2025 Southeastern Residency Conference

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


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

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

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

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

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


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


Conclusions: In Progress  

Title: Activation Accuracy of Proprietary Bag and Vial Systems

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

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

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

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

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

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

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

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

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

Authors: Kyli Latimer, Abigayle Campbell

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

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

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

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

Contact: kyli.latimer@selfregional.org

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

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

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

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

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

Title: Evaluation of an Automated Dispensing Cabinet Patient Medication Management Software’s Impact on Medication Dispense Rates 


Authors: Trey Carter, Claire Johns 


Background: As healthcare technology advances, many inpatient institutions have moved to utilizing automated dispensing cabinets (ADC) to store and dispense medications. Less utilized medications may be stored in the institution’s central pharmacy and dispensed to non-automated patient-specific bins. Automating the medication storage and distribution process allows the ADC to store patients’ medications in patient-specific bins via medication management software and ensures a regulated, monitored process to reduce potential for error. This study is designed to evaluate medication dispensing rates from the central distribution pharmacy pre- and post-patient medication management software implementation at our institution.  


Methods: This study is an IRB-approved; pre-post analysis of medication re-dispense rates from a central distribution pharmacy. Patient medication management software was implemented at Baptist Health Lexington in August 2024.  A retrospective chart review was conducted on patients who received a medication dispensed from our institution’s central distribution pharmacy between January 1st, 2024 and June 30th, 2024 to identify the rates at which medications were re-dispensed. For bulk items, the length of time between consecutive dispenses of the same medication was also assessed. Additionally, post-patient medication management software implementation medication re-dispense data were collected from September 1st, 2024 to February 28th, 2025. The primary endpoint of this study is the difference in the medication re-dispense rate from our central distribution pharmacy pre- and post- patient medication management software implementation. The secondary endpoint is the difference in length of time between consecutive dispenses of bulk items. 


Results: In Progress


Conclusion: In Progress

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

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

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


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


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

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

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

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

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

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

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.

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.

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

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.

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?