2016 Fall Journal

North Carolina Pharmacist Volume 96 Number 4 Fall 2016 A d v a n c i n g P h a r m a c y. Im p r o v i n g H e a l t h .

The NCAP Annual Convention Charlotte, November 4-5, 2016 NCAP Start your Engines .......

Ready Set INNOVATE!

Meetings held at the Charlotte Convention Center

Featuring Keynote Speaker Ricky Craven, NASCAR Analyst for ESPN, and a Reception at the NASCAR Hall of Fame

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Official Journal of the North Carolina Association of Pharmacists 1101 Slater Road, Suite110 Durham, NC 27703 Phone: (984) 439-1646 Fax: (984) 439-1649 www.ncpharmacists.org Like us on Facebook: North Carolina Association of Pharmacists Follow us on Twitter: NC Assoc of Pharm

JOURNAL STAFF

North Carolina Pharmacist Volume 96 Number 4

Fall 2016

Inside • From the President ................................................................................4

EXECUTIVE EDITOR Penny Shelton

• From the Executive Director ...............................................................5

EDITOR/STAFF WRITER Ralph Raasch

• Full Convention Program.........................................................7-13

LAYOUT/DESIGN Rhonda Horner-Davis

BOARD OF DIRECTORS PRESIDENT Stephen Eckel PRESIDENT-ELECT Stefanie Ferreri PAST PRESIDENT Ashley Branham TREASURER Thomas D’Andrea

BOARD MEMBERS Susan Bear Jamie Brown Paige Brown Jennifer Burch David Catalano Steve Dedrick Lisa Dinkins Ouita Gatton Jennie Hewitt Stephen Kearney Macary Marciniak Keely Ray Jeff Reichard

NCAP STAFF

Linda Goswick Sandie Holley Teressa Reavis Rhonda Horner-Davis Ron Williamson 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.

• Best Practice Roundtables............................................................14 • Abstracts...................................................................................15-25 • Pfizer Dinner Symposium ..........................................................27 • The Exhibitor Program ..................................................................28 • Keynote Speaker and NASCAR Hall of Fame..........................29-30 • NCAP Awards ..................................................................................31-33 • NCAP Past Presidents...............................................................35 • From the NCAP Residency Committee...............................................37-38 • Student Pharmacist Network Social Event..............................40 • From the Student Pharmacist Network .....................................................41 • Guideline for Authors................................................................42-43 • Editorial Board...................................................................................44

North Carolina Pharmacist is supported in part by: • Mutual Drug..............................................................................................................2

• Pharmacists Mutual Companies................................................................................6 • Pharmacy Quality Commitment..............................................................................26

• Epic RX......................................................................................................................3

• Pharmacy Technician Certification Board...............................................................36 • NCAP Career Center...............................................................................................39

• VIP Pharmacy Systems............................................................................................46 ADVERTISING

For rates and deadline information, please contact Sandie Holley at Sandie@ncpharmacists.org

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•From the NCAP President • Stephen F. Eckel, PharmD, MHA, BCPS

You spoke, we listened, and we acted. How will you respond?

One of the major activities of a pharmacy association is to provide venues for continuing education and an opportunity for networking. This is usually accomplished through an annual meeting. These balance cutting-edge content, knowledgeable speakers, opportunities for people to dialogue, and areas for exhibitors to demonstrate new products.

NCAP has a long-standing fall annual meeting, which from many accounts has been very successful. It has a large number of attendees, a strong residency showcase, breadth of content, and numerous exhibitors. For the past few years, it has been located in Raleigh and held during the week. From an outsider, one would think it was successful, and it has been. However, we were not satisfied. We wanted to find ways to better engage our membership, especially students and new practitioners, and to branch out to others who typically do not attend our meeting: We decided to ask numerous people about how to make our meeting even better. After hearing their perspectives, we listened and acted upon this information. A few things that we are doing based upon these conversations: · New venue – we are going to Charlotte this year. While not centrally located, it is still an exciting city with plenty of activities. If you do not get the opportunity to visit Charlotte often, we will be downtown, and there is much to see and do. · New times – our conference will be Friday and Saturday. This is intentional, as many people cannot get out of work to attend when held during the week. By placing part of the meeting over the weekend, we hope to get more pharmacists, spouses, and students to come, since many will not have work obligations to interfere. · Plenty of fun – we are having a reception on Friday evening at the NASCAR Hall of Fame. We also have Ricky Craven as one of our keynote speakers. He will even be available for autographs. For the new practitioners, and anyone else who wants to attend, there is a late night get-together after the reception, having time to relax on a Friday evening. Even if you have all of the CE you need, come to our meeting for this experience.

Besides these new changes, there are some other reasons to attend: · Great education – our committee has organized a contemporary program that has something for everyone. · Town hall – hear about updates happening within your profession and professional association.

Many changes are occurring, and we want you to know all about them. We also want to hear how we can even be better. · Awards – come celebrate with your fellow pharmacists and learn who will be receiving our association’s top awards.

You spoke, we listened, and then we acted. I am very happy and impressed with the upcoming educational program. Now we just need to know how you will respond. Can I count on you attending our fall meeting?

I would appreciate any insights and experiences you might have on this perspective. You can let me know what you think by email at seckel@unc.edu. You can also follow me on Twitter at @stepheneckel.

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

Collective Grit I think you will realize in time that I enjoy finding modern day relevance in age-old quotes. As I sit and contemplate what message I hope to convey in my column for this special “convention” issue, segments of a Henry Ford quote begin to percolate. Ford is credited with the following statement: “Coming together is a beginning, staying together is a progress, and working together is success.”

In the late1990’s, many of North Carolina’s pharmacy leaders recognized our greater potential as a profession, as well as how much more impactful our collective voice would be if we united the separate factions of pharmacy. One organization—NCAP— one voice for pharmacy was thus formed in 2000. I am sure at the time, the “coming together” or beginning may have seemed insurmountable, perhaps the most difficult step. After all, how would we get all of these groups to embrace a merger; and how could we get everyone to play nicely together in the proverbial sandbox. As difficult as that task must have been at the time, I believe the next steps, the “staying together” and “working together” have become the greater challenges.

NCAP will soon be 17 years old and we have struggled in recent years for various reasons to continue to demonstrate value and relevance (i.e., success).

This is particularly true if the benchmark for success is measured by progress on meaningful issues. But, here’s the thing! If we want real progress, then

we, as individual pharmacists, must invest in our Association and view NCAP as a conduit by which “we” bring about necessary change. A close analogy to this point is how we think of a church, synagogue or mosque. Externally one might view a church as the actual building, but a church is really the people, and the mission of the organization is made possible through the work of the parishioners. Similarly NCAP is not a distant headquarters, but rather needs strong membership and its members “working together” to successfully meet the needs of our profession across the state.

The “staying together” aspect of Ford’s quote is really about our “stick-to-it-ness” or persistence. Pharmacists in my opinion have historically been amazing adaptors. Rules, regulations, contracts, external forces and whatever else gets thrown our way, we tend to figure out a way to adjust.

Where we need some improvement is in our “coming together” to proactively take a stand. Standing firm and fighting for what is important to us, instead of always being the ones forced to adapt. Our adaptability AND our taking a stance could be viewed as our “grit” factor.

Back when I was much younger and way more athletic, I used to have this travel ball coach who when things were not going so well would call a huddle.

His huddle was filled with “what are you doing” and “wake up out there” pleas.

Newly motivated, our huddle would end with an upward swoosh from our pyramid of hands and coach always sent us back into the game with this funny little colloquialism, “get a little grit in your craw”. As a young 20-something player, I barely had a clue as to what the heck he meant, let alone an appreciation for the relevance of his quirky motivational statement. But today, his words ring true for when times are tough and not necessarily in your

favor, you need to dig deep. When the usual approach is not working, you dig deeper.

There must be something to what my ole coach used to say. Apparently there’s maybe even a little science behind his words. I recently finished reading Angela Duckworth’s book “Grit: The Power of Passion and Perseverance”. Dr. Duckworth is a Harvard and Oxford scholar who has spent much of her career studying the essence of success and its interrelation with passion, focus and persistence. Her work has shown that these factors enmeshed together form something she refers to as “grit”, which she denotes as being more important than talent or degree of education.

When I was reading “Grit”, I couldn’t help but draw a comparison to what it will take for NCAP and pharmacists in our state to succeed. As a profession, we constantly face any number of threats. The only way for us to conquer these threats is through our collective “grit” factor. To do this we must first come together, stick together and work together. Interestingly, Dr. Duckworth entitled the first chapter in her book, “Showing up”, aptly titled since in order for us to really come together, we must first show up.

In our very busy lives as pharmacists there are few prime opportunities for us to come together, the NCAP Convention is one of those rare opportunities. President Eckel has in his column eloquently outlined the benefits afforded to those who choose to attend our convention. I will just add that I hope you will take advantage of this opportunity. We need every pharmacist coming together and working together to elevate our collective grit factor so we can bring about meaningful change.

Find out how gritty you are in Charlotte!

I’ll see you there.

Pharmacy Proud!!!!

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2016 NCAP Annual Convention “NCAP, Start Your Engines…Ready Set INNOVATE!”

Charlotte Convention Center November 4-5, 2016

Developed with UNC Eshelman School of Pharmacy Co-Sponsored by Campbell University College of Pharmacy & Health Sciences Fred Wilson School of Pharmacy High Point University Wingate University School of Pharmacy

Friday, November 4 8:00 am - 6:00 pm

APhA Diabetes Certificate Program – Room 213D

8:00-9:00 am

Registration/Continental Breakfast/Networking

9:00-9:30

Welcome, Announcements & Rite of Roses – Ballroom B

Moderators: Jenn Wilson, PharmD, BCACP Assistant Professor of Pharmacy Levine College of Health Sciences Wingate University School of Pharmacy Education Committee, Co-Chair

Lisa Dinkins, PharmD, BCACP Director of Introductory Pharmacy Practice Experience Assistant Professor of Pharmacy Levine College of Health Sciences Wingate University School of Pharmacy Education Committee, Co-Chair

9:30-10:30

ACPE#: 0046-9999-16-190-L04 (1.0 hr P/T) “Ready, Set, Innovate” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1. Describe ways that innovation can drive change 2. Describe ways to turn challenges into opportunities 3. Apply real-life examples from NASCAR experiences to the pharmacy setting

Ricky Craven NASCAR Analyst ESPN

10:30-11:30

Auto Card Signing with Ricky Craven – No CE - Lobby

Penny S. Shelton, PharmD, CGP, FASCP Executive Director North Carolina Association of Pharmacists

10:30-10:45 Break

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10:45-11:45

ACPE#: 0046-9999-16-191-L01 (1.0 hr P/T) “Opiate Epidemic Across NC” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1. Discuss the opiate epidemic across NC 2. Describe the role of the pharmacist 3. List benefits and risks of medications used in the treatment of opioid use disorder 4. Create a list of community resources pharmacists can use for patient referral

Andrew J. Muzyk, PharmD Associate Professor Campbell University College of Pharmacy &Health Sciences Clinical Specialist in Internal Medicine-Psychiatry Department of Pharmacy, Duke University Hospital

Vera Farkas Reinstein, PharmD, BCPS Clinical Pharmacist Alliance Behavioral Healthcare

11:45-1:50 pm

Lunch & Exhibits – Ballroom CD

12:50-1:50

ACPE#: 0046-9999-16-192-L04 (1.0 hr P) – Ballroom CD “Innovation Pit Stops – Roundtable Presentations” Learning objectives for Pharmacists: At the completion of this knowledge-based activity, the participant will be able to: 1. Describe best practices in pharmacy practice

1:50-2:00

Topics/Facilitators: a. AmCare Tool Kit – Mollie Scott b. Community Value Added – Cortney Mospan c. Community Pharmacy & Physician Collaborative Practice Relationships – Olivia Bentley d. Pharmacogenomics Testing in Community Pharmacy – Amina Abubakar e. Precepting/Experiential – Paige Brown f. Public Health – Stephanie Kiser g. Educating Providers About Guidelines – Laura Bowers h. CPP Credentialing in Ambulatory Care – Caron Misita i. Transitions of Care at Mission Hospital – Aubrie Rafferty j. The Clinical Training Center: A Layered-Learning Rotation Model – Jordan Masterson k. Tackling the Opioid Epidemic in Western NC – Courtenay Wilson l. BPS Certification for Pharmacists – Pete Koval, Terry McInnis, Jerry McKee m. Innovative Pharmacy Topics – Joe Moose n. It’s a Team Effort: Integrating Community Pharmacists Into Team-Based Care – Chelsea Phillips Renfro o. Falls Risk Reduction Tool Kit – Penny Shelton p. Role of CPP in the Inpatient Space – Susan Bear, Moderator Lisa Brennan, MaryBeth Bobek q. Role of the Pharmacist in Transitions of Care & Population Health Management – Nick Wilkins, Moderator, Kelly Avey, Bill Hitch r. Implementation of a Pharmacist-Centered Chronic Care Management Team – Fern Paul-Aviles, Moderator, Rebecca Gandy s. Role of Pharmacist: Virtual ICU – Sonia Everhart, Moderator, Desiree Komisky

Break

2:00-3:30

ACPE#: 0046-9999-16-193-L01 (1.5 hrs – P/T) “Immunize for Healthy Lives: 2016 Immunization Update” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1. Discuss legal considerations related to immunization practice

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in North Carolina (T)

2. Discuss significant updates to the Centers for Disease Control

and Prevention (CDC) Advisory Committee on Immunization

Practices (ACIP) recommendations for childhood and adult

vaccines

3. Describe the proper use of key vaccines, including but not

limited to, influenza, pneumococcal, shingles, tetanus (Td/Tdap),

human papillomavirus (HPV) and hepatitis B vaccines

4. Utilize CDC recommendations to determine needed vaccines

for a patient

5. Identify resources to stay up-to-date on vaccine-related

information (T)

Macary Weck Marciniak, PharmD, BCACP, BCPS, FAPhA

Clinical Associate Professor

UNC Eshelman School of Pharmacy

Laura A. Rhodes, PharmD Community Practice Engagement Fellow UNC Eshelman School of Pharmacy

3:30-3:45

Break

3:45-5:15

ACPE#: 0046-9999-16-194-L01 (1.5 hrs – P/T) “Specialty Pharmacy for the Non-Specialist” (3 presenters) Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to:

1A. “Hot Topics in Oncology for the Non-Oncology Practitioner” a. Describe the mechanisms of action and rationale of immunotherapies used for various malignancies (including ipilimumab, pembrolizumab, nivolumab, chimeric antigen receptor (CAR) T-cell therapy) b. Outline management recommendations for adverse effects associated with immunotherapies c. List additional novel treatment strategies for malignancies (including T-VEC) (T)

Jacqueline L. Olin, MS, PharmD, BCPS, CDE, FASHP, FCCP Professor of Pharmacy Wingate University School of Pharmacy

1B. “Hot Topics in HIV for the Non-HIV Practitioner” a. Describe the mechanisms of action and rationale of novel antiretrovirals b. Highlight recent changes in the HIV treatment guidelines (T) c. Provide an overview of antiretrovirals in development and how they may affect the future of HIV therapy

Olga Klibanov, PharmD, BCPS Professor of Pharmacy Clinical Specialist, Infectious Diseases/HIV Wingate University School of Pharmacy

1C. “The Evolving Management of Hepatitis C Treatment for the Non-Specialist” a. Identify current treatment strategies for the management of Hepatitis C Virus (HCV) and explain challenges associated with available treatment b. Recommend appropriate methods for evaluating and managing adverse effects associated with HCV treatments c. Describe areas of potential pharmacist intervention in HCV management

5:15-6:00

Lisa Fletcher, PharmD, BCPS, AAHIVP, CCP UNC Medical Center Department of Pharmacy ACPE#: 0046-9999-16-195-L04 (.75 hr – P/T) “NCAP Town Hall Meeting” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1. Describe past year highlights of the North Carolina Association of

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Pharmacists and expected changes that will occur with the Association, including operations and projected budgetary changes 2. Discuss issues impacting pharmacists in various practice settings and how the practice forums and committees within NCAP can be better used for engagement, communication and advocacy work to bring meaningful change and value

Moderator: Penny S. Shelton, PharmD, CGP, FASCP Executive Director North Carolina Association of Pharmacists

Stephen F. Eckel, PharmD, MHA, BCPS Clinical Associate Professor UNC Eshelman School of Pharmacy Associate Director and Residency Program Director UNC Hospitals President, NCAP

Thomas D’Andrea, RPh, MBA Vice President of Pharmacy Services Neil Medical Group Treasurer, NCAP

Stefanie Ferreri, PharmD, BCACP, CDE, FAPhA Clinical Associate Director and Executive Vice-Chair Division of Practice Advancement and Clinical Education UNC Eshelman School of Pharmacy President-Elect, NCAP

6:30-9:00

Ashley Branham, PharmD, BCACP Director of Clinical Services Moose Pharmacy Past President, NCAP NASCAR HALL OF FAME RECEPTION

Sponsored by:

Campbell University College of Pharmacy & Health Sciences

Fred Wilson School of Pharmacy - High Point University UNC Eshelman School of Pharmacy

Wingate University School of Pharmacy

North Carolina Association of Pharmacists

School Preceptor Awards

10:00 pm-1:00 am

SPN/NPN Social Event VBGB Beer Hall and Garden ncapwusop@gmail.com

Saturday, November 5 7:00-8:00 am

Registration/Continental Breakfast/Networking – Ballroom B

8:00-9:30

Welcome/Announcements

Moderators: Jenn Wilson, PharmD, BCACP Assistant Professor of Pharmacy Levine College of Health Sciences Wingate University School of Pharmacy Education Committee, Co-Chair

Lisa Dinkins, PharmD, BCACP Director of Introductory Pharmacy Practice Experience Assistant Professor of Pharmacy Levine College of Health Sciences Wingate University School of Pharmacy Education Committee, Co-Chair

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ACPE#: 0046-9999-16-196-L04 (1.5 hrs – P/T) “North Carolina Association of Pharmacists: State of the Association Address” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1. Describe North Carolina Association of Pharmacists’ organizational health 2. Identify key strategic organizational initiatives 3. Describe organizational changes designed to improve Association effectiveness 4. Describe organizational changes designed to improve value and connectedness for North Carolina pharmacists

Penny S. Shelton, PharmD, CGP, FASCP Executive Director North Carolina Association of Pharmacists

9:30-10:15

Awards/Installation of Officers Fifty Plus Club

10:15-10:30

Break

10:30-12:00 pm

ACPE#: 0046-9999-16-197-L0-1 (1.5 hrs – P/T) “OTC Jeopardy” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1. Identify and explain aspects of the effective and safe practice of pharmacy of self-care treatment 2. Describe the usage and effectiveness of over-the-counter medications 3. Classify different groups of over-the-counter medications based on drug treatment class

Moderator: Stefanie Ferreri, PharmD, BCACP, CDE, FAPhA Clinical Associate Director and Executive Vice-Chair Division of Practice Advancement and Clinical Education UNC Eshelman School of Pharmacy President-Elect, NCAP

12:00-1:30

Coordinator: Becky Szymanski, PharmD, BCPS Manager, Clinical Pharmacy Services PGY1 Residency Program Director Pharmacy Services-Carolinas Medical Center-NorthEast Carolinas HealthCare System

12:30-1:30

Poster Sessions – Pre-Function Ballroom CD

CONCURRENT SESSIONS:

1:30-2:30

ACPE#: 0046-9999-16-198-L01 (1.0 hr – P/T) – Ballroom B (1A) “Clinical Pearls” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1A. “Proton Pump Inhibitor Use in the Elderly: Are the Risks Greater Than the Benefits?” a. Review current literature on the potential association between proton pump inhibitor (PPI) use and increased risk for myocardial infarction, chronic renal insufficiency, and dementia b. Discuss methods for de-prescribing PPIs and reducing the inappropriate prescribing of PPIs during transitions of care

Lunch & Exhibits – Ballroom CD

Lori Edwards, PharmD, CGP, CIC, FASCP Consultant Pharmacist Neil Medical Group

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1B. “How to LAFF With Your Patients: Listen, Assess, Facts, Fun” a. Describe concise method of performing Medication Therapy Management with tools to help strengthen relationships.

Harskin ‘H.J.’ Hayes Jr., PharmD Clinical Pharmacist Moose Pharmacies

1C. “Naloxone Standing Order – The Pharmacist’s Responsibility in Preventing Opioid Overdose” a. Describe the NC Good Samaritan’s Act 2 b. Describe how to dispense Naloxone using the NC Naloxone Standing Order

Cathy H. Huie, PharmD, FIACP, CPP Brame Huie Pharmacy

1D. “Fosfomycin: A Viable Treatment Option for Multi-Drug Resistant UTIs” a. Explain fosfomycin’s role against common uropathogens b. Identify the ideal place in therapy for fosfomycin

Leslie Barefoot, PharmD, BCPS Pharmacy Clinical Coordinator Carteret Health Care

1E. “The Hidden Side of SGLT2 Inhibitors: Euglycemic Diabetes Ketoacidosis” a. Discuss how the mechanism of action of SGLT2 inhibitors contribute to the development of euglycemic diabetic ketoacidosis b. Review risk factors for developing euglycemic diabetic ketoacidosis

Matt Watson, PharmD PGY2 Critical Care Resident Wake Forest Baptist Health

OR

(2A) New Practitioner Network Led Programming with Student Pharmacist

Network – No CE

Stephanie Kiser, RPh Clinical Assistant Professor Director, Rural Health & Wellness UNC Eshelman School of Pharmacy - Asheville Campus

2:30-2:45

Break

CONCURRENT SESSIONS:

2:45-3:45

ACPE#: 0046-9999-16-199-L04 (1.0 hr – P/T) (2A)“Mental Health First Aid as a Skill Set for Community Pharmacy” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: a. Describe the opportunity to positively impact individuals living with mental illness, their families, and the patient’s healthcare providers b. Describe how Mental Health First Aid is one evidence-based training tool which can begin a process of bending the curve in terms of minimizing stigma associated with mental illness c. Describe the importance of building mental health literacy in the community pharmacy setting in order to better understand and respond to signs of mental illness among their patients served Jerry McKee, PharmD, MS, BCPP Assistant Director-Pharmacy Operations and Payer Programs Community Care of North Carolina OR

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2:45-3:45

ACPE#: 0046-9999-16-200-L04 (1.0 hr – P) (2B)“ASHP Clinical Skills Competition” Learning objectives for Pharmacists: At the completion of this knowledge-based activity, the participant will be able to: 1. Describe the elements of the local and national clinical skills competition for student pharmacists by the American Society of Health-System Pharmacists 2. Critically analyze the components of a care plan for a given patient case 3. Construct clinically appropriate questions to correctly identify optimal drug therapy for given patient case

Coordinators:

Carrie L. Griffiths, PharmD, BCCCP Assistant Professor of Pharmacy Wingate University School of Pharmacy Levine College of Health Sciences

Jacqueline L. Olin, MS, PharmD, BCPS, CDE, FASHP, FCCP Professor of Pharmacy Wingate University School of Pharmacy

Kim Kelly, PharmD, BCPS

Clinical Pharmacist Faculty

PGY1 Residency Director

Harnett Health System

Clinical Assistant Professor

Campbell University Department of Pharmacy Practice

3:45-4:00 Break 4:00-5:00

ACPE#: 0046-9999-16-201-L04 (1.0 hr – P/T) “Centers of Excellence – NC Division of Public Health’s Engagement of Pharmacists to Improve Outcomes in Obesity, Diabetes, Heart Disease and Stroke” Learning objectives for Pharmacists/Technicians: At the completion of this knowledge-based activity, the participant will be able to: 1. Describe the Centers for Disease Control and Prevention’s (CDC’s) investments in state/local public health programs that utilize pharmacists 2. Explain how to become involved in the NC Division of Public Health’s “Centers of Excellence” (an extension of Community Care of North Carolina) by supporting the National Diabetes Prevention Program and American Heart Association’s Check/Change/Control Blood Pressure Program 3. Differentiate the various levels of implementation (basic, enhanced, advanced) and respond to a call for action/participation in Centers of Excellence 4. Discuss reimbursement opportunities for delivering these programs and their quality improvement implications for community pharmacies

Lori E. Hall, PharmD Commander, USPHS State Consultation Team Division of Diabetes Translation, Program Implementation Branch Centers for Disease Control and Prevention

April B. Reese, MPH Health Systems Unit Manager Division of Public Health, Community and Clinical Connections for Prevention and Health Branch North Carolina Department of Health and Human Services

4:00-6:30

Residency Showcase – Room 217

It’s not too Late ................................. Click here to Register!

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R O U N D TA B L E S Roundtables will be held on Friday, November 4, 2016, from 12:50-1:50 pm, and have been accredited for 1 hour ACPE credit. There are 19 topics, and you will have the opportunity to visit 3 tables during the hour-long session.

Approximately 18 minutes will be allotted per topic with 2 minutes to rotate. Please see the list of topics and facilitators below:

a.

AmCare Tool Kit – Mollie Scott

b.

Community Value Added – Cortney Mospan

c.

Community Pharmacy & Physician Collaborative Practice Relationships – Olivia Bentley

d.

Pharmacogenomics Testing in Community Pharmacy – Amina Abubakar

e.

Precepting/Experiential – Paige Brown

f.

Public Health – Stephanie Kiser

g.

Educating Providers About Guidelines – Laura Bowers

h.

CPP Credentialing in Ambulatory Care – Caron Misita

i.

Transitions of Care at Mission Hospital – Aubrie Rafferty

j.

The Clinical Training Center: A Layered-Learning Rotation Model – Jordan Masterson

k.

Tackling the Opioid Epidemic in Western NC – Courtenay Wilson

l.

BPS Certification for Pharmacists – Pete Koval, Terry McInnis, Jerry McKee

m.

Innovative Pharmacy Topics – Joe Moose

n.

It’s a Team Effort: Integrating Community Pharmacists Into Team-Based Care – Chelsea

o.

Falls Risk Reduction Tool Kit – Penny Shelton

p.

Role of CPP in the Inpatient Space – Susan Bear, Moderator Lisa Brennan, MaryBeth Bobek

q.

Role of the Pharmacist in Transitions of Care & Population Health Management – Nick

r.

Implementation of a Pharmacist-Centered Chronic Care Management Team – Fern Paul-

s.

Role of Pharmacist: Virtual ICU – Sonia Everhart, Moderator, Desiree Komisky

Phillips Renfro

Wilkins, Moderator, Kelly Avey, Bill Hitch Aviles, Moderator, Rebecca Gandy

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ABSTRACTS The numbered abstracts are divided into three sections: Original Research, Quality Improvement Evaluations, and Case Reports. Within each section, the abstracts are in alphabetical order based on the lead author’s last name.

ORIGINAL RESEARCH 1. Title: Utilization of APPE Student Pharmacists to Optimize Inpatient Glycemic Control Authors: Joel Bibby, 2017 PharmD Candidate1, Becky Szymanski, PharmD, BCPS2 (advisor) Institution: 1University of North Carolina at Chapel Hill Eshelman School of Pharmacy, 2Carolinas Healthcare System NorthEast Objective: The primary purpose of this study was to determine if student monitoring and interventions with regard to glycemic management could reduce the percentage of out of range point-of-care blood glucose checks. Secondary objectives were to analyze the success of student interventions themselves, including the percent of interventions accepted by physicians, type of interventions made, and type of interventions accepted.

Methods: TheraDoc, a patient monitoring software system was set up to send reports of blood glucose values outside of the range of 70-180 mg/dL. The report was set up for one 15-bed general medicine unit. Students received daily reports of out-of-range values, and recommended interventions to physicians under the supervision of staff pharmacists. The interventions took place Monday through Friday during the months of June and July 2016.

Results: Full analysis of the data is still being completed.

20 separate student interventions were accepted by physicians, and patient’s glycemic management was closely reviewed each day. Detailed excel sheets were kept for out-of-range daily glucose reports, intervention reports, and overall reporting for all point-of-care blood glucose results.

These are currently being assessed for trends in glycemic control in the unit that was studied before student intervention and during student intervention.

Conclusion: There is potential to optimize patient care with interventions by APPE students. Statistical efficacy of the student interventions is currently being analyzed.

A preliminary informal review of interventions shows that students were able to make successful interventions that improved glycemic control in specific patients.

2. Title: Evaluation of Clostridium difficile Treatment Outcomes Based on Severity of Illness and Antibiotic Treatment Authors: Sara R. Britnell, PharmD1, V. Paul DiMondi, PharmD, BCPS1,2, Amy Clarke, PharmD, BCPS1, William E. Bryan, PharmD, BCPS1, Mary L. Townsend, PharmD, AAHIVP1,2 Affiliations: 1Durham Veterans Affairs Medical Center, Durham, NC; 2Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina Objective: Clostridium difficile infection has been classified as an urgent threat by the Centers for Disease Control.

Current antibiotic recommendations for Clostridium difficile infection (CDI) vary based on severity of illness, with differences between severity criteria and treatment between two guidelines. The primary objective was to compare cure rates based on treatment received for patients with mild-tomoderate and severe CDI. Secondary objectives included the rate of recurrence based on treatment received for patients with mild-to-moderate and severe CDI, rates of cure and recurrence for patients with complicated CDI, and the proportion of patients receiving guideline-directed therapy.

Methods: This retrospective single-center study included all patients with a positive Clostridium difficile PCR who received treatment for CDI at the Durham VA Medical Center between August 2013 to August 2015.

Results: A total of 191 patients met inclusion criteria. The population was mostly male (93%) with mean age 67 years.

The majority of patients had mild-moderate CDI (n=147), with clinical cure rates of 70.8% and 54.5% for metronidazole and vancomycin-treated patients, respectively (P=0.26). Among patients with severe CDI (n=27), both metronidazole and oral vancomycin achieved clinical cure rates of 50% (P=1.00). Recurrence rates were not significantly different based on antibiotic selection in patients with mild-moderate (P=0.70) or severe disease (P=0.38). Overall, 90.6% of mild-moderate and severe patients received guideline-directed treatment.

Conclusion: The absence of a detected difference between metronidazole and vancomycin in the mild-moderate group in both cure and recurrence validates current guideline recommendations. This study also identifies potential underutilization of oral vancomycin, with reduced guideline adherence when this agent is indicated.

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3. Title: Statin Adherence to ADA Guidelines in an Academic Internal Medicine Clinic

cost savings and the number of pharmacists’ recommendations that are approved by providers.

Authors: Adam Corey, PharmD candidate1, Jen Kim, PharmD, BCPS, BCACP, CPP2

Methods: Patients within the ACO who fall into any of the quality measure’s three defined categories will be identified from the ACO database. Each patient will be reviewed to assess if the quality metric was met. The five Triad HealthCare Network (THN) practices with the lowest quality metric scores will be targeted for on-site education by a pharmacist. The pharmacist will contact the THN provider and visit the practice to share recommendations for initiation or change of therapy. The quality metric will be evaluated preand post- physician practice education, and the metric for the first quarter of 2016 will be compared to the metric for the final quarter of 2016.

Institution: 1UNC Eshelman School of Pharmacy, Chapel Hill, NC; 2Cone Health - Internal Medicine Center and Area Health Education Center, Greensboro, NC Objective: This study aims to describe the adherence to guidelines put forth by the American Diabetes Association with regard to the use of statin therapy in lipid-lowering treatment. Per 2016 recommendations, all patients with Diabetes Mellitus between the ages of 40 and 75 should be on statin therapy, if tolerated. This includes patients with atherosclerotic cardiovascular comorbidities and at least one risk factor who are indicated for therapy with highintensity statin.

Methods: This retrospective, descriptive study analyzed all patients aged 40-75 and diagnosed with diabetes mellitus with a documented clinic encounter between January 1, 2015 through August 15, 2016. Patients were excluded if they did not have a documented primary care physician at the time of data collection. Data collected included current medications, medical conditions, height, weight, LDL, and history of statin use.

Results: Six hundred forty patients were ultimately included in the study. The majority of patients (407, 63.6%) are currently on statin therapy with 38.3% on high-intensity, 51.8% on moderate intensity, and 9.8% on low intensity. Of the 233 (36.4%) not currently taking a statin, only 12 (5.2%) had a non-statin lipid-lowering agent on profile.

Conclusion: Based on the available data, guideline-directed treatment is being followed for a majority of patients in the setting of medical resident training. Opportunities to improve statin prescribing habits for diabetic patients have been identified within an academic internal medicine center.

4. Title: Evaluation of Statin Medication Therapy for the Prevention and Treatment of Cardiovascular Disease within an Accountable Care Organization Authors: Amanda D’Ostroph, PharmD Candidate1, Dawn Pettus, PharmD, BCACP1, 2, Rachel Henderson, PharmD2, Elisabeth Dhalla, PharmD2 Institutions: 1UNC Eshelman School of Pharmacy, Chapel Hill NC; 2Triad HealthCare Network, Greensboro NC Objective: The primary objective is to evaluate the impact of pharmacists’ intervention on the use of statin medication therapy in patients for prevention and treatment of cardiovascular disease within an accountable care organization (ACO) and to evaluate the impact of the ACO’s fulfillment of the quality metric. Secondary objectives include evaluating

Results: Out of 22,256 patients identified by a targeted medication review from the first quarter of 2016, 1,752 (7.9%) patients in the ACO have an indication for statin therapy but are not on it. The five THN practices with the lowest quality metric scores have scores of 68.75%, 73.26%, 75.68%, 75.74%, and 78.95%. The pharmacist educated these practices on the quality metric and made recommendations to providers to consider initiating statin therapy or switching to a generic statin therapy. Research is ongoing to assess data following on-site practice education.

Conclusion: The medication review highlighted areas where pharmacists can help guide THN providers in the prescribing of statin therapy in order to help minimize cost to the patient and insurance plan and to optimize patient care.

5. Title: Trends in Transmitted Antiretroviral Drug Resistance in an Urban HIV Clinic in North Carolina, 2008-2014 Authors: Johanna C. Dresser1, Amenti A. Palmer1, Olga M. Klibanov1, Christian R. Dolder2, Tagbo J. Ekwonu3 Institutions: 1Wingate University School of Pharmacy, Wingate NC; 2VA Northern California Healthcare System, Mather, CA; 3Eastowne Family Physicians, Charlotte NC Objective: The 2012 World Health Organization (WHO) report estimates that the prevalence of transmitted drug resistance mutations (TDRMs) in HIV-infected treatmentnaïve patients in high-income countries is 10-17%. We sought to assess TDRMs in a single practice in Charlotte, NC, 2008-2014.

Methods: The primary endpoint was the prevalence of TDRMs 2008-2014. Antiretroviral (ARV) drug susceptibility was retrospectively analyzed in treatment-naïve patients 2008-2014. Secondary endpoints included TDRM rates in recently diagnosed patients (HIV diagnosis in the last 12 months), predictors of persistence with care (12 months of follow-up data available) in patients who were initiated on ARVs 2008-2014, and virologic success (HIV-1 RNA <50

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copies/mL after 12 months of therapy). Descriptive statistics, Pearson’s chi-square analysis, Fisher’s exact, and logistic regression methods were used to analyze results.

Results: Among 333 treatment-naïve patients who entered care 2008-2014 (75% male, 88% African American, median CD4 count 312 cells/mm3), 48 (14%) had >1 TDRM. Yearto-year comparisons indicated a 0% TDRM rate in 2008, 12% in 2009, 8% in 2010, 16% in 2011, 10% in 2012, 24% in 2013, and 24% in 2014 (p=0.033). NNRTI resistance was most common (38/48; 79%), followed by NRTI (5/48; 10%) and PI (2/48; 4%). Of the 313 patients initiated on HAART 2008-2014, 243 (78%) demonstrated persistence in care and 201 (64%) achieved virologic success. Factors associated with persistence in care included recent HIV diagnosis (p=0.012), age (p=0.005), and initiation of HAART (p<0.001). Factors associated with achieving HIV-1 RNA <50 copies/mL included a recent HIV diagnosis (p=0.002), age (p=0.039), and female gender (p=0.026).

Conclusions: The prevalence of TDRMs in our clinic through 2012 resembled the 2012 WHO report, but increased significantly in 2013 and 2014. Clinical outcomes such as persistence in care and virologic success rates are suboptimal; efforts must be focused on improving these outcomes in urban HIV clinic settings.

6. Title: Evaluation of Medication Administration in Newly Placed Enteral Feeding Tubes and Development of an Automatic Pharmacy Consult Authors: Ashley Ford, PharmD; Kevin DeSanty, PharmD, MPH, BCPS, CGP Institution: Carolinas HealthCare System NorthEast, Concord, NC Objectives: To determine the appropriateness of medications and specific medication formulations that were administered to patients with newly placed enteral feeding tubes at Carolinas HealthCare System NorthEast (CHS NE).

Methods: Patients were captured through the use of ICD-9 codes. Retrospective data was reviewed to determine areas of improvement for medication administration via enteral feeding tubes. Patients were included if an enteral feeding tube was placed at CHS NE during the current admission. Patients were excluded if they were younger than 18 years of age, pregnant, observation status, had a previously placed enteral feeding tube, or had an enteral feeding tube for feeding use only. The primary endpoint was to assess the percentage of hospitalized patients with an enteral feeding tube who have one or more inappropriate formulations on their active medication list.

Results: The majority of enteral feeding tubes placed were due to dysphagia or ventilator dependence. 53% of enteral feeding tubes captured were PEG tubes, with 25% being orogastric. Most patients used more than one type of

enteral feeding tube throughout their hospitalization. 39% had at least one inappropriate medication active prior to enteral tube placement. 28% had at least one oral longacting medication crushed and given via tube. 84% were discharged with an enteral feeding tube. Of these patients, only 22% left with a depart medication summary that was accurately updated with appropriate medications/medication routes.

Conclusions: Patients with enteral feeding tubes placed during hospitalization belong to a patient population that has not been previously monitored at this institution. Results from this study have demonstrated that pharmacist involvement is beneficial in ensuring appropriate medication therapy in patients with enteral feeding tubes. Approval of the aforementioned guideline, and the creation of a pharmacy alert when an enteral feeding tube order is placed are critical next steps to establish a monitoring service at this institution.

7. Title: Analysis of the Diagnosis and Treatment of Urinary Tract Infections in the Home-Based Primary Care Population at the Veterans Affairs Western New York Healthcare System Authors: Megan Gee, PharmD1,2, Kari Kurtzhalts, PharmD1, James Ford, PharmD1, John Sellick, DO1, Kari Mergenhagen, PharmD, BCPS AQ-ID1 Institution: 1Veterans Affairs Western New York Healthcare System, Buffalo NY; 2Durham Veterans Affairs Medical Center, Durham NC Objective: Urinary tract infections (UTIs) account for over 8 million visits to healthcare practitioners each year, and nearly half of these individuals will experience a second UTI within a year. Antibiotics have shown to reduce the duration of symptoms, but unclear and underutilized guidelines, especially for men, have led to a significant overuse of antibiotic treatment. Despite the high frequency of UTIs and the need to manage the utilization of antibiotics appropriately, there is no gold standard to identifying and treating UTIs appropriately.

Methods: We utilized McGeer’s criteria to analyze the appropriateness of the diagnosis and treatment of urinary tract infections (UTIs). A retrospective review of HomeBased Primary Care (HBPC) patients from January 1st, 2006 to August 1st, 2015 at the Veterans Affairs Western New York Healthcare System (VAWNYHCS) was conducted to determine appropriateness of diagnosis, treatment, and renal dosing. Multiple variables were collected and analyzed with a bivariate analysis followed by a multivariate logistic regression analysis.

Results: McGeer’s criteria were not met in the majority of patients (73.5%) treated for a UTI. Patients with a documented allergy were more likely to be treated appropriately (p=0.0147). Flank pain, dysuria, and increased urinary

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frequency were symptoms that statistically improved treatment appropriateness (p=0.0048, p=0.0263, and p=0.0418, respectively).

well as their pursuit of a rural practice setting, will be evaluated over time.

Conclusions: McGeer’s criteria are underutilized in the HBPC population at the VAWNYHCS for the diagnosis and treatment of UTIs. Additional checkpoints such as a documented allergy improved the appropriateness of antibiotic therapy, and symptoms of flank pain, dysuria, and increased urinary frequency increased the likelihood of appropriate treatment. Further research is needed to determine if a documented allergy improves appropriateness of antibiotic prescribing for other infections as well.

9. Title: The Use of an Empathy Assignment to Increase Students’ Comfort with Diabetes Nutrition Counseling

8. Title: Incorporation of Pharmacy Rural Health Scholars into Practice Authors: Rebecca Grandy, PharmD, BCACP, CPP, Irene Park, PharmD, BCACP, CPP, Stephanie Kiser, BSPharm, Mollie Scott, PharmD, BCACP, CPP Institution: UNC Eshelman School of Pharmacy Objectives: To describe learning opportunities and preceptor responsibilities in the longitudinal Rural Pharmacy Health Certificate clinical experience.

Methods: Rural scholars are paired with rural practice pharmacists in Western North Carolina over a three-year period. In years one and two, scholars complete six hours of shadowing each semester. Scholars are required to complete a population health needs assessment and must design and implement a project addressing an identified community health need. A one-month rotation is completed in year four.

Results: As of May 2016, eight scholars from two cohorts have completed a total of thirty-two shadowing experiences. Twenty-two were completed with assigned preceptors in their rural sites, two with a physician in their assigned rural site, and eight in a different rural practice site. Activities included point-of-care laboratory training, blood pressure monitoring, pharmacotherapeutic reviews, and direct interaction with patients and providers. Eight population health needs assessments have been completed. Students are responsible for scheduling shadowing experiences, and developing and executing population health needs assessments. Preceptor responsibilities include providing shadowing experiences and facilitating communication between the scholars, clinic staff, and school of pharmacy.

Conclusions: In the first two years of the certificate program, exposure of pharmacy learners to rural pharmacy practice has increased. Longitudinal scheduling challenges were overcome through inter-professional collaboration.

Completion of the population health needs assessment builds student skills needed to affect change in rural communities. The impact of these experiences on preparation of students in addressing the needs of rural populations, as

Authors: Kira Harris, PharmD, BCPS, CDE, Dawn Battise, PharmD, BCACP, Cassie Boland, PharmD, BCACP, Megan Coleman, PharmD, BCPS, CPP, Delilah McCarty, PharmD, BCACP, CDE, Kimberly Nealy, PharmD, BCPS, Rashi Waghel, PharmD, BCACP, CPP, Jenn Wilson, PharmD, BCACP Institution: Wingate University School of Pharmacy, Wingate, NC Objective: The primary objective was to determine if the use of an empathy assignment on third year introductory ambulatory care rotations increased students’ comfort in counseling patients about diabetes nutrition. Secondary objectives were to determine if use of the assignment increased students’ empathy and/or knowledge of dietary recommendations for patients with diabetes.

Methods: Students completing rotations at nine clinical practice sites, focused on chronic disease state management, were invited to participate in the study. Students at five of the nine sites completed an empathy assignment in which they tracked calories and carbohydrates in their current diet, designed and followed a diet appropriate for patients with diabetes, and wrote a reflection of their experiences. Students at the remaining sites served as the control group. All study participants completed a preand post-survey including demographics, current dietary habits, comfort with nutrition counseling, the Kiersma-Chen Empathy Scale (KCES), and a knowledge-based quiz.

Results: This interim analysis includes 23 completed survey responses from the first year of the study. Participants had a mean age of 25.3 years and were mostly female (78.3%).

Most students had minimal or no diabetes counseling experience at baseline. Student comfort with counseling on a diabetes diet increased 5.1 points (out of 10) in the intervention group, and 4.1 points in the control group.

The mean KCES empathy score increased from 85.3 to 92.6 (+7.3) in the intervention group, and from 87.6 to 92.1 (+4.5) in the control group (max score 105). Knowledge based quiz scores also increased by 7.5% in the intervention group and 5.7% in the control group.

Conclusion: The interim analysis suggests students completing the empathy assignments had a slightly greater improvement in comfort with diabetic counseling, empathy, and knowledge. These results support the continuation of the study for another year as planned.

10. Title: Is Learning Improved When Students Generate and Answer Peer Written Questions?

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Authors: Shelby L. Hudson, MS, PharmD Candidate, Adam Persky, MS, PhD, Michael B. Jarstfer, PhD Institution: The University of North Carolina Eshelman School of Pharmacy, Chapel Hill NC Objectives: PeerWise is a software package that allows students to generate, peer-review, and answer multiplechoice questions. This study examines whether student learning is impacted by generating multiple-choice questions and by answering peer-generated multiple-choice questions. We hypothesize that students answering the most questions would perform better on examinations than students answering lower amounts of questions.

Methods: Students enrolled in Medicinal Chemistry III over a 3-year period were asked to create, answer, and rate at least one question per exam period. Students’ total reputation scores and its components (question authoring, answering, and rating) and total answer scores (correctness of answers submitted indicating agreement with the author’s chosen answer) were considered in reference to final course grades. Question components were compared based on exam score tertiles.

Results: The upper and middle tertiles had greater reputation scores than the lower tertile (p < 0.001 and p=0.011 respectively) with no distinction between the upper and middle tertiles (p = 0.232). Number of questions authored was greater for the upper tertile than the middle (p=0.012) and lower tertiles (p<0.001), but there was no significant difference between the middle and lower tertiles (p = 0.055). There were no significant differences in total answer scores between the three tertiles (p > 0.05). The question rating component for the upper tertile was significantly greater than the lower tertile (p = 0.012), but there was not a significant difference between the upper and middle or lower tertiles (p = 0.480 and 0.215 respectively).

Conclusions: The more thoughtful creation of questions by students is associated with superior course performance.

The correctness of answers submitted or the number of questions answered, however, did not relate to student performance.

11. Title: Novel Genetic Marker of Diarrhea in Renal Cell Carcinoma Patients Treated with Sorafenib Authors: Allison Karabinos1, Amy Etheridge2, Carol Peña3, Daniel Crona2, and Federico Innocenti2,4 Institutions: 1The University of North Carolina, Eshelman School of Pharmacy and 2Center for Pharmacogenomics and Individualized Therapy, Chapel Hill, NC; 3Bayer HealthCare Pharmaceuticals, Montville, NJ; 4Lineberger Comprehensive Cancer Center, Chapel Hill, N Objective: Sorafenib, the first oral anti-angiogenic multiki-

nase inhibitor, is used in the treatment of metastatic renal cell carcinoma (mRCC). Common toxicities experienced by patients treated with sorafenib limit its use and affect adherence to treatment, reducing sorafenib efficacy. No biomarkers are currently available to identify patients at risk of toxicity.

Methods: mRCC patients (N=153) treated with sorafenib, as part of the TARGET study, were genotyped for common germline DNA variants in 56 candidate genes. Associations between 5846 variants and grade 2-4 toxicities were analyzed. Patients treated for ≤28 days were excluded.

Toxicities included diarrhea, hypertension, hand-foot skin reaction, and rash or desquamation. For each toxicity, the worst grade event for each patient was used. After linkage disequilibrium-based pruning, 685 variants were utilized for analysis via chi-squared test.

Results: Out of 153 patients, 28 (18%) experienced grade ≥2 diarrhea. The A allele of rs917881 (G>A) in the EGFR gene was associated with an increased risk of grade ≥2 diarrhea (P=0.00006; P=0.04 after Bonferroni’s correction; OR 3.6). The frequency of grade ≥2 diarrhea was 50% (3/6) in AA, 33% (15/45) in GA, and 10% (10/102) in GG patients. The frequency of grade 3 diarrhea was 8% (4/51) in patients with the A allele (AA+GA) versus 2% (2/102) in patients with the GG genotype. No other variants were significantly associated with sorafenib toxicity.

Conclusion: To our knowledge, this is the first reported study of a genetic basis of sorafenib toxicity. RAF kinase, a critical component of the EGFR signaling pathway, is a known target of sorafenib. Patients with the rs917881 A allele treated with sorafenib may be at an increased risk for diarrhea as a result of decreased EGFR expression potentiated by sorafenib-induced inhibition of the RAF/MEK/ERK pathway, which regulates chloride secretion. Replication analyses in additional patient cohorts and functional studies are ongoing.

12. Title: Assessing the Impact of a Didactic Lecture for Student Pharmacists on Legislative Advocacy Authors: Cortney M. Mospan, PharmD, BCACP, CGP, Geoffrey A. Mospan, PharmD, BCPS Institution: Wingate University School of Pharmacy Objectives: The objectives of this study were to (1) assess the impact of a didactic lecture within a pharmacy law course on student pharmacists’ knowledge and attitudes towards legislative advocacy; and (2) identify student pharmacists’ experiences with legislative advocacy.

Methods: An electronic pre- and post- survey was administered to second-year student pharmacists who attended a 40 minute didactic lecture on Legislature and Professional Advocacy within a pharmacy law course. The survey was modified from a previously validated survey. All responses

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were anonymous and matched via self-generated code.

Survey responses were summarized using descriptive statistics and Wilcoxon signed rank tests were used to analyze matched pre- and post- data.

ate to use the database, after completion of the activity (p < 0.001). Student pharmacists also showed statistically significant increases in two of the four knowledge-based assessment questions.

Results: A total of 62 pre- and post- surveys were usable for data analysis, providing a 57% response rate. The majority of students were dues paying members of at least one pharmacy organization, with 24.2% previously contacting their legislator regarding pharmacy policy and legislation. Pharmacy students were generally unaware of their legislative representation and did not know what to expect when meeting with them. All 3 knowledge items showed statistically significant improvement from pre- to post-, and 7 of 8 skills showed statiscally significant improvement.

Following the lecture, 85.4% of students agreed or strongly agreed they were more prepared to be an advocate for the profession and 75.8% showed an increased commitment to engaging in advocacy.

Conclusion: This pilot activity resulted in statistically significant increases in student pharmacist knowledge and confidence in using PDMPs and should be considered in pharmacy school curricula.

Conclusions: A brief, didactic lecture had a positive influence of pharmacy studentâ&#x20AC;&#x2122;s knowledge and attitudes towards legislative advocacy. Student pharmacists also felt more prepared to be an advocate for the profession with increased commitment. Introduction of legislative and advocacy topics within PharmD curricula may increase the prevalence of advocates within the profession of pharmacy.

13. Title: A Prescription Drug Monitoring Program Activity for Student Pharmacists in a Pain Pharmacotherapy Course Authors: Geoffrey Mospan, Pharm.D., BCPS, Michelle DeGeeter, Pharm.D., CDE Institution: Wingate University School of Pharmacy, Hendersonville NC Objective: The objective of this research was to determine if an activity on Prescription Drug Monitoring Programs (PDMPs) inserted into a school of pharmacy curricula improved student pharmacists knowledge of PDMPs and their role in pain management.

Methods: Third year student pharmacists in a required pain pharmacotherapy course were given a pre-assessment to record baseline knowledge of PDMPs and were asked 4 point Likert scale questions to gauge confidence levels in using a PDMP. A 40 minute activity with both didactic portions and case based scenarios was utilized to educate student pharmacists on PDMPs. Mock patient cases in the community setting were administered which included a medication profile and a report mimicking an actual PDMP report. Following the cases, students were given a post-assessment, with the same questions as the pre-assessment.

Results: With a response rate of 52%, student pharmacists were more confident in their ability to utilize a database to dispense a prescription and decide when it is appropri-

14. Title: Correlation of Pharmacy Work Experience to Student Performance, Comfort Level, and Satisfaction in a First-Year Doctor of Pharmacy Top 200 Drugs Course Authors: Kimberly L Nealy, PharmD, BCPS, Cassie L Boland, PharmD, BCACP, CDE Institution: Wingate University School of Pharmacy, Wingate NC Objective: To evaluate the effect of prior pharmacy experience on performance in, comfort level with, and satisfaction with a first-year pharmacy school basic drug knowledge course.

Methods: Students taking a two semester, first-year Top 200 Drugs course completed three questionnaires: one before the first semester, one before the second semester, and one at the end of the second semester. The first questionnaire inquired about pharmacy experience prior to starting school and comfort level with drug information prior to their first year in pharmacy school. The second and third questionnaires collected information regarding any new pharmacy experience (e.g. extracurricular work, volunteering, or IPPE), comfort level with course content, and satisfaction with the course.

Results: Students who had previous pharmacy experience performed better than their non-experienced peers in the first semester of this course (mean grade 88.0 vs 84.8 respectively [p = 0.033]) but this difference diminished after the second semester (mean grade 88.1 vs 86.8 [p = 0.349]). The students with experience were also more comfortable with course content prior to starting the course and after the first semester than their peers; however, by the end of the final semester, there was no difference between the groups. Finally, the experienced students were more satisfied with the course after both semesters.

Conclusions: Previous pharmacy experience before starting pharmacy school does not appear to project long-term performance improvements when compared to those who gained experience during their first year of school, although satisfaction with the Top 200 Drugs course remained higher in the group with previous experience. Future studies may examine whether previous pharmacy experience is a predictor of later academic outcomes or whether the type or

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amount of experience impacts performance or satisfaction results.

15. Title: Impact of a Pharmacist Discharge Counseling Program on 30-day COPD Readmission Rate Authors: Carrie Tilton, PharmD Candidate1, Johanna Dresser, PharmD Candidate1, James Wheeler, PharmD, BCPS2, Laura Frantz, PharmD, BCPS2, Jacqueline Olin, MS, PharmD, BCPS, CPP, CDE, FASHP, FCCP2 Institution: 1Wingate University School of Pharmacy, Wingate NC; 2Novant Health Presbyterian Medical Center, Charlotte NC Objective: To analyze and compare 30-day readmission rates to national averages for inpatients enrolled in a pilot medication management and discharge counseling program.

Methods: This is a single center, IRB approved, retrospective chart review. Medical records of patients counseled by a transitions of care pharmacist that were admitted to the progressive pulmonary unit between September 2014 to May 2015 were analyzed and compared to historical averages. As part of an institution approved protocol, eligible patients were assessed for an optimal COPD medication regimen, completed an inhalational capacity measurement (via in dial check) by a respiratory therapist, and counseled by a transitions-of-care clinical pharmacist at discharge.

Results: One hundred forty-seven of 200 patients sampled received pharmacist counseling. Forty-six patients were readmitted within 30 days resulting in a 23% readmission rate. Of those counseled, 39 patients were readmitted, resulting in a 19.5% readmission rate. When deceased patients were excluded from this population, the readmission rate for counseled patients decreased further to 15.5%. In comparison, the 2015 CMS National average COPD 30day readmission rate was 20.7%.

Conclusion: COPD is a complex, progressive disease.

30-day readmission rates were decreased in patients who received in-depth counseling from a transitions-of-care pharmacist. For health systems at risk of incurring CMS reimbursement penalties for COPD readmissions, pharmacist discharge counseling can be an effective strategy to decrease readmissions.

16. Title: Evaluation of Alterations in Plasma Blood Glucose with Oral Corticosteroid Use in COPD Exacerbation Authors: Monica White1, Taylor S. Morrisette1, Melissa Janis1, Treavor T. Riley, PharmD, BCPS, BCCCP1,2 Institution: 1Wingate University School of Pharmacy,

Hendersonville NC; 2Pardee UNC Healthcare, Hendersonville NC Objective: The primary purpose of this study was to determine if a correlation exists with the presence or absence of diabetes mellitus and average plasma glucose levels during a hospital stay in patients being treated with oral corticosteroids for COPD exacerbation. A secondary objective was to determine if the hospital length of stay differs based on history of diabetes.

Methods: This was a single-center, retrospective cohort study involving 750 patients hospitalized from January 1, 2012 to December 31, 2015, with a primary diagnosis of COPD exacerbation. This study was approved by the Institutional Review Board at the tertiary acute-care center where the data were collected.

Results: Of the 750 patients identified, 736 patients met inclusion criteria. Of these patients, 210 presented with a history of diabetes mellitus and 526 with no previous history. Age of patients between groups were similar (69.7±10.3 vs 68.3±11.9 years respectively, p=0.112). The average plasma glucose level during the hospital stay was 216mg/dL in patients with diabetes compared to 165 mg/ dL in patients without diabetes (p=0.028). There was no statistical difference found in average length of hospital stay between groups (3.39±1.85 vs 3.38±2.03 respectively, p=0.967).

Conclusion: Patients admitted for COPD exacerbation with a history of diabetes mellitus have higher average plasma glucose levels during hospital stays compared to those without a history of diabetes mellitus. This result coincides with oral corticosteroid use impacting glucose metabolism.

History of diabetes mellitus did not affect length of stay for patients admitted for COPD exacerbation.

17. Title: Impact of a Third-Year Elective Course Focusing on Post­Graduation Preparation Authors: Shayna Vance, PharmD Candidate, Megan Coleman, PharmD, BCPS, CPP, Jenn Wilson, PharmD, BCACP Institution: Wingate University School of Pharmacy Objective: This research examined the perceived usefulness of a third-year elective course focusing on post­ graduation preparation. A secondary objective was to determine the number of students previously enrolled in the course who matched with a residency program compared to the number who applied but did not match, both within the elective itself, as well as school­wide.

Methods: Students enrolled in the elective during their third professional year were asked to participate in a survey during their fourth professional year. The survey was used to evaluate students’ perceived usefulness of course related

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content and activities in preparation for their post­graduation plans. Program match results for all graduating students, available from aggregate school data, were compared to match results for students previously enrolled in the elective. Descriptive statistics were used to describe findings.

Results: All students previously enrolled in the elective completed the survey (n=14). In the survey, 50% of students indicated they sought a post­graduate training opportunity in the form of a residency program, while the remaining 50% pursued other employment opportunities.

Of the activities and content in the elective, the workshop on composing letters of intent, cover letters, and thank you cards was ranked as most useful. All students pursuing residency programs found the elective to be helpful in navigating the post­graduate training process. Six of the seven students pursuing other employment found the elective to be helpful in navigating the employment process. For the secondary objective, the students previously enrolled in the elective had a 100% match rate with a residency program, compared to the 77% match rate for all school graduates.

Conclusion: The elective course was perceived as helpful in post­graduation preparation by almost all of the respondents. The elective may help students more successfully secure their desired post­graduation position, particularly related to residency programs.

Results: The incidence of hypoglycemia in this patient population was 5%, whereas the overall incidence of hypoglycemia at this institution was 2.5%. All patients experienced hyperglycemia, however high corrective dose insulin was utilized in only 29% of patients. In terms of adherence to best practices, the standard order set was used 92% of the time, an endocrine consult was placed 55% of the time, and the U-500 insulin home regimens were dose reduced 29% of the time. 68% of patients with episodes of hypoglycemia did not have their U-500 insulin dose reduced at admission.

Conclusions: A 50% dose reduction upon admission and the use of High Corrective Dose Insulin should be actively recommended by pharmacists to providers to avoid hypoglycemic events. The U-500 alert should be modified to remind pharmacists that all U-500 orders are to be entered via order set, and that the physician should be called with the pharmacist recommending a 50% dose reduction and the use of High Corrective Dose Insulin. The P&T Committee voted to revise the powerplan so that the diabetes teaching consult would be automatically checked, a 50% dose reduction will occur, and high dose corrective insulin will automatically be ordered.

19. Title: Evaluation of an Algorithm for ADC Optimization Authors: Jared Frye, PharmD Candidate, Carrie Tilton, PharmD Candidate, Andre Harvin, PharmD, MS, BCPS

QUALITY IMPROVEMENT EVALUATIONS 18. Title: Evaluation of Patient Safety When Using U-500 Insulin in an Acute Care Setting Authors: Ashley Ford, PharmD; Tina Hipp, PharmD, BCPS; Becky Szymanski, PharmD, BCPS Institution: Carolinas HealthCare System NorthEast, Concord, NC Objectives: To evaluate patient safety in the acute care setting when using U-500 insulin, and to determine overall compliance with best practices for U-500 insulin recommended by the organization’s medication safety counsel.

Methods: The Institutional Review Board approved this study. A total of 62 unique patient encounters were evaluated. Inclusion criteria included patients at least 18 years of age with diabetes mellitus admitted to Carolinas HealthCare System NorthEast from July 1, 2014 to June 30, 2015. Patients with known pregnancy or the use of an insulin pump were excluded. The primary endpoint collected was the incidence of hypoglycemia as defined by blood glucose less than 70 mg/dL.

Institution: Wake Forest Baptist Medical Center, Winston Salem, NC Objective: The primary objective of this study was to improve the efficiency of automated dispensing cabinets (ADCs) inventory by optimizing the controlled substance medications stored in specific patient care areas measured by the number of reorder and critically low values. Additionally, the study would evaluate the impact on call volume to central pharmacy and financial implications.

Methods: This study focused on the optimization of 17 ADCs located in the Comprehensive Cancer Center Hospital at Wake Forest Baptist Medical Center. These cabinets serve a diverse patient population including oncology, BMT, transplant, and intensive care units. ADC utilization was evaluated from February 1, 2016 through May 1, 2016 with data available from the ADC server and institution electronic medical record. An optimization algorithm was established based on guidelines determined within the department. Changes to the ADC included: Min/Max level adjustments, bin relocation, and addition/deletion of items.

Reconfiguration of the ADCs was a 6-week project. ADC utilization was again evaluated after a pre-determined onemonth washout period to determine the effectiveness of the optimization algorithm.

Results: After implementing the ADC algorithm to the 17

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ADCs, increased efficiency was indicated by a decrease in count days, low days, and zero days. The average count day decreased from 13.2 to 6.9 (47.91 percent -change) whereas the median change decreased from 5 to 2 (60 percent-change). The average low days decreased from 1.74 to 0.16 (90.75 percent-change). The average zero days decreased from 0.155 to 0.016 (89.10 percent-change).

team of students as part of a population health management course. Continued efforts are needed to further address provider resistance towards statin prescribing.

Conclusion: Wake Forest Baptist Medical Center noticed a significant increase in efficiency in the Comprehensive Cancer Center after implementing the ADC algorithm to 17 ADCs.

Authors: Samson Lee, PharmD, James Groce, PharmD, CACP, Jennifer Kim, PharmD, BCPS, BCACP, CPP

20. Title: Interprofessional Analysis of the Factors Affecting Achievement of Adequate Statin Use in a Multidisciplinary Family Medicine Clinic

Objective: The primary objective of this study is to determine the change in prevalence of suboptimal high-risk warfarin patients after implementation of a systematic process for conversion to direct oral anticoagulant (DOAC) therapy within a pharmacist-run anticoagulation clinic. Secondary objectives include physician acceptance of recommendations, and (at 3 months following conversion to DOAC) rates of bleeding or thromboembolism, adverse effects, and adherence measured by proportion of days covered (PDC).

Authors: Jennifer Ku, PharmD Candidate1, Trang Leminh, PharmD Candidate1, Payal Patel, PharmD Candidate1, Meg Zomorodi, PhD, RN2, Nicole R. Pinelli, PharmD, MS1 Institution: 1UNC Eshelman School of Pharmacy, Chapel Hill, NC; 2UNC School of Nursing, Chapel Hill, NC Objective: To identify factors affecting statin underuse in a multidisciplinary family medicine clinic using an interprofessional team-based quality improvement approach.

Methods: An interprofessional team of students in pharmacy (n=3), nursing (n=2), medicine (n=2), public health (n=1), and social work (n=1) completed a new 13-week population health management course at the University of North Carolina at Chapel Hill as part of the Healthcare PROMISE initiative and a 13-week immersion period to analyze statin use at a family medicine clinic. During the immersion, students shadowed and interviewed 13 healthcare providers from multiple professions and support staff using the Ottawa Decision Guide. Interprofessional team members conducted a community needs assessment to determine intervention priorities. Data were collected through interviews, subjective observational notes, and statistics on statin use. Data were then analyzed by determining themes, discussing factors that impeded statin use, and utilizing the Primary Care Collaborative Quality Measures Reporting Guide to prioritize which factors could be most influenced by the team.

Results: The needs assessment indicated that patient and provider knowledge on statin use benefits were the primary concerns. The team recommended a 4-component effort targeting patient education that included a check-in survey, informational posters and brochures, a provider script, and a personalized “statin choice tool.” All of these, except the “statin choice tool”, were implemented in April 2016. Two months after implementation, statin use in patients with diabetes increased 9% (from 57.3% to 66.3%).

21. Title: Development of a Process to Convert Warfarin Patients to Direct Oral Anticoagulant Therapy

Institution: Cone Health Internal Medicine Anticoagulation Clinic, Greensboro, NC

Methods: The Dose Response® system was used to generate 106 patient records. Seventy-six patients who met inclusion criteria were then reviewed by a pharmacy resident using explicit clinical criteria to identify suboptimal high-risk warfarin patients who may benefit from conversion to DOAC. The pharmacy resident selected the appropriate DOAC and communicated with the care team, including the primary care physician, and social worker or financial counselor if cost assistance was needed. A face-to-face clinical pharmacist office visit was scheduled with each patient for clinical assessment, conversion, and education. Clinical pharmacists contacted patients monthly for adherence and clinical reviews.

Results: Seventeen of the 76 (24%) were identified as suboptimal high-risk warfarin patients. After process implementation, 7 (9%, p<0.05%) remained as suboptimal high-risk warfarin patients for various reasons including cost barriers and patient preference. Rate of physician acceptance of recommendations was 100%. After 3 months of follow-up, there were no bleeding or thromboembolism outcomes reported, but 1 headache was noted which subsided and was potentially caused by unrelated clinical conditions. PDC at 3 months was 94%.

Conclusion: A team-based population management DOAC process was successfully implemented and reduced the prevalence of suboptimal high-risk warfarin patients in this setting.

Conclusion: This study demonstrates the effectiveness of a quality improvement plan developed by an interprofessional

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CASE REPORTS 22. Title: Ketamine Protocol for Use in Chronic, Refractory Pain Authors: Carrie. L. Griffiths, Pharm.D., BCCCP, Jeryl J. Villadolid, Pharm.D., BCPS, BCOP Institution: Wingate University School of Pharmacy and Carolinas HealthCare System – Levine Cancer Institute Introduction: Ketamine is a phencyclidine derivative that centrally antagonizes N-methyl-D- aspartate (NMDA) excitatory receptors and causes dissociative analgesia. It is thought to mediate opioid hyperanalgesia and intractable pain by resetting the upregulation of NMDA. The safety profile of ketamine includes changes in vital signs via sympathetic activation, psychotomimetic effects, and hypersalivation. This medication is only commercially available as an intravenous solution, which can be used to compound an oral formulation.

Case: A 49-year-old female with metastatic ovarian squamous cell carcinoma was admitted with chronic pain due to increasing abdominal disease burden. She had pain on admission despite a combination of opioids at an equivalent oral morphine daily dose of 1240 mg with fentanyl patches, patient-controlled analgesia with hydromorphone, and methadone. She was treated with a trial of ketamine and able to reduce her use of opioids with improved pain relief.

She received intravenous ketamine in the ICU using a test dose of 5 mg, followed by a continuous infusion of 0.1 mg/ kg/hr titrated based on response and symptoms. Within a week, her pain regimen was transitioned to oral ketamine, a decreased dose of methadone, and morphine as needed in anticipation for discharge to hospice.

Discussion: The collaboration of multidisciplinary teams at our institution lead to the implementation of ketamine use and a positive outcome for her; however there is not a formal protocol to ensure standard best practices if use is expanded to sites across the healthcare system. A comprehensive literature review will be used to create an evidence-based protocol and electronic order set for the healthcare system. The purpose of the protocol is to optimize the safe and effective use of ketamine for the treatment of adult and pediatric patients with chronic, refractory pain. The protocol will include initial ketamine dosing, titration recommendations, monitoring parameters, treatment of toxicity, and dispensing processes.

23. Title: A Case of Rasburicase-Induced Methemoglobinemia Treated with Vitamin C Authors: Prutha Lavani, PharmD Candidate, Brianna Alexander, PharmD, BCPS

Institution: Duke University Hospital, Durham, NC; UNC Eshelman School of Pharmacy, Chapel Hill, NC Introduction: Rasburicase is a recombinant urate oxidase enzyme that converts uric acid into allantoin and is used for the management of tumor lysis syndrome (TLS). Although an effective treatment, it is associated with the severe complication of methemoglobinemia. Methemoglobinemia develops when the iron in hemoglobin is oxidized from the ferrous to ferric form, which is unable to carry oxygen, leading to hypoxia.

Case: A 70-year-old African American male with a past medical history of aortic stenosis, light-chain amyloidosis, diffuse large B-cell lymphoma, and chronic kidney disease was admitted to the hospital for acute kidney injury and altered mental status. Admission labs prior to starting therapy were significant for uric acid 16.2 mg/dL, creatinine 5.3 mg/dL (baseline 1.5), phosphorus 6.1 mg/dL, and hemoglobin 7.3 mg/dL. Baseline pulse oximetry was 95% on 2L nasal cannula and methemoglobin was 1.5%. Tumor lysis syndrome was suspected and the patient was administered 6 mg of rasburicase. The next day, pulse oximetry showed significant hypoxia at 80% on 6L nasal cannula and hypotension with systolic blood pressures in the 70s.

An arterial blood gas was drawn which showed 10.3% methemoglobin. The G6PD status of the patient was unknown at the time, so methylene blue was not started. The patient was treated with ascorbic acid 500 mg oral twice daily and four units of packed red blood cells. Over the next two days, methemoglobin improved to 4.3%.

Discussion: In this case, first line treatment for methemoglobinemia, methylene blue, was not used to prevent further worsening in the setting of an unknown G6PD status.

Ascorbic acid, a reducing agent and antioxidant, was administered instead as its mechanism is independent of the NADPH pathway impacted in G6PD deficiency. Ascorbic acid is a reasonable option for the treatment of mild methemoglobinemia in patients with an unknown G6PD status.

24. Title: Dulaglutide-Induced Reversible Renal Impairment Authors: Kristin Payne, PharmD Candidate, Victor Bui, PharmD Candidate, Shawn Riser Taylor, PharmD, CDE Institution: Park Ridge Health, Hendersonville, NC, Wingate University School of Pharmacy – Hendersonville Campus, Hendersonville, NC Introduction: As one of the newest medications to treat type II diabetes mellitus (T2DM), glucagon-like peptide-1 receptor agonists (GLP-1a) are being prescribed more often, but this class is not without adverse effects. Case reports of acute kidney injury (AKI) have been reported with exenatide and liraglutide, however, as of the submittal of this abstract, no case reports of AKI or renal impairment associated with dulaglutide have been published.

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Case: A 63-year-old white female with past medical history of T2DM, hypertension, heart failure, chronic kidney disease (CKD), dyslipidemia, hypothyroidism, and tobacco use, who also drinks caffeine daily, presented for an appointment on 4/8/16. Recent results (3/28/16) revealed hemoglobin A1c 7.7%, serum creatinine (SCr) 1.6mg/dL, glomerular filtration rate (GFR) 34ml/min, and blood pressure 104/60mmHg. The patient reported home blood glucose readings in the upper 100mg/dL range. Prescription medications included metformin 850mg TID, canagliflozin 300mg daily, glipizide 10mg BID, aspirin 81mg daily, carvedilol 12.5mg BID, furosemide 40mg daily, lisinopril 10mg daily, simvastatin 40mg daily, and levothyroxine 88mcg daily. Dulaglutide 0.75mg weekly was initiated. On 5/4/16, SCr had more than doubled to 3.4mg/dL with a GFR of 13.7ml/min, and dulaglutide was subsequently discontinued 5/5/16. Following discontinuation of dulaglutide, SCr improved to 2.0 then 1.7mg/dL with GFR of 26ml/min, then 31.6ml/min on 5/12/16 and 5/31/16, respectively.

Discussion: This patient most likely experienced pre-renal reversible renal impairment. The patient’s concomitant diseases and medications may have made her more susceptible to volume depletion. The Naranjo score for this case is 7: probable adverse drug reaction. When initiating GLP-1a therapy, if renal impairment already exists, it is recommended to assess baseline renal function and to monitor it regularly. Furthermore, use in moderate-severe CKD is not recommended. This case supports these recommendations and associates dulaglutide with reversible renal impairment.

EKG. Patient admitted to taking 48 loperamide tablets one week prior to admission. Patient’s hospital course was complicated by a worsening bradycardia and prolonged QT (636 ms), cardiac arrest and placement of AICD. Patient recovered and was able to be discharged. Approximately 2 months later, the patient expired unexpectedly. Autopsy revealed an aortic blood loperamide level of 1.8 mg/L with a level greater than 20 mg/L in the liver and a diphenhydramine level in the liver of 37 mg/kg.

Discussion: Loperamide, a synthetic μ-opioid agonist, is normally used as an antidiarrheal agent that acts locally by inhibiting peristalsis of the intestinal tract. In large and chronic doses, loperamide responds as other abused opioid drugs leading to QT prolongation, brady-arrhythmias and Torsades de Pointes. These cardiac abnormalities are usually only corrected with electrical pacing or cardioversion. Clinicians should consider loperamide-associated toxicity when QT prolongation, brady-arrhythmias or Torsades are present with a negative opioid drug screen.

25. Title: A Fatal Case of Loperamide Abuse Authors: Angie Pegram, PharmD, BCPS, CDE1,2, Heather Kehr, PharmD, BCPS1,2, Ronald Pollack, MD1 Institution: 1Cabarrus Family Medicine Residency Program, Concord, NC; 2Wingate University School of Pharmacy, Wingate NC Introduction: The US Food and Drug Administration issued a drug safety announcement in June 2016 regarding abuse and misuse of loperamide. High doses of loperamide may cause euphoria and reduce symptoms of opioid withdrawal but also could lead to serious heart problems and even death. Since the medication is relatively cheap and readily available, abuse potential is high. In abuse cases, patients may also ingest other medications with loperamide which can increase its absorption across the blood-brain barrier, inhibit metabolism and enhance its euphoric effects.

Case: A 23-year-old female with a history of polysubstance abuse, anxiety and depression presented with a syncopal episode. Initial EKG showed sinus tachycardia with 2:1 AV block; follow-up EKG showed polymorphic ventricular tachycardia. Patient’s home medications were discontinued without recurrence of arrhythmia. Fourteen days after initial hospitalization, patient presented with another syncopal episode and bradycardia with prolonged QT on

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26

You’re Invited!

Pfizer Cordially Invites You to Attend An Informational Program Featuring

Chad J Kodiak, PHARMD RPh

Identifying Adult Candidates for Pneumococcal Pneumonia Vaccination: It Starts with a Question Thursday, November 3, 2016 6:00 PM Eastern Registration Dinner and Presentation to Follow

Morton's The Steakhouse 227 West Trade Street Charlotte, NC 28202 (704) 333-2438

Hosted by Lori Mc Lamb Please RSVP via our Registration Portal at: www.pfizerrsvphcp.com or via phone (800) 292-6204 Please reference Meeting ID# EZ30076189 If you plan to attend, kindly make every effort to arrive by the designated start time and to remain through the duration of the program. Please be advised that late arrivals may be prohibited from participating in the event.

Notice: This event is conducted in accordance with the PhRMA Code on Interactions with Healthcare Professionals (HCPs) and is limited to invited HCPs and appropriate non-HCP staff. Please note that for out-of-office programs, only HCPs (as defined by Pfizer policy) may attend. Before providing an RSVP or attending an out-of-office program, please confirm with your Pfizer representative that you meet the definition of “HCP” and any other requirements of attendance. Attendance by guests or spouses is not appropriate for any Pfizer speaker program unless the individual independently qualifies as an appropriate attendee. In addition, Pfizer policy prohibits attendance by HCPs who practice in a specialty for which the relevant Pfizer product does not have an FDA-approved indication and prohibits attendance by Pfizer speakers who have been trained on the product or topic to be presented.

State and Federal Employees: State and federal laws and regulations may limit your ability to receive meals. By attending this event, you confirm that you have obtained any necessary approvals from your employer.

Public Disclosures: The cost of meals provided to U.S. HCPs is subject to Pfizer’s national public disclosure policy as well as applicable state and federal law such as the National Physician Payment Transparency Program (otherwise known as “Sunshine”). Pfizer's disclosure allocates the cost of meals equally across all attendees who have not opted out of receiving a meal or have consumed a meal regardless of opt-out status.

State Law Restrictions: Regardless of where you practice or reside, if you are an HCP who is licensed in Minnesota or Vermont, you may not attend this event. Additionally, if you are an employee/agent of a Vermont HCP (e.g., PAs, non-prescribing nurses, etc.), regardless of where you practice or reside, you may not attend this event.

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Featured Early Bird Exhibitors Boehringer-Ingelheim Pharmaceuticals Cardinal Health EPIC Pharmacies, Inc. Fresenius Kabi, USA, LLC GEMCO Medical Liberty Software McKesson NC Department of Insurance Novo Nordisk Pfizer Pharmacists Mutual Companies PharMEDium Pioneer Rx Sanofi Silvergate Pharmaceuticals VIP Pharmacy Systems Walgreens Visit participating exhibitors with your Pit Stop Card and become eligible to win a Free NCAP Membership for One Year!

Pit Stop Cards will be distributed with your Registration Materials Sorry, Students are not eligible

Interested Exhibitors .................... Click here to Register!

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Ready

Set

Innovate!

Friday Morning 9:30

Keynote Speaker Ricky Craven NASCAR Analyst for ESPN at the

Charlotte Convention Center Followed by an Autograph Card Signing

Ricky Craven NASCAR Analyst, ESPN

@RickyCravenESPN, 43.3K Followers

Website: www.rickycraven.com

A driver with wins in each of NASCAR’s top three series, Ricky Craven is currently a NASCAR analyst for ESPN and frequently appears across all of ESPN’s platforms.

During his racing career, Craven captured Rookie of the Year titles in both the NASCAR Nationwide Series (1992) and the NASCAR Spring Cup Series (1995), winning races in both series while adding a victory in the NASCAR Camping World Truck Series. He also won the 1991 championship of what was then known as the NASCAR Busch Grand National North Series. A native of Newburgh, ME, Craven was inducted into the Maine Sports Hall of Fame in 2013.

About Ricky

Contact Information

• Craven joined ESPN in 2008 and frequently appears on SportsCenter and other ESPN news platforms • During his driving career, Craven won the Rookie of the Year titles in both the NASCAR Nationwide Series (1992) and NASCAR Sprint Cup Series (1995) • Additionally, he won races in both series as well as in the NASCAR Camping World Truck Series. He also won the 1991 championship of what was then known as the NASCAR Busch Grand National North Series • Finished as the runner-up in the NASCAR Nationwide Series point standings in both 1993 and 1994 before joining the Winston Cup Series in 1995 • Won the 1995 Winston Cup Series Rookie of the Year award with team owner Larry Hendrick, and also drove Hendrick Motorsports, SBIII Motorsports and Midwest Transit Raction before joining PPI Motorsports in 2001 • Won two NASCAR Sprint Cup races including the 2001 Old Dominion 500 at Martinsville Speedway and the 2003 Carolina Dodge Dealers 400 at Darlington Raceway, where he edged Kurt Busch at the finish line by .002 seconds, which is tied for the narrowest margin of victory in NASCAR history • Born and raised in Newburgh, ME, Craven began racing at the age of 15 and started his career at Unity Raceway in Unity, ME, where he won the track championship in 1983 Larry Jones, VP, Talent Marketing Email: ljones@csetalentrep.com Office: (678) 741-6726 Cell: (404) 545-5883

Available For...

Appearances

Autographs

Radio Appearances

Commercials

Speaking Engagements

Awards and Honors • 1995 Winston Cup Series Rookie of the Year • 1992 Busch Series Rookie of the Year • 1991 Busch North Series Champion • 1990-91 Busch North Series Most Popular Driver • 1990 Busch North Series Rookie of the Year • 1981 Unity Raceway Rookie of the Year

CSE Talent 150 Interstate North Parkway Atlanta, GA 30339 www.csetalentrep.com

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NASCAR Hall of Fame Reception Friday Night 6:30-9:00 Awards will be presented at 7:30 Campbell, UNC and Wingate Preceptor Awards High Point Community Partner of the Year Award

Come Casual in your Best NASCAR Attire Best Dressed Member will receive a Free NCAP meeting registration in 2017

Great Hall

 300 Person Seated Meal  500 Person Standing Reception  14’ x 18’ Indoor Billboard  A/V Capabilities  Views of Uptown Charlotte

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AWARDS Rite of Roses NCAP will honor members who have died since the previous Convention, Friday, November 4, 9:00 a.m.

School Awards

The Schools of Pharmacy will present awards, including preceptor awards, during the reception Friday evening at the NASCAR Hall of Fame, with a special award being presented by High Point University, Fred Wilson School of Pharmacy.

NCAP Awards

The following awards will be presented by NCAP on Saturday morning, November 4 at 9:30 a.m.

Bowl of Hygeia Award (sponsored by American Pharmacists Association Foundation and National Alliance of State Pharmacy Associations) Criteria for this award are: (1) Licensed to practice pharmacy in NC; (2) Has not previously received the Award; (3) Is not currently serving nor has he/she served within the immediate past two years on its awards committee or as an officer of the Association in other than an ex officio capacity; (4) Has compiled an outstanding record of community service, which, apart from his/her specific identification as a pharmacist, reflects well on the profession.

Cardinal Health Foundation Rx Champions Award (sponsored by Cardinal Health) This award recognizes a pharmacist for his/her work within the pharmacy community to raise awareness of the serious public health problem of prescription drug abuse.

Don Blanton Award Presented to the pharmacist who has contributed most to the advancement of pharmacy in North Carolina during the past year. This award was established by Charles Blanton in memory of his father, Don Blanton, who served the North Carolina Pharmaceutical Association as President 1957-58.

Excellence in Innovation Award (sponsored by Upsher-Smith Laboratories) Presented to a pharmacist practicing in North Carolina who has demonstrated Innovative Pharmacy Practice resulting in improved patient care.

Distinguished Young Pharmacist Award (sponsored by Pharmacists Mutual Companies) Criteria for this award are: (1) Entry degree in pharmacy received less than 10 years ago (2006 or later graduation date); (2) Licensed to practice pharmacy in NC; (3) Actively practices retail, institutional, managed care or consulting pharmacy; (4) Participates in national pharmacy associations, professional programs, state association activities and/or community service.

Community Care Pharmacist of the Year – Honors a pharmacist who is outstanding in the practice of community pharmacy.

Health-System Pharmacist of the Year – Honors a pharmacist who is outstanding in the practice of healthsystem pharmacy.

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McKesson Leadership Award – Honors the NCAP President-Elect NCPA Leadership Award – Honors the NCAP President-Elect NCAP President’s Award – Honors the NCAP President

NCAP President’s Service Award – Presented by the President in recognition of outstanding service to NCAP

ASHP Leadership Award – Presented to the Chair of the Health-System Practice Forum in recognition of leadership Fifty Plus Club – Honors pharmacist members who celebrate their 50th year as a licensed pharmacist.

Past Award Recipients

The following have been honored with awards since 2000 when NCAP was formed. Awards were presented

by NCPhA, NCSHP and NCASCP prior to 2000. The names of these recipients can be found on the NCAP website www.ncpharmacists.org.

Bowl of Hygeia Award

2000 2001 2002 2003 2004 2005 2007 2008 2009 2010 2011 2012 2013 2014 2015

Gene Minton, Roanoke Rapids Donald Heaton, Grandy Gina Upchurch, Durham Stephanie N. Kiser, Asheville Stan Haywood, Asheboro David R. Work, Chapel Hill F. Michael James, Raleigh Fred M. Eckel, Chapel Hill Robert Ashworth, Carolina Beach Al Lockamy, Raleigh John M. Johnson, Raleigh Beverly Lingefeldt, Raleigh Jean Douglas, Greensboro Ronald Maddox, Holly Springs David Moody, Youngsville

2000 2001 2002 2003 2004 2005 2006 2007 2008

W. Keith Elmore, Wilmington Stephen Caiola, Chapel Hill Barry Bunting, Asheville Daniel Garrett, Greensboro Bryan Bray, High Point David Moody, Youngsville Gina Upchurch, Durham Robert Supernaw, Wingate Rebecca Chater, Fayetteville

Don Blanton Award

2009 2010 2011 2012 2013 2014 2015

John Kessler, Chapel Hill Mary Margaret Johnson, Angier Troy Trygstad, Chapel hjill Mollie Scott, Candler Mary Parker, Mebane Gene Minton, Littleton Robert Blouin, Chapel Hill

2000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

William Burch, Durham Jennifer Burch, Durham Bryan Bray, High Point Donald Holloway, Durham Martha Lyon, Blowing Rock Randal Von Seggern, Greensboro Rebecca Chater, Asheville John Kessler, Carrboro Ronald DeVizia, Raleigh Larry Long, Gastonia Tim Ives, Efland Joe Moose, Mt. Pleasant Mary Parker, Mebane Huyla Coker, Camden Stephen Eckel, Chapel Hill Ouita Gatton, Raleigh Amina Abubakar, Charlotte

2000 2001 2002 2003 2004 2005

Joseph Moose, Mount Pleasant Penny Shelton, Raleigh Beth DeWitt Greck, Asheville Beth Williams, Kernersville Christie Hughes, Asheville Stephen Eckel, Chapel Hill

Excellence in Innovation Award

Distinguished Young Pharmacist Award

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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Leigh Foushee, Raleigh Stefanie Ferreri, Durham Jennifer Askew Buxton, Wilmington James Bowman, Matthews Abbie Williamson, Raleigh Debra Kemp, Graham Andrew Muzyk, Pittsboro Amber McLendon, Buies Creek Jamie Brown, Durham Tasha Woodall, Horse Shoe

2012 2013 2014 2015

Jerry McKee, Durham Karen Suess, Dunn Susan Miller, Fayetteville Theodore Pikoulas, Raleigh

2000 2001

2002

2003 2004 2005 2006 2007 2008 2009 2010

2011 2012 2013 2014 2015

Alan Boyd, Durham Dan Garrett, Greensboro Beth Williams, Kernersville Joe Johnson, Greensboro William Harris, Apex William C. Rustin, Jr., Raleigh No Award Rep. Winkie Wilkins, Raleigh No Award Brenden O’Hara, Cary John Kessler, Chapel Hill No Award Jennifer Noped, Winston-Salem Jennifer Gommer, Holly Springs Regina Schomberg, Clemmons Ashley Branham, Concord Dennis Williams, Chapel hill Leigh Foushee, Raleigh Debra Kemp, Hillsborough

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

John Kessler, Carrboro Bill Harris, Apex Betty Dennis, Carrboro Vance Collins, Roanoke Rapids No Award Jane Younts, Greensboro No Award Stephen Caiola, Chapel Hill Regina Schomberg, Clemmons Timothy Randolph, Huntersville Deborah Montague, Chapel Hill

Cardinal Health Generation Rx Champions Award

President’s Service Award

Health-System Pharmacist of the Year

2011 2012 2013 2014 2015

Kathey Fulton Rumley, Washington Minal Patel, Winston-Salem Michael Soucie, Newport Lynn Eschenbacher, Durham Becky Szymanski, Charlotte

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

No Award Bill Mast, Henderson Betsy Bryant Mike James, Raleigh No Award Stefanie Ferreri, Chapel Hill No Award Beverly Lingerfelt, Cary Joseph Moose, Mt. Pleasant Joe Heidrick, Durham Tasha Michaels, Durham Nathan Hemberg, Reidsville Jessica Lee, Chapel Hill Ashley Branham, Concord Ouita Gatton, Raleigh Ruth Hall Higgins, Asheville

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Ross Brickley, Garner Larry Long, Gastonia Margaret Sgritta, Mooresville No Award No Award No Award Valerie Brooks, Cary Larry Pope, Winston-Salem Judith Jones, Charlotte Holly Nunn, Raleigh No Award Ted Hancock, Wilmington Penny Shelton, Raleigh No Award Michelle Ames, Raleigh Tom D’Andrea (presented at Chronic Meeting)

2007 2008 2009 2010 2011 2012 2013

Kay Vass, Mint Hill Penny Shelton, Raleigh Cecil Davis, Winston-Salem Charlotte Matheny, Greensboro Robert K. Smith, Hickory Cheryl Kendrick, Greensboro Gianna Bryan, Winston-Salem

Community Care Pharmacist of the Year

Chronic Care Pharmacist of the Year

Dale Jones Memorial Award for Excellence in Geriatrics

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2014 2015 2016

Jena Ivey Burkhart, Chapel Hill Cathy Fuquay, Oak Ridge T. Andrew Hunter, Matthews (presented at Chronic Meeting)

Ambassador Award

(recognizes national leadership in pharmacy) 2007

2008

2011

Bruce Canaday, Wilmington (American Pharmacists Association) Ross Brickley, Garner (American Society of Consultant Pharmacists) David Moody, Durham (Health Distributors Management Association) Penny Shelton, Raleigh (American Society of Consultant Pharmacists)

Excellence in Government Award

(recognizes legislative leadership on behalf of pharmacy) 2006 2007 2013

2014

Representative Edd Nye Senator William Purcell Senator Fletcher Hartsell, Jr, Representative Marilyn Avila US Rep. G. K. Butterfield

INSTALLATION OF OFFICERS NCAP 2017 officers will be installed Saturday, November 5, 9:30 a.m.

President

Stefanie Ferreri

Past President Stephen Eckel

Treasurer

Tom Dâ&#x20AC;&#x2122;Andrea

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The North Carolina Pharmacists wishes to recognize the leadership and contributions of the Past Presidents of the Association.

NORTH CAROLINA ASSOCIATION OF PHARMACISTS PAST PRESIDENTS Kevin Almond, 2000 William Harris, 2001 Ross Brickley, 2002 Jack Watts, 2003 Mark Gregory, 2004 Davie Waggett, 2005 Dennis Williams, 2006 Beth Williams, 2007 Penny Shelton, 2008 Brenden Oâ&#x20AC;&#x2122;Hara, 2009 Regina Schomberg, 2010 Cecil Davis, 2011 Jennifer Buxton, 2012 Mary Parker, 2013 Michelle Ames, 2014 Ashley Branham, 2015 35

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The Committee has collected summary notes from roundtable leaders from the NCAP Residency Conference held in July 2016.

Notes available are the following: Recruitment Challenges of Residency Programs Brock Harris Recruiting-Related Challenges and Approaches 1. Online presence: online information and the ease of directing candidates to standardized, accessible information 2. Online information sessions: live webinars to distribute program details as well as answer questions of candidates, may be beneficial for programs with multiple programs and limited resources for in-person recruiting 3. Social media presence: meeting candidates on platforms they use regularly and the social media policy-related concerns of organizations and health-systems 4. Return on investment of recruiting: schools of pharmacy career/residency days, location of conferences or schools of pharmacy in relation to program, a fee structure or no charge recruitment days 5. Budget source for recruiting: human resources compared to department of pharmacy budget use for recruitment travel Selection-Related Challenges and Approaches 1. Large number of applications: include current and/or former residents in applicant evaluations, current and former residents have an understanding of the type of candidate who may thrive in the program 2. Application evaluation: varying methods to evaluate applications in order to standardize scoring; multiple evaluators scoring complete application independently followed by discussion compared to single evaluator scoring single application section then compiling scores 3. Logistics of onsite interviewing: several methods discussed to streamline processes; administrative help for candidate travel and interview arrangements to resident program director making the arrangements with candidates 4. Assessing psychosocial-related characteristics of candidates: residents evaluate in social setting (lunch) to candidates completing a short presentation about themselves to the pharmacy team 5. Limiting onsite interviewing through technology: using technologies (SkypeTM, Google HangoutTM, etcâ&#x20AC;Ś) to communicate directly with candidates allowing both candidate and program to determine if onsite interview is necessary John Brock Harris, Pharm.D., BCPS, BCPPS, Wingate University School of Pharmacy, Clinical Pharmacy Specialist â&#x20AC;&#x201C; Pediatrics, Novant Health Hemby Childrenâ&#x20AC;&#x2122;s Hospital, Charlotte, North Carolina 37

Unpredictable Situations Amy Holmes RPDs and preceptors have faced many unpredictable situations throughout the years. Having this as a roundtable discussion topic allowed us to share our experiences and provide ideas on how we’ve dealt with them. Some involve routine answers like partnering with Human Resources (HR) or referrals to Employee Assistance Programs (EAP) while others have relied on more “outside the box” thinking.

Several things have resulted in programs extending their commitment due to leaves of absence during the residency year from bereavement leave for the death of a parent to medical reasons such as pregnancy or the illness of the resident or a member of their family. While medical residency allows for a “home rotation” after pregnancy for research/writing, their residencies are longer. This likely would not be in alignment with ASHP requirements.

Some residents are “non-traditional” in that they have children and are balancing their family along with residency. One RPD in the group described how she felt that the non-traditional resident was a learning experience for her co-residents, while representatives of another program reported having problems related to missing time on a regular basis due to “mom” duties.

Surprisingly, there were several examples of issues with impairment -- definitely an area where HR gets involved. One astute RPD reported that she tells each class at the beginning of the year, “Don’t do drugs.” An alcohol-related issue that resulted in criminal charges and subsequent enrollment in a substance abuse program with the board occurring between the match and start of residency, which put a restriction of 32-40 hours per week on one resident. Is it possible to meet the requirements for graduation of the program with this limit on hours? Limiting work hours is a potential outcome for anyone going through substance abuse recovery.

Delays in licensure are pretty common occurrences. One program reported “doubling up” duties in order to get everything accomplished without the need to extend residency. Likewise, another program reported remediating residents by assigning extra projects during the next rotation in order to be able to eventually “pass” them in the one that they did not complete successfully. A great idea that many may wish to incorporate is a contingency letter written at the beginning of June that spells out exactly what each resident has left to complete in order to get their certificate. The resident is required to sign this letter to demonstrate that they have read the letter and are aware of what must be completed. An unpaid 90-day extension has been offered to allow someone to finish the checklist.

The helicopter parents have arrived -- there was a report of a call received from the parent of a candidate who did not match. This RPD suggests, “It’s coming. Be prepared.”

Plagiarism is not something that would be expected to be a problem with a college graduate yet some preceptors report residents who pled ignorance of what constitutes plagiarism. Still others have run into problems with inadvertent self-plagiarism because the residents didn’t know that they couldn’t reuse their own material for two assignments. A suggested solution is to use the UNC policy on plagiarism and have each class sign at the beginning of the year.

Mental health problems are not uncommon. EAP is a good first step in assisting residents with mental health issues.

RPDs, especially those who are not in administrative roles, are encouraged to seek leadership training (specifically with regards to difficult conversations but certainly not limited to that). Other subjects that were touched on and might be useful topics for future educational programming for preceptors are resident/preceptor relationships -- where to draw the line and potential issues for litigation so that RPDs are versed in the right things to say or not say.

Amy Holmes, PharmD, Novant Health Forsyth Medical Center, Winston-Salem

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NOVEMBER

4

Come out and mingle with the â&#x20AC;&#x153;NCAPersâ&#x20AC;?

VBGB Beer Hall and Garden 10 pm-1 am

!

The Student Pharmacy Network invites all the NCAP members to enjoy a night at the tented-heated patio with music, craft beers on tap, corn hole, giant jenga, giant chess, giant connect 4 and giant fun while networking with NC pharmacists. Only 2.5 miles away from the Nascar Hall of Fame!

920 Hamilton Street, Charlotte, NC 28206 (704)333-4111

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NO COVER! Questions: NCAPWUSOP@gmail.com

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The 2016 Student Leadership Conference

On Saturday, September 24th, NCAP hosted its annual Student Leadership Conference at First Health Moore Regional Hospital in Pinehurst, NC. This year 101 student pharmacists represented all four North Carolina schools of pharmacy to network with one another and develop personal leadership skills. The theme of this year’s conference was “Developing Influence, Forging Change” with guest speakers focusing on a variety of leadership-focused topics. The NCAP Student Pharmacist Network also coordinated a team-building activity, challenging students to think outside the box and reach a common goal. Dr. Penny Shelton, NCAP Executive Director, then closed the conference with a final charge to students.

Dr. Shelton shared with students the importance of their impact on North Carolina pharmacy and challenged them to stay “Pharmacy Proud” as they move forward with their profession.

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Guidelines for Authors North Carolina Pharmacist is published quarterly by the North Carolina Association of Pharmacists, and is a benefit for NCAP members. North Carolina Pharmacist features articles of various types (research, reviews, advice for trainees, education, legislative updates, opinions) intended to inform, educate and motivate pharmacists, from students to seasoned practitioners in all areas of pharmacy, to advance the care of patients and the pharmacy profession. Authors will be asked to sign a conflict of interest disclosure and a statement of the originality of their submission.

To ask any questions, or to submit a manuscript for consideration, please contact Ralph H. Raasch, PharmD, Interim Editor, at ralphhraasch@gmail.com.

Types of Articles Accepted Reviews: Systematically driven, comprehensive, and reproducible summaries of current research in primary pharmacy and biomedical literature on clinical, administrative, legal, humanistic, or economic topics. The text is limited to 3000 words with a maximum of 3 tables and figures (total) and up to 20 references.

Special Articles: Reports in such areas as, but not limited to: new drugs/clinical knowledge, economic policy, legislative issues, education, ethics, law, and health care delivery. The text is limited to 3000 words with an abstract and a maximum of 3 tables and figures (total), and up to 20 references.

Case Reports/Case Series: Describe one or a series of patients exhibiting a new or unique clinical feature (e.g. receiving treatment with an investigational product, response to therapy, adverse reaction, etc). Case reports/series should not discuss the usual course of therapy (see clinical problem solving below). The text is limited to 2500 words with an abstract and a maximum of 3 tables and figures (total), and up to 25 references.

Clinical Problem-Solving: Considers the step-by-step process of clinical decision- making. Information about a patient is presented in stages to simulate the way such information emerges in clinical practice in order to highlight the evolving management of that patient. The text should not exceed 2500 words, and there should be no more than 15 references.

Business Model Articles: Objective discussions of innovative pharmacy practices. The text is limited to 1500 words.

Editorials/Commentary: Provide commentary and/or analysis concerning a previously published article in the Journal or on a current pharmacy practice issue. They may include one figure or table.

Editorials are limited to 1000 words, with up to 10 references.

Human Interest Articles: These articles focus on the â&#x20AC;&#x153;human interestâ&#x20AC;? side of pharmacy. Editors are looking for inspirational stories about NCAP members, successful patient outcomes, and more. Word count is limited to 1,250.

Original Research and Quality Improvement Articles: These articles focus on human subjects, nonhuman subjects research (e.g., compatibility/stability studies, MUEs, analysis of medication safety datasets), and QI projects (e.g., improving programs, services, technologies)

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For all types of articles: When referring to medications, use generic names of drugs throughout the manuscript, unless the specific trade name of a drug is directly relevant to the discussion.

Formatting Manuscripts for the North Carolina Pharmacist General 1. The manuscript text is double-spaced in a 12-point Arial font throughout (including tables, references, footnotes, figure captions, and author identification [ID]) on 8.5 by 11-inch pages with margins of at least 1 inch all around.

2. All pages are numbered consecutively in the lower-right corner, beginning with the title page and including tables.

3. Each of the following elements begins on a separate page in this sequence: author(s) and title page, text, references, appendixes, tables, and figures.

Author ID and title of manuscript page 1. This author ID page facilitates blinding of the manuscript.

2. For each author, include name, professional degree(s), job title, contact information, and disclosure of any potential conflicts of interest.

3. Please specify the corresponding author.

4. Include a concise, informative title of the manuscript.

Text 1. Names of authors, institutions, and patients are not mentioned, except in descriptive reports in which institutional identification is essential to understanding the program.

2. Case Studies are described in the following order: Problem (followed by Background, depending on content), Analysis and Resolution, Discussion, and Conclusion. Include: adverse events, AE causality/probability assessment, outcome 3. For Case Reports manuscripts, the patient’s age, sex, race, weight, pertinent medical history, and baseline laboratory values are included, as well as generic names, manufacturers, formulations, and routes of administration of all drug products use. Include: adverse events, AE causality/ probability assessment, outcome 4. Descriptive headings are used to identify major sections of the manuscript; subheadings also may be used.

5. Every reference, figure, table, and appendix is cited in the text in numerical order. (Order of mention in text determines the number given to each.)

6. For software important to the manuscript, denotes in parentheses or a footnote the version, manufacturer, city, and state.

References 1. Includes the heading “References.”

2. Are identified in text, tables, and legends by superscript Arabic numbers.

3. Are double-spaced on pages separate from the text and numbered consecutively as they appear in the text. References that appear only in tables or figure captions should receive consecutive numbers based on the placement of the first mention of the table or figure in the text.

4. Do not include any “unpublished observations” or “personal communications.” (References to written, not oral, communications may be inserted in parentheses in the text or included as footnotes.)

5. Have been verified by the author(s) against the original documents.

6. Abbreviations of journal titles conform to those used by the National Library of Medicine for MEDLINE indexing (www.nlm.nih.gov/services/medline_titles.html; additional guidance available at: www.nlm.nih.gov/pubs/factsheets/constructitle.html).

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North Carolina Pharmacist Editorial Board Chronic Care Forum Ross Brickley (Garner)

Rhonda Gentry (Asheville)

ross.brickley@gmail.com

rhondaroogentry@gmail.com

Ted Hancock (Wilmington) thancock@wilmingtonhealth.com Keely Ray (Davidson)

Community Care Forum

KeelyR@NeilMedical.com

Ashley Branham (Concord)

ashley@moosepharmacy.com

Lisa Dinkins (Wingate) lisa.dinkins@gmail.com

Andria Eker (Asheville) aeker@blueridgeaccess.com Leigh Foushee (Buies Creek)

foushee@campbell.edu

Tasha Michaels (Hendersonville)

Health System Forum

tmichaels@blueridgerx.com

Jean Douglas (Greensboro)

jjmdouglas@aol.com

Amy Holmes (Winston-Salem)

apholmes@novanthealth.org

Andrew Lucas (Chapel Hill)

andrew.lucas@alumni.unc.edu

Ouita Gatton (Raleigh) ouita.gatton@kroger.com

Tim Giddens (Wilmington) tim.giddens1@gmail.com Angela Livingood (Burgaw) Ron Small (Advance)

Multiple Affiliations or At-Large

angela.livingood@nhrmc.org rhsmall@yadtel.net

John Kessler (Carrboro) jkessler@secondstoryhealth.com Larry Long (Gastonia)

Bill Taylor (Buies Creek)

larry.long@emailMM.com taylorw@campbell.edu

Letters to the Journal â&#x20AC;&#x201C; The Editorial Board and Editor welcome your comments regarding the Journal and any of its contents. In particular, we would like to hear from you concerning professional issues related to practice/ professional dilemmas/potential conflicts of interest. If you have comments, please send to Ralph H. Raasch, Interim Editor, mail to: ralphhraasch@gmail.com.

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Itâ&#x20AC;&#x2122;s not too late to Register for the

2016 NCAP Annual Convention November 4-5 at the

Charlotte Convention Center

Click here to Register!

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