7 minute read
PGY1/PGY2 Health-System Pharmacy Administration Residency
Evaluation of the impact of revisiting just culture within a pharmacy department in an academic medical center
Stephanie Crowley, PharmD, MS; Engie Attia, PharmD; Mobolaji Adeola, PharmD; Alex Varkey, PharmD, MS; Catherine Hatfield, PharmD; David Wallace, PharmD
PURPOSE
The primary objective was to assess change in perceived just culture after distribution of the medication safety newsletter, which was measured by change in percentage of negative responses (PNR) to the just culture assessment tool (JCAT) pre- and post- intervention.
METHODS
The primary objective was to assess change in perceived just culture after distribution of the medication safety newsletter, which was measured by change in percentage of negative responses (PNR) to the just culture assessment tool (JCAT) pre- and post- intervention.
RESULTS A total of 118 (40.5%) and 79 (27.5%) of pharmacy department employees completed the pre-and post-Just Culture Assessment Tool (JCAT) surveys, respectively. For the primary endpoint there was an unexpected statistically significant increase in overall JCAT PNR between the pre- and post-surveys (p=0.035). These results were likely due to confounders related to response rate rather than the intervention itself. There were statistically significant increases in PNR for the ‘Openness of Communication’ (p=0.009) and ‘Continuous Improvement’ (p=0.032) domains.
CONCLUSION
Cultivating a just culture is developed over time and is a dynamic process that is influenced by many factors. Just culture process improvements are likely to impact more than one just culture domain thus utilizing a validated tool to measure changes at the domain level may be beneficial.
PGY2 - PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP RESIDENCY
Stephanie Crowley, PharmD, MS
Stephanie earned her PharmD and her MS in Pharmacy Leadership and Administration from University of Houston College of Pharmacy in 2019 and 2021, respectively. Following her completion of her PGY2 residency, Stephanie will assume the role of pharmacy operations manager at HCA Kingwood. Primary project preceptor: Engie Attia, PharmD, BCPS
Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Alcalde Southwest Leadership Conference.
Evaluation of anti-Xa level-based enoxaparin bridge therapy in patients with left ventricular assist devices.
Nathan Jones, PharmD; May Achi, PharmD
PURPOSE Patients with a left ventricular assist device (LVAD) on warfarin with sub-therapeutic INR values require additional pharmacologic anticoagulation to prevent blood clots. This study aims to assess the bleeding risk of enoxaparin in association with anti-Xa results for LVAD patients.
METHODS
This is a single-center, observational, retrospective study of up to 50 patients admitted to Houston Methodist Hospital from January 2016 through September 2020. Patients included had implanted LVAD (HVAD, HEARTMATE II or III), received ≥ 2 doses of enoxaparin, had one or more anti-Xa levels for enoxaparin, and INR <2. Patients will be excluded if they had LVAD implantation during the same hospital visit, GI bleeding within the last 30 days, or who only received one dose of enoxaparin during their hospital stay. The incidence of major bleeding and transfusion requirements will be assessed as primary safety outcomes in addition to incidence of minor bleeding events, transfusion requirements and the incidence of thromboembolic events while receiving enoxaparin. Descriptive statistics will be performed to determine if the specific anti-Xa goal is associated with improved safety.
RESULTS
A total of 81 encounters were included, with 25 encounters having at least 1 anti-Xa result. Patients were administered a mean enoxaparin dose of 1.24 mg/kg/day for an average of 1.44 days. Major bleeding occurred in 1 encounter with a corresponding anti-Xa of <0.5 IU/mL. Thrombosis occurred in 1 encounter with a corresponding anti-Xa of 0.5-0.9 IU/mL.
CONCLUSION
In patients with LVAD admitted to Houston Methodist Hospital on enoxaparin, a similar rate of bleeding and thrombosis occurred between anti-Xa groups. Additional studies would be necessary to determine anti-Xa goals for enoxaparin bridging in these patients.
PGY1 - PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP RESIDENCY
Nathan Jones, PharmD
Nathan completed his undergraduate coursework and earned his PharmD from the University of Kansas School of Pharmacy in 2020. Following this year, he will continue into the second year of his combined PGY1/PGY2/MS HSPAL residency program. Primary project preceptor: May Achi, PharmD, BCPS
Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference
Cost effectiveness analysis of remdesivir in COVID-19 patients at a large academic medical center
Gabrielle Wu, PharmD, MS; Stephen Ma, MBA; Michael Fahey II, PharmD, MBA; Divya Varkey, PharmD, MS; Kevin Garey, PharmD, MS, FASHP
PURPOSE Cost-effectiveness analysis (CEA) is one form of health economic evaluation. In general, a CEA model can establish the comparative impact of a new intervention on “individuals’ length of life and health-related quality of life”, commonly measured as quality-adjusted life-year (QALY). A decision model for remdesivir was adapted and built in TreeAge software, then validated with real-world data collected at an academic medical center. The purpose of the model was to determine the changes in hospitalization costs associated with the differences in treatment using remdesivir plus standard of care versus treatment with standard of care alone.
METHODS
The design was a long-term longitudinal cohort decision tree model study. The target population comprised of adult patients admitted between March 6, 2020 and May 31, 2020 with a novel severe acute respiratory syndrome coronavirus 2 infection. Hospitalized patients with moderate or severe category of disease based on the institution’s COVID-19 treatment algorithm at the time of patients’ admissions were included. The decision tree structure was an adaptation of the CEA model published by the Institute for Clinical and Economic Review (ICER). This model aimed to estimate the incremental cost required to gain one unit of health benefit, or per QALY, for remdesivir at the $50,000 QALY threshold.
RESULTS The incremental cost-effectiveness ratio was $346,622 as determined by the adapted CEA model based on parameters from the ACTT-1 trial. This incremental cost-effectiveness ratio value was not considered to be cost-effective. The modified CEA model populated with real-world patient data resulted in an incremental cost-effectiveness ratio value of $3,280,952, which was considered not cost-effective.
CONCLUSION
Remdesivir was concluded to not be cost-effective in reducing disease-severity bundled hospitalization costs when used to treat hospitalized patients with COVID-19 disease in combination with standard of care, as compared to standard of care alone. However, the results of this study are not extractable to other countries where hospital payments are based on per diem estimates and are not bundled into one single cost regardless of the duration of hospital stay.
PGY2 -PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP RESIDENCY
Gabrielle Wu, PharmD, MS
Gabrielle earned her BS in Cellular and Molecular Biology from UOM in 2014 and PharmD from UNC in 2019. She also received her MS in Pharmacy Leadership and Administration from the UH Pharmacy in 2021. Following completion of her PGY2 residency, Gabrielle will assume the role of pharmacy program coordinator in financial management at Cedars-Sinai Medical Center. Primary project preceptor: Kevin Garey, PharmD, MS, FASHP
Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Alcalde Southwest Leadership Conference
Niha Zafar, PharmD; Niaz Deyhim, PharmD, MS; Sunny Bhakta, PharmD, MS; Magdi Ayyad, RPh; Alex Varkey, PharmD, MS
PURPOSE
The purpose of this study was to explore the processes to successfully implement centralized pharmacy order verification services in a multi-hospital health system and evaluate its impact on operational efficiency, productivity, and quality.
METHODS
A quasi-experimental study was performed to evaluate the implementation of centralized pharmacy order verification in a multi-hospital health system. The study timeframe included a pre-intervention period from June 2020 to August 2020 and a post-intervention period from April 2021 to June 2021. A pilot with three of eight institutions in the healthsystem was initially established in September 2020, with a phased approach to inclusion of additional institutions to allow time for pharmacists to develop comfort with unfamiliar orders and adjustments to workflow. A shared work queue was created with orders from specific units from each institution for centralized verification. The primary endpoint was the productivity measured through average hourly order verification rates. The secondary endpoints included aggregate verification turnaround time and medication orders adjusted per 100 orders verified as an objective surrogate for safe practices.
RESULTS
The average hourly order verification rate after implementation of the pilot was 105 orders per hour, compared to an average of 46 orders per hour for all hospitals in the health-system prior to the pilot. The aggregate verification turnaround time decreased overall from 7.25 minutes in the pre-implementation period to 5.25 minutes in the post-implementation period. The number of medication orders adjusted per 100 orders verified remained similar between the pre- and postimplementation periods.
CONCLUSION
Implementation of a centralized pharmacy order verification pilot demonstrated an increase in pharmacist productivity while maintaining quality of medication order review. Continuous evaluation of process improvements and quality assurance is essential for successful implementation of these services. Further assessment is needed to determine the long-term opportunities for advancement and expansion of onsite pharmacist roles to provide value-added services to individual institutions.
PGY1 - PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP RESIDENCY
Niha Zafar, PharmD
Niha completed her undergraduate coursework and earned her PharmD from the University of Houston College of Pharmacy in 2020. Following completion of her PGY1 residency, Niha will continue her residency training in the combined program as a PGY2 Pharmacy Administration Resident.
Primary project preceptor: Alex Varkey, PharmD, MS, FAPhA
Presented at 2020 Virtual Vizient Pharmacy Network; 2021 Virtual Midwest Pharmacy Residents Conference; 2021 ASHP Virtual Conference for Pharmacy Leaders
