Final Program - Canadian Society of Hospital Pharmacists

Transcription

ANNUAL
PROFESSIONAL
PRACTICE
CONFERENCE
The Largest Pharmacy
Conference in Canada
FEbRUARy 1-5, 2014
CONFÉRENCE
ANNUELLE SUR
LA PRATIQUE
PROFESSIONNELLE
Le plus grand congrès en
pharmacie au Canada
1-5 FÉvRIER 2014
Final Program
Programme final
The Sheraton Centre
Toronto Hotel
123 Queen Street West
Toronto, ON
What is CSHP 2015?
Qu’est-ce que le projet SCPH 2015?
Vision of pharmacy practice excellence in the year 2015
Strategic objective of CSHP’s Vision 2014 which aims to improve
patient medication outcomes and safety by advancing practice
excellence
●
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A quality care initiative
●
Un projet axé sur la qualité des soins
●
A project aiming to answer the questions… “What would make the
most difference to our patients?” and “What will convey the positive
contributions of the pharmacist?”
●
Un projet qui vise à répondre aux questions suivantes : « Qu’est-ce qui
serait le plus profitable pour nos patients? Qu'est ce qui permettrait de
communiquer les contributions positives du pharmacien? »
●
Six specific goals that will guide practitioners towards the CSHP vision
●
●
Sub-objectives that include measurable targets with established
baselines used to monitor progress, which can be reviewed and
revised as practice goals change
Six buts précis qui aideront les pharmaciens à concrétiser la vision de la
SCPH
●
Des objectifs sous-jacents qui sont assortis de cibles mesurables nous
permettant d'établir un point de référence et de suivre les progrès, et
qui pourront être réexaminés et modifiés à mesure que les objectifs et
les lignes directrices de la pratique changent
●
●
●
Une vision de l’excellence en pratique pharmaceutique en l’an 2015
Un objectif stratégique de la Vision 2014 de la SCPH, lequel s’applique
à améliorer les résultats et la sécurité de la pharmacothérapie des
patients en faisant avancer l’excellence en pratique.
CSHP
Targeting Excellence in Pharmacy Practice
SCPH
Goals
Buts
1
Increase the extent to which pharmacists help individual hospital
inpatients achieve the best use of medications
1
2
3
Accroître le degré d'intervention des pharmaciens auprès de
chaque patient hospitalisé afin d'assurer l'utilisation optimale des
médicaments.
Increase the extent to which pharmacists help individual
non-hospitalized patients achieve the best use of medications
2
Accroître le degré d'intervention des pharmaciens auprès de la
clientèle non hospitalisée afin d'assurer une utilisation optimale des
médicaments.
4
Increase the extent to which pharmacy departments in hospitals and
related healthcare settings have a significant role in improving the
safety of medication use
3
Étendre l'application du principe des décisions fondées sur les
preuves à la pratique clinique quotidienne des pharmaciens des
établissements de santé dans le but d'améliorer la pharmacothérapie
5
Increase the extent to which hospitals and related healthcare settings
apply technology effectively to improve the safety of medication use
4
Accroître le rôle joué par les départements de pharmacie des
établissements de santé dans l'amélioration de l'utilisation sécuritaire
des médicaments.
6
Increase the extent to which pharmacy departments in hospitals and
related healthcare settings engage in public health initiatives on
behalf of their communities
5
Étendre l'application efficace des technologies dans les
départements de pharmacie des établissements de santé pour
améliorer l'utilisation sécuritaire des médicaments.
6
Accroître le degré d'intervention des départements de pharmacie
des établissements de santé dans la mise en oeuvre d'initiatives de
santé publique.
Increase the extent to which hospital and related healthcare setting
pharmacists actively apply evidence-based methods to the
improvement of medication therapy
To get started on CSHP 2015 now, go to CSHP’s website at www.cshp.ca.
There you will find the complete list of goals and objectives, a
self-assessment tool, presentations and more.
*CSHP 2015 was adapted with permission from the ASHP 2015 Initiative.
Point de mire sur l’excellence en pratique pharmaceutique
Pour vous engager dès maintenant dans le projet SCPH 2015, visitez le
site Web de la SCPH au www.cshp.ca. Vous y trouverez une liste
complète des buts et des objectifs du projet, un outil d’autoévaluation,
des présentations et d'autres renseignements.
*Le projet SCPH 2015 est une adaptation approuvée de l’ASHP 2015 Initiative.
www.cshp.ca
Dear Colleague,
On behalf of the Officers, Council and staff of the Canadian Society of
Hospital Pharmacists (CSHP), it is our pleasure to welcome you to CSHP’s
45th 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 2014 offerings – and enjoy yourself in the
process.
At any time throughout the conference, the Officers and staff of CSHP are
available to you. Please let us know if we can answer any of your questions,
address any of your concerns or be of assistance in any way.
We look forward to welcoming each of you to another spectacular
conference.
Thank you for your ongoing support of CSHP!
Patricia Macgregor
bSc, RPh, MRPharmS, MHSc, CHE
CSHP President
Myrella Roy
bScPhm, PharmD, FCCP
Executive Director
4
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 45e 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 2014 – tout en vous divertissant.
Nous vous rappelons qu’au cours du congrès, la Direction et le personnel
de la SCPH seront à votre entière disposition. Nous ferons tout en notre
pouvoir pour répondre à vos questions, discuter des sujets qui vous
préoccupent et vous aider au besoin de quelques manières que ce soit.
Nous sommes impatients de vous accueillir à cet autre congrès
exceptionnel et vous remercions de votre appui soutenu à la SCPH.
Patricia Macgregor
b. Sc., R. Ph., M. R. Pharm. S.,
M. H. Sc., C.H.E.
Présidente de la SCPH
Myrella Roy
b. Sc. Phm., Pharm. D., FCCP
Directrice générale
5
Table of Contents
Table des matières
Executive, Council and Staff
Bureau de direction, Conseil et Personnel
Executive Committee
bureau de direction
7
Council
Conseil
7
CSHP Staff
Personnel de la SCPH
7
With Thanks
Remerciements
CSHP Industry Corporate Members
Entreprises membres du secteur de l’industrie
8
CSHP Hospital Corporate Members
Entreprises membres du secteur hospitalier
8
CSHP Sponsors 2013
Commanditaires de la SCPH en 2013
9
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
Program
Programme
Program of Events
Programme des événements
13
Speakers Abstracts
Résumés des conférenciers
19
SES 2014 Call for Abstracts
Demande de résumés pour les SÉÉ 2014
39
Oral Presentations
Présentations orales
42
Poster Abstracts
Résumés des affiches
44
Poster Abstract Reviewers
Réviseurs des présentations par affiches
68
CSHP Fellows
Associés de la SCPH
69
Faculty
Conférenciers
72
Exhibitor List
Liste des exposants
73
6
Executive Committee • Bureau de direction
President
Présidente
Patricia Macgregor
The Hospital for Sick Children
Toronto, ON
President Elect
Président désigné
Past President
Président sortant
Director of Finance
Directrice des finances
Executive Director
Manitoba
Quebec
Québec
Prince Edward Island
Île-du-Prince-Édouard
New Brunswick
Nouveau-Brunswick
Newfoundland and Labrador
Terre-Neuve-et-Labrador
Nova Scotia
Nouvelle-Écosse
Student Delegate
Déléguée des étudiants
Office Administrator (CSHP
2015 & Board of Fellows)
Agente de bureau (SCPH
2015 et Conseil des
associés)
Doug Sellinger
Regina Qu’Appelle Health
Region
Regina, SK
Deborah Emery
Thunder bay Regional Health
Sciences Centre
Thunder bay, ON
bruce Millin
Fraser Health Authority
Langley, bC
Myrella Roy
Canadian Society of Hospital
Pharmacists
Société canadienne des
pharmaciens d’hôpitaux
Ottawa, ON
Council • Conseil
British Columbia
Colombie-Britannique
Shirin Abadi
bC Cancer Agency
vancouver, bC
Alberta
Sherilyn Houle
University of Alberta
Edmonton, Ab
Saskatchewan
Zack Dumont
Regina Qu’Appelle Health
Region
Regina, SK
Pat Trozzo
CancerCare Manitoba
Winnipeg, Mb
Diem vo
Hôpital Pierre-boucher
Longueuil, QC
Ontario – Senior/Principal
Mario bédard
The Ottawa Hospital
Ottawa, ON
Faith Louis
Horizon Health Network
Fredericton, Nb
Ontario – Junior/Débutante
Christina Adams
Northwest Telepharmacy
Solutions
Pembroke, ON
Theresa Hurley
QEII Health Sciences Centre
Halifax, NS
Amy Cheverie
Kings County Memorial Hospital
Montague, PE
Justin Peddle
Memorial University
St. John’s, NL
Jaskiran Otal
University of Waterloo
Waterloo, ON
CSHP Staff • Personnel de la SCPH
Executive Director
Executive Assistant
Adjointe de direction
Finance Administrator
Agente des finances
Operations Manager
(on leave)
Gérante des opérations
(en congé)
Interim Conference & PSN
Administrator
Agente par intérim des
congrès et des RSP
Publications Administrator
Agente des publications
Interim Operations Manager
Gérante des opérations par
intérim
Membership & Awards
Administrator
Agente du service aux
membres et des prix
Olga Chrzanowska
Myrella Roy
Laurie Frid
Desarae Davidson
Coordinator, Professional &
Membership Affairs
Coordonnatrice, Affaires
professionnelles et service
aux membres
Rosemary Pantalone
Anna Dudek
Colleen Drake
Web Administrator
Agente du Web
Susan Maslin
Ontario Branch & Advocacy
Administrator
Agente de la section de
l’Ontario et de la
valorisation
Robyn Rockwell
CHPRB Administrator
Agente du CCRPH
vacant
Gloria Day
Cathy Lyder
7
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
2013-2014 CSHP
Industry Corporate Members
2013-2014 CSHP
Hospital Corporate Members
(At time of printing)
(At time of printing)
2013-2014 Entreprises membres
du secteur de l’industrie
2013-2014 Entreprises membres
du secteur hospitalier
(au moment de l’impression)
(au moment de l’impression)
• Alveda Pharmaceuticals Inc.
• Alberta Health Services
• AstraZeneca Canada Inc.
• Horizon Health Network
• baxter Corporation (Canada)
• Interior Health Authority
• bayer Inc.
• London Health Sciences Centre
• bCE Pharma
• Lower Mainland Pharmacy Services
• bioSyent Pharma Inc.
• Northern Health Authority
• Eli Lilly Canada Inc.
• Northwest Telepharmacy Solutions
• Galenova Inc.
• University Health Network
• Healthmark Services Ltd.
• Hospira Healthcare Corporation
• LEO Pharma Inc.
• McKesson Canada Corporation
• Mylan Canada
• Omega Laboratories Ltd.
• Pendopharm, a Division of Pharmascience Inc.
• Pfizer Canada Inc.
• Pharmaceutical Partners of Canada
A Company of the Fresenius Kabi Group
• Sandoz Canada Inc.
• Servier Canada Inc.
• SteriMax Inc.
• TEvA Canada Ltd.
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CSHP Sponsors 2013
The following list reflects all sponsorship
received from January 1 to December 31,
2013.
Commanditaires de la
SCPH en 2013
La liste suivante reflète toutes les
commandites reçues du premier janvier
au 31 décembre 2013.
Diamond Sponsor
Commanditaires diamant
$80,000 or greater
80 000 $ et plus
Platinum Sponsor
Commanditaires platine
Donor Sponsor
Commanditaires donateurs
• Sandoz Canada Inc.
• Abbott Laboratories Inc. / AbbvIE
• Allied Pharmacy Products Inc.
• Alveda Pharmaceuticals Inc.
• Amgen Canada Inc.
• b.braun Medical Inc.
• baxter
• bCE Pharma Inc.
• bioSyent Pharma Inc.
• bristol-Meyers Squibb Canada
• Calea
• Canadian Council on Continuing
Education in Pharmacy
• Canadian Forces
• Canadian Institute for Health Information
• Canadian Patient Safety Institute
• Canadian Pharmaceutical Distribution
Network
• Canadian Pharmacists Association
• Cardinal Health Canada
• College of Pharmacists of british
Columbia
• ESbE Scientific
• Galenova Inc.
• Health Match bC
• HealthPRO
• Hoffman La Roche Limited
• Johnson & Johnson Family of
Companies
• Lexicomp Inc.
• Lundbeck Canada Inc.
• Manrex Ltd.
• McKesson Canada Corporation
• Medtronic of Canada
• Meta Healthcare IT Solutions
• Northern Health Authority
• Northwest Telepharmacy Solutions
• Novartis Pharma Canada
• Novo Nordisk Canada Inc.
• Omnicell
• Ontario College of Pharmacists
• Optimer Pharmaceuticals
• Otsuka Pharmaceutical Inc.
• PCCA Canada
• PharmaSystems Inc.
• RxFiles Academic Detailing Program
• Shoppers Drug Mart Specialty Health
• Servier Canada Inc.
• SteriMax Inc.
• Swisslog Healthcare Solutions
• Truven Health Analytics
• valeo Pharma
• WIS International
$60,000 - $79,999
Gold Sponsor
Commanditaires or
$40,000 - $59,999
• AstraZeneca Canada Ltd.
• Hospira Healthcare Corporation
• Teva Canada Ltd.
Silver Sponsor
Commanditaires argent
$20,000 - $39,999
• Apotex Inc.
• Astellas Pharma Canada
• bayer Inc.
• Eli Lilly Canada Inc.
• Pendopharm/Pharmascience
• Sanofi Canada
Bronze Sponsor
Commanditaires bronze
$10,000 - $19,999
• boehringer-Ingelheim Canada Ltd.
• LEO Pharma Inc.
• Merck Canada Inc.
• Mylan Canada
• Omega Laboratories Limited
• Sunovion Pharmaceuticals Inc.
CSHP
Targeting Excellence in Pharmacy Practice
SCPH
Point de mire sur l’excellence en pratique pharmaceutique
CSHP would like to acknowledge and thank the following CSHP Sponsors for their
contributions to CSHP 2015 initiatives:
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$1000 - $9,999
About the CSHP Foundation
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-centred
pharmacy practice in hospitals and related healthcare
settings for the betterment of public health.
The Foundation raises funds that are used to:
Chairperson
Carolyn bornstein
Trustees
Fred Cuvelier
Aidan Griffin
Heather Neville
Marlo Palko
Glen Pearson
Myrella Roy
Terri Schindel
• promote research within organized healthcare settings
related to the practice of pharmacy; • the advancement of pharmaceutical science; and • programs of pharmaceutical education so that the public interest may be well
served and protected. The nine trustees of the Foundation are appointed by Council annually. CSHP
Council also appoints one of the trustees as chairperson, who reports to Council.
The Foundation operates independently from CSHP in accordance with its
Trust Deed.
• See the CSHP Foundation video on youTube
• Read the CSHP Foundation Fact Sheet
• view the CSHP Foundation 25th Anniversary Presentation,
1988-2013
Fundraising
In order to accomplish its goals, the Foundation seeks
funding from a variety of sources. An annual fundraising
campaign is initiated each summer to solicit funds
from individual members of the Society,
pharmaceutical companies and other
companies/trade associations that are
associated with hospital pharmacy.
The trustees are proud that the
Foundation’s administrative costs are
negligible. A number of CSHP members
provide their services on a voluntary basis
so that the funds raised can be directed
almost entirely to the research and
education objectives of the Foundation.
www.cshpfoundation.ca
Upcoming Events
Événements à venir
Professional Practice
Conference (PPC):
Summer Educational
Sessions (SES):
January 31-February 4, 2015
Sheraton Centre Toronto Hotel
August 9-12, 2014
Delta St. John’s Hotel and
Conference Centre
St. John’s, Newfoundland & Labrador
January 30-February 3, 2016
Sheraton Centre Toronto Hotel
Satellite Symposiums
CSHP would like to thank the following
sponsors of Satellite Symposiums for
their participation in conjunction with
the PPC 2014.
Sunday, February 2
12:15-13:45
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
Monday, February 3
17:30-19:30
• bayer Inc.
17:30-19:30
• Hospira Healthcare
Corporation
Wednesday, February 5
12:40-14:10
August 15-18, 2015
Westin Hotel
Ottawa, Ontario
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.
• Janssen Inc.
67th Summer Educational Sessions
Delta St. John’s Hotel and
Conference Centre
St. John’s, NL
August 9-12, 2014
Breakfast and
Luncheon Availability
See the program section for more details.
For more information please contact
Susan Maslin
Interim Conference & PSN Administrator
(613) 736-9733, ext. 229 or
[email protected]
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
Claudia bucci, PharmD
Sunnybrook Health Sciences Centre
Toronto, ON
Roxane Carr, PharmD, bCPS, FCSHP
bC Children’s and Women’s Health
Centre
vancouver, bC
Lorie Carter, bScPhm
Eastern Health
Marystown, NL
Elaine Chong, PharmD, bCPS
bC Ministry of Health Services
New Westminster, bC
Judy Chong, bScPhm
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
EP
Canadian Council on
Continuing Education in Pharmacy
The Educational Services Committee
(ESC) of CSHP has been working for
approximately 10 months on the content
and format of PPC 2014. 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
2014 PPC Program
Goal:
• To provide registrants with quality
educational sessions.
Objectives:
• To provide educational sessions which
inform, educate and motivate clinical
practitioners and managers.
• To provide leadership in hospital
pharmacy practice by presenting
sessions on innovative pharmacists’
roles, pharmacy practice and pharmacy
programs.
• To promote life-long learning skills
through active participation in
problem-based workshops.
• To provide registrants with networking
and sharing opportunities through the
exhibits program and poster sessions.
• To promote excellence in pharmacy
practice research through oral and
poster presentations of original work
and award winning projects.
• To provide an opportunity for
Pharmacy Specialty Networks to meet
and share their expertise with others.
Ernest Law, bScPhm, ACPR
PharmD Student
University of british Columbia
vancouver, bC
Le comité des services éducatifs travaille
depuis près de 10 mois à l’élaboration du
contenu et de la forme de la CPP 2014. 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 2014
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.
Kat Timberlake, PharmD (on leave)
Toronto, ON
Erica Wang, bScPhm, PharmD
Kelowna General Hospital
Kelowna, bC
12
Program
Programme
2. The Role of Iron in the Management of
Anemia
CIvIC bALLROOM SOUTH
Marisa battistella, bScPhm, PharmD, ACPR
University Health Network
Toronto, ON
Saturday, February 1
Samedi 1er février
3. Which Methods to Answer Your Research
Question? Qualitative? Quantitative or
Both?
15:00-17:00 Registration
Inscription
CONCOURSE COAT CHECK
SIMCOE DUFFERIN
17:30-19:00 CHPRB Students & Residents Networking
Event
Réception de réseautage du CCRPH pour les
étudiants et les résidents
Lisa Dolovich, bScPhm, PharmD, MSc
McMaster University
Hamilton, ON
4. CSHP 2015 Winning Success Stories –
Hospital Residency Award Winner and
More…
PROvINCIAL bALLROOM
Sunday, February 2
Dimanche 2 février
CITy HALL
Facilitator:
Carolyn bornstein, bScPhm, ACPR, FCSHP,
CGP
Southlake Regional Health Centre
Newmarket, ON
Inscription
08:00-08:15 Opening Remarks
Remarques préliminaires
Jessica Power, bScPhm
victoria General Hospital
victoria, bC
DOMINION bALLROOM
08:15-09:15 Motivational Plenary
Séance plénière de motivation
12:15-13:45 Satellite Symposium
Luncheon included
Symposium satellite
DOMINION bALLROOM
Dîner inclus
Change Your Thoughts. Change Your Life!
DOMINION bALLROOM NORTH
With Stuart Ellis, a.k.a. “Twitchy”
Cleanrooms/Sterile Preparation: Compliance
and Cost Optimizing towards USP <797>
Sterile Preparation within Canadian Budget
and Regulatory Framework
Sponsored by Sandoz Canada Inc.
9:30-11:00
Facilitated Poster Session
Discussions of Original Research, Award
Winning Projects and Pharmacy Practice
Projects
bruce C. Peat
H.E.P.A. Filter Services Inc. and Design Filtration
Lisa Campbell
Healthmark Services Ltd.
Séance animée de présentations par affiches
Discussions sur des projets de recherche
originale, des projets primés et des projets
dans le domaine de la pratique
pharmaceutique
Hosted by Healthmark Services Ltd.
14:00-16:00 Workshops & PSN Sessions
Ateliers et séances des RSP
PROvINCIAL bALLROOM
1. How to Write a Research Paper and Get it
Published
11:15-12:00 Concurrent Sessions
Séances concomitantes
CITy HALL
Peter Zed, bSc, bScPhm, ACPR, PharmD,
FCSHP
vancouver, bC
1. Update on Hepatitis C Management
CIvIC bALLROOM NORTH
Alice Tseng, bScPhm, PharmD, FCSHP, AAHIP
Toronto General Hopsital
Toronto, ON
13
Monday, February 3
Lundi 3 février
2. Infectious Diseases PSN
RSP en infectiologie
Inscription
Infections in Solid Organ Transplants
Shahid Husain, MD, MS
Toronto, ON
08:00-08:15 Announcements
Annonces
Antibiotic Prophylaxis in Surgery: Issues &
Controversies
DOMINION bALLROOM
08:15-09:15 Plenary Session
Séance plénière
Sumit Raybardhan, bScPhm, ACPR, MPH
North york General Hospital
Toronto, ON
DOMINION bALLROOM
3. Global Health PSN
RSP en santé mondiale
Developing an Advanced Pharmacy Practice
Framework: Key Learnings and Strategic
Outcomes
SIMCOE DUFFERIN
Lisa Nissen, bPharm, PhD, FPS, FHKAPh, FSHP
Queensland University of Technology
brisbane, Australia
Ethical Issues in Global Health
Jessica Sleeth, MPH, CHE, bPHE, bA
Queen’s University
Kingston, ON
Sponsored by Pharmaceutical Partners of Canada
09:15-09:45 New Fellows Presentation
Présentation des nouveaux membres
associés
Working as a Pharmacist with Médecins
Sans Frontières
Alexandra Marcil, bSc, bScPhm
Médecins Sans Frontières
Winnipeg, Mb
Acknowledgement of the Recipient of the
Distinguished Service Award
Reconnaissance du lauréat du prix pour
service distingué
4. Psychiatry PSN
RSP en psychiatrie
Acknowledgement of the CSHP Foundation
Grant Recipients
Reconnaissance des boursiers de la
Fondation de la SCPH
Lithium….Is It Still Useful?
Wende Wood, bA, bSP, RPh, bCPP
Ontario Pharmacists Association
Toronto, ON
DOMINION bALLROOM
09:45-10:15 Break, Exhibits
Pause, Kiosques
Anxious? Don’t Panic: A Review of Anxiety
Disorders
SHERATON/OSGOODE HALLS
barbara Thomas, PharmD
Eastern Health
St. John’s, NL
10:20-11:30 Panel Discussion
Panel
DOMINION bALLROOM
16:10-17:50 Awards Ceremony
Managing Expensive Oncology Drugs
Everyone welcome
Elaine Chong, PharmD, bCPS – Moderator
bC Ministry of Health
vancouver, bC
Cérémonie de remise des prix
bienvenue à tous
PROvINCIAL bALLROOM
Jin – Hyeun Huh, bScPhm, ACPR, bCPS
Toronto, ON
18:00-19:30 Career Opportunities Evening
Soirée de perspectives d’emploi
LOWER CONCOURSE vIDE
Lyndee yeung, bScPhm, MbA
Cancer Care Ontario
Toronto, ON
14
Hazel Markwell, bA(Hon), MA, PhD, ThD
Centre for Clinical Ethics
Toronto, ON
1. Primary Care PSN
RSP en soins de santé primaires
1. Clinical Trials in Internal Medicine that will
Change Your Practice
Challenges and Opportunities in
Intraprofessional Pharmacist Collaboration
in Primary Care
Peter Thomson, bScPhm, PharmD
Winnipeg Regional Health Authority
Winnipeg, Mb
Suzanne Singh, bScPhm, PharmD
Mount Sinai Academic Family Health Team
Toronto, ON
2. Using Physical Assessment in Your
Practice!
Taking Responsibility for Patient Care:
A Toolkit for Pharmacists on Primary Care
Teams
CITy HALL
Derek Jorgenson, bSP, PharmD, FCSHP
University of Saskatchewan
Saskatoon, SK
Glen Pearson, bScPhm, PharmD, FCSHP
Edmonton, Ab
2. Emergency Medicine PSN
RSP en urgentologie
3. Oral Abstract Session
Selected Papers from Original Research,
Award Winners and Research and
Education Grants
PROvINCIAL bALLROOM NORTH
Acute Analgesia in Emergency
Departments: Is Our Performance Painful?
Please see page 42 for abstracts
Richard Wanbon, bSc, bScPhm, ACPR, PharmD
Island Health
victoria, bC
Séance d'exposés oraux
Communications choisies parmi les travaux
de recherche originale et les projets des
récipiendaires de prix, de bourses de
recherche et de perfectionnement
Adverse Drug-Related Events and
Emergency Department Visits:
Opportunities and Challenges for
Pharmacists
veuillez consulter les résumés à la
page 42
Peter Zed, bSc, bScPhm, ACPR, PharmD,
FCSHP
vancouver, bC
SIMCOE DUFFERIN
4. A Pharmacist’s Tale: The Journey from
Clinician to Director
3. Paediatric PSN
RSP en pédiatrie
Allan Mills, bScPhm, ACPR, PharmD
Mississauga, ON
SIMCOE DUFFERIN
Update on Management of Urinary Tract
Infection in Children: What Does the
Evidence Say?
12:30-13:50 Lunch, Exhibits, Posters
Dîner, Kiosques, Affiches
Jennifer Poh, bScPhm, ACPR, PharmD
Toronto, ON
14:00-15:00 Landmarks in Pharmacy Practice Research:
More and More Evidence for the Beneficial
Impact of Pharmacist Care
Tools to Improve the Health Literacy of
Sick Children and their Families
DOMINION bALLROOM
Ross Tsuyuki, bScPhm, PharmD, MSc, FCSHP,
FACC
Edmonton, Ab
Régis vailliancourt, OMM, CS, bPharm,
PharmD, FCSHP
The Children’s Hospital of Eastern Ontario
Ottawa, ON
15
4. Workshop
Atelier
09:45-10:15 Break, Exhibits
Pause, Kiosques
CITy HALL
Which National Clinical Pharmacy Key
Performance Indicators (cpKPI) are You
Measuring? A Practical and Interactive
cpKPI Guide to What, When, Why and How
1. The Double-Edged Sword: How Can a
Drug Be a Life Saver and Potentially Fatal
at the Same Time? Drug Interactions in
Oncology
Olavo Fernandes, bScPhm, ACPR, PharmD,
FCSHP
Toronto, ON
Scott Edwards, bScNeuro, bScPhm, PharmD
Eastern Health
St. John’s, NL
Kent Toombs, bScPhm, ACPR
Capital Health
Halifax, NS
2. CSHP 2015: What Pharmacy Directors
Want!
17:30-19:30 Satellite Symposiums
Dinner included
SIMCOE DUFFERIN
Souper inclus
Carolyn bornstein, bScPhm, ACPR, FCSHP,
CGP
Southlake Regional Health Centre
Newmarket, ON
1. Evolution in Thrombosis Management:
Clinical Challenges in the Treatment of
Venous Thromboembolism
3. Scrutinizing Statins in the Prevention of
Cardiovascular Disease: New Safety
Concerns
Menaka Pai, bSc, MSc, MD, FRCPC, AbIM
McMaster University
Hosted by bayer Inc.
Glen Pearson, bScPhm, PharmD, FCSHP
Edmonton, Ab
2. Outstanding Issues in Medication
Reconciliation
PROvINCIAL bALLROOM SOUTH
Margaret Colquoun
ISMP Canada
1. Inspiring the Leader Within: Powerful
Pearls & Potent Principles
Hosted by Hospira Healthcare Corporation
SIMCOE DUFFERIN
Tuesday, February 4
Mardi 4 février
Shirin Abadi, bScPhm, ACPR, PharmD
bC Cancer Agency
vancouver, bC
Inscription
2. Antibiotic Locks for Catheter-Related
Bloodstream Infections: There’s a Lock for
That!!!
Annonces
Alfred Gin, bScPhm, PharmD, FCSHP
Health Sciences Centre
Winnipeg, Mb
DOMINION bALLROOM
08:15-9:30
Comprehensive Patient Care: A Team-Based
Sport
3. Outpatient Clinic Scheduling of
Pharmacist Call Back for Oral
Chemotherapy
DOMINION bALLROOM
barbara Farrell, bScPhm, PharmD, FCSHP
veronique French-Merkley, MD, CCFP, CoE
bruyère Continuing Care
Ottawa, ON
Sean Hopkins, bScPhm
The Ottawa Hospital Cancer Centre
Ottawa, ON
16
12:15-13:50 Lunch, Exhibits, Posters
Dîner, Kiosques, Affiches
4. Workshop (encore)
CITy HALL
Which National Clinical Pharmacy Key
Performance Indicators (cpKPI) are You
Measuring? A Practical and Interactive
cpKPI Guide to What, When, Why and
How
14:00-15:00 Use of Insulin in Hospital
DOMINION bALLROOM
Alice y.y. Cheng, MD, FRCPC
Mississauga, ON
Olavo Fernandes, bScPhm, ACPR, PharmD,
FCSHP
Toronto, ON
Kent Toombs, bScPhm, ACPR
Capital Health
Halifax, NS
1. Internal Medicine PSN
RSP en médecine interne
Wednesday, February 5
Mercredi 5 février
Role of Suboxone for Opioid Dependence
beth Sproule, RPh, bScPhm, PharmD
Juno Kim, RPh, bScPhm
Centre for Addiction and Mental Health
Toronto, ON
Inscription
Constipation
Annonces
Peter Thomson, bScPhm, PharmD
Winnipeg Regional Health Authority
Winnipeg, Mb
DOMINION bALLROOM
08:15-09:15 CPSI Patient Safety Lecture
Conférence de l’ICSP sur la sécurité des
patients
2. Surgery PSN
RSP en chirurgie
DOMINION bALLROOM
Tranexamic Acid as a Blood Conservation
Strategy
The Oncology Under-Dosing Incident:
Lessons Learned
Melanie MacInnis, bScPhm, PharmD
IWK Health Centre
Halifax, NS
Elaine Chong, PharmD, bCPS – Moderator
bC Ministry of Health
vancouver, bC
Optimizing Surgical Antibiotic Prophylaxis:
What’s New? What You Can Do
Marshall Moleschi, Registrar
Ontario College of Pharmacists
Toronto, ON
Rosemary Zvonar, bScPhm
The Ottawa Hospital
Ottawa, ON
Sandy Jansen, bScPhm, MHS
London Health Sciences Centre
London, ON
3. Small Hospital PSN
RSP des petits hôpitaux
Jake Thiessen, bScPhm, MSc, PhD
University of Waterloo
Waterloo, ON
SIMCOE DUFFERIN
Roads to the Information Superhighway
Sponsored by the Canadian Patient Safety
Institute
Commanditée par l’Institut canadien sur la
sécurité des patients
Jeff barnett, bScPhm, ACPR, PharmD
bC Cancer Agency
victoria, bC
Kurt Schroeder, bScPhm
Interlake – Eastern Regional Health Authority
Selkirk, Mb
09:15-10:15 Biologicals: What Pharmacists Need to Know
About Monoclonal Antibodies
DOMINION bALLROOM
17
Tom McFarlane, bScPhm, PharmD
Cambridge Memorial Hospital
Cambridge, ON
12:40-14:10 Satellite Symposium
Luncheon included
Symposium satellite
Dîner inclus
10:15-10:45 Break
Pause
DOMINION bALLROOM NORTH
Subsequent Entry Biologics: What a
Pharmacist Needs to Know
DOMINION FOyER
Dr. John Marshall, MD MSc FRCPC
McMaster University
Hamilton, Ontario
1. Deprescribing Benzodiazepines: Do We
Need a New Approach?
Carolyn Whiskin, bScPhm
Charlton Centre
Hamilton, Ontario
barbara Farrell, bScPhm, PharmD, FCSHP
bruyère Continuing Care
Ottawa, ON
Hosted by Janssen Inc.
2. The Hierarchical Teaching Model:
Redefining the Structure in Experiential
Pharmacy Training
1. Medication Safety PSN
RSP en sécurité des médicaments
CITy HALL
Tim T. y. Lau, bScPhm, ACPR, PharmD, FCSHP
vancouver Coastal Health
vancouver, bC
Implementing Insulin Pens in Institutions
Sara Kynicos, MPharm, RPh
Toronto Western Hospital
Toronto, ON
3. Overdoses That Should Send a Chill Up
Your Spine
Jeremy Johnson, RN, bScN, MN Student, CDE
St. Joseph’s Healthcare
Hamilton, ON
Debra Kent, bA, PharmD, DAbAT, FAACT, RPh
bC Drug and Poison Information Centre
vancouver, bC
2. Cardiology PSN
RSP en cardiologie
Novel Anticoagulants in Atrial Fibrillation:
Practical Tips from the Trenches
1. Neuromuscular Blocking Agents in the
Intensive Care Unit
Natalie Crown, bScPhm, ACPR, PharmD
Women’s College Hospital
Toronto, ON
CITy HALL
Norman Dewhurst, bScPhm, ACPR, PharmD,
RPh
Toronto, ON
Kori Leblanc, bScPhm, ACPR, PharmD
Toronto General Hospital
Toronto ON
2. Treatment Decisions in Osteoporosis
Heart Failure with Preserved Ejection
Fraction: The Younger Misunderstood
Sibling of Heart Failure with Reduced
Ejection Fraction
Elaine beltijar, bScPhm
Women’s College Hospital
Toronto, ON
Arden barry, bScPhm, PharmD, ACPR
Mazankowski Alberta Heart Institute
Edmonton, Ab
3. Updates in Management of
Gastrointestinal Bleeding
16:15
Jennifer Teng, bScPhm, ACPR, PharmD
Toronto, ON
18
Close of the 45th Annual Professional
Practice Conference
Clôture de la 45e Conférence annuelle sur la
pratique professionnelle
Speaker Abstracts
Résumés des conférenciers
Anemia is a frequent complication reported in pregnancy and
conditions such as chronic kidney disease, cancer, chronic heart
failure, inflammatory bowel disease and heavy uterine bleeding
and is associated with increased morbidity and mortality. Optimal
management strategies for anemia are not clearly defined,
leading to highly variable approaches to patient care and
suboptimal clinical outcomes. A chief cause of anemia is
dysregulation of iron homeostasis and erythropoiesis due to
ongoing inflammatory processes. A critical balance exists in
providing sufficient iron to maintain adequate iron stores,
ensuring erythropoiesis but also minimizing the potential for long
term toxicity associated with iron overload. In this 45 minute
session, we will review molecular metabolism of iron metabolism
and the role of iron replacement. Using different patient cases,
we will compare and contrast the different iron products
available in Canada and determine ways to best choose therapy
for these patients.
SUNDAY, FEBRUARY 2
DIMANCHE 2 FÉVRIER
Update on Hepatitis C Management
Alice Tseng, BScPhm, PharmD, FCSHP, AAHIVP, Toronto General
Hospital, Toronto, ON
The advent of the directly acting antivirals (DAAs) boceprevir and
telaprevir revolutionized the field of hepatitis C therapy.
Combining a DAA with pegylated-interferon and ribavirin as
triple therapy has led to significantly higher rates of sustained
virological response (SvR) in patients infected with HCv
genotype 1. The recent approval of two new agents, simeprevir
and sofosbuvir have further altered the treatment landscape,
offering simpler and more efficacious regimens to a wider
population. Additionally, several new drugs are in late phase 3
development, and are anticipated to come to market in the
upcoming months.
Goals and Objectives
1. To review molecular metabolism of iron
boceprevir, telaprevir and simeprevir are substrates and inhibitors
of CyP3A4. These agents also inhibit p-glycoprotein and
telaprevir may inhibit renal transporters. Therefore, the potential
for interactions between DAAs and concomitant medications is
high, particularly if treatment for comorbid conditions including
HIv is required. Preliminary data indicate that up to 83% of HCv
infected patients initiating triple therapy with a DAA have at least
one drug-drug interaction. Potential consequences of drug
interactions include viral breakthrough and development of
resistance, sub-optimal disease/symptom management, or drug
toxicities and possible non-adherence. Pharmacists can play a
critical role in identifying, preventing and managing drug
interactions in this population.
2. To compare and contrast different iron products available on
the Canadian market with respect to efficacy, safety and
dosing
Self-Assessment Questions
1. What are possible immediate and delayed adverse effects
seen with iv iron
2. What are conditions that cause underutilization of iron?
Which Methods to Answer Your Research
Question? Qualitative? Quantitative? Or Both?
Lisa Dolovich, BScPhm, PharmD, MSc, McMaster University,
Hamilton, ON
1. To update pharmacists on the current standard of care for
patients with hepatitis C genotype 1 infection.
The purpose of this session is to discuss the broad nature of
qualitative, quantitative and mixed methods research designs.
2. To provide a review of current and new directly acting
antivirals (DAAs).
The basis for choosing a research design starts with the research
question. Questions focused on how and why can be addressed
well using qualitative research designs. Questions focused on
what, whether and who can be addressed well using quantitative
research designs. Mixed methods research designs incorporate
both qualitative and quantitative research designs into a
structured approach that combines the learnings from each
research approach. Pharmacy has typically focused on
quantitative research designs that are best for comparisons
between medications. Health services research including
pharmacy practice research including program evaluation often
benefits from findings generated from qualitative and mixed
methods studies along with quantitative studies. Examples from
recently planned or completed pharmacy program evaluation
3. To outline a strategy for identifying and managing drug-drug
interactions involving DAAs.
1. What is the rationale for DAA-based combination therapy for
hepatitis C infection?
2. How are HCv protease inhibitors metabolized and how can
drug interactions be identified and managed in this
population?
The Role of Iron in the Management of Anemia
Marisa Battistella, BScPhm, PharmD, ACPR, University Health
Network, Toronto, ON
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research will be used to highlight how to make decisions among
research designs.
2. To describe the positive and negative aspects of smartphone
use.
3. To discuss methods for evaluating the integration of
smartphones into pharmacy practice.
1. To describe the qualitative, quantitative and mixed methods
research designs.
4. To appreciate the importance of integrating a research project
into the pharmacy residency program in promoting
evidence-based practices.
2. To describe a mixed methods study that uses both qualitative
and quantitative research approaches.
1. What types of technology support can be used to facilitate
smartphone implementation across a multi-center pharmacy
department?
1. What are the benefits of using a qualitative research design?
2. What are the main considerations to take into account when
choosing a research design?
2. What further research is needed to aid other health
departments and organizations in deciding how to endorse
smartphone technology in their own departments?
Integration of Smartphones into Clinical Pharmacy
Practice: An Evaluation of the Impact on
Pharmacists’ Efficiency
How to Write a Research Paper and Get It
Published
Jessica Power, BScPhm, ACPR, Victoria General Hospital,
Vancouver Island Health Authority, Victoria, BC; Sean Spina,
BScPhm, ACPR, PharmD, Royal Jubilee Hospital, Vancouver
Island Health Authority, Victoria, BC; David Forbes, BScPhm,
ACPR, MPA, BCPS, Nanaimo Regional General Hospital,
Nanaimo, BC; Curtis K. Harder, BScPhm, ACPR, PharmD, Royal
Jubilee Hospital, Victoria, BC; Sherry Lalli, BScPhm, ACPR, Royal
Jubilee Hospital, Victoria, BC; Peter Loewen, BScPhm, ACPR,
PharmD, FCSHP, Vancouver General Hospital, University of British
Columbia, Vancouver, BC; Peter Zed, BSc, BScPhm, ACPR,
PharmD, FCSHP, University of British Columbia, Vancouver, BC
Peter J. Zed, BSc, BScPhm, ACPR, PharmD, FCSHP, Faculty of
Pharmaceutical Sciences (Department of Emergency Medicine),
Faculty of Medicine, University of British Columbia, Vancouver, BC
Following the completion of any research project the research
team often then starts to think about the preparation of a
manuscript and submission for publication consideration.
However, many factors must be considered in the preparation of
a research paper before, during and following the completion of
the project, which will both reduce some of the challenges in the
knowledge translation of research findings but also increased the
likelihood of acceptance of the submitted manuscript. This
workshop will review the many factors a research team should
consider at all stages of the research project development and
conduct and provide several tips to optimize publication success.
The workshop will allow participants to work together in small
groups to navigate several key steps in this process and when
possible an interactive discussion will be encouraged allowing
participates to share successes and failures from their own
experiences.
Personal smartphones are used frequently by healthcare
practitioners in hospitals to assist in the provision of care. The
vancouver Island Health Authority (vIHA) is one of the first health
authorities in Canada to endorse the iPhone® smartphone as a
potentially valuable tool for clinical practice. We collaborated
with the University of british Columbia (UbC) Faculty of
Pharmaceutical Sciences to design and conduct our research.
Our objective was to measure smartphones effect on
pharmacists’ efficiency, to assess pharmacist acceptance of
corporate smartphones, and to investigate how these devices are
being utilized.
1. To review several factors at all stages of a research project that
must be considered to increase the success of a research
paper being published.
We conducted a multi-center time-trial, survey, and observational
prospective study which enrolled 90 pharmacists across 8
hospitals on vancouver Island. Participants performed a time-trial
of 22 situational drug information questions before and after
receiving an iPhone. They also completed both demographic and
satisfaction surveys. A subset of 14 of the 90 pharmacists
participated in a pre and post iPhone® implementation 8 hour
direct observation study. Lastly, communication data from the
phone service provider was collected and analyzed. To the best
of our knowledge this is the first study of its kind in North
America.
2. To discuss the core components of a research paper.
3. To discuss strategies to manage an unsuccessful journal
submission.
1. What factors must be considered before, during and following
the completion of a research project to increase the chance
your project will be published?
2. What strategies should be considered to improve the
likelihood of a manuscript being accepted following a
rejection from a journal on the first (or second!) submission?
1. To understand the impact of mobile technology in pharmacy
practice.
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Antibiotic Prophylaxis in Surgery: Issues
and Controversies
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Ethical Issues in Global
Health
Sumit Raybardhan, BScPhm, ACPR, MPH, North York General,
Toronto, ON
Jessica Sleeth, MPH, CHE, BPHE, BA, Office of Global Health,
Faculty of Health Sciences, Queen’s University, Kingston, ON
The goal of this session is to provide a critical appraisal of the
new clinical practice guidelines for surgical antimicrobial
prophylaxis led by the American-Society of Health-System
Pharmacists (ASHP). This review will focus on the evaluative basis
of the guidelines by drawing on examples from the
recommendations in antimicrobial dosing, antimicrobial choice,
and the timing and duration of antimicrobial prophylaxis.
The purpose of this session is to review current literature and
practices regarding the ethics of global health work. Several
perspectives will be examined, including: the academic
institution, host institution or non-governmental organization,
and the learner/preceptor/pharmacist perspective. An important
perspective to consider is that of the host institution/organization
and the interaction with the pharmacist (and/or
learner/preceptor).
Several important changes have occurred since the previous
iteration of the ASHP surgical prophylaxis guidelines. These
include, but are not limited to: approval of a new antimicrobial
for surgical prophylaxis, changes in epidemiology and resistance
patterns of causative pathogens in surgical site infections, as well
as a greater incorporation of pharmacokinetic and
pharmacodynamic parameters into appropriate antimicrobial
dosing. Furthermore, given the growing public health crisis
around antimicrobial resistance, evaluation of these guidelines in
the context of existing antimicrobial stewardship principles is an
essential consideration.
The Office of Global Health (OGH) at Queen’s University has
developed comprehensive pre-departure training and
post-arrival debrief sessions to decrease the potential risk and
improve the experience for the learner and host
institution/preceptor. Development of long-term sustainable
partnerships is also an important goal. Our programming can be
applied to various situations, including that of pharmacists
working in both short and long-term roles in international
settings. A very important aspect to examine is that of bilateral
exchanges between North and South institutions and
organizations.
With over 80 pages of text and 1000 references, this guideline
provides a robust overview of the evidence in this field.
Identifying gaps and areas of controversies in the
recommendations are an important aspect of implementing any
guidelines. Participants in this session will benefit from a broader
understanding of the evidence underpinning, as well as the,
limitations and gaps within key recommendations, and will be
able to create a framework for applying these guidelines to their
practice setting.
Advocacy, both at home and abroad, is another important
component of global health ethics. Throughout the session we
will examine how the OGH integrates advocacy into the
education curriculum and global health placement program. The
goal of this session is to transfer the knowledge the OGH has
acquired over the last 4 years to the audience in a manner that
ensures the programming and discussion points are relevant to
your specific clinical responsibility whether it is as a learner,
preceptor, or pharmacist working in a global health setting in
Canada or abroad.
1. To provide an overview of the evidence framework
underpinning the ASHP antimicrobial surgical prophylaxis
guidelines.
1. Discuss ethical issues surrounding global health work for
learners and professionals and potential solutions to mitigate
personal risk and volunteer tourism.
2. To describe controversies in key recommendations around
antimicrobial dosing, choice, and duration in surgical
procedures.
2. Examine the potential for bilateral exchanges and long-term
partnerships with non-government organizations and
academic institutions abroad.
3. To highlight gaps in recommendations within the guidelines.
1. What is the key difference between the evidence framework
used in the ASHP clinical practice guideline for surgical
antimicrobial prophylaxis versus other standardized evidence
frameworks?
1. Is the global health work I am involved in taking course in an
ethical manner that I am comfortable with?
2. What key messages can I take away from this session to my
organization/academic institution to potentially improve the
safety and ethics of our global health work?
2. What is the ideal dosing strategy for cefazolin in surgical
prophylaxis settings?
3. Describe one area of surgical antimicrobial prophylaxis that
the guidelines do not address.
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Working as a Pharmacist with Médecins
Sans Frontières
antipsychotics seemed to push lithium out of the spotlight. A
long list of potential short-term and long-term side effects, along
with the need for therapeutic drug monitoring, made lithium a
less than appealing option. but limitations of alternative agents
have come to light, and newer data on possible anti-suicidality
and neuroprotective effects have brought lithium back to the
forefront. So what is the role of lithium in the
psychopharmacology world of today? This presentation will look
at the evidence base for the use of lithium in the treatment of
bipolar disorder and treatment refractory depression and discuss
therapeutic monitoring and the management of side effects. Use
in special populations such as the elderly and pregnant and
lactating women will also be reviewed.
Alexandra Marcil, BScPhm, Médecins Sans Frontières,
Winnipeg, MB
The purpose of this session is to describe the work of a
pharmacist working with Médecins Sans Frontières (MSF) around
the world, using examples from field experiences in Democratic
Republic of the Congo, Pakistan, and Jordan.
MSF is an international, independent, medical humanitarian
organisation that delivers emergency aid to people affected by
armed conflict, epidemics, natural disasters and exclusion from
healthcare. MSF offers assistance to people based on need,
irrespective of race, religion, gender or political affiliation. Some
30,000 MSF staff from all over the world provide assistance to
people in crisis. MSF staff are professionals who choose to work
for MSF because of a commitment to and concern for people’s
health and survival. They are doctors, nurses, midwives, surgeons,
anaesthetists, epidemiologists, psychiatrists, psychologists,
pharmacists, laboratory technicians, logistics experts, water and
sanitation engineers, administrators and other support staff.
1. To describe the place of lithium in the treatment of psychiatric
disorders yesterday, today and moving forward
2. To examine management strategies for the short and long
term side effects of lithium
1. Which do you see used in the treatment of bipolar disorder in
your practice more frequently – lithium or atypical
antipsychotics?
Pharmacists manage drugs and medical equipment in MSF
projects. They work closely with international and national
members of the team to ensure good pharmaceutical practices
and adherence to national rules. Pharmacists work with the
logistics and medical teams and ensure a positive collaboration
between them. They are responsible for the quality,
appropriateness and smooth coordination of the medical supply
lines, including the storage, distribution and ordering process of
drugs and medical supplies. Pharmacists working with MSF
implement improvements and monitor medical consumption
systems in end-user units. They analyze actual consumption
figures and medical data. They assist and advise on local
purchase, drug destruction and medical donations.
2. What are the key monitoring parameters for long-term lithium
therapy?
3. What is the role of lithium now and moving forward?
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This session is intended to provide an update on the
pharmacological treatment of anxiety disorders to aid
pharmacists in their understanding of the optimal use of
medications utilized in the management of these disorders.
1. To provide pharmacists with examples of the tasks performed
by pharmacists working with MSF.
2. To draw parallels between MSF fieldwork and that of
pharmacists currently practicing in Canada
Anxiety disorders as a group are characterized by various
combinations of key features such as excessive anxiety, worry,
avoidance, and compulsive rituals which are associated with
impaired functioning or significant stress. They are among the
most common psychiatric disorders with a lifetime prevalence of
approximately 17%. between 1 in 5 – 10 patient visits to a
primary care physician are by those presenting with symptoms of
an anxiety disorder. These disorders typically present when an
individual is in his or her early twenties but can develop in
adolescence or later in life. The chronic and disabling nature of
these conditions is often underestimated leading to
under-diagnosis and under-treatment and considerable disability
including functional impairment, increased use of psychiatric and
non-psychiatric medical services, reduced work productivity and
suicidal behaviour. Rates of suicide attempts and completions is
ten times that of the general population.
1. What activities do MSF pharmacists perform in their fieldwork
that are similar to tasks performed by pharmacists in Canada?
2. What skills are needed to be able to perform the tasks of an
MSF pharmacist?
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Anxious? Don’t Panic: A Review of
Anxiety Disorders
Barbara Thomas, PharmD, Eastern Health and Faculty of
Pharmacy and Medicine (Department of Psychiatry), Memorial
University of Newfoundland, St. John’s, NL
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Lithium… Is It Still Useful?
Wende Wood, BA, BSP, RPh, BCPP, Ontario
Pharmacists Association, Toronto, ON
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A naturally-occurring element, lithium has been used as medicine
for centuries. Its use in psychopharmacology stretches back
decades. Long considered the gold-standard for the treatment of
bipolar disorder, the aggressive marketing of second-generation
22
3. List the goals of pharmacological treatment, identify
monitoring parameters for efficacy and tolerability as well as
review the evidence that may help guide decisions around
duration of therapy
While the etiology of anxiety disorders remains largely unknown,
dysregulation of several neurotransmitter systems has been
postulated. Several classes of psychiatric medications are used
clinically in the management of these disorders with varying
levels of evidence to support their use. This presentation will
review these medications in context of treatment guidelines and
current evidence. Antidepressants are widely regarded as
first-line treatment for many anxiety disorders. However, there is
increasing use of other agents such as pregabalin and
pharmacological classes including
4. Identify the role and discuss the appropriate use of
benzodiazepines in the management of anxiety disorders
5. Discuss the differences that exist in the diagnosis and clinical
presentation of anxiety disorders in children and adolescents
and be able to identify with the specific treatment challenges
and differing treatment approaches in this patient population
the second-generation antipsychotics. The optimal use of these
therapies will be discussed in terms of defining treatment goals
and expectations, initiating and monitoring therapy.
Pharmacological treatment perils will be discussed including the
role of medication in the management of anxiety disorders in
youth.
1. The most recent guidelines for the treatment of anxiety
disorders in Canada were published in 2006. Is there more
recent data that would support a shift in our approach to
treating these disorders?
2. As a pharmacist do I know how to help an individual
undergoing pharmacological treatment for an anxiety disorder
get the best out of that treatment?
1. Review the epidemiology, etiology, symptomatology, clinical
course and prognosis of various anxiety disorders
2. For select anxiety disorders identify different pharmacological
therapies and approaches that can be employed in treatment
MONDAY, FEBRUARY 3
LUNDI 3 FÉVRIER
1. To provide an overview of the Australian Advanced Pharmacy
Practice Framework (APPF) development process
Developing an Advanced Pharmacy Practice
Framework: Key Learnings and Strategic Outcomes
2. To discuss the key principles and objectives of the APPF in the
context of practitioner development
Lisa Nissen, BPharm, PhD, FPS, FHKAPh, FSHP, School of Clinical
Sciences, Queensland University of Technology, Australia
3. To discuss strategic outcomes for the profession and future
directions now the APPF is in place
We often feel like the pharmacy profession has been at a
"crossroad" for decades. The traditional roles for our profession
in the supply and dispensing of medicines have slowly been
evolving, moving towards cognitive service provision, leveraging
off our growing recognition within the health sector as societies
medicines experts. yet, the mechanisms needed to best facilitate
these changes have not always been clear. While professional
practice for pharmacists has expanded in many countries to
include areas like prescribing and vaccination, and the concepts
of “Advanced Practice” have also been embedded within
political and health system frameworks, within Australia the value
of these to the wider health sector have only just grown
momentum. Recently, a number of key health policy changes and
profession wide practice initiatives have pointed a way forward
for pharmacy practice in Australia, including the introduction of
the profession wide Australian Advanced Pharmacy Practice
Framework. built on the core competencies for pharmacists, this
document seeks to provide a practice progression pathway for
the whole profession, and to provide a training and development
pathway that transcends individual practice scopes and locations.
This presentation will discuss the development of the framework
and the key outcomes and strategic learnings for the profession
in Australia.
1. How does the APPF relate to the development of Advanced
practitioner training in Canada?
2. Can the key learnings and messages from the Australian
experience be used in reviewing the training needs in Canada?
Managing Expensive Oncology Drugs
Jin-Hyeun Huh, BScPhm, ACPR, BCPS, University Health
Network, Toronto, ON; Lyndee Yeung, BScPhm, MBA, Cancer
Care Ontario, Toronto, ON; Hazel Markwell, BA(Hon), MA, PhD,
ThD, Centre for Clinical Ethics, Toronto, ON
Societal values on timely and equitable access to new cancer
therapies needs to be balanced with evidence-based coverage
and the sustainability of a public funding system. As the cost of
new cancer drugs continues to rise, public payers and healthcare
administrators are faced with making difficult choices when it
comes to managing access to new and expensive cancer
therapies that may not offer significant benefit, or where
evidence gaps may exist. In Canada, a pan-Canadian Oncology
23
activities of pharmacist and discuss how we need to take focus
away from the drugs and move it to the patient.
Drug Review Process has been established to promote the
consistency in the review of new cancer therapies. A
pan-Canadian brand Drug Pricing Alliance has also been created
to help jurisdictions make listing decisions after each drug review.
In Ontario, other public drug funding programs have also been
established to help improve access to new cancer therapies.
Regardless of all these initiatives, there continues to be
challenges in the provision of new and expensive cancer
therapies at all levels of the health care system. Questions arise
related to the ethics of resource allocation and the process by
which such decisions are made. From an ethical perspective,
some would suggest that the best that we can do is to provide
“good enough care”, given that limiting treatment options is
unavoidable. Others however raise questions as to equity and
fairness and whether or not clinicians should ever be
“gatekeepers”.
1. Understand what impacts the outcome of patients with major
bleeding on oral anticoagulants
2. Describe why normalizing blood glucose values are of little
importance in diabetic ketoacidosis
3. Want to return to the practice and develop ways to reduce
creating their own workload
1. Why do antidotes make little difference to the outcome of
patients with major bleeding on oral anticoagulants?
2. What is one major error internal medicine house staff makes in
managing diabetic ketoacidosis
1. To provide an overview of the drug review and approval
process in Ontario, as well as the strategies that have been
implemented to improve access to cancer therapies
3. Why do you want to order a drug level?
Using Physical Assessment in Your Practice!
2. To understand the current structure and management within
and outside the hospital setting to provide intravenous and
oral chemotherapies
Glen J. Pearson, BSc, BScPhm, PharmD, FCSHP; University of
Alberta, Mazankowski Alberta Heart Institute, Edmonton, AB
3. To look at the ethics of resource allocation and to propose a
framework which might inform the review and approval
process in Ontario.
The purpose of this session is to provide a review of how
pharmacists may use physical assessment skills in their daily
practice, for purpose of evaluating the need for and outcomes
associated with pharmacotherapy interventions.
Clinical Trials in Internal Medicine that will Change
Your Practice
In recent years, pharmacists in some regions of Canada have been
granted a new, expanded scope-of-practice through legislation.
This has allowed pharmacists to embrace new responsibilities,
such as adapting prescriptions, administering injectable
medications, accessing and ordering laboratory values and
prescribing independently. Along with this expanded scope of
practice, pharmacists have sought to broaden and advance their
knowledge base and skills to include other patient care activities
traditionally performed by other members of the health care team,
such as physical assessment (PA). PA is the systematic process of
evaluating the body and its function. It is divided into 4 separate
processes: inspection, palpation, percussion and auscultation.
Typically, pharmacists develop inspection skills, but are less
familiar with the other processes. Development of PA skills
beyond inspection has the potential to allow pharmacists to
augment their assessment and monitoring of drug therapy, and to
increase their effectiveness in a collaborative health care team
environment.
Peter Thomson, BScPhm, PharmD, Winnipeg Regional Health
Authority and University of Manitoba Faculty of Pharmacy,
Winnipeg, MB
This session is intended to take a less mainstream approach.
Rather than review a few large landmark trials, it will explore
some common misconceptions in clinical practice for acute care
medicine.
Much has been discussed about the newer oral anticoagulants
and their associated risks and benefits compare to warfarin. We
will explore the relevance of one of the many sub analysis now
available – management and outcomes of major bleeding with
dabigatran and warfarin.
Diabetic ketoacidosis is often thought of as an Emergency and
Intensive Care Issue. In practice, In Winnipeg, after early
assessment in ER, many patients are managed by Internal
Medicine. We will discuss a relatively obscure article from Spain
on the Management of DKA in a teaching hospital and compare
some of the findings from an audit of practice in two of the
teaching hospitals in Winnipeg. We will also discuss the
challenges for all pharmacists in preventing unintentional
misadventures in the medical emergency.
This presentation will focus on provides examples of opportunities
where pharmacists who have developed PA skills may apply them,
within their scope of practice, to assess and monitor drug therapy
in their patients.
1. To review various opportunities for pharmacists to use acquired
physical assessment skills to assume a broader role in to
assessing and monitoring a patient’s drug therapy.
There is no question workloads on medicine wards are increasing
- on a straight line upwards. We will briefly explore clinical
24
Landmarks in Pharmacy Practice Research: More
and More Evidence for the Beneficial Impact of
Pharmacist Care
1. What are the barriers preventing pharmacists from performing
physical assessment in practice?
Ross T. Tsuyuki, BScPhm, PharmD, MSc, FCSHP, FACC, Faculty of
Medicine and Dentistry, University of Alberta, Edmonton, AB
2. What physical assessment skills are required to assess a
patient’s response to -blocker therapy?
Pharmacy practice is changing, at least that’s what they are
saying… but it’s a tough world out there and you need to have
evidence to “get” anything. It’s important that we all become
familiar with the evidence for the benefit of pharmacist care. In
this presentation I will review some of the most important
developments in pharmacy practice research.
2. To provide pharmacists with a rationale for and a motivation to
acquire physical assessment skills.
A Pharmacist’s Tale: The Journey from Clinician to
Director
Allan Mills, BScPhm, PharmD, FCSHP, Trillium Health Partners,
Mississauga, ON
In the face of this mountain of evidence, why is it not changing
practice very much? Is it us? I will talk about some preliminary
work which suggests that pharmacists are the biggest barrier to
practice change.
This session will provide those individuals considering
administrative roles with an overview of a transition from bedside
clinician, to clinical manager and director. The session will look at
the personal learning associated with such a transition and
provide advice for those considering such an evolution.
1. Discuss some of the recent evidence for the impact of
pharmacist care on patient outcomes.
In this presentation the knowledge and skills sets that are
required to fulfill a formal leadership role will be reviewed. We
will review the core functions of a pharmacist and how the clinical
skills, knowledge and systems thinking that pharmacists
demonstrate align with tasks associated with pharmacy
administrative roles. The session will also include a review of the
perspective changes required to function at a senior
administrative level and will review the value of a personal vision
statement as a tool to guide actions and skill development.
Formal and informal leadership will be reviewed and we will
discuss how to identify opportunities as they arise that can allow
for clinicians to develop and demonstrate leadership. Other
opportunities to expand skills and demonstrate capabilities will
also be discussed.
2. Understand the role of leadership, personality traits and
organizational culture in advancing (or not advancing)
pharmacy practice.
1. List 2 recent major pharmacy practice trials give a “thumbnail
sketch” of their results.
2. Describe some of the barriers to the implementation of
pharmacy practice research evidence.
Challenges and Opportunities in
Intraprofessional Pharmacist
Collaboration in Primary Care
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Lastly, the session will look at the satisfying aspects of a formal
leadership role and the need for more pharmacy leaders in the
future.
Suzanne Singh, BScPhm, ACPR, PharmD, Mount Sinai Academic
Family Health Team, Toronto, ON
Pharmacists in primary care have a responsibility to collaborate
with pharmacists working at other practices sites when needed
to consult, refer and coordinate care to ensure the right care is
provided to the right patient at the right time. While this may
seem obvious to many practitioners, differences related to
historical and evolving roles within discrete practice
environments, organizational cultures, biases and beliefs,
geographic separation and economic drivers, at times coupled
with perceived intraprofessional rivalry, may in fact complicate
the establishment of productive intraprofessional care, to the
detriment of our patients and our profession. This session will
highlight strategies to cultivate effective partnerships between
pharmacists working across the spectrum of health care
interfaces encountered by patients and their families, with a
focus on optimizing medication management for patients in
primary care. Examples of practice scenarios including
intersections of care where intraprofessional collaboration would
1. To provide an overview of the skills and knowledge required to
function at a director level.
2. To inform clinicians of opportunities that can be utilized to
prepare for an administrative role.
3. To review the importance of informal and formal leadership
opportunities in the development of career goals.
1. How can a personal vision statement facilitate one’s
professional development?
2. What tangible steps can be taken to create leadership
opportunities to facilitate personal development?
25
be beneficial will be provided. Shared-care intraprofessional
models for patient-care initiatives at the primary care level will
also be discussed.
1. To provide recommendations that will assist pharmacists
practicing on interprofessional primary care teams to select
services that they should provide that will optimally impact
patient outcomes.
1. To discuss barriers to and enablers of effective collaborative
relationships between pharmacists caring for patients in
primary care
2. To convince pharmacists practicing on interprofessional
primary care teams to be proactive and take responsibility for
patient care on their teams.
2. To provide specific examples of patient-centered primary care
initiatives that feature shared-care between pharmacists
working across various health care settings
1. List four services that primary care team pharmacists can
provide to take responsibility for patient care and improve
patient outcomes.
1. What strategies may be implemented to foster effective
collaborative practice between pharmacists in different
settings to optimize medication management for patients in
primary care?
2. Explain why it is important for pharmacists practicing on
interprofessional primary care teams to be proactive and take
responsibility for patient care on their teams.
2. Which patient-centered primary-care initiatives may warrant a
concerted intraprofessional approach to care planning?
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Taking Responsibility for Patient Care:
A Toolkit for Pharmacists on Primary
Care Teams
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Acute Analgesia in Emergency
Departments: Is Our Performance Painful?
Richard Wanbon, BSc, BScPhm, ACPR, PharmD, Royal Jubilee
Hospital – Island Health, Victoria, BC
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The purpose of this session is to review analgesic strategies and
performance assessments for the treatment of Emergency
Department (ED) patients presenting with acute pain.
Derek Jorgenson, BSP, PharmD, FCSHP, University of
Saskatchewan, Saskatoon, SK
Acute pain is a common presentation with ED patients and acute
pain is also induced by numerous procedures performed in EDs.
There are a number of common and less common strategies to
prevent and treat pain, yet our ability to utilize these options in a
safe, effective and timely manner requires improvement. Much
attention has rightfully been focused on medication safety issues
with opiates, however identifying processes to improve the
delivery of analgesia is also important.
It is becoming increasingly common for interprofessional primary
care teams to recruit non-dispensing pharmacists to practice
alongside the other health professionals as direct patient care
providers. However, since this is a relatively new role, many
pharmacists are unsure of the services that they should offer to
optimally impact patient outcomes. The aim of this study is to
develop recommendations that will assist pharmacists practicing
on interprofessional primary care teams to select services that
they should provide that will optimally impact patient outcomes.
We performed a local chart audit of patients presenting to our
ED with acute pain. based on this audit, we implemented several
regional processes including the introduction of an Emergency
Department analgesia protocol. Implementation strategies and
barriers will be discussed in addition to an assessment of our preand post-protocol audit data. A quick review of both common
and less traditional analgesic options for a variety of patient
groups will also be provided.
A comprehensive literature search was performed to identify
peer-reviewed and non peer-reviewed papers that describe the
optimal services that pharmacists should provide in this setting.
In addition, practicing pharmacist experts from across Canada
were invited to take part in one-on-one telephone interviews to
provide advice based on their personal experiences.
Sixty-five relevant papers were identified and reviewed during
the literature search and 15 pharmacist experts were interviewed.
The overall theme that emerged was that pharmacists in this
setting need to proactively identify high-risk patients and
intervene to optimally impact patient care. They cannot just wait
for physicians to refer patients. To achieve this goal pharmacists
on interprofessional primary care teams can: (1) build a
relationship of trust and respect with the team; (2) Generate their
own patient referrals; (3) be an educator; (4) Screen the overall
patient population for drug therapy problems; (5) Offer shared
medical appointments.
1. To provide both published and local data identifying
sub-standard provisions of analgesia to ED patients.
2. To share our local experience with several initiatives we
implemented to improve the quality of analgesia-related care
provided to ED patients with acute pain.
3. To review analgesic options to consider for ED patients with
acute pain.
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Update on the Management of Urinary
Tract Infections in Children: What Does
the Evidence Say?
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1. Is there an opportunity to improve the quality of
analgesia-related care to ED patients elsewhere?
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2. How can other health regions in Canada utilize Island Health’s
ED experience to improve the quality of analgesia-related care
to ED patients with acute pain?
Jennifer Poh, BScPhm, ACPR, PharmD, Hospital for Sick Children,
Toronto, ON
Urinary tract infections (UTIs) are among the most commonly
diagnosed bacterial infections in childhood. Although frequently
encountered, the management of UTIs remain among one of the
more controversial issues in pediatric care. This has been even
more so with the emergence of resistance to commonly used
antibiotics, and recent evidence regarding the use of antibiotic
UTI prophylaxis. The goal of this session is to provide an
up-to-date summary of the literature surrounding the diagnosis,
treatment and prophylaxis of UTIs in the pediatric population
with particular attention to practical questions about its
management for the pediatric pharmacist.
Adverse Drug-Related Events and
Emergency Department Visits:
Opportunities and Challenges for Pharmacists
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Peter J. Zed, BSc, BScPhm, ACPR, PharmD, FCSHP, Associate
Professor and Associate Dean, Practice Innovation, Faculty of
Pharmaceutical Sciences, Associate Member, Department of
Emergency Medicine, Faculty of Medicine, University of British
Columbia, Vancouver, BC
In the era of increased attention to overall patient safety, several
interventions have been implemented to attempt to reduce
medication misadventure in both the community and hospital
setting. However, patients continue to experience adverse
drug-related events (ADREs) which are associated with significant
morbidity and mortality and result in many emergency
department visits. Only recently has the magnitude and
characterization of ADREs been evaluated in Canada but
unfortunately very little has been done to address this growing
problem placing significant burden on our health-care system.
As pharmacists we must identify, treat and prevent drug-related
problems. This session will outline the impact of ADREs in
Canada and discuss the overall burden on our health-care system.
Patient populations at risk and the drugs/drug classes most
commonly associated with ADREs will also be discussed. The
session will include numerous case studies illustrating the issues
and discuss how many of these events could have been
prevented. Finally, strategies and future directions will be
outlined to describe how pharmacists can identify and prevent
ADREs.
2. When should we consider UTI prophylaxis in a pediatric
patient?
1. Apply evidence-based recommendations and guidelines to the
treatment of children suspected of having a UTI
2. Use evidence-based recommendations to guide the choice of
antibiotic prophylaxis for UTIs in children.
1. What are the indications for hospitalization and/or parental
antibiotic therapy in children with UTIs?
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Tools to Improve the Health Literacy of
Sick Children and their Families
Régis Vaillancourt, OMM, CS, BPharm, PharmD, FCSHP,
Children’s Hospital of Eastern Ontario, Ottawa, ON
Four out of 10 adult Canadians aged 16 to 65 - representing 9
million Canadians - struggle with low literacy. Of these, fifteen
percent have great difficulty to understand any printed materials;
and an additional 27 per cent can only handle simple reading
tasks (Adult Literacy and Life Skills Survey, 2005).
1. To discuss the overall health care impact of adverse
drug-related events.
2. To discuss factors associated with identifying patients at risk
and drug classes commonly associated with adverse
drug-related events.
Health literacy is defined as "The degree to which individuals
have the capacity to obtain, process, and understand basic
health information and services needed to make appropriate
health decisions". Families with poor literacy or health literacy
skills have the poorest health outcomes. Low levels of health
literacy, language differences and cultural variations are barriers
to effective communication between healthcare providers and
their patients.
3. To discuss strategies pharmacists can utilize in their practice to
identify, manage and prevent adverse drug-related events.
1. What are the patient, drug and system factors that increase
the risk of adverse-drug-related events that result in
emergency department visits?
Pictograms are clever tools that help overcome communication
barriers between healthcare providers and their patients. The use
of pictograms together with written instructions, improves
patient comprehension, understanding and recall of health
information. In fact, it has been demonstrated that the less
2. What strategies can pharmacists utilize in their practice to
manage and prevent adverse drug-related events?
27
care; it is associated with evidence of impact on meaningful
patient outcomes; it is pharmacist sensitive; and it is feasible to
measure. cpKPIs may allow pharmacists to re-focus and prioritize
their patient-care efforts on interventions “that matter” and
influence important outcomes such as hospital re-admissions.
cpKPI were collaboratively developed, with representatives from
all 10 provinces, with the goal to advance pharmacy practice to
improve patient outcomes.
education someone has; the more combining written instructions
with pictures improves their understanding of health information.
We have been creating and validating pictograms for the past 14
years, and collaborate in pictogram design and validation in
Africa, India, Central America, the Caribbean and Europe. With
this experience, our team has developed a process to create and
validate pictograms to support patient counselling. The process
involves the following steps: semiotic analysis, design,
guessability, translucency and recall.
In this session, we will review 1) the key elements of the national
consensus process, 2) the final overall national Delphi results (the
final 8 consensus cpKPI) and the3) post-Delphi cpKPI “next step”
phases. A focus of the interactive session will be to obtain
workshop participant feedback on: outstanding cpKPI-specific
controversial questions, practical implementation issues and a
draft national cpKPI knowledge mobilization kit.
1. Understand the difference between literacy and health literacy
2. Understand the link between literacy and health outcome
3. Describe the method to create and to validate pictogram
based counseling tools
1. Pictogram comprehension is similar amongst different
cultures?
1. To outline the key elements of the national consensus process
in developing clinical pharmacy key performance indicators
(cpKPI) for hospital pharmacists
2. Semiotic analysis is the capacity of patients to guess the
meaning of a pictogram?
2. To report the final pan-Canadian results of the recent Delphi
consensus process to establish a final suite of cpKPI
3. To summarize the post-Delphi phases in the national cpKPI
process (interprofessional and patient stakeholder feedback,
national measurement systems, knowledge mobilization kit)
Which National Clinical Pharmacy Key Performance
Indicators (cpKPI) are You Measuring? A Practical
and Interactive cpKPI Guide to What, When, Why
and How
4. To review and gather workshop participant feedback on key
components of the draft national knowledge mobilization kit,
cpKPI controversial outstanding questions and practical
implementation issues.
Olavo Fernandes, BScPhm, ACPR, PharmD, FCSHP, UHN,
Toronto, ON, Leslie Dan Faculty of Pharmacy, University of
Toronto; Kent Toombs, BScPharm, ACPR, Capital Health,
Halifax, NS
1. State 3 reasons why implementing cpKPI in your hospital/
department is valuable to advancing pharmacy practice and
patient outcomes..
Key Performance Indicators (KPIs) are quantifiable measures of
quality that reflect the critical success factors of an organization.
A set of eight Canadian hospital clinical pharmacy key
performance indicators (cpKPI) was recently established using a
systematic, pan-Canadian, consensus-building (modified-Delphi)
process. A cpKPI is defined by 5 characteristics: it reflects a
desired quality practice; it is a metric which links to direct patient
2. List the final 8 national consensus clinical pharmacy KPI.
3. List 3 anticipated practical barriers and proposed solutions to
the implementation of cpKPI at your hospital.
TUESDAY, FEBRUARY 4
MARDI 4 FÉVRIER
Barbara Farrell, BScPhm, PharmD, FCSHP and Veronique French
MD, CCFP, CoE, Bruyère Continuing Care, Ottawa, ON
responsibilities, communicate clearly and regularly, and have
strategies for conflict management in place. Other important
elements include cooperation, assertiveness, autonomy,
coordination, growth of mutual trust and
responsibility/accountability. Strong leadership, effective
administrative support and organizational commitment to
collaboration and teamwork are key.
Interprofessional teams enhance comprehensive patient care,
improve patient safety and reduce workload issues that cause
burnout among health care professionals. Successful teams share
a common purpose and goal (e.g., patient centred care),
understand each member’s expertise, define roles and
At an undergraduate level, health care professionals are taught
to complete comprehensive, profession-specific assessments and
may or may not be exposed to the roles and responsibilities of
others. In practice, with multiple professionals contributing to
patient care, providers need to understand the potential
Comprehensive Patient Care: A Team-Based Sport
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contributions of each, and learn to coordinate assessments and
interventions in a comprehensive plan that efficiently maximizes
their contributions and minimizes duplication.
1. To better understand the mechanisms by which DDIs occur.
2. Discuss how a hospital pharmacist can systematically assess an
oncology patient for clinically significant DDIs.
Clinical scenarios from inpatient geriatric rehabilitation and
outpatient geriatric day hospital will be used to illustrate
successes and challenges with team-based care. These will
emphasize the importance and efficiency of developing
patient-centred goals as a team, rather than as individual
professionals. The importance of defining expectations for
contributions and determining what the group is trying to
accomplish will be discussed. Mechanisms to ensure team
members ask precise and relevant questions of each other, and
to avoid repetition of workload will be described. Flexible
approaches to team management when team members change,
as well as approaches to managing conflict and dysfunction will
be discussed.
1. How can a hospital pharmacist identify clinically significant
DDIs in a cancer patient?
2. What is the impact of DDIs in oncology?
CSHP 2015: What Pharmacy Directors Want!
Carolyn Bornstein, BScPhm, ACPR, CGP, FCSHP, The Arthritis
Program, Southlake Regional Health Centre, Newmarket, ON
The CSHP 2015 initiative, launched in 2008, provides a vision of
what pharmacy practice excellence will look like in the year 2015.
The 6 goals promote safe, effective, and evidence-based
medication use, and a meaningfully contribution to public health.
Canadian hospital pharmacy department progress with the
thirty-six pharmacy practice-related objectives have been
reported in the Hospital Pharmacy in Canada Reports1.
1. Consider the elements of successful collaboration in assessing
the strengths and weaknesses of their own interprofessional
teams.
2. Utilize learning as a springboard to improve their own team
functioning.
A CSHP online survey in 2012 identified the respondents’ top 10
high priority CSHP 2015 objectives, as well as their stage of
implementation for each objective2. Pharmacy directors and
managers who responded to the 2012 survey indicated that they
would like CSHP to provide more assistance with the CSHP 2015
initiative. Another CSHP online survey in June 2013 (in English
and French) was used to identify the objectives for which support
was highly desirable, and how the respondents preferred the
support be provided3. The survey also identified the most
common competing priorities with CSHP 2015, and the
respondents’ key factors for their success with new pharmacy
programs or services. Some respondents who had achieved the
2015 objective volunteered to offer support or advice to others.
1. List the elements of successful interprofessional collaboration.
2. Is my patient care team functioning as a group of individual
professionals or as an integrated unit?
The Double-Edged Sword: How Can a Drug Be a
Life Saver and Potentially Fatal at the Same Time?
Drug Interactions in Oncology
Scott Edwards, Cancer Care Program, Eastern Health,
St. John’s, NL
This presentation will highlight the results of the 2013 survey. It
will also compare the high priority objectives of 2012 with the
objectives identified as needing support in 2013. In addition to
highlighting the many resources and tools currently available to
assist pharmacy directors and managers working to achieve the
2015 objectives, other requested tools/methods of sharing will
be revealed, along with CSHP’s plans as to what they can provide.
The purpose of this session is to provide the hospital pharmacist
with an overview and review of drug-drug interactions (DDIs) in
oncology.
Cancer patients are at a high risk for drug-drug interactions due
to potentially impaired pharmacokinetics. Oncology patients are
also commonly prescribed many medications which further
increases the risk. It has been determined that one-third of
ambulatory cancer patients are at risk for DDIs.
1. To compare and contrast the CSHP 2015 Top 10 High Priority
Objectives from a 2012 survey with the results of a 2013 online
survey to identify which CSHP 2015 objectives pharmacy
directors and managers would like support for.
Oral oncology agents represent a major breakthrough in the
treatment of cancer but most of these oral agents have a high
potential for DDIs. A recent study found 23-74 percent of
patients taking an oral kinase inhibitor were also on a drug that
had the potential to reduce the effectiveness of the cancer
treatment or increase its toxicity.
2. To identify current competing priorities for the CSHP 2015
initiative.
This session will use a cased based approach to identify and
resolve clinically significant DDI’s, highlighting the role and
impact of the hospital pharmacist in improving patient care.
3. To review the currently available resources and tools to
support achieving the CSHP 2015 objectives, and to future
plans for additional methods of sharing and supporting
pharmacy directors and managers with this initiative.
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Inspiring the Leader Within: Powerful Pearls &
Potent Principles
1. Name the top 3 CSHP 2015 objectives that pharmacy leaders
would like more support to achieve.
Shirin Abadi, BScPhm, ACPR, PharmD, BC Cancer Agency,
Vancouver, BC
2. List at least 3 competing priorities for the CSHP 2015 initiative
that pharmacy leaders in Canada are currently facing.
Effective pharmacy leadership can have a tremendous influence
on one’s ability to positively impact patient care and improve
patient health outcomes. Regardless of one’s position within the
healthcare system, there are multiple opportunities for
pharmacists to lead and to make a positive difference. by gaining
a better understanding of the key leadership strategies, it is
possible to take one’s practice to the next level.
3. What methods of resource sharing did the survey respondents
prefer/request from CSHP?
Scrutinizing Statins in the Prevention of
Cardiovascular Disease: New Safety Concerns
This presentation will provide an overview of a few key
leadership principles that would enable pharmacists to increase
their leadership effectiveness, while highlighting important
strategies for continued success. by reflecting on different
perspectives and broadening one’s point of view, additional
insights will be gained about one’s leadership potential.
Glen J. Pearson, BSc, BScPhm, PharmD, FCSHP; University of
Alberta, Mazankowski Alberta Heart Institute, Edmonton, AB
The purpose of this session is to provide a review of recent
identified statin-associated adverse effects/intolerances and
appropriate management suggestions.
Recently, clinical studies have identified or provided insight into
the effects of statin therapy on muscles, cognition, cataracts,
diabetes, kidney disease, and cancer. Among adverse drug
effects, the greatest controversy pertains to purported effects on
cognition and the emergence of diabetes during long-term statin
therapy. Some of this evidence has prompted regulatory
authorities to require drug labeling changes or safety warnings
for drugs in this class. In addition, clinicians a faced with the
challenges of managing statin intolerance among patients
prescribed this therapy.
1. To describe the key leadership principles, which apply to one’s
pharmacy practice.
2. To identify opportunities for improving one’s leadership
effectiveness.
1. What are some strategies that you could incorporate in your
daily work that would improve your leadership effectiveness?
The clinical and academic observations in aggregate indicate that
overall risk/benefit ratio favors therapy in patients meeting
criteria for lipid lowering therapy and Cv risk reduction.
Furthermore, the CCS guidelines recommends that all purported
statin-associated symptoms should be evaluated systematically,
incorporating observation during cessation, re-initiation to
identify a tolerated, statin-based therapy for chronic use.
2. How would you take your current practice to the next level?
Antibiotic Locks for Catheter-Related Bloodstream
Infections: There's a Lock for That!!!
Alfred Gin, BScPhm, PharmD, FCSHP, Health Science Centre,
Winnipeg, MB
Nosocomial bloodstream infections (bSIs) are a common
complication associated with the use of intravascular devices for
venous access. Although bSIs may emanate from different organ
sites, a majority of bSIs are associated with intravascular or
central venous catheters. Catheter-related bSIs (CRbSIs) are
associated with significant morbidity and mortality. Of the
estimated 250,000 cases of bSIs in the United States, 80,000
cases of central line associated bSI occur in the intensive care
unit. Among affected patients, CRbSIs increase the cost and
length of hospitalization.
1. To review the evidence for recently identified statin-associated
adverse effects, such as new-onset diabetes, memory
impairment, etc.
2. To provide a clear definition for the clinical syndrome of “statin
intolerance” and outline a recommended statin intolerance
management approach.
1. What is the incidence of new-onset diabetes mellitus
associated with long-term statin therapy?
Significant efforts have been directed towards the prevention of
bSIs through catheter selection and placement; aseptic
techniques; and the development of catheter
insertion/maintenance bundles. Treatment of primary CRbSIs
usually involves systemic antibiotic therapy with/without the
removal of the infected catheter. Several guidelines and reviews
for the prevention and management of CRbSIs have been
2. Is a creatine kinase (CK) elevation required for a patient to be
intolerant to a statin?
3. In patients with statin-induced myopathy, does the use of
Co-enzyme Q10 (ubiquinone) reduce or prevent these
symptoms?
30
published. Lost among the myriad of recommendations are those
recommending the use of antibiotic lock therapy (ALT). ALT has
been used to treat and/or prevent CRbSI in patients especially
those with long term indwelling devices. ALT involves the
intra-luminal instillation of an antimicrobial solution (usually with
an anticoagulant) or ethanol for a specified period of time.
Despite recent recommendations, questions and the lack of
familiarity with ALT remain.
1. What are the 3 types of insulin and the pros and cons of the 3
insulin regimens?
2. What are the ideal insulin strategies to deal with special
populations such as variable feeding and glucocorticoid
therapy?
This talk will review the pathogenesis and epidemiology of
CRbSIs and the application of ALT for treatment. Studies,
considerations and limitations of ALT will also be provided.
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Role of Suboxone in Opioid
Dependence
Beth Sproule, BScPhm, PharmD, Centre for Addiction and
Mental Health and University of Toronto, Toronto, ON; Juno Kim,
BScPhm, Centre for Addiction and Mental Health, Toronto, ON
1. To provide the pharmacist an understanding of catheter
related blood stream infections.
The purpose of this session is to review the role of
buprenorphine, marketed as Suboxone®, in the treatment of
opioid dependence. Compared to methadone, its partial
mu-opioid agonist properties confer desirable features such as
increased safety in overdose, reduced potential for abuse, and
the ability to titrate to a stable dose quickly. However, the partial
agonism also means that even when prescribed at maximal doses
it may not be sufficient for all patients, and special considerations
are needed during induction to avoid precipitating withdrawal.
The addition of naloxone to the Suboxone® product formulation
is intended to further reduce the risk of abuse by injection, but
does not eliminate the risk. At the Centre for Addiction and
Mental Health, a flexible short-term buprenorphine dosing
protocol has been developed for inpatients undergoing
medically-assisted withdrawal from opioids (primarily prescription
opioids), largely replacing the previous protocol using clonidine.
Importantly, opioid substitution therapy with buprenorphine or
methadone, has been shown to be far more effective than
detoxification in improving health and drug outcomes in the
treatment of opioid dependence. When patients taking
buprenorphine or methadone are hospitalized, pharmacists play
a key role in ensuring the safe maintenance of this treatment
during transitions in care.
2. To identify indications and considerations for the use of
antibiotic lock therapy.
1. What is an antibiotic lock?
2. What are the recommendations for antibiotic lock therapy?
Use of Insulin in Hospital
Alice Y.Y. Cheng, MD, FRCPC, Trillium Health Partners,
Mississauga, ON
The purpose of this session is to review the types of insulin and
insulin regimens available for use in the hospital setting.
There are 3 types of insulin: basal, bolus and premixed. There are
also 3 fundamental regimens in type 2 diabetes – basal alone,
basal bolus and premixed. In the hospital setting, achieving and
maintaining glycemic control is a challenge due to system and
patient-related factors. Insulin is the usual mainstay of therapy in
hospital. but what regimen should be used?
• Continuation of pre-existing insulin regimen and the original
doses is a good starting point for patients admitted previously
on insulin
1. To describe the role of buprenorphine in the treatment of
opioid dependence compared to methadone, based on its
unique pharmacology.
• A regimen consisting of routine basal + routine bolus insulin or
mealtimes + correction dose bolus insulin regimen is ideal in
hospital
2. To explain the use of buprenorphine and its effectiveness in
substitution therapy and medically-assisted withdrawal.
• Sliding scale bolus insulin alone as the treatment in hospital is
inappropriate
• Frequent reassessment of the routine insulin regimen is
required to ensure good results
1. What are the clinical significant differences in the
pharmacokinetics and pharmacodynamics of buprenorphine
and methadone?
1. To review the 3 types of insulin and the pros and cons of the 3
fundamental insulin regimens in type 2 diabetes
2. When would buprenorphine be chosen over methadone in
opioid substitution therapy?
2. To describe practical strategies to dose insulin in the hospital
setting
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Constipation
Peter Thomson, BScPhm, PharmD; Winnipeg Regional Health
Authority and University of Manitoba Faculty of Pharmacy,
Winnipeg, MB
1. Describe the impact of TXA on reducing blood loss when
administered in the peri-operative setting by either topical or
intravenous route.
This session will use a case based format to discuss constipation.
The focus will be on the difficult to manage patient from a few
different perspectives: refractoriness to laxatives, adverse effects
or intolerance to laxatives and constipation associated with pain.
In addition to discussing laxatives an introduction to non-drug
related concepts will be provided.
2. Understand the risk of thromboembolic events and rate of
occurrence in the peri-operative setting in the face of TXA
administration.
1. What impact does study design have on being able to make
statements on the safety and efficacy profile of using TXA to
reduce the need for peri-operative transfusions?
1. Describe some common adverse effects with specific laxatives
2. In which patients would TXA be contra-indicated and another
blood conservation strategy be utilized?
2. Describe the difference between functional and organic bowel
syndromes
2. Discuss the building blocks of cognitive behavioral therapy
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Optimizing Surgical Antibiotic Prophylaxis:
What’s New? What You Can Do
Rosemary Zvonar, BScPhm, ACPR, FCSHP, The Ottawa Hospital,
Ottawa, ON
1. What is a normal bowel routine?
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Surgical site infections are associated with patient morbidity,
mortality and increased health care costs. It has been well
established that timely administration of appropriate antibiotics
peri-operatively can reduce the incidence of surgical site
infections and is recommended for high-risk procedures. Thus,
optimizing delivery of surgical antibiotic prophylaxis is an
important patient safety goal and an obvious quality
improvement target. Pharmacists can play an important role in
evaluating and optimizing practice at their institution.
Tranexamic Acid as a Blood Conservation
Strategy
Melanie MacInnis; BScPhm, PharmD; IWK Health Centre, Halifax,
NS
With the evolution of the concepts of bloodless medicine and
blood conservation; pharmacologic strategies are gaining more
clout as one of options to minimize blood loss and the need for
blood transfusions. Tranexamic acid (TXA), a lysine analogue; has
been used intravenously for many years to manage perioperative
blood loss. In the past ten years; the literature has exploded with
information on the efficacy of TXA in reducing the need for
blood transfusions.
Antibiotics administered for surgical prophylaxis should be
narrow spectrum, active against organisms of concern at the
surgical site, well tolerated, and administered such that adequate
serum and tissue concentrations are achieved from the time of
incision until closure. Although studies are available to inform
practice for a variety of surgical procedures, a number of
uncertainties remain. Guidelines for the use of antimicrobial
surgical prophylaxis, developed jointly by a number of key
Societies, have recently been published. These guidelines
summarize the current literature and provide a basis on which to
standardize practice. Recommendations pertaining to dosing,
choice, timing and duration of prophylaxis within the guidelines
will be reviewed.
While the efficacy of systemic TXA is established; the studies are
not powered sufficiently to inform reliably on risk of adverse
events such as thromboemolic complications. Wide ranges of
dosing strategies are reported in the literature. Topical
administration of TXA is one way to attempt to maximize the
coagulation afforded by TXA while minimizing the theoretical
systemic adverse events. The topical administration of TXA is just
starting to be reported in the literature; but again not in any
studies with enough power to reliably determine
thromboembolic risk.
1. To review the general principles of antibiotic prophylaxis in
surgery
This session will review the rationale for blood conservation
strategies, the pharmacologic profile of TXA, and its place in
therapy as a blood conservation strategy. Evidence for use of
TXA, both topical and systemic, will be reviewed with a focus in
orthopedic surgeries. Cardiovascular, vascular, spine, and
emergency/trauma will also be reviewed.
2. To highlight key recommendations in the recent clinical
practice guidelines for antibiotic surgical prophylaxis
3. To identify ways in which pharmacists can work with other
healthcare practitioners to improve the delivery of antibiotic
prophylaxis at their institution
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done by Canada Health Infoway – a federal body that
collaborates with all of the provinces that promotes the
transformation of health care through the use of health
information technology. The Pharmacists Reference Group is
composed of pharmacists from several practice areas and is
involved in advising CHI and assisting in the adoption of
information technology by pharmacists. both these groups have
representation from CSHP and have been working on activities
intended to promote the use health information technology by
pharmacists.
1. List 5 quality indicators which should be assessed when
evaluating surgical prophylaxis practice
2. What are the antibiotic regimens recommended for
prophylaxis for General and Orthopaedic surgeries?
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Roads to the Information Superhighway
Kurt Schroeder, BScPhm, ACPR, Director of Pharmacy,
Interlake-Eastern Regional Health Authority, Selkirk, MB; Jeff
Barnett, BScPhm, MSc, FCSHP, Director of Clinical Informatics,
BC Cancer Agency, Victoria, BC
There are many challenges in pharmacy practice for project
implementation and sustainability. Informatics projects in rural or
regionalized organizations provide a unique logistics that
requires a strategic approach
The purpose of this session is to provide an overview of current
e-Health activities across Canada and highlight some of the
challenges and opportunities facing pharmacists practising in
rural communities.
1. To provide pharmacists with an understanding of e-Health
activities across Canada
There are 2 main national committees looking at the interests of
pharmacists in regard to health information technology. CSHP is
represented at the National e-Pharmacy Task Force which
involves several national groups such as CPHA, CADS, and
NAPRA. This committee evolved from the activities outlined in
the bluePrint for Pharmacy. It looks at information technology
issues such as e-prescribing, drug information systems and
electronic health records and makes recommendations to the
appropriate organizations and legislative bodies.
2. To describe CSHP involvement at the national level in e-Health
3. To identify key barriers for informatics project implementation
in rural practice and strategies that address these barriers.
1. How will the national e-Health strategies impact hospital
pharmacy programming?
2. How can local pharmacy informatics projects be designed to
better support the national Infoway strategy?
The other committee is the Canada Health Infoway, Pharmacist
Reference Group. This group is actively involved with the work
remains: safeguarding the quality of the drug supply. Good
intentions are not enough to mitigate risks. Greater vigilance
through a series of recommendations, along with checks and
balances, will close gaps in: group purchasing organizations,
vendors, hospitals, the Ontario College of Pharmacists, Ontario
Hospital Association and Health Canada.
WEDNESDAY FEBRUARY 5
MERCREDI 5 FÉVRIER
The Oncology Under-Dosing Incident: Lessons
Learned
The challenges of navigating the grey are not reserved for
practitioners but also apply to the Ontario College of
Pharmacists. Although current legislation excludes the College
from regulatory oversight of hospital pharmacies and Health
Canada holds jurisdiction for drug manufacturers, how clear are
these divisions of authority? When standing at these borders we
must consider the risks of assuming that others have stepped in,
where we have stopped. The delivery of safe and effective
healthcare is complex and dependent on all stakeholders
committed to working collaboratively.
Sandy Jansen, BScPhm, MHS, London Health Services, London,
ON; Jake J. Thiessen BScPhm, MSc, PhD, University of Waterloo,
Waterloo, ON; Marshall Moleschi, Ontario College of
Pharmacists, Toronto, ON
On March 22, 2013, with one single phone call received from
Lakeridge Hospital, the landscape for hospital pharmacy
changed dramatically. being at the centre of a critical incident
involving one patient is something every pharmacist and
technician dreads, but being at the centre of an event that
impacted 691 patients locally and over 1200 patients across two
provinces is something most of us cannot comprehend and is
certainly not something we train for or plan for. This presentation
will focus on leadership lessons learned from the front line.
1. To understand leadership lessons learned from the hospital
pharmacy front line during the oncology under-dosing incident.
Through the oncology review, pharmacy’s identifiable footprints
were evident in affected hospitals, outsourcing vendors
(Marchese Hospital Solutions), the group purchasing organization
(Medbuy), and oversight regulatory agencies. Notwithstanding
Pharmacy’s expanding professional role, a critical responsibility
2. To understand how the recommendations and their potential
impact to stakeholders.
3. To understand the roles of regulatory authorities.
33
Biologicals: What Pharmacists Need to Know
About Monoclonal Antibodies
Deprescribing Benzodiazepines: Do We Need a
New Approach?
Tom McFarlane, BScPhm, PharmD, Cambridge Memorial
Hospital, Cambridge, ON
Barbara Farrell, BScPhm, PharmD, FCSHP, Bruyère Continuing
Care and Bruyère Research Institute, Ottawa, ON
Since the advent of a process to produce monoclonal antibodies
won its discoverers the Nobel Prize in 1984, these agents have
become widespread in medicine in a number of applications,
particularly as therapeutic drugs. Furthermore, the number of
monoclonal antibodies receiving approval for therapy is
skyrocketing, with dozens of potential candidates for future
approval in the pharmaceutical pipeline. As the use of these
agents becomes more prevalent, it will be incumbent upon
pharmacists to have some familiarity with the therapeutic action
and potential adverse effects which relate to them.
benzodiazepines are associated with sedation, dizziness,
cognitive impairment, falls, hip fractures, and motor vehicle
accidents. yet, between 22% -27% of adults 65+, and over 30%
of those 85+, use them regularly. Up to 50% of people taking
benzodiazepines do so long-term despite only short-term
evidence (up to 6 weeks) for insomnia and Health Canada
recommendations for anxiety limited to 2 months.
Stopping benzodiazepines is difficult due to patient resistance,
withdrawal symptoms, and physician prescribing practices.
Reports of withdrawal symptoms, some severe (e.g. seizures,
psychosis) are frightening. Rebound insomnia is common and
patients may believe they need medication indefinitely for sleep.
Health care providers often have difficulty helping patients taper
benzodiazepines. Physicians sometimes prescribe for short-term
insomnia treatment but hesitate to deprescribe for many reasons.
This presentation will give an overview of the monoclonal
antibodies which are currently in use in therapeutic treatment in
the settings of cancer treatment, autoimmune disease, and other
uses. Topics covered will include classification of monoclonals,
differences between murine, chimeric, humanized, and fully
human antibodies, mechanisms of action, potential side effects
such as infusion-related reactions, and the place of
antibody-directed treatment in the oncology and autoimmune
settings.
The most consistently effective methods to stop benzodiazepines
include slow tapering and support through cognitive behavioural
therapy, psychological counseling, and self-help. These
approaches are not commonly used, however, perhaps due to
lack of expertise or perceived expense. With interprofessional
health care teams and focus on supports for self-management,
there is potential for team approaches to assist patients with
benzodiazepine tapering.
Also covered will be future directions in monoclonal antibody
treatment, including discussion of various agents in the
pharmaceutical pipeline which are imminently awaiting approval,
drug-antibody conjugates, and the potential impact of so-called
“follow-on” or “biosimilar” monoclonal antibodies on the
healthcare system given the large number of expiring patents on
monoclonals in the next few years.
In September 2013, the Canadian Institute of Health Research
funded a 1.5 day meeting at the bruyère Research Institute,
Ottawa. Over 50 health care professionals, researchers and
stakeholders discussed and identified components of an
interprofessional model to benzodiazepine deprescribing. A
grant writing team was established and has begun work
developing a related research grant framework which will be
discussed during the session.
1. To familiarize pharmacists with the concept, naming
conventions, and basic properties of monoclonal antibodes
2. To give an overview of the therapeutic uses of various
monoclonal antibodies
3. To outline the patient management issues seen with various
monoclonals
1. Explain the reasons why attempts should be made to
deprescribe benzodiazepines
4. To delineate the impact of monoclonal antibodies on the
health care system from both treatment and cost perspectives
2. Describe a framework for an interprofessional team approach
to benzodiazepine tapering
1. What therapeutic areas are monoclonal antibodies typically
used in, and what is their impact within these areas?
1. What are the risks of continuing benzodiazepine use in the
elderly?
2. What is the role of the pharmacist in the management of
patients receiving these agents?
2. How can I work with other health care professionals to
facilitate reduction of benzodiazepine use in the elderly?
3. What potential impact might future directions in biologic
drugs have on the Canadian healthcare system?
The Hierarchal Teaching Model: Redefining the
Structure in Experiential Pharmacy Training
Tim T.Y. Lau, PharmD, ACPR, FCSHP, Vancouver Coastal Health,
Vancouver, BC
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Colchicine overdose results in multi-system toxicity and potential
for poor outcome must be recognized early. There is no specific
antidote; various agents have been used with limited success.
The demand for high-quality experiential training for pharmacy
students, pharmacy residents, and PharmD students has been
increasing in Canada. However, the limited number of preceptors
and clinical placements in hospitals make it difficult to
accommodate these trainees and ensure their learning objectives
are fulfilled. Traditionally, the one-to-one preceptor to student
model has been the main teaching strategy at most institutions,
but this approach is time intensive and is suboptimal in catering
to the need of this large population. Consequently, more
effective models of experiential education are needed.
Dapsone overdose causes methemoglobinemia and delayed
hemolysis. Patients with chronic disease tend to have worse
outcomes. Pulse oximetry cannot be used to diagnose or
monitor these patients. Methylene blue can be life-saving and
repeated doses may be required.
Ecstasy overdose can result in severe hyperthermia. These
patients require rapid cooling, sedation, paralysis and possible
use of dantrolene.
The hierarchical teaching model with senior students mentoring
junior students is traditionally used in medical training. Under this
approach, pharmacy students at various levels of training would
be overseen by an attending pharmacy preceptor. The
advantages and disadvantages of this teaching model will be
reviewed.
Acetaminophen in massive amounts can result in metabolic
acidosis, coma and hypotension within several hours of ingestion.
This clinical presentation is not secondary to hepatic failure and
early aggressive treatment with consideration of hemodialysis is
essential.
1. To provide an overview of different experiential training
models for pharmacy internships.
1. To discuss drug overdoses associated with rapid deterioration
in clinical status or where aggressive management may be
required.
2. To highlight the advantages and disadvantages of a
hierarchical teaching model.
2. To discuss current approach to managing toxicity of these
overdoses.
1. What are some considerations when setting up a hierarchical
teaching model for a pharmacy internship?
2. What should be considered when evaluating trainees under
the hierarchical teaching model?
1. What potential toxicity and treatment can a clinical pharmacist
anticipate when managing a patient who has overdosed on
hydroxychloroquine?
Overdoses That Should Send a Chill Up Your Spine
2. What antidote may a clinical pharmacist require in managing a
massive bupropion overdose?
Debra A. Kent, BA(Biol), PharmD, DABAT, FAACT, B.C. Drug and
Poison Information Centre, Provincial Health Services Authority,
Vancouver, BC
3. With regard to lactic acidosis secondary to acetaminophen
overdose, compare pathophysiology and approach to
management following early acidosis seen with massive
ingestion vs late acidosis following development of fulminant
hepatic failure.
The purpose of this session is to familiarize clinical pharmacists
with some uncommon but potentially fatal overdoses. This
case-based discussion highlights overdoses resulting in rapid
deterioration of clinical status such as hydroxychloroquine,
bupropion, colchicine, dapsone, ecstasy and massive amounts of
acetaminophen. by anticipating potential toxicity and
understanding aggressive approach to management, clinical
pharmacists can improve outcomes in patients who have
overdosed on these agents.
Neuromuscular Blocking Agents in the Intensive
Care Unit
Norman Dewhurst, BScPhm, ACPR, PharmD, St. Michael’s
Hospital & University of Toronto, Toronto, ON
The goal of this session is to provide pharmacists with an
overview of the use of neuromuscular blocking agents (NMbAs)
in the critical care setting.
Hydroxychloroquine overdose can result in rapid onset of
hypotension, hypokalemia, conduction delays and cardiac arrest.
Aggressive resuscitation includes fluids, vasopressors, sodium
bicarbonate, and electrolytes.
NMbAs paralyze skeletal muscle by blocking the transmission of
nerve impulses at the myoneural junction. A number of NMbAs
are available, differing in their pharmacologic and
pharmacokinetic properties. Patient-specific factors should be
taken into consideration when selecting the most appropriate
agent to maximize efficacy and minimize toxicity.
bupropion overdose commonly results in seizures but following
large ingestions, patients can develop multiple seizures and
cardiac dysrhythmias. Management requires sedation and
anticonvulsants; Iv lipid emulsion has been used successfully for
asystole.
NMbAs have many clinical applications, including immobilizing
patients for emergency intubation or procedural interventions,
facilitating mechanical ventilation for acute respiratory distress
35
safety, convenience, and cost, but may also rely on overall
patient preference.
syndrome (ARDS) and status asthmaticus, decreasing elevated
intracranial or intra-abdominal pressures, and facilitating
therapeutic hypothermia after ventricular fibrillation-associated
cardiac arrest. The available evidence suggests that the
short-term administration of neuromuscular blockade in select
patients may be safe and potentially beneficial.
Treatment duration has recently been a hot topic of contention in
the wake of media reports describing long-term risks associated
with bisphosphonate use, i.e. osteonecrosis of the jaw [ONJ] and
atypical femoral fractures [AFF], which have also been linked to
denosumab. bisphosphonates and denosumab have
undoubtedly been proven as effective therapies for reducing
fracture rates in clinical trials for up to 3 years. Long-term efficacy
data has been less robust, although treatment extension trials
have provided some insight over 6 to 10 years of continued use,
which will be reviewed in this session. Information about ONJ
and AFF (re: incidence rates, clinical presentation, and risk
factors) will also be discussed.
However, the continuous administration of NMbAs is associated
with a number of adverse effects and complications, including
post-paralytic syndrome, prolonged neuromuscular weakness
and inability to wean from the ventilator. Medical errors with
NMbAs also cause profound morbidity and mortality. Serious
adverse events occur when NMbAs are used without adequate
knowledge, experience or safeguards. Pharmacists are the ideal
healthcare providers to manage the complexities associated with
NMbA use in critically ill patients.
1. To provide an overview of the medication options available for
the treatment of osteoporosis.
1. Compare and contrast the pharmacologic and
pharmacokinetic properties of available NMbAs.
2. To discuss the use of fracture risk assessment tools (CAROC /
FRAX) to help identify patients in need of treatment.
2. Describe the rationale and current therapeutic indications for
NMbA use.
3. To describe the rare risks associated with long-term treatment
and to review important patient counselling points.
3. Summarize recent literature on the use of NMbAs to
prevent/treat ARDS.
4. To examine the efficacy data from treatment extension trials
and to provide guidance for either continuing or stopping
therapy.
4. Discuss practical considerations for the use of NMbAs.
1. Which NMbAs are preferred in patients with renal and/or liver
dysfunction?
1. When should treatment be initiated and which medication
should be selected?
2. List 5 drugs or conditions that affect the activity of NMbAs.
2. What do I know about ONJ and AFF risks related to long-term
treatment with bisphosphonates / denosumab?
3. List the goals of therapy and monitoring parameters for
patients on NMbAs.
3. How long should treatment be continued?
4. Which supplemental medications should be initiated or
avoided in patients on NMbAs?
Treatment Decisions in Osteoporosis
Updates in Management of Gastrointestinal
Bleeding
Elaine Beltijar, BScPhm, Women’s College Hospital:
Multidisciplinary Osteoporosis Program, Toronto, ON
Jennifer Teng, BScPhm, ACPR, PharmD, St. Michael’s Hospital,
Toronto, ON
The purpose of this presentation is to provide an overview of the
pharmacological options in the management of postmenopausal
osteoporosis and to address common questions encountered in
daily practice relating to the initiation of treatment, the choice of
agent, long-term safety concerns, and the duration of therapy.
The purpose of this session is to provide a brief overview of
pharmacologic management of upper-gastrointestinal bleeding
(UGIb), variceal and non-variceal.
Many hospital pharmacists encounter patients with
gastrointestinal bleeding regularly in their practice. Pharmacists
are essential in identifying drug and disease related causes of
upper gastrointestinal bleeding and recommending treatment
for prevention of recurrent bleeding.
Over the past two decades, the number of treatment options,
available in Canada, has expanded to include several
anti-resorptive agents (oral and intravenous bisphosphonates,
raloxifene, hormone therapy, denosumab) and a bone-forming
agent (teriparatide). Treatment initiation should be based on a
review of patients’ clinical risk factors and the evaluation of their
absolute 10-year fracture risk, either using the CAROC or FRAX
fracture risk assessment tools. Selection of the appropriate
therapeutic agent involves the consideration of its anti-fracture
efficacy, administration, side effect profile, drug-interactions,
Topics of discussion will include acute management of variceal
and non-variceal bleeding, when to restart antiplatelets or
anticoagulants after a bleeding event, post-GI bleeding
gastroprotection, treatment of H. pylori, and antibiotic
prophylaxis for variceal bleeding.
36
been created in hopes that these will facilitate discussion within
your own institution.
1. To provide pharmacists with an overview of the epidemiology,
risk factors, and diagnostic procedures for patients with
variceal and non-variceal bleeding.
1. To provide an understanding of the benefits and risks of
implementing insulin pens in your institution.
2. To describe evidence based treatment and prevention
strategies for variceal and non-variceal gastrointestinal
bleeding.
2. To describe insulin pen implementation processes and factors
to consider.
1. What are the clinical benefits ( e.g. risk of rebleeding, mortality
benefits) of using pantoprazole infusion or octreotide infusion
for GI bleeding?
1. What are the benefits and risks associated with implementing
insulin pens within my own institution?
2. What are the considerations in implementing insulin pens
within my own institution?
2. When should antiplatelets or anticoagulants be re-started after
an episode of GI bleeding?
3. What type of gastroprotection should be used after an
episode of GI bleeding?
PHARMACY
PHARMACY
SPECIALTY
SPECIALTY
NETWORKS
NETWOR
RKS
K
4. What antibiotic treatments or treatment regimens are
recommended in patients with variceal or non-variceal
gastrointestinal bleeding?
PHARMACY
PHARMACY
SPECIALTY
SPECIALTY
NETWORKS
N
ETWORKS
P
PSN
SN
AT E
P
PSN
SN
AT E
Novel Anticoagulants in Atrial Fibrillation:
Practical Tips from the Trenches
Natalie Crown, BScPhm, ACPR, PharmD, Women’s College
Hospital, Toronto, ON; Kori Leblanc, BScPhm, ACPR, PharmD,
Toronto General Hospital, Toronto, ON
The purpose of this session is to discuss common issues
encountered by pharmacists surrounding the initiation,
monitoring, and management of new oral anticoagulants in
clinical practice. The focus will be on the management of novel
anticoagulants for stroke prevention in atrial fibrillation.
Implementing Insulin Pens in
Institutions
Sara Kynicos, MPharm, RPh, University Health Network, Toronto
ON; Jeremy Johnson, RN, BScN, MN student, CDE, St. Joseph’s
HealthCare Hamilton, Hamilton, ON
In recent years, the availability of new oral anticoagulants has
changed the landscape of anticoagulation therapy. The use of
these new agents is growing rapidly, in part due to several
advantages over warfarin. However, distinctions amongst new
agents exist, and clinicians struggle with optimal management of
these drugs in some scenarios. This presentation will aim to
present common clinical situations and formulate practical
management approaches based on current available evidence.
Topics addressed will include: an approach to initiation &
monitoring, choice of agent and in select patients populations,
peri-procedural management for planned or urgent surgical
interventions, and laboratory monitoring of the new agents.
In recent years, there has been growing interest in using insulin
pen devices for subcutaneous insulin administration in hospital
settings; primarily related to how to introduce insulin pens safely.
Although risks exist, transitioning to insulin pens correctly can
reduce medication error potential, improve staff safety, reduce
insulin costs and wastage, enhance nurse and patient satisfaction,
promote educational best practice and support transitions of
care.
The purpose of this session is to describe experiences from pen
implementation projects at a number of institutions, including
the benefits and risks identified from both a pharmacy and
nursing perspective.
When planning to implement insulin pens, a number of factors
should be considered including which stakeholders to involve,
how to roll-out to multiple areas, patient flow considerations and
plans for specific patient populations, in addition to fundamental
decisions surrounding the choice of insulin pen devices and
needles to use.
1. Assess the appropriateness and tailor anticoagulation therapy
to specific clinical situations.
In order to ensure a successful implementation, staff education
relating to insulin administration using insulin pen devices and
the processes involved are crucial aspects in circumventing risk.
Focus should also be given to the design of the dispensing and
labeling process during pharmacy hours and after hours.
4. Describe an approach to monitoring ongoing therapy
2. Identify risk factors for bleeding complications with
anticoagulants
3. Develop a peri-procedural anticoagulation plan
1. What factors are important to consider when choosing an
anticoagulant for stroke prevention in a patient with atrial
fibrillation?
In this session, we will share our experiences, discuss challenges
and opportunities that we have faced and share tools that have
37
published evidence (including the recently completed TOPCAT
study) and corresponding guideline recommendations for the
treatment of HFpEF will be discussed, as the management of
HFpEF (specifically how it differs from heart failure with reduced
ejection fraction) is not well appreciated and understood by most
clinicians. As well, a brief summary of some of the emerging
therapies for the treatment of HFpEF will also be included. Finally,
pharmacists will be provided with a practical case-based
approach as to how to treat HFpEF in practice.
2. Describe your approach to making a recommendation
surrounding the peri-procedural management of new oral
anticoagulant?
3. What parameters will include in a follow-up plan for a patient
receiving long term therapy with a new oral anticoagulant?
Heart Failure with Preserved Ejection
Fraction: The Younger Misunderstood
Sibling of Heart Failure with Reduced Ejection
Fraction
PHARM
ACY
PHARMACY
S
PECIALTY
SPECIALTY
N
ETWORKS
NETWORKS
P
PSN
SN
AT
TE
1. To summarize the current definition, classification and
diagnosis of HFpEF.
Arden Barry, BSc, BScPhm, PharmD, ACPR, Mazankowski Alberta
Heart Institute, Edmonton, AB
2. To summarize the primary literature and guideline
recommendations for the treatment of HFpEF.
This session will provide pharmacists with a general overview of
heart failure with preserved ejection fraction (HFpEF), which is
also known as diastolic heart failure. HFpEF is a commonly
misunderstood clinical presentation of heart failure, though the
prevalence of HFpEF is increasing. This session will cover the
terminology, definition and classification of HFpEF, and will also
briefly review the pathophysiology and diagnosis. The limited
3. To outline a practical approach for the treatment of HFpEF.
1. What is HFpEF?
2. What are the prime0w do they differ from heart failure with
reduced ejection fraction?
38
SES 2014 Call for Abstracts
Demande de résumés pour les SÉÉ 2014
2014 Summer Educational Sessions (SES)
Delta St. John’s Hotel & Conference Centre
St. John’s, Terre-Neuve et Labrador
9 au 12 août 2014
Séances éducatives d'été (SÉÉ) 2014
Delta St. John’s Hotel and Conference Centre
St. John’s, Newfoundland and Labrador
August 9 to 12, 2014
INFORMATION GÉNÉRALE
GENERAL INFORMATION
Catégorie
Category
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.
Author must specify the category that best suits the particular
abstract. Abstracts will be judged according to the category
submitted to by authors.
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.)
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.)
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.
Abstract Submissions
Soumission de résumés
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 2 randomly
assigned, blinded, and independent reviewers. Abstracts are
selected on the basis of scientific merit, originality, level of
interest to pharmacists, and compliance with style rules using a
standardized scoring system. Disagreement between the 2
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.
Le non-respect des exigences de présentation des résumés (voir
ci-dessous), y compris la soumission d’un résumé dont l’anonymat n’a
pas été préservé ou l’utilisation de toute autre règle de présentation,
entraînera le rejet automatique de cette soumission.
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.
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.
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 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.
39
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.
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.
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.
Abstract Style Rules
Règles de style pour les résumés
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.
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.
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.
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.
Original Research:
Headings are: Background, Objective(s), Methods, Results,
Conclusion(s)
Recherche originale :
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.
Les en-têtes sont : Contexte, Objectif(s), Méthodologie,
Résultats, Conclusion(s)
Le Contexte devrait décrire brièvement la raison d’être de l’étude.
L’Objectif devrait inclure les principaux objectifs de l’étude. La
Méthodologie devrait inclure le plan de l’étude, la méthodologie, les
interventions et l’analyse statistique. La rubrique Résultats devrait
fournir les principaux résultats obtenus. La Conclusion devrait
comprendre la conclusion principale et l’interprétation des résultats
qui sont supportés par les données fournies.
Case Reports:
Études de cas :
Headings are: Background, Case description, Assessment
of causality, Literature review, Importance to practitioners
Les en-têtes sont : Contexte, Description du cas, Analyse de
causalité, Évaluation de la documentation, Importance pour le
praticien
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
Le Contexte devrait décrire brièvement la raison d’être de l’étude
de cas. La Description devrait fournir des détails sur le cas étudié.
40
Les détails devraient être suffisamment nombreux pour définir
clairement le cas à l’étude et soutenir l’analyse de causalité.
L’Analyse de causalité devrait donner une description de l’analyse de
causalité. Il est fortement recommandé d’utiliser un outil objectif
comme l’échelle de Naranjo. L’Évaluation de la documentation
devrait examiner brièvement la documentation existante 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.
assessment of causality section should describe assessment of
causality. Strong consideration should be given to using an
objective tool such as the Naranjo scale. The literature review
section should briefly examine current literature relating to or
surrounding the case report. The importance to practitioners
section should briefly describe implications/importance of the
case report to pharmacy practitioners.
Pharmacy Practice:
Pratique pharmaceutique :
Headings are: Background, Description, Action, Evaluation,
Implications
Les en-têtes sont : Contexte, Description, Action, Évaluation,
Répercussions
The background section should briefly describe background and
rationale for service, program, problem, need, etc. The
description section should describe the concept, service, role, or
situation. The action section should describe the steps taken to
identify and resolve a problem(s), implement change, or develop
and implement the new program. The evaluation should describe
the evaluation process of the project and results of evaluation.
The implications section should describe the concept’s
importance and usefulness to current and/or future practice.
Le Contexte devrait décrire brièvement la toile de fond et la raison
d’être du service, du programme, du problème, du besoin, etc. La
Description devrait fournir des détails sur le concept, le service, le
rôle ou la situation. La rubrique Action devrait décrire les étapes
prises pour 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.
Abstract Text
Texte du résumé
• 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.
• 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.
• 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
Confirmation par courriel de la réception du
résumé
Submission Deadline:
Date limite de soumission :
CSHP 67th Summer Educational Sessions (SES)
May 9, 2014
67e Séances éducatives d’été (SÉÉ)
9 mai 2014
you should receive an email confirmation of your abstract
submission. If you have not received an email confirmation by the
deadline, please contact:
vous devriez recevoir une confirmation par courriel de la réception
de votre résumé. Si vous n’avez pas reçu de confirmation par
courriel avant la date limite, veuillez communiquer avec madame
Susan Maslin:
Téléphone : (613) 736-9733, poste 229
Télécopieur : (613) 736-5660
Courriel : [email protected]
Susan Maslin:
Tel.: (613) 736-9733, ext. 229
Fax: (613) 736-5660
Email: [email protected]
41
Oral Abstract Session: Intriguing
Papers from Original Research, Award
Winners and Research and Education
Grants
Results: vTE was significantly and independently predicted by the time
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
Conclusion: The time to the first dose of prophylaxis is an important
to initiation of vTE prophylaxis postoperatively (R= 0.240, p = 0.010).
The R2 value for this model was 0.057, showing 5.7% of the variability in
diagnosis of vTE was due to this variable. The R value shows a weak but
significant correlation between time to the first dose of prophylaxis and
the diagnosis of vTE. Patients diagnosed with symptomatic vTE
received the first dose of prophylaxis an average of 24.6 (SD 11.1) hours
post-operatively, and controls 18.6 (SD 10.4) hours post-operatively.
and modifiable predictor for symptomatic vTE post orthopedic surgery.
Time to first dose should be considered when developing systems to
improve patient care.
Implementation and Evaluation of an “Avoid Heparin”
Program on the Incidence, Clinical Consequences and
Resource Use Associated with Heparin-Induced
Thrombocytopenia
Claudia Bucci1,2, Artemis Diamantouros1,2, Joy Makari1,2, Kelly McGowan1,
William Geerts1,3
Monday, Febuary 3
Lundi 3 février
Sunnybrook Health Sciences Centre, Toronto, ON
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
3
Faculty of Medicine, University of Toronto, Toronto, ON
1
2
11:40 – 12:25
Simcoe / Dufferin
Rationale: Heparin-induced thrombocytopenia (HIT) is a transient,
immune-mediated syndrome occurring in a sensitized individual with
previous heparin exposure. Unfractionated heparin (UFH) is one of the
most common drugs used in hospitals but up to 5% of patients exposed
to heparin develop HIT. HIT leads to thrombosis, amputations, death,
and is associated with a massive disease and resource burden.
1. Risk Factors Associated with venous Thromboembolic Disease in
Orthopaedic Surgery Patients: A Retrospective Case Control Study for
Quality Analysis
2. Implementation and Evaluation of an “Avoid Heparin” Program on the
Incidence, Clinical Consequences and Resource Use Associated with
Heparin-Induced Thrombocytopenia
Objectives: The “Avoid Heparin” program was implemented as a
hospital-wide patient safety intervention to reduce the risk of
developing HIT by replacing UFH with low molecular weight heparin
(LMWH). The evaluation of the program aimed to examine the impact of
this quality improvement strategy on the incidence of HIT and its
consequences.
3. Does Interprofessional Medication Reconciliation from Admission to
Discharge Reduce Post-Discharge Patient Emergency Department
visits and Hospital Readmissions?
Methods: A multi-disciplinary task force reviewed the literature for each
type of heparin exposure and prepared recommendations for practice
modifications. In March 2006, the “Avoid Heparin” program was
implemented replacing Iv and SC UFH with SC LMWH for all therapeutic
and prophylactic indications and removing UFH from arterial and central
venous lines.
Risk Factors Associated with Venous Thromboembolic
Disease in Orthopaedic Surgery Patients: A Retrospective
Case Control Study for Quality Analysis
A retrospective chart review of all suspected HIT cases from 2003 to
2011 was conducted to evaluate incidence of HIT and related
thrombosis. All cases of suspected HIT were adjudicated using explicit
criteria for Negative (NEG), HIT and HIT with thrombosis (HITT).
Outcomes in the Pre-Intervention Phase (2003-05) were compared to
those in the Avoid-Heparin Phase (2007-11). There were no changes to
the investigation of HIT over the study period.
Manal Rostrom2, Danette Beechinor1,2, Blair Ernst1, Allan Mills1,3
Credit Valley Hospital and Trillium Health Centre, Mississauga, ON
University of Waterloo School of Pharmacy, Kitchener, ON
3
University of Toronto, Toronto, ON
1
2
Rationale: The rate of symptomatic venous thromboembolism (vTE) at
our institution in the 2011 and 2012 calendar years was 1.75% following
total knee arthroplasty (TKA), 1.73% following total hip arthroplasty
(THA), and 2.07% following hip fracture surgery (HFS), higher than
reported rates despite appropriate thromboprophylaxis, which are
0.80% and 0.35%, respectively, in the first 14 days. This was an
opportunity to systematically explore all modifiable and process related
risk factors for vTE to determine if there were any potential quality
related improvements.
Results: The annual number of suspected HIT cases decreased 34%
from the Pre-Intervention Phase to the Avoid-Heparin Phase (p<0.001).
Adjudicated HIT decreased 73% from 11 to 3/10,000 admissions
(p<0.001) and HITT decreased 80% from 5 to 1/10,000 admissions
(p<0.001). Although the use of LMWH increased more than 6-fold from
2003-2011, the annual rate of LMWH-associated HIT remained constant
at 1/10,000 admissions per year, p=1.000. The total inpatient care days
associated with HIT cases decreased 82% in the Avoid-Heparin phase.
Patients with HIT in the Pre-Intervention and Avoid-Heparin Phases had
similar age, sex, admitting service, duration of heparin exposure, and
length of stay. We did not identify any other factors that could account
for the observed reduction in HIT and HITT.
Objectives: To determine the impact of modifiable perioperative
clinical practices on the development of vTE and to demonstrate the
importance of systematic analysis of outcome data for quality
improvement.
Conclusion: A dramatic reduction in the incidence of HIT was observed
Methods: This retrospective case control study included patients 18
after the implementation of a hospital-wide “Avoid Heparin” program.
To our knowledge, this is the first quality improvement study
demonstrating the success of a hospital-wide HIT prevention strategy.
The findings strongly support our local “avoid-heparin” policy and
should be considered by every hospital. Implementation of a simple
years of age or older, undergoing a TKA, THA, or HFS at our institution
in 2011 and 2012. For each case, 3 controls without vTE were matched
for sex, age (± 5 years), surgery, and year of surgery. Data analysis was
conducted using stepwise multiple regression analysis.
42
(GIM) were identified through administrative databases. The intervention
group (patients receiving interprofessional admission to discharge
reconciliation supported by an electronic platform) was compared to a
control group. The outcome was defined as a composite of emergency
department or hospital readmissions within 30 days of the index
discharge. A multivariate logistic regression model was used to adjust
for age, gender, number of medications, and LACE index.
heparin avoidance intervention can lead to a dramatic decrease in the
burden of HIT and in the costs of HIT care as well as to improved patient
safety and quality of care.
Does Interprofessional Medication Reconciliation from
Admission to Discharge Reduce Post-Discharge Patient
Emergency Department Visits and Hospital Readmissions?
Results: From 2007-2011, a total of 9,931 unique GIM patient visits
(n=8678 patients) met the criteria of the study. The main analysis did not
detect a difference in outcomes between the intervention group
(540/2541) and control (1423/7390) for the primary endpoint. The
adjusted odd’s ratio was 1.058 (21.25% vs. 19.26%, 95% CI 0.945-1.19,
p= 0.326). After propensity score adjustment, the relative risk of
readmission was 0.88 (16.7% intervention vs.18.9% control, 95% CI
0.59-1.32, p=0.535). Increasing number of medications, LACE index
score, as well as male gender were independently correlated with a
higher risk of hospital visits. Also, subgroup analyses of high-risk groups:
patients ≥65 years, LACE index ≥10, those on high-alert medications,
and ≥10 medications did not detect a statistically significant outcome
difference between groups.
Michelle Baker1, Chaim M. Bell2,3,6, Wei Xiong1, Edward Etchells4,6, Peter
Rossos1,6, Kaveh Shojania4, Kelly Lane1, Tim Tripp1, Mary Lam1, Kimindra
Tiwana5, Nita Dhir1, Derek Leong1, Gary Wong1,6, Jin Huh1,6, Emily
Musing1,6, and Olavo Fernandes1,6
University Health Network, Toronto, ON
Mount Sinai Hospital, Toronto, ON
3
St. Michael’s Hospital, Toronto, ON
4
5
Institute for Safe Medication Practices Canada, Toronto, ON
6
1
2
Rationale: Medication reconciliation has been shown to reduce
potential adverse drug events, but its specific impact on post-discharge
hospital readmission is still not known.
Conclusion: A 5 year observational evaluation of interprofessional
medication reconciliation did not detect a difference in 30 day
post-discharge patient hospital visits. Future prospective studies could
focus on an enhanced reconciliation intervention bundle on avoidable
“medication-related” hospital admissions and post-discharge adverse
drug events.
Objective: To evaluate the impact of integrated interprofessional
(pharmacist-prescriber) medication reconciliation on patient emergency
department visits and hospital readmissions.
Study Design and Methods: In this observational cohort study at a
tertiary-care hospital, patients discharged by General Internal Medicine
43
Poster Sessions
Séances d’affichage
There are two different types of poster presentations at PPC 2014. 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 2014. 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
Séance animée d’affichage
Posters in the facilitated poster session consist of a mixture of award
winners and those abstracts submitted in the categories of original
research and pharmacy practice. They are grouped as 5 or 6 posters
with similar themes outlined below. The author of each poster will do a
6 minute presentation in front of their poster highlighting the key points
of their work. This will be followed by questions and group discussion.
The presentations within each group will occur in sequence as the
participants move from one poster to the next. The session is scheduled
from 09:30 to 11:30.
Les affiches de la séance animée d’affichage sont formées d’un mélange
de résumés primés et de résumés soumis dans les catégories recherche
originale et pratique de la pharmacie. Elles sont combinées en groupes
de cinq ou six affiches ayant des thèmes similaires comme il est fait
mention ci-dessous. L’auteur de chaque affiche fera une présentation de
six minutes devant son affiche, faisant ressortir les principaux points de
son travail. Cette présentation sera suivie d’une période de questions et
d’une discussion de groupe. Les présentations à l’intérieur de chaque
groupe auront lieu les unes à la suite des autres au fur et à mesure que
les participants se déplaceront d’une affiche à la suivante. Cette séance
se déroulera de 9 h 30 à 11 h 30.
Traditional Poster Sessions
Posters in the traditional sessions were selected from those submitted in
the categories of original research and pharmacy practice. Although no
formal presentations will occur, the author of each poster will be
available during the presentation timeslot for discussion and questions.
Posters will be available for viewing throughout the day.
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 tout au long de la journée.
CSHP 2015
CSHP 2015 is a quality program that sets out a vision of pharmacy
practice excellence in the year 2015. Through this project, CSHP
challenges hospital pharmacists to reach measurable targets for 36
objectives grouped under 6 goals, all aimed toward the effective,
scientific, and safe use of medications and meaningful contributions to
public health. CSHP 2015 applies to inpatients and outpatients,
community and hospital pharmacists, and all practice settings. Posters
identified with a “CSHP 2015” logo are those judged by the CSHP 2015
Steering Committee to be particularly relevant to one or more of the 36
objectives.
SCPH 2015
Le projet SCPH 2015 est un programme axé sur la qualité qui propose
une vision de l’excellence en pratique pharmaceutique en l’an 2015. Au
moyen de ce projet, la SCPH met les pharmaciens d’établissements au
défi d’atteindre les cibles mesurables de 36 objectifs répartis entre 6
buts, visant tous l’utilisation efficace, scientifique et sûre des
médicaments ainsi que des contributions significatives à la santé
publique. Le projet SCPH 2015 s’applique aux patients hospitalisés et
externes, aux pharmaciens d’hôpitaux et communautaires, et à tous les
milieux de pratique. Les affiches marquées du logo « SCPH 2015 » sont
celles que le comité directeur du projet SCPH 2015 a jugé
particulièrement appropriées à l’un ou l’autre des 36 objectifs.
Sunday, February 2, 2014
Dimanche 2 février
09:30-11:00 (presentations)
Provincial Ballroom
Clinical 1
1. Retrospective Analysis of the Implementation Success of an
Antimicrobal Stewardship Program in a Community Hospital
Without an Infectious Disease Physician
2. Risk Factors of Adverse Drug Reaction: Related Hospitalizations
Among Seniors, 2006 – 2011
3. Chemotherapy-Induced Nausea and vomiting in Children Receiving
High Dose Methotrexate With or Without vincristine: Preliminary
Results
4. Safe Swallowing of Oral Liquid Medications in Patients with
Dysphagia: A Patient Quality and Safety Initiative
Facilitated Poster Sessions: Discussion of Original Research, Award
Winning Projects and Pharmacy Practice Projects
Séance animée de presentations par affiches: Discussions sur des projets
de rechereche originale, des projets, primes et des projets dans le
domaine de la pratique pharmaceutique
Education
5. Systematic Approach to Evaluate Hazardous Antineoplastic Drugs
by a Provincial Healthcare Organizations
1. Do Learning Styles of Pharmacy Practice Residents Change When
They Enter Practice?
2. Implementation and Assessment of a Continuous Pharmacy Student
Clinical Roles in a Hemodialysis Unit
3. Institutional Pharmacists’ Perspectives on Precepting: A
Comprehensive Province-Wide Study
4. Assessment of the Effect of behavioural Change Strategies on
Knowledge Translation and Interventions from Disease State
Education Modules: DSEM-KT Study
5. Accuracy of Medication Histories Documented by Pharmacy
Students versus Health Care Professionals
Clinical 2
1. Evaluation of a Secondary Stroke Prevention Checklist Implemented
on a Stroke-Medicine Unit in a Community Teaching Hospital
2. Losartan-Induced Autoimmune Hepatoxicity: A Case Report
3. venous Thromboembolism Prophylaxis in Long Term Care: A
Prevalence Chart Review
4. Patterns and Predictors of Use of Oral Anticoagulants for Atrial
Fibrillation
5. Aluminum Exposure from Calcium Gluconate 10% Injection in
Neonates Receiving Parenteral Nutrition
44
21. Médias sociaux, comportements en linge et pharmaciens: linges
directrices et réflexions
22. Experience with Dexmedetomidine in a Medical Intensive Care Unit
As a Community Teaching Hospital
Professional Practice
1. Comparison of the Levels of Conformity between the Medication
Management Standards of Accreditations Canada and the Results
of the Hospital Pharmacy in Canada Report
23. Adherence to Hospital Sepsis Treatment Guidelines
2. The Role of Clinical Informatics in Improving the Assessment of
venous Thromboembolism Risk and Prophylaxis
Tuesday, February 4, 2014
Mardi 4 février
09:45-10:15 (viewing)
Sheraton/Osgoode Halls
3. How Do Local, Provincial and National Perspectives on Clinical Key
Performance Indicator Critical Activity Areas Compare?
4. The Role of Online/Smartphone Applications in Type II Diabetes
Management: A Qualitative Study
5. Laboratory Test Ordering by Pharmacists in Canada: A Nationwide
Study of Policies and Practices
1. Drug Shortages in Health Care Institutions: Perspectives in Early 2014
2. Adverse Drug Reaction-Related Hospitalizations Among Seniors,
2006 - 2011
Monday, February 3, 2014
Lundi 3 février
09:45-10:15 (viewing)
Sheraton/Osgoode Halls
3. Development of a Process to Ensure Timeline Home Medication
Access for Patients Awaiting Admission In the Emergency
Department
4. Reduction of Polypharmacy in a Rehabilitation and Progressive Care
Unit
1. National Canadian venous Thromoembolism (vTE) Prevent Audit
Day: Design and Results
5. What Doses Should Our Chemotherapy Robot Prepare?
6. The Effect of Residual Renal Function and Other Patient Factors on
Gram Positive Peritonitis Outcomes
7. Can a Collective Community Mental Health Smoking Cessation
Program Reduce Cigarette Consumption?
2. Improving Influenza vaccinations Uptake in the Progressive Care
Unit of a Community Teaching Hospital
3. Appropriateness of Using Alternate Oral Anticoagulants in Poorly
Controlled Warfarin Patients
8. Comparison Among Atovastatin, Rosuvastatin and Pravastatin with
Focus on Efficacy and Safety Profiles
9. The Path Forward: Solutions from a Province-Wide University Health
Authority Engagement Initiative
4. Personalized Medicine: Teaching Strategies for a Novel Clinical
Pharmacy Residency Rotation
5. Stroke Prediction in Atrial Fibrillation: Meta-Analysis of the
Predictive Performance of the CHADS2 and CHA2DS2-vASc Clinical
Prediction Rules
6. Development of Guidelines for Safe Management of Antithrombotic
Medications Prior to Elective Surgical and Diagnostic Procedures in
a Community Hospital Setting
7. Opportunities to Enhance Institutional Experiential Education in
british Columbia: Learner Perspectives
10. Successful Medication Reconciliation Implementation in a Multi-Site
Acute Care Facility
11. Facilitation of Medication Reconciliation by a Clinical Registered
Pharmacy Technician in an Orthopedic Unit of a Community
Hospital: A Pilot Project
12. Impact of a Multidisciplinary Program on Smoking Cessation
Medication Use Patterns
8. Exploring Innovative Institutional Learner-Preceptor Models Across
Health Disciplines: A Systemic Review
13. Impact des données probantes sur l’implantation des codes-barre
en milieu hospitalier
14. Impact des données probantes sur l’implantation des pompes
inteligentes en milieu hospitalier
15. Impact des données probantes sur l’implantation de la
reconciliation medicamenteuse en milieu hospitalier
9. Patient Medication Education at Discharge: A Multidisciplinary
Team based Approach (TEACH)
10. How Do National Clinical Pharmacy Key Performance Indicators
Align With Top-Ranked Consensus Selection Criteria?
11. Handbook for a Pilot Study to Reduce Potential Hospitalizations
Due to Preventable Drug-Drug Interactions
16. Prescribing Patterns and Safety of Intramuscular Olanzapine in
Hospitalized Elderly Patients
12. What are the Appropriate Clinical Pharmacy Key Performance
Indicators for Hospital Pharmacists
17. Optimizing Pharmacotherapy in a Geriatric Day Hospital: A
Medication Use and Cost Analysis
13. Démarche pour la mise à niveau d’un secteur de soins
pharmaceutiques le cas de la chiurgie pediatrique
14. Stability of Clobazam 1mg/mL in Extemporaneously Compounded
Suspensions Using Oral Mix vehicle in PET, PvC, Glass bottles and
Plastic Oral Unit-Dose Syringes
15. Stability of Domperidone 5mg/mL in Extemporaneously
Compounded Suspensions Using Oral Mix vehicle in PET, PvC,
Glass bottles, and Plastic Oral Unit-Dose Syringes
16. Iv to PO Stepdown Interventions in a Community Hospital Without
an Infectious Disease Physician
17. Update of the Canadian Labels for Antipsychotic Drugs Following a
Review of the Evidence on the Risk of venous Thromboembolism
Associated with the Use of These Medications
18. Pharmacists Joining a Multi-Disciplinary Specialty Private Practice
19. Impact and Role of Pharmacists in Cystic Fibrosis
20. Evaluation of Change in a Clinical Pharmacist Practice Model in a
Community Hospital
18. Home Care Pharmacy Services: A Demonstration Project
19. Impact des données probantes sur l’implantation des prescripteurs
électroniques en milieu hospitalier
20. Impact des données probantes sur l’implementation d’aides à la
décision Clinique pour les prescripteurs électroniques en milieu
hospitalier
21. Impact of an “Avoid-Heparin” Quality Improsvement Program on
the Incidence, Clinical Consequences and Resource Use Associated
with Heparin-Induced Thrombocytopenia (HIT)
45
anticoagulation monitoring, antibiotic assessment and review, resolution
of drug coverage issues, responding to drug information questions and
monthly blood work review. Students also perform pharmacotherapy
work ups (select patients) and assist with research projects and medical
writing. The outgoing student trains the subsequent student and
participates in near-peer teaching with students on experiential rotations.
SUNDAY, FEBRUARY 2
DIMANCHE 2 FÉVRIER
Do Learning Styles of Pharmacy Practice Residents Change
When They Enter Practice?
Evaluation: Four jobs were posted for UW co-op students and one for
UT students. Twenty seven to forty five students applied for each one
position, indicating high interest in this role. An anonymous evaluation
survey was administered to all participating students (survey monkey) as
well as HD unit medical and nursing staff. Students highly valued the
experience. HD team members appreciate increased accessibility of
pharmacy staff.
Peter Loewen1,2; Janice Yeung1,2; Anca Jelescu-Bodos2; Torey Lau1
Faculty of Pharmaceutical Sciences, The University of British Columbia,
Vancouver, BC
2
Lower Mainland Pharmacy Services, Vancouver, BC
1
Rationale: Learning styles (LS) of medical residents change over time
from the more passive Assimilator toward more active preferences like
Accommodator or Converger. We have shown pharmacy residents to be
predominantly Assimilators at the start of their residency program.
Whether learning styles of pharmacy residents change after they enter
practice has never been studied.
Importance: This model may be transferable to other HD units or
similar practice sites with increasing patient numbers, changing
pharmacist responsibilities or increased number of advanced pharmacy
practice experiential learners.
Objective: To describe the evolution of learning styles of pharmacy
Institutional Pharmacists’ Perspectives on Precepting:
A Comprehensive Province-Wide Study
residents as they transition from residency into practice.
Study Design & Methods: Prospective observational survey and
semi-structured interviews. A complete provincial cohort of former
pharmacy residents (n=28) who had their LS characterized during their
residency and were now 1 year post-residency were invited to repeat the
Pharmacists’ Inventory of Learning Styles (PILS). Interviews were
administered to consenting participants to gain additional insights.
Michael Legal; Donna Rahmatian; Kyle Collins; Patricia Gerber; Angela
Kim-Sing; Peter J. Zed; Peter S. Loewen, Faculty of Pharmaceutical
Sciences, The University of British Columbia, Vancouver, BC
Rationale: It is a challenge to provide sufficient quantities of high
quality institutional experiential placements for learners. In recent years,
this issue has become increasingly acute in pharmacy due to curricular
and program changes in Canada. In british Columbia a comprehensive
multi-stakeholder engagement project was undertaken to identify
solutions. This report describes the pharmacist engagement portion of
the project.
Results: 27 residents (96%) completed the PILS survey and 16 (59%)
completed the interview. 13 (48%) changed their dominant LS and 20
(74%) changed their secondary LS. Six (22%) participants did not change
either LS. The overall proportion of dominant Assimilators (59%) and
Convergers (26%) remained similar to baseline (52% and 26%,
respectively), meaning participants had adopted and abandoned
different learning styles in similar numbers. Change in LS was associated
with receiving preceptor training (p<0.05). Of the 12 preceptors
interviewed, 58% stated that they had adjusted their teaching practices
based on knowledge of their LS.
Objectives: To characterize the perspectives of institutional pharmacists,
identify potential solutions to capacity challenges and to find ways to
better support preceptors and learners.
Methods: Pharmacist perspectives were gathered using a mixed
methods approach. An online survey was deployed to all hospital
pharmacists in bC. In addition, focus groups and structured interviews
were conducted across the province. The survey utilized a combination
of likert, ranking, multiple-answer, and open field responses. Focus
groups and interviews were recorded and the resulting transcripts were
analyzed using qualitative methods and iterative coding to identify
major themes.
Conclusions: Change in dominant and/or secondary learning style is
common after 1 year in practice compared to during pharmacy practice
residency. There is no overall direction to the shifts, however, with
residents transitioning in and out of more active learning styles with
similar frequency. Overall after a year in practice, the cohort of former
residents we studied remained mostly Assimilators, who prefer passive
learning approaches. These results contrast with medical students, who
adopt more active preferences like Accommodator.
Results: A total of 233 pharmacists responded to the survey and over
200 participated in the focus groups and interviews. Pharmacists
indicated that teaching is an important professional role and they
appear to be intrinsically motivated to precept. Workload, lack of time
to teach, inadequate staffing, lack of faculty support and unprepared
learners were major barriers. Participants identified a need to strengthen
the curriculum to increase learner exposure to institutional practice and
to enhance their practice-readiness. Human resource support was the
most desirable solution for workload issues. Multi-learner models were
viewed favourably as a capacity solution but increased teaching
workload and limited physical space were concerns. A more robust
relationship with the faculty was also desired.
Implementation and Assessment of a Continuous Pharmacy
Student Clinical Role in a Hemodialysis Unit
Karen Cameron1,2, Marisa Battistella1,2, Colette Raymond1,2
1
2
Rationale: In 2011, the hemodialysis (HD) pharmacist role at a 300
patient tertiary care HD unit changed to clinician scientist, necessitating
restructuring the way clinical pharmacy services were delivered. This
change corresponded with availability of four month co-op students
from University of Waterloo (UW) and summer students from University
of Toronto (UT).
Conclusions: This project highlighted some key challenges faced by
preceptors and suggests some possible solutions. These solutions will
require collaboration and commitment by all parties to ensure success.
Description: Many core clinical pharmacist activities are ideally suited
to be performed by pharmacy students in a supervisor-teacher model.
Experiences in hospital settings/direct patient care areas are sought
after as opportunities to practice core skills. A pharmacy student job
description was created.
Assessment of the Effect of Behavioral Change Strategies
on Knowledge Translation and Interventions from Disease
State Education Modules: DSEM-KT Study
Implementation: Since January 2012, four UW and one UT pharmacy
student have carried out the role. One summer term the role was split
with two volunteer UT students. One term (winter 2013) did not have a
student. Student activities include: medication reconciliation,
Richard Slavik, Sarah Murray, Sean Gorman, Nicole Bruchet, Dawn Dalen,
Brett Hamilton, Interior Health Authority, Kelowna, BC
Rationale: Pharmacists require continuous professional development
(CPD) to resolve drug related problems (DRPs) for patients with priority
46
disease states. To promote pharmacist CPD, eight 4-week disease state
education modules (DSEMs) were delivered from January 2009 to
December 2011. After each DSEM, lists of disease-specific key
pharmacist interventions (DSEM KPI) - evidence-based interventions
proven to reduce mortality, morbidity, or health care utilization, were
developed to guide pharmacists’ interventions. A recent study showed
that DSEMs improved process of care measures by pharmacists, but not
for the subgroup of patients with heart failure (HF).
medication histories done by the health care professional (with 133/151
unintentional discrepancies). The difference in unintentional
discrepancies between the groups was statistically significant (p <0.001).
Objective: To determine if the application of multifaceted professional
behavioral change strategies improves knowledge translation of HF
therapeutics for clinical pharmacists and improves processes of care
measures for HF patients.
Retrospective Analysis of the Implementation Success of
an Antimicrobial Stewardship Program in a Community
Hospital Without an Infectious Disease Physician
Methods: Prospective quasi-experimental, one group, pre/post study
evaluating proven multifaceted behavioral change strategies on clinical
pharmacists from July 1, 2012 to July 31, 2013. The primary outcome
was the change in proportion of pharmacist-resolved HF DRP/DSEM
DRP. Secondary outcomes included the change in proportion of
pharmacist-resolved HF KPI/DSEM KPI, the change in quiz scores
evaluating clinical pharmacists’ knowledge of HF therapeutics, and the
primary outcome analyzed by site.
Mark Taylor, Andrea Wist, Gayathri Radhakrishnan, Rebecca Strutchbury,
Joel Varsava, Alicia Oesch; Bluewater Health, Sarnia, ON
Results: The proportion of pharmacist-resolved HF DRP/DSEM DRP
Description: bWH is a 326-bed community hospital without an
Infectious Disease Physician. Our Stewardship program is designed
based on the Infectious Disease Society of America (IDSA) guidelines.
We used the 2 IDSA proactive models: Prospective audit with
intervention and Formulary Restriction.
Conclusion: Pharmacy students in the pre-admission clinic documented
medication histories containing fewer discrepancies than staff in the
emergency department and are, therefore, a viable hospital resource to
help improve patient safety and continuity of patient care.
Rationale: There is a paucity of data on the impact of the
implementation of an Antimicrobial Stewardship Program in community
hospitals without an Infectious Disease physician. This report of the
bluewater Health (bWH) Stewardship Program, with emphasis on the
pharmacist, serves as a sustainable template for community hospitals to
satisfy the Accreditation Standards.
increased from 9.6% to 15.3%; (relative risk increase [RRI] 59.7%, 95%
confidence interval [CI] 43.4-78.0%). The proportion of
pharmacist-resolved HF KPI/DSEM KPI increased from 4.4% to 9.7% (RRI
119.1%, 95% CI 82.3-163.6%). Knowledge translation quiz scores
increased from 16.8/20 (84%) to 18.9/20 (95%), p<0.05.
Implementation Steps: Our process included the following steps:
Conclusions: There was a statistically significant increase in knowledge
1. Creation of a bWH antimicrobial guideline and antibiogram in 2011.
translation of HF therapeutics for clinical pharmacists and a statistically
significant increase in the proportion of resolved HF DRP/DSEM DRP
and HF KPI/DSEM KPI for HF patients. bundled behavioral change
strategies should be provided after future DSEMs to improve knowledge
translation for pharmacists and care of patients with priority diseases.
2. Implementation of a “restricted” antimicrobial selection process
based on cost, adverse events, negative patient outcome risks.
3. Monitoring of antimicrobials’ Defined Daily Dosing (DDD)
4. Monitoring of Clostridium Difficile infection rates.
Evaluation: The Stewardship program was evaluated using qualitative
Accuracy of Medication Histories Documented by
Pharmacy Students versus Health Care Professionals
and quantitative parameters. Quantitative parameter(s) include: Number
of antimicrobial orders which necessitated Clinical Interventions initiated
by pharmacists (Table 1), trends in Defined Daily Dose (DDD) of 2 broad
spectrum antimicrobials, trends in Clostridium Difficile rates.
Facca N.M.1, Ahrari S.1,2, Stovel J.1,3, Seabrook J.A.3,4, Jansen S.1
London Health Sciences Centre, London, ON
University of Waterloo, Waterloo, ON
3
Western University, London, ON
4
Children’s Health Research Institute, London, ON
1
Qualitative Parameter(s) Include: Pharmacists’ self perceived level of
2
comfort and competency regarding antimicrobials. On a Likert Scale of 1
to 4, pharmacists rated their competency and comfort as 1.42 (pre
implementation) and 1.89 (post implementation)
Rationale: A multi-site teaching hospital has successfully implemented a
Table 1: Summary of Quantitative Parameters for Clinical
Interventions (see page 48)
mixed model of medication reconciliation across all in-patient units.
Accurate medication histories reduce medication errors and prevent
adverse drug events. Pharmacists have been shown to obtain more
accurate medication histories than other health care professionals. Due
to lack of pharmacist resources, pharmacy students were trained to
complete medication histories in the pre-admission clinic at this facility
to support medication reconciliation workflow.
Relevance to Practice: by highlighting our strategies, we will be
adding to the current paucity of literature that surrounds antimicrobial
stewardships in community hospitals without Infectious Disease
Physicians.
Risk Factors of Adverse Drug Reaction–Related
Hospitalizations Among Seniors, 2006 to 2011
Objective: To compare the number and types of medication
discrepancies in the best possible medication history captured by a
pharmacy student compared to other health care professionals.
Michele Arthur and Michael Gaucher, Canadian Institute for Health
Information, Ottawa, ON
Methods: This quasi-experimental retrospective study took place from
March to April 2013. Patients included in the study were admitted for
orthopedic surgery and were required to have had the medication
history reviewed by at least one other health care professional. A trained
pharmacy student documented the medication history in the
pre-admission clinic, whereas the first health care professional
documented medication histories upon patient presentation to the
emergency department. An independent investigator reviewed charts to
detect discrepancies between the initial and reviewed medication
histories. Unintentional discrepancies were reviewed with a clinical
pharmacist.
Rationale: Adverse drug reactions (ADRs) are defined by the World
Health Organization as adverse effects of a drug that was properly
administered in the correct dose, for therapeutic or prophylactic use.
Seniors are at greater risk for ADRs, as well as other types of
drug-related adverse events, due to the number of drugs they take,
their higher prevalence of certain chronic conditions and age-related
changes in the body.
Objectives: This analysis examined potential risk factors for ADR
hospitalizations and compared seniors’ drug therapy pre-admission and
post-discharge to see if ADR-related hospitalizations led to changes in
drug therapy.
Results: There were 38 medication discrepancies found in the 50
medication histories done by the pharmacy student (with 37/38
classified as unintentional discrepancies) versus 151 found in the 50
47
Study Design and Methods: This analysis used hospital discharge
data from the Discharge Abstract Database and drug claims data from
the National Prescription Drug Utilization Information System Database
to assess potential risk factors for ADR hospitalizations among seniors
on public drug programs in Alberta, Manitoba and P.E.I.
Objective: To describe the prevalence of acute and delayed phase
CINv in children aged 4-18 years receiving HD-MTX ± vincristine.
Study Design and Methods: Children about to receive HD-MTX were
eligible to participate in this prospective, observational study. Patients
received antiemetics as ordered by their primary care team. Nausea
severity (assessed using the Pediatric Nausea Assessment Tool; PeNAT),
time of emetic episodes, and administration of antiemetics were
recorded in a diary beginning immediately prior to HD-MTX
administration, for 24 hours after the patient achieved a MTX
concentration of < 0.1µM (acute phase), and for up to an additional 7
days (delayed phase). Complete CINv control was defined as: no
vomiting, no retching and a maximum PeNAT score of 1 (out of 4).
Results: The number of drugs was the most significant risk factor, with
seniors taking 15 or more drugs being 6.4 times more likely than seniors
taking fewer than 5 drugs to have been hospitalized for an ADR. Other
factors associated with hospitalizations for ADRs were age and
hospitalizations in the previous year. The relationship between new drug
starts and ADR-related hospitalizations varied by drug class. Of seniors
hospitalized for an opioid-related ADR, 33.2% started taking an opioid
within 30 days of hospitalization, while only 28.2% of seniors
hospitalized for an anticoagulant-related ADR started an anticoagulant
within a year of hospitalization.
Results: Data are available for 23 patients (mean age: 12±3.9 years; 14
boys). Fourteen patients received HD-MTX plus vincristine while 9
received HD-MTX alone. The average MTX dose was 9g/m2 (range:
3-12g/m2). Antiemetic prophylaxis consisted of either ondansetron (16)
or granisetron (7) with (10) or without (13) dexamethasone. Six patients
also received nabilone. Ten patients received breakthrough antiemetics
(lorazepam ± dimenhydrinate). Mean duration of the acute and delayed
phases were 81.7 and 144.8 hours, respectively.
Conclusion: Although it is often necessary for seniors to take multiple
drugs to manage their chronic conditions, regular medication reviews
can help reduce the risk of adverse events including drug interactions. A
high proportion of the hospitalizations related to anticoagulant ADRs
occurred more than a year after starting therapy, which underscores the
importance of ongoing monitoring.
One (4%) and 7 (30%) patients experienced complete CINv control
during the acute and delayed phases, respectively. More patients
experienced complete vomiting control during the acute (52%) and
delayed (61%) phases than experienced complete nausea control (4 and
30%, respectively).
Chemotherapy-Induced Nausea and Vomiting in Children
Receiving High Dose Methotrexate With or Without
Vincristine: Preliminary Results
Conclusion: Acute and delayed phase CINv control, most especially
Jacqueline Flank1,4; Sara Lavoratore1; Helen Vol1; Tracey Taylor1; Elyse
Zelunka1; Paul Nathan2; Anne Marie Maloney3; L. Lee Dupuis1,4
nausea control, following HD-MTX administration is sub-optimal.
Subsequent analyses will evaluate the influence of guideline-consistent
antiemetic prophylaxis on CINv control.
Department of Pharmacy, The Hospital for Sick Children, Toronto, ON
Department of Paediatrics, Division of Haematology/Oncology, The
Hospital for Sick Children, Toronto, ON
3
Department of Nursing, The Hospital for Sick Children, Toronto, ON
4
1
2
Safe Swallowing of Oral Liquid Medications in Patients
with Dysphagia: A Patient Quality and Safety Initiative
Aarthi Iyer and Darien Heathcote, Trillium Health Partners, Mississauga
Hospital, Mississauga, ON
Rationale: Chemotherapy-induced nausea and vomiting (CINv)
negatively influences the quality of life of children receiving
chemotherapy. Little is known about the severity of CINv experienced
by children receiving Iv methotrexate ≥ 1g/m2/dose (HD-MTX).
Table 1: Summary of Quantitative Parameters for Clinical Interventions
Antibiotic Stewardship Clinical
Interventions
24 SEP- 21 NOV
2012
(58 DAYS)
22 NOV - 22 JAN
2013
(61 DAYS)
23 JAN - 27 FEB
2013
(35 DAYS)
28 FEB - MAR 18
2013
(13 DAYS)
19 MAR - APR 30
2013
(42 DAYS)
01 MAY - MAY 31
01 JUNE - JUNE 30 01 JULY - JULY 31
(31 DAYS)
(30 DAYS)
(31 DAYS)
Total number of anti infective orders
reviewed
124
253
167
83
230
162
163
182
# of orders dispensed as ordered
(includes no pharmacist intervention or
physician unwilling to accept
recommendations)
88 (71%)
157 (62%)
111(66%)
66 (80%)
154 (67%)
93 (57%)
90 (55%)
103 (57%)
# of orders that pharmacists intervened to
make dose/frequency/duration/lab order
changes (includes discontinuation of nonrestricted antimicrobials)
16 (13%)
55 (22%)
39 (23%)
9 (11%)
55 (24%)
43 (27%)
44 (27%)
40 (22%)
# of orders that pharmacists intervened to 9 (7.2%)
change drug (broad spectrum to narrow
spectrum abx change or change based on
C&S or change based on indication)
26 (10%)
10 (6%)
6 (7%)
9 (8%)
17 (11%)
13 (8%)
19 (10.4%)
# of orders where IV antibiotics changed
from IV to PO (involving physician
with/without pharmacist intervention)
5 (4%)
11 (4%)
6 (4%)
2 (2%)
1 (0.4%)
3 (2%)
9 (5.5%)
9 (4.9%)
# of orders where restricted IV antibiotic
was discontinued after intervention from
pharmacist
5 (4%)
3 (1%)
0 (0%)
0 (0%)
1 (0.4%)
5 (3.1%)
7 (4.3%)
11 (6.0%)
# of orders where restricted IV antibiotic
was continued after intervention from
pharmacist
1 (0.8%)
1 (0.004%)
1(0.6%)
0 (0%)
0 (0%)
1 (0.6%)
0 (0%)
0 (0%)
% of pharmacist time in doing
Stewardship
22% ( 22% OF 322
HRS)
21% (21% OF 585
HRS)
33% (33% OF 193
HRS)
35% ( 35% OF 274
HRS)
35% (34% OF 715
HRS)
38% (38% OF 414
HRS)
43% (43% OF 351
HRS)
41% (41% OF 453
HRS)
( (
#
(
#
#
# #
# #
#
#
#48 #
#
#
# #
#
#
#
#
# #
#
#
##
#
Rationale: Patients with oropharyngeal dysphagia are at aspiration risk,
making the administration of oral medications challenging. Liquid
medications may be too thin and the use of xantham gum based
thickeners for liquid medications has not been evaluated.
• Drug evaluation: NIOSH decisions are based on its evaluation criteria
and external consultations. based on the NIOSH proposed changes
(2006, 2011), fulfilling the criteria would not necessarily make a drug
hazardous.
Objectives: This project sought to:
Results: We identified hazardous drugs by assessing their inherent
toxicity and developed safe handling policies based on occupational
exposure related to dosage form. Our list consists of drugs in the
current NIOSH list and assessed by bCCA because NIOSH review was
not confirmed. A drug is hazardous if designated by NIOSH. Other
drugs are hazardous if they fulfill the NIOSH criteria or used primarily as
antineoplastic but insufficient information to evaluate with NIOSH
criteria.
• classify the viscosity of commonly prescribed liquid medications
• standardize thickening of liquid medications
• establish an institution specific collaborative process for thickening
liquid medications
Study Design & Methods: viscosity of commonly prescribed liquid
medications was visually determined. Next, serial quantities of water
(thinnest consistency) were added to applesauce to determine the
threshold at which its puree consistency is altered. Finally, medications
prescribed in volumes above 10 mls were tested with thickening agent.
viscosity of the prepared product was determined using The Line
Spread Test.
Conclusion: bCCA has adopted an approach within the NIOSH
framework and it follows the precautionary principle when there is risk of
harm affecting individuals not directly benefiting from these hazardous
drugs.
Results: It was determined that up to 2.5 ml of thin liquid added to
16 ml of applesauce does not alter the consistency of applesauce. For
medications prescribed in volumes greater than 10mls, for which
crushable alternatives are not available, recipes with thickener were
established. The final consistency attained was pudding thickening (with
the exception of Lactulose).
Evaluation of a Secondary Stroke Prevention Checklist
Implemented on a Stroke-Medicine Unit in a Community
Teaching Hospital
Monica Lee, Vickie Chang, Parisa Parnian, Rochelle Liem, Tiffany Kan,
North York General Hospital, Toronto, ON
Rationale: The use of antithrombotic therapies and management of
cardiovascular risk factors are vital to preventing recurrent strokes.
Hospital pharmacists can play an important role in ensuring patients
admitted with a stroke or transient ischemic attack (TIA) be discharged
on evidence-based secondary prevention medications.
Description and Steps Taken: based on current evidence and best
practice recommendations, a secondary stroke prevention checklist was
developed and implemented on the stroke-medicine unit. The checklist
assists pharmacists in the systematic assessment of patients’ stroke risk
factors as well as their secondary prevention therapies. It also serves as a
communication tool for follow-up issues when patients are reassessed at
the stroke prevention clinic. A retrospective chart review was conducted
to evaluate the adherence to checklist completion by pharmacists. In
addition, the proportion of patients discharged on secondary prevention
drug therapies was examined.
Conclusion: Administering liquid medications to patients with
oropharyngeal dysphagia is a significant challenge. We developed a
standardized approach to the safe and effective administration of liquid
medications.
Evaluation: During a 2-month period, 37 patients with a mean age of
73.4 years were discharged with a diagnosis of stroke or TIA. The
secondary stroke prevention checklist was completed in 31 (84%)
patients, with follow-up issues documented in 29 (94%) of them. Among
the 35 (95%) patients who suffered from an ischemic event, 33 (94%)
were discharged on antithrombotic therapies, 26 (74%) on
antihypertensive drugs, and 29 (83%) on lipid-lowering agents. A higher
proportion of these patients with a completed checklist were discharged
on secondary prevention therapies than those without a checklist
(antithrombotics, 100% vs. 67%; antihypertensives, 79% vs. 50%;
lipid-lowering drugs, 93% vs. 33%).
Systematic Approach to Evaluate Hazardous Antineoplastic
Drugs by a Provincial Healthcare Organization
Nadine Badry, Joan Fabbro, Mário de Lemos, Provincial Pharmacy, BC
Cancer Agency, Vancouver, BC
Rationale: The US National Institute for Occupational Safety and Health
(NIOSH) list of hazardous drugs and evaluation criteria provide a
foundation to help identify hazardous formulary drugs. However, we
needed to develop further guiding principles to adopt the NIOSH
guidelines.
Importance: The implementation of a checklist by pharmacists helps
ensure consistent evaluation of stroke survivor’s risk factors and
application of appropriate secondary prevention therapies. It may also
improve follow-up management of stroke patients across the continuum
of care. Such a tool may be adopted by other hospital units to ensure
optimal care in stroke patients.
Objective: To identify hazardous oncology drugs used by the bC
Cancer Agency (bCCA).
Study Design/Methods: Three guiding principles were developed.
• Inherent toxicity vs. occupational exposure: NIOSH defines hazard
based on inherent drug toxicity. Safe handling policies are driven by
workers’ protection from this toxicity before considering the
resource-dependent operations to minimize occupational exposure.
We found no strong evidence to support differentiating hazard levels
(high, low).
Losartan-Induced Autoimmune Hepatotoxicity:
A Case Report
• NIOSH reviews: We assumed drugs marketed pre-2004 were reviewed
since NIOSH List 2004 was compiled from major US organizations.
Drugs marketed post-2004 were ascertained with NIOSH lists (2010,
2012) and proposed lists (2004-12).
well-characterized and makes up a significant portion of autoimmune
hepatitis. The angiotensin receptor blockers (ARbs), have been linked to
hepatotoxicity. We describe a probable case of losartan-induced
autoimmune hepatotoxicity, which represents the first such case
reported in the literature.
Rochelle Liem, Monica Lee, Nitin Sarin, North York General Hospital,
Toronto, ON
Rationale: Drug-induced autoimmune hepatitis (DIAIH) is
49
thromboprophylaxis. This would help minimize exposure in low risk
patients and potentially provide cost-savings.
Description: A 74-year-old female presented to hospital with a 6-week
history of malaise, low-grade fever, anorexia, weight loss and jaundice.
Her past medical history consisted of hypertension,
non-insulin-dependent diabetes mellitus, gastrointestinal reflux,
osteoporosis, and depression. Medications at the time of admission
included metformin, lansoprazole, escitalopram, aspirin, vitamin D,
calcium carbonate, and losartan 100mg daily. Losartan was started 4
months prior to her initial symptoms. The patient denied alcohol or illicit
drug use. Laboratory results showed ALT 560 U/L, AST 827 U/L, ALP 135
U/L, total bilirubin 359 umol/L, GGT 396 U/L, and INR 2.15. viral
serologies were negative. IgG was grossly elevated at 30.91 g/L and
ANA was positive at 1.6. A liver biopsy was consistent with autoimmune
liver injury. Corticosteroids were started and the patient’s liver enzymes
gradually decreased. Losartan was never resumed. Her follow-up
investigations 21 months later revealed normal liver enzymes. She has a
complete resolution of clinical symptoms.
Patterns and Predictors of Use of Oral Anticoagulants for
Atrial Fibrillation
Caroline Brais1,2; Marie-Hélène Turgeon1,2; Josiane Larochelle1,2; Lucie
Blais2,3; Marie-Pierre Garant4; Anne-Sophie Tousignant5; Diane Rochon5;
Paul Farand5; Geneviève Letemplier5; Sylvie Perreault2; Marie-France
Beauchesne1,2,4
Pharmacy Services, Centre hospitalier universitaire de Sherbrooke,
Sherbrooke, Québec
2
Faculty of Pharmacy, Université de Montréal, Montréal, Québec
3
Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal,
Québec
4
Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier
universitaire de Sherbrooke, Sherbrooke, Québec
5
Department of Medicine, Centre hospitalier universitaire de
Sherbrooke, Université de Sherbrooke, Sherbrooke, Québec
1
Causality Assessment: Drug molecules can trigger an immune
response when they are bound to self-proteins. The patient
demonstrated clinical characteristics of autoimmune hepatitis, which
resolved after losartan was discontinued. The Naranjo score of 7
indicates a probable adverse drug reaction.
Rationale: In the era of new oral anticoagulants (NOAC) for atrial
fibrillation (AF), few studies have identified patterns of NOAC use over
warfarin.
Literature Evaluation: Hepatotoxicity associated with ARb’s has been
reported in the literature. There has been one case report describing
probable autoimmune hepatitis with irbesartan.
Objectives: To describe oral anticoagulants (OAC) use and to identify
patterns associated with the choice of NOAC over warfarin.
Importance: Practitioners should be aware of this potentially fatal
adverse drug reaction with losartan and other ARbs. In patients who
present with autoimmune hepatotoxicity, a thorough medication review
should be performed to rule out this adverse drug reaction.
Methods: A cohort of patients on OAC for AF was built from inpatient
Venous Thromboembolism Prophylaxis in Long Term Care:
A Prevalence Chart Review
Results: In the 6-month period following dabigatran availability in the
hospital, 447 patients met our inclusion criteria: 59 (13%) were on NOAC
(dabigatran) and 388 (87%) on warfarin. About 71%, 25% and 3% of
patients on NOAC were prevalent users, incident users, and patients
who switched OAC, respectively. The NOAC group had a lower mean
CHADS2 score (2.34 versus 2.76, p = 0.018), a higher mean creatinine
clearance (72 versus 53 mL/min, p < 0.001), a lower proportion of
coronary artery disease (34% versus 55%, p = 0.002) and a lower
proportion of dementia (9% versus 20%, p = 0.039) than the warfarin
group.
records of hospitalisations between October 2011 and March 2013. A
nested case-control study was conducted to identify predictors of
NOAC use among new users of OAC.
Tiffany Kan1, Danette Beechinor2, Anjana Sengar3, Ramola Bhojwani3,
Christina Lee2, Barbara Clive2, Allan Mills2,3
Trillium Health Partners Credit Valley Hospital, Mississauga, ON
3
Trillium Health Partners Mississauga Hospital, Mississauga, ON
1
2
Rationale: Despite recommendations to provide venous
thromboembolism (vTE) prophylaxis in acutely ill medical and surgical
patients, there are currently no recommendations that suggest the use
of thromboprophylaxis in long term care (LTC) patients. There is also a
lack of evidence demonstrating the safety and efficacy of
thromboprophylaxis in this population.
In the nested case-control study (n = 245 incident users), 40 (16%)
patients on NOAC (dabigatran and rivaroxaban) were compared to 205
(84%) patients on warfarin, using a multiple logistic regression analysis.
Renal insufficiency independently decreased the probability of NOAC
use versus no renal insufficiency (OR 0.363; 95% confidence interval
0.133 – 0.990). NOAC use probability independently decreased whilst
the number of chronic medications increased (OR 0.844; 95%
confidence interval 0.748 – 0.952). Prior stroke independently predicted
NOAC use compared to no stroke history (OR 2.480; 95% confidence
interval 1.108 – 5.549).
Objectives: To assess current practices of thromboprophylaxis and to
determine if there is an excess of patients receiving thromboprophylaxis
in the LTC setting.
Study Design and Methods: A retrospective chart review was
conducted at a large community teaching hospital. Patients admitted to
complex continuing care, alternate level of care, or LTC beds were
eligible for inclusion during a two-week evaluation period. The Padua
Prediction Score was used to assess risk factors for vTE, and to stratify
patients into high or low risk of vTE. The rate of pharmacologic
thromboprophylaxis and the cost of providing thromboprophylaxis to
low risk patients were determined.
Conclusion: The percentage of NOAC use is low. Patients with a normal
renal function, a stroke history and fewer chronic medications are more
likely to receive a new oral anticoagulant.
Aluminum Exposure from Calcium Gluconate 10% Injection
in Neonates Receiving Parenteral Nutrition
Results: A total of 124 patients with a mean age of 76.3 years were
included in the study. Advanced age, acute infection, and reduced
mobility were the most prevalent risk factors for vTE. Seventy-three
(59%) patients were receiving thromboprophylaxis. Among these
patients receiving thromboprophylaxis, 55 (75%) patients were
considered to be at low risk of vTE. The annual cost of providing
thromboprophylaxis to low risk patients was approximately $165,600.
Renee Woo1, Amelia Rodrigues1, Vera Riss1, Marialena Mouzaki2, Joan
Brennan-Donnan3, Glenda Courtney-Martin3, Elaine Lau1
Department of Pharmacy, The Hospital for Sick Children, Toronto, ON
Department of Gastroenterology, Hepatology and Nutrition, The
Hospital for Sick Children, Toronto, ON
3
Department of Clinical Dietetics, The Hospital for Sick Children,
Toronto, ON
1
2
Conclusion: These findings suggest that there may be an excess of LTC
patients receiving thromboprophylaxis despite being at low risk of vTE.
This prompts the need for education and validated risk assessment
models to better identify LTC patients who may benefit from
Rationale: Aluminum exposure from parenteral nutrition (PN)
exceeding 4-5 mcg/kg/day can be associated with central nervous
system toxicity, bone and liver damage, and anemia in preterm infants
and those receiving prolonged PN. In 2011, Health Canada issued an
alert regarding aluminum leaching from glass vials of calcium gluconate
50
medications), 0.64 (monitoring quality and achieving positive results),
0.71 (appropriately ordering and transcribing medications) and 0.76
(properly labelling and storing medications). We noted an important
discrepancy between the 2010 MMS on-site surveys and 2009/2010 HPC
results for a total of 62 criteria.
10% injection manufactured by Pharmaceutical Partners of Canada (PPC),
the sole Canadian supplier. SickKids® uses this product to prepare PN.
Description of Concept: To identify alternative calcium gluconate 10%
injectable products that can be safety added to PN. To predict aluminum
exposure in Neonatal Intensive Care Unit (NICU) patients receiving PN
containing calcium gluconate from PPC and compare to predicted
aluminum exposure from alternative products.
Conclusion: A total of 60% of the MMS criteria have been paired with
some 2009-2010 HPC results. The average calculated discrepancy ratio
between both sources is 0.62±0.28. Further studies are required to
explore the reasons for such discrepancy.
Problem Resolution: Alternative calcium gluconate products were
investigated by the SickKids® Drug Information Service. The predicted
amount of aluminum neonates received from PPC calcium gluconate in
PN during July 2011 was calculated, and compared to predicted
amounts from alternative sources. Actual aluminum content in SickKids®
PN (with PPC product) was measured using inductively coupled plasma
mass spectrometry.
The Role of Clinical Informatics in Improving the
Assessment of Venous Thromboembolism Risk and
Prophylaxis
Vaishali Sengar, Brenda Cardiff, Vera Dounaevskaia, Heather Kertland,
Karen Ng, Rosemary Tanzini, Chris Hayes, St. Michael’s Hospital, Toronto,
ON
Evaluation: Calcium gluconate 10% injections by b. braun (10mL plastic
ampoule, Germany) and Phebra (10mL glass vial, Australia) were
identified. The predicted average aluminum content neonates would
receive from calcium gluconate products in PN by PPC, b. braun, and
Phebra was 62 mcg/kg/day, 1.25 mcg/kg/day, and 24 mcg/kg/day,
respectively. The predicted aluminum content from PPC and Phebra
products exceeded the recommended safe aluminum limit, unlike the
b. braun product. Measured aluminum content in our PN samples (with
PPC product) was 29.2 mcg/kg/day, six times the recommended safe
limit. International pediatric advisory groups have recommended using
calcium gluconate packaged in plastic to avoid aluminum leaching.
Rationale: Due to the morbidity and mortality associated with hospital
acquired venous thromboembolism (vTE), Accreditation Canada has
made the documentation of vTE risk assessment a required
organizational practice. We wanted to determine how a recently
implemented Computerized Provider Order Entry (CPOE) system could
support this requirement.
Description of concept: A hospital specific vTE prophylaxis guideline
had informed the development of a paper-based physician’s order set
which included risk assessment documentation. This order set was used
to build the service specific admission order sets during CPOE
implementation. Following implementation of CPOE, data from the
physician ordering system was extracted to identify the percentage of
patients with documented vTE prophylaxis assessment and/or treatment
within 24 hours of admission. Data was compiled quarterly on a
corporate and admitting service basis and shared unblinded with
physician and care team leadership.
Importance to Practice: SickKids® pharmacy has switched to using
calcium gluconate manufactured by b. braun and is following PPC’s
investigation for alternate packaging of calcium gluconate.
Comparison of the Level of Conformity Between the
Medication Management Standards of Accreditation
Canada and the Results of the Hospital Pharmacy in
Canada Report
Methods and Evaluation: Initial assessment/treatment rates were
established. Following the initial roll-out, optimizing strategies were
implemented using Plan Do Study Act methodology to assess for impact
on the overall and individual service rates. Changes implemented
included; incorporating the vTE order set into the admission order sets
that had been missed on initial build, opening the vTE order set section
within the admission order set to prompt for assessment, modifying
order set content to address surgical services pre-operative
considerations and adding an electronic reminder when patients were
admitted not using an admission order set. Each of these contributed to
increasing rates of vTE prophylaxis assessment/treatment.
Isabelle Barthélémy1, Denis Lebel1, Cynthia Tanguay1, Régis Vaillancourt2,
Chris Niro3, Jean-François Bussières1,4
Pharmacy Department and Pharmacy Practice Research Unit, CHU
Sainte-Justine, Montréal, QC
2
Pharmacy Department, Children’s Hospital of Eastern Ontario, Ottawa,
ON
3
Accreditation Canada, Ottawa, ON
4
Faculty of Pharmacy, Université de Montréal, Montréal, QC
1
Rationale: We proposed to Accreditation Canada to explore the
discrepancy about the conformity of the drug use process between the
accreditation process compliance rating and the Canadian pharmacy
survey.
Conclusions: The use of clinical informatics order set standardization
and design principles and the sharing of service level data was
successful in improving the rates of vTE prophylaxis
assessment/treatment.
Objectives: The main objective was to compare the level of conformity
between the Medication Management Standards (MMS) of
Accreditation Canada and the results of the Hospital Pharmacy in
Canada (HPC) Report. The secondary objective was to discuss any
important discrepancies between both sources.
How Do Local, Provincial and National Perspectives on
Clinical Pharmacy Key Performance Indicator Critical
Activity Areas Compare?
Study Design and Methods: This is a retrospective cross-sectional
study. Whenever possible, each MMS criterion was paired by a
pharmacy resident with specific results from the 2009-2010 HPC report.
Pairing was validated by a five-person panel. A discrepancy ratio was
calculated between the results of the 2009-2010 HPC and the 2010
MMS by dividing both levels of conformity per criterion.
Bannerman, H.1, Gorman, S.2, Toombs, K.3, Lo, J.1, Shukla, S.1, Doucette,
D.4, Slavik, R.2, Semchuk, B.5, Chan, W.1, Benninger, N.1, MacKinnon, N.6,
Bell, C.7, Slobodan, J.8, Lyder, C.9 , Pereira, T.8, Bjelajac-Mejia, A.10, Spina,
S.11, Fernandes, O.1,12
Interior Health Authority, Kelowna, BC
3
Capital Health, Halifax, NS
4
Horizon Health Network, Moncton, NB
5
Regina Qu’Appelle Health Region, Regina, SK
6
University of Cincinnati, Cincinnati, OH
7
8
Alberta Health Services, Red Deer, AB
9
Canadian Society of Hospital Pharmacists, Edmonton, AB/Ottawa, ON
10
The Hospital for Sick Children, Toronto, ON
1
2
Results: A total of 60% (81/135 criteria) of the MMS criteria have been
paired with some 2009-2010 HPC results by the panel members. The
average calculated discrepancy ratio between MMS and HPC results is
0.62±0.28 [min: 0.05 - max: 1.19]. The average discrepancy ratio
between MMS and HPC results per domain was respectively the
following: 0.49 (safely administering medications), 0.58 (accurately
preparing and dispensing medications), 0.61 (working together to
promote medication safety), 0.62 (carefully selecting and procuring
51
11
12
Evaluation: The assessment of the 7 apps revealed some key features
Vancouver Island Health Authority, Victoria, BC
that were available in some but not others – medication reminders;
tracking of blood glucose readings, insulin dosing, physical activity,
weight, blood pressure readings, and carbohydrate intake; electronic
synchronization with healthcare providers, and glucometer compatibility.
We identified that simplicity of the app, ease of use, and cost were the
key factors in determining the best app for self-management of diabetes.
ibG Star and Glucose buddy both fulfilled these criteria, and Tactio
Health was a close second.
Rationale: A set of hospital clinical pharmacy key performance
indicators (cpKPI) was recently developed using a systematic, national,
consensus-building process. The cpKPI were grouped into 8
evidence-informed critical activity areas (i.e. pharmaceutical care,
discharge medication reconciliation, patient medication education)
representing hospital pharmacist best practices which demonstrated
improvements in meaningful patient outcomes. The relative importance
of the critical activities is not known.
Importance to Practice: Smartphones are now an integral part of the
daily life of many Canadians. As a result, there is an increase in apps
available for self-management of diabetes. Patients play a critical role in
chronic disease management. Pharmacists can expect to receive
questions about the role of smartphone apps in the management of
diabetes. When recommending phone apps to diabetic patients, it is
important to individualize app selection to ensure optimal benefits to
patient care.
Description: Our objective was to determine local, provincial, and
national perspectives of pharmacists on the relative importance of cpKPI
critical activities and how these perspectives compare with each other.
Participant pharmacist subgroups included the: national cpKPI working
group (n=11), national Delphi panel (n=25), provincial subgroup (Ontario
branch) (n=14), local clinical pharmacy leaders (n=10), and local front line
pharmacists (Kelowna/ Toronto n=23). Each participant was asked to
identify the relative importance of 8 critical activities based on the
question, “Will a cpKPI in this critical activity area advance clinical
pharmacy practice to improve the quality of patient care?” Each
participant was given 20 “dot” votes to assess (assign dots for relative
importance) the critical activities.
Laboratory Test Ordering by Pharmacists in Canada:
A Nationwide Study of Policies and Practices
Peter Loewen, Julia Higgins, Faculty of Pharmaceutical Sciences, The
University of British Columbia, Vancouver, BC
Evaluation: A total of 83 hospital pharmacists from all 10 provinces
participated. Pooled results indicated that the three most important
critical activity areas were; (1) Pharmaceutical Care - Integrated (24%); (2)
Interprofessional Patient Care Rounds (15%); and (3) Discharge
Medication Reconciliation (13%). between subgroups, the most
important critical activity was the same (Pharmaceutical Care), but there
was some variation on second and third rankings. The national Delphi
panel ranked Interprofessional Patient Care Rounds and Admission
Medication Reconciliation second and third most important respectively.
Rationale: Clinical laboratory tests provide information that is essential
for pharmacotherapeutic decision-making. Having the authority to order
tests also streamlines care provision. There is limited data available on
the prevalence and nature of policies and regulation to support
laboratory test ordering by pharmacists.
Objective: To characterize pharmacist laboratory test ordering policies
across Canadian health delivery units (HDU: health authorities, regions,
hospitals).
Importance: Pharmacists’ perspectives at the local, provincial, and
national levels appear to align on the most important cpKPI critical
activities. Pan-Canadian collaboration to standardly implement cpKPI in
these domains may serve to advance pharmacy practice to improve
patient outcomes.
Study Design & Methods: Pan-Canadian cross-sectional policy
analysis including legislative, regulatory, professional association, HDU,
and individual pharmacist key informant perspectives. Data sources were
web searches and key informants (pharmacy directors and practice
leaders) in all Canadian HDUs. Key informants were approached by
e-mail to request relevant policy documentation. Policies were stratified
geographically and categorized by scope, nature, and context using an
iterative approach.
The Role of Online/Smartphone Applications in Type II
Diabetes Management: A Qualitative Study
Results: Six provinces have legislation permitting pharmacists to order
Alina R. Rashid, Certina Ho, School of Pharmacy, University of Waterloo,
Waterloo, ON
lab tests and in 2 of these the pharmacy regulator has implemented
policies accordingly (QC, Ab). 108 key informants responded,
representing 90% of identified HDUs. Of the 53 policies identified, 11
authorize pharmacists to order a broad scope of laboratory tests, 18
restrict pharmacists to a limited set of tests or restrict this authority to
specific settings. Policy development is underway in 9 of the 24 HDUs
where none currently exists. In 4 HDUs an existing policy is being
expanded in scope. broadly permissive policies were found in provinces
where legislation is permissive or pending with the exception of british
Columbia where 50% of HDUs have broadly permissive policies despite
the lack of supportive legislation. besides a lack of regulatory support,
the major barriers identified by key informants were laboratory
accreditation standards and sources of funding for laboratory tests.
Rationale: Diabetes is a chronic medical condition that affects the lives
of over 9 million Canadians. Multiple interventions, including
smartphone applications (or apps), have been developed for patients to
self-manage this condition.
Description of Concept: This study intends to identify a list of
smartphone applications that can be recommended to patients for
self-management of diabetes with respect to medication adherence,
physical activity, diet, and weight management.
Steps Taken: An environmental scan was performed to identify and
evaluate the top 7 diabetes management apps for iPhone, iPad, iPod
Touch, Android, and Windows Phones. These apps were assessed based
on features, usability, and their authority, accuracy, currency, objectivity,
and quality. We interviewed 4 Certified Diabetes Educators (CDEs) and
obtained their feedback and experience on the use of these apps in
diabetes patient education.
Conclusions: Laboratory test ordering by Canadian HDU pharmacists is
common and moving toward ubiquity along with legislation and
regulatory changes.
52
workflow. Collaboratively, patient’s consent was obtained. The clinical
pharmacist ensured all patients who consented, received the vaccine
prior to discharge from the unit. A standardized letter indicating vaccine
administration date was included upon discharge.
MONDAY, FEBRUARY 3
LUNDI 3 FÉVRIER
National Canadian Venous Thromboembolism (VTE)
Prevention Audit Day: Design and Results
Evaluations: During a three and a half month period, ninety patients
Artemis Diamantouros, Sunnybrook HSC, Safer Healthcare Now and
University of Toronto, Toronto, ON; Anne MacLaurin, Canadian Patient
Safety Institute, Edmonton, AB; Virginia Flintoft, Safer Healthcare Now
and University of Toronto, Toronto, ON; William Geerts, Sunnybrook
HSC, Safer Healthcare Now and University of Toronto, Toronto, ON
out of the one hundred and twenty-five admitted to RPCU were
screened. Of the ninety patients, fifty-four were eligible for influenza
vaccinations. A total of forty-four patients consented and received the
vaccine. This initiative resulted in a more than five time increase in
ordered and administered influenza vaccine compared to the same prior
period on the unit.
Rationale: venous Thromboembolism (vTE) is one of the most common,
Impact: The implementation of an interprofessional vaccination
program led to increased influenza vaccine uptake among a vulnerable
population. Implementing the pharmacist driven influenza screening tool
in the whole hospital along with screening for other vaccines will be the
next goal for our institution.
and costly complications of hospitalization. Most hospitalized patients
are at risk for vTE and studies prove vTE is preventable.
Objectives: To establish a national estimate of vTE prophylaxis rates,
raise awareness, and promote use of a new vTE data collection tool
created for the audit.
CSHP
Methods: A National Call to Action and information call was held to
2
promote participation. National and provincial agencies were involved
to endorse the audit and hospitals and health authorities were invited to
register. The audit was to be conducted on a sample of at least 20
general medicine or surgery patients or both. A detailed workbook
providing instructions on how to participate and an optical mark
recognition data collection form was made available to all participants.
Data were submitted by fax or direct entry to the CPSI Patient Safety
Metrics System.
Debbie Kwan, Patricia Marr, Kori Leblanc, Chandani Upadhyay, Manal
Rostom, Jessica Jakob, Victoria Siu, and Toni Basinski, University Health
Network and University of Toronto, ON
Rationale: Patient outcomes with warfarin therapy are best when INR
time in therapeutic range (TTR) is optimized. A TTR of ≥ 60% has been
suggested for achieving high quality anticoagulation. At the Toronto
Western Family Health Team, warfarin continues to be the most
commonly used oral anticoagulant and is managed by the pharmacists.
Results: The Audit Day was a success in attracting interest and
establishing a Canadian vTE prophylaxis estimate. Data on 4667
patients was reported by 118 hospitals, up from 14 in 2012. . Overall
81% of patients received appropriate vTE prophylaxis. The use of order
sets contributed to higher vTE prophylaxis rates. Results showed
variability in vTE prophylaxis by patient group, province and provincial
regions. Audit Day survey feedback indicated all respondents would
participate in a 2014 Audit Day.
Description: We conducted a quality improvement evaluation to 1)
Assess the quality of warfarin therapy management using TTR, 2)
Compare the characteristics of patients who achieved an accepted TTR
vs. those who did not, 3) Assess the appropriateness of switching
patients with poor TTRs to a novel oral anticoagulant (NOAC).
Steps Taken to Identify and Resolve Problem: A retrospective chart
Conclusions: Providing detailed instructions, an audit tool and audit
review was conducted for patients on warfarin therapy for a 12 month
period. TTR was calculated using the Rosendaal method. Demographic
and clinical characteristics were compared between patients with poor
(i.e. TTR < 60%) vs. good (i.e.TTR ≥ 60%) control. Charts of poorly
controlled patients were further reviewed to determine whether they
could have been safely switched to a NOAC. Specific criteria used
included: appropriate indication for anticoagulation, patient
comorbidities, renal function and potential for drug interactions.
support reduced reporting burden and improved participation. Limiting
the patient sample to medical/surgical patients made it difficult for small
sites to achieve the desired sample size. Participant education was
required to assist with determinations of ‘appropriate vTE prophylaxis’
and reasons prophylaxis was not used. Improved planning and
participation strategies will be required to expand the audit to even
more centers in 2014.
CSHP
2
Targeting Excellence
in Pharmacy Practice
Appropriateness of Using Alternate Oral
Anticoagulants in Poorly Controlled Warfarin
Patients
Evaluation: A total of 168 charts were reviewed; 30% (51) had an
Improving Influenza Vaccination Uptake In The
Progressive Care Unit of a Community Teaching
Hospital
average TTR < 60%. There were no statistically significant differences in
demographic and clinical characteristics between poor vs. acceptable
control groups. Of the poor control group, 65% (33) had an indication
that allowed use of a NOAC. Five (9.8%) patients had an absolute
contraindication to using a NOAC. Relative contraindications and
precautions were not assessed since appropriateness of NOAC therapy
would depend on subsequent interventions to manage these.
Sonia Wang, Sumit Raybardhan, North York General Hospital, Toronto,
ON
Rationale: The development of a coordinated influenza vaccination
program among a vulnerable institutional population is important to
reduce the risk of influenza infection and complications.
Implications for Future Practice: TTRs should be routinely assessed
proactively to identify poorly controlled warfarin patients. Those with
suboptimal TTRs should be considered for NOAC therapy unless a
contraindication exists.
Description: The Rehabilitation and Progressive Care Unit (RPCU) at
North york General Hospital is a short stay unit for patients awaiting
placement to alternate level of care facilities. The patients on this unit
have an average age of eighty-five years with multiple comorbidities,
representing a high risk group for influenza infection and complications.
Recurrent influenza outbreaks have been noted particularly in this unit. A
pharmacist-led initiative of systematically screening and educating
patients was developed to facilitate a collaborative approach for
influenza vaccination in this vulnerable population.
Personalized Medicine: Teaching Strategies for a Novel
Clinical Pharmacy Residency Rotation
Facca N.M.1, Jansen S.1, Kim R.B.1,2
1
2
Method: An evidence-based screening tool with expert input was
created to determine eligibility for the influenza vaccine. An in-service
was given to RPCU staff, educating them on the safety and effectiveness
of the influenza vaccine and familiarizing them with the screening tool
London Health Sciences Centre, London ON
Schulich School of Medicine and Dentistry, Western University, London
ON
Rationale: Pharmacists are well positioned within the health care team
to provide patient care based on pharmacogenomics, an emerging field
53
of clinical relevance for individualized drug therapy. Current curricula of
the pharmacy schools and residency programs across Canada lack
substantial education in this field.
likelihood ratios (SSLR). SSLR magnitudes indicate weak, moderate, or
strong predictive performance. No prior research has studied the
CHADS2 or CHA2DS2-vASc CPRs from this perspective.
Description: The ultimate goal of the rotation is to familiarize the
Objectives: To measure the clinical usefulness of the CHADS2 and
resident with the new field of medicine known as personalized medicine
or pharmacogenomics.
CHA2DS2-vASc CPRs for stroke prediction using SSLRs.
Study Design & Methods: Meta-analysis using PRISMA guidelines.
Implementation: To better develop the skills of pharmacists to be able
Prospective and retrospective studies reporting stroke rates in
CHADS2/CHA2DS2-vASc strata were included. Data was pooled with
and without adjustment to account for the effects of antithrombotic
therapy use in cohorts where this was reported. SSLRs were computed
using Peirce & Cornell’s method and predictive strength of the SSLRs
were classified using Jaeschke’s scheme.
to provide pharmacogenomics-based pharmaceutical care, a mandatory
pharmacy residency rotation in personalized medicine was established.
Learning objectives for the rotation were defined and specific, validated
teaching strategies were deployed by the preceptor.
Evaluation: The residents were given a survey at the end of the rotation
Results: 2249 citations were screened and 43 articles were included in
the analysis. Pooled adjusted CHADS2 data (n=30 studies, N=319,992
patients) showed that a score of 0 weakly predicts low stroke risk (SSLR0.225; 95% CI 0.219 to 0.232) while a score ≥ 3 weakly predicts
increased stroke risk (SSLR+ 3.70; 95% CI 3.66 to 3.75). Pooled adjusted
CHA2DS2-vASc data (n=16 studies, N=256,672 patients) showed that a
score of 0 predicts decreased stroke risk with moderate strength (SSLR0.104; 95% CI 0.096 to 0.112) while a score ≥5 weakly predicts increased
stroke risk (SSLR+ 2.80; 95% CI 2.76 to 2.84). CHADS2 and
CHA2DS2-vASc scores ≥3 and ≥5, respectively do not have sufficiently
distinct SSLRs to warrant use of individual scores for clinical
decision-making.
to assess the mandatory personalized medicine rotation and assess the
teaching strategies used during the rotation (response rate of 80%).
Answers to the survey questions used the following assessment scale:
does not apply, strongly disagree, disagree, agree, and strongly agree.
See table below.
Relevance: Personalized medicine is a new and exciting field of
medicine. To be able to use pharmacogenomics information to provide
personalized therapeutic recommendations to patients, pharmacists
need adequate training and education. The introduction of a mandatory
pharmacy residency rotation achieves this learning need for future
pharmacists. Teaching strategies that can be used by a pharmacist
preceptor for a pharmacy residency rotation in personalized medicine
have been described.
Conclusions: A CHA2DS2-vASc score of 0 is a clinically useful negative
predictor of stroke. No other stratum or group of strata for CHADS2 or
CHA2DS2-vASc, including extreme scores, demonstrated better than
weak stroke predictive performance in this comprehensive meta-analysis.
Stroke Prediction in Atrial Fibrillation: Meta-Analysis of the
Predictive Performance of the CHADS2 and
CHA2DS2-VASc Clinical Prediction Rules
Development of Guidelines for Safe Management
of Antithrombotic Medications Prior to Elective
Surgical and Diagnostic Procedures in a
Community Hospital Setting
CSHP
2
Peter Loewen, Christopher Yearwood, Faculty of Pharmaceutical
Rationale: Guidelines recommend using the CHADS2 or
Shelita Dattani, Queensway Carleton Hospital, Ottawa, ON
CHA2DS2-vASc stroke clinical prediction rules (CPRs) in patients with
atrial fibrillation (AF). Their clinical usefulness is dependent on their
predictive performance, which can be measured using stratum-specific
Survey Responses (%)
Survey Question to Residents
(80% response rate)
Does Not
Apply
Strongly
Disagree
Disagree
Agree
Strongly
Agree
The personalized medicine rotation increased my skills, knowledge and competency in the
provision of pharmacogenomics-based pharmaceutical care.
0
0
0
75
25
The assigned readings were useful at developing a baseline of knowledge required for this
rotation.
0
0
0
25
75
The online tools demonstrated were effective at allowing me to apply my knowledge of
pharmacogenomics.
0
0
0
75
25
The teaching strategy of case-based learning was effective.
0
0
0
50
50
The teaching strategy of modeling (done by the preceptor) was effective.
0
0
0
50
50
The teaching strategy of coaching (done by the preceptor) when I was actively engaged in
patient care was effective.
0
0
0
50
50
Overall, the teaching strategies used during the rotation were effective to accomplish
learning goals and objectives.
0
0
0
75
25
The time allotted for each learning objective/activity was sufficient.
0
0
0
75
25
The total time allotted in the pharmacy residency program (i.e two weeks) is sufficient to
achieve the learning goals and objectives of this rotation.
0
0
0
75
25
I agree that personalized medicine should be a mandatory rotation for pharmacy residents.
0
0
0
100
0
What I learned in this rotation about pharmacogenomics is useful for my career as a
pharmacist.
0
0
0
50
50
54
pharmacists and expressed a desire for preceptors to be afforded more
time “just to teach”. Precepting models which incorporate peer, tiered
or group learning were viewed positively. Learners expressed frustration
at a mismatch in expectations between preceptors, learners, and the
Experiential Office.
Rationale: Annually, 10% of patients taking antithrombotic agents
undergo procedures that require temporary discontinuation of therapy.
The ultimate goal is to minimize thromboembolic events while balancing
risk of bleeding in the peri-procedural period. In recent years, we have
seen increased use of new oral anticoagulants and anti platelets at our
institution. Review of multiple patient cases has demonstrated
inconsistencies in peri-procedural management of these agents.
Conclusions: This project highlighted some key challenges faced by
learners and suggests some possible solutions. These solutions will need
to be part of a comprehensive institutional experiential education
strategy.
Description: Our multidisciplinary task group developed a guideline,
initially focusing on an approach to interruption of therapy for all
commonly used antithrombotic agents. The primary goal was to
facilitate decision making and to support safe and consistent practice. A
secondary goal was to promote clear communication between all
stakeholders regarding interruption of therapy prior to surgical or
diagnostic procedures.
Exploring Innovative Institutional Learner-Preceptor
Models Across Health Disciplines: A Systematic Review
Allison Gamble; Kieran Shah; Stacey Tkachuk; Michael Legal; Peter S.
Loewen; Peter J. Zed, Faculty of Pharmaceutical Sciences, The University
of British Columbia, Vancouver, BC
Steps Taken To Develop the Guideline: Due to the paucity of
published evidence in this area, feedback was solicited from several
external and internal stakeholders and a conservative, consensus based
approach was used to develop recommendations.
Background: It is a challenge to provide sufficient quantities of high
quality experiential placements for learners in hospital settings. In recent
years, this issue has become increasingly acute due to curricular and
program changes in Canada. Most placements in institutional pharmacy
employ the traditional 1:1 (learner-to-preceptor model). Drawbacks of
this model are an inability to adapt to increasing numbers of learners in
the system and lack of opportunities for peer-learning. Novel (>1:1)
models may offer a solution.
Evaluation: The guideline was presented to key stakeholder groups
including surgery, anesthesia, medicine, radiology, nursing and pharmacy.
Stakeholder representatives then tested “real world” application of the
guidelines to patients in our preoperative assessment clinic. based on
this initial evaluation, further suggestions were implemented. The
evaluation validated that development of guidelines facilitated safe and
consistent practice and education of patients prior to procedures. It also
highlighted the importance of clear communication among all providers,
the proceduralist and the patient.
Objectives: To conduct a systematic review of the literature
encompassing multiple health disciplines’ experience with novel
learner-preceptor models and to compare the advantages and
disadvantages of these models. This systematic review will be valuable
both to Canadian pharmacy programs, and to other health discipline
faculties facing institutional experiential placement shortages.
Relevance to Current and Future Practice: This initiative provides a
starting point to enable our providers to safely and consistently manage
interruption of antithrombotic therapy prior to procedures.
Methods: Eight health and education literature databases were
searched. Search terms related to the type of learner, health discipline
(pharmacy, medicine, nursing, occupational therapy (OT), physiotherapy
(PT), dietetics, dentistry, speech therapy or audiology),
institutional/hospital experience, and preceptor model. Data from
included studies were synthesised descriptively, and the
advantages/disadvantages of different models of were summarized in a
narrative format.
Another evaluation is ongoing, using a question-based audit tool to
assess compliance with the guidelines in the preoperative setting
followed by a patient interview on the day of surgery.
Opportunities to Enhance Institutional Experiential
Education in British Columbia: Learner Perspectives
Michael Legal; Donna Rahmatian; Kyle Collins; Marguerite Billingsley;
France Carriere; Patricia Gerber; Angela Kim-Sing; Peter J. Zed; Peter S.
Loewen; Faculty of Pharmaceutical Sciences, The University of British
Columbia, Vancouver, BC
Results: Seventy-three articles were included in the final review.
Sixty-four articles related to nursing, OT or PT education, while 4 articles
related to pharmacy, 2 to dietetics, 2 to speech therapy while 1 was
interprofessional. Eight learner-preceptor models were identified: 1:1,
2:1, 3:1, greater than 3:1 (up to 10:1), 2+:2+ (collaborative learning
groups), 1:2 (shared precepting), 1:‘0’ (interprofessional precepting), and
tiered (or ‘learner-as-preceptor’).
Background: It is a challenge to provide sufficient quantities of high
quality institutional experiential placements for learners. In recent years,
this issue has become increasingly acute in pharmacy due to curricular
and program changes in Canada. In british Columbia a comprehensive
multi-stakeholder engagement project was undertaken to identify
solutions. This report describes the learner engagement portion of the
project.
Conclusion: Each model offers unique advantages and disadvantages.
While no model was superior to the others, the 2:1 model may facilitate
peer learning and increase institutional placement capacity, without
substantially increasing preceptor workload. To our knowledge this is the
first review of its kind to include pharmacy models.
Objectives: To characterize the perspectives of pharmacy learners in
relation to experiential education in the institutional environment.
Research Methods: The perspectives of undergraduate students,
pharmacy practice residents and post graduate doctor of pharmacy
students were gathered through focus groups and one on one
structured interviews. Focus groups and interviews were recorded and
the resulting transcripts were analyzed using qualitative methods and
iterative coding to identify major themes.
CSHP
2
Patient Medication Education at Discharge:
A Multidisciplinary Team Based Approach
(TEACH)
Cheyanne Boehm1, Lynette Kosar1, Lisa Ruda1, Lori Zulyniak1
1
Results: A total of 50 learners participated. Learners felt that the
Rationale: Healthcare models lack effective means of communicating
undergraduate program emphasizes community practice and that there
is a lack of exposure to hospital practice. Undergraduate students
reported being anxious prior to their hospital placements and spent
much of their time on rotation learning to adapt to the practice
environment. They felt that an early hospital experiential placement
towards the end of second year would be beneficial. They also
suggested updating course and practice lab content to include: hospital
terminology, abbreviations, interpretation of labs, systematic approach
and chart note writing. Learners viewed precepting as added work for
patients’ drug therapies upon hospital discharge. Up to 45% of
discharge medications are first prescribed in hospital, which increases
the risk of patient adverse events if adequate medication education is
not received.
Objectives: The purpose of the study was to propose a feasible and
sustainable patient-centered medication discharge education process
for atrial fibrillation (AF) patients within the Cardiac Surveillance Unit
(CSU) at the Regina General Hospital. The objectives were:
55
1. To identify the current medication discharge education process.
Evaluation: The top-five Slavik-11 criteria were: 1) high quality evidence,
2) clinically important outcomes, 3) best suited to pharmacist role, 4)
attributable to direct patient care, and 5) specific to a pharmaceutical
care process. The top-five candidate cpKPIs for these categories varied
from the consensus cpKPIs. However, average overall ratings of
candidate cpKPIs correlated well with the composite mean Slavik-11
ratings for each of the candidate cpKPI (R = 0.973, P < 0.0001).
2. To elicit the enablers for the provision of patient medication
discharge education.
3. To elicit the barriers for the provision of patient medication discharge
education.
4. To determine what medication discharge education is essential for
patients to receive to promote adherence and safety.
Importance: The Slavik-11 consensus criteria appear to align well with
the final-eight consensus cpKPI. Utilization of the Slavik-11 scoring scale
in selecting national cpKPIs provides a systematic approach to ensure
that the entire spectrum of predefined ideal attributes is considered.
5. To provide suggestions for further consideration of a multidisciplinary
medication discharge education process.
Study Design and Methods: A single multidisciplinary focus group
including pharmacists, nurses, and a social worker, was conducted.
CSHP
Results: Thematic coding was used to identify the current process,
2
enablers, barriers, and essential information, and to propose the
following suggestions: (1) All CSU providers should be responsible for
providing patient education; (2) Use pharmacy technology to identify
patients for education; (3) Provide consistent written and verbal
information to increase patient understanding; (4) Facilitate patient
access to discharge medications; (5) Improve inpatient and outpatient
provider communication; (6) Expand use of the Cardiac Teaching
Document to all CSU members; (7) Create an AF pathway; (8) Develop
additional education tools and house materials online.
Handbook for a Pilot Study to Reduce Potential
Hospitalizations Due to Preventable Drug-Drug
Interactions
Atsushi Kawano, Certina Ho, Institute for Safe Medication Practices
Canada (ISMP Canada), Toronto, ON
Rationale: Hospital reports on medication incidents suggest 37-51% of
reported adverse drug events, including drug-drug interactions (DDIs),
may have been prevented with appropriate interventions. The Institute
of Clinical Evaluative Sciences conducted population-based studies
examining the association between specific DDIs and hospitalizations.
Conclusion: The ideas proposed build upon the current process and
Description of Concept: This study intends to compile a list of
integrate aspects of discharge medication education that have been
successful for CSU or other teams. Implementation of these suggestions
may improve both patient understanding and adherence to AF
medications.
evidence-based DDIs with association to an increased risk of
hospitalizations and develop a treatment algorithm handbook to
facilitate pharmacists or clinicians in ambulatory care in identifying and
offering recommendations to prescribers to prevent these DDIs.
Steps Taken: A comprehensive literature search was conducted and
How Do National Clinical Pharmacy Key Performance
Indicators Align With Top-Ranked Consensus Selection
Criteria?
articles were selected based on relevant DDIs that were associated with
an increased risk of hospitalization. Evidence-based treatment
algorithms were created to suggest alternative therapeutic options for
three common community infections – Group A -hemolytic
Streptococcus pharyngitis, outpatient community-acquired pneumonia,
and uncomplicated lower urinary tract infections.
Lo, J.1, Gorman, S.2, Toombs, K.3, Bannerman, H.1, Shukla, S.1, Slavik, R.2,
Semchuk, B.4, Doucette, D.5, Chan, W.1, Benninger, N.1, MacKinnon, N.6,
Bell, C.7, Slobodan, J.8, Lyder, C.9, Pereira, T.8, Bjelajac-Mejia, A.10, Spina,
S.11, Fernandes, O.1, 12
Evaluation: Evidence-based DDIs identified in this study involved either
a macrolide or trimethoprim-sulfamethoxazole. In all cases, the evidence
supported an alternative to either antibiotic for selected community
infections. Older persons were underrepresented in trials evaluating
antibiotic therapy for community infections. Selecting an appropriate
antibiotic required using data derived primarily from children and adults.
A treatment algorithm handbook was created for clinicians in
ambulatory care.
3
Capital Health, Halifax, NS
4
5
6
University of Cincinnati, Cincinnati, OH
7
8
9
10
The Hospital for Sick Children, Toronto, ON
11
Vancouver Island Health Authority, Victoria, BC
12
1
2
Importance to Practice: The list of evidence-based DDIs with
association to an increased risk of hospitalizations identified in this study
was made available to all pharmacists via the Ontario College of
Pharmacists quarterly publication, Pharmacy Connection, in Spring 2013.
Pharmacists/clinicians have the option of using the treatment algorithm
handbook developed in this project to help resolve and prevent these
DDIs.
Rationale: National consensus candidate clinical pharmacy key
performance indicators (cpKPIs) and selection criteria (Slavik-11)
representing pan-Canadian cpKPI ideal attributes have been established.
A Slavik-11 scoring scale was designed to facilitate a balanced
assessment of competing perspectives for individual cpKPIs.
CSHP
2
Description: Objectives: 1) To report national Delphi panelist priority
ranking of consensus cpKPI selection criteria and the top-five cpKPIs for
each of the top-five selection criteria, 2) to determine how panelist
ratings of candidate cpKPIs based on individual top-ranked Slavik-11
criteria align with the overall ratings and consensus cpKPIs. An electronic
survey instrument using a 9-point Likert scale was used by the panel (n =
26) to rate each candidate cpKPI on individual Slavik-11 criteria and
assign an overall score. The pre-defined consensus threshold was
reached when ≥75% of panelists assigned the candidate cpKPI an
overall rating of ≥7. Panelists also ranked the importance of each
Slavik-11 criterion in advancing clinical pharmacy practice to improve the
quality of patient care. The five candidate cpKPIs with the highest mean
ratings for each Slavik-11 criterion were compared to the consensus
cpKPIs. Overall scores were compared to Slavik-11 composite means.
What are the Appropriate Clinical Pharmacy
Key Performance Indicators for Hospital
Pharmacists?
Olavo Fernandes1, Sean K. Gorman2, Richard S. Slavik2, William M.
Semchuk3, Douglas Doucette4, Heather Bannerman5, Jennifer Lo5,
Simone Shukla5, Winnie Chan5, Natalie Benninger5, Neil J. MacKinnon6,
Chaim M. Bell7, Jeremy Slobodan8, Catherine Lyder9, Peter J. Zed10, Kent
Toombs11
3
Regina Qu'Appelle Health Region, Regina, SK
4
5
6
University of Arizona, Tucson, AZ
7
1
2
56
auteurs ont décrit l’évolution du rôle clinique du pharmacien en
chirurgie. Une revue de l’activité pharmaceutique en 2012-2013, a
permis de recenser 2,89 interventions/heure de soins décentralisé (40%
modification de la thérapie, 26% continuité des soins, 13%
conseils/histoires) pour un total de 17867 admissions. La mise à jour
envisagée du secteur de pratique inclut l’implantation de bilan
comparatif médicamenteux avec profil web sur l’intranet pour
l’ambulatoire, la consultation systématique via tablette numérique à
l’étage de tous les dossiers pharmacologiques informatisés, la révision
des protocoles et des pratiques afin de standardiser la
pharmacothérapie, la production de plans de soins pharmaceutiques
pour transmission au pharmacien communautaire pour les
pharmacothérapies complexes, etc.
10
University of British Columbia, Vancouver, BC
11
Capital District Health Authority, Halifax, NS
8
9
Rationale: Key performance indicators are quantifiable measures of
quality. Clinical pharmacy key performance indicators (cpKPI) aim to
advance clinical pharmacy practice and improve patient care. There are
currently no published, systematically-derived cpKPI.
Objectives: To systematically develop a core set of national cpKPI.
Study Design and Methods: A cpKPI working group systematically
and sequentially established a cpKPI consensus definition, 8
evidence-derived cpKPI critical activity areas, 26 candidate cpKPI, and
11 cpKPI ideal attributes in addition to 1 overall consensus criterion.
Over a 3-month period, 26 clinical pharmacists and hospital pharmacy
leaders participated in a 3-round modified Delphi survey. Using an
Internet-based, pre-tested survey instrument, panelists independently
rated the 26 candidate cpKPI using the 11 cpKPI ideal attributes and 1
overall consensus criterion on a 9-point Likert scale. A meeting was
facilitated between rounds 2 and 3 to debate the merits of each
candidate cpKPI and clarify wording. Consensus was reached if 75% or
more of the panelists assigned a score of 7-9 on the consensus criterion
during the third Delphi round.
Conclusion : Il existe peu de données sur la hiérarchisation des
programmes de soins et des activités pharmaceutiques. Cette étude
décrit une démarche de mise à jour en chirurgie pédiatrique.
Stability of Clobazam 1mg/mL in Extemporaneously
Compounded Oral Suspensions Using Oral Mix Vehicle in
PET, PVC, Glass Bottles and Plastic Unit-Dose Syringes
Blake E. Ziegler, Andrea Walsh, Scott E. Walker, Shirley Law, Karen
Lingertat-Walsh, Pacita Sales, Departments of Pharmacy at Sunnybrook
Health Sciences Centre and The Hospital For Sick Children, Toronto, ON
Results: All panelists completed the 3 Delphi rounds and 25/26 (96%)
attended the meeting. Eight candidate cpKPI of activities performed by
pharmacists met the consensus definition after the third Delphi round: 1)
performing admission medication reconciliation (including best possible
medication history); 2) participating in inter-professional patient care
rounds; 3) completing pharmaceutical care plans; 4) resolving drug
therapy problems; 5) providing in-person disease and medication
education to patients 6) providing discharge patient medication
education; 7) performing discharge medication reconciliation; and 8)
providing bundled, proactive direct patient care activities.
Background and Rationale: An oral liquid formulation of clobazam is
not commercially available in Canada and has not been previously
studied. An extemporaneous oral liquid formulation is required for
administration to patients who cannot swallow intact tablets.
Objective: To evaluate the stability of clobazam 1mg/mL prepared in
Oral Mix vehicle and stored in 3 types of containers (amber glass, amber
polyethylene terephthalate [PET] and amber polyvinylchloride [PvC])
over 91 days at 4ºC and 23º and polypropylene oral plastic syringes at
23ºC only.
Conclusions: A Delphi panel of hospital pharmacists was successful in
Methods: A reverse-phase stability-indicating liquid chromatographic
method was validated before the study. Three separate batches of
clobazam suspension 1mg/mL were prepared with Oral Mix. Fifty mL
aliquots of the suspension were stored in 100mL bottles (amber glass,
amber PET, or amber PvC). Half of the bottles from each container type
were stored at 23ºC and the other half at 4ºC. On study days
0,2,7,14,21,28,42,56,72 and 91, clobazam concentration was
determined in samples drawn from bottles stored at each temperature
in each type of container. Oral syringes, filled with 2mL suspension, were
stored at 23ºC and tested on days 0,2,7,21,42 and 91.
determining 8 consensus cpKPI. Measurement and assessment of these
cpKPI, which are believed to be generalizable to other health systems,
will serve to advance clinical pharmacy practice and improve patient care.
CSHP
2
Démarche pour la mise à niveau d’un secteur de
soins pharmaceutiques : le cas de la chirurgie
pédiatrique
Aurélie Guérin1, Maxime Thibault1, Christina Nguyen1, Denis Lebel1,
Jean-François Bussières1,2
Results: The concentration of clobazam 1mg/mL in Oral Mix in all study
Département de pharmacie et Unité de recherche en pratique
pharmaceutique, Centre Hospitalier Universitaire Sainte-Justine,
Montréal, QC
2
Faculté de pharmacie, Université de Montréal, Montréal, QC
1
samples from bottles and oral syringes remained within 4% of the initial
concentration. based on the fastest degradation rate with 95%
confidence, on day 91 suspensions stored in bottles at 23ºC and 4ºC
had between 91-94 % and 95-96% remaining respectively. Oral syringes
at 23ºC had 89% remaining on day 91.
Justification : Depuis deux décennies, les pharmaciens hospitaliers
exercent majoritairement de façon décentralisée dans les programmes
de soins. On reconnait les difficultés inhérentes à la hiérarchisation de
ces programmes et des activités pharmaceutiques lorsque les ressources
disponibles sont insuffisantes.
Conclusions: Using the fastest degradation rate, clobazam 1mg/mL oral
suspension in Oral Mix in all bottle types retained more than 95% of the
initial clobazam concentration at 4C, more than 91% at 23C and only
89% when stored in oral syringes on day 91.
Objectif : Mettre à jour le niveau de pratique utilisé en soins
pharmaceutiques en chirurgie pédiatrique.
Stability of Domperidone 5mg/mL in Extemporaneously
Compounded Suspensions Using Oral Mix Vehicle in PET,
PVC, Glass Bottles and Plastic Oral Unit-Dose Syringes
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 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.
Karen Lingertat-Walsh, Shirley Law, Scott Walker, and Pacita Sales,
Departments of Pharmacy at Sunnybrook Health Sciences Centre and
The Hospital For Sick Children, Toronto, ON
Background and Rationale: Domperidone 1mg/mL and 10 mg/mL in
ORA-blend was studied previously in PvC bottles only. Oral Mix is a new
vehicle manufactured in Canada, similar in composition to ORA-blend.
Stability of domperidone 5mg/mL using Oral Mix was determined using
Résultats : Des 137 articles recensés, 15 ont été retenus. Nous ne
recensons aucune activité pharmaceutique spécifique reposant sur des
données de très bonne qualité (A). Nous recensons cinq activités
pharmaceutiques reposant sur des données de bonne qualité (b) et sept
comportant un niveau de preuve insuffisant (C, D). Toutefois, plusieurs
57
different bottle types and plastic oral syringes which has not been
previously done.
Update of the Canadian Labels for Antipsychotic Drugs
Following a Review of the Evidence on the Risk of Venous
Thromboembolism Associated With the Use of These
Medications
Objective: To evaluate the stability of domperidone 5mg/mL
suspension prepared in Oral Mix and stored in 3 types of containers
(amber glass, amber polyethylene terephthalate [PET] and amber
polyvinylchloride [PvC]) over 91 days at 4ºC and 23ºC and
polypropylene oral syringes at 23ºC only.
David Duguay, Co Pham, Marc Berthiaume, Marketed Pharmaceuticals
and Medical Devices Bureau, Marketed Health Products Directorate,
Health Canada, Ottawa, ON
Methods: A validated reverse-phase stability-indicating liquid
Rationale: venous thromboembolism (vTE) has been reported with
chromatographic method was used. Three separate batches of
domperidone 5mg/mL suspension were prepared in Oral Mix.
Seventy-five mL aliquots of the suspension were stored either in amber
PvC and amber glass (250mL bottles), amber PET (100mL bottles) or
1.5mL in polypropylene oral syringes . Half the bottles of each container
type were stored at 23ºC and the other half at 4ºC. On study days
0,1,2,4,7,10,14,21,28,35,42,49,63,77,91 domperidone concentration was
determined in samples from bottles stored at each temperature in each
container type and from polypropylene oral syringes.
antipsychotics use in numerous published case reports and in several
studies since the introduction of phenothiazines in Canada in the 1950’s.
Objectives: The purpose of the review conducted by Health Canada
was to evaluate the association between the risk of vTE and the
utilization of antipsychotics as a class, and to recommend strategies to
mitigate risk as needed.
Study Design and Methods: Health Canada conducted a review of
cases of vTE with antipsychotic drugs reported in the Canadavigilance
database between January 1st, 1965 and May 31, 2011, and a review of
published studies and case reports related to vTE and antipsychotics.
Results: The concentration of domperidone 5mg/mL in Oral Mix in all
study samples from bottles and oral syringes remained within 6% and
7% of the initial concentration. based on the fastest degradation rate
with 95% confidence, on day 91 suspensions stored in bottles at 23C
and 4C had between 88-92% and 92-93% remaining respectively. Oral
syringes at 23C had only 87% remaining.
Results: As of May 31, 2011, the Canadavigilance database contained a
total of 140 unique reports of vTE associated with antipsychotic drugs
(most cases were reported with clozapine [69%]* and some with
olanzapine, risperidone, quetiapine, haloperidol, flupenthixol, and
loxapine). A literature search from 1948 to September 9, 2011 identified
over 80 published case reports of vTE suggestive of an association with
antipsychotic drugs, in addition to 14 pharmacoepidemiology studies on
this specific issue. The review demonstrated a consistent trend in studies
suggesting an increased risk of vTE with exposure to antipsychotic
drugs.
Conclusion: Using the fastest degradation rate, domperidone 5mg/mL
oral suspension in Oral Mix in all bottle types retained more than 92% of
the initial domperidone concentration at 4ºC, more than 88% at 23ºC
and only 87% when stored in polypropylene syringes on day 91.
CSHP
2
IV to PO Stepdown Interventions in a
Community Hospital Without an Infectious
Disease Physician
Conclusion: The evaluation of the risk of vTE gathered from
epidemiological studies, published case reports, and reports of adverse
drug reactions in pharmacovigilance databases has resulted in a
recommendation to update the Canadian Product Monographs of all
antipsychotic drugs.
Andrea Wist, Gayathri Radhakrishnan, Kayleigh Curts, Bluewater Health,
Sarnia, ON
Rationale: This project demonstrates the successes
*Clozapine is available in Canada only through a restrictive distribution
system. This drug is under an increased level of scrutiny compared to
other antipsychotics.
(Pharmacoeconomics and Time) of implementing Iv to PO antibiotic
stepdown involving a multidisciplinary approach, as part of a
stewardship program in line with Accreditation Standards.
Description: bluewater Health (bWH) is a 326 bed community hospital
without an Infectious Disease Physician. bWH had an automatic Iv to PO
stepdown policy only for 5 antibiotics since 2007. In this project, all Iv
antibiotics on formulary were included for review.
Table 1: Summary of IV to PO Outcomes
Implementation: All patients initiated on Iv antibiotics in Med
Telemetry unit (MEDT) were reviewed on Day 3 of antibiotic therapy.
Patients were excluded if they transferred in or out of MEDT during their
Iv antibiotic therapy. The project period covered 4 weeks in May-June
2012. The pharmacist reviewed the patient’s clinical status to determine
eligibility for stepdown. If patient met eligibility, the pharmacist notified
the clinician of an appropriate PO alternative. Follow up was done the
next day to determine if the suggestion was accepted, partially
accepted or rejected. Iv to PO stepdown data was also captured when
there was no pharmacist involvement. The amount of time spent in
reviewing patients and follow up was also collected.
# of orders ineligible for Iv → PO (15%)
3
# of orders discontinued (20%)
4
# of orders discontinued with pharmacist and physician
involvement
(3)
# of orders discontinued with physician involvement only
(1)
# of orders eligible for Iv → PO (50%)
10
# of orders changed to PO with pharmacist and physician
involvement
(6)
# of orders changed to PO with physician involvement only
(3)
Upon completion, the cost of total PO antibiotic therapy was subtracted
from the cost of the anticipated full duration of Iv therapy (if PO
conversion was not completed) to calculate cost savings.
# of orders continued as Iv
(1)
# of orders lost to follow up (15 %)
3
Evaluation: 18 patients (who had a total of 20 antibiotic orders) were
Antibiotics reviewed: Ceftriaxone, Ceftazidime ,
Moxifloxacin, Cefazolin, Azithromycin, Ciprofloxacin,
Metronidazole.
–
included.
See Table 1.
Average amount of time required to review patients who
were eligible for Iv to PO:
Relevance to Practice: This project adds to current literature on Iv to
PO antibiotic conversions, creating a template on how it can be
accomplished without an Infectious Disease Physician.
Cost savings by switching to PO
58
50
minutes
$2128.96
CSHP
2
Pharmacists Joining a Multi-Disciplinary Specialty
Private Practice
Results: A total of 217 articles were initially identified. Only four
relevant articles were included in our analysis Nine key indicators of the
impact were identified: drug level costs, dosing adjustment costs,
costs/admission, total costs, length of stay, quality of life, levels/patient,
days to goal of therapy and courses with pharmacokinetics goals. Eight
of the nine indicators showed a positive impact of the pharmacist in
cystic fibrosis. Twenty-four key indicators about the role of pharmacists
were identified. Amongst the pharmaceutical activities, pharmacists
were providing medication reconciliation, patient counseling, drug
therapy evaluation, pharmacokinetics consultation, drug information and
medical rounds.
Kerry Wilbur, College of Pharmacy, Qatar University, Doha,
Qatar; Jason Kur, Artus Health Centre & University of British Columbia,
Vancouver, BC
Rationale: Pharmacists have assumed medication management roles in
both inpatient hospital and outpatient primary health care settings;
however, proliferation of pharmacists in private practices is not yet
pervasive. (CSHP 2015 Objective 2.1). Established multidisciplinary
teams may not recognize the potential contributions of pharmacists
joining these settings, which may contribute to barriers to integration
and patient care.
Conclusion: There are limited data published about the role of
pharmacists in cystic fibrosis. While it seems relevant to support such
clinical implication, pharmacists involved in that program of care should
better document and evaluate their impact.
Objective: Explore the attitudes and perceptions among
multidisciplinary members of a private rheumatology clinic towards the
skills and responsibilities of a pharmacist joining their practice.
CSHP
Methods: The physicians, nurse, physiotherapist and office
2
administrators of a private rheumatology clinic were invited to
participate in focus group and semi-structured interviews to discuss their
understanding of pharmacist skills and knowledge and how they would
foresee a pharmacist assuming patient care responsibilities in their
current setting. Sessions were audio recorded and transcribed verbatim.
Thematic content analysis of the data was supported with nvivo10
software.
Evaluation of a Change in Clinical
Pharmacist Practice Model in a Community
Hospital
Monica Lee, Jenny Chiu, Saadia Fazil, Edith Rolko, North York General
Hospital, Toronto, ON
Rationale: North york General is a 420-bed community hospital staffed
with 23 full-time equivalent (FTE) clinical pharmacists. Historically, clinical
pharmacists rotated through different areas and were not assigned to
specific units. It was determined that a change from this rotation-based
model to a designated unit-based model would enable pharmacists to
develop clinical expertise and improve service to patients and staff.
Results: Discussions with two physicians, the nurse, the physiotherapist
and one office administrator were conducted. Concepts related to two
key themes emerged from the seeding questions and included positively
viewed pharmacist roles broadly related to activities that encompass
provision of drug information and management of medications. Less
enthusiasm was found for pharmacist documentation of their patient
assessments and care plans in the shared medical record. Disparate
views arose regarding anticipated volume of pharmacist responsibilities
and independent follow up with patients. Most members were not
comfortable with pharmacists conducting physical assessments and
impressed the need for a team member who could adapt to variations in
workflow preferences across rheumatologists in the practice.
Description and Steps Taken: Clinical pharmacists were asked to
provide the units they preferred to service. The pharmacy leadership
group then discussed and finalized assignments. The designated
unit-based model was implemented in early 2012. A one-year
post-implementation survey was developed to evaluate pharmacists’
view of how this change has affected job satisfaction, workload and
contribution to patient care. Clinical pharmacists who worked 30 hours
per week or more, and have practised in both models for at least one
year were invited to participate.
Conclusions: Overall, existing multidisciplinary staff exhibited
Evaluation: An on-line survey consisting of nine questions was sent to
favourable attitudes towards a pharmacist joining their practice setting,
but expressed conflicting concerns regarding sufficient workload to
support a full-time position.
15 pharmacists, of which 14 (93%) responded. Eleven (79%) pharmacists
indicated that their job satisfaction has improved with the new model.
All respondents agreed that they would better cultivate clinical expertise
with the designated unit-based model. However, most considered the
rotation-based model to be associated with the development of a
broader scope of skills and knowledge. Interestingly, 9 (64%)
respondents felt less comfortable covering units that were not their
designated units. With respect to workload, 6 (43%) felt that workload
has increased with the new model, while 7 (50%) perceived no change.
Thirteen (93%) pharmacists believed the quality of care provided with
the designated unit-based model to be superior to the rotation-based
model.
Impact and Role of Pharmacists in Cystic Fibrosis
Aurélie Guérin, Denis Lebel1, Jean-François Bussières1,2
Pharmacy Department and Pharmacy Practice Research Unit, CHU
Sainte-Justine, Montréal, QC
2
Faculty of pharmacy, Université de Montréal, Montréal, QC
1
Rationale: Cystic fibrosis is an autosomal recessive genetic disorder that
affects the lungs, the pancreas, the liver and the intestine. The
pharmacotherapy contributes to a better quality of life, reduced
hospitalizations and prolonged survival.
Importance: Overall, clinical pharmacists considered the change in
practice model to be positive. Further studies should be conducted to
examine how patients and staff perceive this
Objective: The aim of this study was to review the literature on the
impact and the role of pharmacists in cystic fibrosis.
Médias sociaux, comportements en ligne et pharmaciens :
lignes directrices et réflexions
Study Design and Methods: A Web portal about the evidences of the
impact and the role of pharmacists in specific diseases, programs of care
or pharmaceutical activities was developed. A literature search on
Pubmed® was conducted: pharmacist OR clinical pharmacy OR
pharmaceutical care AND cystic fibrosis. Articles about the role and the
impact of pharmacists in cystic fibrosis in French and English from
1990-2013 were included. For each article included in the analysis, key
indicators that document the impact of pharmacist with statistical
analysis and the role of pharmacists with only quantitative or qualitative
metrics were identified. All relevant pharmaceutical activities in that
context were also identified.
Aurélie Guérin, Denis Lebel, Jean-François Bussières, CHU
Sainte-Justine, Département de pharmacie et unité de recherche en
pratique pharmaceutique, Montréal, QC
Justification : Avec l’émergence de nombreux outils de
communications, la place des médias sociaux comportent de
nombreuses opportunités et défis pour les pharmaciens et ses
collaborateurs.
59
Objectifs : Recenser et comparer les lignes directrices et normes
pouvant contribuer à l’encadrement des comportements en ligne
professionnels.
Conclusion : Avec l’émergence de nombreux outils de communications
et le développement des médias sociaux, 11 sociétés savantes ont
publié des lignes directrices pour encadrer le comportement en ligne
des professionnels dans le domaine de la santé.
Méthodologie et démarche de l’étude : Étude descriptive. À partir
Voir tableau ci-dessous.
d’une revue documentaire, nous avons identifié les principales lignes
directrices de société savantes médicales et pharmaceutiques publiées
sur les médias sociaux. Nous avons ensuite comparé le contenu et la
portée des lignes directrices proposées.
CSHP
2
Résultats : Nous avons recensé 11 lignes directrices de 11 sociétés
savantes dont quatre canadiennes, trois américaines, deux britanniques
et une australienne. Dix sociétés savantes sont médicales et une
pharmaceutique. Treize paramètres ont été extraits des lignes directrices.
Quatre paramètres font davantage consensus à savoir la protection des
renseignements personnels des patients, le respect de la frontière
professionnel-patient, l’évitement de la communication des
renseignements personnels sur soi et la saisie des enjeux des
communications en ligne. Il existe peu de balises en pharmacie et les
pharmaciens doivent être sensibilisés aux opportunités et enjeux reliés
aux comportements en ligne.
Paramètres
1. Assurer la protection des renseignements
personnels des patients
Bonnie Thieu, North York General Hospital, Toronto, ON
Rationale: Sedative agents are commonly used in mechanically
ventilated patients to control agitation. These include opioid analgesics,
benzodiazepines, and propofol, all of which can cause delirium and
respiratory depression. Dexmedetomidine is an alpha-2 adrenergic
agonist that does not cause respiratory depression and may be
associated with a lower risk of delirium. As a result of its favourable
profile, our institution has recently added dexmedetomidine to the drug
bMA
A/NZ
GMC
ACP
AMA
ASHP
AMC
X
X
X
X
X
X
X
2. Exercer une prudence quant au partage
de données relatives aux cas cliniques, aux
anecdotes et expériences pratiques
X
X
3. Échanger des renseignements et
documenter ces échanges après
consentement éclairé des patients et
soignants
X
5. Respecter la frontière
professionnel-patient
X
X
X
6. Éviter de communiquer des
renseignements personnels sur soi
X
8. Surveiller sa présence sur le web
9. Identifier clairement son identité et
déclarer ses conflits d’intérêts
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
11. Fournir des conseils conformes aux
meilleures données disponibles et aux
données probantes
X
X
X
X
X
X
12. Comprendre les technologies utilisées et
les publics rejoints
X
X
X
X
CMQ
X
10. Obtenir les consentements appropriés et
mentionner l’origine des renseignements
divulgués
13. Saisir les enjeux des communications en
ligne et l’ensemble du cadre juridique
applicable
ACPM CMPNb CPSbC
X
4. Comprendre et utiliser adéquatement les
paramètres de gestion de la protection
des renseignements
7. Être conscient de son image en ligne et
de son influence sur la profession
Experience with Dexmedetomidine in a Medical
Intensive Care Unit at a Community Teaching
Hospital
X
X
X
X
X
X
Légende: bMA : british Medical Association, A/NZ-MACDT: Australian Medical Association Council of Doctors- in-Training, New Zealand Medical
Association Doctors-in-Training Council, New Zealand Medical Students’ Association, Australian Medical Students’ Association, Australian Medical
Association, GMC: General medical council, ACP-FSMb: American College of Physicians and the Federation of State Medical board, AMA: American
Medical Association, ASHP: American Society of Health-System Pharmacist, AMC: Association médicale canadienne, ACPM : Association canadienne
de protection médicale, CPSbC: College of Physicians and Surgeons of british Columbia, CMPNb : Collège des médecins et pharmaciens du Nouveau
brunswick et CMQ: Collège des médecins du Québec.
60
formulary. However, due to the high cost of this drug, strict guidelines
have been established for its use, which outline specific indications,
contraindications, and maximum duration of therapy.
Rationale: A quality improvement initiative was undertaken to examine
and characterize aspects of antimicrobial therapy in patients with sepsis
or severe sepsis/septic shock.
Objective: To evaluate adherence to hospital guidelines for the use of
Objectives: The primary objective was to evaluate empiric antimicrobial
dexmedetomidine by clinicians.
prescribing for sepsis and severe sepsis/septic shock as a surrogate of
adherence to hospital treatment guidelines. The secondary objectives
were to determine the timing of administration, adequacy of the
spectrum of initial therapy and frequency of modifications.
Methods: We conducted a retrospective chart review of all patients
initiated on dexmedetomidine in the medical intensive care unit (ICU)
from January 1, 2012 to December 31, 2012. The primary endpoint was
overall concordance with hospital guidelines, including the indications
for which dexmedetomidine was prescribed; the presence of any
contraindications; and the total duration of therapy. Descriptive statistics
was used to analyze the data.
Study Design and Methods: Retrospective chart review was
performed using a convenience sample of sequentially selected records
with a diagnosis of sepsis or septic shock. Adherence (full and partial)
was evaluated by comparing the empiric regimen (antibiotic, dose, route,
timing) to the hospital treatment guidelines. Adequacy of the initial
regimen was determined using microbiology results and
guideline/expert consensus when the former was inconclusive.
Opportunity for spectrum modification was assessed by expert
consensus.
Results: Over the 1-year period, 13 patients were prescribed
dexmedetomidine. All patients had one or more of the approved
indications. However, 9 patients (69%) also had 1 or more
contraindications to the use of dexmedetomidine. In addition, 7 patients
(46%) remained on the drug for longer than the recommended duration
of 72 hours. Overall, none of the dexmedetomidine use was in complete
concordance with hospital guidelines.
Results: Seventy charts were reviewed, of which 66 met the inclusion
criteria (34 sepsis, 32 severe sepsis/septic shock). Regimens prescribed
for 35 patients were evaluable for adherence. The most common reason
for exclusion from the adherence analysis was a suspected site of
infection not addressed in the guidelines (22/31). Adherence of the
prescribed regimen to the guidelines was found in 15/35 (43%) with only
3 of these being fully adherent. Antibiotics were administered within 1
hour of the diagnosis of severe sepsis/septic shock in 15/32 (47%)
patients. The initial spectrum was deemed adequate in 49/66 (74%)
patients. The opportunity for spectrum modification existed in 20/29
cases in which no change was made.
Conclusions: The use of dexmedetomidine was discordant with
guidelines established by our institution with respect to indications,
contraindications, and duration of therapy. It is necessary to identify
barriers to adherence, revise the guidelines, and re-educate the ICU
team.
CSHP
2
Adherence to Hospital Sepsis Treatment
Guidelines
Conclusions: Several areas for improvement in the sepsis initiative at
I. Wong1, S. Elsayed2,3, G.W. Thompson3,
A.M. Bombassaro3,4, J. Newman4
this institution were identified. A minority of evaluable patients received
empiric antimicrobial therapy adherent to the treatment guidelines.
Gaps were noted in the scope of the guidelines, timely antimicrobial
administration, adequacy and modification of the initial spectrum.
School of Pharmacy, University of Waterloo, Waterloo, ON
Departments of Microbiology & Immunology and Pathology &
Laboratory Medicine, Western University, London, ON
3
Department of Medicine, Western University, London, ON
4
Pharmacy Services, London Health Sciences Centre, London, ON
1
2
2012-2013. The number of manufacturers involved in drug shortages
decreased from 58 in 2011–2012 to 38 in 2012–2013. Most of the drug
shortages in 2012–2013 involved generic drug manufacturers, which
represented 85% of the total number of drug shortages and 87% of the
total number of drug-shortage days. Most therapeutic classes were
affected by shortages in 2012–2013. The main drug classes affected
were central nervous system agents (23%), cardiovascular drugs (13%)
and anti-infective agents. The percentage of parenteral formulations
among the total number of drug shortages increased from 33% in
2011-2012 to 36% in 2012-2013. In terms of duration, parenteral
formulations drug shortages accounted for and increased from 37% of
days in 2011-2012 to 47% in 2012-2013.
TUESDAY, FEBRUARY 4
MARDI 4 FÉVRIER
Drug Shortages in Health Care Institutions: Perspectives in
Early 2014
Isabelle Barthélémy, Denis Lebel, Jean-François Bussières, CHU
Sainte-Justine, Montreal, QC
Rationale: The drug shortage crisis represented a total opportunity cost
of more than half a million dollars for five Quebec University Hospital
Centers and contributed to the postponement of pharmaceutical
activities.
Conclusion: A decrease in the number of drug shortages was observed
for 2012-2013, but there was an increase in the percentage of parenteral
formulations drug shortages and duration. There was also an increase in
the number of drug shortages involving generic manufacturers.
Objectives: To describe drug shortages for the period of 2006-2013.
Study Design and Methods: Retrospective study. Drug shortages
data have been collected from the Fridaypm.com Website since 2006.
The number of drug shortages, average duration, number of
manufacturers involved and therapeutic classes involved were collected
for each year.
Adverse Drug Reaction–Related Hospitalizations Among
Seniors, 2006 to 2011
Results: From 2006-2013, the annual number of drug shortages was of,
respectively, 493, 400, 441, 679, 429, 1081 and 497. A 46% decrease
was observed in 2012-2013 compared with 2011–2012. An increase in
the average duration of drug shortages was observed, from 108±130
days in 2006-2010, to 103±85 in 2011-2012 and to 168±153 in
Michele Arthur, Michael Gaucher, Canadian Institute for Health
Information, Ottawa, ON
Rationale: Adverse drug reactions (ADRs) are defined by the World
Health Organization as adverse effects of a drug that was properly
administered in the correct dose, for therapeutic or prophylactic use.
61
Seniors are at greater risk for ADRs, as well as other types of
drug-related adverse events, due to the number of drugs they take,
their higher prevalence of certain chronic conditions and age-related
changes in the body.
A formal evaluation is planned to assess the contribution of this process
to improving access and communication around home medications
initiated in the ED.
Objectives: This analysis examines the prevalence of ADR-related
CSHP
hospitalizations among seniors. It also examines the drugs and the types
of reactions most commonly associated with these hospitalizations.
2
Discharge Abstract Database and Hospital Morbidity Database from all
Canadian provinces. Hospitalizations due to ADRs were identified using
ICD-10 diagnosis and external cause codes.
Rationale: The Rehabilitation and Progressive Care Unit (RPCU) at
North york General Hospital has the third highest number of
medications dispensed among all medicine units. Patients in this unit are
on average 85 years or older with multiple comorbidities, thus putting
them at high risk of polypharmacy. The pharmacist can play an important
role in minimizing inappropriate drug therapies while these patients
await discharge to the next level of care.
Results: In 2010–2011, 1 in 200 Canadian seniors was identified as
having an ADR-related hospitalization (five times more than non-seniors).
Anticoagulants were the drug class most commonly associated with
ADR-related hospitalizations. The most common diagnosis associated
with anticoagulants was bleeding. Other drugs commonly associated
with ADR-related hospitalizations were antineoplastic drugs and opioids
and related analgesics. The most common diagnosis associated with
ADR-related hospitalizations due to antineoplastic drugs was
neutropenia, while the most common diagnosis associated with
opioid-related hospitalizations was constipation.
Description and Steps Taken: A literature review was performed to
establish the approach to reducing polypharmacy. Six criteria were used
when considering whether a medication was unnecessary, or dose or
duration of therapy was excessive. A documentation form was
developed to guide the process of assessment and to document the
intervention plan and outcomes. Medication reviews were systematically
performed by the unit pharmacist within 72 hours of a patient’s transfer
to the RPCU. The process was piloted between January and March 2013.
Conclusion: Many of the commonly observed ADRs were well known
reactions. Although it is not always possible to prevent an ADR from
occurring, patient monitoring and education are important to ensure
that ADRs can be identified quickly so that harm to the patient, and in
turn the likelihood of hospitalization, can be minimized.
2
Sonia Wang, Monica Lee, North York General Hospital,
Toronto, ON
Study Design and Methods: This analysis used data from the
CSHP
Reduction of Polypharmacy in a Rehabilitation
and Progressive Care Unit
Evaluation: During the 3-month period, 106 (81%) of the 131 patients
in the RPCU had their medications reviewed by the unit pharmacist.
Forty-eight drug therapy problems related to unnecessary medications
or excessive dose or duration were identified in 29 (27%) patients. Of
the recommendations made by the pharmacist, 44 (92%) were accepted
by the physicians. The average time between identification and
resolution of a drug therapy problem was 2.4 days. Common classes of
drugs identified to be unnecessary include anticoagulants, laxatives,
anti-infectives, and vitamins.
Development of a Process to Ensure Timely
Home Medication Access for Patients Awaiting
Admission in the Emergency Department
Shelita Dattani, Queensway Carleton Hospital, Ottawa ON
Rationale: In our Emergency Department (ED), patients frequently wait
several hours before a final decision is made for admission to hospital.
These patients do not consistently receive their home medications
during this time as a complete Medication Reconciliation is usually not
performed until the point of admission. This has great potential to
compromise patient safety and efficiency of care.
Implications: Minimizing polypharmacy in the elderly patients can
reduce the risk of adverse effects, and improve compliance and quality
of life. The RPCU unit is a perfect setting for conducting thorough
medication reviews and discontinuing any inappropriate drug therapies,
since patients are closely monitored by a collaborative healthcare team.
The interventions may ultimately improve patient safety and reduce cost
to the healthcare system.
Description: Our multidisciplinary task group developed a consistent
and streamlined process in order to:
CSHP
A. Ensure timely access to patient’s home medications during longer ED
stays
2
b. Enhance interdisciplinary communication of home medication
initiation prior to admission.
What Doses Should Our Chemotherapy Robot
Prepare?
Rita Kwong, Roy Lee, Jeanne Chu, Tamara Rumsey, Princess
Margaret Cancer Centre, Toronto, ON
Steps Taken to Implement Change: In order to minimize duplication
of successful processes, our pharmacist-led multidisciplinary team
evaluated a modification of our current best Possible Medication History
(bPMH) form.
Objective: Manual preparation of parenteral chemotherapy doses
poses inherent patient and occupational safety risks. In 2012, an Iv robot
was installed in our chemotherapy pharmacy that serves over 120
patients daily in our outpatient systemic chemotherapy unit and also 130
oncology inpatients. The pharmacy implementation team developed a
list of criteria to identify the cancer treatment drugs to be prepared by
the robot. The drug list was used to guide the ramp up during
implementation.
This tool was designed to:
A. Trigger completion of a bPMH on patients remaining in the ED
greater than four hours.
b. Provide an opportunity for the ED physician to continue home
medications as needed for patients with longer ED stays.
Method: The pharmacy team analyzed the robot’s efficiency factors and
technological limitations to identify those drugs and doses that are
technically compatible with the robot. Past chemotherapy order records
were used to assess frequency of prescribing for each drug. Drug
characteristics and drug distribution workflow for both just-in-time and
next day model of care were also reviewed. The team then developed
specific selection criteria for chemotherapy drugs that would benefit
from robotic production and their priority in the implementation.
Evaluation: A pharmacist conducted education and brainstorming
sessions with ED and pharmacy staff prior to modification and
implementation of the revised form.
After implementation, focus group surveys revealed that modification to
our bPMH form has motivated staff to complete medication
reconciliation for those patients with longer ED stays and has improved
patient’s early access to home medications.
Results: All chemotherapy drugs used at the cancer centre were
identified and categorized based on the selection criteria that included
frequency of use, supply format, presence of barcodes, drug stability,
usual dose volume, applicable dispensing format, and cost. The drugs
were then grouped in priority for production ramp up.
Relevance to Current and Future Practice: This
multidisciplinary–driven process change has improved efficiency of care
in the ED and through admission. It contributes to a safer and enhanced
patient experience in the hospital.
62
Conclusion: Thirty-three drugs used in our centre were identified as
Design/Methods: Using a naturalistic design, data was collected by
convenient sampling from a single community mental health recovery
center at baseline, pre implementation of the smoking cessation
program, and then compared at six to eight weeks into the program.
Sessions involved education, information, activities, games, coping
methods, support, and encouragement weekly for one hour.
potentially compatible with the robot based on known enhancements to
be released by the vendor. As of September 2013, we had implemented
the drugs in our first phase with over 9 frequently dispensed hazardous
drugs being prepared by the robot. Additional drugs will be added as
we modify our workflow and as the known product enhancements are
released.
Results: Number of cigarettes smoked per day was reduced from a
mean of 24.13 (SD 9.471) to 1.5710 (SD 4.72) for those who remained
enrolled in the program at weeks six to eight, p=0.005. A minimum of
13 cigarettes daily decreased to a new minimum of zero. A maximum of
50 cigarettes daily dropped to a maximum of 15. Nicotine dependence
could not be assessed given number of non-smokers at data collection,
there were no reflective changes to medications, and overall satisfaction
of the program appeared positive.
The Effect of Residual Renal Function and Other Patient
Factors on Gram Positive Peritonitis Outcomes
Rachel Whitty1, Philip Lui1,2, Alex Kiss3, Linda Dresser1,2 and Joanne M.
Bargman1
Faculty of Pharmacy, University of Toronto, Toronto, ON
3
Sunnybrook Research Institute, Toronto, ON
1
2
Conclusions: The smoking cessation group intervention provided
benefit to those who remained enrolled; further investigation should be
explored using larger scale trials.
Rationale: Gram positive organisms are the most common cause of
peritonitis in patients treated with peritoneal dialysis (PD).
Pharmacokinetic studies have indicated that clearance of antibiotics is
higher with Continuous Cyclic Peritoneal Dialysis (CCPD) than
Continuous Ambulatory Peritoneal Dialysis (CAPD), and that patients
who are non-anuric have lower cefazolin concentrations compared to
patients who are anuric. Few studies have examined how these and
other factors affect peritonitis treatment outcomes.
Comparison Among Atovastatin, Rosuvastatin and
Pravastatin with Focus on Efficacy and Safety Profiles
Lolwa Barakat1, Amin Jayyousi2, Abdulbari Bener3,4,5, Bilal Zuby6, and
Mahmoud Zirie2
Departments of Pharmacy and Clinical Pharmacy, Hamad General
Hospital, Hamad Medical Corporation, Doha, Qatar
2
Departments of Medicine and Endocrinology, Hamad Medical
Corporation, Doha, Qatar
3
Department of Medical Statistics and Epidemiology, Hamad Medical
Corporation, Doha, Qatar
4
Departments of Public Health and Medical Education, Weill Cornell
Medical College in Qatar, Doha, Qatar
5
Department of Evidence for Population Health Unit, School of
Epidemiology and Health Sciences, The University of Manchester,
Manchester, UK
6
Pediatric Intensive Care Unit, Department of Pediatrics, Hamad
Medical Corporation, Doha, Qatar
1
Objective: The objective of this study was to determine the effect of
PD modality, renal creatinine clearance, and other patient factors on
gram positive peritonitis treatment outcomes in patients treated with PD.
Methods: between 2003 and 2010, all gram positive peritonitis
episodes treated with cefazolin at a large tertiary care hospital were
included. A Cox proportional hazards model was used to examine the
relationship between the primary outcome, time to resolution of the
intraperitoneal (IP) white blood cell (WbC) count, and the following
factors: PD modality, renal creatinine clearance (CrCL), PD vintage,
hospitalization during peritonitis treatment, age, change in antibiotic
during peritonitis treatment, and cefazolin dose per kilogram of body
weight. Polymicrobial infections were excluded.
Rationale: Qatar has a high prevalence of diabetes and heart disease.
Results: There were 119 patients with 177 peritonitis episodes in this
Statins are commonly prescribed in diabetic patients with dyslipidemia.
Data is lacking to show head to head comparison of the 3 most
commonly prescribed statins in Qatar with regards to effect on serum
lipid levels and safety profiles on muscular, hepatic and renal functions in
diabetic patients in this country.
study. Lower CrCL was associated with a greater likelihood of resolution
of the IP WbC count (p=0.0002). Shorter duration of PD was associated
with a greater likelihood of resolution (p=0.005). Interestingly, age was
also statistically significant (p=0.03) with older age associated with
greater resolution.
Objectives: To compare the effects of atorvastatin, rosuvastatin and
Conclusions: Longer PD vintage may be associated with changes to the
pravastatin on lipid profile and possible impact on muscular, hepatic and
renal functions.
peritoneal membrane that leads to decreased resolution. The
association between greater renal function and non-resolution suggests
renal cefazolin clearance contributing to lower cefazolin concentrations
and treatment failure. The unexpected association of younger age with
non-resolution warrants further investigation.
CSHP
2
Study Design and Methods: A retrospective observational study on
350 consecutive diabetic patients with dyslipidemia who were
prescribed any of the 3 statins, during the period September 2005 –
September 2009. Data on lipid (serum triglycerides (TG), total
cholesterol (Chol), high-density lipoprotein (HDL-C) and low-density
lipoprotein (LDL-C) levels), muscular (creatinine phosphokinase), hepatic
enzymes (Alanine transaminase (ALT), aspartate transaminase (AST) and
alkaline phosphatase (ALP)) and renal (serum creatinine,
microalbuminuria & glomerular filtration rate) profiles were collected at
baseline and after 2 years of treatment, using Electronic and paper
patient records.
Can a Collaborative Community Mental Health
Smoking Cessation Program Reduce Cigarette
Consumption?
Kayla Cameron & Andrew Brillant, Saint John Regional Hospital, Saint
John, NB
Rationale: To contribute to the growing body of evidence supporting
community based smoking cessation interventions in the mental health
population. Hopes include that those living with mental illness will gain
further access to alike programs where they feel accepted, satisfied, and
can obtain benefits while paving their way to a healthier lifestyle.
Results: At the end of 2 years of treatment, rosuvastatin 10 mg reduced
LDL-C by 29.03%, followed by atorvastatin 40 mg (22.8%) and
pravastatin 20 mg (20.3%). Serum triglyceride level showed greatest
reduction by 25.1% with rosuvastatin 10mg. Triglyceride levels were
reduced with atorvastatin 40 mg and pravastatin 40 mg by 21.6% and
13.5%, respectively. No effects on the muscular or hepatic profiles were
observed with any of these statins. Atorvastatin resulted in the least
number of patients with new onset of microalbuminuria (10.9%),
followed by rosuvastatin (14.3%) and then pravastatin (26.6%).
Objectives: Determine if a smoking cessation group based program
would result in a reduced number of cigarettes smoked per day.
Secondary aims included changes in nicotine dependence, medication
changes reflective of smoking reduction, and participant satisfaction.
63
Conclusion: In Qatari diabetic dyslipidemic population, the most
Douglas M.1, Goldszmidt M.1,3, Johnson N.1, Glover C.1, Lawson S.1, Lee
S.1,2, Lemaire D.1, Loblaw C.1, Macpherson M.1, Martin M.1, Neumann L.1,
Sumpton J.1, Vandervecht A.1, Yoon J.1 and Walker R.1,3
effective statin in reducing serum LDL-C and triglyceride levels was
rosuvastatin 10 mg. The safest statin in relation to renal function was
atorvastin.
London Health Sciences Centre, London, ON
3
Western University, London, ON
1
2
The Path Forward: Solutions from a Province-Wide
University-Health Authority Engagement Initiative
Background: Medication reconciliation is a required organizational
practice by Accreditation Canada, and has been shown to reduce both
medication errors at interfaces of care and prevent adverse drug events.
Michael Legal; Donna Rahmatian; Kyle Collins; Patricia Gerber; Angela
Kim-Sing; Peter S. Loewen; Peter J. Zed, Faculty of Pharmaceutical
Description: Previous strategies to implement medication reconciliation
in one of Canada’s largest acute care teaching hospitals focused on
admission and were limited in spread across all inpatient units. The goal
of this project was to establish a medication reconciliation process at all
interfaces of care.
Rationale: It is a challenge to provide sufficient quantities of high
quality experiential placements for learners in institutional settings. In
recent years, this issue has become increasingly acute due to curricular
and program changes in Canada. There is a critical need to develop
approaches that address these challenges and ensure healthy and
adaptable experiential programs in the future.
Action: A strategy was devised to implement a new process and forms.
The medication reconciliation project team engaged with various
stakeholders to ensure successful adoption and implementation. broad
stakeholder communication strategies were used to inform and sustain
change. The educational process included:
Approach: A comprehensive and rigorous methodology was employed
to engage preceptors, learners and health authority leaders in british
Columbia. Root causes for capacity challenges were identified and
potential solutions articulated. Local feedback was combined with
recommendations from the literature and best practices from across
North America.
• Early general information sessions with frontline staff and leadership;
• Creation and distribution of tools and resources including workflows,
web-based training modules, posters, and presentations;
Solutions: Several broad areas of solutions were identified: health
authority- faculty partnership, novel learner-preceptor models, direct
faculty support for preceptors and learners, learner preparation, and
enhanced experiential office. Formal, mutually beneficial partnerships
between the faculty and health authorities will ensure preceptors and
sites are equipped to provide optimal experiences for learners, while the
faculty will benefit from a reliable supply of placements. The faculty will
promote the use of pairs, small tiers and facilitated multi-placements for
junior learners. Dedicated clinical faculty or protected teaching time for
preceptors will address workload concerns and teaching support needs.
A comprehensive preceptor development program that leverages
technology and preceptor networks will ensure preceptors have the
skills to teach. The addition of an early hospital practice experience and
inclusion of acute care content in the curriculum will improve the
preparedness of learners. Creation of a user friendly “preceptor portal”
on the Faculty’s website will provide an enhanced customer oriented
approach.
• Unit specific planning, workflow reviews, and follow-up sessions led by
the project team with clinical and clerical staff; and
• Unit specific educational sessions led by clinical educators for all
frontline staff and by the project team for prescriber and pharmacy
staff.
Evaluation: The project team and Health Records set up a process to
abstract information from the medication reconciliation forms and
generate reports that would assess staff and prescriber compliance.
See table below.
Implication: Medication reconciliation was successfully implemented at
admission, transfer, and discharge across all inpatient units of this
institution as of June 2012. The process continues to be successful and
sustainable. Institutions that are in the process of fully adopting
medication reconciliation would benefit from using similar strategies to
be successful in implementing this vital patient safety initiative.
Implications: While these solutions will require substantial investment
Facilitation of Medication Reconciliation by a
Clinical Registered Pharmacy Technician in an
Orthopedic Unit of a Community Hospital:
A Pilot Project
CSHP
and the commitment of all parties involved, the result will be a modern,
collaborative, and adaptable institutional experiential program. These
solutions could have broad applicability to other jurisdictions in Canada.
CSHP
2
2
Successful Medication Reconciliation
Implementation in a Multi-site Acute Care
Facility
Lindsay Yoo, Jenny Chiu, Jocelyn Jackson, Mary Salgado-Corpuz, Yuen
Chan-Lau, Joyce Choy, Edith Rolko, North York General Hospital,
Toronto, ON
Facca N.M.1, Ahrari S.1,2, Jansen S.1, Sellery C.1, Laman D.1, Bogorad I.1,
Andress P.1, Runnels R.1,2, Barbour G.1, Buschell P.1, Caldwell K.1,
Channon C.1, Creasor L.1, Davies M.1, Delamere K.1, Dhaliwal S.1,2,
Compliance (%) with Medication Reconciliation
Preadmission
Site 1
Site 2
Admission
Site 1
Site 2
89.6
verification of best
Possible Medication
History
Site 1
Site 2
85.7
Transfer
Site 1
Discharge
Site 2
Site 2
70
F2013 Q2
88.2
56.1
92.9
73.1
93.1
69.5
66.6
35.5
81.5
55.5
F2013 Q3
90.5
51.7
94.9
72.3
94.9
68.1
65.6
39.6
82.0
53.9
F2013 Q4
93.3
64.5
96
70.6
95.7
66.9
65.8
46.6
81.1
53.9
F2014 Q1
96.5
87.5
96.7
73.7
96.3
70.1
73.2
74.9
82.9
57.1
64
19.9
Site 1
F2013 Q1
73.1
interactive teaching session on behaviour modification. After these
group sessions, patients were individually assessed by a physician. The
selected medication was dispensed in two-week allocations at the
clinic’s pharmacy.
Rationale: A previous study at North york General Hospital identified
delays in completion of a best Possible Medication History (bPMH) to be
associated with low rates of admission Medication Reconciliation
(MedRec) performed in surgical in-patients. In order to improve the
admission MedRec rates, means to enhance the timeliness of bPMH
completion were explored.
Objective: To describe a multidisciplinary approach and its impact on
smoking cessation medication use patterns.
Description and Steps Taken: With the expanded scope of registered
Methods: A retrospective analysis was performed comparing
pharmacy technicians (RPhTs), our goal was to develop a bPMH RPhT
role to facilitate the process of conducting a bPMH. We first performed
a literature review and reviewed the experience of bPMH RPhTs at other
institutions. Then, we examined the current bPMH and admission
MedRec workflow in our hospital. Finally, we defined the role of the
bPMH RPhT and developed a bPMH training and certification program
for RPhTs. One RPhT was certified, and the bPMH RPhT role was piloted
in the orthopedic unit for approximately 1 month.
dispensing records of patients who expressed interest in smoking
cessation to a health care team member from June to December 2011
(pre-program implementation) and June to December 2012 (first 6
months after program implementation). Specifically: the selected
therapy, completion of the 12 week therapy, and first to last fill intervals
(as estimations of time spent in therapy).
See table below.
Evaluation: During the 20 days on the unit, the bPMH RPhT
interviewed 78 of 140 (55.7%) patients, who were taking an average of 7
medications. The RPhT verified the availability of patient’s own supply in
31 (67.4%) of the 46 patients who were on non-formulary medications.
based on workload data, it was determined the RPhT saved the
pharmacist 80 minutes per day in bPMH interviews and documentation.
The RPhT prioritized and referred 67% of patients for further evaluation
by the pharmacist (e.g. NF alternatives, need for influenza vaccine, etc).
Comparing this period to the same a year ago, an increase from 57.3%
to 87.9% in admission MedRec was observed.
Conclusion: Our new multidisciplinary approach was able to encourage
Importance: The bPMH RPhT role helped facilitate admission MedRec
2
more patients to initiate smoking cessation medication therapy, with an
absolute increase in the number of people completing the 12 week
therapy. Unexpectedly, there was a reduction in the proportion of
people completing therapy and a marked decrease in the estimated
time spent in therapy for those who did not complete it. Further
follow-up and analysis are required to determine the clinical significance,
and possible next steps to improve adherence.
CSHP
and potentially saved pharmacists’ time, thus allowing them to focus on
other clinical activities. This initiative should be further evaluated and
possibly expanded to other areas.
Impact des données probantes sur l’implantation
des codes-barres en milieu hospitalier
Aurélie Guérin1, Denis Lebel1, Jean-François Bussières1,2
CHU Sainte-Justine, Département de pharmacie et unité de recherche
en pratique pharmaceutique, Montréal, QC
2
1
Impact of a Multidisciplinary Program on Smoking
Cessation Medication Use Patterns
Justification : On reconnaît les difficultés inhérentes à l’implantation de
nouvelles technologies dans le circuit du médicament en hôpital.
Certains auteurs considèrent qu’il faut en moyenne plus de 15 ans au
réseau de la santé pour qu’un changement soit implanté à plus de 50%
en présence de données probantes.
Koren Lui, Livia Vodenicar, Janice Ma, Canadian Armed Forces Health
Services Group, Ottawa, ON
Background: In May 2012, a multidisciplinary smoking cessation
program was implemented at a Canadian Armed Forces medical clinic.
The program aimed to enhance patient access and convenience to
multidisciplinary support. Weekly clinics were conducted for self-referred
and medically referred patients. A pharmacist educated patients
regarding available medication therapies (nicotine replacement therapy
(NRT), varenicline, and bupropion) to aid the patients in making
informed choices. A health promotions team member followed with an
Objectifs : Évaluer les délais entre la publication des meilleures preuves
disponibles et l’implantation de lecteurs codes-barres pour
l’identification du patient durant le processus d’administration du
médicament au Canada.
Méthodologie et démarche de l’étude : Étude descriptive et
rétrospective. À partir d’une revue documentaire sur Pubmed et Google,
les meilleures preuves disponibles ont été identifiées à partir de revues
(méta-analyses, revues systématiques, revues de littérature), les études
descriptives issues de ces revues et les recommandations. Le taux
d’implantation a été calculé à partir des données des rapports canadiens
sur la pharmacie hospitalière de 1985-1986 à 2011-2012.
Results
Pre-Program
Implementation
(June-Dec 2011)
Post-Program
Implementation
(June-Dec 2012)
Self or medically
referred for smoking
cessation
201
322
Subsequently initiated
medication therapy
187
317
Champix
125 (67.2%)
222 (70.0%)
Zyban
21 (11.2%)
45 (14.2%)
NRT
40 (21.5%)
50 (15.8%)
revues de littérature (2003-2011), 16 études descriptives différentes
issues de ces revues (2002-2008) et quatre recommandations
(2004-2011). La première mention d’implantation de lecteurs
codes-barres pour l’identification du patient durant le processus
d’administration du médicament apparaît en 2001-2002. Son
implantation demeure limitée au Canada, soit 3% (2003-2004), 8%
(2005-2006), 3% (2007-2008), 6% (2009-2010) et 4% (2011-2012).
Compte tenu du faible taux d’implantation, on ne peut calculer le délai
entre la publication des meilleures preuves et l’implantation à large
échelle de lecteurs codes-barres pour l’identification du patient durant
le processus d’administration du médicament au Canada.
Completed 12-wk Tx
36 (19.6%)
48 (15.4%)
Conclusion: Il existe peu de données sur les délais observés entre la
Did not complete
12-wk Tx
147 (80.3%)
263 (84.6%)
Loss to Follow-up
First to last fill interval
4
6
72.1 days
25.6 days
Résultats : Nous avons recensé une revue systématique (2010), trois
publication des meilleures preuves disponibles et l’implantation de
technologies. S’il existe des preuves de l’utilité des lecteurs
codes-barres pour l’identification du patient durant le processus
d’administration du médicament au Canada, il est raisonnable de penser
qu’il faudra quelques années avant que cette technologie ne soit
largement implantée au Canada.
65
revues (1993-2012) et cinq recommandations (2006-2013). On
s’intéresse au préalable à l’implantation de l’histoire médicamenteuse
dès 1985-1986 au Canada. L’implantation était alors de 6%. Le terme de
réconciliation médicamenteuse apparaît en 2005-2006. En 2011-2012,
son implantation était, respectivement, de 85 % à l’admission, 47% au
transfert et de 44% au départ. En tenant compte du processus complet
de réconciliation médicamenteuse, le délai entre la publication des
meilleures preuves disponibles et l’implantation à large de la
réconciliation médicamenteuse au Canada n’est que d’une année.
Impact des données probantes sur l’implantation des
pompes intelligentes en milieu hospitalier
2
1
Conclusion : Il existe peu de données sur les délais observés entre la
nouveaux processus. L’ajout de la réconciliation médicamenteuse aux
pratiques organisationnelles requises d’Agrément Canada n’est sans
doute pas étranger au court délai d’implantation de cette pratique.
disponibles et l’implantation de pompes intelligentes au Canada.
Prescribing Patterns and Safety of Intramuscular
Olanzapine in Hospitalized Elderly Patients
les meilleures preuves disponibles ont été identifiées, soit les les revues
d’implantation a été documenté à partir des données des rapports
canadiens sur la pharmacie hospitalière de 1985-1986 à 2011-2012.
Amy Wong1, Kam-Tong Yeung2, Fran Wolfe2, Monica Lee2
1
2
Background: Intramuscular (IM) olanzapine is sometimes used to
manage acute behavioural and psychological symptoms in hospitalized
elderly patients with dementia or delirium. However, its use for this
indication is off-label and safety concerns remain.
Résultats : Nous avons recensé une revue systématique (2007), trois
revues de littérature (2008-2011), 13 études descriptives différentes
issues de ces revues et trois recommandations (2009-2012). On
s’intéresse à l’implantation des pompes intelligentes au Canada pour la
première fois en 2007-2008. Son implantation demeure importante
depuis, soit 61 % (2007-2008), 68% (2009-2010) et 75% (2011-2012).
Compte tenu du faible nombre de données probantes soutenant
l’efficience des pompes intelligentes, on ne peut calculer, le délai entre
la publication des meilleures preuves disponibles et l’implantation à
large échelle des pompes intelligentes au Canada.
Objectives: To identify prescribing patterns of IM olanzapine and
associated adverse effects, and to compare the results to those from a
case series of elderly patients who received the drug when it first
became available for these patients in 2008.
Methods: We conducted a retrospective chart review of all in-patients
aged 65 years or older who received at least one dose of IM olanzapine
between November 2010 and December 2012. Patient demographics,
comorbidities, IM olanzapine treatment details, concurrent medications,
and documented adverse effects were analyzed.
Conclusion: Il existe peu de données sur les délais observés entre la
technologies. La majorité des hôpitaux au Canada ont implanté des
pompes intelligentes malgré l’absence de recommandations de sociétés
savantes et d’études de bonne qualité. Cette implantation n’est pas
étrangère au renouvellement des équipements.
CSHP
2
North York General Hospital, Toronto, ON
Results: Seventy-six patients were identified to have received at least
one dose of IM olanzapine. Of the 100 orders, 52 (52%) were written by
psychiatrists and 32 (32%) by geriatricians. The most common
indications included agitation (64 individuals, 84%) and refusal or
inability to take oral medications (23 individuals, 30%). The mean dose
given at one time was 4.2 mg (±2.6 mg). Eighteen (24%) individuals
experienced constipation, 15 (20%) experienced lethargy and 11 (15%)
experienced drowsiness. Serious adverse effects observed included 9
cases (12%) of hypotension, 3 (4%) falls within 24 hours post dose, and 1
(1%) case of aspiration pneumonia. Compared to the previous case
series, prescribing patterns remained the same with respect to
predominant prescribers and indications. Lethargy and drowsiness
continued to be commonly experienced adverse effects while the
incidence of falls, infections and extra-pyramidal symptoms was lower in
the current cohort.
de la réconciliation médicamenteuse en milieu
hospitalier
2
1
Justification : Les différentes étapes de transition de soins du patient à
l’hôpital sont à risque majeur d’erreurs médicamenteuses. On reconnaît
par ailleurs les difficultés inhérentes à l’implantation de nouveaux
processus. Certains auteurs considèrent qu’il faut en moyenne plus de
15 ans au réseau de la santé pour qu’un changement soit implanté à
plus de 50% en présence de données probantes.
Conclusions: In the acute setting, psychiatrists and geriatricians may
disponibles et l’implantation de la réconciliation médicamenteuse au
Canada.
CSHP
prescribe IM olanzapine for behavioural symptoms in elderly patients.
Commonly experienced adverse effects include lethargy, drowsiness and
constipation. Close monitoring is the key to ensuring safe use.
2
Optimizing Pharmacotherapy in a Geriatric Day
Hospital: A Medication Use and Cost Analysis
Barbara Farrell1,2,3, Evan Steed1,2,3, Danielle Paes1,2,3, Salima
Shamji1,2, Veronique French Merkley1,2, Anne Monahan1,2
nous avons identifié les meilleures preuves disponibles, soit les revues
Bruyère Continuing Care, Ottawa, ON
University of Ottawa, Ottawa, ON
3
1
2
Rationale: Polypharmacy in the elderly is associated with adverse drug
reactions, emergency room visits, hospitalization and cost.
Deprescribing and interprofessional team interventions are important
approaches to reducing polypharmacy, pill burden and cost.
Résultats : Nous avons recensé 10 revues systématiques (2009-2013),
une revue de littérature (2005), 70 études descriptives issues de ces
66
Objective: To determine impact—on medication use and cost to a
Summary: A home care pharmacist was effectively able to resolve
clients’ high-risk medication-related issues that were unable to be
resolved by other healthcare team members.
Study Design and Methods: Pre- and post-intervention medication
numbers (prescription & non-prescription), pill burden (number of oral
doses per day) and Ontario Drug benefit (ODb) acquisition drug costs
(using lowest priced generic drug - excluding ‘as needed’ medications
and those not covered by ODb) for 8 patient cases accepted for
publication. Calculations independently verified by a second researcher.
Daily and yearly ODb program cost-savings estimates and projections
made using annual GDH admission rates.
CSHP
provincial drug program—of interprofessional medication review and
interventions aimed at optimizing pharmacotherapy for patients
admitted to a 12-week Geriatric Day Hospital program.
2
2
1
Results: Average daily per patient medication use was reduced by 4.4
medications (from 17.5 to 13.1) and average daily pill burden was
reduced by 5.2 doses (from 21.8 to 16.6). Estimated per patient
medication cost savings were $2.55 per day, with annual cost savings
projected at $930 per patient. If extrapolated to the 350 patients
admitted to the GDH each year, medication review and interventions
aimed at optimizing pharmacotherapy could result in savings of
approximately $325,000 in medication costs to ODb annually.
Limitations include highly selected patient cases, and inclusion of only
some costs related to medication use.
disponibles et l’implantation de prescripteurs électroniques au Canada.
les meilleures preuves disponibles ont été identifiées, les revues
Conclusion: Inter-professional medication review and interventions
during GDH admissions reduced medication use and pill burden with
important projected savings. Future economic modeling should include
costs relating to medications not covered by ODb, mark-up and
dispensing fees, pharmacist time spent and benefits of
pharmacotherapy optimization (e.g. reduced hospitalization, falls etc.).
CSHP
2
1
2
des prescripteurs électroniques en milieu
hospitalier
Résultats : Nous avons recensé trois méta-analyses (2008-2013), 13
revues systématiques (2003-2013), quatre revues de littérature
(2003-2010), 198 études descriptives issues de ces revues (1984-2011) et
quatre recommandations (2010-2011). On s’intéresse à l’implantation de
prescripteurs électroniques au Canada pour la première fois en
2001-2002. Son implantation demeure limitée, soit 7% (2001-2002), 5%
(2003-2004), 6% (2005-2006), 5% (2007-2008), 8% (2009-2010) et 8%
(2011-2012). Compte tenu du faible taux d’implantation, on ne peut
calculer le délai entre la publication des meilleures preuves disponibles
et l’implantation à large échelle de prescripteurs électroniques au
Canada.
Home Care Pharmacy Services:
A Demonstration Project
Douglas Doucette1, Terry Morrissey2, Ann Nickerson2
Regional Pharmacy Services, Horizon Health Network, Moncton, NB
Extra-Mural Program, Moncton Area, Horizon Health Network,
Moncton, NB
Rationale: In 2008 clinical pharmacy services were introduced to home
care clients in the Extra-Mural Program (EMP) in collaboration with a
multidisciplinary team. A second phase of the demonstration project
evaluated the pharmacist’s role in providing a feasible and sustainable
service to EMP clients. The project was intended to align pharmacy
services with EMP needs for a designated geographical area, avoid
duplication of existing services and obtain meaningful outcome
measures.
technologies. Le délai d’implantation des prescripteurs électroniques
n’est peut-être pas étranger aux coûts, à la complexité de l’implantation
et aux preuves limitées dans la littérature.
CSHP
Description of Project: This project evaluated the effectiveness of the
2
pharmacy services provided to EMP clients over a 12-month period in
2012-2013. Clients referred to the pharmacist had at least 2 previous
attempts by health care professionals to resolve the high-risk symptoms
or medication-related problems, and were classified by the clients’
likelihood for adverse outcome or admission to hospital. Once accepted
on the pharmacy caseload the pharmacist conducted a home visit to
establish a care plan and provided additional follow-up visits or phone
calls as required. Clinical and quality measures of the medication-related
issues identified were used to assess the impact of the interventions.
d’aides à la décision clinique pour les
prescripteurs électroniques en milieu hospitalier
2
1
Justification: On reconnaît les difficultés inhérentes à l’implantation de
Project Evaluation: Working with clients and healthcare team members
to establish goals of therapy, the pharmacist was able to fully or partially
resolve 305 of 330 (92.4 percent) of clients’ medication-related issues.
This result is even more compelling considering many clients were
deemed high/urgent priority based on their symptoms, quality of life, or
risk of hospital admission. Although often requested to investigate 1
unresolved symptom or issue, clients seen by the pharmacist had a
median of 5 medication-related issues. The percent of clients on the
pharmacy caseload admitted to hospital (per quarter) ranged from 21 to
50 and often involved consultation between pharmacist and attending
physician.
disponibles et l’implantation d’aides à la décision clinique pour les
prescripteurs électroniques au Canada.
les meilleures preuves disponibles ont été identifiées, les revues
67
Rationale: Unfractionated heparin (UFH) is one of the most common
drugs used in hospitals but produces heparin-induced
thrombocytopenia (HIT) in up to 5% of exposed patients. HIT leads to
thrombosis, amputations, death, and massive use of resources. Can HIT
be prevented?
Résultats : Nous avons recensé 3 méta-analyses et revues
systématiques (1999-2013), 17 revues systématiques (1998-2013), sept
revues de littérature (1994-2012) et deux rapports (2011,2012), 341
études descriptives différentes issues des revues (1957-2012) et une
recommandation (2006). On s’intéresse à l’implantation d’aides à la
décision clinique pour les prescripteurs électroniques au Canada pour la
première fois en 2001-2002. Son implantation évolue progressivement,
soit 33% (2001-2002), 14% (2003-2004), 75% (2005-2006), 58%
(2009-2010) et 75% (2011-2012). Le délai calculé entre la publication des
meilleures preuves et l’implantation à large échelle de prescripteurs
électroniques au Canada était de 5 ans, soit entre 2000 et 2005.
Objective: To examine the impact of a formal hospital-wide strategy to
limit exposure to UFH on the incidence of HIT and its consequences.
Study Design and Methods: A multi-disciplinary task force reviewed
the literature for each type of heparin exposure and prepared
recommendations for practice modifications. A comprehensive
“Avoid-Heparin Program” was implemented at a Canadian teaching
hospital in 2006 as a specific attempt to reduce HIT and improve patient
safety. This involved replacing intravenous(Iv) and subcutaneous (S/C)
UFH with LMWH for prophylactic and therapeutic indications and
removing UFH from arterial and central venous lines. The program was
evaluated by retrospective chart review.
technologies. On reconnaît que le changement est difficile et sa gestion
complexe, particulièrement au sein de grandes organisations. Il a fallu 5
années pour implanter à large échelle des aides à la décision clinique
pour les prescripteurs électroniques au Canada; le nombre de
prescripteurs électroniques implanté demeure toutefois extrêmement
limité.
Measures: All cases of suspected HIT 2003-2011 were adjudicated
using explicit criteria into Negative, HIT and HIT with thrombosis (HITT).
Outcomes in the Pre-Intervention Phase (2003-05) were compared to
those in the Avoid-Heparin Phase (2007-11).
Results: The annual number of suspected HIT cases decreased 34%
from the Pre-Intervention Phase to the Avoid-Heparin Phase (p<0.001).
Adjudicated HIT decreased 73% from 11 to 3/10,000 admissions
(p<0.001) and HITT decreased 80% from 5 to 1/10,000 admissions
(p<0.001). The hospital expenditure on HIT-safe anticoagulants also
decreased 41% in the Avoid-Heparin Phase; this led to mean cost saving
of $257,910/year.
Impact of an “Avoid-Heparin” Quality
Improvement Program on the Incidence, Clinical
Consequences and Resource Use Associated with
Heparin-Induced Thrombocytopenia (HIT)
CSHP
2
Kelly McGowan1,2, Joy Makari2,3, Peter Rempel2, Claudia Bucci1,2,3,
Artemis Diamantouros1,2,3, William Geerts1,2
Conclusion: To our knowledge, this is the first quality improvement
study demonstrating the success of a hospital-wide HIT prevention
strategy. Implementation of a simple heparin avoidance intervention can
lead to a dramatic decrease in the burden of HIT, the costs of HIT care,
and ultimately to improved patient outcomes.
Faculty of Medicine, University of Toronto, Toronto, ON
3
1
2
Poster Abstract Reviewers
Réviseurs des présentations par affiches
Sincere appreciation is extended to the Research Committee members for reviewing the
abstract submissions for PPC 2014.
David blackburn
Roxane Carr
Dawn Dalen
Scott Edwards
Sean Gorman
Janice Irvine-Meek
Natalie Kennie
Marc Perreault
Ajudicators:
Céline Corman
Sheri Koshman
68
CSHP New Fellows
Nouveaux associés de la SCPH
publications, posters and oral presentations to her credit. She has
received the Award for Teaching Excellence from Memorial’s
School of Pharmacy on two occasions and has been recognized
with several awards for her commitment to the pharmacy
profession. Notable among these include being named as the
Preceptor of the year for the University of Colorado in 2010 and
receiving the Alfred G. Dawe Distinguished Service Award in 2006
for her contributions to CSHP at the branch level.
CSHP Fellow status is conferred by the board of Fellows upon
CSHP members who have demonstrated noteworthy, sustained
service and excellence in the practice of pharmacy in an
organized healthcare setting.
She has held a variety of leadership positions with a number of
professional organizations including CSHP, where she is currently
serving as Senior Advisor and Membership Committee chair for
the NL branch. She has previously held positions with the NL
branch executive including: President, Secretary, and Treasurer,
and has served as co-chair of the national AGM in 2003. Dr.
bishop is also a member of the Canadian Pharmacy Practice
Research Group, the Association of Faculties of Pharmacy of
Canada (AFPC), Pharmacists Association of NL and the NL
Pharmacy board. She is also a member of the Canada Health
Infoway/AFPC’s Informatics project working group and serves as
an expert advisor for the NL Peer-to-Peer Project, an initiative of
the NL Centre for Health Information.
Board of Fellows 2013-2014
Conseil des associés 2013-2014
Chairperson
Présidente:
Kris Wickman, FCSHP
Chair-Elect:
Président désigné
Shallen Letwin, FCSHP
Past Chair
Président sortant:
Board Members
Membres du Conseil:
Janice Irvine-Meek, FCSHP
James Mann, FCSHP
Régis vaillancourt, FCSHP
Pat Trozzo (ex-officio
member)
Peter Loewen, FCSHP
David Blackburn, BSP, PharmD, FCSHP
Lisa Bishop, PharmD, FCSHP
David blackburn is an Associate Professor
and Chair in Patient Adherence in the
College of Pharmacy and Nutrition, at the
University of Saskatchewan. He is also the
Director of the Saskatchewan Drug Utilization
and Outcomes Research Team (SDUORT).
After graduating with a bachelor of Science
in Pharmacy in 1995 from the U of S, David
worked briefly as a community pharmacist
before completing a hospital residency program in Saskatoon and
then moved to Toronto to complete a Doctor of Pharmacy
degree from the University of Toronto in 2001. His research
program is focused on patient adherence, drug utilization, health
outcomes, and chronic disease management in primary care
settings. He has extensive experience in the use of the
Saskatchewan’s health-administrative databases for studying the
use of prescriptions and their influence on health outcomes. He
continues to teach undergraduate pharmacy students and trains
Master’s and PhD level candidates in the College of Pharmacy &
Nutrition. His ultimate goal is to discover the true determinants of
medication non-adherence in order to design effective and
practical solutions for this public health epidemic.
Dr. Lisa bishop is an assistant professor
with the School of Pharmacy at
Memorial University with a cross
appointment to Memorial’s Faculty of
Medicine. She is a family practice pharmacist
in an interdisciplinary teaching clinic where
she provides pharmaceutical care to the
patients at the clinic. Dr. bishop is also a
former critical care pharmacist from
Eastern Health in St. John’s.
Dr. bishop began her pharmacy career as a student in Memorial’s
bachelor of science in pharmacy program. Upon graduation she
began working as a staff hospital pharmacist and a community
relief pharmacist in St. John’s, eventually going on to complete a
hospital pharmacy residency at St. Joseph’s Hospital in Hamilton,
Ontario. Dr. bishop returned to Newfoundland and Labrador (NL)
in 1998 and began working as a critical care pharmacist, a
position she held until 2006. She then joined Memorial University
as a clinical faculty member. She completed a Non-Traditional
Pharm.D from the University of Colorado in 2007.
Dr. bishop has made a significant contribution to hospital and
community pharmacy practice in NL at a number of levels in the
last 18 years. Her work with the critical care program with Eastern
Health and her time as a family medicine pharmacist have
advanced the provision of quality patient care in this province.
Her current role is one that she established in a family practice
clinic that also serves as an academic teaching site for family
medicine residents. Dr. bishop has developed a new position in
this clinic, successfully integrating the role with a family medicine
team from a variety of disciplines.
Margaret Gray, BSP, FCSHP
Margaret graduated from University of
Saskatchewan with her bachelor’s degree in
pharmacy (bSP) with distinction 1987. After a
very brief stint as a community pharmacist
(weeks!), she moved to Edmonton where she
worked as a hospital staff pharmacist at
Misericordia Hospital (1987-95). Her clinical
practice areas included internal medicine,
pharmacokinetics and ICU/CCU. She initiated
Dr. bishop is also an accomplished scholar and educator with
contributions to a number of peer-reviewed journals and other
69
Mits Miyata, BScPhm, ACPR, FCSHP
a multi-disciplinary antimicrobial utilization program for the
Misericordia and then Caritas in 1991-95. When healthcare
services were regionalized in Alberta in 1995, the ICU at the
Misericordia was closed and Margaret moved into a regional
position with Capital Health as a DUE pharmacist where her focus
was on medications used in anaesthesia and critical care (1995-97).
In this role, she served as co-chair of the Anaesthesia Advisory
Subcommittee to P&T, as well as a member of regional P&T (then
DTC) from 1995-2005. In 1997 she moved from her DUE role to
an expanded antimicrobial DUE role (1997-2005), returning to her
love of infectious diseases. In 2006, Margaret took on the
challenge of joining the Clinical Practice Leader team at Capital
Health (which became Alberta Health Pharmacy Services in 2008)
where she continues to work. In this role she maintains an active
clinical practice with the adult ID consult team at University of
Alberta Hospital as well as working on clinical pharmacist practice
issues at several sites in and around Edmonton and as far away as
the Cold Lake Hospital.
Mits is a Pharmacy Director with the Lower
Mainland Pharmacy Services (LMPS), which is
a consolidation of regional hospital pharmacy
departments spanning four health authorities
in the Greater vancouver area. After
graduating from the University of british
Columbia (UbC), Mits subsequently
completed a Hospital Pharmacy Residency at
St. Paul’s Hospital (vancouver), and a Health
Care Management Program at the british Columbia Institute of
Technology (bCIT).
Mits has held numerous leadership positions during his career,
including President of the Pharmacy Examining board of Canada
(PEbC), and Chair of the board of Examiners of the College of
Pharmacists of british Columbia (CPbC). Over the years, he has
contributed to the scientific literature, and has presented his work
to his colleagues, most recently at the CSHP Summer Educational
Sessions 2013.
Through her career Margaret has been dedicated to the
advancement and promotion of the pharmacist role in healthcare.
She has precepted innumerable students, and residents students
throughout her career (recently adding PharmD students to this
list), as well as being a Clinical Academic Colleague at the
University of Alberta Faculty of Pharmacy where she teaches in
the Advanced Therapeutics and Infectious Diseases courses. She
is also a regular presenter to the U of A Medicine’s Division of ID
academic half days for the ID and medical microbiologist fellows,
as well as at the Edmonton zone divisional ID rounds. Margaret
has worked to attain her additional prescribing authority and
injection certification with the Alberta College of Pharmacists;
ensuring she is willing to walk the talk of full scope of practice.
She is currently serving as the chair of the Alberta College of
Pharmacists Competence Committee. Margaret has presented
talks at meetings including CSHP AGMs and SES, banff Seminar,
Alberta Pharmacists Association meetings, posters at AMMI
Canada (Association of Medical Microbiologists and ID), and has
published in the Annals of Pharmacotherapy as well as the
International Journal of Infectious Diseases. Margaret has served
as a contributing editor for bugs & Drugs as well as for the
University of Alberta Medicine’s publication of Drugs & Drugs.
Mits has actively served CSHP as the current PEbC Representative,
a past Executive Mentee, past Chair of the SES Sustainability task
Force, and a past Senior Chair of the Advocacy Committee. He is
an active Council member on the local CSHP bC-branch Council
and is the most recent bC branch Distinguished Service Award
recipient. He also currently sits on the bC Provincial Pharmacy and
Therapeutics Committee and well as the Drug benefits Council
for the Ministry of Health.
Outside of the work setting, Mits holds a national certification as a
power tumbling judge, is an avid distance runner and swimmer,
and is currently training for the 2014 Tough Mudder in Whistler, bC.
Jennifer Ryan, BScPhm, PharmD, ACPR, FCSHP
Jennifer Ryan is currently the Regional
Education and Research Coordinator for the
Horizon Health Network in New brunswick
and an adjunct clinical faculty member at
Dalhousie University, College of Pharmacy.
Margaret’s contribution to the profession is also evident in her
work with CSHP. She joined the society when she was still a
student at U of S. After moving to Edmonton, she served on the
Alberta branch council as chapter chair, president and then
moved to being the Alberta branch delegate from 1997-2000.
From 2000-2003 Margaret served CSHP as the vision Liaison and
president from 2001-02. She has served CSHP on several
committees, and task forces, including being the current chair of
the CSHP Advocacy Committee.
Jennifer received her bachelor of Pharmacy
in 1999 from Dalhousie University, Halifax,
Nova Scotia and completed the Canadian
Hospital Pharmacy Residency Program at the Hospital for Sick
Children in Toronto, Ontario in 2000. She received her Doctor of
Pharmacy in 2006 from the University of Florida. From
2001-present she has held several positions within the Horizon
Health Network including: Clinical Manager, Pharmacy Residency
Coordinator and Pharmacy Practice Leader in Nephrology.
Jennifer’s research interests have included areas of prevention
and medication adherence in patients with chronic kidney disease
and diabetes and pharmacy education. Jennifer has presented
nationally and internationally.
Margaret has been recognized for her contributions to the
profession and CSHP with the Practitioner and Meritorious
Service Awards from the branch, the Isobel Stauffer Meritorious
Service Award from CSHP national, and the Pharmacy Centennial
Award of Distinction from the Alberta College of Pharmacists and
Alberta Pharmacists Association.
Jennifer has served CSHP in many capacities both at the branch
and National Level including a term as president of the Nb branch,
Chair of the National Advocacy Committee, and co-chair of the
CSHP AGM planning committee in Saint John, Nb in 2009. She
continues to contribute as a reviewer for CJHP
Margaret is also active at home, managing a busy family life with
her husband, brian and two children, Ian and Lindsay.
70
she instructed and also precepted residents and PharmD students
on rotation in the internal medicine practice setting and
supervised several pharmacy residency and undergraduate
projects. She also participated in UbC’s Continuing Pharmacy
Professional Development Canadian Practice Program designed
for foreign-trained pharmacists to achieve competencies for
practice in Canada and Canadian-trained pharmacists re-entering
practice following prolonged absence.
In addition to her ongoing role in hospital pharmacy, Jennifer has
recently started a “new adventure” with her pharmacist husband
and opened a Medicine Shoppe Pharmacy in their community
town of Grand bay-Westfield, Nb.
Kerry Wilbur, BScPhm, PharmD, ACPR, FCSHP
Kerry Wilbur graduated from Dalhousie
University in Halifax with her bachelor of
Science in Pharmacy in 1997. Following
completion of the hospital pharmacy
residency program at the QEII Health
Sciences Centre, she traveled to vancouver
where she earned her Doctor of Pharmacy
degree from the University of british
Columbia in 2000. Kerry accepted a position
as a Pharmacotherapeutic Specialist at vancouver General
Hospital where she was responsible for providing pharmaceutical
care to patients admitted to internal medicine and acute care for
elders units. In 2002, she assumed the co-coordinator role of
vancouver General’s hospital pharmacy residency program and
served as chair of the bC hospital pharmacy residency committee.
In 2007, Kerry relocated to Doha, Qatar to be part of the
founding faculty of the country’s first College of Pharmacy which
was the first international program accredited by the Canadian
Council of Accreditation of Pharmacy Programs (CCAPP). She is
currently an Associate Professor and Director of the PharmD
program. In 2011, she completed a Masters of Science in Public
Health through the University of London School of Tropical
Medicine and Hygiene.
Since joining as a pharmacy student, Kerry has had the privilege
to serve CSHP in various capacities including bC branch treasurer,
National Research and Education Committee member, National
awards and CJHP reviewer, and national Membership Committee
chair. She continues to promote advanced pharmacy practice
models and link Qatar pharmacists to a wider professional
community through QU-supported CSHP-membership for all QU
PharmD students and preceptors.
During this time, she also held a Clinical Associate Professor
position in the Faculty of Pharmaceutical Sciences at UbC where
CSHP Fellows Program
CSHP Fellowship Criteria
The CSHP Fellows program was initiated over 40 years ago to
distinguish members who, through their practice activities and
contributions to CSHP and the profession, were worthy of a
recognition that signified outstanding leadership, dedication and
commitment to practice excellence and professional growth.
Please visit the CSHP website for more detailed information on
each criterion.
1. Candidate must have practiced pharmacy for at least ten years,
of which a minimum of five must have been in an organized
health care setting.
To date, 167 members of CSHP have achieved the distinction of
being recognized as a Fellow of the Canadian Society of Hospital
Pharmacists (FCSHP).
2. Candidate must demonstrate support and leadership for the
profession through active, current membership and voluntary
participation in CSHP for a minimum of five consecutive years.
Candidate must show consistent involvement, including
leadership, in professional pharmacy association activities.
Participation in APES is considered equivalent to participation
in CSHP activities. The candidate must be a current active or
honorary life member of CSHP.
The Goals of the Fellows Program are:
• To challenge CSHP members to achieve peer recognition for
practice excellence.
• To promote worthwhile contributions to the pharmacy literature.
• To promote research in pharmacy.
3. Candidate must have demonstrated sustained practice focus
and excellence.
• To promote the role of pharmacists as primary health care
professionals through active involvement in hospital,
professional, educational, and community activities.
4. Candidate must have contributed to pharmacy knowledge
through publication, presentation, and research.
• To recognize members who serve as models for others through
exemplary practice.
5. Candidate must have demonstrated ongoing commitment to
educating health care practitioners and the public.
• To apply for Fellow status, candidates are required to complete
an application which documents the member’s achievements in
several key criteria areas, and includes letters of support from
two recommenders. Each application is evaluated by members
of the board of Fellows using the following criteria.
6. Candidate must provide the names of at least two (2)
recommenders of whom he or she has requested to submit
confidential recommendations attesting to the contributions of
the candidate, and who support the application for Fellow
status.
71
Faculty
CSHP would like to recognize the generous contributions of the following speakers:
Conférenciers
La SCPH désire souligner les généreuses contributions des conférenciers suivants :
Shirin Adabi
Shahid Husain
Sumit Raybardhan
Jeff Barnett
Sandy Jansen
Kurt Schroeder
Arden Barry
Jeremy Johnson
Suzanne Singh
Marisa Battistella
Derek Jorgenson
Jessica Sleeth
Elaine Beltijar
Debra Kent
Beth Sproule
Carolyn Bornstein
Juno Kim
Jennifer Teng
Alice Y.Y. Cheng
Sara Kynicos
Jake Thiessen
Natalie Crown
Tim T.Y. Lau
Barbara Thomas
Elaine Chong
Kori Leblanc,
Peter Thomson
Melanie MacInnis
Kent Toombs
Alexandra Marcil
Alice Tseng
Hazel Markwell
Ross Tsuyuki
Tom McFarlane
bScPhm, PharmD
Régis Vaillancourt
OMM, CD, bPharm, PharmD, FCSHP
Alan Mills
Richard Wanbon
Marshall Moleschi
Wende Wood
Lisa Nissen
Lyndee Yeung
Glen Pearson
Peter Zed
Jennifer Poh
Rosemary Zvonar
bScPhm, ACPR, PharmD
bSc, bScPhm, PharmD, ACPR
bScPhm, PharmD, ACPR
bScPhm
bScPhm, ACPR, FSCHP, CGP
MC, FRCPC
Moderator
PharmD, bCPS
Norman Dewhurst
bScPhm, ACPR, PharmD, RPh
Lisa Dolovich
bScPhm, PharmD, MSc
Scott Edwards
bScNeuro, bScPhm, PharmD
Barbara Farrell
bScPhm, PharmD, FCSHP
Olavo Fernandes
bScPhm, ACPR, PharmD, FCSHP
Veronique French-Merkley
MD, CCFP, CoE
Alfred Gin
Sean Hopkins
bScPhm
Jin-Hyeun Huh
bScPhm, ACPR, bCPS
MD, MS
bScPhm, ACPR, MPH
bScPhm, MHS
bScPhm
RN, bScN, MN Student, CDE
bSP, PharmD, FCSHP
bA, PharmD, DAbAT, FAACT, RPh
RPh, bScPhm
bScPhm, PharmD
MPH, CHE, bPHE, bA
RPh, bScPhm, PharmD
MPharm, RPh
bScPhm, MSc, PhD
bScPhm, ACPR, PharmD, FCSHP
bScPhm, PharmD
bSc, bScPhm
bA(Hon), MA, PhD, ThD
Registrar
bPharm, PhD, FPR, FHKPh, FSHP
72
PharmD
bScPhm, PharmD
bScPhm, ACPR
bScPhm, PharmD, FCSHP, AAHIP
bScPhm, PharmD, MSc, FCSHP, FACC
bSc, bScPhm, ACPR, PharmD
bA, bSP, bCPP
bScPhm, MbA
bSc, bScPhm, ACPR, PharmD, FCSHP
bScPhm
The Sheraton Centre Toronto Hotel
All booths are 8’ x 10’, except where noted.
Floor plan subject to facility approval.
79 equivalent 8’ x 10’ booths.
■ RESERvED
Exhibitor List (at time of printing)
Liste des exposants (au moment de l’impression)
Company
Compagnie
Booth #
Kiosque #
Company
Compagnie
Booth #
Kiosque #
Mylan Pharmaceuticals Inc. .......................................................101
Northwest Telepharmacy Solutions ...........................................102
Northern Health Authority .........................................................104
Novartis Pharmaceuticals Canada Inc........................................507
Omega Laboratories Limited .....................................................205
PCCA Canada Corp. ..................................................................123
Pendopharm, Division of Pharmascience ..................................111
Pfizer Canada..............................................................................502
Pharmascience............................................................................109
PharmaSystems Inc.....................................................................410
Pharmaceutical Partners of Canada
A Company of the Fresenius Kabi Group ...............................300
Qlean Air Scandinavia ................................................................230
RxFiles Academic Detailing Program.........................................119
Sandoz Canada Inc. ............................................................201/203
Sanofi Canada.............................................................................308
Servier Canada ...........................................................................207
SteriMax Inc.........................................................................112/114
Sunovion Pharmaceuticals Inc. ...................................................129
Swisslog Healthcare Solutions....................................................411
Teva Canada ...............................................................................310
Truven Health Analytics ..............................................................113
valeo Pharma..............................................................................400
AbbvIE........................................................................................115
Allied Pharmacy Products Inc.....................................................408
Alveda Pharmaceuticals .............................................................409
Apotex Inc. ................................................................................306
AutoMed Technologies Canada.................................................406
bayer Inc. ...................................................................................224
bCE Pharma................................................................................402
bioSyent Pharma ........................................................................100
Canadian Forces Recruiting Centre ...........................................117
Canadian Institute for Health Information .................................500
Canadian Patient Safety Institute...............................................236
Canadian Pharmaceutical Distribution Network........................222
Canadian Pharmacists Association.............................................501
Cardinal Health Canada ......................................................103/105
Eli Lilly Canada Inc. ....................................................................107
ESbE Scientific ............................................................................228
Galenova.....................................................................................209
Health Match bC ........................................................................106
Healthmark Services ...................................................................108
Hospira Healthcare Corporation.........................................213/215
Lexicomp ....................................................................................404
Manrex ........................................................................................125
McKesson Canada Corp.............................................................407
Medisca.......................................................................................234
73
67TH SUMMER EDUCATIONAL SESSIONS
67E SÉANCES ÉDUCATIvES D’ÉTÉ
bUILDING ON THE PAST, CONNECTING FOR THE FUTURE
APPUyONS-NOUS SUR LE PASSÉ, COOPÉRONS POUR L’AvENIR
Delta St. John’s Hotel & Conference Centre
August 9-12 Août
Connecting pharmacists across Canada
PHARMACY SPECIALTY NETWORKS
NETWORK
W
WORK
communicate
CSHP has more
than 20 PSNs to
join! Check out
www.cshp.ca for
a complete list.
Join the Pharmacy Specialty Network! CSHP membership will connect
you with what’s important – people and information.
PSNs:
• connect members with others who share a passion for a particular facet
of pharmacy practice
• facilitate the quick exchange of ideas, developments, methods,
experiences, knowledge to improve practice
• support collaboration on projects, research, and educational programs to
address the needs of the members of a PSN
• provide additional opportunities for members to serve as both opinion
leaders and key resources for CSHP Council on professional specialty
issues, including development of relevant position statements, guidelines,
and information papers
Participation in PSNs is free of charge to CSHP members
Visit MY.CSHP.ca and sign up today!
Join Us!
CSH P M E M BERSH I P H A S M A NY A DVA NTAGES
MEMBER BENEFITS
A
s a member of CSHP, you connect
not only to a strong professional
organization, but also to a dynamic
network of over 3,500 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 Hospital Pharmacy Residency Board
Continuing Education
CSHP 2015
Partner Discount Programs
Fellows Program
Pharmacy Specialty Networks (PSNs)
Products and Services
Professional Liability/Malpractice Insurance
CSHP Research and Education Foundation
For more information about CSHP member benefits, please contact:
Membership services
T: 613-736-9733, ext. 222 | F: 613-736-5660 | E: [email protected] | www.cshp.ca

Final Program - Canadian Society of Hospital Pharmacists

Transcription

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