Common use of Learning Objectives Clause in Contracts

Learning Objectives. Review the current literature that supports the use of a 2-bag fluid system for the management of DKA Identify monitoring parameters for patients presenting with DKA Which of the following is considered an indicative parameter of DKA? A Serum bicarbonate < 15 mmol/L B: Serum potassium < 3 mEq/L C: Venous pH > 7.3 D: Serum glucose > 200 mg/dL Which of the following is predicted to be affected by implementation of a 2-bag fluid system for management of DKA? A Incidences of DKA B Number of hospital admissions C Time to acidosis correction D A delay in fluid adjustment administration Lucas Canter*, PharmD; Sean Patterson, PharmD; Todd Super, PharmD; James Curtis, PharmD, BCPS; Troy Shirley, PharmD, MBA; Amanda Ackerman, PharmD, BCPS Bronson Battle Creek,5366 Glenn Valley Drive,Apt. 3B,Battle Creek,MI,49015 canterl@bronsonhg.org Purpose: The use of direct oral anticoagulants (DOACs), such as apixaban, rivaroxaban, edoxaban, and dabigatran, has been increasing in clinical care since their introduction in 2010. These medications offer benefits such as an improved safety profile, similar efficacy, standard dosing regimens, and a lack of routine and necessary monitoring when compared to warfarin, which has been the standard of venous thromboembolism (VTE) and atrial fibrillation therapy since its development over 60 years ago. However, there are some factors which can compromise safe use that must be considered. Increased prices often confer a higher out of pocket cost, which can impact adherence. Because these medications do not require frequent monitoring, patients may develop worsening liver and/or kidney function which may go unnoticed for long periods of time. This can lead to inappropriate dosing The purpose of this study was to assess DOAC use in a small health system and to determine whether patients are being appropriately dosed and monitored while taking these medications. Methods: In this retrospective study, patients initiated on a DOAC during the study period were identified and categorized based on various criteria, including renal and liver function, age, relevant past medical history, and concurrent medications that increase bleeding risk. Patients who met all inclusion criteria were identified using ICD-9/10 codes. The primary outcome of this study was to determine the prescribing and monitoring accuracy of DOAC dosing in the outpatient setting. Secondary outcomes included the incidence of bleeding on DOAC therapy, the use of blood transfusions and reversal agents for severe bleeding, and overall cost of associated patient admissions. Results and conclusions will be presented at the Great Lakes Pharmacy Resident Conference. Review the adverse clinical outcomes associated with inappropriate dosing of DOACs Recognize the advantages and disadvantages to DOAC therapy Which DOAC has an FDA approved reversal agent? A Edoxaban B: Rivaroxaban C: Apixaban

Learning Objectives. Review Describe the current literature role a pharmacist can fill in the hospital discharge process Identify characteristics that supports put a patient at high risk for unplanned readmission Which responsibility is most appropriate to be performed by a discharge pharmacist? A Fax the use of a 2-bag fluid system discharge summary to the primary care physician B: Perform medication reconciliation at dicharge C: Arrange for the management of DKA Identify monitoring parameters for patients presenting with DKA appropriate outpatient follow up D: Coordinate patient transportation Which of the following is considered an indicative parameter of DKAa risk factor for unplanned readmissions? A Serum bicarbonate < 15 mmol/L BErrors on medication reconciliation B Counseling a patient on new medications C Scheduling outpatient appointments D Allowing the patient to set up their own transportation Q1 Answer: Serum potassium < 3 mEq/L CB Q2 Answer: Venous pH > 7.3 D: Serum glucose > 200 mg/dL Which of the following is predicted to be affected by implementation of a 2-bag fluid system for management of DKA? A Incidences of DKA B Number of hospital admissions C Time to acidosis correction D A delay in fluid adjustment administration Lucas Canter*Xxxxxxx X. Xxxx, PharmD*; Sean PattersonXxxx X. Xxxxxxxx, PharmD, BCNSP, FCCP; Todd Super, PharmD; James CurtisXxxx X. Xxxxx, PharmD, BCPS, BCCCP; Troy ShirleyXxxx X. Xxxxxx, PharmD, MBAFCCP; Amanda AckermanXxxxxx X. Xxxxxx, PharmD, BCPS Bronson Battle Creek,5366 Glenn Valley DriveBCPS, BCCCP; Xxxxxxx X. Xxxxxxx, PharmD, BCPS, BCCCP; Xxxx X. Xxxxxxx, PharmD, BCPS, BCCCP Eskenazi Health,720 Xxxxxxxx Xxxxxx,Apt. 3BXxxxxxxxxxxx,Battle Creek,MI,49015 canterl@bronsonhg.org XX,00000 xxxxxxx.xxxx@xxxxxxxxxxxxxx.xxx Purpose: The use of direct oral anticoagulants (DOACs)Refeeding syndrome describes metabolic changes, such as apixabanincluding fluid shifts and fluctuations in glucose, rivaroxaban, edoxabanprotein, and dabigatranelectrolytes, has been increasing in clinical care since their introduction in 2010when initiating nutrition. These medications offer benefits such as an improved safety profileRefeeding hypophosphatemia, similar efficacyhowever, standard dosing regimens, and a lack of routine and necessary monitoring when compared to warfarin, which has been the standard of venous thromboembolism (VTE) and atrial fibrillation therapy since its development over 60 years agodescribes phosphorus depletion upon nutrition initiation. However, there are some factors which can compromise safe use that must be considered. Increased prices often confer a higher out of pocket cost, which can impact adherence. Because these medications do not require frequent monitoring, patients may develop worsening liver and/or kidney function which may go unnoticed for long periods of time. This can lead to inappropriate dosing The purpose objective of this study was is to assess DOAC use classify electrolyte deficiencies in a small health system burn patients as either refeeding syndrome or refeeding hypophosphatemia and to determine whether patients are being appropriately dosed and monitored while taking these medicationsdefine risk factors for each. Methods: In this This retrospective study, chart review includes adult burn patients initiated on admitted from 10/1/16 to 8/31/17 with at least a DOAC during the study period were identified and categorized based on various criteria, including renal and liver function, age, relevant past medical history, and concurrent medications that increase bleeding risk. Patients who met all inclusion criteria were identified using ICD-9/10 codesday length of stay. The primary outcome of this study is to assess and classify electrolyte deficiencies including hypophosphatemia, hypokalemia, and hypomagnesemia. Refeeding syndrome is defined as deficiencies in all three electrolytes at any point, with refeeding hypophosphatemia defined as isolated hypophosphatemia.Preliminary Results: Data collection is on-going with 20 patients reviewed. On Day 0, patients had average potassium, magnesium, and phosphorus levels within normal ranges. Median (IQR) nadir potassium and magnesium levels were within xxxxx ranges. Nadir phosphorus was markedly low [1.8 mg/dL (1.4-2.8), range 1-6.4]. By Day 7, all levels had returned to determine the prescribing normal. Overall, 10 patients were classified as refeeding hypophosphatemia, 4 met refeeding criteria and monitoring accuracy of DOAC dosing 6 had neither deficiency. The median (IQR) total body surface area (TBSA) was 10% (6-13) in the outpatient setting. Secondary outcomes included refeeding hypophosphatemia group, 22% (18-29) in the incidence of bleeding on DOAC therapy, the use of blood transfusions and reversal agents for severe bleedingrefeeding group, and overall cost of associated patient admissions7% (5-7) in the group with neither deficiency (p = 0.004). Results and conclusions will be presented Groups were well-matched at the Great Lakes Pharmacy Resident Conference. Review the adverse clinical outcomes associated with inappropriate dosing of DOACs Recognize the advantages and disadvantages to DOAC therapy Which DOAC has an FDA approved reversal agent? A Edoxaban B: Rivaroxaban C: Apixabanbaseline.

Learning Objectives. Review the current literature that supports the use Recognize potential causes of a 2-bag fluid system for the management of DKA heparin infusion dosing errors Identify monitoring parameters for patients presenting potential negative outcomes associated with DKA heparin infusion dosing errors Which of the following is considered an indicative parameter of DKAnot a common contributing factor to heparin infusion dosing errors? A Serum bicarbonate < 15 mmol/L Time constraints for nursing staff B: Serum potassium < 3 mEq/L Calculation requirements for dose adjustments C: Venous pH > 7.3 Manual pump programming D: Serum glucose > 200 mgIV pump/dL EMR interoperability Which of the following is predicted to be affected by implementation is/are potential consequences of a 2-bag fluid system for management of DKAheparin infusion dosing errors? A Incidences Prolonged hospitalization B Increased cost of DKA treatment C Negative clinical outcomes D All of the above Q1 Answer: D Q2 Answer: D C Focus on Enterobacter spp. and bacteremia D All of the above ACPE Universal Activity Number 0121-9999-18-859-L05-P Q1 Answer: B Q2 Answer: D ACPE Universal Activity Number of hospital admissions C Time to acidosis correction D A delay in fluid adjustment administration Lucas Canter0121-9999-18-357-L01-P Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) *Esther J. Chung, PharmD; Sean Patterson, PharmD; Todd Super, PharmD; James CurtisZahra Khudeira, PharmD, BCPS; Troy Shirley, MA, Tejal Patel, PharmD, MBA; Amanda AckermanBCPS, Sameer Shah, PharmD, BCPS Bronson Battle Creek,5366 Glenn Valley DriveMHA Sinai Health System,1500 South Fairfield Ave,AptChicago,IL,60608 esther.chung@sinai.org PurposeIn today's environment of capitated reimbursement coupled with rising drug costs, hospitals should investigate different strategies of cost savings and containment. 3B,Battle Creek,MI,49015 canterl@bronsonhg.org PurposePharmacy accounts for 10-20% of the total hospital budget with drug and operational costs increasing annually Pharmacy leadership should continuously balance benefits and costs of medications without compromising clinical outcomes. Utilizing reduced dose alteplase for central venous catheter (CVC) clearance is one cost savings initiative. This study aims to evaluate current literature on reduced dose alteplase to restore clearance to CVCs. The goal is to implement this reduced dose alteplase at this institution. MethodsA literature review utilizing reduced dose alteplase for restoration of CVCs from 2000 onward will be performed. Studies determining the efficacy of doses lower than conventional 2mg per 2ml dose will be included and evaluated for the following criteria: The use of direct oral anticoagulants (DOACs)dose preparation and storage, such as apixaban, rivaroxaban, edoxabandose escalation procedures, and dabigatran, has been increasing in clinical care since their introduction in 2010percentage of successful restoration of catheter clearance after the first dose. These medications offer benefits such as an improved safety profile, similar efficacy, standard dosing regimens, and a lack A retrospective electronic medica record review of routine and necessary monitoring when compared alteplase 2mg per 2ml doses from October 2016 to warfarin, which has been September 2017 will be conducted. Data collected will include the standard total number of venous thromboembolism (VTE) and atrial fibrillation therapy since its development over 60 years ago. However, there are some factors which can compromise safe use that must be considered. Increased prices often confer a higher out of pocket cost, which can impact adherence. Because these medications do not require frequent monitoring, patients may develop worsening liver and/or kidney function which may go unnoticed for long periods of time. This can lead to inappropriate dosing The purpose of this study was to assess DOAC use in a small health system and to determine whether patients are being appropriately dosed and monitored while taking these medications. Methods: In this retrospective study, patients initiated on a DOAC doses administered during the study period were identified with focus on patients requiring greater than a single dose for non-patent CVCs. All alteplase orders will be reviewed to assess documentation and categorized success of catheter patency. A presentation to the Pharmacy and Therapeutics Committee will include a hospital specific practice change based on various criterialiterature review and this study. Implementation will involve training of pharmacy personnel in preparation and storage of doses, including renal nursing and liver function, age, relevant past medical historystaff education of dose escalation guidelines, and concurrent medications that increase bleeding risk. Patients who met all inclusion criteria were identified using ICD-9/10 codes. The primary outcome education of this study was to determine the prescribing and monitoring accuracy of DOAC dosing in the outpatient setting. Secondary outcomes included the incidence of bleeding on DOAC therapy, the use of blood transfusions and reversal agents for severe bleeding, and overall cost of associated patient admissionsCVC management. Results and conclusions will be presented at the Great Lakes Pharmacy Resident Conference. Review the adverse clinical outcomes associated with inappropriate dosing of DOACs Recognize the advantages and disadvantages to DOAC therapy Which DOAC has an FDA approved reversal agent? A Edoxaban B: Rivaroxaban C: ApixabanIn progress.Conclusion In

Learning Objectives. Review Define acute kidney injury in a pediatric population using the current literature pRIFLE criteria Recognize factors that supports may increase the use risk of a 2-bag fluid system for AKI in children receiving vancomycin What percent decrease in estimated creatinine clearance defines pediatric acute kidney Injury category per the management of DKA Identify monitoring parameters for patients presenting with DKA pRIFLE criteria? A 20% B: 25% C: 50% D: 75% Which of the following is considered an indicative parameter of DKAhas been correlated with increased AKI incidence in children receiving vancomycin therapy? A Serum bicarbonate < 15 mmol/L BHigher vancomycin daily doses B Lower vancomycin troughs C Use of concomitant cephalosporins D Use of concomitant IV fluids Q1 Answer: Serum potassium < 3 mEq/L CC Q2 Answer: Venous pH > 7.3 DA ACPE Universal Activity Number 0121-9999-18-318-L01-P Activity Type: Serum glucose > 200 mg/dL Which of the following is predicted to be affected by implementation of a 2Knowledge-bag fluid system for management of DKA? A Incidences of DKA B Number of hospital admissions C Time to acidosis correction D A delay in fluid adjustment administration Lucas Canter*based Contact Hours: 0.5 (if ACPE number listed above) Xxxxxxx X Xxxxxx, PharmD*; Sean PattersonXxxxxx Xxxxxx, PharmD; Todd Super, PharmD; James Curtis, PharmD, PharmD BCPS; Troy ShirleyXxxxx Xxxxx, PharmD, MBA; Amanda Ackerman, PharmD, PharmD BCPS Bronson Battle Creek,5366 Glenn Valley DriveUniversity of Chicago Medical Center,5841 X Xxxxxxxx Xxx,Apt. 3BXxxxxxx,Battle Creek,MI,49015 canterl@bronsonhg.org XX,00000 xxxxxxx.xxxxxx@xxxxxxxxxxx.xxx Purpose: The use of direct Direct oral anticoagulants (DOACs), such as apixaban, rivaroxaban, edoxaban, and dabigatran, has been increasing in clinical care since their introduction in 2010. These medications ) offer benefits such as an improved safety profile, similar efficacy, standard dosing regimens, and a lack of routine and necessary monitoring when compared to warfarin, which has been over standard-of-care warfarin for the standard treatment of venous thromboembolism (VTE) and or stroke prevention in non-valvular atrial fibrillation therapy since its development over 60 years ago(NVAF) due to lack of routine laboratory monitoring requirements, dietary restrictions, and reduced incidence of drug-drug interactions. However, dose adjustments of DOACs may be necessary based on certain clinical criteria which may lead to inappropriate prescribing and the potential for increased rates of adverse events. Methods: A single-center, retrospective observational cohort study was conducted to evaluate the adverse event rates of inappropriately dosed dabigatran, rivaroxaban, and apixaban in adult patients with a diagnosis of VTE or NVAF. The primary objective was the composite rate of bleeding and thrombosis between patients who were prescribed an inappropriately dosed DOAC compared to patients who were appropriately dosed. Secondary objectives include rates of thrombosis, rates of bleeding, prescribing services, reasons for inappropriate dosing, and rates of inappropriate dose adjustment for each DOAC.Results: Among the 158 patients included, the rate of inappropriately dosed DOACs was 10.8%. The most common indication for DOAC prescribing was NVAF (55.7%). Rivaroxaban was the most frequently prescribed DOAC (53.8%). Inappropriately dosed DOACs occurred most frequently with apixaban (52.9%).The primary endpoint found no significant difference in composite rates of bleeding and thrombosis in the inappropriately prescribed group (11.8%) compared to the appropriately prescribed group (21.3%) (p=0.19). The overall rate of adverse events was 20%, with minor bleeding being the most commonly reported adverse event.Conclusions: Initial findings show low rates of inappropriately prescribed DOACs. No differences in the composite rate of bleeding or thrombosis were seen in patients who received an inappropriately dosed DOAC for treatment of VTE or stroke prevention in NVAF compared to those who were appropriately dosed. List the pros and cons of direct oral anticoagulants compared to warfarin Review the dosing recommendations of direct oral anticoagulants for non-valvular atrial fibrillation and treatment of venous thromboembolism What are the potential advantages of direct oral anticoagulants when compared to warfarin? A Reduced monitoring requirements B: Availability of reversal agents for all of the direct oral anticoagulant C: Decreased risk of drug-drug and drug-food interactions D: A and C What is the appropriate dose of apixaban for an 82 year old female with an acute pulmonary embolism who weighs 57 kg with a serum creatinin of 1.2 mg/dL? A 2.5 mg twice daily B 5 mg twice daily C 5 mg BID x 7 days, followed by 2.5 mg BID D 10 mg BID x 7 days, followed by 5 mg BID Q1 Answer: D Q2 Answer: D ACPE Universal Activity Number 0121-9999-18-319-L01-P Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) *Xxxxxxxx X. Xxxxxxx, PharmD, Xxxx X. Xxxxxxxx, PharmD, BCPS Northwestern Memorial Hospital,251 E. Huron St.,Suite LC- 700,Chicago,IL,60611 xxxxxxxx.xxxxxxx@xx.xxx Purpose: Medication errors cause preventable adverse drug events in approximately 1.5 million individuals each year; however, only 10-20% o all errors are reported. The use of “triggers” such as abnormal lab results, antidote administration, and xxxxx xxxxx to identify adverse event is an effective method to identify and track medication errors. However, there are some factors which is currently no standardized methodology to detect and report adverse drug events utilizing trigger tools. Errors commonly occur durin medication ordering/prescribing. The computerized provider order entry (CPOE)-based function of medication order voiding is a way for clinicians to remove medication orders from a patient’s active medication list, including those that were placed in error. Therefore, a voided order may serve as a proxy for medication order entry errors. Analysis of prescribing errors identified in voided orders can compromise safe use that must be consideredprovide useful insight into the source of these errors as a step towards reducing them. Increased prices often confer a higher out of pocket cost, which can impact adherence. Because these medications do not require frequent monitoring, patients may develop worsening liver and/or kidney function which may go unnoticed for long periods of time. This can lead to inappropriate dosing The primary purpose of this study was to assess DOAC use in a small health system and is to determine whether patients are being appropriately dosed and monitored while taking these medicationsif voided medication orders can serve as a useful method for detecting prescribing errors. Methods: In this This is a single-center, retrospective studychart review of a random sample of inpatient medication orders that were voided between January 1, patients initiated on a DOAC during 2016 and December 31, 2016 at Northwestern Memorial Hospital. Data will be obtained from Cerner’s PharmNet and will include voided order ID, position of person placing the study period were identified order and categorized based on various criteriavoiding it, including renal and liver function, age, relevant past medical historydate/time order was voided, and concurrent medications new orders placed within 10 minutes of the voided order. Orders will be analyzed to determine the proportion of voided orders that increase bleeding riskare potentially medication errors. Patients who met all inclusion criteria were identified using ICD-9/10 codesMedication errors will be categorized as one of the following: wrong route, wrong dose, wrong schedule, wrong strength, wrong indication, wrong drug, duplicate order, or not clinically appropriate. The primary outcome of this study was endpoint will be to determine the prescribing and monitoring accuracy of DOAC dosing in the outpatient setting. Secondary outcomes included assess the incidence of bleeding on DOAC therapy, medication order entry errors among voided medication orders. Identify potential trigger tools which can be used to recognize adverse drug events. Define the use CPOE-based function of blood transfusions and reversal agents for severe bleeding, and overall cost medication order voiding. Which of associated patient admissions. Results and conclusions will be presented at the Great Lakes Pharmacy Resident Conference. Review the adverse clinical outcomes associated with inappropriate dosing of DOACs Recognize the advantages and disadvantages to DOAC therapy Which DOAC has following would NOT serve as a trigger tool that an FDA approved reversal agentadvers drug event may have occurred? A Edoxaban Medication order abruptly discontinued B: Rivaroxaban Administration of glucagon C: ApixabanPotassium level of 6 D: Nausea after chemotherapy session Which of the following statements is true about the CPOE-based function of medication order voiding? A Function of voiding is standardized across all institutions B Orders can be voided before or after medication administration C Discontinuing an order is the same as voiding it Xxxxxxxxx X Xxxxxx, PharmD, MBA*; Xxxxxxx X Xxxxxx, PharmD Candidate; Xxxxxxx X Xxxx, PharmD; Xxxxxxxx X Xxxxxxxx, PharmD, MBA, BCPS; Xxxxxx X Xxxxxxxxxxxx, PharmD, MHA University of Kentucky HealthCare,800 Xxxx Xxxxxx,X000,Xxxxxxxxx,XX,00000 xxxxxxxxx.xxxxxx@xxx.xxx

Learning Objectives. Review the current existing literature that supports the use of a 2-bag fluid system and guideline recommendations for the management utilization of DKA Identify monitoring parameters nafcillin and cefazolin in methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia Discuss the selection of optimal therapy in patients with MSSA bacteremia based on clinical considerations and patient characteristics According to the IDSA guidelines, which of the following antimicrobials i first-line for patients presenting with DKA catheter-related infections and infective endocarditis due to MSSA? A Penicillin G B: Nafcillin C: Cefazolin D: Ceftriaxone Which of the following statements is considered an indicative parameter of DKAtrue regarding nafcillin and cefazolin? A Serum bicarbonate < 15 mmol/L BNafcillin does not require a renal dose adjustment B Cefazolin penetrates the central nervous system C Cefazolin is most often dosed every 4 hours, thus, usually requirin D Cefazolin is associated with causing acute kidney injury (e.g. inter Q1 Answer: Serum potassium < 3 mEq/L CB Q2 Answer: Venous pH > 7.3 D: Serum glucose > 200 mg/dL Which of the following is predicted to be affected by implementation of a 2-bag fluid system for management of DKA? A Incidences of DKA B Number of hospital admissions C Time to acidosis correction D A delay in fluid adjustment administration Lucas Canter*Xxxxxxxx X. Xxxxxxx, PharmD; Sean Patterson, PharmD; Todd Super, PharmD; James Curtis, PharmD, BCPS; Troy Shirley, PharmD, MBA; Amanda Ackerman* and Xxxxxxxxx Xxxxx Justice, PharmD, BCPS Bronson Battle Creek,5366 Glenn Valley DriveSt. Claire Regional Medical Xxxxxx,000 Xxxxxxx Xxxxxx,Apt. 3BXxxxxxxx,Battle Creek,MI,49015 canterl@bronsonhg.org XX,00000 xxxxxxxx.xxxxxxx@xx-xxxxxx.org Purpose: The use According to the Center for Disease Control and Prevention, approximately one in every ten patients in the United States reports having an allergic reaction to a penicillin class antibiotic, but less than one percent of direct oral anticoagulants (DOACs)the population is truly allergic. Patients with reported beta lactam allergies are more likely to receive alternative antibiotics that ma be less efficacious, such as apixabanmore costly, rivaroxaban, edoxaban, and dabigatran, has been increasing in clinical care since their introduction in 2010or have more adverse effects. These medications offer benefits such as an improved safety profile, similar efficacy, standard dosing regimens, and a lack of routine and necessary monitoring when compared to warfarin, which has been the standard of venous thromboembolism (VTE) and atrial fibrillation therapy since its development over 60 years ago. However, there are some factors which can compromise safe use that must be considered. Increased prices often confer a higher out of pocket cost, which can impact adherence. Because these medications do not require frequent monitoring, patients may develop worsening liver and/or kidney function which may go unnoticed for long periods of time. This can lead to inappropriate dosing The purpose of this study was is to assess DOAC use the reliability of self-reported penicillin and cephalosporin allergies and the impact of a pharmacist-led questionnaire on antimicrobial therapy among hospitalized patients at St. Claire HealthCare.Methods: This is a single-center, prospective, observational study. Patients 18 years of age or older will be included if they have an allergy to penicillins or cephalosporins documented in the electronic medical record and are receiving an antibiotic other than penicillins or cephalosporins. If patients are unable to participate in a small health system verbal interview, are not admitted to the hospital, or are on guideline appropriate therapy regardless of their listed allergy they will be excluded. Data to be collected include baseline demographics, reason for admission, results of the allergy questionnaire, antibiotic prescribed and to determine whether patients indication, prescribing physician, percentage of antibiotics that are changed as a result of pharmacist intervention, discrepancies between electronic medical record and questionnaire, and adverse drug reactions. The likelihood of a self-reported allergy being appropriately dosed and monitored while taking these medications. Methods: In this retrospective study, patients initiated on a DOAC during the study period were identified and categorized true allergy will be determined based on various criteriaquestionnaire results and will be categorized as probable, including renal possible, or unlikely. Results will be grouped b the reliability of the reported allergy (probable, possible, or unlikely) and liver function, age, relevant past medical history, whether the antibiotic was changed based on questionnaire results and concurrent medications that increase bleeding risk. Patients who met all inclusion criteria were identified using ICD-9/10 codes. The primary outcome of this pharmacist intervention.Results and Conclusions: This study was to determine the prescribing and monitoring accuracy of DOAC dosing is in the outpatient setting. Secondary outcomes included the incidence of bleeding on DOAC therapy, the use of blood transfusions and reversal agents for severe bleeding, and overall cost of associated patient admissionsprogress. Results and conclusions will be presented at the Great Lakes Pharmacy Residency Conference pending data collection and analysis. Identify the prevalence of true versus reported penicillin allergies in the Unites States Recognize the difference between an allergy and an adverse effect What percentage of the United States population has a true penicillin allergy? A ≤ 0.1% B: ≤ 1% C: ≤ 5% D: ≤ 10% Which of the following would most likely be considered a true penicillin allergy? A Red non-itchy rash, uneventful second exposure B Nausea and diarrhea, eventful second exposure C Swelling and itching of hands, never re-exposed D A & c Q1 Answer: B Q2 Answer: C ACPE Universal Activity Number 0121-9999-18-310-L01-P ACPE Universal Activity Number 0121-9999-18-311-L01-P Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Xxxxxx X Xxxxxxxxxxx, PharmD*; Xxxxx Xxxxxxxx, PharmD, BCPS; Xxxx Xxxxxx, PharmD, BCPS; Xxxxxxxx Xxxxxxxx, PhD OhioHealth Grant Xxxxxxx Xxxxxx,000 Xxxxx Xxxxx Xxx,Xxxxxxxx,XX,00000 xxxxxx.xxxxxxxxxxx0@xxxxxxxxxx.xxx Purpose: The purpose of this study is to evaluate and validate the current trauma ventilator associated pneumonia (VAP) protocol at OhioHealth Grant Medical Center. Per protocol, patients with a length of stay less than seven days are empirically initiated on levofloxacin monotherapy, which may limit the scope of antimicrobial coverage. Studies from other Xxxxx 0 Xxxxxx Xxxxxxx emphasize the value of selecting empiric antibiotics for VAP from institution-tailored algorithms in order to optimize antibiotic use and ensure appropriate antimicrobial coverage. The objective of this study is to provide evidence-based, hospital-specific support for the trauma VAP protocol at OhioHealth Grant Medical Center. Methods: This study was submitted to the Institutional Review Board for approval. This study is a retrospective, single-center review of patients admitted to the OhioHealth Grant Medical Center trauma intensive care unit (TICU) and critical care units with suspected VAP and empirically initiated on levofloxacin between th dates of June 1, 2015 through December 31, 2017. Patients were included when treated for at least 7 days for VAP, received a bronchoalveolar lavage (BAL) per protocol, and admitted with trauma as their primary service line. The primary aim is to evaluate the incidence o drug-bug mismatch in trauma ICU patients treated per protocol with levofloxacin for suspected VAP. Secondary aims include comparing total antibiotic days and total ventilator days for patients requiring changes to empiric therapy versus those who did not. In addition, pertinent patient medical history will be collected and assessed to provide support and recommendations to the current trauma VAP protocol. Results/Conclusions: A total of 237 patients were screened during the data collection process. Of these patients, 71 were included for evaluation and analysis. Results and conclusions will be presented at the 2018 Great Lakes Pharmacy Residency Conference. Define current practice recommendations from IDSA guidelines for ventilator associated pneumonia. Select appropriate empiric antibiotic therapy for ventilator associated pneumonia patients based off of hospital and unit antibiograms. In which patients do the 2016 IDSA HAP/VAP Guidelines recommend empiric anti-MRSA antibiotics in ventilator associated pneumonia (VAP) A Patients in a unit where >10-20% S. aureus is methicillin resistant B: Patients with five or more days of hospitalization prior to VAP occ C: Patients with prior IV antibiotic use within 90 days D: All of the above Which of the following are possible negative outcomes of inappropriate empiric antibiotic therapy in ventilated patients? A Prolonged ventilator days B Prolonged antibiotic days Xxxxx X. Xxxxxxxx, PharmD*, Xxxxxxxxx Xxxxxx, PharmD, BCPS, BCACP, CACP, Xxxx Xxxxxxx, PharmD, Xxxxxxxx Xxxxxx, MD, Xxxx Xx, PharmD, MPH, BCPS University of Michigan Health System,3525 Green Brier Blvd,APT 21B,Ann Arbor,MI,48105 xxxxxxxx@xxx.xxxxx.xxx Purpose: The current recommendation per the prescribing information for rivaroxaban is to avoid the use of rivaroxaban in patients with a creatinine clearance (CrCl) between 15 and 80 ml/min receiving combined P-gp and moderate CYP3A4 inhibitors unless the potential benefit justifies the potential risk. Given the ambiguity of this recommendation, the approach to managing this interaction, especially in various tiers of renal function, remains unclear. The objective of this study is to assess the proportion of patients with major and clinically relevant non-major bleeding in patients on rivaroxaban with concomitant diltiazem, a combined P-gp and moderate CYP3A4 inhibitor, in a real- world setting. Methods: The treatment group will include patients age 18 years or older with nonvalvular atrial fibrillation on rivaroxaban and diltiazem. The control group will be identified as patients with nonvalvular atrial fibrillation on rivaroxaban without concomitant diltiazem. Patients in the control group will be matched 1:1 to the treatment group by age and renal function. Patients with a CrCl less than 30 ml/min or taking concomitant medications identified as combined P-gp and moderate or strong CYP3A4 inhibitors (other than diltiazem) or combined P-gp and strong CYP3A4 inducers will be excluded. The following data will be collected from the electronic medical record for both groups: age, race, gender, weight, renal function, comorbidities, baseline labs, medications, major bleeding events, and non-major clinically relevant bleeding events. The primary outcome of the composite of major bleeding and non-major clinically relevant bleeding will be compared between the treatment and control groups. Results/Conclusions: To be presented at the Great Lakes Pharmacy Resident Conference. Review the adverse clinical outcomes associated with inappropriate dosing of DOACs Recognize the advantages and disadvantages to DOAC therapy Which DOAC has an FDA approved reversal agent? A Edoxaban B: Rivaroxaban C: Apixaban.

Learning Objectives. Review the current literature Identify drivers to optimize site of care for specialty medications that supports the use require physician administration List key considerations when developing a site of a 2-bag fluid system for the management of DKA Identify monitoring parameters for patients presenting with DKA care program Which of the following is considered an indicative parameter a reason to optimize site of DKAcare for specialty medications that require physician administration? A Serum bicarbonate < 15 mmol/L To direct patients to a higher-cost site of care B: Serum potassium < 3 mEq/L To increase drug expenditure in the hospital outpatient setting C: Venous pH > 7.3 To increase adherence to specialty medications D: Serum glucose > 200 mg/dL Which To reduce drug expenditure while maintaining quality of care Key patient considerations when developing a site of care program may include: A Ease of access to care B Influence of hospitals in the following is predicted to be affected by implementation of a 2-bag fluid system for management of DKA? region C Provider autonomy D Financial gain Q1 Answer: D Q2 Answer: A Incidences of DKA B Number of hospital admissions C Time to acidosis correction D A delay in fluid adjustment administration Lucas CanterXxxxxx Xxxxxxx*, PharmDPharm.D.; Sean PattersonXxxxxxxx Xxxxxxx, PharmD; Todd Super, PharmD; James Curtis, PharmDPharm.D., BCPS, BCCCP; Troy ShirleyXxxx Xxxxx, PharmDMD, MBAMS; Amanda AckermanXxxxxxx Xxxxxx, PharmDPharm.D., BCPS, Xxxxxxxxx Xxxx, Pharm.D., BCPS Bronson Battle Creek,5366 Glenn Valley DriveUniversity of Louisville Hospital,530 X Xxxxxxx Xx,Apt. 3BLouisville,Battle Creek,MI,49015 canterl@bronsonhg.org KY,40202 xxxxxxx@xxx.xxx Purpose: The use Peptic ulcer bleeding occurs frequently and results in substantial patient morbidity, mortality and medical expense. Peptic ulcer bleeding accounts for 31-67% of direct oral anticoagulants upper gastrointestinal bleeding with 20% of cases complicated by continued or recurrent bleeding. Currently, proton pump inhibitor (DOACsPPI) therapy is the treatment of choice. In cases of non-variceal upper gastrointestinal bleed (NVUGIB), such as apixabanPPIs have shown superiority in reduction of re-bleeding to H2-receptor antagonists, rivaroxaban, edoxabanoctreotide, and dabigatran, has been increasing in clinical care since their introduction in 2010somatostatin. These medications offer benefits such The objective of this study is to determine the effect of octreotide as an improved safety profileadjunct to PPI therapy on re- bleeding rates in NVUGIB. Methods: A retrospective, similar efficacymulti-center cohort study was conducted in patients experiencing NVUGIB that received both octreotide and a PPI or a PPI alone. Patients over the age of 18 who underwent endoscopy within 24 hours of admission were screened for inclusion. Exclusion criterion included pregnancy, standard dosing regimensgastric o esophageal varices or gastric cancer. The primary endpoint was the rate of re-bleeding within seven days of endoscopy. Re-bleeding was defined as the occurrence of hematemesis, melena, or blood in the nasogastric tube plus, either shock or a reduction in hemoglobin. Secondary endpoints included seven day mortality, requirement of surgical intervention or interventional radiology, units of blood transfused and length of stay. A pooled analysis was used to assess the primary outcome. Descriptive statistics were used to assess secondary outcomes, and a lack of routine and necessary monitoring when compared logistic regression was applied to warfarin, which has been the standard of venous thromboembolism (VTE) and atrial fibrillation therapy since its development over 60 years agosubgroup analysis. However, there are some factors which can compromise safe use that must be considered. Increased prices often confer a higher out of pocket cost, which can impact adherence. Because these medications do not require frequent monitoring, patients may develop worsening liver and/or kidney function which may go unnoticed for long periods of time. This can lead to inappropriate dosing The purpose of this study was to assess DOAC use in a small health system and to determine whether patients are being appropriately dosed and monitored while taking these medications. MethodsResults/Conclusion: In this retrospective study, patients initiated on a DOAC during the study period were identified and categorized based on various criteria, including renal and liver function, age, relevant past medical history, and concurrent medications that increase bleeding risk. Patients who met all inclusion criteria were identified using ICD-9/10 codes. The primary outcome of this study was to determine the prescribing and monitoring accuracy of DOAC dosing in the outpatient setting. Secondary outcomes included the incidence of bleeding on DOAC therapy, the use of blood transfusions and reversal agents for severe bleeding, and overall cost of associated patient admissions. Results and conclusions will be presented at the Great Lakes Pharmacy Resident Conference. Review Conference Discuss guideline recommendations for non-variceal upper gastrointestinal bleed management Describe the adverse clinical outcomes associated with inappropriate dosing proposed mechanism for theorized benefit of DOACs Recognize octreotide use in non-variceal upper gastrointestinal bleed The 2003 Consensus statement grades the advantages and disadvantages to DOAC therapy Which DOAC has an FDA approved reversal agentuse of octreotide for treatment in non-variceal upper gastrointestinal bleed as what level of evidence? A Edoxaban Level A B: Rivaroxaban Level B C: ApixabanLevel C D: Level D Octreotide is proposed to have which of the following actions during a gastrointestinal bleed? A Reduces splanchnic blood flow and motility B Increases acid secretion C Cytoprotective effects D A and C Q1 Answer: C Q2 Answer: D ACPE Universal Activity Number 0121-9999-18-730-L04-P ACPE Universal Activity Number 0121-9999-18-412-L01-P Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Xxxxxxxxx X. Xxxx, PharmD*; Xxxxx X. Xxxxxxx, PharmD, BCCCP; Xxxx