Download presenters during one of the two moderated sessions

The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 NHIA is pleased to once again feature the Idea Exchange— an original poster session showcasing
innovativesolutionsformanyoftoday’schallengingscenariosandimprovementopportunitiesinourfield.
PosterschosenfortheNHIAIdeaExchangediscusscutting‐edgedevelopmentsforalternate‐siteinfusion
bestpractices,qualityimprovementsuccesses,clinicalresearchaswellaseducationalcasestudies!Posters
willbeondisplayintheExpositionHallattheErnestN.MorialConventionCenterthroughouttheregular
NHIAExpositionhoursonMarch21‐23.
Meetanddialoguewithposterpresentersduringoneofthetwomoderatedsessions:
Monday,March21from6:00to7:00pm
ModeratedSessionFeaturing
AllODD‐NumberedPosters
Tuesday,March22from1:00to2:00pm
ModeratedSessionFeaturing
AllEVEN‐NumberedPosters
BOARD POSTER TITLE POSTER TYPE 1 Home infusion therapy with a patient history of IV drug abuse: can it be done safely? Case Study Bridget Smith, RPh1; John Nosach, RN2; Nicole Braddock, RN3. ¹ Soleo Health; ²Bioscrip; ³Care New England Original Research Study Sara Keller, MD, MPH, MSHP1; John Adamovich, MHA2; Mitra Gavgani, PharmD;2 David Hirsch, RN, MSN, MBA2; Deborah Williams, BSN, MPH2; Mary Myers, MS, RN;2 Dawn Hohl, PhD, RN2; Kathleen Pulice, BS1; Amanda Krosche, BS1; Sara Cosgrove, MD, MS1; Trish Perl, MD, MS1. 1
Department of Medicine, The Johns Hopkins University School of Medicine; 2Johns Hopkins Home Care Group, Johns Hopkins Medicine 2 3 4 5 6 7 8 Complications of Peripherally Inserted Central Catheters, tunneled Central Venous Catheters, and Midlines in the Home Adding a Reimbursable Medication Therapy Management (MTM) Program in a Home Infusion Pharmacy Innovative Configuration and Electronic Pathways between Health System and Home Infusion Software to Facilitate Documentation Requirements Re‐design of a home infusion focused pharmacy residency program for conversion to the ASHP 2014 standards Utilization of a new, proprietary molecular testing panel to guide anti‐
infective therapy at local wound care centers—research in process Pharmacy Residency Preceptor Development Program: Evaluation, Creation, and Implementation of a Unique Custom Tailored Plan Efficacy, Safety, Tolerability, and Pharmacokinetics of Human Immune Globulin Subcutaneous, 20%: Final Analysis of a Phase 2/3 Study in Patients With Primary CONTRIBUTING AUTHORS Performance Ellen Stefancik, RPh, MS MTM, Cleveland Clinic At Home Infusion Improvement Pharmacy Tricia C. Sirois, PharmD; Lisa R. Klein, PharmD; Warren S. Performance Deppong, PharmD; Nicholas D. Thompson, BS; Kimberly R. Improvement Jacobson, BBA; Christopher J. Maksym, PharmD. University of Michigan Health System, HomeMed Performance Amy Lee, PharmD; Tom Rout, BS, RPh; Melinda Sater, PharmD, Improvement BCNSP; Brooke Schaat, PharmD; and Vicki Baer RPh. Option Care Original Research Robert Ross Harless Woods, PharmD1; Ed Eiland, PharmD, MBA, BCPS‐ID, FASHP2; Bradley Gilchrist, PharmD2. 1
Vital Care of Meridian; 2Vital Care, Inc. Joshua Shane Jaussi, PharmD, MBA; Thomas Rout, BS, RPh; Performance Robin Espiriti, RPh, BCNSP; Claudine Salanski, PharmD. Option Improvement Care Original Research Study Daniel Suez, MD1; Isaac Melamed, MD2; Iftikhar Hussain, MD3; Mark Stein, MD4; Sudhir Gupta, MD5; Kenneth Paris, MD6; Sandor Fritsch, PhD7; Christelle Bourgeois, PhD7; Heinz Leibl, PhD7; Barbara McCoy, DVM, PhD8; Leman Yel, MD8. 1
Allergy, Asthma & Immunology Clinic, PA, Irving, TX, USA; The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 BOARD POSTER TITLE Immunodeficiency Disease (PIDD) in North America POSTER TYPE CONTRIBUTING AUTHORS IMMUNOe Health Centers, Centennial, CO, USA; 3Vital Prospects Clinical Research Institute, PC, Tulsa, OK, USA; 4Allergy Associates of the Palm Beaches, North Palm Beach, FL, USA; 5
University of California at Irvine, Irvine, CA, USA; 6LSU Health Sciences Center, Childrens Hospital of New Orleans, New Orleans, LA, USA; 7Baxalta Innovations GmbH, Vienna, Austria; 8
Baxalta US Inc, Cambridge, MA, USA 2
9 The stability and sterility of repackaged intravenous lipid emulsions for unit‐dose administration 10 Effect of Text Message‐Based Patient Communications on Pharmacy Lead Time—research in process Collin Chan, PharmD1; Jane Gannon, MS, RPh1; Jay M. Mirtallo, Performance MS, RPh, BCNSP, FASHP, FASPEN2; Tiffany Fancher, PharmD1; Improvement Tarak Patel, PharmD1. 1
Coram/CVS Specialty Infusion Services; 2Ohio State University 11 Vancomycin concentrations used in home infusion: Experience of one national provider Performance Elizabeth Lagasse, PharmD; Gene Decaminada, RPh. Option Care Improvement 12 13 14 15 16 17 18 19 Nutritional Response in Cancer Patients on Home Parenteral Nutrition: A Retrospective Review A Pediatric Training Program for Home Infusion Pharmacists: Approaches to Improve Confidence and Competency Piperacillin/Tazobactam: Continuous vs Intermittent Dosing in Home Infusion Cathflo Activase Usage Rates In Catheter Care Across Different Medication Therapies In Home Infusion Care Adverse Drug Events in Infliximab Patients Infused in the Home Care Setting: A Retrospective Chart Review Improving Patient Satisfaction: Matching Nurse Experience to SCIg Patient Needs Retrospective Review of Home Infusion Inotrope Patients: A Descriptive Report on Demographics, Readmissions, and Costs A Team Approach to Establishing a Specialty Pharmacy Center of Excellence Model in Immune Disorders Original Research Study Original Research Study Alexandre Ivanov, PharmD; Michelle Simpson, PharmD; Thomas Rout BS, RPh; Julie Selfridge, RPh; Option Care Ashley Tran, Pharm.D, R.Ph1; Charmagne Emelue, MS, RD, CNSC, LD1; Jay Mirtallo, MS, RPh, BCNSP, FASHP, FASPEN2; Sharon Lockwood, MS, RD, LD, CD, CNSC1. 1
Coram/ CVS Specialty Infusion Services, 2The Ohio State University Performance Marlee Andis, PharmD; Suzanne Kluge, B.S. Pharm.; Mintu Shah, Improvement PharmD; Julie Selfridge, B.S. Pharm. Option Care Original Research Study Michael Anderson, PharmD; Sherry Heinrichs, PharmD. Coram CVS/Specialty Infusion Services Original Research Study Alfred Olumba, PharmD; Lisa Seifert, RPh, FASHP, ASQ‐CMQ/OE; Tom Rout, BS RPh. Option Care Sarah Smith, BSN, RN, MPA1; Kendra Curry, PharmD1; Tom Rout, BS, RPh1; Heather S. Kirkham, PhD, MPH2; Julia Zhu, MPH, MS2; Steve Kennedy, PharmD, CSP.2 1
Option Care; 2Walgreen Co R. Becky Gamez, RN, BSN, IgCN; Pamela Brown, RN; Javier Performance Mendoza, RN; Isabella Wasciewisz, RN; Altruistix Nursing Improvement Services, Inc. Original Research Study Original Research Study Case Study Noreen Chan, PharmD. Coram/CVS Specialty Infusion Services Charles Brian Mckee, BA; Kirsten Moloney, RPh; Stacy Bryant‐
Wimp, BA, CHC; Jay Bryant‐Wimp, RPh; Amanda Bax, BA, RN; Kelsey Jett, Pharm D, BCBS; Elizabeth Black, CPhT; Karen Heckemeyer, RN, CRNI; Jennifer Rentschler, RN; Kathleen Maier; Kasey May, BSBA; Natasha Hernandez, BA; Kali Stark, BSBM; Kelsey Pritchett, BA; and Dana Fleenor. Accurate Rx Pharmacy The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 BOARD 20 21 22 23 24 25 26 27 POSTER TITLE POSTER TYPE CONTRIBUTING AUTHORS Retrospective Review of Needle Peg Gruenemeier, RN, CRNI, CHC1; Carol Ernst, RN1; Kimberly Length During Hyaluronidase‐
Case Study Duff, RN, BSN2. facilitated Subcutaneous 1
BioRx; 2Baxalta US, Inc Administration of Immune Globulin G Monitoring On‐Call Pages for Home Jesse S. Peterson, PharmD; Dana Simonson, PharmD, BCPS; Case Study Colleen Blissenbach, MBA. Fairview Home Infusion, Minneapolis, Infusion Pharmacists as a Continuous Quality Improvement Measure MN Challenges Associated With Jesse S. Peterson, PharmD; Theresa Rahn, RN, BSN; Dana Case Study Simonson, PharmD, BCPS. Fairview Home Infusion, Minneapolis, Collecting Outcomes Data for Home Parenteral Nutrition Patients MN Increasing Patient Referral Logan Davis, PharmD, MBA; Christian VonDrehle; Chris Newlin, Performance Acceptance Rate Throughout a PharmD; Anna Thompson; Brandi Semmes, CPhT; Tim Doner; Improvement National Home Infusion Organization Michele Winstead. VITAL CARE, INC. Development of electronic assessment tools for patients with Performance Barbara Prosser, RPh; Christine Miller, PharmD; Todd E. Hare, chronic inflammatory demyelinating Improvement RPh; Nicholas Bertsch, PharmD; Kevin Ross, RN. Soleo Health polyneuropathy receiving immune globulin therapy Janet K Sluggett, BPharm (Hons), GradDipClinEpid, PhD1; Nicholas A Sharley, BPharm2; Karen J Reynolds, FTSE, FAHMS, FIEAust, PhD, MSc, MA, BA(Hons), Grad Cert Tert Ed3; Andrew J Sluggett, BPharm BSc(Hons) DipMgt, Chief Pharmacist/General Temperature variation in the home Original Manager1 setting: implications for continuous 1 Research CPIE Pharmacy Services, Adelaide, SA, Australia; 2 Pharmacy ambulatory infusions Department, The Queen Elizabeth Hospital, Adelaide, SA, Australia; 3 Medical Device Research Institute, School of Computer Science, Engineering & Mathematics, Flinders University, Adelaide, SA, Australia Demonstrating the Need for Performance Neal de Beer, PhD; Joe Barbrie; Carlos Gutierrez; Paul Lambert, Adjustable Flow Rate Control with Improvement MBA. EMED Technologies Corporation Mechanical Pumps during SCIg Infusion Therapy Original Julie Lyon, RN1; Dave Grady1; Heather Peacock, PharmD1; Laura A Rural Home Infusion Provider’s Research Seiberlich, MS.2 Experiences Using Smart Infusion 1
Study Pump Technology Big Sky IV Care, 2Smiths Medical, ASD, Inc. FINALABSTRACT#1
TITLE:HomeinfusiontherapywithapatienthistoryofIVdrugabuse:canitbedonesafely?
AUTHORS:BridgetSmith,RPh1;JohnNosach,RN2;NicoleBraddock,RN3.¹SoleoHealth;²Bioscrip;³CareNewEngland
BACKGROUND:Intravenousheroinusagehasskyrocketedinthepastdecade;theCDCreportsa63%increaseoverthepast
11years.Patientcaseswithahistoryofrecentdrugabuseareoftennotacceptedbyhomeinfusionprovidersbecauseof
associatedliability,questionablecompliance,risk,andpreconceivedjudgment.Individualswhoabuseintravenousdrugsare
atanelevatedriskforcomplications,requiringintravenousantibioticsforissuessuchassofttissueinfections,endocarditis,
abscesses,andsepsis.Patientsadmittedtothehospitalforintravenousantibiotictreatment,whichpotentiallymaybelong
term,maybenefitfromhomeinfusiontherapy.Thealternativeistokeeppatientsinthehospitalorsendthemtoa
rehabilitationfacility.Healthcarecostscanbesignificantlylesswhentreatingpatientsinahomesettingcomparedtoan
inpatientfacility.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 PURPOSE:Thepurposeofthisprojectwastoidentifyacomprehensivemodelforthesuccessfultreatmentofpatientswitha
historyofintravenousdruguse(IVDU)inthehomeinfusionsetting,andhighlightpotentialhealthcarecostsavingsofthis
model.
METHODS:LRisa28‐year‐oldfemalewithanextensivehistoryofIVDUandmethadonetreatment.Shehadpreviouslybeen
drugfreeforathree‐yearperiod,relapsedaftertryingtoweanoffmethadone,andisnowadmittedtohospitalforsacroiliac
(SI)jointinfection.Patienthadresumedmethadonepriortoadmission,butshewasfoundtobeinpossessionofneedlesin
theER.LRremainedhospitalizedforapproximatelythreeweeks,withcomplicationsrelatedtopainmanagementand
regulationofmethadone.SherequiredhomemanagementofIVcefazolintherapyforthreeadditionalweeks.This
organizationwascontactedbytheCaseManagerafterfourotherhomeinfusionprovidersrefusedtotakeheronserviceforIV
antibioticsviaaperipherallyinsertedcentralcatheter(PICC).Patientalsorefusedtobeplacedinarehabilitativefacilityto
completeherantibiotictherapybecauseshewasadamantaboutresuminghernursingcoursesonschedule.Ourclinicalteam
extensivelydiscussedtheriskvs.benefitoftreatingLRathomeanddevelopedaplanthatencompassed:evaluatingthe
patientandobtainingverbalassurancesfromherregardingremainingdrugfree;evaluatingandobtainingparents’consent
andsupport;clearlycommunicatingtheconsequencesofnon‐compliancewiththepatient;coordinatingweeklydrugscreens
withthemethadoneclinic;clearlycommunicatingtheplantothemedicalteam;andcloselymonitoringthepatientathome.
RESULTS:LRwasdischargedhometoherparent’scare.Shekepthercommitmenttocompleteaurinetoxicologyscreen
weekly.Methadonewasregulatedproperlypriortodischargeandadministrationresumedupondischargethroughher
methadoneclinic.Thepatientcompleted21daysIVcefazolinandremainedheroin/drugfreeduringthecourseoftreatment.
PainresolvedasdidtheSIInfection.Patientresumedherstudiesonschedule.Potentialcostsavingswithhomeinfusion
therapywereapproximately$48,000(hospitalvs.home).
DISCUSSION:PatientswithahistoryofdrugabusemayattimesrequireIVtherapyathome.Thesepatientsmaybenefitfrom
acomprehensiveplan,compassionatecare,andachancetosucceedwithoutjudgment.Extrapolatingdatafromthissingle
patientcasetoalargerpatientpopulationisdifficult,howeveritisanimportantfirststep.
CONCLUSION:ThisorganizationprovidedhomeintravenousantibiotictherapytoarecentIVDUpatientsuccessfullyby1)
refrainingfromjudgementand2)institutingacomprehensivetreatmentplan.Thissuccessresultedinasignificantcost
savingsforthehospitalandtheinsurer.
FINALABSTRACT#2
TITLE:ComplicationsofPeripherallyInsertedCentralCatheters,tunneledCentralVenousCatheters,andMidlinesin
theHome
AUTHORS:SaraKeller,MD,MPH,MSHP1;JohnAdamovich,MHA2;MitraGavgani,PharmD;2DavidHirsch,RN,MSN,MBA2;
DeborahWilliams,BSN,MPH2;MaryMyers,MS,RN;2DawnHohl,PhD,RN2;KathleenPulice,BS1;AmandaKrosche,BS1;Sara
Cosgrove,MD,MS1;TrishPerl,MD,MS1.1DepartmentofMedicine,TheJohnsHopkinsUniversitySchoolofMedicine;2Johns
HopkinsHomeCareGroup,JohnsHopkinsMedicine
BACKGROUND:Centralvenouscatheter(CVC)complications,suchascentralline‐associatedbloodstreaminfections(CLABSI)
havebeenafocusofbenchmarkingandqualityimprovementamonginpatients.However,fewprospectivestudieshave
followedpatientswithCVCsinthehomeafterhospitaldischargetomeasureoutcomes.
PURPOSE:Thepurposeofthisprojectwastodescribeandquantifycathetercomplicationsandrisksforcatheter
complications,andhospitalreadmissionsamongpatientsdischargedfromtwoacademicmedicalcenterswithCVCs,andto
quantifypotentialenvironmentalexposuresamongpatientsdischargedfromtwoacademicmedicalcenterswithCVCs
METHODS:Wepresentananalysisofaprospectivecohortstudyofpatientsdischargedfromtwoacademicmedicalcentersto
homewithCVCs,includinginformationonCVCcomplications(CLABSI,catheter‐associatedvenousthromboembolism[CA‐
VTE],catheterocclusion,cathetermalposition,inadvertentcatheterremoval)andhospitalreadmissions.Patients>18yearsof
age,whowereEnglish‐speaking,abletogiveconsent,andnotonhospicewhoweredischargedwithtunneledCVCs,
peripherallyinsertedcentralcatheters(PICCs),andMidlinecatheterstothehomefromtwoacademicmedicalcenters,one
tertiarycareandonecommunity‐basedhospital,wereconsentedinthisIRB‐approvedstudy.Patientsdischargedbetween
March2015andOctober2015wereeligible,leaving173patientsinthestudy.Telephonesurveyquestionswerepre‐
determinedandweremultiplechoiceandwererepeatedeveryotherweekforthedurationtheirCVCswereinplace.Surveys
wereperformedbyresearchassistantswithresponsesplacedinasecureelectronicdatabase.Chartabstractionswere
performedbyaregisterednursewhoisalsoaninfectionpreventionistaswellasaninfectiousdiseasesphysicianandoccurred
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 throughthirtydayspost‐catheterremoval.Catheterdayswerenotusedinanalyses.CLABSIsweredeterminedbasedonNHSN
criteria.Hospitalreadmissionswerecountedthroughthirtydayspost‐catheterremoval.Descriptivestatisticswereusedto
describethedataset.
RESULTS:ThepopulationincludedprimarilypatientswhorequiredPICCsforoutpatientparenteralantimicrobialtherapy
(OPAT).Themeanagewas52.2,128(75.3%)werewhite,and88(51.8%)weremale.Most(N=121,71.2%)hadPICCs.The
majorityhadCVCsforOPAT(N=132,77.6%),followedbychemotherapy(N=34,20.0%)andtotalparenteralnutrition(N=22,
12.9%).Mostdidhavepetsinthehome(N=99,57.5%),and19.7%ofpatients(N=34)usedwellwaterintheirhomeswhere
theywerecaringfortheircatheters.Somehaddoneyardworkorgardeningsincegettingtheircatheters(12.3%),butmany
hadcookedusingrawmeats(38.7%).CA‐VTEwereconfirmedbasedonultrasoundevidenceasdocumentedintheinpatient
oroutpatientelectronicmedicalrecord.CLABSIswereconfirmedbasedonreviewofresultsintheelectronicmedicalrecord,
basedonNHSNcriteria.Readmissionswereverycommon.66patients(39.1%)werereadmittedwhilehavingtheircatheter.
Cathetercomplicationswerealsocommon.7.1%ofpatientshadacatheterocclusionrequiringalteplase,9(5.3%)hadaCA‐
VTE,7(4.2%)hadacatheter‐associatedbloodstreaminfection(CABSI),and5(3.0%)hadabloodstreaminfectionnotmeeting
CABSIcriteria.
DISCUSSION:AlmosttwoinfivepatientswithCVCsinthehomearereadmittedfromthetimeofhospitaldischargeto30days
afterCVCremoval.However,itispossiblethatmanyoftheseadmissionsarerelatedtounderlyingcomorbiditiessuchas
patientswithmalignanciesforwhichtheyarecurrentlyundergoingtreatment.Wenotedthatmostpatientshadexposuresto
pets,andtwoinfivehadcookedwithrawmeats.Weareperformingotherqualitativestudiestounderstandwhetherthese
activitiesareriskfactorsforCVCcomplications.
CONCLUSION:CVCcomplicationsandhospitalreadmissionsforpatientswithCVCsathomemaybecommon.Weshould
focusonidentifyingmodifiableriskfactorsforthesecomplications.
FINALABSTRACT#3
TITLE:AddingaReimbursableMedicationTherapyManagement(MTM)PrograminaHomeInfusionPharmacy
AUTHORS:EllenStefancik,RPh,MSMTM,ClevelandClinicAtHomeInfusionPharmacy
BACKGROUND:MedicationTherapyManagement(MTM)isaservicethatoptimizestherapeuticoutcomes,withorwithout
theprovisionofaproduct.ThefivecoreelementstoMTMare:CMR(comprehensivemedicationreview),PMR(personal
medicationrecord),MAP(medicationactionplan),pharmacistinterventionand/orreferral,anddocumentation/follow‐up.
MTMserviceshavelongbeenacorecomponentofpharmacistcarethathavehistoricallybeen“bundled”withinadailyper
diemratepaidbycommercialinsurerstocoverabroadrangeofprofessionalservices,equipmentandsuppliesinthehome
infusionsetting.PublicationsregardinghomeinfusionpharmacysuccessimplementingabillableMTMprogramarelacking.
Datafroma“HospitalatHome”modelpublishedbyJohnsHopkinsin2012providedsomedirectioninthisprojectinrelation
tomedicationuseinterventionsthatwereassociatedwithfindingsofcosteffectivenessandincreasedpatientsafety.We
believethatitispossibletocreateareimbursableMTMprogramatoursiteofcare.
PURPOSE:Thepurposeofthisprojectwastoassesstheimpactofatransitionfromaninformalhomeinfusionprovider‐
specificMTMprogramtoareimbursableMTMprogram.
METHODS:ASWOTanalysis(strength,weakness,opportunity,threats)wasperformedtoassesstheviabilityofa
reimbursableMTMprogram.Thecurrentperdiembillingmodelwasidentifiedasaweaknessinthatitwouldnotreadily
accommodatebillingadditionalfeesforpharmacyconsultation.ThirdpartybillersofMTMserviceswereexploredand
OutcomesMTM®wasselectedduetotheirexperienceinhealthplancollaboration,successobtainingpriorauthorizationto
bypassthe”facetoface”requirementofsomeplansforperformingCMRs,andtheirsuccessinobtainingreimbursementfor
pharmacistrecommendationsmadetoothercliniciansonthepatient’scareteam(TIPS).Pharmaciststaffingwasidentifiedas
apotentialweaknessandweelectedtocloselymonitorworkload.Supportstaffwillbeaddedtoassistinpreparationactivities
(appointmentscheduling,printingoutcurrentmedicationlists,labs,etc.)tofreeuppharmacisttime.Trainingwasprovidedto
thepharmacistcurrentlyprovidingMTM.ProgramimpactwillbemeasuredinpharmacisttimespentonMTMactivities,
reimbursementreceived,andcostavoidanceforourhealthsystem.
RESULTS:Inthefirstthreeweeksofimplementation,twoCMRshavebeencompleted.Bothwereacceptedfor
reimbursement($75each).Twoofthreepharmacyinterventionsmadewithaphysician(TIPS)wereaccepted($15each).
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 Pharmacisttimespentwasapproximately3.5hours(includingpreparation,patientinterview,anddocumentation)atastaff
costofapproximately$199.50comparedtopotentialreimbursementof$182.
DISCUSSION:WhilecostsofstafftimespentcompletingtheMTMdocumentationexceededthetotalreimbursementreceived,
theprojectisstillintheearlyphaseofimplementationandareductionintimespentdocumentingisanticipatedwithongoing
useandpractice.
CONCLUSION:ItistoosoonintheprocesstodeclarethetransitiontoareimbursableMTMprogramisasuccess,however,
earlyresultsareencouragingandwewillcontinuetoassess.
FINALABSTRACT#4
TITLE:InnovativeConfigurationandElectronicPathwaysbetweenHealthSystemandHomeInfusionSoftwareto
FacilitateDocumentationRequirements
AUTHORS:TriciaC.Sirois,PharmD;LisaR.Klein,PharmD;WarrenS.Deppong,PharmD;NicholasD.Thompson,BS;Kimberly
R.Jacobson,BBA;ChristopherJ.Maksym,PharmD.UniversityofMichiganHealthSystem,HomeMed
BACKGROUND:Asahomeinfusionpharmacywithinalargerhealthsystem,ordersfulfillinglegal,dispensing,andbilling
requirementswerereceivedandprocessedwithinapaperbasedworkflow.Recently,ourhealthsystemtransitioneditscare
managementtoasingle,electronichealthrecord(eHR).Inordertogainefficiency,decreasetimedelaysinorderprocessing,
realizecompliantandcompleteordercontent,andaugmentcommunicationbetweenprescribersandhomeinfusionstaff,our
pharmacyimplementedelectronicpathwaysdesignedtosupportthetransferofordersandbillingdocumentsrequiring
physiciansignature.
PURPOSE:Thepurposeofthisperformanceimprovementprojectwasto:implementanelectronictransferpathwaybetween
healthsystemandpharmacysoftwareapplicationstoyieldcomplete,compliantordersandphysiciansignedbilling
documents;eliminatetimeconsumingpaperbasedprocesses;andfacilitateimprovedcommunicationamongallpatientcare
providers.
METHODS:Healthsystembasedsoftwaretemplatesweredesignedtorequirecompletecontentforordersthatcouldthenbe
transmittedelectronicallytoourdepartment;prescriberuseofthenewtemplatesservedasthemeasurementtoassessthe
numberofcompleteversusincompleteordersreceived.Additionally,usingpharmacysoftwaredataextractionandinterface
technology,payerrequiredbillingdocumentsweredeveloped,androutedelectronicallyforphysiciansignature;beforeand
aftervolumecomparisonsofpaperversuselectronicallygeneratedbillingdocumentsservedasthemeasurementtoassessthe
reductioninpaperbasedprocesses.Observationalchangesinthefrequencyofstaffinitiatedorderclarificationwith
prescriberswereusedtomeasureanyimprovementincommunication.
RESULTS:Therearenowover50ordersinuse.Theseordersetsguidetheprescribertocreatecompleteorders;orderdata
elementsarenolongermissingyieldingcompletedocumentationuponinitialreceiptoftheorder.Changes,modifications,and
updatestothehomeinfusiontherapyregimenarenowvirtuallyavailabletoallcareprovidersaccessingthehealthsystem
eHRwhichhasimprovedcommunicationbydecreasingtheneedfororderclarificationphonecalls.Theactivemedication
profileisupdatedautomaticallyatthetimeofelectronicprescribing.Allsystemextractedcertificatesofmedicalnecessity
(CMNs)areprocessedviaanelectronicworkflowfor“insystem”patientsratherthanfaxedormailedforsignature,resulting
inthereductionofpaperbasedprocessesandtheabilitytoprocessclaimsclosertothedateofserviceprovision.Generation
ofpaperCMNsdecreasedfrom100%to5%.Reportsrevealandprompttheactionnecessarytoobtainre‐certificationfor
CMNspriortoexpiredstatusandwhenpayerrequirementsdictatetherapyre‐certification.Theaverageturnaroundtime
fromCMNcreationtoreturnofaphysiciansigneddocumenthasdecreasedfromapproximately10daystoanaverageof4.6
days.
DISCUSSION:Thisperformanceimprovementprojectdemonstratedthatreceiptofcompleteorderdocumentationand
efficientcommunicationareachievedwithreplacingpaperbasedprocesseswithelectronicpathways.
CONCLUSION:Developmentandimplementationofelectronicpathwaysbetweenhealthsystemandhomeinfusionpharmacy
partnersfacilitatesdocumentationrequirementsbysatisfyingcompleteordercontent,creatingamoreefficientelectronic
orderprocesswhilealsoreducingprovider‐prescriberorderclarifications.Correspondingimprovementsinrevenuecycle
performancearelikelytofollow.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 FINALABSTRACT#5
TITLE:Re‐designofahomeinfusionfocusedpharmacyresidencyprogramforconversiontotheASHP2014
standards
AUTHORS:AmyLee,PharmD;TomRout,BS,RPh;MelindaSater,PharmD,BCNSP;BrookeSchaat,PharmD;andVickiBaer
RPh.OptionCare
BACKGROUND:In2014,theAmericanSocietyofHealth‐SystemPharmacist(ASHP)updatedcriteriaforPostgraduateYear
One(PGY1)PharmacyResidencyPrograms.Thesevenprinciplesadoptedinthe2005ASHPStandardswererevisedto
establishsixprimarystandardstodefinethecontentandstructureofanaccreditablePGY1program.Accreditedresidency
programsarerequiredtomeetthenewstandardsbeginningwiththe2016residencycycle.Literatureshowsmanymedical
programsandclerkshipsconvertedtheircurriculatoalongitudinalformatandreportedimprovedlearningobjective
outcomesovertraditionalblockrotations.WeexpectsimilarresultsforourPGY1program.
PURPOSE:Thepurposeofthisprojectistoconvertthisnationalhomeinfusionprovider’sPGY1programtomeettherevised
2014ASHPStandards.ThenewstandardswillexpandourcurrentLearningExperience(LE)structurebyaddinga
comprehensivesetofactivitiesdesignedtoprovidedirection,enhanceoutcomemeasurability,andensurequalityresident
performanceevaluationandfeedback.TherevisedLEstructurewillserveasatemplatetoprovideequivalentexperiencesat
allresidencysites.
METHODS:Asurveywillbeconductedtoassesspreceptorandresidents(pastandcurrent)perceptionsregardingthe
strengthsandweaknessesofourexistingprogramstructure.Resultsfromcompletedsurveys(n=25)willbeconsideredinthe
selectionofourprogramformat(blockvslongitudinalrotationdesign),usefulnessofthecurrentLEdescriptionsasaprogram
tool,andtimingofexpectedgoalachievement.TheASHP2014Standardsandrelatedresources(suchasASHPGuidance
documentsandtheAugust2015ASHPonsitesurveyresults)willbeappliedintherevisionofthisorganization’sPGY1
ResidencyProgramManual.Toachievecompliancewiththerevisedstandards,wewillincreasetheutilizationofdetailed
activitiesforeachLEthataremeasurableandsupportthe2014ASHPCompetencyAreas.Wewillalsoincorporatetheuseof
customizedplansforeachresident,reflectingtheirspecificneeds,strengths,andareasforimprovementasrelatedtothegoals
andobjectivesoftheprogram.TherevisedPGY1curriculumwillprovidestructureandguidancethroughthedevelopmentof
toolscontainingparametersforthecompletionandevaluationofthe2014ASHPCompetencyAreas.
RESULTS:Preceptorandresidentsurveyresults(n=25)indicatedalongitudinalprogramformatwaspreferred,andLE
descriptionsneededimprovement.Thefinaldesignincludesawell‐definedandorganizedsetofactivities.Toolswerecreated
toassistpreceptorsandresidents,includingaworkinggridandimprovedLEdescriptions.Thesetoolsaidinthereductionof
redundantevaluationsandprovideusefulguidanceonadailybasisforresidentsandpreceptors.Thisdesignachieves
compliancewiththe2014ASHPStandards.
DISCUSSION:ThenewPGY1programdesignprovidesatemplatetobothexistingandnewsitestomeetthenewaccreditation
standards.Thiswillbeimplementedstartingthe2016residencycycle.Minoradjustmentsandimprovementswillbemade
followingtheimplementationofthisprogramformatbasedonpreceptorandresidentfeedbackthatwillcontinuetobe
considered.
CONCLUSION:Thepurposewasaccomplishedwiththere‐designofthePGY1program,compliantwiththe2014ASHP
Standards.
FINALABSTRACT#6
TITLE:Utilizationofanew,proprietarymoleculartestingpaneltoguideanti‐infectivetherapyatlocalwoundcare
centers—researchinprocess
AUTHORS:RobertRossHarlessWoods,PharmD1;EdEiland,PharmD,MBA,BCPS‐ID,FASHP2;BradleyGilchrist,PharmD2.
1VitalCareofMeridian;2VitalCare,Inc.
BACKGROUND:Targetenrichedmultiplexpolymerasechainreaction(TEM‐PCR)isauniquetechnologyinvolvingrapid
moleculartestingallowingforidentificationofpathogensinblood,sputum,orotherbodilyfluids.Woundinfectionsare
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 challengingtotreatandrepresentasignificanthealthcareconcernduetoantibioticresistanceandassociatedcosts.TEM‐PCR
canbeutilizedtodetectpathogensinthepresenceofantibioticsandoffersonedayresults.Collaborationbetweenmedical
laboratoriesutilizingTEM‐PCRtechnologyandoutpatientpharmaciesprovidinganti‐infectiverecommendationserviceshave
notyetbeenstudiedtodate.
PURPOSE:Thepurposeofthisclinicalresearchprojectistoestablishapharmacyconsultingserviceandimproveaccuracy
andtimelinessofanti‐infectiverecommendationsprovidedthroughtheuseofTEM‐PCRresults.Additionally,thisresearch
seekstoevaluatetheimpactoftheTEM‐PCRpanelintreatmentofwoundinfectionsbycomparingittothestandard
phenotypicculture,timelinessofcultureresultsfortreatmentguidance,anti‐infectivetherapychangesduetoTEM‐PCR
findings,clinicalinterventionsresultingfromtheconsultingservice,andoutcomesoftherapy.
METHODS:Patientswillundergoculturecollectionduringadmissionorfollow‐upservicesatawoundcarecenterbetween
October2015andOctober2016.Atotalof25TEM‐PCRpanelswillbeutilizedforthisstudyandtheprogramanddata
evaluated,retrospectively.Allpatientswithwoundsdeemedclinicallynecessarytoculturebythephysicianwillbeincluded,
andthosewhoarenotcandidateswillbeexcluded.AstandardphenotypiccultureandsensitivitytestandTEM‐PCRpanelwill
beconductedforeachwoundcultured.Uponreturnoftheresults,apharmacistwillutilizetheresultsinconjunctionwith
availablemedicalrecordstoprovideclinicalrecommendationsforanti‐infectivetherapy.ClinicianswillcompareTEM‐PCR
panelandphenotypiccultureandsensitivityresultsandadjusttherapywhenwarranted.Patientchartswillbereviewedto
evaluatepatientwoundhealingandclinicalresolution.
RESULTS:Currently,13TEM‐PCRpanelshavebeenutilizedon12patients.Clinicalconsultationsresultedin21clinical
interventionsanda92.3%acceptancerate.TEM‐PCRreturned1.69dayssoonerandidentifiedmoremicroorganismsthanthe
phenotypicmethod.BoththeTEM‐PCRandphenotypiccultureandsensitivityidentifiedatleastoneofthesame
microorganisms38.46%ofthetime.
DISCUSSION:Thusfar,TEM‐PCRhasallowedidentificationofmicroorganismsinthepresenceofantimicrobialsandreturned
onaveragegreaterthan1dayfasterthanphenotypiccultureandsensitivity.Thesecomponentswereusefulinthetreatment
oflong‐termwoundsandestablishmentofapharmacyantimicrobialconsultationprogramwithwoundcareclinics.The
consultationprogramaidedquickerguidanceofantimicrobials,aidedantimicrobialstewardship,andresultedinnumerous
clinicalinterventions.Acceptanceoftheclinicalprogramwasbetterthanexpectedduetospeedofidentificationand
consistentfollowupbyclinicians.
CONCLUSION:PreliminaryresultsindicateutilizationofTEM‐PCRoffersmoretimelyresultsforearlierguidancein
antimicrobialtherapyparticularlyinanoutpatientwoundcarepopulation.Overall,theestablishedpharmacyconsultation
serviceincoalitionwiththeTEM‐PCRpaneloffersauniquemethodofantimicrobialstewardshipandcollaborationofheath
careprofessionals.Theconsultationservicehadahighrateofphysicianacceptance. FINALABSTRACT#7
TITLE:PharmacyResidencyPreceptorDevelopmentProgram:Evaluation,Creation,andImplementationofaUnique
CustomTailoredPlan
AUTHORS:JoshuaShaneJaussi,PharmD,MBA;ThomasRout,BS,RPh;RobinEspiriti,RPh,BCNSP;ClaudineSalanski,PharmD.
OptionCare
BACKGROUND:ASHPreleasednewaccreditationstandardsforpostgraduateyearone(PGY1)Pharmacyresidencyprograms
inSeptember2014.Havingasoundplanandprograminplacethatfollowsthestandardsoftheaccreditingbodyisessential.
Thecurrentpreceptordevelopmentprogramdoesnotmeetthesestandards.Thisprojectwillspecificallyaddress
improvementtothisorganization’scompliance,primarilywithstandard4,whichdefinestherequirementsoftheresidency
programdirectorandpreceptors.Theprojectwilladdressstandards4.4.d:evaluation,skillsassessment,anddevelopmentof
preceptorsintheprogram;4.4.e:creatingandimplementingapreceptordevelopmentplanfortheresidencyprogram;and
4.8.a‐f:preceptors’qualifications.
PURPOSE:TheobjectivesandgoalsofthisprojectaretoensurecompliancewiththenewASHPstandards,andidentifyand
addressopportunitiesforimprovementinourpreceptordevelopmentprogram.
METHODS:Theplanforaccomplishingthisperformanceimprovementprojectwillbeconductedovera5‐monthperiod.
October2015:Conductanelectronicpre‐surveywhichmeasuresthepreceptors’knowledgeofthefourASHProlesof
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 precepting,aswellastheneedsandpreferencesofthepreceptors.ASHPdefinesthefourrolesofpreceptingas:direct
instruction,modeling,coaching,andfacilitating.Inaddition,thequalificationsofeverypreceptorwillbedocumentedand
comparedwithcurrentaccreditationstandards.November2015:Collectresourcesforpreceptordevelopment.December
2015‐January2016:Evaluatethesurveyresultsanddesignaplanconsistentwiththeneedsandpreferencesdeterminedby
thesurvey.Createandimplementthepreceptordevelopmentprogram.February2016:Re‐evaluatefindingsbysendingouta
post‐surveywhichmeasuresthesuccessoftheprogram.Thesurveytoolbeingusedisanelectronicinternetbased
application.Theparticipantsforthisprogramarethecurrent29PGY1preceptors.
RESULTS:Thepre‐surveywascompletedby10preceptors,ofwhich7demonstratedknowledgeofthefourASHProlesof
precepting.Analysisofpreceptorqualificationsrevealedtheneedforadditionaleducationorsupportintheareasofthe
facilitatingandmodelingrolestoachievefullcompliancewiththe2014standards.Resourcescreatedtofacilitatethe
necessarypreceptordevelopmentincludededucationaltoolssuchaspostersandjobaidsforeachpreceptorandjobsite,as
wellasfrequentemailscontainingpreceptoreducationandskills.Documentswerealsoprovidedtofacilitateandguidepre
andpostrotationdiscussionstoidentifyareasforimprovement.Thepost‐surveywascompleted6preceptors,ofwhichall6
demonstratedappropriateknowledgeofallfourASHProlesofprecepting.Post‐surveyresultsshowedpreceptorswere
satisfiedoverallwiththeinformationandjobaidsprovided.
DISCUSSION:Theplanthatweenvisionedanddefinedbythepre‐surveywassuccessfullydesignedandimplementedand
deemedeffectivebythepost‐survey.Thisprogramwillbeconsideredsuccessfulifthestandardsforpreceptordevelopment
arefoundtobesufficientupontheASHPaccreditationsurveys.
CONCLUSION:Thisprogramisincompliancewiththeaccreditationstandards,andprovidesafoundationforfuture
developmentandimprovement.
FINALABSTRACT#8
TITLE:Efficacy,Safety,Tolerability,andPharmacokineticsofHumanImmuneGlobulinSubcutaneous,20%:Final
AnalysisofaPhase2/3StudyinPatientsWithPrimaryImmunodeficiencyDisease(PIDD)inNorthAmerica
AUTHORS:DanielSuez,MD1;IsaacMelamed,MD2;IftikharHussain,MD3;MarkStein,MD4;SudhirGupta,MD5;KennethParis,
MD6;SandorFritsch,PhD7;ChristelleBourgeois,PhD7;HeinzLeibl,PhD7;BarbaraMcCoy,DVM,PhD8;LemanYel,MD8.
1Allergy,Asthma&ImmunologyClinic,PA,Irving,TX,USA;2IMMUNOeHealthCenters,Centennial,CO,USA;3VitalProspects
ClinicalResearchInstitute,PC,Tulsa,OK,USA;4AllergyAssociatesofthePalmBeaches,NorthPalmBeach,FL,USA;5University
ofCaliforniaatIrvine,Irvine,CA,USA;6LSUHealthSciencesCenter,ChildrensHospitalofNewOrleans,NewOrleans,LA,USA;
7BaxaltaInnovationsGmbH,Vienna,Austria;8BaxaltaUSInc,Cambridge,MA,USA
BACKGROUND:Humanimmuneglobulinsubcutaneous,20%(IGSC20%)isanewsubcutaneouslyadministered,ready‐for‐
use,liquidpreparationwithhighconcentrationofpurifiedhumanimmunoglobulinG(IG).HighproteinconcentrationinanIG
productallowsfortheuseofasmallervolumeofthedesiredtotalIGdoseduringconventionalsubcutaneousadministration.
PURPOSE:Wereportfinalresultsfromaphase2/3studytoevaluatethesafetyandefficacyofIGSC20%inpatientsaged≥2
yearswithPIDDinNorthAmerica.
METHODS:Patientswhowereaged≥2years,hadreceivedIGreplacementtherapy(300‐1000mg/kgbodyweightevery3to
4weeks)≥3monthsbeforeenrollment,andhadaserumIGtroughlevelof>500mg/dLatscreeningwereincluded.InEpoch1
(13weeks),intravenousIG10%(IGIV)wasadministeredatpre‐studydosesevery3to4weeks.InEpochs2‐4,IGSC20%was
administeredweeklyasfollows:Epoch2(approximately12‐16weeks):145%oftheweeklyequivalentEpoch1dose;Epoch3
(12weeks):doseadjustedperareaundertheIGconcentrationversustimecurve(AUC)inEpochs1‐2;Epoch4(40weeks):
doseadaptedindividuallyperEpoch3serumIGtroughlevels.Theprimaryendpointwastherateofvalidatedacuteserious
bacterialinfections(VASBIs).
RESULTS:Intotal,74patientsaged3‐83yearswithPIDDreceivedIGSC20%;67patientscompletedthestudy.Nopatient
discontinuedIGSC20%duetoaseriousadverseevent(SAE)oradversereaction(AR).OneVASBI(rate=0.012perpatient‐
year;P<0.0001)wasreported;theall‐infectionratewas2.41perpatient‐year.AlllocalARs(rate=0.022perinfusion)were
mild(92.5%)andmoderate(7.5%)inseverity.Ofthe4327IGSC20%infusionsadministered,themedianinfusionratewas60
mLperhourpersite(<1‐hourmedianinfusiontime).A30‐59‐mLvolumepersitewasusedin67.4%ofinfusions;7.4%of
infusionsemployeda≥60mLpersitevolumewithouttolerabilityissues.Overall,84.9%ofinfusionswereadministeredinto≤2
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 infusionsitesand99.8%ofinfusionswerecompletedwithoutadministrationchanges.GeometricmeanserumIGtroughlevels
(g/L)were14.74(IGSC20%1‐weekinterval;n=57),11.58(IGIV3‐weekinterval;n=19)and10.19(IGIV4‐weekinterval;
n=50).TheratioofthegeometricmeansofAUCperweekforIGSC20%treatmentoverIGIV10%was109%(90%confidence
interval:104‐113,n=49).
DISCUSSION:InpatientswithPIDDwhoweretreatedwithIGSC20%,VASBIandinfectionrateswerelow,andinfusionsmost
administeredinto≤2siteswerewell‐toleratedatrelativelyhighinfusionrates.
CONCLUSION:Finaldatafromthisphase2/3studyconfirmstheefficacy,safetyandtolerabilityofIGSC20%treatmentin
patientswithPIDDinNorthAmerica.
FINALABSTRACT#9
TITLE:Thestabilityandsterilityofrepackagedintravenouslipidemulsionsforunit‐doseadministration
AUTHORS:AlexandreIvanov,PharmD;MichelleSimpson,PharmD;ThomasRoutBS,RPh;JulieSelfridge,RPh;OptionCare
BACKGROUND:Intravenouslipidemulsions(IVLEs)playavitalroleinnutritionsupporttherapybyprovidingasourceof
caloriesandessentialfattyacids.Emulsionstabilityiscompromisedwhenthefinallipidconcentrationinatotalnutrient
admixture(TNA)islessthanrequiredforadmixturestability,thuspromptingrepackagingofIVLEsforunit‐dosedispensing
(i.e.,dispensingastheoriginalconcentrationaftertransfertoaunit‐dosecontainer).Thepracticeofrepackaginglacks
literaturesupportandpublishedrecommendationslimitthebeyond‐use‐date(BUD)to12hours.USPChapter<729>outlines
stabilityglobulesizelimitsforcommerciallypreparedIVLEsthatmaybeappliedtorepackagedproductstoassesstheimpact
ofcompoundingandstorageonemulsionstability.PharmaciesassignBUDsthatrepresentthestabilityandsterilityofthe
compoundedproduct.ForrepackagedIVLEs,stabilityandsterilitytestingiswarranted,inordertojustifyassigningaBUDof9
daysrefrigeratedat2°Cto8°C.
PURPOSE:Assessthestabilityandsterilityof20%IVLEsrepackagedintopolypropylenesyringesandDEHPfreeIVbagsto
supportaBUDof9daysrefrigerated.
METHODS:Twoindependentlaboratoriesperformedstabilityandsterilitytesting.Stabilitytestingwascarriedoutin
accordancewithUSPChapter<729>.Dynamiclightscatteringtechniquewasusedtodeterminethemeandropletdiameter
(MDD),withanupperlimitof500nanometers,andlightobscurationtechniquewasusedtodeterminethepercentageof
volume‐weightedparticleswithdiametergreaterthan5microns(PFAT5),withanupperlimitof0.05%.Threesamplesper
containertypewerecompoundedinthelab,oneforbackgroundparticulates,followedbytwosamplesof20%IVLEtestedin
triplicateattimeoftransferforstartingMDDandPFAT5,andthenagainonday9afterrefrigeratedstorage.Compounded
samplesterilitywasassessedviastandardtestsforbacteriaandfungi.Threesamplespercontainertypewerecompoundedby
threepharmacybranchesondifferentdaysandatdifferenttimes(i.e.,beginning,middle,andendofcompounding).Samples
wererefrigeratedpriortoshipmentandduringtransportwithtemperaturecontrolconfirmationuponreceipt.Certificatesof
analysisandresultsummarieswereprovidedbybothlaboratoriesupontestcompletion.Outcomeparametersincluded
pass/failresultsforstabilityandsterility.
RESULTS:Atpointoftransferandafter9daysofrefrigeratedstorage,repackagedunit‐dose20%IVLEscompliedwithlimits
foremulsionstabilityassetforthbyUSPChapter<729>.Sterilitywasdemonstratedafter14daysofincubationinallsamples,
asevidencedbynobacterialorfungalgrowth.
DISCUSSION:Relianceonextendedstabilitydataisessentialtothedispensinganddeliveryofcompoundedsterile
preparationsformultipledaysoftherapy.Repackagedunit‐dose20%IVLEsareoftendispensedonasevendaycycle,andthis
projectprovidesevidencetoallowsuchpractice.
CONCLUSION:CompliancewithUSPsetlimitsforemulsionstabilityandstandardtestsforsterilitysupporttherepackaging
of20%IVLEsintopolypropylenesyringesandDEHP‐freeIVbagswithanassignedBUDof9daysrefrigerated.Compounding
proceduresshouldfollowprofessionalstandardsassetforthbyUSPchapter<797>relatedtosterilepreparationquality
assurance.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 FINALABSTRACT#10
TITLE:EffectofTextMessage‐BasedPatientCommunicationsonPharmacyLeadTime—researchinprocess
AUTHORS:CollinChan,PharmD1;JaneGannon,MS,RPh1;JayM.Mirtallo,MS,RPh,BCNSP,FASHP,FASPEN2;TiffanyFancher,
PharmD1;TarakPatel,PharmD1.
1Coram/CVSSpecialtyInfusionServices;2OhioStateUniversity
BACKGROUND:Atitsroot,leadtimeisaconceptthatcallsforprocessingofordersinadvance.Inthehomeinfusionsetting,
itallowsforreducedshippingcosts,adequatetimeforcompoundstoreachappropriaterefrigeratedtemperaturespriorto
shipping,andincreasedflexibilityinprocessingstatorders.Timelycommunicationwithpatientsplaysanimportantfactorin
leadtime,asthecurrentrefillprocessrequirescommunicationwithpatientspriortodispensing.Thisorganizationhas
experiencedchallengesattimesinreachingpatientswhoareoftennotfreetotalk,unavailable,orgenerallyhardtogetahold
of,andthisstudywilllooktoimprovethiscommunicationbyutilizingtextmessagingasrefillreminders.
PURPOSE:Thisstudywillmeasuretheeffectonattainingleadtimewhenusingtextmessage‐basedcommunicationsfor
processingrefills.
METHODS:Weconductedastudyofprescriptiondataobtainedfromonebranchofthisnationalproviderorganization.This
isaperformanceimprovementprojectthatisapprovedbythisorganization’sCorporateReviewBoard.Datawillbecollected
for3monthspriortoand3monthspostimplementationoftheuseoftextmessages(January1,2016).Anestimated900
ordersforeachgroupwillbegathered.Allnewandexistingpatientswillbeofferedtheopportunitytoreceivetextmessage
reminders.Prescriptiondatawillincludespecialtymedicationsandantibioticsnotdose‐dependentonlabresults
(vancomycinandaminoglycosidesareexcluded).Flushesandordersfilledforthefirsttimewillbeexcluded.Theprimary
endpointforthisstudywillevaluatethepercentageofprescriptionsthatattainedleadtime.Leadtimewillbeattainedwhen
thecompoundinginstructionsfortheIVroomareprintedbefore12:00PM,2daysbeforethescheduleddeliverydate.
Secondaryendpointswillincludeanevaluationoftheaveragenumberofdayspriortoshipmentthatthecompounding
instructionsareprintedandofthepercentageofordersthatattainedleadtimeforpatientswhoenrolledanddidnotenrollin
textmessages.
RESULTS:Inthepre‐implementationgroup,936orderswereanalyzed.Inthepost‐implementationgroup,currently320
ordershavebeenanalyzed,with41ofthosefromspecialtypatientsenrolledintextmessages.Thepre‐implementationgroup
had72%(674/936)ofordersattainingleadtimeversusthe60.9%(195/320)ofordersinthepost‐implementationgroup.
Ordersfromspecialtypatientsenrolledintextmessagesreachedleadtime82.9%(34/41)ofthetimeandwereprintedon
average7.1dayspriortodelivery,whereasordersfromspecialtypatientsnotenrolledreachedleadtime54.3%(110/171)of
thetimeandwereprintedonaverage4dayspriortodelivery.
DISCUSSION:Althoughwedidnotseeourexpectedincreaseinattainingleadtimeforordersoverall,wedidseeahigher
proportionofordersattainingleadtimefrompatientsenrolledinreceivingtextmessagealerts.Moredata,however,is
neededtofurtherpursuetextmessagingasaviablealternativeinimprovingpatientcommunication.
CONCLUSION:Inconclusion,thispreliminarydatashowsprogresstowardfindingasolutionforimprovedcommunication
withpatientstopositivelyimpactpharmacyleadtime.
FINALABSTRACT#11
TITLE:Vancomycinconcentrationsusedinhomeinfusion—experienceofonenationalprovider.
AUTHORS:ElizabethLagasse,PharmD;GeneDecaminada,RPh.OptionCare
BACKGROUND:ThecurrentHomeInfusionPharmacystandardforthepreparationofvancomycintobeadministeredinthe
homecallsforaconcentrationof4‐5mg/mLwhengivenviaacentralline.Thisislargelydrivenbytheknowninfusion
reactionsassociatedwithvancomycin.However,thesehavebeenprimarilylinkedtothepHofthesolutionandtheinfusion
rateofthedose.TheFDAapprovedpackageinsertrecommendsthatvancomycinbereconstitutedatconcentrationslessthan
orequalto5mg/mLforadultswhichmaybeincreasedto10mg/mLinfluidrestrictedpatients.Therehasbeenanincreased
demandforintravenousvancomycintobeprovidedtopatientsinelastomericdevicestopromotepatientcomplianceand
ensureasteadyrateofinfusionrangingfrom50mL/hrto250ml/hrinvolumesfrom50mLto500mL.Currentdatashowsthat
vancomycinisstableinonebrandofelastomericdevicesforupto28daysatconcentrationsupto15mg/mL.Increasingthe
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 concentrationofvancomycinwillresultindecreasedinfusionvolumes,resultingintheuseofsmallerelastomericdevices.The
useofsmallerelastomericdevicesmaypresentacostsavings,decreasingtheoverallcosttotheHomeInfusionprovider.
PURPOSE:Thepurposeofthisprojectistoexaminedispensingdatafromamulti‐sitenationalhomeinfusionproviderto
determineifitispossibletousesmallerelastomericdevicestoadministervancomycinandtheassociatedcostsavings.
METHODS:Vancomycindatawascompiledfromallbranchlocationswithinthisnationalhomeinfusionorganizationfrom
November1,2014throughOctober31,2015.Datawascollectedfrom13,602individualvancomycinordersprovidedfor
adultsinBBraunAccufloelastomericdevicesfrom92branchlocations.Theorderswereexaminedtodeterminethe
concentrationthatvancomycinwascompoundedatandtheelastomericsizeused.Thiswasthenusedtocalculatethe
potentialcostsavingsperdoseforeachorderifcompoundedat10mg/mLandplacedinasmallerelastomericdevice.
RESULTS:Ofthe13,602dispenses,3317weredispensedatconcentrations<5mg/mL,5624between5‐7mg/mL,1340at
greaterthan7andlessthan10mg/mL,1907at10mg/mLand1414at>10mg/mL.Analysisofthedispensingdatashowed
thatifallorderscompoundedatlessthanorequalto10mg/mLwerecompoundedathigherconcentrationscloserto
10mg/mL,therewouldbeanaveragesavingsof$2.99perunitdispensed.
DISCUSSION:Theresultsofthisstudymayleadtoashiftinthegenerallyacceptedcompoundingconcentrationfor
vancomycinfrom4‐5mg/mLto10mg/ml.Inaddition,thecostsavingsassociatedwithincreasedvancomycinconcentrations
makeelastomericdevicesmoreaccessibletopatientsduetodecreasedsolutionvolumeandsmallerelastomericdevicesize
required.
CONCLUSION:Theresultsshowthatitispossibletoincreasethevancomycinconcentrationupto10mg/mLtoprovidethe
doseinasmallervolumewithasmaller,lesscostlyelastomericdevice.However,itisunclearatthistimeifincreasingthe
concentrationwillleadtoincreasedadverseevents.Furtherstudiesarerequiredtodeterminethepatientoutcomesof
increasedvancomycinconcentrations.
FINALABSTRACT#12
TITLE:NutritionalResponseinCancerPatientsonHomeParenteralNutrition:ARetrospectiveReview
AUTHORS:AshleyTran,Pharm.D,R.Ph1;CharmagneEmelue,MS,RD,CNSC,LD1;JayMirtallo,MS,RPh,BCNSP,FASHP,
FASPEN2;SharonLockwood,MS,RD,LD,CD,CNSC1.
1Coram/CVSSpecialtyInfusionServices,2TheOhioStateUniversity
BACKGROUND:Poornutritionstatusassociatedwithcancerisoftenanindicatorofpoorprognosis.Thesepatientsmay
sufferfrominvoluntaryweightlossduetocachexia,fatigueandanorexia.Parenteralnutritionisoftenindicatedincancer
patientswhenmalnutrition,gastrointestinalobstructionarepresent,andasadjuvantsupportwithoncologytreatment.Total
parenteralnutritioninsomepatientsmaybelifepreservingandevenlifeprolongingdependingonthepatients’diseasestate
and/orprogression.Anestablishedhistoryofhomeparenteralnutrition(HPN)allowsconvenienceandcomfortforpatients
andisasafealternativetohospitalcare.
PURPOSE:Thepurposeofthisprojectistodeterminewhetheradultcancerpatientsachieveapositivenutritionalresponse
whenplacedonHPN.
METHODS:Thisstudyisaretrospective,descriptive,chartreview.Clinicaldatawillbecollectedatthestartofcarefor
patientscurrentlyreceivingHPNand2monthsafterinitiationofHPN.Patientcharts,andtheRegisteredDietitians
comprehensivenutritionassessmentsandnursingnoteswillbeusedtocollectspecificclinicalinformation.Theprimary
endpointofthisstudyistoassessthefrequencyofpositivenutritionalresponsesinadultcancerpatients.Asuccessin
achievingapositivenutritionalresponsewillbedefinedashavingnoweightlossafter60daysofHPNstartofcareand
receiving>60%ofmacronutrientsbasedonfacility’sregistereddieticians’assessment.Sixtydayswasdeterminedtobethe
timeperiodappropriatetoassessthepatients’repletionofnutritionalstatus.Studyinclusioncriteriacapturedpatientswho
haveadiagnosisofcancer,anindicationforHPN,andanordertoreceiveHPNforaminimumof60days.Patient
demographicsreportedincludeage,gender,cancerdiagnosis,andindicationforHPN.Exclusioncriteriaincludedanypatient
notactivelyonservice,onhospicecare,pregnantornursing,orundertheageof18yearsold.
RESULTS:FourteenHPNpatientsmettheinclusioncriteria.Femalesrepresented64%overall.Meanagewas57years.Nine
outoffourteen(64%)patientsthatwereincludedinthisstudyexperiencednoweightlossafterbeingonserviceforHPNafter
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 sixtydays.Allpatientsincludedinthestudyreceivedgreaterthan60%ofmacronutrientneedsbasedonthefacility’s
registereddieticiannutritionalassessments.
DISCUSSION:Amajorityofadultcancerpatientsservedbythisorganizationexperiencednoweightlossaftersixtydaysof
HPNstartofcare,and100%ofpatientshadmorethan60%oftheirestimateddailycaloricneedsprovidedbyHPN.For
patientsnotachievingasuccessfulresponse,barrierstomaintainingweightweremostcommonlydiseaseprogressionand
reporteddecreasedoralintakeasaresultofdiseaseprogression.
CONCLUSION:HPNappearstopreventfurtherweightlossinsomecancerpatients.Limitationsofthisstudyincludesample
size,relianceonandpotentialvariationofdatafrommedicalrecordsandweightdocumentation.
FINALABSTRACT#13
TITLE:APediatricTrainingProgramforHomeInfusionPharmacists:ApproachestoImproveConfidenceand
Competency
AUTHORS:MarleeAndis,PharmD;SuzanneKluge,B.S.Pharm.;MintuShah,PharmD;JulieSelfridge,B.S.Pharm.OptionCare
BACKGROUND:Pediatricpatientsareatgreaterriskofmedicationerrorscomparedtoadultspartlyduetophysiologic
immaturity.Pediatricdosesoftenresultinsmallvolumes,posinguniquecompoundingchallenges.Theexistingpediatric
therapyeducationwithinthisnationalhomeinfusionorganizationisnotpharmacist‐specific.Additionally,physiciansand
payershaveinquiredaboutthepediatrictherapytrainingourpharmacistsreceivewhichallowthemtohavecompetencein
thatpatientpopulation.Aliteraturesearchrevealedsuccessofalecture‐basedprograminpediatrictherapiesforhospital
pharmacists,butnoneexistforhomeinfusionpharmacists.
PURPOSE:Thepurposeofthisprojectistodevelopandimplementapediatrictherapytrainingprogramwhichwillimprove
homeinfusionpharmacists’confidenceandcompetencybyintroducingastep‐by‐stepapproachandprovidingpertinent
resources.
METHODS:Approximately100pharmacistswithinthisorganizationwereinvitedtocompleteapre‐assessmentviaan
anonymousonlinesurveytool.Confidencewasself‐reportedonascalefrom0‐10.Competencywasshownbypercentof
correctanswersfromtherapy‐basedquestionsastheyrelatedtopediatricpatients.Aslideshowpresentationandjobaids
weredistributedaftercompletionofthepre‐assessment.Thepresentationoutlinedastep‐by‐stepapproachforevaluating
pediatricordersandthejobaidsincludedpertinentpediatrictherapyandinfusiondeviceresources.Pharmacistshadtwo
weekstoreviewtheresourcesandcompletethepost‐assessment.Participantshadthechoicetoselect“Idonotknowthe
answertothisquestion”onallquestions.Successoftheprogramwillbeachievedifconfidencescoresincreaseby25%and
percentofquestionsansweredcorrectlyincreaseby50%.Directcosts(~$300)includedliteraturefortheresidenttoreview.
Resultswerecollectedover1month.
RESULTS:Atotalof52pharmacistscompletedthepre‐assessment.Thefourbiggestareasofweaknesswerepediatric‐
specificinfusionpumpprogramming,knowledgeoforganization‐specificmaximumvolumeofadministration,renalfunction
concepts,andknowledgeofmaintenancefluidrequirements.Atotalof15pharmacistscompletedboththepre‐andpost‐
assessmentsandwereincludedinresults.Averagebaselineconfidencescorewas5.4/10.Onthepre‐assessment,participants
averaged51%correctanswers,17%incorrectanswers,and31%“donotknow”answers.Uponcompletingtheprogram,
confidencescoresincreasedtoanaverageof7.3/10(26%increase).Performanceimprovedtoanaverageof85%correct
answers(67%increase),9%incorrectanswers(47%decrease),and6%“donotknow”answers(81%decrease).Inaddition
todirectresourcecosts,indirectcostsincludedtimefortheresidenttodeveloptheprogramandpharmaciststoparticipate.
Timeinvestedwilltranslatetoqualityofcareforpatientsandsatisfactionforphysiciansandpayers.
DISCUSSION:Thisprogramsucceededinincreasingpharmacists’confidencescoresby26%andpercentofcorrectanswers
by67%,indicatingimprovedcompetency.Thepre‐assessmentexposeddeficienciesandresourcesprovidedwereeffectivein
meetingprojectgoals.Programimplementationiswarrantedforallpharmacistsinvolvedinpediatriccarewithinthis
organizationalongwithmakingthedevelopedresourcesaccessibleforallpharmacists.
CONCLUSION:Theadditionofapediatrictherapyprogramforhomeinfusionpharmacistswillcontributetoimproved
confidenceandcompetencywhileprovidingmedicationstopediatricpatients.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 FINALABSTRACT#14
TITLE:Piperacillin/Tazobactam:ContinuousvsIntermittentDosinginHomeInfusion
AUTHORS:MichaelAnderson,PharmD;SherryHeinrichs,PharmD.CoramCVS/SpecialtyInfusionServices
BACKGROUND:Theimprovementofinfectiousdiseaseoutcomesisveryimportantasitleadstoincreasedpatientwellness
andoverallreductioninhealthcarecosts.Differencesinmedicationadministrationcanoftenbeclinicallysignificant.The
purposeofthisstudyistodetermineifcontinuouspiperacillin/tazobactamdosingresultsinfewercomplicationsandtherapy
failures.Thiswillfillagapintheliteratureastherearecurrentlynopublishedstudiesevaluatingcontinuousdosinginthe
homeinfusionsetting.
PURPOSE:Thepurposeofthisresearchstudyistodetermineifcontinuousdosingofpiperacillin/tazobactaminthehome
infusionsettingisassociatedwithfewercomplicationsandtherapyfailuresthanintermittentdosing.
METHODS:Thestudyisaretrospectivechartreview.DatafromelectronicchartingwillbecollectedfromNovember2013to
November2015.Thisstudycomparedthetwomethodsofadministrationinordertoestablishadifferenceinclinical
outcomes.Theinformationusedtoestablishaclinicaldifferenceinoutcomesincludedhospitaladmissions,changeoftherapy,
andreinfectionwithin30daysofcompletingtherapy.Hospitaladmissionisdefinedasaneedforhospitalizationdueto
complicationsrelatedtotheprimaryinfection.Changeoftherapyisdefinedaschangingantibioticsduetofailureof
piperacillin/tazobactamtoeradicatetheinfection.Re‐infectionisdefinedasarecurrentinfectionoccurringwithin30daysof
thepreviousinfectionthathasthesamediagnosisasthepreviousinfection.Inclusioncriteriaextendedtopatientsage18
yearsorolderandtreatmentwithpiperacillin/tazobactammonotherapy.Exclusioncriteriaextendedtopatientswitha
diagnosisofcancer,pregnancy,orseverekidneydisease.Dataanalysiswasperformedusingachisquaretesttodetermine
statisticalsignificance.Successfulclinicaloutcomesweredefinedascompletionoftherapywithnochangesintherapy,no
hospitalizations,andnoreinfectionsoccurringwithin30daysoftherapycompletion.
RESULTS:Atotalof85patientswereincludedinthisstudy.Forty‐fivepatientsreceivedthedrugbyintermittentdosing
and40patientsreceivedthedrugbycontinuousadministration.Therewere4(8.9%)changestotherapyintheintermittent
groupand5(12.5%)changesinthecontinuousgroup(P=0.59).Therewas1(2.2%)hospitalizationintheintermittentgroup
and2(5%)inthecontinuousgroup(P=0.49).Therewas1(2.2%)reinfectionintheintermittentgroupand1(2.5%)inthe
continuousgroup(P=0.93).Overall,6patients(13.3%)failedtherapyintheintermittentgroup,and8patients(20%)inthe
continuousgroup(P=0.40).
DISCUSSION:Continuousinfusionswerenotassociatedwithfewercomplicationsortreatmentfailures,howeverother
potentialadvantagesofthisrouteofadministrationmaywarrantfurtherstudy.Inthehomewherepatientsadministertheir
owntherapy,continuousadministrationmaybeadvantageousforreducingthenumberoftimestheintravenouslineis
accessedeachday,whichcouldresultinimprovedcomplianceanddecreasedriskofinfection.Howevercontinuousinfusion
requirestheuseofapumpwhichaddscomplexityandcosttotheregimen.
CONCLUSION:Continuousdosingofpiperacillin/tazobactamwasnotassociatedwithfewercomplicationsortherapyfailures
thanintermittentdosing.
FINALABSTRACT#15
TITLE:CathfloActivaseUsageRatesInCatheterCareAcrossDifferentMedicationTherapiesInHomeInfusionCare
AUTHORS:AlfredOlumba,PharmD;LisaSeifert,RPh,FASHP,ASQ‐CMQ/OE;TomRout,BSRPh.OptionCare
BACKGROUND:Maintainingintravenous(IV)catheterpatencyisvitalfortimelyadministrationofinfusedmedications.
Publishedprotocolssupportnormalsalineand/orheparinasflushand/orlocksolutionstoreduceocclusionrisk.Alteplaseis
usedtorestorepatencywhenanocclusionisdetected.Alteplaserequiressignificantnursingresourcessuchexpertiseand
timetoadminister.Itisacostlyandinconsistentlyreimbursedtreatmentforcatheterocclusions.Inthepastyear,this
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 organizationnotedanincreasedusageofalteplase,necessitatingacloserexaminationoffactorsthatmaybecontributingto
catheterocclusionsinordertoidentifyopportunitiesforreducingthiscomplication.
PURPOSE:Thepurposeofthisprojectistoidentifyanycorrelatingfactorswithinthisprovider’shomeinfusionpatient
populationsthatcanbelinkedtotherecentincreaseinalteplaseuse.
METHODS:Thisretrospectivecohortstudyexaminedmedicalrecordsofpatients’dispensedalteplase(CathfloActivase®,
Genentech)betweenSeptember,2013andSeptember,2015,fromthreepharmacylocationsofthisnationalinfusionprovider
organization.Additionalcriteriaincludedcathetertype(peripherallyinsertedcentralcatheter[PICC]orimplantedport)anda
serviceperiodofatleastoneweek.Patientswithperipheralcatheters,oracancerdiagnosis,wereexcludedfromthestudy.
Secondaryvariablesincluded:frequencyofdrugadministration;flushprotocolfollowed;dwelltimeofcatheterbefore
alteplaseadministration;numberofcatheterlumens;patientage;andsourceofnursingcare(e.g.,companynursingor
contractednursing).
RESULTS:Atotalof210patientsreceivedalteplase(84inyearoneand126inyeartwo),withthemajority(72.8%)on
antibiotictherapy(68inyearone,86inyeartwo).Alteplaseusewithantibiotictherapiesincreasedfrom5.9%ofallpatients
prescribedantibioticsinyearone(n=1139patients)to8.4%inyeartwo(n=1012patients).Alteplaseusewithinotropes
doubledfrom13%inyearoneto29.7%inyeartwo,howeverthisfindingprovedtobeinsignificantduetosmallsamplesize.
Flushingprotocolsincluded:13(6%total,7.1%antibiotic)saline‐only;161(77%total,56.5%antibiotic)saline+drug+saline
+heparin10units/mL(SASH‐low);31(15%total,10.4%antibiotic)SASH‐high(heparin100units/mL);andfive(2%total,
0%antibiotic)other(i.e.,D5W).PICCsaccountedfor95.2%(100doublelumen,92singlelumenand5triplelumen),and
implantedportswere4.8%ofstudypatientcatheters.Averagedwelltimeuntilocclusionwas39.7daysforallpatients,and
25.5daysforantibioticpatients.Patientage,dosingfrequencyandnursingproviderfindingswerenotsignificant.
DISCUSSION:Onlyantibioticswereassociatedwithincreasedalteplaseuse,andflushingprotocolsmayhaveanassociation
withdifferences.IndoublelumenPICCs,useofsaline‐onlyversusfinalheparinflushwasassociatedwithadifference.
AlteplaseuseinSASH‐HighforsinglelumenPICCalsoincreased.Exactreasonsforchangewasnotevident.
CONCLUSION:Thisstudydemonstratedthatantibiotictherapywasassociatedwithanincreaseduseofalteplase.Further
studyofthisiswarrantedtoexploreadditionalvariablesthatmaycontributetothisincrease,suchaspatientcomplianceand
flushtechniqueemployedbythenurses.
FINALABSTRACT#16
TITLE:AdverseDrugEventsinInfliximabPatientsInfusedintheHomeCareSetting:ARetrospectiveChartReview
AUTHORS:SarahSmith,BSN,RN,MPA1;KendraCurry,PharmD1;TomRout,BS,RPh1;HeatherS.Kirkham,PhD,MPH2;Julia
Zhu,MPH,MS2;SteveKennedy,PharmD,CSP.2
1OptionCare;2WalgreenCo
BACKGROUND:Infliximabinfusionshavebeenadministeredinthehomecaresettingforover15years,however,thesafety
relatedtoadversedrugevents(ADEs)inthissite‐of‐carecontinuestobeatopicofdebate.ExistingliteraturereportsofADEs
wheninfliximabisadministeredinalternativesitesofcare,includingthehome,rangesfrom2.5–5.6%.Thesesamestudies
concludethat“infliximabcanbesafelyandeffectivelyadministeredinahome‐caresetting(ValdezR.PM,2001)”that“Home
infusionispractical,safe…(Buchanan,2006)”,andfinally,Condinoetalconcludethat“infliximabinfusionsadministeredat
homeweresafe(CondinoAA,2005)”.Despitetheavailableevidence,additionalstudiesdocumentingADEoccurrenceinthe
homecaresettingareneeded.
PURPOSE:ThepurposeofthisstudyistodocumentratesofADEsexperiencedbypatientswhoreceivedinfliximabinthe
homecaresetting,whichincludesbothhomeandambulatorytreatmentsites(ATS),throughthisnationalhomeinfusion
provider.ThesedatawillbecomparedtopublisheddatainsimilartreatmentsettingsusingestablishedFDAADEcategories.
METHODS:AretrospectivechartreviewofpediatricandadultpatientswasconductedtodeterminetherateofADEsfor
infliximab.Patientinclusioncriteria:oneormoreinfliximabinfusionsadministeredinthehomecaresettingbetweenMay1st,
2012andMay31st,2014,atanyprescribeddoseandfrequency,withcompletedatasetsavailable.291uniquepatientswere
included,representing1,866infusions.FDAADEclassificationswereusedtodeterminetheratesofADEs:Mild–nausea,
fever,chills,headache,fatigue,dizziness,palpitations,flushing.Moderate–bronchospasm,angioedema,hypo/hypertension,
rigors,urticaria,fever,chestdiscomfort.Severe–disablingorlifethreatening:hypoxia,ARDsyndrome,myocardialinfarction,
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 ventricularfibrillation,cardiogenicshock,feverwithrigors,anaphylaxis(requiringhospitalization).Inthisstudy,safetyis
definedasanADErateconsistentwithpreviousreports.ThisstudyisapprovedbyQuorumIRB(protocolnumberQR#:
29558/1).
RESULTS:1,866infliximabinfusionswereincludedinthisstudy,1,441(77.2%)athome,410(22%)inanATS,and15(<1%)
werenotidentifiedspecificallyashomeorATS.NoneoftheseinfusionswereassociatedwithasevereADE.Thirteen(13;0.7%
oftotal)infusions,among7uniquepatients,wereassociatedwithareportofamoderateADE,andsixty‐five(65;3.48%of
total)infusions,among30uniquepatients,werereportedasresultinginamildADE.TheoverallADEoccurrencewas4.2%.
DISCUSSION:ADEratesforinfliximabadministeredbythisproviderwereconsistentwithpreviouslypublishedreports
deemingthehomecaresettingasasafesite‐of‐care.Thesedataarerelevanttothehomeinfusionindustrybyfurther
documentingthesafetyofinfliximabwhenadministeredinthehomeorATS.
CONCLUSION:Thisstudydocumentsa4.2%occurrenceofADEsexperiencedbypatientsreceivinginfliximabinthehome
caresettingbetweenMay1st,2012andMay31st,2014.Thisrateisconsistentwithresultsinsimilarstudiesandisconsistent
withpublishedstatementsdescribinghomeasasafesite‐of‐careforinfliximab.Studylimitationsincludethelackofan
equivalentcomparisongroup,controlforage,andcomorbidities.
FINALABSTRACT#17
TITLE:ImprovingPatientSatisfaction:MatchingNurseExperiencetoSCIgPatientNeeds
AUTHORS:R.BeckyGamez,RN,BSN,IgCN;PamelaBrown,RN;JavierMendoza,RN;IsabellaWasciewisz,RN;Altruistix
NursingServices,Inc.
BACKGROUND:Challengesfacingpatientswhoself‐infusesubcutaneousimmunoglobulin(SCIg)includethemanagementof
previoushealthconcepts,anxietyandalimitednumberoftrainingvisitstoachieveconfidenceandcompetencywhile
maintainingorimprovinggeneralhealthoutcomes.Thesechallengescanimpactthepatient’soverallsatisfactionandsuccess
withthistherapyandcanbecompoundedbyinstitutionalprotocols,insurancereimbursementandstaffexperienceand
education.Ourorganizationclassifiesinfusionnursesaccordingtothreelevelsofexperiencewithimmunoglobulintherapy
administration:accomplished(fewerthan3visitsannuallyandor2year(s)ofexperience),proficient(3to6visitsannually
andor3to5yearsofexperience),andexpert(greaterthan6visitperyearandmorethan5yearsofexperience).Newdrug‐
specificprotocolsthatrepresentasignificantchangefromtheusualmayresultinallnursescategorizedas“accomplished”
untilcompetencyandconfidencearedemonstratedinthenewproduct/preparationandadministrationtechniques.
PURPOSE:Thepurposeofthisprojectwastodeterminewhetherthereareanycorrelationsbetweenpatient
compliance/successfulparticipationinSCIgtherapyandtheexperiencelevelofthenurseprovidingtheirSCIgtraining.
METHODS:Aretrospectiveanalysiswasconductedofpatientsatisfactionsurveyresultsfrom181uniqueSCIgpatients
treatedbetweenJanuary2010andDecember2014.SurveysweresentwhenpatientsachievedindependencewithSCIG
administration,andeverythreemonthsthereafterforoneyear.Experiencelevelofthenursewhoperformedtheinitial
teachingvisitwasrecordedforeachpatientwhoreturnedasurveyat3months,aswasthenumberofvisitsrequireduntil
eachpatientdemonstratedindependenceinself‐administration,andwhetherthepatientdiscontinuedSCIGtherapyduring
thestudyperiod.Thepatientsurveyutilizedafive‐levelLikertscale(stronglydisagree,disagree,neutral,agree,andstrongly
agreeandmeasuredthepatient’srecallofkeyteachingconcepts,techniquesandperceptionofcareprovidedbynursingand
pharmacystaff.
RESULTS:Thesurveyresponserateforindependentpatientsat3monthswas89%,withdiminishingreturnsover
subsequentintervals.DatarevealedthatpriorexperiencewithIVIGhadnosignificantimpactonSCIGsatisfactionscores,
compliancewithself‐infusionteaching,orpatientretention.Numberofvisitstoachievepatientindependencewere4for
patientstaughtbyaccomplishednurses(23of181),3withproficientnurses(28of181)and2to3withexpertnurses(130of
181).PatientsweremorelikelytoremainonSCIg,andreportedhigheroverallsatisfactionscoreswheneducationwas
providedbyaproficientorexpertlevelimmunoglobulininfusionnurse.Thesepatientsweremorelikelytoworkthrough
infusion‐relatedissuesandstayontherapy,thanpatientswhoweretaughtbyanaccomplishednurse.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 DISCUSSION:Ourdatasuggeststhatnurses’experiencelevelhadagreaterimpactonpatientretentionofteaching,
satisfactionwiththetreatment,andtheircontinuationwiththerapy,thananyotherfactor.Areviewofnurseorientationand
supervisioninthefirstyearofemploymentisindicatedbasedonthesefindings.
CONCLUSION:Inconclusion,thisstudydemonstratednurseexperienceleveldoescorrelatetopatientcomplianceand
successfulparticipationinSCIGtherapy.Favorablesatisfactionresponsesmayalsobeinfluencedbyotherselectionbiases,
andfurtherresearchiswarranted—includingacloserexaminationofthefactorsthatcontributetonursecompetencyand
expertiseinadministeringandteachingself‐administrationofSCIGtherapy.
FINALABSTRACT#18
TITLE:RetrospectiveReviewofHomeInfusionInotropePatients:ADescriptiveReportonDemographics,
Readmissions,andCosts
AUTHORS:NoreenChan,PharmD.Coram/CVSSpecialtyInfusionServices
BACKGROUND:Thegoalofhomeinotropetherapyistoprovideaneffective,cost‐savingalternativetohospitalizationfor
StageDheartfailure(HF)patients.RecentCongressionaleffortstopasslegislationchangingtheMedicarePartB
reimbursementtoAverageSalesPricemethodologywoulddramaticallylowerthereimbursementforhomeinotropictherapy,
raisingconcernsaboutthistreatmentoption’sfuturefinancialfeasibility.Whileevidenceexistsdemonstratinglowercare
costswithhomeinfusiontherapyversushospitalization,furtherresearchisneededtovalidatethehomeinotropecost‐
effectivenessbeyondsite‐of‐careincluding30‐dayHFreadmissionimpact.
PURPOSE:Thepurposeofthisprojectistodescribedemographics,readmissions,anddailycarecostsfromthreemajor
teachinginstitutionsforhomeinotropepatientpopulationmanagedbyanationalhomeinfusioncompany.
METHODS:Aretrospectiveanalysisofpatientmedicalrecordsreferredbythreecentersyielded61inotropepatients.Study
inclusioncriteriawereallinotropepatientsfromOctober1,2014toSeptember30,2015toalignwithMedicarestatistical
reports.Demographicdataincludedgender,age,lengthoftherapyandpayer.Patientoutcomesincluded30‐dayreadmissions,
unplannedhospitalizationratesandprimaryreason.Dailycostdatawascalculatedfromalowandhighrangedividedbythe
averagelengthofstayreportedinstatedatabase15‐dayreadmissions,startingApril2014throughMarch2015forpatientsat
leastage18andpreviouslypublishedhomeinotropecosts.
RESULTS:Theresultsshowedtheaverageinotropepatientwasa55yearoldmalereceivingmilrinonefor173dayswith
commercialinsurance.Therewere13femalepatients(21.3%)and48malepatients(78.7%).48patients(78.6%)received
milrinoneand13patients(21.3%)dobutamine.Reimbursementcoveragedemonstrated31commercialinsurancepatients
(50.8%),21traditionalMedicarepatients(34.4%),6Medicaidpatients(9.8%),2self‐paypatients(3.4%),and1hospice
patient(1.6%).The30‐dayreadmissionratescomparinghomeinotropedatatoMedicaredatawere7.1%and21.5;6.7%and
23.4;and12.2%and25.2%forHospitalA,BandC,respectively.Themostcommonunplanned<30dayhospitalizationreason
wasinsufficientresponse(62.5%).ThedailycostrangeofaHFreadmissionwas$3,382.94‐$7,191.18forHospitalA,
$4,364.64‐$10,943.21forHospitalB,and$2,623.15‐$6,485.96forHospitalC.1Literaturereportshomeinfusiondailycost
rangeforthefirstmonthofdobutamineandmilrinoneas$72‐$127and$184‐$734,respectively.2,3
DISCUSSION:Therewerestudydataacquisitionchallenges.Daterangesdidnotalignbetweencost,homeinotrope,and
hospitaldata.Otherlimitationsincludedsinglestatedatausedforreadmissionscostsand30‐dayMedicareHFreadmission
ratesdonotincludeallpayers.Homeinotropecostsvariedwidelyduetoinsurance,weightbaseddosing,anddrugchoicewith
literatureestimatesbasedona75kgpatientdosedat0.5mcg/kg/min(milrinone)and5mcg/kg/min(dobutamine).2
CONCLUSION:Thisstudyprovidesadescriptivereportofdemographics,readmissions,andcostsforhomeinotropepatients.
Theresultsdemonstratelower30‐dayreadmissionratesandreinforcelowersite‐ofcarecostsprovidingafoundationfor
furtherexaminationanddemonstratetheneedforthoughtfullegislationtopreservethiscost‐effectivetherapyoption.
FINALABSTRACT#19
TITLE:ATeamApproachtoEstablishingaSpecialtyPharmacyCenterofExcellenceModelinImmuneDisorders
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 AUTHORS:CharlesBrianMckee,BA;KirstenMoloney,RPh;StacyBryant‐Wimp,BA,CHC;JayBryant‐Wimp,RPh;Amanda
Bax,BA,RN;KelseyJett,PharmD,BCBS;ElizabethBlack,CPhT;KarenHeckemeyer,RN,CRNI;JenniferRentschler,RN;
KathleenMaier;KaseyMay,BSBA;NatashaHernandez,BA;KaliStark,BSBM;KelseyPritchett,BA;andDanaFleenor.Accurate
RxPharmacy
BACKGROUND:CentersofExcellencesharecommonelementsandhavebeenestablishedforavarietyofhealthcareservices.
Theseelementsincludeleadership,commitment,focus,interdisciplinaryinvolvement,qualifications,competence,volume,
standardization,outcomes,performance,researchandpublication.Whilepracticeguidelineshavedevelopedstandardsofcare
forimmunetherapy,providersmayfinditdifficulttoestablishconcretecriteriathatpredictanddescribethequalityofthe
immunetherapysupportservicestheyprovide.TheSpecialtyPharmacyandHomeInfusionCenterofExcellenceprogramisa
voluntaryprocessbywhichahomeinfusionpharmacyorganizationcanassureinclusionoftherapystandardsintoits
practices,developandpromotestaffexpertise,fosterinterdisciplinarycollaboration,anddemonstrateexcellencein
specializedcare.
PURPOSE:Thisprovider’sinterdisciplinaryhomecareteamsetouttoachieveaCenterofExcellencequalificationinImmune
Disordersthatreflectstheorganization’smission,whichistoempowerclientsandcaregiverstobeself‐sufficientinthe
treatmentoftheirchronicmedicalcondition,improvingclinicaloutcomeswhilebeingagoodstewardofthepatients’health
caredollar.
METHODS:Thisaccreditedorganization’sinterdisciplinaryteamhasadesignatedteamleaderandrepresentationfromsales,
marketing,pharmacy,nursing,intake,reimbursement,andoperations,includingtwomemberscertifiedinarelevant
professionalspecialty.Duringthethreemonthsleadinguptothecriterionsubmissionforqualification,weeklyandmonthly
meetingswereimplementedtodefinesuccess,inadditiontoopportunitiesforimprovement.Programsuccesswas
determinedbytheteam’sabilitytoassessclinicalandsupportstaffcompetenceusingaccreditationstandards,measureand
reportallhumanistic,clinicalandfinancialoutcomesincludingreferralpatterns,createprogramspecificmarketingmaterials,
evaluatepatientandreferralsourcesatisfaction,andactivelyparticipateinpatientsupportgroupsandprofessionalsocieties.
RESULTS:ThisorganizationwasawardedthedesignationSpecialtyPharmacyandHomeInfusionCenterofExcellence.The
organizationmaintaineda5outofpossible5ratingonpatientsatisfactiontomeetthehumanisticoutcome.Themeasurement
chosenforclinicaloutcomeishospitalizationrate.Duringthethreemonthspriortoqualification,theorganizationhadnot
experiencedanyhospitalreadmissionsforimmunedisorders.Duringthethirdandfourthquartersof2015theorganization
hasexperienced300%referralgrowth.
DISCUSSION:TheCenterofExcellencemodelhelpstheimmunedisordersteamidentifyandcorrectdeficiencies,track
progress,andachievespecificgoals.Theorganizationlearnedthatinordertowinonemustkeepscore.Humanisticchallenges
canbeovercomeiftheyaremeasured.Clinicalbarrierssuchasadherenceandinfectionratescanbeaddressediftheteam
collaboratesontheseissues.Organizationscanmeettheirfinancialgoalsiftheycreategrowthinitiativescenteredupon
clinicalbestpractices,inadditiontointernalandexternalmarketing.
CONCLUSION:TheSpecialtyPharmacyandHomeInfusionCenterofExcellencemodelhasprovidedasystematicapproach
forimplementingtheorganization’smissiontoempowerclientsandcaregiverstobeself‐sufficientinthetreatmentoftheir
chronicmedicalcondition,improvingclinicaloutcomeswhilebeingagoodstewardofthepatients’healthcaredollar.
FINALABSTRACT#20
TITLE:RetrospectiveReviewofNeedleLengthDuringHyaluronidase‐facilitatedSubcutaneousAdministrationof
ImmuneGlobulinG
AUTHORS:PegGruenemeier,RN,CRNI,CHC1;CarolErnst,RN1;KimberlyDuff,RN,BSN2.
1BioRx;2BaxaltaUS,Inc.
BACKGROUND:PatientsrequiringimmuneglobulinG(Ig)replacementmayreceiveIgintravenously(IVIG)every3‐4weeks;
subcutaneouslySCIG;conventional),usuallyevery1‐2weeks(multipleneedlesticks);orsubcutaneously,facilitatedby
recombinanthumanhyaluronidase(IGHy;HYQVIA)every3‐4weeks(1‐2needlesticks).Needlelengthisanimportant
considerationtoenhancelocaltolerabilityandpreventIgGleakage.Currently,needlelengthselectionforIGHyadministration
isbasedonclinicaljudgment.NoobjectiveneedlelengthdataexistsforSCIGandIGHyreplacement,forwhichinfusion
volumescanbeaslowas10mLorashighas600mL.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 PURPOSE:Thepurposeofthisretrospectivereviewistopresentdataonneedlelengthinrelationtotolerabilityandbody
massindex(BMI)inIGHy‐treatedpatients,toassistinprovidingguidanceforchoosingappropriateneedlelength.
METHODS:DatawerecollectedfromIGHy‐treatedpatientsaffiliatedwithamulti‐sitespecialtypharmacy.Patient
characteristics(Height,weight,calculatedBMI,age,sex,initialneedlelengthatstartandendoframpupphase),IGHydosing,
numberofinfusionsites,patientreportsofleakageorsideeffectsandcorrelationofdifferentneedlelengthtomeanBMIare
reported.
RESULTS:Overall,66PIDDpatients(aged13‐74years;meanBMI29.3[15.1‐61.4])receivedIGHy.Patientspreviously
receivedIVIG(26%),conventionalSCIG(42%)orweretreatment‐naive(32%).PatientscompletingIGHyramp‐up(N=58)
wereevaluated.Forpatientsusinga6mm,9mm‐or12mm‐lengthneedle,meanIginfusionvolumeswere250mL,325mLand
385mLandmeansites/infusionwere1.5,1.39and1.22,respectively.Nine(15%)patientsswitchedfroma9‐mmtoa12‐mm
needle;themostcommonreasonforthisswitchwasduetoIGleakagefromtheinfusionsite,whichwasresolvedwithuseofa
longerneedle.ThemeanBMIforpatientsusinga9mmneedlewas27.8whilethemeanBMIforpatientsusing12mmneedle
was39.1.
DISCUSSION:InconventionalSCIGtheneedlelengthstaysthesameforsubsequentweeklydosingunlessleakageoccurs
requiringalongerneedle.UnlikeconventionalSCIG,forHyaluronidase‐facilitatedSubcutaneousAdministrationofImmune
GlobulinG,thedoseschangethroughouttheramp‐upphaseandthetotalvolumewhentheramp‐upphaseiscompletedis
largerthanconventionalSCIG.ThisshouldbekepttopofmindwhentransitioningpatientstoIGHy,thereforealongerneedle
mayneedtobeavailabletoachievebetterpatienttolerability.
CONCLUSION:ThisstudyprovidesinsightintoneedlelengthconsiderationsinpatientstreatedwithIGHy,particularlywhen
switchingfromSCIG,sinceIGHyallowsforlargerinfusionvolumesintoasinglesite.DatafromIGHy‐treatedpatientssuggest
that,althoughthemajorityofpatientsswitchingfromSCIGdowellwiththeiroriginalneedlelength,some(particularlythose
withahigherBMI)mayrequirealongerneedleforimprovedtolerabilityandleakagepreventionattheinfusionsite.
FINALABSTRACT#21
TITLE:MonitoringOn‐CallPagesforHomeInfusionPharmacistsasaContinuousQualityImprovementMeasure
Authors:JesseS.Peterson,PharmD;DanaSimonson,PharmD,BCPS;ColleenBlissenbach,MBA.FairviewHomeInfusion,
Minneapolis,MN
Background:Thisorganizationutilizesanafter‐hourspagersystemtoprovideappropriatepatientcareintimeofneed.The
after‐hourssystemtakescallsbetween5:01pmand7:59amweekdays,andalldayonholidaysandweekends.Theon‐call
servicetakesamessagefromthecallerandsendsatextmessagetothepharmacistoncall.Ifthepatientdoesnotreceivea
responsewithin15minutes,thepharmacistiscalled.Allofthisdataismaintainedandstoredelectronically,butnot
characterizedbasedonthereasonforcall.Forthepastseveralmonths,on‐callpharmacistshavementionedthatmostafter‐
hourscallshavebeenlogisticalproblems.
Purpose:Thepurposeofthisstudywastocharacterizeon‐calldatatoseewhatissuesoccurredandidentifypotentialchanges
thatcouldbemadetoworkflowtoenhancebothpatientcareandemployeesatisfaction.
Methods:Asix‐monthperiodoftimewasanalyzed.Callswerecategorizedintothefollowingdefinitions:“clinicalcalls”(calls
thatcouldpotentiallyrequireapharmacist’sexpertise),“logisticalcalls”(callsthatcouldimpactpatientcare,butdonotneed
tobehandledbyapharmacist),or“othercalls”(noinformationprovided).Callsweresortedbywhentheywerereceivedon
weeknights(5pm–5:59pm,6pm–7:59pm,8pm–11:59pm,midnightand7:59am).Weekendsandholidayswereanalyzed
separatelybecausetheon‐callservicewasbeingutilized24hoursaday.
Results:BetweenMay1standOctober31stof2015(184days),1006callswerereceivedbytheon‐callpharmacist.Ofthese
calls,465(46%)wereclassifiedasclinical,514(51%)aslogisticaland27(3%)asother.Atotalof389callswerereceivedon
weekendsandholidays,whiletheremaining617callswerereceivedonweeknights.Ofthe617weeknightcalls,196callswere
receivedbetween5‐5:59pm(83clinical,110logistical),240callsbetween6‐7:59pm(36clinical,140logistical),148calls
between8pm–midnight(63clinical,82logistical),and33callsbetweenmidnightand7:59am(14clinical,18logistical).
Discussion:Wefounditdifficulttoquantifythetruenatureofafter‐hourscallsbasedonthelevelofcategorizationbeing
providedbytheansweringservice.Movingforward,itwillbeimportanttoworkwithouransweringservicetogeneratea
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 standardsetofreasonspatientscalled.Withthemajorityofcallspertainingtologistics,promise(delivery)timewindowsand
workflowcouldbereevaluated.Communicatingadeliverywindowof6‐9pmtopatientswhileholdingstaffaccountablefora
6‐8pmdeliverywindowisonepotentialexampleofanimprovementthatmaydecreaselogisticscalls.Finally,staffinghours
couldbereevaluatedtobetteraccountforworkload.
Conclusion:Fromthissix‐monthanalysis,thereisevidencethattheon‐callpharmacistisreceivingmorelogisticalthan
clinicalcalls.Whileweaccomplishedourobjectiveofanalyzingcalldataandidentifyingopportunitiestoimprove,welearned
thatmorespecificdataisneededtofacilitateanalysisandidentifyareasofimprovementthatwouldenhancepatientcareand
employeesatisfaction.Futurestudiescouldfocusontheamountoftimespentresolvinglogisticalcalls,astheyaretakingtime
awayfrompatientcareactivities.
FINALABSTRACT#22
TITLE:CharacterizingOutcomesDataforHomeParenteralNutritionPatients
Authors:JesseS.Peterson,PharmD;TheresaRahn,RN,BSN;DanaSimonson,PharmD,BCPS.FairviewHomeInfusion
Background:Unplannedhospitalizationsrepresentasignificant(andpotentiallyavoidable)costtothisnation’shealthcare
system.Forthisreason,unplannedhospitalizationshavebecomeatargetforcostreductioninmanypay‐for‐performance
initiatives.TheNHIAOutcomesDefinitionsincludeunplannedhospitalizations“related”totheinfusiontherapyprovided,with
reasoncodesforthesehospitalizations,andoutcomescodestodescribetheirresolution.Useofthesecodesbyallproviders
withintheindustrywouldallowforthebenchmarkingofpotentiallypreventablehospitalizations.Individualproviderscould
thenexaminethesereasonandoutcomecodesastheyseektounderstandwhataspectsofpatientcare(providedornot
provided)mayhavecontributedtoeachrelatedhospitaladmission.
Purpose:Thepurposeofthisstudywastocollectandcharacterizeoutcomesdata,specificallyunplannedhospitalizationsin
chronicHPNpatients.
Methods:AreportwasgeneratedinCPR+,thisorganization’selectronichealthrecord(EHR),forallHPNpatientsplacedon
hold(withareason)duringatwo‐monthperiod.AchartreviewwasconductedtoincludeonlypatientsreceivingHPNservice
duringthisperiod.Forpatientswhowereadmittedtothishomeinfusionprovider’saffiliatedhospitals,medicalchartswere
examinedforadmissionreasonandsubsequentdischargediagnosis.Thatinformationwasthencharacterizedaccordingtothe
NHIAoutcomedefinitions.Forthosepatientswithlineinfections,chartswerereviewedtoidentifynursingagenciesforany
patterns.Accessdeviceevents,interventions,andoutcomecodeswerealsoassigned.
Results:Overatwo‐monthtimeperiod,therewere32relatedunplannedhospitalizationsforHPNpatients.Further
investigationrevealed6unplannedhospitalizationswereforpatientswhowerenotreceivingHPNduringthespecifiedtime
period.OftheHPNpatientunplannedhospitalizations(n=26),17wereadmittedwithinourhealthsystem(13patientswith1
unplannedhospitalization,2patientswith2unplannedhospitalizations).Ofthose17unplannedhospitalizations,7were
relatedtohomeinfusioncarewith6confirmedinfectionsand1dislodgeddevice.NoneoftheHPNtherapieswerechanged,
however6unplannedhospitalizationsresultedinadischargehomeonantibiotictherapy.Ofthoseinfections,3unplanned
hospitalizations(2patients)werereceivingpharmacyonlyservices,3unplannedhospitalizations(3patients)werereceiving
regionalnursingservices,and1unplannedhospitalizationwasreceivingnursingservicesfromourhospitalsystem’shome
healthagency.
Discussion:Collectingandclassifyingoutcomesdatainhomeinfusionpresentsnumerouschallenges.Patientadmissionto
outsidehospitalspreventedthecollectionandreportingofoutcomesdataforsomepatients.AccordingtoNHIAoutcomes
definitions,eachpatientwhowasadmittedonHPNwasalsodischargedonHPN(andresumptionwouldtechnicallyoccur
withoutchanges).However,patientsreturnedhomewithanadditionalinfusiontherapy(antibiotics).Thissubtlenuance
highlightstheimportanceofclearlydefiningoutcomecategoriesearlyintheprocesstoensureaconsistentanalysis.
Conclusion:Fromthistwo‐monthanalysis,thereisevidencethatsomeunplannedhospitalizationsarerelatedtohome
infusioncare,specificallyintravenousaccessdevices.Whileweaccomplishedourobjectiveofcollectingoutcomesdata,this
studyexposedsomeofthechallengesassociatedwithitscharacterization.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 FINALABSTRACT#23
TITLE:IncreasingPatientReferralAcceptanceRateThroughoutaNationalHomeInfusionOrganization
AUTHORS:LoganDavis,PharmD,MBA;ChristianVonDrehle;ChrisNewlin,PharmD;AnnaThompson;BrandiSemmes,CPhT;
TimDoner;MicheleWinstead.VITALCARE,INC.
BACKGROUND:Thesuccessandgrowthofthisorganizationisdependentonactivatingasmanypatientreferralsaspossible.
Theorganizationcollectedpatientreferralacceptanceratedatathroughout2014,andinQ42014theaverageacceptancerate
was83.2%.Commonreasonsforinactivationincludedtherapycostissues,payernetworkissues,andpharmacyoperation
issues.Inlate2014,theorganizationcreatedaprocesscalled“CodeBlue”inanattempttoacceptpatientreferralsatriskfor
inactivation.TheprocessisinitiatedbyaPatientAccountRepresentativewhenapharmacyreceivesareferralthatisatrisk
forinactivation,alsoreferredtoasa“No‐Go”.TheCodeBlueteamconsistsofmultipledepartmentdirectors,managers,staff
andtheCEO.Membersoftheteamhaveexperienceandexpertiseinpharmacyoperations,payercontracting,drugtherapy
selection,andreimbursement.
PURPOSE:Thegoalofthisprojectistoincreasethepercentageofhomeinfusionreferralsthatareacceptedontoservice
(“activated”).
METHODS:Datawascollectedfromtheorganization’spharmacyoperationssoftwaresystemtomeasureourprogressandthe
impactofCodeBluethroughouttheyear.Metricsmeasuredwere1)monthlyreferralacceptancerates;2)Quarterlysumofall
referralsinvolvingCodeBlueand3)QuarterlyacceptancerateofreferralsinvolvingCodeBlue.CommonCodeBlueteam
interventionsutilizedtoincreasereferralacceptancerateincluded:therapeuticdrugsubstitutionstolowertherapycosts;
utilizationofapatient’spharmacybenefitplanfordrugcoveragewhenmedicalbenefitcoveragewasunavailable;and
initiatingpartnershipsbetweentheorganization’spharmaciesinanefforttoaccessmorepayernetworks.Itwasnotedthat
knowledgeoftheCodeBlueprocedurecouldbeimproved.StepsweretakentoincreasepharmacyawarenessofCodeBlue,as
wellasinternalawareness,andthecompletionofCodeBluerequestsinatimelymanner.Theorganization’sawarenessof
CodeBluewasmeasuredbytrackingtheoverallutilizationofCodeBlue.
RESULTS:UtilizationofCodeBluehasincreased500%throughout2015asthisprojecthasbeencarriedout.Thepercentage
ofCodeBluesconvertedintoacceptedreferralshasincreasedfrom15%inQ42014to45%attheendofQ32015.Thereferral
acceptanceratebetweenJanuaryandSeptember2015is85.8%,animprovementof2.6%fromQ42014.
DISCUSSION:Theprojecthasdemonstratedthataheightenedawarenessofreasonsfornon‐acceptanceandpatientreferrals
andcommoninterventionstotroubleshootreferralscanincreasereferralacceptance.
CONCLUSION:TheincreaseduseofCodeBlueprocesseshaspositivelyaffectedandisdirectlycorrelatedtoanincreaseinthe
patientreferralacceptancerate.
FINALABSTRACT#24
TITLE:Developmentofelectronicassessmenttoolsforpatientswithchronicinflammatorydemyelinating
polyneuropathyreceivingimmuneglobulintherapy
AUTHORS:BarbaraProsser,RPh;ChristineMiller,PharmD;ToddE.Hare,RPh;NicholasBertsch,PharmD;KevinRoss,RN.
SoleoHealth
BACKGROUND:Chronicinflammatorydemyelinatingpolyneuropathy(CIDP)notonlyaffectsapatientbyitsphysical
symptoms,butthechronicnatureofthisdiseasealsohasalastingimpactonqualityoflife.Theprogressiveandirreversible
natureofCIDPwarrantstheearlyinitiationofimmuneglobulintherapytohelppreventpermanentdisability.Qualityoflife
investigationstendtobesubjectiveinnatureanddifficulttoquantify.Ongoingdatacollectioninthisspecificpatient
populationisminimal,whichhighlightstheimportanceofcollectingandanalyzingtheeffectoffirst‐lineimmuneglobulin
therapyforthetreatmentofCIDP.Thedevelopmentofelectronicassessmenttoolswillassistinstreamlineddatacollectionso
thatresponsetotherapycanbetrendedandappropriateinterventionscanbemade.
PURPOSE:Thepurposeofthisprojectwastodesignelectronicassessmenttoolsforfutureutilizationintrendingqualityof
lifeandtheimprovementorprogressionofsymptomsassociatedwithCIDPinpatientsreceivingimmuneglobulin(IG)
therapy.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 METHODS:ExistingassessmenttoolsusedintheevaluationofCIDPsymptomswereresearchedbyamultidisciplinaryteam.
InstrumentssuchastheRAND36‐ItemHealth(SF‐36)Questionnaireandtheinflammatoryneuropathycauseandtreatment
(INCAT)scalewereexaminedbecauseoftheiruseinclinicaltrialsandtheirfocusonactivitiesofdailylivingandqualityoflife.
Freetextcontentwaslimited,helpingtofacilitatestreamlinedelectronicdatacollectionforuseinfutureresearch.
RESULTS:Atotalofthreestandardizedassessmentswerecreatedinthisprovider’selectronicmedicalrecordssystem:an
initialassessment,andongoingassessment,andalifestyleassessment.Theparametersincludedintheseassessmenttools
weredevelopedbasedonthisprovider’sexperienceasthemostsignificantconsiderationswithinthispatientpopulationin
regardstoclinicaloutcomesandpayorrequirements.Theresponsestoquestionsassessingsubjectiveinformation,suchas
painlevelanddifficultybalancing,wereassignedanumericscaleinordertoquantifysymptomsthatmayotherwisebe
challengingforpatientstoconvey.Theuseofthesetoolswillbetestedbyonesiteofthisnationalproviderbeforebeingmade
availableforusewithinallsites.
DISCUSSION:Theinitialassessmentisdesignedtoobtainbaselinedataforeachpatient.Inthiscircumstance,baselineis
definedastheinitiationofserviceswiththisproviderofIGtherapy.Theinitialassessmentwillassistindifferentiating
betweenpatientsnaïvetoIGtherapyincomparisontothosewhohavereceivedIGtherapyinthepast.Itwillalsoallowforthe
patientstoexpresstheirgoalsandexpectationsrelatedtoIGtherapy.Theongoingassessmentwilloperateascontinuing
clinicalevaluationofthepatients’symptomspriortoeachinfusion.Thelifestyleassessmentisdesignedtoassessthepatient’s
mood,energylevel,sleep,stress,andactivitiesofdailyliving.
CONCLUSION:StandardizedelectronicassessmenttoolsweredevelopedtoassessthesymptomsandqualityoflifeforCIDP
patientsreceivingIGtherapy.Companywideimplementationiscurrentlypendingwiththegoalofoutcomesdatacollection
andanalysisinthefuture.
FINALABSTRACT#25
TITLE:Temperaturevariationinthehomesetting:implicationsforcontinuousambulatoryinfusions
AUTHORS:JanetKSluggett,BPharm(Hons),GradDipClinEpid,PhD1;NicholasASharley,BPharm2;KarenJReynolds,FTSE,
FAHMS,FIEAust,PhD,MSc,MA,BA(Hons),GradCertTertEd3;AndrewJSluggett,BPharmBSc(Hons)DipMgt,Chief
Pharmacist/GeneralManager1
1CPIEPharmacyServices,Adelaide,SA,Australia;2PharmacyDepartment,TheQueenElizabethHospital,Adelaide,SA,
Australia;3MedicalDeviceResearchInstitute,SchoolofComputerScience,Engineering&Mathematics,FlindersUniversity,
Adelaide,SA,Australia
BACKGROUND:InAustralia,patientsreceivingextendedtreatmentwithparenteraldrugsinthehomearegenerallyvisited
oncedailybynursingprovidersand24‐hourcontinuousinfusionsarecommonpractice.Cliniciansneedtoconsiderwhethera
patient’shomeenvironmentissuitablefordrugadministrationandifdrugstabilitywillbemaintained;however,onlytwo
Australianstudieshaveassessedtemperaturevariationduringanextendedinfusioninthehome.Neitherstudy
simultaneouslyassessedoutside,ambientandinfusionsolutiontemperaturesduringthestudyperiod.
PURPOSE:Thepurposeofthisstudyistoinvestigatetemperaturechangesduringa24hourperiodandassesstheeffectofice
packsoninfusionsolutiontemperature.
METHODS:Sixhealthyvolunteers(withoutintravenousaccess)woreawaistpouchcontaininganelastomericinfusiondevice
for24hoursduringautumninAdelaide,SouthAustralia.Theinfusiondevicecontained250mL0.9%sodiumchlorideinjection
solutionanditremainedfullduringthestudyperiodasnoinfusiontookplace.Theinfusiondevicewasconnectedto
temperaturedataloggerswhichmeasuredinfusionsolutiontemperatureandambienttemperatureeverytenminutes.Outside
temperatures,measuredat30minuteintervals,wereobtainedfromtheBureauofMeteorology.Volunteersrecordedtheir
activitieseveryhourduringwakinghours.Inaseparateexperiment,aninfuserwasplacedinsideawaistpouchcontaining
tworeusabledryicepacks(approximately4”x4”)andincubatedat77°For90°Ffor24hours.Theincubationtemperatures
wereselectedbasedontheambienttemperaturesrecordedwhenvolunteerscarriedtheinfusiondevices.Theicepackswere
replacedeveryeighthours.
RESULTS:Themeantemperatureoftheinfusionsolutionswornbythevolunteersrangedfrom72.9°Fto82.2°F,andthe
cumulativetimetheinfusionsolutionexceeded77°Frangedfromsixto20hours.Examinationoftheactivitydiariesshowed
volunteersspentmostoftheirtimeindoors,inanairconditionedenvironment.Spikesinambienttemperatureoccurredwhen
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 volunteerswentoutsideduringtheday,travelledinacar,ormovedtoaroomwithoutairconditioning.Theinfusers
surroundedbyicepacksusuallymaintainedasolutiontemperaturebelow68°Fwhenincubatedat77°F,whileinfusers
incubatedat90°Fmaintainedasolutiontemperaturegreaterthan68°Fforuptoelevenhours.
DISCUSSION:Infusionsolutionsadministeredovera24‐hourperiodinthehomecanreachtemperaturesabove86°Fduring
autumninSouthAustralia,particularlywhenpatientsareexposedtoenvironmentswithoutairconditioning.Icepacksare
commonlyrecommendedtokeepinfusionsolutionscoolduringa24‐hourcontinuousinfusioninthehome;however,
cliniciansstillneedtoconsiderwhetherstabilitywillbemaintainedwhenicepacksareused,astemperaturesofupto77°F
wereobservedwhenicepackswerechangedthreetimesaday.
CONCLUSION:Thehighambientandinfusionsolutiontemperaturesobservedinthisstudyhighlighttheneedtofurther
exploredrugstabilityathightemperaturesformedicinesadministeredbycontinuousinfusioninthehome,anddetermine
whetherexposuretohightemperatureshasanegativeimpactontherapeuticoutcomes.Intheabsenceofthisinformation,
cliniciansneedtocarefullyconsiderlocalconditionswhenassessingpatientsuitabilityforcontinuousinfusionsinthehome.
FINALABSTRACT#26
TITLE:DemonstratingtheNeedforAdjustableFlowRateControlwithMechanicalPumpsduringSCIgInfusion
Therapy
AUTHORS:NealdeBeer,PhD;JoeBarbrie;CarlosGutierrez;PaulLambert,MBA.EMEDTechnologiesCorporation
BACKGROUND:Studiesofprimaryimmunodeficiency(PID)patientstreatedwithsubcutaneousimmuneglobulin(SCIG)
revealadvantagesovertheintravenousinfusion(IVIG)route,including:patientabilitytoself‐administerSCIG;lowriskof
systemicadversereactions;andincreasedcosteffectivenessofthehomesiteofcare.Severalchallengeshavealsobeen
identified,includingmanagementoflocalinfusionreactions,anddifficultyinachievingthedesiredinfusiondurationwhen
usingmechanicalpumpswithfixedratecontrol(FRC)sets.MatchingtheFRCsettoeachpatient’sprescriptionanddesired
infusiondurationoftenrequireshomeinfusionproviderstocarryawiderangeofFRCsetsizes,whichhasinventorycostand
controlimplications.PrimingFRCsetscanalsobedifficultforpatientsduetothenarrowtubingdiameteranddrugviscosity.
Anadjustableflowregulatorcouldprovideacost‐effectivealternativetoFRCsetsforproviders,whilefacilitatingpatient
controloftheinfusiondurationandprimingprocess.
PURPOSE:Thisstudysoughttodemonstratethefunctionalityofanadjustableflowregulatordevicewhenusedin
combinationwithmechanicalpumpsinthelab,comparingitsperformancetoFRCsetsintermsofflowratesandforce
requiredtoprime.
METHODS:ViscosityanddensityofvariousIgproductswereanalyzedatdifferenttemperaturestocreatesimulantfluidsfor
benchflowratetesting,usingtheVersaRate®adjustableflowregulatorandvariousFRCsets.SCIg60Infuser(EMED
Technologies)andFreedom60(RMSMedicalProducts)mechanicalpumpsweretestedusingboththeadjustableandFRCsets
(whichareFDAclearedforthisuse).Forcerequiredtoprimea24gaugebifurcatedneedlesetincombinationwithtwo
comparableFRCsandtheadjustableratesetwasanalyzedusingahandheldforcegauge.
RESULTS:Igproductviscositiesrangedfrom12.5cPat25°C(77°F)to15.5cPat20°C(68°F).Flowratetestsusingthe
adjustableflowregulatoratdifferentpositionsettingsprovidedrepeatableresultsrangingfrom7ml/hr(single24ganeedle
set,position1)upto220ml/hr(6‐site24ganeedleset,position6).Incomparison,atleast6differentFRCsetswereneededto
achievethesamerangeofflowrates.Primingforceresultsshoweda76.5%reductioninforcerequiredwhenusingthe
adjustableflowratesetatposition6(4lb)comparedtousingfixedratesets(17lb).
DISCUSSION:Variationsobservedindrugviscositiesindicateadependencyontemperaturewithapotentialimpactonflow
rates.Ifviscosityincreasesduringtherapyorfromonetreatmenttothenext,mechanicalpumpsusingFRCsetsareunableto
increasepressuretomaintainapresetflowrate,whichcanleadtolongerinfusiontimes.Avariableflowregulatorcouldbe
adjustedduringtherapyifnecessarytoachieveexpectedinfusiontimes.
Therangeofflowratescouldalsoallowforasignificantreductioninproductinventorywhichwouldpositivelyimpact
providers.
CONCLUSION:Thisstudydemonstratedthatvariableflowregulatorsusedincombinationwithmechanicalpumpsare
capableofprovidingaconsistentrangeofflowrates,performingthefunctionofatleastsixFRCsets,andneedingthreetimes
lessforcetoprimetheinfusionsetup.
The2016NHIAIdeaExchangePosterSessionwithAbstractsMarch21‐23,2016 FINALABSTRACT#27
Title:ARuralHomeInfusionProvider’sExperiencesUsingSmartInfusionPumpTechnology
Authors:JulieLyon,RN1;DaveGrady1;HeatherPeacock,PharmD1;PeterKratz,MS2;LauraSeiberlich,MS2
1BigSkyIVCare,2SmithsMedical,ASD,Inc.
Background: Recent data has been published describing the advantages of smart pump technology (SPT) for large home
infusionproviders.Withfewerpatientsinaruralsetting,questionsremainabouttheamountofworkandvaluethetechnology
bringstosmallerhomeinfusionproviders(HIP).Patientsservicedbythisprovidercovera200mileradius,andtheabilityto
haveadevicethatiswell‐acceptedbypatients,withthepotentialtodecreasehomecarevisits,wouldimprovetheefficiencyof
anHIP’soperations.
Purpose:ThepurposeofthisstudywastodetermineifSPTisafeasiblealternativetopreviousambulatoryinfusionpump
technologyinaruralHIPsetting
Methods:FollowingIRBapproval,theproviderwastrainedonanewambulatorysmartpumpandmedicationsafetysoftware
(MSS) (CADD®‐Solis VIP, Smiths Medical, St. Paul, MN). Clinicians documented all training, and time spent creating and
validating the drug library. The staff performed 10 scenarios simulating pump programming using the final library and
answered 10 assessment questionnaires. Eligible patients included those requiring an infusion pump from Jan‐Oct 2015.
Patientconsentwasobtained,followedbytraining,thenpatientsrecordedpumpinteractiondetailsfor5‐7daysaftertheir
infusionbegan.Atelephonesurveyassessingpatientsatisfactionwiththepumpwasconducted7‐10daysafterstartofcare.
Librarycreationeffortswerereviewedandsummarized.Descriptivestatisticswereusedtosummarizepumpprogramming
andpatientsatisfactiondata.
Results:Aftermanufacturertraining,providerstaff(onepharmacistandtwonurses)spentatotalof7hourscreatingafully
validateddruglibrarycontaining16ofthemostcommonlyadministeredprotocols.Fortheprogrammingevaluation,clinicians
agreedthepumpwaseasytoprogram(29/30,96.7%)andfeltcomfortablewithprogrammingafteranaverageof7.67times.
Ninepatientswereenrolledinthestudy,providingdatafrom59pumpusedays.Infusionsweretotalparenteralnutrition(4)
orContinuous(Ancef4,5FU1).Patientsreportedtheywere100%satisfied/verysatisfiedwiththepumponall59pumpuse
daysandsatisfiedoverallaftercompletingthestudy.Patientsexperiencedatotalof53alarms[lowreservoir(17),lowbattery
(1),andinfusioncomplete(35)].52ofthe53alarmswereresolvedwithoutcontactingtheHIP.Easeofresolvingwasratedin
41instancesasveryeasy(33),easy(7),orsomewhatdifficult(1).
Discussion: Staff effort required to create a drug library and establish safety parameters was minimal, and the pump
programmingexercisewasbeneficialtoestablishfamiliaritybeforeusingonpatients.Patientsbothnewandexperiencedwith
homeinfusionwereabletoindependentlyusethenewpumpwithminimalcallstotheHIP.Easytofollowhelpscreensonthe
pumpallowedagreaterlevelofindependence.Patientsreportedtheydidnotwanttogobacktousingthepumptheyhadused
previously.
Conclusion:SmartambulatoryinfusionpumptechnologycanbesuccessfullyimplementedintooperationsofaruralHIPand
caneffectivelybeusedbypatientstoahighlevelofsatisfaction.Thesedataprovideconfidencethatsmartpumpsarea
feasiblealternativeforaruralHIPwithwideservicearea.