Department of Pharmacy 2019 YEAR IN REVIEW

MISSION

To extend the healing ministry of Christ through holistic,

people-centered health care by the core values of:

Quality, Innovation, Service, Integrity, Transparency

VISION

The department will be recognized for the highest quality of

pharmaceutical care & compassionate, Christian service.

We will provide clinical & operational service, professional

leadership, & educational excellence that exceeds customer

satisfaction.

We will move pharmacy health forward through innovative use

of technology, people & passion.

Our reputation will be one of collaborative teamwork, employee

satisfaction, & superior patient outcomes.

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Table of Contents 4–5

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Letter from Director

Our Team

The Work that We Do

Princeton in the News

Drug Information & Formulary Management

Procurement

Medication Safety

An Initiative for Improvement

Antimicrobial Stewardship

Partners in Patient Care

Pharmacy Residents

Pharmacy Students

Institutional Involvement

Local, State, & National Organizations

Publications & Awards

Presentations

Posters

Service Anniversaries

Looking Ahead to 2020

Message from the Director

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For 2019, the Princeton Department of Pharmacy chose the

phrase MOVING PHARMACY FORWARD: CHAPTER II

to highlight the groundwork necessary to support pharmacy

excellence. Much like the foundation of a building, a majority

of the day-to-day clinical and operational pharmacy work goes

unseen. Nevertheless, daily accomplishments have translated

into measurable metrics that led our facility to an “A” Leapfrog

score.

Our department welcomed an assistant director of pharmacy in

June. Dr. Tom Achey brings a wealth of innovative leadership

ideas. In particular, a walking gallery strategic planning session,

held in the fall, engaged all pharmacy staff and steered us

towards a robust, equitable Strategic Pharmacy Plan for 2020.

The team took on numerous leadership roles in local, state, and

national organizations! A clinical pharmacy specialist, Dr. Sarah

Blackwell, won a service award from the Alabama Society of

Health-System Pharmacists. I was honored to become the first

pharmacist in Alabama to pass the new Board Certification in

Sterile Compounding Preparations (BCSCP) exam!

The technician team rose to new heights by creating SMART

inventory goals. The technical staff was challenged to document

their inventory stewardship prowess; this culminated into a

national poster presentation. Led by Brandon Roberts, Inventory

Management Specialist, supported by senior pharmacy

technicians, Calvin Jackson and Marcia Harris, the team noted a

$1.4 million reduction in pharmaceutical spend and a 42

percent decrease in inventory-on-hand over the last 3 years!

(Continued on next page)

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Fostering the A.R.T. (Accountable, Reliable, & Transparent) of Safety

highlighted Medication Safety Committee scorecards, Hospital Improvement

Innovation Network (HIIN) metrics, emergency department culture follow-

up review implementation, and antimicrobial stewardship awareness.

Successful mock surveys focused on sterile preparations along with

controlled substance storage and monitoring. Six clinical pharmacy

specialists and three pharmacy residents documented over $9 million in cost

avoidance in FY19.

Auburn and Samford Colleges of Pharmacy sent 8 IPPE students and 50

APPE students to complete challenging rotations in institutional hospital

pharmacy, cardiology, internal medicine, antimicrobial stewardship, surgical

critical care and medical critical care. Team members stretched beyond

Alabama boundaries to teach students in adjacent states in subjects as diverse

as stroke education, inventory management, human capital, and innovation.

Three former students successfully matched to Princeton’s PGY1 residency

program!

These accomplishments would not be possible without the flexibility,

cooperation, and teamwork of the finest pharmacy staff members. We will

miss George Whorton, RPh, who resigned in December after 41 years of

dedicated service.

The future is bright! On the horizon lies an automated dispensing cabinet

upgrade, PGY2 residency expansion, nursing unit-based pharmacists, and a

myriad of leadership opportunities.

We look forward to “being the best”.

Best Regards,

Helen E. McKnight, PharmD, DPLA, MBA, BCSCP

Director of Pharmacy

MOVING PHARMACY FORWARD! Chapter II

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The Pharmacy Department consists of 52 caregivers,

including 29 pharmacists, 18 technicians, 3 pharmacy

residents, and two pharmacy interns. The central

pharmacy operates 24 hours a day, seven days a week.

Pharmacy specialists at Princeton Baptist Medical Center

are integrated into the Medical Intensive Care, Surgical

Intensive Care, Cardiovascular Intensive Care, Neuro

Intensive Care, Palliative Care, and Internal Medicine

patient care teams.

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11 Board-

Certified

Pharmacists Alabama’s first

BCSCP!

12 PTCB-

Certified

Technicians

37 FTEs

The team is responsible for ensuring regulatory compliance,

strategic planning, budget management, scheduling, staff

development & accountability, clinical and operational policy

& procedures, coordinating patient care activities, medication

and patient safety activities, and human resources practices.

We shall move pharmacy health forward through people, passion, and vision. 8

Average Turn Around Times

Overall Verifications 17 minutes

STAT Verifications 3 minutes

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Dispensed more than 1.7 million doses!

We shall integrate innovative technology advances that improve drug efficiency, safety, and delivery.

96% Medication

Scan Rate

(Goal >95%)

98% Patient

Scan Rate

(Goal >95%)

93% Smart Pump

IV Compliance

(Goal >90%)

10

0

5000

10000

15000

20000

25000

INTERVENTIONS

Therapy Modification

Renal Dose Adjust

Lab Order

IV to PO

Anticoagulation

Antibiotics

0

5000

10000

15000

20000

CONSULTS

Restricted Abx

Other

Warfarin+Argatroban

TPN

Aminoglycosides

Vancomycin

We shall improve patient outcomes through the highest pharmaceutical care standards.

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106

Code Blue

Responses

350 ED

Cultures

Follow-Up

$9.2 million

estimated in

cost-avoidance

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This year, Princeton Baptist earned the #3

ranking of “2019-2020 Best Hospitals” in

Alabama by U.S. News & World Report.

Princeton Baptist Medical Center rated as

high performing in the areas of heart

failure, colon cancer surgery and chronic

obstructive pulmonary disease.

Princeton Baptist earned an ‘A’ for the Fall 2019

Leapfrog Hospital Safety Grade, a national distinction

recognizing the hospital’s achievements protecting

patients from harm and providing safer health care.

The score is based on performance in preventing

medical errors, injuries, accidents, infections and

other harms to patients in their care.

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Drug Information & Formulary Management Our staff provide expertise and support for health care

professionals throughout the hospital.

These services coordinate the clinical on-call program,

Princeton Baptist Medical Center Formulary, drug use

policy, medication evaluations, guideline development, and

drug shortages & recalls management.

These services support caregivers in taking care of patients.

166

New Drug

Shortages

2,124 Drug

Information

Questions

Major Drug Shortages

Antibiotics

Cardiovascular

CNS Agents

Contrast Media

Electrolytes

EENT

Topical Anesthetics

14

0

10

20

30

40

50

60

2019 Formulary Activity

Added withRestriction

Deleted

Change inRestriction

Added

0

2

4

6

8

10

12

Cost Savings Initiatives

Formulary

Restrictions

Change in

Formulation

Removal

from

Formulary

Items Reviewed n

Medication use evaluation 7

Order Sets 3

Policies & Procedures 22

Guidelines 12

The P&T evaluates formulary requests, develops guidelines and

restrictions, reviews cost and utilization issues, and develops and

reviews outcomes projects and drug use evaluations. The Committee

meets monthly, jointly chaired by a member of the medical staff and

the assistant director of pharmacy serving as Secretary.

Drug Information & Formulary Management

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Procurement

Accomplishments

• Aligned IV fluid contract with Baxter

• Cost-savings using McKesson Indigent Reimbursement Program

• Changed OR workflow with vials to syringes

• Minimized waste with select package size optimization

• Streamlined Outpatient MRI contrast process

• Ensured minimum charge reliably applied to capture revenue

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Medication Safety Medication Safety coordinates a comprehensive program

dedicated to assuring excellence in medication safety and

quality.

They facilitate the continuous evaluation of the

medication management system to implement strategies

that reflect medication safety best practices and mitigate

or eliminate actual and potential system vulnerabilities.

Activities n

Reported medication safety events 646

Unit Inspections 720

Adverse drug events identified,

prevented, or treated 145

We shall use accountable, reliable, and transparent approaches to medication safety and just culture.

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An Initiative for Improvement The Hospital Improvement Innovation Network (HIIN) works at

the national, state, regional, and hospital system level to “sustain

and accelerate national progress and momentum towards

continued harm reduction.”

Goal: To reduce all-cause inpatient harm by 20 percent by 2019

Data collection involves chart review and root cause analysis for:

INR >5 for any patient on warfarin, naloxone administration for

any patient receiving an opioid, and blood glucose level <50 for

randomly selected patients on insulin.

Adverse Drug Events Reduction from Baseline

Anticoagulation 12.4%

Hypoglycemia 24.7%

Opioids 52.0%

Below AL

Average in

3 categories

Below U.S.

Average in

2 categories

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Clinical Activities

Daily activities conducted by the antimicrobial stewardship pharmacist:

· Assist with empiric antimicrobial selection

· Target therapy to specific pathogens

· Optimize antimicrobial dosing

· Shorten duration of antimicrobials

· Convert intravenous antimicrobial to oral administration

· Coordinate with infectious disease physician

· Review restricted antimicrobials

Accomplishments

· Publication of annual antibiogram

· Approval of surgical antibiotic prophylaxis protocol

· Adjustment in azithromycin stop time

· Participation in antibiotic awareness week

· Pharmacist achieved stewardship certification

· Meropenem dosage optimization

Medication Usage Evaluations

· Procalcitonin

Research Projects

· Vancomycin dosing in obese patients

Education

· Vancomycin nursing, pharmacy, and lab education module published

· Antimicrobial review for medical residents

· Emergency department fellow education

Antimicrobial Stewardship

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Formulary Additions

· Meropenem-vaborbactam

Guidelines for Use

· Voriconazole

· Itraconazole

· Amphotericin B (liposomal)

· Posaconazole

Antimicrobial Stewardship

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525

575

625

675

725

3Q 2018 4Q 2018 1Q 2019 2Q 2019 3Q 2019 4Q 2019

Total Antibacterial Utilization

Teaching Hospitals (n=29) Non-Teaching Hospitals(n=130)

Princeton Baptist Medical Center

Partners in Patient Care

Pharmacy is well-supported by a dedicated group of

clinical analysts that provide clinical informatics,

automation, and information systems support. They are

an invaluable part of our patient care team. We are

fortunate to have a dedicated group of employees

ensuring our technology remains online and up-to-date.

We shall provide a collaborative work environment among health profession disciplines.

The pharmacy is integrated in collaboration with our

physicians, midlevel practitioners, nursing staff, and

other allied health professionals.

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Partners in Patient Care Our Human Resources Team plays an integral role in

supporting pharmacy staff and leaders to provide optimal

care. The team not only aids in hiring excellent caregivers

but also ensures that those employees are protected and

have a safe and supportive work environment.

Our Pastoral Services Team diligently support our staff.

They routinely dedicate time to the department blessing the

team during our daily huddle and devotion.

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PGY1 Pharmacy Practice Residency Program

The purpose of our PGY1

Pharmacy Practice Residency

Program is to educate and train

pharmacists with the primary

emphasis on the development of

practice skills in a number of

specialized pharmacy practice

areas. A pharmacist completing

this program will be a

competent generalist who can

function in multiple roles

within a pharmacy system.

2019-2020 Residents

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Achievements

New PGY2 Internal Medicine position planned in 2020

Realigned orientation experience

Enhanced focus on preceptor scholarship

Increased cohesiveness of longitudinal experiences

Incorporated pharmacy interns into research project(s)

• Emily Johnson, PharmD, BCPS

• Emergency medicine pharmacist; UAB Hospital (Birmingham)

• Alston Poellnitz, PharmD

• Clinical pharmacist; DCH Regional Medical Center (Tuscaloosa)

• Elizabeth Wood, PharmD

• Pharmacist; Vanderbilt Wilson County Hospital (Lebanon, Tenn.)

2019 Graduates

• Carrie Ellison, Auburn University

• John Michael Herndon, Auburn University

• Alyssa Osmonson, Auburn University

Current Residents

We shall foster a teaching environment for the next generation of healthcare providers.

12th Class

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Pharmacy Students

Princeton Baptist Medical Center offered over 50 advanced

pharmacy practice experience (APPE) rotations to multiple

pharmacy schools in Alabama. There are also introductory

pharmacy practice experiences offered to students.

Students work alongside our pharmacists to learn operational

and clinical components of pharmacy practice. They participate

in activities such as dispensing medications, taking medication

histories, answering drug information questions, and

participating in clinical rounding.

Members of our team lectured at schools in Alabama, Florida,

and Wyoming on hospital inventory management, human

capital for healthcare leaders, applied pharmacoeconomics, and

literature evaluation and application.

We shall prepare the next generation of pharmacy students and residents for excellence through education and preceptorship.

3,250+ Hours

of Education

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Institutional Involvement

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Antimicrobial Stewardship Committee Patient Safety Committee

Baptist Physicians Alliance – Medicine Patient Safety Rounds

BBH Pharmacy Directors Council Product Conversion Committee

BBH Pharmacy Standardization

Committee Performance Improvement Council

Code Blue Committee Pharmacy & Therapeutics Committee

Core Sepsis Committee Princeton Heart Institute

Department of Medicine Rapid Response/Event Analysis

ED Sepsis Task Force Readmissions Team

Facility Research Committee Residency Advisory Committee

Hospital-Acquired Infection

Committee Residency Research Committee

Infection Control Committee Special Care Committee

Interdisciplinary Diversion Team Stroke Committee

Medical Executive Committee Surgical Site Infection Committee

Medication Safety Committee Tenet ADM Steering Committee

Metabolic & Bariatric Surgery

Committee Tenet AL/TN Pharmacy Group

Nursing Council TJC Preparation Committee

Local, State, & National Organizations

• Alabama Infectious Diseases Society

• Alabama Society of Health-System Pharmacists

• Director of Organizational Affairs – Sarah Blackwell

• InPharmative Quarterly Editorial Board – Nathan Pinner

• New Practitioners Committee Chair – Sarah Blackwell

• New Practitioners Committee – Natalie Tapley, Mary Katherine Stuart

• Newsletter Committee – Helen McKnight

• Programming Committee – Natalie Tapley

• American Association of Colleges of Pharmacy

• American College of Clinical Pharmacy

• Clinical Administration PRN Annual Meeting Planning Committee – Tom Achey

• Clinical Administration PRN Education & Research Subcommittee – Tom Achey

• Critical Care PRN Membership Committee – Sarah Blackwell

• American Society of Health-System Pharmacists

• Section of Clinical Scientists and Specialists Midyear Clinical Meeting

Programming Committee – Nathan Pinner

• Section of Pharmacy Practice Leaders New & Emerging Leaders Advisory Group

Vice-Chair – Tom Achey

• Section of Pharmacy Practice Managers Innovation Management Advisory Group

– Tom Achey

• Society of Critical Care Medicine

• Vizient University Health System Consortium

• Supply Chain Optimization Committee Member – Tom Achey

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Publications Achey TS, McEwen CL, Hamm MW. Implementation of a workflow system with

electronic verification for preparation of oral syringes. Am J Health-Syst Pharm.

February 2019; 76(suppl 1):S28-33.

Core A, Pinner N, Bethea B, Starr JA. Timing of anticoagulation in atrial fibrillation

status post cardioembolic stroke. J Pharm Pract. Jan 2019.

Phelps P, Achey TS, Mieure KD, Cuellar L, MacMaster H, Pecho R, Ghafoor V. A

survey of opioid medication stewardship practices at academic medical centers.

Hospital Pharmacy. February 2019; 54(1):57-62.

Pinner N, Oliver W, Veasey T, Starr J, Eudaley S, Hutchison A, Wargo K. Frequency

of β-blocker use following exacerbations of COPD in patients with compelling

indication for use. South Med J. November 2019; 112(11):586-590.

Awards Service Award, Alabama Society of Health-System Pharmacists - Sarah Blackwell

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Presentations NATIONAL

Aspiration Exasperation: Antibiotics often Exploited. Clinical pearl for Infectious Diseases

Hot Topics at the ASHP Midyear Clinical Meeting. December: Las Vegas, NV. Blackwell S..

COPD: Are Eosinophils Really a Thing Now?. Clinical pearl at the ASHP Midyear Clinical

Meeting. December: Las Vegas, NV. Pinner N.

From Insight to Action: Developing a Data-Driven Culture. Educational session at the ASHP

Midyear Clinical Meeting. December: Las Vegas, NV. Achey TS, Hill JD, Bruce BD.

Single- vs. Dual-Antiplatelet in the Acute Phase of Stroke. Clinical pearl for Therapeutic

Debates 2019 at the ASHP Midyear Clinical Meeting. December: Las Vegas, NV. Starr JA,

Mucksavage J.

REGIONAL

Beliefs, Values, and Ethics, Oh My! An Administrative Case Study. Educational session for

Alabama Society of Health-System Pharmacists webinar series. October: Birmingham.

Achey TS.

Goal Setting and Delegation. Presentation to collegiate members of Theta Chi Fraternity

Theta Chi University conference. February: Athens, GA. Achey TS.

It Begins Now: Preparing for Post Graduate Residency Training. Presentation to pharmacy

students at Samford University MSOP. March: Birmingham. Blackwell S.

Leadership 101. Presentation to collegiate members of Theta Chi Fraternity Theta Chi

University conference. February: Athens, GA. Achey TS.

Utilizing Learners in Your Practice Site. Presentation for Preceptors Forum at the ALSHP

Summer Meeting. July: Point Clear, AL. McKnight H, Maxson R., Roberts M.

Weathering the Chill: The Pharmacist’s Role in Targeted Temperature Management.

Educational session for Alabama Society of Health-System Pharmacists webinar series.

April: Birmingham. Blackwell S.

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Presentations LOCAL

Anticoagulant Reversal. Presentation to emergency medicine fellows and physicians at

Alteon Health, Alabama Central Division. December. Stuart MK.

Assessment of Clinical Outcomes following Guideline-Directed Sepsis Care in a Private

Tertiary Hospital: A Retrospective Cohort Study. Presentation to hospital administrators,

physicians, and nurses at Princeton Baptist Medical Center. February – April. Blackwell S.

Hyperglycemic Crises and Insulin. Presentation to emergency medicine fellows and

physicians at Alteon Health, Alabama Central Division. April. Germain K.

Intranasal Medication Administration. Presentation to emergency medicine fellows and

physicians at Alteon Health, Alabama Central Division. December. Germain K.

Pain, Agitation, and Delirium: Operationalizing the ABCDEF Bundle. Grand Rounds

Presentation to physicians, residents, and pharmacists at Department of Medical Education,

Princeton Baptist and Grandview Medical Centers. September. Blackwell S.

The Sepsis Circus: Juggling Care and Quality Measures. Presentation to emergency

medicine fellows and physicians at Alteon Health, Alabama Central Division. September.

Blackwell S.

The Sepsis Circus: Juggling Care and Quality Measures. Grand Rounds Presentation to

physicians, residents, and pharmacists at Department of Medical Education, Princeton

Baptist and Grandview Medical Centers. September. Blackwell S.

Interprofessional Education Topics

Antimicrobial Review

Crash Cart

Medication Histories & Reconciliation

Pneumonia

Urinary Tract Infections 30

Posters Assessing discharge prescribing patterns after heart failure exacerbation at Princeton Baptist Medical

Center. Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas. Osmonson AJ, Starr

JA, Germain K, Stuart MK.

Assessment of outcomes in patients with end-stage renal disease and congestive heart failure following fluid

resuscitation for sepsis and septic shock. Presentation at the ASHP Midyear Clinical Meeting. December:

Las Vegas. Herndon JM, Holder H, Achey TS, Blackwell SB.

Assessing the impact of pharmacist led interventions on rate of severe hypoglycemia in hospitalized patients

on insulin. Presentation at ALSHP Fall Clinical Meeting. October: Birmingham. Germain K, Autrey M.

Evaluating clinical outcomes associated with ceftriaxone monotherapy in non-obese versus obese patients.

Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas. Patel U, Chaudhari A, Tapley N.

Evaluation of antifungal consumption and adherence to recommendations for use in a tertiary care hospital.

Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas. Harding B, Alkire J, Blackwell

S, Pinner N.

Evaluation of cefazolin dosing among obese and non-obese patients. Presentation at the ASHP Midyear

Clinical Meeting. December: Las Vegas. Lee C, Elston R, Autrey M, Tapley N.

Evaluation of cefepime dosing among obese and non-obese patients. Presentation at the ASHP Midyear

Clinical Meeting. December: Las Vegas. Archer A, Holder M, Germain K, Tapley N.

Evaluation of oral anticoagulant prescribing for hospitalized patients with nonvalvular atrial fibrillation at

a community teaching hospital. Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas.

Patel KN, Uichanco MT, Rusk R, Autrey M, Stuart MK.

Impact of pharmacist-led antibiotic discharge service on pneumonia readmission. Presentation at the ASHP

Midyear Clinical Meeting. December: Las Vegas. Ellison C, Autrey M, Tapley N, Germain K.

Impact of Pharmacy Technician-Led Inventory Stewardship at a Community Hospital. Presentation at the

ASHP Midyear Clinical Meeting. December: Las Vegas. McKnight H, Roberts B, Jackson C, Harris M.

Utilization of procalcitonin to guide antimicrobial therapy. Presentation at the Southeastern Critical Care

Summit. April: Atlanta. Subramanyam S, Wood E, Tapley N, Wynne D.

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Service Anniversaries Celebrating 10 Years

April Marlin

Celebrating 5 Years

Megan Autrey

Brandon Roberts

Celebrating 3 Years

Hillary Holder

Helen McKnight

Kristy Sanders

Mary Katherine Stuart

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Looking Ahead with Strategic Planning

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Many team members participated in our two-week strategic planning

session incorporating a walking gallery with opportunity to

brainstorm, prioritize, & strategize departmental goals for next year!

COMING IN 2020 For next year, Princeton Baptist Medical Center will implement a

clinical pharmacist to provide 8 hours of coverage in the Emergency

Department. This position, in addition to a new internal medicine

clinical pharmacist, will reduce inappropriate medication use, improve

patient outcomes, and reduce the number of discrepancies in the

admission medication reconciliation process.

In turn, their contributions will drive the efficiency of order verification

for patients being admitted and reduce the number of medication-related

adverse events seen as a result of inaccurate medication histories.

Our post-graduate residency training program is growing with the

addition of a PGY2 Internal Medicine residency!

HCAHPS scores regarding communication about medications will be an

area of focus for widespread influence by our pharmacy team.

We look forward to our future successes in the coming year!