Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ANNUAL PROFESSIONAL PRACTICE CONFERENCE The Largest Pharmacy Conference in Canada February 2-6, 2013 Final Program The Sheraton Centre Toronto Hotel 123 Queen Street West Toronto, ON CONFÉRENCE ANNUELLE SUR LA PRATIQUE PROFESSIONNELLE Le plus grand congrès en pharmacie au Canada 2-6 février 2013 Programme final What is CSHP 2015? Qu’est-ce que le projet SCPH 2015? Vision of pharmacy practice excellence in the year 2015 Strategic objective of CSHP’s Vision 2014 which aims to improve patient medication outcomes and safety by advancing practice excellence ● ● A quality care initiative ● Un projet axé sur la qualité des soins ● A project aiming to answer the questions… “What would make the most difference to our patients?” and “What will convey the positive contributions of the pharmacist?” ● Un projet qui vise à répondre aux questions suivantes : « Qu’est-ce qui serait le plus profitable pour nos patients? Qu'est ce qui permettrait de communiquer les contributions positives du pharmacien? » ● Six specific goals that will guide practitioners towards the CSHP vision ● ● Sub-objectives that include measurable targets with established baselines used to monitor progress, which can be reviewed and revised as practice goals change Six buts précis qui aideront les pharmaciens à concrétiser la vision de la SCPH ● Des objectifs sous-jacents qui sont assortis de cibles mesurables nous permettant d'établir un point de référence et de suivre les progrès, et qui pourront être réexaminés et modifiés à mesure que les objectifs et les lignes directrices de la pratique changent ● ● ● Une vision de l’excellence en pratique pharmaceutique en l’an 2015 Un objectif stratégique de la Vision 2014 de la SCPH, lequel s’applique à améliorer les résultats et la sécurité de la pharmacothérapie des patients en faisant avancer l’excellence en pratique. CSHP Targeting Excellence in Pharmacy Practice SCPH Goals Buts 1 Increase the extent to which pharmacists help individual hospital inpatients achieve the best use of medications 1 2 3 Accroître le degré d'intervention des pharmaciens auprès de chaque patient hospitalisé afin d'assurer l'utilisation optimale des médicaments. Increase the extent to which pharmacists help individual non-hospitalized patients achieve the best use of medications 2 Accroître le degré d'intervention des pharmaciens auprès de la clientèle non hospitalisée afin d'assurer une utilisation optimale des médicaments. 4 Increase the extent to which pharmacy departments in hospitals and related healthcare settings have a significant role in improving the safety of medication use 3 Étendre l'application du principe des décisions fondées sur les preuves à la pratique clinique quotidienne des pharmaciens des établissements de santé dans le but d'améliorer la pharmacothérapie 5 Increase the extent to which hospitals and related healthcare settings apply technology effectively to improve the safety of medication use 4 Accroître le rôle joué par les départements de pharmacie des établissements de santé dans l'amélioration de l'utilisation sécuritaire des médicaments. 6 Increase the extent to which pharmacy departments in hospitals and related healthcare settings engage in public health initiatives on behalf of their communities 5 Étendre l'application efficace des technologies dans les départements de pharmacie des établissements de santé pour améliorer l'utilisation sécuritaire des médicaments. 6 Accroître le degré d'intervention des départements de pharmacie des établissements de santé dans la mise en oeuvre d'initiatives de santé publique. Increase the extent to which hospital and related healthcare setting pharmacists actively apply evidence-based methods to the improvement of medication therapy To get started on CSHP 2015 now, go to CSHP’s website at www.cshp.ca. There you will find the complete list of goals and objectives, a self-assessment tool, PowerPoint presentations and more. *CSHP 2015 was adapted with permission from the ASHP 2015 Initiative. Point de mire sur l’excellence en pratique pharmaceutique Pour vous engager dès maintenant dans le projet SCPH 2015, visitez le site Web de la SCPH au www.cshp.ca. Vous y trouverez une liste complète des buts et des objectifs du projet, un outil d’autoévaluation, des présentations PowerPoint et d'autres renseignements. *Le projet SCPH 2015 est une adaptation approuvée de l’ASHP 2015 Initiative. www.cshp.ca Dear Colleague, On behalf of the Officers, Council and staff of the Canadian Society of Hospital Pharmacists (CSHP), it is our pleasure to welcome you to CSHP’s 44th Annual Professional Practice Conference. Over the last 10 months, CSHP’s Educational Services Committee has worked hard to assemble an impressive faculty of pharmacy specialists and develop a program of exceptional educational value with topics covering a wide range of specialties, management issues and pharmacy practice-related challenges. This conference is designed to maximize your opportunities for professional development, networking and socializing with practitioners from across the country. It is our hope that you are able to take full advantage of the 2013 offerings – and enjoy yourself in the process. At any time throughout the conference, the Officers and staff of CSHP are available to you. Please let us know if we can answer any of your questions, address any of your concerns or be of assistance in any way. Be sure to take a few minutes and stop by the CSHP booth during the exhibits program and say hello. We look forward to welcoming each of you to another spectacular conference. Thank you for your ongoing support of CSHP! 4 Douglas Sellinger Myrella Roy BSP, MA BScPhm, PharmD, FCCP CSHP President Executive Director Chères (Chers) collègues, Au nom de la Direction, du Conseil et du personnel de la Société canadienne des pharmaciens d’hôpitaux (SCPH), nous avons le plaisir de vous souhaiter la bienvenue à la 44e Conférence annuelle sur la pratique professionnelle de la SCPH. Au cours des dix derniers mois, le comité des services éducatifs de la SCPH s’est affairé à rassembler un groupe impressionnant de conférenciers spécialisés en pharmacie et à vous préparer un programme d’une valeur éducative exceptionnelle avec des sujets touchant un large éventail de spécialités, de questions relatives à la gestion et de défis posés à la pratique pharmaceutique. Ce congrès est destiné à maximiser les possibilités de perfectionnement professionnel, de réseautage et de rencontre avec d’autres praticiens de toutes les régions du pays. Nous espérons que vous pourrez tirer pleinement profit de ce que nous vous offrons en 2013 – tout en vous divertissant. Nous vous rappelons qu’au cours du congrès, la Direction et le personnel de la SCPH seront à votre entière disposition. Nous ferons tout en notre pouvoir pour répondre à vos questions, discuter des sujets qui vous préoccupent et vous aider au besoin de quelques manières que ce soit. Pendant le salon des exposants, assurez-vous d’effectuer un arrêt au stand de la SCPH afin de nous saluer! Nous sommes impatients de vous accueillir à cet autre congrès exceptionnel et vous remercions de votre appui soutenu à la SCPH. Douglas Sellinger BSP, MA Présidente de la SCPH Myrella Roy B. Sc. Phm., Pharm. D., FCCP Directrice générale 5 Table of Contents Table des matières Executive, Council and Staff Bureau de direction, Conseil et Personnel Executive Committee Bureau de direction 7 Council Conseil 7 CSHP Staff Personnel de la SCPH 7 With Thanks Remerciements CSHP Industry Corporate Members Entreprises membres du secteur de l’industrie 8 CSHP Hospital Corporate Members Entreprises membres du secteur hospitalier 8 CSHP Sponsors 2012 Commanditaires de la SCPH en 2012 9 Awards Program Programme des prix Distinguished Service Award Prix pour service distingué 10 Isabel E. Stauffer Meritorious Service Award Prix Isabel E. Stauffer pour service méritoire 10 New Hospital Pharmacy Practitioner Award Prix du nouveau praticien en pharmacie hospitalière 10 Hospital Pharmacy Student Award Prix de l’étudiant en pharmacie hospitalière 10 2012-2013 Awards Committee Comité des prix 2012-2013 11 2012-2013 Awards Program Programme des prix 2012-2013 11 Tribute to Appraisers Hommage aux évaluateurs 11 Conference Information Information sur la conférence Upcoming Events Événements à venir 12 Satellite Symposiums Symposiums satellites 12 CSHP Educational Services Committee Comité des services éducatifs 13 Program Programme Program of Events Programme des événements 14 Speakers Abstracts Résumés des conférenciers 22 SES 2013 Call for Abstracts Demande de résumés pour les SÉÉ 2013 41 Oral Presentations Présentations orales 44 Poster Abstracts Résumés des affiches 45 Poster Abstract Reviewers Réviseurs des présentations par affiches 64 CSHP Fellows Associés de la SCPH 65 Faculty Conférenciers 68 Exhibitor List Liste des exposants 69 6 Executive Committee • Bureau de direction President Président Past President Présidente sortante Director of Finance Directrice des finances Executive Director Directrice générale Doug Sellinger Regina Qu’Appelle Health Region Regina, SK Janice Munroe Fraser Health Authority Langley, BC Deborah Emery Thunder Bay Regional Health Sciences Centre Thunder Bay, ON Myrella Roy Canadian Society of Hospital Pharmacists Société canadienne des pharmaciens d’hôpitaux Ottawa, ON Quebec Québec Prince Edward Island Île-du-Prince-Édouard Diem Vo Hôpital Pierre-Boucher Longueuil, QC Amy Cheverie Kings County Memorial Hospital Montague, PE President Elect Présidente designée Patricia Macgregor The Hospital for Sick Children Toronto, ON Council • Conseil British Columbia Colombie-Britannique Bruce Millin Fraser Health Authority Langley, BC Manitoba Pat Trozzo CancerCare Manitoba Winnipeg, MB Alberta Ontario – Senior/Principal Sherilyn Houle University of Alberta Edmonton, AB Olavo Fernandes University Health Network Toronto, ON Saskatchewan Ontario – Junior/Débutant Zack Dumont Regina Qu’Appelle Health Region Regina, SK Mario Bédard The Ottawa Hospital Ottawa, ON New Brunswick Nouveau-Brunswick Faith Louis Horizon Health Network Fredericton, NB Nova Scotia Nouvelle-Écosse Theresa Hurley QEII Health Sciences Centre Halifax, NS Newfoundland and Labrador Terre-Neuve-et-Labrador Justin Peddle Memorial University St. John’s, NL Student Delegate Déléguée des étudiants Megan Riordon Dalhousie University Halifax, NS CSHP Staff • Personnel de la SCPH Executive Director Directrice générale Executive Assistant Adjointe de direction Myrella Roy Rosemary Pantalone Operations Manager (on leave) Gérante des opérations (en congé) Interim Conference & PSN Administrator Agente par intérim des congrès et des RSP Laurie Frid Susan Maslin Anna Dudek Interim Operations Manager Gérante des opérations par intérim Membership & Awards Administrator (on leave) Agente du service aux membres et des prix (en congé) Publications Administrator Agente des publications Desarae Davidson Coordinator, Professional & Membership Affairs Coordonnatrice, Affaires professionnelles et service aux membres Cathy Lyder CHPRB & Advocacy Administrator Agente du CCRPH et de la valorisation Gloria Day Finance Administrator Agente des finances Pamela Saunders CSHP 2015 Project Coordinator Coordonnatrice du projet SCPH 2015 Carolyn Bornstein Colleen Drake Robyn Rockwell Web Administrator Agente du Web Interim Membership & Awards Administrator Agente par intérim du service aux membres et des prix Olga Chrzanowska Cheryl Mallory Interim Office Administrator (CSHP 2015 & Board of Fellows) Agente de bureau par intérim (SCPH 2015 et Conseil des associés) Ontario Branch Administrator Agente de la section de l’Ontario CSHP Research and Education Foundation Administrator Agente de la Fondation pour la recherche et l’éducation de la SCPH Janet Lett Susan Korporal 7 2012-2013 CSHP Industry Corporate Members 2012-2013 CSHP Hospital Corporate Members (At time of printing) (At time of printing) 2012-2013 Entreprises membres du secteur de l’industrie 2012-2013 Entreprises membres du secteur hospitalier (au moment de l’impression) (au moment de l’impression) • Alveda Pharmaceuticals Inc. • Alberta Health Services • AstraZeneca Canada Inc. • Fraser Health Pharmacy Services • Baxter Corporation (Canada) • Horizon Health Network • BioSyent Pharma • London Health Sciences Centre • Eli Lilly Canada Inc. • Medbuy Corporation • Galenova Inc. • North Bay Regional Health • Healthmark Ltd. • Northern Health Authority • Hospira Healthcare Corporation • University Health Network • Janssen Inc. • McKesson Canada Corporation • Mylan Pharmaceuticals • Omega Laboratories Ltd. • Pendopharm, a Division of Pharmascience Inc. • Pfizer Canada Inc. • Pharmaceutical Partners of Canada A Company of the Fresenius Kabi Group • Pharmascience Inc. • Sandoz Canada Inc. • Sanofi-aventis Canada Inc. • Servier Canada Inc. • SteriMax Inc. • TEVA Canada Ltd. 8 CSHP Sponsors 2012 The following list reflects all CSHP Sponsorship received from January 1 to December 31, 2012. Commanditaires de la SCPH en 2012 La liste suivante reflète toutes les commandites reçues du premier janvier au 31 décembre 2012. Diamond Sponsor Commanditaires diamant $80,000 or greater 80 000 $ et plus Platinum Sponsor Commanditaires platine Donor Sponsor Commanditaires donateurs $60,000 - $79,999 $1000 - $9,999 • Abbott Laboratories Inc. Gold Sponsor Commanditaires or $40,000 - $59,999 • Alveda Pharma • AmeriscourceBergen Canada • Amgen Canada Inc. • Apotex Inc. • Bayer Inc. Silver Sponsor Commanditaires argent • Bristol-Meyers Squibb Canada • BioK Plus $20,000 - $39,999 • Canadian Agency for Drugs and Technologies in Health (CADTH) • AstraZeneca • Canadian Forces • Boehringer-Ingelheim Canada Ltd. • Canadian Institute for Health Information (CIHI) • Eli Lilly Canada Inc. • Hospira Healthcare Corporation • Otsuka Pharmaceutical Inc. • TEVA Canada • Canadian Pharmaceutical Distribution Network (CPDN) • Cardinal Health Canada • Galenova Inc. • Healthmark Ltd. Bronze Sponsor Commanditaires bronze • Helmer Scientific • Hoffman La Roche Limited $10,000 - $19,999 • Astellas Canada • Johnson & Johnson Family of Companies • McKesson Canada • LEO Pharma Inc. • Medbuy • Lexi-comp Inc. • Merck Canada Inc. • Lundbeck Canada Inc. • Omega Laboratories Limited • Mylan Pharmaceuticals • Pendopharm, a division of Pharmascience Inc. • Northwest Telepharmacy • Sanofi-aventis Canada Inc. • Novartis Pharma Canada • Northern Health • Ontario College of Pharmacists (OCP) • Paladin Inc. • PCCA Canada • Purdue Pharma • RxFiles - Academic Detailing Program • Servier Canada Inc. CSHP Targeting Excellence in Pharmacy Practice SCPH • Shoppers Drug Mart Specialty Health • SteriMax Inc. • Sunovion Pharmaceuticals Inc. Point de mire sur l’excellence en pratique pharmaceutique CSHP would like to acknowledge and thank the following CSHP Sponsors for their contributions to CSHP 2015 initiatives: • Pfizer Canada • Pharmaceutical Partners of Canada, a Company of the Fresenius Kabi Group • Lilly Canada 9 Distinguished Service Award Prix pour service distingué Sponsored by Johnson & Johnson Family of Companies This award recognizes outstanding achievement in hospital pharmacy practice. Individuals are nominated by their peers. 2013 Winner Isabel E. Stauffer Meritorious Service Award Prix Isabel E. Stauffer pour service méritoire Sponsored by Pharmaceutical Partners of Canada A Company of the Fresenius Kabi Group This award recognizes prolonged service and involvement in CSHP, primarily at the branch or chapter level. Régis Vaillancourt Individuals are nominated by their peers. Past Winners 2013 Winner 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 Carolyn Bornstein Myrella Roy Emily Musing Robin Ensom Nancy Roberts Thomas W. Paton Linda Poloway Bill Bartle Garry King Bob Nakagawa Glen R. Brown Charlie Bayliff* James Blackburn Bonnie Salsman Scott Walker Rosemary Bacovsky Kevin Hall James L. Mann William McLean Pauline Beaulac William Wilson C. Brian Tuttle Reta Fowler Alan Samuelson Bruce R. Schnell Jack Dancey William R. Foltas* Donna M. Shaw* Sister Grace Sauvé Mary T. Gannon* J. Glen Moir* Brian A. Dinel Betty C. Riddell Jack L. Summers* Douglas J. Stewart* Phyllis Yagi* Orest Buchko Muriel Hale Anne O’Toole Leonard Gibson* J. Edwin Smith* Paule Benfante Gordon Brown* Isabel E. Stauffer* Jacqueline McCarthy Michael J.V. Naylor *Deceased 10 Marita Tonkin Past Winners 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1999 1998 1998 1997 1996 1996 1995 1995 1994 1994 1993 1992 1992 1991 1991 1990 1989 1988 1987 1986 1986 Judy Chong John McBride Victoria Sills Lynda Chilibeck Catherine Doherty Harry S. Hopkins Susan Poulin Donna Wheeler-Usher Nancy Roberts Margaret Gray Margaret Colquhoun No candidates this year Kelly Babcock Linda Poloway Kenneth McGregor Larry Legare Emily Somers No candidates this year Dennis Leith Robert S. Nakagawa Donna Pipa Kristina Wichman Rosemary Bacovsky Roy A. Steeves No candidate this year John Iazzetta Cecilia Laskoski Louanne Twaites David Windross Doris A. Thompson Fred Rumpel D. Bryce Thompson Alan Samuelson Herbert A. Dixon A.W. Stanley Garvin New Hospital Pharmacy Practitioner Award Prix du nouveau praticien en pharmacie hospitalière Sponsored by Sandoz Canada Inc. This award acknowledges new hospital pharmacy practitioners, who through their service to patient care, to education or research, to the profession and to the society, are worthy of recognition. The individuals exhibit promising leadership, dedication and commitment to practice excellence and professional growth. 2013 Winners Anna Huisman & Mayce Al-Sukhni Past Winners 2012 Christina Adams & Erin Marie Yakiwchuk 2011 Zack Dumont & Shanna Trenaman 2010 Erin Cashin & Rochelle Gellatly 2009 Eva Cho & Lynette Kolodziejak 2008 Yvonne Kwan & Adrienne Lindblad 2007 Tracy Cheung & Jennifer Dyck 2006 Dawn Dalen & Gloria Tsang 2005 Stephanie Ong & Kerry Wilbur Hospital Pharmacy Student Award Prix de l’étudiant en pharmacie hospitalière Sponsored by CSHP and the Canadian Association of Pharmacy Students and Interns (CAPSI) This award recognizes pharmacy students who show promise as future hospital pharmacy practitioners through their student activities or their experiential training in direct patient care, research or education. The winners exhibit eagerness, dedication and a positive attitude toward the academic learning, the practice, and the profession of hospital pharmacy. 2013 Winner Emily Li Past Winners 2012 2011 2010 2009 2008 2007 2006 2005 Sarah Hasenbank Jessica Gagatek & Timothy Leung Christine Leong Amy Grossberndt Omolayo O. Famuyide Cathryn Sibbald Justin Lee Stephanie Ong & Kerry Wilbur 2012-2013 Awards Committee Comité des prix 2012-2013 Sincere appreciation is extended to the CSHP National Awards Committee. Chairperson Présidente Members Membres Kathryn Hollis Candra Cotton Janice Ma My-Linh Nguyen Pooja Patel 2012-2013 Awards Program Programme des prix 2012-2013 The CSHP general awards program will be presented in six categories with nine sponsors, as listed below. Management and Leadership Best Practices Award Safe Medication Practices Award Sponsored by: Sponsored by: • Apotex Inc. • Medbuy Corporation Patient Care Enhancement Award • Medbuy Corporation • McKesson Canada • HealthPRO Procurement Services Inc. Sponsored by: Teaching, Learning and Education Award • TEVA Canada Sponsored by: • Eli Lilly Canada Inc. Pharmacotherapy Best Practices Award Sponsored by: • Merck Canada Inc. • Pfizer Canada Inc. CSHP 2015 Hospital Pharmacy Residency Award Sponsored by: • Pharmaceutical Partners of Canada, A Company of the Fresenius Kabi Group Award Ceremony & Reception 2012-2013 Tribute to CSHP National Award Appraisers Hommage aux évaluateurs Award appraisers are an integral part of the CSHP National Awards program. We would like to extend our sincere thanks to the individuals listed below who volunteered their time to review this year’s award submissions. We are very grateful to you for sharing your time and expertise in support of the CSHP Awards Program. Without your dedicated efforts on the Society’s behalf, the program would not exist. Shirin Abadi Mayce Al-Sukhni Alison Alleyne Maria Anwar Trudy Arbo Tejinder Bains Arden Barry Margaret Batz Danette Beechinor Alka Bhalla Andrew Brillant Annie Brooks Glen Brown Richard Cashin Alice Chan Natalie Crown Mario de Lemos Artemis Diamantouros Anar Dossa Douglas Doucette Dinie Engels Barb Evans Abimbola Farinde Michelle Foisy Jennifer Gibson Susan Halasi Nicholas Honcharik Sherilyn Houle Christine Hughes Cynthia Jackevicius Valentina Jelincic Derek Jorgenson Christopher Judd Jean-Yves Julien Zahra Kanji Heather Kertland Sheri Koshman Anna Lee Larry Legare Adrienne Lindblad Anita Lo Peter Loewen Barry Lyons Mark Makowsky Lisa McCarthy Karen McDermaid Susana McKenna Debra Moy Tania Mysak Cindy Natsheh Sandra Nelson Doris Nessim My-Linh Nguyen Patricia Pracsovics Irina Rajakumar Cheryl Sadowski Salma Satchu Theresa Schindel Kurt Schroeder Brenda Schuster Winnie Seto Roy Steeves Daniel Thirion Régis Vaillancourt Lori Wazny Ken Wou Sharon Yamashita Peter Zed Rosemary Zvonar If you are interested in acting as an appraiser for the 2013-2014 Awards Program, please contact Robyn Rockwell: Tel.: 613-736-9733, ext. 222 Fax: (613) 736-5660 or Email at [email protected]. Sponsored by: • Hospira Healthcare Corporation 11 Upcoming Events Événements à venir Professional Practice Conference (PPC): Summer Educational Sessions (SES): February 1-5, 2014 Sheraton Centre Toronto Hotel August 10-13, 2013 Hyatt Regency Calgary Calgary, Alberta January 31-February 4, 2015 Sheraton Centre Toronto Hotel January 30-February 3, 2016 Sheraton Centre Toronto Hotel August 9-12, 2014 Delta Newfoundland Hotel St. John’s, Newfoundland & Labrador August 8-11, 2015 Hilton London Ontario London, Ontario Satellite Symposiums Symposiums satellites CSHP would like to thank the following sponsors of Satellite Symposiums for their participation in conjunction with the PPC 2013. Sunday, February 3 12:15-13:45 Satellite Symposium SPONSORSHIP OPPORTUNITY 66th Summer Educational Sessions • Bayer Inc. Wednesday, February 6 12:40-14:10 • Sanofi Inc. See the program section for more details. Hyatt Regency Calgary Calgary, AB August 10 to 13, 2013 Breakfast and Luncheon Availability For more information please contact Desarae Davidson Conference & PSN Administrator (613) 736-9733, ext. 229 or [email protected] 12 For further information, please contact Desarae Davidson, Conference & PSN Administrator. Tel.: (613) 736-9733, ext. 229 Fax: (613) 736-5660 Email: [email protected] • Pfizer Canada Inc. Monday, February 4 17:30-19:30 Attendance at CSHP conferences, PPC and SES, are approximately 550 and 250 respectively, excluding exhibitors. Please note we offer an exhibit program at both events. The Educational Services Committee Le comité des services éducatifs Chairperson • Présidente Clarence Chant, PharmD, FCSHP, FCCP St. Michael’s Hospital Toronto, ON Members • Membres Margaret Ackman, PharmD, FCSHP Alberta Health Services Edmonton, AB Toni Bailie, BScPhm Mount Sinai Hospital Toronto, ON Claudia Bucci, PharmD Sunnybrook Health Sciences Centre Toronto, ON Roxane Carr, PharmD, BCPS, FCSHP BC Children’s and Women’s Health Centre Vancouver, BC Lorie Carter, BScPhm Eastern Health Marystown, NL Elaine Chong, PharmD, BCPS BC Ministry of Health Services New Westminster, BC Judy Chong, BScPhm Royal Victoria Hospital of Barrie Barrie, ON Leah Edmonds, BScPhm QEII Health Sciences Centre Halifax, NS Alfred Gin, PharmD, FCSHP Health Sciences Centre Winnipeg, MB Derek Jorgenson, BSP, PharmD University of Saskatchewan Saskatoon, SK Ernest Law, BScPhm, ACPR PharmD Student University of British Columbia Vancouver, BC Kat Timberlake, PharmD The Hospital for Sick Children Toronto, ON Erica Wang, BScPhm, PharmD Kelowna General Hospital Kelowna, BC Desarae Davidson Conference & PSN Administrator Canadian Society of Hospital Pharmacists Ottawa, ON The Educational Services Committee (ESC) of CSHP has been working for approximately 10 months on the content and format of PPC 2013. The committee also plans the Summer Educational Sessions, in conjunction with the local host task force and the national office. The ESC is comprised of a core committee of 15 CSHP members as well as corresponding members from the CSHP branches. Goal and Objectives for the 2013 PPC Program Goal: • To provide registrants with quality educational sessions. Objectives: • To provide educational sessions which inform, educate and motivate clinical practitioners and managers. • To provide leadership in hospital pharmacy practice by presenting sessions on innovative pharmacists’ roles, pharmacy practice and pharmacy programs. • To promote life-long learning skills through active participation in problem-based workshops. • To provide registrants with networking and sharing opportunities through the exhibits program and poster sessions. • To promote excellence in pharmacy practice research through oral and poster presentations of original work and award winning projects. • To provide an opportunity for Pharmacy Specialty Networks to share their expertise with others and meet as Networks. EP C.C.E.P. Canadian Council on Continuing Education in Pharmacy Le comité des services éducatifs travaille depuis près de 10 mois à l’élaboration du contenu et de la forme de la CPP 2013. Le comité prépare aussi les Séances éducatives d’été de la SCPH en collaboration avec le Groupe de travail hôte local et le personnel de la SCPH. Le comité comprend 15 membres principaux et membres correspondants des sections de la SCPH. But et objectifs du programme de la CPP 2013 But : • Présenter des conférences éducatives de qualité aux participants. Objectifs : • Présenter aux personnes inscrites des conférences éducatives susceptibles d’informer, d’instruire et de motiver les cliniciens et les gestionnaires. • Orienter la pratique de la pharmacie hospitalière en présentant des conférences sur les nouveautés touchant le rôle du pharmacien, la pratique de la pharmacie et les programmes de pharmacie. • Développer des habiletés pour un apprentissage continu par une participation active à des ateliers de formation axés sur la résolution de problèmes. • Donner aux participants des occasions de réseautage et d’échanges grâce au salon des exposants, aux séances d’affichage et aux discussions interactives structurées. • Promouvoir l’excellence dans la recherche en pratique pharmaceutique par des présentations orales et des séances d’affichage sur des travaux originaux et des projets primés. • Donner l’occasion aux réseaux de spécialistes en pharmacie de se réunir et de partager leur savoir-faire. 13 Program Programme Saturday, February 2 • Samedi 2 février 15:00-17:00 Registration Inscription CONCOURSE COAT CHECK 17:30-19:00 CHPRB Residency Networking Reception Everyone welcome Réception de réseautage relative à la residence du CCRPH Tammy Bungard, BSP, PharmD University of Alberta Department of Medicine Edmonton, AB 2. Calcium Myths: Should We Change Our Approach to the Clinical Use of Calcium Supplements? CONFERENCE B/C Carlos Rojas-Fernandez, BScPhm, PharmD University of Waterloo School of Pharmacy RBJ-UW Schlegel Research Institute on Ageing Waterloo, ON Bienvenue à tous ESSEX BALLROOM Sunday, February 3 • Dimanche 3 février 07:30-17:00 Registration Inscription CONCOURSE COAT CHECK 08:00-08:15 Opening Remarks Remarques préliminaires GRAND BALLROOM EAST 08:15-09:15 Motivational Plenary Séance plénière de motivation 3. Exploring Ethical Issues that Affect Hospital-Based Pharmacists SIMCOE/DUFFERIN Sally Bean, JD, MA Sunnybrook’s Health Science Centre, Joint Centre for Bioethics & University of Toronto Toronto, ON 4. A Guide to Doing Your Own Meta-Analysis or Systematic Review CONFERENCE D/E Salmaan Kanji, PharmD The Ottawa Hospital Ottawa, ON GRAND BALLROOM EAST André Picard National Public Health Reporter The Globe and Mail Sponsored by Sandoz Canada Inc. through an unrestricted educational grant 09:30-11:00 Facilitated Poster Session Discussions of original research, award-winning projects and pharmacy practice projects Séance animée de présentations par affiches Discussions sur des projets de recherche originale, des projets primés et des projets dans le domaine de la pratique pharmaceutique GRAND BALLROOM FOYER & VIDE 11:15-12:00 Concurrent Sessions Séances concomitantes 1. Novel Oral Anticoagulants: Beyond the Clinical Trials PROVINCIAL SOUTH 12:15-13:45 Satellite Symposium Luncheon included Symposium satellite Dîner inclus GRAND BALLROOM EAST Compounding Conundrums: Outsourcing Shortages, Clean Room Design & Hazardous Drugs Eric Kastango, MBA, RPh, FASHP ClinicalIQ, LLC and CriticalPoint LLC Madison, NJ Hosted by Pfizer Canada Inc. 14:00-16:00 Workshops & PSN Sessions Ateliers et séances des RSP 1. An Introduction to Survey Methodology WINDSOR Lauren Bresee, BScPhm, ACPR, MSc, PhD Alberta Health Services Calgary, AB 2. Cardiology PSN RSP en cardiologie PROVINCIAL SOUTH 14 Canadian Cardiovascular Society Guidelines for the Use of Antiplatelet Therapy: 2012 Focused Update Margaret Ackman, BScPhm, PharmD, FCSHP Alberta Health Services Edmonton, AB Update on the Management of Acute and Recurrent Pericarditis Yvonne Kwan, BScPhm, ACPR University Health Network Toronto, ON 3. Pharmacist-in-Training PSN RSP des pharmaciens en apprentissage CONFERENCE D/E Career Options Following a Hospital Residency Megan Riordon, BScPhm – Moderator Kingston General Hospital Kingston, ON Allan Mills, BScPhm, PharmD, FCSHP Trillium Health Partners Mississauga, ON Stephanie Lynch, BScPhm, ACPR University of Toronto Toronto, ON Debra Moy, BScPhm, ACPR, MEd University of Toronto Faculty of Pharmacy Toronto, ON 4. Psychiatry PSN RSP en psychiatrie CONFERENCE B/C Depression and the Older Patient: A Focus on Disease Presentation and Pharmacotherapy Carlos Rojas-Fernandez, BScPhm, PharmD University of Waterloo School of Pharmacy RBJ-UW Schlegel Research Institute on Ageing Waterloo, ON Pain in Psychiatry Joel Lamoure, RPh, DD, FASCP London Health Sciences Center Western University London, ON 16:10-17:50 Awards Ceremony Everyone welcome 18:00-19:30 Career Opportunities Evening Soirée de perspectives d’emploi LOWER CONCOURSE VIDE CSHP Foundation Silent Auction Vente aux enchères par écrit de la Fondation de la SCPH LOWER CONCOURSE FOYER Monday, February 4 • Lundi 4 février 07:30-17:00 Registration Inscription LOWER CONCOURSE FOYER 08:00-08:15 Announcements Annonces GRAND BALLROOM EAST 08:15-09:15 Use of the Positive Deviance Approach to Improve Reconciliation of Medications and Patients Medication Management after Hospital Discharge: The Experience of Waterbury Hospital (Connecticut) GRAND BALLROOM EAST Michael Gardam, MSc, MD, CM, FRCPC University Health Network Women's College Hospital Toronto, ON 09:15-09:45 New Fellows Presentation Présentation des nouveaux membres associés Acknowledgement of the Recipient of the Distinguished Service Award Reconnaissance du lauréat du prix pour service distingué Acknowledgement of the CSHP Foundation Grant Recipients Reconnaissance des boursiers de la Fondation de la SCPH GRAND BALLROOM EAST 09:45-10:15 Break, Exhibits Pause, Kiosques SHERATON/OSGOODE HALLS 10:20-11:30 Pharmacy Issues and Controversies Forum – Panel Discussion Forum sur des questions et controverses en pharmacie – Panel GRAND BALLROOM EAST Cérémonie de remise des prix Bienvenue à tous ESSEX BALLROOM 15 Men are From Mars, Women are From Venus: Are Hospital and Provincial Drug Plan Formularies on Different Planets? Elaine Chong, PharmD, BCPS – Moderator BC Ministry of Health Director, Clinical Decision Support, Pharmaceutical Services Vancouver, BC Faith Louis, BScPhm, MBA Horizon Health Moncton, NB Leanne Jardine, BScPhm, MBA Government of New Brunswick Department of Health Fredericton, NB Pour plus de détails, s’il vous plaît voir la page 44 CONFERENCE D/E 4. The Prescription Opioid Crisis in Ontario PROVINCIAL SOUTH Irfan Dhalla, MD, MSc, FRCPC St. Michael’s Hospital University of Toronto Toronto, ON 12:30-13:50 Lunch, Exhibits, Posters, Silent Auction Dîner, Kiosques, Affiches, Vente aux enchères par écrit SHERATON/OSGOODE HALLS Bill Wilson, RPh, BSP, FCSHP Mount Sinai Hospital Toronto, ON 11:40-12:25 Concurrent Sessions Séances concomitantes 1. How to Interpret Chest Radiography: General Approach and Implications for Pharmacists in Monitoring Drug Therapy CONFERENCE B/C Alberto Goffi, MD St. Michael’s Hospital Toronto, ON 2. Thinking in the Abstract: Less Picasso and More Science, How to Write a Killer Abstract SIMCOE/DUFFERIN Margaret Ackman, BScPhm, PharmD, FCSHP Alberta Health Services Edmonton, AB 3. Oral Abstract Session Séance d'exposés oraux Selected Papers from Original Research, Award Winners and Research and Education Grants For details on the specific projects, please see page 44 CONFERENCE D/E CONFERENCE D/E Communications choisies parmi les travaux de recherche originale et les projets des récipiendaires de prix, de bourses de recherche et de perfectionnement 16 13:55-14:55 Prescribing a Drugectomy – Who, What, Why, Where and When GRAND BALLROOM EAST James McCormack, BScPhm, PharmD University of British Columbia Faculty of Pharmaceutical Sciences Vancouver, BC 15:00-17:00 Workshops & PSN Sessions Ateliers et séances des RSP 1. Paediatric PSN RSP en pédiatrie CONFERENCE D/E Drugs in Breastfeeding Myla Moretti, MSc The Hospital for Sick Children Toronto, ON Knowledge Translations Strategies from SickKids for the Removal of Codeine from the Hospital Formulary Cecile Wong, BSc(Hon.), BScPhm, ACPR The Hospital for Sick Children Toronto, ON 2. Primary Care PSN RSP en soins de santé primaires PROVINCIAL SOUTH Ten Tips to Successfully Integrate into a Primary Care Team Derek Jorgenson, BSP, PharmD, FCSHP University of Saskatchewan College of Pharmacy Saskatoon, SK Initiating Insulin in a Primary Care Setting Christine Papoushek, PharmD Toronto Western Hospital Family Health Team Toronto, ON 3. Geriatrics PSN RSP en gériatrie CONFERENCE B/C The Evidence for Deprescribing: Trials and Tribulations Barbara Farrell, BScPhm, PharmD, FCSHP Bruyere Continuing Care Ottawa, ON Senior Friendly Hospital Initiatives Barbara Liu, MD, FRCPC Regional Geriatric Program of Toronto Toronto, ON 4. Dealing with Difficult People ESSEX BALLROOM Sam Louie, BScPhm University of British Columbia Faculty of Pharmaceutical Sciences North Vancouver, BC 17:30-19:30 Satellite Symposium 08:15-9:30 Canadian Patient Safety Lecture Conférence de I’ICSP sur la sécurité de patients GRAND BALLROOM EAST Optimal Positioning of Pharmacists in the Health Care System to Improve Patient Outcomes Peter Kaboli, MD, MS Iowa City VA Health Care System Iowa City, IA Sponsored by the Canadian Patient Safety Institute through an unrestricted grant Commanditée par l’Institut canadien sur la sécurité des patients grâce à une subvention sans restriction 09:45-10:15 Break, Exhibits Pause, Kiosques SHERATON/OSGOODE HALLS 10:25-11:10 Concurrent Sessions Séances concomitantes 1. Best Papers in Acute Care 2012 PROVINCIAL SOUTH Michael Legal, BScPhm, ACPR, PharmD St. Paul’s Hospital Lower Mainland Pharmacy Services Vancouver, BC Dinner included Symposium satellite Souper inclus GRAND BALLROOM EAST 2. A New Pharmacy Practitioner Speaks: The Future is Now! CSHP 2015 Hospital Pharmacy Residency Award Winner SIMCOE/DUFFERIN New Oral Anticoagulant Therapy: From Study to Practice Peter Gross, MD, MSc, FRCP (c) Hamilton Health Sciences Hamilton, ON William Semchuk, MSc, PharmD, FCSHP Regina Qu’Appelle Health Region Regina, SK Hosted by Bayer Inc. Tuesday, February 5 • Mardi 5 février 07:30-17:00 Registration Inscription CONCOURSE COAT CHECK 08:00-08:15 Announcements Annonces Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE) Carolyn Bornstein, BScPhm, ACPR, FCSHP, CGP – Moderator Canadian Society of Hospital Pharmacists Ottawa, ON Eric Landry, BSP Saskatoon Health Region Regina, SK 3. How Should Life-Saving Drugs Be Priced? CONFERENCE B/C Chris MacDonald, PhD Ryerson University Toronto, ON GRAND BALLROOM EAST 17 11:20-12:05 Concurrent Sessions Séances concomitantes 1. What’s New in COPD – The Latest or Greatest? SIMCOE/DUFFERIN Deon Druteika, BSc BScPhm, PharmD, ACPR Alberta Health Services Edmonto, AB 2. How to Write a Case Report: A Practical Guide for Pharmacists CONFERENCE D/E Mark Makowsky, BSP, PharmD University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences Edmonton, AB 3. Pharmacy Technicians in Clinical Roles: Where Are We At? CONFERENCE B/C Céline Corman, BSP, MSc The Ottawa Hospital Ottawa, ON Kim Lamont, CPhT The Ottawa Hospital Ottawa, ON 12:15-13:50 Lunch, Exhibits, Posters, Silent Auction Dîner, Kiosques, Affiches, Vente aux enchères par écrit SHERATON/OSGOODE HALLS 14:00-15:00 Optimizing Patient Care: A Patient/Pharmacist Journey GRAND BALLROOM EAST Christine Papoushek, PharmD Toronto Western Hospital Family Health Team Toronto, ON 15:10-17:10 Workshops & PSN Sessions Ateliers et séances des RSP 1. Surgery PSN RSP en chirurgie SIMCOE/DUFFERIN Post Operative Nausea and Vomiting: Treatment vs Prophylaxis Melanie MacInnis, RPh, BScPhm, PharmD Hamilton Health Sciences Hamilton, ON 18 The Role of the Pharmacist in a Pre-Operative Assessment Clinic Melanie MacInnis, RPh, BScPhm, PharmD – Moderator Hamilton Health Sciences Hamilton, ON Beverly Barbato, RN, BScN, MEd (c) Hamilton Health Sciences Centre Hamilton, ON Kiran Saini, BScPhm St. Michael’s Hospital Toronto, ON Sandra Hicks, BScPhm, ACPR, RPh Toronto East General Hospital Toronto, ON 2. Medication Safety PSN RSP en sécurité des médicaments CONFERENCE B/C New Managing Medications Standards and Required Organizational Practices – What You Need to Know to Prepare for Accreditation Janice Munroe, BScPhm Fraser Health Authority Langley, BC Régis Vaillancourt, BPhm, PharmD, FCSHP Children’s Hospital of Eastern Ontario Ottawa, ON Julie Greenall, RPh, BScPhm, MHSc Institute for Safe Medication Practices Canada Toronto, ON 3. Anticoagulation PSN RSP en anticoagulation PROVINCIAL SOUTH The Role of Novel Anticoagulants in Patients with DVT/PE Reginald Smith, PharmD Victoria Heart Institute Victoria, BC VTE Management in Cancer Patients Bill Bartle, BScPhm, PharmD, FCSHP Sunnybrooke Health Sciences Centre Toronto, ON 4. Dealing with Difficult People (encore) ESSEX BALLROOM Sam Louie, BScPhm University of British Columbia Faculty of Pharmaceutical Sciences Vancouver, BC Wednesday, February 6 • Mercredi 6 février 07:30-15:00 Registration Inscription CONCOURSE COAT CHECK 08:00-08:15 Announcements Annonces GRAND BALLROOM EAST 08:15-09:15 Antimicrobial Stewardship – From Resistance to Required Procedure GRAND BALLROOM EAST Linda Dresser, PharmD, FCSHP University Health Network Toronto, ON 09:15-10:15 New Agents in Type 2 Diabetes: Who, What, When, Why? 3. Thinking in the Abstract: Less Picasso and More Science, How to Write a Killer Abstract (encore) CONFERENCE D/E Margaret Ackman, BScPhm, PharmD, FCSHP Alberta Health Services Edmonton, AB 11:50-12:35 Concurrent Sessions Séances concomitantes 1. Skin Reactions to Medications SIMCOE/DUFFERIN Debra Sibbald, BScPhm, RPh, ACPR, MA, PhD University of Toronto - Leslie Dan Faculty of Pharmacy Toronto, ON 2. My Phone Can Do What? A Sn“App” Shot of How our Patients Can Use Smartphones CONFERENCE B/C Sean Spina, BScPhm, ACPR, PharmD Vancouver Island Health Authority Victoria, BC 3. New Antipsychotics GRAND BALLROOM EAST CONFERENCE D/E Alice Y.Y. Cheng, MD, FRCPC Credit Valley Hospital St. Michael’s Hospital Mississauga, ON 10:15-10:45 Break, Posters Pause, Affiches GRAND BALLROOM FOYER 10:55-11:40 Concurrent Sessions Séances concomitantes 1. Top Papers in Infectious Diseases That May Change Your Practice… or Not CONFERENCE B/C Alfred Gin, BScPhm, PharmD, FCSHP Health Sciences Centre Winnipeg, MB 2. Oral Cancer Agents: What a Non-Oncology Pharmacist Needs to Know SIMCOE/DUFFERIN Daniela Gallo-Hershberg, PharmD North York General Hospital Toronto, ON Wende Wood, BA, BSP, BCPP Ontario Pharmacists’ Association Toronto, ON 12:40-14:10 Satellite Symposium Luncheon included Symposium satellite Dîner inclus GRAND BALLROOM EAST Novel Approaches to Meeting the Accreditation Canada Venous Thromboembolism Prophylaxis and Medication Reconciliation Required Organizational Practices Allan Mills, BScPhm, PharmD, FCSHP Trillium Health Partners Mississauga, ON Hosted by Sanofi Aventis 14:15-16:15 Workshops & PSN Sessions Ateliers et séances des RSP 1. Global Health PSN RSP en santé mondiale SIMCOE/DUFFERIN 19 Facilitating Sustainable Impact at Home and Abroad Lab to Bedside: Optimizing the Pharmacist’s Approach to Microbiology Results Interpretation Jennifer Gibson, BSP, ACPR Health Sciences Center Winnipeg, MB Doret Cheng, BScPhm, PharmD, RPh Mount Sinai Hospital Toronto, ON 2. Infectious Disease PSN RSP en infectiologie CONFERENCE B/C Optimizing Vancomycin Dosing: It’s Getting Creepy! Linda Sulz, BSP, PharmD Regina Qu’Appelle Health Region Regina, SK 20 David Richardson, MD, FRCPC William Osler Health System Brampton, ON 16:15 Close of the 44th Annual Professional Practice Conference Clôture de la 44e Conférence annuelle sur la pratique professionnelle Awards Ceremony P lease join us for our CSHP’s National Awards Ceremony and Cocktail Reception! It is an opportunity to congratulate your colleagues, network, and socialize with members. CSHP Foundation Silent Auction T his year’s CSHP Foundation Fundraiser at PPC 2013 will once again be the popular silent auction. Items will be on display starting Sunday, February 3, This event is open to the public (you do not have to be 2013 inside the Career Opportunities Evening (Lower registered for the PPC to attend). Concourse Vide) and on Monday and Tuesday during the Sunday, February 3, 2013 • 16:10-17:50 exhibitor lunches (12:15-13:50) in the Exhibit Hall. Essex Ballroom Final bids will be tallied at 13:00 on Tuesday. Winners will be Cocktails to follow announced at the end of the exhibits program. We request your presence in order to pick up your item(s). All payments Career Opportunities Evening T must be made on-site. Money raised on behalf of the Foundation means you are helping to support the development of research skills among practicing hospital pharmacists as well as research projects his annual networking and recruitment event will and targeted pharmacy education programs undertaken by take place after the Awards Ceremony on Sunday, CSHP members. February 3, 2013. Join us in the Lower Concourse Vide (new location!) from 18:00-19:30 and chat with hospitals and other organizations from across the country. This event is open to the public (you do not have to be registered for the PPC to attend). Refreshments will be provided. 21 Speaker Abstracts Résumés des conférenciers Sunday, February 3 Dimanche 3 février Calcium Myths (CSHP 2013): Should we Change Our Approach to the Clinical Use of Calcium Supplements? Novel Oral Anticoagulants: Beyond the Clinical Trials Carlos Rojas-Fernandez, PharmD, University of Waterloo School of Pharmacy, RBJ-UW Schlegel Research Institute for Ageing, McMaster University School of Medicine and The Centre for Family Medicine, Kitchener, ON Tammy J. Bungard, BSP, PharmD, Department of Medicine, University of Alberta, Edmonton, AB The purpose of this session is to highlight challenges encountered in daily practice with novel oral anticoagulants, with insight from robust landmark clinical trials, available reports of post-marketing surveillance, and local practice patterns. With little change in oral anticoagulant options over the past 60 years, the recent past has seen the emergence of several novel therapies, including dabigatran, rivaroxaban and apixaban. While robust clinical trial data support their use for stroke prevention for atrial fibrillation (RE-LY, ROCKET AF, ARISTOTLE) and the treatment of venous thromboemoblism (EINSTIEN, EINSTEIN-PE, RECOVER), the front line clinician is still left with many daily practice scenarios that are less well defined. Ongoing data is slowly emerging outside of clinical trials, lending insight into the application of these agents in the real world. Common clinical questions arising daily encompass the lack of antidotes / proven reversal strategies, inability to assess coagulation status in unique cases, and lack of experience or comfort with peri-procedural management. Clinical issues remain unanswered, including the ideal option for patients already well controlled on warfarin, the instinctive desire to perform inter-trial comparisons of agents’ efficacy (that should be limited to hypothesis generation alone), and reimbursement for these new agents across the country. While significant progress has occurred in the recent past, we are early in our journey to achieve population effectiveness with oral anticoagulation therapies. Goals and Objectives 1. To provide pharmacists with an overview of challenges encountered with the real world use of novel oral anticoagulants. Self-Assessment Questions The purpose of this presentation is to provide a critical analysis of the evidence that suggests an association between the use of calcium supplements and adverse cardiovascular outcomes and provide pragmatic clinical guidance regarding their use. Ensuring sufficient calcium and vitamin D intake is paramount for optimal bone health. Unfortunately, many people do not ingest sufficient quantities of either nutrient from dietary sources. Not surprisingly, many patients with osteopenia or osteoporosis have been using calcium supplements to meet their necessary daily intake of calcium for years without major concerns. Recent epidemiological studies have raised potential concerns by demonstrating associations between the use of calcium supplements and adverse cardiovascular outcomes. These studies received widespread media attention that anecdotally contributed to many patients discontinuing use of these supplements without a critical evaluation of the clinical relevance and applicability of the findings. Indeed, many health care professionals also accepted these findings at face value and likewise suggested that use of calcium supplements be curbed. At present time, a critical assessment of the evidence regarding the potential risk of calcium supplements leads to the conclusion that when evidence from epidemiological studies is balanced with that of randomized controlled trials assessing the effect of calcium on fracture prevention, the benefits of calcium supplementation outweigh the cardiovascular risk. At this time, then, there is no cause to change routine practice surrounding supplemental calcium use in patients who have, or are at risk for, osteoporosis or osteopenia. Goals and Objectives 1. To understand the hypothetical basis behind the notion that supplemental calcium may increase the risk of cardiovascular disease. 1. How do the presented strategies and evidence apply to my practice setting? 2. To describe results from epidemiological studies which demonstrate an association between calcium supplements and increased risk of cardiovascular disease. 2. What impact will these newer oral anticoagulants have in my practice? 3. To outline limitations of said epidemiological studies in #2. 4. To be able to put these data into clinical context and state how such data should be used in the care of patients who require calcium supplementation. 22 Exploring Ethical Issues That Affect Hospital-Based Pharmacists A Guide to Conducting and Appraising Systematic Reviews Sally Bean, JD, MA Sunnybrook Health Sciences Centre and University of Toronto, Joint Centre for Bioethics, Toronto, ON Salmaan Kanji, PharmD, The Ottawa Hospital, Ottawa, ON The purpose of this session is to highlight ethical issues that hospital-based pharmacists encounter and propose ways to systematically think through the nuance and complexity of these ethical issues when they arise. Given pharmacists’ unique role within the circle of care, ethical issues arising in pharmacy can have far-reaching implications. Three ethical issues that routinely arise for hospital-based pharmacists include the following: i) conflicts of interest ii) resource allocation/stewardship and iii) patient advocacy. Institutional and healthcare provider relationships with pharmaceutical companies have the potential for creating an actual, apparent or perceived conflict of interest that might interfere with a primary duty to patients. Pharmacists may be placed in the difficult position of implementing institutional agreements with pharmaceutical companies that may be in tension with duties to the patient. Pharmacists play a leading role in managing institutional drug formularies in which cost-effectiveness determinations inform resource allocation and stewardship decisions that may have significant implications to healthcare providers and patients. Additionally, during the recent Canada-wide Sandoz injectible drug shortage, hospital pharmacists were key stakeholders in managing supply and suggesting alternatives solutions. Details from Ontario’s Ethics Framework for Resource Allocation during the Drug Supply Shortage will be shared (Bean et al 2012; Gibson et al 2012). A systematic review is a review that has been prepared using a systematic approach to the search and synthesis of published information on a specific topic. Search strategies, study appraisal and synthesis are pre-determined and described explicitly to minimize bias and random error. Systematic reviews are often used to provide clinicians with consolidated evidence from multiple sources to answer specific clinical questions or to inform guideline development. Systematic reviews are also used as scoping tools to identify gaps in the existing literature that may be relevant for subsequent research. A systematic review is not synonymous with meta-analysis. Meta-analysis refers to the analytic technique used to synthesize evidence from multiple sources but is not always possible when the studies that provide the evidence do not meet a pre-defined level of homogeneity. Systematic reviews are considered to provide high grades of evidence relative to other forms of research and while most pharmacists may not need to skills to conduct a systematic review, they should have the skills to critically appraise one. The purpose of this session will be to discuss the systematic review process from the perspective of a novice researcher and also identify critical components that clinicians should consider for critical appraisal. Goals and Objectives 1. To discuss a step-wise approach to conducting a systematic review. 2. To discuss how to critically appraise the conduct and reporting of a systematic review and meta-analysis. In patient advocacy related scenarios, pharmacists must consider potential magnitude of harm to the patient and their corresponding duty to act as well as inform patients of any concerns and encourage them to seek additional information from their physician (Eaton 2008). 3. To understand and recognize the advantages and limitations of systematic reviews. Goals and Objectives 1. What are the essential components of a systematic review? 1. To identify key ethical issues encountered by hospital-based pharmacists. 2. How do I determine the external validity of a systematic review? 2. Build ethics capacity to identify and systematically address ethical issues when they arise. 3. How do I focus my clinical question into something that might be amenable to a systematic review? Self-Assessment Questions Self-Assessment Questions 1. When ethical issues arise in the pharmacy contest, what are the potential impacts to patients and other stakeholders? 2. What are some of the key questions I should pose when thinking through complex ethical issues? An Introduction to Survey Methodology Lauren C. Bresee, BScPhm, ACPR, MSc, PhD, Alberta Health Services, Calgary, AB Surveys are useful tools for conducting research and gathering information from a sample of people. However, carefully designing and implementing a survey is vital for ensuring the validity of results obtained from a survey. The purpose of this workshop is to review the advantages and disadvantages of using a survey to conduct research, and to work through the steps to creating and implementing a survey, including developing survey objectives, selecting an 23 appropriate survey frame, data collection, data capture and coding, data analysis, and data dissemination and reporting. We will also discuss the common types of bias associated with survey research, and review strategies to minimize these biases. Ideally, participants will come to the workshop with a research question that can be answered with a survey, that can be developed throughout the workshop. Goals and Objectives 1. To ensure pharmacists understand the advantages and disadvantages of using a survey to conduct health research. 2. To provide pharmacists with detailed steps for creating and implementing a survey. 3. To provide pharmacists with ways to minimize common biases associated with survey research. Self-Assessment Questions 1. What is the difference between validity and reliability, and how do these terms apply to survey design? 2. What are the major sources of bias that need to be considered when using a survey to conduct a study? 3. What are the steps in designing and implementing a survey? Canadian Cardiovascular Society Guidelines for the Use of Antiplatelet Therapy: 2012 Focused Update Margaret L. Ackman, BScPhm, PharmD, FCSHP. Alberta Health Services, Edmonton, AB The Canadian Cardiovascular Society created a set of guidelines for the use of antiplatelet agents in the outpatient setting in 2010/11. In 2012, the primary panel chose to update the guidelines in selected areas based upon literature review and availability of various agents on the Canadian market. The areas chosen included: antiplatelet therapy for secondary prevention in the first year following acute coronary syndrome (ACS), percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG), the interaction between clopidogrel and proton pump inhibitors (PPIs) and the use of novel oral anticoagulants for secondary prevention following ACS. This session will provide a brief orientation to GRADE, the system used to provide context to both the weight of the recommendation and the strength of the evidence supporting it. It will also outline the values and preferences utilized in the creation of these recommendations. The supporting evidence for the new guidelines will be reviewed to facilitate interpretation of the guidelines and their application to practice. The new guidelines incorporate ticagrelor and prasugrel preferentially over clopidogrel in ACS. The recommendations 24 also address the length of dual antiplatelet therapy for a number of different therapeutic strategies. There are guidelines for antiplatelet agents with respect to surgical procedures and, specifically, CABG following ACS. The use of rivaroxaban, dabigatran or apixaban in combination with dual antiplatelet therapy is not recommended for the management of ACS. The guideline for the use of clopidogrel and proton pump inhibitors remains unchanged but the newer evidence considered will be reviewed. Goals and Objectives 1. To review the changes in the 2012 Focused Update of the Canadian Cardiovascular Society Guidelines for the Use of Antiplatelet Therapy 2. To review the evidence supporting the new and revised guidelines to facilitate their interpretation and application to practice Self-Assessment Questions 1. In your practice, what barriers do you anticipate to the adoption of these guidelines? 2. How will you balance the values and preferences used in the creation of these guidelines with those of your patients? Update on the Management of Acute and Recurrent Pericarditis Yvonne Kwan, BScPhm, ACPR, University Health Network, Toronto, ON The purpose of this session is to provide an overview of pericarditis and to review the pharmacological options in the management of acute and recurrent cases. Pericarditis accounts for 5% of emergency room admissions for chest pain. Treatment of pericarditis should be targeted at the specific cause, although the cause is idiopathic and often presumed to be viral in the majority of cases (>80%) in developed countries. Therefore, medical therapy is empirical with the goals being symptom control and prevention of complications, especially recurrences. Acetylsalicylic acid (ASA) and nonsteroidal anti-inflammatory drugs (NSAIDs) are considered first-line empiric anti-inflammatory therapy for pericarditis. ASA is preferred for patients with ischemic heart disease or with any indication for ASA use as antiplatelet therapy. Corticosteroids are also used, but are associated with a higher risk of recurrences and a more prolonged course. They are recommended for patients with contraindications to ASA or NSAIDs, treatment failure of first-line anti-inflammatory drugs, severe recurrent cases, or for specific conditions such as systemic inflammatory diseases or pregnancy. Colchicine as adjunct therapy to ASA or NSAIDs is also useful in the treatment of acute and particularly recurrent pericarditis, and evidence of efficacy is mainly derived from the COPE, CORE, and CORP trials. The literature on colchicine will be reviewed in this session. Goals and Objectives 1. To provide pharmacists with a general overview of pericarditis. 2. To discuss treatment options for acute and recurrent pericarditis. 3. To review the evidence for colchicine in acute and recurrent pericarditis. Self-Assessment Questions 1. Which medication(s) will you use to treat acute pericarditis in a patient who has coronary artery disease? 2. What is the role of colchicine in the management of acute and recurrent pericarditis? Career Options Following a Hospital Residency Allan Mills, PharmD, FCSHP, Trillium Health Centre, Mississauga, ON, Debra Moy, BScPhm, ACPR, MEd, University Health Network, Toronto, ON, Stephanie Lynch, BScPhm, ACPR, PharmD Candidate, University of Toronto, Toronto, ON The purpose of this session is to provide pharmacy students, interns, and residents with insight into different career options post completion of a hospital residency program. Three panel speakers will discuss their personal experiences and describe their career choices since graduating from a Canadian pharmacy program. They will talk about their respective residency experience and how this affected their opportunities for work as a hospital pharmacist, what jobs they chose to pursue, and their respective changes in career paths leading up to their current employment. discuss preferred pharmacotherapeutic approaches for its appropriate treatment. Geriatric (or late-life depression) is common in older adults. Its incidence increases significantly after age 70 to 85, as well as among those admitted to hospitals and those who reside in long term care facilities. In this population, depression contributes to excess morbidity, complicates management of comorbid conditions, and is associated with worsened health outcomes. Diagnosis and management of depression often presents clinicians with a challenge, and is often undetected or undertreated for various reasons, including the (incorrect) belief that depression is a part of normal ageing. Furthermore, symptoms of depression in older people may not always be similar to those in younger people, further complicating its proper assessment. Age-related changes in pharmacokinetic and pharmacodynamics also impact selection, dosing, and monitoring for prescribed psychopharmacologic regimens. Optimising management of depression and providing sound advice to older patients with depression requires pharmacists to have an adequate knowledge and understanding of the disease, its presentation, and its pharmacotherapeutic managment. Goals and Objectives Describe how the presentation of depression may differ in older people. 1. State the goals of pharmacotherapy for depression. 2. Describe the difference between response and remission in depression pharmacotherapy. 3. Identify which antidepressants are best suited for older people and explain why. 4. Be able to design a pharmacotherapeutic regimen for older depressed patients. Following each of the speakers’ presentation, there will be a question and answer period to allow current residents to enquire about additional experiences and explore what opportunities should present in the future. 5. Be able to provide appropriate disease state and pharmacotherapeutic counselling. Goals and Objectives Pain in Psychiatry 1. To provide pharmacy students, interns, and residents with insight into different career options post completion of a hospital residency program Joel Lamoure, RPh, DD, FASCP, Department of Psychiatry, Western University; London Health Sciences Centre, London, ON 2. To facilitate discussion between current residents seeking information about varied employment opportunities and experienced practitioners The purpose of this session is to allow the participant to address the pain and non-pain elements associated with chronic pain, fibromyalgia and post-operative pain in a collaborative, interactive approach. Depression and the Older Patient (CSHP 2013): A focus on Disease Presentation and Pharmacotherapy Pain in psychiatry may become present either antecedent or during a psychiatric condition. As pain and depression or other affective mood disorders have a very strong prevalence and direct correlation, it is essential for pharmacists to have a demonstrated comfort and competency in this area. Carlos Rojas-Fernandez, PharmD, University of Waterloo School of Pharmacy, RBJ-UW Schlegel Research Institute for Ageing, McMaster University School of Medicine and The Centre for Family Medicine, Kitchener, ON The purpose of this presentation is to provide an overview of depressive illness in older people, its presentation, and Pain may present in the form of nerve, autoimmune, traumatic, post-operative or other formats. Medications that are used to treat pain often have a strong overlap with psychiatric medications, often directly overlapping with similar neurotransmitters such as serotonin, dopamine or 25 norepinephrine. As well, these medications may have an indirect impact on dopamine, acetylcholine in addition to the direct effects. In converse, depression and psychiatry may have a root cause at interleukin-6 and other pain modulating pathways and what has been labeled, as somatization may in fact be a direct extension of heightened pain sensitivity. This session will address neurotransmitter function, medication interfaces of pain and psychiatry and root cause analysis of both depression and pain. Epidemiological assessment using autoimmune disorders such as multiple sclerosis and Crohn’s disease will be addressed. Common pitfalls managing pain and psychiatry will also be reviewed, including serotonin syndrome, post-operative challenges, discontinuation syndrome and aspects of personalized medicine/polymorphisms. Goals and Objectives 1. To provide hospital pharmacists an enhanced understanding of common pitfalls in pain management with psychiatric patients Monday, February 4 Lundi 4 février Use of the Positive Deviance Approach to Improve Reconciliation of Medications and Patients Medication Management after Hospital Discharge: The Experience of Waterbury Hospital (Connecticut) Michael Gardam, MSc, MD, CM, MSc, FRCPC, University Health Network and Women’s College Hospital; Tuberculosis Clinic Toronto Western Hospital; University of Toronto, Toronto, ON Medication Reconciliation is a highly complex problem facing Canadian healthcare. Traditional strategies for improvement have typically focused upon data collection forms and databases; yet experience from the field suggests that other improvement strategies are also required. Complexity science suggests that rather than relying on one large improvement strategy, allowing many small improvements that are sensitive to local context and conditions, may help bring about more profound improvement. Engagement of front line staff who are “touching the problem”, i.e. those staff that take medication histories, prescribe medications etc. is central to developing strategies that work. This presentation will describe how the behavioural approach “Positive Deviance” has been used to bring about substantial improvements in med rec. 26 2. To be able to describe common neurotransmitters and their interface between pain and psychiatry 3. To be able to apply in a case-based, collaborative, patient-centric approach the management, identification and management in a patient with psychiatric conditions and post-operative pain Self-Assessment Questions 1. What are the common pathways that link pain and psychiatry in regards neurotransmitters and root cause presentation? 2. How can the clinical triad of serotonin syndrome be aggravated by and misdiagnosed based on clinical presentation from a neurotransmitter and clinical presentation? 3. How can treatment resistant depression be aggravated by a medical condition causing pain and how does it change management, especially considering a personalized medicine approach? Goals and Objectives 1. To provide an introduction to complexity science and front line ownership 2. To explain why complex problems like medication reconciliation are often not successfully solved using traditional methodologies 3. To illustrate the above points with case studies and lessons from the field. Men are From Mars, Women are From Venus: Are Hospital and Provincial Drug Plan Formularies on Different Planets? Moderator: Elaine Chong, PharmD, BCPS, Pharmaceutical Services, Ministry of Health, Government of British Columbia, Vancouver, BC; Leanne Jardine, BScPhm, MBA, Pharmaceutical Services, Department of Health, Government of New Brunswick, Fredericton, NB, Faith Louis, BScPhm, MBA, Horizon Health Network, Fredericton, NB, Bill Wilson, RPh, BSP, FCSHP, Mount Sinai Hospital, Toronto, ON Prepare to be enlightened, engaged and perhaps even entertained by this Pharmacy Issues and Controversies Forum, where “men are from Mars and women are from Venus” – in the context of drug review collaboration and formulary alignment. This forum will explore whether hospital and provincial drug plan formularies are on different planets, or whether we are actually closer than we think. Drug formularies are a cornerstone for both hospital pharmacy and the provincial drug plan, but there has traditionally been lack of communication between hospital pharmacists and staff at ministries of health. This has led to different formulary decisions in some cases. However, the existing barriers and silos are being addressed; in a few provinces, there are established and active collaborative partnerships between hospital pharmacy and the provincial drug plan when it comes to formulary decisions. There are those who embrace these collaborative partnerships as a positive evolution to support continuity of care and facilitate medication reconciliation for our patients; however, there are others who view these changes as having significant implications on patient safety, independence, budgetary risk, and workload. A number of questions remain to be answered. In this forum, session speakers will engage the audience in a lively dialogue on their perceptions and experiences about collaboration on drug review processes and decision-making, as well as formulary alignment, between hospital pharmacy and the provincial drug plan. Multiple perspectives will be discussed and debated. Participants will be invited to share ideas, ask questions, and express their individual opinions. Goals and Objectives 1. To compare and contrast the advantages and disadvantages of drug review collaboration and formulary alignment between hospital pharmacy and the provincial drug plan. 2. To facilitate the sharing of perceptions and ideas on drug review collaboration and formulary alignment. 3. To learn about provincial drug review processes, and how to consider provincial drug plan formularies when completing a hospital formulary drug review. Self-Assessment Questions 1. What are the advantages and disadvantages of drug review collaboration and formulary alignment between hospital pharmacy and the provincial drug plan? and response to treatment. To interpret a CXR, to gain useful diagnostic information and to avoid potential errors in interpretation is essential to follow a systematic approach. Identification details and technical quality of the examination should always be assessed. There are five basic radiographic densities, which appear as various shades of black and white: gas (black), fat (dark grey), soft tissue and blood vessels (light grey), bone (white), and metal (bright white). Various systems may be used; a simple method follows a modified ABCDE approach, where each letter corresponds to a critical domain: A (air – large airways, lung, and pleura); B (bones & soft tissues); C (circulation – heart, mediastinum, and vascular markings); D (diaphragm and gastric bulla); E (extras – lines and tubes). CXR has a great potential in the first diagnosis of many lung disorders, pending knowledge and correct interpretation of several signs; however health care providers should be aware that the sensitivity is low, particularly in bedside-acquired images. Moreover, CXR has been extensively used as follow-up study to monitor response to treatment in several diseases; however, routine short-term follow-up CXRs of hospitalized patients with severe community acquired pneumonia seem to provide no additional clinical value. Finally, recent studies suggest routine CXRs may not be warranted for all critically ill patients, but should be considered only in selected patients as on demand strategy. Goals and Objectives 1. To develop a consistent and thorough systematic approach for interpreting chest radiographies 2. To discuss the role and implications for pharmacists of chest radiography for diagnosis of chest disorders and monitoring of response to treatment Self-Assessment Questions 1. In assessing a chest radiography, what are the major findings that can discriminate an alveolar consolidation from an atelectasis? 2. What provinces currently have collaborative partnerships for drug review and formulary alignment? 2. Is chest radiography useful for short term follow-up of patients admitted for community acquired pneumonia? Is there any role for routine chest radiographies in stable ICU patients? 3. What provincial drug plan considerations should hospital pharmacists think about when completing a hospital formulary drug review? Thinking in the Abstract: Less Picasso and More Science. How to Write a Killer Abstract How to Interpret Chest Radiography: General Approach and Implications for Pharmacists in Monitoring Drug Therapy Alberto Goffi, MD, St. Michael’s Hospital, Toronto, ON Chest radiography (CXR) plays an important role not only to determine absence or presence of disorders that involve the thorax (airways, lungs, pulmonary vessels, mediastinum, heart, pleura, and chest wall) but also to follow their course Margaret L. Ackman, BScPhm, PharmD, FCSHP. Alberta Health Services, Edmonton AB So, how do you distill months (or possibly years) of work into less than 300 words? How do you clearly convey how you conducted your research and your interpretation of the results along with their potential impact? A good abstract will interest the reader in learning more about your work. The goal of this session is to provide some practical tips to create a clear, balanced abstract that illustrates the importance and relevance of your research to your peers. 27 This will include recommendations for an abstract writing process, included content and writing style. 2. To understand the extent of opioid-related harm in Ontario. Abstract review for presentation at a conference is a blinded peer-review process and your abstract must stand on its own throughout. Common reasons for abstract rejection with respect to both content and context will be discussed along with some strategies to avoid these pitfalls. In addition, this session will review and provide clarity on adhering to the specific requirements concerning abstract categories and format guidelines used by CSHP and other organizations (blinding, word count, etc.). 3. To better appreciate the evidence base for chronic opioid therapy for chronic pain. Goals and Objectives 1. To provide some practical tips to create a clear, balanced abstract that illustrates the importance and relevance of your research to your peers. 2. To review common reasons for abstract rejection with respect to content, context and specific format requirements. Self-Assessment Questions 1. What activities should you perform prior to beginning to write an abstract? 2. What information do you include in each section of the abstract? 3. What should you do once you have a draft version of your abstract? 4. To review some potential strategies to reduce opioid-related harm. Self-Assessment Questions 1. What can pharmacists do to reduce the risk of fatal opioid overdose and opioid addiction? 2. Why has the burden of opioid addiction and fatal opioid overdose increased so dramatically in Ontario? Prescribing a Drugectomy – Who, What, Why, Where and When James McCormack, BScPhm, PharmD, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC The purpose of this session is to outline some of the problems with medication use and show how target shooting is often not a good thing and why most of the dose recommendations in the CPS are wrong. To that end, I will also discuss why pharmacists should, before someone else does, champion the idea of rational evidence-based medication use that follows the concepts of shared-informed decision making. Following from these ideas the concepts of drugectomies and drug re-evaluation will be also be discussed. Goals and Objectives The Prescription Opioid Crisis in Ontario Irfan Dhalla, MD, MSc, FRCPC, St. Michael’s Hospital and University of Toronto, Toronto, ON Opioids have been used for medicinal purposes for thousands of years and there is near universal acceptance for their use in patients suffering from acute pain or pain near the end of life. Over the last 25 years, many physicians have also become comfortable prescribing opioids, often at high doses and for long periods of time, to individuals with chronic non-cancer pain. Over the same time period, the burden of opioid addiction and fatal opioid overdose has increased dramatically. The number of prescription opioid overdose deaths in North America now far exceeds the number of deaths from HIV/AIDS and rivals the number of deaths from motor vehicle collisions. In this session, the speaker will describe the underlying reasons for the prescription opioid crisis, provide data from studies conducted in Ontario as well as in other jurisdictions documenting the extent of opioid-related harm, review the evidence base for long-term opioid therapy in chronic non-cancer pain, and discuss strategies that can be used to reduce opioid-related harm. Goals and Objectives 1. To learn about how the prescription opioid crisis arose. 28 1. Appreciate some of the strengths and limitations of the medical evidence and clinical practice guidelines when it comes to common conditions in primary care 2. Understand the responsibility of health professionals to incorporate patient values into the decision making process 3. To be able to incorporate the relevant evidence into shared-informed decision making for common conditions seen in primary care. Self-Assessment Questions 1. What level of evidence are most recommendations for chronic disease states based upon? 2. What is the correct starting dose for most medications? 3. Whose responsibility is it to improve drug use? Drugs in Breastfeeding Myla Moretti, MSc, The Hospital for Sick Children, Toronto, ON Breast feeding is accompanied by numerous clinical and psychosocial advantages for both the mother and her child. The issue of maternal drug therapy during lactation, however, remains complex. That is, when a mother requires treatment for her own well-being what are the risks of unnecessarily exposing a child to a drug? In fact, this situation is quite common, with some 95% of women requiring drug therapy at some point during lactation. The situation is further complicated by the fact that most drugs do pass into human milk and little is known about their effects on the infant. Fortunately, most drugs do not gain access to milk in concentrations high enough to achieve clinically significant plasma concentrations in the infant or cause adverse events. Despite this, evidence is scant. Pain is one of the most common indications necessitating pharmacotherapy in a lactating patient, but recent studies have shed light on possible concerns with using opiates in selected patients. This new evidence will be discussed. Goals and Objectives 1. To better understand the principles governing drug transport into milk 2. To be able to evaluate and understand the scientific methodologies used in ascertaining infant risk following maternal exposure to drugs in lactation. 3. To gain a better knowledge of the issues surrounding the use of opiates in breastfeeding mothers. Knowledge Translation Strategies from SickKids for the Removal of Codeine from the Hospital Formulary Cecile Wong, BSc(Hon.), BScPhm, ACPR, The Hospital for Sick Children, Toronto, ON The purpose of this session is to describe the Knowledge Translation Strategies used at The Hospital for Sick Children in removing codeine from the hospital formulary. Codeine, a popular opioid analog is commonly used in the treatment of mild to moderate pain in both adults and children. Recently, there has been growing concern about the safety of codeine use in children. There are several case reports of morphine intoxication in children after ingesting codeine-containing products. As well due to the genetic polymorphism of the enzyme CYP2D6 that converts codeine into morphine, a patient can potentially be a poor or extensive metabolizer of codeine. If a patient is a poor metabolizer, codeine is an ineffective analgesic agent. If a patient is an extensive or ultra-rapid metabolizer, codeine is converted to morphine at a much faster rate resulting in higher than expected morphine blood levels. Therefore putting the patient at risk of morphine intoxication. For these reasons, SickKids has removed codeine and codeine-containing products from its hospital formulary. Knowledge translation (KT) strategies were used to help with the transition of removing codeine and supporting the practice of using oral morphine as the agent of choice for the treatment of moderate to severe pain in children. Goals and Objectives 1. To discuss the rationale why SickKids removed codeine and codeine-containing products from its hospital formulary. 2. To discuss the knowledge translation strategies used at SickKids to help with the transition of removing codeine from the hospital formulary and to support the practice change of using oral morphine for the treatment of moderate to severe pain in children. Self-Assessment Questions 1. Why is there a growing concern about codeine’s use in children? 2. Which knowledge translation strategies were used at SickKids? a. b. c. d. Develop educational material Provide educational sessions to key stakeholders Use of reminders All of the above Ten Tips to Successfully Integrate into a Primary Care Team Derek Jorgenson, BSP, PharmD, FCSHP, University of Saskatchewan, College of Pharmacy, Saskatoon, SK Pharmacists are taking on an increasingly complex direct patient care role in the primary health care system. One of these new pharmacist roles that is becoming increasingly common in Canada and abroad is that of the integrated member of an interprofessional primary care team. Despite the fact that there is mounting evidence regarding the impact and value of this new role for pharmacists, many challenges and barriers exist to successfully integrating a pharmacist onto an existing primary care team. Some of these barriers include: lack of pharmacist role clarity, poor pharmacist confidence and assertiveness, lack of support and mentorship, inadequate training and skills and space / infrastructure issues within the clinic. Consequently, many pharmacists have been reported to struggle significantly in their attempt to successfully integrate onto a new primary care team. To our knowledge, there are few resources available to support pharmacists through their integration and many pharmacists are not aware of the resources that are available. The purpose of this presentation is to provide a list of clear and practical suggestions and resources that will assist pharmacists who are attempting to integrate into an existing primary care team. Goals and Objectives 1. Summarize the common barriers that exist to pharmacists successfully integrating into existing primary care teams. 2. Discuss a list of clear and practical suggestions that will assist pharmacists who are attempting to integrate into an existing primary care team. 3. Provide a list of useful resources that will assist pharmacists who are attempting to integrate into an existing primary care team. 29 Self-Assessment Questions 1. List four tips that will assist pharmacists who are attempting to integrate into an existing primary care team. 2. List three useful resources that will assist pharmacists who are attempting to integrate into an existing primary care team. Initiating Insulin in a Primary Care Setting Christine Papoushek, PharmD, Toronto Western Hospital Family Health Team, Toronto, ON The management of Diabetes in a family practice setting is a complex issue and most often requires the incorporation of multiple providers and multiple drug regimens. Insulin therapy in the management of Type 2 Diabetes is often a necessary strategy in order to achieve a patient’s individual target HbA1c. However, there are multiple patient, physician and evidence-based barriers that can interfere with the initiation of insulin therapy in a primary care setting. Acknowledging and addressing these barriers is imperative to appropriately initiate insulin in any patient requiring therapy. This presentation will provide the participant with the knowledge and skills required to appropriately initiate insulin in a Primary Care setting. Goal and Objectives To provide pharmacists with the necessary knowledge and skills to appropriately initiate insulin in a patient with Type 2 Diabetes. 1. Identify and address specific barriers to initiating insulin in patients with Type 2 DM. 2. Summarize the evidence for various HbA1c targets in managing Type 2 DM 3. Identify and list appropriate HbA1c targets for specific patient populations. 4. Describe a rationale for choosing specific HbA1c targets in different patient populations. 5. Identify and list appropriate, effective, initial insulin regimens for specific patient populations. 6. Identify and choose different dose adjustment regimens for specific patient populations. The Evidence for Deprescribing: Trials and Tribulations Barbara Farrell, BScPhm, PharmD, ACPR, FCSHP, Bruyère Continuing Care, Ottawa, ON This session provides an overview of ‘deprescribing trial’ research - methods used, outcomes achieved, limitations and emerging questions. ‘Deprescribing’ is an approach to tapering or stopping medications to address the growing problem of polypharmacy in the elderly. Inappropriate medication use is associated with non-adherence, adverse reactions, fall risk, errors, hospitalization and mortality. Approaches to screening for, and managing polypharmacy are not routinely used in practice. Two systematic reviews examine approximately 30 deprescribing trials. These include randomized controlled trials with pharmacists or physicians using generic algorithms, as well as some drug class specific approaches (e.g. cardiovascular medications like digoxin, diuretics and antihypertensives; fall and cognition affecting medications like opioids, benzodiazepines, antidepressants and other psychoactive agents; acetylcholinesterase inhibitors; acid-suppressive agents; bisphosphonates). Reduced medication usage and costs are common outcomes. Few trials have assessed outcomes such as hospitalization, specialist referral, or mortality, or improved function. Some small class specific trials have demonstrated differences in clinical outcomes (e.g. reduced falls, improved cognition and psychomotor function), however, details regarding tapering and monitoring procedures are often missing. Use of a generic algorithm for stopping medications has shown reduced referral rate, global improvement in health and reduced mortality in addition to reduced cost of drugs. Some studies demonstrate adverse drug withdrawal events (ADWE) (e.g. aggression, agitation, angina etc) that warrant careful monitoring. There is a need to implement guidelines with detailed approaches to tapering and stopping medications, and monitoring for ADWE, and for research examining long-term effectiveness in terms of clinical and system-related outcomes. Goals and Objectives 1. To provide an overview of ‘deprescribing trial’ research methods and outcomes. Self-Assessment Questions 2. To discuss limitations of ‘deprescribing trial’ research and emerging research questions. 1. How do I initiate insulin in a 55 year old male with an HbA1c of 9% taking metformin 500mg tid? Self-Assessment Questions 1. What types of deprescribing trials have been published? 2. How do I advise this patient to adjust his dose according to his blood glucose values? 30 2. What are the limitations of, and emerging research questions from this body of literature? Senior Friendly Hospital Initiatives Barbara Liu, MD, FRCPC, Regional Geriatric Program of Toronto, Toronto, ON In 2010, the fourteen Local Health Integration Networks (LHINs) of Ontario identified senior friendly hospitals (SFH) as a strategy to reduce functional decline of older patients admitted to hospital. The LHINS were guided by the five-domain senior friendly hospital framework of the Regional Geriatric Programs (RGP) of Ontario and the RGP’s expertise to provide clinical leadership to the strategy. The five domains of the RGPs SFH framework are organizational support, processes of care, emotional and behavioural environment, ethics in clinical care and research, physical environment. One hundred and fifty-five hospitals contributed data that led to a provincial summary report. Two priorities were identified – prevention of functional decline through interprofessional early mobilization strategies and 2) prevention and management of delirium through interprofessional strategies. Hospitals were asked to describe their improvement plan related to one of these priorities. To support hospitals in the delivery of their improvement plan, a toolkit of resources to screen, assess and manage older patients with functional decline and delirium has been collated. To monitor progress, two indicators for each of priorities, delirium and functional decline, were identified. www.rgp.toronto.on.ca and www.seniorfriendlyhospitals.ca The multisite collaborative project – Mobilizaiton of vulnerable elders in Ontario (MOVE ON) will describe the application of the SFH framework and Knowledge-to-Action cycle to a quality improvement project aligned with the SFH strategy priorities. At the national level, B Parke, B Liu and A Juby are leading a collaboration to develop quality and safety standards for older people in Canadian Hospitals. Goals and Objectives 1. To describe the Ontario senior friendly hospitals strategy 2. Identify promising practices and opportunity for improvement identified in the environmental scan Tuesday, February 5 Mardi 5 février Best Papers in Acute Care 2012 Michael Legal BScPhm, PharmD, ACPR, St. Paul’s Hospital, Lower Mainland Pharmacy Services, Vancouver, BC The purpose of this session is to highlight some of the key papers which contributed to our understanding of pharmacotherapeutics in acute care in 2012. The papers reviewed in this session have broad applicability to 3. To describe the applciaiton of the senior friendly hospital framework to an improvement priority – early mobilization. Dealing with Difficult People Sam Louie, BScPhm, University of British Columbia, Vancouver, BC The purpose of this session is to describe the choices, develop an understanding and review the communication tools to deal with difficult people. It is a natural reaction to avoid dealing with demanding people in our lives. Sometimes we think we have no choice. Yet we have 4 major options to select from. Before we dismiss people outright, we should examine why we should be interested in engaging them and how we can inspire their conduct. Understanding what is difficult behaviour and why it happens are keys to appreciating how we may adjust our strategy to optimize outcomes. We will explore the assertiveness scale, “people versus task” focus and how these elements relate to the 4 major intents of human response. Effectively influencing others starts with our own actions. The selection and use of fundamental communication skills are integral to developing relationships. We will highlight the 5 basic essentials of our personal leadership tool box. Furthermore listening to understand, speaking to be understood and reducing the gaps in communication are crucial to our conduct. Adjusting our attitude and behaviour toward difficult people are the first steps to influencing those who are at their worst to do their best. In the end – if no one loses, we all win. Goals and Objectives 1. To provide pharmacists with knowledge of choices, understanding and communication tools to deal with Difficult People. Self-Assessment Questions 1. What are the four intents of human response? 2. What are five basic principles of our leadership tool box? pharmacists working in various acute care settings from internal medicine through to cardiology and critical care. Key aspects of design including strengths, limitations and applicability to clinical practice will be discussed. Relevant background and context will be also be provided in order to allow attendees to better understand how the paper “fits” into our current understanding of the topic area in question. Goals and Objectives 1. To provide pharmacists with an update on a few of the literature developments in acute care in 2012. 31 2. To provide a critical overview of aspects of study design highlighting strengths and limitations. 3. To help pharmacists understand how the findings of these papers may relate to their own clinical practice. Self-Assessment Questions 1. How do the discussed studies relate to your clinical practice? 2. How will the results of these studies influence how you care for your patients (if at all)? Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE) Eric Landry, BSP, Linda Sulz, BSP, PharmD, Ali Bell, MA, MSc, Lane Rathgeber, BSc, MD, CCFP(EM), Heather Balogh, BSP, Saskatoon Health Region, Regina, SK Introduction: Overuse of fluoroquinolone (FQ) antibiotics is associated with outbreaks of MRSA and C. difficile-associated diarrhea and increasing resistance to gram-negative organisms.1 The Regina Qu’Appelle Health Region (RQHR) has seen increasing E. coli resistance to ciprofloxacin over the last decade.2 The purpose of this study was to evaluate and optimize empiric treatment of Regina General Hospital (RGH) emergency department (ED) outpatients with uncomplicated UTIs, using antimicrobial stewardship principles to align prescribing with local resistance data and best practice. Methods: An educational strategy, aimed at ED physicians, presented the changes in RQHR antibiotic resistance patterns, principles of antimicrobial stewardship, the drivers of resistance, and a literature review of best practice for outpatient UTIs. An overview of baseline findings from a retrospective chart review, along with the suggested best practice was also presented. A post-intervention audit was conducted in the same manner as the baseline audit for comparison purposes. Results: Adherence to best practice significantly increased from 40.6% pre-intervention, to 65.8% post-intervention (P<0.001; OR = 2.81, 95% CI 1.51-5.25). There was also a significant change in overall antibiotic selection from pre to post-intervention (P<0.001; OR = 0.25, 95% CI = 0.11-0.58). Further statistical analysis suggests this significance was driven by a decrease in ciprofloxacin use from 32.3% in pre-intervention to 10.5% post-intervention. Future interventions may be required to further improve adherence and to determine what effect this may have on reducing resistance rates of E. coli to ciprofloxacin. 1. Wong-Beringer A, Nguyen LH, Lee M, Shriner KA, Pallares J. An antimicrobial stewardship program with a focus on reducing fluoroquinolone overuse. Pharmacotherapy. 2009 Jun; 29(6):736-43. 32 2. RQHR Antibiogram [cited 2011 Nov 21]. Available from: http://rhdintranet/micro/public/AntimicrobialSusceptibilit y/AntibiogramResults.htm Goals and Objectives 1. To raise awareness of the potential antimicrobial stewardship interventions which exist in the treatment of a very common infection, outpatient urinary tract infections. 2. To provide an example of a simply designed, pharmacist lead, interprofessional collaboration on an antimicrobial stewardship initiative in the emergency room setting. Self-Assessment Questions 1. What are some of the consequences of fluoroquinolone overuse? 2. Which antimicrobial resistance rates are issues in your health region? 3. Is there opportunity to influence prescribing habits through educational intervention? Other CSHP 2015 “winning” success stories will also be highlighted at the end of the session. How Should Life-Saving Drugs Be Priced? Chris MacDonald, PhD, Ryerson University, Toronto, ON The purpose of this talk is to examine various candidate principled bases for corporate decisions regarding the pricing of life-saving drugs. The emphasis here is not on public policy, but on corporate decision-making. Pricing is under-explored in the business ethics literature. The default for most products is that they may be priced according to what the market will bear. But life-saving pharmaceuticals have characteristics that suggest putting them in a class of their own. The question: how should a pharmaceutical company price its products? We set aside, here, considerations of government price controls and the limits imposed by insurance schemes. Several candidate ethical principles arise. Should prices be set at a level lower than what the market would bear, as a principled response to consumer need? Alternatively, should companies be guided by principles related to distributive justice, seeking to ensure that everyone in society has fair access to health resources? Or should pharma be guided by compensatory justice, pricing drugs lower than the market might bear as a way of repaying public contributions to the costs of R&D? Finally, should companies be guided by a principle of non-exploitation, pricing in a way that refuses to take unfair advantage of those who are gravely ill? I argue that each of these proposed principles is subject to serious objections. This seems to bring us back to the default, free-market solution. I conclude with the deeper questions this conclusion raises about the decision to leave the marketing of pharmaceuticals to the private sector. Goals and Objectives 1. To provide pharmacists with an understanding of key candidates for principled corporate decisions about pricing life-saving drugs. 2. To explain ethical strengths and weaknesses of those candidate principles. Self-Assessment Questions 1. What are the most commonly-raised candidates for principled corporate decisions about pricing life-saving drugs? Self-Assessment Questions 1. How do indacaterol and roflumilast differ from other COPD therapies? 2. Is indacaterol and roflumilast safe to use in my patient population? 3. Do roflumilast or indacaterol offer any additional benefit to what I currently offer my COPD patients? How to Write a Case Report: A Practical Guide for Pharmacists Mark J. Makowsky, BSP, PharmD, Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB 2. What are the ethical strengths and weaknesses of those candidate principles? The goal of this session is to provide practicing pharmacists with the practical knowledge necessary to get a patient case report published in the medical literature. New Drugs in COPD – The Latest or Greatest? Practicing clinicians may contribute to the literature in many ways, but case reports are an accessible and scientifically valuable way to participate in scholarly activity. Case reports are a structured form of scientific and professional communication normally focused on an unusual single event. They improve our understanding of a case and help to improve clinical decision-making. Deon Druteika, BSc, BScPhm, PharmD, ACPR, Alberta Health Services, Edmonton, AB The purpose of this session is to provide a brief overview of indacaterol and roflumilast; 2 new agents in the Chronic Obstructive Pulmonary Disease (COPD) armamentarium. Many hospital pharmacists encounter patients with COPD regularly in their practices, either as a result of a COPD exacerbation or as a preexisting comorbidity. Staying abreast of the latest information for managing both stable disease as well as COPD exacerbations is vital for nearly all clinicians whose patient population consists of adults. Because of the limited impact drugs have on the course of the disease in patients with COPD, new drug development is needed. Indacaterol is an inhaled long acting beta agonist (LABA). Its long duration of action permits once daily dosing. Placebo-controlled studies have demonstrated improvements in lung function over a 12 week period. Comparative trials utilizing the approved dose in Canada are needed. The key steps to preparing a case report for publication are to: identify a case, systematically gather relevant information, choose a target publication, prepare the manuscript using a structured format, submit the manuscript online, and finally, revise and resubmit the manuscript if required. Generally speaking, editors who accept pharmacotherapy related case reports are looking for novel, poorly appreciated, unusual or interesting patient situations. The most important rule for writing a good case report is to be very clear about the single message that you want to bring and to be brief. Authors are encouraged to refer to the existing literature, instructions for authors of relevant journals, and relevant guidelines to assist in manuscript preparation. Roflumilast, an oral phosphodiesterase (PD) inhibitor, is a relatively new therapy that is indicated for severe COPD patients. It has been studied as add on therapy to bronchodilators for chronic management. To date it has been shown to improve lung function and reduce exacerbations in select COPD patients. An important part of case reporting is establishment of the probability of causality. The Naranjo Adverse Drug Reaction (ADR) Probability Scale or the Drug Interaction Probability Scale (DIPS) should be used for ADR and Drug Interaction (DI) reports respectively. Authors of manuscripts are encouraged to be persistent if your manuscript is initially rejected or requires revision. Goals and Objectives Goals & Objectives 1. To review the pharmacology, pharmacokinetics and adverse effects of indacaterol and roflumilast. At the end of the session, the participant should be able to: 1. Describe the types of case reports editors are looking for. 2. To review the evidence evaluating efficacy and safety for each of these two agents 3. To discuss the place in therapy for these new agents with respect to our current standard of care 2. List key journals that accept case reports & know what reviewers expect. • Know how to format your case report. • Know how to establish causality in adverse drug reaction or drug interaction reports. 33 3. Recognize inherent limitations of case reports. clinical studies pharmacy technicians from inception to expansion at The Ottawa Hospital 4. Know what to expect after manuscript submission. Self-Assessment Questions 1. What are the major types of case reports that journal editors are looking for? 2. List the top four targets for publication of an ADR case report. 3. What are the essential pieces of information to report in your case? 4. What are the main limitations of case reports in general? Pharmacy Technicians in Clinical Roles: Where Are We At? Celine Corman, BSP, MSc, Kim Lamont, CPhT, The Ottawa Hospital, Ottawa, ON The roles and responsibilities of pharmacy technicians have expanded over the years as the profession of pharmacy has evolved. In the 1980-90’s technician roles were developed to support the clinical activities of the pharmacist. It was recognized that with proper training and education that pharmacy technicians could specialize and provide further support thus creating the first clinical pharmacy technician position. This eventually lead national and provincial pharmacy organizations to focus on promoting pharmacy technician education, certification and scope of practice. In this presentation we will present on the various roles that currently exist for “clinical” pharmacy technicians. We will then focus on our experience and the growth of these positions at our institution. - namely the clinical studies pharmacy technicians and the medication reconciliation pharmacy technicians. We will present on how we were able to show through work-place training that the pharmacy technician was the best person to do the best possible medication histories at our institution. We were able to get funding to establish 3 FTE positions at each Emergency department and then eventually an another FTE position for the Units of each main campus. With the deployment of the electronic medication module for i-pads, it was determined more support was required so more FTEs will be directed toward this position. Our clinical studies pharmacy technician roles and responsibilities will also be described and how they allow for pharmacists on-call not requiring a return to site. Goals and Objectives 1. To review the literature of the various roles of clinical pharmacy technicians that have been established across North America. 2. To describe in detail the roles and responsibilities of medication reconciliation pharmacy technicians and 34 Self-Assessment Questions 1. What are the benefits of creating clinical pharmacy technician positions in your institution and where do you see you could benefit from such positions? 2. What are some of the clinical activities described below that could be performed by pharmacy technicians? a. b. c. d. e. hypertension clinic support anticoagulation management medication histories a&c all of the above Optimizing Patient Care: A Patient/Pharmacist Journey Christine Papoushek, PharmD, Toronto Western Hospital Family Health Team, Toronto, ON From a patient’s journey through the healthcare system can help all healthcare providers, especially pharmacists to identify strategies to minimize the gaps in providing high quality care and improve the patient’s overall experience. Pharmacists are in a unique position within the healthcare system to not only optimize the patient’s medication related experience but to work collaboratively with other health care providers to enhance the patient’s overall experience. Christine will utilize her experience as a stroke survivor, a patient advocate and a pharmacist to identify (care gaps) and disseminate feasible collaborative strategies which can result in positive health outcomes for patients. Goal and Objectives To gain insight and desire to improve upon your patient care skills and move your practice forward to optimize the care you provide to your patients. 1. Identify three critical themes that could be utilized in the provision of care that will assist pharmacists in addressing the patient’s primary needs. 2. Identify three basic principles that can enhance the care delivery to the patient. Self-Assessment Questions 1. What are the basic principles and critical themes that I can incorporate into my care delivery that will help me to provide optimal care to my patient? 2. What changes do I have to make to my practice style and/or practice setting so that I can optimize patient care skills and inter-professional collaboration to improve the outcomes of my patients? Post Operative Nausea and Vomiting: Treatment vs Prophylaxis Melanie MacInnis, RPh, BScPhm, PharmD, Hamilton Health Sciences; Hamilton, ON Post Operative Nausea and Vomiting (PONV) is one of the most common post operative complications, and has multi-factorial causation. The term PONV can include post-anesthetic nausea and vomiting; as well as opioid induced nausea and vomiting; or even the sensation of nausea as a result of the type of surgery performed. These factors will be considered while briefly outlining the pathophysiology of PONV; and pharmacology of agents used in the management of PONV. With the recent challenges in obtaining adequate supply of various anti-emetic agents; a debate has emerged on which strategy is most effective in minimizing this common post-operative complication. The literature will be reviewed; with a focus on patient assessment for risk factors in developing PONV to select patients appropriate for PONV prophylaxis. Goals and Objectives 1. Provide an overview of the pathophysiology of PONV and the drugs used to manage this post-operative complication. 2. Review factors to consider In patient assessment on when to use a prophylactic approach to treat PONV. 3. Review principles for PONV treatment post-operatively for all patients whether or not they have received prophylaxis. The Role of the Pharmacist in a Pre-Operative Assessment Clinic Moderator: Melanie MacInnis, RPh, BScPhm, PharmD, Hamilton Health Sciences, Hamilton, ON; Panelists: Sandra Hicks, BScPhm, ACPR, Toronto East General Hospital; Toronto, ON, Kiran Saini, BScPhm, Saint Michael’s Hospital, Toronto, ON, Beverly Barbato, RN, BScN, MEd (c), Hamilton Health Sciences; Hamilton, ON This panel discussion with representatives from community and tertiary care hospitals; pharmacy and administration will discuss roles and view points with the following objectives in mind: 1. Discuss different models for pharmacist integration in pre-operative assessment clinics 2. Discuss differing levels of service provided by pharmacists in pre-operative assessment clinics 3. Discuss the differences in expectations for a pharmacist vs a pharmacy technician working in a pre-operative assessment clinic 4. Discuss how a pharmacist involvement in a patient’s care prior to admission to hospital can benefit patient care and create efficiencies New Managing Medications Standards and Required Organizational Practices – What You Need to Know to Prepare for Accreditation Janice Monroe, BScPhm, Fraser Health Authority, Langley, BC, Régis Vaillancourt, BPhm, PharmD, FCSHP, Children’s Hospital of Eastern Ontario, Ottawa, ON, Julie Greenall, RPh, BScPhm, MHSc, FISMPC, ISMP Canada, Toronto, ON The purpose of this session is to describe changes in Accreditation Canada Managing Medications Standards and Required Organizational Practices (ROPs), provide the surveyor perspective on how the new changes will be assessed and offer an opportunity for discussion about approaches to meet the new standards and ROPs. This session will be of benefit to pharmacists in management and direct care roles. Accreditation has proven to be a strong driver of practice change. In 2008, Accreditation Canada launched the QMentum Standards, which included a specific component devoted to Managing Medications. In 2011-12, Accreditation Canada convened a working group of pharmacists with broad experience from across Canada to review and update the Managing Medications Standards and ROPs. The new standards will become effective in January 2014. Goals and Objectives 1. Describe changes to Managing Medications Standards and Required Organizational Practices ROPs; 2. Provide background information on the rationale for selected changes; 3. Provide the surveyor perspective on how the new changes will be assessed; and 4. Offer an opportunity for discussion about challenges and possible approaches to meeting the new standards and ROPs. Self-Assessment Questions 1. How will the new Managing Medications Standards and ROPs enhance patient safety in my practice setting? 2. What are the priority areas for attention in my practice setting? VTE Management in Cancer Patients B. Bartle, BScPhm, PharmD, FCSHP, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON The purpose of this session is to review and update the attendants’ knowledge of the management and prevention of venous thrombosis(VTE) in cancer patients. Many studies have demonstrated that patients with malignancy are increased risk of developing VTE, with as many as 50% developing an event after their diagnosis. Factors affecting the development of VTE include tumour type, extent of disease, and chemotherapy to list some of the 35 important ones. Some research has shown that an unprovoked VTE may pre-date the diagnosis of cancer by several years. Targeted screening for certain cancers may be indicated in some of these latter patients. anticoagulant doses of a LMWH can be lowered around 3 months if there is clinical or imaging evidence of clot resolution or an increase in the bleeding risk or a major bleeding episode. Cancer patients are more likely to have upper extremity clots because of indwelling catheters; they are also more likely to have ‘incidental’ clots diagnosed because of the serial imaging of tumour sites for staging and to assess therapy. These incidental clots may be managed with lower doses of a LMWH. Because of their relatively high rate of VTE, prophylaxis is indicated in all cancer patients who are hospitalized; bleeding risk needs to be assessed frequently. Patients who have cancer surgery may benefit from extended prophylaxis post discharge. Recent evidence suggests that patients who are receiving outpatient chemotherapy may benefit from VTE prophylaxis; however, the effect size was small, however. The treatment of VTE requires a little more thought than in the non-cancer patient. If the cancer is in remission , then LMWH/warfarin or rivaroxaban(Xarelto™) can be used. However, VTE in this setting may mean that the cancer has returned. For patients with cancer undergoing active treatment, then a LMWH is indicated ,based on a several RCTs. Dalteparin is the only LMWH approved for treatment of cancer-related thrombosis in Canada. There is presently insufficient evidence to use any of the new oral anticoagulant agents(NOACs) in this setting, except in unique circumstances. Patients receiving full anticoagulant doses of any drug in this setting require monitoring of platelet counts and end-organ dysfunction where appropriate. Generally, the anticoagulant is continued indefinitely, unless the clot is induced by an indwelling infusion device that is eventually removed. Full Wednesday, February 6 Mercredi 6 février Antimicrobial Stewardship – From Resistance to Required Procedure Linda Dresser, PharmD, FCSHP, University Health Network, Toronto, ON In 2009 a point prevalence study (EPICII) of antimicrobial use in 1265 intensive care units (ICUs) from 75 countries was published. Among the findings was that 71% of all ICU patients were receiving antibiotics while 51% were considered actively infected; suggesting at least 20% of antimicrobial use was unnecessary. It has long been recognized that inappropriate use of antimicrobials has contributed to many of the current challenges in managing infectious diseases including antimicrobial resistance and superinfections (e.g. C. difficile). In addition, the number of new antimicrobial agents coming to market has dropped to almost zero for many years. In Canada, the only new antimicrobial approved this year was for the treatment of C. difficle disease. The combination of increasingly difficult to treat infections and the lack of new agents in the armamentarium has reached crisis state in many countries including the USA leading to a number of initiatives lead by national and international infectious diseases societies to not only encourage new drug research and development but also 36 Updated ASCO guidelines on thrombosis and cancer are due out in 2013. Goals and Objectives 1. To provide pharmacists with an overview of the epidemiology, mechanisms, risk factors and diagnostic procedures for cancer patients with VTE 2. To describe both evidence-based and experiential practice treatment and prevention strategies for cancer-related VTE Self-Assessment Questions 1. List both the cancer and non-cancer related risk factors associated with cancer-related VTE. 2. How long should anticoagulation be taken by cancer patients? to optimize antimicrobial prescribing. The first set of guidelines published by the Infectious Disease Society of America, designed to improve antimicrobial prescribing, appeared in 1988 and the most recent in 2007. The first set of guidelines was largely ignored however the latter have served as the template and starting point for antimicrobial stewardship programs around the world. Without recognition at a national or governing level guidelines and programs may be doomed to limited impact. In Canada, the importance of improving or optimizing antimicrobial use has been recognized by Accreditation Canada through the introduction of a new required organizational practice (ROP) for stewardship programs in acute care institutions. The purpose of this presentation is to describe the evolution of antimicrobial stewardship in our health care institutions and to highlight the new Accreditation Canada required organizational practice on stewardship. The presentation will discuss the challenges facing the practitioner with respect to difficult to treat infectious diseases, the elements of an antimicrobial stewardship program (ASP), and some commonly utilized metrics of outcomes and how the ROP can be met in our health care settings. Goals and Objectives 1. To provide the context for the need and expected benefits of establishing ASP’s in Canadian health care institutions. 2. To discuss the Accreditation Canada ROP for Antimicrobial Stewardship and how it can be met in our health care settings. Self-Assessment Questions Self-Assessment Questions 1. What is the mechanism of action of the incretin therapies and differences between DPP-4 inhibitors and GLP-1 receptor agonists? 1. What are 3 detrimental consequences of inappropriate antimicrobial prescribing? 2. What are the 3 question-format to decide the next antihyperglycemic agent? 2. Identify the key components of a successful ASP that will meet the new ROP. Top Papers in Infectious Diseases That May Change Your Practice…or Not New Agents in Type 2 Diabetes: Who, What, When, Why? Alfred Gin, BScPhm, PharmD, FCSHP, Health Sciences Centre Winnipeg, Winnipeg, MB Alice Y.Y Cheng, MD, FRCPC, Credit Valley Hospital/St. Michael’s Hospital, Mississauga, ON As 2012 comes to end and a new year begins, global concerns with antibiotic resistance and the paucity of new antibiotic agents continue to garner our attention. Methicillin-resistant Staphylococcal aureus or outbreaks of Clostridium difficile disease highlight gaps or limitations in antibiotic pharmacotherapy. These concerns can be challenging for pharmacists as we try to optimize antibiotic therapy and improve patient outcomes. Despite the ‘doom and gloom’, ongoing research and/or position statements have continued to advance our understanding and management of infections. The presentation will highlight and review a selection of papers from the recent past to the present that have or will impact patient antimicrobial patient care. Topics may range from clinical trials or diagnostics. Glycemic control over time has been shown to be an effective strategy to reduce both microvascular and macrovascular complications among people with type 2 diabetes. Fortunately, the number of antihyperglycemic agents available for the treatment of type 2 diabetes has expanded significantly in the past 3 years, which has provided more choice for patients. However, more choices can create confusion unless there is clarity as to how to individualize the therapy to suit the specific patient. The various classes of agents can be broadly categorized into those that address insulin resistance, insulin deficiency and other pathways. The newest agents are the incretin based therapies – DPP-4 inhibitors and GLP-1 receptor agonists. The incretins are gut hormones secreted in response to eating and promotes increased insulin and reduced glucagon to control blood glucose levels. However, this is done in a glucose-dependent fashion to avoid hypoglycemia. GLP-1 is the primary incretin and DPP-4 is the enzyme that breaks down GLP-1. Among those with T2DM, the incretin effect is blunted. Therefore, the treatment modalities currently available are DPP-4 inhibitors and GLP-1 receptor agonists. All of the available antihyperglycemic have advantages and disadvantages with respect to efficacy, hypoglycemia risk, weight effects, side effects and tolerability. There is no single best agent to use in T2DM after metformin. The 3-question format: What is the degree of hyperglycemia? What is the risk of hypoglycemia? Does the patient have a drug plan? Along with a few other questions can help one individualize therapy effectively and avoid any reflex choices after metformin. Goals and Objectives By the end of the session, participants will be able to: 1. Discuss the mechanism of action / pros & cons of the agents available to treat T2DM 2. Apply the 3-question method to decide what agent is best suited for a patient 3. Explain the proposed 2013 Canadian Diabetes Association clinical practice guideline algorithm for pharmacologic treatment of T2DM Goals and Objectives 1. Review and analyze select studies/statements from the recent past and present that may impact a pharmacist’s management of infectious diseases. 2. Identify potential gaps/opportunities Self-Assessment Questions 1. What antibiotic received approval from Health Canada for the treatment of C. difficile diarrhea? 2. What do the 2009 vancomycin guidelines say and don’t say? Oral Cancer Agents: What a Non-Oncology Pharmacist Needs to Know Daniela Gallo-Hershberg BScPhm, PharmD, North York General Hospital, Toronto, ON The purpose of this session is to discuss potential issues relating to safety and toxicity for patients prescribed oral cancer agents in a hospital setting, as well as strategies to minimize the risk of exposure to family members and health care providers. Use of OCAs has increased tremendously over the last decade and approximately 30% of new agents in development are in oral formulation. OCAs are more convenient for both health care providers, as well as patients. OCAs require fewer 37 visits to the systemic therapy clinics, as well as less chair time and health care resources. The disadvantage being that patients have the potential to go several weeks without seeing a health care provider to monitor for signs and symptoms of toxicity or errors in administration. The potential for harm, secondary to medication errors with OCAs, is equal to that associated with parenteral chemotherapy, due to their narrow therapeutic index. Unlike parenteral chemotherapy orders, prescriptions for OCA’s are not frequently reviewed for accuracy by health care providers with oncology expertise. Education of patients and/or primary caregivers is crucial in ensuring patient safety. Guidelines relating to safe handling, disposal and administration of parenteral chemotherapy should also be adhered to for patients receiving OCAs to minimize exposure to family members or other health care providers. Goals and Objectives 1. To increase awareness of the safety risks associated with oral cancer agents as compared to parenteral cancer agents 2. To discuss ways to minimize risk of error and exposure with the use of oral cancer agents in a hospital setting 3. To determine reliable and accurate resources available to pharmacists when evaluating a patient prescribed an oral cancer agent in a hospital setting Self-Assessment Questions 1. What are the prescription requirements for an antineoplastic agent based on the American Society of Health System Pharmacists guidelines? 2. How can hospital pharmacists improve the safety of dispensing and administering oral cancer agents within their programs? Skin Reactions to Medications Debra Sibbald, BScPhm, MA, PhD, ACPR, CEHPEA and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON The purpose of this session is to enable pharmacists to hone their skills in the evaluation of the causal relationship between a medication and an adverse skin reaction, including differential and etiologic diagnoses. This often involves evidence of a temporal relationship and eliminating other principal non drug-related causes. Skin disorders are the most common adverse reactions attributed to medications and account for about 5% of hospitalizations in dermatology departments. Any skin disorder can be imitated, induced or aggravated by drugs. With rare exceptions, drug-induced skin disorders have little symptomatic specificity. Severe reactions account for less than 10% of all skin disorders due to drugs that result in a 38 hospital consultation. The most common ones account for about 80% of all drug-related reactions and involve signs and symptoms of pruritus, urticaria and maculo-papular eruptions. Little is known about the pathophysiologic mechanisms of drug-induced dermatitis. While usually considered to be hypersensitivity reactions, this has only been demonstrated with a few reactions and a few drugs. As professionals, pharmacists specialize in pharmaco-vigilance, which requires training and awareness of pertinent criteria for triggers, risks and aggravating factors. Chronological patterns, course of the event over time, and the investigation of non-drug origins contribute to a valid analysis. Best practice guidelines for appropriate action in individual cases will vary. Goals and Objectives 1. Describe a process for approaching a drug adverse reaction in skin 2. Recognize signs & symptoms of common skin reactions 3. Identify top drugs which most commonly cause these reactions and suspected mechanisms 4. Determine patient management Self-Assessment Questions 1. What are the differentiating features in assessing whether skin reactions are due to a medication or due to a disease? 2. What features of a skin reaction to medication determine management issues, such as urgency, decision to continue or discontinue therapy and the risks of re-adminstration of the medication in the future? My Phone Can Do What? A Sn“App” Shot of How Our Patients Can Use Smartphones Sean P. Spina, BScPhm, ACPR, PharmD, Vancouver Island Health Authority, Victoria, BC The goal of this session is to provide the pharmacist with an overview of how patients are using smartphone technology. Over the past decade, the use of technology in healthcare has grown exponentially. In addition to the healthcare system embracing technology, patients have begun to realize the benefits of smartphone technology. With the invention of the internet and more recently, smartphones, patients are more empowered now than ever before to take control of their own health care. Patients are now using their smartphones to help them monitor their adherence to drug therapy, manage their drug therapy and communicate with their healthcare team. The smartphone has become an integral part of many patient’s lives and we must be informed enough about this new technology to help patients make decisions about their health. Incorporating technology into clinical practice can be overwhelming at times. This session will outline how smartphones can be effectively incorporated into clinical practice including a review of common clinically useful applications for patients and pharmacists. Facilitating Sustainable Impacts At Home and Abroad Goals and Objectives Jennifer Gibson, BSP, ACPR, Health Sciences Centre, Winnipeg, MB, Doret Cheng, BScPhm, PharmD, RPh, Mount Sinai, Hospital, Toronto, ON 1. To provide pharmacists with an overview of how smartphone technology can be used by our patients. 2. To provide pharmacists with practical suggestions of ways that smartphones can improve patient’s ability to manage their medications. 3. To update pharmacists on new apps that will improve their ability to provide patient care. Self-Assessment Questions 1. List 5 smartphone applications which can be used by your patients 2. Describe how smartphone technology allows patients to make informed decisions about their health care choices. 3. How smartphone technology can allow patients to play a more active role in their health management. New Antipsychotics Wende Wood, BA, BSP, BCPP, Ontario Pharmacists’ Association, Toronto, ON Many psychiatric disorders, from schizophrenia to bipolar disorder to even depression and anxiety, are being increasingly treated with atypical antipsychotics. That said, there are significant deficiencies in the current treatments available both in terms of efficacy and adverse events. In 2012 two new agents were introduced to the Canadian market – asenapine and lurasidone. This presentation will look at their pharmacology, efficacy, indications, side effects, drug interactions, dosage, availability and cost. Formulary considerations and place in current therapy will also be discussed. Sustainable development is defined as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.”i The World Health Organization Rio Declaration on Environment and Development states that human beings are at the centre of concerns for sustainable development, and that they are entitled to a healthy and productive life, in harmony with nature. The goals of sustainable development can only be achieved in the absence of a high prevalence of debilitating diseases, while obtaining health gains for the whole population requires poverty eradication.ii Various authors have discussed ethical factors and other considerations in providing aid and/or foster development.iii,iv,v,vi,vii These concepts are crucial when engaging with others, both locally and abroad. Pharmacists, as essential members of the health care team, can make impacts towards the global goal for just and equitable access to health and medicines. The purpose of this session is to describe the available evidence for sustainable impacts in health and the field of pharmacy. Illustrations of key principles are made through the presenters’ personal experiences in The Gambia [Gibson] and Pharmacists Without Borders Canada’s (PSF Canada) work in Uganda [Cheng]. Goals and Objectives 1. Provide pharmacists with an overview of the best available evidence for sustainable impacts for health at home and abroad 2. Provide an illustration through the work of Pharmacists Without Borders Canada mission in Uganda Goals and Objectives Self-Assessment Questions 1. Understand the need for new medications in the antipsychotic class 1. Describe the difference between aid and development 2. Identify new antipsychotics on the Canadian market and discuss their place in therapy 2. List 3-5 key concepts to consider when participating in a development endeavour 3. Explain possible limitations in applying these concepts 3. Describe indications, side effects and other characteristics of the new antipsychotics Self-Assessment Questions Optimizing Vancomycin Dosing: It’s Getting Creepy! 1. What is the efficacy of the new antipsychotics and how does that compare to antipsychotics previously available? Linda A. Sulz, BSP, PharmD, Regina Qu’Appelle Health Region, Regina, SK 2. How should therapy with the new antipsychotics be monitored. Vancomycin has been in use for nearly 50 years to treat patients with serious gram-positive infections, primarily caused by methicillin-resistant Staphylococcus aureus (MRSA). Infections due to MRSA have increased as has vancomycin use which may contribute to rising vancomcyin minimum 39 inhibitory concentration (MICs) among susceptible strains of S. aureus, referred to as ‘MIC creep’. In 2006, S. aureus susceptibility breakpoints for vancomycin were decreased from 8mg/L to 4mg/L due to evidence it was less effective against MRSA with MICs >4 mg/L. Vancomycin failures continue to occur, however, despite in vitro susceptibility, particularly if S. aureus MICs are 1 - 2mg/L. Emerging evidence suggests enhanced bactericidal effect is achieved when the ratio of vancomycin’s area under the concentration-time curve (AUC24) and the MIC exceeds 400. Using this evidence to increase the probability of optimal vancomycin concentrations, and improve clinical outcomes, an update on vancomycin therapeutic monitoring recommends trough levels be minimally 10mg/L and 15 - 20 mg/L in select patients. Few published studies, however, report the clinical relevance of the AUC:MIC and vancomycin trough. A retrospective cohort study of vancomycin in patients with MRSA bacteremia was conducted to determine the correlation of susceptibility to patient outcomes. There were multiple independent predictors of vancomycin failure, including having an initial trough <15 mg/L and isolates with a MIC >1 mg/L supporting achieving an AUC/MIC >400. This must be balanced, however, with the potential for increased toxicity, specifically nephrotoxicity, as was shown when vancomycin was 4g or more/day. Compounding this, is that vancomycin doses are based on total body weight and with our ‘growing’ population, doses greater than 4g are often required in clinical practice. Goals and Objectives 1. To provide an understanding of the basis on which the recommendations for higher vancomycin trough levels in adult patients were made 2. Using actual cases, assist pharmacists to balance individual patient risks to benefits when aiming for the new target vancomycin serum trough levels Self-Assessment Questions 1. What are the potential risks to patients with strict adherence to the higher vancomycin trough levels and how might this be avoided or mitigated? 2. How can the evidence be used to identify which patients will benefit most by achieving target vancomycin trough levels of 15-20mg/L? 40 Lab to Bedside: Optimizing the Pharmacist’s Approach to Microbiology Results Interpretation David Richardson, MD, FRCPC, William Osler Health System, Brampton, ON The purpose of this session is to highlight some challenges related to the use of the Clinical and Laboratory Standards Institute (CLSI) Antimicrobial Susceptibility Testing (AST) Standards in clinical practice. The CLSI publishes the Performance Standards for Antimicrobial Susceptibility Testing (M100) yearly. The subcommittee that develops these standards includes experts in infectious diseases, pharmaceuticals, and medical microbiology. This document suggests the antimicrobials to test and report for groups of organisms, along with interpretive criteria (breakpoints) for those tested. Microbiology laboratories use these standards to help determine which antibiotics to report for a given organism isolated from a given source. Formulary information, antibiogram data, and local epidemiology are also important aspects taken into account when deciding which antibiotics to selectively report. When major revisions are made in the CLSI AST Standards these need to be reviewed carefully by the microbiology laboratory and a plan for implementation developed. This implementation plan requires the input of several key players including infectious diseases physicians, pharmacists, and members of antimicrobial stewardship and infection control programs. Communication regarding changes is paramount to an effective implementation. Goals and Objectives 1. To review the CLSI Antimicrobial Susceptibility Testing Standards with a focus on the aspects important to a clinical pharmacist. 2. To discuss the challenges that can occur when there are major changes to the standards. Self-Assessment Questions 1. What role do changes to AST standards play in a clinical pharmacist’s practice? 2. What mechanism do clinical pharmacists have to learn about changes in antibiotic reporting? Call for Abstracts Demande de résumés 2013 Summer Educational Sessions (SES) Séances éducatives d’été (SÉÉ) 2013 Hyatt Regency, Calgary, Alberta August 10 to 13, 2013 GENERAL INFORMATION Category Author must specify the category that best suits the particular abstract. Abstracts will be judged according to the category submitted to by authors. 1. Original Research (includes Pharmaceutical/Basic Science, Clinical Research, Drug Use Evaluations, Systematic Reviews and Meta-Analysis, Pharmacoeconomics Analysis, etc.) 2. Case Reports 3. Pharmacy Practice (includes Administration Projects, Health Professional Education, Medication Safety Initiatives, etc.) CSHP 2015 CSHP 2015-related abstracts will be designated as such at SES. If your abstract is linked to CSHP 2015 initiatives, please clearly indicate this on the online abstract submission form. Abstract Submissions All abstract submissions must be submitted no later than 18:00 (Eastern Daylight Time) on May 10, 2013. Abstracts must be submitted electronically as a file in MS Word Format. Please complete the abstract submission form online at CSHP’s Web site (http://www.cshp.ca) prior to submitting the abstract. If you are submitting more than one abstract, an abstract submission form must be completed for each abstract. Abstracts are then submitted by e-mail to [email protected]. You will receive a confirmation email if your abstract has been received. Abstract review and grading is conducted by 2 randomly assigned, blinded, and independent reviewers. Abstracts are selected on the basis of scientific merit, originality, level of interest to pharmacists, and compliance with style rules using a standardized scoring system. Guidance for authors and sample abstracts will be available on the CSHP website shortly at www.cshp.ca/event/SES2013. Disagreement between the 2 reviewers will be adjudicated by a third, blinded independent reviewer. The decision of the adjudicator will be the final decision. Failure to comply with style requirements for submission (see below), including submission of an unblinded abstract or any other style rules, will result in automatic rejection of the submission. Abstracts of papers published or in-press are not eligible. Abstracts previously presented at other national or Hyatt Regency, Calgary, Alberta 10 au 13 août 2013 INFORMATION GÉNÉRALE Catégorie L’auteur doit indiquer la catégorie qui sied le mieux au résumé qu’il soumet. Les résumés seront évalués en tenant compte de la catégorie mentionnée par les auteurs. 1. Recherche originale (y compris la recherche pharmaceutique, fondamentale ou clinique, les évaluations de l’utilisation des médicaments, les examens systématiques et les méta-analyses, les analyses pharmacoéconomiques, etc.) 2. Observations cliniques 3. Pratique pharmaceutique (y compris les projets administratifs, la formation des professionnels de la santé, les projets liés à la sécurité des médicaments, etc.) SCPH 2015 Les résumés qui sont en lien avec le projet SCPH 2015 seront désignés comme tels sur les lieux des SÉÉ. Si votre résumé est lié au projet SCPH 2015, assurez-vous de le mentionner clairement sur le formulaire de soumission en ligne de résumés. Soumission de résumés Tous les résumés doivent être soumis au plus tard à 18 h (heure avancée de l’Est) le 10 mai 2013. Les résumés DOIVENT être présentés électroniquement et le fichier doit être en format MS Word. Veuillez remplir le formulaire de soumission de résumés en ligne affiché sur le site Web de la SCPH à http://www.cshp.ca avant de soumettre votre résumé. Si vous présentez plus d’un résumé, vous devez remplir un formulaire pour chaque résumé soumis. Les résumés sont ensuite expédiés par courriel à [email protected]. Vous recevrez un courriel confirmant la réception de votre résumé. Les résumés sont examinés et évalués par deux réviseurs indépendants assignés au hasard et en aveugle. Les résumés sont choisis en tenant compte de leur valeur scientifique, de leur originalité, de leur intérêt pour les pharmaciens et du respect des règles de présentation, ceci à l’aide d’un système normalisé de notation. Des directives à l’intention des auteurs et des exemples de résumés seront affichés d’ici peu sur le site Web de la SCPH à www.cshp.ca/event/SES2013. S’il y a divergence d’opinions entre les deux réviseurs, une troisième personne indépendante examinera le résumé en aveugle et prendra une décision finale. Le non-respect des exigences de présentation des résumés (voir ci-dessous), y compris la soumission d’un résumé dont l’anonymat n’a pas été préservé ou l’utilisation de toute autre règle de présentation, entraînera le rejet automatique de cette soumission. Les résumés d’articles qui ont déjà été publiés ou qui sont sur le point de l’être ne sont pas admissibles. Les résumés qui ont déjà été présentés lors d’un autre congrès national ou international peuvent être pris en considération et peuvent être acceptés comme des reprises s’ils n’ont pas été publiés dans une revue scientifique en tant que comptes rendus d’un congrès. Ces 41 international meetings may be considered for inclusion as encore presentations if they have not been published as an abstract in a scientific journal as conference proceedings. These encore presentations will be marked as such. These submissions must include the original conference/date on the abstract submission form. Abstracts presented previously at national CSHP events (PPC or SES) will not be eligible to be presented again as an encore. Encore abstracts must still follow all style and blinding rules. Accepted abstracts will be published in the final SES 2013 program and also in the Canadian Journal of Hospital Pharmacy. Abstracts will be published as submitted. Authors of accepted abstracts will be notified within 4 weeks of the deadline submission. Authors are responsible for their own transportation and accommodations at SES. Early registration fees will apply to all accepted poster applications. Guidelines for posters will be provided to authors of accepted abstracts. Date and method of presentation will be determined by the Education Services Committee. It is the responsibility of the presenting author to be at their designated poster boards during the poster viewing hours. If the presenting author cannot be there for the assigned date, it is the presenting author’s responsibility to find an alternate author as presenter. Abstract Style Rules Abstracts that do not adhere to the rules will be rejected. Title should be brief and should clearly indicate the nature of the presentation. Capitalize only the first letter of each word of the title. Do not use abbreviations in the title. List the authors (last name, first initial) under the title. Institutional affiliation, city, and province should be listed under the list of authors with reference marks identifying author affiliation(s). Please underline the name of the author who will present the poster if accepted. Omit degrees, titles, and appointments. The required font is Times New Roman, 12 point. Organize the body of the abstract, using the exact headings below, according to the selected category as follows. The abstract (including the title and body) should be blinded and not include any identifying information including the geographic location, authors, programs or institutions of origin. Author names will be removed after submission for blinded review. Original Research: Headings are: Background, Objective(s), Methods, Results, Conclusion(s) The background section should briefly describe the rationale for the study. The objective section should include the main study objective(s). The method section should include study design, methods, intervention, and statistical analysis. The results section should provide main results. The conclusion section should include the main conclusion and interpretation of the results which are supported by the data provided. 42 résumés seront clairement identifiés comme des reprises de présentations antérieures. Le formulaire de soumission doit faire mention de la date et du nom du congrès où le résumé a été présenté auparavant. Les résumés qui ont déjà été présentés à un événement national de la SCPH (CPP ou SÉÉ) ne seront pas admissibles et ne pourront pas être présentés en tant que reprises. Les résumés présentés en reprise doivent tout de même respecter toutes les règles de présentation et d’anonymat. Les résumés qui auront été acceptés seront publiés dans le programme final des SÉÉ 2013 et dans le Journal canadien de la pharmacie hospitalière. Ils y seront publiés tel quel. Les auteurs des résumés choisis seront avisés dans un délai de quatre semaines après la date butoir de soumission. Les auteurs doivent assumer leurs propres frais de déplacement et d’hébergement pour les SÉÉ. Tous les auteurs des résumés acceptés auront droit aux frais d’inscription anticipée. Des directives concernant l’affichage seront fournies aux auteurs dont les résumés auront été acceptés. Il incombe au comité des services éducatifs de décider des dates et des modalités de présentation. L’auteur qui présente le résumé se doit d’être présent à son tableau d’affichage pendant les heures de présentation des affiches. Si l’auteur ne peut être présent à la date assignée, il a la responsabilité de désigner un remplaçant qui pourra en faire la présentation. Règles de présentation des résumés Les résumés qui ne se conforment pas aux règles de présentation seront rejetés. Le titre devrait être bref et indiquer clairement la nature de la présentation. Seule la première lettre du premier mot du titre doit être en majuscule. Le titre ne doit pas contenir d’abréviations. Le nom des auteurs (nom de famille et initiale) doit apparaître sous le titre. Les noms des établissements auxquels sont affiliés les auteurs, la ville et la province où sont situés les établissements devraient être précisés sous la liste des auteurs avec des appels de notes servant à indiquer les affiliations du ou des auteurs. Veuillez souligner le nom de l’auteur qui présentera l’affiche si le résumé est accepté. Les diplômes, les titres et les affectations ne doivent pas être mentionnés. Il faut utiliser la police Times New Roman 12. Le texte du résumé doit être organisé conformément aux règles propres à la catégorie à laquelle il appartient, en utilisant les en-têtes exactes mentionnées ci-dessous. Le résumé (dont le titre et le texte) doit préserver l’anonymat et ne contenir aucune information susceptible de révéler l’emplacement géographique, les auteurs, les programmes et les établissements d’origine. Les noms des auteurs seront retirés après la soumission pour que l’examen soit effectué en aveugle. Recherche originale : Les en-têtes sont : Contexte, Objectif(s), Méthodologie, Résultats, Conclusion(s) Le Contexte devrait décrire brièvement la raison d’être de l’étude. L’Objectif devrait inclure les principaux objectifs de l’étude. La Méthodologie devrait inclure le plan de l’étude, la méthodologie, les interventions et l’analyse statistique. La rubrique Résultats devrait fournir les principaux résultats obtenus. La Conclusion devrait comprendre la conclusion principale et l’interprétation des résultats qui sont supportés par les données fournies. Case Reports: Observations cliniques : Headings are: Background, Case description, Assessment of causality, Literature review, Importance to practitioners Les en-têtes sont : Contexte, Description du cas, Analyse de causalité, Évaluation de la documentation, Importance pour les praticiens. The background section should briefly describe the rationale for the case report. The case description should provide details of the case. Enough details should be provided to clearly outline the case and support the assessment of causality. The assessment of causality section should describe assessment of causality. Strong consideration should be given to using an objective tool such as the Naranjo scale. The literature review section should briefly examine current literature relating to or surrounding the case report. The importance to practitioners section should briefly describe implications/importance of the case report to pharmacy practitioners. Le Contexte devrait décrire brièvement la raison d’être de l’observation clinique. La Description devrait fournir des détails sur le cas étudié. Les détails devraient être suffisamment nombreux pour définir clairement le cas à l’étude et soutenir l’analyse de causalité. L’Analyse de causalité devrait donner une description de l’analyse de causalité. Il est fortement recommandé d’utiliser un outil objectif comme l’échelle de Naranjo. L’Évaluation de la documentation devrait examiner brièvement la documentation existante liée ou apparentée à l’étude de cas. La rubrique Importance pour les praticiens devrait décrire brièvement les répercussions de l’observation clinique sur les soins aux patients et son importance pour les pharmaciens. Pharmacy Practice: Pratique pharmaceutique : Headings are: Background, Description, Action, Evaluation, Implications Les en-têtes sont : Contexte, Description, Action, Évaluation, Répercussions The background section should briefly describe background and rationale for service, program, problem, need, etc. The description section should describe the concept, service, role, or situation. The action section should describe the steps taken to identify and resolve a problem(s), implement change, or develop and implement the new program. The evaluation should describe the evaluation process of the project and results of evaluation. The implications section should describe the concept’s importance and usefulness to current and/or future practice. Le Contexte devrait décrire brièvement la toile de fond et la raison d’être du service, du programme, du problème, du besoin, etc. La Description devrait fournir des détails sur le concept, le service, le rôle ou la situation. La rubrique Action devrait décrire les étapes prises pour cerner et résoudre les problèmes, effectuer le changement, ou développer et entreprendre le nouveau programme. L’Évaluation devrait décrire le processus utilisé pour l’évaluation du projet et les résultats de l’évaluation. La rubrique Répercussions devrait énoncer l’importance du concept et l’utilité pour la pratique actuelle et future. Abstract Text • Le corps du résumé (excluant le titre et les auteurs) ne doit pas dépasser 300 mots. Ceci comprend les en-têtes requises comme mentionné précédemment. Tout résumé qui dépasse le nombre de mots permis sera rejeté. • Un tableau compte pour 30 mots. • Un graphique compte pour 60 mots. • Les résultats ou l’évaluation doivent être inclus dans le résumé. Il est inacceptable de mentionner que les résultats seront discutés. Les résumés qui procèdent de cette manière seront rejetés. • Le début des paragraphes ne doit pas être précédé d’un alinéa. • Placer les abréviations entre parenthèses après le terme qu’elles remplaceront, la première fois que le terme est utilisé. Veuillez limiter au minimum l’utilisation d’abréviations. • Les nombres doivent être écrits en chiffres, sauf lorsqu’ils s’agit du premier mot d’une phrase. • Seuls les noms génériques des médicaments, du matériel, des instruments et de l’équipement doivent être employés. • Les résumés ne doivent pas contenir de citations ni de numéros de référence. Abstract body (not including title and authors) is limited to 300 words. This includes the required section headings as outlined above. Any abstract that exceed the word count will be rejected. • Each table is equivalent to 30 words. • Each graphic is equivalent to 60 words. • Results or evaluation must be included in the abstract. It is not acceptable to state that results will be discussed. Abstracts doing so will be rejected. • Do not indent the start of a paragraph. • Place abbreviations in parentheses after the full word the first time it appears. Please keep abbreviated terms to a minimum. • Use numerals to indicate numbers, except to begin sentences. • Use only generic names of drugs, material, devices, and equipment. • Do not include citations or reference numbers. Email Confirmation of Abstract Submissions You should receive an email confirmation of your abstract submission. If you have not received an email confirmation by the deadline, please contact Desarae Davidson: Tel.: (613) 736-9733, ext. 229 Fax: (613) 736-5660 Email: [email protected] Texte du résumé : Confirmation par courriel de la réception du résumé Vous devriez recevoir une confirmation par courriel de la réception de votre résumé. Si vous n’avez pas reçu de confirmation par courriel avant la date limite, veuillez communiquer avec madame Desarae Davidson: Téléphone : (613) 736-9733, poste 229 Télécopieur : (613) 736-5660 Courriel : [email protected] 43 Oral Presentations of Award-Winning Projects and Original Research Présentations orales de projets primés et de recherche originale 1 Dept of Psychology, Mount Allison University, Sackville, NB Pharmacy Services, Horizon Health Network, NB 3 College of Pharmacy, Dalhousie University, Halifax, NS 2 Rationale: Recently discharged patients were surveyed about their preferences for pharmacy services as part of a phone questionnaire to determine the percentage of patients who recalled interacting with the pharmacist during their hospital admission (CSHP 2015 Objective 1.5). Objective: To analyse content of former patients’ open-ended survey responses to a telephone questionnaire. Monday February 4 Lundi 4 février 11:40-12:25 Conference D/E 1. Clinical Benefits and Economic Impact of Post-surgical Care Provided by Pharmacists in a Canadian Hospital 2. What Patients Want: Preferences Regarding Hospital Pharmacy Services 3. Medication Reconciliation Standardization in a Regional Health Authority Renal Program Clinical Benefits and Economic Impact of Post-Surgical Care Provided by Pharmacists in a Canadian Hospital Neville H.L., Chevalier B., Daley C., Nodwell L., Harding C., Hiltz A., MacDonald T., Skedgel C., MacKinnon N.J., Slayter K., Capital District Health Authority, Halifax, NS Rationale: The impact of clinical pharmacists on improving the quality of patient care in surgery is not well described. Objectives: The objective was to prospectively evaluate clinical and economic outcomes after clinical pharmacist services were added to two general surgery wards in an adult tertiary care centre. Study Design & Methods: This was a prospective, observational study. All clinical interventions were documented and assessed for severity, value and the probability of preventing adverse drug events (ADE). Cost avoidance was calculated using two methods: by avoiding additional days in hospital ($3593/ADE) or additional hospital costs ($7215/ADE). Two pharmacists independently categorized the interventions; disagreements were resolved by consensus. Results: The pharmacists made 1097 interventions in six months with a 98% acceptance rate by surgical staff. Half of the interventions were rated significant for severity (561, 51.1%) and value (559, 51.0%). One-quarter of the interventions had a 40% or greater probability of preventing an ADE (270, 24.6%). Cost avoidance was estimated to be $0.68 – 1.36 million or $617 to $1239 per intervention. Conclusions: The importance of having pharmacists manage the drug therapy needs of the post-surgical patient was demonstrated. Investments in a clinical pharmacist position in surgery may yield a benefit to cost ratio of 7:1. Key words: clinical pharmacist, cost avoidance, interventions, quality, surgery What Patients Want: Preferences Regarding Hospital Pharmacy Services Paula Buckley1, Odette Gould1, Douglas Doucette2,3 44 Methods: A telephone questionnaire was conducted with former inpatients randomly selected following discharge from hospitals in Horizon Health Network, New Brunswick. Responses were recorded to the question “what service or information would you like a pharmacist to provide in the hospital that would most help you in managing your medications?” Two raters established response categories, obtained acceptable inter-rater agreement, and independently scored the survey responses. Results: Sixty-three percent (n=445) of all responses obtained were related to Information About Medication (e.g. purpose, adherence, side effects). Self-Disclosure (23.7%, n=167), detailing experiences with pharmacies, medication or hospital, was the second most common global category. Subjects’ responses were less frequently associated with Pharmacy Services (7.7%, n=54) and their Information Source for Medications (5.3%, n=37). Conclusions: Most patients would like a pharmacist to provide a general medication overview during their admission. Results suggest many patients are unaware of other clinical pharmacy services. Key words: clinical pharmacy services, expanded pharmacy services, patient expectations Medication Reconciliation Standardization in a Regional Health Authority Renal Program Mary Lou Lester, Piera Calissi, Interior Health Renal Program, Kelowna, BC Background: Maintenance of an up-to-date medication list, using medication reconciliation (MedRec) to identify discrepancies, has been shown to reduce adverse drug events in hemodialysis patients. Objectives: Develop and implement a renal program-wide, sustainable MedRec program primarily using nurses. Methods: The project team worked with the hemodialysis nurses to develop a standardized MedRec process utilizing the provincial patient database and guidelines from Safer Healthcare Now. The nurses were educated and given tools to support them to gather a best possible medication history (BPMH). An Evaluation Analyst developed a Logic Model and Data Collection Plan to support the project. Results: After one year, the percentage of medications with a discrepancy and the average number fell from 23% to 15% and 3.9 to 2.7 per patient, respectively. Over 85% of the staff surveyed stated that there were now clear processes and tools in place to conduct a BPMH, update the medication lists in the provincial renal database, and to communicate the medication information to the patient and other caregivers. Conclusions: A project team consisting of three hospital pharmacists with support from an Evaluation Analyst was able to successfully standardize a MedRec process in a regional outpatient HD program primarily using nurses. Key Words: medication reconciliation, hemodialysis, renal, BPMH (best possible medication history). Poster Sessions Séances d’affichage There are two different types of poster presentations at PPC 2012. A Facilitated Poster session on Sunday and traditional Poster sessions on Monday, Tuesday and Wednesday. Deux types de présentation par affiches seront offerts dans le cadre de la CPP 2013. Une séance animée de présentations par affiches qui se tiendra le dimanche et des séances traditionnelles d’affichage qui auront lieu lundi, mardi et mercredi. Facilitated Poster Session Posters in the facilitated poster session consist of a mixture of award winners and those abstracts submitted in the categories of original research and pharmacy practice. They are grouped as 5 or 6 posters with similar themes outlined below. The author of each poster will do a 6 minute presentation in front of their poster highlighting the key points of their work. This will be followed by questions and group discussion. The presentations within each group will occur in sequence as the participants move from one poster to the next. The session is scheduled from 09:30 to 11:30, but posters will be displayed throughout the day. Traditional Poster Session Posters in the traditional sessions were selected from those submitted in the categories of original research and pharmacy practice. Although no formal presentations will occur, the author of each poster will be available during the presentation timeslot for discussion and questions. Posters will be available for viewing throughout the day. CSHP 2015 CSHP 2015 is a quality program that sets out a vision of pharmacy practice excellence in the year 2015. Through this project, CSHP challenges hospital pharmacists to reach measurable targets for 36 objectives grouped under 6 goals, all aimed toward the effective, scientific, and safe use of medications and meaningful contributions to public health. CSHP 2015 applies to inpatients and outpatients, community and hospital pharmacists, and all practice settings. Posters identified with a “CSHP 2015” logo are those judged by the CSHP 2015 Steering Committee to be particularly relevant to one or more of the 36 objectives. Séance animée d’affichage Les affiches de la séance animée d’affichage sont formées d’un mélange de résumés primés et de résumés soumis dans les catégories recherche originale et pratique de la pharmacie. Elles sont combinées en groupes de cinq ou six affiches ayant des thèmes similaires comme il est fait mention ci-dessous. L’auteur de chaque affiche fera une présentation de six minutes devant son affiche, faisant ressortir les principaux points de son travail. Cette présentation sera suivie d’une période de questions et d’une discussion de groupe. Les présentations à l’intérieur de chaque groupe auront lieu les unes à la suite des autres au fur et à mesure que les participants se déplaceront d’une affiche à la suivante. Cette séance se déroulera de 9 h 30 à 11 h 30. Séance traditionnelle d’affichage Les affiches pour les séances traditionnelles ont été choisies parmi celles soumises dans les catégories recherche originale et pratique de la pharmacie. Bien qu’aucune présentation officielle n’ait été prévue, les auteurs de chaque affiche seront sur place pendant les heures d’affichage et pourront répondre aux questions et s’entretenir avec vous. Les affiches pourront être examinées tout au long de la journée. SCPH 2015 Le projet SCPH 2015 est un programme axé sur la qualité qui propose une vision de l’excellence en pratique pharmaceutique en l’an 2015. Au moyen de ce projet, la SCPH met les pharmaciens d’établissements au défi d’atteindre les cibles mesurables de 36 objectifs répartis entre 6 buts, visant tous l’utilisation efficace, scientifique et sûre des médicaments ainsi que des contributions significatives à la santé publique. Le projet SCPH 2015 s’applique aux patients hospitalisés et externes, aux pharmaciens d’hôpitaux et communautaires, et à tous les milieux de pratique. Les affiches marquées du logo « SCPH 2015 » sont celles que le comité directeur du projet SCPH 2015 a jugé particulièrement appropriées à l’un ou l’autre des 36 objectifs. Sunday, February 3 Dimanche 3 février 4. Dextromethorphan in the Treatment and Prevention of Methotrexate Induced Neurotoxicity in Pediatric Patients with Acute Lymphoblastic Leukemia 09:30-11:30 (presentations) Vide and Grand Ballroom Foyer (lower concourse) 5. The Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD-PICU) Facilitated Poster Sessions: Discussion of Original Research, Award Winning Projects and Pharmacy Practice Projects Séance animée de présentations par affiches: Discussions sur Clinical des projets de recherche originale, des projets primés et des projets dans le domaine de la pratique pharmaceutique 1. Evaluation of In-Hospital and Post-Discharge Utilization of Preventative Cardiovascular Pharmacotherapy in Patients who have Undergone Coronary Artery Bypass Graft Surgery Infectious Disease/Paediatrics 2. Efficacy of Telepharmacist Directed Anticoagulation Management Service 1. Needs Assessment for Antimicrobial Stewardship in Long-Term Care: A Descriptive Study and Survey 2. Evaluation of an Antimicrobial Stewardship Program in a General Medicine Unit and an Intensive Care Unit using Historical and Concurrent Control Groups 3. Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE) 3. Pharmacists Focus on Opioid Management within an Interprofesional Ambulatory Clinic Specializing in Chronic Pain Disorders 4. Assessment of Patient Post-Operative Pain Management Before and After Implementation of a Pain Management Pathway 5. Evaluation of a Discharge Process Implemented on a Stroke-Medicine Unit in a Community Teaching Hospital 45 Safety 1. Expanding the Role of Medication Reconciliation Teams in Optimizing Pediatric Outcomes 2. Interdisciplinary Medication Safety Initiative to Improve Narcotic Use Practices in a Post Anesthesia Care Unit (PACU) 3. Analysis of Opioid Incidents Requiring Naloxone Administration 4. Development of a Training Program for Hazardous Drugs Handling 5. Multicenter Study of Environmental Contamination with Hazardous Drugs in Hospitals Professional Practice 1. Enhancing Collaborative Pharmaceutical Care for Chronic Kidney Disease Patients – Survey of Community Pharmacists 2. Exploring Alternative Funding of Rituximab for Rheumatology Clinic Patients: A Pharmacy Let Interprofessional Collaboration Pilot 3. Development of a Pharmacy Department Teaching Guideline in the Era of Expanded Experiential Education 4. What are the Appropriate Selection Criteria for National Hospital Clinical Pharmacy Key Performance Indicators (cpKPI)? 5. Ranking of Healthcare Programs Based on Health Outcome, Health Costs and Safe Delivery of Care in Hospital Pharmacy Practice Monday, February 4 Lundi 4 février 09:45-10:15 (viewing) 13:15-13:50 (presentations) Sheraton/Osgoode Halls 1. Evaluation of Students' Experience in the “Foundations for Advanced Pharmacy Practice” Rotation 2. Assessment of Implementing Disease State Education Modules and its Effect on Specific Pharmacist Interventions: AIMS Study 3. Comparison of the Consistent and Consult-Based Pharmacy Practice Models in a Heart Failure Clinic 4. Exploration of a Primary Care Pharmacy Specialty Network Listserv Archive Using Analysis 5. Implementation of a United States Pharmacopeia (USP) 797 Compliant Central Intravenous Admixture Program 6. Impact of a Pre-Printed Care Order on Influenza and Pneumococcal Vaccination Rates in Older Inpatients in Medicine Units 7. Drug Samples in Outpatient Units: A Constant Problem 8. Impact and Appreciation of Two Methods Aiming at Reducing Hazardous Drug Environmental Contamination: Centralized of Tuve Priming in the Pharmacy and Use of a Closed-System Transfer Device 9. Multicenter Study Environmental Contamination with Hazardous Drugs in 33 Canadian Hospitals 10. Environmental Contamination with Methotrexate in Canadian Retail Pharmacies 11. Exploration des données de doses définies journalières et jours de traitements en pédiatrie – une analyse comparative 2001-2002, 2005-2006 et 2010-2011 12. Mise à jour des soins pharmaceutigues pédiatriques en clinique de VIH-SIDA 46 Tuesday, February 5 Mardi 5 février 09:45-10:15 (viewing) 13:15-13:50 (presentations) Sheraton/Osgoode Halls 1. Drug Availability in Canada: What Should Hospital Pharmacists Consider? 2. Perception of the Impact of Drug Shortages on Healthcare Professionals and Patients in Canada 3. Implantation d'une nouvelle rѐgle d'utilisation de las vancomycine: une étude pré-post 4. Does Interprofessional Medication Reconciliation from Admission to Discharge Reduce Post- Discharge Patient Emergency Department Visits and Hospital Readmissions? 5. Dissemination of Pharmacy-Initiated Medication Outcome Monitoring Procedure for Nurses in a Long-Term Care Hospital 6. Pharmacists' Interventions During the Periodic Medication Review Reduce Preventable Adverse Drug Events 7. What are the Appropriate Candidate Clinical Pharmacy Key Performance Indicators (cpKPI) for Hospital Pharmacists? 8. Evaluation of Cancer Treatment Order Entry by a Clinical Support Pharmacy Technician (Oncology) in a Medical Day Unit 9. Evaluation of the Impact of a Pre-Admission Best Possible Medication History on the Admission Medication Reconciliation Rate Among Surgical In-Patients 10. Can a Culture of Safety be Enhanced in a Department of Pharmacy? 11. Removal of Concentrated Electrolyte from Patient Care Areas: A Focus on Magnesium Sulfate Injection: Patient Safety and Drug Shortage Implication 12. A Before and After Study of the Implementation of Bedside Medication Storage and Prefilled Narcotics Syringes to a Post Anesthesia Care Unit Wednesday, February 6 Mercredi 6 février 10:15-10:45 (presentations) Grand Ballroom Foyer 1. Facilitating Improved Glycemic Control in the Non-Critically Ill Inpatient Setting 2. Mechanical Mitral Valve Thrombosis with Dabigatran 3. Quetiapine- Associated Serotonin Syndrome: A Case Report 4. Dabigatran Etexilate: A Qualitative Study of Administration, Adherence, Proper Storage and Patient Satisfaction in Ambulatory Patients 5. Evaluation of Antimicrobial Stewardship Program on Leukemia Service Through Prospective Audit and Feedback 6. Determination of Vancomycin Pharmacokinetics in Neonates to Develop Practical Initial Dosing Recommendations 7. Assessing the Adequacy of Documentation in Patients Receiving Antibiotic Therapy 8. A Survey to Evaluate Critical Care Trainee's Perception of Antimicrobial Stewardship Programs in Intensive Care Units 9. Empiric Antibiotic Prescribing for Urosepsis in the Emergency Department Sunday, February 3 Dimanche 3 février Lisa Dong-Ying Wu, Sandra A. N. Walker, Marion Elligsen, Lesley Palmay, Andrew Simor, Nick Daneman, Sunnybrook Health Sciences Centre, Toronto, ON (intervention groups) receiving antimicrobial agents were assessed by the ASP team using prospective audit and feedback. Drug utilization as defined daily doses (DDDs) and costs were compared using two different controls. For each unit the historical control consisted of antimicrobial utilization and cost on the intervention unit for the same time period in the previous year. The concurrent control consisted of the change in antimicrobial utilization and cost between the same two time periods on a similar unit at the alternate campus without ASP intervention (i.e., GM unit at Campus 2 and ICU at Campus 1). Rationale: Recent evidence suggests long-term care (LTC) patients Results Needs Assessment for Antimicrobial Stewardship in Long-Term Care: A Descriptive Study and Survey may benefit from antimicrobial stewardship interventions to optimize antibiotic use through standardization of treatments, indications and duration of therapy. Objectives: The objectives were to assess antibiotic use and need for antimicrobial stewardship services in LTC and to identify LTC health professionals’ perspectives regarding antimicrobial stewardship enhancement at their institution. Metric Study Design and Methods: A retrospective descriptive study of antibiotic use was conducted among elderly patients (n=336) residing in a 17-unit LTC facility at Sunnybrook Health Sciences Centre, Ontario, Canada between April 1,2011 to March 31,2012 using a computerized database. Sunnybrook LTC health professionals (n=15; 9 physicians, 5 pharmacists and 1 nurse) were surveyed with an online Google™ Docs Form. General DDDs/1000 Medicine patient-days for Unit all antimicrobial agents Results: There were 358 patient encounters, 835 antibiotic prescriptions, 275 cultures and 170 sensitivities analyzed. The palliative care unit had the highest number of patient encounters (28.5%) and the physical support unit had the highest mean antibiotic orders per patient encounter (4.09). Most antibiotic courses (83.7%) were <10 days. Cephalosporins (30.1%) and fluoroquinolones (28.1%) were the antimicrobials most frequently used. Urine was the most common culture source (59.3%) and Escherichia coli (38%) was the most common bacteria identified in urine. Most apparent urinary tract infections were treated with ciprofloxacin (34%); yet sensitivity data revealed 32% of E.coli were ciprofloxacin-resistant in LTC. The online survey had a 60% response rate (9/15; 4 physicians, 4 pharmacists, and 1 nurse) and found that 33% of respondents thought current antibiotic use in LTC was sub-optimal and 67% regarded antimicrobial stewardship service to be important in LTC. ICU Intervention unit (Oct-Dec 2011, with ASP) vs. historical control (same unit, Oct-Dec 2010, no ASP) Concurrent control (Oct-Dec 2011 vs. Oct-Dec 2010, similar unit as intervention group, different campus, no ASP) - 25% + 7% Total cost for all antimicrobial agents - 45% (CAN$13K) + 40% (CAN$7K) DDDs/1000 patient-days for all antimicrobial agents - 13% Total cost for all antimicrobial agents - 49% (CAN$28K) + 26 % (CAN$20K) + 1% Conclusion: Compared to the previous year impressive changes were observed in drug utilization and cost with the introduction of an ASP. These were validated by use of a concurrent control unit. Based on these positive results, the antimicrobial stewardship program was broadened. CSHP 2 Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE) Conclusion: Our study identified that focussed antimicrobial stewardship may be required in our extended care units. Targeted surveillance of all patients with urine cultures may be the antimicrobial stewardship initiative that would have the greatest impact in our LTC units. See Speaker Abstract on page 31. Evaluation of an Antimicrobial Stewardship Program in a General Medicine Unit and an Intensive Care Unit using Historical and Concurrent Control Groups Dextromethorphan in the Treatment and Prevention of Methotrexate Induced Neurotoxicity in Pediatric Patients with Acute Lymphoblastic Leukemia Lizanne C. Béïque1,2, Rosemary Zvonar1, Gary E. Garber1,2,3 Keith Miller, Jessica Stovel, London Health Sciences Centre, London, ON 1 The Ottawa Hospital, Ottawa, Ontario 2 University of Ottawa 3 Ottawa Hospital Research Institute Background and Rationale: Methotrexate (MTX) is an essential component of treatment for acute lymphoblastic leukemia (ALL). Neurotoxicity is a frequent complication of methotrexate therapy that may affect non-compliance and have potential long-term implications. Dextromethorphan (DM), a non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor has been used as a neuroprotectant to prevent and treat neurotoxicity without prohibitive toxicity. Rationale: In 2011, an Antimicrobial Stewardship Program (ASP) was introduced on a General Medicine (GM) unit and an Intensive Care Unit (ICU) in a 1000-bed tertiary care hospital. Since acute care beds are distributed over two geographically distinct campuses with some overlap in services, there was a unique opportunity to examine antimicrobial use using the alternate campus as a comparator. Objectives: To assess the impact of an ASP on a GM unit and in the ICU using both historical and concurrent control groups. Study Design and Methods: An ASP was introduced and piloted on a GM unit at Campus 1 and an ICU at Campus 2 between October and December 2011. Patients on these two units Targeting Excellence in Pharmacy Practice Eric Landry, BSP, Saskatoon Health Region, Regina, SK Objective: We report a case series examining the use of DM in the treatment and prevention of MTX neurotoxicity. A retrospective chart review of ALL patients known to have experienced neurologic sequellae secondary to methotrexate and/or patients who received DM during the course of treatment was conducted to determine the prescribing patterns of DM. 47 Results: 8 ALL pediatric patients (6 female, mean age 9 years) after receiving IT MTX (mean 8.1 days) experienced neurological adverse events (vomiting (37%), headache (87%), lethargy (50%), seizures (50%), encephalopathy (12%), arthralgia (37%), hemiparesis (62%), ataxia (12%)). Six of the patients received dextromethorphan treatment at a mean dose of 3.7 mg/kg/day. All of the patients treated with DM experienced a resolution of symptoms following a mean of 5 days. Six of these patients who received subsequent doses of IT MTX were treated prophylactically with a mean dose of 2.5 mg/kg divided twice daily, 24 hours prior to administration and for 48 hours post IT MTX administration. Two of the 6 patients who received prophylactic doses experienced recurrent neurotoxic episodes. Conclusions: These results suggest that dextromethorphan should be considered as an adjunct therapeutic agent to use in patients who experience methotrexate-induced neurotoxicity. Prophylactic use of dextromethorphan may prevent the negative neurologic outcomes observed among pediatric patients with leukemia treated with repeated doses of intrathecal MTX. Further prospective research is required to support the use of DM to prevent or treat MTX neurotoxicity. The Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD-PICU) Laura Carney, Jennifer Kendrick, Roxane Carr, Children’s and Women’s Health Centre of BC, Vancouver, BC Background: Critically ill children require sedation for comfort and to facilitate interventions. Dexmedetomidine is a newer sedative with little safety data in pediatrics, particularly with durations of therapy greater than 48 hours. Objective: To quantify the frequency of adverse events and withdrawal syndromes associated with dexmedetomidine and describe its use for continuous sedation in critically ill children. inhibitors or angiotensin receptor blockers), are recommended in patients who have undergone coronary artery bypass graft (CABG) surgery. Objective: To evaluate the rate of secondary prevention medication utilization from discharge to one-year post-CABG surgery for a cohort of adult patients at the Mazankowski Alberta Heart Institute in Edmonton, Alberta. Study Design Methods: A retrospective analysis was performed using a clinical patient registry. A randomly selected subset of patients was invited to evaluate medication utilization at one-year post-surgery using community pharmacy records. Results: The registry identified 1,031 patients. The mean age was 66 years and 80% were male. The proportion of patients discharged on all four medications post-CABG surgery was 35%. The individual utilization rates for ASA, statins, -blockers and angiotensin-modulating agents were 96%, 94%, 92% and 42%, respectively. Of the patients invited to participate in the one-year evaluation, 151 (39%) provided consent. The proportion of patients on all four medications at one-year was 48%. Individual utilization rates for ASA, statins, -blockers and angiotensin-modulating agents were 95%, 84%, 84% and 65%, respectively. Conclusion: The rate of utilization of four secondary prevention medications was 35% at discharge and 48% at one-year post-CABG surgery. These rates were primarily limited by the low use of angiotensin-modulating agents. Efficacy of a Telepharmacist Directed Anticoagulation Management Service Cody Hotel1, Kurt Schroeder1,2, Teryl Gosnell2, Theresa Crann2, Kevin McDonald2 1 2 Interlake Regional Health Authority, Selkirk, MB Northwest Telepharmacy Solutions, Winnipeg, MB Methods: A retrospective medical record review of patients who Rationale: High staff turnover rates in remote communities are received dexmedetomidine for sedation in the Pediatric Intensive Care Unit. Adverse events were assessed using a Naranjo Score to determine the likelihood of an association with dexmedetomidine. common, and can result in suboptimal care for the patients of those areas. These issues become especially important in situations that require close monitoring of therapy. Pharmacist involvement in warfarin dosing and management has been shown to improve patient outcomes through increased %-time in range (%-TIR) and decreased bleeding and thrombotic events. Results: Included were 144 patients (median age 34 months (range 0 to 17.7 years)) with 153 treatment courses. Mean infusion rate was 0.42 (SD 0.17; range 0.05 to 2) mcg/kg/h. Median therapy duration was 20.5 (range 0.75 to 854.75) hours. Hypotension (N=81 (52.9%)) and bradycardia (N=38 (24.8%)) were the most common adverse events, and were “probably” attributable to dexmedetomidine in 17 (11%) and 9 (6%) of treatment courses, respectively. Agitation and hypertension were the most common withdrawal symptoms observed. Conclusions: Dexmedetomidine is commonly administered for greater than 24 hours in our institution and is generally well tolerated. Patients receiving dexmedetomidine for over 24 hours should be monitored for withdrawal following discontinuation. Key Words: Dexmedetomidine, Critical Care, Children, Sedation Evaluation of In-Hospital and Post-Discharge Utilization of Preventative Cardiovascular Pharmacotherapy in Patients who have Undergone Coronary Artery Bypass Graft Surgery Arden R. Barry, Mazankowski Alberta Heart Institute, Alberta Health Services, Sheri L. Koshman, Division of Cardiology, University of Alberta, Colleen M. Norris, Division of Cardiac Surgery, University of Alberta, David B. Ross, Division of Cardiac Surgery, University of Alberta, Glen J. Pearson, Division of Cardiology, University of Alberta, Edmonton, AB Rationale: Secondary prevention medications, including acetylsalicylic acid (ASA), statins, -blockers and angiotensin-modulating agents (angiotensin-converting enzyme 48 Description and Implementation: A pharmacist directed anticoagulation program was developed by a telepharmacy service to provide stable, accessible care to a remote community. An advanced directive for automatic pharmacist-assisted warfarin dosing was established for patients in the region. Physicians enrolled patients in the program after giving the first warfarin dose and International Normalized Ratio (INR) test. Telepharmacists entered patient data into the DawnAC computer software, and proceeded to dose warfarin based on INR. Two telepharmacists remotely accessed lab data, faxed patient specific dosing letters to corresponding community health centres, and faxed prescriptions to retail pharmacies. Telepharmacists also contacted patients/caregivers at home, providing education, dosing information, and test dates, or to ask questions pertaining to therapy. Evaluation: From August 1st, 2011 to July 31st, 2012, there were 66 active patients in the program spread out over 6 small communities in the region. In that period, patients had a %-TIR of 67.1%, were above range 10.6% of the time, and below range 22.3% of the time. Aside from clinical outcomes, patients experienced improved quality of care as a result of regular follow-up, continuity of care, and increased access to a pharmacist for education. Barriers included language (Cree vs. English), difficulty in accessing INR testing, and on occasion decreased communication with patients who did not own a phone. Impact/Importance: The telepharmacist directed service was found to be both an effective and practical method of intervention, resulting in improved outcomes for the patients. CSHP 2 Targeting Excellence in Pharmacy Practice Pharmacists Focus on Opioid Management within an Interprofessional Ambulatory Clinic Specializing In Chronic Pain Disorders Karen Ng, Altum Health, University Health Network, Toronto Ontario, Victoria Su, Altum Health, University Health Network, Toronto, Ontario, Laura Murphy, University Health Network, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario Study Design and Methods: After local REB approval, we conducted a retrospective review of 120 consecutive patients, 80 from before the POPMA, and 40 following the introduction of the POPMA. We collected pertinent analgesia outcomes, and medications administered from the time of admission to discharge. The two patient groups were analyzed for differences in continuous outcomes with a t-test, and in categorical variables with a chi square analysis. Results: The primary mode of analgesia was significantly changed rehabilitation for injured workers created new clinical pharmacist positions in 2009. This coincided with the publication of recent Canadian guidelines on opioid use in chronic non-cancer pain (CNCP), and was primarily in response to increasing demand from third party payers for medication assessments and opioid management strategies for patients. from PCA to OMA (p<0.001). Pain scores at rest (adjusted difference 0.88, p = 0.004) and with activity (1.21, p = 0.001) were higher in the post group. Nausea was not statistically different on post-op days 1 or 2 (p=0.122, p=0.059). There was no change in pruritus, sedation or bowel activity. Patients in the post group trended toward earlier mobilization (p=0.144). Discharge occurred sooner in the post group (3.41d vs 2.97d; p = 0.036). Description: Pharmacists complete medication assessments in Conclusion: The POPMA was successful in minimizing the use of collaboration with clinic physicians focusing on chronic pain, opioid dependence, and mental health disorders. Formal reports outlining an opioid management plan for implementation by patients’ family physicians are completed. Selected patients engage in interprofessional treatment programs which include pharmacist consultations to recommend and monitor opioid rotations, opioid tapering, initiation of alternative pain medications, and management of side effects. PCA in post-gynecologic surgery patients. A statistically significant increase in post-operative pain was noted between groups; however this increase is not arguably significant clinically. Patients tended to mobilize sooner in the recovery period without PCA. Discharge home was facilitated by OMA and early mobilization. A trend toward an increase in nausea may be due to oral medication administration on an empty stomach. Rationale: A hospital ambulatory clinic focusing on functional Steps Taken: After an initial pilot with a 0.5 full time equivalent (FTE) pharmacist, pharmacy services expanded to 3 FTE positions. Pharmacists developed standardized processes and documentation templates for medication assessments and consultations, and participated in expansion of services to patients with substance use disorders. Evaluation: Retrospective chart review of patients who completed assessment and further pharmacist consultations from January 2011 to June 2012. Patients were identified from billing data and clinical reports. Pharmacists completed 433 medication assessments during the study period. Twenty-nine patients assessed had follow-up pharmacist consultations; of these, 21 patients had opioid reduction as a treatment goal. Average daily morphine equivalence (ME) at the time of assessment was 358mg, and patients reduced their ME by an average of 26%. Importance: Pharmacists focused on opioid management in clinic patients through medication assessment and consultations. This focus addresses an increasing need for collaboration between pharmacists and community physicians. Future growth opportunities include collaboration with clinic anesthesiologists to optimize pain management, and mentorship of community pharmacists to provide standardized opioid assessments and to collaborate with prescribers in their areas. Assessment of Patient Post-Operative Pain Management Before and After Implementation of a Pain Management Pathway Melanie MacInnis; Hamilton Health Sciences, Hamilton, ON, James Paul; Hamilton Health Sciences, Hamilton, ON, Lori Olivieri; Hamilton Health Sciences, Hamilton, ON Rationale: A post-operative pain management algorithm (POPMA) was implemented in collaboration with anesthesiologists and gynecologic surgeons. The POPMA provided guidance for therapy selection based on patient characteristics and promoted oral multi-modal analgesia (OMA) over patient controlled analgesia (PCA). Objectives: To evaluate the impact of a POPMA on pain control and recovery from surgery. The outcomes measured included prescriber’s compliance to the pain algorithm; VAS pain scores; nausea and vomiting; pruritus; sedation; bowel recovery; mobilization; and time to discharge. CSHP 2 Targeting Excellence in Pharmacy Practice Evaluation of a Discharge Process Implemented on a Stroke-Medicine Unit in a Community Teaching Hospital Monica Lee, Parisa Parnian, Rochelle Liem, Vickie Chang, Thomas Chan, Celina Dara, Sharon Eng, Edith Rolko, North York General Hospital, Toronto, ON, Princess Margaret Hospital, University Health Network, Toronto, ON Rationale: Ensuring the completion of medication reconciliation and patient counselling at the point of discharge may help reduce hospital readmissions. These objectives are also in alignment with the CSHP 2015 goals. We sought to characterize the drug-related issues identified at patient discharge, and the pharmacist workload associated with a newly-implemented discharge process. Description and Steps Taken: Components of the discharge process were defined. Criteria were developed for identifying patients with complex and/or high-risk medication regimens who would benefit from the discharge process. A database was created to document the issues identified, interventions made and the time spent on each discharge. The process was then implemented on a 35-bed stroke-medicine unit, where patients were previously identified to have a high readmission rate. Evaluation: During a 6-month period, pharmacists applied the discharge process to 318 (77.6%) of the 410 eligible patients. Discharge medication reconciliation was performed by the physicians in 270 (84.9%) patients. One hundred and ten drug-related issues were noted in 61 (19.2%) patients. Discrepancies frequently identified were discontinued drug inadvertently resumed upon discharge (32.7%), omitted drug (18.2%), and discrepant dose and/or frequency (8.2%). Drug therapy problems encountered include inappropriate dose (9.1%) and drug not indicated (8.2%). Discharge counselling was provided to 223 (70.1%) patients and/or their caregivers. Of the patients who did not receive the discharge process, 44.2% did not have medication reconciliation completed by the physicians. On average, pharmacists spent 25 minutes per discharge process. The mean number of discharge process performed was 2.5 per weekday. Importance: Findings indicate that pharmacists play a crucial role in identifying and resolving drug-related issues at patient discharge. The results also imply that adherence to medication reconciliation at discharge may help improve completion of the pharmacist discharge process. 49 Expanding the Role of Medication Reconciliation Teams in Optimizing Pediatric Outcomes chart reviews were used prior to the PDSA to select the most frequently administered narcotic doses; and again after the intervention to evaluate the intervention’s success. Tassnim Moradipour1, Régis Vaillancourt1, Daphne Quiggin1, Leandro Avila2 Evaluation: All nurses at the intervention site reported that they 1 Children’s Hospital of Eastern Ontario 2 University of Waterloo Rationale: A standardized Medication Reconciliation (MR) workflow was implemented. The MR process has expanded to include gathering information about the immunization status of patients and the smoking status of patients and parents. The MR process has also been used as a tool to increase the number of flu shots ordered. Objectives: To describe the MR process and to assess the impact of the expanded role. Study Design: A retrospective chart audit of patients admitted during the first 7 days of each month for 1 year to assess the key components of the MR program – specifically: medication discrepancies, rates of regular immunizations and flu shots, and smoking status of patients and parents. Results: In the one-year period from October 1, 2011 to September 30, 2012, there were 6069 patients admitted. Of these patients, 68% (4155) were eligible for MR and of these patients, 92% (3831) had BPMHs within 24 hours of admission. The retrospective chart audit showed that patients are, on average, on 1.7 medications pre-admission. This totals 1408 medications for the 823 patient charts audited. Of these medications, there were 888 discrepancies of which 27% (242) were drugs, doses, or instructions that were unintentionally missed or incorrectly ordered on admission. MR identified that 23% of admitted patients either did not have their regular vaccinations up to date or had unknown vaccination status. MR also identified the 76% of our patients who did not have their flu shot or had unknown flu vaccination status. Furthermore, we found that nearly 3% of patients smoked and almost 24% of patients have a parent that smokes. Conclusions: CHEO’s MR workflow has been effective in identifying medication discrepancies in order to ensure continuation of appropriate medications on admission but its role in patient care may be extended to include increasing the potential for timely immunization and smoking cessation. CSHP 2 Targeting Excellence in Pharmacy Practice Interdisciplinary Medication Safety Initiative to Improve Narcotic Use Practices in a Post Anesthesia Care Unit (PACU) Eric Romeril, Hamilton Health Sciences, Hamilton, ON, Melanie MacInnis, McMaster University & Hamilton Health Sciences, Hamilton, ON, Leslie Gauthier, McMaster University & Hamilton Health Sciences, Hamilton, ON, Leslie Gillies, Hamilton Health Sciences, Hamilton, ON, Marianne Kampf, Hamilton Health Sciences, Hamilton, ON, James Paul, McMaster University & Hamilton Health Sciences, Hamilton, ON Rationale: The PACU is a high risk environment for medication errors, due to frequency and complexity of medication administration in high acuity patients. Multi-dosing from a single narcotic syringe is prevalent. In addition, a safe work environment for staff members with chemical dependencies needs to be promoted. Description: A multi-disciplinary committee investigated possible solutions and lead practice change for medication safety in the PACU. Steps Taken: A focus group analyzed the current medication use process in PACU and developed a process map. This activity identified many high risk practices and environmental factors to which the staff had become tolerant. Solutions were proposed. The chosen solution was manufactured unit dose syringes and bedside lock-boxes. Qualitative data was collected from nurse surveys, observer debrief interviews, and direct observation. Retrospective 50 wanted to continue unit dose syringe system. The intervention completely eliminated narcotic waste documentation problems, and showed a trend towards reduction of patient’s average pain score. It took 7 hours of Pharmacy technician time a week to manufacture the unit dose syringes. A retrospective chart review uncovered irregularities with medication dispensing and documentation from the automated dispensing cabinet; such that the integrity of signature chain was interrupted. Our team decided to stop using the syringes, as the risk of diversion and medication occurrence was still present and did not offset the resources required to prepare unit dose syringes. Importance: A multi-disciplinary effort to improve safety of narcotic use in the PACU for both staff and patients was successful in changing nursing practice; however the logistical issues of product production and dispensing limited the success of the project. Analysis of Opioid Incidents Requiring Naloxone Administration Katherine Lang, Allison Marcil, Lynette Kosar, Zack Dumont, Lisa Ruda, Kaitlyn McMillan, Department of Pharmacy Services, Regina Qu’Appelle Health Region (RQHR), Regina, Rationale: Opioid analgesics are high alert medications that are known to cause adverse drug events. Objective: To determine the cause of opioid incidents that require the administration of naloxone (opioid reversal agent). Methods: A retrospective chart review of inpatients who received naloxone for reversal of toxicity resulting from licit, in-hospital opioid use was conducted. Cases were analyzed to determine preventability, and preventable cases were assessed to determine the phase of the medication process where incident occurred, as well as the type of incident that occurred (determined through thematic grouping). The drug responsible for toxicity was determined, and the proportion of cases documented by occurrence reporting was noted. Results: Thirty-six cases were identified, 29 (80.6%) of which were preventable. The primary medication incident occurred most frequently in the prescribing phase, but multiple phases were often involved. Six types of incidents were identified thematically. Morphine was the drug that most frequently resulted in toxicity. Two (5.6%) cases were documented by occurrence reports. Conclusion: Opioid incidents occurred in the acute care centres under study. Targeted educational initiatives or policy changes are required to decrease the frequency of these incidents and better document their occurrence. Key Words: medication incident, naloxone, opioid toxicity, adverse drug event Development of a Training Program for Hazardous Drugs Handling Woloschuk D.M.M., Simoens W., Woods L., Mendelson F.. Winnipeg Regional Health Authority Pharmacy Program, Winnipeg, MB Objective: We sought to create an effective, accessible, sustainable, multi-faceted pharmacy staff training program for safe handling of hazardous drugs that could be easily adapted for other disciplines. We also wanted to design a program that would advise staff on an ongoing basis about known or reasonably foreseeable risks to safety and health arising from hazardous drugs used in pharmacy work areas. Methods: We conducted a needs assessment, then designed and evaluated a set of instructional materials that form a comprehensive training program for safe handling of hazardous drugs. The materials include a slide presentation intended for face-to-face inservices, a self-learning package in hard copy and on-line format, an annual refresher quiz, and a mock spill drill. Results: Since inception of the training program in 2010, 335 pharmacy staff members have completed one or more training program components. Field tests of each component have improved content, enabled high success rates on refresher quizzes, and identified opportunities to improve the region’s Safe Medication Handling policy. The training program has been easy to sustain at a reasonable cost. Conclusion: Our experience has shown that improving staff safety requires not only a policy and associated procedures, job aides and work tools, but also a comprehensive training program to ensure initial and ongoing use of job aides and work tools by front line staff members. Adoption of the pharmacy hazardous drugs training program for training of nursing personnel region-wide attests to the quality of the program and to pharmacy’s medication safety leadership role. Training program materials will be available for viewing during the facilitated poster presentation. Multicenter Study of Environmental Contamination with Hazardous Drugs in Hospitals Jean-François Bussières, BPharm, MSc, MBA, FCSHP, CHU Sainte-Justine, Montreal, QC, Cynthia Tanguay, BSc, MSc, CHU Sainte-Justine, Montreal, QC, Karine Touzin, BSc, MSc, CHU Sainte-Justine, Montreal, QC, Éric Langlois, MSc, Centre de toxicologie du Québec (CTQ), Institut National de Santé Publique du Québec (INSPQ), Quebec, QC; Michel Lefebvre, MSc, Centre de toxicologie du Québec (CTQ), Institut National de Santé Publique du Québec (INSPQ), Quebec, QC Introduction/Objectives: Since the publication of the National Institute for Occupational Safety and Health Alert on hazardous drugs in 2004, many healthcare organizations have reviewed their guidelines and procedures for handling hazardous drugs. Occupational exposure may occur when handling, compounding or administering a drug considered to be hazardous, from storage to waste management. The aim of this project was to measure environmental contamination with cyclophosphamide (CP), ifosfamide (IF) and methotrexate (MTX) in pharmacy and patient care areas of hospitals. Description of the project/Methods: Twelve standardized Conclusions: Periodic surface contamination measurements are necessary to ensure that current practices limit healthcare workers occupational exposure to hazardous drugs. This project have helped participating centers identify their specific areas for improvement. The overall results from this project will also serve as an attainable goal that any Canadian hospital may refer to in order to reduce the risks to healthcare workers’ safety. Enhancing Collaborative Pharmaceutical Care for Chronic Kidney Disease Patients –Survey of Community Pharmacists Lisa Zhu, Andrea Fox, Yu Chun Chan, Sunnybrook Health Sciences Centre, Toronto, Ontario Rationale: The Kidney Care Clinic (KCC) at Sunnybrook Health Sciences Centre provides multidisciplinary care for stage 3-5 chronic kidney disease (CKD) patients. As CKD patients are at high risk of drug therapy problems, clinic pharmacists review medications and provide recommendations at each visit. Between clinic visits potential gaps in care exist. Community pharmacists are ideally situated to identify and resolve drug therapy problems arising between visits. Objectives: The study objectives were to determine: i) community pharmacists’ confidence level in managing CKD patients; ii) opportunities for improving collaboration between clinic and community pharmacists; iii) the key clinical information this group would utilize when caring for CKD patients. Methods: An anonymous survey was sent via mail and online to community pharmacies providing prescription medications to current clinic patients. A total of 318 surveys were sent to 96 pharmacies. Data were analyzed using descriptive statistics including frequencies, ranges and measures of central tendency. Results: Fifty-one completed surveys were received. Less than a third of pharmacists were aware that a KCC patient was a client of their pharmacy. Ninety percent were confident in providing counseling on medications to manage CKD. Less than two-thirds indicated confidence in recommending drug dosing changes based on kidney function. Over 75% of pharmacists indicated a willingness to play a greater role in managing CKD patients. All agreed that they would benefit from education on CKD complications and management. Clinical information ranked most useful included an updated medication list with indications and details regarding recent medication changes. measurement sites within pharmacy (6 sites) and patient care areas (6 sites) were selected. Sites were sampled mid-week at the end of the day. Samples were analyzed for the presence of CP, IF and MTX by UPLC-MS-MS technology. The limit of detection (LOD) was 0.0015 ng/cm2 for CP, 0.0012 ng/cm² for IF and 0.0060 ng/cm2 for MTX. Conclusion: Community pharmacists indicated willingness to have Project Experience/Results: A total of 25 hospitals participated in the project (37% response rate). Overall, 259 samples were collected between April 2008 and January 2010 (147 samples from 25 pharmacy areas and 112 samples from 24 patient care areas). No hospital was using a closed system transfer device (CSTD) at the time of the study. The median[min-max] number of sites per center with at least one positive sample for at least one drug of the three hazardous drugs evaluated was 6[1-12]. A total of 135(52%) samples were positive for CP, 53(20%) were positive for IF and 7(3%) were positive for MTX. The median[min-max] concentration was of 0.0035[<LOD-28] ng/cm2 for CP, <LOD [<LOD-8.6] ng/cm2 for IF and <LOD [<LOD-0.58] ng/cm2 for MTX. Exploring Alternative Funding of Rituximab for Rheumatology Clinic Patients: A Pharmacy Led Interprofessional Collaborative Pilot Discussion: CP levels were a good indicator to estimate the level of hazardous drug contamination, considering that it is still largely used in most healthcare centers. It also allowed a good comparison with other studies. Our results from 25 hospitals indicated that it is feasible to have a similar (and in some cases, lower) proportion of CP positive surface samples without the use of a closed-system transfer device. greater involvement in the care of CKD patients. Results reveal a need to increase awareness of clinic patients among providers. Participants were receptive to continuing education and initial efforts should focus on renal drug dosing adjustments and CKD complications. Tools for transferring clinical information require development. Bernadette Chevalier1, Anne Hiltz1, Heather Hemming1, Mary Lou Robertson1, Alissa Decker1, Vickie Sullivan1, Randi Monroe1, Catherine Gaulton1, Paula Bond1, Donna Gamble1, Evelyn Sutton1,2, Christy Simpson1,2 1 2 Capital Health, Halifax, NS Dalhousie University, Halifax, NS Rationale and Description of Role: The majority of chronic disease management has shifted from inpatient to outpatient settings without a strategy to ensure our people, facilities and drug resources are appropriately and consistently utilized. To help address this, a pharmacist led interprofessional working group was 51 established and included pharmacy, nursing, social work, medicine, legal, bioethics, and administrative representation. The group drafted a policy to provide an equitable, consistent process in determining how drugs and their administration are funded in outpatient settings. This policy requires patients to use their insurance to pay for their drugs; our institution is the payor of last resort. Development and Implementation: Rheumatology was selected as a pilot clinic to test and further inform this policy. Rituximab in rheumatoid arthritis patients was targeted as costs had increased from $96,000 to $897,000 in four years. A Medication Resource Specialist was hired to work with patients and clinic staff around drug insurance reimbursement and pharmaceutical patient assistance program (PPAP) enrollment. Clinic nurses, physicians, and pharmacy staff were in-serviced and resource manuals, clinic files, and forms were developed. Information letters were mailed to clinic patients. Evaluation: Most (90%) of the 40 patients who received at least one dose during the three month pilot had drug insurance. No clinically significant delays in treatment occurred as a result of investigating insurance. Fifty-one clinic infusions were outsourced and paid for by PPAP. Cost savings for avoided clinic visits based on case costing estimates were $19,125. Cost savings for rituximab were $304,700. Satisfaction surveys completed by staff, stakeholders, and patients provided valuable feedback. Future Practice Implications: The pilot demonstrated a successful interprofessional collaboration that resulted in significant cost savings while ensuring high quality patient care. Lessons learned throughout the pilot will be applied to the policy in preparation for its institution-wide roll out. Development of a Pharmacy Department Teaching Guideline in the Era of Expanded Experiential Education Karen Cameron1,2; Cindy Natsheh1,2; Emily Musing1,2, Olavo Fernandes1,2 1 2 University Health Network, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, ON Rationale: The change in academic landscape in pharmacy education has drastically increased the number of student experiential rotations that teaching hospitals need to provide. This has led to a number of issues surrounding pharmacist teaching activities including: 1) consistency in handling requests for teaching, 2) recognition and compensation, and 3) difficulty prioritizing teaching amongst other activities and between the various teaching activities. Importance: This teaching guideline is applicable and may be of interest to other pharmacy departments facing similar challenges of addressing increased teaching commitments and balancing professional responsibilities. What are the Appropriate Selection Criteria for National Hospital Clinical Pharmacy Key Performance Indicators (cpKPI)? Natalie Benninger, Richard Slavik, Kent Toombs, Doug Doucette, Jeremy Slobodan, Sean Gorman, Winnie Chan, Bill Semchuk, Cathy Lyder and Olavo Fernandes CSHP National Clinical Pharmacy Key Performance Indicator Task Force (Toronto, Ontario, Canada) Rationale: A CSHP National Task Force was established to develop a core set of national Clinical Pharmacy Key Performance Indicators (cpKPI) for hospital pharmacists via a systematic (Delphi) evidence-informed consensus process. Key Performance Indicators (KPIs) are quantifiable measures of quality and an international consensus on appropriate cpKPIs has not been established. The main objectives of this evaluation were to 1) establish a national consensus on cpKPI selection criteria (ideal attributes/properties) 2) construct a Delphi survey instrument and 3) develop consensus evidence tables for key published papers to inform cpKPI selection. Description: Input was gathered nationally from task force teleconferences as well as national/ local workshops with front-line pharmacy practitioners/leaders. A literature review was conducted and the most important published evidence was identified by cpKPI task force consensus. Systematic evidence tables were created, outlining: the methods/results, strengths/limitations, comparative findings, and proposed highlights for application/synthesis to the cpKPI selection process. Evaluation: The evidence tables (n=7, 1 process and 6 outcome papers) were was used to inform dialogue and debate on a global inventory of candidate cpKPI and to narrow down proposed cpKPI selection criteria. A final set of 11 consensus cpKPI selection criteria (“Slavik-11”) were established by utilizing the 5 cpKPI definition characteristics, 4 AHRQ quality indicator parameters and teleconference debate. A Delphi survey instrument, utilizing a 9-point Likert scale, was constructed with the criteria (to be used by the Delphi panel to rank each candidate cpKPI) Importance: A core set of national cpKPI would serve to harmonize hospital pharmacists toward working together toward optimizing evidence-informed patient outcomes and permit internal and external benchmarking. A national cpKPI task force established a consensus set of cpKPI selection criteria, a Delphi instrument to rank candidate cpKPI and corresponding evidence tables to support and inform the final determination of a core suite of national cpKPI. Description: In order to address these issues, a consultative process involving front-line pharmacy staff, peer hospitals and academic institutions was used to develop a Pharmacy Department Teaching Guideline. A series of teaching town hall meetings were held inviting participants to provide input on the key issues. A draft of the guideline was developed and shared with staff, peer hospitals and academic institutions for feedback. The guideline was implemented in July 2012. Ranking of Healthcare Programs Based on Health Outcome, Health Costs and Safe Delivery of Care in Hospital Pharmacy Practice Evaluation/Results: The resultant operational guideline includes 6 key practical points which deal with: 1) experiential teaching commitments (pharmacist expectations), 2) management of off-site teaching (establishment of pharmacist teaching days), 3) departmental support for preceptor training, 4) consistency in staff recognition, 5) consistency in compensation (honorariums/fees paid to department), and 6) central handling of all teaching requests. After guideline implementation, the number of available departmental student rotations as well as number of pharmacists involved in experiential rotations and off site teaching has increased. We have shared our guideline with peer hospitals who are in varying stages of implementation of a similar model. Introduction: Given the often limited human and financial 52 Jean-François Bussières, BPharm, MSc, MBA, FCSHP, CHU Sainte-Justine, Montreal, QC, Lionel Brisseau, D.Pharm, CHU Sainte-Justine, Montreal, QC, Denis Bois, B.Pharm. M.Sc., Centre hospitalier universitaire de Montréal, Marc Vallée, B.Pharm., M.Sc., Centre hospitalier universitaire de Sherbrooke, Marie-Claude Racine, B.Pharm., MSc, Centre hospitalier universitaire de Québec, André Bonnici, B.Pharm MSc, Director, Centre universitaire de santé McGill, Montréal, QC resources, managers should consider the best evidence available on a profession’s impact to plan healthcare services within an organization. Data are few on ranking healthcare programs in order to prioritize which healthcare program would mostly benefit from the delivery of pharmaceutical care by decentralised pharmacists. The aim of this project was to establish a consensual and coherent ranking of healthcare programs that involve the presence of decentralized pharmacists, based on health outcome, health costs and safe delivery of care. Project Description: This descriptive study was derived from a structured dialogue (Delphi technique) among directors of pharmacy department. We established a quantitative profile of healthcare programs of five sites that involved the provision of decentralised pharmaceutical care. A summary table of evidence established a unique quality rating per inpatient or outpatient healthcare program. Each director rated the perceived impact of pharmaceutical care per inpatient or outpatient healthcare program on three fields: health outcome, health costs and safe delivery of care. Directors agreed by consensus on the final ranking of healthcare programs. Project Results: A ranking was assigned for each of the 18 healthcare programs for outpatient care and the 17 healthcare programs for inpatient care involving the presence of pharmacists, Monday, February 4 Lundi 4 février Evaluation of Students’ Experience in the “Foundations for Advanced Pharmacy Practice” Rotation Teo V., Lui K., Diamantouros A., Sunnybrook Health Care Sciences Centre, Toronto, ON Rationale for Report: In September 2011, the Leslie Dan Faculty of Pharmacy began to offer a combined BScPhm, PharmD program providing students in 4th year of the BScPhm program or those who have completed the BScPhm program, the opportunity to continue toward the completion of a PharmD degree. Description of Situation: Unlike prior PharmD classes where the pre-requisite was at least one year of clinical practice, these students may or may not have had prior clinical experience. The need was identified for a “foundations rotation” in order to ensure a minimum level of preparedness prior to students’ advanced clinical rotations. The objective of our project was to gain a deeper understanding of the experiences’ of the 7 students involved in the inaugural offering of this rotation at Sunnybrook HSC. Approach to the Situation: A focus group was conducted with the students on the last day of their rotation. Data collected was transcribed and reviewed by the investigators. Common themes were summarized for discussion. Evaluation and Results of Project: Students expressed that the foundations rotation improved preparedness for future advanced clinical rotations. Opinions were divergent based on amount of prior clinical experience. Post-baccalaureate students found the rotation to be quite similar to previous structured practical experiential rotations. For students that had no prior experiential experience, they found the rotation overwhelming at times. All students expressed that they were unclear about the objectives of the rotation and the expectations of preceptors. Usefulness to Future Practice: The experience of these students will be used to ensure improved communication and clarity of expectations on the part of students and preceptors. Further studies are required to determine which specific variables, when modified, will result in the greatest improvement in performance of advanced clinical rotations. based on health outcome, health costs and safe delivery of care. There was a good correlation between ranking based on data from the 2007–2008 Canadian report on hospital pharmacy practice and the ranking proposed by directors of pharmacy department. Discussion: The use of strength of evidence quality rating combined with Delphi technique allowed our panel experts to propose a final consensual ranking of which healthcare programs would need to benefit from pharmaceutical care. Our study suggested that the ranking by the panellists was influenced by the quality of the evidences available and by current allocation of pharmacists in healthcare programs in Canada. Conclusions: A novel approach used to rank healthcare programs that include the provision of pharmaceutical care by decentralised pharmacists was described. This ranking approach was based on the perceived impact of pharmaceutical care healthcare program on three fields: health outcome, health costs and safe delivery of care. Assessment of Implementing Disease State Education Modules and its Effect on Specific Pharmacist Interventions: ‘AIMS’ Study Brett Hamilton, Richard Slavik, Victoria Slavik, Pharmacy Department Interior Health Authority, Faculty of Pharmaceutical Sciences, University of British Columbia, Kelowna, BC Rationale: Priority disease states are high impact and prevalent diseases that account for a large proportion of health care utilization and costs. Randomized control trials have shown that pharmacists resolving drug-related problems (DRPs) for patients with priority diseases can improve the overall quality of drug therapy and decrease health care utilization and costs. To promote clinical pharmacist continuous professional development (CPD), eight 4-week disease state education modules (DSEMs) were delivered from January 2009 to December 2011. At the end of each DSEM, a list of key pharmacist interventions (KPI) or evidence-based interventions proven to reduce mortality, morbidity or health care utilization was developed to guide pharmacists’ interventions. Current evidence has not proven that pharmacist CPD improves patient care. Objective: To determine if provision of 4-week DSEMs for clinical pharmacist CPD is associated with objective improvements in patient care. Study Design and Methods: Retrospective, observational study of DRPs resolved by health authority pharmacists from October 1, 2008 to March 31, 2012. The two primary outcomes were the change in proportion of total DRPs that were DSEM DRPs and KPIs from the 6-month PRE module phase compared to the 6-month POST module phase assessed by chi-square analysis with a two-tailed p value less than 0.025 (97.5% confidence interval [CI]). Results: Primary analysis showed the proportion of total DRPs that were DSEM DRPs increased from 27.9% to 30.2%; (relative risk increase [RRI], 8.3%; 97.5% CI, 1.9-15.3%). The proportion of total DRPs that were KPIs increased from 21.7% to 24.4%; (RRI, 12.3%; 97.5% CI, 4.5-20.8%). Conclusions: There was a statistically significant and clinically important increase in the proportion of DSEM DRPs and KPIs after completion of the DSEMs. This study suggests that using DSEMs for clinical pharmacist CPD on priority disease states are associated with objective improvements in patient care. 53 CSHP 2 Targeting Excellence in Pharmacy Practice Comparison of the Consistent and Consult-Based Pharmacy Practice Models in a Heart Failure Clinic Mei Shi, North York General Hospital, Toronto, ON Rationale: Although pharmacist interventions in heart failure clinics have demonstrated a reduction in hospitalizations and mortality, the extent of pharmacist involvement and its impact on the type of interventions has not been examined in the literature. The consistent and consult-based pharmacy practice models were compared to evaluate the difference between the types of interventions performed and barriers to providing services. Description and Steps Taken: One pharmacist assessed patients in both models. In the consistent practice model, the pharmacist assessed all patients scheduled during a full clinic day once weekly. In the consult-based practice model, the pharmacist was contacted at the cardiologist’s or nurse’s discretion on an ad-hoc basis over the remaining clinic days. Interventions were prospectively documented and categorized as follows: identification of drug therapy problems (DTPs), patient education, therapeutic drug monitoring (TDM), drug information, obtaining a medication history, or a combination of interventions. participation by practice setting, academic affiliation and province. Simple coding using NVivo classified main content of the posts. Results: One hundred and twenty-nine participants (52.7% of listserv members) posted to the listserv. Participants worked in family practice (31%), community pharmacy (20%), hospital pharmacy (12%), clinics (11%) and other (26%), with 20% having an academic affiliation. Over half practiced in Ontario (52.7%) with others distributed across Canada. Agreement between coders was excellent (0.78); 623 posts were coded. Postings were diverse including patient-specific therapeutic questions, information exchange and practice management needs. Some questions prompted simple answers while others generated conversation and debate. Participants would benefit from education regarding posing comprehensive clinical questions and extrapolating evidence to individual, complex patients. Several participant roles emerged. Conclusion: The PC-PSN listserv provides participants from varied practice and geographic backgrounds with a forum to discuss issues and solicit input and support. Prominent learning needs that include critical appraisal and formulating focused questions, will assist educators in designing useful education experiences. Participant roles may affect participation and warrant further analysis. Applying this methodology to other listservs would aid understanding of factors that contribute to successful listserv use. Evaluation: Over a 6-month period, the pharmacist assessed 115 patients during 189 encounters in the full-day clinics and 28 patients by consultation. In the consult-based practice model, pharmacist interventions were primarily directed towards performing medication histories (46.2%). In the consistent practice model, medication histories represented 2.7% of the pharmacist’s interventions and the remaining time was dedicated to identifying DTPs (46%), providing education (18%), a combination of interventions (14.4%), TDM (14.4%), and drug information (4.5%). Barriers to the consult-based practice model included a lack of established relationship with patients, inconsistent follow-up monitoring, and dependency on a physician or nurse for referral. Importance: Results suggest that a consistent practice model is superior to a consult-based practice model as pharmacists increase their involvement in managing patients’ medications to improve safety and outcomes rather than simply performing medication histories. This also aligns with CSHP 2015’s objective of managing medication therapy for 70% of complex patients in ambulatory/specialized care clinics. Exploration of a Primary Care Pharmacy Specialty Network Listserv Archive Using Content Analysis Barbara Farrell, Bruyère Research Institute1, Melanie Trinacty, The Ottawa Hospital2, Terri Lisa Sunstrum, Bruyère Research Institute3, Karishma Kak, Bruyère Research Institute4, Ottawa, ON1,2,3,4 Schindel, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Lisa Dolovich, Department of Family Medicine, McMaster University, Hamilton, ON, Natalie Kennie, Summerville Family Health Team, Mississauga, ON, Grant Russell, School of Primary Health Care, Monash University, Melbourne, Australia, Nancy Waite, School of Pharmacy, University of Waterloo, Waterloo, ON Rationale: Canadian pharmacist roles and responsibilities are evolving with increased commitment to primary health care reform and legislation for expanding scope. Little is known about pharmacist educational and support needs in this evolving field. The Canadian Society of Hospital Pharmacists and the Canadian Pharmacists Association jointly host the Primary Care Pharmacist Specialty Network (PC-PSN) which uses a listserv to enable sharing of knowledge. Objectives: This study examined participant use and educational needs revealed by contributions to the PC-PSN listserv. Study Design and Methods: Qualitative inductive and deductive content analysis was used to examine one year of archived PC-PSN listserv posts (2010). This was complemented by documenting 54 CSHP 2 Targeting Excellence in Pharmacy Practice Implementation of a United States Pharmacopeia (USP) 797 Compliant Central Intravenous Admixture Program Yuen Chan-Lau, Thomas Chan, Joyce Choy, Christine Ling, Renee Tam, Alefiyah Adamjee, Jocelyn Jackson, Maryam Mohammed Shafiei, Sarah Truong, Edith Rolko, North York General Hospital, Toronto, ON Rationale: The objective of implementing a Central Intravenous Admixture (CIVA) program which is compliant with USP 797 standards means Intravenous (IV) medications should be prepared under an International Organization for Standard (ISO) Class 5 environment by trained personnel using aseptic techniques with quality assurance to provide highest quality admixtures. Description and Steps Taken: The 4 foci to ensure the CIVA program implementation meet USP 797 standard are: the IV preparation area is constructed to provide an ISO 5 environment, development of policy and procedures for IV admixture personnel training and certification, standardize admixing procedure and worksheets with calculation formulas to ensure admixtures sterility and accuracy, and a vigilant quality assurance process and equipment, an electronic air sampler and incubator, to ensure the sterile preparations meet the USP standards of sterility, stability and expiry. Evaluation: Prior to CIVA implementation, pharmacy prepared fewer than 10 medications in the form of minibag plus and contracted out approximately 5 high usage medications. The implemented program now provides over 50 drugs, including premixed syringes and epidural, minibag plus medications were converted to premixed products. The need for nurses to prepare sterile IV drugs has been reduced by 80%. Drug wastage is monitored and only high usage medications are batched. An average of 20 different admixtures is prepared per day, compared to 20 per month prior to CIVA implementation. The CIVA program is currently staffed with 2 full-time technicians with a daily capacity of over 300 IV bags or syringes. Importance: The implemented CIVA program ensures IV preparation sterility with an established expiry date and is still growing. Quality assurance monitoring of air and surface in the IV preparation areas and personnel process validation is performed routinely and analyzed. CIVA program implementation enables nurses to have more time to provide other patient care activities. Impact of a Pre-Printed Care Order on Influenza and Pneumococcal Vaccination Rates in Older Inpatients on Medicine Units Lorie Carter1, Sheri Koshman2, Margaret Gray3, Christine Hughes2, Jane Xu3, Cheryl Sadowski2 1 Pharmacy Services, Eastern Health, Marystown, NL University of Alberta, Edmonton, AB 3 Pharmacy Services, Alberta Health Services, Edmonton, AB 2 Rationale: Adults 65 years of age and older are at increased risk of adverse outcomes related to influenza and pneumococcal infections. Vaccinating hospital inpatients is recommended as an important strategy to improve population vaccine coverage, and may be facilitated using a pre-printed care order (PPCO). However, this strategy has received only limited study. Results: A total of number of 78955, 75487 and 91000 doses of drug samples were documented, respectively, in 2007, 2009 and 2012. The ratio of dose of drug samples per patient-visit was respectively of 0.40, 0.38 and 0.41. Only 19% of doses documented were listed on the hospital drug formulary and 4% of doses were expired. Despite the implementation of a web intranet form to declare drug samples given by industry sales representatives, most drug samples doses were not declared. Conclusion: The number of drug samples documented in our outpatient clinics has stayed stable for five years. While it appears possible to proscribe their distribution locally in outpatient clinics, it is difficult to do so when regulatory authorities do not proscribe their distribution for a province. We believe drug samples do not contribute to better patient care and should only be dispensed by retail pharmacy through a structured approach with a documentation of doses dispensed in the patient record. Objectives: To evaluate uptake and impact of a PPCO implemented to improve inpatient influenza and pneumococcal screening and vaccination rates. Methods: We conducted a retrospective analysis of patients ≥ 65 years of age admitted to internal medicine at a tertiary care hospital. Charts were randomly selected and reviewed for patients admitted within a three month period during the vaccine campaign in 2010/2011 (pre-PPCO group) and compared to patients admitted during the same three month time period in 2011/2012 (post-PPCO group). Internal medicine pharmacists assisted in the roll-out of the PPCO. Data collection was completed by a single reviewer using standardized forms. Results: There were 100 patients in the pre group and 77 patients in the post group. Of the examined post group charts, 35% contained the PPCO, which was fully completed in 65% of cases. Results were compared using chi-square or fisher’s exact tests. Rates of screening were higher in the post group for both influenza vaccination (75.3% vs. 13%, p<0.0001) and pneumococcal vaccination (80.5% vs. 11%, p<0.0001). Vaccination of eligible patients was also higher in the post group for both influenza vaccination (33.3% of 27 patients vs. 6.4% of 94 patients, p<0.001) and pneumococcal vaccination (29.4% of 34 patients vs. 2.2% of 92 patients, p<0.0001). Conclusions: Use of a PPCO resulted in higher influenza and pneumococcal screening and vaccination rates in eligible internal medicine inpatients aged ≥ 65 years. Use of a PPCO with pharmacist-supported roll-out can help contribute to achieving target national immunization rates. Drug Samples in Outpatient Units: A Constant Problem Barthélémy, Y. Khvan, T.Ly, S.Atkinson, J-F., Bussières, Isabelle Barthélémy, CHU Sainte-Justine, Montreal, QC, Yemsoktheavy Khvan, University of Montreal, Montreal, QC, Hoang Ngan Tina Ly, University of Montreal, Montreal, QC, Suzanne Atkinson, CHU Sainte-Justine, Montreal, QC, Jean-François Bussières, CHU Sainte-Justine, Montreal, QC Rationale: In Canada, the Food and Drug Act allow the distribution of drug samples to physicians, dentists and pharmacists. Most provincial regulatory authorities do not proscribe their distribution in healthcare settings. Drug sample use may bypass the optimal drug-use process in hospitals and retail pharmacies. Objectives: The objective of this study is to compare the number of drug samples available in outpatient clinics in a teaching hospital in 2007, 2009 and 2012. Study Design and Methods: This is a cross-sectional observational study. In our hospital, drug samples were not allowed in patient wards but were tolerated in outpatient clinics. Drug samples were collected by pharmacy staff through unannounced visits. The total number of doses of drug samples was calculated in 2007, 2009 and 2012. A ratio of dose of drug samples per patient visit was also calculated. Impact and Appreciation of Two Methods Aiming at Reducing Hazardous Drug Environmental Contamination: Centralization of Tube Priming in the Pharmacy and Use of a Closed-System Drug Transfer Device Annie Guillemette, CHU Sainte-Justine at the time of the study, Montreal, QC, Hélène Langlois, CHU Sainte-Justine at the time of the study, Montreal, QC, Maxime Voisine, CHU Sainte-Justine at the time of the study, Montreal, QC, Delphine Merger, CHU Sainte-Justine, Montreal, QC, Karine Touzin, CHU Sainte-Justine at the time of the study, Montreal, QC, Roxane Therrien, CHU Sainte-Justine, Montreal, QC, Geneviève Mercier, CHU Sainte-Justine, Montreal, QC, Denis Lebel, CHU Sainte-Justine, Montreal, QC, Jean-François Bussières, CHU Sainte-Justine, Montreal, QC Rationale: The NIOSH alert recommends hazardous drug tubes to be primed in the pharmacy rather than in patient care zones and states that a closed-system drug transfer device (CSTD) may be used when preparing and administering hazardous drugs. Objectives: To evaluate the impact and appreciation of two methods aiming at reducing hazardous drug environmental contamination: centralization of tube priming in the pharmacy and use of a CSTD. Study Design and Methods: This is a prospective, experimental and comparative study. Sites in the hematology-oncology satellite pharmacy and care unit were analyzed for the presence of cyclophosphamide, ifosfamide and methotrexate before and after centralization of tube priming in the pharmacy and before and after using a CSTD. The limits of detection for cyclophosphamide, ifosfamide and methotrexate were, respectively, of 0.0015ng/cm², 0.0012ng/cm² and 0.0060ng/cm². Data was compared with a chi-square test. The pharmacy technician satisfaction was evaluated using a questionnaire. Results: A total of 225 samples was quantified. After the centralization of tube priming in the pharmacy, no significant difference was found in the proportion of positive samples for cyclophosphamide (15/45(33%) vs. 10/45(22%), p=0.239), ifosfamide and methotrexate. Traces of cyclophosphamide found on the floor in patient care areas was significantly reduced (median[min-max] 0.08[0.06-0.09]ng/cm² vs. 0.03[0.02-0.05], p<0.0001). After using a CSTD, a significant difference was found for the proportion of cyclophosphamide positive samples (15/45(33%) vs. 0/45(0%), p<0.0001), but no significant difference was found for ifosfamide (12/45(27%) vs. 5/45(11%), p=0.059) and methotrexate (1/45(2%) vs. 2/45(4%), p=0.557). Pharmacy technicians raised issues following the centralization of tube priming (e.g. workload) and the use of CSTD (e.g. spills, particles, workload and handling difficulties). Conclusion: Centralization of tube priming in the pharmacy did not increase surface contamination in pharmacy, but reduced floor contamination in patient care areas. CSTDs reduced contamination in pharmacy, but issues were raised by pharmacy technicians. 55 Multicenter Study of Environmental Contamination with Hazardous Drugs in 33 Canadian Hospitals Delphine Merger, CHU Sainte-Justine, Montreal, QC, Cynthia Tanguay, CHU Sainte-Justine, Montreal, QC, Éric Langlois, Institut national de santé publique du Québec, Quebec, QC, Michel Lefebvre, Institut national de santé publique du Québec, Quebec, QC, Jean-François Bussières, CHU Sainte-Justine, Montreal, QC Rationale: A 2004 National Institute for Occupational Safety and Health Alert on hazardous drugs prompted many healthcare organizations to review their guidelines, policies and procedures for the safe use of hazardous drugs. Yet, no safe occupational exposure limit exists. Objectives: The main objective of this study was to describe environmental contamination with cyclophosphamide, ifosfamide and methotrexate in pharmacy and patient care areas of Canadian hospitals in 2012. The secondary objective was to compare the 2012 environmental monitoring results with the 2008-2010 results. Study Design and Methods: This is a descriptive and comparative study. Six standardized sites in the pharmacy and six sites on wards were sampled in each participating center. Samples were analyzed for the presence of cyclophosphamide, ifosfamide and methotrexate by UPLC-MS-MS. The limit of detection (LOD) was 0.0018 ng/cm² for cyclophosphamide, 0.0022 ng/cm² for ifosfamide and 0.008 ng/cm² for methotrexate. A sample was considered positive if the value was above the LOD. The comparison of surface contamination between the 2008-2010 and 2012 studies was made with the 75th percentile of cyclophosphamide concentration. Results: A total of 33 hospitals participated in the study and 363 samples were collected. Overall, 40%(147/363) of the samples were positive for cyclophosphamide, 18%(68/363) were positive for ifosfamide and 5%(17/363) were positive for methotrexate. In 2012, the 75th percentile value of cyclophosphamide surface concentration was of 0.01ng/cm2, which is four times lower than the 2008-2010 75th percentile of 0.04 ng/cm2. In both studies, the 75th percentile for ifosfamide and methotrexate concentration was lower than the LOD. Conclusion: Surface contamination by hazardous drugs in Canadian hospitals is improving both in terms of the proportions of positive samples and in terms of the surface concentration of hazardous drugs. A local 75th percentile value should be use to assess local contamination and interpret local results. Environmental Contamination with Methotrexate in Canadian Retail Pharmacies Delphine Merger, CHU Sainte-Justine, Montreal, QC, Cynthia Tanguay, CHU Sainte-Justine, Montreal, QC, Éric Langlois, Institut national de santé publique du Québec, Quebec, QC, Michel Lefebvre, Institut national de santé publique du Québec, Quebec, QC, Jean-François Bussières, CHU Sainte-Justine, Montreal, QC LOD. Nine working practice were assessed in participating retail pharmacies. Results: Twenty retail pharmacies participated in the study and 60 samples were analyzed. No traces of cyclophosphamide or ifosfamide were detected. Traces of methotrexate were found in 12 out of the 20 pharmacies (60%). Twenty-two percent (13/60) of the samples were methotrexate-positive: 10%(2/20) from methotrexate containers, 55%(11/20) from pill counter trays used only for hazardous drugs and 0/20(0%) from the preparation counters. Forty percent (8/20) of the participating retail pharmacies had a storage space reserved for hazardous drugs and none of them had a preparation area reserved for handling methotrexate tablets. All the participating retail pharmacies had a pill counter reserved for handling hazardous drugs and it was cleaned after use. The nature of the product used to clean the pill counter varied by participant, such as alcohol, soap and water and Wet Ones® wipes. None of the participants cut or crushed methotrexate tablets. Conclusion: Retail pharmacists must be made aware of the presence of hazardous drugs on working surfaces and of the need to comply with personal protection measures to reduce staff occupational exposure to hazardous drugs. Exploration des données de doses définies journalières et jours de traitements en pédiatrie – une analyse comparative 2001-2002, 2005-2006 et 2010-2011 Schott A, Guillot J, Roy H, Ovetchkine P, Lebel D, Bussières JF, Alexia Schott, CHU Sainte-Justine, Montréal, QC, Justine Guillot, CHU Sainte-Justine, Montréal, QC, Hélène Roy, CHU Sainte-Justine, Montréal, QC, Philippe Ovetchkine, CHU Sainte-Justine, Montréal, QC, Denis Lebel, CHU Sainte-Justine, Montréal, QC, Jean-François Bussières, CHU Sainte-Justine, Montréal, QC Justification : L’usage des antibiotiques fait l’objet d’une surveillance accrue. Dans le cadre de nos activités de parrainage des antimicrobiens, nous nous sommes intéressés à la quantification de leur utilisation. Objectifs : Calculer et discuter les ratios de doses définies journalières (DDJ) et de jours de traitements (JT) par 1000 jours-patients (1000JP) en pédiatrie. Méthodologie et démarche de l’étude : Une étude rétrospective, transversale, descriptive réalisée au sein d’un centre hospitalier mère-enfant canadien. L’étude porte sur les exercices financiers 2001-2002, 2005-2006 et 2010-2011 concernant 51 antibiotiques. Sont exclus les antifongiques. Les données ont été extraites du dossier pharmacologique informatisé, couplé aux données relatives aux admissions, départs et transferts de patients. Nous avons calculé des ratios de DDJ selon le barème de l’Organisation mondiale de la santé. Bien que les JT soient préférés en pédiatrie, nous avons exploré les deux ratios par 1000 JP. Résultats : Le nombre total de DDJ/1000JP est passé de 402,76 en Objectives: The objective was to evaluate environmental contamination with methotrexate, cyclophophamide and ifosfamide in Canadian retail pharmacies and to describe practices in Canadian retail pharmacies when handling hazardous drugs. 2001-2002, à 456,17 en 2005-2006 et 549,56 en 2010-2011. Le nombre total de JT/1000JP est passé de 464,97 en 2000-2001, à 517,44 en 2005-2006 et 657,49 en 2010-2011. Onze antibiotiques ont connu une baisse de leur DDJ/1000JP de 2000-2001 à 2010-2011 [valeur de 2010-2011 représente de 7 à 2000% de la valeur de 2000-2001] et 9 antibiotiques ont connu une baisse de leur JT/1000 JP de 2000-2001 à 2010-2011 [la valeur de 2010-2011 représente de 7 à 1000% de la valeur de 2000-2001]. Study Design and Methods: This is a descriptive and transversal Conclusion : Il existe peu de données quantitatives sur l’utilisation Rationale: The NIOSH list of hazardous drugs includes 167 drugs. This growing number of hazardous drugs represents a challenge for retail pharmacies. study. Three standardized sites were sampled in each participating retail pharmacy. Samples were analyzed for the presence of cyclophosphamide, ifosfamide and methotrexate by UPLC-MS-MS. The limits of detection (LOD) were 0.10ng/mL, 0.12ng/mL and 0.41ng/mL for cyclophosphamide, ifosfamide and methotrexate, respectively. A sample was considered positive if the value was above 56 des antibiotiques en pédiatrie. Les programmes de parrainage des antimicrobiens et les autorités gouvernementales exigent des mesures de quantification afin de comparer les profils d’utilisation entre hôpitaux. Il s’agit de la première étude canadienne à décrire sur trois exercices financiers répartis sur 10 années la consommation d’antibiotiques en pédiatrie. Mise à jour des soins pharmaceutiques pédiatriques en clinique de VIH-SIDA F. Stockel, J-F. Bussières, Freia Stockel, CHU Sainte-Justine, Montréal, QC, Jean-François Bussières, CHU Sainte-Justine, Montréal, QC Justification : Depuis deux décennies, les pharmaciens hospitaliers exercent majoritairement de façon décentralisée dans les programmes de soins. On reconnait les difficultés inhérentes à la hiérarchisation de ces programmes et des activités pharmaceutiques lorsque les ressources disponibles sont insuffisantes. Objectif : Mettre à jour le niveau de pratique utilisé en soins pharmaceutiques pédiatriques en clinique de VIH-SIDA. Méthodologie et démarche : Il s’agit d’une étude descriptive avec Résultats : Un total de 52 articles pertinents ont été identifiés et 30 ont été utilisés afin de coter l’impact selon les sept indicateurs. Une revue de l’activité pharmaceutique en 2011-2012, a permis de recenser la réponse à 155 demandes d’information et 199 interventions (43% ajustement de la pharmacothérapie, 28% continuité de soins, 16% bilan comparatif, 13% autre) pour l’équivalent de 170 heures-travaillées (c.-à-d. couverture clinique de 1-2 jours-semaine) et une cohorte active de près de 70 patients. La mise à jour envisagée du secteur de pratique inclut l’aménagement d’un espace, la documentation écrite des interventions, l’intégration de la fonction à l’équipe de pédiatrie avec jumelage avec un 2ème pharmacien, la rédaction de protocoles et de feuilles d’ordonnances pré-rédigéees, la déclaration proactive d’effets indésirables, la création d’un club de lecture, l’implication dans les écoles, etc. revue documentaire menée dans un centre hospitalier universitaire mère-enfant canadien. À partir des meilleures preuves, l’impact du pharmacien en soins VIH-SIDA a été coté selon sept indicateurs de résultats (c.-à-d. mortalité, morbidité, coût, erreurs, effets indésirables, observance et satisfaction). La revue des activités pharmaceutiques en vigueur a servi de base à des discussions sur la mise à jour du secteur. Conclusion : Il existe peu de données sur la hiérarchisation des Tuesday, February 5 Mardi 5 février and during periods of supply shortages requires leveraging both financial and human resources. Drug Availability in Canada: What Should Hospital Pharmacists Consider? Andrew Mica and Larry Green, Amgen, Thousand Oaks, CA Rationale: Drug shortages are an increasing challenge to healthcare in Canada and other countries and can result in the consideration of alternative medications, potentially increasing risk to patients. Although Health Canada maintains a list of drugs in short supply via the Canadian Drug Shortage Database, there is an urgent need for pharmacists to identify potential drug shortages and to understand how manufacturers manage drug supply. Description: Using biologics as an example, this report highlights supply chain parameters and resources that pharmacists should consider when assessing a manufacturer’s ability to maintain and deliver a continuous drug supply. Steps Taken: As a measure of manufacturer ability to maintain adequate drug supply, inventory turns for 7 major US manufacturers were evaluated between 2006−2010 (low inventory turn denotes a large amount of stock). Key practices employed by leading biologics manufacturers to mitigate the risk of drug shortages were assessed from publicly available data sources, including the US Food and Drug Administration, the American Society of Health System Pharmacists, and manufacturers’ websites. Evaluation: Biotech manufacturers (n=2) had 1−1.5 turns, large pharmaceutical manufacturers (n=2) had 1.5−2.0 turns, and generic manufacturers (n=3) had 2−4 turns. Key factors that can enable biologics manufacturers to ensure a continuous supply of products to patients include (1) maintenance of strategic safety stocks, (2) active management of raw material supplies, (3) establishment of redundant manufacturing capabilities and strategic capacity management, (4) active management of robust and secure cold chain distribution networks, and (5) effective integration of global manufacturing systems that link patient demand to production scheduling. Importance: Understanding and considering how manufacturers manage drug supply should be an integral part of the hospital pharmacist’s role when making formulary decisions. Ensuring that approved biologic drugs are available through normal operations programmes de soins et des activités pharmaceutiques. Cette étude décrit une démarche de mise à jour en clinique de VIH-SIDA en pédiatrie. Perception of the Impact of Drug Shortages on Healthcare Professionals and Patients in Canada Barthélémy, D. Lebel, J-F. Bussières, Isabelle Barthélémy, CHU Sainte-Justine, Montreal, QC, Denis Lebel, CHU Sainte-Justine, Montreal, QC, Jean-François Bussières, CHU Sainte-Justine, Montreal, QC Rationale: In 2011, Sandoz Canada received a warning letter from the Food and Drug Administration. In order to remediate to the non-conformity issues raised, Sandoz suspended and reduced the production of a significant amount of products. That created a major drug shortage crisis in Canadian hospitals. Objective: To evaluate the perception of the impact of the 2012 drug shortages on healthcare professionals and patients. Design and Methods: This is an observational study through a web survey in a teaching hospital. A questionnaire of 54 items was developed and pre-tested on five people. A target of 30 responses per health professional category was expected. Results: A total of 32 physicians, 16 medical residents, 28 pharmacists, 33 nurses and 30 pharmacy technicians participated. 98% of respondents believed that the current crisis demonstrates the vulnerability of the Canadian market, 79% have been affected by the crisis and 87% had to modify at least one aspect of their practice. 64% experienced an increased workload (more than 30 minutes/day for a third of the respondents), 10% perceived an increase in medication errors, 6% a prolonged length of stay for some patients and 3% noted delays for elective surgeries. No respondents could link a death to the drug shortage crisis. 97% believed the current legal obligations for manufacturers are insufficient and 63% associated drug shortages to the generic industry. 96% indicated that there should be at least two Canadian manufacturers for critical drugs. 100% agreed that drug manufacturer should notify Health Canada before drug shortages or market withdrawal, 63% mentioned that drug manufacturers should have the obligation to identify a relevant alternative in case of shortage. Conclusion: These are the first results about healthcare professionals perceptions following the current drug shortages experienced with Sandoz Canada and manufacturers in 2012. Actions from all stakeholders are required. 57 Implantation d’une nouvelle règle d’utilisation de la vancomycine : une étude pré-post Annie Lavoie, CHU Sainte-Justine, Montréal, QC, Anais Delicourt, CHU Sainte-Justine, Montréal, QC, Sophie Penfornis, CHU Sainte-Justine, Montréal, QC, Denis Lebel, CHU Sainte-Justine, Montréal, QC, Philippe Ovetchkine, CHU Sainte-Justine, Montréal, QC, Jean-François Bussières, CHU Sainte-Justine, Montréal, QC Justification : En 2009, de nouvelles recommandations concernant les modalités d’utilisation de la vancomycine ont été émises. Dans le but de se conformer à ces recommandations, la règle d’utilisation locale a été modifiée. Objectif : Évaluer la conformité des prescriptions suivant la modification de la règle d’utilisation locale et décrire l’utilisation de la vancomycine dans un hôpital pédiatrique. Méthodologie : Étude quasi-expérimentale de type pré-post sans groupe témoin. La phase pré s’est déroulée du 01-03-2010 au 30-06-2010 et la phase post du 16-12-2010 et au 02-03-2011. Pour l’intervention, l’écart thérapeutique du prélèvement pré-dose (creux) a été élargi de 5-10 mg/L à 5-15 mg/L et l’indication pour le prélèvement du post-dose a été précisée. Afin d’améliorer la conformité à la règle, plusieurs actions ont été entreprises : formation d’un comité, approbation par le comité de pharmacologie et diffusion lors de conférences midi. Les posologies et valeurs de prélèvement pré-dose ont été comparées pré et post-intervention avec un test t. Résultats : Des 710 ordonnances de vancomycine rédigées entre le 01-03-2010 et le 02-03-2011, 340 ont été incluses (96 pré et 74 post). L’âge moyen des patients était de 6,8±5,7 ans. La posologie initiale quotidienne était de 43±10,6 mg/kg/jour pré et de 48,4±10,8 mg/kg/jour post-intervention (p=0,002). La valeur moyenne±écart-type du prélèvement pré-dose a augmenté de 8,07±3,8 mg/L à 10,46±5,83 (p=0,004). La proportion de dosages de type post-dose a diminué de 49% en pré contre 38% en post. Le nombre moyen de prélèvements par ordonnance de vancomycine a diminué de 3,1 en pré à 1,5 en post. Conclusion : Cette étude démontre l’adhésion des prescripteurs à de nouvelles recommandations locales pour l’utilisation de la vancomycine par voie parentérale. L’intervention a permis d’augmenter significativement la dose moyenne initiale et la valeur pré-dose obtenue et de réduire significativement le recours au prélèvement post-dose. Does Interprofessional Medication Reconciliation from Admission to Discharge Reduce Post-Discharge Patient Emergency Department Visits And Hospital Readmissions? Michelle Baker, Chaim M. Bell, Wei Xiong, Edward Etchells, Peter Rossos, Kaveh Shojania, Kelly Lane, Tim Tripp, Mary Lam, Kimindra Tiwana, Nita Dhir, Derek Leong, Gary Wong, Jin Huh, Emily Musing, and Olavo Fernandes, University Health Network, Toronto, ON Rationale: Medication reconciliation has been shown to reduce potential adverse drug events but its specific impact on post-discharge hospital readmission is still not known. Objective: To evaluate the impact of integrated inter-professional (pharmacist-prescriber) medication reconciliation on patient emergency department visits and hospital readmissions. Study Design and Methods: In this observational cohort study at a tertiary-care hospital, patients discharged by General Internal Medicine (GIM) were identified through administrative databases. The intervention group (patients receiving interprofessional admission to discharge reconciliation supported by an electronic platform) was compared to a control group. The outcome was defined as a composite of emergency department or hospital readmissions within 30 days of the index discharge. A multivariate 58 logistic regression model was used to adjust for age, gender, number of medications, and LACE index. Results: From 2007-2011, a total of 9,931 unique GIM patient visits (n=8678 patients) met the criteria of the study. The main analysis did not detect a difference in outcomes between the intervention group (540/2541) and control (1423/7390) for the primary endpoint. The adjusted odd’s ratio was 1.058 (21.25% vs. 19.26%, 95% CI 0.945-1.19, p= 0.326). After propensity score adjustment, the relative risk of readmission was 0.88 (16.7% vs.18.9%, 95% CI 0.59-1.32, p=0.5350). Increasing number of medications, LACE index score, as well as male gender were independently correlated with a higher risk of hospital visits. Also, subgroup analyses of high-risk groups: patients ≥65 years, LACE index ≥10, those on high-alert medications, and ≥10 medications did not detect a statistically significant outcome difference between groups. Conclusion: A 5 year observational evaluation of interprofessional medication reconciliation did not detect a difference in 30 day post-discharge patient hospital visits. Future prospective studies could focus on an enhanced reconciliation intervention bundle on avoidable “medication-related” hospital admissions and post-discharge adverse drug events. CSHP 2 Targeting Excellence in Pharmacy Practice Dissemination of a Pharmacy-Initiated Medication Outcome Monitoring Procedure for Nurses in a Long-Term Care Hospital Sophie Pang1, Lawrence Jackson2, Patricia Gordon3, 1Pharmacy Student, Leslie Dan Faculty of Pharmacy, and Departments of 2Pharmacy and 3 Nursing, Veterans Centre, Sunnybrook Health Sciences Centre, Toronto, ON Rationale: A Pharmacy-initiated procedure to help nurses monitor and document outcomes from targeted medication interventions had been successfully implemented on two patient care units of a long-term care hospital. The implementation of an electronic documentation system, PointClickCare® (PCC) provided an opportunity to disseminate this procedure to the remaining 15 units while orienting all staff to specific features of the PCC system. Project Description: To disseminate this procedure, a PPC resource guide was developed as an instructional aid. Group and individual nursing in-services were conducted on all units to describe the advantages of this monitoring procedure and provide step-by-step instruction on building a medication Care Plan and creating a medication Alert. In-services were arranged in collaboration with the PCC Nurse Clinician, and the Advanced Practice Nurse and Patient Care Manager for each unit. A guide for medication monitoring parameters, already in use at the hospital, was employed. Data on the number of medication-related Progress Notes was collected on two units before and after the in-service to assess impact. Nurses’ satisfaction with the in-service was obtained using a feedback form and through informal post-session comments. Evaluation of Project: Nurses valued the medication monitoring guide and found the instructions provided in the in-service easy to understand. The number of medication interventions lacking progress notes fell from 64% to 48% and from 43% to 24% in the two units respectively, after the in-service. In addition, the number of medication interventions with multiple notes in the subsequent seven days increased slightly. Importance to Future Practice: Effective dissemination of practice innovations is important for continuous quality improvement. Utilizing a variety of strategies, including in-services, resource guides, one-on-one teaching and audit and feedback, increases the likelihood of success. Insights gained in terms of enablers and barriers to dissemination can be applied to future implementation efforts. CSHP 2 Targeting Excellence in Pharmacy Practice Pharmacists’ Interventions During the Periodic Medication Review Reduce Preventable Adverse Drug Events Alena Hung1,2, Lawrence Jackson2, Edward Kung2, Victoria Hsu2, Dean Yang2, Froozan Amin2, Evelyn Williams31,2 Doctor of Medicine Candidate, Faculty of Medicine, University of Manitoba and Departments of 2Pharmacy and 3Medicine. Veterans Centre, Sunnybrook Health Sciences Centre, Toronto, ON Introduction: Preventable adverse drug events (pADEs) are the negative outcomes resulting from suboptimal prescribing, dispensing, administering, or monitoring of a medication. They are common in elderly long-term care patients and can lead to unnecessary harm. The majority of pADEs result from inappropriate prescribing and monitoring. The periodic medication review (PMR) presents an opportunity for pharmacists to identify inappropriate prescribing, intervene, and ultimately reduce the occurrence of preventable adverse drug events. Objective: To determine the number of therapeutic interventions made by pharmacists at the time of a PMR and their impact on reducing pADEs in a long-term care hospital. Methods: Data from PMRs conducted in the winter of 2010/2011 was collected retrospectively by reviewing Physician’s Orders and pharmacists’ notes. The PMR consists of a complete review of each patient’s medications by the physician, nurse and pharmacist as well as implementation of solutions to eliminate inappropriate medication use. Any intervention to increase appropriateness was deemed to represent a pADE. To increase the yield of pADEs identified, pharmacists utilized a structured therapeutic thought process based on the Drug Related Problem (DRP) categories of Strand and explicit criteria for prescribing in the elderly (Beers Criteria). Outcomes were compared to data collected in 2004. Results: Four hundred and fifteen interventions were made in 206 of the 508 residents. Common interventions included: no valid indication (29%), requires lab monitoring (27%), dosage or frequency adjustment (24%), and new medication required (10%). The most frequently involved drug classes were central nervous system (20%), followed by gastrointestinal (16%) and cardiovascular (11%). Results were comparable to data obtained in 2004. Conclusion: Pharmacists, working with physicians and nurses and guided by the patients’ goals, can reduce preventable adverse drug events. The PMR serves as an important opportunity for the identification of such pADEs and is an important patient safety procedure. practitioners /leaders on 1) the definition and 2) a potential global inventory of candidate cpKPI. Evaluation: The consensus definition for a cpKPI included five characteristics. It should 1) reflect a desired quality practice; 2) be attributable to direct patient care; 3) be evidence-based to meaningful patient outcomes; 4) be sensitive/suited to pharmacy/pharmacist activities and 5) be feasible to measurable. An “evidence map” summarizing 7 key pharmacy practice papers and other factors was created to help the working group filter and establish 8 final candidate “critical activity/ focused topic “areas (“Doucette-8”). This categorization and a global cpKPI inventory review helped to facilitate debate and discussion in creating a pre-Delphi candidate cpKPI list. Importance: A national CSHP cpKPI task force established a pre-Delphi cpKPI consensus definition and an evidence-informed list of candidate cpKPI. These results will be used to inform a national Delphi panel to establish a final core suite national cpKPI will help better define minimum standards and permit benchmark comparisons within and between hospitals. National cpKPI would serve to advance clinical pharmacy practice toward desired quality evidence-informed outcomes. Evaluation of Cancer Treatment Order Entry by a Clinical Support Pharmacy Technician (Oncology) in a Medical Day Unit Neville H, Broadfield L, Harding C, Heukshorst S, Rolle M, Sweetapple J, Pharmacy Department, Capital Health, Halifax NS Rationale: Pharmacy technicians’ responsibilities are expanding to new roles such as the technical task of chemotherapy order entry, which can free pharmacists to provide more clinical services. Objectives: To determine whether trained clinical support pharmacy technicians (CSPT) enter chemotherapy orders as safely and efficiently as pharmacists. We measured the time needed for order entry, order entry checking, workflow interruptions, and errors with a pharmacist compared to a CSPT. Study Design and Methods: This was a before and after observational study of oncology order entry for ambulatory hematology patients. Timings were performed by an independent observer using a personal digital assistant. Data were exported to Microsoft Excel for analysis. Difference of means test was used to determine if there was a significant difference between the two phases. Results: There were 144 and 128 individual orders timed for the CSHP 2 Targeting Excellence in Pharmacy Practice What are the Appropriate Candidate Clinical Pharmacy Key Performance Indicators (cpKPI) for Hospital Pharmacists? Winnie Chan, Doug Doucette, Kent Toombs, Richard Slavik, Jeremy Slobodan, Sean Gorman, Bill Semchuk, Natalie Benninger, Cathy Lyder and Olavo Fernandes, CSHP National Clinical Pharmacy Key Performance Indicator Task Force, Toronto, ON Rationale: Key Performance Indicators (KPIs) are quantifiable measures of quality. Currently, there is no established national or international consensus on the explicit definition or the core topic foci for clinical pharmacy KPIs (cpKPI). The primary objective of this evaluation was to establish a consensus definition and a core set of Pre-Delphi phase candidate cpKPI via a systematic, national evidenced informed process. pharmacist (Phase 1) and the technician (Phase 2) for order entry, respectively. After outliers were removed, there was no difference in the mean time to enter chemotherapy orders (pharmacist 00:45 sec, technician 00:48 sec, p=0.92). There were 114 and 122 individual orders timed for order entry checking by the pharmacist in Phase 1 and Phase 2, respectively. Phase 2 was significantly faster than Phase 1 (1:12 min vs 1:24 min, p<0.05). There were 33 non-order entry related interruptions (total 39:38 min) in Phase 1, and 25 interruptions (total 30:08 min) in Phase 2. Errors were 3 in Phase 1 and 0 in Phase 2; all were rated as having no effect on patient care. Conclusion: Chemotherapy order entry by a pharmacy technician was proven to be not inferior to a pharmacist for safety and efficiency. Changes in scope of practice for clinical support pharmacy technicians can increase the amount of time for direct patient care by pharmacists in the oncology setting. Description: A national cpKPI working group (cpKPIWG), with regional representation, was formed in May 2011 and became a CSHP taskforce in August 2012. Core cpKPI published literature and national (CSHP 2015) measures were reviewed. Feedback was systematically gathered via teleconferences (regional practice model and metric sharing), a national call to members, and national/regional/ local workshops with front-line pharmacy 59 CSHP Evaluation of the Impact of a Pre-Admission Best Possible Medication History on the Admission Medication Reconciliation Rate Among Surgical In-Patients 2 Targeting Excellence in Pharmacy Practice Tatiana Lee, Thomas Chan, Sharon Eng, Christine Ling, Edith Rolko, Monica Lee, North York General Hospital, Toronto, ON Rationale: At North York General Hospital, patients scheduled for elective surgeries are required to attend the Pre-Admission Clinic (PAC) for an initial assessment prior to their procedures. This involves obtaining a Best Possible Medication History (BPMH) by the PAC pharmacist, thereby facilitating the completion of medication reconciliation upon the patients’ admission to the surgical units. We examined the impact of this process on admission medication reconciliation rates among surgical in-patients. Description and Steps Taken: To characterize the workflow of the PAC pharmacist and evaluate its impact on admission medication reconciliation rates. Information gathered over a two-week period included: patient characteristics, days elapsed between PAC visit and surgical date, and completion of in-patient BPMH and medication reconciliation. Additionally, differences in BPMH between the PAC encounter and day of surgery were examined. Evaluation: During the two-week period, 31.8% (n=124) of patients assessed at the PAC were admitted after their procedures. Of these, 40.3% (n=50) have been interviewed by the PAC pharmacist. Patients assessed by the PAC pharmacist were found to have a higher completion rate of admission medication reconciliation (86.0%) compared to those who were not (58.1%), with a higher proportion completed within the first 24 hours of admission (93.0% vs. 79.1%). The average number of days between the PAC encounter and surgery was 12.3, whereby 22.0% of patients demonstrated differences in their BPMHs. These differences were mostly unintentional discrepancies in documentation (63.6%, n=7), rather than actual changes to medication regimens (36.4%, n=4). Importance: Findings suggest that a BPMH obtained by a PAC pharmacist facilitates the completion of admission medication reconciliation among surgical in-patients. Intentional changes in medication regimens were uncommon between the time of PAC assessment and day of surgery. Results indicate that all patients who will be admitted post-surgery should have their BPMHs obtained by the PAC pharmacist. Can a Culture of Safety be Enhanced in a Department of Pharmacy? Heather Kertland, PharmD, Clarence Chant, PharmD, Salma Satchu, PharmD, Jill Garland, BScPhm, Elaine Tom, BScPhm, St. Michael's Hospital, Toronto, ON Rationale: While pharmacists are key in ensuring the safe use of medications, the culture of safety within the Pharmacy department is not well described in the literature. We sought to assess the departmental safety culture and determine if an intervention that addressed an identified safety concern could improve the overall safety culture. Methods: An initial departmental safety culture assessment using the validated Hospital Survey on Patient Safety Culture survey was conducted. The findings of the survey were then used to establish the intervention: an open communication forum termed Safety Rounds to discuss medication incidents. These rounds were held twice monthly for four months, followed one month later by a repeat survey. Results: A total of 71% of eligible pharmacists completed the baseline survey. The overall safety culture was 46% positive and the dimensions of concern were: communication openness, feedback and communication about error and hospital handoffs and transitions. The post intervention survey was completed by 50% of eligible pharmacists. The overall safety culture did not change (43% positive) however there were substantial changes in the proportion of positive responses in several dimensions including: feedback and 60 communication about errors (25 to 58%), communication openness (38 to 51%), organizational learning (56 to 71%), and teamwork within the unit (71 to 88%). Dimensions that demonstrated a decrease in the proportion of positive responses were: hospital management support (72 to 56%), handoffs and transitions (14% to 5%), and teamwork across hospital units (45 % to 34%). Conclusion: The open communication forum, Safety Rounds did not change the overall culture of safety but led to improvements in important dimensions and identified areas requiring further work. CSHP 2 Targeting Excellence in Pharmacy Practice Removal of Concentrated Electrolyte from Patient Care Areas - A Focus on Magnesium Sulfate Injection: Patient Safety and Drug Shortage Implications Andrea Beaman. The Credit Valley Hospital and Trillium Health Centre, Mississauga ON Rationale: Concentrated magnesium sulfate vials were available on patient care areas for preparation of doses by nurses. The hospital has previously removed other concentrated electrolyte solutions from patient care areas. Although magnesium may be administered over 1-2 minutes in patients with persistent pulseless ventricular tachycardia or ventricular fibrillation, there are risks with undiluted administration for non-urgent indications, including hypotension and asystole. Description of Situation: Removal of concentrated electrolyte solutions from patient care areas is an ISMP initiative and Accreditation Canada Required Organizational Practice to reduce patient risk. Other concentrated electrolytes were removed, but concentrated magnesium remained on many of the patient care areas. Injectable magnesium vials are in short supply nationally, and nurses were using 5 g single-use vials to prepare 1-4g doses, resulting in product waste. Steps Taken to Implement Change: • Evaluation of current stock locations and prescribing patterns • Consultation with Physicians and Clinical Educators in affected patient care areas • Development of standardized doses and concentrations, and an automatic substitution policy that nurses can apply to STAT doses and pending Pre-Printed Order revisions. • Education and implementation of switch to magnesium premixed minibags for all patient doses. • Concentrated magnesium vials retained for crash cart use, and preparation of paediatric doses. Evaluation: We will benefit from reduced patient-risk; reduced nursing time spent preparing doses, more efficient use of pharmacy services, and reduced waste through implementation of a standardized hospital-wide concentration in premixed magnesium in minibags. Importance and Usefulness to Practice: This practice change will enhance patient safety and compliance with accreditation requirements. Pharmacists and pharmacy technicians will also function to full scope to ensure patients receive the safest medication options. Stewardship of health care resources through use of auto-sub to reduce wasted nursing time and pharmaceutical resources. A Before and After Study of the Implementation of Bedside Medication Storage and Prefilled Narcotics Syringes to a Post Anesthesia Care Unit (PACU) Eric Romeril, Hamilton Health Sciences, Hamilton, ON, Melanie MacInnis, McMaster University & Hamilton Health Sciences, Hamilton, ON, Leslie Gauthier, McMaster University & Hamilton Health Sciences, Hamilton, ON, Leslie Gillies, Hamilton Health Sciences, Hamilton, ON, Marianne Kampf, Hamilton Health Sciences, Hamilton, ON, James Paul, McMaster University & Hamilton Health Sciences, Hamilton, ON Rationale: Front line PACU staff asked for help redesigning their medication use system due to safety concerns. It is a high risk environment for medication errors, attributed to patient acuity, frequency of high risk medication administration events (MAE). Objective: To analyze the impact of introducing bedside-stored medications and prefilled unit-dose syringes on patient, medication errors and nursing practice deviations(NPD). Methods: This was a REB-approved, blinded, prospective, before-and-after study. The before and after observation periods were each 2 weeks; separated by one week for process change. Two PACUs were chosen from the same multi-site tertiary care hospital system; one served as intervention site and one as control. Trained observers used a standardized case report form to gather data from MAE at both sites using convenience sampling. Data collection and analysis was blinded. Relative risk with associated 95% confidence interval (CI) is used to report the estimates for binary outcomes, p values are calculated using Student’s T test. Wednesday, February 6 Mercredi 6 février CSHP 2 Facilitating Improved Glycemic Control in the Non-Critically Ill Inpatient Setting Targeting Excellence in Pharmacy Practice Henry Halapy, Rosemary Tanzini, Catherine Yu, St. Michael’s Hospital, Toronto, ON Rationale: The use of subcutaneous insulin in the non-critically ill inpatient setting is often characterized by the use of sliding scale insulin in the absence of a scheduled anti-hyperglycemic order, which may result in poor glycemic control. Description: The purpose of this project was to design and implement preprinted order sets in order to streamline safe, effective insulin use and encourage the use of standing basal-bolus insulin (BBI) and correction factor scales (CF) over sliding scale insulin. Methods: The preprinted order sets and CF scales were designed and developed by a multi-professional group (diabetes pharmacist, 2 endocrinologists, diabetes nurse educator). They were designed to be easy to use, facilitating ordering of insulin regimens via the use of streamlined check boxes, and encouraged the use of standing BBI regimens coupled with patient-specific standardized CF scales. Order sets were developed for multiple clinical scenarios: initiating multiple dose insulin injections, initiating 1 to 2 insulin injections for type 2 diabetes, maintenance of home insulin regimens, and insulin use in patients who are not eating. The CF scales were incorporated into each individual insulin order set. A hospital wide education program was designed and delivered to clinical pharmacists and nurse educators and physician chiefs to encourage the use of the insulin order sets. Evaluation: Feedback from clinical pharmacists regarding the clinical use of the order sets was encouraging, but uptake into clinical practice has not been universal throughout the institution. A retrospective chart review comparing pre- and post-implementation performance of the CF scale indicated that the proportion of blood glucose values spent at >11.0 mmol/L was 39% lower (p=0.03) without an increase in hypoglycemia. Conclusions: Insulin preprinted order sets have been helpful in encouraging appropriate and safe insulin practice. Challenges remain with increasing universal uptake of the order sets in the institution. Results: MAE were recorded at the control (before[n=36], after[n=92] ) and intervention sites (before[n=62], after[n=90]). After exclusion of incomplete or incorrect records( n=48), the remaining data was analyzed (n=280). There were not enough MAE observations to analyze the medication error data. A significant reduction in NPD was seen in the control (ARR= 0.307 p= 0.001[95%CI= 0.116-0.471]). No definite change was seen in the intervention (ARR= 0.031 p= 0.367[95%CI= -0.041-0.124]). Of all MAE observed 78.9% were narcotic products. All NPDs (n=4) at the intervention site were waste related before, and none were after (n=0). Conclusions: Due to problems with data collection, observer standardization and lower than anticipated MAE; definitive conclusions cannot be reached regarding medication error rate. Nursing practice deviations related to narcotic wasting were reduced. A significant finding may be reached with a higher number of observed MAE and more rigorous observer training. Rationale: While dabigatran etexilate is as effective as warfarin for thromboprophylaxis in atrial fibrillation, the same has not been demonstrated for other indications such as thromboprophylaxis of mechanical heart valves. Description: In July 2010, a 26 year-old female underwent a mechanical mitral valve replacement and received warfarin postoperatively. In May 2012 she was switched to dabigatran 150 mg twice daily due to a cutaneous reaction secondary to warfarin. Regular refill history did not suggest adherence to dabigatran was an issue. In August 2012, she presented to hospital with pulmonary edema and cardiogenic shock. A transesophageal echocardiogram revealed a large mobile mass attached to the mitral valve and a mean transmitral gradient of 25 mmHg (normal < 2 mmHg). During valve replacement surgery, minimal pannus was noted and the existing valve was extensively thrombosed with one leaflet completely fixed and immobile. Assessment of Causality: The literature indicates prosthetic valve thrombosis (PVT) can occur within a month of inadequate anticoagulation. Evaluation of the Literature: There are three published case reports that describe both mitral and aortic PVT with dabigatran anticoagulation, all presenting within two months of switching from warfarin. One in vitro study demonstrated that low-dose rivaroxaban resulted in higher thrombus burden on mechanical valves compared to heparin, enoxaparin or high-dose rivaroxaban. A search of clinical trial registries for all of the new oral anticoagulants and prosthetic valves found only RE-ALIGN (NCT 01452347), a phase II study assessing the safety and pharmacokinetics of dabigatran 150, 220 and 300 mg po twice daily. Importance to Pharmacy Practitioners: Dabigatran and other new oral anticoagulants should not be used as an alternative to warfarin in patients with mechanical valves until efficacy can be established. One hypothesis is that higher doses will need to be used for this indication. Quetiapine-Associated Serotonin Syndrome: A Case Report Mayce Al-Sukhni1, Mark McIntyre2 1 2 University of Toronto, Toronto, ON Mount Sinai Hospital, Toronto, ON Rationale: Quetiapine is an atypical antipsychotic used for treating Mechanical Mitral Valve Thrombosis with Dabigatran Jenny Jong, Andrea Narducci, Johanna Proceviat, St. Michael’s Hospital, Toronto, ON schizophrenia, bipolar disorder, and major depressive disorder. Atypical antipsychotics, including quetiapine, have been implicated in serotonin syndrome in combination with other serotonergic 61 agents. We describe a novel case of serotonin syndrome possibly due to the combination of risperidone and quetiapine. Description: A 57-year-old female with a history of psychotic depression was brought to the emergency department after being found at home with confusion, diaphoresis, and rigidity. Medications on admission included risperidone 5mg daily and quetiapine 25mg as needed. She reported increased quetiapine ingestion immediately prior to admission, and her medication vial was empty on discovery. On examination, she was slightly febrile (temperature=37.8oC); hypertensive (blood pressure=158/91mmHg); tachycardic (124 beats/minute); and tachypneic (23 respirations/minute). Her creatine phosphokinase was normal (165 IU/L). The patient was diagnosed with serotonin syndrome. Quetiapine and risperidone were held and the patient’s symptoms resolved with supportive management. One week after admission, risperidone was reintroduced at a low dose and was tolerated well. Quetiapine was not reinitiated. Causality Assessment: Excess stimulation of post-synaptic neurons at serotonin receptor subtypes 5-HT1A and 5-HT2A can cause serotonin syndrome. Both quetiapine and risperidone are antagonists at 5-HT2A. Additionally, quetiapine is a partial agonist at 5-HT1A. In the current case, there is biological plausibility for the combined antagonism of quetiapine and risperidone at 5-HT2A leading to a relative increase in serotonin concentration at the 5-HT1A receptor and, thus, to serotonin syndrome. The Naranjo score of 4 indicates a possible adverse drug reaction. Literature Evaluation: Several reports have implicated quetiapine in the development of serotonin syndrome. This is the first such case where a full serotonin agonist was not involved. Importance to Pharmacy Practitioners: This case suggests that quetiapine taken with risperidone may lead to serotonin syndrome. Pharmacists should be aware of this potential adverse effect. Dabigatran Etexilate: A Qualitative Study of Administration, Adherence, Proper Storage, and Patient Satisfaction in Ambulatory Patients Melissa Lo, Paula Brown, Artemis Diamantouros, Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Rationale: Dabigatran is a direct thrombin inhibitor recently approved in Canada for the prevention of stroke in patients with atrial fibrillation (AF). As a newly approved drug, there is a paucity of patient experience with dabigatran and much to be learned from “real-world” use. Objectives: To gain insight into the experiences and challenges of patients prescribed dabigatran. Study Design and Methods: A qualitative study was conducted using semi-structured interviews of 23 adult patients with AF using dabigatran. Patients were identified as taking dabigatran either at discharge from hospital or as ambulatory patients filling their prescription at the outpatient pharmacy. The interviews were recorded, transcribed, and coded for themes using grounded theory methodology. Results: Common themes relating to drug administration included patients reporting difficulty swallowing the capsules and opening the foil-sealed packaging. In patients with poor dexterity potentially harmful measures were taken to overcome this limitation. Few problems were reported regarding adherence to the twice daily medication regimen as most patients used dosettes. Many patients reported storing their medication in an area inappropriate for the strict storage requirements of this drug. Patients overall preferred dabigatran compared to warfarin due to its perceived greater efficacy and lack of INR monitoring and dietary restrictions. However, patients reported concerns regarding cost and lack of a reversal agent for dabigatran. 62 Conclusions: Patients generally preferred dabigatran over warfarin therapy for AF. However, there appears to be a lack of assessment to ensure patients are appropriate candidates for dabigatran. Upon initial prescribing of dabigatran, pharmacists should assess the patient’s ability to open the packaging, swallow the capsules and resources to pay for the medication. Education should be provided regarding proper storage. These issues should be reinforced and reevaluated regularly to ensure dabigatran is being used appropriately and to reduce the risk of adverse effects or drug ineffectiveness. CSHP 2 Targeting Excellence in Pharmacy Practice Evaluation of Antimicrobial Stewardship Program on Leukemia Service through Prospective Audit and Feedback Miranda So1, Lucie Pivnick2, Marilyn Steinberg2, Tanaz Jivraj2, Stephen Lapinsky2, Andrew Morris1,2, Shahid Husain1 1 2 University Health Network, Toronto, ON Mount Sinai Hospital, Toronto, ON Rationale: Patients with haematological malignancies are vulnerable to infections and often receive multiple or prolonged courses of antimicrobials. Emergence of multi-drug resistant organisms and prevalence of C. difficile infections (CDI) have highlighted the need for antimicrobial stewardship programs (ASP), although literature documenting their impact on this immunocompromised population is limited. Program: University Health Network launched ASP on Leukemia service in February 2010. Intervention: Prospective audit-and-feedback: an infectious diseases physician and a pharmacist with advanced training review with the leukemia team 3x /week all patients on at least one antimicrobial, or have microbiology results pending. Suggestions were made regarding diagnostic investigations; antimicrobial selection; duration; dosing; and adverse effects. Evaluation: The following were compared retrospectively based on pre-ASP (fiscal year 09/10) and post-ASP (fiscal years 10/12 combined) periods by unpaired t-test: monthly antibiotic and antifungal consumption in defined daily dose per 100 patient-days (DDD/100 PD); monthly antibiotic and antifungal costs/100 PD. Incidence of bacteremias, fungemias, CDI and intensive care admission were examined for trend. Impact: ASP significantly reduced antibiotic consumption and antifungal costs. Antifungal consumption remained stable, attributed to improved consistency in fluconazole prophylaxis, and significant decrease in consumption of costly antifungals to treat fungemias, which decreased significantly by 62%. Coagulase-negative staphylocci (CNST) bacteremia decreased but gram-negative bacteremia increased. A CDI outbreak in Q3/4 of FY 11/12 drove overall increase in CDI post-ASP. Prospective audit and feedback improved certain clinical outcomes but detailed analyses of patient characteristics (e.g. performance score, duration of neutropenia, central line maintenance) are required to understand the rise in ICU admission and gram-negative bacteremias. Table 1 (See page 63) Determination of Vancomycin Pharmacokinetics in Neonates to Develop Practical Initial Dosing Recommendations Julianne Kim, Sandra AN Walker, Dolores C Iaboni, Scott E Walker, Marion Elligsen, Michael S Dunn, Vanessa Allen, Andrew Simor, Nick Daneman, Sunnybrook Health Sciences Centre, Toronto, ON Rationale: Variability in neonatal vancomycin pharmacokinetics (PKs) and lack of consensus for optimal troughs in neonatal intensive care units (NICUs) poses challenges to dosing vancomycin in neonates. Table 1. Comparison of outcome measures in the Pre-ASP and Post-ASP periods p-value (<0.05 denotes statistical Pre. Vs. Post-ASP significance) FY 09/10 (Pre-ASP) FY 10/12 (Post-ASP) DDD 190.65 ± 13.6 166.09± 36.45 13.19%i 0.032 Cost ($) 6225.39 ± 611.16 5723.99 ±1031.64 7.21%i 0.131 DDD 104.29 ±10.63 106.34± 8.97 1.95%h 0.550 Cost ($) 10511.92 ±2522.61 7690.84 ±2694.44 26.8%i 0.005 Fluconazole DDD 50.77 ±14.92 59.22± 13.06 16.6%h 0.078 Voriconazole DDD 20.1 ±5.03 16.57± 4.92 17.6%i 0.052 Liposomal amphotericin DDD 6.22 ± 3.23 4.2 ±2.80 32.5%i 0.061 Echinocandins DDD 13.10 ± 8.21 10.58 ± 7.44 19.3%i 0.359 Parameter Antibiotics Antifungals Positive blood cultures/total sent (%) 202/1807 (11.2%) Most common aerobic gram-positive isolate and incidence (#episode per 100 PD) CNST; 0.709 CNST; 0.581 0.417 Incidence of fungemia (# episode per 100 PD) 0.057 0.022 CDI incidence (cases per 100 PD) 0.567 0.931 ICU admission per 100 PD 0.283 0.421 Lacey DeVreese,1 Rosemary Zvonar,1 Dr. Gary Garber1,2,3, 1 The Ottawa Hospital, Ottawa, ON University of Ottawa, Ottawa, ON 3 Ottawa Health Research Institute, Ottawa, ON 2 Rationale: Clear and consistent documentation of antibiotic use in medical charts facilitates communication and regular review of therapy. Appropriate documentation related to antibiotic use has been advocated in the medical literature and by various organizations. Objective: To assess the adequacy of antibiotic documentation prior to the implementation of an antimicrobial stewardship program. Study Design and Methods: Three key aspects of antibiotic use 520/4230 (12.3%) Incidence of 0.274 gram-negative bacteremia (# episode per 100 PD) Assessing the Adequacy of Documentation in Patients Receiving Antibiotic Therapy were retrospectively evaluated to assess documentation practices for the purpose of the study: 1) the rationale (indication) for the initiation of antibiotic therapy; 2) reassessment of antibiotic therapy; and 3) the intended duration of therapy. Documentation was considered adequate if the rationale, evidence of reassessment, and a plan for duration of therapy were recorded in the medical chart within 24, 96 and 96 hours of initiation of antibiotic therapy, respectively. Each component was assessed individually and collectively as a bundle (i.e., documentation of all three components in each chart). Inclusion of these three aspects on the Pharmacy Clinical Documentation Form and the proportion of patients considered for transition from intravenous to oral therapy were also recorded. Results: Of the 75 medical charts reviewed, 76%, 71% and 31% met Objective: To determine vancomycin PKs in neonates and evaluate dosing regimens to provide practical initial recommendations to target trough concentrations most commonly used in NICUs. Methods: Fifty neonates who received vancomycin with at least one set of steady-state levels were evaluated retrospectively. Mean PKs were determined using first-order PK equations and univariate linear regression (p<0.2) followed by multivariate backward linear regression (MVR) (p<0.05) was completed to identify covariates of clearance (Cl) and volume of distribution (Vd). CART was used to identify any breakpoints for significant covariates of Cl and Vd. Monte Carlo Simulation (MCS) was used to evaluate initial dosing recommendations for target troughs of 15-20 mg/L, 5-20 mg/L and < 20 mg/L. Results: MVR identified a linear continuous relationship of the significant variables with Cl and Vd. However, although the regression equations were significant, they are impractical for clinical application. No CART breakpoints for covariates of Cl or Vd existed. MCS revealed that mg/kg dosing was optimal, where 9-12 mg/kg iv q8h attained the target of 15-20 mg/L in 15-21% of patients and continuous infusion with a loading dose of 10mg/kg followed by 25-30 mg/kg/24h had a probability of target attainment of 28-32%. Initial dosing of 9-15 mg/kg iv q12h achieved targets of 5-20 mg/L and < 20 mg/L in 56-76% and 92-99% of patients, respectively. Conclusions: Initial vancomycin dosing recommendations for neonates were determined. Due to the variability in neonatal vancomycin PKs, monitoring of serum concentrations is recommended when trough concentrations between 15-20mg/L or 5-20mg/L are desired. criteria for adequate documentation of the rationale, reassessment of therapy, and a plan for duration of therapy, respectively. All three bundle components were documented in sixteen charts (21%). Of 47 Pharmacy Documentation Forms available, rationale was indicated in 69%, there was evidence of reassessment in 51%, and a plan for the duration of therapy was documented in 20%. Twenty-three of the 75 (31%) charts reviewed had evidence that intravenous to oral transitioning was considered. Conclusions: Key aspects of antimicrobial use are inconsistently documented in medical charts at our institution. Educational efforts and collaboration with an antimicrobial stewardship team may help to ensure a more systematic approach to antimicrobial documentation. A Survey to Evaluate Critical Care (Medical) Trainees’ Perception of Antimicrobial Stewardship Programs in Intensive Care Units Linda Dresser1, Marilyn Steinberg2, Miranda So1, Chaim Bell2, Damon Scales3, Andrew Morris1,2 1 University Health Network, Toronto, ON Mount Sinai Hospital, Toronto, ON 3 Sunnybrook Health Sciences Centre, Toronto, ON 2 Rationale: Antimicrobial stewardship program (ASP) is an interprofessional collaboration to optimize antimicrobial therapy and minimize adverse events e.g., C. difficile infections and emergence of resistant pathogens in patients. The initiative is usually led by a pharmacist teamed with a physician (both with infectious diseases training/interests), advising the clinical team on investigations, antimicrobial selection, dosing, duration and adverse effects management. Accreditation Canada has mandated that Antimicrobial Stewardship Programs (ASP) be a Required Operating Procedure for all Canadian acute care hospitals in the next accreditation cycle. Currently, ASPs have been implemented in some intensive care units (ICU) in the Greater Toronto Area (GTA). Medical critical care trainees (CCTs) may have varied experiences in ICUs with and without ASP. 63 Objective: To determine CCTs’ perceptions and attitudes towards interprofessional collaboration through ASPs in the ICU. Methods: All CCTs who have rotated through GTA ICUs between July 2010 and June 2012 were invited to complete an online, anonymous survey assessing their experiences and attitude towards ASP and stewardship team using a 5-point Likert scale: strongly disagree (1); agree (2); neutral (3); agree (4); strongly agree (5). Results: Response rate to the survey was 32% (18/57). Forty-four percent of respondents were familiar with the concept of ASP prior to training as a Critical Care Fellow. During their fellowship, 22% (4/18) rotated through an ICU that did not have an ASP, while 94% (17/18) rotated through at least one ICU that had an ASP. Half recommended a change regarding frequency of stewardship rounds. Table 1. Survey items and responses Survey items % Responded “strongly agree” or “agree” combined The ASP functioned as I expected. 84% (16/19) I feel that stewardship rounds were appropriately focused on patient care. 87% (13/15) I found verbal/written feedback to be 100% (18/18) useful. I feel that the ASP increased my knowledge of appropriate antimicrobial use in the ICU. 89% (16/18) I feel that this ASP model was an efficient use of my time. 83% (15/18) I feel that the ASP affected my autonomy in a NEGATIVE manner. 17% (3/18) I feel that the patients in the ICU benefited from having an ASP in place. 88% (15/17) I would like to see changes made to how the ASP team interacts with me/my team. 50% (9/18) Empiric Antibiotic Prescribing for Urosepsis in the Emergency Department Emily Black1, Dawn Dalen2, Denise Werry2, Edith Blondel-Hill2, Mike Ertel2 1 2 Qatar University, Doha, Qatar Kelowna General Hospital, Kelowna, BC Rationale: Urinary tract infections, including urosepsis are a common complaint of patients presenting to the emergency department (ED). Despite increased resistance of urinary pathogens to fluoroquinolones, rates of fluoroquinolone prescribing are on the rise resulting in suboptimal empiric antibiotic prescribing. Objectives: The primary objective of this retrospective review was to describe choice of empiric antibiotic prescribing in patients with urosespis presenting to the ED. An assessment of patient outcomes and evaluation of time to empiric antibiotic administration were secondary objectives of this study. Study Design and Methods: A retrospective chart review was conducted of patients over the age of 18 presenting to the ED with urosepsis. Optimal choice of empiric antibiotic selection was determined using a predefined algorithm which considered patient specific factors and local patterns of resistance. Results were summarized using descriptive statistics. Results: We reviewed 50 consecutive charts of patients who presented to the ED with urosepsis. A total of 27 patients, representing 54% of the study population, received suboptimal empiric antibiotics. The most common reason antibiotics were considered suboptimal was the use of antibiotics with a known local resistance rate of greater than 10%. The most commonly prescribed agent with resistance rates greater than 10% was ciprofloxacin. Other contributing reasons for suboptimal antibiotic prescribing in our study population included use of empiric agents that were not sensitive to the pathogen isolated, inappropriate empiric dosing, and double coverage of urosepsis with ciprofloxacin and a second antimicrobial agent. Mean time from presentation to antibiotic administration was 295.6 minutes. Conclusion: Improvement in the empiric choice of antibiotics and Conclusion: CCTs consider ASP valuable to both patients and clinicians without posing a threat to their autonomy. time to administration of antibiotics for the management of urosepsis in the ED is needed. Clinical pharmacists can play a key role in ensuring improved patient care by targeting individual patients with urosepsis to promote optimal empiric antibiotic prescribing. Poster Abstract Reviewers Réviseurs des présentations par affiches Sincere appreciation is extended to the abstract reviews for PPC2013. Educational Services Committee Research Committee Adjudicators Margaret Ackman Toni Bailie Roxane Carr Lorie Carter Leah Edmonds Alfred Gin Kat Timberlake Erica Wang David Blackburn Roxane Carr Dawn Dalen Sean Gorman Salmaan Kanji Natalie Kennie Marc Perreault Peter Zed Sheryl Zelenitsky Clarence Chant Sheri Koshman 64 CSHP New Fellows Nouveaux associés de la SCPH CSHP Fellow status is conferred by the Board of Fellows upon CSHP members who have demonstrated noteworthy, sustained service and excellence in the practice of pharmacy in an organized healthcare setting. Board of Fellows 2012-2013 Conseil des associés 2012-2013 Chairperson Président: Board Members Membres du Conseil : supervised over 16 pharmacy resident research projects in the last 20 years, presented some of his research results in national and international meetings, and published articles in peer reviewed journals. He is an active member of the CSHP ID-PSN, and the Society of Infectious Diseases Pharmacists, as well as the APES (Association des Pharmaciens en Établissements de Santé du Québec). He is the acting president of APES Regroupement des Pharmaciens Experts en Infectiologie. Luc has made several presentations on the use of antimicrobials over the years, at the provincial and national levels. He also contributed to numerous advisory boards, and is a reviewer for a number of publications. Peter Loewen, FCSHP Chair-Elect: Présidente désignée Kris Wickman, FCSHP Past Chair Président sortant: Shallen Letwin, FCSHP Janice Irvine-Meek, FCSHP Peter Zed, FCSHP Pat Trozzo (ex-officio member) Jim Mann, FCSHP Luc Bergeron, BPharm, MSc, FCSHP Luc Bergeron is a pharmacist and currently is chairman and coordinator of the Antimicrobial Stewardship Committee of the CHU de Québec. His practice encompasses both adult and pediatric medicine at the CHUL hospital (one of the five hospital forming the CHU de Québec) in Québec City. He is also an Associate Clinical Professor at the Faculté de Pharmacie of Université Laval. He began working as a pharmacist at the CHUL in 1987, where he was also appointed adjunct chief of pharmacy from 1996 to 1998, and clinical coordinator from 2005 to 2007. Luc received his pharmacy degree from Université Laval, in Québec City in 1986. He completed a residency in hospital pharmacy at L’Hôtel-Dieu de Québec hospital the following year and earned a masters degree in hospital pharmacy at the Université Laval in 2003. His involvement in teaching began 25 years ago. He has contributed to the training of pharmacy and medical students in several clinical rotations: infectious diseases, adult internal medicine, adult and pediatric ambulatory care clinics (OPAT), and more recently in emergency medicine. He teaches antimicrobial pharmacology and pharmacotherapy in both undergraduate and graduate curriculum. He also is a lecturer for postgraduate dentistry residents at the Faculté de médecine dentaire of Université Laval, and is involved in teaching clinical pharmacology of antimicrobials to microbiology residents. His research interests focus on appropriate use and safety issues of antimicrobial agents in adults and children. He has Deborah Kelly, BScPhm, PharmD, FCSHP Dr. Debbie Kelly is an associate professor with the School of Pharmacy at Memorial University with a cross appointment to Memorial’s Faculty of Medicine. She is the Clinical Pharmacotherapy Specialist for the provincial HIV program through Eastern Health, a board member with the AIDS Committee of Newfoundland and Labrador (ACNL) and the past-chair of the Newfoundland and Labrador Pharmacy Board (NLPB). Dr. Kelly began her pharmacy career as a student in Memorial’s bachelor of science in pharmacy program. Upon graduation she completed a hospital pharmacy residency at the Queen Elizabeth II Health Sciences Centre in Halifax, NS. She then went on to complete her Pharm.D at the University of Toronto and returned to Memorial University as a clinical faculty member in 1999. In that role she established clinical practices with the HIV program, as well as in the Veteran’s Pavilion long-term care facility. Over the last 13 years, Dr. Kelly has played a key role in the development of HIV patient care in Newfoundland and Labrador, significantly expanding her scope of practice in all aspects of HIV treatment, education and awareness. As an extension of her work with Eastern Health’s clinical team and the ACNL, Dr. Kelly has led a number of interprofessional and community outreach initiatives. Most recently she was the principal investigator on a CIHR application to host a Café Scientifique on World AIDS Day in 2011 and in March 2012 was a co-organizer and speaker for the first provincial HIV conference for primary healthcare providers in Newfoundland and Labrador. Dr. Kelly is an accomplished scholar and educator. She has been published in a number of peer-reviewed journals and has many other publications, posters and oral presentations to her credit. She has received the Bristol Myers Squibb Award for Teaching Excellence from Memorial’s School of Pharmacy on three occasions and has been recognized with several awards for her commitment to the pharmacy profession, including being named one of the Top 100 Notable Pharmacists by the NLPB (1910-2010). She has held 65 leadership positions and is an active member of several professional organizations including CSHP, having served as Advocacy representative (2009-12) and Secretary (2000-02) for the NL branch, the Canadian HIV/AIDS Pharmacists Network, serving as Secretary (2003-05) and Chair (2005-06), and the NLPB, currently serving her second 3-year term as board member and past-chair. She is actively involved in the Professional Practice Committee of the NLPB, pursuing legislative change to support advancing scope of practice and pharmacist prescribing in Newfoundland and Labrador. Heather Kertland, BScPhm, PharmD, FCSHP Heather Kertland graduated with her Bachelor of Science in Pharmacy from the University of Toronto and completed a hospital pharmacy residency at McMaster University Medical Centre. She then took five months off to circumnavigation the globe and upon her return to Canada she started practicing at Sunnybrook Health Sciences Centre. Her work at Sunnybrook did not last long as Heather had a thirst for knowledge and the desire to become an advanced pharmacy practitioner. Heather went on to obtain her Doctor of Pharmacy degree from Wayne State University in Detroit and a Cardiovascular Research Fellowship at Hartford Hospital. Heather is currently a Clinical Pharmacy Specialist/Leader in the Heart and Vascular Program at St Michael’s Hospital and an Assistant Professor at the Leslie Dan Faculty of Pharmacy, University of Toronto. Previous positions include Director of the Doctor of Pharmacy Programme at Rhodes University in Grahamstown, South Africa and Clinical Pharmacist at the Winnipeg Health Sciences Centre. Heather has contributed to CSHP in many different capacities. She has served on and chaired the National Membership Committee, the Educational Services Committee and the Practice Specialty Network Coordinating Committee. She continues to support CSHP as an award appraiser and reviewer for CJHP. A member, since its inception, of the Canadian Cardiovascular Pharmacist’s Network (CCPN) Heather has contributed to the development of the many practice tools that the group has produced. She has served on the review panel for the Canadian Cardiovascular Society Practice Guidelines for Atrial Fibrillation and most recently was an author and reviewer for the CCS patient education materials on atrial fibrillation. 66 Bill McLean, BScPhm, PharmD, FCSHP A staunch CSHP supporter, Dr. Bill McLean has routinely pushed us into the future, usually with a debate and argument. Starting with early days of the Ontario Branch Education Committee, one of his earliest efforts was to develop a proposal for a clinical clerkship as part of the undergraduate program, an attempt to educate the academic community on Pharmacy’s responsibilities extending well beyond the drug product. Eventually, our Faculties increased clinical practical training and offered the PharmD degree (his Michigan training almost 30 years earlier). For much of the 1970’s, (under his watch) the Ontario Branch Annual Meeting was a well- attended dinner (dance) meeting which highlighted a day long educational program (creatively the first pro/con discussions of a current therapeutic issues). Not surprising, Bill’s leadership led him to be President of the Ontario Branch in 1976-77. He led us into the era of Clinical Pharmacokinetics with seminars and novel practice consults. Based on his ever present patient care focus at Ottawa General, he attempted to free staff pharmacists from drug distribution, by establishing a non-pharmacist dispensary supervisor position (one of the first in the early 80’s). As a clinical practitioner himself, Bill had a strong sense of patient care responsibility whether in a clinic or the ICU. In order to facilitate the director’s clinical practice he became one of the first director-clinical practitioners in Canada. The Ontario Branch has recognized his leadership in by establishing the William McLean Clinical Pharmacist Award. Bill further supported the profession and CSHP through his conduct of a very strong hospital pharmacy residency program (that for years involved his cross Canada tour to interview potential candidates); the residents became the ‘backbone’ of a clinical toxicology 24/7 on call pharmacy service-yet another of Bill’s clinical interventions that remains to this day. Bill is always willing to share his passion for the profession in dialogue or controversial rebuttal both on stage or in his numerous publications (135 to date). His practice routinely focused on our patient care responsibilities; in addition, his practice research such as the Clinical Pharmacy Services Study and the BC Community Pharmacy Asthma study made major changes in clinical practice. He is recipient of CSHP’s Distinguished Service Award in 1994. While he has retired from practice and teaching, he still contributes to the CJHP and as an advisor on a school of pharmacy for the U-Ottawa and U-Moncton; the contributions of this very distinguished clinical practitioner will be felt for generations of pharmacists. Ann Nickerson, BScPhm, FCSHP Ann Nickerson’s career in hospital pharmacy has led her into research projects with Dalhousie University, national presentations and publications on Medication Reconciliation and Seamless Care. Ann was instrumental in implementing Medication Reconciliation and then Seamless Care at the Moncton Hospital as a patient safety issue. Since then she has been a leader across the country for implementing these programs through many CSHP initiatives and publications. Ann has worked with Safer HealthCare Now! to develop their Getting Started Kits in both the acute care setting and now in Home care. Currently, she is working with the Extra-Mural New Brunswick Home Care Program in a demonstration project to show the value of having a pharmacist as part of the homecare team. Ann lives in Riverview, NB with her husband Gary Nickerson. CSHP Fellows Program T he CSHP Fellows program was initiated over 40 years ago to distinguish members who, through their practice activities and contributions to CSHP and the profession, were worthy of a recognition that signified outstanding leadership, dedication and commitment to practice excellence and professional growth. To date, 162 members of CSHP have achieved the distinction of being recognized as a Fellow of the Canadian Society of Hospital Pharmacists (FCSHP). The Goals of the Fellows Program are: • To challenge CSHP members to achieve peer recognition for practice excellence. • To promote worthwhile contributions to the pharmacy literature. CSHP Fellowship Criteria Please visit the CSHP website for more detailed information on each criterion. 1. Candidate must have practiced pharmacy for at least ten years, of which a minimum of five must have been in an organized health care setting. 2. Candidate must demonstrate support and leadership for the profession through active, current membership and voluntary participation in CSHP for a minimum of five consecutive years. Candidate must show consistent involvement, including leadership, in professional pharmacy association activities. Participation in APES is considered equivalent to participation in CSHP activities. The candidate must be a current active or honorary life member of CSHP. • To promote research in pharmacy. 3. Candidate must have demonstrated sustained practice focus and excellence. • To promote the role of pharmacists as primary health care professionals through active involvement in hospital, professional, educational, and community activities. 4. Candidate must have contributed to pharmacy knowledge through publication, presentation, and research. • To recognize members who serve as models for others through exemplary practice. • To apply for Fellow status, candidates are required to complete an application which documents the member’s achievements in several key criteria areas, and includes letters of support from two recommenders. Each application is evaluated by members of the Board of Fellows using the following criteria. 5. Candidate must have demonstrated ongoing commitment to educating health care practitioners and the public. 6. Candidate must provide the names of at least two (2) recommenders of whom he or she has requested to submit confidential recommendations attesting to the contributions of the candidate, and who support the application for Fellow status. 67 Faculty CSHP would like to recognize the generous contributions of the following speakers: Conférenciers La SCPH désire souligner les généreuses contributions des conférenciers suivants : Margaret Ackman Alfred Gin Mark Makowsky BScPhm, PharmD, FCSHP BScPhm, PharmD, FCSHP BSP, PharmD Bill Bartle Albert Goffi James McCormack PharmD MD BScPhm, PharmD Beverly Anne Barbato Julie Greenall Allan Mills RN, BScN, Med (c) RPh, PScPhm, MHSc PharmD Sally Bean Sandra Hicks Myla Moretti JD, MA BScPhm, ACPR, RPh MSc Carolyn Bornstein Leanne Jardine Debra Moy BScPhm, ACPR, FSCHP, CGP BScPhm, MBA BSc, BScPhm, ACPR, Med Lauren Bresee Derek Jorgenson Janice Munroe BScPhm, ACPR, MSc, PhD PharmD, BSP BScPhm Tammy Bungard Peter Kaboli Christine Papoushek BSP, PharmD MD, MS PharmD Alice Y.Y. Cheng Salmaan Kanji André Picard MC, FRCPC BScPhm, PharmD The Globe and Mail Doret Cheng Yvonne Kwan David Richardson BScPhm, PharmD, RPh BScPhm, ACPR MD, FRCPC Elaine Chong Kim Lamont Carlos Rojas-Fernandez PharmD, BCPS CPhT BScPhm, PharmD Celine Corman Joel Lamoure Kiran Saini BSP, MSc RPh, DD, FASCP BScPhm Irfan Dhalla Barbara Liu Debra Sibbald MD, MSc, FRCPC MD, FRCPC BScPhm, RPh, ACPR, MA, PhD Linda Dresser Sam Louie Reginald Smith PharmD BScPhm PharmD Deon Druteika Faith Louis Sean Spina BSc, BScPhm, PharmD, ACPR BScPhm, MBA BScPhm, ACPR, PharmD Barbara Farrell Michael Legal Linda Sulz BScPhm, PharmD, FCSHP BScPhm, ACPR, PharmD BSP, PharmD Daniella Gallo-Hershberg Stephanie Lynch Régis Vaillancourt PharmD BScPhm, ACPR BPhm, PharmD, FCSHP Michael Gardam Chris MacDonald Bill Wilson MSc, MD, CM, FRCPC PhD RPh, BSP, FCSHP Jennifer Gibson Melanie MacInnis Cecile Wong BSP, ACPR BScPhm, PharmD, CGP BScPhm Wende Wood RPh, BA, BSP, BCPP 68 The Sheraton Centre Toronto Hotel All booths are 8’ x 10’, except where noted. Floor plan subject to facility approval. 79 equivalent 8’ x 10’ booths. ■ RESERVED Exhibitor List (at time of printing) Liste des exposants (au moment de l’impression) Company Compagnie Booth # Kiosque # Alveda Pharma....................................................................407 Amerisourcebergen Canada................................................117 Apotex Inc. ..........................................................................119 AstraZeneca Canada Inc. ...................................................228 Bayer Inc. ............................................................................408 B. Braun Medical – Canada ................................................125 BioSyent Pharma .................................................................123 Blueprint for Pharmacy .......................................................234 Canadian Forces ..................................................................105 Canadian Institute for Health Information ........................103 Canadian Patient Safety Institute (CPSI) ............................409 Cardinal Healthcare.....................................................404/406 Canadian Pharmaceutical Distribution Network ...............222 Eli Lilly Canada Inc. ...........................................................100 Fresenius Kabi...............................................................224/226 Galenova..............................................................................213 Healthmark Ltd. ..................................................................112 Helmer Scientific ..................................................................402 Hospira Healthcare ...............................................306/308/310 Lexicomp .............................................................................211 McKesson Canada ..............................................................501 Merck Canada Inc. ..............................................................230 Meta Healthcare IT Solutions ..............................................129 Company Compagnie Booth # Kiosque # Mylan Pharmaceuticals Inc. . .............................................410 North West Telepharmacy ...................................................104 Northern Health ..................................................................102 Omega Laboratories Limited...............................................205 PCCA Canada Corp. . ..........................................................115 Pendopharm a Division of Pharmascience Inc...................111 Pfizer Canada Inc. ........................................300/302/401/403 Pfizer Canada Inc ................................................................236 Pharmascience.....................................................................110 Pharmaceutical Partners of Canada A Company of the Fresenius Kabi Group ....................207/209 RxFiles ..................................................................................101 Sandoz Canada Inc. ....................................................201/203 Sanofi-Aventis Canada........................................................411 SDM Specialty Health Network ...........................................109 Servier Canada ....................................................................108 SteriMax Inc.........................................................................113 Sunovion Pharmaceuticals Inc............................................107 Swisslog Healthcare Solutions .............................................127 TEVA Canada.......................................................................400 Truven Health Analytics......................................................232 WI International..................................................................106 69 WANTED WHO: Exhibitors, Registrants & Visitors WHAT: SES 2013 WHERE: WHEN: CALGARY Connecting pharmacists across Canada PHARMACY SPECIALTY NETWORKS NETWORK W WORK communicate CSHP has more than 20 PSNs to join! Check out www.cshp.ca for a complete list. Join the Pharmacy Specialty Network! CSHP membership will connect you with what’s important – people and information. PSNs: • connect members with others who share a passion for a particular facet of pharmacy practice • facilitate the quick exchange of ideas, developments, methods, experiences, knowledge to improve practice • support collaboration on projects, research, and educational programs to address the needs of the members of a PSN • provide additional opportunities for members to serve as both opinion leaders and key resources for CSHP Council on professional specialty issues, including development of relevant position statements, guidelines, and information papers Participation in PSNs is free of charge to CSHP members Visit MY.CSHP.ca and sign up today! Join Us! CSH P M E M BERSH I P H A S M A NY A DVA NTAGES MEMBER BENEFITS A s a member of CSHP, you connect not only to a strong professional organization, but also to a dynamic network of over 3,100 hospital pharmacy colleagues. When you join CSHP, you instill fresh energy into a 66-year-strong association for expanding and improving programs and services. ● ● ● ● ● ● ● ● ● ● ● Advocacy Awards Program Canadian Hospital Pharmacy Residency Board Continuing Education CSHP 2015 Partner Discount Programs Fellows Program Pharmacy Specialty Networks (PSNs) Products and Services Professional Liability/Malpractice Insurance CSHP Research and Education Foundation For more information about CSHP member benefits, please contact: Membership services T: 613-736-9733, ext. 222 | F: 613-736-5660 | E: [email protected] | www.cshp.ca 72