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Friday, April 25
 

8:30am EDT

The Implementation of a Passive Bin-Based Perpetual Medication Inventory Model within Ambulatory Clinics at an Academic Medical Center
Friday April 25, 2025 8:30am - 8:45am EDT
Olympia 1
Title: The Implementation of a Passive Bin-Based Perpetual Medication Inventory Model within Ambulatory Clinics at an Academic Medical Center


Authors: Elly Glazier, Jared Gabbert, Grayson Peek


Background: Ambulatory clinics store and dispense high-value medications with little visibility into inventory quantity or product movement. Automated dispensing cabinets are frequently used within inpatient settings to combat this issue but are a large capital investment for the clinic setting. In current state, pharmacies and clinics follow complex workflows to manage the inventory of high-value medications to meet patient demand while minimizing drug waste. This has led  to unrealized opportunities in inventory optimization due to large information gaps. We assessed a passive bin-based inventory model that leverages a system that records every transaction by a clinic team member. The system records these transactions in real time via light sensors and can both register the removal and replacement of medication products. The system then uses artificial intelligence and various algorithms to recommend inventory optimizations via the assessment of the recorded medication transactions and notably requires no electronic health record integration.


Methods: This study was conducted over 10 weeks and included select medications at two ambulatory locations. We assessed if the utilization of a passive bin-based inventory model within ambulatory clinics allowed for a decrease in inventory on-hand valuation. Inventory valuation was assessed prior to implementation and following system recommendations at the conclusion of the pilot. Accuracy of the system was validated via twice weekly manual cycle counts. The primary outcome was the valuation of the inventory on hand change recommended by the system at the conclusion of the evaluation. Secondary outcomes included the accuracy of the system as well as the outcome of a comparison of pre- and post- implementation satisfaction surveys (modified MAS-NAS) offered to nursing staff, as well as the cost of facility modifications required for implementation.


Results: The passive bin-based inventory recorded 3,454 dispenses during the study period. The average days on hand tabulated ranged from 1.5 days to over 30 days. The total inventory valuation decrease across both clinics included 69 product units for a total of $34,000 of average wholesale price. The accuracy of the model was established to be 84.6% at the neurology site and 96.3% at the orthopedics site. Though not extrapolatable due to volume, the results of the modified MAS-NAS nursing satisfaction survey showed a negative change from pre- to post- survey but notably were generally positive regarding the post implementation passive bin-based technology questions.

Conclusions: In this retrospective pre and post implementation study, the utilization of passive bin-based perpetual medication inventory models reduced inventory on hand valuation but was not statistically significant. Additionally, the model offers the opportunity to greatly increase inventory visibility in a difficult to manage care setting. Additional studies that assess benefits of visibility with powered results should be considered as the implementation of this model improves.
Presenters
avatar for Elly Glazier

Elly Glazier

PGY2 Health System Pharmacy Administration and Leadership Resident, Vanderbilt University Medical Center
Elly Glazier, Pharm.D., MMHC, (she/her) is a PGY2 Health-System Pharmacy Administration and Leadership resident at Vanderbilt University Medical Center in Nashville, TN. She is a recent graduate of the University of Missouri-Kansas City School of Pharmacy and completed her pre-pharmacy... Read More →
Evaluators
avatar for Abbi Rowe
avatar for Stephanie Ring

Stephanie Ring

Pharmacy Formulary Manager, Department of Veterans Affairs
Friday April 25, 2025 8:30am - 8:45am EDT
Olympia 1
  Administration (ADM), Vanderbilt University Medical Center
  • global Y

8:30am EDT

Assessing Provider Awareness and Confidence in Prescribing Connected Insulin Pens for Diabetes Management
Friday April 25, 2025 8:30am - 8:45am EDT
Athena D
Title: Assessing Provider Awareness and Confidence in Prescribing Connected Insulin Pens for Diabetes Management 
Authors: Caroline McKenna, PharmD & Casey Wells, PharmD, BCACP, CPP 
Objective: Determine provider readiness and confidence in prescribing connected insulin pens, caps, or buttons and comfortability in assessing generated reports. 
Self-Assessment Question: What is one benefit to using connected insulin pens (CIPs) for diabetes management? 
Background: 
Although there have been significant technological advancements around insulin delivery for the management of diabetes, some devices are underutilized due to lack of provider awareness. Connected insulin pens (CIPs) and pen caps offer an additional method for diabetes management in outpatient clinics. Various products, like the Abbott Bigfoot Pen, Lilly Tempo Button, Medtronic InPen, and NovoEcho Pens allow tracking of basal and/or bolus dosing, calculations for doses, and timing of insulin on board via Bluetooth and iOS/Android Smartphone applications. This study sought to assess provider readiness and confidence in prescribing connected insulin pens, caps, or buttons and comfortability in assessing generated reports.  
Methods: 
Baseline CIP prescribing levels were assessed through an internal dashboard for the four CIPs mentioned above. A survey was then distributed to 50 prescribers to investigate awareness of CIP products, who may qualify for use, comfortability in prescribing, and confidence in evaluating CIP-generated reports to adjust settings. Answers were provided via a Likert Scale (ex: 1 = Very Low Confidence and 5 = Very High Confidence). The final question from the survey asked how respondents would like to best learn about CIPs between a variety of modalities.  
Results: 
This abstract describes baseline prescribing trends and results from prescribers' readiness and confidence survey. Only 24 CIPs were prescribed by providers at baseline, with 95.8% being prescribed in the Internal Medicine and Endocrinology Clinic. Based on the initial survey results, 66% of responders had not heard of CIP technology. Of those who did have knowledge of CIP products, more than 75% had less than medium confidence in identifying patients who may qualify CIPs, with mixed opinions for patients who may qualify. The preferred learning methods for education about CIPs included live presentation by a pharmacist and a comparison sheet of available products.  
Conclusions: 
More education around connected insulin pens and pen caps is needed for prescribing providers caring for patients with diabetes. Educational sessions have been scheduled and comparison table compiled with intent to re-survey post-session and present at future conferences. 

Moderators
avatar for Katrina White, PharmD, BCACP

Katrina White, PharmD, BCACP

Residency Program Director, Quality Assurance Program Manager, Gulf Coast Veterans Health Care System
Presenters
avatar for Caroline McKenna

Caroline McKenna

Caroline is originally from Saratoga Springs, NY and completed her doctorate of pharmacy degree from the University of Pittsburgh School of Pharmacy in 2024. She graduated with an area of concentration in global health, and is currently completing a PGY-1 in Ambulatory Care at the... Read More →
Evaluators
avatar for Cori Edmonds

Cori Edmonds

Clinical Pharmacist, Residency Program Director, Vanderbilt Specialty Pharmacy
Friday April 25, 2025 8:30am - 8:45am EDT
Athena D
  Ambulatory Care (AMB), Mountain Area Health Education Center /UNC Eshelman School of Pharmacy
  • global Y

8:30am EDT

From Chatroom to Classroom: Enhancing Pharmacy Students’ Patient Counseling Skills with AI
Friday April 25, 2025 8:30am - 8:45am EDT
Athena C
Background: 
Effective communication skills are essential for pharmacy students, as they directly impact patient care and counseling quality. Traditional methods such as role-playing, simulated patients, and virtual patient interactions are commonly used in pharmacy education to enhance these skills. However, these approaches have notable limitations, including increased faculty workload, the need for trained standardized patients, and the high cost and potential technical challenges of virtual simulation software. The integration of artificial intelligence (AI) presents an innovative solution to address these challenges. The purpose of this study was to assess first-year pharmacy student confidence gains in communicating with patients using an AI chatbot in a communications course. 


Methods: 
First-year pharmacy students at the University of Georgia College of Pharmacy participated in this study. ChatGPT prompts were developed to simulate patient interactions, guiding the chatbot to engage with students as if they were patients picking up a new prescription. Embedded rubrics assessed students' soft skills, accuracy of medication counseling, and use of PRIME questions. The chatbot provided real-time feedback on strengths and areas for improvement. 
Electronic surveys measured students' confidence before and after a graded standardized patient activity. Confidence was assessed across seven domains: patient introduction, patient interviewing, use of probing questions, active listening, nonverbal communication, patient-centered education, and provision of accurate medication information. Students initially registered for ChatGPT and completed a pre-survey capturing demographics and baseline counseling confidence. They then engaged in a chatbot-guided counseling session before a week-long independent practice period. A post-survey followed the first graded standardized patient session to evaluate changes in confidence. Students had the option to use the chatbot again before a second graded encounter, after which they completed the same post-survey. Descriptive statistics analyzed demographic data, and a Wilcoxon Signed Rank Test assessed changes in confidence based on pre- and post-survey results following chatbot utilization. 


Results
A total of 145 first-year pharmacy students enrolled in the Pharmacy Intercommunications course at the University of Georgia. Of these, 117 completed all components of pre- and both post-surveys. Among pre-survey respondents (n=126), 70.3% reported pharmacy work experience, with 60.7% (n=88) having experience in a community setting. Additionally, 57% (n=72) had at least one year of work experience. Prior to the study, 62.8% had used ChatGPT, while 35.9% reported feeling comfortable using it. A Wilcoxon Sign-Rank Test indicated that median post-survey ranks for confidence across all 7 confidence domains were statistically significantly higher than the pre-survey ranks. The largest changes were seen in confidence introducing oneself to the patient and stating the purpose of the interview (Z=6.82, p<0.001), interviewing and assessing patient knowledge by using PRIME questions (Z= 6.954, p<0.001), using probing questions to clarify information (Z=6.941, p<0.001), tailoring counseling to meet patient specific needs (Z= 5.457, p<0.001), and providing complete and accurate information during the counseling session (Z= 5.19, p<0.001). A Wilcoxon Sign-Rank Test comparing confidence between the first post-survey and the second post-survey indicated that median post-survey ranks for confidence were statistically significant across all domains with the exception of confidence in the ability to demonstrate active listening (Z=0.885, p=0.376) and confidence in communicating interest and confidence through body language (Z=1.825, p=0.068).  


Conclusions
Incorporating an AI chatbot as a counseling tool in the classroom resulted in a statistically significant increase in first-year pharmacy students’ confidence when counseling a graded simulated patient. These findings highlight the potential of AI as an effective educational tool to enhance student learning.
Moderators
avatar for Devki Gajera
Presenters
avatar for Sarah Thompson

Sarah Thompson

PGY2 Ambulatory Care Resident, University of Georgia College of Pharmacy
Sarah Thompson is the PGY2 Ambulatory Care resident with the University of Georgia College of Pharmacy. Sarah completed her first year of residency training with Baylor Scott and White in Temple, Texas and completed pharmacy school at the University of Texas at Tyler in Tyler, Te... Read More →
Evaluators
avatar for Erin Himes
Friday April 25, 2025 8:30am - 8:45am EDT
Athena C
  Ambulatory Care (AMB), University of Georgia College of Pharmacy
  • global Y

8:30am EDT

Comparison in Clinical Outcomes with Lorazepam vs. Midazolam use in Patients Admitted to a Community Hospital for Alcohol Withdrawal
Friday April 25, 2025 8:30am - 8:45am EDT
Athena G
Title: Comparison in Clinical Outcomes with Lorazepam vs. Midazolam use in Patients Admitted to a Community Hospital for Alcohol Withdrawal


Authors: Caitlin Ferguson, Stephen Melton


Background: Alcohol withdrawal is an urgent medical condition which occurs when an individual disrupts or discontinues regular alcohol consumption. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) is a widely used tool for assessing the severity of alcohol withdrawal symptoms and guiding treatment (1). Current guidelines state longer acting benzodiazepines are preferred due to clinical benefits and longer duration of action (2). Recent drug shortages have led to a shift toward using alternative medications such as midazolam in place of the traditional protocolized lorazepam. By comparing outcomes of each benzodiazepine, healthcare providers can make informed decisions about treatment alternatives.  


Methods: Baptist Health Lexington implemented a protocol to utilize midazolam in lieu of lorazepam during a period of drug shortage. This retrospective study analyzes local clinical outcome data comparing the use of lorazepam and midazolam in patients with alcohol withdrawal before and after the ASHP-designated lorazepam drug shortage in February 2023. Data will be analyzed via review of hospital electronic medical record six months prior and six months after the protocol initiation. The primary outcome is to evaluate the differences in hospital length of stay in number of days for each treatment regimen. The following secondary outcomes will also be assessed: maximum and average CIWA score, total number of lorazepam equivalents administered, and ICU length of stay. Appropriate statistical tests will then be analyzed to assess the clinical outcomes of the two medications. The data collected will be de-identified from individual patient charts and presented only in aggregate.  


Results: In progress 


Conclusions: In progress 
Moderators
avatar for Tia Collier

Tia Collier

Medical ICU and Neuroscience ICU Clinical Pharmacist and PGY2 Critical Care Residency Program Director at Erlanger in Chattanooga, TN.
Presenters
avatar for Caitlin Ferguson

Caitlin Ferguson

Pharmacist, Baptist Health Lexington
Caitlin is originally from Greenup, Kentucky but has lived in Versailles, Kentucky most of her life. She received his Doctor of Pharmacy from the University of Kentucky in May 2024. Her current practice interests include cardiology and critical care. Upon completion of her PGY1 residency... Read More →
Evaluators
avatar for Sarah Frye

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2
Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree... Read More →
Friday April 25, 2025 8:30am - 8:45am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Baptist Health Lexington
  • global Y

8:30am EDT

Comparison of purge reliability between heparin- and bicarbonate-based purge solutions during Impella support
Friday April 25, 2025 8:30am - 8:45am EDT
Athena H
Title: Comparison of purge reliability between heparin- and bicarbonate-based purge solutions during Impella support
Author Names: Jessica Donald, Breanne Mefford, Bryan Love, Jenna Cox
 
Background: Impella heart pumps are temporary mechanical circulatory support (MCS) devices used beyond procedural settings in patients with cardiogenic shock to support heart function by unloading the right or left ventricle. A solution is utilized to suppress denatured protein or thrombus deposition within the purge gaps of the Impella device. Heparin-based purge solutions are recommended by the device manufacturer, who advises against the use of non-heparin anticoagulants within the purge solution. While direct thrombin inhibitors were initially explored as a purge solution option for patients with heparin-induced thrombocytopenia, pump failures and other complications have been documented with their use. Sodium bicarbonate has emerged as an alternative, stabilizing the pump without affecting systemic heparin levels, simplifying anticoagulation management. Although FDA-approved in April 2022 for patients intolerant to heparin, data related to its clinical use remains limited.


Methods: This retrospective, observational cohort study aims to assess the efficacy of a sodium bicarbonate-based purge solution as an alternative to heparin-based purge solutions for patients receiving Impella support. The primary outcome will focus on purge reliability, defined as a composite measure of: a 25% increase in purge pressure from baseline, and/or a 50% reduction in purge flow rate (for index flow rates >15 mL/hr) or a 30% reduction (for index flow rates ≤15 mL/hr). Secondary outcomes will include the individual components of the primary composite outcome, along with the use of alteplase in the purge solution, as well as variations in purge flow rates and pressures.
 
Results: In Progress
 
Conclusion: In Progress
Moderators
avatar for Rebecca Orr
Presenters
avatar for Jessica Donald

Jessica Donald

PGY2 Critical Care Pharmacy Resident, Prisma Health Richland Hospital
PGY2 Critical Care Pharmacy Resident
Evaluators
avatar for Martin Gordon

Martin Gordon

Clinical Pharmacy Specialist- Critical Care, Spartanburg Medical Center
Martin Gordon, PharmD, BCCCP is the Clinical Pharmacy Specialist for Medical Critical Care and Residency Program Coordinator for the PGY1 Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Gordon completed his Doctor of Pharmacy degree from Presbyterian... Read More →
Friday April 25, 2025 8:30am - 8:45am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Prisma Health Richland - University of South Carolina
  • global Y

8:30am EDT

Evaluation of inappropriate stress ulcer prophylaxis continuation after discharge from the intensive care unit
Friday April 25, 2025 8:30am - 8:45am EDT
Athena I
Title: Evaluation of inappropriate stress ulcer prophylaxis continuation after discharge from the intensive care unit 
Authors:  Abigail McBrayer, Jamarius Carvin, Elaina Etter, Rachele Hollis 
Background/Purpose: Critically ill patients that require admission to the intensive care unit (ICU) are at an increased risk of gastrointestinal (GI) stress ulcers. Stress ulcer prophylaxis (SUP) is achieved through proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) administration. While the optimal duration of SUP therapy is unclear, current literature recommends discontinuing SUP upon resolution of risk factors, most commonly at the time of discharge from the ICU. Inappropriate SUP continuation can negatively affect both the patient and the hospital system. This study evaluates the rate of inappropriate continuation of PPIs or H2RAs for SUP after ICU discharge.  
Methods: This study was a single-center, retrospective chart review from May 1, 2023, to October 31, 2023.  Patients qualified for inclusion if they were greater than 18 years of age, received SUP during their ICU stay, were discharged from the ICU to an intermediate care unit or acute care floor, and had an active SUP order upon transfer to the non-ICU area. Patients were excluded if they had pre-existing conditions requiring acid suppressive therapy (AST) including gastroesophageal reflux disease, peptic ulcer disease, Barrett’s esophagus, and dyspepsia, were discharged directly from ICU to another healthcare facility, or were on appropriately continued AST. The primary outcome was the percentage of patients inappropriately continued PPIs or H2RAs at discharge from the ICU. Inappropriate continuation was defined as patients being continued on SUP after discharge from the ICU, when there are little to no risk factors to warrant the use of SUP. Secondary outcomes included healthcare costs, length of time on inappropriate AST, and the number of patients discharged home with a PPI or H2RA.   
Results: Throughout the study period, 406 patients were assessed for inclusion, with 180 meeting inclusion criteria. The leading reason for exclusion was patient death before ICU discharge, accounting for 55 patients (24%)
Moderators
CM

Charleen Melton, PharmD, BCCCP

Clinical Pharmacy Asst Manager, PGY1 and EM PGY2 RPC, CaroMont Health
Presenters
avatar for Abigail McBrayer

Abigail McBrayer

PGY-1 Pharmacy Resident, Grady Memorial Hospital
Evaluators
BM
Friday April 25, 2025 8:30am - 8:45am EDT
Athena I
  Critical Care/Emergency Medicine (CCM), Grady Memorial Hospital
  • global Y

8:30am EDT

Analysis of Prosthetic Joint Infections in a Community Hospital
Friday April 25, 2025 8:30am - 8:45am EDT
Athena A
Title: Analysis of Prosthetic Joint Infections in a Community Hospital  
Authors: Sydney Hege, Heather Gibson, Allison Cid, Gretchen Arnoczy 


Background: Joint replacement surgery has become a common surgical procedure for patients and improves independence, mobility, and quality of life. Prosthetic joint infections (PJIs) are a serious complication of prosthetic joint implantation and must be managed appropriately. Management of infections vary from practice to practice and current guidelines offer a range of recommendations. This study aims to compare the treatment of PJIs at FirstHealth of the Carolinas to current guideline recommendations. 

Methods: Eligible participants were identified via retrospective chart review using electronic medical records from March 1st, 2022, through September 30th, 2023. This 18 months of data was censored at 12 months post-infection and included data from all FirstHealth of the Carolinas facilities. Patients were included if they were ≥ 18 years old, diagnosed with a PJI at FirstHealth, treated by an Infectious Disease (ID) physician, and discharged on outpatient parenteral antibiotic therapy (OPAT). Only pregnant patients were excluded. The primary objective was to analyze initial antimicrobial treatment duration of PJIs, utilization of rifampin in staphylococcal infections, and use and duration of suppressive antimicrobials compared to Infectious Diseases Society of America (IDSA) guideline recommendations. Secondary objectives include evaluating Clostridioides difficile infection (CDI) rates, antimicrobial complications, and prolonged or recurrent infection within 12 months of surgery for confirmed PJI. All data collected was de-identified and only the primary investigators have access to the data via a password encrypted file.


Results: A total of 95 patients were identified. 10 patients were duplicates, leaving 85 patients included in this IRB-exempt study. Patient characteristics evaluated included age, gender, body mass index (BMI), type of prosthetic joint, diabetes diagnosis, time since initial surgery to diagnosis of PJI, and tobacco use.  The majority of PJIs were categorized as late infections (47%), followed by delayed (27%), and early infections (22%). The main prosthetic joints infected were knee (64%) followed by hip (27%), while causative organisms included staphylococcus aureus (37%), followed by non-aureus staphylococcus (22%) and streptococcus species (14%). PJI procedures included debridement, antibiotics, and implant retention (DAIR) (31%), 1 stage (41%), 2 stage (2%), and our modified 2 stage procedure (22%). During this time frame, 2200 hip and knee surgeries were performed at FirstHealth. Out of 85 PJIs, 45 patients had their initial surgery at FirstHealth, estimating an annual rate of PJIs at FirstHealth of 0.83% compared to 1-2% in the U.S. The initial intravenous (IV) antimicrobial treatment duration of 4-6 weeks per IDSA guidelines was achieved in 82 of 85 patients (96%), while the use of adjunctive rifampin for staphylococcal PJIs was utilized in 15 of 39 eligible patients (38%). The use of suppressive oral antimicrobials after IV therapy is recommended in DAIR or 1 stage procedures and 54 of 61 eligible patients (89%) received suppression. The secondary objectives included a CDI rate of 1 in 85 patients (1.2%), 16 reported IV antimicrobial complications, and 9 of 85 patients (10.6%) experienced a prolonged or recurrent infection. 


Conclusion: In this study, results show that FirstHealth’s current standard of practice for managing PJIs mostly aligns with IDSA guideline recommendations. Of note, there is room for improvement in our duration of oral suppression and rifampin utilization in managing these infections. However, there were low rates of complications, including CDI, as well as a low rate of prolonged or recurrent infection in this population. Further steps should be taken to assess the need for a standardized protocol for the treatment of PJIs at FirstHealth of the Carolinas.
Moderators
JK

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1
Presenters
avatar for Sydney Hege

Sydney Hege

PGY1 Pharmacy Resident, FirstHealth Moore Regional Hospital
Sydney Hege, PharmD, is originally from Lexington, NC. She attended Appalachian State University in Boone, NC, where she earned a bachelor’s degree in Chemistry. She went on to attend Campbell University College of Pharmacy & Health Sciences in Buies Creek, NC, where she earned... Read More →
Evaluators
avatar for Melissa Padgett

Melissa Padgett

Residency Program Director, HCA Florida West Hospital
Melissa Padgett earned her Doctor of Pharmacy in 2014 from Belmont University College of Pharmacy in Nashville, TN. After receiving her PharmD, she completed a post-doctoral PGY1 pharmacy residency at HCA Florida West Hospital in June of 2015. From there, she stayed on as a full-time... Read More →
Friday April 25, 2025 8:30am - 8:45am EDT
Athena A
  Infectious Disease (ID), FirstHealth Moore Regional Hospital
  • global Y

8:30am EDT

Optimizing Metronidazole Administration: A Comparative Analysis of Every Twelve Hours Versus Every Eight Hours Dosing for Anaerobic Infections
Friday April 25, 2025 8:30am - 8:45am EDT
Athena B
Title: Optimizing Metronidazole Administration: A Comparative Analysis of Every Twelve Hours Versus Every Eight Hours Dosing for Anaerobic Infections 


Authors: Taylor J. Merritt, Kat Petersen, Benjamin Albrecht, Sujit Suchindran, Sarah B. Green 
Emory University Hospital- Atlanta, GA   


Background: Metronidazole has historically been the drug of choice for anaerobic infections, conventionally dosed every eight hours. Its hydroxy metabolite can exhibit 30-65% activity of the parent drug and has a half-life extending up to 11.65 hours. Serum levels of metronidazole exceed the minimum inhibitory concentration at twelve hours for most anaerobes. Thus, an argument that can be made for dosing every twelve hours for most anaerobic infections. The objective of this study is to determine the probability that patients receiving oral or intravenous metronidazole at a dosing frequency of every twelve hours would have a more or equivalent desirable outcome, measured by desirability of outcome ranking (DOOR), than patients receiving a traditional, every eight hours frequency for the treatment of confirmed anaerobic infections.   


Methods: This was a retrospective, quasi-experimental, multi-center analysis which reviewed adult patients who received metronidazole for the treatment of confirmed anaerobic infections. Included patients received 500 mg doses of intravenous or oral metronidazole at a dosing frequency of eight or twelve hours, for at least 72 hours in duration. Patients were excluded if the indication for metronidazole was hepatic encephalopathy, surgical prophylaxis, or treatment of Clostridioides difficile, central nervous system, parasitic, sexually transmitted, or Helicobacter pylori infections. Those who received metronidazole every eight hours for ≥ 72 hours before transition to every twelve hours, received concomitant antibiotics with anaerobic coverage for ≥ 72 hours, or had an organism with documented resistance to metronidazole were also excluded. The primary outcome was the probability that a patient receiving metronidazole every twelve hours would have a more or equivalent desirable outcome than a patient receiving every eight-hour dosing. Secondary outcomes included an assessment of outcomes specific to the subgroup of immunocompromised patients in the study. 


Results: Baseline demographics were similar between the two groups. The majority of included patients were male (55%), Black (62%), and had an average age of 61 years. The average length of stay was 22 days overall, which was also comparable amongst groups. The overall DOOR distribution between groups was similar and there was no significant difference in the probability of a more desirable outcome for patients who received metronidazole every twelve hours compared to traditional every eight-hour dosing (51.3% [95% CI: 43.5%, 59.0%]; p-value= 0.7417). Of the individual DOOR components, there was a statistically significant difference in treatment failure with a higher probability of desired result (i.e. treatment success) in the every twelve-hour dosing group (p-value= 0.021). Analysis of the immunocompromised subgroup also found no difference in probability of desirable outcomes (45.9% [95% CI: 30.1%, 62.6%]; p-value= 0.6388). 


Conclusion: We found no significant differences in desirable outcomes between the dosing groups for total study patients and the immunocompromised subgroup. The results discussed above included criteria for the DOOR analysis such as treatment failure, unsuccessful discharge, adverse effects, and transition to hospice or death. This provides evidence to support that every twelve hours dosing of metronidazole could be considered over every eight hours for most anaerobic infections, due to the similar DOOR ranking in addition to the time saving component, increased convenience for nursing staff, and expected reduction in cost in contrast to dosing every eight hours. 
Moderators
avatar for Christele Francois

Christele Francois

Emergency Medicine Clinical Pharmacy Specialist, Emory University Hospital
Christele Francois, PharmD, is board certified in pharmacotherapy. She is a member of the Department of Pharmacy at Emory University Hospital and currently practicing as an Emergency Medicine Clinical Pharmacy Specialist. Dr. Francois obtained a Bachelor of Science degree at the University... Read More →
avatar for Allie Hale

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System
Presenters
avatar for Taylor Merritt

Taylor Merritt

PGY1 Pharmacy Resident, Emory University Hospital
Dr. Taylor Merritt is from West Green, Georgia. She received her Bachelor of Science in Pharmaceutical Sciences and Doctor of Pharmacy degrees from Mercer University College of Pharmacy in Atlanta, Georgia. She is currently a PGY1 Pharmacy Resident at Emory University Hospital. Her... Read More →
Friday April 25, 2025 8:30am - 8:45am EDT
Athena B
  Infectious Disease (ID), Emory University Hospital
  • global Y

8:30am EDT

Effect of Antidepressant Continuity on Analgosedation in Mechanically Ventilated Patients
Friday April 25, 2025 8:30am - 8:45am EDT
Parthenon 1
Title: Effect of Antidepressant Continuity on Analgosedation in Mechanically Ventilated Patients

Authors: Isabelle Perling, Sarah Blackwell, Kenda Germain, John Michael Herndon

Objective: Assess the effect of antidepressant continuity or discontinuity on analgosedation in mechanically ventilated patients. 

Self Assessment Question: True or False: Abrupt cessation of antidepressants can cause antidepressant discontinuation syndrome that typically occurs in patients using SSRI or SNRI medications with short half-lives.

Background: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first line treatment options for depression and anxiety and are used for many other psychiatric disorders. In critically ill patients with mental disorders, psychiatric symptoms may be heightened due to a change in environment and physical condition. Despite this, many antidepressants are not continued in the critical care setting for various reasons. Abrupt cessation of antidepressants can cause antidepressant discontinuation syndrome (ADS), with symptoms including agitation, mood changes, insomnia, dizziness, nausea, and vomiting. ADS has a mean onset of two days after discontinuation and is most common in patients using agents with short half-lives. The syndrome can mimic hyperactive intensive care unit (ICU) delirium, which may lead to increased sedative doses to maintain goal sedation, while the underlying cause is left untreated.

Methods: This is a single center, retrospective chart review in patients who were on SSRI or SNRI therapy prior to a hospitalization where they were subsequently intubated. Included patients were 18 years of age or older, receiving outpatient SSRI or SNRI therapy prior to hospitalization, and initiated on mechanical ventilation within 48 hours of admission. Patients with current substance abuse, need for deeper sedation, acute neurological events, chronic invasive mechanical ventilation, pregnancy, or incarceration were excluded. Patients who restarted SSRI or SNRI therapy between 49 and 72 hours were also excluded. Outcomes were compared between patients who resumed their SSRI or SNRI within 48 hours of intubation and patients for whom their SSRI or SNRI was held for more than 72 hours after intubation. The primary endpoint was the dose of IV analgosedation at 72 hours represented by the fraction of IV sedation score (FISS). FISS is a novel scoring system created to compare analgosedation medications and doses for patients on various agents. It is calculated by dividing the dose of each analgosedation agent by the typical maximum dose at the facility. Each of these are then added together to create the numerical FISS. Secondary endpoints included FISS at 24 and 48 hours, RASS at 24, 48, and 72 hours, ICU and hospital lengths of stay, duration of mechanical ventilation, and duration of IV analgosedation. Statistical tests included the student’s t-test and the Wilcoxon rank sum test.

Results: Forty patients were analyzed. FISS was similar between patients who continued their antidepressant and the discontinuity group at 72 hours post intubation, 0.95 ± 1.02 vs. 0.60 ± 0.66 (p = 0.194). There was no difference in FISS at 24 and 48 hours, RASS, ICU and hospital LOS, and duration of mechanical ventilation or analgosedation.

Conclusion: Antidepressant continuity did not result in a difference in analgosedation needs or other outcomes. The novel FISS offers a practical way to compare analgosedation needs across various agents but needs external validation for external use.

Contact information: isabelle.perling@orlandohealth.com
Moderators
avatar for Margaret Williamson

Margaret Williamson

Clinical Pharmacy Specialist, East Alabama Health
Presenters
IP

Isabelle Perling

PGY1 Pharmacy Resident, Baptist Health Princeton Hospital
Isabelle (Izzy) Perling, PharmD, is a PGY1 Pharmacy Resident from Atlanta, Georgia. She completed her undergraduate courses at Auburn University before receiving her PharmD from the University of Georgia College of Pharmacy. Izzy serves on the hospital's Antimicrobial Stewardship... Read More →
Evaluators
avatar for Emily Johnson

Emily Johnson

PGY1 Residency Program Coordinator - Acute Care/Clinical Pharmacist Team Lead - MedSurg, Cape Fear Valley Medical Center
Friday April 25, 2025 8:30am - 8:45am EDT
Parthenon 1
  Internal Medicine (IM), Princeton Baptist Medical Center
  • global Y

8:30am EDT

Effectiveness and safety of high-dose unfractionated heparin for venous thromboembolism prophylaxis in obese patients
Friday April 25, 2025 8:30am - 8:45am EDT
Parthenon 2
Title: Effectiveness and safety of high-dose unfractionated heparin for venous thromboembolism prophylaxis in obese patients
Authors: Amber DeVillier, Lacey Ioppolo, Mallory Stringer, Eric Shaw
  1. Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable condition causing 60,000 to 100,000 deaths annually in the United States. DVT involves thrombus formation in extremities, while PE occurs when a thrombus blocks a pulmonary artery. Risk factors include Virchow’s triad which consists of venous stasis, endothelial injury, and hypercoagulability. Obesity, an independent VTE risk factor, promotes inflammation, impaired fibrinolysis, and procoagulant activity. The CDC defines obesity as a BMI ≥ 30 kg/m². Hospitalized patients face increased VTE risk due to immobility and surgical endothelial injury. Chemical prophylaxis, such as unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fondaparinux, is essential. Standard dosing of UFH is 5,000 units subcutaneously every 8 hours. In patients with an increased BMI the dosing parameters are not as clear. The dosing for DVT prophylaxis in patients with obesity ranges from 5,000 to 7,500 units subcutaneously every 8 hours. Studies on high-dose UFH of 7,500 mg subcutaneously every 8 hours in obese patients show mixed outcomes, with potential bleeding risks in class III obesity (BMI ≥ 40 kg/m²). Further research is needed to clarify optimal dosing regimens by BMI and assess safety and efficacy.
  2. Methods: This was a single-center, retrospective chart review of patients that were started on either standard-dose UFH of 5,000 mg subcutaneously every 8 hours or high-dose UFH of 7,500 mg subcutaneously every 8 hours for DVT prophylaxis between January 2018 and September 2024. Patients were included if they were 18 years old or older, received either standard-dose or high-dose UFH within 48 hours of admission, and if their BMI was ≥ 40 kg/m² and body weight ≥ 120 kg. The primary outcome was incidence of new VTE during hospital stay. The secondary outcomes included any bleeding that resulted in discontinuation and a composite of ISTH major bleeding.
  3. Results: A total of 352 patients were screened, with 108 patients included in this study. There were 83 patients in the standard-dose UFH group and 25 in the high-dose UFH group. The primary outcome was not statistically different between standard-dose compared to high-dose (2.4% vs 0%; p-value 1.000). The secondary outcome of composite ISTH major bleeding was also not significantly different between standard-dose and high-dose (18.1% vs 32%; p-value 0.252). When looking at individual components of ISTH major bleeding, there were significantly more rates of blood transfusions in the high-dose group compared to the standard-dose group (12% vs 1.2%; p-value 0.038). The secondary outcome of UFH prophylaxis discontinuation due to bleeding occurred in 2 (1.9%) of patients in standard-dose group and none of the patients in the high-dose group.
  4. Conclusions: This study showed that there was no difference in the incidence of new VTE between high-dose and standard-dose UFH, but notably, high-dose UFH was associated with more blood transfusions.
Contact Amber DeVillier (amber.devillier@hcahealthcare.com) with any questions.
Presenters
avatar for Amber Devillier

Amber Devillier

PGY1 Pharmacy Resident, Memorial Health University Medical Center
My name is Amber DeVillier, and I attended University of Louisiana Monroe (ULM) College of Pharmacy. I am currently a PGY1 Pharmacy Resident at Memorial Health University Medical Center in Savannah, GA.
Evaluators
avatar for Jason Dover

Jason Dover

PGY-1 Residency Program Director, Clinical Pharmacist Emergency Medicine/Internal Medicine, East Alabama Medical Center
Friday April 25, 2025 8:30am - 8:45am EDT
Parthenon 2
  Internal Medicine (IM), Memorial Health University Medical Center
  • global Y

8:30am EDT

Impact of Pharmacist-Led Transitions of Care Services for Patients Discharging on Oral Chemotherapy
Friday April 25, 2025 8:30am - 8:45am EDT
Olympia 2
Title: IMPACT OF PHARMACIST-LED TRANSITIONS OF CARE SERVICES FOR PATIENTS DISCHARGING ON ORAL CHEMOTHERAPY


Authors: Nathan Park, Courtney Mallon, Ashley Mull


Objective: To determine the effect of pharmacist-led transitions of care services for patients discharging on oral chemotherapy at the University of Tennessee Medical Center.


Background:
Oral anticancer therapies have changed the course of therapy in a growing number of malignancies that have traditionally been managed with intravenous (IV) chemotherapy. The increasing use of oral anticancer therapies benefits patient convenience and quality of life. However, several challenges now exist for patients from medication procurement, adherence, and safe handling and administration of these agents. Pharmacists are uniquely trained to improve outcomes through increased medication adherence, patient knowledge, and drug monitoring. This study aims to determine the effect of pharmacist-led transitions of care (TOC) services for patients discharging on oral chemotherapy at the University of Tennessee Medical Center.


Methods:
This prospective, single-center, quality improvement initiative included adult patients being discharged from the inpatient oncology service who filled a prescription for an oral chemotherapy at the University of Tennessee Specialty Pharmacy from January 1st, 2024 to October 1st, 2024. The primary endpoint was the average number of interventions made by oncology pharmacists regarding oral chemotherapy prescribed at discharge. Interventions included in the study included: drug-drug interactions, drug-disease clarification, dosing adjustments (non-renal/hepatic/toxicity), toxicity adjustment, drug acquisition, renal adjustments, hepatic adjustments, and other interventions. Secondary endpoints were the average number of interventions made within 1 week of discharge and the length of time in days between the prescription being sent to the pharmacy and the patient receiving their medication. 


Results:
A total of 23 patients were included in the study. At time of discharge, a total of 10 interventions were made with the average number of interventions per patient being 0.43. Of the 10 interventions made at discharge, five of them were involving drug acquisition. At follow-up, four interventions were made for an average number of interventions per patient of 0.17. All follow-up interventions involved patient counseling. The average length of time for patients to receive their medication was 8.83 days with a median (IQR) time of 4 (6.5) days. 


Conclusion:
Pharmacists most frequently intervened at time of discharge with most interventions being related to drug acquisition. Follow-up calls resulted in fewer interventions, but all interventions involved patient counseling. The study supports the need for further pharmacist involvement with transitions of care services.
Moderators
avatar for Kristen Kilby

Kristen Kilby

PGY2 Oncology Resident, Northside Hospital
Kristen Kilby attended pharmacy school at the University of South Carolina. She then completed a PGY-1 residency at Baptist Memorial Hospital- Memphis and a PGY-2 Oncology residency at Northside Hospital in Atlanta, GA. She is currently a clinical oncology specialist focused on malignant... Read More →
Presenters
SP

Sang Park

Pharmacy Resident, University of Tennessee Medical Center
Dr. Park grew up in Ooltewah, TN. He obtained his Bachelor of Science in Chemistry from the University of Tennessee Knoxville and his Doctor of Pharmacy degree from the University of Tennessee Health Science Center College of Pharmacy. His clinical interests include solid tumor cancers... Read More →
Evaluators
avatar for Amy Porter
Friday April 25, 2025 8:30am - 8:45am EDT
Olympia 2
  Oncology (ONC), University of Tennessee Medical Center
  • global Y

8:30am EDT

Dose-Dependent QTc Prolongation of Methadone in Pediatric Patients
Friday April 25, 2025 8:30am - 8:45am EDT
Athena J
Title: Dose-Dependent QTc Prolongation of Methadone in Pediatric Patients


Authors: Kaitlyn Currie, Justin K. Chen, Janae Townsend, Jillian Mantione


Objective: Determine thedose relationshipfor methadone and QTc prolongation in the pediatric population.


Background: Methadone is a synthetic opioid commonly used to wean patients off continuous opioid infusions to prevent withdrawal. Methadone is associated with prolongation of the QTc intervalon electrocardiogram (EKG). In pediatric patients, the dose-dependent relationship of methadone to QTc prolongation has not been established. The primary aim of this study was to investigate the risk of QTc prolongation in pediatric patients maintained on methadone at Children’s Healthcare of Atlanta. 


Methods: A retrospective chart review of patients less than 18 years old initiated on methadone between January 1, 2023 and April 30, 2024, in the intensive care setting. Patients were excluded if they received methadone for <24 hours, did not have EKG results while on methadone, had a history of long QT syndrome, or if they were on methadone for the following indications: chronic pain, palliative care, and/or addiction.

Results: A total of 79 patients met criteria for inclusion, comprised of 266 EKGs. The median age was 0.91 years (IQR 0.36-5.49) with 40 (50.9%) of patients being male. The median baseline QTc was 424 ms (IQR 408-441) for those who had an EKG prior to methadone initiation. There was no correlation between methadone weight-based dose and length of QTc (r=0.07, p=0.23). An analysis comparing low (<0.25 mg/kg/day), moderate (0.25-0.5 mg/kg/day), and high (>0.5 mg/kg/day) dosing of methadone did not show a difference in QTc among the three groups (p=0.71). A secondary analysis comparing patients with a baseline QTc and their QTc on methadone showed no difference (424 ms versus 430 ms, p=0.24).  

Conclusion: This retrospective analysis could not determine a relationship between weight-based methadone dosing and QTc. Patients did not experience a statistically significant difference between their baseline QTc and their QTc on methadone. 
Presenters
avatar for Kaitlyn Currie

Kaitlyn Currie

PGY1 Pharmacy Resident, Children's Healthcare of Atlanta
I am a current PGY1 pediatric pharmacy resident at Children's Healthcare of Atlanta. I completed my pharmacy schooling at Northeastern University in Boston, MA.
Evaluators
avatar for Azur Eckley

Azur Eckley

Clinical Pharmacy Practitioner, Ralph H. Johnson VA Medical Center
Dr. Azur Eckley, BCPS  is currently a Clinical Pharmacy Practitioner in ambulatory care specialty clinics including cardiology, gastroenterology and nephrology at the Ralph H Johnson VA Medical Center in Charleston, SC. She is a graduate of the University of Tennessee College of... Read More →
BS
Friday April 25, 2025 8:30am - 8:45am EDT
Athena J
  Pediatric (PED), Children's Healthcare of Atlanta
  • global Y

8:50am EDT

Impact of Daily Pharmacist Anticoagulation Review in a Rural Hospital
Friday April 25, 2025 8:50am - 9:05am EDT
Olympia 1
Title: Impact of Daily Pharmacist Anticoagulation Review in a Rural Hospital

Authors: Grace Kenley, Lindsey Arthur

Objective: will be included in presentation

Self Assessment Question: will be included in presentation

Background:  Anticoagulants are used for a variety of indications which leads to their frequent administration in hospitalized patients. Whether utilizing anticoagulants for therapeutic indications or for venous thromboembolism (VTE) prophylaxis, dosing is highly individualized to each patient based on factors such as weight and renal function. As patients’ clinical statuses can fluctuate from admission to discharge, it is imperative to review the appropriateness of each anticoagulation regimen on a daily basis. The consequences of inappropriate anticoagulation regimens can be severe, including adverse events such as bleeding or thrombosis. Due to these risks, anticoagulants are included on the Institute for Safe Medication Practices (ISMP) list of high alert medications. The purpose of this study is to determine the impact of daily pharmacist review of anticoagulants within a newly implemented floor-based pharmacist model in a rural hospital.

Methods: A prospective cohort study will be conducted on patients admitted to the medical and telemetry floors at Self Regional Healthcare during the hours of 7:00 AM to 3:30 PM on weekdays between February 24th, 2025 through March 26th, 2025. Anticoagulation regimens, both treatment and prophylaxis, will be reviewed on each patient for appropriateness in terms of indication and patient specific factors such as renal function and weight. Patients not on any type of anticoagulation will be reviewed to determine if therapy is warranted. Patients will also be educated on the importance of anticoagulation if refusals are documented. The primary outcome is the number of anticoagulation recommendations made to ensure appropriate therapy. Secondary outcomes include number of dosage adjustments, number of frequency adjustments, number of anticoagulant initiations, number of anticoagulant discontinuations, number of bleeding events, number of thrombotic events, and number of patient educations performed. 

Results: Between February 24th, 2025 – March 26th, 2025, 1,046 patients were admitted to medical and telemetry-monitored floors. During this period, 67 anticoagulation recommendations were made. Of the 67 recommendations, 60 were accepted by providers, resulting in a 90% acceptance rate.  The most common rejection was the addition of SCDs for patients refusing chemoprophylaxis (4 of the 7 rejections). Results for secondary outcomes are as follows: 29 dosage adjustments, 6 frequency adjustments, 12 initiations, 3 discontinuations, 14 SCDs added on, 2 bleeding events, 1 thrombotic event, and 3 patient educations performed.  

Conclusion: Ultimately, having a pharmacist located on the floor increased the number of therapeutically appropriate anticoagulation recommendations which may lead to decreased adverse bleeding or thrombotic events.
Presenters
avatar for Grace Kenley

Grace Kenley

Pharmacy Resident, Self Regional Healthcare
Hi, I'm Grace! I am from Anderson, SC and am currently a PGY1 resident at Self Regional Healthcare. 
Evaluators
avatar for Abbi Rowe
avatar for Stephanie Ring

Stephanie Ring

Pharmacy Formulary Manager, Department of Veterans Affairs
Friday April 25, 2025 8:50am - 9:05am EDT
Olympia 1
  Administration (ADM), Self Regional Healthcare
  • global Y

8:50am EDT

Clinical Impact of GLP-1 and GIP/GLP-1 Receptor Agonist Access Issues in a Primary Care Setting
Friday April 25, 2025 8:50am - 9:05am EDT
Athena C
Title: Clinical Impact of GLP-1 and GIP/GLP-1 Receptor Agonist Access Issues in a Primary Care Setting

Authors: Alexandra Cochran, Laura Schalliol, Savannah Owen, Holly Lowe, and Gabriella V Rosellini

Objective: 
The primary objective is to evaluate the percent change in HbA1c for the prescribed GLP-1 or GIP/GLP-1 receptor agonist for the treatment group compared to the control group. 
The secondary objectives are to evaluate the change in weight and BMI for the prescribed GLP-1 or GIP/GLP-1 receptor agonist for the treatment group compared to the control group and to observe the medication adjustments made to maintain glycemic control in the absence of a GLP-1 and GIP/GLP-1 receptor agonist therapy.

Self Assessment Question: What are some potential strategies to mitigate the impact of GLP-1 and GIP/GLP-1 receptor agonist access issues on patient outcomes?
A. Expanding patient assistance programs
B. Utilizing SGLT2 inhibitors or insulin as alternatives
C. Implementing clinic-based sample programs
D.  All of the above

Background: Type 2 diabetes mellitus (T2DM) is a growing global health concern that requires comprehensive management to minimize complications. The complications of T2DM, including cardiovascular disease, chronic kidney disease, neuropathy, and retinopathy, can significantly impact a patient’s quality of life and overall health outcomes. Effective management of T2DM includes not only controlling blood glucose levels but also promoting weight management. However, despite significant advancements in diabetes therapies, many patients still struggle to achieve optimal control due to barriers such as medication costs, accessibility, and adherence.
The introduction of glucagon-like peptide-1 (GLP-1) receptor agonists, such as liraglutide, semaglutide, dulaglutide, and exenatide, revolutionized T2DM treatment by providing both glycemic control and weight reduction. The widespread use of GLP-1 receptor agonists has led to improved health outcomes, especially in patients with comorbid cardiovascular disease, and have become a cornerstone in the management of T2DM. Moreover, the recent advent of dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist, tirzepatide, has shown significant metabolic effects as well.
Despite the efficacy of these therapies, challenges in accessing GLP-1 and GIP/GLP-1 receptor agonists have emerged as a significant issue for many patients. Medication shortages, delays in prior authorization, and high out-of-pocket costs can impede timely access to these treatments, disrupting the continuity of care. Access barriers are particularly concerning, as they can lead to periods of inadequate glycemic control. Furthermore, patients who experience these disruptions may need to rely on less effective therapies

Methods: This study is a single-center, retrospective cohort analysis that utilizes medical records accessed via the electronic health record. Medical records were screened for patients prescribed any of the studied medications between January 1, 2022, and July 31, 2024. Inclusion criteria included adult patients aged eighteen years or older and having a T2DM diagnosis. Once included, patients were further divided into a treatment group and a control group. Exclusion criteria included patients who were younger than 18 years of age, with either no follow-up documentation or a medication discontinuation due to adverse effects.
 
Results: A total of 379 patients were reviewed for this study, with 247 patients meeting the inclusion criteria. Of these, 51 patients experienced an access issue with the prescribed GLP-1 or GIP/GLP-1 receptor agonists while 196 were included but did not experience any of the studied access issues. Of the 247 patients included, the average age was 59.5 years with 49% of the patient population being male.
The average change in HbA1c was -0.42% in the treatment group and -0.75% in the control group (p = 0.2128), indicating no statistically significant difference. Similarly, the average weight change was -1.91 kg in the treatment group and -2.13 kg in the control group (p = 0.7022). BMI changes followed a comparable trend, with an average reduction of -0.7 kg/m2 in the treatment group and -0.75 kg/m2 in the control group (p = 0.812).
 
Conclusion: Access issues for GLP-1 and GIP/GLP-1 receptor agonists can lead to clinically significant changes in glycemic control, weight, and BMI in patients with T2DM. This study reinforces the need for proactive management strategies and a collaborative approach among healthcare providers to mitigate the effects of access issues on patient health outcomes. Further research is needed to explore the long-term effects of medication access interruptions, including their impact on diabetes-related complications and overall patient outcomes. Additionally, studies should investigate the efficacy of alternative therapies, such as SGLT2 inhibitors or insulin regimens, in maintaining glycemic control when GLP-1 and GIP/GLP-1 receptor agonists are unavailable.
Moderators
avatar for Devki Gajera
Presenters
avatar for Alexandra Cochran

Alexandra Cochran

PGY-1 Resident, South College School of Pharmacy
My name is Alexandra Cochran, and I am the current PGY-1 Community-Based Pharmacy Resident at South College School of Pharmacy. I earned my Doctor of Pharmacy degree from The University of Tennessee Health Science Center. My professional interests lie in ambulatory care pharmacy and... Read More →
Evaluators
avatar for Erin Himes
Friday April 25, 2025 8:50am - 9:05am EDT
Athena C
  Ambulatory Care (AMB), South College School of Pharmacy
  • global Y

8:50am EDT

The impact of a Mental Health Pharmacotherapy Clinic at a Federally Qualified Health Center
Friday April 25, 2025 8:50am - 9:05am EDT
Athena D
Authors: Michaelyn Moretz, PharmD; Carrington Royals, PharmD; Sara Messier, PA-C; Reagan K. Barfield, PharmD, BCPS; P. Brandon Bookstaver, PharmD, FCCP, FISDA, BCPS; Robert Bailey


Objective: The purpose of this study is to assess whether pharmacist impact in mental health services will provide increased access to services and improved patient outcomes at a medically underserved Federally Qualified Health Center (FQHC) as compared to clinician interventions. 


Self-Assessment Question: Which of the following areas of behavioral health are pharmacists able to make an impact in? Select all that apply. 
A. Prescribing and monitoring psychiatric pharmacotherapy- Correct
B. Billing for services
C. Diagnosing patients with mental health disorders
D. Optimizing current patient medication regimens - Correct


Background: As the number of mental health clinicians continues to decrease, there is a disproportional demand for adequate provider access. Pharmacist-driven medication therapy adjustments improve access opportunities in this population with the goal of improving quality of life and outcomes for adults with various mental health disorders. Though the use of psychiatric medications is becoming more accepted by the public, there is an indwelling lack of confidence in continued care by providers due to the disease complexity, as well as schedule limitations and the overwhelming need for increased providers in rural areas. Pharmacists are becoming a proposed solution in performing these beneficial services. 


Methods: Established patients of a medically underserved FQHC enrolled in current mental health services eligible for a pharmacotherapy consult within the 6-month study period were included. The primary endpoint for the study was the change in measurable outcomes via mental health screening scores. The secondary endpoints were the potential revenue generation based on pharmacist visits overall and overall impact. Cost-savings and financial benefits were measured by revenue generated over the 6-month study period overall and the conversions of patients to the FQHC pharmacy. Impact was measured by patient satisfaction, disease improvements, adequate lab monitoring, medications reconciled, patient assistance provided through programs, and no-show rates.


Results: In progress


Conclusion: In progress
Moderators
avatar for Katrina White, PharmD, BCACP

Katrina White, PharmD, BCACP

Residency Program Director, Quality Assurance Program Manager, Gulf Coast Veterans Health Care System
Presenters
avatar for Michaelyn Moretz

Michaelyn Moretz

PGY-1 Pharmacy Resident, Tandem Health- University of South Carolina
Michaelyn Moretz, PharmD, originally from Waycross, GA, is currently completing her PGY1 pharmacy residency at Tandem Health and the University of South Carolina. She graduated from the University of Georgia College of Pharmacy in 2024. Michaelyn's professional interests lie in psychiatry... Read More →
Evaluators
avatar for Cori Edmonds

Cori Edmonds

Clinical Pharmacist, Residency Program Director, Vanderbilt Specialty Pharmacy
Friday April 25, 2025 8:50am - 9:05am EDT
Athena D
  Ambulatory Care (AMB), Tandem Health - University of South Carolina
  • global Y

8:50am EDT

Evaluation of VTE Prophylaxis in Trauma Patients at a Large Community Hospital
Friday April 25, 2025 8:50am - 9:05am EDT
Athena B
Evaluation of VTE Prophylaxis in Trauma Patients at a Large Community Hospital
Authors: Sarah Skaggs Gatewood and Jerry Robinson
Objectives:
  1. Identify current recommendations for proper VTE prophylaxis in trauma patients.
  2. Explain the implementation of guideline directed VTE prophylaxis management.
  3. Compare VTE event rates before and after implementation.
Background/Purpose: In 2022, the American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma published a clinical protocol with updated recommendations for inpatient venous thromboembolism (VTE) prophylaxis after trauma.  The dosing of enoxaparin for VTE prophylaxis in trauma patients at Huntsville Hospital did not match these recommendations. Trauma patients are at an increased risk of VTE, including deep vein thrombosis and pulmonary embolism. Pharmacologic and mechanical VTE prophylaxes are often necessary to decrease the risk of thromboembolic events after a trauma occurs. This project seeks to explore previous institution-specific dosing based on age, renal function, and other factors, compared to updated dosing to match 2022 recommendations.
Methods: This single-center, pre-post implementation, quasi-experimental study evaluated adult patients 18 years of age or older admitted to Huntsville Hospital under the care of trauma services from January 1st, 2024, to January 31st, 2025. Data was collected from the electronic health record (EHR) and analyzed using descriptive statistics. The following pre-intervention and post-intervention data were collected: patient demographics, hospital length of stay, renal function, VTE prophylaxis dosing, lab monitoring, and risk factors. Patients were excluded if they had a length of stay less than 72 hours, did not receive any mechanical VTE prophylaxis, or if they transferred to a long-term facility. A classification of patients was made based on current VTE prophylaxis guidelines after the trauma algorithm published by the American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma1. The primary endpoint was appropriate compliance with the 2022 algorithm for VTE prophylaxis post-trauma. Efficacy was assessed via anti-Xa monitoring, targeting a range of 0.2-0.4 units/mL, with 10 mg dosing adjustments for levels outside this range.  Secondary endpoints included composite rates of deep vein thrombosis and pulmonary embolism, patient length of stay, days on VTE prophylaxis, and adverse drug events (ADEs) related to enoxaparin administration. Hospital-specific data and current policies were reviewed to identify areas of improvement, which included adherence to practice guidelines for VTE prophylaxis in trauma patients. Post-intervention data included the same metrics as listed for the pre-implementation data set. An ongoing quality review was performed in the post-intervention phase to identify potential changes and ensure compliance.
Results: A total of 160 patients (mean age, 50 years) were studied, 80 in the pre-implementation group and 80 in the post-implementation group, with similar baseline characteristics, risk scores, overall length of stay, and days on VTE prophylaxis between groups. Adherence to guidelines was noted to be overall 44% in the pre-implementation group and 84% in the post-implementation group for all patients included. No anti-Xa levels were checked in the pre-implementation phase. In the post-implementation phase, target range anti-Xa levels were achieved in 53 out of 80 patients (87%), with 43 patients (70%) having their first level within the target range. The incidence of VTE events was similar between groups but lower in the post-implementation phase, with only 9% of patients experiencing VTE events versus 13% in the pre-implementation phase.
Conclusion: The implemented order set and ongoing feedback integration lead to successful protocol implementation. Overall compliance with the 2022 published algorithm for post-trauma venous thromboembolism prophylaxis was achieved in 84% of patients. Anti-Xa monitoring post implementation occurred in 87% of patients versus zero prior to implementation. VTE events were less in the post implementation phase as well. An ongoing review will be continued to evaluate ordering options as well as opportunities to optimize monitoring and adherence.
Self-Assessment Question:
What is the primary purpose of anti-Xa monitoring in patients?
  1. To assess renal function
  2. To evaluate anticoagulant effect of current dosing strategy for effectiveness and safety
  3. To monitor for potential allergic reactions
  4. To check for the development of deep vein thrombosis (DVT)

Moderators
avatar for Christele Francois

Christele Francois

Emergency Medicine Clinical Pharmacy Specialist, Emory University Hospital
Christele Francois, PharmD, is board certified in pharmacotherapy. She is a member of the Department of Pharmacy at Emory University Hospital and currently practicing as an Emergency Medicine Clinical Pharmacy Specialist. Dr. Francois obtained a Bachelor of Science degree at the University... Read More →
avatar for Allie Hale

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System
Presenters
avatar for Sarah Skaggs Gatewood

Sarah Skaggs Gatewood

PGY-1 Resident, Huntsville Hospital
Sarah is a PGY1 Resident at Huntsville Hospital in Huntsville, Alabama, originally from Rainsville, Alabama. She earned her Doctor of Pharmacy degree from Samford University. Sarah remains involved in multiple areas of pharmacy including serving as an Executive Consultant for the... Read More →
Friday April 25, 2025 8:50am - 9:05am EDT
Athena B
  Cardiology (CAR), Huntsville Hospital
  • global Y

8:50am EDT

Effects of selective serotonin reuptake inhibitors on stress ulcer bleeding in critically ill patients
Friday April 25, 2025 8:50am - 9:05am EDT
Athena G
Title: 
Effects of selective serotonin reuptake inhibitors on stress ulcer bleeding in critically ill patients


Authors: 
Morgan Keller, Sabrina Croft, Joseph Crosby


Objective: 
To be presented in slides


Self Assessement Question: 
To be presented in slides


Background:
Critically ill patients in the intensive care unit have increased risk for gastrointestinal complications, including stress ulcers and bleeding due to physiological stress, mechanical ventilation, and pharmacological interventions such as anticoagulants and corticosteroids. Prophylactic treatments such as proton pump inhibitors and H2-receptor antagonists are commonly used to mitigate this risk. The aim of this study is to determine whether the use of selective serotonin reuptake inhibitors is associated with an increased incidence of gastrointestinal bleeding with critically ill patients.


Methods:
This retrospective, observational chart review evaluates adult patients who are critically ill and admitted to one of the St. Joseph’s/Candler intensive care units who are taking selective serotonin reuptake inhibitor medications compared to patients with a comparator ICD 10 code (NSTEMI I21.4) not taking selective serotonin reuptake inhibitor therapy. A computer-generated list identified patients who were admitted to one of the St. Joseph’s/Candler intensive care unit (ICU), coronary care unit (CCU), or neuro-intensive care unit (NICU) with selective serotonin reuptake inhibitor therapy in patient from August 1 2020-August 1 2024. Comparatively, a second computer-generated list identified patients who were admitted to one of the St. Joseph’s/Candler ICU, CCU, or NICU with ICD 10 code I21.4 from August 1 2020-August 1 2024. Subjects were then be reviewed for study inclusion or exclusion based on the aforementioned criteria, and Microsoft office excel was used to randomize patients and select 50 patients per treatment arm. Chart review was conducted to determine if the patient was diagnosed with a gastrointestinal bleed during their specific visit. All data was collected and analyzed through Microsoft office excel. Primary outcomes and input variables are summarized with means and standard deviations for continuous measures, and proportions and percentages for non-continuous measures. Any adjusted analysis conducted was through multivariable regression.


Results:
Among the 100 critically ill patients admitted to the ICU, CCU, or NICU unit at St. Joseph’s and Candler Hospital, nine (9%) of patients were found to have a gastrointestinal bleed. Of the 9 patients who had a gastrointestinal bleed, seven (77.8%) of the patients were not on selective serotonin reuptake inhibitor therapy (SSRI) whereas 2 (22.2%) were on SSRI therapy. Among the nine patients diagnosed with a gastrointestinal bleed, five patients were in the CCU, one patient in the NICU, one patient in the St. Joseph’s ICU, and two patients in the Candler ICU. 71 (71%) of patients were on stress ulcer prophylaxis with either proton pump inhibitors or histamine type-2 receptor antagonists and only one of these patients experienced a gastrointestinal bleed. 
The primary endpoint analysis demonstrated no statistically significant association between SSRI therapy and increased risk of gastrointestinal bleeding in critically ill patients admitted into intensive care units, (p-value of 0.08). The lack of statistical significance suggests other clinical factors may contribute to the numerically fewer patients who experienced gastrointestinal bleeding on selective serotonin reuptake inhibitor medications than those patients not on selective serotonin reuptake inhibitor therapy.


Conclusion:
Selective serotonin reuptake inhibitor therapy does not appear to significantly increase the risk of gastrointestinal bleeding in critically ill patients admitted to intensive care units. Despite the predisposing factors of these patients to gastrointestinal complications, the observed incidence of bleeding was not higher in patients receiving selective serotonin reuptake inhibitors compared to those not receiving selective serotonin reuptake inhibitors who were diagnosed with NSTEMI. Considering the study’s limitations of retrospective design and small sample size, further research with larger, multicenter data should explore the potential relationship of selective serotonin reuptake inhibitors and gastrointestinal bleeding risk in critically ill patients. 
Moderators
avatar for Tia Collier

Tia Collier

Medical ICU and Neuroscience ICU Clinical Pharmacist and PGY2 Critical Care Residency Program Director at Erlanger in Chattanooga, TN.
Presenters
MK

Morgan Keller

Pharmacy Resident, St. Joseph's/Candler Health System
avatar for Morgan Keller

Morgan Keller

PGY1 Resident, Candler Hospital
Dr. Morgan Keller is originally from Longwood, Florida. She completed her Bachelor’s Degree in Interdisciplinary Medical Sciences at Florida State University before completing her Doctor of Pharmacy Degree from Auburn University’s Harrison College of Pharmacy. Dr. Keller is completing... Read More →
Evaluators
avatar for Sarah Frye

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2
Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree... Read More →
Friday April 25, 2025 8:50am - 9:05am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Candler Hospital
  • global Y

8:50am EDT

Evaluation of Desmopressin in Preventing Overcorrection of Hyponatremia Among Patients with Renal Dysfunction
Friday April 25, 2025 8:50am - 9:05am EDT
Athena H
Title: Evaluation of Desmopressin in Preventing Overcorrection of Hyponatremia Among Patients with Renal Dysfunction


Authors: Kelsea Mabie, Tara Kennell, Rajarshi Patel, Brooke Smith, Aaron Chase, Kelli Henry


Background: Hyponatremia is a common cause for hospital and intensive care unit (ICU) admission. Treatment strategies vary based on patient presentation and the presumed cause of hyponatremia, but center around sodium repletion, fluid balance management, and discontinuation of offending agents. Increasing serum sodium must be done in a slow, controlled fashion to prevent overcorrection which may cause adverse neurological effects, including osmotic demyelination syndrome (ODS). One method to prevent sodium overcorrection includes administering desmopressin to decrease free water loss via the kidneys, avoiding hemoconcentration and rapid increase in sodium. Studies have demonstrated desmopressin is a useful agent for this indication; however, there is limited evidence on the efficacy of desmopressin in the setting of renal dysfunction.  


Methods: This was a single center, retrospective cohort study at an academic medical center that received exemption from the institutional review board. Adult patients with a serum sodium <125 mEq/L who received one or more doses of intravenous (IV) desmopressin during their admission were included. Patients were excluded if they received desmopressin for a diagnosis of diabetes insipidus or hemorrhage. The primary outcome was the difference in rate of sodium overcorrection (>8 mEq/L) 24 hours after the first desmopressin dose in patients with renal dysfunction compared to those without renal dysfunction. Renal dysfunction was defined as creatinine clearance less than 30 mL/min. Secondary outcomes included rate of correction before and after desmopressin, proportion of patients achieving a sodium correction of 5–10 mEq/L within 24 hours of presentation, and rate of overcorrection at 24 and 48 hours after presentation. Outcomes were assessed with chi-squared, t-test, and Mann-Whitney U as appropriate. All patient demographics were categorized using mean and standard deviation or median and interquartile range.


Results: Sixty-five patients were included in this study with 14 patients (21.5%) having renal dysfunction. Forty-three (66.2%) patients were male, 54 (83.1%) were admitted to the ICU, and 17 (26.2%) received a home medication associated with hyponatremia. Baseline variables including age, sex, ICU admission, renal function, baseline sodium, weight, and fluid status were well-balanced between groups. Patients in the renal dysfunction group received significantly more milliequivalents of sodium through IV fluids compared to those without renal dysfunction (90.7 vs 284.2 mEq, p=0.001), which was primarily driven by 0.9% sodium chloride administration. There was no difference in the primary outcome of rate of overcorrection 24 hours after administration of desmopressin (9.8 vs 21.4%, p=0.476). The mean change in sodium 24 hours after desmopressin was similar between groups (2.43 vs 3 mEq/L, p=0.691), with no difference in rate of overcorrection at 24 hours (9.8 vs 28.6%, p=0.173) or 48 hours (5.9 vs 14.3%, p=0.632) after admission. Correction within goal range was similar between groups at 24 hours after admission (51.0 vs 50.0%, p=1.000) and after desmopressin administration (17.6 vs 28.6%, p=0.597). There were no differences in safety outcomes. 


Conclusion: Our study did not demonstrate a difference in overcorrection of sodium after desmopressin in those with impaired versus normal renal function. Overall, there was a low incidence of overcorrection, though this study was likely underpowered. The results did not reach statistical significance however, the observed differences in sodium overcorrection rates could suggest that renal dysfunction may not influence the clinical response to desmopressin. Future studies are warranted to determine the effect of renal dysfunction on safety and efficacy of desmopressin.  
Moderators
avatar for Rebecca Orr
Presenters
KM
Evaluators
avatar for Martin Gordon

Martin Gordon

Clinical Pharmacy Specialist- Critical Care, Spartanburg Medical Center
Martin Gordon, PharmD, BCCCP is the Clinical Pharmacy Specialist for Medical Critical Care and Residency Program Coordinator for the PGY1 Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Gordon completed his Doctor of Pharmacy degree from Presbyterian... Read More →
Friday April 25, 2025 8:50am - 9:05am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Wellstar MCG Health/University of Georgia College of Pharmacy
  • global Y

8:50am EDT

Tolerability of Enteral Nutrition in ICU Patients Receiving Vasopressors
Friday April 25, 2025 8:50am - 9:05am EDT
Athena I
Title: Tolerability of Enteral Nutrition in ICU Patients Receiving Vasopressors 

Authors: Micah A. McKinnie, Megan Langley, Jana Mills 

Background/Purpose: Critically ill patients are often faced with malnutrition and are thought to require more high-protein and calorie-dense diets. Due to favorable mortality outcomes, implementation of enteral nutrition within 24-48 hours of ICU admission is recommended for critically ill patients who cannot receive an oral diet. However, studies have shown that patients in the ICU are unlikely to receive the amount of nutrition they were initially prescribed. One contributing factor is the practice of delaying or pausing enteral nutrition for patients on high or increasing doses of vasopressors due to the risk of serious complications, such as ischemic or necrotic bowel. The lack of strong evidence has led to an ongoing debate about whether patients requiring ongoing vasopressors should receive enteral nutrition. As more evidence regarding the safety of initiating early enteral nutrition in patients on vasopressors emerges, there is potential for a professional consensus to be made. This may allow for a greater portion of the nutritional needs to be met in these critically ill patients. This retrospective single-center chart-review study seeks to explore further if patients receiving vasopressors exhibit a decreased tolerance to enteral feedings, resulting in an inability to achieve adequate nutrition.  
 
Methods: A retrospective review was conducted to identify patients admitted to the ICU from January 2024 through August 2024. Patients included in the study were at least 18 years old, on mechanical ventilation for at least 24 hours, admitted to the ICU for greater than 72 hours, and had a consult for enteral nutrition during their ICU stay. Patients were excluded if they were on vasopressors for less than 24 hours, were placed on end-of-life care, underwent GI surgery, or had other contraindications to enteral nutrition. Patients were subdivided into either the treatment group (vasopressors for at least 24 hours) or the control group (no vasopressors) to compare the primary outcome of the average percent of daily caloric goals met. Secondary outcomes included the average daily rate of vasopressors, the median time patients received enteral nutrition, the median time of interruption, and incidences of suspected intolerance to enteral feeding. Data was collected for the total course of the prescribed enteral feeding while in the ICU, or until vasopressors were discontinued (if applicable).  
 
Results: The average percent of caloric goals met while in the ICU was 46.7% for the vasopressor group and 56.9% for the control group. The vasopressor group was found to have both a lower median time receiving enteral nutrition (3 days vs 5 days, p-value 0.002) and a lower median time of enteral nutrition interruption (26 hours vs 45 hours, p-value 0.003). Incidences of suspected intolerance occurred in 28.2% of the vasopressor group and 7.7% of the control group. The median vasopressor rate during the study period was 0.072mcg/kg/min norepinephrine equivalents, and the median vasopressor rate at the time of suspected intolerance was 0.158mcg/kg/min norepinephrine equivalents. 
 
Conclusions: Mechanically ventilated patients requiring vasopressors in the ICU tended to receive a lower percentage of caloric goals through enteral nutrition than those not requiring vasopressors. Regardless of vasopressor use, this patient population was generally underfed while in the ICU. However, the clinical significance of these findings needs further exploration, and prospective research may be beneficial.
Moderators
CM

Charleen Melton, PharmD, BCCCP

Clinical Pharmacy Asst Manager, PGY1 and EM PGY2 RPC, CaroMont Health
Presenters
avatar for Micah McKinnie

Micah McKinnie

PGY1 Pharmacy Resident, Emory Decatur Hospital
Micah McKinnie is a current PGY1 Pharmacy Resident at Emory Decatur Hospital in Decatur, GA. She is originally from Atlanta, GA, and received her PharmD from the University of Georgia College of Pharmacy in 2024. Her current clinical interest is critical care. Dr. McKinnie's future... Read More →
Evaluators
BM
Friday April 25, 2025 8:50am - 9:05am EDT
Athena I
  Critical Care/Emergency Medicine (CCM), Emory Decatur Hospital
  • global Y

8:50am EDT

LVADing the Way: Narrowing Antibiotics Without Increasing Infection Risk
Friday April 25, 2025 8:50am - 9:05am EDT
Athena A
Title: 
LVADing the Way: Narrowing Antibiotics Without Increasing Infection Risk


Authors: 
Shyam Patel; Dusty Lisi; Mahmoud Abdou


Objectives: 
To evaluate the impact of different antimicrobial prophylaxis in patients undergoing LVAD implantation on infection free survival. 


Background: 
Driveline infections are one of the most serious and common complications associated with left ventricular assist device (LVAD) implantation. With an increase in prevalence of LVADs being used as a bridge to heart transplant or as destination therapy in end-stage heart failure, there is growing concern about optimizing perioperative antimicrobial management in LVAD procedures to prevent driveline infections and LVAD-associated infection (LVADI). Current guidelines for surgical infection prophylaxis (SIP) for LVAD implantation are not well established, leading to varied SIP regimens including single and multi-drug regimens covering the common pathogens such as Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae, and Enterobacter species. Institutions may also opt to cover for rare fungal and Pseudomonas infection based on institution-specific pathogen prevalence and antimicrobial resistances.

Broad spectrum antimicrobials have been the regimen of choice for LVAD SIP; however, the overuse of antimicrobials has led to several undesirable outcomes such as antimicrobial resistance and increased healthcare costs with questionable effects on patient outcomes. Several recent studies have found that narrow LVAD SIP regimens did not impact the infection-free survival or all-cause mortality as compared to different multi-drug regimens.

On August 13th, 2023, Emory Healthcare changed its SIP for LVAD implantations. This updated protocol replaced the previous regimen containing micafungin, vancomycin, and cefepime/levofloxacin with one that contains vancomycin and cefuroxime. The goal of this study is to evaluate the effectiveness of this new narrower drug regimen without pseudomonas and fungal coverage and its outcome on infection-free survival and mortality in LVAD patients at our institution compared to the previous multi-drug broad spectrum SIP. 


Methods:
A multi-center, retrospective chart review IRB-approved study was conducted to analyze patients meeting inclusion criteria pre- and post-implementation of a standardized LVAD SIP protocol (August 13th, 2023). Included patients who were at least 18 years of age and had received either a HeartMate 2, HeartMate 3, or HeartWare device at Emory Saint Joseph’s Hospital or Emory University Hospital. Patients were excluded if they did not have antimicrobial prophylaxis documented at the time of LVAD surgery, were receiving antimicrobial therapy 2 weeks prior to LVAD implantation for a previously diagnosed infection or had with concerns for infection prior to procedure. The primary outcome was time-to-infection. Secondary outcomes included percent driveline infection within 1st year, time-to-mortality,  infection type, and organism type. 


Results (pre-protocol vs post-protocol implementation): 
Ultimately, 62 patients were included in the pre-protocol implementation group and 18 patients in the post-protocol implementation group. Baseline demographics were similar between the two groups with the exception of a lower BMI in the pre-protocol group (27.6 vs.29.8 kg/m², p=0.04) and a higher percentage of individuals requiring pre-operative mechanical support in the pre-protocol group (65% vs 39%, p=0.01).There were a greater percentage of documented LVADI in the pre-protocol group (37% vs 33%); however, this was not correlated to a decreased time to infection between the pre-protocol and post protocol groups (267 vs 454 days, p=0.76). Both groups had similar percentage of mortality (15% vs 17%) with no difference in time to mortality (1847 vs 423 days, p=0.85).


Conclusions: 
Following the implementation of a protocol to narrow LVAD SIP by replacing the previous regimen containing micafungin, vancomycin, and cefepime/levofloxacin with one that contains vancomycin and cefuroxime for LVAD surgeries, there was no change to time to LVADI or mortality. Despite the small sample sizes and the differences in their sizes, this antimicrobial stewardship strategy was successful in reducing improper antimicrobial use across out healthcare system without compromising patient outcomes.
Moderators
JK

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1
Presenters
avatar for Shyam Patel

Shyam Patel

PGY1 Pharmacy Resident, Emory Healthcare
Dr. Shyam Patel is a PGY-1 Pharmacy Resident at Emory Saint Joseph’s Hospital. He earned his Doctor of Pharmacy degree from the University of Georgia College of Pharmacy and will be continuing his training as a PGY-2 Oncology Pharmacy Resident at the University of Alabama at Birmingham... Read More →
Evaluators
avatar for Melissa Padgett

Melissa Padgett

Residency Program Director, HCA Florida West Hospital
Melissa Padgett earned her Doctor of Pharmacy in 2014 from Belmont University College of Pharmacy in Nashville, TN. After receiving her PharmD, she completed a post-doctoral PGY1 pharmacy residency at HCA Florida West Hospital in June of 2015. From there, she stayed on as a full-time... Read More →
Friday April 25, 2025 8:50am - 9:05am EDT
Athena A
  Infectious Disease (ID), Emory Saint Joseph’s Hospital
  • global Y

8:50am EDT

Implementing a Pharmacy Clinical Decision Support Council for a 54 Hospital health-system.
Friday April 25, 2025 8:50am - 9:05am EDT
Athena J
Title: Implementing a Pharmacy Clinical Decision Support Council for a 54Hospital health-system.

Authors: Sabrina Desmond, Pharm.D.; Fei Wang, Pharm.D.; Craig MacDonald, Pharm.D.

Objective: To describe the creation and maintence of a clinical decision support oversight group to manage alerts within a multi-state health system.

Self Assessment Question: True or False: The only purpose of a clinical decision support council is to eliminate as many alerts as possible to reduce alert fatigue.

Background: Pharmacy-driven clinical decision support (CDS) is a critical element for optimizing medication safety and therapeutic outcomes in inpatient hospital systems. Pharmacy teams often manage an extensive array of drug-related alerts that can range from formulary and dosing recommendations to drug interactions and therapeutic duplications. Without focused oversight, these alerts can become overwhelming and lead to alert fatigue which could compromise the quality of patient care. A pharmacy-specific CDS Council can address these challenges by standardizing alert strategies, prioritizing clinically relevant notifications, and driving evidence-based enhancements to medication-related workflows.

Methods: Constructing an advisory group to oversee drug-related alerts required several steps:

  • Establishing a workflow for alert review submissions
  • Creating specialized workgroups that could provide insight for alert reviews
  • Construct a voting structure that allows for diverse assessment and input
Items are entered into the CDS review process by inputting a request into a ticket management platform. After submission, items are reviewed by a workgroup comprised of electronic health record (EHR) analysts and pharmacy informatics experts to evaluate the request and propose solutions for consideration. Following that initial review, solutions are discussed and voted on independently by a medication safety workgroup and a clinical workgroup. Each of these workgroups have at least one representative from each of the eight regions within the hospital system. Finally, solutions and voting results are presented to a final council that includes leaders in clinical, medication safety, EHR, and informatics specialties. All results are discussed, and final actions are determined.

To evaluate the interventions made by this CDS council, requests have been categorized into 4 groups: alert deactivation, alert activation, creation of a custom alert, and no action taken. A secondary analysis was performed to better understand the reasons for taking no action. Therefore, the group "no action taken" was further subcategorized into one of the following: alert is appropriate, alert is not indicated, functionality not available, or exists in current state.

Results: A total of 59 items were tracked from August 1st, 2024 - March 31, 2025.The number of items reviewed were categorized into the 4 groups as follows:

  • Alert deactivation: 4 items 
  • Alert activation: 11 items
  • Creation of custom alert: 12 items
  • No action taken: 32 items

Since there were 32 items that were categorized as "no action taken," these items were further subcategorized as follows:

  • Alert is appropriate: 18items 
  • Alert is not indicated: 5 items
  • Functionality not available: 5 items
  • Exists in current state: 4 items

Conclusion: A structured workflow is needed in order to perform a systematic review and comprehensive assessment for CDS enhancements within a health system. By gathering insight from diverse specialties and system-wide representatives, balanced adjustments can be made to alert settings. These adjustments potentially lead to management of alert fatigue and other limitations experienced with CDS tools. Further investigation is needed to assess the overall impact that is made when adjusting alert settings. Additionally, further optimization and expansion of the CDS Council process can allow for proactive investigation of potential alert adjustments as well as an assessment of other CDS components beyond alert settings.

Presenters
avatar for Sabrina Desmond

Sabrina Desmond

PGY 2 Informatics Resident, AdventHealth
As a PGY2 Informatics Resident at AdventHealth, I am dedicated to leveraging technology and data to enhance patient care and operational efficiency. Having graduated from the University of Florida College of Pharmacy and Stetson University, I look forward to fortifying my connections... Read More →
Evaluators
avatar for Azur Eckley

Azur Eckley

Clinical Pharmacy Practitioner, Ralph H. Johnson VA Medical Center
Dr. Azur Eckley, BCPS  is currently a Clinical Pharmacy Practitioner in ambulatory care specialty clinics including cardiology, gastroenterology and nephrology at the Ralph H Johnson VA Medical Center in Charleston, SC. She is a graduate of the University of Tennessee College of... Read More →
BS
Friday April 25, 2025 8:50am - 9:05am EDT
Athena J
  Informatics (INF), AdventHealth Orlando
  • global Y

8:50am EDT

Major Risk Factors Associated with the Development of Candidemia in Intensive Care Units at University Hospital in Mobile, AL
Friday April 25, 2025 8:50am - 9:05am EDT
Parthenon 2
Title: Major Risk Factors Associated with the Development of Candidemia in Intensive Care Units at University Hospital in Mobile, AL 
 
Authors: Kennadi Johnson, Ashley Hawthorne, Callie Seales
 
Background: Data on candidemia in the United States are limited. The Centers for Disease Control and Prevention (CDC) reports that approximately 25,000 cases of candidemia occur annually with a mortality rate of 25%. Due to its opportunistic nature, candidemia is primarily seen in critically ill and immunocompromised patients. Common risk factors include immunosuppression, current Candida colonization, central venous catheter placement, recent abdominal surgery, and broad-spectrum antibiotic use, to name a few. The “Candida score” was developed in 2009 and may be utilized as a predictor of invasive Candida infection; however, it has numerous limitations. The Infectious Diseases Society of America (IDSA) 2016 Clinical Practice Guideline for Management of Candidiasis recommends initiating empiric antifungal therapy in select critically ill, non-neutropenic patients.
 
Methods: In this retrospective, single-site study, patients were identified via a report in the medical record to capture all patients ≥ 18 years of age in the Intensive Care Units (ICU) with Candida in ≥ 1 blood culture(s). Patients not admitted to the ICU or with neutropenia were excluded. The following data was collected: age, gender, race, date and ward of admission, length of stay, collection date of first positive Candida blood culture, vital signs and labs at ICU admission and within 72-hours of positive Candida blood culture, past medical history, time of intubation and extubation, in-hospital mortality, and empiric antifungal therapy. Pre-disposing factors including pacemaker or defibrillator placement, any mode of dialysis, central venous catheter (CVC), foley catheter, total parental nutrition (TPN) use, home medications, history of intravenous (IV) drug use, presence of multifocal Candida colonization, and recent abdominal surgery were also collected. The primary objective of this study is to identify risk factors associated with the development of candidemia in ICU at our institution. The secondary objectives are to evaluate the performance of the “Candida score”, in-hospital mortality, incidence of candidemia by ICU location, and frequency of empiric antifungal therapy. Descriptive statistics were utilized to describe the results, and the “Candida score” was calculated for each patient.      
 
Results: Between October 1, 2018, and July 1, 2024, thirty-five patients met the inclusion criteria. The pre-disposing factors occurring in ≥ 50% of the study population were CVC (n=32, 19%), foley catheter (n=30, 86%), mechanical ventilation (n=29, 83%), and severe sepsis (n=20, 57%). Candida albicans was the most common species isolated (n=15, 43%). The percentages of patients admitted to the medical intensive care unit (MICU), surgical-trauma intensive care unit (STICU), and neuroscience intensive care unit (NSICU) were 49% (n=17), 46% (n=16), and 6% (n=2), respectively. In-hospital mortality occurred 63% (n=22) of the sample. The “Candida score” was only positive for 40% (n=14) of the sample, and 46% (n=16) of patients received empiric antifungal treatment.      
 
Conclusion: In this analysis, CVCs, foley catheters, severe sepsis, and mechanical ventilation were the most common characteristics amongst patients who developed candidemia. Lastly, the “Candida score” failed to accurately predict the likelihood of developing in candidemia in non-neutropenic, critically ill patients at University Hospital in Mobile, AL.
Presenters
avatar for Kennadi Johnson

Kennadi Johnson

PGY-1 Pharmacy Resident, USA Health University Hospital
Kennadi Johnson is a first-year pharmacy resident at USA Health University Hospital in Mobile, AL. A proud graduate of William Carey University School of Pharmacy, Kennadi has developed a keen interest in pharmacy informatics, ambulatory care, and oncology. During her academic journey... Read More →
Evaluators
avatar for Jason Dover

Jason Dover

PGY-1 Residency Program Director, Clinical Pharmacist Emergency Medicine/Internal Medicine, East Alabama Medical Center
Friday April 25, 2025 8:50am - 9:05am EDT
Parthenon 2
  Internal Medicine (IM), USA Health University Hospital
  • global Y

8:50am EDT

Outcomes Associated with Formal Infectious Diseases Consultation for Positive Blood Cultures with Staphylococci Other Than Staphylococcus aureus
Friday April 25, 2025 8:50am - 9:05am EDT
Parthenon 1
Title: Outcomes Associated with Formal Infectious Diseases Consultation for Positive Blood Cultures with Staphylococci Other Than Staphylococcus aureus 


Authors: Kellee B. Geren, Brandon Hawkins, Mary Joyce Wingler, Jessica Ortwine, Samantha Walker, Helen Ding, Bryan Walker, Cami Andreini 


Objective: This study attempted to determine the impact of infectious diseases consultation on the clinical management, readmission, and mortality of patients with Staphylococcus lugdunensis, Staphylococcus pseudintermedius, or Staphylococcus schleiferi isolated from a blood culture. 


Self Assessment Question: True or False: Infectious diseases consultation in patients with S. lugdunensis, S. pseudintermedius, or S. schleiferi bacteremia resulted in a significant decrease in mortality or 30-day readmission.


Background: There is data suggesting infections caused by S. lugdunensis, S. pseudintermedius, and S. schleiferi may be associated with a higher acuity of illness. However, there is limited data defining the management of these organisms when isolated from a blood culture, as well as the impact of infectious disease consultation on mortality in these patients.


Methods: This was a multi-center, observational, retrospective cohort study that compared the clinical management and disease course of patients with (consult group) and without an infectious diseases consultation (no consult group). Adult patients admitted between January 1, 2014 and March 1, 2024, with blood cultures positive for one of the specified organisms were included. Patients were excluded if S. aureus was isolated at any point during admission or if they discharged, died, or transitioned to hospice prior to blood culture speciation. 


Results: The primary outcome composite of 90-day all-cause mortality from index blood culture or 30-day readmission due to bloodstream infections caused by S. lugdunensis, S. pseudintermedius, or S. schleiferi was 17.9% in the no consult group and 12.2% in the consult group (p = 0.308). Hospital length of stay was a median of 6.82 days in the no consult group compared to a median of 11.69 days in the consult group (p < 0.001). Thirty-day mortality was 12.8% in the no consult group versus 8.5% in the consult group versus (p = 0.379). 


Conclusion: In patients who received an infectious diseases consult, 90-day mortality, 30-day mortality, and 30-day readmission were numerically, but not significantly, lower. A larger study is needed to assess the impact of infectious diseases consultation on mortality for specific staphylococci. 
Moderators
avatar for Margaret Williamson

Margaret Williamson

Clinical Pharmacy Specialist, East Alabama Health
Presenters
avatar for Kellee B. Geren

Kellee B. Geren

PGY1 Acute Care Pharmacy Resident, University of Tennessee Medical Center
Dr. Geren grew up in Cleveland, Tennessee. She completed her Bachelor of Science in Biology at Milligan University where she was also a member of the women's volleyball team. She completed her Doctor of Pharmacy degree at East Tennessee State University Bill Gatton College of Pharmacy... Read More →
Evaluators
avatar for Emily Johnson

Emily Johnson

PGY1 Residency Program Coordinator - Acute Care/Clinical Pharmacist Team Lead - MedSurg, Cape Fear Valley Medical Center
Friday April 25, 2025 8:50am - 9:05am EDT
Parthenon 1
  Internal Medicine (IM), University of Tennessee Medical Center
  • global Y

8:50am EDT

Randomized, Blinded Study of Olanzapine 2.5mg versus 5mg in Quadruplet Prophylaxis of Nausea/Vomiting after High-Dose Melphalan for Autologous Transplantation (The FONDO-LOW Trial)
Friday April 25, 2025 8:50am - 9:05am EDT
Olympia 2
Title: Randomized, Blinded Study of Olanzapine 2.5mg versus 5mg in Quadruplet Prophylaxis of Nausea/Vomiting after High-Dose Melphalan for Autologous Transplantation (The FONDO-LOW Trial)


Authors: Hanh Tran, E. Behren Ketchum, Vamsi Kota, Amber Clemmons


Objective: This study aims to determine the optimal dose of olanzapine when added to triplet prophylaxis in preventing CINV while minimizing the risk of daytime sedation after high-dose melphalan for patients with multiple myeloma receiving auto-HCT.


Self Assessment Question: In the FONDO-LOW study, subjects were assessed for emesis episodes, nausea severity, and sedation severity over five consecutive days. Each day, they rated their nausea and sedation severity using a 4-point scale based on their experiences in the past 24 hours. (True)


Background: Chemotherapy-induced nausea and vomiting (CINV) is a common and difficult to manage side effect. Olanzapine is an FDA-approved atypical antipsychotic that blocks multiple neuronal receptors involved in nausea/vomiting pathways. The FOND-O trial conducted at our institution by Clemmons and colleagues previously determined that adding olanzapine 10 mg to triplet prophylaxis (fosaprepitant, ondansetron, dexamethasone) improved CINV for patients undergoing high-dose chemotherapy for autologous stem cell transplantation (auto-HCT). Results from that trial led to the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) guidelines offering the olanzapine-based quadruplet regimen as an option for this population. Despite the high efficacy, several studies have shown that the 10 mg olanzapine dose may be associated with substantial daytime somnolence. Current NCCN guidelines recommend low-dose olanzapine of 5 mg or 2.5 mg if 10 mg or 5 mg, respectively, causes excessive sedation. Additionally, many transplant centers endorse utilizing lower doses to avoid the sedating effect of olanzapine. Despite the use of lower doses in practice, no publications have evaluated an optimal dose of olanzapine in reducing CINV and minimizing daytime sedation when added to standard triplet therapy for patients receiving high-dose melphalan for auto-HCT.


Methods: This is a single-center, prospective, randomized, double-blind study. Inclusion criteria are adult patients 18 years and older who receive high-dose melphalan 140-200 mg/m2 prior to auto-HCT. Patients will be randomized to receive encapsulated olanzapine 5 mg or 2.5 mg tablet orally on the day of high-dose melphalan and for three additional days post-chemotherapy in addition to standard triplet antiemetic prophylaxis consisting of an NK-1 receptor antagonist, ondansetron, and dexamethasone. Primary endpoint is percentage of patients achieving overall CINV complete response (CR), defined as no emesis and no more than mild nausea on 0-4 scale (0-none, 1-mild, 2-moderate, 3-severe), between the two olanzapine dosing groups. Secondary endpoints are complete protection (CR plus no breakthrough antiemetic use), total number of emetic episodes and breakthrough antiemetic doses, rate of study drug discontinuation, and incidence of no more than mild daytime sedation per patient report on the 4-point scale (none to severe). All outcomes will be reported in acute (chemotherapy day), delayed (four days after chemotherapy), and overall 5-day assessment periods. With an 80% power alpha of 0.05, 86 patients recruited for each arm to detect a 10% difference between groups. Hence, a total of 172 patients will be accrued for 3 years. Descriptive statistics are utilized to analyze patient demographics whereas Chi-square and t-test are used for primary and secondary outcomes.


Results: In Progress


Conclusion: In Progress
Moderators
avatar for Kristen Kilby

Kristen Kilby

PGY2 Oncology Resident, Northside Hospital
Kristen Kilby attended pharmacy school at the University of South Carolina. She then completed a PGY-1 residency at Baptist Memorial Hospital- Memphis and a PGY-2 Oncology residency at Northside Hospital in Atlanta, GA. She is currently a clinical oncology specialist focused on malignant... Read More →
Presenters
avatar for Hanh Tran

Hanh Tran

PGY2 oncology pharmacy resident, Wellstar MCG Health
Hanh Tran is a PGY2 oncology pharmacy resident at Wellstar MCG Health, Augusta, GA. She graduated from the University of Florida College of Pharmacy and completed her PGY1 residency at Wellstar MCG Health as well. Her clinical interests include malignant hematologies, solid tumors... Read More →
Evaluators
avatar for Amy Porter
Friday April 25, 2025 8:50am - 9:05am EDT
Olympia 2
  Oncology (ONC), Wellstar MCG Health Medical Center
  • global Y

9:10am EDT

Med-to-Bed Program Expansion to Transplant Services
Friday April 25, 2025 9:10am - 9:25am EDT
Olympia 1
Title: Med-to-Bed Program Expansion to Transplant Services


Authors: Amelia Hornaday, Alyson Ghizzoni-Burns, Heather Kundert, Alexandra Pyatt, Danielle Eskens


Objective: To expand the med-to-bed program to transplant services.


Background: Prisma Health has an established Kidney Transplant Program. It is vital to provide patients with strong continuity of care to support them through life post-transplant. Med-to-Bed programs were developed to decrease readmissions, improve medication adherence, reduce barriers to medication access, improve patient experience, and increase discharge prescription capture. Greenville Memorial Hospital’s med-to-bed program is offered to nearly all inpatient units through Upstate Medical Pharmacy, an internal outpatient pharmacy. Discharge prescriptions for transplant patients are currently being filled and mailed to the hospital by a third-party pharmacy. Given the increasing number of transplants and desire to expand services offered, it is imperative to the patient and organization to develop a process to include solid organ and bone marrow transplant services within the med-to-bed program.


Methods: Current and proposed processes were evaluated and compared to outside institutions to determine best practices. A Medicare Part B billing contract was established at Upstate Medical Pharmacy and test claims were billed for various insurance types. A workgroup was established consisting of both pharmacy and transplant staff to operationalize the workflow. Prior to go-live, education will be provided to transplant nursing and providers, inpatient pharmacy staff, and the outpatient med-to-bed team. Upon program expansion go-live, respective units will be auto-enrolled for med-to-bed in the electronic health record at the point of patient admission. The primary outcome is revenue generation and continued prescription capture rate.


Results: In progress


Conclusion: In progress
Presenters
AH

Amelia Hornaday

PGY-2 Health-System Pharmacy Administration and Leadership, Prisma Health - Upstate
Amelia is the current PGY-2 HSPAL resident at Prisma Health-Upstate. She is from Greenville, South Carolina and attended the University of South Carolina for both undergrad and pharmacy school. Go Gamecocks! Her areas of interest include oncology and infusion, specialty pharmacy... Read More →
Evaluators
avatar for Abbi Rowe
avatar for Stephanie Ring

Stephanie Ring

Pharmacy Formulary Manager, Department of Veterans Affairs
Friday April 25, 2025 9:10am - 9:25am EDT
Olympia 1
  Administration (ADM), Prisma Health-Upstate
  • global Y

9:10am EDT

Evaluating the Impact of “On the Spot”– a Remote Pharmacy Hypertension Consult Service
Friday April 25, 2025 9:10am - 9:25am EDT
Athena D
Title: 
Evaluating the Impact of “On the Spot”– a Remote Pharmacy Hypertension Consult Service 


Authors:
Briana Bethune; Jamie Coates; Naomi Yates


Background:   
Nearly half of adults in the United States have hypertension, although only 22.5% are considered controlled. Studies have shown that pharmacist intervention can improve management of hypertension through scheduled pharmacy appointments. However, no studies appear to examine pharmacist impact on blood pressure during nurse visit appointments where clinical pharmacy is not physically present. The purpose of this study was to determine whether immediate remote blood pressure consultation by clinical pharmacy specialists reduces time to blood pressure goal in patients diagnosed with hypertension.  


Methods:  
This IRB-exempt, observational, retrospective cohort study was conducted within an integrated healthcare delivery system. This study included adult patients diagnosed with hypertension who had a blood pressure reading between 140-179/90-109 mmHg after repeat check at a nurse visit from November 2023 to August 2024. Patients were excluded from the study if they were pregnant, receiving hospice/palliative care, or had a GFR < 30 mL/min/1.73 m2. Patients in the treatment group received an immediate consultation from a remote, on-call pharmacist for medication review and optimization as needed.  Patients in the control group received usual care where the “Doctor of the Day” was consulted for recommendation(s) as their schedule permitted.  The primary outcome of this study was to assess time to blood pressure goal (defined as ≤ 140/90 mmHg) for patients managed by the “On the Spot” pharmacy hypertension consult service compared to patients who received usual care. The secondary objectives were to evaluate medication optimization, change in blood pressure from baseline, and the percentage of patients who achieved blood pressure goal compared to usual care. The tertiary objective was to compare the percentage of patients enrolled in remote blood pressure monitoring (RBPM) where “On the Spot” was utilized versus usual care. Results were assessed at 4 months post intervention and data was analyzed using descriptive statistics.  


Results:
The study included 1,726 participants with 1466 patients in the control group and 260 patients in the intervention group. The average time to achieve blood pressure control was 31.93 ± 27.43 days in the control group and 31.21 ± 25.85 days in the intervention group, showing no statistically significant difference (p=0.72). Patients that received medication changes on the day of the nurse visit at a higher rate in the intervention group (62.31%) compared with the control group (35.54%, p<0.0001). The percentage of patients who achieved the blood pressure goal of ≤ 140/90 mmHg was similar between both groups with 87.08% in the control group and 88.21% in the intervention group (p= 0.51).  Similarly, changes in systolic and diastolic blood pressure from baseline were comparable in the control and intervention groups (systolic: -24.91 vs. -23.06 mmHg, p = 0.13; diastolic: -8.27 vs. -9.76 mmHg, p = 0.09, respectively). The percentage of patients enrolled in RBPM was significantly higher in the intervention group at 63.08% versus 6.55% in the control group (p<.0001). 


Conclusion:
The "On the Spot" remote pharmacy hypertension consult service demonstrated a significant impact on process measures, including higher rates of medication optimization and enrollment in RBPM compared to usual care. While the time to blood pressure control and overall blood pressure control rates were similar between groups, the higher medication intervention rates and RBPM enrollment suggest that integrating remote pharmacist consults into nurse visits enhances hypertension management workflow efficiency. Benefits include reducing delays in care, clearing physician and nurse schedules, and increasing rate of follow up. These findings highlight the value of immediate remote pharmacist intervention and underscore the potential for integrated remote pharmacy services to enhance hypertension management in healthcare systems.




Moderators
avatar for Katrina White, PharmD, BCACP

Katrina White, PharmD, BCACP

Residency Program Director, Quality Assurance Program Manager, Gulf Coast Veterans Health Care System
Presenters
BB
BB

Briana Bethune

PGY2 Ambulatory Care Resident, Kaiser Permanente GA
Kaiser Permanente GA PGY2 Ambulatory Care Resident
Evaluators
avatar for Cori Edmonds

Cori Edmonds

Clinical Pharmacist, Residency Program Director, Vanderbilt Specialty Pharmacy
Friday April 25, 2025 9:10am - 9:25am EDT
Athena D
  Ambulatory Care (AMB), Kaiser Foundation Health Plan of Georgia, Inc.
  • global Y

9:10am EDT

Evaluation of the Impact of a Pharmacist-led Smoking Cessation Clinic Within a Primary Care Setting
Friday April 25, 2025 9:10am - 9:25am EDT
Athena C
Title: Evaluation of the Impact of a Pharmacist-led Smoking Cessation Clinic Within a Primary Care Setting


Authors: Tiffany Gilchrist, Victoria McCarthy, Zil Tyler, Regan Wilson


Objective: To evaluate the effectiveness of a pharmacist-led smoking cessation clinic over a three-year period at the Piedmont Athens Regional Clay Community Care Clinic (CCCC)

Background: Smoking cessation plays a critical role in disease prevention and can significantly improve patient health outcomes. Pharmacists can be a great resource to assist individuals with smoking cessation due to their extensive background in pharmacotherapy and easy accessibility. This retrospective study aimed to evaluate the effectiveness of a pharmacist-led smoking cessation clinic over a three-year period at the Piedmont Athens Regional Clay Community Care Clinic (CCCC). This study hypothesized that patients who establish care with a pharmacist will demonstrate higher quit rates compared to patients who do not establish care with a pharmacist.
  
Methodology: This was a single-center, retrospective chart review of adult patients with a history of cigarette smoking referred to the CCCC pharmacist-led smoking cessation clinic from July 1, 2021 to June 30, 2024. Patients interested in smoking cessation are referred to the pharmacist-led smoking cessation clinic by their primary care provider. However, some patients do not establish care despite pharmacist outreach efforts. The primary outcome of this study is the percentage of patients who successfully quit smoking. Secondary outcomes include the percentage of patients who relapsed after quitting and the percentage of patients who successfully quit after previous unsuccessful quit attempts. Pre-specified subgroup analyses were evaluated for patients who established care with a pharmacist which included time to quit, percentage of patients who adhered to pharmacotherapy if prescribed, percentage reduction of cigarettes smoked from baseline, the percentage of patients who quit after receiving medication and behavioral counseling vs percentage of patients who quit with behavioral counseling alone, and the total number of follow-up visits completed with a pharmacist in patients who quit. Data collected included current cigarette usage at each encounter, pack-year history, pharmacological agents if prescribed, number of follow-up visits, reason for discharge, previous quit attempts, and if patients relapsed after quitting. Continuous data was analyzed using the Mann-Whitney U test and presented as an interquartile range (IQR) or medians. Categorical data was analyzed using the Chi-Square test and presented as percentages or numbers. Statistical significance was met for the primary and secondary outcomes of the study if the p < 0.05. 
  
Results: A total of 171 eligible patient referrals were reviewed, with 150 patients meeting the inclusion criteria. Baseline characteristics were similar between groups, with an average age of 53.5 years and 51.5% male patients. Among the 75 patients who did not establish care with a pharmacist, 67 (89%) did not receive smoking cessation pharmacotherapy. In the intervention group, the most commonly utilized pharmacotherapy was nicotine replacement therapy, prescribed in 54.6% of cases. The primary outcome—patients who quit smoking—was achieved in 14.7% of patients managed through the pharmacist-led smoking cessation clinic, compared to 1.3% of patients who did not establish care (p = 0.003). For secondary endpoints, there was a significant difference in patients who quit smoking after previous unsuccessful quit attempts (13.3% vs. 0%, p = 0.02). No significant difference in patients who relapsed after quitting was found between both groups (5.3% vs. 0%, p = 0.46).
  
Conclusions: In conclusion, patients who established care with a pharmacist had a statistically significant improvement in successful smoking cessation. 

Moderators
avatar for Devki Gajera
Presenters
avatar for Tiffany Gilchrist

Tiffany Gilchrist

PGY-1 Pharmacy Resident, Piedmont Athens Regional
Dr. Tiffany Gilchrist is a PGY-1 pharmacy resident at Piedmont Athens Regional. She is originally from Stone Mountain, Georgia, and served eight years as a pharmacy technician in the United States Navy. She earned her bachelor's degree at Purdue University Global and her Doctor of... Read More →
Evaluators
avatar for Erin Himes
Friday April 25, 2025 9:10am - 9:25am EDT
Athena C
  Ambulatory Care (AMB), Piedmont Athens Regional
  • global Y

9:10am EDT

IMPACT OF A MULTIDISCIPLINARY TEAM IN THE MANAGEMENT OF SUBJECTS WITH HEART FAILURE
Friday April 25, 2025 9:10am - 9:25am EDT
Athena B
IMPACT OF A MULTIDISCIPLINARY TEAM IN THE MANAGEMENT OF SUBJECTS WITH HEART FAILURE
Nicole DeLalla, Athena Colon, Richard Lane, Reginald Leandre, Tracey Dobbs
AdventHealth Apopka – AdventHealth Apopka, Florida, FL
Background: In 2024, nearly seven million individuals in the United States were diagnosed with heart failure.1,2 The resulting healthcare-related expenditure for treatment of this disease state has been calculated at over $3 million.1,2 In order to improve clinical outcomes, studies have shown that guideline-directed medical therapy (GDMT) can increase survival rates by 6.3 years. Additionally, GDMT has the potential to alleviate financial burden as a single heart failure-related hospitalization can cost about $15,000. 3,4 A study by Fallon and colleagues found that taking an interdisciplinary approach to heart failure management resulted in a 6% decrease in 30-day recurrent admissions in this patient population.5 However, there are limited studies focusing on how inpatient interventions affect rehospitalizations.
Methods: This was a single-center, retrospective chart review conducted at AdventHealth Apopka between July 1st, 2024 to December 31st, 2024. Included subjects were 18 years of age or older with a diagnosis of heart failure with reduced ejection fraction (HFrEF), defined as ejection fraction (EF) less than 40%. The exclusion criteria were subjects with an EF of 40% or greater, a history of a heart transplant, or planned heart transplant at the time of index visit. The primary objective was to assess the impact of a multidisciplinary heart failure management team on 30-day readmission rates. Secondary objectives included 30-day cardiovascular-related readmission, 30-day all-cause mortality, dose optimization defined as dose titration of GDMT medications or addition of at least one GDMT medication drug class, and inpatient length of stay (LOS). In addition, safety outcomes evaluated were incidence of acute kidney injury (AKI), hypotension, bradycardia, and hyperkalemia. 
Results: A total of 904 subjects were reviewed. Among those patients 146 subjects were included while 758 subjects were excluded. Baseline characteristics showed mainly white/Caucasian males with an average age was 67 years old. The 30-day readmission rates among the included patients were 33%. The 30-day cardiovascular readmission rate was 14%, and the 30-day all-cause mortality rate was 7%. Beta blockers had the highest incidence of dose titration at 17 %. The highest incidence of GDMT initiation was both beta blocks and diuretics with 27%. The average LOS was about 4.92 days.
Conclusion: In conclusion, this study saw a readmission rate of 33% after a multidisciplinary heart failure management team. When compared to national readmission rate of 25%, there is an eight percent difference in readmission rates to this study.6 This would suggest that there are areas of opportunities to further development of this heart management team.
 
References
HF stats 2024: Heart Failure Epidemiology and ... Accessed February 25, 2025. https://onlinejcf.com/article/S1071-9164(24)00232-X/fulltext.
  • Centers for Disease Control and Prevention. Heart Failure. CDC. https://www.cdc.gov/heart-disease/about/heart-failure.html. Published October 14, 2022. Accessed September 11th, 2024
  • Martin SS, Aday AW, Almarzooq ZI, et al. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association [published correction appears in Circulation. 2024 May 7;149(19):e1164. doi: 10.1161/CIR.0000000000001247]. Circulation. 2024;149(8):e347-e913. doi:10.1161/CIR.0000000000001209   
  • Weiss AJ, Jiang HJ. Overview of Clinical Conditions With Frequent and Costly Hospital Readmissions by Payer, 2018. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); July 20, 2021.
  • Fallon JM, Anderson K, McElhaney E, Lewis DA, Williams JB. Pharmacy-led optimization of transitions of care in patients with heart failure. J Am Coll Clin Pharm. 2024;7(6):778-786. doi:10.1002/jac5.1982. 
Foroutan F, Rayner DG, Ross HJ, et al. Global comparison of readmission rates for patients with heart failure. Journal of the American College of Cardiology. 2023;82(5):430-444. doi:10.1016/j.jacc.2023.05.040
Moderators
avatar for Christele Francois

Christele Francois

Emergency Medicine Clinical Pharmacy Specialist, Emory University Hospital
Christele Francois, PharmD, is board certified in pharmacotherapy. She is a member of the Department of Pharmacy at Emory University Hospital and currently practicing as an Emergency Medicine Clinical Pharmacy Specialist. Dr. Francois obtained a Bachelor of Science degree at the University... Read More →
avatar for Allie Hale

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System
Presenters
ND

Nicole DeLalla

PGY1 Resident, AdventHealth
Nicole DeLalla, an AdventHealth Apopka resident, is passionate about serving her community and providing quality patient care. Outside of work, she enjoys reading, playing videogames, going out to eat
Friday April 25, 2025 9:10am - 9:25am EDT
Athena B
  Cardiology (CAR), AdventHealth Apopka
  • global Y

9:10am EDT

Dexamethasone versus dexamethasone and fludrocortisone in patients with septic shock and acute respiratory distress syndrome
Friday April 25, 2025 9:10am - 9:25am EDT
Athena I
Title: Dexamethasone versus dexamethasone and fludrocortisone in patients with septic shock and acute respiratory distress syndrome


Authors: Gabrielle Cromley, PharmD; Audrey Johnson, PharmD, BCCCP; Eric K. Shaw PhD; Stephanie Lesslie, PharmD, BCPS, BCCCP


Objective: The purpose of this study was to compare duration of vasopressors within 30 days in patients with septic shock and ARDS who received either dexamethasone or dexamethasone and fludrocortisone.


Self Assessment Question: By what mechanism does mineralocorticoid activity improve septic shock?


Background:
Corticosteroids are recommended for both septic shock and moderate to severe acute respiratory distress syndrome (ARDS). Hydrocortisone is recommended in septic shock requiring vasopressors and it has both glucocorticoid and mineralocorticoid effects. Its mineralocorticoid effect provides additional benefit in septic shock by increasing fluid retention and peripheral vascular resistance. Dexamethasone is recommended for ARDS given the findings of the DEXA-ARDS trial which showed decreased duration of mechanical ventilation and all-cause mortality. Dexamethasone exhibits pure glucocorticoid activity and does not have mineralocorticoid activity. For patients with septic shock and ARDS, the ideal corticosteroid regimen is not clearly defined. The addition of fludrocortisone to dexamethasone may be beneficial in these patients given its mineralocorticoid effects. The purpose of this study is to determine if the addition of fludrocortisone to dexamethasone reduces vasopressor duration in patients with septic shock and ARDS.
 
Methodology: 
This single-center, retrospective cohort study was conducted at a 711-bed academic medical center. All data was collected from electronic medical records (EMR) by individual chart review. EMR reports of dexamethasone and fludrocortisone administrations between May 2020 through September 2024 were generated. Mechanically ventilated adult patients were included if they met all of the following criteria: PaO2:FiO2 < 200; receiving antibiotic therapy; requiring vasopressor support ≥ 10 mcg/min norepinephrine equivalent; administration of dexamethasone for ARDS with or without fludrocortisone for ≥ 48 hours. Patients were excluded if they met any of the following criteria: cardiogenic shock, chronic corticosteroid use, brain death, pregnant, or incarcerated. Patients who received concomitant fludrocortisone and dexamethasone were excluded if fludrocortisone was initiated > 5 days after starting dexamethasone. The primary outcome was the duration of vasopressors within 30 days. Secondary outcomes included all-cause mortality, ICU mortality, duration of mechanical ventilation in ICU survivors, ICU length of stay, and cumulative norepinephrine equivalent (NEE) dose, and fluid balance.
 
Results:
Twenty-nine patients were included in the dexamethasone only group and 15 patients were included in the dexamethasone/fludrocortisone group. Median duration of vasopressors within 30 days was 5 days (IQR 3.5 – 13) in dexamethasone/fludrocortisone group and 5 days (IQR 3 – 10) in the dexamethasone only group (p = 0.81). All-cause mortality was similar with 10 (66.%7) in the dexamethasone/fludrocortisone group and 18 (62.1%) in the dexamethasone only group (p = 0.76). ICU mortality was also similar with 9 (60%) in the dexamethasone/fludrocortisone group and 18 (62.1%) in the dexamethasone only group (p = 0.89). Median ICU length of stay was 11 days (IQR 8.5 – 26.5) for dexamethasone/fludrocortisone versus 12 days (IQR 8 – 21) in the dexamethasone only group (p = 0.84). Median duration of mechanical ventilation was 5 days (IQR 4 – 8) in the dexamethasone/fludrocortisone group compared to 7 days (IQR 6 – 12) in the dexamethasone only group (p = 1.0). The dexamethasone/fludrocortisone group required a median of 55,684 mcg NEE (IQR 36,132 – 86,663) cumulatively compared to 41,651 mcg NEE (IQR 13,686 – 62,784) with dexamethasone only (p = 1.0). Median difference in fluid balance after corticosteroids was +1.9 L (IQR -2.8 – 6.5) in the dexamethasone/fludrocortisone group and +0.54 L (IQR -2.6 – 4.9) in the dexamethasone only group (p = 1.0).
 
Conclusion: 
Patients with septic shock and ARDS had similar duration of vasopressors within 30 days whether they received dexamethasone/fludrocortisone or dexamethasone alone. There were no differences in all-cause mortality, ICU mortality, or ICU length of stay between groups. Patients who received dexamethasone/fludrocortisone had numerically shorter duration of mechanical ventilation and more positive fluid balance but these findings were not statistically significant. This study was underpowered and limited by its small sample size. Larger randomized controlled trials are needed to investigate the effects of fludrocortisone and dexamethasone in patients with ARDS and septic shock.


Resident contact: garbrielle.cromley@hcahealthcare.com
Moderators
CM

Charleen Melton, PharmD, BCCCP

Clinical Pharmacy Asst Manager, PGY1 and EM PGY2 RPC, CaroMont Health
Presenters
avatar for Gabrielle Cromley

Gabrielle Cromley

PGY-2 Critical Care Pharmacy Resident, Memorial Health University Medical Center
PGY-2 Critical Care Pharmacy Resident 
Evaluators
BM
Friday April 25, 2025 9:10am - 9:25am EDT
Athena I
  Critical Care/Emergency Medicine (CCM), Memorial Health University Medical Center
  • global Y

9:10am EDT

Optimizing Outpatient Antibiotic Therapy: Impact of Continuous Infusion Beta-Lactams and Vancomycin on Patient Adherence and Clinical Outcomes
Friday April 25, 2025 9:10am - 9:25am EDT
Athena G
Title: Optimizing Outpatient Antibiotic Therapy: Impact of Continuous Infusion Beta-Lactams and Vancomycin on Patient Adherence and Clinical Outcomes
 
Authors: Tarik Prince, Tyler Martin, Geren Thomas, Megan Mills
 
Objective: To compare the impact of continuous infusion (CI) versus intermittent infusion of beta-lactams and vancomycin in outpatient parenteral antibiotic therapy (OPAT) on patient adherence, clinical outcomes, and device-related complications, while assessing potential advantages of CI based on pharmacokinetic/pharmacodynamic principles.
 
Self-Assessment Question: How does continuous infusion (CI) of beta-lactams and vancomycin in OPAT compare to intermittent infusion in terms of patient adherence, clinical outcomes, and device-related complications? Provide at least one potential advantage of CI based on pharmacokinetic/pharmacodynamic principles.


Background: Beta-lactam antibiotics are widely used globally, and their bactericidal activity depends on optimizing pharmacokinetics by maximizing the fraction of time their concentration exceeds the minimum inhibitory concentration (fT>MIC). Continuous infusion (CI) over 24 hours has been demonstrated to improve fT>MIC, potentially leading to enhanced bacterial eradication, reduced resistance development, and lower relapse rates compared to intermittent infusion. While robust data exist for inpatient settings—showing reduced mortality, shorter hospital stays and improved clinical cure rates—the impact of CI in outpatient parenteral antibiotic therapy (OPAT) remains underexplored, especially concerning patient adherence and clinical outcomes. This study investigates CI versus intermittent infusion of beta-lactams and vancomycin in OPAT, focusing on treatment success, adherence rates, and device-related complications such as catheter occlusions and infections.
Methods: This prospective, quasi-experimental study evaluated patients discharged on CI antibiotics versus intermittent dosing. Inclusion criteria included adults (≥18 years) receiving OPAT with beta-lactam antibiotics for infections requiring prolonged therapy. Stability data for beta-lactams and vancomycin administered via CI through elastomeric devices were reviewed for compatibility with 24-hour CI. A dosing protocol was developed, detailing drug preparation, concentrations, device use, and patient monitoring. Patient adherence was assessed through self-reports (documenting missed doses), shipment tracking (confirming on-time medication delivery), and provider follow-ups (verifying compliance with administration schedules). Adherence was defined as 100% of prescribed doses received without missed or delayed doses. Secondary outcomes include clinical response, adverse effects, and hospital readmission rates within 30 days post-treatment completion. Data will be analyzed descriptively, with logistic regression for adherence predictors.
Results: An interim analysis was conducted, including six patients in the intermittent infusion group. The mean age was 71 years (range 51–90 years), with 67% of patients being male. The infections treated included osteomyelitis, urinary tract infection, Methicillin-Sensitive Staphylococcus aureus (MSSA) bacteremia, pneumonia, MSSA wound infection, and Pseudomonas aeruginosa wound infection. Adherence rates were 67%, with four patients adhering to therapy. Clinical response was achieved in 66% of patients, with no readmissions within 30 days post-discharge. Despite non-adherence in two patients, both achieved clinical cure. The most notable adverse event was a rash, which prompted a change in therapy. 
Conclusion: No definitive conclusions can be drawn at this time due to the small sample size and data available only for one arm of the study. Given the limited sample size, further research with a larger cohort is needed to explore factors influencing adherence and its potential impact on clinical outcomes. Data collection is ongoing for both the intermittent infusion and continuous infusion groups, and additional retrospective data may be required to strengthen these findings.
Moderators
avatar for Tia Collier

Tia Collier

Medical ICU and Neuroscience ICU Clinical Pharmacist and PGY2 Critical Care Residency Program Director at Erlanger in Chattanooga, TN.
Presenters
avatar for Tarik Prince

Tarik Prince

PGY-1 Pharmacy Resident, Archbold Memorial Hospital
My name is Tarik Prince, and I am a PGY1 Pharmacy Resident at John D. Archbold Memorial Hospital in Thomasville, GA. I earned my Doctor of Pharmacy degree from Mercer University, and my primary interests lie in emergency medicine, critical care, and antimicrobial stewardship.My research... Read More →
Evaluators
avatar for Sarah Frye

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2
Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree... Read More →
Friday April 25, 2025 9:10am - 9:25am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), John D. Archbold Memorial Hospital
  • global Y

9:10am EDT

Doxycycline Versus Azithromycin for Chlamydia Treatment in the Emergency Department
Friday April 25, 2025 9:10am - 9:25am EDT
Athena A
Title: Doxycycline Versus Azithromycin for Chlamydia Treatment in the Emergency Department 

Authors: Paakhee Shah, Dora Hall, Sarah Cullen 

Background/Purpose: 
Chlamydia is a sexually transmitted infection with a high rate of incidence, and most commonly affects those 24 years old and younger. It can often present asymptomatically, so it is important to test and treat patients routinely. Untreated chlamydia infection can cause complications such as pelvic inflammatory disease, ectopic pregnancy, and infertility. Before the 2021 Sexually Transmitted Infections (STI) Treatment Guidelines were released by the Centers for Disease Control and Prevention (CDC), the treatment of choice for chlamydia infection was a one-time oral dose of azithromycin 1 gram. With its continued use, Chlamydia trachomatis has developed resistance to azithromycin, especially in patients with rectal infection. The 2021 CDC STI Treatment Guideline recommends using doxycycline 100 mg orally twice daily for 7 days, which is highly efficacious in urogenital, rectal, and oropharyngeal infections. Azithromycin should still be used as an alternative in pregnant patients, in patients where nonadherence is a high concern, or patients with an allergy to doxycycline. 
A previous evaluation of prescribing according to the CDC Guidelines at Emory Decatur Hospital (EDH) and Emory Hillandale Hospital (EHH) showed that 66% of patients received doxycycline and azithromycin double coverage inappropriately. As a result of the evaluation, an order panel was developed to prompt providers to prescribe doxycycline over azithromycin, unless indicated otherwise. This study's purpose was to determine if the increased use of doxycycline reduces treatment failure incidence and contributes to better patient outcomes.  

Methods: 
This single-center, retrospective cohort study aimed to evaluate the impact of the updated CDC guidelines and hospital order panel on re-infection rates and treatment failure. Outcomes compared two cohorts: cohort one included 224 patients who were treated for Chlamydia infection in the emergency department with only doxycycline and cohort two included 40 patients who were treated for Chlamydia infection in the emergency department with only azithromycin. The primary outcome was treatment failure or re-infection rates, defined as having a subsequent positive NAAT test three to four weeks after initial diagnosis. Secondary outcomes included order panel and CDC guideline adherence and prescribing patterns of doxycycline versus azithromycin.  

Results: 
The incidence of treatment failure in the doxycyline group was 0.9% (n=2) and 5% in the azithromycin group (n=2) (OR 5.8, 95% CI [0.8-42.7], p-value 0.11) with a power of 0.3. For secondary endpoint of appropriate antibiotic use following the placement of the order panel, 88.3% of patients received the appropriate antibiotic selection, 9.1% of patients received azithromycin inappropriately, and 2.7% of patients had a treatment duration of longer than 7 days. Of the 173 patients that were screened to determine the secondary endpoint incidence of double coverage following placement of the order panel, 1.7% of patients received double coverage (n=3).  

Conclusion: 
The study was not adequately powered to identify a statistically significant difference in re-infection or treatment failure between doxycycline and azithromycin, but more patients who received azithromycin experienced re-infection/treatment failure compared to doxycycline. Antibiotic selection for treatment of Chlamydia infection should continue to be based on 2021 CDC STI Guideline recommendations with doxycycline as the agent of choice. Creation of the order panel was beneficial in minimizing double coverage and allowed for better treatment administration.
Moderators
JK

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1
Presenters
avatar for Paakhee Shah

Paakhee Shah

PGY-1 Pharmacy Resident, Emory Decatur Hospital
PS

Paakhee Shah

PGY-1 Pharmacy Resident, Emory Decatur Hospital
Paakhee Shah grew up in Suwanee, GA and now lives in Cumming, GA. She did her undergraduate studies at the University of Georgia and received her Doctor of Pharmacy degree from the University of Florida in Gainesville, FL. Her professional interests include ambulatory care and infectious... Read More →
Evaluators
avatar for Melissa Padgett

Melissa Padgett

Residency Program Director, HCA Florida West Hospital
Melissa Padgett earned her Doctor of Pharmacy in 2014 from Belmont University College of Pharmacy in Nashville, TN. After receiving her PharmD, she completed a post-doctoral PGY1 pharmacy residency at HCA Florida West Hospital in June of 2015. From there, she stayed on as a full-time... Read More →
Friday April 25, 2025 9:10am - 9:25am EDT
Athena A
  Infectious Disease (ID), Emory Decatur Hospital
  • global Y

9:10am EDT

Apixaban Safety and Efficacy for the Treatment of Venous Thromboembolism in Patients on Dialysis
Friday April 25, 2025 9:10am - 9:25am EDT
Parthenon 2
APIXABAN SAFETY AND EFFICACY FOR THE TREATMENT OF VENOUS THROMBOEMBOLISM IN PATIENTS ON DIALYSIS 
L. Ashton Dickinson, TJ Hodge, Robert Moye, Kimberly Keller, Abby Cowan, Taylor Bird, Ross M. Nesbit 
University of Tennessee Medical Center – Knoxville, TN 
 
Background/Purpose: While there is data in favor of using apixaban for the treatment of acute venous thromboembolism (VTE) in patients with End Stage Renal Disease (ESRD), more data is needed to inform safe and efficacious dosing in this population. This study evaluated the safety and efficacy outcomes of various apixaban dosing strategies for acute VTE in adult hospitalized patients with ESRD on dialysis.    
Methodology: This was a single-center, retrospective analysis that drew data from dialysis patients who experienced an acute VTE between the period of January 2016 and December 2023. Groups compared included patients who received apixaban 10 mg BID for 7 days (full lead-in dosing) with 5 mg BID thereafter to patients who received apixaban 10 mg BID for 0-6 days (modified lead-in dosing) with 5 mg BID thereafter. Patients > 18 years with ESRD on maintenance dialysis (hemodialysis or peritoneal) and a newly diagnosed acute VTE receiving anticoagulation therapy with apixaban were included in this study. Primary endpoints collected comprised of&n
Presenters
LA

Luren Ashton Dickinson

PGY1 Pharmacy Resident, University of Tennessee Medical Center
Dr. Dickinson grew up in Cumming, Georgia. She obtained a Bachelor of Science in Biology and later a Doctor of Pharmacy degree from the University of Georgia. Next year, she will be participating in the PPD Clinical Research and Drug Development Fellowship at the University of North... Read More →
Evaluators
avatar for Jason Dover

Jason Dover

PGY-1 Residency Program Director, Clinical Pharmacist Emergency Medicine/Internal Medicine, East Alabama Medical Center
Friday April 25, 2025 9:10am - 9:25am EDT
Parthenon 2
  Internal Medicine (IM), University of Tennessee Medical Center
  • global Y

9:10am EDT

Description of Clinical Pharmacist Interventions on an Acute Care Unit
Friday April 25, 2025 9:10am - 9:25am EDT
Parthenon 1
Title: Description of Clinical Pharmacist Interventions on an Acute Care Unit
Authors: Jamarius Carvin, Kelley Frances Henley, Niaima Geresu, Irene Bemis, Kristina Evans, Stella Ye 
Objective: Evaluate the impact of a dedicated clinical pharmacist on acute care unit interventions 
Self-assessment: How did a dedicated pharmacist affect daily interventions? 
Background: In a clinical setting, pharmacists optimize medication therapy and enhance patient safety. Studies have shown pharmacists identify and prevent errors with potential cost avoidance. Quantifying their impact is crucial for justifying clinical pharmacy services, especially concerning medication errors at hospital discharge, which pose risks and increase costs. Pharmacist-led medication reconciliation at discharge (PMRD) has shown positive impacts on reducing medication errors, preventing adverse drug events and improving patient safety. Pharmacists also provide drug information, optimize therapy, and improve cost-effectiveness. It is important to continue to evaluate the impact of a clinical pharmacist in an evolving healthcare field, so this research investigates the impact of implementing a dedicated clinical pharmacist on an acute care unit by quantifying interventions. 


Methods: This retrospective chart review was conducted at Grady Health System (GHS). The study compared two periods on a 40-bed acute care unit: a baseline period (20 weekdays in April 2024) with usual GHS pharmacy protocol and an intervention period (20 weekdays from May-June 2024) with a dedicated pharmacy resident. The primary outcome was the average number of pharmacist interventions per day. Secondary outcomes included intervention categorization, the number of patients with interventions, the total number of interventions, and high-risk medication interventions. Exclusion criteria were duplicate documented interventions. Descriptive statistics and chi-squared testing were used for analysis. 


Results: The average number of interventions per day increased from 5.7 (± 2.6) in the control period to 16.85 (± 7.8) in the intervention period. The total number of documented interventions in the control period was 99 compared to 337 in the intervention period.  The number of patients with at least one documented pharmacist intervention increased from 61 to 175
Moderators
avatar for Margaret Williamson

Margaret Williamson

Clinical Pharmacy Specialist, East Alabama Health
Presenters
avatar for Jamarius Carvin

Jamarius Carvin

PGY2 Internal Medicine Pharmacy Resident, Grady Memorial Hospital
PGY2 Internal Medicine Pharmacy Resident at Grady Memorial Hospital
Evaluators
avatar for Emily Johnson

Emily Johnson

PGY1 Residency Program Coordinator - Acute Care/Clinical Pharmacist Team Lead - MedSurg, Cape Fear Valley Medical Center
Friday April 25, 2025 9:10am - 9:25am EDT
Parthenon 1
  Internal Medicine (IM), Grady Memorial Hospital
  • global Y

9:10am EDT

Paclitaxel infusion reaction evaluation and prevention strategies at a large community hospital outpatient chemotherapy infusion center
Friday April 25, 2025 9:10am - 9:25am EDT
Olympia 2
Title: Paclitaxel infusion reaction evaluation and prevention strategies at a large community hospital outpatient chemotherapy infusion center
 
Authors: Emma Pride1; Allison Bass1; Amanda Ouzts1; Melissa Strobel2; F. Joseph Kelly2
Pharmacy Department, Huntsville Hospital – Huntsville, Alabama1
Tennessee Valley Gynecologic Oncology – Huntsville, Alabama2
 
Purpose/Background: Paclitaxel, a widely used drug in the treatment of gynecologic malignancies, is associated with hypersensitivity reactions in an estimated 2-4% of patients, and infusion related reactions in around 27% of patients, despite pre-medications.  There are known risk factors for paclitaxel reactions including respiratory dysfunction, obesity (defined as a body mass index ≥ 25), no history of alcohol consumption, and postmenopausal status. Recent updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide new insights into managing infusion-related reactions and hypersensitivity reactions in this setting, yet practical applications remain limited for management and prevention. Utilizing this information and other literature, this study aimed to evaluate the incidence of paclitaxel reactions at a large outpatient infusion center and implement a process improvement initiative focused on optimizing infusion protocols and premedication timing to enhance patient safety and support continued use of first-line therapy.
 
Methodology: This single-center, IRB-approved, pre-post implementation study evaluated female patients aged ≥18 years with gynecologic malignancies who received 3-hour paclitaxel infusions at Huntsville Hospital’s outpatient infusion center. The pre-intervention group included 224 patients who received paclitaxel from February 1, 2022, to December 31, 2024. Data collected from the electronical medical record included demographic factors, known reaction risk factors, and premedication timing. A new paclitaxel titration protocol and modified premedication timing strategy were implemented starting February 3, 2025 through April 1, 2025. Post-intervention data included patients receiving paclitaxel beginning on that date, regardless of treatment cycle. The primary endpoint was the occurrence of any documented reaction to paclitaxel. 
 
Results: A total of 224 patients were included in the pre-implementation analysis, of whom 44 (19.6%) experienced a reaction to paclitaxel. Of these, 11 (25%) were classified as hypersensitivity reactions, 28 (63.6%) as infusion-related reactions, and 5 (11.4%) could not be clearly classified. Common risk factors identified included BMI ≥ 25 (n=156), with 23% of these patients experiencing a reaction. Additionally, 84% of patients who reacted had premedications administered ≥45 minutes before paclitaxel. Following the implementation of updated premedication timing and infusion titration protocols, no reactions were documented in the initial 43 post-implementation administrations across cycle 1, cycle 2, and subsequent cycles. 
 
Conclusion: Implementation of an updated paclitaxel infusion protocol—including more prompt administration of premedications, priming lines with paclitaxel rather than normal saline, and a modified titration schedule—was associated with a reduction in infusion-related and hypersensitivity reactions. While initial post-intervention data is promising, continued monitoring is warranted to confirm the long-term impact in a larger cohort. 
Moderators
avatar for Kristen Kilby

Kristen Kilby

PGY2 Oncology Resident, Northside Hospital
Kristen Kilby attended pharmacy school at the University of South Carolina. She then completed a PGY-1 residency at Baptist Memorial Hospital- Memphis and a PGY-2 Oncology residency at Northside Hospital in Atlanta, GA. She is currently a clinical oncology specialist focused on malignant... Read More →
Presenters
avatar for Emma Pride

Emma Pride

PGY1 Pharmacy Resident, Huntsville Hospital
Emma Pride graduated from Auburn University in 2021 with a Bachelor of Science in Biomedical Sciences and a minor in Human Development and Family Studies. She went on to earn her Doctor of Pharmacy degree from the Auburn University Harrison College of Pharmacy in 2024. Currently... Read More →
Evaluators
avatar for Amy Porter
Friday April 25, 2025 9:10am - 9:25am EDT
Olympia 2
  Oncology (ONC), Huntsville Hospital
  • global Y

9:10am EDT

Comparative Outcomes of Post-Transplant Cyclophosphamide (PTCy) vs Non-PTCy-Based GVHD Prophylaxis Regimens in Allogeneic Hematopoietic Stem Cell Transplantation
Friday April 25, 2025 9:10am - 9:25am EDT
Athena J
Title: Comparative Outcomes of Post-Transplant Cyclophosphamide (PTCy) vs Non-PTCy-Based GVHD Prophylaxis Regimens in Allogeneic Hematopoietic Stem Cell Transplantation


Authors: Gyunash Akibova, Kristen Kilby, Henry Kent Holland, Justin LaPorte, Eva Karam 
 
Objective: This study aims to evaluate the long-term outcomes of PTCy-based GVHD prophylaxis in alloHSCT recipients over a 10-year period at Northside Hospital. The primary objective is to assess chronic GVHD-free relapse-free survival (CGFRFS) in patients receiving PTCy compared to those who did not. Secondary objectives include evaluating overall survival (OS), relapse-free survival (RFS), NRM, and the incidence of acute and chronic GVHD.
 
Background: Graft-versus-host disease (GVHD) is a significant complication following allogeneic hematopoietic stem cell transplantation (alloHSCT), particularly in patients with human leukocyte antigen (HLA)-mismatched or haploidentical donors. Traditional GVHD prophylaxis regimens, such as a calcineurin inhibitor (CI) and methotrexate (MTX), have been effective but are still associated with risks of acute and chronic GVHD, as well as non-relapse mortality (NRM). Post-transplant cyclophosphamide (PTCy) alone or in combination with a CI with or without mycophenolate has emerged as a promising approach for GVHD prophylaxis, showing favorable results in reducing GVHD incidence in alloHSCT recipients. A recent retrospective study at The Blood and Marrow Transplant Program at Northside Hospital suggested the benefits of PTCy beyond haploidentical transplants, prompting further investigation into its long-term outcomes.
 
Methods: This single-center, retrospective chart review will include patients who underwent alloHSCT at Northside Hospital between January 1, 2013, and December 31, 2023. Recipient health records will be identified using a proprietary database to identify patients who received an alloHSCT during the study period. Data will be extracted from electronic health records (Cerner Powerchart®, OncoEMR®) and hospital databases. Patients will be excluded if they are receiving a second alloHSCT. Key data points include patient demographics, HLA disparity, use of PTCy, GVHD incidence, time to GVHD onset, disease relapse, and survival outcomes. 
 
Results: In Progress
 
Conclusion: In Progress
Presenters
avatar for Gyunash Akibova

Gyunash Akibova

PGY2 Pharmacy Oncology Resident, Northside Hospital
PGY2 Pharmacy Oncology Resident at Northside Hospital Atlanta 
Evaluators
avatar for Azur Eckley

Azur Eckley

Clinical Pharmacy Practitioner, Ralph H. Johnson VA Medical Center
Dr. Azur Eckley, BCPS  is currently a Clinical Pharmacy Practitioner in ambulatory care specialty clinics including cardiology, gastroenterology and nephrology at the Ralph H Johnson VA Medical Center in Charleston, SC. She is a graduate of the University of Tennessee College of... Read More →
BS
Friday April 25, 2025 9:10am - 9:25am EDT
Athena J
  Transplant (TRP), Northside Hospital
  • global Y

9:30am EDT

Empty
Friday April 25, 2025 9:30am - 9:45am EDT
Athena J
Evaluators
avatar for Azur Eckley

Azur Eckley

Clinical Pharmacy Practitioner, Ralph H. Johnson VA Medical Center
Dr. Azur Eckley, BCPS  is currently a Clinical Pharmacy Practitioner in ambulatory care specialty clinics including cardiology, gastroenterology and nephrology at the Ralph H Johnson VA Medical Center in Charleston, SC. She is a graduate of the University of Tennessee College of... Read More →
BS
Friday April 25, 2025 9:30am - 9:45am EDT
Athena J

9:30am EDT

Evaluation of a Pharmacist-Led Cardiovascular-Kidney-Metabolic (CKM) Initiative
Friday April 25, 2025 9:30am - 9:45am EDT
Athena C
Title: Evaluation of a Pharmacist-Led Cardiovascular-Kidney-Metabolic (CKM) Initiative 


Objective: To evaluate the impact of a pharmacist-led cardiovascular-kidney-metabolic (CKM) initiative to assist in early detection in management of CKD to slow disease progression and prevent cardiovascular disease. 


Background: In 2023, the American Heart Association (AHA) published a presidential advisory on Cardiovascular- Kidney-Metabolic (CKM) Health, which defines CKM syndrome as a health disorder attributable to connections among obesity, diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD), including heart failure, atrial fibrillation, coronary heart disease, stroke, and peripheral artery disease. The AHA recommends that patients be screened across their life span with the main aim to reduce the risk of CKD progression and prevent associated cardiovascular outcomes. This wholistic approach includes patient-centered pharmacologic and nonpharmacologic therapy which may include treatment of obesity, diabetes, hypertension, hyperlipidemia, and CKD to reduce cardiovascular disease risk factors. In order to slow progression and prevent associated adverse outcomes of CKM, it requires an interdisciplinary team of nephrology, cardiology, endocrinology, and primary care. However, there are barriers to this wholistic approach which include provider difficulty managing risk factors, provider concerns about adverse drug reactions , patient acceptance, affordability of treatment, and lack of comprehensive integrated clinical information systems. The inclusion of a clinical pharmacist in this multidisciplinary team can help address these barriers to increase the number of patients on guideline-directed therapy with the ultimate goal to reduce CKD and CVD risk in CKM. Pharmacists at our institution have implemented a CKM initiative to assist in early detection in management of CKD to slow disease progression and prevent cardiovascular disease. 


Methods: A single-center retrospective chart review was conducted at Piedmont Columbus Regional Midtown Family Medicine Center and Piedmont Community Health Clinic to evaluate the impact of the pharmacist-led CKM initiative conducted between October 1, 2024, through February 28, 2025. The study included patients screened by clinical pharmacists at Piedmont Columbus Community Health and Piedmont Columbus Family Medicine and excluded patients on renal replacement therapies and renal transplant patients. The primary outcome was the percent of patients receiving CKM screening with an actionable recommendation by the pharmacist [obtainment of a laboratory assessment, addition of guideline directed therapy, adjustment in guideline directed therapy doses, or referral to the pharmacist managed clinic for chronic disease state management (DM, HTN, HLD, CKD, obesity management, smoking cessation)]. Secondary outcomes included percent of patients on guideline-recommended therapies for CKM pre- and post-intervention, percent of patients diagnosed with CKD through screenings, percent of patients with a positive clinical outcome, and number of medications obtained through patient assistance programs. Descriptive statistics were used to analyze the primary objective and both chi-square and descriptive statistics were used to analyze the secondary outcomes.  


Results: In progress


Conclusion: In progress
Moderators
avatar for Devki Gajera
Presenters
avatar for Jennie Reese

Jennie Reese

PGY2 Pharmacy Resident, Piedmont Columbus Regional Midtown
PGY2 Ambulatory Care Pharmacy Resident 
Evaluators
avatar for Erin Himes
Friday April 25, 2025 9:30am - 9:45am EDT
Athena C
  Ambulatory Care (AMB), Piedmont Columbus Regional Midtown
  • global Y

9:30am EDT

Tripping on Serotonin and Norepinephrine Reuptake Inhibitors: Evaluating the Fall Risk in Older Adults using Claims Data
Friday April 25, 2025 9:30am - 9:45am EDT
Athena D
Title: Tripping on Serotonin and Norepinephrine Reuptake Inhibitors: Evaluating the Fall Risk in Older Adults using Claims Data 


Authors: Lakedra White, Chelsea Keedy, Kristen Pierce, Jianing Xu, Jinae Lee, Hanna Kim, Daniel Hall, Ashlee Greene, Jessica Osborn, Joshua Caballero


Background: Major depressive disorder is a common mental health issue in older adults, often treated with antidepressants. However, their use can increase the risk of falls and fractures which can significantly contribute to morbidity and mortality in this population. Most research has focused on selective serotonin reuptake inhibitors, despite the widespread use of serotonin and norepinephrine reuptake inhibitors in older adults. Overall, limited data exist on the comparative fall risk among serotonin and norepinephrine reuptake inhibitors. As a result, this study aims to assess differences in fall risk associated with serotonin and norepinephrine reuptake inhibitors in an older population.


Methods: A retrospective cohort study was completed using the MarketScan® Medicare Supplemental claims from 2015 to 2021. The study included adults aged 65 and older with a prescription claim for a serotonin and norepinephrine reuptake inhibitor (i.e., duloxetine, venlafaxine, desvenlafaxine, milnacipran, and levomilnacipran). Individuals were followed for 30 days after their prescription claim to identify falls, defined using International Classification of Diseases, 9th Revision codes E8800- E8889 and International Classification of Diseases, 10th Revision codes W00-W19 and V00141. The primary outcome was the percentage of patients who experienced a fall within 30 days of the medication claim. Descriptive statistics were used for analysis. A larger study will similarly compare fall risk and related injury in older adults newly started on these agents. The date of their first prescription claim will be defined as the index date. Individuals will be excluded if they are prescribed serotonin and norepinephrine reuptake inhibitors or selective serotonin reuptake inhibitors within the preceding two months. Individuals will also be excluded if they have a history of fall or related injury within the preceding six months.


Results: There were 194,821 individuals with a prescription claim for a serotonin and norepinephrine reuptake inhibitor from 2015 to 2021. The average age was 72.5 (+/-8.1) years and 70% were female. Within 30 days of the prescription claim, 2,171 (1.1%) patients experienced a fall. The serotonin and norepinephrine reuptake inhibitor approximate prescribing rate included duloxetine (65%), venlafaxine (30%), desvenlafaxine (4%), milnacipran (0.8%), and levomilnacipran (0.4%). The serotonin and norepinephrine reuptake inhibitor fall rate included duloxetine (1.22%), venlafaxine (0.96%), milnacipran (0.76%), desvenlafaxine (0.70%), and levomilnacipran (0.54%).


Conclusion: Preliminary findings suggest a fall rate of approximately 1% within the first 30 days for most serotonin and norepinephrine reuptake inhibitors. While duloxetine appears to have the highest fall rate, further comparisons between serotonin and norepinephrine reuptake inhibitors are needed to determine statistical and clinical significance. Additionally, it is unknown if specific doses may be associated with an increased risk of falls and fractures which needs to be further elucidated. These findings can assist providers in carefully selecting the safest serotonin and norepinephrine reuptake inhibitor and dose for older patients.
Moderators
avatar for Katrina White, PharmD, BCACP

Katrina White, PharmD, BCACP

Residency Program Director, Quality Assurance Program Manager, Gulf Coast Veterans Health Care System
Presenters
avatar for Lakedra White

Lakedra White

PGY2 Ambulatory Care Resident, St. Joseph's/Candler Health System
Dr. Lakedra White is originally from Thomasville, Georgia. She earned her Bachelor of Science Degree in Biology from Columbus State University in Columbus, Georgia before earning her Doctor of Pharmacy degree from the University of Georgia in Athens, Georgia. Dr. White’s professional... Read More →
Evaluators
avatar for Cori Edmonds

Cori Edmonds

Clinical Pharmacist, Residency Program Director, Vanderbilt Specialty Pharmacy
Friday April 25, 2025 9:30am - 9:45am EDT
Athena D
  Ambulatory Care (AMB), St. Joseph's/Candler Health System
  • global Y

9:30am EDT

Safety Outcomes of Tirofiban Weight Based Dosing Strategy in Overweight Patients
Friday April 25, 2025 9:30am - 9:45am EDT
Athena B
Title: Safety Outcomes of Tirofiban Weight Based Dosing Strategy in Overweight Patients
Authors: Merrie Barnett-Brock, Audrey Johnson, Sofiya Paciotti
Background: Tirofiban is a GIIb/GIIIa receptor antagonist therapy used for the treatment of myocardial revascularization in non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Tirofiban dosing is weight based utilizing actual body weight. There is a hole in the literature regarding studies with information regarding safety outcomes in patients >85kg, including obese patients. Specifically, the previous literature lacks any information regarding safety outcomes in obese patients. Current studies show incidence of bleeding ranging from 0.4% to 5%. This is a major gap in the literature that this study hopes to resolve. 
Methods: This IRB-approved, retrospective, single-center cohort study included patients from a 711-bed academic medical center in Savannah, Georgia. Adult patients treated with tirofiban for cardiac conditions at Memorial Health University Medical Center between January 1, 2015 and September 27, 2024 were utilized as the cohort. Other inclusion criteria included receipt of tirofiban ≥1 hour and patients dosed on actual body weight with renal dose adjustment using a creatinine clearance calculation with actual body weight. Patients were excluded if they were a protected population or if the patients were discharged <48 hours from when infusion started. The aim of this study was to assess the safety outcomes of patients with a weight ≥85 kg with a primary outcome of major bleeding defined by the ISTH criteria and secondary outcomes of minor bleeding, mortality, and rescue agents utilized. These outcomes were further assessed amongst subgroups based on BMI, renal function, and weight. The BMI subgroups included 3 categories, category one being BMI <30 kg/ m2, category two being BMI 30-40 kg/m2, and category three being BMI >40 kg/m2. The weight subgroups included three categories, category one being 85-119.9 kg, category two being 120-149.9 kg, and category three being ≥150 kg. 
Results: Of the 304 patients screened, 47 were included in the final analysis. The majority of patients were white males and no patients were found to have renal dysfunction. The median weight observed in the patient population was 98 kg and the median BMI was 30.7 kg/m2. We observed a 29.7% incidence of major of bleeding. For the subgroups defined by BMI, major bleeding was found to be 44.4% in the category 1 patients, 17.3% in the category 2 patients, and 33.3% in the category 3 patients. Major bleeding occurred specifically in the weight subgroups with 30.9% of the category 1 patients, 25% of the category 2 patients, and 0% in category 3 patients. Secondary outcomes in the overall cohort included mortality in 2.1% of the population, minor bleeding in 12.7%, and 2.1% of the patients utilized a rescue agent.
Conclusions: This retrospective study provides descriptive information regarding major bleeding occurrences in patients weighing ≥85 kg where both BMI and weight subgroups were observed. We observed 29.7% of the patient population experienced major bleeding. These findings demonstrate that further research with adequately powered studies are needed to show the incidence of major bleeding amongst higher weight patients receiving tirofiban. 
Disclosures: "This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities."
Best contact point for follow up of interested participants: merrie.barnettbrock@hcahealthcare.com
Moderators
avatar for Christele Francois

Christele Francois

Emergency Medicine Clinical Pharmacy Specialist, Emory University Hospital
Christele Francois, PharmD, is board certified in pharmacotherapy. She is a member of the Department of Pharmacy at Emory University Hospital and currently practicing as an Emergency Medicine Clinical Pharmacy Specialist. Dr. Francois obtained a Bachelor of Science degree at the University... Read More →
avatar for Allie Hale

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System
Presenters
avatar for Merrie Barnett-Brock

Merrie Barnett-Brock

PGY1 Pharmacy Resident, Memorial Health University Medical Center
My name is Merrie Barnett-Brock, I am a PGY1 Pharmacy Resident at Memorial Health University Medical Center. I graduated from the University of Georgia College of Pharmacy in 2024. Next year I will pursue a PGY2 in oncology at Ochsner Medical Center in New Orleans. 
Friday April 25, 2025 9:30am - 9:45am EDT
Athena B
  Cardiology (CAR), Memorial Health University Medical Center
  • global Y

9:30am EDT

Efficacy and Safety of Reduced-dose Insulin for the Treatment of Hyperkalemia in the Emergency Department
Friday April 25, 2025 9:30am - 9:45am EDT
Athena G
Title:
Efficacy and Safety of Reduced-dose Insulin for the Treatment of Hyperkalemia in the Emergency Department 
Authors:
Blake Henderson, PharmD; Cortney Storey, PharmD, MBA; Cassey Starnes, PharmD, BCPS; Kevin Sullivan, PharmD, BCCCP; Elsa Hendrick, 2026 PharmD candidate; Jessie Lipstreuer, PharmD, BCEMP
Objective:
The purpose of this study was to assess the efficacy and safety outcomes between patients treated with reduced-dose versus standard-dose insulin for the treatment of hyperkalemia in the emergency department
Self-Assesment Question:
What is the recommended standard IV insulin dose for the treatment of hyperkalemia in the emergency department?
Background:
Hyperkalemia is a common, potentially fatal electrolyte abnormality. Hyperkalemia occurs in 1% - 10% of hospitalized patients with up to 2% - 3% identified in the emergency department. Recent estimates have shown that hyperkalemia leads to more than 800,000 annual emergency department (ED) visits in the United States with a growing prevalence due to an aging population with associated comorbidities
Methods:
This single-center, retrospective, IRB-approved study evaluated adult patients who received intravenous (IV) insulin, either reduced dose of 5 units or standard of 10 units, for the treatment of hyperkalemia from January 1, 2020 to July 31, 2024. Exclusion criteria included patients who received IV insulin for indication other than hyperkalemia, missing repeat labs within 12 hours of insulin administration, and receipt of emergent dialysis prior to first repeat potassium. The primary outcome was median change in potassium, defined as change from baseline to first repeat potassium, then from 4-18 hours post administration of the first dose of IV insulin. Secondary efficacy outcomes included repeat IV insulin doses required for persistent hyperkalemia within 12 hours, change in blood glucose (BG) at 1, 6, and 12 hours post IV insulin, additional dextrose given within 12 hours of initial IV insulin, pathway compliance with appropriate initial insulin dose and initial appropriate dextrose given for patients with a BG < 250, and hospital length of stay. The primary safety outcomes included incidence of hypoglycemia (BG <70 mg/dL) and severe hypoglycemia (BG < 54 mg/dL). IV insulin. Data was sourced from the electronic medical record and collected using REDCap and statistical analysis was conducted using SPSS. Continuous data was assessed using Student’s t-test or Mann-Whitney U test. Categorical data was assessed using Chi-square test or Fisher’s exact test.
Results:
Forty-six patients were included in the standard dose insulin group and ninety patients were included in the reduced dose insulin group. The primary outcome, mean change in potassium, was not significantly different between both groups [95% CI: -0.296 to 0.236; p=0.83) or at 4-18 hours post IV insulin administration [95% CI: 0.429 to -7.346; p=0.43]. For secondary efficacy outcomes, there was no statistically significant difference in glucose levels at baseline [95% CI: -45.935 to 13.849; p=0.29), 6 hours [95% CI: -36.146 to 19.566; p=0.56], or at 12 hours post IV insulin administration [95% CI: -33.120 to 20.129; p=0.63]. For safety outcomes, no statistically significant difference was found in incidence of hypoglycemia (10 vs 22 patients, p = 0.52) or severe hypoglycemia (6 vs 10 patients, p = 0.91) in both groups.
Conclusions:
In this retrospective, observational study, there was no difference found in median reduction of potassium levels with standard dose IV insulin vs reduced dose IV insulin. No significant differences in secondary safety and efficacy outcomes were observed.
Moderators
avatar for Tia Collier

Tia Collier

Medical ICU and Neuroscience ICU Clinical Pharmacist and PGY2 Critical Care Residency Program Director at Erlanger in Chattanooga, TN.
Presenters
avatar for Blake Henderson

Blake Henderson

PGY2 Critical Care Pharmacy Resident, University of Tennessee Medical Center
Evaluators
avatar for Sarah Frye

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2
Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree... Read More →
Friday April 25, 2025 9:30am - 9:45am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), University of Tennessee Medical Center
  • global Y

9:30am EDT

Evaluation of the Efficacy and Safety of Increased Quetiapine Dosing Frequency for Treatment of Delirium and Agitation in Trauma ICU Patients
Friday April 25, 2025 9:30am - 9:45am EDT
Athena I
Title: Evaluation of the Efficacy and Safety of Increased Quetiapine Dosing Frequency for Treatment of Delirium and Agitation in Trauma ICU Patients


Authors: Nicole Johnson, Madalyn Kirkwood Brakel


Background: Delirium is a phenomenon characterized by acute onset or fluctuating mental status. Delirium is highly prevalent among patients in intensive care 
units (ICUs) and is a predictor of poor clinical outcomes. Though current guidelines do not recommend routine treatment of delirium, they acknowledge that short-term use of antipsychotics may be beneficial for patients who are agitated or in severe distress. Pre-ICU trauma is a non-modifiable risk factor for the development of delirium, yet trauma patients are often excluded from studies evaluating the management of ICU delirium. Quetiapine has a favorable pharmacokinetic profile 
for the management of delirium given its rapid onset of action, high bioavailability, and a relatively short half-life, however literature evaluating the effect of 
dosing frequency is limited. This study aims to evaluate the efficacy and safety of increased quetiapine dosing frequency (every 6 – 8 hours) compared to historical dosing regimens for the management of ICU delirium and agitation in trauma ICU patients


Methods: This study is a retrospective, single-center chart review evaluating patients admitted to Our Lady of the Lake Regional Medical Center (OLOLRMC) between August 2020 and August 2024. An epic-generated report identified patients admitted to the trauma service who received quetiapine in an ICU. From this list, a subgroup of eligible adult patients who received at least 48 hours of quetiapine therapy after documented ICU delirium, based on Confusion Assessment Method for ICU (CAM-ICU) score, were identified. Patients were excluded based on pre-specified exclusion criteria. The primary endpoint of this study is percentage of delirium free days (DFDs) following dose optimization. Secondary endpoints include the percentage of hyperactive DFDs following dose optimization, percent of Richmond Agitation-Sedation Scale (RASS) scores at goal following dose optimization, time from quetiapine initiation to ICU stepdown, time from dose optimization to ICU
stepdown, and clinically significant QTc prolongation following quetiapine initiation.



Results: Baseline characteristics were similar between groups. The median percentage of DFD was 0 and 0.33 days in the more frequent dosing and historical dosing groups respectively (p=0.026). The median percentage of hyperactive DFD was 0.65 and 0.75 days in the more frequent dosing and historical dosing groups respectively (p=0.027). Percentage of RASS at goal was similar between groups. The median time from dose optimization to ICU stepdown was 4 days in the more frequent dosing group vs 6 days in the historical dosing group (p=0.5). More frequent dosing was not associated with an increased risk of QTc prolongation.


Conclusion: More frequent dosing does not appear to reduce the percentage of DFD but may reduce time to ICU stepdown in trauma patients while maintaining safety

Moderators
CM

Charleen Melton, PharmD, BCCCP

Clinical Pharmacy Asst Manager, PGY1 and EM PGY2 RPC, CaroMont Health
Presenters
NJ

Nicole Johnson

PGY1 Pharmacy Resident, Our Lady of the Lake Regional Medical Center
Nicole is from Gonzales, Louisiana. She graduated with her Doctor of Pharmacy degree at the University of Louisiana Monroe College of Pharmacy in  2024 and is currently a PGY-1 pharmacy resident at Our Lady of the Lake Regional Medical Center in Baton Rouge. Her clinical areas of... Read More →
Evaluators
BM
Friday April 25, 2025 9:30am - 9:45am EDT
Athena I
  Critical Care/Emergency Medicine (CCM), Our Lady of the Lake Regional Medical Center
  • global Y

9:30am EDT

Retrospective review of food bolus resolution following pharmacologic treatment in a community hospital emergency department
Friday April 25, 2025 9:30am - 9:45am EDT
Athena H
Title: Retrospective review of food bolus resolution following pharmacologic treatment in a community hospital emergency department   


Authors: Abigail E. Hall; Taylor Servais; Rachel Langenderfer; Brittany NeSmith; Ryan Lally; Evan McDonald


Objective : Identify pharmacological options available for the treatment of food bolus impactions  


Self Assessment Question: For food bolus impactions, EGD remains the definitive treatment, but during the interim period which medications are available for treatment? (answers: Glucagon; Nitroglycerin)


Background: A food bolus is a medical emergency where food is impacted in the esophagus with a sudden onset of symptoms. The definitive treatment for food bolus is esophagogastroduodenoscopy (EGD), but pharmacotherapeutic management can be utilized in the interim to attempt resolution. The American Society for Gastrointestinal Endoscopy (ASGE) guideline for management of food impactions notes administration of intravenous (IV) glucagon to induce esophageal relaxation and aid with bolus passage, but use is associated with adverse events. Although the ASGE guidelines do not discuss effectiveness of oral nitroglycerin, case reports suggest it may be useful for the management of food bolus due to its ability to cause local smooth muscle relaxation.  The purpose of this study is to evaluate resolution of food bolus among patients treated with glucagon only, glucagon and nitroglycerin, and nitroglycerin only.


Methods: This is a retrospective cohort study of adult patients presenting to a St. Francis Emergency Department (ED) with a food bolus. Patients were included if they received intramuscular (IM) or IV glucagon or oral nitroglycerin. Patients were excluded if they did not have an identified food bolus or their treatment outcomes were not recorded. The primary outcome evaluated was resolution of food bolus following pharmacologic treatment. Secondary outcomes included need for hospital admission, performance of emergent EGD, and documented adverse effects. Data was collected from May 20, 2022 to November 30, 2024, retrieved from chart review via electronic medical records, and maintained confidentially.


Results: There were a total of 89 patients screened. Six of these patients were excluded based on proposed criteria. Eighty-three patients who received nitroglycerin or glucagon for the indication of food bolus within a St. Francis ED between May 20, 2022 and November 30, 2024 were included. Twenty-three (27.7%) patients had resolution with medication administration alone. Glucagon alone was administered to 43 patients, nitroglycerin alone was administered to 9 patients, and 31 patients received both nitroglycerin and glucagon.  Resolution of food bolus following medication administration occurred in 15 (34.9%), 3 (33.3%), 5 (16.1%) of patients respectively. The secondary outcome of requiring emergent EGD occurred in 60 patients following medication administration, and of these patients, all achieved resolution following EGD. There were eight patients requiring hospital admission. Of the patients that required admission four patients received glucagon alone, and four patients received glucagon and nitroglycerin. However, patients that were admitted were for the purposes of receiving an EGD or requiring monitoring after EGD. None of the patients experienced adverse effects of headache, flushing, or hypotension with either agent. Emesis was documented following the administration of glucagon or nitroglycerin in 19 (20.4%) and 4 (9.1%) of patients respectively. 


Conclusion: This retrospective cohort study evaluated the resolution of food bolus with the administration of nitroglycerin alone, glucagon alone, or glucagon and nitroglycerin administration. No agent was found to be superior for the resolution of food bolus. Medication administration resulted in a small portion of food bolus resolution, leading to most patients requiring EGD following medication administration. However, emesis was documented more frequently following glucagon administration than following nitroglycerin administration. With minimal occurrences of resolution following any medication administration, additional factors such as medication cost and adverse effect profile should be considered when choosing a pharmaceutical agent for the treatment of a food bolus.
Moderators
avatar for Rebecca Orr
Presenters
avatar for Abigail Hall

Abigail Hall

PGY1 Pharmacy Resident, Bon Secours St. Francis Downtown
My name is Abigail Elise Hall. I am from Greenwood, SC. I am currently a PGY1 pharmacy resident at Bon Secours St. Francis Downtown, which I obtained following my graduation from Presbyterian College School of Pharmacy in 2024. My professional interests include emergency medicine... Read More →
Evaluators
avatar for Martin Gordon

Martin Gordon

Clinical Pharmacy Specialist- Critical Care, Spartanburg Medical Center
Martin Gordon, PharmD, BCCCP is the Clinical Pharmacy Specialist for Medical Critical Care and Residency Program Coordinator for the PGY1 Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Gordon completed his Doctor of Pharmacy degree from Presbyterian... Read More →
Friday April 25, 2025 9:30am - 9:45am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Bon Secours St Francis Downtown
  • global Y

9:30am EDT

Carbapenem Stewardship: Reducing Overuse in Empiric Treatment Strategies
Friday April 25, 2025 9:30am - 9:45am EDT
Athena A
Title: Carbapenem Stewardship: Reducing Overuse in Empiric Treatment Strategies

Authors: Reshma Patel, Kristina Nakhla, Michael Saxon, Melissa Letzin 

Objective: This study aims to retrospectively evaluate carbapenem utilization across Northside Hospital’s five campuses to assess adherence to current Northside Hospital defined criteria, refine prescribing practices and reduce carbapenem overutilization.

Background: Carbapenems, a broad-spectrum class of antibiotics, are often overutilized in inpatient settings. While carbapenems are effective as a primary treatment option for infections caused by extended spectrum β-lactamase (ESBL)-producing bacteria, their overuse has raised concerns about developing carbapenem-resistant organisms. Establishing and adhering to appropriate carbapenem prescribing criteria is necessary to support effective stewardship.

Methods: This multi-center, randomized, retrospective chart review included patients 18 years or older, admitted to the inpatient medical-surgical floor at Northside Hospital campuses and received more than one dose of empiric carbapenem therapy from July 2023 through July 2024. Patients who received a single carbapenem dose in the emergency department, admitted to the intensive care unit (ICU), or on bone marrow transplant (BMT) service were excluded. The primary objective was to assess the appropriateness of carbapenem therapy based on current Northside Hospital defined criteria. Secondary objectives included evaluating average days of therapy for carbapenems, average days of therapy for total antibiotics, percentage of patients with confirmed ESBL isolates, and percentage of patients with confirmed multi-drug-resistant organism (MDRO) infections. 

Results: The retrospective review of 150 eligible patients indicated significant overutilization of carbapenems across all Northside Hospital campuses. The study population consisted of 57% (86/150) females and 43% (64/150) males. Only 48% (72/150) of patients met the appropriate criteria for carbapenem therapy. 52% (78/150) of patients did not meet the appropriate criteria for carbapenem therapy. The most commonly treated infections in the patients that met appropriate criteria for carbapenem prescribing were urinary tract infections (35%), intra-abdominal infections (24%), empiric coverage for sepsis (11%). The most commonly treated infections in the patients that did not meet appropriate criteria for carbapenem prescribing were urinary tract infections (36%), intra-abdominal infections (35%), and bacteremia (25%). The average duration of carbapenem therapy was 6.5 days, while the average duration for total antibiotic therapy was 7.6 days in patients with confirmed ESBL/MDRO infections. The average duration of carbapenem therapy was 5.8 days, while the average duration for total antibiotic therapy was 7.9 days in patients with no ESBL/MDRO infection or negative culture. Confirmed ESBL isolates were identified in 6% (9/150) of patients. Confirmed MDRO were identified in 5% (7/150).

Conclusion: This study highlights overutilization of carbapenem therapy across Northside Hospital campuses outside of the ICU, BMT service and single doses in the emergency department. With 48% of patients meeting appropriate criteria for its use, the findings suggest opportunities to optimize prescribing practices when initiating antimicrobial therapy. A majority of carbapenems were ordered without meeting clinical indications. Implementing standardized protocols and reinforcing antimicrobial stewardship across all campuses could enhance the appropriate use of carbapenems while reducing the risk of resistance and improving patient outcomes.
Moderators
JK

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1
Presenters
avatar for Reshma Patel

Reshma Patel

PGY1 Pharmacy Resident, Northside Hospital Atlanta
Reshma Patel is from Macon, GA. She did her undergraduate studies at Mercer University and received her Doctor of Pharmacy degree from Mercer University College of Pharmacy. Reshma early committed to the PGY2 in Oncology at Northside Hospital Atlanta. Outside of pharmacy, Reshma enjoys... Read More →
Evaluators
avatar for Melissa Padgett

Melissa Padgett

Residency Program Director, HCA Florida West Hospital
Melissa Padgett earned her Doctor of Pharmacy in 2014 from Belmont University College of Pharmacy in Nashville, TN. After receiving her PharmD, she completed a post-doctoral PGY1 pharmacy residency at HCA Florida West Hospital in June of 2015. From there, she stayed on as a full-time... Read More →
Friday April 25, 2025 9:30am - 9:45am EDT
Athena A
  Infectious Disease (ID), Northside Hospital
  • global Y

9:30am EDT

Evaluation of Quality Measure Outcome Adherence in the Treatment of Spontaneous Bacterial Peritonitis in Patients at a Large Community Hospital
Friday April 25, 2025 9:30am - 9:45am EDT
Parthenon 1
Title: 
Evaluation of Quality Measure Outcome Adherence in the Treatment of Spontaneous Bacterial Peritonitis in Patients at a Large Community Hospital

Authors:
Leeann Gowan, Christen Freeman, Doug Carroll

Objective:
Discuss adherence to quality measure outcome set forth by the American Association for the Study of Liver Diseases (AASLD) for the treatment of spontaneous bacterial peritonitis.

Self Assessment Question:
What is the recommended albumin dose patients treated for SBP should receive within 12 hours of the ascitic fluid test result?

Background: 
Spontaneous Bacterial Peritonitis (SBP) is an ascitic fluid infection with an unknown source of origin. This infection is one of many complications resulting from advanced liver cirrhosis and ascites. As recommended by the American Association for the Study of Liver Diseases (AASLD) practice guidance, a diagnostic paracentesis should be performed on all patients with suspected SBP. Management of SBP includes the use of antibiotics and albumin. Empiric IV antibiotics should be initiated in all patients with an ascites polymorphonuclear (PMN) count >250 cells/mm3. 

Furthermore, patients with cirrhosis have an increased risk of worsening liver and renal function from bacterial infections. The appropriateness of treatment of SBP has not been assessed at DCH. Consequently, this is a disease state, that if quality measures are not met, can progress to high rates of mortality and worsening liver and renal function. The purpose of this study was to evaluate percentage adherence to a specific cirrhosis quality measure set forth by the Practice Committee of the AASLD, in the treatment of SBP in patients at DCH Regional Medical Center and Northport Medical Center.

Methods:
This was a retrospective chart review of patients treated for SBP at DCH Regional Medical Center (a large community 583-bed hospital) and Northport Medical Center (a 204-bed community hospital). Patients were included if they were 19 years old or older, had an ICD-10 diagnosis of cirrhosis and ascites and SBP or had an ascitic fluid PMN count >250 cells/mm3. 

A list of patient encounters was generated from the electronic health record (EHR) from May 2021 to July 2024. Patients that were selected for review first, were those with an ICD-10 diagnosis code for SBP, then those with an ascitic fluid white blood cell count (WBC) count. A PMN count was calculated by multiplying the total WBC by the percentage of PMNs in the differential (neutrophils). The primary outcome measure was percentage adherence to meeting all 3 criteria of the guideline recommended quality measure outcome: hospitalized patients with ascites, with an ascitic fluid PMN count of ≥ 250 cells/mm3, should receive: empiric antibiotics and albumin 1.5 g/kg within 12 hours of the ascitic fluid test result and receive albumin 1.0 g/kg on day 3. Secondary outcomes were comparison of results for those with a GI consult, characterization of antibiotic regimen, and patient encounter mortality rate. For the statistical analysis, descriptive statistics were utilized. This study was IRB exempt.

Results:
This study included a total of 40 patients. Overall, there were zero patients that met all 3 criteria of the quality measure outcome. Twenty-eight patients met at least one criteria (70%). Patients with a GI consult overall had improved outcomes. Twelve patients were empirically treated with a 3rd generation cephalosporin (54.5%). Five patients (22.7%) were treated for 5-7 days out of the twenty-two patients only treated for SBP.

Conclusion:
This study observed many ways to improve treatment of SBP at DCH. Areas of improvement include correct albumin dosing, administration of albumin within the 12-hour range, and administration of the second dose of albumin on day 3.
Moderators
avatar for Margaret Williamson

Margaret Williamson

Clinical Pharmacy Specialist, East Alabama Health
Presenters
avatar for Leeann Gowan

Leeann Gowan

PGY1 Pharmacy Resident, DCH Regional Medical Center
I am a graduate of Samford University’s McWhorter School of Pharmacy and a PGY1 pharmacy resident at DCH Regional Medical Center. This topic has been the subject of my longitudinal research project under the supervision of Christen Freeman, Pharm.D., MBA, BCCCP, CNSC, Senior Clinical... Read More →
Evaluators
avatar for Emily Johnson

Emily Johnson

PGY1 Residency Program Coordinator - Acute Care/Clinical Pharmacist Team Lead - MedSurg, Cape Fear Valley Medical Center
Friday April 25, 2025 9:30am - 9:45am EDT
Parthenon 1
  Internal Medicine (IM), DCH Regional Medical Center
  • global Y

9:30am EDT

The Clinical Puzzle of Anaerobic Bacteremia: Unpacking Traits of Infections and Patients with Anaerobic Bloodstream Infections and Impact of Adequate Treatment
Friday April 25, 2025 9:30am - 9:45am EDT
Parthenon 2
Title: The Clinical Puzzle of Anaerobic Bacteremia: Unpacking Traits of Infections and Patients with Anaerobic Bloodstream Infections and Impact of Adequate Treatment 
Authors: Sonjala Mallory, James Holland, Tyler Martin, Geren Thomas 


Background: Anaerobic bloodstream infections (BSIs) are rare but clinically significant, with mortality rates ranging from 15% to 55%. These infections are commonly associated with immunosuppression, malignancies, and surgical interventions. The most frequent causative pathogens include Bacteroides spp., Clostridium spp., and Fusobacterium spp., with increasing resistance complicating treatment. Distinguishing true infections from contaminants, particularly Cutibacterium spp., remains a diagnostic challenge. This study aims to characterize anaerobic BSIs, identify factors distinguishing true infections from contamination, and assess the impact of timely and appropriate antibiotic therapy on patient outcomes.


Methods: This retrospective, cross-sectional study was conducted at a teaching hospital from January 2019 to April 2024. Sixty patients with confirmed anaerobic bloodstream infections were included. Patient demographics, source of infection, and clinical severity (PITT Bacteremia Score) were collected. Microbiological data, including blood culture results, were used to determine antibiotic adequacy. Patients were divided into two groups based on whether they received adequate or inadequate antibiotic therapy. Outcomes of interest include infection resolution, length of hospital stay, and 30-day all-cause in-hospital mortality. The correlation between appropriate indication documentation and antibiotic selection was evaluated. Descriptive statistics were used to summarize characteristics, and correlations between treatment adequacy, documentation, and outcomes were explored.


Results: In-Progress


Conclusion: In-Progress
Presenters
avatar for Sonjala Mallory

Sonjala Mallory

Pharmacy Resident, Archbold Memorial Hospital
PGY1 Resident at Archbold Memorial  Hospital
Evaluators
avatar for Jason Dover

Jason Dover

PGY-1 Residency Program Director, Clinical Pharmacist Emergency Medicine/Internal Medicine, East Alabama Medical Center
Friday April 25, 2025 9:30am - 9:45am EDT
Parthenon 2
  Internal Medicine (IM), John D. Archbold Memorial Hospital
  • global Y

9:30am EDT

Evaluating Iron Sucrose Discordance Among Patients Within Cone Health Outpatient Infusion Centers
Friday April 25, 2025 9:30am - 9:45am EDT
Olympia 2
Title: Evaluating Iron Sucrose Discordance Among Patients Within  
Cone Health Outpatient Infusion Centers   


Authors: Jessica Robles, Yatin Patel


Objective: Evaluate the impact of transitioning iron sucrose administration to IV push on iron sucrose discordance and infusion reactions


Self-Assessment Question: True or False: The incidence of infusion reactions with iron sucrose 200 mg is similar between administration via IV push vs IVPB infusion.


Background: Discordance is defined as an inappropriate dose or timing of administration of intravenous (IV) iron based on institutional policies. Social drivers of health, which are nonmedical factors impacting health outcomes, likely play a role in IV iron discordance. Social drivers of health can be quantified through a social vulnerability index (SVI), which is a novel composite measure encompassing variables that correspond to key social drivers of health; however, SVIs have not been studied in the evaluation of iron discordance. The dosing schedule of IV iron products also likely contributes to discordance. Older-generation IV iron products require more frequent dosing and have a higher incidence of discordance, but these products continue to have high utilization due to payor coverage and lower cost per dose. Iron sucrose, an older-generation IV iron product, is Cone Health’s preferred IV iron product, therefore it is essential to continually optimize its use by the health-system. In response to the nationwide fluid shortage, Cone Health outpatient infusion centers transitioned the administration of iron sucrose 200 mg doses from an IV piggyback (IVPB) infusion to an IV push. The purpose of this study was to evaluate the impact of this transition on iron sucrose discordance.


Methods: This was an IRB-reviewed and exempt, multi-center, pre-post study which evaluated iron sucrose discordance over three-month periods in the pre- and post-intervention groups. Adults who received their prescribed course of iron sucrose within the study period at one of the ten Cone Health outpatient infusion centers were included. Patients who did not have a Federal Information Processing Standards (FIPS) code available were excluded. The primary outcome was the incidence of iron sucrose discordance. A treatment course was deemed discordant if the patient did not receive at least one gram of iron sucrose within a 14-day period. Secondary outcomes included reason for iron sucrose discordance, incidence of iron sucrose infusion reactions, and Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry (CDC/ATSDR) SVI rankings. Primary and secondary outcomes were analyzed using descriptive statistics and a multiple regression model.


Results: There were 613 treatment courses included in the pre-intervention group, while 543 treatment courses were included in the post-intervention group. Among both groups, patient demographics were not statistically different, and most treatment courses were administered at a Cone Health cancer center (82.5% in the pre-intervention group vs 79.6% in the post-intervention group). After the transition of 200 mg doses to IV push, the usage of 200 mg doses increased from 71.2% to 82.7% (p < 0.001), and the incidence of discordance was statistically unchanged (88.9% vs 87.7%; p < 0.26). The incidence of discordance due to insufficient dose decreased in the post-intervention group (68.4% vs 57.3%, p=0.001); however, the incidence of discordance due to prolonged duration increased in the post-intervention group (15.4% vs 19.5%, p=0.001). The incidence of infusion reactions was not statistically different between groups (0.3% vs 0.06%, p=0.15). There was not a clear difference in SVI rankings between concordant and discordant treatment courses. 


Conclusion: The transition of 200 mg iron sucrose doses to administration via IV push did not impact the incidence of discordance or infusion reactions, suggesting utility in the continued use of 200 mg push doses even after the resolution of the fluid shortage. The transition appeared to result in more patients receiving at least one gram of iron sucrose but increased the duration of the treatment course. There was no clear relationship found between SVI rankings and iron sucrose discordance.
Moderators
avatar for Kristen Kilby

Kristen Kilby

PGY2 Oncology Resident, Northside Hospital
Kristen Kilby attended pharmacy school at the University of South Carolina. She then completed a PGY-1 residency at Baptist Memorial Hospital- Memphis and a PGY-2 Oncology residency at Northside Hospital in Atlanta, GA. She is currently a clinical oncology specialist focused on malignant... Read More →
Presenters
avatar for Jessica Robles

Jessica Robles

PGY1 Acute Care Pharmacy Resident, Cone Health
Jessica Robles is PGY1 Acute Care Pharmacy Resident at Moses Cone Hospital in Greensboro, NC. She is from Taylorsville, NC and attended pharmacy school at High Point University. After residency, she will be working as an oncology infusion pharmacist at a Cone Health cancer center... Read More →
Evaluators
avatar for Amy Porter
Friday April 25, 2025 9:30am - 9:45am EDT
Olympia 2
  Oncology (ONC), Cone Health
  • global Y

9:30am EDT

Impact of Patient Preference on Inpatient Analgesia
Friday April 25, 2025 9:30am - 9:45am EDT
Olympia 1
IMPACT OF PATIENT PREFERENCE ON INPATIENT ANALGESIA


Lauren Alaine “Lainey” LaMoyne, MaryAnn Birch, Lisa Scott


HCA Florida West Hospital – Pensacola, FL


Background/Purpose: Non-opioid analgesics are often underutilized as part of a multimodal approach. Additionally, patients may prefer non-opioids for moderate to severe pain, but these agents are often only prescribed for mild pain. In response, several changes were implemented to policy and an analgesic order set, and provider and nursing education was provided. The purpose of this study was to see if a pain management intervention consisting of usage of a standardized order set, new policy, and education will increase the usage of non-opioids administered for pain.


Methodology: This is a single center, quasi-experimental study conducted at a 515-bed academic hospital. Adult acute care inpatients were included if they were ordered a PRN (as needed) opioid pain medication and a non-opioid (acetaminophen or ibuprofen). Patients were identified using facility surveillance software reports. Patients were excluded if they had opioid use disorder, active malignancy, requirements of greater than 60 morphine milliequivalents per day before admission, contraindication or allergy to study drug, intravenous acetaminophen administration, incomplete documentation of pain scale, use of a scheduled opioid, and/or opioid reversal prior to inpatient status. Patients were also excluded if admitted to the labor and delivery unit, the intensive care unit, or palliative care. Cohort 1 consists of patients prescribed both opioids and non-opioids (acetaminophen or ibuprofen) without utilization of the revised opioid order set. Cohort 2 includes patients prescribed medications from the revised opioid order set. The primary outcome is the number of times a non-opioid was given for analgesia. The secondary outcomes are patient-reported pain scores and the number of times a non-opioid was given for moderate to severe pain per patient preference.


Results: One hundred and six patients were included in this study. The primary outcome of number of times a non-opioid was given for analgesia per length of days was 0.71 and 1.27 for cohorts 1 and 2, respectively (p=0.0362). The number of times a non-opioid was given for moderate to severe pain per length of days analyzed was 0.03 in cohort 1 and 0.2 in cohort 2 (p=0.0263). The number of times an opioid was given for moderate to sever pain per length of days analyzed was 1.3 in cohort 1 as compared to 1.3 in cohort 2 (p=0.8630). The mean non-opioid change in pain score was 1.4 in cohort 1 and -2.3 in cohort 2 (p=0.0818). The mean opioid change in pain score was -4.0 for cohort 1 as compared to -3.8 in cohort 2 (p=0.4879).
 
Conclusions: There was a statistically significant increase in the number of times non-opioids were administered for analgesia and a statistically significant increase in scheduled APAP utilization. There was also a statistically significant increase in the number of times opioids were given for breakthrough pain. Opioid administrations for moderate to severe pain did not result in a statistically significant difference, and there was no statistical difference in average daily MME between cohortss. Pain Scores could not be accurately assessed due to small sample size. Future studies with a larger sample size are warranted to further investigate the implications of patient preference.


This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.
Presenters
avatar for Lauren LaMoyne

Lauren LaMoyne

PGY-1 Pharmacy Resident, HCA Florida West Hospital
Lainey is a PGY-1 pharmacy resident at HCA Florida West Hospital. She is originally from Baton Rouge, Louisiana and attended the University of Tennessee for pharmacy school. Lainey has an interest in emergency medicine, intensive care, pediatrics, and infectious disease. 
Evaluators
avatar for Abbi Rowe
avatar for Stephanie Ring

Stephanie Ring

Pharmacy Formulary Manager, Department of Veterans Affairs
Friday April 25, 2025 9:30am - 9:45am EDT
Olympia 1
  Pain Management (PM), HCA Florida West Hospital
  • global Y

9:50am EDT

Empty
Friday April 25, 2025 9:50am - 10:05am EDT
Athena J
Evaluators
avatar for Azur Eckley

Azur Eckley

Clinical Pharmacy Practitioner, Ralph H. Johnson VA Medical Center
Dr. Azur Eckley, BCPS  is currently a Clinical Pharmacy Practitioner in ambulatory care specialty clinics including cardiology, gastroenterology and nephrology at the Ralph H Johnson VA Medical Center in Charleston, SC. She is a graduate of the University of Tennessee College of... Read More →
BS
Friday April 25, 2025 9:50am - 10:05am EDT
Athena J

9:50am EDT

Improving Compliance with Gout Management Guidelines: Implementing a Standardized Order Menu for HLA-B*5801 Testing in Veterans Prescribed Allopurinol
Friday April 25, 2025 9:50am - 10:05am EDT
Athena D
Title: Improving Compliance with Gout Management Guidelines: Implementing a Standardized Order Menu for HLA-B*58:01 Testing in Veterans

Authors: Roslyn Mays; Mary Kalyn Pounders

Background/Purpose: 
Gout is a common and significant health issue among veterans, particularly in those with comorbid conditions like chronic kidney disease and cardiovascular disease. Allopurinol, the first-line recommended treatment for gout, carries the rare risk of a severe adverse hypersensitivity reaction, allopurinol hypersensitivity syndrome (AHS). The risk of AHS is higher in those with the HLA-B*58:01 allele, which is most prevalent in African American and Asian populations. The American College of Rheumatology (ACR) 2020 Gout Management Guidelines recommend routine genetic testing for HLA-B*58:01 in these higher-risk ethnicity groups before initiation of allopurinol. As of July 2024, preliminary data from the Atlanta VA revealed significant noncompliance with these guideline recommendations. This project aimed to improve compliance with the ACR allele testing recommendations by implementing a standardized order menu with prompts for allele testing in recommended patient groups, thus in hopes of reducing the risk of AHS in at-risk veterans.

Methods: 
This was a single-site, retrospective quality improvement project designed to evaluate the impact of a standardized HLA-B*58:01 allele order menu on compliance with the ACR 2020 gout management guideline recommendations. Eligible participants included veterans aged 18 or older prescribed allopurinol for non-hematologic or oncologic indications within the timeframe both prior to and following the implementation of the order menu in July 2024. Eligible patients were identified using the VA National Quality Enhancement Research Initiative (QUERI) Gout Safety Dashboard. Patients prescribed allopurinol for conditions other than gout, such as tumor lysis syndrome, were excluded using prescriber data. Baseline data was collected on key variables such as race/ethnicity, urate-lowering therapy (ULT) status, HLA-B*5801 allele testing results, and the type of prescribing provider (primary care physician or rheumatologist). The primary endpoint was the percentage of new ULT users prescribed allopurinol who received guideline-recommended HLA-B*58:01 testing before and after introducing the standardized order menu. Statistical analysis was used to compare testing compliance rates before and after the intervention. Upon data review, the impact of the order menu on allele testing was assessed to identify specific areas needing improvement, allowing for future targeted interventions in areas of continued non-compliance.

Results:
Upon review, after the implementation of the order menu, the percentage of new ULT users with guideline recommended HLA-B*58:01 test results increased by 5.2%. The total number of patients with an HLA-B*58:01 test result increased from 3.6% to 5.1%. The percentage of African American (AA) patients tested for the allele rose by 2.2%, while Asian patients demonstrated a 3.9% increase. While these changes are encouraging with a new ULT non-compliance rate decrease from 96.7% to 91.6%, more than 90% of at-risk patients remained untested, indicating that more targeted interventions may be necessary to achieve substantial improvements.

Conclusion:
The introduction of a standardized HLA-B*58:01 allele testing order menu resulted in a modest increase in testing compliance for new ULT users. While this increase is a positive step, the continued rate of non-compliance suggests the need for further refinements in the intervention. Potential future directions for this project include enhancing provider education, incorporating automated reminders, and exploring other interventions or tools to further enhance facility compliance. Continued monitoring and refinement of this intervention will be essential to achieving better compliance rates to the ACR 2020 gout guideline recommendations, and thus, a further reduction in risk for AHS development in at-risk veteran groups.
Moderators
avatar for Katrina White, PharmD, BCACP

Katrina White, PharmD, BCACP

Residency Program Director, Quality Assurance Program Manager, Gulf Coast Veterans Health Care System
Presenters
avatar for Roslyn Mays

Roslyn Mays

PGY1 Pharmacy Resident, Veteran Affairs-Atlanta
I’m Roslyn Mays, a PGY1 pharmacy resident at the Joseph Maxwell Cleland Atlanta VA Medical Center. Originally from the Panhandle area of Florida, I completed both my undergraduate studies and Doctor of Pharmacy degree at the University of Florida—Go Gators! I’m passionate about... Read More →
Evaluators
avatar for Cori Edmonds

Cori Edmonds

Clinical Pharmacist, Residency Program Director, Vanderbilt Specialty Pharmacy
Friday April 25, 2025 9:50am - 10:05am EDT
Athena D
  Ambulatory Care (AMB), VA-Atlanta, GA- Atlanta VA Health Care System
  • global Y

9:50am EDT

Chlamydia return rates in the ED in a community-based health system following treatment with doxycycline or azithromycin
Friday April 25, 2025 9:50am - 10:05am EDT
Athena B
Title:
Chlamydia return rates in the ED in a community-based health system following treatment with doxycycline or azithromycin
 
Authors: 
Witney Butler
Devon Burhoe
Erica Merritt
Joseph Crosby


Background:
Sexually transmitted infections (STIs) are a major public health concern, with 1.6 million Chlamydia cases reported in 2022. Emergency Departments (EDs) play a key role in treatment, yet many patients still receive azithromycin despite CDC guidelines favoring doxycycline. Studies show doxycycline is more effective due to its sustained drug levels, while a single dose of azithromycin may be less effective in high bacterial loads or resistance. Comparing return rates between treatments, considering demographics and pharmacist follow-up, could inform hospital protocols. Logistic regression analysis may provide insights to optimize Chlamydia management and reduce ED return visits.


Methods:
This was a retrospective, observational cohort chart review that evaluated adult patients who tested positive and were treated for Chlamydia within a community-based health system and returned within 30 days after their initial visit. Patients were excluded if pregnant or tested negative for Chlamydia. A computer-generated list identified patients with a positive Chlamydia test from December 1, 2021, to August 31, 2024. Subjects were reviewed for study inclusion or exclusion based on the criteria.  Information was gathered from the subjects' electronic health records, including the prescribed antibiotic and whether they returned to the ED within 30 days for a STI complaint. If the patient was seen multiple times within the study period, there must have been at least 6 months between visits to be counted as a new study entry in the data. Patients were evaluated based on demographic characteristics including gender, sexual orientation, age, race, co-infections, insurance type, and if there was follow up by a pharmacist with a documented note in the patient’s chart. Pharmacists only contacted the patient if the test was positive and the patient was not treated correctly for Chlamydia. 


Results:
Of the 1,664 ED encounters with a positive Chlamydia test, 33 patient encounters met inclusion criteria by returning to the ED within 30 days. For comparison, a control group of 33 patients who did not return within 30 days was randomly selected. Logistic regression analysis indicated that antibiotic choice does not significantly impact 30-day return rates for patients treated for Chlamydia (p = 0.067). Logistic regression analysis also showed that ages 18-45 years old, male sex, and African American race were associated with higher odds of 30-day ED return, while having insurance reduced the odds by 46%. Compared to no antibiotics, doxycycline and azithromycin significantly reduced return odds by 76% and 61%, respectively. Co-infection with gonorrhea was also associated with lower return rates which reduced the odds by 44%.

Conclusion: 
Antibiotic selection does not appear to significantly impact 30-day ED return rates for patients with Chlamydia, suggesting it may not be a primary factor in patient return visits. More data in a larger, prospective trial is needed to determine if there is a true relationship between initial antibiotic choice and return visit to the ED. Further research should also explore adherence monitoring strategies or microbiological data to refine STI management protocols in community-based health systems.

Resident follow-up email:
butlerwi@sjchs.org
Moderators
avatar for Christele Francois

Christele Francois

Emergency Medicine Clinical Pharmacy Specialist, Emory University Hospital
Christele Francois, PharmD, is board certified in pharmacotherapy. She is a member of the Department of Pharmacy at Emory University Hospital and currently practicing as an Emergency Medicine Clinical Pharmacy Specialist. Dr. Francois obtained a Bachelor of Science degree at the University... Read More →
avatar for Allie Hale

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System
Presenters
avatar for Witney Butler

Witney Butler

PGY-1 Pharmacy Resident, Candler Hosptial
Witney Butler is a current PGY-1 pharmacy resident at St. Joseph's/Candler Health System with a strong interest in emergency medicine. A graduate of the University of Georgia College of Pharmacy, Witney has demonstrated a passion for optimizing acute care and addressing complex medication... Read More →
Friday April 25, 2025 9:50am - 10:05am EDT
Athena B
  Community Pharmacy (CP), Candler Hospital
  • global Y

9:50am EDT

Evaluation of Rapid Sequence Intubation Agent Selection on Hemodynamics in Emergency Room Patients
Friday April 25, 2025 9:50am - 10:05am EDT
Athena H
Title: Evaluation of Rapid Sequence Intubation Agent Selection on Hemodynamics in Emergency Room Patients


Authors: Jaclyn Gruver, Thomas Neal, Tracey Bastian, Valerie Van Vickle


Background: Rapid sequence intubation (RSI) is the process of administering a sedative induction agent and a paralytic agent to assist endotracheal intubation. The goal of induction is to induce general anesthesia, which allows for the administration of paralytics and the facilitation of optimal intubating settings. Shock index (SI) has been used by some emergency departments as a clinical severity score. It is defined as heart rate (HR) divided by systolic blood pressure (SBP) and normally ranges from 0.5 to 0.7. An SI greater than 0.9 is linked to increased risk for decompensation and poor outcomes. The purpose of this study is to evaluate the impact of induction agent selection (etomidate, ketamine, and propofol) on peri-/post- intubation hemodynamics after RSI in Emergency Room (ER) patients.


Methods: This study was an Institutional Review Board approved, single-center, retrospective chart review evaluating patients aged 18 years and older who were intubated in the ER, received one of the induction agents for RSI (etomidate, ketamine, or propofol), and survived to hospital admission. Patients who were intubated in the ER from January 1, 2022 to August 31, 2024 were identified using data from a medication dispensing cabinet report for the intubation kit, which included the induction agents. The primary objective is to evaluate the differences in pre-intubation and post-intubation shock index between etomidate, ketamine, and propofol. Secondary endpoints include: incidence of bradycardia (HR < 60 bpm) within 30 minutes of intubation, tachycardia (HR > 100 bpm) within 30 minutes of intubation, hypertension (SBP > 140 mmHg or DBP > 90 mmHg) within 30 minutes of intubation, hypotension (SBP < 90 mmHg or DBP < 60 mmHg) within 30 minutes of intubation, treatment of hypotension within 30 minutes of intubation, and dose of agent used for RSI. The safety outcome is 28 day ventilator-free days (VFD).


Results: In progress.


Conclusion: In progress.
Moderators
avatar for Rebecca Orr
Presenters
JG

Jaclyn Gruver

PGY1 Pharmacy Resident, Williamson Medical Center
 
Evaluators
avatar for Martin Gordon

Martin Gordon

Clinical Pharmacy Specialist- Critical Care, Spartanburg Medical Center
Martin Gordon, PharmD, BCCCP is the Clinical Pharmacy Specialist for Medical Critical Care and Residency Program Coordinator for the PGY1 Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Gordon completed his Doctor of Pharmacy degree from Presbyterian... Read More →
Friday April 25, 2025 9:50am - 10:05am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Williamson Medical Center
  • global Y

9:50am EDT

Pharmacist Impact Within a Post-Intensive Care Clinic at a Safety Net Hospital
Friday April 25, 2025 9:50am - 10:05am EDT
Athena G
Title: Pharmacist Impact Within a Post-Intensive Care Clinic at a Safety Net Hospital 
Objective: To evaluate the impact of a critical care pharmacist in the Post-ICU Clinic (PIC).


Self Assessment Question: Describe the most common interventions made by the critical care pharmacist in the PIC clinic?


Authors: Alexandria Howell1, Sam Pournezhad1, Tarun Kapoor2, Nicole Herbst3, Marina Rabinovich1 
  1. Grady Memorial Hospital; Atlanta, GA
  2. Emory University Hospital, Atlanta, GA
  3. Hershey Medical Center, Hershey, PA
Background: It is estimated more than half of intensive care unit (ICU) survivors are faced with a constellation of new symptoms following prolonged ICU stays. Post-ICU Syndrome is defined as new onset weakness, fatigue, cognitive decline, intrusive memories, and/or depression, and is associated with poor quality of life and increased risk of rehospitalization. ICU survivors require close follow-up with continuity of care to ensure all problems are appropriately addressed. Post-ICU Clinics have been established to combat these public health concerns; however, there are a limited number of clinics nationwide. The PIC at Grady Memorial Hospital is a multidisciplinary clinic consisting of a critical care clinical pharmacist, critical care physician, and physical medicine and rehabilitation physician. Pharmacists play a critical role in the clinic by evaluating the patient’s quality of life and ensuring optimization of medication regimens.  


Purpose: To describe and quantify the interventions made by critical care trained pharmacists in the post-ICU ambulatory setting. 


Methods: This was a single centered retrospective chart review study evaluating critical care trained pharmacist interventions in the PIC Clinic from June 2022 to July 2024. Patients were referred to the PIC clinic if they spent more than 4 days in the ICU and/or more than 48 hours mechanically ventilated. Adult patients evaluated by the clinical pharmacist during the PIC visit were included for study evaluation. The primary endpoint was the total number of pharmacist interventions and median number per patient. Secondary endpoints included types of medication interventions and medications classes with interventions. 
 
Results: One-hundred patients met inclusion criteria. More than half (53%) of patients were admitted to the medical ICU. The most common ICU diagnosis was respiratory failure (36%), followed by trauma (25%). Clinical pharmacists completed 254 interventions during the time period, with a median of 3 per patient (interquartile range [IQR] 1.8-4). The most common intervention was medication initiation (24%) followed by medication discontinuation (23%). Medication classes with the highest frequency of pharmacist interventions were analgesics (25%) followed by cardiac medications (22%). 
 
Conclusion: The critical care clinical pharmacist is a key member of the PIC by providing medication interventions with a median of 3 per patient. Medication interventions performed by the pharmacist may optimize patients’ pharmacotherapy regimens and quality of life but additional studies are needed. 
 
Moderators
avatar for Tia Collier

Tia Collier

Medical ICU and Neuroscience ICU Clinical Pharmacist and PGY2 Critical Care Residency Program Director at Erlanger in Chattanooga, TN.
Presenters
avatar for Alexandria Howell

Alexandria Howell

PGY-2 Critical Care Pharmacy Resident, Grady Memorial Hospital
Alexandria (Alex) Howell, PharmD, is the Critical Care Pharmacy Resident. She received her Doctor of Pharmacy from the University of Maryland Baltimore School of Pharmacy and completed her PGY-1 pharmacy residency at Grady Memorial Hospital. Her professional interests include critical... Read More →
Evaluators
avatar for Sarah Frye

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2
Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree... Read More →
Friday April 25, 2025 9:50am - 10:05am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Grady Memorial Hospital
  • global Y

9:50am EDT

Implementing a Pharmacist Driven Proton Pump Inhibitor (PPI) Deprescribing Intervention in a Veteran Patient Population
Friday April 25, 2025 9:50am - 10:05am EDT
Athena C
Title: Implementing a Pharmacist Driven Proton Pump Inhibitor (PPI) Deprescribing Intervention in a Veteran Patient Population
Authors: Kristin Allen, Marisa Strychalski, Kye Grooms

Background: 
Proton pump inhibitors (PPIs) are among the most commonly prescribed medications in the VA to treat acid-related stomach disorders. The American College of Gastroenterology (ACG) recommends up to an 8-week course of a PPI for symptomatic relief of gastroesophageal reflux disease (GERD). The PPI should then be tapered off and discontinued or switched to a histamine 2 receptor antagonist (H2RA) for maintenance therapy. The long-term use of PPIs can potentially lead to adverse events such as osteoporosis and bone fractures. Due to these potential long-term risk, they are also included on the American Geriatric Society (AGS) Beers Criteria for potentially inappropriate medication use in older adults. Furthermore, Veterans on long-term PPIs with a low BMI (defined as a BMI of 19 kg/m2 and lower) are at even higher risk of osteoporosis and bone fractures, as low BMI is an independent risk factor in and of itself. The purpose of this study was to limit the potentially inappropriate continuation of formulary PPIs in a geriatric Veteran patient population most vulnerable to developing or worsening osteoporosis by reducing the PPI dose, stopping the PPI, and/or switching to a formulary preferred H2RA.

Methods:  
A data query identified geriatric Veterans (>75 years old) who have an active prescription for omeprazole or pantoprazole for at least 2 years and had at least one of the following: a low BMI, a diagnosis of osteoporosis, or were on osteoporosis prevention/treatment in the last 2 years. Veterans who were deemed appropriate for intervention based on chart review were contacted by phone. Through shared decision-making, the Veteran either continued the PPI at their current dose, reduced the dose, discontinued the PPI, and/or switched to an H2RA and were then scheduled for telephone follow-up for any interventions made. The primary endpoint was the percent difference in PPI utilization following pharmacist intervention. The secondary endpoint was the difference in the total daily dose of the PPI and H2RA for all patients on therapy following pharmacist intervention. The tertiary endpoint was to determine if the results of the DEXA scans performed show new/clinically relevant findings and require intervention. Data collected also included baseline characteristics such as age, weight (in kilograms), body mass index, serum creatinine, sex, and if the patient had a DEXA scan on file with the VA. 

Results:
25 patients were contacted and 72% of patients agreed to the deprescribing intervention. The utilization of low dose PPIs and high dose PPIs decreased by 8% and 24% and the utilization of as needed famotidine and non-pharmacologic strategies increased by 24% and 8% following pharmacist intervention. In total, 20% of Veterans were able to de-escalate PPI therapy and 32% were able to successfully discontinue the PPI and switch to as needed famotidine or non-pharmacologic strategies only. The total daily dose of PPIs decreased by 370 mg and the famotidine dose increased by 120 mg in total across 25 patients. One patient was started on a non-formulary PPI due to uncontrolled GERD symptoms on the formulary agents. Three out of four DEXA scans showed osteopenia/osteoporosis and two patients were started on treatment while one was referred to Endocrinology for further management.

Conclusion:
The pharmacist driven deprescribing intervention was able to de-escalate and discontinue PPI therapy, reduce the total daily dose of PPIs, increase the total daily dose of famotidine, and initiate osteopenia/osteoporosis treatment in those with new/clinically relevant DEXA scan results which illustrates the important role pharmacist play in reducing the risk of adverse drug events and pill burden as well as improving the overall health of the geriatric Veteran patient population.
Moderators
avatar for Devki Gajera
Presenters
avatar for Kristin Allen

Kristin Allen

PGY-1 Pharmacy Resident, Ralph H. Johnson VA Health Care System
Kristin Allen is originally from Destin, Florida. She moved to Charleston from Birmingham, Alabama where she completed her fourth year APPE pharmacy school rotations. She received her bachelor’s degree in biomedical sciences from Auburn University in 2021 and completed her Doctor... Read More →
Evaluators
avatar for Erin Himes
Friday April 25, 2025 9:50am - 10:05am EDT
Athena C
  Geriatrics (GER), VA - Charleston, SC - Ralph H. Johnson Veterans Affairs Medical Center
  • global Y

9:50am EDT

Incidence of AKI Before and After Implementation of Pharmacy-Driven Acyclovir Protocol
Friday April 25, 2025 9:50am - 10:05am EDT
Athena A
Title: Incidence of AKI Before and After Implementation of a Pharmacy-Driven Intravenous Acyclovir Protocol 

Authors: Eryn Meegan, Will Anderson, Dustin Ziegler, Kishan Patel

Objective: To assess the occurrence of AKI rates before and after implementing a pharmacy-driven intravenous acyclovir protocol aimed at optimizing dosing and intravenous hydration

Self-Assessment Question: True or False - Pharmacy involvement resulted in increased IV fluids ordered alongside IV acyclovir

Background: Acyclovir, a nucleoside analogue antiviral, is a well-recognized cause of drug-induced acute kidney injury (AKI) through crystal nephropathy, which results from intratubular obstruction due to crystalline precipitation in distal tubular lumens. In order to mitigate the risk of acyclovir-induced nephrotoxicity, the Cone Health Pharmacy and Therapeutics Committee approved and implemented a pharmacy-driven intravenous acyclovir protocol in May 2022. With this protocol, the pharmacy team aimed to improve patient safety by providing tailored dosing recommendations and ensuring appropriate fluid administration. The purpose of this study was to evaluate the effect of implementing this pharmacy-driven protocol on AKI rates. 

Methods: This institutional review board-approved, retrospective cohort study evaluated the implementation of a pharmacy-driven protocol to reduce the risk of AKIs in patients on intravenous acyclovir. This study was conducted within Cone Health, a single hospital system, between April 2020 to August 2024. Patients were included if they were 18 years or older and received at least 24 hours of intravenous acyclovir within the pre-consult implementation period of April 2020 to April 2022 or the post-consult implementation period of August 2022 to August 2024. Patients were excluded if they had end-stage renal disease, presented with an AKI, if baseline renal function was unknown, or if serum creatinine was not trended throughout the duration of acyclovir treatment. The primary endpoint was the incidence of AKI as defined by the 2012 KDIGO guidelines: an increase in serum creatinine by greater than or equal to 0.3 mg/dL within 48 hours, or an increase in serum creatinine to greater than or equal to 1.5 times baseline within the prior 7 days. The secondary endpoint evaluates the protocol's effectiveness in preventing AKI by assessing duration of intravenous fluid administration ordered per protocol. Fisher's exact test and descriptive statistics were used to analyze the data as appropriate.  

Results: Of the 120 patient charts reviewed, 31 met inclusion criteria (11 in the pre-implementation period and 20 in the post-implementation period). Baseline characteristics were similar between the two groups. Notably, more patients in the post-implementation group were on concomitant nephrotoxic agents compared to the pre-implementation group (13 patients vs. 8 patients). Median duration of acyclovir therapy increased from 2.4 days (IQR 1.7–4.0) in the pre-implementation group to 3.3 days (IQR 2.5–4.9) in the post-implementation group. The rate of AKI was 18% before implementation and increased to 25% after implementation, though this difference did not reach statistical significance (P = 0.38). Intravenous fluids were ordered for all patients (100%) compared to 82% pre-implementation, though this difference was not statistically significant (P = 0.12). The median duration of IV fluid administration significantly increased from 0.8 days (IQR 0.3–2.4) to 3.5 days (IQR 2.9–6.4) post-implementation (P = 0.0006). The rate of appropriate acyclovir dosing remained consistent between groups (91% vs 90%, P = 0.93). Similarly, the frequency of under-dosing was low and comparable (9% vs 10%, P = 0.99), and no patients in either group were over-dosed.

Conclusion: Implementation of a pharmacy-driven intravenous acyclovir protocol led to a significant increase in the duration of IV fluid administration. While the incidence of AKI was numerically higher in the post-implementation group, this difference was not statistically significant. Dosing accuracy remained high across both groups, with minimal under-dosing and no cases of overdosing observed. These findings suggest that the protocol successfully enhanced supportive care practices without compromising dosing safety, though further evaluation in a larger cohort may be warranted to better assess its impact on AKI prevention.
Moderators
JK

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1
Presenters
EM

Eryn Meegan

PGY1 Pharmacy Resident, Cone Health
Current Acute Care PGY1 Pharmacy Resident at Cone Health Alamance Regional Medical Center Cone. I earned my Doctor of Pharmacy degree from D'Youville University School of Pharmacy. Upon completion of residency, I have accepted a full-time clinical pharmacist role within Cone Health... Read More →
Evaluators
avatar for Melissa Padgett

Melissa Padgett

Residency Program Director, HCA Florida West Hospital
Melissa Padgett earned her Doctor of Pharmacy in 2014 from Belmont University College of Pharmacy in Nashville, TN. After receiving her PharmD, she completed a post-doctoral PGY1 pharmacy residency at HCA Florida West Hospital in June of 2015. From there, she stayed on as a full-time... Read More →
Friday April 25, 2025 9:50am - 10:05am EDT
Athena A
  Infectious Disease (ID), Cone Health
  • global Y

9:50am EDT

Impact of a Pharmacist-Led Glycemic Management Consult Service in Hospitalized Patients
Friday April 25, 2025 9:50am - 10:05am EDT
Parthenon 2
Title: Impact of a Pharmacist-Led Glycemic Management Consult Service in Hospitalized Patients  


Authors: Dion Blocker, Michelle Marbury, Mariam Agbe


Background: Diabetes is a major chronic health problem, and its prevalence continues to grow nationwide. If left uncontrolled, patients may develop microvascular and macrovascular complications, which can lead to morbidity, mortality, and decreased health-related quality of life. Wellstar Cobb Medical Center is the only hospital in the Wellstar Health System with a pharmacist-led glycemic management consult service. The clinical pharmacy team manages patients admitted to the hospital and makes a vast number of interventions. Based on the lack of evidence regarding pharmacist-led glycemic management, this study aims to evaluate the safety and efficacy of pharmacy-managed basal-bolus regimens in hospitalized patients. 


Methods: The design of the study is a single-center, retrospective, noninferiority chart review of adult patients admitted to Wellstar Cobb Medical Center. A drug utilization report will be used to identify hospitalized adults who received insulin therapy at Wellstar Cobb Medical Center from January 2018 to July 2024. A maximum of 500 patients will be randomized and included from each treatment group. This study aims to examine the incidence of hypoglycemic events with a pharmacist-led glycemic-monitoring protocol compared to usual care. This study will compare the time to euglycemia after the first abnormal glycemic level, average incidence of hypoglycemic events, total length of stay, continued hyperglycemia after initial regimen, and hospital readmission within 30 days. Data will be obtained from Enterprise Data Analytics due to data query limitations identified in Epic Slicer Dicer. Adult patients with a past medical history of diabetes who are admitted with a blood glucose level greater than 140 mg/dL on basal, bolus, or continuous insulin will be included in the study. Patients using only sliding scale insulin, experiencing critically ill COVID-induced hyperglycemia, with concurrent insulin pump therapy, on hospice, or with consecutive readings of blood glucose 110-180 mg/dL with no more than two BG readings outside the range within 48 hours of admission without a pharmacy to dose basal bolus consult will be excluded from the study. 


Results: The study analyzed 100 hospitalized adult patients divided into two groups: those managed by pharmacist-led glycemic consultation (n=50) and those managed by usual care without pharmacist consultation (n=50). Although not statistically significant, patients receiving pharmacist consultation achieved euglycemia faster (60.7 ± 49.9 hours) compared to the usual care group (93.2 ± 108.6 hours, p=0.05). Additionally, a significantly greater proportion of patients reached euglycemia in the pharmacist consultation group (82%) compared to the control group (50%, p=0.0007). The pharmacist consultation group experienced fewer cases of continued hyperglycemia 72 hours after insulin initiation (38% vs. 66%, p=0.005), which was statistically significant. Length of stay and hypoglycemic events did not significantly differ between groups.

Conclusion: Although not statistically significant, the pharmacist-led glycemic management consult service was associated with improved time to achieve euglycemia in hospitalized patients compared to usual care. Although there was no statistically significant difference in time to euglycemia, hypoglycemic events or length of hospital stay, pharmacist-managed care effectively achieved statistically significant effects on persistent hyperglycemia and achieving euglycemia. These findings support the integration of pharmacist services into hospital glycemic management protocols.
Presenters
avatar for Dion Blocker

Dion Blocker

PGY2 Health-System Pharmacy Administration and Leadership, Wellstar Cobb Medical Center
Dion Blocker, PharmD is originally from Augusta, Georgia, and he is the current PGY2 HSPAL resident at Wellstar Cobb Medical Center/Wellstar Health System. Dr. Blocker attended the University of Georgia where he received his Bachelor of Science degree in Biology. Dr. Blocker continued... Read More →
Evaluators
avatar for Jason Dover

Jason Dover

PGY-1 Residency Program Director, Clinical Pharmacist Emergency Medicine/Internal Medicine, East Alabama Medical Center
Friday April 25, 2025 9:50am - 10:05am EDT
Parthenon 2
  Internal Medicine (IM), Wellstar Cobb Medical Center / Wellstar Health System PGY1/PGY2 HSPAL
  • global Y

9:50am EDT

Rates of Gastrointestinal Bleeding in Patients Taking Concomitant Dual Antiplatelet Therapy (DAPT) and SSRI/SNRI Therapy Within One Year of Acute Coronary Syndrome (ACS)
Friday April 25, 2025 9:50am - 10:05am EDT
Parthenon 1
Title: Rates of Gastrointestinal Bleeding (GIB) in Patients Taking Concomitant Dual Antiplatelet Therapy (DAPT) and SSRI/SNRI Therapy Within One Year of Acute Coronary Syndrome (ACS) 
 
Authors: Hannah Holbert, Thaddeus McGiness, A. Shaun Rowe, Travis Fleming


Objective: Evaluate potential gastrointestinal bleeding risk associated with combined SSRI/SNRI and DAPT in patients receiving these medications for twelve months post-ACS.


Self-Assessment Question: Which of the following was associated with increased rates of GIB in patients at 12 months post-ACS?  a. Aspirin + prasugrel + duloxetine; b. Aspirin + prasugrel + sertraline; c. Aspirin + clopidogrel + venlafaxine; d. Aspirin + ticagrelor + fluoxetine; e. None of the above  


Background: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) modulate serotonin, which promotes mood enhancement in the central nervous system (CNS) and hemostasis in the peripheral nervous system (PNS). Inhibition of serotonin reuptake in the CNS increases emotional stability, making SSRIs and SNRIs useful antidepressants. In the PNS, these drugs prevent serotonin-mediated platelet aggregation, increasing bleeding risk. Because depression is common following major adverse cardiovascular events, there is a potential for patients to take concomitant SSRI or SNRI therapy with dual antiplatelet therapy (DAPT) for 12 months post-percutaneous intervention. The purpose of this study was to evaluate if patients receiving this combination were at a greater risk of gastrointestinal bleeding due to multiple antiplatelet mechanisms compared to those receiving DAPT alone. 
 
Methods: This single center retrospective cohort study included adult patients diagnosed with acute coronary syndrome (ACS) and treated with percutaneous intervention, stent implantation, and DAPT between January 1, 2014, to January 1, 2024. Patients were excluded from this study if they received DAPT for any indication other than ACS (e.g., ischemic stroke), if they had a previous diagnosis of cirrhosis, Helicobacter pylori infection, or cancer of the gastrointestinal tract, or if any of the following medications were on their discharge medication list: anticoagulants, systemic steroids, systemic non-steroidal anti-inflammatory drugs (NSAIDs), ginseng, garlic, ginkgo, or vitamin E. The primary outcome of this study was rates of gastrointestinal bleeding within 12 months of ACS diagnosis. Additional secondary outcomes included length of stay, therapy modifications at discharge, and 30-day and 90-day readmission rates.
 
Results: The primary outcome was observed in five patients (3%) in the DAPT group and no patients in the DAPT plus SSRI or SNRI group (P = 0.336). Readmission at 30 days occurred in 23 patients (13.6%) in the DAPT group and 10 patients (17.9%) in the DAPT plus SSRI or SNRI group (P = 0.436). Patients who were readmitted within 90 days of ACS discharge included 37 patients (21.9%) and 19 patients (33.9%) in the DAPT and DAPT plus SSRI or SNRI group, respectively (P = 0.071). There was no statistical difference between median length of stay between the two groups (P = 0.430). One notable baseline characteristic was a documented history of coronary artery disease (CAD). In the DAPT only group, the majority (106 patients; 62.7%) did not have a prior history of CAD, whereas 37 patients (66.1%) in the DAPT plus SSRI or SNRI group did have a documented history of CAD. This finding regarding past medical history of CAD was statistically different between both groups (P < 0.001). 
 
Conclusion: This study found no statistical difference in the rate of GIB in patients who received DAPT compared to those who received DAPT plus an SSRI or SNRI post-ACS. A statistical difference was observed, however, when comparing SSRI or SNRI use in patients based on prior history of CAD. Because patients with a prior history of CAD were more likely to take SSRIs or SNRIs, this study further endorses the use of these agents to treat secondary mental health disorders following ACS. Additionally, none of the patients in this study population who were taking SSRIs or SNRIs experienced a GIB, implying that use of these antidepressants could be considered both effective and safe in this population. More research should be conducted to further evaluate if the use of SSRIs or SNRIs in patients receiving DAPT for one-year post-ACS  impacts rates of bleeding events, especially in women, racial minorities, patients who underwent elective PCIs, and patients who experienced other types of bleeding events.   
Moderators
avatar for Margaret Williamson

Margaret Williamson

Clinical Pharmacy Specialist, East Alabama Health
Presenters
avatar for Hannah Holbert, PharmD, MPH

Hannah Holbert, PharmD, MPH

PGY2 Pharmacotherapy Resident, University of Tennessee Medical Center
Dr. Hannah Holbert, a Knoxville native, obtained her bachelor's degree in Health and Human Sciences from the University of Tennessee. She then attended pharmacy school at the University of Tennessee Health Science Center, where she received her Bachelor’s in pharmaceutical sciences... Read More →
Evaluators
avatar for Emily Johnson

Emily Johnson

PGY1 Residency Program Coordinator - Acute Care/Clinical Pharmacist Team Lead - MedSurg, Cape Fear Valley Medical Center
Friday April 25, 2025 9:50am - 10:05am EDT
Parthenon 1
  Internal Medicine (IM), University of Tennessee Medical Center
  • global Y

9:50am EDT

A Review of the Incidence of Pneumocystis Pneumonia Infection with or without Pneumocystis Pneumonia Prophylaxis in Patients with Brain Tumors
Friday April 25, 2025 9:50am - 10:05am EDT
Olympia 2
Title: A Review of the Incidence of Pneumocystis Pneumonia Infection with or without Pneumocystis Pneumonia Prophylaxis in Patients with Brain Tumors 


Authors: Gabrielle McCammack, Marley Watson, Danielle Rustem, Brooke Rowling, Benjamin Albrecht, Kimberly Hoang, Manali Rupji, Xiyuan Ji, Jeffrey Switchenko


Background: Temozolomide is an oral alkylating agent administered with radiation for high-grade gliomas. According to the temozolomide drug monograph, patients should receive prophylaxis against Pneumocystis pneumonia (PCP) while receiving concurrent chemotherapy and radiation treatment. However, the Infectious Diseases Society of America recommends prophylactic antibiotics in chemotherapy regimens with less than 3.5% risk of contracting PCP. There are many suspected risks factors for development of PCP, yet recent studies have shown the incidence of PCP infection in this patient population is low, less than 1%. In addition, prophylactic antibiotics for PCP are associated with side effects and additional costs for patients. The decision to prescribe PCP prophylaxis for patients at Emory Healthcare is provider specific. The purpose of this study is to determine the incidence of PCP development with or without PCP prophylaxis and evaluate possible risk factors correlating with PCP development. 

Methods: This is a retrospective chart review of adult patients with brain tumors treated with concurrent phase temozolomide with radiation therapy at Emory Healthcare. Patients with high grade gliomas on concurrent temozolomide with radiation therapy will be included and will be categorized based on use of prophylactic antibiotics for PCP. Patients will be excluded for use of prophylactic antibiotics with activity against PCP for another indication, having reduced radiation courses, starting PCP prophylaxis after one week of chemotherapy treatment, or having insufficient documentation to confirm chemotherapy cycles. The primary outcome is to determine the incidence of PCP development with or without PCP prophylaxis, with safety as a secondary outcome. Descriptive statistics using mean and standard deviations for numerical variables and frequency and percentages for categorical clinicopathological variables. 

Results: A total of 67 patients were included in the study, 20 received PCP prophylaxis, 47 did not receive PCP prophylaxis. The mean age of patients was 54 years old in the prophylaxis group, and 55 in the without prophylaxis group. Most patients were on high dose steroids (prednisone equivalents > 20mg daily) for 1 month prior to treatment; 15 (75%) in the with prophylaxis group and 38 (80.9%) in the without prophylaxis group. Three patients in the without prophylaxis group had an immunocompromising condition at baseline; with 2 (4.3%) patients on hydroxychloroquine and 1 (2.1%) patient on infliximab. For patients on PCP prophylaxis, 9 (45%) were on trimethoprim/sulfamethoxazole, 10 (50%) inhaled pentamidine, and 1 (5%) on atovaquone. No patients developed a PCP infection; therefore, an analysis was not performed.

Conclusion: No cases of PCP were found for patients on treatment or 90 days post treatment in either the with or without prophylaxis groups. No events occurred despite 79.1% and 4.5% of the patient population being on high dose steroids or immunocompromising medications, respectively. Though some patients had a reduction in ALC while on treatment, more data is needed to determine if this is a true risk factor for development of PCP infection. Larger studies are needed to further assess and define risk factors for developing PCP infection while on concurrent temozolomide and radiation treatment and ultimately create a risk stratification tool that can better identify patients requiring PCP prophylaxis to minimize additional medication use and side effects.
Moderators
avatar for Kristen Kilby

Kristen Kilby

PGY2 Oncology Resident, Northside Hospital
Kristen Kilby attended pharmacy school at the University of South Carolina. She then completed a PGY-1 residency at Baptist Memorial Hospital- Memphis and a PGY-2 Oncology residency at Northside Hospital in Atlanta, GA. She is currently a clinical oncology specialist focused on malignant... Read More →
Presenters
GM

Gabrielle McCammack

PGY1 Specialty Pharmacy Resident, Emory University Hospital Midtown
Gabrielle McCammack is from Peachtree City, Georgia. She completed her pre-pharmacy coursework and received her Doctor of Pharmacy from the University of Georgia. Following her PGY1, Gabrielle will stay with Emory University Hospital Midtown to complete a PGY2 in oncology. Her professional... Read More →
Evaluators
avatar for Amy Porter
Friday April 25, 2025 9:50am - 10:05am EDT
Olympia 2
  Oncology (ONC), Emory University Hospital Midtown
  • global Y

9:50am EDT

Initiative To Improve Lithium Safety Monitoring at Veterans Affairs Medical Center
Friday April 25, 2025 9:50am - 10:05am EDT
Olympia 1
Title: Initiative To Improve Lithium Safety Monitoring at Veterans Affairs Medical Center

Authors: Cydney Smalls, Carrie Sartin, William Erwin

Objective: To evaluate the effectiveness of recommendations provided by a pharmacist via chart review regarding lithium therapeutic drug levels and safety monitoring for Veterans.

Self-Assessment Question:

Background: Lithium is a well-established therapy for mood disorders, known for its effectiveness in mood stabilization and significant reduction in suicide risk. Despite its clinical benefits, lithium therapy is challenging due to its narrow therapeutic index, making patients susceptible to toxicity. Consequently, frequent monitoring of serum lithium levels and organ function (Scr, ECG, TSH, electrolytes, CBC) is critical. This quality improvement initiative aims to evaluate the impact of clinical pharmacist recommendations provided via chart notifications on enhancing lithium monitoring practices.

Methodology: This quality improvement project is designed as a multi-center, prospective cohort analysis, exempt from Institutional Review Board approval. It investigates provider responses to clinical pharmacist recommendations made through a chart-based review for Veterans on lithium therapy at the Fayetteville NC VA Coastal Health Care System (FNCVACHCS). Participants were identified using the Veterans Affairs Lithium Lab Monitoring Dashboard. Recommendations were communicated to providers using a standardized note template embedded within the computerized patient record system (CPRS). The primary outcome measures the percentage of recommendations accepted by prescribers, determined by new orders placed within one week of the note's documentation. Secondary outcomes include evaluating the average duration between note documentation and completion of recommended safety monitoring tests, incidence rates of supra-therapeutic lithium levels along with associated side effects, and the proportion of accepted recommendations not carried out by patients.

Results: Forty-six notes were entered to communicate recommendations to prescribers. Regarding the primary outcome, providers accepted 37% (17) of these recommendations. The average time from note entry to completion of recommended safety monitoring tests was 13 days. Notably, no supratherapeutic lithium levels were reported during the observation period. However, 47.1% (8) of provider-accepted recommendations were not completed by patients, indicating a significant gap between provider acceptance and patient adherence.

Conclusions: Despite the inconsistent laboratory monitoring parameters for Veterans on lithium therapy, the results showed that Veterans for whom lab values were reviewed showed no significant concerns. There were limitations with the initiative which included providers not acknowledging the recommendation within the computerized patient record system (CPRS), resulting in variability in the implementation of recommended monitoring practices. Identified barriers, including time constraints and alert fatigue, likely contributed to this inconsistency. Addressing these challenges through targeted education, streamlined workflows, and supportive feedback is essential to enhancing provider adherence, thereby ensuring consistent patient safety practices. Efforts to mitigate these barriers are crucial to sustaining the initiative without placing undue burden on healthcare providers.
Presenters
avatar for Cydney Nicholson Smalls

Cydney Nicholson Smalls

PGY-1 Pharmacy Resident, Fayetteville NC VA Coastal Health Care System
Cydney Nicholson Smalls, Pharm.D, MSPH is a PGY-1 Pharmacy Practice resident at the Fayetteville VA Coastal Health Care System. She earned her Doctor of Pharmacy and Master of Science in Public Health degrees from Campbell University College of Pharmacy & Health Sciences. Upon completion... Read More →
Evaluators
avatar for Abbi Rowe
avatar for Stephanie Ring

Stephanie Ring

Pharmacy Formulary Manager, Department of Veterans Affairs
Friday April 25, 2025 9:50am - 10:05am EDT
Olympia 1
  Psychiatric Pharmacy (PSY), VA - Fayetteville, NC – Fayetteville VA Coastal Health Care System
  • global Y

9:50am EDT

Evaluation of Pharmacists’ Review on Discharge Medication Reconciliation in Transitions of Care
Friday April 25, 2025 9:50am - 10:05am EDT
Athena I
Title: Evaluation of Pharmacists’ Review on Discharge Medication Reconciliation in Transitions of Care 

Authors: Courtney Reliford, Sydney Bowman, Leborah Cole Lee, Randy Hooks, Kayla Brown 

Objective: To evaluate discharge medication reconciliation accuracy in patients with a pharmacist’s review and in patients without a pharmacist’s review.   

Background: Medication reconciliation is a critical component of safe transitions of care. The transition period from the hospital to home or another facility is a vulnerable period for patients and presents various opportunities for pharmacist involvement. Studies have demonstrated the value of pharmacists in transitions of care and medication reconciliation. According to the World Health Organization, more than 40 percent of medication errors may result from inadequate reconciliation in handoffs during hospital admission, transfer, and discharge. Within our institution, pharmacists review 30 to 40 percent of discharge medication reconciliations. This project is designed to evaluate discharge medication reconciliation for accuracy for patients with and without a pharmacist’s review. 

Methods: The Institutional Review Board approved this retrospective chart review of discharge medication reconciliation accuracy in patients with a completed pharmacist’s review and patients without a pharmacist’s review. Study participants were randomly selected for review based on discharges between January 1, 2023, through May 31, 2024. Study participants were randomized to either a control group or a pharmacist reviewed transitions of care group. The primary outcome was the incidence of medication discrepancies at discharge with a pharmacist’s review versus medication discrepancies without a pharmacist’s review. Secondary outcomes included average number of discrepancies per patient, discrepancies by patient location, discrepancies by physician specialty group, length of stay, percentage of patients with a discrepancy related to high-risk medications, type of discrepancies, and 30-day and 90-day hospital re-admission rates. Types of discrepancies included dose, route, frequency, medication, duplication, omission, unnecessary order, and untreated indication. Data were analyzed using Chi-Square, Fisher’s Exact test, Student’s t-test or Mann-Whitney U, depending on data type and distribution. 

Results: A total of 17,675 patients were identified over the study timeframe and randomized. Two hundred and nine patients were screened for inclusion: 99 in the pharmacist intervention group and 110 in the control group to achieve a total of 75 patients in each group.  Baseline characteristics were comparable between the two groups, except for the total number of discrepancies identified (29 discrepancies in the control group (3%) vs. 11 discrepancies in the pharmacist review group (1%), p = 0.005). There were fewer patients with a medication discrepancy in the pharmacist review group compared with the control group (31 % vs. 5%, p < 0.001). The median number of discrepancies also differed between the groups (IQR: 0-1 in the control group vs. 0-0 in the pharmacist review group, p value <0.001). While 30-day readmissions rates were similar between the groups, 90-day readmissions differed with 20 readmissions in the control group (27%) versus 8 readmissions (11%) in the pharmacist review group (p = 0.012). There were no statistically significant differences in discrepancies for high-risk medications between groups, defined as anticoagulants, potassium, narcotics, and insulin.   

Conclusions: This study showed clinically and statistically significant reductions in discrepancies on discharge as well as lower 90-day readmission rates when discharge medications were reviewed by a pharmacist, showing benefit of pharmacists’ participation in transitions of care. Strengths of this study include the inclusion of multiple different pharmacists' review on medication reconciliations, and inclusion of diverse patient populations. Limitations include a small sample size and inclusion of surgery patients who often have little to no changes in home medications. Future studies could provide a more thorough review of discrepancies across the continuum of care.  
 
Moderators
CM

Charleen Melton, PharmD, BCCCP

Clinical Pharmacy Asst Manager, PGY1 and EM PGY2 RPC, CaroMont Health
Presenters
avatar for Courtney Reliford

Courtney Reliford

PGY-1 Pharmacy Resident, East Alabama Medical Center
Courtney Reliford is a PGY1 Pharmacy Resident at East Alabama Medical Center. Originally from Douglas, GA, she earned her Doctor of Pharmacy degree from the University of Georgia. Her clinical interests include psychiatry, ambulatory care, and critical care. Upon completion of her... Read More →
Evaluators
BM
Friday April 25, 2025 9:50am - 10:05am EDT
Athena I
  Transitional Care (TC), East Alabama Medical Center
  • global Y

10:20am EDT

Optimizing Patient Care: The Role of Pharmacy-Driven Nursing Education in Enhancing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores
Friday April 25, 2025 10:20am - 10:35am EDT
Olympia 1
Title: Optimizing Patient Care: The Role of Pharmacy-Driven Nursing Education in Enhancing Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores

Authors: Leah Franks and David Collette

Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a national patient satisfaction tool that measures the perception of hospital care. This survey is completed by patients after discharge. Associated scores are directly linked to hospital reimbursement and STAR ratings. A review of recent Huntsville Hospital HCAHPS results revealed that scores were lowest surrounding the Communication about Medicines Domain. This domain addresses whether the indications and side effects of medications were discussed with patients during their hospital stay. Thus, the purpose of this pharmacy pilot project is evaluating if targeted pharmacy education on low-scoring nursing units results in an HCAHPS score improvement.

Methods: A single-center, institutional review committee approved, pre-post analysis was conducted at Huntsville Hospital to assess the impact of pharmacist-driven education as it relates to HCAHPS score improvement. The primary endpoint for this study was HCAHPS Top Box score improvement regarding the “Communication about Medicines” HCAHPS domain.  This study reviewed HCAHPS data (provided by Press-Ganey (PG)) between November 2023 to February 2025. As principal investigator, I worked with the Patient Experience Team to develop education materials for both nurses and patients in an effort to improve the patient experience in regards to the communication surrounding medication administration. Education materials developed included medication tip sheets and nursing education documents. Discussion with nursing unit directors and educators regarding advantages and barriers to success was required before implementation of process change could take place. Analysis was performed by PG and sent to primary investigator for review for pre-data (November 2023 – February 2024) and post-data (November 2024 – February 2025).

Results: A medical unit, two surgical units (A & B), and a neurological unit were included in the study. Pre-implementation Top Box Percentage scores (PG Percentile Rank) were as follows for each unit: Medical Unit – 59.72 (50), Surgical Unit A – 49.28 (5), Surgical Unit B – 57.29 (35), and Neurological Unit – 67.45 (89). Post implementation Top Box scores (PG Percentile Rank) were as follows: Medical Unit – 60.29 (45), Surgical Unit A – 67.43 (85), Surgical Unit B – 54.17 (13), and Neurological Unit – 44.00 (1). Monthly trends of each unit reveal fluctuations in overall data surrounding the primary endpoint.  In addition, at a pilot study debrief with hospital administration and nurse managers for each of the four units, differences in implementation methods for each unit was reported.

Conclusion: Overall, mixed results were seen across the units regarding the primary endpoint. A numerical increase was seen in the Top Box Scores for two out of the four units. Of note, after implementation differences were noted in the debrief, it was concluded that having a higher degree of nurse leadership integration/dissemination of the medication tip sheets correlated with higher HCAHPS Top Box scores.  Limitations included the variations in nursing unit implementation of the pilot project, nurse turnover, inability of primary investigator to participate in repeat educations for nursing units, and small sample size. A clear, general implementation plan would need to be utilized before hospital-wide or system-wide implementation could take place.
Moderators
SS
Presenters
avatar for Leah Franks

Leah Franks

PGY-1 Pharmacy Resident, Huntsville Hospital
Leah Franks is a PGY-1 Pharmacy Resident at Huntsville Hospital in Huntsville, Alabama and is originally from Meridian, Mississippi. She earned her Doctor of Pharmacy degree in 2024 from the University of Mississippi. Leah will continue her post-graduate training at Huntsville Hospital... Read More →
Evaluators
DK
Friday April 25, 2025 10:20am - 10:35am EDT
Olympia 1
  Administration (ADM), Huntsville Hospital
  • global Y

10:20am EDT

Impact Assessment of Food Deserts and Food Insecurity on Diabetes Mellitus
Friday April 25, 2025 10:20am - 10:35am EDT
Athena D
Title: Impact Assessment of Food Deserts and Food Insecurity on Diabetes Mellitus


Authors: 
Allison Eppenauer


Background: 
The worldwide epidemic and challenges of managing diabetes mellitus (DM) is partially driven by the intake of nutrient-poor and highly processed foods, however access to nutrient dense foods can be limited by financial restrictions and proximity to supermarkets. Areas of low access have been identified by the United States Department of Agriculture (USDA) Economic Research Service (ERS) Food Access Research Atlas as ‘food deserts’. As negative health outcomes of residing in food deserts or experiencing food insecurity have been previously demonstrated in other studies, this study aims to evaluate if these factors are an area that requires additional focus within the current population of patients with DM at the Ralph H. Johnson Veterans Affairs Healthcare System (RHJVAHS). Identification or focus on patients residing in food deserts or experiencing insecurity may allow clinicians to streamline preventative interventions during diabetes management to improve outcomes.


Methods: 
This project is a retrospective observational longitudinal cohort study for quality improvement comparing DM outcomes in veterans residing in a food desert/experiencing food insecurity and those not residing in a food desert/experiencing food insecurity. Eligible patients in the study included all patients enrolled within the RHJVAHS catchment area who had an active ICD 9/10 code diagnosis of DM or A1c > 6.5% between January 1, 2016 and December 31, 2018 with at least one annual visit with a VA provider in a primary location. Patients were then targeted over a follow up period to include lab values, hospitalizations, and deaths during the follow up period. 

The primary endpoint for this project was to determine if there is a significant difference in the frequency of uncontrolled A1c or urine albumin-creatinine ratio (UACR) based on a composite status of residing in a food desert or experiencing food insecurity and food insecurity alone. The secondary endpoint analyzed the difference in the frequency of all-cause hospitalizations, DM-related hospitalizations and mortality based on a composite status of residing in a food desert or experiencing food insecurity and food insecurity alone.


Results: Of the 4,209 veterans included in this study, 2054 (49%) patients were found to be residing in a food desert. 18 (0.004%) of patients screened positive for food insecurity. The primary outcome of uncontrolled A1c and UACR did not differ significantly between between the composite group of non-food desert/non-food insecurity (NFD/NFI) vs food-desert/food insecurity (FD/FI).  A1c >7% occurred in 45.7% of NFD/NFI vs. 44.2% FD/FI; p = 0.338.) A1c >8% occurred in 16.8% of NFD/NFI vs. 15.1% FD/FI; p = 0.133.) UACR >30 occurred in 39.1% of NFD/NFI vs. 39.5% FD/FI; p = 0.791. UACR >300 occurred in 4.2% of NFD/NFI vs. 5.4% FD/FI; p = 0.167. 

The primary outcome did not differ in patients with food insecurity alone with overall similar findings to the composite group. Although not statistically significant, patients with food insecurity had higher UACR >30 (63.6% in those experiencing food insecurity vs. 39.2% in those without, p = 0.098.)

The secondary outcome of all-cause hospitalization rate, DM-related hospitalizations, and mortality did not differ between NFD/NFI vs. FD/FI - about 20% of patients were hospitalized for any reason, 4% hospitalized due to complications of DM, and~20% of patients passed away. In food insecurity alone, all-cause hospitalizations was higher in those experiencing food insecurity vs. those not (44.4% vs 20.8%, respectively, OR 3.0 (1.2 - 7.7); p = 0.014.) DM-related hospitalizations did not differ between groups (3.7% in food insecurity vs. 5.6% in non-food insecurity; p = 0.864.) Mortality was also higher in patients with food insecurity (44.4% vs 20.2%, respectively, p = 0.018)

Additionally, patients with food insecurity had higher odds of missing a UACR lab value within the reporting period (19.7% vs 38.9%; OR 2.6 (1.0 - 6.7) ; p = 0.042.)


Conclusion: 
In summary, there was no difference in DM outcomes (UACR, A1c, hospitalizations, or mortality) between patients residing in a food desert/experiencing food insecurity versus those who are not. Patients with food insecurity were less likely to be evaluated for UACR despite the fact their UACR >30 trended higher than patients without food insecurity. Additionally, patients with food insecurity were more likely to be hospitalized for any reason or have higher mortality rate than those without food insecurity. The project was limited by the small patient population included in the food insecurity group which likely contributed to underreported findings. Data was not collected from other facilities, limiting the information available for patients seen at other medical centers which is an especially important consideration for patients residing in rural areas that may not seek care at the VA facility a significant distance away. Patients were also excluded if their address changed during the follow-up period. 
Moderators
avatar for Ashley Woodhouse

Ashley Woodhouse

SJCH2St. Joseph's/Candler Health System (Ambulatory)PGY2
Presenters
avatar for Allison Eppenauer

Allison Eppenauer

Post-Graduate Year 1 Pharmacy Practice Resident, Ralph H. Johnson Veterans Affairs Healthcare System
Allison (Ali) received her Associate’s degree in Pre-Pharmacy from State Fair Community College in Sedalia, Missouri in 2020 and completed her Doctor of Pharmacy from the University of Missouri-Kansas City in 2024. She is a current PGY1 resident at the Ralph H. Johnson VA Healthcare... Read More →
Evaluators
avatar for Anne Warren
Friday April 25, 2025 10:20am - 10:35am EDT
Athena D
  Ambulatory Care (AMB), VA - Charleston, SC - Ralph H. Johnson Veterans Affairs Medical Center
  • global Y

10:20am EDT

Implementation of the Pharmacogenomic Testing for Veterans (PHASER) Program among High Suicide-Risk Veterans: A quality improvement project
Friday April 25, 2025 10:20am - 10:35am EDT
Athena C
Title: Implementation of the Pharmacogenomic Testing for Veterans (PHASER) Program among High Suicide-Risk Veterans: A quality improvement project


Authors: Adirika Obiako, Christina Laird, Shari Brown, Tiffany Jagel


Objective: The primary objective of this quality improvement project is to increase testing and evaluate the impact of implementing PHASER in patients that are at a high risk of suicide who are on a mental health medication impacted by the PHASER panel.


Background: PHASER is an initiative designed to provide patients and providers access to high quality, evidence-based pharmacogenomic laboratory testing and recommendations that help optimize medication efficacy and reduce trial and error prescribing. The PHASER panel tests 15 different genes and multiple alleles that impact drug metabolism of over 73 commonly prescribed medications.


Methods: Patients flagged for a high risk for suicide have been identified from the High-Risk Flag Patient Tracking Report. Once these patients were identified, patients’ mental health medication regimen was reviewed to see if they were taking any mental health medications that were impacted by the PHASER testing panel. Patients on the high suicide risk dashboard were contacted and offered testing. Testing was ordered and scheduled for patients that were agreeable. Patients completed a one-time blood draw which was sent to a third-party testing facility where the test was performed and analyzed. Results were uploaded to patient medical records. The results highlight the type of metabolizer for each of the 15 genes and which of the 73 medications may require dose modification. Medications impacted were listed. When required, evidence-based dose adjustments were advised to prescribers based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. 


Results: 19.7% of candidates completed testing and their appointment with the pharmacogenomics pharmacist to review results for potential medication changes. Variants for cytochrome enzymes involved in pharmacogenomics influenced major depressive disorder medication metabolism were common. CYP2B6 and CYP2C19 had 53.6% variance present. CPY2D6 had 54% variance present. All of the patients included in the project had 1 of 3 cytochrome enzymes impacted and 51.3% who had 2 or more impacted. An average of 4.6 of the panel's 16 pharmacogenomic influenced major depressive disorder medications were impacted. 33.3% of patients had an actionable variant for a currently prescribed major depressive disorder medication and 20% required a pharmacogenomic guided dosage adjustment due to patient reported adverse drug event. These patients had been on their major depressive disorder medication for less than 3 months. 46.3% had been on major depressive disorder therapy for 3 months or more with no issues reported with adverse drug events or efficacy.

Conclusion: Definitive conclusions cannot be draw outside of the objective data reported, but some interesting parallels with what has been reported in the literature were noted. The literature reports Veterans carry at least 1 pharmacogenomic variant that can impact therapy decisions. We found these patients averaged 6 variants that impacted an average of 16 medications on the 73-medication panel. 1.6 of those variants were for a cytochrome enzyme involved in processing of pharmacogenomic influenced medications for major depressive disorder. Literature reports patients fail an average of 2-3 medications before finding symptom relief with depression. For 80% of the patients that completed testing this was true. These patients failed an average of 2.5 trials and this included pharmacogenomic influenced major depressive disorder medication trials only, it did not include trials for major depressive disorder medications that are not influenced by pharmacogenomics.
Moderators
avatar for Devin Lavender

Devin Lavender

Clinical Assistant Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2
Ambulatory Care, Scholarship of Teaching and Learning, Resident and Student Development.
Presenters
avatar for AJ Obiako

AJ Obiako

Hello! My name is AJ Obiako and I'm a non-traditional PGY-1 resident at the Gulf Coast Veterans Health Care System in Pensacola, FL. I'm also a 2018 Auburn Harrison College of Pharmacy graduate. I have an interest in ambulatory care, cardiology, and endocrinology. Outside of pharmacy... Read More →
AO

Adirika Obiako

Non-Traditional Resident, Gulf Coast Veterans Health Care System
Non-Traditional Resident that graduated from the Auburn College of Pharmacy in 2018. 
Evaluators
CW

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, Kaiser Permanente Georgia
Friday April 25, 2025 10:20am - 10:35am EDT
Athena C
  Ambulatory Care (AMB), VA-Biloxi, MS - Gulf Coast Veterans Health Care System
  • global Y

10:20am EDT

Antidote Assessment in a Community Health System
Friday April 25, 2025 10:20am - 10:35am EDT
Athena G
Title: Antidote Assessment in a Community Health System

Authors: Madison Owen, Rachel Rumbarger, Jon Oriet, Jonathan Worley

Objective: Identify antidote management trends to improve patient safety and outcomes.

Self Assessment Question: Which of the following is a key factor in improving patient outcomes related to antidote management?

Background: Antidotes are essential in the management patients with toxic exposures, as delays or unavailability can significantly increase morbidity and mortality. However, global deficiencies in antidote stocking arise due to infrequent use, limited education, inadequate awareness, supply chain interruptions, and constrained hospital resources. Expert consensus guidelines for antidote stocking in hospitals were updated in 2018 to address these challenges. Cone Health initially evaluated its antidote PAR (Periodic Automatic Replenishment) levels in 2018, based on these guidelines. Since then, changes in drug availability, the introduction of new antidotes, system expansions, and a lack of routine oversight necessitated a 2024 review. This review identified misalignments with updated guidelines, leading to system-wide inventory adjustments at emergency care locations. Changes were driven by guideline recommendations, usage patterns, waste considerations, and cost-effectiveness, leading to adjustments in PAR levels for 18 antidotes across multiple closely located sites. This study aimed to evaluate current antidote practices and assess whether recent inventory changes improved alignment with guidelines and patient care.

Methods: This was a multi-center, IRB-approved, retrospective study that evaluated patients who received a select antidote for a toxicological emergency at four hospitals and two free-standing emergency departments​ within Cone Health. Exclusion criteria included incomplete medical records, antidote use outside of toxicological emergencies, or patients treated in non-emergency settings. Utilizing the 2018 Expert Consensus Guidelines for Stocking of Antidotes in Hospitals That Provide Emergency Care and the in-house hospital vulnerability assessment updates and antidote indication and dosing updates, the inventory PAR levels for antidotes at Cone Health were updated, resulting in modifications to the PAR levels for digoxin immune fab, glucagon, and 16 other antidotes. A pre-post intervention design was used, with pre-intervention data collected from March 2018 through March 2024 and post-intervention data from April 2024 through February 2025. The primary objective was to assess the composite appropriateness of antidote utilization based on guideline recommendations, including dose accuracy and time to administration. Secondary objectives included evaluating individual metrics for dose and administration timing and determining the adequacy of current antidote inventory. Descriptive statistics were utilized for analysis.

Results: A total of 231 patients met inclusion criteria, with 128 in the pre-intervention group and 103 in the post-intervention group. Following antidote inventory adjustments, adherence to guideline-recommended dosing improved, with no cases of suboptimal dosing in the post-intervention group. For the composite primary outcome, optimal timing was achieved in 70% (90/128) of cases and optimal dosing in 97% (124/128) in the pre-intervention group, compared to 71% (73/103) and 100% (103/103), respectively, in the post-intervention group. Despite modifications to PAR levels, including increases for some antidotes, no instances of stock depletion leading to treatment delays were observed. Inventory adequacy was maintained across all emergency care sites.

Conclusion: Optimizing antidote inventory based on updated guideline recommendations improved adherence to dosing accuracy and administration time without compromising availability. The modest reduction in administration time suggests improved efficiency, though further enhancements could positively impact patient outcomes. These findings underscore the importance of routine antidote inventory assessments in improving patient safety and resource management. Future research should focus on prospective antidote utilization evaluation, identifying opportunities for optimization through order set utilization, and cost-effectiveness analysis to refine stocking strategies further.
Presenters
avatar for Madison Owen

Madison Owen

PGY1 Acute Care Resident, Cone Health
I am a pharmacist currently training as a PGY-1 Acute Care Pharmacy Resident at Moses H. Cone Memorial Hospital in Greensboro, North Carolina. My current clinical interests include ambulatory care, pediatrics, and academia. Next year, I will be at UNC Health for a PGY2 in Ambulatory... Read More →
Evaluators
avatar for Blake Johnson
MH
Friday April 25, 2025 10:20am - 10:35am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Cone Health
  • global Y

10:20am EDT

Characterization of External Ventricular Drain-Associated Ventriculitis
Friday April 25, 2025 10:20am - 10:35am EDT
Athena I
Title: Characterization of External Ventricular Drain-Associated Ventriculitis
Authors: Jordan Glasgow (Jordan.Glasgow@wellstar.org), Joy Peterson, Karen Barlow 
Objective: Identify risk factors for developing ventriculitis after the placement of an EVD. 
Self-assessment Question: Which of the following may be a risk factor for EVD-associated ventriculitis?  
Background: Hospital-acquired infections (HAI) increase morbidity, mortality, and healthcare costs. However, HAI associated with external ventricular drains (EVDs) are not routinely tracked. Surveillance of these infections can help identify risk factors, causative pathogens, and preventative strategies. The aim of this study is to characterize patients who develop ventriculitis after EVD placement in a large community teaching hospital. We seek to identify practical monitoring parameters and modifiable risk factors to improve patient outcomes in the neurocritical care unit. 
Methods: This is an observational, retrospective chart review of patients admitted to Wellstar Kennestone Regional Medical Center (WKRMC) from December 2021 to August 2024 with a diagnosis of ventriculitis after EVD placement. Additional eligibility criteria are patients ≥ 18 years of age with an EVD in place ≥ 24 hours. Descriptive statistics were performed are the data.   
Results: A total of eighteen EVDs were placed in nine patients with ventriculitis in this IRB-approved study. Each patient had a median of two EVDs installed during their stay and received an average of 15.5 ± 11.12 days of antibiotic therapy. The median length of stay in the neurocritical care unit (neuro ICU) and hospital was 28 days (25-29) and 31 days (25-34), respectively. Two EVDs were placed in the Emergency Department (ED) (11.1%), seven EVDs were placed in the neurocritical care unit (ICU) (38.9%), and nine EVDs were placed in the operating room (50%). Ten of the eighteen EVDs (55.6%) were associated with ventriculitis. Of these ten EVDs, five were linked to culture confirmed ventriculitis, while the other five were associated with a clinical diagnosis of ventriculitis. All EVDs placed in the ED were linked to ventriculitis, while four EVDs placed in both the neuro ICU and OR were also linked to ventriculitis. Among the EVDs associated with culture positive ventriculitis, three were used for intrathecal medication administration. The isolated pathogens in cultured confirmed ventriculitis include Enterobacter cloacae, Neisseria spp, Serratia marcescens, and non-ESBL Klebsiella aerogenes.
Conclusion: Insertion of multiple EVDs and EVD manipulation may be associated with the development of ventriculitis. Additionally, the number of bedside EVDs linked to ventriculitis may be similar to those placed in the operating room. However, further studies including patients who do not develop ventriculitis after EVD placement as a comparator are needed to assess the incidence of ventriculitis following bedside installation.
Moderators
AP
Presenters
avatar for Jordan Glasgow

Jordan Glasgow

PGY1 Pharmacy Resident, Wellstar Kennestone Regional Medical Center
My name is Jordan Glasgow, and I am a PGY1 Pharmacy Resident at Wellstar Kennestone Regional Medical Center in Marietta, GA. I completed my pharmacy education at the University of Georgia, and I recently matched to a PGY2 Emergency Medicine program with UCHealth and the University... Read More →
Evaluators
avatar for Robin Fischer

Robin Fischer

PGY1 Pharmacy Practice Resident, MRMC1McLeod Regional Medical CenterPGY1
Hello my name is Robin Fischer and I am one of the PGY1 pharmacy practice preceptors / mentors at McLeod Regional Medical Center. I am a retired deputy sheriff from Charleston County Sheriff's Office and I obtained a bachelor’s degree in Criminal Justice Administration. Once I retired... Read More →
Friday April 25, 2025 10:20am - 10:35am EDT
Athena I
  Critical Care/Emergency Medicine (CCM), Wellstar Kennestone Regional Medical Center
  • global Y

10:20am EDT

Evaluation of Pseudoephedrine as Adjunctive Therapy in Acute Spinal Cord Injuries
Friday April 25, 2025 10:20am - 10:35am EDT
Athena H
Title: Evaluation of Pseudoephedrine as Adjunctive Therapy in Acute Spinal Cord injuries


Authors: Gianna Antinone, Taylor Law, Amanda McKinney, Mary Massaro, John Gripentrog, Stephanie Scott, and A. Shaun Rowe


Objective: To evaluate the efficacy of pseudoephedrine as an adjunctive agent to IV vasopressors in acute spinal cord injuries 


Self Assessment Question: True/False: The addition of oral pseduoephedrine to IV vasopressors for MAP augmentation post-SCI resulted in a short duration of IV vasopressors.  Answer: False


Background: Spinal cord injury (SCI) is defined as acute traumatic damage to the spinal cord, resulting in temporary or permanent neurolgical damage. Neurogenic shock, defined as bradycardia and hypotension, is common within this population. The relative recommendation immediately after injury is to augment mean arterial pressure (MAP) to a goal of 85-90 mmHg for one week to adequately perfuse the spinal cord. Commonly used treatments for MAP augmentation include intravenous (IV) and oral vasopressors such as pseudoephedrine (PSE) and midodrine. This study evaluates the efficacy of pseudephedrine as an adjunctive agent to IV vasopressors in patients with acute spinal cord injuries. 


Methods: We performed a retrospective cohort study of trauma-surgical critical care patients at the University of Tennessee Medical Center from October 1, 2015, to January 1, 2024. Patients were included if 18 years of age and older, diagnosed with a spinal cord injury, and required IV vasopressor intiation upon admission to achieve a MAP goal > 85 mmHg for the first 5 days after injury. Patients were divided into two groups of either vasopressor monotherapy or vasopressor in combination with PSE to augment the goal MAP. The primary outcome of this study compared the time to IV vasopressor discontinuation between the two groups. Secondary outcomes included incidence of central line placement and duration, ICU and hospital length of stay, all-cause ICU and hospital mortality, successful discontinuation of IV vasopressors post-pseduoephedrine initiation, IV vasopressor re-initation within 24hrs of discontinuation, and incidence of bradycardia. 


Results: Among the 751 patients identified for inclusion, 201 patients met inclusion criteria, of which 136 patients received vasopressor monotherapy, whereas 65 patients received vasopressor plus adjunctive PSE to maintain MAP goals. The duration of IV vasopressors was 70 hours versus 106 hours in the adjunctive PSE group (p=0.0299). Central line placement, duration of central line placement, hospital and ICU length of stay, hospital mortality, and ICU mortality were similar between the two groups. 80.7% of patients has successful discontinuation of vasopressors once PSE was initated. The incidence of bradycardia was more prominent in the adjunctive PSE group (44.6%) compared to vasopressors alone (25.7%), p=0.0072. 


Conclusion: Although this study did not meet the primary outcome of reducting time to IV vasopressor discontinuation, this study demonstrated successful discontionuation of vasopressors post-PSE iniation in 80% of the study population who received PSE as adjunctive therapy. This study is limited by a small sample population and retrospective nature. 
Moderators
avatar for Maggie Goode

Maggie Goode

Critical Care Pharmacist, Mobile Infirmary Medical Center
.
Presenters
avatar for Gianna Antinone

Gianna Antinone

PGY2 Critical Care Pharmacy Resident, University of Tennessee Medical Center
Dr. Gianna Antinone grew up in Weirton, WV. She obtained her Doctorate of Pharmacy from West Virginia University in Morgantown, WV. After graduation, she completed a PGY1 Pharmacy Residency at Charleston Area Medical Center in Charleston, WV. Her clinical interests include critical... Read More →
Evaluators
MM
Friday April 25, 2025 10:20am - 10:35am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), University of Tennessee Medical Center
  • global Y

10:20am EDT

Clinical and Microbiologic Characteristics of Candida auris Isolates at Grady Health System
Friday April 25, 2025 10:20am - 10:35am EDT
Athena B
Title: Clinical and Microbiologic Characteristics of Candida auris Isolates at Grady Health System   
 
Authors: Saira Mirza, PharmD; Joseph Corbino, PharmD, MSc; Shreena Advani, PharmD; Joseph Torrisi, PharmD; Sheetal Kandiah, MD, MPH; Susan M. Ray, MD 
 
Objective: The objective of this study was to identify risk factors associated with increased mortality among admitted individuals with pathogenic cultures for Candida auris and assess sensitivities to currently recommended antifungal agents. 
 
Self-Assessment Question: What was a significant risk factor contributing to mortality in this study? 
 
Background: First isolated in 2009 from the ear canal of Japanese individuals, Candida auris has quickly emerged as an important pathogen of worldwide concern. C. auris, similar to other 
Presenters
SM
Evaluators
AS
avatar for Laura Schalliol

Laura Schalliol

Residency Program Director, South College School of Pharmacy
Friday April 25, 2025 10:20am - 10:35am EDT
Athena B
  Infectious Disease (ID), Grady Memorial Hospital
  • global Y

10:20am EDT

Impact of Guideline Implementation on Management of Long Bone Osteomyelitis
Friday April 25, 2025 10:20am - 10:35am EDT
Athena A
Title: Impact of Guideline Implementation on Management of Long Bone Osteomyelitis

Authors: Melat Endashaw, Jessica Howard-Anderson, Jesse Jacob, Trinh Vu, K. Ashley Jones

Purpose: This study aims to evaluate the impact of a standardized approach to managing osteomyelitis of long bones and foot on hospital length of stay, readmission rates, and antibiotic-related adverse events. The results of this study may support novel strategies for the treatment of complex bone infections.

Background: Standard treatment for osteomyelitis, including diabetic foot osteomyelitis (DFO), usually requires surgical intervention followed by prolonged courses of intravenous (IV) antimicrobials. Emerging evidence suggests that oral antimicrobials can effectively treat complex bone and joint infections, offering similar therapeutic outcomes while reducing cost and complications. The 2019 Oral Versus Intravenous Antibiotics (OVIVA) Trial demonstrated these findings, prompting changes in clinical practices at various institutions. Recently, the Infectious Diseases Society of America (IDSA) and International Working Group on the Diabetic Foot (IWGDF) published a guideline recommending oral therapies as acceptable treatments for patients with DFO and shorter treatment durations in certain cases. In August 2023, Emory University Hospital Midtown, an academic medical center in Atlanta, Georgia, implemented institutional guidance on osteomyelitis of long bones and foot, including DFO, that created OVIVA and IWGDF informed, standardized recommendations on the selection of empiric and pathogen-directed therapies with a focus on minimizing the need for IV antimicrobials and outpatient parenteral antimicrobial therapy (OPAT), while promoting oral therapy for stable patients after adequate source control. It also addresses the importance of multidisciplinary involvement to provide a clear framework for managing osteomyelitis of long bones and DFO, with the goal of streamlining and optimizing care for these patients.  

Methods: This is a single-center, retrospective study evaluates adult patients diagnosed with osteomyelitis of long bones, including DFO, who received antibiotic treatment. The study population were evaluated in two groups: patients treated prior to guideline implementation from October 1, 2022 to March 31, 2023 and patients treated after guideline implementation from February 1, 2024 to July 31, 2024. Exclusion criteria included patients with implanted hardware at the infection site, septic arthritis or native vertebral osteomyelitis, necrotizing or non-bacterial infection, blood cultures positive for Staphylococcus aureus or Staphylococcus lugdunensis, or concurrent invasive infection without sufficient evidence for use of oral antimicrobials (e.g., endocarditis, meningitis). Patients who underwent curative amputation without further intent to treat with antibiotics for osteomyelitis were also excluded. The primary outcome was hospital length of stay. Secondary outcomes include rates of readmission and antibiotic-related adverse events. Statistical analysis used rank-sum and chi-squared tests, with an alpha of 0.05 to determine statistical significance.

Results: Of the 545 patient charts reviewed, 98 met inclusion criteria (45 pre-implementation group and 53 post-implementation). Baseline characteristics were similar between groups. Notably, more patients were discharged on oral therapy in the post-implementation group compared to pre-implementation (64.2% vs. 53.3%, p=0.28). Median length of stay was similar in the pre- and post-implementation groups (13 days vs. 12 days; p=0.26). Readmission rates (37.3% vs. 48.8%, p=0.26) and antibiotic-related adverse events (25.5% vs. 37.2%, p=0.23) were lower post-implementation though not statistically significant.

Conclusion: The implementation of institutional guidance for the treatment of long bone osteomyelitis, including DFO, may improve patient outcomes such as hospital length of stay, readmission rates, and complications, though our study was limited with a small sample size.

Contact: melat.endashaw@emoryhealthcare.org
Moderators
BK

Brian Knott

Clinical Pharmacy Supervisor, AdventHealth Winter Park
Presenters
avatar for Melat Endashaw

Melat Endashaw

PGY1 Pharmacy Resident, Emory University Hospital Midtown
Melat Endashaw is a PGY1 Pharmacy Practice Resident at Emory University Hospital Midtown in Atlanta, Georgia. She earned her PharmD at the University of Georgia and will be starting a PGY2 residency in infectious diseases with Emory Healthcare this June.
Evaluators
CL
Friday April 25, 2025 10:20am - 10:35am EDT
Athena A
  Infectious Disease (ID), Emory University Hospital Midtown
  • global Y

10:20am EDT

Impact of Hyperglycemia Education on Blood Glucose Control
Friday April 25, 2025 10:20am - 10:35am EDT
Parthenon 1
Title: Impact of Hyperglycemia Education on Blood Glucose Control
Authors: Maegan Huebner, Kaitlyn Claybrook, Martina Goings, Danna Nelson 
Objective: To evaluate the impact of provider hyperglycemia management education at Baptist Medical Center South through its effect on inpatient glucose control. 
Background: Hyperglycemia in hospitalized patients, defined as a serum blood glucose level greater than 140 mg/dL, is a common occurrence in acutely ill patients. The American Diabetes Association (ADA) currently recommends the use of insulin as the preferred treatment for hyperglycemia in the inpatient setting. Basal or basal plus bolus regimens are preferred, while prolonged sliding scale as sole hyperglycemia treatment is not recommended. Recommendations for maintaining blood glucose less than 180 mg/dL and tailoring insulin regimens around patient enteral intake can improve outcomes, shorten patient length of stay, and reduce readmission rates. To increase adherence to ADA guidelines, physician groups including family medical residents, general medicine residents, and hospitalists from Baptist Medical Center South received a 30 minute interactive presentation on hyperglycemia management.
Methods: This is a retrospective chart review of pre and post physician education for patients who had an order for sliding scale insulin and a serum blood glucose level greater than 200 mg/dL. Patients excluded were those less than 19 years old, prisoners, patients with a singular increased blood glucose level, patients admitted for diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS), patients with an insulin pump, those requiring a continuous insulin infusion, and pregnancy. Pre-education data was collected and analyzed in June 2024 and post-education data was collected and analyzed in October 2024. Information collected on the selected patients included demographics, length of stay, ordering physician, blood glucose levels, hypoglycemia events, A1c, insulin regimens while hospitalized, and any other oral anti-diabetic medications used. 
Results: After randomization, a total of 40 pre-implementation patients and 75 post-implementation
patients were reviewed and included. For the pre-implementation group, the average length of stay was 14.01 days, 25% experienced a hypoglycemia event, and the average blood glucose was 189.7 mg/dL. The average starting dose for insulin glargine was 10 units per day. The amount of time blood glucose levels were >200 mg/dL was 39.8%. For the post-implementation group, the average length of stay was 17.03 days, 36% experienced a hypoglycemia event, and the average blood glucose was 176.2 mg/dL. The amount of time blood glucose levels were >200 mg/dL was 28.9%. The average starting dose for insulin glargine was 17 units per day. All patients had a sliding scale insulin order besides one patient in the post-implementation group. The most common sliding scale order was written for level 1. 
 
Conclusion: The post-implementation group demonstrated a reduction in the time blood glucose levels were greater than 200 mg/dL, but higher rates of hypoglycemia were also observed. These effects may have been impacted by differences among the study group numbers and patient demographics. The post-implementation group was observed to receive a higher average starting dose of insulin glargine. Providing guideline-based hyperglycemia education to physicians resulted in improved blood glucose control but did not significantly impact hospital length of stay.
 
Moderators
avatar for Matt Conley

Matt Conley

Pharmacy Informatics Specialist, AdventHealth
Presenters
MH

Maegan Huebner

PGY-1 Pharmacy Resident, Baptist Medical Center South
Maegan Huebner, PharmD is from Montgomery, AL and received her B.S in       Nutrition Wellness at Auburn University in 2020. She received her Doctor of    Pharmacy at Auburn University Harrison College of Pharmacy in 2024. She is a current resident at Baptist Medical Center... Read More →
Evaluators
EM
Friday April 25, 2025 10:20am - 10:35am EDT
Parthenon 1
  Internal Medicine (IM), Baptist Medical Center South
  • global Y

10:20am EDT

Vasopressor-Sparing Effects of Methylene Blue versus Hydroxocobalamin for Vasoplegic Syndrome Post-Cardiac Surgery
Friday April 25, 2025 10:20am - 10:35am EDT
Parthenon 2
Title: Vasopressor-Sparing Effects of Methylene Blue versus Hydroxocobalamin for Vasoplegic Syndrome Post-Cardiac Surgery

Authors: Cameron Garramone, Reena Patel, Michael Byers, Deidra Garrett

Objective: Compare vasopressor-sparing effects calculated using the vasoactive-inotropic score (VIS) after the administration of methylene blue or hydroxocobalamin for vasoplegic syndrome (VS) post-cardiac surgery.

Self-Assessment Question: What is the difference between methylene blue and hydroxocobalamin in vasopressor-sparing effects for vasoplegic syndrome post-cardiac surgery?

Background: VS is a life-threatening condition that occurs in 5% to 25% of patients undergoing cardiac surgery using cardiopulmonary bypass (CBP) with a mortality rate as high as 25%. The mainstay of managing VS is catecholamine vasopressors, such as epinephrine and norepinephrine. For VS refractory to vasopressors, second-line therapies such as methylene blue and hydroxocobalamin play a key role in its management. Several studies evaluated the use of these therapies and showed a significant decrease in vasopressor requirements and improvement in hemodynamic parameters. At Piedmont Atlanta Hospital, methylene blue is the initial choice for treating refractory VS unless contraindications, such as concomitant use of serotonergic drugs or those with glucose-6-phoshate dehydrogenase (G6PD) deficiency, are present. The VIS calculation, a commonly used tool in research settings, was utilized to objectively quantify the degree of vasopressor support required to maintain hemodynamic stability. Further research is warranted given the lack of direct comparator studies for treating VS using this scoring tool.

Methodology: This was a retrospective chart review of adult patients who underwent cardiac surgery and received either methylene blue or hydroxocobalamin for the treatment of VS between January 2022 and August 2024. Types of cardiac surgery included coronary artery bypass graft, heart valve procedures, left ventricular assist device implant, and heart transplantation. Patients were excluded if interventions were administered > 24 hours post-cardiac surgery, supported on extracorporeal membrane oxygenation (ECMO) prior to surgery, or received tocilizumab intraoperatively. The primary outcome was percent change in VIS from baseline to 24 hours after methylene blue or hydroxocobalamin administration. Secondary outcomes included percent change in VIS from baseline to each timepoint (1, 2, 6, and 12 hours), percent change in mean arterial pressure (MAP) from baseline to 24 hours, need for additional VS treatment (methylene blue or hydroxocobalamin [if not used initially] and angiotensin II), need for ECMO 24 hours post-cardiac surgery, and number of vasopressors discontinued at 6 hours. Clinical outcomes included length of stay from time of procedure and hospital mortality at 24 hours. Statistical analysis was completed using Wilcoxon Rank Sum or independent t-test and chi-square or Fischer’s exact test where appropriate. A p-value of < 0.05 was considered statistically significant.

Results: In the assessed cohort, 35 patients from each group were included for analysis. When comparing methylene blue to hydroxocobalamin, there was a statistically significant difference noted in the primary outcome of percent change in VIS from baseline to 24 hours (-46.4% vs -64.8%; p=0.027), and percent change in MAP from baseline to 24 hours (12.3% vs 22.2%; p=0.012). No statistical significance was found in need for additional VS treatment (40% vs 25.7%; p=0.203), need for ECMO 24 hours post-cardiac surgery (5.7% vs 11.3%; p=0.238), or number of vasopressors discontinued at 6 hours (22.9% vs 22.9%; p=1). The use of hydroxocobalamin had a numerically higher incidence of 2 or more vasopressors being discontinued at 6 hours (37.5% vs 75%; p=0.137), but not statistically significant. There was a statistically significant difference for percent change in VIS from baseline to 12 hours (-29.4% vs -51.9%; p=0.04), but not at 1 hour (-2% vs -13.6%; p=0.153), 2 hours (-7.3% vs -22.6%; p=0.061), or 6 hours (-22.8% vs -28%; p=0.401).

Conclusions: There was a statistically significant difference noted in the primary outcome as well as the secondary outcomes of percent change in VIS from baseline to 12 hours and percent change in MAP from baseline to 24 hours. However, there were no major differences noted in any other secondary outcomes or clinical outcomes. Study limitations included the retrospective design, small patient population, and non-standardized vasopressor weaning protocol. Prospective trials with a larger sample size are warranted in this population.
Moderators
BJ

Brook Jacobs

Clinical Coordinator, Critical Care Clinical Specialist, Emory Decatur Hospital
Presenters
avatar for Cameron Garramone

Cameron Garramone

PGY1 Pharmacy Resident, Piedmont Atlanta Hospital
Cameron is currently completing his PGY1 pharmacy residency training at Piedmont Atlanta Hospital in Atlanta, GA. He received his Doctor of Pharmacy degree at the University of Georgia. Upon completing his residency, he plans to stay on at Piedmont Atlanta and continue to work as... Read More →
Evaluators
EI
Friday April 25, 2025 10:20am - 10:35am EDT
Parthenon 2
  Internal Medicine (IM), Piedmont Atlanta Hospital
  • global Y

10:20am EDT

Assessment of Infusion Reaction Rates with Day 1 administration vs Day 5 Administration of Rituximab or biosimilars in Dose-adjusted R-EPOCH
Friday April 25, 2025 10:20am - 10:35am EDT
Olympia 2
Title: Assessment of Infusion Reaction Rates with Day 1 administration vs Day 5 Administration of Rituximab or biosimilars in Dose-adjusted R-EPOCH
Authors: Xiaoshan Chai, Elena Cukurs, Chynna Bambico, Sarah Gifford

Background
Infusion-related reactions (IRRs) are a significant concern with rituximab, especially when combined with cytotoxic chemotherapy, such as EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) for treating B-cell non-Hodgkin lymphomas. Rituximab, a monoclonal antibody targeting CD20 on B-cells, is known to elicit IRRs, including symptoms like fever, chills, and hypotension, particularly during the first infusion. Factors that increase the chance of developing IRRs include bulky disease with high tumor burden, increased cytokine release, and bone marrow involvement. The administration of rituximab for aggressive lymphomas with higher tumor burden further increases the risk of IRRs, necessitating vigilant supportive care to mitigate these reactions effectively. Management strategies involve premedication, titration of infusion rates, and monitoring. One approach to mitigate IRRs is by administering EPOCH first to debulk the tumor mass prior to introducing rituximab.  This study conducted a retrospective chart review to compare the incidences of infusion reactions in B-cell lymphomas patients who received rituximab on either day 1 (D1) or day 5 (D5) of   R-EPOCH from 2022 to 2024.

Methods
A retrospective chart review was conducted on patients over the age of 18 who had not previously received anti-CD20 monoclonal antibodies and had completed at least one cycle of R-EPOCH. Patient records were obtained from the electronic health records (EHR) systems of the oncology departments across sites at AdventHealth Central Florida Division. The primary outcome measured was the incidence of IRRs. Secondary outcomes included incidences of tumor lysis syndrome, types of IRRs, the maximum rate of rituximab infusion achieved, and the average time from the start of infusion to the onset of reactions.

Results
A total of eighty-three patients were included in the IRB-approved study, with 63 qualifying for primary analysis (11 in the D5 group and 52 in the D1 group). The primary endpoint revealed an incidence of IRR of 27.3% (3/11) in the D5 group and 30.8% (16/52) in the D1 group (P = 1). The most common type of infusion related reaction was hypotension in both groups. The median maximum infusion rate was 75 mL/hr in the D5 group and 100 mL/hr in the D1 group. The median time from infusion to the occurrence of IRRs was 110 minutes in the D5 group compared to 75 minutes in the D1 group.

Conclusion
We observed a similar rate of infusion-related reactions between groups. Further analysis will be necessary to confirm these findings and inform the optimal scheduling of rituximab administration within the R-EPOCH regimen.

Assessment Question
Based on the study's findings, which of the following statements best describes the impact of administering rituximab on Day 5 (D5) versus Day 1 (D1) in the R-EPOCH regimen regarding infusion-related reactions (IRRs)?
A. Patients in the D5 group experienced significantly fewer IRRs compared to the D1 group.
B. The incidence of IRRs was similar between the D1 and D5 groups
C. Rituximab infusion rates were lower in the D1 group compared to the D5 group, proving that early administration improves infusion tolerance
D. D1 rituximab administration resulted in less severe IRRs
Moderators
SC

Schylar Cheyenne Hathaway

Clinical Pharmacist
Special interest include Ambulatory Care and Women's Health.
Presenters
avatar for Xiaoshan Chai

Xiaoshan Chai

PGY1 Resident, AdventHealth Orlando
PGY1 resident at AdventHealth Orlando
Evaluators
avatar for Lacey Ioppolo

Lacey Ioppolo

PGY-1 RPD and Clinical Pharmacy Manager, Memorial Health University Medical Center
Lacey Ioppolo PharmD, BCCCP, is a Clinical Pharmacy Manager and PGY-1 Pharmacy Residency Program Director at Memorial Health University Medical Center in Savannah, GA. She obtained her Doctor of Pharmacy from The University of Florida in 2018 and completed her PGY-1 Pharmacy Residency... Read More →
Friday April 25, 2025 10:20am - 10:35am EDT
Olympia 2
  Oncology (ONC), AdventHealth Orlando
  • global Y

10:20am EDT

Utility of Clonidine Conversion to Prevent Dexmedetomidine Withdrawal Syndrome in Pediatric Patients
Friday April 25, 2025 10:20am - 10:35am EDT
Athena J
TITLE: Utility of Clonidine Conversion to Prevent Dexmedetomidine Withdrawal Syndrome in Pediatric Patients
 
AUTHORS: Emily Hardy, Andrea Gerwin, Renee Hughes, Paige Klingborg 
 
BACKGROUND: In 2022, the Society of Critical Care Medicine (SCCM) issued a guideline recommending alpha-2 receptor agonists as the preferred class for sedation in critically ill pediatric patients. Amidst emerging concern regarding potential dexmedetomidine withdrawal in this population, recent evidence has supported the use of clonidine, another alpha-2 agonist, as a bridging agent to mitigate or prevent withdrawal. While some institutions may have implemented the use of clonidine in dexmedetomidine weaning, there is no consensus or validated protocol. This study aimed to examine the relationship between cumulative dexmedetomidine exposure and clonidine requirements and will expand upon a previous analysis at the study site that focused on a period prior to the SCCM guideline update.  

METHODS: This IRB-approved, single center, retrospective observational study focused on patients admitted to the PICU from January 2018 to May 2024. Inclusion criteria included receipt of a continuous dexmedetomidine infusion > 24 hours and enteral clonidine for treatment or prevention of dexmedetomidine withdrawal. Patients were excluded if they used clonidine prior to admission or if clonidine was initiated for an alternate indication. Included patients were divided into two groups – a non-escalation and an escalation group – based on whether the patient received an increase in their clonidine dose (at provider discretion). The primary outcome assessed the relationship between cumulative dexmedetomidine exposure and maximum required clonidine dose. Secondary outcomes included dexmedetomidine withdrawal assessment, rate of clonidine failure following initial clonidine dose, hospital and ICU length of stay, ventilator days, central line days, and incidence of tracheostomy placement.
 
RESULTS: Compared to the non-escalation group, the escalation group had a statistically significant increase in duration of dexmedetomidine (346.4 vs 284.3, p-value=0.0114) and increased cumulative dexmedetomidine dose (341.2 vs 230.8, p-value=0.0128). The difference in initial clonidine dose was not significant (5.7 vs 4.9, p-value=0.7928). The escalation group had a statistically significant increase in hospital LOS (36 vs 27.5, p-value=0.0355) and ICU LOS (27 vs 20.5, p-value=0.0426). There was no statistically significant difference in ventilator days, CVL days, or incidence of tracheostomy.  
 
CONCLUSION: Higher cumulative dexmedetomidine exposure is associated with higher clonidine dose requirements. Both hospital and ICU LOS were significantly decreased in patients who did not require an increase in their clonidine dose. Utilizing cumulative dexmedetomidine exposure to determine initial clonidine dose may be beneficial.
Moderators
CN

Candace Nichols

Clinical Pharmacy Specialist, Kaiser Permanente
Presenters
avatar for Emily Hardy

Emily Hardy

PGY1 Pharmacy Resident, Erlanger
Erlanger PGY1 Pharmacy Resident
Friday April 25, 2025 10:20am - 10:35am EDT
Athena J
  Pediatric (PED), Erlanger Health System
  • global Y

10:40am EDT

Evaluation of Blood Glucose Goal of 110-150 mg/dL in Cardiovascular Intensive Care Patients
Friday April 25, 2025 10:40am - 10:55am EDT
Olympia 1
Title: Evaluation of Blood Glucose Goal of 110-150 mg/dL in Cardiovascular Intensive Care Patients 
Authors: Joy Dahlen, Jessica Odom, Carly Sisk, Benjamin Gustafson, Alex Ewing, Lyndsay Gormley 
Objective: To determine if a target blood glucose range of 110-150 mg/dL after cardiac surgery resulted in a difference in hypoglycemia incidence compared to previous goal ranges
Background: Hyperglycemia is common in patients, with and without diabetes, who have undergone cardiac surgeries such as coronary artery bypass grafting (CABG) and is associated with many adverse outcomes including increased risk of infection, longer hospital length of stay, and increased risk of mortality. Avoiding hyperglycemia after cardiac surgery mitigates these complications.  However, there is controversy over the ideal goal blood glucose range for patients after cardiac surgery. 
Methods: This multi-center, pre- and post-interventional, retrospective cohort study evaluated patients undergoing cardiac surgery utilizing the new Prisma Health cardiac insulin drip with a goal blood glucose of 110-150 mg/dL (moderate) compared to previous goals of 100-140 mg/dL (low) or 120-160 mg/dL (high). Patients were identified based on a surgical report for all cardiac surgeries and then randomized to include a total of 200 patients, divided into four groups of 50 (two pre-intervention and two post-intervention groups from two institutions. Patients were included in the study if aged 18 years or older, underwent cardiac surgery, and received an insulin drip. Patients were excluded from the study if they were placed on extracorporeal membrane oxygenation (ECMO), died in the operating room, or had an open chest post-surgery. The primary outcome was incidence of hypoglycemic events (<70 mg/dL) per 1000 ICU days. Secondary outcomes included: incidence of severe hypo- and hyperglycemic events per 1000 ICU days, incidence of sternal wound infection and positive blood cultures, and 30-day mortality.  
Results: A total of 200 patients were screened for inclusion, and 182 patients were included in the study. The primary outcome of incidence of hypoglycemia <70 mg/dL was significantly lower between pre- and post- intervention group for Site A, increasing the goal from low 100-140 mg/dL to moderate 110-150 mg/dL (317.46 events per 1000 ICU days in the pre-group vs. 138.25 in the post-group, p=0.0006). There was not a significant difference in hypoglycemic events in the pre- and post-intervention groups for Site B, decreasing the goal from high 120-160 mg/dL to moderate 110-150 mg/dL (13.47 events per 1000 ICU days in the pre-group vs. 20 events per 1000 ICU days in the post-group, p=0.56). There were no significant increases in incidence of sternal wound infection, positive blood cultures, or morality from the moderate goal. 
Conclusions: A blood glucose goal of 110-150 mg/dL resulted in significantly lower incidence of hypoglycemic events (<70 mg/dL) compared to a blood glucose goal of 100-140 mg/dL. A blood glucose goal of 110-150 mg/dL did not significantly increase incidence of hypoglycemic events compared to a goal of 120-160 mg/dL. 

Self-assessment question: Which of the following post-operative goal glucose ranges had the highest incidence of hypoglycemia?
Moderators
SS
Presenters
avatar for Joy Dahlen

Joy Dahlen

Pharmacy Resident, Prisma Health
Current PGY1 Acute Care Resident at Prisma Health Upstate, originally from North Dakota, pursuing a PGY2 in Healthcare Administration and Leadership 
Evaluators
DK
Friday April 25, 2025 10:40am - 10:55am EDT
Olympia 1
  Administration (ADM), Prisma Health-Upstate
  • global Y

10:40am EDT

A Dose of Change: Advancing Buprenorphine Induction Practices in the ED
Friday April 25, 2025 10:40am - 10:55am EDT
Athena C
Title: A Dose of Change: Advancing Buprenorphine Induction Practices in the ED
Authors: Samantha Keen, Rebecca Maloney
Objective:  Final pending
Self Assessment Question: Final pending
Background: 
Opioid use disorder (OUD) continues to be one of the most pressing public health crises in the United States, claiming thousands of lives each year through overdose and contributing to a wide range of social, health, and economic burdens. Emergency departments (EDs) often serve as critical initial points of care for veterans in acute opioid-related crises, yet many leave without access to evidence-based treatment. This initiative aims to improve care quality by implementing standardized buprenorphine induction protocols in the ED, focusing on reducing barriers to treatment initiation and facilitating transitions to outpatient care. Despite the strong evidence and growing support for buprenorphine induction in the ED, our facility does not currently offer this service to veterans presenting with OUD. This gap in care is significant, as veterans who come to the ED for issues related to opioid use often leave without being connected to ongoing treatment, leading to continued cycles of misuse and repeated ED visits. Implementing standard buprenorphine induction protocols in the ED would help bridge this gap, providing veterans with immediate access to life-saving treatment and significantly improving their chances of long-term recovery.  By addressing logistical challenges, enhancing care coordination, and fostering staff engagement, the project seeks to improve patient outcomes, reduce ED recidivism, and promote continuity of care for veterans with OUD.
Methods: 
This prospective interventional cohort study will be conducted in the emergency department at the James H Quillen VA Medical Center.  The study will consist of two phases: a baseline period (pre-implementation) and an intervention period (post-implementation).  During the baseline period, data will be collected retrospectively on patients presenting with OUD to the ED and treated with standard care.  During the intervention period, a buprenorphine induction protocol with an order set will be implemented.  Education on appropriate use of the protocol will be provided to the ED mental health providers.  This intervention will be implemented as part of standard of care treatment for this quality improvement project.  Following implementation and education, this intervention will be considered standard of care for management of OUD in the ED.  Data collection for both phases will include the number of patients screened, buprenorphine inductions performed, and rates of successful outpatient referrals.   Following evaluation of the data collected, continuous monitoring of outcomes and quality metrics will occur.   Outcomes measured will be the number of patients who receive a buprenorphine prescription through the ED and referrals the SUD clinic.  
Results: In progress
Conclusions: In progress
Moderators
avatar for Devin Lavender

Devin Lavender

Clinical Assistant Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2
Ambulatory Care, Scholarship of Teaching and Learning, Resident and Student Development.
Presenters
avatar for Samantha Keen

Samantha Keen

PGY1 Pharmacy Resident, James H Quillen VA Medical Center
Dr. Samantha Keen grew up in in Southwest Virginia where she attended Southwest Virginia Community College and received an Associates of Science degree. She then moved to Johnson City, TN in 2020 to attend East Tennessee State University where she earned a Bachelor of Pharmaceutical... Read More →
Evaluators
CW

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, Kaiser Permanente Georgia
Friday April 25, 2025 10:40am - 10:55am EDT
Athena C
  Ambulatory Care (AMB), VA - Mountain Home, TN - James H. Quillen VA Medical Center
  • global Y

10:40am EDT

Analyzing the implementation of a remote, pharmacist-managed hypertension clinic for veterans
Friday April 25, 2025 10:40am - 10:55am EDT
Athena D
PURPOSE:
Recognizing that veterans have a higher prevalence of cardiovascular disease (CVD) and CVD-related mortality than the general population, there is a need to manage risk factors, including blood pressure. Over 70% of patients within the Veterans Affairs healthcare system have hypertension (HTN), but less than 33% have controlled blood pressure. To address the issue of uncontrolled blood pressure and reduce CVD risk, a remote, population health-based, pharmacist-managed quality improvement HTN management service was implemented at a rural Veterans Affairs clinic. This project aims to evaluate the implementation of the service.
 
METHODS:
This retrospective study evaluated the implementation of the pharmacist-managed HTN clinic using the RE-AIM implementation science framework, a five-domain model designed to assess the impact and implementation of health interventions. The domains of reach, effectiveness, and implementation were evaluated. Reach outcomes included the demographics of veterans who participated in the clinic. Effectiveness outcomes were collected at three months and the most recent visit. Outcomes included changes in baseline blood pressure and home monitoring, the percentage of veterans whose blood pressure was controlled,  and the number and types of interventions completed. Implementation outcomes include the average number of patient visits, percentage of eligible patients completing at least one visit, average number of completed visits, number of unsuccessful visit attempts, percentage of calls successfully completed, and number and types of barriers to blood pressure management.
 
RESULTS:
In progress
 
CONCLUSION:
In progress
Moderators
avatar for Ashley Woodhouse

Ashley Woodhouse

SJCH2St. Joseph's/Candler Health System (Ambulatory)PGY2
Presenters
avatar for Carlos Salgado

Carlos Salgado

PGY1 Resident Pharmacist, Auburn University Clinical Health Services
Dr. Carlos Salgado received a bachelor of science in pharmaceutical sciences from the University of Tennessee in 2022 and went on to complete his Pharm.D. at Tennessee in 2024. He began his career in pharmacy as a pharmacy technician with Kroger, advancing to senior technician and... Read More →
Evaluators
avatar for Anne Warren
Friday April 25, 2025 10:40am - 10:55am EDT
Athena D
  Ambulatory Care (AMB), Auburn University Clinical Health Services

10:40am EDT

Evaluation of a heparin calculator best practice alert (BPA) implementation at a multi-hospital health system
Friday April 25, 2025 10:40am - 10:55am EDT
Athena B
Title: Evaluation of a heparin calculator best practice alert (BPA) implementation at a multi-hospital health system 
Authors: Brittaney-Ann Simpson, Kirsten DiPiro, Ambra Hannah, Jerri Jenkins  
Objective: Describe the use of a heparin infusion calculator dose mismatch Best Practice Alert (BPA) within a health system  
Self Assessment Question:
Background: The electronic heparin calculator has demonstrated benefits in reducing medication errors by minimizing manual calculations in the hospital setting. At Wellstar Health System, heparin infusion initiation and maintenance follow a nurse-driven protocol.  This study evaluated the effectiveness of the heparin infusion calculator dose mismatch Best Practice Alert (BPA) in improving adherence to the heparin calculator and its impact on correct dosing and therapeutic efficacy.  
Methods: A multicenter retrospective chart review was conducted analyzing adult patients who received a heparin infusion 90 days before BPA implementation (May 24, 2023 to August 22, 2023) and 90 days after (October 1, 2023 to December 30, 2023).  Patients were included if they exceeded the maximum starting dose requiring a weight-based heparin infusion adjustment (weight >83.3 kg on low/neuro dose heparin and >125 kg on high dose heparin). Patients were excluded if the heparin infusion was initiated in a procedural area, ordered outside of the heparin order sets, restarted after interruption, or continued on Xa monitoring after receiving a direct oral anticoagulant within 72 hours of heparin initiation. Additionally, patients were excluded from therapeutic efficacy calculations and safety measures if the heparin infusion was less than 24 hours. The primary outcome was to evaluate the impact of the BPA on adherence to heparin calculator weight-based dosing on initiation of a heparin infusion. The secondary outcome evaluated the time to therapeutic heparin levels while safety outcomes assessed major and minor bleeding events. 
Results: A total of 212 patients were included in each study arm. Between both study groups, the majority of patients received low-dose heparin (82%), with acute coronary syndromes being the most common indication (41.7%). The BPA was triggered 33 times in the post-implementation cohort, with an acceptance rate of 84.8% (28 cases). Incorrect initial heparin rates were significantly lower in the post-BPA group at 2.5% (n=5) compared to 6.8% (n=13) in the pre-BPA group (P=0.008). For secondary outcomes, the mean time to achieve the second therapeutic level was similar between groups (27 hours; P=0.53). There was no statistically significant difference in major and minor bleeding events (P=1.0 and P=0.49, respectively).
Conclusions: Implementation of the heparin calculator BPA was associated with improved compliance with starting the correct infusion rate for patients that exceeded the max rate based on weight.  No correlation was observed between heparin calculator compliance and the time to therapeutic levels or bleeding events. Further studies are needed to assess the BPA’s impact on heparin infusion rate adjustments over time.
Presenters
avatar for Brittaney-Ann Simpson

Brittaney-Ann Simpson

PGY1 Pharmacy Resident, Wellstar Kennestone Regional Medical Center
I am a PGY1 pharmacy resident at Wellstar Kennestone Regional Medical Center in Marietta, GA. I completed pharmacy school at Union University. My current interests include pain management, ambulatory care, and internal medicine. Outside of pharmacy, I enjoy traveling and spending... Read More →
Evaluators
AS
avatar for Laura Schalliol

Laura Schalliol

Residency Program Director, South College School of Pharmacy
Friday April 25, 2025 10:40am - 10:55am EDT
Athena B
  Cardiology (CAR), Wellstar Kennestone Regional Medical Center
  • global Y

10:40am EDT

Evaluating the Use of Angiotensin II vs. Methylene Blue in the Management of Refractory Distributive Shock in Patients with Liver Failure
Friday April 25, 2025 10:40am - 10:55am EDT
Athena G
Title: Evaluating the Use of Angiotensin II vs. Methylene Blue in the Management of Refractory Distributive Shock in Patients with Liver Failure  
Authors: Kaanan Shah, Marion Javellana, Peter Moran, Kendall Huntt, Alley Killian  
Background: Angiotensin II (AGII) and methylene blue (MB) are agents used in the management of refractory shock as adjunctive agents, typically in combination with catecholamines, vasopressin, and/or corticosteroids. However, many studies have excluded patients with liver failure. In liver failure, patients experience a high cardiac output and low systemic vascular resistance causing hypotension. These agents are thought to be beneficial in this setting as AGII activates angiotensin type 1 receptors thus increasing blood pressure and systemic vascular resistance and MB disrupts the cGMP signaling pathway leading to vasoconstriction. The purpose of this study is to compare the efficacy of AGII and MB in refractory shock in patients with liver failure.  
Methods: The institutional review board approved this single center, retrospective chart review study. Patients over the age of 18 that received AGII for at least 3 hours or a bolus dose of at least 1 mg/kg and/or a continuous infusion of MB between October 1, 2022 through September 16, 2024 were included. Patients were excluded if they had no documented liver failure, were pregnant, had active internal bleeding or cardiogenic shock, received intraoperative administration of the study agents or MB as an antidote. The primary outcome is the improvement of shock defined as a percent decrease in catecholamine and vasopressin requirement 3 hours after administration of the study agent based on norepinephrine equivalence. Secondary outcomes include percent decrease in catecholamine and vasopressin requirements at the 1-, 8-, and 24-hour marks post-initiation of the study agents, liberation from vasopressors, adverse events, length of ICU stay, and incidence of ICU mortality. Data from the primary and secondary outcomes were analyzed using intention-to-treat and continuous data was compared using the student t-test or Mann-Whitney U test to determine statistical significance.   
Results: Twenty-four patients were included, with five patients in the AGII group and 19 patients in the MB group. Vasopressor requirements decreased at the 3-hour mark after MB but increased after AGII, though not a statistically significant difference (-11.7 vs. +11.3; p = 0.783). Only 18 patients in the MB group and 4 patients in the AGII group survived to the 8-hour mark and there was an increase in NE equivalence with both MB and AGII (+ 9.9 vs. + 38.3; p = 0.731). Additionally, only 15 patients in the MB group and 3 patients in the AGII group survived to the 24-hour mark and patients in the MB group saw a decrease in NE equivalence while patients in the AGII group saw an increase (-15.1 vs. +71.8; p = 0.331). Mortality in the 94.7% in the MB group and 80% in the AGII group. One patient in each group was successfully liberated from vasopressors.     
Conclusions: AGII and MB are agents used to treat refractory shock. This study demonstrated MB’s potential benefit, compared to AGII, in managing shock in patients with liver failure with an initial reduction in vasopressor requirements. The lack of sustained response to the study agents could potentially be explained by the severity of hepatic dysfunction and associated vasodilatory shock. The two patients who were liberated from vasopressors received liver transplants. Limitations of this study include a small and unequal patient population, the retrospective, single-center nature of the study, and its local applicability. This highlights a need for further research on these agents in the management of shock in patients with liver failure in order to find a beneficial place in therapy for them.  

Presenters
avatar for Kaanan Shah

Kaanan Shah

PGY1 Pharmacy Resident, Emory University Hospital
Dr. Kaanan Shah is a current PGY1 Pharmacy Resident at Emory University Hospital. She received her Bachelors of Science in Biology from the University of Houston and her Doctor of Pharmacy from the University of North Texas Health Science Center College of Pharmacy in Fort Worth... Read More →
Evaluators
avatar for Blake Johnson
MH
Friday April 25, 2025 10:40am - 10:55am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Emory University Hospital
  • global Y

10:40am EDT

Incidence and outcomes of positive urine drug screen in neurocritical care
Friday April 25, 2025 10:40am - 10:55am EDT
Athena I
Title: Incidence and outcomes of positive urine drug screen in neurocritical care 
Authors: Siavash Panahi, Morgan Daniel, Sam Pournezhad, Katleen Chester
Objective: To assess the incidence and clinical outcomes associated with positive UDS results in patients admitted to the neurocritical care unit (NCCU) of a large, urban, academic medical center.
Self Assessment Question: Is the incidence higher or lower than Medical and Surgical ICU?
Background: Substance use disorder (SUD) remains a major public health concern, affecting approximately 20.4 million individuals in the United States. Various substances, including amphetamines (AMP), fentanyl, opiates, cannabinoids (CBD), cocaine, benzodiazepines (BZDs), barbiturates (BAR), and methadone, exert significant effects on the central nervous system. Urine drug screening (UDS) is commonly used in hospitalized patients to detect these substances or their metabolites. While previous studies have evaluated the impact of positive UDS results in medical and surgical intensive care units (ICUs), limited data exist on the influence of positive UDS findings on neurocritical care unit (NCCU) admissions and patient outcomes. The objective of this study is to assess the incidence and clinical outcomes associated with positive UDS results in patients admitted to the NCCU of a large, urban, academic medical center.
Methods: This retrospective review analyzed NCCU admissions at Grady Memorial Hospital from January 2016 to December 2023. The study included all NCCU patients with at least one UDS result, considering only the first UDS per encounter. Patients were excluded if they received any dose of the listed substances after hospital arrival and before UDS sample collection. The primary outcome was the incidence of positive UDS results. Secondary outcomes included hospital length of stay (LOS), ICU LOS, the incidence of positive results for each substance, prevalence of single-substance versus multi-substance use, opioid exposure via morphine milligram equivalents (MME), and mortality rates.
Results: Among the 2,430 NCCU encounters, 46% (n = 1,116) were associated with a positive UDS result. Of these, 70% (n = 779) were positive for a single substance, while 30% (n = 367) indicated multi-substance use. The most frequently detected substances were BZDs (19.5%), fentanyl (13.5%), and cannabinoids (11.9%). Patients with positive UDS results had a significantly higher median hospital LOS (7 days [IQR: 3–16] vs. 6 days [IQR: 3–14], p = 0.003), while ICU LOS was slightly longer but not statistically significant (3.3 days [IQR: 1.6–7.9] vs. 2.9 days [IQR: 1.5–6.9], p = 0.09). Patients with positive UDS results demonstrated significantly higher opioid exposure during admission, with median MME levels of 378.75 (IQR: 59–2250) compared to 120.75 (IQR: 18–1098) in UDS-negative patients (p < 0.001). Substances associated with significantly higher MME included amphetamines, barbiturates, BZDs, cannabinoids, methadone, and opiates (p < 0.05 for all), whereas cocaine and fentanyl did not show statistically significant differences. Overall mortality did not significantly differ between UDS-positive and UDS-negative patients (21.2% vs. 19.9%, p = 0.46). However, subgroup analysis revealed significantly higher mortality rates among patients testing positive for cocaine (26.9%, p = 0.044) and BZDs (28.6%, p = 0.00013), while other substances did not show statistically significant differences.
Conclusion: This study highlights a high prevalence of substance use among NCCU patients, with BZDs, fentanyl, and CBD being the most frequently detected substances. Positive UDS results were associated with prolonged hospital LOS and higher opioid exposure. Additionally, patients testing positive for cocaine and BZDs exhibited significantly higher mortality rates, underscoring the need for targeted interventions in this population. These findings emphasize the impact of substance use on neurocritical care outcomes and the importance of optimizing management strategies for affected patient.
Moderators
AP
Presenters
avatar for Siavash Panahi
SP

Siavash Panahi

PGY-1 Pharmacy Resident, Grady Health System
I am one of Grady's PGY-1 pharmacy residents and I will be the toxicology fellow next year at Georgia Poison Center. 
Evaluators
avatar for Robin Fischer

Robin Fischer

PGY1 Pharmacy Practice Resident, MRMC1McLeod Regional Medical CenterPGY1
Hello my name is Robin Fischer and I am one of the PGY1 pharmacy practice preceptors / mentors at McLeod Regional Medical Center. I am a retired deputy sheriff from Charleston County Sheriff's Office and I obtained a bachelor’s degree in Criminal Justice Administration. Once I retired... Read More →
Friday April 25, 2025 10:40am - 10:55am EDT
Athena I
  Critical Care/Emergency Medicine (CCM), Grady Memorial Hospital
  • global Y

10:40am EDT

Valproic Acid Augmentation in Traumatic Brain Injury Related Agitation
Friday April 25, 2025 10:40am - 10:55am EDT
Athena H
  1. Title: Valproic Acid Augmentation in Traumatic Brain Injury Related Agitation
  2. Authors: Michelle Allsup, Peterson Worrell
  3. Background: Traumatic brain injuries (TBIs) are a prevalent issue with many patients experiencing cognitive/behavioral symptoms such as agitation, impulsiveness, and irritability. TBIs were defined as subdural hematoma, subarachnoid hematoma, skull fractures, and cerebral contusion given that it was caused by a traumatic event, such as a fall or motor vehicular collision. The purpose of this study is to identify if valproic acid (VPA) augmentation has a significant difference in these patients’ agitation.
  4. Methods: This retrospective, observational, cohort study included adult trauma patients admitted to the hospital diagnosed with TBI, and initiated on of VPA and/or quetiapine for agitation. Patients were excluded if they pregnant, incarcerated, and taking any of the following prior to admission – antipsychotics, mood stabilizers, or VPA. These patients were individually chart reviewed from July 31, 2024 to January 31, 2025. The primary outcome was the time to documented resolution, in days, of agitation and the length of time until dose reductions occurred. The secondary outcomes are the incidence of adverse drug reactions (ADR) and the incidence of valproic acid discontinuation due to an ADR or persistent ADRs. As needed medications were also evaluated prior to VPA initiation and after VPA initiation.
  5. Results: A total of 8 patients were included in this IRB-approved study. The included patients were then split amongst themselves to examine the before VPA initiation and after VPA initiation. The primary outcome of time to documented resolution of agitation in the pre-VPA time period was a median of 0 days and in the post-VPA time period was 1.5 days. The length of time until dose reductions occurred in the pre-VPA time period was 0 days with quetiapine and in the post-VPA time period was 3.5 days with quetiapine and 0 days with VPA. There were no documented adverse events and no discontinuations due to ADRs. There was a total of 36 doses of as needed medications (haloperidol or lorazepam) given 72 hours prior to VPA initiation and a total of 20 doses of as needed medications given 72 hours after VPA initiation.
  6. Conclusion: We observed that VPA may reduce agitation in patients post-TBI whose agitation was not controlled on quetiapine alone. We found that there were more frequent dose reductions of quetiapine on discharge. There was less use of as needed medications after VPA initiation than prior to VPA initiation. A larger sample size is needed to determine if valproic acid decreases agitation in TBI patients. This should be conducted in a multicenter, prospective, randomized controlled study. This will aid in fully evaluating the benefit of VPA for agitation in patients post-TBI.


Contact: Michelle Allsup at michelle.allsup@hcahealthcare.com with any questions.
Moderators
avatar for Maggie Goode

Maggie Goode

Critical Care Pharmacist, Mobile Infirmary Medical Center
.
Presenters
avatar for Michelle Allsup

Michelle Allsup

PGY-1 Pharmacy Resident at Memorial Health University Medical Center, michelle.r.allsup@gmail.com
PGY-1 pharmacy resident at Memorial Health University Medical Center in Savannah, Georgia. I am from St. Augustine, Florida. I graduated from Auburn University Harrison College of Pharmacy in May 2024. I graduated from Auburn University with a bachelors of science in biomedical sciences... Read More →
Evaluators
MM
Friday April 25, 2025 10:40am - 10:55am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Memorial Health University Medical Center
  • global Y

10:40am EDT

Real World Comparison of Intravenous versus Oral Antimicrobial Therapy for Bone and Joint Infections
Friday April 25, 2025 10:40am - 10:55am EDT
Athena A
Title: Real World Comparison of Intravenous versus Oral Antimicrobial Therapy for Bone and Joint Infections
Authors: Maura Kreiser, Sarah Al Mansi, Ismael Yunusa, Caroline Derrick, P. Brandon Bookstaver, Majdi N. Al-Hasan, Yorika Hammett, Morgan Pizzuti
Background: Outpatient Parenteral Antimicrobial Therapy (OPAT) has expanded significantly over the past few decades, driven by its clinical efficacy and cost-effectiveness. A landmark study in this field, the OVIVA trial (Oral versus Intravenous Antibiotics for Bone and Joint Infection), demonstrated the non-inferiority of oral antimicrobials compared to intravenous (IV) therapy for treating bone and joint infections. However, OVIVA was conducted before the widespread use of certain long-acting injectables or highly bioavailable antimicrobials, such as dalbavancin and linezolid, respectively, which are now commonly used for prolonged treatment durations. Since OVIVA, there has been increased comfort with prescribing oral antimicrobials for bone and joint infections, yet real-world prescribing patterns and outcomes remain understudied. This study aims to evaluate local, real-world use of IV versus oral antimicrobials in bone and joint infections and assess treatment and logistic failure rates.
Methods: This retrospective cohort study included adult patients with a bone and/or joint infection admitted to and discharged from one of four study locations. Patients were eligible if they had an infectious diseases consultation between January 2023 and August 2024 that outlined at least 4 weeks of planned antimicrobial therapy. The primary outcome was treatment failure within one year of active antimicrobial treatment, defined as provider-determined treatment failure, microbiologic recurrence, hospital readmission, radiologic or operative evidence of persistent or worsening infection, mortality, or antimicrobial changes due to adverse events or intolerance. Secondary outcomes included logistic failure rates and risk factors for treatment and logistic failure. The primary outcome was assessed using Cox regression, while secondary outcomes were analyzed using both descriptive statistics and logistic regression.
Results: In Progress
Conclusions: In Progress
Moderators
BK

Brian Knott

Clinical Pharmacy Supervisor, AdventHealth Winter Park
Presenters
avatar for Maura Kreiser

Maura Kreiser

PGY2 Infectious Diseases Pharmacy Resident, Prisma Health Richland Hospital - University of South Carolina
Maura is currently a PGY2 Infectious Diseases Pharmacy Resident at Prisma Health Richland Hospital. She completed her PGY1 Acute Care Residency at Prisma Health Richland Hospital, and PharmD at UNC Eshelman School of Pharmacy. 
Evaluators
CL
Friday April 25, 2025 10:40am - 10:55am EDT
Athena A
  Infectious Disease (ID), Prisma Health Richland - University of South Carolina
  • global Y

10:40am EDT

Transitioning RFID Medication Tray Solutions: A Nine-Hospital Network Implementation
Friday April 25, 2025 10:40am - 10:55am EDT
Athena J
Title: Transitioning RFID Medication Tray Solutions: A Nine-Hospital Network Implementation
Authors: Nina Desai, PharmD.; Hiren Shah, PharmD., BCPS; Craig MacDonald, PharmD.
Objective: To address the conversion between RFID systems and the challenges that arise during this process.
Self Assessment Question: True or False. Vendors will always be able to transfer currently tagged products to a new system during a vendor conversion. 
Background:
RFID (radio-frequency identification) in pharmacy enhances the accuracy and efficiency of medication management. By tagging medications with RFID, pharmacies can automate the tracking process and reduce human error. AdventHealth utilizes RFID technology for code trays and anesthesia station trays. Trays and medications are equipped with RFID tags containing unique identifiers for precise tracking and inventory control. The goal of the system is to monitor tray and medication inventory and notify staff when items are nearing expiration or trays need restocking.
AdventHealth is in the process of transitioning vendors for RFID tray solutions. The key benefit of System B is the ability to purchase pre-tagged items directly from AdventHealth’s established wholesaler.
During a brand-new RFID go live a drug library would be built and the items required in the pharmacy would be tagged and entered into the system. With a conversion the existing information and tagged products would ideally be transferable to the new system, removing potential work and redundant inventory. While most published information focuses on implementing new RFID system, this presentation addresses the conversion between RFID systems and the challenges that arise during this process.
Methods: 
AdventHealth’s Central Florida Division is transitioning from System A to System B in a structured three-phase approach. Each phase includes three hospitals and phase three includes sites using mobile solutions for anesthesia-station trays, including the 1,366-bed flagship hospital. The conversion is led by the pharmacy informatics team, vendor representatives and local pharmacy leadership.
System A was not able to transfer existing drug registry information into System B, requiring a conversion process for existing tagged inventory. The preparation of tagged items for the conversion involved commissioning medications previously tagged in System A, purchasing pre-tagged items from the wholesaler, and newly tagging items by the pharmacy.
An action plan was developed for the six weeks preceding the go-live. The first two weeks were spent gathering and preparing tray, NDC, user, and site data. The next week was dedicated to training users, with each site completing buyer, superuser, and general staff training. The following three weeks focused on commissioning to ensure tagged medication was available during go-live. Additionally, sites were encouraged to purchase additional inventory pre-tagged through the wholesaler associated with System B. The existing tagged inventory was separated by lot and commissioned, with daily tracking of commissioned items.
These commissioning weeks provided enough items to reach the project milestones (three-tiered progression):
  1. Completed at least one of each tray template.
  2. Completed at least three of each tray template.
  3. Completed high-priority trays.
Results:
Phase one was completed in December 2024, and phase two will finish by mid-March 2025. The team initially faced a steep learning curve, including commissioning bottlenecks. During some commissioning steps, we are limited to a single System B kiosk, which caused significant bottlenecks. For reference, a smaller site with nearly 200 beds has an inventory of nearly 3,000 tagged items in System A that needed to be commissioned into system B.
The action plan was adjusted after each go-live, leading to significant improvements in preparation and execution. As the flagship hospital transitions to a mobile solution in phase three, the plan will continue to evolve.
Conclusion: In progress
Moderators
CN

Candace Nichols

Clinical Pharmacy Specialist, Kaiser Permanente
Presenters
avatar for Nina Desai

Nina Desai

PGY2 Informatics Pharmacy Resident, AdventHealth
I am currently on my second year of my PGY 1/2 Pharmacy Informatics Residency at AdventHealth in Orlando, Florida and a graduate from the University of Florida College of Pharmacy in Gainesville, Florida. My goal is to utilize technology and data to enhance patient care, medication... Read More →
Friday April 25, 2025 10:40am - 10:55am EDT
Athena J
  Informatics (INF), AdventHealth Orlando
  • global Y

10:40am EDT

Justification of a Specialty Pharmacy Discharge Medication Reconciliation Program: A Descriptive Study
Friday April 25, 2025 10:40am - 10:55am EDT
Parthenon 2
TITLE: Justification of a Specialty Pharmacy Discharge Medication Reconciliation Program: 
A Descriptive Study 
Caroline Joncas, Taylor Wells 
 
BACKGROUND: Specialty pharmacies provide medications for patients living complex medical conditions including cancer, Human Immunodeficiency Virus, Multiple Sclerosis, and rheumatology conditions. These medications account for 55% of the United States medication expenditure. While previous literature has established the value of medication reconciliations at time of hospital discharge in patients on chronic medication therapy, minimal literature is available describing the impact on patients receiving medications from specialty pharmacies . The purpose of this study was to retrospectively identify opportunities for pharmacist interventions at time of discharge in patients receiving specialty medications and determine the type, severity, and cost savings associated with these interventions.   
 
METHODS:  This single-center retrospective descriptive study included patients with a documented fill history of a specialty medication at Cape Fear Valley Specialty Pharmacy for HIV or an oncologic disease state within 1 month of an inpatient admission between January 2022 and January 2024. Discharge summaries and specialty follow-up visit notes were reviewed for medication discrepancies. The primary endpoint was the number of opportunities for pharmacist intervention and associated cost avoidance, defined as number of errors found and the associated cost based on error severity. A validated scale was used to grade the severity of errors from no error to potentially lethal. 
 
RESULTS: A total of 90 patient encounters met inclusion criteria. Of these encounters, 76 (84%) were associated with cancer, 6 (7%) with HIV, and 8 (9%) with other diagnoses. Overall, 9 (10%) encounters had a medication error at time of hospital discharge. The majority of errors were identified as significant (78%), with one serious error and one potentially lethal error. The most common type of error was inappropriate omission (78%). The cost avoidance associated with these errors was $14,960 over the two-year study period.  
 
CONCLUSION: This study indicates that while some cost savings are possible through targeted medication reconciliations at time of discharge for specialty patients, the overall opportunity is not large enough to justify a medication reconciliation position specific to specialty pharmacy. However, this service would be a beneficial addition into the specialty pharmacy workflow, as there were significant cost savings considering the small number of issues identified by this study. 
Moderators
BJ

Brook Jacobs

Clinical Coordinator, Critical Care Clinical Specialist, Emory Decatur Hospital
Presenters
avatar for Caroline Joncas

Caroline Joncas

PGY1- Acute Care, Cape Fear Valley Medical Center
My name is Caroline Joncas and I am currently a PGY1 Acute Care Resident at Cape Fear Valley Medical Center in Fayetteville, NC. I graduated with my PharmD from the University of Rhode Island. Following my PGY1 training, I am pursuing oncology pharmacist job opportunities.
Evaluators
EI
Friday April 25, 2025 10:40am - 10:55am EDT
Parthenon 2
  Internal Medicine (IM), Cape Fear Valley Medical Center
  • global Y

10:40am EDT

Evaluating Adherence to Eye Care Recommendations Amongst Patients Receiving Antibody Drug Conjugates for Gynecologic Malignancies
Friday April 25, 2025 10:40am - 10:55am EDT
Olympia 2
Title: 
Evaluating Adherence to Eye Care Recommendations Amongst Patients Receiving Antibody Drug Conjugates for Gynecologic Malignancies


Authors: 
Ram Patel, PharmD
Kelli McCrum, PharmD
Michael Saxon, PharmD, BCPS


Objectives: 
  1. Primary Objective: Assess compliance with prescribed eye drops.
  2. Secondary Objectives:
    1. Identify correlations between adherence and ocular toxicity.
    2. Evaluate the effectiveness of patient education in mitigating adverse effects.


Self Assessment Questions: 
How does adherence to eye care measures correlate with the incidence of ocular toxicity? What factors influence patient adherence to prophylactic eye drop regimens?


Background: 
Antibody-drug conjugates (ADCs) such as mirvetuximab soravtansine and tisotumab vedotin have demonstrated efficacy in treating gynecologic malignancies but are associated with ocular toxicity, necessitating preventive eye care measures. This study aims to evaluate adherence to prophylactic eye drop regimens among patients receiving these therapies. The primary objective is to assess compliance with prescribed eye drops, while secondary objectives include identifying correlations between adherence and ocular toxicity and evaluating the effectiveness of patient education in mitigating adverse effects.


Methods: 
A cross-sectional, prospective study was conducted to assess adherence to prophylactic eye drops in patients receiving mirvetuximab soravtansine or tisotumab vedotin. Eligible patients completed a structured questionnaire evaluating adherence to steroid, lubricating, and vasoconstrictor eye drops (for tisotumab patients only). Inclusion criteria consisted of patients actively receiving ADC therapy, those prescribed prophylactic eye drops, and English-speaking patients. Data collection included duration of eye drop prophylaxis, frequency, dosage, and adherence, measured via a Likert scale. Patients also assessed their understanding of eye care importance and reported any ocular symptoms.


Results:
Preliminary data from four patient encounters indicate adherence to eye drop regimens at 100%, adequate understanding of their regimen at 100%, and minimal ocular toxicities. Reported toxicities include dry eyes being reported in 100% of patient encounters, blurry vision reported in 25%, and sensitivity to light reported in 25%. Our current hypothesis suggests that higher rates of adherence correlates with a lower incidence of ocular toxicity. With the limited number of patient encounters thus far demonstrating adherence and understanding of their regimens, more data is needed to draw any further conclusions or correlations. This study also examines patient-reported barriers to adherence, such as difficulty remembering doses, perceived ineffectiveness, or discomfort caused by the drops. 


Conclusion: 
This study provides valuable insights into adherence patterns, ocular toxicity risks, and the effectiveness of patient education in mitigating adverse events. Identifying key adherence barriers and their impact on toxicity rates may inform strategies to improve compliance and patient outcomes. Enhanced adherence to prophylactic eye care measures could reduce treatment-related complications, improving tolerability and quality of life for patients receiving ADC therapy. Ultimately, these findings may contribute to the development of standardized adherence protocols to optimize patient care and minimize ocular toxicity in clinical practice. 
Moderators
SC

Schylar Cheyenne Hathaway

Clinical Pharmacist
Special interest include Ambulatory Care and Women's Health.
Presenters
avatar for Ram Patel

Ram Patel

PGY1 Pharmacy Resident, Northside Hospital
My name is Ram Patel, and I am a PGY1 Pharmacy Resident at Northside Hospital in Atlanta, GA. Originally from Chicago, IL, I completed both my undergraduate and pharmacy school education there before moving south for residency.My passion for oncology pharmacy stems from a deep interest... Read More →
Evaluators
avatar for Lacey Ioppolo

Lacey Ioppolo

PGY-1 RPD and Clinical Pharmacy Manager, Memorial Health University Medical Center
Lacey Ioppolo PharmD, BCCCP, is a Clinical Pharmacy Manager and PGY-1 Pharmacy Residency Program Director at Memorial Health University Medical Center in Savannah, GA. She obtained her Doctor of Pharmacy from The University of Florida in 2018 and completed her PGY-1 Pharmacy Residency... Read More →
Friday April 25, 2025 10:40am - 10:55am EDT
Olympia 2
  Oncology (ONC), Northside Hospital
  • global Y

11:00am EDT

Empty
Friday April 25, 2025 11:00am - 11:15am EDT
Olympia 1
Moderators
SS
Evaluators
DK
Friday April 25, 2025 11:00am - 11:15am EDT
Olympia 1
  Administration (ADM), Baptist Health Lexington
  • global Y

11:00am EDT

Pharmacist-Led Deprescribing of Inappropriately Prescribed Inhaled Corticosteroids in Veterans with Chronic Obstructive Pulmonary Disease
Friday April 25, 2025 11:00am - 11:15am EDT
Athena C
Title: 
Pharmacist-Led Deprescribing of Inappropriately Prescribed Inhaled Corticosteroids in Veterans with Chronic Obstructive Pulmonary Disease


 Authors:
Jessica Parks, Amber Jefferson, Lauren Howard, Cassandra Warsaw


Introduction:
Chronic obstructive pulmonary disease (COPD) management consists of bronchodilators and inhaled corticosteroid (ICS). ICS use is recommended with a history of COPD hospitalizations, two or more moderate COPD exacerbation within the last two years, eosinophil (EOS) count of 300 cells/µL or higher, or if the patient is diagnosed with concomitant asthma. ICS should be considered as a last-line option due to increased risk for oral candidiasis, hoarse voice, and pneumonia. Previous studies have shown benefits of pharmacist-led clinics for the management of chronic disease states. The purpose of this quality improvement initiative was to investigate the impact of pharmacist-led deprescribing of inappropriately prescribed inhaled corticosteroids in Veterans with COPD, regardless of initial ICS-containing regimens.


Methods:
Retrospective chart reviews were completed for the initiative. A total of 123 Veterans, identified using the COPD Dashboard, were included in the review. Descriptive statistics were used for data analysis. Veterans were included if assigned to the designated primary care clinic, diagnosed with COPD, and had an active ICS prescription. A total of 54 Veterans met inclusion criteria. Charts were reviewed for an appropriate indication for ICS use. Updated pulmonary function tests (PFTs) and complete blood cell counts (CBC) were scheduled with consent. If the ICS was deemed inappropriate, then the pharmacist contacted the Veteran via telephone to provide education and utilized Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines to determine appropriate therapy. Veterans were contacted via telephone to conduct a COPD management appointment, and based on patient-specific factors, the pharmacist recommended to either discontinue or continue the ICS-containing inhaler. If an ICS was discontinued, a long-acting muscarinic antagonist (LAMA) or LAMA/long-acting bronchodilator agonist (LABA) was prescribed as alternative therapy. Interventions were documented in the electronic health record using a specified note template. Data collection occurred between July and November 2024. The project was approved by the Pharmacy and Therapeutics committee as a quality improvement initiative, which is exempt from IRB approval.


Results:
Upon examination of charts, it was noted that PFT results and CBC lab work were outdated in accordance to GOLD guidelines for COPD therapeutic management. A total of 21 Veterans obtained updated PFTs and 9 Veterans obtained updated CBC labs. There were a total of 54 Veterans that met inclusion criteria and there were a total of 33 Veterans deemed appropriate for ICS deprescribing. Overall, 76% (N=25) of Veterans agreed to ICS de-escalation.


Conclusions:
The data collected further supports the necessity of pharmacist-led clinics to ensure appropriate medications are prescribed and monitoring parameters are upheld. Additionally, pharmacist-led deprescribing of inappropriate ICS inhalers reduces the risk of adverse effects and enables pharmacists to identify patients requiring updated COPD monitoring.
Moderators
avatar for Devin Lavender

Devin Lavender

Clinical Assistant Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2
Ambulatory Care, Scholarship of Teaching and Learning, Resident and Student Development.
Presenters
avatar for Jessica Parks

Jessica Parks

PGY-2 Ambulatory Care Pharmacy Resident, Fayetteville VA Health Care Center
Jessica Parks, Pharm.D. is a PGY-2 Ambulatory Care resident. She earned her Doctor of Pharmacy Degree from Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. She completed her PGY-1 pharmacy residency at the Erie VA Medical Center. Her practice interests include chronic... Read More →
Evaluators
CW

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, Kaiser Permanente Georgia
Friday April 25, 2025 11:00am - 11:15am EDT
Athena C
  Ambulatory Care (AMB), VA - Fayetteville, NC – Fayetteville VA Coastal Health Care System
  • global Y

11:00am EDT

Proper Sodium-Glucose Transport Protein 2 Inhibitor use in New York Heart Association class II-IV heart failure patients
Friday April 25, 2025 11:00am - 11:15am EDT
Athena D
Title: Proper Sodium-Glucose Transport Protein 2 Inhibitor use in New York Heart Association class II-IV heart failure patients
Authors:
Primary: Mary Sizer
Secondary: Melissa Johnson, Joseph Crosby, Akshaya Arunkumar, Ashlee Greene
Objective: To determine if HF patients are being prescribed SGLT2 inhibitors more often in collaborative care of a physician and pharmacist versus a physician alone in the primary care setting.
Self-Assessment Question: To be presented with slides
Background:
Sodium-Glucose Transport Protein 2 (SGLT2) inhibitors were recently added to the heart failure guidelines in 2022 and can help prevent heart failure hospitalizations by up to 30%. Being a Class I recommendation for heart failure with reduced ejection fraction and a Class 2a recommendation for preserved ejection fraction, it is crucial that these medications are used correctly in the outpatient setting. Pharmacists are not consulted on all heart failure patients in primary care offices at our health system. Identifying these potential gaps in care would ultimately improve outcomes for patients and help advocate for further pharmacy involvement within primary care offices.
 
Methods:
This was a multi-center, retrospective study identifying SGLT2 inhibitor use in outpatient heart failure New York Heart Association (NYHA) class II-IV patients at St. Joseph’s/Candler primary care clinics from August 1, 2023, to August 1, 2024. Patients were identified through a report capturing heart failure ICD10 codes and reviewed for eligibility. Patients considered for inclusion were at least 18 years old with a diagnosis of heart failure that followed at participating St. Joseph’s/Candler affiliated offices. Patients that were on dialysis, had a reported allergy or contraindication for use, or were pregnant/lactating were excluded. Eligible patients were stratified into physician/pharmacist cohort or a physician-only cohort. Medication data was obtained and patients were classified into groups SGLT2 inhibitor use and no use. The primary objective was to determine if heart failure patients are being prescribed SGLT2 inhibitors more often in collaborative care of a physician and pharmacist versus a physician alone in the primary care setting. Secondary objectives included determining if patients were prescribed appropriate heart failure doses, determining if appropriate outpatient use correlates with less hospital admissions, and comparing rates of use in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Data was analyzed to determine any gaps of care or implicating trends at the participating primary care clinics.
 
Results:
Three hundred forty-eight patients were screened for eligibility with total n of 300. Pharmacy was consulted on 82 of the 300 patients with 30/82 on a SGLT2 inhibitor (36.6%). Of the 30 patients on a SGLT 2 inhibitor in the pharmacist/physician cohort, 28 of them had correct heart failure dosing (93.3%). The remaining 2 patients in the pharmacy cohort had diabetes and were receiving the recommended dose for diabetes. The physician-only cohort (218 patients) was found to have 73 patients on a SGLT2 inhibitor (33.4%). Fifty-one of these patients were found to be on correct heart failure dosing (69.8%) with 10 of the remaining 22 patients with incorrect dosing being due to diabetes (45.4%). Hospital admissions due to heart failure were less prevalent in the pharmacy cohort (31.77% vs 44.0%). The pharmacy/physician cohort had 13 patients with HFrEF, 7 of which were on an SGLT2 inhibitor (53.8%) compared to 26/56 patients in the physician-only cohort. Likewise, 23/69 patients with HFpEF were on an SGLT2 inhibitor in the pharmacy group (33.3%) with 47/162 (29.0%) in the physician-only group.
 
Conclusions: 
Rates of SGLT2 inhibitor use in heart failure patients NYHA class II-IV were overall higher in the pharmacist/physician group, although comparable between the groups. The biggest impact was seen in the heart failure dosing. Pharmacy involvement resulted in appropriate dosing for all patients on a SGLT2 inhibitor. All-cause hospitalizations were similar; however, hospitalizations due to heart failure saw the largest difference favoring pharmacy involvement.  Collaborative care was more likely to prescribe a SGLT2 inhibitor for both heart failure with reduced and preserved ejection fraction. 
Moderators
avatar for Ashley Woodhouse

Ashley Woodhouse

SJCH2St. Joseph's/Candler Health System (Ambulatory)PGY2
Presenters
avatar for Mary Sizer

Mary Sizer

Pharmacy Resident, Candler Hospital
Mary Sizer is a current PGY1 acute care pharmacy resident at St. Joseph's/Candler in Savannah, GA. Mary is from Cincinnati, OH and received her PharmD degree from West Virginia University in Morgantown, WV. She will be staying at St. Joseph's/Candler for her PGY2 residency in Ambulatory... Read More →
Evaluators
avatar for Anne Warren
Friday April 25, 2025 11:00am - 11:15am EDT
Athena D
  Ambulatory Care (AMB), Candler Hospital
  • global Y

11:00am EDT

Injectable Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Outcomes in Patients Without Diabetes in Outpatient Cardiology Clinics
Friday April 25, 2025 11:00am - 11:15am EDT
Athena B
Title: Injectable Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Outcomes in Patients Without Diabetes in Outpatient Cardiology Clinics
 
Authors: Kristina Benbow, Madison Burke, Lauren Schultz, Marina Carter, Deborah Hurley, Benjamin Tabor
 
Background: Glucagon-Like Peptide-1 (GLP-1) receptor agonists have emerged as clinically significant treatment options for type 2 diabetes, obesity, and cardiovascular (CV) risk reduction. To date, Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes (SELECT Trial) is the only trial to comprise of non-diabetic patients with preexisting CV disease defined as myocardial infarction, stroke, or symptomatic peripheral artery disease. In this trial, semaglutide was superior to placebo in reducing a CV composite of death from CV causes, nonfatal myocardial infarction, and nonfatal stroke. This study explores an expansion of the inclusion criteria used in the SELECT Trial, using a large outpatient cardiology population. 
 
Methods: This retrospective cohort study includes adult patients prescribed injectable GLP-1 receptor agonists followed by Prisma Health Cardiology between January 2022 and April 2023. Data was collected through April 2024. Patients were assigned to the control group if they never filled the medication with all other patients considered the intervention group. The primary outcome is a composite of death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke. Secondary outcomes include total change in patient health variables (body weight, blood pressure, cholesterol, hemoglobin A1c), hospitalization or urgent medical visit for heart failure, and death from any cause. Descriptive statistics, stratified analyses (control vs intervention group), and multivariable logistic regression will be used to summarize the data and to evaluate the association of GLP-1 use and risk of death and other non-fatal cardiovascular outcomes.
 
Results: 123 patients without diabetes were prescribed a GLP-1 receptor agonist, 83 received the medication (intervention) and 40 did not (control). The primary endpoint did not differ between study arms, with no occurrences of death from CV cause or nonfatal stroke in either group. There was a nonsignificant trend in the control group for nonfatal MI (n=2 control, n=0 intervention; p=0.104). There were no occurrences of death from any cause and hospitalization or urgent medical visit for heart failure between groups. Secondary outcomes reflected a statistically significant reduction for intervention group in body weight (-1.0 kg control, -8.4 kg intervention; p<0.001), BMI (-0.2 kg/m2 control, -3.2 kg/m2 intervention; p<0.001), LDL (+1.4 mg/dL control, -34.1 mg/dL intervention; p<0.001), systolic blood pressure (+1.4 mmHg control; -7.9 mmHg intervention; p<0.001), and diastolic blood pressure (+1.2 mmHg control; -5.4 mmHg intervention; p=0.003). There was no difference in change in A1c between arms (0.0 ± 0.9 control, 0.0 ± 0.3 intervention; p=0.374).

Conclusions: Although unable to find a statistically significant difference in the composite primary endpoint, secondary cardiovascular outcomes favored the use of GLP-1 receptor agonists in patients without diabetes. There was a statistically significant lowering of known cardiovascular risk factors, including body weight, LDL, and blood pressure. Limitations of this study include a small study size which does not allow for true evaluation of primary endpoint, inclusion of patients irrespective of adherence to the GLP-1 receptor agonist or changes to background medications, and lack of available laboratory data points for many patients (notably, A1c and LDL). Unlike the SELECT Trial which looked exclusively at patients with a past medical history of MI, stroke, or symptomatic peripheral artery disease, this study was able to find CV benefit in a population both without CV history and in patients with coronary artery disease, all who were baseline close to having controlled/goal labs and vitals. Ultimately, this data helps advocate for insurance approval of GLP-1 receptor agonist in patients without diabetes secondary to their CV benefit.
Presenters
KB

Kristina Benbow

PGY1 Pharmacy Resident, Prisma Health Richland Hospital
Kristina is a current PGY1 Pharmacy Resident at Prisma Health Richland Hospital, and is looking forward to staying for her PGY2 training in Cardiology. She completed her PharmD education at the University of South Carolina College of Pharmacy.
Evaluators
AS
avatar for Laura Schalliol

Laura Schalliol

Residency Program Director, South College School of Pharmacy
Friday April 25, 2025 11:00am - 11:15am EDT
Athena B
  Cardiology (CAR), Prisma Health Richland - University of South Carolina
  • global Y

11:00am EDT

Comparison of emergency department weight based levetiracetam dosing in patients with status epilepticus
Friday April 25, 2025 11:00am - 11:15am EDT
Athena G
Title: Comparison of emergency department weight based levetiracetam dosing in patients with status epilepticus  
Authors: Zackery Moreo, Kelly Bodine, Olivia Morgan, John Patka  
Objective: Evaluate impact of levetiracetam dosing in the ED on need for subsequent antiseizure medications (ASMs)  
Self-Assessment Question: What is the optimal dose of levetiracetam in patients with SE? 
Background: Status epilepticus (SE) is defined as a seizure with five minutes or more of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery between seizures. SE is a neurological emergency requiring immediate evaluation and management to prevent significant morbidity and mortality. Benzodiazepines are first line treatment for aborting seizure activity; however, in SE seizures may be refractory requiring second line treatment options. Guidelines for SE recommend the use of levetiracetam as a second line agent but, the dosing recommendations for levetiracetam vary. Other available studies have compared the use of levetiracetam at various doses to other antiseizure medications (ASMs), but few have compared the efficacy of different levetiracetam dosing strategies to each other. Due to this and the variation in guideline recommendations, dosing throughout the emergency department (ED) may differ. 
Methods: This was a retrospective cohort study of adult patients presenting to the ED with SE and received at least one dose of levetiracetam from January 2023 to December 2023. The primary outcome was percentage of patients requiring subsequent ASM’s 6-hours from initial levetiracetam dose. Secondary outcomes included the percentage of patients receiving guideline recommended dose of benzodiazepines, use of institutional order set, escalation of care (ICU admission or intubation). Primary and secondary outcomes were assessed utilizing Chi-Square analysis. 
Results: A total of 300 patients were screened, 253 patients met inclusion criteria and were included in the final analysis. There was a total of 145 patients in the levetiracetam ≥ 60 mg/kg group and 108 patients in the levetiracetam < 60 mg/kg group. Patients had median age of 60, majority were male (56.6%) and black (82%). Patients had a mean weight of 73.1 kg (±18.2) in ≥ 60 mg/kg group and 80.1 kg (±22.6) in the < 60 mg/kg group. Ninety-seven patients (66.9%) in the ≥ 60mg/kg group had a history of epilepsy and 96 (66.2%) were prescribed ASM prior to admission, and 62 (57.4
Presenters
avatar for Zack Moreo

Zack Moreo

PGY-1 Pharmacy Resident, Grady Memorial Hospital
I was born and raised in Los Angeles California. I attended UNC at Chapel Hill for Pharmacy School and I'm a current PGY-1 pharmacy resident at Grady Memorial Hospital. I'm staying on next year to complete a PGY-2 in Emergency Medicine. 
Evaluators
avatar for Blake Johnson
MH
Friday April 25, 2025 11:00am - 11:15am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Grady Memorial Hospital
  • global Y

11:00am EDT

Evaluating the Safety and Efficacy of Bicarbonate Use in Moderate-to-Severe Diabetic Ketoacidosis
Friday April 25, 2025 11:00am - 11:15am EDT
Athena I
Title: Evaluating the Safety and Efficacy of Bicarbonate Use in Moderate-to-Severe Diabetic Ketoacidosis

Authors: John Ethan Young, Ashley Crisler, Bianca Rivera-Ramirez, McKenzie Hodges

Objective: To evaluate the effects of sodium bicarbonate therapy on the resolution of DKA and its associated outcomes
 
Self-Assessment Question: Which of the following is not characteristic of diabetic ketoacidosis? (A) Hyperglycemia (B) Metabolic alkalosis (C) Ketosis (D) Metabolic acidosis

Background: Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes characterized by hyperglycemia, metabolic acidosis, and elevated ketone levels. While the mainstays of DKA treatment include insulin therapy, fluid resuscitation, and electrolyte correction, the use of sodium bicarbonate to treat acidosis remains controversial. The American Diabetes Association (ADA) 2024 guidelines recommend considering sodium bicarbonate only in cases of severe acidosis (pH <6.9), but its routine use varies widely across institutions. Preliminary evidence from randomized studies has shown no significant improvement in morbidity or mortality with sodium bicarbonate therapy in DKA patients with pH levels between 6.9 and 7.1. However, there remains a gap in the literature regarding its impact on time to DKA resolution, which this study seeks to address. By clarifying the role of sodium bicarbonate in DKA management, this study aims to provide insight into optimizing treatment strategies and minimizing unnecessary interventions in the care of DKA patients.
 
Methods: A retrospective chart review was performed on adult patients treated for diabetic ketoacidosis (DKA) at Piedmont Columbus Regional Midtown between January 1, 2023 and December 31, 2023. Patients had to be 18 years of age or older and have clinical evidence of moderate-to-severe DKA. Patients that met these parameters were divided into two groups based on the administration of a sodium bicarbonate infusion. Patients were excluded if they presented with euglycemic DKA or if their insulin infusion was terminated prior to DKA resolution. The primary objective was time to DKA resolution. Secondary objectives included duration of insulin infusion, recurrence of acidosis, incidence of hypokalemia, hospital length of stay, and ICU length of stay. An independent t-test was used for the primary outcome, as well as the secondary outcomes of insulin infusion duration and length of stay, while a Chi Square Test was used to evaluate the recurrence of acidosis and incidence of hypokalemia.
 
Results: The patients receiving bicarbonate (n=32) had an average time to DKA resolution of 21.9 hours, while the patients receiving the standard of care (n=31) had an average time of 18.4 hours. Additionally, there was no difference seen for the secondary outcomes of insulin infusion duration [23.4 h vs 20.3 h], recurrence of acidosis [15.6% vs 3.2%], incidence of hypokalemia [65.6% vs 51.6%], and ICU length of stay [4.6 d vs 3.3 d]. There was a statistically significant difference for incidence of moderate hypokalemia [28.1% vs 6.5%] and hospital length of stay [10.3 d vs 5.2 d].
 
Conclusion: This study demonstrates that bicarbonate therapy is not efficacious in the management of DKA and may increase the incidence of moderate hypokalemia, risk of fluid overload, and potentially contribute to longer hospital length of stay. In conclusion, bicarbonate therapy should be seldom used for DKA, and the decision should be made by weighing the risks and benefits.
Moderators
AP
Presenters
avatar for John Young

John Young

PGY-2 Critical Care Pharmacy Resident, Piedmont Columbus Regional Midtown
PGY-2 Critical Care Pharmacy Resident at Piedmont Columbus Regional Midtown
Evaluators
avatar for Robin Fischer

Robin Fischer

PGY1 Pharmacy Practice Resident, MRMC1McLeod Regional Medical CenterPGY1
Hello my name is Robin Fischer and I am one of the PGY1 pharmacy practice preceptors / mentors at McLeod Regional Medical Center. I am a retired deputy sheriff from Charleston County Sheriff's Office and I obtained a bachelor’s degree in Criminal Justice Administration. Once I retired... Read More →
Friday April 25, 2025 11:00am - 11:15am EDT
Athena I
  Critical Care/Emergency Medicine (CCM), Piedmont Columbus Regional Midtown
  • global Y

11:00am EDT

Evaluation of Appropriateness of Antibiotics Prescribed at ED Discharge for Urinary Tract Infections or Community Acquired Pneumonia in Medicare Patients 65+
Friday April 25, 2025 11:00am - 11:15am EDT
Athena H
Title: Evaluation of Appropriateness of Antibiotics Prescribed at ED Discharge for Urinary Tract Infections or Community Acquired Pneumonia in Medicare Patients 65+ 

Authors: Gabrielle Hopkins, Carlen Johnson, Nicole Gonzalez

Background: Antibiotics are some of the most prescribed medications in the Emergency Department. However, providers are often required to prescribe antibiotics prior to definitive culture results. Studies have shown that inappropriate prescribing may lead to patient harm, including adverse events, treatment failure, antimicrobial resistance, and hospital readmission. Community acquired pneumonia (CAP) and urinary tract infections (UTI) are among the top discharge diagnoses with the highest 30-day all-cause readmissions. This retrospective study aims to provide insight into ED discharge antibiotic prescribing patterns in Medicare patients 65+ for CAP or UTI at AdventHealth Central Florida Division (CFD) South campuses.

Method: The study was conducted as a retrospective chart review. Reports were populated through the electronic health record identifying Medicare patients 65 years at all AdventHealth CFD South campuses who were discharged from the ED with at least one antibiotic for CAP or UTI during the period of June 1, 2023 to June 30, 2024. Patients who were less than 65 years old, pregnant, incarcerated, discharged from the ED with CAP or UTI with no oral antibiotics, or had missing documentation were excluded from the study. De-identified patient data including demographics, antibiotic agent, antibiotic dose, duration of therapy, antibiotic appropriateness based on culture results, and markers of infection were collected for assessment. The primary outcome of this study was to evaluate the appropriateness of discharge ED antibiotic prescribing for CAP or UTI within the Medicare 65+ population. The antibiotic agent, dose, frequency, duration of therapy, and appropriateness of each agent based on culture results were assessed. The secondary outcome was inappropriate renal dosing associated with discharge antimicrobial treatment. Collected data was analyzed using descriptive statistics. 

Results: A total of 158 patients met the inclusion criteria and were included in data analysis. The median age was 78 years, the median weight was 72.5 kg, and the median height was 65 inches. The most common comorbidities included cardiac [131, (82%)], neurological [45,(28%)], and diabetes [38, (24%)]. Fifty-one patients diagnosed with UTI (34%) received ceftriaxone in the emergency department prior to discharge. Upon discharge, the most prevalent antimicrobial agent prescribed for UTI was cephalexin [65,(44%)] and most common organism identified was Escherichia coli [30, (18%)]. Cystitis was found to be the most common indication for antimicrobial therapy upon discharge [133 (84%)]. Nine (5.6%) patients were diagnosed with CAP. The most prevalent agent prescribed for CAP upon discharge was azithromycin [5, (55%)] and Mycoplasma pneumoniae [1 (11%] was identified to be the most common organism for CAP. The median duration of antimicrobial therapy was 7 days for UTI and 7 days for CAP. Further analysis revealed drug-bug mismatch in 22 (28%) patients, renal function mismatch in 87 (55%) patients and no microbiologic results in 40 (25%) patients.

Conclusion: Discharge antibiotic prescribing patterns varied amongst each CFD campus for Medicare 65+ patents who were discharged home on antimicrobial therapy for UTI or CAP. Twenty-eight percent (28%) of antibiotics prescribed at discharge did not appropriately treat the culture identified pathogens. Fifty-five percent (55%) of the antibiotics were dosed inappropriately based on renal function. This demonstrates an opportunity for pharmacist involvement to improve future patient care. Future directions include opportunities to improve rates of bug-drug match selection, education and resources for ED providers on proper antibiotic selection. Lastly, standardization of order sets for discharge antibiotics for patients discharged from all CFD EDs may improve appropriate discharge antibiotic prescribing. 

Self-Assessment Question: Which was the most common bacteria identified in patients with UTI? 
A. Staphylococcus aureus 
B. Escherichia coli 
C. Klebsiella pneumoniae 
D. Proteus mirabilis
Moderators
avatar for Maggie Goode

Maggie Goode

Critical Care Pharmacist, Mobile Infirmary Medical Center
.
Presenters
avatar for Gabrielle Hopkins

Gabrielle Hopkins

PGY1 Pharmacy Resident, AdventHealth Orlando
PGY1 Pharmacy Resident at AdventHealth Orlando
Evaluators
MM
Friday April 25, 2025 11:00am - 11:15am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), AdventHealth Orlando
  • global Y

11:00am EDT

Functional Cure of Hepatitis B Infections Among Patients Co-infected with HIV on Tenofovir-based Antiretroviral Therapy
Friday April 25, 2025 11:00am - 11:15am EDT
Athena A
Title: Functional Cure of Hepatitis B Infections Among Patients Co-infected with HIV on Tenofovir-based Antiretroviral Therapy
Authors: Adesuwa Utomwen, Emily Steinbock, Minh Pham
Site: Cone Health – Moses H. Cone Memorial Hospital; Greensboro, NC

Objective: Define functional cure of HBV infections and identify the ideal guideline-directed treatment regimen used for HIV and HBV coinfected patients

Background:
Human immunodeficiency virus (HIV) affects approximately 1.2 million people in the United States, and among these patients, it is estimated that 10% are coinfected with chronic hepatitis B viral (HBV) infection. In patients with HBV, functional cure, defined by loss of hepatitis B surface antigen (HBsAg), is rare. Only 2-4% of HBV mono-infected patients receiving treatment achieve functional cure. Some studies have suggested that patients co-infected with HIV and HBV achieve higher rates of functional cure, approximately 7-10%, likely due to lifelong exposure to antiretroviral therapy (ART).  ART regimens containing tenofovir are the most widely recommended treatment for HBV co-infected patients. Patients achieving functional cure should be re-vaccinated to help stimulate the production of hepatitis B antibodies (anti-HBs). The primary objective of this study was to determine the incidence rate of functional cure among patients coinfected with HIV/HBV who were taking a tenofovir-based ART regimen.

Methods:                                                                                                         
This study was a single-centered, prospective, IRB-approved, interventional study evaluating the incidence of HBsAg loss among HIV/HBV co-infected patients over a 7-month period from August 1, 2024 to February 28, 2025. The study population was identified using a report that included patients with confirmed diagnoses of both HIV and Hepatitis B at the Cone Health Regional Center for Infectious Diseases clinic. Patients were included if they were 18 years of age or older, had confirmed HIV and HBV diagnoses, and were currently receiving care at the RCID clinic. Patients were excluded if they were lost to follow-up at the RCID clinic, diagnosed with hepatitis C viral infection, not receiving treatment with a tenofovir-containing therapy regimen, or were currently involved in another research study. For patients meeting the inclusion criteria, the researcher scheduled HBsAg labs to be collected during patients’ future appointments, notified providers of these orders, and determined the need for vaccinations based on the laboratory results.  The primary outcome was the incidence of functional cure of hepatitis B. The secondary outcome reviewed lab collection patterns. Subgroup analyses involved a comprehensive description of patients meeting the primary objective.

Results:
A total of 37 patients were included in this study. Two (5.4%) patients achieved functional cure of HBV after being treated with long-term ART (Biktarvy) for more than 2 years (95% CI 0.7-18.2). Out of the 37 enrolled patients, labs were only ordered for 31 because the remaining appointments were outside of the study time period. Ultimately, labs were collected for 12 (74%) of appointments due to logistical reasons. None of the patients who achieved functional cure of HBV were eligible for HBV re-vaccination due to the production of anti-HBs at the time of cure. Thus, both patients seroconverted without requiring the HBV vaccine. One patient with functional cure of HBV developed an anti-HB level of 10, indicating complete protection against HBV. It is uncertain if the remaining cured patient achieved full immunity because the appropriate quantitative anti-HB lab was not ordered.

Conclusion:
The incidence of functional cure amongst patients co-infected with HIV and HBV was lower than previously reported rates in the literature, which is likely due to our small sample size and high exclusion rate. Our results add new local evidence about the incidence of functional cure of hepatitis B in patients coinfected with HIV and validate the need for universal HBV therapy in this population.  Practice changing recommendations that can be gathered from this study includes implementing a new standardized workflow protocol for coinfected patients to encourage laboratory stewardship, providing additional guidance that will assist practitioners with medication management decisions for specific clinical scenarios (i.e. requiring immunosuppressive therapy) and creating opportunities to involve current on-site RCID pharmacists into this new workflow. Further local studies are needed, however, to determine the most accurate incidence of hepatitis B functional cure rates within this region and to evaluate the most appropriate means of properly monitoring this unique patient population.
Moderators
BK

Brian Knott

Clinical Pharmacy Supervisor, AdventHealth Winter Park
Presenters
avatar for Adesuwa Utomwen

Adesuwa Utomwen

Acute care PGY1 resident at Cone Health Hospital, Cone Health
Adesuwa Utomwen is a pharmacist who is currently completing her acute care residency at Cone Health Hospital. She is from Riverdale, Georgia, and has completed her pharmacy degree at the University of Georgia. She recently accepted a position as a clinical pharmacist at Cone Health... Read More →
Evaluators
CL
Friday April 25, 2025 11:00am - 11:15am EDT
Athena A
  Infectious Disease (ID), Cone Health
  • global Y

11:00am EDT

Assessing the Utility of Enoxaparin Anti-Xa Monitoring in Obesity for Venous Thromboembolism (VTE) Prophylaxis on Clinical Outcomes in the Hospital Setting
Friday April 25, 2025 11:00am - 11:15am EDT
Parthenon 2
Title: Assessing the Utility of Enoxaparin Anti-Xa Monitoring in Obesity for Venous Thromboembolism (VTE) 
Prophylaxis on Clinical Outcomes in the Hospital Setting 
Authors: Emilee Byrd, Angelica Marques, Ann Maxwell 
Background: Anti-Xa monitoring has been suggested to assess enoxaparin dosing in certain patient populations for the treatment of venous thromboembolism (VTE). However, there is no clear guidance on goal ranges for prophylactic enoxaparin and how this can affect the bleeding or clotting risk. Morbid obesity (BMI >40 kg/m2) is an important factor that can increase the risk of VTE. Some institutions have adopted anti-Xa monitoring in this patient population to guide prophylactic dosing. The purpose of this research study is to assess the use of anti-Xa monitoring for VTE prophylaxis using enoxaparin in obesity and its impact on clinical outcomes.   
Methods: This is a retrospective, observational single center cohort study evaluating morbidly obese patients admitted to McLeod Regional Medical Center that received prophylactic dosing of enoxaparin between August 1, 2023 and July 31, 2024. In order to be included in the study, patients needed to be 18 years or older, have a BMI >40 kg/m2, receive at least three doses of enoxaparin, and have at least one anti-Xa level collected. Patients with acute kidney injury (AKI) within the last seven days, pediatric patients, pregnant patients, orthopedic surgery patients, and trauma patients will be excluded.  The primary outcome is a composite of any VTE and any bleeding during hospitalization following prophylactic enoxaparin initiation. Secondary outcomes will include the individual components of the primary outcome (VTE, bleeding), number of repeat anti-Xa levels, percentage of anti-Xa levels in goal range and percentage of anti-Xa levels drawn within an appropriate time frame.  
Results: A total of 218 patients with a BMI >40 kg/m2 and receiving enoxaparin for VTE prophylaxis were reviewed. After applying the exclusion criteria, 81 patients were included in the study.  
The median age of patients included was 58 [IQR 44,70] with normal renal function and a median BMI of 50 [IQR 44,58]. Of the 81 patients included, 11% were also on concomitant NSAIDs and 40% of patients were receiving concomitant antiplatelet therapy with the most common being aspirin.  
For the primary composite outcome there were no incidences found of VTE and any bleeding in the 81 patients included in the study. 79% of the 81 anti-Xa levels collected were within the appropriate time frame with 59% of those levels being within the goal range. The incidence of sub-therapeutic levels that were collected within the appropriate time frame was 27% and 14% for supra-therapeutic levels. 
Conclusions:  Dose adjusting enoxaparin for VTE prophylaxis in morbidly obese patients does not appear to increase bleeding or VTE events. Anti-Xa monitoring can for VTE prophylaxis can lead to wasted resources when levels are drawn inappropriately and also lead to additional blood draws from the patient to obtain the level within the time frame. Based on the findings from this study, in patients with stable renal function receiving BMI dosing of enoxaparin it is reasonable to not check anti-Xa levels as this was not correlated with VTE or bleeding. Concomitant therapy with aspirin did not appear to increase the risk of bleeding.
Moderators
BJ

Brook Jacobs

Clinical Coordinator, Critical Care Clinical Specialist, Emory Decatur Hospital
Presenters
avatar for Emilee Byrd

Emilee Byrd

PGY-1 Pharmacy Resident, McLeod Regional Medical Center
PGY-1 Resident at McLeod Regional Medical Center
Evaluators
EI
Friday April 25, 2025 11:00am - 11:15am EDT
Parthenon 2
  Internal Medicine (IM), McLeod Regional Medical Center
  • global Y

11:00am EDT

Safety and Efficacy of Direct-acting Oral Anticoagulants versus Warfarin in the Treatment of Venous Thromboembolism in Severely Obese Patients
Friday April 25, 2025 11:00am - 11:15am EDT
Parthenon 1
Title: Safety and Efficacy of Direct-acting Oral Anticoagulants versus Warfarin in the Treatment of Venous Thromboembolism in Severely Obese Patients


Authors: Olukemi Omotola, Madeline Shepherd, Evelyn Grafton


Objective: This study aims to compare the efficacy and safety of DOACs, particularly apixaban and rivaroxaban, versus warfarin in patients with severe obesity diagnosed with VTE.


Background: Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious and potentially life-threatening condition. Anticoagulation therapy is the cornerstone of treatment for VTE to prevent clot progression, recurrence, and associated complications. Traditionally, warfarin has been the mainstay of treatment; however, direct-acting oral anticoagulants (DOACs), such as apixaban and rivaroxaban, have gained widespread use. In contrast to warfarin, their fixed dosing, fewer drug interactions, and lack of routine laboratory monitoring requirements make DOACs an appealing alternative. In the general population, DOACs have demonstrated non-inferior or superior efficacy and safety profiles compared to warfarin for the treatment of VTE. However, data is limited regarding their use in patients with severe obesity, defined as a body mass index (BMI) ≥ 40 kg/m². Given the growing prevalence of obesity, determining the safest and most effective anticoagulation strategies in this population is critical. 


Methods: This was a retrospective chart review of adult patients with a BMI of > 40 kg/m2 who received either apixaban, rivaroxaban, or warfarin for the treatment of venous thromboembolism from January 1, 2019 to September 30, 2024. Patients were excluded if they were pregnant or breastfeeding, had known hypersensitivity or contraindications to one of the study drugs, experienced active bleeding within 6 months of the start of the study time frame, had a history of a known hypercoagulable state, or if they received a fibrinolytic, mechanical thrombectomy, or underwent EkoSonic endovascular system (EKOS) procedure. The primary endpoint was VTE recurrence within one year. Secondary endpoints included major bleeding occurrence, clinically relevant non-major bleeding (as defined by the International Society of Thrombosis and Hemostasis), and all-cause mortality at one year. 


Results: The study included 76 patients, with 60 in the DOAC group and 16 in the warfarin group. For the primary outcome, 6 patients (10%) in the DOAC group experienced VTE recurrence versus 2 patients (12.5%) in the warfarin group (p=0.3186).  In the DOAC group, 3 patients (5%) experienced a major bleeding event, compared to 1 patient (6.3%) in the warfarin group (p= 0.4268). Two patients (3.3%) in the DOAC group experienced clinically relevant non-major bleeding, while no patients in the warfarin group had this type of bleeding event (p= 0.6211).  Finally, in the DOAC group, there were no reported deaths, while in the warfarin group, 2 patients (12.5%) died (p= 0.0421), making this the only statistically significant finding in the study.


Conclusion: DOACs are a safe and effective alternative to warfarin for treating VTE in severely obese patients. Given their comparable efficacy and lower all-cause mortality, DOACs may be a preferred choice in clinical practice.
Moderators
avatar for Matt Conley

Matt Conley

Pharmacy Informatics Specialist, AdventHealth
Presenters
avatar for Olukemi Omotola

Olukemi Omotola

PGY-1 Pharmacy Resident, Piedmont Atlanta Hospital
Olukemi is currently completing her PGY-1 pharmacy residency training at Piedmont Atlanta Hospital in Atlanta, GA. She received her Doctor of Pharmacy degree at the University of Charleston School of Pharmacy. Upon completing residency, she plans to stay on at Piedmont Atlanta and... Read More →
Evaluators
EM
Friday April 25, 2025 11:00am - 11:15am EDT
Parthenon 1
  Internal Medicine (IM), Piedmont Atlanta Hospital
  • global Y

11:00am EDT

Incidence of nausea and vomiting with modified antiemetic regimens for patients receiving carboplatin AUC ≥ 4
Friday April 25, 2025 11:00am - 11:15am EDT
Olympia 2
Title: 
Incidence of nausea and vomiting with modified antiemetic regimens for patients receiving carboplatin AUC ≥ 4


Authors: Ramsey Shane, Amanda Cass


Objective: 
The purpose of this study is to determine the incidence of CINV with different antiemetic regimens and alterations in antiemetic regimens in patients receiving a modified antiemetic regimen with carboplatin AUC ≥ 4. 


Background: 
Chemotherapy-induced nausea and vomiting (CINV) is a major side effect of cancer treatment that affects patient quality of life. The National Comprehensive Cancer Network (NCCN) provides CINV recommendations for patients based on the emetic risk of the chemotherapy agents in their regimen, previous use of antiemetic agents, and patient risk factors. In the updated 2017 NCCN CINV guidelines, carboplatin emetic potential was updated from all carboplatin doses being moderately emetogenic to carboplatin AUC < 4 classified as moderately emetogenice and AUC ≥ 4 as highly emeticemetogenic. This recommendation adds neurokinin-1 receptor antagonists (NK-1 RA) to the standard regimen of a 5-HT3 receptor antagonists and dexamethasone with or without olanzapine for antiemetic prophylaxis in patients receiving carboplatin with AUC ≥ 4 mg/mL. There is debate amongst clinicians if the highly emetic classification is clinically necessary empirically citing additional adverse effects of antiemetic agents and financial burden for the healthcare system as reasons. The current practice at Vanderbilt University Medical Center (VUMC) includes a variety of antiemetic options for treatment plans including carboplatin AUC ≥4, and antiemetic regimens are decided by disease state groups based on their experience. Thus, not all regimens using carboplatin AUC ≥ 4 are treated as a highly emetic chemotherapy regimen.


Methods:
A retrospective, single-center cohort analysis was conducted including patients who received chemotherapy regimens containing carboplatin AUC ≥ 4 between January 2019 through July 2024 at the Vanderbilt Ingram Cancer Center (VICC). The treatment plans included in this study came from patients receiving treatment for either lung, gynecologic, or gastrointestinal cancers. Additionally, patients had to complete at least 2 cycles of therapy with carboplatin AUC ≥ 4. Patients were excluded if their treatment plan contained other cytotoxic chemotherapy agents except for paclitaxel. Data was collected through chart review in electronic medical record. The primary objective was to determine the incidence of CINV with different antiemetic regimens and if there was a change in the antiemetic regimen during treatment with carboplatin and up to three weeks after the carboplatin dose.  


Results: 
A total of 243 patients were screened for inclusion across the three disease states. There were 50 patients included from gynecology and lung cancers, and there were 41 patients included from the gastrointestinal cancers. Data analysis is still ongoing. 


Conclusion:
In Progress
 
Moderators
SC

Schylar Cheyenne Hathaway

Clinical Pharmacist
Special interest include Ambulatory Care and Women's Health.
Presenters
RS

Ramsey Shane

PGY1 Pharmacy Resident, Vanderbilt University Medical Center
Ramsey is a current PGY1 Pharmacy Resident at Vanderbilt University Hospital. Previously, she attended Samford University for pharmacy school where she earned her PharmD and MPH. She is staying at VUMC to complete a PGY2 in Hematology/Oncology next year.
Evaluators
avatar for Lacey Ioppolo

Lacey Ioppolo

PGY-1 RPD and Clinical Pharmacy Manager, Memorial Health University Medical Center
Lacey Ioppolo PharmD, BCCCP, is a Clinical Pharmacy Manager and PGY-1 Pharmacy Residency Program Director at Memorial Health University Medical Center in Savannah, GA. She obtained her Doctor of Pharmacy from The University of Florida in 2018 and completed her PGY-1 Pharmacy Residency... Read More →
Friday April 25, 2025 11:00am - 11:15am EDT
Olympia 2
  Oncology (ONC), Vanderbilt University Medical Center
  • global Y

11:20am EDT

Evaluating the Efficacy of a Standardized Diuretic Order Panel versus Provider-Prescribed Diuretic Dosing in Acute Decompensated Heart Failure (ADHF)
Friday April 25, 2025 11:20am - 11:35am EDT
Athena I
Evaluating the Efficacy of a Standardized Diuretic Order Panel versus Provider-Prescribed Diuretic Dosing in Acute Decompensated Heart Failure (ADHF)
Yanise Hurt, Jarvett Cox
 
 
Background: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization, often driven by fluid overload. Effective diuresis is critical 
to improving clinical outcomes in this population; however, variability in prescribing practices can lead to inconsistent care and suboptimal results. The 
implementation of a standardized Heart Failure Diuresis Panel offers an evidence-based approach to diuretic therapy, promoting consistent and effective fluid removal while potentially reducing hospital length of stay. This study aimed to evaluate the clinical outcomes of ADHF patients treated with diuretics using a standardized panel compared to those managed with individualized provider-prescribed dosing, focusing on its impact on hospital length of stay.
 
Methodology: This retrospective, single-center chart review included 168 adult patients admitted with a primary diagnosis of ADHF at Wellstar Cobb Medical Center between January 1, 2023, and December 31, 2023. Patients were stratified into two groups based on their diuretic management: those who 
received therapy guided by the standardized Heart Failure Diuresis Panel and those managed with provider-prescribed dosing. The primary endpoint of
 the study was hospital length of stay. Secondary endpoints included the mean time to transition from intravenous (IV) to oral diuretics, door-to-diuretic 
time, 30-day heart failure readmission rates, mean changes in urine output and body weight, and diuretic prescriptions at discharge. Data was extracted from electronic medical records through a computer-generated report, and statistical analyses were conducted using t-tests for continuous variables and chi-square tests for categorical variables to evaluate the impact of the standardized panel on clinical outcomes.
 
Results: In the comparison of patients managed with the Heart Failure Diuresis Panel versus provider-prescribed diuretic dosing, there was no significant difference in hospital length of stay (4.79 days vs. 4.75 days; P=0.47) or in the mean time to transition from IV to PO diuretics (68.9 hours vs. 68.4 hours; P=0.23). Similarly, door-to-diuretic time (7.1 hours vs. 7.7 hours; P=0.41), 30-day heart failure readmission rates (8.3% vs. 9.5%; P=0.79), and diuretic 
prescription rates at discharge (85.7% vs. 76.2%; P=0.35) did not differ significantly between groups. However, the panel group demonstrated significantly greater mean urine output at 24 hours (1,584 mL vs. 1,283 mL; P=0.048), indicating enhanced diuretic responsiveness, though no significant differences were observed at 2 or 48 hours. The mean change in body weight was comparable between groups both at 24 hours (0.86 kg vs. 0.50 kg; P=0.29) and at discharge (3.07 kg vs. 2.62 kg; P=0.35). Although the standardized panel did not significantly affect hospital length of stay or most secondary 
measures, it was associated with improved early diuretic efficacy as demonstrated by greater urine output within the first 24 hours.
 
Conclusion: The Heart Failure Diuresis Panel did not demonstrate a significant impact on primary or secondary outcomes, including hospital length of 
stay. However, the consistent administration of appropriate IV diuretic dosing by providers not utilizing the panel suggested that its core principles have been effectively integrated into routine clinical practice. These findings are consistent with the DOSE trial, which underscores the importance of optimized diuretic strategies for symptom relief and fluid management in heart failure. This presents an opportunity to improve provider adherence to these 
protocols, potentially further optimizing patient outcomes.
Moderators
AP
Presenters
avatar for Yanise Hurt

Yanise Hurt

PGY1 Resident, Wellstar Cobb Medical Center
My name is Yanise Hurt. I am a PGY1 Resident at Wellstar Cobb Medical Center, with a Doctor of Pharmacy degree from Philadelphia College of Osteopathic Medicine and a Master of Public Health from Georgia Southern University.
Evaluators
avatar for Robin Fischer

Robin Fischer

PGY1 Pharmacy Practice Resident, MRMC1McLeod Regional Medical CenterPGY1
Hello my name is Robin Fischer and I am one of the PGY1 pharmacy practice preceptors / mentors at McLeod Regional Medical Center. I am a retired deputy sheriff from Charleston County Sheriff's Office and I obtained a bachelor’s degree in Criminal Justice Administration. Once I retired... Read More →
Friday April 25, 2025 11:20am - 11:35am EDT
Athena I

11:20am EDT

Impact of a Remote Continuous Glucose Monitoring Service in an Ambulatory Care Setting
Friday April 25, 2025 11:20am - 11:35am EDT
Athena C
Title: Impact of a Remote Continuous Glucose Monitoring Service in an Ambulatory Care Setting
Authors: Alexa Williams, Matthew Holt, Ryan Cromer, TJ Henderson, Aayush Patel
Background: Continuous glucose monitoring (CGM) offers an alternative to the traditional self- monitoring blood glucose methods. Traditional methods, which may negatively impact patient satisfaction, cannot account for glycemic excursions and hypoglycemic unawareness. CGM provides more data points to assess glycemic variation and generates an ambulatory glucose profile (AGP) which provides calculated percentages of time in range (TIR), time below range (TBR), and time above range (TAR) for glucose levels in a measured time period as well as hourly. The reported glycemic trends can be used by providers to better understand the time and frequency glucose levels are out of the recommended range and customize diabetes regimens appropriately. At the Piedmont Columbus Family Medicine Center, many patients have begun using CGMs to share data with their providers. Based on glycemic trend data, providers can make informed decisions on customizing patient-specific regimens and continue to monitor their patient’s blood glucose levels closely. The purpose of this retrospective chart review was to compare the mean difference in A1c improvement between patients managed with remote CGM and those managed without this service in a multidisciplinary family medicine practice. 
Methods: A retrospective chart review was completed of patients with diabetes at Piedmont Columbus Family Medicine Center with a baseline A1c ≥7, comparing those utilizing CGMs with those not utilizing CGMs. Improvement in A1c was determined from the baseline A1c at the beginning of the study to the final A1c level recorded for each patient. The mean difference in A1c was determined from all patients within each group and the overall improvement in A1c between the control group and the treatment group was compared. The LibreView® and Dexcom Clarity® systems were used to store patient’s blood glucose levels from their CGM to determine TIR, TBR, and TAR within various date ranges. Baseline TIR, TBR, and TAR were determined at the beginning of the study time period and then again around the time of each A1c measured for each patient. Improvement in TIR, TBR, and TAR were determined from baseline to the final values measured at the end of the study. Data was collected from patients beginning on January 1, 2024 until February 28, 2025.
Results: There was a total of 78 patients included in the study, 39 patients that utilized CGM and 39 patients that did not utilize CGM. Baseline characteristics were similar between groups, with the largest difference seen in race and diabetes type. For the primary objective of mean difference in A1c, the CGM patients had a baseline A1c of 9.3% and a final A1c of 8.1% with an average reduction of 1.2% and the non-CGM patients had a baseline A1c of 8.0% and a final A1c of 6.7% with an average reduction of 1.3%. The mean difference in A1c was not statistically significant between groups. For secondary objectives, the CGM patients had a total baseline TIR of 53.8% and a final TIR of 57.2% with an average increase of 3.3%, a total baseline TBR of 0.5% and a final TBR of 0.6% with an average increase of 0.1%, and a total baseline TAR of 45.7% and a final TAR of 42.2% with an average reduction of 3.5%. These secondary objectives were not statistically significant. There was a total of 189 pharmacy interventions, 172 in the CGM group and 17 in the non-CGM group.
Conclusion: Continuous glucose monitoring offers an alternative to traditional finger stick monitoring, providing glucose trends and reports such as the ambulatory glucose profile including detailed analysis of time in, above, and below range. The impact of A1c was similar between groups, however the duration of patient inclusion for non-CGM patients was higher, offering more time for patients to better control their diabetes. While there was not a statistically significant difference seen between groups, average A1c was improved when utilizing a CGM, which may provide a good option for patients with uncontrolled diabetes.
Contact: alexa.williams@piedmont.org
Moderators
avatar for Devin Lavender

Devin Lavender

Clinical Assistant Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2
Ambulatory Care, Scholarship of Teaching and Learning, Resident and Student Development.
Presenters
avatar for Alexa Williams

Alexa Williams

PGY1 Pharmacy Resident, Piedmont Columbus Regional Midtown
PGY1 Pharmacy Resident at Piedmont Columbus Regional Midtown. Graduated from the University of Georgia College of Pharmacy. After residency, plans to continue pharmacy career in Atlanta, Georgia.
Evaluators
CW

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, Kaiser Permanente Georgia
Friday April 25, 2025 11:20am - 11:35am EDT
Athena C
  Ambulatory Care (AMB), Piedmont Columbus Regional Midtown
  • global Y

11:20am EDT

Operation Weight Loss: Impact of Pharmacist Guided Weight Loss Medication Management Service for Veterans
Friday April 25, 2025 11:20am - 11:35am EDT
Athena D
Title
Operation Weight Loss: Impact of a Pharmacist Guided Weight Loss Medication Management Service for Veterans
Authors
Amanda Collett-Burgdorf, Fayza Griffin, Brittney Howard
Practice Site
Fayetteville NC VA Coastal Health Care Center
BackgroundEvaluate the impact of a pharmacist-led weight loss medication management service in a Veteran population.MethodsThis was a retrospective, prospective quality improvement initiative. Eligible Veterans with verifiable participation in the comprehensive lifestyle intervention (CLI) provided by our facility, MOVE!, were prescribed one of the following five medications approved by the Food and Drug Administration for weight loss: naltrexone/bupropion, orlistat, phentermine/topiramate, semaglutide, or tirzepatide. Veterans were excluded if they were not established with a Department of Veterans Affairs (VA) primary care provider. Data was collected via the Computerized Patient Records System (CPRS).  Post-medication initiation, Veterans were assessed by a Clinical Pharmacist Practitioner (CPP) at 4-week intervals to assess tolerability and weight loss.  Results47 Veterans were included. 28 (59.57%) achieved ≥ 5% TWBL. 

By medication:
  • semaglutide (n=32): 59.38% achieved ≥5% TBWL, 90.63% ≥3% TBWL
  • tirzepatide (n=6): 83.33% achieved ≥5% TBWL
  • phentermine/topiramate (n=6): 50% achieved ≥5% TBWL
  • orlistat (n=2): 50% achieved ≥5% TBWL
  • naltrexone/bupropion (n=1): 0% achieved ≥3% TBWL
ConculsionsPharmacist-led medication management of anti-obesity medications appeared effective in achieving the primary endpoint of 5% TBWL or greater at 12 weeks after medication initiation. As anticipated, semaglutide and tirzepatide displayed the highest success rates. One limitation of this quality improvement initiative was the small sample sizes for some medications, namely the oral medication options.  The findings align with clinical trial data and highlight the role of pharmacists in optimizing weight loss therapy. Future initiatives may focus on assessing success rates beyond 3 months to identify the long-term benefit of a pharmacist-led weight management medication service. 





Moderators
avatar for Ashley Woodhouse

Ashley Woodhouse

SJCH2St. Joseph's/Candler Health System (Ambulatory)PGY2
Presenters
AC

Amanda Collett-Burgdorf

PGY1 Pharmacy Resident, Fayetteville NC VA Coastal Health Care System
Amanda Collett-Burgdorf, Pharm.D. is a PGY-1 Pharmacy Practice resident. She earned her Doctor of Pharmacy Degree from Campbell University College of Pharmacy & Health Sciences.  Upon completion of her residency, she aspires to obtain a position with the Department of Veterans Affairs... Read More →
Evaluators
avatar for Anne Warren
Friday April 25, 2025 11:20am - 11:35am EDT
Athena D
  Ambulatory Care (AMB), VA - Fayetteville, NC – Fayetteville VA Coastal Health Care System
  • global Y

11:20am EDT

Evaluation of Protamine Dosing Strategies Following Cardiopulmonary Bypass
Friday April 25, 2025 11:20am - 11:35am EDT
Athena B
EVALUATION OF PROTAMINE DOSING STRATEGIES FOLLOWING CARDIOPULMONARY BYPASS
Justine Bur, Amanda Sowder, Hetal Patel
AdventHealth Orlando-Orlando, FL


OBJECTIVE: Compare the impact of low, medium, or high protamine dosing on bleeding outcomes following cardiopulmonary bypass assisted cardiac surgery.


BACKGROUND: Protamine is used to reverse the anticoagulant effects of heparin after cardiopulmonary bypass (CPB). Improper dosing of protamine may lead to increased postoperative bleeding. Although it is paramount to have an appropriate protamine-to-heparin dosing ratio, evidence remains weak on guiding optimal dosing and inconsistencies exist between guidelines. At our institution, protamine dosing is routinely based off the initial heparin bolus. To our knowledge, no studies have compared protamine-to-heparin dosing ratios in otherwise healthy patients undergoing initial, elective CPB-assisted cardiac surgery. 


METHODS: A single centered, retrospective analysis was performed at a major tertiary referral hospital. Healthy adults aged 18 to 75 years old who underwent CPB-assisted coronary artery bypass graft or valve repair or replacement, with or without concomitant left atrial appendage ligation, MAZE, or myectomy were included. Exclusion criteria included chronic kidney disease or dialysis, liver dysfunction, hematologic disorders, pregnancy, or cancer. Patients were also excluded if they received non-packed red blood cell products in the operating room (OR). Primary endpoints included 24-hour chest tube output and 24-hour postoperative allogeneic transfusion requirements. Secondary endpoints included reintubation within 24 hours and operative re-exploration within 24 hours due to postoperative bleeding. All endpoints were measured after disposition from OR to the intensive care unit. Outcomes were evaluated based on low (<1:1), medium (1:1), and high (>1:1) protamine-to-heparin dosing ratios based on initial heparin and protamine boluses administered.


RESULTS: Seventy of the 267 patients screened between February 2023 and January 2025 were included in the analysis. Patients were median age 60 years, median BMI of 28.6 kg/m2 and 42 (60%) were male. At baseline, median pre-operative labs included: hemoglobin 13.6 g/dL, hematocrit 40.3%, platelets 240,000/μL, ACT 107 seconds, INR 1.0 and aPTT 29.6 seconds. Mitral valve replacement, 37 (53%), and repair, 15 (21%), were the most common cardiac surgeries. Median bypass time was 82 minutes. Median heparin and protamine boluses administered were 36,000 units and 320 mg, respectively. Protamine-to-heparin dosing ratios were characterized as follows: 32 (46%) patients comprised low, 28 (40%) comprised medium, and 10 (14%) comprised high. Twenty-four-hour chest tube output for low, medium, and high dose groups totaled 468, 530, and 850 mL, respectively (p=0.136). Of the 36% of patients who received transfusions, median total volume of transfusions for low, medium, and high dose groups were 506, 349, and 473 mL, respectively (p=0.936). No patients were reintubated due to postoperative bleeding within 24 hours and one patient in the high dose group returned to the OR for re-exploration for postoperative bleeding. Lastly, the median time to extubation of low, medium, and high dose groups was 226, 188, and 351 minutes, respectively (p=0.052).


CONCLUSION: This is the first study evaluating association of protamine-to-heparin dosing ratios with bleeding outcomes in otherwise healthy patients undergoing initial, elective CPB-assisted cardiac surgery. Despite the small sample size, there was a trend in increased post-operative 24-hour chest tube output as the protamine-to-heparin ratio increased. Although time to extubation did not statistically differ between groups, the greater time to extubation experienced by the high dose protamine group presents a clinically interesting finding for further exploration.


Presenters
JB

Justine Bur

PGY1 Pharmacy Resident, AdventHealth Orlando
Evaluators
AS
avatar for Laura Schalliol

Laura Schalliol

Residency Program Director, South College School of Pharmacy
Friday April 25, 2025 11:20am - 11:35am EDT
Athena B
  Cardiology (CAR), AdventHealth Orlando
  • global Y

11:20am EDT

Comparative Analysis of Sedation and Analgesia Requirements in Trauma Patients Presenting with a Positive Drug Toxicology Screen
Friday April 25, 2025 11:20am - 11:35am EDT
Athena H
    • Title: Comparative Analysis of Sedation and Analgesia Requirements in Trauma Patients Presenting with a Positive Drug Toxicology Screen 
    • Authors: Sydney Kermeen, Sarah Alimenti, Michael Honaker, Kenji Leonard, and Emily Whitehead
    • Objective: Compare analgesia and sedation requirements in trauma patients requiring intubation after presenting with a positive urine drug screen (UDS) and/or serum ethanol level to patients presenting with a negative toxicology screen.
    • Self Assessment Question: True or False: Due to impaired drug metabolism and increased drug tolerance, trauma patients acutely intoxicated with amphetamine, cocaine, PCP, MDMA, or ethanol may have higher opioid requirements during mechanical intubation?
    • Background: Pre-injury illicit substance use and intoxication are predictors of ICU admission and increased analgesia and sedation requirements in patients admitted to the hospital following traumatic injuries. Literature evaluating analgesia and sedation in patients presenting with a positive toxicology screen is limited and further research is warranted to guide treatment.
    • Methods: This was a single-center, retrospective, observational study including adult patients admitted to the surgical intensive care unit (SICU) who were intubated for at least 48 hours following a trauma and presented with either a positive urine drug screen (UDS) for cannabinoids, cocaine, amphetamines, phencyclidine, ecstasy and/or elevated serum ethanol level within the first 24 hours of admission.  Patients were excluded if they had withdrawal of care or were transferred out of the SICU within 48 hours of admission, utilized short acting opiates for at least 30 days or long-acting opiates as a home medication, had a pre-diagnosed psychiatric illness, or utilized pentobarbital, chemical paralysis, or extracorporeal membrane oxygenation during the study period. The control group included patients presenting with both a negative UDS and serum ethanol level. There were two comparator groups: group 1 with both a positive UDS and serum ethanol level, and group 2 with a positive UDS and negative serum ethanol level. The primary outcome was median daily dose of opioid requirements in morphine milligram equivalents until extubation, transfer from SICU, or 30 days. Some of the secondary outcomes included mean daily benzodiazepine use, mean daily dose of continuous sedation, utilization of adjunctive analgesia and sedation agents, length of mechanical ventilation, average daily pain scores, and percentage of time within goal sedation.
    • Results: A total of 151 patients were included in the analysis, with 50 patients each in the UDS(-)/EtOH(-) and USD(+)/(-) groups and 51 patients in the UDS(+)/EtOH(+) group. Baseline characteristics and patient demographics between groups were similar between groups. There were no differences in median daily MME, LME, dexmedetomidine, or ketamine use between groups; however, intoxicated patients in the UDS(+)/EtOH(+) and UDS(+)/EtOH(-) used a significantly higher median dose of propofol (30.9 [21.5, 36.7] and 33.9 [22.7, 50.0]  vs 33.9 [13.7, 33.6] mcg/kg/min). UDS(+)/EtOH(+) and UDS(+)/EtOH(-) groups also used more adjunctive agents (66.7 % and 82.0% vs 46.0%, p=0.0008) and ERAS medications (45% and 47% vs 46%, p=0.0028). Additionally, intoxicated patients achieved lower RASS levels on continuous sedation compared to non-intoxicated patients (-1 [-2.0, 1.0] and -1 [-2.0, 1.0] vs -2 [-2.8, 1.0]). Of note, the incidence of mortality was higher in the non-intoxicated group (7% and 1% vs 11%, p=0.0101). There were no differences in duration of intubation, BPS scores, ICU LOS, hospital LOS, self extubation, or trach placement.
    • Conclusion: Mechanically-ventilated patients with a positive UDS and/or serum ethanol level may not have higher MME or LME requirements. However, multimodal adjunctive analgesia and sedation methods may be warranted.

       sydney.kermeen@ecuhealth.org


Moderators
avatar for Maggie Goode

Maggie Goode

Critical Care Pharmacist, Mobile Infirmary Medical Center
.
Presenters
avatar for Sydney Kermeen

Sydney Kermeen

PGY2 Critical Care Resident, ECU Health Medical Center
Sydney Kermeen is originally from Memphis, Tennessee. She received her Bachelor of Science in Chemical Engineering from Christian Brothers University and attended The University of Tennessee Health Science Center College of Pharmacy where she received her Bachelor of Science in Pharmaceutical... Read More →
Evaluators
MM
Friday April 25, 2025 11:20am - 11:35am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), ECU Health Medical Center
  • global Y

11:20am EDT

Comparative Effects of 3% Sodium Chloride Continuous Infusion Versus Intermittent Boluses on Renal Outcomes
Friday April 25, 2025 11:20am - 11:35am EDT
Athena G
Title: Comparative Effects of 3% Sodium Chloride Continuous Infusion Versus Intermittent Boluses on Renal Outcomes


Authors: Abbygail Wilbourn, Braiden Sorgenfrei, Alex Ewing, Jenna Sorgenfrei, Michael Wagner


Objective: Identify hypertonic saline administration that leads to decreased adverse renal outcomes while achieving target serum sodium levels for intracranial pressure management.


Self Assessment Question: What strategy does the 2024 American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) guidelines recommend for ICP management in TBI?


Background: Cerebral edema, often resulting from traumatic brain injury (TBI), can lead to elevated intracranial pressure (ICP), which is associated with poorer outcomes. American College of Surgeons and Neurocritical Care Society guidelines recommend hyperosmolar therapy, such as hypertonic saline or mannitol, for managing elevated ICP; however, these guidelines primarily focus on bolus dosing, with limited data on continuous infusion strategies. This study aims to evaluate whether intermittent bolus therapy reduces the incidence of acute kidney injury (AKI) compared to continuous infusion of hypertonic saline, with the goal of improving safety and informing best practices for hyperosmolar therapy at a 864-bed academic medical center in South Carolina, USA.


Methods: This single-center, retrospective study at a 864-bed academic medical center in South Carolina, USA assessed trauma patients admitted to the ICU between January 2022 and December 2023 who received either intermittent boluses or continuous infusion of 3% sodium chloride for suspected elevated intracranial pressure (ICP). Primary outcomes included the combined incidence of acute kidney injury (AKI), hyperchloremia, and metabolic acidosis within 7 days, while secondary outcomes focused on individual complications, time to serum sodium goals, and major renal events. Data were collected through chart review and stored in REDCap, with approval from the institution’s IRB.


Results: A total of 88 patients were included (61 continuous infusion, 27 bolus). Continuous infusion patients were younger and had longer ICU stays (6.8 vs 4.8 days, p=0.02), though hospital stays were similar. Hypertonic saline exposure was higher in the continuous group, particularly on days 2–3 (p<0.001). The combined incidence of acute kidney injury, hyperchloremia, and metabolic acidosis was significantly higher in the continuous group (91.8% vs 66.7%, p=0.009), mainly due to hyperchloremia (p=0.002). Multivariate analysis confirmed infusion method as a significant predictor (aOR 0.19, p=0.03). Switching to sodium acetate occurred in 38 patients, more commonly in the infusion group but not statistically significant. Those who switched had higher hyperchloremia incidence after day 4 (p=0.0009). No differences were found in secondary outcomes.


Conclusion: Bolus therapy achieved similar time to target sodium levels while resulting in fewer electrolyte-related complications—particularly hyperchloremia—and a lower combined incidence of kidney injury, hyperchloremia, and metabolic acidosis compared to continuous infusion. These findings suggest that bolus therapy may be a safer and more favorable strategy for hypertonic saline administration.
Presenters
avatar for Abbygail Wilbourn

Abbygail Wilbourn

PGY-2 Critical Care Pharmacy Resident, Prisma Health-Upstate
Abbygail Wilbourn is a native of Auburn, Alabama. She earned her Bachelor of Science in Biology from Birmingham-Southern College before attending the University of Kentucky, where she completed both her Doctor of Pharmacy and Master of Science in Pharmaceutical Sciences degrees. Dr... Read More →
Evaluators
avatar for Blake Johnson
MH
Friday April 25, 2025 11:20am - 11:35am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Prisma Health-Upstate
  • global Y

11:20am EDT

Impact of an Antimicrobial Stewardship Bundle on the Treatment of Urinary Tract Infections in Older Adults
Friday April 25, 2025 11:20am - 11:35am EDT
Athena A
Title: Impact of an Antimicrobial Stewardship Bundle on the Treatment of Urinary Tract Infections in Older Adults
Authors: Elly R. Sherman, PharmD; Maria Muehrcke, PharmD, MBA, BCPS; Laura Bobbitt, PharmD, BCIDP
Objective: To assess how antimicrobial prescribing changed after the implementation of a geriatrics-specific antimicrobial stewardship bundle
Background: Urinary tract infections (UTIs) are a common indication for hospital admission in geriatric patients. However, these infections are often misdiagnosed, especially in patients with altered mental status. The risks of overtreating UTIs include the development of antimicrobial resistance and adverse drug effects, including C. difficile colitis. Many institutions, including Vanderbilt University Hospital (VUH), have implemented antimicrobial stewardship initiatives in response to these risks. This retrospective, single-center analysis aims to assess how antimicrobial prescribing changed after the implementation of a geriatrics-specific antimicrobial stewardship bundle at VUH. 
Methods: Included patients were ≥65 years of age, admitted to the geriatrics teaching service, and had a urinalysis ordered during admission. Patients with a neurogenic bladder, altered urologic anatomy, concomitant infection, who were receiving antibiotics immediately prior to admission, were neutropenic, or transitioned to comfort care within 48 hours of admission were excluded. The primary outcome was days of antimicrobial therapy per 1000 patient days. Secondary outcomes included rates of discontinuation of antibiotic therapy in asymptomatic bacteriuria, duration of therapy, rates of C. difficile colitis within 90 days, and proportion of patients with an inappropriate UTI diagnosis.
Results: In progress
Conclusions: In progress
Moderators
BK

Brian Knott

Clinical Pharmacy Supervisor, AdventHealth Winter Park
Presenters
avatar for Elly Sherman

Elly Sherman

PGY1 Pharmacy Resident, Vanderbilt University Medical Center
Elly is a current PGY1 Pharmacy Resident at Vanderbilt University Medical Center in Nashville, TN and will be staying on to complete her PGY2 in Infectious Diseases. She completed her undergraduate coursework and Doctor of Pharmacy degree at the University of Georgia and is excited... Read More →
Evaluators
CL
Friday April 25, 2025 11:20am - 11:35am EDT
Athena A
  Infectious Disease (ID), Vanderbilt University Medical Center
  • global Y

11:20am EDT

Blood Glucose Control in Post-Coronary Artery Bypass Graft (CABG) Patients
Friday April 25, 2025 11:20am - 11:35am EDT
Parthenon 1
Title: Blood Glucose Control in Post-Coronary Artery Bypass Graft (CABG) Patients


Authors: Elise M. Richoux, Leslie A. Hamilton, Heather Wallhauser, Rachael Samples, Taylor Bird, Robert E. Heidel, Travis Fleming


Objective: The objective of this study was to evaluate the median of time within goal blood glucose range following CABG surgery while receiving a continuous insulin infusion in groups before and after an insulin protocol change.


Presentation Objective: Evaluate the impact and incidence of goal blood glucose attainment in patients post-CABG on a continuous insulin infusion before and after an insulin protocol change.


Self Assessment Question: Which statement best describes the impact of hyperglycemia during and after cardiac surgery?
 
Background: Hyperglycemia following cardiac procedures is common. This is likely due to surgical stress triggering catecholamine and cortisol release, along with intraoperative hypothermia induced during cardiopulmonary bypass, which stimulates sympathetic activity. Elevated blood glucose levels during the intra-operative and post-operative period of cardiac surgery is associated with an increased risk of mortality in patients with and without diabetes as well as prolonged ventilator times, atrial fibrillation, and delirium. Controlling blood glucose levels can mitigate consequences such as prolonged ventilation, delayed sternal wound healing, and risk of mortality in patients with and without diabetes. Existing literature has inconsistency in blood glucose targets relative to observed outcomes, prompting consideration of the optimal level of glycemic control for post-CABG patients. More recently, the Society of Thoracic Surgeons (STS) published consensus statements on perioperative cardiac care which included a goal blood glucose range of 140-180mg/dL once an insulin infusion is initated. A protocol change implemented in August 2023 for cardiothoracic surgery patients replaced the previous insulin drip titration method, based on a multiplier and a blood glucose goal of 110-139 mg
Moderators
avatar for Matt Conley

Matt Conley

Pharmacy Informatics Specialist, AdventHealth
Presenters
ER

Elise Richoux

PGY-1 Pharmacy Resident, University of Tennessee Medical Center
Dr. Richoux grew up in Luling, Louisiana. She completed her pre-pharmacy education at the University of Louisiana at Lafayette and attended Samford University McWhorter School of Pharmacy where she received a Bachelor of Science in Pharmacy Studies and a Doctor of Pharmacy degree... Read More →
Evaluators
EM
Friday April 25, 2025 11:20am - 11:35am EDT
Parthenon 1
  Internal Medicine (IM), University of Tennessee Medical Center
  • global Y

11:20am EDT

The Use of Direct Oral Anticoagulants in the Setting of Acute Kidney Injury and the Incidence of Bleeding
Friday April 25, 2025 11:20am - 11:35am EDT
Parthenon 2
TITLE: The Use of Direct Oral Anticoagulants in the Setting of Acute Kidney Injury and the Incidence of Bleeding   AUTHORS: Marion Javellana; Kyle Furlow; Nicole Metzger; Kayla Ann Phillips; Manila Gaddh; Ananth Vadde; Anna Crider; Amanda Van Prooyen; Carrie Callahan

OBJECTIVE: To determine if using direct oral anticoagulants (DOACs) in patients with acute kidney injury (AKI) increases bleeding events.

SELF ASSESSMENT QUESTION: Which of the following was the primary outcome measured in this study? A) Hospital length of stay (LOS) B) Major bleeding events C) 30-day all-cause readmissions
Moderators
BJ

Brook Jacobs

Clinical Coordinator, Critical Care Clinical Specialist, Emory Decatur Hospital
Presenters
avatar for Marion Javellana

Marion Javellana

PGY2 Internal Medicine and Chief Pharmacy Resident, Emory Univeristy Hospital
Dr. Marion Javellana is the current PGY2 Internal Medicine and Chief Pharmacy Resident at Emory University Hospital in Atlanta, GA. She received both her Bachelor of Science in Pharmaceutical Sciences and Doctor of Pharmacy from Mercer University College of Pharmacy and completed... Read More →
Evaluators
EI
Friday April 25, 2025 11:20am - 11:35am EDT
Parthenon 2
  Internal Medicine (IM), Emory University Hospital
  • global Y

11:20am EDT

Reduced Corticosteroid Dosing in Pediatric Renal Transplant Patients
Friday April 25, 2025 11:20am - 11:35am EDT
Olympia 2
Title: Reduced Corticosteroid Dosing in Pediatric Renal Transplant Patients
 
Authors: Alexander Durant, Aubrey Slaughter, Bailey Horne


Objective: To investigate the effects of maintenance corticosteroid dose reduction on blood pressure, hemoglobin A1c, and bone mineral density in pediatric renal transplant patients.
 
Background: Renal transplantation requires immediate and chronic immunosuppression to avoid acute organ rejection, which can compromise the integrity of the transplanted organ and be fatal. Consequently, a lifelong immunosuppressive regimen is required for all renal transplant recipients. One integral component of the backbone immunosuppressive regimen is corticosteroid therapy. In pediatric patients, there is a notable lack of data evaluating the deleterious effects associated with chronic corticosteroid therapy post-renal transplantation, as pediatric patients are often excluded from clinical trials and are consequently underrepresented in the literature. Wellstar MCG Health has recently transitioned from using prednisone or prednisolone doses of 0.1 mg/kg/day to 0.05 mg/kg/day, representing a 50% dose reduction in maintenance corticosteroid therapy. The purpose of this chart review is to investigate the effects of maintenance corticosteroid dose reduction on blood pressure, hemoglobin A1c, and bone mineral density in pediatric renal transplant patients.


Methods: This single-center, observational chart review included pediatric patients followed in the Wellstar MCG Health pediatric renal transplant clinic between 01/01/2022 and 12/31/2024. Exclusions included patients undergoing treatment for renal transplant rejection and patients no longer followed at the pediatric renal transplant clinic. The primary outcomes included a reduction in antihypertensive dosage or number of antihypertensive agents, an improvement in hemoglobin A1c or reduction in hyperglycemic agent dosage, and an improvement in BMD Z-score above -2.0 or a ≥20% improvement from baseline. Data analysis will utilize descriptive statistics for a non-parametric data set (e.g., median, IQR).


Results: A total of 13 patients were included in this chart review. The median patient age was 17 years. There were no notable differences between pre-reduction and post-reduction median systolic or diastolic blood pressure measurements or Z-scores. Dose reduction appeared to be associated with a decrease in median A1c of approximately 0.15 mg/dL. Corticosteroid dose reduction was also linked to a decrease in the number of prescribed osteoporosis medications in 57% of patients. The reduction had little impact on the number of prescribed anti-hypertensive and hyperglycemic agents prescribed per patient.


Conclusions: Corticosteroid dose reduction may contribute to improved glycemic control and a decrease in the number of osteoporosis medications prescribed per renal transplant patient. However, this review did not find a corresponding improvement in bone mineral density or blood pressure readings following the dose reduction.
Moderators
SC

Schylar Cheyenne Hathaway

Clinical Pharmacist
Special interest include Ambulatory Care and Women's Health.
Presenters
avatar for Alexander Durant

Alexander Durant

PGY-1 Pharmacy Resident, Wellstar MCG Health
I am a PGY1 resident at Wellstar MCG Health and am the early-commit resident for the Oncology PGY-2 position at Wellstar MCG Health. I graduated from the University of Georgia in 2024.
Evaluators
avatar for Lacey Ioppolo

Lacey Ioppolo

PGY-1 RPD and Clinical Pharmacy Manager, Memorial Health University Medical Center
Lacey Ioppolo PharmD, BCCCP, is a Clinical Pharmacy Manager and PGY-1 Pharmacy Residency Program Director at Memorial Health University Medical Center in Savannah, GA. She obtained her Doctor of Pharmacy from The University of Florida in 2018 and completed her PGY-1 Pharmacy Residency... Read More →
Friday April 25, 2025 11:20am - 11:35am EDT
Olympia 2
  Oncology (ONC), Wellstar MCG Health Medical Center
  • global Y

11:40am EDT

Evaluating the impact of a pharmacist-driven osteoporosis screening and treatment program in women veterans at the Birmingham VA Health Care System (BVAHCS)
Friday April 25, 2025 11:40am - 11:55am EDT
Athena I
Title: Evaluating the impact of a pharmacist-driven osteoporosis screening and treatment program in women veterans at the Birmingham VA Health Care System (BVAHCS)



Authors: Sara Chirambo; Lisa Ambrose



Objective: 
The purpose of this quality improvement project is to evaluate the effectiveness of
pharmacist-led interventions using the VA Osteoporosis Screening Dashboard to enhance the
identification of osteoporosis/osteopenia in patients seen in the Women's Health clinic at BVAHCS.


Self Assessment Question: 
What is the impact of pharmacist intervention in osteoporosis screening?


Background:  
Osteoporosis is a common chronic bone disease characterized by low bone mass and
deterioration of bone structure. It predominantly affects women, with higher prevalence
compared to men. Bone mineral density (BMD) peaks in early adulthood and declines with
age, increasing fracture risk. The USPSTF and National Osteoporosis Foundation recommend
routine screening for women aged 65 and older, typically using dual energy x-ray
absorptiometry (DEXA). Despite guideline recommendations, screening rates for osteoporosis
remain low. This project aims to evaluate whether the use of the VA Osteoporosis Screening
Dashboard by pharmacists improves identification of osteoporosis/osteopenia at the Birmingham VA.




Methods:
- Patients without a DEXA scan will be identified via the VA Osteoporosis Screening Dashboard
- Patients identified on dashboard will be reviewed and eligibility will be confirmed via chart review
- Pharmacists will communicate screening recommendations with patient 
- Pharmacists will place order for DEXA scan with patient consent
- DEXA scan will be scheduled through Medical Support Assistants (MSAs) at the Birmingham VA
- Pharmacists will contact patients to discuss DEXA/FRAX results and counsel patients on lifestyle modifications to reduce risk of osteoporosis. If patients are confirmed to have osteoporosis/osteopenia, treatment will be initiated by PharmD provider


Inclusion Criteria:
- Women aged 65 years and older
- No prior history of receiving DEXA scan in Computerized Patient Record System (CPRS)
- Patients followed by a provider in Women’s Health clinic


Exclusion Criteria:
- Patients currently receiving pharmacotherapy for osteoporosis or osteopenia
- Patients previously diagnosed with osteopenia or osteoporosis


Results:
The pharmacist-led osteoporosis screening initiative at the Birmingham VA Women's Clinic demonstrated a positive impact on patient care. 47/80 patients were reached by phone and of those 47, 33 patients were interested in a DXA screening. 57% patients reached who were interested scheduled a DXA scan. The pharmacist's outreach efforts, supported by the use of an osteoporosis dashboard created by the VISN7 VA Academic Detailing team resulted in an increase in screening rates compared to baseline. The intervention achieved a high patient acceptance rate, suggesting that direct pharmacist engagement encouraged participation.


Conclusion:
This quality improvement (QI) project highlights the value of pharmacist intervention in advancing preventative health measures within the VA healthcare system, specifically within women's health. By proactively identifying patients in need of screening and facilitating access to care, pharmacists played a role in increasing osteoporosis screening rates among older female veterans. 
Moderators
AP
Presenters
SC

Sara Chirambo

PGY1 Pharmacy Resident, Birmingham VA Health Care System
Sara was born in Malawi, Africa and raised in Mobile, AL.  She received her Bachelor of Science in Public Health at the University of Alabama at Birmingham in 2020 and achieved her Doctor of Pharmacy at the Auburn University Harrison College of Pharmacy in 2024.  Her clinical interests... Read More →
Evaluators
avatar for Robin Fischer

Robin Fischer

PGY1 Pharmacy Practice Resident, MRMC1McLeod Regional Medical CenterPGY1
Hello my name is Robin Fischer and I am one of the PGY1 pharmacy practice preceptors / mentors at McLeod Regional Medical Center. I am a retired deputy sheriff from Charleston County Sheriff's Office and I obtained a bachelor’s degree in Criminal Justice Administration. Once I retired... Read More →
Friday April 25, 2025 11:40am - 11:55am EDT
Athena I

11:40am EDT

Diabetes Outcomes of Patients Followed by Embedded Pharmacists in Primary Care Clinics
Friday April 25, 2025 11:40am - 11:55am EDT
Athena D
Title: Diabetes Outcomes of Patients Followed by Embedded Pharmacists in Primary Care Clinics


Authors: Cassie Twisdale, Amy Robinson, Danielle Land, Alex Ewing 


Objective: Identify diabetes outcomes and early impacts of having embedded pharmacists in primary care clinics


Self Assessment Question: Which of the following were early impacts within 3-6 months of having pharmacists manage diabetes in primary care clinics?
A) Significant lowering of A1c
B) Close follow up with phone visits
C) Increased prescribing of GLP-1 agonists
D) All of the Above


Background: The American Diabetes Association supports the use of a collaborative, multidisciplinary team approach to improve patient care when managing diabetes. Pharmacists ensure patients are on optimal guideline directed medical therapy, provide patient education, and monitor with close follow-up to allow for quicker dose escalations. Prisma Health recently embedded clinical pharmacists into two additional primary care clinics. This study will assess the pharmacists’ impact on quality of care by comparing diabetes outcomes of patients managed by newly embedded clinical pharmacists to diabetes outcomes of patients managed exclusively by providers.  


Methods: A multicenter, observational, retrospective cohort study was conducted examining adults 18 years of age or older with a diagnosis of diabetes and a hemoglobin A1c (A1c) above 8%. Patients in the pharmacist intervention group were referred to the PharmD between December 2023 to March 2024 and were required to have at least two interactions with the pharmacists during the study period. Comparator clinics were two primary care clinics within the health system that did not have an embedded pharmacist but were of similar size and patient demographics to the investigated clinics. Patients meeting inclusion criteria from the comparator clinics were randomly selected for analysis using a random number generator. The primary outcome was the reduction in A1c from baseline to next A1c three to six months later. Secondary outcomes include percent of patients on a continuous glucose monitor (CGM), number of CGM touchpoints or interpretations, number of visits during study period, use of evidence-based therapies, emergency room or hospital admissions related to diabetes care, weight loss, and number of patients assisted with medication access issues.  


Results: A total of 98 patients were included in the IRB-approved study with 49 patients in the pharmacist intervention group and 49 patients in the comparator primary care provider group. Baseline characteristics were similar between groups. The pharmacist group had a change in A1c from 9.97% to 7.83% at 3-6 months while the provider group had change in A1c of 9.51% to 9.36% at 3-6 months. A significant difference was found with the pharmacist group lowering A1c by 2.14% compared to the provider group lowering by 0.15% (p<0.001). Secondary outcomes of phone encounters, medication adjustment, continuous glucose monitor use, and assistance with medication access were statistically significant (p<0.001 for all). Pharmacists also initiated more GLP-1 RAs compared to provider (20 additional patients vs 1 additional patient, p<0.001). In patients with cardiovascular disease, pharmacists also had significantly more patients on a GLP-1 RA compared to the provider group (68.42% vs 11.76%, p=0.002) No significant differences were found between groups with SGLT-2 inhibitor use, emergency room or hospital admissions related to diabetes care or weight loss.


Conclusion: Pharmacist management of type 2 diabetes significantly lower A1c.  Pharmacists were able to provide closer follow up and assist with more medication access and continuous glucose monitor assessment than primary care providers. The early impacts of pharmacist management of diabetes can help to provide additional justification of more pharmacists in the primary care setting. Additionally, the impacts of pharmacists on diabetes outcomes help to support an automatic referral to pharmacists for patients with uncontrolled diabetes.
Moderators
avatar for Ashley Woodhouse

Ashley Woodhouse

SJCH2St. Joseph's/Candler Health System (Ambulatory)PGY2
Presenters
avatar for Cassandra Twisdale

Cassandra Twisdale

PGY1 Ambulatory Care Pharmacy Resident, Prisma Health Upstate
Cassie is currently a PGY1 Ambulatory Care Pharmacy Resident at Prisma Health Upstate in Greenville, SC. She received her bachelor’s degree in Biochemistry from Washington and Lee University. At the University of North Carolina, she received her Doctor of Pharmacy and a graduate... Read More →
Evaluators
avatar for Anne Warren
Friday April 25, 2025 11:40am - 11:55am EDT
Athena D
  Ambulatory Care (AMB), Prisma Health-Upstate
  • global Y

11:40am EDT

Impact of Pharmacist-Led Intervention on Maintenance Inhaler Appropriateness in COPD Exacerbations
Friday April 25, 2025 11:40am - 11:55am EDT
Athena B
Impact of Pharmacist-Led Intervention on Maintenance Inhaler Appropriateness in COPD Exacerbations  
Kaysey Gilchrist, Emily Cooley, Taylor Wells, Danielle McGlynn, Michael Pitt
Background: Chronic Obstructive Pulmonary Disease (COPD) exacerbations are associated with worsening outcomes, including repeat hospital admissions. The Centers for Medicare and Medicaid created a Hospital Readmissions Reductions Program, which financially penalizes hospitals for excessive 30-day readmission rates of certain conditions, including COPD. Previous literature has indicated that pharmacists are uniquely positioned to identify interventions for COPD therapy optimization based on knowledge of clinical guidelines and insurance formularies. However, this study did not describe the implementation of pharmacist led transitions of care initiatives for patients with COPD. The purpose of this study was to identify the impact of pharmacist-led interventions in COPD patients prior to discharge on 30-day hospital readmission rates for COPD by evaluating appropriate maintenance inhaler therapy.
Methods: In July 2024, a new transitions of care service was implemented at Cape Fear Valley Medical Center (CFVMC) which enabled pharmacists to review patients admitted for a COPD exacerbation and send recommendations to the attending provider for optimization of maintenance inhaler regimens before discharge. Adult patients admitted to CFVMC between March 1, 2024 – June 30, 2024 (pre-intervention) and October 1, 2024 – January 31, 2025 (post-intervention) with a primary diagnosis of COPD exacerbation identified by ICD 10 and DRG diagnosis codes were retrospectively reviewed in this single-center study. The primary endpoint was to compare the percentage of patients admitted for COPD exacerbation who are discharged on appropriate maintenance inhaler therapy regimens pre- and post-pharmacist-led intervention. 
Results: A total of 146 hospital encounters were included in the study with 59 hospital encounters in the pre-intervention group and 87 hospital encounters in the post-intervention group. Of the 146 hospital encounters included in the study, 32 regimens (54%) were appropriate at discharged in the pre-intervention phase compared to 67 (77%) in the post-intervention phase (P=0.004). The rate of 30-day hospital readmissions was lower in the post-intervention group compared to the pre-intervention group (19.5% vs 37.3%; P = 0.02).
Conclusions reached to date: This study provides further evidence to confirm the positive impact of pharmacist-led interventions on the provision of guideline-directed maintenance inhaler therapy in patients with COPD prior to discharge from a community teaching hospital. 
Presenters
KG

Kaysey Gilchrist

PGY1 Community-Based Pharmacy Resident, Cape Fear Valley Health System
PGY1 Community-Based Pharmacy Resident
Evaluators
AS
avatar for Laura Schalliol

Laura Schalliol

Residency Program Director, South College School of Pharmacy
Friday April 25, 2025 11:40am - 11:55am EDT
Athena B
  Community Pharmacy (CP), Cape Fear Valley Health System
  • global Y

11:40am EDT

Angioedema Resolution: Evaluation of Low Dose and High Dose Steroids
Friday April 25, 2025 11:40am - 11:55am EDT
Athena H
Title: Angioedema Resolution: Evaluation of Low Dose and High Dose Steroids
Authors: Cristina V. Martinez, Evan C. Hardbeck, Nicholas Filk, Neha Naik, Maria C. CreelBulos, Jasleen K. Bolina 


Background: According to the Centers for Disease Control, angioedema affects approximately 110,000 patients annually in the United States. Angioedema is characterized by self-limited swelling of the mucosal tissues in the face and larynx. It can become life-threatening if airway obstruction occurs, requiring prompt emergency care. Angioedema can be classified as either hereditary or acquired. In hereditary cases, swelling occurs due to a bradykinin response, whereas in acquired cases, it is triggered by a histamine response. Bradykinin-mediated angioedema is initially treated with a C1- esterase inhibitor, while histamine-mediated angioedema is managed with corticosteroids, antihistamines, and epinephrine. While corticosteroids are commonly used to treat angioedema there is a notable gap in current literature on optimal dosing strategies. This retrospective review aims to evaluate steroid use in angioedema patients by comparing low dose and high dose regimens to elucidate current practices, trends, and outcomes in symptom resolution.


Methods: This multicenter, retrospective, observational study included patients aged 18 years or older, diagnosed with angioedema, who received more than one dose of corticosteroids over a two-year period. Patients were excluded from the study if they were known to be pregnant or incarcerated. Patients were stratified into four groups based on their initial steroid agent and the secondary steroid treatment to which they were transitioned. Groups 1 and 2 received an initial high dose of steroids followed by a low dose in Group 2 or remained on high dose in Group 1. Groups 3 and 4 received an initial low dose followed by a high dose in Group 3 or remained on a low dose in Group 4. High dose was defined as an equivalent dose of hydrocortisone equal or greater to 250 mg. The primary objective of this study was resolution of angioedema, defined as discontinuation or de-escalation of steroid therapy, de-escalation of oxygen therapy, or documentation of resolution of symptoms. Secondary objectives included adjuvant angioedema treatments used, oxygen requirements over two days, incidence of intubation, hospital length of stay, ICU length of stay, and adverse effects including infection and hyperglycemia post steroid initiation.


Results: A total of 66 patients were categorized into four groups based on initial and subsequent steroid doses. The median time to angioedema resolution in the high dose to high dose group (Group 1) and the high dose to low dose group (Group 2) was 2 days. The low dose to high dose group (Group 3) had the shortest resolution time, with a median time of one day. In the low dose to low dose group (Group 4), the median time to resolution was 2.5 days. Group 1 included all patients who required intubation, accounting for 15% of the total study population. ICU length of stays was longest at 3 days in Group 1 followed by 2.5 and 1.5 days in Group 2 and 4 respectively. Additionally, patients in the higher dose regimen groups experienced higher rates of hyperglycemia and infection when compared to regimens with lower doses.


Conclusion: This study highlights the gap in current guidance for the use of corticosteroid dosing strategies for angioedema. While high dose regimens are commonly used, practitioners should assess patient specific factors due to increased risk of adverse effects with higher dosing regimens. Transitioning to lower doses may provide a safer and equally effective alternative. This area of practice calls for future research to develop standardized guidelines to optimize corticosteroid use in angioedema treatment, ensuring both efficacy and safety for patients.
Moderators
avatar for Maggie Goode

Maggie Goode

Critical Care Pharmacist, Mobile Infirmary Medical Center
.
Presenters
CM

Cristina Martinez

PGY1 Pharmacy Resident, Emory University Hospital
Cristina Martinez is originally from Miami, FL. She earned both her Bachelor of Public Health and Doctor of Pharmacy degrees from the University of Florida in Gainesville. She is currently a PGY1 Pharmacy Resident at Emory University Hospital in Atlanta, Georgia. Her professional... Read More →
Evaluators
MM
Friday April 25, 2025 11:40am - 11:55am EDT
Athena H
  Critical Care/Emergency Medicine (CCM), Emory University Hospital
  • global Y

11:40am EDT

Evaluating the Safety and Efficacy of Vasopressin in Patients with Hemorrhagic Shock
Friday April 25, 2025 11:40am - 11:55am EDT
Athena G
Title: Evaluating the Safety and Efficacy of Vasopressin in Patients with Hemorrhagic Shock


Authors: Amanda Fisher, Martin Gordon, Sarah Frye


Objective: Evaluate the safety and efficacy of vasopressin on blood and fluid requirements in hemorrhagic shock.


Self-Assessment Question: True or false: In this study, patients who received vasopressin had significantly lower requirements of blood products compared to those who did not receive vasopressin.


Background: Hemorrhagic shock is associated with a high rate of mortality in the first 24 hours following injury. Management includes stopping the bleeding, aggressive fluid resuscitation, and preventing hypotension. Complications of fluid resuscitation include increased bleeding, acute respiratory distress (ARDS), hemodilution, and hypothermia. There is controversy over whether early initiation of vasopressors can reduce fluid requirements and restore hemodynamics. Arginine vasopressin (AVP) is a neuropeptide that is secreted in response to hypotension by the posterior pituitary. It is essential in maintaining vasomotor tone in hypovolemic and septic shock, and secretion is associated with vasoconstriction. In hemorrhagic shock, patients are at risk of AVP deficiency in the first 48 hours of injury. While not currently recommended by the Advanced Trauma Life Support guidelines, vasopressors can be used when blood pressure is unable to be maintained despite volume resuscitation and are addressed in the European guidelines. This study is designed to compare vasopressin used adjunctly with a catecholamine vasopressor to a catecholamine vasopressor alone on the cumulative volume of blood products infused in a 48-hour period in trauma patients admitted with hemorrhagic shock.


Methods: This was a single center, retrospective, cohort study that evaluated the safety and efficacy of utilizing vasopressin with catecholamine vasopressors on the cumulative volume of blood products in patients with hemorrhagic shock. Included patients had a diagnosis of hemorrhagic shock, received catecholamine vasopressors, and were treated in an adult critical care unit from January 2020 to January 2024.Patients were excluded if they received CPR on arrival or immediately prior to hemorrhagic shock diagnosis, those with “do not resuscitate” orders at the time of diagnosis, and those who had hemorrhagic shock due to a gastrointestinal bleed. The primary outcome of the study was the cumulative volume of blood products infused within 48 hours after diagnosis of hemorrhagic shock. Secondary outcomes included cumulative volume of crystalloid fluids, total vasopressor requirements, ICU length of stay, and 30-day mortality.


Results: A total of 63 patients met inclusion criteria with 15 patients in the vasopressin group and 48 in the vasopressor only group. Patients in the vasopressin group received 10 units of blood compared to 12 units of blood in the vasopressor only group (p=0.846). Those in the vasopressin group had higher cumulative vasopressor requirements over a 48-hour period (12,621 mcg norepinephrine equivalents vs 240.5 mcg norepinephrine equivalents, p=0.002) and had a longer duration of mechanical ventilation compared to the vasopressor only group (4 days vs 2 days, p=0.023). There were no significant differences in cumulative fluid, 30-day mortality, ICU and hospital length of stays, and adverse events.


Conclusion: This study demonstrated that the use of vasopressin did not decrease the volume of blood products utilized in hemorrhagic shock patients; however, patients receiving vasopressin had higher vasopressor requirements and required mechanical ventilation longer than those who received vasopressors alone.
Presenters
avatar for Amanda Fisher

Amanda Fisher

PGY2 Critical Care Pharmacy Resident, Spartanburg Medical Center
PGY2 Critical Care Pharmacy Resident at Spartanburg Medical Center
Evaluators
avatar for Blake Johnson
MH
Friday April 25, 2025 11:40am - 11:55am EDT
Athena G
  Critical Care/Emergency Medicine (CCM), Spartanburg Medical Center
  • global Y

11:40am EDT

Clinical Outcomes in Patients who Receive Ertapenem vs. Meropenem for Extended Spectrum Beta-Lactamase Infections and Have Hypoalbuminemia
Friday April 25, 2025 11:40am - 11:55am EDT
Athena A
Title: Clinical Outcomes in Patients who Receive Ertapenem vs. Meropenem for Extended Spectrum Beta-Lactamase Infections and Have Hypoalbuminemia

Authors: Kendall Ferrara, Melissa George, Joshua Rumph

Background: There are limited and conflicting data currently available for the treatment of ESBL infections in patients with hypoalbuminemia. The standard approach for patients with ESBL infections is treatment with a carbapenem. Ertapenem, compared to other carbapenems, is highly protein bound. In patients that are hypoalbuminemic and/or critically ill, this leads to an increased free fraction of ertapenem and a significantly decreased half-life. Limited clinical literature has shown a significantly increased risk of mortality, readmission, and length of stay in patients who are hypoalbuminemic and receive ertapenem compared to patients receiving other carbapenems. Based on this data, the Infectious Diseases Society of America (IDSA) Antimicrobial-Resistant (AMR) Guidance document suggests utilizing meropenem or imipenem-cilastatin in patients that are critically ill and/or experiencing hypoalbuminemia for ESBL infections outside of the urinary tract. Historically at East Carolina University (ECU) Health, ertapenem has been more commonly used than meropenem for ESBL infections regardless of clinical status or albumin. This study aims to evaluate the treatment failure of ertapenem compared to meropenem in patients who have ESBL infections and hypoalbuminemia. 

Methods: This was a system-wide, retrospective chart review of hospitalized adult patients at ECU Health with hypoalbuminemia who received ertapenem or meropenem for at least 72 hours and had non-urine cultures positive for ESBL Enterobacterales. Hypoalbuminemia was defined as an albumin ≤2.5 g/dL within 72 hours before or after initiation of antibiotic treatment. SlicerDicer in EPIC and the electronic medical record (EHR) were utilized to identify patients. The primary endpoint was treatment failure defined as a composite of 30-day all-cause mortality and infection related readmission. Secondary outcomes included the individual components of the composite outcome, 90-day all-cause mortality and infection related readmission, and hospital length of stay (LOS). Subanalyses of patients with bacteremia and patients admitted to an intensive care unit (ICU) were also performed.

Results: A total of 156 patients with ESBL infections and hypoalbuminemia were included in the study. Of those included, 104 (66.7%) received ertapenem and 52 (33.3%) received meropenem. Overall, baseline characteristics were similar between groups. There was a statistically significant difference in age (70 vs 63 years old) and weight (78.1 vs 90.6 kg), however, these differences are not clinically significant and the difference in weight may be attributed to our institution’s previous rapid molecular blood culture protocol recommending meropenem in patients with a BMI ≥35 kg/m2. Although patients in the meropenem group had significantly lower albumin levels (2.1 g/dL vs 2.3 g/dL, p = 0.0131), this was not clinically significant. The most common type of culture in both groups was blood (57.7% vs 44.2%). Wound cultures were the second most common (18.3% vs 28.8%). ESBL Escherichia coli was the most frequently isolated organism in both groups (54.8% vs 40.4%). There was no statistically significant difference in the primary outcome of treatment failure between the ertapenem and meropenem groups (34.6% vs 46.2%, p = 0.1682; RR 0.75, 95% CI 0.505-1.113). Secondary outcomes, including 30- and 90-day all-cause mortality and infection-related readmission, also showed no significant differences. Subgroup analyses (ICU, age ≥65, bacteremia) revealed no significant differences but were limited by small sample sizes.

Conclusion: In patients with ESBL infections and hypoalbuminemia, there was no significant difference in treatment failure between ertapenem and meropenem. Although numerical differences favored ertapenem, the study was underpowered to detect a statistical significance. Larger, prospective studies are needed to confirm these findings. 

Contact: Kendall.Ferrara@ecuhealth.org
Moderators
BK

Brian Knott

Clinical Pharmacy Supervisor, AdventHealth Winter Park
Presenters
KF
Evaluators
CL
Friday April 25, 2025 11:40am - 11:55am EDT
Athena A
  Infectious Disease (ID), ECU Health Medical Center
  • global Y

11:40am EDT

Pharmacist Impact on Inpatient Guideline-Directed Medical Therapy Prescribing in Heart Failure with Reduced Ejection Fraction
Friday April 25, 2025 11:40am - 11:55am EDT
Parthenon 1
Title: Pharmacist Impact on Inpatient Guideline-Directed Medical Therapy Prescribing in Heart Failure with Reduced Ejection Fraction


Authors: Hayley Harrod-Meeks, Kyle Starling, Hunter McDowell 


Objective: This project aimed to evaluate the impact of pharmacist intervention on inpatient prescribing of HFrEF GDMT at Atrium Health Navicent (AHN).


Self Assessment Question: True or False: Pharmacist intervention can increase inpatient prescribing of HFrEF GDMT?


Background: Heart failure with reduced ejection fraction (HFrEF) is a serious condition associated with high morbidity and mortality. The American Heart Association (AHA) guidelines recommend four classes of medications to reduce these risks: renin-angiotensin-aldosterone system (RAAS) inhibitors, beta blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose co-transporter 2 (SGLT-2) inhibitors. However, hesitancy to initiate or adjust these medications during hospitalization due to transient hypotension or acute kidney injury may worsen patient outcomes. We hypothesize that pharmacists play a key role in improving inpatient guideline-directed medical therapy (GDMT) prescribing. 


Methods: This was a pre-post study that involved physician education and pharmacist intervention. Prior to the intervention period, a brief educational guide on HFrEF GDMT was provided to hospital physicians. During the intervention period, patient chart reviews were conducted to make appropriate recommendations to physicians and to determine outcomes. Patients were included in the analysis if they met all four of the following criteria: were 18 years-old or older, admitted to AHN, had an ejection fraction less than 40%, and had an EPIC-calculated readmission risk score of at least 20%. Key exclusion criteria included patients requiring renal replacement therapy at discharge or those who died during hospital admission. The primary outcome was the percentage of patients discharged on each eligible pillar of GDMT. Secondary outcomes included the percentage of patients discharged on each individual GDMT pillar and the percentage of patients readmitted to AHN within 30 days of discharge. Chi-square analysis was performed to assess differences in outcomes. 


Results: In the intervention group, 24% of patients met the primary outcome while only 12% of baseline patients were discharged on all eligible GDMT pillars of HFrEF (P=0.023). Out of each medication class, the MRAs and SGLT-2 inhibitors were the least commonly prescribed in both groups. However, prescribing of both MRAs and SGLT-2 inhibitors was statistically higher in the intervention group, with a 16.3% increase in MRA prescribing (P=0.014) and a 14.6% increase in SGLT-2 inhibitor prescribing (P=0.031). Thirty-day readmission rates were reduced by 7.7% in the intervention group, though this was not statistically significant (P=0.244). 


Conclusion: In this pre-post study, we found that pharmacist intervention can significantly increase inpatient HFrEF GDMT prescribing, especially by increasing the prescribing of MRAs and SGLT-2 inhibitors. 30-day readmission rates also trended down in the intervention group, though not significantly. Key limitations in this study included physician turnover and hesitancy to change HFrEF regimens when an acute heart failure exacerbation was not the patient’s primary problem. Overall, this study showed that pharmacists play a key role in helping improve inpatient HFreF GDMT prescribing.  
Moderators
avatar for Matt Conley

Matt Conley

Pharmacy Informatics Specialist, AdventHealth
Presenters
HH

Hayley Harrod-Meeks

PGY1 Pharmacy Resident, Atrium Health Navicent
Dr. Harrod-Meeks is a graduate from Mercer Univeristy's College of Pharmacy, and currently serves as a PGY1 pharmacy resident at Atrium Health Navicent in Macon, GA
Evaluators
EM
Friday April 25, 2025 11:40am - 11:55am EDT
Parthenon 1
  Internal Medicine (IM), Atrium Health Navicent The Medical Center
  • global Y

11:40am EDT

PROTHROMBIN COMPLEX CONCENTRATE IN OBESE PATIENTS WITH FACTOR XA INIBITOR-ASSOCIATED BLEEDING
Friday April 25, 2025 11:40am - 11:55am EDT
Parthenon 2
Title: Prothrombin complex concentrate in obese patients with factor Xa inhibitor-associated bleeding


Authors: Lam Ho, Alyssa Osmonson, John Michael Herndon, Jessica Starr


Objective: To evaluate the effectiveness of weight-based versus fixed-dose 4F-PCC for the reversal of factor Xa inhibitor-associated bleeding in obese patients 


Self-Assessment Question: Based on the result of this study, patient receiving weight-based regimen developed more thrombotic event?


Background: Many studies have demonstrated the effectiveness of 4F-PCC in reversing anticoagulation and managing bleeding associated with factor Xa inhibitors; however, there is a lack of data to guide optimal dosing in obese patients. Specifically, the role of fixed-dosing in this population requires further exploration. 


Methods: This a multicenter, retrospective cohort study conducted from January 2016 through April 2024. Electronic medical records of obese patients (BMI ≥30 kg/m²) receiving apixaban, rivaroxaban, or edoxaban who were treated with 4F-PCC were reviewed.  Patients were included if they were ≥18 years of age and had major bleeding associated with factor Xa inhibitors.  Major bleeding was defined as intracranial or critical-site hemorrhages, hemodynamic instability (SBP <90 mmHg, SBP drop >40 mmHg, HR >100 bpm), hemoglobin decrease >2 g/dL, or need for ≥2 PRBC units. Exclusion criteria included pregnant patients, and those transferred to an outside health system. The primary outcome is all-cause mortality. Secondary outcomes include hematoma expansion (≥6 mL or ≥33% increase), thromboembolic events, the need for a second 4F-PCC dose, and 48-hour transfusion requirements.


Results: Seventy-seven patients were included in the study. Mortality rates were 25% (n=12) in the fixed-dose group and 44.8% (n=13) in the weight-based group (p=0.0718). No thrombotic events were observed in either group. Two patients in the weight-based group required a second dose (p=0.0653). Transfusion within 48 hours was needed in 22.9% (n=11) of patients in the fixed-dose group and 20.1% (n=6) in the weight-based group (p=0.8194). Hematoma expansion occurred in one patient receiving weight-based dosing (p=0.5464).


Conclusions: This study found no difference in mortality between fixed-dose and weight-based dosing regimens. No thrombotic events were observed in either group. Larger studies are needed to evaluate the safety and efficacy of fixed-dose versus weight-based 4F-PCC for factor Xa inhibitors-associated bleeding in obese patients.


Moderators
BJ

Brook Jacobs

Clinical Coordinator, Critical Care Clinical Specialist, Emory Decatur Hospital
Presenters
LH

Lam Ho

PGY-1, Baptist Health Medical Center
Lam Ho, PharmD is a PGY1 Pharmacy Resident originally from Vietnam. She earned her Doctor of Pharmacy from Auburn University. Lam serves on the local Medication Safety Committee, and her research is on fixed dosing of four-factor prothrombin complex concentrate in patients with obesity... Read More →
Evaluators
EI
Friday April 25, 2025 11:40am - 11:55am EDT
Parthenon 2
  Internal Medicine (IM), Princeton Baptist Medical Center
  • global Y

11:40am EDT

A Retrospective Evaluation of an Electronic Medical Record Alert to Pharmacists on the Incidence of Inappropriate Medication Administration in Patients with Feeding Tubes
Friday April 25, 2025 11:40am - 11:55am EDT
Athena C
Title: A Retrospective Evaluation of an Electronic Medical Record Alert to Pharmacists on the Incidence of Inappropriate Medication Administration in Patients with Feeding Tubes 

Authors: Devin O'Brien, Rosemary Garbowski, Matthew Lane, Saumil Vaghela

Background: Medication administration is an important part of the foundation for medication safety and efficacy. Various studies have demonstrated the frequency of inappropriate administration of medications through a feeding tube. Many of these studies have shown that pharmacist interventions can positively impact the percentage of medications administered appropriately in patients with feeding tubes. Few studies have evaluated the effectiveness of a pharmacist-directed alert on the appropriate administration of medications. The purpose of this study was to evaluate the effectiveness of an electronic medical record alert to pharmacists on the incidence of inappropriate medication administration in patients with feeding tubes.  

Methods: A retrospective chart review was conducted using the electronic medical record (EMR) at an acute care community hospital. Chart reviews were conducted on patients with tube feeding (TF) orders who were admitted prior to and following implementation of the EMR alert. The pre-implementation period was between June 1, 2024 and August 31, 2024. The post-implementation period was between October 1, 2024 and December 31, 2024. A wash-out period was designated between September 1, 2024 and September 30, 2024 to ensure that all patients with a TF order triggered the alert to pharmacists in the EMR. Patients were included if they had a TF order placed and had at least one scheduled medication ordered to be administered enterally. Patients were excluded if they were covered by a service that participated in daily multidisciplinary team rounding, as the medications for these patients were individually evaluated regardless of the pharmacist-directed alert. The primary outcome for this study was the composite incidence of inappropriate medication administration and medication administration omissions in patients with feeding tubes (for example: crushed medications that should not be crushed per the package insert or a liquid administered through the feeding tube that has potential for binding to the feeding tube). The secondary outcome for this study was inappropriate administration of high risk medications. All data points collected for each patient were compiled in an electronic spreadsheet. 

Results: A total of 52 patients were included in the study, 29 in the pre-implementation group and 23 in the post-implementation group. For the primary endpoint of composite incidence of inappropriate medication administration and medication administration omissions,122 errors were found in the pre-implementation group and 71 in the post-implementation group. For the secondary outcome of inappropriate administration of high risk medications, there were zero patients in both groups. 

Conclusion: An EMR alert to pharmacists to evaluate medications in patients with feeding tubes may help to decrease the number of inappropriate medication administrations
Moderators
avatar for Devin Lavender

Devin Lavender

Clinical Assistant Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2
Ambulatory Care, Scholarship of Teaching and Learning, Resident and Student Development.
Presenters
avatar for Devin O'Brien

Devin O'Brien

Pharmacy Resident, CaroMont Regional Medical Center
Devin O'Brien is a PGY-1 pharmacy resident at CaroMont Regional Medical Center (CRMC). She is from Richmond, Virginia and attended University of Richmond for her undergraduate coursework, then Virginia Commonwealth University for her doctorate of pharmacy. 
Evaluators
CW

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, Kaiser Permanente Georgia
Friday April 25, 2025 11:40am - 11:55am EDT
Athena C
  Medication Safety (MES), CaroMont Regional Medical Center
  • global Y

11:40am EDT

Assessing Utilization Trends of Granulocyte Colony-Stimulating Factors (G-CSF) in an Outpatient Cancer Setting
Friday April 25, 2025 11:40am - 11:55am EDT
Olympia 2
Title: Assessing Utilization Trends of Granulocyte Colony-Stimulating Factors (G-CSF) in an Outpatient Cancer Setting   
Authors: Shayan Tavassoli, Alexia Greene, Thomas Morris 
Background: This study aims to identify gaps between current utilization and guideline recommendations by evaluating usage trends of granulocyte colony-stimulating factors at FirstHealth Outpatient Cancer Center. Previous literature showed that granulocyte colony-stimulating factors have shown both overuse and underuse when comparing to guideline recommendations.  
Methods: A retrospective observational study was conducted to evaluate the use of granulocyte colony-stimulating factors in cancer patients at FirstHealth Outpatient Cancer Center between March 1, 2022, and March 30, 2024. The study included patients with active diagnoses of breast, lung, pancreatic, or colorectal cancer who received a dose of granulocyte colony-stimulating factors. Exclusion criteria applied to patients receiving secondary prophylaxis for febrile neutropenia, weekly chemotherapy cycles, investigational agents, or those who underwent bone marrow or hematopoietic transplants within 30 days of chemotherapy. Patient characteristics included age, gender, cancer type, chemotherapy regimen, absolute neutrophil count, creatinine clearance, bilirubin levels, and provider documentation related to granulocyte colony-stimulating factors use. Patients were classified into three risk groups—high, intermediate, and low—based on the risk of febrile neutropenia according to NCCN guidelines. The primary outcome looked to find the percentage of patients who received at least one dose of granulocyte colony-stimulating factors for primary prophylaxis of febrile neutropenia during their chemotherapy regimen for the treatment of either lung, pancreatic, breast, or colorectal cancer. The secondary outcome looked to evaluate the characteristic differences between patients who received granulocyte colony-stimulating factors and those who did not during the study period. All patient data has been stored in a password-protected file with access restricted to investigators, ensuring confidentiality and data security throughout the study. 
Results: During the study’s timeframe, 4% (214/4931) patients with either lung, pancreatic, colorectal, or breast cancer received granulocyte colony-stimulating factors. Individual baseline characteristics were evaluated in total for 50 patients who received granulocyte colony-stimulating factors and 44 patients who did not receive granulocyte colony-stimulating factors. In the treatment group, 28% (14/50) vs. 6.8% (3/44) patients would be categorized as intermediate risk factor for febrile neutropenia based on guideline recommendations, and 86% (12/14) in treatment group vs. 100% (3/3) in control group of patients with intermediate risk chemotherapy regimen had risk factors to consider adding granulocyte colony-stimulating factors.
Conclusions: Overall, granulocyte colony-stimulating factor usage aligned closely with NCCN guideline recommendations in this study. Intermediate risk groups require consideration from providers when deciding if granulocyte colony-stimulating factors are necessary based on patient characteristics. Limited sample size may require further research to determine significant gaps of granulocyte colony-stimulating factors in comparison to guideline recommendations. 
Moderators
SC

Schylar Cheyenne Hathaway

Clinical Pharmacist
Special interest include Ambulatory Care and Women's Health.
Presenters
avatar for Shayan Tavassoli

Shayan Tavassoli

PGY1 Pharmacy Resident, FirstHealth Moore Regional Hospital
Shayan Tavassoli, PharmD who is a PGY1 pharmacy resident at FirstHealth Moore Regional Hospital in Pinehurst, NC. Shayan's interests include oncology, infectious disease, and emergency medicine. 
Evaluators
avatar for Lacey Ioppolo

Lacey Ioppolo

PGY-1 RPD and Clinical Pharmacy Manager, Memorial Health University Medical Center
Lacey Ioppolo PharmD, BCCCP, is a Clinical Pharmacy Manager and PGY-1 Pharmacy Residency Program Director at Memorial Health University Medical Center in Savannah, GA. She obtained her Doctor of Pharmacy from The University of Florida in 2018 and completed her PGY-1 Pharmacy Residency... Read More →
Friday April 25, 2025 11:40am - 11:55am EDT
Olympia 2
  Oncology (ONC), FirstHealth Moore Regional Hospital
  • global Y
 
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