Poster #1

PRIMARY AUTHOR'S NAME Toni M. Darnell, PharmD PRACTICE LOCATION Ascension Saint Thomas Rutherford Hospital ADDITIONAL AUTHORS Jonathan Hughes, PharmD, BCPS, BCACP Melissa Ragheb, PharmD, BCGP James Benton Turner, PharmD, BCPS Allyson Wunderlich, PharmD, BCPS TITLE OF POSTER Effect of a reporting system in managing appropriate use of direct-acting oral anticoagulants (DOACs) in the outpatient setting ABSTRACT Purpose: Recent analyses demonstrate roughly 25% of patients taking DOACs are prescribed an inappropriate dose, exposing patients to increased risk of thrombosis or bleeding. The use of clinical decision support and reporting systems in the outpatient setting can efficiently identify potential medication errors or safety issues within a large clinic population. Pharmacists integrated in primary care clinics are well positioned to monitor and resolve anticoagulant drug therapy problems. To date, the role and impact of such a service has not been evaluated in our health system. Methods: This is a single center qualitative study which has been submitted and deemed exempt from the Institutional Review Board as non-human subjects research. A report within AthenaNet will be generated weekly to include all patients within the Saint Louise Clinic with a new DOAC prescription. The report will populate the patient name, the DOAC regimen, and relevant baseline characteristics and laboratory values including age, weight, serum creatinine, and creatinine clearance allowing the study pharmacists to efficiently assess appropriateness of the DOAC regimen. Weekly report screenings will take place from October 2018 to December 2018. Based on the reports generated, study pharmacists will evaluate each DOAC regimen and make recommendations to the prescribing physician as appropriate. The number of interventions proposed will be captured as the primary outcome. Secondary outcomes will include the number of proposed interventions accepted by prescribers, number of inappropriate DOAC regimens identified, and the nature of the drug therapy problem. Results and Conclusion: Preliminary results revealed a total of 65 patients who were prescribed a DOAC at the Saint Louise Clinic. Of the 65 patients reported, 8 regimens were identified as inappropriate and required further investigation and recommendation to adjust the regimen. Final results and conclusions are to be determined.

Poster #2 PRIMARY AUTHOR'S NAME Brittany A. Donahue, PharmD PRACTICE LOCATION Ascension Saint Thomas Rutherford Hospital ADDITIONAL AUTHORS Noah Ploegman, PharmD, BCCCP Sarah Knoll, PharmD Parks Miller, PharmD Katherine Teare, PharmD, BCCCP TITLE OF POSTER Evaluation of risk factors for development of hypoglycemia in patients with diabetic ketoacidosis while on a continuous intravenous insulin infusion ABSTRACT Purpose: Patients admitted to the hospital with diabetic ketoacidosis (DKA) are placed on a continuous intravenous insulin infusion to control blood glucose until the anion gap acidosis has resolved. A computer software program, Glucostabalizer, is utilized to adjust the insulin infusion rate based on blood glucose measurements and a prespecified target blood glucose range. Even though frequent blood glucose measurements are performed, some patients will develop hypoglycemia while on the insulin infusion. The objective of this study is to evaluate factors that may increase the risk of patients with DKA developing hypoglycemia while on a continuous intravenous insulin infusion. Methods: Adult patients admitted through the emergency department at Saint Thomas Rutherford Hospital for treatment of diabetic ketoacidosis (DKA) started on a continuous intravenous insulin infusion were evaluated. Patients who developed hypoglycemia, defined as blood glucose less than 70 mg/dl, were compared to patients who did not experience hypoglycemia during the study period. Presence of three risk factors for developing hypoglycemia were evaluated for both groups. Risk factors that were assessed included Type I diabetes versus Type II diabetes, presence of infection and level of renal function. Presence of infection was determined by discharge ICD-10 codes and renal function was based on estimated glomerular filtration rate (eGFR). Odds ratios will be used to assess the relationship between having a risk factor and developing hypoglycemia while on a continuous intravenous insulin infusion. Results/Conclusions: To be determined.

Poster #3

PRIMARY AUTHOR'S NAME Brittany N. Wininger, PharmD PRACTICE LOCATION Ascension Saint Thomas Rutherford Hospital ADDITIONAL AUTHORS Dalton Walsh, PharmD, BCPS Genna Holder, PharmD, MEd Kacie Migliavacca, PharmD, BCPS Jade Oertle, PharmD TITLE OF POSTER Impact of perioperative gabapentin administration on postoperative opioid use in intra-abdominal surgery patients ABSTRACT Purpose: Opioids remain an effective option for postoperative pain control; however, the opioid epidemic in the U.S. demonstrates the need for reducing opioid use. Guidelines for perioperative pain management recommend utilizing a multimodal approach to analgesia by adding non-opioid agents with different mechanisms of pain control. The primary purpose of this study is to determine if perioperative gabapentin administration decreases postoperative opioid use in intra-abdominal surgery patients. Methods: This study will be a single-center, retrospective chart review. Patients will be included in the study if they were 18 years of age or older and had an intra-abdominal surgical procedure during the time period of the study. Patients will be excluded if the chart review shows prior gabapentin or pregabalin use, postoperative gabapentin use only, an opioid allergy, or pregnancy. The control group will be defined as those who did not receive gabapentin perioperatively. The intervention group will include patients that received a preoperative gabapentin dose. The intervention group will be further divided into two groups based on if the patient received gabapentin postoperatively. The primary outcome will evaluate if perioperative gabapentin administration decreases postoperative opioid use in intra-abdominal surgery patients. Secondary outcomes will evaluate gabapentin dose and frequency, type of intra-abdominal surgical procedure, and postoperative pain scores. Results: To be determined. Conclusion: To be determined.

Poster #4 PRIMARY AUTHOR'S NAME Emily K. Byers, PharmD PRACTICE LOCATION Ascension Saint Thomas West Hospital ADDITIONAL AUTHORS Jarett Worden, PharmD Robin Tagatz, BS Pharm, PharmD, MSIHCM TITLE OF POSTER Impact of nasal methicillin-resistant Staphylococcus aureus (MRSA) screening on the length of empiric vancomycin therapy for pneumonia ABSTRACT Purpose: The purpose of this study is to determine the extent to which the nasal MRSA polymerase chain reaction (PCR) screen impacts the length of empiric vancomycin therapy for pneumonia. Methods: This study is a retrospective chart review of adult patients who were treated for pneumonia empirically with vancomycin therapy from April 1, 2017 to August 31, 2018. Patients were separated into two groups; non-PCR screened patients who were treated from April 1, 2017 to August 31, 2017 and PCR screened patients who were treated from April 1, 2018 to August 31, 2018. Data will be analyzed to determine if the implementation of a nasal MRSA PCR screen impacted the length of empiric vancomycin therapy for pneumonia. Secondary outcomes include incidence of acute kidney injury (AKI), time to clinical improvement, and number of vancomycin levels drawn. Results: Pending Conclusion: Pending

Poster #5 PRIMARY AUTHOR'S NAME Madison J. Como, PharmD PRACTICE LOCATION Ascension Saint Thomas West Hospital ADDITIONAL AUTHORS Caroline Barone, PharmD Kwame Asare, PharmD, BCPS, BCNSP TITLE OF POSTER Incidence of rejection in heart transplant patients who received induction therapy versus those who did not ABSTRACT Purpose: Some heart transplant patients receive induction therapy, most commonly those considered to be at a high risk for rejection or who have compromised renal function. The purpose of this study is to determine if the use of induction therapy in heart transplant patients is beneficial in reducing the risk of rejection within 3 months post-transplant without increasing the risk of infection requiring hospitalization, and if induction therapy can reduce the risk of nephrotoxicity by delaying calcineurin inhibitor initiation post-transplant. Methods: This study was an IRB-approved, single center, retrospective electronic chart review of patients who received a cardiac transplant at Ascension Saint Thomas West Hospital between April 1, 2016 and July 31, 2018. Patients were categorized into one of two groups: patients who received induction therapy and patients who did not. Patients who received induction therapy were then divided into two subgroups: those who received basiliximab for induction therapy and those who received antithymocyte globulin. Data was analyzed to determine incidence of rejection within the first three months post heart transplant in patients who received induction therapy versus those who did not. Secondary outcomes include the incidence of infection requiring hospitalization within the first three months post heart transplant and the timing of calcineurin inhibitor initiation and incidence of nephrotoxicity within the first three months post heart transplant. Preliminary Results: From twelve out of forty-eight patients reviewed, two patients received induction therapy with antithymocyte globulin, two patients received induction therapy with basiliximab, and eight patients did not have induction therapy. No patients in the induction therapy groups experienced rejection requiring treatment. Two out of eight patients experienced rejection requiring treatment who did not receive induction therapy (25 percent). There were no incidences of infection requiring hospitalization in patients who received induction therapy. One out of eight patients who did not receive induction therapy experienced infection requiring hospitalization (13 percent). One patient in the antithymocyte globulin group included in this endpoint experienced nephrotoxicity (100 percent). One out of two patients in the basiliximab group experienced nephrotoxicity (50 percent). Two out of eight patients who did not receive induction therapy experienced nephrotoxicity (50 percent). Conclusion: Pending.

Poster #6 PRIMARY AUTHOR'S NAME Maggie A. Klingensmith, PharmD PRACTICE LOCATION Ascension Saint Thomas West Hospital ADDITIONAL AUTHORS Kwame Asare, PharmD, BCPS, BCNSP Caroline Barone, PharmD Jordan Brooke Tullos, PharmD TITLE OF POSTER Comparison of two antithymocyte globulin (rabbit) dosing regimens in kidney transplant recipients ABSTRACT Purpose: Antithymocyte globulin (rabbit) is FDA approved for induction therapy in renal transplant recipients at a dose of 1.5mg/kg/dose for 4-7 days. Alternative dosing strategies for thymoglobulin still exist. Strategies involving higher doses and prolonged duration can be associated with increased adverse effects, thus making the optimal dose and duration hard to define. The purpose of this study is to compare two different dosing strategies of antithymocyte globulin in kidney transplant recipients. Methods: In April 2017, Ascension-Saint Thomas West Hospital initiated a new antithymocyte globulin dosing regimen of 2mg/kg for 3 doses for induction therapy in kidney transplant recipients. These patients previously received 1.5mg/kg/dose for 4 doses with the same total cumulative dose of 6mg/kg. This study will compare antithymocyte globulin, 1.5mg/kg/dose for 4 doses versus 2mg/kg/dose for 3 doses. The primary objective is to compare the efficacy of two thymoglobulin dosing regimens for induction in kidney transplant recipients based on acute rejection rates between groups. The secondary objectives are to compare length of stay, incidence of malignancy, and incidence of adverse effects between study groups. Preliminary Results: From the 2mg/kg dosing group, no patients experienced acute rejection, 2/6 (33 percent) patients experienced leukopenia, 1/6 (17 percent) experienced thrombocytopenia, 1/6 (17 percent) acquired cytomegalovirus within 90 days post transplant. From the 1.5mg/kg dosing group, no patients experienced acute rejection and 1/3 (33 percent) patients experienced leukopenia. Average length of stay was 164 hours for the 1.5mg/kg dosing group and 88 hours for the 2mg/kg group. Conclusion: pending

Poster #7 PRIMARY AUTHOR'S NAME Jennifer M. Misencik, PharmD PRACTICE LOCATION Ascension Saint Thomas West Hospital ADDITIONAL AUTHORS Tonya L. Thomas, PharmD TITLE OF POSTER Enteral versus intravenous phenobarbital bolus dosing for alcohol withdrawal syndrome ABSTRACT Purpose: Phenobarbital (PHB) has been found to be a valuable treatment alternative for Alcohol Withdrawal Syndrome (AWS) resulting in the widespread introduction of PHB protocols. The purpose of this study was to determine if a difference in clinical outcomes exists for patients given an enteral bolus dose of PHB versus those given the standard intravenous (IV) bolus dose for the treatment of AWS. Methods: This study was an IRB-approved, single center, retrospective cohort of patients admitted to Ascension-Saint Thomas West Hospital and initiated on PHB for the treatment of AWS from April 1, 2017-October 1, 2018. The primary objective was to compare the difference in medical intensive care unit (MICU) length of stay between patients who received enteral versus IV PHB as a bolus dose. Patients were included if they were 18 years of age or older, had a diagnosis of AWS, were initiated on the PHB protocol within 24 hours of hospital admission, received either an enteral or IV bolus dose of PHB, and were a MICU patient during the admission. Secondary outcomes included incidence of mechanical ventilation or seizure occurring after PHB protocol initiation, need for adjunctive or sedative agents for AWS symptom control, total dose of PHB given, and total hospital length of stay. Study outcomes were examined using descriptive and inferential statistics, as appropriate. A p-value <0.05 was deemed as statistically significant. Results: After retrospective chart review 32 patients were included in the study. No significant difference existed in MICU length of stay between the enteral (n=16) and IV PHB (n=16) groups. The enteral PHB group was associated with a lower initial bolus dose (194.4 mg vs. 260 mg, p<0.01), although there was no significant difference in total PHB dose given. Requirements for adjunctive or sedative agents did not differ significantly between groups. There were no events of respiratory depression requiring intubation or withdrawal seizures in either group. Conclusion: Enteral PHB may be a safe and effective option for bolus dosing in the treatment of AWS.

Poster #8 PRIMARY AUTHOR'S NAME Manisha S. Modi, PharmD, MPH PRACTICE LOCATION Ascension Saint Thomas West Hospital ADDITIONAL AUTHORS Matt Bibb, PharmD, BCGP Michelle Wilcox, PharmD TITLE OF POSTER Comparison of elastomeric infusion pump utilization and reduction of narcotic use post-procedure in thoracoscopy ABSTRACT Purpose: The purpose of this study is to determine the utilization of an elastomeric infusion pump filled bupivacaine and measure its reduction in narcotic use in post-thoracoscopy. Methodology: This study is a retrospective observational chart review of adult patients who underwent thoracoscopy from July 1, 2017-July 1, 2018 at Ascension-Saint Thomas West Hospital. Patients were separated into two groups of pain management post-procedure: intervention group with elastomeric infusion pump filled bupivacaine and a control group. The primary objective was to compare the utilization of an elastomeric infusion pump and narcotic use post-thoracoscopy. Patients were included if they were older than 18 years of age and underwent thoracoscopy. Patients were excluded if they were pregnant or had allergy to amide anesthetics, such as lidocaine, mepivacaine, etidocaine, prilocaine, and ropivacaine. Data was analyzed to determine total narcotic use inpatient post-procedure. Secondary objective was to determine total amount of narcotic prescribed at discharge. Results: Pending Conclusion: Pending

Poster #9 PRIMARY AUTHOR'S NAME Rebecca C. Moore, PharmD PRACTICE LOCATION Ascension Saint Thomas West Hospital ADDITIONAL AUTHORS Jeannie Watson, PharmD, BCPS Jarett Worden, PharmD, BCPS TITLE OF POSTER Impact of FilmArray™ Meningitis/Encephalitis Panel on time to optimal therapy for bacterial meningitis ABSTRACT Purpose: The purpose of this study is to determine the impact of the FilmArray™ Meningitis/Encephalitis Panel (MEP) on time to optimal therapy for patients diagnosed with bacterial meningitis compared to standard of care. Methods: This study is a retrospective electronic medical record review of adult patients with suspected meningitis who received a lumbar puncture within 48 hours with cerebrospinal fluid (CSF) cultures. Patients were divided into two groups: a control group with blood cultures and CSF cultures from January 1, 2017 – August 31, 2017 and a study group with blood cultures, CSF cultures, and the MEP from January 1, 2018 – August 31, 2018. Patients who had confirmed fungal or viral meningitis and those who had co-infections are excluded. Data was analyzed to determine time to antibiotic de-escalation or streamlining after a positive or negative MEP. Secondary outcomes include total duration of antibiotics, clinical improvement, length of stay, and mortality. Results Pending. Conclusions Pending.

Poster #10 PRIMARY AUTHOR'S NAME Bethany G. Leachman, PharmD PRACTICE LOCATION Blount Memorial Hospital ADDITIONAL AUTHORS Rachel Lazim, PharmD, BCCCP, BCNSP Patrick Blankenship, PharmD, BCPS Kyle Allmond, PharmD, BCPS Jamie Chapman, PharmD, BCPS TITLE OF POSTER Adult procedural sedation in the emergency department ABSTRACT Purpose: Initial management of many orthopedic injuries requires urgent closed reduction to improve alignment of dislocated joints. Sedative/analgesia agents are often necessary to achieve sufficient relief of anxiety and pain during manipulation of the extremity. A recently published article found that decision support tools increased appropriate indication-specific dosing of ketamine in procedural sedation. No standard exists for the selection of procedural sedation agents used at BMH and remains physician dependent. This study will evaluate outcomes associated with creating an ED procedural sedation order set, potentially decreasing incidence of adverse effects, increasing compliance with guideline dosing, better patient monitoring documentation, and promoting safety/efficacy of the medications. Methods: This is a retrospective, single-center, cohort study. Our control group will consist of adult patients greater than 18 years old presenting to the ED requiring close joint reduction with procedural sedation from July 1, 2017 to July 1, 2018. Information to be collected includes: medication and doses utilized to facilitate the procedure, patient’s weight, adverse effects noted on progress notes, pharmacist presence, charge capture, and need for administration of any supportive care medications. Utilizing current literature and with the help and input of ED physicians, the ED procedural sedation order set will be created. After the approval and implementation of this ED procedural sedation order set, the control patients will be compared to the intervention group of adult patients greater than 18 years old presenting to the ED with need for closed reduction with procedural sedation from January 1, 2018 to March 1, 2018. The same information gathered for the control group will be collected for the intervention group, and all data will be assessed for trends and differences. Patients will be excluded if they have any listed allergies to any of the procedural sedation medications being studied. Results: pending

Poster #11 PRIMARY AUTHOR'S NAME Tanner R. Shields, PharmD PRACTICE LOCATION Blount Memorial Hospital ADDITIONAL AUTHORS Amy Porter PharmD Fern Pruss PharmD Alan Knauth PharmD, BCPS Robert Lucas PharmD, MBA, BCPS, FASHP, DPLA TITLE OF POSTER Development of a computerized prescriber order entry (CPOE) chemotherapy order set in a community hospital ABSTRACT The American Society of Health System Pharmacists (ASHP) and the American Society of Clinical Oncology (ASCO) recommend that computerized prescriber order entry (CPOE) be implemented in health systems for chemotherapy orders to increase safety and reduce errors. The objective of this project is to describe the development and implementation of a CPOE chemotherapy order set in a community hospital. A retrospective review of paper chemotherapy orders from January 1, 2018 to June 30, 2018 was conducted to assess the number and types of errors or clarifications documented. Types of errors and clarifications documented included: missing patient information, missing diagnosis, wrong or missing height, weight, or body surface area, wrong or missing dose, missing dates or cycle number, wrong or missing pre-medications, illegible drug name, unapproved abbreviations, wrong dosage units, and wrong treatment frequency. The order set will be created using current paper order sets, primary literature, Institute for Safe Medication Practices best practices for creating order sets, as well as published articles on similar implementations. From this information a CPOE order set will be created for use by our physicians for inpatient and outpatient admissions. The development of the CPOE order set will involve oncology pharmacists, informatics pharmacists, an oncology nurse practitioner, and oncology nurses. This project will describe the development and implementation of the order set and its use in a community hospital.

Poster #12 PRIMARY AUTHOR'S NAME Jessica M. Some, PharmD PRACTICE LOCATION Blount Memorial Hospital ADDITIONAL AUTHORS Brad Crane, Pharm.D., BCPS-AQ ID Abby Bussey, Pharm.D. Emily Duncan, Pharm.D., BCPS Stephanie Grimes, Pharm.D. TITLE OF POSTER Impact of a pharmacist-led provider education on antibiotic prescribing rate for acute respiratory tract infections in adults within an ambulatory care setting ABSTRACT Purpose: Inpatient and outpatient antibiotic use has contributed to the rise of antibiotic-resistant bacteria. Antimicrobial stewardship has been well implemented in the inpatient setting; however, the same focus hasn’t been applied in the outpatient setting, where the Centers for Disease Control reports the majority of prescribing occurs. Patients with acute respiratory conditions commonly caused by viruses often receive care in the outpatient setting, presenting an opportunity to examine antibiotic prescribing rates. The study’s purpose is to evaluate the impact of pharmacist-led provider education on antibiotic prescribing rates for acute bronchitis, acute sinusitis, and acute pharyngitis in an ambulatory clinic setting. Methods: A pharmacist-led educational session was presented in September 2018 to providers at an internal medicine and family medicine clinic regarding antimicrobial stewardship, antibiotic prescribing rates at the clinic, and best practices in antibiotic prescribing for acute bronchitis, acute sinusitis, and acute pharyngitis. This information was also supplied to prescribers who were unable to attend. The primary endpoint of this IRB-approved, retrospective cohort analysis is to compare antibiotic prescribing rates in patients with acute bronchitis, acute sinusitis, and acute pharyngitis before the educational session (October-December 2017; Pre-Intervention) and afterwards (October-December 2018; Post-Intervention). Patients under the age of 18 or with chronic sinusitis will be excluded. The secondary endpoint of this study is to compare antibiotic prescribing rates among provider categories (physician, nurse practitioner, physician assistant). Results and Conclusion: Research is in progress.

Poster #13 PRIMARY AUTHOR'S NAME Megan E. Nesbitt, PharmD PRACTICE LOCATION Catholic Health Initiatives Memorial Hospital

ADDITIONAL AUTHORS Patrick Ellis, Pharm.D. Daniel Marsh, Pharm.D., BCPS TITLE OF POSTER Evaluation of ketamine, lidocaine, and haloperidol as alternatives to opioids for pain management within the emergency department ABSTRACT Purpose: The number of deaths due to opioid abuse continues to rise each year. In efforts to decrease the amount of opioids prescribed to patients in their community, hospitals across the nation are implementing alternative treatment pathways. The objective of this study is to evaluate the use of specific medications (ketamine, lidocaine, haloperidol) within an established treatment pathway as effective and safe alternatives to opioids for pain management. Methods: This retrospective chart review will examine patients treated with one of three medications (ketamine, lidocaine, haloperidol) in the emergency department of a 369-bed acute care community hospital from June 01, 2018 to July 31, 2018 as part of an established pathway in the treatment of pain with alternatives to opioids. The following data will be collected: type of pain indicated, dosage of medication, timing of administration, pain scores, adverse events, and additional pain medications administered. Differences in pain scores pre and post administration of the alternative medication will be calculated. The proportion of patients who received additional medications for the treatment of pain will be calculated as well as the proportion of these patients who received opioids. Finally, the number and nature of adverse events will be determined. Results: An average reduction in pain scores was observed with each medication, ranging from 3 to 7 point reductions depending on the source of pain. There were also instances in which no reduction in pain score occurred with each medication, mainly with extremity fracture and headache. In patients treated with ketamine, 83.3% of patients with abdominal pain, 57.1% of patients with musculoskeletal pain, and 100% of patients with renal colic experienced reductions in pain scores. In patients treated with lidocaine, 40% of patients with abdominal pain, 100% of patients with musculoskeletal pain, and 75% of patients with renal colic demonstrated reductions in pain scores. In patients treated with haloperidol, 66.7% of patients with abdominal pain and 100% of patients with musculoskeletal demonstrated reductions in pain scores. Lidocaine was inappropriately dosed in one patient. There were 3 reported adverse reactions to ketamine, none of which led to further intervention. Conclusion: Out of pain scores recorded, a reduction in pain severity was observed in the majority of pain indications for all three study medications. Opioids were administered in <40% of cases following the study medication. No serious adverse drug events occurred.

Poster #14 PRIMARY AUTHOR'S NAME Nisha H. Patel, PharmD PRACTICE LOCATION Catholic Health Initiatives Memorial Hospital

ADDITIONAL AUTHORS Patrick Ellis, Pharm.D. Prisca Taylor, Pharm.D. Jaeik Lee, Pharm.D., BCPS TITLE OF POSTER Medication use evaluation of albumin 25% in a community-based hospital ABSTRACT Purpose: Albumin 25% provides oncotic pressure by pulling of interstitial fluid, which results in intravascular volume expansion. While this mechanism may promote its use for a variety of medical conditions, primary literature assessing the clinical appropriateness of albumin usage is lacking for many indications and such therapy may be associated with greater costs. The objective of this study is to re-evaluate the prescribing patterns of albumin 25% in a 369 bed community-based hospital following focused provider education regarding a previous albumin use evaluation conducted in 2017. Methods: An observational study was performed by retrospectively reviewing charts of approximately 100 patients who were prescribed albumin 25% during the months of May to July 2018. Prescribing patterns of physicians were evaluated and categorized based on the appropriateness with the use of primary literature and guidelines. By the general consensus of two pharmacists and a physician, indications were categorized into one of three groups: appropriate, controversial, or inappropriate. Data collection points consisted of ordering provider and their specialty, indication, dose, number of doses, and duration of therapy. Indications were assessed by utilization of orders, progress notes, and dictation reports. The results of this study will be used to determine the need for formalized restriction criteria of albumin 25% to reduce potential inappropriate utilization of albumin 25%. Results: After presentation of 2017 albumin usage to prescribers, the category of appropriate use for albumin 25% increased by 20% from 2017 to 2018. There was a 19% decrease in controversial use between 2017 and 2018. Inappropriate and undetermined use between both years remained similar. In 2017, nephrologist had the most controversial orders with intradialytic hypotension and diuresis of critically ill patients being the highest areas of utilization. In 2018, there was a significant decrease in orders from nephrologist of 16.6% orders versus 38.4% in 2017. However, there was a significant increase in controversial orders from the hospitalist group in 2018 with 27 orders versus 5 orders in 2017. Conclusion: In comparison between 2017 and 2018, the usage of albumin has shifted in the right direction with a decrease of usage for controversial indications. This shift was primarily driven by changes in nephrology’s prescribing practice and education to dialysis nurses. However, there was an increase of albumin usage within the hospitalist group for nephrotic syndrome/diuretic resistance. This suggests that there is still further room for improvement in order to decrease albumin usage and reduce overall cost.

Poster #15 PRIMARY AUTHOR'S NAME Courtney E. Pearson, PharmD, MPH PRACTICE LOCATION Catholic Health Initiatives Memorial Hospital

ADDITIONAL AUTHORS Linda S. Johnson, Pharm.D., BCPS TITLE OF POSTER Assessment of the appropriateness of urinalysis orders in patients presenting to the emergency department ABSTRACT Purpose: Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and treatment of urinary tract infections (UTIs) recommend against routine screening for and treatment of UTIs in asymptomatic patients. In our emergency department, UTIs are often over-diagnosed and over-treated due to the inappropriate procurement of urinalyses with reflex to urine culture in asymptomatic patients. The objective of this study is to evaluate the appropriateness of urinalysis collection and characterize its downstream consequences such as antibiotic misuse and Clostridium difficile infection. Methods: This retrospective chart review will identify patients examined in the emergency department of a 369-bed acute care community hospital between July 15, 2018 and July 21, 2018 from whom a urine sample was collected and urinalysis performed. The following data will be collected: symptoms of UTI, origin of urinalysis order, result of urinalysis, antibiotic use, reflex urine culture, and development of adverse events. The proportion of urinalyses ordered via nurse-driven protocol versus physician orders will be determined. Additionally, the proportion of urinalyses collected in asymptomatic patients will be identified. Finally, the proportion of reflex urine cultures in asymptomatic patients, subsequent antibiotic therapy, and adverse consequences of antibiotics will be documented. Results: During the study period, 489 UA orders were identified. 350 of these UAs (71.6%) were ordered and collected in the absence of symptoms for UTI. Of these inappropriate UA orders, 231 patients (66%) were discharged from the emergency department while 119 patients (34%) were admitted to the hospital. Of the discharged patients, 53 (22.9%) had positive UAs that reflexed to culture which resulted in 17 patients (32%) receiving antibiotics. Of these patients, 1 (5.8%) developed further colonization with more resistant organisms. Of the admitted patients, 40 (33.6%) had positive UAs that reflexed to culture which resulted in 28 patients (70%) receiving antibiotics. Of these patients, 2 (7.1%) developed further colonization with more resistant organisms. 56% of inappropriate UAs were not ordered from automatic protocols. Of the 44% of inappropriate UAs that were ordered from automatic protocols, the most frequently used protocols were abdominal symptoms, sepsis, and fever. Conclusions: Over 70% of UAs were obtained from asymptomatic patients in the emergency department, which frequently resulted in inappropriate treatment with antibiotics and, in some cases, colonization with more resistant organisms. Further education to ED staff and the re-evaluation of the necessity of UA orders on automatic protocols is needed to change current practices and reduce inappropriate UA ordering.

Poster #16 PRIMARY AUTHOR'S NAME Alanna H. Rufe, PharmD PRACTICE LOCATION Catholic Health Initiatives Memorial Hospital

ADDITIONAL AUTHORS Linda S. Johnson, PharmD, BCPS TITLE OF POSTER Impact of pharmacist-led clinical intervention in reducing intravenous vancomycin use at a community hospital ABSTRACT Purpose: Vancomycin is the most utilized antibiotic at CHI Memorial. Its use is associated with adverse drug reactions, bacterial resistance development, and increased use of clinician time. A clinical criterion document along with a pharmacy service has been developed and implemented to effectively stop inappropriate vancomycin use. Residents perform a daily review of vancomycin use on assigned floors and make active interventions in accordance with this document. This study aims to evaluate the impact of this pharmacist-led initiative on vancomycin utilization at CHI Memorial. Methods: This retrospective chart review will identify patients admitted to CHI Memorial from September 2017 and September 2018, initiated on IV vancomycin. Data will be collected through the electronic medical record system and the clinical surveillance assistant. The main outcome will be evaluated as days of vancomycin therapy per 1000 patient days. Other data evaluated will include median duration of IV vancomycin, indication for IV vancomycin use, rate of accepted interventions, and rate of alternative anti-MRSA therapies in the pre- and post-periods. Results: Vancomycin use was decreased in the post intervention period with an absolute difference of 17 days of therapy per 1000 days present. Indication specific median durations of therapy were not considerably affected with the exception of bacteremia, which correlated with an increase in MRSA bacteremia rates in the post-intervention period. Days of therapy per 1000 days present for alternative anti-MRSA agents did not appear to be affected in response to the implementation of this initiative. The intervention acceptance rate was 95%. Conclusion: IV vancomycin utilization was decreased in the post-intervention period, with MRSA rates being similar to slightly higher in the post-intervention period. The intervention acceptance rate was high which contributes to the validation and provider support of this initiative. Moving forward, we are focusing on early and consistent intervention with providers.

Poster #17 PRIMARY AUTHOR'S NAME Jana B. Formby, PharmD PRACTICE LOCATION Fort Sanders Regional Medical Center ADDITIONAL AUTHORS J Aubrey Waddell, PharmD, FAPhA, BCOP Joel Morrison, PharmD, BCPS, BCOP Christopher C Norris, PharmD TITLE OF POSTER Evaluation of carboplatin dosing standardization for patients who are underweight, overweight, or have a low serum creatinine at a regional cancer center ABSTRACT Purpose: The purpose of this project is to review and use all the available literature to construct a carboplatin area under the curve (AUC) dosing guideline for a regional cancer center. The main focus of the review will be factors that cause the greatest variance in the Cockcroft-Gault equation, which is accepted in oncology practice to approximate the glomerular filtration rate that is used in the modified Calvert formula for AUC dosing of carboplatin. A secondary purpose is to measure the effect of the guideline on the range of mg/m2 doses achieved in the period before and after implementation. Methods: This study will be submitted to the Institutional Review Board for approval. A literature review will be conducted using Medline and Pubmed for all available literature concerning the use of body weight and serum creatinine in the Cockcroft-Gault formula in general and specifically in the use of the Cockcroft-Gault formula as an estimation of GFR in the modified Calvert formula for AUC dosing of carboplatin. The data obtained from this literature review will be used to construct a carboplatin dosing guideline to be approved by the institution. Information to be gathered includes 0gender, height, weight, body surface area, serum creatinine, and calculated carboplatin doses. Analyzed patients will include those who received carboplatin during the one month before guideline implementation compared to patients who received carboplatin the month following. All patient data will be recorded without patient identifiers and maintained confidentially. The carboplatin doses in the periods before and after the implementation of the guideline will be compared using descriptive statistics. Results: not applicable Conclusion: not applicable

Poster #18 PRIMARY AUTHOR'S NAME Penny J. Hembree, PharmD PRACTICE LOCATION Fort Sanders Regional Medical Center ADDITIONAL AUTHORS Dana Walters, PharmD, BCPS, BCGP Stefanie Reid, PharmD, BCCCP Tommy Paterson, PharmD Christopher Norris, PharmD TITLE OF POSTER Validation study of a healthcare system sliding scale insulin protocol ABSTRACT Purpose: Insulin is a universal high-risk medication, meaning that it has great potential to cause patient harm when used in error. In order to avoid medication errors as a health system, it is important to have a dosing and monitoring protocol in place. An updated protocol for sliding scale insulin was developed for consistency of care across our health system. The objective of this study is to validate adherence, safety and efficacy of the updated protocol. Methods: This project will be submitted for Institutional Review Board exemption. Retrospective review of patients receiving blood glucose management protocol will be analyzed for the months of October and November 2018. Data will be collected utilizing hospital system compiled data reports. Adherence to the protocol will be evaluated to determine compliance with the dosing and timing of insulin administration. Patients will then be assessed to determine the response to any insulin which has been administered. For patients with significant hypoglycemia and significant hyperglycemia, possible confounding factors will be determined. This data will then be assessed to determine opportunities to strengthen our protocol as well as to identify non-compliance requiring education.

Poster #19 PRIMARY AUTHOR'S NAME Madison N. Iman, PharmD PRACTICE LOCATION Fort Sanders Regional Medical Center ADDITIONAL AUTHORS Stefanie M. Reid, PharmD, BCCCP Sperry K. Wheeler, PharmD, BCPS Christopher C. Norris, PharmD TITLE OF POSTER Evaluation of auto-verified, high-risk medication orders on medication safety and optimization in the emergency department ABSTRACT Purpose: The Joint Commission requires pharmacists to prospectively review all medication orders prior to administration. An exception to this standard is in the emergency department when a licensed independent provider is available for immediate intervention. Auto-verification is a function that allows a provider to submit medication orders for verification without prospective pharmacist review. Auto-verification may lead to unnoticed, harmful errors with high-risk medications. The objective of this study is to evaluate the impact of auto-verification of high-risk medication orders in the emergency department to determine if prospective pharmacist review should be implemented to optimize patient therapy and minimize medication errors. Methods: This study is under review by the Institutional Review Board. This is a retrospective, electronic medical record review of auto-verified, high-risk medication orders in the emergency department during October 1st, 2018 to November 30th, 2018. These medication orders will be evaluated for appropriateness to determine if prospective review by a pharmacist can minimize medication errors and optimize patient outcomes. The evaluation for appropriateness of medication orders will include, but is not limited to: dose, drug, route, access to medications, contraindications, and drug interactions. Results: N/A Conclusion: N/A

Poster #20 PRIMARY AUTHOR'S NAME Hannah E. Lasley, PharmD PRACTICE LOCATION Fort Sanders Regional Medical Center ADDITIONAL AUTHORS Joel Morrison, PharmD, BCPS, BCOP Dillon Elliott, PharmD, BCPS, BCCCP Christopher C. Norris, PharmD TITLE OF POSTER Evaluation of pharmacist intervention on length of therapy and appropriate use of stress ulcer prophylaxis ABSTRACT Purpose: The use of stress ulcer prophylaxis with proton pump inhibitors (PPI) and histamine-2 receptor blockers (H2RA) is clinically indicated in critically ill patients with risk factors for bleeding. Recent literature suggests these agents are often continued once the patient is no longer critically ill and may be continued upon discharge; patients may also be prescribed these agents when their risk of bleeding is low. Evaluating necessity of stress ulcer prophylaxis and discontinuing these medications, as appropriate, can aid in preventing continuation of acid suppressing therapy (AST) when no longer indicated, reducing adverse drug reactions, unnecessary cost, and/or nosocomial infections. Methods: This study will be submitted to the Institutional Review Board for approval and will be conducted in a regional referral community hospital utilizing the electronic medical record. Data will be collected over two months on patients admitted in the surgical intensive care unit, neurological intensive care unit, stepdown unit, as well as two general medical floors that have PPIs and H2RAs initiated upon admission. The appropriateness of AST will be evaluated using national guidelines. Pharmacists will actively seek discontinuation of AST in patients who do not meet indicated criteria. The following will be documented: the number of patients initiated on stress ulcer prophylaxis appropriately or inappropriately, if prophylaxis was discontinued when no longer warranted, length of inappropriate therapy, if applicable, if AST was unnecessarily continued upon discharge, and acceptance of pharmacist recommendation. Results: N/A Conclusions: N/A

Poster #21 PRIMARY AUTHOR'S NAME Matthew A. Messer, PharmD PRACTICE LOCATION Fort Sanders Regional Medical Center ADDITIONAL AUTHORS Nancy Granger, DPh Lori Schirmer, PharmD, BCPS, BCNSP Scott Wegryn, MD Chris Norris, PharmD TITLE OF POSTER Development and implementation of a health system policy for periprocedural management of anticoagulation ABSTRACT Purpose: Anticoagulated patients in need of an interventional radiology (IVR) procedure present a special challenge to the health care team, where they must balance patient need for anticoagulation with the need to perform IVR procedures in a timely manner. In order to prevent delays in performing IVR procedures and resuming anticoagulation post-procedure, a policy will be developed and implemented across a health care system to enhance patient quality and safety. Quality and safety will be enhanced by minimizing time to IVR procedures and expediting resumption of anticoagulation. Methods: An extensive literature review and expert consensus related to IVR periprocedural management of anticoagulation will be used to develop the policy which will stratify patients according IVR procedure bleed risk and risk of venous thromboembolism (VTE). Once risk for procedure related bleeding and VTE is established, discontinuation and resumption of anticoagulation will be tailored according to the established risk categories and the anticoagulant the patient is receiving. Implementation of the developed policy will ideally be integrated into the computerized practitioner order entry (CPOE) system to flag these patients for periprocedural IVR anticoagulation management. This project has been submitted to the Institutional Review Board for approval. Results: N/A Conclusion: N/A

Poster #22 PRIMARY AUTHOR'S NAME Charity M. Loput, PharmD PRACTICE LOCATION Hospital Corporation of America ADDITIONAL AUTHORS Connie Saltsman, PharmD, MBA, CPHIMS, FHIMSS Jennifer Harris, PharmD, CPHIMS Dan Roberts, PhD, ACNP, RN Risa Rahm, PharmD, CPHIMS TITLE OF POSTER Evaluation of Medication Administration Timing Variance Using Information from a Large Health System Clinical Data Warehouse ABSTRACT The Centers for Medicare and Medicaid Services (CMS) requires hospitals to develop policies directing the timing of medication schedules. Medications are generally expected to be administered within a 30 to 60 minute window of scheduled drug therapy. Published literature has estimated that medications are administered at times outside the accepted window in up to 73% of cases, primarily due to late administration. Delayed medication administration can significantly impact patient outcomes for high risk medications including antibiotics, anticoagulants, insulin and other therapeutic classes. Historically, direct nursing observation has been used to assess the medication administration process, but the observer effect, single unit/facility observation, and nurse staffing can confound the findings of these studies. The use of time-referenced information captured through the electronic medical record (EMR) and barcode administration can be used to assess trends in medication administration and identify areas for improvement. Years of EMR data can be drawn from multiple facilities and aggregated into a clinical data warehouse (CDW) to form a more robust sample population. Currently, there is limited literature using time-referenced data to assess trends in medication administration.

Poster #23 PRIMARY AUTHOR'S NAME Michelle M. Yazdchi, PharmD PRACTICE LOCATION Hospital Corporation of America ADDITIONAL AUTHORS Elizabeth Hofammann, PharmD, BCPP Carol White, PharmD, BCPS, BCGP, CPHIMS Hayley Burgess PharmD, BCPP, CPPS TITLE OF POSTER Use of a real-time clinical decision support tool to identify renal dosing opportunities for clinical pharmacist intervention ABSTRACT Purpose: The safe and effective use of medications in the setting of renal insufficiency is complicated by changes pharmacodynamics and pharmacokinetics of medications as kidney function decreases. Through analysis of clinical interventions identified with and captured by a real-time clinical decision support tool, this study aims to describe the impact of pharmacist-driven renal dose adjustment services in a large health-system. Methods: This multi-center, retrospective, process improvement study will utilize real-time clinical decision support tool data generated by 158 hospitals from January 1 through June 30, 2018. Data will be collected on patients with potential renal dose adjustment of medication(s) during hospitalization as identified by the real-time clinical decision support tool. Subsequent bar-code medication administration data will be evaluated to identify changes to therapy within pre-specified time frames. Medication costs and opportunities will then be assessed using wholesale acquisition cost. This project has been approved by the University of Tennessee Health Science Center Institutional Review Board. Results: Research in progress. In representation of the roughly 1.2 million annual inpatient admissions to HCA Healthcare facilities, for the data collection period we anticipate reporting on more than 56,000 renal dosing interventions identified by a set of clinical decision support rules encompassing approximately 100 individual medications. Conclusion: Research in progress.

Poster #24 PRIMARY AUTHOR'S NAME Nikkina L. Hankins, PharmD PRACTICE LOCATION Lipscomb University College of Pharmacy ADDITIONAL AUTHORS Benjamin N. Gross, PharmD, MBA, BCPS, BCACP, BC-ADM, CDE, ASH-CHC Richard Randolph, PharmD TITLE OF POSTER Analyzing the prescribing trends of opioids within Tennessee with HB1831/SB2257 amendment 015082 in a rural pharmacy setting ABSTRACT Purpose The objective of the research study is to investigate the current prescribing trends of opioids in a rural pharmacy. With the new prescription guidelines in the state of Tennessee, prescribers are required to include the medication name, dose, quantity, and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. With the regulation requiring documentation of ICD-10 codes, this research study will assess the total of opioids prescribed, the correlation between the medications, prescribers, and ICD-10 code, the prescriber's scope of practice, and the morphine milligram equivalents (MME) per day. Methods Up to 10,000 dispensed opioid prescriptions will be analyzed during the course of 6 months. All of the prescriptions will be collected from one rural pharmacy in Tennessee. Prescriptions will be collected and analyzed daily using the WinRx database to document each prescription. Prescriptions will be excluded from this investigation if they fall within the following criteria: prescriptions written for controlled medications without an MME, prescriptions written before or on December 31, 2018, but not dispensed, and prescriptions without an ICD-10 code due to being written before July 1 but were dispensed after July 1. When reviewing each prescription, the drug, quantity, day supply, ICD-10 codes, and prescriber will be exported and collected from the WinRx database. ICD-10 codes’ descriptions will be verified by the International Classification of Diseases 10th Edition Clinical Modification Book for 2018. The total of MME per day will be calculated using the opioid conversion chart provided by the Centers for Disease Control and Prevention. At the completion of this review, the prescribing trends of opioids will be used to investigate new methods to promote alternative prescribing options to local practitioners and education for patients receiving substantially high amounts of MME. Results This research project is currently still in progress. At the completion of the data collection, the prescriptions will be categorized to see how many of each opioid was prescribed, which ICD-10 codes were used the most when prescribing, the trends of different types of practice, and how many prescriptions were written for large amounts of MME daily. Conclusions At the completion of this review, the prescribing trends of opioids will be used to investigate new methods to promote alternative prescribing options to local practitioners and education for patients receiving substantially high amounts of MME. This information will be vital in discovering more ways community pharmacists can assist with the opioid epidemic.

Poster #25 PRIMARY AUTHOR'S NAME Bridget A. Lynch, PharmD PRACTICE LOCATION Lipscomb University College of Pharmacy ADDITIONAL AUTHORS Phil Baker PharmD Elizabeth Breeden DPh, MS Kevin Clauson PharmD TITLE OF POSTER Employing a digital health platform to enhance medication adherence and satisfaction in patients from a membership pharmacy for the uninsured ABSTRACT Purpose: Poor medication adherence has been well documented in literature as having a negative impact on patient outcomes and readmission rates. The reasons for poor adherence are varied and range from economic issues to forgetfulness. While economic issues prove to be a more challenging problem to resolve, self-care including forgetfulness could be addressed by utilizing a patient’s smart phone. The adoption and utilization of smartphones has increased markedly over the past few years making them an ideal intervention tool for medication adherence. While numerous studies have shown the use of SMS (short message service) reminders increase patient adherence to medications, many of these reminders were automated and not based on real time adherence. In this study, we will explore a digital health platform (DayaMed, Memphis, TN) that can be administered by pharmacists via a dashboard and provide tiered, real-time medication adherence services and interventions via patients’ smart phones. The objective of this study is to evaluate the impact of this digital health platform on patient medication adherence and adoption. Methods: Institutional review board (IRB) approval will be secured prior to initiation of recruitment for this study. The study will use a randomized, open-label, parallel design. Following recruitment and allocation patients randomized to intervention arm and standard of care (i.e., control) arms will participate for a period of six months. Patients will be recruited from a nonprofit membership pharmacy for the uninsured (Good Shepherd Pharmacy, Memphis, TN). After completing the informed consent process at the first visit, all patients will complete an initial survey (e.g., baseline medication adherence via self-report, demographic data) followed by survey administration at days 30 and 90. Bi-directional medication adherence data will be captured by means of the platform and app on a continuous basis throughout the study in the intervention group. The primary outcome of this study is self-reported medication adherence through the companion application (app). Secondary outcomes include, utilizing the digital health platform to validate RMA (real time medication adherence) as a method of measuring medication adherence compared to the established MPR (Medication Possession Ratio), and to measure user satisfaction with the digital health platform. Results: This project is currently research-in-progress Conclusion: Data collection is currently ongoing

Poster #26 PRIMARY AUTHOR'S NAME Neefiyah E. Mousa, PharmD, MM PRACTICE LOCATION Perkins Drugs ADDITIONAL AUTHORS Justin Kirby, Pharm D Ben Gross, Pharm D TITLE OF POSTER Evaluating the impact of influenza and streptococcal point of care testing and collaborative practice prescribing in a community pharmacy setting ABSTRACT Purpose: Based on data collected by the Centers for Disease Control and Prevention (CDC) during the 2017-2018 influenza season, more than 30,000 people were hospitalized for complications from influenza like illnesses (ILI). The severity of last year’s flu season can be partially attributed to patients’ limited access to providers and delayed medication administration as a result. Oseltamivir must be given within 48 hours of symptom onset in order for it to be effective, but rarely is it actually given in that time period. Community pharmacies are uniquely positioned to provide testing and prescription services to this population as they do not run on an appointment based model and are able to see patients more frequently and efficiently. Also to provide basis for differential diagnosis, this study includes a model for testing and prescribing for Group B Strep as this patient population could also benefit from ease of access to this service in a pharmacy setting. This study aims to determine if providing these services in a community pharmacy will increase patient access and help prevent late prescribing and administration of antivirals and antibiotics. Methods: This study has been approved the Lipscomb Institutional Review Board. The services will be advertised in the all of the pharmacy’s promotional materials and patients will be evaluated based on self-identified need for services. In collaboration with a physician, the resident pharmacist developed a triage decision tree for evaluating patient symptoms, accounting for comorbidities, and collecting vitals. The following data will be collected for all patients: patient age, gender, blood pressure, heart rate, respiration rate, O2 saturation, temperature, medication history, and past medical history. Patients will be excluded if diagnosed comorbidities are uncontrolled or untreated or immunosuppressed. All patients will be required to sign a liability waiver. Pharmacist or pharmacist’ agent will follow up with all patients within 5 days of antibiotic or antiviral therapy. Patients will be referred to primary care for negative strep rapid test for throat culture and to prevent any complications.

Poster #27 PRIMARY AUTHOR'S NAME Rachel I. Cole, PharmD PRACTICE LOCATION South College School of Pharmacy ADDITIONAL AUTHORS Kristi Hawn, PharmD Nikki Sowards, PharmD Tyler Dougherty, PharmD Laura Schalliol, PharmD, BCACP TITLE OF POSTER Impact of pharmacy resident and pharmacy students on medication therapy management completion rate and reimbursement in an independent long-term care pharmacy serving assisted living facilities ABSTRACT Purpose: Time is the leading obstacle to medication therapy management (MTM) completion by pharmacists, which can create a missed opportunity for an independently owned pharmacy to remain competitive. A post graduate year-1 (PGY-1) community pharmacy resident leading MTM-certified advanced-pharmacy-practice-experience (APPE) students can significantly increase MTM completion by incorporating this valuable service into the learning objectives for the rotation. The purpose of this study is to determine the financial feasibility of increasing MTM completion rate and reimbursement in an independently owned long-term care pharmacy by utilizing a PGY-1 resident (PI) and APPE students to complete MTM services for residents of assisted living facilities. Methods: Advanced-pharmacy-practice-experience students directed by the PI will complete medication management services for patients in assisted living facilities who receive their medications from Mac’s LTC Solutions. The PI and APPE students will provide this service telephonically from Mac’s LTC Solutions. This research project will involve a record review over 20 weeks of the reimbursement generated from this MTM service and the change in completion rate for MTM. Data will be pulled from Mirixa and OutcomesMTM in the form of a report and completion rates will be recorded weekly. The primary outcome is MTM reimbursement from completed MTM sessions from October 2018 to February 2019. A completed MTM will be defined as a submitted claim, whether this be for a complete medication review, a request for a 90-day fill, or other covered service. Minimal, if any, patient risk will be involved in this record review as the focus will be on the cost-benefit to the long-term care pharmacy. This research may provide valuable data that may be used by independently owned long-term care pharmacies in implementing and/or expanding this service. Results: Data collection and analysis is ongoing. Results will be presented at the Southeastern Residency Conference in April 2019. Conclusion: Pending final results.

Poster #28 PRIMARY AUTHOR'S NAME Shivani Patel, PharmD PRACTICE LOCATION South College School of Pharmacy ADDITIONAL AUTHORS Alicia Potter DeFalco, PharmD, BCPS Laura Schalliol, PharmD, BCACP Brian Winbigler, PharmD, MBA TITLE OF POSTER Rescheduling of gabapentin: influence on prescribing patterns ABSTRACT Purpose: Gabapentin has potential addictive properties that can lead to higher abuse and misuse. The rescheduling of gabapentin as a controlled substance places tighter regulations on dispensing and prescribing. Prescribers may take further steps to determine if the patient is a true candidate of the medication. The purpose of this project is to identify chronic gabapentin patients before July 1, 2018, and compare their gabapentin use after July 1, 2018, when gabapentin became a schedule V medication in the state of Tennessee. This project will look for a decrease in prescribing gabapentin after it became a schedule V medication. Methods: This study will be submitted to the Institutional Review Board for approval. Patients with a 90- day fill rate of gabapentin before July 1, 2018 will be evaluated for the study. These patients will be followed until January 2019 to assess if the prescribing pattern of gabapentin will show a decrease in fill rate. Kroger will provide a list of patients who have been receiving gabapentin among their stores in Knoxville, TN Division 4 area. The following data will be obtained from Kroger: patient name, age, gender, city, sale date, product name, product strength, quantity dispensed, and store number. All data will be de-identified to further assess for change in prescribing pattern. This data will help to disclose the primary outcome if there is a decrease in prescribing gabapentin after it became a schedule V medication in the state of Tennessee. Results: N/A Conclusions: N/A

Poster #29 PRIMARY AUTHOR'S NAME Justice B. Parrish, PharmD Candidate PRACTICE LOCATION Union University ADDITIONAL AUTHORS Jennifer S. Byrd, PharmD, BCACP, BC-ADM TITLE OF POSTER Evaluating the timing of antihypertensive administration among patients ABSTRACT Purpose: The morning surge in blood pressure (BP) is known to increase the risk of myocardial events in the first several hours post awakening. The 2018 Diabetes Standards cite that there is growing evidence for bedtime dosing of at least one antihypertensive medication which improves BP, reduces cardiovascular (CV) events, and reduces mortality. The purpose of this investigation was to evaluate the timing of antihypertensive administration of patients prescribed antihypertensive medications. Methods: The institutional review board approved this study as exempt. An anonymous, Qualtrics survey was created utilizing a variety of questions related to antihypertensive medications, dosing times, and healthcare professional interactions. The survey was distributed through Union University College of Pharmacy’s Facebook page. Eligible participants included hypertensive adults prescribed at least one antihypertensive medication. Results: A total of 95 responses were received and sixty-five were included in the final analysis. Responses were excluded if respondents did not report a diagnosis of hypertension. Sixty-four percent of respondents were prescribed one antihypertensive medication; twenty-seven percent, two antihypertensives; six percent, three antihypertensives; and two percent, four antihypertensives. The most frequently reported missed dose occurred in the morning (25 percent), while the majority stated never missing a dose (approximately 56 percent). Approximately 88 percent of respondents reported never receiving a recommendation concerning the most appropriate time of day to consume an antihypertensive medication from a pharmacist, while 55 percent reported never receiving a recommendation from a medical prescriber. Of those that received a recommendation from a medical prescriber, fifty-two percent recommended in the morning; ten percent, at bedtime; thirty-one percent, one or more in the morning and one or more in the evening; and three percent, one or more in the morning and one or more at bedtime. Of those that received a recommendation by a pharmacist, seventy-five percent recommended all in the morning; approximately 13 percent recommended one or more in the morning and one or more in the evening and one or more in the morning and one or more at bedtime, respectively. Conclusion: This investigation suggests patients receive little counseling concerning timing of medication administration by prescribers and even less from pharmacists. The majority of patients were advised to take all antihypertensive medications in the morning. Healthcare professionals may be unaware of the benefits concerning CV outcomes related to consuming an antihypertensive at bedtime. Increased awareness of this simple intervention may prove to be clinically beneficial.

Poster #30 PRIMARY AUTHOR'S NAME Tiffany D. Rice, PharmD Candidate PRACTICE LOCATION Union University ADDITIONAL AUTHORS Jennifer S. Byrd, PharmD, BCACP, BC-ADM Andrew C. Martin, PharmD TITLE OF POSTER Evaluating hospitalizations for adverse drug reactions in local clinic patients ABSTRACT Purpose: Preventable adverse drug reactions (ADR) can be serious and result in hospital admission. Ideally, health care providers would identify patients at risk for an ADR and intervene in time to prevent an event. Studies have identified prevalence of admissions due to preventable ADRs ranging from three to nine percent; however, prevalence is influenced by many factors and is unique for every health care system. The purpose of this pilot study was to evaluate the feasibility of identifying patients of a large, regional outpatient clinic admitted to our hospital due to an ADR, characterizing potential risk factors that may have contributed to their ADRs. Methods: Patients who had an ADR that resulted in admission were identified from ADR cases reported to the hospital Pharmacy and Therapeutics Committee. This patient list was cross-referenced with the outpatient clinic electronic medical record (EMR) to identify patients that had an established relationship with a provider, primary or specialist, at the clinic. Patients were included in this retrospective review if their most recent clinic visit was not more than one year prior to their ADR. Data collected included patient demographics; home medication list; number and type of comorbidities; clinic visit history; ADR event date, description, severity, and probability; and length of stay. Results: We identified 20 clinic patients admitted for an ADR during April 2017. Three patients were admitted to a critical care unit, and the median length of stay was 3 days (range 1-13). Median patient age was 64 years (range 26-90 years). Races were equally represented. Twelve patients were female, and eight were male. Based on body mass index, 13 patients were obese. Ninety percent of patients had at least five comorbidities. The median number of home medications was 12.5 (range 1-24). Anticoagulants and insulin were associated with three and two events, respectively. Cardiovascular agents were implicated in seven events, and gabapentin was implicated in three. The median number of PCP/Specialist visits in the last year was 3.5 (range 1-43). Three ADRs were determined to be preventable, and 18 ADRs were “definitely” related to the culprit medication per the Naranjo Adverse Drug Reaction Probability Scale. The median ADR severity was 3, requiring additional therapeutic intervention but not ICU admission. Conclusion: We were able to match 20 hospital admissions (of which 15 percent were preventable and 90 percent were “definitely” related to the culprit medication) in a one-month interval to clinic patients in a separate outpatient health system suggesting that further investigation of potential risk factors for ADRs is possible. Their financial, physical, and emotional burden on patients can be substantial, so an effort to identify contributing factors unique to our clinic population could be meaningful.

Poster #31 PRIMARY AUTHOR'S NAME Kristin C. Davis, PharmD Candidate PRACTICE LOCATION University of Tennessee Health Science Center ADDITIONAL AUTHORS Mahmoud A. Shorman, MD Michael P. Veve, PharmD, MPH TITLE OF POSTER Outcomes in Patients with methicillin-resistant Staphylococcus aureus Bacteremia Treated with Ceftaroline fosamil ABSTRACT Purpose: Ceftaroline fosamil (CPT) is a broad-spectrum cephalosporin approved for the treatment of acute bacterial skin and skin structure infections and community-acquired bacterial pneumonia; however, data demonstrating the effectiveness of CPT in treating methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are limited. The purpose of this study is to describe treatment characteristics and identify outcomes of patients who received CPT for MRSA BSI. Methods: This was an IRB approved, cross sectional study performed at a large, academic medical center from 1/2015 to 6/2018. Adult patients with confirmed MRSA BSI who received CPT for at least 72 hours were included. Pharmacy decision support software was utilized to identify eligible patients. The primary outcome of interest was composite, and included death at 30-days, clinical worsening, or failure to clear MRSA BSI within 7-days of CPT. Results: 54 patients were included. The median (IQR) age was 48 (38-62) years, 52% were male, and 54% had a history of IV drug use. 98% received an antibiotic with activity against MRSA prior to CPT. The most common BSI sources were: multiple (35%), endocarditis (30%), skin and skin structure (11%), osteoarticular (9%), central line-related (4%), and other/unknown (9%). Rationale for CPT use was acute nephrotoxicity (34%) or primary treatment failure (19%). The median time to CPT initiation was 5 (3-9) days and duration of therapy was 35 (13-47) days. 52% of patients cleared BSI within 7 days of CPT, but 29% had cleared BSI prior to therapy. 11% of patients worsened clinically on CPT, 8% died within 30-days, and 22% were readmitted within 30-days. Overall, 30% of patients met criteria for the composite poor outcome; variables associated with the composite outcome included prior hospitalization within 30-days (unAdjOR, 6.8; 95%CI, 1.4-32) and mechanical ventilation (unAdjOR, 9; 95%CI 1.3-61). Conclusion: CPT may be a useful treatment option for MRSA BSI. Further data are needed to determine the effectiveness of CPT in MRSA BSI.

Poster #32 PRIMARY AUTHOR'S NAME Robert W. McCormick, PharmD Candidate PRACTICE LOCATION University of Tennessee Health Science Center ADDITIONAL AUTHORS Nancy Borja-Hart PharmD, BCPS TITLE OF POSTER Opioid use prevalence within mainstream hip-hop & R&B songs - A lyrical content analysis ABSTRACT Purpose: Previous literature has demonstrated a so called “hip-hop effect”, a finding that the hip-hop genre has a much higher prevalence of drug use in its lyrical content. This, alongside the inception of streaming services, exposes at-risk groups (namely adolescents) to this lyrical content. In the current climate of opioid overuse, we sought to investigate the lyrical content of popular hip-hop songs from recent years. Methods: Hip-hop & R&B songs listed on the Billboard Top 100 from the years 2008-2017 were selected as our sample. The lyrics for each song were copied from genius.com and evaluated individually by two investigators. Analysis was initially done individually and then reviewed congruently to discuss any discrepancies in content analysis. Lyrical content was noted if it contained probable substance use, with several substances recorded for analysis (opioids, alcohol, marijuana, cocaine, and “other”). References related to the distribution or “sale” of said substances was excluded from analysis. Unfamiliar slang terminology was evaluated using annotations from the lyric’s genius.com page. Lyrical content was recorded to evaluate the total number of references per year, songs containing each reference per year, and the number of references mentioned per song-hour of time per year. Results: A total of 367 songs were included in the analysis. Lyrical content demonstrated an inconsistent, but overall quantifiable increase in opioid mention within the Hip-hop & R&B songs that qualified for Billboard’s year-end Top 100. The year with the most opioid references was 2017 (n=65), and Future’s song ‘Mask Off’ accounted for 24 of those references. The number of songs referencing opioids per year follows the increasing trend, with 2017 (n=14) containing twice as many songs as the prior year (2016; n=7). Opioid use references saw increases of ~16x in frequency from 2008 to 2017 (n = 1.3238 ref/song-hour in 2008; n = 21.2363 ref/song-hour in 2017). Excluding alcohol, each substance group saw significant increases in frequency across this time span. Cocaine reference trends strongly correlate with the trends outlined by opioids. 2017 contained the most cocaine references (n=53) and the most songs containing cocaine references (n=9). References per song-hour also demonstrate approximately a 16x increase in frequency of cocaine references from 2008 to 2017. Conclusion: Increased popularity of the genres and availability to access music allows for greater exposure to this content. While no causal relationship can be established, at-risk individuals may be influenced by the culture they surround themselves with. Ultimately, the opioid crisis is a multi-faceted problem that may confer influence from popular media.

Poster #33 PRIMARY AUTHOR'S NAME Mostafa Moarefian, PharmD Candidate PRACTICE LOCATION University of Tennessee Health Science Center ADDITIONAL AUTHORS Nancy Hart, PharmD TITLE OF POSTER Evaluation of cinnamon’s effect on type 2 diabetes as add-on therapy ABSTRACT BACKGROUND: Herbal supplements including cinnamon have been broadly investigated for their health benefits. Cinnamon has been shown to have a hypoglycemic effect which is considered beneficial for diabetic patients. OBJECTIVE: This review aims to discuss the effects of cinnamon on fasting blood glucose (FBG) and HbA1c levels in patients with type 2 diabetes as add-on therapy. METHODS: A database search in PubMed, Google Scholar, and Science Direct was conducted based on the keywords “cinnamon”, “diabetes”, and “fasting blood glucose”. Randomized placebo-controlled trials on human subjects with type 2 diabetes were included in this review. Included studies used cinnamon powder (or extract with powder equivalent) for at least 6 weeks for FBG and 12 weeks for A1c evaluation. RESULTS: Eight studies met inclusion criteria. Patients included (n=570) had an age range of 49.1-62.8 years, a baseline A1c of 6.79-8.38%, and a dose range of 1-3 g cinnamon. Reductions in FBG with cinnamon ranged from 1.22 to 19.98 mg/dL, and they were significant in two studies compared to placebo (P<0.05). Three studies on A1c showed statistically significant reduction of 0.22 to 0.83 (P<0.05) in patients with moderately controlled baseline A1c. Those studies used 1-2 g cinnamon daily for duration of at least 12 weeks. CONCLUSION: Cinnamon could reduce fasting blood glucose and A1c significantly in moderately controlled baseline levels (FBG~160 mg/dL and A1c~8%). The use of 1-2 g cinnamon daily for at least 12 weeks, in addition to oral antihyperglycemic agents, can improve FBG and HbA1c in patients with type 2 diabetes.

Poster #34 PRIMARY AUTHOR'S NAME An N. Vo, PharmD Candidate PRACTICE LOCATION University of Tennessee Health Science Center ADDITIONAL AUTHORS Robin Lennon-Dearing, PhD, MSW Nancy Hart, PharmD, BCPS TITLE OF POSTER Assessment of pharmacy and social work students’ attitudes following an interprofessional activity using the SPICE-R2 assessment tool ABSTRACT Purpose: To assess and evaluate the impact of an interprofessional activity between pharmacy and social work students on student attitudes as measured by the Student Perceptions of Interprofessional Clinical Education-Revised version 2 (SPICE-R2) Methods: Third-year pharmacy students (n= 159) and social work students (n=10) participated in a 2-hour case-based interprofessional education (IPE) focused on cultural competence. According to Kirkpatrick Assessment Model, SPICE-R2 is a level 2a learning used to evaluate the modification of attitudes/perceptions. SPICE-R2 utilizes a 5-point response scale (1 = strongly disagree, 5 = strongly agree), and it contains 10 items which reflect a 3-factor model capturing interprofessional teamwork and team-based practice; roles and responsibilities for collaborative practice; and patient outcomes from collaborative practice. SPICE-R2 was administer via Qualtrics and analyzed using SPSS (Version 25). Descriptive statistics were summarized; and the Wilcoxon Signed-Rank Test was used to compare pre- and post-activity responses. Results: Seventy-two students completed the pre- and post IPE surveys (Pharmacy: n=71, Social Work: n = 1). Student attitudes toward roles/responsibilities for collaborative practice were positive in relation to 2 individual items: I have an understanding of the courses taken by, and training requirement of other health professionals (p =0.000) and I understand the roles of other health professionals within an interprofessional team (p =0.000). Positive attitudes toward 2 items in patient outcomes from collaborative practice was also noted by the item Healthcare cost are reduced when patients/clients are treated by an interprofessional team (p = 0.002) and Patient/client-centeredness increases when care is delivered by an interprofessional team (p = 0.001). However, there were no statistically significant differences in the domain of interprofessional teamwork and team-based practice. Conclusion: Overall, responses reflected positive attitudes toward IPE activity in 2 domains: roles/responsibilities for collaborative practice and patient outcomes from collaborative practices.

Poster #35 PRIMARY AUTHOR'S NAME Allison Karst, PharmD, BCPS PRACTICE LOCATION VA Tennessee Valley Healthcare System ADDITIONAL AUTHORS Michelle Colvard, PharmD, BCPP Jonathan Lister, PharmD, BCPS, BCPP Jennifer R. Bean, PharmD, BCPS, BCPP TITLE OF POSTER Impact of a Trainee Interdisciplinary Program on Outcomes in a Mental Health Setting ABSTRACT Background According to National Alliance on Mental Illness (NAMI), 43.8 million adults experience mental illness each year with only 40% receiving mental health (MH) services. Several barriers exist to accessible MH treatment, including stigma, misdiagnosis, and shortage of MH prescribers. Due to increasing demand for MH services, the healthcare system is moving toward an interprofessional approach. The purpose of the behavioral health interdisciplinary program (BHIP) is improved coordination and continuity of care, improved Veteran health status, and increased provider collaboration. The trainee BHIP (tBHIP) team consists of a PGY2 psychiatric pharmacy resident, PGY3 psychiatry resident, and post-doctoral psychology fellow supervised by qualified MH preceptors. Objectives The primary objective of this project is to evaluate the impact of a tBHIP team on treatment outcomes as measured by standardized assessments (PHQ-9, GAD-7, PCL-5). Secondary objectives are to assess changes in emergency department (ED) visits and psychiatric hospitalizations and to analyze cost-saving potential of the tBHIP model. Methods This project is a single-center, retrospective, observational analysis of adult Veterans at the Murfreesboro campus of the Veterans Affairs Tennessee Valley Healthcare System from August 2013 through April 2018. Adults age 18 and older referred to the tBHIP team will be included. Exclusion criteria includes individuals who could not be reached for scheduling, enrollment in clinic for < 90 days, failure to complete standardized assessments, or enrollment in the clinical video telehealth (CVT) tBHIP clinic. Eligible patients will be identified using the annual tBHIP excel sheet. Manual electronic medical record review will then be utilized to exclude patients based on defined criteria. Patient demographics to be collected include age, race, gender, referral source and date, intake date, psychiatric diagnoses, currently enrolled or discharge date, psychiatric hospitalizations and mental-health related ED visits 2 years prior to and 2 years following enrollment in tBHIP, and mental health assessment measures (at time of intake, most recent [if currently enrolled] or prior to discharge [if historical patient]). Outcomes Average standard assessment measures, psychiatric hospitalizations, and mental health-related emergency department visits will be compared pre- and post-clinic enrollment. Additionally, cost-saving potential of the tBHIP model will be analyzed.

Poster #36 PRIMARY AUTHOR'S NAME Garrett Crothers, PharmD, BCPS PRACTICE LOCATION Vanderbilt University Medical Center ADDITIONAL AUTHORS Amy Myers, PharmD, BCPS Lauren McCluggage, PharmD, BCPS TITLE OF POSTER Evaluation of use of fentanyl patches in opioid naive patients ABSTRACT Fentanyl is a potent opioid, and the inappropriate use of the patch formulation is linked with serious adverse effects, including death. From 2008 to 2010, the United States Food and Drug Administration (FDA) reported that fentanyl patches were the highest ranking drug involved in serious adverse events. The Institute for Safe Medication Practices (ISMP) included a new best practice regarding fentanyl patch prescribing in their 2018-2019 Targeted Medication Safety Best Practices for Hospitals. ISMP recommends that hospitals should eliminate the administration of fentanyl patches for patients with acute pain or who are opioid naïve. Current literature has demonstrated that up to 51.3% of fentanyl orders are inappropriate based on national safety regulations. ISMP recommends that health-systems utilize electronic alerts and hard stops along with not stocking patches in common areas that treat acute pain (emergency departments, operating rooms, post-anesthesia care units, and procedural areas). Currently at Vanderbilt University Hospital (VUH), fentanyl patches are only indicated for chronic pain management. Fentanyl patches are not approved by the Pharmacy, Therapeutics, and Diagnostics (PT&D) Committee for use in acute or post-operative pain. The purpose of this medication use evaluation was to assess the inpatient frequency of ordering fentanyl patches inappropriately for opioid naïve patients. This was a retrospective review of all patients at VUH who had an order placed for a fentanyl patch between July 1, 2018, and July 31, 2018. The primary outcome was the incidence of fentanyl patches ordered and administered to opioid naïve patients. Based on the ISMP Best Practice, opioid tolerance is defined by receiving therapy for one week or longer with at least 60 mg oral morphine/day, 25 mcg transdermal fentanyl/hour, 30 mg oral oxycodone/day, 8 mg oral hydromorphone/day, 25 mg oral oxymorphone/day, 60 mg oral hydrocodone/day, or an equianalgesic dose of another opioid. Patients not meeting criteria for opioid tolerance will be defined as opioid naïve. Secondary outcomes assessed included the fentanyl dose ordered, indication (acute versus chronic pain), home morphine milligram equivalence (MME), patient age, patient gender, ordering provider type, ordering provider team, and adverse effects assessed by the presence of a rapid response. Fifty-five patients received a fentanyl patch at VUH during the study period. Out of those 55 patients, 6 (10.9%) were opioid naïve according to the ISMP definition. One of the 6 opioid naïve patients received acute treatment with a fentanyl patch whereas the other 5 were receiving chronic therapy. Additionally, 37 of 55 patients (67.3%) had a fentanyl patch administration without a medication reconciliation conducted by a member of the pharmacy. Opportunities, such as more robust clinical decision support, exist for VUH to eliminate transdermal fentanyl administrations to opioid naïve patients.

Poster #37 PRIMARY AUTHOR'S NAME Michael K. Wisner, PharmD PRACTICE LOCATION Vanderbilt University Medical Center ADDITIONAL AUTHORS David Mulherin, PharmD Scott D. Nelson, PharmD, MS TITLE OF POSTER Multifactor advanced clinician support as a alternative to traditional drug-drug and drug-pregnancy interaction alerts ABSTRACT The combination of computerized physician order entry (CPOE) and clinician decision support (CDS) associated with CPOE has been shown to reduce medication errors and improve patient safety. However, it has also been shown that an overabundance of alerts can cause provider alert fatigue, which results in providers ignoring alerts even when they are clinically relevant. A common form of CPOE CDS is drug-drug interaction (DDI) alerts, which are solely based upon the pairing of two drugs. In some cases, these DDIs are only clinically relevant if a patient has other predisposing risk factors for the possible interaction adverse event. Another common form is drug-pregnancy alerts which are only based a drug ordered for a female patient of child-bearing age, some of which may only be applicable in the third trimester, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Advanced CDS, which takes into consideration multiple patient factors, have been proposed as a more specific alternative for such DDIs. Based upon review of provider response rates to our current commercial drug alert system, we plan to test replacing a select number of alerts with high override rates with advanced CDS. First, we plan to replace our potassium supplement/potassium sparing diuretic DDI alert with a risk factor scoring system alert. Next, we will replace a drug-pregnancy alert for NSAIDs, which currently triggers for all females of childbearing age unless they have a negative pregnancy status, with a CDS alert that will be limited individuals who are documented as being actively pregnant. Additionally, we will replace several DDI alerts for QT prolongation with a CDS alert that employs a risk factor scoring system. The effect of these changes will be measured by comparing the basic alert triggering rate to that of the multifactor CDS, as well as provider acceptance rates and provider override rates from before and after implementation. The alerts associated with the commercial drug vendor will be hidden from providers but will continue to trigger in the background to account for changes in prescribing habits not attributable to the CDS changes. The objective of this project is to increase the specificity of the drug interaction CDS alerts without negatively impacting alert sensitivity or patient safety.