Common use of Learning Objectives Clause in Contracts

Learning Objectives. Recognize pharmacokinetic changes that may occur during extracorporeal membrane oxygenation (ECMO) in adult patients Identify the recommended parameter that determines initial argatroban dosing in heparin-induced thrombocytopenia Which of the following pharmacokinetic changes is commonly described in adult patients receiving extracorporeal membrane oxygenation? A Decreased volume of distribution B: Increased drug absorption C: Sequestration of lipophilic drugs D: Sequestration of hydrophilic drugs FDA labeling recommends adjustment of initial argatroban dose in heparin-induced thrombocytopenia based on which of the following parameters? A Creatinine clearance B MELD score C Child-Pugh classification D Alanine aminotransferase (ALT) Q1 Answer: C Q2 Answer: C Caleb J. Divens, PharmD, MBA*; Jeffrey A. Johnson, PharmD Veteran Affairs - Aleda E. Lutz Medical Center,1500 Weiss St,Saginaw,MI,48602 Caleb.Divens@va.gov Purpose: The purpose of this work is to develop and implement a service that allows for clinical pharmacists to attend educational presentations during work hours. The VA provides many continuing education opportunities for its employees. Pharmacists are required to receive 30 CE hours by the time their license is up for renewal, but with high-volume prescription processing and occasional staff shortages, pharmacists are reluctant to complete CE at work. Awareness and implementation of a service to allow clinical pharmacists to complete CE at work will increase pharmacist engagement amongst healthcare professionals in the VA as well as increase job satisfaction as reflected in the annual All-Employee Survey. Methods: A base survey was distributed to clinical pharmacists to establish the needs of an educational opportunities service. Gaps in scheduling continuing education opportunities were identified with pharmacy leadership. Based upon results of the base survey, the service was established providing continuing education opportunities for pharmacists to attend during their scheduled work shifts. Continuing education opportunities include on- site presentations, teleconference presentations, and online CE resources. Clinical pharmacists are encouraged to identify other continuing education opportunities to add to the service. Post- attendance surveys are completed by the pharmacist every time continuing education has been completed on their shift, and a recap of the presentation is presented at pharmacy meetings with the rest of the department to facilitate engagement. A midpoint and final survey will be conducted to evaluate pharmacist participation in the service as well as feedback for service improvement. Feedback will be reviewed and implemented into the educational service as deemed beneficial to the pharmacists. The educational service is limited to clinical pharmacists with the intention of expanding to pharmacy technicians once adequate pharmacist participation is obtained. Results and Conclusions: Results and conclusions will be presented at the Great Lakes Pharmacy Residency Conference.

Learning Objectives. Recognize pharmacokinetic changes Explain clinical factors that may occur during extracorporeal membrane oxygenation (ECMO) affect hemoglobin level in adult patients Identify the recommended parameter that determines initial argatroban dosing with Non-Dialysis Dependent Chronic Kindey Disease associated anemia Describe methods to ensure success of change management in heparin-induced thrombocytopenia new service development Which of the following pharmacokinetic changes is commonly described reasons could further explain a hemoglobin level dropping below therapeutic goal range despite ESA therapy in adult anemic patients receiving extracorporeal membrane oxygenationwith CKD? A Decreased volume of distribution Improved kidney function B: Increased drug absorption Blood loss C: Sequestration of lipophilic drugs Low ferritin and low % iron saturation D: Sequestration of hydrophilic drugs FDA labeling recommends adjustment of initial argatroban dose in heparin-induced thrombocytopenia based on which B & c Which of the following parametersstakeholders did NOT constitute the major guiding coalition for developing the telephonic monitoring program for patients self-administering ESA? A Creatinine clearance Pharmacy interns and pharmacy technicians B MELD score Clinical pharmacy staff and pharmacy managers C ChildNursing staff and nursing managers D Providers and physician champion Activity Type: Knowledge-Pugh classification D Alanine aminotransferase based Contact Hours: 0.5 (ALTif ACPE number listed above) Q1 Answer: C D Q2 Answer: C Caleb J. DivensA ACPE Universal Activity Number 0121-9999-18-385-L01-P Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Jean Y Doh, PharmD*, Laura N Hencken, PharmD, MBA*; Jeffrey A. JohnsonBCCCP, PharmD Veteran Affairs - Aleda E. Lutz Medical Center,1500 Weiss StLinda D Mlynarek, RPh, BCNSP, Nancy C MacDonald, PharmD, BCPS, FASHP Henry Ford Health System,2799 W Grand Blvd,SaginawDetroit,MI,48602 Caleb.Divens@va.gov MI,48202 jdoh2@hfhs.org Purpose: Patients discharged on parenteral nutrition (PN) are at a high risk for readmission. A recent study looking at a population discharged on PN observed a 31.6% readmission rate within 30 days with 21.1% of readmissions related to PN. Internal quality data at Henry Ford Hospital (HFH) shows a high readmission rate for patients discharged on PN. Additionally, Medicare requires documentation of objective evidence to support a clinical diagnosis needing outpatient PN. In May 2017, the HFH Nutritional Support Services implemented a PN discharge checklis to standardize the discharge process and ensure the required Medicare elements are coordinated early in the admission and are met prior to discharge. The purpose of this work study is to develop and implement a service that allows improve transition of care for clinical pharmacists to attend educational presentations during work hours. The VA provides many continuing education opportunities for its employees. Pharmacists are required to receive 30 CE hours patients being discharged on PN by evaluating the time their license is up for renewal, but with high-volume prescription processing and occasional staff shortages, pharmacists are reluctant to complete CE at work. Awareness and implementation effect of a service novel PN discharge checklist and identifying patient characteristics related to allow clinical pharmacists to complete CE at work will increase pharmacist engagement amongst healthcare professionals in the VA as well as increase job satisfaction as reflected in the annual All-Employee Surveyhospital readmission. Methods: A base survey This study is an IRB approved, retrospective quasi-experimental study of patients discharged from HFH on PN between January 1, 2014 and May 31, 2018. Patients were excluded if they were transferred to another acute care hospital or discharged against medical advice. The primary endpoint was distributed the completion of a PN discharge bundle which included identification of a responsible provider to clinical pharmacists monitor PN after discharge, meeting a daily caloric requirement of 20-35 kcal/kg/day, and cycling the PN prior to establish the needs discharge. The secondary endpoints included documentation of an educational opportunities serviceall checklist components, hospital length of stay, frequency of hospital encounters, cause of hospital encounter, and time to readmission. Gaps in scheduling continuing education opportunities were identified with pharmacy leadership. Based upon results Data collected included electronic medical record documentation of the base surveydischarge checklist components, the service was established providing continuing education opportunities patient demographics, hospital length of stay, reason for pharmacists to attend during their scheduled work shifts. Continuing education opportunities include on- site presentationshospitalization, teleconference presentationsPN order information, and online CE resources. Clinical pharmacists are encouraged time to identify other continuing education opportunities to add to the service. Post- attendance surveys are completed by the pharmacist every time continuing education has been completed on their shift, and a recap of the presentation is presented at pharmacy meetings with the rest of the department to facilitate engagement. A midpoint and final survey will be conducted to evaluate pharmacist participation in the service as well as feedback for service improvement. Feedback will be reviewed and implemented into the educational service as deemed beneficial to the pharmacists. The educational service is limited to clinical pharmacists with the intention of expanding to pharmacy technicians once adequate pharmacist participation is obtainedreadmission. Results and Conclusions: :Results and conclusions will be presented at the Great Lakes Pharmacy Residency Resident Conference.

Learning Objectives. Recognize pharmacokinetic changes Discuss why increasing age is a cause of increased risk for adverse drugs reactions. Identify medications that may occur during extracorporeal membrane oxygenation (ECMO) be considered potentially inappropriate in adult the elderly population as defined by the 2015 American Geriatric Societ Beers Criteria. Why are elderly patients Identify the recommended parameter that determines initial argatroban dosing in heparin-induced thrombocytopenia Which of the following pharmacokinetic changes is commonly described in adult patients receiving extracorporeal membrane oxygenationmore susceptible to adverse drug reactions? A Decreased volume of distribution Increase in hepatic and renal blood flow B: Increased drug absorption Decreased first-pass clearance in the liver C: Sequestration Increase in levels of lipophilic drugs serum proteins D: Sequestration Increase in the ratio of hydrophilic drugs FDA labeling recommends adjustment of initial argatroban dose in heparin-induced thrombocytopenia based on which of lean body weight to body fat Which Beers Criteria medication is correctly matched to the following parameters? A Creatinine clearance B MELD score C Child-Pugh classification D Alanine aminotransferase (ALT) Q1 Answer: C Q2 Answer: C Caleb J. Divensrationale fo Xxxxxxxxx X. Xxxxxxx, PharmD*; Xxxxx X. Xxxxxxx, PharmD, MBA*; Jeffrey A. Johnson, PharmD Veteran Affairs - Aleda E. Lutz Medical Center,1500 Weiss StBCPS Deaconess Health System,600 Xxxx Xxxxxx,SaginawXxxxxxxxxx,MI,48602 Caleb.Divens@va.gov XX,00000 xxxxxxxxx.xxxxxxx@xxxxxxxxx.xxx Purpose: Vancomycin is an antibiotic commonly used for a wide variety of bacterial infections. Although renal function plays a major role in the dosing of vancomycin, guidelines do not exist for vancomycin dosing in patients undergoing hemodialysis. The purpose of this work study is to develop compare the safety and implement efficacy of a service that allows newly implemented dosing protoco for clinical pharmacists vancomycin in hemodialysis patients to attend educational presentations during work hoursa previously used protocol.Methods: Vancomycin usage data for patients receiving hemodialysis while admitted to the hospital was reviewed. The VA provides many continuing education opportunities for its employees. Pharmacists are required Data from on year prior to receive 30 CE hours by the time their license is up for renewal, but with high-volume prescription processing and occasional staff shortages, pharmacists are reluctant to complete CE at work. Awareness and implementation of a service the new dosing protocol and one year after implementation were gathered from the electronic medical record. Information gathered, including vancomycin dosing, serum vancomycin levels, and timing of administration, were used to allow clinical pharmacists to complete CE at work will increase pharmacist engagement amongst healthcare professionals in compare the VA as well as increase job satisfaction as reflected in the annual All-Employee Survey. Methods: A base survey was distributed to clinical pharmacists to establish the needs of an educational opportunities service. Gaps in scheduling continuing education opportunities were identified with pharmacy leadership. Based upon results effectiveness of the base survey, the service was established providing continuing education opportunities for pharmacists to attend during their scheduled work shifts. Continuing education opportunities include on- site presentations, teleconference presentations, and online CE resources. Clinical pharmacists are encouraged to identify other continuing education opportunities to add updated protocol to the servicepreviously used protocol. Post- attendance surveys are completed by In addition, reported errors involving vancomycin usage in hemodialysis were gathered from the pharmacist every time continuing education has been completed on their shift, and a recap hospital’s error reporting system to compare the safety of the presentation is presented at pharmacy meetings with original protocol to the rest safety of the department new protocol. Patient identifiers have been removed from all data in order to facilitate engagementmaintain patient confidentiality. A midpoint and final survey will be conducted to evaluate pharmacist participation in the service as well as feedback for service improvement. Feedback will be reviewed and implemented into the educational service as deemed beneficial to the pharmacists. The educational service is limited to clinical pharmacists with the intention of expanding to pharmacy technicians once adequate pharmacist participation is obtained. Results and Results/Conclusions: Results and conclusions will be presented at the Great Lakes Pharmacy Residency Resident Conference Identify common causes of missed doses in patients receiving vancomycin per the hemodialysis protocol. Select a plan of action for a patient with a subtherapeutic or supratherapeutic vancomycin level using the institutiton's vancomycin in hemodialysis protocol. Which of the following may have contributed to missed or incorrect vancomycin doses while using the original vancomycin in hemodialysis protocol? A Extra hemodialysis sessions B: PRN order which does not alert RN that dose is due C: Multiple PRN vancomycin orders on inpatient order list D: All of the above GW is a 47-year-old female receiving vancomycin per the hemodialysis protocol for MRSA bacteremia. Current dose is 500 mg during the last hour of every hemodialysis session. Trough obtained prior to t A Continue current dose B Give 15 mg/kg re-load, then increase dose to 750 mg during the la C Increase dose to 750 mg during the last hour of every hemodialysi D Hold dose and repeat level prior to the next hemodialysis session Q1 Answer: D Q2 Answer: C being potentially inappropriate in older adults? ACPE Universal Activity Number 0121-9999-18-854-L05-P A Ibuprofen & highly anticholinergic B Methocarbamol & extrapyramidal effects C Amitriptyline & high rates of physical dependence D Terazosin & orthostatic hypotension Q1 Answer: B Q2 Answer: D Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) ACPE Universal Activity Number 0121-9999-18-305-L01-P Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Xxxxxxx X. Xxxxxxxx, PharmD*; Xxxxxxxx X. Xxxxxx, PharmD, BCPS; Xxxxx X. Xxxx, MD, Xxxxxxxxxxx X. Xxxxxx, MD, Xxxxxxx X. Xxxxxxx, Ph Xxxxxx Medical Center,1105 Xxxxx Xxxxxx,Xxxxxxxx Xxxx,XX,00000 xxxxxxxxx00@xxx.xxx Purpose: Penicillin, ampicillin, or cefazolin are the drugs of choice in pregnant women with Group B Streptococcus (GBS) colonization. In patients with a reported penicillin allergy, these drugs are not used and instead the patient is prescribed vancomycin or clindamycin, which are associated with more adverse events and longer length of stay. The purpose of this study is to de-label reported penicillin allergies in pregnant women with GBS colonization. The antimicrobial stewardship team at Xxxxxx Medical Center performs penicillin allergy skin testing for inpatients, but did not have a process for de-labeling penicillin allergies in pregnant women in the outpatient setting. Methods: This wa a pre-post study of penicillin allergic GBS-positive pregnant patients wh gave birth at Xxxxxx Medical Center. Baseline data was gathered for al women who gave birth from July 2016 – July 2017. In the prospective arm of the study, pregnant women with a self-reported penicillin allergy were referred by their obstetrician to undergo penicillin allergy assessment and skin testing at a local Allergist’s office. GBS-positive pregnant women with a reported penicillin allergy were included. Patients were excluded for the following reasons: the patient was referred for testing but could not undergo testing, the patient reported a hypersensitivity reaction other than a Type I reaction, or if the patient had severe immunosuppression (i.e. Neutropenia, HIV+ with CD4 < 200 Immunosuppressives for organ transplant), not including diabetes or corticosteroid use. The primary outcome of this study was to determine the percentage of patients who received the preferred antibiotics after the implementation of the skin testing referral process. Secondary outcomes include length of inpatient hospital stay, neonatal Group B Streptococcal infection, and reported adverse effects to the administered antibiotic. Results: Initial results and conclusions will be presented at the 2018 Great Lakes Pharmacy Resident Conference.

Learning Objectives. Recognize pharmacokinetic changes that may occur during extracorporeal membrane oxygenation (ECMO) Describe the significance of medication errors and adverse drug events. Identify outcomes of pharmacist involvement in adult patients Identify the recommended parameter that determines initial argatroban dosing in heparin-induced thrombocytopenia medication reconciliatio Which of the following pharmacokinetic changes is commonly described in adult patients receiving extracorporeal membrane oxygenationtrue? A Decreased volume Transitions of distribution care do not include transferring inpatient floors or g B: Increased drug absorption Medication discrepancies are less common in patients with compl C: Sequestration A majority of lipophilic drugs adverse events after discharge are medication relate D: Sequestration Medication errors earn the US billions of hydrophilic drugs FDA labeling recommends adjustment dollars each year. Pharmacist involvement in medication reconciliation has been shown to result in: A Less medication discrepancies identified B Higher rates of initial argatroban dose hospital readmissions C Reductions in heparin-induced thrombocytopenia based on which emergency department visits D All of the following parameters? A Creatinine clearance B MELD score C Child-Pugh classification D Alanine aminotransferase (ALT) above Q1 Answer: C Q2 Answer: C Caleb J. DivensDavid S. Dakwa, PharmD, MBA*; Jeffrey A. Johnson* & Bruce W. Chaffee, PharmD Veteran Affairs - Aleda E. Lutz Medical Center,1500 Weiss StPharmD, FASHP University of Michigan Health System,1030 Island Drive Court #107,Ann Arbor,Saginaw,MI,48602 Caleb.Divens@va.gov MI,48105 davidsd@med.umich.edu Purpose: Many patient care demands require the attention of a pharmacist and a substantial amount of pharmacist time is devoted to prospective order review and verification. Currently, there is no established evidence evaluating how much time could potentially be saved if standardized, low-risk orders were automatically verified, allowing the pharmacist to optimize their time to the most important patient-related activities. The purpose of this work study objective is to develop quantify the time required to verify medication orders and implement a service that allows for clinical characterize pharmacist behaviors affiliated with order verification and information retrieval behavior. Reallocation of time could allow pharmacists to attend educational presentations during work hoursfocus their efforts on more complex patient-related activities. Representation of the order verification process will illustrate how pharmacists review drug orders stratified into low to high complexity categories, while documenting the time utilized to complete the task at UMHS.Methods: This study analyzes the order-review time of experienced pharmacists verifying medications in real-life environments. All experienced (>1 year of pharmacist experience and >6 months of University of Michigan or Epic experience) pharmacists verifying medication orders within a determined 30-day period at the adult, cardiovascular, and children’s hospitals will be observed in the study. The VA provides many continuing education opportunities for its employeespharmacists are monitored via Morae usability software but blinded to which computers are performing the data collection and retrieval. Pharmacists are required to receive 30 CE hours Complexity is prospectively defined by using a classification system including the time their license is up for renewaldegree of order variability, but with ISMP high-volume prescription processing and occasional staff shortages, pharmacists are reluctant to complete CE at work. Awareness and implementation of a service to allow clinical pharmacists to complete CE at work will increase pharmacist engagement amongst healthcare professionals in the VA as well as increase job satisfaction as reflected in the annual All-Employee Survey. Methods: A base survey was distributed to clinical pharmacists to establish the needs of an educational opportunities service. Gaps in scheduling continuing education opportunities were identified with pharmacy leadership. Based upon results of the base survey, the service was established providing continuing education opportunities for pharmacists to attend during their scheduled work shifts. Continuing education opportunities include on- site presentations, teleconference presentations, and online CE resources. Clinical pharmacists are encouraged to identify other continuing education opportunities to add to the service. Post- attendance surveys are completed by the pharmacist every time continuing education has been completed on their shift, alert classification and a recap of the presentation is presented at pharmacy meetings with the rest of the department to facilitate engagementpharmacist perception survey. A midpoint and final survey Statistical analysis will use a mixed model as there are correlations within each drug that can be conducted to evaluate pharmacist participation in the service as well as feedback for service improvementcaptured. Feedback will be reviewed and implemented into the educational service as deemed beneficial to the pharmacists. The educational service is limited to clinical pharmacists with the intention of expanding to pharmacy technicians once adequate pharmacist participation is obtained. Results and Results/Conclusions: Results and conclusions will be presented at the Great Grea Lakes Pharmacy Residency Conference.

Learning Objectives. Recognize pharmacokinetic changes that may occur during extracorporeal membrane oxygenation (ECMO) the rationale for utilizing pharmacy technicians to complete medication histories Identify common pharmacist interventions made in adult patients Identify the recommended parameter that determines initial argatroban dosing in heparin-induced thrombocytopenia medication histories completed by MRTs Which of the following pharmacokinetic changes is commonly described in adult patients receiving extracorporeal membrane oxygenationdescribes the rationale for utilizing pharmacy technicians to complete medication histories? A Decreased volume Published literature does not support role of distribution pharmacy technicians B: Increased drug absorption Pharmacy technicians are the only members on the healthcare tea C: Sequestration of lipophilic drugs Pharmacy technicians can effectively document the best possible D: Sequestration Pharmacy technicians can replace pharmacists to oversee medica What type of hydrophilic drugs FDA labeling recommends adjustment of initial argatroban dose medications showed highest medication error rates in heparin-induced thrombocytopenia based on which of the following parametersmedication histories completed by MRTs? A Creatinine clearance Over-the-counter medications B MELD score Anti-hypertensives C ChildAntibiotics D Anti-Pugh classification D Alanine aminotransferase (ALT) glycemic agents ACPE Universal Activity Number 0121-9999-18-705-L04-P Q1 Answer: C Q2 Answer: C Caleb J. DivensA Activity Type: Knowledge-based Contact Hours: 0.5 ACPE Universal Activity Number 0121-9999-18-860-L05-P (if ACPE number listed above) Activity Type: Knowledge-based Contact Hours: 0.5 (if ACPE number listed above) Christina Ciccone, PharmD*; Kimberly Cooper, PharmD, MBA*; Jeffrey A. JohnsonCathy Spencer, PharmD, BCPS, AAHIVP; Faith Childress, PharmD; Katherine Blain, PharmD, MPH; Misty Stutz, PharmD, Julie Burris, PharmD Veteran Affairs Sullivan University College of Pharmacy / Walgreens - Aleda E. Lutz Medical Center,1500 Weiss StLouisville,8403 Tapestry Circle, Apt 202,Louisville,Saginaw,MI,48602 Caleb.Divens@va.gov KY,40222 cciccone@sullivan.edu Purpose: :The purpose of this work study is to develop demonstrate improvement in blood pressure control and implement medication adherence in patients with hypertension through a service pharmacist-led hypertension management program that allows for clinical pharmacists to attend educational presentations during work hours. The VA provides many continuing education opportunities for its employees. Pharmacists are required to receive 30 CE hours by the time their license is up for renewal, but with high-volume prescription processing and occasional staff shortages, pharmacists are reluctant to complete CE at work. Awareness and implementation of economically sustainable in a service to allow clinical pharmacists to complete CE at work will increase pharmacist engagement amongst healthcare professionals in the VA as well as increase job satisfaction as reflected in the annual All-Employee Surveylarge chain retail pharmacy setting. Methods: This prospective cohort study involves a pharmacist providing monthly counseling sessions lasting approximately 20-30 minutes over the phone or face-to-face. On the initial visit, pharmacists perform interventions intended to help improve blood pressure control through medication counseling, adherence counseling, and hypertension disease state education. On the first follo up visit, patients are counseled, given a home blood pressure monitor, and instructed on its use. The primary outcome is the difference in hypertensive patients’ systolic and diastolic blood pressures pre-and post-management program. Secondary outcomes include the proportion of patients achieving their goal blood pressure post-program, improvement in patient-reported medication adherence, and proportion of patients receiving miscellaneous pharmacist interventions (immunization, MTM, etc.). A base survey was distributed paired student’s t-test will be used to clinical pharmacists analyze the primary outcome and to establish analyze adherence. Descriptive statistics will be used to analyze other secondary outcomes.Preliminary Results: Seventeen patients were enrolled in the needs study and completed their initial visit. Data collection is ongoing, with 5 patients having completed the study. Preliminary results for the primary outcome show an average decrease in systolic blood pressure of 5.1 mmHg and an educational opportunities service. Gaps average decrease in scheduling continuing education opportunities were identified with pharmacy leadership. Based upon results diastolic blood pressure of 2.5 mmHg after completion of the base survey, program. Results for the service was established providing continuing education opportunities for pharmacists to attend during their scheduled work shifts. Continuing education opportunities include on- site presentations, teleconference presentations, and online CE resources. Clinical pharmacists are encouraged to identify other continuing education opportunities to add to the service. Post- attendance surveys are completed by the pharmacist every time continuing education has been completed on their shift, and a recap of the presentation is presented at pharmacy meetings with the rest of the department to facilitate engagement. A midpoint and final survey secondary outcomes will be conducted to evaluate pharmacist participation in the service as well as feedback for service improvement. Feedback will be reviewed and implemented into the educational service as deemed beneficial to the pharmacists. The educational service evaluated after data collection is limited to clinical pharmacists with the intention of expanding to pharmacy technicians once adequate pharmacist participation is obtained. Results and Conclusions: Results and conclusions will be presented at the Great Lakes Pharmacy Residency Conferencecompleted.