2025 Southeastern Residency Conference

Title: Impact of a Pharmacist Daily Medication Review on the Rates of Intravenous to Oral Conversions and Renal Dose Adjustments 
 
Authors: Johny Nguyen and Lisa Gibbs  


Objective/Self Assessment: Will be included in the presentation 
 
Background/Purpose: A hospitalized patient’s clinical status may fluctuate during their admission, requiring monitoring of medications for potential renal dose adjustments or transitions from intravenous (IV) to oral (PO) routes of administration. Pharmacist led IV to PO and renal dose adjustment protocols have been created at our institution but are not utilized on a consistent basis. Our pharmacy practice model consists of pharmacists following service lines within our institution (e.g., cardiology, psychiatry, internal medicine). However, patients who are covered by hospitalists do not have a dedicated pharmacist.
Preliminary data was collected in September and October of 2024 to assess the number of eligible IV orders for conversion using our existing protocol as well as the need for an expanded renal dose adjustment protocol beyond antimicrobials. This data showed an opportunity for improvement in the utilization of our protocols as well as cost-savings for our institution. Additionally, an adjustment was made to the renal adjustment protocol to include famotidine and gabapentin based on preliminary data. This project aims to evaluate the impact of utilizing our institution’s renal dose and IV to PO protocols within a newly implemented decentralized floor-based pharmacist model.

Methodology: This study is a prospective analysis that was conducted during a 4-week span in February and March 2025. All adult patients admitted to medical or telemetry monitored floors at Self Regional Healthcare were included. A pharmacist was stationed on each floor for daily monitoring of patients' medication therapy, including renal dose adjustments and IV to PO opportunities. Patients receiving medications included in our protocols were flagged for potential adjustment using our institution's electronic health record software functionality. Patients were also assessed for medication adjustments outside of pharmacy approved protocols. The primary outcome of this study was the number of IV to PO or renal adjustment interventions made per protocol. Secondary outcomes include number of IV to PO or renal dose adjustment interventions made outside of protocol via recommendation to provider, provider acceptance rates, and IV to PO cost savings.
Results:

Between February 24th, 2025 – March 26th, 2025, 1046 patients were admitted to medical and telemetry-monitored floors. During this period, 37 IV to PO transitions occurred and 68 medications were renally dosed adjusted. Of the 68 medications that were renally dose adjusted, 62 were adjusted per protocol and 6 outside of protocol. Similarly, 34 medications were transitioned to PO per protocol while 3 were outside of protocol. Provider acceptance was 100% for enoxaparin, sitagliptin, and rosuvastatin renal dose adjustment recommendations but 0% for pravastatin. Both folic acid and thiamine transition to PO therapy achieved a 100% provider acceptance rate. Total cost savings from IV to PO transitions was $1,135.44, with the greatest savings seen with levothyroxine, at $737.

Conclusion: Ultimately, having a pharmacist located on the floors to perform renal dose adjustments and IV to PO transitions improved patient care and reduced healthcare-associated costs.

Title: Empowering Pharmacy Practice through Data Democratization
 
Authors: Benjamin G. Edouard, Sydney Kchao, Alyssa Billmeyer


Background: Data democratization is the process of making data accessible, comprehensible, and functional within all members of an organization. This study aims to identify and assess data utilization and the quality of data democratization within pharmaceutical services. Historically, data access and reports have been consolidated to a team of analytic specialists. However, pharmacists today may need critical information but may face challenges in finding the best way to access the right resources or information. The implementation of analytics within the healthcare setting has grown exponentially as technology evolves, but pharmacy practice still has an opportunity to grow. This study plans to test this concept within a hospital system to gauge how pharmacists stand to benefit from sifting through data more efficiently when the tools are more easily accessible. The value to the organization’s front-line pharmacists will be the empowerment to make robust and impactful clinical decisions that are data-driven. When pharmacists have more access to the right data, it could result in more ideas, innovations, creative interventions, and more informed therapeutic management. 
 
Methods: The study design focused on pre-post surveys to assess the impact on pharmacists’ daily activities. The source of participants were the Emory University Hospital Midtown’s clinical pharmacists as a nonrandomized control group. Staff was contacted through email with the pre-surveys attached. Clinical pharmacy specialists who work within the inpatient, oncology, or ambulatory care areas of Emory Healthcare and who have an identified need for the use of data within their work area were the inclusion criteria set in the study. Once all of the pre-surveys are collected, they will be analyzed to implement training sessions for the clinical pharmacy specialists on using SlicerDicer and other data analytics tools to obtain information that may be useful to them to make daily interventions. For the study’s primary outcome, clinical pharmacists participating in the survey were sent a pre-intervention survey to measure baseline use of data and how it impacts their clinical decisions, and it will be contrasted with a post-intervention survey. The post-intervention survey reassesses the pharmacist’s views on the tools and accessibility of data needs. Secondary outcomes will include reporting analytics used by pharmacists to assess changes in practice, such as the number of reports and average duration of access. These outcomes will help assess changes in attitudes, perceptions, behavior, practices, barriers, and challenges around data access that could benefit pharmacy practice. The surveys are being collected from Microsoft Forms, and then the results will be measured using Microsoft Excel spreadsheets. Data collection will also be sourced from Epic Systems at Emory University Hospital Midtown. SlicerDicer software is also within Epic; reports will be gathered from there specifically. Statistical analysis methods will include tests for reliability and validity among the surveys. 
 
Results: Preliminary survey results included 17 responses from EUHM clinical pharmacists. The clinical areas represented in the pre-survey included, but were not limited to, cardiac critical care, hepatology, and oncology. When asked to identify specific data elements that could be reported to them and how these elements would support their daily tasks, 16 out of 17 participants identified gaps in data accessibility. Nearly 60% of the requested data access types aligned with Reporting Workbench functionality, while approximately 30% of the desired data elements corresponded with SlicerDicer capabilities. Additional results are pending and will further clarify pharmacists’ data accessibility needs and whether the staff felt the intervention helped their workflow. 


Conclusions: In Progress  

Title: Activation Accuracy of Proprietary Bag and Vial Systems

Authors: Ellis Simerly, Becky Goldstein, Scott Gourley, George Smith, Doug Furmanek, Harrison Jozefczyk

Objective: The primary endpoint was the proportion of properly activated bag and vial systems.

Self-Assessment Question: Are proprietary bag and vial systems properly activated by nursing staff?

Background: Proper medication administration is critical to ensuring patient safety and therapeutic efficacy, with device activation playing a central role in preventing errors. Proprietary bag and vial systems are widely used in clinical settings to facilitate accurate medication delivery However, improper activation of these devices could result in medication errors, suboptimal dosing, and adverse patient outcomes. Despite widespread use, there is limited published research examining the accuracy of proprietary bag and vial system activation. Lack of research in activation systems leaves a gap in understanding of activation errors and their potential prevalence. This study aimed to address this gap by evaluating the accuracy of proprietary bag and vial system activation in clinical settings. By identifying error rates of common activation mistakes, this research sought to inform improvements in training, protocols, and device usage, ultimately enhancing patient safety and medication administration practices.

Methods: This study was conducted over one month or until 100 encounters were audited. The primary endpoint was the proportion of properly activated bag and vial systems. The secondary endpoints were to identify patterns of activation errors related to specific drugs and evaluate the distribution of activation errors across different levels of inpatient acuity. Report generation identified encounters where these activation systems were to be utilized. In-person audits were then performed to verify activation status. Focus was on the device malfunction rather than evaluating individual providers. Device malfunction was defined as the vial not securely attached to the bag, the incomplete transfer of medication into diluent, the incomplete mixing of the medication in the vial, or the compromised integrity of the system due to leaks of contamination. Audits were conducted by a trained research team member, who underwent training on study objectives, data recording, and intervention policy. This study followed a non-punitive, quality improvement approach, ensuring that identifiable provider information was not linked to observations to maintain confidentiality. Observations were documented on paper and transcribed into a secure data collection tool for analysis.

Results: A total of 85 observations were made, with 96% of proprietary bag and vial systems properly activated. The remaining 4% of errors were found exclusively on medical-surgical nursing units. Of these errors, 33% (n=1) involved pre-attached IV admixture systems with ampicillin-sulbactam, while 67% (n=2) were associated with vial reconstitution adapter systems and vancomycin. The errors with pre-attached systems involved incomplete reconstitution, while those with vial reconstitution systems were due to incomplete transfer to diluent.

Conclusion: This study identified a 4% overall error rate, with vial reconstitution adapter systems accounting for 67% of errors, all of which occurred on medical-surgical nursing units, highlighting a need for targeted education. Future steps could include implementing training focused on proper activation techniques, utilizing a checklist with automated alerts for each activation process, and conducting a follow-up study to evaluate post-education error rates. Limitations include the national fluid shortage, which likely reduced system use and underestimated error rates, as well as the study’s reliance on a single observer.

OPIOID CONSUMPTION: THE IMPACT OF REVISIONS TO AN INPATIENT OPIOID ORDER SET
Eisha Ludtke, Lisa Scott, MaryAnn Birch
HCA Florida West Hospital-Pensacola, FL

Background/Purpose:
Investigate the impact of revisions made to an inpatient opioid order set on overall opioid consumption amongst hospitalized patients and education given to providers regarding the new order sets.

Methodology:
This single-center quasi-experimental study conducted at a 515-bed academic hospital with data collection beginning September 2024 and was continued until March of 2025. Patients were excluded if admitted to the labor and delivery unit, the intensive care unit, palliative care, or to the operating room. Patients with active malignancy, opioid use disorder, opioid reversal prior to admission, opioid tolerance, scheduled opioid use, pain management consults, contraindications or allergies to study drugs, incomplete pain scale documentation by nursing, or non-numerical pain scale orders were also excluded from this study. Cohort 1 consists of patients prescribed both opioids and non-opioids (acetaminophen or ibuprofen) outside the opioid order set. Cohort 2 includes patients prescribed analgesic medications from the revised opioid order set. Cohorts were identified through facility surveillance software reports. The study evaluates the frequency of opioid administration. The primary endpoint of this study evaluated the average MME administered per 24 hours of a patient's stay, while secondary endpoints included the number of times the available MME increased, the percentage of patients with breakthrough pain orders, the number of times an opioid for breakthrough pain was given divided by the inclusion time, the percentage of patients with a scheduled acetaminophen order, and the frequency a non-opioid was given for analgesia divided by inclusion time.

Results:
Baseline demographics between both cohorts, including age, sex, race, BMI, Charleston Comorbidity Index, surgical patient status, prior opioid use, presence of adjunctive pain medication, and length of stay, showed no statistical differences. For the primary endpoint, there were no statistical differences between cohort 1 and cohort 2 regarding the mean MME consumed by hospitalized patients per 24 hours of their stay, the number of times the MME increased throughout the stay, or the number of times an order for breakthrough pain was given, divided by the inclusion time (p-values: 0.9952, 0.5572, and 0.1121, respectively). The implementation of the order set increased the percentage of patients with a breakthrough pain order from 31% to 60%, demonstrating a statistically significant difference between pre- and post-intervention groups (p-value: 0.0031). An increase in the percentage of patients with a scheduled acetaminophen order from 19% to 88% post-intervention was observed (p-value: <0.0001). Lastly, there was a statistically significant increase in the frequency of either acetaminophen or NSAID administration for analgesia, divided by inclusion time, indicating more administrations of non-opioids in the post-intervention group (p-value: 0.0453).

Conclusions:
Despite the addition of a breakthrough pain (BTP) order, there was no statistical difference in average morphine milligram equivalents (MME) per day, although the number of BTP orders increased significantly. This increase was anticipated due to the prechecked BTP order in the new set, which physicians could uncheck if desired. Concerns about increased opioid consumption were unfounded, as BTP orders involved lower potency opioids compared to those for moderate or severe pain. The unchanged MME, combined with significant BTP order results, indicates that standardizing the order set improved overall pain control. While there was no statistical difference in early opioid administration, offering a lower potency BTP opioid may theoretically reduce early administrations due to uncontrolled pain. Scheduling acetaminophen led to better around-the-clock pain control and increased use of opioid-sparing agents. The prechecked scheduled acetaminophen order encouraged non-opioid analgesia. Limitations include a restricted sample size due to the time required for implementation and education, and some providers' preference for custom order sets. A larger sample size and proper use of the new order set could demonstrate lower opioid use and greater utilization of opioid-sparing agents. Further data collection is needed to assess these outcomes. Potential confounders include cognitive issues and drug-seeking behavior, which could affect pain perception and reporting.

Presentation Objective:
Review the impact of a revised analgesic order set on opioid consumption, non-opioid analgesic use, early opioid administrations, dose increases, and morphine equivalent increases, while also exploring how these changes influenced patient care and treatment preferences for moderate to severe pain.

Best Contact for Follow Up: Eisha Ludtke, eisha.ludtke@hcahealthcare.com

Title: Implementation of a Pharmacist-Managed Buprenorphine Induction Protocol for Patients with Opioid Use Disorder (OUD) in the Inpatient Setting  


Authors: Madeline Lysogorski, PharmD, Charleen Melton, PharmD, BCCCP, Holly McLean PharmD, CPP, BCPS, BCCCP, Joe Norton PharmD, BCPS  
 
Background: 
In recent years, there has been an increase in research published discussing high-dose buprenorphine for induction of Medication-Assisted Therapy (MAT) in patients with Opioid Use Disorder (OUD), with the primary setting being inpatient induction. However, none of these studies specifically highlight interventions that can be made by a clinical pharmacist during the induction process. This study aims to evaluate the impact of a pharmacist-managed buprenorphine MAT- induction protocol in hospitalized patients with OUD. 
 
Methods:  
This study is being conducted as a prospective chart review at CaroMont Regional Medical Center, a 476-bed not-for-profit community hospital located in Gastonia, NC. Patients will be evaluated for withdrawal symptoms by an attending physician, who will subsequently order a pharmacy consult for patients to be initiated on buprenorphine. The patients will then be enrolled in the pharmacy protocol and followed until they are successfully maintained on their maintenance dose (Day 3 of the consult). Data will be collected utilizing the hospital’s electronic health record (EHR) and will evaluate patients that were initiated on the buprenorphine initiation protocol from November 1st, 2024, through March 31st, 2025. Those included in the study will be adult inpatients over 18 years old that are initiated on the pharmacist-managed buprenorphine protocol. Patients will be excluded if they are part of a vulnerable population (under 18 years old or incarcerated), if they are already established on a buprenorphine/naloxone regimen outpatient, or if they were initiated on buprenorphine in the emergency department (ED) and discharged to complete induction outpatient. The primary outcome to analyze in this study is the number of patients who had successful buprenorphine induction on the pharmacist-managed protocol, defined as the patient not leaving AMA, completing the induction protocol during their admission, and being successfully connected to care at discharge.  
 
Results: A total of 15 patients were enrolled in the study. 13/15 patients (86.66%) had successful induction, and met our primary endpoint . 2/15 patients left AMA prior to completion of the protocol, with the average hospital length of stay being 4.5 days. The average total daily dose of buprenorphine that patients received was 19.6mg, and the average total buprenorphine dose received during admission was 58.3mg. The majority of patients (8/15) were connected to care with a local health department that provides MAT services with a bridge prescription until they were able to be seen by a provider. 
 
Conclusions: High dose buprenorphine induction in the inpatient setting is the ideal environment, due to consistent monitoring for withdrawal management. No patients in this study failed induction due to adverse events. Addressing institutional barriers can make the protocol more successful and increase recruitment. 

Title:
Evaluating the Impact of an Intravenous Workflow Management System on Error Detection During Sterile Compounding
Authors:
Alex Kwan, Christopher Duphren 
Objective:
To evaluate the error detection rate and error types between products prepared without technology and those with IVWMS. 
Self Assessment Question:
Does the use of IVWMS increase the detection of errors during IV compounding, True or False?
Background: 
            Intravenous (IV) medication errors remain a significant patient safety concern, with manual preparation error rates reaching up to 37% for complex solutions. To mitigate this, hospitals are adopting IV workflow management systems (IVWMS), which utilize barcode scanning and volumetric verification to enhance error detection when verifying compounding sterile products (CSP). Studies have shown that IVWMS detect errors at significantly higher rates than manual processes and eliminate incorrect drug errors. Despite these benefits, adoption is limited; only 24.7% of larger hospitals had implemented such technology by 2017. The Institute for Safe Medication Practices (ISMP) emphasizes the importance of these technologies for improving IV preparation safety. This study aims to evaluate the implementation of an IVWMS at a tertiary hospital to assess its impact on compounding accuracy and efficiency. 
Methods:
            This single-center, prospective study with retrospective data collection aims to assess the impact of an IVWMS on reducing medication errors during IV medication preparation in a hospital setting. The primary objective of this study is to evaluate the error detection rate and error types between products prepared without technology and those with IVWMS. The secondary objective was to evaluate the benefit of IVWMS between adult and pediatric IV doses. Compounded sterile products produced at the inpatient pharmacy of Wellstar MCG and the Children’s Hospital of Georgia two weeks before and after the implementation of IVWMS were evaluated. Compounded chemotherapy, parenteral nutrition, and renal replacement therapy were excluded. Pharmacists were given a standard data collection form and instructed to record errors identified during compounding before IVWMS. Post-IVWMS error detection reports were generated from the software and analyzed. Errors were defined as deviations from the details on the patient label or institutional CSP preparation policies. Descriptive statistics, including means, medians, and frequencies, will be used to characterize the data and compare pre- and post-implementation groups to assess the impact of the IVWMS.
Results:
The total number of IV doses prepared before and after the implementation of the IVWMS were 2818 and 3183, respectively. IVWMS significantly enhanced error detection during intravenous medication compounding (n = 25, 0.89% vs. n = 281, 8.83%; p < 0.05). The top three error types before IVWMS were incorrect medication (32%), compounding method or technique issue (28%), and incorrect medication volume (24%). With IVWMS, incorrect medication was the most common error detected (92%). The types of errors detected were similar with IVWMS compared to without IVWMS across adult and pediatric populations. The frequency of errors detected for pediatric patients increased after the implementation of IVWMS (n = 13, 52% vs. n = 198, 70.5%).
Conclusion:
The large increase in post-implementation errors reflects the enhanced detection and documentation capabilities of the IVWMS. Compounding technique-related issues decreased post-implementation, which may suggest that IVWMS standardizes compounding practices. A significant implementation challenge identified was the need for frequent mixture record maintenance due to concurrent EHR transition, highlighting the importance of accurate master formula documentation for reliable barcode scanning verification. The use of IVWMS demonstrated improvement in detecting potential intravenous medication compounding errors, with a 10-fold increase in error detection. Study findings emphasize the critical importance of maintaining accurate mixture records within the IVWMS for optimal error detection. Future focus should include ongoing monitoring of IVWMS compounding records, regular updates to mixture records, and continued assessment of error patterns to optimize IVWMS effectiveness.

Title: Clinical Impact of Pharmacist Involvement in Discharge Medication Reconciliation at a Rural Community Hospital 

Authors: Kyli Latimer, Abigayle Campbell

Background: Medication discrepancies occurring at hospital discharge have shown increased risk of adverse patient outcomes, hospital readmissions, and overall health care cost. Incorporation of a pharmacist within the discharge process can allow effective communication between transitions of care, prevent medication errors, and prevent patient harm. The objective of this study was to evaluate the impact of pharmacists on the discharge medication reconciliation process at a rural community hospital. 

Methods: This was a single center, retrospective chart review, pre-post pilot implementation study taken place at a rural community hospital. The pilot implementation period was conducted from February 24th, 2025 to March 26th, 2025, and consisted of having a clinical pharmacist decentralized to four different medical or telemetry floors (non-intensive care units). Pharmacist responsibilities primarily included discharge medication reconciliation and patient education, renal dose adjustments, anticoagulation monitoring and management, and transitioning therapies from intravenous to oral (IV to PO) routes. Retrospective data was collected over a one-week period for both the pre- (September 18th, 2023 to September 25th, 2023) and post- (March 17th, 2025 to March 24th, 2025) pilot groups. Adult patients discharged from one of four medical or telemetry floors were included in the study. Patients were excluded if they were discharged from any other patient care floor or outside of the designated hours of pharmacist coverage (weekdays from 0700 to 1530). Any patients that were discharged to a skilled nursing or rehabilitation facility were also excluded from receiving medication education at discharge. The primary outcome was the percentage of patients who had pharmacist involvement in the discharge process, defined as receiving both discharge medication reconciliation and medication education. Secondary outcomes assessed included the total number of medication errors identified during discharge medication reconciliation, the type and associated harm of each error, as well as patient discharge location. 

Results: A total of 170 patients were included in this study (93 patients in the pre-pilot group and 77 patients in the post-pilot group). Baseline characteristics were overall similar between groups. The percentage of patients that had both discharge medication reconciliation and medication education completed by a pharmacist increased by 16.6% (23.7% pre-pilot group vs. 40.3% post-pilot group). The number of medication errors identified at discharge was also higher in the post-pilot group compared to the pre-pilot group (22 (2.1%) vs. 7 (0.59%)). The most common type of medication error identified at discharge in both groups was ‘other’, often due to discrepancies with the frequency, directions, or patients’ preferred pharmacy at discharge.  

Conclusion: In this study, a higher percentage of patients had a pharmacist involved in the discharge process during the post-intervention group compared to those patients in the pre-pilot group, which also resulted in an increase in the percentage of medication errors identified in the post-pilot group. Limitations of this study include it being a retrospective chart review with minimal sample size, reliance on pharmacy specific documentation, and the limited study period of review. Despite this, these results show the benefit of pharmacist involvement in the discharge process. Future directions include the optimization and standardization of the current discharge process as well as the implementation of a pharmacist-led discharge process. 

Contact: kyli.latimer@selfregional.org

Title: THE USE OF LEVOCARNITINE AND VITAMIN B IN ADULT PATIENTS WITH ACUTE LYMPHOBLASTIC LUKEMIA RECEIVING PEGASPARGASE


Authors: Veronica Bekheit, Caralyn Escobar, Hunter Burnstine, Stephen Tomasek


Background: Pegaspargase, a key component in the treatment of acute lymphoblastic leukemia (ALL), is associated with significant toxicities, including hepatoxicity, which can impact treatment tolerance and outcomes. Levocarnitine and vitamin B supplementation have been proposed as potential adjuncts to mitigate these adverse effects. This study aims to describe the utilization patterns of levocarnitine and vitamin B in adult patients with ALL receiving pegaspargase and assess trends in patient outcomes. 

Methods: A retrospective, descriptive analysis was conducted on adult patients ≥18 years old diagnosed with ALL who received pegaspargase as part of their chemotherapy regimen. Patient demographics, liver function test results, pancreatic liver enzyme levels, and levocarnitine and vitamin B supplementation regimens were gathered through a retrospective chart review. Trends in laboratory values before and after supplementation were analyzed.

Results: The group receiving both levocarnitine and vitamin B experienced a higher number of mild hepatotoxicity cases (Grades 1–2); however, instances of severe toxicity (Grades 3–4) were still observed. The use of levocarnitine and vitamin B may help maintain liver enzymes (AST, ALT, ALP) and pancreatic markers (amylase, lipase) closer to baseline levels. This suggests a potential role in reducing the severity of treatment-related toxicities.

Conclusion: Levocarnitine and vitamin B supplementation may help maintain normal liver and pancreatic enzyme levels during pegaspargase therapy. This approach shows potential to reduce treatment-related toxicities and may serve as a low-risk supportive care strategy for similar patient populations at other institutions.

Survey of Healthcare Professionals’ Satisfaction and Perceived Impact on Quality of Care with Pharmacy Pain Management Services 
Alice Chang, Danny Basri, Jasmine Jones, Arielle Spurley 
 
 
Background/Purpose:   
Wellstar Kennestone Hospital (KH) initiated an inpatient pain management consult service to provide additional support for patients not managed by palliative care or anesthesia-led acute pain consult services. Previous studies have demonstrated that involvement of a pharmacy pain management service is associated with better pain control and functional improvement. There is limited research that describes healthcare professionals’ (HCP) perceptions on the impact of pharmacy pain management services. We evaluated HCP satisfaction with pharmacy pain management services and characterized their perceived impact on the quality of patient care. 
 
Methods:  
The survey was based on existing literature and prior feedback from HCPs. To enhance clarity, the survey was pretested with a multidisciplinary focus group including members of the KH Pain Assessment and Management Committee and external colleagues. The survey tool was updated based on respondents’ feedback. This study was conducted at Wellstar Kennestone Hospital from April 1, 2024, to July 31, 2024. A voluntary, anonymous survey using Microsoft Forms was distributed to prescribers (physicians and advanced practice providers), pharmacists, and nurses via email. Unit leaders also shared a link to the survey with their nursing staff during shift huddles. The study was approved by the Wellstar IRB, and informed consent was obtained from each respondent at the start of the survey to confirm their willingness to participate. 
 
Results:  
Of the 105 respondents, 86% agreed or strongly agreed the involvement of the pharmacy pain service improved patient care quality. Additional perceived benefits included professional confidence and efficiency: 82% felt increased professional confidence in their ability to provide quality care to their patients and 77% reported the pharmacy pain service allowed them to spend time on other patient care activities. Furthermore, 84% indicated improvement in the quality of communication between the treatment team and the patient and 86% noted the pharmacy pain service improves a patient’s understanding of the pain management plan and goals. Respondents expressed strong endorsement of the pharmacy pain management services in the comments section. However, while many comments suggested expanding the availability and scope of the pain consult service, only 68.6% preferred the pain management pharmacist independently make dose adjustments to currently ordered pain medications. 
 
Conclusion:  
The availability of pharmacy pain services resulted in a high level of satisfaction and perceived benefits amongst prescribers, nurses, and pharmacists. Most respondents reported that communication and patient understanding of their treatment were improved when the pharmacy pain management service was asked to assist in a patient’s care. Respondents supported expansion of pharmacy pain service availability. However, there was less support for pharmacists to be granted the authority to make independent medication adjustments. Further research is needed to explore differences in perceptions regarding advanced pharmacy practice roles to better understand the factors influencing HCPs’ views. 
 

UTILIZATION OF PATIENT ALIGNED CARE TEAM CLINICAL PHARMACIST PRACTITIONERS TO DECREASE ENDOCRINOLOGY COMMUNITY CARE CONSULTS


Kaile Allen, Amanda Carlisle, Bridget Roop
Birmingham VA Health Care System- Birmingham, AL


The United States has a large percentage of individuals with at least one chronic disease state. It has been reported that about 37 million Americans are diagnosed with diabetes. Clinical Pharmacy Practitioners (CPPs) are some of the most accessible healthcare providers for managing chronic disease states, such as diabetes. The Birmingham VA Healthcare System (BVAHCS) utilizes multiple community-based outpatient clinics (CBOCs) with designated CPPs to serve its Veteran population. The purpose of this project is to increase utilization of CPPs before considering endocrinology referrals for patients with Type II diabetes.




The project will consist of a retrospective chart review to obtain data in regard to endocrinology referrals and the appropriateness of the referral. The retrospective data will be from FY 2023-2024 and collected on a specific data collection form. BVAHCS Veterans will be included if they are diagnosed with type 2 diabetes and referred to an endocrinologist. A post-intervention analysis will consist of reviewing patients referred to a CPP and endocrinology after the education on CPP consults is provided to the CBOC providers. The data will be reviewed by means of descriptive statistics to identify trends in A1c, renewed community care referrals once A1c goal is achieved, and the number of patients referred to CPPs pre-and post-interventional education and the number of endocrinology consults pre- and post-intervention.


178 patients were included in this project from FY23-FY24. The average A1c prior to endocrinology referral for FY23 and FY24 was 9.0% and 8.9%, respectively. The average A1c post-endocrinology referral was 7.8% for both FY23 and FY24. 42% of patients from FY23 after seeing endocrinology had an A1c of <7% and 84% of those patients continued to see endocrinology regardless of achieving a target A1c goal. 40% of patients from FY24 after seeing endocrinology had an A1c of <7% and 94% of those patients continued to see endocrinology regardless of obtaining a target A1c goal. 58% of patients from FY23 and 60% of patients from FY24 had an A1c of >7%. 83% and 90% of those patients from FY23 and FY24, respectively, continued to see the endocrinologist and continued to have an uncontrolled A1c. FY24 data in regard to CPP consults revealed 17 consults within a 6 month period averaging about 3 consults per month. Post-intervention, the data revealed 21 new CPP consults in a 3 month period, averaging about 8 consults per month. Post-Intervention CPP Consults increased by about 40% or around 5 consults per month. Due to the time limitations of this study, a change in the number of endocrinology consults was not observed.


We observed an increase in CPP utilization after provider education was provided by our academic detailing pharmacist on the utilization of CPPs prior to placing community care endocrinology referrals. We also observed that many patients continue to see these specialized providers regardless of obtaining an A1c at goal. This was an important discovery and the renewal process for endocrinology consults is an area that revealed promise for process improvement. Future directions could include investigating the criteria for community care renewals, especially for chronic disease states that can be managed by VA CPPs and the monetary impact of CC at the BVAHCS.

Resident email: kaile.allen@va.gov

Title: Evaluation of the Clinical Pharmacist’s Role on Interdisciplinary Rounds within an Acute Collaborative Care Unit
Authors: Ebony Crawford, Pam Ku, Maegan Whitworth, Alexandra Cooper
Background: Clinical pharmacists are well established as essential members of interdisciplinary healthcare teams, particularly during bedside academic roun ds. Specifically, clinical pharmacists integrated into interdisciplinary rounds have been shown to improve patient outcomes and reduce adverse drug events and healthcare costs. However, the role and impact of pharmacists in non-academic settings, where there is less emphasis on education and more on interdisciplinary communication, efficiency, and patient through-put, remains underexplored. In April 2024, Wellstar MCG Health piloted structured non-academic interdisciplinary rounds (IDRs) led by hospital medicine providers on Acute Collaborative Care Units (ACCUs).  These rounds aim to improve communication and standardize the discharge process, ultimately to optimize patient outcomes and through-put. The purpose of this study is to quantify and characterize the clinical and financial contributions of acute care medicine pharmacists participating in hospital medicine IDRs within an ACCU and to determine the optimal allocation of clinical pharmacist resources. 
Methods: This was a single-center, retrospective, observational study that included patients ≥ 18 years old who were admitted to an ACCU and received at least one documented clinical pharmacy intervention  between August 1st – September 30th, 2024. Data were obtained through a Cerner Report and Theradoc. The primary objective was to determine the number of daily interventions made by acute care medicine pharmacists participating in ACCU IDRs. Secondary outcomes include characterization of clinical pharmacy interventions made and daily pharmacist workload. Descriptive statistics were used for analysis.
Results: A total of 80 patients were included with a median age of 62 years (IQR 50–70), and 52.5% were male. The majority identified as white (48.8%) or Black/African American (36.3%), with a median hospital length of stay of 6 days (IQR 4–16.1). The total number of clinical pharmacist interventions documented was 174, with a median of 1.5 interventions per patient daily (IQR 1–3). The most common intervention types were dose optimization (n = 47), transitions of care at admission (n = 28), and pharmacokinetic consults (n = 27). Most interventions were accepted by prescribers (77%), while 6% were modified and 17% had an unknown/pending response. When comparing patients admitted on ≤10 vs. >10 medications at admission, there was no statistically significant difference in length of stay (6.8 vs. 5.1 days; p = 0.234). One pharmacist managed a mean of 44 patients daily, with 14 patients on ACCUs and 25 on unit-based services. Daily time allocation averaged 153.7 minutes, including preparation (56.7 min), rounding (48.3 min), and follow-up (48.7 min).
Conclusion: Clinical pharmacists in non-academic interdisciplinary rounds led to diverse clinical interventions that improved medication management and care transitions. These findings support the value of pharmacists in optimizing patient care beyond academic rounding services.

Objective: To assess the clinical impact of an acute care medicine pharmacist in hospital medicine IDRs within an Acute Collaborative Care Unit (ACCU)
Assessment Question: Which of the following statements best reflects the current understanding of clinical pharmacists' roles in hospital medicine interdisciplinary rounds (IDRs)?

Title: Developing Pharmacy Processes for a National Group Purchasing Organization in Non-Acute Settings
Authors: Samantha Randlett, Alyssa Huff, Jason Braithwaite
Objective: Identify and assess components of GPO and supply chain processes that will enhance value for non-acute members.
Self-Assessment Question: How can we identify value and cost savings provided back to non-acute members that are part of a group purchasing organization?
Background: Group purchasing organizations (GPOs) have improved contracting performance and have added value to acute care facilities for many years. They do this by bringing the power of negotiation for all buyers into a unified community and provide leverage to strongly bargain with manufacturers, distributors, and vendors in the supply chain. With new healthcare policies pushing patients to receive care at lower-cost sites, healthcare leaders require adaptation to support migration to the non-acute care space. As GPOs are evolving to offer additional services and analytical insights and savings for their members, the non-acute space becomes an important area to understand.
Methods: This is a process improvement study focused on pre-specified rostered non-acute members that were active in both periods. Non-acute care sites consist of ambulatory surgery centers, physician clinics, home care, long term care, and other. Utilizing the baseline knowledge HealthTrust has on how to achieve cost savings, streamline processes, and optimize the supply chain in the acute space will allow the ability to translate into the non-acute space. Baseline data of non-acute purchases were assessed from August 2023 to January 2024. Discussions with non-acute facilities and vendors were started in August 2024. This process involved engaging manufacturers, distributors and educating members on how to optimize purchasing. The goal of this process improvement study is to provide value around specific drugs by identifying the class of trade nuances to optimize purchasing. The primary outcome is percentage of on-contract spend improvement. The secondary outcomes include important metrics such as manufacturer and distributor alignment and new contract value. To ensure better control on potential variables such as seasonality, results are based on the same timeline one year later; August 2024 to January 2025. 
Results and Conclusions: Our preliminary results demonstrate the challenges and time required to ensure on-contract purchasing whether utilizing a current contract or obtaining a new one. From period 1 to period 2, there is an increase of 8% in overall total spend and increase in membership by 15%. When reviewing on-contract purchasing between periods, there is a decrease by 19% due to new visibility in data, addition of clinics within current members, contract negotiations, and overall delay in contract load after relationships are developed. Chargeback relationship awareness increased by 100% and no contract exists increased by 23%. While these are our preliminary results, this shows the continued importance to improve pharmacy processes within the GPO in the non-acute space. 

Title: Implementing a Population Management Tool for Specialty Gastrointestinal (GI) Medications in a Veterans Affairs Health Care System (VAHCS)
Authors: Alexandra Carlson, Azur Eckley

Background:
Pharmacologic therapy for moderate to severe Ulcerative Colitis (UC) and Crohn’s Disease (CD) includes high-cost, high-risk biologic agents such as infliximab, adalimumab, ustekinumab, vedolizumab, and risankizumab, as well as small molecule inhibitors such as upadacitinib and tofacitinib to induce and maintain remission. Barriers to success with these agents include adherence which can lead to the development of antidrug antibodies (ADAs) and can result in a loss of response or failure of therapy. With a limited number of medication options comes the need to ensure medication appropriateness, efficacy and adherence in our Veteran patients. This project aims to develop a population health management tool to assist pharmacists in making efficient and effective interventions to encourage improved clinical outcomes and patient adherence.
Methods:
In this prospective, quality improvement project, a population management tool, or “dashboard,” was created and implemented to make interventions at our local VAHCS from 11/14/24-3/14/25. Included were Veterans cared for by the Ralph H Johnson VAHCS and treated with one of either five biologic injectable agents or one oral small molecule inhibitor. Patients followed outside of our facility were excluded. Corporate Data Warehouse (CDW) program utilized to list patient name, medication, prescription details, lab values, appointment dates, and pertinent endpoint data to identify those overdue for next dose, without GI follow up and more. Our primary composite endpoint compared pre- and post-dashboard event rates of suboptimal response, which was defined by presence of >1 induction dose for select agents, short-term steroid prescriptions with UC/CD diagnosis, or admissions linked to diagnosis codes. The secondary outcome was to compare rates of nonadherence defined by patients having either delayed outpatient prescriptions based on proportion of days covered (PDC) <80%, or delayed infusion appointment if prescribed intravenous agent. The tertiary endpoint was to track the quantity and type of interventions made by a pharmacist. Clinical judgement was used to triage the urgency of interventions made and patients intervened on based on type of flag on the dashboard.
Results:
There were 110 total patients populated on the dashboard with UC or CD and prescribed one of the six select agents and this project compared event rates of both suboptimal response and nonadherence to biologics from pre- and post-dashboard periods. The primary endpoint showed a decrease in number of steroid prescriptions and re-induction doses but no improvement in number of admissions, with composite of 0.49 events per pt year in baseline period decreased to 0.25 in project period (p=0.107). Regarding the tertiary endpoint, the baseline time period reached 33 total patients, including 61 notes, and 62 interventions made while the project period reached 22 patients and included only 22 notes with a total of 139 interventions made. While there were differences in documentation of interventions, we found that overall notes per patient year decreased from 1.50 to 0.46 notes per patient year. With a statistically significant p-value of <0.001 our tertiary result highlights the utility in making efficient interventions.
Conclusion:
The Specialty GI dashboard proved to be an effective and efficient way to monitor patients on biologic agents or small molecule inhibitors for IBD showing a decrease in events rates of suboptimal response and nonadherence while increasing the amount of interventions made per patient. While only one endpoint proved to be statistically significant, this population management tool is easy to use and would benefit all members of the interdisciplinary healthcare team. Overall, increased use of this population health management tool will have a positive impact on patient-centered outcomes and encourage continued adherence to these specialty high-risk and high-cost agents.

Title: Evaluation of Pharmacist-Led Opioid Stewardship Efforts in a Community Hospital 
Authors: Mia Passarelli, Amanda Herndon, Keith Johnson 
Background/purpose: Acute pain is a primary driver of hospital admissions in the United States, with opioids remaining the most used analgesics for management. However, the rise in opioid prescribing and consumption has significantly contributed to the ongoing opioid crisis. To address these concerns, the Centers for Disease Control and Prevention guidelines highlight the need for responsible opioid prescribing to reduce associated risks. Research on pharmacist-led opioid stewardship programs has shown improvements in both the safe and effective opioid utilization. This study seeks to evaluate the impact of pharmacist-driven opioid stewardship interventions on pain management safety and efficacy within a community hospital setting.   
Methodology: This study received Institutional Review Board exemption. Utilizing a quasi-experimental, retrospective, comparative design, this study evaluated opioid stewardship practices before and after the implementation of a pharmacist-led opioid stewardship protocol. Upon receiving opioid orders, pharmacists performed a comprehensive chart review to assess the need for medication-related interventions in accordance with a locally approved protocol. This review excluded orders for patients with chronic pain, cancer pain, those receiving palliative or hospice care, as well as cases involving acute postoperative pain and ischemic chest pain. This protocol served as a framework for selecting opioid analgesics and adjunctive therapies, ensuring a comprehensive approach to pain management. Pharmacists implemented a range of interventions, including converting intravenous opioids to oral formulations, adding analgesic orders for lower pain scales if omitted, prescribing naloxone for patients receiving more than 50 morphine milligram equivalents (MME) daily, and initiating bowel regimens for patients on scheduled opioid therapy. All pharmacist interventions were documented. The primary outcome was adherence to appropriate pain scale, defined as correspondence between the patient-reported pain scale and the administered medication’s ordered pain scale. Secondary outcomes included the incidence of analgesic order panel utilization, the incidence of oral opioid administration, incidence of methylnaltrexone administered for opioid induced constipation, and naloxone administration rates following the administration of an opioid analgesic.   
Results: A total of 2,878 patients were included, 1,419 in the pre-intervention group and 1,459 in the post-intervention group. For the primary outcome of incidence of adherence to appropriate pain scale, 77.9% of administrations were considered adherent in the pre-intervention group and 89.2% in the post-intervention group p < 0.001). Compared to the pre-intervention group, the incidence of analgesic order panel utilization was higher in the post-intervention group (25.5% vs. 38.2%; p < 0.001). The incidence of naloxone administration did not differ significantly between the pre- and post-intervention groups (0.21% vs. 0.14%; p = 0.63). Incidence of methylnaltrexone administered for opioid induced constipation occurred in 0.41% of the post-intervention group compared to 1.13% of the pre-intervention group (p = 0.02). Of all opioid administrations 60.01% were oral opioids in the post-intervention group compared to 63.27% in the pre-intervention group (p < 0.001).
Conclusions: The pharmacist-led opioid stewardship protocol significantly improved the adherence to appropriate pain scales and the utilization of available order panels. The protocol effectively implemented the initiation of bowel regimens, limiting the requirement for opioid induced constipation treatment.

Title: 
Prevalence, Incidence, and Outcomes of Selective-Serotonin Reuptake Inhibitor (SSRI) and Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) Duplication of Therapy 


Authors:
Gabrielle E. Hall, Aaryn Brewster, Cameron Lanier


Objective:
Identify the prevalence, incidence, and associated outcomes of duplicative prescribing and ordering of SSRI and SNRI therapy at three regional hospitals within a regional health system. 


Self Assessment Question:
What percentage of patients on SSRI or SNRI therapy at baseline were prescribed or ordered duplicative therapy while admitted to a study hospital during the research period?


Background: 
Multiple patients have been identified as having been prescribed or ordered duplicative SSRI and SNRI therapy. This is not a guideline recommended therapy due to the increased risk for adverse events, specifically serotonin syndrome, resulting from using multiple serotonergic agents in combination. Our goal is to identify how often these duplications are occurring and to promote patient safety through recommending appropriate prescribing practices.  


Methods:
This is a retrospective chart review with subgroup analysis. The patient population consists of patients exposed to either two SSRIs, two SNRIs, or an SSRI and SNRI combination while inpatient. Patients were divided into two groups based on those on duplicative therapy prior to admission and those who started on duplicative therapy during admission.  
The primary outcome for this study is prevalence of duplications of therapy as compared to those on SSRI or SNRI at baseline. The secondary outcome is incidence of duplications of therapy as compared to those on an SSRI or SNRI at baseline. Further secondary outcomes of the study include a logistic regression analysis comparing the exposure group to the control group to assess outcomes including similarities and differences in their baseline demographics and reported adverse events. 


Results:
The primary outcome for this study was prevalence of duplications of therapy where out of 7545 patients on an SSRI or SNRI at baseline 152 patients (2%) were on duplicative therapy. The secondary outcome of incidence of duplications of therapy revealed 81of the of 7545 patients (1%) on an SSRI or SNRI at baseline were started on duplicative therapy inpatient. Of the 152 patients on duplicative therapy, 81 patients (53%) were initiated on those duplicate agents while inpatient. Another finding includes 588 patients out of 7545 patients (8%) on an SSRI or SNRI at baseline were on multiple serotonergic agents.  Frequently duplicated medications include escitalopram with duloxetine (40/152, 26%), sertraline with duloxetine (40/152, 26%), and fluoxetine with duloxetine (19/152, 12.5%). Duloxetine was found to be a duplicated medication in 111 of 152 patients (73%).

Cutting Pharmacy Waste: Establishing a Process to Streamline Excess Medication Sharing
JingJie Yu, Abbi Rowe
 AdventHealth Orlando, Orlando FL 
Objective: (1) To evaluate the current medication-sharing process, (2) identify, implement, and assess a new and more efficient process to facilitate medication-sharing. 
Self-assessment: 
Background: Poor management of medication inventory can lead to shortages, and waste and is associated with increased pharmacy costs. The nine campuses across AdventHealth’s Central Florida Division (CFD) can easily share medications due to regulatory allowances, internal courier services, and proximal geography. Pharmacy buyers currently use a Microsoft Teams chat to attempt medication transfers. This method lacks an organized framework to ensure all necessary information is provided to effectively facilitate sharing excess inventory. 
Methodology: This is a multi-centered, pre-test and post-test comparative study of medication transfer attempts between hospital campuses in CFD. The pre-intervention period started from March 1, 2024, to August 31, 2024. The post-intervention takes place from February 1, 2025, to March 31, 2025. T-test or Wilcoxon Signed Rank test will be used for statistical analysis. All medication transfer attempts were included in the study. Non-medication transfers, supply transfers, and transfers outside of the CFD campuses were excluded. This study’s primary outcome is the number of successful medication transfer attempts. Secondary outcomes included cost avoidance and total volume of medication waste reduction. 
Results: In the pre-test period, 8 out of 9 campuses attempted a medication transfer via the designated Teams Chat. There were 83 attempted transfers representing a total of 924 individual units and a total acquisition cost of $64,444.93. Of the 83 attempts only 3 were successfully completed with just 2 of these having confirmed administrations. The total acquisition cost of the completed transfers was $7,404.30. Nine of the transfer attempts were missing key pieces of information to evaluate the feasibility of use at another campus. Of these, 1 was missing the medication strength, 6 were missing the quality available for transfer and 3 were missing product expiration dates. Post-test results are in progress.
Conclusion: The historic process of sharing excess medication inventory across the division has resulted in minimal successful transfers. During the pre-intervention period, most campuses made relatively few transfer attempts. A new process utilizing a standardized Microsoft Form with required fields was implemented to help facilitate transfer attempts. Education on the new process and ideal medication transfer targets were provided to pilot campus buyers and operations managers. Post-test results are in progress. Transfer attempts lacking the necessary information to assess the feasibility were most commonly missing information on the quality of excess medication available for transfer. This method hindered the effectiveness of medication transfers. 

Title: Expansion of Pharmacy Services to Improve Patient Care Outcomes and Quality Metrics in a Rural Community Hospital
Authors: Andrew Howell, Stephanie Smith, Kyli Latimer, Johny Nguyen, Grace Kenley
Background: Pharmacists play a key role in the medication outcomes of patients across a variety of health care settings. Equipped with a toolbox of drug knowledge and communication skills, pharmacists are uniquely positioned to be the liaison between patients and medications. Recent studies have supported the idea that regular pharmacist review of patients admitted to the hospital improves patient care outcomes and increases hospital cost savings and quality metrics. The objective of this study is to assess the impact of expansion of pharmacy services on patient care outcomes and hospital quality metrics in a rural, community hospital.
Methods: This is a single center, pre-post implementation study at a 358-bed, community hospital in rural South Carolina. The implementation phase will take place from February 24 – March 21, 2025 and will consist of the placement of pharmacists on the adult medical (non-intensive care unit) floors where most patients have traditionally been managed solely by hospitalists. The duties of the pharmacists placed on the floors will include both distributive and clinical responsibilities, with an emphasis on discharge medication reconciliation and education, renal dose adjustment, anticoagulation monitoring and management, and intravenous to oral (IV to PO) transitioning. Additionally, pharmacists will be responsible for attending multidisciplinary rounds in order to review patients, present recommendations, and assist with medication-related questions and inquiries. Streamlined policies and monitoring aids have been developed to ensure that workflow is consistent and standardized and to help prevent potential confounders. Tools have been developed to assist with documentation of medication interventions and clinical responsibilities. To measure the effect of the intervention on hospital quality measures and patient outcomes, changes in medication areas of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and 30-day readmission rates will be assessed both before and after the implementation of the intervention. Secondary outcomes will focus on changes in Leapfrog scores, average length of hospital stay, and time to prescription order verification. Any increase in quality metrics from before to after the implementation will be considered statistically significant. 
Results: From February 24 – March 26, 2025, 1046 patients were enrolled in the pilot study. 30-day readmission rates are not yet available since the end of the pilot period. Data from 39 HCAHPS surveys for the month of April are available through April 19, 2025. From March to April, there was an increase in scores for “Communication about Medicines” (March = 68, April = 77), “Discharge Information” (March = 29, April = 92), and “Care Transitions” (March = 38, April = 75). Of note, the domain, “Care Transitions” had its name changed to “Care Coordination” starting in April 2025. For secondary outcomes, Leapfrog and length of stay data for the pilot period is not yet available.
Conclusions: After implementation of the pilot, an increase in HCAHPS scores was observed for all three domains pertaining to medication questions, suggesting that pharmacists may play a role in bettering patients’ perceptions of their care. Pharmacists are well equipped and positioned to assist with transitions of care services.

Title: Implementation of an Internal Inventory Integrity Team within a Community Health System  


Authors: Maura Rodriguez, Heath Jennings, Craig MacDonald, Bradley Morgan  


Objectives:   
- Discuss the benefits of appropriate hospital pharmacy inventory management. 
- Determine important operational outcomes of an internal inventory team. 
- Identify opportunities for future research and ways to expand inventory services. 

Self-Assessment Question: True or False: When conducting inventory services, it is essential to consider the size and model of the central pharmacy, the inventory software and equipment utilized, the qualifications and training of personnel, and the timing of the inventory process.  

Background: Appropriate inventory management is critical for maintaining regulatory requirements, patient safety, financial forecasting, and integrity of pharmacy operations within a health system. While specific statistics on the exact number of health systems that utilize outsourced inventory vendors for pharmacy product counts are not readily available, it is known that outsourcing various pharmaceutical services, including inventory management, is an established practice in the healthcare industry. Many health systems are adopting this practice to improve efficiency, accuracy, and cost-effectiveness. This study aims to determine whether a difference exists in inventory accounting practices with implementation of an internal inventory integrity team.  

Methodology:   
This study employed a mixed-methods, phase-based approach to evaluate the implementation of an internal inventory integrity team within a ten-facility community health system. Quantitative analysis was performed through the implementation of an internal team. A small sample of cycle count audit data was collected from central pharmacies of varying sizes and models over two separate three-day periods. Audits immediately preceded the biannual inventory period conducted by the outsourced service provider in August and November of 2024. Primary outcomes and tracked metrics included inventory accuracy, timing of inventory counts, personnel requirements, and discrepancies in inventory records. The study utilized perpetual inventory workflow management software as a comparator group for internal and external inventory count accuracy rates. Descriptive statistics were employed to compare audit data collected via convenience sampling for the August audit and purposive sampling for the November audit. The focus was on timing, accuracy, and the complexity of inventory across different pharmacy models.  
Predictive modeling was utilized to estimate labor required for comprehensive counts across two different central pharmacy models of varying sizes. This will be used to validate audit time accuracy derived from the initial data. The timing and accuracy of inventory processes were monitored, with an emphasis on time validation and personnel requirements for timely completion.  
Financial impact was reviewed for the implementation of the internal inventory integrity team. These projections accounted for expected program costs including salaries as well as capital and operational expenses to complete a full internal inventory count across all facilities. Expected program savings and net savings was forecasted utilizing the relative value unit developed through the time analysis which was based on inventory size and complexity.

Results: 
The internal team had higher accuracy rates than the external vendor in Phase 1A (89.7% vs. 85.8%), Phase 1B (86.8% vs 72.1%), and Phase 2 (81.9%). Baseline inventory management system accuracy rates decreased from Phase 1A (11.4%) to Phase 1B (9.4%) and corrected inventory management system discrepancies increased from Phase 1A (7.0%) to Phase 2A (8.1%). External accuracy dropped significantly from 85.8% to 72.1%, respectively during Phase 1A to Phase 2B.
A team of up to five members (1.21-5.04 FTE) would be required to count all sites within a three-day period to ensure accuracy, precision of inventory counting and external industry competitors. Upcoming Phase 3 cost projections for a full internal inventory supported count provides a net savings of $123,200.

Conclusion:
Internal accuracy was higher and more consistent than the external vendor but there is still a need to identify how to improve inventory management system accuracy rates. Time analysis revealed that experienced technicians and buyers were most efficient, and a team of two to five members is required for accurate inventory counting at various facilities. Financially, using an internal team for inventory services is more cost-effective and time-efficient than relying on external vendors and implementing an internal inventory team would provide a net savings of $123,200. Further research will focus on system wide perpetual inventory with reliable real-time inventory management system count accuracy for quality assurance and process improvement.

Ttile: Impact of Liposomal Bupivacaine on Postoperative Opioid Consumption in Thoracic Surgery


Authors: Stefanie Pappas, Jordan Brooke Bibb, John Lazaar


Introduction: With advancements in multimodal and regional anesthesia, non-opioid pain management strategies have become increasingly popular. Local anesthetics can play a key role in minimizing opioid use and related complications; however, their effectiveness is often limited by a short duration of action. At Ascension Saint Thomas Hospital West (ASTHW), elastomeric infusion pumps were commonly utilized in thoracic surgery patients to deliver plain bupivacaine at the surgical site via an indwelling catheter. In June 2022, liposomal bupivacaine, a long acting formulation, was added to hospital formulary and replaced the use of infusion pumps. Research on liposomal bupivacaine has shown benefits such as reduced opioid use, lower pain scores, and shorter hospital stays, although results vary based on surgical site, technique, and intervention. The purpose of this study was to determine the impact on inpatient opioid consumption in thoracic surgery patients when utilizing a liposomal bupivacaine block compared to local infiltration of plain bupivacaine via an elastomeric infusion pump. 


Methods: This is a single-center, retrospective chart review of patients who underwent robotic lobectomy at ASTHW during two time periods: June 2021 through June 2022 and August 2022 through March 2024. Patients were included if they were at least 18 years of age and received either a single administration of liposomal bupivacaine or a continuous administration of plain bupivacaine via an elastomeric infusion pump. Patients with a history of substance use disorder, concurrent use of buprenorphine, methadone, naltrexone, were pregnant, or incarcerated were excluded. The primary outcome was to determine if there was a difference in postoperative morphine milligram equivalent (MME) usage between the two cohorts. Secondary outcomes included postoperative pain scores, hospital length of stay and incidence of post-operative wound infection.


Results: Sixty-two patients were included in the study (plain bupivacaine = 34; liposomal bupivacaine = 24). There was no statistically significant difference in postoperative MME usage between the plain bupivacaine group and liposomal bupivacaine group on day 1 (36.5  vs. 41.3; p = 0.92), day 2 (15 vs. 15; p = 0.84) or day 3 (2.5  vs. 3.25 ; p = 0.91).  The groups were also similar in postoperative pain scores, hospital length of stay, and incidence of wound infection.


Conclusion: 
In our study of patients undergoing robotic lobectomy, single administration of a liposomal bupivacaine block was comparable to local infiltration of plain bupivacaine for postoperative opioid consumption. Further research is needed to confirm any potential benefit; however, it appears that liposomal bupivacaine may be a similar and less invasive alternative for our thoracic surgery patients.