Download Final Program - Canadian Society of Hospital Pharmacists

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.
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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?
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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.
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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.
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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.
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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.
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• 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.
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• 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.
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first time it appears. Please keep abbreviated terms to a
minimum.
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equipment.
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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:
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Texte du résumé :
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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.
●
●
●
●
●
●
●
●
●
●
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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