North Carolina Pharmacist Volume 100 Number 3

North Carolina Pharmacist Volume 100 Number 3 Summer 2019 Advancing Pharmacy. Improving Health.

Look Inside for Convention Details!

Time is Running Out! Register Today!

Official Journal of the North Carolina Association of Pharmacists

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Official Journal of the North Carolina Association of Pharmacists 1101 Slater Road, Suite 110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649

www.ncpharmacists.org EDITOR-IN-CHIEF Tina Thornhill LAYOUT/DESIGN Rhonda Horner-Davis EDITORIAL BOARD MEMBERS Anna Armstrong Jamie Brown Lisa Dinkins Jean Douglas Brock Harris Amy Holmes John Kessler Angela Livingood Bill Taylor

BOARD OF DIRECTORS

North Carolina Pharmacist Volume 100 Number 3

Summer 2019

Inside • From the President .....................................................................................4 • From the Executive Director ...........................................................................5 • Why should you register for the NCAP Convention? ....................................8 • Convention Schedule.......................................................................................9 • Convention Highlights ..........................................................................12 • Poster Session Abstracts..........................................................................16 • Best Practices Roundtable Topics....................................................................30 • The Benefits of NCAP.................................................................................32

EXECUTIVE DIRECTOR Penny Shelton PRESIDENT Debra Kemp PRESIDENT-ELECT Dave Phillips PAST PRESIDENT Stefanie Ferreri TREASURER Thomas D’Andrea

North Carolina Pharmacist is supported in part by: • Smith Drug Company ......................................................................................2 • Pharmacists Mutual Companies ....................................................................7 • Pharmacy Quality Commitment ..................................................................11

BOARD MEMBERS

• EPIC Pharmacies Inc ....................................................................................15

Shannon Brown Andria Eker Brock Harris Angela Livingood Holly Nunn Kevin Helmlinger Tasha Woodall Jennifer Wilson

• Pharmacy Technician Certification Board ..................................................29

North Carolina Pharmacist (ISSN 0528-1725) is the official journal of the North Carolina Association of Pharmacists. An electronic version is published quarterly. The journal is provided to NCAP members through allocation of annual dues. Opinions expressed in North Carolina Pharmacist are not necessarily official positions or policies of the Association.

Publication of an advertisement does not represent an endorsement.

Nothing in this publication may be reproduced in any manner, either whole or in part, without specific written permission of the publisher.

• VUCA Health .................................................................................................31 • NCAP Career Center .....................................................................................34

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For rates and deadline information, please contact Rhonda Horner-Davis at rhonda@ncpharmacists.org

•From the President • Debra Kemp, PharmD, BCPS, BCACP

As I write this column for the ‘summer’ issue, I am amazed that the summer of 2019 is nearly over. Truly, where does time go?

Summer vacations are coming to an end, young kids are back in school, parents have once again assumed the role of Uber drivers to accommodate an endless number of practices, pharmacy residents are feeling the stress of layered responsibilities, pharmacy students are a few weeks into fall curriculum or several months into PY4 rotations, and pharmacists across the state are already gearing up for influenza season. While many of these global seasonal changes are predictable, the minute details frequently change. One could easily say the same for pharmacy. Our unifying mission, optimal medication use in all patients, largely remains the same but the avenues we all undertake to accomplish this mission significantly vary and are continuously evolving.

We are incredibly fortunate to practice pharmacy in North Carolina, and my time thus far as President has only amplified my respect and pride for the progressive pharmacy initiatives

throughout the state. Despite increased workload with fewer resources, you all do amazing things for NC residents! The 2019 NCAP Annual Convention was designed with this in mind - Best Practices: oPtimizing HeAlth-Related outcoMes (PHARM). I cannot think of a better theme to gather and network, share best practices, re-energize, and empower each other to advance the profession of pharmacy with true diligence, innovation, and commitment.

Please join us September 26-27 in Winston-Salem at the Benton Convention for an impressive array of CE programming, clinical pearls, roundtable best practice discussions, certificate programs, Health-Systems leadership forum, OTC Jeopardy, residency showcase, and numerous other exciting sessions. Attendees at the 2018 convention stated they could feel the energy and enthusiasm in the room; I fully anticipate the 2019 convention will prove to be the same plus more.

Don’t miss out!

Outside of convention planning, the Association continues to be incredibly busy. In July NCAP welcomed over 250 residents and preceptors for the 20th Annual Residency Conference. I would like to extend special appreciation to Holly Canupp, the conference planning committee, and NCAP staff who made this event such a success. The Board of Directors is currently amid multiple strategic planning ses-

North Carolina Pharmacist

sions to update our association’s plan and ensure NCAP activities are focused on key critical issues.

Membership feedback and concerns are consistently considered in all discussions and have led to proposed revisions to the NCAP Bylaws (last updated 2016).

Though not yet finalized, once approved by the Board of Directors, the revised Bylaws will be submitted via email to full membership for a vote. Please be on the lookout for this notification in the next few weeks. Your input is critical and a vote from each member is requested.

As I have said before, NCAP is OUR organization! What changes would you like to see within NCAP over the next few years?

What do you like most about NCAP that you would not want to change? How can we modernize the association while also remaining loyal to our roots and core mission? What ideas do you have to improve membership benefits? How can we better connect with pharmacists and pharmacy technicians throughout the state? Please flood my inbox and let me know your thoughts via email at dwobbleton@gmail.com.

Lastly, I would like to thank all NCAP members who selflessly give their time and energy to support and advance the association.

NCAP is thriving because of you!

I look forward to seeing you in Winston-Salem at the NCAP Annual Convention.

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•From the Executive Director• Penny Shelton, PharmD, BCGP, FASCP

Convention in a Nonconventional Light

Well, it’s that time of year again!

Time for pharmacists, technicians and student pharmacists to begin making their plans to attend the NCAP Annual Convention, scheduled for September 26-27 in Winston-Salem. Our convention is just a few short weeks away, and registration is starting to roll in. The Convention Planning Committee has lined up an amazing array of sessions and speakers. The NCAP staff has listened to feedback, and we have incorporated more networking and fun opportunities for attendees. Although, I could devote my entire column to outlining all of the convention’s great continuing education and networking opportunities available for your professional development, I will instead refer you to pages 12-15, of this issue, for a summary of programming highlights.

I do hope you enjoy this special convention issue of The North Carolina Pharmacist. I think our President, Debra Kemp, in her column, has shared some important insights regarding the anticipation of our Annual Con-

vention, strategic planning, and upcoming Association changes.

In her column, she extended a warm invitation to you to attend the convention; and I would like to challenge you to not only make plans to attend the convention, but to recruit one or more other pharmacists and technicians to come with you. My convention challenge is issued to you in a nonconventional light. What do I mean by this? Well, when people hear, NCAP Annual Convention, or for that matter any convention, the word ‘convention’ evokes the thought of ‘an event’. In fact, here at NCAP we classify and promote our annual convention as an event.

I am proposing that we stop thinking of our state pharmacy association’s convention as an event; and instead, start thinking of the NCAP Annual Convention as a platform for industry disruption. We should see this once-ayear gathering for our profession as a means for organizing and prioritizing our issues, unifying our members, strengthening our numbers, identifying our tactics, and amplifying our voice. Conventions should be about the convening of everyone who cares

North Carolina Pharmacist

about our profession. Yes, the professional development, information, and continuing education are important components; but, if our Association, like most state pharmacy associations, only has one major annual event, then our Annual Convention should be devoted to assembling and honing of our power.

I agree with Debra, when she states that we are fortunate to practice pharmacy in North Carolina. We do have some of the most innovative pharmacists and progressive clinical services, nationwide. But, we also have impediments and our profession faces real threats and difficult challenges here at home. Many states have managed to pass landmark PBM legislation. In NC, we have had quite a fight this year trying to get traction with our PBM Bill. The power of our opposition is palpable in the halls of our Legislative Building. We have seen PBM unfair business tactics crush the viability of small local pharmacies. Ohio had to enact legislation to allocate funding, in order to prevent further independent pharmacy closings in their state. Here in North Carolina, in the first six months of

Page 5 Volume 100 Number 3 Summer 2019

2019, we have seen as many closures as we typically see, on average, for an entire year. In addition, over the past few years, we have seen mergers, acquisitions and corporate decisions based on profit-loss statements, all of which have led to downsizing of positions, reduction of hours and salaries, as well as the closing of pharmacies. I share this information, not for ‘doom and gloom’, but as a message on the importance of coming together. If you take the approach of putting your head down and working as hard as you can, when you finally look up, you may realize you should of / could of put a little more time into getting involved and organized. We cannot afford to wait for a crisis to happen as the impetus for getting organized.

We must use NCAP to remain vigilant and to use our strength to, at best, prevent crises, and at worst, not fall victim to inaction, because we have to spend time getting organized when a crisis happens. A strong organized NCAP is necessary to both advance and secure our profession.

If you think some of the changes I described do not apply to you, then let me be the first to say, “you are wrong”. When one sector of our profession is negatively impacted, there is a ripple effect that will eventually, either directly or indirectly, impact every sector of our profession. The impact may not be immediately obvious, nor may it happen quickly; but history tells us, it will happen.

Even if this ripple was not true, we are pharmacists or pharmacy technicians first and foremost, regardless of our practice setting; and therefore, we should care

enough to want to do something when any aspect of our profession is threatened.

As I said, it is not all ‘doom and gloom’, there is much hope regarding our profession and the advancing roles that pharmacists are crafting now, and those we will have in the future. I spend a lot of time building awareness among non-pharmacy stakeholders regarding how pharmacists can help beyond our traditional roles. The Governor’s Office is one such important stakeholder.

We pushed hard to be able to have the Governor Cooper join us at our Convention this year, and even though he is not able to be there in person, he cared enough about the invitation, and the value that pharmacists provide, that he is preparing a message that will be shared during lunch on Thursday, September 26th.

If we want provider status, more easily facilitated collaborative practice agreements, strong PBM legislation, fair market compensation for dispensed medications, payment for pharmacist-provided patient care services, telepharmacy regulation, and pharmacist roles in medical cannabis for our state, then it will take all of us working together. NCAP is the conduit for your voice and power.

The NCAP Annual Convention is the platform for bringing us all together. Please help make a difference and join us at this important ‘convening’ of our profession in Winston-Salem on September 26-27 at the Benton Convention Center.

Pharmacy Proud, Penny

North Carolina Pharmacist

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Dress to Express Join us on Thursday, September 26 in your favorite pair of jeans and a shirt representing your alma mater !

Everyone that shows up in school colors gets entered into a giveaway.

​Open to everyone!

Page 6 Volume 100 Number 3 Summer 2019

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Best Practices: oPtimizing HeAlth-Related outcoMes PHARM If PHARMACY is a part of who you are, then the 2019 NCAP Annual Convention is a Must Be There Event for you! Regardless of where you work, your practice setting, or whether you are a pharmacist, technician, student pharmacist, or other pharmacy advocate, there is something relevant for you at the Convention this year. ​Our theme, “Best Practices,” is sure to resonate, motivate, and empower those who attend.

This year for the first time we are offering both the NACDS Point-of-Care Certificate Program and an interactive forum with the Pharmacy Directors for the new Medicaid Managed Care Organizations. In addition, last year at the convention the attendees identified top issues for the profession. These issues included medical cannabis, telepharmacy, and best practices including collaborative practice opportunities. The program for the convention will deliver all of these and more, including favorites such as round table discussions, OTC Jeopardy, and our annual poster session. Back this year, by popular demand, will be clinical pearls, the silent auction, the Health-Systems leadership forum, and a new opening networking kickoff, as well as a few extra surprises!

On behalf of the NCAP Board of Directors and Staff, we look forward to welcoming you to the “Twin City” in September for the 2019 NCAP Annual Convention!

North Carolina Pharmacist

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2019 Annual NCAP Convention

Thursday, September 26

7:30am

8am-12pm

8am-10am

10am-12pm

12pm-1:15pm

1:15pm-2:15pm 2:15pm-2:30pm

2:30pm-3:45pm

2:30pm-3:45pm

3:45pm-4pm

4pm-5pm

Registration Opens

NACDS Point-of-Care Certificate Program Workshop Macary Weck Marciniak & Ouita Gatton

Networking Kickoff with Exhibitors

Opening General Session with Lunch and Awards

NCCARES360 Training Workshop

Telepharmacy Best Practices Lindsey Amerine, Giyae Lee-Thorton, & Timothy Weber Break

Roundtables: Best Practice Discussions

Clinical Services Impact on Pharmacy Reimbursement & DIR Fees Nikki Scott

Clinical Pearls Breakouts: Inpatient and Outpatient

Reception with Exhibitors

Break

Inpatient

• Shorter is Better: Updates on Gram-Negative Bacteremia Treatment - Alison Ivey • Handling Antibiotics with Care: The Expansion of Antimicrobial Stewardship into the Ambulatory Setting - Erin Gentry • Use of Direct-Acting Oral Anticoagulants (DOACs) in Morbidly Obese Patients - Nick Orvin • Reversal of Factor Xa Inhibitors in Acute, Life-Threatening Bleeding: Where Are We Now? - Erin Roach

Outpatient

• Naloxone - Innovative Ways to Increase Dispensing in a Community Pharmacy - Ouita Gatton • Professional Continuous Glucose Monitoring - Christina Sherrill • The Pharmacist eCare Plan - Streamlining Communication Across Care Settings -Cody Clifton • Steps for Deprescribing ICS in COPD in Clinical Practice - Erika Rae McClain

5pm-7pm

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Page 9 Volume 100 Number 3 Summer 2019

7:30am

8:15am-8:30am

8:30am-10:30am

9am-12pm

10:30am-10:45am

10:45am–11:45am

10:45am–11:45am

11:45am–1pm

12pm-2pm

1pm-2pm

1pm-2pm

2pm-2:15pm

2:15pm – 4:15pm

2:15pm – 3:45pm

Friday, September 27

Registration Opens with Breakfast Welcome and Announcements CBD and Medical Cannabis Health-Systems Administrative/Leadership Forum Break Immunization Update Ouita Gatton & Courtney Humphries Poster Session

Industry Sponsored Lunch (Novo Nordisk) Confronting CVD in Patients with Type 2 Diabetes: A Review of the Pathophysiologic Links and Management Strategies Dr. Gauri Dhir

NCAP Recognitions

Health-Systems Reverse Tradeshow Lunch

Transitions of Care Panel Lindsey Burgess, Bill Hitch, Tasha Michaels, Dave Phillips

OTC Jeopardy

Break

Residency Showcase

Inpatient and Outpatient Concurrent Sessions

2:30pm - 5:30pm

Opioid/BZD Deprescribing Stefanie Ferreri

Law Update Geoff Mospan

NC Medicaid Managed Care Forum

North Carolina Pharmacist

Page 10 Volume 100 Number 3 Summer 2019

2019 NCAP Annual Convention Programming Highlights

2019 NCAP Annual Convention Programming Highlights NACDS Point-of-Care Testing Certificate Program First time this program has been offered in NC. The training provides an opportunity to gain skills and information necessary to develop a testing program for influenza, Group A streptococcus, HIV, and Hep C. Target Audiences: Community Pharmacists, Hospital or Ambulatory Care Pharmacists interested in starting Employee Health Programs.

NC Cares 360 Training First time this program has been offered for continuing education credit to pharmacists and technicians. This training teaches participants to screen for social determinants of health and use a statewide referral platform to help patients gain access to needed services. Target Audiences: Academia, Ambulatory Care and Community pharmacists and technicians, as well as NCAP Cardinal Health Grant participants.

Opening Networking & Exhibition Session We have listened to your feedback calling for more time to network and socialize. Therefore, this year we are kicking off convention with a networking and exhibitor session. Don’t miss out on your chance to win fabulous prizes, while mingling with friends, colleagues and vendors. Target Audiences: All. Opening General Session Don’t miss out on this opening session with lunch on Thursday, September 26. We will be sharing a special message and insights from Governor Roy Cooper. In addition, we will be recognizing and honoring our award recipients.

Telepharmacy Best Practices This plenary session will utilize a panel of local and national speakers to cover current and future telepharmacy application in all practice settings, including sharing best practices across the nation. Wondering about telepharmacy and telehealth practices in North Carolina? This session will also provide an update on the work of the NCAP Telepharmacy Task Force.

Target Audiences: All. North Carolina Pharmacist

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2019 NCAP Annual Convention Programming Highlights Clinical Services Impact on Pharmacy Reimbursement & DIR Fees This session will utilize a national speaker to share best practices for dealing with DIR fees, audits, and clinical services aimed at improving the financial position and sustainability of community pharmacies. Target Audiences: Community Pharmacists and Technicians.

Best Practice Discussion Roundtables Back by popular demand, enjoy an hour and fifteen minutes rotating to topics of your choice. This year we have approximately 20 facilitators, covering an array of clinical, business, and service development topics. Target audiences: All Inpatient & Outpatient Clinical Pearls Choose to attend a clinical-pearl-breakout session. Come hear colleagues from across the state share brief platform presentations on either four inpatient or four outpatient best practices. Target Audiences: All Reception & Exhibition After a day of professional growth, unwind with a glass of wine, great food, and another opportunity to visit with the vendors.

This night is all about making connections and having fun!

Make sure you are present, for this is when all prizes, for the day, will be announced. This is also your opportunity to browse the silent auction at your leisure, participate in the 50/50 raffle and snap your photos for the NCAP Convention Scavenger Hunt. Target Audiences: All Cannabidiol and Medical Cannabis Got questions about CBD oil regulation? Do you wonder about North Carolina’s chances for approving medical cannabis? Do patients in your practice setting ask for CBD options? Then come chill with us this morning as we engage with our speakers on this clinical, regulatory, and legislative update. Target Audiences: All Immunization Update This session will cover new 2019 legislation, protocols and information related to expanded immunization authority for pharmacists in North Carolina. Target Audiences: Academia, Ambulatory Care and Community Pharmacists and Technicians.

North Carolina Pharmacist

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2019 NCAP Annual Convention Programming Highlights Posters Session Come browse this year’s posters and speak with the authors about their research. This year we have over 25 projects representing case reports, treatment protocols, innovative services and quality improvement initiatives. Target Audiences: All Industry Sponsored Lunch & General Session Come enjoy lunch, sponsored by Novo Nordisk, while listening to a NC endocrinologist share views about “Confronting CVD in Patients with Type 2 Diabetes. After this presentation we will conclude our annual awards and recognitions. Target Audiences: All Transitions of Care This session will employ a pharmacist-led panel sharing models of care transitions throughout various practice settings that address patient safety strategies and improvement in patient outcomes. Target Audiences: All OTC Jeopardy Brush up on your OTC knowledge while cheering on the school of your choice during this popular trivia-based competition.

Target Audiences: All Afternoon Concurrent Sessions Choose an interactive, 90-minute session on either “Opioid/Benzodiazepine Deprescribing” strategies or a “NC Pharmacy Law” update. Target Audiences: All Residency Showcase This annual session enables residency programs to share information about their programs with prospective candidates.

The session also allows student pharmacists to exchange their CVs and business cards with prospective programs. Target Audiences: Registered Residency Programs and any convention registrant interested in learning more about residency programs.

2019 NCAP Annual Convention Programming Highlights Health-System Administrative/Leadership Forum This forum, for health-system administrators and leaders, takes place on Friday, September 27 and includes three hours of continuing education sessions which address diversion management, emergency preparedness, site of care, employee engagement, and resiliency. The forum also includes a reverse showcase during lunch with health-system related vendors.

Target Audiences: Health-system administrators, managers and emerging leaders.

North Carolina Pharmacist

Page Volume 100 Number Care 3 Summer 2019 NC14Medicaid Managed Forum

Are you concerned about NC Medicaid moving to managed

engagement, and resiliency. The forum also includes a reverse showcase during lunch with health-system related vendors.

Target Audiences: Health-system administrators, managers and emerging leaders.

NC Medicaid Managed Care Forum Are you concerned about NC Medicaid moving to managed care? Do you understand the implications for pharmacy in this new healthcare landscape? This forum provides a great opportunity to meet and ask questions of the pharmacy directors and chief medical officers for the NC Medicaid Managed Care Organizations.

Target Audiences: All pharmacy Medicaid providers.

Need a Professional Headshot?

NCAP has contracted with an apprentice photographer to set up equipment, in the Convention Center, for taking professional head shots on Friday, September 27th. There will be a place to sign up at the NCAP booth. Depending on the interest, the photographer will do as many sittings as feasible, working from the sign-up sheet. The sitting is free for 3 different poses, but you will need to purchase the digital file of your photos for $10, or with touch ups for $20. Payment Method: cash or check.

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2019 NCAP Annual Convention

Poster Session Abstracts

Assessing Patient Satisfaction after Implementation of a New Primary Care Model Authors: Carrie Berkompas, PharmD Candidate1, Irene Park Ulrich, PharmD, BCACP, CPP2; Phillip Hughes, MS2; Brunilda Lugo, MS, PhD2 Institution: 1UNC Eshelman School of Pharmacy and 2Mountain Area Health Education Center Objective: Mountain Area Health Education Center at Cane Creek is a primary care clinic employing one clinical pharmacist and four providers.

In 2016, a new pharmacist-physician covisit model of care was created. In this model, patients who may benefit from pharmacist intervention who are scheduled to see a provider are identified and seen by both the pharmacist and physician. This covisit increases the complexity of the visit and allows the physician to see more patients, increasing clinic revenue; however, potential consequences include longer visits for patients who see both physician and pharmacist and reduced time

with the physician. (1) The purpose of this study was to determine whether this model affected patient satisfaction with their care.

Methods: Data was collected using a 15-item electronic satisfaction survey that is routinely distributed to patients for ongoing quality assurance. Surveys completed between June 1, 2015 – May 31, 2016 and between June 1, 2016 – May 7, 2018 were included.

The primary objective of this study was any difference in satisfaction responses before and after covisit model implementation. Data was analyzed using a chi-square analysis. This study was exempt by the Mission Hospital Institutional Review Board.

Results: One-hundred seventyseven patients completed the survey before covisit implementation and 872 after implementation. There was no difference in the proportion of patients who saw their provider within 15 minutes of their appointment time (p=0.290), the proportion of patients who would recommend this practice to a family member or

North Carolina Pharmacist

friend (p=0.191), or the overall quality of care provided (p=0.488). Fewer patients felt their wait time to see a provider was too long (34.9% vs.

25.5%, p=0.002).

Conclusions: There were no significant differences in patient satisfaction before and after implementation of the covisit model. Patients did not have as long of a wait to see a provider in the covisit model.

References 1 Ulrich, I., Patel, S. and Gilmer, B. (2019). Evaluation of a pharmacist– physician covisit model in a family medicine practice. Journal of the American Pharmacists Association, 59(1), pp.129-135.

Comparison of Student Pharmacists’ Clinical Interventions by Semester during APPE Internal Medicine and Critical Care Rotations Authors: Molly Casey, PharmD Candidate; Susan Smith, BS, PharmD, BCPS; Carrie L. Griffiths, PharmD, BCCCP, FCCM Institution: Wingate University School of Pharmacy Objective: The purpose of this project was to assess the clinical interventions made by student pharmacists completing internal medicine and critical care rotations during their APPE year to determine if there is a difference in the number and type of interventions between rotation block, rotation type, and student participation in a concentrated learning experience.

Methods: Student clinical interventions were retrospectively collected from 2013-2018. Interventions were organized into nine broad categories which were further subdivided into specific intervention types. The primary objective was to determine if there was a difference in the number of interventions documented in rota-

Page 16 Volume 100 Number 3 Summer 2019

tion blocks 1-3, 4-6, and 7-9. Secondary objectives compared interventions made by students during internal medicine versus critical care rotations, and by those who participated in a concentrated learning experience versus those who did not. Descriptive statistics and Fisher’s Exact tests were conducted for appropriate endpoints.

Results: A total of 848 interventions were included in the analysis.

Students had an average of 39.15 interventions in Blocks 1-3, 18.2 in Blocks 4-6, and 62 in Blocks 7-9. Significantly more students were above the median number of interventions in Blocks 7-9 compared to Blocks 4-6 (p=0.048), and in Blocks 1-3 compared to Blocks 4-6 (p=0.036). There was no significant difference between Blocks 1-3 and 7-9. Significantly more interventions were above the median for students completing critical care rotations (p=0.03). There was no difference in the number of clinical interventions above the median based on student participation in a concentrated learning experience (p=0.34).

Conclusions: Although there was a difference in the number of interventions made during three semesters, the detailed findings from our comparative between-semesters analyses were surprising. More research is needed to assess the relationship of student program to intervention number, as well as the association of rotation type with number of student interventions.

Evaluation of Educational Intervention on Vaping Products in High School Students Authors: Michelle Chaplin PharmD BCACP CDE, Shannon Apgar PharmD Candidate, Jackie Brogie PharmD Candidate, Andrew Burch PharmD Candidate, Marianna Gray PharmD Candidate, Benjamin Gustafson PharmD Candidate, Jackson Hetzler PharmD

Candidate, Daniel Hough PharmD Candidate, Chris Gillette PhD Institution: Wingate University School of Pharmacy Objective: ​The use of vaping products has increased in recent years and has shown significant risks while predisposing individuals, particularly young adults, to cigarette smoking. The primary objective was to determine if an educational intervention on the risks associated with vaping would improve knowledge of these risks.

Methods: ​An anonymous pre-survey evaluated baseline knowledge of West Henderson High School students on the risks of vaping and current vaping behaviors. A 50-minute educational intervention was presented to the students in health and physical education classes in 4 groups on separate occasions focusing on five measured objectives. After the educational intervention, knowledge was re-evaluated using an anonymous post-survey. Data were analyzed using a chi-squared test, a one-sample binomial test and a one-sample median test, where appropriate.

Results:​Of the usable data on 235 high schoolers, the majority were male (52.77%, n=124) and 9th graders (53.19%, n=125). Before the educational session, 40.85% (n=96) reported vaping is safer than smoking. Immediately after the educational session, there was a statistically significant reduction in students who reported vaping being safer than smoking (pre = 40.85%, post=24.68%, p<0.0001). The median number of correct quiz answers improved from 8 (IQR=3) to 11 (p<0.0001). Of the students surveyed, 39.15% (n=92) reported current vaping behavior and 44.57% (n=41) vape multiple times per day. Stress reduction was the most reported reason to vape (n=48), while the most reported reason to stop was personal/family health (n=43).

North Carolina Pharmacist

Conclusion: ​The educational intervention was effective at improving student knowledge of the risks of vaping products. Future studies into stress reduction and mental health for high school students are warranted as most students cited stress as the reason for vaping.

Week of Wellness: A Student-Led Wellbeing & Resilience Initiative at the UNC Eshelman School of Pharmacy Authors: Henry Clark PharmD Candidate, Erin Mays PharmD Candidate, Suzanne Harris PharmD, BCPP, CPP, Brad Wingo MEd, Mollie Scott PharmD, BCACP, CPP Institution: UNC Eshelman School of Pharmacy Objective: The UNC Eshelman School of Pharmacy Student Senate serves as the governing organization of the PharmD student body. This year, a major objective of Student Senate was to produce innovative solutions that address the well-being and resiliency of the student body, faculty, and staff.

In collaboration with the UNC Eshelman School of Pharmacy Task Force on Well-Being and Resilience, the UNC Eshelman School of Pharmacy Student Senate planned and implemented the first annual “Week of Wellness” in the 2019 spring semester.

Methods: Week of Wellness was dedicated to promoting wellness in students, faculty, and staff, and specific recommendations were asked of the UNC Eshelman School of Pharmacy community. Course directors were asked to hold no major exams and/ or high stakes deliverables (>5% of total course grade) for eligible classes.

Leaders of student organizations were asked to refrain from holding organization meetings or events, and instead collaborate together and develop

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programming that would cater to the well-being and resiliency of the entire student body, faculty, and staff.

Results: During the inaugural Week of Wellness, a total of 14 student organizations hosted wellness-related events. Twenty-four events were held across both the Chapel Hill and Asheville campuses across a sevenday span (Figure 1). The events fell into six different categories: community building (n=12), physical health (n=4), informational (n=3), faculty/ staff appreciation (n=2), fundraisers (n=2), and community service (n=1).

All fundraising proceeds were donated to the KE Beta Mu Well-being Endowment/Mikey Nam Award.

Conclusion: The creation and implementation of a student-driven Week of Wellness initiative was a multi-step process that required longitudinal planning and support from many members of the UNC Eshelman School of Pharmacy community. Sustainability will require backing from members of school administration, academic deans, course coordinators, student organization leadership, and faculty, staff, and students for meaningful results.

Opioid Safety at the Pharmacy: Medicare Special Innovation Project Author: Michael Crooks, PharmD Institution: Alliant Quality Objective: As the Medicare Quality Improvement Organization for NC, Alliant Quality sought to engage community pharmacy teams in a quality improvement initiative to develop strategies for improved opioid risk screening and increased naloxone dispensing through use of the state standing order for naloxone.

Methods: To support Community Pharmacies in increasing access to

naloxone, pharmacy teams were engaged in a year-long quality improvement initiative to implement procedures to screen patients for opioid risk and make proactive recommendations to patients to receive naloxone. Pharmacies were supported by monthly group coaching calls, direct technical assistance, guided quality improvement activities and resources shared on a project webpage.

Results: Forty-eight teams were recruited to join the project and 22 completed the entire 12-month term, including self-reporting of monthly naloxone dispensing. These teams increased naloxone dispensing from an average of 1.6 patients receiving naloxone per pharmacy per month to an average of 4 reaching a total of 810 naloxone doses reported during the re-measurement period.

In the Medicare population, these teams increased quarterly naloxone dispensing by over 800% from an average of 7.1 to 65.2 beneficiaries receiving naloxone per 1000 chronic opioid users. Meanwhile, statewide quarterly naloxone dispensing in the Medicare population increased from 1.6 to 7.5 beneficiaries receiving naloxone per 1000 chronic opioid user.

Conclusion: Community Pharmacy Teams are successful at improving naloxone distribution rates when engaged in longitudinal, quality improvement projects to develop processes for using the state standing order for naloxone dispensing.

Teams that remained engaged in the project exceeded the dispensing rates of teams that enrolled in but did not complete the program as well as statewide averages among other community pharmacies.

Evaluation of Intravenous Fat Emulsions with Initiation of Parenteral Nutrition in the ICU over the First Seven Days

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Authors: Rebecca Farley, PharmD Candidate; Nathan Batchelder, PharmD, BCPS Institution: Moses H. Cone Memorial Hospital - Greensboro, NC Objectives: The primary outcome of this medication use evaluation was to evaluate the use of intravenous fat emulsions in critically ill patients receiving parenteral nutrition over the first seven days of an ICU stay.

Secondary outcomes included length of stay, time on mechanical ventilator, rates of infection, use of propofol, risk of hepatic abnormalities and hypertriglyceridemia.

Methods: This retrospective analysis included reviewing electronic health records of patients on parenteral nutrition in the ICU from January 1st 2019 thru May 31st 2019. Data collected included, but was not limited to: ICU and hospital length of stay, time on mechanical ventilator, rates of infections, LFTs, total bilirubin, and triglycerides.

Results: Data is currently being collected and analyzed among a total of 30 patients who were admitted to the ICU and initiated on parenteral nutrition. Currently, out of five patients who have met inclusion criteria, four of them had intravenous fat emulsions held for the first seven days in the ICU. Specific factors identified as reasons for early initiation of intravenous fat emulsions were being clinically stable or transferring out of the ICU before the first seven days.

Conclusion: The 2016 ASPEN guidelines recommend withholding intravenous fat emulsions in critically ill patients for the first seven days or at least limiting the amount to 100 g over the first week. Preliminary results may suggest there is a sub population of ICU patients where it is reasonable to initiate intravenous lipid emulsions early.

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An Analysis of the Association between a Diagnosis of Depression and Comorbid Chronic Diseases in Patient Visits with Chronic Obstructive Pulmonary Disease in the National Ambulatory Medical Care Survey Authors: Megan Gidron, PharmD/ MSCR Candidate; Sheniece Carpenter, PharmD/MSCR Candidate; Diana Charles, PharmD/MSCR Candidate; Michael R. Jiroutek, DrPH, MS, Melissa A. Holland, PharmD, MSCR Institution: Campbell University College of Pharmacy & Health Sciences Objective: Chronic Obstructive Pulmonary Disease (COPD) is a chronic condition that affects an estimated 12 million people in the United States.

Prior studies have demonstrated an association between COPD and depression. However, there is limited data available on the effect of comorbidities on depression in patients with COPD. The objective of this study was to assess the association between the number of comorbid conditions on the prevalence of depression as well as other socio-demographic factors of interest in patient visits with COPD. Methods: This was a retrospective, cross-sectional, observational, IRB-exempt study of patient visits for those 18 years of age or older with a diagnosis of COPD in the National Ambulatory Medical Care Survey (NAMCS) during the years 2005-2015. Patient visits with the following diagnoses were excluded: bipolar disorder, panic disorder, phobic disorder, anxiety disorder, schizophrenia, eating disorder, obsessive compulsive disorder (OCD), and alcohol or drug abuse. Chi-square tests of independence and a multivariable logistic regression model were conducted.

Results: A total of 4,847 patient survey visits were included, representing an extrapolated, weighted national estimate of 135,406,736 visits be-

tween 2005 - 2015, inclusive. Adjusting for factors of interest, diagnosis of depression in patient visits with COPD was significantly more likely for those with 4 to 6 comorbidities, 7 or more comorbidities, aged 18-64, and utilizing Medicaid/SCHIP for payment.

A diagnosis of depression in patient visits with COPD was significantly less likely for males, non-white patients, and those with the comorbidity of diabetes.

Conclusion: In patient visits with COPD, a significant increase in the diagnosis of depression was found in the presence of ≥ 4 comorbidities and certain socio-demographic factors. COPD patients with multiple comorbidities should be screened for depression.

Neonatal Sepsis: Safety of Ceftriaxone versus Cefotaxime Authors: Garrett B. Hile, PharmD; Kaitlin Musick, PharmD Candidate; Adam J. Dugan MS; Abby M. Bailey, PharmD; Gavin T. Howington, PharmD Institution: University of Kentucky HealthCare, Lexington, KY Objective: Ceftriaxone and cefotaxime are appealing options for the treatment of neonatal infections due to their broad-spectrum of activity. Given ceftriaxone’s potential to precipitate hyperbilirubinemia, alternative agents are recommended in neonates. In response to cefotaxime shortage, our institution adopted a protocol for management of neonatal sepsis: neonates ≤ 14 days old can receive ampicillin plus cefepime and neonates ≥ 15 days old can receive ampicillin plus ceftriaxone. The objective of this study was to compare the safety profiles between ceftriaxone and cefotaxime in the treatment of neonatal infections.

Methods: This was a single-center

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retrospective chart review of patients receiving ceftriaxone or cefotaxime for the treatment of neonatal infections between January 1, 2013 and August 31, 2018. Patients were 30 days or younger at the time of antimicrobial administration and must have received at least one dose of ceftriaxone or cefotaxime during hospital admission. A subgroup analysis was performed that excluded patients 14 days of age or less that received cefotaxime.

Results: 232 patients were included in the analysis. Patients receiving cefotaxime were younger (7.0 versus 22.0 days; p<0.001), with younger gestational ages (37.9 versus 38.0 weeks; p=0.043), and lower weights on admission (3.0 versus 3.7 kilograms; p<0.001) compared to ceftriaxone. Patients that received cefotaxime were more likely to see an increase in bilirubin levels from baseline to abnormal compared to ceftriaxone (22% versus 2.2%; p=0.004), and had larger mean increases in bilirubin levels between baseline and abnormal (0.9 mg/dL versus 0.0 mg/dL; p=0.026). Subgroup analysis revealed no statistical significance between age, gestational age, weight, baseline bilirubin, number with abnormal bilirubin levels, and peak bilirubin level.

Conclusion: Patients receiving ceftriaxone did not have a higher likelihood of developing hyperbilirubinemia compared to those receiving cefotaxime during their hospital stay, therefore, ceftriaxone appears to be safe in neonates 15 days and older.

An Evaluation of Adherence to Osteoporosis Screening and Treatment Guidelines in Primary Care Authors: Marcia Hooks, PharmD/ MBA Candidate, Kimberly Lovin Nealy, PharmD, BCPS, CDE, CPP, Melissa Tolley Nink, Ph.D.

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Objectives: It is estimated that 10.3% and 43.9% of Americans 50 years and older in the United States have osteoporosis (OP) or low bone mass, respectively. (1) Osteoporotic fractures can lead to morbidity and mortality in older adults. Many therapies are available to increase bone mineral density (BMD), reduce OP-related fractures, and decrease mortality after hip fractures; however, many at risk patients remain undiagnosed and untreated.

We aim to evaluate adherence to evidence based recommendations for osteoporosis screening and treatment in a health system-affiliated family medicine clinic.

Methods: The Atrium Health Institutional Review Board approved this retrospective case study conducted at Cabarrus Family Medicine - Prosperity Crossing (CFM-PC). Electronic databases containing OP-associated CPT billing and ICD-10 codes were used to identify patients with diagnoses of osteoporosis, osteoporosis-related fragility fractures, or osteopenia between June 1, 2018 and May 31, 2019.

Demographics, DEXA results, medications, and laboratory data were evaluated to determine if participants were on recommended therapy.

Results: There are currently 1,286 patients 50 years and older under provider care at CFM-PC (63.3% female).

Of these patients, 40 (3.11%) have a formal diagnosis of osteoporosis and 20 (1.56%) have osteopenia. Twentyone patients with OP (52.5%) have an active prescription for OP therapy (bisphosphonate or denosumab).

Three patients with osteopenia (15%) were on alendronate 70mg weekly.

Conclusions: These results indicate there is a low rate of diagnosis of osteoporosis and osteopenia of CFM-PC patients compared with the national average. Of those diagnosed, active treatment rates are also low. This study is not without limitations. There may be omissions of documentation

if care was provided by non-system specialists. Additionally, patients not currently on therapy may be on an appropriate therapy-free, postbisphosphonate drug holiday. Nonetheless, these results identify areas for improvements in osteoporosis care for this vulnerable population.

References: (1) Wright NC, Looker AC, Saag KG, et al. The Recent Prevalence of Osteoporosis and Low Bone Mass in the United States Based on Bone Mineral Density at the Femoral Neck or Lumbar Spine. J Bone Miner Res. 2014; 29(11):2520-2526.

SMASH the Smoking - Students Mentoring Against Smoking in the Homeless (SMASH) Project

Authors: Yusu Liu, PharmD Candidate, Ashley N. Buige, PharmD Candidate, Casey J. Wells, PharmD Candidate, Yujiao Sun, PharmD Candidate, Kaitlyn M. Van Peursem, PharmD Candidate, Jacqueline M. Zeeman, PharmD

Institution: UNC Eshelman School of Pharmacy Objective: To characterize smoking patterns in the homeless population and identify barriers to quitting attempts through a student-led smoking cessation program.

Methods: This prospective, interventional, descriptive study evaluated a novel smoking cessation program at a homeless shelter led by student pharmacists. After a two-week screening process, eligible participants were enrolled into one of two groups: (1) nicotine replacement patches + weekly motivational interviewing (MI) sessions, or (2) weekly MI sessions only. Demographic data, quitting habits, and perceived barriers to quitting were collected.

Results: Fifteen participants were enrolled with most being female (53.3%), African American (66.7%),

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and a current homeless shelter resident (60.0%) with a mean age of 40 years. Mental illnesses (73.3%) and asthma/COPD (33.3%) were the most frequently reported comorbidities.

Seven participants (46.7%) used NRT in the past. Among those who smoked <10 cigarettes daily (66.7%), half reported only purchasing from a store.

Among participants who smoked >10 cigarettes daily (33.3%), forty percent obtained cigarettes through purchase or friends. The majority of participants (93.3%) reported more than one reason to quit. Frequently reported reasons included “to be healthier or prevent health problems” (80%), “to save money” (80%), and “to feel better” (53.3%). Prominent reported barriers to quitting included “being around smokers often” (66.7%), “coping with stress” (60%), and “unable to stop cravings” (33.3%). Key smoking triggers identified were “when feeling stressed or need to calm down” (73.3%) and “when first waking up” (66.7%). Participants were most interested in discussing “ways to handle stress” (73.3%) and “healthier lifestyles” (73.3%) during MI sessions.

Conclusion: Most homeless shelter residents enrolled in the pharmacy student-led smoking cessation program reported smoking less than 10 cigarettes daily with previous quit attempts and mental health comorbidities. While most participants reported greater than one motivator to quit, barriers to quitting were associated with their stress and lifestyle.

An Analysis of Herpes Zoster Prevalence and Associated Predictors Utilizing the National Ambulatory Medical Care Survey: 2006-2015 Authors: Evan Lucas, PharmD/MSCR Candidate; Alexia Greene, PharmD/ MSCR Candidate; Melissa Holland, PharmD/MSCR, Michael Jiroutek, DrPH, MS Institution: Campbell University College of Pharmacy & Health Sciences

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Objective: The incidence of herpes zoster (HZ) has increased over the past 60 years. The economic burden to the US is estimated to be $1.1 billion annually. Studies have shown no association between this increase and the introduction of antivirals or varicella vaccination. Additional studies have demonstrated a correlation with older age and female gender. The objective of this study was to evaluate trends in patient visits with a diagnosis of HZ over the years 2006-2015 utilizing data from the National Ambulatory Medical Care Survey (NAMCS) and to analyze any associations with socio-demographic factors of interest.

Methods: This was a retrospective, cross-sectional observational, IRBexempt study including patient visits for those 18 years and older. Visits with immunocompromised patients were excluded. A plot of visits with an HZ diagnosis by year (with 95% confidence intervals) was constructed in addition to the utilization of a multivariable logistic regression model to assess predictors of HZ. Results: A total of 301,442 visits meeting the inclusion/exclusion criteria between the years 2006-2015, inclusive, were included. The survey design allows extrapolating this survey total to generate a national estimate of 745,688,997 visits with a diagnosis of HZ annually. No significant change in the prevalence of HZ visits across the study years was observed. Adjusting for factors of interest, visits with a diagnosis of HZ were significantly less likely for those: aged 18-35 and 36-49 (versus ≥65), in the non-white race group (versus white race group), having 4 or more chronic conditions (versus 0-3 conditions), and with an insurance payment type of ‘Medicaid/ SCHIP/Other’ (versus private insurance).

Conclusions: HZ prevalence was fairly consistent across the study years with no significant change in ambulatory

visits for HZ noted. Differences in the rate of diagnoses of HZ remain across several levels of socio-demographic factors of interest.

Evaluation of hospital-acquired venous thromboembolism in pediatric patients in an academic medical center: A retrospective chart review

Authors: Ashley McCallister, PharmD, MBA, BCPPS, Yasmina Abajas, MD, Mariah Gibbs, PharmD Candidate, Kelsey Mueller, PharmD Candidate

Institution: UNC Eshelman School of Pharmacy Objective: Recommendations for venous thromboembolism (VTE) prophylaxis in pediatrics are not standardized as they are for adult patients. While pediatric patients are at low risk for clot development at baseline, in hospitalized children, the risk greatly increases. Without well-defined guidelines for VTE prophylaxis in pediatrics, decision to use prophylaxis is provider-dependent. Children’s Hospital’s Solutions for Patient Safety (SPS) established bundle for VTE prevention in this patient population. Based on the SPS bundle, would pediatric patients who developed a clot while admitted to the University of North Carolina Children’s Hospital meet criteria for pharmacologic prophylaxis?

Methods: Single-site, retrospective chart review of pediatric patients admitted to UNC Children’s Hospital between August 2013 to December 2018 with a new diagnosis of a VTE during hospitalization. Patients were excluded if received therapeutic anticoagulation at time of clot, admitted with active clot, or in the Neonatal Intensive Care Unit.

Patients who developed a VTE during admission were assessed for VTE

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risk factors as aligned with SPS’s VTE prevention bundle. Patient age, unit and service admitted to were evaluated, along with type of prophylaxis received prior to clot development.

Results: Out of 314 charts reviewed, 85 patients were included. When assessed for SPS’s Standard Elements for Screening, 44 patients (51.8%), met criteria for pharmacologic prophylaxis. Upon further screening with SPS’s Recommended Elements for Screening, 71 patients (83.5%), met criteria for pharmacologic prophylaxis; however, only 3 patients (4.2%) received appropriate pharmacologic VTE prophylaxis.

Conclusions: Based on the results of this retrospective chart review, the SPS VTE prevention bundle would have identified patients at risk for clot development. Our institution is standardizing the practice for evaluating and recommending VTE prophylaxis in pediatrics. A future study examining clot prevention is warranted to identify adherence to the practice changes at our institution.

Interprofessional Substance Use Disorder Education in Health Professions Programs: A Scoping Review of the Literature Authors: Andrew Muzyk, Pharm D; Zachary Smothers, MS; Kathryn M Andolsek, MD, MPH; Melissa Bradner, MD, MHSA; Jeffery Bratberg, PharmD; Seth Clark, MD, MPH; Kathryn Collins, BA; Gerard Greskovic, BSPharm; Larry Gruppen, PhD; Mark MacEachern, MLIS; Susan Ramsey, PhD; Jennifer Ruiz Veve, BS; Jeanette Tetrault, MD Institution: Campbell University College of Pharmacy and Health Sciences Objectives: The purpose of this scoping review is to: 1) provide a comprehensive evaluation and summation

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of published literature on interprofessional substance use disorder (SUD) education, and 2) appraise research quality and outcomes of this published literature. The goal is to inform educators of interventions that may be useful for creating their own courses and to identify areas of improvement.

Methods: Three Ovid MEDLINE databases (MEDLINE, In-Process & Other Non-Indexed Citations, and Epub Ahead of Print), Embase.com, ERIC via FirstSearch, and Clarivate Web of Science were searched from inception to December 7, 2018 to identify articles relevant to interprofessional SUD education of health professions students.

Results: Study authors screened one thousand eight hundred and forty-five unique Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation articles, and 14 met inclusion criteria. Publications dated from 2014-2018 and most discussed students from at least three different health professions programs (71%). Study authors scored articles using the Medical Education Research Study Quality Instrument (MERSQI).

The mean MERSQI score was 10.64 (SD = 1.73). Curriculum topics included general substance use (29%), tobacco (29%), alcohol (21%), and opioids (21%). Educational interventions varied by study, and improved students’ educational outcomes related to SUDs and/or interprofessionalism.

Conclusions: Interprofessional SUD educational interventions improved the knowledge, skills, and attitudes of health professions students toward SUDs and interprofessional collaboration. Interprofessional SUD education provides an important opportunity to develop a future workforce prepared to manage one of the most complex public health threats.

Assessing the safety and efficacy of a newly implemented dexmedeto-

midine protocol for severe alcohol withdrawal patients in a community teaching hospital Authors: Morgan Phillips PharmD Candidate, Virginia Bland PharmD Candidate, Lindsay Harris PharmD, BCCCP, Heidi Phillips PharmD, BCPS, CPP, Ryan Tilton PharmD, Kaitlyn Bankieris PhD, Elizabeth Michalets PharmD, BCPS, FCCP; Department of Pharmacy, Institutions: Mission Hospital, Asheville, NC; UNC Eshelman School of Pharmacy Objective: Approximately 25% of hospitalized patients with alcohol use disorder exhibit alcohol withdrawal symptoms. Benzodiazepines are used for primary symptom management, whereas dexmedetomidine can be used off-label as an adjunctive agent for symptom management. The purpose is to compare the safety and efficacy of dexmedetomidine in combination with benzodiazepines before and after guideline implementation in severe alcohol withdrawal patients.

Methods: This is a retrospective before and after comparison study. IRB review and Research Institute approval were obtained. The before protocol implementation group (BPG) assesses the use of dexmedetomidine in severe alcohol withdrawal (SAW) with a sedation protocol. The after protocol implementation group (APG) assesses the use of dexmedetomidine with a newly implemented dosing protocol specific for SAW patients. Electronic data mining is used with some manual extraction.

Results: A total of 136 patients were included in the BPG. The average age was 54.7 years (SD±13.5) and average ICU length of stay was 6.8 days (SD±5.1). Medication related results for the BPG are as follows: average duration of dexmedetomidine exposure was 2.2 days (SD±2.3); average

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cumulative lorazepam dose prior to dexmedetomidine was 26.4 mg (SD±30.4mg); and average cumulative lorazepam dose during dexmedetomidine exposure was 21.2mg (SD±36.3mg). Before, during and after completion of the dexmedetomidine infusion, the median Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score was 11 (IQR=8.6), 10 (IQR=6.5), and 6 (IQR=6), respectively.

Bradycardia, defined as a heart rate <50 beats per minute, occurred in 16 patients (11.8%) before dexmedetomidine initiation; while 120 patients (88.2%) had documented bradycardia during dexmedetomidine exposure. A total of 80 patients (58.8%) required mechanical ventilation and 17 patients (12.5%) died.

APG data collection and analysis are ongoing.

Conclusion: Forthcoming after APG analysis.

Assessment and clinical utility of pharmacogenomic testing by registered pharmacists and other healthcare practitioners in North Carolina Authors: Brianne S. Raccor, PhD; Isabel Alcala-Maddox, PharmD Candidate; Tristyn Cartrette, PharmD Candidate; Amber K. Hill, PharmD Candidate; Kaitlin Shields, PharmD Candidate; Chantley Thomas, PharmD Candidate; Pius Fasinu, PhD, RPh; Antoine Al-Achi, PhD, MPharm, MS, CT; Dorothea K. Thompson, JD, PhD Institution: Campbell University College of Pharmacy and Health Sciences Objective: The purpose of this study was to assess the knowledge, use, and perceptions of pharmacogenomic testing among registered pharmacists and other healthcare practitioners in North Carolina (NC).

Methods: QualtricsXM was used to develop a 22-item survey that was

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validated by using a subpopulation of nine practitioners from various healthcare disciplines. Using this subpopulation, the reliability of the instrument was analyzed via multivariate modeling of the numerical scores. The validation analysis resulted in a value of 0.9438 for Cronbach’s α, which is considered an excellent value for reliability. Registered pharmacists had the highest reliability value (0.9464), whereas physical therapists had the lowest value (0.9200). The IRBapproved and voluntary survey was subsequently disseminated via email and social media outlets to licensed NC healthcare practitioners. A total of 808 practitioners responded to the survey, of which 745 met the criteria for inclusion in the analysis.

Results: Among respondents, 93% agreed that pharmacogenomic testing improves drug selection, and 88% agreed it helps minimize adverse drug events. However, 93% of respondents indicated either never or rarely using pharmacogenomic testing in their own clinical practice. Practitioners had educational experience with pharmacogenomics through continuing education, course work, and on-thejob training. A substantial percentage (31%) reported receiving no training.

The most frequently cited barriers to implementation of testing were cost and insufficient training (33% and 28%, respectively). Most pharmacists (71%) believed that they had a responsibility for delivering pharmacogenomic test results, but the majority felt incompetent in interpreting (68%) and communicating (64%) these results.

Conclusion: As a driver of personalized medicine, pharmacogenomic testing has the potential to improve drug efficacy and safety. This study suggests that NC pharmacists would benefit from more education on pharmacogenomics to enhance their practice. Current educational opportunities have not translated to increased

use and/or perception of competency in pharmacogenomics.

Evaluation of a pharmacist-led approach for transitioning patients to an angiotensin receptor-neprilysin inhibitor Authors: Krishna Rana, PharmD Candidate; Sonalie Patel, PharmD; Zack Deyo, PharmD Institution: UNC Medical Center Objective: To determine if a pharmacist-led outpatient angiotensin receptor-neprilysin inhibitor (ARNI) replacement and titration program led to more patients achieving target doses of sacubitril-valsartan (97/103 mg BID) compared to usual care. The 2016 ACC/AHA/HFSA Focused Update of the Guideline for the Management of Heart Failure recommends replacing an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) with an angiotensin receptor-neprilysin inhibitor (ARNI) to reduce morbidity and mortality in patients with chronic symptomatic heart failure with reduced ejection fraction (HFrEF); however, recently, the CHAMP HF Registry showed that 67% of eligible patients were not prescribed ACE/ARB/ARNI and only 14% of patients on ARNI therapy were on target doses, exposing significant gaps in care for this population.

Methods: A single-center, retrospective electronic medical record review identified 791 patients with active sacubitril-valsartan prescriptions and at least two outpatient cardiology visits with a pharmacist or usual care provider between January 2015 through September 2018. The primary outcome was the percentage of patients who achieved a target sacubitril-valsartan dose of 97/103.

The secondary outcome was the mean dose of sacubitril-valsartan achieved between each group.

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Results: 64 patients had sacubitrilvalsartan initiated by a pharmacist and 727 by usual care. 60.9% (n=39) of patients in the pharmacist group achieved target dose, whereas 18% (n=131) of patients managed by usual care achieved the target dose (95% CI 0.306-0.551, p<0.0001). The mean daily dose of sacubitril-valsartan in the pharmacist group was 230.2 ± 128.75 mg and 172.2 ± 98.02 mg daily in the usual care group. The average daily dose was 58 mg higher in the pharmacist group (95% CI 25-90.9, p = 0.0008).

Conclusion: A pharmacist-led outpatient ARNI replacement and titration program was more likely to achieve target dose and a higher mean dose compared to usual care.

Sickle Cell Disease Rehospitalizations: Pain Resolution Authors: Candace Reid, PharmD Candidate; Jacqueline Olin, MS, PharmD, BCPS, CPP, CDE, FASHP; Geoffrey Mospan, PharmD, BCPS Institution: Novant Presbyterian Hospital, Charlotte, NC; Wingate University School of Pharmacy Objectives: Patients with sickle cell disease (SCD) frequently seek care for resolution of vaso-occlusive crises (VOC) which cause severe pain, often necessitating opioids. As pain management is subjective, there are no systematically reviewed and complete guidelines available in the United States for its management in SCD. As a result, SCD individuals may experience inadequate pain control. The primary objective of this study was to determine the average amount of time to reach pain resolution in patients admitted to the hospital for VOC. This allows a clearer understanding of opiate use in VOC pain management.

Methods: Medical records of patients

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admitted to Novant Health Presbyterian Medical Center with SCD being managed with opioids and who had prior hospital admissions due to VOC were reviewed. The data collected included home and hospital pain medications (IV and PO), pain scores, and length of stay. The primary outcome was the time to pain resolution as defined by a >20% pain reduction upon admission.

Results: Ten patients with 79 encounters had a mean length of stay at 4.9 days. These patients had an average time of 9.23 hours to reach pain resolution. An average opiate dose of 18.2 mg morphine equivalents were used to reach >20% pain reduction.

Conclusions: Overall, there is variability in patient analgesia required for a >20% pain reduction. This could be due to the home pain management differences and patient specific parameters. The amount of time to reach a >20% pain reduction is beneficial to providers in treating VOC. Prescribing Prevalence of Sodium/ Glucose Cotransporter 2 inhibitors and Glucagon-like peptide-1 agonist in patients with both Type 2 Diabetes Mellitus and ASCVD Authors: Sprague T, Kim J, Wadsworth D Institution: Cone Health Internal Medicine Clinic, Greensboro, NC; Cone Health Medical Group, Greensboro, NC Objective: To evaluate prescribing prevalence of Sodium/Glucose Cotransporter 2 inhibitors (SGLT-2) and Glucagon-like peptide-1 agonist (GLP-1) in patients with both Type 2 Diabetes Mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD).

Methods: This cross-sectional analy-

sis collected EPIC data to determine how many patients at five Cone Health Medical Group Clinics (Internal Medicine, Family Medicine, Community Health and Wellness, Patient Care Center, and Lebauer Heartcare Clinic) had DM/ASCVD overlap and were seen in the two years prior to May 2019. Descriptive statistics were used to determine the number of patients on either SGLT-2 inhibitors, GLP-1 agonist, or a diabetes medication combination including either the SGLT-2 or GLP-1.

Results: Evaluating prevalence of GLP-1 agonist and SGLT-2 inhibitor prescribing in patients with both DM and ASCVD after first line therapy with Metformin showed 2019 patients found within the 5 clinics that have DM/ASCVD overlap. Of these patients, 1440 of the 2019 patients were not currently on a SGLT-1 inhibitors or GLP-1 agonist when accounting for overlap between the different clinics.

Conclusion: These results show that since the new ADA update there are still several patients who could benefit from further evaluation of their T2DM regimen and how a GLP-1 or SGLT-2 could be added. This study will inform prescribers of the number of their patients not on ADA guideline recommended therapy and the importance of using this therapy in patients with DM/ASCVD. Assessment of the preventative health needs of under-resourced populations served by a free, student-run healthcare organization in North Carolina Authors: Jessica Stickel, PharmD Candidate1, Susan Ngo, PharmD Candidate1, Akshara Kumar, PharmD Candidate1, Laura A. Rhodes, PharmD, BCACP2, Jacqueline M. Zeeman, PharmD1 Institutions: 1The University of North Carolina at Chapel Hill Eshelman School of Pharmacy; 2Palm Beach Atlantic University Lloyd L. Gregory

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School of Pharmacy, West Palm Beach, FL Objective: Preventative health services are integral to ensuring a communityâ&#x20AC;&#x2122;s long-term health. Often, these services are underutilized by minority and under-resourced populations. This study aims to characterize the preventative health needs and existing gaps of underresourced populations served by a free, student-run healthcare organization.

Methods: This institutional review board-approved, cross-sectional study recruited participants from a Spanish-language church and a homeless shelter. Participants were at least 18 years old, completed a background survey, and engaged in a preventative health consultation (PHC) with student pharmacists.

During the PHC, pertinent recommendations from the United States Preventive Services Task Force and Centers for Disease Control and Prevention immunization schedule were discussed. Shared decisionmaking was used to determine the top three recommendations for each participant, balancing the urgency of each recommendation with participant preferences and values.

Recommendations were grouped (vaccinations, cancer screenings, communicable disease screenings, chronic disease screenings, health behaviors, pharmacotherapy interventions, and other) for analysis and analyzed using descriptive statistics.

Results: Twenty-nine people enrolled in the study. Participant demographics were fifty-five percent male (n=16), mean age 47.1 years (13.2 SD), and mean BMI 31.4 kg/m2 (5.6 SD). Twenty percent (n=6) of participants had a positive PHQ-2 and thirty-one percent (n=9) reported current tobacco use.

Eighty-seven recommendations were made; frequencies were health behaviors (n=25, 28.7%),

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vaccinations (n=16, 18.4%), chronic disease screenings (n=16, 18.4%), communicable disease screenings (n=15, 17.2%), cancer screenings (n=11, 12.6%), other (n=4, 4.6%), and pharmacotherapy interventions (n=0). The most frequent category for Spanish-speaking participants was vaccinations (n=10, 23.8%), while health behaviors was most frequent for homeless participants (n=16, 48.5%).

Conclusion: The highest-prioritized preventative health recommendation categories were health behaviors, vaccinations, and chronic disease screenings. These findings suggest that future student-led initiatives to target identified gaps in preventative healthcare should focus on providing health behavior education and support, chronic disease screenings, and vaccine clinics.

Reticulocyte count utility in sickle cell disease acute pain crisis management: does increased reticulocyte count correlate to increased opioid quantities needed during acute pain crises?

Authors: Daniel Thompson, Student Pharmacist; Jacqueline Olin, MS, PharmD, BCPS, CPP, CDE, FASHP, FCCP; Geoffrey Mospan, PharmD, BCPS Institution: Novant Health Presbyterian Medical Center, Charlotte NC; Wingate University School of Pharmacy, Wingate NC Objective: Patients with sickle cell disease (SCD) commonly seek medical care for vaso-occlusive pain crises (VOC). Treatment of VOC regularly requires administration of intravenous opiates. Appropriate treatment of the severe VOC pain is critical. The primary objective of this study was to assess if reticulocyte count is an accurate index of pain severity and pain management needs in SCD patients experiencing a VOC.

Methods: Medical records of individuals admitted to Novant Health Presbyterian Medical Center receiving patient-controlled analgesia (PCA) were reviewed to identify SCD patients experiencing VOC. Patients were excluded if they were under 18 years old, had a reticulocyte count <2.5%, and if there was an occurrence of stroke, blood transfusions, priapism, acute chest syndrome, or another indication for opioids. Data collected included: demographics, admission and discharge reticulocyte count, time on PCA, length of stay, and admission vital signs. A Spearman Rank correlation analysis was used to assess the relationship between the total time on PCA and admission reticulocyte count.

Results: Out of 11 patients identified, the mean age was 29 years old.

The patients included 7 females and 4 males. From the 11 patients, 47 admissions for VOC met inclusion criteria. The mean admission reticulocyte count was 10.33%, and the mean time on PCA was 119 hours. A soft positive relationship was observed between time on PCA and admission reticulocyte count. A Spearman Rank Correlation analysis between time on PCA and admission reticulocyte count revealed the following: R²=0.217 and p=0.142. The analysis showed no statistical significance between the two values.

Conclusion: While the results of this study did not show a statistically significant relationship between reticulocyte count and time on PCA, the small sample size impacts the ability to draw a strong conclusion. A larger study is needed to assess reticulocyte utility in this population.

A Cross-Sectional Analysis of Inhaled Corticosteroid Therapy De-escalation Opportunities in Patients who have COPD

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Authors: Daniel Wadsworth, PharmD Candidate; Jennifer Kim, PharmD, BCPS, BCACP, CPP; Taylor Sprague, PharmD Candidate Institution: Moses H. Cone Memorial Hospital, Greensboro NC Objectives: The primary purpose of this study was to assess prescriber adherence to novel de-escalation recommendations for inhaled corticosteroids (ICSs) from the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines at four outpatient clinics as of July 2019.

Specifically, adherence was analyzed for recommendations suggesting ICS therapy discontinuation on the basis of pneumonia history, exacerbation history, and blood eosinophil levels.

Secondary objectives were to characterize reasons for prescribers’ noncompliance to ICS discontinuation and to describe the prescribing prevalence of each ICS in patients with Chronic Obstructive Pulmonary Disease (COPD) but not asthma.

Methods: The medical records of 1155 patients who had a diagnosis of COPD but not asthma from June 30, 2017 to June 30, 2019 were reviewed.

Data collected included exacerbation history, pneumonia history, ICS prescription, and other agents prescribed for management of COPD on the patient’s medication list.

Results: Seven hundred and fifty-six patients had a most recent blood eosinophil level less than 300 cells/ µL. Of those patients, 123 (16%) were currently prescribed an ICS. Two hundred and seventy-three patients had a documented history of pneumonia, and eighty-four (30%) of those patients were prescribed an ICS. Further analytical findings are still underway.

Conclusions: This study will help to understand the current prescribing patterns of ICSs in COPD exclusive

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of asthma and assess the need for prescriber education on new updates to the 2019 GOLD guidelines. Future interventions by pharmacy staff may help to rectify these differences.

“Time is brain”: A retrospective comparative analysis of the emergency department pharmacists’ impact on the time for door-to-TPA administration in ischemic stroke patients Authors: Kenicia Walker, BA, PharmD/ MSPH Candidate; Kecia Missos, BS, PharmD/MSPH Candidate; Manali Patel, PharmD, MBA, BCPS Institution: Duke Regional Hospital, Durham NC; Campbell University College of Pharmacy and Health Sciences Objective: The purpose of this study is to assess how the presence of an emergency department pharmacist can impact the time to administration of tPA. Methods: This study assessed length of time for the administration of tPA with an emergency department pharmacist present at patient bedside and without an emergency department pharmacist. Data was collected through a retrospective chart review of all patients who had received tPA over an 11-month period in 2017.

Descriptive statistics were used to evaluate the primary outcome.

Results: A total of 34 patients received tPA during the study period. Thirty patients were used in the statistical analysis, 14 patients received tPA with an emergency department pharmacist present and 16 received tPA without an emergency department pharmacist (four patients were removed as statistical outliers). The median door-toadministration time when an emergency department pharmacist was present was 82 minutes, compared to 91.5 minutes without an emergency department pharmacist.

Conclusions: The median time for ischemic stroke patients to receive tPA with an emergency department pharmacist at bedside is approximately 10 minutes less compared to the time without the emergency department pharmacist. Although the comparison of the two groups was not statistically significant, a clinical significance is still present due to the high importance of quicker tPA administration in stroke patients. This study demonstrated that emergency department pharmacists are integral part of the hospital stroke team and shows the possibility of improved care for ischemic stroke patients.

Evaluation of antimicrobial prescribing for acute uncomplicated cystitis and pyelonephritis in an urgent care center Authors: Caroline Welch, PharmD; Sarah Dobbins, PharmD; Beth Becker, PharmD, BCPS; Kelli Kirkpatrick, PharmD; Christie Dresback, PharmD Institution: Mission Hospital, Asheville, North Carolina Objective: We aimed to evaluate the appropriateness of antimicrobial prescribing for both uncomplicated cystitis and pyelonephritis in light of current IDSA guidelines (appropriate drug, dose, and duration), available culture data, available renal function, and patient allergies.

Methods: This retrospective study reviewed 602 female, non-pregnant patients ages 18 years and older with an ICD-10 code for acute uncomplicated cystitis or pyelonephritis that received an electronic prescription from a single urgent care clinic in the Mission network located in Asheville, North Carolina between August 1, 2016 and August 1, 2018. Patients were excluded if they had a diagnosis of a complicated urinary tract infec-

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tion, which included patients with poorly controlled diabetes (A1C >7%) and immunocompromised patients.

Results: Appropriate prescribing in accordance with IDSA guidelines occurred in 53% of the 602 patients included, with the majority of cases being acute uncomplicated cystitis.

The most common discordances with the guidelines included a duration of therapy that was too long (34% of patients) and drug selection that was not considered first line even after consideration of patient allergies (17% of patients). Renal function was unknown in 57% of patients.

Conclusions: Providing appropriate therapy to treat urinary tract infections is crucial to prevent treatment failures and emergence of resistant organisms. The results of this retrospective chart review found that roughly half of the patients that presented with acute uncomplicated cystitis and pyelonephritis in the urgent care clinic were not being treated with antibiotic regimens that align with IDSA guidelines.

Utilization of Pharmacists in Physician Assistant Curricula in the United States Authors: Dustin Wilson, PharmD, BCPS1,2; Jennifer Adema, PharmD Candidate1; Carrie Baker, PharmD Candidate1; John Conyers, PharmD Candidate1; Morgan Treece, PharmD Candidate1; Peter Fenn, DHSc, MPAS, PA-C1 Institutions: 1 Campbell University College of Pharmacy & Health Sciences; 2 Duke University Hospital Objective: The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) has accredited 236 physician assistant (PA) programs. The ARC-PA requires a program’s curriculum to include

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instruction in pharmacology and pharmacotherapeutics. The ARC-PA states PA program instructional faculty can include medical practitioners from other disciplines of healthcare.

Despite pharmacists being recognized as ideal teachers of pharmacology/ pharmacotherapeutics, there is a gap in knowledge of the incorporation and utilization of pharmacists in health sciences curricula. The objective of this study was to describe the number of PA programs who utilize pharmacists to lecture pharmacology/pharmacotherapeutics content.

Methods: This was an IRB-approved, prospective, cross-sectional, cohort survey. All programs on the ARC-PA website in which the email address for the Director of Pre-Clinical Education/ Didactic Education, Academic Coordinator, or Chair/Director was identified were included in the study. An electronic survey was distributed to each program with a reminder email sent two weeks after the initial email.

The survey collected data on program characteristics as well as utilization of pharmacists in the curriculum. Descriptive statistics were used for all analyses.

Results: Of 187 programs receiving the survey, 66 completed the survey.

Overall, 83% of programs reported that pharmacists were utilized to deliver pharmacology/pharmacotherapeutics content. For those programs who utilize pharmacists, approximately 82% reported pharmacists teach more than 51% of the lectures.

Twenty-three (35%) programs have a full-time pharmacist on faculty to coordinate these courses.

Conclusions: More than 80% of programs responding to the survey utilize pharmacists to deliver pharmacology/ pharmacotherapeutics content. Utilization of pharmacists in other health sciences curricula is warranted.

Improving Infusion Safety with Targeted Training Authors: Emily Woodfield, PharmD Candidate; April Cooper, PharmD; Jimmy Greenlee, MHA, RPh Institution: Campbell University College of Pharmacy & Health Sciences; Duke Health Systems, Durham, NC; Duke Regional Hospital, Durham, NC Objective: The primary purpose of this evaluation is to improve medication safety through increased Guardrail compliance with the Alaris Smart Pumps.

Methods: Nurses input the patient ID into the Alaris Smart Pump before starting an infusion. Nurses choose to start either a basic infusion or a medication from the Guardrail system that is equipped with safety features. Data is collected from the patients receiving basic infusions, and if possible, the nurse involved is identified the next day. The nurse manager then speaks with the nurse who took care of that patient to remind them of the Guardrail policy to ensure safety measures are in place when administering an infusion. If a medication is not found in the Guardrail system, then pharmacy is asked to input the medication limits into the program by the end of the month so that future patients may remain within the safety boundaries.

Results: Compliance with Guardrails has increased by 7.53% from January (90.25%) to June (97.05%) 2019.

It was found that basic infusions decreased by 71.90%, from 3,011 a month down to 846, between January and June 2019.

Conclusion: It was found, by reminding nurses to use Guardrails almost immediately after they had chosen not to use a Guardrail, we were able drive up Guardrail use for subsequent infusions. Improved Guardrail compliance means more likelihood to infuse drugs safely.

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Impact of Medium Fidelity Manikins on First-Year Pharmacy Student Confidence and Accuracy with Physical Assessment Using a Spaced Learning Model Authors: Madison Yates, PharmD Candidate; Heather Pruneau, PharmD Candidate; Peter Gal, PharmD; Ron Ragan, RPh, PhD Institution: High Point University Objective: (1) To determine if P1 Doctor of Pharmacy students’ confidence and accuracy with physical assessment improved from baseline after repeated exposures with medium fidelity manikins as a component of case-based learning. (2) To determine longitudinal retention in confidence and accuracy after a semester of no exposure to manikins Methods: P1 students are enrolled in a case-based course in the fall and spring, Case Recitation I and II. The use of medium-fidelity manikins was incorporated into the fall semester course to provide physical assessment experience that aided in solving casebased scenarios. Identical surveys (“pre-exposure” and “post-exposure”) were conducted at the beginning and end of the course to evaluate changes in student confidence and accuracy with assessing heart rate, blood pressure, and lung sounds as a result of practicing with the manikins. Manikins were not incorporated into the spring semester course and the same surveys (“follow-up”) were administered at the end of this semester to evaluate the long-term retention of confidence and accuracy. Only students who completed all six surveys were included.

Results: Fifty-six students were included. The difference in confidence in assessing heart rate, blood pressure, and lung sounds between preand post-exposure were all significant

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(p<.001). The difference in accuracy between pre- and post-exposure for blood pressure and lung sounds were significant (p<.01) but heart rate was not significant. Measures in confidence and accuracy between post-exposure and follow-up did not show significant decline in any of the three measures. 100% of students considered it a useful experience to use manikins to learn physical assessment skills.

Conclusion: The use of medium fidelity manikins and a spaced learning strategy allows successful training of P1 pharmacy students to recognize normal versus abnormal lung sounds, and accurately measure heart rate and blood pressure.

Case Report of Amoxicillin/Clavulanate-Induced Severe Pancytopenia Authors: Ramiel N. Ngeve, PharmD Candidate,1 Chris Larck, PharmD, BCOP, CPP,2 Donald C. Moore, PharmD, BCPS, BCOP, DPLA 2 Institutions: 1 High Point University; 2 Levine Cancer Institute, Atrium Health, Concord, NC Introduction: Drug-induced pancytopenia is a rare hematologic disorder associated with certain medications.

Pancytopenia is characterized by anemia, neutropenia, and thrombocytopenia. Pancytopenia can arise from a decrease in the production or an increase in the destruction of blood cells. Immunosuppressants and chemotherapy are known causative agents of pancytopenia due to their mechanism of action, and pancytopenia has previously been associated with antibiotics such as piperacillin, ceftriaxone, and ceftazidime. Seldom case reports exist of amoxicillin/ clavulanate-induced pancytopenia.

This report aims to illustrate an event of amoxicillin/clavulanate-induced pancytopenia.

Case Presentation: A 46-year old female with no significant medical history was prescribed a 10-day course of amoxicillin/clavulanate 875 mg twice daily for an ear infection presented with severe pancytopenia requiring hospitalization. Her admission CBC showed a hemoglobin of 2.2 g/dL, WBC of 2.8x103/ÂľL, and platelets of 37x103/ÂľL with no apparent signs of acute blood loss. Amoxicillin/clavulanate was her only recently started medication. Normal lactate dehydrogenase and haptoglobin levels ruled out intravascular hemolysis. A bone marrow biopsy found no evidence of malignancy or aplastic anemia, but erythroid hyperplasia and features of dysmegakaryopoiesis were identified prompting a PCR analysis of the Jak2 Exon12 mutation which showed a negative V617F mutation. Viral studies

for parvovirus, HIV, and hepatitis were negative. She was transfused with 3 units of packed red blood cells, and only recovered after discontinuation of antibiotic and a further transfusion of 1 unit of platelets.

Discussion: Given the lack of other possible etiologies and the temporal relationship with pancytopenia onset and recovery, amoxicillin/clavulanate was considered the probable offending agent per the Naranjo scale.

Because drug-induced pancytopenia is dangerous and potentially life-threatening, re-challenging a suspected medication in hopes of establishing a causative agent is not a recommended practice.

Bring Cash to Buy Tickets

for the 50/50 Raffle

Kick off the Convention with Exhbitors at 10:00 am Thursday! Stop by and visit each booth to recieve tickets to enter drawings for great prizes . Winners will be annouced Thursday night at the reception.

You must be present to win!

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2019 NCAP Annual Convention Best Practices Roundtable Topics

Establishing a System Pharmacist Peer Review Process

Population Health and the Clinical Pharmacist Practitioner (CPP)

presented by: Laura Dunlap

presented by: Alaina Olenik and Amanda Ruble

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Utilization of Clinical Advancement Programs to Drive Employee Engagement presented by: Kamaria Brown ​

Transitions of Care at Atrium Health - Expanding the Role of the Ambulatory Care Pharmacists into Post-Acute Care Patient Follow-Up presented by: Meaghan Moss and Jessica Cole

Integration of Front-Line Clinical Pharmacists into the Design and Standardization of Clinical Service Processes Across a Health System

Implementation of Pharmacy Services within an Employer-Sponsored Health Plan

​

​

presented by: Thomas Choiniere

Strategic Utilization of EMR Technology to Optimize Drug Expense Through the Care Continuum presented by: Susan Bear ​

Expansion of Outpatient “Coumadin Clinics” to DOAC Monitoring

presented by: Laura Skaff and Amanda Woods ​ North Carolina Pharmacist

​

presented by: Lydia Wang

Incorporating Specialty Pharmacy Services in Clinical Review of Oral Oncology Prescriptions presented by: Nicole Cowgill ​

Sustaining Pharmacy Services within a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) presented by: Bobbie Williamson

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​

New Inhaler Devices Recently Introduced to Market presented by: Catie Travis ​

Cannabidiol (CBD) Oil in Institutional Settings presented by: Dave Phillips ​

Unique Strategies for Pain Management presented by: Jennifer Kim

Helping Seniors Select a Part D Plan presented by: Marilyn Disco​

Discussion of Models for Inter-professional Rounding Services in a Variety of Practice Settings presented by: TBD ​

Discussion of Inpatient CPP Models and Barriers to Implementation presented by: TBD ​

Discussion of the Components of a Comprehensive Medication Reconciliation Service presented by: TBD ​

Utilizing Pharmacists to Improve Population Health Outcomes in Patients with Diabetes presented by: Sarai Ibrahim ​

Did you know the average pharmacy prints 35 miles of paper each year?

By using MedsOnCue you can do your part to #savetheearth. VUCA Health has been engaging with boards of pharmacy across the country and your pharmacy management system vendor to allow patients to select a new digital form of medication information, including videos. Contact us today to learn more on how you can enhance your patient engagement and minimize your printing burden.

NC Medicaid Transition to Managed Care presented by: Anna Armstrong

407.878.1662 | info@vucahealth.com | www.VUCAHealth.com North Carolina Pharmacist

Page 31 Volume 100 Number 3 Summer 2019

The Benefits of NCAP: One Student-Pharmacist’s Experience Yanying Yang, PharmD Candidate, UNC Eshelman School of Pharmacy

The North Carolina Association of Pharmacists (NCAP) provides perspective and opportunity while fostering professional and personal growth, not just for pharmacists, but for student pharmacists. In June, I had the fortune of having an advanced pharmacy practice experience (APPE) at NCAP and experienced this growth firsthand. During my rotation, I saw many benefits of NCAP membership for student-pharmacists and wanted to share what I learned.

Entering this rotation, I had very little understanding of association management or how NCAP operated and served the profession. On my first day, Dr. Penny Shelton, NCAP’s Executive Director and my preceptor, discussed the projects and experiences I would gain during the month. She also encouraged me to share my perspective on how NCAP could improve student-pharmacist membership.

NCAP is the only pharmacy organization in the state that represents the entire pharmacy profession. They provide support and advocate for pharmacists and technicians in all practice environments. NCAP focuses on equipping pharmacists and technicians with what they need, via education, networks, tools and resources, to enhance patient care and tackle public health issues. The NCAP mission is to unite, serve and advance the profession. The Association helps to elevate the role of pharmacists by making

sure the profession is represented and voice is heard among non-pharmacy stakeholders. NCAP is essentially the conduit for organizing members to address problems and create solutions.

The Association advocates for legislative, regulatory, and policy changes that transcends pharmacy practice, reaching and benefitting the population at large. In addition to practice advancement and advocacy services, NCAP also offers innovative and evolving resources, continuing education, as well as in-person and virtual networking opportunities for professional development. The benefits of NCAP membership are incontrovertible for practicing pharmacists, but as a student you might ask, how will an NCAP membership benefit me?

Did you know that students have a voice and are represented on the NCAP Board of Directors? I suppose I had not given much thought to the governance structure for NCAP. I knew there was an NCAP Student Pharmacist Network (SPN), but did not realize the SPN Chair also served as a voting member of the NCAP Board of Directors. During my APPE, I had the opportunity to assist in the preparation of the agenda and meeting materials for the Board of Directors meeting.

I also observed how the Board of Directors and Executive Committee conducts business on behalf of the members and Association.

Dr. Cheryl Viracola, the Director of Practice Advancement for NCAP, also served as my preceptor. Under the tutelage of Drs. Viracola and Shelton, I had the opportunity to work on a variety of grants and projects. NCAP is a driver of change and while I had not given it much thought, “change” is extremely important. The projects supported by NCAP help secure the future of pharmacy practice, which is something every student pharmacist should see as a benefit. During this rotation in Association Management, I spent about 60% of my time working on various projects and grants for NCAP. I helped with background and

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best practices research, procurement of screening and assessment tools and resources, as well as patient education materials. NCAP not only obtains grants to help with practice advancement concepts, but they work hard to focus on stakeholder engagement, funding and scalability. They address workflow and service delivery in a pragmatic way so that what is implemented will work in ‘the real world’.

Another opportunity that I had during my time at NCAP was working on the creation of promotional pieces to help with project recruitment and participation. Furthermore, I was given the ability to take the lead on creating the webpage design for a new certificate program that NCAP will be launching soon. I also worked on the repackaging of content for a live CE workshop to create on-demand learning modules.

My rotation in Association Management provided me the opportunity to help the NCAP staff with the components of the Residency Conference, Independent Pharmacy Legislative Town Hall, and the NCAP Annual Convention. Hereto, I never gave much thought to everything that goes into hosting an event, but from the contract negotiations, to establishing digital registration, to planning and promoting content, and much more, I now have a greater appreciation for everything that goes into planning and running statewide events. More importantly, I see how the planning of these events ties into the Association’s strategic plan and overarching work on behalf of the profession.

On the policy side of things, I had the opportunity to do some research on the USP 797/800 changes and enforcement date, as well as observe meetings for groups like the Opioid Prescription Drug Advisory Committee, the Telepharmacy Task Force, and the Medical Cannabis Task Force.

Advocacy is large part of what NCAP does. As the next generation of pharmacists, student pharmacists will greatly benefit from the work being

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conducted by NCAP today.

Before NCAP, I ignored a right that we, as citizens and constituents, have to exercise our voice by contacting our representatives to discuss concerns and advocate for changes in our communities. During my APPE, Dr. Shelton encouraged me to meet with my Representative and Senator in the North Carolina General Assembly. We reviewed pieces of legislation and established talking points. She also arranged for me to spend time with Tony Adams, the NCAP Lobbyist, and Representative Wayne Sasser, the only pharmacist in the General Assembly.

Prior to my rotation, I did not know or understand the power of one constituent. I was afraid that these Representatives would ignore my message, and that a single unfamiliar voice would not even register on a politicianâ&#x20AC;&#x2122;s radar. My fear of not knowing what to do was why I had never previously attempted to advocate at this level; NCAP lifted the curtain. I became acquainted with Representative Wayne Sasser, the only Representative with a background in pharmacy.

He showed me how the bills and laws

they vote on impacts the pharmacy profession as a whole. I also met with Tony Adams, the NCAP Lobbyist, who gave me a crash course on the ins and outs of lobbying. As it turns out, lobbying is just a fancy word for speaking your passion out loud to anyone who is willing to spare a few minutes of their time. That is also exactly how it felt when I sat in my Representativeâ&#x20AC;&#x2122;s office. I was only scheduled to meet with her for 15 minutes, but as she continued to inquire about my knowledge on the issues, that 15 minutes turned into 30. The interaction was so positive because I felt heard. Every student pharmacist has this same ability within them. Having the opportunity to visit my legislators, while accompanied by a seasoned lobbyist who was kind and patient to an inexperienced student, was invaluable. The lessons I learned and the confidence I gained is why NCAP is so impactful for any pharmacist or future pharmacist. NCAP helped me find my voice and gave me a great sense of achievement.

In closing, if as a student pharmacist you have not already recognized the

value of NCAP, then here are few other reasons that should convince you. Did you know that NCAP has a relationship with the Pharmacy Network Foundation to subsidize and the cost of registration for students to attend various NCAP events? Did you know that the NCAP Endowment Fund supports a limited number of small student loans, up to $1000, for P4 students? NCAP also has partnerships with financial advisors who offer discounts on services for new graduates who may be looking to get a handle on their student loan debt.

NCAP also offers many opportunities for students to serve as interns or as members of committees, task forces and special project teams. One of the greatest benefits of becoming involved with NCAP is the connections you can make. Doors open due to relationships, and as an NCAP member, your list of contacts will definitely grow. Finally, I highly recommend conducting an APPE at NCAP. This is a way to round-out your final of year of pharmacy school with an amazingly, eye-opening, and unique skill-development experience!

Click here to book your room at the Winston-Salem Marriott

Attendees must Book by 9/16 for the NCAP Block Rate from $159.00 USD/Night North Carolina Pharmacist

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North Carolina Pharmacist

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