Final Program - Canadian Society of Hospital Pharmacists
46 Commemorative Issue PPC•CPP ANNUAL PROFESSIONAL PRACTICE CONFERENCE January 31 - February 4, 2015 CONFÉRENCE ANNUELLE SUR LA PRATIQUE PROFESSIONNELLE 31 janvier - 4 février 2015 FINAL PROGRAM PROGRAMME FINAL The Sheraton Centre Toronto Hotel 123 Queen Street West Toronto, ON Numéro commémoratif CSHP SCPH EXCELLENCE IN PHARMACY PRACTICE EXCELLENCE EN PRATIQUE PHARMACEUTIQUE Thank You •Merci bien FOR PAVING THE WAY • D’OUVRIR LA VOIE Along the bottom of every page of this program is a list of the 200 pharmacy departments who committed to CSHP 2015 by: •Making CSHP 2015 part of their pharmacy’s strategic plan •Encouraging and supporting their pharmacists to improve the effective, evidence-based and safe use of medications through CSHP 2015 •Sharing success stories related to the implementation of CSHP 2015 objectives •Promoting the pharmacist in quality patient care 2 GOALS BUTS 1 1 2 2 Increase the extent to which pharmacists help individual hospital inpatients achieve the best use of medications Increase the extent to which pharmacists help individual non-hospitalized patients achieve the best use of medications 3 Increase the extent to which hospital and related healthcare setting pharmacists actively apply evidence-based methods to the improvement of medication therapy 4 Increase the extent to which pharmacy departments in hospitals and related healthcare settings have a significant role in improving the safety of medication use 5 Increase the extent to which hospitals and related healthcare settings apply technology effectively to improve the safety of medication use 6 Increase the extent to which pharmacy departments in hospitals and related healthcare settings engage in public health initiatives on behalf of their communities Accroître le degré d’intervention des pharmaciens auprès de chaque patient hospitalisé afin d’assurer l’utilisation optimale des médicaments Accroître le degré d’intervention des pharmaciens auprès de la clientèle non hospitalisée afin d’assurer une utilisation optimale des médicaments 3 Étendre l’application du principe des décisions fondées sur les preuves à la pratique clinique quotidienne des pharmaciens des établissements de santé dans le but d’améliorer la pharmacothérapie 4 Accroître le rôle joué par les départements de pharmacie des établissements de santé dans l’amélioration de l’utilisation sécuritaire des médicaments 5 Étendre l’application efficace des technologies dans les départements de pharmacie des établissements de santé pour améliorer l’utilisation sécuritaire des médicaments 6 Accroître le degré d’intervention des départements de pharmacie des établissements de santé dans la mise en oeuvre d’initiatives de santé publique ALBERTA: • AHS – Clinical, Education, Operations Mgrs • AHS Central, Calgary & Edmonton of the objectives now align with Accreditation Canada’s 2013 medication management standards We’ve seen the number of pharmacy residency program positions increase by: from 72 in 2007 to over 100 in 50% of the targets were reached or within reach! CSHP SCPH EXCELLENCE IN PHARMACY PRACTICE EXCELLENCE EN PRATIQUE PHARMACEUTIQUE Thank you to our sponsors: FAMILY OF CONSUMER COMPANIES Branches caring for life The final CSHP 2015 progress update as part of the Hospital Pharmacy in Canada 2013/14 Report will be released in the spring of 2015 and will be available at www.lillyhospitalsurvey.ca Zones • Alberta Children’s Hospital • Alberta Hospital • Bentley Care Centre • Centennial 3 Dear Colleague, On behalf of the Officers, Board and staff of the Canadian Society of Hospital Pharmacists (CSHP), it is our pleasure to welcome you to CSHP’s 46th Annual Professional Practice Conference. Over the last 10 months, CSHP’s Educational Services Committee has worked hard to assemble an impressive faculty of pharmacy specialists and develop a program of exceptional educational value with topics covering a wide range of specialties, management issues and pharmacy practice-related challenges. This conference is designed to maximize your opportunities for professional development, networking and socializing with practitioners from across the country. It is our hope that you are able to take full advantage of the 2015 offerings – and enjoy yourself in the process. This year marks the culmination of the CSHP 2015 initiative – Targeting Excellence in Pharmacy Practice. This conference will celebrate the work done to date and will examine if this initiative has made a difference to pharmacy practice in Canada. At any time throughout the conference, the Officers and staff of CSHP are available to you. Please let us know if we can answer any of your questions, address any of your concerns or be of assistance in any way. We look forward to welcoming each of you to another spectacular conference. Thank you for your ongoing support of CSHP! Bruce Millin BSc(Pharm), ACPR CSHP President 4 Myrella Roy BScPhm, PharmD, FCCP Executive Director Centre for Mental Health and Brain Injury • Consort Hospital and Care Centre • Drayton Chères (Chers) collègues, Au nom de la Direction, du Conseil et du personnel de la Société canadienne des pharmaciens d’hôpitaux (SCPH), nous avons le plaisir de vous souhaiter la bienvenue à la 46e Conférence annuelle sur la pratique professionnelle de la SCPH. Au cours des dix derniers mois, le comité des services éducatifs de la SCPH s’est affairé à rassembler un groupe impressionnant de conférenciers spécialisés en pharmacie et à vous préparer un programme d’une valeur éducative exceptionnelle avec des sujets touchant un large éventail de spécialités, de questions relatives à la gestion et de défis posés à la pratique pharmaceutique. Ce congrès est destiné à maximiser les possibilités de perfectionnement professionnel, de réseautage et de rencontre avec d’autres praticiens de toutes les régions du pays. Nous espérons que vous pourrez tirer pleinement profit de ce que nous vous offrons en 2015 – tout en vous divertissant. Cette année marque le point culminant du projet SCPH 2015 – Point de mire sur l’excellence en pratique pharmaceutique. Ce congrès célèbrera le travail accompli à ce jour et permettra de voir si ce projet aura réussi à changer la pratique de la pharmacie au Canada. Nous vous rappelons qu’au cours du congrès, la Direction et le personnel de la SCPH seront à votre entière disposition. Nous ferons tout en notre pouvoir pour répondre à vos questions, discuter des sujets qui vous préoccupent et vous aider au besoin de quelques manières que ce soit. Nous sommes impatients de vous accueillir à cet autre congrès exceptionnel et vous remercions de votre appui soutenu à la SCPH. Bruce Millin B. Sc. (Pharm.), ACPR Président de la SCPH Myrella Roy B. Sc. Phm., Pharm. D., FCCP Directrice générale Valley Hospital and Care Centre • Drumheller Health Centre • Edmonton General Continuing 5 Table of Contents Table des matières CSHP Board and Staff Conseil SCPH et personnel Executive Committee Bureau de direction 6 Branch, A.P.E.S. and Student Delegates Délégués des sections et de l’A.P.E.S., et déléguée étudiante 7 CSHP Staff Personnel de la SCPH 7 With Thanks Remerciements CSHP Sponsors 2014 Commanditaires de la SCPH en 2014 CSHP Industry Corporate Supporters Entreprises partisanes du secteur de l’industrie 10 CSHP Hospital Corporate Supporters Entreprises partisanes du secteur hospitalier 10 CSHP 2015 Initiative Acknowledgements Remerciements à l’égard du projet SCPH 2015 70 Conference Information Information sur la conférence Upcoming Events Événements à venir 11 Satellite Symposiums Symposiums satellites 11 CSHP Educational Services Committee Comité des services éducatifs 12 9 ProgramProgramme Program of Events Programme des événements 13 Speakers Abstracts Résumés des conférenciers 20 SES 2015 Call for Abstracts Demande de résumés pour les SÉÉ 2015 40 Oral Presentations Présentations orales 43 Poster Abstracts Résumés des affiches 44 Poster Abstract Reviewers Réviseurs des présentations par affiches 65 Faculty Conférenciers66 Exhibitor List Liste des exposants 68 Executive Committee Bureau de direction President Président Past President Présidente sortante President Elect Président désigné Treasurer Trésorière Bruce Millin Fraser Health Authority Langley, BC Glen Pearson Mazankowski Alberta Heart Institute Edmonton, AB 6 Patricia Macgregor The Hospital for Sick Children Toronto, ON Executive Director Directrice générale Myrella Roy Canadian Society of Hospital Pharmacists Société canadienne des pharmaciens d’hôpitaux Ottawa, ON Deborah Emery Thunder Bay Regional Health Sciences Centre Thunder Bay, ON Care Centre • Foothills Medical Centre • Fort Saskatchewan Health Centre • Grey Nuns Branch, A.P.E.S. and Student Delegates Délégués des sections et de l’A.P.E.S., et déléguée étudiante British Columbia Colombie-Britannique Shirin Abadi BC Cancer Agency Vancouver, BC Alberta Tania Mysak University of Alberta Hospital Edmonton, AB Saskatchewan Zack Dumont Regina Qu’Appelle Health Region Regina, SK Manitoba Pat Trozzo CancerCare Manitoba Winnipeg, MB Ontario – Senior/Principal Mario Bédard The Ottawa Hospital Ottawa, ON Ontario – Junior/Débutante Christina Adams North West Telepharmacy Solutions Pembroke, ON A.P.E.S / Québec Diem Vo Hôpital Pierre-Boucher Longueuil, QC New Brunswick Nouveau-Brunswick Pamela Yafai Saint John Regional Hospital Saint John, NB Nova Scotia Nouvelle-Écosse Kim Abbass Cape Breton Regional Hospital Sydney, NS Prince Edward Island Île-du-Prince-Édouard Amy Carpenter Kings County Memorial Hospital Montague, PE Newfoundland and Labrador Terre-Neuve-et-Labrador Justin Peddle Memorial University St. John’s, NL Student Étudiante Jaskiran Otal University of Waterloo Waterloo, ON CSHP Staff Personnel de la SCPH Executive Director Directrice générale Myrella Roy Operations Manager (on leave) Gérante des opérations (en congé) Laurie Frid Interim Operations Manager Gérante des operations par intérim Desarae Davidson Coordinator, Professional & Membership Affairs Coordonnatrice, Affaires professionnelles et service aux membres Cathy Lyder Executive Assistant Adjointe de direction Rosemary Pantalone Interim Conference & PSN Administrator Agente par intérim des congrès et des RSP Membership & Awards Administrator Agente du service aux membres et des prix Robyn Rockwell CPRB Administrator Agente du CCRP Gloria Day Finance Administrator Agente des finances Anna Dudek Publications Administrator Agente des publications Suzanne Purkis Office Administrator (CSHP 2015 & Fellows [FCSHP] Recognition Committee) Agente de bureau (SCPH 2015 et Comité de reconnaissance des associés [FCSHP]) Pamela Saunders CSHP 2015 Project Coordinator Coordonnatrice du projet SCPH 2015 Carolyn Bornstein CSHP Foundation Administrator Agente de la Fondation de la SCPH Janet Lett Web Administrator Agente du Web Olga Chrzanowska Ontario Branch & Advocacy Executive Assistant Adjointe de direction de la section de l’Ontario et de la valorisation Anne Stacey Susan Maslin Community Hospital • Hanna Health Centre • Innisfail Health Centre • Leduc Community 7 sponsorship The Canadian Society of Hospital Pharmacists (CSHP) is the national voluntary organization of pharmacists committed to patient care through the advancement of safe, effective medication use in hospitals and other collaborative health care settings. Founded in 1947, CSHP is a member-driven association which operates at several levels: national, provincial branches, local chapters, committees, and task forces. CSHP is thriving and now supports 3400 adherent (members and supporters) through: •Advocacy •Education: Professional Practice Conference, Banff Seminar, Summer Educational Sessions, and numerous branch and chapter educational sessions •Information Sharing: Publication of the Canadian Journal of Hospital Pharmacy, Discussion Forums through the Pharmacy Specialty Networks •Development of Guidelines for Best Practices •Facilitation of Research: Grants through the Research and Education Foundation •Recognition of Excellence: Awards Program and Fellows Program •CSHP 2015: A quality program proposing 36 objectives to achieve a vision of pharmacy practice excellence in the year 2015 together we make a difference 8 Hospital • Mazankowski Alberta Heart Institute • Misericordia Community Hospital • Olds CSHP Sponsors 2014 The following list reflects all sponsorship received from January 1 to December 31, 2014. Commanditaires de la SCPH en 2014 La liste suivante reflète toutes les commandites reçues du premier janvier au 31 décembre 2014. Diamond Sponsor Commanditaires diamant $80,000 or greater 80 000 $ et plus Platinum Sponsor Commanditaires platine $60,000 - $79,999 Gold Sponsor Commanditaires or $40,000 - $59,999 • AstraZeneca Canada Ltd. • Sandoz Canada Inc. Silver Sponsor Commanditaires argent $20,000 - $39,999 • Apotex Inc. • Eli Lilly Canada Inc. • Hospira Healthcare Corporation • Mylan Canada • Sanofi Canada caring for life • Teva Canada Limited Bronze Sponsor Commanditaires bronze $10,000 - $19,999 • Alveda Pharmaceuticals Inc. • Astellas Pharma Canada • Bayer Inc. • Canadian Patient Safety Institute • LEO Pharma Inc. • Omega Laboratories Limited • Pharmascience Inc. • SteriMax Inc. • Sunovion Pharmaceuticals Inc. Donor Sponsor Commanditaires donateurs $1000 - $9,999 • Abbott Laboratories Inc. • AbbVie Corporation • Accord Healthcare Inc. • AirClean Systems Canada • AmerisourceBergen • Amgen Canada Inc. • Association of Allied Health Professionals • AutoMed Technologies Inc. • B.Braun Medical Inc. • Baxter Corporation (Canada) • BCE Pharma Inc. • BD Medical • BioSyent Pharma Inc. • BMS Pfizer Alliance • Boehringer-Ingelheim Canada Ltd. • Calea • Canadian Agency for Drugs and Technologies in Health • Canadian Forces • Canadian Institute for Health Information • Canadian Pharmaceutical Distribution Network • College of Pharmacists of British Columbia • Cubist Pharmaceuticals • Galenova • Global Medical Products • Healthmark Services Ltd. • HealthPRO • Hoffman La Roche Limited • Janssen-Ortho • Johnson & Johnson • Kit Check • Lexicomp Inc. • Lundbeck Canada Inc. • McKesson Canada Corporation • MDA Inc. • Medbuy • Medisca Corporation • Merck Canada Inc. • Memorial University School of Pharmacy • Newfoundland and Labrador Centre for Health Information • North West Telepharmacy Solutions • Novartis Pharma Canada • Novo Nordisk Canada Inc. • Omnicell • Ontario College of Pharmacists • Otsuka Pharmaceutical Inc. • PCCA Canada • Pendopharm, A Divison of Pharmascience Inc. • Pharmacists Association of Newfoundland and Labrador • QleanAir Scandinavia • RxFiles Academic Detailing Program • Scotiabank • Servier Canada Inc. • Sphynx Medical Inc. • Sunovion Pharmaceuticals Inc. • Swisslog Healthcare Solutions • Takeda • Truven Health Analytics • University of Florida Working Professional Doctor of Pharmacy Program • University of Toronto • Valeant Canada • Wolters Kluwer Clinical Drug Information Hospital and Care Centre • Peter Lougheed Centre • Ponoka Hospital and Care Centre • 9 2014-2015 CSHP Industry Corporate Supporters 2014-2015 CSHP Hospital Corporate Supporters This list recognizes our Industry Corporate Supporters for the year July 1, 2014 - June 30, 2015 (At time of printing) This list recognizes our Hospital Corporate Supporters for the year July 1, 2014 - June 30, 2015 (At time of printing) 2014-2015 Entreprises partisanes du secteur de l’industrie 2014-2015 Entreprises partisanes du secteur hospitalier La liste suivante reconnaît nos entreprises partisanes du secteur de l’industrie au cours de l’année d’adhésion du premier juillet 2014 au 30 juin 2015 (au moment de l’impression) La liste suivante reconnaît nos entreprises partisanes du secteur hospitalier au cours de l’année d’adhésion du premier juillet 2014 au 30 juin 2015 (au moment de l’impression) • Accord Healthcare Inc. • Horizon Health Network • Alveda Pharmaceuticals Inc. • London Health Sciences Centre • Baxter Corporation (Canada) • Lower Mainland Pharmacy Services • Bayer Inc. • Northern Health Authority • BCE Pharma Inc. • North West Telepharmacy Solutions • Eli Lilly Canada Inc. • University Health Network • Fresenius Kabi Canada Ltd. • Galenova Inc. • Healthmark Services Ltd. • Hospira Healthcare Corporation • Johnson & Johnson Inc. • MDA Inc. • Mylan Canada • Omega Laboratories Ltd. • Pendopharm, a Division of Pharmascience Inc. • Pharmascience Inc. • Sandoz Canada Inc. • Servier Canada Inc. • SteriMax Inc. • TEVA Canada Limited • Valeant Canada 10 Redwater Health Centre • Rimbey Hospital and Care Centre • Rocky Mountain House Health Upcoming Events Événements à venir Professional Practice Conference (PPC): Summer Educational Sessions (SES): January 30-February 3, 2016 Sheraton Centre Toronto Hotel Toronto, ON Join us as we retire the SES program in 2015. Please note the date as it is a week later than usual. February 4-8, 2017 InterContinental Toronto Centre Toronto, ON August 15-18, 2015 Westin Hotel Ottawa, Ontario Satellite Symposiums Symposiums satellites CSHP would like to thank the following sponsors of Satellite Symposiums for their participation in conjunction with the PPC 2015. Sunday, February 1 Attendance at CSHP conferences, PPC and SES, are approximately 500 and 150 respectively, excluding exhibitors. Please note we offer an exhibit program at both events. For further information, please contact Susan Maslin, Interim Conference & PSN Administrator. Tel.: (613) 736-9733, ext. 229 Fax: (613) 736-5660 Email: [email protected] Satellite Symposium SPONSORSHIP OPPORTUNITY 12:00-13:30 • Bayer Inc. Monday, February 2 68th Summer Educational Sessions 17:30-19:30 • The France Foundation •M cKesson Canada Corporation The Westin Ottawa Ottawa, ON Aug 15-18, 2015 Tuesday, February 3 Breakfast and Luncheon Opportunities 17:30-19:30 • Canadian Cardiovascular Pharmacists Network • Hospira Healthcare Corporation See the program section for more details. For more information please contact Susan Maslin Interim Conference and PSN Administrator (613) 736-9733, ext 229 or [email protected] Centre • Rockyview General Hospital • Royal Alexandra Hospital • St. Mary’s Hospital 11 The Educational Services Committee Le comité des services éducatifs Chairperson Président Clarence Chant, PharmD, FCSHP, FCCP St. Michael’s Hospital Toronto, ON Staff Liaison Employée de liaison Susan Maslin Members Membres Margaret Ackman, PharmD, FCSHP Alberta Health Services Edmonton, AB Bernadette Almeida, RPh, BScPhm, ACPR Trillium Health Partners Toronto, ON Jessica Beach, BScPharm Interior Health Practice Resident Kelowna, BC Roxane Carr, PharmD, BCPS, FCSHP BC Children’s and Women’s Health Centre Vancouver, BC Lorie Carter, BSc(Pharm) Eastern Health Marystown, NL Elaine Chong, PharmD, BCPS BC Ministry of Health Services New Westminster, BC Judy Chong, BScPhm Ontario College of Pharmacists Toronto, ON Leah Edmonds, BScPhm QEII Health Sciences Centre Halifax, NS Alfred Gin, PharmD, FCSHP Health Sciences Centre Winnipeg, MB Derek Jorgenson, BSP, PharmD, FCSHP University of Saskatchewan Saskatoon, SK Sharan Lail, BScPhm, ACPR St. Michael’s Hospital Toronto, ON Kat Timberlake, PharmD The Hospital for Sick Children Toronto, ON The Educational Services Committee (ESC) of CSHP has been working for approximately 10 months on the content and format of PPC 2015. The committee also plans the Summer Educational Sessions, in conjunction with the local host task force and the national office. The ESC is comprised of a core committee of 15 CSHP members as well as corresponding members from the CSHP branches. Goal and Objectives for the 2015 PPC Program Goal: •To provide registrants with quality educational sessions. Objectives: •To provide educational sessions which inform, educate and motivate clinical practitioners and managers. •To provide leadership in hospital pharmacy practice by presenting sessions on innovative pharmacists’ roles, pharmacy practice and pharmacy programs. •To promote life-long learning skills through active participation in problembased workshops. •To provide registrants with networking and sharing opportunities through the exhibits program and poster sessions. •To promote excellence in pharmacy practice research through oral and poster presentations of original work and award-winning projects. •To provide an opportunity for Pharmacy Specialty Networks to meet and share their expertise with others. EP C.C.C.E.P Canadian Council on Continuing Education in Pharmacy Le comité des services éducatifs travaille depuis près de 10 mois à l’élaboration du contenu et de la forme de la CPP 2015. Le comité prépare aussi les Séances éducatives d’été de la SCPH en collaboration avec le groupe de travail hôte local et le personnel de la SCPH. Le comité comprend 15 membres principaux et membres correspondants des sections de la SCPH. But et objectifs du programme de la CPP 2015 But : •Présenter des conférences éducatives de qualité aux participants. Objectifs : •Présenter aux personnes inscrites des conférences éducatives susceptibles d’informer, d’instruire et de motiver les cliniciens et les gestionnaires. •Orienter la pratique de la pharmacie hospitalière en présentant des conférences sur les nouveautés touchant le rôle du pharmacien, la pratique de la pharmacie et les programmes de pharmacie. •Développer des habiletés pour un apprentissage continu par une participation active à des ateliers de formation axés sur la résolution de problèmes. •Donner aux participants des occasions de réseautage et d’échanges grâce au salon des exposants, aux séances d’affichage et aux discussions interactives structurées. •Promouvoir l’excellence dans la recherche en pratique pharmaceutique par des présentations orales et des séances d’affichage sur des travaux originaux et des projets primés. •Donner l’occasion aux réseaux de spécialistes en pharmacie de se réunir et de partager leur savoir-faire. Erica Wang, BScPhm, PharmD Kelowna General Hospital Kelowna, BC 12 • Stettler Hospital and Care Centre • Stollery Children’s Hospital • Sturgeon Community Program Programme Saturday, January 31 Samedi 31 janvier 12:00-17:00Registration Inscription CONCOURSE COAT CHECK 12:00-14:00 Ontario Hospital Pharmacy Residency Program Information Session (Cycle 2016-2017) CIVIC BALLROOM 17:00-19:00 Career Opportunities Evening Soirée de perspectives d’emploi DOMINION BALLROOM Sponsored by Pfizer Canada Inc. Luncheon included Symposium satellite Dîner inclus 08:30-17:00Registration Inscription CONCOURSE COAT CHECK DOMINION BALLROOM New Oral Anticoagulants: Real Life Application Bill Semchuk, MSc, PharmD, FCSHP Regina Qu’Appelle Health Region Regina, SK Benjamin Bell, MD FRCPC North York General Hospital North York, ON Anil Chopra, MD, FRCPC University Health Network Toronto, ON Sponsored by Bayer Inc. 13:45–14:30 Concurrent Sessions Séances concomitantes Sunday, February 1 Dimanche 1er février CITY HALL AND CHURCHILL 12:00-13:30 Satellite Symposium CONCOURSE LEVEL 19:00-21:00 CSHP 2015 Celebration and Opening Reception Everyone welcome Célébration du projet SCPH 2015 et réception d’ouverture Bienvenue a tous Discussions sur des projets de recherche originale, des projets primés et des projets dans le domaine de la pratique pharmaceutique BIRCHWOOD BALLROOM 15:00-17:00 CPRB Residency Networking Reception Réception de réseautage relative à la résidence du CCRP Séance animée de présentations par affiches 1. Clinical Renal Drug Dosing: Is Cockcroft-Gault Dead? BIRCHWOOD BALLROOM Marisa Battistella, BScPhm, PharmD University of Toronto Toronto, ON 09:00-09:15 Opening Remarks Remarques préliminaires DOMINION BALLROOM 09:15-10:15 CPSI Patient Safety Lecture Conférence de l’ICSP sur la sécurité des patients DOMINION BALLROOM After the Error: Failure to Success Dr. Brian Goldman, MD, MCFP(EM), FACEP Mount Sinai Hospital Toronto, ON Sponsored by the Canadian Patient Safety Institute 10:30-12:00 Facilitated Poster Session Discussions of original research, award winning projects and pharmacy practice projects Hospital • Sundre Hospital and Care Centre • Three Hills Health Centre • University of 13 2. Drug-Induced Sexual Dysfunction The ASP of “ASP”iration Pneumonia: A Stewardly Approach to the Diagnosis and Treatment of Aspiration Pneumonia CHESTNUT Luis Viana, BScPhm, MEd, PharmD, ACPR, CGP University of Waterloo Waterloo, ON 3. Knowledge Translation Research Primer for Pharmacists: A Practical Approach Monika Kastner, PhD St. Michael’s Hospital Toronto, ON PINE Creating a Culture of Recognition Sean Spina, BSc(Pharm), ACPR, PharmD Sherry Lalli, BSc(Pharm), ACPR Vancouver Island Health Authority Victoria, BC 4. The Hospital Pharmacist: Back to the Future PINE Bill Wilson, RPh, BSP, FCSHP Mount Sinai Hospital Toronto, ON 14:45-16:45 Workshops & PSN Sessions Ateliers et séances des RSP 3.Workshop Atelier MAPLE Kevin Duplisea, BScPharm, PharmD, ACPR University Health Network Toronto, ON 1. Geriatrics PSN RSP en gériatrie 4.Workshop Atelier MAPLE From Rags to Riches: How to Turn Residency Research Projects into Publications Sheri Koshman, BScPharm, PharmD, ACPR University of Alberta Edmonton, AB Winnie Seto, BScPhm, PharmD, MSc, ACPR, RPh The Hospital for Sick Children Toronto, ON CHESTNUT Guidance on Guidelines: Applying the New Hypertension and Diabetes Guidelines to the Oldest Old Cheryl Sadowski, BSc(Pharm), PharmD, FCSHP University of Alberta Edmonton, AB 17:00-19:00 Awards Ceremony Saurabh Patel, BScPharm Orillia Soldiers’ Memorial Hospital Orillia, ON 2. Internal Medicine PSN RSP en médecine interne Bienvenue à tous Medication-Related Emergency Room Admissions in the Elderly BIRCHWOOD BALLROOM Everyone welcome Cérémonie de remise des prix Overview of Inhalers for Chronic Obstructive Pulmonary Disease: Hospital Formulary Considerations Lawrence Jackson, BScPhm Sunnybrook Health Sciences Centre Toronto, ON Rosa Maria Tanzini, BScPharm St. Michael’s Hospital Toronto, ON Sponsored by Hospira Healthcare Corporation Monday, February 2 Lundi 2 février 07:30-17:00Registration Inscription CONCOURSE COAT CHECK 08:15-08:30Announcements Annonces DOMINION BALLROOM 08:30-09:30 Plenary Session Séance plénière Has CSHP 2015 Really Made a Difference? Did We Hit the Target? 14 DOMINION BALLROOM DOMINION BALLROOM Neil MacKinnon, BSc(Pharm), MSc(Pharm), PhD University of Cincinnati Cincinnati, OH Alberta Hospital • Villa Caritas • Westview Health Centre BRITISH COLUMBIA: • Burnaby Olavo Fernandes, BScPhm, ACPR, PharmD, FCSHP University Health Network Toronto, ON a.Assessing the Impact of an Expanded Moderator: Carolyn Bornstein, BScPhm, ACPR, FCSHP, CGP Southlake Regional Health Centre Newmarket, ON Soomi Hwang, BSc(Pharm), RPh 09:45-10:15 Break, Exhibits Pause, Kiosques SHERATON/OSGOODE HALLS 10:20-11:30 Panel Discussion Panel DOMINION BALLROOM PharmD 2.0: What Does the New PostProfessional PharmD Mean for Me? Scope of Practice for Pharmacists at a Community Hospital Surrey Memorial Hospital Surrey, BC Donna Woloschuk, PharmD, MEd, FCSHP Winnipeg Regional Health Authority Winnipeg, MB Jill Hall, BScPharm, ACPR, PharmD University of Alberta Edmonton, AB Neil MacKinnon, BSc(Pharm), MSc(Pharm), PhD University of Cincinnati Cincinnati, OH Tom Brown, PharmD Women’s College Hospital Toronto, ON Moderator: Margaret Ackman, BSc(Pharm), PharmD, FCSHP Alberta Health Services Edmonton, AB 11:40-12:25 Concurrent Sessions Séances concomitantes 1. Clinical Trials in Internal Medicine That Will Change Your Practice DOMINION BALLROOM Sharan Lail, BScPhm, ACPR St. Michael’s Hospital Toronto, ON c.Optimized Dosing of Cefazolin in Patients on Nocturnal Home Hemodialysis b. Quality Improvement of Non-Sterile Compounding in Winnipeg Regional Health Authority Pharmacies Marisa Battistella, BScPhm, PharmD University Health Network Toronto, ON 3. The Management of Traumatic Brain Injury BIRCHWOOD BALLROOM Paola Saccucci, BSc(Hons), RPh, PharmD St. Michael’s Hospital Toronto, ON 4. Business Plan Preparation for Pharmacists: How to Get Your Ideas Noticed CHESTNUT Amanda Goodwin, BSP, RPh, MBA University of Toronto Toronto, ON 12:30-13:50 Lunch, Exhibits, Posters Dîner, Kiosques, Affiches SHERATON/OSGOODE HALLS 14:00-15:00 Changes to Interim Federal Health, the Effects on Refugees and the Health Care Community Response DOMINION BALLRO OM 2. Oral Abstract Session Intriguing Papers from Original Research, Award Winners and Research and Education Grants Séance d’exposés oraux Communications fascinantes choisies parmi les travaux de recherche originale et les projets des récipiendaires de prix, de bourses de recherche et de perfectionnement MAPLE Hospital • Children’s & Women’s Hospital • Delta Hospital • Eagle Ridge Hospital • GF 15 Doug Gruner, MD, CCFP, FCFP University of Ottawa Ottawa, ON 15:10-17:10 Workshops & PSN Sessions Ateliers et séances des RSP 1. Global Health PSN RSP en santé mondiale CHESTNUT Development of International Advanced Pharmacy Practice Experiences for Student Pharmacists: The Purdue University Experience in Global Health in Kenya and Nuclear Pharmacy in England James E. Tisdale, PharmD, BCPS, FCCP, FAPhA, FAHA Purdue University Indianapolis, ID Pain Management in Developing Countries Doret Cheng, BScPharm, PharmD University of Toronto Toronto, ON 2. Surgery PSN RSP en chirurgie BIRCHWOOD BALLROOM Implementation of Enhanced Recovery after Surgery Programs Robin McLeod, MD, FRCS, FACS Cancer Care Ontario Toronto, ON New Warnings about Use of Hydroxyethyl Starch (HES) Solutions Eric Romeril, BSc, BScPharm, ACPR Hamilton Health Services Burlington, ON 3. Workshop Atelier MAPLE From Rags to Riches: How to Turn Residency Research Projects into Publications (Encore) Sheri Koshman, BScPharm, PharmD, ACPR University of Alberta Edmonton, AB Winnie Seto, BSc(Pharm), PharmD, MSc, ACPR, RPh The Hospital for Sick Children Toronto, ON 4. Workshop Atelier PINE Creating a Culture of Recognition (Encore) Sean Spina, BSc(Pharm), ACPR, PharmD Sherry Lalli, BSc(Pharm), ACPR Vancouver Island Health Authority Victoria, BC 17:30-19:30 Satellite Symposiums Dinner included Symposiums satellites Souper inclus 1. The Changing Future of Biological Therapy: Clinical Implications of Biosimilars DOMINION BALLROOM Dan Martinusen, BSc(Pharm), ACPR, PharmD (Chair) Vancouver Island Health Authority, Victoria, BC Flay Charbonneau, BSc(Pharm) Sunnybrook Health Sciences Centre Toronto, ON George Dranitsaris, BPharm, MS, PhD, FCSHP Augmentium Pharma Consulting Guelph, ON Hosted by The France Foundation 2. New Provincial Integrated Pharmacy Supply Chain Model CIVIC BALLROOM SOUTH Moira Wilson, BSc(Pharm) Horizon Health Network Saint John, NB Hosted by McKesson Canada Corporation Tuesday, February 3 Mardi 3 février 07:30-17:00Registration Inscription CONCOURSE COAT CHECK 16 Strong Rehabilitation Centre • Interior Health Authority: 100 Mile District General Hospital, 08:00-08:15Announcements Annonces DOMINION BALLROOM 11:15-12:00 Concurrent Sessions Séances concomitantes 08:15-09:15 Use of Social Media in Health Care Dr. Mike Evans St. Michael’s Hospital Toronto, ON Sponsored by Sandoz Canada Inc. 09:30-10:00 Break, Posters, Exhibits Pause, Affiches, Kiosques SHERATON/OSGOODE HALLS 10:15-11:00 Concurrent Sessions Séances concomitantes PINE DOMINION BALLROOM BIRCHWOOD BALLROOM Margaret Ackman, BSc(Pharm), PharmD, FCSHP Alberta Health Services Edmonton, AB 2. Technology in Clinical Practice... Is the Digital Revolution Creating Better Patient Care? BIRCHWOOD BALLROOM Sean Spina, BSc(Pharm), ACPR, PharmD Vancouver Island Health Authority Victoria, BC 3. CSHP 2015: Winning Project of the Hospital Pharmacy Residency Award and Winning Success Stories of the National Competition CHESTNUT Facilitator: Carolyn Bornstein, BScPhm, ACPR, FCSHP, CGP Southlake Regional Health Centre Newmarket, ON Award Winning Project: Assessment of the Effect of Behavioural Change Strategies on Knowledge Translation and Pharmacist Interventions for Antimicrobial Stewardship: ‘PIAS-KT Study’ Sukhjinder Sidhu, BScPhm Medical Pharmacy Calgary, AB Allison McGeer, MD, FRCPC Mount Sinai Hospital Toronto, ON 3. You Can’t be a Little Bit Sterile: An Overview of CSHP’s Compounding: Guidelines for Pharmacies 2014 1. Recent Trials in Cardiology that Should Impact Your Practice Maria Zhang, RPh, BScPhm, PharmD Centre for Addiction and Mental Health Toronto, ON 2. Ebola Virus Disease: Risks, Prevention and Treatment CHESTNUT DOMINION BALLROOM 1. Electronic Cigarettes: Seeing Past the Smokescreen Doug Sellinger, BSP, MALT Regina Qu’Appelle Health Region Regina, SK 12:15-13:50 Lunch, Exhibits, Posters Dîner, Kiosques, Affiches SHERATON/OSGOODE HALLS 14:00-15:00 Management of Diabetes in the Acute Illness Setting DOMINION BALLROOM Alice Cheng, MD, FRCPC Trillium Health Partners Mississauga, ON 15:10-17:10 Workshop & PSN Sessions Atelier et séances des RSP 1. Cardiology PSN RSP en cardiologie DOMINION BALLROOM Drug Induced QT Interval Prolongation in Hospitalized Patients: What’s a Pharmacist to Do? James E. Tisdale, PharmD, BCPS, FCCP, FAPhA, FAHA Purdue Univeristy Indianapolis, IN The Impact of Inflammatory Arthritis on Cardiovascular Disease Risk: What It is and What to Do About It! Jill Hall, BScPharm, ACPR, PharmD University of Alberta Edmonton, AB Arrow Lakes Hospital, Ashcroft Hospital and Community Health Care Centre, Boundary 17 2. Medication Safety PSN RSP en sécurité des médicaments 17:30-19:30 Satellite Symposiums Dinner included Symposiums satellites CHESTNUT Souper inclus Reporting Medication Events: You Don’t Know What You Don’t Know Janice Munroe, BScPharm Fraser Health Services Langley, BC Jennifer Turple, BScPharm, ACPR Institute for Safe Medication Practices Canada Halifax, NS Jennifer Pickering, BScPhm Hamilton Health Sciences Centre Hamilton, ON Claudia Bucci, PharmD Sunnybrook Health Sciences Centre Toronto, ON Shaun Goodman, MD St. Michael’s Hospital Toronto, ON Hosted by Canadian Cardiovascular Pharmacists Network 3. Paediatrics PSN RSP en pédiatrie 1. Continuity of Care of the ACS Patient CIVIC BALLROOM SOUTH PINE Controversies in Closure of Patent Ductus Arteriosus Dolores C. Iaboni, BSc(Pharm) Sunnybrook Health Sciences Centre Toronto, ON Oral Extemporaneous Compounding References: Pros and Cons Karen Walsh, BScPhm, ACPR, RPh Hospital for Sick Children Toronto, ON 4.Workshop Atelier MAPLE To Use or Not to Use the Hospital Pharmacy in Canada Report? Jean-François Bussières, BPharm, MSc, MBA, FCSHP Centre hospitalier universitaire Sainte-Justine Montreal, QC 2. Compounding: It’s Time to Talk BIRCHWOOD BALLROOM Cathy Lyder, BScPharm, MHSA Canadian Society of Hospital Pharmacists Edmonton, AB Joan Fabbro, BScPharm, ACPR BC Cancer Agency Kelowna, BC Hosted by Hospira Healthcare Corporation Wednesday, February 4 Mercredi 4 février 07:30-15:00Registration Inscription CONCOURSE COAT CHECK 08:00-08:15Announcements Annonces DOMINION BALLROOM 08:15-09:15 Antimicrobial Resistance: Is it as Scary as Ebola? DOMINION BALLROOM Linda Dresser, PharmD, FCSHP University Health Network Toronto, ON 09:15-10:15 HIV Infection and Treatment: A Primer for Pharmacists 18 DOMINION BALLROOM Michelle Foisy, BScPharm, PharmD, ACPR, FCSHP, AAHIVP Northern Alberta HIV Program Edmonton, AB Hospital, Cariboo Memorial Hospital, Creston Valley Hospital & Health Centre, Dr. Helmcken 10:15-10:45Break Pause DOMINION FOYER 14:15-16:00 PSN Sessions Séances des RSP 10:55-11:40 Concurrent Sessions Séances concomitantes 1. Oncologic Emergencies 1. Psychiatry PSN RSP en psychiatrie CHESTNUT Mental Health Medication Side Effects in the Workplace PINE Sonia Cheung, BScPhm, ACPR, RPh Trillium Health Partners Mississauga, ON 2. The Limited Role of Aerosolized Antibiotics CHESTNUT Gary Wong, BScPhm University Health Network Toronto, ON 3. Practicing Pharmacy with Diverse Populations: Going Beyond Cultural Competency BIRCHWOOD BALLROOM Jeff Wong, BScPharm Hamilton Family Health Team Hamilton, ON 11:50-12:35 Concurrent Sessions Séances concomitantes 1. Addressing Medication Errors in HIV Inpatients: A Clinician’s Guide to Antiretroviral Assessment Now You Feel Better but Your Heart Doesn’t: Cardiovascular Side Effects of Psychotropic Medication Michelle Foisy, BScPharm, PharmD, ACPR, FCSHP, AAHIVP Northern Alberta HIV Program Edmonton, AB Jamie Kellar, RPh, BScHK, BScPhm, PharmD Centre for Addiction and Mental Health Toronto, ON 2. Infectious Diseases PSN RSP en infectiologie BIRCHWOOD BALLROOM Fecal Transplants: What Pharmacists Need to Know Susy Hota, MD, MSc, FRCPC University Health Network Toronto, ON What We’ve Learned about Antimicrobials from Ontario Databases: Outcomes and Adverse Effects Muhammad Mamdani, PharmD, MA, MPH St. Michael’s Hospital Toronto, ON CHESTNUT Joel Lamoure, RPh, DD, FASCP Western University London, ON 16:15 Close of the 46th Annual Professional Practice Conference Clôture de la 46e Conférence annuelle sur la pratique professionnelle 2. Documentation in Electronic Medical Records #FTW PINE Andrew Liu, HBSc, BScPhm, RPh Toronto East General Hospital Toronto, ON 3. Are We Choosing Wisely? Quality, Value and Irrationality in Hospital Practice BIRCHWOOD BALLROOM Mark McIntyre, PharmD, ACPR, RPh Mount Sinai Hospital Toronto, ON 12:40-14:10 Lunch Break Please note there is no scheduled satellite symposium. Delegates are on their own for lunch. Memorial Hospital, East Kootenay Regional Hospital, Elk Valley Hospital, Golden & District 19 Speaker Abstracts Résumés des conférenciers SUNDAY, FEBRUARY 1 DIMANCHE 1ER FÉVRIER how medications affect neurotransmitter or hormone levels is important to understanding how medications can impair sexual function. Clinical Renal Drug Dosing: Is Cockcroft-Gault Dead? Cardiovascular medications like beta blockers (norepinephrine inhibition), thiazide diuretics (central alpha receptor blockade, decreased dopamine response) and spironolactone (blocks androgen receptors) affect sexual function. Medications with anticholinergic effects affect sexual function by reduction of acetylcholine. Antidepressants like SSRIs, SNRIs and TCA s can affect sexual function by affecting serotonin, acetylcholine, dopamine and prolactin levels. Oral contraceptives and some anticonvulsants can increase sex hormone binding globulin thus reducing free estrogen or testosterone. Drugs that specifically have an anti-hormonal effect, like cancer chemotherapy agents and 5-dihydroxytestorone antagonists, reduce the effects of estrogen or testosterone and can be a cause of sexual dysfunction. Antipsychotic agents cause sexual impairment via anticholinergic effects, decreased dopamine effects and increased prolactin levels. Marisa Battistella, BScPhm, PharmD, University of Toronto, Toronto, ON Patients with acute or chronic kidney disease require drug dosage adjustment. The challenge, however, is how to accurately estimate a patient’s kidney function in both acute and chronic kidney disease to determine drug dosing. Clinicians must assess kidney function and consider how the kidney functionassociated changes in the disposition of drugs and their active or toxic metabolites will impact the drug therapy needs of individual patients. There are numerous ways to calculate the kidney function, each with their own limitations. In this 45 minute session, using patient cases, we will review the different methods to determine renal function and their applicability to drug dosing. Goals and Objectives 1. Describe the origins and limitations of serum creatinine and resulting equations used to estimate renal function. 2. Determine a suitable dosing regimen for a given drug and patient. 3. Using case-based learning, apply dosing principles in a group setting. Self-Assessment Questions 1. What is the best equation for estimating renal function when drug dosing? 2. What are key factors to consider when determining drug dosing in a patient with decreased renal function? Drug Induced Sexual Dysfunction Luis Viana, BScPhm., MEd, PharmD, ACPR, CGP, University of Waterloo, Waterloo, ON Human sexual response consists of three phases: libido, sexual arousal and orgasm. Key neurotransmitters involved in human sexual response include dopamine, acetylcholine, serotonin and norepinephrine. Estrogen, testosterone, prolactin, nitric oxide and sex hormone binding globulin also play a role in the human sexual function. In both men and women, impaired sexual response can present as decreased libido. For men, sexual dysfunction can manifest as erectile dysfunction and impairment or absence of ejaculation. For women, diminished vaginal lubrication and decreased genital sensation/swelling can impair the sexual response. Impairment of sexual function as an adverse effect of medications is often under-recognized. An understanding of 20 Pharmacists are often the first health care professional sought when a person presents with symptoms of sexual dysfunction that affects their quality of life. It is vital to perform a drug regimen review to identify potential drug induced sexual dysfunction. In some cases, withdrawal of the causative agent or dose reduction is possible. When this is not possible, changing to an alternative medication which is not associated or has less effect on sexual function is an option. Finally, when a causative medication must be continued because of therapeutic benefit, medications which improve sexual function like PDE-5 inhibitors (in men and women) are appropriate if there are no contraindications. Vaginal estrogen cream is an option in women in some situations. Sexual dysfunction is sometimes overlooked as an adverse effect of medications. Advising our patients and providing therapeutic interventions to manage drug induced sexual dysfunction is an important role for pharmacists. Goals and Objectives 1. Identify neurotransmitters and other endogenous substance which can influence the three stages of human sexual response. 2. Examine how drug induced alterations of neurotransmitter balance can affect sexual function. 3. Examine the role of nitric oxide and sex hormone binding globulin in human sexual response. 4. Compare similarities and differences of sexual dysfunction in men and women. 5. Recognize different classes of medications which can cause sexual dysfunction. Hospital, Invermere & District Hospital, Kelowna General Hospital, Kootenay Boundary 6. Propose alternative medication management strategies to minimize the effects of drug induced sexual dysfunction. Knowledge Translation Research Primer for Pharmacists: A Practical Approach Monika Kastner, PhD, Li Ka Shing Knowledge Centre, St. Michael’s Hospital, Toronto, ON Knowledge translation (KT) is a relatively new term to describe an old problem. It is about closing the gap between what we know and what we do, moving research into action, and making users aware of knowledge toward improved health and health care systems. The practice of KT involves developing and implementing a plan for making knowledge users aware of the knowledge generated through a research project. The science of KT is studying the determinants of knowledge use and effective methods of promoting the uptake of knowledge. There are two broad types of KT: 1) End-of-grant KT involves the researcher developing and implementing a plan for making knowledge users aware of the knowledge generated through a research project; 2) Integrated KT is a way of doing research that engages potential knowledge users as partners in the research process, making it more likely that findings are more relevant and will be used by them. Failure to use research evidence to inform practice ad policy is evidenced across all settings and decision-making groups. To address these challenges, a framework has been developed by Graham and colleagues to help achieve effective knowledge translation called the Knowledge-to-action (KTA) framework. The first concept of the KTA framework is knowledge creation, which conveys the idea that knowledge can be distilled before it is ready to be applied. The second concept of the KTA framework in the action cycle, which emphasizes the dynamic action steps that are needed to apply the knowledge created, and intended to deliberately cause change within health care systems and groups. Goals and Objectives 1. To understand the concept of knowledge translation (KT). 2. To understand the two broad types of KT. 3. To introduce a framework for KT: the “knowledge-to-action” (KTA) cycle. 4. To illustrate how the KTA framework can be applied in research for translating best evidence into practice. Self-Assessment Questions 1. Did you find this presentation clear and understandable? 2. Did the presentation achieve its intended objectives? 3. Was the topic relevant to you? The Hospital Pharmacist: Back to the Future Bill Wilson,RPh, BSP, FCSHP, Mount Sinai Hospital, Toronto, ON This presentation will provide the learner with a brief history of Hospital Pharmacy practice and in particular the changing role of the Pharmacist with the purpose of providing context for the future role of Hospital based pharmacists. It is important to understand where the profession has come from and where it is likely to be heading in an effort to optimize the efforts to enhance patient care. The presentation will also provide an update on the current climate in Health care including government funding and changes to reporting requirements that affect hospital Pharmacy. In addition the presentation will discuss the changing demographics and the expectations of the public with respect to their health and health care. The discussion will then attempt to predict or foresee the opportunities for hospital pharmacists in the future and in particular their role both inside and outside the walls of the hospital. Goals and Objectives 1. To describe the history of Hospital Pharmacy and to understand the changes in practice that have occurred. 2. To describe the changing environment public expectations and its impact on practice. 3. To attempt to predict the future roles of Hospital Pharmacists and to describe some strategies on how to get there. PHARMACY SPECIALTY NETWORKS Guidance on Guidelines: Applying the New PSN Hypertension and Diabetes Guidelines to N E T W O R K • C O M M U N I C AT E the Oldest Old Cheryl Sadowski, BSc(Pharm), PharmD, FCSHP, University of Alberta, Edmonton, AB Multimorbidity is a common presentation in older adults, where multiple disease states and syndromes create challenging cases with conflicting choices. This is most common in the oldest old, defined as seniors age 80 years and older. This population lives with many comorbidities, but they are often excluded from clinical trials, and many guidelines do not provide direction specific to this age group. Most clinical practice guidelines are based on a single disease, and recommendations are built on evidence that comes from clinical trials that enroll a narrow patient population without multimorbidity. This results in poor applicability to the patient population, as recommendations for one guideline can directly contradict the recommendation from another guideline that would be relevant for the same patient. This conundrum applies to commonly used guidelines, such as diabetes or hypertension. While some comorbidities are discussed within each guideline, the multimorbidity patient is not used as an example, and pharmacists are still left with many challenges of how to apply the evidence-based recommendations to a complex geriatric patient. To provide direction to clinicians, the American Geriatrics Society (AGS) developed ‘guidelines for guidelines’, direction on how to address decision making and care for patients with multimorbidity. This presentation will focus on application of the AGS principles of care in relation to the most current hypertension and diabetes guidelines. Regional Hospital, Kootenay Lake Hospital, Lillooet Hospital & Health Centre, Nicola Valley 21 Goals and Objectives After attending this session the participant should be able to: 1. Describe the challenges of applying current evidence to an older adult population. 2. Identify the guideline recommendations that apply to older adults. 3. Contrast the health care needs of the fit versus frail older adult. 4. Apply guideline recommendations in a context of complexity, comorbidity, and frailty. Self-Assessment Questions 1. Based on the AGS Principles of Care, what is the first step in making a decision about therapy for an older adult? 2. Identify 3 ways the hypertension and diabetes guidelines can be improved to address care for older adults age 80 years and older. PHARMACY SPECIALTY NETWORKS Medication-Related Emergency Room PSN Admissions in the Elderly N E T W O R K • C O M M U N I C AT E Saurabh Patel, BScPharm, Orillia Soldiers’ Memorial Hospital, Orillia, ON In Canada, approximately, 65% of people older than 65 take more than 5 medications daily with 25% of this population taking more than 10 medications. In the next four decades, the elderly population will double and seniors will be living an average of 5 years longer, leading to a significant increase in healthcare utilization including consumption of multiple medications. The elderly are at increased risk of drug-drug interactions and adverse drug events with use of multiple medications to treat acute and chronic conditions. It is estimated that 10% of the emergency department admissions can be attributed to medications. Pharmacists are in key position to identify, treat, and prevent these drug-drug interactions and adverse drug events. This presentation will outline common medication culprits and drugdrug interactions that are a common cause for admission to the emergency department. The presentation will also highlight how polypharmacy and prescribing cascades may contribute to hospitalization in the elderly population. Finally, the presentation will outline strategies pharmacists can use to optimize medication regimens in the elderly. Goals and objectives of the presentation will be covered with real cases and evidence from the literature. Goals and Objectives 1. Outline the epidemiology of the aging population and their use of medications. 2. Discuss pharmacokinetic and pharmacodynamic changes associated with aging and the implication for use of medications in older adults. 22 3. Identify medications or classes of medications that put older adults at risk of hospitalization (i.e. ER admissions). 4. Review drug-drug interactions that are clinically relevant in older adults. 5. Review polypharmacy and prescribing cascades that may increase risk of hospitalization in older adults. Self-Assessment Questions 1. List medications or classes of medications that have shown to increase risk of hospitalization in older adults. 2. Outline strategies to optimize medication regimens in older adults to prevent unnecessary hospitalizations. PHARMACY SPECIALTY NETWORKS Overview of Inhalers for Chronic PSN Obstructive Pulmonary Disease: Hospital N E T W O R K • C O M M U N I C AT E Formulary Considerations Lawrence Jackson, BScPhm, Sunnybrook Health Sciences Centre, Toronto, ON; Rosa Maria Tanzini, BScPhm, St. Michael’s Hospital, Toronto, ON An onslaught of new inhalation therapies and new inhaler devices mainly targeting the COPD population, have recently been marketed or are anticipated. This session addresses formulary management issues and provides an approach to analyzing hospital formulary requirements, taking into account the context of when the inhaler is being initiated and used, device selection and discharge planning. Managing Chronic Obstructive Pulmonary Disease (COPD) imposes a high burden and cost impact on the healthcare system. As such, preventing acute exacerbations of COPD has become a focus of many studies. A partnership between American College of Chest Physicians and Canadian Thoracic Society has produced preliminary guidelines on prevention of acute exacerbations. New inhaled medications include long-acting anticholinergics/ muscarinic receptor antagonists (LAMA), ultra long-acting beta2agonists (LABA), inhaled corticosteroid/ultra long-acting beta2agonist combinations (ICS/LABA) and long-acting muscarinic antagonist/long-acting beta2-agonist combinations (LAMA/ LABA). Range of products and devices provides options which may make treatment more convenient (in particular, combination products) and permit strategies to improve efficacy/tolerance. This session will highlight some of the differences between the therapeutic alternatives and devices, as well as discuss factors which may influence formulary decisions. Goals and Objectives 1. Introduce the new inhalers and identify potential place in therapy. 2. Highlight recently published COPD guidelines. 3. Address hospital formulary requirements. Hospital and Health Centre, Penticton Regional Hospital, Princeton General Hospital, Queen Self-Assessment Questions 1. List new bronchodilators for management of COPD. 2. What are potential cost reduction strategies for hospitals? Creating a Culture of Recognition Sean P. Spina, BSc(Pharm), ACPR, Pharm D, Sherry L. Lalli, BSc(Pharm), ACPR, Vancouver Island Health Authority, Victoria, BC Employers want a highly productive staff force that is engaged, motivated and effective. Employees wish to be recognized for the hard work that they do. When employees are valued for their efforts in a meaningful way it helps to create a positive work environment, boosts morale, increases engagement and improves productivity. In addition, a supportive work environment which recognizes employees for their contributions to both their colleagues and patients improves performance and commitment and ideally leads to better patient outcomes. With tight budgets and increasing demands on time and resources, many employers find it challenging to develop a staff recognition program tailored to their workforce. Many also question the value of such a program to their organization. The goal of this session is to help stimulate creative thinking in developing an employee recognition and appreciation program, which can be implemented in a variety of settings. During the workshop, participants will be encouraged to share their views and experiences with employee recognition programs for the benefit of the other attendees. This interactive workshop will allow participants the opportunity to work through various realistic scenarios as they develop various employee recognition and appreciation programs. This workshop is designed for both front line pharmacists and supervisors. Goals and Objectives 1. To provide participants with an overview of employee recognition programs. 2. To understand the current landscape of staff appreciation programs in pharmacy practice. From Rags to Riches: How to Turn Residency Research Projects into Publications Sheri Koshman, BScPharm, PharmD, ACPR, University of Alberta, Edmonton, AB; Winnie Seto, BScPhm, PharmD, MSc, ACPR, RPh, The Hospital for Sick Children, Toronto, ON Hospital pharmacists are increasingly called upon to precept resident research projects (RRP) while coping with competing demands from clinical workload, teaching commitments, and professional activities. RRP can be mutually beneficial for both the resident and preceptor. The RRP provides a valuable learning opportunity for residents and offer preceptors an opportunity to mentor pharmacy residents and advance clinical pharmacy research. Preceptors, however, need effective strategies to ensure successful completion of RRP and timely publication of project findings. This workshop will allow participants, in small groups, to discuss various topics pertaining to residency projects including: a priori planning of the RRP, setting up the resident to succeed, identifying common barriers and challenges and strategies to overcome these and tactics for knowledge translation including publication. Participants will be encouraged to share successes and failures from their own experiences in an interactive manner during the workshop. This workshop is aimed at novice preceptors, current preceptors and future preceptors of RRP. Goals and Objectives By the end of the workshop, the participant should be able to: 1. Outline key consideration when planning for a RRP 2. Discuss how to develop and execute a research plan with the resident to complete their RRP 3. Identify common challenges with RRP and describe techniques to ensure successful completion of the RRP 4. Define knowledge translation (KT) and describe potential opportunities for KT of RRP. Self-Assessment Questions 3. To appreciate the benefits and disadvantages of employee recognition programs. 1. What are the key issues that I need to plan for prior to offering a RRP? 4. To provide guidelines on the creation of employee recognition programs. 2. What are common challenges with RRP that I can anticipate and plan for? Self-Assessment Questions 3. How do I facilitate getting the RRP published? 1. List 4 guiding principles in developing a successful employee recognition program. 2. List 4 benefits of a successful employee recognition program. 3. List 4 disadvantages of an employee recognition program. Victoria Hospital, Royal Inland Hospital, Shuswap Lake General Hospital, South Okanagan 23 MONDAY, FEBRUARY 2 LUNDI 2 FÉVRIER Has CSHP 2015 Really Made a Difference? Did We Hit the Target? Neil J. MacKinnon, BSc(Pharm), MSc(Pharm), PhD, James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH; Olavo Fernandes BScPhm, ACPR, PharmD, FCSHP, University Health Network, Toronto ON and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON; Moderator - Carolyn Bornstein, BScPhm, ACPR, FCSHP, CGP, Southlake Regional Health Centre, Newmarket, ON Eight years ago, “CSHP 2015” was developed as a vision of what pharmacy practice excellence might look like in the year 2015. It is based on 6 goals and 36 supporting objectives with measurable targets, addressing many services provided by pharmacists in hospitals and related healthcare settings. Since 2007, Canadian pharmacists have been challenged to “hit the target” of as many objectives as they could. The Canadian Society of Hospital Pharmacists (CSHP) has supported this health care quality initiative, challenging its members to enhance the safe, effective and evidence-based use of medications, ultimately improving the health of Canadians. Awareness and promotion of CSHP 2015 has taken many forms, including CSHP on Twitter (with almost 1000 followers) and a CSHP 2015 blog. Members have been supported with more than 200 - 2015 related posters and presentations at CSHP conferences, the development of three tool kits, almost 100 success stories on the website, 20 webinars, 34 virtual posters, and 8 pharmacy student videos. Progress with the CSHP 2015 initiative has been captured by the Hospital Pharmacy in Canada Report since 2008. Data collected from self-reported surveys suggests that members have come within 30% of the targets for 50% of the 36 objectives. Systematically looking back on CSHP 2015 in this milestone year, has the campaign actually made a sustainable difference to pharmacy practice and patient care? In this interactive session, we will debate the merits, accomplishments, innovations, challenges, lessons learned and areas of future improvement for the CSHP 2015 campaign. Goals and Objectives Self-Assessment Questions 1. State 3 specific ways through which the CSHP 2015 campaign meaningfully advanced hospital pharmacy practice or patient care since its inception in 2007. 2. List 3 innovations established with the CSHP 2015 campaign that could be effectively used in other professional society endeavors. 3. Outline 3 specific challenges encountered by the CSHP 2015 campaign in advancing hospital pharmacy practice and/or patient care. PharmD 2.0 – What Does the New Post-Professional PharmD Mean for Me? Moderator: Margaret L. Ackman, BSc(Pharm), PharmD, Alberta Health Services, Edmonton AB; Thomas ER Brown, PharmD, Women’s College Hospital and Leslie Dan Faculty of Pharmacy, Toronto, ON; Jill Hall, BScPharm, ACPR, PharmD, Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton AB; Neil Mackinnon, BSc(Pharm), MSc(Pharm), PhD, James L Winkle College of Pharmacy, Cincinnati, OH In this session, panel members will challenge participants to think critically about their biases, concerns and opinions regarding the transition that is occurring in Canada with respect to the PharmD degree. As the profession moves to an entry level PharmD and post-professional degrees become more widely available, the pharmacists in any given institution or on any given team will have a ‘mix’ of different credentials. How will this impact you personally or does it make a difference? Do other health care professionals perceive a difference in credentials? As the scope of practice continues to expand, what do we need and how do residency programs and post-professional degree programs fit in? What do post-professional degree programs offer to you as an individual? Your institution? Your profession? Bring your smart phones/tablets to share your opinions through polling. The panel will share their thoughts and there will also be opportunities to engage the panel in discussion. We welcome and need the opinions of pharmacists with a variety of educational backgrounds and experiences to inform this discussion. Goals and Objectives 1. To outline the key elements of the CSHP 2015 campaign and evaluate its impact according to systematic criteria (structures, processes, outcomes). 1. To review the current national picture with respect to entry level and post-professional PharmD programs. 2. To summarize the influential accomplishments, innovations and successes of the CSHP 2015 campaign. 2. To facilitate sharing of perceptions and ideas surrounding post-professional degree programs in the domains of personal, institutional and professional impact. 3. To debate challenges, lessons learned and areas of future improvement for CSHP 2015 from various stakeholder perspectives. Self-Assessment Questions 1. What impact are post-professional degree programs likely to have on you personally? 2. What impact are post-professional degree programs likely to have on the profession and the health of Canadians? 24 General Hospital, Vernon Jubilee Hospital • Jim Pattison Outpatient Care and Surgery Centre Clinical Trials in Internal Medicine That Will Change Your Practice Sharan Lail, BScPhm, ACPR, St. Michael’s Hospital, Toronto, ON Every year, a plethora of internal medicine-related papers are published. An ideal general internal medicine pharmacist must prioritize, review and critique many landmark trials to provide optimal patient care and contribute to the interdisciplinary team. The difficult, yet expected, task of being familiar with frontline evidence spanning all therapeutic areas, while also safely and effectively applying these results, is something most pharmacists share. This session will evaluate four significant recent internal medicine studies that are unlikely to be covered in other pharmacy specialty network presentations. In addition to generating lively discussions, these studies will also potentially change the practice of pharmacists treating general internal medicine patients. Goals and Objectives 1. Review and appraise four studies published in 2014 related to internal medicine. 2. Describe how the results of these four studies can be integrated into your daily practice. Self-Assessment Questions 1. Describe the patient population which is most likely to benefit from the interventions in each study. 2. Describe how the proposed intervention(s) is equivalent or superior to the current standard of care in each study. The Management of Traumatic Brain Injury Paola Saccucci, BSc(Hons), RPh, PharmD, St. Michael’s Hospital, Toronto, ON Traumatic Brain Injury (TBI) occurs when an external force causes brain dysfunction. The purpose of this session is to provide pharmacists with an overview of the pharmacological management of TBI in the intensive care unit. The goal of TBI management is the prevention of hypoxia and hypotension from the time of injury. Intracranial pressure (ICP) management strategies such as osmotic therapy and induced barbiturate coma will be reviewed. Once the primary injury has been treated, the goal includes limiting secondary injury. Pharmacists play an important role in recommending treatment and preventative options of secondary complications. Frequent secondary brain injury issues requiring pharmacist interventions may include; increasing ICP, maintenance of cerebral perfusion pressures (CPP) and blood pressure, fever and shivering, autonomic dysreflexia and glycemic control. This session will also simultaneously summarize the 2007 ‘Brain Trauma Foundation’ guidelines and review subsequent updates in the literature. Goals and Objectives 1. To provide an overview of the evidence for the management of traumatic brain injury in the intensive care unit. 2. To describe evidence based treatment and prevention strategies for secondary brain injury complications in TBI patients. 3. To review the 2007 guidelines from the Brain Trauma Foundation and summarize subsequent updates since its publication. 4. Discuss practical considerations commonly encountered in TBI patients. Self-Assessment Questions 1. What are 3 potential secondary brain injury complications of TBI patients? 2. Should seizure prophylaxis be initiated in all TBI patients? If so, when and for what duration of therapy? 3. What is the least sedating treatment regimen for the management of shivering in severe TBI patients? Business Plan Preparation for Pharmacists: How to Get Your Ideas Noticed Amanda Goodwin, BSP, RPh, MBA, University of Toronto, Toronto, ON Pharmacy practice is an evolving concept, as are career and business opportunities for Pharmacists in Canada. Clinical and patient care skills are an important component of a pharmacist’s skill set; however, whether pharmacists are designated managers or clinicians, all pharmacy practitioners need to understand and appreciate the aspects of practice that are both economic and managerial in nature. Furthermore, as the Pharmacy practice landscape continues to evolve, the need for Pharmacists to understand business concepts and develop compelling business plans has never been more critical. Without a solid understanding of how to navigate the business environment in which they currently operate, Pharmacists risk missing out on opportunities to move their profession forward and impact the healthcare landscape. The goal of this session is to provide an overview of business plans as a tool to enable pharmacists to implement effective programs and practice models in order to drive the Pharmacy profession forward. In addition, this session will provide attendees with insights on how to get their ideas noticed by decision makers. Preventative recommendations include ensuring initiation of thromboprophylaxis, antiepileptic agents for seizures prophylaxis. Considerations for the use of antiparkinsonian medication in the chronic care phases of TBI will be reviewed. • Lion’s Gate Hospital • Lower Mainland Pharmacy Services • St. Joseph’s General Hospital 25 Goals and Objectives 1. To discuss the role of business plans and the business planning process in implementing new programs, businesses or ideas. 2. To discuss what makes a particular business plan good or bad and how to get your ideas noticed. Self-Assessment Questions 1. What are the top three things I should know when developing a business plan? 2. What are three things I can do to get my business plan noticed by decision makers? Changes to Interim Federal Health, the Effects on Refugees and the Health Care Community Response Doug Gruner MD, CCFP, FCFP, Department of Family Medicine, University of Ottawa, Ottawa, ON Canada has for many years had an international reputation for ensuring that refugees have reasonable access to health care through the Interim Federal Health Program (IFHP). Since 1957, the IFHP had provided temporary coverage of medical costs for refugees without financial means while they await qualification for provincial or territorial coverage. The IFHP covered doctor’s visits, diagnostic tests like x-rays and blood tests, as well as medications and other necessary therapies. It also provided emergency dental and basic vision care. This health care coverage was similar to that of low-income Canadians. In June 2012 the federal government made drastic cuts to the IFHP. The rationale for these cuts was to save taxpayers money, discourage refugees from coming to Canada and to stop the overly generous benefits refugees receive which Canadians do not. Two years after implementation there is no evidence to support the government claims. Rather there are increased health care costs, mass confusion amongst both refugees and healthcare providers resulting in diminished access and most concerning it has put the lives of refugees and especially refugee children at risk. The response by the health care community to the cuts has been unprecedented. There are over twenty national health care organizations who have publically demanded the cuts be reversed. Recently a court decision has struck down the 2012 order in council which thus forces the government to rescind the cuts effective November 2014. Surprisingly the government has decided not to respect this ruling and thus is in breach of the rule of law and contempt of court. Goals and Objectives 1. To understand the reasoning behind the creation of the IFHP, its importance as a mechanism to ensure high quality health care for all refugees and why the recent government cuts to the program endanger the lives of refugees. 26 2. To explore the advocacy efforts of the healthcare community in response to these cuts. 3. To encourage thought and discussion around equity and access to health care for vulnerable populations and specifically our role as health care practitioners in ensuring we meet the needs of these vulnerable groups. Self-Assessment Questions 1. What is social accountability as it relates to the health care concerns of a community and what is our role as health care professionals in this social contract? 2. How do you define advocacy, and what role do health care professionals play when government policy is out of line with what you as a health care professional feel is best for your patients. PHARMACY SPECIALTY NETWORKS Development of International Advanced PSN Pharmacy Practice Experiences for Student N E T W O R K • C O M M U N I C AT E Pharmacists: The Purdue University Experience in Global Health in Kenya and Nuclear Pharmacy in England James E. Tisdale, PharmD, College of Pharmacy, Purdue University, Indianapolis, ID The Purdue University College of Pharmacy (COP) offers unique international Advanced Pharmacy Practice Experiences (APPE), including the Purdue Kenya Program (PKP) and an APPE in Nuclear Pharmacy in London, England. The PKP was initiated in 2003, with the first APPE students arriving in Eldoret, Kenya in 2005. The PKP is affiliated with the United States Agency for International Development (USAID) – Academic Model Providing Access to Healthcare (AMPATH), initiated in 2001 to address care of patients initially with human immunodeficiency virus, and later expanded to address a wide array of diseases in a global health program located in Western Kenya. The PKP is unique in that two full-time faculty members of the Purdue University COP are based full-time in Kenya. The Purdue COP sends 28 students annually to Kenya for an 8-week APPE in global health at the Moi Teaching and Referral Hospital (MTRH), affiliated with Moi University. Activities in which the students participate include: daily multidisciplinary inpatient clinical rounds; care of patients in pharmacist-managed clinics for HIV/AIDS, anticoagulation, cardiology, and diabetes; provision of continuing education lectures; adherence counseling; outreach efforts for orphaned and vulnerable children; formulary development; and others. The Purdue University COP international APPE in Nuclear Pharmacy was established in 2007 at St. Bartholomew’s Hospital and the Royal London Hospital Trust in London, England. Several students participate annually in this APPE, the focus of which is nuclear pharmacy compounding in aseptic conditions. Both international experiences are in high demand and are highly rated by students. • Northern Health • Peace Arch Hospital • Powell River General Hospital • Providence Goals and Objectives Goals and Objectives 1. Describe the Advanced Pharmacy Practice Experience (APPE) in Global Health offered in Kenya by the College of Pharmacy, Purdue University. 1. Review the current state of pain management in the global context. 2. Describe the APPE in Nuclear Pharmacy offered in London, England by the College of Pharmacy, Purdue University. 3. Describes some principles/criteria that can be used to determine whether a specific international site may be acceptable for offering of an APPE. Self-Assessment Questions 1. Which of the following is the most important characteristic of a potential site for an international Advanced Pharmacy Practice Experience (APPE) for student pharmacists? a. E nglish is first and primary language of country that is potential site of APPE b. Location has beautiful scenery c. Safe housing is available for faculty and students d. Opportunity to develop new infrastructure at potential site 2. Purdue University students who participate in the Global Health APPE in Eldoret, Kenya participate in which of the following activities? a.Multidisciplinary inpatient clinical rounds b.Pharmacist-managed diabetes clinic c.Adherence counseling d.All of the above PHARMACY SPECIALTY NETWORKS PSN Pain Management in Developing Countries N E T W O R K • C O M M U N I C AT E Doret Cheng, BSc.Pharm, PharmD, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Pain relief and optimal management of pain in cancer, acute and chronic illnesses, trauma and peri-operative settings remain an elusive target in most developing countries. Stark differences and global inequities exist between high and low income countries. According to 2010-2012 estimates from the International Narcotic Control Board, 92% of the world’s morphine is consumed by 17% of the world’s population while the rest of the world population (83%) consumes just 8%. This surrogate measure, the total medical consumption of opioids, has been used as an indicator of access and the global divide between low, medium and high income countries. This imbalance is particularly problematic since it is estimated that over 70 per cent of cancer deaths actually occur in low- and middle-income countries. In this session, we will explore the various barriers to pain management in developing countries, the data that support the global divide in opioid use between countries and case studies to illustrate some proposed approaches to best practice in developing countries. 2. Identify barriers that developing countries face towards optimal pain management. 3. Illustrate some strategies to address barriers. 4. Determine how pharmacists can contribute as a bridge to this global divide. Self-Assessment Questions 1. What is the Morphine Manifesto? 2. Name 4 main barriers in pain management that limit access to opioids for pain control. Implementation of Enhanced Recovery after Surgery Programs Robin S McLeod, MD, FRCS, FACS, University of Toronto and Cancer Care Ontario, Toronto, ON Enhanced Recovery after Surgery (ERAS) pathways are multimodal programs which include a bundle of interventions which have been shown to decrease the amount of stress and gut dysfunction in individuals undergoing elective colorectal surgery and lead to enhanced recovery and decreased morbidity and length of stay. The published trials and guidelines often differ in the included interventions but generally include shortened pre-operative fast, multimodal pain management, restrictive intra-operative fluid regimens, early feeding and ambulation and omission of drains, tubes and catheters. As well, education of patients is an important component of the pathway. While the evidence is strong supporting ERAS programs, they are difficult to adopt, largely because they require a commitment from all members of the peri-operative team. The most often sited barriers to adoption are related to lack of collaboration and even active or passive resistance from members of the perioperative team, lack of hospital resources, social and cultural settings, and the organizational environment. Due to the relatively large number of interventions that must be adopted simultaneously by a multidisciplinary team, ERAS guidelines require a tailored implementation strategy to increase adherence. Some strategies which have been shown to be effective include inclusion of interventions supported by strong evidence, key opinion leaders and communities of practice, and audit and feedback. When implemented, ERAS programs have been shown to decrease the mean length of stay by 2-3 days and morbidity by 50%. The University of Toronto developed an ERAS strategy which has been implemented at 15 academic hospitals in Ontario. This talk will focus on the process taken to develop and implement an ERAS guideline and the results achieved. Health Care: St. Paul’s Hospital, Mount St. Joseph’s Hospital • Royal Columbian Hospital • 27 Goals and Objectives 1. Discuss the concept of Enhanced Recovery after Surgery (ERAS) and interventions which are included in ERAS guidelines 2. Understand implementation strategies which have been shown to improve uptake of ERAS 3. Discuss outcomes achievable with ERAS pathways Self-Assessment Questions 1. Adoption of an ERAS guideline results in all but one of the following: a.Decreased length of stay b.Decreased complications c.Decreased patient satisfaction d.Improved pain management 2. Which of the following interventions is part of an ERAS guideline: a.Shortened pre-operative fast b.Increased use of narcotics c.Prolonged use of catheters to decrease urinary tract infections d.Mobilization of patients beginning on post-operative day 2 PHARMACY SPECIALTY NETWORKS New Warnings about the Use of PSN Hydroxyethyl Starch (HES) Solutions information. These updates will be reviewed in addition to pathophysiological considerations and recent publications. Goals and Objectives 1. Relate basic differences in physical properties and expected uses for commonly used classes of intravenous fluids (blood, crystalloid, colloid). 2. Contrast and compare the differences between HES use as described in the literature and product information. 3. Identify patients, in whom HES therapy would be safest, based on current literature and product information. Self-Assessment Questions 1. List the contraindications for HES therapy in Canada. 2. Describe the place in therapy for HES in surgical populations. Creating a Culture of Recognition Encore presentation – please refer to Sunday program. From Rags to Riches: How to Turn Residency Research Projects into Publications Encore presentation – please refer to Sunday program. TUESDAY, FEBRUARY 3 MARDI 3 FÉVRIER N E T W O R K • C O M M U N I C AT E Eric JP Romeril BSc, BScPharm, ACPR, Hamilton Health Sciences, Burlington, ON Recent Trials in Cardiology that Should Impact Your Practice The purpose of this session is to present a balanced view of the available evidence and warnings regarding the use HES solutions in surgical patients. Margaret L. Ackman, BSc(Pharm), PharmD, Alberta Health Services, Edmonton AB The ideal choice of agent to augment blood volume can be highly contentious issue; for some indications it is still hotly debated in the medical literature. A relatively new option in our arsenal of IV fluids is known as hydroxyethyl starch (HES). These colloid preparations have been used for a few decades to augment blood volume in place of crystalloid or alternative colloids (albumin); and have been marketed in a variety of sizes. HES preparations are thought to differ fundamentally from other IV fluids in their pharmacokinetic and pharmacodynamic properties; depending on their chemical composition and source material. Thus some authors postulate different clinical conditions could result in differing effectiveness and safety profiles for the same medication. Recently there has been concern in published literature regarding possible adverse outcomes when using HES in critically ill patients, especially patients with septic shock. Furthermore, the publication base supporting the use of HES has been compromised by alleged fraud, publication bias and industry influence. In response Health Canada, the US (FDA) and Europe (EMA) have all issued warnings and changes to product 28 Cardiovascular diseases are broadly relevant across almost all medical specialties. Although many trials are published in cardiology each year, this ‘snapshot’ session will highlight recently published trials that would be considered practice changing. This session will examine some additional options for the treatment of heart failure and some considerations for the use of novel oral anticoagulants in the cardioversion and also in valvular heart disease. We will look at current data regarding duration of dual antiplatelet therapy and the safety of triple therapy. In addition, we will examine a potential new use for an old drug and try to bring clarity to the issue of surrogate endpoint use in evaluating lipid therapy. What works and what doesn’t? What’s safe? How long should we treat? What does the future hold? This whirlwind session will present the recently available evidence that tries to address these questions. Goals and Objectives 1. To provide participants with a ‘snapshot’ of recent trials in the area of heart failure, valvular heart disease, antiplatelet therapy and coronary disease. Squamish General Hospital • St. Mary’s Hospital • Surrey Memorial Hospital • University Self-Assessment Questions 1. What therapies should you consider for a heart failure patient outside of the standard therapy of ACE inhibitor, beta blocker and aldosterone antagonist? 2. What considerations are there regarding duration of dual antiplatelet therapy and the use of triple therapy? Technology in Clinical Practice… Is the Digital Revolution Creating Better Patient Care? Sean P. Spina, BSc (Pharm), ACPR, Pharm D, Vancouver Island Health Authority, Victoria, BC The goal of this session is to introduce pharmacists to current literature on the incorporation of technology into patient care. This session will also examine some of the benefits of and barriers to the use of technology in clinical practice. Over the past decade, the use of technology in healthcare has grown exponentially. Despite the rapid growth and refinement of technology and the willingness of clinicians to incorporate it into practice, the anecdotal benefits are routinely questioned in view of the identified challenges. These challenges and possible solutions are examined in this session and some common clinically useful mobile applications are reviewed. Ward-based pharmacists resolving drug therapy problems (DTPs) improve antimicrobial appropriateness for urinary tract infections (UTI) and pneumonia. However, not all resolved DTPs for these diseases carry the same positive impact on antimicrobial appropriateness, therefore Interior Health has identified key pharmacist interventions (KPIs), defined as resolved DTPs associated with antimicrobial appropriateness. Pharmacist professional development at Interior Health has been delivered using disease state education modules. Unfortunately, education alone often fails to produce sustained knowledge transfer and behavior change. It should therefore be included as part of a multi-faceted strategy. At the time of this study it was unknown whether a multi-faceted behavioral change strategy targeting pharmacists would improve antimicrobial appropriateness. The objective of PIAS-KT was to evaluate the impact of a multifaceted behavior change strategy on pharmacist knowledge and practice for UTI and pneumonia patients. A one group, pre/post study was conducted across Interior Health to evaluate the impact of an 8-week knowledge and behavior change strategy on pharmacists at IH. The primary outcome was change in proportion of UTI and pneumonia DTPs resolved from the 6-month pre- to 6-month post-intervention phase. Goals and Objectives Goals and Objectives 1. To review the methods and clinical findings of the PIAS-KT study. 1. To provide pharmacists with an overview of how technology can benefit patient care and affect clinician efficiency. 2. To discuss how ward-based pharmacists can contribute to antimicrobial stewardship-related endpoints. 2. To provide the pharmacists with an overview of the challenges faced by clinicians in incorporating technology into clinical practice. Self-Assessment Questions 3. To update pharmacists on new apps that will improve their ability to provide patient care. 1. How can other health regions utilize the methods in PIAS-KT to improve antimicrobial appropriateness? Self-Assessment Questions 2. What strategies can be used to minimize pharmacists from shifting priorities away from other highly valuable evidencebased interventions? 1. List 4 potential benefits of having technology incorporated into clinical practice. Electronic Cigarettes: Seeing Past the Smokescreen 2. List 4 barriers or challenges in efficiently implementing technology into clinical practice. Maria Zhang, RPh, BScPhm, PharmD, Centre for Addiction and Mental Health, Toronto, ON 3. Outline how the incorporation of technology into clinical practice can improve the delivery of patient care. Since its development by a pharmacist in the mid-2000s, electronic cigarette (e-cigarette) production and use has exploded worldwide. Its global market value is estimated to be 3 billion USD for over 400 products. E-cigarettes are a heterogeneous group of battery-powered products that deliver chemicals including nicotine and flavourings, via an inhaled aerosol. Currently, there is no e-cigarette product on the North American market that is approved for smoking cessation. Despite this, advocates for their use, including current smokers and some public health experts are touting e-cigarettes as “an innovation that will make cigarettes obsolete”. On the other hand, some medical experts, policy makers and scientists worry that e-cigarettes will prove to be a synergistic risk with combustible tobacco products and undo the substantial progress made in Assessment of the Effect of Behavioral Change Strategies on Knowledge Translation and Pharmacist Interventions for Antimicrobial Stewardship: ‘PIAS-KT Study’ Sukhjinder Sidhu, BScPhm, ACPR, completed at Interior Health, BC This session will outline how Interior Health pharmacists actively contributed to improving antimicrobial stewardship-related endpoints in the absence of a stewardship program. of British Columbia Hospital • Vancouver General Hospital • Vancouver Island Health 29 tobacco control over the past several decades. Interestingly, the tobacco industry’s stake in this business is growing. Many unknowns exist surrounding the utility of e-cigarettes as a smoking cessation aid, its “gateway” effects to cigarettes, and its overall safety. However, critical information is emerging as science attempts to catch up to its popularity. For example, nicotine overdoses from ingested or spilled cartridges have been reported. Lack of regulation for the hundreds of products available to consumers has led to exposure to toxic contaminants and exploded batteries. Epidemiological data correlated a dramatic increase in use of e-cigarettes by youth with increased intentions to smoke cigarettes. This presentation aims to provide pharmacists with a timely review on the impact of electronic cigarettes on individual and public health. Goals and Objectives 1. Recognize and describe electronic nicotine delivery systems, including electronic cigarettes. 2. Evaluate the place in therapy of electronic cigarettes as a smoking cessation aid. 3. Describe the potential and documented harms associated with electronic cigarettes on an individual and population level Self-Assessment Questions: 1. What are the risks and potential benefits of electronic cigarette use on an individual and population level? How would you convey this to a patient? 2. Which patient population(s) may be at particular risk of harms associated with electronic cigarette use? Ebola Virus Disease: Risks, Prevention and Treatment Alison McGeer, MD, FRCPC, Mount Sinai Hospital, Toronto, ON Ebola virus is a filovirus that causes a severe systemic infection with a very high case fatality rate. The disease is endemic in central Africa, where it was first identified more than 40 years ago. The reservoir is thought to be fruit bats. Human infections occur from contact by hunting or eating bushmeat; the virus is then transmitted from person to person. Until 2014, outbreaks of Ebola virus disease (EVD) occurred most often in difficult to reach, rural areas of central Africa, and only a few hundred cases had been identified. In 2014, a new focus of disease appeared in West Africa, which was not recognized until it had spread to urban areas in three countries. By the end of November, nearly 16000 cases and 6000 deaths have been reported. EVD is frightening because of its high case fatality rate, and its transmission to healthcare workers. This talk will update attendees on the status of the outbreak, and on on-going work to better prevent inhospital transmission and to prevent and treat disease. 30 2. To review what is known about hospital transmission of EVD and its prevention. 3. To discuss vaccines and therapeutic agents under investigation. Self-Assessment Questions 1. What is the risk of an Ebola virus disease outbreak in Canada? 2. What is the development path for current Ebola virus vaccines? 3. Which therapeutic agents are going to be tested for the treatment of EVD in West Africa? You Can’t be a Little Bit Sterile: An Overview of CSHP’s Compounding: Guidelines for Pharmacies 2014 Douglas Sellinger, BSP, MALT, Regina Qu’Appelle Health Region, Regina, SK Patients have always expected and trusted that compounded preparations are safe for administration. In recent years, it has become evident that trust has been eroded. Where do we go from here, and how do we get there? The recently published document CSHP Compounding: Guidelines for Pharmacies provides information on non-sterile and aseptic compounding as well as guidance pertaining to compounding preparations containing hazardous drugs. The CSHP compounding guidelines combine information from the US, UK, Australia, Europe, and Canada to create a unique and unified compounding approach for Canadian pharmacies. This comprehensive guideline can be applied not only to hospital and related healthcare settings but to community compounding pharmacies. This presentation provides an overview of the 5 Ps of compounding. People, Physical Environment, Procurement, Procedures and Proof combine to create safe preparations to improve the likelihood of positive patient outcomes and reduce the risks associated with compounding. How does the number of ingredients, ingredient packages, number of entries into the packages, sterility of initial ingredients, training of staff, and process validation affect the relative risk that a preparation is appropriate and aseptic? Attendees will learn how these factors and others combine into a risk assessment score for each compound. They will also be able to apply the risk assessment score to compounds to determine a reasonable beyond use date. Goals and Objectives 1. Link the CSHP Compounding Guidelines to the 5 P’s (People, Physical Environment, Procurement, Procedures and Proof) of preparation. Goals and Objectives 2. Know how to use the preparation risk assessment table to create a risk assessment score. 1. To provide an update on the state of the outbreak of EVD in West Africa. 3. Utilize the preparation risk assessment score to inform the assignment of a beyond use date/time. Authority: BC Cancer Agency, Campbell River Hospital, Cowichan District Hospital, Lady Management of Diabetes in the Acute Illness Setting Alice YY Cheng, MD, FRCPC, Credit Valley Hospital, Mississauga, ON and St. Micheal’s Hospital, Toronto, ON Diabetes is common among hospitalized patients. Hyperglycemia has been associated with adverse outcomes in medical, surgical and critically ill populations. The Canadian Diabetes Association 2013 clinical practice guidelines recommend glucose levels of 5-10 mmol/L among non-critically ill patients and 8-10 mmol/L among the critically ill. Achieving these targets are challenging for a number of reasons including the rapid changes of acute illness, variable eating patterns, medications that worsen glycemia and co-morbidities that affect the choice of antihyperglycemic agents. If the patient’s home antihyperglycemic regimen cannot be used in hospital, insulin is the antihyperglycemic agent of choice because of its flexibility and safety in a variety of medical conditions. When using insulin in hospital, the preferred regimen is scheduled basal insulin + scheduled bolus insulin + correction (supplemental) bolus insulin which has been shown to achieve and sustain glycemic control better than stand-alone sliding scale insulin. In addition to the specifics of insulin dosing, organization of care in hospital to improve glycemic control will also be discussed. Goals and Objectives By the end of this session, participants will be able to: 1. Select and dose the most appropriate insulin regimen for inhospital patients. 2. Manage hyperglycemia in special populations (NPO, parenteral feeding, glucocorticoids). 3. Discuss strategies to improve the organization of care in hospital to improve glycemic control. Self-Assessment Questions 1. What are the recommended glycemic targets in hospitalized patients? 2. What is the most appropriate insulin regimen for an 80 kg non-critically ill hospitalized patient who is able to eat and drink reliably? PHARMACY SPECIALTY NETWORKS Drug-Induced QT Interval Prolongation in PSN Hospitalized Patients: What’s a Pharmacist N E T W O R K • C O M M U N I C AT E to Do? James E. Tisdale, PharmD, College of Pharmacy, Purdue University, Indianapolis, ID Prolongation of the corrected QT (QTc) interval is a common phenomenon in hospitalized patients. Over 25% of patients hospitalized in cardiac care units (CCUs) were found to have QTc interval prolongation, and nearly 20% of patients in CCUs had QTc > 500 ms. Of the patients with QTc interval prolongation on admission, > 1/3 subsequently were prescribed a QT intervalprolonging drug; of the patients with QTc interval > 500 ms on admission, > 40% were subsequently prescribed a QTc interval-prolonging drug. QTc interval prolongation can lead to the ventricular proarrhythmia known as torsades de pointes, which may result in sudden cardiac death. A Scientific Statement from the American Heart Association and American College of Cardiology Foundation recommended increased awareness of risk factors and increased attention to QT interval monitoring. Independent risk factors for QTc interval prolongation in hospitalized patients include older age, female sex, hypokalemia, diagnoses of acute myocardial infarction, heart failure or sepsis, having a QTc interval > 450 ms on admission, taking a loop diuretic, taking one QTc interval-prolonging drug, and taking ≥ 2 QTc interval-prolonging drugs. Assessment of QTc interval prolongation risk factors and calculation of a QTc interval risk score may enhance risk assessment and facilitate risk reduction. Clinical decision support systems incorporating risk quantification may be effective for modifying prescribing of noncardiovascular QT interval-prolonging drugs and reducing the risk of QTc interval prolongation in hospitalized patients, and for warning clinicians when their patients have QTc interval > 500 ms. Goals and Objectives 1. Describe the prevalence of corrected QT (QTc) interval prolongation in hospitalized patients, and the prevalence of prescribing of QT interval-lengthening drugs to patients with pre-existing QTc interval prolongation. 2. Describe risk factors for QTc interval prolongation and their respective contribution to QTc interval prolongation in hospitalized patients. 3. Describe methods for reducing the prescribing of QT intervalprolonging drugs and decreasing the risk of QTc interval prolongation in hospitalized patients. Self-Assessment Questions 1. Which of the following is an independent risk factor for QTc interval prolongation in hospitalized patients? a. Chronic obstructive pulmonary disease b. Diabetes mellitus c. Taking digoxin d. Taking a loop diuretic 2. In hospitalized patients, a clinical decision support system incorporating a validated risk score for QTc interval prolongation significantly reduced the risk of: a.Prescribing of QTc interval-prolonging drugs b.QTc interval prolongation c.Sudden cardiac death d.Torsades de pointes Minto/Gulf Islands Hospital, Nanaimo Regional General Hospital, Port Hardy Hospital, Port 31 PHARMACY SPECIALTY NETWORKS The Impact of Inflammatory Arthritis on PSN Cardiovascular Disease Risk: What It is and N E T W O R K • C O M M U N I C AT E What to Do About It! Jill Hall BScPharm, ACPR, PharmD, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB 3. What strategies should be undertaken to appropriately assess and manage cardiovascular risk in patients with inflammatory arthritis? PHARMACY SPECIALTY NETWORKS Reporting Medication Events: You Don’t PSN Know What You Don’t Know N E T W O R K • C O M M U N I C AT E The increased mortality in patients with rheumatoid arthritis has been known for several decades and is largely attributable to cardiovascular disease. The increased cardiovascular risk is partly due to traditional risk factors, including hypertension, dyslipidemia, diabetes, tobacco use, and obesity, but is compounded by the inflammatory burden of this autoimmune disease and potentially the medications used to manage symptoms. Despite this, cardiovascular risk in these patients is often underestimated, under-assessed, and consequently undertreated. Recent guidelines have recognized inflammatory arthritis as an independent risk factor and have made suggestions to modify current assessment tools for these patients. However, there is a lack of understanding of and evidence for how to best assess and manage risk in this patient population. Do standard risk stratification tools work or do they need a multiplication factor to ensure accurate assessment? Do current drug therapies work ‘as well’ in inflammatory arthritis patients? Do disease modifying anti-rheumatic drugs or agents used for symptom management impact the efficacy of cardiovascular medications? Should surrogate targets be the same as for the general population? How can we best ensure patients are appropriately screened and treated to reduce cardiovascular morbidity and mortality? This session will review the factors that contribute to cardiovascular morbidity and mortality in patients with inflammatory arthritis and describe efforts underway to best assess and manage this risk. Janice Munroe, BScPharm, Lower Mainland Pharmacy Services - Fraser Health, Langely, BC; Jennifer Turple, BScPharm, ACPR, ISMP Canada, Halifax, NS Adverse drug events (ADEs) are defined as “an injury from a medicine or lack of an intended medicine. Includes adverse drug reactions (ADRs) and harm from medication incidents.1” The speakers will describe the various medication event reporting systems available in Canada for both ADRs and medication incidents. Discussion will involve a review of regulatory frameworks for the collection of ADEs, including emphasis on some new mandatory reporting expectations. The speakers will bring perspective on reporting from the hospital perspective through to the national perspective. The role of the patient in reporting medication incidents will also be described including references to studies and tools and resources to support active patient engagement. Jennifer will describe a Ontario’s provincial approach to learning from critical medication incidents reports. Janice will also describe Fraser Health’s trial of ADR reporting through their Patient Safety and Learning System and how this might impact ADR reporting provincially and nationally. The speakers will lead a discussion on how ADE reporting of can be supported and facilitated for hospital pharmacists. 1. eveloped by the collaborating parties of the Canadian D Medication Incident Reporting and Prevention System. 2005.available at http://www.ismp-canada.org/definitions.htm Goals and Objectives Goals and Objectives 1. To understand how traditional (diabetes, hyperlipidemia, hypertension, smoking) and non-traditional (inflammatory burden, medications) risk factors contribute to the increased cardiovascular risk in patients with rheumatoid arthritis. 1. To describe various medication incident reporting programs in Canada. 2. To increase awareness of the additional cardiovascular risk in this patient population and the need for systematic assessment and management of these risks in primary care. 3. To explore the current evidence of how to best assess and manage cardiovascular risk in patients with inflammatory arthritis. Self-Assessment Questions 1. Describe the impact that additional (nontraditional) cardiovascular risk factors have on morbidity and mortality for inflammatory arthritis patients. 2. To describe how medication incident reports can inform meaningful changes to improve medication and patient safety. 3. To describe a hospital-based adverse drug reaction reporting program and the impact of Vanessa’s law on front line practitioners. Self-Assessment Questions 1. What are the various adverse drug event reporting systems at the local, provincial, and national levels? And, available to health professionals and patients? 2. What regulatory frameworks exist for adverse drug event reporting? 2. Which disease modifying anti-rheumatic (DMARD) therapies have been shown to reduce cardiovascular risk in patients with rheumatoid arthritis? 32 McNeill Hospital, Royal Jubilee Hospital, Saanich Peninsula Hospital, St. Joseph’s General PHARMACY SPECIALTY NETWORKS Controversies in Closure of Patent Ductus PSN Arteriosus N E T W O R K • C O M M U N I C AT E Dolores C. Iaboni, BSc(Pharm), Sunnybrook Health Sciences Centre, Toronto, ON The ductus arteriosus (DA) is a normal fetal blood vessel that is necessary for fetal circulation. The persistence of the patency of the DA after birth has been associated with morbidities particularly in the preterm population. Patent ductus arteriosus (PDA) occurs on the third day of life in approximately 30% of premature infants with a birthweight of less than 1500g. Historically, closure of the PDA has been a standard of treatment. Although there has been a shift towards treatment of only the hemodynamically significant PDA, the question of which pharmacological agent to use continues to challenge clinical pharmacists caring for this vulnerable population. This presentation will provide the clinical pharmacist with a summary of the evidence for the timing of treatment and choice of pharmacological agents in the closure of PDA. The most common agents, intravenous indomethacin and intravenous ibuprofen will be discussed as well as the newer, more controversial choices, oral ibuprofen and oral and intravenous acetaminophen. The mechanisms of action, pharmacokinetics, efficacy, and side effects of these various agents will be covered. A brief discussion of future directions in research for these pharmacological agents will also be presented. Goals and Objectives 1. To present the controversies in closure of the patent ductus arteriosus with focus on the pharmacological agents. 2. To provide the clinical pharmacist with the evidence to choose the appropriate agent when presented with a particular patient with PDA. 3. To discuss the gaps in the literature and future directions for research. Self-Assessment Questions 1. Compare and contrast the mechanisms of action of the various agents used in PDA closure. 2. Describe the advantages and disadvantages of the various dosage forms for the pharmacological agents used in the closure of PDA. 3. Determine the agent of choice when presented with a particular preterm patient. PHARMACY SPECIALTY NETWORKS Oral Extemporaneous Compounding PSN References: Pros and Cons N E T W O R K • C O M M U N I C AT E Karen Walsh, BScPhm, ACPR, RPh, Hospital for Sick Children, Toronto, ON Extemporaneous oral formulations are required by pediatric and geriatric patients, patients with feeding tubes and patients who cannot swallow tablets/capsules. Meeting the needs of our patients can be challenging for Pharmacists when asked to compound these oral liquid formulations that are not commercially available. It may be very easy to locate a formulation with a quick search. However, what should you know about the references you are using? The purpose of this session will be to review the pros and cons of some of the more commonly used oral compounding references that are available to the practicing Pharmacist. Identifying the criteria of a valid stability study using Trissel’s principles and CSHP’s Policy for Publication of Chemical Study Manuscripts will also be highlighted. Goals and Objectives 1. To give an overview of what are the more commonly used references that are available to the Pharmacist for compounding oral extemporaneous products. 2. To highlight the pros and cons of each reference. 3. To understand what to look for when critiquing stability studies. Self-Assessment Questions 1. What are the criteria of a valid stability study using Trissel’s principles and CSHP’s Policy for Publication of Chemical Study Manuscripts? 2. What are the main pros and cons of the International Journal of Pharmaceutical Compounding? 3. What references will you use to find a compounding recipe? To Use or Not to Use the Hospital Pharmacy in Canada Report? Jean-François Bussières, BPharm, MSc, MBA, FCSHP, CHU SainteJustine, Montréal, QC The Hospital Pharmacy Practice in Canada is monitored with an annual or bi-annual survey of hospitals with at least 50 acute care beds. A report is prepared and published in the spring by an independent board of hospital pharmacists representing the different regions of the country. While the report has been published since the 1985-1986 and is easily accessible on the web, its use by hospital pharmacy directors and frontline pharmacists can enhanced through group discussions and meetings. In the context of financial constraints and numerous professional challenges, hospital pharmacists and other stakeholders may benefit of further exploration of the rich data contained in this report. Goals and Objectives 1. To identify key results of the 2013/14 Hospital Pharmacy Report in Canada. 2. To illustrate how the report can be used by hospital pharmacists. Hospital, Tofino General Hospital, Victoria General Hospital, West Coast General Hospital • 33 WEDNESDAY, FEBRUARY 4 MERCREDI 4 FÉVRIER Antimicrobial Resistance: Is it as Scary as Ebola? Linda Dresser, PharmD, FCSHP, University Health Network, Toronto, ON The Ebola virus outbreak in West Africa has captured the attention of the world similar to the SARS epidemic of 2003. To date, there have been greater than 13,000 confirmed cases and almost 5000 deaths reported (as of November 2, 2014). The threat of Ebola is scary and everyone knows it. The threat of antimicrobial resistance is scary too, but not everyone knows it. The World Health Organisation (WHO) issued a report on Antimicrobial Resistance Surveillance in 2014 and the Centers for Disease Control and Prevention (CDC) published the Antibiotic Resistance Threat Report in 2013. Some of the take home messages from these statements include: infections due to drug resistance organisms are found worldwide, all are associated with an excess risk of morbidity and mortality, treatment options are limited or non-existent for some multi-drug resistant pathogens and there are few new agents in the drug development pipeline. Like the Ebola virus pandemic there was a significant lag between the time of recognition of the issue to a global response; like Ebola the world is scrambling to catch up and contain the problem and progress is less than ideal; unlike Ebola there is not going to be a vaccine that might prevent future outbreaks; unlike Ebola you are likely going to encounter a patient with an antibiotic resistant infection on a regular basis regardless of where you practice. Unlike Ebola, despite the calls to action of leading health promotion agencies the threat that is much closer to home is largely underappreciated by clinicians and public. This presentation will focus on the actions recommended by health agencies to address the threats of antimicrobial resistance and progress and prospects. Over the past 3 decades there have been major advances in HIV treatment and we now have over 25 drugs from 6 different classes. In patients who can adhere to therapy and achieve an undetectable viral load, HIV is now considered a chronic manageable disease and life expectancy is near normal. Goals of therapy include virologic suppression, immune reconstitution, prevention of morbidity and mortality, and prevention of transmission of HIV to uninfected persons. Treatment has become more effective, easier to take and is generally less toxic. However, new challenges have emerged as a result of treating an aging population with numerous comorbidities. First-line therapy includes the use of triple combination ARVs with at least two drug classes included in the regimen. ARVs are selected based on efficacy, resistance patterns, tolerability and patient specific factors. Therapy is indicated in all patients who are ready to start, and in particular in those with a CD4 count < 350 cells/mm3. To facilitate taking chronic ARVs and to minimize pill burden, the focus in recent years has been on the development of once daily single table regimens (STRs) and fixed-dose combination (FDC) formulations. The pros and cons of some of the newer regimens will be highlighted, including the management of common/ significant drug interactions and side effects. Goals and Objectives 1. To provide pharmacists with an understanding of the most recent guidelines for treating HIV-infected individuals. 2. To provide pharmacists with current information on new antiretrovirals and their role in managing HIV disease. Goals and Objectives Self-Assessment Questions 1. To update the audience on the current threat level of antimicrobial resistance. 1. Which regimens are considered first-line therapy in treating HIV disease? 2. To highlight the key pathogens of concern for pharmacists managing patient in Canadian healthcare institutions. 2. What are the advantages of some of the newer antiretrovirals? 3. To describe progress and prospects for addressing antimicrobial resistance. Self-Assessment Questions 1. List the 3 microorganisms considered to be at threat level urgent by the CDC. 2. List 3 strategies to address the issue of antimicrobial resistance at a population or patient level. HIV Infection and Treatment: A Primer for Pharmacists Michelle Foisy, BScPharm, PharmD, ACPR, FCSHP, AAHIVP, Northern Alberta Program, Royal Alexandra Hospital, Edmonton, AB. 34 The goal of this session is to provide pharmacists with an update on the most current HIV treatment guidelines including the goals of therapy, when to initiate treatment, and the role of various antiretrovirals (ARVs). Oncologic Emergencies Sonia Cheung, BScPhm, ACPR, Trillium Health Partners, Mississauga Hospital, Mississauga, ON The purpose of this session is to provide a broad overview of commonly encountered oncologic emergencies and their recommended management strategies. Despite improved survival and decreased mortality in certain cancer types, and as the life expectancy of the general population lengthens, the prevalence of cancer continues to climb. Thus, it is not surprising that oncologic emergencies as a result of cancer or its treatment are commonly seen in the acute hospital setting. Some of these oncologic emergencies may develop insidiously over weeks or months, while others are true medical emergencies that may develop in a matter of hours, and left Vernon Jubilee Hospital MANITOBA: • Dauphin Regional Health Centre NEW BRUNSWICK: untreated, may lead to devastating consequences such as paralysis and death. Not uncommonly, an oncologic emergency may be the presenting condition that leads to a new cancer diagnosis. This session will review 5 common oncologic emergencies that are commonly encountered in the acute hospital setting: hypercalcemia of malignancy, superior vena cava syndrome, malignant spinal cord compression, brain metastases leading to increased intracranial pressure and seizures, and tumor lysis syndrome. The etiology, presentation, diagnosis, and management of each of these oncologic emergencies will be discussed. Currently recommended treatment strategies will be reviewed in the context of available evidence and management guidelines. Goals and Objectives 1. To goal of this session is to provide pharmacists with a working knowledge of common oncologic emergencies and their management strategies. 2. Describe the etiology, presentation, diagnosis and management of commonly encountered oncologic emergencies. 3. Review the evidence behind currently recommended prevention and management strategies for selected oncologic emergencies. Self-Assessment Questions 1. What are some of the most commonly encountered oncologic emergencies and how do they present? 2. How can these oncologic emergencies be best prevented and managed? The Limited Role of Aerosolized Antibiotic Gary Wong, BScPhm, University Health Network, University of Toronto, Toronto, ON Ventilator-associated pneumonia (VAP) and Hospital acquired Pneumonia (HAP) still have poor outcomes despite are attempts to improve antibiotic regimens. Multidrug-resistant pathogens and achieving high concentration of antibiotics at the site of infection are challenges in this disease state. Aerosolized administration of antibiotics have the potential of providing high local concentrations in the lung at the site of infection and minimizing system concentration limited some concentration dependent adverse reactions. This concept has the potential to improve efficacy and decrease the risk of microbial resistance. There are several factors which influence the deposition of antibiotic into the distal small airways. Nebulization devices have had many engineering improvements over the few years optimizing the delivery of aerosolized antibiotics (AA). Several recent retrospective reviews on the use of AA used in adjunctive therapy with systemic antibiotics have shown to improve survival. This is in contrast to the older studies which showed a limited benefit of aerosolize antibiotics. Goals and Objectives 1. To give you some insight into important factors which influence the delivery of aerosolized antibiotics into the lungs. 2. To review some of the important studies in aerosolized antibiotic. 3. To give some insight of future of aerosolized antibiotics. Self-Assessment Questions 1. What are some of the factors which impact the delivery of aerosolized antibiotic in patient with Pneumonia? 2. What is the present role of aerosolized antibiotic in the therapy of Pneumonia in patient in a hospital setting? Practicing Pharmacy with Diverse Populations: Going Beyond Cultural Competency Jeffrey Wong, BScPhm, Hamilton Family Health Team, Hamilton, ON Our patients hold a range of diverse identities. In order to provide a truly patient-centered approach, we must consider the implications of this diversity as we provide pharmaceutical care. While obtaining “cultural competency” is commonly considered the standard, there are limitations to this end-point driven approach. It risks labeling patients as “the other”, simplifying their life experiences into convenient checkboxes. Operating under an evidence-based approach, traditional cultural competency training has been shown to be largely inadequate and potentially harmful. The increasing complexity of multiculturalism necessitates a new paradigm. This session will provide you with an evolved framework and tools on how to optimize patient care when working with diverse populations. Diversity will be defined in its broadest sense, encompassing cultural diversity, sexual and gender diversity, diversity in healthcare philosophies, and more. This session will focus on the concept of diversity humility, which recognizes the importance of empathy and lifelong self-critique. It recognizes that pharmacists are not just passive observers when working with diverse patients, but that we bring our own baggage. The topic of narrative medicine will be explored, focusing on practical strategies on how to start listening narratively. We will also discuss the historical narratives of unique patient groups, as they provide important context for the current power imbalances in our society and for how members of these groups may interact with our healthcare system. Goals and Objectives 1. Develop and apply your diversity humility, while distinguishing between using generalizations, instead of stereotypes, to help provide patient-centered pharmaceutical care to diverse populations. • Centre hospitalier universitaire Dr-Georges-L.-Dumont • Charlotte County Hospital • Dr. 35 2. Understand how the issues of privilege and the various levels of oppression can impact how our patients seek and receive healthcare. 3. Appreciate the importance of empathy, through the use of narrative listening, in improving patient outcomes. Self-Assessment Questions 1. What are the 3 main facets of cultural humility? 2. How is cultural humility different from cultural competency? 3. What does it mean to interview a patient using a narrative style? 4. How does this approach help redress power imbalances between provider and patient? Addressing Medication Errors in HIV-Positive Inpatients: A Clinician’s Guide to Antiretroviral Assessment Michelle Foisy, BScPharm, PharmD, ACPR, FCSHP, AAHIVP, Northern Alberta Program, Royal Alexandra Hospital, Edmonton, AB; Elliot Pittman, BScPharm, PharmD; Emily Li, BScPharm, PharmD, Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, AB The goals of this session are to provide an overview of the literature on drug error in hospitalized HIV-positive patients and to introduce an educational guide designed to assist nonHIV clinicians in assessing HIV patients on antiretroviral (ARV) therapy with the goal of identifying and preventing drug-error in this population. The focus of the session will be on patient assessment with use of a case presentation to illustrate how the guide can be used in practice. With advancements in pharmacotherapy, HIV is now considered a treatable chronic disease; however, many HIV-infected individuals are hospitalized for other comorbidities. Due to the complexity of ARV therapy and the fact that non-specialized clinicians are often unfamiliar with HIV management, very high rates of medication errors in this population have been reported in the literature and involved mostly ARVs. Errors occurred mainly at the time of prescribing on admission, but were also found at other stages of hospitalization such as dispensing by the pharmacy, medication administration on the unit, and prescribing on discharge. The main reasons for drug error were lack of both medication knowledge and accurate medication reconciliation. Recognizing the significance of medication error in the hospital setting, and the need for staff education, we developed a comprehensive evidence-based ARV patient assessment framework. The guide consists of a 3-step process addressing patient admission, internal unit transfer and discharge. Supplementary appendices include information on specific laboratory tests, drug interactions, ARV agents, and additional resources. 36 Goals and Objectives 1. To provide pharmacists with an understanding of the types and clinical significance of medication errors that have been reported in HIV-positive hospitalized. 2. To provide pharmacists with a guide to assessment of antiretroviral therapy in HIV-positive patients with the goal of identifying, managing and preventing medication errors in this population. Self-Assessment Questions 1. What are the most common types of medication errors that occur in hospitalized HIV-positive patients? 2. What is the clinical significance of medication error in this population? 3. How can pharmacists use the antiretroviral assessment guide to support inpatient practice? Documentation in Electronic Medical Records #FTW Andrew Liu, HBSc, BScPhm, RPh, Toronto East General Hospital, Toronto, ON Toronto East General Hospital implemented Computerized Provider Order Entry and electronic Medication Administration Record (eMAR) in 2009 for all in-patients and day-surgery patients. Shortly thereafter, electronic best possible medication history (BPMH) documentation was introduced and today virtually 100% of BPMH’s are documented electronically. Pharmacists’ clinical documentation at our hospital has progressed substantially toward seamless electronic entries. In this session, a brief review of the journey for pharmacists converting from primarily paper documentation will be discussed. Additionally, the review will encompass examples of electronic documentation formats in acute in-patient services, antimicrobial stewardship, ambulatory areas, such as dialysis and preadmission clinic, and strategies that were leveraged to help increase ease and uptake. The electronic patient record environment that will be used to illustrate these points is Cerner. Goals and Objectives 1. To provide a brief overview of converting to electronic documentation. 2. To illustrate examples of electronic clinical documentation incorporated into routine practice in various settings. 3. To review some sustainability strategies and benefits with electronic clinical documentation. Self-Assessment Questions 1. How might you use electronic documentation tools to support your clinical initiatives? 2. How can electronic documentation support inter professional workflow? Everett Chalmers Regional Hospital • Grand Manan Hospital • Hôpital Stella-Maris-de- Are We Choosing Wisely? Quality, Value and Irrationality in Hospital Practice confusion/clarity, sedation, agitation/aggression, discontinuation syndrome and dry mouth. Mark McIntyre, PharmD, ACPR, RPh, Mount Sinai Hospital, Toronto, ON The pharmacist can help the patient identify these adverse effects and risks using pharmaceutical care tool education and effective empathic communication techniques. In return, the patient will have a better chance at adherence, therapeutic success (personal and workplace) and prevent confusion and potential negative outcomes. Medications have value only if data can justify the risk to the patient as well as the resources utilized to obtain and deliver them. A cornerstone of our profession is the ability to discern the balance between safety, cost and efficacy and deliver optimized patient care and value. This tenant significantly predates current initiatives such as the Choosing Wisely Campaign and reveals pharmacists to be uniquely suited to assist in improving healthcare quality and reducing waste. Clinicians, including pharmacists, frequently overlook the common and established in favour of the new and different when appraising which therapies are clinically valuable. This choice carries a potentially negative consequence for both patient care and resource utilization. Our discussion will focus on the utility of frequently prescribed medications and highlight the opportunity cost of investing resource in that which has little clinical efficacy. Goals and Objectives 1. To highlight the most commonly overprescribed medications leading to waste in the institutional environment. 2. To assess ways by which pharmacy as a profession can improve quality/value and reduce waste in the healthcare system. Self-Assessment Questions Goals and Objectives By the end of this session, the participants will be able to: 1. Identify the psycho-social and patient care models that revolve around mental health patient care, filtered through provincial labour legislation. 2. Have an enhanced application of medications that may cause changes in cognition, agitation, aggression and resultant discontinuation syndrome. 3. Be empowered to dialogue with patients/caregivers or employers and provide proactive pharmaceutical care in a personalized manner to help prevent negative workplace situations. Self-Assessment Questions 1. What are steps that you take to ensure the patient is safe in all facets of their bio-psycho-social aspect when starting a medication? 1. What are the most commonly over-utilized therapies in your institution? 2. Which medication group causes the most workplace interactions with mental health medication, causing agitation, irritability and cognitive clouding? 2. How could you assess the impact of these therapies on your patient’s health or departmental budget? 3. How can pharmacists improve cognition and cognitive symptoms in their patients when re-entering the workplace? 3. How do you change culture and improve quality within your institution? PHARMACY SPECIALTY NETWORKS Now You Feel Better but Your Heart PSN Doesn’t: Cardiovascular Side Effects of N E T W O R K • C O M M U N I C AT E PHARMACY SPECIALTY NETWORKS Mental Health Medication Side Effects in PSN the Workplace N E T W O R K • C O M M U N I C AT E Joel Lamoure RPh, DD, FASCP, Western University, Lawson Research Institute, EIM-CARE Inc., London, ON Mental health conditions may affect anywhere from one in four to up to half of Canadians in their lifetimes, depending on the quoted literature. The probability of a person directly knowing somebody directly impacted from a mental health condition is almost 100 percent. Given that the mainstays of therapies revolve around medications and psychological interventions, most people with a mental health diagnosis are on multiple medications. Medications, coupled with stigma and psycho-social stressors create a situation where dialoguing about the medications are not in the open forum. As such, side-effects are quietly “suffered” by patients, and may appear as differences to co-workers, friends and family who may not understand the root causes of these changes. In this presentation, we will focus on cognition/ Psychotropic Medication Jamie Kellar, RPh, BScHK, BScPhm, PharmD, Centre for Addiction and Mental Health, Toronto, ON Psychotropic medications, including antipsychotics, antidepressants and mood stabilizers are the main stay of treatment for mental illnesses. These medications are very effective in treating schizophrenia, major depressive disorder, anxiety disorders and bipolar disorder, yet they can be associated with numerous side effects because of their actions on numerous receptors and physiological systems in the body (1). Many of these medications affect cardiovascular function both directly and indirectly, with up to 75% of patients in clinical trials and observational studies experiencing some type of cardiovascular adverse effect (1). Cardiovascular side effects of psychotropic drugs include postural hypotension, tachycardia, palpitations, heart failure, arrhythmias, myocarditis, metabolic syndrome, and sudden cardiac death (1, 2, 3). This picture is further complicated by the fact that individuals with mental illness are more likely to suffer from cardiovascular disease (4). Hence, the goals for Kent • Hotel-Dieu of St. Joseph • Miramichi Regional Hospital • Oromocto Public Hospital 37 this presentation are to discuss the cardiovascular side effects associated with psychotropic medications; describe the proposed mechanisms for such adverse effects and evaluate the available treatment options available to minimize the adverse effects. Particular attention will be paid to postulated mechanisms of antipsychotic induced weight gain and metabolic syndrome and current evidence regarding pharmacological treatment options to prevent and treat this phenomenon. Self-Assessment Questions 1. Which psychotropic induced cardiovascular side effects are the most common? Which are less common but more serious? 2. Which class of psychotropic medication is associated with the most cardiac side effects? Of this class, which particular medication has the highest risk of cardiovascular side effects? 3. What pharmacological agent has the strongest evidence in the treatment and prevention of antipsychotic induced weight gain and metabolic syndrome? Fecal Transplants: What Pharmacists Need to Know Susy Hota, MD, MSc, FRCPC, University Health Network, Toronto, ON Recurrent Clostridium difficile infection (CDI) remains a common and serious health care associated infection with 1 in 5 patients experiencing recurrent disease. In this presentation, I will discuss challenges with managing recurrent CDI, fecal transplantation as a possible treatment for recurrent CDI and will review new, innovative approaches to fecal transplantation. Goals and Objectives 1. To provide a review of the current evidence behind fecal transplantation as a treatment for recurrent CDI. 2. To outline new developments in the field of fecal transplantation. Self-Assessment Questions 1. What level of evidence exists for fecal transplantation as a treatment for recurrent CDI? 2. What are the largest current barriers to fecal transplantation as a treatment for patients with recurrent CDI? PHARMACY SPECIALTY NETWORKS What We’ve Learned about Antimicrobials PSN from Ontario Databases: Outcomes and N E T W O R K • C O M M U N I C AT E Adverse Effects Muhammad Mamdani, PharmD, MA, MPH, St. Micheal’s Hospital, Toronto, ON This session provides an overview of clinical research principles as they relate to using large databases to study the safety and effectiveness of antimicrobial therapies. The strengths and limitations of clinical trial methodologies and how the findings translate to clinical practice will be reviewed as well as interpretation of observational studies that examine rare outcomes and the clinical impact of drug-drug interactions. Attendees will gain a deeper understanding of how to interpret research findings of large studies that examine the safety and effectiveness of antimicrobials. Goals and Objectives 1. To gain a broader appreciation of antimicrobial research using large databases and its application to clinical practice. 2. To gain a better understanding of clinical research principles. 3. To review the strengths and limitations of clinical trial and observational epidemiology designs. 4. To better understand the nuances of interpreting clinical research findings of studies assessing the effectiveness and safety of antimicrobials 3. To demonstrate what patients are learning about fecal transplantation through media and internet coverage. 38 • Sackville Memorial Hospital • Saint John Regional Hospital • St. Joseph’s Hospital & CSHP Research and Education Foundation Fondation pour la recherche et l’éducation de la SCPH Unlock the future... you are the key Ouvrez les portes à l’avenir... Vous en êtes la clé T he CSHP Foundation is an independent, charitable organization created by the Canadian Society of Hospital Pharmacists to support research and educational programs that advance patient-centered pharmacy practice in hospitals and related healthcare settings for the betterment of public health. Research and Education Grants and Pharmacy Leadership Academy Scholarships for CSHP Members And the 2014 winners are… Research Grants • Tammy Bungard: Patient-centred Care for Warfarin Management: A Pilot Study to Transition Care to High Risk Patients • Grant: $15,750 • Sheryl Zelenitsky: Is the Recommended Cefazolin Prophylaxis Adequate in Cardiac Surgery? • Grant: $10,210 • Emily Black: Impact of Antimicrobial Stewardship Strategies in the Emergency Department: A Qualitative Systematic Review • Grant: $500 Education Grants • Barbara Farrell: Applying Evidence-Based Medicine to the Elderly, Frail and Complex (Thematic Conference Development) • Grant: $5,055 Pharmacy Leadership Academy (PLA) Scholarship • Sheena Neilson: Alberta Health Services, Pharmacy Services Business Operations Team Member • Tuition: $7,500 2015 PLA Scholarship Application Deadlines ASHP Foundation by February 13 and CSHP Foundation by March 27, 2015 Visit the Foundation website for details. These 2014 grants were made possible by the donations of our generous sponsors: AstraZeneca Canada Ltd., Pfizer Canada Inc., Sanofi Canada, Sandoz Canada Inc., Pendopharm, Mylan Canada, SteriMax Inc. and CSHP members. www.cshpfoundation.ca Community Health Centre • Sussex Health 39 SES 2015 Call for Abstracts 2015 Summer Educational Sessions (SES) Westin Ottawa Ottawa, ON August 15 to 18, 2015 Séances éducatives d’été (SÉÉ) 2015 The Westin Ottawa Ottawa, ON 15 au 18 août 2015 INFORMATION GÉNÉRALE GENERAL INFORMATION Catégorie Category Author must specify the category that best suits the particular abstract. Abstracts will be judged according to the category submitted to by authors. 1. Original Research (includes Pharmaceutical/Basic Science, Clinical Research, Drug Use Evaluations, Systematic Reviews and Meta-Analysis, Pharmacoeconomics Analysis, etc.) 2. Case Reports 3. Pharmacy Practice (includes Administration Projects, Health Professional Education, Medication Safety Initiatives, etc.) L’auteur doit indiquer la catégorie qui sied le mieux au résumé qu’il soumet. Les résumés seront évalués en tenant compte de la catégorie mentionnée par les auteurs. 1. Recherche originale (y compris la recherche pharmaceutique, fondamentale ou clinique, les évaluations de l’utilisation des médicaments, les examens systématiques et les méta-analyses, les analyses pharmacoéconomiques, etc.) 2. Études de cas 3. Pratique pharmaceutique (y compris les projets administratifs, la formation des professionnels de la santé, les projets liés à la sécurité des médicaments, etc.) SCPH 2015 CSHP 2015 CSHP 2015 related abstracts will be designated as such. If your abstract is linked to CSHP 2015 initiatives, please clearly indicate this on the online abstract submission form. Les résumés qui sont en lien avec le projet SCPH 2015 seront désignés comme tels sur les lieux. Si votre résumé est lié au projet SCPH 2015, assurez-vous de le mentionner clairement sur le formulaire de soumission en ligne de résumés. Soumission de résumés Abstract Submissions Abstracts must be submitted electronically as a file in MS Word Format. Please complete the abstract submission form online at CSHP’s Web site (http://www.cshp.ca) prior to submitting the abstract. If you are submitting more than one abstract, an abstract submission form must be completed for each abstract. Les résumés DOIVENT être présentés électroniquement et le fichier doit être en format MS Word. Veuillez remplir le formulaire de soumission de résumés en ligne affiché sur le site Web de la SCPH à http://www.cshp.ca avant de soumettre votre résumé. Si vous présentez plus d’un résumé, vous devez remplir un formulaire pour chaque résumé soumis. Abstract review and grading is conducted by two randomly assigned, blinded, and independent reviewers. Abstracts are selected on the basis of scientific merit, originality, level of interest to pharmacists, and compliance with style rules using a standardized scoring system. Disagreement between the two reviewers will be adjudicated by a third, blinded independent reviewer. The decision of the adjudicator will be the final decision. Les résumés sont examinés et évalués par deux réviseurs indépendants assignés au hasard et en aveugle. Les résumés sont choisis en tenant compte de leur originalité, de leur intérêt pour les pharmaciens et du respect des règles de style, ceci à l’aide d’un système normalisé de notation. S’il y a divergence d’opinions entre les deux réviseurs, une troisième personne indépendante examinera le résumé à l’aveugle et prendra une décision finale. Failure to comply with style requirements for submission (see below), including submission of an unblinded abstract or any other style rules, will result in automatic rejection of the submission. Encore Presentations: Abstracts of papers published or in-press are not eligible. Abstracts previously presented at other National (other than another CSHP meeting) or International meetings may be considered for inclusion as encore presentations. Details including the citation of a published abstract and/or name, location and dates of the conference presented at must be included. These encore 40 Demande de résumés pour les SÉÉ 2015 Le non-respect des exigences de présentation des résumés (voir cidessous), y compris la soumission d’un résumé dont l’anonymat n’a pas été préservé ou l’utilisation de toute autre règle de présentation, entraînera le rejet automatique de cette soumission. Présentations en rappel : Les résumés d’articles publiés ou sur le point de l’être ne sont pas admissibles. Les résumés ayant déjà été présentés au cours d’un autre congrès national (autre qu’un congrès de la SCPH) ou international peuvent être évalués en tant que présentations en rappel. Il est nécessaire de préciser le nom, le lieu et les dates de la conférence où la présentations a été faite ou la référence du résumé publié. Ces présentations seront identifiées comme des rappels. Les résumés de présentations en rappel doivent aussi respecter l’ensemble des règles de style et d’anonymat, et ils seront évalués selon les mêmes critères que les autres résumés. Les résumés qui auront été acceptés seront publiés dans le programme final et le Journal canadien de la pharmacie hospitalière ( JCPH). Ils y seront publiés tels quels. Pour ce qui est des présentations en rappel, seuls les noms des auteurs, la référence d’origine et le titre du résumé seront publiés dans le JCPH à moins qu’il y ait suffisamment d’espace pour les publier. Centre • The Moncton Hospital • Upper River Valley Hospital NOVA SCOTIA: • Capital presentations will be marked as such. Encore abstracts must still follow all style and blinding rules and will be assessed as per standard evaluation criteria. Accepted abstracts will be published in the final program and in the Canadian Journal of Hospital Pharmacy (CJHP). Abstracts will be published as submitted. Only the abstract title, authors, and original citation will be published in CJHP for encore presentations, unless space permits. Authors of accepted abstracts will be notified within 4 weeks of the deadline submission. Authors are responsible for their own transportation and accommodations. Early registration fees will apply to all accepted poster applications. Guidelines for posters will be provided to authors of accepted abstracts. Date and method of presentation will be determined by the Education Services Committee. It is the responsibility of the presenting author to be at their designated poster boards during the poster viewing hours. If the presenting author cannot be there for the assigned date, it is the presenting author’s responsibility to find an alternate author as presenter. Abstract Style Rules Abstracts that do not adhere to the rules will be rejected. Title should be brief and should clearly indicate the nature of the presentation. Capitalize only the first letter of each word of the title. Do not use abbreviations in the title. List the authors (last name, first initial) under the title. Institutional affiliation, city, and province should be listed under the list of authors with corresponding footnotes identifying author affiliation(s). Please underline the name of the author who will present the poster if accepted. Omit degrees, titles, and appointments. The required font is Times New Roman, 12-point. Organize the body of the abstract, using the exact headings below, according to the selected category as follows. The abstract (including the title and body) should be blinded and not include any identifying information including the geographic location, authors, programs or institutions of origin. Author names will be removed after submission for blinded review. Original Research: Headings are: Background, Objective(s), Methods, Results, Conclusion(s) The background section should briefly describe the rationale for the study. The objective section should include the main study objective(s). The method section should include study design, methods, intervention, and statistical analysis. The results section should provide main results. The conclusion section should include the main conclusion and interpretation of the results which are supported by the data provided. Case Reports: Headings are: Background, Case description, Assessment of causality, Literature review, Importance to practitioners The background section should briefly describe the rationale for the case report. The case description should provide details of the case. Enough details should be provided to clearly outline the case and support the assessment of causality. The assessment of causality section should describe assessment of causality. Les auteurs des résumés choisis seront avisés dans un délai de quatre semaines après la date butoir de soumission. Les auteurs doivent assumer leurs propres frais de transport et d’hébergement. Tous les auteurs des résumés acceptés auront droit aux frais d’inscription anticipée. Des directives concernant l’affichage seront fournies aux auteurs dont les résumés auront été acceptés. Il incombe au comité des services éducatifs de décider des dates et des modalités de présentation. L’auteur qui présente le résumé se doit d’être présent à son tableau d’affichage pendant les heures de présentation des affiches. Si l’auteur ne peut être présent à la date assignée, il a la responsabilité de désigner un remplaçant qui pourra en faire la présentation. Règles de style pour les résumés Les résumés qui ne se conforment pas aux règles de présentation seront rejetés. Le titre devrait être bref et indiquer clairement la nature de la présentation. Seule la première lettre du premier mot du titre doit être en majuscule. Le titre ne doit pas contenir d’abréviations. Le nom des auteurs (nom de famille et initiale) doit apparaître sous le titre. Les noms des établissements auxquels sont affiliés les auteurs, la ville et la province où sont situés les établissements devraient être précisés sous la liste des auteurs avec des appels de notes servant à indiquer les affiliations du ou des auteurs. Veuillez souligner le nom de l’auteur qui présentera l’affiche si le résumé est accepté. Les diplômes, les titres et les affectations ne doivent pas être mentionnés. Il faut utiliser la police Times New Roman 12. Le texte du résumé doit être organisé conformément aux règles propres à la catégorie à laquelle il appartient, en utilisant les en-têtes exacts mentionnés ci-dessous. Le résumé (dont le titre et le texte) doit préserver l’anonymat et ne contenir aucune information susceptible de révéler l’emplacement géographique, les auteurs, les programmes et les établissements d’origine. Les noms des auteurs seront retirés après la soumission pour que l’examen soit effectué à l’insu. Recherche originale : Les en-têtes sont : Contexte, Objectif(s), Méthodologie, Résultats, Conclusion(s) Le Contexte devrait décrire brièvement la raison d’être de l’étude. L’Objectif devrait inclure les principaux objectifs de l’étude. La Méthodologie devrait inclure le plan de l’étude, la méthodologie, les interventions et l’analyse statistique. La rubrique Résultats devrait fournir les principaux résultats obtenus. La Conclusion devrait comprendre la conclusion principale et l’interprétation des résultats qui sont supportés par les données fournies. Études de cas : Les en-têtes sont : Contexte, Description du cas, Analyse de causalité, Évaluation de la documentation, Importance pour le praticien Le Contexte devrait décrire brièvement la raison d’être de l’étude de cas. La Description devrait fournir des détails sur le cas étudié. Les détails devraient être suffisamment nombreux pour définir clairement le cas à l’étude et soutenir l’analyse de causalité. L’Analyse de causalité District Health Authority • Colchester East Hants Health Authority • Dartmouth General 41 Strong consideration should be given to using an objective tool such as the Naranjo scale. The literature review section should briefly examine current literature relating to or surrounding the case report. The importance to practitioners section should briefly describe implications/importance of the case report to pharmacy practitioners. Pharmacy Practice: Headings are: Background, Description, Action, Evaluation, Implications The background section should briefly describe background and rationale for service, program, problem, need, etc. The description section should describe the concept, service, role, or situation. The action section should describe the steps taken to identify and resolve a problem(s), implement change, or develop and implement the new program. The evaluation should describe the evaluation process of the project and results of evaluation. The implications section should describe the concept’s importance and usefulness to current and/or future practice. Abstract Text • Abstract body (not including title and authors) is limited to 300 words. This includes the required section headings as outlined above. Any abstract that exceed the word count will be rejected. • Each table is equivalent to 30 words. • Each graphic is equivalent to 60 words. • Results or evaluation must be included in the abstract. It is not acceptable to state that results will be discussed. Abstracts doing so will be rejected. • Do not indent the start of a paragraph. • Place abbreviations in parentheses after the full word the first time it appears. Please keep abbreviated terms to a minimum. • Use numerals to indicate numbers, except to begin sentences. • Use only generic names of drugs, material, devices, and equipment. • Do not include citations or reference numbers. Email Confirmation of Abstract Submissions Submission Deadline: CSHP 68th Summer Educational Sessions (SES) 11:59 p.m. May 10, 2015 You should receive an email confirmation of your abstract submission. If you have not received an email confirmation by the deadline, please contact: Susan Maslin: Tel.: (613) 736-9733, ext. 229 Fax: (613) 736-5660 Email: [email protected] 42 devrait donner une description de l’analyse de causalité. Il est fortement recommandé d’utiliser un outil objectif comme l’échelle de Naranjo. L’Évaluation de la documentation devrait examiner brièvement la documentation existante en lien ou apparentée à l’étude de cas. La rubrique Importance pour le praticien devrait décrire brièvement les répercussions de l’étude de cas sur la pratique de la pharmacie et son importance pour les pharmaciens. Pratique pharmaceutique : Les en-têtes sont : Contexte, Description, Action, Évaluation, Répercussions Le Contexte devrait décrire brièvement la toile de fond et la raison d’être du service, du programme, du problème, du besoin, etc. La Description devrait fournir des détails sur le concept, le service, le rôle ou la situation. La rubrique Action devrait décrire les étapes prises pour identifier et résoudre les problèmes, effectuer le changement, ou développer et entreprendre le nouveau programme. L’Évaluation devrait décrire le processus utilisé pour l’évaluation du projet et les résultats de l’évaluation. La rubrique Répercussions devrait énoncer l’importance du concept et l’utilité pour la pratique actuelle et future. Texte du résumé • Le corps du résumé (excluant le titre et les auteurs) ne doit pas dépasser 300 mots. Ceci comprend les en-têtes requis comme mentionné précédemment. Tout résumé qui dépasse le nombre de mots permis sera rejeté. • Un tableau compte pour 30 mots. • Un graphique compte pour 60 mots. • Les résultats ou l’évaluation doivent être inclus dans le résumé. Il est inacceptable de mentionner que les résultats seront discutés. Les résumés qui procèdent de cette manière seront rejetés. • Le début des paragraphes ne doit pas être précédé d’un alinéa. • Placer les abréviations entre parenthèses après le terme qu’elles remplaceront, la première fois que le terme est utilisé. Veuillez limiter au minimum l’utilisation d’abréviations. • Les nombres doivent être écrits en chiffres, sauf lorsqu’il s’agit du premier mot d’une phrase. • Seuls les noms génériques des médicaments, du matériel, des instruments et de l’équipement doivent être employés. • Les résumés ne doivent pas contenir de citations ni de numéros de référence. Confirmation par courriel de la réception du résumé Date limite de soumission : 68es Séances éducatives d’été (SÉÉ) 23 h 59, 10 mai 2015 Vous devriez recevoir une confirmation par courriel de la réception de votr e résumé. Si vous n’avez pas reçu de confirmation par courriel avant la date limite, veuillez communiquer avec madame Susan Maslin : Téléphone : (613) 736-9733, poste 229 Télécopieur : (613) 736-5660 Courriel : [email protected] Hospital • East Coast Forensics • Eastern Shore Memorial Hospital • Hants Community Oral Abstract Session: Intriguing Papers from Original Research, Award Winners and Research and Education Grants Séance d’exposés oraux : Communications fascinantes choisies parmi les travaux de recherche originale et les projets des récipiendaires de prix, de bourses de recherche et de perfectionnement MONDAY, FEBRUARY 2 LUNDI 2 FÉVRIER 11:40 – 12:25 MAPLE 1. Assessing the Impact of an Expanded Scope of Practice for Pharmacists at a Community Hospital 2. Quality Improvement of Non-Sterile Compounding in Winnipeg Regional Health Authority Pharmacies 3. Optimized Dosing of Cefazolin in Patients on Nocturnal Home Hemodialysis ASSESSING THE IMPACT OF AN EXPANDED SCOPE OF PRACTICE FOR PHARMACISTS AT A COMMUNITY HOSPITAL Hwang S,1 Koleba T,2 Mabasa V2 Surrey Memorial Hospital, Surrey, BC 2 Burnaby Hospital, Burnaby, BC 1 Introduction: Clinical pharmacists at Burnaby Hospital began including expanded scope of practice (ESP) activities in their practice on April 1, 2012. ESP activities that a pharmacist may perform without prior authorization from a prescriber include re-ordering chronic medications, initiating OTC medications, changing drug formulations, changing drugs within same therapeutic classes, and titrating medication doses. The objective of this study was to describe and assess the impact of ESP at Burnaby Hospital, in terms of ESP activities performed and their associated outcomes, and the experience of pharmacists and the impact of ESP on physicians after its implementation. Methods: All ESP activities by pharmacists required documentation in the patient health care record via a Clinical Pharmacy Note (CPN). CPNs were collected from April 1st to September 30th, 2012 and were reviewed. Physicians and participating pharmacists were surveyed to gather feedback on their experiences. Results: A total of 227 CPNs produced by 11 clinical pharmacists were reviewed. These CPNs documented 194 activities that met the inclusion criteria. Of 194 activities, 135 (69.6%) were titrating medication doses. The majority of the outcomes were deemed to enhance clinical outcomes of the patient (81.5%). All of eight pharmacists and fourteen physicians surveyed either agreed or strongly agreed that the implementation of ESP improved overall quality of comprehensive patient care. Discussion: There was a high percentage of ESPs that pharmacists have traditionally performed, such as vancomycin and phenytoin pharmacokinetic dosing, and renal dosing services as expected. Since ESP implementation, pharmacists also provided new services, such as re-ordering chronic medications, initiating OTC medications, changing medications within therapeutic class, and titrating various other medications. Conclusion: Hospital pharmacists integrated ESP activities into their clinical practice with relative ease. These activities resulted in improved patient-related clinical and humanistic outcomes, as well as decreased health-care costs. QUALITY IMPROVEMENT OF NON-STERILE COMPOUNDING IN WINNIPEG REGIONAL HEALTH AUTHORITY PHARMACIES Woloschuk DMM, Simoens W, Balagus S., Winnipeg Regional Health Authority, Winnipeg, MB Objectives: We established policy, staff training, and quality assurance (QA) monitoring for non-sterile compounding (NSC) scales in Winnipeg Regional Health Authority (WRHA) pharmacies to improve patient safety and to enable delegation of NSC checking to non-pharmacists. Description: We inspected NSC practices and equipment at eight pharmacies. Based on identified gaps, we focused quality improvement efforts on policy and equipment that underpin NSC safety. Those efforts enabled staff training and a quality assurance (QA) program, and form a basis for regional master NSC recipes. Experience: Inspections conducted May-November 2012 showed that no pharmacy met procedures, recipe, and quality control (QC) process criteria. No pharmacy scales met all QA criteria, 4 (25%) scales required replacement, and 80% of scales needed new reference weights in order to perform routine QC. During January-June 2013, policy for scale operation, maintenance and QC, and mass determination checking standards were developed. To facilitate staff training, inservice slides and scale operation job aids were created and tested. Equipment and staff skill upgrades were completed June 2014. Follow-up QA audits are underway. Discussion: Best practices can fall by the wayside in busy pharmacies. Without detailed NSC standards, we had the cumbersome task of creating our own detailed policy, QC and QA monitoring processes for pharmacy scales. Staff welcomed the new measures. Conclusion: Improving NSC requires policy, procedures, and comprehensive QC and QA monitoring. Standardization of NSC foundational elements at eight hospital pharmacies has assured quality and, in concert with a concurrent project, enabled delegation of NSC checking to non-pharmacists at two of those pharmacies. OPTIMIZED DOSING OF CEFAZOLIN IN PATIENTS ON NOCTURNAL HOME HEMODIALYSIS Law V,1 Walker S,2 Dresser L,1 Battistella M,1 University Health Network and University of Toronto, Toronto, ON Sunnybrook & Women’s College Health Sciences Centre and University of Toronto, Toronto, ON 1 2 Background: Nocturnal hemodialysis (NHD) is an increasingly popular dialysis modality with demonstrated cardiovascular benefits; however infection remains a common complication. Antimicrobial dosing data are unknown for NHD. Methods: Prospective, open-label, pharmacokinetic study of cefazolin during NHD. Fifteen patients received a 2g intravenous (IV) infusion of cefazolin immediately after NHD on day one and a second dose after NHD on day two. Blood samples were drawn at 0, 60, 180, and 360 minutes during hemodialysis (HD) and 0, 30, and 60 minutes post-infusion of cefazolin on day two. Dialysate samples were collected at 0, 180, and 360 minutes during HD on day 2. Samples were analyzed by high-performance liquid chromatography. Pharmacokinetic parameters were determined. Pharmacokinetic modeling was used to assess optimal dosage regimens. Results: Median cefazolin clearance was 1.65L/hr (IQR: 1.36-2.19L/hr) and half-life was 3.44hrs (IQR: 2.93-4.36hrs) during NHD. The percentage of cefazolin removed from blood in 8-hour NHD session was 80%. Modelpredicted steady-state cefazolin concentrations for an 8-hour NHD showed current dosing regimen, 2g followed by 1g IV after each NHD, achieved target concentrations of 6 x minimum inhibitory concentration (MIC) breakpoint of 8 mg/L, for Staphylococcus specie, for at least 50% of the dosing interval in a 70kg individual. Conclusion: Cefazolin clearance in NHD is slower than clearance rates reported for high-flux conventional hemodialysis; however, NHD has a longer hemodialysis duration leading to more drug removal. Modeling suggests that the current dosing regimen, 2g load followed by 1g IV after each NHD is adequate to reach recommended pharmacodynamic targets. Hospital • Nova Scotia Hospital • Queen Elizabeth II Health Science Center ONTARIO: • 43 Poster Sessions Séances d’affichage There are two different types of poster presentations at PPC 2015: a facilitated poster session on Sunday and traditional poster sessions on Monday and Tuesday. Deux types de présentation par affiches seront offerts dans le cadre de la CPP 2015. Une séance animée de présentations par affiches qui se tiendra le dimanche et des séances traditionnelles d’affichage qui auront lieu lundi et mardi. Facilitated Poster Session Posters in the facilitated poster session consist of a mixture of award winners and those abstracts submitted in the categories of original research and pharmacy practice. They are grouped as five or six posters with similar themes outlined below. The author of each poster will do a six-minute presentation in front of their poster highlighting the key points of their work. This will be followed by questions and group discussion. The presentations within each group will occur in sequence as the participants move from one poster to the next. The session is scheduled from 10:30 a.m. to 12:00 p.m. on Sunday, February 1, 2015. Traditional Poster Sessions Posters in the traditional sessions (in the exhibit hall on Monday and Tuesday) were selected from those submitted in the categories of original research and pharmacy practice. Although no formal presentations will occur, the author of each poster will be available during the presentation timeslot for discussion and questions. Posters will be available for viewing on Monday and Tuesday until 2 p.m. CSHP 2015 CSHP 2015 is a quality program that sets out a vision of pharmacy practice excellence in the year 2015. Through this project, CSHP challenges hospital pharmacists to reach measurable targets for 36 objectives grouped under six goals, all aimed toward the effective, scientific, and safe use of medications and meaningful contributions to public health. CSHP 2015 applies to inpatients and outpatients, community and hospital pharmacists, and all practice settings. Posters identified with a “CSHP 2015” logo are those judged by the CSHP 2015 Steering Committee to be particularly relevant to one or more of the 36 objectives. Sunday, February 1, 2015 Dimanche 1er février 10:00 – 12:00 (presentation) City Hall and Churchill Facilitated Poster Sessions: Discussion of Original Research, Award Winning Projects and Pharmacy Practice Projects Séance animée de présentations par affiches : Discussions sur des projets de recherche originale, des projets primes, et des projets dans le domaine de la pratique pharmaceutique Infectious Diseases 1. Acute Kidney Injury with Tobramycin-Impregnated Bone Cement Spacers in Prosthetic Joint Infections: A Controlled Study 2. Comparison of the Accuracy of 4 Sets of Criteria at Predicting Presence of Pseudomonas Aeruginosa in Patients Admitted for Pneumonia 3. Trends of Antibiotic Usage in the Inpatient Acute Care Setting: Is there Evidence of Seasonality? 4. Efficacy and Safety of Atazanavir plus Raltegravir Dual Therapy in TreatmentExperienced HIV-1 Infected Patients 5. Outcomes in Documented Pseudomonas Aeruginosa Bacteremia Treated with Intermittent Infusion Intravenous Ceftazidime, Meropenem and Piperacillin/Tazobactam: A Retrospective Study 6. Impact of Infection with Extended-Spectrum β-Lactamase (ESBL)-Producing Escherichia Coli or Klebisella Species on Outcome and Hospitalization Costs 44 Séance animée d’affichage Les affiches de la séance animée d’affichage sont formées d’un mélange de résumés primés et de résumés soumis dans les catégories recherche originale et pratique de la pharmacie. Elles sont combinées en groupes de cinq ou six affiches ayant des thèmes similaires comme il est fait mention ci-dessous. L’auteur de chaque affiche fera une présentation de six minutes devant son affiche, faisant ressortir les principaux points de son travail. Cette présentation sera suivie d’une période de questions et d’une discussion de groupe. Les présentations à l’intérieur de chaque groupe auront lieu les unes à la suite des autres au fur et à mesure que les participants se déplaceront d’une affiche à la suivante. Cette séance se déroulera de 10 h 30 à 12 h le dimanche 1er février. Séances traditionnelles d’affichage Les affiches pour les séances traditionnelles ont été choisies parmi celles soumises dans les catégories recherche originale et pratique de la pharmacie. Bien qu’aucune présentation officielle n’ait été prévue, les auteurs de chaque affiche seront sur place pendant les heures d’affichage et pourront répondre aux questions et s’entretenir avec vous. Les affiches pourront être examinées jusqu’à 14h, lundi et mardi. SCPH 2015 Le projet SCPH 2015 est un programme axé sur la qualité qui propose une vision de l’excellence en pratique pharmaceutique en l’an 2015. Au moyen de ce projet, la SCPH met les pharmaciens d’établissements au défi d’atteindre les cibles mesurables de 36 objectifs répartis entre 6 buts, visant tous l’utilisation efficace, scientifique et sûre des médicaments ainsi que des contributions significatives à la santé publique. Le projet SCPH 2015 s’applique aux patients hospitalisés et externes, aux pharmaciens d’hôpitaux et communautaires, et à tous les milieux de pratique. Les affiches marquées du logo « SCPH 2015 » sont celles que le comité directeur du projet SCPH 2015 a jugé particulièrement appropriées à l’un ou l’autre des 36 objectifs. Medication System Management / Education 1. Tracking Dispensary Turnaround Time 2. Perceptions and Practices Associated with Reporting Adverse Drug Reactions among Medical and Pharmacy Residents in Quebec 3. Adherence to the Institute for Safe Medication Practices Canada’s “Do Not Use” List of Dangerous Abbreviations in Paper and Electronic Medication Orders 4. Opportunities to Enhance Institutional Experiential Education: Place Students in Pairs Projects 5. Optimization of Workflow and Medication Safety in Unit Dose Dispensing 6. Antimicrobial Medications Incidents and Accidents and Consumption in 2012 – 2013 Pharmacy Practice 1. How Do Patient, Non-Patient and Hospital Pharmacist Stakeholder Perspectives on Clinical Key Performance Indicators for Hospital Pharmacists Compare? 2. Standardization of Pharmacist Attendance at Rounds 3. Standardization of Pharmacists Involvements in Best Possible Medication History and Medication Reconciliation 4. Quality of Nurse-Acquired Best Possible Medication History in Ambulatory Hemodialysis Centre 5. Assessing Completeness of Best Possible Medication History by Profession 6. Pharmacist Workload on General Medicine and Surgery Units Alexandra Marine & General Hospital • Baycrest Hospital • Brant Community Healthcare Therapeutics 1. Evaluation of Interventions to Improve Management of Behavioural and Psychological Symptoms of Dementia in a Residential Care Facility 2. Single versus Dual Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation: A Systemic Review 3. Evaluation of Enoxaparin Pharmacokinetics and Pharmacodynamics to Develop Dose Banding Based on Total Body Weight and Renal Function 4. Adherence to Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery 5. Follow-up Point Prevalence Survey of Antimicrobial Use in the Cardiac and Paediatric Critical Care Unit 6. Telepharmacy Support of an Antimicrobial Stewardship Program in a Small Rural Acute Care Hospital Monday, February 2, 2015 Lundi 2 février 09:45 – 10:15 (viewing) 13:15 – 13:50 (presentations) Sheraton / Osgoode Halls 1. Evaluation of Inhaled Corticosteroid Prescribing for Chronic Obstructive Pulmonary Disease in Family Medicine Teaching Units 2. Stability of an Epidural Analgesic Admixture Containing Ropivacaine and Epinephrine in Cassette Reservoirs 3. Extended Stability of Sodium Phosphate Solutions in Polyvinylchloride Bags 4. Stability of 100 mg/mL Ertapenem in Syringes and the Manufacturer’s Glass Vial at 4C and 23C 5. Utilization of Dexmedetomidine in Patients Admitted to a Tertiary Care Medical Surgical Intensive Care Unit 6. Review of the Safety of Disease-Modifying Anti-Rheumatic Drug Therapy in Patients with Chronic Kidney Disease 7. Recherche en pratique pharmaceutique: des recettes et astuces en linge 8. Publications comportant des retombées négatives de l’activité pharmaceutique 9. Comparaison du niveau d’accord à des énoncés sur l’éthique pharmaceutique entre étudiants en pharmacie et pharmaciens hospitaliers canadiens 10. Littérature sur le rôle et les retombées du pharmacien : perceptions d’etudiants 11. Démarche pour la mise à niveau de soins pharmaceutiques : l’exemple de l’immunisation 12. The Evaluation of Paclitaxel Hypersensitivity Reactions Following the Discontinuation of Prophylactic Pre-Medications 13. Impact of Experiential Learning on the Professional and Personal Development of Undergraduate Pharmacy Students 14. Effectiveness of Extracurricular Journal Clubs on Pharmacy Students’ Learning of Evidence-Based Medicine 15. An Environmental Scan of Transition Courses for Pharmacy Students Prior to Advanced Pharmacy Practice Experience Rotations 16. Adherence to Abiraterone among the First Recipients Following its Release in Canada 17. Development and Implementation of a Peer-Assisted Learning Model to Teach Pharmacy Students in a Clinical Trials Rotation 18. Opportunities to Enhance Institutional Education: Mutually Beneficial Activities Analysis 19. Doctor of Pharmacy Students Acquire Skills in Curriculum Design and Project Management Through Participation in an Education Project with Coaching Support 20.Prevalence of Co-Trimoxazole Induced Hyperkalemia in Chronic and Acute Users in a Tertiary Teaching Hospital 21. Planning and Evaluation of a Computerized Prescriber Order Entry Implementation 22. Patient-Perceived Usefulness and Usability of a Smartphone/Online Application in Type 2 Diabetes Self-Management Tuesday, February 3, 2015 Mardi 3 février 09:30 – 10:00 (viewing) 13:00 – 13:50 (presentations) 1. Pompes intelligentes : évaluation pratique des limites de détection 2. Retrospective Review of Emerging Drug Use in a Mother Child Centre in Quebec 3. Unlicensed and Off-Label Drug Use in a Mother-Child Tertiary Care Hospital 4. Is Pediatric Drug Information the Same for All Children Around the World 5. Démarche pour la mise à niveau d’un secteur de soins pharmaceutiques : le cas de la pédiatrie 6. Conformité des ordonnances à la règle d’emission des médicaments : étude pilote au sein d’un CHU mère-enfant 7. Audit of the Labelling of Hazardous Drugs in the Canadian Market 8. Tolerability of Darunavir / Ritonavir, Tenofovir / Emtricitabine for Human Immunodeficiency Virus Postexposure Prophylaxis 9. Prophylaxis of Post-Traumatic Infectious Endophthalmitis: Probability of Fluoroquinolone Success Using Monte Carlo Simulations 10. Natural Health Product Use in Patients with Rheumatological Conditions 11. Multidisciplinary Review Process Demonstrates the Need for Early Pharmacist Notifications with Treatment Intervention Benefits in Clostridium Difficile Infection (CDI) 12. Pharmacist’s Perception of the Implementation of Computerized Prescriber Order Entry on their Practice 13. Anticoagulation and Antiplatelet Patterns in Patients with Atrial Fibrillation Post-Percutaneous Coronary Intervention 14. A Pharmacy Practice Residency Program at a Paediatric Quaternary Hospital: Program Review and Evaluation 15. Patient Satisfaction with Chronic HIV Care Provided Through an Innovative Pharmacist and Nurse-Managed Clinic or Multidisciplinary Clinic 16. Use of Therapeutic Drug Monitoring to Improve Paediatric Clinical Pharmacy Service at a Tertiary Hospital 17. Guideline for the Prevention of Breakthrough and Treatment of Refractory Chemotherapy-induced Nausea and Vomiting in Pediatric Cancer Patients 18. Impact of Pharmacist Interventions on Outpatient Parenteral Antimicrobial Therapy Information Transfer at Hospital Discharge 19. Survey of Healthcare Professionals on the Role of Pharmacists in an Outpatient HIV Clinic Setting 20.Predictor of Bacteremia in the Elderly 21. Determination of Gentamicin Pharmacokinetics in Neonates to Develop Practical Initial Extended-Interval Dosing Recommendations 22. Impact of Length of Stay on the Distribution of Gram Negative Organisms and the Likelihood of Isolating a Resistant Organism in a Canadian Burn Centre 23. Customization and Implementation of a Compounding Software Solution for Safe and Efficient Sterile and Non-Sterile Compounding 24. Correlation Between Length of Smoking Cessation Therapy and Rate of Abstinence in Pragmatic Conditions SUNDAY, FEBRUARY 1 DIMANCHE 1ER FÉVRIER ACUTE KIDNEY INJURY WITH TOBRAMYCIN-IMPREGNATED BONE CEMENT SPACERS IN PROSTHETIC JOINT INFECTIONS: A CONTROLLED STUDY Aeng E,1 Shalansky K,2 Lau T,2 Zalunardo N,2 Bowie W,2 Li G2, Duncan C2 1 2 Surrey Memorial Hospital, Surrey, BC Vancouver General Hospital, Vancouver, BC Background: Antibiotic-impregnated bone cement spacer (ACS) with tobramycin +/- vancomycin is commonly used in a two-stage replacement of an infected prosthetic joint. Objectives: We investigated the incidence and risk factors for acute kidney injury (AKI) within 7 days post-operatively after implantation of tobramycinimpregnated bone cement. Methods: This was a prospective, observational, controlled study of 119 patients from Aug 2011 to Feb 2013. The tobramycin group included 50 consecutive patients who received ACS with tobramycin for the first stage revision of an infected hip or knee arthoplasty. The control group consisted of 69 consecutive patients who had a routine hip arthroplasty revision without ACS. AKI was defined as an increase of 50% or greater in serum creatinine from baseline within the immediate 7-day post-operative day (POD) period. Results: The incidence of AKI was higher in the tobramycin group compared to the control group (20% vs. 4.3%, p=0.01). A multivariate analysis adjusting for potential confounders also confirmed the higher incidence of AKI in patients receiving tobramycin ACS (OR 7.2; 95% CI 1.5-33.5). Mean onset of AKI was on POD 3 in both groups and patients with AKI had longer duration of hospital stay (18.6 ± 13.7 days vs 8.8 ± 7.0 days, p < 0.0001). Other risk factors for AKI were baseline co-morbidity (OR 6.2; 95% CI 1.3-29.1), and administration of post-operative intravenous vancomycin (OR 5.3; 95% CI 1.6-17.7) or angiotensin System • Bruyère Continuing Care • Carleton Place and District Memorial Hospital • Chesley 45 converting enzyme inhibitors/angiotensin II receptor blockers (OR 4.0; 95% CI 1.2-13.04). Use of pre-manufactured bone cement containing gentamicin was also a risk factor in the tobramycin group (OR 4.5, 95% CI 1.1-19.3). Conclusions: The incidence of AKI in infected hip or knee arthroplasties with tobramycin ACS was greater than in routine total hip arthoplasties. Measures to minimize AKI risk in the peri-operative period may reduce the incidence. COMPARISON OF THE ACCURACY OF 4 SETS OF CRITERIA AT PREDICTING PRESENCE OF PSEUDOMONAS AERUGINOSA IN PATIENTS ADMITTED FOR PNEUMONIA Sylvestre A,1,2 Matukas L,1,3 Haj R,1 St. Michael’s Hospital, Toronto, Ontario; 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario; 3 Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario 1 Background/Objective: Optimizing the use of antipseudomonal agents requires a balance between providing coverage of likely pathogens and minimizing the risk of bacterial resistance. Criteria have been proposed to identify which patients are at risk for P. aeruginosa, but none of these have been validated. We aimed to evaluate the accuracy of different criteria at predicting positive respiratory cultures with P. aeruginosa in patients admitted with pneumonia. Methods: A retrospective chart review was conducted. Culture-positive patients admitted at a single center for pneumonia between 2009-2013 were included. Four sets of criteria consisting of risk factors for P. aeruginosa were applied to a single population. Criteria included: decision support from the St. Michael’s Hospital pneumonia admission orders (criteria 1; reference criteria), the ATS/ IDSA pneumonia guidelines (criteria 2) and two prospective studies: Arancibia et al (criteria 3) and von Baum et al (criteria 4). The primary outcome was the area under the receiver operating curve (AUROC) produced by each set of criteria. Secondary outcomes included the sensitivity and specificity of each criteria and the incidence of each risk factor in the studied population. Results: Twenty-six cases and sixty controls (with and without positive respiratory cultures for P. aeruginosa, respectively) were included. Both groups had similar age, gender and disease severity. The AUROC produced by criteria 2 [0.695 (95% CI, 0.586-0.789); p=0.5576], criteria 3 [0.629 (95% CI, 0.5180.730); p=0.0716] and criteria 4 [0.720 (95% CI, 0.613-0.811); p=0.9803] were not statistically significant from the AUROC produced by the reference criteria [0.721 (95% CI, 0.614-0.813)]. While all criteria produced similar specificity, the St. Michael’s Hospital reference criteria had the highest sensitivity. Conclusions: All criteria compared had similar accuracy and low clinical value for predicting positive respiratory cultures with P. aeruginosa in patients admitted with pneumonia. TRENDS OF ANTIBIOTIC USE IN THE INPATIENT ACUTE CARE SETTING: IS THERE EVIDENCE OF SEASONALITY? Wang X,1 Walker SAN,1,2,3 Elligsen M,1 Nevers W,1 Palmay L,1 Daneman N,3,4 Simor A,3,4 Leis JA3,4 unnybrook Health Sciences Centre (SHSC), Department of Pharmacy, Toronto, S ON 2 University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, ON 3 SHSC, Division of Infectious Diseases, Toronto, ON 4 University of Toronto, Faculty of Medicine, Toronto, ON 1 Background: Despite the high volume of antibiotic consumption and consequences of antibiotic overuse, little is known about patterns of antibiotic use in hospitalized patients. Understanding patterns of antibiotic use could improve efficiency of antimicrobial stewardship programs by matching interventions to the time of year. Objectives: To evaluate the presence of seasonality with the use of major classes of antibiotics. To determine the amplitudes, peaks, troughs, and size of any observed seasonal shift in antibiotic use among specific antibiotics that exhibit a seasonal component. To identify whether seasonality of antibiotic use is associated with community versus hospital acquired infections (<48hours versus >48hours of admission, respectively). Methods: Hospitalized patients of one acute care teaching hospital who were prescribed systemic antibiotics between December 1st, 2010 and November 30th, 2013 were included. A time series analysis was employed; the smallest divisible unit was days, with the data presented in equally spaced intervals. A seasonal cycle, defined in the study as 12 months, was assessed using a Poisson regression. 46 Results: 86,468 clinical encounters were included. Seasonality was evident for azithromycin, ceftriaxone, ciprofloxacin, ceftazidime, and cloxacillin. The magnitude of these individual seasonal relationships varied significantly, with azithromycin exhibiting the strongest seasonal influence (rate ratio 1.55 95%CI 1.41-1.70). Antibiotics commonly used to treat community acquired respiratory tract infections (ceftriaxone, levofloxacin, and azithromycin) exhibited peak use during winter months, suggesting a temporal correlation to the annual influenza season with a community influence on hospital antibiotic usage. Monthly counts of antibiotic use were not significantly correlated with monthly C.difficile infection. Conclusions: Antimicrobial stewardship programs may increase efficiency by understanding antibiotic seasonal patterns of use in order to concentrate efforts based on predictable surges in use. In addition, seasonality may impact antibiotic use independent of stewardship interventions and should be considered when evaluating these initiatives. EFFICACY AND SAFETY OF ATAZANAVIR PLUS RALTEGRAVIR DUAL THERAPY IN TREATMENT-EXPERIENCED HIV-1 INFECTED PATIENTS Chen C,1 Tseng A,1,2 Sterling S,2 Salit I1,2 1 2 University of Toronto, Toronto, ON University Health Network, Toronto, ON Background: Atazanavir (ATV) plus raltegravir (RAL) is a non-traditional regimen which avoids ritonavir-associated toxicity and interactions and may be effective in patients resistant or intolerant to nucleoside reverse transcriptase inhibitor (NRTIs). Experience in treatment-experienced patients has been promising but data are limited. Objective: To evaluate the efficacy and safety of twice daily ATV/RAL in treatment-experienced patients. Methods: A retrospective review of HIV clinic patients between January 1, 2007 and June 31, 2014 was conducted. Patients on concomitant ritonavir or with less than 6 months follow-up were excluded. Efficacy and safety data at 24, 48 weeks and most recent follow-up were compiled. Results: Sixteen patients were included for analysis: median (range) age 48.5 (36-76) years, 14 (87%) male, 9 (56%) Caucasian, 11 (69%) men who have sex with men. Median duration of HIV infection was 21 (4-27) years, 4 (25%) had prior AIDS-defining illnesses. Patients received a median of 8.5 (3-14) prior antiretroviral regimens. All patients had pre-existing drug resistance (n= 14 NRTI, 11 non-NRTI, 2 protease inhibitor and 1 raltegravir). Baseline viral load (VL) was undetectable in 9 (56%) patients for a median of 72 (2-130) months prior to starting ATV/RAL; the median VL was 4.39 (1.96-5.2) log10 copies/mL for 7 (44%) patients at baseline. Baseline median CD4+ was 223 (<10-1023) cells/mm3, with median nadir of 104 (<10-697) cells/ mm3. Reasons for initiating ATV/ RAL included adverse reactions/tolerability (n=9), treatment failure (n=4), cost/ convenience (n=2), and drug interactions (n=1). Median duration of follow-up was 23.9 (6.1-51.9) months. Fourteen (87.5 %) patients achieved and maintained virologic suppression. Two patients experienced virologic rebound due to treatment interruption/ nonadherence without development of new resistance mutations. The median increase in CD4+ count was 143 cells/mm3. No patients experienced serious medication-related adverse events. Conclusion: Atazanavir plus raltegravir is an effective, durable and safe regimen in treatment-experienced patients. OUTCOMES IN DOCUMENTED PSEUDOMONAS AERUGINOSA BACTEREMIA TREATED WITH INTERMITTENT INFUSION INTRAVENOUS CEFTAZIDIME, MEROPENEM, AND PIPERACILLIN/ TAZOBACTAM: A RETROSPECTIVE STUDY Kwee F,1 Walker SAN,1,2,3 Elligsen M,1 Palmay L,1 Simor A,3,4 Daneman N,3,4 unnybrook Health Sciences Centre, Department of Pharmacy, Toronto, ON S University of Toronto, Leslie L. Dan Faculty of Pharmacy, Toronto, ON 3 Sunnybrook Health Sciences Centre, Department of Microbiology and Division of Infectious Diseases, Toronto, ON 4 University of Toronto, Faculty of Medicine, Toronto, ON 1 2 Background: P. aeruginosa is one of the leading causes of nosocomial Gram- negative bloodstream infections and is particularly difficult to treat because of its multiple resistance mechanisms in combination with the lack of novel antipseudomonal antibiotics. Despite the knowledge of time dependent killing with β-lactam antibiotics, most hospitals currently administer β-lactam antibiotics by intermittent rather than extended infusions. Hospital • Children’s Hospital of Eastern Ontario • Clinton Public Hospital • Durham Objectives: To determine clinical outcomes, microbiological outcomes, total hospital costs and infection-related costs in patients with P. aeruginosa bacteremia receiving intermittent intravenous anti-pseudomonal β-lactam antibiotics in a tertiary care institution. Methods: This retrospective descriptive study collected data from patients TRACKING DISPENSARY TURNAROUND TIME Tilli T,1,2 Garland J,1 Davies P,1 Lail S1 1 2 St. Michael’s Hospital, Toronto, ON Faculty of Pharmacy, University of Toronto, Toronto, ON admitted between March 1, 2005 and March 31, 2013 with Pseudomonas aeruginosa bacteremia who received at least 72 hours of ceftazidime, meropenem, or piperacillin/tazobactam to determine outcomes and costs. Background: Delays in medication turnaround time (TAT) can result in harm to Results: A total of 103 patients were included in the analysis. Clinical cure was seen in seventy-nine (77%) patients, with bacterial eradication achieved in 87% of the evaluable patients. Twenty-eight patients (27%) died within 30 days of therapy. The median total hospital stay cost and infection-related hospital stay cost for hospitalized patients with P. aeruginosa bacteremia were $121,718 (Cdn) and $29,697 (Cdn), respectively. Description: In-patient interim dose dispensing TAT was analyzed at a teaching hospital. Medications were ordered in a Computerized Physician Order Entry environment with 24 hour cart exchange and a robotic dispensing system. Dispensary TAT began at the point of medication order validation by the pharmacist, and concluded once medications left the dispensary via porter or pneumatic tube. Time spent in each step of the dispensing process was measured to identify potential areas of improvement. Conclusions: P. aeruginosa bacteremia is a significant nosocomial infection that continues to cause considerable mortality and cost to the healthcare system. To the best of our knowledge, no existing studies have identified total and infection related hospital costs for patients with Pseudomonas aeruginosa bacteremia treated with intermittent infusion anti-pseudomonal β-lactams. This study may provide important baseline data to assess the impact of implementation of continuous infusion beta-lactam strategies in hospitalized patients. IMPACT OF INFECTION WITH EXTENDED-SPECTRUM β-LACTAMASE (ESBL)-PRODUCING ESCHERICHIA COLI OR KLEBSIELLA SPECIES ON OUTCOME AND HOSPITALIZATION COSTS Maslikowska JA,1 Walker SAN,1,2,3 Elligsen M,1 Mittmann N,4,5 Palmay L,1 Daneman N,3,6,7 Simor A,3,6,7 unnybrook Health Sciences Centre (SHSC), Department of Pharmacy, Toronto, S ON 2 University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, ON 3 SHSC, Division of Infectious Diseases, Toronto, ON 4 SHSC, HOPE Research Centre, Toronto, ON 5 University of Toronto, Department of Pharmacology, Toronto, ON 6 University of Toronto, Faculty of Medicine, Toronto, ON 7 Sunnybrook Research Institute, Toronto, ON 1 Background: Extended spectrum β-lactamase (ESBL)-producing bacteria are important sources of infection; however Canadian data elucidating the impact of ESBL-associated infection are limited. Objectives: To determine whether patients who are infected with ESBL- producing E. coli or Klebsiella spp. (ESBL-EcKs) exhibit differences in (i) clinical outcome; (ii) microbiological outcome; (iii) mortality; and/or (iv) hospital resource use in comparison to patients infected with non-ESBL-producing strains. Methods: We conducted a retrospective case-control study of patients admitted to hospital between June 2010 and April 2013. Seventy-five case patients infected with ESBL-EcKs were matched one-to-one with controls infected with non-ESBL-EcKs. Patient-level cost data were provided by the institution’s Business Office. Clinical data were collected using the Antimicrobial Stewardship database, electronic patient records, and paper charts. Results: Patients had a mean age of 68 years, 47% of whom were male. Median infection-related hospitalization costs per patient were greater for cases than controls (CN$10,507 vs. CN$7,882; median difference, CN$3,416; p=0.04). The primary driver of increased costs was prolonged infection-related hospital length of stay (IR-LOS) (8 vs. 6 days; p=0.02). Cases were more likely to experience clinical failure (25% vs. 11%; p=0.03), with a higher rate of all-cause mortality (17% vs. 5%; p=0.04). Less than half of case patients were prescribed appropriate empiric antimicrobial therapy, while controls received adequate initial treatment in nearly all circumstances (48% vs. 96%; p<0.01). Conclusions: Our results suggest that patients with infection caused by ESBL-EcKs are at increased risk for clinical failure and mortality, and that the additional cost to the Canadian healthcare system to treat one patient with an ESBL-positive infection is a median of CN$3,416 more due to prolonged IR-LOS. Since our study only evaluated infected patients and controls, unmeasured confounding factors that may influence both the likelihood of acquiring ESBLEcKs and mortality may exist (e.g., comorbidities, severity of illness, LOS). patients. Dispensary TAT is defined as the time elapsed from the start to the end of the medication dispensing process. Action: The in-patient pharmacy dispensary workflow was mapped and the time for each step in dispensing was documented for 651 medication orders. The steps were: 1) medication label printed, 2) medication dispensed, 3) medication checked, 4) medication left the dispensary. The medication name, patient identification number, and urgency were captured for each prescription. The data was analyzed to determine the average dispensary TAT and the time taken to complete each step. Evaluation: The average dispensary TAT for all prescriptions was 56 minutes; this was divided into an average of 14 minutes to dispense and check a medication, and an average of 42 minutes for a medication to leave the dispensary. Stat medications labeled as a one-time dose, due within the hour, or new start, had an average dispensary TAT of 35, 44, and 56 minutes, respectively. Non-stat medications had an average dispensary TAT of 61 minutes. Implications: Stat medications must be clearly identified and prioritized for timely delivery. The evaluation of dispensary TAT revealed relatively quick dispensing and checking, but a relatively prolonged time for medications to leave the dispensary. As a patient safety initiative, strategies to improve dispensary TAT should target medication delivery. PERCEPTIONS AND PRACTICES ASSOCIATED WITH REPORTING ADVERSE DRUG REACTIONS AMONG MEDICAL AND PHARMACY RESIDENTS IN QUEBEC Cerruti L,1 Lebel D,1 Bussières JF,1,2 harmacy Department and Pharmacy Practice Research Unit, CHU SainteP Justine, Montreal, QC 2 Faculty of pharmacy, Université de Montréal, Montreal, QC 1 Background: The success of drug safety surveillance relies on an efficient pharmacovigilance system, spontaneous reporting of adverse drug reactions (ADR) by healthcare professionals to regulatory authorities. Residents should play a role in the detection and reporting of serious, unexpected and unusual ADR. Objective: The aim of this study was to compare perceptions and practices associated with reporting ADR among medical and pharmacy residents. Methods: A prospective descriptive study was conducted in March/April 2014 using a web questionnaire with 16 items and 5 sections: demographics, pharmacovigilance training and practices, obstacles to reporting ADR and measures to improve ADR reporting. The self-administered questionnaire was sent by email to Quebec pediatric medical residents and pharmacy residents. Results: Thirty-six medical residents (response rate 36/151,24%) and 34 pharmacy residents (34/67,51%) completed the survey. Aside undergraduate pharmacy curriculum, only 2 residents had completed additional pharmacovigilance training. Unlike medical residents, pharmacy residents believed that they were well-prepared to report and analyze an ADR and that pharmacovigilance was well-covered in their curriculum (24/34,71% versus 10/35,29%). During their residency, the majority of respondents were exposed to more than 100 patients (63/70,90%) and to more than 4 serious/unexpected ADR (51/70,73%). 7/36 medical residents and 33/34 pharmacy residents reported at least one or more serious or unexpected ADR to the regulatory authority. While most important obstacles to reporting ADR were different between both groups, lack of experience was common. Finally, regarding measures to improve ADR reporting, respondents saw decentralized pharmacists in patient care wards as a key success factor as well as onsite designed pharmacovigilance pharmacy coordinator. Hospital • Grey Bruce Health Services • Hamilton Health Services • Holland Bloorview 47 Conclusions: This study revealed a lack of satisfaction in pharmacovigilance training in medicine curriculum but a willingness of both residents to contribute to drug safety surveillance. A better understanding of perceptions and obstacles to reporting ADR can help identify measures to improve ADR reporting. CSHP 2 Targeting Excellence in Pharmacy Practice ADHERENCE TO THE INSTITUTE FOR SAFE MEDICATION PRACTICES CANADA’S “DO NOT USE” LIST OF DANGEROUS ABBREVIATIONS IN PAPER AND ELECTRONIC MEDICATION ORDERS Cheung S,1 Hoi S,1 Fernandes O,1,2 Huh J,2 Kynicos S,2 Murphy L,2 Lowe D2 1 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Department of Pharmacy Services, University Health Network, Toronto, ON Background: Dangerous abbreviations on the Institute for Safe Medication Practices (ISMP) Canada’s “Do Not Use” list have resulted in harmful medication errors. Data comparing the rates of dangerous abbreviation use in paper and electronic medication orders are limited. Objectives: To compare the rates of dangerous abbreviation use, defined by ISMP Canada’s “Do Not Use” list, in paper and electronic medication orders. Secondary objectives include determining the proportion of patients at risk of medication errors due to dangerous abbreviations and those most commonly used. Methods: We conducted 1-day cross-sectional audits of medication orders using a convenience sample of 5 patients per nursing unit at a 6-site teaching hospital organization in December 2013 and January 2014. Proportions of paper and electronic medication orders containing dangerous abbreviation(s) were compared using a Chi-squared test. Proportion of patients with at least 1 medication order containing dangerous abbreviation(s) and the top 5 dangerous abbreviations used were described. Results: Overall, 258 charts were reviewed, with 3 excluded as patients were discharged before electronic orders could be reviewed. The proportions of paper and electronic medication orders containing dangerous abbreviation(s) were 172/714 (24.1%) and 9/2207 (0.4%), respectively (p<0.001). Overall, 76 out of 255 (29.8%) patients had at least 1 medication order containing dangerous abbreviation(s). Those most commonly used were “D/C”, drug name abbreviations, “OD”, “U”, and “cc”. Conclusions: Electronic medication orders have significantly lower rates of dangerous abbreviation use than paper medication orders. Almost one-third of patients are at risk of harmful medication errors from dangerous abbreviation use. OPPORTUNITIES TO ENHANCE INSTITUTIONAL EXPERIENTIAL EDUCATION: PLACING STUDENTS IN PAIRS PROJECT Yu F, Luong W, Legal M, Loewen P, University of British Columbia, Vancouver, BC Background: Our faculty recently conducted a province-wide stakeholder engagement project to identify strategies to better support learners and preceptors who participate in experiential placements at hospital sites. With program expansion there is an increased need for high quality experiential placements. A key project suggestion was to promote the adoption of non-1:1 learner-preceptor models and that pairs of learners should be the default model for entry to practice learners. Description: This study aimed to gain a deeper understanding of the practical use of the paired model in order to identify and develop ways to better support local preceptors who consider adopting non-1:1 models. Action: The perspectives of learners and preceptors who recently participated in a paired rotation were gathered through one on one semi-structured interviews. The interviews were recorded and the resulting field notes were analyzed using qualitative methods and iterative coding to identify major themes. Evaluation: A total of 17 preceptors and 9 learners participated. General perspectives on the paired model were quite positive. Learners and preceptors both agreed that paired learning promoted peer-assisted learning. Being able to “bounce ideas off of each other” allowed students to feel more confident, independent, and less-intimidated. One area of concern was that differences in ability, learning styles or personalities can present as a challenge. Tips and suggestions on how to minimize learner conflict, optimize time management, and approach learner evaluations were identified. Implications: This work provides insight into the perspectives of local CSHP 2 OPTIMIZATION OF WORKFLOW AND MEDICATION SAFETY IN UNIT DOSE DISPENSING Targeting Excellence in Pharmacy Practice Facca N, DiCarlo A, Eddy S, Hasan R, Spence Haffner R, Jansen S, London Health Sciences Centre, London, ON Background: A need was identified to increase patient safety and efficiency in the inpatient unit dose area of a pharmacy within a major, acute care, tertiary, academic hospital. Changes were desired before the transition of pharmacy services to 24/7 and computerized provider order entry implementation. Description: Redesigning the workflow and workspace was thought to reduce interruptions, which in turn would decrease medication filling errors and increase patient safety. Reducing time to fill medication carts would increase efficiency and effectiveness. Action: A thorough analysis (using a LEAN quality improvement approach) of the processes, workspace and workflow was completed. The volume of activity was analyzed to determine optimal staffing levels. The schedule was revised to align shifts with peak activity. Reducing non-essential, non-value added work was desired. An event was held to sort, set in order, shine, standardize and sustain (“5S”) the proposed future state. “Plan-Do-Check-Act” cycles were completed during implementation to refine processes. Evaluation: Direct observation of work, timing of medication cart filling, counts of medication returns, counts of adverse event reports and discussions with staff were done to assess current and future state. One month after implementation, the number of interruptions during medication cart filling had decreased by 43%. There was positive staff feedback on the space redesign. Fewer adverse errors were reported and a decreased amount of time was noted in filling the medication carts. Independent double checking of medication carts increased by 10% (this value has continued to improve since implementation). Ninety-five percent of medication carts were filled within the new target time. There was no change in the number of steps required to fill each medication cart. Implications: A quality improvement approach helped to identify opportunities for increased efficiency and safety within the pharmacy environment. Positive results were obtained after thorough analysis of workflow and workspace redesign. ANTIMICROBIAL MEDICATIONS INCIDENTS AND ACCIDENTS AND CONSUMPTION IN 2012-2013 Bérard C,1 Lebel D,1 Bussières JF1,2 1 2 harmacy Department and Pharmacy Practice Research Unit, CHU SainteP Justine, Montreal, QC Faculty of Pharmacy, Université de Montréal, Montreal, QC Background: The optimisation of antimicrobial use includes prevention, risk management systems and consumption data analysis. Currently, defined daily dose (DDD) and days of therapy (DOT) are used to monitor antimicrobial drug consumption. In 2010, Health-Canada implemented a federal program to improve medication incident and accidents (I/A) reporting. In Quebec, according to the Ministère de la Santé et des Services Sociaux (MSSS), the reporting of medication I/A occurring in any health care situation has been mandatory since 2002. These I/As are notified in a national data register. Objectives: The objective was to quantify antimicrobial-associated I/A rates and to compare them with antimicrobial drug consumptions in a university motherchild hospital. Methodology: Antimicrobial drug consumption data was extracted from pharmaceutical software (GESPHARx8®) for all hospitalized patients who received systemic antimicrobials between April 1st, 2012 and March 31st, 2013. I/As were reported using the MSSS approved written formulary (AH-223) and were paired with associated antimicrobial drug consumption data, using two new approaches: I/As/DDD and I/As/DOT ratios. Results: The table on the right shows I/As and drug consumption data for antimicrobial agents in our center. Ten antimicrobial agents (29% of antimicrobial agents) associated with the highest number of I/A reports accounted for 76% of the DDD, 70% of DOT and 58% of I/As reports. Conclusion: Ten antimicrobial agents were associated with 58% of all I/A reports and were also commonly prescribed in our center (according to DDD and DOT). As part of antimicrobial stewardship and risks management program, it can be useful to compare I/A reports and consumption data to focus on antimicrobial agents that should be closely evaluated. preceptors and learners regarding the paired model. Compiling their tips and suggestions into educational materials for preceptors may assist them in making the transition to novel learner-preceptor models. 48 Kids Rehabilitation Hospital • Hospital for Sick Kids • Huron Perth Healthcare Alliance CSHP 2 HOW DO PATIENT, NON-PATIENT AND HOSPITAL PHARMACIST STAKEHOLDER PERSPECTIVES ON CLINICAL PHARMACY KEY PERFORMANCE INDICATORS FOR HOSPITAL PHARMACISTS COMPARE? Incidents and accidents and consumption data for antimicrobial agents Antimicrobial agent Number of I/A Number of DDD Number of DOT Number of I/A/10000 DDD Number of I/A /10000 DOT Ampicillin 34 9199 9309 37 37 Vancomycin 31 3342 6102 93 51 Gentamycin 27 2879 8061 94 33 Tobramycin 18 3835 5323 47 34 Amoxicillin 15 3827 4143 39 36 Piperacillin + tazobactam 15 2501 5440 60 28 Cefotaxime 15 3149 4643 48 32 Cefazolin 14 3140 4652 45 30 Cloxacilline 14 2526 1854 55 76 Clindamycin 12 2223 3024 54 40 Acyclovir 8 397 2683 202 30 Metronidazole 7 1390 2585 50 27 Ceftriaxone 6 612 1244 98 48 Meropenem 6 1755 1864 34 32 Amoxicillin + clavulanic acid 5 1649 1375 30 36 Linezolid 5 133 189 376 265 Erythromycin 4 497 1002 80 40 Fluconazole 4 2558 5230 16 8 Ticarcillin + clavulanic acid 4 1176 2509 34 16 Doxycyclin 3 84 198 357 152 Cefoxitine 3 329 713 91 42 Cephalexin 2 748 1165 27 17 Ceftazidime 2 1873 1987 11 10 Rifampicin 2 190 306 105 65 Imipenem + cilastatine 1 54 78 185 128 Cefprozil 1 104 218 96 46 Amphotericin B (liposomal) 1 278 494 36 20 Ganciclovir 1 185 460 54 22 Azithromycin 1 1084 999 9 10 Levofloxacin 1 568 702 18 14 Voriconazole 1 414 483 24 21 Caspofungin 1 1198 1683 8 6 Colistimethate 1 412 501 24 20 medical rounds as an activity that improves patient outcomes. Since numerous types of medical rounds are available on patient care units, selecting relevant ones to attend while ensuring other clinical duties are fulfilled has become challenging for a large group of pharmacists in a variety of practice settings with competing priorities. Clarithromycine 1 791 1075 13 9 Ciprofloxacine 1 2257 2097 4 5 Total 315 48158 75082 Non applicable Non applicable Description: Due to the large variation in types of rounds available on different patient care units, a standard approach towards the prioritization of pharmacist attendance at rounds was required. Legend: defined daily dose (DDD), days of therapy (DOT), incidents and accidents (I/A) Targeting Excellence in Pharmacy Practice Mourao D,1 Raymond C,1,2 Slobodan J,3 Gorman SK,4 Toombs K,5 Doucette D,6 Nghiem CL,2 Law V,1 De Angelis C2,7, McGillicuddy P1,8, Nichol K1,9,10, Bell B11,12, Fernandes O1,2 University Health Network, Toronto, ON 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON 3 Alberta Health Services, Red Deer, AB 4 Interior Health Authority, Kelowna, BC 5 Capital District Health Authority, Halifax, NS 6 Horizon Health Network, Moncton, NB 7 Sunnybrook Odette Cancer Centre, Toronto, ON 8 Wightman-Berris Academy, University of Toronto, Toronto, ON 9 Dalla Lana School of Public Health, University of Toronto, Toronto, ON 10 Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON 11 Mount Sinai Hospital, Toronto, ON 12 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON 1 Background: The systematic, evidence-informed consensus process of developing the national clinical pharmacy key performance indicators (cpKPI) for hospital pharmacists to date has not involved stakeholder feedback. Description: To systematically gather national stakeholder feedback on the cpKPI and compare quantitative data among stakeholder subgroups to refine and optimize the cpKPI. Action: A focus group or individual interview was used to gather stakeholder feedback on the consensus cpKPI. The focus group/interview consisted of an informative presentation, a questionnaire and qualitative discussion. A stakeholder was defined as: (i) a person or leader who interacts with an inpatient hospital pharmacist on a regular basis; (ii) a person involved in the measurement of quality/performance indicators; or (iii) a person who is a recipient of direct patient care from an inpatient hospital pharmacist. Stakeholders included hospital pharmacists, physicians, nurses, allied health professionals, hospital administrators, non-hospital pharmacists and patients. Quantitative data was analyzed using descriptive statistics. Evaluation: Feedback was gathered from 126 stakeholders (79 hospital pharmacists, 30 non-patients and 17 patients). Overall, 91% (107/117) of participants agreed or strongly agreed that measuring these cpKPI for hospital pharmacists will be useful in advancing clinical pharmacy practice to improve the quality of patient care. The highest priority cpKPI varied among the subgroups. Drug therapy problems resolved was the highest priority cpKPI for hospital pharmacists, whereas admission medication reconciliation and patient education at discharge were the highest priority for non-patients and patients respectively. The cpKPI statements that were least understood by participants were development and implementation of a pharmaceutical care plan (68%, 81/125) and bundled patient care interventions (70%, 84/125). Implications: Stakeholders felt that measuring these consensus cpKPIs is important, although there is some variation among stakeholder subgroups as to the most important and useful cpKPI. These perspectives will serve to optimize the consensus cpKPI and prioritize implementation. CSHP 2 1 2 Targeting Excellence in Pharmacy Practice STANDARDIZATION OF PHARMACIST ATTENDANCE AT ROUNDS Proceviat J,1 Dewhurst NF,1,2 Tom E1 St.Michael’s Hospital, Toronto, ON Leslie Dan Faculty of Pharmacy, Toronto, ON Background: Evidence supports the active participation of pharmacists in Action: A survey was developed and validated by a group of clinical pharmacists from a variety of practice areas to gather information on current state of pharmacist involvement in various rounds available. Data was collected detailing types of rounds available, frequency of attendance, and pharmacist perceived value of attendance. The results were used to develop a policy on pharmacist attendance at rounds. Evaluation: Responses were received from 31/33 (94%) clinical pharmacists practicing on inpatient units. Rounds were routinely attended by 31/33 pharmacists. Twelve different types of rounds were attended by pharmacists, with the top three being multidisciplinary, bedside, and bullet (discharge) rounds. These three were ranked as “high” value added rounds, where drug therapy problems (DTPs) were identified and resolved by 79% (22/28) of pharmacists. High value added rounds were attended daily by 58% (11/19) of pharmacists. DTPs were resolved by 53% (10/19) of pharmacists at multidisciplinary rounds compared to 73% (8/11) at bedside rounds and 50% (4/8) at bullet rounds. • Kingston General Hospital • Kincardine Hospital • Lakeridge Health • London Health 49 Implications: Multidisciplinary, bedside and bullet (discharge) rounds were identified to be value added and assist to identify and resolve DTPs. These rounds are prioritized for attendance by a pharmacist, regardless of patient care area, allowing for standardization of pharmacist practice. CSHP 2 Targeting Excellence in Pharmacy Practice STANDARDIZATION OF PHARMACISTS INVOLVEMENT IN BEST POSSIBLE MEDICATION HISTORY AND MEDICATION RECONCILIATION Dewhurst NF,1,2 Proceviat J,1 Tom E1 St.Michael’s Hospital, Toronto, ON 2 Leslie Dan Faculty of Pharmacy, Toronto, ON 1 Background: Medication reconciliation is an important safety initiative, but variation exists amongst pharmacists in selection of which patients are prioritized. In order to balance performance of medication reconciliation and other clinical duties, standard criteria for prioritization was necessary. Description: In order to minimize variation amongst pharmacists in patient selection, the process of standardizing practice for best possible medication history (BPMH) initiation and medication reconciliation was required to allow all pharmacists to apply a consistent approach. Action: Data was collected to enable description of demographic and medication related characteristics of admitted inpatients. Characteristics were analysed to determine the optimal combination to capture at least half of all admissions, a cut-off deemed by pharmacists as a reasonable amount to allow time for other duties. The identified characteristics were used as the basis for pharmacist selected patient prioritization. Validation of use of this criterion occurred to determine the feasibility of use in practice. Evaluation: Two medical and 2 surgical units were audited over a 7-day period. 126 patient charts were reviewed, with 106 (84%) having a documented BPMH. Pharmacists initiated 51 (48%) BPMHs. Of these, 36 (71%) patients were aged ≥ 65. Prior to admission, 36 (71%) patients were on high risk medications and 42 (82%) patients were on ≥ 5 medications. These characteristics were tried in 12 permutations to identify criteria that would capture 50% of all admissions. The criterion of high risk medications was expected to be present in 52% of all audited patients, and therefore selected as criteria for pharmacist prioritization of BPMH initiation. Implications: Prioritizing patients on high risk medications was identified as the best criteria to standardize pharmacist initiated BPMH. Standardization enables the discipline to set minimum criteria for when BPMHs and medication reconciliation will be provided by pharmacists to enable a balance of clinical duties. QUALITY OF NURSE-ACQUIRED BEST POSSIBLE MEDICATION HISTORY IN AN AMBULATORY HEMODIALYSIS CENTRE Zhao L, Chong S, Newman P, Kingston General Hospital, Kingston, ON Background: Hemodialysis (HD) patients are vulnerable to adverse drug events due to complex medication regimens, frequent dose changes, and poor adherence. An accurate best possible medication history (BPMH), obtained during medication reconciliation, can be utilized to identify and resolve drugrelated problems. Due to resource limitations, the BPMH is often obtained by nurses in HD centres. Objectives: The primary objective was to compare the accuracy of BPMHs obtained by nurses to pharmacists for HD outpatients at our hospital. Secondary objectives include analysis of BPMH discrepancies, discrepancy severities, identification of process improvements, and evaluation for educational opportunities. Methods: A sample of HD outpatients was randomly selected to be interviewed independently by both a nurse and a pharmacist in a crossover design. BPMHs were manually documented on an existing medication list for each patient and compared following both sets of interviews. Discrepancies between nurseacquired and pharmacist-acquired BPMHs were analyzed. Results: Fifty-nine patients were included in the study; 2 pharmacists and 27 nurses obtained BPMHs. Nurses and pharmacists agreed on 678 of the total 821 medication regimens reviewed (agreement rate = 82.6%). Of the 161 discrepancies identified, the most common type was incorrect frequency (31.7%) followed by incorrect dose (31.1%). The majority (75.3%) of the discrepancies were judged to have no potential to cause harm. However, 24.7% of the discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration. The top three drug classes involved in these potentially harmful discrepancies were anti-diabetics, analgesics, and mineral supplements. 50 Conclusion: Nurses at the hospital HD centre were able to obtain BPMHs with similar accuracy as pharmacists. Continued training on patient interview and BPMH documentation is required to further improve quality of nurse-acquired BPMHs. Education on high risk drug classes is necessary to reduce number of potentially harmful discrepancies. CSHP 2 ASSESSING COMPLETENESS OF BEST POSSIBLE MEDICATION HISTORY BY PROFESSION Targeting Excellence in Pharmacy Practice Sweet K, Sellinger D, Dimond J, Regina Qu’Appelle Health Region, Pasqua Hospital, Regina, SK Background: A prior study illustrated the increased accuracy of the Best Possible Medication History (BPMH) when performed by trained pharmacy technicians. This study examines continued effectiveness of pharmacy technicians across a 3 month trial. Description: The completion of a BPMH is required for all admitted patients. An accurate BPMH minimizes the potential for errors during medication reconciliation. The responsibility of gathering BPMH is not delegated to one particular profession, though the task is typically performed by a Registered Nurse (RN) or a Licensed Practical Nurse (LPN). Initially, it was unknown which profession would be best suited to gathering BPMH. Action: A prior study indicated that allowing pharmacy technicians to collect BPMH increased the overall accuracy of the information. Subsequently, a pilot project was implemented in the Emergency Department. Trained pharmacy technicians gathered all BPMH information including allergies, prescriptions, herbals, and over-the-counter (OTC) medications. Other professions only gathered BPMH when the Pharmacy Department was closed. Evaluation: An auditing form was developed to perform a retrospective chart review of 941 patients who visited the Emergency Department during a 3 month period. The auditing form was designed to determine the completeness of BPMH, and quantify the use of dangerous abbreviations. The results of this evaluation show that, when compared to RNs and LPNs, pharmacy technicians had higher rates of completed BPMH information, including a larger number of herbals and OTC medications identified. Pharmacy technicians also have significantly lower rates of dangerous abbreviations present on BPMH forms. Implications: The accuracy and completeness of BPMH information can be increased by delegating the duty to pharmacy technicians. As pharmacy technicians become licensed, their expanding scope of practice could include the gathering of BPMH. An accurate BPMH will allow physicians and pharmacists to make more informed clinical decisions, thereby improving patient care and safety. PHARMACIST WORKLOAD ON GENERAL MEDICINE AND SURGERY UNITS Peragine C,1,2 DeCaria K,1 Marchesano R,1 Appel G,1 Barnes M,1 Chan K,1 Compani S,1 Do J1, Harper J,1 Kim J1, Ko E1, Le M1, Lee J1, Lo C1, Natanson R1, Pradhan R1, Redekop L1, Rzyczniak G1, Tsang L1, Vella D1, Vyas A1, Carating H1, Walker SE1,2 1 2 Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Background: Our institution chose to change a 36-bed surgical oncology/ general surgery unit to a mixed unit containing 24 surgical oncology/general surgery beds and 12 short-stay (SS) general internal medicine (GIM) beds. Objective: Determine the difference in pharmacist workload as a function of service and length of stay (LOS). Methods: A data collection form was developed to capture specific pharmacist tasks completed on each patient. Tasks included medication history and reconciliation, dose clarifications, drug related problems and discharge counseling/tasks. For a period of 4 weeks pharmacists recorded the time to complete every task associated with each patient to determine total time/task as well as the total pharmacist time/patient (PTPP). ANOVA was used to evaluate workload factors, differences between services and calculate confidence intervals around mean times. Results: Data on 550 patients were obtained. The majority of patients were either GIM patients (n=191) or surgery patients (n=159). Pharmacist time per GIM patient averaged 40.8 minutes and the time per surgery patient averaged 28.7 minutes. The LOS for these patients averaged 9.3 and 8.1 days, respectively. When focusing only on SS-GIM patients, the average time per patient was 49.7 minutes (n=31) spread over 3.46 days. The average time for surgical oncology/ general surgery patients averaged 28.1 minutes (n = 29 patients) over 6.56 days. When the difference in PTPP is combined with LOS, replacing 12 – general surgery beds with SS-GIM patients, PTPP increases by 50% (lowest estimate: Sciences Centre • Mackenzie Health • Mount Sinai Hospital • North York General Hospital GIM vs. Surgery) to 90% (highest estimate: SS-GIM vs. surgical oncology/general surgery). evaluate the quality of cohort and case-control studies. Outcomes of interest included all-cause mortality, major thrombotic events and bleeding events. Conclusion: Adjusting the mix of patients on a unit significantly affects workload and justifies an increase in pharmacist full time equivalents from 1.0 to between 1.5 and 1.9. Results: Four articles met the inclusion criteria (2 RCTs and 2 cohort studies) for a total of 662 patients. Included trials compared the combination of ASA plus clopidogrel to ASA alone. Duration of DAPT ranged from 1 to 6 months. All included studies were deemed to be at high-risk of bias and could not be metaanalyzed due to selective outcome reporting and variable follow-up. Qualitative analysis of individual studies demonstrated no statistically significant reduction in all-cause mortality with DAPT compared to single antiplatelet therapy. Furthermore, DAPT did not reduce thrombotic events and resulted in a similar or higher risk of bleeding. EVALUATION OF INTERVENTIONS TO IMPROVE MANAGEMENT OF BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA IN A RESIDENTIAL CARE FACILITY Tremblay L,1 Siu J,1 De Lemos J,1 Chang J,1 Kelly J,2 Wilkins-Ho M,3 Wakefield R3 Lower Mainland Pharmacy Services, Vancouver, BC Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC 3 Vancouver Coastal Health, Vancouver, BC 1 2 Background: An estimated 80% of nursing home residents with dementia are affected by behavioural and psychological symptoms of dementia (BPSD). Behavioural measures are the first-line treatment for BPSD, with pharmacological measures only recommended if these fail. In the elderly with dementia, antipsychotics increase absolute mortality rate by 1% and are only proven to be effective for aggression, agitation and psychosis. Despite this, antipsychotic prescribing continues to increase. A practice guideline for BPSD management and panel of Quality Actions assessments were recently implemented in a Canadian health authority to improve management of BPSD. Conclusions: Current published evidence, though limited by low methodological quality, suggests a lack of benefit and potential harm with DAPT compared to single antiplatelet therapy in patients post-TAVI. Therefore, the routine use of DAPT in these patients should be re-evaluated until more evidence is available. EVALUATION OF ENOXAPARIN PHARMACOKINETICS AND PHARMACODYNAMICS TO DEVELOP DOSE BANDING BASED ON TOTAL BODY WEIGHT AND RENAL FUNCTION. Feng T2, Walker SE1,2, Bartle B1,2, Diamantouros A1,2 1 2 Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Objectives: Our primary outcome was to determine if the proportion of Background: Enoxaparin’s clinical efficacy and safety are occasionally Methods: We conducted a retrospective observational study. We included Objectives: To create an enoxaparin dosing banding table with doses rounded residents receiving appropriate initial antipsychotic therapy increased after implementation of interventions. Our secondary outcomes were to determine if reassessment for efficacy and tapering of antipsychotics improved after implementation of interventions. residents with dementia at a residential care facility with an antipsychotic initiated during specific time periods and excluded those with an antipsychotic order of under 24 hours. By consensus, “appropriate antipsychotic initiation” was defined as low dose initiated, target symptom documented and appropriate, and behavioural measures documented before and during antipsychotic therapy. Results: Forty-nine residents were included in total; 22 residents preintervention and 27 post-intervention. The proportion of residents receiving appropriate initial antipsychotic therapy was not significantly increased between pre- and post-intervention time periods. Lack of behavioural measures was the largest contributor for inappropriate antipsychotic initiation. There was a trend towards increased rates of reassessment for efficacy and no difference in rates of reassessment for tapering between pre- and post-intervention time periods. Conclusions: Our study failed to show an increase in appropriateness of antipsychotic initiation between pre- and post-intervention time periods. Future directions should focus on improving implementation of behavioural measures to improve management of BPSD. SINGLE VERSUS DUAL ANTIPLATELET THERAPY FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: A SYSTEMATIC REVIEW Turgeon R1, Barry A2 F aculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC 2 Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB 1 Background: Transcatheter aortic valve implantation (TAVI) is a viable alternative to surgical aortic valve replacement or medical management in individuals with calcific aortic stenosis at high-risk for surgical complications or who are not surgical candidates. Guidelines currently recommend dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and clopidogrel for 1 to 6 months following TAVI primarily based on expert consensus. Objective: To evaluate the efficacy and safety of DAPT compared to single antiplatelet therapy in patients undergoing TAVI. Methods: CENTRAL, EMBASE, MEDLINE and unpublished sources of literature were searched from inception to July 2014. Included were randomized controlled trials (RCTs), cohort and case-control studies that compared DAPT to single antiplatelet therapy post-TAVI. Risk of bias for RCTs was assessed using the Cochrane Risk of Bias Tool. The Newcastle-Ottawa Scale was used to measured by anti-Xa levels. Pharmacokinetic parameters based on antiXa concentrations change as a function of total body weight (TBW) and renal function. Most available dose banding charts to do not appear to have rigorously considered the large body of published pharmacokinetic data. to the nearest pre-filled syringe size, based on TBW and renal function using published pharmacokinetic parameters. Methods: A MEDLINE and EMBASE search yielded 31 studies with pharmacokinetic and/or pharmacodynamic data. Weighted mean kinetic data (half-life, volume, clearance) from patients being treated for acute thromboembolic events in published randomized controlled trials was calculated. A relationship between the volume and TBW and between half-life and renal function was generated. Steady state antiXa peak concentrations (AXa-max) and area-under-the-curve (AUC) were simulated using Monte Carlo methods. Doses were selected, optimizing efficacy while minimizing bleeding, and rounding to the nearest pre-filled syringe size for 7 TBW and 4 creatinine clearance bands. Results: A relationship for volume vs. total body weight from 5 studies determined a weighted average relationship for volume: V (L) = 0.06511TBW(kg)-0.63455; n=1127 and for half-life as a function of creatinine clearance: Half-Life (hr)= -1.103 ln(CrCl) +7.5339; n=259. Doses achieving steady state AXa-max targets of 1.0IU/mL, but not exceeding 1.8 and an AUC between 73-97IU*hr/mL were calculated and displayed in the Table. Creatinine Clearance Total Body Weight (kg) 50-100 mL/min 30-50 mL/min 15-30 mL/min 0-15 mL/min <47 40 mg BID 30 mg BID 30 mg BID 40 mg OD 48-63 60 mg BID 60mg BID 40 mg BID 40 mg BID 64-78 80 mg BID 80 mg BID 60 mg BID 40 mg BID 79-96 100 mg BID 80 mg BID 80 mg BID 60 mg BID 97-115 120 mg BID 100 mg BID 100 mg BID 80 mg BID 116-140 150 mg BID 120 mg BID 120 mg BID 100 mg BID Conclusions: This dose banding chart is built from pharmacokinetic data and represents a different approach to calculate weight-based doses. These recommended doses offer greater resolution for renal function and AXa-max concentrations of 1.0IU/mL but limit large AUC and AXa-max values. • Pembroke Regional Hospital • Perth and Smith Falls District Hospital • Providence 51 CSHP 2 Targeting Excellence in Pharmacy Practice ADHERENCE TO CLINICAL PRACTICE GUIDELINES FOR ANTIMICROBIAL PROPHYLAXIS IN SURGERY Somers E,1 MacLaggan T,1 Glennie H,2 Salmon J2 Horizon Health Network, Moncton, NB 2 Horizon Health Network, Saint John, NB 1 Background: Adherence to clinical practice guidelines for antimicrobial prophylaxis in surgery has been reported to be suboptimal in many facilities. Objectives: The primary objective of this study was to identify the proportion of surgical patients who received appropriate perioperative antimicrobial prophylaxis within 4 hospitals. Methods: A retrospective chart review of all patients admitted to the included hospitals for class I or II surgeries, who were discharged between September 15 and September 21, 2013, inclusive was completed. Definitions of appropriate use, choice, dose, timing, intraoperative dosing, and duration of prophylactic antimicrobial were developed from current clinical practice guidelines. Completely appropriate antimicrobial prophylaxis was defined as adherence to all 5 definitions listed above (use, choice, dose, timing, intraoperative dosing, and duration). Descriptive statistics were used to analyze data. Results: A total of 253 patients were included in the analysis. The 5 most common surgical sites (and proportion of total surgeries) were orthopedic (36.8%), intra-abdominal (15.9%), gynecologic (9.5%), urologic (7.5%), and cardiac (7.5%). The proportion of all surgical patients who received completely appropriate antimicrobial therapy was 40.7%. The proportion of all surgical patients who received correct use, choice, dose, timing, intraoperative dosing, and duration of prophylactic antimicrobial was 90.3%, 88.6%, 62.3%, 91.1%, 84.6%, 83.9% respectively. Adherence to guidelines for dosing and duration of prophylactic antimicrobial were shown to be lowest. Inappropriate postoperative duration was most common in urologic surgery with 58.9% of urologic surgery patients receiving postoperative antimicrobials for greater than 24 hours. The cause of all (100%) inappropriate dosing was under-dosing. Conclusion: Adherence to guidelines for antimicrobial prophylaxis in surgery can be improved within the included hospitals. This study identifies antimicrobial dosing for all surgeries and post-operative antimicrobial duration in urologic surgery as potential targets for antimicrobial stewardship intervention. FOLLOW-UP POINT PREVALENCE SURVEY OF ANTIMICROBIAL USE IN THE CARDIAC AND PAEDIATRIC CRITICAL CARE UNIT De Castro C, Pong S, Blinova E, Boodhan S, Richardson S, Clarke M, Zhao XY, Timberlake K, Lau E, Bitnun A, Cox P, Schwartz S, Seto W, The Hospital for Sick Children, Toronto, ON CSHP 2 Targeting Excellence in Pharmacy Practice TELEPHARMACY SUPPORT OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM IN A SMALL RURAL ACUTE CARE HOSPITAL Dhaliwall S,2 Coulas S,1 Kuiack J,1 Malinowski J,1 McDonald K2 1 2 St. Francis Memorial Hospital, Barry’s Bay, ON North West Telepharmacy Solutions, Brampton and Deep River, ON Background: Accreditation Canada identified an Antimicrobial Stewardship Program (ASP) as a Required Organizational Practice in all acute care hospitals. Clinical pharmacists have been identified as a key member of a successful ASP. This small rural acute care hospital utilizes a telepharmacy model of care with a remote clinical pharmacist. Description: The hospital is a 20- bed acute care hospital with no on-site clinical pharmacist and requested the remote clinical pharmacist to help lead the ASP to prepare for Accreditation in December 2013. Action: The remote clinical pharmacist performed a gap analysis to identify areas requiring improvement for a successful ASP which included the need for an Antimicrobial Stewardship committee, an IV to PO conversion program for antibiotics, development of guidelines and clinical pathways for common infections, hospital specific antibiogram, and pvrospective audit with intervention and feedback. The remote clinical pharmacist participated in meetings with nurses, physicians and other key stakeholders using OTN videoconference technology to develop a plan for the ASP which was approved by the Medical Advisory Committee. The remote clinical pharmacist started prospective data collection in September 2013. Evaluation: The implemented and innovative ASP was accepted by Accreditation Canada in December 2013. Figure 1 – Days of Therapy (DOT) per 1000 Patient Days Over 1 Year 350 DOT per 1000 Patient Days 300 250 200 150 Background: A 2008 point prevalence survey in the critical care unit (CCU) of our paediatric hospital found a high rate of inappropriate antimicrobial use. Several initiatives including the Antimicrobial Stewardship Program were recently implemented. Current literature supports ongoing surveillance to evaluate the impact of such initiatives and to monitor trends over time. Objectives: To determine the prevalence of infections and antimicrobial use in the CCU, to assess the appropriateness of antimicrobial prescribing, and to compare results with the previous 2008 study. Methods: In this cross-sectional study, all CCU patients receiving systemic antimicrobials during one week in October 2013 (Period A) and February 2014 (Period B) were followed until completion of antimicrobial therapy or discharge. Four blinded clinician assessors rated appropriateness of antimicrobials prescribed according to 9 pre-defined criteria. Disagreements on overall appropriateness were resolved during a consensus meeting. Descriptive and comparative analyses were performed by a biostatistician. Results: Of 139 patients in CCU during both periods, 111 (80%) received antimicrobials. A diagnosis of infection was definite in 29% and presumed in 20% of patients. Sepsis, bloodstream infections and pneumonia were the most prevalent infections. The most frequently prescribed antimicrobials were cefazolin, vancomycin, ceftriaxone, piperacillin-tazobactam, and gentamicin. Empiric therapy was the most common indication. Inappropriateness ratings ranged from 15.4 to 52.5%. Post consensus meeting, 43 (39%) patients were rated as having overall inappropriate antimicrobial use by at least 3 of 4 assessors. The most common reasons for inappropriate use were inappropriate duration, unnecessary use, and overly broad spectrum. Compared to the previous study, the prevalence of infections, antimicrobial use, and inappropriate antimicrobial prescribing were generally similar. Conclusion: Prevalence of antimicrobial use in CCU patients remains high with a significant proportion still considered inappropriate. Further research to evaluate and resolve factors associated with inappropriate antimicrobial use in critically ill children is needed. 52 100 50 0 Sept. Oct.. Nov. Dec. Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Implication: Small rural and remote acute care hospitals without access to an on-site clinical pharmacist can successfully implement and maintain an ASP by seeking support from experienced remote clinical pharmacists. MONDAY, FEBRUARY 2 LUNDI 2 FÉVRIER EVALUATION OF INHALED CORTICOSTEROID PRESCRIBING FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN FAMILY MEDICINE TEACHING UNITS Falk J, Sandhu J, University of Manitoba, Winnipeg, MB Background: Inhaled corticosteroids (ICS) provide modest benefits and concerning harms in clinical trials of chronic obstructive pulmonary disease (COPD) patients. Their use in this population continues to be promoted, but prescribing patterns have not been well studied. Objective: To study the utilization and prescribing patterns of ICS in COPD management in a family medicine setting. Healthcare • Queensway Carleton Hospital • Ross Memorial Hospital • Royal Victoria Methods: A retrospective electronic medical record review at two family medicine teaching clinics was performed. Included were patients 35 years of age or older who either had an ICD-9 COPD diagnosis or billing code or who were using tiotropium. Patients with asthma were excluded. Patient characteristics were collected for the COPD population with specific analysis performed on patients recently started on ICS within the last year, including the number of patients who met current guideline criteria for ICS initiation, reasons for not meeting criteria, and occurrence of benefit/harm discussions prior to initiation. Results: Of the 137 patients analyzed, 41 (30%) were currently using ICS. Of these, 35%, 43%, and 22% were on high, moderate, and low dose ICS, respectively. Seven patients were recently started on ICS. Of these, 5 met 2007 Canadian guideline criteria for ICS initiation based on having one (n=4) or more (n=1) exacerbations/year, but only 1 had undergone appropriate trials of other therapies prior to ICS initiation. Five patients were initiated on a fluticasone/ salmeterol combination inhaler after inadequate response to only salbutamol and ipratropium. Only two patients met the 2011 American/European guideline criteria, and 1 patient met the 2013 international GOLD criteria. No documentation existed regarding discussions of potential benefits, harms or costs of ICS prior to these initiations. Conclusion: Although ICS were generally initiated in patients meeting Canadian COPD exacerbation criteria, most had not previously undergone adequate trials of other COPD inhalers and most did not meet the newer international criteria. STABILITY OF AN EPIDURAL ANALGESIC ADMIXTURE CONTAINING ROPIVACAINE AND EPINEPHRINE IN CASSETTE RESERVOIRS. Perks B, Law S, Iazzetta J, Walker SE 1 1 2 1 1,2 1,.2 Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON. Background: Admixtures containing local anesthetics and epinephrine are no published reports documenting the extended stability of sodium phosphate injection in iv solutions. Objective: The objective of this study was to evaluate the stability of 30 and 150mmol/L of sodium and phosphate in 5% dextrose in water (D5W) or 0.9% sodium chloride (NS) solutions stored in PVC bags at 23C or 4C over 63 days. Methods: On study-day zero, 30 and 150mmol/L solutions of sodium phosphate in D5W or NS were prepared in PVC bags and stored at 4C and 23C. During the 63-day study period the concentration of sodium and phosphate was determined on 12 study days. A beyond-use date was determined as the time taken for the concentration to decline to 90% of the initial concentration, based on fastest degradation rate determined from the 95% confidence interval (CI) for both sodium and phosphate. Results: The analytical method was accurate (2.06% deviation) and reproducible (CV%), averaging 1.32% for standards and Quality Control samples. Sodium and phosphate retained more than 94% of the initial concentration over the 63 study period. The time to achieve 90% of the initial concentration, based on the 95% confidence interval, exceeded the 63 day study period, regardless of temperature, concentration or solution. Conclusions: We conclude that sodium phosphate solutions at concentrations of 30 or 150mmol/L diluted in either NS or D5W retain more than 94% of the initial concentration over a period of 63 days when stored at 4C or 23C. When assigning a beyond use date (BUD), USP 797 recommendations should be followed. STABILITY OF 100 MG/ML ERTAPENEM IN SYRINGES AND THE MANUFACTURER’S GLASS VIAL AT 4C AND 23C Law S,1 Iazzetta J,1,2 Perks B,1 Walker SE1,2 1 2 Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON increasingly used in epidural pain management. Published reports on the stability of ropivacaine-epinephrine containing admixtures (with or without opioids) are lacking. Background: Prophylactic administration of ertapenem as a single 1g IV dose Objective: The objective of this study was to evaluate the stability of Objective: The objective of this study was to evaluate the stability of ertapenem, reconstituted with 0.9% sodium chloride to achieve a final concentration of 100 mg/mL, and stored in polypropylene syringes or the manufacturer’s original glass vial. epinephrine 0.005mg/mL in combination with ropivacaine 0.125%, 0.3% or 0.5% in cassette reservoirs at 23C or 4C, with or without protection from light. Methods: On study-day zero, 32 solutions of epinephrine and ropivacaine were prepared in reservoir cassettes (CADD©) and stored at 4C and 23C protected from fluorescent room light. An additional solution of 0.005mg/ mL epinephrine with 0.3% ropivacaine, also prepared in reservoir cassettes (CADD©), was exposed to normal fluorescent light. Samples were assayed on 15 study days over a 66-day period using a validated, stability-indicating, liquid chromatographic method with ultraviolet detection. Stability was defined as the time taken for the concentration to decline to 90% of the initial concentration, based on the fastest degradation rate determined from the 95% confidence interval. Results: The analytical method was accurate (<2.0% deviation) and reproducible (average CV% <2%). Epinephrine and ropivacaine solutions retained more than 95% of their initial concentration for 31 days and more than 90% of the concentration for 66 days regardless of temperature, concentration or light protection. The time to achieve 90% of the initial concentration, based on the 95% confidence interval, exceeded the study duration of 66 days. Conclusions: Epinephrine and ropivacaine solutions stored in cassette reservoirs retained more than 90% of the initial concentration over a period of 66 days when stored at 4C or 23C. Exposure of the solutions to normal fluorescent light did not affect stability. When assigning a beyond use date (BUD), USP 797 recommendations should be followed. has been shown to reduce sepsis after prostate biopsy. Previous ertapenem stability studies have not evaluated concentrations of 100mg/mL. Methods: On study-day zero, 100 mg/mL solutions of ertapenem were packaged in polypropylene syringes or the manufacturer’s glass vials and stored at 4C and 23C unprotected from fluorescent room light. Samples were assayed using a validated, stability-indicating liquid chromatographic method with ultraviolet detection. A beyond-use date was determined as the time taken for the concentration to decline to 90% of the initial (day 0) concentration, based on fastest degradation rate determined from the 95% confidence interval (CI). Results: Reconstituted solutions stored in polypropylene syringes exhibited a degradation rate of approximately 2.99% per day at 4C and 19.0% per day stored at 23C. When stored in the manufacturer’s glass vial, the degradation rate was similar, approximately 2.95% per day at 4C and 19.1% per day during storage at 23C. Analysis of variance detected differences in percent remaining due to temperature (p<0.0015), study day (p=0.0052) but not container (p = 0.9790). When a 95% confidence interval for the degradation rate was determined, solutions retained at least 90% of the initial concentration after storage at 2.9 days at 4C or approximately 0.44 days (~10 hours and 40 minutes) at room temperature. Conclusion: A 100 mg/mL ertapenem solution stored in a polypropylene syringe or manufacturer’s vial, will retain more than 91.5% of the initial concentration when stored for 48 hours at 4C and an additional 2 hours at 23C. EXTENDED STABILITY OF SODIUM PHOSPHATE SOLUTIONS IN POLYVINYLCHLORIDE BAGS. UTILIZATION OF DEXMEDETOMIDINE IN PATIENTS ADMITTED TO A TERTIARY CARE MEDICAL SURGICAL INTENSIVE CARE UNIT Perks B,1 Iazzetta J,1,2 Chan PC,3,4 Law S,1 Brouzas A,3 Walker SE1,2 Lovering S,1 Singh J,2 Carter A2,3 1 Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON 3 Department of Biochemistry, Sunnybrook Health Sciences Centre, Toronto, ON 4 Faculty of Medicine, University of Toronto, Toronto, ON 1 2 2 Background: ISMP has suggested and Accreditation Canada has mandated improve comfort and ventilator synchrony, but traditional sedatives can increase the risk of ICU delirium. The alpha-2 adrenergic agonist dexmedetomidine may be associated with less delirium, however it is considerably more expensive. It was added to our tertiary care hospital formulary in September 2011 for use in delirious patients who are anticipated to be ready for extubation within 48 hours. the elimination of concentrated electrolytes from patient care areas. Sodium phosphate injection is one such concentrated electrolyte. Providing sodium phosphate as a dilute solution prepared by pharmacy would comply with the required organization practice. However, to our knowledge, there have been Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Toronto Western Hospital, University Health Network, Toronto, ON 3 Department of Pharmacy Services, University Health Network, Toronto, ON Background: Patients on mechanical ventilation may require sedation to Hospital • Sault Area Hospital • Seaforth Community Hospital • St. Francis Memorial 53 Objective: To examine the use of dexmedetomidine and adherence to prescribing restrictions among patients admitted to our tertiary care medical surgical intensive care unit. Methods: A retrospective chart review of patients prescribed dexmedetomidine from September 1, 2013 to November 30, 2013. Adherence to restricted use criteria was ascertained using the following three criteria: (1) readiness to wean, as per fixed respiratory parameters, (2) presence of delirium, as defined by the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), (3) duration of use less than 48 hours. Descriptive statistics were used for all outcomes assessed. Results: Six patients were identified for inclusion. Adherence to all three prescribing restrictions was 17% (n=1). Eighty-three percent (n=5) met the criteria for readiness to wean towards extubation and 33% (n=2) had a positive CAM-ICU assessment. CAM-ICU ratings were not documented or could not be assessed for 67% (n=4) despite 50% (n=2) of these patients actively receiving delirium treatment. Eighty-three percent (n=5) were administered dexmedetomidine for less than 48 hours. Fifty percent (n=3) were extubated during dexmedetomidine administration. Conclusion: Dexmedetomidine was not used in strict accordance to restriction criteria in the majority of patients. The greatest area for improvement in meeting restriction criteria was for CAM-ICU assessments. Research examining the barriers to CAM-ICU screening and documentation is warranted. CSHP 2 Targeting Excellence in Pharmacy Practice REVIEW OF THE SAFETY OF DISEASE-MODIFYING ANTIRHEUMATIC DRUG THERAPY IN PATIENTS WITH CHRONIC KIDNEY DISEASE Carpenter T,1 Hall J,2 Katz S1 1 2 Division of Rheumatology, University of Alberta, Edmonton, AB Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB astuces de notre équipe de recherche, basées sur des exemples concrets de projets de recherche en pratique pharmaceutique réalisés par notre équipe. Action : À partir de l’idée originale, nous avons identifié 13 thèmes (par exemple mise en place, revue de la littérature, statistiques, écriture, valorisation, suivi) et 29 articles (par exemple identifier un problème, commencer un projet, choisir un devis, faire une revue de la littérature reproductible, analyser les données, créer une affiche). Six articles ont été finalisés à ce jour. Évaluation : Ces articles sont utilisés dans la formation des nouveaux étudiants, qui sont également invités à commenter leur contenu. Un suivi de la consultation de ces articles en ligne est effectué. Répercussions : À notre connaissance, il s’agit de la première initiative visant à rédiger un ouvrage en ligne soutenant la recherche en pratique pharmaceutique et se basant sur des exemples concrets de projets de recherche. Le partage de cet outil en ligne à la communauté pharmaceutique est susceptible de contribuer au développement de cette recherche nécessaire aux décideurs et cliniciens du réseau de la santé. PUBLICATIONS COMPORTANT DES RETOMBÉES NÉGATIVES DE L’ACTIVITÉ PHARMACEUTIQUE Guérin A1, Leroux A1, Lebel D1, Bussières JF1,2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC 2 Faculté de pharmacie, Université de Montréal, Montréal, QC 1 Justification : Il existe une tendance à davantage publier des résultats ayant obtenu un résultat positif que des résultats négatifs. Ce biais de publication est un frein à l’avancement des connaissances. Objectifs : L’objectif était d’évaluer le taux de publications incluant au moins un indicateur de retombées négatif de l’activité pharmaceutique au sein de la littérature et de présenter un portrait de ces articles. agents for patients with inflammatory arthritis and co-existing chronic kidney disease in order to assist clinicians in prescribing safe and effective therapy. Méthodologie et démarche de l’étude : Une recherche bibliographique a été réalisée sur PubMed de 2008 à 2014. Les articles présentant le rôle, les interventions et les retombées des pharmaciens ont été sélectionnés et analysés par deux assistantes de recherche. Le taux de publication comportant au moins un indicateur de retombées négatif a été calculé. La profession des auteurs a été collectée. Les indicateurs de retombées négatifs de l’activité pharmaceutiques ont été comptabilisés. Methods: Medline (Ovid, 1946-July 28, 2014) and EMBASE (Ovid, 1974-July Résultats : Un total de 203 articles ont été inclus. Le taux de publication Background: Recommendations regarding the use of disease modifying anti-rheumatic drugs (DMARDs) in both chronic kidney disease and renal replacement therapy are limited in guiding clinicians in the choice of therapy. Objective: We aimed to review the available evidence for disease modifying 28, 2014) database searches were conducted to identify literature related to the use of DMARDs in patients with reduced renal function. Case reports or series, cohort studies, pharmacokinetic studies, and randomized controlled studies that reported efficacy or safety parameters in English were eligible for inclusion. Results: Ninety-three studies examining DMARDs in chronic kidney disease were identified, the vast majority of which were case reports or case series. While limited, the current literature suggests that antimalarials, azathioprine and TNFα inhibitors can be used safely in patients with chronic kidney disease with appropriate dosing adjustments. In patients receiving renal replacement therapy, antimalarials, leflunomide, TNFα inhibitors, and non-TNF biologics appear to be safe, but data suggest that methotrexate and gold are unsafe. Conclusion: Many DMARDs are likely safe to use in patients with inflammatory arthritis and co-existing chronic kidney disease. However, more prospective studies are needed to support these results and to guide the creation of clinical practice guidelines for this population. RECHERCHE EN PRATIQUE PHARMACEUTIQUE : DES RECETTES ET ASTUCES EN LIGNE comportant au moins un indicateur de retombées négatifs était de 5,4% (11/203). Les premiers auteurs de chaque article étaient tous pharmaciens. Dix indicateurs de retombées négatives de l’activité pharmaceutiques ont été comptabilisés, à savoir les coûts de médicaments, les coûts totaux, le nombre de divergences de prescription, le nombre d’interactions médicamenteuses, le nombre de complications d’hyperglycémie, la durée de séjour, le taux de réadmission aux urgences, l’observance aux corticostéroïdes inhalés et la durée appropriée de traitement. Conclusion : Cette revue documentaire met en évidence le fait qu’il existe peu de données sur les retombées négatives de l’activité pharmaceutique. Ceci n’est pas étonnant compte tenu de l’émergence de la recherche évaluative en pharmacie et du biais de publication commun à toutes les professions. COMPARAISON DU NIVEAU D’ACCORD À DES ÉNONCÉS SUR L’ÉTHIQUE PHARMACEUTIQUE ENTRE ÉTUDIANTS EN PHARMACIE ET PHARMACIENS HOSPITALIERS CANADIENS Guérin A1, Lebel D1, Bussières JF1,2 1 Bérard C,1 Tanguay C,1 Bussières JF,1,2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D CHU Sainte-Justine, Montréal, QC 2 Faculté de pharmacie, Université de Montréal, Montréal, QC 1 Contexte : Il existe relativement peu de recherche en pratique pharmaceutique. Les étudiants et pharmaciens hospitaliers impliqués dans ce domaine sont formés le plus souvent par eux-mêmes à partir d’un nombre limité d’ouvrages. Description : Afin de soutenir la formation de ces jeunes professionnels, nous avons retenu le concept d’un « livre de recettes » sur la recherche en pratique pharmaceutique issu de notre expertise, de nos réalisations et d’une revue de la littérature. Ce livre est co-rédigé par les étudiants en formation de notre centre et les chercheurs de l’équipe. Afin d’assurer le partage des connaissances, l’outil a été mis en ligne et prend la forme d’articles structurés. Les articles comportent une mise en contexte, des connaissances théoriques et pratiques ainsi que des 54 2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D CHU Sainte-Justine, Montréal, QC Faculté de pharmacie, Université de Montréal, Montréal, QC Justification : L’éthique fait partie intégrante de la pratique pharmaceutique. Objectifs : Comparer le niveau d’accord d’étudiants en pharmacie et de pharmaciens hospitaliers sur des énoncés portant sur l’éthique pharmaceutique. Méthodologie et démarche de l’étude : Enquête effectuée du 1er octobre 2012 au 2 décembre 2013 pour les étudiants et du 29 août 2014 au 2 septembre 2014 pour les pharmaciens. Un questionnaire de huit sections et 43 énoncés a été développé portant sur les sujets suivants : formation et études (5 questions), recherche clinique (7), mise sur le marché et publicité (5), évaluation et données probantes (5), dispensation de médicaments (4), soins pharmaceutiques (9), aspects économiques (6) et déontologie (2). Une échelle de Likert à quatre choix a été utilisée afin de mesurer le niveau d’accord. L’issue principale était la différence entre le niveau d’accord des étudiants en pharmacie et des Hospital • St. Mary’s Memorial Hospital • St. Mary’s of the Lake – Mental Health • Southlake pharmaciens hospitaliers. Le test du chi-carré a été utilisé. Une valeur de p inférieur à 0,05 est considérée significative. Résultats : Un total de 347 étudiants et de 398 pharmaciens ont répondu à l’enquête. Il y avait une différence statistiquement significative en ce qui concerne le niveau d’accord pour 29 énoncés sur les 43. Les différences portaient sur les huit sections du questionnaire, soit formation et études (3/5 questions significativement différentes), recherche clinique (2/7), mise sur le marché et publicité (2/5), évaluation et données probantes (4/5), dispensation de médicaments (4/4), soins pharmaceutiques (5/9), aspects économiques (6/6) et déontologie (2/2). Les résultats confirment une grande sensibilité éthique des étudiants en pharmacie et pharmaciens hospitaliers vis-à-vis de la plupart de ces énoncés. Conclusion : Cette étude montre qu’il existe une différence entre pharmaciens et étudiants en pharmacie sur des énoncés portant sur l’éthique pharmaceutique. LITTÉRATURE SUR LE RÔLE ET LES RETOMBÉES DU PHARMACIEN : PERCEPTIONS D’ÉTUDIANTS CANADIENS Guérin A1, Lebel D1, Bussières JF1,2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC 2 Faculté de pharmacie, Université de Montréal, Montréal, QC 1 Justification : Les facultés de pharmacie canadiennes travaillent sur la transformation des programmes de baccalauréat. Alors que les étudiants sont exposés au cours de leur cursus aux preuves sur la pharmacothérapie, l’exposition aux preuves sur le rôle et retombées du pharmacien est limitée. Objectifs : L’objectif principal était d’évaluer la perception d’étudiants canadiens vis-à-vis de la littérature sur le rôle et retombées du pharmacien. L’objectif secondaire était d’évaluer leur perception vis-à-vis du site Internet Impact Pharmacie recensant les preuves sur le rôle et retombées du pharmacien. Méthodologie : Nous avons développé et pré-testé sur des étudiants en pharmacie un questionnaire de 19 questions visant à explorer la perception des étudiants vis-à-vis de la littérature sur le rôle et les retombées du pharmacien et leurs premières impressions sur le site Impact Pharmacie. Nous avons exposé une cohorte de 3ème année à la littérature sur le rôle et les retombées du pharmacien. Le site Impact Pharmacie servait de support à la présentation. Nous avons administré le questionnaire et des statistiques descriptives ont été réalisées. Résultats : Un total de 121 étudiants a participé au sondage (93% des étudiants). Quatre-vingt-neuf pourcent (108/121) des étudiants étaient d’accord pour dire que l’exposition d’un pharmacien à des preuves sur le rôle et les retombées du pharmacien amène des changements de pratique. Quatre-vingt-neuf pourcent (105/118) étaient d’accord pour dire que ces preuves sont utiles pour la décision de gestionnaires. Par ailleurs, 37% (44/120) des étudiants ont déclaré que les enseignements relatifs à l’évaluation des pratiques professionnelles n’incluent pas systématiquement des preuves. Les étudiants considéraient le site Impact Pharmacie pertinent et utile pour la formation des pharmaciens. Conclusion : Les étudiants canadiens perçoivent la littérature sur leurs rôles et retombées comme utile à leur formation. L’intégration de cette littérature peut être faite à l’aide du site Impact Pharmacie. DÉMARCHE POUR LA MISE À NIVEAU DE SOINS PHARMACEUTIQUES : L’EXEMPLE DE L’IMMUNISATION Guérin A1, Bédard P1, Lebel D1, Bussières JF1,2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC 2 Faculté de pharmacie, Université de Montréal, Montréal, QC 1 Justification : L’administration d’un médicament par injection (p.ex. la vaccination) est permise aux pharmaciens dans au moins six provinces canadiennes. En outre, le Protocole d’immunisation du Québec ne précise actuellement pas de rôle spécifique pour le pharmacien. Objectifs : Mettre à jour le niveau de pratique utilisé en soins pharmaceutiques en immunisation. Méthodologie et démarche de l’étude : Il s’agit d’une étude descriptive avec revue documentaire menée dans un centre hospitalier universitaire mère-enfant canadien. La démarche de mise à niveau proposée comporte trois étapes soit une revue de la documentation, une description du profil du secteur et une description de la mise à jour du niveau de pratique. Résultats : La revue de la documentation a permis de recenser 19 articles sur le rôle du pharmacien en immunisation. Nous n’avons recensé aucune activité pharmaceutique spécifique reposant sur des données de très bonne qualité. En 2013-2014, il y avait une dépense annuelle en vaccins de 4227 dollars, une dépense annuelle en médicaments de 27 633 944 dollars, et un total de 9254 doses de produits immunisants prescrits chez 3544 patients. Selon la revue de la littérature, la mise à jour envisagée de l’activité d’immunisation inclut notamment un bilan comparatif ciblant les besoins en immunisation, la consultation systématique des dossiers pharmacologiques des patients hospitalisés depuis plus d’un mois afin de s’assurer l’adhésion au Protocole d’immunisation du Québec, la déclaration systématique des effets indésirables vaccinaux et l’implantation de capsules d’informations sur les nouveautés vaccinales. Conclusion : Cette étude descriptive met en évidence le rôle du pharmacien en immunisation dans un centre hospitalier de soins universitaire. Il existe peu de données sur le rôle du pharmacien pour cette activité; notre revue documentaire a toutefois permis d’identifier une quinzaine de changements et d’améliorations à nos pratiques actuelles. THE EVALUATION OF PACLITAXEL HYPERSENSITIVITY REACTIONS FOLLOWING THE DISCONTINUATION OF PROPHYLACTIC PRE-MEDICATIONS Meyer C1, Raymond C1, Lee R2, Amir E3, Mackay H2, Oza A4, Warr D2, Ng P2 Pharmacy, University Health Network, Toronto, ON Medical Oncology, Princess Margret Hospital, Toronto, ON 3 Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON 4 Dept. of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON 1 2 Background: Paclitaxel administration is associated with a variable rate of hypersensitivity reactions (HSRs). Such reactions are infrequent beyond the second dose. Pre-medications comprising of corticosteroids and anti-histamines are administered to reduce the risk of HSRs, but are associated with adverse effects and a longer visit time. It is unclear if pre-medications are needed beyond the second dose. Objectives: Pre-medications were discontinued for all patients receiving paclitaxel-based regimens beyond the second dose. We sought to evaluate this practice change and hypothesize that this policy is unlikely to result in an increased rate of HSRs. Methods: A retrospective chart review was performed over a four-month period to review the incidence of HSRs. Adult patients were included if they received paclitaxel-based chemotherapy and did not have an HSR during the first two doses. Surveys were administered to patients receiving weekly paclitaxel to evaluate patient preference. Time required to administer premedications was also estimated. Results: Of 187 patients who met the inclusion criteria, 77 patients received weekly paclitaxel, seven patients received dose-dense paclitaxel every two weeks and 103 patients received paclitaxel every three weeks. Two of 111 patients receiving paclitaxel + platinum (1.80%) and two of 76 patients receiving paclitaxel +/- trastuzumab (2.63%) had non-severe HSRs. An average of 90 minutes of chair time per patient (per clinic visit), was saved by omitting pre-medications. Of 52 surveys, 23 (44%) were returned and 20 patients (86.9%) preferred treatment without pre-medications compared to their first two doses with premedications. Conclusion: In patients receiving paclitaxel + platinum regimens or paclitaxel +/- trastuzumab, the discontinuation of pre-medications is a safe and feasible option if a patient has not experienced a HSR during the first or second dose of paclitaxel. Omission of pre-medications has substantial time saving implications for chemotherapy chair time. IMPACT OF EXPERIENTIAL LEARNING ON THE PROFESSIONAL AND PERSONAL DEVELOPMENT OF UNDERGRADUATE PHARMACY STUDENTS Certina Ho, Brett Morphy, Atsushi Kawano, School of Pharmacy, University of Waterloo, Waterloo, ON Background: The School of Pharmacy at the University of Waterloo is the only undergraduate pharmacy program in Canada that includes a co-op component. Pharmacy has evolved from a dispensing-focused to a patient-oriented health care profession over the last decade. Training of new pharmacy graduates should be well-balanced in both academic and experiential settings. Regional Health Centre • Stevenson Memorial Hospital • Stratford General Hospital • 55 Objectives: This is a qualitative study with an objective to find out how co-op Description: This study aimed to scan the education literature to identify how pharmacy programs in North America have designed their transition courses to optimize student preparedness and confidence prior to clinical rotations. Methods: Open-ended questions were used in semi-structured interviews Action: A comprehensive literature review was conducted on six databases (IPA, Scopus, Embase, Medline, CINAHL, and ERIC). Articles were selected for review based on relevance and with a focus on course content, structure, and impact on measurable outcomes. Refining search terms, conducting ancestry searches, and scoping the curricula of other pharmacy schools through their universityaffiliated websites were completed to saturate findings. experiential learning experience affects pharmacy students’ professional and personal development. and focus groups to allow pharmacy students, co-op employers, and faculty members to freely express their viewpoints. An inductive approach was applied when generating themes from the transcribed data collected in this study. Thematic analysis was conducted using NVivo. Results: Main themes were identified from 19 pharmacy students’ interviews, 12 co-op employers’ phone interviews, and 2 faculty focus groups. Students developed confidence, identified self- and career-related discovery; they provided constructive feedback to the co-op program and shared the challenges in classroom versus real-world practice during the interviews. Co-op employers recognized students’ individual growth during co-op, yet pointed out some mismatches between the curriculum and expectations in co-op during their phone interviews. Faculty members were pleased to see that students took ownership of their learning, the integration of knowledge between classroom and work placements, and students’ maturity and professional growth during co-op; but were a bit concerned about the unstructured nature of co-op. Conclusion: We have made assumptions on students’ professional and personal development during co-op placements. However, we attempted to use triangulation of data from co-op employers and faculty members to substantiate our findings. In future curricular development, institutions should consider a hybrid of structured and unstructured experiential education for pharmacy students to complement classroom teaching. EFFECTIVENESS OF EXTRACURRICULAR JOURNAL CLUBS ON PHARMACY STUDENTS’ LEARNING OF EVIDENCE-BASED MEDICINE AND CRITICAL APPRAISAL Tsang J, Certina H, Olla W, Power M, Morphy B, Patel S, Poon C, Tong B, School of Pharmacy, University of Waterloo, Waterloo, ON Background: In hospital pharmacy practice, journal club ( JC) often serves as a means of knowledge exchange among clinicians for the application of evidence to patient care. Objective: We simulated JC in school with the objective of studying the effectiveness of voluntary student-driven JC in the learning of evidence-based medicine (EBM) and critical appraisal (CA) in undergraduate pharmacy students. Methods: Eight one-hour JC sessions were organized by students in two consecutive academic terms as extracurricular activities. Attendance and presentations by students were voluntary. Students who attended JC were asked to complete an online questionnaire to self-report their learning and understanding of EBM and CA concepts. JC presenters were invited to focus groups to share their feedback and learning on EBM and CA skills. Results: Attendance of each JC ranged from 25 to 50 students. 28 students completed the online questionnaire. After attending JC, 57% students agreed or strongly agreed that they were able to critically appraise primary literature in a timely fashion; 68% believed that they were able to formulate clinically-relevant conclusions from research studies; and 57% were confident in presenting clinical decisions based on assessment of a research study. We conducted three focus groups with 22 student presenters and a thematic analysis was performed on the transcribed data. Student presenters found themselves more proactive in seeking evidence-based clinical decisions. They strived for continuous development of their CA skills and recognized the importance of critically analyzing methods and results presented in clinical trials. the target population, setting, study design, and the statistical strength of the evidence. Commonly identified instructional approaches included assessments of learning needs, supplementary reviews of therapeutic topics, peer and near-peer teaching models, hands-on activities, and online modules. Only two studies in the pharmacy literature quantified the impact of a transition course on students’ preparedness to clinical rotations. Implications: From the sheer diversity of findings, it is clear that a proposed model for guiding the development of a transition course is needed. The rationale behind the various instructional approaches used in existing transition courses have predominantly been extrapolated from education research in other health disciplines. With the expanding landscape of contemporary pharmacy practice, it is essential for curriculum development and current pharmacists to understand how to best prepare students for their profession. ADHERENCE TO ABIRATERONE AMONG THE FIRST EIGHTY-SIX RECIPIENTS FOLLOWING ITS RELEASE IN SASKATCHEWAN, CANADA Smith AD,1 Olson C,2 Lyons B,2 Tran D,3 Blackburn DF 3 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Saskatoon Cancer Centre, Saskatoon, SK 3 College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK 1 2 Background: Prostate cancer is the most common cause of cancer among Canadian males. In the province of Saskatchewan, patients with metastatic castration-recurrent prostate cancer (mCRPC) who have failed androgen deprivation therapy are commonly treated with docetaxel-based therapy. However, docetaxel is associated with toxic side effects and requires intravenous administration. Recent advancements in prostate cancer treatments have produced abiraterone, a chronic, orally administered, Cytochrome P 17 inhibitor. Although abiraterone offers certain advantages, its oral administration places the responsibility for optimal adherence on the patients. To our knowledge, adherence to abiraterone in a real-world setting has never been described. Objective: The objective of this study was to measure adherence to abiraterone among the first patients to receive it in Saskatchewan, Canada. Methods: De-identified electronic pharmacy claims were obtained from the Saskatchewan Cancer Agency. All patients with at least one dispensation for abiraterone between August 2011 and October 2013 were eligible. The primary endpoint was the percentage of patients achieving optimal adherence at six months defined as a medication possession ratio (i.e., MPR) ≥80%. Results: One hundred forty-one patients received abiraterone during the study period. Of these, 86 could be followed for at least six months. Optimal adherence was achieved in 82.6% (71/86) patients at six months with 79.1% achieving an MPR of at least 90%. Of those with available follow-up to one year, 81.6% (31/38) maintained optimal adherence during the entire period. Conclusion: Traditional didactic teaching/learning in classroom serves as an Conclusions: Among the first Saskatchewan patients who have received AN ENVIRONMENTAL SCAN OF TRANSITION COURSES FOR PHARMACY STUDENTS PRIOR TO ADVANCED PHARMACY PRACTICE EXPERIENCE ROTATIONS DEVELOPMENT AND IMPLEMENTATION OF A PEER-ASSISTED LEARNING MODEL TO TEACH PHARMACY STUDENTS IN A CLINICAL TRIALS ROTATION introduction to EBM and CA. JC offered pharmacy students a platform to further practice and apply their knowledge on EBM and CA skills. Students need to continuously practice these skills in order to be prepared as a medication therapy expert capable of evaluating and applying EBM in practice. Paw Cho Sing E, Ho C, Lee A, University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, ON Background: During the final year of their program, pharmacy students have the opportunity to consolidate their theoretical knowledge and skills through experiential learning in the form of Advanced Pharmacy Practice Experience (APPE) rotations. However, the transition from structured learning processes in the classroom to clinical practice often poses a formidable challenge for learners. Hence, an effective transition course is needed to bridge didactic and practical education. 56 Evaluation: Appraisal of the compiled literature involved an evaluation of abiraterone, medication non-adherence does not appear to present a threat to the successful treatment of patients with mCRPC. As more cancer therapies are being delivered by chronic, oral medications, non-adherence should become an important quality indicator. De Buono K, Leung B, DeLuca S, Princess Margaret Cancer Centre, Toronto, ON Background: With increased experiential education requirements for pharmacy students and limited preceptors, there is a high demand for hospital-site rotations. Peer-assisted learning (PAL) and near-peer teaching (NPT) are two methodologies that may help address this demand. Description: During a clinical trials rotation with two pharmacists, one doctor of pharmacy student and one fourth-year student, student activities were reviewed and characterized as PAL, NPT or individual. The rotation was used as a trial to Trillium Health Partners • The Ottawa Hospital • The Scarborough Hospital • Toronto identify if PAL and/or NPT are suitable learning strategies with the intended goal of having one preceptor taking multiple students. Action: The doctor of pharmacy student had a 5-week rotation and started one week earlier than the fourth-year student who had a 4-week rotation. In addition to individual activities, students engaged in collaborative activities with peers. Numerous activities were tailored to PAL, including protocol review and weekly topic discussions (for example Research Ethics). An NPT activity that occurred was senior peer review of a junior peer’s work to provide constructive feedback. Evaluation: Participants were asked to comment on whether they thought this model was beneficial and feasible for future rotations. For assessment, a feedback form was developed using a Likert-type scale and was provided for review to pharmacists not participating in the program. PAL was the predominant strategy utilized, likely due to the specialized nature of the rotation. Implications: Participants described the PAL model as a constructive and feasible model for future rotations, and also more applicable than NPT in this setting. The adoption of a PAL model may facilitate preceptors taking more than one student. The feedback form may be a useful tool to evaluate the adopted model in future rotations. OPPORTUNITIES TO ENHANCE INSTITUTIONAL EXPERIENTIAL EDUCATION: MUTUALLY BENEFICIAL ACTIVITIES ANALYSIS Luong W, House N, Legal M, Loewen P, University of British Columbia, Vancouver, BC Background: Our faculty conducted a province-wide stakeholder engagement study to identify strategies to better support learners and preceptors who participate in experiential placements at hospital sites. With program expansion there is an increased need for high quality experiential placements. A key priority is to increase student involvement in patient care and site activities. Enhanced student impact or value-add at the site is likely to increase the willingness of sites to host students and will enrich the student experience. Description: Our stakeholder engagement project recommended that 30% of a student’s time be spent performing mutually beneficial activities (MBAs). These activities should be practical, appropriate for the learner’s skill level, occur in realtime, and be both beneficial to the learner’s education and preceptor/pharmacy department. Action: This project utilized stakeholder feedback, literature review and informal interviews with hospital pharmacy coordinators to identify a raw list of MBAs. This list was then evaluated using an electronic survey deployed to hospital pharmacists and coordinators, and recent faculty graduates. The survey employed Likert and open-field responses. The open field responses were analyzed for themes using qualitative methods. Evaluation: There were a total of 127 respondents. Activities were assessed based on four categories: learner preparedness, preceptor comfort, benefit to student learning, and benefit to the pharmacy department. Taking the curriculum into account, these MBAs were split into three tiers: activities all students can complete, activities students can complete with additional training, and a preceptor’s “wish list”. Implications: Promoting these activities as providing benefit to both the student and patient care would not only lead to reduced workload for preceptors but also augment existing institutional pharmacy services. Many of the activities identified are current targets of the national CSHP 2015 initiative to provide a higher standard of care across Canada. DOCTOR OF PHARMACY STUDENTS ACQUIRE SKILLS IN CURRICULUM DESIGN AND PROJECT MANAGEMENT THROUGH PARTICIPATION IN AN EDUCATION PROJECT WITH COACHING SUPPORT Jackson L,2 Makari J,1,2 Edwards P,1 Hehar H,1 Lo J,1,2 Lui M,1,2 Gerges S,1 Amin F,2 Zhu L,2 Do J,2 Fox A2 1 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Sunnybrook Health Sciences Centre, Toronto, ON Background: Project management and curriculum design concepts are not caring for nephrology patients. The co-primary outcomes of students’ perception of the impact that the project had on their acquisition of skills and the impact of coaching support were measured through use of a feedback form and a wrap-up session. Subjective evaluation tools were created based on the project management and curriculum design components. Scoring ranged from 1 (no change) to 4 (significant improvement). Action: Students took responsibility for tasks and the timeline. Tasks included developing the needs assessment tool, drug monitoring monographs for anemia and hyperphosphatemia, a brief oral presentation, pre- and post-tests, and nursing feedback forms. Evaluation: Overall, students rated the extent of skills acquisition as 2.75/4 and the impact of coaching as 3.4/4. Students rated ‘confidence to manage a project’ and the ‘administrative leadership’ aspect of coaching highest. Students felt that involvement in the project helped to develop leadership skills and will be helpful for their integration into teams in future. Implications: Pharmacists often lead or participate in clinical practice initiatives that promote optimal patient care or process improvement. This activity invariably involves project work and education of stakeholders. Acquiring project management and curriculum design skills early in a pharmacist’s career can be beneficial to their future success. Students placed a high value on the coaching they received. PREVALENCE OF CO-TRIMOXAZOLE INDUCED HYPERKALEMIA IN CHRONIC AND ACUTE USERS IN A TERTIARY TEACHING HOSPITAL Jassim Z, Moustafa R, Abdel- Aziz H, Hamad Medical Corporation, Doha-Qatar Introduction: Hyperkalemia is serious condition as it can be fatal sometime. Many drugs can cause hyperkalemia as side effect like co-trimoxazole. Objectives: Primary: evaluate the risk of hyperkalemia in patients receiving co- trimoxazole. Secondary: 1) detect the changes of potassium level from baseline to 7, 14, 21, and 30 days, 2) determine the association between co-trimoxazole dose and potassium level, 3) examine the relationship between renal function and hyperkalemia Method: A retrospective observation study of all patients treated with cotrimoxazole during Jan 2012 till Jan 2013. Exclusion criteria include patients received less than 2 doses or have no lab test. Patient’s medical records (both electronic and paper-based) were used to collect required data. Data analyzed using descriptive & inferential analyses. Result: 161 patients were included in this study. Patients were taking co- trimoxazole either as once daily (47%) or every other day (53%). Co-trimoxazole was taken at doses: 480mg (19.1%), 960mg (66%), and 1920mg (14.9%). Eightynine patients (55.3%) were taking other concomitant medications that may also increase potassium level (i.e. ACE-I and B-blocker). Around 26% of the patients treated with co-trimoxazole developed Hyperkalemia during the observed time (42 out of 161 patients). There was no significant correlation between cotrimoxazole doses and hyperkalemia (25.9% in 480mg, 31.2% in 960 and 28.6% in 1920mg; p=0.863) in each dose group, however, 82.5% of hyperkalemia cases were associated with significant increase in serum creatinine (p=0.00). The highest mean change of potassium level in once daily dosing was at “baseline-7 days” interval, while it was highest at “baseline-30 days” interval in every other day dosing. However; none of the changes from baseline to 7, 14, 21 and 30 days was found to be significant. Conclusion: Although many patients taking co-trimoxazole developed Hyperkalemia, the effect of renal function and use of other concomitant medications can’t be ignored. CSHP 2 Targeting Excellence in Pharmacy Practice PLANNING AND EVALUATION OF A COMPUTERIZED PRESCRIBER ORDER ENTRY IMPLEMENTATION Tom E,1 Chong D,1 Satchu S,1 Kertland H1,2 St. Michael’s Hospital, Toronto, ON 2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON 1 Background: The introduction of computerized prescriber order entry (CPOE) and electronic medication administration records (eMAR) to all non-critical care areas of our hospital occurred as a staggered rollout. Our goal was to ensure a smooth transition throughout the implementation. explicitly taught in the Pharmacy curriculum. Experience in these areas may serve to cultivate leadership capacity and career development. The project requirement for final year Pharmacy students during experiential training provided an opportunity to evaluate the students’ acquisition of skills from exposure to these concepts and the impact of coaching support. Description: The pharmacy department developed and delivered a rollout plan as each of the 13 patient cares area went live. Description: Students were introduced to the Project Management Institute’s framework and a curriculum design framework. Coaching support was provided by five staff pharmacists. The project involved an education session for nurses Action: Early work included development and implementation of order sets, policy and procedures and assessment of pharmacists’ daily workflows. Prior to each launch, the unit’s pharmacist was engaged to anticipate the shift in East General Hospital • University Health Network, Toronto • Walkerton Hospital • West 57 medication order review activities, address service-specific issues and identify required supports and scheduling needed during the launch. System training and support to all pharmacists was provided with the first unit launch. For subsequent units review of new service-specific orders and tip sheets were used. Debriefing sessions were held with the pharmacists weekly after each roll out. Learnings from each launch were incorporated into the next unit launch. Evaluation: Six months after the implementation pharmacists were asked how the rollout could have been improved. Overall, the pharmacists felt the rollout went well particularly as the staggered approach allowed for learnings to be applied to subsequent rollouts. Pharmacists gained experience with computerized orders and with the knowledge of several hospital electronic systems found that they became the unit’s “go to” person for questions related to the CPOE/eMAR system. It was thought that physicians should have received more training prior to the launch. Education was desired for topics that were “new” for pharmacists (e.g., assessment and validation of all IV infusion orders). Implications: Careful and intentional planning led to a seamless rollout from the pharmacy department perspective. Feedback from the pharmacists was incorporated into the rollout plan when CPOE/eMAR was launched in the critical care units. CSHP 2 Targeting Excellence in Pharmacy Practice PATIENT-PERCEIVED USEFULNESS AND USABILITY OF A SMARTPHONE/ONLINE APPLICATION IN TYPE 2 DIABETES SELF-MANAGEMENT Corey T, Li K, Ho C, School of Pharmacy, University of Waterloo, Waterloo, ON Background: Few studies have taken a qualitative approach to determine the potential role of smartphone applications or “apps” in self-management activities of Type 2 Diabetes (T2DM). A qualitative approach may identify pragmatic issues on the use of disease-management apps that may not arise through quantitative analyses. Objective: This study aimed to evaluate patients’ perceived usefulness and usability of a smartphone/online app – Glucose Buddy – in T2DM selfmanagement. Methods: A convenient sample of 6 participants with T2DM was recruited from a family health team clinic and a community pharmacy. Participants were instructed to use Glucose Buddy on their smartphone or computer. Phone interviews were conducted at 2 and 4 weeks to determine facilitators and barriers of the use of the app, the impact on diabetes self-management, and overall patient-perceived impact on health. A qualitative thematic coding approach was used to identify recurring themes. Results: Participants had varied opinions regarding the perceived usefulness and usability of the app for T2DM self-management. Some felt that the app helped increase their adherence to glucose monitoring, which led to a greater sense of control over their condition. However, this did not always lead to an increase in other self-management activities such as exercise. The usability of the app also varied among the participants, with “confusion” being identified as a common theme. Lack of intuitive acronyms throughout the app also led to challenges in using and navigating the app. Conclusions: The impact of smartphone/online application on T2DM self-management appears to be individualized. The tracking features seem to positively impact certain aspects of disease management (e.g., glucose monitoring) but not others (e.g., exercise). Pharmacists should be aware of the practical issues when recommending phone apps to diabetic patients. It is important to individualize app selection to ensure optimal benefits to patient care. TUESDAY, FEBRUARY 3 MARDI 3 FÉVRIER CSHP 2 Targeting Excellence in Pharmacy Practice POMPES INTELLIGENTES: ÉVALUATION PRATIQUE DES LIMITES DE DÉTECTION Guérin A,1 Lebel D,1 Bussières JF1,2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC 2 Faculté de pharmacie, Université de Montréal, Montréal, QC 1 Justification : L’établissement des limites hautes et infranchissables des pompes intelligentes se fait au sein de chaque établissement de santé en fonction des besoins et des particularités de chaque secteur de soins et à partir d’ouvrages de références. 58 Objectifs : L’objectif de cette étude était de vérifier au sein du service des soins intensifs d’un hôpital mère enfant, si les limites hautes et infranchissables des pompes intelligentes détectaient les erreurs. Méthodologie et démarche de l’étude : Une revue de l’utilisation de tous les médicaments perfusés entre le 01 mai 2013 et le 01 mai 2014 a été réalisée à partir du dossier pharmacologique informatisé (GesPharx CGSI TI, Québec, Qc)®. L’étude a porté sur tous les patients de l’unité de soins intensifs pédiatriques. Nous avons regardé pour chaque prescription si la dose prescrite dépassait les doses hautes et infranchissables. Afin de tester nos limites, nous avons simulé pour chaque prescription une erreur de 10 fois la dose en multipliant la dose prescrite par 10. Résultats : L’étude a porté sur 2084 prescriptions et sur 3503 jours d’administration de perfusion continue pour un total de 33 patients. Respectivement 5% (113/2084) et 2% (35/2084) des prescriptions étaient audessus des limites hautes et infranchissables pour les doses prescrites. Pour les erreurs simulées de 10 fois la dose, seulement 24% (509/2084) et 42% (875/2084) auraient été détectées par les limites hautes et infranchissables. Le top 3 des médicaments pour lesquels le nombre de prescriptions réelles est resté le moins détecté par les limites hautes était l’hydromorphone 5mg/ ml (n=13/13), le sufentanil préparé sur place (n=1/1) et le sufentanil 5mcg/ml (n=15/16). Conclusion : Cette étude démontre la nécessité de réévaluer périodiquement les limites utilisées pour les pompes intelligentes. RETROSPECTIVE REVIEW OF EMERGING DRUG USE IN A MOTHER-CHILD CENTER IN QUEBEC Corny J,1 Pelletier E,1,2 Lebel D,1 Bussières JF1,3 harmacy department and Pharmacy Practice Research Unit, CHU Sainte P Justine, Montréal, QC Pharmacy and Therapeutics Committee, CHU Sainte Justine, Montréal, QC 3 Faculty of Pharmacy, Université de Montréal, Montréal, QC 1 2 Background: Unapproved and off-label drug use in children is an important issue, with reported prevalences of 1-33% and 9-34% respectively. In a teaching hospital, clinicians are frequently confronted with conditions requiring emerging drugs (e.g. drugs without a notice of compliance, off-label drug uses with limited scientific literature and costly drugs (>300$CAD/dose)). Objective: To evaluate use of emerging drugs within our hospital. Methods: We identified retrospectively emerging drugs used between 2013- 01-01 and 2014-02-28. Following variables were collected in patient file (initial prescription): age, dates/hours of written intention to use the drug, prescription and first dose administered, written justification (alternatives used/eliminated, efficacy and safety endpoints, delays between intention and prescription, between prescription and first dose administered) and written documentation of consent from parents/patients. Descriptive statistics were performed. Results: A total of 26 emerging drugs (99 prescriptions, 89 patients) were identified. Top-five therapeutic classes (American Society of Health-System Pharmacists formulary) used were: 44:00–Enzymes (23% of drugs), 10:00– Antineoplasic agents (15%), 92:00–Miscellaneous therapeutic agents (15%), 28:00–Central nervous system agents (12%), 08:00–Anti-infective agents (8%) and 84:00–Skin and mucous membrane agents (8%). Drugs were either unapproved in Canada (42%), used off-label (27%) or costly (31%). Median patient’s age at initial prescription was 4 years-old [0-18]. Median delay between prescriber’s intention and prescription was 2 days [0-333] and was 0 day [0404] between prescription and first dose administered. Longer delays were associated with outpatient reimbursement authorization processes. Efficacy and safety endpoints were documented in 33% and 10% respectively. In 26% of prescriptions, a side effect was documented. Only 19% of prescriptions were associated to a documented verbal/written consent. Conclusion: This study describes 26 emerging drugs involving 99 prescriptions (89 patients) and their current challenges, such as the lack of efficacy and safety endpoints defined to ensure the treatment is effective and safe. UNLICENSED AND OFF-LABEL DRUG USE IN A MOTHER-CHILD TERTIARY CARE HOSPITAL Corny J,1 Bailey B,2 Lebel D,1 Bussieres JF1,3 harmacy department and Pharmacy Practice Research Unit, CHU Sainte P Justine, Montréal, QC 2 Emergency Department, CHU Sainte Justine, Montréal, QC 3 Faculty of Pharmacy, Université de Montréal, Montréal, QC 1 Haldimand General Hospital • William Osler Health System • Winchester District Memorial Background: In the last decades, several governmental initiatives were implemented to increase clinical research and decrease unlicensed and offlabel drug use rates in pediatrics. However, it is unclear how much progress was made. Objective: The objective was to assess the unlicensed and off-label drug uses in a university mother-child hospital. Methods: We conducted a cross-sectional study in a tertiary university motherchild hospital in Quebec. All active prescriptions during a 24-hour period were analyzed. Unlicensed drug use was defined as the use of nonmarketed drugs in Canada or marketed drug with pharmacy compounding. Off-label drug use was defined as the use of marketed drugs in Canada for an unapproved age group, indication, dosing, frequency or route of administration. We also determined if off-label drug uses were associated with strong scientific support, using Lexicomp’s® and Micromedex® databases. Number and proportion of unlicensed and off-label drug uses and proportion of off-label drug use with strong scientific support were measured. Results: A total of 2,698 drug prescriptions was extracted on March 5th, 2014 and included 308 inpatients. Unlicensed drug use rate was 6.8% (n=77 nonmarketed drugs, n=107 marketed drug with pharmacy compounding) and included 57 different drug substances. Off-label drug use rate was 35.7% and included 161 substances. Reasons for off-label drug use were: unapproved age group (n= 436, 45.2%), indication (n= 100, 10.4%), dosing (n= 262, 27.2%), frequency (n=306, 31.7%) and route of administration (n=75, 7.8%). Of all offlabel drug use prescriptions, 35.4% (n= 341) were with strong scientific support. Conclusion: This study allowed us to obtain unlicensed and off-label drug use rates for pediatric inpatients in our center. We found that 6.8% of prescriptions were unlicensed and 35.7% were off-label. Of off-label prescriptions, only 35.4% were associated with a strong scientific support. These results compare with literature results around the world. IS PEDIATRIC DRUG INFORMATION THE SAME FOR ALL CHILDREN AROUND THE WORLD? Corny J,1 Lebel D,1 Bussières JF1,2 harmacy department and Pharmacy Practice Research Unit, CHU Sainte P Justine, Montreal, QC 2 Faculty of Pharmacy, Université de Montréal, Montreal, QC 1 Background: Several governmental initiatives were implemented around the world in the last decade to increase clinical research and available data for drugs used in pediatrics. However, pediatric initiatives and requirements concerning the information contained in product monographs can differ between countries depending on the legislation where the drug is marketed. Description: We compared product monograph requirements for pediatric information between Canada, USA and Europe. Action: Using the web portals of Health-Canada, Food and Drug Administration (FDA) and European Medicines Agency (EMA), we retrieved product monographs requirements concerning pediatrics. Evaluation: According to regulations in Canada, USA and Europe, a pediatric use section is mandatory in the product monograph. If no clinical trials have been performed or if data in pediatrics is insufficient, manufacturers have to indicate that drug should not be used in children. However, depending on the area where the drug is marketed, other requirements for pediatric information in the product monograph are different. In Canada, additional requirements by HealthCanada include age, pediatric dosing, pharmacology and pharmacokinetics. Additionally, manufacturers have to determine if special drug monitoring has to be performed in children. In USA, FDA requires the same information, as well as pediatric precautions, warnings, contraindications and side effects. FDA is also the only agency requiring the mention of inactive ingredients potentially dangerous for a specific subpopulation (e.g. neonates). In Europe, additional requirements by EMA includes pediatric dosing, pharmacology, precautions, side effects, interactions with other drugs or other type of interaction and overdose management. Implications: This comparison of product monographs requirements for pediatrics in Canada, USA and Europe showed that governmental initiatives didn’t have the same impact on available data for pediatrics. This can lead to misinformation of clinicians who are confronted to different monograph and profile of drugs used in pediatrics. DÉMARCHE POUR LA MISE À NIVEAU D’UN SECTEUR DE SOINS PHARMACEUTIQUES : LE CAS DE LA PÉDIATRIE Leroux A,1 Guérin A,1 Bédard P,1 Lebel D,1 Bussières JF1,2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC 2 Faculté de pharmacie, Université de Montréal, Montréal, QC 1 Justification : Le concept de pratique fondée sur les preuves est peu à peu intégré en pharmacie. Objectif : Mettre à jour le niveau de pratique utilisé en soins pharmaceutiques pédiatriques à partir de données probantes. Méthodologie et démarche : Il s’agit d’une étude descriptive avec revue documentaire menée dans un centre hospitalier universitaire mère-enfant canadien. La démarche de mise à niveau proposée comporte deux étapes soit une revue de la documentation des articles publiés en français et anglais entre 2009 et 2014 et une description de la mise à jour du niveau de pratique. Résultats : Des 236 articles recensés, 14 ont été retenus. Nous avons recensé un article reposant sur des données de très bonne qualité (A), deux articles reposant sur des données de qualité acceptable (B), un article reposant sur des données de qualité insuffisante et 10 articles décrivant le rôle et les retombées du pharmacien sans analyse statistique. La mise à jour envisagée du secteur de pratique inclut une rencontre des parents de tous les patients en début d’hospitalisation, la prescription des modifications d’antibiothérapie suite aux dosages sériques, la déclaration à Santé Canada de tous les effets indésirables, la présentation d’un club de lecture au sein du département de pédiatrie, la certification de pharmaciens au Board Pharmacy Speciality pédiatrique, la vérification systématique des ordonnances de départ, et l’identification et la documentation au dossier de tous les médicaments en la possession des patients. Conclusion : Cette étude descriptive met en évidence le rôle du pharmacien en pédiatrie dans un centre hospitalier de soins universitaire mère enfant. Il existe peu de données sur le rôle du pharmacien pour cette activité; notre approche fondée sur les preuves et sur la réévaluation de nos activités a toutefois permis d’identifier une quinzaine de changements et d’améliorations à nos pratiques actuelles. CONFORMITÉ DES ORDONNANCES À LA RÈGLE D’ÉMISSION DES MÉDICAMENTS : ÉTUDE PILOTE AU SEIN D’UN CHU MÈREENFANT Ballandras C,1 Lebel D,1 Atkinson S,1 Bussières JF1, 2 épartement de pharmacie et Unité de recherche en pratique pharmaceutique, D Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC 2 Faculté de pharmacie, Université de Montréal, Montréal, QC 1 Contexte : En vertu du cadre juridique en vigueur, le chef du département de pharmacie d’un établissement de santé doit établir une règle d’émission des ordonnances de médicaments encadrant notamment la rédaction des ordonnances et les prescripteurs autorisés. Objectif : Évaluer la conformité des ordonnances à la règle d’émission des médicaments au sein d’un CHU mère-enfant. Méthodologie : Au sein de notre établissement, les ordonnances de médicaments sont manuscrites ou électroniques selon les unités de soins. Une grille d’audit comportant 22 critères a été créée. Neuf critères portaient sur la conformité des feuilles d’ordonnances (p.ex. présence de l’adressographe) et 13 critères portaient sur la conformité du contenu des ordonnances de médicaments (p.ex. présence de la dose). L’audit a été réalisé sur l’ensemble des ordonnances numérisées reçues à la pharmacie le 17 juin 2014. Résultats : Un total de 359 feuilles d’ordonnances correspondant à 746 ordonnances a été analysé. Le taux global de conformité des feuilles d’ordonnances était de 19,5%(70/359). Le taux de conformité était supérieur à 90% pour 5/9 critères (p.ex. présence de la date de naissance). Cependant, le poids n’était présent que dans 64,1%(230/359) des cas et le statut allergique dans seulement 24,5%(88/359) des cas. Le taux global de conformité du contenu des ordonnances était de 23,9%(178/746). Le taux de conformité était supérieur à 90% pour 10/13 critères (p.ex. présence de la date). Cependant, l’heure de prescription n’était présente que dans 67%(500/746) des cas et la mention du nom générique dans 79,2%(591/746) des cas. Conclusion : Moins du quart des feuilles d’ordonnances et des ordonnances se conformaient entièrement à la règle d’émission des ordonnances. Il est difficile Hospital • Windsor Regional and Leamington District Hospital (Hôtel-Dieu Grace) PRINCE 59 pour des prescripteurs de se plier à toutes ces règles; le recours à la prescription électronique est envisagé au sein de notre établissement pour pallier à ces écarts. CSHP 2 Targeting Excellence in Pharmacy Practice AUDIT OF THE LABELLING OF HAZARDOUS DRUGS IN THE CANADIAN MARKET Janes A,1 Bérard C,1 Bussières JF1,2 harmacy Department and Pharmacy Practice Research Unit, CHU SainteP Justine, Montreal, QC 2 Faculty of Pharmacy, Université de Montréal, Montréal, QC 1 Background: There are no guidelines regarding the commercial labelling of hazardous drugs in Canada. However, it is essential that hazardous drugs can be clearly and easily identified throughout the drug-use process in order to prevent occupational exposure for health professionals. Objective: To describe the current state of the labelling of hazardous drugs in Canada. Methods: The list of hazardous drugs issued by the National Institute for Occupational Safety and Health (NIOSH) in 2012 was used. Outer and inner labels of hazardous drugs from one Canadian wholesaler were analysed. For each label, we evaluated the presence of symbols or mentions about the existence of a risk. We defined a label as compliant if at least 1 of the 3 following criteria was present: cytotoxic symbol, “cytotoxic/toxic” mentions or safe handling precaution mentions. We calculated the proportion of compliant labels. Results: A total of 336 drugs were analysed on August 21st, 2014, out of which 42% (141/336) were antineoplastic drugs. Of these 336 products, 383 labels were assessed (i.e.18 outer packaging when available, 240 outer labels and 125 inner labels). Of all the labels analyzed, 80% (305/383) of the labels were noncompliant (Table 1). Among the 20% compliant labels, 72% (56/78) corresponded to antineoplastic drugs. Table 1. Proportion of compliant labels of hazardous drugs study site changed its PEP therapy to darunavir/ritonavir (DRVr) and tenofovir/ emtricitabine (TDF/FTC). To date, no studies have assessed the tolerability of this medication combination as PEP. Objectives: The primary objective of this study was to assess tolerability of DRVr + TDF/FTC. The secondary objectives were to explore adherence, discontinuation rates, seroconversion and quality of life associated with DRVr + TDF/FTC treatment as a PEP regimen. Methods: Patients receiving DRVr + TDF/FTC were asked to voluntarily complete three self-report questionnaires measuring common adverse effects, adherence and quality of life during the first and fourth (last) weeks of treatment. Participants were recruited from the study site. The results were and reported analyzed using measures of central tendency and descriptive statistics (SPSS v20). Results: Fifty-one subjects were enrolled in the study from April to November 2013. Sixty percent were female with a mean age of 34 years. DRVr + TDF/FTC were discontinued in 24 subjects (47%), 6 (12%) were considered treatmentrelated discontinuations. Commonly reported moderate side effects during weeks one and four were tiredness/fatigue (61%, 36%), nausea (56%, 4%) and loss of appetite (47%, 40%). Severity was described as at least moderate in 60% and 20% at weeks 1 and 4 respectively. Sign test indicated that the frequency and severity of side effects significantly improved over the course of PEP treatment (p<0.05). Mean adherence was above 95% at all times. Compared to subjects seen at the infectious diseases clinic, subjects at the second site reported worse adherence at week 1 but similar at week 4. No HIV seroconversion occurred during the study. Conclusion: Once daily DRVr + TDF/FTC as PEP is convenient, well tolerated, and associated with few treatment-related discontinuations. PROPHYLAXIS OF POST-TRAUMATIC INFECTIOUS ENDOPHTHALMITIS: PROBABILITY OF FLUOROQUINOLONE SUCCESS USING MONTE CARLO SIMULATIONS Peragine C2, Palmay L1, Walker SAN1,2,3, Walker SE1,2 Drug type Label types Compliant N(%) Non compliant N(%) All hazardous drugs (n=336) Outer packaging (n=18) 7 (39%) 11 (61%) Outer label (n=240) 55 (23%) 185 (77%) Inner label (n=125) 16 (13%) 109 (87%) Total (n=383) 78 (20%) 305 (80%) Antineoplastic hazardous drugs (n=141) Outer packaging (n=12) 7 (58%) 5 (42%) globe injury. One case series reported that moxifloxacin 800mg PO Q12H can deliver intraocular concentrations that exceeded the MIC90 of common pathogens, but equivalent studies using other fluoroquinolones have not been conducted. Outer label (n=125) 38 (30%) 87 (70%) Objective: To determine pharmacokinetic (PK) and pharmacodynamic (PD) Inner label (n=37) 11 (30%) 26 (70%) Total (n=174) 56 (32%) 118 (68%) properties of ciprofloxacin, levofloxacin, and moxifloxacin to model the likelihood of microbiologic success and compare the efficacy of 9 potential recommended dosing regimens. Nonantineoplastic hazardous drugs (n=195) Outer packaging (n=6) 0 (0%) 6 (100%) Methods: A literature search determined the weighted mean of all PK variables Outer label (n=115) 17 (15%) 98 (85%) Inner label (n=88) 5 (6%) 83 (94%) Total (n=209) 22 (11%) 187 (89%) Conclusion: Less than a quarter of hazardous drugs labels were considered compliant in clearly identifying the risk of occupational exposure. Health Canada should define criterias required to clearly identify hazardous drugs. TOLERABILITY OF DARUNAVIR/RITONAVIR, TENOFOVIR/ EMTRICITABINE FOR HUMAN IMMUNODEFICIENCY VIRUS POSTEXPOSURE PROPHYLAXIS Hutton L,1 MacPherson P,2,3 Corace K,4 Leach T5 , Giguère P 1,6 Department of Pharmacy, The Ottawa Hospital, Ottawa, ON Division of Infectious Diseases, The Ottawa Hospital, Ottawa, ON 3 Faculty of Medicine, University of Ottawa, Ottawa, ON, 4 Department of Psychology, The Ottawa Hospital, Ottawa, ON 5 Department of Emergency Medicine, Sexual Assault and Partner Abuse Care Program, The Ottawa Hospital, Ottawa, ON 6 The Ottawa Hospital Research Institute, Ottawa, ON 1 2 Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON 3 Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON 1 2 Background: Infectious endophthalmitis is a serious complication of open- required to generate an oral concentration time profile. Steady state peak plasma concentrations of the unbound drug (fCmax ) and the unbound 24hour plasma AUC (fAUC24h) were generated. The free concentration was used, assuming that free-drug concentrations in plasma approximate the vitreous humor concentrations in the eye. Pathogen-specific fAUC24h:MIC breakpoints were used to determine microbiologic success. A Monte Carlo simulation with 1 million iterations per regimen was used to determine the proportion of the simulated population that exceeded the pathogen-specific fAUC24h:MIC breakpoints. A 10% difference in success was judged clinically significant. Results: Nine fluoroquinolone regimens were assessed for each pathogen. Using the fAUC24h:MIC endpoint, the highest chance of overall prophylactic success was achieved using a regimen of levofloxacin 1000mg daily (85.6% success rate). 400mg moxifloxacin BID was a close second achieving success in 81.2% of cases. This difference is not clinically significant. Both levofloxacin (500mg daily) and moxifloxacin (400mg daily) achieved microbiological success in more than 75% of cases and performed better than maximal doses of ciprofloxacin (750mg BID) achieving success in 68.4% of cases. Conclusion: No safety data exits for 400mg BID of moxifloxacin. Simulation suggests that prophylactic use of 1000mg of levofloxacin po daily (a Health Canada approved dose) has the highest probability of attaining PK/PD targets and microbiological success for preventing post-traumatic endophthalmitis. Background: Postexposure prophylaxis (PEP) for HIV has improved in tolerability and dosing complexity over the past two decades. In March 2013, the 60 EDWARD ISLAND: • Community Hospital • Health PEI • Kings County Memorial Hospital NATURAL HEALTH PRODUCT USE IN PATIENTS WITH RHEUMATOLOGICAL CONDITIONS Dissanayake T,1 Hagen K,2 Katz S,1 Hall J2 1 2 Division of Rheumatology, University of Alberta, Edmonton, AB Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB Background: Natural health products (NHPs) are naturally occurring substances available without a prescription, frequently used to restore or maintain good health, often in addition to or in place of conventional therapy. Previous literature has shown that the prevalence of NHP use is higher in patients with rheumatological conditions compared to the general population. However, NHP use is frequently under-reported and thus represents a common but often overlooked aspect of the patient medication history. Objective: The aim of this study was to describe the population-based rates and patterns of NHP use in patients with rheumatologic conditions. Methods: We conducted an observational cross-sectional survey of patients with rheumatological conditions in Edmonton, Alberta. Patients attending the 2 largest rheumatology clinics over an 8-week period were invited to participate. Response items included self-reported NHP use, medical conditions and medications, as well as demographic data. Data were analyzed using descriptive statistics and included an inflammatory arthritis subgroup. Results: Of the 1063 patients who completed the survey (response rate, 36%), 60% reported using of one or more NHPs, with a mean of 2.9 products. When excluding vitamins and minerals, the prevalence decreased to 40% and the mean number of NHPs to 1.8. There were no differences between the entire cohort and the IA subgroup. A variety of NHPs were reported, with management of joint health being the most common indication. The majority of patients stated that they would not discontinue conventional prescribed medication in favour of NHPs. Almost 65% of NHP users stated they informed their physicians of NHP use, however, only 20% informed their pharmacist and even fewer informed other health care professionals. A minority of patients noted any benefit or adverse effect from therapy. Conclusion: Our study confirmed the frequent use, but underreporting, of NHPs by patients with rheumatologic conditions. CSHP 2 Targeting Excellence in Pharmacy Practice MULTIDISCIPLINARY REVIEW PROCESS DEMONSTRATES THE NEED FOR EARLY PHARMACIST NOTIFICATION WITH TREATMENT INTERVENTION BENEFITS IN CLOSTRIDIUM DIFFICILE INFECTION (CDI) CSHP 2 Targeting Excellence in Pharmacy Practice PHARMACIST’S PERCEPTION OF THE IMPLEMENTATION OF COMPUTERIZED PRESCRIBER ORDER ENTRY (CPOE) ON THEIR PRACTICE Kertland H1,2, Tom E1 1 2 Department of Pharmacy, St. Michael’s Hospital, Toronto, ON Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON Background: CPOE is advocated as a patient safety initiative. The impact of this technology has been measured by metrics such as reduced medication turnaround time and decreased inappropriate antibiotic choices. However, how it impacts a pharmacist’s practice is not known. Objective: We wished to determine how this technology impacted a pharmacist’s practice. Methods: We conducted a qualitative study inviting pharmacists who worked a minimum of six months prior to and following the implementation of CPOE to participate. One-on-one interviews were conducted using a semi-structured guide by a trained interviewer. Two investigators analyzed the verbatim transcripts to identify themes. The analysis was validated with a group of eligible pharmacists Results: Fourteen pharmacists were interviewed and all thought it had a positive impact on their practice. Pharmacists perceived that CPOE had the greatest impact on their role in the medication system, direct patient care and interdisciplinary team collaboration. For the first two roles, major themes were improved efficiency (e.g., prioritization of orders, timely medication order review, quicker resolution of problem orders, complete medication profile was available for patient assessment) and safety (easier to determine appropriate timing of next dose, no illegible writing, increased time to resolve complex problems). Interdisciplinary team communication, particularly order clarification with physicians, was facilitated by the timeliness of order review. The use of technology revealed new safety concerns that emphasized the essential role that a pharmacist has to ensure patient safety. Conclusion: Overall, pharmacists perceived that the introduction of CPOE had a positive impact on their practice. It permitted a more efficient assessment of medication and patient information providing additional time to identify and resolve drug therapy problems. New types of safety concerns were detected which needed to be addressed. CSHP 2 Targeting Excellence in Pharmacy Practice ANTICOAGULATION AND ANTIPLATELET PATTERNS IN PATIENTS WITH ATRIAL FIBRILLATION POSTPERCUTANEOUS CORONARY INTERVENTION Popovski Z, Dhami R, Creamer L, Jansen S, Elsayed S, Nancekevill B, Newman A, Bossy J, Vandersluis C., London Health Sciences Centre, London, ON Woods E,1 Ackman M,1 Graham M,2 Koshman S,2 Boswell R,1 Barry A1 Background: A multidisciplinary review process of nosocomial CDI revealed 2 numerous medication related improvement opportunities. In addition to important infection control interventions, pharmacists’ scope of practice was identified as critical to addressing medication-related issues in the treatment of CDI. Description: Antimicrobial stewardship pharmacists reviewed nosocomial CDI cases for medication related issues and made recommendations to reduce the risk and/or improve treatment of CDI. Recommendations included broad antimicrobial stewardship initiatives which will serve in planning priorities. In addition, discordance with evidence based guidelines for treatment of CDI revealed a need for early notification of pharmacists to address treatment issues. Action: A new process for direct notification of all pharmacists of CDI by the Microbiology Lab was developed to ensure prompt treatment according to guidelines. Interventions include matching disease severity stratification to treatment regimen, reducing time to initial dose as well as ensuring reassessment of systemic antimicrobials and proton pump inhibitors. Evaluation: Monthly audits of pharmacists’ interventions in all CDI cases ranged from 42% to 100%. Pharmacists report interventions are required in >90% of CDI cases and acceptance of >90% of medication related recommendations. Planned process improvements include ongoing education and electronic documentation of interventions. Implications: Our multidisciplinary review process provided valuable education about the pharmacists’ role in prevention and treatment of CDI. Including pharmacists in the initial notification of CDI by the Microbiology lab ensures prompt appropriate therapy and addresses numerous medication related issues identified in a multidisciplinary review process. Clinical and economic outcomes will also be measured before and after the new process. Our intervention was submitted as a corporate quality improvement project (QIP) and the important role of pharmacists’ early intervention has been well established. 1 Pharmacy Services, Alberta Health Services, Edmonton, AB Division of Cardiology, University of Alberta, Edmonton, AB Background: Guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, in patients with non-valvular atrial fibrillation (NVAF) who undergo percutaneous coronary intervention with stenting (PCI). Objective: The objective of this study was to characterize the real-world use of anticoagulant and antiplatelet therapy at discharge in patients with NVAF postPCI, and identify determinants of the most commonly utilized regimens. Methods: A retrospective chart review was conducted at the Mazankowski Alberta Heart Institute from January 2011 to December 2013. Adult inpatients with NVAF undergoing PCI were included. The primary outcome was the proportion of patients discharged on TAT. Results: The cohort consisted of 71 patients (median age 75 years, 73% male), with median CHADS2 and HASBLED scores of 2 and 3, respectively. Nine patients (12%) had a previous gastrointestinal (GI) bleed. At discharge, 42% received TAT and 38% received clopidogrel and ASA (dual antiplatelet therapy or DAT). Of those who received TAT, 53% had a recommended duration of one month followed by warfarin and ASA indefinitely, whereas 23% had a recommended TAT duration of one year. DAT was recommended for one year in 37% and six months in 19%. Novel oral anticoagulants with antiplatelet drugs were prescribed in 8% of patients, while 7% received ticagrelor and ASA and 1.4% received warfarin and clopidogrel. No patients with a previous gastrointestinal (GI) bleed received TAT. In a multivariate logistic regression analysis, female sex and gastroesophageal reflux disease were independent predictors for use of DAT. • Prince County Hospital • Queen Elizabeth Hospital • Souris Hospital • Western Hospital 61 Conclusion: Despite a guideline-based indication, less than half of eligible patients received TAT, and 20% received non-evidence based combinations including novel oral anticoagulants and ticagrelor. Other than consideration of GI bleed, the rationale for using DAT in place of TAT was unclear. Further studies are needed to understand variance from guideline-based therapy. CSHP 2 Targeting Excellence in Pharmacy Practice A PHARMACY PRACTICE RESIDENCY PROGRAM AT A PAEDIATRIC QUATERNARY HOSPITAL: PROGRAM REVIEW AND EVALUATION Chung E1,2, Zao J,1,2 Seto W,1,2 Bjelajac Mejia A1,2 1 2 The Hospital for Sick Children, Toronto, ON Leslie Dan Faculty of Pharmacy, Toronto, ON Background: A pharmacy practice residency is defined by the Canadian Pharmacy Residency Board (CPRB) as an organized, directed, and accredited program that focuses on developing the residents’ competencies in direct patient care, pharmacy operations, project management, personal practice aspects of pharmacy practice, and leadership roles. Description: Two pharmacy residency positions that focus on paediatric pharmacy practice have been offered annually since 1984 at a single site in Canada. It is a 12-month general residency program that is accredited by CPRB and is affiliated with the University of Toronto. No published work has reviewed the development or examined the outcomes of the pharmacy residency program. Therefore, our purpose is to review the evolution of this program and determine its impact on the institution. Action: Data was extracted from CPRB accreditation documents, preceptor meeting minutes, residency advisory committee meeting minutes, past and current residency coordinators, residency program files, the residency program outline, residency research meeting minutes, and the Residency Matching Service (RMS) rank lists. Evaluation: Recent milestones of the paediatric pharmacy residency program include an expansion of rotations, the addition of teaching opportunities, the development of structured assessment tools, a revision of the recruitment process, and an enhancement of the residency experience. Since 1984, there have been 54 program graduates. Ninety-two percent of candidates who were matched to the program were ranked top 3 by the hospital since the implementation of RMS in 2003. Accomplishments of the graduates include 15 local and national awards, and 27 publications in peer-reviewed journals. Seventy-three percent of graduates are currently employed at the institution. Implications: This paediatric pharmacy residency program has produced accomplished clinical pharmacists with distinguished awards and significant contributions to paediatric practice and the literature. It has also seen a significant retention of program graduates competent in providing paediatric care. CSHP 2 Targeting Excellence in Pharmacy Practice PATIENT SATISFACTION WITH CHRONIC HIV CARE PROVIDED THROUGH AN INNOVATIVE PHARMACIST AND NURSE-MANAGED CLINIC OR A MULTIDISCIPLINARY CLINIC Kielly J,1,2 Kelly DV,1,2 Biggin J,1 Asghari S3 School of Pharmacy, Memorial University of Newfoundland, St. John’s, NL Eastern Health, St. John’s, NL 3 Faculty of Medicine, Memorial University of Newfoundland, St .John’s, NL 1 2 Background: Utilizing health professionals to their full scope supports provision of effective and efficient care. Pharmacist and nurse-led clinics are an established model for many chronic diseases but not yet for HIV. At our centre all HIV+ patients are seen by a multidisciplinary team (MDC: physician, nurse, pharmacist and social worker) at least yearly but some attend an HIV-specialist pharmacist/nurse clinic (PNC) for alternate biannual visits. Objective: To assess patient satisfaction with chronic HIV care received through MDC and PNC. Methods: A telephone survey was administered to consenting, eligible patients (English-speaking adults who attended the MDC or PNC between January-July 2014). Survey questions came from Patient Assessment of Chronic Illness Care (PACIC) which measured overall satisfaction, and Patient Satisfaction Survey for HIV Ambulatory Care (PSS-HIV), which assessed access to care, medical visits, and quality of care. The survey was pretested for face and content validity. Descriptive statistics were used to describe patient characteristics and satisfaction scores. T-test compared satisfaction scores between PNC and MDC. Logistic regression examined associations between independent variables (e.g. demographics) and dependent variables (e.g. satisfaction with care). 62 Results: Response rate was 51.6% (49/95 patients). Overall satisfaction was high (mean PACIC score 3.14 out of 5), and did not differ between PNC and MDC (2.96 vs. 3.19, p=0.42). Satisfaction on domains assessed by PSS-HIV are described in the table. Only geographic location was predictive of satisfaction on multivariate analysis, with rural respondents indicating higher satisfaction (p=0.05). Percentage of respondents* who agreed with selected satisfaction statements (from PSS-HIV survey) Access to Care Appointment availability met my needs 35/40 (88%) Off hours care was available when needed 17/24 (71%) I could access care via phone or email to discuss medical questions 38/42 (90%) Medical Visits Providers asked for my input in deciding treatment plans 42/47 (89%) Providers explained medication side effects in a way I could understand 47/47 (100%) Providers suggested ways to help remember to take my HIV medications 40/46 (87%) Overall Quality of Care I would rate my providers’ knowledge of the newest developments in HIV medical standards as excellent/very good 39/45 (87%) Most frequently selected descriptors used to reflect how respondents felt about care received through clinic: Caring 49/49 (100%) Friendly 49/49 (100%) Respectful 48/49 (98%) Understanding 48/49 (98%) *Not all respondents answered all questions Conclusions: Patients are satisfied with both clinics, supporting PNC as an innovative model for chronic HIV care. Comparison of outcomes between clinics is needed to ensure high quality care for all patients. CSHP 2 Targeting Excellence in Pharmacy Practice USE OF THERAPEUTIC DRUG MONITORING TO IMPROVE PAEDIATRIC CLINICAL PHARMACY SERVICE AT A TERTIARY HOSPITAL Lim SH,1 Chen W,1 Seto W1,2,3 1 Leslie Dan Faculty of Pharmacy, University of Toronto, ON 2 Department of Pharmacy, The Hospital for Sick Children, Toronto, ON 3 Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON Background: Therapeutic drug monitoring (TDM) of certain medications is essential in the maintenance of serum drug concentrations within the desired therapeutic range, above which toxicity occurs and below which ineffective therapy occurs. As paediatric patients undergo physiological changes that leads to different pharmacokinetic parameters compared to adults, a TDM service was initiated at a tertiary hospital. Since then, TDM service has expanded to align with the hospital’s strategic directions: create a culture of service of excellence, optimize patient safety and foster clinical research excellence. Description: TDM service expansion initiatives were implemented in 3 domains: clinical patient care, continuous quality improvement and clinical pharmacy research. Action: Clinical patient care improvements were identified through TDM based initiatives. Annual review of TDM results and clinical pharmacist TDM recommendations in ensuring continuous quality improvement and patient safety were analyzed. Evidence to improve medication dosing in paediatric patients was generated from TDM research studies. Evaluation: TDM certification program, development of new assays, staff TDM education and new order sets were implemented to improve clinical patient care. Review of TDM results and pharmacist TDM recommendations identified information gaps in current paediatric dosing regimens. TDM research studies SASKATCHEWAN: • Kelsey Trail Health Region: Hudson Bay Health Care Facility, Kelvington have led to practice changes such as the hospital-wide implementation of oncedaily dosing aminoglycosides. Description: Pharmacists can contribute to successful OPAT through antimicrobial stewardship and patient education. Implications: Through the application of clinical pharmacy research methodology and quality improvement process, initiatives were implemented to improve paediatric clinical pharmacy service through TDM. Action: An intervention set was developed for Antimicrobial Stewardship pharmacists to systematically assess and document an optimal OPAT regimen and monitoring plan for physicians to include in the electronic hospital discharge summary (eDS). GUIDELINE FOR THE PREVENTION OF BREAKTHROUGH AND TREATMENT OF REFRACTORY CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING IN PEDIATRIC CANCER PATIENTS Flank J,1, 4 Robinson PD,5 Holdsworth M,6 Portwine C,7 Gibson P,8 Phillips R,10, 11 O’Shaughnessy E,12 Maan C,9 Stefin N,13 Sung L,2, 3 Dupuis LL1, 3, 4 Department of Pharmacy, The Hospital for Sick Children, Toronto, ON Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON 3 Research Institute, The Hospital for Sick Children, Toronto, ON 4 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON 5 Pediatric Oncology Group of Ontario, Toronto, ON 6 Department of Pharmacy Practice & Administrative Sciences, University of New Mexico, Albuquerque, NM, USA 7 Department of Pediatrics, McMaster University, Hamilton, ON 8 Department of Paediatric Oncology/Haematology, Children’s Hospital at London Health Sciences Centre, London, ON 9 Department of Psychology, Children’s Hospital at London Health Sciences Centre, London, ON, 10 Department of Oncology, Leeds Children’s Hospital, Leeds, West Yorkshire, UK 11 University of York, Heslington, York, UK 12 Department of Nursing, Children’s Hospital of Eastern Ontario, Ottawa, ON 13 McMaster Children’s Hospital, Hamilton, ON 1 2 Background: Control of chemotherapy-induced nausea and vomiting (CINV) in children receiving chemotherapy remains sub-optimal. The best approach to manage breakthrough CINV is uncertain. Objectives: To provide clinicians with an evidence-based approach to treat breakthrough CINV and prevent refractory CINV in children and to identify evidence gaps in this field. Methods: An inter-professional, international panel of experts was convened. A systematic search for existing guidelines on this topic was undertaken. Since no guideline was identified for adaptation or endorsement as assessed using the Appraisal of Guidelines Research and Evaluation II instrument, systematic reviews of primary studies evaluating interventions for breakthrough and/or refractory CINV in oncology patients of any age and the general safety of such interventions in children were undertaken. Recommendations were developed through review of the evidence and differences in interpretation among panel members were resolved by consensus. The GRADE approach was used to describe the quality of evidence and strength of recommendations. Results: A total of 4335 references were identified by the search strategy. After screening titles and abstracts, 109 papers were retrieved in full and 61 satisfied the eligibility criteria. Recommendations made include: ensuring guidelineconsistent acute antiemetic prophylaxis is provided, upgrading the antiemetic prophylaxis a patient is receiving to that suggested for a chemotherapy regimen of a higher emetogenicity ranking, and the use of additional antiemetic agents, such as olanzapine. Evidence gaps identified include: the outcomes of CINV prophylaxis escalation in children experiencing breakthrough or refractory CINV and the optimal pediatric dose of additional antiemetic agents such as olanzapine. Conclusions: This guideline provides clinicians with evidence-based recommendations intended to improve CINV control and quality of life in pediatric cancer patients. Prospective evaluation of the contribution of this guideline to CINV control and trials to address the significant evidence gaps identified are needed. CSHP 2 Targeting Excellence in Pharmacy Practice IMPACT OF PHARMACIST INTERVENTIONS ON OUTPATIENT PARENTERAL ANTIMICROBIAL THERAPY INFORMATION TRANSFER AT HOSPITAL DISCHARGE Jia Ning Liu,1 McKenna S,1 Guo L,1 Hopman W2 Department of Pharmacy Services, Kingston General Hospital, Kingston, ON 2 Department of Public Health Sciences, Faculty of Medicine, Queen’s University, Kingston, ON 1 Background: Successful outpatient parenteral antimicrobial therapy (OPAT) after hospital discharge depends on effective information transfer. However, essential details to be communicated to primary care providers remain to be standardized. Evaluation: This prospective, double-armed cohort study evaluated the eDS for adult patients who received either usual care alone (n = 62), or systematic pharmacist-conducted assessment and documentation (SPCAD) of antimicrobial therapy in addition to usual care (n = 20), prior to hospital discharge with OPAT. The primary outcome was the proportion of eDSs containing all six predefined OPAT details: antimicrobial name, regimen, duration, indication, laboratory monitoring, and most-responsible physician(s). This outcome was not significantly changed by the SPCAD process compared with usual care alone (30.0% versus 17.7%, P = 0.24). The groups did not differ significantly in the secondary outcomes, which were the proportion of eDSs containing any combination of the OPAT details and early rehospitalisation rates among a geographically accessible subgroup. All 17 potential interventions were conducted for at least 60% of patients, supporting their future application. Timely identification of patients was identified as a challenge. Implications: To our knowledge, this was the first study to assess, and attempt to improve with pharmacist interventions, the completeness of OPAT information transfer in adult patients. The pre-discharge pharmacist interventions appeared to be practical. However, this study lacked statistical power to conclude their impact on the completeness of OPAT information transfer. Further investigation on the effects of pharmacist activities at hospital discharge on OPAT is warranted given the importance of communication at this care transition. CSHP 2 Targeting Excellence in Pharmacy Practice SURVEY OF HEALTHCARE PROFESSIONALS ON THE ROLE OF PHARMACISTS IN AN OUTPATIENT HIV CLINIC SETTING Wong A,1 Giguère P,2 Robinson L,3 Martel D,4 Toy J,5 Sulz L,6 Sheehan N,1 Lemire B,1 Foisy M7 McGill University Health Centre, Montreal, QC The Ottawa Hospital, Ottawa, ON 3 Windsor Regional Hospital, Windsor, ON 4 Centre Hospitalier de l’Université de Montréal, Montréal, QC 5 St. Paul’s Hospital, Vancouver, BC 6 Regina General Hospital Regina Qu’Appelle Health Region, Regina, SK 7 Northern Alberta HIV Program, Alberta Health Services, Edmonton, AB 1 2 Background: Pharmacists with various roles are involved in the inter-disciplinary care of HIV-infected patients. A survey of HIV healthcare professionals was developed to determine and prioritize factors requiring referral for clinical pharmacy services. Objectives: To describe how HIV healthcare professionals perceive the relative importance of HIV pharmacist activities and to compare the pharmacists’ perception to the perception of other healthcare professionals. Methods: This descriptive cross-sectional survey study targeted Canadian HIV practitioners involved in interdisciplinary teams including pharmacists, physicians, nurses etc. Data was collected anonymously using Fluid Survey, a secure online survey, by a snowball sampling technique. Comparative statistics were done using Wilcoxon signed-rank, chi-square or exact Fisher’s tests. Results: Of the estimated 335 emails requesting participation, 95 participants completed the survey (estimated response rate of 28%). Of the 53 criteria that were investigated, 19 (36%) were characterized as “very important” by more than 50% of respondents. Pharmacists had a tendency to attribute a greater importance to the evaluation of patients on complex treatment regimens (p=0.04), counselling for initiation in antiretroviral therapy (p=0.01), pregnancy (p=0.02) and pediatrics (p=0.02). Forty-five (47%) respondents considered that the development of a screening tool would help identify high risk patients who require pharmacy consultation, while 71 (76.3%) respondents believed that implementation of a screening tool could be easily integrated into daily practice. Conclusion: This national survey likely reflects an adequate sample of HIV healthcare professionals across Canada. A large variety of pharmacist related activities were considered as “very important” by a majority of participants though the relative importance of activities differed between the healthcare professionals. The different perceptions of the role of an HIV pharmacist warrant the development of a short and simple screening tool to identify at risk patients for referral to pharmacy in order to optimize patient care. Hospital, Melfort Hospital, Nipawin Hospital, Porcupine Carragana Hospital, Tisdale Hospital 63 PREDICTORS OF BACTEREMIA IN THE ELDERLY Bannerman H, Walker SAN, Williams E,4,5 Liu B5 1 1,2,3 Methods: Patient demographics and steady-state gentamicin concentration Elligsen M, Walker SE, Palmay L, Jackson L, 1 1,2 1 1,4 unnybrook Health Sciences Centre (SHSC), Department of Pharmacy, Toronto, S ON 2 University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, ON 3 SHSC, Division of Infectious Diseases, Toronto, ON 4 SHSC, Veterans Centre, Toronto, ON 5 University of Toronto, Faculty of Medicine, Toronto, ON 1 Background: Diagnosing infection in elderly patients is challenging because typical manifestations seen in younger adults are often more subtle, or nonexistent, in the geriatric population, resulting in a delayed diagnosis. A delay in diagnosis of bacteremia in geriatric patients occurs in > 20% of cases, and misdiagnosis occurs in 35%. Objectives: The objective of this study was to identify predictors of bacteremia in elderly patients to provide clinicians with a practical tool to aid in the diagnosis of bacteremia in the elderly to: 1) minimize unnecessary exposure to antimicrobials; and 2) improve early identification of elderly patients who require antibiotic treatment for bacteremia. Methods: A retrospective chart review of patients >80 years old admitted to hospital over a 4-year period was conducted. One hundred and five bacteremic patients (cases) were matched to non-bacteremic controls for gender, age, hospital ward, length of stay, and date of stay on the matching unit. Bivariate logistic regression was used to identify laboratory and clinical parameters that were significantly associated with infection (p<0.05; adjusted odds ratio (OR)) and Classification and Regression Tree (CART) analysis was used to identify breakpoints for these parameters. Results: Statistically significant parameters and their corresponding breakpoints that were determined to be associated with infection were maximum temperature (Tmax)(>37.55C) (OR=42.575), neutrophils (>7.95)(OR=1.923), a change in level of consciousness (LOC)(Yes = 1, No = 0)(OR=1.571), blood urea nitrogen (BUN)(> 10.05)(OR=1.359), glucose (>7.35)(OR=1.167), albumin (<33.5)(OR=1.038) and alanine aminotransferase (ALT) (>19.5)(OR=1.005). The significant regression equation determined was: Ln(odds of infection) = - 150.299 + 3.751(Tmax) + 0.654(neutrophils) + 0.452(change in LOC) + 0.307(BUN) + 0.154(glucose) + 0.038(albumin) + 0.005(ALT). Conclusions: The derived parameters, regression equation, and breakpoints may be useful in improving the predictive capability of diagnosing infection in patients >80 years old and will be evaluated and further refined in a prospective study. DETERMINATION OF GENTAMICIN PHARMACOKINETICS IN NEONATES TO DEVELOP PRACTICAL INITIAL EXTEND EDINTERVAL DOSING RECOMMENDATIONS Potvin M,1 Walker SAN,1,2,3 Elligsen M,1,3 Iaboni D,4 Walker SE,1,2 Palmay L,1,3 Findlater C,4 Seto W,2,5 Simor A,3,6 Ng E4,6 data were retrospectively collected for 60 neonates. Mean pharmacokinetic values were calculated using first-order pharmacokinetic principles and multiple linear regression was performed to determine significant covariates of clearance (Cl) and volume of distribution (Vd). A classification and regression tree (CART) analysis was performed to determine the existence of breakpoints for significant covariates. Monte Carlo Simulation (MCS) was used to identify optimal dosing recommendations for each CART-identified subgroup. Results: Gentamicin Cl and Vd were significantly associated with weight at gentamicin initiation. CART-identified breakpoints for weight at gentamicin initiation were: ≤ 850g, 851-1200g, and >1200g. No significant difference in pharmacokinetics (elimination rate constant and Cl) existed for neonates weighing >1200g versus 851-1200g, due to inadequate sample size (N=14 neonates) and weight range in the >1200g subgroup (range:1210-2789g; mean:1744g). This prohibited development of robust dosing recommendations and necessitated their exclusion from dosage development. MCS identified that 3-4mg/kg/dose administered every 48 hours for neonates weighing <850g, and every 24 hours for neonates weighing 851-1200g provided the best probability of attaining conventional targets (peak:5-10mg/L, trough:<2mg/L). MCS identified that 8-9mg/kg/dose administered every 72 hours in neonates weighing <850g and every 48 hours in neonates weighing 851-1200g provided the best probability of attaining EID targets (peak:12-20mg/L, trough:<0.5mg/L). Conclusions: In conclusion, this study provides initial dosing recommendations for conventional and EID regimens in neonates weighing <1200g. Further studies are needed to prospectively evaluate these dosing recommendations and to identify dosing recommendations in neonates weighing >1200g. IMPACT OF LENGTH OF STAY ON THE DISTRIBUTION OF GRAM NEGATIVE ORGANISMS AND THE LIKELIHOOD OF ISOLATING A RESISTANT ORGANISM IN A CANADIAN BURN CENTRE Wanis M,1 Walker SAN,1,2,3 Daneman N,3,4,5,6 Elligsen M,2 Palmay L,2 Simor A,3,4,5,6 Cartotto R7 University of Toronto, Leslie L. Dan Faculty of Pharmacy, Toronto, ON Sunnybrook Health Sciences Centre, Department of Pharmacy, Toronto, ON 3 Sunnybrook Health Sciences Centre, Department of Microbiology and Division of Infectious Diseases, Toronto, ON 4 University of Toronto, Faculty of Medicine, Toronto, ON 5 Sunnybrook Research Institute, Toronto, ON 6 Institute for Clinical Evaluative Sciences, Toronto, ON 7 Sunnybrook Health Sciences Centre, Ross Tilley Burn Centre, Toronto, ON 1 2 Rationale: Infection is a common complication in burn injury patients. The impact of hospital length of stay (LOS) on the distribution and susceptibility of Gram negative bacteria (GNB) causing infection in burn patients remains unexplored. Objectives: To characterize the distribution of GNB causing infection and to identify changes in susceptibility with LOS in a tertiary care burn centre. Methods: A retrospective review of patients with documented positive clinical Sunnybrook Health Sciences Centre - Department of Pharmacy, Toronto, ON 2 University of Toronto - Leslie Dan Faculty of Pharmacy, Toronto, ON 3 Sunnybrook Health Sciences Centre - Division of Infectious Diseases, Toronto, ON 4 Sunnybrook Health Sciences Centre - Women and Babies Program, Toronto, ON 5 Hospital for Sick Children - Department of Pharmacy, Toronto, ON 6 University of Toronto- Faculty of Medicine, Toronto, ON (non-screening) GNB cultures identified from the antimicrobial stewardship program database was completed. Duplicate cultures were excluded. Positive cultures included in the analysis were categorized into five clinically relevant time periods (in days) based on the specimen date of collection relative to the patient’s date of admission: A (0-7), B (7-14), C (14-21), D (21-28), E (>28). Chisquare for proportions was used to compare the 5 time periods. When the χ2 p-value was <0.05, the Marascuilo procedure was used to identify where the significant difference(s) between the 5 time periods occurred. Background: Despite safe and effective use of extended-interval dosing (EID) Results: The proportion of patients with clinical cultures for P.aeruginosa increased with hospital LOS (period 0-7 days: 8% vs period >28 days: 55%; p<0.05). Conversely, clinical cultures for H.influenzae occurred most commonly within the first 7 days of hospitalization (period 0-7 days: 36% vs period >28 days: 0.7%; p<0.05). The proportion of Enterobacteriaceae isolation was highest between 7-14 day of hospitalization and lowest when LOS > 28 days (period 7-14 days: 62% vs. period > 28 days: 38%; p<0.05). Resistance to antibiotics was directly proportional to hospital length of stay (% patients with multidrug resistant GNB increased from 6% (LOS 0-7days) to 44% (LOS >28days); p<0.05). 1 of aminoglycosides in other patient populations, no consensus exists regarding EID recommendations for neonates. Objective: The objective of this study was to determine gentamicin pharmacokinetics in neonates, and develop initial mg/kg dosing recommendations that optimize peak and trough concentration targets for conventional and EID regimens. Conclusions: This study provides objective evidence illustrating changes in species and resistance patterns of GNB causing infection in burn injury patients as a function of hospital length of stay. 64 • Regina Qu’Appelle Health Region: Regina General Hospital, Pasqua Hospital, Wascana Rehab CSHP 2 Targeting Excellence in Pharmacy Practice CUSTOMIZATION AND IMPLEMENTATION OF A COMPOUNDING SOFTWARE SOLUTION FOR SAFE AND EFFICIENT STERILE AND NON-STERILE COMPOUNDING Perks B, Bains A, Vidotto S, DeFigueiredo S, Cotter N, Rideout T, Lye M, Chow L, Walker SE, Department of Pharmacy, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON Background: The number and potential consequences of error and workload in a busy Hospital Pharmacy compounding centre were reviewed. Root cause analysis pointed to potential problems caused by: multiple versions of worksheets; manual systems for labeling; lack of a weight check system; lack of barcode ingredient verification. Description: A solution was sought to: Secure master formulation documents; ensure weights were accurate; ensure ingredients used were correct; automatically generate worksheets/labels thereby minimizing errors and improving productivity. Action: A specifications document was developed outlining the required functionality. This was created through a literature search; internet search; discussion with medication safety and Pharmacy staff. Options explored were an in-house or external vendor custom solution; external customization of off-theshelf software and internal customization of off-the-shelf software. The latter was decided upon as the most cost-effective end feasible alternative which allowed introduction of the barcode verification feature. Evaluation: The time to implement the solution was roughly one year from inception. One-time expenditures on software and hardware were approximately $ 10,000. Non-sterile compounding using the implemented software solution resulted in a reduction of labelling errors from 0.5% to 0%. Use of the software solution allows for an 80% time reduction in the administrative elements of compounding (Lot Number creation, Beyond Use Date Assignment, Worksheet Printing, Label Printing) (5 minutes vs 1 minute). Errors due to incorrect “picking” of ingredients are nearly impossible with the barcode scanning verification feature. CSHP 2 Targeting Excellence in Pharmacy Practice Lui K, Ma J, Canadian Forces Health Services Group, Petawawa, ON Background: In May 2012, a multidisciplinary smoking cessation support program was implemented, aimed to enhance patient access and convenience. The program consisted of weekly clinics run by pharmacists, physicians, and the health promotions team. A drug use evaluation was done as an initial program assessment and demonstrated that the new program increased uptake of smoking cessation therapy compared to the same six-month timeframe in the preceding year, though with a marked decrease in the duration patients were on pharmacotherapy. The significance of these observations on rate of success in smoking cessation, however, is unknown. Existing literature suggests a positive correlation between duration of therapy and the rate of abstinence at one year in trial conditions. This relationship in a clinical setting is not well understood. Objective: To describe the relationship between duration of smoking cessation pharmacotherapy and rate of success in smoking cessation in pragmatic conditions. Method: A retrospective analysis was conducted using dental and dispensing records of patients who expressed interest in smoking cessation to a health care team member from June to December 2011 and June to December 2012. Specifically, patients’ smoking status at the annual dental exam in the calendar year following their smoking cessation attempt was compared against their time spent on pharmacotherapy, estimated by the number of days between the first and last fill of their smoking cessation medication. Results Number of patients initiating smoking cessation pharmacotherapy 2011 187 2012 317 Implications: A dedicated, customized compounding software solution improves productivity and reduces the chance of errors in compounding. Productivity gains and cost-effectiveness in any particular environment will depend on volume of compounding. Labelling and Beyond Use Date assignment errors can be reduced to practically zero. Customization and implementation of a compounding software solution is achievable utilizing existing in-house Pharmacy resources. CORRELATION BETWEEN LENGTH OF SMOKING CESSATION THERAPY AND RATE OF ABSTINENCE IN PRAGMATIC CONDITIONS Smoking status at annual dental exam Dental record not available Average number of days spent on pharmacotherapy Standard deviation Time spent on pharmacotherapy not available Yes 124 (66%) 1 33.37 43.16 4 No 62 (33%) 33.37 42.97 Yes 227 (71%) 31.67 30.85 No 88 (27%) 31.92 30.93 2 6 Conclusion: We were unable to observe differences in length of therapy between those with successful attempts versus those unsuccessful. Although a multidisciplinary program was implemented in 2012, the results were similar to 2011. Our multidisciplinary approach did not impact the relationship. Poster Abstract Reviewers Réviseurs des présentations par affiches Sincere appreciation is extended to the Research Committee for reviewing the abstract submissions for PPC 2015. David Blackburn Lauren Bresee Roxane Carr Dawn Dalen Scott Edwards Sean Gorman Natalie Kennie Marc Perreault Winnie Seto Adjudicators: Marie-France Beauchense Sheri Koshman Centre, South-East Integrated Care Centre – Moosomin • Saskatoon Health Region: St. Paul’s 65 Faculty CSHP would like to recognize the generous contributions of the following speakers: Conférenciers La SCPH désire souligner les généreuses contributions des conférenciers suivants : Margaret Ackman BSc(Pharm), PharmD, FCSHP Marisa Battistella BScPhm, PharmD Carolyn Bornstein BScPhm, ACPR, FCSHP, CGP Thomas E.R. Brown PharmD Jean-François Bussières Winnie Seto Jamie Kellar Sean Spina Sheri Koshman Rosa Maria Tanzini RPh, BScPhm, PharmD BScPharm, PharmD, ACPR Sharan Lail BSc(Pharm),ACPR, PharmD, BScPharm James E. Tisdale PharmD, BCPS, FCCP, FAPhA, FAHA Sherry Lalli Jennifer Turple BSc(Pharm), ACPR Alice Y.Y. Cheng Joel Lamoure Doret Cheng BSc(Pharm), PharmD, MSc, ACPR, RPh BScPharm, ACPR BPharm, MSc, MBA, FCSHP MC, FRCPC RPh, DD, FASCP, OSM Andrew Liu BScPharm, ACPR Luis Viana BScPhm, M Ed, PharmD, ACPR, CGP Karen Walsh BScPharm, PharmD HBSc, BScPhm, RPh Sonia Cheung Neil MacKinnon Linda Dresser Muhammad Mamdani PharmD, MA, MPH BScPhm Kevin Duplisea Allison McGeer Jeff Wong BScPhm, ACPR, RPh PharmD, FCSHP BScPharm, PharmD, ACPR Olavo Fernandes PhD, FCSHP MD, FRCPC Mark McIntyre RPh, BScPhm, ACPR, PharmD, FCSHP PharmD, ACPR, RPh Michelle Foisy Robin McLeod Amanda Goodwin Janice Munroe Doug Gruner Saurabh Patel Jill Hall Eric Romeril Susy Hota Paolo Saccucci BScPharm, PharmD, FCSHP, AAHIVP BSP, RPh, MBA MD, CCFP, FCFP BScPharm, ACPR, PharmD MD, MSc, FRCPC Dolores C. Iaboni BSc(Pharm), ACPR, RPh Bill Wilson RPh, BSP, FCSHP Gary Wong BScPharm Maria Zhang BScPhm, PharmD MD, FRCS, FACS BScPharm BScPharm RPh, ACPR, BScPhm, BSc BSc(Hons), RPh, PharmD Cheryl A. Sadowski BSc(Pharm) BSc(Pharm), PharmD, FCSHP Lawrence D. Jackson Doug Sellinger BScPharm 66 Monika Kastner PhD BSP, MA Hospital, Saskatoon City Hospital, Royal University Hospital, Humboldt District Hospital • Sun Celebrate with us! Only 1 ONE SES REMAINS AUGUST 15-18 AOÛT Westin Hotel, Ottawa Country Health Region: St. Joseph’s Hospital QUEBEC: • Catherine Booth Hospital • Centre 67 n Reserved Exhibitor List (at time of printing) Liste des exposants (au moment de l’impression) Company Compagnie Booth # Kiosque # AbbVie Corporation.........................................................................................222 Accord Healthcare Canada Inc....................................................................112 Alveda Pharmaceuticals Inc........................................................................209 Apotex Inc. .......................................................................................................... 215 AutoMed Technologies Canada.............................................................. 400 Bayer Inc. ..............................................................................................................411 BCE Pharma Inc................................................................................................ 402 BioSyent Pharma Inc......................................................................................408 Boehringer Ingelheim Canada Ltd. ......................................................... 127 Canadian Agency for Drugs and Technologies in Health..............406 Canadian Institute for Health Information............................................ 123 Canadian Patient Safety Institute..............................................................224 Canadian Pharmaceutical Distribution Network................................ 213 Eli Lilly Canada Inc. ..........................................................................................115 Fresenius Kabi Canada Ltd........................................................ 101/103/105 Galenova............................................................................................................. 207 Global Medical Products............................................................................. 236 Healthmark Services Ltd.....................................................................106/108 Hospira Healthcare Corporation.....................................................300/302 Intelligent Hospital Systems....................................................................... 228 Kit Check................................................................................................................119 MDA.........................................................................................................................114 68 Company Compagnie Booth # Kiosque # Medisca................................................................................................................403 Mylan Canada ..................................................................................................304 North West Telepharmacy Solutions......................................................102 Novartis Pharmaceuticals Canada Inc...................................................405 Omega Laboratories Limited..................................................................... 205 Omnicell Inc........................................................................................................ 107 Ontario College of Pharmacists.................................................................109 PCCA Canada Corp. ........................................................................................410 Pendopharm, A Division of Pharmascience Inc................................... 111 Pfizer Canada....................................................................................................404 Pharmascience Inc...........................................................................................104 Ricoh Canada.....................................................................................................409 RxFiles Academic Detailing Program.......................................................113 Sandoz Canada Inc. ..............................................................................201/203 Sanofi Canada Inc............................................................................................ 401 Sidra Medical and Research Center ....................................................... 226 SteriMax Inc..............................................................................................308/310 Sunovion Pharmaceutical Inc.................................................................... 230 Swisslog Healthcare Solutions...................................................................129 Teva Canada Limited.....................................................................................306 Truven Health Analytics................................................................................. 125 Valeant Canada................................................................................................ 100 Wolters Kluwer Clinical Drug Information........................................... 407 Henri Bradet • CHU Sherbrooke • CSSS Cavendish • CSSS de Kamouraska • CSSS de la Connecting pharmacists across Canada PHARMACY SPECIALTY NETWORKS NETWORK W WORK communicate CSHP has more than 20 PSNs to join! Check out www.cshp.ca for a complete list. Join the Pharmacy Specialty Network! CSHP membership will connect you with what’s important – people and information. PSNs: • connect members with others who share a passion for a particular facet of pharmacy practice • facilitate the quick exchange of ideas, developments, methods, experiences, knowledge to improve practice • support collaboration on projects, research, and educational programs to address the needs of the members of a PSN • provide additional opportunities for members to serve as both opinion leaders and key resources for CSHP Council on professional specialty issues, including development of relevant position statements, guidelines, and information papers Participation in PSNs is free of charge to CSHP members Visit MY.CSHP.ca and sign up today! Thank You CSHP would like to acknowledge and thank the following CSHP 2015 champions: CSHP 2015 Tool Kit 1 Complex Inpatients Need Medication Experts: Optimizing the Pharmacists’ Role on the Healthcare Team Facilitator: Steve Shalansky Contributors: Charles Au (student), Barb Coulston, Catherine Doherty, Olavo Fernandes, Lori Romono-Slack, Bill Semchuk, Anureet Sohi, Joyce Totton CSHP 2015 Tool Kit 2 From Paper to Practice: Incorporating Evidence into Pharmacy Practice CSHP 2015 Organization & Site Champions 2012: Wasem Alsabbagh, Danette Margaret Ackman, Judith Agnew, Carla Anderson, Chelsea Argent, Maureen Arvidson, Kelly Babcock, Michele Babich, Arlene Banbury, Chaela Barry, Vincent J Basques, Eric Beaudoin, Marie-France Beauchesne, Mario Bedard, Veronique Briggs, Dawn Calder, Greg Carpentier, Charlotte Chase, Jenny Chiu, Judy Chong, Dana Cole, Mark Collins, Michael Conci, Lyne Constantineau, Martin Côté, Ian Creurer, Brenda Deleff, Savminderjit Dhaliwall, Catherine Doherty, Christine Donaldson, Douglas Doucette, Joanne Dumais, Patti Ferguson, Olavo Fernandes, Susan Fockler, Carly Fournier, Trevor Fox, Shelley Frost, Uchenwa Genus, Dorothy George, George Ho, Nathan Ho, Vicki Hoffman, Karen Horon, Susan HowlettWise, Jason Howorko, Ryan Itterman, Kyla Jackson, Mark Jackson, Dawn Jennings, Sandra Kagoma, Andrea Kent, Sherry Krause, Mary Kwan, James Lam, Joanne Leclair, Barry Lyons, Jessica Ma, Lorraine Maybank, Shelley McKinney, Marvin Menssa, Debra Merrill, Bruce Millin, Allan Mills, Mits Miyata, Linda Morris, Margaret Murray, Martha Nystrom, Fruzsina Pataky, Kevin Peters, William Roe, Tracey Rumbles, Heather Rurka, Diana Russo, Steve Shalansky, Marlene Slipp, Jeremy Slobodan, Iain Smith, Brad Steeves, Gordon Stewart, Lindsay Tabin, Marita Tonkni, Régis Vaillancourt, Deb van Haaften, Adil Virani, Anne Vojt, Deanna Waknuk, Pat Wallace, Bill Wilson, Lee Wohl Beechinor, Karen Cameron, Sheila Dattani, Doug Doucette, Debbie Kwan, Jennifer Lo, Sandra Walker 2013: Arden Barry, Lizanne Beique, Lorie Carter, Winnie Chan, Vickie Chang, Doug Doucette,Olavo Fernandes, Eric Landry, Mary Lou Lester, Melanie MacInnis, Tassnim Moradipour, Karen Ng, Parisa Parnian, Eric Romeril, Victoria Su, Donna Woloschuk Contributors: Christina Adams, Alison Alleyne, Artemis Diamontouros, Erwin Friesen, Natalia Persad (student), Miranda So, Laura Tsang 2014: Cheyanne Boehm, Karen Cameron, Doug Doucette, Joan Fabbro, Barbara Farrell, Susan Fockler, Certina Ho, Aarthi Iyer, Jessica Power, Gayathri Radhakrishnan,Vaishali Sengar, Richard Slavik, Sean Spina, Kent Toombs, Andrea Wist CSHP 2015 Tool Kit 3 CSHP 2015 Webinar Presenters One Dose at a Time: Implementing a Unit-Dose Medication Management System 2012: Emily Muir Facilitator: Anisha Lakhani Facilitator: Judy Chong Contributors: Greg Atherton, Jan Beales, Susan Fockler (Case Study), Patricia Macgregor (Case Study), Debra Merrill, Doug Sellinger, Jill Skinner (Case Study), Mark Walker, Meiti Yang 70 CSHP 2015 Virtual Poster Presenters 2013: Celine Corman, Sara Corrigan, Sherry Lalli, Kim Lamont, Janice Munroe, Doris Nessim, Monique Pitre, Doug Sellinger, Sean Spina, Régis Vaillancourt, Elaine Wong 2014: Shirin Abadi, Hina Ahmed, Maria Anwar, Danette Beechinor, Celina Colgrave, Olavo Fernandes, Sean Gorman, Susan Howlett-Wise, Francesca Le Piane, Andrew Liu, Lisa Nodwell Allan Mills, Karen Riley,Rhonda Roedler, Kent Toombs Minganie • Hébergement Father Dowd • Hébergement St-Andrews • Hébergement Ste- CSHP SCPH EXCELLENCE IN PHARMACY PRACTICE EXCELLENCE EN PRATIQUE PHARMACEUTIQUE CSHP would like to acknowledge and thank the CSHP members who led the CSHP 2015 initiative: CSHP Presidents who were Vision Liaisons to the CSHP 2015 Initiative CSHP 2015 Steering Committee Members CSHP 2015 Branch Champions Judy Chong • 2009-2015 Lori Romonko-Slack, AB Régis Vaillancourt • 2003-2006 Ian Creurer • 2009-2015 Maria Anwar, AB Carolyn Bornstein • 2006-2009 Don Kuntz • 2009-2015 Steve Shalansky, BC Neil MacKinnon • 2009-2012 Anisha Lakhani • 2009-2015 Jan Beales, MB Patricia Macgregor • 2012-2015 Cathy Lyder • 2009-2015 Ashley Walus, MB Jean-François Guévin • 2010-2015 Jodi Symes, NB Kevin Duplisea • 2009-10 Leslie Manuel, NB Winnie Lau • 2009-10 Lindsay Lord Doucet, NB Diane Brideau-Laughlin • 2010-12 Amy Flynn, NB Régis Vaillancourt • 2012-2015 Pam Rudkin, NL Emily Muir • 2012-2015 Sarah Fennell, NL Arden Barry, AB Heather Ryan, NL Student Members: Natalia Persad • 2010-2012 Victor Tsang • Since 2012 Heather Slaney, NL Catherine Doherty, NS Jillian Reardon , NS Jaclyn Tran, NS Christina Cella, ON Toni Bailie, ON Tribute to Barbara Wells, CSHP 2015 Project Coordinator Barb was the first CSHP 2015 Project Coordinator from January 2009 to just before her death in June 2010. In this short time Barbara left a significant legacy to the project: the formation of the Steering Committee under her chairmanship, the recruitment of the first Branch Champions, the creation of the CSHP 2015 Crosswalk, the development of the first 2015 survey of hospital pharmacy leaders to help inform the priorities of the Steering Committee, and the initial concepts for a CSHP 2015 communication plan. Sammu Dhaliwall, ON Kelly Herget, PEI Barry Lyons, SK Bill Semchuk, SK Eric Landry, SK Casey Phillips, SK CSHP 2015 Project Coordinators Barbara Wells • January 2009 to May 2010 Carolyn Bornstein • May 2010-2015 Marguerite • Hôpital du Sacré-Coeur de Montréal • Richardson Hospital 71 Join Us! CSH P M E M BERSH I P H A S M ANY A DVA NTAGES MEMBER BENEFITS A s a member of CSHP, you connect not only to a strong professional organization, but also to a dynamic network of over 3,100 hospital pharmacy colleagues. When you join CSHP, you instill fresh energy into a 67-year-strong association for expanding and improving programs and services. ● ● ● ● ● ● ● ● ● ● ● Advocacy Awards Program Canadian Pharmacy Residency Board Continuing Education CSHP 2015 Partner Discount Programs Fellows Program Pharmacy Specialty Networks (PSNs) Products and Publications Professional Liability/Malpractice Insurance CSHP Research and Education Foundation For more information about CSHP member benefits, please contact: Membership services T: 613-736-9733, ext. 222 | F: 613-736-5660 | E: [email protected] | www.cshp.ca
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