ISHP 2020 Fall Meeting
2020 Fall Virtual Poster Session
Poster Title: Evaluation of prescribing practices of long-acting injectable antipsychotics
Poster Authors: Samichhya Baruwal, PharmD; Shelby White, PharmD, BCPS, BCPP; Josh Gerving, PharmD, BCPS, BCPP
Abstract: Long-acting injectable (LAI) antipsychotics can be effective treatment options in patients who relapse due to non-adherence. LAI antipsychotics carry the potential for error with regards to dosing, titration, and administration. While the pharmacists at our institution perform an initial evaluation of the medication to assess appropriateness, pharmacists do not conduct a review on the continued use of these agents. This retrospective medication use evaluation aims to evaluate the prescribing practices of long-acting injectable antipsychotics at our medical institution. This project has the potential to shed light on the importance of pharmacist interventions in dosing and administration of LAI antipsychotics. Patients will be included if they are at least 18 years of age and have an active LAI antipsychotic prescription within the last 120 days. This project did not require an IRB approval as it is an internal quality improvement project.
Poster Title: Alteplase replacement program evaluation
Poster Authors: Emily Bush, PharmD
Abstract: Close monitoring of alteplase is important to ensure safe, appropriate, and cost-effective use. The product return and replacement offered by Genentech is beneficial to offset high costs for medication wasted. The purpose of the review is to examine replacement program practices and assess cost-saving opportunities. This project meets criteria for and was approved by IRB as a performance improvement project and not research involving human subjects. A retrospective chart review was conducted from January 2019 to September 2020 for acute ischemic stroke patients presenting to the emergency department to compare how frequently we are wasting alteplase vials versus getting replacement product through Genentech. Since initiation, alteplase replacement programs have been used 70% of the time. The replacement program through Genentech has decreased the lost revenue associated with alteplase waste by 77%. Moving forward, we will increase utilization of reimbursement opportunities to further minimize the cost burden of alteplase.
Poster Title: Evaluation of hypertension management interventions identified by an electronic dashboard tool
Poster Authors: Kristin Cleverdon, PharmD; Paul Black, PharmD, BCPS; Patrick Spoutz, PharmD, BCPS; Jen Diaz, PharmD
Abstract: SAIL performance measures have demonstrated that our medical institution is not meeting the national target for hypertension management. In response to this issue, an electronic dashboard was created to identify patients who could benefit from a clinician evaluating and assisting with blood pressure control. This prospective medication use evaluation (MUE) seeks to assess the effectiveness of nursing and pharmacist interventions made in response to the Hypertension Management Dashboard initiated in July 2020. IRB was not required as it is an internal quality improvement project. The MUE will ultimately look at the type of intervention made by clinicians, the result of the intervention (ie medication initiated), the change in blood pressure before and after an intervention, and the SAIL ihd53h_ec measure in FY20 Q2 vs. FY21 Q2. Patients will be included if they are reviewed by staff in response to dashboard inclusion anytime between July 2020 and April 2021.
Poster Title: Assessment of intraveneous immune globulin and body weight dosing
Poster Authors: Brittany Galop, PharmD, MS; Dallin Poulsen, PharmD MBA/HSA; and Mel Sater, PharmD
Abstract: Intravenous immune globulin (IVIG) requires weight-based dosing with guidelines supporting actual body weight (ABW). The purpose of this study is to determine whether switching IVIG dosing from ABW to IBW reduces cost. This retrospective study is a medication utilization evaluation that includes patients 18 years and older who received an IVIG dose from January 1 to December 31, 2019. This project meets criteria for and was approved by IRB as a performance improvement project (PI) and not research involving human subjects. 197 patients received at least one dose with 56.4% (711) of IVIG being dosed off of ABW while 43.6% (550) received IBW dosing. The utilization of IBW dosing reduced cost by approximately $930,000 for the 2019 fiscal year. Moving forward, we look to utilize this data to standardize IBW dosing for all new IVIG initiations at our health system’s facilities.
Poster Title: Rational Use of Rasburicase
Poster Authors: Maria Herbison, PharmD and Yvonne Hewett, PharmD
Abstract: The purpose of this project was to assess current dosing practices and identify potential cost savings of rasburicase for tumor lysis syndrome in the adult oncology population. A retrospective chart review was conducted from January 1, 2019 - July 31, 2020. Thirty-seven oncology patients were identified and all received rasburicase using flat-based dosing, the most common initial dose being 7.5 mg. Only two patients required repeat dosing. The average cost of rasburicase for each patient was $8,097. In conclusion, utilizing one-time flat-based dosing of rasburicase is sufficient at treating hyperuricemia related to tumor lysis syndrome in most adult oncology patients. Further cost savings may be achieved in the future utilizing lower initial flat-based doses of rasburicase. This project meets criteria for and was approved by IRB as a performance improvement project and not research involving human subjects.
Poster Title: Evaluation of the safety and efficacy of vancomycin when dosed based on steady state trough
Poster Authors: Grayson Kendall, PharmD; Charles Jensen, PharmD; and Kristen Thomas, PharmD
Abstract: In an effort to reduce vancomycin toxicities new dosing strategies are being implemented. We sought to establish a reference to compare new and traditional dosing outcomes. A retrospective chart review of all pediatric patients who had received at least 3.5 consecutive days of vancomycin was performed. This medication utilization evaluation was determined to be exempt from review by the Institutional Review Board as it was retrospective, no greater risk was imposed, and was classified as performance improvement. 30 patients met criteria (7 females, 23 males, aged 1 week to 14 years old). Two of these patients developed acute kidney injury, both with initial CrCl less than 30 mL/minute, one with a trough greater than 15 mcg/mL and one with additional nephrotoxic medications. This data will aid in assessing the appropriateness of AUC:MIC dosing and its impact on the rates of toxicity and resolution of infection in pediatric patients.
Poster Title: Utilizing Meds 2 Beds Pharmacists to Promote Safe Opioid Disposal
Poster Authors: Alexandria Schultz, Catherine Gundlach, Megan Turner
Abstract: With the recent revision of The Joint Commission standards, health systems are required to adequately address patient education regarding safe storage and disposal of opioids. Almost all orthopedic surgical patients receive opioid pain medications upon discharge and may not take the full amount prescribed as post-operative pain diminishes. Targeting this population, patients receiving opioids upon discharge using the Meds 2 Beds pharmacy discharge bedside delivery service will be provided a medication disposal pouch with counseling. A pharmacist will perform a follow-up phone call four to five weeks post discharge inquiring about the amount of pain medications used, disposal pouch use, and patient satisfaction of medication counseling. The information will be analyzed to identify potential areas of improvement for counseling, institutional discharge pain medication prescribing, and unused medication disposal rates. This project was approved by the institutional review board as a performance improvement project and not research involving human subjects.
Poster Title: Improving analgesia in burn patients: implementation of a subanesthetic ketamine protocol in a burn intensive care unit
Poster Authors: Rachel Proteau, PharmD; Lindsey Reeder; Erin Berry; and Eliza Borzadek
Abstract: Effective burn pain management is exceptionally complex, with prolonged and highly variable sources of pain throughout burn care. Opioids are a mainstay of therapy; however, effects of long term use are of significant concern. Ketamine at “subanesthetic” (i.e. analgesic) doses has gained popularity as an opioid sparing alternative across multiple pain settings. Among burn patients, ketamine is often cited for adjunct analgosedation, particularly during dressing changes. Analgesic applications of ketamine in unintubated patients represent a novel strategy for burn pain management at this institution. The primary objective of this project will be to determine whether implementation of a ketamine protocol significantly reduces cumulative morphine milligram equivalents (MME) required for pain management among unintubated burn patients in the burn intensive care unit. Data will be obtained via chart review and comparative statistics will be used for analysis. This project is Institutional Review Board (IRB) exempt as a quality improvement project.
Poster Title: Evaluating time to administration and average units given of prothrombin complex concentrate in fixed vs non-fixed dosing of warfarin reversal
Poster Authors: Tania Villaneuva-Sanchez, PharmD and Kathy Glem, PharmD, BCCP
Abstract: Prothrombin complex concentrate (Kcentra) is an agent used in the reversal of anticoagulation in life-threatening bleeds and contains factors II, VII, IX, proteins C and S. The purpose of this MUE is to evaluate a newly implemented process of using fixed-dosed Kcentra in warfarin reversal. Data will be collected via retrospective chart review to compare the average time from order entry to administration, and the average number of units being given in fixed vs non-fixed dosing. This project is IRB exempt because it is a performance improvement project. Results are pending.
Poster Title: Implementation of a standardized venous thrombosis prophylaxis protocol at a community hospital
Poster Authors: Angela Cheung, PharmD; Brecon Powell; Eliza Borzadek; Erin Berry
Abstract: Venous thromboembolism (VTE) is a major public health problem affecting 350,000 to 600,000 Americans annually. VTE is widely believed to be the most common preventable cause of hospital death. Appropriate thromboprophylaxis in high-risk medically ill patients has been shown to reduce risk of VTE by 30-65 percent, has a low incidence of major bleeding, and well-documented cost-effectiveness. VTE prophylaxis has been the Joint Commission’s National Patient Safety Goal since 2008. Despite the general availability of evidence-based best practices, institutions continue to struggle with implementation of standardized VTE prophylaxis protocols. The objective of this project is to assess the institutional adherence with an evidence-based VTE prophylaxis guidelines before and after implementation of a standardized protocol. Data collected will include patients’ demographic characteristics, body mass index, an assessment of risk of thrombosis and bleeding and will be collected via chart review utilizing electronic health records. This project is Institutional Review Board exempt.
Poster Title: Using social network analysis to identify facilitators
Poster Authors: Courtney Bonnema and Renee Robinson
Abstract: Many regions in Alaska are designated as Health Professional Shortage Areas. Patients in rural communities tend to have poorer access to healthcare and higher rates of diabetes. A social network analysis, quantifying relationships between providers, groups, and healthcare systems, was conducted. IRB approval obtained. Members of the Alaska Diabetes Coalition, a statewide initiative of healthcare providers and community partners, were surveyed to identify barriers to diabetes care and determine existing connections between patients, providers, and healthcare centers employed in their management. The top three reported barriers included; lack of insurance/inadequate insurance, lack of access/ability to pay for healthy foods, lack of patient engagement in diabetes self-care. Analysis of the network showed that tribal health sites have the greatest number of existing connections used to support diabetes management. It also demonstrated that community level partnerships do exist, but there are opportunities for sites to utilize resources closest to them.
Poster Title: Alaska assisted living home immunization program: A multidisciplinary, community health initiative for underserved populations in South Central Alaska
Poster Authors: Talethia Bogart, Jacob Jordan, Renee Robinson
Residents of assisted living homes (ALH) are especially susceptible to vaccine preventable illnesses, due largely to close quarters, typically being over the age of 65, and having more co-morbidities on average. The objectives of this program were 1) combat increased incidence of influenza, specifically among the high-risk, ALH population; 2) immunize all consenting ALH residents; 3) increase herd immunity through immunization of healthcare workers and resident family members; 4) expand program outreach; 5) provide student pharmacists the opportunity to learn and master skills needed for future practice. Seventeen teams, consisting of 66 volunteers, traveled across Southcentral Alaska, and administered 497 influenza vaccines in October, 2019. Continued recruitment efforts of community medical professionals, along with multidisciplinary student involvement, lays the foundation for ALH program sustainability and growth. Multidisciplinary medical teams provide volunteers and the public valuable exposure to skill sets of various medical providers, increasing public knowledge and interdisciplinary collaboration.
Poster Title: Understanding influenza vaccination rates, perceptions, and vaccine hesitancy in K-12 teachers and staff surveyed within the West Ada School District
Poster Authors: Dalys Davenport, PharmD Candidate; Elaine Nguyen, PharmD, MPH; Kevin Cleveland, PharmD, ANP; Kathy Eroschenko, PharmD
Abstract: Purpose: Misinformation and hesitancy contributes to decreased vaccination. Given the prominent role that teachers/staff serve in communities, we surveyed this population to understand influenza vaccination uptake, motivations, knowledge, and hesitancy.
Poster Title: Using National Survey Data: A Cross-Sectional Analysis of Surverys with Questions on Chronic Diseases and Social Determinants of Health
Poster Authors: Kathryn Fox, BA; Tayler Daniels'; Renee F. Robinson, PharmD, MPH, MSPharm; Elaine Nguyen, PharmD, MPH
Abstract: Introduction: Surveys are tools utilized by organizations and researchers to assess various populations. This project aimed to consolidate a list of national health surveys to make data source identification easier.
Poster Title: Exploring barriers and facilitators to pharmacist-provided diabetes self-management education and support
Poster Authors: Gabriela Gawlik; Renee Robinson; Elaine Nguyen
Abstract: Purpose: Pharmacists are healthcare professionals with necessary clinical experience and knowledge to effectively manage and educate patients with diabetes and provide diabetes self-management education and support (DSMES) services. However, barriers exist to community pharmacists’ implementation of DSMES. The aim of the study is to explore pharmacists’ perspectives on DSMES, identify barriers and facilitators to pharmacist DSMES implementation, and guide program development to expand access to pharmacist-provided DSMES in Idaho.
Poster Title: Cross-sectional analysis of commercially available mobile health applications for self-management of attention deficit hyperactivity disorder
Poster Authors: Kyle Logue; Courtney Bonnema; Annie Enderle; Renee Robinson
Abstract: Attention deficit hyperactivity disorder (ADHD) affects 10% of children in the United States. ADHD is primarily managed with medication and behavioral therapy. Many children with ADHD do not have access to these necessary treatments and additional support to manage their condition successfully. Mobile health applications (MHAs) have been used in other conditions to support self-management; however, it is unclear if commercially available ADHD MHAs support ADHD management. This study aims to identify and evaluate existing ADHD MHAs for ADHD self-management. A search for ADHD MHAs was completed in July 2020. The Mobile Application Rating Scale (MARS) was used to assess engagement, functionality, aesthetics, and information quality. To determine if the information provided was evidence-based, we use an adapted content assessment scale. Readability was assessed using Flesch-Kincaid Scale. Study deemed not research by Institutional Review Board.
Poster Title: Cross-sectional review of population health management studies with pharmacist involvement
Poster Authors: Radhika Narsinghani, PharmD Candidate 2021; Glenda Carr, PharmD; Amber Fisher, PharmD; Kathy Eroschenko, PharmD; Elaine Nguyen, PharmD, MPH
Abstract: Purpose: To systematically characterize studies with pharmacist involvement in population health management (PHM) by chronic diseases.
Poster Title: Associating PHQ-9 Scores and Food Insecurity
Poster Authors: Brittany Burch, Glenda Carr, PharmD
Abstract: This study assessed whether an association between food insecurity and depression scores exist in participants presenting to a Community Health Screening (CHS) as approved by ISU Human Subject Committee. The Patient Health Questionnaire-9 (PHQ-9) and two validated food insecurity questions were reviewed from 138 participants (100 female, 38 male) who completed the CHS. PHQ-9 scores between 10-29 indicate moderate to severe depression and were considered a positive for this analysis. Using a Chi Square test, there was a statistically significant finding using a p-value <0.05 for each food insecurity question; worried about running out of food (p=0.0003) and running out of food (p=0.0134). Although there are many different factors that contribute to depression, food insecurity is to be considered to be one of them. Based on these findings from this population, food insecurity should be considered when diagnosing and treating depression.
Poster Title: Cross-sectional analysis of mobile health applications to support self-management of post-traumatic stress disorder
Poster Authors: Nana McMillan; Renee Robinson, PharmD, MPH, MSPharm
Abstract: Purpose: Mobile health apps can help increase access to care and provide strategies for post-traumatic stress disorder (PTSD) self-management. We sought to describe and compare consumer-driven mobile health apps available for PTSD self-management.
Methods: We conducted a cross-sectional analysis of commercially-available PTSD apps. We obtained readability scores for the apps that met our inclusion criteria using Flesch Kincaid, evaluated usability using the mobile application reading scale, and apps were assessed for resources, education, and tools for self-management. Study IRB Exempt.
Results: Our initial search yielded 199 apps, 16 apps specific to PTSD; however, 13 did not meet our inclusion criteria (consumer-directed, designed for PTSD management, English, no-cost). Only three apps provided treatment information, and only two were evidence-based. App readability scores ranged from grade 12 to 18.
Conclusion: Most currently available PTSD apps are not evidence-based, readable, and do not support self-management. Evidence-based, patient-guided, commercially-available PTSD apps are needed.
Poster Title: Mapping Idaho's community pharmacies and population density to evaluate accessibility
Poster Authors: James Parrish; Jose Lopez; Austin Pothikamjorn; Elaine Nguyen; and Renee Robinson,
Abstract: BACKGROUND: Pharmacists are the most accessible healthcare providers, capable of providing a wide range of healthcare services in the community setting. Our objective is to determine availability of community pharmacies in Idaho relative to geographic population density. This will highlight geographical areas and potential opportunities to fulfill community healthcare needs.
METHODS: Study data was collected from Idaho State Board Pharmacy website in July of 2020, and US population census data. A search was conducted to obtain a website-generated list of all active, licensed, community pharmacies with physical addresses. Data was collected into a spreadsheet for consolidation of information. ArcGIS software was then used to map community pharmacy and population data to identify potential geographical areas where pharmacies could better serve the community. This project utilizes publicly available data and is exempt from IRB review.
Poster Title: Mental health pharmacists: review of types of engagement and opportunities for collaborative partnership
Poster Authors: Mikayla Romney; Julia Boyle; and Renee Robinson
Abstract: Purpose: Describe mental health patient care, collaborative practice services provided by mental health pharmacists within a local medical center. Discuss potential for increased access to mental health services by incorporating pharmacists into the psychiatric treatment team and opportunities for pharmacists to address the persisting gap in mental health services.
Poster Title: Cross-sectional study for opioid support applications: Identifying tools to support addiction self-management
Poster Authors: Carrie Urena and Renee Robinson
Abstract: Misuse of and addiction to opioids is a serious national crisis, affecting public health social and economic welfare. Healthcare and support resources available to help individuals struggling with substance use disorder (SUD) in rural communities are limited. The primary aim of this study is to describe and compare consumer-directed mHealth apps available to support addiction self-management efforts in individuals with SUD. A multi-domain, 3-tier inclusion criterion was developed and used to identify relevant customer-focused apps on Google Play and Apple App Store, n=10. Few available mHealth apps were evidence-based, supported self-management, or provided necessary connections to available online and telehealth resources needed. In fact, no mHealth apps met all criteria; evidence-based, support self- management, or connect to necessary resources. More real time self-management supports are needed to overcome access barriers (e.g., transportation issues, provider shortages, and geographical constraints), and augment currently available mental health supports.
Poster Title: Perceived stress levels of students between different programs within the Kasiska Division of Health Sciences
Poster Authors: Megumi Harris; Madeline Foster; Brecon Powell, PharmD
Abstract: The purpose of this study was to assess the perceived stress levels between different programs with the Kasiska Division of Health Sciences. As well as, assessing if there is a difference between perceived stress levels brought on by COVID-19. IRB approval was exempt under category two. Students were emailed a survey link to Qualtrics and informed consent was in that email. There was no change between stress levels between different programs. However, there were changes between stress levels between different programs due to the transition with COVID-19. Programs that had a significant change in stress levels included: Counseling, Medical Lab Science, and Physical Therapy. Programs that had no significant change in stress levels included: Dental Hygiene, Pharmacy, Occupational Therapy, Physician Assistant. Due to the ongoing need for socially distanced and online learning environments, it may be beneficial for universities to consider increasing support for students.
Poster Title: Cross-sectional analysis of mobile health apps for self-management of depression or anxiety
Poster Authors: Radhika Narsinghani, PharmD; Renee Robinson, PharmD, MPH, MSPharm
Abstract: Purpose: Compare consumer-directed mobile-health applications (mHealth apps) available for self-management of depression and/or anxiety.
Poster Title: Idaho pharmacists’ willingness and needs to provide COVID-19 services
Poster Authors: Tayler Daniels; Jeremy Boyle; Christopher Owens; and Renee Robinson
Abstract: Purpose: To determine Idaho pharmacists’ willingness to provide COVID-19 services, assess needed resources to provide services, and identify/prioritize other unmet community needs.