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Jim Owen

ICHP Mission Statement
Advancing Excellence in Pharmacy

ICHP Vision Statement
ICHP dedicates itself to achieving a vision of pharmacy practice where:

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

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

KeePosted is an official publication of, and is copyrighted by, the Illinois Council of Health-System Pharmacists (ICHP). KeePosted is published 10 times a year. ICHP members received KeePosted as a member benefit. All articles published herein represent the opinions of the authors and do not reflect the policy of the ICHP or the authors’ institutions unless specified. Advertising inquiries can be directed to ICHP office at the address listed above. Image disclaimer: The image used in the Pharmacy Tech Topics™ advertisement is the property of © 2017 Thinkstock, a division of Getty Images. 

Copyright © 2017, Illinois Council of Health-System Pharmacists. All rights reserved.

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Ambulatory Care Network
Help Us Help You (to Advance Pharmacy Practice)

Feature Article

by Brian T. Cryder, PharmD BCACP CACP, Associate Professor of Pharmacy Practice; Reggie Greenwood, Midwestern University Chicago College of Pharmacy Candidate Class of 2019, Phi Delta Chi - Beta Xi, Professionalism Committee Chair

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Call for Entries: 2017 Best Practice Award

Feature Article

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

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

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

Applicants must be ICHP members for a minimum of 90 days prior to submission. If you have any questions related to the program please contact Trish Wegner at trishw@ichpnet.org.

Previous Winners

2016

Maya Beganovic, PharmD and Sarah M. Wieczorkiewicz, PharmD, BCPS

"MALDI-TOF alone versus MALDI-TOF combined with real-time antimicrobial stewardship interventions on time to optimal therapy in patients with positive blood cultures"

2015

Kuntal Patel, Pharm.D., Pavel Prusakov, and Heather Vaule

“Osteopenia of Prematurity (aka Better Bones for Babies)”

2014

Arti Phatak, Pharm.D.; Brooke Ward, Pharm.D., BCPS; Rachael Prusi, Pharm.D.; Elizabeth Vetter, Pharm.D.; Michael Postelnick, BS Pharm, BCPS (AQ Infectious Diseases); and Noelle Chapman, Pharm.D., BCPS

“Impact of Pharmacist Involvement in the Transitional Care of High-Risk Patients through Medication Reconciliation, Medication Education, and Post-Discharge Callbacks”

2013

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

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

Online entry form: Click (here) or paste the link below in your browser.
http://ichpnet.org/pharmacy_practice/professional_practice/best_practices/application_form/ 

Submission deadline: July 1, 2017

Eligibility

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

Instructions for preparing manuscript

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

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

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

Format

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

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

• The program will be featured at the ICHP Annual Meeting. You will need to prepare a poster to present your program and/or give a verbal presentation. Guidelines will be sent to the winner.
• You will be asked to electronically submit your manuscript to the ICHP KeePosted for publishing. This program will be accredited for CPE and will require that you complete material for ACPE accreditation.
• You will receive a complimentary registration to the ICHP Annual Meeting, recognition at the meeting and a monetary award distributed to your institution.
• Non-winning submissions may also be considered for publication in the ICHP KeePosted, but your permission will be obtained beforehand.

Thank you to PharMEDium for providing a grant for the 2017 Best Practice Award!

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President's Message
Which Came First: Innovation or Collaboration? Part 2 of 2

by Charlene Hope, PharmD, MS, BCPS, ICHP President

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Directly Speaking
What Keeps You Up at Night?

by Scott A. Meyers, Executive Vice President

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I suspect, from personal experience, that anyone’s answer if that question is asked will depend on which time of year it is, which night of the week it is or even how old you are.  I assume it happens to many if not all of you but the frequency and duration probably vary based on age and level of responsibility at home and at work.

So what keeps you, our members up at night, and is there something we can do to help you deal with it?  If the answer is money, probably not.  Although our dues are very reasonable and lag far behind many other pharmacy and health care professional organizations in Illinois and across the nation. And our meetings are a bargain!  If you’ve attended a recent Midyear or APhA Annual Meeting, you know exactly what I mean.  I personally, am contemplating attending an association executive meeting in August, and the registration fee for that is $899!

If what keeps you up at night is pharmacy practice related, we can help.  In addition to the cutting-edge education that our Educational Affairs Division provides through the Champion webinars and CPRN (Clinical Practice and Research Network) programs and what the Meeting Planning Committees produce for the Spring and Annual Meetings, ICHP provides a variety of opportunities to network with your peers at meetings and online.

If it’s not money or practice related problems, what about the expansion of practice or practicing at the top of your license?  ICHP’s Division of Government Affairs works year-in and year-out to guide legislation and regulation that will create a scope of pharmacy practice that matches where today’s education is aiming.  Unfortunately, it doesn’t mean we’re there yet, but every day that group is pushing closer and closer to where we need to be.

Drug pricing has been keeping me from getting my rest lately.  As I see new products that come to market with costs of more than a year’s salary for any pharmacist, let alone someone near the poverty level, I question when and where it will all end?  It looks like it could be soon as Congress and the General Assembly begin taking up drug pricing legislation as a result of these outrageous prices!

I also lose sleep over the way health care and pharmacy specifically are paid!  PBM’s seem to have lost their cost-savings focus and crossed over to the dark-side, snagging profits and savings for themselves with much of it coming from the backs of their pharmacist colleagues in the community practice settings!  Initially, PBM’s did a great job of saving employers money on the medication side of the insurance equation.  But now as they cut themselves in for more and more of the rebates they collect while slicing dispensing fees and medication cost reimbursements down to nearly nothing, the pharmacists who run these PBM’s have forgotten what value a pharmacist could bring if they would only pay them for their MTM services!

Most importantly to me is the cost of health care!  Whether the Republicans in Congress are successful in repealing and replacing the Affordable Care Act doesn’t keep me up at night.  Hoping that all of Congress realizes, soon enough, that the entire system is broken and needs more than a simple plan switch, does!  Health care is a benefit every human should receive, at least at a basic level.  And our nation should be able to provide a basic system that provides care as well as any in the world.

But every human needs to respect and value that benefit by doing everything in their power to help their own outcomes.  This means eating well balanced healthy meals, exercising, adhering to medication and other therapies, not smoking, and avoiding other risky behaviors.  It also means using the system correctly.  Finding a primary care physician or other provider and not using the emergency rooms for non-emergencies.  Unfortunately, I’m not sure what you do with those who continue to disrespect and misuse the system?  But wouldn’t it be nice if that was our biggest health care problem?

It also means we will all have to pay for it – which many individuals will protest.  I’m sure we’ll hear, “Why do I have to pay for someone’s pregnancy when I’m a 60-year old guy?”  But this 60+ year old guy understands why that’s necessary.  Or we’ll hear from the younger generation, “I’m healthy, why do I need to pay for some old guy’s health care?”  If they’re lucky and live right, they will become that old guy or gal!  So none of that will keep me up at night.  Perhaps it’s time to admit that everyone will need to pay for health care for everyone.  Just like we pay for retirement for everyone.  One less thing to keep us up.

There are plenty of problems to keep every American up at night, but I’m not sure it’s happening enough.  If it were, we would probably be closer to a reasonable solution.  If that ever happens with health care, we can shift gears and spend our sleeplessness worrying about global warming, running out of fossil fuels  or the day that giant asteroid eventually changes life on earth as we know it!  I’m sorry if I have given you more to keep you up at night, but maybe if we all spent a few more sleepless minutes thinking about it, somebody will actually do something positive about it!

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ICHPeople

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This is Cora Elizabeth Wozniak. She was born on 3/2/17 at 7 pounds, 3 ounces and 21 inches long. 
____________________________________________________

Two ICHP Past Presidents receive ASHP Honors! Two more ICHP members become Fellows of ASHP!

Max L. (Mick) Hunt, R.Ph., M.S., M.B.A., FASHP, Associate Professor Emeritus, College of Pharmacy, Northeast Ohio Medical University, Rootstown, Ohio and ICHP Past President (1979-1980) has been named this year’s recipient of ASHP’s Harvey A. K. Whitney Award, ASHP’s highest honor.

Mr. Hunt is a pharmacy leader with a long career in pharmacy administration and education who is noted for his role in the adoption of key advancements in pharmacy practice, commitment to developing future generations of pharmacy leaders, and active service to the profession.  Mick will receive his award and make his Whitney Lecture Presentation at the ASHP Summer Meeting in Minneapolis in June.

Read more here: https://www.ashp.org/news/2017/03/09/20/39/hunt-to-receive-2017-whitney-award

 

Caryn Dellamorte Bing, R.Ph., M.S., FASHP, Principal Consultant, CB Healthcare Consulting, Las Vegas and ICHP Past President (1987-1988) will receive ASHP’s 2017 Distinguished Leadership Award for Ambulatory Care at the ASHP Midyear Meeting in Orlando, Florida in December.

Ms. Bing is a nationally recognized expert, author, and speaker with more than 35 years of practice and management experience in home care, specialty, and acute care pharmacy.

ICHP members Jan Keresztes and Jennifer Phillips (ICHP Past President 2016-2017) have also been named Fellows of the American Society of Health-System Pharma

cists and will receive their Fellow recognition at the 2017 ASHP Summer Meeting in Minneapolis in June.

Hi-Tech
How I Joined the Pharmacy Technician Profession

by Clara Gary, Pharmacy Technician

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Government Affairs Report
HB2392 is Not the Fix We Need

by Jim Owen and Scott Meyers

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This is the first time in many years that we have actually received pushback from our members on a legislative issue – which is actually a good thing from the perspective that some of our members are paying attention to what goes on in Springfield.  And we realize it’s our job to really pay attention to what goes on in Springfield, so we would like to share some of the details that you, our members, don’t have time to see.

First, let us describe what the real HB2392 does and doesn’t do for pharmacy:

1. The bill would set a prescription filling limit of 10 prescriptions per hour in a pharmacy.
2. It would require at least one pharmacy technician to be on duty whenever the practice of pharmacy is conducted.
3. It would mandate two 15-minute breaks and a 30-minute meal for every pharmacist who works at least 7 hours.
4. If a pharmacist has to work during their lunch or break period, the pharmacy is required to pay that pharmacist triple time for the entire day.
5. It would prohibit employers from requiring pharmacists to participate in activities such as advertising or soliciting that may jeopardize patient health, safety or welfare or any activities or external factors, including promotional requirements and productivity quotas that interfere with the pharmacist’s ability to provide appropriate professional services.
6. The bill would require pharmacies to prohibit their pharmacists from working more than an 8-hour shift.
7. It would require every pharmacy “to make available at all times a room on the pharmacy’s premises with adequate seating and tables for the purpose of allowing the pharmacist to enjoy break periods in a clean and comfortable environment”.  This is the exact language from this bill!
8. The pharmacy would be required to keep a complete and accurate record of the break periods of its pharmacists.
9. The bill requires every pharmacy to keep records of any errors in the receiving, filling, or dispensing of prescriptions of any kind, including any errors resulting in an adverse drug interaction or adversely affecting the health of the patient.
10. The bill does provide whistleblower protection to any pharmacy employee that reports violations of the Act.

Hopefully, it is crystal clear that this bill is flawed!  Very flawed.  As it is currently written, this bill would hamstring pharmacies and slow the processing of prescription orders so that within a week, most pharmacies would be behind by at least another week.  Even if the language is rewritten so that the 10 prescription per hour limit is per pharmacist rather than pharmacy, there would need to be a dramatic demand for additional pharmacists creating significant cost increases for every pharmacy, unless that is, they cut pharmacist wages by one-half or more!  And since there is a significant surplus of pharmacists, that might be the answer.  One answer we’re sure our members won’t support.

But even more critical, this bill prevents pharmacies from using 7-on-7-off scheduling for third shifts and four 10-hour day scheduling at any time!  Do we really want that?  I think it will become exceedingly hard to staff 24-hour pharmacies anywhere if shifts are mandated to be 8-hours or less.

The error reporting language is catastrophic – every single error in receiving, filling or dispensing!  That means even if there is no impact on the patient.  That means errors made by technicians and caught by pharmacists or other technicians would need to be written up and retained for 5 years.  It will be very easy for a plaintiff’s lawyer to establish a pattern of errors or negligence with these records available and unprotected.

Yes, the mandated lunch is reasonable and yes, the whistleblower protection is acceptable.  But those limited benefits don’t come close to outweighing the damage this bill would do to pharmacies and their staffs in general.  ICHP is fighting this bill because of the shift restrictions and orders per hour limit.  We do not support the tactics that some chain employers use to measure productivity and performance.

ICHP has been questioned about our relationship with the Illinois Retail Merchants Association (IRMA) who represent the chain pharmacies.  Why we aren’t sympathetic to the plight of our colleagues in the chains – the colleagues who claim to get no bathroom or meal breaks.  Truthfully, we are sympathetic to the rank and file chain employee.  But the situation is Springfield demands something most pharmacists don’t understand.

Springfield demands a unified front from pharmacy if we are to be taken seriously.  If ICHP says one thing, IPhA another and IRMA yet another, the General Assembly and the various agencies walk away.  They listen to the biggest voices in Springfield and pharmacy unified is still small but worth listening to, however, separately, even IRMA’s credibility is questioned.  So many times we hear, “How does the pharmacists’ association feel about this bill?” and “what about IRMA?”  If a legislator hears something different from anyone of us, their immediate response is, “Come back and talk to us when pharmacy can get its position together!” 

Is that fair? Of course not.  Every interested party should be heard.  But in Springfield the pharmacy vote is relatively small compared to many industries, so fractured positions carry even less weight.  Therefore, it is critical when a bill comes along that none of us like, we fight it together, regardless of the different reasons for not liking it.

So now collectively, ICHP, IPhA and IRMA are fighting a bill that is bad for pharmacy practice and our patients, but through this fight makes each of us look like we don’t care about our colleagues in the profession.  That couldn’t be further from the truth.  What is true is that all three organizations have lost faith in those pharmacists whose continued mantra is “I don’t have time to counsel the patient!”  In a subject matter hearing on February 22^nd, Rep. Mary Flowers blamed the employers for creating that attitude because “pharmacists work for two masters and the primary master is their employer.” I (Scott) told her that every pharmacist takes an oath at graduation, to serve their patients first, with these very words, “I will consider the welfare of humanity and relief of suffering my primary concerns.”  Those pharmacists who failed to counsel their patients let those patients down, let their community down and let their profession down.  And now because they failed to serve their primary concerns, we fight this horrible bill together.

ICHP is now monitoring over 80 bills and resolutions in the 100^th General Assembly, and this list is provided for your review.  For more details on the bills or resolutions that have significant impact on pharmacy, go to www.ilga.gov and click on the tab titled “Bills and Resolutions”.  Some bills are not included below as they are shell bills or fringe bills that we monitor but do not feel currently warrant concern.

2017 Illinois General Assembly Bill Summary

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Educational Affairs
Implementation and Evaluation of a Student Mentorship Program at a College of Pharmacy

by Shaziya Barkat, Pharm D Candidate, Midwestern University Chicago College of Pharmacy, SSHP President; Jen Phillips, PharmD, BCPS, FCCP Associate Professor, Midwestern University Chicago College of Pharmacy, SSHP Co-Advisor; Kathy Komperda, PharmD, BCPS Associate Professor, Midwestern University Chicago College of Pharmacy, SSHP Advisor

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Introduction

As humans, we’re always growing and learning. Even the most experienced professional needs guidance, and an often overlooked yet beneficial resource to help oneself develop is mentorship. Mentorship involves a relationship between at least two individuals – a more experienced person (“mentor”) and a less experienced person (“mentee”) that is typically long-term and often occurs in a professional setting.¹  Mentoring has largely been correlated with positive outcomes for both the mentor and the mentee.²  For example, in one study analyzing the impact of a pharmacist mentorship program, pharmacist mentees reported an increased level of self-perceived competency and confidence and both the mentors and the mentees reported an increase in job satisfaction as a result of the program.²  This impact is not necessarily limited to pharmacists or adults.  A multi-disciplinary meta-analysis found that mentoring was associated with a wide range of positive outcomes including behavioral, attitudinal, health-related, motivational, and career outcomes.³

Implementation of a Pharmacy Student Mentorship Program

In September 2015, the Midwestern University Chicago College of Pharmacy (MWU-CCP) Illinois Council of Health-System Pharmacists (ICHP) student chapter launched a new college-wide mentorship program on the Downers Grove Campus. The mission of this program was to ease the transition of incoming student pharmacists and to foster professional relationships among all levels of students in the College of Pharmacy.

To find the best fit, first-year student pharmacists were matched with either a second- or third-year student pharmacist based on a questionnaire assessing specific preferences. The questionnaire focused on interests, professional goals, self-identified strengths and weaknesses, and availability. Inclusion criteria and requirements of the program are outlined in Table 1. A total of 98 students, 49 mentors and 49 mentees, participated in this program in the 2015-2016 academic year. Approximately 136 hours of mentorship were logged during that time.   

 
Table 1: Inclusion Criteria and Mentorship Program Requirements

Educational Affairs Poster Abstracts
2017 ICHP-MSHP Spring Meeting Poster Abstracts

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EDITOR’S NOTE: For a detailed list of all posters as presented at the 2017 ICHP-MSHP Spring Meeting, please refer to the Spring Meeting Handouts Page, http://www.ichpnet.org/events/spring_meeting/2017/program_handouts.php.

All research was to have results and conclusions by the time of presentation. This may not be reflected in the posted abstracts below.

PLATFORM PRESENTATIONS

1. Breaking Real and Perceived Barriers to Voluntary Reporting of Safety Events by Pharmacy Personnel in an Acute Care Institution

2. Student Attitudes and Behaviors on Utilization of a Virtual Dispensing Software in a Healthcare Communications Course

ORIGINAL

1. Utilizing Existing Staff to Address Antimicrobial Stewardship Needs in a Small Urban Community Hospital (Poster #9)

2. The Optimization of Automated Dispensing Cabinets in an Academic Medical Center (Poster #10)

3. Medication Utilization and Patient Falls Correlated with the Use of Melatonin and Zolpidem in the Hospital (Poster #11)

4. Most Valuable Components of Residency Training at the University of Chicago Medicine (Poster #28 – not presented)

5. Management of Heparin Infusions in the Obese Population (Poster #30)

ENCORE

1. Evaluation of Sustained Virologic Response Rates after Hepatitis C Virus Treatment among a Diverse Patient Population at an Urban Academic Medical Center (Poster #13 – not presented)

2. Pharmacy Desensitization in a Collaborative Practice with Allergy Clinic (Poster #34)

STUDENT

1. The Deprescribing Conversation Project: Giving Nurses the “Words” (Poster #18)

2. Reducing Polypharmacy: Deprescribing at an Academic Medical Center (Poster #36)

3. Fall Risk Assessments in a Community-based Senior Outreach Program (Poster #39)

4. Dose Adjustments of Thiopurines in Patients Based on Thiopurine Methyltransferase Activity (Poster #41)

5.  The Impact of Pharmacist-Driven Pantoprazole to Famotidine Substitution Protocol on Rates of Hospital-Acquired Clostridium difficile (Poster #42 – not presented)

6. Evaluation of Pain Medication Management in Patients Admitted to a Large Academic Hospital (Poster #43 – not presented)

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ICHP Poster Presentations - Platform Presentation 1

Category: Encore

Title: Breaking Real and Perceived Barriers to Voluntary Reporting of Safety Events by Pharmacy Personnel in an Acute Care Institution

Purpose: Purpose Voluntary incident reporting by healthcare personnel discloses adverse events and errors so patient safety and quality of care can be tracked and improved. However, it is estimated that adverse events in healthcare systems are underreported at an annual rate of 50 to 96%. Barriers to reporting include fear of individual or organizational repercussion; a belief that reporting errors can measure practitioner competence; and potential legal concerns associated with error reporting. The purpose of this study is to assess perceived and real barriers to voluntary reporting of safety events by pharmacy personnel at Northwestern Memorial Hospital (NMH) in Chicago, IL. 

Methods: An anonymous survey on attitudes and barriers to reporting in the Northwestern Events Tracking System (NETS) was created in SurveyMonkey and emailed in September 2016 to 171 pharmacists and 112 technicians at NMH via email listservs. The survey consisted of 17 questions on demographics, awareness of event reporting, and concerns with event reporting using a Likert scale. The same survey will be emailed out to the same group after education and process improvement(s) have been implemented, in order to measure changes in awareness of the NETS process and any changes in barriers to use.  Prior to administration of the survey, the number of medication safety events (those that are categorized as “Adverse Drug Reactions” and “Medication/Fluid”) reported in NETS by pharmacists and pharmacy technicians were measured from all reports submitted under these categories from December 2015 through February 2016. These data will be collected again after education and process improvement(s) are implemented, in order to assess any changes in reporting by pharmacy personnel. 

Results: Prior to this survey, 34 medication safety event reports were made by pharmacists and 3 were made by pharmacy technicians in the measured 3 month period. Of the 283 pharmacy personnel who received the survey, 114 completed it (40% response rate). A majority of respondents are pharmacists (72%), and a majority work in an inpatient setting (83%). Nearly all respondents are aware of the NETS (98%) and of how to access and submit reports (96%), but many claim they rarely (34%) or never (18%) report an event through the NETS. The top 4 identified barriers to reporting based on those who responded “Strongly Agree” or “Agree” to statements about perceived barriers are as follows: fear of distrust among colleagues for submitting a report involving them (36%); a lack of follow-up after an incident report is submitted (34%); concern that information can be traced back to the person who submitted the report (32%); and a concern that disciplinary action will be taken upon the person involved in the event based on the report (28%).     

Conclusions: Survey results demonstrate that fear of repercussion, lack of anonymity, and distrust among colleagues are major barriers to event reporting. Fostering a just culture through emphasis on patient safety both at the level of pharmacy leadership and throughout the department, along with streamlining management of events and providing follow-up on improvements made should help to break these barriers.

Submitting Author: Lara Ellinger, PharmD, BCPS

Organization: Northwestern Memorial Hospital

Authors: Lara Ellinger, PharmD, BCPS, Drug Information and Medication Safety Pharmacist; Tina Lertharakul, PharmD Candidate, Midwestern University; Katherine Gauen, PharmD, Pharmacy Administration PGY2 Resident, Northwestern Memorial Hospital.

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ICHP Poster Presentations - Platform Presentation 2                            

Winner: Best Platform Presentation 2017

Category: Student Research Complete

Title: Student Attitudes and Behaviors on Utilization of a Virtual Dispensing Software in a Healthcare Communications Course

Purpose: Student Attitudes and Behaviors on Utilization of a Virtual Dispensing Software in a Healthcare Communications Course  Purpose: The Accreditation Council for Pharmacy Education (ACPE) requires that medication preparation and dispensing be incorporated into didactic coursework. While it is taught and practiced in the earlier years of pharmacy education, it is not until students are on Advanced Pharmacy Practice Experiences (APPEs) that the skills and knowledge are tested in a real world environment. The actions of verifying and dispensing medications only comprise a small portion of the activities required during the APPE community rotation.  To better prepare students for the potential role of dispensing in their future practice, aspects of dispensing should be incorporated early on in the curriculum. Previous studies using a limited population of pharmacy students have shown students are willing to use a virtual dispensing software and perceive it to be helpful. The objective of our study is to explore student perceptions and use of virtual dispensing software in a broader, larger student population.

Methods: A virtual dispensing software (MyDispense) was incorporated into a required communications course. MyDispense was developed by Monash University in Australia for use in their pharmacy curriculum and has been modified for use in other countries, including the US. The exercises used in this course focused on common problems seen in community practice, including contacting the prescriber for clarification, drug interactions between different prescription medications, and drug interactions between prescription and over the counter medications.  This questionnaire-based study was conducted at Midwestern University Chicago College of Pharmacy in Downers Grove, Illinois. All third year pharmacy students who had used MyDispense as part of the communications course were eligible to participate. The questionnaire collected information regarding student usage of MyDispense, perceptions of the software, and demographics. The questionnaire was administered via SurveyMonkey at the beginning of a required course session once all MyDispense assignments and quizzes were completed for the course. Descriptive statistics were utilized for results of this study. This project was approved by the Midwestern University IRB.   

Results: One hundred sixty-two students participated in the study, resulting in a 91.5% response rate. The majority was female (75%) and had a bachelor’s degree (66%).  The median age was twenty-five years old. Most students had pharmacy work experience (85%), with a majority of that experience being in community pharmacy (83%).  One hundred and four students (64%) completed at least 80% of the practice exercises. One hundred and thirty-six students (85%) felt that using MyDispense was a positive learning experience and one hundred and thirty-nine students (87%) stated that MyDispense made them more aware of the dispensing process, including performing tasks such as checking for drug interactions, contacting the prescriber as necessary, and asking the patient relevant questions. Additionally, one hundred and forty-eight students (92.5%) felt that there would be a benefit from using MyDispense earlier on in the curriculum. 

Conclusions: The implementation of a virtual dispensing program in a required course was received positively, as shown by the usage of the students. A majority of students found a significant benefit from using MyDispense. Despite that most of these students had previous and current community pharmacy work experience, most students achieved a better insight into the dispensing process and into the role of the pharmacist in the community setting.

Submitting Author: Michael Serlin, PharmD Candidate

Organization: Midwestern University Chicago College of Pharmacy

Authors: Michael William Serlin- PharmD Candidate, Midwestern University Chicago College of Pharmacy; Jennifer Mazan, PharmD, Professor, Midwestern University Chicago College of Pharmacy; Kathy E. Komperda, PharmD, BCPS, Professor, Midwestern University Chicago College of Pharmacy.

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ICHP Poster Presentations – Original 1

(presented as Poster #9)

Category: Original-Research in Progress

Title: Utilizing Existing Staff to Address Antimicrobial Stewardship Needs in a Small Urban Community Hospital  
                                                                                 

Purpose: Antimicrobial stewardship is a necessary responsibility in healthcare facilities to control the emergence of bacterial resistance, health care costs, and healthcare-acquired infection rates.  The Joint Commission adopted a new Medication Management standard (MM.09.01.01) to define required elements of Antimicrobial Stewardship Programs (ASPs), effective 1/1/17.   In preparation, the study site’s Pharmacy Department sought to develop an ASP pilot with existing pharmacy staff.  The purpose was to determine if an internal change made to the staffing model, allowing a lead pharmacist dedicated time to perform ASP activities, was effective in reducing the duration of broad-spectrum antibiotics and overall anti-infective use.   

Methods: The pilot was conducted at a small community hospital with an average daily census of 69 patients comprised of 40% behavioral health patients from 6/13/16 to 12/13/16 compared to a pre-intervention period of 1/1/15 to 12/31/15.  Before pilot initiation, the feasibility of dedicating an entire shift to ASP efforts was determined by evaluating the average number of orders processed on weekdays versus weekends. A weekend shift was moved to Monday to assign an existing staff member as the designated lead ASP pharmacist for the department.  ASP presentations, readings, and competency questions provided further training for pharmacy staff. The lead ASP pharmacist reviewed antimicrobial drug therapy based on daily trigger reports and monitored for clinical response.  Interventions focused on drug-bug mismatch, de-escalation, discontinuation, and duration of therapy opportunities.  The pharmacy staff was encouraged to make antimicrobial stewardship interventions throughout the week.   The number of pharmacist-driven ASP interventions and duration of therapy for the most impacted broad-spectrum antibiotics were the primary outcomes.  Cost per adjusted patient days for anti-infectives was the secondary outcome.    

Results: Research in Progress. There was a 6-fold increase in the number of antimicrobial stewardship interventions with 310 interventions in the 6-month post-intervention period as compared to 51 interventions in the 12-month pre-intervention period.  The two most impacted antibiotics by this pilot were levofloxacin (90 interventions) and piperacillin-tazobactam (38 interventions).   The average durations of therapy decreased by 4% and 1% for levofloxacin and piperacillin-tazobactam respectively in the post-intervention versus the pre-intervention periods.  Average anti-infective cost per adjusted patient day decreased from $4.94 to $3.10 in the pre-intervention versus the post-intervention period. (Additional data to be presented at the meeting.)

Conclusions: Research in Progress. In hospital settings across the United States, ASPs are being created to optimize the use of antibiotics, prevent resistance and minimize adverse events. As shown in the pilot, for smaller community hospitals, creating internal infrastructure to support ASP efforts can still make an impact. (Additional data to be presented at the meeting.)

Submitting Author: Zeina Samara, PharmD

Organization: Westlake Hospital

Authors: Zeina E. Samara, PharmD, Clinical Pharmacist Tenet Healthcare - Westlake Hospital; Dan V. Ciarrachi, RPh, Clinical Pharmacist Tenet Healthcare - Westlake Hospital; Charlene Hope Henry, PharmD, MS, BCPS, Quality and Safety Pharmacy Manager, Chicago Market, Tenet Healthcare - MacNeal, Weiss, West Suburban, Westlake; Stacy Thomas Scaria, PharmD, Clinical Pharmacist Tenet Healthcare – West Lake Hospital; Deanna McMahon Horner, PharmD, BCPS, Clinical Pharmacy Manager, UnitedHealthcare Medicare & Retirement, Part D STARs.

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ICHP Poster Presentations – Original 2

(presented as Poster #10)

Category: Original-Research in Progress

Title: The Optimization of Automated Dispensing Cabinets in an Academic Medical Center  
                                                                                          

Purpose: The University of Chicago’s pharmacy department strives to direct operations around the effective use of automation and technology. This project was primarily conducted to ensure the proper utilization of current automation and technology, specifically automated dispensing cabinets (ADCs), in the most efficient manner to meet the patient care needs of the medical center. The University of Chicago Medical Center has contemporary pharmacy automation solutions in place, some of which include ADCs. An attempt to maximize the efficiency of the drug distribution technology was made, focusing in on the medication dispensing carousels located within the pharmacy and the automated dispensing cabinets located in the adult patient care areas throughout the medical center (The Center for Care and Discovery and the Mitchell Hospital). The primary objective of the optimization efforts were to maximize the amount of medications dispensed as common stock instead of patient specific doses from the ADCs, which ultimately reduces the time and effort needed to complete the daily cartfill process, which are all patient specific doses that are not loaded as common stock medications in the ADCs. A secondary objective was to reduce the amount of time involved in restocking of common stock medications in the ADCs on a daily basis by the pharmacy technicians.

Methods: Pharmacy automation analysts are members of the pharmacy informatics team, primarily responsible for maintenance of the cabinets, par and stock adjustments, and report writing. The analysts were able to evaluate specific canned reports to draft velocity reports, showing which ADCs possessed medications not being utilized effectively and which ADCs were missing medications as common stock items that were being routinely added and dispensed as a patient specific dose medication. Par levels for each drug added to the ADCs were adjusted as space allowed to account for package sizes stored centrally in pharmacy and to require an ADC restock no more than twice weekly. Velocity reports were run for the adult inpatient locations in the medical center, not including the emergency room or procedural area ADCs. This included a total of 104 ADCs reviewed. Common stock medications and associated par levels were added or adjusted in the ADC database starting in November 2016 and completed in March 2017.

Results: Of the 104 ADCs analyzed, the common stack rate of medications pulled increased from 85.4% in November to 86% in March, resulting in about a 0.5% increase in the rate of dispenses classified as common stock. The number of patient specific dispenses in every month went from 1,828 in November 2016, up to 1,936 in January 2017, and back down to 1,866 in March. Additionally, the number of restock transactions generated monthly for the ADCs went from 11,903 in November 2016, to 12,362 in January 2017, and then down to 11,602 transactions in February.

Conclusions: The results of the optimization efforts during the project did not show significant changes overall in the metrics identified. This 5 month longitudinal process was not robust enough to improve the percentage of common stock dispensing, reduce the number of patient specific dispenses from the ADCs, or reduce the number of medication restock transactions generated from the storage carousels. Efforts to optimize the ADCs through other means (par vs. utilization reports, ordered medications without removals, etc.) will be reviewed by the pharmacy automation team to ensure an ongoing, proactive approach to improving the use of the ADCs.

Submitting Author: Anthony Scott, PharmD

Organization: The University of Chicago Medicine

Authors: Kevin Colgan, MA, FASHP, Vice President, Chief Pharmacy Officer, The University of Chicago Medicine; Anthony C. Scott, PharmD, Assistant Director of Pharmacy Operations, The University of Chicago Medicine; Monika K. Lach, PharmD, PGY-1/PGY-2 Health-System Pharmacy Administration Resident, The University of Chicago Medicine; Bernice Y. Man, PharmD, PGY-2 Health-System Pharmacy Administration Resident, The University of Chicago Medicine.

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ICHP Poster Presentations – Original 3
(presented as Poster #11)

Category: Original-Research in Progress

Title: Medication Utilization and Patient Falls Correlated with the Use of Melatonin and Zolpidem in the Hospital

Purpose: Patient falls is one of the most common adverse events reported in the inpatient care settings.  Among hospitalized patients, rates of falls range from 1.97 to 8.40 falls per 1000 patient-days.   Patient falls prolong hospitalization, increase cost of care, and have the potential to cause serious injury. There are multiple risk factors reported in literature that are associated with falls, including: advanced age, muscle weakness, gait or balance problems, visual impairment, dizziness or vertigo, cognitive deficits, and use of psychotropic medications.  Zolpidem is among one of the psychotropic medications commonly used in the inpatient setting that has been reported to decrease balance and has been independently associated with falls. Zolpidem use in hospitalized patients may be a potentially modifiable risk factor for falling.  At University of Chicago Medicine (UCM), melatonin, an alternative sleep aide was added to the formulary in 2014.  This project aims to compare falls that correlated with the use of zolpidem and melatonin as well as to analyze the prescribing pattern of zolpidem and melatonin at UCM since the addition of melatonin to formulary. 

Methods: A retrospective analysis was conducted using data collected from patients between July and December of 2014 and July and December of 2015, which were defined as periods pre and post addition of melatonin to formulary respectively. Patients included in the study were greater than 18 years of age who received either zolpidem or melatonin or fell during the study time periods. Patients were identified by either having an adverse event report submitted for a fall and/or if they had an active medication order for either melatonin or zolpidem on pharmacy utilization reports.. Patients were excluded if they fell during an outpatient visit or if the location of the fall could not be determined due to incomplete reporting. The primary objective was to compare the incidence of falls in patients receiving melatonin or zolpidem, or both agents, or neither agent. The secondary objective was to analyze the utilization trends of zolpidem and melatonin at UCM during the study period.  The following data will be collected: age, gender, date of patient fall, admitting service, hospital unit, days of sleep aide therapy, dosage and proximity of the last dose to the fall.  

Results: Research in Progress. To be presented at meeting.

Conclusions: Research in Progress. To be presented at meeting.

Submitting Author: Lida Thimothy, PharmD, BCPS

Organization: University of Chicago Medical Center

Authors: Lida Thimothy, PhamD, BCPS, Clinical Pharmacist, University of Chicago Medical Center; Hailey Soni, PharmD, BCPS, Clinical Pharmacy Specialist - Internal Medicine, University of Chicago Medical Center; Judy Doty, MSN, RN, Nursing Quality Manager, University of Chicago Medical Center; Meghan Conroy Sweis, MSN, RN, Nursing Quality Specialist, University of Chicago Medical Center; Randall Knoebel, PharmD, BCOP, Clinical Manager, University of Chicago Medical Center.

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ICHP Poster Presentations – Original 4

(presented as Poster #28)

Category: Original-Research in Progress

Title: Most Valuable Components of Residency Training at the University of Chicago Medicine

Poster not presented.

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ICHP Poster Presentations – Original 5

Winner: Best Original Poster Presentation 2017

(presented as Poster #30)

Category: Original-Research in Progress

Title: Management of Heparin Infusions in the Obese Population

Purpose: An update to the heparin infusion protocol for the treatment of venous thromboembolism was implemented in a community hospital.  The objective was to review the effects of using adjusted body weight (AdjBW) for patients weighing >150 kg.

Methods: This was a retrospective quality improvement project.  Obese patients who were prescribed heparin were divided into three groups: 100-119 kg, 120-149 kg, and ≥150 kg.  Inclusion criteria included documentation of a bolus and initial infusion and ≥2 PTT results.  The primary outcome was time to first therapeutic PTT.  Secondary outcomes included median initial PTT, median PTT at 24 hours, and bleeding episodes.   

Results: The median times to therapeutic range for the 100-119 kg, 120-149 kg, and > 150 kg groups were 21 hours (IQR 13-25 h), 22 h (IQR 18-24 h), and 6 h (IQR 6-16 h) respectively.  Therapeutic range was 65-104 seconds.  At first PTT draw, the median PTT was 171 seconds (IQR 116-215 s), 186 s (IQR 117-260 s), and 77 s (IQR 65-92 s) and at 24 hours after the start of the infusion the median PTT was 83 s (IQR 70-112), 95 s (IQR 82-108), and 60 s (IQR 51-76 s) respectively.

Conclusions: The use of AdjBW for heparin boluses and initial infusion rates in patients weighing > 150 kg shortened time to therapeutic range compared to patients weighing 100-150 kg.  However, these patients required several upward titrations to maintain therapeutic PTTs at 24 hours.  Patients weighing 100-150 kg achieved highly supratherapeutic anticoagulation and required several downward titrations to achieve therapeutic range at 24 hours.  Use of BMI in place of an actual body weigh cut-off for identifying patients at risk of over anticoagulation with standard heparin doses should be investigated.

Submitting Author: Kathryn Wdowiarz, PharmD, BCPS

Organization: Midwestern University and Edward Elmhurst Healthcare

Authors: Kathryn Wdowiarz, PharmD, BCPS, Assistant Professor, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Internal Medicine Clinical Pharmacist, Edward Elmhurst Healthcare, Naperville, I; Danielle Petric, PharmD Candidate, Midwestern University Chicago College of Pharmacy, Downers Grove, IL.

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ICHP Poster Presentations – Encore 1                      

(presented as Poster #13)

Category: Encore

Title: Evaluation of Sustained Virologic Response Rates after Hepatitis C Virus Treatment among a Diverse Patient Population at an Urban Academic Medical Center

Poster not presented.

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ICHP Poster Presentation – Encore 2                

Winner: Best Encore Poster Presentation 2017

(presented as Poster #34)

Category: Encore

Title: Pharmacy Desensitization in a Collaborative Practice with Allergy Clinic

Purpose: Purpose:   Desensitization is a medical treatment for some types of allergies with the aim to induce or restore tolerance to the allergen by reducing its tendency to induce IgE antibody production. Patients are desensitized through the administration of escalating doses of allergen that gradually decreases the IgE-dominated response. The purpose of this poster is to summarize and describe a model for an ambulatory care pharmacy to prepare, label and provide all desensitization medication needs to the Allergy clinic for patient specific administration.  

Methods: Patient is seen at the Medical Center and is diagnosed with a disease state that requires the patient to use a drug they may be allergic to. For example, a patient may have a documented metronidazole allergy, but needs the drug for treatment of their diagnosed condition. The Allergy Clinic doctors become involved in the case and will enter a desensitization prescription for the patient. This prescription is sent to the outpatient pharmacy with a time and date that the order is needed by. The outpatient pharmacy assesses the appropriateness of the order by conducting a detailed clinical review, checking the compatibility and stability of products, as well as dosing calculations. Once all clinical requirements are met, the outpatient pharmacy also ensures the products are available and can be ordered through the pharmacy ordering system. With everything in place, the order is prepared and the Allergy Clinic staff picks up the order to administer to the patient in the clinic.   

Results: This full-circle collaboration between an outpatient pharmacy and clinic staff allows for a mechanism of completing desensitization orders and ensuring delivery to the Allergy Clinic for the most effective patient care. It was determined that the outpatient pharmacy was best equipped to provide the desensitization orders to the Allergy Clinic because of the detailed clinical review provided, ability to order required products directly, as well as use of an on-site clean room. The outpatient pharmacy has an agreement with the Allergy clinic to have all orders prepared in time for the clinic staff to pick up and take back to clinic. Overall, a model of an outpatient pharmacy-prepared desensitization order was designed and implemented successfully for an affiliated Allergy Clinic. Specifically, patients that were noted to have a documented allergy were able to successfully undergo treatment for their medical condition without increased risk to their health.

Conclusions: An outpatient pharmacy staffed with pharmacists providing thorough clinical review of all desensitization orders and equipped with a sterile compounding facility is best suited to meet the needs for preparation of desensitization orders. All desensitization orders were prepared in a timely and efficient manner, allowing for patient access to quality care and further contributing to positive outcomes such as decreasing risk of allergic reaction during treatment, avoiding major side effects to medications, and decreasing cost for this sensitive patient population.

Submitting Author: Daniel Haywood, PharmD Candidate

Organization: University of Illinois Hospital & Health Sciences System, EEI Ambulatory Care Pharmacy

Authors: Sami Labib, RPh, Clinical Assistant Professor, Pharmacy Practice Assistant Director, Clinical Instructor. Monazzah Sarwar, PharmD, Clinical Instructor, Clinical Pharmacist; Steven Menachof, PharmD Candidate, EEI Extern; Daniel Haywood, PharmD Candidate, EEI Extern.

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 ICHP Poster Presentation – Student 1
(presented as Poster #18)

Category: Student-Research in Progress

Title: The Deprescribing Conversation Project: Giving Nurses the “Words”

Purpose: With the growth of the older adult population in the United States, healthcare professionals are increasingly involved in end-of-life care across a multitude of practice settings including hospitals, skilled nursing facilities, home care, and hospices. Nurses typically are front line providers for patients nearing the end of life and are often expected to deliver precise communication regarding futile treatments and unnecessary medications to patients and families.  These conversations can be challenging for nurses as well as emotional for patients and families, who find it difficult to understand why a medication once perceived as beneficial is now being discontinued. Pharmacists with their unique knowledge of pharmacotherapy including medication time-to-benefit (i.e. for statins and other preventive agents) and medication risk-to-benefit profiles may be able to provide nurses with the “words” for difficult deprescribing conversations. The purpose of this “Deprescribing Conversation Project” is to enhance hospice nurses’ knowledge and comfort with deprescribing conversations by providing a structured dialogue for discussing the benefits and burdens of drug therapy in patients with limited life expectancies.   

Methods: Two patient-nurse vignettes were scripted and filmed using student pharmacist actors. Each scenario represents a common deprescribing situation; the first video depicts a conversation about discontinuing cholinesterase inhibitor therapy in a patient with late stage dementia. The second video depicts a conversation regarding inhaler polypharmacy in a patient with advanced pulmonary disease and diminished inspiratory capability. Each video illustrates a rational, patient-centered conversation about medication risk and benefit in the context of the patient's goals and life expectancy.  With tactful and empathetic communication, the student pharmacist actor also addresses patient and family concerns as well as misconceptions. Registered hospice nurses in northern Illinois will be recruited to participate in viewing these two videos via email correspondence. Before and after viewing the videos, the study participants will be asked to complete a pre and post-survey to assess their perspective and knowledge of deprescribing and their comfort level with conducting these conversations. Pre-survey results will be compared to post-survey results to assess whether the filmed vignettes improved nurses’ knowledge and comfort with deprescribing conversations.  

Results: Research in Progress. To be presented at meeting.

Conclusions: Research in Progress. To be presented at meeting.

Submitting Author: Patrice Davis, PharmD Candidate

Organization: University of Illinois at Chicago (UIC) College of Pharmacy at Rockford

Authors: Patrice Davis, PharmD Candidate, UIC College of Pharmacy at Rockford; Hans Scheerenberger, PharmD Candidate, UIC College of Pharmacy at Rockford; Laura Meyer-Junco, PharmD, BCPS, CPE, UIC College of Pharmacy at Rockford.

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ICHP Poster Presentation – Student 2

Winner: Best Student Poster Presentation 2017

(presented as Poster #36)           

Category: Student-Research in Progress

Title: Reducing Polypharmacy: Deprescribing at an Academic Medical Center

Purpose: Polypharmacy is a growing problem within the healthcare system contributing to an increased risk of adverse drug reactions, potential drug-drug interactions, non-adherence to medications, and associated health care costs.  The objective of this study is to reduce polypharmacy through the process of deprescribing. Deprescribing is defined as the process of tapering, stopping, discontinuing, or withdrawing drugs that are deemed inappropriate or no longer necessary.  Deprescribing aims to manage polypharmacy and improve patient outcomes; therefore, reducing the risks associated with using multiple medications. Additionally, this study aims to enhance the standard of care by evaluating a patient’s home medication list during an inpatient hospitalization with the overall goal of simplifying the patient’s drug regimen.    

Methods: This project was conducted in conjunction with a deprescribing quality improvement initiative at an academic medical center in Springfield, IL. The quality improvement team identified patients aged 65 years or older, taking at least 8 medications at home who were admitted to the Southern Illinois University (SIU) Internal Medicine Team and were patients at the SIU Internal Medicine Team Clinic. The patient’s home medication list was reviewed upon admission to the hospital by a pharmacist or a physician on the quality improvement team and potential unnecessary or inappropriate medications were identified with the intent of deprescribing. Stopping these medications was discussed with the patient and documented within their electronic health record. This study used a retrospective chart review to determine which home medications upon admission were considered inappropriate and eligible to be stopped and which medications were actually stopped. The study also recorded the physician rationale for why a particular medication was deprescribed.   

Results: Of the numerous patients screened, 31 were eligible for this study. Of these eligible patients, the average number of medications upon admission and discharge was 16 and 15, respectively. On average, 3 medications were deprescribed per patient, yet 5 or more medications were discontinued in 26% of patients. The medications discontinued varied widely from antihypertensive agents, antiplatelet medications, antibiotics, and proton pump inhibitors amongst several other pharmacologic classes. In 45% of patients, the rationale for discontinuation of at least one medication was noted as unnecessary medication therapy and occasionally, the medication was responsible for the patient’s hospitalization.

Conclusions: Polypharmacy is a prominent issue in patients 65 years and older. These patients are on several medications, often unnecessarily. The process of deprescribing has several different challenges, but this initiative demonstrated the positive impact of simplifying a patient’s drug profile and it would be beneficial if such research was conducted on a larger scale.  

Submitting Author: Morgan Atwood, PharmD Candidate

Organization: Southern Illinois University Edwardsville School of Pharmacy

Authors: N/A

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ICHP Poster Presentation – Student 3
(presented as Poster #39)

Category: Student-Research in Progress

Title: Fall Risk Assessments in a Community-based Senior Outreach Program

Purpose: Falls among older adults are a serious public health concern. Each year, one in three Americans 65 years and older falls. Of those falls, 55 percent lead to an unintentional injury or death. Medications are a modifiable risk factor for falls; therefore, screening for high-risk drug therapies plays a key role in mitigating medications' impact on falls risk. Furthermore, nationally recognized resources, tools and evidence-based falls prevention programs, exist to empower older adults to decrease their risk of falls. The aim of this study was to screen community based older adults for fall risk, promote community based Matter of Balance program (MOB), and refer those taking high-risk medications to comprehensive medication review (CMR). 

Methods: Older adults were screened for fall risk in September 2016, predominantly, at local senior centers (n=15) and one Senior Fest. Assessments included: CDC STEADI Fall Risk Checklist (high risk: if answered Yes to 4 or more questions, if fallen in the past year, if taking medications for sleep or mood disorders, and/or if experiencing dizziness or fatigue due to medications), Timed Up and Go (TUG) test (high risk: >12 seconds), orthostatic blood pressure, and high risk medication class review. All older adults were encouraged to participate in MOB, and those taking high-risk medications were encouraged to have health care provided CMR. Program evaluation was assessed. 

Results: Four hundred thirty nine participants (mean age 72.9, range 47-95) were assessed for fall risk. When permitted, those identified at higher risk of falls via the CDC STEADI tool (244/439, 55.58%) were further assessed. Reasons identified for fall risk included: TUG test (69/244, 28.28%), orthostatic blood pressure (11/244, 4.51%), and high-risk medications (150/244, 61.48%). High-risk medication classes included: CNS active medications- benzodiazepines, antipsychotics, anti-epileptics, antidepressants, sedatives, anti-parkinsons’, opioids, muscle relaxants and/or antihistamines (52/244, 21.31%), antihypertensives (126/244, 51.64%), and sulfonylureas (17/244, 6.97%). Older adults with two or more CNS active medications (20/244, 8.2%). Older adults likely to participate in CMR (163/439, 37.13%), MOB (169/439, 38.5%) and/or make changes to their home environment (153/439, 34.85%) as a result of the program were referred.

Conclusions: Fall risk assessments by health care providers in community based older adults accompanied with referral to structured evidence based medication reviews and self-care training programs contributes to overall public health, safety promotion and national fall prevention efforts.

Submitting Author: Yesha Patel, PharmD Candidate

Organization: University of Illinois at Chicago College of Pharmacy

Authors: Yesha Y. Patel, PharmD Candidate 2017, University of Illinois at Chicago College of Pharmacy, Hospital Pharmacy Extern, University of Illinois Hospital and Health Sciences System; Michael J. Koronkowski, PharmD, Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy; Adam Bursua, PharmD, Clinical Assistant Professor, Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy; Kristen L. Goliak, PharmD, Clinical Associate Professor, Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy.

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ICHP Poster Presentation – Student 4
(presented as Poster #41)

Category: Student-Research in Progress

Title: Dose Adjustments of Thiopurines in Patients Based on Thiopurine Methyltransferase Activity

Purpose: Azathioprine is a prodrug whose active metabolite, 6-mercaptopurine (6-MP), is a purine analogue that exerts its immunosuppressive effects by interfering with DNA synthesis and repair. 6-MP is metabolized by the enzyme thiopurine methyltransferase (TPMT) to produce 6-methylmercaptopurine (6-MMP).  Deficiency of this enzyme leads to excessive amounts of 6-MP, which then causes the metabolism to occur down an alternate pathway. This can result in life-threatening myelosuppression.   TPMT is a cytoplasmic transmethylase that is present in most bodily tissues such as the heart, placenta, pancreas, intestine, and red blood cells. When using standard dosing, low levels of TPMT activity have been associated with an increased risk for thiopurine toxicities such as severe myelosuppression. Conversely, high activity levels have been associated with suboptimal treatment.  Several studies have examined whether there is a benefit to testing markers of TPMT activity prior to the administration of thiopurines to guide empiric dosing adjustments. Currently, University of Chicago Medicine does not have a protocol that addresses specific starting doses and subsequent dose adjustments of thiopurines based on TPMT phenotype category. The purpose of this retrospective single center study is to identify optimal dosing for patients based on their TPMT phenotype category.

Methods: A lab report of all TPMT results from 1/1/2015 to 6/30/2016 will be used to identify patients that received phenotype testing. Additional data will be obtained from the electronic medical record, including patient demographics and baseline characteristics [age, sex, race, CrCl, TPMT phenotype category (low, low normal, normal, or high), indication for treatment, specific thiopurine drug utilized, initial thiopurine dose, CBC, AST, ALT, alkaline phosphatase, bilirubin, number of subsequent dose adjustments, and final dose].  The primary endpoint will be the final dose for each TPMT phenotype category. Secondary endpoints are the percentage of patients that received dose adjustments based on TPMT phenotype category, the average number of dose adjustments, and the percentage of patients who experiences toxicities and adverse events.      Inclusion Criteria:  •All patients at UCM who received TPMT phenotype testing between January 1, 2015 and June 30 2016  Exclusion Criteria:  •Patients who received no doses of thiopurine drugs following TPMT testing •Pregnant and lactating women  •Patients taking febuxostat, doxorubicin, or allopurinol at the time of thiopurine initiation  •Patients with a blood transfusion within 60 days prior to TPMT testing •History of use of alkylating agents: Altretamine, Bendamustine, Busulfan, Carboplatin, Carmustine, Chlorambucil, Cisplatin, Cyclophosphamide, Estramustine, Ifosfamide, Lomustine, Mechlorethamine, Melphalan, Oxaliplatin, Procarbazine, Streptozocin, Thiotepa, Dacarbazine, Temozolomide  •Renal transplant rejections  •Renal impairment, defined as CrCl <50 ml/min, or patients on Hemodialysis or Continuous Renal Replacement Therapy   Statistical Analysis:  •Descriptive Statistics •Multi-variant logistic regression

Results: Research in Progress. To be presented at meeting.

Conclusions: Research in Progress. To be presented at meeting.

Submitting Author: Brittany Huff, PharmD Candidate

Organization: University of Chicago Medical Center

Authors: Brittany M Huff, PharmD Candidate, Chicago State University College of Pharmacy, Student Pharmacist; Trevor N. Christ, PharmD, University of Chicago Medical Center, Clinical Pharmacy Specialist-Adult Hematology/Oncology;  Shannon M. Rotolo, PharmD, BCPS, University of Chicago Medical Center, Clinical Pharmacy Specialist-General Pediatrics.

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ICHP Poster Presentation – Student 5

(presented as Poster #42)

Category: Student-Research in Progress

Title: The Impact of Pharmacist-Driven Pantoprazole to Famotidine Substitution Protocol on Rates of Hospital-Acquired Clostridium difficile

Poster not presented.

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ICHP Poster Presentation – Student 6                     

(presented as Poster #43)

Category: Student-Research in Progress

Title: Evaluation of Pain Medication Management in Patients Admitted to a Large Academic Hospital

Poster not presented.

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Board of Pharmacy Update
Highlights of the March Board of Pharmacy Meeting

by Scott A. Meyers, Executive Vice President

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The March 14^th Board of Pharmacy Meeting was held at the Illinois Department of Financial and Professional Regulations offices in Springfield. These are the highlights of that meeting.

Practice Act Sunset – The Department is running two identical bills that will update the Pharmacy Practice Act Sunset date and a few other changes.  The bills, SB0902 sponsored by Sen. Dale Righter, R-Mattoon and HB3462 sponsored by Rep. Mike Zalewski, D-Riverside would extend the effective date of the Act through Dec. 31, 2027 and would also make a few minor changes including requirement of email addresses for each registrant or applicant, removal of State Board of Pharmacy member per diems, deletion of the minimum required number of pharmacy inspectors and deletion of the position of deputy pharmacy compliance coordinator. 

Affiliated Monitors – Beth Anne Compton, JD, Regional Director of Affiliated Monitors presented an overview of their company and services that could be used by pharmacies or pharmacists who have been court ordered independent monitors as a condition of a discipline against their licenses.  The company already works with the Illinois Medical Board as an independent monitor of physicians who have received discipline of some sort and are now required to provide regular reports from an independent monitor.  Situations like Medicare fraud, insurance fraud, diversion or other violations often require an outside company to provide reports to the Board.  Affiliated Monitors currently provide services to individual clients (not the State agencies, medical boards or pharmacy boards) in 27 State and have live cases where they monitor individuals practices defined by court order for five State Boards of Pharmacy in Rhode Island, New Jersey, Tennessee, Colorado and Nevada.  They have provided pharmacy monitoring services in Texas and Iowa in the past.  They work for and are paid by the disciplined individual but report to the respective medical or pharmacy board of that State.  The presentation was informational so that the Board and Department staff are familiar with their services.

2017 License Renewals – Chances are this article will be published in April, and the deadline for 2017 license renewals will be past (March 31^st).  This year only pharmacy technicians’, certified pharmacy technicians’ and student pharmacists’ licenses are up for renewal.  At the time of the Board meeting nearly two-thirds of the licensed individuals had still not renewed.  ICHP sent out a reminder to its pharmacy director members in March reminding them to make sure their technicians renewed before the deadline.

Legislative Update – At each Board of Pharmacy meeting, ICHP or IPhA staff provide a summary of pharmacy-related legislation before the General Assembly.  At this meeting a 23-page document was summarized by yours truly.  While ICHP has over 80 bills and resolutions that it is currently monitoring, about 20 of these bills were discussed.  A full report of bills before the General Assembly can be found in the Government Affairs Report in this issue of KeePosted.

Next Board of Pharmacy Meeting – The next meeting of the Illinois Board of Pharmacy will be held at 10:30 AM on Tuesday, May 9^th at the James R. Thompson Center in downtown Chicago.  Announcements and agendas are posted at least 14 days in advance on the IDFPR pharmacy website. The profession is welcome to attend the open portion of this meeting.

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Therapy Dog Thursday

College Connection

by Aprille Banchoencharoensuk, P2, ICHP Secretary, Rosalind Franklin University of Medicine and Science College of Pharmacy

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As students in a graduate program, we often find ourselves stressed out with upcoming exams and deadlines.  To cope with the stress, some students join intramural groups or others seek comfort from their family and friends.  However, this can be difficult with a busy schedule or when home is thousands of miles away.  There are others like myself who use a different outlet provided by our school - Therapy Dog Thursday. 

Therapy Dog Thursday is an event that is organized by a Rosalind Franklin University of Medicine and Science’s (RFUMS) faculty, Beth Friedman.  Once a month, Beth organizes the meetings with these cuddly pups from Our House of Hope Rescue.  This rescue organization was founded in 2007 and is led by a wonderful woman, Lisa Krinninger, who is the Executive Director.  Currently all of the dogs in this organization are living with foster families and are available for adoption.  For a few hours that day, the dogs join us for a time filled with belly rubs and scratches behind the ear.  Each visit we are always joined with new furry faces and once in a while, we get to meet the occasional rabbit. This organization also fosters and rehabilitates a variety of different animals such as gerbils, squirrels, and turtles.  This program serves as a great way for these animals to socialize and to find prospective homes.  It is also a great resource for animal lovers or those who find comfort in cute and fluffy four legged friends.

The first time I visited these pups, I was in my first year at RFUMS.  I was still acclimating to graduate school life and was stressed out due to having to commute two and half hours every day to school.  Therapy Dog Thursday fit right into my busy schedule, since it was offered on campus and during convenient hours around lunch.  I was able to walk right over to the area where these pups sat during my break and instantly, I was untroubled with the stresses of school and commuting.  All the dogs are so friendly and well behaved.  I was met with wagging tails and lots of kisses.  I sat there with the dogs and made my rounds to pet each one.  I paid particular attention to a scruffy black dog that reminded me a lot of my cousin’s dog I grew up with, that recently passed away.  I sat there for the remainder of the hour petting her and forgetting the laundry list of things I had to do.  Fellow classmates and students from other professional programs joined me that day for the company of these sweet dogs.  Therapy Dog Thursday is a great way to help students unwind and get away from our hectic schedules.  Somehow, just a simple visit from these furry friends can uplift the spirit, which is why I choose to continue to stop by when I can.

I am currently in my second year in pharmacy school at RFUMS. I no longer have the stress of commuting since I have moved closer to campus, but school is still as hectic as the previous year.  I stop by to visit the dogs whenever I can, even if it is for a few minutes.  Since moving closer to campus, I have had to leave my own dog at home which gives me a lot more reason to continue to visit these dogs.  This organization has helped me as well as countless other students and faculty by finding comfort in these friendly pups.

This program has been very well received since it began three years ago. A recent survey about the program was conducted and demonstrated positive impact on current and former students.  Therapy Dog Thursday has been able to help brighten days, while helping us destress from school, and cope with missing our own furry babies waiting for us at home while we attend school.  There is something soothing about visiting these animals which truly make them therapy dogs.  I look forward to many more Therapy Dog Thursdays and I hope that other schools will consider adopting a similar program as well.

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Developing Leadership, A Reflection

College Connection

by Lisa Nguyen, PS-3, ICHP-MWU Historian, Midwestern University Chicago College of Pharmacy

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Upcoming Events

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

Wednesday, April 12, 2017

NISHP CPE Program Double Feature - IMMUNOTHERAPY AGENTS

Part I: Understanding Lemtrada (Not for CPE Credit)

Barry Jay Riskin, MD

Part II: Management of Toxicities for Novel Immunotherapy Agents (CPE)

Young Bae, PharmD, BCPS, BCOP

Michael Schmidt, PharmD

Reel Club | Oakbrook, IL

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Thursday, April 13, 2017
Pharmacist Role in Hospice and Palliative Care
Chris Herndon, PharmD
West Central Society LIVE Program
Saint Francis Medical Center | Peoria, IL

Accredited for pharmacists and pharmacy technicians | 1.0 contact hour (0.1 CEU)

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Tuesday, May 9, 2017 - Save the Date
Combating the Opioid Epidemic Through SBIRT
Tran Tran, PharmD, BCPS
Champions LIVE Webinar

Accredited for pharmacists and pharmacy technicians | 0.5 contact hours (0.05 CEU)
Save the date! Watch for more information in upcoming news briefs.

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Tuesday, May 9, 2017 - Save the Date
Pharmacist Role in Hospice and Palliative Care
Chris Herndon, PharmD
Sangamis Society LIVE Program

Accredited for pharmacists and pharmacy technicians |1.0 contact hour (0.1 CEU)  Save the date! Watch for more information in upcoming news briefs.

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Tuesday, May 18, 2017 - Save the Date
Crohn's Disease and Ulcerative Colitis: New Perspectives in Therapy
Cassandra Collins, PharmD
OSF Saint Francis Medical Center, Peoria
West Central Society LIVE Program

Accredited for pharmacists and pharmacy technicians |1.0 contact hour (0.1 CEU) 
Save the date! Watch for more information in upcoming news briefs.

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Thursday, June 15, 2017
Cultivating Safety in the Pharmacy
Adam Bursua, Pharm.D., BCPS
Champions LIVE Webinar for Pharmacy Technicians

Accredited for pharmacy technicians and pharmacists | 0.5 contact hour (0.05 CEU)
Save the date! Watch for more information in upcoming news briefs.

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Saturday, July 1, 2017
2017 Best Practice Award Submissions Due
More information on the 2017 Best Practice Award and Program coming soon.

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Leadership Profile
Lara K. Ellinger, PharmD, BCPS - Drug Information and Medication Safety Pharmacist, Northwestern Memorial Hospital

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What is your current leadership position in ICHP?

Director of Educational Affairs

What benefits do you see in being active in a professional association such as ICHP?

Learning from and exchanging ideas with other like-minded pharmacists; being encouraged by colleagues to challenge myself; and working together to further the profession of pharmacy.

What initially motivated you to get involved in ICHP?

I liked the sense of community I felt at ICHP events and the idea of developing my pharmacy leadership skills outside of my work setting.

Where did you go to pharmacy school?

University of Illinois at Chicago College of Pharmacy (UIC)

Where have you trained and/or worked?

I completed a PGY-1 Pharmacy Residency at Northwestern Memorial Hospital (NMH) in Chicago and then completed a PGY-2 Drug Information Residency at UIC. After my PGY2, I began as a faculty member practicing in Drug Information at UIC, and currently I work in drug information and medication safety at NMH.

What special accomplishments have you achieved?

I think staying involved and active in my career and balancing my home life is a special accomplishment J

Describe your current area of practice and practice setting.

I work in a large academic medical center in downtown Chicago. I have a hybrid position that includes drug information, medication use policy, and medication safety. I respond to drug information requests from practitioners within the institution; prepare monographs and help coordinate P&T committees; serve as pharmacy lead for the Medication Safety P&T Committee; review medication errors and adverse events; and make process changes to prevent errors and facilitate creating a just culture in my department and institution overall. The best part of my job is collaborating with multiple departments (e.g., Risk, Quality, Performance Improvement) to implement changes that make our institution safer for patients.  

Is there an individual you admire or look up to or a mentor that has influenced your career?

Desi Kotis for setting daily examples of leadership and leading me to numerous career-advancing opportunities; Joan Stachnik for endless support and reminders to stay balanced in life; Mike Gabay for instilling thoroughness and efficiency in all of my work; Amy Lodolce for treating me as a colleague when I was a resident; and Mike Fotis for encouraging me to always seek opportunities for involvement in the profession of pharmacy.

What advice would you give to student pharmacists?

Whatever you choose to do right after graduation, keep in mind that it’s actually not the most important decision despite it feeling that way sometimes! There are also multiple pathways to get to where you want to be. For most people, where they want to be is constantly evolving.

What pharmacy related issues keep you up at night?

Figuring out how I can best utilize residents and students to help me get projects done. I really can’t be effective in this position without them. It’s a win-win situation!

Do you have any special interests or hobbies outside of work?

Of course! They include hiking, skiing, crafting, and calligraphy.

Do you have a favorite restaurant or food?

I eat everything! A great place for steak is Bavette’s in Chicago. Although they don’t advertise it, you can bring in your own bottle(s) of wine, but their rule is you have to share a glass with someone else dining there. You can either choose who you give the glass to or the server can. The food is so good, I usually have to be rolled out of that place.

What is your favorite place to vacation?

Anywhere that has mountains

What is the most interesting/unique fact about yourself that few people know?

I’ve climbed and summited a few mountains!

What 3 adjectives would people use to best describe you?

Proactive, reliable, motivated

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ICHP Pharmacy Action Fund (PAC) Contributors

Names below reflect donations between January 1, 2016 and January 1, 2017. Giving categories reflect each person's cumulative donations since inception.          Save to PDF

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Officers and Board of Directors

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JENNIFER ARNOLDI 
Secretary 
jearnol@gmail.com

LARA ELLINGER 
Director, Educational Affairs 
laelling@nm.org

CARRIE VOGLER

Director, Marketing Affairs

217-545-5394

cvogler@siue.edu

KRISTI STICE 
Director, Professional Affairs

217-544-6464 ext.44660 
kristi.stice@hshs.org

CAROL HEUNISCH 
Director, Organizational Affairs 

847-933-6811

cheunisch@northshore.org

KATHRYN SCHULTZ

Director, Government Affairs

312-926-6961

kathryn_schultz@rush.edu

DAVID TJHIO 

Chairman, Committee on Technology 
816-885-4649 
david.tjhio@bd.com

COLLEEN BOHNENKAMP

Chairman, New Practitioners Network

Colleen.Bohnenkamp@nm.org

BRYAN MCCARTHY

Co-Chairman, Ambulatory Care Network

Bryan.McCarthy@uchospitals.edu

VIRGINIA NASH

Co-Chairman, Ambulatory Care Network

nash_virginia@msn.com

CLARA GARY

Technician Representative

cgary1@uic.edu

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

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

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

Regional Directors

NOELLE CHAPMAN 
Regional Director North

312-926-2547

nchapman@nmh.org 

ED RAINVILLE 
Regional Director Central 
ed.c.rainville@osfhealthcare.org 

LYNN FROMM 
Regional Co-Director South

618-391-5539

frommL@andersonhospital.org

TARA VICKERY GORDEN 
Regional Co-Director South

618-643-2361 x2330

tvgorden@hmhospital.org

Student Chapter Presidents

FLORENCE PATINO 
President, Student Chapter 
Chicago State University C.O.P. 

fpatino@csu.edu

SHAZIYA BARKAT 

President, Student Chapter

Midwestern University Chicago C.O.P. 
sbarkat14@midwestern.edu

KASIA PLIS 
President, Student Chapter 
Roosevelt University C.O.P. 

kplis@mail.roosevelt.edu

JORIE KREITMAN 
President, Student Chapter 
Rosalind Franklin University C.O.P. 
jorie.kreitman@my.rfums.org

MALLORY BELCHER 
President, Student Chapter 
Southern Illinois University Edwardsville S.O.P
mabelch@siue.edu

LEVI PILONES 
President, Chicago Student Chapter
University of IL C.O.P. 
lpilon2@uic.edu 

TREVOR LUMAN 
President, Rockford Student Chapter 
University of IL C.O.P. 
tluman2@uic.edu

ICHP Affiliates 

ANTOINE JENKINS 
President, Northern IL Society (NISHP)

at-jenkins@csu.edu

JARED SHELEY 
President, Metro East Society (MESHP)

jpsheley@gmail.com 

KATELYN CONKLEN 
President, Sangamiss Society

Conklen.Katelyn@mhsil.com

ED RAINVILLE 
President, West Central Society (WSHP)  
ed.c.rainville@osfhealthcare.org

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

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Welcome New Members!

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Welcome New Members:

New Member	Recruiter
Mohammed Alchaar	Lauren Stambolic
Angela Barnes
Jacqueline Barraclough
Mike Bolanos
Melissa Bonacquisti
Todd Branson	Ken Ring
Toni Burke
Patricia Cantieri
Ashley Cha	Lauren Stambolic
Benjamin Chong
Teresa Colvin
Deb Egerere
Lauren Ellis
Nicole Ewald
Michelle Fine
Ernestine Foster	Jan Keresztes
Tomas Garbaliauskas
Paloma Garcia	Katarzyna Plis
Sheila Grasso
Michele Hentcheu
Genie Lil Herrera	Darina McDee
Serin Homsi	Lauren Stambolic
Deborah Jafraty
Don Janczak
Holly Jones	Cheryl Scantlen
Taylor Jones
Theodora Jurichko
Katie Kaczmarski
Amir Kagdi
Jennifer Karp	Jo Ann Haley
Beverly Kenny
Kristina Laurente
Amy Lee
Pohung Lin
Christine Lydon	Lauren Stambolic
Anna Majerczak	Katarzyna Plis
Katrina Marquez
Nichele Marquis	Matthew Vogel
Doug Moon
Victoria Nguyen
Darlene Nicoloff
Selina Nokes
Kara Ozee	Kristi Stice
Tuyen Pham	Yuxiang Ou
Kenneth Ring
Christy Roe
Drazen Savic	Michelle Jeong
Paul Stranges
Alaa Sulh	Katarzyna Plis
Leke Sylaj
Patrick Tednes
Scott Tyler
Adam Wahab
Dyson Wake	Henry Dunnenberger
Hannah Wake	Henry Dunnenberger
Asha Yusuf   Save to PDF

Legislative Day 2017
Under the Dome

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