2021 Virtual Poster Session Abstracts

April 16, 2021: Session 1

• Authors: Veronica Arceri, PharmD; Amber Jerauld, PharmD, BCACP; Erin Pauling, PharmD, BCACP; Lyndsay Carlson, PharmD, BCACP; James Jester, PharmD
• Title: Pharmacist recommended deprescribing of potentially inappropriate medications (PIMs) in the geriatric patient population of primary care clinics
• Abstract
  • Introduction/Background: A medication’s risk of adverse drug events (ADEs) can outweigh the benefit of use in certain older adults. Pharmacists can play an active part in reducing ADEs by making deprescribing recommendations.
  • Objectives: Assess the impact of an ambulatory care pharmacist’s recommendations on PIM use. Identify barriers to deprescribing medications in the ambulatory care setting.
  • Methods: Prospective pilot study, approved by the hospital system’s institutional review board, of a sample of patients aged ≥65 years on ≥10 medications receiving primary care services from an ambulatory care clinic. The intervention consisted of ambulatory care pharmacists reviewing medication lists and identifying PIMs using guidelines such as Beers Criteria and STOPP/START. Deprescribing recommendations were made to the patient’s primary care provider prior to an upcoming patient appointment. Pre- and post-intervention medication lists were compared to identify the number of PIMs deprescribed. Reasons for unsuccessful recommendations were documented to identify barriers to deprescribing.
  • Results: A total of 338 PIMs were identified on the medication lists of 155 patients (53%) with a median of 2.2 PIMs per patient. Of 55 patients having a provider visit, a total of 26 (47%) patients had a successful intervention of at least 1 PIM deprescribed. Of 33 total medications deprescribed, the most common medications were proton pump inhibitors (27%), anticholinergic medications (27%), and central nervous system active medications (24%). The most common barriers to deprescribing were the belief that the risks of medication continuation had been minimized and that a specialist prescribed the medication.
  • Conclusions: Ambulatory care pharmacists are well positioned to identify PIMs and make deprescribing recommendations to providers. Future opportunities include workflow changes to improve the efficiency of medication list review and continued patient and provider education on the risks of PIM use.

• Authors: Holly Goetz, PharmD; Ashley Besignano-Long, BS PharmD, BCACP; Elaena Quattrocchi, BS, PharmD CDE, FASHP
• Title: Risk of Fluoroquinolone Associated Aortic Aneurysm/Dissection in an Urban Primary Care Clinic 
• Abstract
  • Introduction/Background: In December 2018, the U.S. Food and Drug Administration (FDA) issued a safety communication for fluoroquinolones (FQ) reporting increased risk of aortic aneurysm (AA) or aortic dissection (AD). The communication was based on four trials published between 2015 and 2018.
  • Objectives: The purpose of this retrospective chart review is to analyze the percent of patients in an urban community that are at an increased risk for AA/AD associated with FQs. Risk is defined as history of AA/AD, peripheral atherosclerotic vascular diseases (ASCVD), hypertension, specific genetic disorders involving blood vessel changes, and elderly age, which we define as ≥ 65 years old.
  • Methods: Retrospective chart review was performed for patients seen in the primary care clinic between January and February 2020. The study included patients ≥ 21 years old. Chart review was randomized by selecting every 3rd patient. The primary endpoint is the percent of patients at risk for AA/AD based on the aforementioned risks. Secondary endpoints include the number of risk factors per patient and the percent of patients prescribed a fluoroquinolone in the last 2 years. Descriptive statistics were utilized.
  • Results: Two-hundred fifty patients were included. The mean age was 52 years old and 54% of patients were female. The overall risk associated with FQs in an urban primary care clinic for AA/AD was 52%. The most common risk factor was hypertension, followed by elderly age, peripheral ASCVD, and history of AA/AD. A total of 45 patients (18%) had more than one risk factor for AA/AD. Of the 250 patients, 8.4% of patients had a prescription for FQ in the last two years.
  • Conclusion: In conclusion, 52% of patients were at risk of AA/AD associated with FQs in an urban primary care clinic. Providers should continue antimicrobial stewardship efforts, remain aware of safety concerns, and prescribe fluoroquinolones judiciously.

• Authors: Connie Liang; Ashley Leung; Chung-Shien Lee, PharmD, BCPS, BCOP; Jennifer Hernandez, PA-C; Dimitre Stefanov, PhD; Kit Cheng, MD; Veena John, MD
• Title: Retrospective Analysis of Adverse Events in Ovarian Cancer Patients Treated with PARP Inhibitors
• Abstract
  • Introduction/Background: Targeted therapy has become the mainstay maintenance treatment of patients with ovarian cancer including patients with BRCA1 or BRCA2 mutations. Poly ADP-ribose polymerase inhibitors (PARPi) are effective in treating patients who are in complete or partial remission. PARPi cause hematological adverse events (AEs), but have not been compared directly to each other.
  • Methods: We conducted a single institution, retrospective study on patients who were treated with PARPi from 2016 to October 2020. Patients were stratified according to which PARPi they received. Our primary objective was to assess the incidence of hematological and non-hematological AEs associated with the use of PARPi used in ovarian cancer patients. Data from absolute neutrophil, hemoglobin and platelet count during the first 2 cycles were graded for hematologic toxicity according to CTCAE v5.0.
  • Results: total of 126 patients received a PARPi during the study time frame. 34 were excluded and 92 patients were included for analysis. Median age of patients were 64.3 (range, 33.8-92.3) years, 66 (71.7%) white, and 84 (91.3%) with ECOG PS of 0/1. Thirty-one (33.7%) patients received niraparib and 61 (66.3%) patients received olaparib. The niraparib group experienced more hematologic AEs, with 11 (35.5%) (95%CI 19.2-54.6), 20 (64.5%) (95%CI 45.4-80.8), and 18 (58.1%) (95%CI 39.1-75.5) experiencing neutropenia, anemia, thrombocytopenia, respectively. Eight (13.1%) (95%CI 5.8-24.2), 24 (39.3%) (95%CI 27.1-52.7), 16 (26.2%) (95%CI 15.8-39.1) patients in the olaparib group experienced neutropenia, anemia, thrombocytopenia, respectively.
  • Conclusions: This single institution retrospective study outlines the hematological toxicities observed between two PARPi. Although there are four FDA approved PARPi, our data compared only two of the four. Niraparib tended to be associated with a higher risk for hematologic toxicities than olaparib. Anemia was the most common hematologic toxicity which was consistent with what has been widely documented in literature.

• Authors: Kathleen Hartman; Joshua Barlow; Julie Bennet, PharmD, BCIDP; Shawn Phillips, PharmD, BCPS
• Title: Evaluating the use of Dexamethasone in hospitalized COVID-19 positive patients requiring oxygen support
• Abstract
  • Introduction/Background: Recent data suggest that among patients with COVID-19 and the need for oxygen support therapy, dexamethasone 6 – 10 mg daily decreases mortality and the need for mechanical ventilation. Previous studies suggest the greatest mortality benefit was seen in patients that required invasive mechanical ventilation. This study seeks to examine the effect of dexamethasone therapy in a small acute care community hospital.
  • Objectives: The primary objective is to evaluate the effect of dexamethasone on oxygen requirements in patients with COVID-19. Secondary objectives include evaluating the impact of comorbid conditions on dexamethasone treatment and evaluate if dexamethasone decreases need for mechanical ventilation.
  • Methods: This is a retrospective review of all patients with COVID-19 who received dexamethasone 6 mg for the treatment of COVID 19 from 12/20/20 to 1/13/21. The primary outcome is patient oxygen requirement before and during dexamethasone treatment. Secondary outcomes include need for mechanical ventilation, and effects of pre-existing medical conditions. Statistical analysis was conducted using chi square and T-test as appropriate with an alpha of p < 0.05 for statistical significance.
  • Results: A total of 55 patients were analyzed, 24 patients (44%) did not require supplemental oxygen at baseline and 31 patients (56%) required supplemental oxygen at baseline. Overall, 29.1% of patients had an escalation of oxygen therapy. Among patients who required supplemental oxygen at baseline, 25% had an escalation in oxygen requirement compared to 33% among patients with no oxygen requirement at baseline (RR 0.77; 95% CI 0.34-1.76). No patients were intubated and there was no statistical difference in comorbidities between arms.
  • Conclusions: Overall, 70% of patients who received dexamethasone treatment for COVID-19 did not require escalation of oxygen therapy. Further research is required at our institution to evaluate the effect of broader dexamethasone dosing strategies for COVID-19 patients. 

• Authors: Kaitlyn Cassidy, PharmD; Bhumi Pandhi, PharmD, BCPS 
• Title: Evaluation of Kcentra® utilization in a community hospital setting
• Abstract
  • Introduction/Background: Kcentra is a prothrombin complex concentrate containing factors II, VII, IX, X, and protein C and S. Kcentra is used for the reversal of vitamin K or non-vitamin K antagonists, such as apixaban, rivaroxaban, or edoxaban in patients with acute major bleeding or need for an urgent surgery. Northwell Health System implemented an internal guideline for the safe and effective use of Kcentra.
  • Objective: The objective of this study is to evaluate the appropriateness of Kcentra utilization in a community hospital based on health-system guidelines.
  • Methods: IRB approval was not needed for this quality initiative. A retrospective chart review was conducted to evaluate the use of Kcentra between January 1 and December 31, 2020. Patients over the age of 18 who were admitted to Huntington Hospital and received Kcentra were included. Patient data collected from the electronic medical records included the date of Kcentra administration, indication, dose, concurrent anticoagulant use, administration of vitamin K with Kcentra, and the ordering discipline. A sub-analysis of the appropriateness of vitamin K usage in Huntington Hospital between June 1 and July 30, 2020 was also conducted.
  • Results: This review identified 100 patients who were administered Kcentra between January 1 and December 31, 2020. Kcentra was prescribed outside of the health-system guidelines in 22 of these instances; 9 of which were surgical patients, 6 of which were emergency department patients, 4 of which were critical care patients and 3 of which were general medicine patients. A sub-analysis of vitamin K orders between June 1 and July 30, 2020 showed 29 of 73 orders to be inappropriate as per hospital guidelines. Of these instances, 12 were ordered by surgery, 12 were ordered by hospitalists, 3 were ordered by critical care, and 2 were ordered by the emergency department.
  • Conclusion: Based on this review, the majority of inappropriate Kcentra use was found to be in surgical and emergency department patients, followed by critical care and general medicine patients. The misuse of vitamin K was also found among these ordering specialties. Educational intervention and additional prescribing guidance will be targeted for these ordering specialties through in-service presentations and patient cases.

• Authors: Rebecca Khaimova, PharmD, BCACP; Briann Fischetti, PharmD, AAHIVP, BCACP; Rebecca Cope, PharmD, BCACP; Leonard Berkowitz, MD; Anjali Bakshi, MD
• Title: Serological Response with Heplisav-B® in Prior Hepatitis B Vaccine Non-Responders Living with HIV
• Abstract
  • Introduction/Background: As people living with HIV (PLWH) are at risk for contracting Hepatitis B Virus (HBV), they should be screened for HBV and vaccinated if not immune. Seroconversion rates in PLWH receiving traditional recombinant HBV vaccines (Engerix-B® and Recombivax-HB®) have historically been low with at most 70% achieving immunity. In 2017, a recombinant, adjuvanted HBV vaccine (Heplisav-B®) was approved for use in HIV-negative patients. Although Heplisav-B® has shown superior seroprotection in this population compared to Engerix-B® and Recombivax-HB®, its efficacy in PLWH is currently unknown.
  • Objective: The objective of this study is to evaluate the rate of seroconversion following Heplisav-B® administration in PLWH with previous HBV vaccination failure.
  • Methods: Retrospective, cross-sectional study at The Brooklyn Hospital Center’s HIV primary care clinic in Brooklyn, NY. Research was reviewed and approved by the IRB. HIV-positive adults who received at least two doses of Heplisav-B® and had previously failed to seroconvert after vaccination with Engerix-B® or Recombivax-HB® were included. The primary outcome is the percentage of PLWH who became seropositive following Heplisav-B®.
  • Results: A total of 67 patients met the inclusion criteria. Twenty-five (37.3%) PLWH had failed at least 2 courses of recombinant vaccines. Fifty-eight (86.6%) PLWH became seropositive (Anti-HBs >10 mIU/mL) at least two months after completing Heplisav-B®. For the 9 (13.4%) patients that did not develop immunity, 3 (33%) had a detectable HIV RNA and 3 (33%) had a CD4 count <200 cells/mm3.
  • Conclusions: Heplisav-B® was highly effective in achieving immunity to HBV in PLWH who failed non-adjuvanted recombinant vaccines.

• Authors: Kaitlyn McCarthy, PharmD; Jacqueline Cleary, PharmD, BCACP; Terrin Pierce, PharmD Candidate; Christ Ange Katche, PharmD, MBA; Katie Cardone, PharmD, BCACP, FNKF, FASN, FCCP
• Title: Naloxone Access and Distribution in Albany County Community Pharmacies
• Abstract
  • Introduction/Background: Opioid overdose deaths continue to be on the rise in the United States. In response, states implemented laws to expand naloxone access. In Albany county, there were 49 pharmacies dispensing naloxone with standing orders as of September 2019. However, it is unclear how many of these pharmacies have naloxone in stock and available to patients when requested.
  • Objectives: To determine the availability of naloxone from community pharmacies in Albany County. To identify barriers for accessing naloxone in Albany County.
  • Methods: Pharmacies listed on New York’s Directory of Pharmacies Dispensing Naloxone with Standing Orders (last updated September 2019) located in Albany county were included (n=49). Pharmacists at each listed location were contacted via telephone to participate in 8 survey questions regarding naloxone availability, barriers to stocking naloxone, and number of naloxone prescriptions dispensed. This study was determined to be exempt by the institution’s institutional review board.
  • Results: Of the 49 pharmacies listed in the directory, 4 were permanently closed and 1 was unable to be surveyed despite multiple attempts. Of the 44 pharmacies surveyed, 1 did not regularly stock naloxone. Forty-three of 44 pharmacies that stocked naloxone carried the intranasal formulation, 1 stocked the intramuscular kit, and 1 stocked the auto-injector. Twenty-nine of 44 (66%) pharmacies reported receiving an average of 0 naloxone prescriptions per week, with the remaining pharmacies receiving 1-2. All but 2 pharmacists believed naloxone was appropriate for patients with opioid abuse disorders or on chronic opioid therapy.
  • Conclusions: Naloxone is stocked and available at 98% of pharmacies in Albany county; however, very few prescriptions are received and dispensed. Most pharmacists believe naloxone is appropriate for patients with an opioid abuse disorder or are on chronic opioid therapies. Given the infrequent dispensing of naloxone from pharmacies, future research to identify reasons for low utilization is warranted. 

• Authors: Jessica Farrell, PharmD; Mitchel Miller, PharmD; Kelsey Hennig, PharmD, BCPS; Kaitlyn McCarthy, PharmD; Christ Ange Katche, PharmD, MBA; Jacqueline Cleary, PharmD, BCACP
• Title: Pharmacist-Led Multidisciplinary Approach to Opioid Tapering in a Large Private Rheumatology Practice: Patient Outcomes
• Abstract
  • Introduction/Background: With the evolution of disease modifying anti-rheumatic drugs medications, the need for opioids in the treatment of rheumatic diseases has decreased. However, rheumatology professionals are often presented with patients in whom chronic opioid therapy was started prior to the availability of newer DMARDs and may require reductions in opioid doses.  Current guidelines suggest opioid tapering should be considered in patients with chronic noncancer pain on >90 mg morphine equivalent dose (MED) daily or in combination with other high-risk medications. 
  • Objectives: The aims of our project are to assess provider perspective and baseline knowledge on opioid taper regimens, provide education and support related to opioid management, and demonstrate improved patient outcomes when a pharmacist is part of the multidisciplinary team in a rheumatology practice.
  • Methods: The pharmacy team developed a three phased program starting in June 2019 including provider/staff education, updates to workflows, and implementation of individualized patient taper plans. Patients identified by providers are enrolled in the pharmacy service. The pharmacy team serves as a continuous resource to providers and works directly with patients enrolled in the service. Baseline characteristics, historical data on opioid related efficacy/side effects, and daily morphine equivalents are collected/tracked for each patient.
  • Results: A total of 19 patients are enrolled in the pharmacy opioid taper service. All patients are co-managed by the pharmacist and the provider.  Daily initial starting doses ranged from 200 MED to 20 MED.  A total of 5 patients (26%) have successfully tapered off opioids.  Nine patients (47%) have had reductions in opioid doses.  Five patients (26%) have remained on the same initial dose.
  • Conclusion: Successful opioid tapering is a time intensive process and requires a multidisciplinary approach.  This provides an opportunity for pharmacists to play an essential role as part of a team-based approach to ensure a successful opioid taper or discontinuation while minimizing adverse events.

• Authors:
• Title: Utilizing Levels of Entrustability for Students to Self-Assess Pharmacy Operations and Practice Skills Performance on an Institutional Introductory Pharmacy Practice Experience
• Abstract
  • Introduction/Background: Most students enter the institutional Introductory Pharmacy Practice Experience (IPPE) without prior hospital experience.  We were interested to learn how IPPE student learners on an institutional IPPE would self-assess their own baseline and subsequent gains in learning, and their perceived need for preceptor supervision, utilizing levels of entrustability.  Entrustable professional activities (EPAs) encompass core responsibilities in which trainees should attain sufficient performance competency prior to entry into professional practice. There are five levels of increasing trust in assessing the learner’s attainment of EPAs. 
  • Objective: Our aim was to evaluate the IPPE student’s self-assessment of their abilities and knowledge of institutional pharmacy practice prior to and after completion of the IPPE. 
  • Methods: A voluntary eight-question pre- and post- IPPE survey pertaining to institutional pharmacy operations and practice skills was distributed to ten institutional IPPE students at one hospital during summer 2020. Three levels of entrustability were utilized for students to self-assess abilities and knowledge about institutional pharmacy practice: level 1 (observe), level 2 (perform with direct, proactive supervision), and level 3 (perform with reactive supervision, on request and readily available).   
  • Results: Ten students (100%) completed the pre-survey with 80% completing the post-survey.  Prior to their institutional IPPE, 50% of students worked in community pharmacy, 20% in institutional pharmacy, and 30% did not work.  When comparing pre- and post- survey results, for the 14-item Pharmacy Operations question, students’ EPA level increased from 1.1 to 2.5 (p<0.003), indicating decreasing need for supervision; for the 16-item pharmacy skills, EPA level increased from 1.9 to 2.9 (p<0.001).
  • Conclusion: Based on student self-assessment, the institutional IPPE affords students ample growth toward practice competency in pharmacy operations and skills, underscoring the vital preceptor role and curricular importance of the institutional IPPE. Future aims are to fill in identified gaps in perceived learning/skills development, and to compare student and preceptor assessments.

April 26, 2021: Session 2

• Authors: Albania M. Mitchell; Victoria M. Fazio; Laurie L. Briceland, PharmD; Katrina van der Kloet, PharmD
• Title: Exploring the Impact of Educating Student Pharmacists about Social Determinants of Health and Implicit Bias
• Abstract
  • Introduction/Background: Social determinants of health (SDOH) and implicit bias influence patient care and subsequent health outcomes. This was recently exemplified by the racial inequalities and healthcare disparities noted in the Black Lives Matter movement and the COVID-19 pandemic. It is critical that healthcare providers are educated to properly address these topics. We aimed to introduce these topics to first professional year (P1) pharmacy students and assess their learning.
  • Objectives: Our purpose was to compare P1 students’ knowledge on implicit bias before and after educational intervention, and to qualitatively document student learning and specific pharmacy applications to address cultural competency/SDOH that students proffered in written papers. A secondary objective was to compare baseline knowledge on implicit bias between P1 pharmacy and M1 medical students.
  • Methods: A five-question Implicit Bias pre/post-test was developed and administered to 130 P1 students in Foundations of Pharmacy 2020 course before and after receiving online asynchronous instruction/reading, provided by student authors; results were compared. A subset of students wrote detailed Topic Exploration Papers on Cultural Competency/SDOH, citing primary literature, demonstrating learning, and suggesting applications to implement in eventual pharmacy practice. This educational research was deemed IRB exempt.
  • Results: Students demonstrated improved posttest scores on 4 of 5 Implicit Bias questions (<0.05 Wilcoxon signed rank test); there was no difference in baseline pretest scores of medical versus pharmacy students. Based on written papers on Cultural Competency/SDOH that were rubric-graded, students demonstrated knowledge on the topic and supporting literature, and provided practical application to their future practice of pharmacy.
  • Conclusions: Educational intervention significantly improved the knowledge of P1 students regarding Implicit Bias; students who further researched Cultural Competency/SDOH demonstrated knowledge and strategies to employ in practice. It is the hope that these educational activities plant the seed for lifelong learning and application of this important topic.

• Authors: Julie Mei, PharmD; Jessica Snead, PharmD, BCGP, BCPS; Alana Ciolek, PharmD, BCPS; Jason Babby, PharmD, MBA, BCPS, DPLA
• Title: Evaluation of Pharmacy Well-Being and Resilience During COVID-19 within Three Major NYC Hospitals
• Abstract
  • Introduction/Background: Burnout is defined as a severe stress condition leading to physical, emotional, and mental exhaustion. According to a 2018 ASHP survey, 53% of pharmacists reported burnout including emotional exhaustion, reduced personal accomplishment, and being unaware of resources available at work. The purpose of this study is to evaluate the effects COVID-19 pandemic had on pharmacy teams with regards to burnout.
  • Methods: An anonymous 25 question, IRB exempt, retrospective, cross-sectional quantitative survey aimed at evaluating the well-being of pharmacy teams during the COVID-19 pandemic were distributed across three hospitals in New York City, Mount Sinai Beth Israel, NewYork Presbyterian Hospital/Columbia University Irving Medical Center and Weill Cornell Medical Center. Individuals were given three weeks to complete the survey with a reminder email sent during week two.
  • Results: The questionnaire had an 18.8% response rate which included pharmacists, pharmacy clinical managers, pharmacy directors, and technicians. Results suggested that 55% of individuals felt some degree of irritability, 57% felt stressed, and 62% felt tired. Due to increased work demands, 49% did not want to go to work and 49% had trouble sleeping. Although individuals experienced symptoms of burnout, 52% had positive thoughts about work, and 65% felt appreciated at work. As many as 87% knew resources existed to address burnout, but did not use them. A majority reported ignoring their newfound stress, while others developed unhealthy habits. Many individuals expressed desires to keep a normal routine during the pandemic.
  • Conclusion: Many individuals in pharmacy teams across New York City felt symptoms of burnout during the COVID-19 pandemic. It is important to regularly gauge how individuals feel during stressful situations and how to best serve their needs. Going forward, it is imperative to not only educate pharmacy teams about the available resources, but also encourage everyone to utilize them to promote wellbeing and resilience.

• Authors: Katharine Russo, Carina Acosta, Kimberly Ng, PharmD, BCPS
• Title: Evaluating P4 Pharmacy Students’ Perceptions of Remote Advanced Pharmacy Practice Experiences (APPEs) due to the COVID-19 Pandemic
• Abstract
  • Introduction/Background: COVID-19 has greatly altered the way pharmacy education is conducted and necessitated the restructuring of experiential experiences for fourth-year PharmD (P4) students. As the pandemic continues to disrupt learning, colleges of pharmacy have adapted to offer remote and hybrid rotations. While colleges worked hard to set up rotations for students, it is important to consider the strain placed on preceptors as well as the impact on the educational experience for P4 pharmacy students. 
  • Objective: The objective is to assess P4 pharmacy students’ perceptions of remote APPEs due to the COVID-19 pandemic. 
  • Methods:  A survey was developed to quantitatively assess student satisfaction, communication, and patient and healthcare provider interactions during remote APPEs. Institutional review board approval was granted and informed consent received from each participant. From December 1-December 31, 2020, the survey was distributed to P4 students through a variety of online methods including direct emailing, the ASHP Pharmacy Student Forum, and Class of 2021 Facebook groups for each respective college. 
  • Results: 144 survey responses were collected. On average, 3 rotations were completed remotely. More than half of participants had patient interactions (56.3%) and worked directly with other healthcare professionals (57.6%). Students reported phone calls as the primary method of communication with patients (43.1%). Communication between students and preceptors was a combination of emails, text messages, and video conferencing (25.7%) on a daily basis (76.4%).  Many students enjoyed their remote APPE experience (47.9%). A majority understood the roles and responsibilities of their preceptor (64.6%), improved their critical thinking skills (63.9%), and completed rewarding assignments (53.5%). Overall students felt that they did not receive the same experience virtually (77.1%) and would prefer in-person rotations (74.3%).
  • Conclusion:  The insight gained from this survey may help clinical rotation coordinators and preceptors understand student preferences to guide future decisions on the delivery mode of APPEs.

• Authors: Rebecca Rainess, PharmD; Peter Campbell, PharmD, BCOP; Jennifer Santamala, PharmD, BCOP; Monica Mehta, PharmD, MPH, BCIDP
• Title: Outcomes Associated with De-escalation of Antibiotics in Febrile Neutropenia
• Abstract
  • Introduction/Background: Patients with hematologic malignancies frequently develop febrile neutropenia (FN) and subsequently receive long courses of broad-spectrum antibiotics. Consequences of long-term use of broad-spectrum antibiotics include antibiotic resistance and Clostridium difficile associated diarrhea. In order to prevent the extended use of these agents, some hematology-oncology teams have implemented strategies to de-escalate antibiotics, even in patients who remain neutropenic. Currently, many centers are slow to adopt de-escalation strategies in fear of treatment failure from overly narrow agents in vulnerable patients.
  • Objective(s): This study’s objective is to compare the outcome of antibiotic management approaches between patients who remained on broad spectrum anti-pseudomonal antibiotics until neutrophil recovery (conventional group) and those who were de-escalated based on positive culture results (de-escalation group). This study will provide insight into outcomes associated with each of these strategies.
  • Methods: This is a retrospective observational cohort study of adult patients with a hematologic malignancy and a diagnosis of FN receiving broad-spectrum antibiotics with a positive culture result from June 2017 to June 2020. The primary endpoint is the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic within two weeks of antibiotic de-escalation. Secondary endpoints include the incidence of Clostridium difficile associated diarrhea, incidence of cultures with multi-drug resistant pathogens, length of hospitalization, duration of broad-spectrum antibiotics, and all-cause 30-day mortality. This study has been approved by the hospital’s Institutional Review Board.
  • Results: in progress.
  • Conclusions: in progress.

• Authors: David Sabatino; Amrita Henneman, PharmD, BCOP; Samrah Ahmad, PharmD, BCPS, CACP, BCOP; Erin Jou, MD; Bradley Goldberg, MD
• Title: Evaluation of the Efficacy of Ursodiol for Prevention of Hepatotoxicity in Patients Receiving
•  Gemtuzumab Ozogamicin and Inotuzumab Ozogamicin
• Abstract
  • Introduction/Background: Oncology patients undergoing therapy with gemtuzumab ozogamicin (GO) and inotuzumab ozogamicin (InO) are at increased risk for hepatotoxicity. Ursodiol prevents hepatotoxicity in stem cell transplant patients and extrapolation to patients receiving GO and InO has been recommended, however data supporting its efficacy are lacking. The increased use of GO and InO warrants further studies optimizing risk reduction strategies to lower the incidence of hepatotoxicity.
  • Objective(s): The primary objective is to determine the incidence of hepatotoxicity in patients receiving GO and InO with or without ursodiol. The secondary objectives were to determine grade and time to hepatotoxicity, incidence of veno-occlusive disease, and dose adjustments for hepatotoxicity.
  • Methods: This is an IRB approved retrospective cohort study of adult patients at North Shore University Hospital from 2016 to 2020. Patients who received at least one dose of GO or InO were included. The primary outcome was incidence of hepatotoxicity, defined as grade ≥1 according to Common Terminology Criteria for Adverse Events. Fisher’s exact and the Mann-Whitney test were used to compare variables. A logistic regression was used to compare the proportion of hepatotoxicity adjusted for concomitant hepatotoxic medications and prior chemotherapy. P <0.05 was considered statistically significant.                                                               
  • Results: Of the 49 patients included in this study, 17 patients developed hepatotoxicity. There was a non-significant, lower incidence of hepatotoxicity in patients that received concomitant ursodiol versus patients who did not (14% versus 43%; p=0.10). Median days (17 versus 11; p=0.66) and doses (4 versus 2; p=0.28) to hepatotoxicity were higher in the ursodiol group. After adjusting for concomitant hepatotoxic medications and prior chemotherapy, ursodiol did not significantly reduce the incidence of hepatotoxicity.
  • Conclusions: The use of ursodiol prophylaxis was associated with a similar incidence of hepatotoxicity, but may delay the time to occurrence.

• Authors: Emmy Katz, PA; Jessica Farrell, PharmD; Christ Ange Katche, PharmD, MBA
• Title: Rituximab as Alternative Treatment for Cutaneous Polyarthritis Nodosa (cPAN) in Adult Patient with Liver Injury
• Abstract
  • Introduction/Background: Cutaneous polyarthritis nodosa (cPAN) is a necrotizing inflammation of medium-small arteries without glomerulonephritis and may be associated with hepatitis B. The recommended treatments are cyclophosphamide with/or high dose steroid. Alternative treatments are azathioprine (AZA), methotrexate (MTX), leflunomide, mycophenolate mofetil. Liver insufficiency constitutes a limitation to using most recommended treatment options. Here we report the use of rituximab (RTX) for the management of poorly controlled cPAN in an adult with liver injury.
  • Case: A 50-year-old woman with biopsy proven cPAN presented to the clinic with uncontrolled symptoms refractory to steroid. The patient is currently on prednisone 9 mg daily. Her past medication trials include MTX, and AZA. Both MTX and AZA were discontinued due to the insidious onset of drug induced liver injury. Tocilizumab (TOC), infliximab (INF), and RTX were viable treatment options reported in the literature. Given the hepatotoxicity risk with TOC and INF, RTX 1000 mg IV administered at week 0, 2, then every 6 months was initiated in October 2020. Patient liver enzymes returned to normal, her steroid dose was effectively reduced to 5 mg daily without any new skin lesions. During month 4 follow-up, the patient presented no overt clinical symptoms.
  • Discussion: Cutaneous PAN is a rare form of vasculitis often refractory to treatment. Although some evidence suggests high remission rate with RTX, only a few case reports for its use in cPAN are published in the literature. The duration of initial remission after RTX treatment remains unclear, it is stipulated re-treatment should be at clinical flare, repopulation or rising anti-neutrophil cytoplasmic antigen (ANCA). The patient next schedule dose is due in May 2021, therapy may be altered based on clinical symptoms and B-cell repletion.
  • Conclusion: This case provides clinical support for the potential use of rituximab in the management of cPAN in adult patients.

• Authors: Mohamad Sow, PharmD; Jennifer S. Lee, PharmD, BCPS, BCCCP
• Title: Retrospective evaluation of andexanet alfa versus four-factor prothrombin complex concentrate for factor Xa inhibitors reversal
• Abstract
  • Introduction/Background: Prior to Andexanet-alfa (AA), four factor prothrombin complex concentrate (4F-PCC) was the standard approach for reversal of factor Xa inhibitors (FXa inhibitor). With AA approval in 2018, several guidelines updated their recommendations to have AA as the first line agent for FXa inhibitor reversal. However, given its expensive cost and uncertainty of comparable benefit, many institutions have yet to introduce to the formulary or imposed strict criteria.
  • Objectives: The objective is to assess the appropriateness of AA usage and evaluate comparable efficacy and safety with 4F-PCC.
  • Methods: This was a quantitative, retrospective, multi-center study approved by institutional review board.  Patients who received either 4F-PCC or AA for reversal of FXa inhibitors for life-threatening bleeds were included. Exclusion criteria include receipt of 4F-PCC for vitamin K antagonist reversal and subtherapeutic 4F-PCC dosing. The primary endpoint was the percentage of patients achieving good hemostasis, defined by the modified International Society of Thrombosis criteria of effective hemostasis. Secondary endpoints were additional need for reversal agent or blood transfusions and in-hospital mortality. Descriptive statistics was utilized.
  • Results: 85 patients were included. 84% had intracranial hemorrhage (ICH). There was no statistically significant difference in hemostasis achievement between the AA and 4F-PCC group (38% vs. 40%, p=1); however, the additional reversal agent requirement (5% vs. 9%, p=0.68) and receipt of blood transfusion (13% vs. 21%, p=0.39) were numerically lower in the AA group. There were no significant differences in thrombotic events (0% vs. 2%, p=1) and in-hospital mortality (36% vs. 40%, p=0.82)
  • Conclusion: Utilization of AA did not correlate with greater hemostatic efficiency. In contrast to previous studies where neurologist evaluated the rating of hemostasis in ICH patients, this study was based on retrospective chart review by pharmacists, potentially skewing the interpretation of hemostasis.  Larger trials with more standardized definition of hemostasis are needed to validate these results.

• Authors: Jaclyn Connors, PharmD; Christine Ciaramella, PharmD, BCCCP; Yoonsun Mo, PharmD, BCPS, BCCCP; Ankur Mogla, MD; Nabil Mesiha, MD; John Zeibeq, MD; James Gasperino, MD, PhD, MPH, DABT
• Title: Use of non-paralytic agents to achieve optimal intubation conditions in crash airways
• Abstract
  • Introduction/Background: Crash endotracheal intubations are considered to be high risk, so paralytic agents are commonly used to increase the chance of first-pass success. The critical care team at The Brooklyn Hospital Center prefers to avoid paralytic use due to the requirement of bag-valve mask ventilation to maintain a patient’s oxygen saturation, especially in the event of a failed airway.
  • Objective: The objective of this study was to describe intubation conditions using sedative agents in the absence of paralytic agents.
  • Methods: This was a single-center, prospective, observational study approved by the institutional review board of all patients intubated at a community teaching hospital from April 1, 2018 to March 31, 2020. Patients were included if they were age 21 years or older and underwent a crash endotracheal intubation by the critical care team. Patients were excluded if they were intubated for elective reasons, intubated by the anesthesia team for surgical procedures, intubated by the emergency medicine team, or given a paralytic agent for the initial intubation attempt. The primary outcome was overall intubation conditions based on a validated scoring system which assessed jaw relaxation, vocal cord position, and response to intubation. Secondary outcomes were achievement of first pass success, types and frequency of sedative agents used, and frequency of the addition of vasopressors after intubation. Statistical analysis was descriptive using mean with standard deviation and median with interquartile range.
  • Results: A total of 199 patients were included. Overall, 86.4% of patients were determined to have an intubation grade of good or excellent upon the initial attempt. Approximately 77.9% of patients achieved first pass success. Propofol was the most common sedative agent used. Only nine patients required the addition of vasopressors after intubation.
  • Conclusions: Ideal intubation conditions may be achieved on initial attempt without the use of paralytic agents and without frequently requiring the addition of vasopressors.

• Authors: Melanie Slaby, PharmD; Christine Ciaramella, PharmD, BCCCP;, Avinash Ram, MD; Holly Thompson, MD, FACEP, FAAEM
• Title: Effect of nitroglycerin dosing strategy on resolution of respiratory distress in sympathetic crashing acute pulmonary edema
• Abstract
  • Introduction/Background: A common practice in management of patients presenting to the emergency department (ED) with sympathetic crashing acute pulmonary edema (SCAPE) is to initiate intravenous nitroglycerin (IV NTG) infusion at rates higher than the range of 5 to 20 mcg/min recommended in current guidelines. The potential benefit of afterload reduction with rates exceeding 200 mcg/min has been theorized but little evidence supports improved outcomes.
  • Objective: To discern any effect of initial rate of IV NTG continuous infusion on intubation for SCAPE.
  • Methods: This single-center retrospective study approved by the institutional review board included patients age ≥ 18 years with documented receipt of IV NTG in the ED for SCAPE between January 1, 2017 and November 30, 2020. SCAPE was defined as evidence of respiratory distress or hypoxia and pulmonary edema with initial systolic blood pressure (SBP) > 160 mmHg. Baseline characteristics were analyzed with Pearson Chi-Square and one-way ANOVA. Binomial logistic regression was performed to evaluate effect of low (1 to 199 mcg/min) versus high (≥ 200 mcg/min) initial rate of IV NTG on intubation in the ED and intensive care unit admission (ICU). Adverse events were analyzed using descriptive statistics. 
  • Results: There were no differences between low- and high-rate groups on intubation rate (11% vs 2%, OR 0.17, 95% CI 0.02 – 1.61, p = 0.123) or ICU admission (11% vs 12%, OR 1.15, 95% CI 0.3 – 4.41, p = 0.837). One episode of SBP < 90 mmHg was observed after intubation in a patient in the high-rate group who also received a bolus dose.
  • Conclusions: Initial rate of IV NTG infusion is unlikely to impact intubation or ICU admission. Safety outcomes are comparable between low- and high-rate infusions.

• Authors: Colleen Bond, PharmD, BCPS
• Title: Transition from intravenous to enteral ketamine for treatment of refractory status epilepticus
• Abstract
  • Introduction/Background: Refractory status epilepticus (RSE) is difficult to treat as patients have failed standard treatment.  Ketamine can be used to treat RSE as suggested by guidelines.  Once control is reached with a ketamine infusion there is limited data to transition to long-term treatment.
  • Case: A 23-year-old man with Rasmussen encephalitis presented in status epilepticus. Optimization of oral antiepileptic agents and infusions of midazolam and ketamine were required to halt seizures.  After stabilization the patient was transitioned to enteral ketamine in an effort to reduce stay in intensive care unit (ICU).
  • Discussion: Seven case reports were identified in the literature for use of enteral ketamine.  Enteral ketamine was initiated gradually up titrated. Infusions of ketamine and midazolam were discontinued and patient remained on oral ketamine without recurrence in epileptiform abnormalities. Our case included a more aggressive oral regimen without adverse effects observed.
  • Conclusion: This case supports the use of enteral ketamine to transition a patient off ketamine infusion for treatment of RSE. Introduction of enteral ketamine may result in reduced ICU length of stay without recurrence of seizure.

No Oral Presentation 

• Authors: Salma Aziz, PharmD, BCPS; Shujaat Bhatti, PharmD; Heide Christensen, PharmD; Anne-Marie Kesicier, PharmD
• Title: Impact of transitions of care pharmacists on readmission rates at two community hospitals
• Abstract
  • Introduction/Background: Transitions of care (TOC) is the coordination and continuity of health care during movement of patients between settings. During transitions, gaps in medication management can lead to negative outcomes and increase in readmission rates. Pharmacists play a significant role in assuring safe and effective medication practice during transitions. The current study aims to evaluate the impact of adding pharmacists to TOC teams for the management of COPD and HF patients.
  • Methods: A clinical pharmacist was incorporated on TOC teams of two sister hospitals. The responsibilities of the pharmacists included bedside visit for medication reconciliation, medical therapy evaluation, medication affordability, and counseling. The TOC pharmacists focused on acute visits for COPD and HF. Readmission rates for each hospital were analyzed.
  • Results: In the six-month study period between July and December 2019, a total of 641 patients were seen by two TOC pharmacists. A total of 2,553 interventions were documented. Medical Center A saw an overall decrease in COPD readmission rate from 18.6% to 13.1% while HF readmission rate increased from 15.8% to 16.2%. Medical Center B saw an overall decrease in COPD readmission rate from 22.3% to 14.7% while HF readmission rate increased from 21.3% to 23.8%.
  • Conclusions: Both hospitals demonstrated a reduction in COPD readmission rates while HF readmission rates fluctuated. The TOC pharmacists made numerous interventions which may have led to positive outcomes such as improved quality of care, reduced adverse drug events, and potential cost-savings to the healthcare system. This study was able to display the important role pharmacists play in TOC teams and the impact it has on readmission rates.

• Authors: Veronica Daniel, PharmD; Michael Mandarino, PharmD, BCPS; Magda Fulman, PharmD, BCPS; Daryl Schiller, PharmD, FASHP, BCPS, AQ-ID; James Kelleher, MD, MBA
• Title: Impact of the Shared Decision-Making Model on Patient Willingness and Utilization of Long-Acting Injectable Antipsychotics in a Community Hospital
• Abstract
  • Introduction/Background: The shared decision- making model (SDM) has proven to be an extremely effective method to engage patients in their treatment plans. There is limited literature assessing the role of pharmacist-led SDM in patients with schizophrenia or schizoaffective disorder. Lack of patient awareness has been documented to be a barrier in the use of LAIA. Therefore, pharmacists have the opportunity to educate patients on the benefits of LAIs while encouraging them to participate in treatment decisions. The purpose of this study is to determine if education provided by a pharmacist influences patient’s willingness to utilize LAIA medications.
  • Objective: The primary outcome is the utilization of LAIA medications in those who received pharmacist education compared to standard of care alone. Secondary outcomes include patient willingness which will be assessed by the pharmacist and by a post-randomization provider questionnaire. Patients will be included if diagnosed with schizophrenia or schizoaffective disorder, bipolar disorder, treated with oral antipsychotics with documented non-adherence, and provider approval. Patients will be excluded if prior treatment failure with LAIA, medication not covered by insurance, age less than 18 years old, court order therapy, or prior participation in study.
  • Methods: This is a randomized, single-centered study that is IRB approved. Informed consent will be obtained by all patients. Patients will be randomized 1-to-1 to receive pharmacist education based on time of informed consent. The provider will be blinded to which interventional group the patient was randomized. Education will be provided using a poster demonstration followed by shared decision making counseling techniques so that the pharmacist can properly assess willingness to initiate LAIA. Providers will complete a post-randomization questionnaire to determine if patients expressed interest regarding initiating an LAI. The incidence rate o f LAIA usage during hospitalization will be compared between the two groups.
  • Results: In Progress
  • Conclusions: In Progress

• Authors: Maura Falli, PharmD; Katherine Cabral, PharmD, BCPS, BCCP, AACC; Sunjeev Konduru, PharmD, BCPS
• Title: Assessing the Safety and Efficacy of Continuing Dofetilide at a Reduced Dose When the QTc Interval is Prolonged After the Second Dose
• Abstract:
  • Introduction/Background: Dofetilide prescribing information recommends discontinuing therapy if the QTc is greater than 500 milliseconds (ms) after the second dose. Since removal of the Risk Evaluation and Mitigation Strategy for dofetilide, prescribing patterns at our institution have deviated from standard recommendations.
  • Objectives: The study objective was to evaluate the safety and efficacy of continuing dofetilide at a reduced dose when the QTc is greater than 500 ms after the second dose.
  • Methods: This was a retrospective electronic medical records review approved by the Institutional Review Board on October 1, 2020. Patients receiving at least 3 doses of dofetilide between 01/01/2016 and 07/20/2020 were screened. Those receiving a dose reduction after the second dose were reviewed, and those whose dose was reduced due to a QTc interval over 500 ms were included. Data collected included patient demographics, heart rhythm, QTc intervals, adverse events, and discontinuation reasons. The outcomes were to assess the number of patients discharged on dofetilide, those in sinus rhythm at discharge and 3-month-follow-up, and adverse events. Descriptive statistics was utilized to analyze the findings.
  • Results: Seventy-one patients were included. The starting dose was 500 mcg in 86% (n=61) and 250 mcg in 14% (n=10) of patients. At discharge 88% (n=63) of patients continued dofetilide with 58% (n=42) in normal sinus rhythm and 11% (n=8) in atrial fibrillation. During follow-up, 79% (n=56) remained on their discharge dose, and 82% (n=46) of these patients were in normal sinus rhythm. Reasons for discontinuing dofetilide included prolonged QTc (27%, n=4), abnormal rhythm (20%, n=3), nausea/itching (7%, n=1), patient’s request (7%, n=1), and not documented (40%, n=6). No cases of torsades de pointes were observed.
  • Conclusion: The results suggest that reducing the dose when the QTc interval is greater than 500 ms after the second administration may be a safe and effective strategy.

• Authors: Justin Im, PharmD; Lance Cho, PharmD; Carl Zipperlen, BS Pharm, BCGP; Gregory E. Gilbert, EdD, MSPH, Pstat; Daniel Kurbanov, MD
• Title: Impact of Phenobarbital on benzodiazepine utilization in patients with Alcohol Withdrawal Syndrome
• Abstract:
  • Introduction/Background: Patients suffering from alcohol withdrawal syndrome admitted into intensive care units (ICU) are often treated with high-dose continuous infusion benzodiazepines, which have been associated with agitation, respiratory depression, increased length of stay (LOS), and delirium. Literature suggests that phenobarbital may be a promising alternative therapeutic option due to its ability to directly potentiating gamma-Aminobutyric acid receptors and antagonize excitatory neurotransmitters. The primary objective of this study is to assess the impact of phenobarbital use on benzodiazepine utilization in patients with alcohol withdrawal syndrome (AWS).
  • Methods: This is a single-center retrospective cohort study at a 22-bed ICU which does not utilize a phenobarbital protocol, comparing outcomes in patients with AWS who were treated with strictly benzodiazepines versus patients who used phenobarbital as an adjunct. The primary outcome of this study is the total amount of benzodiazepines administered. Secondary endpoints included ICU LOS, delirium, incidence of antipsychotic medication and dexmedetomidine use, and death.
  • Results: 71 patients were included in the final analyses of this study. 79% of the patients were treated with benzodiazepines only, and 21% were treated with phenobarbital adjunct. Patients received higher amounts of benzodiazepines when treated with phenobarbital versus benzodiazepine monotherapy (646mg vs. 395mg)and had a longer median ICU LOS (181 hours vs. 93.3 hours). In a subgroup analysis, the patient who received phenobarbital within 24 hours of presentation (n=1) displayed the shortest length of stay (13.2 hours) and least benzodiazepine utilization (33.8mg). There was no difference in mortality. However, higher rates of antipsychotic and dexmedetomidine use, and delirium were observed when phenobarbital was used adjunct.
  • Conclusions: This study shows that utilizing phenobarbital without a protocol does not lead to less benzodiazepine usage or a shorter ICU LOS. However, the subgroup analysis suggests phenobarbital utilization earlier in therapy may lead to better shorter ICU LOS and overall less utilization of benzodiazepines.

• Authors: Christ Ange Katche, PharmD, MBA; Jessica Farrell, PharmD; Katie Cardone, PharmD, BCACP, FNKF, FASN, FCCP
• Title: NSAIDs Safety Awareness Among Patients Receiving Care at Community Rheumatology Care Practice
• Abstract:
  • Introduction/Background: Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are the cornerstone of pain management in patients with rheumatic diseases such as rheumatoid arthritis, osteoarthritis, and gout. The mechanism of action of NSAIDs lend them a unique side effect profile that is not always known by patients. Chronic or inappropriate NSAIDs use can lead to an increased risk of serious adverse events such as gastrointestinal bleed, acute renal injury, worsening of cardiovascular disease and renal disease. Pai et al proposed new modes of education to empower providers and patients with skills to evaluate kidney risk of NSAIDs. They suggest the analyses of large data sets to evaluate risk and develop targeted strategies to reduce preventable harm from NSAIDs. Here, we conduct a survey to assess the awareness regarding key adverse events of NSAIDs in the adult patients currently receiving care at a local rheumatology clinic. 
  • Objective: To determine NSAIDs risk profile awareness among patients receiving care at a local rheumatology clinic. Patients were excluded if they did not have any active email address on file.    
  • Methods: A self-administered survey instrument was developed and tested in a small sample of 25 volunteers. The questionnaire will be sent electronically to approximately 1,500 adult patients receiving care at the clinic. 
  • Results: Results are pending. Data collected will be analyzed using Redcap and Microsoft Excel. Finding will be presented using descriptive statistics. Participants will be grouped by age, comorbidity, and risk category for comparative analysis.
  • Conclusions: We foresee the identification of patterns and area in need for intervention to further enhance patient safety to be societal benefit of this research project. The findings will contribute to the body of literature on NSAIDs safety, continue to enhance our understanding of patients/consumers practice to further ensure patients safety.

• Authors: Wesley D. Kufel, PharmD, BCIDP, BCPS, AAHIVP; Stephanie Schwartz; Yvonne Xu; Ashley Oshiro; Tristan Guillen, Robert W. Seabury, PharmD, BCPS, DABAT
• Title: Evaluation of Daptomycin Dosing in Obese Patients at an Academic Medical Center
• Abstract:
  • Introduction/Background: Daptomycin is typically dosed using total body weight. However, dosing practices in obese patients are less clear and alternative dosing weights may be used. Furthermore, doses may be rounded to the nearest vial size to minimize potential drug waste.
  • Objectives: The primary outcome was to assess if rounding to the nearest daptomycin vial size impacted clinical failure among obese patients. Secondary outcomes included daptomycin dosing characterization, clinical or microbiological cure, and 90-day all-cause mortality.
  • Methods: This was a single center, retrospective cohort study of hospitalized obese patients treated with daptomycin between September 1, 2013 and September 1, 2020. Patients were included if they were >18 years of age, had a BMI >30 kg/m2, and received daptomycin for >48 hours. Patients were excluded if they received renal replacement therapy, had rhabdomyolysis on admission, were pregnant, and/or had pathogens identified as daptomycin non-susceptible. Descriptive statistics were used for demographic and clinical data. Comparisons of categorical data were performed using chi-squared or Fisher exact test, as appropriate. Comparisons of continuous data were performed using Student t-test or Mann-Whitney U test, as appropriate.  This study was deemed exempt by our institutional review board.
  • Results: After inclusion and exclusion criteria were applied, 228 patient encounters were evaluated. The mean weight and BMI were 111.3 kg and 39.1 kg/m2, respectively. Total and adjusted body weights were used for dosing in 95.6% and 4.4% of patients, respectively. Clinical failure, microbiological failure, and 90-day all-cause mortality occurred in 7.9%, 0.9%, and 14.9% of patients, respectively. Clinical failure was higher among those who had their dose rounded down to the nearest vial size (17.6% versus 6.1%, p=0.034).
  • Conclusions: Total body weight was still the most common dosing weight used for daptomycin in obese patients. Rounding daptomycin doses down to the nearest vial size increased the risk of clinical failure among hospitalized obese patients.

• Authors: Yuman (Yumi) Lee, PharmD, BCIDP, AAHIVP; Nicole Bradley, PharmD, BCPS, BCIDP; Saralinh Trinh, PharmD
• Title: Antimicrobial Stewardship Practices in Community Pharmacies Across the United States
• Abstract:
  • Introduction/Background: Antimicrobial stewardship (AMS) in the community is essential as majority of antibiotic prescribing occurs in the community. Pharmacists are recognized by CDC as co-leaders for optimizing antimicrobial use.
  • Objective: The purpose of this study is to evaluate current AMS practices in community pharmacies across the United States and identify challenges.
  • Methods: A 15-item survey was created based on CDC’s Core Elements of Outpatient AMS. Baseline demographics, current policies and practices, and pharmacists’ perceptions were collected. A survey invitation was posted on the Facebook group, Pharmacist Moms, in September 2019. Participation was voluntarily and anonymous. IRB approval was obtained from St. John’s University.
  • Results: Participants included 61 community pharmacists from 25 states. 88.5% work in a chain pharmacy with 54.1% in staff positions and 37.7% in management. 37.7% have been practicing for >10 years, 36.1% for 6-10 years and 26.2% 5 or less years. Minimal responses met CDC’s Core Elements: commitment (27.9%), action (24.6%), tracking and reporting (14.8%), and education and expertise (23% for pharmacists, 9.8% for patients). In regards to perception, 67.9% felt AMS is important in the community. 88.5% would participate in AMS if the opportunity were provided. 91.8% were unsure or had no plans to implement AMS within the next 2 years. Challenges reported include the lack of time/staff (83.6%), pushback from prescribers (68.9%), lack of leadership (57.4%), lack of financial incentives (52.5%), pushback from patients (52.5%), lack of pharmacist knowledge/training (39.3%), lack of funding/financial support (29.5%), lack of legal requirement (21.3%), lack of information technology support (21.3%), and lack of pharmacist interest (11.5%).
  • Conclusions: There is a lack of AMS practices in community pharmacies. Many challenges exist in the community inhibiting the full potential of pharmacists in AMS efforts. This study highlights the importance and need for addressing these issues as regulations and strategies for AMS in community settings develop.

• Authors: Tenzin Legdup, PharmD; Rachel Reed, PharmD, BCPS; Brent Carlson PharmD, BCPS, BCCCP, BCIDP
• Title: Evaluation of Corticosteroid Prescribing for Immune-mediated Adverse Effects Associated with Pembrolizumab and Nivolumab in an Outpatient Oncology Clinic Setting
• Abstract:
  • Introduction/Background: Immune-checkpoint inhibitors have been one of the main components of cancer treatments in oncology but due to their enhanced T-cell activity, they can lead to immune-mediated adverse effects. Corticosteroids are first line options for managing immune-mediated adverse effects. However, inconsistency in corticosteroid prescribing such as dose and duration would potentially delay cancer treatment due to ineffective management of immune-mediated adverse effects, and also decrease the efficacy of immunotherapy-checkpoint inhibitors.
  • Objective: The primary objective is to evaluate corticosteroid use for immune-mediated adverse effects resulting from programmed cell death protein 1 (PD-1) inhibitors, pembrolizumab and nivolumab, including type of corticosteroid prescribed, initial dose, and total duration in reference to the National Comprehensive Cancer Network’s guidelines on managing immunotherapy-related toxicities.
  • Methods: A retrospective single-center cohort analysis was conducted to review patient electronic medical records via MEDENT^TM. Data was collected from a printed report of 228 patients who were administered pembrolizumab or nivolumab from August 2018 to August 2020. Each patient was evaluated on the type of immunotherapy received, steroid type given including initial dose and duration. The type of immune-mediated adverse effect and grade of severity were also evaluated. All clinical research was approved by the institutional review board.
  • Results: 37 patients met the inclusion criteria. Rash was the most common adverse effect at 40.5% followed by pneumonitis (10.8%), increased transaminitis (10.8%), colitis (10.8%), inflammatory arthritis (10.8%), pruritis (5.4%), myalgia (5.4%), and adrenal insufficiency (5.4%). Only 27% of patients met NCCN-guideline based initial steroid dose based on severity. The mean duration of steroid use was 46 days (range: 6-450 days). Seventy-six percent of patients restarted immunotherapy.
  • Conclusion: Initial steroid prescribing for immune-related adverse effect at UHS Medical Oncology is highly variable with the majority of patients not receiving guideline-recommended steroid dose. A steroid dosing protocol for immune-mediated adverse effect would streamline dosing consistent with NCCN guideline recommendations.

• Authors: Talisa M. Marchese; Andrea Jaenecke; Nicole E. Cieri-Hutcherson; Darowan S. Akajagbor; Timothy C. Hutcherson
• Title: Assessment of engagement by pharmacy residents and student pharmacists in a virtual layered-learning environment: pilot in a two-hour synchronous virtual teaching and learning certificate session
• Abstract:
  • Introduction/Background: Many local PGY-1 residents complete a teaching and learning certificate program. One class session addresses technology for experiential and didactic education, reviewing services such as applications, programs, and software that promote efficiency, organization, and drug information. The most recent session was offered in a synchronous online fashion.
  • Objectives: The objective of this study was to describe the transition of a teaching and learning certificate class session from in-person delivery to synchronous online delivery, as well as characterize overall participant engagement using layered learning with faculty, PGY1 residents, and doctor of pharmacy students.
  • Methods: This study was approved by the program IRB. Participant data was collected using a voluntary pre-session questionnaire. A two-hour virtual class session was conducted and recorded via Zoom, from which participant interaction data was extracted in 15-second increments and stratified into five domains: Discussion, Service, Adoption, Questions, and Chat.
  • Results: The session included 25 student, resident, or faculty participants. A total of 12 of 23 (52.2%) student or resident participants spoke during the class session; conversely, they interacted to a greater degree via chat (100%, mean = 2.96 entries per participant, standard deviation = 3.47). There was a positive correlation (<0.0001) between the number of chat entries by all participants and the number of chat entries that conveyed a positive indicator of service adoption. There was also a strong positive correlation (p = 0.0182) between faculty and student participants where student chat activity increased when faculty speaking time increased. Additionally, there was a strong positive correlation (p = 0.0251) observed for resident participants where resident chat activity increased when resident speaking time increased.  
  • Conclusions: The utilization of a chat feature during online presentations and virtual class sessions may increase student and resident participant engagement. Further research is warranted as to whether these relationships hold during in-person sessions.

• Authors: Christin Picinic, B.A., PharmD; Nirvana Awad, PharmD, BCPS; Nicholas Quinn, PharmD, BCCP; Keith Veltri, BPharm, PharmD; Daniel Appiah, PharmD; Pavel Goriacko, PharmD, BCPS, MPH; Emily Messing, PharmD, BCPS; Ngan Nguyen
• Title: Safety and efficacy analysis of anticoagulation modalities in COVID-19 patients in the ICU
• Abstract:
  • Introduction/Background: COVID-19 is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and can lead to systemic coagulation activation. Coagulation seems to be associated with admission to the intensive care unit and death.  Studies have shown that anticoagulation prophylaxis dosing in COVID-19 patients seems to predispose patients to severe clotting, and treatment dosing seems to predispose patients to bleeding. The correct dosing in anticoagulation medications seems to be absent. NIH COVID-19 treatment guidelines recommend the use of therapeutic anticoagulation to manage patients with known or suspected thromboembolic events. There is limited data available regarding appropriate dose of anticoagulation to treat COVID-19 patients.
  • Objective: The primary outcome is to determine the difference in hospital mortality among the various anticoagulation strategies (prophylactic vs therapeutic doses of UFH, LMWH, or DOAC) from the index date till event occurrence or discharge in critical care COVID-19 patients. The secondary objective is to determine the incidence of venous thromboembolism among the anticoagulant strategies during the study period as well as to determine the incidence of major bleeding among the various anticoagulation strategies. Patients will be included in the ICU cohort if COVID + within 72 hours of ICU admission, 18 years +, transferred from medical floor to ICU within 72 hours, initiated on one anticoagulation therapy for >72 hours within 48 hours of ICU admission, intubated within 24- hour of presentation to the ICU. Excluded patients are DNR/DNI status within 48 hours of admission, as well as palliative care patients.
  • Methods: This is observational, retrospective, multi-centered study, which includes study sites of Montefiore Medical Center - Moses campus (MMC) and Montefiore Nyack, both under the umbrella of Montefiore Health System. Retrospective medical chart reviews and data collection will be done in the ICU (Montefiore Nyack) and medical floors (MMC).
  • Results/ Conclusion: Pending

• Authors: Yuliya Rakouskaya, PharmD; Leora Blander, PharmD; Magda Fulman, PharmD, BCPS
• Title: Comparison of the Coagulation Factor Xa (recombinant) Inactivated-zhzo versus Four-Factor Prothrombin Complex Concentrate (4F-PCC) for the Reversal of Factor Xa Inhibitor-Induced Acute Bleeding: An Observational, Multi-Centered Retrospective Study
• Abstract:
  • Introduction/Background: The number of patients who receive factor Xa inhibitors is growing, therefore the need for an antidote for major bleeds has increased over the years. Currently available data on the effectiveness and safety of four-factor prothrombin complex concentrate (4F-PCC) and coagulation factor Xa inactivated-zhzo (Andexxa) for reversal of direct oral anticoagulant (DOAC) induced major bleeding, have not evaluated mortality as a primary outcome. In addition, previous major studies were single-group cohort studies with no control group, which have provided no input on the comparative mortality of these agents.
  • Methods: In order to evaluate and compare the effects of both reversal agents on mortality, an observational, multicentered, retrospective study will be completed. Mortality will be the primary outcome comparing four-factor prothrombin complex concentrate (4F-PCC) to coagulation Factor Xa inactivated-zhzo (Andexxa). Data collected will be from August 1st, 2018 to 31st, 2020 using electronic health records. The search will be performed to identify patients who received either four-factor prothrombin complex concentrate (4F-PCC) or coagulation Factor Xa inactivated-zhzo. Inclusion criteria will include: 18 y/o or older, chronic use of direct factor Xa inhibitor presenting with major bleed, last dose of direct factor Xa inhibitor (DOAC) was administered within 24 hr of a reversal agent. Exclusion criteria will include: pregnancy, hx of the acute coronary syndrome within 30 days, INR &gt;2, a reversal of DOAC prior to surgery, and reversal of vitamin K inhibitors.
  • Results: In progress Conclusion: We expect to contribute data on the mortality of coagulation factor Xa (recombinant), inactivated-zhzo, and 4-Factor prothrombin complex concentrate to compare the safety and efficacy of these antidotes. We anticipate for our findings to be utilized as guidance for patient outcome-based care and be utilized for formulary decision making.

• Authors: Ravena Rampersaud, PharmD; Carl Zipperlen, BS Pharm, BCGP; Jomi Oommen, PharmD, BCIDP; Gregory E. Gilbert, EdD, MSPH, Pstat
• Title: Impact of high-dose versus low-dose enoxaparin for thromboembolic prophylaxis in COVID-19 patients
• Abstract:
  • Introduction/Background: The novel Coronavirus 2019 is a viral infection that has shown to be associated with a hypercoagulable state. Due to the novelty and unpredictability of Sars-Cov-2, there is not much high-quality evidence to guide the decision-making process with regards to anticoagulation. The aim of this study is to identify the clinical impact of administering high-dose versus low-dose enoxaparin Sars-Cov-2 patients at a hypercoagulable state.
  • Objective: To determine the clinical impact of administering high-dose (therapeutic) enoxaparin compared to low-dose enoxaparin in patients in a hypercoagulable state due to Sars-Cov-2 infection
  • Methods: The methods include a retrospective cohort study of patients with laboratory confirmed cases of Sars-Cov-2 initiated on anticoagulant therapy with enoxaparin from March 2020 to July 2020. The clinical outcomes including mortality, bleeding events and thrombosis were evaluated throughout the study.
  • Results and Conclusion: Our study evaluated clinical outcomes including mortality, bleeding and clotting. The mortality rate in the low-dose group was 17% versus 34% in the high-dose group (p=0.033). There were no bleeding events documented in the low-dose group, while there were five events (7%) of bleeding in the high-dose group (p= 0.058). Of the five bleeding events in the high-dose group, three were gastrointestinal bleeds (4%) and two (3%) were brain bleeds. Clotting was slightly more common in the low-dose group, however, the rates were similar (p=1.00). There were two clotting events in the low-dose group (3%) and one in the high-dose group (1%). All clotting events were deep vein thrombi.
  • The data gathered can serve as a foundation for clinical guidance and future studies that explore appropriate anticoagulation doses for the Sars-Cov-2 population. Future prospective studies will provide a better analysis of the impact of anticoagulation intensity on clinical outcomes like preventing clots versus increased bleeding risk, as well as a clearer picture of mortality outcomes.

• Authors: Alexandra Simms, PharmD, MS; Jennifer Fiebert, PharmD, BCPS, BC-ADM, BCGP 
• Title:  Assessment of medication related risk factors associated with fall occurrences in a community hospital
• Abstract:
  • Introduction/Background: Falls occurring among adults age 65 and older continue to be a cause for concern in the inpatient setting. Fall occurrences often result in patient harm and are associated with increased length of stay, reduced quality of life and increased costs to both patients and hospitals. Research shows that up to one third of hospital falls can be prevented.  Medications have been identified as an independent risk factor for falls as the use of potentially inappropriate medications in the elderly population can negatively impact patient safety. The purpose of this initiative is to identify and characterize high risk medication use in patients who experienced a fall while hospitalized. 
  • Methods: A retrospective drug utilization evaluation will be conducted to assess all falls that have occurred at Huntington Hospital from January 1st 2020 through December 31st 2020. Inclusion criteria are patients 65 years and older who were admitted to the hospital and experienced a reported fall. Information including demographics (age, sex, weight), date and time of fall, unit fall occurred on, admitting diagnosis, level of injury, medications taken within 24 hours of fall and pertinent laboratory results will be collected from the electronic medical record and fall events report for 2020 and analyzed. 
  • Results: Pending