2025 Poster Session Abstracts

April 5, 2025

A RETROSPECTIVE COHORT STUDY ON TIME AT TARGET SEDATION IN MECHANICALLY VENTILATED PATIENTS WITH MALIGNANCIES

Aisha Siddique, Christina Candeloro, Ananda Dharshan, Han Yu, Fang Mengyu, Brian Ho, Amy Thoby, Aubrey Defayette
Anderson Cancer Center, Roswell Park Comprehensive Cancer Center

  • BACKGROUND: There is limited literature exploring the efficacy and safety of dexmedetomidine and propofol in the critically ill mechanically ventilated oncology population. Patients with an underlying malignancy may benefit from the analgesic properties of dexmedetomidine, optimizing analgesia and sedation.
  • OBJECTIVE: Does dexmedetomidine (D group) for mechanically ventilated (≥ 24 hours) adult patients with malignancies improve time at target sedation (TTS) when compared to propofol (P group) or the combination of propofol and dexmedetomidine (P&D group)?
  • METHODS: This was a retrospective, single center, cohort study. The primary outcome was the percentage of time RASS score was within goal (TTS).  Continuous outcomes were examined using Kruskal-Wallis and Wilcoxon rank-sum tests. Fisher's exact test and logistic regression were used to compare categorical outcome. A post-hoc secondary analysis of two groups was conducted by reassigning the P&D patients to either the P or D group based on longer infusion time.
  • RESULTS: A total of 113 patients were included (P group: n=94, D group: n=12, P&D group: n=7). The median TTS was 29.7% in the P group, 24.2% in the D group, and 32.3% in the P&D group (p=0.7492). More patients in the P&D group (71.5%) and the P group (55.3%) required the use of as needed propofol, compared to the D group (16.7%). The MDD of as needed fentanyl was significantly higher in the P&D group (125mcg/day, IQR 92.5-165) compared to the P (75mcg/day, IQR 50-100) and D group (50mcg/day, IQR 50-61.9) (p=0.0136). There was no statistically significant difference in all other secondary outcomes. The secondary analysis (P group: n=99; D group: n=14) found more hypotension (92.9% vs 63.6%; p =0.0334) and vasopressor use (100% vs 73.7%; p =0.0372) in the D group.
  • CONCLUSION: Dexmedetomidine for mechanically ventilated patients with malignancies did not result in a difference in TTS compared to propofol or the combination.

EVALUATION OF THE INCIDENCE AND MANAGEMENT OF IFOSFAMIDE INDUCED NEUROTOXICITY

Aubrey Defayette, Catherine Forbes, Ilana Cypes, Morgan Marriott
Roswell Park Comprehensive Cancer Center

  • BACKGROUND: Neurotoxicity is a recognized adverse effect related to ifosfamide therapy; however, the overall incidence varies greatly in the literature. The mechanism behind this toxicity is not well understood making it difficult to identify which patients may be at high risk. Potential risk factors for developing neurotoxicity can include Eastern Cooperative Oncology Group (ECOG) performance status of greater than or equal to 2, renal dysfunction, and hypoalbuminemia. Symptoms can range from mild confusion to seizure and unresponsiveness, and there is no well-defined standard of care for managing these toxicities. Despite ifosfamide's place in therapy for numerous malignancies, there remains a paucity of data regarding ifosfamide induced neurotoxicity.     
  • OBJECTIVE: The objective of this study is to report the incidence of ifosfamide induced neurotoxicity in patients with lymphoma and identify patient specific factors that may be associated with an increased risk. Time to onset of symptoms and pharmacologic management strategies will also be evaluated.
  • METHODS: This is a retrospective cohort study of adult patients treated at an NCI designated cancer center from January of 2023 to May of 2024. All patients were treated with ifosfamide in combination with carboplatin and etoposide (ICE) on an inpatient lymphoma service. Relevant patient demographics, past medical history, laboratory values, and medication information will be collected. In patients experiencing neurotoxicity, signs and symptoms, as well as duration and details of treatment approach will be assessed. The primary outcome is the overall incidence of neurotoxicity. Descriptive statistics will be used to describe the patient population and report on the endpoint of interest. An internal committee has approved this medication use protocol.
  • RESULTS: In progress
  • CONCLUSION: In progress

ANESTHESIA CONTROLLED SUBSTANCE WASTE COLLECTION AND TESTING INITIATIVE

Christopher Abi-Assaf, Karen Erickson
NewYork-Presbyterian Columbia University Irving Medical Center

Diversion risks in perioperative areas are heightened by complex workflows and high controlled substance (CS) volumes. The anesthesia-controlled substance waste testing initiative systematically collects and tests CS waste from all perioperative cases to minimize diversion risks. It integrates automated dispensing systems, random waste sampling, and real-time documentation to ensure compliance with DEA and ASHP guidelines. Implemented at a 738-bed academic medical center, the program serves all anesthesia-related surgical and procedural cases. The program was developed through interdisciplinary collaboration (pharmacy, anesthesia, nursing), and utilizes automated dispensing cabinet technology, UV Spectrometers and diversion monitoring software. Pharmacists lead surveillance, waste reconciliation, and staff training, while pharmacy technicians facilitate the collection of the anesthesia waste.The indicative's effectiveness is measured through 100% CS waste collection for testing in perioperative areas, a reduction in discrepancies between dispensed and administered CS doses, volume of random CS tests completed, pass rates for randomized CS waste testing, as well as the classification of the testing failures themselves. This program is tailored for high-volume perioperative settings but scalable to outpatient clinics and procedural suites that utilizes existing anesthesia workstations (AWS) with attached external return bins (ERBs) and portable UV spectrometers to analyze and verify CS waste. The CS waste collection is conducted daily and concurrently during the overnight AWS restocking times but can be modified for other areas handling CS depending on operating room availability. Training modules and workflow optimizations ensure consistent implementation for all pharmacy staff.This initiative positions pharmacists at the forefront of patient safety and regulatory compliance. By implementing a systematic approach to CS management, it significantly reduces the risk of drug diversion and improves overall medication safety. The program's focus on education, policy revision, and technological solutions represents a novel, comprehensive approach to a persistent challenge in healthcare settings.

IMPACT OF A STATE-WIDE EDUCATION SERIES ON PHARMACIST KNOWLEDGE OF LGBTQIA+ HEALTH

Rebecca Chu, Doreen Chiu, Veronica Zafonte, Anthony Gerber
North Shore University Hospital, Montefiore Heath System, NYU Langone Hospital - Long Island, New York City Health + Hospital/Bellevue

  • BACKGROUND: Despite increased awareness around health issues like HIV, STIs, and safer sex practices, LGBTQIA+ individuals continue to face significant barriers to culturally competent care, with 41.6% fearing discrimination by healthcare providers. Pharmacists are well-positioned to address these gaps through personalized counseling and medication management. However, studies show that most pharmacy curricula inadequately prepare students to meet these needs.
  • OBJECTIVE: This study aimed to design and implement a state-wide education series for pharmacy students, residents, technicians, and pharmacists to enhance their knowledge of LGBTQIA+ healthcare needs and assess changes in knowledge and perception after the activity.
  • METHODS: Four local chapters of the New York State Council of Health-System Pharmacists are offered a series of LGBTQIA+ healthcare education programs from August 2023 to June 2024 through virtual, in-person, and hybrid events. Attendees are asked to complete a pre-event survey to assess their knowledge and perceptions before the programs, with demographic data also collected. Statistical analysis will be conducted to evaluate changes in scores before and after attending the programs. The study has received IRB approval.
  • RESULTS: A total of 268 individuals attended the lecture series, with 56 and 44 participants completing pre- and post-series surveys, respectively. Respondents were predominantly pharmacists, the majority identifying as female and straight. Post-series surveys showed significant improvements in perceptions of pharmacists' roles in LGBTQIA+ health, particularly in preparedness to address LGBTQIA+ issues (p< 0.001), advocate for patients (p< 0.001), and pursue further education (p = 0.007). Comfort in caring for LGBTQIA+ individuals increased (p = 0.002), along with reduced endorsement of stigmatizing views about transgender care (p< 0.001). No significant changes were noted regarding workplace challenges faced by LGBTQIA+ individuals.
  • CONCLUSION: The educational series improved pharmacists' knowledge, perceptions, and comfort in LGBTQIA+ care, emphasizing the importance of integrating such training into pharmacy education to reduce health disparities.

EVALUATION OF EMPIRICALLY DOSED PARENTERAL VANCOMYCIN USING WEIGHT-BASED VERSUS BAYESIAN-BASED MODELING

Sheren Deyab
Deyab S*, Mei J, Pereira L, Faour R, Budovich, A 
One Brooklyn Health - Brookdale

  • INTRODUCTION: Vancomycin, a glycopeptide antibiotic, is effective against infections caused by Staphylococcus aureus (including MRSA), streptococci, and enterococci. ASHP/IDSA/SIDP guidelines recommend an empiric dose of 15-20 mg/kg based on actual body weight, administered every 8-12 hours, with a target AUC of 400-600 mg*h/L for most adults. Pharmacokinetic monitoring software can provide empiric dosing recommendations based on population kinetics based on similar patient characteristics.
  • OBJECTIVE: Given the lack of data comparing empiric dose recommendations of vancomycin Bayesian modeling and a weight-based approach, our study aims to directly evaluate the relationship between these two regimens.
  •  METHODS: This IRB-approved retrospective cohort study at One Brooklyn Health - Brookdale included non-critically ill adult patients treated with vancomycin (15-20 mg/kg) between January 1 and December 31, 2023. Patients with acute kidney injury, on hemodialysis, or with a BMI > 30 kg/m2 were excluded. The primary outcome of the study was the difference in number of patients achieving therapeutic AUC using empiric weight-based versus Bayesian modeling.  Secondary outcomes included the correlation between weight and AUC and the difference in number of patients with subtherapeutic AUC (< 400 mg*hour/mL) or supratherapeutic AUC (> 600 mg*hour/mL) between the two groups. The safety outcome is the difference in number of patients with an AUC ≥ 650 mg*hour/mL between both groups.
  •  RESULTS: Therapeutic AUC was achieved in 53% of patients using Bayesian modeling compared to 55% with weight-based dosing (p > 0.05). The weight-based group had higher rates of subtherapeutic AUC (19% vs. 12%) and lower rates of supratherapeutic AUC (35% vs. 26%). A trend toward increased AKI risk was noted in the Bayesian group (26% vs. 21%).
  • CONCLUSIONS: Rodvold’s model for Bayesian dosing demonstrated comparable AUC outcomes to weight-based dosing. Bayesian-based software may be a viable option for empiric vancomycin dosing when creatinine clearance is capped.

EVALUATING EARLY INTERVENTION STRATEGIES TO DECREASE TIME TO FIRST ANALGESIC IN SICKLE CELL VASO-OCCLUSIVE EPISODES

Samuel Gerardi, Ashley Woodruff, Stephanie Seyse, Jennifer Abeles, and Nicole Cieri-Hutcherson
Buffalo General Medical Center and University at Buffalo

  • BACKGROUND: Sickle cell disease (SCD) is a recessively inherited hemoglobin disorder that results in sickled hemoglobin leading to blockages in blood vessels, pain, and organ damage. Vaso-occlusive episodes (VOEs) are microvascular blockages that can result in severe pain and hospitalizations. Despite guidelines recommending analgesia within 60 minutes of triage, patients with SCD often experience delays in treatment. Literature supports the use of care paths and order sets to decrease admission rates and lengths of stay.
  • OBJECTIVE: To assess if education and increased availability of point-of-care tools reduce the time to first analgesic for patients with SCD admitted to the emergency department (ED). The primary outcome will be time to first analgesic in the ED. Secondary outcomes will include length of stay (ED and inpatient), order set and care path utilization, time to max dose of analgesic, admission rate, and association of lab values with VOE.
  • METHODS: In January 2025, a pharmacist provided education through in-service presentations and dissemination of handouts to ED and medicine staff. Educational material was developed by pharmacists and sickle cell specialized physicians. Interventions for the ED included a novel workflow for triaging patients with SCD, emphasizing timely analgesia, use of order sets, point-of-care tools, and navigation to care paths. Medicine teams received workflows for opioid weaning, appropriate use of care paths, and order sets. A list of patients admitted to BGMC with a VOE diagnosis will be generated from 1/26/25-5/1/25 to perform a retrospective chart review. Patients will be included if they are > 18 years old and have an established HbSS diagnosis (ICD-10-CM D57.0). Patients will be excluded if they are diagnosed with non-SS type SCD or successful hematopoietic stem cell transplant. Descriptive statistics will be used to summarize demographic and clinical characteristics. Categorical variables will be described using frequencies and analyzed using chi-squared test and Fisher's Exact.

EVALUATION OF OPIOID REVERSAL WITH NALOXONE IN AN INPATIENT SETTING: A MULTI-CENTER MEDICATION USE EVALUATION

Nicholas Hwee, Alla Khaytin, and Matthew Piccolino 
Mount Sinai Brooklyn

  • BACKGROUND: Opioid use is prevalent in hospitals, due to the need for potent analgesics in managing acute pain from trauma, surgical procedures, malignancy, and sickle cell disease. Given the ongoing opioid crisis, it remains critical to evaluate and optimize oral opioid and intravenous (IV) prescribing practices to effectively manage pain while minimizing the risks associated with opioid use.
  • OBJECTIVE(S): Evaluate inpatient opioid reversal with naloxone at Mount Sinai Health System and identify preventable naloxone administrations. The primary endpoint is to evaluate the proportion of preventable naloxone IV administrations in response to inpatient opioid therapy. The secondary endpoints were the proportion of PRN opioid orders with documented pain scales appropriate for patient order parameters, proportion of opioid orders dosed inappropriately based on patient’s organ failure status, common inpatient opioids, and respiratory depressants coadministered with inpatient opioids in preventable overdoses.
  • METHODS: A multi-center, retrospective chart review of all patients greater than 18 years old admitted to one of the MSHS hospitals, who have received at least one dose of injectable naloxone for inpatient opioid reversal between January 2024 and June 2024. Patients will be identified based on naloxone administration reports from each hospital utilizing electronic medical record system. This study will use descriptive statistics such as ratios and proportions for analysis of primary and secondary endpoints.
  • RESULTS: Of the 100 patients included, 47 were deemed to have preventable naloxone IV administrations. 45/90 PRN opioids orders have documented pain scales appropriate for patient order parameters and 39/148 opioid order doses should have been reduced due to patient’s organ failure status. The most common inpatient opioids were hydromorphone, morphine, and oxycodone with respiratory depressants lorazepam, diazepam, and baclofen being coadministered for opioid overdose requiring naloxone administration.
  • CONCLUSIONS: There are areas of improvement in opioid prescribing practices across the health system to help prevent unnecessary overdoses resulting in naloxone administrations.

IMPLEMENTATION OF A CONTINUOUS GLUCOSE MONITORING (CGM) PROGRAM WITHIN A SKILLED NURSING FACILITY

Lucy Keers, Patrick Meek, Lauren Fina, Michael Burke, Michael R. Brodeur
ACPHS | Trinity Health

  • BACKGROUND: Since their invention in 1999, continuous glucose monitoring (CGM) devices have been used in type 1 diabetes (T1DM) patients to monitor their blood glucose levels. Recently, insulin-treated type 2 diabetes (T2DM) patients have shown increased interest in CGM use. Given these trends, it is imperative for healthcare systems, particularly long-term care facilities, to enhance their understanding of CGMs.
  • OBJECTIVE: The primary aim is to measure baseline knowledge and attitudes toward CGM devices among nursing staff in a long-term care setting, with an end goal to implement a CGM protocol.
  • METHODS: This project will assess nursing staff knowledge and attitudes toward continuous glucose monitoring (CGM) using pre- and post-educational assessments. A multiple-choice and true/false knowledge assessment will measure understanding of CGM technology, clinical indications, data interpretation, and patient counseling. A Likert scale-based attitude assessment will evaluate perceptions of CGM’s usefulness, confidence barriers, and willingness to recommend it. Both assessments will be piloted, refined, and administered before and after the educational module. The assessments will then be used to develop CGM materials for each unit, analyze data, and produce a final manuscript. This project met criteria for an exempt study through Trinity Health Institutional Review Board (IRB).
  • RESULTS: Results and conclusions are still in progress for this quality improvement project as conduction of educational modules is still in session.

IMPLEMENTATION OF A PHARMACY-LED CHARITABLE MEDICATION PROGRAM TO OPTIMIZE MANAGEMENT OF UNINSURED PATIENTS WITH TYPE 2 DIABETES

Sally Ko, Daniya Mathew,Carissa Escober Doran, Caitlyn Gordon, Preethi Samuel, Agnes Cha
Northwell Health

Service/ProgramVivo Pharmacy is the outpatient pharmacy network for Northwell Health and has partnered with the Dispensary of Hope, a charitable medication program, since 2020. Eligible uninsured patients enrolled in the program have access to formulary medications for chronic conditions, including type 2 diabetes (T2DM), at no cost. Given the complexities of T2DM and high medication costs, pharmacy services to improve T2DM management have been implemented across three primary outpatient clinics. Clinical pharmacy specialists, residents, and interns conduct intake assessments, review patients’ medications, provide diabetes education, recommend formulary treatment options, and support patient follow up. Pharmacy service coordinators help facilitate medication access, including Dispensary of Hope enrollment, and serve as liaisons to patients. Justification/Documentation Due to the substantial cost of diabetes treatment, lack of insurance coverage may contribute to medication nonadherence, poor diabetes control, and increased rates of complications. Implementation of a charitable medication program allowed our pharmacy teams to provide guideline-directed T2DM medication management and improved medication access for patients regardless of insurance status. Of 273 uninsured patients enrolled between January 2021 and July 2023, the mean A1C decreased from 9.6% at baseline to 8.0% at the latest measurement (p<0.0001). In addition, the proportion of patients with A1C below 7% increased from 15.4% to 35.2% (p<0.001). Adaptability This program involved collaboration between ambulatory and dispensing pharmacy teams to meet an unfilled need in treating a vulnerable patient population. Partnering with the Dispensary of Hope allows pharmacy programs to provide essential T2DM medications to uninsured patients. Significance Implementation of this pharmacy program was associated with significant A1C reductions. Through a yearly participation fee, Vivo Pharmacy dispensed $2,733,185 worth of medications at no cost to the patient. Pharmacy-led initiatives to provide access to free medications can remove an important adherence barrier, thereby improving glycemic control and optimizing outcomes for patients with diabetes in community clinics.

CHARACTERIZATION OF POST RAPID SEQUENCE INTUBATION SEDATION IN THE EMERGENCY DEPARTMENT: A MULTI-CENTER RETROSPECTIVE CHART REVIEW

Anthony Liang, Alla Melamed Khaytin, Mina Michael
Mount Sinai Brooklyn

  • BACKGROUND: Post rapid sequence intubation (RSI) sedation is crucial for maintaining patient comfort and preventing adverse complications related to being awake while paralyzed. This medication use evaluation's objective is to determine if the current post-RSI sedation practices in the emergency departments (ED) of the Mount Sinai Health System (MSHS) hospitals are providing appropriate sedation coverage after rocuronium administration.
  • METHODS: This is a multi-center, retrospective, chart review of 200 patients 18 years or older who underwent rocuronium-based RSI in the ED across MSHS from January 1st, 2021, to January 1st, 2024. Patients extubated/expired in the ED, pregnant/incarcerated, intubated post cardiac/traumatic arrest, or with documented appropriate rationale for withholding/delaying post-RSI sedation were excluded. The primary endpoint is to determine the proportion of patients that received post-RSI sedation and analgesia within appropriate timeframe. Secondary outcomes include proportion of patients receiving either agent within specified timeframes (within induction agent's duration of action [DoI], 30 minutes, or 60 minutes), time to post-RSI sedation, time to post-RSI analgesia.
  • RESULTS: 200 patients were included, 11% of patients received both post-RSI sedation and analgesics within the DoI, 19% within 30 minutes, and 30% within 60 minutes. Almost all the patient received either a sedative or analgesic within 60 minutes (91%). Notably, post RSI analgesia was given within the prespecified time frames at about half the rate of post RSI sedation. Additionally, median time to post RSI analgesia was 41 minutes which was more than double the median time to post RSI sedation of 17 minutes.
  • CONCLUSION: Overall, there was poor compliance with timely initiation of post RSI sedation and analgesia observed across the health system. Further EMR enhancements should be considered to streamline post RSI agents ordering process and provide further guidance. Future education on importance of initiating timely post RSI sedation and analgesia, as well as, addressing potential barriers are warranted.

DRUG INDUCED NEUTROPENIA AND THROMBOCYTOPENIA FROM DIFFERENT BETA-LACTAM ANTIBIOTICS IN A SINGLE PATIENT

Nadin Mostafa, Troy Kish
The Brooklyn Hospital Center

  • Beta-lactam associated hematological toxicities such as thrombocytopenia and neutropenia are rare but serious adverse effects. Limited case reports often describe these toxicities following use of a single agent. We present an unusual situation where a patient developed two different cytopenias to two different beta-lactam antibiotics following a prolonged treatment course. A 33-year-old male, with uncontrolled HIV, presented with symptoms of stroke and seizures. On imaging, a right frontoparietal lesion from possible brain abscess was seen. Cefepime 2000mg every 8 hours was initiated along with metronidazole, sulfamethoxazole-trimethoprim, and vancomycin. Initial laboratory tests showed white blood cells (WBC) 9900 cells/µL, neutrophils 86.6%, absolute neutrophil count (ANC) 8573 cells/μL, and platelets 145 x 10³/μL. The patient developed thrombocytopenia, with platelet levels declining to a nadir of 73 × 10³/μL by day twenty-six of cefepime therapy. Three days later, cefepime was discontinued, and the patient was transitioned to meropenem 2000 mg every 8 hours. Platelet count resolved five days after cessation of cefepime and remained within the normal range afterwards. Patient’s labs at meropenem initiation were WBC 2700 cells/µL, neutrophils 57.5%, ANC 1552 cells/μL, and platelets 90 x 10³/μL. Thirty-eight days later, an ANC nadir of 262 cells/mcL was observed. Meropenem was discontinued on day thirty-nine and ANC returned to normal of 1958 cells/μL five days later. Literature review identified 3 cases of cefepime-induced thrombocytopenia and 2 cases of meropenem induced neutropenia, with similar delayed onset and resolution following drug discontinuation. This case adds to the existing evidence by documenting the concurrent development of two different cytopenias from two different medications. Clinicians should be aware of the potential for beta lactam-induced cytopenias, particularly with prolonged treatment. Regular monitoring of blood counts and timely discontinuation are essential to minimize complications. Case report is acknowledged by the institutional board review for publication.

IMPACT OF A GERIATRIC MEDICATION SAFETY INITIATIVE (GEMSI) PHARMACIST DRIVEN PROCEDURE ON OPIOID UTILIZATION IN A TRANSITIONAL CARE UNIT (TCU)

John Noviasky, Jaylan M. Yuksel, Kyle X Eilert, John Noviasky, Kelly R. Ulen, Sabeena Valentin, Vincent Lorello, Jasmeen Kaur, Faiza Ahmed, Kenneth L McCall
SUNY Upstate, SUNY Binghamton

  • OBJECTIVE: A pharmacist-driven procedure, the Geriatric Medication Safety Initiative (GEMSI), was created in May 2017. The primary outcome of this study was to examine the opioid morphine milligram equivalent per day (MMED) pre- and post-implementation of GEMSI. Secondary outcomes included length of stay (LOS) and acetaminophen utilization per day.
  • DESIGN: This was a retrospective, single-center cohort study with pre- and post-implementation groups. Data was extracted via chart review to determine the reason for admission, length of stay, non-opioid pain medication usage, and MMED. Data are expressed as mean, standard deviation (SD), and n (%).
  • PATIENTS AND SETTING: Residents greater than or equal to 65 years old admitted to a Transitional Care Unit (TCU) in 2016 or 2018 were included. Residents were excluded if they were acutely ill and/or transferred off the TCU.Results: In total, 566 residents were included. The overall mean MMEDs pre and post-GEMSI were 9.5 (+/- 18.0) compared to 8.5 (+/-22.7) mg/day respectively (P=0.186). The TCU length of stay decreased from a mean of 12.4 to 11.1 days (P = 0.005) and the average acetaminophen utilization increased from 673 to 722 mg/day from pre- to post-GEMSI (P< 0.001). In a subgroup analysis of patients that reported pain, the mean MMEDs were 15.3 (+/- 21.3) compared to 10.9 (+/- 18.7) mg/day, respectively (P = 0.038).
  • CONCLUSION: A pharmacist-driven procedure for multimodal pain management was associated with a decreased MMED and reduced LOS. Future large-scale studies need to be conducted to replicate these results in different practice settings.

IMPACT OF A PHARMACIST-SUPPORTED REMOTE PATIENT MONITORING (RPM) HYPERTENSION (HTN) PROGRAM

Brianna Perumpail, Hanlin Li, Nadine Dandan
NewYork-Presbyterian Hospital

  • BACKGROUND: Hypertension (HTN) is a chronic disease that affects nearly half of adults in the United States and can cause significant complications. The initiation of remote patient monitoring (RPM) has expanded access to care, leading to improved adherence and patient outcomes. Among healthcare professionals, pharmacists are uniquely positioned to support better blood pressure (BP) control through RPM services. There is limited evidence evaluating the effectiveness of pharmacist management of patients with HTN when pharmacists have independent authority to adjust medication regimens. Within NewYork-Presbyterian ambulatory care clinics, clinical pharmacists assist with RPM initiation and adjustment of medications through collaboration with referring providers.
  • OBJECTIVE: The objective of this study is to examine how a pharmacist-supported RPM HTN program can impact the ability to reach blood pressure goals for patients with HTN when compared to patients managed solely by their provider. The primary endpoint is the number of patients to reach BP goal of< 140/90 mmHg as defined by Healthcare Effectiveness Data and Information Set (HEDIS) measures. Secondary endpoints include the number of patients to reach BP goal of< 130/90 mmHg as per clinical guidelines, pharmacist interventions and categorization by type, point reduction in BP, and frequency of PharmD visits versus MD visits.
  • METHODS: This is a single-center, retrospective chart review of adults (≥ 18 years) referred to the RPM HTN program between January 1, 2021 and December 21, 2023. Patients will be excluded if they were disenrolled due to being unable to be reached, inappropriately referred, not engaged in the program (≥ three missed appointments) or expired patients. The two comparison groups will be patients with HTN managed by a pharmacist and those managed by the provider. Pertinent data collected will include demographics, baseline BP readings along with readings 6 months and 12 months after, pharmacist intervention types, and number of visits.
  • RESULTS: In progress
  • CONCLUSION: In progress


IMPLEMENTATION OF AN AUTOMATED SYSTEM FOR TRACKING AND MANAGING TRAYS AND KITS IN A HEALTHCARE FACILITY

Tsu Han Poh-Gracia
Westchester Medical Center

  • INTRODUCTION: In our facility, we relied on pen and paper to log the contents of crash cart trays and kits such as RSI and HIV PEP kits. This method was time-consuming and led to backlogs. Medication recalls further complicated the process, making searches difficult. In early 2024, we implemented MedEx® TraySafe, an automated system using QR codes and cameras to scan trays and kits, ensuring accurate medication configuration and reduced turnaround times.
  • CASE: To streamline our implementation, we implemented MedEx® TraySafe in three stages. First, we prepared medications, trays, kits, carts, and locations by integrating QR codes and tagging all components of the crash cart. This ensured accurate tracking within the system. Next, we trained pharmacy personnel on system use. TraySafe's camera technology processed tagged medications into designated trays or kits, which were then assigned to tagged carts. This improved accuracy and traceability. Finally, we trained the distribution department to scan tagged carts into designated locations using handheld devices. All transactions were logged in the system, ensuring seamless tracking and retrieval.
  • DISCUSSION: MedEx® TraySafe significantly improved workflow efficiency by eliminating manual documentation and enhancing tracking. The system's ease of use streamlined medication management and reduced backlogs. A challenge arose with the rapid depletion of tagged medications, impacting continuity. To address this, we improved inventory management and replenishment schedules. Allocating more time to maintaining tagged supplies will ensure optimal performance. Overall, MedEx® TraySafe enhanced efficiency, medication safety, and inventory management, refining our processes.
  • CONCLUSION: MedEx® TraySafe transformed our medication management by improving efficiency, accuracy, and safety. Automation eliminated documentation burdens and reduced backlogs. Despite initial challenges in supply management, adjustments in inventory practices have mitigated the issue. Ongoing monitoring and system optimization will ensure sustained workflow improvements and patient safety.

 
TIME FROM RECONSTITUTION-TO-ADMINISTRATION OF SUBCUTANEOUS AZACITIDINE

Nicole Suker, Christina L. Lombardi
Department of Pharmacy, St. Peter's Hospital, Albany, New York

  • INTRODUCTION: Azacitidine is a hypomethylating agent used to treat acute myeloid leukemia, and myelodysplastic syndromes. Azacitidine is available in intravenous (IV), subcutaneous, and oral formulations. For the subcutaneous and IV formulations, administration of the solution must be completed within an hour of reconstitution. This short solution expiration is due to the instability of the molecule in water at room temperature. This instability lends itself to being more cytotoxic. 
  • OBJECTIVE: The purpose of this review was to evaluate if the time from reconstitution-to-administration was within one hour of reconstitution within St Peter's Health Partners. This project will be used to identify areas of improvement.
  • METHODS: This is an institutional review board approved retrospective review of all administrations of subcutaneous azacitidine in adults between the dates of May 10th, 2021, to August 30th, 2022, within St Peter's Health Partners. The sites within St Peters Health Partners included St. Peter's Hospital, St. Peter's Cancer Care Center, and St. Mary's Cancer Treatment Center. Electronic health records for each administration were reviewed. The difference between the start time of preparing the azacitidine and the administration time was gathered. Successful administration was defined as administration within one hour of the start time of preparation. 
  • RESULTS: In total there were 156 administrations for 10 patients. Two of those administrations were considered unsuccessful. The success rate was 98.7%. The average time from reconstitution-to-administration was 13 minutes 49 seconds, with a standard deviation of 12 minutes 40 seconds. More than half of the administrations had 10 minutes or less between preparation start and administration.
  • CONCLUSION: A large majority of the administrations occurred within the hour after reconstitution. Both late administrations occurred within St. Peter's Cancer Care Center. Both patients required blood transfusions, possibly prolonging their appointment. Increased awareness of azacitidine's short expiration should help avoid late administration.

 
CONTENT ANALYSIS OF PATIENT-FACING EDUCATIONAL MATERIALS ON MEDICATION USE IN DIALYSIS

Paris Dade, Alexis R Gregoire, Daphne Cheng, Wendy M. Parker, Katie E. Cardone
Albany College of Pharmacy and Health Sciences, Maria College

  • BACKGROUND: Patients on dialysis may require education regarding their medication regimens. Patient-facing educational materials can be found via various online sources. It is unknown what content gaps exist in these materials.
  • OBJECTIVE: Evaluate the content, readability, and comprehensiveness of electronically available patient-facing materials on medication use in dialysis.
  • METHODS: Electronically available patient education handouts about medications in dialysis were analyzed using a standard content analysis design. Handouts were identified via online searches and were included if they focused on medications used in dialysis, patient-facing, from organizations, governmental agencies, health care groups, or universities, and in English. A thematic code framework was developed before the initial review of handouts then modified as articles were coded. Flesch-Kincaid reading levels were determined using Microsoft  Word.
  • RESULTS: n=20 handouts were analyzed. The median Flesch-Kincaid level was 9.6 (IQR 9.25-10.8). No thematic codes were included in all handouts. Eleven included diseases or complications: hypertension (7/11), diabetes (4/11), anemia (4/11),  hyperlipidemia (3/11), mineral and bone disease (1/11). Medication use considerations were discussed: 65% included routes of administration, 35% side effects, and 35%  mechanisms of action. The most commonly included medication classes were phosphate binders (75%), iron (70%), vitamin D (65%), and erythropoiesis-stimulating agents (60%). Five handouts discussed medications to avoid. Fourteen advised patients to discuss medications with the healthcare team, 65% recommending a pharmacist.
  • CONCLUSION: Handouts regarding medication use in dialysis are readily available online. They contain important information but are written at a higher than optimal reading level and may be missing some key content. Thus, there is a need for comprehensive, patient-friendly educational handouts regarding medications in dialysis.


IMPACT OF CLINICAL PHARMACISTS ON ACCESS TO BIOLOGIC THERAPY FOR ASTHMA WITHIN AN INTEGRATED DELIVERY NETWORK SPECIALTY PHARMACY

Patricia Lorquet, Devang Shah, Lucrecia Campisi,Thom Coco,  Audra Manekas
Hackensack Meridian Health/ Binghamton University School of Pharmacy and Pharmaceutical Sciences

  • BACKGROUND: Current literature evaluating the efficacy of biologic therapies used in the management of severe asthma has shown a reduction in healthcare utilization by decreasing the frequency of exacerbations and need for maintenance oral corticosteroid use. High cost and access barriers, including prior authorizations and cost-savings program enrollment can delay the initiation of effective biologic therapies. The purpose of this study is to analyze interventions and cost savings made by clinical pharmacists within an Integrated Delivery Network Specialty Pharmacy (IDSNP) by facilitating access to biologics for patients with moderate-severe asthma.
  • METHODS: This is a single center retrospective study that will include patients enrolled in respiratory disease therapy management observed over a two-year period, August 18, 2022 to May 15, 2024. Patients were included if they were 18 years or older, filled a prescription for omalizumab, mepolizumab, benralizumab, dupilumab or tezepelumab and had a diagnosis of asthma, moderate asthma or severe asthma. Patients were excluded if they were not seen by a network provider or specialist. Primary outcomes evaluated were the total number of interventions made by clinical pharmacists and their associated cost savings. Secondary outcomes evaluated include types of interventions made, the turn around time of prescriptions (SP-TAT) and patient adherence (PDC). An exploratory outcome evaluated was the rate of additional health care utilization following the initiation of biologics. Data analysis was performed using descriptive statistical analysis, with continuous variables summarized by mean (SD) or median (IQR); continuous variables summarized by frequencies (percentages).
  • RESULTS: The IDNSP provided a significant impact of cost-savings to patients by increasing access to biologics and optimization of therapy for moderate to severe asthma.
  • CONCLUSION: This study's findings highlight opportunities to explore cost-avoidance to the health network  related to biologics dispensed from the IDNSP, as observed with the reduction of OCS use and hospitalizations following initiation of therapy.

SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS OF LIVE FECAL MICROBIOTA THERAPEUTICS FOR RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION

Conor McCloskey, Corinne Le Reun, Dianne Nguyen, Carl V. Crawford, Darell Pardi, Sunita Nair, Mark Wilcox
Clarivate Analytics Ltd, London, England; Independent biostatistician, Guadeloupe, France; Nestlé Health Science, Bridgewater, NJ, USA; Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA; Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, USA; Nestlé Health Science, Vevey, Switzerland; Microbiology & Leeds Institute of Medical Research, Leeds Teaching Hospitals & University of Leeds, Leeds, UK

  • INTRODUCTION: Clostridioides difficile infection (CDI) is a debilitating, potentially fatal gastrointestinal tract infectious disease. CDI treatment includes antibiotics, which can further disrupt gut microbiota/increase recurrence risk. AGA guidelines on fecal microbiota–based therapies suggest using live microbiota therapies after standard-of-care antibiotics over not in adults with recurrent CDI (rCDI). This study compared clinical efficacy/safety of FDA-approved live fecal microbiota therapeutics in preventing recurrences among participants with ≥1 previous rCDI.
  • METHODS: A systematic literature search (SLR) was conducted using Medline, Embase, and Cochrane databases to identify randomized controlled trials (RCTs) examining select fecal microbiota therapeutics in patients with rCDI (fecal microbiota spores, live-brpk [VOS]; fecal microbiota live-jslm [RBL]). Efficacy/safety of oral VOS and rectal RBL were compared using Bayesian network meta-analysis (NMA). Outcomes included treatment success (no recurrence of CDI) at 8 weeks (primary), time to rCDI (over 24 weeks), and serious adverse events (SAEs) over 24 weeks. Subgroup analyses by age were conducted for the primary outcome.
  • RESULTS: Of publications identified in the SLR, 9 reporting results for 3 RCTs (1 for VOS [NCT03183128; N=182]; 2 for RBL [NCT02299570, NCT03244644; N=350]) were eligible for the NMA. VOS-treated patients had greater odds of being recurrence-free at 8 weeks versus RBL-treated patients for the entire population (OR, 3.09 [95% CrI: 1.29⁠–⁠7.75]; statistically significant), those aged <65 years (OR, 4.43 [95% Crl: 0.98–25.71]), and those aged ≥65 years (OR, 2.59 [95% Crl: 0.75–9.55]). Recurrence risk over time was significantly less with VOS versus RBL (HR, 0.36 [95% CrI: 0.25–0.53]). VOS demonstrated numerically reduced odds of SAEs over 24 weeks versus RBL.
  • DISCUSSION: This indirect comparison of treatment effectiveness of novel fecal microbiota therapeutics among participants with rCDI showed significantly greater odds of being recurrence-free at 8 weeks and reduced chance of SAEs over 24 weeks with VOS versus RBL.

RELATIVE VACCINE EFFECTIVENESS OF CELL-BASED VERSUS EGG-BASED QUADRIVALENT INFLUENZA VACCINES AGAINST TEST-CONFIRMED INFLUENZA IN THE UNITED STATES 2022-23 INFLUENZA SEASON

Andrew Rennekamp
CSL Seqirus Vaccines

  • INTRODUCTION: Egg-based influenza vaccine viruses often acquire egg-adaptive mutations in the hemagglutinin protein that can alter their antigenicity and may contribute to reduced vaccine effectiveness. Cell-based vaccine manufacturing avoids egg adaptation. We recently demonstrated improved effectiveness of cell-based quadrivalent influenza vaccines (QIVc) compared with egg-based quadrivalent influenza vaccines (QIVe) in preventing test-confirmed influenza during the 2017-18 to 2019-20 influenza seasons in the population aged 4-64 years in the United States.
  • OBJECTIVE: Estimate the relative vaccine effectiveness (rVE) of QIVc versus egg-based QIVe in preventing test-confirmed influenza among individuals aged between 6 months and 64 years in the outpatient care setting, during the 2022-23 influenza season in the US.
  • METHODS: The study applied a retrospective test-negative design among individuals aged 6 months to 64 years vaccinated with either QIVc or QIVe in 2022-23 and who had an influenza test obtained in routine outpatient care within +/- 7 days of a documented acute respiratory or febrile illness. Exposure, outcome, and covariate data were obtained from outpatient electronic health records linked to pharmacy and medical claims. rVE was estimated by comparing the odds of testing positive for influenza among QIVc recipients with the odds among QIVe recipients, using a doubly robust analysis that combined inverse probability of treatment weighting with multivariable adjustment.
  • RESULTS: The study included 43,086 tested patients, of whom 18.6% received QIVc and 81.4% received QIVe. QIVc was more effective than QIVe in preventing test-confirmed influenza in the outpatient care setting, with an estimated rVE of 7.7% (95% CI: 0.9% - 13.9%).
  • CONCLUSIONS: This study demonstrated superior effectiveness of QIVc compared to QIVe in preventing outpatient test-confirmed influenza in the population aged 6 months to 64 years during the 2022-23 season in the United States. These findings add to the body of evidence supporting improved effectiveness of cell-based versus egg-based vaccines.


UTILIZING VARIOUS ARTIFICIAL INTELLIGENCE PLATFORMS TO DETERMINE ACCURATE OPIOID CONVERSIONS

Jacqueline Cleary

  • INTRODUCTION: This study aims to evaluate the accuracy and consistency of three artificial intelligence (AI) platforms- Pathway, Chatgpt, and OpenEvidence- when calculating opioid conversions. Opioid conversion is a vital component of pain management especially when patients require transitions between different opioid medications due to factors such as side effects, drug interactions or treatment efficacy. While traditional opioid conversion methods such as manual calculations and conversion tables, are widely used, they can be time-consuming and prone to human errors which can lead to suboptimal patient outcomes. Recent advancements in AI offer an opportunity to address these challenges by using technology to simplify and speed up the conversion. The incorporation of artificial intelligence into clinical practice is a great opportunity to improve the efficiency and accuracy of these conversions. 
  • METHODS: Every Tuesday, Thursday and Saturday at 5:00pm, each AI platform- Pathway, Chatgpt, and OpenEvidence-will be asked to provide the opioid conversion for each of the following pairs in both directions: methadone and oxycodone, fentanyl and hydromorphone, IV morphine and oxycodone, buprenorphine transdermal patch and hydrocodone, tramadol and oxymorphone. Only immediate release formulation will be used as opposed to extended release. Data will be collected over a 2-week period, resulting in six data points per opioid pair. Responses from each platform will be analyzed descriptively. The response from each platform will be categorized into two groups: one where the platform provides a precise conversion and another where the platform offers a range or expresses uncertainty. The results will then be compared for consistency, clarity, and accuracy. 
  • RESULTS: In progress
  • CONCLUSION: In progress