Houston Methodist Department of Pharmacy Annual Research Report 2019-2020 by Houston Methodist Professional Publications

HOUSTON METHODIST DEPARTMENT OF PHARMACY Annual Research Report | 2019-2020

2019-2020 HOUSTON METHODIST POSTGRADUATE PHARMACY RESIDENCY & FELLOWSHIP CLASS Houston Methodist Department of Pharmacy The Department of Pharmacy at Houston Methodist collaborates with the health care team to provide innovative, personalized, cost-effective pharmaceutical care in a culture dedicated to quality and safety. The pharmacy department’s vision is to be recognized as a global leader of pharmaceutical care in the health care setting. To that end, we strive to: • Continuously improve the quality and safety of patient care and the medication management process • Cultivate an environment of collaboration and teamwork • Provide high-quality training and education to our technicians, student interns, residents and pharmacists • Maximize the use of automation and information technology • Maximize cost efficiencies and resource utilization

TABLE OF CONTENTS

2 | Letter from Daniel L. Metzen, PharmD, MBA

3 | Letter from Alex C. Varkey, PharmD, MS

System Director of Pharmacy Services, Houston Methodist Director of Pharmacy Services, Houston Methodist Hospital

4 | Pharmacy Research Committee Members

5 | Letter from Katherine Perez, PharmD, BCPS-AQ ID

Chair of Pharmacy Research Committee, Houston Methodist

6 | Pharmacy Research Funding

7 | Pharmacy Research Fellowship

8â&#x20AC;&#x201C;30 | 2019-2020 Houston Methodist Hospital Pharmacy Postgraduate Trainees 8 | PGY1 Pharmacy Residency Anna Curtis, PharmD Diane Dreucean, PharmD Taryn Eubank, PharmD Johnny Hoang, PharmD Nicholas Jakowenko, PharmD Aaron Krapfl, PharmD

14 | PGY1 International Graduates

22 | PGY2 Infectious Diseases Pharmacy Residency

Joshua Knight, PharmD

23 | PGY2 Internal Medicine Pharmacy Residency

Hayley Brazeale, PharmD

24 | PGY2 Oncology

Pharmacy Residency

Karen Abboud, PharmD Ghalia Bakhsh, PharmD Zain Malik, PharmD

Rodrigo De La Torre, PharmD Godsfavour Umoru, PharmD

26 | PGY2 Solid Organ Transplant Pharmacy Residency

17 | PGY1/PGY2 Health-System Pharmacy Administration Residency Stephanie Crowley, PharmD Gabrielle Wu, PharmD Niaz Deyhim, PharmD, MS

Megan Cooper, PharmD Danielle Ecabert, PharmD

28 | Clinical Pharmacy Fellowship

20 | PGY2 Critical Care Pharmacy Residency

Emily Highsmith, PharmD Chelsea Lopez, PharmD

31 | System Pharmacy Research Bibliography

in Outcomes Research Tomona Iso, PharmD Anh Thu Tran, PharmD Farrah Yuan, PharmD

LETTER FROM THE SYSTEM DIRECTOR OF PHARMACY SERVICES Thank you to all who contributed to the endeavors in this annual report. The effort and energy put behind this work ultimately provides us the knowledge to deliver unparalleled quality care to the patients we serve. Consistent with previous years, the report demonstrates the pharmacy teamâ&#x20AC;&#x2122;s dedication to excellence, innovation and the highest commitment to our patients. Hats off to another amazing year!

Daniel L. Metzen, PharmD, MBA System Director of Pharmacy Services, Houston Methodist

LETTER FROM THE DIRECTOR OF PHARMACY SERVICES ON BEHALF OF THE HOUSTON METHODIST HOSPITAL PHARMACY MANAGEMENT TEAM, I want to extend my sincere appreciation to all of our graduating residents and fellows. Our residents and fellows fully invest in their respective opportunities to grow both personally and professionally and, in the process, make a lasting impact on our effort to optimize patient outcomes. This year was especially challenging given our need to respond to the global COVID-19 pandemic. As usual, our team responded with unparalleled efforts in patient care and in facilitating cutting-edge research. The Houston Methodist Pharmacy Department’s Investigational Drug Services (IDS) division was put into hyper-drive this year. With Houston Methodist’s active engagement in COVID-19 related drug studies, our IDS services are tracking toward a 263% increase in investigational medication dispensing events in 2020. This surge in activity required pharmacy staff across our facilities — some who may not have traditionally been involved in investigational drug trials — to participate in the care of patients on investigational therapies. Our IDS team stepped up to train staff and oversee dispensing and inventory processes so that every requirement and safeguard was applied to every patient. IDS staff kept pace with the patient enrollment and ensured product supplies were attained timely. Our organization and patients are indebted to these pharmacy team members. As has been the case for over 30 years, the bulk of our department-initiated research activity has resided in our pharmacy training programs, and we continue to be grateful for the hard work and dedication of our pharmacy learners, preceptors/practitioners, and staff. These are a few of our greatest accomplishments in the 2019-2020 residency year: • Pharmacy investigators from across Houston Methodist received external funding totaling over $787,000 • Pharmacy learners and preceptors were responsible for 25 poster and platform presentations across four regional and national conferences • 27 publications in peer-reviewed journals and other literature sources were produced by Houston Methodist pharmacy learners and leaders Each of these achievements took considerable commitment and an immense amount of work. Our successes in research and scholarship are a true testament to the pharmacy department’s commitment to working alongside other health care disciplines in advancing patient care. As we move ahead to the 2020-2021 residency year, we will continue with laser focus on what we do each and every day. That includes enhancing our medication distribution, clinical services, and regulatory/quality compliance efforts to provide an environment of unparalleled safety, quality, service, and innovation for our patients.

Alex C. Varkey, PharmD, MS, FAPhA Director of Pharmacy Services, Houston Methodist Hospital

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PHARMACY RESEARCH COMMITTEE MEMBERS

Katherine K. Perez, PharmD, BCPS-AQ ID Chair

Jill C. Krisl, PharmD, BCPS Vice Chair; Project Approval Lead

Mobolaji Adeola, PharmD, BCPS Member

David R. Putney, PharmD, MPH, BCPS - AQ Cardiology Project Alignment Lead

Michael Sirimaturos, PharmD, BCNSP, BCCCP, FCCM Education Lead

Michael Johnson, PhD External Statistician Consultant & University of Houston Collaboration Lead

Joshua T. Swan, PharmD, MPH, BCPS, FCCM Past Chair & Research Infrastructure Lead

Hanna Zaghloul, PharmD, BCOP Visibility Lead

Christine Pham, PharmD Member

Tomona Iso, PharmD Member

Anh Thu Tran, PharmD Member

Farrah Yuan, PharmD, BCPS Member

Engie Attia, PharmD, BCPS Project Development Lead

Elsie Rizk, PharmD Project Support

LETTER FROM THE PHARMACY RESEARCH COMMITTEE CHAIR Welcome to the Department of Pharmacyâ&#x20AC;&#x2122;s fifth edition of the Annual Research Report. I am absolutely thrilled to showcase the outstanding patient care initiatives our department has accomplished in the setting of the coronavirus pandemic. Over the course of 2019-2020, members of our pharmacy department have spearheaded key research collaborations to optimize care in surgical, internal medicine, infectious diseases, transplant, critical care and oncology patient populations. The pharmacy department continues to demonstrate dedication and resolve towards the advancement of pharmacy practice and patient care. This year has shown that we have the ability to successfully pivot when necessary. The mission of the Pharmacy Research Committee is to ensure excellence in the quality and feasibility of research conducted, and the quality of research training provided by the Department of Pharmacy at Houston Methodist. The committee has continued to optimize established programs, including project proposal development, project approval, resident alignment, support, education, visibility, and building a more robust research infrastructure and partnership with the Houston Methodist Research Institute. Clinician and preceptor education was a focal point for 2019-2020. The committee developed a training infrastructure by providing fundamental research training classes to clinicians and by providing ongoing support from project development to completion. We have had several changes to our membership roster, including an expansion to 12 members and a formalized role for our pharmacy research fellows as leads of the support program. Our preceptors, residents, and staff are an energetic team committed to high quality and innovative patient care, education, research, leadership, and advocacy. As always, our goals are grounded in our mission to be unparalleled. I would like to sincerely thank all members of the Pharmacy Research Committee for their hard work, dedication and continued expertise, which have been vital to our success.

Katherine K. Perez, PharmD, BCIDP Chair, Pharmacy Research Committee

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PHARMACY RESEARCH FUNDING Joshua T. Swan, PharmD, MPH, BCPS, FCCM, Administrative Specialist in Research and Associate Professor of Pharmacy in Surgery and Outcomes Research, received $468,358 in external funding to support five investigator-initiated studies. This success was possible due to tremendous support from fellows in the Clinical Pharmacy Fellowship in Outcomes Research. • “Effect of intraoperative liposomal bupivacaine on inpatient hospital costs after colorectal surgery: a pharmacoeconomic analysis of a single center, retrospective, cohort study.” Pacira Pharmaceuticals; $60,242 • “Validation and testing of a clinical research surveillance service to support clinical trial enrollment, screening, and protocol compliance monitoring.” VigiLanz Corporation; $87,516 • “Optimization of opioid discharge prescriptions following thyroid and parathyroid surgeries.” Subaward to the parent award under direction of Douglas Thornton, PhD, PharmD, at the University of Houston; HHS000437900001 Texas Health and Human Services; $75,000 • “Improving adherence to rabies post exposure prophylaxis guideline recommendations for rabies immune globulin at a multi-hospital health system through education, collaboration, and clinical decision support.” Grifols North America; $126,100 • “Incidence and management of midline catheter complications: a multi-hospital, retrospective study.” Genentech; $119,500

Katherine K. Perez, PharmD, BCIDP, Clinical Specialist in Infectious Diseases and Assistant Professor of Allied Health Sciences, received $318,568 in funding from participation in the industry-sponsored study, “A multi-center, multi-country retrospective cohort study to evaluate the clinical outcomes in adults with severe COVID-19.” The work was published in the Clinical Infectious Diseases Journal with Dr. Perez as the second author on the work. This effort was supported by the fellows in the Clinical Pharmacy Fellowship in Outcomes Research program.

PHARMACY RESEARCH FELLOWSHIP Houston Methodist Clinical Pharmacy Fellowship in Outcomes Research ACCP Program Review Announcement The American College of Clinical Pharmacy (ACCP) Research Fellowship Program Review Committee on Sept. 11, 2020, recognized the Houston Methodist Clinical Pharmacy Fellowship in Outcomes Research as meeting the ACCP Guidelines for Research Fellowship Training Programs. This prestigious designation was awarded after an extensive review of the fellows’ training experiences and demonstrated record of peer-reviewed publications and attainment of external funding. Only 4 pharmacy fellowship programs nationally can claim this recognition. The two-year Houston Methodist Clinical Pharmacy Fellowship in Outcomes Research, led by Joshua Swan, PharmD, MPH, trains pharmacists to become faculty in pharmacy academia or clinical scientists in either heath systems or the biopharmaceutical industry. Fellows gain over 3,000 hours of structured education and first-hand applied experiences in the topics of epidemiology, biostatistics, clinical pharmacology, ethics and regulatory compliance. To date, six fellows have been enrolled in the program. Two have graduated with one starting a career in academia and the second as a health-system outcomes researcher. Four are currently in training. Obtaining ACCP’s recognition validates the quality of training the fellowship program provides at Houston Methodist. This builds on successes of the institution’s eight postgraduate pharmacy residency programs accredited by the American Society of Health-System Pharmacists (ASHP) and the most recent Pharmacy Informatics program that is currently in candidate status.

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Impact of Lactobacillus supplementation on postoperative infection rates amongst patients undergoing orthotopic liver transplantation Anna Cuttis, PharmD; Mozhgon Moaddab, PharmD; Jesse E. Harris, PharmD; Duc Nguyen, MD, PhD; Edward Graviss, PhD, MPH; Constance Mobley, MD, PhD; R. Mark Ghobrial, MD, PhD PURPOSE

RESULTS

Disruption of intestinal flora during orthotopic liver transplant (OLT) may increase the risk of bacterial translocation and infection. Postoperative infections remain a leading cause of morbidity within the first three months of transplant. Perioperative use of Lactobacillus has been shown to decrease post-transplant infections in patients with median Model for End-stage Liver Disease (MELD-Na) scores around 15. In this study, we sought to compare postoperative infection rates amongst patients undergoing OLT with MELD-Na scores > 30 who received perioperative Lactobacillus versus those that did not.

A total of 26 patients were identified that met inclusion criteria in the Lactobacillus group, and were subsequently matched 2:1 with 51 patients that had not received Lactobacillus. The median (interquartile range) MELD-Na score for included patients was 36 (30-40). Postoperative infections occurred in 3 (11.5%) patients within 14 days post-transplant in the Lactobacillus group and in 7 (13.7%) patients in the non-Lactobacillus group (p=1.00), respectively. There were no significant differences found among the secondary outcomes. CONCLUSION

METHODS

We performed a retrospective, single-center, matched cohort study of adult liver transplant recipients from 20162019. Patients were included in the Lactobacillus group if they received at least five days of Lactobacillus therapy in the perioperative setting. The primary outcome was incidence of infections within 14 days post-OLT.

Among adult patients with MELD-Na scores > 30 who underwent OLT, patients who received perioperative Lactobacillus supplementation versus those who did not receive Lactobacillus had no difference in postoperative infection rates within 14 days of OLT. There were no indicators of increased harm observed from probiotic supplementation. Further evaluation of the optimal timing and dosing regimen of probiotics is warranted to assess their impact on post-operative outcomes in this population.

PGY1 PHARMACY RESIDENCY

Anna Curtis, PharmD Anna earned her PharmD from the University of Houston College of Pharmacy in 2019. Following the completion of her PGY1 residency, Anna will continue her postgraduate training as a PGY2 Solid Organ Transplant Pharmacy Resident at Houston Methodist Hospital. Primary project preceptor: Mozhgon Moaddab, PharmD, BCPS Presented at 2019 VizientÂŽ Pharmacy Network, Las Vegas, NV

Evaluation of characteristics and dosing regimens in patients with therapeutic failure on apixaban and rivaroxaban Diane Dreucean, PharmD; Steffany Nguyen, PharmD; Kevin Donahue, PharmD; Eric Salazar, MD, PhD; Melanie Ruegger, PharmD PURPOSE

RESULTS

Recent cases of therapeutic failure with apixaban and rivaroxaban have been reported. Potential risk factors associated with therapeutic failure such as dose deviations outside of package labeling recommendations, and the use of direct factor Xa-specific inhibitor levels to guide clinical decision making continue to be areas of further investigation. This study aimed to describe characteristics and dosing regimens in patients on apixaban or rivaroxaban who experienced a therapeutic failure.

A total of 190 patients were included in the final analysis. In patients presenting with breakthrough thromboembolism, 78% were on a regimen that matched package labeling recommendations. Anti-Xa levels were documented in 66 patients, the majority of which fell within institutional expected ranges at time of thrombosis. Therapy interruptions immediately prior to thrombosis were observed in 22% of patients and 17% of those patients received parenteral anticoagulation during interruption. Upon discharge, 46% of patients continued the same anticoagulation regimen with no changes. The mortality rate was 6%.

METHODS

This study was an IRB approved, retrospective, descriptive study conducted on patients admitted to the Houston Methodist Hospital System between May 2016 and August 2019, with a new documented thromboembolic event while on apixaban or rivaroxaban therapy. Patients were excluded if they received apixaban or rivaroxaban for a condition other than treatment or prevention of venous thromboembolism or stroke prevention in non-valvular atrial fibrillation. The primary objective was to describe the appropriateness of anticoagulation regimens as per FDA package labeling in patients presenting with therapeutic failure. The secondary objectives of the study were to evaluate factor Xa inhibitor-specific anti-Xa level(s), anticoagulation therapy interruptions, use of parenteral “bridge” anticoagulation therapy during interruption of factor Xa inhibitor therapy, history of factor Xa inhibitor use, and mortality associated with apixaban or rivaroxaban failure.

CONCLUSION

Utilization of apixaban and rivaroxaban outside the scope of package labeling requirements may lead to higher rates of therapeutic failure and cannot be routinely recommended due to lack of safety and efficacy data. In patients who present with therapeutic failure on apixaban or rivaroxaban, a thorough review of risks and benefits should be conducted to mitigate future risk of recurrent thrombosis.

PGY1 PHARMACY RESIDENCY

Diane Dreucean, PharmD Diane earned her PharmD from the University of Houston College of Pharmacy in 2019. Following the completion of her PGY1 residency, Diane will continue her postgraduate training as a PGY2 Pharmacy Resident in critical care at Houston Methodist Hospital. Primary project preceptor: Melanie Ruegger, PharmD, BCPS Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

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Incidence of invasive fungal infections in leukemia and myelodysplastic syndrome patients receiving antifungal prophylaxis Taryn A. Eubank, PharmD; Eleanor Hobaugh, PharmD, BCOP; Cynthia El Rahi, PharmD, BCOP; Jasleen Randhawa, MD PURPOSE

RESULTS

Invasive fungal infections continue to be a common cause of morbidity and mortality in neutropenic patients undergoing chemotherapy for acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), and myelodysplastic syndrome (MDS) despite prophylactic use of antifungal agents. Barriers such as cost, insurance approval, and increased dosing frequency and pill burden contribute to the use of alternative antifungal prophylaxis such as fluconazole. Due to these barriers, we conducted a retrospective study to address the following research question: Are the rates of invasive fungal infections increased in leukemia and MDS patients receiving prophylaxis with fluconazole compared to voriconazole or posaconazole?

Our cohort consisted of 94 patients that met inclusion/ exclusion criteria. Invasive fungal infection rates in the cohort was found to be 8.5%. A majority of patients were initiated on fluconazole prophylaxis (64%) with voriconazole being the second most utilized agent (33%). The rate of invasive fungal infections specific to initial antifungal prophylaxis agent utilized was the following: fluconazole (6.4%), voriconazole (2.13%), and posaconazole (0%).

METHODS

A retrospective chart review was conducted on all patients with leukemia and MDS who received antifungal prophylaxis during induction or re-induction of chemotherapy between January 1, 2017 to January 1, 2019. The primary outcome of incidence of invasive fungal infection was defined as proven, probable, or possible fungal infection and secondary outcomes included: (1) toxicities experienced from the antifungal agents such as elevated liver enzymes, QTc prolongation, or CNS side effects (hallucinations or nightmares), (2) drug-drug interactions or, (3) financial barriers to treatment including cost or insurance coverage gap.

CONCLUSION

In summary, our institution’s overall invasive fungal infection rate was found to be 8.5% which falls within published literature rates. Treatment with fluconazole for antifungal prophylaxis in our study population resulted in a higher occurrence of invasive fungal infections in comparison to voriconazole or posaconazole prophylaxis. These results may be used to improve antifungal prophylaxis practices within our system.

PGY1 PHARMACY RESIDENCY

Taryn Eubank, PharmD Taryn earned her bachelor’s degree in biochemistry and molecular biology from Harding University in 2015, and her PharmD from Harding University College of Pharmacy in 2019. Following completion of her PGY1, Taryn will continue her postgraduate training as a PGY2 Pharmacy Resident in infectious diseases at Houston Methodist Hospital. Primary project preceptor: Eleanor Hobaugh, PharmD, BCOP Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

Predictors of 90-day readmissions associated with hypo- or hyperglycemic events in new kidney transplant recipients Johnny Hoang, PharmD; Leroy Koh, PharmD; Mobolaji Adeola, PharmD; Archana Sadhu, MD; Ian Dunne, PharmD PURPOSE

RESULTS

Predictors of hospital readmissions in patients with type 2 diabetes have been well studied and validated; however, risk factors for readmissions related to hypo- or hyperglycemic events in kidney transplant patients are not well elucidated. The objective of this study was to identify predictors of 90day readmissions associated with hypo- or hyperglycemic events in new kidney transplant patients.

Fifty four cases readmitted with a glycemic event within 90 days from index admission were identified and matched to 162 controls. In the final multivariate model, a history of diabetes pre-transplant (OR=36.08 [5.21-203.03], p<0.001) and documented infections before readmission (OR=4.23 [1.58-12.12], p=0.003) were significantly associated with an increased in hypo- or hyperglycemiaassociated readmissions. In addition, the odds of readmission increased by 37% as age increased by one year (p=0.034). The use of basiliximab (OR=0.073 [0.0150.32], p=0.002) and alemtuzumab (OR=0.13 [0.021-0.58], p=0.003) compared to anti-thymocyte globulin for induction were associated with fewer readmissions due to glycemic events.

METHODS

A retrospective, matched case-control study was conducted from May 2016 to April 2019 which analyzed kidney transplant recipients. Cases were defined as patients 18 years or older with a hypo- (blood glucose < 70 mg/dL) or hyperglycemic (blood glucose > 300 mg/dL) event within 24 hours of readmission during the first 90 days following index admission for transplant. Exclusion criteria consisted of patients with scheduled readmissions or multi-organ transplants. Cases were matched to controls in a 1:3 ratio by transplant date and length of stay of the index transplant admission. Predictors of 90-day readmissions were first identified by univariate analyses followed by multivariate logistic regression modeling.

CONCLUSION

Our findings suggest that identifying older patients at the time of transplant, targeting patients with diabetes, preventing infections post-transplant, and use of alemtuzumab or basiliximab for induction may reduce the risk of hospital readmissions related to hypo- or hyperglycemic events.

PGY1 PHARMACY RESIDENCY

Johnny Hoang, PharmD Johnny earned his PharmD from the University of Houston College of Pharmacy in 2019. Following the completion of his PGY1 residency, Johnny will continue his postgraduate training as a PGY2 Solid Organ Transplant Pharmacy Resident at Houston Methodist Hospital. Primary project preceptor: Ian Dunne, PharmD, BCPS Presented at 2019 VizientÂŽ Pharmacy Network, Las Vegas, NV

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Apixaban and rivaroxaban anti-Xa level utilization and associated bleeding events within an academic health system Nicholas Jakowenko, PharmD; Steffany Nguyen, PharmD; Melanie Ruegger, PharmD; Ashley Dinh, PharmD; Eric Salazar, MD, PhD; Kevin R. Donahue, PharmD PURPOSE

RESULTS

There are situations in which monitoring of anti-Xa levels for oral factor Xa inhibitors (FXaI) may be useful, but there is a paucity of data correlating these levels with clinical outcomes. The aim of this study was to evaluate anti-Xa levels for apixaban and rivaroxaban and their association with major bleeding events.

A total of 979 anti-Xa levels were drawn during the study period, of which 606 were included in final analyses. The most common reasons for ordering levels were bleeding, prior to a procedure, and preceding heparin initiation. There were 146 confirmed major bleeding events in 105 (72%) patients taking apixaban and 41 (28%) taking rivaroxaban, with the most common site being intracranial (63%). Median anti-Xa levels in patients with a major bleed compared to those without were lower in patients taking apixaban (86 ng/ mL vs 105 ng/mL), but higher in those taking rivaroxaban (110 ng/mL vs 60 ng/mL). Fifty-four patients received fourfactor prothrombin complex concentrate and five patients received andexanet-alfa. Factors significantly associated with an increased odds of bleeding were an age > 80 years, inappropriately high dosing regimens, and modest anti-Xa levels (100-300 ng/mL) for rivaroxaban specifically. Observed anti-Xa levels 2-4 hours post-dose had high inter-patient variability and were often outside the expected ranges.

METHODS

All anti-Xa levels ordered across the Houston Methodist system for apixaban and rivaroxaban from May 2016 to September 2019 were evaluated for inclusion irrespective of whether a patient received an inpatient dose of FXaI. Levels were excluded if therapeutic heparin or low-molecular weight heparin products were administered 24 hours prior, or a level was deemed to be ordered in error based on patient drug exposure. The primary endpoint was major bleeding events per the International Society of Thrombosis and Haemostasis (ISTH) criteria. Secondary endpoints included reversal agent use, reasons for ordering an anti-Xa level, and all anti-Xa levels following a documented inpatient dose. Those with and without a major bleed were compared with the Mann-Whitney U test, and binary logistic regression was utilized to elicit potential associations between major bleeding and selected study variables.

CONCLUSION

Anti-Xa levels for apixaban and rivaroxaban may be helpful in patients with major bleeding, prior to a surgical procedure, and those transitioning to intravenous anticoagulation therapy. Higher anti-Xa levels were not necessarily associated with major bleeding, but older age and inappropriately high dosing regimens were. Further investigation regarding FXaI anti-Xa level use in clinical practice is warranted.

PGY1 PHARMACY RESIDENCY

Nicholas Jakowenko, PharmD Nick earned his PharmD from MCPHS University - Boston in 2019. Following completion of his PGY1 residency, Nick will be embarking on a PGY2 residency in critical care at Banner – University Medical Center in Tucson, AZ. Primary project preceptor: Kevin Donahue, PharmD, BCPS Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

Timing of granulocyte colony stimulating factor (GCSF) initiation in patients with hematologic malignancies receiving autologous hematopoietic stem cell transplantation (HSCT) Aaron Krapfl, PharmD; Laquisa Hill, MD; Hanna Zaghloul, PharmD, BCOP PURPOSE

RESULTS

To evaluate the impact of GCSF on hematopoietic recovery following autologous stem cell transplantation and to determine if timing of GCSF administration relative to HSCT impacts clinical outcomes.

In total, 210 patients were included for analysis. Initiation of GCSF prior to day +10 from HSCT was associated with a faster time to engraftment when compared to initiation of GCSF after day +10 (11.73 days vs 13.47 days, respectively), and a decreased length of hospital stay (17.85 days vs 18.28 days). Subgroup analysis based on conditioning regimen and disease state had similar results associating earlier GCSF initiation with faster time to engraftment, decreased length of stay, and in many cases, fewer days of IV antibiotics.

METHODS

A retrospective, observational review was conducted on adult patients who received an autologous HSCT at Houston Methodist Hospital between June 2016 and June 2019. Patients also must have received at least one dose of GCSF any time between the date of transplant and the date of hospital discharge. The primary outcome was time to neutrophil engraftment from the date of HSCT. Secondary outcomes included time to neutrophil engraftment from time of nadir, absolute neutrophil count (ANC) at the time of GCSF initiation, day of GCSF initiation relative to HSCT, number of GCSF doses, incidence of infection, incidence of febrile neutropenia, duration of intravenous antibiotics, and length of hospital stay. Subset analyses were performed based on conditioning regimen and disease state.

CONCLUSION

This study supports use of granulocyte colony stimulating factor prior to day +10 post autologous HSCT in patients with non-Hodgkin’s lymphoma, Hodgkin’s lymphoma, and multiple myeloma.

PGY1 PHARMACY RESIDENCY

Aaron Krapfl, PharmD Aaron earned his PharmD from Concordia University - Wisconsin in 2019. Following completion of his PGY1, Aaron will continue his postgraduate training as a PGY2 pharmacy resident in oncology at Rush University Medical Center in Chicago, IL. Primary project preceptor: Hanna Zaghloul, PharmD, BCOP Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

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Incidence of major bleeding associated with the use of direct oral anticoagulants in peripheral artery disease Karen Abboud, PharmD; Allison Wilson, PharmD; Michelle Murillo, PharmD; Nghi (Andy) Bui, PharmD; Van-Anh Le, PharmD; David Putney, PharmD PURPOSE

RESULTS

Patients with peripheral artery disease (PAD) are at high risk for major adverse cardiovascular and limb events despite the use of aspirin. In the COMPASS trial, lowdose rivaroxaban and aspirin showed reduced MACE and MALE but higher bleeding events compared to aspirin alone. Limited data exist on the use of other direct oral anticoagulants (DOACs) in PAD. The purpose of this study was to evaluate the safety and efficacy of DOACs in patients with PAD.

A total of 52 patients met eligibility criteria. Endovascular interventions were performed in 30 (55.8%) patients and surgical interventions in 27 (51.9%) patients. The majority received apixaban (n=42; 78.8%), and the remaining received rivaroxaban (n=11; 19%). Concomitant single antiplatelet therapy (SAPT) was received by 37 (71.2%) patients. The most common antithrombotic regimen was apixaban 5 mg twice daily with SAPT (n=28; 54%). Major bleeding occurred in 4 (7.7%) patients. Three patients experienced surgical site bleeding, and one patient experienced gastrointestinal bleeding. Combination of aspirin and apixaban was utilized in 3 of those patients. Major adverse cardiovascular events developed in 2 (3.8%) patients. Major adverse limb events developed in 14 (26.9%) patients. Combination of SAPT and DOAC was utilized in half of those patients.

METHODS

This IRB-approved, retrospective, health-system-wide, descriptive study was conducted on patients admitted with a diagnosis of PAD or carotid artery stenosis and an active order for a DOAC between May 2016 and October 2019. Patients with concurrent indications for oral anticoagulation were excluded. The primary endpoint was the incidence of major bleeding, defined as the composite of fatal bleeding, symptomatic bleeding into a critical organ or surgical site requiring reoperation, or bleeding requiring hospitalization, within 90 days of DOAC initiation. Secondary endpoints included the incidence of major adverse cardiovascular and limb events within 90 days of DOAC initiation. Major adverse cardiovascular events (MACE) were defined as the composite of cardiovascular death, myocardial infarction or stroke. Major adverse limb events (MALE) were defined as the development of acute or chronic limb ischemia. Standard descriptive statistics were utilized to evaluate baseline characteristics and outcomes.

CONCLUSION

Hospitalized patients undergoing revascularization for PAD are at higher risk for MALE. The incidence of major bleeding with standard doses of DOACs, especially apixaban, was higher than seen with low-dose rivaroxaban without a discernible added benefit on MALE. Until larger clinical trials evaluate the efficacy and safety of alternative anticoagulants, low-dose rivaroxaban remains the only indicated DOAC for PAD.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Karen Abboud, PharmD Karen earned her bachelorâ&#x20AC;&#x2122;s degree in pharmacy from the Lebanese American University in 2018, and her PharmD from the Lebanese American University in 2019. Following completion of her PGY1 residency, Karen intends to pursue a PGY2 residency in oncology. Primary project preceptor: Allison Wilson, PharmD, BCPS Presented at 2020 Pharmacy Research Committee Annual Research Symposium, Houston Methodist Hospital

Determining the proportion of patients with low-risk pulmonary embolism who can be managed safely as an outpatient Ghalia Bakhsh, PharmD; Daniela Espino, PharmD; David Putney, PharmD, BCPS PURPOSE

RESULTS

The American College of Emergency Physicians suggested that patients with acute PE who are deemed low mortality risk using risk stratification, may be safely discharged from the ED on anticoagulation and treated as an outpatient. The purpose of this study is to describe eligible patients who were diagnosed with pulmonary embolism in the ED that could be managed safely in the outpatient setting.

Among the 1400 patients that were diagnosed with pulmonary embolism as the primary indication, 723 (52.6%) found to have pulmonary embolism severity index score less than 86; 124 (41.3%) of them were male patients. The average age was 53.6 (± 15.11) years. The initial anticoagulation used to treat the pulmonary embolism once confirmed was enoxaparin in 160 (53.7%) patients, continuous intravenous heparin drip in 138 (46%) patients, apixiban in 1 (0.7%) patients, and rivaroxaban in 1(0.7%) patients. The overall average length of stay was 5.9 (± 5) days. None of the patients had a recurrent venous thromboembolism within 30 days, three patients had major bleeding as defined by the criteria of the International Society on Thrombosis and Haemostasis (ISTH), and one patient (0.3%) expired during hospitalization.

METHODS

The institutional research committee approved this retrospective cohort review. The electronic medical record was utilized to obtain a list of adults aged 18 or older who were diagnosed with a pulmonary embolism in the emergency department at the Houston Methodist Health system from January 2017 to December 2018. Baseline data that was used to calculate the pulmonary embolism severity index and simplified pulmonary embolism severity index include age, gender, heart rate, blood pressure, oxygen saturation, temperature, and past medical history. The primary outcome is to identify the proportion of patients with newly diagnosed low-risk pulmonary embolism. A score of less than 86 was considered low risk. The secondary outcome is a composite rate of recurrent VTE, major bleeding, and all-cause mortality at hospital discharge in low-risk PE population.

CONCLUSION

Almost 50 percent of the patients who presented to the emergency department with pulmonary embolism were found to have a very low/low mortality risk defined as 3.5% or less. Utilizing the risk assessment tool and assessing patients’ social status can guide health care providers in distinguishing patients eligible for successful outpatient pulmonary embolism management. Further evaluation in a selected population composed of very low/low-risk patients will provide a foundational pre-protocol data to be used in creating a hospital-specific protocol for managing acute low risk pulmonary embolism in the outpatient setting.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Ghalia Bakhsh, PharmD Ghalia earned her PharmD from King Saud University in Riyadh, Saudi Arabia, in 2014. Following completion of her PGY1, Ghalia will work as a clinical pharmacist specialist at King Fahad Medical City in Saudi Arabia, and plans to continue her postgraduate training as a PGY2 resident in critical care. Primary project preceptor: Daniela Espino, PharmD Presented at 2020 Pharmacy Research Committee Annual Research Symposium, Houston Methodist Hospital

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Assessing impact of a pharmacist-led oral chemotherapy medication therapy management (MTM) program in a large academic medical center Zain Malik, PharmD; Veronica Ajewole, PharmD, BCOP; Monica Chintapenta, PharmD PURPOSE

RESULTS

Oral chemotherapy medications have allowed for ease of administration and have led to an increase in outpatient management of cancer. However, their management in the outpatient setting pose unique challenges, medication adherence, difficulty monitoring toxicities, and drug interactions. Hence, this project was conducted to evaluate the impact of a Board-Certified Oncology Pharmacistled MTM program for oral chemotherapy patients in the ambulatory setting.

A total of 100 patient charts were reviewed and 71 patients were identified to have been impacted by pharmacy intervention during the time frame. Eighty percent of patients received oral chemotherapy education by a clinical pharmacist. Total number of drug-drug interactions noted prior to chemotherapy initiation were 117; of those, category C and category B interactions tied at 38 percent, respectfully. Additionally, 13 dose adjustments to patientâ&#x20AC;&#x2122;s oral chemotherapy were made by a clinical pharmacist. A total number of required supportive care interventions was 74 with predominance in antiemetic prophylaxis. A therapy discontinuation incidence of 24 percent was observed.

METHODS

A single-center, retrospective chart review was conducted on patients in the oral chemotherapy MTM program from January 1st to July 15th, 2019. An EPIC report was created to consolidate 100 patients who have been newly prescribed an oral chemotherapy agent. Patient charts and oncology clinical pharmacist documentations were reviewed up to 90 days from initiation of oral chemotherapy to determine the primary and secondary outcomes of this observational study. Primary outcome was to identify the number of patients who had a pharmacy intervention that led to a change over the total number of patients that a pharmacist interacted with. Secondary outcomes assessed were pharmacist education of patients, drugdrug interactions addressed, dose modifications, number of required supportive care interventions, and toxicity checks at 30, 60, and 90 days.

CONCLUSION

Board-Certified Oncology pharmacist positively impacted the oral chemotherapy management for patients in the ambulatory setting. The most notable interventions were identified as antiemetic prophylaxis, addressing drug-drug interactions, and patient education.

PGY1 PHARMACY RESIDENCY - INTERNATIONAL GRADUATES

Zain Malik, PharmD Zain earned his bachelorâ&#x20AC;&#x2122;s degree in chemistry from Northeastern Illinois University in 2015, and his PharmD from the University of Illinois at Chicago in 2019. Following completion of his PGY1, Zain intends to pursue a PGY2 residency in oncology. Primary project preceptor: Ajewole Veronica, PharmD, BCOP Presented at 2020 Pharmacy Research Committee Annual Research Symposium, Houston Methodist Hospital

Impact of optimizing carousel dispensing technology on overall inventory turnover Stephanie Crowley, PharmD; Linda Haines, PharmD, MS; Michael Fahey, PharmD, MBA; Sunny Bhakta, PharmD, MS PURPOSE

RESULTS

Inventory optimization has been a longstanding focus for pharmacy administrators when managing departmental costs. Current literature reveals optimizing automated dispensing cabinets has an impact on cost-savings, however, literature to support medication carousel optimization is limited. The purpose of this study was to evaluate the impact optimizing carousel dispensing technology has on inventory cost-savings.

There were a total of 1,427 unique medications that met inclusion criteria in both vertical carousels in the pre-optimization phase with 1.7% (N=24) high cost medications. The projected cost impact is > $100,000 in savings. Post analysis has been delayed due to the coronavirus pandemic and will be made available in the summer of 2020. CONCLUSION

METHODS

This single center, quasi-experimental study evaluates 24week pre- and 24-week post- optimization of two vertical carousels. Seasonal medications and medications not present during both pre- and post-periods were excluded from this study. Carousel dispensing technology was used to review the utilization activity for each carousel inventory item. The utilization activity was used to calculate weekly usage and projected minimum and maximum PAR levels using a 4-day and 7-day system, respectively. Projected PAR level adjustments were reviewed for appropriateness and entered into the carousel dispensing technology. The primary objective of this study is to evaluate the impact that optimizing the vertical carousels has on inventory turnover. Secondary objectives include change in inventory carrying costs for high-cost and non-high cost drugs, and analysis of frequently expired medications.

The use of carousel dispensing technology to optimize carousel inventory may improve overall inventory turnover and reduce carrying-costs. Further studies are needed to evaluate the long-term impact of carousel optimization on inventory turnover and medication expirations.

PGY1 - PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION RESIDENCY

Stephanie Crowley, PharmD Stephanie earned her PharmD from the University of Houston College of Pharmacy in 2019. She is also a Master of Science candidate in Pharmacy Leadership and Administration at the University of Houston College of Pharmacy. Stephanie will continue postgraduate training at Houston Methodist Hospital as a PGY2 Health-System Pharmacy Administration and Leadership Resident. Primary project preceptor: Linda A. Haines, PharmD, MS, BCPS Presented at 2019 VizientÂŽ Pharmacy Network, Las Vegas, NV

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Impact of an electronic health record-integrated barcode-enabled medication delivery tracking system Gabrielle Wu, PharmD; Ghalib Abbasi, PharmD, MS, MBA; Linda Haines, PharmD, MS; Sunny Bhakta, PharmD, MS PURPOSE

RESULTS

The medication delivery structure for inpatient pharmacy at a 1,119-bed academic affiliated hospital includes a team of designated couriers. These couriers assist in the delivery of first doses, re-dispensed doses, and compounded pharmaceuticals from centralized and satellite pharmacy locations. Currently, the couriers scan medications at the point of departure from pharmacy, without any subsequent scanning upon delivery at the receiving patient care areas. Without delivery scanning, missing doses can create financial wastes, contribute to unnecessary reworks and increases in medication request messages. This research study aims to assess the impact of implementing an electronic health record (EHR)-integrated barcode-enabled delivery tracking functionality to enhance data-driven process improvements.

Analysis of pre-implementation data for the two studied units revealed 2.8% and 2.0% average monthly redispense rates, and 387 and 501 average monthly completed medication messages. Post-implementation data for the two studied units showed 1.9% and 1.8% average monthly re-dispense rates, with 30.5% and 10.0% relative reductions, respectively. On average, 427 and 435 medication messages were completed per month during post-implementation. Average monthly acquisition cost associated with re-dispensed medications decreased from $667 to $550 and from $693 to $423 pre- and postimplementation for the two studied units.

METHODS

The study timeframe consisted of three months pre- and post-implementation phases, with a washout period in between. The medication tracking function was integrated within the hospital’s EHR system and implemented on two selected patient care units with high volumes of non-automated dispensing cabinet (ADC) re-dispensed doses. Pre- and post-implementation data were extracted from EHR dispense reports. The study’s primary endpoints assessed the rate of non-ADC medication re-dispenses, volume of medication messages as an indicator for missing dose requests, and acquisition cost of re-dispensed medications.

CONCLUSION

Implementation of a closed-loop, barcode-enabled, EHRintegrated medication delivery tracking system led to decreased average monthly non-ADC re-dispense rates and lower acquisition costs associated with re-dispensed medications for both studied units. Study limitations impacting evaluation of study results were identified. Additional studies to compare these results with the impact of mobile medication dose-tracking technology, which was implemented hospital system-wide, is warranted.

PGY1 -PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION RESIDENCY

Gabrielle Wu, PharmD Gabrielle earned her bachelor’s degree in cellular and molecular biology from the University of Michigan in 2014, and her PharmD from the University of North Carolina in 2019. Following completion of her PGY1 residency, Gabrielle will continue her postgraduate training as a PGY2 Pharmacy Resident in Health System Pharmacy Administration and Leadership at Houston Methodist Hospital. Primary project preceptor: Sunny Bhakta, PharmD, MS, BCPS Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

Systemization and evaluation of the impact of a pharmacy technician career ladder in a multi-hospital system Niaz Deyhim, PharmD, MS; Sunny B. Bhakta, PharmD, MS; Alex C. Varkey, PharmD, MS; Divya Varkey, PharmD, MS; René J. Martinez, Ph.T.R.; Kevin W. Garey, PharmD, MS; Daniel L. Metzen, PharmD, MBA PURPOSE

RESULTS

Career ladders have been formally designed to assist in the motivation of pharmacy technician employees to undertake more of an active approach in career progression and participate in the advancement of innovative pharmacy leadership practices. The ability to identify organizational benefits and perceptions of a career ladder for technicians will support the imperatives set forth at the 2017 Pharmacy Technician Stakeholder Consensus Conference and in the American Society of Health-System Pharmacists 2018 Pharmacy Forecast.

A total of 123 currently employed pharmacy technicians completed the theory of reasoned action survey. Questionnaire assessment revealed statistical significance within one domain, leadership and career advancement, indicated by Pharmacy Technician IIs and IIIs (P=0.006). Review of employee data within the pre-intervention and post-intervention periods identified 104 and 145 pharmacy technicians, respectively. A total of 56 career promotions were indicated by the data. The promotion rate of new hire employees in the post-intervention period was comparatively reduced in a one-year timeframe but maintained similar to historic information in a two-year timeframe. The termination volume in the pre-and post-intervention periods was 59 (56.73%) and 42 (28.97%), respectively. The new hire turnover rate remained constant despite a standardized career ladder.

METHODS

A retrospective multi-center study was performed to evaluate organizational and pharmacy technicianoriented outcomes. The timeframe encompasses a preintervention period from January 2013 through December 2015 and a post-intervention period from January 2017 through December 2019. The main intervention was the implementation of a systemized pharmacy technician career ladder. The primary endpoint was to assess the perceptions of pharmacy technicians toward career advancement through a theory of reasoned action survey. Secondary endpoints included new hire pharmacy technician one-year and two-year promotion and turnover rates.

CONCLUSION

Pharmacy technicians demonstrate attributes to pursue employment with career advancement and leadership opportunities. An employee’s organizational commitment is not linearly associated with the institution of a career ladder or incentivized benefits.

PGY2 -PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION RESIDENCY

Niaz Deyhim, PharmD, MS Niaz earned her bachelor’s degree in biomedical sciences from Texas A&M University Kingsville in 2014, and her PharmD from Texas A&M University Rangel College of Pharmacy in 2018. She also received her master’s degree in Pharmacy Leadership and Administration from the University of Houston College of Pharmacy in 2020. Following the completion of her PGY2 residency, Niaz will be pursuing employment opportunities in pharmacy management. Primary project preceptor: Sunny B. Bhakta, PharmD, MS, BCPS Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

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Outcomes associated with 4-factor prothrombin concentrate complex administration to reverse factor Xa inhibitors in bleeding patients Emily Highsmith, PharmD; Celia Morton, PharmD; Sara Varnado, PharmD; Kevin Donahue, PharmD; Annette Lista, PharmD PURPOSE

RESULTS

The purpose of this study was to evaluate outcomes in patients who received 4-factor prothrombin complex concentrate (4F-PCC) for reversal of oral factor Xa inhibitors (FXaI) in the setting of major bleeding.

Thirty-eight patients were included and 28 (74%) patients achieved hemostasis. The median dose of 4F-PCC was 50 units/kg and 4 patients received an additional dose of 4F-PCC with a median of 33 units/kg. In patients who achieved hemostasis, the median dose was 50 units/kg and in those who failed to reach hemostasis, a median dose of 30 units/kg was seen. Two patients (5%) experienced an ischemic stroke on day 7 following administration of 4F-PCC, 1 of which had not been resumed on venous thromboembolism (VTE) prophylaxis. Within the subgroup analysis, there was no difference in overall rates of hemostasis between the 4F-PCC and andexanet alfa groups. The only statistically significant difference seen was hemostasis was achieved less often with 4F-PCC in bleeds at sites other than GIB or ICH and in patients who received 25 units/kg instead of 50 units/kg.

METHODS

This was a retrospective, descriptive study conducted on patients 18 years of age or older who received 4F-PCC for reversal of oral FXaI associated bleeding from May 2017 to July 2019. Patients were excluded if they received a vitamin K antagonist or dabigatran in the previous 48 hours. The primary endpoint was the incidence of hemostasis and associated dosing strategies. Additional endpoints included patient disposition and incidence of thromboembolic events within 30 days. A subgroup analysis comparing 4F-PCC to andexanet alfa was conducted on patients who received their oral FXaI within 18 hours of 4F-PCC.

CONCLUSION

4F-PCC remains a reasonable option to utilize for reversal of oral FXaI and doses of 25 – 50 units/kg appear to be safe and effective for the majority of patients. VTE prophylaxis should be resumed as soon as clinically appropriate.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Emily Highsmith, PharmD Emily earned her bachelor’s degree in integrative biology from the University of California Berkeley in 2015, and her PharmD from The University of the Pacific in 2018. She completed her PGY1 residency at Cape Fear Valley Health in Fayetteville, NC. Following completion of her PGY2 residency, Emily will work as a clinical pharmacy specialist at MD Anderson Cancer Center’s Emergency Department. Primary project preceptor: Annette D. Lista, PharmD, BCCCP Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

Direct oral to parenteral anticoagulants: strategies for inpatient transition Chelsea N. Lopez, PharmD; Luma Succar, PharmD; Sara Varnado, PharmD; Kevin R. Donahue, PharmD PURPOSE

RESULTS

The primary objective of this study is to describe the impact on bleeding rates of two different strategies for transitioning from a DOAC to a parenteral anticoagulant: delayed, clinically-driven strategy versus standard, per package insert strategy.

A total of 300 patients were included. The primary endpoint of bleeding was higher in the delayed group versus the standard group, 25 % and 12 % (Odds Ratio 0.39; p <0.05). Patients who bled, in both groups, had a higher severity of illness, a greater incidence of acute kidney injury and, when available, higher median DOAC anti-factor Xa levels.

METHODS

This is a single center, descriptive, cohort study conducted at a large-academic medical center. Included patients were 18 years of age or older, admitted inpatient, and received at least one dose of a DOAC prior to initiation of therapeutic parenteral anticoagulation. The primary endpoint is the incidence of major bleeds upon transition from a DOAC to a parenteral anticoagulant via a standard versus an intentionally delayed strategy. The secondary outcomes evaluate renal function, reason for delay, DOAC anti-factor Xa levels, INR values, blood product administration, and thrombotic complications.

CONCLUSION

Despite a more conservative approach, patients in the delayed group experienced more bleeding, which highlights emerging challenges of inpatient anticoagulation management. Further prospective studies analyzing DOAC pharmacodynamics and kinetics, in acutely ill patients, are warranted.

PGY2 CRITICAL CARE PHARMACY RESIDENCY

Chelsea Lopez, PharmD Chelsea received her bachelorâ&#x20AC;&#x2122;s degree in neurobiology from The University of Texas at Austin in 2014, and her PharmD degree from the University of Illinois- Chicago in 2018. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2 residency, Chelsea will stay on as a Clinical Specialist in the Surgical-Liver ICU at Houston Methodist. Primary project preceptor: Kevin R. Donahue, PharmD, BCPS Presented at 2019 VizientÂŽ Pharmacy Network, Las Vegas, NV

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Short-term outcomes of software-supported AUC-guided vancomycin dosing at an urban healthcare system Joshua Knight, PharmD; Tomona Iso, PharmD; Katherine Perez, PharmD; Joshua T. Swan, PharmD, MPH; Chase Janak, PharmD; Judy Ikwuagwu, PharmD; William Musick, PharmD PURPOSE

RESULTS

The 2019 IDSA/ASHP vancomycin therapeutic drug monitoring (TDM) guidelines recommend targeting a vancomycin AUC of 400-600 mcg*h/ml. Two methodologies are endorsed: (a) multi-level TDM and calculation/estimation of AUC, or (b) a limited-sampling strategy utilizing TDM software and Bayesian pharmacokinetic (PK) analysis. In January 2018, our institution, a 933-bed quaternary care center, adopted a Bayesian PK software program to assist with AUC-targeted vancomycin dosing. The aim of this study was to compare process measures and early outcomes after the implementation of an AUC-targeted vancomycin dosing protocol utilizing PK software.

3451 encounters were included in the analysis. The Bayesian, nomogram, and traditional groups comprised 659, 303, and 2489 encounters, respectively. There were no statistically significant differences between the groups in mg/kd/day, levels/DOT, or average vancomycin trough. However, encounters in the Bayesian group were less likely to have an abnormal trough value (<10 or >20 mg/ dL) in both the unadjusted (OR 0.8, 95% CI 0.67-0.95) and adjusted (aOR 0.83, 95% CI 0.69-0.98) analyses. Additionally, a statistically significant reduction in AKI was seen in both the Bayesian (aOR 0.72, 95% CI 0.58-0.89) and nomogram (aOR 0.71, 95% CI 0.53-0.95) groups as compared to the traditional dosing group.

METHODS

In this this single-center, retrospective, quality-improvement project, patients > 18 years of age with a pharmacy dosing consult who received at least one dose of vancomycin and at least one TDM value documented between January 1st 2018 and December 31st 2019, were included. Exclusion criteria included baseline serum creatinine ≥2, weight ≥ 100 kg, renal replacement therapy prior to vancomycin treatment, AKI prior to vancomycin regimen, or vancomycin ordered for prophylaxis. Patients were stratified into three groups based on modality of vancomycin dosing: per clinical pharmacist’s judgment, per AUC-targeted empiric dosing nomogram, or dosed and monitored using AUC via PK software. Vancomycin TDM variability over time, vancomycin dosing, vancomycin monitoring, and rates of acute kidney injury (AKI) were compared.

CONCLUSION

Use of AUC-guided Bayesian software appears to reduce the proportion of patients with a trough outside of goal range and decrease the incidence of AKI.

PGY2 INFECTIOUS DISEASES RESIDENCY

Joshua Knight, PharmD Josh earned his bachelor’s degree in English literature and French language from Francis Marion University in 2014, and his PharmD from The Medical University of South Carolina in 2018. He completed his PGY1 residency at McLeod Regional Medical Center. Following the completion of his PGY2 residency, Josh will serve as an infectious disease specialist at Grand Strand Medical Center in Myrtle Beach, SC. Primary Project Preceptor: William Musick, BCIDP Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV

Analysis of direct oral anticoagulant therapy with concomitant use of interacting antiretroviral agents Hayley Brazeale, PharmD; Amaris Fuentes, PharmD; Mobolaji Adeola, PharmD PURPOSE

RESULTS

There is a theoretical interaction between certain human immunodeficiency virus (HIV) antiretroviral (ARV) agents and direct oral anticoagulants (DOACs) via binding of cytochrome P450 (CYP) 3A4 and p-glycoprotein (PGP) receptors. The significance and clinical applicability of this interaction is currently unclear. The present study aimed to assess population characteristics, prescribing patterns, and outcomes for patients receiving concomitant interacting therapy.

Thirty-six patients were identified, comprising 72 hospital admissions. The most common DOAC prescribed was apixaban (83.3%). The most frequent interacting ARVs were ritonavir (50%) and darunavir (44.4%). Assessing the net effect of combined ARVs per individual regimen, 63.9% were receiving CYP3A4 inhibiting regimens and 77.8% had a neutral PGP effect. Of the 72 encounters, 26 (36.1%) of DOAC orders were dosed appropriately per current HIV guideline recommendations. Twentyone (29.2%) were overdosed, 24 (33.3%) should avoid combination, and 1 (1.4%) did not require adjustment. Twenty pharmacy interventions were recognized, including dose reduction, discontinuation, and anti-Xa monitoring. Six DOAC levels were obtained with 50% resulting higher than anticipated. Eleven (30.6%) patients experienced bleeding and 2 (5.6%) had thrombosis occur. Of the adverse events, all patients had chronic kidney impairment or end stage renal disease.

METHODS

A single center, retrospective review was performed of all patients older than 18 years of age that were prescribed a DOAC for any indication with concurrent interacting ARV therapy from June 2016 through June 2019. Patients were followed for 90 days post-DOAC initiation. The primary objective was to assess population characteristics and prescribing patterns. Secondary objectives were to evaluate safety outcomes (bleeding and/or thrombosis), DOAC level monitoring, hospital readmissions, outpatient follow up related to anticoagulation, and interventions made for DOAC therapy modification.

CONCLUSION

As DOAC utilization is growing and indications are expanding, increasing use in HIV patients could be expected. More frequent dose adjustment or avoidance is recommended per HIV guidelines. Our data suggest that the majority of patients receive primarily CYP3A4 inhibiting ARV regimens, which may increase the risk of bleeding. Careful consideration should be employed for patients with renal insufficiencies. Further studies are warranted to assess safety and efficacy within this patient population.

PGY2 INTERNAL MEDICINE RESIDENCY

Hayley Brazeale, PharmD Hayley earned her PharmD from the Texas Tech University Health Sciences Center School of Pharmacy in 2018. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2 residency, Hayley will begin her role as Clinical Pharmacy Specialist in Internal Medicine at Houston Methodist. Primary project preceptor: Mobolaji Adeola, PharmD, BCPS Presented at 2019 VizientÂŽ Pharmacy Network, Las Vegas, NV

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Use of preemptive plerixafor plus granulocyte-colony stimulating factor in multiple myeloma patients during peripheral blood stem cell collection prior to autologous stem cell transplant Rodrigo De La Torre, PharmD; James Cox, PharmD, BCOP; Audrey Scholoff, NP; Gloria Obi, NP; Rammurti Kamble, MD; George Carrum, MD PURPOSE

RESULTS

Standard autologous stem cell mobilization regimens for multiple myeloma patients consist of granulocyte colony stimulating factors (G-CSF) alone or in combination with plerixafor and/or chemotherapy. Our institution administers G-CSF starting Friday with plans to check peripheral blood (PB) CD34+ count on the following Monday. Depending on the PB CD34+ cell count that day, plerixafor can be given and the PB CD34+ cell count is assessed the following day. Since November 2018 our institution has used preemptive plerixafor plus G-CSF, regardless of the PB CD34+ count on day 4, with plans to start stem cell collection on day 5 to reduce the number of apheresis days and associated costs.

In the preemptive plerixafor group, 77% collected their CD34+cell/kg target over one day of apheresis versus 29% in the historical control group, while 23% collected over two days of apheresis versus 67% (respectively). The majority of patients required one dose of plerixafor in the preemptive plerixafor group versus two doses in the historical control group to achieve target collection. Secondary outcomes are currently being evaluated.

METHODS

CONCLUSION

Use of preemptive plerixafor allowed for multiple myeloma patients to collect their CD34+ cell count through less apheresis days. Understanding the clinical outcomes of using preemptive plerixafor will help clinicians optimize CD34+ cell collection time in this patient population.

This is a single-center retrospective review of multiple myeloma patients that underwent stem cell collection and transplant at Houston Methodist Hospital from June 2016 to August 2019. Parametric statistical analysis will be used to evaluate the primary and secondary outcomes.

PGY2 ONCOLOGY PHARMACY RESIDENCY

Rodrigo De La Torre, PharmD Rodrigo earned his bachelorâ&#x20AC;&#x2122;s degree in biology from the University of St. Thomas in 2007, and his PharmD from the University of Houston College of Pharmacy in 2018. Following completion of his PGY2 residency, Rodrigo will assume the role of Oncology Pharmacy Clinical Specialist at Houston Methodist Willowbrook Hospital. Primary project preceptor: James Cox, PharmD, BCOP Presented at 2019 VizientÂŽ Pharmacy Network, Las Vegas, NV; 2020 HOPA Conference, Tampa, FL

Evaluation of efficacy and safety of pegfilgrastim when given less than two weeks from dose-dense chemotherapy regimens Godsfavour Umoru, PharmD; Hanna Zaghloul, PharmD, BCOP; Cynthia El-Rahi, PharmD, BCOP; Joe E. Ensor, PhD PURPOSE

RESULTS

In oncology clinical practice, waiting 14 elapsed days between the administration of pegfilgrastim and the subsequent chemotherapy cycle (as recommended by the prescribing information for pegfilgrastim) is not feasible for multi-cycle dose-dense regimens scheduled every 14 days. This study evaluated the efficacy and safety of pegfilgrastim when used as primary prophylaxis for febrile neutropenia in patients at a multi-hospital health system receiving dosedense chemotherapy regimens.

One hundred and sixty four patients with breast cancer who received pegfilgrastim support for dose dense doxorubicin and cyclophosphamide qualified for the model and statistical analysis of the primary endpoint. The mean age was 52±12 years. Eighty-eight percent of patients received pegfilgrastim on-body injector while 13% received pegfilgrastim injection. The mean number of elapsed days between pegfilgrastim and chemotherapy administration was 13±0.5 days. Method of pegfilgrastim delivery and elapsed days for the three levels in the model (days 12, 13, 14) had no significant effect on the change in ANC (p = 0.8663 and p = 0.8434 respectively); however, patient’s age (p = 0.0125) had a significant effect on the change in ANC.

METHODS

Patients who received pegfilgrastim as primary prophylaxis for dose-dense chemotherapy regimens scheduled every 14 days and considered to be high risk for febrile neutropenia were included. The primary endpoint was the impact of timing on the change in mean absolute neutrophil counts (ANC) between chemotherapy cycles when pegfilgrastim is given <14 days before the next chemotherapy cycle. A generalized linear mixed-effects model with fixed effects for pegfilgrastim delivery method, elapsed days between pegfilgrastim administration and chemotherapy, and absolute neutrophil count (ANC) at the subsequent cycle was fitted to the change in ANC between chemotherapy cycles data. The elapsed days factor was considered a fixed categorical effect with three levels; 12, 13, and 14 days.

CONCLUSION

In order to maintain the dose-intensity of chemotherapy regimens scheduled every 14 days, physicians are unable to follow package insert recommendations for pegfilgrastim. However, current practice related to primary prophylaxis with pegfilgrastim at Houston Methodist is safe and effective and aligns with guideline recommendations (minimum of 12 elapsed days between pegfilgrastim and subsequent chemotherapy).

PGY2 ONCOLOGY PHARMACY RESIDENCY

Godsfavour Umoru, PharmD Godsfavour earned his bachelor’s degree in chemistry from Cameron University in Oklahoma and his PharmD from The Ohio State University College of Pharmacy. Following completion of his PGY2 residency, Godsfavour will transition to Oncology Pharmacy Clinical Specialist at Houston Methodist Hospital. Primary project preceptor: Hanna Zaghloul, PharmD, BCOP Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV; 2020 HOPA Conference, Tampa, FL

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Medication knowledge retention and adherence following transplant: Is there room for improvement? Megan Cooper, PharmD; Alex Rogers, PharmD; Terri Menser, PhD; Jill Krisl, PharmD PURPOSE

RESULTS

Transplant recipients’ complex medication regimens following transplant can lead to non-adherence, which is linked to increased rates of rejection and graft loss. In this study, we assessed medication knowledge retention and its impact on adherence in transplant patients following index hospital discharge.

Two hundred twenty-three patients were identified, patients were excluded if follow-up questionnaires were not completed. Baseline comfortability, knowledge, and adherence scores were 4.59/5 (91.8%), 0.83/1 (83.0%), and 11.89/12 (99.1%), respectively; the change in each respective score was +0.12, -0.01, and -0.05. The largest negative change was observed in the liver and lung recipients, which was driven by the decreased adherence scores amongst the liver recipients, while a decrease in medication knowledge drove the decline for the lung recipients.

METHODS

We performed a single-center, retrospective chart review of all English literate adults transplanted at our center from April 2019 to November 2019 seen for initial clinic visits at the JC Walter Jr. Transplant Center. The primary endpoint was medication knowledge retention and adherence following discharge, assessed through an original medication knowledge questionnaire and the immunosuppressant therapy adherence scale, respectively. The questionnaire included: medication comfortability (scored 1-5), knowledge (scored 0-1), and adherence (scored 0-12).

CONCLUSION

Our findings suggest that medication education should be an ongoing effort to ensure retention of knowledge and emphasize adherence. This warrants the expansion of pharmacy services for ongoing education in the outpatient setting. Reinforcement of inpatient education practices are likely particularly important for those identified with low level of caregiver support and lower health literacy.

PGY2 SOLID ORGAN TRANSPLANTATION PHARMACY RESIDENCY

Megan Cooper, PharmD Megan earned her bachelor’s degree in biochemistry from The University of Texas in 2013, and her PharmD from the University of Houston College of Pharmacy in 2018. She completed her PGY1 residency at Houston Methodist Hospital. Following completion of her PGY2, Megan will be pursuing job opportunities in solid organ transplant. Primary project preceptor: Jill Krisl, Pharm, BCPS Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV; 2020 American Transplant Congress

Safety and efficacy of valganciclovir for cytomegalovirus prophylaxis in solid organ transplant patients on hemodialysis Danielle Ecabert, PharmD; Christine Pham, PharmD; Brett J. Pierce, PharmD; William L. Musick, PharmD PURPOSE

RESULTS

Cytomegalovirus (CMV) infection after solid organ transplant (SOT) is associated with significant morbidity and mortality. Valganciclovir is the most commonly used antiviral for prophylaxis. However, there are currently minimal clinical outcomes-supported data to guide valganciclovir dosing in SOT patients requiring hemodialysis (HD). Our institution’s current valganciclovir dosing for patients on HD is 450 mg two or three times weekly post-HD. The purpose of the study is to determine the safety and efficacy of this dosing strategy in SOT patients on HD.

Thirty-seven patients were included, of which 84% were liver transplant recipients. Seventy-five percent of patients were CMV moderate risk (D+/R+), and there were no high risk patients (D+/R-). All patients received valganciclovir three times weekly. Zero patients developed CMV infection while on valganciclovir prophylaxis. The overall rate of CMV infection at one year was 16%. Thrombocytopenia occurred in 24% of patients. Leukopenia occurred in 51% of patients, though moderate and severe neutropenia (absolute neutrophil count < 1000 cells/µL and < 500 cells/µL, respectively) only occurred in 30% and 13% of those cases, respectively. Granulocyte colony stimulating factor was administered to 14% of patients while on valganciclovir prophylaxis.

METHODS

We conducted a retrospective chart review of all adult heart, liver, lung, and multi-organ transplant recipients between May 2016 and June 2018 with end stage renal disease on HD post-transplant. Valganciclovir was used for universal CMV prophylaxis dosed 450 mg two or three times weekly post-HD for a duration of 3 to 12 months per institution protocol depending on the transplanted organ. The primary outcome was the rate of CMV infection while on valganciclovir prophylaxis. Secondary outcomes included the following within one year post-transplant: overall rate of CMV infection, type of CMV infection, CMV resistance, and rates of leukopenia (white blood cell count < 3500 cells/µL) and thrombocytopenia (platelets < 100,000 cells/µL) while on valganciclovir prophylaxis.

CONCLUSION

Valganciclovir 450 mg three times weekly was effective and relatively safe for CMV prophylaxis in non-high risk SOT patients on HD. Further exploration of alternative dosing strategies may be necessary to improve safety outcomes while maintaining similar efficacy.

PGY2 SOLID ORGAN TRANSPLANTATION PHARMACY RESIDENCY

Danielle Ecabert, PharmD Danielle earned her PharmD from Northeastern University in 2018. She completed her PGY1 residency at Carolinas Medical Center in Charlotte, NC. Following completion of her PGY2, Danielle will assume the role of an abdominal and thoracic clinical transplant pharmacist at University Hospitals Cleveland Medical Center in Cleveland, OH. Primary project preceptor: Brett J. Pierce, PharmD, BCPS Presented at 2019 Vizient® Pharmacy Network, Las Vegas, NV; 2020 American Transplant Congress

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Viable hemostasis obtained with prothrombin complex concentrate in patients who refuse allogeneic blood transfusion and undergo complex cardiac surgery: a case series Tomona Iso, PharmD; Elsie Rizk, PharmD; Jesse E. Harris, PharmD; Eric Salazar, MD, PhD; Kirk Heyne, MD; Elizabeth Herrera, MD; Jessica Varisco; Joshua T. Swan, PharmD, MPH PURPOSE

RESULTS

Managing coagulopathies and acute blood loss during cardiac surgery remains uniquely challenging among patients who refuse allogeneic blood transfusion due to religious beliefs or other personal reasons. Human fourfactor prothrombin complex concentrate (4F-PCC) may reduce blood loss during surgery.

Nine patients who refused allogeneic blood transfusion due to religious beliefs (Jehovah’s Witnesses) were included. Patients received 1 (n=5), 2 (n=3), or 3 (n=1) administrations of fixed dose 4F-PCC. The median (IQR) intraoperative 4F-PCC dose per administration was 500 (500 to 1,000) units. Additional intraoperative cointerventions included protamine (n=9), aminocaproic acid (n=8), fibrinogen concentrate (n=6), desmopressin (n=6), factor VIIa (n=2), and tranexamic acid (n=1). Outcomes included postoperative death (n=1), major postoperative bleeding (n=1), deep vein thrombosis (n=2), and ischemic stroke (n=1).

METHODS

This case series included adults who refused allogeneic blood transfusion, underwent an on-pump complex cardiac surgery at Houston Methodist Hospital from January 1, 2015 to June 30, 2019, and received 4F-PCC intraoperatively. Hemostatic agents administered in the operating room (OR) and up to 14 days after surgery were evaluated. Hemoglobin was evaluated until postoperative day (POD) 14 and at hospital discharge. Postoperative complications and death were evaluated until POD30 or hospital discharge.

CONCLUSION

This case series describes the use of fixed doses of intraoperative 4F-PCC, along with other intraoperative hemostatic agents, to control blood loss among patients who refuse allogeneic blood transfusion undergo complex cardiac surgery. When allogeneic blood transfusion is refused, viable hemostasis can be obtained using 4F-PCC during complex cardiac surgeries with a high risk of bleeding. Further research is needed to develop hemostatic protocols for these high-risk patients. GRANT ACKNOWLEDGEMENT

Dr. Swan received research funding from CSL Behring to support this study. FELLOW – CLINICAL PHARMACY FELLOWSHIP IN OUTCOMES RESEARCH

Tomona Iso, PharmD Tomona earned her bachelor’s degree in pharmacy from Tohoku Pharmaceutical University in 2006, and her PharmD from Nova Southeastern University College of Pharmacy in 2018. Following completion of her fellowship, Tomona will seek a researcher position at a research institute. Primary project preceptor: Joshua T. Swan, PharmD, MPH, BCPS, FCCM

Alteplase for the treatment of midline catheter occlusions: a retrospective, single-cohort, descriptive study Elsie Rizk, PharmD; Anh Thu Tran, PharmD; Frank Soto, RN; David Putney, PharmD, MPH; Amaris Fuentes, PharmD; Eric Salazar, MD, PhD; Joshua T. Swan, PharmD, MPH PURPOSE

RESULTS

This retrospective study evaluated the efficacy and safety of alteplase when used off-label for treating midline catheter occlusions among hospitalized patients.

This study included 49 hospital admissions, 50 midline catheters, 53 occlusion events, and 59 alteplase administrations. Of 53 occlusion events, 32 (60%) were partial occlusions, 17 (32%) were complete occlusions, and 4 (8%) could not be categorized due to lack of documentation. Withdrawal function was restored in 47% (25 of 53) of occlusion events, and infusion function was restored in 65% (11 of 17) of complete occlusion events. One alteplase dose was administered for 47 occlusion events, and two doses were administered for 6 occlusion events. After alteplase treatment, midline catheters remained active for a median of 2.5 days (interquartile range 1 to 6). Of 50 midline catheters, 30 (60%) were maintained until discharge, 17 (34%) were replaced due to malfunction, and 3 (6%) were removed as they were no longer indicated. Local bleed at the midline catheter site was documented within 48 hours after alteplase in 5 (9%) occlusion events.

METHODS

Adults who received at least one dose of alteplase in a midline catheter from January 2015 through May 2018 at a multi-hospital health-system were included. A complete catheter occlusion was defined as withdrawal and infusion malfunction, and partial occlusion was defined as withdrawal malfunction only. If the index occlusion event resolved for 24 hours or longer and reoccurred, the second event was analyzed as new occlusion event. The primary outcome was restoration of the ability to infuse or withdraw from at least one lumen of the midline catheter treated with alteplase.

CONCLUSION

Alteplase administration into midline catheters was associated with restoration of most infusion malfunctions and half of withdrawal malfunctions. Local bleeds after alteplase were infrequent and mild.

FELLOW – CLINICAL PHARMACY FELLOWSHIP IN OUTCOMES RESEARCH

Anh Thu Tran, PharmD Anh Thu earned her bachelor’s degree in mathematical biology from the University of Houston in 2012, and her PharmD from the Texas A&M University Irma Lerma Rangel College of Pharmacy in 2019. Anh Thu will continue postgraduate training at Houston Methodist Hospital as a second-year Clinical Pharmacy Fellow. Primary project preceptor: Joshua T. Swan, PharmD, MPH, BCPS, FCCM

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Development of rabies post-exposure prophylaxis quality improvement bundle at a multi-hospital health system Fangzheng Yuan, PharmD; Tomona Iso, PharmD; Elsie Rizk, PharmD; Anh Thu Tran, PharmD; Robert B. Saldana, DO; Ngoc-anh A. Nguyen, MD; Prasanth R. Boyareddigari, MD; Daniela Espino, PharmD; Navreet S. Sindhwani, MD; Michael C. Runken, Pharm.D; Joshua T. Swan, PharmD, MPH PURPOSE

RESULTS

This study develops, implements, and measures the impact of a rabies postexposure prophylaxis (PEP) bundle on adherence to Centers for Disease Control and Prevention (CDC) guideline recommendations for human rabies immune globulin (HRIG) patient selection and delivery.

The study is actively enrolling patients and this abstract provides an interim update on program milestones. A rabies PEP order set, a rabies PEP discharge set, and structured documentation fields for HRIG administration sites were developed and implemented in the EHR in December 2019. A total of 28 live education sessions were conducted from November 2019 to February 2020 and reached approximately 32% (203 of 641) of the ED nurses and 37% (81 of 220) of the providers across the system. Educational materials were disseminated electronically to all ED staff. Patient educational materials were incorporated into the EHR.

METHODS

This quasi-experimental study included patients who received rabies PEP (HRIG or rabies vaccine) across 15 emergency departments (EDs) in the Houston Methodist health system. The rabies PEP bundle was implemented in December 2019, and included electronic health record (EHR) enhancements, ED staff education, and patient education. Patients who received rabies PEP from January 2015 to June 2018 were included in the historical control group. Patients who will receive rabies PEP from December 2019 to December 2020 will be included in the post-implementation group. Quality assurance analysis was conducted in the first 4 patients who received rabies PEP following implementation. The primary outcome was full adherence to all 6 quality indicators for HRIG: (1) patient selection, (2) dose, (3) timing, (4) administration into and around wound, (5) administration distant from rabies vaccine, and (6) administration that avoids the buttock.

CONCLUSION

The rabies PEP bundle was developed, implemented, and optimized. Enrollment of post-implementation group is ongoing. Results will be available after December 2020.

FELLOW â&#x20AC;&#x201C; CLINICAL PHARMACY FELLOWSHIP IN OUTCOMES RESEARCH

Farrah Yuan, PharmD Farrah earned her PharmD from St. Louis College of Pharmacy in 2018. She completed her PGY1 residency at Ascension-St. Joseph Hospital in Milwaukee, WI. Following completion of her fellowship, Farrah will look for job opportunities to serve as a patient-oriented clinicianresearcher. Primary project preceptor: Joshua T. Swan, PharmD, MPH, FCCM, BCPS â&#x20AC;&#x192;

SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2015 TO 2020 Abbasi G. Ensuring 340B Program Integrity. PP&P. 2018;15(7): 26-31 Abbasi G, Gay E. Impact of sterile compounding batch frequency on pharmaceutical waste. Hosp Pharm. 2017;52(1):60-4. Adeola M, Azad R, Kassie GM, et al. Multicomponent Interventions Reduce High-Risk Medications for Delirium in Hospitalized Older Adults. J Am Geriatr Soc. 2018;66:163845. Aitken SL, Alam MJ, Khaleduzzaman M, et. al. In the Endemic Setting, Clostridium difficile Ribotype 027 Is Virulent But Not Hypervirulent. Infect Control Hosp Epidemiol. 2015;36(11):1318-23. Ajewole BV, Cox JE, Swan JT, et al. Incidence of chemotherapyinduced peripheral neuropathy within 12 weeks of starting neurotoxic chemotherapy for multiple myeloma or lymphoma: a prospective, single-center, observational study. Supportive Care Cancer. 2020 Apr;28(4):1901-1912. Alam MJ, Walk ST, Endres BT, et. al. Community Environmental Contamination of Toxigenic Clostridium difficile. Open Forum Infect Dis. 2017;4(1):ofx018. Almasri DM, Lai L, Noor AO, et al. Modelling the Costeffectiveness of Statin Therapy in Rheumatoid Arthritis: A Markov-cycle Evaluation from National Data Bank for Rheumatic Diseases. J Pharm Health Serv Res. 2017;8:139145. Alvarez PA, Nguyen DT, Schutt R, et al. In-hospital use of nonsteroidal anti-inflammatory drugs in patients with heart failure in academic centers in the United States. Int J Risk Saf Med. 2016;28(4):181-8. Alvarez PA, Putney D, Ogunti R, et al. Prevalence of in-hospital nonsteroidal antiinflammatory drug exposure in patients with a primary diagnosis of heart failure. Cardiovasc Ther. 2017;35(3). Babic JT, Sofjan A, Babin M, et al. Significant publications on infectious diseases pharmacotherapy in 2015. Am J Health Syst Pharm. 2017;74(4):238-52. Bhakta SB, Colavecchia AC, Haines L, et al. A systematic approach to optimize electronic health record medication alerts in a health system. Am J Health Syst Pharm. 2019;76(8):530-6. Bhakta SB, Colavecchia AC, Coffey W, et al. Implementation and Evaluation of a Sterile Compounding Robot in an Oncology Satellite Pharmacy. Am J Health Syst Pharm. 2018;75(11 Supplement 2):S51-7. Bosso JA, Casapao AM, Edwards J, et al. Clinical pathway for moderate to severe acute bacterial skin and skin structure infections from a US perspective: a roundtable discussion. Hosp Pract (1995). 2016;44(4):183-9. Bui LN, Pham VP, Shirkey BA, Swan JT. Effect of delirium subtypes on administrative documentation of delirium in the surgical intensive care unit. J Clin Monit Comput. 2017;31(3):631-40. Bui LN, Swan JT, Shirkey BA, et al. Chlorhexidine bathing and Clostridium difficile infection in a surgical intensive care unit. J Surg Res. 2018;228:107-11. Bui LN, Swan JT, Perez KK, et al. Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical Intensive Care Unit. J Surg Res. 2020;250:161-171.

Bui NA, Adeola M, Azad R et al. Prevalence of Cognitive Impairment Among Elderly Patients Upon Hospital Admission Using Mini-Cogâ&#x201E;˘ Assessments Performed by Advanced Pharmacy Practice Experience Students. J Pharm Pract. 2018. Epub ahead of print. Carmichael J, Jassar G, and Nguyen P. Healthcare Metrics: Where Do Pharmacists Add Value? Am J Health-Syst Pharm. 2016 Oct 1;73(19):1537-47. Christensen PA, Olsen RJ, Perez KK, et al. Real-time Communication With Health Care Providers Through an Online Respiratory Pathogen Laboratory Report. Open Forum Infect Dis. 2018;5(12):ofy322. Chung C. Current targeted therapies in lymphomas. Am J Health Syst Pharm. 2019;76(22):1825-1834. Chung C. Driving toward precision medicine for B cell lymphomas: Targeting the molecular pathogenesis at the gene level. J Oncol Pharm Pract. 2020;26(4):943-966. Chung C. New Therapeutic Targets and Treatment Options for Thrombotic Microangiopathy: Caplacizumab and Ravulizumab. Ann Pharmacol. 2020. Published Online First July 25, 2020 Chung C. Oral Targeted Therapies for B-Cell Lymphoma. US Pharm. 2020;45(2)(Specialty&Oncology suppl) Pages11-16 Chung C, Kim S, Bubalo J. Instilling value, quality, and safety through hematology and oncology stewardship. Am J Health Syst Pharm. 2019. 2019;76(9):617-621. Chung C, Lee R. An update on current and emerging therapies for epithelial ovarian cancer: Focus on poly(adenosine diphosphate-ribose) polymerase inhibition and antiangiogenesis. J Oncol Pharm Pract. 2017;23:454-69. Chung C, Ma H. Driving toward precision medicine for acute leukemias: are we there yet? Pharmacotherapy. 2017;37: 1052-72. Chung C. Management of neuroendocrine tumors. Am J Health Syst Pharm. 2016;73:1729-44. Chung C. Restoring the switch for cancer cell death: Targeting the apoptosis signaling pathway. Am J Health Syst Pharm. 2018;75: 945-52. Chung C. Role of immunotherapy in targeting the bone marrow microenvironment in multiple myeloma: an evolving therapeutic strategy. Pharmacotherapy. 2017;37:129-43. Chung C. Tyrosine kinase inhibitors for epidermal growth factor receptor gene mutation-positive non-small cell lung cancers: an update for recent advances in therapeutics. J Oncol Pharm Pract. 2016;22:461-76. Chung H, Coralic A. A multidisciplinary assessment instrument to predict fall risk in hospitalized patients: A prospective matched pair case study. Journal of Nursing Education and Practice. 2016;6(6). Colavecchia AC, Putney DR, Johnson ML, Aparasu RR. Discharge medication complexity and 30-day heart failure readmissions. Res Social Adm Pharm. 2017;13(4):857-63. Cox SR, Liebl MG, McComb MN, et al. Association between health literacy and 30-day healthcare use after hospital discharge in the heart failure population. Res Social Adm Pharm. 2017;13(4):754-8.

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SYSTEM PHARMACY RESEARCH BIBLIOGRAPHY 2015 TO 2020 Coyle L, Entezaralmahdi M, Adeola M, et al. The perfect storm: copper deficiency presenting as progressive peripheral neuropathy. Am J Emerg Med. 2016;34(2):340.e5-6. Davis ML, Sparrow HG, Ikwuagwu JO, et al. Multicentre derivation and validation of a simple predictive index for healthcare-associated Clostridium difficile infection. Clin Microbiol Infect. 2018;24(11):1190-4. Dobesh PP, Varnado S, Doyle M. Antiplatelet angents in cardiology: A report on aspirin, clopidogrel, prasugrel and ticagrelor. Curr Pharm Des. 2016;22(13): 1918-32. Donahue KR, Gossai T, Succar L, et al. Second victim syndrome and the pharmacy learner. Journal of the American Pharmacists Association. 2020; 60(4):e14-e17. Duhon B, Varkey AC, Woodruff AL, et al. Chapter 16: Resiliency and Well-Being. ASHP Preceptors Handbook 4th edition. December 2019. U6263; ISBN: 978-1-58528-626-3 Ekinci E, Nathoo S, et al. Interventions to improve endocrine therapy adherence in breast cancer survivors: what is the evidence? J Cancer Surviv. 2018;12(3):348-356. Fitousis K, Klasek R, Mason PE, Masud F. Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients. Perfusion. 2017;32(3):23844. Fong G, Skoglund EW, Phe K, et al. Significant Publications on Infectious Diseases Pharmacotherapy in 2016. J Pharm Pract. 2018;31(5):469-80. Friemel M, Marlow B, Peek GK, Bhakta SB. Impact to Site of Care Trends: An Introduction and Strategy to Identify the Issues with the Infusion Center Enterprise. ASHP Section of Pharmacy Practice Managersâ&#x20AC;&#x2122; Advisory Group on Management of the Pharmacy Enterprise. June 2018.

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2019 QUICK FACTS HOUSTON METHODIST

8 2,393 915,817 1.2

Hospitals Operating beds Patient encounters Million outpatient visits

126,038

Admissions

25,543

Employees

Nearly 7,000

Aï¬&#x192;liated physicians

HOUSTON METHODIST RESEARCH INSTITUTE

1,978

Credentialed researchers

706

Faculty

606

Active clinical trials

1,354

Ongoing clinical protocols

1,268

Peer-reviewed publications

5,218

Collaborations around the world

$66.3M

Extramural research funding

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HOUSTON METHODIST houstonmethodist.org/pharmacy

112020