (106) were performed in triplicate for aztreonam, aztreonam/avibactam, and aztreonam/vaborbactam. Time kills were performed at either fCmax or ¼, ½, 1, 2, and 4x the MIC. A >3 log10 reduction in CFU/mL from the starting inoculum was considered to be bactericidal. Synergy was considered to be ≥2 log10 reduction in CFU/mL compared to the most active agent alone.

Results: Only one of the 37 isolates (2.7%) was susceptible to aztreonam alone (MIC50/90> 128/>128 mg/L; MIC range 8->128 mg/L). Combining aztreonam with avibactam restored aztreonam susceptibility in 97.2% (35/36) of aztreonam-resistant isolates (MIC50/90 2/4 mg/L; MIC range 0.5-16 mg/L). Combining aztreonam with vaborbactam restored aztreonam susceptibility in 11.1% (4/36) of aztreonam-resistant isolates (MIC50/90 64/>128 mg/L; MIC range 2->128 mg/L). In time kill analyses, aztreonam alone failed to demonstrate bactericidal activity against any of the tested isolates at fCmax. Aztreonam/avibactam showed bactericidal activity at 4x MIC in 3/5 isolates while aztreonam/vaborbactam exhibited bactericidal activity against only 1/5 isolates at fCmax.

Conclusions: Combining aztreonam with avibactam resulted in restored susceptibilities at a higher rate than combing aztreonam with vaborbactam. This suggests that this combination could be an effective treatment alternative for S. maltophilia resistant to currently preferred agents. Until the commercial availability of aztreonam-avibactam, aztreonam combined with ceftazidime-avibactam may be an optimal treatment option for S. maltophilia, including isolates resistant to levofloxacin and/or sulfamethoxazole-trimethoprim. Future studies with this combination against S. maltophilia are warranted.

Spring Meeting Poster Abstracts
Original Poster Abstracts

ORIGINAL POSTER ABSTRACTS

On Site #1 – Original Research

Title: Operationalizing Dispensing Free Naloxone out of a Level 1 Trauma Center Emergency Department (ED)

Submitting Author: Rolla Sweis, PharmD, MA, BCPS

Authors: Diana Bottari, DO, Medical Director Pediatric Pain Management, Advocate Children's Hospital; Chris Boyle, PharmD, Clinical Pharmacist, Advocate Christ Medical Center; Meghan Soso, PharmD, BCPS, Clinical Manager, Advocate Christ Medical Center and Advocate Children's Hospital; Judith Brown-Scott, RPh, Operations Manager, Advocate Christ Medical Center and Advocate Children's Hospital; Mary Hormese, PharmD, BCPS, ED Pharmacist, Advocate Christ Medical Center and Advocate Children's Hospital; Marc McDowell, PharmD, BCPS, ED Pharmacist, Advocate Christ Medical Center and Advocate Children's Hospital; Rolla Sweis, PharmD, MA, BCPS, VP Operations, Advocate Christ Medical Center; Frank Belmonte, DO, MPH, VP Medical Management, Advocate Children's Hospital.

Organization: Advocate Christ Medical Center

Abstract

Purpose: Advocate Christ Medical Center in Oak Lawn, IL, is a 788-bed teaching institution. Advocate Christ is a leader in health care and is a major referral hospital in the Midwest. The hospital has one of the busiest Level I trauma centers in Illinois with more than 105,000 ED visits annually. As part of Advocate Health Care, Advocate Children’s is one of the largest pediatric services providers in the nation. Advocate Children’s Hospital in Oak Lawn has 35,000 ED visits annually.

The opioid crisis is a public health epidemic without boundaries. In 2017, in Illinois, 2,199 people died of opioid-related overdoses—nearly 2x the number of Chicago homicides and over 2x the number of car related deaths in the state reported that year. Since 2010, Advocate has served more than 30,000 patients for overdose or addiction treatment.

EDs are a major touch point in the opioid battle. After a non-fatal overdose, a patient is more likely to experience a fatal overdose. For every 1 fatal overdose there are an estimated 30 non-fatal overdoses. With inadequate treatment resources to treat the surge of patients, we are left to leave many patients on their own after an overdose. We wanted to assess the feasibility of dispensing free naloxone from one of our busiest EDs.

Methods: In partnership with a community program, Advocate Christ Medical Center and Children’s Hospital were able to obtain naloxone free of charge to both the hospital and patients through grants. Each kit provides 3 doses of 0.4mg naloxone, 3 intramuscular syringes and an outreach pamphlet. Lot numbers and expiration dates were documented in event of a recall. The risk department was consulted and approved all processes.

When a patient was identified (presented with overdose or opioid related event), or patient requested a naloxone kit, a “dummy” order was placed in the electronic medical record. A nurse, physician or ED pharmacist could place the order. The order triggered an outpatient label. The naloxone kit was labelled with all qualifiers required per Illinois dispensing laws. The labelled kit was then sent to the ED. The patient and/or family watched a brief video outlining how to identify an overdose, actions to take when an overdose has occurred, instructions to call 911, and how to administer naloxone. Dispensing of naloxone was reported to the Illinois prescription monitoring program.

Patients who refused to watch the instructional video did not receive the kit.

Results: In a 3-month period 40 kits were dispensed in the ED. One concern was increased volume of patients only wanting naloxone. However, this was not the case. We designed a handout in such an event which listed local pharmacies that participate in dispensing of naloxone without a prescription, including a pharmacy located within our hospital. An additional concern was the dispensing of the naloxone kit would delay discharge, but since all providers were educated on how to identify patients to offer the kit to, this did not occur.

Conclusion: As the opioid epidemic continues, we need to look at innovative ways to combat the crisis. Patients who die from an overdose are unable to go to rehabilitation. Most overdoses do not occur alone. Dispensing of the kit was not only to possibly save the patient’s life, but also potentially someone else’s. Dispensing of free naloxone from a level 1 busy tertiary hospital is feasible without adding to the wait times.

In conclusion, hospitals partnering with community outreach programs to combat the opioid crisis is one step in taming the crisis. Many community outreach programs have resources that hospitals do not. Many hospitals have touch points that community outreach programs do not. Combining our advantages has led to 120 doses of naloxone in our communities. The crisis is not one systems responsibility but all our responsibility.

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On Site #2 – Original Research

Title: Implementation of an enhanced recovery after surgery (ERAS) protocol in bariatric surgical patients to decrease post-operative nausea and vomiting: a retrospective chart review

Submitting Author: Kayla DuBois, PharmD, MBA

Authors: Kayla DuBois, PharmD/MBA, PGY1 Pharmacy Practice Resident, Memorial Medical Center; Jennifer Ratliff, RPh, BCPS, Memorial Medical Center; Orlando Icaza, Jr., MD, FACS, Memorial Medical Center; Tiffany Turner, APRN, MSN, CBN, Memorial Medical Center; Don Ferrill, PharmD, BCPS, Memorial Medical Center.

Organization: Memorial Medical Center

Abstract

Purpose: Nausea and vomiting in the post-operative period is a significant concern for both patients and providers that leads to greater patient dissatisfaction and contributes to increased hospital length of stay and morbidity. Decreasing post-operative nausea, vomiting, and opioid use is a priority among health care providers. This study aims to enhance the small pool of currently available published literature and provide evidence of a novel enhanced recovery after surgery (ERAS) program in bariatric surgical patients. This ERAS program employs a pre-operative regimen of aprepitant, transdermal scopolamine, acetaminophen, pregabalin, and celecoxib to decrease post-operative antiemetic and opioid requirements.

Methods: This study has gained approval from the local Institutional Review Board. The retrospective chart review will identify patients who underwent bariatric surgeries, including roux-en-y gastric bypass and sleeve gastrectomy, and compare outcomes pre- and post-implementation of the ERAS program. Exclusion criteria include any patient in the post-implementation group in which the ERAS protocol was deviated from, patients who underwent revision of a previous bariatric procedure, and patients on chronic opioid therapy prior to the procedure. The following data will be collected for analysis: age, gender, length of hospital stay, procedure start and end time, Bariatric Risk Score, American Society of Anesthesiologists Physical Status score, allergies, intra-operative drug administration, route of anesthesia, chronic opioid use, serum creatinine, pain scores, post-operative antiemetic use, and post-operative opioid use. The primary outcome will be post-operative anti-emetic use, measured as the number of individual doses of antiemetic agents and the number of individual antiemetic agents administered in the post-operative period (cumulatively at 24 hours, 48 hours, and total period). Secondary outcomes will include post-operative opioid use measured as total morphine milligram equivalents administered in the post-operative period (cumulatively at 24 hours, 48 hours, and total period), hospital length of stay, and cost analysis.

Results: Presented at meeting

Conclusions: Presented at meeting

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On Site #3 – Original Research

Title: Impact of pharmacy process improvements within the emergency department on time to antibiotic administration and outcomes in patients with sepsis

Submitting Author: Katelyn Fryman, PharmD

Authors: Katelyn Fryman, PharmD, Memorial Medical Center; Megan Metzke, PharmD, BCPS, BCCCP, Memorial Medical Center; Michael Guithues, PharmD, BCPS, Memorial Medical Center; Julie Downen, PharmD, BCPS, CLSSBB, Memorial Medical Center; Don Ferrill, PharmD, BCPS, Memorial Medical Center; Trupesh Chanpura, MD, Memorial Medical Center.

Organization: Memorial Medical Center

Abstract

Purpose: The surviving sepsis campaign recently released new guidelines which recommend initiating intravenous antibiotics as soon as possible, not to exceed one hour after recognition of sepsis. The objective of this study is to implement new pharmacy processes to decrease time to antibiotic administration, as well as evaluate the effect these processes had on patient outcomes.

Methods: This study was approved by the local Institutional Review Board. Patients will be identified by initiation of the sepsis order set in the electronic medical record system. Exclusion criteria will include patients that transferred from an outlying hospital, patients who did not receive antibiotics within the first six hours, patients missing time of antibiotic administration, patients receiving antibiotics prior to sepsis presentation, and patients without suspected or diagnosed sepsis. Both a retrospective and prospective review of these patient charts will be completed to determine if there are any significant changes in patient outcomes after implementation of new processes. New processes include an alert to pharmacists when a patient has suspected sepsis, stocking commonly prescribed antibiotics for sepsis in the automated dispensing machine for removal, and education to nursing staff in the emergency department on the importance of timely antibiotic administration. The following data will be collected: patient demographics, time to antibiotic initiation, mortality, hospital length-of-stay, intensive care unit length-of-stay, and duration of vasopressor use. All data will be stored and collected on secure health system computers. Data collection documents will be encrypted, and password protected to prevent exposure of data to unintended persons.

Results: Presented at meeting

Conclusion: Presented at meeting

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On Site #38 – Original Research

Title: Value of pharmacy technician clinical support role in primary care

Submitting Author: Emily Hoadley, PharmD

Authors: Emily M. Hoadley, PharmD, PGY-2 Ambulatory Care Pharmacy Resident, Northwestern Memorial Hospital; Bridget M. Dolan, PharmD, Clinical Pharmacist, Northwestern Medicine Specialty Pharmacy; Amy E. Wainright, PharmD, BCACP, BCGP, Clinical Pharmacist, Northwestern Medicine Specialty Pharmacy; Joshua J. Wentland, CPht, Pharmacy Technician Specialist, Northwestern Medicine Specialty Pharmacy.

Organization: Northwestern Memorial Hospital

Abstract

Purpose: A pharmacy technician practicing at the top of their license is a valuable asset that supports medication optimization and access, including but not limited to, identification of patients who would benefit from additional medication or disease state education and financial assistance. A clinical support pharmacy technician has the potential to increase the reach and impact of clinical pharmacists in a cost-effective manner. At Northwestern Medicine, a pharmacy technician was added to the Care Coordination team, composed of nurses, social workers, and a pharmacist, to support outpatient primary care clinics in May 2018. Evaluating the success of this position may set a valuable precedent for a non-dispensing pharmacy technician role in team-based care. The purpose of this project is to describe the role and assess the interventions of a pharmacy technician added to the Care Coordination team.

Methods: The role, workflow, and responsibilities of the pharmacy technician will be obtained via interview and described. Care Coordination team members will be surveyed to assess their perception of the role of the pharmacy technician and the value of this role in Care Coordination. A retrospective review of all interventions and patient interactions recorded by the Care Coordination pharmacy technician from May 2018 to December 2018 will be completed. Descriptive statistics will be used to determine the type, quantity, and outcome of the interventions. Additionally, cost savings to the patient, when applicable, will be reported.

Results: The pharmacist and pharmacy technician identified the workflow and responsibilities for the role. Referrals to the pharmacy technician came from the Care Coordination team, primary care providers outside of the Care Coordination team, and quality metric reporting. Responsibilities included: performing medication formulary investigation, obtaining insurance coverage and financial assistance by completing forms for prior authorizations and patient assistance programs, working with the pharmacist to provide recommendations for alternate covered therapies and relaying the information back to the prescribers and staff, and triaging patients to the pharmacist for clinical intervention or education. A majority of the interventions were related to medications for diabetes and interventions took the pharmacy technician a median of 30 minutes to complete. From May to December 2018, the technician reported a total of 608 interventions completed or ongoing. These interventions resulted in cost savings to our patients of at least $50,000 per month.

Conclusions: A clinical support pharmacy technician was successfully added to the Care Coordination team at Northwestern Medicine in May 2018. The pharmacy technician role has provided significant financial benefit to our patients. Clearly defining the role, responsibilities, and scope of practice of the pharmacy technician in a primary care setting will allow for pharmacy technicians and pharmacists to practice at the top of their licenses. Future addition of clinical support pharmacy technicians to multidisciplinary teams in primary care is a cost effective way to extend the reach of clinical pharmacy services.

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On Site #39 – Original Research - Winner Best Original Poster

Title: Cost Savings Associated with a Therapeutic Conversion of Insulin Aspart to Insulin Lispro

Submitting Author: Sarah Kessler, PharmD

Authors: Sarah G. Kessler, PharmD, PGY-2 Internal Medicine Pharmacy Resident, University of Chicago Medicine; Jennifer Austin Szwak, PharmD, BCPS, Clinical Pharmacist Specialist, Internal Medicine PGY2 Internal Medicine Residency Program Director, University of Chicago Medicine; Hailey P. Soni, PharmD, BCPS, Clinical Pharmacist Specialist, Internal Medicine, PGY1 Pharmacy Residency Program Coordinator, University of Chicago Medicine; Randall Knoebel, PharmD, BCOP, PGY1 Pharmacy Residency Program Director, Senior Manager, Pharmacy Health Analytics & Drug Policy Director, Pain Stewardship Pharmacy, University of Chicago Medicine.

Organization: University of Chicago Medicine

Abstract

Purpose: As drug prices continue to increase affecting all areas of patient care in which medications are administered or dispensed, identifying avenues for reducing costs has become critical. One avenue hospitals can control their drug expense is through optimization of procurement practices, including examining purchases on wholesale acquisition cost (WAC) to identify unnecessary spending. Insulin aspart, our formulary rapid acting insulin, had a high percentage of its spend falling to the WAC account. Insulin aspart is available only in 10mL vials and 3mL Flexpens, resulting in a significant amount of unused drug due to short dating of product and stocking procedures on the floor. The purpose of this study was to determine whether a therapeutic interchange from insulin aspart to insulin lispro would result in decreased WAC expenditure and overall cost savings.

Methods: In an effort to minimize waste and reduce WAC expenditure, the Pharmacy Department shifted its formulary rapid acting insulin product from insulin aspart to insulin lispro to capitalize on a smaller vial size of 3mL. In order to do this, current supply of insulin aspart was short dated, and insulin lispro was pre-loaded into the automated dispensing cabinets. Insulin lispro was inaccessible until the day of implementation. On the day of implementation, all new orders for rapid acting insulin defaulted to insulin lispro. Concurrently, pharmacists converted previously active insulin aspart orders to insulin lispro. The primary outcome of this study was to determine whether this conversion would result in a reduction in insulin expenditure.

Results: The average monthly cost of rapid acting insulin prior to changing from insulin aspart to insulin lispro was roughly $13,000 per month. After changing to insulin lispro, the average monthly cost of rapid acting insulin decreased to roughly $7,000. This resulted in a cost savings of about $5,000 per month. Additionally, a large decrease in the percentage of expenditure falling to WAC was noted. Further reduction in average cost per month is expected as costs become more stable over time.

Conclusions: By converting the formulary insulin from 10mL insulin aspart vials to 3mL insulin lispro vials, the University of Chicago Medicine was able to capitalize on both reduced cost and reduced WAC by reducing waste. The pharmacy department hopes to continue pursuing this form of procurement practice with additional insulin formulations.

Spring Meeting Poster Abstracts
Encore Poster Presentations

ENCORE POSTER ABSTRACTS

On Site #4 – Encore

Title: The Financial Impact of Pharmacist Interventions in an Ambulatory Care Oncology Clinic

Submitting Author: Taylor Conklin, PharmD

Authors: Taylor Conklin, PharmD, Northwestern Memorial Hospital; Alison Svoboda, PharmD, Northwestern Memorial Hospital; Farah Barada, PharmD, Northwestern Memorial Hospital; Chelsea Gustafson, PharmD, Northwestern Memorial Hospital; Caitlin Bowman, PharmD, Northwestern Memorial Hospital.

Organization: Northwestern Memorial Hospital

Abstract

Purpose: The role of oncology clinical pharmacists has continued to evolve in the past decade, as there has been a transition from inpatient management to outpatient management through ambulatory care clinics. A number of previous studies have determined a significant benefit of incorporating a clinical pharmacist into these ambulatory oncology clinics; however, very few studies justify pharmacists’ impact through revenue opportunities and cost avoidance. Randolph et al.’s pilot study on cost avoidance in an ambulatory oncology clinic uncovered the need for more full-time clinical pharmacists in the outpatient setting. Their interventions could be extrapolated to an estimated annual cost avoidance of $282,741 per pharmacist per year. Northwestern Memorial Hospital currently has implemented one full time equivalent devoted to its outpatient oncology clinic. This pharmacist has been embedded within the care teams specifically working with GI and melanoma patients. Additionally, physicians have started to bill at a higher tier when incorporating a clinical pharmacist in their model. This presents opportunities for both cost avoidance and a potential new source of revenue within the clinic. The purpose of this study was to determine the impact of clinical pharmacists in the ambulatory oncology clinic through cost avoidance and opportunity for revenue capture.

Methods: This prospective, observational study took place during a four week period. The clinical pharmacist documented four categories of interventions and corresponding time spent per intervention in their daily workflow: chemotherapy regimen review, medication teaching, supportive care, and medication reconciliation. The cost avoidance values assigned to these interventions were compiled from previous literature and updated for current inflation for 2018. An analysis of tier billing was collected during this study period to identify gaps in revenue opportunities within the GI and melanoma practice.

Results: A total of 205 interventions were documented during this four-week period. The most frequent intervention made by clinical pharmacists was medication reconciliation (n = 74), followed by supportive care (n = 54). Cost avoidance per intervention was calculated by multiplying the time spent for intervention by cost-avoidance values outlined in previous literature. The cost avoidance calculated during the study period was $21,403. This number was extrapolated to a 40 hour work week with 52 weeks per year, and was calculated to be $278,309. The analysis of tier billing determined the estimated annual revenue captures missed by not billing a pharmacist during patient appointments to be $52,427. This opportunity cost for revenue capture was added to the annual net benefit. The estimated cost of employing a clinical pharmacist in the oncology clinic was $116,310. Subtracting this cost from the annual cost avoidance yielded a net benefit of $214,356 per pharmacist.

Conclusion: This study concluded that full-time clinical pharmacists are financially beneficial to ambulatory oncology clinics. Given the financial impact, adding more full-time equivalent pharmacists may provide more revenue benefits and potential income growth.

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On Site #5 – Encore

Title: Student Pharmacist Driven Medication History Training Pilot Program

Submitting Author: Haley Fox, PharmD Candidate

Authors: Haley M. Fox, PharmD Candidate; Amanda Kojda, PharmD Candidate; Lauren Strombolic, PharmD Candidate; Denise Lamm, PharmD Candidate; Omar Jaber, PharmD Candidate; Andrew Mclnerney, PharmD Candidate; Sophia Gilardone, PharmD Candidate; Rolla Sweis, Advocate Christ Medical Center, PharmD, MA, BCPS; Marc McDowell, Emergency Medicine Pharmacist, Advocate Christ Medical Center, PharmD, BCPS.

Organization: Advocate Christ Medical Center

Abstract

Purpose: To pilot a medication history program in a high volume emergency department using experienced pharmacy students to train novice students. The Emergency Department (ED) at Advocate Christ Medical Center (ACMC) is a 120 bed level 1 trauma center. Obtaining medication histories is an essential process for appropriate pharmacotherapy management of patients being admitted from the ED. Typically, this function is performed by nursing staff; however, high rates of errors have been observed, which may lead to worse patient outcomes. Evidence suggests student pharmacists can effectively obtain medication histories and avoid potential adverse drug events. We sought to explore utilizing experienced student pharmacists to train novice student pharmacists in obtaining accurate medication histories in a high capacity hospital such as ACMC.

Methods:- Seven student pharmacists were recruited for this project including three experienced students and four novice students. Experienced students participating in the program required at least 120 hours of previous ED medication history experience. The novice students had no prior experience in obtaining medication histories. All student pharmacists underwent a six-hour training process with an ED pharmacist. Students were educated on the basics of the electronic medical record (EMR) and underwent a basic review of how to perform medication histories. Subsequently, each student performed a medication history and were observed by an ED pharmacist. For two weeks, the experienced students led and supervised the novice students obtaining medication histories. The final week of the pilot program, experienced and novice students practiced independently. The ED pharmacist reviewed all medication histories for accuracy and completeness. Patients were identified as requiring a medication history if an admission request was placed in the EMR. If all patients being admitted had their medication histories performed, students were instructed to proactively acquire medication histories based on the Emergency Severity Index Tool, a five-level triage urgency scale. This pilot program evaluated all patients in the ACMC ED from December 26th, 2017 to January 13th, 2018.

Results: Over a span of three weeks, the seven pharmacy students participating in the medication reconciliation pilot program completed 466 medication histories. Twice weekly, each novice student was paired with an experienced student and participated in eight hour shifts. These teams obtained medication histories under the direction of the experienced students for the first two weeks of the program. During the training weeks, an average of 18.08/24 medication histories were completed during each eight hour shift. After completing two weeks of training, novice and experienced students obtained medication histories independently for one week. On average, the experienced students completed 22.17 medication histories per eight hour shift, while the novice students completed an average of 13.25 medication histories per 8 hour shift. Once completed, a 15% sample size of all medication history was reviewed by an ED pharmacist for accuracy and completeness. Correct drug, frequency, route, dose, dosage form, and patient compliance were evaluated. Experienced students had an overall accuracy rate of 97.9% compared to novice students 96.8% when practicing independently. Across all students, modest improvements were observed in all categories.

Conclusions: Through this program, novice pharmacy students were able learn how to complete accurate medication histories in a timely manner in the ED. The results did show that novice students were able to complete fewer medication histories per shift; however medication histories completed by the novice students were as accurate as experienced students and speed would likely be gained with experience. Overall, a student precepted medication history pilot service was an effective program in the training of novice students to accurately complete medication histories.

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On Site #6 – Encore

Title: Assessing current gaps in practice and improving hospital adherence to ISMP's Best Practice recommendations surrounding oral methotrexate use in non-cancer indications

Submitting Author: William Justin Moore, PharmD

Authors: William Justin Moore, PharmD, PGY1 Pharmacy Resident, Northwestern Memorial Hospital; Justin Daniel Fisher, PharmD, PGY2 Pharmacy Resident, Northwestern Memorial Hospital; Daniel J. Wojenski, PharmD, BCOCP, Hematology/Oncology Practice Coordinator, Northwestern Memorial Hospital.

Organization: Northwestern Memorial Hospital

Abstract

Purpose: Medication errors associated with methotrexate have been reported to include nearly every identifiable facet of patient care, including prescribing, dispensing, patient education, and medication reconciliation. With an array of therapeutic indications including those of oncologic and non-oncologic use, the largest obstacle in addressing medication errors related to methotrexate surrounds the frequency of dosing. Methotrexate was added to the Institute for Safe Medication Practices’ (ISMP) List of High-Alert Medications in 2003 in an effort to curtail avoidable oversight. Reports of adverse or fatal errors have been featured over 60 times in ISMP’s Medication Safety Alert! Newsletters since 1996. The vast majority of these reports include oral methotrexate being prescribed for the treatment of non-oncologic disease states with many errors resulting in hospitalizations and patient deaths. The inconsistent practice surrounding methotrexate in non-oncologic indications is a multi-faceted issue facing clinicians and patients across the continuum of care. Despite an abundance of case reports highlighting preventable and sometimes fatal healthcare errors, awareness and adherence to ISMP Best Practice recommendations regarding methotrexate is disproportionately low. Among 501 US hospitals who provided self-assessments of compliance to ISMP recommendations only 46% reported full implementation of the seven recommended best practices. Pharmacists play a vital role in the stewardship of medication safety to ensure patients receive appropriate therapy while minimizing potential harm. This project aims to evaluate our institution’s adherence to ISMP’s Best Practice recommendations surrounding methotrexate for non-oncologic indications in an effort to prevent adverse medication errors and improve patient care.

Methods: Admitted patients with active orders for oral methotrexate were analyzed including those orders placed from June 1, 2018 through September 15, 2018. Data points collected included indication, dose, frequency, route of administration instructions, and prescriber specialty. In addition, all outpatient orders for oral methotrexate prescribed during the same time period were also analyzed. Data collected included number of tablets prescribed, duration of therapy as days supplied, and administration instructions. Each inpatient and outpatient order was considered to be “compliant” if it met all criteria listed in the ISMP Best Practice Recommendations or “noncompliant” if it did not. Orders were evaluated based on each of the seven ISMP recommendations individually and comprehensively.

Results: At our institution oral methotrexate prescribing does not consistently adhere to ISMP Best Practice Standards. Rheumatoid arthritis accounted for the majority of uses, with 64% and 57% of inpatient and outpatient orders, respectively. Among the seven Best Practice recommendations our institution was 100% adherent to only two of the seven standards. We identified the following gaps: inadequate discharge education and counseling including patient comprehension strategies via verbal and written education; lack of uniform prospective auditing of dosing regimens performed by healthcare professional prior to discharge or administration; inability to place order with day-specific administration instructions; a lack of limitations surrounding maximum days of prescribed therapy; inconsistent ordering practices regarding verification of the ordering provider as an oncologist.

Conclusions: As a result of this investigation, gaps were identified and addressed in order to improve medication safety by better adhering to ISMP recommendations through IT improvements and optimization of patient discharge counseling. Various quality initiatives will be implemented to address these gaps in practice to ensure safe and quality healthcare is delivered to those patients receiving methotrexate for non-oncologic indications. This project may serve as a reference for other institutions to identify gaps in practices relating to quality and safety surrounding methotrexate in this setting of use in order to limit preventable medication errors and provider oversight. There is a dire need for continued implementation of quality initiatives across health-systems to reduce the occurrence of medication errors with methotrexate.

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On Site #7 – Encore

Title: Impact of Team-Based Learning on Pharmacy Students’ Knowledge and Confidence in Searching Primary Literature

Submitting Author: Elana Nelson, PharmD

Authors: Elana M. Nelson, PharmD, Instructor/Laboratory Instruction Coordinator, Pharmacy Practice, Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy; Samantha Spencer, PharmD, Clinical Assistant Professor, Pharmacy Practice, Drug Information Group, University of Illinois at Chicago College of Pharmacy; Courtney D. Krueger, PharmD, Clinical Assistant Professor, Pharmacy Practice, Drug Information Group, University of Illinois at Chicago College of Pharmacy.

Organization: University of Illinois at Chicago College of Pharmacy

Abstract

Purpose: To evaluate the impact of team-based learning (TBL) on knowledge and confidence in primary literature searching skills for pharmacy students.

Methods: TBL was integrated into a drug information course to teach primary literature searching skills. Previously, a traditional lecture format was used. To assess the impact of TBL, students instructed in both formats were invited to participate in an online survey that assessed perceived confidence and primary literature searching knowledge one year after completion of the course. Survey results were compared between cohorts.

Results: 42 and 63 pharmacy students in the TBL and traditional lecture cohort, respectively, completed the survey. For knowledge assessment questions, no statistically significant difference in scores existed between cohorts. 100% of students in the TBL cohort reported the course improved their ability to search primary literature versus 94% in the traditional lecture cohort (p=0.034). For the primary literature recitation, the TBL format differed substantially from the delivery in the traditional cohort and 90% of students in the TBL cohort agreed or strongly agreed that the recitation improved their ability to search primary literature compared with 79% in the traditional lecture cohort (p=0.016).

Conclusions: Our findings are consistent with previous research showing that incorporating TBL into drug information courses can have a positive effect on confidence. Further research is needed to assess the long-term impact and sustainability of TBL on knowledge retention and clinical application of primary literature searching skills during student clerkships and future professional practice.

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On Site #40 – Encore – Winner Best Encore Poster

Title: Comparing the efficacy of serum vancomycin concentrations of pharmacist-driven versus infectious disease physician-driven dosing of vancomycin

Submitting Author: John Talili, PharmD Candidate

Authors: John A. Talili; PharmD Candidate, Southern Illinois University Edwardsville School of Pharmacy; Elizabeth A. Cady, PharmD, BCPS, Southern Illinois University Edwardsville School of Pharmacy; Maithili Deshpande, PhD, Southern Illinois University Edwardsville School of Pharmacy; Natalie R. Tucker, PharmD, BCPS, HSHS St. John's Hospital.

Organization: Southern Illinois University Edwardsville School of Pharmacy

Abstract

Purpose: Vancomycin, an antibiotic, is primarily used in the treatment of methicillin-resistant Staphylococcus aureus infections. The dosing/monitoring of vancomycin has been widely adopted by clinical pharmacists, via protocols and collaborative practice agreements. However, physicians may take the responsibility of dosing/monitoring. It is unknown whether pharmacists or specifically, infectious disease-trained physicians, can more safely and effectively dose vancomycin. The purpose of this retrospective study was to compare 1. the percentage of time vancomycin troughs were within range and 2. the average number of vancomycin levels ordered per day of vancomycin therapy between ID physicians and pharmacists within an institution.

Methods: This study was a retrospective chart review and was approved by the institutional review board. The study included patients who were 18 years of age and/or older. The dates of the review were arbitrarily chosen from March 19, 2018 to August 5, 2018. Patients were included if they had been treated with vancomycin. At this 431-bed hospital, protocol states that all vancomycin is to be dosed and monitored by a pharmacist, unless the patient is under the care of the ID consult service. In this case, the ID physician will dose and monitor the vancomycin. Patients were grouped into two categories with their vancomycin being dosed by either 1. a pharmacist or 2. an infectious disease physician. Patients were excluded if they were below 18 years of age. The primary outcome was the percentage of vancomycin serum drug levels (defined as troughs and random levels) within goal range (in mcg/mL), as dosed by either pharmacist or infectious diseases physician. Goal ranges were determined based on the patient’s infectious disease diagnosis. Secondary endpoints were the average number of vancomycin levels per day drawn and average number of days patients were on vancomycin therapy.

Results: The sample consisted of 30 patients (15 in each group), of which 16 were male and 14 were female. The mean age was 63 years old with 6 patients (three from each group) on hemodialysis during the study period. A total of 151 vancomycin levels were drawn in this patient population. Pharmacists had a total of 65 vancomycin levels drawn with 29 levels within range (45%) while infectious disease physicians had a total of 86 levels drawn with 42 levels within range (49%). Between the pharmacist and infectious disease physician dosing groups, there was no statistically significant difference in vancomycin levels within range (p = 0.61). In terms of average number of vancomycin levels drawn, pharmacists and infectious diseases physicians were similar with 0.62 and 0.51 respectively with no statistical difference (p = 0.65). Patients were on vancomycin for an average of 7 days (the longest of which was on vancomycin for 17 days) with pharmacist dosing and 11.2 days (the longest of which was on vancomycin for 48 days) with infectious diseases dosing with no statistical difference between the two groups (p = 0.22).

Conclusions: In this retrospective study, pharmacists and infectious diseases physicians had similar efficacy in terms of dosing vancomycin within goal range (troughs and random levels) and in terms of number of vancomycin levels drawn per day of therapy. Limitations include a small sample size and the fact that an ID pharmacist often recommends vancomycin doses/monitoring on the ID consult service. A larger study with more patients included must be conducted to optimally assess outcomes and to successfully determine which team is more effective at dosing and monitoring vancomycin, whether it be pharmacists or infectious disease physicians.

Spring Meeting Poster Abstracts
Student Research Poster Abstracts

STUDENT RESEARCH POSTER ABSTRACTS

On Site #8 – Student Research

Title: Concurrent use of benzodiazepines and opioids: a drug utilization review-based investigation in a community hospital

Submitting Author: Ashley Riley, PharmD Candidate

Authors: Ashley M. Riley, PharmD candidate, Southern Illinois University Edwardsville; Kristi D. Stice, PharmD, BCPS, Executive Director of Pharmacy and Quality Systems, Decatur Memorial Hospital.

Organization: Southern Illinois University Edwardsville School of Pharmacy

Abstract

Purpose: Concurrent use of benzodiazepines and opioids places patients at increased risk of oversedation. Pharmacists are in a unique position to be able to provide prescribers with drug expertise, contributing to safe and optimal patient care. Through utilization of intervention tools and electronic health system reports, pharmacists can identify patients who are at risk for oversedation events related to concurrent benzodiazepine and opioid therapy. The goal of this retrospective drug utilization review-based quality improvement project is to improve patient outcomes and maximize patient safety related to opioids and benzodiazepines in the hospital setting.

Methods: Drug utilization reports specific to the medical and surgical nursing floors of a single hospital site were obtained. Data collected included the number of patients prescribed opioids and benzodiazepines concurrently, the number of patients prescribed opioids, the number of naloxone reversals in patients prescribed opioids, and the number of pharmacist interventions related to concurrent use. Prescriber and pharmacist education was presented and a report was constructed within the electronic health record system to help pharmacists identify patients on concurrent opioid and benzodiazepine therapy. Pharmacists were educated on how to generate the report and were encouraged to track interventions made addressing concomitant medication orders. Data was collected before and after implementation of the electronic health record report and prescriber education.

Results: A total of 70 patients were on concurrent opioid and benzodiazepine therapy in October 2017. A total of 60 patients were on concurrent opioid and benzodiazepine therapy in November 2017. Concurrent drug utilization decreased in 2018, with records of 51 patients in October and 36 patients in November. The surgical nursing floor had higher incidence of concurrent use compared to the medical nursing floor. A total of 20 pharmacist interventions were recorded in 2018 specific to the surgical nursing and medical nursing hospital floors. A total of 705 patients were prescribed opioids during their hospital stay in 2017 compared to 678 patients in 2018. Naloxone administrations decreased from 6 administrations in 2017 to zero administrations in 2018. Overall, there needs to be more studies conducted to determine the relationship between pharmacist methods of communication for intervention and changes in prescribing patterns.

Conclusions: There was a clinically significant reduction in the number of patients on concurrent opioid and benzodiazepine therapy, which was mirrored by a reduction in naloxone reversals as well. These findings suggest that opioid and benzodiazepine stewardship may play a role in reducing adverse events and increasing patient safety overall.

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On Site #9 – Student Research

Title: A Retrospective, Single Center Study Evaluating COPD Management and Hospital Readmissions

Submitting Author: Lauren Ballweg, PharmD Candidate

Authors: Lauren Ballweg, PharmD Candidate; Carrie N. Vogler, PharmD, BCPS, SIU School of Medicine.

Organization: Southern Illinois University Edwardsville

Abstract

Purpose: Chronic Obstructive Pulmonary Disease (COPD) contributes to 5% of global deaths and billions in health care spending. The increased attention of health care spending and the push towards value-based services has lead Centers for Medicare and Medicaid Services (CMS) to take a closer look at patients with COPD, and the rates of hospital admissions and readmissions. This shift in focus comes with the intent of improving quality of life, decreasing exacerbations and disease progression, and provides a role for pharmacists to ensure proper medication prescribing and utilization. The GOLD Guidelines provide recommendations for COPD medications throughout different stages of disease progression; initial treatment, step up therapy and exacerbations. The primary objective of this study is to assess the hospital discharge medications for COPD after a hospitalization due to an exacerbation. This study will evaluate the COPD medications used and the recurrence of hospital readmission rates among this population.

Methods: The study was conducted via retrospective chart review of patients admitted to SIU Internal Medicine Hospitalist services at Memorial Medical Center between December 1, 2017 and July 1, 2018. Eligible patients were identified by ICD 10 codes indicative of COPD or acute COPD exacerbation. Once participants were identified the medications used for the management of COPD were assess and compared to the recommendations of the GOLD 2018 Guidelines. Primary outcomes included 30 day all cause readmission rates for patients with documented COPD; COPD medications prescribed at discharge and the appropriateness of dosing compared to GOLD guidelines; and hospitalization due to COPD exacerbation.

Results: Presented at meeting

Conclusions: Presented at meeting

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On Site #10 – Student Research

Title: Does The Infusion Time of IVIG Matter in Kawasaki Disease?

Submitting Author: Joseph Griffin, PharmD Candidate

Authors: Joseph Patrick Griffin, PharmD Candidate, Chicago State University; Angela Powell, PharmD Candidate, Chicago State University; Shannon Rotolo, PharmD, Clinical Pharmacist, University of Chicago Medicine; Palak Bhagat, PharmD, Clinical Pharmacist, University of Chicago Medicine; Allison Bartlett, MD, Associate Professor Pediatrics, Section of Infectious Diseases, University of Chicago Medicine.

Organization: Chicago State University / University of Chicago Medicine

Abstract

Purpose: Evaluate if there is a difference in the incidence of coronary aneurysms in those who received an Intravenous Immune Globulin (IVIG) 2g/kg dose over 10-12 hours as compared to those who received a dose over less than 10 hours.

Methods: Patients diagnosed and treated for Kawasaki Disease with IVIG at University of Chicago Medicine will be determined by drug utilization reports. The reports will include patients who received IVIG between September 1, 2008 and August 31, 2018. Data will be collected through chart review and patients will be divided into two groups based on duration of infusion (less than 10 hours or 10-12 hours). The primary endpoint will be the incidence of coronary aneurysms. The secondary endpoint will be the resolution time of acute phase reactants and defervescence. The safety endpoints will measure the risk of thrombosis and renal dysfunction.

Results: Presented at meeting

Conclusions: Presented at meeting

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On Site #11 – Student Research

Title: A comparison of renal outcomes among targeted immunotherapies

Not presented – Results not available at time of meeting.

On Site #12 – Student Research

Title: Analyzing the Role of Pharmacists in Overcoming Inadequate Documentation of Angiotensin Converting Enzyme Inhibitor Induced Drug Reactions in the Electronic Medical Record (Updated title)

Submitting Author: Myesha Tabriz, PharmD Candidate

Authors: Myesha Tabriz, PharmD Candidate, University of Illinois at Chicago (UIC) College of Pharmacy; Reham Awad, PharmD Candidate, University of Illinois at Chicago (UIC) College of Pharmacy; Alvin Godina, PharmD, BCPS, Roosevelt University/Advocate Christ Medical Center; Marc McDowell, PharmD, BCPS, Advocate Christ Medical Center.

Organization: University of Illinois at Chicago College of Pharmacy / Advocate Christ Medical Center

Abstract

Purpose: Angiotensin Converting Enzyme Inhibitor (ACE-I) induced drug reactions such as a dry cough or angioedema are common drug related adverse reactions experienced by patients. Improper documentation of such drug related adverse events, or the lack thereof, may pose severe or life threatening risks to patients if left unnoticed by health care providers. Therefore, the objective was to identify the prevalence of undocumented or inadequately documented ACE-I induced reactions in the banner of the electronic medical record (EMR). Furthermore, the chart review will examine the accuracy of medication induced drug reaction documentation and will assess the role of pharmacists’ in improving proper documentation in the EMR banner.

Methods: The charts of all patients enrolled in the Advocate Christ Medical Center (ACMC) outpatient congestive heart failure (CHF) clinic were reviewed from December 18, 2018 to January 11, 2019. Initially, the patient banner in Cerner PowerChart was assessed for documentation of an ACE-I adverse reaction. Subsequently, the patient chart was reviewed utilizing the “chart search” function with key words such as “ACE-I” for instances of reported ACE-I adverse effects elsewhere in the EMR. The data that was collected included whether or not the patient experienced an ACE-I adverse reaction, whether or not it was documented correctly, and if it was documented by a pharmacist. Correct documentation was assessed based on proper listing of the drug or drug class that caused the adverse effect, followed by what the adverse effect was, and when the adverse effect occurred.

Results: There was a total of 804 patients that were enrolled in the ACMC outpatient CHF clinic that were analyzed in this study. Of the 804 patients, 117 patients had an unintended side effect to an ACE-I such as a dry cough and angioedema. Of the 117 patients, 38 cases had correct documentation of a noted adverse effect to an ACE-I in the banner of the EMR, 39.47% of which were documented by a pharmacist. Additionally, there were 43 cases of inadequate documentation of ACE-I induced adverse reactions with only 9.3% being documented by a pharmacist. Inadequate documentation comprised of an ACE-I reported in the banner as a warning without indicating the adverse reaction that the patient experienced or the onset. Moreover, there were 36 cases of ACE-I induced adverse reactions that were present in the patient’s chart; however, were not documented in the banner. The 36 cases that were not documented in the EMR banner comprise 30.77% of the total allergies that were found among the heart failure patients that were analyzed.

Conclusion: Overall, there is a higher incidence of ACE-I induced adverse reactions that were mis-documented or not documented compared to those that were correctly documented which allows us to conclude that improvements must be implemented in order to achieve proper documentation in the EMR. Unfortunately, there is a lack of available guidelines for proper documentation of allergies and significant adverse reactions within patients’ health record. Therefore, future implications from this study include the standardization of allergy documentation for all healthcare professionals to follow in order to overcome the discrepancy and errors observed in the current system due to the higher incidence of inadequate documentation completed by healthcare professionals outside the field of pharmacy.

Additionally, based on the results, it is evident that pharmacists do not currently play a major role in documentation of drug induced reactions in the EMR. Over the years, pharmacists have gained the role of completing medication reconciliation interviews; therefore, pharmacists’ role should expand to include documentation of patient allergies and drug induced reactions. The role expansion could help overcome issues that were observed in the EMR such as missing information of the drug-induced reaction, time that the reaction occurred, as well as incorrect information being documented under the allergy section of the EMR banner.

If we were to improve the study, a larger population would be analyzed to further solidify our conclusion. Additionally, the data analysis would include the quantification of re-prescribing of an ACE-I in the incidents of correct, incorrect, or mis-documentation as a measure of patient safety. Lastly, the study would further support the need for pharmacists to be responsible for conducting medication reconciliation interviews and documenting it in the EMR. To conclude, this study calls for a standardization of allergy and drug induced reaction documentation as well as the expanded role of the pharmacist in this setting.

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On Site #41 – Student Research

Title: Nalbuphine as a Primary Parenteral Opioid for Acute Pain in a Large Community Hospital: A Retrospective Review.

Submitting Author: Danielle Vahlkamp, PharmD Candidate

Authors: Danielle Vahlkamp, PharmD Candidate, Southern Illinois University Edwardsville School of Pharmacy; Amanda Daniels, PharmD, BCPS, HSHS St. Elizabeth's Hospital; Chris Herndon, PharmD, FASHP, Southern Illinois University Edwardsville School of Pharmacy.

Organization: Southern Illinois University Edwardsville School of Pharmacy

Abstract

Purpose: To determine if intravenous (IV) nalbuphine could be a reasonable, alternative parenteral analgesic option to treat acute pain in a hospital when compared to first-line pain medications such as intravenous morphine during drug shortages.

Methods: This retrospective chart review occurred at HSHS St. Elizabeth’s Hospital in O’Fallon, IL between January 1, 2018 and June 30, 2018. Patients admitted to HSHS St. Elizabeth’s Hospital who received IV morphine or IV nalbuphine for the treatment of acute pain were included in analysis. The primary outcome was the average pain score during an individual hospital stay. Secondary outcomes consisted of required change in parenteral opioid during hospital stay, opioid presence at admission, change in dose from initiation, delayed discharge due to uncontrolled pain, opioid related adverse effect, and opioid prescription at discharge.

Results: A total of 138 participants were included in the study. Only 123 were included in the primary outcome after 15 were excluded for the utilization of multiple pain scoring systems. Neither the primary outcome nor any of the secondary outcomes were found to be statistically significant, which suggests that there is no difference in efficacy or safety of parenteral morphine and nalbuphine. Although there was not statistical difference between groups in required dose changes, there was a trend toward an increased frequency in the morphine group.

Conclusions: The data suggests that nalbuphine is as effective as morphine for acute pain management in an inpatient setting when parenteral analgesia is required, with no statistical difference in adverse drug reactions, required dose changes, or in adverse drug reactions. Having an option for treating acute pain that would provide equal pain relief as a long-time, first-line agent while having less frequent and severe side effects could be clinically significant. However, larger, more detailed studies are needed.

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On Site #42 – Student Research

Title: Dispense this, not that! Requirements for confident opioid dispensing

Submitting Author: Ashley Riley, PharmD Candidate

Authors: Ashley M. Riley, PharmD Candidate, Southern Illinois University Edwardsville; Katrina A. Trentham, PharmD Candidate, St. Louis College of Pharmacy; Nicole M. Gattas, PharmD, BCPS, FAPhA, Associate Professor of Pharmacy Practice, St. Louis College of Pharmacy; Amy M. Tiemeier, PharmD, BCPS, Director, Community Partnerships & Associate Director, Experiential Education & Associate Professor, Pharmacy Practice, St. Louis College of Pharmacy; Halvor T. Olsen, PharmD, Pharmacy Clinical Services Manager, Walmart Health and Wellness; Amy E. Bias, PharmD, Pharmacy Clinical Services Manager, Walmart Health and Wellness; Chris M. Herndon, PharmD, BCACP, Professor, Pharmacy Practice, Southern Illinois University Edwardsville School of Pharmacy.

Organization: Southern Illinois University Edwardsville School of Pharmacy

Abstract

Purpose: As opioid overdose deaths continue to rise across the United States, healthcare providers are taking action to recognize and combat this crisis. Pharmacists play a key role in opioid stewardship, with prescriber and pharmacist communication essential in satisfying corresponding responsibility. This survey aims to identify key information necessary for pharmacists to confidently and responsibly dispense prescribed opioid medications in accordance with laws, policies, and professional judgement. Once identified, key information could be formatted into a universal form or checklist for use by prescribers and pharmacists. A universal tool would improve interdisciplinary communication, reduce patient care delays, promote safe and effective use of opioids, as well as in overall improved patient outcomes. 2.

Methods: The Dispense this, not that! Requirements for confident opioid dispensing survey is a 16-item survey tool (Qualtrics, Provo, Utah, USA) that was distributed electronically to members of the Illinois Pharmacists Association (IPhA) and Missouri Pharmacy Association (MPA) in late 2018. Participation was voluntary and anonymous. The survey questions were designed to identify key information perceived as necessary for pharmacists to confidently dispense opioid prescriptions, as well as information regarding demographics, work setting, location, and general knowledge. The Institutional Review Boards of both Southern Illinois University Edwardsville and St. Louis College of Pharmacy approved the study.

Results: A total of 274 surveys were submitted from members of the Illinois Pharmacists Association and Missouri Pharmacy Association. The majority of pharmacists (greater than 50% of respondents) reported dispensing opioids without the following information: diagnosis, diagnosis code, prior pharmacologic and nonpharmacologic treatment attempted, patient reported pain severity, past medical history, and previous treatment trials with opioids. Information that was deemed not necessary for dispensing opioids by the majority of respondents was patient family history and patient imaging. The majority of respondents deemed the last fill date of any opioid for the patient and confirmation that the prescription drug monitoring database had been reviewed by the prescriber or prescriber’s agent as information that should be required documentation for all opioid prescriptions.

Conclusions: Our findings suggest that, ideally, pharmacists would require documented information from prescribers that is not currently mandated to be on opioid prescriptions. There needs to be improvements in prescriber and pharmacist communication regarding opioid prescriptions in order to satisfy corresponding responsibility, improve patient safety, and improve pain management.

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On Site #43 – Student Research – Winner Best Student Poster

Title: A Retrospective, Single Center Study Evaluating Readmission Rates and Medications for Patients with Heart Failure with Preserved Ejection Fraction

Submitting Author: Troy Kramer, PharmD Candidate

Authors: Troy Kramer, PharmD candidate; Carrie Vogler, PharmD, Southern Illinois University Edwardsville School of Pharmacy; Mukul Bhattarai, MD, Memorial Medical Center; Robert Robinson, MD, Memorial Medical Center.

Organization: Southern Illinois University Edwardsville

Abstract

Purpose: Heart failure with preserved ejection fraction (HFpEF) has significantly less guideline driven treatment options compared to hearth failure with reduced ejection fraction (HFrEF). This stems from a lack of trials demonstrating medications with improved clinical outcomes for this patient population. The primary objective of this study is to determine which medications and dosages are related to readmission rates for HFpEF patients.

Methods: A retrospective, single center, chart review was performed on patients with HFpEF at an academic medical center. The study was approved by the institution’s IRB. Heart failure patients between the ages of 18-89 with an ejection fraction ≥45% reported on an ECHO were included in the study. Demographic data was also collected. Primary outcomes include 30 day all cause readmission rates along with 30, 60, and 90 day heart failure related readmission rates. Other primary outcomes include prescribing patterns of heart failure medications at discharge and medications prescribed that could be potentially harmful medications in patients with heart failure. Secondary outcomes include patient safety by comparison of readmission rates. Descriptive statistics will be used to analyze the data.

Results: Presented at meeting

Conclusion: Presented at meeting

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On Site #44 – Student Research

Title: Acute pain management for patients with an opioid dependence disorder receiving Suboxone, naltrexone or methadone

Submitting Author: Erin Lindstrom, PharmD Candidate

Authors: Carrie N. Vogler, PharmD, BCPS, Clinical Associate Professor, Southern Illinois University Edwardsville School of Pharmacy; Katelyn Conklen, PharmD, BCPS, Clinical Pharmacist, Memorial Medical Center; Erin M Lindstrom, PharmD candidate.

Organization: Southern Illinois University Edwardsville School of Pharmacy

Abstract

Purpose: Opioid dependence disorders are treated with medications that alter the opioid receptor response to the offending agents. These actions are desirable for preventing opioid abuse but complicate the treatment for acute pain episodes. The purpose of this study it to determine how acute pain is being treated in this population.

Methods: A retrospective chart review at a non-profit academic medical center was conducted from 3/31/2015 to 3/31/2018 and approved by the institutional review board. Patients admitted to the hospital that are 18-89 years old experiencing acute pain and receiving Suboxone (buprenorphine/naloxone), naltrexone, or methadone for the indication of opioid dependence disorder will be included in this study. Patients on hospice will be excluded. Data will be collected regarding age, gender, reason for hospital admission, significant social history, significant medication history, significant past medical history, opioid dependence therapy, adjuvant therapy used, discharge medications, pain scores and the amount of daily oral morphine milligram equivalents (MME) received. The primary outcomes include type and amount of medication used for inpatient pain management. Safety outcomes include naloxone use, any respiratory rate less than 8 breaths per minute, and daily MME above 50 mg or 90 mg.

Results: Presented at meeting

Conclusion: Presented at meeting

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On Site #45 – Student Research

Title: Application of the Utah Bleeding Risk Score to LVAD Supported Patients at Advocate Christ Medical Center: A Retrospective Study (Updated title)

Submitting Author: Andrew McInerney, BS, PharmD Candidate

Authors: George Gavrilos, PharmD, MA, Advocate Christ Medical Center; Tatyana Lawrecki, PharmD, BCPS, Advocate Christ Medical Center; Krystina Chickerillo, FNP, ACNS-BC; Nora Krause, FNP, ACNS-BC; Tracy Aicher, FNP, ACNS-BC; Nicole Graney, ACNS-BC; Andrew McInerney, BS, PharmD Candidate, University of Illinois at Chicago College of Pharmacy; Marc McDowell, PharmD, BCPS, Advocate Christ Medical Center; Devin Mehta, MD, Advocate Christ Medical Center; Muhyaldeen Dia, MD, Advocate Christ Medical Center.

Organization: Advocate Christ Medical Center

Abstract

Purpose: Continuous-flow left ventricular assistant devices (CF-LVAD) have improved survival rates in advanced heart failure patients; however, gastrointestinal (GI) bleeding is commonly seen post-implant, resulting in further health complications, increased healthcare expenses, and increased mortality. Recently, researchers at the Utah Transplantation Affiliated Hospitals program developed the Utah Bleeding Risk Score (UBRS) to estimate bleeding risk in this patient population (Yin, et al.). Their study identified seven pre-implant variables most predictive for post-implant GI bleeding. The aim of this study is to evaluate CF-LVAD patients at Advocate Christ Medical Center (ACMC) who have experienced bleeding post-implant and apply the UBRS tool to this patient population.

Methods: CF-LVAD recipients (all devices) at ACMC between 2012 and 2017 who experienced post-implant GI bleeding were evaluated. The following variables were assessed, and patients were assigned one or two points for: age >54 years (1 point), history of previous bleeding (2 points), coronary artery disease (1 point), chronic kidney disease (1 point), severe right ventricular dysfunction (1 point), mean pulmonary artery pressure <18 mm Hg (2 points), and fasting glucose >107 mg/dL (1 point). The risk of each patient having a GI bleed post-implant was then applied using the UBRS, defined as: low (0–1 points), intermediate (2–4), and high risk (5–9). Corresponding 3-year GI bleeding rates found by Yin and colleagues were 4.8%, 39.8%, 83.8% in each risk group respectively.

130 of 562 (23.1%) patients implanted with a CF-LVAD from January 2012 – December 2017 experienced at least one episode of post-implant GI bleeding. Variables assessed are listed below:

Variable	Results N=130 (%)
Age >54	114 (87.7)
History of Previous Bleeding	20 (15.4)
Coronary Artery Disease	77 (59.2)
Chronic Kidney Disease	31 (23.8)
Severe Right Ventricular Dysfunction	3 (2.3)
Mean Pulmonary Artery Pressure <18 mmHg	7 (5.4)
Fasting Glucose > 107 mg/dL	85 (65.4)

Utah bleeding scores are listed below:

Risk Score	Results N=130 (%)
Low (0–1 Points)	14 (10.7)
Intermediate (2–4 Points)	99 (76.2)
High (5–9 Points)	17 (13.1)

The mean UBRS was 2.83.

Conclusions: Yin and colleagues found the UBRS to be a simple predictive model based on pre-implant clinical factors that can effectively risk stratify CF-LVAD patients based on their probability of GI bleed. In their study, they observed an intermediate risk of GI bleed in all CF-LVAD supported patients based on UBRS. In the subset of CF-LVAD supported patients at ACMC who experienced a post-implant GI bleed, the same intermediate risk probability was observed. Yin’s study found a three-year, 39.8% risk of GI bleed post-implant for intermediate risk patients, and while a direct correlation cannot be made between our two patient populations at this time, we observed a 23.1% overall incidence of post-implant GI bleeding in CF-LVAD supported patients over a five-year period, the majority (76.2%) of whom were found to be at intermediate risk. Prospective, multicenter validation studies should be conducted to further elucidate the accuracy and usefulness of this tool in clinical practice.

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On Site #46 – Student Research

Title: Rocuronium versus succinylcholine in the traumatically injured brain: A prospective observational cohort (RVSTIB)

Submitting Author: Ammarah Nadeem, PharmD Candidate

Authors: Ammarah Nadeem, PharmD Candidate, Advocate Christ Medical Center; Chuxian Tang, PharmD Candidate, Advocate Christ Medical Center; Samson Tang, PharmD Candidate, Advocate Christ Medical Center; Marc McDowell, PharmD, BCPS, Advocate Christ Medical Center; Sabrin Jaber, PharmD, Advocate Christ Medical Center.

Organization: Advocate Christ Medical Center

Abstract

Purpose: According to the Centers for Disease Control and Prevention, there were approximately 2.8 million traumatic brain injury (TBI)-related emergency department (ED) visits in 2013. Patients with a TBI require rapid sequence intubation (RSI) to prevent hypoxia and death. A recent retrospective study suggests that the use of succinylcholine in patients with severe TBI is associated with increased mortality. However, due to rocuronium’s longer duration of action compared to succinylcholine, this may obscure neurological examination or delay treatment for seizure potentially leading to worse outcomes. This study aims to evaluate the incidence of mortality in patients with a TBI after being administered succinylcholine or rocuronium. (104).

Methods: This is a prospective, single center observational study performed at a large tertiary community teaching hospital in patients greater than 18 years of age presenting with a traumatic brain injury (TBI) requiring rapid sequence intubation (RSI) in the emergency department (ED). Patients who received more than one paralytic or received a paralytic other than rocuronium or succinylcholine for the purpose of RSI, had a surgical airway placed, were< 18 years of age, pregnant, sustained an in-hospital or out-of-hospital cardiac arrest prior to intubation, or had an attempt to intubate outside the ED were excluded. The primary outcome of this study is incidence of mortality. The following data points will be collected: age, sex, race, height, weight, pre-intubation Glasgow Coma Score, baseline serum creatinine and potassium, type of traumatic head injury (defined as blunt or penetrating), mechanism of injury, additional injuries, number of intubation attempts, pre-intubation vitals (oxygen saturation, systolic and diastolic blood pressure, and heart rate), sedative induction agent and dose used for RSI, paralytic agent and dose used for RSI, incidence of mortality, total length of stay (LOS), intensive care unit LOS, type of intracranial injury (defined as: subarachnoid hemorrhage, subdural hematoma, epidural hemorrhage, or intraventricular hemorrhage), presence of mid-line shift, mass effect, or skull fracture, and history of anticoagulant or antiplatelet use. Data will be collected without patient identifiers and analyzed using descriptive statistics. (226).

Results: Out of ten total patients, six were administered succinylcholine and four were administered rocuronium. The incidence of in-hospital mortality was similar in both groups (33% vs 54%, p=0.54). Succinylcholine was associated with a non-significant increase in hospital (6.5 vs 1.8, p=0.10) and ICU LOS (14.8 vs 4.8, p=0.17). (48).

Conclusion: In TBI patients, there is no difference between rocuronium and succinylcholine in the incidence of in-hospital mortality when used for RSI. There was also no difference between groups in ICU or hospital LOS. Larger studies are required in order to meet power and determine significance. (45).

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On Site #47 – Student Research

Title: Diluted single-syringe administration of adenosine for the rapid conversion of supraventricular tachycardia in the Emergency Department

Submitting Author: Alexandria Nudo, PharmD Candidate

Authors: Alexandria Nudo, PharmD Candidate, Advocate Christ Medical Center; Kevin Johns, PharmD Candidate, Advocate Christ Medical Center; Sonal Sahni, PharmD Candidate, Advocate Christ Medical Center; Robert Mokszyck, PharmD, BCPS, Advocate Christ Medical Center; Neal Lyons, PharmD, BCPS, Advocate Christ Medical Center; Allyson Greenberg, PharmD, BCPS, Advocate Christ Medical Center; Mary Hormese, PharmD, BCPS, Advocate Christ Medical Center; Marc McDowell PharmD, BCPS, Advocate Christ Medical Center.

Organization: Advocate Christ Medical Center

Abstract

Purpose: Supraventricular tachycardias (SVT) are a common cause for emergency department visits. Adenosine is an effective treatment to abate SVT, however differing methods exist for administration. No studies have prospectively evaluated differing methods of administration in a large number of patients. To evaluate the efficacy of adenosine in a single-syringe diluted with normal saline compared to the standard two-syringe method for rapid conversion of SVT to normal sinus rhythm.

Methods: A single center, prospective, observational study was conducted from November 1, 2016 through February 28, 2018 on patients presenting to the emergency department in SVT treated with adenosine. Drug was prepared by the pharmacist and method of administration was at the preference of the physician. Adenosine was either prepared as a single-syringe combined with a 0.9% NaCl flush to a total of 20ml or as the conventional two separate syringes. Rates of conversion from SVT to normal sinus rhythm were recorded.

Results: Presented at meeting

Conclusions: Presented at meeting

College Connection

Chicago State University College of Pharmacy
My First Experience in a Hospital Pharmacy

College Connection

by Makek Hassan - P2, SSHP Member

This past semester I completed an institutional Introductory Pharmacy Practice Experience (IPPE) at Jackson Park Hospital and Medical Center, located on the southside of Chicago. This was my first experience with a hospital pharmacy; the majority of my pharmacy experience comes from the community setting. I was truly pleased and I learned a great deal from this new experience.

Initially, I was a bit apprehensive because this environment was new for me. I was oriented to the site and my preceptor provided an overview of general institutional pharmacy practice, workflow within the pharmacy, and inventory. Then, I was afforded the opportunity to engage in clinical aspects of pharmacy practice. I was able to interact with patients, nurses, physicians, medical students, and other healthcare professionals. These interprofessional interactions seemed different compared to those in the community setting. They appeared to be more “personal” in the sense that you can tell that many of the pharmacists have interacted with the same physicians, nurses, respiratory therapists, etc. for a long time. I was able to attend various meetings along with my preceptor such as P&T, patient safety, and other hospital initiatives such as antibiotic stewardship. I learned new skills such as conducting drug utilization reviews. I interviewed patients and discussed treatment and transition plans with physicians. I saw the importance of discharge medication counseling for patients. These interactions provided me with a sense of importance for the pharmacy profession and I saw the critical impact of the pharmacist in the institutional setting.

Overall, I was grateful for the opportunity to be placed at this particular hospital with so many opportunities for engagement and to learn from others. This IPPE allowed me to explore clinical pharmacy as an option in the future. It is never too early to begin planning ahead and institutional pharmacy is definitely a possibility for me. ■

Midwestern University Chicago Collge of Pharmacy
Guidance for APPE Rotations From a Current 4th Year Pharmacy Student

College Connection

by Dean J. Brock, ICHP member

The most difficult transition of my life occurred when I finished the didactic portion of pharmacy school and began my Advanced Pharmacy Practice Experiences (APPEs). The reason why the transition was so burdensome, was that I originally believed that each APPE would simply consist of a Monday through Friday, 9 a.m. to 5 p.m. rotation, in which I would learn what clinical information was truly important for me to be a knowledgeable and efficient pharmacist. I was wrong.

The truth of the matter is that each APPE rotation will have a different schedule and student expectations. The best way to be successful during each APPE rotation is to be inquisitive, proactive, and professional. Each APPE rotation will have one primary preceptor that will be responsible for the student’s midpoint and final evaluations. The student may interact with other preceptors throughout the rotation. Inquiring about the daily student expectations of each individual preceptor is critical for success. Asking the preceptor in advance for a template or outline for a topic discussion, in-service, journal club, or patient case presentation will ensure both the preceptor and student are on the same page for that particular assignment.

As the student progresses through each of his or her APPE rotations the preceptor’s expectations increase, sometimes exponentially. The best strategy the student can have to meet and exceed the preceptor’s expectations is to be proactive and optimize time management. There will always an APPE assignment that is due or NAPLEX studying that needs to be completed so the student should mentally prepare to be productive for the duration of each day of his or her APPE rotation.

Perhaps, one of the most used words during the first three years of pharmacy school was “professionalism.” It seemed like the advice that was given about being professional while on rotations was simply common-sense guidance. However, while on each of my rotations I realized that it was not always followed or implemented by students. It seemed that on a daily basis, students would be late, dressed unprofessionally, or using their phones for non-rotation related activities. While the preceptor may not directly call the student out on their unprofessional behavior, the preceptors are always watching and this behavior can negatively impact the student’s evaluations. Being professional is one aspect of the APPE rotation that is 100% under the student’s control; don’t squander this opportunity to make a great first impression of yourself and your school.

In order for a student to be successful on each APPE rotation, he or she must be inquisitive, proactive, and professional. Some APPE rotations will be significantly more strenuous than others, but if the student is able to strategize and adapt quickly to the expectations of each individual preceptor, he or she is more likely to be successful. Keeping in mind the sacrifices that were made to get through the didactic portion of pharmacy school, as well as the rewards for those sacrifices after finishing pharmacy school, the motivation to flourish at each APPE rotation should be colossal. ■

Roosevelt University College of Pharmacy
Springing into Something New!

College Connection

by Kristina Khaireddine PS3, SSHP President

The SSHP chapter at Roosevelt College of Pharmacy has been quite busy these past few months with planning and executing many events, journal clubs, and fundraisers! As an E-Board, we have worked hard to bring some exciting new changes to our College of Pharmacy while still maintaining our traditional events.

Although various schools stress the importance of obtaining a residency, many lack the tools to adequately prepare students to do so. Our SSHP chapter at RUCOP recognized this weakness and decided to act on it. Together with the help of Student Services and clinical faculty we were able to implement the first annual Residency Week. Each day of the week focused on reviewing different types of residencies, learning to navigate PHORCAS, or specific workshops to help strengthen a student's portfolio. This week long event had a good turnout and we plan to continue to host this event going forward.

As for fundraisers, we purchased a customized thermos with our school logo and sold them to our student body and faculty during our winter term. They were an absolute hit and sold out pretty quickly. We are currently planning on selling lab value medical badge cards along with a patient work-up book for our spring term. We are sure these will be a hit considering our class is preparing to head out to APPE rotations in a short few months.

Currently, we are working with Student Services and clinical faculty to run a week long event called an “APPE Boot Camp”. This event will also be a first for our chapter. It is designed to help prepare our fellow P3 students be successful on APPE rotations. We plan to have each day during the week designated to strengthen different skills such as topic discussions, concentrated SOAP notes, how to properly work-up and present patients, as well as present journal clubs. We are very excited to get the ball rolling on this event and bring new changes to our campus!

We are also preparing for our annual Residency Round Table. We have reached out to several area hospitals to invite current pharmacy residents to RUCOP to answer questions regarding their path to residency. Our last Residency Round Table event was extremely successful and we are hoping this one will be the same. ■

Rosalind Franklin University College of Pharmacy
Wellness Week at Rosalind Franklin University of Medicine and Science

College Connection

by Shayda Ashraf, PharmD Candidate 2020, Illinois Council of Health System Pharmacists - Historian

Mental health is important to all healthcare professionals and it is imperative to know what can be done in order to ensure mental health “self-care”, as well as the health and safety of patients. As pharmacy students, the pressure of practicals, exams, and presentations weigh heavily on us and the little reminders about the importance of self-care can be extremely beneficial.

As the end of the academic year approaches, finals week is a daunting obstacle for most students. Finals week can be overwhelming for all students and the need for “self-care” is very important during the closing stretch of the quarter. Each year, RFUMS hosts a week of events to help reduce the stress of worried students that roam the halls. This series of events is known as “Wellness Week.” Wellness Week is packed with activities for students to remind them of the importance of self-care. Wellness Week is held the week before finals during the winter quarter, and each day consists of at least five events. Students are able to sign up for days they plan to attend for some specialized events; for others, they are open to anyone and everyone who has a few free minutes to attend. To make it easily accessible, the events during Wellness Week are free for all RFUMS students.

Various free workout classes such as yoga, circuit training, and TRX were offered to help maintain health and reduce stress during exam preparation. The breakfast-for-dinner buffet has been an event the school holds for its students each year. This is an event we all look forward to and appreciate the faculty members and cafe employees who help bring the event together for us. Other events included cooking demonstrations, pottery workshops, painting classes, chair massages, and therapy dogs.

After a week of relaxation and constant reminders to put yourself first in the upcoming week, students feel more at ease when entering finals week. You could see an instant change in the students’ attitude and demeanor; students were certainly refreshed and ready to get through finals week and move on to what the next quarter has to offer. We could not have done it without the help of the staff here at RFUMS, who are always ensuring the students are supported holistically and set up for success in whatever they want to do in the future. ■

Southern Illinois University Edwardsville School of Pharmacy
My Jamaica Mission: A Life Changing Experience

College Connection

by Paris Smith, P3, Vice President Southern Illinois University Eadwardsville (SIUE) - School of Pharmacy

One aspect that drew me to attend the Southern Illinois University Edwardsville (SIUE) School of Pharmacy was the opportunity to volunteer outside of the United States. I have always wanted to serve others who are not as fortunate to have adequate, accessible health care. My dream came true when I was selected to participate in the 2018 Jamaica Dental Mission Trip. The weeklong trip in late July consisted of four days in clinic followed by three days of vacation in Montego Bay, Jamaica.

Our crew consisted of SIUE and ATSU School of Dental Medicine students, dentists, and Aspen Dental Group dentists. The inclusion of pharmacy students in the clinic helped provide well-rounded health care and screenings. The fearless leader of our group, Dr. McCloud, was a dentist who grew up in Montego Bay and has been organizing this trip for ten years.

We split our time to cover two separate clinics over the four days. One clinic was in an area called Flankers and the other was at a school in Kew Park. The dentists, pharmacists, and students spent two days at both clinics to be able to experience each setting. Kew Park was bigger than Flankers, and we had more room to treat patients and perform procedures. The clinics consist of full 12-hour days; the pharmacy students helped to triage patients by taking their blood pressure, performing medication reconciliation, obtaining past medical histories, and documenting allergies. Our services helped to ensure that patients can tolerate the dental procedures without issues such as allergic reactions to the antibiotics. I loved this aspect because I could practice taking blood pressures and interviewing patients in a loud, chaotic environment.

At the end of the procedures, the patients were prescribed antibiotics and a generic, over-the-counter analgesic for pain. We counseled the patients on how to take their new medications and what to avoid if they had a tooth extraction. Every patient left the clinic with a new toothbrush, toothpaste, and floss. Most importantly, every child treated went home with a toy; this tugged at my heart and made me emotional. The toys were in the original box, and some of the kids told us they never had a brand-new toy before. The gratitude I felt seeing the smiles on their faces was unexplainable. Such a small act of kindness left an immense impact on the children during our trip.

On the last day of clinic at Kew Park, the dental and pharmacy students gave a presentation to the patients who were waiting to be seen. We presented on proper brushing and flossing technique and hypertension, diabetes, and nutrition, respectively. The pharmacy students also mentioned the importance of medication adherence, exercise, diet, and smoking cessation. Over the course of four days, we treated 695 patients with prophylaxis, fillings, extractions, and denture placement.

One of the best parts of the experience was interacting with the dentists. I remember one scenario where they were prescribing ibuprofen to a patient with hypertension. I stepped in to recommend acetaminophen instead, explained my rationale, and together we were able to treat the patient properly. I was proud to advocate for my patient and use my medication knowledge. More than that, collaborating with another healthcare provider who accepted my recommendation was a great feeling.

This trip may have mentally and physically exhausted me, but nonetheless, it was a fulfilling and humbling experience in which to have participated. The patients were immensely grateful. The majority of our patients only see a dentist annually during this mission trip. I remember seeing patients walk miles from their houses to the clinic so their children could be seen by a provider. This reminded me to never take anything for granted; we are fortunate to live in a country where we have access to healthcare. Not only did this mission trip make me a better person, I will also be a better pharmacist. I will strive to provide optimal care to every patient whether through medications, screenings, or a yearly physical. If the people of Montego Bay can walk miles to a dental clinic, we can certainly make an appointment with our primary care physician and talk to our local pharmacists to make sure that we are living healthy lives. ■

University of Illinois at Chicago College of Pharmacy
Students Advocating for the Profession of Pharmacy

College Connection

by Shannon Menard, P3

The Practice Advancement Initiative (PAI), the initiative started by the American Society of Health-Systems Pharmacists (ASHP) that empowers pharmacists and pharmacy students to advocate for our profession and advance the practice of pharmacy to provide the best care for our patients. PAI Week is a specific week designated by ASHP and ICHP for student chapters to promote this initiative. This year, the University of Illinois at Chicago (UIC) College of Pharmacy (COP) chapter developed a few different events to participate in PAI Week.

The week started with speakers Dr. Henri Manasse and ICHP Executive Vice President Scott Meyers at a general body meeting (GBM) on Monday, February 25th. Dr. Manasse focused on how pharmacy is changing and the importance of advocating for our profession. Scott Meyers followed with a discussion about Legislative Day. Students were able to gain an insight on what to expect if they chose to attend Legislative Day and also learned about current bills that are being reviewed in Springfield. Prior to the GBM, I was not familiar with what bills were being reviewed that impacted pharmacy practice. I felt informed and prepared to discuss these bills with legislators when I attended Legislative Day 2019 a few weeks after the GBM.

The rest of the week, we set up a booth in the COP lobby to continue the conversation about PAI and promote registration for Legislative Day. Students were invited to fill out a questionnaire asking what provider status for pharmacists would mean to them. This sparked a conversation among the students about how they could advance practice while in pharmacy school as well as when they graduate. Most students discussed how the impact of provider status would impact pharmacy and patient outcomes while others brought up potential issues/obstacles that may be encountered. This lead to a healthy debate on how provider status could be implemented in the state. Our contribution to advocacy also consisted of computer booths to recruit and register students to participate in Legislative Day 2019.

We finished our week of festivities by hosting a trivia booth where we quizzed students on what they learned during PAI Week. All winners were entered into a raffle to win reimbursement for the cost of Legislative Day registration. By the deadline to register for Legislative Day, UIC COP was able to recruit 56 students to attend Legislative Day 2019.

Legislative Day 2019 took place on Wednesday, March 13th. UIC pharmacy students joined other students and pharmacists from all over Illinois to advocate for our profession directly to senators and house representatives. The highlight of the day was attending the rally inside the Capital where we lobbied for House Bill 465 and Senate Bill 652 which promotes Pharmacy Benefit Manager regulation by increasing transparency and removing the gag clause imposed on pharmacies. The rally hyped up the crowd and motivated us to find our legislators in search of sponsorship of the bill. This opportunity provided a hands on experience on how to advocate for the profession of pharmacy and a glimpse of what it takes to make lasting changes in legislation. I hope that students left this experience feeling as though they contributed to pharmacy advocacy and that they continue to advocate for our profession as they progress through school and their careers as pharmacists. ■

Board of Directors

Noelle Chapman President 773-502-0928 E-mail Noelle	Travis Hunerdosse Immediate Past President, Committee Chair, Nominations Committee 312-926-6124 E-mail Travis	Carrie Vogler President-Elect 217-545-5394 E-mail Carrie
Kathryn Schultz Treasurer 312-926-6961 E-mail Kathryn	Ed Rainville Secretary 309-655-7331 E-mail Ed	Scott Meyers Executive Vice President ICHP Office 815-227-9292 E-mail Scott
Amy Boblitt Regional Director Central 217-788-3015 E-mail Amy	Elise Wozniak Regional Director Northern E-mail Elise	Lynn Fromm Regional Director Southern 618-391-5539 E-mail Lynn
Mary Lee Organizational Affairs Director 630-515-7311 E-mail Mary	Karin Terry Professional Affairs Director 309-655-3390 E-mail Karin	David Martin Educational Affairs Director E-mail David
Bernice Man Marketing Affairs Director 312-694-2878 E-mail Bernice	Christopher Crank Government Affairs Director 630-978-4853 E-mail Chris	Kristine VanKuiKen Technician Representative 312-355-2035 E-mail Kristine
Bryan McCarthy Chairman, New Practitioners Network 773-702-1030 E-mail Bryan	Brian Cryder Ambulatory Care Network Chair 630-515-7656 E-mail Brian	David Tjhio Chairman, Committee on Technology 816-885-4649 E-mail David
Jennifer Phillips Editor & Chairman - KeePosted 630-515-7167 E-mail Jennifer	Milena McLaughlin Assistant Editor - KeePosted 630-515-7293 E-mail Milena	Sandra Durley 340B Network Chair (312) 996-4940 Email Sandra

Tara Vickery Gorden

Small and Rural Hospital Network Chair
(618) 643-2361 ext 2335
Email Tara

Student Chapter Presidents

Erin Hermes Chicago State University College of Pharmacy E-mail Erin	Shivek Kashyap Midwestern University Chicago College of Pharmacy E-Mail Shivek	Kristina Khaireddine Roosevelt University College of Pharmacy E-mail Kristina
Brit Der Rosalind Franklin University College of Pharmacy E-mail Brit	James Reimer Southern Illinois University Edwardsville School of Pharmacy E-mail James	Henry Okoroike University of Illinois at Chicago College of Pharmacy E-mail Henry
Hannah Dalogdog University of Illinois at Chicago College of Pharmacy Rockford Campus E-mail Hannah

Northern Illinois Society of Health-System Pharmacists (NISHP)

Denise Kolanczyk President E-mail Denise	Milena McLaughlin President-elect E-mail Milena	Erika Hellenbart Immediate Past President E-mail Erika
David Martin Treasurer E-mail David	Andrew Merker Secretary E-mail Andrew	Richard Puccetti Technician Representative E-mail Richard

West Central Society of Health-System Pharmacists (WCSHP)

Ed Rainville

President

E-mail Ed

Metro East Society of Health-System Pharmacists (MESHP)

Jared Sheley

President

E-mail Jared

Sangamiss Society of Health-System Pharmacists

Billee Samples

President

E-mail Billee

Megan Stoller

President-elect

E-mail Megan

Julie Downen

Immediate Past President

E-mail Julie

Vacant Roles at Affiliates

President - Rock Valley Society

President - Southern IL Society

President - Sugar Creek Society

ICHP Pharmacy Action Fund (PAC)
As of 4.1.19

Pharmacy Action Fund
(As of 4.1.19)

Welcome New Members!

Welcome new members!

Joined in January
Aneesh Asokan
Omar Cano
Craig Carrell
Kathi Carrico
Estrella Cervantes
Alicia Davis
Jim Hernandez
Brionna Hudson
Faaieza Khan - Recruited by Erin Hermes
Troy Kramer
Daniella Mazzaro
Michele Monzon-Kenneke
Reem Motan
Savan Patel - Recruited by Faaieza Khan
Sonalie Patel
Timothy Sassack
Dragana Tanasic
Luz Vargas
Kyle Vost
Traci Williams - Recruited by Bryan McCarthy

Joined in February

Chantale Abuh Fonji
Gadallah Alawi
Ellen Bennett - Recruited by Richard Puccetti
Refaela Beqi
Kristen Brady
Alexus Brown
Justin Coleman
Beza Daniel
Keah Demmer
Samija Drndar
Marianne Equiban
Shams Fadhil
Eva Galka
Roberto Garcia
Mary Gawron
Amanda Gertz
Danerra Grahn
Keosha Hawkins
Leslie Johnson
Ryan Kelly
Celia Lee
Danielle Lee
Nikola Markoski
Kimberly McCarter
Chul Min
Wasim Mohammad
Makenna Mongan
Michelle Mongan
Jimmy Nguyen
Kyrah Offett
Osayawemwen Osakue
Amanda Page - Recruited by Milena McLaughlin
Ronak Patel - Recruited by Alex Tandyk
Shivani Patel
Heather Powell
Tonya Reid
Adnan Restum
Humna Shaikh
Mohammad Skahkwar
Hasmik Sotelo
Amber Tiffany
Julianne Vanderhoogt-Davis - Recruited by Desi Kotis
Stephane Wabo
Amanda Whistler
Bethany Wond
Megellan Yadao

Joined in March
Dean Brock
Eva Delt
Lori Garrett
Joel Hernandez
Yasmin Malki
Lauren Miskell
John Parise - Recruited by Scott Drabant
Jessica Seadler - Recruited by Beth Cady
Sarah Surmeier

Upcoming Events

WCSHP CPE Event

May 9, 2019
Topic: Going down the tubes: drug administration via enteral feeding tubes
(Presentation will be accredited for health-system pharmacists and pharmacy technicians)

NISHP Double Feature
May 14, 2019 at 6:00 pm
Blackbird - Chicago, IL
Presentation 1: The Evolution of Quality in the 503B Industry
(Presentation 1 is not available for CPE - sponsored by SCA Pharma)
Presentation 2: 2019 Pharmacy Practice Pearls
(Presentation will be accredited for health-system pharmacists)

Sangamiss CPE event
May 14, 2019
Topic: The Pharmacists' Patient Care Process (PPCP) and Entrustable Professional Activities (EPAs)
(Presentation will be accredited for health-system pharmacists)

Champions webinar
May 23, 2019 at noon
Topic: MERINO trial: Effect of Piperacillin/tazobactam vs Meropenem on 30-day Mortality in Patients with E. Coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance
See your practice site Champion to participate!

2019 ICHP Annual Meeting
September 12-14, 2019
Drury Lane Conference Center - Oakbrook Terrace, IL

2019 Leadership Retreat
November 15-16, 2019
I Hotel and Conference Center - Champaign, IL
By invitation only

2020 ICHP Spring Meeting
March 27-28, 2020
Embassy Suites Conference Center - East Peoria, IL

Collaborative Pharmacy Task Force
◆May 14, 2019 ◆June 11, 2019
◆July 9, 2019 ◆August 13, 2019

Print Entire Issue

November 2021

Directly Speaking Don't Just Network, Make Friends

President's Message Spring Has Sprung

Columns

March Board of Pharmacy Update Highlights of the March 2019 Meeting

Collaborative Pharmaceutical Task Force Deliberations (March 2019) We're Getting Closer But No Votes Yet

Collaborative Pharmaceutical Task Force Deliberations (April 2019) Still Closer to Voting, but Different Opinions Appear

Government Affairs Report Legislative Day, New Lobbyists and Lots of New Bills

ICHP Leadership Spotlight Interview - Alifiya F. Hyderi, PharmD Leadership Profile

ICHP Leadership Spotlight Interview - Jared Sheley, PharmD Leadership Profile

New Practitioners Network Mentors Matter: Finding the Match to Make the Right Move

Professional Affairs What are Position Statements and why does ICHP have them?

Professional Affairs Call for Best Practice Award

Educational Affairs Implementing Anticoagulation Dosing Guidance and Drug-Drug Interaction Procedures

Features

Looking For Some Leaders How would you like to run for an ICHP Office?

Legislative Day Highlights Under the Dome #13 is Under our Belts

Student Chapter Video Contest 2019

Champions Subcommittee Be a Champion!

ICHP/MSHP Spring Meeting Poster Session Abstracts

Spring Meeting Platform Presentations Platform Presentation Abstracts

Spring Meeting Poster Abstracts Original Poster Abstracts

Spring Meeting Poster Abstracts Encore Poster Presentations

Spring Meeting Poster Abstracts Student Research Poster Abstracts

College Connection

Chicago State University College of Pharmacy My First Experience in a Hospital Pharmacy

Midwestern University Chicago Collge of Pharmacy Guidance for APPE Rotations From a Current 4th Year Pharmacy Student

Roosevelt University College of Pharmacy Springing into Something New!

Rosalind Franklin University College of Pharmacy Wellness Week at Rosalind Franklin University of Medicine and Science

Southern Illinois University Edwardsville School of Pharmacy My Jamaica Mission: A Life Changing Experience

University of Illinois at Chicago College of Pharmacy Students Advocating for the Profession of Pharmacy

More

Board of Directors

ICHP Pharmacy Action Fund (PAC) As of 4.1.19

Welcome New Members!

Upcoming Events

Directly Speaking
Don't Just Network, Make Friends

President's Message
Spring Has Sprung

March Board of Pharmacy Update
Highlights of the March 2019 Meeting

Collaborative Pharmaceutical Task Force Deliberations (March 2019)
We're Getting Closer But No Votes Yet

Collaborative Pharmaceutical Task Force Deliberations (April 2019)
Still Closer to Voting, but Different Opinions Appear

Government Affairs Report
Legislative Day, New Lobbyists and Lots of New Bills

ICHP Leadership Spotlight Interview - Alifiya F. Hyderi, PharmD
Leadership Profile

ICHP Leadership Spotlight Interview - Jared Sheley, PharmD
Leadership Profile

New Practitioners Network
Mentors Matter: Finding the Match to Make the Right Move

Professional Affairs
What are Position Statements and why does ICHP have them?

Professional Affairs
Call for Best Practice Award

Educational Affairs
Implementing Anticoagulation Dosing Guidance and Drug-Drug Interaction Procedures

Looking For Some Leaders
How would you like to run for an ICHP Office?

Legislative Day Highlights
Under the Dome #13 is Under our Belts

Champions Subcommittee
Be a Champion!

ICHP/MSHP Spring Meeting
Poster Session Abstracts

Spring Meeting Platform Presentations
Platform Presentation Abstracts

Spring Meeting Poster Abstracts
Original Poster Abstracts

Spring Meeting Poster Abstracts
Encore Poster Presentations

Spring Meeting Poster Abstracts
Student Research Poster Abstracts

Chicago State University College of Pharmacy
My First Experience in a Hospital Pharmacy

Midwestern University Chicago Collge of Pharmacy
Guidance for APPE Rotations From a Current 4th Year Pharmacy Student

Roosevelt University College of Pharmacy
Springing into Something New!

Rosalind Franklin University College of Pharmacy
Wellness Week at Rosalind Franklin University of Medicine and Science

Southern Illinois University Edwardsville School of Pharmacy
My Jamaica Mission: A Life Changing Experience

University of Illinois at Chicago College of Pharmacy
Students Advocating for the Profession of Pharmacy

ICHP Pharmacy Action Fund (PAC)
As of 4.1.19