PPC ANNUAL PROFESSIONAL PRACTICE CONFERENCE January 30 - February 3, 2016
The Sheraton Centre Toronto Hotel 123 Queen Street West Toronto, ON CPP CONFÉRENCE ANNUELLE SUR LA PRATIQUE PROFESSIONNELLE 30 janvier - 3 février 2016
Final Program Programme final
SPECIAL INTEREST COMMUNITIES OF PRACTICE Connecting pharmacists across Canada FOR IMPROVED PATIENT CARE
P ARMAC PECIA T NET OR NETWORK communicate
CSHP has more Join the Pharmacy Specialty Network! CSHP membership will connect than 20 PSNs to you with what’s important – people and information. join! Check out www.cshp.ca for a complete list. PSNs:
• Connect members with others who share a passion for a particular facet of pharmacy practice
• Facilitate the quick exchange of ideas, developments, methods, experiences, and knowledge to improve practice
• Support collaboration on projects, research, and educational programs to address the needs of the members of a PSN
• Provides additional opportunities for members to serve as both opinion leaders and key resources for the CSHP Board on professional specialty issues, including development of relevant position statements, guidelines, and information papers
Participation in PSNs is free of charge to CSHP members.
Visit MY.CSHP.ca and sign up today! Welcome Bienvenue
Dear Colleague, Chères (Chers) collègues,
On behalf of the Board and staff of the Canadian Society Au nom du Conseil et du personnel de la Société of Hospital Pharmacists (CSHP), it is our pleasure to canadienne des pharmaciens d’hôpitaux (SCPH), nous welcome you to CSHP’s 47th Annual Professional Practice avons le plaisir de vous souhaiter la bienvenue à la 47e Conference. Conférence annuelle sur la pratique professionnelle de la SCPH. Over the last 10 months, CSHP’s Educational Services Committee has worked hard to assemble an impressive Au cours des dix derniers mois, le comité des services faculty of pharmacy specialists and develop a program of éducatifs de la SCPH s’est affairé à rassembler un groupe exceptional educational value with topics covering a wide impressionnant de conférenciers spécialisés en pharmacie range of specialties, management issues and pharmacy et à vous préparer un programme d’une valeur éducative practice-related challenges. exceptionnelle avec des sujets touchant un large éventail de spécialités, de questions relatives à la gestion et de défis This conference is designed to maximize your opportunities posés à la pratique pharmaceutique. for professional development, networking and socializing with practitioners from across the country. It is our hope Ce congrès est destiné à maximiser les possibilités de that you are able to take full advantage of the 2016 perfectionnement professionnel, de réseautage et de offerings–and enjoy yourself in the process. rencontre avec d’autres praticiens de toutes les régions du pays. Nous espérons que vous pourrez tirer pleinement At any time throughout the conference, the Officers of the profit de ce que nous vous offrons en 2016 – tout en vous Board and staff of CSHP are available to you. Please let us divertissant. know if we can answer any of your questions, address any of your concerns or be of assistance in any way. Nous vous rappelons qu’au cours du congrès, la Direction et le personnel de la SCPH seront à votre entière We look forward to welcoming each of you to another disposition. Nous ferons tout en notre pouvoir pour spectacular conference. répondre à vos questions, discuter des sujets qui vous Thank you for your ongoing support of CSHP! préoccupent et vous aider au besoin de quelques manières que ce soit.
Nous sommes impatients de vous accueillir à cet autre congrès exceptionnel et vous remercions de votre appui soutenu à la SCPH. Glen Pearson Myrella Roy BScPhm, PharmD, FCSHP BScPhm, PharmD, FCCP CSHP President Executive Director
Glen Pearson Myrella Roy B. Sc. Phm., Pharm. D., B. Sc. Phm., Pharm. D., FCCP FCSHP Directrice générale Président de la SCPH
4 he CSHP Foundation is an independent, charitable organization created by the Canadian Society of Hospital Pharmacists to support research and educational T programs that advance patient-centered pharmacy practice in hospitals and related healthcare settings for the betterment of public health. Research and Education Grants and Pharmacy Leadership Academy Scholarships for CSHP Members And the 2015 recipients are… Research Grants • Lisa McCarthy, Establishing and Evaluating the Feasibility of ACC-Link (Acute Care to Community Pharmacist Communication Link): A Program to Improve Medication Experiences at Health Care System Transitions – Grant: $10,000 • Marc Perreault, Pain, Agitation and Delirium Management in Critically Ill Adult Patients with Traumatic Brain Injuries: A Multi-centre, Prospective, Observational Study – Grant: $2,800 • Scott Walker, The Development of a Stable Oral Liquid Temozolomide Formulation – Grant: $10,000 • Mark Duffett, Stress Ulcer Prophylaxis in Critically Ill Children: A Multi- centre Prospective Observational Study – Grant: $10,000
Education Grants • Michelle Foisy, The Development of a Pocket Card for Assessing Antiretroviral Therapy in Hospitalized HIV-Positive Patients – Grant: $2,758 • Miranda So, Development and Evaluation of Virtual Interactive Cases to Facilitate Clinical Reasoning Skills in Pharmacy Practice – Grant: $6,120 • Certina Ho, An Evidence-based Communication and Decision-guiding Tool to Evaluate the Complexities of QT Prolongation – Grant: $5,132
Pharmacy Leadership Academy (PLA) Scholarship • Zack Dumont, Clinical Support Pharmacist, Regina Qu’Appelle Health Region – Tuition: $6,500 USD
2016 PLA Scholarship Application Deadlines ASHP Foundation by February 26 and CSHP Foundation by April 8, 2016 See the CSHP Foundation website for details.
Thank You to Our Sponsors: AstraZeneca Canada Ltd., Pfizer Canada Inc., LEO Pharma Inc., Alveda Pharma, ApoLab, Apotex Inc., Canadian Pharmaceutical Distribution Network, Mylan Pharmaceuticals ULC, Omega Laboratories Limited, cshpfoundation.ca Pendopharm, Sandoz Canada Inc., CSHP Members & Branches 5 Table of Contents Table des matières
CSHP Board and Staff Conseil et personnel de la SCPH Executive Committee Bureau de direction 7 Branch, A.P.E.S. and Student Delegates Délégués des sections et de l’A.P.E.S., et déléguée étudiante 8 CSHP Staff Personnel de la SCPH 8
With Thanks Remerciements CSHP Sponsors 2015 Commanditaires de la SCPH en 2015 9 CSHP Industry Corporate Supporters Entreprises partisanes du secteur de l’industrie 10 CSHP Hospital Corporate Supporters Entreprises partisanes du secteur hospitalier 10
Conference Information Information sur la conférence Upcoming Events Événements à venir 11 Satellite Symposiums Symposiums satellites 11 CSHP Educational Services Committee Comité des services éducatifs 12
Program Programme Program of Events Programme des événements 13 Speakers Abstracts Résumés des conférenciers 19 Oral Presentations Présentations orales 41 Poster Abstracts Résumés des affiches 42 Poster Abstract Reviewers Réviseurs des présentations par affiches 71 Faculty Conférenciers 72 Exhibitor List Liste des exposants 74
Executive Committee Bureau de direction
President Past President Executive Director Président Président sortant Directrice générale Glen Pearson Bruce Millin Myrella Roy Mazankowski Alberta Heart Institute Fraser Health Authority Canadian Society of Hospital Edmonton, AB Langley, BC Pharmacists President Elect Treasurer Société canadienne des pharmaciens Présidente désignée Trésorier d’hôpitaux Lauza Saulnier Mario Bédard Ottawa, ON Horizon Health Network The Ottawa Hospital Moncton, NB Ottawa, ON
6 Branch, A.P.E.S. and Student Delegates Délégués des sections et de l’A.P.E.S., et déléguée étudiante
British Columbia Ontario – Senior/Principal Nova Scotia Colombie-Britannique Christina Adams Nouvelle-Écosse Shirin Abadi North West Telepharmacy Solutions Kim Abbass BC Cancer Agency Pembroke, ON Cape Breton Regional Hospital Vancouver, BC Sydney, NS Ontario – Junior/Débutante Alberta Dawn Jennings Prince Edward Island Tania Mysak HealthPRO Procurement Services Île-du-Prince-Édouard University of Alberta Hospital Mississauga, ON Amy Carpenter Edmonton, AB Kings County Memorial Hospital A.P.E.S. / Québec Montague, PE Saskatchewan Diem Vo Zack Dumont Hôpital Pierre-Boucher Newfoundland and Labrador Regina Qu’Appelle Health Region Longueuil, QC Terre-Neuve-et-Labrador Regina, SK Lorie Carter New Brunswick Eastern Health Nouveau-Brunswick Manitoba Bay Bulls, NL Pat Trozzo Pamela Yafai CancerCare Manitoba Saint John Regional Hospital Student Winnipeg, MB Saint John, NB Étudiante Samantha Cunningham University of Saskatchewan Saskatoon, SK
CSHP Staff Personnel de la SCPH Executive Director Interim Conference & PSN Publications Administrator Directrice générale Administrator Agente des publications Myrella Roy Agente par intérim des congrès et Amanda Iannaccio des RSP Operations Manager (on leave) Web Administrator Susan Maslin Gérante des opérations (en congé) Agente du Web Laurie Frid Membership & Awards Olga Chrzanowska Administrator Interim Operations Manager Ontario Branch & Advocacy Agente du service aux membres et Gérante des opérations par intérim Executive Assistant des prix Desarae Davidson Adjointe de direction de la section Robyn Rockwell de l’Ontario et de la valorisation Coordinator, Professional & CPRB Administrator Anne Stacey Membership Affairs Agente du CCRP Coordonnatrice, Affaires Office Administrator (Fellows Gloria Day professionnelles et service aux [FCSHP] Recognition Committee) membres Finance Administrator Agente de bureau (Comité de Cathy Lyder Agente des finances reconnaissance des associés Anna Dudek [FCSHP]) Executive Assistant Pamela Saunders Adjointe de direction Finance Clerk Rosemary Pantalone Commis des finances CSHP Foundation Administrator Julia Waserman-Shapero Agente de la Fondation de la SCPH Janet Lett
7 sponsorship
The Canadian Society of is thriving and now supports 3,000 adherents Hospital Pharmacists (CSHP) CSHP (members and supporters) through: is the national voluntary • Advocacy organization of pharmacists • Education: Professional Practice Conference, Banff Seminar, committed to patient care Harrison Pharmacy Management Seminar, and numerous branch through the advancement and chapter educational sessions of safe, effective medication • Information Sharing: online publication of the Canadian Journal use in hospitals and other of Hospital Pharmacy; online discussion forums through the collaborative healthcare Pharmacy Specialty Networks settings. • Development of guidelines for best practices Founded in 1947, CSHP is a • Facilitation of Research: grants through the CSHP Foundation member-driven association • Recognition of Excellence: Awards Program and Fellows Program which operates at several levels: national, provincial branches, local chapters, committees, and task forces. together we make a difference
8 CSHP Sponsors 2015 Platinum Sponsor • AutoMed Technologies Inc. Commanditaires platine • Bayer Inc. The following list reflects all sponsorship • BioSyent Pharma Inc. $60,000 - $79,999 received from January 1 to December • Bristol-Meyers Squibb Canada 31, 2015. • Canadian Agency for Drugs and Gold Sponsor Technologies in Health Commanditaires de la Commanditaires or • Canadian Cardiovascular Pharmacist Network SCPH en 2015 $40,000 - $59,999 • Canadian Institute for Health La liste suivante reflète toutes les • Apotex Inc. Information commandites reçues du premier janvier • Mylan Canada • Canadian Patient Safety Institute au 31 décembre 2015. • Sandoz Canada Inc. • College of Pharmacists of British • Teva Canada Limited Columbia Diamond Sponsor • Fraser Health Commanditaires diamant Silver Sponsor • Galenova Inc. $80,000 or greater Commanditaires argent • GlaxoSmithKline • Healthmark Services Ltd. 80 000 $ et plus $20,000 - $39,999 • HealthPRO • Astellas Pharma Canada • Innovative OncoSolutions Inc. • AstraZeneca Canada Ltd. • Janssen-Ortho • Eli Lilly Canada Inc. • Johnson & Johnson Inc. • Hospira Healthcare Corporation • Kit Check caring for life • McKesson Canada Corporation • LEO Pharma Inc. • Merck Canada Inc. • Lower Mainland Pharmacy Services • Sanofi Canada Inc. • Lundbeck Canada Inc. • SteriMax Inc. • MDA Inc. • Memorial University School of Bronze Sponsor Pharmacy Commanditaires bronze • North West Telepharmacy Solutions • Nosotech $10,000 - $19,999 • Novartis Pharma Canada • Alveda Pharmaceuticals Inc. • Novo Nordisk Canada Inc. • Baxter Corporation (Canada) • Omnicell • BD / CareFusion, a BD Company • Ontario College of Pharmacists • Boehringer Ingelheim Canada Ltd. • Otsuka Pharmaceutical Inc. • Canadian Pharmaceutical • Ricoh Distribution Network • RxFiles Academic Detailing Program • Medbuy • Sidra Medical and Research Centre • Omega Laboratories Ltd. • Sphynx Medical Inc. • Pendopharm, a Divison of • Swisslog Healthcare Solutions Pharmascience Inc. • Takeda Canada Inc. • Pharmascience Inc. • The France Foundation • Sunovion Pharmaceuticals Inc. • Truven Health Analytics • Valeant Canada • University of Toronto • Wolters Kluwer Clinical Drug Donor Sponsor Information Commanditaires donateurs $1000 - $9,999 • Accord Healthcare Inc. • Accreditation Canada • ACIC/Methapharm • Alexion • Amgen Canada Inc. • ApoLab • ARxIUM
9 2015-2016 CSHP 2015-2016 CSHP Industry Corporate Supporters Hospital Corporate Supporters
This list recognizes our Industry Corporate Supporters for the This list recognizes our Hospital Corporate Supporters for the year July 1, 2015–June 30, 2016 year July 1, 2015–June 30, 2016 (At time of printing) (At time of printing)
2015-2016 Entreprises partisanes 2015-2016 Entreprises partisanes du secteur de l’industrie du secteur hospitalier
La liste suivante reconnaît nos entreprises partisanes du La liste suivante reconnaît nos entreprises partisanes du secteur de l’industrie au cours de l’année d’adhésion du secteur hospitalier au cours de l’année d’adhésion du premier premier juillet 2015 au 30 juin 2016 juillet 2015 au 30 juin 2016 (au moment de l’impression) (au moment de l’impression)
• AstraZeneca Canada Inc. • Alberta Health Services
• Baxter Corporation (Canada) • Horizon Health Network
• Eli Lilly Canada Inc. • Lower Mainland Pharmacy Services
• Fresenius Kabi Canada Ltd. • North West Telepharmacy Solutions
• Galenova Inc. • University Health Network
• Healthmark Services Ltd.
• Hoffman-La Roche Limited
• McKesson Canada Corporation
• MDA Inc.
• Merck Canada Inc.
• Omega Laboratories Ltd.
• Pendopharm, a Division of Pharmascience Inc.
• Pharmascience Inc.
• Sandoz Canada Inc.
• Servier Canada Inc.
• SteriMax Inc.
• Teva Canada Limited
10 Satellite Symposia Symposiums satellites Satellite CSHP would like to thank the following sponsors of Satellite Symposiums for Symposium their participation in conjunction with SPONSORSHIP PPC 2016: OPPORTUNITY Sunday, January 31
12:00-13:30 • Boehringer Ingelheim Ltd. 48th Professional Practice Conference Monday, February 1 InterContinental Hotel 17:30-19:30 • Merck Canada Inc. Toronto, ON February 4-8, 2017 Tuesday, February 2 Lunch and Dinner 17:30-19:30 • Bayer Inc. Opportunities • BD
Wednesday, February 3 For more information please contact 17:30-19:30 • Sanofi Canada Inc. Susan Maslin See the program section for more details. Interim Conference and PSN Administrator (613) 736-9733, ext 229 or [email protected]
Upcoming Events Événements à venir
Professional Practice Harrison Pharmacy 2016 CSHP Annual General Conference (PPC) Management Seminar Meeting NEW LOCATION February 25-27, 2016 October 2016 FOR 2017 Harrison Hot Springs, BC Regina, SK
February 4-8, 2017 For more information on these events, InterContinental Toronto Centre Western Branches please visit www.cshp.ca Toronto, ON Banff Seminar
For further information, please contact March 11-13, 2016 Susan Maslin, Interim Conference & The Banff Centre PSN Administrator. Banff, AB Tel.: (613) 736-9733, ext. 229 Fax: (613) 736-5660 Email: [email protected] 11 The Educational Services Committee EP C.C.C.E.P. Canadian Council on Le comité des services éducatifs Continuing Education in Pharmacy
Chairperson The Educational Services Committee Le comité des services éducatifs Présidente (ESC) of CSHP has been working for travaille depuis près de 10 mois à Elaine Chong, PharmD, BCPS approximately 10 months on the l’élaboration du contenu et de la forme BC Ministry of Health content and format of PPC 2016. The de la CPP 2016. Le comité comprend New Westminster, BC ESC is comprised of a core committee 15 membres principaux et membres of up to 15 CSHP members as well as correspondants des sections de la SCPH. Past Chairperson Président sortant corresponding members from the CSHP branches. But et objectifs du programme Clarence Chant, PharmD, BCPS, FCSHP, FCCP de la CPP 2016 Goal and Objectives for the St. Michael’s Hospital But : Toronto, ON 2016 PPC Program • Présenter des conférences éducatives Staff Liaison Goal: Employée de liaison de qualité aux participants. • To provide registrants with quality Objectifs : Susan Maslin educational sessions. Members • Présenter aux personnes inscrites des Objectives: Membres conférences éducatives susceptibles Margaret Ackman, PharmD, FCSHP • To provide educational sessions which d’informer, d’instruire et de motiver Alberta Health Services inform, educate and motivate clinical les cliniciens et les gestionnaires. Edmonton, AB practitioners and managers. • Orienter la pratique de la pharmacie Bernadette Almeida, BScPhm, ACPR • To provide leadership in hospital hospitalière en présentant des Trillium Health Partners pharmacy practice by presenting conférences sur les nouveautés Toronto, ON sessions on innovative pharmacists’ touchant le rôle du pharmacien, Roxane Carr, PharmD, BCPS, FCSHP roles, pharmacy practice and la pratique de la pharmacie et les BC Children’s and Women’s Health pharmacy programs. programmes de pharmacie. Centre • To promote life-long learning skills • Développer des habiletés pour un Vancouver, BC through active participation in apprentissage continu par une Judy Chong, BScPhm problem-based workshops. participation active à des ateliers de Ontario College of Pharmacists formation axés sur la résolution de • To provide registrants with Toronto, ON problèmes. networking and sharing opportunities Alfred Gin, PharmD, FCSHP through the exhibits program and • Donner aux participants des Health Sciences Centre poster sessions. occasions de réseautage et d’échanges Winnipeg, MB grâce au salon des exposants et aux • To promote excellence in pharmacy Derek Jorgenson, BSP, PharmD, FCSHP séances d’affichage. University of Saskatchewan practice research through oral and Saskatoon, SK poster presentations of original work • Promouvoir l’excellence dans and award-winning projects. la recherche en pratique Sharan Lail, BScPhm, ACPR, PharmD pharmaceutique par des St. Michael’s Hospital • To provide an opportunity for présentations orales et des séances Toronto, ON Pharmacy Specialty Networks to meet d’affichage sur des travaux originaux and share their expertise with others. Heather Slaney, BScPharm, ACPR et des projets primés. Janeway Children’s Health & Rehabilitation Centre • Donner l’occasion aux réseaux de St. John’s, NL spécialistes en pharmacie de se réunir et de partager leur savoir-faire. Kat Timberlake, PharmD The Hospital for Sick Children Toronto, ON Erica Wang, BScPhm, PharmD St. Paul’s Hospital Vancouver, BC 12 Program William Semchuk, MSc, PharmD, FCSHP Regina Qu’Appelle Health Region Programme Regina, SK Indy Ghosh, MD, CCFP (EM) Saturday, January 30 • Samedi 30 janvier York Central Hospital 12:00-17:00 Registration Toronto, ON Inscription Presented by Boehringer Ingelheim Ltd. CONCOURSE COAT CHECK 13:45–14:30 Concurrent Sessions Séances concomitantes 12:30-15:30 Ontario Hospital Pharmacy Residency Program Information Session 1. Top 10 Drug Interactions on the Internal (Cycle 2017-2018) Medicine Ward Not to Miss SHERATON HALL E BIRCHWOOD BALLROOM
16:00-18:00 CPRB Residency Networking Reception Jennifer Bolt, BScPharm, PharmD, ACPR Réception de réseautage relative à la Regina Qu’Appelle Health Region résidence du CCRP Regina, SK PROVINCIAL BALLROOM 2. Drug Use in Pregnancy and Lactation: 18:00-20:00 Career Opportunities Evening Does Briggs Have All the Answers? Soirée de perspectives d’emploi WILLOW CENTRE DOMINION BALLROOM FOYER Brenda Rosenthal, BScPharm Winnipeg Regional Health Authority Sunday, January 31 • Dimanche 31 janvier Winnipeg, MB 08:30-17:00 Registration 3. How to Conduct Research on Behaviour Inscription Change Interventions for Pharmacists CONCOURSE COAT CHECK CHESTNUT 09:00-09:15 Opening Remarks Remarques préliminaires Richard Slavik, BSc(Pharm), ACPR, PharmD, DOMINION BALLROOM FCSHP Interior Health 09:15-10:15 Keynote Speaker Kelowna, BC Conférencier d’ouverture 4. Applying Lean to Improve Safety and DOMINION BALLROOM Efficacy of Pharmacy Services The Whole and Holes of Drug Policy in MAPLE Canada Rick Abbott, BScPharm Jeffrey Simpson Dr. H. Bliss Murphy Cancer Centre The Globe and Mail St. John’s, NL Ottawa, ON 14:45-16:45 Workshops & PSN Sessions Sponsored by Sandoz Canada Inc. Ateliers et séances des RSP 10:30-12:00 Facilitated Poster Session Cardiology PSN Discussions of original research, award winning RSP en cardiologie projects and pharmacy practice projects CHESTNUT Séance animée de présentations par affiches 1. New Treatments for Valvular Heart Discussions sur des projets de recherche originale, Disease and the Impact on Pharmacists des projets primés et des projets dans le domaine de la pratique pharmaceutique Heather Kertland, PharmD, FCSHP CITY HALL AND CHURCHILL St. Michael’s Hospital Toronto, ON 12:00-13:30 Satellite Symposium Luncheon included 2. Crossing the Bridge: A Pharmacist’s Symposium satellite Guide to Managing Patients with Dîner inclus Ventricular Assist Devices DOMINION BALLROOM Diana Mourao, RPh, BScPhm, ACPR University Health Network Changing the Face of Anticoagulation: Toronto, ON Reversing the NOAC Effect. What are the Options? 13 Amita Woods, RPh, PharmD, BScPhm 10:20-11:30 Panel Discussion University Health Network Panel Toronto, ON DOMINION BALLROOM
Medication Safety PSN Novel Experiential Educational Models: RSP en sécurité des médicaments Examples of Success Stories for the CanExEd WILLOW CENTRE Project
Accreditation Meditation: Lessons from the Naomi Steenhof, BEd, BScPhm, ACPR, CGP University Health Network Field and Tips for Success Toronto, ON Janice Munroe, BScPharm Marisa Battistella, BScPhm, PharmD, ACPR Lower Mainland Pharmacy Services University Health Network Langley, BC Toronto, ON Julie Greenall, RPh, BScPharm, MHSc(Bioethics), Carla Findlater, BScPhm, PharmD ACPR, FISMPC Sunnybrook Health Sciences Centre ISMP Toronto, ON Toronto, ON Katrina Mulherin, BScPharm, PharmD Research Workshop Canadian Experiential Education Pharmacy Atelier de recherche Project BIRCHWOOD BALLROOM Fredericton, NB 1. Quality Improvement versus Research 11:40-12:25 Concurrent Sessions Séances concomitantes Sandra Nelson, BSP, ACPR, PharmD, MScQIPS Mount Sinai Hospital 1. Digging in the CABG Patch: A Review Toronto, ON of Secondary Prevention Therapy after Coronary Bypass Graft Surgery 2. Building a Program of Research: BIRCHWOOD BALLROOM Designing a Research Plan in the Context of Program Development and Expansion Arden Barry, BSc, BSc(Pharm), PharmD, ACPR Chilliwack General Hospital Miranda So, BScPhm, PharmD Chilliwack, BC University Health Network Toronto, ON 2. Aboriginal History, Health, and Cultural Safety: What Pharmacists Should Know 17:00-18:30 Awards Ceremony Everyone welcome WILLOW CENTRE Cérémonie de remise des prix Jaris Swidrovich, BSP, PharmD Bienvenue à tous University of Saskatchewan DOMINION BALLROOM Saskatoon, SK
Monday, February 1 • Lundi 1er février 3. Syringes as Medication Storage Devices CHESTNUT 07:30-17:00 Registration Inscription Sandy Jansen, BScPhm, RPh, MHS CONCOURSE COAT CHECK London Health Sciences Centre London, ON 08:15-08:30 Announcements Annonces 4. Oral Abstract Session DOMINION BALLROOM Intriguing Papers from Original Research, Award Winners and Research and Education 08:30-09:30 Plenary Session Grants Séance plénière Séance d’exposés oraux DOMINION BALLROOM Communications fascinantes choisies parmi les Practice-Changing Clinical Trials travaux de recherche originale et les projets des récipiendaires de prix, de bourses de recherche Brent Jensen, BSP et de perfectionnement RxFiles Academic Detailing Program Saskatoon, SK MAPLE
09:45-10:15 Break, Exhibits, Posters a. Learning from Medication Pause, Kiosques, Affiches Incidents One Group at a Time: The SHERATON/OSGOODE HALLS Development and Evaluation of Multi- Incident Analysis Workshops 14 Roger Cheng, RPh, BScPharm, PharmD 2. The Skinny on Lipids: New Advances in Certina Ho, RPh, BScPhm, MISt, MEd Fat Emulsions Institute for Safe Medication Use Canada Samantha Scott, BScPharm, ACPR (ISMP Canada) Nova Scotia Health Authority Toronto, ON Halifax, NS b. Prescribing Patterns of Hospital Pharmacists with Additional Workshop Prescribing Authorization in Alberta Atelier MAPLE Taryn Heck, BScPharm, ACPR Alberta Health Services 1. How to Plan Your Submission for the Edmonton, AB CSHP Research Grant Competition c. Quality Assurance of Aseptic Richard Slavik, BSc(Pharm), ACPR, PharmD, Compounding in Winnipeg Regional FCSHP Health Authority Pharmacies Interior Health Donna Woloschuk, PharmD, MEd, FCSHP Kelowna, BC Winnipeg Regional Health Authority 2. Launching Your Local Project to the Winnipeg, MB National Stage: Tips and Tricks from the 12:30-13:50 Lunch, Exhibits, Posters CSHP National Awards Program Dîner, Kiosques, Affiches Sean Spina, BSc(Pharm), ACPR, PharmD SHERATON/OSGOODE HALLS Vancouver Island Health Authority Victoria, BC 14:00-15:00 Plenary Session Séance plénière Kathryn Hollis, RPh, BScPhm, ACPR, MHA DOMINION BALLROOM Queensway Carleton Hospital Ottawa, ON Physician-Assisted Dying and Impact on the Role of the Pharmacist Workshop Atelier James Downar, MD, CM, MHSc, FRCPC BIRCHWOOD BALLROOM University Health Network Toronto, ON Medical Marijuana for Chronic Pain Rachel Whitty, RPh, BScPhm, ACPR Laura Murphy, BScPhm, ACPR, PharmD University Health Network Michael Wong, BScPhm, ACPR Toronto, ON University Health Network Toronto, ON 15:10-17:10 Workshops & PSN Sessions Ateliers et séances des RSP 17:30-19:30 Satellite Symposium Dinner included Infectious Diseases PSN Symposium satellite RSP en infectologie Souper inclus CHESTNUT DOMINION BALLROOM
1. Diagnostics in the Microbiology Lab: Primer on Antimicrobial Stewardship: MALDI-TOF and Beyond What Should we be Doing? Susan Poutanen, MD, MPH, FRCPC Daniel Thirion, MSc, Pharm D, FCSHP Mount Sinai Hospital McGill University Health Centre Toronto, ON Montréal, QC Linda Dresser, PharmD, FCSHP 2. UTIs: The Good, the Bad and the University Health Network Antibiotic Misuse Toronto, ON Kathy Malejczyk, MD, FRCPC Presented by Merck Canada Inc. Regina Qu’Appelle Health Region Regina, SK Tuesday, February 2 • Mardi 2 février Parenteral PSN 07:30-17:00 Registration RSP en services parentéraux Inscription WILLOW CENTRE CONCOURSE COAT CHECK 1. Smart Pumps 08:00-08:15 Announcements Derek Andrews, BSc(Pharm) Annonces Lions Gate Hospital DOMINION BALLROOM North Vancouver, BC 15 08:15-09:15 Plenary Session 3. TARGeTing Empiric Antimicrobial Séance plénière Therapy: Development of an DOMINION BALLROOM Antibiogram App Assessing and Managing Antimicrobial BIRCHWOOD BALLROOM Allergy: What Every Pharmacist Should Know Reem Haj, BScPharm, ACPR, PharmD St. Michael’s Hospital Jackie Campbell, BSc(Pharm), LLB Toronto, ON Sunnybrook Health Sciences Centre Toronto, ON 12:15-13:50 Lunch, Exhibits, Posters Dîner, Kiosques, Affiches 09:30-10:00 Break, Exhibits, Posters Pause, Kiosques, Affiches SHERATON/OSGOODE HALLS SHERATON/OSGOODE HALLS 14:00-15:00 Plenary Session Séance plénière 10:15-11:00 Concurrent Sessions Séances concomitants DOMINION BALLROOM 1. Those P-Something-Something Inhibitors New Drugs in Diabetes Management for Dyslipidemia Alice Cheng, MD, FRCPC BIRCHWOOD BALLROOM Trillium Health Partners Mississauga, ON Arden Barry, BSc, BSc(Pharm), PharmD, ACPR Chilliwack General Hospital 15:10-17:10 Workshops & PSN Sessions Chilliwack, BC Ateliers et séances des RSP Critical Care PSN 2. Clinical Update in Stroke RSP en soins intensifs CHESTNUT WILLOW CENTRE
Ruby Liang, BScPhm, ACPR, PharmD 1. Hepatorenal Syndrome in the Intensive St. Michael’s Hospital Care Unit Toronto, ON Norman Dewhurst, BScPhm, ACPR, PharmD 3. Choosing Wisely: What Should St. Michael’s Hospital be Hospital Pharmacists’ Top 5 Toronto, ON Recommendations? 2. Etiologies and Management of Acute WILLOW CENTRE Pancreatitis
Jenny Chiu, BScPhm, PharmD, ACPR, RPh Pulkit Bhuptani, BHSc, PharmD Monica Lee, BScPhm, MSc, PharmD, RPh St. Michael’s Hospital North York General Hospital Toronto, ON Toronto, ON Internal Medicine PSN 11:15-12:00 Concurrent Sessions RSP en médecine interne Séances concomitantes BIRCHWOOD BALLROOM 1. Update on New Drugs for Pulmonary Arterial Hypertension 1. Plants vs. Drugs: The Complexities of Natural Health Products and Evidence- CHESTNUT Based Medicine
Sandra Porter, BScPhm Rose Liao, RPh, BSc(Pharm), ACPR University Health Network Trillium Health Partners Toronto, ON Mississauga, ON
2. Immunologic-Related Adverse Events 2. Serious Drug-Induced Skin Reactions Associated with Immune Checkpoint Inhibitors in Cancer Treatment Sandra Knowles, RPh, BScPhm St. Michael’s Hospital WILLOW CENTRE Toronto, ON Mark Pasetka, BSc, BScPharm, PharmD Research Workshop Sunnybrook Health Sciences Centre Atelier de recherche Toronto, ON MAPLE
1. Quality Improvement versus Research (encore)
16 Sandra Nelson, BSP, ACPR, PharmD, MScQIPS 08:15-09:15 Plenary Session Mount Sinai Hospital Séance plénière Toronto, ON DOMINION BALLROOM
2. Building a Program of Research: Tuberculosis Resistance Designing a Research Plan in the Context Kamran Khan, MD, MPH of Program Development Expansion St. Michael’s Hospital (encore) Toronto, ON Miranda So, BScPhm, PharmD 09:15-10:15 Panel Discussion University Health Network Panel Toronto, ON DOMINION BALLROOM
Workshop Exploring Opportunities for Collaboration Atelier across the Spectrum of Formulary CHESTNUT Decision-Making: From Hospitals to Health Authorities to Drug Plans Medical Marijuana for Chronic Pain Brent Fraser, BScPhm, MBA (encore) Canadian Agency for Drugs and Technologies in Laura Murphy, BScPhm, ACPR, PharmD Health Michael Wong, BScPhm, ACPR Toronto, ON University Health Network Bill Semchuk, MSc, PharmD, FCSHP Toronto, ON Regina Qu’Appelle Health Region 17:30-19:30 Satellite Symposium Regina, SK Dinner included Anne Hiltz, BScPharm, MHS, ACPR Symposium satellite Nova Scotia Health Authority Souper inclus Halifax, NS Safety in Numbers: Using Clinical Trial Angie Wong, BScPhm, MSc, ACPR and Registry Data to Assess the Safety Ontario Ministry of Health and Long-Term Care and Efficacy of the NOACs in AF Special Toronto, ON Populations 10:15-10:45 Break DOMINION BALLROOM NORTH Pause DOMINION BALLROOM FOYER Claudia Bucci, BScPhm, PharmD, ACPR Sunnybrook Health Sciences Centre 10:55-11:40 Concurrent Sessions Toronto, ON Séances concomitantes William Semchuk, MSc, PharmD, FCSHP 1. Hyperphosphatemia: A Silent Killer in Regina Qu’Appelle Health Region Chronic Kidney Disease Regina, SK CHESTNUT Tammy Bungard, BSP, PharmD University of Alberta Philip Lui, BScPhm, PharmD Edmonton, AB University Health Network Toronto, ON Presented by Bayer Inc. Using Gravimetric Workflow Solutions and 2. Triple Antithrombotic Therapy its Effectiveness in IV Compounding BIRCHWOOD BALLROOM PROVINCIAL BALLROOM SOUTH Kori Leblanc, BScPhm, ACPR, PharmD E. Thomas Carey, PharmD University Health Network Swedish American Hospital Toronto, ON Rockford, IL 3. Going beyond the Numbers: How to Presented by BD Use Medication Incidents to Evaluate Medication Safety Culture Wednesday, February 3 • Mercredi 3 février MAPLE 07:30-15:00 Registration Inscription Calvin Poon, RPh, BScPhm, ACPR, CDE CONCOURSE COAT CHECK Peterborough Regional Health Centre Peterborough, ON 08:00-08:15 Announcements Annonces DOMINION BALLROOM
17 11:50-12:35 Concurrent Sessions 1. Making Decisions about Séances concomitantes Thromboprophylaxis in Special 1. Biologics in Inflammatory Bowel Disease Populations CHESTNUT Artemis Diamantouros, BScPhm, MEd, PhD Sunnybrook Health Sciences Centre Wenya Miao, BScPharm, PharmD Toronto, ON Mount Sinai Hospital Toronto, ON 2. Thromboprophylaxis and VTE Treatment in Malignancy 2. Street Drugs: Toxicity and Approach to Management Ferid Rashid, BScPharm, ACPR William Osler Health System BIRCHWOOD BALLROOM Brampton, ON Debra A. Kent, BA, PharmD, DABAT, FAACT, Paediatrics PSN and Emergency RPh Medicine PSN BC Drug and Poison Information Centre RSP en pédiatrie et RSP en urgentologie Vancouver, BC MAPLE 3. So Now You’re the Boss! A Toolbox for 1. Cases from the Pediatric Emergency Transitioning from the Front Line to a Department Pharmacy Leadership Role MAPLE Melanie MacInnis, BSc(Pharm), PharmD IWK Health Centre Olavo Fernandes, BScPhm, ACPR, PharmD, Halifax, NS FCSHP University Health Network 2. Pediatric Poisoning: Toddlers to Teens Toronto, ON Debra A. Kent, BA, PharmD, DABAT, FAACT, 12:40-14:10 Satellite Symposium RPh Luncheon included BC Drug and Poison Information Centre Symposium satellite Vancouver, BC Dîner inclus Palliative Care PSN DOMINION BALLROOM RSP en soins palliatifs To Adjust or Not Adjust? That is Your LMWH CHESTNUT Question 1. Deprescribing at the End of Life Scott Walker, MScPhm, FCSHP Artemis Diamantouros, BScPhm, MEd,PhD Sally Tierney, BScPharm Sunnybrook Health Sciences Centre Bruyère Continuing Care Hospital Toronto, ON Ottawa, ON Presented by Sanofi Canada Inc. 2. Palliative Care of the Patients with Dementia 14:15-16:00 PSN Sessions Séances des RSP Carolee Awde, BScPhm, RPh, CDE Anticoagulation PSN Peterborough Regional Health Centre RSP en anticoagulation Peterborough, ON BIRCHWOOD BALLROOM 16:15 Close of the 47th Annual Professional Practice Conference Clôture de la 47e Conférence annuelle sur la pratique professionnelle
See you at PPC 2017 in our new location! Au plaisir de vous revoir lors de la CPP 2017 à notre nouvel emplacement! InterContinental Toronto Centre Toronto, ON February 4-8, 2017
18 Speaker Abstracts 2. List the drug interactions that are common to the internal Résumés des conférenciers medicine population. 3. Outline the strategies to minimize the risk of drug Sunday, January 31 interactions in the internal medicine population. Dimanche 31 janvier Drug Use in Pregnancy and Lactation: Top 10 Drug Interactions on the Does Briggs Have All the Answers? Internal Medicine Ward Not to Miss Brenda Rosenthal, BScPharm, Winnipeg Regional Health Authority, Winnipeg, MB. Jennifer Bolt, BScPharm, ACPR, PharmD, Regina Qu’Appelle Health Region, Regina, SK Answering question on the safe and effective use of medication during pregnancy and lactation is challenging as The internal medicine population is changing. It is one must take into account the risks and benefits to both the increasingly more common for admitted patients to have mother and the fetus or infant. There are several specialized multiple comorbidities, be under the care of several specialists textbooks and electronic resources available to answer these or sub-specialists, and receive multiple medications. These types of questions. Are you using the best resource to find this complexities of patient care increase the risk of medication information? Get a drug information pharmacist perspective misadventures, including drug interactions. on answering questions regarding drug use in pregnancy Drug interactions are common in hospitalized internal and lactation. Is Briggs “Drugs in Pregnancy and Lactation” medicine patients, but the significance of the interactions good enough, or do you need to consider other sources of can vary from low probability of an outcome with minimal information? clinical relevance to high probability of a severe or life- Goals and Objectives threatening event. Many pharmacy departments do have computerized systems to assist in the identification of drug 1. Understand the strengths and weaknesses of standard interactions, however, these programs rarely provide the references for answering questions on medication use clinical context needed to make a patient-specific decision. during pregnancy and breastfeeding. As such, pharmacists must be aware of the clinically relevant 2. Explain why there is a lack of evidence for the safety of interactions in this population, including management medication use in pregnancy and breastfeeding. strategies to mitigate the risk in at-risk populations. 3. Understand the limitations of the FDA Pregnancy Risk The goal of this session is to review the clinical relevance categories when used for clinical decision making. and management strategies of drug interactions common to the hospitalized internal medicine patient. Through the 4. Be able to list maternal and infant factors to consider when presentation of several patient cases, the frequently affected advising on the use of medication during breastfeeding. patient populations and commonly implicated medications 5. Select appropriate references for answering questions on will be identified and approaches to minimize the risk medication use during breastfeeding. through different management strategies will be discussed. Self-Assessment Questions Goals and Objectives 1. What types of evidence are commonly available to support 1. State the prevalence of drug interactions in patients the use of medications in pregnancy and lactation? admitted to the internal medicine ward. 2. Is a medication with an FDA pregnancy risk category rating 2. Describe the implications of drug interactions to patient of B safer than a category C medication? care.
3. Recognize patients who are at high risk for clinically How to Conduct Research on Behaviour significant drug interactions. Change Interventions for Pharmacists 4. Identify the common drug interactions for hospitalized Richard S. Slavik, BSc(Pharm), ACPR, PharmD, FCSHP, Interior patients under the internal medicine service and Health, Kelowna, BC and University of British Columbia, recommend management strategies to mitigate the risk of Vancouver, BC these interactions.
Self-Assessment Questions Despite the availability of evidence-based practices and therapeutic interventions, there is still an enormous gap 1. Describe the patient- and medication-related risk factors for between what we know can maximize health care quality drug interactions. 19 and what is currently being delivered in clinical practice. Applying Lean to Improve Safety and Pharmacists need continuing professional development Effciency of Pharmacy Services to refine their clinical skills and update their therapeutic knowledge to close this gap and advance their practice to Rick Abbott, BScPharm, Dr. H. Bliss Murphy Cancer Center, have the greatest impact on improving patient outcomes. St. John’s, NL Dissemination and implementation research is evolving to Since its formation as a Regional Health Authority in 2005, help us understand how to select, create, deliver, and evaluate Eastern Health has used various methods to address cost, the impact of proven knowledge translation and behavioral quality, safety and service delivery issues. Problems were often change interventions. The behavioral change wheel expressed as high patient wait times, budget overruns, and recognizes that behavioral change interventions must target errors that sometimes impacted patient safety. Eastern Health capability, opportunity, or motivation, and recognizes related traditionally availed of internal and external consultants, functions and policies that must be addressed for successful departmental working groups, and project teams that behavioral change to be sustained. The Canadian Agency usually focused on the most politically significant issues at for Drugs and Technology in Health (CADTH) Prescription the time. In 2010 internal groups experimented with the for Change Database (Rx for Change) has classified and application of Lean tools and theory which led to Eastern critically-appraised proven professional behavioral change Health formally adopting a Lean strategy in 2013. Eastern interventions according to the Cochrane Effective Practice Health’s approach to the application of Lean as a continuous and Organization of Care (EPOC) Review Group: multifaceted improvement methodology is to develop capacity for change interventions; audit and feedback; local opinion leaders; through decentralized problem solving at all levels within local consensus process; educational meetings; educational the organization. Internally developed Lean coaches extend outreach; printed educational materials; reminders; mass the organization’s capacity for change using a structured media; and patient-mediated interventions. Pharmacy approach to build teams and develop employees’ problem practice research using quasi-experimental designs applying solving skills. These new coaches are capable of leading knowledge translation strategies and proven behavioral teams and experimenting with change to achieve measurable change interventions can be used to promote pharmacist incremental improvements. This unique model of sustainable professional development and improve processes of care. A change will enhance Eastern Health’s future efforts in checklist from the Workgroup for Intervention Development becoming a center of excellence in health care. and Evaluation Research (WIDER) Group has provided recommendations to improve reporting of the content of In 2013 Eastern Health Pharmacy Services adopted Lean behavior change interventions in research papers. methodology to improve safety and efficiency of service delivery. Lean methodology was used to successfully Goals and Objectives implement automated dispensing cabinets to patient care 1. To introduce pharmacists to knowledge translation areas and improve safety and efficiency of chemotherapy strategies and proven professional behavioral change delivery. The oncology pharmacy team implemented new interventions. international safety standards of “one mix at time” and significantly decreased average patient wait times for 2. To describe how pharmacists can do pharmacy practice chemotherapy from 80 minutes to zero minutes within research using proven behavioral change interventions existing resources. to promote pharmacist professional development and improve processes of care. Goals and Objectives
3. To introduce pharmacists to the WIDER recommendations 1. Provide a general overview of the basic principles of Lean to improve reporting of the content of behavior change Process Improvements and its application to Health Care interventions. Systems.
Self-Assessment Questions 2. Review opportunities to eliminate waste (non-value added activities) in health care as a key step to process 1. List the three main targets for behavioral change improvement. interventions using the behavioral change wheel. 3. Case Study Review: Applying Lean Process Improvement to 2. List five proven professional behavioral change strategies improve safety and efficiency of pharmacy services. identified by the CADTH Rx for Change Database. Self-Assessment Questions 3. List three of the WIDER recommendations to improve reporting of the content of behavior change interventions. 1. Do you think the Lean methodology of the “Toyota Production System” (TPS) can improve quality and safety of health care delivery?
20 2. How can you apply this methodology to start a process Crossing the Bridge: A improvement project in your place of work? PSN PHARMACY Pharmacist’s Guide to SPECIALTY NETWORKS ManagingNETW ORK • COMMUNICA TE Patients with Ventricular New Treatments for Valvular PSN Assist Devices PHARMACY Heart Disease and the Impact SPECIALTY NETWORKS onNETW ORK • COMMUNICPharmacistsA TE Diana Mourao, RPh, BScPhm, ACPR; Amita Woods, RPh, PharmD, BScPhm, University Health Network, Toronto, ON Heather Kertland, PharmD, FCSHP, St. Michael’s Hospital, Toronto, In Canada, about 500 000 people live with heart failure. End- ON stage heart failure affects tens of thousands of Canadians, For many years the advances in the surgical management and those numbers are expected to rise with only a limited of valvular heart disease involved improvements in surgical number of donor hearts available when transplant is techniques and new valves that had lower thrombotic necessary. A ventricular assist device or “heart pump” is a potential, however, a sternotomy was still required for these mechanical device that is implanted near the heart and is procedures to take place. The more recent advances have specifically designed to replicate the pumping action of a included less invasive methods to replace an aortic valve as heart that is too fragile to pump on its own. A left ventricular well as improve the function of a mitral valve. Transcatheter device (LVAD) replaces the failing heart’s left ventricle and aortic valve replacement and Mitral Clip repairs allows is able to pump a similar amount of blood as a healthy patients who would not otherwise undergo a procedure, heart. Several different types of LVADs are currently available receiving symptoms improving interventions. Pharmacists with newer generation models being designed for long-term caring for patients who have undergone these procedures support and have been shown to improve survival and need to understand how drug therapy will be impacted. How quality of life in patients with advance heart failure (1). LVAD these procedures may impact thromboembolic risk, chronic patients are at increased for many device complications medications and the need for additional therapy. such as thrombosis, bleeding, infection, arrhythmias, and Goals and Objectives right ventricular failure. As a result, the pharmacotherapy associated with this device is highly complex. Clinical 1. Describe the innovations in valve repair and replacement pharmacists can play a key role in identifying and managing and the potential benefit for patients. drug therapy problems in these patients.
2. Explain how TAVR and mitral clip procedures impact drug Goals and Objectives therapy. 1. Describe what a Left Ventricular Assist Device (LVAD) is and Self-Assessment Questions its role in the management of advanced heart failure.
1. A 92 year old female underwent a transcather aortic valve 2. Discuss device-related complications and their replacement to treat her severe aortic stenosis. She is an management. otherwise healthy 92 year old. Following the procedure 3. Describe the role of clinical pharmacists in the care of these which of the following regimens should she receive for patients. stroke prophylaxis Self-Assessment Questions • ASA 325 mg daily • ASA 81 mg daily and clopidogrel 75 mg daily 1. When should an LVAD be considered as an appropriate • Ticagrelor 90 mg BID intervention for a patient? • Warfarin – target INR 2- 3 2. What are ways we can manage complications associated 2. A 72 year old male is admitted to the cardiac intensive with LVADs? care unit for monitoring following a Mitral-clip procedure. Which of the following therapies will require follow-up Accreditation Meditation: following a successful procedure PSN PHARMACY Lessons from the Field and Tips SPECIALTY NETWORKS • Atorvastatin forNETW ORK • COMMUNIC SuccessA TE • Eplerenone • Furosemide Janice Munroe BScPharm, Lower Mainland Pharmacy Services – • Ramipril Fraser Health, Langely, BC; Julie Greenall RPh, BScPharm, MHSc (Bioethics), ACPR, FISMPC, ISMP Canada, Toronto, ON
Accreditation has proven to be a strong driver of practice change. In 2008, Accreditation Canada launched the
21 QMentum Standards, which included a new tracer component From various reports, it is clear that quality problems that provided a “realtime” opportunity for the surveyor to are widespread in healthcare and improvements are validate the application of the standards into practice. In needed. While the philosophy and methodology of quality 2011-12, Accreditation Canada convened a working group improvement has been used in the industrial sector for close of pharmacists with broad experience from across Canada to a century, with Walter Shewhart and W.Edwards Deming to review and update the Managing Medications Standards laying much of the groundwork, it has really only gained and Required Organizational Practices (ROPs). These new momentum in healthcare in the past 15 years. standards were released in 2013 and became effective in The methodologies of quality improvement, which include the January 2014. They have now been used in client hospitals Model of Improvement, Lean and Six Sigma, aim to produce and health regions across Canada. With most hospitals on a local knowledge and effective change. Quality improvement 3-4 year Accreditation cycle, there are still hospitals that are is about taking action; hence, called an applied science. being surveyed on the new standards for the first time. This need for action can be seen as an argument against not This session will highlight some key changes in Standards obtaining evidence. However, the same lens that we assess and ROPs, anecdotal evidence of system change, ongoing whether new treatments should be used, should be applied medication safety challenges and tips for success. The session to quality improvement. While not all quality improvement will be facilitated by Janice Munroe, a seasoned Accreditation needs to be set up as a research study, it would be beneficial Canada Surveyor, and Julie Greenall of ISMP Canada. Both if many are, in order to enable transfer of knowledge and Janice and Julie contributed to the new Standards as members determine which initiatives work, which do not and which of the development working group. They both also continue cause harm. Ironically, many quality improvement studies to provide support to Accreditation Canada as part of an published to date lack the quality of medical research, which informal expert “faculty” for the Medication Management may be due in part to the lack of guidance until recent years Standards. on what a report on quality improvement should entail.
This session will be of benefit to pharmacists in both Goals and Objectives management and direct care roles. This will be an interactive 1. To understand the differences between quality improvement presentation with opportunity for peer-to-peer discussion and and research. shared learning. 2. To understand how quality improvement can be research. Goals and Objectives 3. To learn the components and methodology of quality 1. Understand key changes to the Medication Management improvement research. Standards and Required Organizational Practices (ROPs) introduced in 2014. Self-Assessment Questions
2. Understand the surveyor perspective on how the standards 1. List 2 differences between quality improvement and are assessed. research.
3. Be aware of areas of ongoing challenge from a medication 2. Describe 2 types of study designs that can be used for safety perspective. quality improvement research.
4. Be aware of tips and tools to support organizations in identifying potential areas of vulnerability and Building a Program of Research: implementing improvements. Designing a Research Plan in the Self-Assessment Questions Context of Program Development and Expansion 1. When is an “interdisciplinary approved exception” appropriate? Miranda So, BScPhm, PharmD, University Health Network and University of Toronto, Toronto, ON 2. How will changes to the Medication Reconciliation ROP for the Emergency program and surgical pre-admission Pharmacist-led research initiatives have become more management affect my practice? common in the past decade, as pharmacists are increasingly recognized to be key contributors of evidence and knowledge Quality Improvement versus Research to improve patient care and impact health policies. However, research methods and program planning, specifically for Sandra Nelson, BSP, ACPR, PharmD, MScQIPS, Mount Sinai practice-based research, have traditionally not been an Hospital, Toronto, ON in-depth topic in the undergraduate pharmacy curriculum. This potentially creates a knowledge gap for those who wish to become more engaged in this field, while maintaining 22 their role as practising pharmacists. Practice-based research new and overwhelming evidence, while also correctly and focuses on inquiries that takes place within practice to inform effectively applying these results. This session will evaluate practice, improve service delivery, with the ultimate goals of some significant recent medicine trials published in 2015 in improving care both at the levels of the individual patient various areas such as hypertension, diabetes and internal and the society. Pharmacists are therefore in a great position medicine. In addition to generating lively discussions, to contribute to this realm. these studies will also potentially change the practice of pharmacists treating these specific patients. In addition, I will This workshop aims to approach pharmacist-led research comment on a few trials done in the past. What made some from the perspective of a practising clinician with an of these trials good, bad or ugly? interest to conduct research (as compared to someone with formal, academic training in research). It will provide Goals and Objectives guidance on research planning and capacity building 1. Review and appraise various studies published in 2015 using antimicrobial stewardship as the “prototype”, but the related to pharmacotherapy. knowledge and skills are transferrable to other clinical areas. It will examine the barriers, solutions, as well as identify 2. Describe how the results of these various studies can be opportunities for pharmacists towards research planning, integrated into your daily practice. program development and expansion. It will also provide Self-Assessment Questions the participants with pearls and lessons-learned from those who have been conducting pharmacy practice research of a 1. Describe the patient population which is most likely to spectrum of experience (advanced beginner to expert) and a benefit from the interventions in each study. variety of clinical areas. 2. Describe how the proposed intervention(s) is equivalent or Goals and Objectives superior to the current standard of care in each study.
3. To identify opportunity for research within pharmacy practice and determine the necessary components of a Novel Experiential Educational Models: pharmacy research plan. Examples of Success Stories for the
4. To describe practical approaches to successful CanExEd Project implementation of a research plan, using antimicrobial Naomi Steenhof, BEd, BScPhm, ACPR, CGP, Toronto Western stewardship as the discussion framework. Hospital, Toronto, ON; Marisa Battistella, BScPhm, PharmD, ACPR, 5. To address barriers and solutions related to pharmacist-led University Health Network, Toronto, ON; Carla Findlater, BScPhm, research, as well as identifying opportunities for program PharmD, Sunnybrook Health Sciences Centre, Toronto, ON; Katrina expansion, capacity-building and fostering collaboration Mulherin, BScPharm, PharmD, Canadian Experiential Education amongst pharmacists and with other healthcare for Pharmacy Project, Fredericton, NB professionals. The Canadian Experiential Education (CanExEd) Project Self-Assessment Questions for Pharmacy is consolidating best practice relating to experiential education across the country. 1. How can I spot a research opportunity from my day to day pharmacy practice? The Project consists of seven priorities, one being the integration of the full spectrum of learner-preceptor models 2. What can I do to increase the research capacity in my in experiential education (ExEd) in an informed manner. practice setting? Currently in Canada, one preceptor supervises a single student in more than 90% of experiential rotations. While this Monday, February 1 default approach is effective, the Project has determined there Lundi 1er février is evidence suggesting different configurations may confer benefit to students and their preceptors. In addition, there Practice-Changing Clinical Trials is a need and interest in utilizing different configurations as the ExEd component of Canadian Pharmacy curricula Brent Jensen, BSP, RxFiles Academic Detailing Program, Saskatoon, increases with the entry level Doctor of Pharmacy. This SK session will review the seven priorities of the CanExEd project before focusing specifically on the various novel models Every year, hundreds of medicine-related trials are published used in health professions education and their appropriate making review & understanding of these trials a challenging implementation. The session panel consists of preceptors task. Landmark trials help provide information which can be currently teaching undergraduate and postgraduate students used to optimize patient care management. Pharmacists are in their practices using one or more novel models and a faced with the difficult task of being familiar with all of this 23 recent learner with experience participating in a near-peer (or application of these recommendations in practice. Let’s go hierarchal or pyramidal) learning model alongside students digging in the “CABG” patch, and see what we find! of different educational levels. The panel will highlight Goals and Objectives participants’ successes, challenges, facilitators and future plans relating to model novels of teaching and learning in the 1. To comprehensively review the pharmacotherapeutic field. recommendations and supporting evidence (or lack of) for the secondary prevention of cardiovascular events after Goals and Objectives CABG surgery. 1. To provide an overview of the CanExEd Project and specific 2. To briefly review the therapeutic targets and non- discussion on one Priority within the project: Integration pharmacologic recommendations for the secondary of the full-spectrum of novel preceptor-student models in prevention of cardiovascular events after CABG surgery. experiential education. 3. To provide context regarding the real-world application of 2. Identify the seven priorities of the CanExEd Project for secondary preventive pharmacotherapy in practice. Pharmacy. Self-Assessment Questions 3. List and describe three commonly used novel models of precepting students on rotation. 1. When should dual antiplatelet therapy be recommended after CABG surgery? 4. Consider implementing a novel preceptor-student model of precepting within his/her practice environment. 2. What is the evidence to support the use of statin therapy after CABG surgery? 5. Identify resources to prepare for using a novel model of choice. 3. Should beta-blockers and angiotensin-converting enzyme inhibitors be routinely recommended in all patients post- Self-Assessment Questions CABG surgery? 1. Which novel models might be feasible for my practice?
2. What facilitators will assist/support me in using a novel Aboriginal History, Health, and Cultural model? Safety: What Pharmacists Should Know
Jaris Swidrovich, BSP, PharmD, University of Saskatchewan, Digging in the CABG Patch: A Review Saskatoon, SK of Secondary Preventive Therapy after With an ever-increasing proportion of Aboriginal people in Coronary Artery Bypass Graft Surgery our provinces and territories, pharmacists should be well- Arden Barry, BSc, BSc(Pharm), PharmD, ACPR, Chilliwack General informed of the unique backgrounds and current issues many Hospital , Chilliwack, BC and University of British Columbia, Aboriginal people share. The World Health Organization’s Vancouver, BC Human Development Index ranks Canadians at number 6 in terms of an overall quality of life as it relates to all In the garden of coronary artery disease (CAD), the treatment determinants of health; however, when the same ranking of patients who have undergone coronary artery bypass graft system is applied to only the Aboriginal people in Canada, (CABG) surgery, as compared to other patients with CAD, this number falls to 68 – equivalent to that seen in third-world is like comparing cabbage to other green leafy vegetables— countries. Aboriginal people are significantly overrepresented you’re pretty sure they’re similar, but you don’t really know if in many acute and chronic illnesses, with most of these health that’s actually true. In practice, patients may perceive CABG disparities being traceable back to western colonization. surgery to be a “cure” for their CAD. To the contrary, these patients remain at high-risk for recurrent cardiovascular Pharmacists are ideally situated on the front lines of health events. Recently, the American Heart Association published promotion, disease prevention, and, of course, participating a scientific statement aimed at thoroughly evaluating the in the treatments of various ailments. In these various evidence for secondary prevention after CABG surgery. roles, we undeniably see a high proportion of Aboriginal However, the evidence to support these recommendations people, patients, and families. Understanding the concept is not ideal—most are based on historic studies, subgroup and enforcement of culturally safe care can help ensure our analyses, observational studies, extrapolation from non- Aboriginal patients receive the best possible care, given some CABG studies, or consensus opinion. Despite these limitations, unique differences between Aboriginal and non-Aboriginal this statement still offers useful guidance. This presentation patients. will separate the crops from the weeds by providing attendees This session will highlight important aspects of Aboriginal with a concise review of this statement to aid the viable history necessary to appreciate current health disparities,
24 examine the current state of health of Aboriginal people in In this session we will discuss what we know about this issue, Canada, and describe culturally safe care with tips on how to what we don’t know and the potential implications to the engage in providing culturally safe care. common practice of packaging and storing drugs in syringes.
Goals and Objectives Goals and Objectives
1. Define who Aboriginal people are. 1. To provide an overview of the most current information related to the syringes as storage device issue. 2. Describe the role of the Indian Act. 2. To discuss the gaps in information to date. 3. Summarize key demographic and health disparity information on Aboriginal people in Canada. 3. To discuss potential implications to practice in hospital pharmacy. 4. Identify current restrictive and discriminatory practices. Self-Assessment Questions 5. Summarize cultural safety and describe how to provide culturally safe care. 1. What do I need to consider when I determine what drugs may be stored in syringes beyond 24 hours? Self-Assessment Questions 2. Can I trust published stability studies? 1. What are my top three take-home messages regarding Aboriginal history in Canada? Physician-Assisted Dying and Impact on 2. Describe reasons why significant health disparities are still the Role of the Pharmacist seen between the Aboriginal and non-Aboriginal people of Canada. James Downar, MD, CM, MHSc, FRCPC; Rachel Whitty, RPh, BScPhm, ACPR, University Health Network, Toronto, ON 3. What changes can I make in my current practice to improve my provision of culturally safe care? “Physician-Assisted Death (PAD) will become legal in Canada in the very near future. The Supreme Court’s decision to Syringes as Medication Storage Devices strike down the Criminal Code’s prohibition on PAD has led professionals in the medical, legal, and ethical domains Sandy Jansen, BScPhm, RPh, MHS, London Health Sciences Centre, to make necessary preparations for this new reality. In this London, ON presentation, the speakers will briefly review the key questions and issues that required clarification in the wake of the Carter On August 18, 2015, the Food and Drugs Administration decision, and summarize the work completed to date. They (FDA) in the US issued an alert to health care professionals will also explore the impact of this decision on pharmacists not to administer to patients compounded or repackaged and pharmacy practice in general, and discuss the practical, drugs that have been stored in 3 milliliter (ml) and 5ml legal and ethical challenges that pharmacists will face in a syringes manufactured by Becton-Dickinson (BD) unless there Canada where PAD is legal.” is no suitable alternative available. The FDA suggested that preliminary information indicated that drugs stored in these Goals and Objectives syringes may lose potency over a period of time due to a 1. Be familiar with the key medical, legal and ethical issues possible interaction with the rubber stopper in the syringe. left unanswered by the Carter decision. On August 31, 2015, BD Medical issued a communication to 2. Understand the practical, legal and ethical challenges that Canadian customers stating that they had received reports of pharmacists will face when PAD is legal. reduced drug potency when stored in sterile plastic syringes. The cause of the decreased potency was thought to be due 3. Have an approach to handling ethical issues such as to an interaction of some drugs with one of the two types of conscientious objection within the pharmacy community. rubber stopper that they use in their syringes. This issue occurs Self-Assessment Questions only when drugs are compounded and/or repackaged and stored in affected syringes. 1. What are the key medical, legal and ethical issues left unanswered by the Carter decision? The practice of re-packaging drugs in both oral and parenteral syringes is a standard of practice in hospital 2. What are the practical, legal and ethical challenges that pharmacy and this practice has been in place since the pharmacists will face when PAD is legal? introduction of unit dose dispensing as a standard of practice in the 1980’s. 3. Do I know how my department will handle ethical issues such as conscientious objection?
25 UTIs: The Good, the Bad and the connected to a central server by a wireless network permits PSN the organisation to nimbly adjust the pump drug library PHARMACY Antibiotic Misuse SPECIALTY NETWORKS NETW ORK • COMMUNICA TE content in order to respond to changes in practice and drug Kathy Malejczyk, MD, FRCPC, Regina Qu’Appelle Health Region, availability. More importantly, wireless networking also Regina, SK permits the organisation to harvest a wealth of smart pump usage data in close to real time. Urinary tract infections (UTIs), more specifically cystitis- an infection of the lower urinary tract, is the hardest diagnosis to This presentation will review the process of implementing make especially in elderly hospitalized patients. smart pumps including some of the organisational requirements for success. It will focus on the major task of The diagnosis is often complicated by lack of typical building the drug library and the equally important on-going symptoms in the elderly, the inability of many hospitalized sustainment tasks of managing drug library change and patients to verbalize symptoms as well as the high prevalence reviewing the wirelessly harvested usage data to assist with of asymptomatic bacteriuria in this patient population and a continuous quality improvement (CQI) programs. Participants low tolerance for anything deemed to be a potential infection will be asked to analyse and interpret typical CQI reports. by the well-meaning front line health care workers including nurses and physicians. Goals and Objectives
The above contribute to the over diagnosis and concomitant 1. To familiarize participants with issues created by antibiotic misuse in the management of UTIs. All is not lost implementing smart pumps. however, prescribing behaviour CAN be changed and you 2. To understand the significance of drug-library build should be a part of it! decisions as they relate to the ordering, preparation, The session will focus on empowering Pharmacist to labelling and administration of sterile products. undertake meaningful discussions surrounding the 3. To review the utility of various forms of CQI reporting from management of UTIs in hopes of curtailing antibiotic misuse. smart pump alert data and how they can be affected by Goals and Objectives drug library build decisions.
1. Highlight the complexity of UTI diagnosis. 4. To use standard CQI reports to understand and change bedside parenteral drug administration practices. 2. Discuss an approach to changing prescribers’ behaviour surrounding the treatment of asymptomatic bacteriuria. Self-Assessment Questions
Self-Assessment Questions 1. Describe an ideal smart pump implementation team.
1. Why must a urine C&S be interpreted in the context of the 2. What are key considerations for building an intermittent clinical picture? drug like piperacillin-tazobactam 3.375 g in 50 mL in a smart pump drug library? 2. How common is asymptomatic bacteriuria? 3. Describe the implications of the various build options 3. What are the risks of under and over-treating in (2) as they relate to ordering, preparation, labelling, asymptomatic bacteriuria with antibiotics? administration and CQI data capture/reporting for that drug.
PSN PHARMACY Smart Pumps SPECIALTY The Skinny on Lipids: New NETWORKS NETW ORK • COMMUNICA TE PSN Derek Andrews, BSc(Pharm), Lions Gate Hospital, North Vancouver, PHARMACY Advances in Fat Emulsions SPECIALTY NETWORKS BC NETW ORK • COMMUNICA TE Samantha Scott, BScPharm, ACPR, Nova Scotia Health Authority, Smart pumps are being implemented in increasing numbers Halifax, NS of hospitals and clinics across Canada, to the point their Essential fatty acid deficiency has been known to develop use is now becoming a standard of care. That this so is in patients receiving total parenteral nutrition without the reflected in the growing numbers of Guidelines and Required addition of an intravenous fat emulsion. The continuous Organisational Practices related to smart pumps in the latest glucose exposure causes an increase in insulin release that 2016 Accreditation Canada standards. prevents the breakdown of endogenous fat stores into essential Institution-wide implementation of smart pumps allows fatty acids. Deficiency in omega-3 and omega-6 fatty acids the organisation to effectively standardize parenteral can cause a wide spectrum of clinical side effects (mostly drug concentrations, administration practices and reduce involving the skin and nervous system). infusion-related errors. The implementation of smart pumps The first intravenous fat emulsions available in Canada were 26 comprised solely of soybean oil. These agents were highly effective at preventing essential fatty acid deficiency; however, observational research (e.g. case reports, case series, cohort with prolonged use of higher doses, toxicities developed. studies, or case-control studies via chart reviews, database Fatty liver, respiratory insufficiency and changes to immune research), experimental research (e.g. quasi-experimental, function were caused by the proinflammatory effects of the non-randomized controlled trials, or randomized controlled high ratio of omega-6 fatty acids in soybean oil. trials), and systematic review research (e.g. meta-analyses), and contribute to their profession through dissemination Newer generations of intravenous fat emulsions have been and publication of their findings. Funding for these research developed to provide a more balanced distribution of essential activities may be obtained through the CSHP Research Grant fatty acids, offsetting the proinflammatory effects of omega-6 Competition. This workshop will provide an overview of fatty acids with the anti-inflammatory effects of omega-3 fatty the CSHP Research Grant Competition, help pharmacists acids. Combination products contain lipids from two or more identify problems in practice that provide good opportunities of the following sources: fish oils, olive oil, medium chain to develop into a “FINER” (feasible, interesting, novel, triglycerides and soybean oils better mimic our body’s natural ethical, relevant) research project, and review the major fatty acid composition. components of a successful research proposal: compiling The purpose of this session is to review the different lipid your research team; background; rationale; significance; components and inflammatory effects of the available purpose; hypothesis; objectives; design; setting; study sample; intravenous fat emulsions, to discuss the practical screening and recruitment; treatment allocation; control implications of dosing and administration of these and experimental interventions; outcome measures; study compounds and to briefly review the evidence available to definitions and procedures; sample size calculation; data support their use. This session is meant to be interactive and analysis and statistical considerations; ethical approval; roles promote discussion of the different cases that will be reviewed. of study personnel; funding sources and preparing a budget.
Goals and Objectives Goals and Objectives
1. Explain the difference in lipid components between the 1. To introduce pharmacists to the processes and tools to they available intravenous fat emulsions. can use to submit a research proposal to the CSHP Research Grant Competition. 2. Discuss the practical issues that may arise with administration of the newer intravenous fat emulsions. 2. To describe the “FINER” criteria that may help pharmacists identify problems in practice that provide good 3. Review the evidence to support the use of alternate opportunities to develop into a “research project. intravenous fat emulsions in everyday practice. 3. To review the major components required to develop a Self-Assessment Questions successful research proposal. 1. What are the major differences between the available Self-Assessment Questions intravenous fat emulsions? 1. Recognize the criteria and submission checklist and criteria 2. How do the differences in intravenous fat emulsions impact for evaluation for submissions to the CSHP Research Grant patient safety and therapeutic outcomes? Competition.
How to Plan Your Submission for the 2. List the “FINER” criteria used to identify problems in practice that may provide good opportunities to develop CSHP Research Grant Competition into a research project. Richard S. Slavik, BSc(Pharm), ACPR, PharmD, FCSHP, Interior 3. List the major components of a successful research Health, Kelowna, BC and University of British Columbia, proposal. Vancouver, BC One of the roles of pharmacists is to develop the knowledge, Launching Your Local Project to the skills, and abilities to conduct independent and collaborative National Stage: Tips and Tricks from research. Pharmacists must foster research collaboration opportunities within the healthcare setting to enhance the CSHP National Awards Program relationships, clarify roles and skills, and improve the quality Kathryn Hollis, RPh, BScPhm, ACPR, MHA, Queensway Carleton of patient care. Collaboration on research projects is vital to Hospital, Ottawa, ON; Sean Spina, BSc(Pharm), ACPR, PharmD, ensure process and outcome targets are being met, and to Vancouver Island Health Authority, Victoria, BC promote the development, implementation, and evaluation of important programs and services that will promote quality CSHP’s long-standing National Awards program has patient care. Pharmacists have the opportunities to participate recognized hundreds of CSHP members since its inception in in descriptive research (e.g. surveys and qualitative studies), 1967. The goal of this session is to highlight the importance 27 of the CSHP National Awards Program and to encourage Prior to 2014, 30000 Canadians were authorized to receive the submission of CSHP members’ local projects for National medical marihuana under the previous regulations. This recognition. Previous award winners’ projects have ranged number is expected to increase dramatically under the new from simple to complex projects; however every project has MMPR. Hospitals must prepare to accommodate the use of an equal opportunity to succeed on the national stage. This medical marihuana in patients within appropriate clinical session will highlight multiple submission tips and tricks, parameters by establishing policies and procedures that including a discussion on how members can increase their facilitate smooth transitions, secure storage, safe handling by chances of success by aligning local projects with the National staff and appropriate administration for the setting. Awards criteria. “It always seems impossible until it’s done” – Goals and Objectives Nelson Mandela 1. Understand changes to the Marihuana for Medical Goals and Objectives Purposes Regulations (MMPR) and their impact on patients 1. To appreciate how participants projects align with the and health care professionals. National General Awards categories. 2. Provide an overview of the literature on the efficacy and 2. To appreciate the benefits of applying to the CSHP National safety of medical cannabis for chronic pain. General Awards Program. 3. Discuss the role of the pharmacist in the management of 3. To understand tips & tricks on how best to develop patients seeking and using medical cannabis for chronic submissions worthy of national award recognition. pain.
4. To appreciate the misconceptions in the National Awards 4. Explore implications for hospitals relating to the Program. prescribing, dispensing, storing and administration of medical marihuana and the process for development of Self-Assessment Questions relevant policies and procedures. 1. List 2 of your projects and the Awards Category to which Self-Assessment Questions they could qualify. 1. Under the MMPR regulations, from whom are patients 2. List the 2 benefits of submitting to the CSHP National permitted to source their marihuana from? General Awards Program. 2. What are some of the harms associated with the use of 3. List 2 misconceptions about the CSHP National Awards cannabis? Program. 3. For chronic pain, what is the recommended place in 4. Identify 3 criteria that will improve your chance of therapy for medical cannabis, based on the assessment of becoming a national award winner. efficacy and harms?
Medical Marijuana for Chronic Pain Tuesday February 2 Laura Murphy, PharmD, ACPR, BScPhm; Michael Wong, BScPhm, Mardi 2 février ACPR, University Health Network, Toronto, ON
In Canada the Marihuana for Medical Purposes Regulations Assessing and Managing Antimicrobial (MMPR) came into effect in 2014, resulting in significant Allergy: What Every Pharmacist Should changes to the application or prescribing process and sourcing Know of product. These new regulations have had significant implications for both patients and prescribers, and have seen Jackie Campbell, BSc(Pharm), LLB, Sunnybrook Health Sciences the introduction of producers licensed by Health Canada. Centre, Toronto ON
At the same time, there has been an explosion in publications When selecting an antimicrobial agent, one of the most related to medical cannabis in recent years, with selected frustrating issues for healthcare practitioners is the dreaded randomized controlled trials on the use of smoked and “Drug Allergy” notation in the patient’s record. Often the vaporized cannabis for chronic pain and numerous history of antimicrobial allergy is vague or confusing, yet systematic reviews and meta-analysis. The majority of this prescribing a drug to which the patient is “allergic” (or from body of literature is composed of editorials and commentaries, among that class) is generally avoided. As a result, patients illustrating a great debate within medical and research may be denied first-line therapy and receive alternative communities on the topic. Helpful to clinicians are selected agents that may be less effective, more toxic and/or more articles offering clinical guidance on the management of costly. patients seeking and using medical cannabis for their pain. 28 Following an overview of immunologic reactions to drugs, relevant cardiovascular outcomes. This session will provide we will focus on reactions relating to specific antimicrobial a practical overview of the efficacy and safety of PCSK9 classes. We will discuss strategies to manage patients with inhibitors including critical appraisal of recently published possible antimicrobial drug allergies, including the role clinical trials. of drug allergy testing, avoidance of cross-reacting drugs, Goals and Objectives desensitization, and the use of graded challenges. Finally, we will discuss issues to consider in removing “Allergy” labels in 1. To briefly review the clinical data for pharmacologic agents those patients who can safely take antimicrobials to which developed for the treatment of dyslipidemia over the past they had previously reported an allergy. 10 years.
Goals and Objectives 2. To discuss the efficacy and safety of PCSK9 inhibitors in the treatment of dyslipidemia. 1. Review the types of drug allergy/hypersensitivity reactions, with a focus on selected classes of antimicrobials. 3. To critically appraise recently published clinical trial data for PCSK9 inhibitors including a practical approach to 2. Discuss drug allergy testing, highlighting usefulness and applying this evidence in practice. limitations. Self-Assessment Questions 3. Explore strategies for managing the antimicrobial-allergic patient. 1. Which pharmacologic agents are likely to impact the treatment of dyslipidemia in Canada? 4. Consider the impact of being labelled “allergic” to an antimicrobial. 2. What is PCSK9 and what is its role in the regulation of serum low-density lipoprotein levels? Self-Assessment Questions 3. Do PCSK9 inhibitors, in addition to statin therapy, reduce 1. What are the key barriers in providing optimal cardiovascular events in patients with dyslipidemia? antimicrobial therapy in patients with allergies to these drugs? Clinical Update in Stroke 2. How reliable is skin testing in determining a patient’s allergy to a particular drug or class? Ruby Liang, BScPhm, ACPR, PharmD, St. Michael’s Hospital, Toronto, ON 3. How does your organization undertake removal of the “allergy” label from the patient’s records? The purpose of this session is to provide an overview of the management of stroke – focusing on new evidence and Those P-Something-Something updates in best practice recommendations. Inhibitors for Dyslipidemia Stroke is the third major cause of death and the leading cause of disability in Canada. The goals of therapy in stroke Arden Barry, BSc, BSc(Pharm), PharmD, ACPR, Chilliwack General and transient ischemic attack (TIA) are to limit neurologic Hospital , Chilliwack, BC and University of British Columbia, damage, decrease mortality, minimize long-term disability Vancouver, BC and prevent recurrence. With approximately 62,000 people Over the past decade, the development of new therapies with stroke and TIA treated in Canadian hospitals each year, for the treatment of dyslipidemia has been plagued with hospital pharmacists play an integral role in optimizing overinflated expectations followed by disappointing results patients’ stroke management. about on par with a few not-to-be-named Canadian hockey Secondary prevention strategies should be implemented in franchises. Despite improving in lipid parameters, none of the hyperacute, acute and rehabilitation stages of stroke. these agents have shown a reduction in clinically meaningful Treatment modalities include both non-pharmacologic outcomes. However, 2015 brought new life to this commonly and pharmacologic strategies targeting thrombolysis, encountered scenario, and expectations have started to antithrombotic therapy and management of blood pressure, rise once more. This session will provide attendees with diabetes, and atherosclerotic disease. Recent best practice a brief summary of the agents that have been developed guidelines have been updated with recommendations for the treatment of dyslipidemia over the past 10 years regarding literature published on diagnostic and treatment including cholesteryl ester transfer protein (CETP) inhibitors, options including, but not limited to dual antiplatelet therapy, niacin/laropiprant, phospholipase A2 (PLA2) inhibitors, prolonged cardiac monitoring and endovascular therapy. and proprotein convertase subtilisin/kexin type 9 (PCSK9) Clinicians should be aware of the available evidence, the inhibitors. The focus of the presentation will be on the PCSK9 strength of the recommendations, and how these therapies inhibitors, which, to date, have demonstrated the most may be integrated into existing practice. promising data regarding a potential reduction in clinically 29 Goals and Objectives 3. What recommendations should Pharmacy Organizations and pharmacists propose to the Choosing Wisely 1. Review updates in the Canadian Stroke Best Practice campaign? Recommendations guidelines in the management of hyperacute and acute stroke. Update on New Drugs for Pulmonary 2. Provide an overview of new evidence for the secondary Arterial Hypertension prevention of stroke. Sandra Porter, BScPhm, University Health Network, Toronto, ON Self-Assessment Questions Pulmonary arterial hypertension (PAH) is a debilitating 1. What is the evidence regarding the use of dual antiplatelet disease with an estimated 15% annual mortality rate. therapy after an ischemic stroke? Its pathogenesis involves several changes that occur in 2. Does the use of endovascular therapy change the the pulmonary arterioles, including vasoconstriction, antithrombotic therapy used in secondary prevention of smooth muscle and endothelial cell proliferation, and stroke? intravascular thrombosis. These changes lead to increased pulmonary resistance and eventual right-sided heart failure. Choosing Wisely: What Should Understanding this pathological process has provided us with targets for four classes of medications to treat PAH: be Hospital Pharmacists’ Top 5 phosphodiesterase-5 (PDE-5) inhibitors, endothelin receptor Recommendations? antagonists (ERAs), prostacyclin analogues, and a new soluble Jenny Chiu, BScPhm, PharmD, ACPR, RPh; Monica Lee, BScPhm, guanylate cyclase (sGC) stimulator. MSc, PharmD, RPh, North York General Hospital, Toronto, ON This presentation will provide a review of PAH including There have been many treatments and interventions the four classes of medications used for treatment. It will which may not be substantiated by evidence or may not discuss the evidence behind their place in therapy based on be necessary at all or even harmful. In 2012, the American functional class. First line agents such as the PDE-5 inhibitors Board of Internal Medicine (ABIM) along with Consumer or ERAs are used as monotherapy in less symptomatic disease Reports and 9 medical societies launched the Choosing (WHO functional class II-III), and inhaled or parenteral Wisely campaign. This campaign’s initiative was to engage prostacyclin analogues are considered second line agents, patients and health care professionals in discussions about except in severe cases. The newest class of sGC stimulator, unnecessary interventions, tests, and procedures. It has riociguat, is approved for first line use in a similar role since expanded internationally with over 70 specialty to other oral agents. However, its place in therapy is still societies that have developed more than 415 evidence-based evolving, as there are no head-to-head trials comparing the recommendations. However, none of the pharmacy societies different classes of first line oral agents. have officially published recommendations for this campaign. It is also important to account for the significant risks In today’s healthcare environment, it is important to be associated with each drug class when looking at treatment fiscally responsible and use effective therapies. This session options. This presentation will highlight practical challenges will explore ways that pharmacists can be involved in the encountered by hospital pharmacists including cost, campaign and consider what Pharmacists’ Top 5 Choosing administration, drug interactions, adverse effects, and Wisely Recommendations should be. withdrawal concerns.
Goals and Objectives Goals and Objectives
1. Discuss the Choosing Wisely campaign. 1. To review the classification and pathophysiology of 2. Illustrate one institution’s experience in implementing pulmonary hypertension. Choosing Wisely recommendations. 2. To discuss medications used for treatment of pulmonary 3. Propose Pharmacists’ Top 5 recommendations for Choosing arterial hypertension, including supporting evidence and Wisely. new therapies.
Self-Assessment Questions 3. To highlight practical challenges when using medications to treat pulmonary arterial hypertension. 1. Which of the current Choosing Wisely recommendations can pharmacists have an impact on? Self-Assessment Questions
2. How can pharmacists implement current recommendations 1. List the four classes of medications used in the treatment of in the Choosing Wisely campaign in their practice setting? pulmonary arterial hypertension.
30 2. What are two challenges for hospital pharmacists when Self-Assessment Questions managing patients on treatment for pulmonary arterial 1. What are the four most common body systems affected hypertension? (side effects) by immune-checkpoint inhibitors? Which other systems can experience toxicity, though less Immunologic-Related Adverse Events frequently? Associated with Immune Checkpoint 2. At which points in treatment would a patient expect to Inhibitors in Cancer Treatment experience each of the irAEs associated with the immune- Mark Pasetka, BSc, BScPharm, PharmD, Sunnybrook Health checkpoint inhibitors? Sciences Centre, Toronto, ON 3. How does the mechanism of CTLA-4 inhibition affect Proposed more than one hundred years ago, immune system the way in which you approach the assessment and involvement in the detection and elimination of cancer cells management of gastrointestinal toxicities (namely has only recently garnered therapeutic notice. Research diarrhea)? conducted in the last several decades confirms initial theories; however, tangible outcomes have until recent years been TARGeTing Empiric Antimicrobial elusive. Patients can achieve improved responses and many of Therapy: Development of an the adverse effects associated with traditional chemotherapy Antibiogram App have been minimized or eliminated. As continued experience with these agents accrues, clinicians are realizing that despite Reem Haj, BScPharm, ACPR, PharmD, St.Michael’s Hospital, the pharmacologic approach these medications take, the Toronto, ON fallout from this immunologic stimulation can lead to effects Antibiograms and infectious disease treatment algorithms never or rarely seen in the past. are important tools clinicians can use when making decisions The immune related adverse events (irAEs) that are seen about empiric antimicrobial therapy. Despite availability with immune checkpoint inhibitors used in cancer therapy of the antibiogram and infectious disease treatment appear to be related to inflammatory processes that are a algorithms on the intranet at our institution, many clinicians result of immune system activation. These toxicities most are unaware that these tools exist or have indicated that commonly involve specific body tissues including the skin they are not easy to access. This experience is not unique and mucous membranes, gastrointestinal tract, liver, and to our institution; published surveys of physicians, nurse endocrine system, but can also manifest as pulmonary, renal, practitioners, and medical trainees report that up to half and haematologic disorders. Many of these irAEs can be of respondents are unaware that such tools exist at their managed using relatively non-invasive and readily accessible institution. Furthermore, ease of access has been identified as immunosuppressive therapies which do not appear to affect one of the major barriers to the utilization of these tools at the the anticancer effect of these agents. Moreover, if cessation of point of prescribing. therapy is required, patients may still experience long-term Facilitating access to institution specific antibiograms and clinical benefit. infectious disease treatment algorithms could potentially These medications, initially studied in melanoma patients, improve antimicrobial prescribing. Recognizing that the are acquiring new indications based on emerging evidence in majority of prescribers and pharmacists are using smartphone other cancer types. Additionally, combination treatment with medical applications at the ‘point of care’, the concept of chemotherapy and radiation is being explored to improve an antibiogram smartphone application was proposed at efficacy. Ongoing studies will undoubtedly provide more our institution. A multidisciplinary team of physicians, insight into both the benefit and safety of these agents. pharmacists and IT experts collaborated on the development of the TARGeT (Toronto Area Resistance rates and Guidelines Goals and Objectives to Treatment) smartphone application. 1. Familiar with the agents in this class of anti-cancer Goals and Objectives medications. 1. To describe the stages in the development of the TARGeT 2. Familiar with the common immune-related adverse effects smartphone application. of both CTLA-4 and PDL-1 inhibitors. 2. To discuss the challenges encountered in the development 3. Comfortable in managing patients receiving these agents of the TARGeT smartphone application. and who have developed immune-related adverse effects.
31 3. To describe the impact of the TARGeT smartphone 2. What are the advantages and disadvantages of application on knowledge of and confidence in prescribing concentrated insulins? of antibiotics among senior medical students and residents.
Self-Assessment Questions Hepatorenal Syndrome in the PSN PHARMACY Intensive Care Unit SPECIALTY 1. List 3 strengths and weaknesses of existing antibiogram NETWORKS NETW ORK • COMMUNICA TE smartphone applications. Norman Dewhurst, BScPhm, ACPR, PharmD, St. Michael’s Hospital, Toronto, ON and University of Toronto, Toronto, ON 2. List 3 challenges in the development of medical smartphone applications. The goal of this session is to provide pharmacists with an overview of hepatorenal syndrome (HRS) in the critical care New Drugs in Diabetes Management setting. HRS is defined as the occurrence of renal failure without an identifiable cause, in a patient with advanced Alice YY Cheng, MD, FRCPC, Trillium Health Partners, Toronto, ON liver disease. The onset of HRS may be precipitated by an The pharmacologic treatment options for type 2 diabetes acute insult, such as gastrointestinal bleeding or spontaneous continue to expand rapidly. In 2014, the SGLT2 inhibitor bacterial peritonitis. class of oral antihyperglycemic agents became available in The ideal therapy for HRS is improvement in hepatic Canada, first with canagliflozin, followed by dapagliflozin, function due to partial or full resolution of the primary then empagliflozin. By inhibiting the SGLT2 in the proximal disease. Preventative therapies have been studied with mixed tubule of the kidneys, urinary glucose excretion is increased results. When improvement of liver function is not possible thereby resulting in better glycemic control, potential weight in the short term, medical therapy should be initiated in an loss and blood pressure reduction. Given that these drugs attempt to reverse the acute kidney injury associated with work through the kidneys, reduced renal function reduces HRS. Without therapy, most patients will die within weeks of their glycemic efficacy which is why the current labels require the onset of renal impairment. The most effective treatment an eGFR >60 mL/min to initiate any of them. The primary agents available are vasoconstrictive agents, including adverse effects of this class are genital mycotic infections, the vasopressin analogues, noradrenaline, midodrine and urinary tract infections and other less common side effects. In octreotide. As these patients have high morbidity and September 2015, the results of the first SGLT2 cardiovascular mortality, serious adverse events occur when vasoconstrictive outcome trial was published (EMPA-REG OUTCOME) and it agents are used without adequate knowledge or experience. demonstrated a surprising reduction in cardiovascular death, hospitalization for heart failure and all-cause mortality in For patients who do not respond to medical therapy, the patients with T2DM and pre-existing cardiovascular disease placement of a shunt (transjugular intrahepatic portosystemic which has resulted in practice change. The other major or peritoneovenous) remains an option. Renal replacement updates in 2015 are the introduction of glargine 300 units/ therapy and liver transplantation are other modalities that mL and lispro 200 units/mL. These insulins have the obvious have been used to treat HRS, both which require pharmacist advantage of smaller volume of injection, but interestingly in involvement. Pharmacists are the ideal healthcare providers the case of glargine 300 units/mL, the act of concentrating the to optimize the care of these complex patients. insulin resulted in an improvement in the time-action profile Goals and Objectives so that it is slightly flatter and longer acting, which translates into less hypoglycemia in type 2 diabetes. Although we have 1. Describe the etiology and diagnostic criteria for HRS. had concentrated insulins in the past, these newer insulins 2. Explain the pathophysiologic basis for using are delivered in a way that removes some of the pitfalls of the vasoconstrictive agents in HRS. older concentrated insulin (Humulin R U500). 3. Summarize the recent literature on the use of various Goals and Objectives agents to treat HRS. 1. Describe the mechanism of action, pros and cons of SGLT2 4. Discuss the pharmacist’s role in the management of HRS in inhibitors and the latest CV outcome data. the critical care setting.
2. List the new additions to the insulin market – time-action Self-Assessment Questions profile, pros and cons and potential pitfalls. 1. Compare and contrast the efficacy and adverse effect 3. Name emerging therapies in diabetes profile of vasopressin analogues versus norepinephrine for Self-Assessment Questions treatment of HRS.
1. What are the advantages and disadvantages of SGLT2 2. What is the role of pentoxifylline in HRS patients? inhibitors? 32 3. What are the goals of therapy and monitoring parameters Plants vs. Drugs: The for HRS patients on vasoconstrictor therapy? PSN PHARMACY Complexities of Natural Health SPECIALTY NETWORKS ProductsNETW ORK • COMMUNICA TE and Evidence-Based Medicine Etiologies and Management of PSN Rose Liao, RPh, BSc(Pharm), ACPR, Trillium Health Partners, PHARMACY Acute Pancreatitis SPECIALTY NETWORKS NETW ORK • COMMUNICA TE Mississauga, ON Pulkit Bhuptani, BHSc, PharmD, St Michael’s Hospital, Toronto ON The use of supplements is increasing in the general Acute pancreatitis, an inflammatory disorder of the population and up to 71% of Canadians have used at pancreas, is a leading cause for gastrointestinal tract related least one type of natural health product. Many patients do hospital admissions. While many cases are mild and self- not disclose their use to clinicians. Natural health product limiting in nature, mortality rates can exceed 30% in the and drug interactions can be serious enough to affect the subset of patients with severe presentation. Patients with efficacy of conventional treatments and cause harm to severe acute pancreatitis usually experience multi-organ patients. These can occur through both pharmacokinetic and failure, hemodynamic instability, sub-optimal nutrition, pharmacodynamic mechanisms. This presentation provides infectious complications and a prolonged hospital admission. an overview of these types of interactions and provide clinical Furthermore, they usually require complex interventional examples. procedures. As such their management is primarily Goals and Objectives orchestrated within the intensive care unit setting. 1. Define “natural health product”. The goal of this presentation will be to help clinical pharmacists understand the underlying pathophysiology of 2. Describe natural health product legislation in Canada. acute pancreatitis and how to assess disease severity based on 3. Describe the safety concerns about natural health products. a patient’s clinical presentation. Moreover, the most common etiologies responsible for this disease process will be explored 4. Describe 3 significant drug interactions between a natural and an overview of management strategies, as it relates to a health product and a medication(s). particular etiology, will be provided. Finally, this presentation will give you an appreciation for the role a pharmacist can 5. List 3 reliable resources for information regarding natural play in influencing the management of a patient with acute health products. pancreatitis, be it in selecting appropriate antibiotic regimens Self-Assessment Questions for infectious complications, providing pharmacotherapeutic options for the management of hypertriglyceridemia or in 1. Which of the following is a natural health product? identifying and managing drug-induced pancreatitis. a. Vitamin C Goals and Objectives b. Digoxin c. Cyanide 1. Understand the pathophysiology and severity classification d. Intralipid of acute pancreatitis. 2. Which of the following regarding risks of natural health 2. Outline different etiologies of acute pancreatitis – products is true? specifically: gallstones, alcoholism, hypertriglyceridemia and drug-induced pancreatitis. a. They are strictly regulated by Health Canada b. It costs millions of dollars to introduce 1 natural health 3. Appreciate management strategies, both general and product to market etiology specific, as they relate to disease severity. c. There may be contaminants in natural health products 4. Recognize the role of the clinical pharmacist in managing d. Therapeutic effectiveness is rigorously tested patients with acute pancreatitis. 3. Interactions between natural health products and Self-Assessment Questions medications may occur via:
1. What are the main risk factors for developing acute a. Chelation pancreatitis? b. Competition for excretion c. Inhibition and induction of liver enzymes 2. Which drugs are associated with acute pancreatitis? d. All of the above 3. When is antibiotic therapy appropriate in acute pancreatitis?
33 Serious Drug-Induced Skin Wednesday February 3 PSN PHARMACY Reactions Mercredi 3 février SPECIALTY NETWORKS NETW ORK • COMMUNICA TE Sandra Knowles, RPh, BScPhm, St. Michael’s Hospital, Toronto, ON Exploring Opportunities for Skin eruptions are one of the most common types of Collaboration across the Spectrum adverse drug reactions, with an overall incidence of 2-3% in of Formulary Decision-Making: From hospitalized patients. Although most cutaneous eruptions are not serious (e.g., exanthematous or maculopapular Hospitals to Health Authorities to Drug eruption, photosensitivity, urticaria), some are severe and Plans potentially life-threatening. Drug reactions may be solely Brent Fraser, BScPhm, MBA, Canadian Agency for Drugs and limited to the skin, or they may be part of a systemic reaction. Technologies in Health, Toronto, ON; Bill Semchuk, MSc, PharmD, Severe cutaneous adverse reactions, also known as “SCAR”, FCSHP, Regina Qu’Appelle Health Region; Anne Hiltz, BScPharm, are associated with significant morbidity and mortality MHS, ACPR, Nova Scotia Health Authority, Halifax, NS ; Angie and include four main syndromes: acute generalized Wong, BScPhm, MSc, ACPR, Ontario Ministry of Health and Long- exanthematous pustulosis (AGEP), Stevens-Johnson syndrome Term Care, Toronto, ON (SJS) and toxic epidermal necrolysis (TEN) and drug rash with eosinophilia and systemic symptoms (DRESS). Other serious In today’s health care environment it is important for decision skin eruptions include drug-induced lupus, linear IgA bullous makers to have the right tools that enable them to make dermatosis and serum sickness-like reactions. evidence informed decisions whether it is drugs, devices or procedures. This information may be reviewed in a number SJS and TEN are considered to be clinically the same of different ways using different inputs. This can lead to syndrome with different severities across the spectrum; they different and/or conflicting decisions being made on how a are distinguished by the level of skin detachment. DRESS is technology is used in various settings resulting in the creation associated with fever, rash, eosinophilia and internal organ of barriers that can impede or delay access to medications. involvement; in contrast, internal organ involvement is It is important to ensure that organizations are sharing often absent in AGEP, which is characterized by fever and a information to avoid duplication and to align decisions. pustular drug eruption. CADTH was created in 1989 by Canada’s federal, provincial Using case studies, this presentation will focus on the and territorial governments and is an independent, not- clinical presentations including time to onset and long-term for-profit organization responsible for providing health sequelae, implicated culprit medications, pathophysiology care decision makers with objective evidence to help and important diagnostic and therapeutic considerations make informed decisions about the optimal use of health in the management of SCAR. In addition, the ability to technologies. CADTH recommendations are the basis of drug predict patient susceptibility to SCARs with the use of genetic funding recommendations for the public drug programs, with markers, which are specific to drug, phenotype and ethnicity, the exception of Quebec. Some private sector organizations will be reviewed. also use CADTH recommendations to support their work. Goals and Objectives This panel will explore opportunities for collaboration for After attending this session, the participant should be able to: formulary decision making. CADTH’s Drug Policy Advisory Committee has identified the need to engage other partners 1. Describe the clinical presentation of various severe across the hospital sector and health authorities to determine cutaneous adverse reactions, including SJS and TEN, DRESS if there are opportunities to align the processes for drug and AGEP. reviews and recomemdnations, as well as the formulary 2. Identify the most frequently implicated drugs causing decisions. severe cutaneous adverse reactions.
3. Describe diagnostic and therapeutic options in the Hyperphosphatemia: A Silent Killer in management of patients with SCAR. Chronic Kidney Disease
Self-Assessment Questions Philip Lui, BScPhm, PharmD, University Health Network, Toronto, ON 1. What are distinguishing features of SJS/TEN, DRESS and AGEP? Hyperphosphatemia is highly prevalent in patients with chronic kidney disease (CKD). It can lead to phenotypic 2. What role does pharmacogenetic testing have in predicting changes to smooth vascular muscle cells resulting in systemic patients at risk for severe cutaneous adverse reactions? vascular calcification that is different from atherosclerosis. It is well recognized that hyperphosphatemia is independently 34 associated with increased mortality, however the evidence 2. To summarize a practical approach to assessing the use of to support lowering phosphate is less than convincing. triple antithrombotic therapy and to optimizing the risk/ Nevertheless much resources and effort are dedicated to benefit balance for the patient. manage hyperphosphatemia. Phosphate binders continue to Self-Assessment Questions be the corner stone of treatment for most patients with CKD. The decision to use calcium-based binder versus non-calcium- 1. What are the benefits of antiplatelet and anticoagulant based binder remains difficult due to uncertain benefit in therapies in common CV conditions? meaningful clinical outcomes and significant cost difference. 2. What factors increase bleeding risk in CV patients? There is also a new class of iron-based phosphate binders that may offer a new strategy to treat both hyperphosphatemia 3. What resources/guidelines are available when assessing the and iron deficiency commonly associated with CKD. use of combination antiplatelet and anticoagulation “triple therapy”? Goals and Objectives 4. What strategies are available to optimize the benefit/risk 1. Review the pathophysiology of hyperphosphatemia and balance in patients on “triple therapy”? vascular calcification.
2. Review the treatment targets. Going beyond the Numbers: How to 3. Describe the place in therapy of various phosphate binders, Use Medication Incidents to Evaluate including the new class of iron-based binders. Medication Safety Culture Self-Assessment Questions Calvin Poon, RPh, BScPhm, ACPR, CDE, Peterborough Regional 1. How is vascular calcification different in chronic kidney Health Centre, Peterborough, ON disease compared to atherosclerosis? A positive patient safety culture is an integral component of a 2. Who should be treated with a non-calcium-based safer healthcare system. Conventional cultural measurement phosphate binder? tools, such as surveys and questionnaires, are largely limited by their inability to capture the complex human interaction. Triple Antithrombotic Therapy The purpose of this initiative was to create an analytic tool leveraging medication incidents as a data source to assess Kori Leblanc BScPhm, ACPR, PharmD, University Health Network safety culture. and OpenLab, Toronto ON To develop this tool, 200 medication incidents from two Antithrombotic therapy is a cornerstone in the management incident reporting databases were analyzed qualitatively. of cardiovascular disease. Antiplatelet therapy is indicated Themes that were suggestive of a positive safety culture were in coronary artery disease (CAD), acute coronary syndromes identified and subsequently led to the development of an (ACS), peripheral arterial disease (PAD) and secondary analytic tool. stroke prevention. Anticoagulant therapy may be used for The analytic tool is a 3x4 matrix called the Medication stroke prevention in Atrial Fibrillation (AF), mechanical Safety Culture Indicator Matrix (MedSCIM). MedSCIM uses bioprosthesis and in some case of profound left ventricular qualitative analysis methods to assess a medication incident dysfunction. In some of our CV patients, indications exist on two dimensions: (1) completeness of documentation, for both anticoagulant and antiplatelet therapies – in some and (2) maturity of the incident report with regards to the cases multiple antiplatelet agents – but the combination perspective on patient safety. A low grade on the maturity increases the risk of major bleeding. Finding the balance score is termed “blame-and-shame,” where the clinician at between prevention of cardiovascular events and minimizing fault was victimized and held responsible for the error. The bleeding risk is the goal, but achieving that balance can highest maturity score is “generative,” where the incident be challenging. The concomitant use of dual antiplatelet reporter adopts a systems-based approach for identification therapy using aspirin and a platelet P2Y12 receptor blocker of vulnerable safety gaps in the healthcare system and combined with an oral anticoagulant is referred to as triple implements an action plan. antithrombotic therapy (“triple therapy”). This session will review the available evidence to help provide a framework MedSCIM is an innovative tool that uses medication incidents for pharmacists to use in assessing use of triple therapy and to evaluate medication safety culture in healthcare settings. optimizing the benefits while minimizing the risks. In order to advance patient safety, more resources must be available to better understand and measure patient safety Goals and Objectives culture. MedSCIM offers a novel approach to understand 1. To highlight the benefits and risks and review the current safety culture through the lens of medication incident guidelines around the use of triple antithrombotic therapy. reporting and analysis. 35 Goals and Objectives 2. Review the efficacy and safety of approved biologics and how this evidence translates into the current therapeutic 1. Understand the limitations of conventional quantitative approaches and treatment paradigms for managing CD analysis to medication incident reports. and UC. 2. Recognize a novel approach of using the Medication Safety 3. Describe strategies for optimizing response to biologics, with Culture Indicator Matrix (MedSCIM) to quantitatively a focus on TDM and the use of combination therapy. capture the medication safety culture from medication incident reports. Self-Assessment Questions
Self-Assessment Questions 1. What are some predisposing factors for primary non- response and causes of secondary loss of response to TNF- 1. Identify 2 limitations to conventional quantitative analysis alpha inhibitors? to medication incident reports. 2. What are four patterns of insufficient clinical response to 2. Describe attributes of a positive and negative medication TNF-alpha inhibitors and what strategy is used in each safety culture. situation to regain response?
Biologics in Inflammatory Bowel Street Drugs: Toxicity and Approach to Disease Management Wenya Miao, BScPharm, PharmD, ACPR, Mount Sinai Hospital, Debra A. Kent, BA, PharmD, DABAT, FAACT, RPh, BC Drug Toronto, ON and Poison Information Centre, BC Centre for Disease Control, Crohn’s disease (CD) and ulcerative colitis (UC), the two Provincial Health Services Authority, Vancouver, BC primary constituents of inflammatory bowel disease (IBD), The purpose of this session is to discuss the current trends affect approximately 1 in 150 Canadians. The incidence and in street drug use in Canada, acute clinical effects and the prevalence rates of IBD in Canada are among the highest in approach to treatment. the world. At the center of both disease states are a disruption in intestinal homeostasis and an inappropriate continuing Clinical pharmacists should be knowledgeable about current inflammatory response to the gastrointestinal flora that street drug use and understand the toxicology of these results in chronic mucosal inflammation. substances in order to enhance patient care in the emergency and critical care setting. Drug abuse patterns vary by region, Biologics are one class of therapeutic agents that have been and information volunteered by patients may be unreliable, shown to be effective at inducing and maintaining remission incomplete or unobtainable. Literature and media reports in CD and UC. These monoclonal antibodies target various from other countries may not reflect local street drug use parts of the inflammatory cascade in the gastrointestinal patterns. tract to inhibit mucosal inflammation. Since the arrival of infliximab, the first monoclonal antibody against the The most commonly abused substances in many Canadian proinflammatory cytokine TNF-alpha, in the late 1990s, regions include ethanol, benzodiazepines, prescription many other agents have come to market. These include the opioids, and marijuana. These will not be the primary focus TNF-alpha inhibitors adalimumab, certolizumab pegol, and of this talk. Discussions in this session will highlight toxicity golimumab, the interleukin 12/23 inhibitor ustekinumab, and and management of exposures to street drugs or medications/ the integrin inhibitors natalizumab and vedolizumab. substances purchased from a street or internet source. Substances to be discussed will include illicit opioids, ecstasy, This presentation aims to provide an overview of the GHB and ketamine as well as new synthetic designer drugs therapeutic role of currently available biologic agents in the including the wide variety of phenethylamines (e.g., NBOMe, treatment of CD and UC. Clinical evidence surrounding their 2C substitutes, cathinone, mephedrone, methylone, “bath efficacy and safety, the role of therapeutic drug monitoring salts”, “research chemicals”). (TDM), and options for optimizing their therapeutic effect will be discussed. Life-threatening toxicities of these agents range from extreme agitation, hyperthermia, hypertension, seizures and CNS Goals and Objectives depression to metabolic acidosis, coagulopathy, and multi- 1. Understand the mechanisms of action of the different organ failure. Mechanisms of acute toxicity and approach to classes of biologic agents as they relate to our management will be discussed. understanding of the inflammatory pathways involved in Goals and Objectives IBD.
36 1. To discuss current and emerging street drugs and their 2. To summarize practical tips, strategies and lessons learned toxicity. for the leadership transition from the perspectives of new and experienced leaders. 2. To discuss the current approach to managing toxicity of street drug overdose. Self-Assessment Questions
Self-Assessment Questions 1. State three specific leadership topics that you can benefit from to improve your leadership approach. 1. What are the primary acute toxicities associated with street drugs in Canada? 2. List three common leadership challenges you have encountered and for each at least one approach to learn 2. What treatment strategies should be considered in the more about to address these challenges. management of these patients? 3. Outline two approaches to practice or organizational So Now You’re the Boss! A Toolbox for change management. Transitioning from the Front Line to a Making Decisions about Pharmacy Leadership Role PSN PHARMACY Thromboprophylaxis in Special SPECIALTY NETWORKS Olavo Fernandes, BScPhm, ACPR, PharmD, FCSHP, University PopulationsNETW ORK • COMMUNICA TE Health Network and University of Toronto, Toronto ON Artemis Diamantouros, BScPhm, MEd, PhD, Sunnybrook Health It’s day one and you have just transitioned to be a pharmacy Sciences Centre, Toronto, ON clinical coordinator after seven years as a staff pharmacist. You are very excited and a little bit nervous about your new Venous Thromboembolism (VTE) comprises both deep vein role. You have many questions in your mind: Where do I start thrombosis (DVT) and pulmonary embolism (PE) and is first? How do I develop effective relationships with my new one of the most common and preventable complications of team members? How do I prioritize my day for the diversity hospitalization. VTE is associated with substantial morbidity of new and unfamiliar responsibilities? What are my most and mortality and symptomatic VTE is associated with valuable strengths as a leader to support this team and my extended duration of inpatient stays and high fatality rates. organization? What types of courses and leadership programs Thromboprophylaxis for patients in hospital at risk can should I take? What can I learn from other new leaders? Who reduce VTE by 30-65% and has been shown to have a low risk can I go to advice and mentorship? What role models can I of major bleeding and well-documented cost-effectiveness. look to for inspiration? What am I most in doubt about and As of January 2011, Venous Thromboembolism (VTE) what skills do I need to develop? Prophylaxis is a Required Organizational Practice (ROP) for Many pharmacists make the leap from the front line to a all Canadian hospitals accredited by Accreditation Canada. management/ leadership role. Often clinicians may not Despite significant improvements in VTE prophylaxis in be fully prepared to effectively transition into this very Canadian hospitals, questions still remain as to how to different and important capacity. In this practical interactive best manage patients in what we might consider, “Special session, we will review tips, insights and lessons learned from Populations”. What patient factors need to be considered experienced and new leaders. What tools can equip you to when deciding on thromboprophylaxis? What is the optimal make an impactful, rewarding and effective transition? Tools, duration of prophylaxis in the rehab or long term care setting concepts and topics that will be briefly touched on include: or in palliative care? emotional intelligence, “strengths- finder”, the “Leads” Framework (Leads Self, Engage Others, Achieve Results, This session will aim to review the existing evidence in Develop Partnerships, System Change), situational leadership/ these special populations and will engage the participants leadership styles, change management approaches in discussion regarding application of this evidence to best (examples- Appreciative Inquiry and “The Kotter Model”), manage these patients. conflict management, decision-making, generational Goals and Objectives differences as well as strategic planning/ crafting a vision and strategic priorities for your team. 1. Review existing literature for VTE prophylaxis in special populations. Goals and Objectives 2. Identify practical approaches to managing patients with 1. To outline foundational topics for new leaders making the renal dysfunction, obesity, pregnancy, etc. transition from the front-line to a leadership role.
37 3. Consider optimal duration of VTE prophylaxis beyond the 1. Explain how presentation to the ED change throughout acute care setting (e.g. palliative care, rehab, long term different age classifications. care). 2. What are the most common adverse drug events in children Self-Assessment Questions discovered in the ED?
1. What is an appropriate duration of thromboprophylaxis 3. Name tools for children and adults that aid in assessing for a patient outside of the acute care setting (e.g. rehab, appropriateness of medication therapy. palliative care, long term care)?
2. What, if any, patient characteristics are important to Pediatric Poisoning: Toddlers to PSN consider for thromboprophylaxis? PHARMACY Teens SPECIALTY NETWORKS NETW ORK • COMMUNICA TE Debra A. Kent, BA, PharmD, DABAT, FAACT, RPh, BC Drug Cases from the Pediatric PSN and Poison Information Centre, BC Centre for Disease Control, PHARMACY Emergency Department SPECIALTY Provincial Health Services Authority, Vancouver, BC NETWORKS NETW ORK • COMMUNICA TE Melanie MacInnis, BSc(Pharm), PharmD, IWK Health Centre, The purpose of this session is to discuss pediatric poisonings Halifax, NS and the current approach to management.
The role of the clinical pharmacist in emergency departments Poisonings in children younger than 6 years old make up has been established now for many years. For adult over half of the calls to poison control centres in North and elderly patients; the pharmacist is often involved in America. These exposures are primarily unintentional, often preventing medication errors at transitions of care and occur in the home, and commonly involve substances that identifying pharmacotherapy issues. The ED pharmacist are nontoxic or minimally toxic. Each year however, there needs to be familiar with all aspects of care for the patient – are a few young children who die following an exposure to from primary care to critical care. The role of the pharmacist a medication or chemical. This session will discuss the most in identifying and preventing medication related problems common and the most deadly poisons in the young pediatric is well documented in the adult population. While there population, highlighting the contributing factors and is evidence of the existence of drug related problems and approach to management. perhaps more frequent medication errors in pediatric Poisonings in adolescents are much less frequent than in practice (due to weight based dosing); the incorporation of children younger than 6 years old, however they are more clinical pharmacists in to pediatric emergency practice is likely to be intentional, involve more than one agent and still somewhat limited. The pediatric emergency medicine result in more significant toxicity. This session will discuss pharmacist still needs knowledge in primary to critical care; common drug overdoses in teens, substances commonly however the variety of typical presentations to the ED is abused and the approach to managing these poisonings in an different from adult practice; and changes from neonate emergency room and critical care setting. through to young adult. Goals and Objectives This presentation aims to review literature on medication related adverse events in the pediatric emergency department. 1. To discuss the extent of poisoning and the various This will inform the audience to be able to compare and factors contributing to poisoning in young children and contrast the roles of a pharmacist in the pediatric, adult, and adolescents. elderly populations. Finally; case scenarios for preschool and 2. To discuss the most common and most toxic poisons/drugs childhood asthma, pediatric polypharmacy, and rashes will in each age group. be discussed.
Goals and Objectives 3. To discuss the current approach for managing a poisoned patient. 1. Discuss emerging literature on visits to the PED as a result Self-Assessment Questions of medication related events. 1. List medications potentially fatal to a young child in 1-2 2. Compare and contrast the role of a clinical pharmacist in a doses. pediatric and an adult emergency department. 2. List OTC and prescription medications that are commonly 3. Discuss via case presentation some scenarios for emergency abused by adolescents. pharmacist involvement in the pediatric patient.
Self-Assessment Questions 3. Develop a management plan for a child/teen who presents with the history of ingesting a medication.
38 Palliative Care of the Patients PSN PSN PHARMACY Deprescribing at the End of Life PHARMACY with Dementia SPECIALTY SPECIALTY NETWORKS NETWORKS NETW ORK • COMMUNICA TE NETW ORK • COMMUNICA TE Sally Tierney, BScPharm, Bruyère Continuing Care Hospital, Carolee Awde, BScPhm, RPh, CDE, Peterborough Regional Health Ottawa, ON Centre, Peterborough, ON
The process of tapering, stopping, discontinuing, or Palliative care is complicated in patients who have multiple withdrawing drugs, with the goal of managing polypharmacy conditions, particularly if communication is impaired. and improving outcomes . There are still few comprehensive Delirium is potentially reversible; dementia is a progressive systematic reviews or algorithms for stopping medications life ending disease. Issues in dementia care and treatments in many patients. Most agree that deprescribing is safe, and will be reviewed, with suggestions for assessment tools, should be adopted more frequently. Many ask the following and medications to deprescribe. Caregivers will understand scenarios when thinking about deprescribing a drug: behaviour as communication and frailty as a prognostic syndrome. Anticipating issues and supporting family 1. Is life expectancy shorter than the time the drug takes to caregivers can improve end of life care. obtain a benefit? Goals and Objectives 2. Are the goals of prescribing/deprescribing consistent with those of care? 1. Review challenges of palliative care in patients with dementia. 3. Are there better options available for this particular patient? 2. Distinguish dementia from delirium.
Goals and Objectives 3. Review common issues and treatments in dementia care.
1. Describe the concept of deprescribing. 4. Review assessment tools.
2. End of Life issues – reasons why medications are stopped. 5. Consider frailty in care planning.
3. Guidelines to help in deprescribing: STOPP, Beers. 6. Understand behaviour as communication.
4. Case scenarios. 7. Suggest therapies to deprescribe.
Self-Assessment Questions Self-Assessment Questions
1. What concepts about deprescribing at the EOL will I apply 1. How will I assess the efficacy of medication in a patient in my pharmacy practice? who is nonverbal?
2. How will I enhance my collaborative interaction with my 2. What impact does frailty have on prognosis? health care team in the future?
39 SPOTLIGHT ON... GRANT RECIPIENTS
Salmaan Kanji PharmD 2013 Research Grant Recipient
Validation of a Pain Assessment Tool (CPOT) in Critically Ill Patients with Delirium
Calvin Poon RPh, BScPhm, ACPR, CDE 2012 Education Grant Recipient
Understanding the Limitations to Medication Incident Reporting and How to Analyze Incidents Using a Qualitative Assessment Scale (QAS)
Mark Duffett BSc(Pharm), MSc, RPh, ACPR 2011 Research Grant Recipient
Medication Decision-Making in Critically Ill Children: A Survey of Canadian Pediatric Critical Care Clinicians
Mary Ensom BS(Pharm), PharmD, FASHP, FCCP, FCSHP, FCAHS 2011 Research Grant Recipient
Stability of Propranolol in Extemporaneously Compounded Suspensions: New Formulations for an Old Drug
Nese Yuksel BScPharm, PharmD, FCSHP, NCMP 2011 Research Grant Recipient
Beliefs and Current Practices of Pharmacists with Osteoporosis Treatment in Patients with Renal Failure
Lisa Burry BScPharm, PharmD 2010 Research Grant Recipient
Daily Sedation Interruption Versus No Daily Sedation Interruption for Critically Ill Adult Patients Requiring Invasive Mechanical Ventilation (Review)
Barbara Farrell BScPhm, PharmD, FCSHP 2010 Research Grant Recipient
Identifying Core Competencies for Maximum Effectiveness of Pharmacists Working in Family Practice: A Mixed Methods Study
40 Visit www.cshpfoundation.ca for full Spotlight Reports on the great work of Foundation grant recipients. 3 Faculty of Medicine, University of Calgary, Calgary AB Oral Abstract Session 4 Division of Cardiology, University of Alberta, Edmonton, AB Intriguing Papers from Original Research, Award Winners and Research and Education Grants Introduction: Alberta Health Services has established a vision for clinical pharmacy practice that supports pharmacists working to their full scope of practice, which includes independent prescribing. However, information Séance d’exposés oraux regarding prescribing patterns of hospital pharmacists with additional Communications fascinantes choisies parmi les travaux de recherche prescribing authorization (APA) is lacking. The objective of the study was originale et les projets des récipiendaires de prix, de bourses de recherche et to determine the self-reported frequency and characteristics of prescribing de perfectionnement by hospital pharmacists with APA who provide clinical pharmacy services within inpatient and/or outpatient settings. Monday Febuary 1 Methods: Between January and March 2014, we conducted a descriptive, er cross-sectional study utilizing web-based, self-enumerated survey data. Lundi 1 février Pharmacists employed within inpatient and/or outpatient settings, and 11:40 – 12:25 granted APA as of December 31, 2013, were eligible. Descriptive statistics Maple and logistic regression analysis were used to report outcomes.
1. Learning from Medication Incidents One Group at a Time: The Results: The median frequency of prescriptions written per 10 patients Development and Evaluation of Multi-Incident Analysis Workshops during an average week was 4.2 (IQR 8.0). The most frequently completed 2. Prescribing Patterns of Hospital Pharmacists with Additional Prescribing prescribing activities were following team discussion (1.8 [IQR 2.5]) and Authorization in Alberta adjusting dose based on organ function and clinical assessment (1.0 3. Quality Assurance of Aseptic Compounding in Winnipeg Regional [IQR 2.3]). The leading barrier and enabler for prescribing overall was Health Authority Pharmacies interdisciplinary care team dynamics. Discussion: This study represents the first attempt to quantify the Learning from Medication Incidents One Group at frequency of prescribing among hospital pharmacists with APA. Hospital a Time: The Development and Evaluation of Multi- pharmacists with APA prescribe for almost half of their patients, which Incident Analysis Workshops suggests that pharmacists are utilizing their prescribing rights, in addition to other skills and knowledge, on a regular basis to provide patient care. Cheng R, Pan V, Carthy B, Yoo L, Ng K, Ho C,Yu J, Hyland S, Institute for Safe Collaboration was a key consideration of pharmacist prescribers, supporting Medication Practices Canada, Toronto, ON that pharmacists can still influence prescribing to improve patient care in Introduction: Learning from medication incidents is a fundamental step jurisdictions where independent prescribing is unattainable. towards the advancement of safe medication practices. The multi-incident Conclusion: The results of the study reflect the positive uptake of practicing analysis technique makes possible the analysis of medication incidents to full scope in hospital pharmacy and the ongoing importance of a group at a time and therefore facilitates the process of learning from collaboration in the hospital setting. medication incidents. Purpose: The purpose of this project is to develop and evaluate the Quality Assurance of Aseptic Compounding in effectiveness of an education workshop teaching a step-wise approach for Winnipeg Regional Health Authority Pharmacies conducting a multi-incident analysis. Woloschuk DMM, Caligiuri C, Winnipeg Regional Health Authority, Winnipeg, MB Description of the Project: A full day multi-incident analysis workshop was created included both didactic and hands-on components. A ten- Objectives: We created an effective, sustainable, multi-faceted quality question multiple-choice pre/post-test was developed to evaluate knowledge assurance (QA) program that is compatible with contemporary aseptic acquisition. A participant feedback survey was used to evaluate participant compounding standards and usable by others. satisfaction. A post workshop follow-up survey was then administered to Description of the Project: QA assessments of aseptic operator training participants several months after the workshops to assess the application of and QA audits of aseptic compounding facilities (ACF) and aseptic the multi-incident analysis technique in practice. operators were developed and implemented. A pharmacy assistant, who Results: Eight workshops were delivered since the development of the multi- was independent of teams being audited, gathered all data and reported incident analysis workshop in January 2013 with 61 attendees from diverse it to managers and staff. Education about results promoted adherence to professional backgrounds. 39 pairs of pre/post-test scores were obtained. required practices. The mean pretest score was 36.9% and the mean post-test score was 75.6% Project Experience: Initial training and revalidation at prescribed (p<0.00001). In terms of participant feedback, mean scores ranged from 4.7 intervals affected 306 staff and trainers at 16 ACF since 2009. Most trainers to 4.9 out of 5 in all aspects of the workshop. The post workshop follow-up (21; 84%) exhibited no evidence of practice drift during QA assessments. survey demonstrated that out of eight respondents, five of them applied the ACF inspections (63) conducted September 2011 to June 2015 resulted in 170 techniques into their workplace and found the workshop to be beneficial in citations of which 44.7% were mitigated, 8.8% could only be mitigated by their organization. replacing the ACF, and 35.9% require Maintenance/Housekeeping support Discussion: The evaluation results demonstrated a significant plus ACF shutdown for at least 24 hours to remedy. Practice drift among improvement in the participants’ understanding and application of the aseptic operators was easily detected by serial QA audits. Audit results multi-incident analysis technique; as well as a high degree of participant informed changes to policy and training materials. QA program operation satisfaction. required 4 paid hours per ACF annually for data collection, analysis, and reporting. The QA program was sustainable at reasonable cost. Conclusion: Multi-incident analysis is an innovative analysis technique that greatly enhances the efficiency and quality of medication incident Discussion: Complex equipment and stringent operational requirements analysis. The evaluation results suggest that our multi-incident analysis plus a large workforce that performed aseptic compounding part-time workshops were highly effective in teaching the key concepts and facilitating made it challenging to maintain a high level of compliance to standards. the application of this important analysis technique. Continuous QA monitoring provided a reliable, non-threatening way to identify practice drift and assured prompt attention to equipment and Prescribing Patterns of Hospital Pharmacists with operational deviations. Additional Prescribing Authorization in Alberta Conclusion: Sustaining high quality ACF and aseptic operations benefitted from intermittent, unannounced audits conducted by a third party. Other Heck T,1 Bresee L,2,3 Koshman S,4 Mysak T,1 Gunther M1 pharmacies can easily and with minimal investment use the audit tools in 1 Pharmacy Services, Alberta Health Services, Edmonton, AB their aseptic compounding settings. 2 Pharmacy Services, Alberta Health Services, Calgary, AB 41 Poster Sessions Séances d’affichage
There are two different types of poster presentations at PPC 2016: a Deux types de présentation par affiches seront offerts dans le cadre de la facilitated poster session on Sunday and traditional poster sessions on CPP 2016. Une séance animée de présentations par affiches qui se tiendra Monday and Tuesday. le dimanche et des séances traditionnelles d’affichage qui auront lieu lundi et mardi. Facilitated Poster Session Séance animée d’affichage Posters in the facilitated poster session consist of a mixture of award winners and those abstracts submitted in the categories of original Les affiches de la séance animée d’affichage sont formées d’un mélange research and pharmacy practice. They are grouped as five posters with de résumés primés et de résumés soumis dans les catégories recherche similar themes outlined below. The author of each poster will do a six- originale et pratique de la pharmacie. Elles sont combinées en groupes minute presentation in front of their poster highlighting the key points of de cinq ou six affiches ayant des thèmes similaires comme il est fait their work. This will be followed by questions and group discussion. The mention ci-dessous. L’auteur de chaque affiche fera une présentation de presentations within each group will occur in sequence as the participants six minutes devant son affiche, faisant ressortir les principaux points move from one poster to the next. The session is scheduled from 10:30 de son travail. Cette présentation sera suivie d’une période de questions a.m. to 12:00 p.m. on Sunday, January 31. et d’une discussion de groupe. Les présentations à l’intérieur de chaque groupe auront lieu les unes à la suite des autres au fur et à mesure que les participants se déplaceront d’une affiche à la suivante. Cette séance se Traditional Poster Sessions déroulera de 10 h 30 à 12 h le dimanche 31 janvier. Posters in the traditional sessions (in the exhibit hall on Monday and Tuesday) were selected from those submitted in the categories of original Séances traditionnelles d’affichage research and pharmacy practice. Although no formal presentations will occur, the author of each poster will be available during the presentation Les affiches pour les séances traditionnelles ont été choisies parmi timeslot for discussion and questions. Posters will be available for viewing celles soumises dans les catégories recherche originale et pratique de la on Monday and Tuesday until 2:00 p.m. pharmacie. Bien qu’aucune présentation officielle n’ait été prévue, les auteurs de chaque affiche seront sur place pendant les heures d’affichage et pourront répondre aux questions et s’entretenir avec vous. Les affiches pourront être examinées jusqu’à 14h, lundi et mardi.
Sunday, January 31 3. Epidemiology of 6 Types of Bacteria, Hospital Resistance Rates, and Associated Antibiotic Drug Consumption Rates in a Teaching Hospital Dimanche 31 janvier 4. Implementation of a “Virtual” Vancomycin Clinic 5. Guideline Adherence Audit for Treatment of Pediatric Outpatient 10:00 12:00 (presentation) Urinary Tract Infection Churchill and City Hall Facilitated Poster Sessions: Discussion of Original Research, Award Winning Projects, and Pharmacy Practice Projects Infectious Diseases/Stewardship Séance animée de présentations par affiches : Discussions sur des 1. Developing and Evaluating an Educational Intervention to Guide projets de recherche originale, des projets primes, et des projets dans le in the Implementation of Antimicrobial Stewardship Programs in domaine de la pratique pharmaceutique Community Hospitals 2. Clinicians’ Perspectives of the Enablers of and Barriers to Antibiotic De-Escalation Clinical 3. Impact of Hospital Wide Implementation of an Antimicrobial 1. Short- versus Standard-Term Dual Antiplatelet Therapy after Stewardship Program on the Incidence of Hospital Acquired Percutaneous Coronary Intervention with Drug-eluting Stent Clostridium difficile Infection Implantation: A Meta-Analysis 4. A Retrospective Review of Treatment Appropriateness and Outcomes of 2. Dosing of Amiodarone for Post-Operative Atrial Fibrillation in Cardiac Enterobacteriaceae Bacteremias at a Large Academic Medical Centre: Surgery Patients Opportunities and Implications for Antimicrobial Stewardship 3. Evaluation of Novel Protocol for Treatment of Alcohol Withdrawal Syndrome in Psychiatric Inpatient Populations Pharmacy Practice/Education 4. Analysis of the Adherence to Seizure Prophylaxis Guidelines in 1. Medication Safety Culture Indicator Matrix: Going beyond the Neurosurgery Patients Numbers and Using Incident Reports to Assess Medication Safety 5. Interaction between Psychotropic Medications and Alcohol: Perception Culture in Patients Attending a Psychiatric Day Hospital Program 2. Does Peer-to-Peer Mentoring Make a Difference in Therapeutic Knowledge Acquisition for Student Learning? Infectious Diseases 3. Pharmacy Discharge Services: A Pilot Project Involving Pharmacist and Pharmacy Technicians at a Pediatric Hospital 1. Development and Evaluation of a Screening Tool for Bacteremia in 4. Pharmaceutical Care for Children: A Survey of Pharmacy Students’ Neonates Preparedness and Confidence 2. Evaluation of Oseltamivir Dosing Regimens in Renal Dysfunction: 45 5. Novel Models of Precepting: The Alberta Experience is the New 30
42 Monday, February 1 32. A Comparative Study of the Conformity of the Documentation of Drug Doses Administered Pre and Post Implementation of an Electronic er Lundi 1 février Medication Record 33. Drug Shortages in Health Care Institutions: Perspectives in 2014−2015 09:45–10:15 (viewing) 34. Comparaison de la perception des pharmaciens québécois et 13:00–13:50 (presentations) français vis-à-vis des données sur les rôles et retombées des activités Sheraton/Osgoode Halls pharmaceutiques 1. Structure and Function of Teams in the Pediatric Intensive Care Unit: A 35. Réactions des étudiants en pharmacie à la mise en place d’un code Social Network Analysis de bonnes pratiques pharmaceutiques en ligne et dans les réseaux 2. A Failure Mode Effect Analysis Pre-Post Implementation of an sociaux Electronic Medication Administration Record 36. Chambre des erreurs : une simulation afin de sensibiliser le personnel 3. Étude intérimaire de satisfaction du personnel soignant dans soignant aux risques du circuit du médicament l’implantation d’un formulaire électronique d’administration des doses de médicaments dans le cadre d’un projet pilote en chirurgie pédiatrique Tuesday, February 2, 2016 4. Describing the Benefits of Residency Training through Key Mardi 2 février Performance Indicators 5. Engaging Leadership to Expand Experiential Capacity in Institutional 09:30–10:00 (viewing) Settings 13:00–13:50 (presentations) 6. Standardization of Criteria Used by Pharmacists to Prioritize New Sheraton/Osgoode Halls Patients for Comprehensive Pharmaceutical Care 1. Evaluation of the Sterility of Single-Use Vials Undergoing Multiple 7. Evaluation of Standardization of Pharmacist Involvement in Best Access Following Application of a Closed System Transfer Device Possible Medication Histories and Medication Reconciliation 2. Evaluation of a Critical Incident: Simulating Hydromorphone 8. Safe Insulin Pen Labelling Practices in a Community Teaching Concentrations using Population-Based Pharmacokinetic Parameters Hospital: A Post-Implementation Evaluation 3. Rhabdomyolysis during Treatment with Thrice-Weekly Daptomycin 9. Cost and Waste Impact of Implementing Insulin Pen Devices in a 4. Clinical and Economic Outcomes of Outpatient Parenteral Community Teaching Hospital Antimicrobial Therapy: Experience at a Community Hospital 10. Incidence des effets indésirables médicamenteux dans un centre 5. Varicella Zoster Virus Meningitis Possibly Associated with Zoster hospitalier universitaire mère-enfant de 1989 à 2014 : la loi de Vaccination Vanessa permettra-t-elle d’augmenter le taux de déclaration? 6. Compliance to a Febrile Neutropenia Protocol for Leukemia Patients 11. Developing and Implementing a Competency-Based Program for Based on Antimicrobial Stewardship Principles and Human Factors Pharmacy Technician Students Engineering 12. 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Sunday, January 31 Dosing of Amiodarone for Post-Operative Atrial Fibrillation in Cardiac Surgery Patients Dimanche 31 janvier Lau T,1 Wang E,2 Ye J,2 Chu C,3 Chua D2 Short- versus Standard-Term Dual Antiplatelet 1Vancouver General Hospital, Vancouver, BC Therapy after Percutaneous Coronary Intervention 2St. Paul’s Hospital, Vancouver, BC with Drug-eluting Stent Implantation: 3Faculty of Pharmaceutical Sciences, University of British Columbia Vancouver, A Meta-Analysis BC Basaraba J,1,2 Barry A3,4 Background: Amiodarone is used for the management of post-operative atrial fibrillation (POAF) after cardiac surgery. There is significant 1Mazankowski Alberta Heart Institute, Pharmacy Services, Alberta Health heterogeneity in the dosing of amiodarone for POAF in the literature and Services, Edmonton, AB a lack of guideline recommendations. The optimal dosing strategy of 2Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, amiodarone for the prevention or treatment of POAF is unknown. Edmonton, AB 3Chilliwack General Hospital, Lower Mainland Pharmacy Services, Chilliwack, BC Objective: To determine the optimal dosing strategy of amiodarone to 4Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, prevent or treat POAF. BC Methods: We conducted a cross-sectional, retrospective chart review of Background: Twelve months of dual antiplatelet therapy (DAPT) is adults receiving amiodarone for POAF after cardiac surgery from February recommended after percutaneous coronary intervention with drug- 2013 to July 2014. The primary outcomes were to compare the dose of eluting stent implantation (PCI-DES). However, certain clinical scenarios amiodarone in those who develop POAF versus those who remain in may require premature discontinuation of therapy (e.g., urgent surgical normal sinus rhythm (NSR) for POAF prevention, and to compare the dose procedures, major bleeding). of amiodarone in those who convert to NSR versus those who remain in POAF at discharge for POAF treatment. Objective: To investigate clinically relevant efficacy and safety outcomes associated with a shorter duration of DAPT, compared to 12 months, after Results: Two hundred patients were included with mean age of 68.9 PCI-DES. years. A total of 51.5% underwent coronary artery bypass grafting with an average post-operative length of stay of 11.1 days. The majority received Methods: A systematic search of Medline and Embase (inception to amiodarone for treatment versus prevention of POAF (67% vs. 33%). A April 2015) was conducted. Included were randomized controlled trials total of 166 (83%) patients developed POAF, with a mean time to POAF that compared 6 months (or less) to 12 months of DAPT in patients who of 2.1±1.2 post-operative days, and 144 (87%) of these patients converted underwent PCI-DES. DAPT was defined as acetylsalicylic acid 75-200 mg to NSR before discharge. There was no statistically significant difference daily and clopidogrel 75 mg daily. Outcomes of interest included death, in either dose of amiodarone for POAF prevention in those who develop myocardial infarction (MI), definite or probable stent thrombosis, major POAF versus those who remain in NSR (5897±4223mg vs. 5061±3519mg, bleeding, and any bleeding. An odds ratio (OR) and 95% confidence p=0.38) or dose of amiodarone for POAF treatment in those who are interval (CI) were calculated for each outcome using a Mantel-Haenszel discharged in POAF versus those who convert to NSR (5775±3118mg vs. random effects model (Review Manager, version 5.3). 5067±3462mg, p=0.43). Results: Five studies (4 open-label, 1 double-blind) were included Conclusion: The rate of POAF is high in patients receiving amiodarone constituting 12,078 patients. Three studies investigated 6 months of for prevention or treatment. Receiving approximately 5000mg (oral DAPT, and 2 studies investigated 3 months. Outcomes were reported at 12 equivalent) of amiodarone. months in 4 trials and 15 months in 1 trial. Efficacy outcomes were not statistically significantly different between groups including death (OR Evaluation of Novel Protocol for Treatment of 0.85, 95% CI 0.61-1.18), MI (1.14, 0.85-1.55), and stent thrombosis (1.20, Alcohol Withdrawal Syndrome in Psychiatric 0.67-2.15). There was no significant difference in major bleeding (0.61, Inpatient Populations 0.35-1.03); however, any bleeding was reduced by a relative 41% with shorter-term DAPT (0.59, 0.44-0.79). Butterfield M,1,2 Thorne-Humphrey L,2 Herschenhous N1,2 Conclusion: Shorter duration (3-6 months) of DAPT was not associated 1Department of Psychiatry, Dalhousie University, Halifax, NS with a higher risk of death, MI, or stent thrombosis compared to 12 2Nova Scotia Health Authority – Zone One, Halifax, NS months. Furthermore, it was associated with a lower rate of overall Background: In collaboration with a multidisciplinary group we bleeding, but not major bleeding. Though limited by low event rates developed a novel evidence based treatment algorithm with the goal and study methodology, these data support that DAPT could be safely of more effectively managing alcohol withdrawal (AW) in individuals discontinued before 12 months if required. admitted to acute psychiatric units. Due to the symptom driven nature of the commonly employed CIWA-Ar protocol patients suffering from psychotic, mood, and/or anxiety disorders may receive inappropriate treatment due to some of the counfounding comorbid symptoms seen in both AW and these psychiatric illnesses. 44 Objectives: To improve clincal outcomes while maintaining or improving Background: Interaction between alcohol and certain medications can safety in psychaitric inpatints suffering from AW by employing a novel lead to adverse consequences. Individuals with mental health disorders standardized treatment protocol. are particularly at risk due to the potential pharmacokinetic and pharmacodynamic interactions between psychotropic medications and Methods: Using a retrospective cohort study design, we compared alcohol. It is unknown what education these patients received from their outcomes between patients admitted to psychiatric inpatient units who healthcare providers and how such interactions are managed. required treatment or were at high risk for AW before and after the implementation of this novel treatment algorithm. Our primary outcomes Objectives: To examine whether individuals with mental health disorders were mean duration of benzodiazepine treatment and cumulative dose are aware of the alcohol-drug interactions and how the information is administered. Our secondary outcomes were harm associated with AW used. related complications and benzodiazepine toxicity. Methods: A paper survey was developed to explore mental health Results: Preliminary data show that there are significant differences in patients’ perception of the alcohol-drug interaction. The survey included our primary outcomes. Total benzodiazepine dose in diazepam equivalents questions in three domains: (1) knowledge of the drug-alcohol interaction, administered to individuals treated for AW prior to the implementation (2) consumption of alcohol while taking psychotropic medications, and (3) of the algorithm was 42.7mg while individuals treated after the source of advice regarding the drug-alcohol interaction. Attendants of the implementation of the algorthm recieved 21.6mg (p<0.01). Mean duration Psychiatric Day Hospital Program at North York General Hospital, Toronto, of benzodiazepine treatment time prior to the protocol implementation Ontario were invited to participate. Informed consent was obtained from was 40.2h vs. 9.9h after protocol implementation (p<0.01). Total time on all participants. any AW protocol was 174.4h before protocol implementation vs. 38.7h Results: One hundred surveys were completed between July 2014 and after protocol implementation (p<0.01). No reports of AW seizures or February 2015. Thirty-six responders reported consuming alcohol at benzodiazepine toxicity were reported in either group. (n= 107). least once a week. Seventy-five participants had been counselled by a Conclusions: Our preliminary data suggests that the implementation of healthcare provider regarding the alcohol-drug interaction, with 49 a standardized protocol for the treatment of AW for individuals admitted of them indicating that they followed the advice provided. Half of the to psychiatric inpatient units can result in a clinically meaningful responders denied using alcohol while taking psychotropic medications, reduction in benzodiazepine use without compromising efficacy or safety. while 20 reported worsening of their psychiatric conditions and/or requiring hospitalization when alcohol and psychotropic medications were Analysis of the Adherence to Seizure Prophylaxis used concurrently. Forty-two participants recalled receiving advice from Guidelines in Neurosurgery Patients their pharmacists regarding the interaction. The majority of the responders considered physicians to be the best healthcare professional to provide Liao X,1,3 Chiu A,1 Li K,1 Beechinor D1,2 such information. 1Trillium Health Partners: Mississauga Hospital, Mississauga, ON Conclusions: Although the majority of participants were provided 2Trillium Health Partners: Credit Valley Hospital, Mississauga, ON strategies to avoid negative consequences from the alcohol-drug 3Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON interaction, one-fifth reported an adverse outcome. This indicates that Background: In 2000, the American Academy of Neurology guidelines patients do not necessarily follow the advice from their healthcare recommended that long-term seizure prophylaxis should not be routine providers. Future studies should explore why this gap exists and how to in patients with newly diagnosed brain tumours and that if anti-epileptic minimize it. drugs (AEDs) are used, they should be tapered and discontinued after 7 days post-operatively. Recent data shows that most newly diagnosed brain Development and Evaluation of a Screening Tool for tumour patients continue to receive prophylactic AED. Bacteremia in Neonates Objective: This study aimed to examine the seizure prophylaxis practices Cormier M,1 Walker SAN,1,2,3,4 Elligsen M,1 Choudhury J,1 Walker SE,1,2 Rolnitsky at a regional neurosurgery centre. A,5,6 Findlater C,6 Iaboni D6 Methods: A retrospective chart review was performed in adult patients 1Department of Pha he Hebrew University of Jerusalem, Israel with newly diagnosed brain tumour(s) who underwent neurosurgery 6Women and Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON between January 2010 and December 2014. Patients who had a seizure Background: Clinical and laboratory parameters can aid in the history or used AEDs prior to admission were excluded. The percent (%) detection of bacteremia before clinical deterioration occurs, however of patients who received primary seizure prophylaxis was calculated. current prediction models have poor diagnostic capabilities. Secondary outcomes included: in patients who received prophylaxis, the percent (%) of patients whose AED was appropriately discontinued; drug Objectives: To develop a screening tool for bacteremia in neonates using cost savings if these patients had not received prophylaxis; and patient common laboratory and clinical parameters and determine its predictive characteristics (in terms of number, size, and location of tumours) most value to assist in the early identification of late onset bacteremia (LOB) strongly correlated with seizure prophylaxis using a logistic regression (>72h following birth). model. Methods: A retrospective chart review of neonates admitted to a level Results: Six hundred and ninety (690) patient charts were screened and II–III neonatal intensive care unit (NICU) between March 1, 2012 and 235 patients were excluded, most commonly due to seizure on admission. January 14, 2015 and a prospective evaluation of neonates admitted Overall, 28% (N=129) of 455 included patients over 5 years received to the same NICU between January 15, 2015 and March 30, 2015 were seizure prophylaxis. Phenytoin was the most common prophylactic completed. LOB patients were matched to non-infected controls on several agent. In 61% of patients who received prophylaxis, it was unknown demographic parameters. A Pearson’s Correlation matrix was completed whether the AED was continued in the long-term. The drug cost savings to identify independent variables that were significantly associated with to the organization over 5 years if these patients had not received seizure infection (p<0.05, univariate analysis). Significant parameters were prophylaxis was $4287.52. The patient characteristics most strongly analyzed using iterative binary logistic regression to identify the simplest correlated with receiving seizure prophylaxis were increasing tumour size statistically significant model (p<0.05). The optimal probability cut-off for and decreasing number of tumours. LOB was determined using a Receiver Operating Characteristic curve and the predictive value of the model was assessed. Conclusion: One in 3 patients received seizure prophylaxis. Increased awareness of the organization’s practice patterns may help prevent Results: Thirty-one of 61 patients with a complete data set had LOB unnecessary long-term AED use in the future. (51%). The best binary logistic regression model was (p<0.05): Ln[Odds LOB] = – 25.459 + 0.752(MaxGlucose) + 0.119(MaxHeart Rate (bpm)) Interaction between Psychotropic Medications + 0.108(Bands) + 0.071(MaxNeutrophils)] with a threshold probability and Alcohol: Perception in Patients Attending a categorizing LOB of >41.5%. The sensitivity, specificity and accuracy were Psychiatric Day Hospital Program 90%, 80% and 85%, respectively, with a false positive rate of 20% and a false negative rate of 9.7%. At the study LOB prevalence of 51%, the Cheng C, Mithoowani F, Lee M, North York General Hospital, Toronto, ON 45 positive predictive value, negative predictive value and negative post-test faecium, Staphylococcus aureus, Pseudomonas aeruginosa, Acinotobacter probability were 82%, 89% and 11%, respectively. baumannii, Klebsiella pneumoniae and Escherichia coli. We conducted further data analysis to describe potential associations between resistance Conclusion: The model developed exhibited superior overall predictive and drugs consumption. value compared to currently published neonatal bacteremia screening tools. Validation of the tool in a historic data set will be completed. Results: A total of 189 types of specimens collected from 10,259 patients were available during the five-year period. The 6 targeted bacteria Evaluation of Oseltamivir Dosing Regimens in Renal represented 0.4%, 2.6%, 2.9%, 0.1%, 5.2% and 45.8% of all isolates, Dysfunction: 45 is the New 30 respectively. The aggregated resistance rate was 41.5%, 17.45%, 21.73%, data unavailable, 18.04% and 5.55%, respectively. For the five-year period, Lee JO, Walker SAN, Walker SE, Department of Pharmacy, Sunnybrook Health the antibiotic DDD/1000 PD was 554, 601, 569, 535 and 556, respectively. Sciences Centre, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, The antibiotic DOT/1000 PD was 928, 987, 918, 868, and 866. Further data ON analysis revealed a decrease of susceptibility of E.coli to fluoroquinolones Background: In 2014 the Tamiflu® product monograph (PM) was in the intensive care unit associated with an increase of fluoroquinolones revised to markedly decrease oseltamivir doses for patients with creatinine consumption. A similar trend was noticed for susceptibility of E.coli to clearance less than 60 and 30 mL/min. piperacillin-tazobactam combination and K. pneumoniae with third and Objective: To evaluate the performance of the old and new recommended fourth generation cephalosporins. product monograph dosing regimens based on review of previously Conclusions: The drug resistance to six key bacteria remained stable published literature and development of a relationship between creatinine from 2010 to 2015 as well as DOT/1000 PD in a teaching hospital. clearance and the half-life of oseltamivir carboxylate, the active Surveillance of these markers suggests that optimal drug use can metabolite of oseltamivir. contribute to limit the increase of bacterial resistance. Methods: Articles that reported creatinine clearance (CrCl) and pharmacokinetics parameters (volume, clearance, half-life or Implementation of a “Virtual” Vancomycin Clinic elimination rate constant (K) and Tmax), or permitted calculation Gupta K, Elsayed S, Thompson GW, Hosseini-Moghaddam SM, Silverman M, of the pharmacokinetic parameters for oseltamivir carboxylate (OC) Bombassaro AM, London Health Sciences Centre, London, ON were reviewed. The mean and standard deviation of each parameter Background: Bed management pressures frequently necessitate the was collected and a relationship between creatinine clearance and K transfer of stable patients to the outpatient setting. This poses challenges developed. A multiple oral dosing simulation was created to obtain a for intravenous vancomycin monitoring in patients receiving prolonged steady-state concentration-time profile for dose regimens at varying treatment courses. creatinine clearance values. Description: The Infectious Diseases (ID) service implemented a “virtual” Results: 9 papers describing OC kinetics in 513 adult patients vancomycin clinic as a quality improvement initiative to optimize produced the relationship K= 0.007 + 0.001CrCl allowing simulation of outpatient monitoring. The goal is to ensure that blood work is scheduled concentration–time profiles with an average volume of 186 L for both and collected appropriately relative to dose administration and promptly treatment and prevention. The older PM recommended dosing produced interpreted. concentrations which doubled the peak concentration for patients with CrCl between 30 and 60 and 10 and 30mL/min relative to patients Action: The clinic is “virtual” because it operates from the hospital in with 100mL/min. The 2014 PM recommended dosing produced peak real time while the patient remains in the community. Prior to discharge, concentrations which were about 75% of the peak concentration for ID patients requiring intravenous vancomycin are assessed regarding patients with CrCl of 100 mL/min. Based on the simulation, to achieve their ability to attend a medical laboratory and counselled about the concentrations similar to patients with 100 mL/min, patients receiving importance and timing of serum concentrations. A plan is developed treatment with a CrCl between 30-60mL/min should receive 45mg BID regarding the location and day of monitoring. Approximately 24 hours and patients with CrCl of 10-30mL/min should receive 45mg once daily. after discharge the dose and blood work timing is verbally confirmed with For prevention, patients should have the dosing interval doubled. the patient. Lab results are reviewed by ID and dose changes conveyed to the community care provider. Results and subsequent monitoring are Conclusion: The 2014 PM recommended dosing seems to under-dose discussed with the patient. patients with reduced renal function. Concentrations can be corrected by administration of 45 mg rather than 30 mg. Evaluation: Fifteen patients (17 episodes) have been followed over 8 months. One patient was noncompliant and a second was switched to Epidemiology of Six Types of Bacteria, Hospital an alternative antibiotic resulting in 13 monitored patients (15 episodes). Resistance Rates and Associated Antibiotic Drug Individual episodes were monitored for a range of 6 to 59 days. All serum Consumption Rates in a Teaching Hospital concentrations were interpretable and resulted in 4 dose changes. One patient experienced a toxic trough concentration and nephrotoxicity Cotteret C,1 Roy H,1 Lebel D,1 Turcot J,2 Ovetchkine P,3 Bussières JF1,4 precipitated by newly initiated medications. Results were available 1Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, within 24 hours of collection in all 12 episodes in which blood work was Montréal, QC performed at a hospital laboratory. 2Central Laboratory, CHU Sainte-Justine, Montréal, QC Implications: The “virtual” vancomycin clinic provides the opportunity 3Pediatric Department, CHU Sainte-Justine, Montréal, QC for patients to be actively involved in the management of their therapy. ID 4Faculty of Pharmacy, Université de Montréal, Montréal, QC consultants receive timely and interpretable serum concentrations leading Background: Bacterial drug resistance is associated with antimicrobial to a subjective assessment of improved quality of outpatient intravenous misuse. Such resistances can increase length of stay, drug costs, and other vancomycin care. co-morbidities. Antimicrobial stewardship program should monitor drug resistances and consumption. Guideline Adherence Audit for Treatment of Pediatric Objectives: To describe the epidemiology of hospital resistance rates with Outpatient Urinary Tract Infection regards in antibiotic drug consumption in a teaching hospital. MacInnis M,1,3 MacPhee S,1,2 Fitzpatrick E,1,2 Hurley K,1,2 Burns E,1,2 Lee R1,3 Methods: This cross-sectional descriptive study was conducted in a 1IWK Health Centre, Halifax, NS 500-bed teaching hospital. Pediatric microbiology data (specimens, type 2Department of Emergency Medicine, Dalhousie University, Halifax, NS of samples, resistance) from April 1st, 2010 to March 31st, 2015 were 3College of Pharmacy, Dalhousie University, Halifax, NS extracted from the central laboratory database. Antimicrobial drug Background: Our institution’s Pediatric Emergency Department (ED) consumption data were extracted from GesphaRx® software and reported estimates approximately 2000 patients per year present with a urinary according to defined daily dose (DDD)/1000 patient-days (PD) and days tract infection (UTI). ED physicians perceive that UTI treatment shows the of therapy (DOT)/1000 PD. Six bacteria were targeted: Enteroccocus greatest variation in antimicrobial prescribing. Several clinical and safety 46 organizations recognize that antimicrobial stewardship is an important from an educational intervention. Our program can serve as a foundation intervention in optimizing patient safety, reducing microbial resistance, for future ASP education programs. and improving patient outcomes. Table 1 Objective: To obtain data regarding empiric antimicrobial selection for pediatric patients presenting with signs and symptoms of a UTI. 6 months 6 months Pre intervention Post intervention Methods: We conducted a randomized retrospective chart review of Mean DDD/1000 patient days 10.91 10.32 st 100 patients aged 2 months-16 years presenting to the ED from 1 April Mean LOS (days) 9.85 9.66 st 2013 to 31 March 2014 from a convenience sample. Demographic data, Mortality (%) 3.8 4.2 choice of empiric antimicrobials and culture and sensitivity results were DDD – defined daily doses abstracted from patients’ charts; obtained using a collection tool developed LOS – length of stay by the clinical investigators based on current Canadian guidelines for antimicrobial selection. Clinicians’ Perspectives of the Enablers of and Results: There were 85 females and 20 males in the sample. Forty three Barriers to Antibiotic De-Escalation percent (46) of patients were febrile in the ED. Patients presented with Gauthier M, Taggart LR, Haj R, St. Michael’s Hospital, Toronto, ON a previous history of urinary tract infections 5.7% (6) of the time, and antimicrobial use within the previous 3 months was documented in Background: Antibiotic de-escalation decreases unwarranted 2.9% (3) of cases. Urinalysis showed 78.1% (82) had white blood cells, antimicrobial exposure and could reduce the emergence of resistant 75.2% (79) had microscopic hematuria, 53.3% (56) had bacteriuria and pathogens. As bacterial resistance rates continue to rise, interventions 38.1% (40) had nitrites. Of 105 discharge prescriptions written, 47.6% aiming to maximize de-escalation of antibacterial therapy are (50) aligned with the 6 regimens that were predetermined by the clinical encouraged. investigators to be in accordance with guideline adherence. Urine culture Objectives: We aimed to describe the enablers of and barriers to results obtained after patient discharge revealed 83% (71/86) of positive antibiotic de-escalation and to measure the frequency of de-escalation bacterial cultures were E. coli. following initiation of broad-spectrum antibiotics in a tertiary-care Conclusions: The results of this audit confirm a broad variation in hospital on units without involvement of the antimicrobial stewardship empiric prescribing selection by our ED physicians. This examination of program. practice is an important first step in providing feedback to the prescribers Methods: Semi-structured interviews were conducted with medical with the aim of improving empiric antimicrobial selection for treatment residents, nurse practitioners, pharmacists and staff physicians to identify of UTIs. enablers of and barriers to de-escalation. Two clinical pharmacists independently conducted thematic analysis and agreement on themes was Developing and Evaluating an Educational reached by consensus. Concurrently, a two-month prospective chart audit Intervention to Guide in the Implementation of of new orders of piperacillin-tazobactam or any carbapenem for non- Antimicrobial Stewardship Programs in Community critically ill hospitalized patients determined the frequency of de-escalation Hospitals at 72 hours of therapy. To triangulate the themes identified from the Dresser L,1,2 Steinberg M,1 Duplisea K,3 Nelson S,1 So M,1,2 Bell C,1,4 Morris A1,4 interviews, the clinical pharmacist was contacted if broad-spectrum antimicrobials were continued past 72 hours and barriers to de-escalation 1University Health Network/Mount Sinai Hospital Antimicrobial Stewardship were discussed. Program, Toronto, ON 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Results: Seventeen health professionals agreed to participate in the 3Toronto East General Hospital, Toronto, ON interviews. The enablers and barriers identified from the interviews were 4Department of Medicine, University of Toronto, Toronto, ON consistent with those from the prospective chart audit. Enablers of de- escalation included pharmacist recommendation to de-escalate therapy Background: Antimicrobial stewardship is a multi-disciplinary and prescriber willingness to discuss de-escalation. Barriers to de-escalation programmatic initiative to optimize antimicrobial therapy. Antimicrobial included higher patient acuity, immunosuppression, the fact that de- Stewardship Programs (ASP) are an Accreditation Canada (AcC) Required escalation is not prioritized, the absence of alerts for updated culture Organizational Practice (ROP). There was a perceived need in community results and the lack of readily-accessible resources promoting de-escalation hospitals for educational support. strategies. Based on a chart review of 66 orders of piperacillin-tazobactam Description: We developed and evaluated an educational intervention or any carbapenem, the frequency of de-escalation at 72 hours of therapy designed to provide pharmacists in community hospitals with the was 50%. knowledge and skills required to implement an ASP. Conclusion: Clinicians identified enablers and barriers, which can guide Action: This was a multi-phased project involving 13 self-identified sites. the design of interventions to optimize the frequency of antibiotic de- A needs survey identified learning priorities. Eleven educational modules escalation. The frequency of de-escalation 72 hours following the initiation were developed and delivered over 6 months. Each module included a of piperacillin-tazobactam or any carbapenem was found to be 50%. narrated PowerPoint lecture, recommended readings, case-based scenarios and a live webinar discussion. All sites agreed to submit baseline and post- Impact of Hospital Wide Implementation of an intervention data which included antibiotic consumption; cost, defined Antimicrobial Stewardship Program on the Incidence daily doses (DDD) or days of therapy (DOT), with length of stay (LOS) and of Hospital Acquired Clostridium difficile Infection mortality as balancing measures. Wang X,1 Walker SAN,1,2,3,4 Leis JA4,5 Evaluation: A post-intervention satisfaction survey was distributed 1Department of Pharmacy, Sunnybrook Heath Sciences Centre, Toronto, ON (response rate 59% ([n=17/29]). A large majority of respondents found 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON the presentations useful in improving their infectious diseases knowledge 3Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON (94%), in utilizing ASP principles to optimize antimicrobial prescribing 4Sunnybrook Research Institute, Sunny Health Sciences Centre, Toronto, ON (90%) and in helping their site meet AcC’s ASP ROP (94%). 5Faculty of Medicine, University of Toronto, Toronto, ON Data requested for 1-year pre- and 1-year post- intervention served to Background: Antimicrobial stewardship programs (ASP) have been gauge the impact of the ASP activities and ensured the site’s ability to implemented worldwide to decrease inappropriate antibiotic use, risk of demonstrate metrics of an ASP. All sites encountered significant challenges resistant organisms and C. difficile infection (CDI). Although there has in obtaining this data. We present 12 months of data from 7 sites (Table 1). been some attempt to evaluate the impact of ASPs on CDI, the evidence is Implications: Community hospital pharmacists without formal ID limited to before and after study designs, while methodologically superior training tasked with developing and implementing an ASP can benefit studies are lacking.
47 Objective: The objective of this study was to examine the impact Conclusion: Most patients received appropriate empiric antimicrobial of hospital wide implementation of ASP on the incidence of hospital therapy. Although some patients received definitive therapy with a acquired-CDI (HA-CDI). carbapenem, many received therapy with a non-carbapenem agent with similar outcomes. We suggest that non- -lactams, especially SMX-TMP, Methods: An interrupted time series study was conducted at Sunnybrook β should be explored as carbapenem-sparing treatment options for AmpC Health Sciences Centre (SHCS) using prospectively collected monthly HA- carrying enterobacteriaceae. CDI and community acquired-CDI (CA-CDI) incidence based on Society of Healthcare Epidemiology of America case definitions and institutional antimicrobial utilization from the SHSC-ASP electronic database. The Medication Safety Culture Indicator Matrix: Going study time frame was divided into 63 monthly intervals from September beyond the Numbers and Using Incident Reports to 2008 to November 2013. A segmented autoregressive integrated moving Assess Medication Safety Culture average model was used to compare the pre-ASP and post-ASP periods Poon C, Kawano A, Yoo L, Ho C, Medication Safety Consultant, Institute for Safe in the time series using the pre-ASP period as the reference. CA-CDI was Medication Practices Canada (ISMP Canada), Toronto, ON examined using the same method, to reduce bias attributable to secular Background: A positive patient safety culture is an integral component trends. of a safer healthcare system. Conventional cultural measurement tools, Results: Compared to the pre-ASP period, a cumulative reduction in HA- such as surveys and questionnaires, are largely limited by their inability to CDI incidence of 41 per 1000 patients (relative risk reduction 27%; 95% capture the complex human interaction. CI 10 (7%) -71(47%); p=0.006) was observed at the end of the 37 month Objective: The purpose of this initiative was to create an analytic tool post-ASP period (study month 63). The reduction in cumulative HA-CDI leveraging medication incidents as a data source to assess safety culture. incidence did not plateau and was sustained throughout the post-ASP period. Conversely, CA-CDI remained unchanged from the pre- to post- Methods: Two independent analysts conducted a qualitative analysis ASP period (p =0.43). examining 200 medication incidents from two incident reporting databases. Themes that were suggestive of a positive safety culture were Conclusion: Our study demonstrated a sustained decrease in cumulative identified and subsequently led to the development of an analytic tool. HA-CDI incidence following ASP implementation. While other factors The tool was consolidated and validated by obtaining input from an inter- related to Infection Prevention and Control may have contributed to this professional patient safety expert panel. effect, these findings provide high level evidence to support the beneficial effect of ASPs on institutional incidence of CDI. Results: The analytic tool is a 3x4 matrix called the Medication Safety Culture Indicator Matrix (MedSCIM). MedSCIM uses qualitative A Retrospective Review of Treatment Appropriateness analysis methods to assess a medication incident on two dimensions: (1) and Outcomes of Enterobacteriaceae Bacteremias at completeness of documentation, and (2) maturity of the incident report a Large Academic Medical Centre: Opportunities and with regards to the perspective on patient safety. A low grade on the Implications for Antimicrobial Stewardship maturity score is termed “blame-and-shame,” where the clinician at fault was victimized and held responsible for the error. The highest maturity Yung J,1 Campigotto A,2 Taggart L,3 Leung E3 score is “generative,” where the incident reporter adopts a systems-based 1University of Toronto, Toronto, ON approach for identification of vulnerable safety gaps in the healthcare 2Microbiology, St. Michael’s Hospital, Toronto, ON system and implements an action plan. 3Infectious Diseases/Antimicrobial Stewardship, St. Michael’s Hospital, Toronto, Conclusion: MedSCIM is an innovative tool that uses medication ON incidents to evaluate medication safety culture in healthcare settings. An Background: Infections caused by AmpC carrying enterobacteriaceae ISMP Canada educational workshop with interactive components that can be problematic. Organismal β-lactamase production can be inducible enabled application of MedSCIM was developed. In order to advance upon exposure to β-lactams and lead to clinical treatment failure. Choice patient safety, more resources must be available to better understand of antimicrobial therapy is important, as delay in appropriate empiric and measure patient safety culture. MedSCIM offers a novel approach therapy is associated with mortality, while avoiding unneeded broad- to understand safety culture through the lens of medication incident spectrum antimicrobials is an important component of antimicrobial reporting and analysis. stewardship. There is little data to support the current practice of using carbapenems as first-line agents to treat AmpC enterobacteriaceae, and a Does Peer-to-Peer Mentoring Make a Difference recent study showed cefepime to be as effective as carbapenems. in Therapeutic Knowledge Acquisition for Student Objective: We aimed to study treatment appropriateness and outcomes Learning? for serious enterobacteriaceae infections, and explore carbapenem-sparing Huang TB, Ho C, Paw Cho Sing E, Vinh M, Lee A, Leslie Dan Faculty of options. Pharmacy, University of Toronto, Toronto, ON Methods: Microbiology reports identified patients with bacteremia Background: Aiming to better prepare students for Advanced Pharmacy caused by AmpC carrying enterobacteriaceae during a 1 year period at a Practice Experience rotations and the licensing examination, we large academic medical centre. Appropriateness of therapy was assessed implemented a peer-to-peer mentoring model to analyze the learning by 2 independent reviewers, for both empiric and definitive regimens. impact and the utility of student-led pharmacotherapy sessions (SLPS). Clinical outcomes included all-cause mortality, hospital length of stay, and Description: The SLPS concept strengthens the confidence and microbiological cure. preparedness of students for transition from classroom to practice. This Results: Only 13% of enterobacteriacae bacteremias presented with peer-to-peer mentoring model was implemented as a result of student derepression of the AmpC gene upon first culture. Initial empiric therapy identified need to reinforce pharmacotherapy concepts. was inappropriate (agent not active based on organism sensitivity) in Action: Fourth-year pharmacy students delivered SLPS on Cardiology, 16% of patients. Most patients (58%) were started on empiric piperacillin- Infectious Diseases, and Patient Self-Care online and live to both third- tazobactam (P/T), while few (6%) received an empiric carbapenem. and fourth-year students. Retrospective self-assessment surveys were Definitive therapy was often a fluoroquinolone (FQNs) (29%), a administered after each SLPS. Five knowledge domains (etiology, clinical carbapenem (25%) or P/T (25%). The remainder of patients received presentation, pharmacotherapy, monitoring/follow-up, and overall either sulfamethoxazole-trimethoprim (SMX-TMP) or ceftriaxone. Only knowledge) were assessed. A paired t-test was utilized to evaluate the one patient had persistent bacteremia; other clinical outcomes in patients survey data. Thematic analysis was applied to the qualitative comments deemed to have an “appropriate agent” for definitive therapy were not on the survey. significantly different among agents. Evaluation: Eighty-one students (59% third-years; 41% fourth-years) responded to the survey. Prior to the SLPS, 46.8% of students rated their knowledge ‘Average’ (3 of 5), while 33.1% rated their knowledge ‘Above Average’ (4 of 5) in all knowledge domains. After the SLPS, 53.6% of 48 students rated their knowledge to be ‘Above Average’ (4 of 5), while 27.5% focused on: 1) perceived preparedness to provide pharmaceutical care rated their knowledge ‘Excellent’ (5 of 5) in all knowledge domains. to children; 2) confidence in performing pharmacist duties related to Statistically significant increase (p≤0.01) was shown in all five knowledge pediatric prescriptions; 3) pediatric exposure in formal education; 4) domains post-SLPS for both third- and fourth-year students. Students found demographics. We used linear regression to examine the relationship cases, drug charts and therapeutic overview most useful. Suggestions for between demographics and self-reported preparedness improvement included increased interactions, counselling points, and Results: We received 379 useable responses from 8 of the 10 pharmacy experiential examples. schools in Canada. 10.0% of students had completed an elective course Implications: The peer-to-peer mentoring model was well received by in pediatrics and 11.7% had completed a clinical placement in pediatric students. Students perceived an increased level of therapeutic knowledge care. Overall, 32% of respondents reported being prepared (rating of 5 or after the SLPS. Future SLPS should include more interactive activities, higher on a scale from 1 = not prepared to 7 = very prepared) to provide case development support, and student association involvement. Wide safe and effective pharmaceutical care to children. Students’ preparedness adoption of this peer-mentoring model in pharmacy education is for all pediatric topics was significantly less than the same topic in adults. contingent on research to elucidate its utility and design. 61.5% felt confident in assessing the dose for a child’s prescription, and 57.1% felt confident in searching for, and interpreting, literature to guide Pharmacy Discharge Services: A Pilot Project safe and effective pediatric therapy. Using linear regression, the factors Involving Pharmacist and Pharmacy Technicians at associated with increased self-reported preparedness were the completion a Pediatric Hospital of an elective pediatric course, increased experience with pediatric patients on clinical placements, and university attended. Vaillancourt R, McDonald J, Homsma A, Pouliot A, Children’s Hospital of Eastern Ontario, Ottawa, ON Conclusion(s): A majority of pharmacy students do not feel prepared to provide pharmaceutical care to children upon graduation. Those with Background: It has been estimated that 30% of all hospital discharges more pediatric exposure during their education felt more prepared. How are delayed for non-medical reasons including poor organization of to ensure graduates are prepared to meet practice standards in providing post-discharge health, poor knowledge of social circumstances, and poor care to children remains an important challenge. communication between the hospital and community pharmacy. Studies have shown that patients are at greater risk for medication errors during transitions of care. A pharmacy discharge planning service has the Novel Models of Precepting: The Alberta Experience potential to decrease length of stay, readmission rates due to medication MacDonald M,1,2 Thompson A,2 Ton J,2 Mysak T3 errors, and inappropriate prescribing. 1Pharmacy Services, Alberta Health Services, Calgary, AB Description: The pharmacy department, at our hospital, implemented 2Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, a pilot project to offer pharmacy discharge services on two units from Edmonton, AB July 13, 2015 to September 11, 2015. The objectives were to: 1) improve 3Pharmacy Services, Alberta Health Services, Edmonton, AB patient flow by reducing medication-related discharge delays, and 2) Background: To advance the practice of precepting, and meet expanding improve patient safety through education and medication reconciliation capacity needs in institutional settings, there is interest in novel models at discharge. Patients eligible for the service were “at risk” for: 1) low of precepting. These models expand from the traditional model of one medication literacy; 2) discharge delays; 3) financial barriers, and 4) non- learner precepted by one preceptor. adherence. Objectives: The study’s primary objective was to quantify use of peer- Action: The medication reconciliation technician’s role was to identify assisted learning (PAL), near-peer teaching (NPT) and co-precepting (CoP) patients eligible for the service. Interventions by the discharge pharmacist novel models. Advantages, challenges and strategies to address them, and included education, illustrated medication calendars, suggesting supports needed for implementation were also explored. medication changes to physicians, completing application forms for drug coverage, preparing discharge prescriptions, communicating with the Methods: All institutional pharmacists in Alberta were invited via community pharmacy, requesting social work consultation, and providing a global email list to complete an anonymous online survey (July compassionate drugs. 29- August 21, 2015) using Qualtrics Survey Software. Responses were summarized using descriptive statistics and content analysis of open ended Evaluation: A total of 308 patients were admitted during the pilot phase. responses. Fifty patients were referred to the pharmacy discharge service, the most common reason for referring patients was “complex medication regimens” Results: The survey was completed by 126 pharmacists (12% response (36.7%). A total of 73 interventions were made, with the most common rate). The majority represented staff pharmacists (79%) with acute care being the preparation of discharge prescriptions with communication with practices (57%) in an urban setting (72%). CoP was the highest utilized the community pharmacy to ensure drug availability (n=32). model (71%) followed by PAL (31%) and NPT (16%). Learners supporting each other and promotion of team work were the most agreed upon PAL Implications: Pharmacy technicians and pharmacists play an important and NPT advantages. Sharing precepting responsibility and providing role in discharge planning with nearly 1 pharmacist intervention for every different perspectives for assessing student performance were the top CoP 4 patients admitted. Future evaluation will focus on readmission rates, advantages. Common challenges selected for PAL and NPT were space/ patient and physician satisfaction, drug adherence and patient health technology/computer access limitations, and differences in both learner’s literacy. levels and competency. CoP challenges were ensuring communication continuity between preceptors and the differences in preceptors’ Pharmaceutical Care for Children: A Survey of expectations and subsequent student assessment. The top 4 modalities Pharmacy Students’ Preparedness and Confdence for supporting a preceptor to try a new model were online educational Otal J,1 Duffett M2 sessions (58%), website resources (50%), 1:1 mentorship support (49%), 1Hospital for Sick Children, Toronto, ON and live educational sessions (47%). 2McMaster Children’s Hospital and McMaster University, Hamilton, ON Conclusion: Three novel models of precepting are being used to varying Background: Approximately half of the children in Canada receive at degrees in institutional practice in Alberta. The survey results provide least one prescription medication each year. Pharmacy graduates must be insight for promotion, adoption, and implementation of models to prepared to confidently provide care to these children. advance the practice of precepting and increase placement capacity. Objective: To assess the perceived preparedness and confidence of pharmacy students to provide safe and effective pharmaceutical care to children. Methods: We conducted a self-administered online survey of students in their final 2 years of pharmacy schools in Canada. The questionnaire
49 Monday, February 1 of pre implementation CI/post implementation CI per group were in the same direction) were calculated. Lundi 1er février Results: Average CI were reduced from 3084 pre-implementation to 1905 post-implementation (1.6 times reduction). Average CI for pharmacists Structure and Function of Teams in the Pediatric were higher pre-implementation than nurses (4572 vs. 2180).They were Intensive Care Unit: A Social Network Analysis similar post-implementation (1910 vs. 1913). Risk reduction ratio were Wong J,1,2 Duffett M3 convergent between pharmacists and nurses for 62% (16/26) of the failure modes. The most important perceived risk reduction for nurses were 1Department of Pharmacy, Hamilton Health Sciences, Hamilton, ON related to the following modes: missing double-check documentation (ratio 2Department of Pharmacy, The Hospital for Sick Children, Toronto, ON of 9.1), missing traceability documentation (5.8), missing double-check 3Department of Pediatrics and Clinical Epidemiology and Biostatistics, McMaster action (3.4), wrong patient identity (3.3), missing drug administration University, Hamilton, ON information (2.1) and missing drug dose administered (2.0). Background: Healthcare team dynamics help to shape the delivery and Conclusions: eMAR was theoretically associated with a 1.6 time risk quality of care. In focusing on the relationships among team members, reduction by a panel of seven experts. Risks associated with MAR was social network analysis is an approach to better understanding team perceived higher by pharmacists than nurses. structure and function. Objective: To describe team structure and function within a pediatric Étude intérimaire de satisfaction du personnel intensive care unit (PICU). soignant dans l’implantation d’un formulaire Methods: In this self-administered online survey, we asked all PICU électronique d’administration des doses de staff to select up to 5 of their most influential colleagues in 3 contexts: médicaments dans le cadre d’un projet pilote en information seeking (colleagues that advise on patient care challenges), chirurgie pédiatrique social influence (colleagues that influence their clinical practice), and Mercier G,1 Dulermez T,2 Rousseau A,2 Lebel D,2 Bussières JF2,3 social support (colleagues that help with work-related personal problems). 1Direction du dossier Clinique Informatisé, CHU Sainte-Justine, Montréal, QC We used anonymized data and Gephi to generate network diagrams 2Unité de recherche en pratique pharmaceutique, Département de pharmacie, for each context. Regression was used to analyze relationships between CHU Sainte-Justine, Montréal, QC participant’s characteristics and influence in the unit. 3Faculté de pharmacie, Université de Montréal, Montréal, QC Results: 98 (86.7%) of 113 staff participated. Amongst the 3 networks, Contexte : L’introduction de nouvelles technologies en santé représente there were no weakly connected groups. Few individuals reported no un défi important. links to any colleague: none for information seeking, 2 (2.2%) for social influence, and 7 (7.8%) for social support. The number of links Objectifs : Évaluer la satisfaction du personnel infirmier dans among colleagues was greatest for the information seeking network l’implantation d’un formulaire électronique d’administration des doses (density=0.048), followed by social influence (density=0.041) and social de médicaments (FADME) dans le cadre d’un projet pilote en chirurgie support (density = 0.031). 5 individuals (2 intensivists, 2 RNs and 1 pédiatrique. RT), 3 of whom had formal leadership roles, were amongst the 10 most Méthodologie : Il s’agit d’une étude descriptive transversale menée influential team members in all 3 networks. Using regression, a formal dans un établissement universitaire de 500 lits. Nous avons établi un leadership role was associated with higher influence in all 3 networks. questionnaire pré-implantation et un questionnaire post-implantation The role of profession, part-time status, and years of experience varied in comportant rsepectivement 10 et 17 questions, dont 9 communes aux 2 influence amongst the networks. phases. Une échelle Likert à six choix a été utilisée. Les questionnaires Conclusions: In this healthcare team, there was a core group of ont été remis au personnel infirmier sur les trois quarts de travail en pré- individuals who were among the most relied upon in different contexts implantation (10 au 25 novembre 2014) et post-implantation (18 mai au and few individuals who were weakly connected. These relationship 12 aout 2015). patterns can be used to inform the implementation of practice changes Résultats : Nous avons obtenu un taux de participation de 96% en and for focusing interventions to enhance team functioning. pré (79/82) et de 96% en post (52/54). Des 9 questions communes, on a noté une amélioration associée au FADME pour trois questions, soit A Failure Mode Effect Analysis Pre-Post pour l’obligation de retranscrire trop fréquemment une entrée manuelle Implementation of an Electronic Medication (72% c. 48%), la présence de risques à la retranscription (73% c. 48%), la Administration Record charge de travail associée à la révision à chaque quart de travail (54% Rousseau A,1 Lebel D,1 Mercier G,2 Bussières JF1,3 c. 27%). On a noté une détérioration pour la perception de la sécurité (79% c. 50%), la facilité d’effectuer des ajouts manuels (84% c. 57%) et 1Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, la satisfaction globale (70% c. 55%). On n’a pas noté de différence pour Montréal, QC la documentation (96% c 95%) et le processus de double vérification 2Electronic Health Record Team, CHU Sainte-Justine, Montréal, QC (77% c. 80%). Les risques et l’insatisfaction notées ne sont pas étonnants 3Faculty of Pharmacy, Université de Montréal, Montréal, QC en phase d’implantation lors d’une évaluation intérimaire. Seulement Background: Failure mode effect analysis can be use in the drug use 21% accepteraient de revenir à une documentation papier. Au total, 15 process to assess risks. The documentation of drug doses on printed avantages et 11 inconvénients ont été recensés. medication administration record (MAR) and electronic MAR (eMAR) is Conclusion : L’implantation d’un FADME est un changement associated with medication errors. important qui comporte des avantages et des inconvénients à prendre en Objectives: To conduct a failure mode effect analysis pre-post considération afin de l’optimiser. implementation of an eMAR. Methods: This is a prospective descriptive study conducted in a 500-bed Describing the Benefts of Residency Training mother-child teaching hospital. An Ishikawa diagram of failure modes through Key Performance Indicators associated with the documentation of drug doses was developed by the Mysak T, Neilson S, Pharmacy Services, Alberta Health Services, Edmonton, AB research team composed of 4 members. It contained 26 failures modes Background: If pharmacists apply for authorization, full scope of grouped in six categories. Occurence rating, detection rating and severity practice in Alberta may include Additional Prescribing Authority (APA) rating were adapted from published data. An expert panel composed of a or administration of medications by injection. Pharmacists who complete group of 3 pharmacists and 4 nurses exposed to both MAR and eMAR met an Accredited Canadian Pharmacy Residency (ACPR) program receive once during 90 minutes to assess the first 2 ratings. Severity was scored a training that requires demonstration of competency in provision of posteriori by the research team. Pre-post individual and average criticality patient care and education of other health care professionals. Within indexes (CI) per group and convergence (e.g. when risk reduction ratio our organization, pharmacists are encouraged to work to their full scope, 50 precept pharmacists in training, and contribute to teaching and scholarly Standardization of Criteria Used by Pharmacists activities. We wished to measure the relationship between completing a to Prioritize New Patients for Comprehensive residency and the skills and participation of the pharmacy workforce to Pharmaceutical Care better articulate the benefits of hiring pharmacy residents. Wong L,1,2 Dewhurst NF,1,2 Tom E,1 Proceviat J,1 Chant C1,2 Description: Pharmacy Services maintains a centralized database of 1St. Michael’s Hospital, Toronto, ON employed pharmacists and monitors progress to strategic targets for the 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON scope and ability with which they practice. The goal of this project was to use Key Performance Indicator (KPI) data to characterize the relationship Background: Prioritization of new patients for comprehensive between completing a residency and obtaining expanded pharmacist pharmaceutical care is necessary given time constraints and limited scope designations or participating in teaching, scholarly and precepting resources. activities. Description: Standard criteria for patient prioritization are needed Action: The completion of an ACPR was determined, entered into the to allow pharmacists to apply a consistent approach and ensure database and results for several KPI were compared between ACPR and comprehensive pharmaceutical care is provided in a timely manner. non-ACPR pharmacists. Action: Criteria used to prioritize new patients were identified through a Evaluation: The percentage of pharmacists who completed an ACPR survey administered to all inpatient clinical pharmacists. To corroborate was approximately equivalent (18.4% vs. 18.6%) between frontline survey findings, select pharmacists were interviewed alongside a patient pharmacists and leadership. More clinically deployed pharmacists with chart audit on days with higher anticipated workload. Usual practice is the ACPR designation obtained additional prescribing authorization than to complete a brief initial review of all new patients in order to prioritize those without ACPR (39.5% vs. 21.8%). ACPR pharmacists were more them for comprehensive pharmaceutical care. Pharmacists were likely to precept a pharmacy resident or senior undergraduate pharmacy interviewed to identify information sources and criteria typically used to students than junior pharmacy students. A higher proportion of frontline assign priority during the initial review of all patients. Pharmacists then ACPR pharmacists teach at the University of Alberta compared to non- demonstrated their prioritization process by explaining the rationale ACPR pharmacists (16.7% vs. 4.0%). behind the rank assigned to each new patient for the audit. Criteria identified were categorized into patient and medication factors, and were Implications: Pharmacists who completed an ACPR had higher ranked according to frequency of use. participation rates than their colleagues for key metrics, further supporting the impact residency trained pharmacists provide in our organization. Evaluation: Thirty-four (88%) pharmacists responded to the survey, and 13 pharmacists from 3 medical (28 patients) and 5 surgical (33 Engaging Leadership to Expand Experiential patients) units were interviewed and audited. Information sources most Capacity in Institutional Settings commonly used during initial review of all patients were: 1) patient chart and current admission medication profile, 2) home medication list/best Mysak T,1 MacDonald M,1,2 Thompson A2 possible medication history/medication reconciliation, 3) medication 1Pharmacy Services, Alberta Health Services, Edmonton, AB issue flagged by central pharmacist, 4) patient rounds, and 5) consult/ 2Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, referral from healthcare team. Patient factors ranked highest across the Edmonton, AB survey, pharmacist interview, and chart audit consistently were: 1) acuity Background: The proposed introduction of an entry-to-practice PharmD of illness, 2) high-risk transfer from another unit (e.g. ICU), and 3) age≥65 program will significantly increase placement requirements. In Alberta, years. Medication factors ranked highest were: 1) high-risk medications, 2) there is a provincial approach to delivery of pharmacy services, which therapeutic drug monitoring, and 3) antibiotics. provided opportunity to develop and implement a coordinated approach Implications: Results were used to update practice policy that provides to engaging preceptors and leadership. guidance on the thought process for prioritizing new patients for Description: A standing committee was created, consisting of experiential comprehensive pharmaceutical care. education faculty as well as senior leadership from Alberta Health Services (AHS) provincial pharmacy practice. This committee provides oversight Evaluation of Standardization of Pharmacist and guidance related to delivery of experiential education. Three strategic Involvement in Best Possible Medication Histories committee priorities were identified: engaging pharmacists and leadership and Medication Reconciliation to promote a culture of precepting, determining and building capacity for Dewhurst NF,1,2 Proceviat J,1 Gillespie P,2 Tom E,1 Chant C1,2 placements, and developing /supporting preceptors. 1St. Michael’s Hospital, Toronto, ON Action: Specific committee projects included harmonizing an annual 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Call for Offer (CFO) for placements across the province, setting zone Background: Evidence supports the involvement of pharmacists in capacity targets, facilitating setting of zone specific SMART goals to the medication reconciliation (MR) process to reduce the frequency of promote preceptorship, initiating preceptor communities of support medication errors. To ensure a consistent approach and balance with utilizing bimonthly networking meetings, coordinating communication other pharmacist duties, a standardized policy for best possible medication to management and pharmacists, preceptor development and regular history (BPMH) and MR was developed. Patients taking “high risk” engagement of leadership at zone pharmacy management meetings. medications were deemed most likely to experience an adverse drug event Evaluation: Feedback was received from provincial leadership through a and thus labeled “high priority” for BPMH and MR by pharmacists. survey and focused questions at zone pharmacy management meetings. Description: Following implementation of a standardized BPMH and Responses were aggregated and summarized. There was general support to MR policy for pharmacists, evaluation of adherence and response was continue the harmonize CFO process. Top factors influencing site capacity required. were staffing levels, time commitment and willingness of pharmacists to precept and the ability to schedule consistent preceptors with the Action: An audit was performed to evaluate the number of BPMHs student. Top strategies to address increasing capacity included supporting completed by pharmacists on 2 medical and 2 surgical nursing units. pharmacist precepting skills, trialing novel models of precepting (e.g. Patient and medication related characteristics were collected and peer-assisted learning), and promoting the benefits of precepting to analyzed to quantify the proportion of patients fitting characteristics pharmacists. and subsequently having a BPMH form completed by a pharmacist. Quantitative data was compared to that collected prior to implementation Implications: The harmonized yearly CFO process will be maintained of the prioritization criteria. Pharmacists were interviewed to collect data going forward. Setting strategic priorities and regular communication regarding response to the policy and its effect on their practice. between faculty, practice leadership and zone leadership is required to achieve common goals. The standing committee will focus future efforts Evaluation: The overall number of pharmacist initiated, completed on supporting preceptors, in particular with regards to embracing new and verified BMPHs has increased from 66% to 71% post-policy models of precepting to build capacity. implementation. Furthermore, pharmacists are completing BPMHs 34% 51 more often on high risk patients than other healthcare providers, an of 3,632 pens were collected from returns and the majority were slightly improvement from 15% pre-policy. According to interviews, on average, used (58.5%), while 28.2% were moderately used and 12.8% were close to 1 hour per day is spent on BPMH and MR, with 50% of that time being empty. Few pens were returned unused (0.4%). More short- and rapid- spent on high-priority patients. According to feedback, 74% of pharmacists acting insulin pens were returned slightly used (66.2%) than intermediate- agree that the new policy helps to prioritize patients, and 81% are able to and long-acting insulin pens (46.8%). assess all high priority patients on their unit. Implications: Results suggest conversion to insulin pens from 3 mL vials Implications: The new policy has helped to prioritize patients when resulted in increased acquisition costs with a higher increase in usage of pharmacists are not able to see all patients for BPMH and MR. short- and rapid-acting insulin products. This may potentially be due to a decrease in opportunity of vial sharing when insulin is administered on an Safe Insulin Pen Labelling Practices in a Community ad hoc basis such as with sliding scale orders or one-time orders. Teaching Hospital: A Post-Implementation Evaluation Shi M, Broad N, Choy J, North York General Hospital, Toronto, ON Incidence des effets indésirables médicamenteux dans un centre hospitalier universitaire mère-enfant Background: The Institute for Safe Medication Practices recommended de 1989 à 2014 : la loi de Vanessa permettra-t-elle the use of insulin pens for the safe administration of subcutaneous insulin d’augmenter le taux de déclaration? for inpatients. Concerns of unintentional sharing of insulin pens among Harry M,1 Lebel D,1 Comtois A,2 Bussières JF1, 3 patients have been raised in the literature. Therefore, an audit was conducted 13 months after the implementation of insulin pens to evaluate 1Unité de recherche en pratique pharmaceutique, Département de pharmacie, if they were appropriately labelled as a surrogate indicator for correct CHU Sainte-Justine, Montréal, QC administration practices. 2Service des archives médicales, CHU Sainte-Justine, Montréal, QC 3Faculté de pharmacie, Université de Montréal, Montréal, QC Description and Action: Insulin pens were introduced between May and July, 2014. Education promoting “One Pen, One Patient” and Contexte : Les études concernant l’incidence des effets indésirables proper insulin pen labelling was provided via in-service, posters, and médicamenteux (EIM) en pédiatrie sont peu nombreuses malgré le risque web-based training. Nurses were educated to retrieve insulin pens from accru pour cette population de développer des EIM graves. floor stock and label them with the patient’s identifier. Thirteen months Objectifs : L’objectif principal de notre étude est d’évaluer l’incidence des after the introduction of insulin pens, a physical audit was performed on EIM codés entre 1989 et 2015. L’objectif secondaire est de déterminer les the nursing units over 5 consecutive days and repeated 30 days later to classes thérapeutiques causant les EIM en fonction de l’âge ainsi que la ensure that the results were consistent. All insulin pens in patient-specific proportion d’EIM déclarés auprès de Santé Canada. medications bins were evaluated visually, and unlabeled pens were discarded. The patient’s nurse was then notified, and education regarding Méthodologie : Il s’agit d’une étude descriptive rétrospective des EIM correct labelling practices was provided. dans un centre hospitalier universitaire mère-enfant. Ont été inclus tous les EIM survenus chez des patients âgés de 18 ans et moins sur la période Evaluation: A total of 175 pens in the inpatient setting were evaluated du 1/4/2010 au 18/10/2014. Les résultats issus d’une précédente étude, and 92.6% of pens were found to be labelled. réalisée sur la période 1989-2010, ont été utilisés pour fins de comparaison Table 1. Results from both audits historique. Les moyennes ont été comparées par un test t de Student. Audit 1 Audit 2 TOTAL (n=175) Résultats : Entre 2010 et 2014, on a dénombré en moyenne 1,18 ± 0,08 Labelling Number of Pens Number of Pens Number of Pens EIM codés par jour contre 0,62 ± 0,01 EIM entre 1989 et 2010 (p < 0,001). Categories (%) (%) (%) L’incidence moyenne journalière des EIM en pédiatrie était de 2,1% ±0,7% Labelled 82 (93.2) 80 (92.0) 162 (92.6) en 2010-2014 contre 1,2% ± 0,4% entre 1989 et 2010. Les antibiotiques Unlabelled 6 (6.8) 7 (8.0) 13 (7.4) étaient responsables du tiers des EIM chez les enfants de 0-2 ans et les anticancéreux d’un peu plus de 20% des EIM chez les 3-11 ans. Seulement Implications: The results of this evaluation suggest that 13 months 39% des EIM codés ont été déclarés à Santé Canada en 2010-2014 contre after implementation of insulin pens, compliance with proper labelling 37% en 1989-2010. is high even without continuous education and reinforcement. Future research is required to ascertain if proper labelling correlates with correct Le nombre d’EIM codés a significativement augmenté au cours des administration practices. dernières années. Avec l’adoption de la loi de Vanessa, la détection et la codification des EIM devrait continuer d’augmenter. Une collaboration Cost and Waste Impact of Implementing Insulin Pen accrue entre les archives médicales et le service de pharmacovigilance du Devices in a Community Teaching Hospital département de pharmacie de l’hôpital pourrait aussi être envisagée afin d’accroître le taux de déclaration auprès des autorités. Shi M, Devereaux A, Nauth S, Choy J, North York General Hospital, Toronto, ON Background: Insulin pen devices were introduced to replace vials for the Developing and Implementing a Competency-Based administration of subcutaneous insulin for inpatients in a community Program for Pharmacy Technician Students teaching hospital. The cost and waste impact of the conversion was Nguyen C,1 Sengar A2 evaluated. 1University of Toronto, Toronto, ON Description and Action: Conversion from 3 mL insulin vials to pens 2Trillium Health Partners, Mississauga, ON began on May 5, 2014. Pharmacy purchasing data over a 9-month period between July 1, 2014 and March 31, 2015 was analyzed and compared Background: Competency-based programs (CBPs) are emerging to the data in the same interval over the previous year to avoid seasonal in the medical community because they graduate more competent variations. Insulin pens used in the inpatient setting were returned to the professionals compared to traditional teaching programs. CBPs shift the pharmacy for usage auditing. Usage was evaluated as volume remaining focus on teaching towards learning outcomes as outcomes are a way and categorized as follows: unused, slightly used (0-20%), moderately used to assure teaching methods are effective. This hospital offers a newly (20-80%), and close to empty (>80% used). redesigned outcome based 4-week placement for college students enrolled in pharmacy technician programs. CBP principles were used with the Evaluation: Acquisition costs prior to conversion were $7,836.80 for objective to improve learning outcomes and job satisfaction for students 4,260 mL of short- and rapid-acting insulins and $14,561.22 for 4,415 upon graduation. mL of combination, intermediate-, and long-acting insulins. After the conversion, acquisition costs were $12,633.54 for 5,655 mL of short- and Description: There are many different strategies to implement CBPs. rapid-acting insulins (61.2% increase in cost, 32.7% increase in volume) This program uses 1-on-1 training, hands on experience, multiple and $18,461.93 for 3,950 mL of combination, intermediate-, and long- assessments, and peer teaching and learning. Student goals and objectives acting insulins (26.8% increase in cost, 10.5% decrease in volume). A total were designed using Structure of Observed Learning Outcomes (SOLO) taxonomy which provides a systematic way of describing how a student’s
52 performance grows in complexity, when mastering tasks. SOLO taxonomy Background: Pharmacy practice has considerably changed over the can be applied across different types of learning outcomes and has been years. Some countries survey hospital pharmacy practice (e.g. USA, shown to instill deeper learning in students. Evaluation forms designed Europe). In Canada, an editorial board of hospital pharmacy leaders has using a rubric, are now used in place of the college’s evaluation forms. surveyed hospitals pharmacists in the last 30 years. Action: Essential components of CBP were determined before redesigning Objectives: To describe the evolution of the Hospital Pharmacy in Canada the learning objectives to incorporate effective strategies into the new Report (HPCR). curriculum. Research was done to determine how to effectively apply Methods: This is a retrospective descriptive study. Using published reports, SOLO taxonomy to the development of the curriculum goals and we extracted the following key variables: editorial board foundation, objectives. board members, reports response rate, number of pages/themes, trends for Evaluation: Evaluation forms were completed by students to provide key topics, diffusion strategies and key issues. feedback on preceptor performance and program content. The majority Results: The editorial board for the HPCR has been founded in 1985 with of feedback received was positive and common themes included an four members. Throughout the years, 30 hospital pharmacists joined the “enriching experience” and “thorough understanding of various board and four of these were executive editors. Response rates stayed high concepts”. A total of 57 students have completed the program with a pass with a low 50%(2786/542) in 1985/86 to a high 80%(176/219) in 2011/12. rate of 96%. From an initial 18-page length in 1985/86, it reached a record 148-page Implications: Currently 5 Colleges are associated with the program and in 2013/14. At least 20 themes were covered systematically or periodically: the hospital is remunerated for each student placement. As regulated demographics, clinical pharmacy, drug distribution, financial resources, health care professionals, pharmacy technicians can now demonstrate key human resources including pharmacists and technicians, technologies, competencies and improve job satisfaction upon graduation workload management, patient safety, CSHP2015, regionalization and centralization, pediatrics, evaluation of pharmacy services, ethics and A 10-year Retrospective Study of the Medication future trends. The report has been annual from 1985/86 until 1997/98 and Incidents and Accidents Associated with Drug Dose then every second year. Over time, pharmacy staffing and expenditures Documentation in a Teaching Hospital have increased with the decentralization of pharmacists in a large number of clinical patient care programs, combined to a progressive Rousseau A,1 Lebel D,1 Mercier G,2 Bussières JF1,3 delegation of distribution services to pharmacy technicians with the 1 Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, support of technologies. Diffusion strategies included a paper publication Montréal, QC followed by a web publication in 2001/02 and emails to key stakeholders 2 Electronic Health record Team, CHU Sainte-Justine, Montréal, QC including Hospitals chief executive officers. Regional management 3 Faculté de pharmacie, Université de Montréal, Montréal, QC pharmacy seminars and bi-annual Canadian management seminars were Background: There is a growing need for better documentation of drug opportunities for larger diffusion. doses in patient records and a higher traceability of steps performed by Conclusions: Few healthcare professions can rely on such extensive data healthcare professionals. Medication administration records (MAR) are about their activity. The HPCR is celebrating his 30th Anniversary in 2015. used for such purpose. Objectives: To describe a 10-year period of the medication incidents and Impact of Comprehensive Medication Reviews accidents (I/A) associated with drug dose documentation. Completed by Pharmacy Students in a Complex Continuing Care Program: A Pilot Project Methods: This is a retrospective study conducted in a 500-bed mother- child teaching hospital. All medication I/A were extracted from GesRisk® Rodrigues H, Li W, Kelebay L, Nedzka P, Ng S, Runnymede Healthcare Centre, from April 1st, 2004 until March 31st, 2015 (dates, patient care areas, Toronto, ON descriptions, types, consequences, corrective measures, severity indexes). Background: Adults receiving a large number of medications are at Medication I/A associated with drug dose documentation were identified increased risk for an adverse drug event and increased risk of admission if the description included the words profile, sheet or MAR. A random to acute care. Adults with complex medical needs often require a complex sample of medication I/A were audited to confirm their classification. drug regimen and benefit from regular review of medications to ensure Results: A total 20,598 medication I/A were identified. A quarter were safe medication use. Pharmacists and pharmacy students can play an associated with drugs dose documentation (n=5403, 26.2%). Medication important role in evaluating the appropriateness of medications and documentation I/A were attributed to surgical wards (18%), oncology improving medication safety. wards (14%), pharmacy department (12%) and others areas (56%). They Description: A step-wise, multidisciplinary procedure for completing a were mainly related to drug omissions (33%), error intercepted before drug comprehensive medication review (CMR) was developed. The number administration (20%), time/date of administration (17%), dose/rate (13%) of patients receiving this intervention was limited due to the amount of and others (17%). Their severity index was, in decreasing order of severity: pharmacist time required to complete the CMR. B-incident (23%), C-accident with no consequence (67%), D-patient tested for consequences (7%) and others (3%). Ten percent (5/50) of randomly Action: A CMR role was developed for pharmacy students as part of a selected medication I/A that were classified as not associated with drug pilot project to increase the number of complex continuing care patients dose documentation were considered related to drug dose documentation receiving this intervention. Pharmacy students were oriented to the after analysis. Inversely, 8% (4/50) were included, but were not associated process and followed a systematic approach to assessing each patient’s with documentation. medications. All suggestions were reviewed and cosigned by a clinical pharmacist prior to documentation and discussion with the physician. Conclusions: Twenty-six percent of medication I/A were associated with drug dose documentation. This high proportion demonstrates the Evaluation: A retrospective audit was completed in order to determine importance of the risks associated with manual documentation of drug the impact of the intervention. Three pharmacy students completed doses by nurses. A better understanding of the I/A associated with drugs 47 CMRs over a total of 14 weeks resulting in 139 recommendations. dose documentation can be useful in a patient safety program and when Physicians implemented 77% of the recommendations. Of the accepted implementing an electronic MAR. recommendations, 52% resulted in the discontinuation of a medication, while 40% resulted in the addition of a new order (optimization of an Hospital Pharmacy in Canada Report: 30th existing medication, new medication, monitoring test or consultation). Anniversary Pharmacy student, pharmacist and physician satisfaction was found to be positive. Bussières JF,1 Hall K,2 McKerrow R2 Implications: The successful integration of pharmacy students into the 1 Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, CMR process for adults in a complex continuing care program may have Montréal, QC important implications. It provides pharmacy students an opportunity to 2 Consulting Pharmacist practice their skills and actively engage in providing meaningful patient
53 care while helping pharmacists and physicians optimize drug therapy for prevent the likelihood of negative outcomes with the understanding of patients. common themes and contributing factors that may result in drug tapering errors. Safety Alerts as Drivers for The Pharmaceutical Opinion Program: A Pilot Study to Reduce Potential Medication Incidents Involving Insulin: A Multi- Hospitalizations Due to Preventable Drug-Drug Incident Analysis Interactions Kasprzak C, Ho C, Institute for Safe Medication Practices Canada, Toronto, ON Ho C, Cheng R, Kawano A, Morphy B, Yoo L, Ng M, Kong J, Liang S, Background: Insulin is a life-saving pharmacological therapy used Arjomandpour S, Chen A, Sharma A, Hyland S, Institute for Safe Medication in the management of blood glucose for many diabetic patients. Practices Canada, Toronto, ON However, insulin has been identified as a high alert medication as it Background: Drug-drug interactions (DDIs) represent a potentially has the potential to cause detrimental patient harm when used in error; serious problem that can result in adverse drug events (ADEs), which particularly an excessive dose can lead to life-threatening seizures and account for 2.8% of hospital admissions. Pharmacists are uniquely coma via hypoglycemia. Medication incident reporting can be used to positioned to prevent ADEs by intervening in DDIs. enhance understanding of factors that may contribute to insulin-related medication incidents. Objectives: This project aims to reduce the occurrence of DDIs associated with potential hospitalizations, offer continuing professional development Description: The objective of this multi-incident analysis was to examine opportunities while providing a financially sustainable business model via insulin-related medication incidents and determine potential system-based the Pharmaceutical Opinion Program (POP). improvements which may be customized in pharmacy practice to enhance medication safety. Methods: A Safety Alert regarding 13 evidence-based DDIs was disseminated and reviewed by pharmacists to allow for recognition Action: Reports of medication incidents involving insulin were extracted of the cited DDIs as they were encountered in practice, and to inform from a national incident reporting database between January and communication with prescribers via a pharmaceutical opinion. December 2014. Quantitative data was collected for six months in the form of the total Evaluation: After a review of 226 incidents, 81 were included in this number of POP claims submitted to the provincial ministry before and qualitative, multi-incident analysis. The incidents were then analyzed after the Safety Alert, while qualitative data was obtained through three and categorized into main themes and subthemes. The four main themes focus group sessions. identified were: (1) product selection (related to unique insulin properties), Results: At study completion, 35 pharmacies made 67 POP claims with prescribing, order entry and dispensing as subthemes; (2) therapeutic involving the 13 DDIs in this project, translating to a theoretical regimen change; (3) dosage calculations; and (4) storage requirements. cost avoidance of approximately $73,184 from potentially averted Potential solutions for prevention of insulin-related incidents included the hospitalizations. The difference in the total number of POP claims was use of standardized pre-printed order forms, incorporation of independent not statistically significant (2845 pre-intervention versus 2399 post- double checks throughout the entire pharmacy workflow, and conducting intervention; p = 0.204), however the 18 pharmacies with a net increase comprehensive diabetes-focused medication reviews with patients. in POP submissions exceeded the 13 pharmacies with a net decrease. The Implications: Medication incidents involving insulin in pharmacy focus group discussion indicated that the value of the Safety Alert was practice are common and have the potential to cause serious patient unequivocal. harm. Findings from this analysis are intended to educate health Conclusion: Through disseminating evidence-based DDIs via the Safety care professionals on the vulnerabilities in the medication-use process Alert, this project offers an innovative strategy to capture and reduce DDIs that may contribute to insulin-specific medication incidents and offer associated with potential hospitalizations; deliver continuing education to recommendations to prevent such events from recurring. front-line pharmacists; and provide business opportunities through which cognitive services are reimbursed via the POP. Development of a Framework for Podcast Creation to Supplement Pharmacy Students’ Learning Medication Incidents Involving Drug Tapering Kani M,1 Ho C1, 2 Chen A,1 Ho C1, 2 1Institute for Safe Medication Practices Canada, Toronto, ON 1Institute for Safe Medication Practices Canada, Toronto, ON 2School of Pharmacy, University of Waterloo, Kitchener, ON 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Background: Literature suggests that students perceive podcast as really Background: Prescriptions involving a drug tapering process are often useful additional resource to supplement their learning rather than as a complex in nature, involving multiple, sequential doses of medication(s), substitute for the traditional methods of learning. Podcast takes advantage extensive directions of use, and complex mathematical calculations. All of of the ubiquitous devices and networks to allow for “anytime” learning these considerations illustrate the inherent vulnerability of drug tapering “anywhere”. to errors that may occur at any stage of the medication-use process. Description: Currently, the use of podcasts for teaching and learning at Description: The objective of this multi-incident analysis was to identify the School of Pharmacy is non-existent. This project intended to develop potential systems-based contributing factors and areas of vulnerability a framework for podcast creation to supplement pharmacy students towards medication incidents involving drug tapering. learning. Action: An analysis of medication incidents involving drug tapering was Action: A needs assessment with 138 pharmacy students indicated that performed using reports anonymously submitted to a national incident 100% of respondents have access to podcast-capable devices for listening. reporting database from 2010 to 2014. Although 64% of students do not currently listen or subscribe to podcasts, 77% are very interested or somewhat interested in pharmacy student- Evaluation: 122 medication incidents were analyzed and categorized related content podcasts. into four major themes, all of which are potential contributing factors for drug-tapering incidents: (1) lack of standardized tapering guidelines, Evaluation: To initiate the creation of podcasts for pharmacy students, (2) inadequate patient counseling, (3) operational limitations, and (4) a framework was developed that takes into account the necessary steps complexity of prescription. The four major themes were further divided and elements needed with minimal cost, ease of use, simplicity, and into subthemes, some of which included labeling restrictions, billing sustainability. This framework engages both faculty and students in restrictions, and multi-medication compliance aids. knowledge creation for supplemental student learning and incorporates a continuous quality improvement process to ensure the podcast content is Implications: Errors associated with drug tapering regimens occur on evidence-based. all levels of patient care involving physicians, pharmacists, patients, and caregivers alike. Learning from medication incidents is an imperative step in improving medication-use systems. Pharmacists can mitigate and 54 Implications: Podcasts may offer pharmacy students the opportunity of was estimated as $58,236.77 annually, representing a $50,151.45 increase supplemental learning through the use of a technology that they already from baseline cost. Of this, $14,104.09 was estimated for nursing PPE, carry, depend on, and is part of their social practice. $30,233.71 for pharmacy labor and $5,813.63 for packaging materials. Conclusion: Packaging and administering hazardous drugs cost about Complexity and Vulnerability of Multi-Medication $0.50/UD more than non-hazardous oral dosage forms. Compliance Aids Tsang J, Ho C, Institute for Safe Medication Practices Canada, Toronto, ON Impact of a Geriatric-Hospitalist-Orthopaedic Co- Management Program on Closing the Post-Fracture Background: Traditional processing and dispensing of prescriptions are Care Gap involved with high-level procedures; compliance packaging introduces further complexity and vulnerability in the pharmacy workflow due to its Miao W, Alibhai S, Coleman B, Fan-Lun C, Mount Sinai Hospital, Toronto, ON multi-compartmental design. Background: Over a 6-month period in 2010-2011, Mount Sinai Hospital Description: The objective of this project is to gain a better understanding (MSH) developed and established a new geriatric and hospitalist co- of the potential contributing factors for compliance-pack related management program to care for geriatric hip fracture patients admitted medication incidents and attempt to offer recommendations to prevent to the orthopaedics service. such events from recurring. Objectives: To evaluate the effectiveness of MSH’s geriatric-hospitalist- Action: An analysis of medication incidents related to compliance pack orthopaedic co-management program at increasing osteoporosis preparation was performed using reports anonymously submitted to a treatment among hospitalized older patients post hip fracture and assess national incident reporting database from June 2012 to May 2013. whether the program decreases prescribing of medications associated with falls risk. Evaluation: A total of 170 incident reports were analyzed. Two main themes were identified: (1) order entry and (2) packaging process. Major Methods: This single-center, retrospective, pre-post intervention study concerns with order entry were associated with hospital discharge order, compared the frequency of osteoporosis and falls risk medication discontinuation of medication from new prescription order, new or prescribing before (March 2009-September 2010) and after (March prospective update of prescriptions, and miscalculation. Other concerns 2011-December 2012) implementation of the co-management program. in regards to packaging process included labeling, incorrect time of Every second hip fracture patient aged ≥ 65 years consecutively admitted administration, half-tablet medications, improper return-to-stock to the orthopaedics service between March 2009 and December 2012 procedures, dose or medication omissions, and incorrect medication or was screened for eligibility. A single reviewer extracted data through a strength. With no permanent physical barriers between each packing slot, structured chart review. The 2010 Osteoporosis Canada Guidelines were compliance packaging is more prone to a medication being misplaced in used to define appropriate agents and doses for osteoporosis treatment. another slot during the sealing process. Conducting independent double The Beers Criteria were used to identify fall-risk-increasing drugs (FRIDs). checks is essential in the pharmacy workflow. Primary outcomes were analyzed using interrupted time series methods. Implications: Although multi-medication compliance aids may facilitate Results: Three hundred forty-two patients were included (pre-intervention, patient’s adherence and improve treatment outcomes, the complexity n=139; post-intervention, n=171; transition period, n=32). Primary of the design and procedures for preparation may potentially lead to an outcomes: Implementation of the co-management program was increased risk of errors. Recognizing the vulnerabilities of compliance pack associated with an increase in number of patients whose osteoporosis preparation creates opportunities for pharmacists to implement additional regimen was optimized to meet guideline-recommended doses (RR=1.9, safeguards to enhance medication safety. 95% CI: 1.7-2.2, p<0.001). It was also associated with an increase in number of patients newly initiated on anti-resorptive therapy (RR=1.7, Economic Evaluation of Adding a Drug to the 95% CI: 1.3-2.3, p<0.001). Secondary Outcomes: In the pre-intervention Hospital’s Hazardous Drug List period, 7.9% of patients had a decrease in number or dose of FRIDs during admission compared 18.7% of patients in the post-intervention period Ma N, Kulchycki A, Hayes J, Carating H, Walker SE, Department of Pharmacy, (p=0.006). Sunnybrook Health Sciences Centre, Toronto, ON, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Conclusion: Implementation of a geriatric-hospitalist-orthopaedic co- management program at MSH was associated with a higher frequency Background: Preparation and administration of hazardous drugs can of guideline-concordant osteoporosis treatment and fall-risk medication potentially expose staff, leading to adverse health outcomes. The National de-prescribing among older post-hip fracture patients requiring secondary Institute for Occupational Safety and Health (NIOSH) publishes a list fracture and falls prevention. of hazardous drugs with recommendations for safe handling during preparation and administration. However, several commonly used drugs The Opinions of Hospital Pharmacists in Canada have been added to the list (e.g. warfarin and phenytoin) for which Regarding Marihuana for Medical Purposes harm to staff is questionable. As part of the decision to add a drug to a hospital’s hazardous drug list, the incremental cost for packaging and Mitchell F,1 Gould O,2 LeBlanc M,1 Manuel L1 administration as a hazardous product was considered. 1Horizon Health Network, Moncton NB Objective: To determine the incremental cost of unit dose (UD) packaging 2Mount Allison University, Sackville NB a drug as a hazardous product based on NIOSH standards. Background: Health Canada’s most recent Marihuana for Medical Methods: Labor, material and personal protective equipment (PPE) costs Purposes Regulations have changed the way that patients access for packaging both hazardous and non-hazardous drugs was determined marihuana and the responsibility to authorize its use has been shifted for various methods including blister packaging, Ziploc® bag over wrap, into the hands of health care prescribers. Pharmacists practicing in PACMed®, Cadet®, and AutoBag®. Costs were then used to estimate the hospitals are authorized to place orders for dried marihuana from a cost of adding three drugs, clonazepam, phenytoin, and warfarin, to the licensed producer for in-hospital patient use. As its use increases, hospital hospital’s hazardous drug list. pharmacists may find themselves having an increased role in the care of patients using marihuana for medical purposes. Results: The cost to package non-hazardous drugs using either the Cadet® or PACMed® ranged from $0.05-0.09/UD. Two primary methods Objectives: The primary objective of this study was to determine the for packaging intact tablets and capsules as hazardous drugs were opinions of hospital pharmacists in Canada regarding marihuana for identified. The first method, manually blister packing followed by medical purposes and to assess what factors influence these opinions. overwrapping with a Ziploc® bag, cost $0.77/UD. The second was to Methods: This was an online survey distributed to licensed hospital package the drug with the Cadet®, followed by an AutoBag® overwrap, pharmacists in Canada via individual provincial/territorial pharmacy which cost $0.54/UD. In the previous fiscal year, 108,193 doses of regulatory bodies, pharmacists’ associations, hospital pharmacy directors, clonazepam, phenytoin, and warfarin were dispensed. The total cost to the Canadian Society of Hospital Pharmacists, and the Association des package and administer all doses using the Cadet® packaging method 55 pharmaciens des établissements de santé du Québec. Data was collected Résultats : Omni-Assistant® est une application web hébergée à through FluidSurveys, an online survey tool. Descriptive statistics as well l’extérieur de l’établissement et comporte 14 modules de travail. Sept as multivariate logistic regression models were used to analyze study data. ont été retenus et cinq implantés au sein de notre établissement, soit Results: There were 769 valid responses to the survey. Forty-five percent of les modules M1–optimiseur de tâches, M2–gestion documentaire et pharmacists agreed that marihuana is effective; while 55% agreed that it centre de formation, M3–locaux et équipements, M4–points de contrôle, is safe. Only 17% agreed that they are knowledgeable about marihuana M12–inspection et audits. Jusqu’à maintenant, l’outil s’avère prometteur for medical purposes. Factors that influenced pharmacists’ opinions were pour centraliser la gestion des écarts pour une majorité des éléments de age, education, area of clinical practice, province of work, and personal la pratique pharmaceutique. Toutefois, des modifications doivent être experience. apportées à la base de données, à la navigation en poste fixe et en tablette afin d’en optimiser la navigation et l’utilisation. Conclusion: Many Canadian hospital pharmacists agree that marihuana for medical purposes is safe and effective, yet few consider Conclusions : Cette étude décrit l’implantation d’un logiciel de gestion themselves knowledgeable about it, with approximately 65% of de la qualité et des risques dans un département de pharmacie hospitalier. pharmacists reporting no formal training on the topic. Ce type d’outil apparait utile et nécessaire à l’identification et la prise en charge efficace des écarts de pratique. Safety Implications of the Dose Change Alert in Smart Pumps on the Administration of High-Alert Reconstruction de l’hôpital Saint-Michel en Haïti : Medications perspectives après cinq missions pharmaceutiques 1,2,3 3 3 Goulding C,1 Bedard M2 Bussières JF, Bussières V, Legault M 1 1Baxter Corporation, Mississauga, ON Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, 2The Ottawa Hospital, Ottawa, ON Montréal, QC 2Faculté de pharmacie, Université de Montréal, Montréal, QC Background: Most intravenous medication errors occur during 3Programme intégré de santé en Haïti, CHU Sainte-Justine, Montréal, QC administration. Smart pumps can reduce the incidence of dose or rate errors using soft and hard limits. But industry standard dose error Contexte : Haïti est un pays en reconstruction et de nombreuses reduction software misses errors that occur during titration. The dose initiatives humanitaires sont encore déployées cinq années après le change alert was developed to detect errors during titration. tremblement de terre. À Jacmel, notre équipe participe à un projet de reconstruction de l’Hôpital Saint-Michel en collaboration avec la Croix- Objective: To evaluate the safety implications of the dose change alert in Rouge Canadienne. the SIGMA Spectrum Infusion System on the administration of high alert medications. Objectif : Décrire l’état d’avancement des travaux après la tenue de cinq missions pharmaceutiques. Methods: Observational analysis of continuous quality improvement data from all titratable high-alert drug infusions across 1600 large volume Méthodologie : Il s’agit d’une étude descriptive rétrospective. À partir pumps between May 1st and October 31st 2014 (inclusive). Outcomes des revues documentaires publiées et des rapports de mission rédigés, included dose change alert confirmation and cancellations and drug nous avons fait l’inventaire des constats, des recommandations et des library compliance. réalisations. Results: Compliance with using the drug library was 96.8%. The Résultats : L’Hôpital Saint-Michel est un hôpital départemental de 75 lits. percentage of dose change confirmations and cancellations, within the Depuis octobre 2013, nous avons réalisé cinq missions pharmaceutiques soft limits were 48.1% and 1.9%, respectively. The titration of vasopressors pour un total de 55 jours. Quatre constats ont été identifiés, soit la resulted in the highest percentage (75%) of dose change confirmations. nécessité de réorganiser l’hôpital (n=17 recommandations), le circuit The titration of anticoagulants resulted in the highest percentage (12%) of patient (n=9), le circuit du médicament (n=26) et le département dose change cancellations. de pharmacie (n=63). À ce jour, 27% des recommandations ont été complétées. Les travaux ont notamment permis de structurer et redresser Conclusions: This study provided insight into the safety implications la gestion financière et statistique, d’informatiser la gestion des stocks, de of the dose change alert on the titration of high alert drugs. The dose déménager la pharmacie dans un abri temporaire durant les travaux, change alert allows the hospital to define the percentage dose change d’améliorer le circuit du médicament, d’augmenter les revenus et limit for individual drugs and plays a large role in potentially preventing l’inventaire, de former le personnel, de régulariser la chaîne thermique, de medication errors. créer un comité de pharmacologie pour les médicaments et fournitures de soins, d’évaluer le circuit du médicament et de s’arrimer avec les médecins Implantation d’un logiciel de gestion de la et infirmières, de créer un site web et de de soutenir l’établissement en conformité en établissement de santé dons de médicaments. Le déménagement dans les nouveaux bâtiments Rousseaux G,1 Atkinson S,1 Lebel D,1 Piaget I,1 Bussières JF1,2 est prévu en 2016. Jusqu’à maintenant, un résumé et six articles ont été publiés afin de partager les efforts de reconstruction. 1Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, QC Conclusion : Cette étude illustre la contribution d’un pharmacien à la 2Faculté de pharmacie, Université de Montréal, Montréal, QC reconstruction d’un hôpital départemental en Haïti dans le cadre d’un projet humanitaire canadien. Contexte : La pharmacie est une profession réglementée par plusieurs centaines de critères de conformité issus du cadre juridique et normatif. Pilot Study of Biological Monitoring of Four Auditer les pratiques et assurer un suivi des écarts auprès de toutes Antineoplastic Drugs among Canadian Healthcare les parties prenantes afin de réduire les risques d’accidents est un défi Workers quotidien. Poupeau C,1 Tanguay C,1 Plante C,2 Caron NJ,3 Bussières JF1,4 Objectifs : L’objectif est de décrire l’implantation d’un logiciel de gestion de la conformité en établissement de santé. 1Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montréal, QC Méthodologie : Il s’agit d’une étude transversale descriptive menée dans 2Nursing, CHU Sainte-Justine, Montréal, QC un établissement mère-enfant de 500 lits. Le logiciel Omni-Assistant® 3Centre de toxicologie du Québec, Institut national de santé publique du Québec, (Omnitech Innovations Inc., Canada) a été retenu. L’implantation a été QC menée selon les étapes suivantes : a) formation, b) création de l’identité 4Faculté de pharmacie, Université de Montréal, Montréal, QC des usagers et des locaux, c) activation de la base test, d) exploration des fonctionnalités, e) implantation d’une activité par module, f) production Background: There are health risks to workers occupationally exposed to de vidéos pour partage de connaissance, g) rédaction de politiques et antineoplastic drugs. procédures. Au fil de l’implantation, les modifications à apporter et les Objectives: We hypothesized that implementing a biological monitoring difficultés rencontrées ont été recueillies. program would be feasible. The goal was to present the results of our pilot 56 cross-sectional study of biological monitoring of 4 antineoplastic drugs. Methods: We recruited workers from the hematology-oncology 2Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, department and control workers from the central pharmacy in a mother- BC child university health center. This study was preceded by an information 3Vancouver Island Health Authority IMIT Client Services, Royal Jubilee Hospital, period during which we aimed at enhancing the workers’ awareness and Victoria, BC knowledge of the risks of occupational exposure. Participants filled out a Background: Antiquated paging systems continue to be used by the journal containing activities performed and personal protective equipment majority of hospitals in Canada despite the nearly ubiquitous use of worn. One urine sample was collected at the end of their shift. Samples personal and/or corporate smartphones by hospital clinicians. There is a were analysed by UPLC/MS-MS for the presence of cyclophosphamide, lack of literature evaluating the impact of new communication strategies. ifosfamide, methotrexate and alpha-fluoro-beta-alanine (5-fluorouracile’s main urinary metabolite). Description: Integrated multi-platform smartphone apps, such as the Vocera® Collaboration Suite (VCS), have the potential to be a reliable, Results: The participation rate was 85.7% (102/119). No urine sample efficient, and secure methods of communication in hospitals. had detectable concentrations of any of the four drugs evaluated (0/101; 0/74 nurses, 0/11 pharmacists, 0/9 pharmacy technicians and 0/7 doctors). Action: We examined the effect of VCS, on communication and the In the five days before sampling, 67/92 (72.8%) hematology-oncology efficiency of communication between hospital clinicians (n=153). Our participants performed at least one activity with antineoplastic drugs. primary outcome was the difference in page turnaround time before Nurses wore all of the recommended protection for technical activities and after the implementation of VCS. We also conducted baseline and (86.2%), but rarely for non-technical activities (14.9%). Pharmacists and post-study surveys. This three-month multidisciplinary prospective pharmacy technicians wore all of the recommended protection for all observational study involved two tertiary care hospitals, and one activities (100.0%). community hospital. Hospitalists, obstetricians, intensivists, and pharmacists piloted the VCS smartphone app in the replacement of Conclusions: We implemented a pilot study of biological monitoring of pagers. Switchboard operators, ICU nurses, and ICU unit clerks had access workers with a good participation rate. The absence of positive samples to the app via a desktop computer based web console. was a good indication that the measures in place ensured workers’ safety. We found areas where the worker protection can be enhanced, especially Evaluation: Physicians responded to pages from pharmacists faster for non-technical activities. Repeating the biological monitoring measures (5.5 vs 3 min; p < 0.05) when using VCS compared to traditional pagers. every few years could help confirming that the working practices are Physicians found the app was more efficient, reduced interruptions to continuously followed by workers. patient care, and 81% of physicians wanted to continue using the system. The highest reported drawback of the app was the reduction in phone Feasibility of Pharmacist-Run Group Diabetes battery life. Education Sessions for Patients on a Stroke Rehab Implications: This is the first research objectively demonstrating Unit that the speed of communication improves when hospital clinicians Kumra R,¹ Schwartz F² use smartphone technology compared to pagers. Smartphone based communication systems, such as Vocera® Collaboration Suite, improve ¹Pharmacy, Toronto Rehabilitation Institute, Toronto, ON the speed of, and satisfaction with hospital communication when ²Patient and Family Education, Toronto Rehabilitation Institute, Toronto, ON compared to pagers. Reduced phone battery life should be considered Background: Diabetes education is important post stroke as per stroke when implementing VCS. This project has been recognized by the best practice guidelines. However patients post stroke can have various provincial Minister of Health and has already informed the future deficits that can affect cognition and possibly also impact learning. The communication strategy for 10 acute care hospitals in Canada. feasibility of pharmacist-run group education sessions on a stroke rehab unit was evaluated to determine the feasibility of class-style learning with Headline News: A Simulation Game for Hospital patients with type 2 diabetes post stroke. Pharmacy Leaders Description: Needs assessments were completed with 10 diabetes patients Bussières JF,1 Hall K2 on the unit and 6 unit staff. The results were used to develop a diabetes 1Pharmacy Practice Research Unit and Pharmacy Department, CHU Sainte- session with consideration of adult education principles. These sessions Justine, Montréal, Québec were held every few weeks and diabetes patients were able to attend the 2Consulting pharmacist session. Background: Pharmacists work in a complex environment. To make Action: Patients completed a non-validated diabetes knowledge test before sound decisions in a changing environment, pharmacists must access and and after going to the diabetes education session. Patients completed an pursue quality information. evaluation survey of the session after attending the educational session. Objectives: To evaluate the ability of pharmacy leaders to discriminate Evaluation: Between April-September 2015, there were 35 stroke rehab true and false information in a simulated headline news bulletin. patients with diabetes. The number that attended sessions and signed consent were 7 or 19%. The number of patients that attended the sessions Methods: This is a prospective descriptive study. Participants at a was limited by cognitive barriers of patients, patient language barriers, Canadian pharmacy management seminar were exposed to a 10-minute and patient fatigue. Overall the knowledge test results were improved news bulletin with 20 headlines. Respondents were asked to score their post diabetes session. The mean test result pre session was 5.3/10 and post level of awareness and their evaluation of truthfulness of the material session it was 6.8/10. on a 1-10 scale (1-not familiar or untrue and 10-very familiar or totally true). Average score of awareness and truthfulness were calculated for The overall evaluation of the sessions by the patients showed that the each headline. Thereafter, respondents scored 18 statements regarding sessions met most of their needs and most found the topics useful. their exposure to false information with a 5-level frequency scale and 12 Implications: Pharmacist-run diabetes sessions in the inpatient rehab statements strategies to identify the true from the false with a 2-level scale setting can be beneficial to patients. The limitations of patient attendance Results: Forty participants took part in the simulation game (male due to cognitive, language barriers should be looked at more closely. 52%, >40y.o. 92%). Of the 20 headlines, three were false (score:0), four Possible considerations should be made to include family members at were partly true (score:5) and the rest were true. In most cases (13/20), sessions, and language translation to include more patients. participants were unable to identify the true from the false with precision (i.e. an absolute difference of >3). However, the more aware respondents Integrating Smartphone Communication Strategy were about a topic, the lesser the gap was between the true score and the and Technology into Clinical Practice: A Mixed respondents’ score. There was low correlation between awareness score Methods Research Study and truthfulness score (r2:0,628). At least 50% of respondents have used Webb C,1 Spina S,1,2 Young S3 8/12 strategies proposed to identify the true from the false in their life. A majority of respondents (95%) believed many decisions taken by hospital 1Vancouver Island Health Authority Pharmacy Services, Royal Jubilee Hospital, administrators do not rely on good science. Victoria, BC 57 Conclusions: A simulation using a headline news bulletin format can 1.30 vs. 1.84 medications per patient, respectively. Concordance between help support the reflection of pharmacy managers about finding the true the medication names between QHR and BPMH was found in 48% of and the false in their professional life. the prescription lines; this rate fell to 29% when also factoring daily dosage. When analyzing discrepancies, 29% of the QHR lines that did not Medication Incident Analysis Knowledge match (85/290) referred to as needed medications and 20% of the BPMH Mobilization Tool: Medication Safety Expertise at unmatched lines (89/443) referred to natural health products. Your Fingertips Conclusions: This study suggests that the QHR can provide high-quality Chan M, Cheng R, Duwyn K, Greenall J, Hamilton M, Ho C, Hyland S, Kong information to support the MedRec hospital process. However, it should be J, Lee C, Lee G, Leung H, Liang S, Mutti G, Ng M, Pan V, Reidel A, Salsman C, used as a second source to optimize the BPMH obtained from a thorough Streitenberger K, Watt A, Yu J, Institute for Safe Medication Practices Canada, interview with the patient or his family. More studies are required to Toronto, ON confirm the most optimal way to integrate the QHR to the MedRec process in hospitals. Background: Learning from medication incidents is a fundamental step in improving medication use systems. However, many Canadian hospitals A Comparative Study of the Conformity of the lack the resources and expertise to effectively analyze and learn from their Documentation of Drug Doses Administered Pre and medication incidents. The Knowledge Mobilization Tool (KMT) fills this Post Implementation of an Electronic Medication gap by providing hospital practitioners with access to timely, context- Record specific medication safety information to facilitate medication incident analyses. Rousseau A,1 Lebel D,1 Mercier G,2 Bussières JF1,3 Description: The KMT will be available as a website-based tool hosted 1Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, by the organization. When a medication incident is entered into the KMT, Montréal, QC it will generate a report containing incident-specific information units as 2Electronic Health Record Team, CHU Sainte-Justine, Montréal, QC extracted from the organization’s online safety bulletins. The information 3Faculty of Pharmacy, Université de Montréal, Montréal, QC output will include similar medication incidents, potential contributing Background: There is a growing need for better documentation of drug factors and recommendations for consideration. Each information unit doses in patient records, including higher traceability of steps performed will include a link to the full bulletin. by healthcare professionals. Electronic medication administration Action: Development of the KMT involved extracting information records (eMAR) are expected to increase the documentation of drug from safety bulletins (information units) and incorporating them into administration. a sophisticated information matching algorithm to create the KMT Objectives: To compare the conformity of the documentation of drug prototype. The prototype is then tested and refined for its ability of doses administered pre-post implantation of an eMAR. providing relevant results and user-friendliness. Enhancements to the user interface and refinement of the information matching algorithm will Methods: This retrospective pre-post study was conducted in a 45-bed continue post-launch. pediatric surgery unit. The pre-implementation phase occurred between October 19th-26th, 2014. The post-implementaion phase occurred between Evaluation: To evaluate the information matching algorithm, May 3rd-14th, 2015. Medication administration records were extracted from medication incidents from previously published bulletins were entered into the digitalized patient healthcare record (Chartmax®). We compared the the KMT and the data output indicated an 84.4% sensitivity for retrieving documented steps for each planned drug administration. A chi square test an exact match within the organization’s safety bulletins. With respect to was used to compare conformity. We calculated the ratio of the number of the overall concept and user-friendliness, a preliminary demonstration steps documented on the number of steps that should be documented. of the KMT prototype at a workshop garnered positive feedback from workshop participants. Results: A total of 135 patient charts were consulted. A total 4157 doses (2551 pre-implementation, 1606 post-implementation) were included. Implications: This innovative tool is the first of its kind, and will They represented 543 regular drug orders (280 pre-implementation, contribute to the safety of medication use by providing healthcare 263 post-implementation), 388 as needed drug orders (260 pre- practitioners in hospitals with the needed tools and information to implementation, 128 post-implementation). Post-implementation, the effectively analyze and learn from medication incidents. conformity of the documentation of drug dose administered increased from 79.5% (689/867) to 88.1% (796/904) (p < 0.0001) for regular drug Comparison of Information Available in the doses and from 16.3% (272/1665) to 43.5% (298/685) for as needed drug Medication Profle of an Electronic Health Record doses (p < 0.0001). The ratio of steps documented increased from 0.40 to and the Inpatient Best Possible Medication History 0.56 for regular drug doses and from 0.13 to 0.28 for as needed drug doses. Daupin J,1 Rousseaux G,1 Lebel D,1 Atkinson S,1 Bédard P,1 Bussières JF1,2 However, for drug infusions (n=19 doses pre-implementation, n=17 doses post-implementation), it decreased from 0.63 to 0.51. 1Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montréal, QC Conclusions: This study showed an increase in conformity of the 2Faculty of Pharmacy, Université de Montréal, Montréal, QC documentation of drug doses administered pre and post implementation of an eMAR. While eMAR can contribute to better documentation and Background: Medication reconciliation (MedRec) can improve patient traceability, further gain relies on human factor, enforcement of policy safety. In Canada, most provinces are implementing electronic health and procedures and periodical practice audits. records (EHR). The Quebec Health Record (QHR) can theoretically be used for medication reconciliation. However, the quantity and the quality of Drug Shortages in Health Care Institutions: information available in this HER have not been studied. Perspectives in 2014-2015 Objectives: The aim of the study was to compare the quantity and Rousseau A,1 Lebel D,1 Bussières JF1, 2 quality of the information collected between the inpatient best possible medication history (BPMH) and the QHR. 1Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montréal, QC Methods: This is a descriptive prospective study conducted in a 500-bed 2Faculty of Pharmacy, Université de Montréal, Montréal, QC tertiary mother-and-child university hospital center. All inpatients from May 19th to 26th 2015 were considered for inclusion. Every prescription line Background: Health Canada and many stakeholders recognize the in the BPMH and QHR was compared. importance and the negative impacts of drug shortage on patients, healthcare professionals and the healthcare system. Results: The study included 344 patients. A total of 1,039 prescription lines were analyzed. The medications’ name and dosing were more often Objectives: The aim of this study was to describe Canadian drug available in the QHR (95%) than in the BPMH (61%). However, fewer shortages. medications were reported in the QHR than in the BPMH, with averages of
58 Methods: This is a retrospective descriptive study. All drug shortages Réactions des étudiants en pharmacie à la identified on the list provided by a Canadian wholesaler/distributor mise en place d’un code de bonnes pratiques between Aug 1st, 2014 and Aug 17th, 2015 were included. These data were pharmaceutiques en ligne et dans les réseaux sociaux compared to previous annual data starting in 2006-2007. The number Bussières JF, Unité de recherche en pratique pharmaceutique, Département de of drug shortages and their therapeutic classes, average duration of drug pharmacie, CHU Sainte-Justine, Montréal, QC, Faculté de pharmacie, Université shortages and number and type of manufacturers involved were analyzed. de Montréal, Montréal, QC Results: From 2006-2007 to 2014-2015, the annual number of drug Contexte : Tous les citoyens possèdent désormais une empreinte shortages were, respectively, 493, 400, 441, 679, 429, 1081, 497, 611 and numérique. Les étudiants en pharmacie et les pharmaciens doivent s’en 662. Most therapeutic classes were represented throughout the years. préoccuper. In 2014-2015, they were, in descending order: central nervous system agents (22%), cardiovascular drugs (16%), anti-infective agents (13%), Objectifs : L’objectif de cette étude est de décrire les réactions des autonomic drugs (6%), gastrointestinal drugs (6%), antineoplastic drugs étudiants en pharmacie à la mise en place d’un code de bonnes pratiques (5%), blood formation, coagulation and thrombolysis agents (5%), pharmaceutiques en ligne (CBPPL). hormones and synthetic substitutes (5%) and others (22%). The average Méthodologie : Il s’agit d’une étude descriptive transversale. Dans duration of drug shortages increased from 108±130 days in 2006-2010 to le cadre du cours « Le pharmacien et la loi » (donné en 1ère année du 197±166 in 2014-2015. The number of drug manufacturers involved was Pharm.D. dans une Faculté de pharmacie), les étudiants étaient exposés à reduced from 70 in 2006-2007 to 51 in 2014-2015, which was associated to un article synthèse sur le sujet, puis ils étaient invités à signer un CBPPL. numerous mergers. The proportion of drug shortages associated to generic Quatre semaines après la signature du code, les étudiants pouvaient manufacturers increased from 67% in 2011-2012 (first year captured) to répondre à sept questions relatives à leurs perceptions sur le sujet. Une 86% in 2014-2015. The proportion of drug shortages associated to the échelle Likert et une échelle dichotomique (oui/non) ont été utilisées selon injectable was 33% in 2011-2012 and 36% in 2014-2015. The top-five les questions. manufacturers were Apotex (21%), Teva (14%), Sandoz (8%), Mylan (8%) and Pharmascience (7%). Résultats : Au total, 198 étudiants (taux de réponse : 100%) ont signé le CBPPL en août 2015 et 197 étudiants ont répondu aux questions Conclusion: Drug shortages remain a daily issue for pharmacists and quatre semaine plus tard. Dans l’ensemble, 99% étaient en accord avec other stakeholders. The annual monitoring of the current portrait of drug le fait que la lecture de l’article synthèse les a sensibilisés aux risques des shortages should contribute to the debate and the identification of viable comportements en ligne en exerçant la pharmacie. La majorité (94%) était solutions. d’avis que cet article les a exposés aux opportunités des médias sociaux et autres outils en ligne en pharmacie. Un total de 96% a confirmé que Comparaison de la perception des pharmaciens la lecture du CBPPL les a fait réfléchir et a remis en question certaines québécois et français vis-à-vis des données sur les pratiques. Un total de 73% ont modifié certains paramètres d’accès de rôles et retombées des activités pharmaceutiques leurs comptes en ligne et 28% ont abandonné certaines plates-formes. Breton M,1 Guérin A,1, 2 Bussières JF1, 3 De plus, 89% se sont dits intéressés à un atelier structuré sur l’utilisation responsable des médias sociaux. 1Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, QC Conclusion : La signature d’un code de CBPPL est faisable et contribue à 2Service de Pharmacie, Hôpital Béclère, Paris, France la sensibilisation et à des changements de comportements d’étudiants en 3Faculté de pharmacie, Université de Montréal, Montréal, QC pharmacie de 1er cycle. Contexte : Compte tenu des dépenses élevées en santé, tous les Chambre des erreurs : une simulation afn de professionnels sont confrontés à une révision de leurs modèles de pratique. sensibiliser le personnel soignant aux risques du Cette révision devrait notamment tenir compte des meilleures données circuit du médicament publiées sur les rôles et les retombées d’une activité professionnelle. Daupin J,1 Pelchat V,2 Atkinson S,1 Bussières JF1,3 Objectif : L’objectif principal a été d’évaluer et de comparer la perception et la sensibilité des pharmaciens au Québec et en France vis-à-vis 1Unité de recherche en pratique pharmaceutique, Département de pharmacie, des données sur les rôles et retombées des activités pharmaceutiques CHU Sainte-Justine, Montréal, QC (RRAP). L’objectif secondaire a été de mesurer leur appréciation du site 2Direction des soins infirmiers, CHU Sainte-Justine, Montréal, QC impactpharmacie.org. 3Faculté de pharmacie, Université de Montréal, Montréal, QC Méthodologie : Pour cette étude transversale descriptive, revue de Contexte : Agrément Canada détermine ses exigences en ce qui littérature et séances de remue-méninges entre les membres de l’équipe concerne le circuit du médicament à partir de la norme sur la gestion des de recherche ont permis d’identifier les variables d’intérêt permettant médicaments. d’évaluer la perception et la sensibilité aux RRAP. Un questionnaire en Objectifs : Évaluer la capacité du personnel soignant à identifier des ligne de 33 questions a été créé puis envoyé aux pharmaciens québécois et erreurs reliées au circuit du médicament dans le cadre d’une simulation et français. évaluer la satisfaction du personnel exposé à cette activité. Résultats : Les taux de participation ont été de 13,6% (217/1600) au Méthodologie : Il s’agit d’une étude descriptive transversale. En Québec et de 5,0% (145/2914) en France. Une différence statistiquement préparation à la visite d’agrément, nous avons scénarisé 30 vignettes significative a été mise en évidence pour 10/15 variables évaluant la relatives au circuit du médicament de la prescription à l’administration lecture des données scientifiques relatives aux RRAP par les pharmaciens, de doses de médicaments. Ving-quatre erreurs (pratiques non conformes) et pour 4/12 items évaluant leur perception de l’utilité et de l’utilisation étaient dissimulées. Un aménagement représentant une pharmacie en pratique de ces données. Globalement, les répondants les ont estimées d’étage et une chambre de patient a permis de scénariser de façon réaliste importantes concernant leur utilité et leur intégration dans la pratique. le circuit (p.ex. lit, comptoirs, pompe, ordonnances, étiquettes, seringues, Conclusion : Cette étude met en évidence la perception et la sensibilité chariots). Des plages horaires de jour-soir-nuit ont été offertes avec des pharmaciens de deux milieux de pratique différents quant aux publicité afin d’inciter la participation. Chaque participant avait en main données relatives aux RRAP. Les études évaluatives et comparatives sont une grille afin d’indiquer la présence ou l’absence d’erreur par vignette essentielles pour développer de nouvelles activités, valoriser et améliorer ainsi qu’un questionnaire de satisfaction (13 questions). la qualité des services pharmaceutiques. Les pharmaciens ont besoin Résultats : Au total, 175 personnes (moyenne 12,1±10,5 années d’outils pour les aider. Ainsi, le site impactpharmacie.org, pourrait aider d’expérience) se sont présentées à l’activité (70,4%-infirmières, à favoriser la lecture de la littérature scientifique sur les RRAP et axer 8,3%-pharmaciens, 6,5%-médecins/résidents, 4,7%-assistant-technique, davantage l’enseignement de la pharmacie sur le rôle du pharmacien en 10,7%-autres) durant 9 plages horaires pour 75 heures. Le taux moyen pratique. d’exactitude des participants était de 65,9%±13,1%. Sept vignettes comportaient un taux d’exactitude <50% pour les thèmes suivants :
59 seringue, lavage des mains, identification du patient, port de gants, Methods: A literature search was conducted to determine the weighted relevé de température, abréviation et incompatibilité. Parmi les énoncés, mean of pharmacokinetic variables (volume, half-life, Tmax and les participants ont considété la simulation comme étant très pertinente bioavailability) for three hydromorphone formulations (IV, oral immediate (96%), très efficace (97%) et lui accordait en moyenne une note de release, oral controlled release) described by one compartment model. 8,9±1,2. Une majorité de répondants (84%) envisageait d’apporter des The pharmacokinetic variables were used to simulate the concentration- changements à sa pratique. time profile administration of each dose of hydromorphone to the Conclusion : Cette étude démontre la pertinence et l’efficacité d’une patient to create a total hydromorphone concentration-time profile simulation de type « chambre des erreurs » afin de sensibiliser le personnel for all doses for patients administered naloxone (cases) and those not d’un établissement de santé aux risques du circuit du médicament. administered naloxone (controls). Cases and controls were identified prospectively between October 2014 and June 2015 and were compared for demographics (age, gender), highest hydromorphone concentration and Tuesday, February 2 relationship to highest concentration. Mardi 2 février Results: Three naloxone cases were identified over a 9-month period, indicating a rate of less than 0.5%. Nine controls were identified. The Evaluation of the Sterility of Single-Use Vials average highest simulated concentration of hydromorphone in controls Undergoing Multiple Access Following Application of was 46±17ng/mL, which is not significantly (p=0.22) higher than the a Closed System Transfer Device 31±13ng/mL simulated for naloxone cases. In one of the naloxone cases, a simulated concentration twice that of the concentration simulated when Perks W, Carating H, Iazzetta J, Charbonneau LF, Walker SE, Department naloxone was administered occurred 48 hours prior. of Pharmacy Sunnybrook Health Sciences Centre and Leslie Dan Faculty of Conclusion: Administration of naloxone for opioid induced respiratory Pharmacy, University of Toronto, Toronto, ON depression is a rare event that cannot be predicted by hydromorphone Background: Closed system transfer devices (CSTD) are designed for concentration. The use of naloxone in patients receiving opioids is safe handling of hazardous drugs from preparation to administration. a medication safety event that should be tracked ideally through an According to NIOSH, these devices are airtight and leak-proof. While these electronic Medication Administration Record. devices protect staff, as a closed system they could also minimize microbial contamination. Rhabdomyolysis during Treatment with Thrice- Objective: To test whether attaching a CSTD (Equashield®) to single-use Weekly Daptomycin vials can minimize microbial contamination and extend the “use-by” date Cheng Y, Wilcox N, London Health Sciences Centre, London, ON following multiple withdrawals under extreme-use-conditions. Background: Daptomycin is an antimicrobial effective against Methods: An Equashield® vial adapter was attached to three 20 mL vials multi-drug resistant gram-positive organisms. We report a case of (A, B, C) containing sterile TSB growth medium and placed in each of 6 rhabdomyolysis in a patient treated with daptomycin for vancomycin- biological safety cabinets weekly for 16 weeks. Vial A (control) had no resistant enterococci (VRE). medium removed during the week. One mL of medium was removed once Case description: An adult male presented with tachycardia, worsening daily x5 days from vial B, and twice daily x5 days from vial C. At day 5, fever and neutropenia. Computerized tomography scans revealed right vials were collected, incubated at 37oC for 14 days and inspected visually hip osteomyelitis and a soft tissue abscess. Due to growth of VRE from every 2 days for microbial growth. As a positive control, TSB vials were a prior right hip intraoperative sample, daptomycin 6mg/kg IV was inoculated with less than 102 of S. epidermidis ATC 12228. As a negative initiated on August 26, 2015 for administration post-dialysis thrice weekly. control, an unopened vial of TSB was incubated for the duration of the Baseline creatine kinase (CK) was 14U/L. Daptomycin was well-tolerated study. until September 5 when he complained of left upper limb myalgia. Over Results: All positive control vials demonstrated growth within 48 hours. the next 3 days, pain worsened and was accompanied by considerable All negative control vials showed no growth throughout the study. During inflammation, erythema, and decreased hand sensation. Deep vein the 16-week study all accessed vials remained sterile following storage at thrombosis and compartment syndrome were ruled out. On September room temperature for 5 days and subsequent incubation for 14 days. None 9, his CK level was 33,540U/L, and pain had spread to his right side. At of the 192 vials accessed 1440 times or the 96 vials that had the CSTD that point, daptomycin was discontinued and an additional round of attached but had no broth removed demonstrated contamination. The hemodialysis was administered. CK levels subsequently improved within 95% confidence interval of the contamination rate is 0.000 to 0.035%. the next week. Conclusions: Attachment of a CSTD adapter to single-use vials within an Assessment of causality: The proposed mechanism for this reaction ISO-5 environment has the ability to maintain sterility following multiple may involve the leakage of CK from myocytes. There was a temporal withdrawals during 5 days and stored in worse than ISO-5 conditions. relationship between daptomycin initiation and the observed reaction. A Naranjo score of 7 suggested a probable adverse drug event. Evaluation of a Critical Incident: Simulating Hydromorphone Concentrations using Population- Literature review: While up to 7% of patients in phase III clinical trials Based Pharmacokinetic Parameters experienced CK elevation on daptomycin, few cases of rhabdomyolysis have been described in the literature. To our knowledge, this is the first Zheng H,2 Wong L,2 Bailey C,3 Sawyer J,4 Wu T, 4 Zhou L,4 Van Der Vyver M,4 Belo case of rhabdomyolysis reported in a dialysis patient receiving thrice S,4 Walker SE1,2 weekly daptomycin. 1Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Importance to practitioners: Pharmacists should be aware of this 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON infrequent yet serious adverse event associated with daptomycin. At a 3Quality & Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON minimum, CK should be monitored at baseline and then once weekly. 4Acute Pain Service, Sunnybrook Health Sciences Centre, Toronto, ON More frequent monitoring is warranted in those patients who experience Background: Opioids are commonly used for pain management in myalgia or weakness, CK elevation >1000U/L, or deteriorating renal a postoperative setting but use can be associated with life-threatening function. respiratory depression. Naloxone administration is used to rescue patients suffering from respiratory depression. An unexpected death of a patient Clinical and Economic Outcomes of Outpatient after the hydromorphone dose was increased triggered an investigation Parenteral Antimicrobial Therapy: Experience at a into the safety of opioids in pain management. Community Hospital Objective: To determine if simulated hydromorphone concentrations, Lee A, John S, Lovinsky R, The Scarborough Hospital, Toronto, ON using population based mean pharmacokinetic parameters, are predictive Background: Outpatient parenteral antimicrobial therapy (OPAT) of respiratory depression and naloxone use. facilitates the administration of intravenous antimicrobials to clinically
60 stable patients in the home. OPAT is defined as the intravenous, Compliance to a Febrile Neutropenia Protocol intramuscular, or subcutaneous administration of at least 2 doses of an for Leukemia Patients Based on Antimicrobial antimicrobial agent on different days without intervening hospitalization. Stewardship Principles and Human Factors An OPAT program was developed by the Scarborough Hospital’s (TSH) Engineering Antimicrobial Stewardship team, as an extension of their inpatient So M,1,2 Yeats B,1 Lu S,2 Bell C,1,3,4 Morris A,1,3,4 Husain S1,3,4 stewardship activities. 1University Health Network, Toronto, ON Objectives: To describe the clinical outcomes of patients enrolled into an 2Leslie Dan Faculty of Pharmacy, University of Toronto, ON OPAT program at a community hospital and to determine the impact of 3Mount Sinai Hospital, Toronto, ON OPAT on the duration of hospitalization and health care costs from the 4Department of Medicine, University of Toronto, ON perspective of both the hospital and the Ministry of Health (MoH). Background: We implemented a locally developed febrile neutropenia Methods: The medical records of 151 patients who received 183 courses protocol (FNP) for leukemia patients applying principles of antimicrobial of antimicrobial therapy through the Scarborough Hospital’s OPAT stewardship and human factors engineering (HFE). The World Health program (Toronto, Canada) were reviewed to collect patient demographic Organization and Agency for HealthCare Research and Quality have information, and to determine the indication for parenteral antimicrobial recommended HFE as a tool to improve patient safety through workflow therapy, therapy outcomes, and the occurrence of complications. optimization. Clinicians can self-navigate to relevant sections of the FNP Parenteral antimicrobial regimens and duration of therapy were obtained at point of clinical decision through embedded hyperlinks. The protocol from Bayshore Specialty Rx Health prescription records. was introduced in Sep 2013, updated and re-launched in Sep 2014. Results: Osteomyelitis/septic arthritis (32%), soft skin and tissue infections Objective: To determine the uptake of a human factor-engineered, (22%), and urinary tract infections (14%) were the most common types of stewardship-based febrile neutropenia protocol amongst prescribers. infections treated. The most commonly used antimicrobial was cefazolin (38%). 86% of patients completed therapy as planned. 78% of patients Methods: We conducted prospective point-prevalent surveys (audits) experienced clinical cure, 10% experienced control or improvement on 4 randomly selected dates between October 2014 and June 2015. in their infection while 12% had clinical failure. OPAT saved a total of All leukemia in-patients were included. Compliance checkpoints were 3,586 hospital bed days, with an average of 20 days saved per patient. antifungal and antiviral prophylaxis; surveillance serum galactomannan Antimicrobial cost reduction from the hospital’s perspective was $47,455 (GM); empiric antibiotics with piperacillin-tazobactam and tobramycin while the net cost avoidance of the OPAT program from the MOH’s (P+T) at onset of febrile neutropenia; and de-escalation of empiric perspective was $3,073,050. tobramycin after 72 hours in patients without focus of infection. Fisher’s exact test or Chi square test were used to compare compliance, depending Conclusion: Results from this study support the safety and effectiveness on sample size; significance level p<0.05. of OPAT for patients. OPAT also substantially reduces the duration of hospitalization and health care costs. Results: Audit dates were October 24, 2014, March 12, May 8 and June 22, 2015. A total of 147 charts were reviewed. Between October Varicella Zoster Virus Meningitis Possibly Associated and March, antiviral prophylaxis increased from 8.7% (2/23) to 68.2% with Zoster Vaccination (15/22) (p<0.05), and antifungal prophylaxis increased from 55% (12/22) to 95% (18/19) (p<0.05). Surveillance serum GM increased from 26% Li S, Bombassaro AM, Spicer E, Gupta K, London Health Sciences Centre, (7/27) to 70% (18/26) in eligible patients (p<0.05). Compliance to those London, ON recommendations was maintained subsequently. Empiric P+T and de- Background: The zoster vaccine is recommended in adults 50 years escalation did not change significantly over the 4 audits, with compliance and older for prevention of shingles. It has been shown to reduce disease ranging between 40-53%, and 55-75%, respectively (p=0.83 for both). burden and postherpetic neuralgia. Conclusions: A locally developed guideline designed with HFE and Case description: An immunocompetent adult developed a pounding antimicrobial stewardship principles increased the compliance of headache and burning sensation over the scalp on day 1 after receiving prophylaxis and surveillance GM. Audit findings will inform the ASP team the zoster vaccine. . The patient presented to hospital on day 6 with to target knowledge translation strategies on appropriate empiric regimen aphthous tongue ulcers, an occipital scalp rash and nuchal rigidity. Forty- and de-escalation. eight hours later, audiovisual hallucinations and a vesicular eruption on the anterior neck were noted. Cerebrospinal fluid (CSF) analysis revealed Once Daily Aminoglycoside Pharmacokinetics and elevated protein and nucleated cell count (lymphocytic predominance) Optimal Dosing in the Burn Population: A Prospective and normal glucose. Polymerase chain reaction of CSF was positive for Study varicella zoster virus (VZV), and negative for herpes simplex, enterovirus Lee C,1,2 Walker SAN,1,2,3,4 Walker SE,1,2 Seto W,2,5 Simor S,3,4 Cartotto R,6 and bacteria. The patient responded to acyclovir 10mg/kg IV q8h for 48 Jeschke M6 hours and was discharged on oral acyclovir. 1Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Assessment of causality: The presence of a vesicular rash and central 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON nervous signs and symptoms, including VZV in the CSF, temporally 3Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON following vaccination with no other identifiable medical causes suggests 4Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON an association. The lack of strain typing (wild-type or vaccine), in addition 5Sick Kids Hospital, Toronto, ON to the absence of published case reports of meningitis post-vaccination due 6Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON to the vaccine-strain, suggests a “possible” relationship according to the Naranjo scale. Background: Once-daily aminoglycoside dosing (ODA) is used in most patient populations to optimize antibacterial activity and reduce toxicity. Literature review: A case report described a 79-year-old presenting with Unfortunately, burn patients are excluded from ODA due to concerns varicella meningitis 6 hours post -zoster vaccination, confirmed to be over altered pharmacokinetics resulting in a shortened half-life and low due to the wild-type strain. Post-marketing surveillance of a large adult peak aminoglycoside concentrations. Retrospective studies suggest that cohort identified 4 cases of meningitis, encephalitis and encephalopathy ODA may be appropriate if higher milligram/kilogram doses are used. occurring within 1-14 days post-zoster vaccination, however, strain However, no prospective clinical trials in burn patients exist to confirm relatedness was not specified. these findings. Importance to practitioners: The benefit of the varicella zoster vaccine Objective: To determine the adequacy of once daily tobramycin dosed at has been reported in large well-designed randomized controlled trials 10 mg/kg in adult burn patients. without evidence of excess harm. Ongoing post-marketing surveillance will assist in determining if the vaccine, in rare cases, may cause primary Methods: This prospective single dose pharmacokinetic clinical trial infection or reactivation of latent VZV. was conducted at the Ross Tilley Burn Centre. Patients with a total burn surface area (TBSA) of < 20% and creatinine clearance > 50 ml/min were
61 eligible. A first-order one compartment model was used to determine the and studied competency based pharmacy residency assessment tools pharmacokinetic profile from 3 or 5 tobramycin levels over a 24 hour existed. period per patient. Monte Carlo simulation (MCS) was performed to Description: The residency program developed the assessment tools, determine the probability of target level attainment. carefully selecting competency domains based on the 2010 CPRB residency Results: The mean percent TBSA, partial, and full thickness burn were standards. Education principles based on the Structure of the Observed 10%, 7%, and 4%, respectively. Seven of the eight patients recruited Learning Outcome taxonomy served as the foundation for the assessment achieved peak concentrations of > 20 mg/L (mean of 28.9 ± 6.3 mg/L) and scale in the form a 5 point Likert scale. all patients had a trough level < 0.5 mg/L. The mean half-life, volume of Action: Recently, the residency program sought to explore opinions distribution, and clearance were 2.40 hours, 0.33 L/kg, and 7.31 L/hour, regarding the face and content validity, the ease of use and practicality respectively. The MCS determined probability of attaining target peak regarding the pharmacy residency assessment tools. Residency rotation concentrations with the 10 mg/kg dose was 93%, which almost doubled preceptor focus groups were conducted at one institution by a residency that predicted with the usual 7 mg/kg dose. coordinator utilizing a semi-structured interview guide. Unabridged Conclusion: Burn patients with adequate renal function and < 20% TBSA transcripts were analyzed by another residency coordinator by manually are candidates for ODA. Tobramycin half-life was similar to healthy, non- forming coded units. Coded units were summarized using inductive burn patients. The larger than normal volume of distribution supports the thematic analysis. use of the higher empiric dose of 10 mg/kg with further dose adjustment Evaluation: Six residency preceptors volunteered for focus group based on therapeutic drug monitoring. participation (5 females, 13.5 years of average work experience, age range of 30-50 years). Thematic analysis revealed three major categories: the Multicenter Study of Environmental Contamination assessment tools were considered 1. easy to use overall; 2. to have face with Antineoplastic Drugs in 47 Canadian Hospitals validity; and 3. to have content validity. Regarding practicality, preceptors Poupeau C,1 Tanguay C,1 Caron NJ,2 Bussières JF1,3 indicated an average completion time of 60 to 90 minutes, while a 30 minute completion time was considered reasonable. 1Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, QC 2Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Implications: Preceptors indicated that the pharmacy residency Québec, QC assessment tools were valid and were overall easy to use. But completion 3Faculty of Pharmacy, Université de Montréal, Montréal, QC time for the tools could be shortened. Improving preceptor training and tool formatting could help with addressing the short-comings of the tools Context: Oncology workers are occupationally exposed to antineoplastic and ultimately improve resident assessment. drugs. This exposition can lead to health risks. In order to reduce their exposure, contamination on surfaces should be kept as low as possible. Development and Validation of a Screening Tool for Objectives: To describe a multicenter environmental monitoring study of Bacteremia in Acute Burn Injury Patients cyclophosphamide, ifosfamide and methotrexate in oncology pharmacy Cooper A,1 Walker SAN,1,2,3,4 Elligsen M,1 Lo J,1 Lee C,1,2 Walker SE,1,2 Palmay L,1 and patient care areas in Canada. Cartotto R,5 Jeschke M5 Methods: This is a descriptive and comparative study. Hospitals of more 1Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON than 50 beds were invited to participate. Twelve standardized sites were 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON sampled in each participating center (6 in the pharmacy and 6 in patient 3Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON care areas). Samples were analyzed for the presence of cyclophosphamide, 4Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON ifosfamide and methotrexate by ultra-performance liquid chromatography 5Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, ON tandem mass spectrometry technology. The limit of detection (LOD) was 0.36 pg/cm2 for cyclophosphamide, 0.95 pg/cm2 for ifosfamide and 0.97 Background: Diagnostic criteria for infection and Systemic Inflammatory pg/cm2 for methotrexate. Descriptive statistical analyses (75th percentile) Response Syndrome are not discriminatory in identifying burn patients at were carried out. risk for bacteremia. Results: In 2015, 47 hospitals from Canada participated in this Objective: To develop and validate a screening tool using common study (participation rate 47/202, 23%). A total of 513 samples were laboratory, and clinical parameters to assist in the early identification of quantified. Overall, 35% (177/513) of the samples were positive for bacteremia following acute burn injury (within 10 days post burn). cyclophosphamide, 8% (39/513) of the samples were positive for Methods: A retrospective chart review of matched patients admitted to ifosfamide and 6% (31/517) of the samples were positive for methotrexate. the Ross Tilley Burn Centre from March 12th, 2011 – January 11th, 2015, The 75th percentile value of cyclophosphamide surface concentration and prospective assessment of patients admitted from January 12th, 2015 was 6.7 pg/cm2. The 75th percentiles for ifosfamide and methotrexate – April 30th, 2015 were completed. A Pearson’s Correlation matrix was concentrations were lower than the LOD. The most frequently completed to identify independent variables associated with infection contaminated sites were the front grille of the hood (64%, 30/47), the floor (p<0.05, univariate analysis). Significant parameters were analyzed using in front of the hood (62%, 29/47) and the armrest (61%, 25/41). iterative binary logistic regression to identify the simplest significant model Conclusion: In comparison with other multicenter studies that were (p<0.05). The optimal probability cut-off for bacteremia was determined conducted in Canada, the concentration of antineoplastic drugs measured using a Receiver Operating Characteristic curve. The predictive value of on surfaces is decreasing. However, some sites are still frequently the model was assessed and then validated on a separate historic burn contaminated. Regular environmental monitoring is a good practice in population. order to maintain contamination as low as reasonably achievable. It is Results: Thirty-seven of 156 patients with a complete data set were also an opportunity to increase workers’ awareness on this issue. bacteremic (24%). The best binary logistic regression model was (p<0.05): Ln [odds of bacteremia] =-96.749+3.230(Platelet Volatility) + Investigation of the Face and Content Validity, and 2.235(MaxTemperature (oC))+0.339(%FullBurn) + 0.242(%PartialBurn) Perceived Usefulness of the Pharmacy Residency + 0.045(MaxHeartRate (bpm)) with a threshold probability categorizing Competency-Based Assessment Tools bacteremia of >48%. The sensitivity, specificity, accuracy, false positive Halapy H, St. Michael’s Hospital and Leslie Dan Faculty of Pharmacy, University rate (FPR) and false negative rate (FNR) were 89%, 98%, 96%, 2% and of Toronto, Toronto, ON 11%, respectively. At the study bacteremia prevalence of 24%, the positive predictive value, negative predictive value, positive and negative Background: In 2011 to 2012, a hospital residency program developed likelihood ratio, and positive and negative post-test probability were and implemented, in collaboration with other provincial residency 94%, 97%, 53, 0.11, 94% and 3%, respectively. The sensitivity, specificity, programs, competency based assessment tools for all its general pharmacy accuracy, FPR, and FNR of the tool in the validation cohort (n=26) was residency pharmacy residency rotations in response to changes to the 100%, 100%, 100%, 0% and 0%, respectively. Canadian Pharmacy Residency Board (CPRB) 2010 residency standards. At the time of development of the residency assessment tools, no validated 62 Conclusion: The developed and validated bacteremia screening tool were formed with the Ontario College of Pharmacists and the Ministry in acute burn injury patients has excellent predictive ability to assist in of Health to ensure pharmacy accreditation and opening. Finally, 50 identifying patients for whom blood cultures should be requested. pharmacy volunteers were recruited to carry out daily operations. Evaluation: Following the Pan Am and Parapan Am games, statistics A Study to Determine the Pharmacological were collected. In total, 1953 prescriptions were dispensed for 1189 Management of Delirium in the Cardiovascular patients. Top usage nations included Brazil (290 prescriptions), Intensive Care Unit Canada (276), Venezuela (170). Most commonly dispensed drug classes Tsang L, Ng O, Adhikari N, Sunnybrook Health Sciences Centre, Toronto, ON were analgesics & anti-inflammatories (658), antibiotics (233) and dermatological (182). Background: Delirium is a recognized post-operative adverse event whose significance has intensified due to effects on morbidity and Implications: This project created a model for comprehensive pharmacy mortality. Currently, the rate of delirium post cardiac surgery in the services that can be used for future large, multi-sport games. cardiovascular intensive care unit (CVICU) at our institution is unknown and the pharmacological treatment modalities are not standardized and Ciprofloxacin-Induced Steven-Johnson’s Syndrome vary greatly. Treated with Cyclosporine: A Case Report Objective: To determine the rate of delirium, the presence of risk factors AuYeung J, Lee M, North York General Hospital, Toronto, ON that may predict the development of delirium and pharmacological Background: Steven-Johnson’s Syndrome (SJS) is an idiosyncratic treatment modalities used in post- operative cardiovascular surgery reaction involving skin sloughing traditionally treated with systemic patients admitted to the CVICU. corticosteroids. We describe a probable case of ciprofloxacin-induced SJS Methods: In this retrospective chart review, all patients undergoing treated with cyclosporine and corticosteroid. cardiovascular surgery from April 1 to December 31, 2014 were reviewed. Case Description: A 66-year-old Caucasian female presented with a Differences between patients were analyzed using Chi-square analysis. rash on her trunk, neck and extremities. She had a fever, progressive Results: The review included 420 patients of which 17% (n=73) developed dysphagia, odynophagia, dysuria and painful ulcerations to her genitalia. delirium post-cardiovascular surgery in the CVICU. No significant Her past medical history included chronic obstructive pulmonary disease, differences were found between groups with respect to pre-operative osteoporosis, osteoarthritis, stress urinary incontinence and migraines. co-morbidities and the development of delirium. Of those who became She reported a history of rash to sulfa drugs and azithromycin. Oral delirious, 83.6% (n=61) received a pharmacological agent for the ciprofloxacin was initiated 8 days prior, following a urological procedure. treatment of delirium, with 52.5% (n=32) receiving 1 medication, 31.1% Laboratory results were unremarkable. Her Nikolsky’s sign was positive. (n=19) receiving 2 and 16.4% (n=10) receiving 3 or more medications. A skin biopsy confirmed the diagnosis. Her symptoms got worse despite Haloperidol was most commonly used (82%) followed by quetiapine initial treatment with methylprednisolone. Five days later, intravenous (60.7%) and dexmedetomidine (13.1%). Those who experienced delirium cyclosporine 3 mg/kg daily was added. Her skin improved dramatically had significantly greater exposure to sedatives including midazolam (57.5 in the first few weeks of cyclosporine, but her dysphagia was slower to vs 17.3%, p<0.00001), lorazepam (26 vs 1.4%, p<0.00001) and zopiclone improve. She was eventually switched to oral cyclosporine and prednisone (26 vs 6%, p<0.00001). No differences in mortality were found however to complete her therapy. She did not experience adverse effects from length of CVICU stay was significantly longer in delirious patients (5.7 vs cyclosporine but developed hiccups from corticosteroid therapy. 1.8 days, p<0.00001). Assessment of Causality: The Naranjo score of 6 indicates a probable Conclusions: Delirium can commonly develop post cardiovascular adverse drug reaction. The exact mechanism is unknown but is thought surgery in the CVICU and it is difficult to predict who will develop it based to be a cytotoxic reaction to drug antigens resulting in keratinocyte on preoperative comorbidities. Therefore, the development of strategies apoptosis. CD8+ T cells, and the cytolytic molecules FasL and granulysin to prevent delirium and to optimize pharmacological management is are thought to be involved. warranted. Literature Review: Twelve case reports involving ciprofloxacin-induced SJS or toxic epidermal necrolysis were found. Two observational studies Design and Implementation of Pharmacy Services for found statistically significant reduction in time to re-epithelialization with the Toronto 2015 Pan Am and Parapan Am Games cyclosporine compared to a historical control group using usual care. Only Tsang L,1 Ojo R2 enteral cyclosporine has been reported in the literature. 1Sunnybrook Health Sciences Centre, Toronto, ON Importance to Practitioners: This case adds to the literature 2Corporate Pharmacy, Toronto, ON of ciprofloxacin-induced SJS. It demonstrates that intravenous or oral cyclosporine can be considered if a patient is not responding to Background: The Toronto 2015 Pan American and Parapan American corticosteroids. games were the largest multi-sport games ever held in Canada. The goal was to design and implement comprehensive pharmacy services for 10 Enjeux relatifs à l’exercice de la pharmacie : 000 athletes and officials and to support an inter-professional medical perception des résidents en pharmacie team of 2000 volunteers. Guérin A,1 Bussières JF1, 2 Description: Pharmacy services were primarily based in the athletes’ village medical polyclinic. An accredited community pharmacy was 1Unité de recherche en pratique pharmaceutique, Département de pharmacie, opened for outpatient prescriptions and a unit-dose medication system was CHU Sainte-Justine, Montréal, QC implemented to support the polyclinic emergency department. Medication 2Faculté de pharmacie, Université de Montréal, Montréal, QC kits were also created for use at 5 satellite accommodation sites for athletes Contexte : L’exercice de la pharmacie est confronté à de nombreux staying outside of Toronto and 47 competition venues. Pharmacist services changements. Les résidents en pharmacie doivent se préparer à ces were provided onsite at the polyclinic and via telephone to satellites and changements dans le cadre de leur formation de 2ème cycle. venues. Objectifs : L’objectif principal était d’évaluer la perception des résidents Action: A comprehensive medication formulary was developed to en pharmacie face à 48 enjeux relatifs à l’exercice de la pharmacie. standardize prescribing and usage. Medication decisions were made in coordination with the chief medical officer and sport specific physicians. Méthodologie : Il s’agit d’une étude descriptive transversale. L’étude An accompanying pharmacy guide was created outlining drug name, ciblait tous les résidents en pharmacie de la cohorte 2015-2016 inscrit au dosing, adverse effects, therapeutic use and compliance to World Anti- programme de maîtrise en pharmacothérapie avancées de deux faculté Doping Agency (WADA) guidelines. This guide encouraged appropriate de pharmacie. Nous avons recueilli des données démographiques et le prescribing and helped educate all practitioners on sport pharmacy. niveau d’accord (échelle de Likert à 4 choix – très en accord, partiellement Policies were also developed for the handling of WADA prohibited en accord, partiellement en désaccord, totalement en désaccord) de medications to avoid inadvertent prescribing and dispensing. Partnerships 63 probabilité d’occurrence d’ici 2025 de 48 pratiques émergentes et Description: Literature suggests that medical students exhibit less anxiety vraisemblables reliées à l’exercice de la pharmacie. and better clinical performance in institutional settings when supported Résultats : Un total de 91% (57/63) des résidents ont répondu à l’enquête. with transitional learning activities, and we predicted the same holds true Un total de 60% (34/57) étaient des femmes et 97% (55/57) se destinaient for pharmacy students. Accordingly, we designed and evaluated an online à la pratique hospitalière. Plus de 80% des répondants étaient d’avis transitional learning module for pharmacy students to complete prior to que 24 des 48 pratiques émergentes évoquées seraient implantées pour their institutional practicum. dans la majorité des cas d’ici 2025 (p.ex. distribution des médicaments Action: Focus groups with students, residents, faculty, and preceptors were sans pharmaciens en hôpital, majorité du temps du pharmacien au conducted to determine desired content and learning outcomes. This input chevet des patients). Pour autant de pratiques émergentes, une majorité guided development of three modules: General Orientation to Institutional des répondants pensaient que leur réalisation était peu probable ou très Practice, Introduction to Patient Charts, and Patient Workup and Report. peu probable (p.ex. poursuites judiciaires de pharmaciens hospitaliers, Evaluation: The first module was evaluated by surveying focus group départements de pharmacie gérés par des non pharmaciens). participants and student users of the module. Data on reactions to the Conclusion : Des résidents en pharmacie hospitalière canadiens ont émis module were collected through items rated on a 5-point Likert scale. leur opinion face à 48 enjeux relatifs à l’exercice de la pharmacie d’ici Evaluation of the other two modules is ongoing. The module’s design 2025. Il est important de tenir compte de l’opinion des futurs résidents en was consistent with the learning needs identified in the focus groups. pharmacie et de les sensibiliser à l’évolution de leur profession. Responses from the student user survey (n=36) demonstrated a mean completion time of 2.20 hours (SD=1.83). Most agreed the first module was Stability of 1.0 and 2.5 mg/mL Bortezomib Solution of appropriate difficulty (M=3.84, SD=0.74) and was logically organized in Vials and Syringes Following Reconstitution with (M=3.64, SD=0.78). Opinion was divided on appropriateness of length and 0.9% Sodium Chloride at 40C and Room Temperature contribution to improved understanding of institutional practice. (230C). Implications: While the transition modules were designed to meet Walker SE, Charbonneau LF, Tyono I, Law S, Department of Pharmacy, learning needs identified by key stakeholders, evaluation data from the Sunnybrook Health Sciences Centre, Leslie Dan Faculty of Pharmacy, University first module indicate mixed views of its learning value. Future iterations of Toronto, Toronto, ON must address feedback regarding content and efficiency of delivery. Background: Previous publications have demonstrated the stability of 1.0mg/mL and 2.5mg/mL of bortezomib for 42 days and 21 days Comparison of Pharmacy Students’ and Pharmacists’ respectively. The introduction of a generic version of bortezomib raised Activities Using a Clinical Pharmacist Workload questions of the stability of the generic formulation and the validity of Measurement Tool extending stability from one brand to another. Chiu J, Lee M, North York General Hospital, Toronto, ON Objective: To evaluate the stability of bortezomib 3.5 mg vials Background: Pharmacy students in the final year of their program are reconstituted with 3.5 or 1.4 mL of 0.9% sodium chloride (NS) during required to complete 7 Advanced Pharmacy Practice Experience (APPE) storage over 42 days at room temperature and at 40C in syringes and rotations. Each rotation is 5 weeks in duration. Student’s activities during manufacturer vials. their direct patient care (DPC) in-patient rotations were analyzed and Methods: On study day 0, 2.5mg/mL and 1.0mg/mL concentrations of compared to clinical pharmacists’ activities in a community teaching the TEVA formulation were prepared. 3 units of each container were stored hospital, to help understand how students contribute to patient care at room temperature and 3 were stored in the refrigerator. Concentration activities. and physical inspection were completed on study days 0, 1, 3, 7, 10, 14, Description: Pharmacy students completing a DPC APPE rotation were 22, 28, 34, and 42. Bortezomib concentrations were determined by a asked to document their activities using the clinical pharmacist workload validated stability-indicating liquid chromatographic method with UV measurement (WLM) tool. This is a Microsoft® Access database consisting detection. The recommended beyond-use-date was determined based of fields to record the volume and time spent on each type of clinical and on the intersection of the lower limit of the 95% confidence interval of non-clinical activity (excluding dispensing). the observed degradation rate and the time to achieve 90% of the initial Action: Data were collected between May 2014 and May 2015. Activities concentration. were classified into 4 main categories and the proportion of time spent Results: The analytical method separated degradation products from on each was analyzed and compared to clinical pharmacists’ data for the bortezomib such that the concentration was measured specifically, same period. accurately (deviations from known averaged 2.5%) and reproducibly Evaluation: Twenty students completed 33 DPC rotations during this (replicate error was less than 1% (CV(%)). During the study period all period. On average, students spent 23.9 days per rotation on site. Students solutions retained more than 95% of the initial concentration in vials documented 69.8% of their hours worked in the WLM database compared and syringes at both temperatures and concentrations. The calculated 63.2% of pharmacists. Table 1 shows the total time and proportion of time beyond-use-date exceeded 42 days for all temperatures, concentrations spent by students compared to pharmacists on various activities. and container combinations. Table 1: Total time and proportion of time spent in activities Conclusions: We conclude that 3.5-mg vials of TEVA bortezomib reconstituted with 3.5 mL or 1.4 mL of NS (concentrations of 1.0 and Students Pharmacists 2.5mg/mL) are physically and chemically stable for at least 42 days Total time recorded 248,019 min 1,393,031 min at 40C or room temperature (230C) in both syringes and the original Activity Category Proportion of Proportion of manufacturer’s glass vials. Student’s Time Pharmacist’s Time Patient assessment 42.3% 43.2% Bridging the Gap from the Classroom to the (includes identification of drug Institutional Practice Site: Evaluation of an Online therapy problems and development Transition Module for Pharmacy Students of care plans) Tchen P, Leung L, Williamson M, Simpson F, Kim-Sing A, Pearson M, Faculty of Pharmacotherapy monitoring 26.9% 31.3% Pharmaceutical Sciences, University of British Columbia, Vancouver, BC Patient education 4.3% 8.2% Background: In recent years, feedback from students and preceptors Non-patient-specific activities 25.9% 17.3% indicates that pharmacy students are ill-prepared for institutional (excludes medication order practicums. They frequently require a prolonged orientation period at the processing; includes continuing practice site and close clinical supervision, which negatively impacts their education (CE) events) ability to achieve learning outcomes. Implications: Pharmacy students and pharmacists spent the majority of their time in patient assessment and pharmacotherapy monitoring. 64 Students spent more time in non-patient specific activities such as CE unreported ADR. Additionally, the patient reports no significant lifestyle events. Compliance with WLM entry into database was similar in both changes that could have contributed to his alterations in mood. groups. This tool helped gain insight into where students spent their time Literature review: There have been no known case reports reporting during the rotation. Future research should aim at finding opportunities in studies of fatigue, anxiety or irritability with apixaban. pharmacist’s activities that students can contribute to. Importance to practitioners: Practitioners should be aware of the Evaluation of Standardization of Pharmacist possibility that apixaban may produce fatigue, anxiety and irritability in Attendance at Rounds some patients. This case report also highlights the importance of reporting adverse drug reactions for new drugs. Proceviat J,1 Dewhurst NF,1,2 Gillespie P,2 Tom E,1 Chant C1,2 1St. Michael’s Hospital, Toronto, ON Evaluation of a Communities of Practice Program for 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Clinical Pharmacists Background: Evidence supports active participation of pharmacists in Gillespie P,1 Tom E,2 Dewhurst NF,1,2 Chant C1,2 medical rounds as an activity that improves patient outcomes. When 1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON numerous types of medical rounds are available on patient care units, 2St. Michael’s Hospital, Toronto, ON prioritizing attendance at relevant rounds is necessary to ensure other clinical duties are fulfilled. A standardized policy was developed and Background: A need for stronger intra-departmental relationships was implemented to prioritize round attendance and ensure balance with other identified given recent organizational changes and expanded scope of pharmacist roles and responsibilities. Pharmacists were expected to attend practice for pharmacists. “high priority” rounds regularly, dictated by round frequency, overall Description: The Pharmacy CoP program was introduced in 2013. workload and staffing. The goals of CoP are to share knowledge, facilitate collaboration and Description: Following implementation of a standardized rounding professional relationships, standardize professional practice approaches policy for pharmacists, evaluation of policy adherence and rounds and create new knowledge through scholarly work. attendance was required. Action: Quantitative and qualitative data were used to evaluate the Action: Pharmacists were surveyed to determine adherence to policy, achievements and perceived value of the CoP program. Data was collected barriers to round attendance, and requests to attend other non-high retrospectively from available CoP agendas and minutes since program priority rounds. Data was collected on type of rounds attended, average inception until September 2015. Two surveys which included Likert scales time spent in rounds and perceived value added to practice. were performed 17 months apart to evaluate pharmacists’ perception of the program in 4 domains: patient outcomes, educational value, Evaluation: Most, 27 of 29 (93%), of pharmacist respondents were able professional relationships, and organizational format. to adhere to the policy, attending the three “high priority” types of rounds outlined in the policy. Multidisciplinary, medical/bedside and bullet/ Evaluation: Each CoP discussed 8 topics monthly, inviting 5 guest discharge rounds were attended by 61%, 26% and 23% of pharmacists, speakers per CoP group over the 17 month period. Distribution of topics respectively. A small proportion of pharmacists attended more than varied between groups. Clinical practice discussion, practice advisory one type of high priority rounds. Average time spent attending priority updates and medication management/goals and objectives accounted for rounds is 30 to 70 minutes per weekday. A minority (24%) of pharmacists 37%, 20% and 13% of topics, respectively. Most pharmacists attended at have been requested to attend other types of rounds including teaching, least 80% of meetings, with the majority (54%) of pharmacists agreeing antimicrobial stewardship program (ASP) and interdisciplinary. Priority that CoP has contributed towards improving patient outcomes. The rounds are perceived to be of higher value than other round types, with majority (48%) of pharmacists agreed that they have gained valuable the exception of ASP rounds. The main perceived barriers to pharmacist clinical pharmacy knowledge and skills through CoP. Most (45%) round attendance are scheduled evening shifts and heavy workload. pharmacists agreed that CoP has helped them to 1) standardize practice with their peers and 2) share responsibility/workload amongst peers for Implications: Data suggests that pharmacists are adhering to the policy, activities related to pharmacist education and medication management. and that it assists in standardizing pharmacist practice and attendance at 54% of pharmacists agreed that the current meeting format was high priority rounds. satisfactory and that CoPs are an effective forum for learning. Suggestions to format change include alternate timing and frequency of meetings. Fatigue, Anxiety and Irritability with Apixaban Implications: The CoP program is effective in expansion of knowledge Ramandt M, Dool P, London Health Sciences Centre, London, ON and will continue in its current form. Each CoP chair will review and Background: Apixaban is indicated to reduce the risk of stroke and implement pharmacist suggested feedback to maximize attendance and systemic embolism in patients with nonvalvular atrial fibrillation. The perceived value. most commonly reported adverse drug reaction (ADR) is hemorrhage, with no noted reports of low energy or mood changes. We describe a case report A Canadian Survey of High-Dose Extended-Interval of dose-related fatigue, anxiety and irritability associated with apixaban Gentamicin and Tobramycin in Pediatric Inpatients use. Strugari C, Gray C, Ruda L, Bell A, Bolt J, Regina Qu’Appelle Health Region, Case Description: A pleasant 76-year old male requiring anticoagulation Regina, SK due to atrial fibrillation was started on apixaban 5mg orally twice Background: The use of high-dose extended-interval (HDEI) daily. Over the following 2 months, the patient and his wife began to aminoglycosides (AMG), a common practice in adult populations, is less notice a gradual decrease in his energy level, followed by significant established for pediatric patients, where AMGs are often dosed utilizing a anxiety and increased irritability. No bruising or bleeding was apparent. multiple daily dosing method. Self-adjustment of his dose to 2.5mg twice daily lead to a dramatic improvement in both the patient’s mood and energy level. These same Objectives: The purpose of this project was to characterize AMG symptoms quickly returned upon re-initiation of the higher dose. As a prescribing practices in pediatric inpatients across Canada. The objective result, apixaban was discontinued and rivaroxaban was initiated. was to determine current practice of Canadian health care delivery organizations regarding HDEI gentamicin and tobramycin for pediatric Assessment of causality: Given the timing and improvement with inpatients, including their criteria and indications for use, dosing and dose reduction, it is likely that the reported symptoms are contributable to monitoring practices, and extent of pharmacist authority to independently apixaban. The Naranjo causality scale indicates a definite adverse drug dose or monitor AMG. reaction with a score of 9. A theoretical drug interaction between diltiazem and apixaban, mediated through CYP3A4 and P-glycoprotein, may have Methods: This study was comprised of an electronic survey of pharmacists occurred. However, an increased serum concentration of apixaban would in Canadian health care delivery organizations providing pediatric be more likely to present as a hemorrhage rather than as a previously inpatient services. Questions focused on demographics, criteria for HDEI tobramycin or gentamicin use in pediatric inpatients, empiric dosing, 65 and monitoring parameters as well as extent of pharmacist authority to 3Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, independently dose and monitor AMGs at their institution. ON 4Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Results: Of the 45 survey participants (48% response rate), 35 (78%) Children, Toronto, ON indicated their health region uses HDEI tobramycin or gentamicin in 5Infection Prevention and Control, The Hospital for Sick Children, Toronto, ON pediatric inpatients. The population characteristics for use of HDEI AMG 6Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON were varied. Dosing recommendations included 10 to 15 mg/kg for 7Faculty of Medicine, University of Toronto, Toronto, ON pulmonary exacerbations in cystic fibrosis, 5 to 8 mg/kg in urinary tract infections, and 6 to 9 mg/kg in febrile neutropenia. 89% of participants Background: Broad-spectrum antimicrobials use, such as meropenem, monitor serum levels and 77% monitor for nephrotoxicity. For prescriptive has been linked to increased rates of resistant organisms. The susceptibility authority, 15.6% (7/45) of participants are authorized to independently of meropenem at our institution remained close to 100% for most isolates; adjust dosing at their institution and 31.1% (14/45) are authorized to order however, there are concerns for increased resistance rates. monitoring parameters. Objectives: To describe meropenem use in patients admitted to the Conclusions: HDEI AMG is frequently utilized for pediatric patients Paediatric Intensive Care Unit (PICU) and Cardiac Critical Care Unit across Canada, although the dosages and monitoring practices varied (CCCU). greatly. The information will be useful for creating a HDEI AMG pediatric Methods: A retrospective chart review was conducted to describe protocol for use in the local health region, as well as for cross-comparison meropenum use over 12 months (January - December 2014) in patients of practice by other centres across Canada. who received meropenem for at least 72-hours during their stay. Research Electronic Data Capture (REDCap), Microsoft® Excel and R Project for Strategies to Support Pharmacy Students’ Progress in Statistical Computing were used to collect and analyze data. Experiential Learning: A Literature Review Results: A total of 110 patient records were screened. Of these, 48 (43.6%) 1 1,2 1,3 Ferruccio L, Cheng D, Natsheh C were included, 12.5% were bone marrow transplant patients, 12.5% were 1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto ON haematology/oncology patients, 18.8% were liver transplant patients, 2Department of Pharmacy, Mount Sinai Hospital, Toronto ON and 2.1% were lung transplant patients. The study revealed that 90.9% 3Department of Pharmacy, University Health Network, Toronto ON of courses received ID consultation; ID agreed with meropenem initiation in 93.8% of cases. The most common initial indication was empiric Background: The transition from formal classrooms to clinical (58.2%), followed by microbiologically proven infection (41.8%). For placements can be challenging for healthcare students. When students indications after 72-hours of initiation, 50.9% remained empiric while encounter difficulty, supportive strategies tend to be drawn from the microbiologically proven infections increased to 49.1%. Meropenem was traditional didactic setting, but this may not address the additional continued past PICU/CCCU discharge in 34.6% courses. For 23.6% courses, competencies that are necessary for success in the clinical setting. meropenem was discontinued for resolution of indication or completion of Description: A literature review was conducted to determine which duration. Meropenem was de-escalated to narrower-spectrum antibiotics strategies are being used to support learners’ progress in experiential for 20% courses. Patient death resulted in meropenem discontinuation education at schools of pharmacy, nursing and medicine when students in 10.9% courses. In the remaining 10.9% courses, meropenem was experience difficulty. The goal was to determine best practices and themes deemed no longer required due to repeated negative cultures or ruled-out that can be applied to the pharmacy experiential education curriculum at infections. Mean duration of Meropenem was 9.7±6 days. our institution. Conclusion: Prolonged meropenem use was mainly in high-risk patients, Action: Searches of four databases (Embase, Medline, International which could contribute to the long duration of therapy and continued Pharmaceutical Abstracts and SCOPUS) were conducted. References of empiric use despite negative cultures. Future studies should explore identified articles were also examined. reasons for continuation of meropenem empirically after 72-hours of Articles included in the analysis addressed (1) the experiential education initiation. of nursing, pharmacy or medical learners, (2) methods of remediation used specifically for learners experiencing difficulty while on clinical Adjunctive Ethanol-Lock Therapy in Paediatric placements, and (3) were written in the English language. Patients with Catheter-Related Bloodstream Infection 1 1 2,3 2,3 Evaluation: Forty-seven articles were identified. Four were from Qi K, Wong E, Peebles E, Atkison P pharmacy, 8 were from nursing and 35 were from medicine. Types of 1London Health Sciences Centre, London, ON studies identified include a description of experiences at the authors’ 2Children’s Hospital, London Health Sciences Centre, London, ON institution(s) (31), surveys of program directors (6), case studies (4), review 3Department of Paediatrics, Western University, London, ON articles (3) and formal/informal recommendations (3). Background: Patients with long-term catheter access are at higher risk Common helpful strategies include student ownership, self-reflection, of catheter-related bloodstream infection (CRBSI). CRBSI is a major source determining the root/underlying cause(s), deliberate practice for mastery of morbidity and may persist despite appropriate antibiotic therapy. It of skills, involvement and support of preceptors/faculty, and using a well- is reported that high concentration (70%) ethanol lock therapy (ELT) constructed learning contract that contains a timeline, concrete end points can prevent CRSBI, due to its bactericidal properties and penetration of and consequences of failure. biofilms. The role of ELT in combination with antibiotics for treatment of Implications: A framework was identified to support students’ progress in acute CRBSI is yet to be established. experiential placements. The 4 main steps include assessment, planning, Objective: To describe ELT utilization in combination with antibiotics for implementation and evaluation. For effective remediation, learning treatment of CBSRI paediatric patients with long-term catheter access. activities should be tailored to the specific competencies the student is Methods: A retrospective review of patient cases was conducted where at struggling with, and the student must be engaged in each step. least one dose of ELT was given between September 2013 and September Evaluation of Meropenem Usage Patterns in the 2015. Clinical outcome of bacteriological cure after initiation of ELT, Paediatric Intensive Care Unit and Cardiac Critical the identity of microorganisms in blood culture and number of catheter Care Unit changes after ELT were defined a priori and assessed. Results: Six patients were treated with ELT and antimicrobials for a Karnieg T,1,6 Pong S,1,6 Timberlake K,1,6 Clarke M,5 Science M,4,7 Schwartz S,3,7 Cox total of 12 events of acute CRBSI. Patients were 4 months to 15 years of P, 3,7 Seto W1,2,6 age; all were TPN-dependent secondary to short bowel syndrome, with 1Department of Pharmacy, The Hospital for Sick Children, Toronto, ON central catheter access. Persistently positive blood cultures in 11 events 2Child Health Evaluative Sciences, Research Institute, The Hospital for Sick were observed prior to ELT. Duration of ELT ranged from 1 to 5 days. Children, Toronto, ON Bacteriological cure after ELT was achieved in 90.9% (10/11) of cases. Two patients required a catheter change after bacteriological cure 66 Conclusion: ELT was demonstrated to have a promising role for target level attainment using pharmacokinetic parameter and bacterial adjunctive treatment of acute CRSBI in combination with antimicrobials minimum inhibitory concentration (MIC) mean and standard deviation. for TPN-dependent paediatric patients with short bowel syndrome. Results: Three patients were recruited for this study. The average steady state concentration and half-life were 4.44 ± 1.45 mg/L and 10.28 ± 2.58 Utilisation des données relatives aux rôles et hours, respectively. MCS predicted the probability of attaining target retombées de l’activité pharmaceutique : étude pilote peak to MIC ratio of 10 and AUC to MIC ratio of 125 to be 15% and 40%, de panels d’experts respectively, for treating PA bacteremia. The maximum concentration Breton M,1 Ferreira E,1,2 Letarte N,2,3 Bussières JF1,2 observed in the daytime long-dwell dialysate and overnight continuous cycling dialysate was 7.43 ± 1.24 mg/L and 3.25 ± 1.15 mg/L, respectively. 1Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, QC Conclusion: Oral ciprofloxacin 750mg twice daily may be reasonable 2Faculté de pharmacie, Université de Montréal, Montréal, QC in CCPD patients for treating bloodstream or peritoneal infections due 3Département de pharmacie du Centre hospitalier de l’université de Montréal, to gram-negative bacteria, including highly susceptible PA species. Montréal, QC Levels achieved were higher than those typically observed in healthy, non-dialysis patients, but were not excessively high to be concerned with Contexte : Les pharmaciens sont peu exposés aux données publiées concentration related ciprofloxacin toxicity. relatives aux rôles et retombées de l’activité pharmaceutique (RRAP). Suite à ce constat, le site Impact Pharmacie, outil visant à valoriser et diffuser Evaluating the Short-Term Sustainability of ces données, a été lancé en 2013. Benzodiazepine Receptor Agonist Discontinuation Objectifs : Cette étude vise à connaître la position de pharmaciens Following Discharge from a General Internal experts quant à l’utilisation des données scientifiques sur les RRAP et leur Medicine Program: A Prospective Observational avis sur la manière d’améliorer la place du site web dans ce contexte. Study Méthodologie : Étude descriptive prospective dans laquelle des Wright AE,1 Treleaven S,1 Holbrook A,2 Wallace C1 pharmaciens experts ont été invités à visiter le site Impact Pharmacie, 1Pharmacy Department, St. Joseph’s Healthcare Hamilton, Hamilton, ON consulter les données relatives aux RRAP de leur domaine, puis à répondre 2Division of Clinical Pharmacology and Toxicology, McMaster University, à un questionnaire en ligne (pré testé) de 26 questions. Ils ont ensuite Hamilton, ON été conviés à une entrevue téléphonique de 60 minutes, semi-structurée, enregistrée et modérée par l’équipe de recherche. Background: Long-term use of benzodiazepine receptor agonists (BRAs), including benzodiazepines, zopiclone and zolpidem, is associated with Résultats : Deux panels de cinq pharmaciens experts, hématologie- adverse outcomes. Abrupt discontinuation of BRAs is challenging due oncologie (HO) et soins intensifs (SI), ont été consultés en septembre to withdrawal effects. Many different strategies have resulted in BRA 2015. Les 10 panélistes exerçaient dans leur programme respectif depuis discontinuation in the short-term; however, evidence supporting the 6-10 ans (30%), 11-15 ans (60%) ou plus de 15 ans (10%). L’enquête en sustainability of these interventions is limited. ligne a montré que 50% de l’ensemble des pharmaciens colligeaient des données descriptives sur leurs activités, mais aucune relative aux Objectives: To determine if BRA discontinuation during hospital retombées. Seulement 20% des pharmaciens ont publié sur leurs activités. admission is sustained 2 weeks after discharge and to determine if En SI, 80% du panel avaient réévalué leur pratique à partir des données any patient, drug or situational factors are associated with sustaining de la documentation scientifique sur les RRAP mais 0% en HO. Pendant discontinuation. la téléconférence, les panélistes ont proposé des moyens d’accroitre Methods: Prospective observational study of patients admitted to the la diffusion des études relatives aux RRAP, d’ajouter un résumé des General Internal Medicine (GIM) service at our institution from March interventions pharmaceutiques ayant davantage de retombées à la section 25th-May 29th, 2015 who were using BRAs prior to admission. Participants « Que retenir » du site. were excluded if admitted for less than 48 hours or if transferred to or Conclusion : La consultation de panels d’experts est une approche from another acute care service. Demographic, drug use and situational pertinente afin de sensibiliser et favoriser l’utilisation des données relatives factor data was collected using self-reported questionnaires and chart aux RRAP. D’autres panels sont prévus dans d’autres disciplines. review. Participants who had their BRA discontinued during admission were followed-up 2 weeks after discharge. Descriptive statistics were used to Pharmacokinetics of Oral Ciprofloxacin at Steady summarize findings. State in Continuous Cycling Peritoneal Dialysis Results: Fifty-three patients admitted to GIM were using BRAs. Twelve Lee C,1,2 Walker SAN,1,2,3,4 Walker SE,1,2 Palmay L,1 Ng J,1 Tobe S,5 Simor A3,4 met the inclusion criteria; most were excluded for admission less than 48 hours or not providing consent. Four participants (33%) had their BRAs 1Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON discontinued during admission and 2 (50%) sustained discontinuation two 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON weeks after discharge. No differences in patient or drug use factors were 3Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON observed between groups however, documentation of BRA discontinuation 4Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON on the discharge prescription was present for those who sustained BRA 5Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON discontinuation and absent for those who did not. Background: Peritoneal dialysis (PD) is typically delivered as continuous Conclusion: Few prescribers discontinued BRAs during admission. Studies ambulatory dialysis (CAPD) or continuous cycling dialysis (CCPD). on prescriber knowledge and attitudes may identify barriers to inpatient Peritonitis is a major complication of PD, which is associated with BRA discontinuation. The sustainability of BRA discontinuation may be increased mortality and PD failure. Pseudomonas aeruginosa (PA) has facilitated by documentation on the discharge prescription however, the been known to cause infection and catheter-related PD complications. small sample size limits firm conclusions. Standardized communication of Oral options for treating PA are limited to ciprofloxacin, but its medication discontinuation upon discharge may improve sustainability of pharmacokinetic profile has mostly been studied in CAPD. BRA discontinuation. Objective: To determine the pharmacokinetics of oral ciprofloxacin and its adequacy for the treatment of PA infections in CCPD patients. Antimicrobials Defned Daily Doses and Days of Methods: Patients were enrolled from the outpatient PD clinic at Therapy in a Mother-Child Teaching Hospital from Sunnybrook Health Sciences Centre. Ciprofloxacin 750mg was given twice 2010−2011 to 2014−2015 daily for a total of 5 doses. Blood was drawn around the fourth and fifth Cotteret C,1,2 Lebel D,1,2 Roy H,1,2 Ovetchkine P,2 Bussières JF1,3 doses to determine steady state concentrations. Dialysate samples were 1Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, taken to observe attainable concentrations in the peritoneal cavity. Monte Montréal, QC Carlo Simulation (MCS) was performed to determine the probability of 2Pediatric Department, CHU Sainte-Justine, Montréal, QC 3Faculty of Pharmacy, Université de Montréal, Montréal, QC 67 Background: Antimicrobial stewardship programs include the learner competence (mostly 5/5 ratings). Assessment tool descriptors were monitoring of defined daily dose (DDD) and days of therapy (DOT) as evaluated similarly through rating how well the descriptors described their surrogate markers of the use of antimicrobials. Such monitoring may corresponding domain item (range of 2-5/5 ratings). This latter finding contribute to optimal drug use and to limit the emergence of drug indicated the need to refine descriptors. An accompanying glossary resistances. document was written as a result of this feedback. Objectives: To describe antimicrobial drug use through the profile of DDD Implications: A standard assessment tool for field-based pharmacy and DOT from 2010-2011 to 2014-2015. training will provide consistency in assessment and facilitate preceptor training across provincial training programs. With positive feedback from Methods: This is a cross-sectional descriptive study conducted at a 500- various training programs, the implementation process is underway. bed mother-child teaching hospital. The study included 53 antibiotics, 10 antivirals and 8 antifungals. All pediatric inpatients from 2010-2011 Attitudes and Beliefs towards Smoking Cessation to 2014-2015 were included. Data was extracted from the pharmacy Medications amongst Canadian Armed Forces information system. Inpatient data was extracted from the admission Personnel software. We calculated DDD/1000 patient-days (PD) ratios as well as DOT/1000 PD. Lui K, Reid R, Windl K, Comeau R, Wong K, Grenier H, Wierstra B, Ma J, Canadian Forces Health Services Group Results: For the five-year period, DDD/1000 PD were 642, 693, 660, 637 and 652, respectively. DOT/1000 PD were 1068, 1150, 1084, 1039 and Background: Despite the presence of organized multidisciplinary 1033, respectively. DOT/1000 PD remained stable over the study period. smoking cessation programs available at the workplace and We observed wide variations in DOT/1000 PD between patient care units, comprehensive drug coverage, rate of tobacco use continues to be high as follows: 2619 in hematology-oncology, 1771 in infectious disease, 1508 amongst Canadian Armed Forces (CAF) personnel. Previous studies in intensive care unit, 1000 in surgery units and 867 in pediatric units. demonstrated associations between positive beliefs about smoking Increased use between 2010-2011 and 2014-2015 was observed especially cessation medications (SCMs) and increased likelihood of continued for linezolid (+469%), piperacillin-tazobactam combination (+103%) and abstinence and latency of relapse. There is currently limited information carbapenems (+50%). pertaining to the attitudes and beliefs towards smoking cessation medications amongst CAF personnel. Knowledge in this regard may aid in Conclusions: There are limited data published about antimicrobial use streamlining interventions to reduce tobacco use rate. in pediatrics in Canada. Measurement of DOT/1000 PD is preferred in pediatrics. While antimicrobial drug use appears stable throughout the Objective: This descriptive study aims to examine attitudes and beliefs of five-year study period in our hospital, detailed data revealed specific trends CAF personnel towards smoking cessation medications. per antimicrobial agents and patient care areas and possibly reflects a Methods: An anonymous and voluntary questionnaire was included as specific activity in a tertiary hospital. DDD/1000 PD and DOT/1000 PD part of departure administration procedures to gather data for this study. should be trended per hospital to support antimicrobial stewardship CAF members relocating from Canadian Forces Base Shilo, Wainwright, programs and corrective actions. Petawawa and Valcartier were offered the questionnaire. Questions were developed by a focus group of health care professionals. It was Development of a Standard Assessment Tool for Field- subsequently reviewed by multidisciplinary clinicians, translated, and Based Pharmacy Training pretested on lay CAF members. Responses were collated centrally by a Halapy H,1,4 Lee A,1 Spizzirri D,2 Yau S,3 Suleiman M2 research nurse and descriptive analysis was done using SPSS. 1Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Results: 2Ontario College of Pharmacists, Toronto, ON Did not 3School of Pharmacy, University of Waterloo, Waterloo, ON 4St. Michael’s Hospital, Toronto, ON Agree Disagree Unsure respond These medications can help 344 16 118 88 Background: Field-based pharmacy training is conducted by schools tobacco users to cut down their (54.1%) (2.5%) (29.6%) (13.8%) of pharmacy, residency training sites and provincial licensing bodies. use. A standard assessment tool utilized by these training programs could These medications can help 327 21 203 85 improve consistency of trainee performance assessments and simplify tobacco users to quit. (51.4%) (3.3%) (31.9%) (13.4%) documentation for preceptors. These medications can help 336 16 199 85 Description: A standard field-based assessment form was developed control cravings and manage (52.8%) (2.5%) (31.3%) (13.4%) through a year-long collaboration with representatives of 4 training withdrawal symptoms. programs in the province. The assessment tool is competency-based The side effects of these 104 62 383 87 derived from national and provincial standards for pharmacy practice. medications can be serious. (16.4%) (9.7%) (60.2%) (13.7%) Education principles based on the Structure of the Observed Learning There are significant drug 52 67 431 86 Outcome (SOLO) taxonomy served as the foundation for the assessment interactions with these (8.2%) (10.5%) (67.8%) (13.5%) scale. medications. Action: Representatives from the training programs met regularly to It is better to quit “cold turkey” 148 138 263 87 develop an assessment tool based on 5 main competency domains of than to use medications. (23.3%) (21.7%) (41.4%) (13.7%) patient care, communication and education, professionalism, professional N= 636 collaboration and practice management. Domains were drawn from the Association of Faculties of Pharmacy of Canada 2010 Educational Results were similar when stratified by tobacco use history or by Outcomes document. The SOLO taxonomy served as the anchor for the 5 geographic location. point Likert scale used in each domain. Domain selection and descriptors Conclusion: Only half of the respondents agreed with the efficacy of for each point on the Likert scale were decided by representatives of the SCMs. Very few respondents expressed significant concerns with side training programs based on consensus. Feedback regarding assessment effects or disagreement with efficacy of SCMs. Unexpectedly, previous tool practicality and design was sought from preceptors, university faculty, smokers who successfully remained abstinent at the time of the study did and residency coordinators. not display differences in beliefs compared to active smokers. Education Evaluation: The assessment tool was tested for content validity by asking pertaining to smoking cessation medications directed at the general CAF residency coordinators to rate how relevant the domains were to pharmacy population may be helpful in the goal of decreasing tobacco use rates across the organization.
68 Characterizing the Role of Infectious Diseases for each elderly patient and grouped according to renal function. Consultant Pharmacists and Antimicrobial Differences were tested using analysis of variance. Stewardship Pharmacists: A Survey of Canadian Results: In a normal patient the AUCss was 3.53mg*hr/L. The average Tertiary Care Academic Hospital AUCss for elderly patients with CrCl>60mL/min (n=18), 30-60mL/min Beach J,1 Ramsey T,2,3 Gorman S,4,1 Lau T,5,1 Calissi P4 (n=70) and 10-30mL/min (n=26) were 3.78mg*hr/L, 2.16mg*hr/L, and 3.14mg*hr/L, respectively, with all groups significantly different from 1The University of British Columbia, Vancouver, BC each other (P<0.001). The concentration-time profiles also demonstrated 2Nova Scotia Health Authority, Halifax, NS elderly patients with CrCl 30-60mL/min and 10-30mL/min achieved lower 3Dalhousie University, Halifax, NS concentrations compared to the normal patients. In order to achieve 4Interior Health Authority, Kelowna, BC similar concentrations, elderly patients with CrCl 30-60mL/min should 5Vancouver General Hospital, Vancouver, BC receive 45mg BID and patients with CrCl 10-30mL/min should receive Background: Infectious diseases consultant (IDC) pharmacists provide 30mg BID. care to their IDC service inpatients. Increasing numbers of antimicrobial Conclusion: The current oseltamivir monograph dosing stewardship (AMS) pharmacists are being employed as a result of the recommendations for the treatment of influenza in patients with renal Accreditation Canada Required Organizational Practice for hospital AMS impairment under doses patients. programs. With pharmacists in IDC and AMS positions, there is potential for overlapping responsibilities. As there is no literature outlining the Defning the Roles of an Experiential Education current tasks for each group in Canada, a survey was designed to illustrate Facilitator: A Pilot Project their roles. Legal M, Leung M, Guenter J, Tse K, University of British Columbia, Vancouver, BC Objective(s): To characterize the clinical, educational, administrative, and research roles of self-identified IDC and AMS pharmacists in tertiary Background: With the recent and imminent changes to the pharmacy care academic hospitals across Canada. education program in British Columbia, placement capacity, teaching workload, and the need for preceptor and learner support are clearly Methods: A survey-based study of IDC and AMS pharmacists at identified as key areas of concerns. The implementation of Experiential Canadian tertiary care academic hospitals was conducted. The Education Facilitators (EEFs) to provide on-the-ground support to questionnaire was open to targeted participants for 8 weeks. An Internet- preceptors and learners at the placement sites was identified as one of based questionnaire platform was used to collect, aggregate, and analyze the strategies to help manage clinical workload and optimize student responses. Descriptive statistics were used to summarize and report data. learning. In April 2015, a pilot EEF position was implemented as a trial to Results: The completed survey response rate was 77% (68/88) and provide support to learners and preceptors at 4 different hospitals. respondents self-identified as IDC (21%), AMS (50%), and dual-role IDC Objectives: The objectives of this report are to explore learners’ and and AMS (29%) pharmacists. IDC pharmacists reported more of the preceptors’ perceptions of the EEF roles, summarize the key findings and following unique clinical roles: communicating with patients, attending provide suggestions for implementation of the permanent EEFs. rounds, involving patients in decision-making, and providing patient education as compared to AMS pharmacists. IDC, AMS, and pharmacists Method: A non-experimental descriptive exploratory design was used who identify themselves as dual-role IDC and AMS pharmacists described to explore learners’ and preceptors’ perceptions of the strengths and similar educational responsibilities. AMS pharmacists performed more weaknesses of the EEF roles. Learners and preceptors were contacted at the of the following administrative and research roles: antibiogram and end of the rotation for feedback. All interviews followed a semi-structured pre-printed order development, antimicrobial metric collection, and format and were audio recorded. Verbatim transcripts and/or detailed field antimicrobial drug use evaluations. Dual-role IDC and AMS pharmacists notes were produced. were involved in less of the unique activities described by those who Data were independently categorized, reassembled and managed in a practiced with a single specialty. systematic way to identify the issues and themes, such as the roles, benefits Conclusion(s): Canadian IDC and AMS pharmacists in tertiary care and challenges of the EEF experience. academic hospitals reported performance of many similar roles. However, Results: The benefits of EEFs include direct support to learners to ease distinct differences were identified between IDC, AMS, and those who their transition from school to real world practice setting, which in turn, identified as dual-role IDC and AMS pharmacists within their clinical, minimizes the workload for preceptors. Role delineation, clear expectations administrative, and research domains. and frequent communications are critical to ensure all stakeholders share a common understanding of EEF roles. Evaluation of Oseltamivir Dosing Recommendations for Elderly Patients Conclusions: This report offers preliminary evidence for the roles of EEFs and provides some insight to potential benefits and challenges of such Ma N, Walker SAN, Walker SE, Department of Pharmacy, Sunnybrook Health roles. Sciences Centre, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Non-Traditional Learner-Preceptor Models: Background: The oseltamivir product monograph recommends dose Development of Preceptor Guidebooks adjustments based on changes in renal function. For treatment of Legal M,1 Guenter J,1 Tse K,1 Leung M,1 Thompson A,1 MacDonald M,2,3 influenza, the monograph recommends 75mg BID for patients with Mulherin K4 creatinine clearance (CrCl)>60mL/min, 30mg BID for patients with CrCl 1 30-60mL/min and 30mg daily for patients with CrCl 10-30mL/min. A University of British Columbia, Vancouver, BC 2 2013 population based pharmacokinetic analysis of oseltamivir and its University of Alberta, Edmonton, AB 3 active carboxylate metabolite (OC) reported that CrCl, age and weight Pharmacy Services, Alberta Health Services, Calgary, AB 4 were significant determinants of the OC concentration (Kamal et al. Association of Faculties of Pharmacy of Canada, Toronto, ON Antimicrobial Agents Chemotherapy 2013). Background: There has been renewed interest in non-traditional learner- Objective: To evaluate OC concentrations using product monograph preceptor models in pharmacy experiential education in Canada due to recommended doses based on the 2013 population based pharmacokinetic increased placement capacity demands as well as support for these models analysis and an elderly population of 114 patients with known age, in educational literature. Development of tools and resources will provide weight and CrCl. benefit to preceptors as they contemplate or begin adopting these models. Methods: OC concentrations were simulated for 114 elderly patients Description: This project compiled the available knowledge, both (age range: 83-101) using product monograph recommended doses. theoretical and practical, into reference guidebooks for preceptors and Concentrations were compared to those simulated in a normal patient experiential education coordinators. Peer assisted learning (PAL), near (55yr; 70kg, CrCl=100mL/min). The peak OC concentration at steady state peer (NP) teaching and co-precepting models were chosen as the focus of (Cmaxss) and area under the curve at steady state (AUCss) was calculated each guidebook. 69 Action: In May-July 2015, preceptors experienced in non-traditional Implementation of an Insulin Pen Trial in an Acute learner-preceptor models were contacted to participate in either a survey Medical and Surgical Patient Population or phone interview. Preceptors from British Columbia (n=18 and 14), Sanaz S, Trillium Health Partners, Mississauga, ON Alberta (n=6 and 6), Ontario (n=8 and 2) and Newfoundland (n=2 and 0) participated in the national survey and interviews, respectively. Questions Background: The use of insulin pens has been shown to improve patient were asked in such a way to extract practical tips and solutions to any safety, patient comfort, transition of care, staff satisfaction and cost perceived challenges of these models. The insights and advice from these savings. champion preceptors were used to create these guidebooks. Description: An insulin pen protocol was developed with input of Other information sources came from precepting guidebooks from other stakeholders including nurses, clinical educators, and pharmacy staff. In health disciplines at various Canadian Universities, experiential education collaboration with our Industry Partners, nursing staff were trained in the faculty and a systematic literature review on the benefits and challenges of safe use of insulin pens and a checklist was developed for certification. learner-preceptor models. Insulin pens are high risk medications, and can pose serious patient safety Evaluation: Three guidebooks were created. Project team members risk in the hospital setting, if used incorrectly. To mitigate this risk, a safety reviewed each for content, format and ease of use. Secondly, suggestions campaign was adopted to emphasise ‘one pen, one patient’, and all staff from experienced preceptors were incorporated. The commonly cited completed the ‘Safe Use of Insulin Pens E-learning Module’ advantages were peer support, clinical independence and enriched Action: Nurses completed staff satisfaction surveys before and after the learning for PAL and NP models and reduced preceptor workload for trial and quality audits were performed throughout, to ensure the policies co-precepting. Strategies for success were offered to help address possible and procedures were correctly and safely implemented. increased workload with PAL and NP and to improve communication and expectations with co-precepting. Evaluation: Significant improvement in needlestick injuries was observed on the medical ward, and none on the surgery ward. Additionally, Implications: Finalized guidebooks will be made available to all no incidents of patients sharing pens were documented on either Canadian faculties/schools as a resource to provide practical tips and ward. Insulin wastage was noticeable with shorter stays and higher advice for preceptors adopting a non-traditional precepting model. dispensing costs with the pen; however there was a reduction in nursing administration times. When evaluating administration, all nurses Standardization of Patient Education by Pharmacists demonstrated correct technique, reflecting good knowledge. Nursing staff Tom E,1 Dewhurst NF,1,2 Proceviat J,1 Gillespie P,2 Chant C1,2 preferred the insulin pen, as did the patients due to convenience and ease of transition of care to the community. The trial did not demonstrate cost 1St. Michael’s Hospital, Toronto, ON savings on the medicine ward with transition to insulin pens, however 2Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON there was a cost savings observed on the surgical ward. The significance of Background: Pharmacists play a vital role in educating patients on the cost savings requires a larger patient population to be established. safe and effective use of medications in a variety of situations. Pharmacists Implications: Patient safety, staff and patient satisfaction will support the must select and prioritize which patients receive education within hospital roll out of insulin pens organization wide. Education and proper training and just prior to discharge. In order to balance performance of patient is imperative for the safe roll-out of insulin pens and support of staff. education and other clinical duties, standard criteria for prioritization was necessary. Inappropriate Administration of Oral Valganciclovir Description: In order to minimize variation amongst pharmacists to Infants with Congenital Cytomegalovirus Infection in patient selection, the process of standardizing practice for patient Harricharan S,1 Harris VC1,2 education was required to allow all pharmacists to apply a consistent approach. 1London Health Sciences Centre, London, ON 2Department of Paediatrics, Western University, London, ON Action: A formalized literature search was performed as a baseline assessment of existing patient education practices. Clinical pharmacists Background: Oral valganciclovir is a mono-valyl ester pro-drug of were surveyed to assess the current methods for patient selection, ganciclovir, available in a 50 mg/mL oral suspension. Its use for the educational practice and documentation. This data was used to develop treatment or prevention of CMV in paediatric patients has increased since criteria for the selection of patients for pharmacist education. oral formulations of ganciclovir were withdrawn from the market. Evaluation: All inpatient pharmacists surveyed participated in the Description: A neonate was discharged from hospital with a prescription provision of patient education, averaging 2 hours of patient education for valganciclovir 40 mg/0.8 mL orally twice daily. The patient’s caregiver per week over 6 patients. The majority of patients were self-referred, estimated she gave approximately 125 mg before realizing this was a followed by physician, nurse and nurse practitioner referrals. Pharmacists larger volume than the baby had received in hospital. The caregiver targeted patients taking on an average 3 new or 9 medications in total. brought the baby to the emergency department, where the baby was Drug-specific criteria were considered most important for prioritization found to be clinically stable. Follow up blood work did not show any of patient education, followed by those patients on a high number of evidence of renal dysfunction or bone marrow suppression, although the medications on discharge. Medication counseling was the most common latter may be a delayed effect requiring further monitoring. type of education provided, followed by medication schedule teaching. Assessment of Causality: The oral syringe provided by the Therapeutic anticoagulants were the most common targeted drug for manufacturer is marked in 100 mg gradations up to 500 mg, with small discharge education, followed by systemic corticosteroids and insulin. lines to denote 25 mg intervals. The patient’s caregiver believes she drew Implications: Prioritizing patients taking therapeutic anticoagulation up 400 mg, as a 40 mg/0.8 mL dose is not measurable with this syringe. was identified as the best criteria to standardize patient education. Literature Review: Administration errors are often reported when less Standardization enables the discipline to set minimum criteria for when than 1 mL of medication per dose is prescribed and can frequently involve education will be provided by pharmacists to enable a balance of clinical infants under 1 year. Errors have been reported secondary to confusion duties. between the desired mg and mL dose to be administered using an oral syringe with mL gradations. Importance to Practitioners: Pharmacists should be made aware that the syringe supplied by the manufacturer with valganciclovir is marked in 100 mg graduations rather than mL and is not appropriate to measure neonatal doses. Concern about this oral syringe was reported to ISMP. An oral syringe, with mL markings, should be supplied and appropriate counselling provided to caregivers to minimize the risk of accidental overdose in this vulnerable population.
70 Two Cases of New Onset Refractory Status Epilepticus: intervention. Both patients received immunologic therapy for presumed Prolonged Barbiturate and Ketamine Therapy autoimmune encephalitis. Ultimately, one patient remained in a persistent vegetative state while the other recovered with a significant reduction in Lougheed C, Debicki D, Althenayan E, Khosravani H, Gofton T, London Health seizure burden. Sciences Centre, London, ON Assessment of causality: Treatment complications, specifically Background: New onset refractory status epilepticus (NORSE) is a hepatomegaly and reversible cerebral changes (as seen on magnetic difficult to control clinical condition with potentially poor outcomes. resonance imaging), were attributed to prolonged barbiturate and Coma induction, including the use of barbiturates and ketamine, is an ketamine use respectively. acceptable therapeutic strategy. However, the use of general anesthetics has potential inherent systemic complications. Thus, the optimal Literature Review: Evidence in the form of randomized controlled therapeutic approach remains unclear. trials in the management of refractory status epilepticus is limited to one study comparing barbiturates to propofol. As such, management of this Case Description: Two cases of young healthy males presenting with severe disorder is directed largely by case reports and small case series. new generalized tonic-clonic seizures following flu-like symptoms were Prolonged barbiturate coma has been described in the order of weeks and managed in the intensive care unit. Continuous electroencephalography not months. monitoring indicated ongoing non-convulsive status epilepticus refractory to numerous antiepileptic drugs. Seizure suppression was achieved Importance to Practitioners: Current practices in the management of through infusions of pentobarbital, thiopental, ketamine, propofol or NORSE are guided by expert consensus, systematic reviews of the literature midazolam. This continued for greater than 6 months with unsuccessful and cumulative practice. Further research into the risks and benefits of weaning attempts. Brain imaging demonstrated evidence of progressive prolonged anesthesia is needed. In the meantime, case reports add to the white matter disease. Other systemic complications included recurrent small body of evidence currently used to direct therapy. infections, hepatomegaly and, in one case, ischemic gut requiring surgical
Poster Abstract Reviewers Réviseurs des présentations par affiches
Sincere appreciation is extended to the Research Committee for reviewing the abstract submissions for PPC 2016.
Marie-France Beauchesne Lauren Bresee Roxane Carr Scott Edwards Jamie Falk Natalie Kennie-Kaulbach Sheri Koshman Stacey MacAulay Holly Mansell Winnie Seto Nancy Sheehan
Adjudicators:
Sean Gorman Marc Perreault
71 Faculty Reem Haj Mark Pasetka CSHP would like to recognize the BScPharm, ACPR, PharmD BSc, BScPharm, PharmD generous contributions of the following Anne Hiltz Calvin Poon speakers: BScPharm, MHS, ACPR RPh, BScPhm, ACPR, CDE Conférenciers Kathryn Hollis Sandra Porter La SCPH désire souligner les généreuses RPh, BScPhm, ACPR, MHA candidate BScPhm contributions des conférenciers Sandy Jansen Susan Poutanen suivants : BScPhm, RPh, MHS MD, MPH, FRCPC
Carolee Awde Brent Jensen Ferid Rashid BScPhm, RPh, CDE BSP BScPharm, ACPR
Rick Abbott Debra Kent Brenda Rosenthal BScPharm BA, PharmD, DABAT, FAACT, RPh BScPharm
Derek Andrews Heather Kertland Samantha Scott BSc(Pharm) PharmD, FCSHP BScPharm, ACPR
Arden Barry Kamran Khan Bill Semchuk BSc, BSc(Pharm), PharmD, ACPR MD, MPH MSc, PharmD, FCSHP
Marisa Battistella Sandra Knowles Richard Slavik BScPhm, PharmD, ACPR RPh, BScPhm BSc(Pharm), ACPR, PharmD, FCSHP
Pulkit Bhuptani Kori Leblanc Jaris Swidrovich BHSc, PharmD BScPhm, ACPR, PharmD BSP, PharmD
Jennifer Bolt Monica Lee Miranda So BScPharm, PharmD, ACPR BScPhm, MSc, PharmD, RPh, BScPhm, PharmD
Jackie Campbell Ruby Liang Sean Spina BSc(Pharm), LLB BScPhm, ACPR, PharmD BSc(Pharm), ACPR, PharmD
Alice Y.Y. Cheng Rose Liao Naomi Steenhof MD, FRCPC RPh, BSc(Pharm), ACPR BEd, BScPhm, ACPR, CGP
Jenny Chiu Philip Lui Sally Tierney BScPhm, PharmD, ACPR, RPh BScPhm, PharmD BScPharm
Norman Dewhurst Melanie MacInnis Rachel Whitty BScPhm, ACPR, PharmD BSc(Pharm), PharmD RPh, BScPhm, ACPR
Artemis Diamantouros Kathy Malejczyk Angie Wong BScPhm, MEd, PhD MD, FRCPC BScPhm, MSc, ACPR
James Downar Wenya Miao Michael Wong MD, CM, MHSc, FRCPC BScPharm, PharmD, ACPR BScPhm, ACPR
Olavo Fernandes Diana Mourao Amita Woods BScPhm, ACPR, PharmD, FCSHP RPh, BScPhm, ACPR RPh, PharmD, BScPhm
Carla Findlater Katrina Mulherin BScPhm, PharmD BScPharm, PharmD
Brent Fraser Janice Munroe BScPhm, MBA BScPharm
Julie Greenall Laura Murphy RPh, BScPharm, MHSc(Bioethics), BScPhm, ACPR, PharmD, ACPR, FISMPC Sandra Nelson BSP, ACPR, PharmD, MScQIPS 72 CSHP National Awards
Awards Committee will soon invite applications and nominations for the 2016-2017 National Awards Program. The CSHP goal of the awards program is to improve patient outcomes by promoting excellence in the practice of pharmacy throughout hospitals and other collaborative healthcare settings. The awards are presented to pharmacists in recognition of their professional dedication. The CSHP-CAPSI Hospital Pharmacy Student Award is presented to a student pharmacist.
The program includes general and special awards. requirements and/or other outcomes attributable to uptake of the technology among staff and patients; may GENERAL AWARDS include a comprehensive review of the potential risks • Management and Leadership Best Practice Award and benefits that the new technology introduces to the • Patient Care Enhancement Award practice setting. • Pharmacotherapy Best Practices Award For the GENERAL AWARDS program, you may apply • Safe Medication Practices Award for two awards per project (for up to two submitted • Specialties in Pharmacy Practice Award projects, for a maximum total of four awards) using the • Teaching, Learning and Education Award online application for general awards. For each SPECIAL • New Technology Award AWARD, applicants or nominators must complete the SPECIAL AWARDS specific online nomination for the intended award.
• Distinguished Service Award Once the program has opened, a call for awards will be • Isabel E. Stauffer Meritorious Service Award issued by email and in the eBulletin. Criteria, application • New Hospital Pharmacy Practitioner Award and nomination forms will be available at the CSHP • CSHP-CAPSI Hospital Pharmacy Student Award website: http://www.cshp.ca/programs/awards/ national_e.asp The Awards Committee is pleased to introduce the New Technology Award, which will be offered for Application and nomination forms, as well as the relevant the first time during the 2016-2017 awards term. This signature forms, are due by September 6, 2016, award recognizes CSHP members who have contributed except for applications and signature forms for the significantly to the development, implementation, and/or Hospital Pharmacy Student Award, which are due by evaluation of new technology in an organized healthcare September 30, 2016. setting and meeting one or more of the following criteria: For award enquiries, please contact: promotes a safe and effective adoption of this new Membership & Awards Administrator technology at other health facilities in Canada; provides Phone: 613-736-9733, ext. 222 a comprehensive review of the technology within their Fax: 613-736-5660 organization. This review may include a systematic E-mail: [email protected] approach to implementation, monitoring resource
73 n Reserved
Exhibitor List (at time of printing) Liste des exposants (au moment de l’impression) Company Booth # Company Booth # Compagnie Kiosque # Compagnie Kiosque # Accord Healthcare Canada Inc...... 100 McKesson Canada Corporation...... 226 Accreditation Canada...... 404 MDA Inc...... 119 ACIC/Methapharm...... 402 Merck Canada Inc...... 405 Alveda Pharmaceuticals Inc...... 209 Mylan Pharmaceuticals ULC ...... 306 ApoLab...... 113 North West Telepharmacy Solutions...... 101 Apotex Inc...... 302/304 Novartis Pharma Canada...... 409 ARxIUM...... 238 Omega Laboratories Ltd...... 310 Baxter Corporation (Canada) ...... 123/125 Omnicell Inc...... 127 BD / CareFusion, a BD Company...... 230/232 Ontario College of Pharmacists...... 109 Boehringer Ingelheim Canada Ltd...... 403 Pendopharm, a Division of Pharmascience Inc...... 112 Canadian Agency for Drugs and Technologies in Health.... 213 Pfizer Canada Inc...... 408/410 Canadian Forces Recruiting Centre...... 117 Pharmascience Inc...... 114 Canadian Institute for Health Information...... 115 Ricoh Canada...... 106 Canadian Pharmaceutical Distribution Network...... 222 RxFiles Academic Detailing Program...... 400 Eli Lilly Canada Inc...... 234 Sandoz Canada Inc...... 201/203 Fresenius Kabi Canada Ltd...... 103/105/107 Sanofi Canada Inc...... 401 Galenova Inc...... 215 SteriMax Inc...... 205/207 Health Canada...... 224 Sphynx Medical Inc...... 407 HealthMatch BC ...... 240 Swisslog Healthcare Solutions...... 108 Healthmark Services Ltd...... 111 Teva Canada Limited...... 308 Innovative OncoSolutions...... 102/104 Think Research...... 411 Johnson Insurance...... 236 Truven Health Analytics...... 129 Lower Mainland Pharmacy Services...... 228 Valeant Canada...... 300 Wolters Kluwer Clinical Drug Information...... 406
74 Injectables
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PI-Injectables-Journal-Ad-CSHP-151203-E.indd 1 2015-12-03 9:46 AM Join Us! CSHP MEMBERSHIP HAS MANY ADVANTAGES
MEMBER BENEFITS
s a member of CSHP, you connect l Advocacy not only to a strong professional l Awards Program organization, but also to a dynamic l Canadian Pharmacy Residency Board network of over 2,700 hospital l Continuing Education Apharmacy colleagues. When you join CSHP, l Partner Discount Programs you instill fresh energy into a 68-year strong l Fellows Program association for expanding and improving l Pharmacy Specialty Networks (PSNs) programs and services. l Products and Services l Professional Liability/Malpractice Insurance l CSHP Foundation
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