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2ND ANNUAL FLORIDA
RESIDENCY CONFERENCE
May 9-10, 2013
University of Florida College of Pharmacy
Gainesville, Florida
Sponsored by the FSHP Research and Education Foundation
2ND ANNUAL FLORIDA RESIDENCY CONFERENCE
Welcome to the Second Annual Florida Residency Conference. We are grateful to all in
attendance and we are looking forward to another great conference full of high quality resident
presentations, as well as some quality time with friends and colleagues. The Florida Residency
Conference Steering Committee has been busy looking ahead to not only this conference but the
future of the FRC.
Last year's attendees at the first annual Florida Residency Conference provided the FRC Steering Committee with great feedback. One of the key changes to the conference this year is our Thursday night social event. Based on your feedback, we replaced the formal dinner with a Networking Reception at The Florida Museum of Natural History with a heavy hors d'oeuvres reception and a cash bar. You will have access to the museum's exhibits and Butterfly Rainforest. We hope you join us for an evening of fun! We have also modified the layout of the program book and spread out the sessions to give attendees more space during the sessions as well as the breaks. We are grateful to the FSHP Research and Education Foundation for their continued support of the Florida Residency Conference. This year the FSHP Research and Education Foundation provided funding for the new 2013 FRC Excellence in Research Award. The Excellence in Research Awards Program was created with the intent of recognizing pharmacy residents for their innovative contributions of original research relevant to health-system pharmacy practice during the calendar year preceding the FRC. The applications received were reviewed, and the top five finalists will be presenting their research during the conference as part of the competition. All five finalists are PGY-1 residents, and one of the finalists will receive the 2013 FRC Excellence in Research Award on Friday. Congratulations to our five finalists:
Joseph Hong, Morton Plant Hospital Joseph Pardo, Lee Memorial Health System Kourtney Marsh, Orlando Health Michael Verbosky, Tampa General Hospital Danielle Pierini, UF College of Pharmacy The FRC Steering Committee would like to thank the University of Florida College of Pharmacy Gainesville Campus for the use of their top-notch facilities, the Pharmacy Department of Shands for providing the parking vouchers for the conference attendees, and the FSHP Office Staff, Pam White and Tamekia Bennett, for their long hours and patience as we strive to make each conference better. 2ND ANNUAL FLORIDA RESIDENCY CONFERENCE
Report of the Florida Residency Conference Steering Committee

In addition to preparing for the FRC 2013 conference, the FRC Steering Committee was charged with
developing a formal FRC Committee structure as well as planning ahead for the impact residency training
growth will have on future conferences. Highlights from those committee charges are highlighted below.
Florida Residency Conference Steering Committee Structure
The FRC Steering Committee has created and approved the FRC Officers and Ad Hoc Committee
Members Responsibility and Elections procedure. The FRC Committee Structure is outlined below.
Applications for all positions are available on the FSHP website with an application date of June 1 each
year.

FSHP Foundation Representative: appointed yearly by the FSHP Foundation Board of Directors. The
representative will serve as a liaison between the FRC Steering Committee and the FSHP Foundation.
FRC Chair: will consist of a three (3) year term. The first year will be served as a FRC Chair Elect, the second year as the FRC Chair, and the third year as FRC Immediate Past Chair. FRC Finance Liaison: FRC Finance Liaison will be responsible for oversight of the FRC budget, investigate scholarship opportunities and coordinate any fundraising efforts. Pharmacy Resident Member: The Pharmacy Resident Member will be a second year pharmacy resident (PGY-2) and will serve one term. Pharmacy Resident member will work with FRC Chair and will be delegated responsibilities set forth by the FRC Chair. AD HOC Members (4 to 6 members): Ad Hoc members will serve to support the FRC Chair, FRC Chair Elect, FRC Immediate Past Chair in their responsibilities in those positions. At least one Ad Hoc committee member will be from the same geographic location of the next FRC meeting. Florida Residency Conference Future Planning Sub-Committee
In November 2012 a FRC Needs Assessment Planning Survey was sent via email to all preceptor attendees of FRC12 as well as additional Residency Program Directors in the state of Florida. 43 people completed the survey. 38% of the responses were completed by people who attended FRC in 2012. Highlights of the survey results included:  The top three geographic areas that were listed as desirable for future FRC meetings: 1. Central FL (Orlando) 2. North FL (Gainesville) 3. Tampa/St Pete area.  Finance was the primary reason why responders would not attend FRC in future years. In addition, more than 50% of responders said they would not want to pay higher rates that maybe necessary if the FRC moves from year to year.  Resident and preceptor attendance growth was estimated at about 9% for 2013 and roughly 20- 25% within five years. With the relatively small expected growth over in the next two years the FRC Steering Committee decided to hold the FRC13 and FRC14 in Gainesville. However, we have started exploring potential meeting sites in both the Tampa/St Petersburg and Orlando areas for future conferences to accommodate the anticipated growth. 2013 FLORIDA RESIDENCY CONFERENCE STEERING COMMITTEE
SUZANNE TURNER, PHARM.D., CHAIRPERSON 2013
Pharmacy Clinical Specialist-Education and Residency Coordinator Lee Memorial Health System, Fort Myers, FL Phone: 239-343-2232 [email protected]
John Armitstead, MS, RPh, FASHP
Carrie Lagasse, Pharm.D., BCPS
System Director of Pharmacy Clinical Specialist, Clinical Resource Utilization Lee Memorial Health System, Fort Myers, FL Co-Director, PGY-1 Pharmacy Residency Phone: 239-343-6490 Shands at the University of Florida, Gainesville, FL Phone: 352-265-0111 ext 44032 [email protected] Kara L. Birrer, Pharm.D., BCPS
Clinical Pharmacist, Trauma/General Surgery Mike Magee, MS, RPh, FASHP
Assistant Director, PGY-1 Pharmacy Residency Director of Pharmacy Orlando Regional Medical Center, Orlando Health, St Joseph's Hospitals South Florida Baptist Hospital, Tampa, FL Phone: 321-841-2593 Phone: 813-870-4868 [email protected]
Mark Ninno, Pharm.D.

Jason Brady, Pharm.D., BCPS
Pharmacy Implementation Manager Clinical Pharmacist, Emergency Medicine VHA Performance Services, Orlando, FL Director, PGY-1 Pharmacy Residency Program Phone: 407-359-1128 Orlando Regional Medical Center, Orlando Health, Phone: 321-841-2597 Christine Price, Pharm.D.
Clinical Coordinator Director, PGY-1 Pharmacy Residency Program Tiffany Jagel, Pharm.D., CDE, BCPS, BCACP
Morton Plant Mease Health Care, Clearwater, FL Clinical Pharmacy Specialist Phone: 727-462-7454 VA Gulf Coast Joint Ambulatory Center, Phone: 850-912-2359 [email protected] William Terneus, Jr., Pharm.D., BCPS
Pharmacy Clinical Manager William Kernan, Pharm.D., BCPS
Director, PGY-1 Pharmacy Residency Program Assistant Director, Department of Pharmacy Indian River Medical Center, Vero Beach, FL Director, PGY-1 Pharmacy Residency Program Phone: 772-567-4311 ext 3027 Cleveland Clinic Florida, Weston, FL [email protected] Phone: 954-689-5646 Email: [email protected] Lisa Thames, Pharm.D., BCPS
Chief, Pediatric Clinical Pharmacy Services Jessica LaFosse, Pharm.D., BCPS
Director, PGY-2 Pediatric Residency Program Pharmacy Residency Coordinator Shands Children's Hospital at UF, Gainesville, FL Pharmacy Educator Phone: 352-265-0111 ext 45926 Learner, Input, Positivity, Developer, Includer [email protected] Holmes Regional Medical Center, Melbourne, FL Phone: 321-434-7309
[email protected]


CONTINUING EDUCATION AND EVALUATIONS
The Florida Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of pharmacy continuing education. This program contains Knowledge Based CPE. CE INSTRUCTIONS:
Request for Continuing Education Forms: After successfully attending preferred sessions in their entirety,
complete the Request for CE Form found in your Program Book and turn it in to verify attendance. Sessions
are in 1.0 hour increments and CE will be awarded according to the completion of the presentation, partial
credits are not acceptable. There is a maximum of 9.0 general credit hours. Complete your form as you attend
the sessions to avoid mistakes. Forms should not be turned in until you are done with sessions. NABP eProfile
IDs and month and date of your birth date are required, CE will not be issued without this information.
EVALUATION INSTRUCTIONS:
Speaker Evaluations: Please complete an evaluation for each speaker and submit them to the session
moderator immediately after each resident's presentation. Also, complete the overall meeting evaluation
form found in your Program Book and turn in with your Request for CE Form when you are done with
sessions.
FSHP Designated Reviewer-Moderator Responsibilities Form: The session moderator is
responsible for completing their portion of this form for each speaker during their session and submitting
the completed forms to the designated FSHP representative at the completion of the session.
THURSDAY, MAY 9, 2013
FRIDAY, MAY 10, 2013
General Session-Precepting for Excellence (1.0 hr)
SESSION II
ACPE UAN 163-999-13-077-L04-P
Session IIa-Internal Medicine Part II (1.0 hr)
ACPE UAN 163-999-13-087-L01-P
SESSION I
Session Ia-Infectious Disease Part I (1.0 hr)
Session IIb-Infectious Disease Part III (1.0 hr)
ACPE UAN 163-999-13-078-L01-P
ACPE UAN 163-999-13-088-L01-P


Session Ib-Ambulatory Care I (1.0 hr)

Session IIc- Infectious Disease Part IV (1.0 hr)
ACPE UAN 163-999-13-079-L01-P
ACPE UAN 163-999-13-089-L01-P


Session Ic- Critical Care Medicine Part I (1.0 hr)

Session IId-Critical Care Medicine Part III (1.0 hr)
ACPE UAN 163-999-13-080-L04-P
ACPE UAN 163-999-13-090-L01-P


Session Id-Internal Medicine Part I (1.0 hr)

Session IIe-Ambulatory Care Part III (0.1 hr)
ACPE UAN 163-999-13-081-L01-P
ACPE UAN 163-999-13-091-L01-P


Session Ie-Administration Part I/Med Safety Part I

Session IIf- Ambulatory Care Part IV (1.0 hr)
(1.0 hr)
ACPE UAN 163-999-13-092-L01-P

ACPE UAN 163-999-13-082-L05-P
Session IIg-Internal Medicine Part III (1.0 hr)

Session If-Infectious Disease Part I (1.0 hr)

ACPE UAN 163-999-13-093-L01-P

ACPE UAN 163-999-13-083-L01-P
Session IIh-Infectious Disease Part V (1.0 hr)

Session Ig-Ambulatory Care Part II (1.0 hr)

ACPE UAN 163-999-13-094-L01-P

ACPE UAN 163-999-13-084-L01-P
Session IIi-Infectious Disease Part VI (1.0 hr)

Session Ih-Critical Care Medicine Part II (1.0 hr)

ACPE UAN 163-999-13-095-L01-P

ACPE UAN 163-999-13-085-L04-P
Session IIj-Critical Care Medicine Part IV (1.0 hr)

Session Ii-Administration Part II (1.0 hr)

ACPE UAN 163-999-13-096-L01-P

ACPE UAN 163-999-13-086-L04-P
Session IIk-Ambulatory Care Part V (1.0 hr)
ACPE UAN 163-999-13-097-L01-P

Session IIl-Ambulatory Care Part VI/Pediatrics Part
I (1.0 hr)
ACPE UAN 163-999-13-098-L01-P
CONTINUING EDUCATION AND EVALUATIONS, CONT.
FRIDAY, MAY 9, 2013
SESSION III
Session IIIa-Critical Care Medicine Part V (1.0 hr)
ACPE UAN 163-999-13-099-L01-P
Session IIIb-Pediatrics Part II (1.0 hr)
ACPE UAN 163-999-13-100-L01-P
Session IIIc- Psychiatry Part I (1.0 hr)
ACPE UAN 163-999-13-101-L01-P
Session IIId-Internal Medicine Part IV (1.0 hr)
ACPE UAN 163-999-13-102-L01-P
Session IIIe-Ambulatory Care Part VII (1.0 hr)
ACPE UAN 163-999-13-103-L01-P
Session IIIf- Community Pharmacy/Internal Medicine Part V (1.0 hr)
ACPE UAN 163-999-13-104-L01-P
Session IIIg-Critical Care Medicine Part VI/Med Safety Part II (1.0 hr)
ACPE UAN 163-999-13-105-L01-P
Session IIIh-Pediatrics Part III (1.0 hr)
ACPE UAN 163-999-13-106-L01-P
Session IIIi-Transplantation (1.0 hr)
ACPE UAN 163-999-13-107-L01-P
Session IIIj-Internal Medicine Part VI (1.0 hr)
ACPE UAN 163-999-13-108-L01-P
Session IIIk-Ambulatory Care Part VIII (1.0 hr)
ACPE UAN 163-999-13-109-L01-P
Session IIIl-Psychiatry Part II/Administration Part III (1.0 hr)
ACPE UAN 163-999-13-110-L01-P
SESSION IV
Session IIIa-Oncology Part I (1.0 hr)
ACPE UAN 163-999-13-111-L01-P
Session IIIb-Administration Part IV (1.0 hr)
ACPE UAN 163-999-13-112-L04-P
Session IIIc-Med Safety Part III (1.0 hr)
ACPE UAN 163-999-13-113-L05-P
Session IIId-Oncology Part II/Administration Part V (1.0 hr)
ACPE UAN 163-999-13-114-L04-P
Session IIIe-Infectious Disease Part VII (1.0 hr)
ACPE UAN 163-999-13-115-L01-P
Session IIIg-Oncology Part III (1.0 hr)
ACPE UAN 163-999-13-116-L01-P
Session IIIh-Administration Part VI (1.0 hr)
ACPE UAN 163-999-13-117-L04-P
Session IIIi-Med Safety Part IV (1.0 hr)
ACPE UAN 163-999-13-118-L05-P
Session IIIk-Pharmacy Informatics/Infectious Disease Part VIII (1.0 hr)
ACPE UAN 163-999-13-119-L01-P


2ND ANNUAL FLORIDA RESIDENCY CONFERENCE
Conference Agenda
All Sessions will be held at the University of Florida College of Pharmacy
THURSDAY MAY 9, 2013
HPNP Front Entrance Courtyard Moderators/Evaluators Meeting 1:30pm-2:45pm Welcome FRC Steering Committee Report Opening Session Session I
Rooms G103, G112, G114, G301, Concurrent Sessions CE Switch
Session I (Continued)
Rooms G103, G112, G114, G301 Networking Reception Florida Museum of Natural History FRIDAY MAY 10, 2013
HPNP Front Entrance Courtyard Continental Breakfast HPNP Reception Hall Session II
Rooms G103, G112, G114, G301, Concurrent Sessions CE Switch
Session II (Continued)
Rooms G103, G112, G114, G301, G312, G307 Refreshment Break HPNP Reception Hall Session III
Rooms G103, G112, G114, G301, Concurrent Sessions CE Switch
Session III (Continued)
Rooms G103, G112, G114, G301, G312, G307 Presentation: It's YOUR Profession! Room G101
Mike Magee, MS, RPh, FASHP **FOR RESIDENTS**
Director of Pharmacy *ATTEND PRIOR to LUNCH*
St Joseph's Hospitals John Armitstead, MS, RPh, FASHP System Director of Pharmacy Lee Memorial Health System FRC Excellence in Research
Award Presentation
All Attendees are Invited
FRC Steering Committee HPNP Reception Hall Session IV
Rooms G103, G112, G114, G301, Concurrent Sessions CE Switch
Session IV (Continued)
Rooms G103, G114, G301, G312 Program Evaluation and Adjourn See you next year at the 2014 Florida Residency Conference!
Tentative 2014 FRC Information Dates: May 8-9, 2014 Location: University of Florida College of Pharmacy, Gainesville, FL 2013 Legend- Programs Represented
All Children's Hospital Baptist Hospital of Miami, Miami, Florida Baptist Hospital, Pensacola, Florida Bayfront Medical Center, St. Petersburg, Florida Broward General Medical Center Bay Pines VA Healthcare System, Bay Pines, Florida Cleveland Clinic Florida, Weston, Florida Coram Specialty Infusion Florida Hospital, Orlando, Florida Florida Hospital for Children, Orlando, Florida Florida Hospital, Celebration, Florida Fort Myers VA Outpatient Clinic, Fort Myers, Florida H. Lee Moffitt Cancer Center & Research Institute Holmes Regional Medical Center, Melbourne, Florida Indian River Medical Center, Vero Beach, Florida James A. Haley Veterans Hospital, Tampa, Florida Lakeland Regional Medical Center, Lakeland, Florida Lee Memorial Health System, Fort Myers, Florida Mayo Clinic of Jacksonville, Jacksonville, Florida Medimix Specialty Pharmacy Memorial Regional Hospital, Hollywood, Florida Mercy Hospital, Hospital, Florida Miami VA Healthcare System, Miami, Florida Morton Plant Hospital, Clearwater, Florida North Florida/South Georgia Veterans Health System, Gainesville, Florida NOVA Southeastern University College of Pharmacy, Fort Lauderdale-Davie, Florida Orlando Health, Orlando, Florida Orlando VA Medical Center, Orlando, Florida Sarasota Memorial Hospital, Sarasota, Florida Shands at the University of Florida Shands Jacksonville Department of Pharmacy, Jacksonville, Florida South Miami Hospital, Miami, Florida St. Anthony's Hospital, St. Petersburg, Florida St. Joseph's Hospital, Tampa, Florida St. Vincent's Medical Center, Jacksonville, Florida Tampa General Hospital, Tampa, Florida University of Florida College of Pharmacy VA Gulfcoast Joint Ambulatory Care Center, Pensacola, Florida WellCare Health Plans, Tampa, Florida West Florida Healthcare, Pensacola, Florida West Palm Beach VA Medical Center Wolfson Children's Hospital/ Baptist Health, Jacksonville, Florida ADMINISTRATION—ADM AMBULATORY CARE—AMB CRITICAL CARE MEDICINE—CCM COMMUNITY PHARMACY—CP INFECTIOUS DISEASE—ID INTERNAL MEDICINE—IM MEDICATION SAFETY—MED PEDIATRICS—PED PHARMACY INFORMATICS—PI PSYCHOLOGY—PSY TOXICOLOGY—TXP Note: Abstracts were reproduced in the format in which they were received.
ABSTRACT ARRANGEMENT BY DESIGNATED CLASSIFICATION
2nd Annual Florida Residency Conference
Opening Session & Session I
Noon1:00 - 1:20pm Session I
CE Switch: 10 mins
4:10 - 4:30
6:00 - 9:00
Reception at Florida Mueseum of Natural History
ABSTRACT ARRANGEMENT BY DESIGNATED CLASSIFICATION
May 10th,
2nd Annual Florida Residency Conference
Session II, III, & IV
Session II
CE Switch: 10 mins
Session III 10:50 -11:10
11:30 - 11:50
CE Switch: 10 mins
Box LUNCH
Session IV
2:40 - 3:00
CE Switch: 10 mins
ABSTRACT ARRANGEMENT BY PRESENTER/PRACTICE SITE
May 9th, 2013
2nd Annual Florida Residency Conference
Opening Session & Session I
(90 people)
(70 people)
(72 people)
(60 people)
(38 people)
(40 people)
Noon1:00 - 1:20pm Session I
Marie A. Lafosse/MRHS
Jessica Saiz de la Mora/BHMF
CE Switch: 10 mins
Nicholas R. Bacon/MVMC
6:00 - 9:00
Reception at Florida Mueseum of Natural History
Note: The asterisks (**) signifies award Finalists of the Excellence Award
ABSTRACT ARRANGEMENT BY PRESENTER/PRACTICE SITE
May 10th, 2013
2nd Annual Florida Residency Conference
Sessions II, III, & IV
Session II
Whitney G. Bunion/WCHB
Matthew Logan Wright/SUF
CE Switch: 10 mins
Diane M. Gomes/SJAX
Olusola O. Apena/SUF
Rochelle M. Forsyth/MCJF
Ji Y. Lee/SUF
Session III
Julie J. Lewandowski-Belfer/MCJF
Kim Tyanne Julien/FMVA
Peter Richard Rabbath/JHVH
CE Switch: 10 mins
Harrison E. Saull/MCJF
Nitha Kan Chou/SAHS
Kristen Johnson /OVAO
Buffet LUNCH
Session IV
Danielle M. Gingras/BPVA
Chungeun Joanne Lee/SJHT
CE Switch: 10 mins
Leigh Anna Soler/MCJF
Heather C Murphy/SVMC
4:10 - Program Evaluation & Adjourn
2ND ANNUAL FLORIDA RESIDENCY CONFERENCE
Opening Session

Welcome & Announcements
Suzanne Turner, Pharm.D.
Chair, 2013 Florida Residence Conference Steering Committee

Welcome from the University of Florida College of Pharmacy
Michael McKenzie, Ph.D.
Senior Associate Dean for Professional Affairs
Department of Pharmacotherapy & Translational Research
University of Florida College of Pharmacy,
Gainesville, FL

Florida Residency Conference Steering Committee Report
Suzanne Turner, Pharm.D, FRC Chair 2013
William Terneus, Pharm.D., BCPS, FRC Chair-Elect 2013


Precepting for Excellence: Navigating Transitions, Continually Learning, Leading our
Profession

Transitioning into the Preceptor Role

Kelly Kasten, Pharm.D., BCPS, Clinical Pharmacist, Indian River Medical Center, Vero
Beach, FL
Upon completion of this activity, attendees should be able to:
 Recognize potential barriers when transitioning from learner to trainer and explain how to
 Identify incremental steps for developing precepting skills  Describe techniques for giving effective feedback to near peers
Mentoring Programs
Antonia Zapantis, MS, Pharm.D., BCPS, Associate Professor, Pharmacy Practice,
Residency Director, PGY2 Pharmacotherapy, Nova Southeastern University, Fort
Lauderdale, FL
Upon completion of this activity, attendees should be able to:
 Describe the components of a successful mentoring program
 Identify barriers preceptors may encounter while mentoring a resident
 Discuss strategies to implement reverse mentoring into rotation design
Leadership Coaching and the Role of the Preceptor
Rena Coll, Pharm.D., Medical Outcomes Specialist, Pfizer, Coral Springs, FL
Upon completion of this activity, attendees should be able to:
 Recognize your role as a leader coming into an organization from residency training
 Describe the challenges of leading in a changing healthcare eco-system
 Review the current pharmacy leaderships concerns of today and the future 
2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session I
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 3:00 - 3:20 Room: G301 Category: ID
Time: 3:20 - 3:40 Room: G301 Category: ID
EVALUATION OF A STEWARDSHIP APPROACH TO OPTIMIZE
DAPTOMYCIN VERSUS VANCOMYCIN FOR METHICILLIN-RESISTANT
ANTIMICROBIAL THERAPY THROUGH USE OF A RAPID
STAPHYLOCOCCUS AUREUS BLOODSTREAM INFECTION
MICROARRAY ASSAY ON BLOOD CULTURES POSITIVE WITH
Joseph Pardo, Sandy Estrada, Kristin Quarterman, Rajendra Sharma, Suzanne Turner ENTEROCOCCUS SPECIES
Lee Memorial Health System Aaron Sango, Yvette McCarter, Jason Ferreira, Donald W. Johnson, Jr., Christopher Purpose/Background: Methicillin-resistant Staphylococcus aureus (MRSA)
A. Jankowski Shands Jacksonville Medical Center bloodstream infections (BSI) are a significant burden on the healthcare system. Purpose/Background: Enterococci are a major cause of bloodstream infection in
Daptomycin is a lipopeptide antibiotic with activity against a wide range of gram hospitalized patients and have limited antimicrobial treatment options due to many positive organisms, including MRSA. Simple dosing regimens and low rates of resistance mechanisms. Vancomycin-resistant enterococci are commonly isolated adverse drug reactions may lead clinicians to utilize daptomycin in lieu of healthcare-associated multidrug-resistant pathogens. Newer molecular technologies vancomycin, the historical standard of care for serious MRSA infections. The have significantly shortened the time to enterococci isolate identification versus purpose of this study was to compare the outcomes of MRSA BSI in patients treated conventional methods. This study was designed to evaluate the impact of rapid with either daptomycin or vancomycin. organism identification and resistance detection by the Verigene® Gram-Positive Blood Culture (BC-GP) test on clinical and economic outcomes for patients with Methodology: This was a multi-center, retrospective, matched-cohort study of
enterococcal bacteremia. patients treated with daptomycin or vancomycin for MRSA BSI between January 2010 and December 2012. Adult patients with at least one blood culture positive for Methodology: A single-center pre-post quasi-experiment was performed to compare
MRSA and at least 72 hours of treatment with intravenous daptomycin or inpatients with documented enterococcal bacteremia from February 1, 2012 to vancomycin were included. Exclusion criteria included receipt of more than two September 30, 2012 (pre-BC-GP period) and October 1, 2013 to February 28, 2013 doses of other anti-MRSA pharmacotherapy, death within 72 hours of admission, (post-BC-GP period). An infectious diseases and/or critical care pharmacist was polymicrobial bacteremia, need for renal replacement therapy at baseline and contacted with results of the BC-GP; effective antibiotics and an infectious diseases concomitant MRSA pneumonia. The primary outcome was infection-related length consult were recommended. The primary outcome assessed time from blood culture of hospital stay. Secondary endpoints included the occurrence of adverse drug draw to initiation of appropriate antimicrobial therapy before and after the BC-GP reactions, microbiologic cure, in-hospital mortality and 30-day infection-related was implemented. Secondary outcome measures assessed the effects of the BC-GP on hospital length-of-stay, infection-related readmission, costs of antimicrobial therapy and hospital admission, rate of adverse effects related to antimicrobial therapy, and Results/Conclusions: At the time of abstract submission, 68 unmatched cases of
MRSA bacteremia occurring during 2012 were included in the study. Mean length of stay was 11 days and 14 days in those receiving vancomycin (n=36) and daptomycin Results/Conclusions: Results pending at time of abstract submission. Conclusion
(n=32), respectively. pending at time of abstract submission. Presentation Objective: Identify differences in clinical outcomes between patients
Presentation Objective: Describe the impact of rapid organism identification and
receiving daptomycin or vancomycin for MRSA bloodstream infections. resistance detection on the management of enterococcal bacteremia. Self Assessment: What is the vancomycin MIC susceptibility breakpoint for MRSA?
Self Assessment: Within what timeframe can the BC-GP identify Enterococcus
species and related resistance genes from time of blood culture positivity? ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 3:40 - 4:00 Room: G301 Category: ID
Time: 3:00 - 3:20 Room: G103 Category: AM
EVALUATION OF EMPIRIC GRAM-NEGATIVE DOUBLE COVERAGE
USE OF SECURE E-MAIL MESSAGING FOR ANTICOAGULATION
USED IN NON-CRITICALLY ILL HOSPITALIZED PATIENTS
FOLLOW-UP
DIAGNOSED WITH HEALTHCARE-ASSOCIATED PNEUMONIA
Deniz Yavas, Steven Totterdale, Rachel Pfaus Bay Pines VA Health Care System Corey Witenko, Donald Johnson, Nadia Iwanyshyn, Jason Ferreira Shands Purpose/Background: To develop anticoagulation management via a secure e-mail
Jacksonville Medical Center messaging system (SM) as an alternative to telephone follow-ups. Purpose/Background: Healthcare-associated pneumonia (HCAP) is defined as
pneumonia in patients admitted from the community but with recent exposure to the Methodology: Patients enrolled in the Sarasota Anticoagulation Clinic were offered
the option to do SM follow-up. Patients at a long-term care facility and those who
healthcare system. Current guidelines suggest the use of an anti-pseudomonal beta- have their INR measured on Friday are not eligible. Also, patients not responding to lactam in combination with either an anti-pseudomonal fluoroquinolone or correspondence twice will be removed from SM monitoring and returned to telephone aminoglycoside, because patients have a higher risk of infection with multidrug- follow-up. Interested patients had to enroll in MyHealtheVet for access to SM. resistant pathogens such as Pseudomonas aeruginosa. There is limited literature on Patients will be sent assessment questions via SM by 3:00 PM the day their blood is the benefits of empiric combination of Gram-negative agents in non-critically ill drawn and will respond by the following morning. Upon receiving answers, patients. The additional use of antimicrobials may increase risk of further resistance, pharmacists will reply with the anticoagulation plan. If the patient's INR exceeds 5, side effects, and hospital cost . The primary objective of this study is to compare no response is received, or clarification is needed, a telephone call will be made. clinical outcomes of a single anti-pseudomonal beta -lactam versus combination Pharmacists will check 24 hours after sending the plan to ensure the message was therapy with the addition of an anti-pseudomonal fluoroquinolone or aminoglycoside. read. If it was not, a telephone call will be made. Patients will be accepted into this
Methodology: This study is an observational retrospective chart review of patients
clinic from November 2012-January 2013. Demographics of patients enrolled and admitted to Shands Jacksonville Medical Center for treatment of HCAP. Patients are number of visits completed in this clinic will be gathered through April 2013. grouped depending on whether they received a single anti-pseudomonal beta-lactam antibiotic or combination with either an anti-pseudomonal fluoroquinolone or Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
aminoglycoside. The primary endpoint is to determine if combination therapy leads to a decreased length of stay. Secondary endpoints include time to first dose of Presentation Objective: The advantages and disadvantages of using SM for
antibiotics, duration of therapy, escalation of therapy, rates of C. difficile infections, anticoagulation follow-ups. transfers to intensive care, and 30-day mortality. Self Assessment: What are some factors to consider when establishing a SM clinic?
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
Presentation Objective: Evaluate the impact of the empirical addition of an anti-
pseudomonal fluoroquinolone or aminoglycoside to an anti-pseudomonal β-lactam in
non-critically ill patients with HCAP.
Self Assessment:
What are potential risks of combination therapy for Gram-negative
bacteria in HCAP?  
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 3:20 - 3:40 Room: G103 Category: AM
Time: 3:40 - 4:00 Room: G103 Category: AM
EVALUATION OF ADHERENCE MEASURES OF A PHARMACIST-
EVALUATION OF A NOVEL CARDIOVASCULAR RISK REDUCTION
MANAGED DIABETES TELEPHONE CLINIC: WEEKLY VERSUS
GROUP ON PATIENT'S 10YR GENERAL CARDIOVASCULAR RISK
BIWEEKLY
Joshua McWilliam, Patricia Fernandez-Quevedo Miami VA Healthcare System Pinal Patel, Hetal Bhatt-Chugani, William Lavinghousez Bay Pines VA Health Care Purpose/Background: Within the Miami VA Healthcare System's Patient-Aligned-
Care-Team (PACT), a novel method for treating patients with multiple Purpose/Background: The purpose of this project is to evaluate the adherence of a
cardiovascular risk factors has been developed. Patients attend (are invited) to weekly versus biweekly telephone-based pharmacist managed diabetes clinic. cardiovascular risk reduction group clinic appointments in which multiple patients are evaluated simultaneously by an interdisciplinary team of healthcare practitioners. Methodology: This project has been reviewed by the Bay Pines Veterans Affairs
Healthcare System (BP VAHCS) Research and Development Committee and meets
The patients interact with each other and with the health care practitioners in order to all criteria for quality assurance. A prospective chart review from October 1, 2012 to obtain a better understanding of their disease states and medical treatments. The February 28, 2013 will be conducted at BP VAHCS. The chart review will access the purpose of this evaluation is to assess the effect these group appointments have on outcomes of a pharmacist-managed telephone diabetes clinic. Diabetic patients the patient's cardiovascular risk factors and overall 10 year cardiovascular disease currently enrolled in the BP VAHCS Pharm PACT telephone clinic with a hemoglobin A1C above 8%, who are on or requiring insulin therapy will be Methodology: Patients who have been enrolled in the Miami VA PACT
identified. Patients with an A1C of > 9% will initially be called weekly vs. those with cardiovascular risk reduction group will be identified and their cardiovascular risk an A1c of 8-9% will initially be called biweekly. Scheduled weekly versus biweekly factors (blood pressure, lipid panel [LDL, HDL, Total Cholesterol], diabetes telephone patients will be traced on a secured document. Adverse events, treatment [HBA1C] and tobacco use) will be evaluated at intervals before and after initiation of adherence, and appointment adherence will be assessed. The BP VAHCS group clinic appointments. Absolute and percent change to each individual risk factor appointment management system will be reviewed over this time period to evaluate will be measured and reported as will overall change in general cardiovascular patient appointment compliance. All data will be maintained confidentially. disease risk as measured by the general cardiovascular disease calculator by The Framingham Heart Study. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Evaluate adherence measures in weekly versus biweekly
telephone appointments in a pharmacist managed diabetes telephone clinic. Presentation Objective: Describe the value (or lack thereof) of a cardiovascular risk
Self Assessment: What is one advantage of having a pharmacist-managed telephone
reduction group in reducing patient's cardiovascular risk factors. Self Assessment: What is the purpose of the cardiovascular risk reduction group?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 3:00 - 3:20 Room: G114 Category: CCM
Time: 3:20 - 3:40 Room: G114 Category: CCM
TIME TO BLOOD PRESSURE CONTROL PRIOR TO THROMBOLYTIC
IS ADRENAL INSUFFICIENCY A COMMON PHENOMENON IN TRAUMA
THERAPY IN PATIENTS WITH ACUTE ISCHEMIC STROKE:
PATIENTS?
COMPARISON OF LABETALOL, NICARDIPINE, AND HYDRALAZINE
Ann McConnell, Brandon Hobbs, Xi Liu-Deryke, John Promes Orlando Health Courtney McKay, Brad Hall, Jennifer Cortes Lakeland Regional Medical Center Purpose/Background: Cortisol is important during periods of severe stress as it
Purpose/Background: Elevated blood pressure is common in patients with acute
increases total body water distribution, enhances vascular tone and endothelial ischemic stroke. Thrombolytic therapy is contraindicated in patients with a systolic integrity, and potentiates the actions of catecholamines. As a normal response to blood pressure (SBP) greater than 185 mm Hg or diastolic blood pressure (DBP) severe infection, illness, surgery, burns, or trauma, circulating levels of cortisol may greater than 110 mm Hg. Elevated blood pressure can lead to a delay in thrombolytic increase. However, when the normal response to stress is impaired, cortisol therapy which is associated with increased mortality. There is currently insufficient concentrations may be decreased as a result of dysfunction anywhere along the HPA evidence to support the use of a particular antihypertensive agent in this setting. The axis and is known as adrenal insufficiency (AI). Random cortisol levels are most aim of this study is to compare the effects of labetalol, nicardipine, or hydralazine on commonly used to diagnose AI. At Orlando Regional Medical Center (ORMC), time to target blood pressure prior to alteplase administration in patients with acute adrenal insufficiency is defined as a random serum cortisol level ischemic stroke. Methodology: A retrospective cohort study evaluating presence or absence of adrenal
Methodology: A retrospective chart review was conducted to identify patients who
insufficiency in trauma patients at ORMC admitted from January 2011 to January had an elevated blood pressure (SBP >185 or DBP >110) and received labetalol, 2012. Patients will be excluded for pregnancy, known infection, and known AI. nicardipine, or hydralazine prior to intravenous alteplase therapy for ischemic stroke. Patients who fulfill inclusion criteria and with no exclusion criteria will be retained Data collection included the following parameters: patient demographics, drug for data analysis. Demographic data including age, gender, race, and home medication names, doses, and administration times of antihypertensive agents administered prior use will be collected. Injury type, injury severity, cortisol concentrations, clinical to alteplase, time of alteplase bolus, blood pressure and heart rate measurements, and data, laboratory data, and clinical interventions will be assessed. baseline National Institute of Health Stroke Scale score. Data were then analyzed to compare time to target blood pressure (SBP Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.

Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission Presentation Objective: Describe the incidence of adrenal insufficiency in a trauma
population and identify any risk factors associated with adrenal insufficiency.
Presentation Objective: Discuss the importance of timely blood pressure control
Self Assessment: Adrenal insufficiency is defined as a random cortisol level less than
prior to thrombolytic therapy for acute ischemic stroke. mcg/dl at Orlando Regional Medical Center. Self Assessment: Which antihypertensive agent was associated with the fastest time
to blood pressure control in this study? ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 3:40 - 4:00 Room: G114 Category: CCM
Time: 3:00 - 3:20 Room: G312 Category: IM
EVALUATION OF EMERGENCY DEPARTMENT MANAGEMENT OF
EFFECTIVENESS OF THE CURRENT WEIGHT BASED HEPARIN
DIABETIC KETOACIDOSIS AND HYPERGLYCEMIC HYPEROSMOLAR
PROTOCOL IN OBESE PATIENTS
SYNDROME
Marie A. Lafosse, Simon Leung, Carla Hawkins-Locke, Madeline Camejo Memorial Matthew Bamber, Deba Rihani, Jason Brady Orlando Health Regional Hospital Purpose/Background: Diabetic ketoacidosis (DKA) and hyperglycemic
Purpose/Background: The 2012 American College of Chest Physician guidelines
hyperosmolar syndrome (HHS) are life-threatening conditions that occur with for prevention of thromboembolic disorders recommend the use of heparin based on uncontrolled or improperly managed diabetes mellitus. In 2009, the American patient weight. Thus, our hospital utilizes a heparin weight based protocol. A cap, Diabetes Association (ADA) developed a consensus statement containing however, is included in the dosing parameters. This study will evaluate whether or recommendations for hyperglycemic crisis management. The purpose of this study is not obese patients achieve goal aPTT within 24 hours of initiating the protocol to evaluate the management of DKA and HHS compared to guideline compared to non-obese patients. recommendations to determine areas for improvement in current practices at our Methodology: Patients 18 years and older receiving heparin therapy for a minimum
of 24 hours from August 1, 2011 through February 1, 2012 were studied. Patients Methodology: Emergency Department (ED) patients ≥18 years of age who presented
were excluded if therapy was utilized for acute coronary syndrome or interrupted to Orlando Regional Medical Center classified as being positive for DKA/HHS as within the initial 24 hours. Patients with incorrect use of the protocol were also defined by consensus guideline were examined in this study. Data related to fluid excluded. Research analysis utilized descriptive statistics and an odds ratio with a 95 repletion, insulin administration, electrolyte management, subcutaneous insulin percent confidence interval. transition, ED disposition, and ED length of stay were collected from admission through resolution of DKA/HHS and compared to consensus statement Results/Conclusions: Of 118 patients identified, 74 were included and 44 were
recommendations. Assessment of total insulin requirements, identification of causes excluded per criteria. It was demonstrated that 73.3 percent of patients with a BMI of hyperglycemic crisis, and development of an ED specific protocol to enhance less than 30 and 45 percent of patients with a BMI greater than or equal to 30 adherence to consensus recommendations was the ultimate intention of this study. reached goal aPTT within 24 hours. Overall, there was no difference in achieving goal aPTT between non-obese and obese patients. Current heparin weight-based Results/Conclusions: Results pending at time of abstract submission. Conclusion
protocol has shown to be effective in both groups. pending at time of abstract submission. Presentation Objective: Describe the effectiveness of the heparin weight-based
Presentation Objective: Determine areas for improvement to adherence of current
protocol in obese patients. DKA/HHS management guidelines of ED patients and create an ED specific protocol Self Assessment: Recall two exclusion criteria and how these would affect patients
for more effective management. reaching goal aPTT? Self Assessment: What is the most common error occurring in DKA/HHS
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 3:20 - 3:40 Room: G312 Category: IM
Time: 3:40 - 4:00 Room: G312 Category: IM
REDUCING INAPPROPRIATE PRESCRIBING OF PROTON PUMP
COLCHICINE VERSUS AMIODARONE FOR THE PREVENTION OF
INHIBITORS IN A COMMUNITY HOSPITAL
POSTOPERATIVE ATRIAL FIBRILLATION AFTER CARDIAC SURGERY
Jessica Saiz de la Mora, Radhan Gopalani, Heidi Clarke Baptist Hospital of Miami Joseph Hong, Christine Price, Joshua Rovin, Pamela Chapin, Colin Fitzgerrel, Purpose/Background: Overuse of stress ulcer prophylaxis (SUP) is a widespread
Michael Ruble Morton Plant Hospital Association issue in hospitals throughout the country. The inappropriate use of SUP is associated Purpose/Background: Post-operative atrial fibrillation (POAF) is a frequent
with increased cost and risks. In addition, overutilization of proton pump inhibitors complication after most types of cardiac surgeries with a 15-50% incidence following (PPIs) for SUP is a growing concern. Certain adverse events associated with SUP, open-heart surgery. Despite ACC/AHA/ESC-supported evidence for use of oral beta- such as community-acquired pneumonia, C. difficile infection, and fractures occur blockers or amiodarone as prophylaxis, POAF continues to be a significant more frequently with PPIs than with H2-antagonists. Nevertheless, PPIs are the most complication. Given the increasing body of evidence which suggests inflammation commonly used medications for SUP in critical care and non-critical care settings. plays a role in POAF induction, the impact of colchicine has been investigated for its The purpose of this study is to optimize the use of pantoprazole in general medical- efficacy in preventing POAF after open-heart surgery. The primary objective of this surgical units through pharmacist-driven implementation of hospital-approved study is to compare the rates of POAF after CABG and valve surgery between patients on colchicine versus amiodarone for prophylaxis. Methodology: This prospective, IRB-approved study includes patients ≥ 18 years of
Methodology: This IRB-approved study is a pre-post study design comparing a
age ordered pantoprazole 40 mg orally or intravenously on general medical-surgical historical control of patients on amiodarone for POAF prophylaxis to a prospective units. Data collected includes patient demographics and pertinent laboratory values, cohort group receiving the colchicine protocol for POAF prophylaxis. Patients diagnostic tests, and home medications. The primary outcome is to compare the meeting inclusion criteria will comprise of adult patients undergoing cardiac surgery number of pantoprazole doses dispensed over a three-month period prior to the study for CABG or valve replacement, without contraindications to colchicine or to the three-month period of the study. The secondary outcomes of this study are to amiodarone, and in normal sinus rhythm at the time of administration. Treatment with assess the number of recommendations made and/or accepted, determine the rates of colchicine will start immediately after surgery. Matched controls for the amiodarone untoward GI symptoms in patients in which pantoprazole was discontinued, and group will be collected systematically utilizing the Society of Thoracic Surgeon's measure associated cost savings. Cardiac Surgery Database. Statistical analysis will be conducted using Chi-square or Fisher's exact tests for nominal data and student's t-tests for discrete and continuous Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Presentation Objective: Discuss the impact of a pharmacist-driven implementation
pending at time of abstract submission. of hospital-approved guidelines to curtail PPI use in a community hospital. Self Assessment: What are some adverse events associated with overuse of PPIs?
Presentation Objective: To compare the rates of POAF after cardiac surgery in
patients receiving colchicine versus amiodarone prophylaxis. Self Assessment: Which pathophysiological mechanism does colchicine target in the
prevention of POAF after cardiac surgery?  
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 3:00 - 3:20 Room: G112 Category: ADM
Time: 3:20 - 3:40 Room: G112 Category: ADM
EVALUATING THE IMPACT OF PHARMACIST INTERACTIONS AND
PATIENT PERCEPTION OF MEDICATION COMMUNICATIONS IN THE
DIRECT PATIENT CARE SERVICES ON SATISFACTION SCORES
HOSPITAL: THE ROLE OF THE PHARMACIST
Michael Verbosky, Kara Jastemski, Maja Gift, Minh Duong, Kimberly Cohen-Pelosi Thanh Hogan, Ben Bato, Donald Floresca Shands Jacksonville Medical Center Tampa General Hospital Purpose/Background: Patient experience in the hospital has become an increasingly
Purpose/Background: As pharmacy transitions to a more patient centered
important measure of how well a healthcare system functions. While the patient's profession, the pharmacist's role in working directly with patients to improve the experience has been documented for decades, there has never been a standardized quality of care becomes essential. Few studies are published evaluating the impact of method that allowed for comparisons between hospitals. In 2002, Centers for direct pharmacist to patient interactions in the hospital setting. The purpose of this Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research project is to increase the pharmacist-patient interactions and to introduce pharmacy and Quality (AHRQ) co-developed the Hospital Consumer Assessment of Healthcare services to promote medication understanding and access. Providers and Systems (HCAHPS) survey. This survey includes 27 unique questions measuring eight dimensions from the patient's perspective. Two of these questions Methodology: The pharmacist on the adult specialty surgery floor conducted patient
visits upon admission and at discharge during the 2½ month quality improvement
specifically address medication communications while in the hospital. While other initiative. Pharmacy services provided included an admission medication assessment, studies have demonstrated the benefit of pharmacist counseling during patient direct access to a pharmacy service line, discharge counseling, and promotion of the discharge in terms of readmission rates and emergency department visits, the onsite outpatient pharmacy. Hospital Consumer Assessment of Healthcare Providers potential benefit of pharmacist intervention during the patient's hospital stay remains and Systems (HCAHPS) survey scores, outpatient pharmacy revenue, and service to be seen. Shands Jacksonville Department of Pharmacy has committed to workflow measures are being evaluated. emphasizing patient-centered medication education and using pharmacy personnel to counsel patients about their medication therapy. This study was designed to evaluate Results/Conclusions: Of the 362 patients admitted to the pilot unit, 161 (44%) were
the impact of patient-centered education at an academic medical center in an effort to seen on admission by the pharmacist. Admission patient interviews averaged 19 increase patient satisfaction and knowledge about their medications. minutes for completion. Discrepancies were found on 36% of the admission Methodology: This study is a pre/post analysis assessing patient perception of
medication reconciliations completed. Conclusion pending at time of abstract medication communications during hospitalization in an academic teaching hospital. A brief five question survey was administered to patients on general medical-surgical
Presentation Objective: Describe how pharmacists can increase direct patient care
units before and after the pharmacy initiative to use pharmacy personnel including interactions to provide and promote pharmacy services. pharmacists, pharmacy residents, and pharmacy students to counsel patients about Self Assessment: What areas of patient satisfaction, shown by HCAHPS scores, do
their medication therapy. pharmacists have the potential to impact through increased patient interaction? Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Identify the role of pharmacist driven patient-centered
education in regards to medication therapy.
Self Assessment:
Poor patient-reported experiences have been associated with which
of the following? a) Lower recovery rates b) Decreased compliance to medications
after discharge c) Increased readmission rates d) All of the above
ABSTRACT REPRODUCTION FORM
Time: 3:40 - 4:00 Room: G112 Category: MED
PHARMACIST IMPACT ON CONTRAST INDUCED NEPHROPATHY
Kristin Morabito, William Kernan, Jamie Riskin, Darshika Patel Cleveland Clinic Purpose/Background: Contrast induced nephropathy (CIN) is one of the most
serious complications associated with administration of intravenous iodinated
contrast. Screening patients for risk factors prior to administering IV contrast dye is
crucial to prevention. A policy was established at our institution for pharmacist
verification of all contrast orders. This retrospective analysis serves to assess the
efficacy of the policy.
Methodology: This study is a retrospective, single-center, observational study
approved by the IRB at CCF. The primary endpoint is to compare the number of
patients that develop CIN before and after policy implementation. Secondary
endpoints are to assess the compliance with the policy, and quantify the number of
interventions pharmacists have made related to contrast orders during the study
period. Patient data includes diagnosis of CIN and serum creatinine level prior to IV
contrast administration. This study will compare pre-policy data, February - May
2011 vs. post policy data, February - May 2012.
Results/Conclusions: For the primary endpoint, 58 patients were assessed for CIN,
for the pre-policy time point, and 349 for the post-policy time point. Zero patients
were found to have CIN in the pre-policy group vs. ten in the post-policy group. For
the secondary endpoint 2 Conclusion pending at time of abstract submission
Presentation Objective: Assess a new pharmacy policy, and pharmacist impact on
decreasing the incidence of contrast induced nephropathy at our institution.
Self Assessment:
Are pharmacists complying with the policy to ensure safer
administration of IV contrast?
2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session I, cont.
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 4:10 - 4:30 Room: G301 Category: ID
Time: 4:30 - 4:50 Room: G301 Category: ID
EVALUATION OF AN ANTIMICROBIAL STEWARDSHIP APPROACH TO
MEASURING THE IMPACT OF A MEDICATION SURVEILLANCE
MINIMIZE OVERUSE OF ANTIBIOTICS IN PATIENTS WITH
SYSTEM ON ANTIMICROBIAL DE-ESCALATION IN A COMMUNITY
ASYMPTOMATIC BACTERIURIA AT AN ACADEMIC TEACHING
HOSPITAL SETTING
HOSPITAL
Carmen Ward, Ernie Cyr West Florida Healthcare Denise Kelley, Patrick Aaronson, Elaine Poon, Yvette McCarter, Ben Bato, Purpose/Background: The use of the computerized pharmacy surveillance system
Christopher A. Jankowski Shands Jacksonville Medical Center Sentri7 has been utilized to streamline pharmaceutical antimicrobial management by Purpose/Background: Asymptomatic bacteriuria (ASB) is a commonly occurring
alerting the pharmacist when patients meet certain criteria that may require an problem in hospital facilities that is often misdiagnosed and mistreated. Current intervention by a pharmacist. These prompts notify pharmacists in real-time of guidelines discourage antimicrobial therapy for ASB unless the patient is pregnant or potential opportunities for antimicrobial de-escalation in an effort to place patients on undergoing a urologic procedure. The unnecessary treatment of ASB has been narrow spectrum antimicrobials, discontinue unnecessary therapy, or convert them to associated with an increased incidence of adverse effects and development of an oral dosage form if intravenous drug was previously being used. If the patient's antimicrobial resistance with no additional benefit on clinical outcomes. This study antimicrobial therapy is ordered by a hospitalist, an automatic IV to PO protocol is in was designed to evaluate the impact of a multi-faceted educational initiative provided place where the pharmacist may independently determine a patient's eligibility for to physicians and pharmacists at an academic medical center in an effort to minimize PO therapy. For all other cases of antimicrobial de-escalation, the physician is either inappropriate antimicrobial use in the setting of ASB. contacted or a preprinted form is filled out by the pharmacist and left in the patient's chart for the physician's review. The primary objective of this study is to measure the Methodology: This study assessed the treatment of ASB through a pre/post
educational initiative. Pocket urine antibiogram cards with ASB recommendations,
clinical and pharmacoeconomic impact of computerized pharmacy surveillance on educational in-services, and ASB awareness flyers were provided to the Emergency antimicrobial de-escalation. Medicine, Internal Medicine, and Hospitalist Medicine services. All patients with Methodology: This is a single-center, open-label, randomized, and retrospective
positive urine cultures (≥ 10 4 CFU/ml) collected between August-October (pre- study. Data collection will be performed on patients who received more than 72 education) and January-March (post-education) were assessed for antimicrobial hours of antimicrobial therapy. A randomized and de-identified sample of 200 treatment of ASB. Secondary endpoints included number of inappropriate patients will be taken. Data will be collected from September 1, 2012 to November antimicrobial days and Clostridium difficile infections within 30 days of treatment of 31, 2012. The following data will be collected from Sentri7 monitoring parameters: age, sex, antimicrobial therapy orders, doses administered, cultures and sensitivities results, pharmacist interventions, and antimicrobial de-escalation. Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Describe the impact of an antimicrobial stewardship
educational initiative on reducing the overtreatment of asymptomatic bacteriuria. Presentation Objective: Describe the utility of a pharmacy surveillance system for
Self Assessment: When is it appropriate to treat asymptomatic bacteriuria?
antimicrobial de-escalation. Self Assessment: What is a pharmacy surveillance system?  
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 4:50- 5:10 Room: G301 Category: ID
Time: 4:10 - 4:30 Room: G103 Category: AM
MONITORING AND OPTIMIZING ANTIBIOTIC SELECTION IN
EVALUATION OF AUTOMATIC CONVERSION FROM ROSUVASTATIN
COMMUNITY-ACQUIRED PNEUMONIA PATIENTS
TO ATORVASTATIN IN AMBULATORY PATIENTS
Jessica LaFosse, Heather McCormick, Stephen Gilbert, Ted Heierman Holmes Nicholas R. Bacon & Patricia Fernandez-Quevedo Miami VA Healthcare System Regional Medical Center Purpose/Background: The Pharmacy and Therapeutics committee at the Miami VA
Purpose/Background: It is best practice that admitted patients with a diagnosis of
Healthcare System approved an automatic conversion of patients receiving pneumonia receive antibiotic therapy consistent with current guidelines within rosuvastatin to a predetermined dose of atorvastatin. It is of utmost importance to twenty-four hours of arrival. The study purpose is to compare appropriateness of evaluate such programs to ensure there is not a decrease in efficacy of such regimens. initial antibiotic selection and timing for patients admitted with a CAP diagnosis with pharmacist monitoring compared to usual care. Methodology: All patients who were automatically converted from rosuvastatin to
atorvastatin within the past year will be identified and evaluated for efficacy of their

Methodology: The usual care group consists of patients diagnosed with CAP before
new medication regimen. Each patient will be evaluated for baseline serum the monitoring program. The data for this group will be retrieved from the health cholesterol levels (prior to the automatic conversion) as well as a follow up lipid system's analytics system using dates from September 30, 2011 to January 26, 2012. panel occurring at least 6 weeks post conversion. In addition, patients will be In the comparator group, patient charts will be reviewed every 24 hours from October evaluated for changes in serum creatinine kinase and liver function tests. Analyses 1, 2012 until December 17, 2012 by a pharmacist. Patients will be included if they are will be performed to determine if there is a significant difference between the two diagnosed with CAP and over the age of eighteen. Immunocompromised and transfer medication regimens. patients will be excluded. The following data was recorded for each patient: admission date and time, antibiotic allergies, antibiotics administered within the first Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
twenty four hours, antibiotic administration date and time, pseudomonas risk, comorbidities, and length of stay. Data will be used to compare the frequency of Presentation Objective: Discuss the effectiveness of atorvastatin in patients
appropriate antibiotic selections between the two groups. This study obtained previously treated with rosuvastatin. approval from the Ethics Committee. Self Assessment: What is the reported difference in potency between rosuvastatin and
Results/Conclusions: Pending at time of abstract submission.

Presentation Objective: Identify patients with community acquired pneumonia and
recommend appropriate antibiotic regimen for treatment.
Self Assessment:
What is an appropriate antibiotic regimen for community-acquired-
pneumonia?
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 4:30 - 4:50 Room: G103 Category: AM
Time: 4:50- 5:10 Room: G103 Category: AM
EVALUATION OF PHARMACY-DRIVEN MEDICATION
PREVENTION OF MEDICATION ERRORS THROUGH PHARMACY-
RECONCILIATION AT THE UNIVERSITY OF FLORIDA & SHANDS
BASED MEDICATION RECONCILIATION
INTERNAL MEDICINE OUTPATIENT CLINIC THROUGH
Rachael Carloni, Bernadette Belgado, Marci DeLosSantos, Karen Malcolm, RETROSPECTIVE CHART REVIEW
Stephanie McCormick, Jennifer Carrillo, Justin Tinsley Shands Jacksonville Medical Danielle Pierini, Katherine Vogel Anderson, Eric Rosenberg UF College of Purpose/Background: Medication reconciliation upon inpatient admission has been
Purpose/Background: Implementation of an effective medication reconciliation
proven to reduce medication errors and improve patient outcomes. This process is process can reduce errors and improve mediation use. Pharmacy service at the Shands currently required by The Joint Commission and recommended by many other Internal Medicine Outpatient Clinic has developed a novel medication reconciliation organizations, such as the Institute for Safe Medication Practices. Despite this, there model involving telephoning a patient the day before his/her appointment scheduled are no clear recommendations about which healthcare providers should perform with a resident physician. This study will evaluate pharmacy service's roles in medication reconciliation. At Shands Jacksonville this is most often completed by identifying opportunities for clinical intervention and providing drug therapy nursing staff, but there has been a recent pharmacy initiative to supplement the recommendations to the resident physicians. process with pharmacy student involvement. The aim of this study is to evaluate the impact of pharmacy involvement in the medication reconciliation process. Methodology: Investigators will perform a retrospective review of the health
system's electronic health record for all patients who were provided medication Methodology: This is a retrospective evaluation including charity patients admitted
reconciliation by the pharmacy service over a six-month period. Data regarding to Shands Jacksonville for inpatient care between September 1, 2012 and January 15, recommendations made by pharmacy will be collected from pharmacy progress notes 2013. Pharmacy medication reconciliation data collection forms will be evaluated to and categorized based on type of recommendation provided (e.g., drug-drug determine discrepancy rates compared to original medication reconciliation interaction, therapeutic duplication, indication for therapy). In order to assess whether performed at the time of admission. The primary objective is to determine the recommendations have been accepted or declined by physicians, resident physician frequency of discrepancies between medication reconciliation performed by encounter notes will be reviewed. If recommendations were not accepted, the pharmacy staff compared to other healthcare professionals. Secondary objectives alternative plan formulated by the physician will be noted. include classification of discrepancy types identified, rates of discrepancy resolution, and identification of drug classes most commonly involved. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Describe the role of a clinical pharmacist in performing
medication reconciliation services in an outpatient setting. Presentation Objective: Describe the advantages of pharmacy involvement in the
Self Assessment: What was the most common category of drug therapy
completion of medication reconciliation for hospitalized patients. recommendations identified in this study? Self Assessment: Which classification of medication discrepancy was identified
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 4:10 - 4:30 Room: G114 Category: CCM
Time: 4:30 - 4:50 Room: G114 Category: CCM
IMPACT OF ACETAMINOPHEN IN REDUCING OPIOID USE
USE OF N-ACETYLCYSTEINE THERAPY BEYOND THE 21-HOUR
INTRAVENOUS PROTOCOL FOR ACETAMINOPHEN TOXICITY
Brittany Herring, Sheila Ader, Carla Hawkins, Madeline Camejo Memorial Regional Rachel O'Geen, Dawn Sollee, Jay Schauben, Thomas Kunisaki Shands Jacksonville Purpose/Background: Opioids cause sedation, respiratory depression and reduced
Purpose/Background: Confusion exists among providers regarding proper utilization
gastrointestinal motility. For this reason, physicians seek alternatives which reduce of the 21 hour intravenous (IV) protocol for N-Acetylcysteine (NAC) treatment of opioid use while maintaining a similar level of efficacy and analgesic effect. This acetaminophen (APAP) overdose, especially when patients present outside the initial study examines intravenous acetaminophen's impact on reducing opioid usage for 8-10 hour window. Many practitioners assume the 21 hour protocol is sufficient in all postoperative pain in female hysterectomy patients. cases of APAP overdose regardless of presentation. Currently, there are no studies evaluating use of this protocol for patients who are started on treatment beyond the Methodology: This is a retrospective study of surgical adult female patients who
FDA approved indications and any factors associated with extension of therapy. have undergone total abdominal hysterectomies. Group A received opioids without around the clock intravenous acetaminophen (January 1 through March 28, 2011). Methodology: This is a non-interventional, retrospective chart review of APAP
Group B was treated with intravenous acetaminophen and opioids (May 1 through exposures handled by the Florida Poison Information Center Network (FPICN). July 16, 2012). The endpoints were to examine the impact of intravenous Inclusion criteria includes any human exposure in the FPICN database coded with IV acetaminophen in reducing opioid use (average amount in morphine equivalents) NAC as a therapy from 2/1/2004 to 6/30/2012, completion of the 21 hour IV NAC within the first 48 hours and perioperatively. protocol, and documented APAP exposure based on serum levels or patient history. Exclusion criteria includes patients not completing 21 hours of therapy, known Results/Conclusions: Postoperative intravenous acetaminophen showed a
history of hepatic disease, co-ingestion of substances known to be hepatotoxic or nonstatistically significant 34% reduction (p=0.2) in opioid use. In both groups, affect coagulation, NAC administered orally prior to IV, administration error, non- opioids were used more frequently in the recovery room than at any other time toxic ingestion based on Rumack-Matthew treatment nomogram, patients lost to postoperatively. Intravenous acetaminophen reduced opioids 18% preoperatively, follow up or with insufficient data to determine outcome. 11% intraoperatively and 16% perioperatively. While the results of this study cannot be conclusive, intravenous acetaminophen shows promise as a useful analgesic in Results/Conclusions: Results pending at time of abstract submission. Conclusion
surgical procedures. Additional research should be conducted to further investigate its pending at time of abstract submission. Presentation Objective: Describe the incidence of extending the 21-hour IV NAC
Presentation Objective: Describe intravenous acetaminophen's role in reducing
protocol for APAP toxicity and factors contributing to extension. opioid use in female hysterectomy patients for pain management. Self Assessment: What are the proposed endpoints for discontinuing NAC therapy
Self Assessment: In moderate to severe postoperative pain, the most effective
for the treatment of APAP toxicity? medication regimens include a) Only opioids b) Only nonopioids c) Opioid and nonopioid combinations ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 4:50- 5:10 Room: G114 Category: CCM
Time: 4:10 - 4:30 Room: G112 Category: ADM
BLEEDING INCIDENCE WITH DIALYSIS PATIENTS ON TREATMENT
REVISION OF THE NEW PATIENT ORIENTATION PROCESS FOR THE
DOSES OF ENOXAPARIN
BAY PINES VETERAN'S AFFAIRS HEALTHCARE SYSTEM (VAHCS)
Chad Edgar, Carla Hawkins-Locke, Madeline Camejo Memorial Regional Hospital CONTINUED
Purpose/Background: The drug manufacturer of enoxaparin recommends a dose
Kristen Fischer, Keri Justice Bay Pines VA Health Care System adjustment for patients with a creatinine clearance at or below 30 mL/min. However, Purpose/Background: A national Veteran's Affairs initiative was recently launched
there is no recommendation for dosing in hemodialysis patients. Therefore, use of to promote patient-centered care with an emphasis on interdisciplinary team enoxaparin is discouraged in dialysis patients due to increased blood levels and the collaboration. The purpose of this project is to streamline the new patient orientation potential for bleeding. process at the Bay Pines VA and outlying clinics by developing a consistent electronic version. Current new patient classes are conducted in a group setting with Methodology: This study is a retrospective chart review conducted from 6/01/2008
to 8/31/2012. A review of the patient's medical records was performed to determine
waived patient confidentially and employ an interdisciplinary team to deliver a dialysis status and the presence of bleeding events. Only patients 18 years or older and on acute or chronic hemodialysis were included in the analysis. Patients with Methodology: Observation of the current process gathered the necessary information
diagnosed bleeding disorders, pregnant/breast feeding patients and those on deep vein about specific content delivered. An interdisciplinary team has been working on a thrombosis (DVT) prophylaxis doses were excluded. All of the study subjects were comprehensive script to provide an overview of pertinent information from each evaluated for the presence of a bleeding event. service. The goal is to make the content available to patients in a standardized digital format on the Bay Pines website, at computer terminals in the Patient Education Results/Conclusions: Out of 69 patients included in the study, 9 bleeding events
were found (13%). On average, patients with bleeding events were older (76.4 years
Resource Center (PERC), through CCTV for inpatients, and on DVD. Having a old) when compared to all study participants (65.4 years old). In addition, the consistent message and multiple points of distribution will improve orientation and majority of patients with bleeding events were on 1-2 other make the process more efficient. anticoagulants/antithrombotics (77.7%). In this study, dialysis patients on treatment Results/Conclusions: The video script has been approved for production. Working
doses of enoxaparin showed a high incidence of bleeding, especially those over the as a patient-centric interdisciplinary team allowed for improvements in the new age of 65 and on concomitant anticoagulants. patient orientation process, including improved patient satisfaction, consistency of information, and increased access to information. Presentation Objective: Describe the incidence of bleeding events in dialysis
patients on treatment doses of enoxaparin. Presentation Objective: Describe the advantages of a standardized patient-centric
Self Assessment: What factors were found to be associated with a higher bleeding
orientation process as part of an interdisciplinary team approach. risk in dialysis patients? Self Assessment: What are the proposed advantages of the restructured patient
orientation process? A. Enhance patient privacy and satisfaction B. Improve consistency and efficacy of information delivered C. Promote patient-centered care utilizing an interdisciplinary team ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 4:30 - 4:50 Room: G112 Category: ADM
Time: 4:50- 5:10 Room: G112 Category: ADM
INITIATION OF PHARMACIST PHARMACOKINETIC PEER-REVIEW
CENTRAL DATABASE TO ACCESS RESTRICTED-USE MEDICATION
EVALUATION
INFORMATION AT THE BAY PINES VETERANS AFFAIRS
Victoria Koenig, Robert Stewart Bay Pines VA Health Care System HEALTHCARE SYSTEM
Purpose/Background: The purpose of this project is to develop and implement a
Ellen Cvejanovich, John Hoeldtke Bay Pines VA Health Care System peer-review evaluation policy for pharmacists at BPVAHCS conducting vancomycin Purpose/Background: The purpose of this project is to develop a central location to
and aminoglycoside pharmacokinetic dosing. access information about medications determined by either Veterans Affairs National Formulary (VANF) or Bay Pines Veterans Affairs Healthcare System (BPVAHCS) to Methodology: An evaluation form will be created for reviewers to assess the
have restricted-use or contain criteria for use. The goal of the development of this standardized performance indicators of vancomycin and aminoglycoside dosing. A central database is to standardize resources for the review of restricted medications. peer-review committee (PRC) will be responsible for conducting the policies and procedures initiated. Five cases from each pharmacist will be reviewed quarterly (if Methodology: A database compiling information about restricted-use medications
available). Patient cases will be randomly identified from clinical notes completed by will be developed. This database will reference VANF criteria for use and drug pharmacists through the VA computerized patient record system (CPRS). The PRC monographs. The database will also compile BPVAHCS criteria for use and will determine who the most appropriate peer is to review a provider's case. After medication restrictions. This information will be obtained from the VANF and assessing the patient case, the reviewer will complete the standardized evaluation BPVAHCS P&T Committee minutes from 2007 to 2012. This database will be form and assign a level 1, 2 or 3 level of pharmacist-provided care. The PRC will uploaded to the Bay Pines Public drive in the PBM folder. This database will be examine peer-review reports, provide a confidential evaluation summary to the developed to allow for updating with new or revised medication use restrictions or reviewed pharmacist, evaluate performance trends and compile a report to be criteria for use. distributed to the pharmacists and pharmacy administrators. Results/Conclusions: Results pending at time of abstract submission Conclusion
Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission pending at time of abstract submission Presentation Objective: Describe the tools needed to develop a centralized database
Presentation Objective: Describe how to develop and implement a pharmacokinetic
to provide access to local and national restricted-use medication information for a peer-review evaluation for pharmacists Veterans Affairs Healthcare Center. Self Assessment: What differentiates peer review levels of 1, 2 and 3?
Self Assessment: Which of the following tools or references were utilized in the
creation of this database? a.Microsoft Excel b.Veterans Affairs PBM National Criteria for use database c.Bay Pines VA P&T Committee minutes d.All of the above 2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session II
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 8:20 - 8:40 Room: G301 Category: IM
Time: 8:40 - 9:00 Room: G301 Category: IM
IMPACT OF DOSE-CAPPING OF UNFRACTIONATED HEPARIN ON
OUTCOME OF PHARMACIST COUNSELING ON PATIENT
TIME TO THERAPEUTIC ANTICOAGULATION: A RETROSPECTIVE
SATISFACTION AND MEDICATION KNOWLEDGE: A PROSPECTIVE
Mary Briand, Rachel Samples, Kelly Biastre Wolfson Children's Hospital/Baptist Whitney Bunion, Marjorie Rochette-DeLucia, Beth Briand, Atinuke Ogunsan Wolfson Children's Hospital/Baptist Health System Purpose/Background: Rapid achievement of therapeutic activated partial
Purpose/Background: Pharmacists play a vital role in the improvement of
thromboplastin time (aPTT) and anticoagulation is important to a positive clinical appropriate medication use and in reducing medication errors among hospitalized outcome in patients receiving unfractionated heparin (UFH). The 2012 American patients. Medication counseling may help increase patient compliance and help to College of Chest Physicians guidelines recommend weight adjusted heparin dosing resolve medication related concerns for the patient. Many hospitals use a survey for initial bolus and initial infusion rate for venous thromboembolism (VTE) therapy called the Hospital Consumer Assessment of Healthcare Providers and Systems with no recommendation on specific weight to be used. This study evaluates the (HCAHPS). This survey is used to assess patients' perspectives of their hospital stay impact of maximum (dose-capped) initial bolus and the initial infusion rates for UFH including counseling about medication indications and side effects. The purpose of on time to therapeutic anticoagulation in adult patients weighing greater than 145 kg this study is to evaluate whether pharmacist counseling affects patient satisfaction (dose-capped weight per hospital protocol). This study also compares the final UFH and medication knowledge as measured by HCAHPS scores and evaluated by infusion rates needed to achieve targeted aPTTs in patients weighing greater than 145 pharmacists administered survey post counseling. kg and patients weighing less than or equal to 145 kg. Methodology: The study population will include adult patients (ages 18 years and
Methodology: This IRB approved study includes two retrospective groups of
up) on a medical-surgical unit. The intervention of the study will consist of hospitalized patients 18 years of age or older who received high-intensity UFH counseling done by a pharmacist or a pharmacy student on the patient's medications. therapy. Information collected includes patient demographics, indication for The participants who provide informed consent will fill out a pre- and post-survey anticoagulation, initial bolus and initial UFH infusion rate, time to therapeutic aPTT, regarding their medication knowledge. Patients will also be asked to complete the final UFH infusion rate, and number of dose adjustments before therapeutic aPTT. HCAHPS survey once receiving it in the mail. Results/Conclusions: Pending at time of abstract submission
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: List the potential complications of weight-based heparin
dosing in patients who weigh more than 145 kg. Presentation Objective: Describe the patient-specific factors that may be affected
Self Assessment: What are the complications of weight-based heparin dosing in
by pharmacist counseling. patients who weigh more than 145kg? Self Assessment: What do hospitals use to measure patient satisfaction?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 9:00 - 9:20 Room: G301 Category: IM
Time: 8:20 - 8:40 Room: G103 Category: ID
DAILY PHARMACEUTICAL CARE INTERVENTIONS FOR CONGESTIVE
IMPLEMENTATION OF A SEPSIS MANAGEMENT PROTOCOL AND
HEART FAILURE PATIENTS IN A COMMUNITY HOSPITAL
EDUCATION PROGRAM IN A COMMUNITY HOSPITAL
Sara Dingwal,l Sylvia Stoffella, Kelly Kasten, William Terneus Indian River Medical William Terneus, Jr., Matthew Lambie, Charles Callahan, George Mitchell, Donald Sullivan Indian River Medical Center Purpose/Background: Congestive heart failure (CHF) is the leading cause of 30-day
Purpose/Background: Severe sepsis remains the primary cause of death in non-
re-hospitalization of Medicare patients in the United States, with rates estimated at cardiac intensive care units nationwide, from 30-50 percent mortality. Between 2003- 23-27% nationally. New Medicare reimbursement strategy reduces payments for care 2007, severe sepsis hospitalizations increased by 71 percent to 710,000 admissions. In of patients re-admitted within 30 days of discharge. Payments are also reduced when 2004, the Surviving Sepsis Campaign (SSC) introduced the first guidelines with a patient satisfaction surveys identify sub-optimal communication with healthcare goal of reducing sepsis mortality by 25% over five years. Implementation of a providers. Healthcare systems are charged with identifying patient-centered care that guideline-based institutional sepsis program has been shown to improve survival. satisfies both expectations. Methodology: A multidisciplinary Sepsis Team developed a patient care protocol
Methodology: During December 2012 and January 2013, newly admitted patients
based upon SSC criteria. The Sepsis Management Protocol will be implemented with a primary diagnosis of CHF were identified using daily census reports. Eligible hospital-wide. Part one will consist of a screening tool for early identification of patients were interviewed by a pharmacist using a standardized questionnaire to sepsis. Patients meeting one of the following: recent procedure or antibiotics, or assess baseline knowledge of CHF medications and to identify potential barriers to suspected or confirmed infection, and two of the following: temperature > 38°C or < medication compliance. Patient-specific daily medication plans were created based 36°C, white blood cells > 12,000 or < 4,000, heart rate > 90, or respiratory rate > 20 upon the questionnaire results to address identified deficit(s) of knowledge and will have labs drawn. The physician will be contacted for a lactate ≥ 4 mmol/L, sources of potential medication non-compliance. During each day of the patients' systolic blood pressure < 90mmHg or > 40mmHg drop from baseline. For patients hospitalization, a pharmacist or an APPE student pharmacist delivered daily who meet SSC criteria, treatment will be accomplished in two steps: 1) a resuscitation medication education for approximately 10-15 minutes, including: daily topic (drug bundle, completed within the first six hours, focused on fluid resuscitation and class) education, including brand/generic names, indication, instructions for use, and appropriate antibiotics, and 2) a management bundle, completed within the first 24 potential side effects. Any changes made to CHF medication regimens were hours, focused on glucose control and corticosteroid use, among other measures. discussed and patients were allowed to ask questions. Education and compliance tools Education will be provided to all healthcare professionals involved prior to protocol were provided based on individuals' level of health literacy, comfort using technology, and CHF medication regimen. Results/Conclusions: Pending at time of abstract submission.
Results/Conclusions: Pending at time of abstract submission
Presentation Objective: Describe the process of implementing a sepsis protocol in a
Presentation Objective: Explore the effects of pharmacy-provided medication
community hospital. education on patient knowledge of CHF medications and barriers to medication Self Assessment: Name one key component of successful implementation of a sepsis
compliance, as well as to determine the relative impact on 30-day re-hospitalization rates
Self Assessment:
What are two new measures that CMS is using to determine quality
of care, and in turn, reimbursement rates? 
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 8:40 - 9:00 Room: G103 Category: ID
Time: 9:00 - 9:20 Room: G103 Category: ID
EVALUATION OF VANCOMYCIN-INDUCED NEPHROTOXICITY (VIN)
IMPACT OF A PHARMACIST-DRIVEN ANTIMICROBIAL
AND INSTITUTIONAL DOSING PROTOCOL
STEWARDSHIP PROGRAM FOR PATIENTS IN THE INTENSIVE CARE
Amanda Chao, Brittany Fries, Shauna Jacobson Orlando Health UNIT ADMITTED WITH SEPSIS
Purpose/Background: Vancomycin is a cornerstone antibiotic for the treatment of
Martha Knoblich, Jennifer Schmeding, Han Truong St. Jospeh's Hospital Gram-positive infections. Nephrotoxicity was common with the use of the old Purpose/Background: There is an increasing rate of resistance growing among
preparations due to toxic excipients, but VIN incidence significantly declined with pathogenic organisms and a delay in the development of new antibiotics. the purified formulation. More recently, however, there has been an increase in the Consequently, the development of Antimicrobial Stewardship Programs (ASPs) to incidence of VIN. While the reason for this trend remains unclear, some explanations aid healthcare professionals in appropriate utilization of antibiotics has been strongly have been proposed, such as the use of higher doses to achieve higher goal trough encouraged. St. Joseph's Hospital has recently implemented a review and feedback levels, increased use of concomitant nephrotoxins, and uncertainty in dosing for system which alerts pharmacists of potential inappropriate antibiotic use. The intent obese patients. Regardless of the cause, VIN often leads to the use of costly or of this study was to review the effectiveness of this ASP. broader spectrum agents. An evaluation of VIN incidence, dosing practices, and identification of risk factors associated with VIN will be invaluable in optimizing Methodology: An IRB-approved, retrospective chart review conducted in the
clinical and stewardship activities of vancomycin. intensive care unit of St. Joseph's Hospital for patients admitted with a diagnosis of sepsis. Patients will be included if they are greater than 18 years of age and started on Methodology: Retrospective chart review was performed in hospitalized patients ≥
a broad-spectrum antibiotic regimen. Exclusion criteria include pregnancy, infections 18 years of age receiving intravenous vancomycin for at least 72 hours. Data influenced by challenging source control, and immunocompromised patients. Data collected included patient demographics, laboratory results, concomitant nephrotoxic will be collected on days of therapy from admission date until antibiotic regimen is medications, vancomycin indication, dose, trough level(s), and duration. Patients with altered and until all antibiotic therapy is discontinued, the types of antibiotics suspected VIN, defined as increase in SCr > 50% from baseline or a doubling of administered, the quantity and type of pharmacist interventions and cost. The serum creatinine, were further evaluated for identifiable risk factors. comparison of a before-ASP implementation group and an after-ASP implementation group will be used to evaluate the impact of the pharmacist-driven ASP. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Describe risk factors and/or dosing practices that may
predispose the patients to develop VIN. Presentation Objective: Describe the impact a pharmacist-driven, review and
Self Assessment: What risk factor most associated with VIN was identified in this
feedback ASP may have on use of antibiotics and overall cost. Self Assessment: What are the potential responsibilities a clinical pharmacist can
assume to assist with antimicrobial stewardship? ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 8:20 - 8:40 Room: G114 Category: ID
Time: 8:40 - 9:00 Room: G114 Category: ID
EVALUATION OF VANCOMYCIN DOSING WEIGHTS IN OBESE
RETROSPECTIVE ANALYSIS TO DETERMINE THE INCIDENCE OF
PATIENTS
ACUTE KIDNEY INJURY IN PATIENTS TREATED WITH PIPERACILLIN-
Amy Stewart, Cassie Kostevicki, Jamie Kisgen Sarasota Memorial Hospital TAZOBACTAM, VANCOMYCIN OR THE COMBINATION
Purpose/Background: Inappropriate dosing of vancomycin can lead to the
Rusha Patel, Robyn Choe, Jamie Kisgen Sarasota Memorial Hospital development of antimicrobial resistance and therapeutic failure. For obese patients, Purpose/Background: Acute kidney injury (AKI) is well documented in the
the optimal dosing strategy to achieve therapeutic concentrations has not been well literature as an adverse effect for vancomycin, whereas piperacillin-tazobactam is not established. An evaluation of vancomycin dosing weights and a comparison of their commonly implicated. However, two recent studies indicate piperacillin-tazobactam predictive value to achieve therapeutic trough concentrations may provide evidence may be associated with a higher incidence of AKI. The goal of this study was to for the development of an optimal dosing strategy for this population. determine if the use of vancomycin alone, piperacillin-tazobactam alone and/or the combination is associated with an increased risk of AKI at our institution. Methodology: This IRB approved retrospective chart review was conducted to
identify obese patients > 18 years of age who received vancomycin therapy for a Methodology: A single center, IRB approved, retrospective study was conducted in
minimum of 48 hours. Obesity was defined as having an actual body weight (ABW) adult patients who received piperacillin-tazobactam, vancomycin or the combination > 150% of ideal body weight (IBW). Patients who had one steady state trough for at least 48 hours. Patients with baseline renal dysfunction (serum creatinine concentration drawn and had a creatinine clearance > 50mL/min were enrolled in the greater than or equal to 2 mg/dl or currently receiving renal replacement therapy), study. Data was collected for patient demographics, renal function, vancomycin receiving vasopressor agents within 48 hours of antibiotic administration, or patients dosing regimens, and trough concentrations. The total daily dose of regimens that on extended infusion piperacillin-tazobactam were excluded. The primary outcome achieved target concentrations of 10-20mcg/mL were analyzed as three weight-based was the incidence of AKI, defined as an increase in serum creatinine of greater than groups (mg/kg) of ABW, IBW, and adjusted body weight (AdjBW). Statistical or equal to 0.5mg/dl or 50% from baseline after at least 48 hours of therapy. The comparison of the predictive value for achieving target trough concentrations for each secondary outcome was overall hospital mortality. One-way ANOVA will be used to group was performed by the use of linear regression analysis. determine significance of the primary outcome. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission. pending at time of abstract submission Presentation Objective: Explain the Infectious Diseases Society of America's
Presentation Objective: Determine the association between piperacillin-tazobactam
recommendation for dosing vancomycin in obese patients and discuss its limitations. and acute kidney injury. Self Assessment: Which weight-based group had the greatest predictive value of
Self Assessment: Which group was associated with the highest rate of acute kidney
achieving target trough concentrations? injury in this study and was that found to be significant? ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 9:00 - 9:20 Room: G114 Category: ID
Time: 8:20 - 8:40 Room: G112 Category: CCM
THE USE OF CEFTAROLINE FOSAMIL IN METHICILLIN-RESISTANT
EVALUATING THE SIGNIFICANCE OF DELAYING INTRAVENOUS
STAPHYLOCOCCUS AUREUS BACTEREMIA IN A COMMUNITY BASED
LIPID THERAPY DURING THE FIRST WEEK OF HOSPITALIZATION IN
HOSPITAL SYSTEM: A RETROSPECTIVE CASE SERIES
THE INTENSIVE CARE UNIT
Aileen N. Martinez, Sandy Estrada, Amy Wecker Lee Memorial Health System Janet Arrazcaeta, Stephen Lemon, Frederick Moore Shands at the University of Purpose/Background: Ceftaroline is a new fifth-generation cephalosporin approved
for the treatment of skin and soft tissue infections caused by MRSA and community- Purpose/Background: American Society for Parenteral and Enteral Nutrition
acquired pneumonia. Limited clinical data exists on the use of ceftaroline for MRSA (A.S.P.E.N.) and the Society of Critical Care Medicine (SCCM) published guidelines bacteremia. The purpose of this study was to determine clinical and microbiologic in 2009 recommending against the use of intravenous (IV) lipids for parenteral outcomes of ceftaroline for the treatment of bacteremia caused by MRSA. nutrition (PN) within the first week of hospitalization in the critically ill. This grade D recommendation is controversial as it is based on the results of 2 small studies and Methodology: A retrospective chart review was performed on every patient in
LMHS who received ceftaroline for ≥5 days for the treatment of MRSA bacteremia.
did not evaluate glycemic control. This will be a retrospective analysis evaluating the The primary end point was microbiologic cure, defined as negative blood cultures for incidence of new infections and glycemic control with receipt of IV lipids within the MRSA at the end of therapy. Secondary outcomes were clinical cure rate defined as first week in the intensive care unit compared to withholding lipid therapy. resolution of all signs and symptoms of infection including decreased white blood Methodology: A retrospective review will be conducted on adult patients who
count and afebrile with a body temperature less than 38°C. Additional secondary received PN with intravenous lipids from May 15, 2011, to May 1, 2012 and adults outcomes included in-hospital mortality, hospital length of stay, antibiotic length of who received PN without intravenous lipids from May 15, 2012, to December 15, stay, 30 day readmission rate and adverse reactions including Clostridium dificile. 2012. The primary outcome is incidence of infection any time after initiation of PN, or a positive culture at least 48 hours after hospitalization for patients on PN at home. Results/Conclusions: Eight patients were included in the study. Preliminary results
suggest that patients received ceftaroline for a median of 10 days (range 5-36 days).
Secondary outcomes will include all-cause inpatient mortality, incidence of Microbiologic cure was achieved in 7 patients (87.5%), and clinical success occurred hyperglycemia, ICU and total length of stay (LOS), duration of mechanical in 6 patients (75%). Our experience suggests that ceftaroline may be an acceptable ventilation, health care expenditures. option for MRSA bacteremia; however, larger studies should be performed before Results/Conclusions: Results pending at time of abstract submission. Conclusion
this antimicrobial is routinely used for this indication. pending at time of abstract submission. Presentation Objective: Determine clinical and microbiologic outcomes of
Presentation Objective: Evaluate the significance in clinical outcomes associated
ceftaroline for the treatment of bacteremia caused by methicillin-resistant with delaying intravenous lipid therapy within the first week of hospitalization in the staphylococcus aureus (MRSA). intensive care unit (ICU). Self Assessment: Ceftaroline is FDA Approved for which indication? a) MRSA
Self Assessment: What is the incidence of infections in patients who receive lipids
Bacteremia b) Skin soft tissue infections c) Community Acquired Pneumonia d) A & within the first week of hospitalization? ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 8:40 - 9:00 Room: G112 Category: CCM
Time: 9:00 - 9:20 Room: G112 Category: CCM
SIMVASTATIN VERSUS PRAVASTATIN FOR THE PREVENTION OF
IMPACT OF DEXMEDETOMIDINE ON EARLY EXTUBATION
VASOSPASM
FOLLOWING CARDIAC SURGERY IN A VETERAN POPULATION: A
Matthew Logan, Wright Darius Faison, Jennifer Bushwitz, Brian Hoh, Spiros RETROSPECTIVE ANALYSIS
Blackburn Shands at the University of Florida Jaela Dahl, Marc Pepin, Bradley Stein James A. Haley Veterans Hospital Purpose/Background: Vasospasm, a complication of aneurysmal subarachnoid
Purpose/Background: Early extubation after cardiac surgery is associated with better
hemorrhage (aSAH), is a major cause of morbidity and mortality among patients who patient outcomes, decreased length of stay, and reduced hospital costs. Historically survive the initial hemorrhage. Nimodipine has been shown to confer a modest following cardiac surgeries, our facility used an analgesia based sedation strategy benefit in patient outcomes after aSAH, but it may not reduce the incidence of with a fentanyl continuous infusion. While effective, this medication is known to vasospasm. Simvastatin and pravastatin have been shown to decrease the incidence of cause respiratory depression, prolonged mechanical ventilation and hospitalization, radiographic vasospasm. Simvastatin was the statin of choice for this indication at our cognitive impairment, constipation, and withdrawal after discontinuation. institution, but concerns from the FDA caused a shift in practice and pravastatin Dexmedetomidine is a new highly specific alpha-2 adrenoreceptor agonist approved became the statin of choice for vasospasm prevention. for short term sedation, which the Cardiothoracic Surgery team started using routinely in 2009 to decrease post-operative intubation time. The purpose of this study is to Methodology: Patients included in the study will be ≥18 years of age, have a new
evaluate if the use of dexmedetomidine in post-cardiac surgery sedation has increased Fisher grade 3 or Modified Fisher grade 3-4 aSAH diagnosed by angiography, and the number of patients extubated within six hours compared to the historical use of will have received simvastatin or pravastatin for vasospasm prophylaxis. The incidence of angiographic vasospasm, clinical vasospasm, and vasospasm based on transcranial doppler criteria will be recorded. In addition, ICU length of stay, hospital Methodology: This is a retrospective cohort study. Inclusion criteria are veterans' age
length of stay, time to vasospasm, in-hospital mortality, and discharge disposition 18 or older undergoing coronary artery bypass graft surgery and/or valve will be recorded. Comparisons among the two groups will be made. repair/replacement between January 1, 2005 and August 31, 2012. Data will be collected on patient demographics as well as preoperative, intraoperative, and Results/Conclusions: Results pending at time of abstract submission Conclusion
postoperative variables associated with extubation timing. The primary outcome will pending at time of abstract submission be assessed by calculating the total intubation time from when the patient leaves the
Presentation Objective: Describe the role of statins in the prevention of vasospasm
operating room and the documented extubation time. Patients will be excluded from and make a comparison between pravastatin and simvastatin for this indication. the study for emergent surgery, crossover sedation, or perioperative variables that Self Assessment: Which medications may prevent vasospasm after aSAH?
predispose them to a complicated post-operative course. Results/Conclusions: Results pending at time of abstract submission.
Presentation Objective: Describe the rationale of dexmedetomidine for decreasing
time to extubation in post-operative open heart patients.
Self Assessment:
Describe the variables collected in this study that can impact
extubation timing in post-operative patients.  
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 8:20 - 8:40 Room: G312 Category: AM
Time: 8:40 - 9:00 Room: G312 Category: AM
IMPROVING IMMUNIZATION RATES AMONG PATIENTS ENROLLED
INCIDENCE OF ANDROGEN DEFICIENCY IN PATIENTS RECEIVING
IN AN OUTPATIENT PHARMACIST-RUN CLINIC
LONG-TERM OPIOIDS FOR THE TREATMENT OF CHRONIC NON-
Ahmad Shehab, Kimberly Finley Florida Hospital-Celebration Health CANCER PAIN.
Purpose/Background: Influenza is a contagious disease which can be spread by
Justin Davis, Julie McCutcheon, Jennifer Mauldin James A. Haley Veterans Hospital coughing, sneezing, and/or nasal secretions. Common symptoms of influenza include: Purpose/Background: Chronic non-cancer pain (CNCP) is a leading cause of
fever/chills, sore throat, cough, headache, muscle aches, fatigue, and runny/stuffy disability for patients in the United States. Opioid-induced endocrinopathy may be nose. Influenza affects 5-20% of the U.S. population and more than 200,000 people one of the least diagnosed and underappreciated consequences in patients receiving are hospitalized for flu-related complications yearly. This number can be greatly long-term opioid therapy. Opioids suppress the hypothalamic-pituitary-gonadal axis reduced by improving annual immunization rates. This project aims to increase which is responsible for the production and secretion of testosterone in men. immunization rates and assess barriers to receiving the annual influenza vaccine. Hypogonadism is associated with adverse sequelae including decreased libido, mood alterations, weight gain and fatigue. Current guidelines state there is insufficient Methodology: This is an IRB-approved study that was conducted via voluntary
anonymous survey. Patients enrolled in any of the Clinical Pharmacy Services (CPS)
evidence to support routine laboratory monitoring for opioid-induced outpatient clinics were offered the influenza vaccine during the month of September endocrinopathy. This study aims to compare the incidence of hypogonadism in and were asked to participate in a survey during their normal clinic visit. Surveys patients receiving opioids for chronic pain against patients not exposed to opioid were completed anonymously and placed in a manila envelope. The survey assessed current vaccination status, expectation for receiving the influenza vaccination this Methodology: This is a retrospective cohort study. A database will be queried to
year, planned location for vaccination, reasons for not receiving vaccination, reasons identify all male patients age 18 to 49 from July 1, 2011 to June 30, 2012 that for receiving vaccination from CPS, and future willingness to receive the vaccine received care at our institution. Eligible patients will be randomly selected for chart review to determine if a low testosterone level was recorded. Patients will be stratified for subgroup analysis by categorizing them based on the total daily dose Results/Conclusions: 131 surveys were returned over the one month collection
period. Results pending at time of abstract submission. Conclusion pending at time of
(TDD) or morphine equivalents (ME) received during the study period. Relevant abstract submission. clinical and demographic data that may contribute to the development of hypogonadism will also be collected. Presentation Objective: Describe a method to improve influenza immunization rates
in the community.
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Self Assessment: What are some ways to improve influenza immunization rates in
the community? Answer: Decrease cost, increase convenience, stress importance, and Presentation Objective: Describe the concern for the development of
debunk any myths associated with the influenza vaccine. hypogonadism in patients receiving chronic opioid therapy and its clinical Self Assessment: What risk factors should prompt evaluation for hypogonadism in a
young male population?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 9:00 - 9:20 Room: G312 Category: AM
Time: 8:20 - 8:40 Room: G307 Category: AM
RETROSPECTIVE COMPARISON OF TIME IN THERAPEUTIC RANGE
IMPACT OF COLLABORATIVE CARE SERVICES FOR HIGH-RISK
UTILIZING 6 WEEK INTERNATIONAL NORMALIZED RATIO
PATIENTS AFTER DISCHARGE FROM A LARGE URBAN ACADEMIC
MONITORING INTERVAL VS 4 WEEK INTERNATIONAL NORMALIZED
MEDICAL CENTER
RATIO MONITORING INTERVAL
Adrienne DeBerry, Billie Nguyen, Karen Malcolm, Ly Nguyen, Judella Haddad- Jennifer Gregory, Amber Beals Florida Hospital-Celebration Health LaClÃ, Russell McKelvey, Julie Ferm Shands Jacksonville Medical Center Purpose/Background: Less frequent INR monitoring may help decrease the amount
Purpose/Background: Healthcare providers have long been aware of the benefits of
of unnecessary warfarin dose changes, decrease overall medical costs, and limit the collaborative care practices. A high risk period for experiencing adverse drug events life inconvenience patients experience with monthly INR monitoring. While there has is the first few weeks following hospital discharge. Events such as changes in drug been research comparing the effectiveness and safety of 6 and 12 week INR regimens, changes in disease state, and communication gaps between inpatient and monitoring, each study has its limitations, including exclusion of specific diagnoses outpatient providers may often accompany the discharge process and may negatively or target INRs. This study will focus of the efficacy and safety of 6 week INR impact continuity of care. Novel approaches to the reduction of readmissions or monitoring in a wider population without the exclusion criteria regarding diagnosis or emergency department visits in the 30 days following discharge should target these factors. This study aims to assess the impact of an interdisciplinary transition of care team on readmissions and emergency department visits in the 30 days following Methodology: A retrospective chart review will be conducted on all patients who
were actively enrolled between April 1, 2012 and January 1, 2013 in an Anticoagulation Management Services. Using a standard data collection form, Methodology: This study is a single-center, observational, prospective case series
baseline characteristics will be collected for those patients who meet inclusion and pre-post study with a historical comparator group involving recently discharged criteria. Time in therapeutic range will be separately calculated for each patient's 4 patients referred to a transitional care team for intensive outpatient follow-up. Patients and 6 week monitoring periods utilizing an electronic anticoagulation software received medication therapy management sessions from pharmacists following system. In addition, extreme INRs (defined as INR ≤1.5 and ≥4), thromboembolic discharge, home visits conducted by case management to further screen for barriers to events (defined as an objectively verified symptomatic deep venous thrombosis, medication access and outpatient care. Physician appointments were scheduled for pulmonary embolism, or stroke) and major bleeding events (associated with patients within days of hospital discharge. Electronic medical records were utilized to hospitalization) will be reported. obtain information regarding details of pharmacists, case management, and physician encounters in the 4 to 6 weeks following discharge. The number and type of Results/Conclusions: Results pending at time of abstract submission Conclusion
medication-related problems uncovered in each pharmacist encounter and information pending at time of abstract submission regarding readmission or emergency room visits in the 30 days following discharge
Presentation Objective: As a clinician monitoring a stable patient's INR, describe
were also obtained from these records. your comfort level in allowing patients to be monitored every 6 weeks vs the previous traditional 4 weeks.
Results/Conclusions: Pending at time of abstract submission.
Self Assessment: What aspect of allowing patient's INR to be monitored every 6
Presentation Objective: Describe the impact of a collaborative transition care team
weeks vs every 4 weeks may lead to a thromboembolic or bleeding event? in reducing readmissions and/or emergency department visits in the 30-days following discharge. Self Assessment: What are some important considerations when implementing an
effective transition of care service?
ABSTRACT REPRODUCTION FORM
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Time: 8:40 - 9:00 Room: G307 Category: AM
Time: 9:00 - 9:20 Room: G307 Category: AM
PHARMACIST IMPACT ON QUALITY OF DIABETES CARE
PHARMACY INTERVENTION ON REDUCTION OF EARLY
Jason Powell, Karen Sando, Jim Taylor UF College of Pharmacy READMISSION RATES IN COPD PATIENTS
Purpose/Background: The purpose of this study is to discover if there is a benefit in
Poe Aunggyi; William Kernan; Martha Espinoza-Friedman; Antonia Zapantis; the utilization of clinical pharmacy services in the management of diabetes in meeting Cleveland Clinic Florida therapeutic goals and overall reduction in diabetes related hospitalizations and Purpose/Background: Chronic Obstructive Pulmonary Disease (COPD) is the
emergency room visits. fourth leading cause of death in U.S. and worldwide. The Centers for Medicare and Medicaid Services has identified early rehospitalization of patients with COPD Methodology: Medical records were retrospectively reviewed for patients seen
within the UF & Shands Community Health and Family medicine clinics between Jan
exacerbations as a performance measure. The primary objective of the study is to 1, 2011 and Jan 1 2012 for a primary or secondary diagnosis of diabetes mellitus evaluate if COPD education by a pharmacist reduces thirty days readmission rates (250.xx). Patients meeting inclusion criteria will be placed in either the intervention from COPD exacerbation. The secondary outcomes include improvements in group (those managed by pharmacy services plus physician) or control group (those medication compliance, vaccination adherence, symptom control and medication managed by physician alone). Hemoglobin A1c, blood pressure, low density lipoprotein, number of all-cause hospitalizations and emergency department visits Methodology: This is a randomized, prospective study comparing outcomes of
will be compared between groups. Attainment of treatment goals (Hemoglobin A1c, treatment and control groups. Subjects are identified by their COPD diagnosis in the Blood Pressure, Low Density Lipoprotien) will be measured against national electronic health record. The study includes patients who have been admitted for ≥ guideline standards for each group. Statistical analysis: Statistical differences in 24 hours with a history of COPD, new diagnosis of COPD, or exacerbation of outcome measures will be compared by using the unpaired t-test. All data is COPD. Exclusion criteria are patients with co morbid conditions, which have greater expressed as mean ± SD. A two-tailed p value of less than 0.05 is considered clinical priority. After randomization, the intervention group receives extensive statistically significant. teaching from a pharmacist on safe and effective use of medication and successful management of COPD. The control group receives standard of care discharge Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
counseling. Thirty days after discharge, patients are contacted via telephone to evaluate thirty-day readmission along with a verbal questionnaire to assess Presentation Objective: Understand the impact pharmacy intervention has in
medication compliance, vaccination adherence, symptom control and medical Self Assessment: How effective is pharmacist intervention in improving therapeutic
outcomes and overall clinical outcomes in patients with diabetes? Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Evaluate if pharmacy education reduces early hospital
readmission rates in COPD patients
Self Assessment:
What are three cardinal symptoms of COPD exacerbation outlined
in the GOLD guideline?  
2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session II, cont.
ABSTRACT REPRODUCTION FORM
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Time: 9:30 - 9:50 Room: G301 Category: IM
Time: 9:50 - 10:10 Room: G301 Category: IM
IMPROVING THE MANAGEMENT OF HYPERKALEMIA IN A LARGE
RESTRICTING THE USE OF INTRAVENOUS N-ACETYLCYSTEINE: AN
COMMUNITY HOSPITAL
ANALYSIS OF RESTRICTION ADHERENCE AND ITS EFFECT ON THE
Dennis Ganyc, Anit Legare, Agnes Kelly, Michelle Demus, Robyn Choe, Ashok RATE OF CONTRAST-INDUCED NEPHROPATHY
Sastry Sarasota Memorial Hospital Olusola O. Apen,a Karly L. Tommolino, James C. McAllister IV Shands at the Purpose/Background: Hyperkalemia is a life threatening emergency which may
University of Florida rapidly progress to cardiac arrest. Several areas for improvement in the management Purpose/Background: Contrast-induced nephropathy (CIN) occurs in 5-50% of
of hyperkalemia have been identified at our institution: delay in physician notification patients after intravascular contrast administration. Common CIN prevention of critical potassium levels in a timely manner, underutilization of hyperkalemia strategies include hydration and N-acetylcysteine (NAC); however, evidence order set, and inconsistent adherence to the treatment algorithm. A recent study has describing the efficacy of NAC for the prevention of CIN is conflicting. At this shown that rapid response team (RRT) involvement provided consistent and timely institution, IV NAC for CIN prevention is restricted to high risk patients. The resolution of hyperkalemia. The objective of this study is to determine if restriction is enforced via criteria-based questions within the order entry component multidisciplinary education, increased protocol awareness and RRT involvement will of Epic, the electronic medical record, and relies on the verifying pharmacist to improve the management of hyperkalemia. determine if criteria are met based on the answers selected. To date, no studies have evaluated the effectiveness of this strategy nor is there data describing the impact of Methodology: This IRB approved study included two retrospective groups: pre-
implementation (Jun - Sep 2012) and post-implementation (Jan - April 2013).
such a restriction. Hospitalized patients ≥ 18 years of age with a serum potassium ≥ 6.3 mmol/L were Methodology: A retrospective chart review was conducted to evaluate the
included in this study. The primary endpoint was a comparison of patients in each effectiveness of the restriction enforcement strategy and compare the CIN rates in group that showed a decrease in serum potassium level by 20% (for initial levels patients who received IV NAC before and after the restriction was implemented. greater than 6.9mmol/L) or reached a target potassium level of 5.5 mmol/L or less Inclusion criteria are 18 years of age or older, receipt of IV NAC and intravascular within 6 hours from the critical alert level being reported. The secondary endpoints contrast, and admission to an inpatient unit or the emergency department. The evaluated hospital length of stay and mortality between the two groups. primary endpoint is the percentage of patients who received greater than one dose of IV NAC who were ineligible to do so. Secondary endpoints include provider and Results/Conclusions: Results pending at the time of abstract submission. Conclusion
pending at the time of abstract submission.
pharmacist compliance with the restriction and CIN incidence rates before and after restriction implementation. Presentation Objective: Describe the principles of hyperkalemia management.

Results/Conclusions: Pending at the time of submission Pending at the time of
Self Assessment: What are the first line agents for the management of hyperkalemia?
Presentation Objective: Describe the efficacy of an IV N-acetylcysteine restriction
enforcement strategy
Self Assessment:
What is the proposed mechanism of NAC to prevent CIN?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 10:10- 10:30 Room: G301 Category: IM
Time: 9:30 - 9:50 Room: G103 Category: ID
CAUSES OF HOSPITAL READMISSION IN PATIENTS WITH HEART
IMPACT OF A PHARMACIST DIRECTED ANTIMICROBIAL
FAILURE WITH AND WITHOUT DISCHARGE INTERVENTION
STEWARDSHIP PROGRAM ON THE MANAGEMENT OF URINARY
Priya R. Parikh, Erin Jones, Garth Graham, Eric Rosenberg Shands at the University TRACT INFECTIONS
Rebekah Seale, Jennifer Moeller, Elizabeth Espinel St. Jospeh's Hospital Purpose/Background: There are approximately 5.7 million Americans diagnosed
Purpose/Background: Antimicrobial stewardship programs (ASP) have become the
with heart failure, accounting for 1.1 million hospitalizations annually. An estimated means for optimizing antimicrobial therapy in healthcare settings. The high incidence 25 percent of patients diagnosed with heart failure are readmitted within 30 days, of urinary tract infections (UTIs) and corresponding antibiotic utilization provides an with patients on Medicare making up the majority. In October 2012, the Centers for opportunity for disease specific streamlining improvements at St. Joseph's Hospital. Medicare and Medicaid Services implemented a reimbursement model reducing The objective of the study is to determine the impact of a pharmacist directed ASP on payment to hospitals whose readmission rates exceed the national average. To help the management of UTIs. develop effective strategies to reduce readmissions, this study will investigate the causes of readmission among patients with heart failure and seek insight into areas Methodology: Institutional Review Board approval was obtained prior to a
retrospective chart review. Adult patients with a complicated UTI in the pre and post
for improvement. education phases are eligible for inclusion. The education phase includes an education
Methodology: English-speaking patients diagnosed with heart failure and readmitted
for clinical pharmacists at St. Joseph's Hospital reviewing IDSA guidelines for the within 30 days of discharge will be prospectively enrolled. Consenting patients and treatment of UTIs in adults. The primary endpoint is defined as the streamlining of their healthcare providers will participate in a standard interview. An expert panel, antimicrobial therapy based on documented cultures and sensitivities by a clinical consisting of two attending physicians and a clinical pharmacist, will convene to pharmacist. The pharmacists' intervention to streamline an antimicrobial regimen for decide on the ultimate cause of readmission based on the data collected. The primary UTIs will be compared pre and post education to determine the impact of a endpoint is to qualitatively describe the causes of readmission in this patient pharmacist directed ASP on the management of UTIs. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. pending at time of abstract submission. Presentation Objective: Describe the impact of a pharmacist driven Antimicrobial
Presentation Objective: Describe areas for strategy development to reduce
Stewardship Program can have on streamlining therapy. readmissions among patients with heart failure Self Assessment: What are the roles of clinical pharmacists in assuring correct
Self Assessment: What was the most common cause of readmission identified in this
antimicrobial use for UTIs in hospitalized patients? ABSTRACT REPRODUCTION FORM
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Time: 9:50 - 10:10 Room: G103 Category: ID
Time: 10:10- 10:30 Room: G103 Category: ID
COMPARISON OF INTRAVENOUS TOBRAMYCIN DOSING METHODS
ASSOCIATION BETWEEN READMISSIONS AND STREAMLINING
USING THE AREA UNDER CONCENTRATION CURVE VERSUS TROUGH
ANTIBIOTIC SELECTION AFTER INITIATION OF
MONITORING IN ADULT CYSTIC FIBROSIS PATIENTS
PIPERACILLIN/TAZOBACTAM IN THE EMERGENCY DEPARTMENT
Kevin Epps, Calvin Tucker,Vanessa Thomas, Harish Bhaskar, Ronni Wetmore, Karen Reeves and Eric Gomez Miami VA Healthcare System Shauna Vaughn St. Vincent's Medical Center Purpose/Background: Hospital readmissions are costly and patients who are
Purpose/Background: Lung disease causes 85% of all mortality in patients
admitted to the hospital are at risk for infections, electrolyte abnormalities, anemia, diagnosed with Cystic Fibrosis (CF). Pseudomonas aeruginosa is a gram-negative stress ulcers, and other comorbidities. At times, antibiotics selected in the emergency aerobic bacterium commonly found in the sputum CF patients. Thus, the CF department are not streamlined after cultures and sensitivities return. Streamlining Foundation recommends the use of two anti-pseudomonas antibiotics, one being an antibiotics selection prevents the development of antimicrobial resistance and aminoglycoside, for treatment of acute pulmonary exacerbations. Using once-daily reduces the likelihood that the patient will develop secondary infections from broad dosing methods, target tobramycin trough levels of less than two mcg/ml are desired spectrum antibiotic use. Streamlining antibiotic use also minimizes adverse drug for suspected pulmonary infections. Recently, was proposed that the area under reactions and toxicity from excessive drug therapy and the unnecessary treatment of concentration curve (AUC) may be a better indicator of toxicity than measurement of trough and peak levels. The purpose of this study was to determine the outcomes of monitoring tobramycin using a goal AUC 80-120 mg.h/L. Methodology: Medication orders for piperacillin/tazobactam started in the
emergency department will be reviewed for a one year period. Patients who have Methodology: This retrospective cohort study evaluated adult CF patients admitted
readmissions to the Miami VA Healthcare System within 30 days will be identified. for acute pulmonary exacerbations. The trough monitoring group consisted of The antibiotic regimen prescribed at the first emergency department visit will be patients from September 2010 through February 2012. The AUC monitoring group reviewed for: 1) appropriateness of regimen, 2) blood cultures collected before included patients from September 10, 2012 through February 2013. All patients were antibiotics administration, 3) antibiotics streamlined within 24 hours of gram stain, 4) dosed at 10 mg/kg/day intravenously. For patients in the AUC group, the levels were antibiotics further streamlined within 24 hours of culture and sensitivity, 5) duplicate inputted into an AUC calculator and the dose was adjusted to obtain an AUC between antibiotic therapy, and 6) relation of 30-day readmission to previous infection. If 80-120 mg.h/L. The objectives of the study were to determine if AUC dosing had an readmission was caused by reinfection, cultures will be reviewed to compare the effect on FEV1, nephrotoxicity, rate of hospital readmissions, number of days resistance and presence of different bacterial strain. intubated, duration of therapy, reduction of cost of tobramycin, and number of days to next CF exacerbation. Results/Conclusions: Pending at time of abstract submission.
Presentation Objective: Determine if streamlining piperacillin/tazobactam after
Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission
gram stain and cultures complete prevents 30-day readmissions. Self Assessment: What types of infections are piperacillin/tazobactam used to treat in the
Presentation Objective: Discuss CF Foundation recommendations for treatment of
emergency department? 1) Lower respiratory tract (community-acquired pneumonia, acute pulmonary exacerbations nosocomial pneumonia) 2) Uncomplicated and complicated skin and skin structures Self Assessment: What class is recommended to be a part of the two anti-
(including diabetic foot infections) 3) Gynecologic (endometritis, pelvic inflammatory pseudomonal therapies for cystic fibrosis patients? A) Cephalosporin B) Penicillin C) disease) 4) Intra-abdominal infections (appendicitis with rupture/abscess, peritonitis) 5) Aminoglycoside D) Fluroquinolones Urinary tract infections 6) Bone and joint infections 7) Septicemia 8) Endocarditis 9) Cystic fibrosis exacerbations  ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 9:30 - 9:50 Room: G114 Category: ID
Time: 9:50 - 10:10 Room: G114 Category: ID
BEYOND THE ANTIBIOGRAM: RATES OF NEPHROTOXICITY WITH
EVALUATION OF PHARMACIST CONSULTATION ON FEBRILE
BETA-LACTAM AND VANCOMYCIN COMBINATIONS TO DETERMINE
NEUTROPENIA TREATMENT AND ANTIMICROBIAL STEWARDSHIP
OPTIMAL EMPIRICAL ANTIMICROBIAL COVERAGE
MEASURES IN A COMMUNITY BASED HOSPITAL
Amy Birch, Lori Dupree, Bethany Della Vecchia, Christopher A. Jankowski Shands Rebecca Gonzalez, Amy Skiff, Sandy Estrada, Suzanne Turner Lee Memorial Health Jacksonville Medical Center Purpose/Background: Hospital-acquired, drug-induced acute kidney injury (AKI) is
Purpose/Background: Evidence to show the impact of antimicrobial stewardship
associated with prolonged length of stay, increased hospital costs, and poor patient directed to immunocompromised patients who experience prolonged neutropenia and/or outcomes. The combination of an anti-psuedomonal beta-lactam with vancomycin is other infections are limited. This study aims to evaluate the appropriateness of febrile a common empiric antimicrobial treatment regimen for nosocomial infections. Recent neutropenia (FN) treatment in medical oncology patients without routine pharmacist literature associated a higher-rate of nephrotoxicity with the use of piperacillin- consultations, to that of a dedicated pharmacist participating in antimicrobial stewardship tazobactam when used in combination with vancomycin, compared to vancomycin efforts to oncology inpatients at Lee Memorial Hospital (LMH). Secondarily, assess therapy alone. The rate of nephrotoxicity with cefepime in combination with pharmacist opportunities to optimize patient care in antimicrobial prophylaxis and/or vancomycin is not well described in published literature. treatment of bacteremia, urinary tract infections, and pneumonia. Methodology: A retrospective, Institutional Review Board-approved review of
Methodology: A retrospective medical record review was conducted for patients
antimicrobial stewardship for oncology patients at least 18 years old admitted to the admitted to Shands Jacksonville Medical Center between January 21, 2012 and medical oncology unit at LMH with any of the above diagnoses. Baseline stewardship October 15, 2012, who received either vancomycin and piperacillin-tazobactam, or interventions will be identified through a retrospective chart review (September-November vancomycin and cefepime for more than 48 hours. The primary comparison was 2011) prior to pharmacist-hospitalist collaboration. These results will be compared to a incidence of AKI, as defined by the Acute Kidney Injury Network (AKIN) criteria. second retrospective chart review (September-November 2012) for the above indications Statistical analytic techniques will be used to control for potential sources of that were evaluated by the multidisciplinary team. Conformity of FN treatment without confounding. Secondary endpoints include time to AKI from initiation of routine pharmacist collaboration, compared to treatment of FN with pharmacist combination therapy, and hospital length of stay. consultation, as well as opportunities and impact of consultations regarding antimicrobial stewardship will be evaluated. Compliance of therapy will be determined based upon Results/Conclusions: Results pending at time of abstract submission. Conclusion
consistency with NCCN Guidelines for Prevention and Treatment of Cancer-Related pending at time of abstract submission. Infections and IDSA Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer. Pharmacist consultations provided, communication method, overall Presentation Objective: Evaluate whether an empiric beta-lactam and vancomycin
acceptance, and consultation type will also be evaluated during the second chart review. combination regimen may be favored based on incidence of AKI. Self Assessment: Is there an association between piperacillin-tazobactam and
Results/Conclusions: Pending at time of abstract submission
increased rates of AKI in patients also receiving vancomycin?  Presentation Objective: Determine the impact of a designated pharmacist performing
antimicrobial stewardship on oncologic patient care outcomes, antimicrobial use and
evaluation of conformity with approved indications and guidelines.
Self Assessment:
What pathogen should be the focus of initial empiric antimicrobial
therapy for febrile neutropenia?  
ABSTRACT REPRODUCTION FORM
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Time: 10:10- 10:30 Room: G114 Category: ID
Time: 9:30 - 9:50 Room: G112 Category: CCM
DEVELOPMENT AND IMPLEMENTATION OF AN ANTIMICROBIAL
REVIEW OF ALBUMIN USE TO OPTIMIZE ITS USE IN A COMMUNITY
STEWARDSHIP NOTE TEMPLATE
HOSPITAL
Victoria Koenig, Victor Rozance Bay Pines VA Health Care System Veronica Sherman, Heidi Clarke, Radhan Gopalani Baptist Hospital of Miami Purpose/Background: The use of antibiotics in hospitalized patients has increased
Purpose/Background: Fluid resuscitation plays an integral role in the management
over the past several decades and problems with excessive and inappropriate use of of patients with intravascular volume depletion as it improves cardiac output and antibiotics have been widely recognized. There are several potential consequences of organ perfusion. The strategy for appropriate fluid resuscitation has been a topic of inappropriate antimicrobial use including: toxicity, resistance, hospital-acquired debate for decades, specifically regarding use of crystalloid versus colloid fluids. In infections, increased morbidity and mortality, prolonged hospital lengths of stay, and response to this clinical dilemma, the University Hospital Consortium (UHC), increased healthcare costs. Antimicrobial stewardship involves the prudent use of comprised of experts on fluid resuscitation from institutions nation-wide, developed antibiotics through optimizing clinical outcomes while minimizing the unintended consensus guidelines for the use of albumin, nonprotein colloid (NPC), and consequences of antimicrobial use. The purpose of this project is to develop a crystalloid solutions. This study will evaluate albumin usage at a community hospital standardized note template for pharmacy antimicrobial stewardship recommendations based on the UHC guidelines in order to develop recommendations to improve its at Bay Pines VAHCS that will increase efficiency of documentation and improve appropriate use. communication with providers. Methodology: A retrospective, randomized chart review of 75 patients prescribed
Methodology: This project has been reviewed by the Bay Pines VAHCS Research
albumin from May 2012 to July 2012 was performed. The appropriateness of and Development Committee and meets all criteria for quality assurance; therefore, it albumin use was determined based on the UHC guidelines. Following the evaluation, is exempt from review by an institutional review board. An antibiotic stewardship a prospective convenience sample of patients admitted to the intensive care unit who note template will be designed and implemented in the VA computerized patient are prescribed albumin will be reviewed by the primary investigator. If albumin is record system (CPRS). This note template will include pertinent patient demographic determined to be inappropriate, a recommendation will be made to the prescriber. information, assess risk for multidrug-resistant organisms, and assess appropriateness of current antibiotic selection. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Identify and evaluate the trends of albumin over-utilization
and establish a pharmacist's role in guiding its appropriate use. Presentation Objective: Describe the process of developing an antimicrobial
Self Assessment: According to the University Consortium Guidelines, albumin is the
stewardship note template. first line option for fluid resuscitation for which indication? Hypovolemia, non- Self Assessment: T/F: A clinical pharmacist with infectious disease training is a core
hemorrhagic shock, plasmapharesis, traumatic brain injury. member of the multidisciplinary antimicrobial stewardship team. ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 9:50 - 10:10 Room: G112 Category: CCM
Time: 10:10- 10:30 Room: G112 Category: CCM
TREATMENT OF WARFARIN-ASSOCIATED INTRACRANIAL
EPOETIN ALFA USE IN RENALLY IMPAIRED INTENSIVE CARE UNIT
HEMORRHAGE: AN EVALUATION OF 3-FACTOR PROTHROMBIN
PATIENTS
COMPLEX CONCENTRATE VERSUS RECOMBINANT FACTOR VIIA
Violeta Barac, Patricia Louzon Florida Hospital Rochelle Forsyth, Jerah Nordeen, Alden Patel, Leah Ward, William D. Freeman Purpose/Background: Monitoring hemoglobin (Hgb) levels in patients with chronic
Mayo Clinic Florida kidney disease may decrease mortality rate as well as risk of adverse cardiovascular Purpose/Background: Warfarin-associated intracranial hemorrhage (wICH) can be a
events. Hemoglobin >13 g/dl can result in cardiovascular events such as stroke. When devastating outcome of therapy. Few studies have examined the use of prothrombin adjusting therapy, Hgb rate of rise, rate of decline, erythropoiesis-stimulating agents complex concentrate (PCC) versus recombinant factor VIIa (rFVIIa) in the treatment (ESA) responsiveness and Hgb variability should be considered. This study will of wICH. Cost, hospital formulary, and physician preference remain the driving evaluate prescribing patterns and patient characteristics, and will assess frequency of forces behind product selection at many institutions. The purpose of this study is to achieving target Hgb levels to identify potential areas of improvement in epoetin alfa assess institutional protocol compliance and to compare the safety, efficacy, and cost of 3-factor PCC versus rFVIIa in the treatment of wICH. Methodology: Patients ≥18 years of age that received at least three doses of epoetin
Methodology: A single-center, retrospective chart review will be conducted of all
alfa, had renal impairment (estimated creatinine clearance patients admitted to the institution with wICH who received either PCC or rFVIIa for wICH between August 2008 and November 2012. The primary objective is to Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission
determine the time to INR normalization, as defined by an INR of less than 1.4. Secondary endpoints include the degree of hematoma expansion, intraoperative Presentation Objective: Evaluate the utilization, prescribing patterns, and Hgb
hemostasis, and the incidence of thromboembolic complications. Additionally, the management of epoetin alfa while promoting more safe and efficient use at Florida drug cost between the two treatment options will be evaluated. Self Assessment: What are the consequences of high Hgb that could be a result of
Results/Conclusions: Results pending at time of abstract submission Conclusion
inadequate epoetin alfa management? pending at time of abstract submission
Presentation Objective: Recognize treatment options for rapid reversal of warfarin-
associated intracranial hemorrhage and the risks and benefits associated with each
therapy.
Self Assessment:
How does the use of PCC compare to rFVIIa in terms of safety and
efficacy when used in warfarin-associated intracranial hemorrhages?
ABSTRACT REPRODUCTION FORM
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Time: 9:30 - 9:50 Room: G312 Category: AM
Time: 9:50 - 10:10 Room: G312 Category: AM
EVALUATION OF AN AMBULATORY CLINIC'S OUTCOMES IN
TRIMETHOPRIM-SULFAMETHOXAZOLE EXPOSURE AND
PATIENTS REQUIRING TEMPORARY INTERRUPTION OF WARFARIN
HYPERKALEMIA IN ELDERLY VETERANS RECEIVING
THERAPY FOR A PLANNED SURGICAL PROCEDURE
Kelly Anderson, Elizabeth Clements Florida Hospital-Celebration Health Jayme Lentz, Tiffany Jagel, Steven Schang VA Gulf Coast Joint Ambulatory Center Purpose/Background: Each year approximately 250,000 patients on warfarin for
Purpose/Background: Hyperkalemia is a potentially life-threatening metabolic
prevention of thromboembolism require temporary interruption of therapy for a problem that could lead to serious conditions, such as conduction abnormalities, planned surgical procedure. Current studies providing good quality evidence of muscle weakness, paralysis, cardiac arrhythmias, or even death. It is estimated that perioperative anticoagulation management are lacking. Thus, anticoagulation up to one-third of heart failure patients on spironolactone have reported management services (AMS) sought to examine the safety and efficacy of hyperkalemia while on therapy. The antibiotic trimethoprim has structural similarity “standard of care" periprocedural anticoagulation management procedures in an to the potassium-sparing diuretic amiloride and similarly blocks the adenosine already established pharmacist-run clinic. This study was designed to meet the triphosphate-dependent sodium potassium pump in the collecting tubule, which could following objectives: safety and efficacy of periprocedural anticoagulation lead to hyperkalemia. The purpose of this study is to evaluate the potential for management procedures including incidence of minor and major bleeding, hyperkalemia in elderly Veterans receiving spironolactone and trimethoprim- thromboembolic events, or death, and the frequency in which physicians approve sulfamethoxazole. interruption of anticoagulation therapy recommendations made by AMS. Methodology: Veterans at least 65 years of age and older during a five year time

Methodology: This is an IRB approved prospective observational study enrolling
period who were taking continuous spironolactone and were initiated on eligible AMS patients who require temporary interruption of warfarin therapy for a trimethoprim-sulfamethoxazole will be identified by reviewing records at the VA planned surgical procedure prior to April 1st, 2013. AMS data collection will include Gulf Coast Veterans Health Care System. Veterans who have at least one baseline the number of days warfarin will be held prior to and following the procedure, use of serum potassium level and at least one serum potassium level within seven days after any bridging agent, and bleeding or thromboembolic events, or death. Safety and administration of trimethoprim-sulfamethoxazole will be included in the efficacy outcomes will be assessed for 30 days following the planned surgical retrospective, chart review study. Baseline serum potassium levels will be compared procedure. The physician approval rate of anticoagulation management to serum potassium levels that were obtained after administration of trimethoprim- recommendations made by AMS will also be recorded. sulfamethoxazole to see if a statistically significant difference exists. In addition, the association of trimethoprim-sulfamethoxazole exposure and hyperkalemia will be Results/Conclusions: Results pending at time of abstract submission. Conclusion
analyzed among several pre-specified subgroups to identify potential risk factors in pending at time of abstract submission. this population. Presentation Objective: Describe factors to consider when developing an
Results/Conclusions: Results pending at time of abstract submission. Conclusion
anticoagulation management plan for a patient requiring temporary interruption of pending at time of abstract submission. warfarin therapy for a planned surgical procedure.
Presentation Objective: Determine the association of trimethoprim-
Self Assessment: Is the current standard of care safe and effective?
sulfamethoxazole exposure and hyperkalemia in elderly Veterans receiving Self Assessment: True or False: Patients taking spironolactone and trimethoprim-
sulfamethoxazole have an increased risk for developing hyperkalemia.  
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 10:10- 10:30 Room: G312 Category: AM
Time: 9:30 - 9:50 Room: G307 Category: AM
SELF-TITRATION OF LONG-ACTING INSULIN: IDENTIFYING
EVALUATION OF VITAMIN D DEFICIENCY/INSUFFICIENCY IN
BARRIERS TO PATIENT ADHERENCE.
VETERANS WITH MUSCLE-RELATED STATIN-INTOLERANCE
Kendrick Murphy, Katrina Fantaski VA Gulf Coast Joint Ambulatory Center Scott Cohen, Jeremy Thoms North Florida/South Georgia Veterans Health System Purpose/Background: At the VA Gulf Coast Joint Ambulatory Care Center, many
Purpose/Background: Statins are the main lipid medications used to reduce
Veterans in the pharmacist-run diabetes clinic are managed via self-titration of long- cardiovascular morbidity and mortality. However, statins have been associated with a acting insulin. Due to the pattern of nonadherence in the Veteran population, it is wide range of skeletal muscle complaints, ranging from myalgia and elevations of hypothesized that many Veterans are nonadherent to their self-titration regimens. The creatine kinase to rhabdomyolysis. Several recent studies have linked vitamin D purpose of this study is to investigate Veteran's adherence to self-titration of long- deficiency with statin myopathy. One study evaluated the effect of vitamin D acting insulin and to identify barriers that may interfere with a Veteran's ability to supplementation in statin-treated patients with myalgia and found that in patients adhere to therapy. whose vitamin D deficiency was corrected, 92% were able to be treated with statins and remain free of myalgia. The purpose of this retrospective review study is to Methodology: This study will be completed via retrospective chart reviews. Charts
evaluate the prevalence of vitamin D deficiency/insufficiency (in both numerical and of Veterans included in this study will be reviewed to identify those who self-titrated categorical terms) in veterans with muscle-related statin-intolerance. We hypothesize long-acting insulin. Veterans who did not self-titrate or do not have a diagnosis of that, on average, those patients with muscle-related statin-intolerance will have lower type 2 diabetes will be excluded. For Veterans with type 2 diabetes, who self-titrated vitamin D levels. long-acting insulin, investigators will review medical records for the following: age, gender, ethnicity, education level, service connection status, body mass index, Methodology: In this retrospective review, investigators will identify patients from
hemoglobin A1c, approximate duration of diagnosis of diabetes, date self-titration the North Florida/South Georgia Veterans Health System with an observed started, type of insulin prescribed, starting dose of insulin, final dose of insulin, date allergy/adverse drug reaction to a statin from September 1, 2007 to August 31, 2012. self-titration stopped, reason(s) why self-titration stopped, self-reports of Exclusion criteria include adverse drug reactions that are historical or are not hypoglycemia, other antidiabetic medications, comorbidities, diagnosis of compliance determined to be muscle-related. Investigators will review patient's medical record for problems, and other providers who are managing Veterans diabetes. Veterans will be vitamin D level, specific statin, time relationship between vitamin D level and date of divided into two groups: 1) Veterans who continued self-titration, and 2) Veterans reaction, and interacting medications. Investigators will evaluate the prevalence of who stopped or were unsuccessful with self-titration for any reason. The groups will vitamin D deficiency or insufficiency in patients with muscle-related statin- be compared in order to identify any significant differences. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. pending at time of abstract submission. Presentation Objective: Identify barriers to adherence in patient's who self-titrate
Presentation Objective: Evaluate the prevalence of vitamin D
long-acting insulin. deficiency/insufficiency in veterans with muscle-related statin-intolerance. Self Assessment: Question: Which of the following are potential barriers to patient
Self Assessment: Based on 25-hydroxy-vitamin D level, how is vitamin D deficiency
adherence? a. History of compliance problems b. Hypoglycemia c. Education level d. Age e. All of the above ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 9:50 - 10:10 Room: G307 Category: AM
Time: 10:10- 10:30 Room: G307 Category: PED
IMPLEMENTATION AND EVALUATION OF DIABETES MANAGEMENT
EVALUATION OF DIABETIC KETOACIDOSIS TREATMENT AT
VIA CLINICAL VIDEO TELEHEALTH
ARNOLD PALMER HOSPITAL FOR CHILDREN
Natalie Pike, Cherylyn Beckey West Palm Beach VA Medical Center Kourtney Marsh, Jennifer Shenk, Susan Norman Orlando Health Purpose/Background: Clinical Video Telehealth (CVT) is a form of telehealth using
Purpose/Background: Diabetic ketoacidosis (DKA) is the leading cause of death in
a real-time, clinical video and audio transmission that is used to virtually connect a children with diabetes mellitus. Published guidelines are consistent in their healthcare professional and a patient. CVT has been shown to improve access to recommendations for the management of patients in diabetic ketoacidosis. Arnold health care and can play a role in managing high-risk patients with chronic disease Palmer Hospital for Children provides care to these patients, however there is no states such as diabetes. The purpose of this project is to describe and disseminate the standardized protocol. An evaluation of the management of DKA at Arnold Palmer results of this project and evaluate the value of this program via a patient satisfaction Hospital for Children may provide the information needed and rationale for creating and implementing a DKA protocol utilizing a two-bag method consisting of two fluid bags with identical electrolyte concentrations, but different dextrose concentrations. Methodology: In addition to describing the implementation of a CVT program, the
process of starting a CVT program, a patient satisfaction survey will be administered Methodology: Hospitalized patients less than 18 years of age at Arnold Palmer
at 6 months post enrollment for patients who actively participate in the CVT program. Hospital that meet inclusion criteria for DKA will be retrospectively reviewed and Patients may be referred to the CVT program via a CPRS consult, which will be enrolled. Information collected will include patient demographics, comorbidities, and restricted to providers in the diabetes specialty clinic. Patients to be considered will pertinent labs and medications during hospitalization. Fluid therapy will be evaluated include patients who reside closer to a community based outpatient clinic (CBOC) through collection of rate, duration, and fluid components. In addition, time required rather than the main medical center with the following characteristics: • Prefer to visit for pharmacy to verify fluids and for them to be started will be recorded. The insulin CBOC's • Without significant hearing or visual impairments • Clinically stable, drip rate throughout therapy will be reviewed. Adverse outcomes related to DKA or unable to meet pre-specified target parameters for glucose control and that do not insulin therapy will also be collected. require extensive physical assessment. • Have a basic and reasonable understanding of their medication regimen and how to administer their medications. Data Results/Conclusions: Results pending at time of abstract submission. Conclusion
Collection: Patient demographics, patients distance from home to the WPB VA and pending at time of abstract submission. from home to the CBOC they use, A1C at baseline and interval visits, Co-morbid Presentation Objective: Describe the current management of diabetic ketoacidosis
conditions, Form of transportation used, travel reimbursement received, frequency of in pediatric patients. visits before and after CVT enrollment, and number of hospitalizations before and Self Assessment: What is the purpose of providing various dextrose concentrations
after CVT implementation. in intravenous fluids during treatment of DKA in pediatric patients? Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
Presentation Objective:  Describe the process of implementing a Clinical Video
Telehealth (CVT) program.
Self Assessment: What was the main obstacle found in implementing the Diabetes
Clinical Video Telehealth Clinic?
2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session III
ABSTRACT REPRODUCTION FORM
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Time: 10:50 -11:10 Room: G301 Category: CCM
Time: 11:10 - 11:30 Room: G301 Category: CCM
SAFETY AND EFFICACY OF REPEATED DOSING HYPERTONIC SALINE
STRESS ULCER PROPHYLAXIS UTILIZATION AND OPTIMIZATION IN
FOR REFRACTORY INTRACRANIAL HYPERTENSION
THE INTENSIVE CARE UNIT
Julie Lewandowski-Belfer, Daniel Jackson, Jerah Nordeen, Robert Darracott, Alden Jose Valdes, Fred Bourne Baptist Hospital Patel, W. David Freeman Mayo Clinic Florida Purpose/Background: Critically ill patients are at risk for developing gastric ulcers
Purpose/Background: To evaluate the safety and efficacy of repeated dosing of
which may lead to clinically significant bleeding. Antiulcer agents can reduce the hypertonic saline (14.6% or 23.4%) in patients with elevated intracranial pressure and risk of ulceration if the patient has one major risk factor (coagulopathy, ventilated to evaluate a dose response comparison of 14.6% versus 23.4% saline. Bolus >48 hours, GI ulcer/bleed within the past year, traumatic injury [brain, spinal cord, administration of hypertonic saline for reduction of intracranial pressure is well burn >35% BSA]) or two minor risk factors (Sepsis, ICU stay >1 week, occult GI documented. Despite the benefits of hypertonic saline, no definitive bleeding >6 days, multiple trauma [excluding brain, spinal cord, burn >35% BSA], recommendations regarding dose, frequency or concentration of hypertonic saline steroid therapy >250mg hydrocortisone or equivalent). While antiulcer agents are solution have been established for treating intracranial hypertension. Following a case prescribed to critically ill patients to reduce the risk of ulceration, not all require report of ten doses of 23.4% saline administered over 48 hours, a protocol for the use prophylaxis. The purpose of the study is to evaluate the appropriate use of stress of multiple doses of hypertonic saline was established for treatment of refractory ulcer prophylaxis in patients admitted to intensive care units. intracranial hypertension at our institution. Methodology: A retrospective chart review will be performed on all patients
Methodology: Observational, retrospective review from January 2008 through July
admitted to the ICUs. Data collection includes: patient demographics, risk factors, 2012, evaluating the safety of repeated doses of 14.6% or 23.4% saline in patients age antiulcer agent chosen, and use of home medications. Education using current 18 or older for reduction of refractory intracranial hypertension. The primary guidelines and latest recommendations will be given to nursing and medical staff objective is to evaluate the safety of repeated dosing of hypertonic saline assessed by through group and individual in-services, pocket cards, and revising a daily nurse- documented adverse effects such as central pontine myelinolysis and MRI or CT rounding form. After education, a prospective chart review will be conducted to re- changes. Secondary objectives include efficacy of repeated dose hypertonic saline evaluate patients admitted to the ICUs. and a dose response comparison between 14.6% and 23.4% saline. Results/Conclusions: Results pending at time of abstract submission Conclusion
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission pending at time of abstract submission. Presentation Objective: Describe when stress ulcer prophylaxis is indicated in a
Presentation Objective: Describe the safety and efficacy of the use of hypertonic
critically ill patient. saline for reduction of intracranial pressure. Self Assessment: Which of the following is not an indication for stress ulcer
Self Assessment: What dose of hypertonic saline (in mEq) was used most commonly
prophylaxis? A. Coagulopathy B. Mechanically ventilated >48 hours C. Sepsis D. Traumatic injury E. ICU stay >1 week AND steroid therapy >250 mg hydrocortisone ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 11:30 - 11:50 Room: G301 Category: CCM
Time: 10:50 -11:10 Room: G103 Category: PED
EVALUATION OF THE USE OF DEXMEDETOMIDINE IN CRITICALLY
THERAPEUTIC DRUG MONITORING OF GENTAMICIN IN NEONATES:
ILL PATIENTS IN THE CARDIOVASCULAR INTENSIVE CARE UNIT
APPROPRIATENESS AND COST SAVINGS.
Micaela Carroll, Robert Kraljevich, Aaron Trujillo, Jorge Garcia, Brent Anderson Tara Nygaard, Jenny Donald, Marisa Hill, Tim L'Hommedieu St. Jospeh's Hospital Broward General Medical Center Purpose/Background: Gentamicin monitoring for neonates on short course therapy
Purpose/Background: Propofol and dexmedetomidine are frequently prescribed to
is often inappropriate and costly. The purpose of this study is to decrease the number sedate postoperative patients in the cardiovascular intensive care unit (CVICU). The of inappropriate gentamicin levels drawn in neonates receiving short course two drugs differ in many ways, including the mechanism of action, side effect profile, gentamicin therapy. and cost. Dexmedetomidine costs considerably more than propofol and is being utilized with increased frequency; it is currently the top expenditure of the Broward Methodology: Institutional Review Board approval was obtained prior to a
retrospective chart review at St. Joseph's Children's Hospital. Antibiotic naive
Health Medical Center (BHMC) pharmacy department. The objective of this study is neonates admitted to the neonatal intensive care unit (NICU) are eligible for to optimize the use of dexmedetomidine at BHMC. inclusion. Initial peak and trough measurements will be assessed and deemed
Methodology: Patients in the CVICU prescribed dexmedetomidine during the month
appropriate if urinary output is less than or equal to 2mL/kg/hr or gentamicin therapy of July 2012 were retrospectively reviewed. This review revealed prescribing patterns is greater than six days. Data to be collected will include the following: demographic and offered insight with regards to duration of dexmedetomidine therapy, incidences data, factors affecting gentamicin concentrations, gentamicin levels and timing, and of hypotension, and achievement of goal Richmond Agitation Sedation Scale (RASS) lab-associated costs. An intervention to ensure appropriate gentamicin monitoring scores. This information is being used to create and implement a new sedation will be followed by a wash out period and post evaluation. protocol. The protocol will be implemented to both cover overall sedation and to outline how and when to use dexmedetomidine in order to control costs and optimize Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
therapy. After the protocol has been implemented, the use of dexmedetomidine in these patients and costs associated with their therapy will be compared to that of the Presentation Objective: List the qualifications for omitting antibiotic therapeutic
historical controls. monitoring in neonates. Self Assessment: What role(s) can pharmacists play in reducing unnecessary
Results/Conclusions: Results pending at time of abstract submission. Conclusion
monitoring in neonates? pending at time of abstract submission.
Presentation Objective: Describe how dexmedetomidine is utilized in critically ill
patients and streamline its use while still providing optimal patient care.
Self Assessment:
What was the most common adverse effect observed during
therapy with dexmedetomidine?
ABSTRACT REPRODUCTION FORM
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Time: 11:10 - 11:30 Room: G103 Category: PED
Time: 11:30 - 11:50 Room: G103 Category: PED
EVALUATION OF VANCOMYCIN DOSING IN OVERWEIGHT AND
INFLUENCE OF COMPUTERIZED PHYSICIAN ORDER ENTRY GUIDED
OBESE PEDIATRIC PATIENTS: A RETROSPECTIVE STUDY IN A NON-
DRUG SELECTION FOR THE TREATMENT OF COMMUNITY
PROFIT, TERTIARY PEDIATRIC INSTITUTION
ACQUIRED PNEUMONIA IN PEDIATRICS: A RETROSPECTIVE STUDY
Elisa Edwards, Katie Wassil Wolfson Children's Hospital/Baptist Health System Jamie Caruthers, Marie Mavis, Nisha Patel Wolfson Children's Hospital/Baptist Purpose/Background: In patients receiving vancomycin therapy, it is important to
achieve therapeutic trough concentrations to maintain efficacy. With the rise in the Purpose/Background: A substantial amount of research exists showing that
overweight and the obese populations, even among children, there is a need to computerized physician order entry (CPOE) systems in adult hospitals reduce evaluate vancomycin therapy in these populations. This study will assess the efficacy medication errors, length of stay, and cost. There is, however, less research regarding of typical vancomycin dosing in overweight and obese children. Traditional the impact of the use of CPOE in the pediatric population and the use of order sets vancomycin dosing in overweight and obese pediatric patients will be compared to within the CPOE system on community acquired pneumonia (CAP). The goal of this the non-overweight, non-obese group by looking at the dose and the time it took to study is to compare physician ordering and treatment guideline adherence of reach therapeutic trough concentration. pediatric patients hospitalized with CAP at WCH before and after CPOE Methodology: This IRB approved retrospective chart review of pediatric patients
aged between 2 and 18 years old at the time of vancomycin treatment, receiving at Methodology: Charts of patients between 3 months and 18 years of age with
least five doses of vancomycin will be identified. Information collected will include community acquired pneumonia will be retrospectively reviewed. Patients meeting patient's sex, weight, height, body surface area (BSA), dose of vancomycin with appropriate inclusion and exclusion criteria will be assessed for the following: age, serum trough concentrations with each intervention, and the time it took to achieve gender, weight, immunization status, suspected bacteria, use of CAP power plan, therapeutic concentration. antibiotic agent and dose. Pre and post CPOE rates of appropriate antimicrobial selection, rates of CPOE power plan use, percentage of correct doses, and rates of Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
antimicrobial selection for a specific age group will be recorded and evaluated. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Presentation Objective: Assess the difference between the time to achieve
therapeutic vancomycin trough concentration between overweight and obese children
pending at time of abstract submission. group and non-overweight, non-obese children group. Presentation Objective: List the advantages and disadvantages of CPOE
Self Assessment: Choose a false statement regarding vancomycin. a. Glycopeptide
antibiotic used to treat many gram positive bacterial infections b. The most current Self Assessment: What are some advantages of CPOE implementation?
guidelines recommend serum trough levels to be within 5 - 10 mcg/mL c. Inhibits bacterial cell wall synthesis d. In children, the half-life is shorter compared to adults ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 10:50 -11:10 Room: G114 Category: PSY
Time: 11:10 - 11:30 Room: G114 Category: PSY
IMPLEMENTATION OF AN INDIGENT PATIENT PRESCRIPTION
EVALUATION OF THE EFFECTIVENESS OF PALIPERIDONE
ASSISTANCE PROGRAM AFTER DISCHARGE AT AN INPATIENT
INJECTION TREATMENT
BEHAVIORAL HEALTH CENTER
Matthew Felser, Carmela Jean Miami VA Healthcare System William Terneus Jr,. Mike Briante, Donald Sullivan Indian River Medical Center Purpose/Background: Paliperidone palmitate is the long-acting injectable form of
Purpose/Background: The Indian River Medical Center (IRMC) provides an
paliperidone used once a month to treat schizophrenia. The objective is to identify the indigent patient assistance program through partnership with a local chain pharmacy overall effectiveness of paliperidone injections as assessed by improvement or lack of to supply patients with their medications after discharge at no charge. The dispensing improvement on the PANSS, MMSE, and/or GAF or the lack of effectiveness as pharmacy charges the hospital the highest cost possible within their fee structure indicated by its discontinuation in patients of the Miami VA Healthcare System. because the hospital is considered a cash customer. Patients discharged from the inpatient Behavioral Health Center (BHC) must be provided with a 30-day Methodology: Data collection will be used to identify the number of Miami VA
patients receiving paliperidone injections between January 1, 2012 and December 31,
prescription which may be costly due to physicians prescribing newer agents. The 2012. The Computerized Patient Record System (CPRS) will be reviewed to monitor purpose of this study is to develop a more cost-efficient program for the hospital for changes in the PANSS, MMSE, or GAF, if documented, as well as if a patient was without compromising the quality of patient care. discontinued from the medication due to lack of effectiveness or for any other reason.
Methodology: 100 indigent patients and 100 non-indigent patients will have
Also evaluated will be the gender, concurrent antipsychotics used while patients are discharge medication reconciliation records reviewed for any antipsychotic, receiving these injections, the number of previous 2nd-generation antipsychotics used antidepressent or antianxiety medication that is prescribed as an outpatient. The prior to injection initiation, if paliperidone was discontinued during the timeframe outpatient indigent charges generated by the local community pharmacy for the time under study, and if any metabolic or extrapyramidal adverse drug reactions occur after period of September 1, 2011 to August 31, 2012 for prescriptions written for BHC a patient begins receiving these injections. patients for psychotropic medications will be assessed as well. The pattern of prescriptions will be used to determine the list of drugs that would be potentially Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission
filled by an outpatient pharmacy. Various local pharmacies will be contacted to determine comparative prices for the drugs and the mechanism the hospital will be Presentation Objective: Describe the effectiveness of long-acting paliperidone on
charged for the drugs. the overall outcome of psychiatric patients in the VA setting. Self Assessment: What is the advantage of paliperidone injection compared to other
Results/Conclusions: Results pending at time of abstract submission Conclusion
second generation antipsychotics? pending at time of abstract submission
Presentation Objective: Assess the importance of implementing a cost-efficient
indigent patient prescription assistance program for indigent, mentally ill patients
Self Assessment:
What is the most commonly prescribed psychotropic medication?  
ABSTRACT REPRODUCTION FORM
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Time: 11:30 - 11:50 Room: G114 Category: PSY
Time: 10:50 -11:10 Room: G112 Category: IM
VARIABILITY IN ANTIDEPRESSANT PRESCRIBING AMONG PRIMARY
TPN STANDARDIZATION: A COST MINIMIZATION ANALYSIS
CARE PHYSICIANS.
Gail Krug, Peter Pasek Bay Pines VA Health Care System Katie Cich, Anzeela Schentrup UF College of Pharmacy Purpose/Background: The purpose of this project is to conduct a cost minimization
Purpose/Background: The use of antidepressant medications, over the past two
analysis of current total parenteral nutrition (TPN) outsourcing service use versus decades, has grown to the point that they are now the third most commonly standardized TPN mixtures. Currently, Bay Pines VAHCS uses Central Admixture prescribed class of medications in the United States. Based on a recent study, 61.4% Pharmacy Service, (CAPS) which delivers customized TPN. Clinimix offers several of patients for whom antidepressants were prescribed did not receive diagnosis for options of premixed solutions with varying compositions to choose from. any psychiatric disorders during the course of a year. The purpose of this study is to Comparison of direct and indirect costs associated with both methods of TPN review the trend in prescribing and management of antidepressant medications to preparation will be conducted to examine weather standardization of TPN therapy patients with or without a psychiatric disorder and to describe variations in treatment would be beneficial to Bay Pines VA Health Care System (VAHCS). among primary care physicians at University of Florida and Shands outpatient primary care clinics. Methodology: Direct and indirect costs of using CAPS and implementing the use of
Clinimix will be compared. Direct costs include cost of solutions with electrolytes, Methodology: Data was collected on all patients prescribed antidepressants > 18
delivery of the product, and cost of additional components such as fats and years of age from January 2009 through December 2012 in University of Florida electrolytes as well as compounding materials needed for the use of Clinimix. This Physicians primary care practices. The frequency of which antidepressants were will be determined by reviewing cost data with the purchasing agent at Bay Pines prescribed with no corresponding psychiatric diagnosis was identified and compared VAHCS, CAPS representatives and drug representatives for Baxter. Indirect costs among primary care clinics. will include monetary estimates of differential workload associated with necessary manipulation of Clinimix preparations as well as differential time required for the Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
verification of Clinimix orders and products. Monetary estimates will be derived by estimating average time spent on a particular task and average technician and Presentation Objective: Describe the current trend in antidepressant prescribing in
pharmacist salaries. primary care clinics.
Results/Conclusions: Results pending at time of abstract submission. Conclusion
Self Assessment: What was the percentage of patients prescribed antidepressants
with no corresponding psychiatric diagnosis?
pending at time of abstract submission. Presentation Objective: Determine the most cost effective method of supplying
TPN at Bay Pines Veterans Affairs Healthcare System.
Self Assessment:
Cost minimization analysis compares: a) Compares outcomes in
terms of their utility b) Comparison of costs in monetary units c) Comparison of
costs and outcomes d) Comparison of outcomes in quantitative non-monetary units
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 11:10 - 11:30 Room: G112 Category: IM
Time: 11:30 - 11:50 Room: G112 Category: IM
ASPIRIN USE AND INTRAOPERATIVE BLEEDING IN HIGH-RISK
SEVERE HYPERGLYCEMIA: COMPARISON OF THE CLINICAL
SURGERIES
MANAGEMENT OUTCOMES
Peter Richard Rabbath, Bradley Stein, Kristin St. John James A. Haley Veterans Hospital Phuoc Bui, Georgia Keriazes Lakeland Regional Medical Center Purpose/Background: Continuing aspirin perioperatively in certain patients is now
Purpose/Background: Inpatient hyperglycemia is associated with poor outcomes
endorsed by the American College of Chest Physicians to prevent postoperative cardiac including increased length of stay, admission to the Intensive Care Unit, increased events. However, this puts patients at greater risk for intraoperative bleeding. There are few mortality, and increased hospital acquired infections. The American Association of trials analyzing intraoperative bleeding and transfusion needs in this patient population. It Clinical Endocrinologists and the Endocrine Society Clinical Practice Guidelines is important to quantify intraoperative blood loss attributed to aspirin continuation so that recommend an insulin regimen in conjunction with blood glucose monitoring to surgeons and anesthetists can accurately anticipate and manage blood loss during high-risk maintain blood glucose in the range of 70 - 180 mg/dl for the management of general surgeries. The purpose of this study is to assess whether continuing aspirin perioperatively hyperglycemia in the non-critical care setting. The study assesses if an insulin significantly increases the amount of intraoperative blood transfusions as well as quantify regimen with basal insulin plus corrective scale insulin and appropriate monitoring is intraoperative blood-loss. more effective than an alternative regimen in controlling blood glucose levels. Methodology: A retrospective cohort chart review will be conducted on patients who
underwent the following surgeries from August 1st, 2005 to August 1st, 2012: Methodology: Medical patients who have a critical blood glucose reading ≥400
cystoprostatectomy, radical retropubic prostatectomy, partial nephrectomy, radical mg/dL were identified and included in the study. Information collected includes: nephrectomy, and total hip arthroplasty. The surgeries were chosen based on their high patient demographics; concurrent oral or IV glucocorticoids, TPN, tube feeding; potential for bleeding and no requirement for intraoperative anticoagulant infusions. Data proportion of managed blood glucose readings in the range of 70-180 mg/dL, and to be collected includes estimated blood loss (EBL), amount of blood transfused in units, critical blood glucose readings ≥400 mg/dL and < 40 mg/dL; and approaches to age, aspirin use and dose, the use of intraoperative colloids, international normalized ratio hyperglycemia management. In addition, outcomes which include length of stay, (INR), and pre-operative hemoglobin levels. Estimated blood loss is calculated by the transfers to the ICU, development of hospital acquired infection, and in-hospital anesthesia team: the amount of blood vacuumed into a container plus the number of mortality were collected. surgical lap sponges [times 80ml] plus the number of Ray-Tec sponges [times 15ml] minus the amount of irrigation used. The amount of estimated blood loss and blood transfused are Results/Conclusions: Results pending at time of abstract submission. Conclusion
found on the scanned anesthesia record. Although the amount of blood loss is an estimate, pending at time of abstract submission. it is the standard practice at our facility for measuring this parameter. Identification of patients will be conducted through the Veterans Health Information Systems and Presentation Objective: Compare outcomes of the clinical management in two
Technology Architecture (VISTA) search via Current Procedural Terminology (CPT) treatment groups of severe hyperglycemia with critical blood glucose ≥400 mg/dL in medical patients. Self Assessment: What was the most common approach to hyperglycemia
Results/Conclusions: Pending at time of abstract submission.
management in this study? Presentation Objective: Determine if patients who continue taking aspirin
throughout the perioperative period require more intraoperative blood transfusions. Self Assessment: According to the American College of Chest Physicians, in which
patients do they recommend the continuation of aspirin throughout surgery?
ABSTRACT REPRODUCTION FORM
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Time: 10:50 -11:10 Room: G312 Category: AM
Time: 11:10 - 11:30 Room: G312 Category: AM
TESTOSTERONE USE AND IMPLEMENTATION OF PRESCRIBING
MEDICATION INDUCED VITAMIN B12 DEFICIENCY: EFFECTS OF
TEMPLATE
METFORMIN AND PROTON PUMP INHIBITORS, ALONE AND
Kim Tyanne Julien, John Hoeldtke Ft Myers VA Outpatient Clinic COMBINED
Purpose/Background: Hypogonadism affects approximately 4 million males in the
Lindsey Bates, Sally Cushnie Ft Myers VA Outpatient Clinic United States with its prevalence increasing with age. Low levels of serum Purpose/Background: Vitamin B12 deficiency can cause anemia and neurologic
testosterone are associated with diminished libido, erectile dysfunction, depression, dysfunction. The neurologic consequences cannot be reversed, and may result in anemia, reduced muscle mass and bone density. There are several FDA approved significant morbidity. Metformin and proton pump inhibitors (PPIs), both widely testosterone delivery systems. There is a large price disparity between the various used, have been associated with vitamin B12 deficiency. These medications are often testosterone delivery systems. Within our healthcare system, testosterone injections used long-term, allowing for depletion of hepatic vitamin B12 stores. Data regarding are formulary preferred. For patients who have a contraindication to testosterone the use of these medications and the decline in B12 levels remains limited and injections, testosterone 1.62% topical gel is the second line agent. The purpose of this guidelines outlining monitoring and supplementation are lacking. The purpose of this project is to create a testosterone prescribing and renewal template to facilitate proper project is to determine the effects on vitamin B12 levels in patients prescribed formulary selection, ordering, for monitoring of testosterone products. metformin and PPIs, both alone and when prescribed in combination. The results may aid in developing guidance for monitoring vitamin B12 levels and providing Methodology: A prescribing and renewal template will be developed for testosterone
replacement therapy. The template will require the appropriate exams, labs and
supplementation. This material is the result of work supported with resources and the imaging to be completed before the initiation of testosterone replacement. use of facilities at the Bay Pines VA Healthcare System. The contents of this paper Contraindications to testosterone injections will be recorded before requesting do not represent the views of the Department of Veterans Affairs or the United States testosterone 1.62% topical gel. Regular monitoring and periodic review of testosterone level will be required to renew the prescription. Methodology: A retrospective chart review will be conducted on three groups of
patients from the Lee County VA Healthcare Center. The groups will include: Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
patients taking metformin, those taking a PPI, and those taking concomitant PPI and metformin. The number of patients deficient in vitamin B12, the frequency of Presentation Objective: Describe the role of a clinical pharmacist in monitoring the
monitoring for deficiencies and the number of patients receiving supplementation appropriateness of prescribing topical testosterone. will be determined. The findings of this review may lead to educational opportunities Self Assessment: What range is considered a low free testosterone level?
regarding monitoring and supplementation in patients taking these medications. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
Presentation Objective: Raise awareness about medication-induced vitamin B12
deficiency with the use of metformin and proton-pump inhibitors, and discuss
potential monitoring and supplementation recommendations.
Self Assessment:
True or False? Patients taking both metformin and omeprazole
tended to have lower vitamin B12 levels when compared to taking either drug alone? 
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 11:30 - 11:50 Room: G312 Category: AM
Time: 10:50 -11:10 Room: G307 Category: CP
EFFECT OF A QUALITY ASSURANCE INITIATIVE ON AN
EFFECTIVENESS OF COMPOUNDED BIOIDENTICAL HORMONE
AMBULATORY CLINICAL PHARMACY SERVICES CLINIC
REPLACEMENT THERAPY IN REDUCING VASOMOTOR SYMPTOMS
Lindsay Jackson, Ruthan White Florida Hospital-Celebration Health AND QOL IN MENOPAUSAL WOMEN
Purpose/Background: Error reporting is essential in continuous quality
Marjohn Armoon, Nancy Hart, Steven Smith, Benjamin Epstein Medimix Specialty improvement (CQI) programs in all pharmacy practice settings. Barriers to reporting quality assurance (QA) issues include finding time to report and meet, having staff Purpose/Background: Bioidentical Hormone Replacement Therapy (BHRT)
involved in reporting, reporting apprehensiveness, and accepting the online describes supplementation of a replacement hormone, whose molecular structure is technology. Data regarding CQI programs in pharmacist-led ambulatory clinics is identical to the hormone existing in the human body, and is often dispensed in limited. The CQI program at a clinical pharmacy services clinic encourages staff to compounding pharmacies for menopausal women experiencing symptoms of report QA issues; however, participation in reporting events is lacking. One hormone deficiency. These hormones include: estradiol, estriol, progesterone, and explanation for under-reporting may include the accessibility of report forms. A new testosterone. This study will evaluate the effectiveness of compounded BHRT in method of reporting QA issues was implemented to enhance visibility of forms. This menopausal women with vasomotor symptoms and QOL, as well as the role of a study will evaluate the effectiveness of a new method for reporting QA issues based clinical pharmacist in this setting. on the frequency of reporting before and after the process change. Secondarily, types of QA issues reported will be examined. Methodology: Peri or post-menopausal women ages 30 to 65 receiving BHRT at the
pharmacy will be enrolled and followed over 12 weeks. Information collected

Methodology: Stacks of QA forms were placed in all work areas and a submission
includes two validated instruments, the Menopause Rating Scale (MRS) and Women's container was placed in a common location. Staff members were asked to complete Health Questionnaire (WHQ) at baseline and 12 weeks and a satisfaction of care and submit QA reports anonymously and voluntarily when quality-related events survey at 12 weeks, evaluating the level of care they received from their clinical occurred. Data collected included total number of reports submitted monthly, type of pharmacist. Other information collected includes a hormonal symptom diary incident reported, reporter's job title, clinic location, and action taken as a result of completed over 12 weeks, demographics, co-morbidities, concomitant medications, and past medications taken, if any, to relieve symptoms. The pharmacist will assess the patient via telephone communication at 2, 4, 8, and 12 weeks for any clinical Results/Conclusions: Results pending at time of abstract submission. Conclusion
changes. After the final assessment at 12 weeks, the MRS, WHQ, and satisfaction of pending at time of abstract submission. care survey will be analyzed
Presentation Objective: Describe the effect of a quality assurance initiative on the
ambulatory clinical pharmacy services clinic.
Results/Conclusions: Results pending at time of abstract submission. Results
pending at time of abstract submission. Self Assessment: What was the most common type of quality assurance incident
reported during the study period? Presentation Objective: Describe the role of a clinical pharmacist in a compounding
pharmacy regarding the care of menopausal women with BHRT. Self Assessment: What are common concerns with hormone replacement that warrant
a study of this nature? 
ABSTRACT REPRODUCTION FORM
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Time: 11:10 - 11:30 Room: G307 Category: IM
Time: 11:30 - 11:50 Room: G307 Category: IM
PREVALENCE OF POTENTIALLY INAPPROPRIATE DRUG-DISEASE
EVALUATION OF THE CONTINUATION OF BETA-BLOCKERS
INTERACTIONS IN VETERANS AFFAIRS COMMUNITY LIVING
PERIOPERATIVELY IN NON-CARDIAC SURGERY PATIENTS
CENTER RESIDENTS USING THE UPDATED BEERS CRITERIA
Andrew Gatton, Nadia Iwanyshyn, Paul Tan, Marci DeLosSantos Shands Kimberly Mattox, Lauren George, Janel Gordon James A. Haley Veterans Hospital Jacksonville Medical Center Purpose/Background: The primary aim is to assess the prevalence of, and factors
Purpose/Background: Non-cardiac surgeries have been associated with post-
associated with, potentially inappropriate medication-disease state combinations operative complications, such as myocardial infarction (MI) and cardiac arrest. Beta- according to the 2012 Beers Criteria in Veterans who are ≥ 65 years old and residing blockers have been studied in non-cardiac surgery patients during the perioperative in Veterans Affairs Community Living Centers (VA CLCs). This is a multi-site period as a possible treatment to decrease post-operative complications. However, retrospective cohort study of VA CLC residents age ≥ 65 years old with a diagnosis beta-blockers can cause detrimental effects, such as hypotension and bradycardia, of heart failure, dementia and/or cognitive impairment, history of falls or hip making their use controversial. This study evaluates the post-operative cardiac fractures, history of peptic ulcer disease and/or stage IV or V chronic kidney disease. outcomes of continuing beta-blockers during the perioperative period in non-cardiac surgery patients. Methodology: The PI and co-investigators will use Veterans Health Information
Systems and Technology Architecture (VISTA) to ascertain residents in the CLC on Methodology: This study is a retrospective chart review of patients on a beta-blocker
October 17, 2012. Then, the Computerized Patient Record System (CPRS) and/or at home who underwent a non-cardiac surgery. Patients were divided into two MDS will be reviewed to identify those who are ≥ 65 years old who have one or more groups. One group was patients that received a beta-blocker on the day of surgery, of the disease states of interest. The recorded age will be based on the age of the post-operative day 1, and post-operative day 2. The second group was patients who resident on October 17, 2012. For the residents meeting the inclusion and exclusion did not receive a beta-blocker on all three days. The primary objective was to criteria, co-investigators will retrospectively record the following data: eGFR if the determine if continuation of beta-blockers during the perioperative period had an resident has stage IV or V chronic kidney disease, ejection fraction if the resident has effect on a composite endpoint of post-operative cardiac complications (i.e., MI, heart failure, sex, race, Hispanic ethnicity, number of days since the most recent cardiac arrhythmias, and ischemia) during index hospitalization. Secondary admission to the CLC, comorbidities, number of regularly scheduled, chronic endpoints included post-operative MI, post-operative ischemia, post-operative medications, use of a proton pump inhibitor if the patient has peptic ulcer disease, and cardiac arrhythmias, post-operative cardiac death, post-operative stroke, hypotension, the potentially inappropriate medications in the drug-disease interactions of interest bradycardia, length of stay, intensive care length of stay, and 30-day readmissions based on 2012 Beers Criteria. due to cardiac complications. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. pending at time of abstract submission. Presentation Objective: Identify potentially interaction medications in elderly
Presentation Objective: Describe the effects of the continuation of beta-blockers in
patients based on specific disease states using the most recent Beers Criteria List. the perioperative period for non-cardiac surgery patients. Self Assessment: What are 3 medications potentially interacting medications for a 85
Self Assessment: What are the most common adverse effects of continuing beta-
year old resident at the CLC with dementia and a history of falls? blockers perioperatively? 2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session III, cont.
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 12:00 - 12:20 Room: G301 Category: CCM
Time: 12:20 - 12:40 Room: G301 Category: MED
EVALUATING THE PHARMACIST ROLE IN THE EMERGENCY
EVALUATION OF PROTON PUMP INHIBITOR (PPI) USE OUTSIDE OF
DEPARTMENT (ED)
CRITICAL CARE IN A COMMUNITY HOSPITAL
Kristina Lee, Judy Tseng South Miami Hospital Jaclyn Chessher, Ernie Cyr West Florida Healthcare Purpose/Background: The American Society of Health-System Pharmacists and
Purpose/Background: In 1999, the American Society of Health-System Pharmacists
current literature support the need for a pharmacist in the emergency department (ASHP) published evidence-based guidelines for stress ulcer prophylaxis (SUP) in (ED). Responsibilities of the ED pharmacist include making therapeutic the intensive care unit. Although ASHP guidelines give no recommendation for using recommendations, providing drug information, monitoring labs, performing PPIs in non-critical care settings, their use in preventing mucosal injury has become medication reconciliation, counseling patients and responding to codes. This IRB- common practice. The purpose of this study is to evaluate the appropriateness of approved study will describe the common services provided and interventions made proton pump inhibitor use outside of the critical care. by a pharmacist, evaluate the current medication reconciliation process and assess ED Methodology: Patients greater than 18 years old admitted to non-critical care floors
nursing staff perception of the pharmacist in the ED of a community-based hospital. on PPIs were identified as possible candidates for retrospective review. Any patient Methodology: A pharmacist was present in the ED for a consecutive two-week
with a documented diagnosis of gastro-intestinal reflux disease (GERD) or had an H2 period in December 2012, and also for one weekday evening per week and one receptor antagonist or PPI on their prior home medication list was excluded. Based weekend afternoon per month from January to February 2013. The pharmacist on ASHP's stress ulcer prophylaxis guidelines as well the American College of provided services such as medication reconciliation, facilitation of stat medications, Gastroenterology's guidelines for prevention of NSAID-related ulcer complication, responding to drug information requests, and chart reviews. Each service provided or patients were divided into possible categories for PPI use: stress ulcer prophylaxis intervention made by the pharmacist was documented in the Quantifi program, which candidates, NSAID-related ulcer prophylaxis candidates, or gastro-intestinal bleeding was then used to generate a summary report. The current medication reconciliation prophylaxis candidates. If patients fell into neither category, PPI use was deemed process in the ED was evaluated for accuracy and completeness using a random sample of medication reconciliation order forms for patients admitted to the hospital Results/Conclusions: Results pending at time of submission. Review of data, thus
from the ED in October and November 2012. A survey was distributed to ED nurses far, shows 47% of patients did not meet criteria warranting anti-secretory therapy. over a four-week period to assess their perception of the pharmacist role in the ED. Conclusion pending at time of abstract submission. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Presentation Objective: Evaluate the use of proton pump inhibitors in preventing
pending at time of abstract submission. mucosal injury in the hospital setting. Presentation Objective: Describe and evaluate the pharmacist role in the ED of a
Self Assessment: In this study, which class of drugs was identified as the largest risk
community-based hospital. factor for GI bleeding in hospitalized patients warranting proton pump inhibitor use? Self Assessment: What was the most common service provided/intervention made by
the pharmacist in this study? ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 12:40 - 1:00 Room: G301 Category: MED
Time: 12:00 - 12:20 Room: G103 Category: PED
SARGRAMOSTIM VS. FILGRASTIM FOR POST-INDUCTION
DOSING ANALYSIS OF A SIMPLIFIED HIGH DOSE MAGNESIUM
CHEMOTHERAPY IN ACUTE MYELOID LEUKEMIA: A
SULFATE INFUSION PROTOCOL FOR STATUS ASTHMATICUS IN PICU
RETROSPECTIVE ANALYSIS
PATIENTS: A PROSPECTIVE PILOT STUDY
Rebecca J. Nelson; Timothy George; Viet Ho; Rod Quilitz, Yanina Pasikhova, Alan Joanna Wrobel, Elisa Edwards, Sarah Katherine Wassil, Jose E Irazuzta Wolfson F. List; Gene Wetzstein H. Lee Moffitt Cancer Center & Research Institute Children's Hospital/Baptist Health System Purpose/Background: Granulocyte-macrophage colony stimulating factor (GM-
Purpose/Background: In pediatric and adult studies, intravenous magnesium sulfate
CSF), sargramostim (Leukine® ) and granulocyte colony stimulating factor (G-CSF), has been shown to significantly improve lung function. A continuous infusion is filgrastim (Neupogen ®) are used to limit myelosuppression in patients with Acute believed to achieve the desired therapeutic concentrations of 3 to 5 mg/dL. A previous Myeloid Leukemia (AML) following post-induction chemotherapy. The additional study demonstrated attainment of these concentrations with a high-dose magnesium immune stimulatory mechanisms of sargramostim suggest that it may offer additional sulfate regimen, including a loading dose followed by a 4 hour continuous infusion, protection against infections, compared to filgrastim. The purpose of this study is to dosed on ideal body weight (IBW). The purpose of this study is to evaluate if a evaluate both sargramostim and filgrastim, in post-induction AML patients, for simplified dosing regimen, 50 mg/kg/hour for 5 hours, is tolerated and reaches the prevalence of infections, length of hospital stay, neutrophil recovery and overall targeted blood levels for refractory status asthmaticus. Methodology: In this prospective pilot study, patients between the ages of 2 and 21
Methodology: Approximately 160 electronic medical records from the hematology
years old will be enrolled from November 2012 to March 2013, consistent with the department database are being evaluated to identify newly diagnosed AML patients inclusion and exclusion criteria. The new dosing regimen is a 50 mg/kg/hour 5 hour receiving induction chemotherapy, from January 2005 to October 2012, who received magnesium sulfate infusion with dosing based on actual or ideal body weight at least one dose of hematopoietic growth factor with either sargramostim (Arm A) or depending on the child's body mass index (BMI) percentile. Patient data collected and filgrastim (Arm B). This retrospective chart review excludes patients younger than 18 analyzed will include patient demographics, vitals, 4 magnesium levels and years of age, those who have received induction chemotherapy for relapsed disease, respiratory function. Safety will be evaluated with the following adverse events: or those diagnosed with acute promyelocytic leukemia (APL or M3 AML). This hypotension, nausea, vomiting, flushing, erythema, vision changes, study was approved by the University of South Florida Institutional Review Board. electrocardiography (ECG) changes, somnolence/respiratory depression, depressed tendon reflexes, muscle weakness. Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Analyze and compare data on the prevalence of culture-
documented bacterial or proven/probable fungal infections. The secondary objectives Presentation Objective: Identify the adverse events associated with supratherapeutic
are to compare and analyze data on the length of hospital stay (LOS), time to magnesium levels. neutrophil recovery, mortality during induction phase, as well as the prevalence of Self Assessment: What are the adverse events associated with supratherapeutic
IDSA defined febrile neutropenia between the two treatment arms. magnesium blood levels?   Self Assessment: Filgrastim stimulates neutrophils, macrophages, and dendritic cells,
which may theoretically broaden immune stimulatory mechanisms and lead to
improved protection against infections. True/False 
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 12:20 - 12:40 Room: G103 Category: PED
Time: 12:40 - 1:00 Room: G103 Category: PED
DEVELOPMENT AND IMPLEMENTATION OF A PHARMACY
EVALUATION OF A NEW VANCOMYCIN DOSING SCHEME IN
PHARMACOKINETIC REVIEW SERVICE
PEDIATRIC PATIENTS
Suzanna Bedy, Katie Namtu All Children's Hospital Juwon Yim, Betsy Bickert Poon, Deborah Maka, Kristen Jones, Caitlin Crosley Purpose/Background: Vancomycin and aminoglycosides often require
Florida Hospital for Children pharmacokinetic calculations and therapeutic drug monitoring. This project will focus Purpose/Background: Traditionally, vancomycin is initially dosed at 10 mg/kg/dose
on implementing a pharmacokinetic review service in which staff pharmacists every 6 hours or 15-20 mg/kg/dose every 6-8 hours for serious infections in children. monitor orders and results for vancomycin and aminoglycoside levels. The primary It has been a challenge to attain therapeutic vancomycin trough levels in a timely endpoints are to determine the incidence of appropriate lab ordering and therapeutic manner in children with normal renal function based on the traditional vancomycin serum drug concentrations pre- and post-implementation of the review service. A dosing guidelines. As a result, a retrospective chart review was conducted at Florida secondary endpoint is to measure the effectiveness of the pharmacokinetic training Hospital for Children from 2009 to 2011 which established a new vancomycin dosing scheme approved by the medical staff. This follow-up study will evaluate the effectiveness of the new vancomycin dosing scheme in attaining goal therapeutic Methodology: The review service will provide 24-hour coverage and will include
vancomycin concentrations. inpatients except for the cystic fibrosis and NICU populations. Pharmacist training for the review service included a pre-test, presentation by the pharmacy resident, and Methodology: Pediatric patients whose vancomycin dosing was determined based
post-test. After the review service has been enacted for one month, post- on the new vancomycin dosing scheme and met the inclusion criteria will be enrolled implementation prospective data will be collected to compare the incidence of in this prospective, observational study. The primary objective is to determine the appropriate lab ordering and therapeutic serum drug concentrations with pre- percentage of patients who attain goal therapeutic vancomycin concentrations with implementation retrospective data. their first dosing regimen. Safety of the new vancomycin dosing scheme will be assessed by evaluating the percentage of patients with initial trough concentrations in Results/Conclusions: Based on a preliminary retrospective data review, areas for
the potentially toxic range and number of patients who experience nephrotoxicity. pharmacist involvement include ensuring vancomycin and aminoglycoside levels are appropriately ordered and timed. Prospective data collection should determine Results/Conclusions: Results pending at time of abstract submission Conclusion
whether or not pharmacists made an impact in this area and in increasing the pending at time of abstract submission incidence of therapeutic serum drug concentrations. Presentation Objective: Describe the effectiveness and safety of a new vancomycin
Presentation Objective: Discuss the importance of a pharmacist pharmacokinetic
dosing scheme in achieving therapeutic trough concentrations in pediatric patients. review/consult service. Self Assessment: What age group of pediatric patients required the highest daily
Self Assessment: What were areas for improvement based on retrospective data?
dose of vancomycin to achieve therapeutic vancomycin concentrations? ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 12:00 - 12:20 Room: G114 Category: TXP
Time: 12:20 - 12:40 Room: G114 Category: TXP
ANALYSIS OF RISK FACTORS AND OUTCOMES FOR POLYOMAVIRUS
EVALUATION OF A TRANSPLANT MEDICATION EDUCATIONAL
INFECTION IN LUNG TRANSPLANT RECIPIENTS
VIDEO ON TRANSPLANT RECIPIENT'S MEDICATION KNOWLEDGE
Beatrice Adams, Angela Logan, Tarik Haddad, Mark Rolfe, Timothy Floreth Tampa AND LEVEL OF COMFORT AT HOSPITAL DISCHARGE
General Hospital Chelsea Sammons; Christina Doligalski Tampa General Hospital Purpose/Background: BK virus (BKV) and JC (JCV) are polyomaviruses (PV)
Purpose/Background: Medication education following organ transplantation is
which cause asymptomatic infection during early childhood. PV reactivation typically imperative for patient and graft survival. Various methods of education have been progresses from viruria to viremia and could result in PVAN (polyomavirus utilized however no standard of care exists. This study seeks to determine the impact associated nephropathy). Renal dysfunction is a late complication that occurs after of a medication educational video on patient knowledge and comfort level. lung transplant due to multi-factorial causes. Currently, there is limited literature Methodology: This single-center, IRB-approved, prospective evaluation compares
describing polyomavirus infection in the cardiothoracic transplant population. post-transplant medication knowledge and comfort via a written assessment tool Methodology: Single-center, retrospective case-control study. Patients 18-75 years
between a standard-of-care cohort and an interventional cohort (standard education that received a lung transplant between July 2009 and August 2012 were included. plus educational video); characteristics of high and low scorers will also be evaluated. Patients were matched based on indication, age, single vs. double lung, and sex. Results/Conclusions: During the standard-of-care cohort, 95 transplants occurred,
Additional information collected includes demographics, PV PCRs, tacrolimus levels, including 73% male, 71% Caucasian and 52% kidney recipients. Sixty-two patients (65%) completed the assessment tool averaging a score of 80.9%. There were no Results/Conclusions: One hundred fifty six patient were included for review and
statistically significant differences in scores based on gender, race, education level, or 12% (n=18) had PV detection, 6% (n=9) BKV, and 6% (n=9) JCV. All 18 patients organ transplanted; however, lung recipients, African-Americans, and non-native had PV detection in the urine, 3% in the plasma. The SCr trended higher in the case English speakers trended towards lower scores. Increase in patient perceived group compared to the control (1.4 vs. 1.0; p=0.017). No significant differences were medication knowledge and preparedness was correlated with higher scores. Questions found in age, sex, FK levels, or rejection. Among the patients that developed viruria, evaluating side effects were most commonly missed; those evaluating drug 3% progressed to viremia which is a lower incidence compared to the renal transplant interactions and administration were consistently answered correctly. Most (75%) population that reports a 50% progression. Monitoring for PV reactivation may be preferred a combination of teaching methods. Over 90% responded that education warranted in lung transplant patients who have a late onset increase in SCr. with the pharmacist was either very or extremely helpful. Preliminary results show there is room for improvement in transplant medication education. Data analysis from Presentation Objective: Evaluate the incidence, outcomes, and risk factors for
the video group is ongoing. polyomavirus reactivation and progression in lung transplant recipients. Self Assessment: What is the incidence of PV reactivation in the lung patients at
Presentation Objective: Determine if baseline characteristics correlate with
medication knowledge or level of comfort following transplant medication education. Self Assessment: What question topic is most commonly answered correctly? A. Side
effects B. Indications C. Drug interactions D. Administration instructions E. C and D  ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 12:40 - 1:00 Room: G114 Category: TXP
Time: 12:00 - 12:20 Room: G112 Category: IM
COMPARISON OF ALEMTUZUMAB VERSUS ANTITHYMOCYTE
IMPACT OF A HOSPITALIST PHARMACIST IN A COMMUNITY
GLOBULIN INDUCTION IN RENAL TRANSPLANTATION
HOSPITAL
Harrison Saull, Cher Enderby, Thomas Gonwa Mayo Clinic Florida Mina Abdalla, Estela Trimino, Janelle Berg Mercy Hospital, A Campus of Plantation Purpose/Background: Due to rejection risk with renal transplant, antibody induction
therapy is employed in approximately 80% of patients as an adjunct to maintenance Purpose/Background: The collaboration between a pharmacist and a hospitalist is a
immunosuppression. Antibody induction therapy should be selected by a novel approach to optimize patient care. Pharmacists have already proven to be comprehensive assessment of immunologic risk, comorbidities, and financial burden. invaluable in various setting such as critical care, emergency medicine and oncology. The purpose of this study is to evaluate compare the acute rejection rate at 1, 4, and Our purpose was to evaluate the effectiveness of a pharmacist-hospitalist team 12 months post- renal transplant between alemtuzumab and antithymocyte globulin approach to patient care in a non-teaching community hospital. induction therapy in normal immunological risk patients. Secondary endpoints Methodology: A collaborative team was formed, consisting of a physician, 2
include: length of hospital stay following renal transplant, patient and graft survival, physician assistants and a pharmacist. The team rounded on internal medicine and cytomegalovirus and BK virus infection rate. patients for 23 days. Interventions were documented, categorized and compared to Methodology: A retrospective single-center cohort design evaluating acute rejection
hospital wide interventions (HWI). Workflow in central pharmacy was also analyzed. rate among normal immunological risk patients 18 years or older at the time of renal Results/Conclusions: During the study period a total of 1845 interventions were
transplantation will be used. Based on institutional protocol, patients receiving documented, of which 621 were completed by the hospitalist pharmacist (33% of alemtuzumab as an induction agent between April 2010 to September 2011 will be HWI) with an acceptance rate of 99%. There were 459 drug regimen modifications included. Patients who received antithymocyte globulin prior to April 2010 will be (43% of HWI), 78 antibiotic interventions (18% of HWI), 54 IV-to-PO conversions included in a number to match the alemtuzumab group. All patients must have (21% of HWI), 27 renal dose adjustments (20% of HWI), and 3 lab tests avoided received standard of care immunosuppressant therapy and rapid steroid taper. All (100% of HWI). Average number of interventions was 27 per day for a total cost biopsy specimens are graded for acute rejection by the Banff scheme by pathology. savings of $28,935. Number of outgoing pharmacy calls dropped from 12 to 2 calls Results/Conclusions: Results pending at time of abstract submission. Conclusion
per day. The hospitalist pharmacist provided additional benefit in core measure pending at time of abstract submission. compliance, medication counseling, providing less expensive therapeutic alternatives and streamlining of admission and discharge medication reconciliation process. Presentation Objective: Evaluate the acute rejection rates between alemtuzumab
Collaboration between hospitalists and pharmacists improved patient care. The and antithymocyte immune globulin as induction therapy in renal transplantation. addition of a hospitalist pharmacist has shown to streamline the medication process, Self Assessment: What is the dosing regimen of alemtuzumab that is utilized for
prevent delays of therapy and improve hospital work flow. induction therapy ? Presentation Objective: Demonstrate the impact of a hospitalist pharmacist in a
community hospital.
Self Assessment:
The hospitalist pharmacist performed less than 25% of
interventions in the institution.
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 12:20 - 12:40 Room: G112 Category: IM
Time: 12:40 - 1:00 Room: G112 Category: IM
IMPACT OF A PHARMACIST DRIVEN PROTOCOL ON THE
EVALUATING THE IMPACT OF BASAL PLUS INSULIN ORDER SET ON
MANAGEMENT OF HEPARIN-INDUCED THROMBOCYTOPENIA.
INPATIENT GLYCEMIC CONTROL
Stephanie Tears, Doug Peterson, Suzanne Turner, Scott Osborne Lee Memorial Nitha Kan Chou, William Braun, Venkata Budharaju, Charles Guastella, Mary Catherine Lincoln, Carolyn Tete, Duangduan Geeratisoontorn, Margaret Myers, Purpose/Background: Heparin-induced thrombocytopenia (HIT) is an uncommon,
Regina Shears-McCloud St. Anthony's Hospital however potentially life-threatening complication of anticoagulant therapy. Initial Purpose/Background: The basal plus insulin (BPI) order set incorporates the
diagnosis of HIT can be accomplished using a 4-T test or a heparin-platelet factor 4 correctional insulin scale with a long- or intermediate-acting insulin. The primary (H-PF4) assay. H-PF4 assays are sensitive but not specific resulting in frequent false objective of this study is to analyze the mean daily capillary blood glucose (CBG) positive results. A serotonin release assay (SRA) must be conducted to definitively after initiation of BPI order set compared to that of sliding scale insulin (SSI) order confirm a diagnosis of HIT. An incorrect diagnosis of HIT can lead to more costly set. This study also compares the number of hypoglycemic events from the two order anticoagulant therapy and the documentation of a false allergy in the patient's permanent electronic medical record. A pharmacist facilitated HIT confirmation Methodology: The BPI order set will replace the SSI order set when St. Anthony's
protocol was newly initiated in March 2012 at Lee Memorial Health System Hospital transitions to Computerized Physician Order Entry on February 26, 2013. (LMHS). The purpose of this study was to compare anticoagulant therapy pre- Analysis of the SSI order set will use data from January 1, 2012 to December 31, protocol and post protocol implementation. 2012. Analysis of BPI order set will use data from February 26, 2013 onwards. The Methodology: This study is a retrospective chart review of LMHS patients. Cases
analysis will include hospitalized patients aged 18-80 years old with CBG readings will be defined as all patients with an order for a Heparin-PF4 antibody assay between 140 mg/dL and 500mg/dL, or type 2 diabetes. Exclusion criteria are as between the months of August-December of 2011 (pre-protocol) and October- follow: diabetic ketoacidosis, type 1 diabetes, clinically relevant hepatic disease, December of 2012 (post- protocol implementation). Data will be obtained through serum creatinine greater than or equal to 3.0 mg/dL, hemodialysis, acute kidney patient charts and electronic medical records. The 4-T test will be calculated for each injury, pancreatic disease, pregnancy, or use of glucocorticoids. The following data will be collected: age, gender, body mass index, hemoglobin A1C, dietary status, and CBG readings on admission and after the initiation of each order set. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Determine if a pharmacist driven protocol improved the
management of HIT by decreasing the number of patient days spent on non-heparin Presentation Objective: Describe the effects of the BPI order set on inpatient
based anticoagulant therapy. glycemic control. Self Assessment: What is the most common anticoagulant used for the treatment of
Self Assessment: What is the difference in mean daily CBG between the BPI and SSI
suspected heparin induced thrombocytopenia at LMHS? ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 12:00 - 12:20 Room: G312 Category: AM
Time: 12:20 - 12:40 Room: G312 Category: AM
EFFICACY AND SAFETY EVALUATION OF VARDENAFIL TO
IMPACT OF NEW STATIN LABEL CHANGES REGARDING LIVER
SILDENAFIL CITRATE CONVERSION
FUNCTION TEST MONITORING ON PRESCRIBING HABITS IN THE VA
Michael O. Chaffman, Stacie R. Hamilton, Zoralys M. Santiago Orlando VA Medical POPULATION
Natasha Antonovich, Kimberly Schnacky Orlando VA Medical Center Purpose/Background: Background/Purpose: Levitra (vardenafil) was identified as a
Purpose/Background: In February 2012 the Food and Drug Administration made
product having a less expensive therapeutic alternative; a therapeutic conversion to several label changes to all statins, one being the removal of routine liver enzyme sildenafil was performed. monitoring. This recommendation was based on evidence found by the National Lipid Association's Liver Expert Panel and Statin Safety Task Force which stated Methodology: Methodology: A detailed dispensing report has been generated to
irreversible liver damage is extremely rare and likely idiosyncratic. Rather it was identify patients previously taking vardenafil 20mg that are now taking sildenafil; the more likely to prompt unnecessary discontinuation of a statin, putting the patient at report captured 205 patients converted during the period of evaluation. A an increased cardiovascular risk. Observing the change in continuation, retrospective chart review will focus on incidence of sildenafil dose escalation post- discontinuation, and nonformulary request rates of statins in the VA population conversion and progress note documentation which reflects drug efficacy/patient provides the opportunity to evaluate the pharmacist's role in implementing labeling treatment satisfaction. Results/Conclusions: Results: Results pending at time of abstract submission.
Methodology: This study involves retrospective and prospective components before
Conclusions: Conclusion pending at time of abstract submission. and after a prescriber education session. Retrospective data will come from a Presentation Objective: Determine global patient level of treatment satisfaction
medication usage evaluation completed by this research team. Prospective data will following the switch from high-dose vardenafil to standard-dose sildenafil citrate be compiled from chart reviews of patients with increased transaminase levels on a within a large VA Medical Center. statin. The education session, presented by the investigators, will cover all label Self Assessment: Were most patients stable on the 50 mg dose of sildenafil?
changes made to statins since June 2011 including the removal of routine liver enzyme monitoring. Chart reviews will include examining changes in LFTs and continuation, discontinuation, and nonformulary statin request rates. Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission
Presentation Objective: Describe the impact of the clinical pharmacist
implementing changes to liver enzyme monitoring in patients taking statins.
Self Assessment:
What benefits will patients and health systems gain by
implementing this monitoring change?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 12:40 - 1:00 Room: G312 Category: AM
Time: 12:00 - 12:20 Room: G307 Category: PSY
RETROSPECTIVE REVIEW OF MANAGEMENT OF MALE PATIENTS AT
COMPARISON OF ADHERENCE RATES BETWEEN CONVENTIONAL
HIGH RISK FOR OSTEOPOROSIS
AND ATYPICAL LONG-ACTING ANTIPSYCHOTIC INJECTABLE
Kristen M. Johnson, Laura VanScoik Orlando VA Medical Center MEDICATIONS
Purpose/Background: Osteoporosis is a skeletal disease characterized by
Brian McKee and Jose Rey Nova Southeastern University College of Pharmacy compromised bone strength, leading to an increased risk for fracture. Early diagnosis Purpose/Background: Treatment of acute psychosis and remission of schizophrenia
of osteoporosis is crucial in order to initiate therapies to slow or possibly reverse the has consistently been achieved through antipsychotic therapy. However, the rate of progression of the disease. The Office of the Inspector General has selected medication nonadherence in patients with schizophrenia has proven to be problematic, osteoporosis as one of the chronic disease management movement's targeted disease with estimated nonadherence rates as high as 40-50%. Ninety-one percent of patients states for clinical pharmacist specialists to identify, monitor, and treat. Osteoporosis with schizophrenia who stopped taking oral medications for one week continued to screening recommendations are established for men as young as 50 years old with abstain from psychotherapeutic treatment until relapse. In addition, patients with certain high-risk factors for developing osteoporosis, such as chronic glucocorticoid schizophrenia who decompensate secondary to nonadherence take longer to stabilize therapy and the use of androgen deprivation therapy. The purpose of this study is to and often require adjustments to previously successful medication regimens. Long- determine if male patients on these high risk medications are being appropriately acting injectable (LAI) antipsychotic medications have decreased medication assessed and managed according to current clinical guidelines. nonadherence. The primary purpose of this study is to assess whether adherence rates are different for conventional LAI antipsychotic medications (haloperidol decanoate Methodology: The study team performed a retrospective chart review of male
and fluphenazine decanoate) compared to the atypical LAI antipsychotic medication patients at high risk for developing osteoporosis due to glucocorticoid or androgen risperidone. Differences in psychiatric rehospitalizations between the LAI groups will deprivation therapy (ADT). The study evaluated approximately 195 patients, be assessed as a secondary objective. separated into two study arms based on medication class. Data collected included patient's risk factors, current treatment for osteoporosis, laboratory tests done to Methodology: Data collection is from an electronic medical record system and
assess risk, and documented fractures after initiation of glucocorticoid or ADT. includes patient demographics, recent prescription data, office visits for LAI administration and any psychiatric hospitalizations. Patients above 18 years of age, on Results/Conclusions: Results pending at time of abstract submission Conclusion
LAI antipsychotic medications between July 1, 2012 and December 31, 2012 with a pending at time of abstract submission diagnosis of schizophrenia will be included. Adherence will be determined based on Presentation Objective: Discuss appropriate identification, screening and
percentages of received LAI medications during the specified time period. A management of male patients at high-risk for osteoporosis. Wilcoxan Mann Whitney test will be used to detect statistical differences between Self Assessment: Should a 51 year old male patient who has been on leuprolide
mean adherence rates for the different LAI antipsychotic medications. therapy for 14 months be assessed for osteoporosis risk?  Results/Conclusions: Pending at the time of abstract submission.
Presentation Objective: Determine if there is a difference in adherence rates for
conventional vs. atypical LAI antipsychotic medications.
Self Assessment:
Risperidone is classified into which type of antipsychotic: conventional
or atypical?  
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 12:20 - 12:40 Room: G307 Category: PSY
Time: 12:40 - 1:00 Room: G307 Category: ADM
COMPARING THE USE OF ANTIPSYCHOTIC TO NO ANTIPSYCHOTIC
IDENTIFICATION OF OPIOID OVERUTILIZATION TRENDS IN A
FOR BEHAVIORAL DISTURBANCES IN DEMENTIA FOR SHORT-TERM
MEDICARE POPULATION
INPATIENT OUTCOMES
Pamela Tabor, David Mostellar, Regina Mears, Angel Wolf WellCare Health Plans Ashley Hillman, Naomi House Wolfson Children's Hospital/Baptist Health System Purpose/Background: Opioid overutilization is a growing health concern which
Purpose/Background: There are currently no medications that are FDA approved to
may result in increased hospitalization and/or death due to overdose. Multiple treat behavioral and psychiatric symptoms of dementia (BPSD). The benefit of guidelines determine a morphine equivalent dose (MED) of 120 mg/day or greater, antipsychotics hasn't been clearly established and there may be an increased risk of over 90 days, as a threshold for patients who may be at risk for side effects or cerebrovascular events and death. Despite these possible harms, they are still often inappropriate overuse of opioid medications. However, having a high MED alone is prescribed for this purpose. Outcomes for outpatients and nursing home patients have not a sole indicator of overutilization risk. The number of physicians prescribing been measured but no studies have been published researching outcomes in inpatient opioid medications and the number of pharmacies dispensing opioid medications also populations. The purpose of this study was to determine if antipsychotics decrease the help identify opioid overutilizers. The purpose of this review is to determine if the use of as needed medications for agitation without increasing length of stay, number of opioid prescribing physicians or the number of opioid dispensing medications for extrapyramidal symptoms (EPS) or 30 day readmissions while in an pharmacies led to a higher average MED. This review will also determine trends inpatient behavioral health unit. based on the type of physician specialty and classification of medications being Methodology: Patients' charts were retrospectively reviewed if they were 65 years of
age and older, and had a dementia related diagnosis or prescribed FDA indicated Methodology: Medicare members enrolled within an MAPD (Medicare Advantage
dementia medications. Demographics, scheduled antipsychotic use, as needed Prescription Drug plan) or PDP (Medicare Prescription Drug plan) who have a MED medications for anxiety or agitation or EPS, length of stay and 30 day readmissions of 120 mg/day or greater for 90 consecutive days ending in October, November, or rates to the psychiatric units were collected. Groups who received scheduled December 2012 will be included in this retrospective review. Medications meeting antipsychotics were compared to groups who did not receive scheduled criteria as opioids are pulled from the CONSORT classification of opioid medications. Physician specialty will be retrieved from the National Provider Identifier (NPI) registry provided by the Center for Medicare and Medicaid Services Results/Conclusions: Results pending at time of abstract submission Conclusion
(CMS) website. Pharmacy claims data utilized for this review includes prescription pending at time of abstract submission. medication information, prescriber NPI, and dispensing pharmacy information. Presentation Objective: Describe the benefits or harms of scheduled antipsychotics
Results/Conclusions: Results pending at time of abstract submission. Conclusion
for patients who are hospitalized for BPSD. pending at time of abstract submission. Self Assessment: What is one harm to giving antipsychotics for BPSD?
Presentation Objective: Identify trends based on a Medicare population to improve
identification of opioid overutilization.
Self Assessment:
What indicators are being utilized to identify members who are
potential opioid overutilizers? a)Total morphine equivalent dose b)Number of
prescribers c)Number of pharmacies d)All of the above  
2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session IV
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 2:00 - 2:20 Room: G301 Category: ONC
Time: 2:20 - 2: 40 Room: G301 Category: ONC
ASSESSMENT OF THE USE OF COLONY-STIMULATING FACTORS
IMPACT OF PHARMACIST INTERVENTION IN THE MANAGEMENT OF
FOLLOWING INDUCTION CHEMOTHERAPY FOR NEWLY DIAGNOSED
BREAKTHROUGH CHEMOTHERAPY-INDUCED NAUSEA AND
ACUTE MYELOGENOUS LEUKEMIA
VOMITING IN AN OUTPATIENT INFUSION CENTER
Andrea Velandia, Melissa Butler, Rebecca Anderson, Jose Sarriera Orlando Health Chungeun J. Lee, Saba Kareem, Kim Perez, Jennifer Showalter St. Jospeh's Hospital Purpose/Background: Due to theoretical concerns for stimulation of leukemia cells,
Purpose/Background: Chemotherapy-induced nausea and vomiting (CINV) is
the routine use of colony-stimulating factors (CSF) following induction recognized as one of the most distressing side effects of chemotherapy treatment. chemotherapy for newly diagnosed acute myelogenous leukemia (AML) is an area of Studies have shown that a considerable number of patients receiving chemotherapy controversy. Data is conflicting regarding effect on duration of neutropenia, use of with optimal premedication continue to report breakthrough nausea and vomiting. antimicrobial therapy, and hospital length of stay (LOS) following early initiation of This study will evaluate the impact of pharmacist intervention utilizing the developed CSF. The purpose of this study is to evaluate time to neutrophil recovery following survey and treatment algorithm in the management of breakthrough CINV. induction chemotherapy, effect of CSF on hospital LOS, number of anti-infective agents initiated and duration of therapy required, and impact of CSF use on day 14 Methodology: Adult patients of at least 18 years of age receiving moderately to
bone marrow biopsy(BMBx) results. highly emetogenic chemotherapy will be enrolled in this Institutional Review Board- approved prospective study in an outpatient infusion center. A validated survey and Methodology: This is a retrospective review of newly diagnosed AML patients ≥ 18
an antiemetic treatment algorithm developed from current practice guidelines will be years of age, who received induction chemotherapy with an anthracycline agent and utilized for evaluation. During the scheduled chemotherapy visit, patients will be cytarabine between October 2002 and October 2012. Based on common strategies for provided with an informed consent form and survey, which will be completed post CSF use, patients will be divided into three groups: receiving CSF within 24-72 hours chemotherapy. The treatment algorithm will provide guidance to obtain appropriate after completing induction, receiving CSF after a negative day 14 BMBx, and not pharmacological recommendations based on patient's responses to survey questions. receiving a CSF. Outcomes to be evaluated per treatment group include time to The patients will follow the recommended treatment plan and complete a second neutrophil recovery, LOS, incidence of febrile neutropenia, requirements for anti- survey to bring in at the next encounter. Data will be collected and outcomes will be infective therapy, impact on day 14 BMBx results, and cost of CSF compared to evaluated in terms of the percent improvement of CINV after a pharmacist's Results/Conclusions: Results pending at time of abstract submission. Conclusion
Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission. pending at time of abstract submission Presentation Objective: Describe the influence of CSF on newly diagnosed AML
Presentation Objective: Describe the effect of a pharmacist intervention on
patients undergoing induction chemotherapy. breakthrough CINV to help improve patient care and quality of life. Self Assessment: Describe three common strategies for using CSF in AML patients
Self Assessment: Which antiemetic agent was recommended most often to prevent
upon completion of induction chemotherapy. a. Administer CSF after a negative day CINV for patients on a moderately emetogenic chemotherapy regimen? 14 BMBx b. No CSF utilization c. Administer CSF within 24-72 hours after completing induction ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 2:40 - 3:00 Room: G301 Category: ONC
Time: 2:00 - 2:20 Room: G103 Category: ADM
EFFECT OF CAPPING SINGLE DOSE IV ONDANSETRON AT 16 MG
FACILITATING THE USE OF COMMUNITY HOSPITAL PHARMACISTS
FROM 32 MG IN MODERATE AND HIGHLY EMETOGENIC
IN THE IMPLEMENTATION OF A MEDICATION THERAPY
CHEMOTHERAPY REGIMENS
MANAGEMENT PROGRAM FOR EMPLOYEES OF A SELF-INSURED
Brandon Wilds, Robin Bettman, Erica Stetz, Thomas Davis St. Vincent's Medical Donald L. Sullivan, William Terneus Jr Indian River Medical Center Purpose/Background: In June 2012, the 32 mg IV dose of ondansetron was
Purpose/Background: Medication therapy management services are dependent upon
removed from the prescribing information due to dose-related QT prolongation. This collaboration of healthcare professionals to optimize medication use in accordance was due to the findings of a randomized, double-blind, four-period crossover study with evidence-based practices. This service is a collaboration among a assessing the prolongation of the QTc interval in 58 patients receiving a single dose multidisciplinary team that strives to improve the quality of care and reduce overall IV ondansetron of 8 mg or 32 mg. At St. Vincent's Medical Center - Riverside, the cost to patients. These services can result in improved patient outcomes, reduce standard of care for moderate and highly emetogenic chemotherapy includes the use adverse drug events, improved mediation adherence, and reduce hospital admissions. of the 5-HT3 antagonist ondansetron for pre-chemotherapy anti-nausea prophylaxis. Indian River Medical Center is a community hospital that is a self-insured institution It is hypothesized that the lower dose could impact patient care as more patients could that provides benefits for their employees and their dependent(s). The average annual potentially experience chemotherapy induced nausea and vomiting. cost in prescription medication makes up a significant component of the total health portfolio. The purpose of this program is to aid in relieving expenditures to the Methodology: A retrospective chart review of patients who received a moderate or
hospital and employees. highly emetogenic chemotherapy regimen and a single IV dose of either 16mg or 32mg of ondansetron from August 31, 2011 to March 31, 2013 will be conducted. Methodology: This pilot project is a retrospective study of the pattern of medication
The number of breakthrough anti-nausea medications, as defined by the National prescribed for employees of Indian River Medical Center and their dependents. Data Comprehensive Cancer Network, used post-chemotherapy will be quantified to will be reviewed retrospectively under an IRB approved protocol. Phase I will review determine if there is a significant difference between treatment groups. the overall medications utilized by physicians and the conformation to the health plan's formulary. Phase II will review the patterns of medication use for individual Results/Conclusions: Results pending at time of abstract submission. Conclusion
patients and the potential for interventions due to less than optimal drug choice, drug pending at time of abstract submission. interactions, potential for reduced clearance in compromised patients and cost.
Presentation Objective: Explain the rationale for lowering the maximum single IV
dose of ondansetron from 32mg to 16mg.
Results/Conclusions: Results pending at time of abstract submission Results pending
at time of abstract submission Self Assessment: Which adverse effect caused by ondansetron led to the removal of
the 32mg IV dose from the prescribing information? Presentation Objective: Describe the role of a clinical pharmacist in improving
patient outcomes through medication therapy management? Self Assessment: What was the most common error identified in this study that
pharmacist can improve upon?
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 2:20 - 2: 40 Room: G103 Category: ADM
Time: 2:40 - 3:00 Room: G103 Category: ADM
IMPLEMENTATION OF THE ASHP PHARMACY PRACTICE MODEL AT
DEVELOPMENT AND IMPLEMENTATION OF A LONGITUDINAL
THE MIAMI VA HOSPITAL
STUDENT LEARNING EXPERIENCE FACILITATED BY PHARMACY
Joy Awoniyi and Vivian Rios Miami VA Healthcare System RESIDENTS
Purpose/Background: ASHP has identified five goals and measures for the
Kristyn Mulqueen, Laura Smoot, Denise Waddell North Florida/South Georgia implementation of the Pharmacy Practice Model throughout the nation. The goals and Veterans Health System measures are that (1) pharmacist roles, practices and activities will improve Purpose/Background: The Malcom Randall Veterans Affairs Medical Center
medication use and optimize medication related outcomes, (2) pharmacy technicians (VAMC) in Gainesville, Florida serves as a clinical rotation site for many pharmacy will prepare and distribute medications and perform other functions that do not students in their final professional year. Eighteen clinical pharmacists at the Malcom require a pharmacist's professional judgment, (3) pharmacists and pharmacy Randall VAMC serve as preceptors for Advanced Practice Pharmacy Experience technicians will have appropriate training and credentials for the activities performed (APPE) rotations, representing diverse fields of clinical pharmacy practice including within their scope of practice, (4) pharmacy departments utilize available automation ambulatory care, geriatrics, adult medicine, cardiology, hospice, oncology and and technology to improve patient safety and improve efficacy and (5) pharmacists surgery. Students rotating through the facility gain invaluable practical experience; will demonstrate leadership in exercising their responsibility for medication use however, didactic and interactive teaching components are often missing from these systems and will be accountable for medication related patient outcomes. The rotations, mainly because preceptors have difficulties finding time for such activities. objective of this project is to evaluate the Miami VA Healthcare System's utilization Implementing weekly educational discussions facilitated by pharmacy residents of the pharmacy practice model as identified by these goals and measures. would serve a dual purpose: to enhance the clinical learning of pharmacy students while simultaneously providing a venue for pharmacy residents to practice their Methodology: The ASHP Hospital Self-assessment worksheet will be completed by
the pharmacy supervisory staff. The ASHP Hospital assessment tool will be used to
teaching skills. evaluate the completed worksheets to determine the current status of the pharmacy Methodology: Preceptors were given the opportunity to have their rotation students
and identify areas of deficiency. The deficient areas will be discussed with the participate in the weekly "Student Education Clinic." Participating preceptors director of pharmacy and ideas for improvement will be suggested. added an insert to their syllabi which clarified the goals and expectations of the weekly student meetings. The resident coordinator arranged a topic schedule and Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission
coordinated communication between resident facilitators, students and preceptors regarding weekly assignments and feedback. Meeting facilitators were encouraged to Presentation Objective: Review and incorporate the five goals of the pharmacy
provide pre-work assignments or reading materials to help the students prepare for practice model initiative into the Miami Veterans Affairs Healthcare System
Results/Conclusions: Pending at time of abstract submission.
Self Assessment: Which of the five goals of the pharmacy practice model initiative
as identified by ASHP was reported as the least implemented in the 2012 national Presentation Objective: Describe how the implementation of the Student Education
Clinic benefited both pharmacy students and residents at the Malcom Randall Veterans Affairs Medical Center. Self Assessment: What types of "meeting themes" were utilized for Student Education
Clinic? A) Topic Discussions B) Patient Case Presentations C) Student Mini-Lectures D) Landmark Trial Series E) All of the above   ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 2:00 - 2:20 Room: G114 Category: MED
Time: 2:20 - 2: 40 Room: G114 Category: MED
PERCENTAGE OF PAIN E-CONSULTS THAT RESULTED IN A THERAPY
PHARMACISTS' RESPONSE TO DRUG-DRUG INTERACTION ALERTS:
IMPACT ON ALERT FATIGUE AS A RESULT OF REDUCING NON-
Danielle M. Gingras and Tracy L. Harvey Bay Pines VA Health Care System CLINICALLY SIGNIFICANT INTERACTION WARNINGS
Purpose/Background: The purpose of this evaluation is to evaluate the
Elizabeth Santiago, Brent Zussy, Dusko Klipa St. Vincent's Medical Center characteristics of recommendations made by a pharmacist through pain e-consults at Purpose/Background: Alert fatigue is experienced by clinical practitioners during
Bay Pines VA Healthcare System (BPVAHCS), and the percentage (%) of consults the order entry process when an abundance of alerts are triggered that are not which resulted in a change in therapy. Positive findings with pain e-consults will help actionable. Alert fatigue has led to a concern of clinically significant alerts being in demonstrating the utility of pharmacists as providing services for managing ignored, thereby increasing adverse events. The purpose of this study is to reduce the chronic pain, as well as, measuring improved adherence to VA/DoD guidelines for number of non-actionable drug-drug interaction alerts viewed during the order entry chronic non-malignant pain. process by re-categorization of severity levels, thereby decreasing alert fatigue and increasing safety. Methodology: A retrospective chart review will be conducted at BPVAHCS to
determine the % of patients whose pain regimen changed as a result of a pain e- Methodology: A retrospective review of drug-drug interaction alerts that were
consult completed by a pharmacist. The characteristics of those recommendations and viewed during the pharmacists' order entry process before filtration, November 3rd their acceptance/rejection rate will then be categorized. Patients who had a pain e- 2012 through December 3rd 2012, and after filtration, January 4th 2013 through consult between January 1, 2012 and March 31, 2012 will be identified for inclusion February 3rd 2013, was conducted. Re-categorization of the non-clinically significant in the study. Criteria for exclusion include patients who received an e-consult but drug-drug interactions, assessed by an expert panel, was performed in December died before September 30, 2012. Included patient's charts will be reviewed for 6 2012. Numerical data was analyzed to determine if there was a statistically significant months after completion of the consult in order to allow sufficient time for potential difference in responses before and after re-categorization of the non-clinically implementation of recommendations. Patient demographics, name and dose of pain significant drug-drug interaction alerts. In addition, the number of errors related to medications, requesting practitioner, type of chronic pain, recommendation of pain e- clinically significant drug-drug interaction alerts were reviewed to ensure there was consult, and consult outcome(s) will be recorded for all participants. not a significant increase secondary to re-categorization. Results/Conclusions: Results pending at time of abstract submission. Conclusion
Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission. pending at time of abstract submission Presentation Objective: Explain the impact of pharmacist recommendations on pain
Presentation Objective: Discuss the impact re-categorization of non-actionable
management via the e-consult program. drug-drug interaction alerts viewed during the order entry process has on alert fatigue Self Assessment: What is the purpose of a pharmacist pain e-consult program?
and patient safety. Self Assessment: What are the potential benefits of reducing the number of non-
clinically significant drug-drug interaction alerts? ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 2:40 - 3:00 Room: G114 Category: MED
Time: 2:00 - 2:20 Room: G112 Category: ONC
OUTCOMES OF PHARMACIST-PROVIDED DISCHARGE MEDICATION
DEVELOPMENT AND ASSESSMENT OF A CHEMOTHERAPY
COUNSELING FOR PATIENTS WITH CONGESTIVE HEART FAILURE
PREPARATION CHECKLIST USING SIMULATIONS
Sylvia Stoffella, William Terneus Jr., Kelly Kasten, Donald Sullivan Indian River Kristy Nguyen, Lisa Hymel, Sandra Prenosil, Pam Lewis Sarasota Memorial Purpose/Background: New expectations by Medicare include payment reductions based
Purpose/Background: The process of reviewing and preparing chemotherapy
upon readmission rates and patient satisfaction scores, thus increasing the need to better medications involves a complex and multi-step process that has the potential for educate patients prior to discharge. The primary objective is to evaluate pharmacy-provided serious or fatal consequences if not done correctly. At our institution, chemotherapy discharge medication counseling in improving disease state and medication knowledge for orders prepared are independently verified by a second pharmacist. The use of a tool patients with a primary diagnosis ofcongestive heart failure (CHF). Also, the investigator such as a checklist has the potential to improve the process of verifying will assess how improving patient education through pharmacy-provided discharge chemotherapy orders. The objective of this study is to assess whether the medication counseling services will affect 30-day post-discharge readmission rates and the implementation of a chemotherapy checklist can decrease chemotherapy errors number of emergency department visits for our study population. during simulation testing.
Methodology: Pharmacists will provide discharge medication counseling to patients with
a primary diagnosis of CHF. Patients will be identified at admission and their knowledge of Methodology: This prospective, randomized, simulation-model pilot study was
currently prescribed CHF medications will be assessed utilizing an admission medication conducted at a large community hospital. A chemotherapy preparation checklist was assessment form. Afterwards, pharmacists or student pharmacists will educate the patient developed to guide the pharmacists through the details of chemotherapy order review and assess the patient prior to discharge with a discharge medication assessment form. A and preparation. In addition, our existing chemotherapy drug reference sheets were scoring rubric will be used for both the admission and discharge medication assessment updated to include critical information as a guide for clinical considerations. questions to determine if there was an improvement in heart failure medication knowledge Pharmacists participating in the simulation will be randomized to one of two groups: through pharmacy-based medication counseling. This scoring rubric will evaluate one using the chemotherapy checklist and chemotherapy updated drug reference medication specific learning and any deficits in medication knowledge that were corrected. sheets and the other using only the existing chemotherapy drug reference sheets. The HCAHPS Insight Press Ganey® scores will be evaluated to determine patient satisfaction. simulation will consist of 20 cases, of which 18 have built-in errors and 2 will serve These scores are not patient specific, but only unit specific for the hospital. Patient as controls. The reliability and validity of the chemotherapy checklist will be demographics that will be collected include age, sex, previous or new diagnosis of CHF, assessed based on simulation results. ejection fraction (%), comorbid conditions, time during admission and discharge, medications, and the incidence of readmission rates and the number of emergency Results/Conclusions: Results pending at time of abstract submission. Conclusion
department visits within a 30-day post-discharge. Data will be reviewed retrospectively pending at time of abstract submission. under an Institutional Review Board approved protocol.
Presentation Objective: Describe the rationale for using a checklist in

Results/Conclusions: Pending at time of abstract submission
chemotherapy preparation. Self Assessment: What are the key components of a chemotherapy checklist to guide
Presentation Objective: Evaluate the role of pharmacy services providing disease
state and medication education to patients admitted with a primary diagnosis of congestive heart failure Self Assessment: What are the most common resources patients utilize to answer
their medication questions?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 2:20 - 2: 40 Room: G112 Category: ADM
Time: 2:40 - 3:00 Room: G112 Category: ADM
EVALUATION OF PHARMACY WORK-FLOW EFFICIENCY FOR
IMPACT OF A CLINICAL PHARMACIST INPATIENT MEDICATION
PATIENT RECEIVING CLOPIDOGREL
COUNSELING PROGRAM ON HCAHPS SCORES
Lashawn S. Morton, Teresa Plotts, Wisener Young Orlando VA Medical Center Christina Lee, Timothy L'Hommedieu, Michael Everett St. Jospeh's Hospital Purpose/Background: Clopidogrel is an antiplatelet agent indicated for specific
Purpose/Background: Hospital Consumer Assessment of Healthcare Providers and
patient populations with variable durations of therapies. Currently, clopidogrel is a Systems (HCAHPS) is a national standardized surveying instrument which measures restricted agent at the Orlando VA Medical Center and is approved or denied by patient perception of their hospital experience. The Centers for Medicare and pharmacy based upon defined criteria. Through the review of patient charts and Medicaid Services utilize HCAHPS scores as one of the metrics to determine completed restricted consults, the assessment and evaluation of the restricted-consult financial reimbursement to hospitals. To improve HCAHPS scores in the process will be the focal point of the project. Once the components of the process are communication about medications domain, the Department of Pharmacy at St. identified, possible improvements in workflow for approval and monitoring of Joseph's Hospital implemented a clinical pharmacist inpatient medication counseling patients prescribed clopidogrel may be elucidated. This project will evaluate the program. The purpose of this study is to evaluate the impact of this program on current process and identify methods which can maximize pharmacy productivity. HCAHPS scores in the communication about medications domain at St. Joseph's Methodology: A drug utilization report was generated for clopidogrel prescriptions
issued between April 1st, 2012 until April 30th, 2012. A random sample of Methodology: This study is a single-center, IRB-approved, retrospective study
approximately 80 patients were selected for inclusion in the medication use conducted at St. Joseph's Hospital. One-on-one medication counseling will be evaluation. Information collected included the status of consult placed, pharmacy provided to all patients who meet HCAHPS eligibility criteria and are admitted to any completion time of consult, duration of therapy, baseline monitoring and follow-up of three specified inpatient units within the hospital. The primary outcome of this study is to determine the impact of clinical pharmacist inpatient medication counseling on HCAHPS scores. This will be accomplished by comparing the Results/Conclusions: Results pending at time of abstract submission. Conclusion
hospital's post-intervention HCAHPS scores for the communication about pending at time of abstract submission. medications domain to baseline scores prior to the program.
Presentation Objective: Determine most efficient pharmacy work-flow for approval
or denial of clopidogrel in regards to its status as a restricted medication.
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Self Assessment: Question: What was the most common process failure identified in
this study? Answer: Pending results  Presentation Objective: Describe the utility of a clinical pharmacist inpatient
medication counseling program on HCAHPS scores.
Self Assessment:
What is the significance of HCAHPS scores meeting the national
50th percentile?
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 2:00 - 2:20 Room: G312 Category: ID
Time: 2:20 - 2: 40 Room: G312 Category: ID
IMPACT OF PHARMACISTS AND AN ID PHYSICIAN-DRIVEN
EVALUATING THE RISK OF BILIARY COMPLICATIONS IN HOME
ANTIMICROBIAL STEWARDSHIP PROGRAM IN A 395-BED, ACUTE
CARE PATIENTS RECEIVING INTRAVENOUS PUSH CEFTRIAXONE
CARE, COMMUNITY HOSPITAL
Andrew Zaki Coram Specialty Infusion Wonhee So, Clinton Holder, William Braun,Charles Guastella, Angela Marquardt St. Purpose/Background: Safety, simplicity of administration, and cost efficiency have
Anthony's Hospital always been important factors in drug therapy decision making. Because of these Purpose/Background: An antimicrobial stewardship program (ASP) intends to
considerations, the use of intravenous push (IVP) antibiotics in the home care setting achieve the most optimal clinical and economical outcomes with minimal adverse continues to be popular. At the same time, there is a desire to have more safety data consequences of antimicrobial use. The primary objective of this study is to compare on IVP ceftriaxone in home care patients. Some evidence suggests that ceftriaxone the magnitude of ASP at St. Anthony's Hospital (SAH) before and after July 9, 2012 may lead to biliary complications such as increased bile viscosity (“biliary with the addition of an infectious disease (ID) physician to the ASP team by looking sludge†) that may or may not lead to gallstones and/or acute pancreatitis. The at the number of interventions. The secondary objective is to evaluate the economical purpose of this study is to add to the overall safety data of IVP ceftriaxone. and clinical impact of the ASP. Methodology: A retrospective cohort study using 30 patient charts of Coram home
Methodology: All hospitalized patients on whom antimicrobial therapy-related
care patients receiving intravenous push ceftriaxone will be conducted to assess for interventions were recorded by pharmacists during 2012 will be included. For pre- any statistically significant increases in amylase, lipase, bilirubin, aspartate analysis of ASP without an ID physician on the team, data from January 1, 2012 to transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) in July 7, 2012 will be used. For post-analysis of ASP with an ID physician on the ASP these patients. The study will analyze the adverse effects of biliary sludge resulting team, data from July 9, 2012 to December 31, 2012 will be used. The following data from the use of ceftriaxone, with respect to patient age and length of therapy. will be collected: patient demographics, number of interventions, types of interventions, acceptance rates of interventions, and the rates of ID consults. In Results/Conclusions: Results pending at time of abstract submission Conclusion
addition, cost for all antimicrobials purchased, duration of antimicrobial therapy, pending at time of abstract submission resistance rates, and the rates of Clostridium difficile will be collected. Presentation Objective: Provide the reader with correlative data for the risk of
biliary sludge when administering ceftriaxone by intravenous push. Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission
Self Assessment: Biliary sludge can eventually lead to what other manifestations?

Presentation Objective: Describe the main changes in ASP before and after the
addition of an ID physician to the ASP team.
Self Assessment:
What is the percentage of the interventions that were made to cases
with ID consults in this study?
ABSTRACT REPRODUCTION FORM
Time: 2:40 - 3:00 Room: G312 Category: ID
IMPACT OF MDR GRAM POSITIVE DE-ESCALATION ON FREQUENCY
OF APPROPRIATE ANTIBIOTIC UTILIZATION IN CRITICALLY ILL
PATIENTS WITH MRSA NEGATIVE BRONCHOALVEOLAR LAVAGE,
BLOOD AND SURVEILLANCE CULTURE RESULTS
Sloka Manvi, Christopher Jankowski, Mark Schreiber, Donald Johnson Shands Jacksonville Medical Center Purpose/Background: Bronchoalveolar lavage (BAL) has been demonstrated to be an
accurate diagnostic technique for identifying ventilator associated pneumonia (VAP)
bacteriology. Current recommendations endorse de-escalating initial antibiotic therapy
based on results of lower respiratory tract cultures. Recent studies have postulated that
active surveillance cultures (ASC) for MRSA have a high negative predictive value for
MRSA colonization, which may predict patients with a high risk of MRSA VAP. Despite
this objective evidence, physicians may be reluctant to discontinue empiric MRSA
antimicrobial coverage (vancomycin/linezolid) for suspected VAP. The purpose of this
study is to determine if early de-escalation of MDR Gram-positive therapy based on
microbiological (BAL/ETA, blood cultures) and rapid molecular testing (MRSA ASC),
leads to a reduction in the number of unnecessary antibiotic treatment days of
vancomycin/linezolid in patients with clinical suspicion of VAP.
Methodology: This study is a pre/post education initiative analysis of early de-escalation
of empiric MRSA antimicrobial therapy based on ASC and culture results. An
observational retrospective chart review will be used to evaluate patients with clinically
suspected VAP, MRSA negative surveillance cultures, negative BAL, and blood culture
results. Appropriate antibiotic utilization will be evaluated by comparing the number of
hours to vancomycin/linezolid discontinuation from initiation, in each study period.
Secondary endpoints include hospital/ICU mortality and length of stay, duration of
mechanical ventilation, subsequent occurrence of VAP, number of pharmacist
interventions, and finally cost associated with the use of MRSA antimicrobial therapy.
Results/Conclusions: Pending at time of abstract submission.
Presentation Objective: Describe the role of education regarding early MDR gram
positive de-escalation in the prevention of unnecessary antibiotic exposure in patients
with clinically suspected VAP.
Self Assessment:
What is the utility of performing ASC for MRSA colonization?  
2ND ANNUAL FLORIDA RESIDENCY
CONFERENCE
Session IV, cont.
ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 3:10 - 3:30 Room: G301 Category: ONC
Time: 3:30 - 3:50 Room: G301 Category: ONC
RETROSPECTIVE REVIEW OF CARBOPLATIN DOSING IN A
INCIDENCE OF SKELETAL-RELATED EVENTS IN PATIENTS WITH
COMMUNITY HOSPITAL
SOLID TUMORS RECEIVING ZOLEDRONIC ACID OR DENOSUMAB
Moe Shwin, Anay Moscu, Radhan Gopalani Baptist Hospital of Miami FOR TREATMENT OF METASTATIC BONE DISEASE
Purpose/Background: At present, there are no clear guidelines whether actual body
Leigh Anna Soler, Jessica Peterson, Nancy Elkhoury, Leah Ward Mayo Clinic weight (ABW), ideal body weight (IBW), or adjusted body weight (AdjBW) should be utilized in the Cockcroft-Gault (C-G) equation for carboplatin dose calculation in Purpose/Background: Metastatic bone disease is a common, clinically important
obese patients. The goal of this study is to determine an optimal weight descriptor for complication of many types of solid tumors. Complications include pathologic estimating glomerular filtration rate (GFR) to be utilized in carboplatin dose fracture, spinal cord compression, and radiation or surgery to the bone. Collectively, calculation via Calvert formula in obese patients. these are referred to as skeletal-related events. Zoledronic acid and denosumab are two medications used to prevent skeletal-related events. Current practice guidelines Methodology: This is an IRB approved retrospective chart review. All patients ≥18
years of age who received at least one dose of carboplatin as monotherapy or as a part
do not recommend one agent over another. The aim of this investigation is to analyze of combination chemotherapy regimen for solid tumor malignancies between June rates of skeletal-related events at the study institution in patients receiving zoledronic 2011 and July 2012 will be stratified into control (Normal body weight patients) or acid or denosumab. Data will be used to determine if either agent should be selected study (Obese patients) group. Carboplatin dose will be calculated using different as a preferred first line agent for prevention of skeletal-related events. weight descriptors in obese patients. The calculated carboplatin dose will be Methodology: Data will be collected from the electronic medical record of each
compared with the actual carboplatin dose administered to determine the difference in patient. Patients with solid tumors with evidence of one or more bone metastases, age carboplatin dose in obese patients. To determine the difference in incidence of > 18 years, and an Eastern Cooperative Oncology Group performance status of 0, 1, carboplatin dose limiting toxicities between control and study group, pre and post or 2 will be included. Patients will be excluded for inadequate renal function or treatment platelet count, electrolytes level and serum creatinine will be collected and previous bisphosphonate use. The primary endpoint is the number of skeletal-related events. Secondary endpoints include rates of hypocalcemia, diagnosis of osteonecrosis of the jaw, and renal deterioration. Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission. Presentation Objective: Demonstrate a difference in incidence of carboplatin
associated toxicities between normal weight patients and obese patients. Presentation Objective: Describe the role of zoledronic acid and denosumab in
Self Assessment: What is the major dose limiting toxicity of carboplatin?
preventing skeletal-related events. Self Assessment: On average, how often do patients with metastatic bone disease
experience a skeletal-related event? ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 3:50 - 4:10 Room: G301 Category: ONC
Time: 3:10 - 3:30 Room: G103 Category: ADM
INCIDENCE OF NAUSEA AND VOMITING IN OBESE PATIENTS
MEDS TO BEDS: PILOTING A PHARMACY INITIATED DISCHARGE
RECEIVING MODERATELY EMETOGENIC CHEMOTHERAPY
PRESCRIPTION CONCIERGE SERVICE
Jamie Lee, Georgia Keriazes, Angela Pearson Lakeland Regional Medical Center Emily Dutton, Minh-Tri Duong, Maja Gift, Kimberly Cohen-Pelosi, Ramon Docobo, Purpose/Background: The American Society of Clinical Oncology has released
Leann Koontz, Angela Logan Tampa General Hospital guidelines that recommend using actual body weight rather than an adjusted body Purpose/Background: There is limited data evaluating the impact of a discharge
weight when dosing chemotherapy in obese patients, especially when the goal is cure. prescription delivery service to the patient bedside. The purpose of this project is to Practice patterns demonstrate that up to 40% of obese patients receive limited evaluate the impact, feasibility, and possible barriers to implementing a pharmacy-run chemotherapy doses that are not based on actual body weight, due to concerns for discharge medication concierge service. overdosing. There have been a number of studies evaluating toxicities, such as myelosuppression in obese patients receiving chemotherapy, but there is lack of Methodology: This 30-day quality improvement initiative included patients over 18
years of age admitted to the Adult Cardiology unit. Patients were offered a discharge
significant data describing the incidence of chemotherapy induced nausea and delivery service and had discharge medications delivered if they chose to participate. vomiting in this population. Nausea and vomiting is known to be a dose dependent Changes in Hospital Consumer Assessment of Healthcare Providers and Systems toxicity. This study will describe the baseline characteristics for obese patients (HCAHPS) survey scores and outpatient pharmacy revenue are being measured to receiving moderately emetogenic chemotherapy. The incidence of chemotherapy evaluate impact. Service workflow measures, including time requirements, patient induced nausea and vomiting will be reported for obese patients receiving logistics, and resource barriers, are being evaluated for house wide implementation. chemotherapy doses based on actual body weight versus an adjusted body weight. Results/Conclusions: Of 154 patients admitted to the pilot unit, 87% (n=134) were
Methodology: A retrospective chart review of obese patients receiving at least one
offered the service with 59% (n=79) electing to have discharge prescriptions dose of moderately emetogenic chemotherapy was conducted. Information collected delivered. Of those selecting the service, approximately half (n=46, 58%) had new included: age, gender, height, weight, BMI, BSA, creatinine, bilirubin, chemotherapy, medications prescribed. Deliveries were made to 72% (n=33) of those with discharge dose, cancer type, predisposing factors contributing to nausea and vomiting, prescriptions. Outpatient pharmacy data shows a 10% increase in outpatient pharmacy antiemetic and breakthrough medications. utilization from the pilot unit. HCAHPS score analysis and further outpatient
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pharmacy data is pending. Review of data, thus far, shows that there is significant pending at time of abstract submission. interest in a discharge prescription delivery service. The impact on HCAHPS scores and outpatient pharmacy profits are being evaluated. Presentation Objective: Describe baseline characteristics, dosing weight strategies,
and incidence of nausea and vomiting in obese patients receiving moderately Presentation Objective: Describe the impact, feasibility, and barriers to
emetogenic chemotherapy. implementing a pharmacy-run discharge medication concierge service. Self Assessment: Does dosing weight strategy affect the incidence of chemotherapy
Self Assessment: What are the potential benefits and barriers of a discharge
induced nausea and vomiting in obese oncology patients receiving moderately prescription delivery service? emetogenic chemotherapy? ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 3:30 - 3:50 Room: G103 Category: ADM
Time: 3:50 - 4:10 Room: G103 Category: ADM
ADHERENCE TO TIMING, SELECTION, AND DURATION OF
THE IMPACT OF PHARMACIST DRIVEN E-FORCSE EDUCATION ON
PROPHYLACTIC ANTIMICROBIAL AGENTS IN SURGICAL PATIENTS:
PHYSICIAN CONTROLLED SUBSTANCE PRESCRIBING PRACTICES
A PROCESS IMPROVEMENT PROJECT FOR BAYFRONT MEDICAL
Jocelyn Congdon, Joseph Cammilleri, Natohya Mallory, Alan Halperin, Patrick Aaronson Shands Jacksonville Medical Center Bao Tran Jackie Decrosta Anthony Spann Jennifer Miles Jeff Bush Bayfront Medical Purpose/Background: Prescription drug abuse continues to be a problem in the
United States. Controlled substances have become increasingly popular and the Purpose/Background: The Surgical Care Improvement Project (SCIP) is sponsored
epidemic of nonmedical use of these medications is on the rise. In order to combat by the Centers for Medicare & Medicaid Services (CMS) in collaboration with this epidemic, statewide Prescription Drug Monitoring Programs (PDMP) have been numerous national partners. The project focuses on the timing, selection, and duration developed and are fully operational in forty-two states. These programs allow of treatment with prophylactic antimicrobial agents, as well as additional measures prescribers, pharmacists, and select law enforcement personnel to track prescriptions surrounding patient safety and care during surgical procedures. Starting fiscal year dispensed for controlled substances. The PDMP in Florida, Electronic-Florida Online 2013, hospital performance on seven of the SCIP measures will determine Reporting of Controlled Substances Evaluation Program (E-FORCSE) allows the reimbursement rates from Medicare. tracking of schedule II, III, and IV medications. Although all controlled substances dispensed in the state of Florida are required to be reported to E-FORCSE, it is not Methodology: Bayfront Medical Center pharmacy residents will retrospectively review
250 surgeries from August to October 2012 to assess antibiotic fallout rates at baseline.
mandatory for this information to be viewed prior to prescribing controlled Patients are eligible for inclusion if 18 years or older. Pregnant patients will be excluded. substances. Since it is not mandatory to review E-FORCSE reports, the benefits of Starting March 1, 2013, the residents will implement processes to decrease fallouts. The this program have yet to be fully determined. It is hypothesized that increased process improvement will include: 1) determine if procedures meet SCIP guideline criteria; awareness and education about the benefits of E-FORCSE will decrease unnecessary 2) determine if scheduled prophylactic antibiotics are appropriate; 3) in-service pharmacists controlled substance prescribing. regarding appropriate scheduling of antibiotics; 4) designate "OnCall" antibiotic container
Methodology: Shands Jacksonville internal medicine residents' controlled substance
for all antibiotics not stocked on floor McKessons; and 5) in-service pharmacy staff on new prescribing rates will be evaluated before and after clinical pharmacist intervention. processes for "OnCall" antibiotic labels. Post implementation, 250 surgeries from March to May 2013 will be compared to baseline to assess antibiotic fallout rates. The primary The intervention provided will entail generation and analysis of E-FORCSE reports outcome of the study is to ensure 100% compliance to the SCIP guidelines, focusing for patients seen by the internal medicine residents. Change in controlled substance specifically on the timing, selection, and duration of prophylactic antibiotic agents. prescribing rates will be evaluated for twenty six medical residents by looking at three month time periods exactly one year apart. Additionally, confidence in Results/Conclusions: Results pending at time of abstract submission Conclusion
controlled substance prescribing will be evaluated with the use of a survey pending at time of abstract submission administered at the conclusion of the study. Presentation Objective: Understand SCIP guidelines, identify compliance issues
Results/Conclusions: Results pending at time of abstract submission. Conclusion
associated with SCIP , be able to develop new processes to improve SCIP compliance pending at time of abstract submission. and be able to measure efficacy of the new process Self Assessment: What was the biggest challange during this process improvement
Presentation Objective: Evaluate the effect of pharmacist driven E-FORCSE
education on controlled substance prescribing rates and practices. Self Assessment: What is the purpose of E-FORCSE?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 3:10 - 3:30 Room: G114 Category: MED
Time: 3:30 - 3:50 Room: G114 Category: MED
IMPACT OF PHARMACY TECHNICIAN ASSISTED MEDICATION
IMPACT OF AN INPATIENT PHARMACIST MANAGED WARFARIN
RECONCILIATION IN THE EMERGENCY DEPARTMENT
SERVICE ON PATIENT SAFETY IN A COMMUNITY HOSPITAL SETTING
Roma Merrick, Christina Gifford, Megan Keese, Elizabeth Santiago, Lauren Stafford Sarah Hayes, Yasaman Homayouni, Kathleen Rottman, Elizabeth Santiago St. St. Vincent's Medical Center Vincent's Medical Center Purpose/Background: Obtaining an accurate and complete medication history is an
Purpose/Background: Warfarin is considered a high- alert medication by The Joint
integral part of The Joint Commission's mandated medication reconciliation process. Commission (TJC) because of patient safety risks including increased risk of Staffing a medication reconciliation pharmacy technician in the emergency bleeding. In 2008, St. Vincent's Medical Center- Riverside (SVMC-R) developed a department may increase patient safety. Pharmacy technicians might obtain a more physician managed anticoagulation protocol, however it's use was not mandatory. In complete and accurate medication history; thereby preventing a greater number of 2012, pharmacists began managing all patients with a therapeutic warfarin order. The medication-related adverse drug events (ADEs). The purpose of this study is to objective of this study is to evaluate the impact of the pharmacist managed warfarin determine the impact a medication reconciliation pharmacy technician may have on service compared to physician managed warfarin dosing either by protocol or own preventing adverse drug events in patients admitted through the emergency management by assessing a composite rate of safety. Methodology: A retrospective chart review of patients who received therapeutic
Methodology: A retrospective chart review of patients admitted through the
warfarin doses during their inpatient stay from August 1, 2011 to July 31, 2012 emergency department was conducted. Patients were excluded from this study if they (physician-managed group) and September 1, 2012 to February 28, 2013 (pharmacist- reported taking no home medications or if they were not interviewed by a certified managed group) was conducted. Patients were included if they were greater than 18 pharmacy technician during hospitalization. The primary endpoint was number of years of age with a therapeutic warfarin order. The primary endpoint was a composite discrepancies related to admission medication histories. The discrepancies were rate of safety of warfarin therapy complications. considered markers of potential ADEs, as any deviation could potentially result in an ADE. Secondary endpoints included classification of drug associated with each Results/Conclusions: Results pending at the time of abstract submission. Conclusion
pending at the time of abstract submission.
discrepancy and time from admission to time of intervention by the pharmacy technician. Lastly, cost of avoidance was calculated using a reconciliation tracking Presentation Objective: Discuss the differences in the safety and effectiveness of
warfarin therapy utilizing a pharmacist-managed dosing service compared to physician- managed. Results/Conclusions: Results pending at time of abstract submission Conclusion
pending at time of abstract submission
Self Assessment: How have studies demonstrated pharmacists' interventions
impacted warfarin therapy management? A.Reduce the time to therapeutic INR

Presentation Objective: Discuss the impact a pharmacy technician may have on
during initiation of warfarin B. Reduce the incidence of supratherapeutic INR during medication reconciliation in the emergency department warfarin titration C. Reduce the length and cost of hospital stay of patients receiving Self Assessment: True or False: In this study, a medication reconciliation pharmacy
warfarin D. All of the above  technician in the emergency department was shown to reduce number of discrepancies found in medication histories, versus those obtained by nurse or physician.  ABSTRACT REPRODUCTION FORM
ABSTRACT REPRODUCTION FORM
Time: 3:50 - 4:10 Room: G114 Category: MED
Time: 3:10 - 3:30 Room: G312 Category: PI
FREQUENCY OF DOCUMENTED THERAPEUTIC FAILURES WITHIN
DEVELOPMENT AND IMPLEMENTATION OF A COMPETENCY-BASED
THE ELECTRONIC MEDICAL RECORD OF A VETERANS AFFAIRS
TRAINING PROGRAM FOR PHARMACISTS UTILIZING A NEW
HOSPITAL
COMPUTERIZED PHYSICIAN ORDER ENTRY (CPOE) SYSTEM IN A
Margaret Swindler, Robert Svingos, Don Reeder North Florida/South Georgia COMMUNITY HOSPITAL
Veterans Health System Kenny Aristide, Jon-Alan Ames, William Terneus Indian River Medical Center Purpose/Background: When a patient fails a medication, most clinicians will
Purpose/Background: On May 20, 2013, Paragon, a CPOE system designed by
document the therapeutic failure in a progress note, but may overlook documenting McKesson, will be implemented at the Indian River Medical Center (IRMC) as the failure in a standardized location where all members of the medical team can method to improve clinical workflow and reduce medication errors and adverse easily look for this information. If a therapeutic failure isn't listed in a consistent events. An ideal CPOE system is designed to support the efficiency of an institutions' location, another clinician could start a medication, not knowing that the patient may medication use process. Appropriate training is a key factor to the successful have tried it in the past without success. This study will look at whether therapeutic implementation of a CPOE system. This project/training program will help ensure failures are being documented in the electronic medical record at the Malcolm that current pharmacy staff and new staff members have the competency necessary to Randall VA medical center, and if so, is there a description of the therapeutic failure. effectively navigate and use the new CPOE system. Methodology: This is a retrospective chart review looking at patients aged 18-89
Methodology: A brief, interactive CPOE competency-based training program with
years old who were on select non-formulary medications due to a therapeutic failure accompanying assessment examination is being developed and implemented. The from Jan 1, 2011 to Jan 1, 2012. The investigators will look at whether the training program includes assigned readings regarding the new CPOE system and therapeutic failure was documented in the ADR/Allergy tab of CPRS, and if so, was details/instructions regarding processing medication orders. The training program there a description of what the therapeutic failure was. will be available for access via online four weeks prior to the CPOE implementation date, May 20, 2013. Pharmacists are required to successfully complete four Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission.
interactive test patient scenarios/medication orders and take an examination. A score of 90 percent or better is deemed as passing the competency examination. Also, a Presentation Objective: Determine the extent to which providers are documenting
comprehensive electronic survey is being created to evaluate pharmacists' perception therapeutic failures in the medical record. of readiness to utilize the new CPOE system. Self Assessment: What is the importance of documenting therapeutic failures in the
Results/Conclusions: Results pending at the time of abstract submission. Conclusion
pending at the time of abstract submission. Presentation Objective: Identify workflow changes in pharmacy practice after the
implementation of a new CPOE system at a community hospital.
Self Assessment:
Following the implementation of a new CPOE system, what types
of intervention are made by pharmacist?
ABSTRACT REPRODUCTION FORM ABSTRACT REPRODUCTION FORM
Time: 3:30 - 3:50 Room: G312 Category: ID
Time: 3:50 - 4:10 Room: G312 Category: ID
EFFICACY OF HEPATITIS C TRIPLE THERAPY IN A GOVERNMENT
IMPACT OF PHARMACIST ON PROPHYLACTIC ANTIMICROBIAL
SPONSORED HEALTHCARE POPULATION
SELECTION FOR COLORECTAL SURGERY
Andrew Coelho, Deepak Singh WellCare Health Plans Jessica Dabady, Ted Heierman, Jessica LaFosse, Heather McCormick Holmes Purpose/Background: Successful treatment of Hepatitis C is highly dependent upon
Regional Medical Center adherence to a complex drug regimen along with associated medical visits. It is Purpose/Background: Development of a surgical site infection (SSI) is associated
unsure if the stringent follow-up and monitoring that occurs during clinical trials is with increased morbidity and mortality following surgical procedures. However, mimicked in the clinical setting. When a complicated dosing regimen is coupled with when used appropriately, prophylactic antimicrobials may prevent the development of many adverse effects, adherence can be a major barrier to proper treatment. The SSIs and improve patient outcomes. The primary objective of this study is to evaluate primary outcome of this study is to evaluate the effectiveness of triple therapy the frequency of appropriate prophylactic antibiotic selection and timing for (peginterferon alfa-2a/2b + ribavirin + an NS3/4A protease inhibitor) in clinical colorectal surgery, between the standard care group and the pharmacist intervention practice by evaluating sustained virological response (SVR) at 24-weeks post treatment. Secondary outcomes include discontinuation rates and non-adherence to drug regimen futility/stopping rules. Methodology: The hospital's electronic medical record system will be used to
retrospectively identify patients who have undergone colorectal surgery. Patients will

Methodology: Claims data was pulled to identify Medicare or Medicaid patients
be placed into one of two groups which will include the standard care (pre- treated for Hepatitis C genotype 1 with peginterferon (PEG), ribavirin (RBV), and implementation) group and the pharmacist intervention (post-implementation) group. either boceprevir (BOC) or telaprevir (TVR) who started therapy between 10/1/11 Patient charts for the pre-implementation and post-implementation group will be and 2/29/12 for this retrospective review. Patient claims were confirmed to have reviewed from September 2011 to January 2012 and September 2012 to January genotype 1 via submitted laboratory data. HCV RNA values submitted to the plan 2013, respectively. Patients who are over the age of 18 and have undergone colorectal during therapy were reviewed for primary and secondary outcomes. HCV RNA surgery will be included in this study. The following data will be collected for values at the end of therapy and 24-weeks post treatment were acquired and assessed included patients: age, gender, allergies, baseline serum creatinine, antibiotic(s) used, for SVR. Patients who have comorbid HIV, have had a liver transplant, lost eligibility start time of antibiotic prior to first incision, and time of last antibiotic dose post- in insurance coverage, or patients whose laboratory data could not be obtained were surgery. The date of next hospital readmission and primary diagnosis will be excluded from this study. collected, if applicable. Results/Conclusions: Results pending at time of abstract submission Conclusion
Results/Conclusions: Results pending at time of abstract submission. Conclusion
pending at time of abstract submission pending at time of abstract submission. Presentation Objective: Determine if the efficacy of triple therapy seen in clinical
Presentation Objective: Assess the frequency of appropriate antibiotic selection and
trials, which is highly dependent on medication adherence, corresponds to similar timing for colorectal surgery, between the standard care group and the pharmacist results in clinical practice. intervention group. Self Assessment: Which is true regarding the new drug class that was recently
Self Assessment: What was the most commonly used antibiotic regimen identified in
developed for the treatment of Hepatitis C? a) This class is approved for use in Hepatitis C genotypes 1, 2, and 3 b) This class acts via inhibition of viral NS3/4A protease c) Drugs include boceprevir and telaprevir d) a and b e) b and c

Source: https://fshp.site-ym.com/resource/resmgr/frc_2013_program_book.pdf

Social mishap exposures for social anxiety disorder: an important treatment ingredient

Social Mishap Exposures for Social Anxiety Disorder: An Important Treatment Ingredient Angela Fang, Alice T. Sawyer, Anu Asnaani, and Stefan G. Hofmann, Boston University Conventional cognitive-behavioral therapy for social anxiety disorder, which is closely based on the treatment for depression, has been shownto be effective in numerous randomized placebo-controlled trials. Although this intervention is more effective than waitlist control group andplacebo conditions, a considerable number of clients do not respond to this approach. Newer approaches include techniques specificallytailored to this particular population. One of these techniques, social mishap exposure practice, is associated with significant improvement intreatment gains. We will describe here the theoretical framework for social mishap exposures that addresses the client's exaggerated estimationof social cost. We will then present clinical observations and outcome data of a client who underwent treatment that included such socialmishap exposures. Findings are discussed in the context of treatment implications and directions for future research.

Prueba pdf

Boletín 16 Laboratorio acreditadopor la red de SENASAL 110 ACTIVIDADES DEL LABORATORIO PREVALENCIA DE ANTICUERPOS ANTI Neospora Los resultados obtenidos para los sueros bovinos fueron caninum EN BOVINOS Y CANINOS los siguientes: 48,3% de las muestras fueron negativas(1538/3187) ; 18.0 % de las muestras resultaron positivas