PGY1 Pharmacy Residency – Sugar Land

Evaluation of a Pharmacy-Initiated Fall Consult

Shireen Rasheed, PharmD; Meghan Thibeaux, PharmD, BCPS; Brittany Yalamanchili, PharmD, BCPS; Punit Shah, PharmD, BCIDP; Kathryn Agarwal, MD

PURPOSE

To assess whether a pharmacy-initiated consult based on the Hester Davis Scale, a nursing driven assessment tool to identify patients at high risk for falls, increased pharmacy interventions in hospitalized patients.

METHODS

This was an IRB approved, single-center, randomized study that enrolled patients ≥ 70 years old with a HDS ≥ 18, and those who had a fall within the past month or during current admission between January to July 2021. Clinical pharmacists performed an evaluation of all medications that increased risk of falls and made recommendations in the intervention group. The primary outcome was the number of accepted pharmacy recommendations to modify medication that increase risk of falls. Secondary outcomes included length of stay (LOS), inpatient falls, and mortality.

RESULTS

The study included 561 patients, 291 patients in the control group and 270 patients in the intervention group. There was an increase in pharmacist recommendations in the intervention group compared to the control group (20% vs 11%; p=0.021). Opioids and cardiovascular agents were the most common categories with accepted interventions.

CONCLUSION

The results of this study suggest a benefit in pharmacistfocused review to optimize pharmacotherapy regimens in patients at high risk of falls. Future studies should aim to assess the association between pharmacist interventions with reduction in falls.

PGY1 PHARMACY RESIDENCY – HOUSTON METHODIST SUGARLAND

Shireen Rasheed, PharmD

Shireen earned her PharmD from Texas A&M Irma Lerma Rangel College of Pharmacy in 2021. Following completion of her PGY1 residency, Shireen will be completing a PGY2 ambulatory care residency at JPS Hospital in Fort Worth, Texas. Primary project preceptor: Meghan Thibeaux, PharmD, BCPS

Presented at 2021 Virtual Vizient Pharmacy Network and 2022 Midwest Pharmacy Residents Conference.

Evaluation of Nasal MRSA PCR-Driven De-Escalation of AntiMethicillin-Resistant Staphylococcus Aureus Antibiotics for Pneumonia: A Multi-Center Retrospective Cohort Study

Cylene Ann Talabucon, PharmD; Punit J. Shah, PharmD, BCPS, BCIDP; Sapana Desai, PharmD, BCPS; Chiamaka Ike, PharmD, BCPS, BCCP, BCCCP; Christine Huls, PharmD, BCPS; Rebecca Kessinger, PharmD, BCCCP; Hoang Huynh, PharmD, MBA, BCPS; Judy Ikwuagwu, PharmD, BCPS, BCIDP

PURPOSE Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of concern in hospital-acquired pneumonia (HAP) and has been infrequently implicated in community-acquired pneumonia (CAP). The administration and monitoring of anti-MRSA antibiotics (vancomycin, linezolid, ceftaroline) for pneumonia are associated with significant healthcare costs and increased risk of adverse events. As MRSA is a natural colonizer of the nares, the nasal MRSA PCR has been identified as a tool to guide antimicrobial therapy in patients with suspected pneumonia. It has a high negative predictive value for ruling out MRSA pneumonia in both CAP (98.4%) and HAP (97.7%) and may be utilized as an antimicrobial stewardship tool for de-escalating anti-MRSA antimicrobials prescribed for pneumonia.

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

Utilizing the MRSA PCR reduced the mean duration of therapy of empiric MRSA therapy for respiratory tract infections by 1.3 days (3.9 days for the no MRSA PCR group versus 2.6 days for the MRSA PCR group; P = 0.0001; 95% CI: 0.94 to 1.71). This was driven by two thirds (63%) of our pharmacists were able to successfully intervene through de-escalating or discontinuing antibiotics. Being admitted into the ICU increased duration of therapy (P < 0.0001; 95% CI: 0.40 to 1.08) versus utilizing the MRSA PCR decreased duration of therapy (P < 0.0001; 95% CI: -1.77 to 1-.01).

CONCLUSION

in conclusion, our retrospective chart review found that using the nasal MRSA PCR resulted in significant reduction in duration of therapy of vancomycin, linezolid, and ceftaroline. These findings support the role of pharmacists and nasal MRSA PCR testing in antimicrobial stewardship to encourage de-escalation of therapy for patients with respiratory tract infections.

PGY1 PHARMACY RESIDENCY – HOUSTON METHODIST SUGAR LAND

Cylene Ann G. Talabucon, PharmD

Cylene completed her PharmD from Belmont University College of Pharmacy in 2021. She completed her PGY1 residency at Houston Methodist Sugar Land Hospital. Following completion of her PGY1, Cylene will be seeking a clinical pharmacist position in the future. Primary project preceptor: Punit J. Shah, PharmD, BCPS, BCIDP

Presented at 2021 Virtual Vizient Pharmacy Network and 2022 Midwest Pharmacy Residents Conference.