2026 Southeastern Residency Conference: Full Schedule

CLASS OF TRADE: AN EXPLORATORY REVIEW THROUGH THE LENS OF A NATIONAL GROUP PURCHASING ORGANIZATION
Benton Zielinski, Laura Crow, Samantha Randlett, Alyssa Huff, Jason Braithwaite
HealthTrust Performance Group/University of Tennessee Health Science Center – Nashville, TN
Background/Purpose: Class of Trade (COT) is a classification of types of healthcare facilities that pharmaceutical suppliers use to determine the price facilities pay for pharmaceutical products. For example, hospitals and retail pharmacies may be classified in different COTs and thus may pay different prices for the same product. No industry standard criteria exist for COT definitions or eligibility determination. Lack of standardization leads to inconsistent COT eligibility determination across pharmaceutical vendors. The purpose of this research was to clarify COT definitions and eligibility criteria as defined by pharmaceutical suppliers to empower healthcare facilities to optimize their pharmaceutical pricing via appropriate COT designation.

Methodology: This was an exploratory review, designed to assess how pharmaceutical suppliers determine COT eligibility. Eligible participants were pharmaceutical suppliers with active contracts with HealthTrust Performance Group (HPG). An anonymous survey was sent to 115 eligible suppliers. Respondents were asked to indicate their supplier type based on their predominant pharmaceutical products (Brands/Reference Biologics, Generics/Biosimilars, or Mixed), whether they use standard definitions for COT, whether an internal or external team determines facility eligibility, and which identifiers are used in this determination. Additionally, respondents were requested to provide their definitions for COTs. The primary endpoint was the frequency distribution of each COT based on total reports across responses. Secondary endpoints were percentage of COT criteria alignment to HPG standard definitions and the number of COTs indicated, both reported by supplier type.

Results: A response rate of 13.0% was achieved, with 15 respondents out of 115 invited to participate. Of these respondents, 8 (53.3%) indicated their supplier type as Brands/Reference Biologics, 5 (33.3%) as Generics/Biosimilars, and 1 (6.7%) as Mixed. The frequency distribution of each COT was reported as follows: 14 (93.3%) Acute Care Hospital; 12 (80.0%) Long Term Care; 11 (73.3%) Ambulatory Care (Hospital-Based); 10 (66.7%) Retail Pharmacy (Specialty); 9 (60.0%) Ambulatory Care (Community-Based); 9 (60.0%) Home Health Care; 9 (60.0%) Retail Pharmacy (Non-Specialty); and 10 (66.7%) use ≥1 additional COT not listed in the survey. Use of standard COT definitions was reported by 14 (93.3%) respondents, with 10 (66.7%) determining COT eligibility internally, 1 (6.7%) externally, and 4 (26.7%) both internally and externally. Average COT criteria alignment between respondents’ definitions and HealthTrust standard definitions were 68.0% for Brands/Reference Biologics, 45.1% for Generics/Biosimilars, and 87.5% for Mixed. The average and range of number of COTs indicated were 9.56 (0-37) for Brands/Reference Biologics, 17.4 (6-31) for Generics/Biosimilars, and 8 (8-8) for Mixed.

Conclusions: Although sample size was limited, this exploratory review identified considerable heterogeneity in COT definitions and facility eligibility criteria across pharmaceutical suppliers, with lower alignment observed among Generics/Biosimilars compared with Brands/Reference Biologics. The lack of standardized, public COT definitions prevents healthcare facilities from optimizing pricing and access to pharmaceutical products, ultimately impacting patient care by constraining financial sustainability.

Moderators

David Laurent

Infectious Diseases Clinical Pharmacist, ECU Health

Presenters

Benton Zielinski

PGY-2 Corporate Pharmacy Administration and Leadership Resident, HealthTrust Performance Group/UTHSC

Evaluators

Deborah Hobbs

Associate Chief, Pharmacy, Carl Vinson VA Medical Center

PGY-1 Pharmacy Residency Program Director & Associate Chief, Pharmacy for Clinical Services at the Carl Vinson VA Medical Center. Chairperson Pro-Tem 2021

Thursday April 30, 2026 9:10am - 9:30am EDT
Olympia 2

Administration (ADM), HealthTrust/University of Tennessee College of Pharmacy

global Y

9:10am EDT

Impact of a Pharmacist-Led Practice Change in Anti-Xa Monitoring on Bleeding Rates in Burn Injury Patients Receiving Enoxaparin for Venous Thromboembolism Prophylaxis

Thursday April 30, 2026 9:10am - 9:30am EDT

Olympia 1

Title: Impact of a Pharmacist-Led Practice Change in Anti-Xa Monitoring on Bleeding Rates in Burn Injury Patients Receiving Enoxaparin for Venous Thromboembolism Prophylaxis
Authors: Jacob King, Nirali Naik
Background: Burn patients are at an increased risk of venous thromboembolism (VTE) and often receive enoxaparin for VTE prophylaxis. Official guidelines do not exist that outline enoxaparin dosing strategies in burn patients, possibly leading to an increased risk of VTE or bleeding events. A recent increase in bleeding events has raised concerns regarding whether current dosing and monitoring is appropriate. The goal of this study was to determine if pharmacist-led monitoring of weight-based enoxaparin compared to current standard practice is associated with less major bleeding events while reducing risk of VTE.
Methods: This study is a single-center retrospective chart review designed to evaluate weight-based enoxaparin dosing and monitoring in burn injury patients in a pharmacist-led protocol (PLP) group compared to current standard practice (SP). Adult patients admitted with a burn injury during two different time periods, who received weight-based enoxaparin for VTE prophylaxis were evaluated. The SP group was reviewed from January 1, 2025, through February 15, 2025 and the PLP group from July 1, 2025 through August 15, 2025. Patients were considered eligible if they received at least 3 consecutive weight-based enoxaparin doses. Patients with renal dysfunction (CrCl < 30 mL/min on admission), coagulation disorders, heparin induced thrombocytopenia, receiving therapeutic anticoagulation or a factor Xa inhibitor within 72 hours of enoxaparin administration, or decompensated cirrhosis were excluded. The primary outcome was to evaluate if a difference exists in major bleeding events when comparing the SP group to the PLP group in regard to anti-Xa monitoring in burn injury patients receiving weight-based enoxaparin for VTE prophylaxis. Secondary outcomes included incidence of patients achieving an anti-Xa within goal range within the first 48 hours, rate of patients who did not achieve goal anti-Xa levels overall, incidence of VTE or minor bleeding events, number of dose adjustments required to achieve goal anti-Xa levels, number of pharmacist interventions and total doses of enoxaparin received during admission. Statistical analysis included descriptive statistics, t-tests for continuous variables, and chi-square or Fisher’s exact tests for categorical variables.
Results: Twenty-five patients were included in the SP group and thirteen patients were in the PLP group. The primary outcome of major bleed events was the same between both groups (p = 1.000). More patients in the PLP group achieved an anti-Xa level within goal range within the first 48 hours (23% vs 0%, p = 0.034). In the PLP group after 48 hours, 2 patients achieved goal anti-Xa levels at the second level and 1 patient at the third level. No patients in the SP group achieved an anti-Xa level within goal range throughout their admission compared to 7 patients in the PLP group (100% vs 54%, p=0.001).
Additional secondary outcomes included the number of pharmacist interventions (n=27), total doses of enoxaparin received during admission (SP group = 332 vs. PLP group n=210), and minor bleed events (p=0.11). There were no reported incidences of VTE events in either group.
Conclusion: There was no statistically significant difference found when evaluating the primary outcome of major bleeding events between groups. Statistical significance was observed in some secondary outcomes: more patients in the PLP group were able to achieve goal anti-Xa levels within 48 hours, with additional patients being able to achieve goal anti-Xa levels prior to discharge. The difference in the findings of the secondary outcomes in the PLP may be correlated with the pharmacist-led interventions. Due to a limited sample size and potential confounding variables, all outcomes should be interpreted with caution and within context. Future research should prioritize prospective studies with larger cohorts and rigorous controls for confounding variables to ensure the definitive validation of all outcomes.
Contact: [email protected]

Moderators

Charleen Melton

Presenters

Jacob King

PGY1 Pharmacy Resident, Wellstar Cobb Medical Center

My name is Jacob King and I am a PGY1 resident at Wellstar Cobb Medical Center. I received my PharmD and Masters of Information Systems from Harding University.

Next year I will be continuing my training at Wellstar Cobb Medical Center with a HSPAL PGY2 residency. My areas of interest include ambulatory care and transitions of care... Read More →

Evaluators

Che Jordan

PGY1 Residency Program Director | Clinical Pharmacy Manager, Grand Strand Medical Center

Thursday April 30, 2026 9:10am - 9:30am EDT
Olympia 1

Administration (ADM), Wellstar Cobb Medical Center / Wellstar Health System PGY1/PGY2 HSPAL

global Y

9:10am EDT

Impact of a Pharmacist-led Weight Management Clinic in a Medically Underserved Population within a Federally Qualified Health Center

Thursday April 30, 2026 9:10am - 9:30am EDT

Parthenon 1

Impact of a Pharmacist-led Weight Management Clinic in a Medically Underserved Population within a Federally Qualified Health Center

Rebecca Axson-Wells1, L. Tate Owens1, N. Leigh Joyner1, Carrington Huneycutt1, Joseph Magagnoli2, P. Brandon Bookstaver2, Robert Etheridge1, Reagan K. Barfield2

1Tandem Health, 2University of South Carolina College of Pharmacy

Background/Purpose: Obesity is a major public health concern associated with diabetes, cardiovascular disease, and hypertension. In South Carolina, 36% of adults are obese, with Sumter exceeding 40%. Access to weight loss medications is limited, particularly in underserved populations. Although pharmacist-led weight management programs have demonstrated improved weight loss, patient outcomes, and adherence, data on their impact within a Federally Qualified Health Center (FQHC) remain limited; therefore, this study evaluates a pharmacist-led weight management clinic in this setting.

Methodology: This was an IRB-approved, retrospective, observational cohort that included adults with a BMI ≥ 30 kg/m2 who attended ≥ 3 visits in the pharmacist-led weight management clinic. An external comparator group was matched based on obesity class, age, and sex from January 1, 2024 - March 13, 2026. Patients were excluded if they were enrolled in the diabetes self-management education clinic, had a diagnosis of diabetes, or were pregnant.

The primary outcome was the percent change in body weight. Secondary outcomes included changes in blood pressure, heart rate, waist circumference, lipid profile, HbA1c, and patient reported quality of life (QOL). Data was extracted from the electronic health record into a REDCap survey. Data was analyzed using linear mixed-effects and logistic regression models adjusting for baseline covariates.

Results: The study included thirty-six patients, with eighteen in each group. While there were mostly similar baseline characteristics (mean age 38.5 years; 83% female), there were a few notable differences. The intervention group had higher Medicaid coverage (72% vs. 22%, p = 0.013), baseline waist circumference (54.7 vs. 46.8 inches, p = 0.005), and HbA1c (5.65% vs. 5.32%, p = 0.033).

There were no significant between-group differences in changes from baseline. Weight decreased in both groups (−1.7 ± 3.5 vs. −0.2 ± 5.8 kg, p = 0.36), as did BMI (−0.6 vs. −0.1 kg/m², p = 0.45). Blood pressure declined similarly (SBP: −5.9 vs. −4.6 mmHg, p = 0.81; DBP: −4.0 vs. −5.3 mmHg, p = 0.78). Descriptive results demonstrated positive outcomes, with quality of life maintained or improved in all patients and no observed worsening over time. Patient satisfaction remained consistently high across all domains, with mean scores approaching ‘very satisfied’ and a median of 5 (IQR = 0) for all items.

Conclusion: In this small cohort, the intervention was not associated with significantly greater improvements in weight or cardiometabolic outcomes compared to usual care. However, trends favored the pharmacist-led intervention group despite a higher baseline disease burden and formulary-related treatment limitations. Patients experienced clinical and patient-centered benefits, including enhanced weight management support, medication optimization, and maintenance or improvement in quality of life. Pharmacist-led care also positively impacted the practice through high patient satisfaction, engagement, and support of comprehensive, team-based chronic disease management.

Moderators

P. David Brackett

RPD, Auburn University Clinical Health Services

Presenters

Rebecca Axson-Wells

PGY1 Pharmacy Resident, TANDEM HEALTH

Rebecca Axson-Wells, PharmD, is a PGY1 Pharmacy Resident at Tandem Health in collaboration with the University of South Carolina College of Pharmacy, with a focus in ambulatory care. She earned her Doctor of Pharmacy from the University of South Carolina College of Pharmacy and completed... Read More →

Evaluators

Carrie Callahan

Internal Medicine (IM) Specialist, PGY2 IM RPD, Emory University Hospital

Thursday April 30, 2026 9:10am - 9:30am EDT
Parthenon 1

Ambulatory Care (AMB), Tandem Health - University of South Carolina

global Y

9:10am EDT

The Change in Blood Pressure and other CGRP-related Adverse Events when used Long-Term for Migraine Prevention - Allison Eppenauer - Allison Eppenauer

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena C

Background -
Since 2018, calcitonin gene-related peptide (CGRP)–targeting therapies have expanded migraine prevention options. Inhibiting endogenous CGRP may pose risks, as recently noted by the US Food and Drug Administration (FDA) with new safety information and now requiring the risks of worsening hypertension and Raynaud’s phenomenon to be included in the labeling for all CGRP-targeting agents. This project aimed to assess the risk of clinically relevant blood pressure changes and other adverse outcomes associated with long-term CGRP-targeting therapy and to identify baseline risk factors that might guide safer use.

Methods -
This is a retrospective observational longitudinal cohort project for quality improvement. Eligible patients enrolled within the Ralph H. Johnson Veterans Affairs Healthcare System (RHJVAHS) who had an active diagnosis of migraine and a documented prescription for CGRP-targeting therapies for migraine prevention between May 17, 2018 and July 31, 2024 were included. Therapies examined were erenumab, fremanezumab, galcanezumab, atogepant, and rimegepant. A longitudinal logistic model was used to evaluate variables over time, from baseline within 1 year prior to starting to 1 year after initiation of CGRP-targeting treatment with quarterly follow-up.
The primary objective was to determine whether there is a clinically relevant change in median blood pressure, defined as an increase in stage of hypertension, increase in antihypertensive medication dose or additional antihypertensive medication added, or any episode of hypertensive crisis after use of a CGRP-targeting agent long-term for migraine prevention. The secondary objective was to determine whether there is an increased incidence of all cause hospitalizations, ER visits, or new Raynaud’s Syndrome diagnosis after use.

Results –
A total of 490 unique patients (5,188 encounters; mean follow-up 2.6 years) were included. The primary composite outcome was observed in 3,253 (64.7%) encounters. Adjusted mean probabilities for the composite outcome were similar across drug exposures. No agent was associated with significantly increased odds of composite outcome versus erenumab 70 mg. Atogepant showed a non-significant lower risk (OR 0.654, 95% CI 0.414–1.034; p=0.07) while a nonsignificant increased risk was observed for encounters with no CGRP-targeting agent refill, OR 1.33 (95% CI: 0.981-1.810]; p = 0.066.
After adjusting for baseline comorbidities, Black race was associated with significantly lower odds of the primary outcome as well as a history of coronary artery disease (CAD) and use of abortive CGRP-targeting therapy. There was no statistically significant association between the primary outcome and the presence of obstructive sleep apnea or chronic kidney disease, however an increasing number of baseline antihypertensive medications was significantly associated with higher odds of the composite outcome.
Secondary analyses revealed 2,728 (54.3%) encounters with hypertension stage progression, but no agent was associated with increased risk compared to erenumab 70 mg. Rimegepant 75 mg was associated with a higher odds ratio (OR 1.852, 95% CI 0.975–3.518; p = 0.06); however, this did not reach statistical significance. Among 564 (11.2%) encounters with escalation of antihypertensive therapy, dose decrease of CGRP therapy was linked to more than a two-fold higher risk of escalation (OR 2.277, 95% CI 1.027–5.046, p=0.043), likely reflecting blood pressure-related medication adjustments. Hypertensive crisis was very rare (n=1). Secondary outcomes occurred infrequently and are not reported here.

Conclusion:
Long-term use of CGRP-targeting therapies in this veteran population was associated with a significant incidence of clinically relevant worsening of hypertension, with nearly 65% of encounters experiencing the composite outcome, driven primarily by progression in hypertension staging. No statistically significant differences in risk were observed between individual CGRP agents and the erenumab 70 mg reference. Numerical higher risk with rimegepant and lower risk with atogepant warrant further study. Ongoing blood pressure monitoring in patients treated with CGRP-targeting drugs remains warranted.

Moderators

Drew Kessell

Presenters

Allison Eppenauer

Post-Graduate Year 2 Pharmacy Practice Resident, Ralph H. Johnson Veterans Affairs Healthcare System

Allison (Ali) received her Associate’s degree in Pre-Pharmacy from State Fair Community College in Sedalia, Missouri in 2020 and completed her Doctor of Pharmacy from the University of Missouri-Kansas City in 2024. She completed her PGY1 residency at the Ralph H. Johnson VA Healthcare... Read More →

Evaluators

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena C

Ambulatory Care (AMB), VA - Charleston, SC - Ralph H. Johnson Veterans Affairs Medical Center

global Y

9:10am EDT

Retrospective Data Review of Adherence Rates, Drug Interactions, and Perceived Outcomes in Patients Prescribed Resmetirom in a Community-Based Specialty Pharmacy

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena I

Authors: Tsuraya Iswanto, Mariam Saba, Victoria Phan

Background: Resmetirom, a selective agonist of THR-β in the liver, received FDA accelerated approval in March 2024 for treatment of metabolic dysfunction-associated steatohepatitis (MASH) with stage F2-F3 fibrosis. Patients prescribed on resmetirom often have comorbidities of hypertension, dyslipidemia, and diabetes. As a limited distribution drug, resmetirom is dispensed only through select specialty pharmacies. Due to its recent approval, adherence and side effect data are limited, creating an opportunity for retrospective data analysis to identify therapy-related barriers and guide interventions.

Methods: This will be a retrospective data analysis (from March 2025 to April 2026) involving patients who were prescribed with resmetirom, have a diagnosis of MASH, and had an initial fill and refills from a community-based specialty pharmacy. Patients will be included in this study if they are prescribed resmetirom and have a documented prescription refill record for at least 5 months. Patients will be excluded from the study if they have been on resmetirom for less than 6 months. Adherence will be analyzed using Proportion of Days Covered (PDC) scores. Patients must have had at least 6 total fills (or 180 days) of therapy for PDC scores to be calculated. The pharmacy dispensing system data with dates of the initial fill and refills will be used for PDC scores. PDC scores will be categorized into two adherence groups: PDC scores will be categorized into two adherence groups: > 98% and < 98%. Therapy outcomes will be assessed by self-reported health status shared by the patient during 6-month therapy reassessments. From pharmacy reassessments calls, the following data will be collected: 1. Data including patient reported side effects 2. Perceived effectiveness of resmetirom in managing MASH treatment 3. Missed doses 4. Challenges while taking resmetirom related to drug therapy • For drug interactions, the pharmacist will identify patients who are on medications that require pharmacist intervention due to major interactions with resmetirom (Statins, CYP2C8 inhibitors, or other hepatotoxic medications).

Results (preliminary results): Overall adherence was high, with a mean PDC of 98.17% and 65.3% of patients classified as highly adherent (≥98%). Patients with ≥98% adherence demonstrated a higher proportion of positive perception compared to those with lower adherence. Adherence showed a non-significant trend towards improved positive perception (OR = 1.54, p = 0.47) and reduced side effects (OR = 0.52, p = 1.00). Confidence intervals were wide, indicating high uncertainty. No statistically significant associations were observed.

Conclusions (reached to date): Adherence to resmetirom therapy was high, and patient-perceived effectiveness was positive. Higher adherence (≥98%) showed trends toward more positive perception (OR 1.54) and fewer side effects (OR 0.52), however were not statistically significant. Limited variability and small sample size likely reduced power to detect associations. These findings can help specialty pharmacists identify strategies that can be implemented to improve therapy outcomes by identifying potential barriers to continuing therapy.

E-mail of resident: [email protected]

Moderators

Courtney Isom

PGY-1 Community-based Residency Director, Cone Health

Presenters

TSURAYA ISWANTO

PGY1 Resident, Walgreens Specialty Pharmacy of Atlanta

Hi! I'm Tsuraya Iswanto, PharmD and am currently a PGY1 Resident at Walgreens Specialty in Atlanta, GA. I graduated from Mercer University last year. After completing residency, I plan on working as a clinical pharmacist in the Infectious Disease department at the Walgreens Specialty... Read More →

Evaluators

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, PGY-2 Ambulatory Care Pharmacy RPD, Kaiser Permanente Georgia

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena I

Community Pharmacy (CP), Walgreens Atlanta

global Y

9:10am EDT

Impact of Pharmacist-Led Blood Glucose Management on Patients in the Medical Intensive Care Unit

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena D

Impact of Pharmacist-Led Blood Glucose Management on Patients in the Medical Intensive Care Unit
Abigail Reeves, Ann Maxwell, Megan Lail, Marwan Elya

Background
Hyperglycemia affects up to 60% of critically ill patients and is associated with increased morbidity, mortality, and healthcare costs. Beginning in January 2026, “Hospital Harm” Severe Hypoglycemia and Severe Hyperglycemia, two measures established by The Centers for Medicare and Medicaid Services, will become mandatory for annual hospital reporting. Pharmacist-managed insulin protocols have demonstrated improved glucose control and reduced severe hypoglycemia, but data in intensive care units remainslimited. This study aims to evaluate the impact of clinical pharmacist consultation for insulin management versus physician or advanced practice provider management on blood glucose time within goal range in critically ill patients.

Methods
This study was a single center, retrospective, chart review of adult patients admitted to the medical intensive care unit (MICU) between June 1st, 2025, through January 31st, 2026. After the first 24-hours of MICU admission, patients 18 years of age and older were screened for inclusion criteria, including new-onset or past medical history of diabetes, glycated hemoglobin (A1c) > 6.5% within three months or during admission, two blood glucoses >180 mg/dL or receipt of insulin therapy. Based on provider discretion, the consult “Pharmacy to manage insulin” was ordered, and electronic medical record (EMR) documentation was utilized to write a daily progress note. Progress notes included history of diabetes, home diabetes regimen if applicable, last three A1C values, current insulin regimen, other diabetes medications, steroid use, dextrose-containing fluids, diet, and changes indicated. Pharmacists managed insulin only during the patients' MICU stay, with the capability to add or adjust long-acting and short-acting insulin. Pharmacistmanagement of blood glucose was conducted from 8:00 a.m. - 5:00 p.m and if urgent adjustment was needed outside of these hours, the intensivist intervened. The consult was limited to the MICU and was discontinued when each patient was physically transferred from the unit. A guidance document was developed for reference after service hours and during cross coverage.

Results
The post-intervention group (n=124) demonstrated improved glycemic control compared to the pre-intervention group (n=112). The post-intervention group achieved a higher number of blood glucose values within the goal range (68.8% vs. 62.7%, p=<0.001). At the patient level, the post-intervention group had a higher median percentage of blood glucoses within goal range (80% vs. 64.3%, p=0.001). Hypoglycemic events showed no significant differences between groups, with similar proportions of patients experiencing hypoglycemia (22% vs. 19%, p=0.575), and no significant change in the total number of hypoglycemic events (2% vs. 1.23%, p=0.067). However, the post-intervention group had a significantly lower proportion of patients with hyperglycemic events (73% vs. 89%, p=0.001) and fewer total hyperglycemic events (30% vs. 36%, p<0.001). Additionally, the percentage of ICU days with hyperglycemia was significantly reduced in the post-intervention group (46% vs. 60%, p<0.001). These findings suggest that the intervention improved glucose control, particularly by reducing hyperglycemic events, without increasing hypoglycemia.

Conclusions
Pharmacist consultation for insulin management was associated with an increase in the number of blood glucose values within the target range and a reduction in hyperglycemic events. These improvements occurred without a significant change in hypoglycemia, indicating that glycemic control improved without increasing hypoglycemic risk.

Moderators

Brittany White

Erlanger

Presenters

Abigail Reeves

PGY1 Pharmacy Resident, Mcleod Regional Medical Center

Evaluators

Alyson Burns

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena D

Critical Care/Emergency Medicine (CCM), McLeod Regional Medical Center

global Y

9:10am EDT

Standardizing Local Inhaled Epoprostenol Use in Acute Respiratory Distress Syndrome: A Quality Improvement Project

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena B

Title: Standardizing Local Inhaled Epoprostenol Use in Acute Respiratory Distress Syndrome: A Quality Improvement Project

Authors: Adelaine Hogan, Ryan Lally, Rachel Langenderfer, Brittany NeSmith

Background: Inhaled epoprostenol (iEPO), a prostacyclin analogue-type pulmonary vasodilator, is often used off-label to treat hypoxemia in patients with acute respiratory distress syndrome (ARDS). Without guideline direction for use, preferences for iEPO dosing, timing of administration, and duration of therapy can vary. A medication use evaluation (MUE) of iEPO utilization for treatment of ARDS was conducted at Bon Secours St. Francis Downtown Hospital from January 1, 2023, through June 1, 2025, which found variation in initial doses and inappropriate prolonged duration of therapy. The purpose of this quality improvement project is to establish safe and efficient iEPO utilization practices when treating patients with ARDS through trial of a respiratory therapy-driven iEPO dosing and weaning protocol.

Methods/Results: This was a single-center, quality improvement project conducted at a 245-bed hospital in Greenville, South Carolina. An iEPO dosing and weaning protocol was developed by the investigators for use within the intensive care unit (ICU) to guide lab obtainment, initiation dose, and weaning parameters for all iEPO patients. The protocol was informed by current literature and reviewed and approved by a pharmacy-led interdisciplinary team of ICU pulmonologists and respiratory therapists. Educational material regarding ARDS, disease management, and protocol implementation was developed by investigators and distributed to ICU staff.

Moderators

Katharine Strickland

Presenters

Adelaine Hogan

PGY-1 Pharmacy Resident, Bon Secours St. Francis Downtown Hospital

Evaluators

Adam Sawyer

PGY1 Residency Program Director, Huntsville Hospital

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena B

Critical Care/Emergency Medicine (CCM), Bon Secours St Francis Downtown

global Y

9:10am EDT

Impact of Provider Education on Adherence to a Urine Culture Guidance Algorithm in a Community Hospital

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena J

Authors: Cameron Howell, PharmD; Layla Marefat, PharmD

Background: Asymptomatic bacteriuria (ASB) is the presence of bacteria [>100,000 colony forming units per milliliter (CFUs/mL)] in the urine without associated genitourinary symptoms. Up to 60% of patients with ASB [and an additional 40% with asymptomatic pyuria and/or nitrituria (ASPN)] receive antibiotics when not indicated. Reflex urine culture algorithms are a tool used to decrease urine culture rates, which reduces unnecessary antibiotic use. Typically, the reflex criteria for these algorithms include urinalysis components, of which pyuria is the most reliable for predicting a clinically significant urinary tract infection (UTI). In 2018, reflex urine cultures were implemented at the Baptist Health System using a traditional cutoff of >5 white blood cells per high power field (WBC/HPF) for pyuria. A recent study found that <10 WBC/HPF has a similarly high negative predictive value for UTI than less stringent cutoffs. Thus, in July 2025, the definition for pyuria was refined to >10 WBC/HPF, leading to a threefold increase in overrides of the algorithm. The aim of this study is to evaluate the impact of delivering education to providers on adherence to a urine culture guidance algorithm.

Methods: A retrospective chart review was conducted on adult patients at a community hospital who had a urine culture obtained from an override of established reflex criteria. The primary outcome was the percentage of inappropriate urine culture overrides. It was assessed for a pre-intervention phase from January 1, 2025, to April 30, 2025, and compared to the post-intervention phase from October 1, 2025, to January 31, 2026. Education was provided to hospitalists, emergency medicine providers, and intensivists. Secondary outcomes included hospital length of stay (LOS), days of therapy (DOT) for patients with an inappropriate urine culture override that received antibiotics for UTI, and concordance of provider inputs for symptoms or "At Risk Population” on the urine culture order with patient chart documentation.

Results: 76 patients were evaluated in the pre-intervention group while 175 patients were evaluated in the post-intervention group. Most urine cultures obtained from overrides resulted in no growth or normal urogenital flora (76.3% vs. 62.3%, p = 0.030). Despite a reduction in inappropriate urine culture overrides compared to the pre-intervention phase, this difference was not statistically significant (57.8% vs. 48.0%, p = 0.15). Hospital LOS, DOT for those with inappropriate urine culture overrides, and concordance of provider inputs for symptoms on the order with patient chart documentation also were not significantly affected. The concordance of provider inputs for “At Risk Population” on the order with patient chart documentation was significantly higher in the post-intervention group (14.3% vs. 68.8%, p < 0.001).

Conclusions: Pharmacist education to providers was not effective in reducing inappropriate urine culture overrides. However, significant limitations were present, especially the difference in reflex criteria between groups. Nevertheless, most urine cultures did not yield clinically significant growth. Additional interventions must be pursued in addition to education to target higher adherence to a reflex urine culture algorithm.

Moderators

Deidra Easley

PGY1 Residency Program Director, Baptist Medical Center South

Presenters

Cameron Howell

PGY1 Pharmacy Resident, Baptist Health Lexington

Cam is a PGY1 pharmacy resident at Baptist Health Lexington in Lexington, KY. He is a proud Wildcat, receiving both his Bachelor of Science in Biology in May 2021 and Doctor of Pharmacy in May 2025 from the University of Kentucky. After residency, he will pursue a position as a clinical... Read More →

Evaluators

Derek Rhodes

Manager / HSPAL RPD, Prisma Health

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena J

Infectious Disease (ID), Baptist Health Lexington

global Y

9:10am EDT

Characterizing the Microbial Landscape of Febrile Neutropenia at an Academic Medical Center

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena H

Title: Characterizing the Microbial Landscape of Febrile Neutropenia at an Academic Medical Center
Authors:
Alexander Durant, PharmD1,2
Amber Clemmons, PharmD, BCOP, FHOPA1,2
Affiliations:
Wellstar MCG Health, Augusta, Georgia
University of Georgia College of Pharmacy, Athens, Georgia
Background:
Febrile neutropenia (FN) is a common and potentially life-threatening complication of myelosuppressive chemotherapy requiring prompt clinical evaluation and empiric antimicrobial therapy. Although historical trends have alternated between gram-positive (GP) and gram-negative (GN) predominance, contemporary literature reveals substantial institutional and regional heterogeneity. Reported culture positivity rates and organism distributions vary, with multidrug-resistant organisms (MDROs) being increasingly prevalent. Additionally, viral and fungal organisms are underrepresented in the literature. This variability limits generalizability and demonstrates a need for institution-specific data to guide practice at Wellstar MCG Health.
Objectives:
This study aimed to: 1) determine culture positivity rates among FN episodes, 2) characterize culture sources and organism distributions, 3) describe the prevalence of MDROs, and 4) identify associations between clinical risk factors and isolation of GP, GN, and other organisms using multivariable regression.
Methods:
This single-center retrospective chart review included adult patients admitted to Wellstar MCG Health with FN between January 1, 2023 and June 30, 2025. Patients admitted prior to the electronic health record transition (EPIC Go-Live, 11/02/2024) were identified using Cerner Discern Analytics and Theradoc based on concurrent fever, absolute neutrophil count (ANC) <1500 cells/microliter, and receipt of empiric antipseudomonal therapy (cefepime, piperacillin-tazobactam, or meropenem). Patients admitted after Go-Live were identified using EPIC SlicerDicer based on ICD-10 codes for fever (R50.81 or R50.9) and neutropenia (D70.1, D70.8, D70.9) during the same admission. Data was collected in REDCap for 500 patients total. Collected data included demographics, malignancy type, chemotherapy regimen, antimicrobial prophylaxis, culture results, organism classification, and MDRO status. Descriptive statistics encompassed microbiology and culture positivity results. Multivariable regression of these variables will identify potential predictors of GP, GN, and MDRO speciation.
Results:
Most episodes (82%) were associated with a hematologic malignancy or post-transplant diagnosis. Blood cultures were positive in 15.2% of FN episodes in our sample, with other positive sources accounting for fewer than 5.2% of episodes. In 68.8% of FN episodes, the ANC at the time of the qualifying fever was less than or equal to 1500 cells/microliter, with 11.2% of episodes being greater than or equal to 1500 cells/microliter, representing CML with blast crisis, AML not in remission, or a fall in the ANC to less than 500 cells/microliter within 48 hours. Additional data regarding microorganism types, resistance patterns, and multivariable regression modeling is pending further analysis.
Conclusion/Discussion:
This study will provide contemporary, institution-specific data describing the microbiologic profile of FN at Wellstar MCG Health. Findings will describe local culture positivity rates, pathogen distributions, and MDRO prevalence while identifying clinical predictors associated with specific organism types. These completed results will address the limitations of prior heterogeneous studies and support evidence-based empiric therapy, antimicrobial stewardship, and institutional risk-stratified management strategies.

Moderators

Camille Robinette

PGY1 RPD, Clinical Pharmacy Specialist, Primary Care, SVAM1Salisbury VA Health Care SystemPGY1

Presenters

Alexander Durant

Evaluators

John Carr

Manager of Clinical Pharmacy Services, SJCHS

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena H

Oncology (ONC), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

9:10am EDT

Evaluation of Early Onset Severe Treatment-related Adverse Events for Fluoropyrimidine-based Chemotherapy

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena G

Title: Evaluation of Early Onset Severe Treatment-related Adverse Events for Fluoropyrimidine-based Chemotherapy
Authors: Alexandria Rakestraw, Alex Balkcom, Rodna Larson
Background:
Fluoropyrimidines such as 5-fluorouracil (5-FU) and capecitabine are commonly used in the treatment of solid tumors. Fluoropyrimidines work by inhibiting thymidylate synthase and incorporating the metabolites into DNA synthesis, disrupting the creation of cancerous cells.
The toxicities of fluoropyrimidines are typically seen within the first few cycles of treatment. Toxicities can occur due to the mechanism of action of fluoropyrimidines or can occur due to genetic mutations but can be enhanced by genetic mutations. Fluoropyrimidines are metabolized by dihydropyrimidine dehydrogenase. Dose reductions are based on variants to avoid potential accumulation and therefore potential toxicities.
This retrospective chart review was designed to identify CTCAE grade 3-5 toxicities in patients receiving fluoropyrimidine-based treatments, explain dose modifications secondary to genotypic variation, and understand the current practice of genotype testing prior to receiving these chemotherapeutic agents.
Methods:
This single-center, retrospective, observational chart-review was conducted at our institution from January 1, 2023, to February [RA1] 1, 2026. Adults >18 were eligible to be included in this study if they received 5-FU or capecitabine for any solid tumor and if the first dose of either medication was given within the study period. Patients were excluded from the study if the patient was being treated in a clinical trial.
The primary objective of the study was to determine the incidence and onset of grade 3-5 fluoropyrimidine-related toxicity within the first three cycles of treatment in correlation with DPYD genotype status. The specified narrowed toxicities include diarrhea, mucositis, cardiotoxicity, palmar plantar erythrodysesthesia, and pancytopenia (thrombocytopenia and neutropenia). Secondary endpoints included identification of genotypic variants, retrospective dose adjustments, time to death, and genotype testing turnaround times.
Results:
Among 85 patients treated with fluoropyrimidine-based chemotherapy (5-FU, n=51; capecitabine, n=34), DPYD genetic testing rates were low overall, yet patients tested prior to treatment initiation experienced a 59% reduction in grade 3+ toxicity events compared to untested patients (10.0% vs 24.6%, RR=0.41).
Conclusions:
These data suggest that pre-treatment DPYD screening may reduce severe fluoropyrimidine-related toxicity, though the difference did not reach statistical significance given the limited sample size. Testing is available as a blood draw that has an average 9-day turnaround time.

Moderators

Alvin N. Tomika

Clinical Pharmacist, AdventHealth

Presenters

Alexandria Rakestraw

Dr. Alexandria Rakestraw grew up in Villa Rica, GA. She completed her undergraduate curriculum and received her Doctor of Pharmacy degree at the University of Georgia. Her professional interests include ambulatory care and oncology. Post PGY-1, her goal is to complete a PGY-2 in an... Read More →

Evaluators

Amy Carr

PGY1 RPD, AdventHealth Orlando

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena G

Oncology (ONC), Emory Decatur Hospital

9:10am EDT

Evaluation of Postoperative Outcomes and the Impact of an Enhanced Recovery Pathway in Patients Who Have Undergone a Laparotomy Procedure

Thursday April 30, 2026 9:10am - 9:30am EDT

Athena A

Evaluation of Postoperative Outcomes and the Impact of an Enhanced Recovery Pathway in Patients Who Have Undergone a Laparotomy Procedure

Mackenzie Winter Waters, Melissa Bagwell, Leborah Cole Lee, Courtney Reliford, Kayla Brown

Abstract
Purpose: Utilization of an enhanced recovery pathway (ERP) perioperatively has shown benefit in reducing postoperative symptoms, complications, length of stay, and readmission rates, but it is not widely utilized at our institution. The purpose of this study was to supplement current literature regarding the clinical impact of an ERP on patient outcomes following surgical procedures by retrospectively assessing patients’ postsurgical outcomes as it relates to ERP utilization compared to those who received standard of care. The hypothesis of this study is that implementation of an ERP would result in a reduction in opioid consumption and a decrease in postoperative complications.

Methods: This single-center, retrospective chart review was approved by the Institutional Review Board at East Alabama Medical Center (EAMC) and evaluated the impact of an ERP after the following elective open laparotomy surgical procedures: gynecologic-oncologic, colorectal, and/or hysterectomy. The primary outcome was total morphine milliequivalents (MME) utilized during inpatient hospitalization stay (IHS). Secondary outcomes included average pain scales, adverse drug events related to narcotics, prescribed narcotic(s) on discharge, incidence of postoperative ileus, incidence of acute kidney injury, adherence to the ERP postoperative analgesic medication regimen (> 75% scheduled doses received), average daily dose of narcotics (in MME) and non-narcotic medications (in mg) used for pain management, length of IHS, 30- and 90-day hospital readmission, and 90-day mortality. Patients were identified using the electronic medical record and assessed for the following inclusion criteria: ≥19 years of age and hospitalized for previously defined elective surgical procedures between May 1, 2024, and May 31, 2025. Exclusion criteria included pregnancy, prisoners, males, length of IHS <24 hours, patients admitted with a bowel obstruction or ileus prior to surgery, and patients who received a patient-controlled analgesia pump for pain management. Criteria were assessed to obtain at least 50 patients in the ERP group and 50 patients in the non-ERP group. Data analysis was conducted using a Chi-square, Fisher’s exact test, Student’s t-test, or Mann-Whitney U test dependent on data type and distribution. All statistical analyses were performed in IBM SPSS Statistics version 30.0.0.0 (IBM Corp., 2024).

Results: There were 1,582 patients screened for inclusion, with 50 patients in each group meeting inclusion criteria. Patients within the ERP group used a lower amount of total MME compared to the non-ERP group (median 766.3 versus 935, P = 0.046). The ERP group had a lower average daily MME utilization (median 242.5 versus 316.7, P = 0.005), lower average pain scales (median 3.4 versus 5.5 (on a 10-point scale), P < 0.001), and a higher average daily utilization of APAP in mg (median 2066.7 versus 1175, P < 0.001). Differences in narcotics prescribed at discharge showed statistical significance (P < 0.001), and post-HOC analysis was performed with the adjusted P value for significance set at < 0.008. Oxycodone was prescribed more frequently in the ERP group (68% versus 28%; P < 0.001) and oxycodone-APAP prescribed more frequently in the non-ERP group (50% versus 10%; P < 0.001). All other secondary outcomes did not show statistical significance.

Conclusion: Utilization of an ERP perioperatively resulted in clinically and statistically significant reductions in narcotic utilization and average pain scales throughout hospitalization. One strength is this study included evaluation of pain outcomes in invasive surgical procedures, which are associated with higher pain scores and longer length of inpatient hospital stay compared to non-invasive surgeries. One limitation of this study was that men were excluded due to the nature of procedures that utilized an ERP. In the future, our organization plans to expand the use of an ERP to other surgical areas, including colorectal surgeries and cesarean deliveries.

Moderators

Aayush Patel

Clinical Pharmacy Specialist, Emergency Medicine, Piedmont Columbus Regional Midtown

Presenters

Mackenzie Winter Waters

PGY1 Pharmacy Resident, East Alabama Medical Center

My name is Mackenzie Winter Waters, and I am a PGY1 pharmacy resident at East Alabama Medical Center in Opelika, AL. I graduated from Auburn University's Harrison College of Pharmacy in May 2025. After the completion of my PGY1, I will be joining UAB Hospital in Birmingham, AL to... Read More →

Evaluators

Abbi Rowe

Director of Pharmacy, AdventHealth

Thursday April 30, 2026 9:10am - 9:30am EDT
Athena A

Pain Management (PM), East Alabama Medical Center

global Y

9:10am EDT

Chemical Restraint Utilization and Standardization in Adult Hospitalized Patients

Thursday April 30, 2026 9:10am - 9:30am EDT

Parthenon 2

Background: Chemical restraints are parenteral medications used to limit patient movement or behavior rather than treat an underlying condition. Risks include oversedation, respiratory compromise, and loss of patient trust. Regulatory standards require their use only for imminent risk after less restrictive measures have failed, with strict monitoring and timely discontinuation. However, real-world practice patterns remain poorly characterized. This study retrospectively evaluated pharmacologic chemical restraint practices in adult patients, including medication selection, dosing patterns, and ordering services, to identify variability and inform development of a standardized institutional order set aligned with patient safety and regulatory standards.

Methods: A retrospective chart review was performed on patients at least 18 years of age who received at least one dose of a medication classified as a chemical restraint between March 1 and August 31, 2025 at Northside Hospital. Eligible episodes involved injectable haloperidol, ziprasidone, olanzapine, ketamine, lorazepam, diazepam, or midazolam ordered for indications such as aggressive or combative behavior, agitation/anxiety, agitation or severe/refractory agitation, psychosis, hallucinations, or chemical restraint. Patients receiving procedural sedation or anesthesia for non‑restraint purposes were excluded. The primary objective was to evaluate the pharmacological treatments used for chemical restraint. Secondary objectives included average dose used per agent and route, use of multiple restraint agents, ordering service, location of administration, and indication.

Results: The retrospective review included 45 eligible patients with violent agitation (agitation scale 3) who received parenteral chemical restraint medications. Haloperidol was the most frequently administered chemical restraint (N = 32; 37%), followed by lorazepam and ziprasidone (N = 20; 23% each), olanzapine (N = 6; 7%), ketamine (N = 5; 6%), and midazolam (N = 3; 4%). Diazepam was not utilized. Mean doses by agent and route were as follows: haloperidol, 3.99 mg intramuscularly (IM) and 2.41 mg intravenously (IV) (N = 70); ketamine, 0.67 mg/kg mg IM and 1 mg/kg IV (N = 5); lorazepam, 1.32 mg IM and 1.17 mg IV (N = 38); and midazolam, 2 mg IM and 3.67 mg IV (N = 6). Olanzapine and ziprasidone were administered exclusively via the IM route, with mean doses of 6.11mg (N = 9) and 10.66 mg (N = 38). The most frequently documented indications were agitation (N = 24; 56%) and agitation/anxiety (N = 17; 38%), while severe or refractory agitation (N = 2; 4%) and aggressive or threatening behavior (N = 1; 2%) were less common, with no other indications documented.

Most chemical restraints were ordered by Internal Medicine Services (62.2%), followed by the Emergency Department (33.3%) and the Intensive Care Unit (4.4%), with the ordering service corresponding to location of administration. Use of multiple chemical restraint agents per episode occurred in 35 cases (77.8%).

Conclusions: This study identified variability in chemical restraint utilization, dosing, route of administration, episode duration, indications, and documentation among adult hospitalized patients at Northside Hospital. Antipsychotics and benzodiazepines were most commonly used, with haloperidol administered most frequently. 77.8% of patients received multiple agents per episode, suggesting lower initial dosing strategies and the absence of a chemical restraint episode duration. These findings demonstrate the need for a standardized order set and highlight opportunities to enhance consistency in chemical restraint practices and clinical documentation. In response, an Adult Chemical Restraint Order Set was developed that includes four-hour chemical restraint episode, maximum 24-hour dosing recommendations, and age- and obstetric-specific recommendations to support appropriate agent selection and dosing. Required nursing assessments of vital signs and behavioral status were aligned with Joint Commission standards, with additional safety measures including integrated Behavioral Health consultation and electrocardiogram monitoring. This standardized framework aims to improve consistency, safety, monitoring, and documentation of chemical restraint use while promoting patient-centered care across hospital services.

Moderators

Beth Phillips

Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2

Presenters

Samuel Van Horn

PGY1 Pharmacy Resident, Northside Hospital

Evaluators

Ben Ferris

RPD, AdventHealth East Orlando

Thursday April 30, 2026 9:10am - 9:30am EDT
Parthenon 2

Psychiatric Pharmacy (PSY), Northside Hospital

global Y

9:30am EDT

Assessing Adherence to ADA-Recommended Annual Vitamin B12 Monitoring in Veterans on Long-Term Metformin Therapy at the Salisbury VA Health Care System

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena A

Authors: Abigail Murray, Brittany Melville, Micah Corriher, Camille P. Robinette

Background: Metformin remains a cornerstone of type 2 diabetes treatment due to its efficacy and safety, but long-term use can reduce vitamin B12 absorption, potentially causing neuropathy, anemia, cognitive changes, and fatigue. The American Diabetes Association (ADA) Standards of Care 2026 recommend annual vitamin B12 monitoring for patients receiving long-term metformin. However, no standardized monitoring process exists within the Salisbury Veterans Affairs Health Care System (SVAHCS). This project evaluated adherence to ADA-recommended vitamin B12 monitoring among Veterans receiving long-term metformin therapy.

Methodology: Veterans across SVAHCS, including Salisbury, Charlotte, and Kernersville locations aged ≥18 years prescribed metformin or Synjardy® (empagliflozin/metformin) for ≥4 consecutive years were included. Eligible Veterans had an active outpatient prescription filled between November 1, 2020, and October 31, 2021, and at least one additional fill between May 1, 2025, and October 31, 2025. The primary outcome was the percentage of eligible Veterans with a documented vitamin B12 level within the previous 12 months. Secondary outcomes included the percentage of Veterans with vitamin B12 deficiency or borderline deficiency within the past year. Data were extracted from the VA Corporate Data Warehouse and included demographics and vitamin B12 laboratory results obtained within the previous 12 months. Descriptive statistics were used for analysis.
Results: A total of 5,037 Veterans met inclusion criteria. The mean age was 70.6 years (range 29–100), and 94.4% were male. Among the cohort, 1,617 Veterans (32.1%) had a documented vitamin B12 level within the past 12 months, while 3,420 (67.9%) did not receive recommended monitoring. Among patients with laboratory testing, 13 Veterans (0.8%) had vitamin B12 deficiency and 244 (15.0%) had borderline vitamin B12 deficiency.
Conclusions: Adherence to ADA-recommended annual vitamin B12 monitoring among Veterans receiving long-term metformin therapy was low. These findings highlight an opportunity to improve guideline-concordant care through targeted provider education and system-level interventions to increase routine vitamin B12 monitoring and support earlier identification of deficiency.

Results: A total of 5,037 Veterans met inclusion criteria. The mean age was 70.6 years (range 29–100), and 94.4% were male. Among the cohort, 1,617 Veterans (32.1%) had a documented vitamin B12 level within the past 12 months, while 3,420 (67.9%) did not receive recommended monitoring. Among patients with laboratory testing, 13 Veterans (0.8%) had vitamin B12 deficiency and 244 (15.0%) had borderline vitamin B12 deficiency.
Conclusions: Adherence to ADA-recommended annual vitamin B12 monitoring among Veterans receiving long-term metformin therapy was low. These findings highlight an opportunity to improve guideline-concordant care through targeted provider education and system-level interventions to increase routine vitamin B12 monitoring and support earlier identification of deficiency.

Conclusion: Adherence to ADA-recommended annual vitamin B12 monitoring among Veterans receiving long-term metformin therapy was low. These findings highlight an opportunity to improve guideline-concordant care through targeted provider education and system-level interventions to increase routine vitamin B12 monitoring and support earlier identification of deficiency.

Moderators

Aayush Patel

Clinical Pharmacy Specialist, Emergency Medicine, Piedmont Columbus Regional Midtown

Presenters

Abigail Murray

PGY1 Pharmacy Resident, Salisbury Veterans Affairs Health Care System

Abigail (Abby) is a PGY1 Pharmacy Resident at the Salisbury Veterans Affairs Healthcare System. She earned her Doctor of Pharmacy degree from West Virginia University School of Pharmacy in Morgantown, West Virginia. Her current practice interests include primary care, anticoagulation... Read More →

Evaluators

Abbi Rowe

Director of Pharmacy, AdventHealth

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena A

Ambulatory Care (AMB), VA â€“ Salisbury, NC â€“ Salisbury VA Health Care System

global Y

9:30am EDT

Evaluation of Documented Medication Access Barriers at Hospital Discharge

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena B

Background: Significant challenges to medication continuity often occur when patients transition from inpatient to outpatient care. At discharge, patients may face medication access barriers (MABs), including high costs, prior authorizations, and medication shortages. These barriers can result in adverse events, delayed therapy initiation, suboptimal disease management, and increased hospital readmissions. Consequently, many institutions have adopted transitions of care strategies, such as pharmacy-led medication reconciliation, to address MABs. Pharmacists are uniquely positioned to identify and mitigate MABs prior to hospital discharge; however, standardized workflows for addressing these barriers remain limited. The purpose of this study is to evaluate current MAB processes, with results used to optimize pharmacist workflow in identifying and addressing MABs and potentially support the creation of a new medication access pharmacy position.

Methods: This was a retrospective cohort study that characterized documented MABs at Prisma Health Richland Hospital and Prisma Health Children’s Hospital – Midlands between May 11th, 2025, and December 11th, 2025. MABs involving intravenous medications were excluded. The primary objective was to characterize documented MABs. Secondary objectives included describing pharmacist assignments, resolution of MABs, communication of MABs, discharge pharmacy practices, ambulatory care follow-up, hospital readmission rates, and time spent completing MAB interventions.

Results: In Progress

Conclusions: In Progress

Moderators

Katharine Strickland

Presenters

Aaron Chung

PGY1 Ambulatory Care Pharmacy Resident

Evaluators

Adam Sawyer

PGY1 Residency Program Director, Huntsville Hospital

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena B

Ambulatory Care (AMB), Prisma Health Richland - University of South Carolina

global Y

9:30am EDT

Optimization of Guideline-Directed Medical Therapy in Veterans Hospitalized with an Acute Heart Failure Exacerbation

Thursday April 30, 2026 9:30am - 9:50am EDT

Parthenon 1

Optimization of Guideline-Directed Medical Therapy in Veterans Hospitalized with an Acute Heart Failure Exacerbation
Benjamin Brewer, Mary Martin McGill
Birmingham VA Health Care System-Birmingham, AL
Background/Purpose: Recent guidance for treatment of heart failure with reduced ejection fraction (HFrEF) states that patients with HFrEF should have guideline-directed medical therapy (GDMT) initiated and then titrated to maximum dose as quickly as possible . Previous studies have shown inpatient titration of GDMT is safe. The purpose of this study is to evaluate the difference in 30-day readmission rate in patients with HFrEF hospitalized with an acute heart failure exacerbation in patients who have GDMT optimized in order to obtain current real world data GDMT usage and evaluate how GDMT utilization at discharge effects patient outcomes.
Methodology: This will be a retrospective observational chart review conducted by reviewing medical records of patients hospitalized with an acute heart failure exacerbation between 3/15/2025 and 9/24/2025. Inclusion criteria will include admission for heart failure exacerbation and documented ejection fraction (EF) < 40%. Exclusion criteria will include patients discharge to palliative care or patients undergoing dialysis. Patients with more than two admissions will only have the first readmission counted. Readmissions were not counted if for non-HFrEF indication. GDMT is considered an angiotensin converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNi), HF-specific beta blocker (BB), mineralocorticoid receptor antagonist (MRA) and sodium glucose cotransporter 2 inhibitor (SGLT2i) at maximum tolerated doses. Medication reconciliation on admission will be compared to the discharge medication list given to the patient. Patients will be grouped by whether GDMT medication was titrated or if therapy was not escalated.
Results: There were 140 patients reviewed and 65 met inclusion criteria. Of those 65 patients included in the study 32 had GDMT titrated at discharge and 33 did not have GDMT titrated at discharge. Nine (28%) patients in the optimized group were readmitted within 30-days and 6 (18%) patients were readmitted from the non GDMT optimized group (Relative Risk: 1.40; p-value: 0.40). Patient population is underpowered for statistical significance, but increased readmission rates could indicate clinical significance. Of the patient’s who had GDMT titrated, the most commonly titrated medication group was SGLT2i. They were optimized in 14 (44.8%) patients, next were BB and ACEi/ARB/ARNi which was each optimized in 13 patients (40.6%), and the least commonly optimized group was MRAs. They were optimized in 7 (21.9%) of patients. In patients who had GDMT titrated 17 (53.1%) also had loop diuretics add or titrated on discharge compare to 13 (39%) in those who did not have GDMT titrated. The pharmacy cardiology clinic provided quicker post discharge follow-up at an average of five days post discharge and met with 52.3% within 30 days of discharge, compared to cardiology clinic (11 days; 18% of patients), and primary care (7 days; 10.8% of patients). Forty-three of the patients received follow-up from a cardiology pharmacist, cardiology, or primary care and of those patients 4 (9.3%) were readmitted compared to those who did not receive follow-up with 30 days 12out of 22 (54.5%) were readmitted.
Conclusions: There were a few limitations that limit the applicability of these results to the overall population. The study had a small sample size evaluated over a short time period, there are many confounding variables, and data was only collected form a single facility. Follow-ups are limited by failure to reach patient, readmission, and possible lack of established care within BVAHCS. From this data medication titration at discharge was not associated with an increase of 30-day readmission. However, the opportunity to further titrate GDMT upon discharge does exist, specifically in MRAs.
Presentation Objective: Evaluate 30-day readmission rates of HFrEF admissions who have GDMT titrated at discharge in the Birmingham VA Health Care System (BVAHCS).
Self-Assessment: Which of the following is not a first line option for optimizing GDMT?

Moderators

P. David Brackett

RPD, Auburn University Clinical Health Services

Presenters

Ben Brewer

Evaluators

Carrie Callahan

Internal Medicine (IM) Specialist, PGY2 IM RPD, Emory University Hospital

Thursday April 30, 2026 9:30am - 9:50am EDT
Parthenon 1

Cardiology (CAR), VA-Birmingham, Al-Birmingham VA Health Care System

global Y

9:30am EDT

Impact of IV Fluid Components on Clinical Outcomes in Type 1 Diabetics Admitted to the PICU in DKA 

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena I

Authors: Alexa Ruzicka, Magen Check, Austin Weiss, Tamara Downing, Ashlee Baucom

Background:
Diabetic ketoacidosis (DKA) is a serious complication of insulin deficiency and a leading cause of hospitalization and mortality among children with type 1 diabetes mellitus (T1DM). Intravenous fluid resuscitation is a critical component of DKA therapy. However, fluid therapy in children carries unique risks, most notably cerebral edema. To mitigate these risks, current pediatric guidelines recommend gradual correction of hyperglycemia and acidosis using continuous insulin infusion and staged fluid replacement. Many institutions utilize a two-bag method, which allows for rapid titration of dextrose concentration while maintaining a continuous insulin infusion and consistent electrolyte delivery. The composition of the standard DKA bags used in the two-bag protocol was changed at the study institution in June 2024. The purpose of this study was to compare clinical outcomes before and after the implementation of the revised two-bag fluid composition for pediatric DKA.

Methods:
This study is an institutional review board approved, single center, retrospective cohort study. Pediatric patients (≤ 17 years of age) with a diagnosis of T1DM admitted to the PICU for management of DKA between June 1, 2023, and July 1, 2025, were eligible for inclusion. DKA was defined according to institutional and International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria. Patients were excluded if custom IV fluid bags were utilized during DKA management. The primary endpoint was the time (in hours) from initiation of IV insulin infusion to transition to subcutaneous insulin therapy, which was a surrogate marker for DKA resolution. Secondary outcomes included time to DKA resolution, defined by biochemical markers including serum bicarbonate, anion gap closure, venous pH and beta-hydroxybutyrate. Additional secondary outcomes included PICU and total hospital length of stay, and incidence of cerebral edema, hypoglycemia and hyperchloremia. Mann-Whitney U tests were used to evaluate baseline characteristics, time to DKA resolution, and length of stay. Chi-squared tests were utilized to evaluate the incidence of treatment-related complications.

Results:
109 pediatric patients met inclusion criteria. There were 44 patients and 65 patients in the previous and current bag composition groups, respectively. Baseline characteristics were similar between groups. The median time to transition to subcutaneous insulin was shorter in the current bag composition group compared to the previous bag composition group (11.98 hours vs 13.75 hours, p = 0.174). There was no statistically significant difference in the biochemical endpoints of DKA resolution between groups.
Rates of treatment-related complications were comparable between groups. The incidence of severe hypoglycemia (< 70 mg/dL) was low in both cohorts (2% vs 3%, p = 0.523), with moderate hypoglycemia occurring at a higher rate (< 100 mg/dL) (23% vs 37%, p = 0.117). Hyperchloremia occurred at a similar rate in both groups (82% vs 83%, p = 0.865). There were no statistically significant differences in cerebral edema (2% vs 6%, p = 0.342) or new-onset T1DM (36% vs 28%, p = 0.338). There were no significant differences observed in PICU length of stay (26.16 vs 27.32 hours, p = 0.91). However, the total hospital length of stay was longer in the current bag composition group (33.9 vs 35.6 hours, p = 0.03).

Conclusion:
The modification of the two-bag IV fluid composition for pediatric DKA did not result in significant differences in time to DKA resolution, complication rates, or PICU length of stay. Hospital length of stay was longer in the current bag composition group.

Contact email: [email protected]

Moderators

Courtney Isom

PGY-1 Community-based Residency Director, Cone Health

Presenters

Alexa Ruzicka

ECU Health

Alexa Ruzicka, PharmD. I am a PGY1 pharmacy resident at ECU Health Medical Center in Greenville, NC. I received my Doctor of Pharmacy from Wilkes University Nesbitt School of Pharmacy in 2025. Following completion of my PGY1, I will be completing a PGY2 in Infectious Diseases at ECU... Read More →

Evaluators

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, PGY-2 Ambulatory Care Pharmacy RPD, Kaiser Permanente Georgia

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena I

Community Pharmacy (CP), ECU Health Medical Center

global Y

9:30am EDT

Patient-Reported Outcomes with Semaglutide Sublingual Suspension for Wellness: A Prospective Observational Study

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena G

Title: Patient-Reported Outcomes with Semaglutide Sublingual Suspension for Wellness: A Prospective Observational Study.

Authors: Jonathan Reynolds; Brandon Sucher

Background:
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have increased in use for the treatment of obesity. This class of medications is associated with weight loss through activation of GLP-1 receptors, which delays gastric emptying and increases satiety. While effective for weight loss, injectable GLP-1 RAs are associated with gastrointestinal side effects, high cost, and the need for subcutaneous injections. In December 2025, semaglutide 25 mg oral tablets were approved by the FDA for the treatment of obesity, providing an alternative formulation for patients. The OASIS-4 clinical trial evaluated the use of semaglutide 25 mg oral tablets dosed once daily for 64 weeks in overweight or obese adults. At the conclusion of this study, the mean percent change in body weight from baseline to week 64 was -13.9%, and the proportion of patients with a weight loss greater than 5% was 79.2%. The most common adverse effects were nausea (46.6%), vomiting (30.9%), constipation (20.1%), dyspepsia (18.1%), and diarrhea (17.6%). Allergic reactions occurred in 3.9% of patients. Health care providers have prescribed compounded semaglutide sublingual (SL) suspension as an alternative to injectable GLP-1 RAs. This study aims to evaluate patient-reported outcomes from patients prescribed compounded semaglutide SL suspension.

Methods:
This prospective observational study utilized patient reported outcomes obtained from patients prescribed compounded semaglutide SL suspension from March 2025 to February 2026. All adult patients who received a prescription for compounded semaglutide SL suspension within a network of 20 compounding pharmacies were eligible. Eligible patients were emailed a link to complete a patient-reported outcome measure (PROM). Patients who did not initially complete the PROM received up to two reminder emails. There were no exclusion criteria for this study. The primary endpoint was the mean percent change in body weight from baseline. Secondary endpoints included overall satisfaction, post-meal fullness, adverse drug reactions, allergic reactions, and the proportion of patients achieving weight loss greater than 5%. Descriptive statistics were used to report data.

Results:
A total of 382 PROMs were emailed to patients, and 47 responses were received (12.3% response rate). The median dose reported was 4 mg SL once daily, and the median duration of therapy was 2 to 3 months. The mean percent change in weight was -1.9%. The median overall satisfaction reported was “somewhat satisfied,” and the median post-meal fullness was “moderately full.” Of the 47 patients, 8 (17%) achieved a weight loss greater than 5%. Two patients (4%) reported adverse reactions. One patient experienced constipation, headache, and fatigue, while the second patient experienced tooth sensitivity. Two patients experienced allergic reactions (4%), with one resulting in treatment discontinuation. One patient reported difficulty performing daily activities. The allergic reactions reported were not life-threatening and did not require hospitalization.

Conclusion:
Compounded semaglutide SL suspension at a median dose of 4 mg once daily was associated with a weight loss of 1.9% over a median duration of 2 to 3 months. The proportion of patients achieving weight loss greater than 5% was 17%. Patients reported a median level of overall satisfaction as “somewhat satisfied,” and a median post-meal fullness of feeling “moderately full.” Compounded semaglutide SL suspension demonstrated a favorable safety profile with a low incidence of reported adverse effects (4%) and allergic reactions (4%). While some benefit was seen, higher doses and a longer duration of compounded semaglutide SL suspension may demonstrate more favorable patient-reported outcomes.

Moderators

Alvin N. Tomika

Clinical Pharmacist, AdventHealth

Presenters

Jonathan Reynolds

PGY1 Community-Based Pharmacy Resident, Revelation Pharma – Innovation Compounding

Evaluators

Amy Carr

PGY1 RPD, AdventHealth Orlando

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena G

Community Pharmacy (CP), Revelation Pharma â€“ Innovation Compounding

global Y

9:30am EDT

Evaluating Antibiotic Overuse

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena J

Evaluating Antibiotic Overuse at Hospital Discharge for Uncomplicated Community Acquired Pneumonia and Urinary Tract Infections: A Retrospective Review

Blake McClellan, Sarah Grace Gunter, Noah Sanford, Braxton Clines, Elizabeth Covington

Abstract
Purpose: Inappropriate antibiotic prescribing at the time of hospital discharge represents a significant challenge to antimicrobial stewardship. Antibiotic overprescribing can carry serious consequences, such as antimicrobial resistance, adverse drug events, and increased healthcare costs. Studies have found high percentages of patients discharged with antibiotic durations exceeding guideline duration for urinary tract infections and community acquired pneumonia. This project evaluated discharge antibiotic prescribing at a community hospital located in the southeastern United States.

Methods: This retrospective chart review was approved by the Institutional Review Boards at East Alabama Medical Center (EAMC) and Auburn University. Study participants were screened from a pre-existing dataset of patients with infectious disease tests resulting post-discharge from August 2022 through October 2024. Inclusion criteria were as follows: findings consistent with uncomplicated urinary tract infection or community acquired pneumonia, discharged alive, and inpatient encounter with microbiology testing performed at EAMC. Exclusion criteria included patients with blood or urine culture contamination, Candida sp. growth in sputum, Pseudomonas sp. growth in stool, vaginal Group B Streptococcal swabs, no inpatient encounter, transfer to another facility at discharge, death prior to culture result, or classification as vulnerable population (<18 years or incarceration). The primary endpoint was percentage of patients with antibiotic overuse post-discharge based on the Vaughn et al. definition: unnecessary antibiotic use, excess duration of antibiotic use, and/or suboptimal use of fluoroquinolone therapy. Secondary endpoints included individual components of the antibiotic overuse definition, median days of antibiotic overuse after discharge, total antibiotic duration, duration of inpatient versus outpatient antibiotics, percentage of antibiotic course accounted for by outpatient antibiotics, percentage of patients with antibiotic order changes during hospital stay, percent overuse based on discharging services and presence of infectious diseases consult. Data were analyzed using descriptive statistics for the overall cohort, with additional comparative analyses performed between patients with and without antibiotic overuse using SPSS (IBM Corp., 2024).

Results: Nearly half (47/100, 47%) of patients experienced antibiotic overuse at hospital discharge. Overuse was driven primarily by excess duration of therapy, while unnecessary antibiotic initiation and suboptimal use of fluoroquinolones was less common. Among patients with overuse, the median number of excess antibiotic days was 3 days (IQR 2,5). The median total duration of therapy was 8 days (IQR 7,10), compared with a median ideal duration of 5 days (IQR 3,7). Most antibiotic exposure occurred in the outpatient setting (78%). When comparing patients with and without antibiotic overuse, there was no difference in overuse based on diagnosis, demographics, insurance status, or discharging service. More patients who experienced antibiotic overuse received a dose in the emergency department (17% vs. 3%, P = 0.044).

Conclusions: Antibiotic overuse at discharge for uncomplicated infections is common at this institution and is primarily driven by excess duration of therapy. The findings from this study help support prior literature and highlight opportunities for antimicrobial stewardship at transitions of care. Direction of future studies may include pharmacist-led interventions at the time of discharge to influence durations of therapy, and further evaluation of predictors of antibiotic overuse at discharge.

Moderators

Deidra Easley

PGY1 Residency Program Director, Baptist Medical Center South

Presenters

Blake McClellan

PGY-1 Pharmacy Resident, East Alabama Medical Center

My name is Blake McClellan, current PGY-1 Pharmacy Resident at East Alabama Medical Center (EAMC). I am a recent graduate of Harrison College of Pharmacy at Auburn University. I am also a Registered Nurse that has specialized in Emergency Medicine for 8+ years, and this experience... Read More →

Evaluators

Derek Rhodes

Manager / HSPAL RPD, Prisma Health

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena J

Infectious Disease (ID), East Alabama Medical Center

global Y

9:30am EDT

Resident Presentation - Alexis Titus

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena D

Moderators

Brittany White

Erlanger

Presenters

Alexis Titus

Evaluators

Alyson Burns

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena D

Internal Medicine (IM), Baptist Health Princeton Hospital

global Y

9:30am EDT

Evaluation of Carbapenem and Valproic Acid Interaction Warnings

Thursday April 30, 2026 9:30am - 9:50am EDT

Parthenon 2

Background: Concomitant administration of carbapenems and valproic acid (VPA) is a well-documented interaction that leads to rapid reductions in serum VPA concentrations with effects observed within 24 hours and persisting up to 7-10 days after discontinuation. This interaction increases the risk of breakthrough seizures, mood destabilization, and is associated with adverse clinical outcomes, including prolonged hospital stays and increased mortality, particularly in critically ill patients. Despite awareness, concomitant prescribing persists in large medical centers. At Grady Health System (GHS), prescribers and pharmacists receive a drug interaction warning when VPA and carbapenems are ordered together. Prior studies report only ~37% compliance with similar alerts, with over 50% of patients developing subtherapeutic VPA levels. Although drug interaction warnings are designed to mitigate this risk, it remains unclear whether these alerts effectively influence healthcare providers' behavior in hospitalized patients. This study aims to evaluate the clinical effectiveness of drug interaction warning targeting the co-administration of carbapenem and VPA and subsequent clinical sequelae at GHS.
Methods: This single-center, retrospective chart review included adults (≥18 years) admitted to GHS between January 1, 2020, and April 1, 2025, who received at least one overlapping dose of VPA and a carbapenem with a triggered drug interaction alert. Patients were excluded if discharged within 48 hours, receiving VPA and carbapenems prior to admission, or if clinical sequelae were documented prior to concomitant exposure. Data collected included demographics, indication for therapy, alert response, and resulting clinical actions (dose adjustment, discontinuation, or substitution). The primary outcome was the proportion of alerts with action versus no action at order entry or verification. Secondary outcomes included the type and frequency of resulting actions, incidence of clinical sequelae, hospital length of stay, duration of antimicrobial therapy, and documented indications for both VPA and carbapenem therapy Descriptive statistics were used, and chi-square and Fisher’s exact analysis evaluated associations between responder type and alert response.
Results: A total of 299 drug interaction alerts across 56 unique patients were analyzed. Clinical action was taken for 65 alerts (22%), while 234 alerts (78%) resulted in no action at order entry or pharmacist verification. Pharmacists were more likely than other providers to override alerts (84.0% vs 71.5%; χ² = 6.73, p = 0.009). Internal Medicine most frequently accounted for the provider responsible for the must-action (45.9%), followed by Infectious Diseases (12.6%). Given that carbapenems are restricted antimicrobials, Infectious Diseases consultation was commonly involved. At the patient level, clinical sequelae occurred in 40% of patients in the action group and 48% in the no-action group (Fisher’s exact p= 0.59). Median hospital length of stay was 22 versus 17 days, and median antibiotic duration was 3 versus 5 days, respectively. Agitation and behavioral changes were the most common sequelae in both groups, while breakthrough seizures and ICU transfer occurred less frequently and at similar rates. When action was taken, the most common interventions were switching the carbapenem, discontinuing valproic acid, or increasing the valproic acid dose.
Conclusions: Among 299 alerts, concomitant VPA and carbapenem use remained common, with alerts most often resulting in no action with no statically significant difference in clinical sequelae. Notably, nearly half of the patients in the no action group experienced adverse clinical outcomes, emphasizing clinical concern. Future research should assess pharmacist education, provider feedback, and alert optimization to improve compliance.

Moderators

Beth Phillips

Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2

Presenters

Sade Blackwood

PGY-1 Pharmacy Resident, Grady Memorial Hospital

Evaluators

Ben Ferris

RPD, AdventHealth East Orlando

Thursday April 30, 2026 9:30am - 9:50am EDT
Parthenon 2

Medication Safety (MES), Grady Memorial Hospital

9:30am EDT

Impact of Autoverification Strategies on Time to Antimicrobial Administration in the Emergency Department

Thursday April 30, 2026 9:30am - 9:50am EDT

Olympia 2

Impact of Autoverification Strategies on Time to Antimicrobial Administration in the Emergency Department

Jessie Vo, Christopher Campbell, Taylor Gregory, Kelley Norris, Alicia Sanchez

Background
Autoverification is the process in which a medication is automatically verified after provider order entry, without pharmacist review. Autoverification of antimicrobials in the emergency department was implemented following health system integration to align with system-wide autoverification practices; however, this was subsequently reverted to reinstate pharmacist verification. Timely administration of antimicrobials has long been recognized as a cornerstone of improving patient outcomes, particularly in those with sepsis. While most autoverification studies focus on quality and process improvement, there is limited data on the impact on clinical outcomes. To address this gap, this study examined if there is a difference in timely administration between autoverified and pharmacist verified antimicrobials.

Methods
A retrospective chart review of patients bedded in the adult and pediatric emergency departments who received an initial dose of oral or parenteral antimicrobial between November 16th, 2024 and January 16th, 2025, was conducted. Eligible patients were separated into two groups: the control group, during which autoverification of antimicrobials was permitted, and the intervention group, during which autoverification of antimicrobials was not allowed. The primary outcome was administration of antimicrobials within one hour of order entry. Secondary outcomes included pharmacist intervention rates and alerts per 100 orders.

Results
A total of 300 orders from 235 patients were included in the analysis, 150 orders in the control group; 150 orders in the intervention group. Significant differences in patient demographics were observed for age, race, and infections (abdominal, bloodstream/catheter-related, empiric/unknown). A significant difference was also observed in the order characteristics for the dispense location. One hundred and three (68.7%) orders in the control group and 87 (58%) of orders in the intervention group were administered within one hour (x2 = 3.67, (p = 0.055)). Compared with the control group, the intervention group observed higher rates of pharmacist intervention (1.33 vs 20 per 100 orders; IRR, 15; 95% CI, 3.58–62.7) and alerts (58 vs 104 per 100 orders; IRR, 1.79; 95% CI, 1.38–2.33).

Conclusion
This study found no difference in administration of antimicrobials within one hour between the control and intervention groups. The intervention group generated more alerts and required greater pharmacist involvement. Together, these findings suggest that excluding antimicrobials from autoverification does not negatively impact timely administration of antimicrobials and may preserve the safety benefits associated with pharmacist verification.

Contact: [email protected]

Moderators

David Laurent

Infectious Diseases Clinical Pharmacist, ECU Health

Presenters

Jessie Vo

PGY-1 Pharmacy Resident, Wellstar MCG Health

Evaluators

Deborah Hobbs

Associate Chief, Pharmacy, Carl Vinson VA Medical Center

PGY-1 Pharmacy Residency Program Director & Associate Chief, Pharmacy for Clinical Services at the Carl Vinson VA Medical Center. Chairperson Pro-Tem 2021

Thursday April 30, 2026 9:30am - 9:50am EDT
Olympia 2

Medication Safety (MES), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

9:30am EDT

Impact of IV Electrolyte Autoverification Compared to Pharmacist Verification in the Emergency Department

Thursday April 30, 2026 9:30am - 9:50am EDT

Olympia 1

Title: Impact of IV Electrolyte Autoverification Compared to Pharmacist Verification in the Emergency Department

Authors: Raven Gadson, Brittany Onyeji, Kirsten DiPiro, Ambra Hannah

Background/Purpose: Autoverification allows medication orders to bypass pharmacist review, which can improve efficiency but also introduces safety concerns. Studies show that removing high‑risk medications from autoverification increases pharmacist involvement and may reduce medication errors. The purpose of this study is to evaluate the safety and efficiency of pharmacist verification to autoverification for intravenous (IV) electrolyte orders in the emergency department setting (ED).

Methods: A retrospective chart review was conducted from August 1, 2024, to March 1, 2025, to compare pharmacist verification with autoverification. Inclusion criteria were age ≥18 years and received an IV Piggyback (IVPB) in the ED of a Wellstar Health System facility that was stocked in the ED Omnicell. The primary end point was a comparison of error rates related to dosing, indication, duplication, drug interaction, and allergies. Secondary end points included the time to final verification and time to administration that occurred in each study group.

Results: A total of 150 IVPB electrolyte orders were analyzed. Baseline demographics and order characteristics were similar between groups. No clinically significant ordering errors were identified in either group (P = 1). Time to final verification was significantly shorter with autoverification versus pharmacist verification (0 minutes vs 3 minutes, P < 0.001). However, time to administration did not differ between groups (40 minutes vs 40 minutes, P = 0.997). Provider order-entry alerts were infrequent and comparable. Among pharmacist‑verified orders, pharmacists received an alert for 18.7% of orders and documented a clinical intervention on 2.7%.

Conclusion: Autoverification of IVPB electrolytes demonstrated no observed increase in ordering errors compared with pharmacist verification and significantly reduced time to final verification, without affecting time to administration. These findings suggest that, within a safeguarded ED workflow, selective autoverification of IVPB electrolyte orders such as those that are pre-mixed, standardized, or placed through an order set may be a safe and efficient strategy. Limitations include retrospective design, modest sample size, reliance on documented interventions, and analysis restricted to medications that were administered. Prospective studies with larger samples are warranted to confirm safety signals and to evaluate operational levers that influence administration time.

List e-mail of resident (or best contact) for follow-up: [email protected]

Moderators

Charleen Melton

Presenters

Raven Gadson

PGY1 Pharmacy Resident, Wellstar Kennestone Regional Medical Center

Raven Gadson, PharmD is a PGY1 Pharmacy Resident at Wellstar Kennestone Regional Medical Center. She attended the University of South Florida where she earned her Bachelor of Science degree, followed by her Doctor of Pharmacy degree from the University of South Florida Taneja College... Read More →

Evaluators

Che Jordan

PGY1 Residency Program Director | Clinical Pharmacy Manager, Grand Strand Medical Center

Thursday April 30, 2026 9:30am - 9:50am EDT
Olympia 1

Medication Safety (MES), Wellstar Kennestone Regional Medical Center

global Y

9:30am EDT

Acute Pain Management in Patients with Opioid Use Disorder: Evaluating Practice and Outcomes Within a Tertiary Care Facility

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena C

Title: Acute Pain Management in Patients with Opioid Use Disorder: Evaluating Practice and Outcomes Within a Tertiary Care Facility

Authors: Breanna Wright, Mary Beth Brinkman, Justin Gruca
TriStar Centennial Medical Center – Nashville, TN

Background: Chronic pain is reported by 20.5% of Americans within the United States. Chronic pain is defined as pain that lasts beyond three months and extends past normal tissue healing time. Although hospitalized patients are treated for chronic pain, they may also require acute pain management in instances such as moderate to severe fractures or post-surgical pain. These instances may lead to undertreated pain by physicians due to fear of cognitive, respiratory, and psychomotor side effects which may be exaggerated with short-term opioid use. It is important to maintain adequate pain management, especially in patients with opioid use disorder (OUD) because undertreated pain has been shown to result in poor health outcomes, including early discharges, negative stigma, and overall mistrust of the healthcare system. Opioid use disorder is defined as a pattern of opioid use associated with a range of consequences, and with increased mortality leading to significant impairment or distress. The American Society of Addiction Medicine (ASAM) have published guidelines for the treatment of OUD, but there is still a lack of consensus among providers as it relates to acute pain management. In this study, we aimed to describe characteristics of acute pain management in patients on chronic opioid therapy within our institution.

Methods: This is a single-center, retrospective cohort study conducted through chart review from January 1, 2025 through July 1, 2025. Patients were identified via a computerized report using a clinical surveillance platform, generated by searching for buprenorphine medication orders. Patients admitted to our facility with acute pain and identified as being on chronic opioid therapy or receiving buprenorphine for opioid use disorder were included. Exclusion criteria consisted of oncology patients, nonverbal patients, patients admitted to the intensive care unit (ICU), patients receiving methadone inpatient or outpatient, and patients undergoing surgery during their admission. The primary endpoint was the average number of as needed (PRN) pain medication orders. Secondary endpoints included pain scale reduction, psychiatric provider consultations, naloxone administrations, methylnaltrexone administrations, and number of unplanned readmissions or emergency department (ED) visits.

Results: A total of 65 patients were screened; 27 patients met inclusion criteria and 38 patients were excluded. Less than half of the patients included within the study were male, and 85% of patients had a prior history of substance use disorder. Twenty-two of 27 patients had a medication-assisted treatment (MAT) regimen prior to index admission to our facility. The average number of PRN pain medication orders was 1.9, with an average of 0.5 PRN opioid orders and 1.4 PRN non-opioid orders. On average, pain scores decreased from admission to discharge by 0.5. Naloxone and methylnaltrexone were not administered to patients included in this study during the index admissions. 4 patients (14.8%) were readmitted within 30 days, while 8 patients (29.6%) visited the emergency department following their index admission.

Conclusion: Pain is a complex condition that can be challenging to manage, both acutely and chronically. This study’s assessment of acute pain control in patients with chronic pain demonstrated outcomes comparable to those reported in prior studies and highlighted the importance of effective acute pain management within this population. Patients had a similar average of PRN analgesic orders to those in prior studies and experienced modest reductions in pain scores from admission to discharge. Increasing the availability of PRN pain medications may further improve pain control in patients with chronic pain.
This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Moderators

Drew Kessell

Presenters

Breanna Wright

Breanna is a 2025 graduate of Auburn University Harrison College of Pharmacy. She is currently a PGY-1 resident at TriStar Centennial Medical Center in Nashville, TN.

Evaluators

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena C

Pain Management (PM), TriStar Centennial Medical Center

global Y

9:30am EDT

Systematic Use of the MORE Tool to Reduce Opioid-Related Adverse Events at a Community Teaching Hospital

Thursday April 30, 2026 9:30am - 9:50am EDT

Athena H

Title: Systematic Use of the MORE Tool to Reduce Opioid-Related Adverse Events at a Community Teaching Hospital
Authors: Mariam Diaby, Kimm Freeman

Background: Opioids are widely used for the management of moderate to severe pain in hospitalized patients; however, their use is associated with significant risk of opioid-related adverse drug events (ORADEs), including respiratory depression, oversedation, delirium, gastrointestinal complications, and increased morbidity and mortality. ORADEs have been linked to prolonged hospital length of stay, higher healthcare costs, and poorer clinical outcomes.

In response, opioid stewardship has become a major focus of inpatient quality improvement initiatives. Numerous stewardship efforts have emphasized multimodal analgesia, dose optimization, avoidance of high-risk medication combinations, and enhanced monitoring of sedation and respiratory status. Pharmacists play a critical role in these initiatives by conducting medication reviews, identifying inappropriate opioid prescribing, mitigating high-risk regimens, and implementing safety-focused interventions. However, sustaining consistent and standardized opioid stewardship practices within routine clinical workflow remains challenging.

The Medication and Risk Factor Review, Optimize, Refer at Risk Patients, Educate and Plan (MORE) tool was developed as a structured framework to standardize opioid stewardship efforts among pharmacists. The MORE tool prompts systematic evaluation of opioid therapy, including assessment of risk factors, optimization of analgesic regimens, reassessment of safety parameters, and patient education.

Methods: This retrospective observational study evaluated implementation of the MORE tool on 3 North Telemetry and 3 South Renal units at Wellstar Cobb Medical Center from December 22, 2025, to January 16, 2026. Adult patients admitted to study units who received at least one opioid medication during hospitalization were eligible. Patients admitted for hospice or comfort measures only, those hospitalized for less than 24 hours, and those who received naloxone for indications unrelated to opioid overdose were excluded.

The primary objective was to quantify and characterize the types of medication-related interventions documented during daily MORE tool utilization. Secondary analysis evaluated potential associations between documented MORE tool interventions and the root causes of naloxone administration during the study period.

Interventions were identified through pharmacist-documented I-Vents within the electronic medical record. Data collected included patient demographics, hospital length of stay, opioid administration records, sedation and risk assessment scores, naloxone administration events, and interventions. Descriptive statistics were used to summarize intervention frequency and type. Comparative analyses were performed to explore associations between MORE tool interventions and naloxone events.

Results: A total of 108 interventions were documented across 67 patients. Of the 108 interventions, 88 were accepted and 20 were rejected. The most common intervention was the conversion of intravenous opioids to oral opioids, which accounted for 33 interventions with 27 being accepted by the provider. Other frequently implemented interventions included the addition of opioid-induced constipation (OIC) prophylaxis (32 interventions), scheduling of Tylenol (4 interventions), and the discontinuation of benzodiazepines (4 interventions).

The overall rate of accepted interventions was 81.5%, with the highest acceptance rates seen in optimizing OIC prophylaxis (100%) and converting intravenous opioids to oral opioids (81.8%). Notably, there were no NARCAN (naloxone) administration events documented during the study period.

Conclusion: The systematic use of the MORE tool in this study demonstrated a high acceptance rate of opioid stewardship interventions, with 81.5% of the documented interventions being implemented. The tool effectively prompted appropriate adjustments in opioid management, particularly in optimizing OIC prophylaxis and converting IV opioids to PO opioids. During the study period, there were no naloxone administration events, suggesting that ORADEs may have been effectively mitigated through this proactive approach. These findings highlight the potential value of utilizing structured tools like the MORE tool in reducing ORADEs and optimizing opioid therapy, thus contributing to improved patient safety and clinical outcomes. Further research with larger cohorts is needed to confirm these findings and assess the long-term impact of such interventions.

Contact: [email protected]

Moderators

Camille Robinette

PGY1 RPD, Clinical Pharmacy Specialist, Primary Care, SVAM1Salisbury VA Health Care SystemPGY1

Presenters

Mariam Diaby

Hello, my name is Mariam Diaby, and I am currently a PGY1 Pharmacy Resident at Wellstar Cobb Medical Center. My professional interests include Infectious Diseases, Internal Medicine and Critical Care. I am deeply passionate about delivering high-quality, patient-centered care and... Read More →

Evaluators

John Carr

Manager of Clinical Pharmacy Services, SJCHS

Thursday April 30, 2026 9:30am - 9:50am EDT
Athena H

Pain Management (PM), Wellstar Cobb Medical Center PGY1

global Y

9:50am EDT

UNFILLED SLOT

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena G

Moderators

Alvin N. Tomika

Clinical Pharmacist, AdventHealth

Evaluators

Amy Carr

PGY1 RPD, AdventHealth Orlando

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena G

global Y

9:50am EDT

Comparative Effectiveness of Acetazolamide Versus Thiazide-like Diuretics for Sequential Nephron Blockade in Acute Decompensated Heart Failure: A Retrospective Cohort Study

Thursday April 30, 2026 9:50am - 10:10am EDT

Parthenon 1

TITLE: Comparative Effectiveness of Acetazolamide Versus Thiazide-like Diuretics for Sequential Nephron Blockade in Acute Decompensated Heart Failure: A Retrospective Cohort Study

AUTHORS: Angel D. Posadas, Otsanya Ochogbu

BACKGROUND: Intravenous loop diuretics are recommended as first-line therapy for the management of volume overload in acute decompensated heart failure (ADHF); however, many patients experience an inadequate diuretic response, resulting in persistent congestion. Sequential nephron blockade with thiazide-like diuretics or acetazolamide is commonly used to enhance diuresis in patients with diuretic resistance. Traditionally, thiazide-like diuretics have been used as add-on therapy when response to loop diuretics is insufficient. More recently, acetazolamide, a carbonic anhydrase inhibitor, has gained interest as an alternative strategy as studies have shown improved decongestion when compared to placebo. This study aimed to compare the effectiveness and safety of acetazolamide versus thiazide-like diuretics when combined with loop diuretics in adult patients hospitalized with ADHF.

METHODS: A single-center retrospective observational cohort study was conducted at AdventHealth Orlando evaluating adult patients hospitalized with ADHF between January 1, 2023 and January 1, 2025. Patients 18 years or older who received intravenous loop diuretics and adjunctive diuresis with either acetazolamide or a thiazide-like diuretic (metolazone or chlorothiazide) during hospitalization were included. Patients were excluded if they were on acetazolamide or a thiazide-like diuretic prior to admission, on extracorporeal membrane oxygenation, had end-stage renal disease, estimated glomerular filtration rate (eGFR) <15 mL/min/1.73m², or concomitant use of both adjunctive agents. The primary endpoint was average daily net fluid balance assessed for up to 72 hours of adjunctive diuretics. Secondary endpoints included net fluid balance at 24, 48, and 72 hours, change in body weight, hospital length of stay, inpatient mortality, 30-day readmission, and adverse events including hypokalemia, acute kidney injury (AKI), and arrhythmias.

RESULTS: A total of 897 patients were screened and 711 were excluded, primarily due to receipt of both adjunctive agents or lack of concomitant use with intravenous loop diuretics. A total of 186 patients were included in the study, 80 who received acetazolamide and 106 who received a thiazide-like diuretic. Baseline characteristics were generally similar between groups; however, patients receiving thiazides had higher baseline serum creatinine, and higher prevalence of chronic kidney disease (CKD). Baseline loop diuretic dose prior to adjunctive therapy was similar between groups (60 mg vs 80 mg; p=0.177). Median duration of adjunctive therapy was longer in the acetazolamide group compared to the thiazide group (2 vs 1 days; p =0.027). There was no difference in the average daily net fluid balance in patients receiving acetazolamide as compared to thiazides (−1634.9 mL/day vs −1553.0 mL/day; p=0.791). There was also no difference in the net fluid balance at 24, 48, and 72 hours between acetazolamide and thiazide groups. Patients receiving acetazolamide had significant weight reduction from admission to discontinuation of the adjunctive agent (−5.56 ± 6.75 kg vs −2.66 ± 6.05 kg; p=0.027) and a longer hospital length of stay (15 days vs 12.5 days; p=0.016). There was no difference in the incidence of inpatient mortality (6.3% vs 11.3%; p=0.235), 30-day readmission (20.0% vs 22.3%; p=0.712), hypokalemia (21.3% vs 23.6%; p=0.706), and arrhythmias (1.9% vs 2.5%; p=1.000). There was a significantly lower incidence of AKI in patients treated with acetazolamide compared with thiazides (20.0% vs 58.5%; p<0.001).

CONCLUSION: There was no difference in net fluid balance in patients treated with acetazolamide as compared to thiazide-like diuretics in patients admitted with ADHF, however, acetazolamide was associated with greater weight reduction. While a lower incidence of AKI was observed with acetazolamide, the higher prevalence of CKD in the thiazide group may have confounded this finding. Overall, these results suggest comparable diuretic efficacy between both agents, but larger randomized controlled trials are needed to evaluate differences in clinical outcomes and safety.

Moderators

P. David Brackett

RPD, Auburn University Clinical Health Services

Presenters

Angel Posadas

PGY1 Health-Systems Pharmacy Administration & Leadership Resident, AdventHealth

Evaluators

Carrie Callahan

Internal Medicine (IM) Specialist, PGY2 IM RPD, Emory University Hospital

Thursday April 30, 2026 9:50am - 10:10am EDT
Parthenon 1

Administration (ADM), AdventHealth Orlando

global Y

9:50am EDT

Levetiracetam Dosing Strategies for Seizure Prophylaxis in the Neurosurgical Intensive Care Unit

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena B

Authors: Alexander Leaman, Mary Tremaine, Sandrine Nelson

Background: Seizures have been reported in up to 25% of patients with traumatic brain injury (TBI) and 15.2% of patients with aneurysmal subarachnoid hemorrhage (aSAH). In TBI, seizures within 7 days of injury are associated with increased length of stay, mechanical ventilation, and worse functional outcomes. Neurocritical Care Society Guidelines from 2024 note that seizure prophylaxis may be considered, recommending levetiracetam over phenytoin, for a short duration (≤7 days). Early seizures in aSAH have not been associated with worse outcomes but may cause acute complications, such as increased intracranial pressure and aneurysmal re-rupture. The 2023 aSAH guidelines state that antiseizure medications (ASMs) may be used for seizure prophylaxis in patients with high-risk features for ≤7 days, avoiding phenytoin due to excess morbidity and mortality. Consequently, levetiracetam is commonly used to prevent seizures in both TBI and aSAH, often prescribed as 500 mg twice daily (BID). However, a retrospective study from 2023 found a lower seizure incidence with 750 to 1000 mg BID. Additionally, a prospective study comparing levetiracetam 20 mg/kg loading dose followed by 1000 mg BID to phenytoin found no difference in seizure incidence. This study investigated the incidence of seizures with levetiracetam 500 mg BID compared to 750 to 1000 mg BID in patients with moderate to severe TBI or aSAH with high-risk features for seizures.

Methods: This was a retrospective study of patients admitted to either of two neurosurgical intensive care units (ICUs) in our health system. Patients were at least 18 years of age admitted with TBI or aSAH with high-risk features for seizures and received at least one dose of levetiracetam between January 1, 2023, and September 1, 2025. Patients were excluded for history of seizure disorder or cerebral neoplasm, ASM use prior to admission, death or withdrawal of care within 7 days, hospital admission less than 7 days, seizures on presentation, pregnancy, incarceration, and estimated creatinine clearance less than 30 mL/min. Patients were analyzed in two groups, those receiving levetiracetam 500 mg BID and those receiving levetiracetam 750 to 1000 mg BID. The primary outcome was the incidence of clinical or electrographic seizures within seven days. Secondary outcomes included adverse effects associated with levetiracetam (anemia, leukopenia, thrombocytopenia, or dose reduction or change to another ASM attributed to somnolence or agitation) and evidence of treatment escalation for seizures (increased levetiracetam dose, treatment duration greater than seven days, or addition of another ASM). A power calculation found that 178 patients would be required to find a 10.2% lower seizure incidence with the higher dosing strategy. Baseline characteristics were reported using descriptive statistics, with nominal outcomes analyzed using the Fisher’s exact test.

Results: A total of 79 patients were included, with 47 in the 500 mg BID group and 32 in the 750 to 1000 mg BID group. Baseline weight, serum creatinine, and Glasgow Coma Scale were similar between groups. There was no difference in seizure incidence in the first 7 days between groups, with 7 patients (14.9%) in the 500 mg BID group and 4 patients (12.5%) in the 750 to 1000 mg BID group (p=0.54). There was also no difference in the incidence of adverse effects or treatment escalation between groups.

Conclusions: In this study, the use of levetiracetam 750 to 1000 mg BID did not result in a lower seizure incidence compared to 500 mg BID. Future studies may help to quantify if a true difference exists between these dosing strategies on the incidence of seizures.

Contact information: [email protected]

Moderators

Katharine Strickland

Presenters

Alexander Leaman

PGY1 Acute Care Pharmacy Resident, AdventHealth Celebration

I am a PGY1 Acute Care resident at AdventHealth Celebration and will begin my PGY2 Critical Care residency at Lakeland Regional Health later this year.

Evaluators

Adam Sawyer

PGY1 Residency Program Director, Huntsville Hospital

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena B

Critical Care/Emergency Medicine (CCM), AdventHealth Celebration

global Y

9:50am EDT

Comparing the efficacy and safety of sotalol and dofetilide for maintenance of normal sinus rhythm at a community health system

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena C

Comparing the efficacy and safety of sotalol and dofetilide for maintenance of normal sinus rhythm at a community health system Abigail Millsaps, Caitlin Casper, Dustin Bivins Northeast Georgia Medical Center – Gainesville, GA
Background: Atrial fibrillation (AF) occurs when inappropriate electrical currents cause the atria to beat out of sync with the ventricles, creating the hallmark irregularly irregular heart rhythm. The risk of developing AF increases with age and structural heart damage, making AF a significant cause of morbidity and mortality worldwide. AF, if left untreated, can lead to cardiomyopathy, heart failure, and thromboembolism.

Sotalol and dofetilide are class III antiarrhythmic drugs used for pharmacologic cardioversion to normal sinus rhythm (NSR) in patients who have atrial fibrillation (AF) or atrial flutter. These agents act on potassium-gated channels in myocardial cells to delay repolarization, prolong the action potential duration, and increase the effective refractory period (ERP). An increase in ERP extends the amount of time that the myocyte cannot be stimulated to fire another action potential, thus leading to a decrease in the incidence of arrhythmogenicity. However, this mechanism of action increases the risk of excessive QT (QTc) prolongation, which can result in torsades de pointes (TdP) or significant ventricular arrhythmias. Therefore, manufacturer labeling and treatment guidelines recommend initiating these medications in a hospital setting with continuous cardiac monitoring.

There is only one randomized controlled trial directly comparing sotalol and dofetilide. The EMERALD trial, conducted in 1999, compared the safety and efficacy of dofetilide and sotalol to placebo for initial cardioversion from AF to NSR and found 29.5% of patients given dofetilide and 5.9% given sotalol converted into NSR without needing direct current cardioversion (DCCV). Researchers also found 71% of patients who converted to NSR and received dofetilide maintained NSR at 6 months compared to 59% who received sotalol. Researchers reported three cases of TdP, all in the dofetilide group.

Purpose: The purpose of this study was to determine if sotalol or dofetilide is more efficacious at maintaining NSR at 6 months post-cardioversion in patients with AF/a-flutter.

Methods: This was a retrospective chart review to determine the percentage of patients in NSR six months post-cardioversion either pharmacologically or via DCCV after being loaded inpatient with dofetilide or sotalol. The study population included adults ≥18 years old at Northeast Georgia Health System (NGHS) between to January 1, 2022 to August 31, 2025 who were hospitalized with AF or a-flutter, completed inpatient loading with sotalol or dofetilide, achieved NSR prior to discharge either pharmacologically or via DCCV, and were continued on the selected treatment at discharge. Patients were excluded if they had a historical use of dofetilide or sotalol, concurrent use of other antiarrhythmic medications, baseline contraindications, documented non-adherence to study medications, history of ventricular arrhythmias, or were part of a vulnerable population. Authors used chi-squared analysis to evaluate primary and secondary endpoints.

Results: Between January 1, 2022 and August 31, 2025, 57 of 335 patients on sotalol and 17 of 53 patients on dofetilide met inclusion criteria. Baseline characteristics were similar between groups. We found no statistically significant difference in normal sinus rhythm at 6-months between sotalol and dofetilide (84.2% vs 82.4%; p = 0.557). There were no statistically significant differences in incidence of TdP or the percentage of patients requiring DCCV prior to discharge (76.5% vs 91.2%; p = 0.116).

Conclusion: Based on these findings, there is no difference between sotalol and dofetilide at maintaining NSR at 6 -months. Only one occurrence of TdP was detected in the sotalol group, and the dofetilide group had a lower percentage of patients requiring DCCV before discharge; however, these were not statistically significant. Limitations of this study included its retrospective nature, small sample size, and reliance on provider documentation.

Moderators

Drew Kessell

Presenters

Abigail Millsaps

PGY-1 Resident, Northeast Georgia Medical Center

Evaluators

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena C

Internal Medicine (IM), Northeast Georgia Medical Center

global Y

9:50am EDT

Pharmacist-Led Calcium Replacement in Trauma Patients - Aileen Jimenez

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena A

Poster Abstract Title: Pharmacist-Led Calcium Replacement in Trauma Patients
Primary Author: Aileen Jimenez
Contact: [email protected]
Co Authors: Heather Wilson and Madeline Mitchell
Background: Blood product administration has been associated with hypocalcemia in trauma patients receiving massive transfusion protocol (MTP) due to the binding of calcium by citrate. Calcium plays an important role in cardiac contractility and associated cardiac output. It also serves as a cofactor for vitamin K dependent clotting factors in the coagulation cascade; therefore, hypocalcemia is associated with increased mortality in trauma patients given its ability to potentiate coagulopathy, acidosis, and hypothermia. The purpose of this project was to evaluate the impact of standardized, pharmacist-led calcium replacement on hypocalcemia within 36 hours of administration of blood.
Methods: This is an IRB-reviewed, determined exempt, retrospective chart review from July 1, 2024 to February 28, 2026. Adult trauma patients, 18 years or older, who received two or more units of blood within a 24-hour period, and were subsequently admitted to an ICU were included. Data points include volume of blood products received, type and dose of calcium product received, timing of first basic metabolic panel (BMP) or arterial blood gas (ABG) after receipt of blood products, ionized calcium, serum calcium, and/or corrected calcium, and occurrence of hypo-/hypercalcemia. The primary outcome of this study was incidence of hypocalcemia within 36 hours the blood transfusion event. Secondary outcomes included achievement of normocalcemia within 36 hours of the blood transfusion event, continued normocalcemia at 72 hours, time between pRBC administration and calcium replacement, time between pRBC administration and first normalized calcium, percentage of patients with hypocalcemia who received calcium within 36h, and in-hospital mortality.
Results: Overall, 47 patients were included: 30 patients in the pre-group and 17 in the post-group. Baseline characteristics were similar between groups except for volume of fresh frozen plasma (FFP) and cryoprecipitate received (p<0.05). There was a statistically significant difference in the primary outcome of hypocalcemia within 36 hours in the pre-group vs post-group, respectively (90.0% vs 58.8%; Fisher's Exact OR: 0.1587; 95% CI (Corrected): [0.0416, 0.7630]; p=0.0232].. Additionally, there was a statistically significant difference in achievement of normocalcemia within 36 hours (55.6% vs 20.0% ; [OR: 0.2000 95% CI (Corrected): [0.0481, 1.1689] p<0.05) and time between pRBC administration and calcium replacement (9.6 hours v 5.8 hours; [median difference -3.79; 95% CI: [-10.71, -1.23]; p<0.05]). Overall, calcium was replaced more frequently in the pre-group compared to the post-group, but this difference was not statistically significant (56.7% vs 47.1% [OR 0.6797; 95% CI [0.2150, 2.2158]; p=0.5583).
Conclusion: The results suggest that the implementation of a pharmacist-led calcium replacement protocol resulted in less hypocalcemia at 36 hours; however, these results may be influenced by calcium being normal at baseline in the post-group. While pharmacist-led calcium replacement was also associated with a significantly lower time to calcium replacement, this did not result in quicker resolution of hypocalcemia. Limitations of this research include a small sample size, retrospective nature, potential for calcium receipt prior to ICU admission, and lack of differentiation between whole blood and pRBC. Future studies assessing a larger group would be beneficial to more clearly delineate the role of pharmacist-led calcium replacement on calcium levels in trauma patients.

Moderators

Aayush Patel

Clinical Pharmacy Specialist, Emergency Medicine, Piedmont Columbus Regional Midtown

Presenters

Aileen Jimenez

Evaluators

Abbi Rowe

Director of Pharmacy, AdventHealth

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena A

Internal Medicine (IM), Cone Health

global Y

9:50am EDT

Enhancing Surveillance of Unlinked Overrides from Automated Dispensing Cabinets with a Company-Wide Dashboard

Thursday April 30, 2026 9:50am - 10:10am EDT

Olympia 1

Background:
Automated dispensing cabinet (ADC) overrides are intended for emergent medication access but introduce risk when medications are removed without an associated order. After a medication is pulled on override, a retrospective order should be placed in the electronic health record (EHR) and the override linked to that order.

Overrides unlinked to orders may reflect breakdowns in ordering workflows, verbal order reconciliation, or documentation practices, increasing the risk of inappropriate medication administration or incomplete clinical review. Additionally, medication administration without a documented provider order may carry legal and licensure implications, as it can be interpreted as practice outside established scope and authorization.

Override monitoring is a critical safety and policy component of ADC governance. A company-wide override dashboard was recently updated to pull data from the EHR instead of pulling data from the ADC. This allowed the additional visualization of overrides being linked to orders in the EHR. However, limitations in filtering functionality and data clarity reduced its effectiveness for identifying trends in overrides unlinked to orders.

Objective:
To evaluate data integrity within a company-wide ADC override dashboard to enhance identification and review of unlinked overrides.

Methods:
This quality improvement initiative evaluated override data without linked orders from AdventHealth Central Florida Division (CFD), consisting of 10 acute care campuses and 11 off-site emergency departments (OSEDs). An evaluation of dashboard performance was conducted to assess usability and data reliability.

Results:
Dashboard filters were refined to allow more precise identification of overrides unlinked to medication orders, including improved medication-level and ADC-level stratification. Following implementation of revised filters, medications and ADCs commonly associated with unlinked overrides were more readily identifiable, enabling targeted analysis rather than broad, non-specific review. During detailed data review, a discrepancy was identified between data displayed and data exported. This prompted review of dashboard logic and strengthened confidence in data interpretation.

Medications and ADCs commonly associated with unlinked overrides were systematically identified, and focused analyses were performed to evaluate opportunities to improve override-to-order linking workflows. These finds were brought to the CFD interdisciplinary Medication Safety Committee to facilitate focused discussions on strategies to improve order linking workflows.

Conclusions:
Refinement and validation of a company-wide ADC override dashboard enhanced transparency, usability, and data reliability in monitoring unlinked overrides. Systematic dashboard optimization and multidisciplinary collaboration are essential to strengthening medication safety surveillance across large health systems.

Moderators

Charleen Melton

Presenters

Ally Krueger

PGY2 Medication-Use, Safety, and Policy, AdventHealth Orlando

Dr. Ally Krueger is a graduate of The University of Tennessee Health Science Center. She chose AdventHealth for residency because of the organization's dedication to medication safety. Ally's goal after residency is to be a medication safety officer, hopefully within AdventHealth... Read More →

Evaluators

Che Jordan

PGY1 Residency Program Director | Clinical Pharmacy Manager, Grand Strand Medical Center

Thursday April 30, 2026 9:50am - 10:10am EDT
Olympia 1

Medication Safety (MES), AdventHealth Orlando

global Y

9:50am EDT

Evaluation of the Medication Discrepancy Rate at Discharge

Thursday April 30, 2026 9:50am - 10:10am EDT

Olympia 2

Title: Evaluation of the Medication Discrepancy Rate at Discharge
Purpose: Medication errors during hospital admissions have unfortunately followed patients out of the hospital. Many hospitals aim to resume accurate home medications within 24 hours of admission. However, medication discrepancies at the point of hospital discharge can be overlooked. The prevention of unnecessary or potentially harmful medications at discharge could reduce medication errors as well as provide a potential cost-savings opportunity for the health system. The purpose of this study is to evaluate the rate of medication discrepancies at hospital discharge by comparing prior-to-admission medication lists to discharge medication orders.
Methods: This study is an institutional review board approved, retrospective chart review. Patients discharged from Mobile Infirmary Medical Center between June 1st, 2025 to August 31st, 2025 will be randomized and evaluated by a manual chart review. Medication discrepancies are defined as intentional or unintentional differences between medication lists. Patients will be excluded if they did not have a home medication list marked as “complete” during the admission, left the hospital admission against medical advice or had more than 2 readmissions during the study period. The primary outcome of this study is to identify the rate of medication discrepancies per medication in patients with a completed prior to admission list. Our secondary outcomes include 30-day readmission rates, types of medication discrepancies, and most common drug classes associated with errors. A subgroup analysis will be completed on patients with at least one unintentional discrepancy, focusing on average number of discrepancies per patient, average length of stay, and average number of home medications. Data that will be collected includes: patient demographics and types of medication discrepancies at the time of hospital discharge.
Results: A chart review was conducted on 350 patients. 137 were excluded, and our final included population was 213. Of the excluded patients, 77 had incomplete prior-to-admission (PTA) lists, 25 did not have any home medications on admission, 24 did not have a discharge medication reconciliation completed, and 11 were readmitted more than twice at the time of review. Baseline characteristics included a mean age of 67 + 14.5, 46% of our population were male, the mean length of stay was 14.3 [5] days, and the mean number of home medications was 6.3 + 4.2. The rate of unintentional medication discrepancies per medication was 6.6%. 87 out of 1345 medications screened had an unintentional discrepancy. The most common type of discrepancy was omission, which accounted for 54% of unintentional discrepancies. Dose was next at 16%, followed by frequency at 13%, other reasons at 9%, duplication at 5%, and route at 3%. Of our total population, 14% were readmitted within 30 days, and 21% of those readmitted had unintentional discrepancies. The top five most common drug classes were analgesics, insulin, statins, beta-blockers, and anticoagulants. 54 (25%) patients from our population had at least one unintentional discrepancy. We found that 85% of these patients had 1-2 discrepancies, 11% had 3-4 discrepancies, and 4% had 5-6 discrepancies. The mean number of discrepancies per patient was 1.6 + 1.1, the mean length of stay in this subgroup was 9.5 [5], and the mean number of home medications was 7.6 + 4.3.
Conclusion: Our study consisted of a thorough chart review of initially 350 patients. Based on exclusion criteria, the included sample size was 213, which is a decently sized sample. Our criteria allows for decent generalizability as it included any adult discharged from mobile infirmary in the span of 3 months, however it did exclude incomplete lists as to focus on discharge medications. We also had to assume that the completed reconciliation was as accurate as possible. This was also a single-center study, though at a large community hospital, and was retrospective, so there was a lack of true control. In conclusion, our study shows that medication discrepancies can still occur at discharge despite a completed prior to admission list, and the medications that have errors are high-risk medications. Future directions include scoring tools, artificial intelligence, and prioritizing the assessment of home medications while on disciplinary rounds. We are hopeful that this study procures a dedicated pharmacist-led reconciliation team and additional medication reconciliation protocols at discharge.

Moderators

David Laurent

Infectious Diseases Clinical Pharmacist, ECU Health

Presenters

Angelyn Wilson

My name is Angelyn Wilson, and I go by Angie. I am from Huntsville, Alabama and currently a Pharmacy Practice PGY-1 Resident at Mobile Infirmary Medical Center in Mobile, Alabama. I completed undergraduate and pharmacy school at the University of Mississippi. My husband, who is in... Read More →

Evaluators

Deborah Hobbs

Associate Chief, Pharmacy, Carl Vinson VA Medical Center

PGY-1 Pharmacy Residency Program Director & Associate Chief, Pharmacy for Clinical Services at the Carl Vinson VA Medical Center. Chairperson Pro-Tem 2021

Thursday April 30, 2026 9:50am - 10:10am EDT
Olympia 2

Medication Safety (MES), Mobile Infirmary Medical Center

global Y

9:50am EDT

Outcomes of Intracranial Stenting During Tirofiban Infusion in Obese Patients: A Retrospective Analysis

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena D

Background: Tirofiban is an intravenous glycoprotein IIb/IIIa inhibitor used after intracranial stenting procedures to reduce the risk of thrombotic complications. However, tirofiban is associated with an increased risk of bleeding, including intracranial hemorrhage (ICH). Balancing thrombotic prevention with bleeding risk remains a challenge in patients undergoing intracranial stent placement. Obesity may influence the safety and effectiveness of antiplatelet therapies due to alterations in drug distribution. Data evaluating tirofiban use in obese patients who have undergone intracranial stenting procedures is limited. Specifically, the impact of obesity on major bleeding and treatment failure outcomes has not been well studied. The purpose of this study is to compare the incidence of intracranial hemorrhage or stent reocclusion, between obese and non-obese patients receiving tirofiban after intracranial stenting procedures.
Methods: This retrospective chart review included adult patients (≥18 years) who underwent elective or emergent intracranial stenting and received intravenous tirofiban during hospitalization at a comprehensive stroke center between July 1, 2018, and June 30, 2025. Patients were grouped based on body mass index (BMI) into obese (BMI ≥30 kg/m²) and non-obese (BMI <30 kg/m²) groups. The primary outcome was treatment failure, defined as a composite outcome of intracranial hemorrhage or stent reocclusion confirmed by imaging during the hospitalization. The secondary outcome was major bleeding, defined by the International Society on Thrombosis and Haemostasis (ISTH) criteria as fatal bleeding, bleeding in critical areas, a drop in hemoglobin of ≥2 g/dL, or leading to a transfusion of ≥2 units of blood. Data collected included demographic characteristics, BMI, relevant comorbidities, indication for the procedure, tirofiban dosing and duration, renal function, and concomitant antiplatelet or anticoagulant therapy. Outcomes were assessed during the tirofiban infusion only. Baseline characteristics were summarized, and outcomes were compared between groups using t-tests, chi-square analysis, or Fisher’s exact test.
Results: A total of 101 patients were included in the analysis, with 59 non-obese and 42 obese patients. Obese patients were younger (54.9 ± 15.1 vs 63.8 ± 14.7 years, p=0.007) and had higher creatinine clearance values (137.4 ± 75.4 vs 85.7 ± 36.5 mL/min, p<0.0001) compared to non-obese patients. As expected, obese patients had significantly higher dosing and actual body weights and received larger tirofiban loading doses. Other baseline characteristics, including sex, severity scores (Hunt & Hess, NIHSS), duration of tirofiban infusion, overlap with oral antiplatelet therapy, and renal dose adjustments, were similar between groups. The primary composite outcome of ICH or stent reocclusion occurred in 30.5% of non-obese patients and 40.5% of obese patients (p=0.299). Major bleeding occurred in 32.2% of non-obese patients compared to 42.9% of obese patients (p=0.273). Rates of individual outcomes, including ICH (22.0% vs 38.1%, p=0.079) and stent reocclusion (11.9% vs 2.4%, p=0.071), were not significantly different between groups. There was no significant difference in major bleeding when comparing severely obese patients (BMI ≥40 kg/m²) to non-severely obese patients (33.3% vs 37.1%, p=0.245).
Conclusions: In this retrospective analysis, obesity was not associated with a statistically significant increase in treatment failure or major bleeding among patients receiving tirofiban following intracranial stenting. However, numerically higher rates of intracranial hemorrhage were observed in obese patients, suggesting a potential safety signal. Given the overall high bleeding risk and lack of obesity-specific dosing guidance, caution remains warranted, and larger, prospective studies are needed to better define optimal dosing strategies and bleeding risk in this population.

Moderators

Brittany White

Erlanger

Presenters

Greg Shulkosky

PGY-1 Resident, Piedmont Atlanta Hospital

Greg Shulkosky is a PGY1 Pharmacy Resident at Piedmont Atlanta Hospital. He completed his Bachelor of Science and Pharmaceutical Sciences and Doctor of Pharmacy degrees at the University of Toledo. He plans to obtain a clinical pharmacist position after completing his PGY1 pharmacy... Read More →

Evaluators

Alyson Burns

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena D

Neurology (NEU), Piedmont Atlanta Hospital

global Y

9:50am EDT

Evaluation of Outcomes for HiDAC-135 Versus HiDAC-123

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena H

Title: Evaluation of Outcomes for HiDAC-135 Versus HiDAC-123
Investigators: Chelsea Hylton
Rachel Matthews
Darby Siler
Laura Beth Parsons
Practice site: Sarah Cannon Cancer Center at TriStar Centennial Medical Center
Background (464/600 words):
Intermediate to high-dose cytarabine (IDAC/HiDAC) is a preferred consolidation chemotherapy regimen for patients with acute myeloid leukemia (AML) that have achieved remission [1]. IDAC/HiDAC is traditionally administered every 12 hours on days 1, 3, and 5 (HiDAC-135). Studies have explored administering cytarabine 3000 mg/m2 every 12 hours on days 1, 2, and 3 (HiDAC-123) to reduce the risk of neutropenia without compromising the clinical outcomes [2]. There was a significant difference in median overall survival of 79 months (HiDAC-123) versus 31 months (HiDAC-135) (P=0.031). HiDAC-135 was also associated with a longer course of hospitalization (P=0.008) and increase in transfusions (P=0.011) [2]. More recent studies have explored administering HiDAC-123 with or without granulocyte colony stimulating factors (G-CSF) to mitigate myelosuppression and relapse [3]. There was no statistically significant difference in overall survival and relapse-free survival, but there was a significant difference in the decreased duration of neutropenia (P<0.0001) [3].
This study compares HiDAC-135 and HiDAC-123 in a real-world setting.
Methods:
This institutional review board (IRB)-approved, single center, retrospective chart review included patients with AML that received 2 or more cycles of IDAC/HiDAC consolidation on the adult hematology service line between 02/01/2023-01/31/2025. The institutional practice changed from HiDAC-135 to HiDAC-123 in January 2024. Patients were excluded if they were enrolled in a clinical trial or were treated on the pediatric service line. Outcomes were compared across groups. Descriptive statistics was used for baseline characteristics and outcomes. Data was collected from electronic medical records after running our pharmacy surveillance platform to include cytarabine orders during the study timeframe.
Results: A total of 132 patients were screened; 12 patients met inclusion criteria (HIDAC-135: n=8; HIDAC-123: n=2;HIDAC-135 to HIDAC-123: n=2). There was a wide variation in age in the HIDA-123 arm, with one patient being over age. Total cycle delays varied across treatment arms: HIDAC-135 at 43%, HIDAC-123 at 100%, and HIDAC-135 to HIDAC-123 at 67%. The median duration of hospitalization was 5 days for HIDAC-135, 3 days for HIDAC-123, and 4 days for HIDAC-135 to HIDAC-123. G-CSF administration was 36% in HIDAC-135, 100% in HIDAC-123, and 60% in HIDAC-135 to HIDAC-123. There was an incidence of hospital readmission for febrile neutropenia (FN) seen in 27.2% in HIDAC-135 and 60% in HIDAC-123, with no FN readmissions in the HIDAC-135 to HIDAC-123 arm. Of note, all three readmissions for FN in HIDAC-123 received G-CSF. Only one of the FN readmissions in the HIDAC-135 arm received G-CSF.
Conclusions/Discussion: Outcomes of this study comparing HIDAC-135 to HIDAC-123 were not consistent with previous studies. Insufficient data due to small patient numbers may have impacted study results and ability to conduct statistical analysis. Though not collected, some patients underwent hematopoietic stem cell transplant instead of receiving all four cycles of HIDAC consolidation. Further analysis is needed to compare results with HIDAC-123 at this institution.
References:
1. Mayer RJ, Davis RB, Schiffer CA, et al. Intensive postremission chemotherapy in adults with acute myeloid leukemia. N Engl J Med. 1994;331(14):896-903. doi:10.1056/NEJM199410063311402
2. Krayem B, Horesh N, Frisch A, Zuckerman T, Ofran Y. Hidac consolidation in aml: comparable outcomes with reduced toxicity using a three-day schedule(HiDAC-123). Eur J Haematol. 2025;115(2):193-195. doi:10.1111/ejh.14432
3. Jaramillo, S - Blood Cancer J (2017) Condensed versus standard schedule of high-dose cytarabine consolidation therapy with pegfilgrastim growth factor support in acute myeloid leukemia.pdf
Contact information: Chelsea Hylton, PharmD
[email protected]

Moderators

Camille Robinette

PGY1 RPD, Clinical Pharmacy Specialist, Primary Care, SVAM1Salisbury VA Health Care SystemPGY1

Presenters

Chelsea Hylton

PGY-2 Oncology Pharmacy Resident, TriStar Centennial Medical Center

Chelsea Hylton is a PGY-2 Oncology Pharmacy Resident at TriStar Centennial Medical Center, in Nashville Tennessee. Chelsea earned her Doctor of Pharmacy degree from Xavier University of Louisiana and later completed a PGY1 residency at Baptist Memorial Hospital in Mississippi. After... Read More →

Evaluators

John Carr

Manager of Clinical Pharmacy Services, SJCHS

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena H

Oncology (ONC), TriStar Centennial Medical Center

global Y

9:50am EDT

Comparison of Ketamine Monotherapy versus Ketamine and Propofol for Procedural Sedation in the Pediatric Emergency Department and the Impact on Time to Discharge

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena J

Title: Comparison of Ketamine Monotherapy versus Ketamine and Propofol for Procedural Sedation in the Pediatric Emergency Department and the Impact on Time to Discharge

Authors: Francesco Mottola; Andrea Gerwin; Maggie Raker; Sarah Sterner; Morgan Padron
Background/Purpose: Optimizing sedation for procedures in the pediatric emergency department (PED) is essential for effective pain control and timely discharge. Ketamine is commonly used as monotherapy, but its associated adverse effects may delay recovery. Combining ketamine with propofol may reduce these effects, potentially shortening time to discharge. However, whether this combination leads to faster discharge compared to ketamine alone remains unclear within current literature. The purpose of this study is to compare discharge times between ketamine monotherapy versus ketamine and propofol when used for procedural sedation in the pediatric emergency department.

Methods: This study is a single-center, retrospective, chart review utilizing electronic health records of patients treated in the PED at the Children’s Hospital at Erlanger between January 1, 2023 and October 30, 2024. Patients were included if they were less than 18 years of age and received either ketamine or the combination of ketamine and propofol for procedural sedation with moderate depth sedation targets. Exclusion criteria included medically complex patients, patients with hypersensitivity to either ketamine or propofol, and patients admitted to the hospital after receiving procedural sedation in PED. The primary outcome is to evaluate whether the combination of ketamine and propofol leads to a quicker discharge time than the use of ketamine alone when used for procedural sedation in the PED. Secondary outcomes include the overall rate of adverse events, administration of pre‑sedation antiemetics, nausea, emesis, emergence reactions, and the mean sedation duration.

Results: Preliminary data included a total of 220 patients with 109 in the ketamine group and 111 in the combination of ketamine and propofol group, respectively. Preliminary results indicate that the mean dose of ketamine was 1.95 mg/kg ± 0.74 in the ketamine group compared to 1.21 mg/kg ± 0.43 in the ketamine and propofol group. The average dose of propofol was 2.38 mg/kg ± 1.12 when used in combination with ketamine. In the ketamine group, the mean duration of sedation was 23.08 minutes ± 16.4 with a mean discharge time of 155.7 minutes ± 105.6 (p< 0.001) compared to a mean sedation duration of 25.33 minutes ± 8.5 in the ketamine and propofol group with an average time to discharge of 112.40 minutes ± 39.57 (p< 0.001). In the ketamine group, 74 patients (67.3%) received pre‑sedation antiemetics, compared with 59 patients (53.2%) in the combination of ketamine and propofol group (p= 0.25). Overall adverse events were reported in 33 (30%) of patients in the ketamine group compared to 10 (9.1%) in the ketamine and propofol group (p < 0.0001). The most common adverse events reported in the ketamine group were emesis (33%) and nausea (45%). In the ketamine and propofol group, the adverse events reported were nausea (70%) and emesis (10%). No emergence reactions were observed between either group.
Conclusions: The use of ketamine and propofol for procedural sedation within the pediatric emergency department may decrease the time to discharge when compared to ketamine alone. This is likely due to the lower incidence of adverse events seen with the combination of ketamine and propofol. When used in combination, lower doses of ketamine were more likely to be used, which may contribute to the lower reported rate of adverse effects. However, patients within the ketamine group were also more likely to receive pre-sedation antiemetics when compared to the ketamine and propofol combination group, which may also impact incidence of adverse effects.

Moderators

Deidra Easley

PGY1 Residency Program Director, Baptist Medical Center South

Presenters

Francesco Mottola

PGY-1 Pharmacy Resident, Erlanger

Evaluators

Derek Rhodes

Manager / HSPAL RPD, Prisma Health

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena J

Pediatric (PED), Erlanger Health System

global Y

9:50am EDT

Evaluation of Staphylococcal Scalded Skin Syndrome Treatment

Thursday April 30, 2026 9:50am - 10:10am EDT

Athena I

Background: Staphylococcal scalded skin syndrome (SSSS) is a serious toxin-mediated dermatologic condition that primarily affects young children and is an important cause of pediatric hospitalization. This syndrome is caused by exfoliative toxins produced by Staphylococcus aureus, resulting in diffuse erythema, skin fragility, and superficial blistering with subsequent desquamation. Current management focuses on eradication of the toxin-producing organism with systemic antistaphylococcal antibiotics in conjunction with supportive care. Beta-lactam antibiotics with activity against methicillin-susceptible S. aureus, such as nafcillin, are considered first-line therapy. Clindamycin is frequently used as adjunctive therapy due to its ability to inhibit bacterial protein synthesis and suppress toxin production. However, the addition of clindamycin for antitoxin use in SSSS has remained controversial with conflicting findings in primary literature of whether it should be added to mainstay treatment. This study evaluates the association between adjunctive clindamycin use in combination with nafcillin and length of stay (LOS) in pediatric patients with SSSS at our institution. Methods: A single-center, institutional review committee (IRC)–approved retrospective analysis was conducted at Huntsville Hospital for Women and Children to evaluate nafcillin monotherapy compared to the combination of nafcillin and clindamycin in relation to LOS of patients admitted between January 1, 2019 and August 31, 2025. Pediatric patients ages one month to 18 years that received at least one dose of nafcillin and with an ICD-10 code L00 for SSSS were included in the analysis. Patients with alternate diagnoses, concomitant infections requiring broader-spectrum antibiotics, or transferred out of the facility due to needing a higher level of care were excluded. The primary outcome was hospital LOS between the two groups. Secondary outcomes included the utilization of adjunctive and supportive medications during hospitalization, specifically the use of scheduled pain medications, scheduled antipruritic medications, as-needed (PRN) pain medications, and PRN antipruritic medications. Continuous variables were summarized using means with standard deviations and medians with interquartile ranges (IQR). Categorical variables were reported as percentages. Analysis for statistical significance was computed using RStudio ®.Results: Eighty-five patients were included in the evaluation of the primary and secondary endpoints. 18 patients were treated with nafcillin monotherapy and 67 were treated with the combination of nafcillin and clindamycin. Mean LOS was 3.89 ± 1.78 days in the nafcillin group and 3.70 ± 1.66 days in the combination group, corresponding to a mean difference of −0.19 days (95% CI −1.10 to 0.69; p = 0.78). Median LOS was 3.5 days (IQR 3.0–4.8) for nafcillin monotherapy and 4.0 days (IQR 3.0–4.0) for combination therapy (Hodges–Lehmann shift 0 days; 95% CI −1 to 1; p = 0.78). No secondary outcomes were statistically significant after adjustment for multiple comparisons. Local microbiologic data demonstrated low clindamycin resistance among MSSA isolates (10%) and overall low prevalence of MRSA isolates (7.4%).Conclusion: The combination of nafcillin and clindamycin use was not associated with a statistically significant reduction in hospital LOS among pediatric patients with SSSS. These findings align with prior literature suggesting limited impact of clindamycin on hospitalization duration1, 2. Additionally, no statistically significant differences were observed in the secondary outcomes evaluating the utilization of scheduled or as-needed medications. Routine adjunctive clindamycin use for LOS reduction in pediatric SSSS is not supported by this data and should be considered within the context of institutional susceptibility patterns and antimicrobial stewardship principles.

Moderators

Courtney Isom

PGY-1 Community-based Residency Director, Cone Health

Presenters

Kelly Bazel

PGY-1 Pharmacy Resident, Huntsville Hospital

Evaluators

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, PGY-2 Ambulatory Care Pharmacy RPD, Kaiser Permanente Georgia

Thursday April 30, 2026 9:50am - 10:10am EDT
Athena I

Pediatric (PED), Huntsville Hospital

global Y

9:50am EDT

Evaluation of Discharge Process from a High Intensity Psychiatric Unit at a Veteran’s Health Care System

Thursday April 30, 2026 9:50am - 10:10am EDT

Parthenon 2

Title: Evaluation of Discharge Process from a High Intensity Psychiatric Unit at a Veteran’s Health Care System

Author’s names: Dalton V. Scott, Lynsey Neighbors, Anisa Britt, Perry Thompson

Background: The Central Alabama Veterans Health Care System (CAVHCS) High Intensity Psychiatric Unit (HIPU) provides mental health (MH) crisis intervention and stabilization to veterans, followed by discharge to the most appropriate level of care, including continued medication management in the outpatient setting. Pharmacy services contribute to this process through discharge medication reconciliation and dispensing the prescribed discharge medications. This project aims to evaluate the timely and appropriate scheduling of follow-up with outpatient MH services as indicated by VHA Directive for veterans discharged from the HIPU to ensure continued medication management in the immediate post-discharge period, and the rates of readmissions related to acute MH within 90 days of discharge.

Methods: This is a retrospective, observational chart review of veterans discharged from the CAVHCS HIPU from 10/01/2024 to 04/22/2025. Exclusion criteria were as follows: veterans with irregular discharge circumstances (e.g., left Against Medical Advice), those transferred to another level of care (e.g., long-term rehabilitation), or those readmitted in the 90-day post-discharge period for non-MH treatment. Primary outcomes included: the rate of veterans who completed outpatient MH prescriber follow-up within ≤ 7 days, 8-30 days, and 31-90 days post-discharge; the rate of readmission for acute MH treatment within 90 days; and the average time to acute MH-related readmission. Secondary outcomes included the rate of pharmacist-entered discharge medication reconciliation notes and the rates of discharge MH medications by class.

Results: Among 166 HIPU discharges, nearly 58% had no outpatient MH follow-up. 15% had scheduled follow-up within ≤ 7 days, followed by 10% within 8-30 days, and 7% within 31-90 days. 3% had walk-in appointments at 8-30 days, and 7% of walk-in appointments occurred at 31-90 days post-discharge. 34% of discharges resulted in readmission within 90 days. 80% of readmissions had no outpatient MH prescriber follow-up. Of those not readmitted, 46% also lacked outpatient MH prescriber follow-up. Pharmacists provided discharge medication reconciliation to 27% of readmitted veterans while 7% of readmitted veterans did not receive the service. Pharmacists provided discharge medication reconciliation to 56% of non-readmitted veterans while 10% of non-readmitted veterans did not receive the service. The evaluated 536 post-discharge MH medications stratified by medication class were as follows: 28% antidepressants, 18% antipsychotics, 2% benzodiazepines, 2% extrapyramidal symptom agents, 4% mood stabilizers, 16% non-benzodiazepine anxiolytics, 27% sleep agents, 2% substance use disorder agents, and 1% long-acting injectable antipsychotics.

Conclusions: The data indicate that the HIPU discharge process is not aligned with VHA Directive, as over half of the discharges evaluated lacked outpatient MH prescriber follow-up. Alarmingly, 80% of readmissions were comprised of veterans who did not receive outpatient follow-up care within the 90-day post-discharge evaluation period. As HIPU providers only provide outpatient prescriptions for 30-day supplies, a lack of appropriate follow-up increases the risk of acute MH relapse. Establishing effective transition processes, timely scheduling, and ensuring continuity of care are essential to mitigate these risks and improve patient outcomes. Pharmacists play a crucial role in preventing HIPU readmissions, as supported by the finding that over half of patients who received pharmacy discharge medication reconciliation were not readmitted within the 90-day post-discharge period. This highlights the importance of pharmacist involvement in discharge processes to improve patient outcomes and reduce readmission rates. These findings provide compelling evidence for implementing processes to improve transitions of care and to advocate for increased pharmacy involvement for veterans discharged from the HIPU.

Moderators

Beth Phillips

Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2

Presenters

Dalton V. Scott

PGY1 Pharmacy Resident, Central Alabama Veterans Health Care System (CAVHCS)

Dalton Scott, PharmD, from Somerville, Alabama, received his Doctor of Pharmacy from Auburn University Harrison College of Pharmacy. His pharmacy practice interests are mental health and ambulatory care. After completing his PGY1, he hopes to obtain a position at the VA where he can... Read More →

Evaluators

Ben Ferris

RPD, AdventHealth East Orlando

Thursday April 30, 2026 9:50am - 10:10am EDT
Parthenon 2

Psychiatric Pharmacy (PSY), VA-Montgomery, AL-Central Alabama Veterans Health Care System

global Y

10:10am EDT

Development of a Pharmacist Credentialing and Privileging Framework - Ellis Simerly

Thursday April 30, 2026 10:10am - 10:30am EDT

Olympia 2

Background: Credentialing and privileging (C&P) formally authorize clinicians to perform defined scopes of practice within a healthcare organization and are widely used for physicians and advanced practice providers. Health‑system pharmacists increasingly deliver protocolized, outcome‑oriented care (dose adjustments, laboratory ordering, device‑data interpretation), yet local processes to recognize this work vary. In South Carolina, pharmacist C&P is not currently implemented, and statewide regulatory guidance for pharmacist‑physician collaborative practice is evolving. To inform the development of a systemwide pharmacist C&P policy and a privilege set that consolidates common, evidence‑based activities currently requiring provider co‑signature, we conducted two surveys: one to characterize internal pharmacist readiness and priorities, and one to benchmark external institutions’ C&P models, barriers, and practical mitigations.

Methods: A multi‑phase, mixed‑methods approach was used to guide development of the pharmacist credentialing and privileging framework. An internal survey was administered to outpatient and ambulatory pharmacists across the health system to evaluate readiness for a C&P process, identify priority privileges, and assess perceived value and competency evaluation preferences. A national benchmarking survey was then distributed through ASHP listservs to collect information on existing pharmacist C&P programs across diverse health systems, including governance models, eligibility criteria, and implementation challenges. Concurrently, existing institutional policies, guidance documents, and South Carolina pharmacy practice regulations were reviewed to identify requirements for alignment with Medical Staff Affairs processes. Findings from surveys and policy review informed the drafting of a standardized C&P policy, privilege structure, and governance pathway, which were reviewed with pharmacy leadership and Medical Staff Affairs to ensure consistency with established credentialing workflows. Next steps will include finalizing the framework, developing supporting education and operational workflows, piloting the process in select practice areas, and preparing for staged systemwide implementation.

Results: The internal survey included 53 respondents representing primarily ambulatory, oncology, and specialty practice settings. Respondents rated the anticipated impact of pharmacist C&P highly across all domains including top‑of‑license practice, efficiency, safety/quality, and provider workload reduction, with mean scores of approximately 4.3–4.5 on a 5‑point scale. A majority, 64.4%, reported feeling mostly or fully ready to undergo a C&P process. When asked which activities should be included in a basic privilege set, pharmacists most frequently endorsed medication dose adjustments (including renal, hepatic, and weight‑based), ordering and interpreting laboratory tests, interpreting device‑generated data (e.g., continuous glucose monitoring and blood pressure), therapeutic substitution, initiation and discontinuation of therapy within protocol, vaccination administration, and modifications to medication reconciliation. For assessment, respondents preferred a blended approach comprising continuing education, peer review of clinical documentation, competency examinations, and direct observation.
The external survey captured 22 responses from pharmacists and pharmacy leaders at other organizations. Most reported that pharmacist C&P is integrated with the Medical Staff Office and aligned to the medical staff appointment/reappointment cycle. Common eligibility models combined a PharmD with residency, board certification, or defined years of relevant experience. Frequently cited implementation barriers included infrastructure and process alignment with medical staff governance, scope clarity, and resource bandwidth; respondents mitigated these by engaging MSA early, standardizing privilege delineations, and specifying documentation and quality‑assurance expectations. Short‑term gains centered on autonomy and interprofessional trust, whereas longer‑term benefits included alignment with medical staff processes, expansion of pharmacist services, and maturation of reimbursement pathways in ambulatory settings.

Conclusions: Internal readiness and externally validated operating models converge on a feasible path to a pharmacist C&P framework in this South Carolina health system. Findings support drafting a broad privilege set covering high‑consensus activities currently requiring provider co‑sign and a aligned policy that specifies eligibility routes and a blended assessment approach. Early engagement with the MSA on format, committee pathway, and reappointment cadence is expected to streamline approval. Results will directly inform policy drafting and selection of an initial ambulatory pilot cohort in the next phase.

Moderators

David Laurent

Infectious Diseases Clinical Pharmacist, ECU Health

Presenters

Ellis Simerly

PGY2 HSPAL Pharmacy Resident, Prisma Health - Upstate

Ellis Simerly is from Charleston, South Carolina. He earned both his Bachelor of Science in Pharmaceutical Sciences and Doctor of Pharmacy from the Albany College of Pharmacy and Health Sciences.

Evaluators

Deborah Hobbs

Associate Chief, Pharmacy, Carl Vinson VA Medical Center

PGY-1 Pharmacy Residency Program Director & Associate Chief, Pharmacy for Clinical Services at the Carl Vinson VA Medical Center. Chairperson Pro-Tem 2021

Thursday April 30, 2026 10:10am - 10:30am EDT
Olympia 2

Administration (ADM), Prisma Health-Upstate

global Y

10:10am EDT

Economic Impact of Sodium Bicarbonate Infusion Order Set Standardization

Thursday April 30, 2026 10:10am - 10:30am EDT

Parthenon 1

Background:
Sodium bicarbonate infusions are primarily used for severe metabolic acidosis and select toxicologic emergencies. Variability in the prescribed concentration and diluents can contribute to medication errors, workflow inefficiencies, and unnecessary waste. On August 19, 2025, Piedmont Healthcare implemented a standardized sodium bicarbonate infusion order set for non-nephrology providers, reducing seven options to two options (150 mEq sodium bicarbonate in one liter of either sterile water for injection or 5% dextrose in water). This study evaluated the financial and operational impact of this standardization intervention.

Methods:
This single-center, retrospective, pre-post study evaluated orders from a sodium bicarbonate infusion order set at Piedmont Columbus Regional Midtown during a pre-standardization period (May – June 2025) and a post-standardization period (November – December 2025) following implementation of a simplified order set. All objectives were evaluated using data from 50 randomly selected patient charts per period. Patient charts were excluded if the ordering provider was a nephrologist or if the order was never prepared. The primary objective, total cost of waste, was defined as the difference between the cost of the product made and the cost of the product administered using average wholesale prices. Secondary outcomes included pharmacy labor inputs and time to first dose. Descriptive statistics were used to evaluate all outcomes.

Results:
Baseline characteristics were similar between groups, with metabolic acidosis as the most common indication for continuous infusion of sodium bicarbonate. In the pre-standardization group, the most frequently ordered products were 150 mEq of sodium bicarbonate in sterile water or 5% dextrose in water, which informed the retention of these options in the standardized order set. The proportion of wasted infusions among the 50 randomly selected patients per group improved from 23% wasted pre-standardization to 14% wasted post-standardization, an absolute waste reduction of 9%. Using average wholesale price to estimate the primary outcome of cost of waste, extrapolation to the number of infusions dispensed in 2025 demonstrated a reduction in estimated annual waste from $28,315 pre-standardization to $17,220 post-standardization, yielding an annual cost savings exceeding $11,000. For secondary outcomes, pharmacy labor time was similar between groups, while time to first dose improved by approximately 7 minutes in the post-standardization group.

Conclusions:
This study found that implementation of a standardized sodium bicarbonate infusion order set for non-nephrology providers reduced waste and saved cost. There was not a meaningful difference in time spent on pharmacy labor, but there was a slight improvement in time to first dose after standardization. Future directions include implementation of batch preparation of the standardized doses to significantly reduce the amount of pharmacy labor needed per bag, and to further reduce time to first dose.

Contact:
[email protected]

Moderators

P. David Brackett

RPD, Auburn University Clinical Health Services

Presenters

Caitlin Brown

PGY-1 Pharmacy Resident, Piedmont Columbus Regional Midtown

Caitlin is a PGY-1 pharmacy resident at Piedmont Columbus Regional Midtown in Columbus, GA. She is from Helena, AL, and attended pharmacy school at Auburn University's Harrison College of Pharmacy.

Evaluators

Carrie Callahan

Internal Medicine (IM) Specialist, PGY2 IM RPD, Emory University Hospital

Thursday April 30, 2026 10:10am - 10:30am EDT
Parthenon 1

Administration (ADM), Piedmont Columbus Regional Midtown

global Y

10:10am EDT

Comparison of Heart Rate and Blood Pressure Control Agents in Acute Aortic Dissection

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena I

Title: Comparison of Heart Rate and Blood Pressure Control Agents in Acute Aortic Dissection
Authors: Brianna Lu, Kathryn Harvell, Ginger Gamble
Background: Anti-impulse therapy is the cornerstone of acute aortic dissection management to prevent rupture or dissection extension and has been shown to decrease long-term aorta-related adverse events. The American Heart Association/American College of Cardiology and European Society of Cardiology recommend a goal heart rate (HR) between 60 and 80 beats per minute and a goal systolic blood pressure (SBP) less than 120 mmHg. Current guidelines recommend beta blockers as initial therapy to achieve goal HR and BP; however, this is muddled by the absence of guideline-directed hierarchies within each drug class and lack of clear criteria for when therapy should be modified.
Methods: This single-center, retrospective, observational analysis identified patients 18 years or older treated for acute aortic dissection at an academic medical center from January 1, 2021 to October 1, 2025 and received intravenous labetalol, esmolol, nitroprusside, nicardipine, clevidipine, diltiazem, or verapamil. The primary outcome was the percent of patients with treatment failure, defined as switching study drugs, death prior to operative intervention, or not at goal HR (less than or equal to 80 bpm) and SBP (less than 120 mmHg) at 3 hours. Statistical analyses include Fisher’s Exact for categorical variables and Mann Whitney-U for continuous variables.
Results: A total of 56 patients met inclusion criteria, and 38 patients were included in the final analysis. Thirty (88%) patients who received esmolol and 3 (75%) patients who received labetalol failed treatment at 3 hours (p = 0.45). At 6 hours, 27 patients who received esmolol and 3 patients who received labetalol failed treatment (p > 0.99). The median time to switch agents was 4.67 hours versus 3.64 hours in the esmolol and labetalol groups (p = 0.69). There was a difference in median time to first goal HR for esmolol at 0.47 hours compared to 0 hours in the labetalol group (p = 0.02). In contrast, there was no difference in median time to first goal SBP or in the percent of HR or SBP readings at goal at either 6 hours or 24 hours. Four patients (11.7%) died in the esmolol group compared to none in the labetalol group. The median intensive care unit length of stay was 4.05 days and 7.55 days for the esmolol and labetalol groups, respectively. A subgroup analysis comparing patients who received esmolol only (n = 11) versus labetalol found no difference in treatment failure rates at 3 hours (p = 0.47) or 6 hours (p > 0.99).
Conclusion: This study suggests there is no difference in treatment failure rates between esmolol and labetalol used for the management of acute aortic dissection at this institution. Secondary outcomes suggest that there may be benefit in the implementation of protocols to assist with optimizing titration of study drugs to achieve goal HR and SBP in a timelier fashion. Additional studies may be warranted to evaluate other differences in clinical outcomes between esmolol and labetalol.
Contact Information: [email protected]

Moderators

Courtney Isom

PGY-1 Community-based Residency Director, Cone Health

Presenters

Brianna Lu

PGY1 Resident, ECU Health Medical Center

Evaluators

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, PGY-2 Ambulatory Care Pharmacy RPD, Kaiser Permanente Georgia

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena I

Community Pharmacy (CP), ECU Health Medical Center

global Y

10:10am EDT

Evaluation of Antipsychotic Administration Strategies in Critically Ill Adults: Comparing Scheduled Quetiapine and PRN Ziprasidone in the ICU

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena B

Background
Intensive care unit (ICU) delirium affects approximately one-third to one-half of critically ill adults and is associated with prolonged mechanical ventilation, increased ICU and hospital length of stay, higher mortality, and long-term cognitive impairment [1]. Contemporary Society of Critical Care Medicine Guidelines for Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (SCCM PADIS) emphasize structured delirium assessment, non-pharmacologic prevention, and cautious sedation, while discouraging routine antipsychotic use based on neutral findings from major randomized trials such as MIND-USA and AID-ICU [2]. Despite these recommendations, antipsychotics remain frequently used, with variability in agent selection and route, including off-label intravenous ziprasidone, raising safety and monitoring concerns. This study aims to compare duration of first-episode ICU delirium in patients receiving scheduled quetiapine versus as needed (PRN) ziprasidone, and to evaluate safety and utilization outcomes, including baseline corrected QT interval (QTc) prolongation, ventilator days, and ICU and hospital length of stay.
Methods
A retrospective analysis was performed in critically ill adults admitted to the ICU who received newly initiated antipsychotic therapy for delirium at AdventHealth Winter Park from December 2023 to November 2025. Eligible patients were ≥18 years old, had an ICU admission, received scheduled quetiapine for >24 hours or PRN ziprasidone, and screened positive on Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Patients were excluded if pregnant, had QTc >500 msec, received antipsychotics prior to ICU admission, or had neurologic or psychiatric conditions confounding delirium assessment, including schizophrenia, bipolar disorder, Parkinson’s disease, traumatic brain injury, stroke, psychosis, dementia, neurosurgical conditions, alcohol withdrawal, or coma. Patients were stratified by regimen (scheduled quetiapine vs PRN ziprasidone). The primary endpoint was duration of first episode of delirium in hours. Secondary outcomes included adverse drug events, QTc prolongation, ventilator days, ICU/hospital length of stay, and an exploratory subgroup comparing intramuscular versus intravenous ziprasidone. Categorical variables were analyzed using chi-square testing, and continuous variables were assessed for normality with the Shapiro-Wilk test and compared using the Mann-Whitney U test when non-normally distributed.
Results
After screening 251 patients, 93 met inclusion criteria; 10 who received both agents were excluded, leaving 83 patients (scheduled quetiapine n=38; PRN ziprasidone n=45). There was no significant difference in duration of first-episode ICU delirium (median 35.0 hours [IQR 24.0-57.5] with quetiapine vs 28.4 hours [IQR 12.9-52.5] with ziprasidone; p=0.29). QTc prolongation >500 ms occurred in 11% of quetiapine and 27% of ziprasidone patients, without statistical significance (p=0.12). Median RASS at positive CAM-ICU was -1.5 (IQR -3.0 to 0.0) vs -1.0 (IQR -2.0 to 1.0), respectively (p=0.34). Subgroup analyses showed no differences in delirium duration or QTc prolongation between intravenous and intramuscular ziprasidone.
Conclusion
In this retrospective study, scheduled quetiapine and PRN ziprasidone were associated with similar durations of first-episode ICU delirium and comparable safety outcomes, including QTc prolongation. Subgroup analyses showed no differences between intravenous and intramuscular ziprasidone. However, this study was limited by an insufficient sample size to achieve adequate statistical power, which may have impacted the ability to detect differences. Overall, antipsychotic selection and route of administration showed no statistically significant difference between delirium duration or safety outcomes.

References:

Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753-1762.

Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU (PADIS). Crit Care Med. 2018.

Moderators

Katharine Strickland

Presenters

Alessandra Trujillo Rodriguez

PGY1 Resident, AdventHealth

Evaluators

Adam Sawyer

PGY1 Residency Program Director, Huntsville Hospital

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena B

Critical Care/Emergency Medicine (CCM), AdventHealth Winter Park

global Y

10:10am EDT

Clinical Management and Outcomes in Patients with Coagulase-negative Staphylococcus spp. in Lone Blood Culture Sets

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena G

Clinical Management and Outcomes in Patients with Coagulase-negative Staphylococcus spp. in Lone Blood Culture Sets
Benjamin K Battle, Andrew B. Watkins
FMOL Health | St. Dominic
Background/Purpose:
Blood cultures remain the standard for diagnosis of bloodstream infections, but blood culture contamination may lead to inappropriate antimicrobial use and increased risk to patients. Contaminants are often skin flora organisms, and coagulase-negative staphylococci (CoNS) are the most commonly identified microorganisms found in contaminated blood cultures. Differentiating contaminants from true pathogens proves a challenge as these microorganisms could potentially cause true infection. This diagnostic uncertainty and desire to treat may lead to unnecessary or inappropriate antibiotic use and/or Infectious Diseases (ID) consults, which result in clinical and economic burdens for the patient and hospital. St. Dominic Hospital has placed an emphasis on reducing blood culture contamination based on an increase in contamination rates over the last year. This study seeks to characterize the clinical management and outcomes of patients with CoNS growing in lone blood culture sets at St. Dominic Hospital, as well as to analyze overall contamination trends and financial impacts of these potential contamination events.
Methodology:
This single-center retrospective observational cohort study includes patients admitted to St. Dominic Hospital from January 1, 2025, to August 31, 2025, that are of at least eighteen years of age with CoNS on one set of blood cultures. Patients with blood cultures positive for Staphylococcus lugdunensis or prior blood cultures with CoNS in multiple sets during admission are excluded. The primary objective is to evaluate the use of antibiotics in patients with CoNS in lone blood culture sets. The secondary outcomes include reviewing the overall trend in hospital blood culture contamination rates, frequency of infectious diseases consults, costs attributable to potential contamination events, impact of contamination on pharmacist workload, and outcomes between patients receiving antibiotics for greater than three days compared to those receiving antibiotics for less than three days.
Results:
A total of 100 patients were included for analysis, with 56 (56%) receiving antibiotics for coagulase-negative Staphylococci spp. in lone blood culture sets, vancomycin serving as the most prevalent antibiotic administered. In the scope of hospital contamination rates, a total of 409 blood cultures in 2025 were characterized as contaminants, accounting for 2.22% of the total blood culture collections. There was no significant difference in mortality regarding patients that received antibiotics for three days or less when compared to patients that received a duration of antibiotics exceeding three days; however, patients receiving a short duration of antibiotics had a significantly shorter length of stay. Infectious disease consults were ordered in 39 patients, with recommendations for ceasing antibiotic use in 19 of the 39 consults. Costs attributable to contamination events were approximately $107,000 per year for the hospital. The increase in pharmacist workload on vancomycin management for patients with potential contaminations neared 18 pharmacist hours per year.
Conclusions:
Of the patients with CoNS in one of two blood culture sets, vancomycin was the primary agent utilized. The estimated costs attributable to contaminated blood culture sets were primarily driven by laboratory costs. Extended duration of antibiotics did not show improvement in mortality, and shorter treatment durations were associated with overall decreased lengths of stay. Future considerations will be educating on identify potentially contaminated blood cultures, and informing care providers on the outcomes of this study in regards to length of stay and mortality.

Moderators

Alvin N. Tomika

Clinical Pharmacist, AdventHealth

Presenters

Konnor Battle

PGY1 Pharmacy Resident, FMOL Health | St. Dominic Hospital

Evaluators

Amy Carr

PGY1 RPD, AdventHealth Orlando

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena G

Infectious Disease (ID), St. Dominic Hospital

global Y

10:10am EDT

Impact of a System-wide Pharmacy Clinical Decision Support Council on Pharmacist-Facing Medication Warning Alerts

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena C

Title: Impact of a System-wide Pharmacy Clinical Decision Support Council on Pharmacist-Facing Medication Warning Alerts
Authors: Benny Zhang, PharmD; Craig MacDonald, PharmD

Background: Clinical decision support (CDS) is a powerful tool that provides clinicians with knowledge and patient-specific information, filtered or presented at appropriate times, to ensure safe and effective patient care. Medication warning alerts can support clinical decision-making, reduce medication errors and adverse drug events, and improve adherence to evidence-based practice. However, redundant or inappropriate medication warning alerts can lead to alert fatigue and result in unintended consequences that may compromise the safety and quality of patient care. In our system, medication warnings are supplied by a third-party vendor and can appear during order entry, verification, or medication administration and impact providers, pharmacists, and nurses. The formation of a system-wide pharmacy clinical decision support council aimed to optimize medication-related alerts to ensure front-end clinicians are seeing relevant and important warnings across a large health-system. The purpose of this study is to evaluate the impact of a system-wide pharmacy clinical decision support council on the volume of pharmacist-facing medication warning alerts.

Methods: This was a retrospective pre-post analysis conducted using EHR extracted data from 2023 to 2026 in a single health-system. Medication warning alerts presented to pharmacists were evaluated. Trends in alert volume (per 1,000 orders) were analyzed over time to assess changes following decisions made by the pharmacy clinical decision support council.

Results: In Progress

Conclusion: In Progress

Moderators

Drew Kessell

Presenters

Benny Zhang

PGY2 Pharmacy Informatics Resident, AdventHealth Orlando

Evaluators

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena C

Informatics (INF), AdventHealth Orlando

global Y

10:10am EDT

Comparing Tenecteplase and Alteplase for Acute Ischemic Stroke: A Real-World Evaluation of Efficacy and Safety

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena A

Comparing Tenecteplase and Alteplase for Acute Ischemic Stroke: A Real-World Evaluation of Efficacy and Safety
Catherine Wise, Katleen Chester, Olivia Morgan, Morgan Daniel; Grady Memorial Hospital, Atlanta, Georgia
Background:
Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. Intravenous fibrinolytics have been the standard of care for AIS for decades, with alteplase historically being the fibrinolytic of choice, however, there is an expanding body of evidence supporting tenecteplase as a safe and effective alternative fibrinolytic. Tenecteplase is a genetically modified variant of alteplase, with increased fibrinogen binding specificity and extended half-life. Unlikealteplase, which has continuous infusions, tenecteplase is administered as a single intravenous bolus, offering practical advantages such as greater workflow efficiency and rapid treatment initiation, leading to shorter door-to-needle (DTN) times, which may translate to improved reperfusion and patient outcomes. Clinicaltrials, including the EXTEND-IA TNK trial further reported improved reperfusion rates when tenecteplase was administered prior to thrombectomy compared with alteplase. The AcT trial further demonstrated that tenecteplase achieves comparable rates of early recanalization and functional recovery, as assessed by the modified Rankin Scale (mRS). Observational cohort studies suggest real-world benefits, including shorter DTN and door-to-puncture (DPT) times. This study aims to further evaluate tenecteplase and alteplase in real-world practice, with an emphasis on safety and efficacy, to assess potential to enhance stroke care and optimize patient recovery within a high-volume comprehensive stroke center.
Methods:
This is a single-center retrospective chart review of patients who presented to Grady Memorial Emergency Care Center who received intravenous fibrinolytics (tenecteplase or alteplase) for AIS treatment between January 2021 to April 2025. Patients under the age of 18, received intravenous fibrinolytics en route to Grady Memorial Hospital via our Mobile Stroke Unit, and in-house stroke patients were excluded from this study. Data was obtained from Institutional Stroke Committeefibrinolytic pharmacy data reports and the Marcus Stroke and Neuroscience Center. The primary outcome of the study was the functional status, defined as mRS, at discharge. Secondary outcomes included average 90-day mRS score, functional independence at 90 days (mRS score of 0-2), Onset-to-Treatment Time (OTT), DNT, DPT for thrombectomy patients, incidence of thrombectomy, successful reperfusion, defined as a TICI score of 2b or 3, incidence of symptomatic intracranial hemorrhage (sICH), defined as neurological deterioration (≥4-point NIHSS increase) attributed to new intracranial hemorrhage on imaging, and overall length of stay (LOS).
Results:
A total of 625 patients were included in the analysis; 246 received tenecteplase and 379 received alteplase. Median admission mRS scores were 0 (IQR 0–1) in both groups. Median admission NIHSS scores and functional independence at discharge did not differ between the tenecteplase and alteplase groups. Discharge mRSscores, and hospital length of stay were similar between the two groups. Median OTT time and DTN times were also not found to be significantly different. Inmechanical thrombectomy patients, median DTP time was 83 minutes for tenecteplase and 90.5 minutes for alteplase (p = 0.381). Mechanical thrombectomy was performed in 24.4% of patients treated with tenecteplase and 21.1% of patients treated with alteplase (p = 0.336) with successful reperfusion was achieved in 100% of tenecteplase and 98.8% of alteplase patients (p = 0.728). SICH occurred in 0.4% of patients in the tenecteplase group and 1.3% of patients in the alteplase group (p = 0.41).
Conclusion:
Tenecteplase and alteplase are considered similar when it comes to safety and efficacy of the two fibrinolytics with no significant difference to show between the two medications. Similar safety and efficacy features can show that tenecteplase could become a strong medication as reflected in our 2026 acute ischemic stroke guidelines.

For additional questions: Contact [email protected]

Moderators

Aayush Patel

Clinical Pharmacy Specialist, Emergency Medicine, Piedmont Columbus Regional Midtown

Presenters

Catherine Wise

PGY1 Pharmacy Resident, Grady Memorial Hospital

Evaluators

Abbi Rowe

Director of Pharmacy, AdventHealth

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena A

Neurology (NEU), Grady Memorial Hospital

global Y

10:10am EDT

Head-to-Head: Atorvastatin vs. Rosuvastatin for Secondary Stroke Prevention in Patients with Acute Ischemic Stroke

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena D

Background/Purpose: Statins are essential in preventing stroke recurrence by atherosclerotic plaque accumulation, which can trigger acute ischemic strokes (AIS) when disrupted. Based on the differences in the pharmacokinetic profiles of atorvastatin and rosuvastatin, it is unclear if one agent is more effective at reducing the rates of stroke recurrence in adult survivors of AIS. The purpose of this study is to evaluate the rates of stroke recurrence in AIS patients receiving high-intensity statin therapy (HIST) with rosuvastatin or atorvastatin.

Methods: In this retrospective cohort study adult patients with a diagnosis of AIS and discharged with HIST were screened if admitted from July 1, 2016, to October 31, 2020. High-intensity statin use was determined by having atorvastatin 40-80 milligrams daily or rosuvastatin 20-40 milligrams daily on the patient’s discharge medication list. The primary outcome of this study was rates of stroke recurrence within five years. Secondary outcomes evaluated were stroke recurrence within twenty-one days, stroke recurrence within one year, and rates of statin discontinuation within five years.

Results: 5-year stroke recurrence from the initial AIS found that 10 (12.5%) of the atorvastatin and 6 (15%) of the rosuvastatin patients had an episode of stroke recurrence (OR 1.235; 95% CI, 0.415-3.681; p = 0.778). Similar to the primary outcomes, none of the secondary outcomes were statistically significant.

Conclusions: Our results support either statin would be efficacious for secondary prevention, though there is an increased risk of myopathy associated with lipophilic statins (i.e., atorvastatin). Due to our studies' small sample size, it would be advantageous for future research to utilize a larger sample size to determine a potential clinical difference.

Moderators

Brittany White

Erlanger

Presenters

Alanna Kologey

PGY-1 Pharmacotherapy Resident, University of Tennessee Medical Center

Evaluators

Alyson Burns

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena D

Neurology (NEU), University of Tennessee Medical Center

global Y

10:10am EDT

The Impact of Inhaled Antibiotic Use in Critically Ill Neonatal and Pediatric Populations

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena J

Title: The Impact of Inhaled Antibiotic Use in Critically Ill Neonatal and Pediatric Populations
Authors: Madeline DiCenso, Andrea Gerwin, Renee Hughes, Paige Klingborg
Background/Purpose: Pediatric and neonatal patients with chronic lung disease or tracheostomies face an elevated risk of pulmonary bacterial infections due to impaired airway clearance and chronic colonization. Prophylactic inhaled antibiotic (iAbx) use is described in cystic fibrosis (CF) patients but is minimally explored in tracheostomized and critically ill children without CF. Retrospective data suggests benefits to prophylactic iAbx therapy, including reduced rates of re-hospitalization and systemic antibiotic use with minimal associated side effects. However, published guidelines directing use do not currently exist. This study will describe our institution’s use of iAbx in critically ill pediatric and neonatal patients, evaluate optimal dosing strategies, and analyze potential improvements in clinical outcomes.
Methods: This was a single center, retrospective, observational chart review conducted using electronic health records from patients admitted to the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) at Children’s Hospital at Erlanger between July 1, 2022, and July 1, 2025. Patients were included if they received iAbx during admission. Patients who did not receive iAbx or with Cystic Fibrosis were excluded. The primary outcome of the study was to describe the usage patterns of iAbx in the NICU and PICU. The secondary outcomes were to evaluate potential benefits of continuous or cycled use of iAbx and to analyze how use of inhaled antibiotics may impact clinical and functional outcomes, such as respiratory status, and days of systemic antibiotics. Due to the young age of our study population, we evaluated days of systemic antibiotics compared to days of life (DoL). Safety outcomes included resistance patterns, and hearing screen results.
Results: Preliminary results on utilization patterns indicate that mean age at initiation of therapy was 29.71 months (1–204-month range). Tobramycin was nebulized at a dose of 300 mg twice daily with the most common duration therapy of 28 days. Before iAbx therapy was initiated, patients had fewer average systemic abx days per DoL (1:14.07) compared to an increased ratio (1:9.54) after iAbx. Fraction of inhaled oxygen (FiO2) requirements were higher in the 14 days prior to iAbx initiation (average 36.7%) compared to the 14 days following iAbx initiation (average 29.7%). Data regarding the safety profile of inhaled antibiotic therapy is still in process.
Conclusions: The use of iAbx in critically ill pediatric patients at Children’s Hospital at Erlanger closely matches regimens presented in other primary literature. There may be an improvement in respiratory status represented by improved ventilator settings associated with use of inhaled antibiotic therapy. Although systemic antibiotic days normalized for DoL increased after therapy initiation, interpretation is limited by varied initiation times, with post‑treatment data constrained by the study’s fixed endpoint. Data regarding safety of inhaled antibiotic therapy and resistance patterns amongst the trial population is ongoing.

Moderators

Deidra Easley

PGY1 Residency Program Director, Baptist Medical Center South

Presenters

Madeline DiCenso

Erlanger PGY-2 Critical Care Resident2026-2027
Erlanger PGY-1 Pharmacy Resident 2025-2026
Lipscomb University, Nashville, TN Class of 2025

Evaluators

Derek Rhodes

Manager / HSPAL RPD, Prisma Health

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena J

Pediatric (PED), Erlanger Health System

global Y

10:10am EDT

Identifying Opportunities to Improve Discharge Prescribing of Newly Initiated Quetiapine During Transitions of Care

Thursday April 30, 2026 10:10am - 10:30am EDT

Parthenon 2

Title: Identifying Opportunities to Improve Discharge Prescribing of Newly Initiated Quetiapine During Transitions of Care: A Medication Use Evaluation
Authors: Audra Butler, Bobby Azevedo, Abigayle Campbell

Background: Design a medication use evaluation to assess inappropriate continuation of inpatient-initiated quetiapine at hospital discharge and identify transition-of-care points where pharmacy interventions may reduce unnecessary continuation.

Methods: This medication use evaluation included a retrospective review of patients discharged between October 1 and December 31, 2025. Data was collected to identify cases in which quetiapine was newly initiated during hospitalization for indications such as agitation, delirium, sedation, or insomnia. Patients were excluded if quetiapine was documented as a home medication or if it was initiated for alternative psychiatric indications, such as schizophrenia and bipolar disorder. Different variables were gathered to evaluate prescribing patterns included initiating and discharging provider, location of prescribing at initiation and discharge, physician specialty group (example: family medicine, hospitalist, intensivist), and documentation of whether a pharmacist was involved with medication reconciliation/review at discharge. Raw data was analyzed to assess correlations in prescribing patterns and factors associated with continuation of quetiapine at discharge.

Results: A review of prescribing patterns revealed that approximately 25 of the 45 patients started on quetiapine while inpatient for an off label indication were inappropriately continued on therapy at discharge. This indicates that more than half of patients lacked appropriate reassessment or discontinuation of therapy prior to transition of care. Additionally, among the 18 patients with dementia who were newly started on quetiapine during their hospital stay, 9 patients (50%) remained on the medication after discharge for an off label indication. Additionally, when stratifying the intended short-term inpatient indications among the 25 patients inappropriately continued on quetiapine at discharge, 19 patients were treated for agitation/delirium and 6 patients were treated for insomnia. Regarding pharmacist involvement at the time of discharge for patients that were continued inappropriately on quetiapine at discharge, a pharmacist participated in medication review for 10 patients, while 15 patients had no documented pharmacist involvement.

Conclusions: The high rate of inappropriate continuation of inpatient-initiated quetiapine beyond its intended short-term use at discharge represents a significant patient safety issue and underscores a critical gap in current medication reconciliation practices. This concern is amplified in vulnerable populations, particularly patients with dementia, where continued antipsychotic use carries substantial risk. Given that antipsychotic use in patients with dementia is associated with increased risks, including cerebrovascular events and mortality, this finding is particularly concerning. These findings support the need for targeted interventions, including education to hospitalist and family medicine residents, increased pharmacist involvement in discharge planning, routine reassessment of medications initiated for acute inpatient indications, and improved documentation regarding intended duration of therapy. Implementing these strategies may reduce unnecessary antipsychotic exposure, limit polypharmacy, and decrease the likelihood of adverse drug events and poor clinical outcomes. Strengthening discharge processes is essential to ensure safer transitions of care and promote more appropriate, patient-centered medication management.

Moderators

Beth Phillips

Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2

Presenters

Audra Butler

PGY-1, Self Regional Healthcare

Audra Butler, PharmD, earned her undergraduate degree from Limestone University (Class of 2021), where she double majored in Health Sciences and Pre-Professional Biology. She went on to receive her Doctor of Pharmacy from Presbyterian College School of Pharmacy (Class of 2025), along... Read More →

Evaluators

Ben Ferris

RPD, AdventHealth East Orlando

Thursday April 30, 2026 10:10am - 10:30am EDT
Parthenon 2

Psychiatric Pharmacy (PSY), Self Regional Healthcare

global Y

10:10am EDT

Improving naloxone prescribing rates for Veterans with stimulant use disorder (StUD) through AudioCARE technology at the Atlanta VA Healthcare System

Thursday April 30, 2026 10:10am - 10:30am EDT

Olympia 1

Title: Improving naloxone prescribing rates for Veterans with stimulant use disorder (StUD) through AudioCARE technology at the Atlanta VA Healthcare System
Presenters: Kathryne Spratlin, PharmD
Authors: Lauren Ramshur, MD; Stephanie Oh, PharmD; Kathryne Spratlin, PharmD; Melanie Pafford, NP; Natalie Haslem, NP; Mary K. Pounders, PharmD, BCACP
Background:
StUD is a prevalent diagnosis among the Veteran population. Veterans with StUD are at increased risk of accidental opioid overdose due to contamination of the illicit drug supply. Harm reduction interventions are recommended strategies to reduce stimulant-related overdose deaths. Using a real-time dashboard, eligible Veterans were identified based on diagnosis of StUD without an active naloxone prescription. This project aimed to evaluate whether AudioCARE technology, an automated Veteran outreach program, can improve naloxone distribution amongst at-risk veterans with StUD in hopes of improving rates of accidental opioid overdoses.
Methodology:
This prospective quality improvement project utilized automated outreach to identify and engage Veterans at risk for accidental opioid overdose due to StUD. A real-time dashboard identified eligible patients with an active diagnosis of StUD without an active naloxone prescription. Through AudioCARE technology, these Veterans were contacted via an automated phone call and given the options to receive a naloxone kit, decline a naloxone kit, or request additional information. Actions were taken based on each individual Veterans’ response. Those who did not respond were listed as non-responders and were re-contacted using the same process 120 days after the date of initial attempt. The dashboard was reviewed monthly to assess the number of actionable Veterans remaining. Prescribing rates, successful rates of contact, and the impact of secondary outreach were evaluated to assess the impact of the AudioCARE intervention.
Results:
AudioCARE outreach successfully identified 1,439 actionable Veterans. After completion of the initial call process, 370 Veterans indicated interest in receiving a naloxone prescription. Prior to implementation of AudioCARE process, 40.1% of Veterans with StUD had an active naloxone prescription; after the first round of outreach, this increased to 47.9%. A second round of calls targeted the 952 Veterans who were unable to be reached during the first round. Of those contacted, 108 additional Veterans requested a naloxone prescription. This further increased the percentage of Veterans with StUD who had active naloxone orders to 48.3%.
Conclusions:
The AudioCARE process was a feasible strategy to improve naloxone access and support harm reduction efforts for at-risk Veterans with StUD at the VA. Future areas of interest include expansion to other high-risk populations, medication adherence outreach, preventative care initiatives, and chronic disease management support.

Moderators

Charleen Melton

Presenters

Kathryne Spratlin

PGY1 Pharmacy Resident, Atlanta VA Health Care System

Hi! My name is Kate Spratlin, and I am one of the current PGY1 Pharmacy Residents at the Atlanta VA Medical Center. I completed my undergraduate degree in Biology from The University of Alabama and earned my Doctorate of Pharmacy from Auburn University's Harrison College of Pharmacy... Read More →

Evaluators

Che Jordan

PGY1 Residency Program Director | Clinical Pharmacy Manager, Grand Strand Medical Center

Thursday April 30, 2026 10:10am - 10:30am EDT
Olympia 1

Psychiatric Pharmacy (PSY), VA-Atlanta, GA- Atlanta VA Health Care System

global Y

10:10am EDT

Early post-transplant conversion from tacrolimus to belatacept in kidney transplant patients

Thursday April 30, 2026 10:10am - 10:30am EDT

Athena H

Early post-transplant conversion from tacrolimus to belatacept in kidney transplant patients
Authors: Mikayla Morrow, Kwame Asare, Victoria Burnette, Nicole Melby

1)Background
Ascension Saint Thomas Hospital West (ASTHW) began using belatacept, a selective T-cell co-stimulation blocker, in kidney transplant recipients more frequently in the fall of 2023. It is used if the patient has slow or delayed graft function post-transplant or experiences intolerance to or toxicity from calcineurin inhibitors. This was the first study at ASTHW evaluating outcomes of belatacept in this patient population. Previous studies that have compared calcineurin inhibitors, such as tacrolimus, to belatacept have found similar patient and graft survival between the groups, and found that belatacept recipients had superior renal function but experienced higher rejection. The purpose of this study was to assess the effect that early conversion from tacrolimus to belatacept post-kidney transplant has on patient renal function.

2)Methods
This retrospective chart review included adult kidney transplant recipients transplanted at ASTHW between April 1, 2023 and April 31, 2025, who received either tacrolimus or belatacept within the first six months post-transplant. Data collected included demographics, transplant characteristics, induction therapy, immunosuppressive regimens, renal function, biopsy-proven acute rejection, incidence of delayed or slow graft function, incidence of infection , hospital length of stay after transplant, readmissions, and cost of therapy. Outcomes were analyzed using descriptive statistics; continuous variables with unpaired t-test and categorical variables with Chi-square or Fisher’s exact tests (alpha < 0.05).

3)Results
Overall, 361 patients were screened and 285 were excluded for incomplete documentation. Of the 76 patients included, 19 were in the belatacept group and 57 in the tacrolimus group. There was a statistically significant difference in age between groups, with the belatacept group having an older median age (p = 0.045). The majority of patients were male and the study was split evenly between Caucasian and African American races. The majority of patients in both groups had slow graft function. Serum creatinine and estimated glomerular filtration rate were statistically significantly better in the tacrolimus-only group at 1, 3, and 6 months post-transplant (p = <0.00001). Survival of the patient and their graft, incidence of infection, and length of stay were not statistically different between groups. Biopsy proven acute rejection was statistically significantly higher in the belatacept group (p = 0.036). There was a statistically significant difference in the readmission rate between the groups, with the belatacept group having more readmissions (p = 0.0051).

4)Conclusions
In this study of kidney transplant recipients receiving either tacrolimus, de novo belatacept, or who underwent early conversion from tacrolimus to belatacept, we observed a significant difference in renal allograft function in favor of tacrolimus use. Further studies are necessary to assess short- and long-term clinical outcomes of utilizing belatacept in place of tacrolimus in patients with slow or delayed graft function.

Moderators

Camille Robinette

PGY1 RPD, Clinical Pharmacy Specialist, Primary Care, SVAM1Salisbury VA Health Care SystemPGY1

Presenters

Mikayla Morrow

Evaluators

John Carr

Manager of Clinical Pharmacy Services, SJCHS

Thursday April 30, 2026 10:10am - 10:30am EDT
Athena H

Transplant (TRP), Ascension Saint Thomas Health

global Y

10:30am EDT

Evaluation of Inhaled Corticosteroid Prescribing for Patients with COPD

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena D

Purpose: Chronic obstructive pulmonary disease (COPD) is one of the most prominent disease states, affecting nearly 16 million people and ranking as one of the top ten causes of mortality. Improper treatment of COPD can lead to disease progression, increased risk of exacerbations, decreased quality of life, and a negative financial impact on the patient. Inhaled corticosteroids (ICS) are not recommended as initial treatment in COPD per the 2025 GOLD report and overprescribing can lead to unnecessary risks. The objective of this study is to investigate the current utilization of ICS therapy in COPD at the Central Alabama Veterans Health Care System (CAVHCS).

Methods: This quality improvement project is a retrospective, observational review of the prescribing of ICS to Veterans with a diagnosis of COPD being treated at CAVHCS from October 1, 2019 to September 5, 2025. A more extensive chart review was completed on a random sample of 100 Veterans from an original sample size of 3,791. Data collected includes Veteran demographics, COPD diagnosis (ICD code), active inhaler prescriptions, documented indications for ICS use, eosinophil counts, FEV1/FVC results, CT scans, X-Rays, history of exacerbations, and hospitalization rates. The data was compiled in a de-identified Microsoft Excel spreadsheet for analysis. Primary outcome assessed was the percentage of Veterans with COPD who have been appropriately prescribed ICS-inhaler therapy. Secondary outcomes include the rate of eosinophil counts monitored prior to initiation of ICS-inhaler therapy, the rate of exacerbations in Veterans with a COPD diagnosis on ICS-inhaler therapy, and the difference in lung function (FEV1/FVC) prior to and following initiation of ICS therapy in Veterans with COPD.

Results: 100 Veterans at CAVHCS diagnosed with COPD were randomly selected for screening and assessment and exactly half of them were prescribed ICS therapy. Of the 50 patients found to be prescribed ICS therapy, 30 of them were prescribed by prescribers actively working at CAVHCS. The other 20 Veterans were prescribed ICS therapy from those outside of the health care system or were prescribed at another VA facility and their medications were reconciled and continued. For the 30 Veterans who had been prescribed ICS therapy by our health system’s providers, 50% of them were determined to have been appropriately prescribed. Of the remaining 50% of patients, 33% were determined to have been inappropriately prescribed and in 15% of patients we were unable to determine appropriateness (e.g unavailable records). In regard to secondary outcomes, there were eight documented and diagnosed episodes of exacerbations. PFTs were documented in 64% of patient charts screened and 85% of Veterans had documented eosinophils.

Conclusions: Results from this project have outlined a prominent disconnect between evidence-based guidelines and prescriber patterns. This affirms the need for providing comprehensive education to our prescribers on the good practice of ICS therapy prescribing. Giving education to providers will close the gap between provider knowledge and prescribing practices, in turn leading to decreased side effects from unnecessary medication use and improved outcomes for our Veterans.

Moderators

Brittany White

Erlanger

Presenters

Brylee Burch

PGY1 Pharmacy Resident, Central Alabama Veterans Health Care System

Brylee Burch, PharmD, received her Bachelor of Science in Biomedical Sciences from Auburn University as well as her Doctor of Pharmacy from Auburn University’s Harrison College of Pharmacy. She is originally from Moulton, Alabama, and her current interests include ambulatory care... Read More →

Evaluators

Alyson Burns

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena D

Ambulatory Care (AMB), VA-Montgomery, AL-Central Alabama Veterans Health Care System

global Y

10:30am EDT

Optimization of Sodium-glucose Cotransporter-2 Inhibitors in Veterans with Heart Failure

Thursday April 30, 2026 10:30am - 10:50am EDT

Parthenon 1

Authors:
Austin Seawright, Natalie Giddens, Marci Swanson, Alexis Pruitt

Purpose:
Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors have demonstrated significant cardiovascular benefits in patients with heart failure, regardless of diabetes status. Despite strong guideline recommendations, prescribing rates remain suboptimal at the Carl Vinson VA Medical Center. This quality improvement project aims to optimize the use of SGLT2 inhibitors in Veterans with heart failure by identifying eligible patients, initiating therapy when appropriate, and improving adherence to guideline-directed medical therapy.

Methods:
This quality improvement project increased SGLT2 inhibitor initiation among eligible Veterans, improving prescribing rates across heart failure phenotypes. Adverse reaction and discontinuation rates were low and consistent with those reported in clinical trials. Pharmacist‑led outreach and structured follow‑up supported expanded access to guideline‑directed therapy, with opportunities for future enhancement through automated alerts and dashboard optimization. Exclusion criteria included: active prescription for an SGLT2 inhibitor, documented severe allergy to an SGLT2 inhibitor, type 1 diabetes mellitus, history of diabetic ketoacidosis, genitourinary infections, eGFR <20 mL/min/1.73m², age ≥90 years, or deceased status. Chart review was conducted to verify eligibility, evaluate contraindications, and identify potential clinical considerations influencing initiation. Eligible Veterans or their providers were contacted via a multimodal approach to provide education regarding benefits and assess interest in therapy. Those agreeable were referred to a pharmacist‑led clinic for further evaluation and potential initiation of empagliflozin, the VA formulary‑preferred agent. Baseline laboratory values, renal function, blood pressure, and medication history were reviewed prior to initiation. Follow‑up included monitoring for tolerability, adverse reactions, adherence, and continued appropriateness of therapy.

Results:
Of 396 Veterans identified, 339 met inclusion criteria. A total of 83 Veterans (24.5%) initiated an SGLT2 inhibitor following outreach and clinical evaluation. The most common reasons for non‑initiation included urinary incontinence (30.5%), predominantly outside care (12.5%), and inability to reach patients (10.2%). Seven adverse drug reactions were reported, most commonly dizziness or renal function decline, with only two events leading to discontinuation. Seven Veterans discontinued therapy. Five discontinuations were attributed to ADRs, while two Veterans self‑discontinued due to concerns regarding polypharmacy. Initiation rates increased across heart failure classifications.

Conclusions:
This quality improvement project increased SGLT2 inhibitor initiation among eligible Veterans, improving prescribing rates across heart failure phenotypes. Adverse reaction and discontinuation rates were low and consistent with those reported in clinical trials. Pharmacist‑led outreach and structured follow‑up supported expanded access to guideline‑directed therapy, with opportunities for future enhancement through automated alerts and dashboard optimization.

Moderators

P. David Brackett

RPD, Auburn University Clinical Health Services

Presenters

Austin Seawright

PGY-1 Pharmacy Resident, Carl Vinson VA Medical Center

Austin Seawright, PharmD, is a PGY-1 pharmacy resident at the Carl Vinson VA Medical Center in Dublin, Georgia. He earned his Doctor of Pharmacy degree from the University of Georgia in 2025. Upon completion of his PGY-1 residency, Dr. Seawright plans to pursue a PGY-2 in Ambulatory... Read More →

Evaluators

Carrie Callahan

Internal Medicine (IM) Specialist, PGY2 IM RPD, Emory University Hospital

Thursday April 30, 2026 10:30am - 10:50am EDT
Parthenon 1

Cardiology (CAR), VA-Dublin, GA-Carl Vinson VA Medical Center

global Y

10:30am EDT

Sotalol Dose Adjustments in Obese versus Non-Obese Patients

Thursday April 30, 2026 10:30am - 10:50am EDT

Olympia 1

Brady Ratliff, Jessica Brumit

Background/Purpose:
Sotalol is a class III antiarrhythmic requiring inpatient monitoring due to the risk of QT prolongation and proarrhythmias. Obesity may alter pharmacokinetics through changes in volume of distribution and renal clearance estimation. While actual body weight (ABW) is recommended per package insert to calculate creatinine clearance (CrCl), this may overestimate renal function in obese patients, potentially leading to drug accumulation and increased proarrhythmic risk. The purpose of this study was to compare the composite rate of inpatient sotalol discontinuation or dose reduction due to QT/QTc prolongation between obese and non-obese patients during monitored initiation.
Methods:
This retrospective cohort study evaluated adult patients admitted for sotalol initiation at a hospital system in Northeast Tennessee and Southwest Virginia from July 2020–June 2025. Patients were stratified by obesity status (BMI ≥30 kg/m2defined as obese). The primary outcome was the composite of inpatient sotalol discontinuation or dose reduction due to QT/QTc prolongation. Secondary outcomes included all-cause discontinuation, all-cause dose reduction, any dose adjustment, bradycardia (HR <50 bpm), sinus rhythm at discharge, serial QT/QTc trends across up to six doses (QT interval applied when HR <60 bpm; QTc applied when HR ≥60 bpm), and differences in CrCl calculated by ABW versus adjusted body weight (AdjBW). Categorical variables were compared using Fisher’s exact test; continuous variables using Mann-Whitney U test.
Results:
A total of 150 patients were included: 91 obese and 59 non-obese. Obese patients were younger (median 69 [IQR 59.5–75] vs. 74 [67–78] years, p=0.003) with significantly higher ABW-based CrCl (102.6 [85.8–140.4] vs. 73.3 [57.1–88.8] mL/min, p<0.001); the median CrCl overestimation using ABW versus AdjBW was 23.8 mL/min in obese patients compared to 7.7 mL/min in non-obese patients (p<0.001). Baseline serum creatinine, electrolytes, QT/QTc, heart rate, rhythm distribution, and starting sotalol dose were similar between groups. The primary composite outcome of discontinuation or dose reduction due to QT/QTc prolongation occurred in 4 obese patients (4.4%) and 3 non-obese patients (5.1%) (OR 0.86 (95% CI 0.19-3.98); p=1). All composite events were discontinuations; no dose reductions attributable to QT/QTc prolongation occurred in either group. All-cause inpatient discontinuation was similar between groups (14.3% vs. 11.9%, p=0.81). All-cause dose reductions were significantly more frequent in non-obese patients (16.9% vs. 3.3%, p=0.006), driven by bradycardia and hypotension rather than QT prolongation. Any dose adjustment did not differ significantly (23.7% vs. 15.4%, p=0.21). Bradycardia rates (18.6% vs. 13.2%, p=0.37), sinus rhythm at discharge (64.4% vs. 58.2%, p=0.5), and serial QT/QTc values at all time points were comparable between groups.
Conclusions:
Obesity was not associated with an increased composite rate of sotalol discontinuation or dose reduction due to QT/QTc prolongation during monitored inpatient initiation. Despite a clinically meaningful overestimation of CrCl using ABW in obese patients, this did not translate into greater QT-mediated adverse events or higher discontinuation rates. Notably, all-cause dose reductions were more frequent in non-obese patients and were driven by bradycardia and hypotension rather than QT prolongation. These findings suggest that obesity alone may not confer additional proarrhythmic risk during standard inpatient sotalol initiation and support current renal dosing guidance regardless of BMI.

Moderators

Charleen Melton

Presenters

Brady B. Ratliff

PGY1 Pharmacy Resident, Ballad Health - Johnson City Medical Center

Evaluators

Che Jordan

PGY1 Residency Program Director | Clinical Pharmacy Manager, Grand Strand Medical Center

Thursday April 30, 2026 10:30am - 10:50am EDT
Olympia 1

Cardiology (CAR), Johnson City Medical Center

global Y

10:30am EDT

Impact of Early Methylene Blue on Vasopressor-Free Days in Medical ICU Patients with Septic Shock

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena A

Impact of Early Methylene Blue on Vasopressor-Free Days in Medical ICU Patients with Septic Shock

Purpose: Septic shock remains a leading cause of intensive care unit (ICU) mortality despite standard therapies such as early antibiotics, fluids, vasopressors, and corticosteroids. Methylene blue has been utilized as an adjunctive agent in the treatment of septic shock by targeting nitric-oxide mediated vasodilation. However, data is lacking. The purpose of this study is to evaluate the impact of early methylene blue administration on vasopressor alive and free days at 28-days in adult patients with septic shock in the medical ICU.

Methods: This single-center, retrospective, cohort study will include adult patients admitted to the medical ICU with septic shock between January 1, 2022 and June 30, 2025 who received norepinephrine, vasopressin, and adjunctive hydrocortisone. The intervention group will consist of patients who additionally received methylene blue within 36 hours of vasopressor initiation and met prespecified inclusion/exclusion criteria. The control group will consist of patients meeting the same inclusion/exclusion criteria but did not receive methylene blue. The primary outcome is vasopressor alive and free days at day 28. Secondary outcomes include daily cumulative vasopressor dose during the first 72 hours after vasopressor initiation, time to vasopressor discontinuation, recurrence of septic shock, ICU and hospital length of stay, and 28-day mortality. Those who receive methylene blue will be assessed for shock liver/liver failure as evidenced by elevated liver function tests three times the upper limit of normal or total bilirubin ≥2 mg/dL, and documentation of serotonin syndrome within 5 days after initiation of vasopressors. Other safety outcomes will include arrhythmias and limb or mesenteric ischemia during the 28-day follow-up period. Data will be collected from the electronic medical record (EMR), recorded using REDCap, and analyzed using appropriate statistical tests.

Results: In progress

Moderators

Aayush Patel

Clinical Pharmacy Specialist, Emergency Medicine, Piedmont Columbus Regional Midtown

Presenters

Abigail Mason

PGY-2 Critical Care Resident, Erlanger

Erlanger PGY-2 Critical Care Resident 2025-2026
Erlanger PGY-1 Pharmacy Resident 2024-2025
University of Tennessee Health Science Center, Memphis, TN Class of 2024

Evaluators

Abbi Rowe

Director of Pharmacy, AdventHealth

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena A

Critical Care/Emergency Medicine (CCM), Erlanger Health System

global Y

10:30am EDT

Utilization of Medication Reconciliation Technicians in the Identification of Adverse Drug Events in the Emergency Department

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena B

Aidan Bush, Patrick Blankenship, Crystal Laudermilk, Susan Roberts, Rob Lucas
Prisma Health Blount Memorial Hospital – Maryville, TN

Background: According to the CDC, adverse drug reactions (ADRs) cause approximately 1.5 million emergency department (ED) visits annually in the United States and are often linked to recent medication changes. Medication reconciliation technicians (MRTs) profoundly impact the quality of patient care within the hospital by obtaining accurate medication histories. While their role in identifying adverse drug reactions is often implied, there is limited research directly demonstrating their impact on patient care through the early identification of ADRs. The purpose of this retrospective cohort study is to evaluate the impact on patient care by expanding the role of MRTs with the addition of a single, targeted question to their usual workflow.

Methods: This single‑center retrospective cohort study evaluated the impact of a workflow adjustment involving MRT‑assisted medication history collection at Prisma Health–Blount Memorial Hospital. The intervention cohort included all patients interviewed by an MRT between September 1–30, 2025. Patients reporting medication changes within the preceding 30 days were referred to a pharmacist for ADR assessment. The primary outcome was the incidence of ADRs identified through the updated MRT process. Secondary outcomes included characterization of ADR types and associated pharmacist interventions.

Results: During September 2025, the pharmacy team identified 17 ADRs, with 7 (41%) directly attributed to the updated MRT‑supported workflow. MRTs completed 1,163 interviews during this period, a slight decrease from 1,330 interviews in 2024, consistent with fewer hospital admissions (713 vs 757, respectively). Among 51 patients reporting a medication change within the previous 30 days, 7 (13.7%) were confirmed to have experienced a true ADR following a pharmacist review. Secondary outcomes showed that ADRs identified through MRT interviews most often involved drug–disease interactions (5, 71.4%), followed by dose‑related events (2, 28.6%). Pharmacists completed 9 interventions in response to identified ADRs, most frequently discontinuing the offending medication (7, 77%) and initiating alternative therapy when indicated.

Conclusions: Although adding the 30‑day medication‑change question did not substantially increase overall ADR interventions, the process meaningfully enhanced the MRT’s role in identifying medication‑related problems and highlighted opportunities to further expand MRT involvement in pharmacy‑led safety workflows.

Moderators

Katharine Strickland

Presenters

Aidan Bush

Pharmacy Resident, Prisma Health Blount Memorial Hospital

Evaluators

Adam Sawyer

PGY1 Residency Program Director, Huntsville Hospital

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena B

Critical Care/Emergency Medicine (CCM), Blount Memorial Hospital

global Y

10:30am EDT

Beyond Pneumonia - Evaluating the Predictive Utility of MRSA Nasal Screening for Infections Outside of the Lungs

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena G

Background: Methicillin- resistant Staphylococcus aureus (MRSA) nasal Polymerase Chain Reaction (PCR) screening is an evidenced based diagnostic tool that can guide decisions regarding the need for anti-MRSA therapy. This evaluation aims to assess the correlation between positive nasal PCR results and culture confirmed Staphylococcus aureus infections. The utility of this screening method will be assessed for skin and soft tissue infections (SSTIs), bacteremia, wound, and urine cultures. These findings may help determine if the use of nasal PCR can be expanded beyond pneumonia to serve as a tool for guiding antimicrobial therapy in suspected MRSA infections at our institution.

Methods: This is a single-center, retrospective study conducted at a 312-bed academic teaching hospital. Hospitalized patients 18 years of age and older who had a positive nasal PCR screening with a corresponding blood, urine, and wound culture outcomes. The primary outcome is to evaluate whether nasal PCR screening demonstrates a predictive value in relation to culture-confirmed Staphylococcus aureus infections. The data will be grouped for each set of cultures and will determine a negative predictive value. The study protocol is designated exempt from review by the Hospital Corporation of America (HCA) Institutional Review Board (IRB).

Results: Based on the blood, urine, and wound culture data, the wound data had the greatest negative predictive value. Overall, 1000 patients were screened, 495 patients were excluded due to the lack of additional body sources. Out of the 505 patients, 52 were excluded due to lacking a blood, urine, or wound culture. There were 453 patients that were then included overall in the data collection. Blood cultures had a negative predictive value of 68.5%, urine cultures 66.1%, and wound cultures 76.2%.

Conclusion: Based on the results from our institution there is correlation that having a negative MRSA Nasal PCR would likely result in negative MRSA/MSSA blood, wound, or urine cultures. The highest NPV was for wound cultures at 76.2%. Further research is needed to assess a larger population and potential impact of antimicrobial agents initiated prior to MRSA Nasal PCR for future studies.

Moderators

Alvin N. Tomika

Clinical Pharmacist, AdventHealth

Presenters

Alexa Czerw

PGY-1 Pharmacy Resident, HCA Trident Health Hospital

Evaluators

Amy Carr

PGY1 RPD, AdventHealth Orlando

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena G

Infectious Disease (ID), Trident Medical Center

global Y

10:30am EDT

Optimal Duration of Daptomycin plus Ceftaroline Combination Therapy in Persistent MRSA Bacteremia - Aliese Dashiell

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena H

Optimal Duration of Daptomycin plus Ceftaroline Combination Therapy in Persistent MRSA Bacteremia
Aliese Dashiell, Brandon Bookstaver, Ryan McCormick, Alex Ewing, Lauren McAbee, Jake Crocker

Background: Daptomycin and ceftaroline combination therapy (combination therapy) has been used as a salvage treatment of persistent methicillin-resistant S. aureus (MRSA) bacteremia for its synergistic effect, with promising clinical data when compared with monotherapy. The ideal duration of combination therapy is currently unclear.

Methods: A retrospective, multi-hospital healthcare system, observational cohort study comparing adult patients with persistent MRSA bacteremia that cleared blood cultures while receiving daptomycin and ceftaroline combination therapy. Patients were grouped into those who received ≤ 7 days of combination therapy after blood culture clearance (short duration group) and those who received > 7 days of combination therapy (long duration group). The primary outcome is a composite of 30-day all-cause mortality and recurrence of MRSA bacteremia. Secondary outcomes include adverse events, 90-day all-cause mortality, 90-day recurrence of MRSA bacteremia, and hospital length-of-stay.

Results: 94 patients were included, with 55 patients in the short duration group and 39 in the long duration group. Within the primary outcome, 10 patients in the short duration group and 7 patients in the long group experienced mortality or MRSA bacteremia recurrence within 30 days of the end of treatment (18.2% vs 18%, p=0.98). The short duration group experienced numerically more 90-day all-cause mortality events than the long duration group (29.1% vs 25.6%, p=0.71). There were similar rates of 90-day MRSA bacteremia recurrence between groups (3.7% vs 2.5%, p=1). The long duration group had a longer median overall hospital length-of-stay (LOS) (40 vs 22 days; p=0.002) and a longer median hospital LOS post-blood culture clearance (13.1 vs 34 days; p=0.001). There was no statistically significant difference in incidence of adverse events. The long duration group had numerically more instances of thrombocytopenia (5.5% vs 18%, p=0.09). Two cases of C. difficile requiring treatment occurred, both in the long duration group.

Conclusions: Among patients with persistent MRSA bacteremia, duration of combination therapy after blood culture clearance had no difference on 30-day mortality or recurrence. Results may help reduce unnecessary antibiotic exposure and hospital length-of-stay.

Moderators

Camille Robinette

PGY1 RPD, Clinical Pharmacy Specialist, Primary Care, SVAM1Salisbury VA Health Care SystemPGY1

Presenters

Aliese Dashiell

PGY1 Acute Care Pharmacy Resident, Prisma Health - Upstate

Evaluators

John Carr

Manager of Clinical Pharmacy Services, SJCHS

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena H

Infectious Disease (ID), Prisma Health-Upstate

global Y

10:30am EDT

Evaluation of an Institutional Inpatient Warfarin Policy Within an Academic Health System

Thursday April 30, 2026 10:30am - 10:50am EDT

Olympia 2

Title: Evaluation of an Institutional Inpatient Warfarin Policy Within an Academic Health System

Authors: Conner Correll Cain; Hannah Young; Gabrielle Iliff; Laura Holden

Background: Warfarin is a commonly used anticoagulant with a narrow therapeutic window that requires precise management to avoid complications. Pharmacist involvement has been shown to optimize warfarin therapy and improve patient outcomes; however, many institutions lack dedicated anticoagulation stewardship roles. This study aimed to evaluate compliance with an institutional anticoagulation monitoring policy for inpatient warfarin management to identify opportunities for a pharmacist-driven anticoagulation stewardship program.

Methods: This multicenter, retrospective cohort study evaluated adult patients administered warfarin at a Prisma Health inpatient facility between February 1, 2024 and August 1, 2024. The primary outcome was overall compliance with the institutional anticoagulation monitoring policy, defined as a composite of baseline international normalized ratio (INR) prior to the first scheduled warfarin dose, daily INR levels ordered until two consecutive therapeutic INRs were achieved on a stable dose, and weekly INR monitoring thereafter. Secondary outcomes included compliance with individual policy components, frequency of pharmacy consultation for warfarin management, time to therapeutic INR, incidence of supratherapeutic INR, warfarin reversal, appropriate bridge therapy, direct oral anticoagulant (DOAC) candidacy, prior to admission medication history, and discharge education.

Results: Of the 500 patient encounters reviewed, 418 met inclusion criteria. The vast majority (93.3%) were compliant with INR monitoring per institutional policy. Pharmacy consultation for warfarin management occurred in 49.8% of the encounters. Appropriate bridge therapy was significantly more common when pharmacy was consulted compared to no consultation (91.3% and 75.4%, p=0.01). Pharmacy completion of prior to admission medication histories occurred in fewer than half of the encounters, whereas warfarin discharge education was completed in over half of the encounters (48.9% and 62.9%).

Conclusions: There was widespread compliance with Prisma Health’s inpatient anticoagulation monitoring policy. Secondary outcomes suggest opportunities to improve pharmacy involvement during transitions of care.

Resident Contact: [email protected]

Moderators

David Laurent

Infectious Diseases Clinical Pharmacist, ECU Health

Presenters

Conner Cain

Evaluators

Deborah Hobbs

Associate Chief, Pharmacy, Carl Vinson VA Medical Center

PGY-1 Pharmacy Residency Program Director & Associate Chief, Pharmacy for Clinical Services at the Carl Vinson VA Medical Center. Chairperson Pro-Tem 2021

Thursday April 30, 2026 10:30am - 10:50am EDT
Olympia 2

Medication Safety (MES), Prisma Health Richland - University of South Carolina

global Y

10:30am EDT

Inpatient Medication Use Evaluation of Chemotherapy-Induced Febrile Neutropenia

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena I

Inpatient Medication Use Evaluation of Chemotherapy-Induced Febrile Neutropenia

Background/Objective: Neutropenic fever occurs in about one percent of chemotherapy patients and requires prompt empiric antipseudomonal β‑lactam therapy. The Infectious Diseases Society of America (IDSA) guidelines recommend monotherapy with cefepime or piperacillin-tazobactam, as first-line empiric therapy. They do not recommend routine antiMethicillin-resistant Staphylococcus aureus (MRSA) coverage unless prior history of MRSA infection or differential diagnosis warrants coverage. In addition, the 2024 Working Group on Infections in Hematology and Oncology (AGIHO) guidelines now recommend discontinuing empiric antibiotic therapy after 72 hours of apyrexia regardless of absolute neutrophil count (ANC). The purpose of this study is to evaluate the appropriateness of antibiotic prescribing patterns for chemotherapy-induced febrile neutropenia (CIFN). The result will help develop a future project involving antimicrobial stewardship interventions with the goal of increasing guideline adherence.

Methods: This was a single-center retrospective cohort study. Patients at least 18 years of age admitted for CIFN between July 2023 to June 2025 at Atrium Health Navicent were identified through International Classification of Disease diagnosis codes. To be included in the study, patients were required to have ANC was less than 500 cells/µL following chemotherapy with a concurrent fever or a MASCC score less than 21 regardless of ANC and received intravenous antibiotics for greater than 72 hours. Patients who had nonchemotherapy induced neutropenic fever or documented allergies preventing guidelineadherent therapy were excluded from the study. The primary outcome was composite of appropriate empiric antibiotic therapy initiation and appropriate de-escalation of therapy after 72 hours. The secondary outcomes included appropriate empiric antibiotic initiation, appropriate de-escalation of empiric therapy at 72 hours, length of antibiotic therapy, microbiological culture results matched with appropriate de-escalation, mortality rate during hospitalization, and adverse events compared to appropriate therapy.

Results: A total of 95 patients were screened, and 42 were included in the study. The mean age was 56.2 years (IQR 49-64.5) with 50% being male. Antipseudomonal β-lactams were the most common empiric agents used with cefepime 71.4% (30/42) and piperacillintazobactam 23.8% (10/42) of cases, followed by vancomycin for MRSA coverage in 83.3% (35/42) of cases, and meropenem for Extended-spectrum beta-lactamase (ESBL) coverage in 2.4% (1/42) of cases. The primary composite outcome of appropriate empiric initiation and appropriate re-evaluation at 72 hours occurred in 19% of patients. The secondary outcomes of appropriate empiric initiation occurred in 31% of patients, and the rate of appropriate antimicrobial evaluation at 72 hours was 57.1% of patients. Culture-matched antibiotics were performed in 71.4% of patients. In-hospital mortality rate was 7.1% and adverse events rate was 2.4% in patients.

Conclusions: Most patients with chemotherapy‑induced febrile neutropenia received inappropriate empiric antibiotic initiation and inappropriate duration of antimicrobials per guideline recommendations. This quality improvement project identified several practice gaps and serves as a baseline for future projects involving antimicrobial stewardship at Atrium Health Navicent.

Moderators

Courtney Isom

PGY-1 Community-based Residency Director, Cone Health

Presenters

Joshua Gaynier

Evaluators

Crystal Wright

Pain and Palliative Care Clinical Pharmacy Specialist, PGY-2 Ambulatory Care Pharmacy RPD, Kaiser Permanente Georgia

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena I

Oncology (ONC), Atrium Health Navicent The Medical Center

global Y

10:30am EDT

Impact of Opioid-Sparing Multimodal Pain Management Order Set on Opioid Use and Clinical Outcomes in Thoracic Surgery Patients

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena J

Impact of Opioid-Sparing Multimodal Pain Management Order Set on Opioid Use and Clinical Outcomes in Thoracic Surgery Patients

Authors: Kylie Michot, Michael Ezebuenyi, Monica Campbell, Jennifer Jones, Greggory Davis

Background: Multimodal analgesia optimizes postoperative pain management while reducing opioid use and associated risks. Pain management is achieved by optimizing the synergistic effects of non-opioid medications with complementary mechanisms of action. The Enhanced Recovery After Surgery (ERAS) Society recommends multimodal analgesia over scheduled opioid therapy for thoracic surgery postoperative pain management. While current evidence highlights the benefits of multimodal strategies, further research is needed to evaluate opioid-sparing effects and clinical impact after thoracotomy. This study evaluates whether implementation of a postoperative multimodal analgesia regimen within an ERAS protocol reduces opioid utilization among thoracic surgery patients undergoing thoracotomy compared to traditional opioid-based postoperative pain management.
Methods: This single-center, retrospective chart review evaluated patients admitted to FMOL Health – Our Lady of the Lake between March 2017 and September 2025 who underwent thoracotomy and received postoperative analgesics from a standardized order set. Patients were excluded if they were younger than 18 years or older than 80 years of age, receiving renal replacement therapy, pregnant, receiving comfort care, or had a documented allergy to a medication included in the order set.
The primary outcome was three-way comparison of opioid utilization, measured in morphine milligram equivalents (MMEs), in patients receiving a multimodal pain management protocol versus usual care with opioids for pain management after a thoracotomy on post-operative day (POD) 0, POD 1-3, and total postoperative length of stay (LOS). Secondary endpoints included chest tube duration, post-operative ventilator duration, intensive care unit (ICU) LOS, hospital LOS, average pain control score on POD 1 and POD 3, time to first dose of opioids after surgery, and opioid prescriptions upon discharge.
Results: A total of 156 patients were included in this study with 78 patients in each group. Regarding baseline characteristics, the majority of the multimodal group had a higher American Society of Anesthesiologists (ASA) Physical Status Score (ASA score >3, 17% vs. 46%; P < 0.001), an overall lower number of female patients (67% vs. 44%, P = 0.004), and patients over the age of 60 (median age, 60 vs. 66; P = 0.005). No difference in inpatient opioid consumption was seen between groups on POD 0 (17 vs. 20; ratio, 1.2; 95% CI 0.68 to 2.05; P = 0.78). There was a statistically significant reduction in inpatient opioid consumption between groups on POD 1-3 (83 vs. 20; ratio, 0.19; 95% CI, 0.11 to 0.34; P < 0.001) and total postoperative LOS (130 vs. 55; ratio, 0.38; 95% CI, 0.24 to 0.62; P < 0.001). Multimodal analgesia reduced pain score on POD 1 (median pain score, 4.6 vs. 3.5; P = 0.003) but had no difference in pain score on POD 3 (median pain score, 3.8 vs. 3.0; P = 0.07). Additionally, multimodal analgesia was associated with decreased chest tube duration (median chest tube days, 3.1 vs. 2.2; P = 0.003), and decreased hospital LOS (median LOS, 4 vs. 3; P = 0.010). There was no difference in discharge opioid prescription MMEs (median discharge MMEs, 225 vs. 300; P = 0.89).
Conclusion: Among patients undergoing thoracotomy, a multimodal analgesia regimen with an ERAS protocol was associated with significant reductions in opioid utilization during POD 1-3 and total postoperative hospitalization but did not demonstrate a difference on POD 0. Limitations include the retrospective nature of this single site study and the inability to access opioid usage data from patient-controlled analgesia (PCA) pumps.
Contact Information: [email protected]

Moderators

Deidra Easley

PGY1 Residency Program Director, Baptist Medical Center South

Presenters

Kylie Michot

PGY-1 Pharmacy Resident, FMOL Health - Our Lady of the Lake

Kylie Michot, Pharm.D., is a PGY-1 pharmacy resident at FMOL Health - Our Lady of the Lake in Baton Rouge, Louisiana. She earned both her Bachelor of Science in Pharmaceutical Sciences and Doctor of Pharmacy degrees from University of Louisiana Monroe. Kylie currently serves as Member-at-Large... Read More →

Evaluators

Derek Rhodes

Manager / HSPAL RPD, Prisma Health

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena J

Pain Management (PM), Our Lady of the Lake Regional Medical Center

global Y

10:30am EDT

Evaluation Of Sickle Cell Fever Protocols in the Pediatric Emergency Department

Thursday April 30, 2026 10:30am - 10:50am EDT

Parthenon 2

Background: Children with sickle cell disease (SCD) are at increased risk for serious bacterial infections due to functional asplenia. Fever in this population is considered a medical emergency requiring rapid evaluation and empiric antibiotics. Guidelines recommend prompt antibiotic administration, while the literature specifically supports delivery within 60 minutes of emergency department (ED) arrival. However, achieving this target is often hindered by ED crowding and limited bed availability. To address this, the Children’s Hospital of Georgia (CHOG) pediatric ED implemented a nurse-driven sickle cell fever triage protocol. This study aims to evaluate whether protocol implementation improved the proportion of patients receiving antibiotics within 60 minutes.

Methods: This is a single-center, retrospective study conducted in the CHOG pediatric ED evaluating a nurse-first sickle cell fever triage protocol with reiteration on May 21, 2025, which allowed triage nurses to obtain IV access, labs, cultures, and notify a provider prior to room assignment. Patients 0–17 years with sickle cell disease who presented to the ED with fever (≥38°C) from November 2, 2024 to October 31, 2025 were included. Encounters with missing key time points or adult ED admissions were excluded. The primary outcome was the proportion of patients receiving antibiotics within 60 minutes of ED arrival. Secondary outcomes included frequency of protocol use and time from arrival to provider evaluation. Outcomes were compared between pre- and post-implementation periods using descriptive statistics, chi-square tests, and t-tests, as appropriate.

Results: A total of 52 patients were included in this IRB-approved study, with 31 in the pre-protocol group and 21 in the post-protocol group. Antibiotics were administered within 60 minutes of ED arrival in 3 patients (9.7%) in the pre-protocol group and 2 patients (9.5%) in the post-protocol group (p = 0.9853). The sickle cell with fever triage protocol was utilized in 1 (3.23%) of pre-protocol encounters compared with 4 (19.05%) of post-protocol encounters (p = 0.0576). The mean time from ED arrival to provider evaluation significantly decreased from 55 minutes in the pre-protocol period to 23 minutes in the post-protocol period (p = 0.0031).

Conclusions: This study found no significant difference in the proportion of patients receiving antibiotics within 60 minutes of ED arrival between the pre- and post-protocol groups at a single institution. There was a significantly faster time to provider evaluation in the post-protocol group, suggesting improved early recognition and prioritization of this high-risk population. While protocol utilization increased in the post-implementation period, it remained relatively low, highlighting the need for further workflow optimization, staff education, and system-level support to enhance adherence. Future efforts should focus on identifying barriers to timely antibiotic administration, particularly challenges with obtaining IV access in this population, and improving consistent protocol activation to better align care with national guidelines and ultimately improve outcomes for children with sickle cell disease presenting with fever.

Contact: [email protected]

Moderators

Beth Phillips

Professor, UGAA1University of Georgia College of Pharmacy (Ambulatory Care)PGY2

Presenters

Anne Abrams

PGY1 Pharmacy Resident, Wellstar MCG Health

Anne Abrams is a PGY1 Pharmacy Resident at Wellstar MCG Health. She completed her Bachelor of Pharmaceutical Sciences and Doctor of Pharmacy degrees at the University of South Carolina. She plans to complete a PGY2 in pediatrics at Wellstar MCG Health/ Children's Hospital of Georgia... Read More →

Evaluators

Ben Ferris

RPD, AdventHealth East Orlando

Thursday April 30, 2026 10:30am - 10:50am EDT
Parthenon 2

Pediatric (PED), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

10:30am EDT

Impact of pre-transplant midodrine use on simultaneous liver-kidney transplant outcomes

Thursday April 30, 2026 10:30am - 10:50am EDT

Athena C

Title: Impact of pre-transplant midodrine use on simultaneous liver-kidney transplant outcomes

Authors: Matthew Molk1, Mojibola Awe2, Teresa Gennaro1, Heather Snyder1, Farjad Siddiqui1; Emory University Hospital, Atlanta, GA1; The Johns Hopkins Hospital; Baltimore, MD2

Objective: Determine the impact of pre-transplant midodrine use on outcomes after SLK transplant related to delayed graft function.

Self Assessment Question: Does midodrine use prior to simultaneous liver-kidney transplant increase the incidence of specific kidney delayed graft function.

Background: Midodrine is commonly used in patients with end-stage kidney and liver diseases for various indications. A previous study suggested that midodrine use prior to kidney transplant worsens post-transplant outcomes, including delayed graft function (DGF), graft failure, and death. Alternatively, another study among simultaneous liver-kidney (SLK) transplant recipients found no significant difference in hospitalization, graft failure, or death in patients treated with pre-transplant midodrine. Given the paucity of data, the purpose of this study was to determine the impact of pre-transplant midodrine use on outcomes after SLK transplant.

Methods: This was a single-center, retrospective chart review of adult patients who received a SLK transplant at Emory Transplant Center between February 2015 and June 2024. Patients who died within 7 days post-transplant were excluded. Patients were placed into 2 study arms determined by their pre-transplant midodrine use. Pre-transplant midodrine use was defined as treatment with midodrine for at least 3 months prior to transplant. The primary outcome was the incidence of kidney-specific DGF, defined as the requirement for dialysis within the first 7 days after transplant. Secondary outcomes included post-transplant hospital length of stay, midodrine use at discharge from index admission, estimated glomerular filtration rate (eGFR) at discharge and 1 year, readmission rates, and kidney allograft survival and patient survival at 1-year post-transplant. Primary and secondary outcomes were analyzed using descriptive statistics.

Results: Of the 104 patients screened, 94 patients met inclusion criteria with 13 patients in the midodrine group and 81 in the non-midodrine group. Median age was similar between groups (57 vs. 58 years) and a majority of patients in both arms were Caucasian and male. Patients in the midodrine had a higher median MELD score at the time of transplant compared to the non-midodrine group (34 vs. 31; p < 0.001). Kidney-specific DGF occurred more frequently in the midodrine group vs. the non-midodrine group, however this difference was not statistically significant (30.8% vs. 12.3%, p = 0.083). The midodrine group had a significantly longer median post-transplant length of stay (17 vs. 11 days, p < 0.001) and a higher incidence of midodrine use at discharge (15.4% vs. 2.5%, p = 0.032). While eGFR at discharge trended lower in the midodrine group (47 vs. 66 mL/min/1.73m², p = 0.075), eGFR at 1-year post-transplant was comparable between groups (53 vs. 56 mL/min/1.73m², p = 0.462). Readmission rates at 6-12 months post-transplant were greater in the midodrine group (54% vs. 17%; p = 0.003). Kidney allograft survival and patient survival at 1-year post-transplant were similar between groups.

Conclusion: Pre-transplant midodrine use in SLK recipients does not appear to affect short term outcomes after transplant; however larger studies need to be conducted.

Moderators

Drew Kessell

Presenters

Matthew Molk

My name is Matthew Molk (PharmD) and I am a PGY-1 resident at Emory University Hospital. I completed my pharmacy school education at the University of Florida. I am planning to pursue a PGY-2 in oncology following my PGY-1 training. I am currently a member of GSHP.

Evaluators

Allie Hale

Clinical Pharmacist and Residency Program Director, Parkridge Health System

Thursday April 30, 2026 10:30am - 10:50am EDT
Athena C

Transplant (TRP), Emory University Hospital

global Y

11:00am EDT

Resident Presentation - Josh Kota

Thursday April 30, 2026 11:00am - 11:20am EDT

Olympia 2

Moderators

Sarah Blackwell

PGY1 Pharmacy RPD/ Clinical Pharmacy Specialist, Medical Critical Care, Baptist Health Princeton Hospital

Sarah Blackwell, PharmD, BCPS, BCCCP, is a Clinical Pharmacy Specialist and PGY-1 Pharmacy Residency Program Director at Baptist Health Princeton Hospital in Birmingham, AL. She obtained her Doctor of Pharmacy from Auburn University in 2011 and completed her PGY-1 Pharmacy Residency... Read More →

Presenters

Josh Kota

Evaluators

Olivia Caron

PGY2 Ambulatory Care RPD, MAHEC

Thursday April 30, 2026 11:00am - 11:20am EDT
Olympia 2

Administration (ADM), Wake Forest Baptist

global Y

11:00am EDT

Pharmacogenomics-Guided Statin Reinitiation in Veterans with History of Statin-Associated Muscle Symptoms

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena B

Pharmacogenomics-Guided Statin Reinitiation in Veterans with History of Statin-Associated Muscle Symptoms
De’Vaughn Vaughn, Jennifer Clark
Fayetteville VA Health Care Center – Fayetteville, NC

Background/Purpose: Statin-associated muscle symptoms (SAMS) are a leading cause of statin discontinuation, leaving high-risk patients undertreated for atherosclerotic cardiovascular disease (ASCVD) prevention. Pharmacogenomic (PGx) testing can identify genetic variants that increase SAMS risk: SLCO1B1 encodes a hepatic uptake transporter affecting systemic exposure to all statins; ABCG2 encodes an efflux transporter modulating absorption and disposition of rosuvastatin; and CYP2C9 encodes a phase 1 metabolizing enzyme responsible for oxidation of fluvastatin and, to a lesser extent, other statins. Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines provide therapeutic recommendations for statin selection and dosing based on these genotypes to improve safety, adherence and effectiveness of statin therapy. The purpose of this quality improvement project is to evaluate the role of PGx-guided, clinical pharmacist led statin reinitiation in veterans with history of SAMS and high ASCVD risk.
Methodology: This single-center, prospective cohort study enrolled 91veterans at the Fayetteville, NC VA Coastal Health Care System who had previously discontinued statin therapy due to reported SAMS. Eligible patients were identified through a statin adverse drug event (ADE) dashboard and had high ASCVD risk (history of type 2 diabetes mellitus and/or coronary artery disease) with prior exposure to no more than 3 statins. Veterans were contacted by the pharmacy resident and project preceptor via telephone and provided informed consent for PGx testing through Baylor Genetics. Following receipt of genotype results for SLCO1B1, ABCG2, and CYP2C9, patients were re-contacted and their PGx results were reviewed. Individualized statin recommendations were provided based on identified genetic variants. The primary outcome was the percentage of Veterans successfully reinitiated on statin therapy following PGx-guided recommendations. Secondary outcomes included rate of statin adherence at 4-6-week follow-up, rate of SAMS recurrence, and percentage of Veterans with LDL goal attainment of < 100mg/dL.
Results: Of 91 eligible Veterans, 50 (55%) consented to PGx testing. Among those tested, 33 (66%) were successfully reinitiated on statin therapy, meeting the primary outcome. PGx testing identified SLCO1B1 decreased function in 12/33 (36%), ABCG2 decreased function in 4/33 (12%), and no actionable variants in 17/33 (52%). At the time of analysis, 21/33 (64%) Veterans had completed 4–6-week CPP follow-up, with 21/21 (100%) reporting adherence to statin therapy. Five Veterans (15%) discontinued therapy prior to follow-up: 3 due to SAMS recurrence (9%), 1 due to headache, and 1 due to epistaxis in the setting of anticoagulation. Among 12 Veterans with paired lipid data who continued therapy, mean LDL decreased from 134 mg/dL to 79 mg/dL (mean reduction: 56 mg/dL). Nine of 12 (75%) achieved LDL <100 mg/dL post-reinitiation. Of the 10 Veterans with baseline LDL >100 mg/dL, 7 (70%) achieved LDL < 100 mg/dL following PGx-guided statin reinitiation. Lipid data collection remains ongoing, with 20 Veterans awaiting post-statin lipid panels.
Conclusions: PGx-guided statin reinitiation resulted in a 66% reinitiation rate among consented Veterans, with a SAMS recurrence rate of only 9% comparing favorably to published recurrence rates of up to 30% with empiric rechallenge. All Veterans who reached 4–6-week follow-up remained adherent to therapy, and 75% of those with paired lipid data achieved LDL < 100 mg/dL. These early findings suggest that PGx-guided, clinical pharmacist-led statin reinitiation is a feasible and effective strategy for closing the treatment gap in high-risk Veterans with prior SAMS. Limitations include incomplete lipid data, lack of standardized baseline labs, and a small sample size. Continued follow-up and lipid panel collection will further define the durability of these outcomes.

Moderators

Elora Hilmas

Pharmacy Clinical Manager, ECU Health

Presenters

De'Vaughn Vaughn

PGY-1 Pharmacy Practice Resident, Fayetteville, NC VA Coastal Health Care System

Hello! I am a graduate of Campbell University's College of Pharmacy and Health Sciences. I am a prior-service Army Veteran with a commitment to continuing to serve my nation through providing patient-centered care to our nation's heroes. My clinical interests include endocrinology/diabetes... Read More →

Evaluators

Brian Hairston

Critical Care Clinical Specialist, FMOL Health | St. Dominic

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena B

Ambulatory Care (AMB), VA - Fayetteville, NC â€“ Fayetteville VA Coastal Health Care System

global Y

11:00am EDT

Evaluation of Prealbumin Levels on Clinical Outcomes in Transthyretin Cardiac Amyloidosis Treated with Transthyretin Stabilizers

Thursday April 30, 2026 11:00am - 11:20am EDT

Parthenon 1

Authors: Jalyn Martin, Justin Joy, Brian Tran, Matthew Brown, Susie Sennhauser, Matthew Gold, Daniel Gold, Kunal Bhatt

Background: Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease caused by myocardial deposition of misfolded transthyretin (TTR) fibrils, resulting in heart failure. TTR stabilizers, including tafamidis and acoramidis, reduce mortality and hospitalization by preventing tetramer dissociation. However, there is no standardized biomarker to assess treatment response. Clinical follow-up commonly incorporates serum prealbumin, N-terminal pro-B-type natriuretic peptide (NT-proBNP), imaging, and hospitalization rates. Prior studies suggest that lower baseline prealbumin and early post-treatment increases are associated with clinical outcomes, but its prognostic utility in real-world populations remains unclear.

Methods: This was a retrospective chart review of adults diagnosed with ATTR-CM who received TTR stabilizer therapy (i.e. tafamidis, tafamidis meglumine, or acoramidis) at the Emory Advanced Heart Failure Clinic between November 1, 2019, to December 1, 2025. Patients were included in this study if they had both baseline and follow-up (≥ 3 months) prealbumin levels. Ineligible patients were those with previous TTR stabilizer or TTR silencer use, on dual stabilizers, on a concurrent TTR silencer (patisiran, vutrisiran, inotersen, or eplontersen), or enrolled in an active ATTR-CM clinical trial. The primary outcome was the absolute change in prealbumin levels following TTR stabilizer therapy. Secondary outcomes included the association between absolute change in prealbumin and all-cause hospitalization and all-cause mortality (time to event analysis), as well as the absolute change in NT-proBNP following TTR stabilizer initiation. Descriptive statistics, paired t-test, logistical regression, and Cox proportional hazard regression were used to summarize the data.

Results: Of 222 patients screened, 150 were excluded, primarily due to missing follow-up prealbumin measurements. A total 72 patients were included in the analysis, all treated with tafamidis. Prealbumin rose significantly after TTR stabilizer initiation, with a mean paired increase of 8.99 mg/dL (95% CI 7.40 to 10.59; p<0.001). The composite outcome of hospitalization and death occurred in 47 (65.3%) patients, with 14 deaths and 47 hospitalizations. After adjustment for age, sex, and race, each 5 mg/dL higher follow-up prealbumin was associated with a lower risk of hospitalization (HR 0.41; 95% CI 0.21 to 0.78; p=0.007) and the composite outcome (HR 0.37; 95% CI 0.20 to 0.69; p=0.002). No significant association was observed for mortality alone with either follow-up prealbumin or change in prealbumin. Mean absolute change in NT-proBNP was 165.7 pg/mL.

Conclusions: Higher prealbumin after TTR stabilizer initiation was associated with a reduced risk of all-cause hospitalizations and composite events. Baseline prealbumin in prealbumin predicted subsequent cardiac-related hospitalizations and all-cause mortality in an exploratory analysis. Further research in larger cohorts with longer follow-up is needed to validate these findings and further identify predictors of response to TTR stabilizer therapy.

Moderators

Jared Briones

Clinical Pharmacist, Adventhealth Apopka

Background/Purpose: In July 2022, AdventHealth Apopka initiated percutaneous coronary intervention services, prompting an interest in the overall performance and care quality of PCI patients. While recommended process metrics by ACC/AHA exist, past researchers have been further examining the relationship... Read More →

Presenters

Jalyn Martin

PGY-1 Specialty Pharmacy Resident, Emory Healthcare

Evaluators

Randy Hooks

Clinical Pharmacist, East Alabama Medical Center

Internal Medicine- East Alabama Health

Thursday April 30, 2026 11:00am - 11:20am EDT
Parthenon 1

Cardiology (CAR), Emory University Hospital Midtown

global Y

11:00am EDT

Evaluation of the PRECISE-DAPT Score in Predicting CABG Related Bleeding Readmissions - Laura Adler

Thursday April 30, 2026 11:00am - 11:20am EDT

Parthenon 2

Evaluation of the PRECISE-DAPT Score in Predicting CABG Related Bleeding Readmissions
Inyeong Choi, Danielle McPherson, Davide Ventura
AdventHealth Orlando, FL

Background/Purpose: Dual antiplatelet therapy (DAPT) is recommended for patients after coronary artery bypass graft surgery (CABG) with concomitant acute coronary syndrome (ACS) or recent history of percutaneous coronary intervention (PCI). Large scale analyses have confirmed the external validity of the PRECISE-DAPT score demonstrating that high risk patients (score ≥ 25) have a 3- to 4-fold increased risk of major bleeding. The PRECISE-DAPT score is a five-item bleeding risk score validated in the PCI patient population to assist clinician’s informed decision making on duration of DAPT. This score is determined by age, creatinine clearance (CrCl), white blood cell (WBC) count, hemoglobin (Hgb), and history of bleeding at baseline. However, no validated bleeding risk scores exist for the CABG population. Recently, Society of Thoracic Surgeons (STS) registry data at AdventHealth noted a high rate of re-admissions due to bleeding complications. The benefit of DAPT after CABG remains uncertain as recent trials show no clear ischemic advantage at the expense of more bleeding. This study aims to evaluate the association of the PRECISE-DAPT score and bleeding readmissions in patients discharged from DAPT after CABG.

Methodology: This study was a retrospective cohort study conducted from August 2022 to August 2025. This study included patients who were re-admitted after CABG at AdventHealth Orlando and Celebration campuses due to bleeding complications within 90 days. Bleeding complications included gastrointestinal bleeding (GIB), anticoagulation complications , pleural or pericardial effusion requiring intervention, or hemorrhagic stroke. The PRECISE-DAPT score was retrospectively calculated based on age, CrCl, WBC, Hgb, and history of bleeding. The primary outcome was to evaluate the association of the PRECISE-DAPT score and re-admissions due to bleeding complications. The secondary outcomes included bleeding events defined by the Bleeding Academic Research Consortium (BARC) criteria, time to re-admission, transfusion requirements, and any changes to antiplatelet or anticoagulant regimens. Categorical data were analyzed via a Chi-square test or Fischer’s Exact test. Continuous data were analyzed via a Mann-Whitney U test or Kruskal-Wallist test.

Results: A total of 95 patients with CABG with or without valve replacements were included in the final analysis. Twenty-five patients had a PRECISE-DAPT score < 25 (low bleeding risk) and 70 patients had a PRECISE-DAPT score ≥ 25 (high bleeding risk). The high-risk group had an average score of 43 and accounted for 74% of all bleeding complications. Additionally, high-risk patients experienced numerically more clinically relevant bleeding events (BARC type 2 or greater) than the low-risk group (28 vs. 8, p = 0.342). After readmission, 53% of DAPT patients in the high-risk group were transitioned to single antiplatelet therapy (SAPT) compared with 23% in the low-risk group. Transfusion requirements were comparable between the two groups, with 22.9% in the high-risk group and 28% in the low-risk group.

Conclusion: Elevated PRECISE-DAPT scores are associated with increased risk. Though currently validated for PCI patients only, the PRECISE-DAPT score offers a viable tool for risk stratification in CABG patients. Incorporating the PRECISE-DAPT score in surgical patients may inform tailored antithrombotic regimens as a strategy to minimize bleeding readmissions.

Moderators

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1

Presenters

Laura Adler

PGY1 Pharmacy Resident, AdventHealth Orlando

Laura Adler is a PGY1 Pharmacy Resident at the AdventHealth Orlando. Dr. Adler received a bachelor's degree in Pharmaceutical Sciences and Doctor of Pharmacy at Massachusetts College of Pharmacy and Health Sciences. After the completion of her current residency program, she will start... Read More →

Evaluators

Jolie Gallagher

Clinical Pharmacy Specialist, Critical Care, Emory University Hospital

I am the clinical pharmacy manager at Emory University Hospital. My background training is in critical care. My current areas of interest are optimization of transitions of care and pharmacist burnout and resilience.

Thursday April 30, 2026 11:00am - 11:20am EDT
Parthenon 2

Cardiology (CAR), AdventHealth Orlando

global Y

11:00am EDT

Iron Supplementation in Patients with Heart Failure with Reduced Ejection Fraction Following Pharmacist-Led Review

Thursday April 30, 2026 11:00am - 11:20am EDT

Olympia 1

Iron Supplementation in Patients with Heart Failure with Reduced Ejection Fraction Following Pharmacist-Led Review
Lauren Finn, Rachel Kile
CHI Memorial Hospital, Chattanooga, TN

Background/Purpose: Heart failure is a leading cause of hospitalization for patients older than 65, requiring proper management during inpatient stays. Iron deficiency is common in heart failure with reduced ejection fraction (HFrEF) and negatively impacts patient outcomes. This project aims to describe the impact of pharmacist intervention on the appropriate initiation of iron supplementation in patients with HFrEF, highlighting the pharmacist's role in optimizing HFrEF management.

Methods: This is a single-center, IRB-approved, quasi-experimental study. We conducted a retrospective chart review comparing the proportion of iron-deficient inpatients with an active diagnosis of chronic systolic heart failure who were appropriately initiated on intravenous iron therapy before and after the implementation of a pharmacist-led review process. Appropriate therapy was defined as a course of IV iron of at least 500 mg in iron-deficient patients. Eligible patients were at least 18 years of age with an ejection fraction of forty percent or less and with a ferritin <100 or ferritin between 100 and 300 and TSAT <20%. The primary endpoints analyzed were readmission rates at 30 and 60 days and the number of patients with appropriate iron therapy initiated. Secondary endpoints will include the number of pharmacist-initiated interventions for iron panels, ferritin levels, and iron supplementation. For both study arms, results will be reported with male and female participants combined, as well as sex disaggregated.

Results: There were not statistically significant differences in age, sex, race, or left ventricular ejection fraction between the pre-intervention and post-intervention groups. Additionally, there was not a statistically significant difference in the type of iron administered, and more patients received sodium ferric gluconate compared to iron dextran across both groups. Post-intervention, 39 patients were initiated on appropriate IV iron therapy as opposed to only 7 pre-intervention, This was a statistically significant difference with a p-value of 0.007. Differences in readmission rates at 30 & 60 days were not statistically significant between groups, but a lower percentage of patients was readmitted post-intervention. Of the 39 appropriate IV iron initiations post-intervention, 23 were pharmacist-initiated, with the remaining being provider-led. The number of pharmacist-initiated orders was 18 for iron panels and 21 for ferritin levels.

Conclusions: Pharmacist-led review significantly improved appropriate IV iron supplementation in patients with HFrEF. Considering that of the 39 patients initiated on appropriate IV iron therapy post-intervention, 23 orders were pharmacist-led, it can be concluded that providers are initiating IV iron therapy as well. Although results for readmission rates were not statistically significant, fewer patients were readmitted post-intervention. Orders for iron panels and ferritin levels were higher in the post-intervention group. Overall, these findings support pharmacist interventions in this patient population to improve adherence to guideline recommendations.

Contact: [email protected]

Moderators

Heather Stanley

Presenters

Lauren Finn

PGY1 Pharmacy Resident, CHI Memorial Hospital Chattanooga, TN

I'm currently a PGY1 resident at CHI Memorial in Chattanooga, TN. I graduated from University of Iowa in 2025 with my PharmD degree and cardiology is my primary clinical interest. My post-residency plans include working as an inpatient pharmacist at University of Tennessee Medical... Read More →

Evaluators

Blake Johnson

Thursday April 30, 2026 11:00am - 11:20am EDT
Olympia 1

Cardiology (CAR), CHI Memorial

global Y

11:00am EDT

Impact of Daptomycin Weight-Based Dosing Strategies in Obese Patients with Staphylococcal and Enterococcal Infections

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena I

Impact of Daptomycin Weight-Based Dosing Strategies in Obese Patients with Staphylococcal and Enterococcal Infections
Coleton Waggoner, Emily Perez, David Laurent
Background: High-dose daptomycin (>8 mg/kg) is increasingly utilized for severe Staphylococcus aureus and Enterococcus infections. However, optimal weight-based dosing in obese patients remains undefined. Daptomycin exposure is nonlinear with weight, and consequently, obese patients may be at risk for excessive exposure and adverse outcomes when dosing by total body weight (TBW).

Methods: This multicenter retrospective cohort study evaluated hospitalized adult obese patients (BMI ≥30 kg/m²) treated with high-dose daptomycin at ECU Health from January 2022 to July 2025. Patients were categorized into TBW or ABW (adjusted body weight) cohorts as determined by infecting pathogen: 8-10 mg/kg ± 0.5 mg/kg for S. aureus or 10-12 mg/kg + 0.5 mg/kg for Enterococcus spp.

The primary outcome was a composite safety endpoint of serum creatinine kinase (CK) elevation (>600u/L), patient-reported myopathy, rhabdomyolysis, or early discontinuation of daptomycin. Secondary outcomes included individual components of the composite safety endpoints as well as efficacy endpoints including readmission at 90 days, mortality at 90 days, resistance development at 90 days, and daptomycin discontinuation due to lack of efficacy. Baseline characteristics and outcomes were compared between groups using chi-square or Fisher’s exact tests for categorical variables and Mann-Whitney U tests for continuous variables.

Results: A total of 101 patients were included (TBW n=40; ABW n=61). Several differences in baseline characteristics existed between groups; the ABW cohort was significantly older (60.8 vs 56.1 years; p=0.025), had a higher mean BMI (38.7 vs 36.1 kg/m2; p=0.041), and had a higher prevalence of concomitant statin use (45.9% vs 20.0%). The primary composite safety outcome occurred in 20.0% (n=8/40) of TBW vs 19.7% (n=12/61) of ABW patients (p=0.78). CK elevation occurred in 20.0% vs 16.4% (p=0.59), myopathy in 5.0% vs 4.9% (p=1.00), and rhabdomyolysis in 2.5% vs 0% (p=0.39) in TBW and ABW groups, respectively. Discontinuation due to safety concerns occurred in 15.0% vs 8.2% (p=0.34). Ninety-day mortality was 20.0% vs 16.4% (p=0.64). There were no significant differences in secondary outcomes.

Conclusions: In this cohort of obese patients receiving high-dose daptomycin, TBW and ABW based dosing strategies demonstrated similar rates of composite safety events, as well as exploratory efficacy outcomes.

Email: [email protected]

Moderators

Lena Tran

Pharmacist, AdventHealth Kissimmee

Presenters

Coleton Waggoner

Evaluators

Jonathan Alligood

Residency Program Director, Phoebe Putney Memorial Hospital

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena I

Community Pharmacy (CP), ECU Health Medical Center

global Y

11:00am EDT

Evaluation of compliance to post bariatric surgery enoxaparin protocol for venous thromboembolism in high-risk patients

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena A

Title: Adherence to Venous Thromboembolism Prophylaxis Protocol in High-Risk Bariatric Surgery Patients
Authors: Ashley Bennett, Adele Robbins, Angelita Incer
Emory Saint Joseph's Hospital - PGY1 - Atlanta, Georgia
Background/Purpose: Venous thromboembolism (VTE) is a recognized postoperative complication following bariatric surgery, with risk stratification performed using the Cleveland Clinic Risk Score (CRC). Emory Saint Joseph’s Hospital implemented a standardized postoperative enoxaparin protocol for high-risk patients to mitigate this risk. According to the protocol, enoxaparin should be initiated within 14 hours of surgery, with dosing adjusted based on body weight and creatinine clearance. High-risk patients, defined as those with a CRC score >0.4, are recommended to continue enoxaparin upon discharge for ongoing VTE prophylaxis. The purpose of this study was to evaluate the compliance rate with the bariatric surgery postoperative enoxaparin protocol for venous thromboembolism prophylaxis.
Methodology: Single-center, retrospective chart review of adult patients who underwent bariatric surgery at Emory Saint Joseph’s Hospital between January 1, 2024, and December 31, 2024. Protected/vulnerable patient populations, including pregnant patients and prisoners, were excluded from the study. The primary outcome was compliance rate with the bariatric surgery postoperative enoxaparin protocol for venous thromboembolism (VTE) prophylaxis. Secondary outcomes included incidence of VTE within 30-days of operation, bleeding complications, length of stay, and all-cause mortality within 30 days of operation. Process-related outcomes included time to first dose of enoxaparin postoperatively and dosing adherence. Continuous variables were summarized using medians and interquartile ranges (IQR). Categorical variables were summarized as counts and percentages.
Results: A total of 118 patients were included in the study, with 86 (72.9%) demonstrating full protocol compliance. Full compliance was achieved if the patient received the correct dose of enoxaparin on the evening of surgery and was appropriately discharged on prophylaxis. Process measure adherence was variable: 96/118 (81.4%) received the first dose within 14 hours postoperatively, and 102/118 (86.4%) were dosed appropriately based on BMI and renal function. Nine patients (5.2%) were classified as high risk (CRC score >0.4). Among these, only 1/9 (11.1%) were appropriately discharged on VTE prophylaxis. Clinical outcomes at 30 days included 3 VTE events (1.7%) and no bleeding or mortality observed. There were no differences in clinical outcomes, such as VTE events or length of stay (LOS), between compliant and non-compliant patients.
Conclusions: Overall, compliance with the bariatric surgery enoxaparin prophylaxis protocol was achieved in 72.9% of patients. Gaps were identified in postoperative administration, timing, dosing, and discharge prescribing for high-risk patients. Despite low compliance, the observed incidence of VTE, bleeding, and mortality was low within 30 days.

Moderators

Elaina Baaklini

Presenters

Ashley Bennett

PGY-1 Pharmacy Resident, Emory Saint Joseph's Hospital

Ashley Bennett is from Leesburg, Georgia. She completed her pre-pharmacy coursework at the University of Georgia and received her Doctor of Pharmacy from Mercer University College of Pharmacy in Atlanta Georgia. Her primary professional interest is critical care and her goal is to... Read More →

Evaluators

Liz Oglesby

Pharmacy Clinical Coordinator, PGY-1 Residency Program, Mobile Infirmary

Liz Oglesby, PharmD, BCPS, is the Pharmacy Clinical Coordinator and PGY-1 Residency Program Director at Mobile Infirmary in Mobile, Alabama. She obtained her doctorate of pharmacy from Auburn University in 2017 and completed PGY-1 training at Baptist Health Princeton Hospital in 2018. Her primary practice foc... Read More →

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena A

Critical Care/Emergency Medicine (CCM), Emory Saint Josephâ€™s Hospital

global Y

11:00am EDT

Cefazolin vs. Clindamycin for Surgical Prophylaxis in Patients with a Beta-Lactam Allergy

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena H

Abstract
Title: Cefazolin vs. Clindamycin for Surgical Prophylaxis in Patients with a Beta-Lactam Allergy
Authors: John Otasowie, Plamen Mangarov, Daniel Rogers, and Mydien Tran
Background
About 20% of all healthcare-associated infections are due to surgical site infections (SSIs), representing a substantial clinical and economic burden with an estimated annual cost exceeding $3.3 billion. Despite advances made in infection control practices by the implementation of preoperative prepping and prophylactic antibiotic administration, SSI remains a significant cause of morbidity and mortality. Appropriate use of perioperative antibiotics is imperative to reduce the rate of SSIs. For most procedures, cefazolin is the drug of choice for surgical prophylaxis due to its proven efficacy and safety, a desirable pharmacokinetic profile, an ideal spectrum of activity against commonly encountered organisms during surgery, and a relatively low cost.
However, penicillin and cephalosporin allergy labels remain a significant barrier to cefazolin use. Approximately 10% of patients report a penicillin allergy, and 2% a cephalosporin allergy. Studies suggest that over 95% of patients labeled with a penicillin allergy do not have an actual immunoglobulin E-mediated allergy and could tolerate penicillin. However, clinicians often utilize alternative agents like clindamycin in the presence of a documented β-lactam allergy. Nevertheless, clindamycin use has been linked to higher rates of SSIs and Clostridioides difficile infection (CDI). Despite these concerns, clindamycin remains a popular prophylactic option for patients labeled with a β-lactam allergy, even when cefazolin may be safely administered. This study evaluated whether patients receiving cefazolin for surgical prophylaxis had comparable outcomes to those receiving intravenous clindamycin in the setting of a documented β-lactam allergy.
Methods
This single-center, retrospective cohort study included patients aged 18 years or older with a documented β-lactam allergy who received either cefazolin or clindamycin for surgical prophylaxis between October 1, 2022, and March 1, 2023. Patients were excluded if they received antibiotics for any indication other than surgical prophylaxis, underwent procedures requiring broader prophylaxis, or lacked documentation to assess 30-day post-op outcomes. The primary outcome was the incidence of SSI within 30 days post-surgery. Secondary outcomes included the incidence of CDI within 30 days post-discharge, the 30-day post-discharge rehospitalization rate, the percentage of perioperative anaphylaxis among cefazolin recipients, and the rate of inappropriate clindamycin use based on β-lactam allergy classification per Emory Guidance. Continuous variables were reported as median (interquartile range); categorical variables were reported as frequencies and percentages. Categorical outcomes were compared using Fisher’s exact test or chi-square based on observed cell frequency; statistical significance was defined as p<0.05.
Results
A total of 233 patients were included: cefazolin (n=139) and clindamycin (n=94). Baseline characteristics were comparable between groups. The 30-day SSI rate was significantly lower in the cefazolin group compared to clindamycin (0.0% vs. 4.3%, p=0.025). No cases of CDI within 30 days post-discharge were observed in either group. The 30-day rehospitalization rate did not differ significantly between groups (5.0% vs. 6.4%, p=0.773). No perioperative anaphylaxis events occurred among cefazolin recipients. Per institutional β-lactam allergy guidance, 93 of 94 clindamycin recipients (98.9%) had a cefazolin-indicated allergy classification, representing inappropriate clindamycin use; only 1 patient (1.1%) had a true contraindication to cefazolin.
Conclusion
Cefazolin demonstrated a statistically significantly lower 30-day SSI rate than clindamycin in β-lactam-allergic patients, with no perioperative anaphylaxis. The absence of CDI and comparable rehospitalization rates further support the safety of cefazolin in this population. Nonadherence to institutional guidance, underscores a substantial stewardship opportunity. These findings support initiatives to reassess β-lactam allergy labels and prioritize cefazolin for surgical prophylaxis in appropriately selected patients.

Moderators

Hannah Schmoock

Internal Med Clinical Pharmacy Specialist, PGY1 Acute Care RPC, McLeod Regional Medical Center

Hello! I am Hannah Schmoock, and I am a Neuro ICU step down pharmacist and PGY-1 pharmacy residency coordinator at McLeod Regional Medical Center in Florence, South Carolina! I am originally from a small town in Mississippi and completed my pharmacy education at the University of... Read More →

Presenters

John Otasowie

PGY-1 Pharmacy Resident, Emory Decatur Hospital

Dr. John Otasowie, originally from Edo State, Nigeria, earned his Bachelor of Science degree in Microbiology from the University of Benin, Nigeria. He later completed his pre-pharmacy coursework at Georgia Gwinnett College and received his Doctor of Pharmacy degree from South University... Read More →

Evaluators

Adam Harnden

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena H

Infectious Disease (ID), Emory Decatur Hospital

global Y

11:00am EDT

Evaluating the Impact of Perioperative Antibiotic Timing on Surgical Site Infections in Hysterectomy and Colorectal Surgeries

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena J

AUTHORS: Brittany Shellhouse, Eric Shaw, Amy Taylor

BACKGROUND: National Healthcare Safety Network (NHSN) defines a surgical site infection (SSI) as an infection that was not present at time of surgery but occurred within 30 days post-operatively. Due to their significant effect on morbidity, hospital length of stay, and costs, national guidelines recommend initiation of most pre-operative antibiotics within 60 minutes of surgery. They also include specific guidance on the choice of agent to use with the various types of procedures, as well as dosing recommendations and re-dosing strategies. The purpose of this study was to examine if there is a correlation between timing of pre-operative antibiotics on the development of post-operative infections, and to examine other potential risk factors for the development of SSIs.

METHODS: This study was a retrospective, single-center, case-control study, which took place at a level-one trauma academic medical center in the United States. It included adults who received pre-operative antibiotics for colorectal and/or hysterectomy surgeries between January 1, 2023 through September 26, 2025. Patients were excluded if they had infections documented as present at time of surgery, or if they were pregnant or incarcerated at time of admission. The event group included patients with NHSN defined SSIs. The control group was matched 1:1 based on surgery type and consisted of patients who did not have a documented SSI. Patients were identified with assistance from the Infection Prevention Workgroup’s data collection of all surgical procedures.

The primary endpoint compared association of antibiotic timing with incidence of post-operative infection. Secondary outcomes included the comparative risk of antibiotic(s) selection, surgery type, emergent versus scheduled surgery, administration of repeat dosing during surgery, continuation of post-operative prophylactic antibiotics, and personnel present at surgery.

RESULTS: This study included 96 total patients matched 1:1 with events versus controls within each group for hysterectomy, colorectal surgeries, and colorectal plus hysterectomy surgeries (40 patients, 52 patients, and 4 patients respectively). For the primary outcome, the median time of antibiotic start and completion prior to surgery was 23 minutes and 15 minutes for the control group and 15.5 minutes and 9 minutes for the event group.
While all antibiotics selected for hysterectomy procedures were correct per guidelines, there was a numerical difference in optimized dosing for the control versus the event group (85% vs 65% respectively). Similarly, all patients were in compliance with repeat dosing per guidelines, but zero patients in the control group received antibiotics post-operatively compared with 5% of patients in the event group.

Appropriate antibiotic selection for colorectal procedures was 65% versus 54% for the control versus the event group; optimized dosing per guidelines was 67% versus 77% for controls versus event group. There was a numerical difference for control versus event group in required repeat per protocol (91% vs 70%), bowel prep administration (58% vs 19%), and use of post-operative antibiotics (27% vs 58%).
For combination colorectal surgery plus hysterectomy, there was a numerical difference in incidence of emergent surgeries for control versus event group (0% vs. 50%). However, this difference was inverse for antibiotic selection with 50% versus 100% compliance for control versus event group.

CONCLUSION: There was a numerical difference in perioperative timing of antibiotics, but no definitive trend in additional factors for increasing risk of SSI development. Limitations to this study were small sample size and inclusion of only two surgery types. Further research across various surgery types may be beneficial in distinguishing perioperative antibiotic timing.

Moderators

Jeremy Walley

Presenters

Brittany Shellhouse

Evaluators

Jessica Sterchi

Clinical Pharmacy Supervisor and Acute Care PGY1 RPD, BMHT1Blount Memorial HospitalPGY1

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena J

Infectious Disease (ID), Memorial Health University Medical Center

global Y

11:00am EDT

Micafungin Treatment Failure in Obese Patients: Standard versus Body Mass Index-Adjusted Dosing Regimens

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena G

Title: Micafungin Treatment Failure in Obese Patients: Standard versus Body Mass Index-Adjusted Dosing Regimens

Authors: Helene Gao, Zachary Halbig, Caroline Gresham, Qian Zhong
Piedmont Athens Regional Medical Center - Athens, GA

Background: Obesity (BMI ≥30 kg/m²) affects more than 40% of adults in the United States and is associated with altered pharmacokinetics, creating uncertainty around optimal antifungal dosing. Micafungin, an echinocandin, is commonly used for invasive Candida infections, with standard dosing recommendations of 100-150 mg daily. However, pharmacokinetic and pharmacodynamic studies suggest that higher doses may be necessary in obese patients to achieve adequate drug exposure. Despite these findings, clinical outcome data supporting dose adjustments remain limited. Existing studies have largely been small, model‑based, or lacking comparison groups, leaving the real-world clinical impact of higher micafungin dosing unclear. This study aimed to compare clinical outcomes in obese adults receiving BMI-adjusted micafungin dosing (150-200 mg daily) versus standard dosing, with a primary focus on treatment failure.

Methods: This IRB-exempt, single-center, retrospective study evaluated obese adult patients admitted to Piedmont Athens Regional who received micafungin for ≥3 days as empiric or definitive antifungal therapy. The BMI-dose-adjusted group consisted of 19 randomly selected patients admitted between October 1, 2020, and October 30, 2025, with a cohort of 19 obese patients receiving standard micafungin dosing. Exclusion criteria included outpatient micafungin initiation, missing weight data, dose changes after ≥2 days, or <3 days of therapy. Data collected included demographics, comorbidities,infection‑related risk factors, key laboratory values, and micafungin treatment characteristics. Clinical variables evaluated included critical‑care interventions, hemodynamic support, and the presence of polymicrobial infection. The primary outcome was treatment failure, defined as all‑cause inpatient mortality or transition to comfort care before discharge. Secondary outcomes included micafungin duration, total hospital length of stay, and occurrence of adverse drug events involving hepatic, renal, or hematologic function. Categorical variables were analyzed using Chi‑squared or Fisher’s exact testing as appropriate, and continuous variables were analyzed using the Mann‑Whitney U test. A multivariable logistic regression was performed to adjust for confounders.

Results: Unadjusted outcomes revealed that treatment failure occurred in 36.8% of patients in the BMI-adjusted group and 42.1% in the standard-dose group (OR=1.25, 95% CI=0.34-4.59; p=0.74). The median duration of micafungin therapy was 5 days in the BMI-adjusted group and 7 days in the standard-dose group (p=0.12), while median hospital length of stay was 16 versus 23 days, respectively (p=0.11). Adverse drug reactions occurred in 36.8% of BMI-adjusted patients and 26.3% of standard-dose patients (p = 0.49). After adjusting for confounders, including SOFA score, number of comorbidities, and polymicrobial infection, there was a trend toward fewer treatment failures in the BMI-adjusted dosing group (OR=0.22, 95% CI=0.03-1.58;p=0.13). Within the observed range of SOFA scores, each 1-point increase within 24 hours of micafungin initiation was associated with approximately 40% increased odds of treatment failure (OR=1.40, 95%CI=1.12-2.47; p=0.002). In exploratory subgroup analyses, BMI-adjusted dosing was associated with 45% lower odds of treatment failure in ICU patients (OR=0.55, 95% CI=0.12-2.47; p=0.43) and 44% lower odds in patients with candidiasis (OR=0.56, 95% CI=0.07-4.76; p=0.59).

Conclusions: In obese adults receiving micafungin, BMI-adjusted dosing was not associated with a statistically significant difference in treatment failure compared with standard dosing. However, accounting for confounders, the analysis demonstrated numerically lower odds of treatment failure with BMI-adjusted dosing, with only SOFA score remaining significantly associated with treatment failure. Furthermore, exploratory subgroup analyses showed a consistent directional association favoring BMI-adjusted therapy. Limitations include the retrospective design, small sample size, and limited power to detect differences in outcomes. Larger, prospective studies are warranted to further evaluate the clinical effectiveness and safety of BMI-adjusted micafungin dosing, particularly in ICU patients.

Moderators

Megan Freeman

Presenters

Helene Gao

PGY1 Pharmacy Resident, Piedmont Athens Regional

Helene Gao, PharmD, is a PGY1 Pharmacy Resident at Piedmont Athens Regional in Athens, GA. She completed her Doctor of Pharmacy degree at the University of Georgia College of Pharmacy and holds a Bachelor of Science in Biochemistry from Georgia Southern University. Upon completing... Read More →

Evaluators

Haley Smith

Neuro Critical Care Pharmacy Specialist / PGY1 RPD, Our Lady of the Lake Regional Medical CenterPGY1

Haley Smith, PharmD, BCPS, BCCCP is the Neuro Critical Care Clinical Pharmacy Specialist and PGY-1 Residency Program Director at Our Lady of the Lake Regional Medical Center in Baton Rouge, LA. Dr. Smith received her Bachelor of Science Degree in Pharmaceutical Sciences from the University... Read More →

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena G

Infectious Disease (ID), Piedmont Athens Regional

global Y

11:00am EDT

Evaluation of Pharmacist Impact on Inpatient Glycemic Management

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena D

Background: Diabetes mellitus and hyperglycemia affect 25% to 40% of hospitalized patients and are associated with prolonged hospital stay, increased infections, and mortality. The 2026 American Diabetes Association (ADA) Standards of Care recommend insulin initiation for persistent hyperglycemia ≥180 mg/dL, with glycemic targets of 100-180 mg/dL for noncritically ill patients and 140-180 mg/dL for critically ill patients. The Centers for Medicare & Medicaid Services (CMS) tracks severe glucose excursions (≥300 mg/dL and ≤40 mg/dL) as electronic clinical quality measures (eCQMs) under the Hospital-Acquired Condition Reduction Program (HACRP). These thresholds represent the more extreme glycemic events that CMS tracks for regulatory reporting and payment penalties, distinguishing them from the broader ADA clinical classification. Effective this year, hospitals are required to track and report eCQMs related to hyperglycemia and hypoglycemia with financial penalties for non-compliance. Additionally, these metrics may become visible in CMS and other quality measurement systems to increase public transparency in regard to inpatient glucose control. Multiple studies have demonstrated that pharmacist interventions can improve glycemic control and reduce hypoglycemic events. The purpose of this study was to assess the impact of pharmacy involvement in glycemic monitoring within our facility’s inpatient population.

Methods: This single-center, retrospective, comparative study evaluated glucose levels in patients ≥18 years who were admitted to a community hospital. Glucose levels drawn during continuous insulin infusions were excluded. The pre-intervention group (December 1, 2024–February 28, 2025) was compared to the post-intervention group (December 1, 2025–February 28, 2026) following protocol implementation and pharmacist education. Patients were identified using automated electronic health record (EHR) alerts that flagged patients who met predefined glycemic criteria. Hyperglycemia alerts are generated when blood glucose exceeds 300 mg/dL on a single occurrence or exceeds 180 mg/dL on two occasions within 24 hours. Hypoglycemia alerts are generated for any blood glucose value <70 mg/dL. Pharmacists reviewed flagged patients' A1c, insulin regimens, glucose trends, nutritional status, renal function, and steroid use before providing recommendations to providers. Primary outcomes included the proportion of glucose measurements ≥300 mg/dL and ≤40 mg/dL. Secondary outcomes included intermediate ranges: ≥180 to <250 mg/dL, ≥250 to <300 mg/dL, and >40 to ≤70 mg/dL. The study was powered to detect a 10% relative reduction in severe hyperglycemia (≥300 mg/dL) at 80% power. Statistical significance was assessed using chi-square tests, with p < 0.05 considered significant.

Results: A total of 74,060 blood glucose measurements were analyzed in the pre-intervention period compared to 67,682 measurements in the post-intervention period. There was no statistically significant difference among baseline characteristics between the two groups. The proportion of severe hyperglycemic measurements (≥300 mg/dL) decreased significantly from 3.19% to 2.94% (ARR 0.25%; p = 0.007). The proportion of severe hypoglycemic measurements (≤40 mg/dL) showed no significant change (0.16% vs 0.15%; ARR 0.01%; p = 0.77). Significant reductions were observed in measurements ≥180 to <250 mg/dL (17.20% vs 14.84%; ARR 2.36%; p < 0.001) and ≥250 to <300 mg/dL (4.46% vs 3.80%; ARR 0.66%; p < 0.001). Level 1 hypoglycemia (>40 to ≤70 mg/dL) showed no difference (1.55% vs 1.66%; ARR −0.11%; p = 0.09).

Conclusions: Implementation of a glycemic monitoring protocol with pharmacist review was associated with significant reductions in severe and intermediate hyperglycemic levels without increasing the incidence of hypoglycemia. These findings support pharmacist involvement in improving glucose control in an inpatient setting. Future directions include the development and implementation of a pharmacist-driven glucose management protocol within our facility. Further evaluation would need to be done to assess patient-level outcomes such as length of stay, infection rates, and 30-day readmissions.

Moderators

Jessica Ringler

Presenters

Cortney Anderson

PGY-1 Pharmacy Resident, AdventHealth

Evaluators

Kaitlyn Ledet

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena D

Internal Medicine (IM), AdventHealth Redmond

global Y

11:00am EDT

Incidence of Bleeding in Patients Receiving Parenteral Anticoagulation and Apixaban Therapy for VTE Treatment

Thursday April 30, 2026 11:00am - 11:20am EDT

Athena C

Title: Incidence of Bleeding in Patients Receiving Parenteral Anticoagulation and Apixaban Therapy for VTE Treatment

Primary: Ashley Hannah, [email protected]
Secondary: Sara Anne Meyer, Lilia Macias, Evaline Inigo, Sarah Lopez

Background: The purpose of this study is to evaluate the association between apixaban dosing and inpatient bleeding in patients treated for venous thromboembolism following initial parenteral anticoagulation. In the inpatient setting, patients with venous thromboembolism are often initiated on parenteral anticoagulation before being transitioned to an oral anticoagulant such as apixaban. This study also aimed to evaluate whether the duration of parenteral anticoagulation was associated with initiation of reduced-dose apixaban. Understanding the factors associated with treatment decisions and clinical outcomes is critical, particularly as bleeding remains a significant complication of anticoagulant therapy.

Methods: A retrospective, randomized controlled trial was conducted involving 289 subjects at St. Joseph’s/Candler Health System from September 2024 to August 2025. Participants received parenteral anticoagulation with either standard heparin or enoxaparin, along with an oral agent. Participants received either 5 mg or 10 mg of apixaban directly following parenteral anticoagulation. This study included patients admitted for a hospital stay that were diagnosed with a venous thromboembolism within twenty-four hours of admission and received treatment with apixaban following parenteral anticoagulation. Participants with a prior history of venous thromboembolism, previous long-term therapeutic anticoagulation with apixaban for three months or severe renal dysfunction were not included. Participants were also excluded if they required anticoagulation therapy plus dual antiplatelet therapy for other indications, or thrombolytic therapy. However, participants on thrombolytic therapy undergoing catheter directed thrombolysis were not excluded.
The primary endpoint of the study was the number of bleeding events documented. Secondary endpoints included the number of patients presenting with first recurrent venous thromboembolism within six months of starting apixaban therapy, confirmed by physician documentation; assessment of severity of illness and its impact on treatment duration, evaluation of total duration of parenteral anticoagulation and its association with initiation of full versus reduced doses of apixaban therapy and lastly, identifying prescriber characteristics and practice settings associated with each treatment approach.

Conclusion: In summary, in this study no statistically significant differences were observed in bleeding events, hemoglobin decline or recurrence rates within six months of therapy between patients initiated on apixaban 5 mg in comparison to 10 mg. Prescribing patterns favored the initiation dose of 10 mg following parenteral anticoagulation for venous thromboembolism. The full dose of 10 mg appeared to be favored among the nine prescriber groups evaluated. Among patients that experienced a bleeding event, hemoglobin decrease greater than 3g/dL or recurrence within six months, apixaban 10 mg was most commonly prescribed.

Moderators

Eric Marr

PGY1 Residency Program Director, Baptist Health Lexington

Dr. Marr graduated with a Bachelor’s degree from Western Kentucky University before obtaining his PharmD and MBA from the University of Kentucky. Dr. Marr completed a PGY1 pharmacy residency at Baptist Health Lexington and joined the organization as a clinical pharmacist following... Read More →

Presenters

Ashley Hannah

Evaluators

Erin Pace

Ambulatory Care Pharmacist, KFHP1Kaiser Foundation Health Plan of Georgia (Managed Care)PGY1

Erin Pace, PharmD, BCACP, CDCES is an Ambulatory Care Clinical Pharmacy Specialist at Kaiser Permanente Georgia. She received her Doctor of Pharmacy from the University of Maryland, Baltimore and completed a Pharmacy Practice Residency at Kaiser Permanente, Santa Clara in San Jose, California. She is a Certifie... Read More →

Thursday April 30, 2026 11:00am - 11:20am EDT
Athena C

Internal Medicine (IM), Candler Hospital

global Y

11:20am EDT

Burnout Among Pharmacy Residents

Thursday April 30, 2026 11:20am - 11:40am EDT

Olympia 2

Background:
Burnout is a syndrome resulting from chronic workplace stress. This syndrome usually presents as emotional exhaustion, cynicism and depersonalization from work, and a reduced feeling of achievement. Pharmacy residents are at high risk of burnout due to long hours and increased workload. Due to limited published literature and small sample sizes, current knowledge regarding the presence of pharmacy resident burnout and contributing factors needs further investigation. This study looked at rates of pharmacy resident burnout in both current and recent PGY-1 and PGY-2 residents using the Oldenburg Burnout Inventory (OLBI), as well as baseline demographics and other potential risk factors using additional non-validated survey questions based on prior literature.

Methods:
Surveys were distributed by email to pharmacy school programs and residency program directors requesting that current and past learners complete them. Surveys were also distributed to eligible participants during professional conferences and meetings throughout the fall of 2025. Pharmacy residents enrolled at an accredited institution during the 2024-2025 or 2025-2026 residency year were included. The primary outcome of this study was to determine the percentage of pharmacy residents that experienced burnout during residency. The OLBI was graded for its overall score on a scale of not burned out (<48) and burned out (≥48), and sub-score for exhaustion (<25 not exhausted; ≥25 exhausted) and disengagement (not disengaged <27; disengaged ≥27). Secondary outcomes included the percentage of pharmacy residents experiencing exhaustion, percentage of pharmacy residents experiencing disengagement, and factors contributing to burnout such as relationship status, having children, distance to family, hours spent on residency-related activities, hours of sleep, number of co-residents, and number of consecutive workdays before having at least 24 hours off. Respondents were asked about interventions offered by the residency program, including mental health resources, mental health days, mentorships, and schedule changes to determine if these interventions were helpful, and whether they would recommend completing a residency to students or would choose to complete a residency again.

Results:
A total of 559 responses collected between September 2025 and February 2026 were included in the analysis. Seventy-seven respondents (13.77%) were considered burned out using a set cut-off of 48 or greater on the OLBI total score. Factors determined to be significantly associated with burnout included hours spent on residency-related activities, hours of sleep, and the number of consecutive workdays. Residents sleeping less than 6 hours per night were associated with higher burnout compared to those sleeping 7–8 hours or more (p <0.001). Exceeding 10 consecutive workdays was associated with higher burnout compared to 10 days or less (p <0.001). There was a positive association between burnout and hospital duty hours, with longer weekly hospital duty hours associated with higher burnout (p < 0.001). Similarly, more hours spent on residency outside of hospital duty hours was associated with higher levels of burnout (p <0.001). According to respondents, mentorships and schedule changes had the highest impact on burnout. Respondents with higher burnout scores were more likely to not recommend completing a residency to students or pursue a residency again themselves (p <0.001).

Conclusion: Based on the study respondents, a majority of pharmacy residents were not burned out during residency. Although the OLBI is a validated scale to assess burnout in adults, the cut-off used to determine burnout in this study has not been validated. Results may also be skewed due to the timing of the survey delivery. Future studies should evaluate burnout at different times throughout the residency year. Hours of sleep, hospital duty hours, outside of hospital duty hours, and the number of consecutive days worked were all factors associated with higher burnout scores.

Moderators

Sarah Blackwell

PGY1 Pharmacy RPD/ Clinical Pharmacy Specialist, Medical Critical Care, Baptist Health Princeton Hospital

Presenters

Hunter McDowell

I am a PGY-1 resident at Memorial Health University Medical Center in Savannah, Ga. I attended Mercer University for my undergraduate degree and the University of Georgia for my pharmacy degree. I have a passion for critical care and internal medicine.

Evaluators

Olivia Caron

PGY2 Ambulatory Care RPD, MAHEC

Thursday April 30, 2026 11:20am - 11:40am EDT
Olympia 2

Administration (ADM), Memorial Health University Medical Center

global Y

11:20am EDT

Taking a Bite Out of Learning: Teaching Pharmacy Students Counseling Points Using Mobile Micro-Learning

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena B

Authors’ Names: Victoria Creo, Rebecca Stone, Jordan Khail

Background
Micro-learning is an educational strategy that delivers brief, instructional content designed to improve learner engagement, knowledge retention, and accessibility of materials. Within pharmacy education, micro-learning may provide an effective method for reinforcing clinically relevant counseling points that can be applied in various practice settings. Limited data exists to evaluate the effectiveness of micro-learning modules as an adjunct educational tool within Doctor of Pharmacy curricula. This study aims to evaluate the impact of micro-learning modules on student knowledge and retention and to assess pharmacy student perceptions regarding usefulness of micro-learning in pharmacy education.

Methods
Doctor of Pharmacy students from all professional years enrolled in accredited pharmacy programs throughout the state of Georgia were invited to participate in this study. Participants completed brief microlearning modules designed to deliver counseling information related to pregnancy prevention and opioid harm reduction strategies relevant to pharmacy practice.

Knowledge assessments were administered before and after completion of the modules to evaluate learning outcomes. A second post survey was also administered to determine knowledge retention thirty days following module completion. Additionally, the pre-/post-surveys will assess student perceptions of relevance of clinical topics to pharmacy profession and confidence in providing counseling on module topics. Post-survey will also evaluate student perceptions of micro-learning modules, including ease of use and willingness to utilize similar modules in future pharmacy learning. Descriptive statistics will summarize participant characteristics and survey responses, and a paired t-test will be computed to assess the difference between the pre-test and post-test knowledge scores.

Results
To date, 50 student pharmacists have completed the pre-intervention survey and baseline knowledge assessment. Mean baseline knowledge scores were 69.4% for the questions related to women’s health topics (prescription and over-the-counter emergency contraception and over-the-counter contraception) and 70.9% for the questions related to opioids and harm reduction topics (naloxone, fentanyl test strips, medication disposal). Post-intervention data collection is ongoing to assess the impact of the microlearning modules on student knowledge and perceptions.

Conclusion
In progress

Moderators

Elora Hilmas

Pharmacy Clinical Manager, ECU Health

Presenters

Victoria Creo

PGY-2 Ambulatory Care Pharmacy Resident, University of Georgia - College of Pharmacy

Dr. Victoria J. Clark Creo is a second year ambulatory care pharmacy resident at the University of Georgia College of Pharmacy. She practices at a VA outpatient clinic in Athens which is a part of the greater Charlie Norwood VA Medical Center in Augusta, GA and also at the Piedmont... Read More →

Evaluators

Brian Hairston

Critical Care Clinical Specialist, FMOL Health | St. Dominic

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena B

Ambulatory Care (AMB), University of Georgia College of Pharmacy

global Y

11:20am EDT

Impact of Anticoagulation Strategies on Thrombotic Events in Patients with Durable Left Ventricular Assist Devices (IMPACT-LVAD)

Thursday April 30, 2026 11:20am - 11:40am EDT

Parthenon 1

Title: Impact of Anticoagulation Strategies on Thrombotic Events in Patients with Durable Left Ventricular Assist Devices (IMPACT-LVAD)
Authors: Asya Bookal, Danielle McPherson, Michelle Dillon

Background/Objective: Advanced heart failure (HF) poses a significant and increasing burden, affecting around 15% of all HF patients. Treatment options for patients with advanced HF include durable left ventricular assist devices (LVAD) which improve 2-year survival by 80% and may be used either as a bridge to heart transplantation or as destination therapy. There are currently three generations of LVADs; newer generations like the HeartMate 3 (HM3) device have a continuous and fully magnetic levitation which improves hemocompatibility and thus safety. Although newer generation devices have less risk of thrombosis, all devices inherently have some; therefore, long-term anticoagulation is recommended. In the acute perioperative period, the competing risks of bleeding and thrombosis must be balanced, which may delay anticoagulation initiation. Institutional anticoagulation strategies have also been impacted post ARIES-HM3 trial. This study aims to evaluate the incidence of thrombotic and bleeding events after HM3 implantation.

Methods: This retrospective review includes adults who underwent durable LVAD placement with a HM3 device at AdventHealth Orlando between August 1, 2022 and August 31, 2025. Patients were excluded if they received an alternate device, required additional mechanical circulatory support with device placement, had delayed chest closure, or history of heparin-induced thrombocytopenia (HIT). The primary endpoint is incidence of thrombotic events after HM3 implantation, defined as deep vein thrombosis (DVT), pulmonary embolism (PE), cardioembolic stroke, thrombus induced acute coronary syndrome (ACS), or device-associated thrombus. Secondary endpoints include bleeding defined by the Mechanical Circulatory Support Academic Research Consortium (MCS-ARC), time to therapeutic anticoagulation, anticoagulation time in the therapeutic range (TTR), and time to initiation of warfarin.

Results: Of 124 patients screened, 88 were included in the study. Patients were on average 58 years old (SD ±13), 65 (74%) were male, 42 (48%) had history of atrial fibrillation, 13 (15%) had history of DVT/PE, 44 (50%) were on therapeutic anticoagulation, and 29 (33%) required MCS preoperatively. Bleeding events occurred in 24 (27%) patients with 12 (50%) being type 2 requiring intervention, but no type 5 fatal bleeding events occurred. Fourteen (16%) patients experienced a thrombotic event with 12 (86%) being upper extremity DVT, 1 (7%) cardioembolic stroke, and 1 (7%) pulmonary embolism. Patients were split into aspirin use pre- and post- ARIES-HM3 trial with all 21 (100%) pre-trial receiving aspirin and 35 (52%) post-trial receiving aspirin. Median time to warfarin initiation was 5 days (IQR 3, 7), time to therapeutic INR was 6 days (IQR 4, 7), and time to therapeutic aPTT was 12 hours (IQR 6, 15). Median TTR for warfarin days 6-10 was 60% (IQR 35, 1), median TTR for parenteral anticoagulation days 1-5 was 49% (IQR 33, 64), and time in subtherapeutic aPTT range was 46% (IQR 24, 60).

Conclusions: Patients who underwent HM3 implantation experienced low rates of thrombotic events despite changes in anticoagulation strategies and did not experience fatal bleeding.

Moderators

Jared Briones

Clinical Pharmacist, Adventhealth Apopka

Presenters

Asya Bookal

PGY-1 Acute Care Resident, AdventHealth Orlando

Evaluators

Randy Hooks

Clinical Pharmacist, East Alabama Medical Center

Internal Medicine- East Alabama Health

Thursday April 30, 2026 11:20am - 11:40am EDT
Parthenon 1

Cardiology (CAR), AdventHealth Orlando

global Y

11:20am EDT

Pharmacogenomic- and Drug-Drug Interaction-Guided Antiplatelet Therapy in Veterans Taking Clopidogrel and Omeprazole

Thursday April 30, 2026 11:20am - 11:40am EDT

Parthenon 2

Title: Pharmacogenomic- and Drug-Drug Interaction-Guided Antiplatelet Therapy in Veterans Taking Clopidogrel and Omeprazole
Authors: Sydney Magrath, Julianne Isaac, David Deen
Background:
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality, with antiplatelet therapy as the foundation for secondary prevention. Clopidogrel, a widely prescribed P2Y12 inhibitor, exhibits variable efficacy due to CYP2C19 genetic polymorphisms and drug-drug interactions, especially with proton-pump inhibitors (PPIs), such as omeprazole. Consensus statements and leading medical journals have begun to recommend utilizing genotype-guided therapy to optimize outcomes in specific indications, such as acute coronary syndrome (ACS) with or without percutaneous coronary intervention (PCI), to optimize outcomes, yet implementation in clinical practice remains limited. The objective of this project is to reduce category X drug-drug interactions between clopidogrel and omeprazole and assess the feasibility of pharmacogenomic testing in Veterans with ASCVD at high risk for major adverse cardiovascular events (MACE).
Methods:
This prospective, interventional quality improvement project utilized a data query to identify Veterans with ASCVD or post-PCI who were prescribed clopidogrel and omeprazole from September 2022 to December 2025 at the Ralph H Johnson VA Health Care System. Veterans were contacted to discuss pharmacogenomic testing and drug-interaction risks and offered to switch to a non-interacting PPI, de-escalate off PPI or to a histamine-2 receptor antagonist where appropriate. Veteran’s most recent blood pressure, lipid panel, and medication list were reviewed for guideline-recommended interventions. Primary outcome was composite implementation rate, defined as proportion of patients contacted who (1) underwent PPI modification and/or (2) have a final antiplatelet regimen that follows Clinical Pharmacogenetics Implementation Consortium (CPIC) and American College of Cardiology (ACC) recommendations. Secondary outcome was incidence of thrombotic events, bleeding, ticagrelor-associated dyspnea, and worsening dyspepsia following intervention. Tertiary outcome was to assess pharmacist interventions.
Results:
Of the 82 patients on clopidogrel and omeprazole with an included ICD-10 code or procedure code, 59 met inclusion criteria and 51 were successfully contacted. At visit 1, 50 of 51 patients agreed to PPI modification and 43 completed pharmacogenomic testing. Nine of the 43 were CYP2C19 intermediate metabolizers, suggesting possible indication for antiplatelet therapy change. All but one patient with CAD indicated for clopidogrel change accepted a therapy modification. Ultimately, 50 of 51 patients had final antiplatelet regimens aligned with CPIC and ACC guidance therefore 98% meeting composite implementation rate.
No thrombotic or bleeding events occurred. Among patients switched to ticagrelor, 1 of 2 experienced dyspnea. Five patients reported worsening dyspepsia after PPI modification, of whom 85% were CYP2C19 rapid metabolizers. Pharmacist interventions included 14 medication reconciliations, 48 adherence counseling sessions, 10 lipid-related interventions, and one antihypertensive intervention.
Conclusion:
This project demonstrated high implementation rates and strong patient acceptance in addressing high-risk clopidogrel-omeprazole DDIs. Genotype-guided antiplatelet therapy was feasible in routine practice and did not result in thrombotic or bleeding events during the project period. Reported adverse effects were minimal and consistent with known drug profiles. These findings support the integration of pharmacist-driven pharmacogenomics and medication optimization into cardiovascular risk-reduction efforts within the Veteran population. Future pathways include identifying eligible patients during inpatient ACS/PCI admissions for earlier PPI modification and pharmacogenomic testing, followed by coordinated outpatient follow-up to optimize antiplatelet therapy.

Moderators

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1

Presenters

Sydney Magrath

PGY1 Resident, Ralph H. Johnson VA Healthcare System - Charleston, SC

Evaluators

Jolie Gallagher

Clinical Pharmacy Specialist, Critical Care, Emory University Hospital

Thursday April 30, 2026 11:20am - 11:40am EDT
Parthenon 2

Cardiology (CAR), VA - Charleston, SC - Ralph H. Johnson Veterans Affairs Medical Center

global Y

11:20am EDT

Association between cephalexin dosing frequency in uncomplicated urinary tract infections and treatment failure in discharged Emergency Department patients

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena D

Association between cephalexin dosing frequency in uncomplicated urinary tract infections and treatment failure in discharged Emergency Department patients
Kameron Francis, Rachel Musgrove, Analise Williams, Fataba Gailor, Meghan Hammond, Devon Burhoe
Background/Purpose: Urinary tract infections (UTI) are among the most common bacterial infections seen in the health care system. Cephalexin, commonly prescribed for UTI, has no standardized dosing frequency indicative of superiority. Cephalexin can be prescribed twice daily, three times daily, or four times daily. This study aims to assess treatment failure with various cephalexin dosing frequencies in the treatment of UTI.
Methodology: A multicenter, retrospective, observational cohort study which collects eligible patients via ICD-10 codes. Eligible patients are those > 18 with documented diagnosis of acute cystitis or uncomplicated UTI with a positive urine culture with susceptibility to cefazolin. Patient must be prescribed cephalexin two, three, or four times daily for five to seven days. Exclusion criteria include complicated or recurrent UTI requiring prophylactic antibiotics, patients without cultures preformed or requiring renally adjusted cephalexin. Treatment failure within 30 days defined as patients who: return symptomatic to the emergence department (ED), present with signs and symptoms of urinary tract infection after initiation of cephalexin treatment seeking medical attention outside of the ED, or required an antibiotic change after the initiation of a 5–7-day course of cephalexin.
Results: 131 patients were included in the study with over 80% of the subjects being female. The subjects were evenly distributed between three dosing strategy groups. 14 subjects (10.7%) had treatment failure occur after receiving their initial cephalexin course (p-value 0.984). Patients most often failed treatment due to returning to the emergency department symptomatic after the initial cephalexin treatment. The average time to treatment failure was 22 days. Six subjects required a change in antibiotic regimen, and half of these subjects received cephalexin twice daily initially. The most common alternative antimicrobial regimen was vancomycin with piperacillin/tazobactam due to the development of urosepsis. There was no incidence of bacterial resistance in any of the 131 subjects.
Conclusions: There was no difference between the rate of treatment failure and the three different dosing strategies for cephalexin in uncomplicated urinary tract infections. Among the fourteen patients that failed therapy, most often it was due to returning to the emergency department symptomatic within 30 days of initial treatment. There were higher rates of an alternative antimicrobial therapy needed due to urosepsis in the twice daily group. Overall, our data aligns with current data which shows no association between treatment failure and dosing strategy in uncomplicated urinary tract infections.

Moderators

Jessica Ringler

Presenters

Kameron Francis

Evaluators

Kaitlyn Ledet

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena D

Critical Care/Emergency Medicine (CCM), St. Joseph's/Candler Health System

global Y

11:20am EDT

Correlation of Methicillin-Resistant Staphylococcus Aureus Polymerase Chain Reaction Nasal Swab in Empyema

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena A

Correlation of Methicillin-Resistant Staphylococcus Aureus Polymerase Chain Reaction Nasal Swab in Empyema
Elliott Wilch; Sarah Frye; Martin Gordon; Cragin Currence

Background: Empyema or pyothorax is defined by the presence of purulent exudate in the pleural space and is a life-threatening infectious condition. The most common cause of empyema is bacterial pneumonia and its resulting parapneumonic effusion. Among these patients, 5 to 10% will develop empyema and 30% will require surgical drainage. The American Association of Thoracic Surgery (AATS) Guidelines for the Management of Empyema recommend covering for methicillin-resistant Staphylococcus aureus (MRSA) in patients with hospital acquired empyema as well as those with post-surgical infections. Both the Infectious Disease Society of America (IDSA) and the AATS guidelines do not provide any guidance on de-escalation of antibiotics before the availability of definitive cultures. This contributes to extended durations of anti-MRSA antimicrobials, potentially leading to antimicrobial resistance, Clostridium difficile infections, increased lengths of stay, and increased costs. The clinical utility of MRSA polymerase chain reaction (PCR) nasal swab is well established for antibiotic de-escalation in pneumonia, with multiple studies showing that an MRSA PCR nasal swab has an excellent negative predictive value (NPV) of up to 98%. These studies have demonstrated that the MRSA PCR nasal swab can be a tool used in antimicrobial stewardship to avoid unnecessary anti-MRSA antibiotics as empiric therapies. While the MRSA PCR nasal swab has demonstrated value in pneumonia, very few studies exist assessing its use in infections such as empyema. The following study was conducted to assess the correlation of MRSA PCR nasal swab in patients with empyema.
Methods: This was a single-center, retrospective cohort study assessing the correlation of MRSA PCR nasal swab in empyema. Adult patients with the diagnosis of empyema who had an MRSA PCR obtained during admission were included in the study. Patients were excluded if there were no definitive cultures collected. The primary outcome for the study was the correlation between the MRSA PCR nasal swab and definitive cultures utilizing NPV in patients with empyema. Secondary outcomes included the correlation between the MRSA PCR nasal swab and definitive cultures utilizing specificity, sensitivity, and positive predictive value in patients with empyema. Antimicrobial agent, duration, and time between culture collection and initiation of antibiotics were also analyzed in the study.
Results: Among the 355 patients initially reviewed, 118 did not meet the inclusion criteria, most commonly due to a lack of culture collection. There were 237 patients included in the final analysis. The primary outcome of negative predictive value was 96%. The secondary outcomes of positive predictive value, sensitivity, and specificity were 45%, 55%, and 94.5% respectively.
Conclusion: When examining the utility of the MRSA PCR in empyema, the NPV and specificity were 96% and 94.5% respectively. This study demonstrates that the MRSA PCR nasal swab assay has the potential to be a vital tool in de-escalating antimicrobial therapy in empyema. Utilizing this tool as a means of de-escalation has multiple potential benefits including limiting MRSA antimicrobials and their associated side effects, reducing rates of resistance, and possibly leading to decreased costs for the patient and the healthcare system. While these results are promising, there are several limitations to this study, primarily its retrospective nature and its limited sample size. Future prospective studies are needed to generalize the findings in larger patient populations.

Moderators

Elaina Baaklini

Presenters

Elliott Wilch

PGY2 Critical Care Resident, Spartanburg Medical Center

Current PGY2 Critical Care resident at Spartanburg Medical Center in Spartanburg, South Carolina.

Evaluators

Liz Oglesby

Pharmacy Clinical Coordinator, PGY-1 Residency Program, Mobile Infirmary

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena A

Critical Care/Emergency Medicine (CCM), Spartanburg Medical Center

global Y

11:20am EDT

Blood Culture Clearance with Different Vancomycin AUC Thresholds in Gram-Positive Bacteremia

Thursday April 30, 2026 11:20am - 11:40am EDT

Olympia 1

Authors: Jada R. Guilford, PharmD; Taylor J. Merritt, PharmD; Sarah B. Green, PharmD, BCIDP, AAHIVP; Sujit Suchindran, MD, MPH; Benjamin Albrecht, PharmD, BCIDP; Emory University Hospital, Atlanta, GA

Background: For more than 60 years, Vancomycin has been used to treat a variety of infections due to gram-positive organisms. Vancomycin has the potential to be nephrotoxic and ototoxic, subjecting patients to possible adverse events, and requires frequent monitoring to ensure appropriate use, increasing healthcare costs. Clinical guidelines currently recommend utilizing the ratio of 24-hour area under the curve (AUC) to minimum inhibitory concentration (MIC) for as the therapeutic target for dosing and monitoring, as this method improved patient outcomes in methicillin-resistant Staphylococcus aureus (MRSA) infections by ensuring adequate drug exposure while minimizing side effects. Currently, target AUCs range from 400-600 mg*hour/L for MRSA infections, assuming an MIC of ≤1 mg/L; however, there is limited data to support an AUC-based dosing strategy for non-MRSA gram-positive bloodstream infections. The purpose of this study is to assess the differences in select patient outcomes, particularly mortality and adverse events, by comparing time to blood culture clearance in patients with a vancomycin AUC ≥ 400 mg*hour/L and those with AUC <400 mg*hour/L within 5 days of therapy for non-Staphylococcus aureus and non-Staphylococcus lugdunensis gram-positive bloodstream infections.
Methods: This is an Institutional Review Board (IRB)-approved, single center, retrospective observational study. Patients were included if they were 18 years or older with a blood culture positive for a non-Staphylococcus aureus or non-Staphylococcus lugdunensis gram-positive organism and received IV vancomycin between May 1, 2024 and April 22, 2025. Patients were also included if they received ≥120 hours of vancomycin, had at least 1 vancomycin level, and vancomycin was still included in the antimicrobial regimen within 48 hours of culture clearance. Patients were excluded if the vancomycin indication was CNS infection, osteomyelitis, or endocarditis or if they did not meet the criteria for use of the Emory Healthcare AUC dosing protocol: on hemodialysis, peritoneal dialysis, or CRRT, had an acute kidney injury (AKI), weight >250 kg or BMI <20 kg/m2, or a peri-operative indication.
Results: A total of 55 patients met inclusion criteria, including 32 patients with an AUC <400 mg*hour/L and 23 patients with an AUC ≥400 mg*hour/L. There was no difference in the primary outcome of time to blood culture clearance between groups. The average time to blood culture clearance was 34.7 hours for AUC <400 and 37.1 hours for AUC ≥400 (p=0.515). More patients in the AUC ≥400 mg*hour/L group experienced acute kidney injury, but this difference was not statistically significant (17.4% vs 3.1%, respectively). Toxicity is typically seen in AUC > 650 mg*hour/L, and median AUC for each group was 293 mg*hour/L and 519 mg*hour/L respectively. There were no incidences of ototoxicity and one case of inpatient mortality in both groups. Inpatient length of stay was a median of 11 days (IQR 7-21.5) for AUC <400 mg*hour/L and 27 days (IQR 9-43.5) for AUC ≥400 mg*hour/L.
Conclusions: Both AUC groups had similar times to blood culture clearance without significant rates of adverse events or all-cause mortality. Lower AUCs were associated with decreased length of stay; however, due to low rates of adverse events, and no matching for acuity beyond exclusion, this difference may not be related directly to different AUCs.

Moderators

Heather Stanley

Presenters

Jada Guilford

Evaluators

Blake Johnson

Thursday April 30, 2026 11:20am - 11:40am EDT
Olympia 1

Infectious Disease (ID), Emory University Hospital

global Y

11:20am EDT

Comparative Outcomes of Oral Beta-Lactams Versus Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Step-Down Therapy in Enterobacterales Bacteremia Secondary to Urinary Tract Infections

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena I

Title: Comparative Outcomes of Oral Beta-Lactams Versus Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Step-Down Therapy in Enterobacterales Bacteremia Secondary to Urinary Tract Infections

Primary: Taylor Hewitt
Secondary: Jordyn Meredith, Joseph Crosby, Courtney Zeigler

Background: This single-center, retrospective, observational cohort study was conducted at St. Joseph’s/Candler Health System to assess treatment failure in patients with Enterobacterales bacteremia secondary to urinary tract infections (UTIs) who received oral step-down antibiotic therapy. The study included patients hospitalized between January 1, 2022, and August 1, 2025, identified using ICD-10 codes for bacteremia. Electronic medical records were reviewed to confirm infection from a urinary source, requiring matching positive urine and blood cultures for Escherichia coli, Klebsiella spp., or Proteus spp. Eligible patients were adults (≥18 years) who received parenteral antibiotics during admission, followed by oral step-down therapy with either a beta-lactam, fluoroquinolone (FQ), or trimethoprim-sulfamethoxazole (TMP-SMX). Exclusion criteria included polymicrobial bacteremia, absence of oral step-down therapy, discharge to hospice, or pregnancy. Patients were stratified into two groups: those who received oral beta-lactams versus those who received FQ or TMP-SMX. The primary outcome was treatment failure, defined as a recurrent positive urine or blood culture for the same organism within 60 days of the initial diagnosis. The secondary outcomes included duration of therapy (both parenteral and oral), and hospital length of stay. Descriptive statistics summarize baseline characteristics and outcomes. Continuous variables were analyzed using Student’s t-test, and categorical variables using chi-square tests or appropriate non-parametric alternatives. Analyses were performed using Microsoft Excel, with statistical significance defined as a two-sided p-value < 0.05.

Results: Thirty-eight patients were enrolled in this study, including 11 patients who received oral beta-lactams and 27 patients who received fluoroquinolones (FQ) or trimethoprim-sulfamethoxazole (TMP-SMX). The primary outcome of treatment failure occurred in 7 patients (64%) from the beta-lactam group and 1 patient (4%) from the FQ/TMP-SMX (p=0.00004). No significant difference was found between the two groups for secondary outcomes duration of therapy and hospital length of stay.

Conclusion: In this study assessing treatment failure in patients with Enterobacterales bacteremia secondary to urinary tract infections (UTIs) who received oral step-down antibiotic therapy, a higher percentage of patients experienced treatment failure in the beta-lactam group compared to the FQ/TMP-SMX group. The secondary outcomes of length of hospital stay and duration of therapy were similar across both groups. Potential limitation factors include inability to assess adherence to antibiotic therapy outpatient and step-down to oral therapy occurring at different points within the hospital stay. Future studies should target a larger population with only in-patient stepdown therapy due to the traceability of patients receiving antibiotics.

Moderators

Lena Tran

Pharmacist, AdventHealth Kissimmee

Presenters

Taylor Hewitt

Evaluators

Jonathan Alligood

Residency Program Director, Phoebe Putney Memorial Hospital

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena I

Infectious Disease (ID), Candler Hospital

global Y

11:20am EDT

Effectiveness of Amoxicillin-Clavulanate for the Treatment of Extended-Spectrum β-Lactamase-producing Enterobacterales (ESBL-E) Urinary Tract Infection

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena G

Title: Effectiveness of Amoxicillin-Clavulanate for the Treatment of Extended-Spectrum β-Lactamase-producing Enterobacterales (ESBL-E) Urinary Tract Infection

Author: Haseeb Ahmed, Nicholas Rosen, Ryan Tilton, Olivia Randazza, John Williamson, Charles Hartis, Michael E DeWitt, Alexandria Taylor, Jennifer J Wenner, Mary Banoub

Background: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, with Enterobacterales being the predominant pathogens. The rise in prevalence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) has led to increased antimicrobial resistance and recurrence rates. This prompts evaluation of alternative treatments such as amoxicillin-clavulanate, in which clavulanate may restore amoxicillin activity against common ESBL enzymes. The IDSA 2024 Antimicrobial-Resistant Gram-Negative guidelines recommend against its use but fail to cite high-quality evidence studying its efficacy in UTI caused by ESBL-E. Other studies, limited by small sample size, suggest clinical efficacy of amoxicillin-clavulanate in the treatment of UTI caused by ESBL-E. This study attempts to bolster the pool of data showing amoxicillin-clavulanate can be as effective as standard of care (SOC) antibiotics for treatment of UTI caused by ESBL-E.

Methods: This multi-site, retrospective cohort study is approved by the Institutional Review Board. Adult patients (≥18 years) with either uncomplicated or complicated UTI with a urine culture positive for ESBL-E (confirmed with susceptibility testing) treated between April 1, 2024, and July 1, 2025, at Atrium Health Wake Forest Baptist facilities were included. Patients must have received at least 72 hours of amoxicillin-clavulanate or SOC therapy. Patients were excluded if they had concurrent bacterial infections, polymicrobial urine cultures, a previous UTI within 90 days already captured in the dataset, anatomic urinary tract abnormalities or instrumentation, renal abscesses, prostatitis, receive in-vitro active antibiotic lead-in therapy for >50% of treatment duration, were immunosuppressed or use methenamine or antibiotics for prophylaxis. The primary endpoint is clinical failure within 90 days, defined as retreatment with antibiotics and either recurrence of UTI symptoms or a repeat urine culture positive for the same organism as the index infection. Secondary endpoints include time to clinical failure and recurrence of resistant organisms (carbapenem-resistant Enterobacterales, SOC-resistant, or amoxicillin-clavulanate-resistant strains) within 90 days. Chi-square or Fisher’s exact tests tested categorical variables, and t-tests or Mann-Whitney U tests will test continuous variables. Kaplan-Meier survival analysis and Cox regression modeling will assess time-to-event outcomes, and multivariable analysis will be used to identify patient factors associated with clinical failure.

Results: A total of 447 patients were screened, of whom 274 patients met inclusion criteria and were analyzed. Fifty-four patients were included in the amoxicillin-clavulanate group, while 220 patients were included in the SOC group. No statistically significant difference was observed in the primary outcome of treatment failure between the SOC and amoxicillin-clavulanate groups (p = 0.11). Patients with prior history of ESBL infection had more than twice the odds of treatment failure (OR 2.09; p = 0.04), a finding that remained significant after adjustment for antibiotic selection and type of UTI (OR 2.11, p = 0.047). Additionally, the use of sulfamethoxazole-trimethoprim for treatment of the index infection was associated with an 82% reduction in clinical failure compared to amoxicillin-clavulanate (p = 0.01).

Conclusions: Among patients treated with antibiotics for urinary tract infection caused by ESBL-producing Enterobacterales species, we were unable to detect a difference in treatment failure within 90 days between amoxicillin-clavulanate and SOC. This indicates that within the limits of this study, amoxicillin-clavulanate may have comparable effectiveness to other agents used to treat urinary tract infections caused by these resistant organisms.

Moderators

Megan Freeman

Presenters

Haseeb Ahmed

PGY1 Pharmacy Resident, Atrium Health - High Point Medical Center

Evaluators

Haley Smith

Neuro Critical Care Pharmacy Specialist / PGY1 RPD, Our Lady of the Lake Regional Medical CenterPGY1

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena G

Infectious Disease (ID), High Point Medical Center, Atrium Health Wake Forest Baptist

global Y

11:20am EDT

Optimizing Anti-Pseudomonal Therapy Through Risk Stratification: Outcomes of Empiric Cefepime and Piperacillin/Tazobactam De-Escalation

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena H

OPTIMIZING ANTIPSEUDOMONAL THERAPY THROUGH RISK STRATIFICATION:EFFICACY AND SAFETY OUTCOMES OF EMPIRIC CEFEPIME AND PIPERACILLIN/TAZOBACTAM DE-ESCALATION THROUGH ANTIMICROBIAL STEWARDSHIP INTERVENTIONS

Jacob Krissinger, Michael Shaw, Rachel Langenderfer, Brittany NeSmith

Bon Secours St. Francis Downtown Hospital, Greenville, South Carolina

Background/Purpose: Antimicrobial-resistant organisms are a growing public health threat and contribute to increased morbidity and mortality, longer hospital stays, and higher healthcare costs. In particular, the utilization of anti-pseudomonal beta-lactam antibiotics significantly contributes to the development of resistance in addition to increasing the risk of complications such as Clostridioides difficile infections. The purpose of this study is to review and evaluate the effectiveness and safety of empiric cefepime and piperacillin/tazobactam de-escalation through an implemented Pseudomonas aeruginosa risk stratification tool utilized by the antimicrobial stewardship team.

Methodology: This study is a single-center, retrospective cohort study including patients admitted to St. Francis Hospital Downtown from January 2025 to August 2025. Data for this study was obtained from the electronic medical record, which includes clinical, pharmaceutical, and laboratory information. Patients were identified via antimicrobial stewardship intervention notes for P. aeruginosa risk stratification. The primary outcome sought to elucidate effectiveness, defined as re-escalation of antibiotics due to infectious cause or clinical deterioration. Secondary outcomes were centered around safety, defined as total days of antimicrobial therapy, development of Clostridioides difficile infection, readmission rate within 90 days, and NHSN Standardized Antimicrobial Administration Ratio (SAAR) data pre and post intervention. Patients were included in this study if they had an active order for cefepime or piperacillin/tazobactam, are 18 years of age or older, and have documentation of completed screening by the antimicrobial stewardship team. Patients were excluded if they had positive microbiological results at the time of audit before de-escalation by the antimicrobial stewardship team, duplicate patients, or de-escalation not pursued. The impact of antimicrobial stewardship intervention on the utilization and de-escalation rates of antipseudomonal beta-lactam antibiotics were evaluated using descriptive statistics.

Results: A total of 523 patients were screened for inclusion, of which 278 were included in the analysis for the primary and secondary outcomes. The most frequent indication prompting anti-pseudomonal beta-lactam de-escalation was intra-abdominal infection (104/278, 37.4%). The mean duration of broad-spectrum anti-pseudomonal beta-lactam therapy prior to intervention was 2 days (SD 1.95). The total number of days on de-escalated therapy was 751 versus the total days of anti-microbial therapy (de-escalated + initial + re-escalated) was 1513 days. For the primary endpoint, 15 patients (15/278, 5.4%) required re-escalation of anti-microbial therapy. The most common regimen used for de-escalation was ceftriaxone plus metronidazole (104/278, 37.4%). The most common reason for re-escalation was suspected worsening infection or clinical deterioration (13/15, 86.7%), and the most frequently used medication for re-escalation was piperacillin/tazobactam (8/15, 53.3%). Regarding the secondary endpoint of safety, 1 patient developed Clostridioides difficile infection after intervention. Additionally, 106 patients (106/278, 38%) were readmitted within 90 days from initial admission.

Conclusion: Based on the primary outcome findings, empiric de-escalation of anti-pseudomonal beta-lactams using risk stratification appears to be effective, as only a small proportion of patients (5.4%) required re-escalation of antimicrobial therapy. These results are consistent with previous studies demonstrating that patients without risk factors for Pseudomonas aeruginosa are unlikely to have infection with this organism and therefore be appropriately managed with narrower spectrum antimicrobial therapy. Regarding secondary outcomes, only one patient developed Clostridioides difficile infection following de-escalation. However, a relatively high readmission rate (38%) within 90 days from initial admission was observed. This may be attributed to factors such as inadequate source control and re-escalation of antibiotics initiated in the emergency department and continued during subsequent admissions. Future investigations evaluating further de-escalation beyond ceftriaxone may be warranted, given its relatively broad spectrum of activity compared to other antimicrobial options.

Moderators

Hannah Schmoock

Internal Med Clinical Pharmacy Specialist, PGY1 Acute Care RPC, McLeod Regional Medical Center

Presenters

Jacob Krissinger

PGY1 Pharmacy Resident, Bon Secours St. Francis Downtown Hospital

Jacob Krissinger is a PGY1 Pharmacy Resident currently at Bon Secours St. Francis Downtown Hospital in Greenville, South Carolina. He completed his Pharmacy education at the University of South Carolina. His future plans involve pursuing a PGY2 in Infectious Diseases at Huntsville... Read More →

Evaluators

Adam Harnden

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena H

Infectious Disease (ID), Bon Secours St Francis Downtown

global Y

11:20am EDT

Management of Lipid-Lowering Therapy for Hospitalized Patients with Acute Coronary Syndrome (ACS)

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena C

Abstract
Purpose/Background: Effective lipid management is a cornerstone of secondary prevention in patients with Acute Coronary Syndromes (ACS). The 2025 Guideline for the Management of Patients with ACS emphasizes obtaining a baseline lipid profile on admission, initiating or continuing high-intensity statin therapy during hospitalization, and considering early initiation of non-statin therapies for high-risk patients. Despite these recommendations, adherence to guideline-directed lipid management remains variable. Previous studies suggest baseline lipid panels are not consistently obtained, statins may be underutilized or prescribed at suboptimal intensities, and follow-up lipid testing is often missed. These gaps may delay achievement of lipid targets and increase the risk of recurrent cardiovascular events. This pharmacy project assessed lipid management practices for ACS patients at Huntsville Hospital and guided development of targeted pharmacy interventions to enhance adherence and optimize inpatient lipid care.

Methodology: A single-center, institutional review committee–approved pre-post analysis was conducted in patients hospitalized with acute coronary syndromes (ACS). A random sample of patients admitted between January 2025 and September 2025 with a documented ACS diagnosis was included in the pre-intervention cohort. Patients were excluded if they had a prior history of ACS or incomplete data. A pharmacy-driven intervention was implemented, consisting of targeted education for transitions of care (TOC) pharmacists and promotion of pharmacist-led discharge optimization. A post-intervention cohort was identified using the same inclusion and exclusion criteria, with the additional requirement of a documented TOC discharge note. The primary endpoints were (1) the proportion of patients with a baseline lipid panel obtained within 48 hours of admission and (2) the proportion of patients discharged on optimized guideline-directed lipid-lowering therapy. Baseline demographics and lipid management variables were collected from the electronic medical record. Descriptive statistics were used for analysis.

Results: A total of 250 patients were included in the pre-intervention cohort and 47 patients in the post-intervention cohort. A baseline lipid panel was obtained in 93.6% of patients pre- and post-intervention. Guideline-directed lipid-lowering therapy at discharge improved from 79.2% to 87.2% post-intervention (absolute increase 8.0%), while non-adherence decreased from 20.8% to 12.8%. Pharmacist interventions were documented in 19.6% of post-intervention cases and included contacting providers to recommend addition of non-statin therapy for patients on high-intensity statins with LDL-C >70 mg/dL.

Conclusion: A pharmacy-driven intervention was associated with improved adherence to guideline-directed lipid management in patients hospitalized with ACS. While baseline lipid panel acquisition was high, improvements in discharge therapy optimization were observed. These findings support the role of pharmacist involvement and targeted interventions in improving lipid management in this high-risk population.

Moderators

Eric Marr

PGY1 Residency Program Director, Baptist Health Lexington

Presenters

AnnMarie Garcia

PGY-1 Pharmacy Resident, Huntsville Hospital

Evaluators

Erin Pace

Ambulatory Care Pharmacist, KFHP1Kaiser Foundation Health Plan of Georgia (Managed Care)PGY1

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena C

Internal Medicine (IM), Huntsville Hospital

global Y

11:20am EDT

Real World Comparison of CAR T-Cell and Bispecific Antibody Therapy in Relapsed/Refractory Multiple Myeloma

Thursday April 30, 2026 11:20am - 11:40am EDT

Athena J

Background: The treatment landscape for relapsed/refractory multiple myeloma (RRMM) has expanded with BCMA- and GPRC5D-directed CAR T-cell therapies and bispecific antibodies (BsAb), which differ in treatment logistics, durability of response, and toxicity profiles, including cytokine release syndrome (CRS), immune effector cell–associated neurotoxicity syndrome (ICANS), infections, and prolonged cytopenias. Comparative real-world data between these modalities remain limited. This study aims to compare treatment-related toxicities between CAR T-cell and bispecific antibody therapies in RRMM, with secondary objectives assessing duration of response, infection risk, hematologic recovery, and timing of CRS and ICANS.
Methods: This single-center, retrospective study included adult patients (≥18 years) with RRMM who received BCMA-directed CAR T-cell therapy with idecabtagene vicleucel or ciltacabtagene autoleucel or BsAb therapy with teclistamab, elranatamab, and talquetamab between March 1, 2021, and February 28, 2025. Descriptive and comparative statistical analyses were conducted to evaluate differences between treatment modalities. The primary objective was to compare treatment-related toxicities, including the incidence and severity of CRS, ICANS, cytopenia, and infections, between patients receiving CAR T-cell therapy and BsAb therapy for relapsed/refractory multiple myeloma. The key secondary objective included duration of response.
Results: A total of 59 adult patients with relapsed or refractory multiple myeloma were included in the study, with 34 receiving CAR T-cell therapy (idecabtagene vicleucel or ciltacabtagene autoleucel) and 25 receiving bispecific antibodies (teclistamab, talquetamab, or elranatamab). Mean age at treatment initiation was similar between CAR T and bispecific therapy groups (62 vs 65 years), as was the median number of prior lines of therapy (4 vs 4). CRS occurred in 66.1% (39/59) patients. Among those with CRS, the maximum documented grade was grade 1 in 69.2% (27/39) patients, followed by grade 2 in 25.6% (10/39), and grade 3 in 5.1% (2/39) patients. CRS occurred more frequently with CAR T therapy compared with bispecific antibodies (73.5% vs 56.0%). ICANS was observed in 18.6% (11/59) patients and occurred at similar rates between those receiving CAR T and bispecific antibody therapy (17.6% vs. 20%). Cytopenias, defined as neutropenia (ANC <1,000 cells/µL) and/or thrombocytopenia (platelets <50 ×10⁹/L), were identified in 39% (23/59) of patients and occurred more frequently with CAR T therapy compared with bispecific antibody therapy (65.2% vs 34.8%). Documented infections occurred in 10/59 (16.9%) patients and were observed at equal rates between CAR T-cell and bispecific antibody therapies. For secondary outcome, the analysis included a total of 35 patients, with 25 patients in the CAR T-cell therapy group and 10 patients in the bispecific antibody group. Patients who received CAR T-cell therapy had longer duration of response. There was a significant difference in duration of response between the two groups (p=0.012).
Conclusions: In this single-center retrospective study, CAR T-cell and bispecific antibody therapies demonstrated comparable overall safety profiles in patients with relapsed or refractory multiple myeloma. Incidence of grade 1 CRS was common and occurred more frequently with CAR T therapy. ICANS and infections occurred at similar rates between treatment groups, while cytopenias were observed more often in patients receiving CAR T therapy. These findings provide real-world insight into the safety profiles of emerging therapies used in the relapsed or refractory setting and may help inform clinical decision-making as use of these agents continues to expand.

[KN1]included

Moderators

Jeremy Walley

Presenters

Reshma Patel

PGY-2 Oncology Pharmacy Resident, Northside Hospital Atlanta

Reshma Patel is from Macon, GA. She did her undergraduate studies at Mercer University and received her Doctor of Pharmacy degree from Mercer University College of Pharmacy. Reshma is a current PGY-2 Oncology Pharmacy Resident at Northside Hospital Atlanta. Outside of pharmacy, Reshma... Read More →

Evaluators

Jessica Sterchi

Clinical Pharmacy Supervisor and Acute Care PGY1 RPD, BMHT1Blount Memorial HospitalPGY1

Thursday April 30, 2026 11:20am - 11:40am EDT
Athena J

Oncology (ONC), Northside Hospital

global Y

11:40am EDT

Characterization of Auto-Verification Gaps in a Post-Merger Health-System - Benjamin Emery

Thursday April 30, 2026 11:40am - 12:00pm EDT

Olympia 2

Background: Auto-verification of medication orders is a critical clinical decision support function intended to improve efficiency while maintaining medication safety. Following a large health system merger, variation in auto-verification protocols may occur, introducing potential safety risks and workflow inefficiencies. This project was initiated prior to the January 1, 2026 update of Joint Commission standards and is therefore based on the previous version, which specified that blanket auto-verification of select medications is not acceptable and required pharmacist review of all medication orders, with limited exceptions as outlined in the “Notes” section of MM.05.01.01.

Objectives: This study aims to describe current auto-verification practices across Prisma Health post-merger, identify discrepancies in clinical appropriateness, and assess potential impacts on medication safety and pharmacist workload, including the potential for increased pharmacist full-time equivalent (FTE) needs if inappropriately auto-verified orders were incorporated into routine verification workload, while ensuring alignment with Joint Commission standards in effect at the time of project initiation.

Methods: A retrospective, descriptive analysis was conducted using Epic SlicerDicer to extract deidentified auto-verified medication orders from December 2025 across Prisma Health. As this project was initiated prior to the January 1, 2026 update to Joint Commission standards, orders were classified as appropriate based on MM.05.01.01. Under these standards, orders were considered appropriate if they fell within specific scenarios in which prospective pharmacy review is not required, as outlined in the “Notes” section. This includes settings such as emergency departments and hospital radiology services, as well as hospital-affiliated ambulatory radiology. Primary outcomes include the proportion of appropriate versus inappropriate auto-verified orders, with subgroup analyses by order type, provider type, and identification of high-alert medications. Secondary outcomes will estimate pharmacist workload impact associated with inappropriate auto-verification.

Results: A total of 84,310 medication orders were auto-verified across Prisma Health from December 1–31, 2025. Of these, 57,062 orders (68%) were classified as appropriate for auto-verification based on Joint Commission–defined exceptions that were in effect at the time of project initiation. Appropriate orders were most commonly associated with Emergency Medicine (n = 45,743), followed by Radiology (n = 6,510), inpatient diagnostic (n = 2,891), ASC radiology (n = 1,884), and ASC diagnostic services (n = 34).
A total of 27,248 orders (32%) were deemed inappropriate for auto-verification. Among these inappropriate orders, the most frequently represented medication categories were fluids, analgesics, gastrointestinal agents, diagnostic agents, and anesthetics.
High alert medications accounted for approximately 22,000 auto-verified orders during the study period. Of these, an estimated 3,900 occurred in Ambulatory Surgery Center settings and approximately 18,000 occurred in inpatient settings.
Analysis by provider type could not be completed due to limitations in data availability and will be addressed in the study’s limitations.
Sites with meaningful staffing impact included GMH (1.7 FTE), Greer (0.3 FTE), and Patewood (0.2 FTE). The top five sites contributed approximately 77% of total workload associated with inappropriate auto-verification, with GMH accounting for 40% alone.

Conclusions: Post-merger variability in auto-verification practices resulted in a substantial proportion of medication orders being inappropriately auto-verified, including high-alert medications. These findings highlight opportunities to standardize auto-verification protocols to ensure safe medication practices. Targeted interventions at high-impact sites may significantly reduce inappropriate auto-verification, improve medication safety, and optimize pharmacist workload.

Moderators

Sarah Blackwell

PGY1 Pharmacy RPD/ Clinical Pharmacy Specialist, Medical Critical Care, Baptist Health Princeton Hospital

Presenters

Benjamin Emery

PGY1 HSPAL Pharmacy Resident, Prisma Health Richland

Evaluators

Olivia Caron

PGY2 Ambulatory Care RPD, MAHEC

Thursday April 30, 2026 11:40am - 12:00pm EDT
Olympia 2

Administration (ADM), Prisma Health Richland - University of South Carolina

global Y

11:40am EDT

Evaluation of the Impact of a Pharmacy Technician Practice Counc

Thursday April 30, 2026 11:40am - 12:00pm EDT

Olympia 1

Background
Pharmacy technicians are essential members of the healthcare workforce, enabling pharmacists to practice at the top of their license while ensuring safe and efficient medication use systems. In July 2024 Wellstar MCG Health established the Inpatient Pharmacy Technician Practice Council (IPTPC) to facilitate collaboration, communication, and continuous improvement in pharmacy technician practice. However, due to scheduling conflicts and the prioritization of other initiatives it became inactive. The council was designed to empower technicians by giving them a formal platform to contribute to decision-making, standardization efforts, and process improvement initiatives. The purpose of this study is to evaluate whether a pharmacy technician–led council improves technician engagement, operational efficiency and quality metrics within the pharmacy department.

Methods
This is a single-center, pre-post interventional study assessing the impact of a technician-led council using surveys. Surveys were distributed through Qualtrics to all inpatient pharmacy technicians employed at WellStar MCG Health with response reminders employed. Survey items collected information about work experience, training, and work life attitudes generated from literature. The purpose of the surveys is to evaluate the impact of the initiatives implemented by the council and assess overall technician engagement. We excluded any inpatient pharmacy technician supervisors and any pharmacy technician part of the IPTPC. The primary outcome was technician engagement. Secondary outcomes included self and social perceptions of technicians, medication error rates, and turnaround time.

Results
A total of 14 of 42 eligible pharmacy technicians completed the primary survey, corresponding to a 33% engagement rate. Response rates for medication delivery structure surveys increased from 9% pre-implementation (4/46) to 17% post-implementation (8/46). Most respondents had ≤4 years of experience (71%). Overall satisfaction with training was high, with 79% of respondents reporting being somewhat or extremely satisfied. Experiential learning factors, including prior work experience and mentorship from supervisors and peers, were rated as more valuable than formal training programs. Satisfaction with coworkers and workflow clarity was generally positive, however dissatisfaction regarding workload and opportunities for advancement was prevalent. Following implementation of the medication delivery schedule change, a higher proportion of respondents reported disagreement that the new medication delivery structure supported timely delivery and manageable workload. Medication delivery turnaround time remained unchanged (pre: 1.46 ± 0.52 hours vs post: 1.48 ± 0.56 hours).

Conclusion
Implementation of an inpatient pharmacy technician practice council demonstrated feasibility but did not result in measurable improvements in operational efficiency or technician engagement during the study period. Further research with larger sample sizes and sustained council activity is needed to better evaluate the impact of technician governance models on engagement, efficiency, and quality outcomes.

Objective
To assess the impact of an inpatient pharmacy technician practice council on self and social perceptions of training and competency of technicians and operational efficiency in a hospital setting.

Assessment Question
Which of the following statements best reflects the current understanding of inpatient pharmacy technician roles within a hospital setting?
A) Pharmacy technicians are primarily limited to distributive tasks, with minimal involvement in advanced responsibilities or workflow improvement initiatives
B) Decreased pharmacy technician job satisfaction is associated with opportunities for role expansion, professional development, and advanced responsibilities
C) Pharmacy technician involvement in structured governance models such as technician practice councils is well-established with literature demonstrating improvements across healthcare systems
D) While pharmacy technician role expansion is supported, the impact of structured governance models such as pharmacy technician practice councils remains under-explored and requires further evaluation

Moderators

Heather Stanley

Presenters

Ebony Crawford

PGY2 HPSAL Resident, Wellstar MCG Health

I am from Port Saint Lucie, FL I graduated from Florida A&M University in Tallahassee, FL with my Doctorate in Pharmacy in May 2024. I am the PGY 2 HSPAL Resident at Wellstar MCG Health and currently attending Augusta University to get my Masters in Business Administration.

Evaluators

Blake Johnson

Thursday April 30, 2026 11:40am - 12:00pm EDT
Olympia 1

Administration (ADM), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

11:40am EDT

SGLT2 Inhibitors for Glycemic coNtrol in hospitAL patients with CKD and HF (SIGNAL-CKD-HF)

Thursday April 30, 2026 11:40am - 12:00pm EDT

Parthenon 2

Background
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve glycemic control and provide cardiovascular and renal benefits in patients with type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD). Despite strong outpatient guideline support, data on inpatient use remains limited. Insulin remains the standard of care for inpatient glycemic management due to safety concerns, including euglycemic diabetic ketoacidosis and acute kidney injury. Consequently, inpatient SGLT2i use remains controversial due to conflicting guideline recommendations and limited safety data, particularly in hospitalized patients with CKD and HF.
Methodology
This IRB-approved multicenter retrospective study included hospitalized adult patients (≥18 years) with T2DM, HF, and CKD admitted between August 2023 and November 2025 who received either SGLT2i in combination with scheduled multimodal insulin (intervention group) or scheduled multimodal insulin alone (control group) Exclusion criteria included type 1 diabetes mellitus, pregnancy or lactation, intensive care unit admission, or use of continuous insulin infusion. The primary outcome was glycemic control measured by daily blood glucose levels. Secondary outcomes included percentage of blood glucose readings in target range (100 to 180 mg/dL), inpatient mortality, length of hospital stay (days), number of insulin injections administered per day, incidence of diabetic ketoacidosis (defined as bicarbonate < 18 mmol/L, pH< 7.3, AG > 12, and serum ketone or urine ketone), incidence of hypoglycemic events (defined as blood glucose < 70 mg/dL), incidence of acute kidney injury (defined as an increase in serum creatinine > 0.3 mg/dL or ≥ 1.5 times above baseline), mean change in body weight.
Descriptive statistics summarize baseline characteristics. Normality was assessed using the Shapiro-Wilk test. Categorical variables were analyzed using Chi-Square tests. Continuous variables were analyzed using Student’s t-test or Mann-Whitney U tests, as appropriate. Statistical significance was defined as a two-tailed alpha of 0.05.
Results
A total of 200 patients were included (100 per group). Baseline characteristics were generally similar between groups except the insulin-alone group had lower eGFR at admission compared to the SGLT2i plus insulin group (20.5 vs. 41.1 mL/min/1.73 m2) and higher serum creatinine at admission (2.77 vs. 1.52 mg/dL). Median daily blood glucose levels were numerically higher in the SGLT2i plus multimodal insulin group compared to multimodal insulin therapy alone (165 vs 160 mg/dL; P < 0.001) Comparable percentage of blood glucose readings within target range (57% vs 59% P = 0.645) were observed.
With secondary efficacy outcomes, there were no significant differences in length of stay (6 vs 5 days; P = 0.199), total daily insulin dose (12.5 vs 8.5 units; P = 0.165), or weight change (-0.05 vs 0.28 P = 0.073). Secondary safety outcomes, including inpatient mortality (1 vs 3; P = 0.621), hypoglycemic events (11 vs 18; P = 0.16), and diabetic ketoacidosis (1 vs 0; P = 1.0), were also comparable between groups
The SGLT2i group had significantly lower 90-day all-cause readmission rates (51% vs 72%; P = 0.002) and lower incidence of acute kidney injury (33% vs 49.5%; P = 0.018), but a higher number of insulin injections per day (3 vs 2; P = 0.01).
Conclusions
Albeit being statistically significant, the addition of SGLT2 inhibitors to insulin therapy did not result in clinically meaningful improvements in glycemic control compared with insulin alone. Observed SGLT2 inhibitor use may be associated with significantly lower rates of acute kidney injury and 90-day readmissions, suggesting potential benefits beyond glycemic management. These findings support further investigation into the role of SGLT2 inhibitors in the inpatient setting.

Moderators

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1

Presenters

Jihyun Chae

Pharmacy Resident, AdventHealth Orlando

Evaluators

Jolie Gallagher

Clinical Pharmacy Specialist, Critical Care, Emory University Hospital

Thursday April 30, 2026 11:40am - 12:00pm EDT
Parthenon 2

Administration (ADM), AdventHealth Orlando

global Y

11:40am EDT

Evaluation of Semaglutide and Tirzepatide on Clinical Improvement in HFpEF and HFmrEF at the Salisbury Veterans Affairs Health Care System

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena D

Authors: Julie A. Gordon, Jon E. Folstad, Charley A. Hepfinger, Camille P. Robinette, Allison E. Strain, Anita A. Kelkar

Background: Heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly reduced ejection fraction (HFmrEF) are highly prevalent among the aging population and contribute to significant morbidity and reduced quality of life. Unlike heart failure with reduced ejection fraction, guideline-directed medical therapy (GDMT) has not demonstrated clear mortality benefits in this population, and treatment primarily focuses on symptom management and comorbidity control. Obesity is a major modifiable risk factor in HFpEF and HFmrEF that contributes to worsening symptoms and increased hospitalizations. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, including semaglutide and tirzepatide, have demonstrated effective weight loss and clinical benefits in this population. However, their impact on heart failure related outcomes has not yet been evaluated at the Salisbury VA Health Care System (SVAHCS). This project aims to evaluate if semaglutide and tirzepatide lead to clinical improvement in Veterans with HFpEF or HFmrEF and how prescribing patterns influence outcomes at the SVAHCS.

Methods: This quality improvement project was a retrospective chart review of Veterans with HFpEF or HFmrEF prescribed semaglutide or tirzepatide for at least six months between January 2022 and July 2025 at the SVAHCS. Collected variables included demographics, duration and dose of therapy, medication titration schedule (standard vs. slow), prescribing discipline (Pharmacy, Endocrinology, Primary Care), and number of titration-related clinic visits attended during therapy. The primary outcome was percentage change in body weight. Secondary outcomes included changes in B-type natriuretic peptide (BNP), ejection fraction (EF), HgbA1C, LDL, blood pressure medication and loop diuretic requirements, and symptoms of heart failure. Prescribing discipline, titration method, and follow-‑up frequency were evaluated.

Results: A total of 266 patients were identified using the Weight Management Patient Report Dashboard. After chart review was performed to confirm eligibility, 52 patients were included, most of whom had HFpEF (90%) and obesity (96%). Patients who remained on the agent for at least 12 months experienced an average weight loss of 6.26% (p-value <0.001). Improvements were observed in weight, LDL, HgbA1C, BNP, and EF, although sample sizes varied. Compared to other disciplines, pharmacist-managed patients attended the highest number of clinic visits during therapy titration and exhibited the greatest percentage of weight loss (p-value=0.24) as well as the largest reduction in BNP (p-value=0.93). However, these differences were not statistically significant. Although most patients (81%) underwent slow titration, those receiving standard titration reached maximum dose more rapidly and achieved greater weight loss (p-value=0.15). Across the cohort, 29% had an antihypertensive medication reduced or discontinued, and patients achieving ≥5% weight loss were more likely to require loop diuretic dose reduction, suggesting improved volume status and symptom control.

Conclusion: Semaglutide and tirzepatide were associated with meaningful weight loss and favorable cardiometabolic trends in Veterans with HFpEF or HFmrEF. Differences in outcomes across prescribing disciplines highlight the importance of follow‑up frequency, access to care, and titration intensity, with pharmacist‑managed care demonstrating the strongest improvements.

Contact: [email protected]

Moderators

Jessica Ringler

Presenters

Julie Gordon

PGY1 Pharmacy Resident, Salisbury Veterans Affairs Health Care System

My name is Julie Gordon and I am a PGY1 pharmacy resident at the Salisbury Veterans Affairs Healthcare System. I graduated with my Doctor of Pharmacy degree from the University of Cincinnati in April of 2025. After residency is completed, I plan on continuing my career within the... Read More →

Evaluators

Kaitlyn Ledet

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena D

Ambulatory Care (AMB), VA â€“ Salisbury, NC â€“ Salisbury VA Health Care System

global Y

11:40am EDT

Real World Conversion from NPH to Insulin Glargine-yfgn in an Outpatient Clinic Setting

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena B

Authors: Faith White, Ah Lim Yoo, Erin Pace
Background:
Insulin glargine-yfgn (Semglee) is a recently approved interchangeable biosimilar to insulin glargine. Comparable cost and clinical efficacy between insulin glargine-yfgn and NPH insulin (Humulin N) prompted institution-wide conversion from its preferred basal insulin NPH to insulin glargine-yfgn. However, there is currently limited guidance regarding the conversion between insulin glargine-yfgn and other insulins due to recent approval. As a result, prescribing information for insulin glargine was utilized to guide the conversion initiative. This prompted either a 1:1 conversion for patients taking up to 50 units of NPH daily or a reduction in NPH total daily dose (TDD) by 20% for patients taking greater than 50 units daily or NPH twice daily. Therefore, this project aims to address the knowledge gap in conversion methods between NPH and insulin glargine-yfgn by evaluating real-world data in an outpatient setting, specifically TDD and changes in glycated hemoglobin (A1c) before and after conversion.
Methods:
This retrospective cohort study was designed to assess conversion methods from NPH to insulin glargine-yfgn within outpatient clinics throughout the study institution. The conversion date was defined as the initial fill date of the first insulin glargine-yfgn order following previous NPH orders. Demographic variables, A1c, and TDD values were collected from an electronic health record. A1c values were collected at baseline (within 6 months prior to conversion) and approximately 6 months after conversion. TDD of NPH was collected at baseline, TDD of insulin glargine-yfgn on the date of conversion, and TDD of insulin glargine-yfgn approximately 6 months after conversion. Inclusion criteria were age greater than or equal to 18 years, type 1 or 2 diabetes, and conversion from NPH to insulin glargine-yfgn between April 1, 2024 and April 1, 2025. Exclusion criteria were concurrent therapy with other insulins (e.g. short acting, rapid acting, premixed formulations), pregnancy, prediabetes diagnosis, titrate-to-target dosing, and discontinuation of insulin glargine-yfgn within 6 months from conversion. The primary outcome was the mean change in TDD of NPH from baseline to the TDD of insulin glargine-yfgn 6 months after conversion. The secondary outcome was the mean change in A1c from baseline to 6 months after conversion. A Wilcoxon Signed Rank test was completed to analyze the TDD and A1c variables among the included participants.
Results:
Of the 1,245 eligible individuals that were screened, a total of 892 patients were included in this study. The majority of the study population were African American (54%), female (53%), and mean age of 65 years. Type 2 diabetes (99.7%) was the more commonly observed diagnosis. The mean TDD of insulin prior to conversion was 43.5 units compared to 38.6 units approximately 6 months after conversion. This indicates a statistically significant reduction in mean TDD by 4.88 units (p < 0.0001). Additionally, there was a statistically significant reduction in A1c by 0.08% (p = 0.0204) from 8.13% prior to conversion to 8.05% after conversion.
Conclusion:
The transition from NPH to insulin glargine-yfgn yielded a slight decrease in TDD and A1c. While the approximate 10% decrease in TDD may be interpreted as clinically significant in some scenarios, the overall A1c reduction was minimal. Current conversion guidance may not provide substantial benefit in A1c control partially due to the recommendations for preemptive insulin dose reduction for safety purposes. However, it may be reasonable to consider an initial 1:1 conversion in appropriate circumstances to provide additional A1c lowering. Such instances may be patients with elevated A1C and those who have not experienced hypoglycemia with the original TDD prior to the conversion.

Moderators

Elora Hilmas

Pharmacy Clinical Manager, ECU Health

Presenters

Faith White

Evaluators

Brian Hairston

Critical Care Clinical Specialist, FMOL Health | St. Dominic

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena B

Ambulatory Care (AMB), Kaiser Foundation Health Plan of Georgia, Inc.

global Y

11:40am EDT

Evaluating the Impact of a Cardiology-Focused Unit on Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction at Hospital Discharge

Thursday April 30, 2026 11:40am - 12:00pm EDT

Parthenon 1

Authors: Joan M. Jakab, William W. Feese, Mitchell S. Hutson, A. Shaun Rowe, & Kaylee W. Behal
Background: Patients with heart failure have complex medication regimens, often involving a need for additional education and care. Multidisciplinary care improves medication adherence and dose optimization of the four pillars of heart failure therapy. Outpatient multidisciplinary integration in heart failure clinics has shown enhanced medication optimization and reduced hospital admission thus the need to assess inpatient multidisciplinary care. The purpose of this study is to evaluate the impact of a multidisciplinary cardiology-focused unit on guideline directed medical therapy (GDMT) at hospital discharge for patients with heart failure with reduced ejection fraction (HFrEF).
Methods: This retrospective cohort study examines 364 patients with HFrEF grouped according to discharge location from either the cardiology-focused multidisciplinary unit or any other unit. Multidisciplinary cardiology-focused units receive heart failure education tailored to each specialty such as disease specific education courses for registered nurses, importance of intake and output documentation, daily weights, and movement by exercise physiology. The primary outcome is GDMT score at discharge. Secondary outcomes include the change in GDMT score from admission to discharge and the percentage of pillars of therapy on each patient’s medication regimen. The subgroup analysis includes pharmacist initiation of GDMT as determined by clinical intervention documentation in the electronic medical record. The secondary safety endpoint includes hospital readmissions at 30 or 90 days.
Results: At discharge, patients admitted to the multidisciplinary cardiology-focused unit achieved higher GDMT scores compared with patients admitted to other units (5 [2, 6] vs. 3 [1, 5]; p=0.0003). The change in GDMT scores from admission to discharge was significantly greater in the cardiology unit (1 [0, 5] vs. 0 [0, 1]; p<0.0001). Patients discharged from cardiology-focused units had a higher number of GDMT medications prescribed (3 [2, 4] vs. 2 [1, 3]; p=0.0005). Thirty or ninety day heart failure-related readmission rates were similar between groups (8 [6.4%] vs. 13 [5.4%]; p=0.7089). Patients admitted to cardiology-focused units were more likely to have at least one heart failure-related pharmacist clinical intervention during admission (61 [48.8%] vs. 63 [26.4%]; p<0.0001; OR 2.7, 95% CI 1.7–4.2).
Conclusions: In this retrospective study, patients with HFrEF who were admitted to the multidisciplinary cardiology-focused unit had higher GDMT scores at discharge indicating greater optimization of GDMT. These findings suggest that a multidisciplinary team plays a critical role in identifying gaps in therapy and promoting evidence-based medication optimization during hospitalization.

Moderators

Jared Briones

Clinical Pharmacist, Adventhealth Apopka

Presenters

Joan Jakab

Evaluators

Randy Hooks

Clinical Pharmacist, East Alabama Medical Center

Internal Medicine- East Alabama Health

Thursday April 30, 2026 11:40am - 12:00pm EDT
Parthenon 1

Cardiology (CAR), University of Tennessee Medical Center

global Y

11:40am EDT

Evaluating Provider Behavior Around Alternative Fluid Orders During the 2024 IV Fluid Shortage

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena I

Evaluating Provider Behavior Around Alternative Fluid Orders During the 2024 IV Fluid Shortage
Authors: Cady Thomas, Jennifer Peltz, Christopher Dennis
Practice site: ECU Health
Contact: [email protected]

Background: In September 2024, Hurricane Helene hit the western part of North Carolina and caused damage to a Baxter manufacturing plant which produces multiple sterile IV fluid products. Most health systems across the US relied on this plant for at least a portion of their IV fluid needs. Damage to the plant led to a major IV fluid shortage across the country. ECU Health utilized a series of medication alternative alerts to provide guidance to providers that were ordering IV fluid products during the shortage. Providers were allowed to select from the approved alternative list or to cancel the orders. The list of alternatives established limits on the amount of fluid that could be ordered and the duration of the orders. After selecting an option from the alternative list, providers had the ability to deviate from the recommendations by modifying order details before signing the orders. The purpose of this study was to evaluate the effectiveness of the medication alternatives in guiding ordering practices and to identify patterns in provider behaviors surrounding use of the tools throughout ECU Health. To establish a baseline expectation for alternative performance during shortages, we referenced prior studies with comparable clinical decision support designs. Sandler et al. reported alternative acceptance in 4.8% of cases and order cancellation in 6.2%.1 When combined, 11.1% of provider actions resulted in a desired outcome (recommended use accepted or no use), a rate we define as non-deviation for the purposes of our analysis. Whether similar outcomes occur around alternative fluid orders in other health systems is unclear.

Methods: The health system’s Clarity database was queried to identify all instances of medication alternatives triggered for IV fluids that were on shortage between October 9, 2024 and January 13, 2025. To better understand provider behavior and clinical impact, alternatives were then grouped into episodes which serve as the primary unit of evaluation for this study. 15,774 IV fluid episodes were included for analysis. The primary objective was to compare the proportion of episode non-deviations at our institution with rates previously reported in the Sandler et al. study. Episodes resulting in orders with deviations were further categorized by waste production and time deviations. Episodes were also categorized by provider type, type of IV fluid ordered, source of the order, hospital location of order origin, and patient age. The rate of non-deviation in our cohort was compared with the rate reported by Sandler et al. using a Chi-square test of independence. Descriptive statistics were used to describe other data points collected.

Results: Among 15,774 episodes, the non-deviation rate was 86.3% in our cohort compared with 11.1% in the comparator study, representing an absolute difference of 75.2% (95% CI 74.3 –76.1). This difference was statistically significant (χ²(1) = 12,203.007, p < 0.001). Of the episodes that resulted in deviations, 181 episodes resulted in time deviations; 2,034 episodes resulted in waste deviations. It was estimated that 815 L of fluid was wasted because of order deviations.

Conclusion: Deviation from recommended alternatives occurred less frequently in our study compared with a prior alternative order study, though direct comparison is limited by differences in clinical context. While our study shows a statistically significant improvement, the vast majority of episodes indicate providers still choose to deviate from the alternative recommendations which resulted in substantial IV fluid wastage. By recognizing prescribing patterns in areas that were more impacted by order deviations during the IV fluid shortage, the institution can employ additional strategies to help further minimize orders that deviate from recommendations.

1. Sandler M, Cavanaugh J, Walton T, Cavendish L, Shah K. Management of an i.v. fluid shortage through use of electronic medical record alerts. American journal of health-system pharmacy. 2020;77:546-551.

Moderators

Lena Tran

Pharmacist, AdventHealth Kissimmee

Presenters

Cady Thomas

PGY1 Pharmacy resident, ECU Health Medical Center

Dr. Thomas is currently a PGY1 at ECU Health Medical Center in Greenville, NC. She completed her undergraduate degree at University of South Carolina and pharmacy school at Eshelman School of Pharmacy at UNC Chapel Hill. She recently accepted a position as the PGY2 Emergency Medicine... Read More →

Evaluators

Jonathan Alligood

Residency Program Director, Phoebe Putney Memorial Hospital

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena I

Community Pharmacy (CP), ECU Health Medical Center

global Y

11:40am EDT

Implementation of Standardized Electrolyte Replacement Practices at a Veteran’s Affairs Hospital

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena A

Emily Robert, Michelle Alonso, and Hunter Perrin
James H. Quillen Veteran Affairs Medical Center – Mountain Home, TN
Contact Information: [email protected]
Background/Purpose: Electrolyte deficiencies are common throughout patient care and often require timely replacement to avoid adverse events. Disturbances in electrolytes are particularly important due to the potential to cause life-threatening complications such as cardiac arrhythmias, seizures, neuromuscular dysfunction, and hemodynamic instability. Despite their clinical significance, electrolyte replacement practices are often variable and provider dependent. The Institute for Safe Medication Practices (ISMP) highlights in its 2024-2025 Targeted Medication Safety Best Practices that hospitals should implement layered strategies across the entire medication-use process to improve safety with high-alert medications, including electrolytes. The purpose of this quality improvement project is to align James H. Quillen Veterans Affairs Medical Center (JHQVAMC) medication-use processes with the 2024-2025 ISMP Targeted Medication Safety Best Practice recommendations regarding high-alert medications used for electrolyte replacement therapies.
Methodology: This project aims to evaluate existing electrolyte replacement protocols and order sets, as well as develop new ones as necessary. This project also aims to ensure appropriate electrolyte replacement product utilization and storage. Accomplishing this will require evaluation of the JHQVAMC current electrolyte replacement practices, including revision of current protocols and order sets. Adjustments to current protocols and order sets will include indication, dosing, frequency, duration, and comments regarding appropriate administration and monitoring. The electrolyte protocols and order sets will be submitted for final approval by the Medication Safety Committee and Pharmacy and Therapeutics Committee. Implementation will occur in the emergency department, hematology/oncology clinic, and inpatient wards, including the intensive care unit. Targeted education will be provided by pharmacy services prior to implementation. A retrospective analysis will be conducted comparing data from a pre-implementation period (June 1, 2025 to September 1, 2025) to a post-implementation period (three months; dates to be determined). Data to be collected during pre- and post-implementation time frames will include: patients with potassium < 3.6 mEq/L or phosphorus < 2.3 mg/dL, number of electrolyte replacement order sets available within the electronic health record (EHR), number of electrolyte replacement protocols available within the EHR, potassium and phosphorus supplementation for potassium < 3.6 mEq/L or phosphorus < 2.3 mg/dL, potassium and phosphorus lab values following supplementation, and Omnicell stocking reports to determine presence of concentrated electrolyte vials intended for dilution.
Results: In progress
Conclusions: In progress

Moderators

Elaina Baaklini

Presenters

Emily Robert

Evaluators

Liz Oglesby

Pharmacy Clinical Coordinator, PGY-1 Residency Program, Mobile Infirmary

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), VA - Mountain Home, TN - James H. Quillen VA Medical Center

global Y

11:40am EDT

Impact of Antimicrobial Stewardship Education on Antibiotic Prescribing Practices for Asymptomatic Bacteriuria and Urinary Tract Infections in the Emergency Department

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena G

Authors: Emily Gunselman; Linda Johnson; Rachel Anderson; Bradley Proctor

Background/Purpose: Asymptomatic bacteriuria (ASB) is defined as “the presence of one or more species of bacteria growing in the urine at specified quantitative counts (>105 colon-forming units [CFU]/mL or >108 CFU/L), irrespective of the presence of pyuria, in the absence of signs or symptoms attributable to urinary tract infection (UTI).”.1 Urinary tract infections (UTIs) are a clinical syndrome that should be diagnosed based on symptoms such as dysuria, urgency, frequency, suprapubic pain, flank pain, and costovertebral angle tenderness with or without systemic signs of infection such as fever, chills, rigors or hemodynamic instability.2 The Infectious Diseases Society of America (IDSA) recommends against screening for and treating ASB, except in pregnant patients or prior to a planned urologic procedure.1 Treating ASB in patients, aside from the aforementioned exceptions, has shown lack of benefit and has also lead to increased risk of harm including: development of symptomatic UTI, colonization with multi-drug resistant gram negative rods, and increased risk of developing Clostridiodes difficile infection (CDI).3,4,5 The Emergency Department (ED) is the most common location for the ordering of urine cultures and early treatment for a suspected UTI. In August of 2025, CHI Memorial Hospital approved an Expected Practice document providing leadership support to not treat ASB.6 Additionally, a guidance document on the management of UTIs was created which detailed empiric treatment recommendations with regards to drug, route, dose, and duration based on national guidelines as well as local antibiogram data for both patients discharging from the ED and those being admitted. Didactic education was provided to the ED clinicians and the guidance documents were made available. The goal of this project was to evaluate appropriateness of ED antibiotic use for ASB and suspected urinary tract infections pre- and post- stewardship intervention.

Methods: This is a single-center, IRB approved, quasi-experimental study. Adult patients seen in the ED with positive urine cultures showing a uropathogen were included. Patients were excluded if they had an outpatient diagnosis of UTI, another suspected source of infection, or neutropenic fever. The primary outcome of this study is to evaluate the appropriateness of empiric antibiotic therapy pre- and post- intervention. Secondary outcomes include safety of intervention, new positive cultures showing resistant organism growth, CDI, and re-presentation to the ED with the same diagnosis within 30 days.

Results:
Primary Outcome: Appropriateness of empiric antibiotic treatment choice for UTI did not improve post-intervention. However, the number of patients who had ASB and received antibiotics did decrease post-intervention.
Secondary Outcomes: There was no shown difference in development of symptomatic UTI, development of CDI, or re-presentation to the ED within 30 days for the same diagnosis between patients that were appropriately treated vs not. However, more patients developed new resistant organism growth in subsequent urine cultures in the group of patients that were not appropriately treated.
No values were found to be statistically significant.

Conclusion:

The educational intervention was not effective at guiding provider empiric antibiotic choice in the ED

ASB was often treated in the pre- and post-intervention periods

The expected practice document was not an effective tool in altering clinical behavior in the ED

Moderators

Megan Freeman

Presenters

Emily Gunselman

PGY-1 Resident, CHI Memorial Hospital

Evaluators

Haley Smith

Neuro Critical Care Pharmacy Specialist / PGY1 RPD, Our Lady of the Lake Regional Medical CenterPGY1

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena G

Infectious Disease (ID), CHI Memorial

global Y

11:40am EDT

Comparative Safety of Inpatient versus Outpatient Step‑Up Dosing for Bispecific T‑Cell Engagers in Multiple Myeloma

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena H

Comparative Safety of Inpatient versus Outpatient Step‑Up Dosing for Bispecific T‑Cell Engagers in Multiple Myeloma
Saumyaa Patel; Chynna Bambico; Jon Shaffer
AdventHealth Orlando, Orlando, FL, USA
BACKGROUND
Bispecific T-Cell Engagers (BiTEs) for relapsed/refractory multiple myeloma were approved with recommended inpatient step-up dosing and post-dose observation to mitigate early toxicities, primarily cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). Emerging literature suggests outpatient step-up dosing may be feasible with standardized monitoring and prophylaxis, but real-world data on patient safety outcomes remains limited. The objective of this study is to compare whether inpatient versus outpatient step-up dosing for teclistamab, talquetamab, and elranatamab affects the incidence and grade of CRS and ICANS.
METHODS
This single-center, retrospective chart review included adults with multiple myeloma initiated on teclistamab, talquetamab, or elranatamab at a tertiary academic hospital between June 1, 2023, and February 30, 2026. Patients were identified from the electronic health records after Institutional Review Board (IRB) approval. They were grouped according to care setting during step-up dosing: inpatient observation as recommended by Food and Drug Administration (FDA) label versus outpatient monitoring. Inclusion criteria included age ≥18 years and first step-up dose administered with follow-up per institutional protocol. Exclusion criteria included initial step-up performed elsewhere, concurrent enrollment in an interventional trial, or clinical instability at step-up initiation (for example, active infection or hemodynamic instability). Baseline variables included age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, and number of prior therapy lines. Primary outcomes included incidence and grade of CRS and ICANS per the American Society for Transplantation and Cellular Therapy (ASTCT) criteria. Secondary outcomes included tocilizumab use, corticosteroid use, fluid bolus use, vasopressor use, supplemental oxygen use, emergency department visit or readmission, and readmission length of stay. Descriptive statistics will summarize baseline characteristics. Categorical outcomes will be compared using chi-squared or Fisher’s exact tests while continuous outcomes will be compared using Mann-Whitney U or student’s t-tests.
RESULTS A total of 41 patients were included, with 11 (27%) receiving outpatient and 30 (73%) receiving inpatient step-up dosing. Baseline characteristics were generally comparable, including age, gender, and prior lines of therapy. CRS occurred less frequently in the outpatient group vs. the inpatient group (9% vs. 47%). All outpatient CRS events were grade 2, while inpatient events were grade 1 (17%) and grade 2 (30%). ICANS was uncommon and occurred in 9% of outpatients vs. 20% of inpatients. All outpatient ICANS events were grade 2, while inpatient events were grade 1 (13%) and grade 2 (7%).
Supportive care interventions were similar overall. Tocilizumab use occurred in 9% of outpatients vs. 13% of inpatients, and fluid boluses were administered only in the inpatient group (23%). Off day corticosteroid use was more common in the outpatient group (91% vs. 30%). Lastly, no patients required vasopressors or intensive care unit admission, and thirty-day hospitalization rates were identical (27% vs. 27%).
CONCLUSIONS Outpatient step-up dosing of bispecific T cell engagers was not associated with increased incidence or severity of CRS or ICANS vs. inpatient initiation. Although CRS rates were lower in the outpatient cohort, escalation of care and healthcare utilization were similar. These findings support the feasibility and safety of outpatient BiTE initiation in appropriately selected patients with standardized monitoring and prophylactic strategies.

Moderators

Hannah Schmoock

Internal Med Clinical Pharmacy Specialist, PGY1 Acute Care RPC, McLeod Regional Medical Center

Presenters

Saumyaa Patel

Acute Care PGY1 Resident, AdventHealth Orlando

Evaluators

Adam Harnden

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena H

Oncology (ONC), AdventHealth Orlando

global Y

11:40am EDT

IV Methadone in Cardiothoracic Surgery

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena C

Title: Evaluation of intraoperative intravenous methadone administration for cardiothoracic surgery analgesia
Author(s): Anna Carlson, Nevena Mihalovich, Ethan Gerrald, Zachary Klick, Paige Behr, Madison Fielding, Akshara Patel; Atrium Health Wake Forest Baptist, Winston Salem, NC

Objective: To evaluate the efficacy and safety of intravenous (IV) methadone as adjunctive analgesia in cardiothoracic surgery (CTS)

Background: Post-operative opioid stewardship has been a focus of national and state level initiatives to curtail the prescribing of excessive opioid analgesics. The use of multimodal analgesics is recommended by the Society of Thoracic Surgery (STS) to reduce morphine milligram equivalents (MME). Pain following CTS is typically most severe within the first 24 hours postoperatively but may persist for several days. To effectively manage postoperative pain, methadone has been used intraoperatively due to its favorable pharmacokinetic profile, including its long half-life of 24-36 hours. Previous studies comparing methadone with shorter-acting opioids suggest reductions in pain scores and MME requirements in patients receiving intraoperative IV methadone. However, studies vary among types of surgery performed, reported opioid-related adverse events, and postoperative day (POD) study follow-up duration. Additional research is warranted to quantify the impact of intraoperative IV methadone and support practice optimization.

Methods: This was a retrospective, single-center, cohort study utilizing electronic health record (EHR) data of patients undergoing CTS, including coronary artery bypass graft (CABG), aortic valve repair (AVR), isolated mitral valve repair or replacement (MVR/MVr), aortic root repair or replacement, or other combinations thereof. Data was collected utilizing an EHR report to identify CTS performed from March 2024 – August 2025. Patients were categorized into two groups: intraoperative IV methadone administration for adjunctive analgesia or standard of care. Key exclusion criteria are preoperative gastrointestinal obstruction (including ileus), mechanical circulatory support after index surgery, continuous infusion opioids within 48 hours prior to CTS, or active or prior opioid use disorder. The primary endpoint was average cumulative MME requirements through POD four or discharge, whichever comes first. Secondary endpoints include difference in daily MME requirements, incidence of naloxone rescue administration, intraoperative MME requirements, percentage of patients extubated within 6 and 24 hours, incidence of postoperative ileus, incidence of opioid-related adverse effects, and opioids prescribed at discharge in MME.
Baseline characteristics assessed were age, sex, comorbidities, and type of CTS performed, as well as use of antiarrhythmic medications, glucagon-like-peptide-1 receptor agonists, and opioid, including methadone, use within 30 days. Results were analyzed utilizing descriptive statistics, with means or medians reported for continuous variables as appropriate. Categorical endpoints were analyzed using Fisher’s exact or chi-square test for normally distributed data.

Results: 200 patients in total were included (IV methadone n=100; standard of care n=100). Baseline characteristics were similar between the two groups aside from a statistically significant difference in incidence of depression. There were no significant differences in type of CTS or number of adjunctive analgesic agents used postoperatively. Cumulative POD 0-4 MME were significantly lower in the methadone group compared with standard of care (167 vs 209; mean difference 42; p=0.046). Reductions in MME requirements were most notable on POD 0 and POD 1 (mean difference 16 and 19, respectively; p=0.006). There were no observed differences in incidence of naloxone administration, extubation within 6 and 24 hours, postoperative delirium, or ICU length of stay. Mean MME prescribed at discharge was significantly lower in the methadone group (126 vs 135 MME; p=0.0047).

Conclusions: Administration of intraoperative IV methadone significantly reduces postoperative MME requirements when compared to standard of care.

Moderators

Eric Marr

PGY1 Residency Program Director, Baptist Health Lexington

Presenters

Anna Carlson

PGY1, Atrium Health Wake Forest Baptist

Evaluators

Erin Pace

Ambulatory Care Pharmacist, KFHP1Kaiser Foundation Health Plan of Georgia (Managed Care)PGY1

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena C

Pain Management (PM), Wake Forest Baptist

global Y

11:40am EDT

Evaluating the Impact of Penicillin Allergy Assessment in Obstetrics and Gynecology Clinics

Thursday April 30, 2026 11:40am - 12:00pm EDT

Athena J

Background:
Approximately 10% of patients report a penicillin allergy; however, fewer than 1% of the population have an IgE-mediated allergy. Penicillin allergy evaluation involves obtaining a detailed history of the reported reaction and may include diagnostic testing such as skin testing and/or an oral penicillin challenge. When appropriate, this process can result in the removal of the allergy label from a patient's medical record, a process known as allergy de-labeling. This practice has been well studied and is considered safe among the general population. Given its safety and effectiveness, the American College of Obstetricians and Gynecologists (ACOG) encourage penicillin allergy evaluation for any patient with a documented penicillin allergy; however, despite these recommendations, this patient population is less likely to undergo evaluation for allergy de-labeling.

Antimicrobial use in pregnancy is common, particularly for managing Group B Streptococcus (GBS), cesarean section prophylaxis, and infectious complications such as chorioamnionitis. ACOG guidelines recommend beta-lactam antimicrobials, including ampicillin and cefazolin, as first-line agents for prophylaxis and treatment during the peripartum period. However, patients labeled as penicillin-allergic are often prescribed second-line, broad-spectrum antimicrobials instead. Wellstar MCG Health (WMCGH) implemented a new penicillin allergy screening assessment process for obstetrics and gynecology patients in September 2025. The purpose of this study is to expand upon existing literature by evaluating the outcomes of this new assessment.

Methods:
This is a single center, retrospective, chart review study evaluating the outcomes of a newly implemented penicillin allergy screening assessment in obstetrics and gynecology patients. All patients 18 years or older who were seen at pre-specified WMCGH women’s clinic locations with a documented penicillin allergy were eligible for enrollment. Patients were excluded if they did not have established care with WMCGH prior to admission and if they were admitted for a non-related OB/GYN encounter. The primary outcome was the difference in the incidence of guideline recommended first-line antimicrobials received for GBS, chorioamnionitis, and surgical prophylaxis. Secondary outcomes included hospital length of stay, incidence of de-labeled penicillin allergy, rate of postpartum and surgical site infections, total days of antimicrobial use, 30-day hospital re-admission, and antimicrobial cost savings.

Results:
A total of 140 patients were included with 97 patients in the pre-implementation group and 43 patients in the post-implementation group. For the primary outcome, 20% of patients in the pre-implementation group received first-line antimicrobials compared to 43% in the post implementation group (p = 0.106). Implementation of penicillin allergy screening was associated with a 29% relative risk reduction in patients receiving non-first line antimicrobial therapy. There was no difference in hospital length of stay between the two groups, and 30-day hospital re-admission was 10% vs. 5% in the pre- and post-implementation groups respectively. The rate of postpartum and surgical site infections was similar between pre- and post-implementation groups (4% vs 5%, p = 0.891) in addition to the total days of antimicrobial use (0.3 vs 0.2 days, p = 0.460). A total of 3 patients (7%) were de-labeled based on penicillin allergy assessment. The pre-implementation group demonstrated higher overall drug cost utilization, largely driven by more costly antimicrobial agents ordered. This difference may become more pronounced with a larger sample size, suggesting potential for meaningful cost savings at scale.

Conclusion:
Patients in the post-implementation group received guideline-recommended first-line antimicrobials more often than those in the pre-implementation group; however, this study was underpowered to detect statistical significance. Patients in the post-implementation group that were appropriately identified and screened were able to be successfully de-labeled. Most de-labeling occurred through an allergy/immunology referral consult and oral amoxicillin challenge. Further studies with larger sample sizes are warranted to better evaluate the impact of this intervention.

[email protected]

Moderators

Jeremy Walley

Presenters

Martine Abouchabki

PGY2 Pediatric Pharmacy Resident, Wellstar MCG Health

Evaluators

Jessica Sterchi

Clinical Pharmacy Supervisor and Acute Care PGY1 RPD, BMHT1Blount Memorial HospitalPGY1

Thursday April 30, 2026 11:40am - 12:00pm EDT
Athena J

Pediatric (PED), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

12:00pm EDT

Systemwide Implementation of a Centralized Remote Order Verification Pilot

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Olympia 2

Background: Onsite clinical pharmacists balance order verification with a range of concurrent responsibilities. These include consults, multidisciplinary rounds, admission and discharge medication reconciliation, and constant involvement with their respective patient care teams. Increasing demands in any one of these areas can limit availability for higher-value clinical activities. A centralized remote order verification (ROV) pharmacist model was created to alleviate these demands. The intention was to support safe and timely order verification, redistribute workload, and allow onsite clinical pharmacists to prioritize clinical responsibilities while maintaining operational efficiency.

Methods: An ROV pilot was first implemented at a single hospital for a 2-week period. The ROV pharmacist would be allowed to verify medication orders remotely, while multiple order types were excluded from the ROV scope. Exclusions included total parenteral nutrition (TPN) orders, pediatric orders (<18 years old), intensive care unit (ICU) orders, non-formulary medications, medications with a listed health-system defined criteria for use (CFU), and a predefined list of emergency department orders. The ROV pharmacist was also allowed to practice within the health-system’s established clinical scope which included interventions such as dose optimization, intravenous-to-oral, and therapeutic interchanges. This ROV model was later approved to expand via three additional 2-week pilots across seven sites. These pilots were also used as an opportunity to test the capacity of a single ROV pharmacist to support multiple campuses. One pilot involved having the ROV pharmacist cover three sites simultaneously, while the other two pilots involved covering two sites at once. A single ROV pharmacist covered all pilot periods. The general model was implemented at most participating sites. At two larger hospitals, the pilot was modified to align with the sites’ existing workflows, and these sites assigned campus designated verification queues to the ROV pharmacist.

Results: After the initial pilot supported the concept, the second pilot showed the ROV pharmacist verified 29.76% of all orders during the shift time, with a total of 7,562 orders verified. Time in the queue shifted more to the 5 to 10 minute and 10 to 15 minute ranges, but the overall dispensing turnaround time decreased by one minute and 21 seconds. The third pilot saw similar numbers with the ROV pharmacist verifying 32.76% of all orders, 7,072 orders in total, and a similar shift with time in the queue. The dispensing turnaround time remained steady increasing by 12 seconds.

Conclusions: The ROV model was able to effectively absorb a significant verification burden without having any operationally significant slowdown. Overall, the model supports capability of creating additional capacity for onsite pharmacist to focus on other clinical and time intensive tasks.

Moderators

Sarah Blackwell

PGY1 Pharmacy RPD/ Clinical Pharmacy Specialist, Medical Critical Care, Baptist Health Princeton Hospital

Presenters

E Marineau

PGY1 Resident, AdventHealth

PGY1 Resident at AdventHealth Orlando

Evaluators

Olivia Caron

PGY2 Ambulatory Care RPD, MAHEC

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Olympia 2

Administration (ADM), AdventHealth Orlando

global Y

12:00pm EDT

Closing the Immunization Gap: Using the RE-AIM Framework to Assess a Pharmacy-Led Initiative- Lauren Mikell

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena B

Closing the Immunization Gap: Using the RE-AIM Framework to Assess a Pharmacy-Led Initiative
Lauren Mikell, Courtney E. Gamston, Greg Peden, Kimberly Braxton Lloyd Auburn University Clinical Health Services -Auburn, AL

Background/Purpose: Vaccinations are critical to prevent illness and complications, while reducing the burden on the healthcare system. Despite these known benefits, immunization uptake in Alabama remains low. Triggered in June 2025 by the CDC’s expanded recommendation for Respiratory Syncytial Virus (RSV) vaccination to individuals aged 50–59 years old with risk factors, an employer-based pharmacy implemented a targeted initiative to close immunization gaps in individuals identified based on pharmacy dispensing records and immunization history.

Methodology: In a one closed-door pharmacy, dispensing records in combination with Alabama Immunization Patient Registry with Integrated Technology (ImmPRINT) were used to assess the need for immunization. In alignment with recommendations for RSV vaccine receipt, patients aged 50 to 74 years taking an SGLT-2 inhibitor, sacubitril/valsartan, insulin, or maintenance inhaler, and those aged 75 and older were identified and reviewed for need for immunization. Patients who had not received their recommended vaccinations were contacted via telephone and invited to the pharmacy for vaccination. Informed by the results, a second round of identification and review was completed for patients aged 50 to 59 years that had not received a pneumococcal immunization through the pharmacy. The RE-AIM implementation science framework was utilized to assess the implementation of this process. Outcomes included Reach: the number of patients identified, reviewed, and contacted; Effectiveness: the number and percentage vaccinated, number and types of vaccines administered; and Implementation: adherence to the protocol and opportunities for improvement.

Results: From August 2025 to March 2026, 363 identified patients were reviewed. A total of 1,291 vaccines were identified as due. Contact was attempted for 284 patients, with 131 successfully contacted (46.1%). Among those reached, 63 (22.2%) expressed that they were either not interested in vaccination or not interested in receiving their vaccines at the clinic and 36 (12.6%) patients reported intention to call the clinic later to schedule their vaccinations. Out of the 252 vaccines recommended to patients via phone, 113 were accepted. As of April 1st, 52 vaccines have been administered in the clinic.

Conclusions: This method was effective for identifying individuals with gaps in immunization receipt. However, the rate of filling those immunization gaps remains low. Over 40% of patients were unreachable via telephone, necessitating investigation of other models of informing patients of their immunization needs. The ability to contact patients to convey the need for vaccination and provide education simultaneously may aid in increasing rates of immunization and strengthen engagement with the service.

Moderators

Elora Hilmas

Pharmacy Clinical Manager, ECU Health

Presenters

Lauren Mikell

Evaluators

Brian Hairston

Critical Care Clinical Specialist, FMOL Health | St. Dominic

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena B

Ambulatory Care (AMB), Auburn University Clinical Health Services

global Y

12:00pm EDT

Characterization of P2Y12 Platelet Function Test Assessment on Antiplatelet Utilization

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Parthenon 1

Background: Despite its prevalence in clinical practice and its widely accepted role in dual antiplatelet therapy regimens, clopidogrel has demonstrated significant interpatient pharmacokinetic variability and pharmacodynamic responses. Poor metabolizers are at increased risk of cardiovascular events following coronary stenting secondary to their inability to properly metabolize the inactive compound into its active form. Platelet reactivity testing measures the degree of platelet aggregation following the administration of an antiplatelet. Using the VerifyNow-P2Y12 Assay, a P2Y12 reaction unit (PRU) ≤208 indicates adequate platelet inhibition, while a PRU >208 indicates inadequate platelet inhibition. Current acute coronary syndrome guidelines do not recommend platelet function testing, however the JACC International Consensus Statement on Platelet Function and Genetic Testing in Percutaneous Coronary Intervention recommends consideration of platelet function testing to guide escalation strategies, de-escalation strategies, or in patients being considered for antiplatelet monotherapy with clopidogrel. In response to a sentinel event at Prisma Health where a patient with a PRU >208 was discharged on clopidogrel, PRU results were added to clinical monitoring for pharmacist assessment. The goal of this research is to assess pharmacist intervention following platelet function testing and characterize clopidogrel utilization in response to PRU levels.
Methods: This is a retrospective, observational cohort study including patients admitted to Prisma Health with coronary stenting and a platelet function test performed with resulting PRU level on clopidogrel. Patient cohorts include those with levels ≤208 (clopidogrel responders) and those with levels >208 (clopidogrel non-responders). The primary endpoint is the percentage of patients on clopidogrel with a PRU >208 that were intervened on by a pharmacist. Secondary endpoints include percentage of patients with high-risk characteristics, contraindications to a preferred P2Y12 inhibitor, appropriate PRU timing and transition to alternative P2Y12 inhibitor, and cardiovascular outcomes.
Results: In progress
Conclusion: In progress

Moderators

Jared Briones

Clinical Pharmacist, Adventhealth Apopka

Presenters

Kristina Benbow

Evaluators

Randy Hooks

Clinical Pharmacist, East Alabama Medical Center

Internal Medicine- East Alabama Health

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Parthenon 1

Cardiology (CAR), Prisma Health Richland - University of South Carolina

global Y

12:00pm EDT

Impact of an Inpatient Heart Failure Consult Service on Readmission Rates and Guideline-Directed Medical Therapy Prescribing: A Single-Center Pre-Post Intervention Study

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Olympia 1

Title: Impact of an Inpatient Heart Failure Consult Service on Readmission Rates and Guideline-Directed Medical Therapy Prescribing: A Single-Center Pre-Post Intervention Study
Authors: Margaret Matthews, Jessica Yarbrough, Rachel Robinson
Purpose: The 2022 AHA/ACC/HFSA Heart Failure Guideline endorses the initiation, continuation, and reinitiation of guideline-directed medical therapy (GDMT) during hospitalization to improve clinical outcomes for patients with heart failure. GDMT use often varies in the hospital setting based on the patient’s clinical status, individual provider preference, concerns about transitions-of-care, and the dynamic course of acute heart failure. To standardize inpatient management and enhance GDMT optimization, our institution implemented an interdisciplinary inpatient heart failure consult service composed of an advanced heart failure cardiologist, clinical pharmacist, and nurse navigator. This study evaluated the impact of the service on 30-day readmission rates and GDMT prescribing patterns at our rural community hospital.
Methods: This single center, retrospective, pre-post intervention study included patients ≥ 18 years old admitted with a primary diagnosis of heart failure. Exclusion criteria followed the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program criteria for heart failure readmissions. The pre-implementation period occurred from January 2024 to June 2024, and the post-implementation period occurred from June 2025 to November 2025. The data collected included patient demographics, renal function, heart failure type, discharging provider, GDMT changes during admission, GDMT prescribed at discharge, and documented contraindications. The primary outcome was 30-day-all-cause readmission rate. Secondary outcomes included 30-day heart failure-related readmission rate and change in GDMT from admission to discharge. Primary and secondary outcomes were compared between the pre- and post-implementation groups using descriptive statistics, with continuous data reported as means and categorical data reported as frequencies and percentages.
Results: A total of 447 patients were included in the analysis, with 254 patients in the pre-intervention group and 193 patients in the post-intervention group. Baseline demographics were similar between groups. Thirty-day all-cause readmission rates remained unchanged following implementation of the inpatient heart failure consult service (27% pre-intervention vs 27% post-intervention). Heart failure-related readmissions among readmitted patients decreased numerically from 51% in the pre-intervention group to 45% in the post-intervention group. Appropriate GDMT prescribing improved from admission to discharge in both groups, with a greater absolute improvement observed post-intervention (+38%, 36% to 74%) compared with pre-intervention (+13%, 41% to 54%). The largest post-intervention increases in individual GDMT classes were observed with mineralocorticoid receptor antagonists (+28%) and sodium-glucose cotransporter-2 inhibitors (+20%). Among post-intervention patients, 40% received a heart failure consult, with 27% readmitted within 30 days.
Conclusion: Implementation of an inpatient heart failure consult service was associated with increased use of GDMT at discharge and supported a more standardized approach to care. No difference in 30-day readmission rates was observed; however, not all eligible patients received a consult, which may have limited the overall impact of the intervention. Greater consult utilization and continued acceptance may further improve clinical outcomes, including readmissions.

Moderators

Heather Stanley

Presenters

Margaret Matthews

PGY1 Pharmacy Resident, Self Regional Healthcare

Margaret Matthews, PharmD, earned her undergraduate degree from Presbyterian College (Class of 2021), where she majored in biology with a minor in chemistry. She went on to receive her Doctor of Pharmacy from Presbyterian College School of Pharmacy (Class of 2025). She is currently... Read More →

Evaluators

Blake Johnson

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Olympia 1

Cardiology (CAR), Self Regional Healthcare

global Y

12:00pm EDT

Clinical Outcomes with Cefazolin Compared to Broad-Spectrum β-lactams as Targeted Therapy for MSSA Bacteremia

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena I

Background: Staphylococcus aureus is one of the most clinically significant bacterial pathogens and can cause a wide range of infections, from mild skin and soft tissue infections to invasive bloodstream infections with severe complications. The standard of care for methicillin-susceptible S. aureus (MSSA) bloodstream infections has been an antistaphylococcal penicillin or a first-generation cephalosporin, such as cefazolin (CZ). Recent literature has shown no efficacy difference between CZ and antistaphylococcal penicillins, but has shown that CZ may be associated with less side effects. This has led to CZ becoming the preferred agent for MSSA bacteremia at our institution. MSSA is also covered by most broad-spectrum β-lactams, including piperacillin-tazobactam (TZP), cefepime (FEP), ertapenem (ETP), and meropenem (MEM). These broad-spectrum agents are primarily used for their activity against Pseudomonas aeruginosa or pathogens at high risk for inducible AmpC production, such as Enterobacter cloacae or Klebsiella aerogenes. Of note, ETP lacks anti-pseudomonal coverage but is used for treatment of other resistant pathogens, such as extended-spectrum β-lactamase (ESBL) producing organisms. In cases of polymicrobial infections, these broad-spectrum β-lactams may be used as targeted therapy for MSSA in addition to the gram-negative pathogens. These agents are also sometimes used in neutropenic patients to treat MSSA while maintaining anti-pseudomonal prophylaxis when indicated. While in vitro activity is expected, there are limited data examining the clinical outcomes of these broad-spectrum β-lactams as targeted therapy for invasive MSSA infections.

Methods: This was a system-wide, retrospective, cohort study conducted at ECU Health assessing hospitalized adults with MSSA bacteremia. Included patients were treated with ≥ 7 days of monotherapy CZ or one of the following broad-spectrum β-lactams: TZP, FEP, ETP, or MEM between August 2019 and December 2025. Patients were excluded if they had MRSA isolated or if they received other antibiotics active against MSSA while receiving the study drug. Patients were identified using SlicerDicer within EPIC and then screened for inclusion. The primary outcome was treatment failure, defined as a composite of 90-day all-cause mortality, 90-day hospital re-admission, and 90-day recurrent MSSA bacteremia. Secondary outcomes included the individual components of the primary outcome at 30 days and 90 days, 90-day C. difficile infections, and new multidrug-resistant organisms isolated within 90 days.

Results: 1,435 patients with S. aureus blood cultures from August 2019 to December 2025 were screened. Of these, 33 patients on broad-spectrum β-lactams were eligible for inclusion (TZP=12, FEP=9, ETP=6, and MEM=6). 33 patients on CZ were then identified for balanced sample sizes, with a total of 66 patients included in the analysis. Average age, BMI, and duration of therapy, were similar between the two groups. The most common reason for exclusion was receiving the study drug for < 7 days (62%). Patients in the broad-spectrum group had nearly twice as long hospital length of stay compared to the CZ group (31 vs 17 days). Patients treated with broad-spectrum β-lactams were more likely to meet the 90-day primary outcome compared to those treated with CZ (OR 0.29; 95% CI 0.10-0.79; p=0.01). This was primarily driven by reduced 90-day mortality and 90-day re-admission.

Conclusion: This study showed a significant benefit in patients that received CZ over broad-spectrum β-lactams in the treatment of MSSA bacteremia. This study adds to the small amount of data comparing outcomes in patients with MSSA bacteremia treated with broad-spectrum β-lactams. Larger, prospective studies are warranted to further explore the most optimal broad-spectrum β-lactam for MSSA when additional coverage is needed.

Moderators

Lena Tran

Pharmacist, AdventHealth Kissimmee

Presenters

Noah Sanford

Evaluators

Jonathan Alligood

Residency Program Director, Phoebe Putney Memorial Hospital

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena I

Community Pharmacy (CP), ECU Health Medical Center

global Y

12:00pm EDT

Post-Thrombectomy Tirofiban in High-Risk LVO Stroke: Evaluating Early Neurological Deterioration

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena A

Background: Acute ischemic stroke (AIS) is a major cause of disability and death in the United States. Early medical management for AIS is essential for reducing morbidity and mortality. While mechanical thrombectomy (MT) has been shown to improve outcomes in patients with large-vessel occlusions (LVO), complications such as re-occlusion and early neurological deterioration (END) continue to pose significant challenges. Glycoprotein IIb/IIIa inhibitors, such as tirofiban, have demonstrated potential benefit in a subset of patients following thrombolytic and/or MT; however, data supporting their routine use post-thrombectomy is limited. Piedmont Columbus Regional Midtown (PCRM) currently uses tirofiban in select post-thrombectomy patients at high risk of re-occlusion , determined by the treating physician based on clinical presentation and angiographic findings. This study aims to evaluate the safety and efficacy of PCRM’s targeted post-thrombectomy tirofiban strategy compared to a matched cohort from the pre-tirofiban era, with a focus on functional outcomes and END.
Methods: A retrospective matched cohort study was conducted on adult patients with LVO stroke who received tirofiban within 3 hours of MT at Piedmont Columbus Regional Medical between January 1, 2024 and December 31, 2025. The primary outcome objective was incidence of END, defined as increase in National Institutes of Stroke Scale (NIHSS) of > 2 within 24 ± 6 hours of mechanical thrombectomy (MT). Secondary objectives included frequency of re-intervention within 48 hours of initial MT, modified Rankin Scale (mRS) at discharge or 90-days post initial intervention, and rate of symptomatic intracranial hemorrhage. A control group was constructed using exact matching on key pre-treatment variables. In total, six patients were included in the treatment group and twelve patients were included in the control group. Data were analyzed using t-tests for continuous variables and Fisher’s exact test for categorical variables.
Results: For the primary objective of END, 50% of patients in the treatment group meet END criteria versus 20% in the control group. For secondary objectives, one patient in the control group required re-intervention while no patients in the treatment group required re-intervention. All treatment group participants had a discharge/90-day mRS of 3-5 compared to 66.7% of control group participants. No patients in either group experienced symptomatic hemorrhagic conversion. None of these outcomes were found to be statistically significant.
Conclusion: There were no statistically significant differences in assessed safety or functional outcomes between groups.
Contact: [email protected]

Moderators

Elaina Baaklini

Presenters

Brooke Landry

PGY-2 Critical Care Pharmacy Resident, Piedmont Columbus Regional Midtown

Evaluators

Liz Oglesby

Pharmacy Clinical Coordinator, PGY-1 Residency Program, Mobile Infirmary

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), Piedmont Columbus Regional Midtown

global Y

12:00pm EDT

The Incidence and Timing of Venous Thromboembolism After 4-Factor Prothrombin Complex Concentrate Administration in Trauma Patients

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena D

Title: The Incidence and Timing of Venous Thromboembolism After 4-Factor Prothrombin Complex Concentrate Administration in Trauma Patients

Authors: Gregory Gurin, Sharon Jordan, Aysu Erdemir

Grand Strand Medical Center – Myrtle Beach, SC

Background/Purpose: Non-activated 4-factor prothrombin complex concentrate (4F-PCC) has been increasingly utilized in trauma patients for hemostasis. This class of medication and the trauma population can increase the risk of thromboembolic complications, necessitating safe and effective prophylaxis. This study is designed to examine the relationship between incidence and timing of venous thromboembolism (VTE) with delayed prophylaxis after 4F-PCC administration in trauma patients.

Methodology: This retrospective study analyzed 2,664 patients aged ≥18 years admitted through the emergency department for traumatic injury and received ≥1 dose of 4F-PCC within 24 hours of arrival. Patients were noted to have high-risk trauma features that include traumatic brain injury, spinal cord injury, long bone fracture, pelvic fracture, and solid organ injury. The primary outcome was the incidence and timing of in-hospital venous thromboembolism. Secondary outcomes included in-hospital mortality, intensive care unit (ICU) admission, ICU length of stay (LOS), and 30-day mortality rate.

Results: Among patients in the final analytical cohort that received chemoprophylaxis, VTE occurred in 103 (3.9%) cases. VTE occurred in 5.1% of patients receiving delayed prophylaxis (>48 hours) compared with 2.4% of those receiving prophylaxis within 48 hours. Male sex (HR = 2.05, p < 0.001), history of VTE (HR = 5.59, p < 0.001) and solid organ injury (HR =2.43, p = 0.011) was associated with an increased risk of developing VTE. In survivors, the same risk factors increase the risk of VTE in addition to spinal cord injury (HR = 3.3, p = 0.017) and increased Elixhauser comorbidity score (HR = 1.16, p = 0.004). Concurrent use of pro-hemostatic agents (tranexamic acid and desmopressin) did not increase the risk of VTE. The median time from 4F-PCC administration to VTE was 135.1 hours (57.4-234.9 hours). Delayed prophylaxis was not associated with a higher risk of in-hospital mortality (HR 1.07; 95% CI 0.84–1.36; p = 0.60) or 30-day mortality (OR 1.10; 95% CI 0.86–1.39; p = 0.46). Delayed prophylaxis was associated with a 2.12-fold increase in the odds of ICU admission (OR = 2.12; 95% CI, 1.63–2.76; p < 0.001). Among patients with any ICU stay, delayed prophylaxis was associated with 60% longer ICU length of stay (IRR = 1.60; 95% CI, 1.46–1.76; p < 0.001). These results represent multivariable adjustments using major demographic and baseline clinical variables.

Conclusions: Delayed pharmacological VTE prophylaxis after 4F-PCC administration in trauma patients was not associated with higher risk of VTE or mortality. However, delayed prophylaxis was associated with increased ICU admission rates and longer ICU LOS. Although 4F-PCC was not associated with increased VTE risk or mortality, current medical management should continue to prioritize VTE prophylaxis once hemostasis has been achieved to minimize complications.

Contact email: [email protected]

“This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.”

Moderators

Jessica Ringler

Presenters

Gregory Gurin

Pharmacy Resident, HCA Grand Strand Medical Center

Dr. Gurin earned his Doctor of Pharmacy degree from the University of New England School of Pharmacy. His professional interests include critical care and administration. Upon completion of his residency, he aims to pursue a position as a critical care pharmacist with future goals... Read More →

Evaluators

Kaitlyn Ledet

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena D

Critical Care/Emergency Medicine (CCM), Grand Strand Regional Medical Center

global Y

12:00pm EDT

Daptomycin Combination Therapy with Ceftaroline versus Anti-Staphylococcal Beta-Lactams for the Treatment of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena G

Title:
Daptomycin Combination Therapy with Ceftaroline versus Anti-Staphylococcal Beta-Lactams for the Treatment of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia

Authors:
Christopher Staten, PharmD
Kelvin Gandhi, PharmD, BCIDP
Lindsey Moeller, PharmD, BCPS

Background:
Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is poorly defined and not well established; recent literature characterizes it as a bloodstream infection with ongoing positive blood cultures for two or more days despite receipt of targeted therapy against MRSA. Persistent bacteremia may occur in up to 39% of S. aureus bacteremia cases, and has been associated with increased mortality, risk of metastasis, and incidence of microbiologic relapse. Traditional pharmacotherapy includes either vancomycin or daptomycin, however when persistent MRSA bacteremia is present, synergistic therapy is oftentimes explored to assist in microbiological eradication. Combination therapies of beta-lactams with daptomycin are currently being clinically evaluated due to their theorized enhancement of daptomycin binding based on data from in vitro studies. Beta-lactam synergy with daptomycin may increase depolarization of the bacterial cell wall to improve daptomycin efficacy and bactericidal activity. Despite strong in vitro data, the in vivo data is inconsistent when demonstrating impact on clinical outcomes. Ceftaroline is most commonly utilized in clinical practice as the synergistic adjunctive agent of choice with daptomycin due to its strong in vitro data, however it is more costly compared to other studied adjunctive agents such as anti-staphylococcal beta-lactams (ASBL).

Methods:
This was a retrospective multicenter cohort study that included hospitalized adult patients with at least one blood culture positive for MRSA from September 1, 2022 to October 31, 2025 at AdventHealth East Florida Division hospitals. Patients were allocated into two groups, either daptomycin plus ceftaroline (DPT/CFT), or daptomycin plus an ASBL (DPT/ASBL), which included cefazolin and oxacillin. Patients were included if they received 72 hours of combination therapy in either group. Excluded patients were those under 18 years of age, pregnant, or received less than 72 hours of combination therapy. The primary outcome was composite clinical failure; composed of 60-day mortality, 60-day recurrence, and persistent bacteremia at day five of combination therapy. A non-inferiority threshold was set at 10.0% based on incidence rates demonstrated by pertinent literature. A multivariate logistic regression was performed on the primary outcome to assess possible confounding variables.

Results:
A total of 53 patients were investigated in this study, 41 in DPT/CFT and 12 in DPT/ASBL. The primary outcome of composite clinical failure was met in 13 (31.7%) in the DPT/CFT group and 3 (25.0%) patients in the DPT/ASBL group (ARD 6.71). The difference of 6.71% did reach the threshold set for non-inferiority of 10% difference. A multivariate logistic regression analysis showed no statistically significant associations identified for the primary outcome by ICU admission, Charlson Comorbidity Index (CCI), time to source control, and duration of combination therapy.

Discussion:
This retrospective analysis comparing daptomycin plus ceftaroline (DPT/CFT) to daptomycin plus ASBL (DPT/ASBL) for persistent MRSA bacteremia, demonstrated that DPT/ASBL was non-inferior to DPT/CFT. Of note, patients in the DPT/CFT arm were generally more critically ill; though not reflected in the differences in APACHE II score, CCI, or Pitt Bacteremia Score, they had more complicated sources of infection, higher ICU admission rates, and increased clinical instability, potentially impacting outcomes.

Conclusion:
Nonetheless, our findings ultimately suggest that DPT/ASBL combination may be an alternative regimen to DPT/CFT in a select clinical context. This combination could provide an alternative option for persistent MRSA bacteremia, but prospective studies are needed to better define the comparative clinical efficacy and safety in different patient populations.

Moderators

Megan Freeman

Presenters

Christopher Staten

PGY-1 Pharmacy Resident, AdventHealth Daytona Beach

My name is Christopher, I go by Ty, I am a PGY-1 Pharmacy Resident at AdventHealth Daytona Beach. I graduated in 2025 from Marshall University School of Pharmacy in West Virginia and attended Ohio Northern University for undergraduate. I have worked in retail pharmacy, hospital pharmacy... Read More →

Evaluators

Haley Smith

Neuro Critical Care Pharmacy Specialist / PGY1 RPD, Our Lady of the Lake Regional Medical CenterPGY1

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena G

Infectious Disease (ID), AdventHealth Daytona Beach

global Y

12:00pm EDT

Fall Occurrences in Relation to Psychotropic Medications: Association with Polypharmacy and Anticholinergic Burden - Brie Levy

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena C

Moderators

Eric Marr

PGY1 Residency Program Director, Baptist Health Lexington

Presenters

Brie Levy

PGY1 Pharmacy Resident, Parkridge Health Systems

Graduated from ETSU Bill Gatton College of Pharmacy. Current PGY1 pharmacy resident at Parkridge Medical Center in Chattanooga, TN. Will be doing a PGY2 in palliative care and pain management at TVHS in Murfreesboro, TN.

Evaluators

Erin Pace

Ambulatory Care Pharmacist, KFHP1Kaiser Foundation Health Plan of Georgia (Managed Care)PGY1

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena C

Internal Medicine (IM), Parkridge Health System

global Y

12:00pm EDT

Assessing Appropriate Use of Trastuzumab and Pertuzumab-Containing Product Reloading Doses After Treatment Delays and Their Effect on Outcomes

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena H

Purpose: Trastuzumab, with or without pertuzumab, is used in the treatment of human epidermal growth factor receptor 2-positive (HER2+) metastatic breast cancer. Both of these monoclonal antibodies require loading doses at treatment initiation and after specified dose delays per their package inserts. This dosing rationale is based on pharmacokinetic studies in patients with solid tumors, which evaluated the time required for serum drug levels to return to steady state after dose interruptions when a patient is not reloaded. Despite this guidance, it is suspected that not all providers prescribe reloading doses as recommended after delays in treatment. To our knowledge, there are no published studies investigating the real-world patient outcomes of not reloading these medications.

Methods: This IRB-approved, retrospective cohort analysis was designed to evaluate the incidence of reloading pertuzumab- and trastuzumab-containing products and their impact on disease progression. Patients were categorized into two groups: those who were appropriately loaded after a dose delay, as defined in the respective medication package inserts. and those who were not. Patients were randomized at a 1:1 ratio. The primary endpoint was to determine which patients were appropriately loaded compared to those who were not. Secondary endpoints included median time of dose delay, reason for dose delay, prescriber-dependent reloading dose practices, and time to disease progression. Descriptive statistics were used to define which patients were appropriately loaded compared to those who were not, the reason for dose delay, and which providers did or did not reload appropriately. A Kruskal-Wallis H test was used to determine the median time of dose delay. A Mann-Whitney U test was used to determine the time to disease progression.

Results: The study included a total of 29 patients. Of the 29 patients, seven patients (24.1%) were reloaded appropriately, and 22 patients (75.9%) were not reloaded appropriately after treatment delay. The median time of dose delay was 21 days (IQR 21-40 days). Many dose delays were not adequately documented with a reason for the delay (31%). The most commonly documented reason for dose delay was hospitalization (27%). When assessing the effect this had on disease progression, patients who were reloaded had a median time to progression of 1461 days (IQR 307-3302), and patients who were not reloaded had a median time to progression of 686 days (IQR 257-967). This difference was not statistically significant (p = 0.36).

Conclusion: This study showed the median time to progression of disease was longer in patients who were properly reloaded after a dose delay. However, this was not statistically significant and did contain a potential outlier in the appropriately reloaded group. The small sample size was a limitation, and therefore, the study was unable to meet power. Future studies are warranted to further assess the impact that reloading may have on disease progression with a larger patient population and potentially including patients with additional disease states that include HER2+ directed therapy.

Moderators

Hannah Schmoock

Internal Med Clinical Pharmacy Specialist, PGY1 Acute Care RPC, McLeod Regional Medical Center

Presenters

Trevyn Flanders

Evaluators

Adam Harnden

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena H

Oncology (ONC), University of Tennessee Medical Center

global Y

12:00pm EDT

Evaluating Appropriate Treatment of Neonatal Late Onset Sepsis in a Level III Neonatal Intensive Care Unit

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Athena J

Background/Purpose: Neonatal sepsis remains a leading cause of neonatal mortality in the United States despite advances in intrapartum screening and antibiotic administration. Late onset sepsis (LOS) is defined as suspected or confirmed sepsis at greater than seventy-two hours of life. Patient presentation is often nonspecific, creating a low threshold for empiric treatment, which may lead to unnecessary antimicrobial administration and increased development of resistant organisms. Previously, there was not a standardized workflow for treating LOS in our neonatal intensive care unit (NICU) and special care nursery (SCN). This led to variations in practices and created an opportunity for care optimization. A pharmacy-driven order set for empiric therapies in the treatment of LOS was implemented at our institution, composed of screening suggestions and empiric antibiotic recommendations based on specified patient risk factors. This review evaluated the appropriate use of this new order set and how effectively LOS is managed by evaluating appropriate antimicrobial selection and culture collection.

Methodology: This was a multi-center, IRB-reviewed determined exempt, retrospective cohort review conducted at the Moses Cone Memorial Hospital NICU and Alamance Regional Medical Center SCN in Greensboro and Burlington, NC, respectively. On November 1, 2024, a pharmacy-driven order set for empiric neonatal LOS treatment went live at both sites. For this evaluation, patients were included if they were admitted to either site and received antimicrobial agent(s) for the treatment of LOS. Patients were excluded if they received antimicrobial(s) for another known indication or if they received antimicrobial agent(s) but were not admitted to one of the study locations. Patients were then divided into a pre-group from December 1, 2023 through October 31, 2024 and a post-group from December 1, 2024 through October 31, 2025. The primary outcome was the composite of positive cultures covered by empiric antibiotics and adequate coverage of “culture negative” sepsis with empiric antimicrobials based on patient risk factors and suspected infection source. Secondary outcomes included number of instances in which 2 initial blood cultures were obtained, percentage of patients with positive blood cultures who had repeat blood cultures obtained, average days of therapy, use of the late onset sepsis order set, and whether appropriate doses of antimicrobials were utilized.

Results: 89 instances of LOS in 60 patients were included in the study. There were 51 instances of LOS included in the pre-order set group, and 38 instances included in the post-order set group. The primary composite outcome of positive cultures covered by empiric antibiotics and adequate coverage for culture negative sepsis was 71% in the post-order set group and 66.7% in the pre-order set group (p=0.659). In the post-order set group, providers were more likely to obtain a set of two blood cultures (instances with 2 initial blood cultures obtained 5.9% vs 57.9%, p<0.001). The pharmacy-driven order set was utilized in 55.3% of instances in the post-order set group. Other secondary outcomes were similar between groups.

Conclusions: The implementation of a pharmacy-driven order set at our institution resulted in a clinically significant increase in empiric coverage of culture negative sepsis and significant trend in increase in number of initial blood cultures collected. There was not a significant difference in the percentage of positive cultures covered by empiric antibiotics. Common reasons that empiric therapy did not cover culture negative sepsis included lack of anaerobic coverage in suspected infections of intraabdominal sources and lack of MRSA coverage in patients with MRSA risk factors. Potential limitations to this evaluation include limited sample-size, single-institution review, and variability of provider preference. Future directions include assessing barriers to utilization of the LOS order set and implementation of strategies to increase utilization.

Moderators

Jeremy Walley

Presenters

Karlen Brovey

Evaluators

Jessica Sterchi

Clinical Pharmacy Supervisor and Acute Care PGY1 RPD, BMHT1Blount Memorial HospitalPGY1

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Athena J

Pediatric (PED), Cone Health

global Y

12:00pm EDT

Beyond First-Line: A Retrospective Evaluation of Vilazodone and Vortioxetine in Veterans with Treatment-Resistant Depression

Thursday April 30, 2026 12:00pm - 12:20pm EDT

Parthenon 2

Madison Brotze and Mark LaBossiere
James H. Quillen VA Medical Center – Mountain Home, TN
Contact Information: [email protected]
Background/Purpose: Depression is common among Veterans, and many do not respond to multiple antidepressant trials, resulting in treatment-resistant depression (TRD). TRD contributes to increased symptom burden, higher healthcare use, and more complex care needs. Vilazodone and vortioxetine are two antidepressants that may offer advantages for Veterans with TRD due to their unique mechanisms and potentially better tolerability profiles. This quality improvement project aims to assess current prescribing of these agents, in addition to evaluating rates of discontinuation, adherence, tolerability, and healthcare utilization associated to identify potential opportunities to improve treatment selection and care processes for Veterans with TRD.
Methodology: This project will identify Veterans initiated on vilazodone or vortioxetine at the James H. Quillen VAMC. Time to discontinuation will be evaluated from the date of medication initiation through 3, 6, and 12 months. Medication adherence will be assessed using the medication possession ratio (MPR), and reasons for discontinuation will be collected from the electronic health record. Healthcare utilization measures, including psychiatric hospitalizations and activation of high-risk suicide flags during treatment, will also be reviewed. Data will be compared between vilazodone and vortioxetine to identify trends, gaps, and opportunities to improve antidepressant management for Veterans with TRD.
Results: In progress
Conclusion: In progress

Moderators

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1

Presenters

Madison Brotze

Evaluators

Jolie Gallagher

Clinical Pharmacy Specialist, Critical Care, Emory University Hospital

Thursday April 30, 2026 12:00pm - 12:20pm EDT
Parthenon 2

Psychiatric Pharmacy (PSY), VA - Mountain Home, TN - James H. Quillen VA Medical Center

global Y

12:20pm EDT

Factors Associated with Successful Publication of Pharmacy Resident Research Projects (Description: Victoria Michel-Milian)

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Olympia 2

Factors Associated with Successful Publication of Pharmacy Resident Research Projects
Title: Factors Associated with Successful Publication of Pharmacy Resident Research Projects
Presenters: Victoria Michel-Milian
Author: Victoria Michel-Milian, Eric K. Shaw, Amy Taylor
Contact information: [email protected]
Background:
American Society of Health-System Pharmacists (ASHP) accreditation standards require pharmacy residents to include research components as part of the practice advancement objective. Despite this, publication rates remain as low as 13% per resident submission, with program publication success rates ranging from 1.8% to 36.2%. Multiple barriers to publication have been suggested but there is a paucity of data for characteristics that lead to successful residency publication. The purpose of this study is to identify key factors that promote successful publication of pharmacy resident research projects.
Methodology:
This study was an observational case-control study of pharmacy residents who presented research projects at pharmacy regional conferences from January 2022 through August 2024. Using ASHP’s list of regional residency conferences, abstracts were identified and assigned a random number to select for inclusion. To identify published vs non-published articles, the included abstracts were cross-referenced with PubMed, Google Scholar, and Web of Science using project titles, author names, and institution affiliations. The primary objective of this study was to determine what factors contribute to successful publications for pharmacy residents. Secondary objectives were to assess potential influencing factors including rates between study characteristics, influence of program characteristics, and commonalities between published studies. In addition to descriptive statistics, chi-square tests and t-tests were performed using SPSS version 28.0.
Results:
This study included 104 abstracts; 15 (14.4%) of were published as of December 1, 2025. Of the outcomes compared, having any author previously published was significantly associated with publication success (80% vs 67.4%, p<0.001). Programs with a research committee also had statistically higher publication rates (60% vs 28.9%, p=0.015). Of the abstracts published, majority of specialties were infectious diseases (23.1%), ambulatory care (18.3%), and critical care (11.5%). Out of the evaluated studies, primary authors were mainly PGY1 residents (78.8%) with the remainder being PGY2 residents (21.2%). Of the published studies, 40% were from a PGY2 program. The mean number of authors per abstract was 3.7 ±1.75. Secondary and tertiary authors most commonly held a PharmD plus a board certification in a specialty (61.7% for secondary and 56.8% for tertiary authorship), with only a few medical degrees (3.2%). There were no significant associations found for when results were published on the conference abstract, center type, listed mentorship program, research coordinator, dedicated time for research or study type. Notably, when comparing published studies, chart reviews had the highest publication rate (29.4%), while quality improvement and surveys had zero published studies. Limitations include incomplete abstract lists across some conferences, inability to confirm resident status for all abstracts, potential author misidentification due to common or changed names, and dependence on websites for program characteristics.
Conclusions:
This study successfully identified some key attributes to pharmacy resident publication including prior publication experience among co-authors, presence of a research committee, and increased number of authors. To increase publication rates, residency programs should consider establishing research committees and ensure residents are precepted by experienced, previously published mentors.

Moderators

Sarah Blackwell

PGY1 Pharmacy RPD/ Clinical Pharmacy Specialist, Medical Critical Care, Baptist Health Princeton Hospital

Presenters

Victoria Michel-Milian

I am a PGY-1 resident at Memorial Health University Medical Center in Savannah, Ga.

Evaluators

Olivia Caron

PGY2 Ambulatory Care RPD, MAHEC

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Olympia 2

Administration (ADM), Memorial Health University Medical Center

global Y

12:20pm EDT

Falling into Z-drugs: An Analysis of Z-drug Use and Fall Risk in Older Adults

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena D

Title: Falling into Z-drugs: An Analysis of Z-drug Use and Fall Risk in Older Adults
Authors: Madelyn Singleton, Laura Schalliol, Kelsee Tignor, Taylor Dabney

Purpose:
This study evaluates the association between Z-drug use and fall risk, evidenced by STEADI Fall Risk Assessment scores (≥4 indicating elevated risk). Z-drugs, including zolpidem (Ambien®, Edluar®), eszopiclone (Lunesta®), and zaleplon, are listed as potentially inappropriate medications in the 2023 Beers Criteria. Findings will help clarify their impact on fall risk and improve prescribing and medication safety in older adults.

Methods:
This study is a single-center retrospective chart analysis including patients 65 or older who completed a Medicare Annual Wellness Visit (MAWV) between January 1 and October 31, 2025, with a STEADI Falls Risk Assessment and an active Z-drug prescription. The STEADI tool utilized is a 12-point questionnaire with scores of ≥4 indicating increased fall risk. Patients were excluded if they had dementia, received hospice or palliative care, or if they resided in a nursing home.

From the de-identified patient list the following data points were collected: patient sex, age, weight, date of MAWV, STEADI Fall Risk Assessment Score, Z-drug prescribed including dose and start date, diagnosis of insomnia or a movement or neurological disorder, documented mobility issues or hearing impairment, care setting, number of medications at time of MAWV and medication list, and history of a fall documented at MAWV. As applicable, a Z-drug end date and insomnia ICD-10 code were recorded. The primary outcome is to evaluate the association between STEADI fall risk scores and the use of Z-drugs. The secondary outcome is to evaluate the association between polypharmacy, defined as ≥5 active medications, and STEADI fall risk scores. Collected data will undergo descriptive statistical analysis.

Results:
Of 78 patients screened, 67 patients were included in the analysis. The average age of the study population was 73 years old and the average STEADI score was 2.3. The most prescribed Z-drug was zolpidem with 52 patients (75%) taking this medication. This study found that 13 patients (19.4%) demonstrated an increased fall risk as shown through the STEADI score with a Z-drug prescription. Additionally, 12 patients (17.9%) were identified as having both an increased fall risk and experiencing polypharmacy.

Conclusion:
In conclusion, the study findings suggest that within the study population there is not an association between Z-drug use and increased fall risk as evidenced by STEADI Fall Risk Assessment Scores of 4 or more.

Moderators

Jessica Ringler

Presenters

Madelyn Singleton

PGY-1 Community Pharmacy Resident, South College School of Pharmacy

Madelyn Singleton is a PGY-1 Community Based Resident at South College School of Pharmacy. She completed her Doctor of Pharmacy at South College School of Pharmacy and is interested in pursuing an ambulatory care position after residency,

Evaluators

Kaitlyn Ledet

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena D

Ambulatory Care (AMB), South College School of Pharmacy

global Y

12:20pm EDT

Pharmacist Impact on Quality of Anticoagulation Management: A Before and After Study

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena B

Pharmacist Impact on Quality of Anticoagulation Management: A Before and After Study

Edward McPartland, Victoria Burnette, Kelley Baxter, Chris Larkin
Ascension Saint Thomas Hospital West

Background/Purpose: Labile International Normalized Ratios (INR), defined as a Time in Therapeutic Range (TTR) less than 60%, has been identified as a key modifiable risk factor for adverse anticoagulation outcomes such as thrombosis or hemorrhage1. Prior evidence demonstrates that even modest improvements in TTR are clinically significant, as increases of 7% and 12% have been associated with the prevention of one major bleeding or thromboembolic event per 100 patient-years, respectively. Within the Ascension Saint Thomas Market (STM), there are several anticoagulation clinics, with Ascension Saint Thomas Hospital West being home to a pharmacist-managed clinic (PMC). In 2024, restructuring within the STM resulted in patients transitioning from one nurse-managed clinic (NMC) to our PMC. This transition provided an opportunity to evaluate clinical outcomes based on differences in clinic structure, such as clinic protocols and scope of practice.
Methodology: This single-center retrospective chart review utilized electronic medical records to evaluate patients managed in the NMC from February 1, 2024 to July 31, 2024, and who were subsequently transferred to the PMC and received care from February 1, 2025 to July 31, 2025. Patients were identified via a transfer list organized by pharmacists during the transfer of care across clinics. Identified patients were reviewed using CoagClinic software for both timeframes, including documented visits and relevant laboratory values. Reports were generated for the specified time periods. Eligible participants were adults (≥ 18 years) who had their INR managed by a healthcare professional at both clinics within the specified timeframe. Patients were excluded if they were pregnant or incarcerated during the study. The primary outcome assessed the difference in TTR between the NMC and PMC. Secondary outcomes included extended TTR (±0.2 INR); peri-procedural bridging with a parenteral anticoagulant; bridging due to subtherapeutic INR; and hospital admissions due to hemorrhagic event, thromboembolic event, or supratherapeutic INR.
Results: A total of 347 patients were screened, of whom 294 met inclusion criteria. Mean TTR was significantly higher in the PMC compared to the NMC (68.2% vs 61.7%, p < 0.001), representing a 6.5% increase. Extended TTR was also significantly improved in the PMC (83.0% vs 75.5%, p < 0.001), corresponding to a 7.5% increase. A clinically significant reduction in hospital admissions due to hemorrhagic events was observed in the PMC compared to the NMC (4 vs 12 events, p = 0.07), although this difference did not reach statistical significance. There were no statistically significant differences in peri-procedural bridging therapy (8 vs 17 events, p = 0.10), subtherapeutic INR bridges (16 vs 8, p = 0.14), hospital admissions due to thromboembolic events (2 vs 2, p = 1), or hospital admissions related to supratherapeutic INR (2 vs 1, p = 1). Additional findings demonstrated significantly more clinic visits in the PMC (13 vs 11 visits, p < 0.001) and improved TTR among high-risk patients with INR goals outside the standard intensity of 2-3 (65.1% vs 56.7%, p < 0.01). Additionally, within the PMC cohort, 8 patients (2.7%) had documented changes to their INR goal during transition from the NMC.
Conclusions: Management within a PMC was associated with significantly improved TTR and extended TTR. Although secondary clinical outcomes did not reach statistical significance, a clinically meaningful reduction in hemorrhagic admissions was observed. The PMC also demonstrated more frequent clinic visits per patient, guideline-recommended goal INR updates, and improved TTR among high-risk patients with INR goal ranges outside of 2–3. These results highlight the potential of pharmacist-managed anticoagulation services to improve anticoagulation quality and facilitate tailored patient care.

Moderators

Elora Hilmas

Pharmacy Clinical Manager, ECU Health

Presenters

Edward McPartland

Evaluators

Brian Hairston

Critical Care Clinical Specialist, FMOL Health | St. Dominic

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena B

Ambulatory Care (AMB), Ascension Saint Thomas Health

global Y

12:20pm EDT

Assessment of Adherence to an Institutional aPTT Level Monitoring Protocol for Unfractionated Heparin Infusions

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Parthenon 1

ASSESSMENT OF ADHERENCE TO AN INSTITUTIONAL aPTT LEVEL MONITORING PROTOCOL FOR UNFRACTIONATED HEPARIN INFUSIONS
George Saied, Rachel Hemberger, Mary Beth Brinkman
TriStar Centennial Medical Center – Nashville, TN
Background: The use of continuous infusion unfractionated heparin (UFH) is common for treatment and prophylaxis of venous thromboembolism (VTE), myocardial infarctions (MI), anticoagulant bridging, and is used second line in several other disease states. UFH has been labeled a “High-Risk Medication” since the early 2000s and has severe adverse effects associated with bleeding and platelet abnormalities. The use of UFH requires close monitoring of laboratory findings, specifically the use of Activated Partial Thromboplastin Time (aPTT), to ensure patient safety and medication efficacy. Supratherapeutic aPTT levels result in increased bleeding risk while subtherapeutic aPTT levels result in increased clotting risk. Due to the frequency of aPTT monitoring, there is potential for delays in blood collection and necessary dose adjustments, thus increasing the risk of patient-safety events. Additionally, there is also potential for aPPT protocol recommendation to be misinterpreted or for the dose to be titrated inappropriately, thus leading to patient-safety events. This study seeks to evaluate adherence to our heparin protocol and identify specific areas for process improvement.

Methods: This was an Institutional Review Board-approved, single-center, retrospective cohort study of adult patients (≥18 years) who received a continuous heparin infusion at TriStar Centennial Medical Center from March 22, 2025 through March 31, 2025. The primary endpoint was adherence to the institutional UFH nursing protocol, defined as appropriate heparin bolus administration, dose titration, and timely aPTT ordering per protocol recommendation. Secondary endpoints included reasons for protocol nonadherence, percentage of aPTT values within the goal therapeutic range, time to achieve therapeutic range, and incidence of bleeding and thrombosis. Drips were followed for the first 72 hours after initiation. Descriptive statistics were used for data analysis.

Results: A total of 59 patients were included (Cardiac Serv, n = 36; DVT/PE, n = 23). The primary outcome of full protocol adherence was achieved in only 7 of 59 patients (11.9%). The most common drivers of non-adherence was incorrect initial drip rate and inappropriate dose titration. The mean percentage of aPTT values within the therapeutic range was 43.6%. Patients who experienced an adverse drug reaction (n=9, 15.3%) had a lower mean percentage of aPTT values in goal compared to those without an ADR (28.6% vs. 46.3%; p=0.056). Time to first therapeutic aPTT was significantly longer in the Cardiac Serv cohort compared to the DVT/PE cohort (0.87 days vs. 0.42 days; p = 0.001). Bleeding events occurred in 6 (10.2%) patients (Cardiac Serv 5.6% vs. DVT/PE 17.4%; p = 0.196) and thrombotic events in 7 (11.9%) patients (Cardiac Serv 8.3% vs. DVT/PE 17.4%; p=0.414). No statistically significant difference in adverse events was identified between cohorts, but trends do support increased risk in DVT/PE versus Cardiac Serv protocols.

Conclusions: Protocol adherence to institutional UFH aPTT monitoring was below goal, with fewer than 1 in 8 patients receiving fully adherent care. Non-adherence was primarily driven by incorrect initial rates and incorrect dose titration. Patients who experienced an ADR spent significantly less time within the therapeutic range, which highlights the clinical consequences of protocol deviations. The Cardiac Serv cohort took a longer time to reach first therapeutic aPTT compared to the DVT/PE cohort. These findings show clear opportunities for targeted nursing education, protocol clarification, and system-level process improvements to optimize UFH therapy and enhance patient safety.

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Moderators

Jared Briones

Clinical Pharmacist, Adventhealth Apopka

Presenters

George Saied

Evaluators

Randy Hooks

Clinical Pharmacist, East Alabama Medical Center

Internal Medicine- East Alabama Health

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Parthenon 1

Cardiology (CAR), TriStar Centennial Medical Center

global Y

12:20pm EDT

The Heart of Monitoring: A Retrospective Evaluation of an Antiarrhythmic Monitoring Program

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Parthenon 2

Title: Retrospective Evaluation of an Antiarrhythmic Monitoring Program
Authors: Kaitlin A Roberts, Rebecca Holt, Cynthia Pohland
Objective: Assess the James H Quillen Veterans’ Affairs Medical Center (JHQVAMC)’s adherence to monitoring recommendations for seven different antiarrhythmic medications (amiodarone, dronedarone, sotalol, dofetilide, mexiletine, propafenone, flecainide).
Self-Assessment Question: Which of the following antiarrhythmics showed significant improvement in adherence to monitoring recommendations between the 2022-2023 resident project and the current resident project? A. Dofetilide, B. Propafenone, C. Dronedarone, D. Flecainide
Background: The purpose of this quality improvement project was to evaluate the current compliance with antiarrhythmic drug (AAD) monitoring program collaboratively developed after a 2023 residency project identified low compliance with routine monitoring.
Methods: Participants were identified by presence of AAD prescription and eligibility was assessed. Patients receiving care at and prescribed an AAD at JHQVAMC between June 2024 – June 2025 were included. Participants were excluded if they were not prescribed an AAD by a VA provider. No more than 50 participants on each antiarrhythmic medication were randomly sampled and retrospectively reviewed to collect the following: demographics (age, sex, race/ethnicity); number of appointments with electrophysiology (EP) providers, non-EP cardiology providers, and cardiology pharmacists; frequency of lab monitoring (potassium (K), magnesium (Mg), liver function tests (LFTs), serum creatinine (SCr), thyroid stimulating hormone (TSH); and frequency of electrocardiograms (EKG). Results of descriptive statistics were used to evaluate compliance with monitoring. The results will then be disseminated to the local EP cardiology team to enhance current practice.
Result: Percentage of appropriate monitoring visits for dronedarone, sotalol, amiodarone, dofetilide, flecainide, mexiletine, and propafenone were 53%, 60%, 80%, 74%, 66%, 90%, and 80% respectively. Percentage of appropriate EKG monitoring for dronedarone, sotalol amiodarone, dofetilide, flecainide, mexiletine, and propafenone was 65%, 66%, 72%, 80%, 72%, 95%, and 80% respectively. The percentage of appropriately monitored labs was as follows: dronedarone had 58% K and LFTs, 16% Mg and TSH; sotalol had 84% K, 46% Mg, 88% SCr; amiodarone had 78% K, 24% Mg, 70% LFTs, 26% TSH; dofetilide had 94% K and SCr, 76% Mg; flecainide had 82% K, 20% Mg, 80% LFTs; mexiletine had 100% K and LFTs, 76% Mg; propafenone had 100% K and LFTs, 40% magnesium.
Conclusions: After pharmacist intervention, JHQVAMC was monitoring the majority of patients on AAD appropriately, with few exceptions that can be improved upon through process improvement such as the creation of lab order sets.

Moderators

Joseph Kohn

PRIS2Prisma Health Richland-University of South CarolinaPGY1

Presenters

Kaitlin Roberts

PGY1 Pharmacy Resident, James H Quillen VA Medical Center

Evaluators

Jolie Gallagher

Clinical Pharmacy Specialist, Critical Care, Emory University Hospital

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Parthenon 2

Cardiology (CAR), VA - Mountain Home, TN - James H. Quillen VA Medical Center

global Y

12:20pm EDT

Impact of GLP-1/GIP Receptor Agonists on HF-Related Hospitalizations

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena I

Impact of GLP-1/GIP Receptor Agonists on HF-Related Hospitalizations

Investigators: Haley Jones, PharmD; Erika Schoenborn, PharmD, BCCP, CPP; Kacy Whyte, PharmD, BCPS, BCCP
Practice Site: ECU Health Medical Center, Greenville, NC
Email: [email protected]

Purpose: Despite advances in guideline directed medical therapy (GDMT), many patients with heart failure (HF) experience persistent symptoms and recurrent hospitalizations. The intersection of HF and metabolic disease is of particular clinical importance, as type 2 diabetes mellitus (T2DM) and obesity are common comorbidities across the HF spectrum and are associated with worse clinical outcomes. Glucagon-like peptide receptor agonists (GLP-1 RAs) are an established treatment for T2DM and have recently gained prominence for their benefits in weight reduction and cardiovascular risk reduction. GLP-1 RAs reduce major cardiovascular events in patients with HFpEF, but conflicting evidence exists on the safety and efficacy in HFrEF. Further investigation is warranted to clarify their role in HF management. The purpose of this study was to assess the association between use of GLP-1 RAs and rate of HF-related hospitalizations for patients with HF.
Methods: This retrospective cohort study included adult patients hospitalized with HF between January 1, 2024, and December 31, 2024. Patients were stratified by LVEF and by receipt of GLP-1 RA therapy. The primary endpoint was the rate of 30-day HF-related readmissions among patients receiving GLP-1 RA compared to those not receiving these medications. Secondary endpoints included 90-day HF-related readmission rates, time to first HF-related hospitalization, change in body weight during the study period, all-cause mortality, and administration of IV diuretics within 90 days. Patients were identified using SlicerDicer based on HF-hospitalizations within the study period, with outpatient prescriptions for a GLP-1 RA (tirzepatide or semaglutide) used to define the treatment group. Data were analyzed using descriptive statistics, Chi-Square, and Mann-Whitney U tests, as appropriate.
Results: A total of 407 patients were screened for inclusion, with 106 patients included in each group. The median age was 69 yrs (IQR 60-77), 52% female, and 53.3% black patients. A total of 22 patients (20.7%) in the treatment group experienced 30-day HF-related readmission, compared with 19 patients (17.9%) in the control group (p = 0.60). Among patients with HFrEF, 30-day readmission occurred in 11 patients (22.9%) in the treatment group and 6 patients (15.8%) in the control group (p = 0.41). At 90 days, HF-related readmission occurred in 38 patients (35.8%) in the treatment group and 41 patients (38.7%) in the control group (p = 0.63). Median time to first HF-related hospitalization was 25 days (IQR 12-64) in the treatment group and 38 days (IQR 15-62) in the control group (p = 0.55). All-cause mortality occurred in 8 patients in the treatment group and 9 patients in the control group (p = 0.80).
In the HFrEF subgroup, increased diuretic doses at 30 days were observed in 27 patients (60.0%) in the treatment group compared with 15 patients (40.5%) in the control group (p = 0.20), and at 90 days in 24 patients (58.5%) versus 14 patients (41.2%), respectively (p = 0.203). In the HFpEF/HFimpEF group, increased diuretic doses at 30 days occurred in 16 patients (37.2%) in the treatment group and 20 patients (41.7%) in the control group (p = 0.91), and at 90 days in 15 patients (37.5%) and 20 patients (46.5%), respectively (p = 0.62).
Conclusions: In this retrospective analysis of patients with HF, GLP-1 RA therapy was not associated with differences in 30-day or 90-day HF-related readmission rates compared with no GLP-1 RA use. Although not statistically significant, a higher proportion of patients with HFrEF receiving GLP-1 RAs required increased diuretic dosing at 30 and 90 days, a pattern not observed in patients with HFpEF/HFimpEF. These findings suggest potential differences in clinical response by ejection fraction and highlight the need for further investigation into the safety and role of GLP-1RA in patients with HFrEF.

Moderators

Lena Tran

Pharmacist, AdventHealth Kissimmee

Presenters

Haley Jones

Evaluators

Jonathan Alligood

Residency Program Director, Phoebe Putney Memorial Hospital

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena I

Community Pharmacy (CP), ECU Health Medical Center

global Y

12:20pm EDT

Does Probiotic Use Protect Against Clostridioides difficile Infections in Patients Taking Antibiotics?

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena A

Does Probiotic Use Protect Against Clostridioides difficile Infections in Patients Taking Antibiotics?

Investigators: Brittany Baskett, Kaitlyn Ledet, Melanie Rae Schrack

Practice Site: FMOL Health - Our Lady of the Lake

Email: [email protected]

Purpose: Patients on prolonged antibiotics are at increased risk of contracting a Clostridioides difficile infection (CDI). The 2017 Infectious Disease Society of America and Society for Healthcare Epidemiology of America guideline for management of CDI stated there is insufficient data to recommend administration of probiotics for primary prevention of CDIs outside of clinical trials, while the 2021 American College of Gastroenterology guideline for management of CDI recommends against prophylactic probiotic use. Recently published data in critically ill patients indicate that probiotics used for CDI prevention during antibiotic therapy may increase the risk of probiotic-related bacteremia. Given a recent rise in probiotic prescribing at this site for primary CDI prevention, this study aimed to evaluate whether probiotics reduce CDI risk in patients receiving antibiotics for five or more days without increasing bacteremia risk.
Methods: This study was a single-center, retrospective chart review of patients admitted to any intensive care or progressive care unit at FMOL Health – Our Lady of the Lake from January 2024 to December 2024. Patients were excluded from data analysis if they were less than 18 years of age, received an antibiotic regimen including less than two antibiotics, antibiotic regimen less than five days or greater than 30 days, had infectious diarrhea of other causes, or a history of pre-existing gastrointestinal disorders. Included patients were split into two groups: receipt of antibiotics without probiotics and receipt of antibiotics with three or more days of concurrent probiotic administration.
The primary outcome was the incidence of hospital-acquired CDI. HA-CDI (hospital-acquired CDI) was defined as a positive C. difficile antigen and toxin test after 72 hours of admission to the hospital. Secondary outcomes included incidence of Lactobacillus bacteremia and percent days covered by probiotics.
Results: A total of 441 patients were included in this study with 147 patients in the probiotic group and 294 patients in the control group. In the control group, one patient (0.3%) was diagnosed with HA-CDI, while five patients (3.4%) in the probiotic group were diagnosed with HA-CDI. There were no incidences of Lactobacillus bacteremia. Average percentage of probiotic coverage was 68% of antibiotic days in the probiotic group.
Conclusion: Among critically ill patients requiring at least two antibiotics for at least five days, there was a difference between groups with HA-CDI occurring more often in the probiotic group. This study supports guideline statements that there is not a widely recognized benefit to prescription of probiotics for prevention of CDI; however, there was no demonstrated harm found in this study.

Moderators

Elaina Baaklini

Presenters

Brittany Baskett

PGY-2 Critical Care Pharmacy Resident, FMOL Health - Our Lady of the Lake

Brittany Baskett is a PGY-2 Critical Care Pharmacy Resident at FMOL Health - Our Lady of the Lake in Baton Rouge, Louisiana. She received her Doctorate of Pharmacy from the University of North Texas Health Science Center and completed her PGY-1 pharmacy residency at Baylor Scott... Read More →

Evaluators

Liz Oglesby

Pharmacy Clinical Coordinator, PGY-1 Residency Program, Mobile Infirmary

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), Our Lady of the Lake Regional Medical Center

global Y

12:20pm EDT

Impact of Early Resumption of Neuropsychiatric Medications on Sedation Outcomes in Critically Ill Patients

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Olympia 1

Title: Impact of Early Resumption of Neuropsychiatric Medications on Sedation Outcomes in Critically Ill Patients
Authors: Jade Gallahair, Victoria Biaggi, Morgan Turney, Joseph Trang

Background: Delirium and agitation are common in critically ill adults and are associated with increased mortality, prolonged ventilation, and longer ICU and hospital stays. Withdrawal from chronic neuropsychiatric medications (NPMs), including SSRIs, SNRIs, benzodiazepines, antipsychotics, and gabapentinoids is a potentially modifiable contributor. Abrupt discontinuation may precipitate withdrawal symptoms such as anxiety, restlessness, insomnia, and psychosis, which can manifest as agitation or delirium in the ICU. Although emerging evidence suggests that early reinitiation of home NPMs may improve sedation and delirium outcomes, existing studies show mixed results, and no standardized guideline informs optimal timing. Additional evaluation is needed to clarify the clinical impact of early NPM resumption. The primary objective of this study is to determine whether early resumption of home neuropsychiatric medications reduces the incidence of agitation within the first 72 hours of ICU admission compared with delayed or no resumption.

Methods: This multicenter retrospective observational cohort study assessed critically ill adults admitted to the ICU who were receiving chronic neuropsychiatric medications prior to hospitalization, focusing on patterns of agitation and timing of medication resumption. Patients were assigned to early initiation (£72 hours) or late initiation (>72 hours or not restarted during ICU stay) groups based on timing of NPM resumption upon ICU admission. The primary endpoint was incidence of agitation, defined as a Richmond Agitation Sedation Scale (RASS) score of +2 to +4 within the first 72 hours of ICU admission. Secondary outcomes included incidence of delirium, duration of mechanical ventilation, new start NPM during ICU admission, hospital length of stay and mortality.

Results: Among the 101 patients initially reviewed, 52 individuals were excluded. A total of 49 patients were included in the final analysis, with 33 patients in the early restart group and 16 patients in the late or no restart group. Differences in baseline home medication classes were also observed, with fewer patients in the early start group prescribed benzodiazepines (21.2% vs 50%; p=0.040). There was no statistically significant difference in the incidence of agitation with 54.5% occurrence in the early start group and 68.8% in the late start (p=0.343). Secondary outcomes were similar between groups for mortality, incidence of delirium, new initiation of neuropsychiatric medications, duration of mechanical ventilation, and hospital length of stay. ICU length of stay was longer in the early start group (14.65 days vs 11.00 days; p=0.023).

Conclusion: In this retrospective cohort study of critically ill adults with preexisting neuropsychiatric medication use, early resumption of home NPMs within 72 hours of ICU admission did not significantly reduce the incidence of agitation compared with delayed or no resumption. Notably, patients in the early restart group experienced a longer ICU length of stay, and baseline differences in home medication classes specifically benzodiazepines were observed between groups.

Moderators

Heather Stanley

Presenters

Jade Gallahair

Evaluators

Blake Johnson

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Olympia 1

Critical Care/Emergency Medicine (CCM), AdventHealth Altamonte Springs

global Y

12:20pm EDT

Oral Beta-lactam (BL) Versus Fluoroquinolone (FQ) or Sulfamethoxazole-Trimethoprim (SMXTMP) in Uncomplicated Gram-Negative Bacteremia (uGNB) - Jared Robbins, Tyler Baumeister, Tracey Bastian Williamson Medical Center - Franklin, TN

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena G

Oral Beta-lactam (BL) Versus Fluoroquinolone (FQ) or Sulfamethoxazole-Trimethoprim (SMXTMP) in Uncomplicated Gram-Negative Bacteremia (uGNB) Jared Robbins, Tyler Baumeister, Tracey Bastian Williamson Medical Center - Franklin, TN

Background/Purpose: Gram negative bacteremia is associated with significant morbidity and mortality. Historically, uncomplicated gram-negative bacteremia (uGNB) has been treated with highly bioavailable oral options like fluoroquinolones (FQ) or sulfamethoxazole/trimethoprim (SMX-TMP). This is primarily due to pharmacokinetic concerns and questionable bioavailability of other agents such as beta-lactam (BL) antibiotics. Therefore, optimal oral step-down agents for uGNB remains highly debated. The unfavorable safety profiles of FQs and SMX-TMP have sparked interest in investigating safer alternatives. Current literature including systematic reviews, meta-analyses, and cohort studies suggest beta-lactams may be an efficacious and safe alternative for uGNB. This study aims to compare the efficacy and safety of BLs versus FQs/SMX-TMP for oral step-down therapy in uGNB in a community hospital setting.

Methodology: This was a single-center, IRB-approved, retrospective study conducted at a 337- bed hospital in Franklin, Tennessee that evaluated clinical failure rates of 100 patients receiving either BLs or FQs/SMX-TMP for the treatment of uGNB. Eligible patients admitted between August 1, 2023, and August 1, 2025, who met inclusion and exclusion criteria were identified for analysis. Baseline characteristics included age, sex, weight, Charlson comorbidity score (CCS), and PITT bacteremia score. The primary outcome was a composite of clinical failure, defined by having 1 of the following; 30-day hospital readmission due to antibiotic intolerance, 30-day recurrent bacteremia caused by the same microorganism, or escalation in therapy. Secondary outcomes included individual components of the primary outcome at 90 days, 90-day incidence of Clostridioides difficile infection (CDI), duration of therapy (summative and breakdown components of IV/PO groups), and hospital length of stay. Safety outcomes included rates of hyponatremia, acute kidney injury, and hyperkalemia as primary cause of re-admission at 30 and 90 days, and a composite of these components.

Results: This trial included 100 total patients, 58 designated in the BL group, and 42 designated in the FQ/SMX-TMP group. Baseline characteristics were comparable between groups, with the exception of age (78.8 years vs 71.3 years, in the BL vs FQ/SMX-TMP groups, respectively; p=0.004) and CCS (5.2 vs 4.2, in the BL vs FQ/SMX-TMP groups, respectively; p=0.04). The primary outcome of 30-day composite clinical failure occurred in 4/58 patients (6.9%) in the BL group, and 4/42 patients (9.5%) in the FQ/SMX-TMP group. (RR 0.72; CI 0.19-2.73; p=0.72). For secondary outcomes, the 90-day clinical failure composite outcome occurred in 3/58 (5.2%) of patients in the BL group, and 4/42 (9.5%) in the FQ/SMX-TMP group. (RR 0.54; CI 0.13-2.3; p=0.449). Average length of stay, IV antimicrobial duration, and oral antimicrobial duration were similar between the two treatment groups. CDI did not occur in either treatment group. The 90-day composite safety outcomes occurred in 0/58 (0%) patients in the BL group, and 2/42 (4.8%) in the FQ/SMX-TMP group (RR 0.15; CI 0.007-3.02; p=0.174). Of the two events in the FQ/SMX-TMP group, both were due to hyponatremia leading to re-admission and occurred within 30 days post-discharge.

Moderators

Megan Freeman

Presenters

Jared Robbins

Evaluators

Haley Smith

Neuro Critical Care Pharmacy Specialist / PGY1 RPD, Our Lady of the Lake Regional Medical CenterPGY1

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena G

Infectious Disease (ID), Williamson Medical Center

global Y

12:20pm EDT

Evaluation of Chromium Picolinate for Blood Glucose Control in Critically Ill Patients

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena C

Evaluation of Chromium Picolinate for Blood Glucose Control in Critically Ill Patients
Christopher Stone, Richard Lane, Jared Briones
AdventHealth Apopka

Background: Glycemic control is a cornerstone in the management of critically ill patients in the intensive care unit (ICU), as both hyper- and hypo-glycemia are associated with increased morbidity and mortality. Dysglycemia in critical illness is multifactorial, resulting from stress‑mediated neuroendocrine activation, inflammatory cytokine release, multiorgan dysfunction, and rapidly changing nutrition requirements. In recognition of adverse outcomes associated with dysglycemia, current ADA guidelines recommend targeting blood glucose levels between 140-180 mg/dL in critical illness. Chromium is a trace mineral involved in macronutrient metabolism, with studies in the outpatient setting indicating potential benefits for insulin sensitivity and glycemic control. Despite these findings, evidence supporting chromium supplementation in critically ill populations remains absent. This study aims to evaluate the effects of chromium picolinate on blood glucose management of critically ill subjects.

Methods: This was a retrospective chart review conducted within the AdventHealth Central Florida Division hospital system. Subjects were included if they were admitted from January 1st, 2022, to December 31st, 2025, age greater than 18 years, admitted to the ICU, diagnosed with type 2 diabetes mellitus or had an A1c of 6.5% or greater, and received continuous infusion insulin. Subjects were excluded if they were diagnosed with type 1 diabetes mellitus, received renal replacement therapy, or had documented chromium use prior to admission. The primary outcome was improved glycemic control, defined as a reduction in total daily insulin requirements of at least 15 units. Secondary outcomes included 30-day all-cause mortality, time to target glucose range (<180 mg/dL), hospital length of stay, ICU length of stay, and rate of adverse drug events.

Results: A total of 90 subjects were included, 45 in each group. Improved glycemic control occurred in 31% (14/45) of the chromium group compared to 13% (6/45) in the control (p-value=0.043). Analyzing the secondary outcomes, hours to target blood glucose range (<180 mg/dL) was 14 and 4 (p-value= 0.035) for the chromium and non-chromium groups respectively. There were no differences between additional outcomes including 30-day mortality, 30-day all cause readmission, hospital length of stay, ICU length of stay, and adverse drug events. Chromium was associated with decreased insulin utilization of 17.8 units compared to an increase of 22.4 units in the non-chromium group by day 3 of treatment (p-value< 0.001).

Conclusion: In critically ill patients with hyperglycemia, chromium picolinate supplementation was associated with a significant reduction in insulin utilization. No differences in adverse event rate were observed between the intervention and control group. These results indicate that chromium supplementation in critically ill patients may improve glycemic control. Limitations include the retrospective study design, lack of chromium level evaluation and the ability to identify an appropriate comparator. Further prospective studies are recommended to further explore the potential benefits of chromium on glycemic control in the critically ill.

Email [email protected]

Moderators

Eric Marr

PGY1 Residency Program Director, Baptist Health Lexington

Presenters

Christopher Stone

PGY-1 Resident, AdventHealth

Evaluators

Erin Pace

Ambulatory Care Pharmacist, KFHP1Kaiser Foundation Health Plan of Georgia (Managed Care)PGY1

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena C

Internal Medicine (IM), AdventHealth Apopka

global Y

12:20pm EDT

Impact on AKIs and Duration of Response in First-Line Treatment for Non-Small Cell Lung Cancer - Tabitha Massengill

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena H

Background
Non-small cell lung cancer (NSCLC) encompasses 87% of lung cancer cases with a 5-10% five-year survival rate1. For non-squamous NSCLC without sensitizing mutations, the KEYNOTE-189 trial showed the combination of carboplatin/pemetrexed plus pembrolizumab increased overall survival and progression-free survival over chemotherapy alone. However, pembrolizumab and pemetrexed are both nephrotoxic agents. When studied using pembrolizumab plus pemetrexed/carboplatin vs. placebo plus pemetrexed/carboplatin, there was a 5.2% vs. 0.5% instance of acute kidney injury (AKI) that occurred2. This study was designed to evaluate the duration of response for patients on carboplatin/pemetrexed/pembrolizumab who developed versus did not develop an AKI

Methods:
This was a multicenter, retrospective cohort study of patients who underwent treatment with carboplatin/pemetrexed/pembrolizumab for non-squamous metastatic NSCLC. Data was collected from January 1, 2022 to December 31, 2025 from patients at Atrium Health Levine Cancer.. A report via electronic medical records in Epic was generated to select patients who have received carboplatin/pemetrexed/pembrolizumab. Within the AKI and no AKI groups, random selection occurred with data collection entered into a RedCAP database. Inclusion criteria consisted of ≥18 years old, stage IV non-squamous NSCLC, and completion of at least 1 cycle of carboplatin/pemetrexed/pembrolizumab. Exclusion criteria were a creatinine clearance < 45 mL/min, a baseline use of prednisone or equivalent ≥ 10 mg not utilized for pre-medication and receiving any oncology treatment outside of Atrium Health facilities. The primary endpoint was the duration of response of first-line treatment after developing an AKI compared to patients who did not. Duration of response was defined by time to death or time to initiating second-line therapy. Secondary endpoints included total cycles of first-line therapy received, cycle of therapy AKI developed in, and re-initiation of treatment after AKI development. Demographics and baseline characteristics were analyzed using Fisher’s exact test (categorical values) and Wilcox rank sum test (continuous values). Time to initiation of second line therapy or death was analyzed with a Kaplan-Meier curve, reporting the log-rank test result between those with versus those without an AKI. Patients were censored at the maximum follow up time if no event was experienced.

Results
169 patients were screened with 80 patients included. The rate of AKI was 11%. Common baseline characteristics include 50-70 years old (59%), white (74%), with an average SCr <1.5 (96%). Eighty-three percent of patients did not have a targetable mutation while 15% had KRAS G12C mutations and 2.5% had EBBR2 mutations. Tumor proportion score (TPS) <1% for the AKI group was 78% and 54% for the non-AKI group. Most deaths occurred in the non-AKI group (37/71 vs. 1/9, p=0.031), which failed to show a statistically significant difference in the two groups.

Conclusion
An early AKI during first-line non-small cell lung cancer treatment has been shown to reduce survival outcomes at 12 months4. This study aimed to evaluate the impact of an AKI could have on duration of response, which was found to have no statistically significant difference; however, the amount of people who had an AKI was larger than past literature studies2. Limitations that could have influenced the lack of statistical difference included not having enough patients to detect a statistically significant difference and different providers electing to use pembrolizumab and pemetrexed together versus pembrolizumab alone, influencing AKI occurrence.

Moderators

Hannah Schmoock

Internal Med Clinical Pharmacy Specialist, PGY1 Acute Care RPC, McLeod Regional Medical Center

Presenters

Tabitha Massengill

Evaluators

Adam Harnden

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena H

Oncology (ONC), Wake Forest Baptist

global Y

12:20pm EDT

Evaluation of RSV hospitalizations in high-risk infants who received nirsevimab vs. palivizumab

Thursday April 30, 2026 12:20pm - 12:40pm EDT

Athena J

Evaluation of RSV hospitalizations in high-risk infants who received nirsevimab vs. palivizumab
Authors: Allison Lopez, Courtney Campbell, Erica Gray, Katelyn Gibson

Background
Respiratory syncytial virus (RSV) is a common acute respiratory infection that can cause mild cold-like symptoms in most infants, but some high-risk infants, such as those born prematurely or with chronic lung or congenital heart disease, can develop severe disease requiring hospitalization. Prophylaxis is the most effective way to prevent severe RSV infection. Palivizumab and nirsevimab are monoclonal antibodies that provide passive immunity by preventing RSV from entering healthy cells. Palivizumab requires monthly dosing during RSV season, while nirsevimab is given as a single dose for the entire season. Our institution recently switched from palivizumab to nirsevimab following updated ACIP, CDC, and AAP guidance. There is established data supporting palivizumab use in high-risk infants, but limited evidence exists for nirsevimab in this population. This study aims to compare RSV-related hospitalizations in high-risk infants receiving nirsevimab versus palivizumab to inform RSV prophylaxis use at our institution.

Methods
This is a single-center retrospective chart review of high-risk infants who received palivizumab or nirsevimab for RSV prophylaxis during the 2022-2023 or 2024-2025 season, respectively. High-risk infants include those born prematurely and those with chronic lung disease or significant congenital heart disease. Infants were included if they met institutional criteria for RSV prophylaxis and received at least one dose of nirsevimab or palivizumab. The primary outcome was the number of hospitalizations with confirmed RSV infection. Secondary outcomes included risk factors for severe RSV, number and timing of prophylactic doses, timing of hospitalization relative to dosing, and the number of confirmed RSV cases in Georgia. The purpose of this study was to evaluate whether a single dose of nirsevimab is sufficient for high-risk infants throughout the RSV season through comparison of hospitalization rates between infants receiving palivizumab versus nirsevimab.

Results
A total of 146 patients were included in this study, with 82 patients receiving nirsevimab and 64 patients receiving palivizumab. The patients in the two groups were similar regarding baseline characteristics, and the majority of patients were African American. Of the patients included, four were hospitalized with confirmed RSV infection. Three of these patients had received nirsevimab and one had received palivizumab. There was no significant difference seen in the primary outcome comparing hospitalizations in the nirsevimab group and the palivizumab group (P = 0.63).

Conclusions
This single-center retrospective chart review demonstrates that the use of nirsevimab for RSV prophylaxis does not increase the risk of hospitalization in high-risk infants compared to palivizumab. No statistically significant difference was seen between nirsevimab and palivizumab in terms of RSV-related hospitalizations. The results of this study support continued utilization of nirsevimab for RSV prophylaxis in high-risk infants.

Contact: [email protected]

Moderators

Jeremy Walley

Presenters

Allison Lopez

Evaluators

Jessica Sterchi

Clinical Pharmacy Supervisor and Acute Care PGY1 RPD, BMHT1Blount Memorial HospitalPGY1

Thursday April 30, 2026 12:20pm - 12:40pm EDT
Athena J

Pediatric (PED), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

1:50pm EDT

Impact of Intravenous Fluid Shortage Mitigation Strategies on Crystalloid Utilization and Clinical Outcomes in Critically Ill Adults

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Olympia 2

Title: Impact of Intravenous Fluid Shortage Mitigation Strategies on Crystalloid Utilization and Clinical Outcomes in Critically Ill Adults

Authors: CC Gooden, Stuart Pope, Amanda Hammond, Neha Naik

Objective: To evaluate the impact of IV fluid shortage mitigation strategies on continuous crystalloid utilization and clinical outcomes among adult ICU patients.

Background: Hurricane Helene damaged a major U.S. IV fluid manufacturing facility in September 2024, triggering nationwide shortages. Emory Healthcare implemented multidisciplinary conservation protocols including prioritizing fluids for resuscitation, minimizing maintenance fluids, and utilizing alternative hydration strategies.

Methods: This multicenter, retrospective chart review included adult patients (≥18 years) admitted to Emory Healthcare ICUs receiving crystalloid fluids during pre-shortage (November 2023–March 2024) and post-shortage (November 2024–March 2025) periods. Patients who were pregnant, incarcerated, or had diabetic ketoacidosis were excluded. The primary outcome was duration of continuous crystalloid infusions. Secondary outcomes included ICU and hospital length of stay, fluid substitution patterns, diuretic/albumin/vasopressor use, acute kidney injury, mortality, and mechanical ventilation duration. Non-parametric data were analyzed using Mann–Whitney U tests and categorical variables using Fisher's exact tests.

Results: Among 100 patients (50 per group), baseline diagnoses were similar (p=0.95), with sepsis/infection most common (55%). Median IV fluid duration decreased from 11.5 days (IQR 6.3–20.8) pre-shortage to 2.0 days (IQR 1.0–4.0) post-shortage (p<0.0001; median difference 8.0 days, 95% CI [6.0–12.0]). Bolus-only resuscitation increased from 10% to 38% (OR 5.52, 95% CI [1.86–16.34]; p=0.002). No significant differences were observed in acute kidney injury or in-hospital mortality (p>0.05).

Conclusions: Implementation of fluid conservation strategies during the national shortage was associated with significant reduction in IV fluid duration and increased use of bolus-only strategies, without observed differences in clinical outcomes. These findings suggest that reduced-duration fluid therapy may warrant further investigation in future studies.

Self-Assessment Question: True or False: Implementation of IV fluid conservation strategies during a national shortage was associated with a reduction in continuous crystalloid infusion duration without increasing adverse clinical outcomes.

Moderators

Karen Babb

Residency Program Director, CHIM1CHI MemorialPGY1

Presenters

CC Gooden

HSPAL PGY-1, Emory University Hospital Midtown

Evaluators

Karen Barlow

PGY1 Residency Program Director, Wellstar Kennestone Regional Medical Center

I received my Doctor of Pharmacy degree from the University of Georgia, College of Pharmacy. Following graduation, I completed a Pharmacy Practice Residency at the Virginia Commonwealth University Health System (formerly Medical College of Virginia Hospital) in Richmond, Virginia... Read More →

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Olympia 2

Administration (ADM), Emory University Hospital Midtown

global Y

1:50pm EDT

Assessment of Pharmacist Led Medication Reconciliation in the Emergency Department at a VA Medical Center 

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Olympia 1

Background:
Medication discrepancies during transitions of care, including emergency department (ED) admissions, are prevalent and can lead to medication errors, adverse drug events (ADEs), and increased healthcare costs.1 Medication reconciliation is the formal process of creating the most accurate medication list and comparing it against medication orders.2 Accurate medication reconciliations are often limited by time constraints, incomplete medication history, and a lack of dedicated staff.3 Pharmacist led medication reconciliations increase accuracy and are shown to improve medication safety. On average, about two-thirds of pharmacists’ recommendations are accepted by clinical providers.1 In the two years since the Emergency Department Clinical Pharmacist Practitioners (ED CPPs) began conducting medication reconciliations at the Salisbury VA Medical Center (SBYVAMC), their impact has not been formally evaluated. The purpose of this quality improvement (QI) project is to assess the number and types of medication discrepancies identified through pharmacist-led medication reconciliations.  

Methods:
A retrospective chart review was conducted at the SBYVAMC from January 1, 2025, to April 1, 2025, utilizing the Computerized Patient Record System (CPRS). Veterans were included if they were 18 years and older, admitted to an inpatient service, and a complete medication reconciliation was performed by an ED CPP. Data collection was compiled in a secure, password-protected REDCap database. In CPRS, the ED CPPs enters medication reconciliation notes and document veterans' medication lists, provided by the veteran, guardian, or an external resource. Demographics, admission diagnosis, and prescription/medication information are recorded in the notes, and a pharmacist, provider, or other clinical team member are alerted. The primary outcome of this study is to identify the number and type of discrepancies identified per medication reconciliation. Secondary outcomes include the number of pharmacist interventions and high-risk medication interventions implemented by the clinical team.

Results:
Out of 418 unique veterans, 400 veterans met inclusion criteria. ED CPPs completed a medication reconciliation on 4.6 veterans a day - identifying a total of 1,400 discrepancies, with an average of 3.5 discrepancies per medication reconciliation and 16.1 discrepancies identified per day. Most medication discrepancies were reported by the veteran, caregiver, or both (n = 438). Most veterans identified as white, non-Hispanic males over the age of 65, which is consistent with the broader veteran population. The most common admitted services were general medicine (n = 223) and psychiatry (n = 113). The ED CPPs alerted 607 pharmacists, providers, or advanced practice providers to their medication reconciliation notes. The most common discrepancy was the veteran self-discontinuing their medication (n = 579), of which 66.3% were appropriately restarted during hospitalization. The second most common discrepancy was incorrect dose, frequency, or timing (n = 379), which was resolved upon admission 68.9% of the time. Another common discrepancy was veterans taking expired, discontinued, or completed medications (n = 345). The intervention to not order these medications upon admission occurred 71.9% of the time. Lastly, based on veteran’s renal function, the ED CPPs made 63 recommendations to hold or adjust medication dose. These recommendations were implemented 47.6% of the time. For high-risk medications, 107 medications were involved in discrepancies and 54 interventions were implemented. For veterans on insulin, the dose determined during medication reconciliation was ordered 27.3% of the time at admission.

Conclusion:
The volume of medication reconciliations and clinical recommendations provided by the ED CPPs improve the accuracy of admission medication regimens at SBYVAMC. This data will provide education to the clinical teams to review the medication reconciliation notes and implement ED CPPs’ recommendations as they see clinically appropriate.

Moderators

Nathan Wayne

Cardiology Clinical Pharmacist, PGY1 RPC, Wellstar MCG Health

I graduated from UGA College of Pharmacy and then completed a PGY1 residency at UNC REX Healthcare in Raleigh, NC and completed a teaching certificate from UNC Eshelman School of Pharmacy. I then completed a PGY2 Cardiology Residency at the University of Kentucky HealthCare in Lexington... Read More →

Presenters

Jada Abrams

PGY1 Pharmacy Resident, Salisbury VA Health Care System

Jada Abrams is a PGY1 Resident at the Salisbury VA Medical Center. She received a bachelor's degree at Howard University in 2021 and graduated from the UNC Eshelman School of Pharmacy in 2025. Her current interests include ambulatory care, academia, and serving underserved communities... Read More →

Evaluators

Nieka Jackson

Pain Clinical Pharmacist Practitioner (Facility PMOP Coordinator)

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Olympia 1

Ambulatory Care (AMB), NC â€“ Salisbury VA Health Care System

global Y

1:50pm EDT

Impact of Midodrine on 30-Day Readmission Rates in Heart Failure Patients with Hypotension - Kaelen Glaze

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Parthenon 1

Abstract
Background and Purpose
Hypotension is a common barrier to optimization of guideline-directed medical therapy (GDMT) in patients with heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF). Midodrine, an oral α₁-adrenergic agonist approved for orthostatic hypotension, has been used off-label to support blood pressure and facilitate GDMT initiation or titration in hypotensive heart failure patients. However, data evaluating its impact on clinical outcomes remains limited. This study aimed to evaluate the association between midodrine use at hospital discharge and 30-day all-cause readmission in hypotensive heart failure patients.

Methods
This retrospective cohort study included adult patients (≥18 years) admitted to the AdventHealth Central Florida Division between October 2024 and November 2025 with HFrEF or HFmrEF (EF <50%) and documented hypotension. Patients were grouped based on discharge with midodrine versus discharge without midodrine. Clinical data was extracted from the electronic health record, including baseline characteristics, use of GDMT at admission and discharge, length of stay (LOS), 30-day all-cause readmission, 30-day mortality, and adverse events such as hypertension and bradycardia.

Results
A total of 142 patients were included (65 intervention, 77 control). Baseline demographics and clinical characteristics were similar between groups. The 30-day all-cause readmission rate was identical between patients discharged on midodrine and those not discharged on midodrine (34% vs 34%, p=0.99). 30-day mortality was low and comparable between groups (2% vs 1%, p=0.49). Median length of stay did not differ significantly (11 vs 9 days, p=0.54).
Hypertensive events occurred more frequently in those discharged with midodrine (31% vs 20%), though this difference was not statistically significant (p=0.11). Rates of bradycardia were similar (21% vs 17%, p=0.95). Changes in GDMT dosing from admission to discharge were comparable between groups, with no significant improvement in GDMT up-titration associated with midodrine use.

Conclusions
In this retrospective cohort of hypotensive HFrEF and HFmrEF patients, discharge on midodrine was not associated with reduced 30-day readmission, mortality, or length of stay compared to patients not discharged on midodrine. While midodrine was frequently used as a supportive agent, its use did not translate into meaningful GDMT optimization and was associated with a numerically higher incidence of hypertensive events.

Moderators

Kimm Freeman

Presenters

Kaelen Glaze

Kaelen Glaze, PharmD, is currently a PGY1 Pharmacy resident at AdventHealth East Orlando. He earned his Doctor of Pharmacy degree from the Nova Southeastern University Barry and Judy Silverman College of Pharmacy. Upon completing his residency, Kaelen intends to pursue a career as... Read More →

Evaluators

Khushbu Patel

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Parthenon 1

Cardiology (CAR), AdventHealth East Orlando

global Y

1:50pm EDT

Evaluation of Second-Dose Antibiotics in the Emergency Department

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena A

Background: Sepsis is a life-threatening emergency with the potential for high morbidity and mortality. Sepsis often has nonspecific symptoms; however timely recognition of infection-related symptoms is critical. Timing of antibiotic administration is directly linked to improved patient outcomes, whereas delay of subsequent antibiotic doses leads to unfavorable patient outcomes.1 This study aims to identify the presence of significant delays in second dose antibiotics following admission and the associated cause of delay.
Methods: This is an Institutional Review Board exempt, multicenter, retrospective chart review within the Baptist Health system. Patients who presented to an emergency department (ED) within the Baptist Health system were identified through an electronic report. A chart review was performed from August 2024 to January 2025 capturing patients with a sepsis diagnosis. The primary outcome was the rate of subsequent antibiotic doses given outside of a 25% variance of the initial antibiotic dosing interval. Secondary outcomes include degree of delays, cause of delays, and all-cause mortality.
Results: A total of 295 patients were reviewed with 200 included. Eligible patients were female, of black ethnicity, with a median age of 64 years. The most common admitting diagnosis was community acquired pneumonia. All patients had an attributable source of infection, with 73% meeting at least 2 systemic inflammatory response syndrome (SIRS) criteria consistent with a sepsis diagnosis. Ceftriaxone was the most frequently administered first-dose antibiotic in the ED. Bacterial pneumonia was most likely to have combination empiric therapy with azithromycin while all other indications – including urinary tract infections, skin and soft tissue infections – were often paired with vancomycin. Upon admission, subsequent antibiotic selections included equal quantities of piperacillin-tazobactam and cefepime with a reduction in ceftriaxone continuations. The primary outcome of a greater than 25% variance in antibiotic administration was present in 30.5% of patients. Preemptive doses greater than 25% were present in 26.5% of patients and were most frequently with ceftriaxone. Delays greater than 25% were present in 4% of patients and most frequent with piperacillin-tazobactam dosed at an 8-hour interval. The degree of delay ranged from 26% – 101% and was most commonly due to ordering, followed by administration. Mortality rate present in the preemptive, in-range, and late groups was 28%, 9%, and 12.5%, respectively.
Conclusion: The importance of appropriate timing of subsequent antibiotics in septic patients cannot be overstated. While this study found a moderate incidence of variance in second-dose antibiotics, only 4% had the potential to experience significant harm due to delays greater than 25%. The Baptist Health System may benefit from additional education regarding the once-dose process in the ED to further reduce incidence of ordering delays. Additionally, pharmacy staff may benefit from education on recommended dosing intervals and appropriate timing of common antibiotics utilized in the ED for septic patients.

Moderators

John Puryear

Presenters

Katelyn Edwards

PGY1 Resident, Baptist Medical Center South

Hello! My name is Katelyn Edwards, PharmD, and I am a current PGY1 pharmacy resident. I graduated from Auburn University in 2022 with my bachelor’s in biomedical sciences. I completed my PharmD at the Harrison College of Pharmacy in 2025. I am excited to begin my PGY2 in infectious... Read More →

Evaluators

Katherine Fuller

Clinical Pharmacy Specialist --Hepatology

Clinical pharmacy specialist at Emory University Hospital Midtown serving Hepatitis B and C patient populations through the Emory Center for Viral Hepatitis. Emory Midtown PGY1 Pharmacy Practice (Specialty Focused) Residency Director.

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), Baptist Medical Center South

global Y

1:50pm EDT

Insulin Treatment Strategies for Emergent Hyperkalemia

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena B

Title: Insulin Treatment Strategies for Emergent Hyperkalemia
Authors: Margaret Brown, Matthew Bamber, William Markle
FirstHealth Moore Regional Hospital Emergency Department – Pinehurst, NC

Background: Hyperkalemia is a medical emergency that can cause cardiac abnormalities and lead to cardiac arrest. Intravenous (IV) bolus insulin regular is a standard medication used to treat emergent hyperkalemia. Insulin shifts potassium and glucose intracellularly, which can lead to hypoglycemia. The objective of this study is to evaluate the rate of hypoglycemia between different doses of IV insulin regular in managing hyperkalemia.

Methods: This retrospective chart review study evaluated the rate of hypoglycemia in hyperkalemic (K > 5 mEq/L) patients treated with 10 or 5 units of IV insulin regular in FirstHealth Moore Regional Hospital Emergency Department between June 2024 and June 2025. The study included patients 18 years and older, with serum potassium > 5 mEq/L, and treatment initiation in the emergency department. Exclusion criteria included initial glucose < 70 mg/dL or > 180 mg/dL and receipt of in-patient dialysis. The primary outcome is the incidence of hypoglycemia (glucose <70 mg/dL). Secondary outcomes include amount of dextrose administered, in-hospital mortality, decrease in serum potassium from baseline, time from insulin administration to serum potassium < 5 mEq/L, time from serum potassium > 5 mEq/L to administration of IV insulin regular, number of patients who received multiple doses of insulin, mean number of doses of insulin received per patient, mean total units of insulin received per patient.

Results: A total of 81 patients were included, with 30 in the group receiving an initial bolus of 10 units IV insulin regular, and 51 patients receiving 5 units IV insulin regular. The primary outcome of the incidence of hypoglycemia found no statistically significant difference between the 10-units and 5-unit groups (5/30 vs 3/51; p=0.12). Only one secondary outcome was statistically significant: the mean number of insulin doses received between the 10-unit and 5-unit groups (1.1 vs 1.5; p = 0.03). Both the 10-unit and 5-unit group produced similar mean potassium reduction (1.58 vs 1.60 mEq/L; p = 0.44).

Conclusions: When comparing the incidence of hypoglycemia between a high and low dose IV insulin regular regimen to treat emergency hyperkalemia, there was no statistically significant difference between the groups. The small sample size may underestimate the true incidence of hypoglycemia. This study did not adjust for administration of concomitant hyperkalemia medications, which could change the overall decrease in serum potassium. Further studies are needed to evaluate the impact of underweight and obesity on hypoglycemia.

Moderators

Erin Murdock

Clinical Oncology Pharmacist / PGY2 Oncology RPC, Northside Hospital

Presenters

Margaret Brown

PGY1 Pharmacy Resident, FirstHealth of the Carolinas

Margaret Brown is a PGY1 Pharmacy Resident at FirstHealth of the Carolinas Moore Regional Hospital. She earned her Doctor of Pharmacy from the University of Connecticut School of Pharmacy. Margaret's areas of interest include emergency medicine and critical care. Outside of pharmacy... Read More →

Evaluators

Kishan Patel

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena B

Critical Care/Emergency Medicine (CCM), FirstHealth Moore Regional Hospital

global Y

1:50pm EDT

Comparative Outcomes and ESBL-Emergence After Beta-Lactam vs First-Line Therapy for Pyelonephritis in the Emergency Department - Halie Anderson

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena J

Background: Acute pyelonephritis is a common and potentially serious bacterial infection of the upper urinary tract that frequently results in emergency department (ED) visits and hospitalizations. The most recent Infectious Diseases Society of America (IDSA) guidelines for the management of complicated urinary tract infections (cUTI), include levofloxacin, ciprofloxacin, and sulfamethoxazole-trimethoprim as first line options. Rising antimicrobial resistance among Enterobacterales rases concern for their effectiveness. Thus, clinicians often turn to oral beta-lactams. While well tolerated, their efficacy for pyelonephritis is less established due to lower renal tissue concentrations and variable oral bioavailability. However, recent evidence indicates favorable outcomes with oral beta-lactams.
Additionally, given the increasing prevalence of extended-spectrum beta-lactamases (ESBLs), understanding the impact of antibiotic selection on the development of future resistance is essential to optimizing antibiotic selection.
This study aimed to evaluate the comparative effectiveness and downstream resistance outcomes of oral beta-lactam therapy versus first-line agents for the treatment of acute pyelonephritis among adults discharged from the ED.

Methodology: This was a multi-site, retrospective, observational cohort study comparing clinical outcomes and the emergence of ESBL organisms in patients treated for pyelonephritis using first-line agents versus beta-lactam antibiotics. Patients 18 years or older with an ICD-10 code diagnosis of pyelonephritis, a positive urine culture, and an outpatient antibiotic prescription for at least 7 days during the study period from April 1, 2024, to July 8, 2025, were included. Patients were excluded if they had polymicrobial cultures, prior ESBL-producing organism within 3 months, more than one dose of intravenous antibiotics, diagnoses of prostatitis, orchitis, epididymitis, or pregnancy, and patients requiring change of prescription from index visit. The primary outcome was rate of treatment failure within 30 days of the initial ED visit; secondary outcomes included antibiotic selection, dosing, duration, and rates of ESBL emergence.
Data collection included baseline characteristics such as age, sex, comorbidities, and urine culture resistance patterns within 3 months prior to the ED visit. Statistical analysis was conducted using Pearson’s Chi-squared tests for categorical variables, Student’s t-tests for continuous variables, and univariate regression for association between antibiotic choice and treatment failure.
Results: A total of 1,396 patients were included in the study between April 2025 and July 2025, 792 patients in the beta-lactam and 604 in the first-line therapy group. The most common reason for exclusion was a change in antibiotic therapy following identification of resistance to the initial agent.
Patient characteristics and demographics were well balanced between the groups. Most patients were female (89%), non-Hispanic or Latino (78%), and 46% received intravenous antibiotics in the emergency department. The most frequently identified baseline pathogen was Escherichia coli (74%), followed by Klebsiella species (7.6%).
The primary outcome, treatment failure, occurred in 78 patients (5.6%), including 53 (6.7%) in the beta-lactam group and 25 (4.1%) in the first-line group (p = 0.040). Guideline appropriate dosing was observed in 477 patients (64%) in the beta-lactam group compared to 571 patients (99%) in the first-line group (p < 0.001). Cefdinir was prescribed 142 (10.8%) times but is not recommended in the IDSA guidelines for pyelonephritis. The most frequently guideline non-compliant therapy was cephalexin, which was appropriately dosed in only 38% (14/68) of cases. ESBL emergence was rare, occurring in 5 patients (0.4%), with 4 cases in the beta-lactam group and 1 case in the first-line group (p = 0.4).
Conclusions: Treatment failure was more frequent in the beta-lactam group. This finding is potentially attributable to inappropriate antibiotic selection and suboptimal dosing. Specifically, the overuse of cefdinir and underdosing of cephalexin likely contributed to these treatment failures. Additionally, our investigation did not demonstrate a significant association between antibiotic choice and the development of ESBL.

Moderators

Kelley Norris

Presenters

Halie Anderson

Evaluators

Ketrin Mount

PGY1 Pharmacy Residency Program Director, James H. Quillen VA Medical Center

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena J

Infectious Disease (ID), Wake Forest Baptist

global Y

1:50pm EDT

Evaluating the Nephrotoxicity of Extended Infusion Piperacillicin/Tazobactam given concomitantly with Vancomycin

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena G

Background

A significant portion of hospitalized adults presenting to a hospital may require treatment with broad spectrum antibiotics. Cases involving suspected infections and sepsis are frequent occurrences in which empiric antibiotic use is warranted. Vancomycin and piperacillin/tazobactam (pip/tazo) comprise a widely used antibiotic regimen incorporating a glycopeptide antibiotic and a β-lactam/β-lactamase inhibitor respectively. This regimen provides broad-spectrum activity against Gram-positive, Gram-negative, and anaerobic pathogens including methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. The aim of this study is to determine the relationship between differing doses of pip/tazo and the incidence of AKI in patients treated with concomitant vancomycin and pip/tazo. By identifying whether higher doses of pip/tazo are associated with increased AKI rates, this research seeks to inform antimicrobial stewardship efforts and optimize patient safety while preserving therapeutic efficacy.

Methods

This retrospective cohort study was conducted to assess the impact of different piperacillin/tazobactam dosing regimens on the incidence of nephrotoxicity for patients receiving concomitant vancomycin therapy. The research site for this study is a 700-bed, not-for-profit, public hospital system in a rural Georgia. In March 2024, the site for this study changed protocol regarding piperacillin/tazobactam administration from 3.375gm to 4.5gm IV extended-infusion. Patients receiving concomitant vancomycin and piperacillin/tazobactam were split into 2 groups based on which piperacillin/tazobactam dosing regimen they received. The Institutional Review Board at the research site approvedwill review the methodology of this study for approval prior to any patient data collection.

Results - Vancomycin + Piperacillin/Tazobactam 3.375g ( n=105): 13 (12.4%) experienced AKI.
Vancomycin +Piperacillin/Tazobactam 4.5g ( n=105) : 16 (15.2%) experienced AKI.
p-value = 0.55

Conclusion - Currently, there is not evidence to suggest that the change in piperacillin/tazobactam extended infusion dosing at the primary site had an impact on nephrotoxic risk for patients being treated with concomitant VPT therapy.

Moderators

Leigh Joyner

Clinical Pharmacist, Tandem Health

Presenters

Justin Eboka

PGY1 Pharmacy Resident, Phoebe Putney Memorial Hospital

I am Justin Eboka, one of the PGY1 Pharmacy Residents at Phoebe Putney Memorial Hospital. I attended the University of Georgia for my pharmacy education. I plan to work in the Oncology space after completion of my PGY1

Evaluators

Kristina Evans

PGY2 Internal Medicine Residency Program Coordinator, Grady Health System

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena G

Infectious Disease (ID), Phoebe Putney Memorial Hospital/The University of Georgia

global Y

1:50pm EDT

Outcomes Associated with Early Versus Late Infectious Disease Consult for Staphylococcus aureus Bacteremia

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena I

Outcomes Associated with Early Versus Late Infectious Disease Consult for Staphylococcus aureus Bacteremia

Authors: Peyton Johnson, Alanna H. Rufe, Adam Harnden, Nancy Bailey, Sarah Vines, W. Creed Carleton

Purpose: Staphylococcus aureus is the most common Gram-positive cause of bacteremia and is a serious infection with up to 30% mortality. Optimal management of Staphylococcus aureus bacteremia (SAB) includes timely source identification, repeat blood cultures, echocardiography, and appropriate antimicrobial therapy. Infectious disease (ID) consultation is recommended as it is associated with improved patient outcomes, with some literature correlating earlier consultation with even better outcomes. At Jackson Hospital and Clinic most patients with SAB receive an ID consult, but the timing is variable. This study evaluated how timing of ID consultation impacts outcomes for patients with SAB.

Methods: This was an institutional review board approved, retrospective chart review at a 344-bed community hospital in Montgomery, Alabama. Adult patients were included if they had a diagnosis of SAB and received an ID consultation between October 1, 2023, and March 31, 2025. Patients were identified via a clinical decision support tool that reported blood cultures growing Staphylococcus aureus. Key exclusions included polymicrobial bacteremia, expiration within 72 hours of index blood culture, or refusal of treatment. Patients were stratified into two cohorts: early consult (ID consultation < 4 days from SAB diagnosis) and late consult (> 4 days).
The components of the primary composite endpoint were source identification, follow-up blood cultures, echocardiography within 5 days, administration of optimal parenteral antistaphylococcal therapy, and adherence to recommended treatment durations. Secondary endpoints included length of stay, in-hospital mortality, 30-day readmission, acute kidney injury, duration of inpatient antimicrobial therapy, and source-control procedures. Baseline demographics, comorbidities, and methicillin-resistant Staphylococcus aureus incidence were extracted. A priori power analysis estimated 88 patients to achieve 80% power. Additional statistical tests were used as appropriate.

Results: A total of 153 patient encounters were reviewed, and 93 patients met inclusion criteria. Among the included patients, 63 patients received an early infectious disease consultation, while 30 patients received a late consultation. Patients were excluded in the absence of ID consultation, polymicrobial bacteremia, death within 72 hours of admission, discharge against medical advice, and duplicate encounters. Baseline characteristics were similar between the early and late consultation groups, including age (60.3 vs 63.1 years), percentage of male patients (65% vs 63.3%), and incidence of methicillin-resistant Staphylococcus aureus (55.6% vs 56.7%).
Mean time to ID consultation was 1.9 days in the early group compared with 4.8 days in the late group (p < 0.0001). The primary composite quality-of care endpoint was achieved in 62% (n = 39/63) of the patients in the early consultation group compared with 53% (n = 16/30) in the late consultation group (p = 0.58). Acute kidney injury occurred significantly less frequently among patients who received early consultation (9.5% vs 33.3%, p = 0.01). No significant difference was found in length of stay, in-hospital mortality, 30-day readmission, duration of antimicrobial therapy, or source-control procedures between groups.

Conclusion: In this retrospective study of 93 patients with Staphylococcus aureus bacteremia, early ID consultation was not associated with a statistically significant improvement in the composite quality-of-care endpoint compared with later consultation. This may be due to an overestimation of the effect size. Early ID involvement was associated with a significantly lower incidence of acute kidney injury, which may support quality initiatives to standardize ID involvement. Implementing an automatic ID consult at the time initial blood cultures identify Staphylococcus aureus may reduce variability in quality-of-care and should be evaluated in future research.

Moderators

Lindsey Arthur

Clinical Pharmacy Manager, Self Regional Healthcare

After graduating Presbyterian College School of Pharmacy in 2016, I completed a PGY-1 Pharmacy Residency at Carteret Healthcare. Following residency, I started my pharmacist career at Self Regional Healthcare. For the majority of my time at Self, I have served as an Internal Medicine... Read More →

Presenters

Peyton Johnson

PGY1 Pharmacy Resident, Jackson Hospital and Clinic

I graduated from Auburn University Harrison College of Pharmacy in May 2025. After I complete my PGY1 residency at Jackson Hospital and Clinic, I will be an Emergency Medicine Pharmacist at UAB Health.

Evaluators

Lyndsay Gormley

RPD, PRIS10Prisma Health-Upstate (Critical Care)PGY2

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena I

Infectious Disease (ID), Jackson Hospital and Clinic

global Y

1:50pm EDT

Resident Presentation - Felipe Gomez

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena H

Title: Association between Enterococcal Infective Endocarditis following a Transcatheter Aortic Valve Replacement
Authors: Felipe Gómez; Caren Azurin; Stefanie Pappas
Affiliation: Ascension Saint Thomas Hospital West, Nashville, TN
Introduction Transcatheter aortic valve replacement (TAVR) is standard therapy for severe aortic stenosis. A severe complication is infective endocarditis (IE), predominantly caused by Enterococcus species (historically 24–34% of cases) due to patient comorbidities and groin contamination during transfemoral access. Our institution’s current prophylaxis protocol utilizes cefazolin, which lacks enterococcal coverage. The primary objective was to assess the association between surgical antibiotic prophylaxis and enterococcal IE risk following TAVR. Secondary objectives evaluated the time to infection, all-cause inpatient mortality, and surgical intervention rates.
Methods A single-center, retrospective observational review was conducted on 102 patients (≥18 years) who underwent TAVR between January 2023 and December 2024. Exclusions included prior antibiotic therapy, concurrent infections, or incarcerated status. Data was collected via REDCap. Statistical analysis utilized Fisher’s exact test for categorical variables and the Mann-Whitney U test for continuous data, with significance defined as p<0.05.
Results Of the 102 patients evaluated, 5 (4.9%) developed IE. Enterococcus spp. was the predominant pathogen, responsible for 80% (4 of 5) of cases. All patients who developed IE received 2 grams of cefazolin prophylaxis. Consequently, no significant association was found between prophylactic choice and IE (p=1.000) due to the near-universal administration of cefazolin. The mean time from surgery to enterococcal IE onset was 497.8 days. The infection rate was 6.4% for transfemoral access versus 0% for the carotid approach (p=0.585). Among the patients who developed IE, mortality was 0%, while 40% (n=2) required surgical intervention.
Discussion & Conclusion Enterococcus caused 80% of TAVR-related IE cases in this cohort, significantly exceeding historically reported rates. The data indicates that current institutional prophylaxis with cefazolin leaves a critical coverage gap for this specific population. Additionally, the higher infection rate in the transfemoral group highlights the risk of groin-sourced enterococcal inoculation. Despite limitations surrounding sample size and retrospective design, these findings provide actionable clinical evidence supporting the revision of the institutional TAVR protocol to incorporate agents with enterococcal activity (e.g., ampicillin/sulbactam) to target the predominant pathogen and improve patient outcomes.

Moderators

Kellie Ball

PGY2 Ambulatory Care Coordinator, University of Tennessee Medical Center

Hi! My name is Kellie Ball and I am currently the Coordinator for the PGY2 Ambulatory Care program at University of Tennessee Medical in Knoxville, TN. I graduated with my PharmD and Masters of Public Health from Samford University in Birmingham, AL.

Presenters

Felipe Gomez

Evaluators

Kelvin Gandhi

Infectious Diseases Clinical Pharmacist, AdventHealth Daytona Beach

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena H

Infectious Disease (ID), Ascension Saint Thomas Health

global Y

1:50pm EDT

Assessing Adherence and Outcomes of Tafamidis and Vutrisiran in Patients with Cardiac Amyloidosis in a Rural Setting

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena D

Authors: Amanda Dunlap, Dillion Frazier, and Cy Sims

Background: Tafamidis and vutrisiran are novel therapeutics shown to improve mortality rates and reduce hospitalization among cardiac amyloidosis patients. However, these medications are associated with substantial costs and prescribing challenges. Considering the high cost, lack of data in a rural healthcare system, and the increasing role of pharmacists in specialty pharmacies, there is a significant administrative interest in gaining a better understanding of the impact these medications have within our community. This project investigated the real-world adherence and outcomes of tafamidis and vutrisiran in a rural setting.

Methods: Tafamidis patients were identified using reports from Therigy. Reports included new starts of tafamidis from January 1, 2022-July 31, 2025, pharmacy turnaround times, and missed doses reported during follow-up. Vutrisiran patients were identified from Soarian Financials by filtering patients who received a prescription for vutrisiran from June 1, 2025-July 31, 2025. Patient charts were reviewed and followed for 6 months prior to treatment initiation and 6 months after the first prescription. The primary outcome of the study was to determine adherence to tafamidis and vutrisiran. Adherence was defined for tafamidis based on pharmacy dispensing records used to calculate the medication possession ratio greater than 80% signified adherence. Adherence for vutrisiran was based on documentation of administration in the patient medical record within 7 days of the next scheduled dose. Secondary outcomes were cardiovascular related hospital admission rates within the same patient 6 months pre-and post-drug initiation, the time from receiving the prescription to dispensing, the number of patients converted from tafamidis to vutrisiran, discontinuation of therapy as documented in the medical record or no fills within 60 days for tafamidis or a missed scheduled injection for vutrisiran, and insurance coverage.

Results: Of 153 patients included in the tafamidis group, 142 patients (92.8%) were found to be adherent. 11 patients (7.2%) were nonadherent with MPR score ranging from 66%-78%. In the vutrisiran group 4 of 13 patients were found to adherent, 7 were nonadherent as they did not receive a dose within 7 days post next scheduled dose, and 2 unable to obtain as the prescription was transferred to a different facility. Vutrisiran administration timing between doses ranged from 90-109 days for the 8 patients who received more than 1 dose, and 1 patient receiving 3 doses. Cardiovascular-related hospital admission rates were similar in the pretreatment group 9.8% vs 7.7% (tafamidis vs vutrisiran) while posttreatment admissions were higher in the vutrisiran group 13% vs 30%. The average time from receiving a prescription for tafamidis to the medication being dispensed from the pharmacy was 4.5 days and 32.2 days for vutrisiran. 13 tafamidis patients were additionally prescribed vutrisiran, and 3 patients were converted from tafamidis to vutrisiran. 7 tafamidis patients discontinued therapy while 3 vutrisiran patients discontinued. 152 patients in the tafamidis group had insurance coverage while 1 patient received 340b pricing. All vutrisiran patients had insurance coverage.

Conclusion: Tafamidis demonstrated high adherence rates, 92.8% of patients achieving a medication possession ratio ≥80, and had short pharmacy turnaround times. The findings highlight important adherence and operational challenges associated with specialty drugs especially in a rural setting. While also demonstrating the importance of specialty pharmacists optimizing access, minimizing delays, supporting adherence, and coordinating care for these patients.

Moderators

Molly Thompson

PGY1 Residency Program Director, HCA Healthcare Trident Hospital

Presenters

Amanda Dunlap

PGY1 Pharmacy Resident, John D. Archbold Memorial Hospital

Evaluators

Naomi Yates

Manager, Clinical Pharmacy Services, KFHP - Kaiser Foundation Health Plan of Georgia (Ambulatory)PGY2

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena D

Internal Medicine (IM), John D. Archbold Memorial Hospital

global Y

1:50pm EDT

Impact of a Clinical Pharmacist Workflow Change on Heart Failure Readmissions

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Parthenon 2

Title: Impact of a Clinical Pharmacist Workflow Change on Heart Failure Readmissions

Authors: Sean Ramoso, Kathrina Gonzales Raymundo, Natalie Ortiz-Gratacos, Richard Lane, Nicholas Mastromarino, Tracey Dobbs
Contact: [email protected]

Background:
Heart failure (HF) is a complex clinical syndrome and a leading cause of morbidity and mortality in the United States.1,2 Hospital readmissions due to HF are associated with increased costs and continue to be a growing health and economic burden.2,3 The American Heart Association estimates that the total costs of HF will increase from $31 billion in 2012 to $70 billion in 2030.4 To reduce HF readmissions, studies have evaluated the implementation of HF-focused multidisciplinary teams and observed reductions in 30-day HF readmission rates. These initiatives focused on transitions of care interventions such as telephone consultations, clinic follow-ups, and comprehensive patient education. Pharmacists can play a key role in these multidisciplinary teams through optimization of pharmacological guideline-directed medical therapy (GDMT) as recommended by the 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) Guidelines for the Management of Heart Failure. Further studies examining the impact of pharmacy-led interventions on HF readmissions and patient outcomes will be beneficial to identify the pharmacist’s role on the multidisciplinary team.

Methods:
A single-center, retrospective, chart review was conducted at AdventHealth Apopka between December 23, 2025 to March 30, 2026. A clinical pharmacist workflow change was implemented, where pharmacists completed HF-focused admission and discharge medication reconciliation reviews aimed at optimizing pharmacological GDMT per the 2022 AHA/ACC/HFSA Guidelines for the Management of Heart Failure. Patients were included if they were 18 years or older, had a diagnosis of HF, and had a HF-focused admission medication reconciliation completed by a pharmacist. Patients were excluded if they were pregnant, had a history of a heart transplant, had a scheduled heart transplant at the time of the index visit, had a diagnosis of dementia, or were discharged to hospice. The primary outcome of this study was the incidence of 30-day cardiovascular (CV)-related readmission rates, based on the index hospital discharge date. Secondary outcomes included 30-day all-cause readmission, inpatient length of stay (LOS), and the incidence of HF GDMT optimization defined as a dose titration, addition/resumption, or discontinuation of a GDMT drug class.

Results:
At the time of data analysis, the HF-focused pharmacist intervention group consisted of 52 patients who had 30-day readmissions data available. A comparator group of 52 patients admitted during the same study period without a HF-focused pharmacist intervention was utilized. For the primary outcome of 30-day CV-related readmission, this occurred in 9/52 (17.3%) patients in the intervention group and 11/52 (21.2%) patients in the comparator group (p = 0.495). For the secondary outcome of 30-day all-cause readmission, this occurred in 17/52 (32.7%) of patients in the intervention group and 16/52 (30.8%) of patients in the comparator (p = 0.946). The mean length of stay in the intervention group was 4.64 +/- 3.79 days compared with 2.94+/- 4 days in the comparator group (p = 0.056). HF GFMT optimization occurred in 41/52 (77.4%) patients in the comparator group and 28/52 (52.8%) of patients in the comparator group (p = 0.013).

Conclusion:
A HF-focused pharmacist workflow change was associated with a numerical, but not statistically significant, reduction in 30-day CV-related readmissions. This pharmacist workflow change was also associated with a significant increase in the incidence of HF GDMT. Key barriers to GDMT optimization included weekday-only coverage, challenges in reliably identifying eligible HF patients, competing staffing responsibilities, and variable acceptance of GDMT recommendations which were often deferred to outpatient follow-up. Next steps should focus on expanding pharmacist coverage to increase completion of HF-focused medication reconciliations, refining the HF patient identification report, implementing strategies to improve GDMT recommendation uptake, and evaluating outcomes over a longer timeframe with a larger sample.

References

Heidenreich, P. A., et al. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(18). https://doi.org/10.1161/cir.0000000000001063

Urbich, M., Globe, G., Pantiri, K. et al. A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020). PharmacoEconomics 38, 1219–1236 (2020). https://doi.org/10.1007/s40273-020-00952-0

Kwok, C. S., et al. (2021). Cost of inpatient heart failure care and 30-day readmissions in the United States. International Journal of Cardiology, 329, 115–122. https://doi.org/10.1016/j.ijcard.2020.12.020

Heidenreich PA, Albert NM, Allen LA, et al. Forecasting the Impact of Heart Failure in the United States: A Policy Statement From the American Heart Association. Circulation: Heart Failure. 2013;6(3):606-619. doi:https://doi.org/10.1161/hhf.0b013e318291329a

Moderators

Lucy Crosby

Medication Policy and Compliance Pharmacist, AUMC2Augusta University Medical Center/University of Georgia College of Pharmacy PGY1

Presenters

Sean Ramoso

PGY1 Pharmacy Resident at AdventHealth Apopka

Evaluators

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2

Sarah Frye, PharmD, BCCCP is the Clinical Pharmacy Specialist for Surgical / Trauma Critical Care and Residency Program Director for the PGY2 Critical Care Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina. Dr. Frye completed her Doctor of Pharmacy degree... Read More →

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Parthenon 2

Internal Medicine (IM), AdventHealth Apopka

global Y

1:50pm EDT

Impact of Antimicrobial Stewardship Provider Education on Patients with Community-Acquired and Aspiration Pneumonia

Thursday April 30, 2026 1:50pm - 2:10pm EDT

Athena C

Authors: Dalia Chamma, Colin Busbee, Holly Mclean, Desmond Durham

Purpose/Background: The initial recommendation for empiric anaerobic coverage in aspiration pneumonia was made in the 1970s, following the identification of anaerobic isolates in multiple studies. This was likely due to poor isolation techniques and the collection of microbiologic specimens later in the course of disease, including after abscesses, necrotizing pneumonia, or empyema had developed. The purpose of this study is to evaluate whether a guideline-based educational intervention directed at prescribers reduces empiric anaerobic coverage in adults hospitalized with community-acquired pneumonia (CAP) or aspiration pneumonia without abscess or empyema, and to assess clinical outcomes, including C. difficile infections, days of therapy with empiric anaerobic coverage, and hospital length of stay.

Methodology: This study will employ a retrospective chart review of patients to evaluate provider prescribing practices pre- and post-education. The educational intervention material is a guideline-based, one-page summary of the American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) 2019 CAP recommendations regarding the appropriate use of empiric anaerobic coverage in aspiration pneumonia. The educational material will highlight the indications for which anaerobic coverage is appropriate, emphasize that the management of aspiration pneumonia follows standard CAP treatment, and summarize the literature that the guidelines are based upon. Educational materials will be presented to the Antimicrobial Stewardship (AMS) Committee and to appropriate service-line leadership committees for review and approval prior to electronic distribution to clinicians. Data will be collected and evaluated from Slicer Dicer reports and the hospital’s electronic records for retrospective reviews of pre- and post-intervention. The primary objective is to compare the proportion of patients with community-acquired or aspiration pneumonia who receive empiric anaerobic coverage before versus after implementation of guideline-based provider education. Secondary objectives include comparing anaerobic antibiotic days of therapy, length of stay, time to clinical stability, and C. difficile infection 30-day readmission rates in patients with aspiration or community-acquired pneumonia in the pre- and post-intervention arms.

Results: In progress.

Conclusions: In progress.

Moderators

Alexis Pruitt

Presenters

Dalia Chamma

Evaluators

Kayla Brown

PGY-1 Residency Program Director, East Alabama Medical Center

Thursday April 30, 2026 1:50pm - 2:10pm EDT
Athena C

Internal Medicine (IM), CaroMont Regional Medical Center

global Y

2:10pm EDT

Development of a Hospital-based Comprehensive Pharmacy Intern Program

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Olympia 1

Background: Contemporary literature calls for health systems to elevate and structure paid pharmacy internships so they benefit both learners and institutions, moving beyond purely distributive tasks and aligning with patient-care activities and workforce needs. While evidence exists that characterizes the structure and impact of single programs, no publications offer a comparison of program structure or utilize internal stakeholder opinion to influence development. This study is therefore timely and novel in using reported data from existing external programs and internal stakeholder data to inform the design of a comprehensive, hospital-based internship program.

Methods: This study employed a cross-sectional, survey-based design to help inform the development of a comprehensive hospital-based pharmacy internship program. Electronic surveys were distributed via REDCap to leaders of pharmacy intern programs at external United States health systems and practicing pharmacists at the institution where the project took place. Surveys included quantitative items (e.g., demographics, program characteristics, Likert-scale perceptions of satisfaction and value) and qualitative open-ended questions exploring program strengths, gaps, and factors influencing intern retention. Data wase analyzed descriptively, with thematic analysis applied to qualitative responses. Findings will be used to identify impactful program elements and stakeholder priorities to inform internship program design.

Results: There were six external intern program survey participants. Progressive, multi-year programs made up 50% of the participants. Medication access, medication history, and discharge education were the most common intern activities. The median percent of time dedication to direct patient care was 40 (IQR 10-85). Interns also participated in journal clubs, patient case presentations, and medication use evaluations. Strengths identified by participants included staffing flexibilities, mutual benefit between interns and institutions, and positive mentoring experiences, yet increasing clinical opportunities, funding, and tracking intern errors and activities were identified as areas for improvement. There were 22 internal pharmacist survey participants. Of the 22, 12 were clinical pharmacist while 6 work in the central pharmacy. Pharmacists identified formal mentoring, project participation, clinical shadowing, transitions of care, direct patient care responsibilities, and the training of technicians and/or new interns as beneficial activities to possibly include in the new design. Pharmacists rated their current involvement as a 2 (IWR 1-4) on a scale of 1-10, but this number jumped to 5.5 (IQR 5-8) when asked how involved they are willing to be. Strengths identified by internal pharmacists included exposure to health system practice, strong operational integration, and high potential. Areas of improvement identified included lack of structure and organization, limited visibility and role clarity, insufficient mentorship and professional integration, underutilization, limited clinical exposure, and desire for longitudinal growth and leadership development.

Conclusion: Institutions have established a need for more formal intern programs with a mutual benefit. There are vast difference in intern programs around the United States, so the development of a new program will more so reflect internal needs. Encouragingly, internal pharmacists are willing to take on a greater role once a formal program is established. The next step is to formalize the design of the program utilizing the survey results.

Moderators

Nathan Wayne

Cardiology Clinical Pharmacist, PGY1 RPC, Wellstar MCG Health

Presenters

Macaleigh Mancuso, PharmD

PGY-1 Acute Care Pharmacy Resident, Prisma Health Richland - University of South Carolina

I am currently a PGY-1 Acute Care Pharmacy Resident in Columbia, South Carolina. I completed my pharmacy education at the Auburn University Harrison College of Pharmacy. Next year, I will be the academic fellow at the University of South Carolina College of Pharmacy. I serve on the... Read More →

Evaluators

Nieka Jackson

Pain Clinical Pharmacist Practitioner (Facility PMOP Coordinator)

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Olympia 1

Administration (ADM), Prisma Health Richland - University of South Carolina

global Y

2:10pm EDT

Transforming Care: Assessing the Role and Impact of Clinical Pharmacist Practitioners through Electronic Consult Services

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Olympia 2

Title:
Transforming Care: Assessing the Role and Impact of Clinical Pharmacist Practitioners through Electronic Consult Services

Authors:
McKinley Corley, Deborah Hobbs, Marci Swanson, Nieka Jackson

Background/Purpose:
The purpose of this project is to evaluate a correlation in e-consults completed by clinical pharmacist practitioners (CPPs) and the impact they have in enhancing Veteran care.

Electronic consults (E-Consults) have been widely used in healthcare systems. An e-consult is initiated by one healthcare provider seeking the opinion of a specialist pertaining to the question at hand. Benefits of e-consults include: engaging specialists earlier in the workup process to minimize unnecessary testing, providing more prompt input from specialists, ensuring more succinct chart documentation, and reducing the need for patient travel. Pharmacists can be one of the specialists that are sought out to respond to the e-consults. E-consults have demonstrated to be an effective method for providers to receive timely pharmacist recommendations. Pharmacists can improve patient outcomes via e-consults by preventing medication-related problems. Research shows that pharmacist recommendations made through e-consults have a positive impact on patient outcomes. The numerous studies conducted within the VA system demonstrate that the Department of Veterans Affairs is at the forefront of using e-consults to improve patient outcomes.

Methodology:
This performance improvement project was approved by the Carl Vinson VA Medical Center Pharmacy and Therapeutics Committee. This project aims to evaluate the implementation rate of clinical pharmacist recommendations and various aspects of the e-consult process. Primary and secondary objectives include characterizing the use and types of clinical pharmacist e-consults, evaluating completion timelines, and assessing the extent of patient management by CPP clinics resulting from e-consults. Data was collected through a retrospective chart review of e-consults using the Integrated Document Manager in VISTA. All clinical pharmacy e-consults completed between 10/01/2024 – 09/30/2025 were evaluated. Exclusion criteria included cancelled e-consults, BHIP Medication Management Consults, and Congestive Heart Failure Re-admission Consults. Collected data encompassed patient demographics (sex, age, race, location), consult details (title, category, requesting provider, and author), reason for e-consult, number of requests per e-consult, time required for completion, the number of accepted recommendations, and referrals to CPP. This comprehensive data collection aims to provide insights into the efficacy and efficiency of clinical pharmacist interventions via e-consults.

Results:
A total of 736 e-consults were completed, leading to 795 recommendations. Out of these recommendations, 688 (86.5%) were accepted by the providers, while 107 (13.5%) were not. The majority of the consults were related to pain management. Impressively, 93.8% of the consults were completed within 72 hours, meeting the established criteria. Additionally, approximately one-third of the patients were referred to CPP clinics as a direct result of the e-consult responses. Overall, this project was highly successful.

Conclusions:
The findings of this project align with published literature supporting pharmacist-led e-consult services. The high acceptance/implementation rate validates the role of the Clinical Pharmacist Practitioners in e-consult services. Opportunities exist to expand and optimize e-consult utilization across the facility, including filling in potential gaps of care and e-consult simplification.

Moderators

Karen Babb

Residency Program Director, CHIM1CHI MemorialPGY1

Presenters

McKinley Corley

PGY-1 Pharmacy Resident

McKinley Corley, PharmD, is a PGY-1 Pharmacy Resident at the Carl Vinson VA Medical Center in Dublin, Georgia. She earned her Doctor of Pharmacy degree from the University of Georgia in 2025. Upon completion of her residency, Dr. Corley will join the Carl Vinson VA Medical Center... Read More →

Evaluators

Karen Barlow

PGY1 Residency Program Director, Wellstar Kennestone Regional Medical Center

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Olympia 2

Administration (ADM), VA-Dublin, GA-Carl Vinson VA Medical Center

global Y

2:10pm EDT

Assessing the Prevalence of Inappropriate Insulin Prescribing at Hospital Discharge

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena B

Assessing the Prevalence of Inappropriate Insulin Prescribing at Hospital Discharge
Darci Conklin, Jack Handshaw
AdventHealth Celebration – Celebration, FL

Background/Purpose: To review current prescribing trends to assess whether patients with diabetes are receiving appropriate insulin therapy at hospital discharge.

Methodology: Retrospective chart review of patients prescribed insulin at discharge from Advent Health Celebration, spanning from March 1st, 2025, to July 31st, 2025. The primary endpoint of the study was a composite of patients deemed to have inappropriate insulin prescriptions at discharge; defined as having at least one of the following: Patients prescribed duplicate insulin therapy, patients prescribed a regimen of correctional insulin only, patients prescribed an insulin prescription with inappropriate instructions, patients not prescribed appropriate insulin administration devices such as pen needles or insulin syringes, patients prescribed insulin when previously controlled on non-insulin antidiabetic medications prior to admission or patients who did not require insulin therapy as per the 2026 ADA Standards of Care in Diabetes guidelines. Secondary endpoints included incidence of each component of the primary composite endpoint, incidence of 30-day and 90-day re-admission due to a diabetes-related cause, patients co-prescribed glucagon, and patients co-prescribed testing supplies. Patients were included in this review if they were aged 18 years or older, had a discharge disposition of self-care or home health, were diagnosed with diabetes prior to or during the reviewed admission, and had a recorded A1c within the 6 months prior to discharge.

Results: A total of 198 patients were initially extracted for retrospective review; however, 39 patients were excluded, leaving 158 patient encounters eligible for analysis. Of the 158 encounters, 70 encounters were found to have inappropriate insulin prescriptions at discharge (70/158, 44.3%). No patients reviewed were prescribed glucagon at discharge, and only 57 patient encounters had patients prescribed testing supplies at discharge (57/158, 36.08%). A total of 21 patients were readmitted within 30 days of discharge (21/158, 13.29%), with 7 of these 21 patients (33.33%) deemed to have an inappropriate insulin prescription at discharge. Similarly, a total of 30 patients were readmitted within 90 days of discharge (30/158, 18.99%), with 10 patients (33.33%) discharged with an inappropriate insulin prescription.

Conclusions: Nearly half of patient encounters reviewed were deemed to have improper prescribing of insulin or associated supplies at hospital discharge. The most common insulin prescription errors seen were prescriptions with incorrect sliding scale instructions and patients not prescribed appropriate administration devices. Readmissions at 30 and 90 days were not seen to be associated with receiving inappropriate insulin prescriptions at discharge. Encounters where patients received a prescription for testing supplies or glucagon were also substantially low to non-existent. Based on the results seen, there is an opportunity for targeted education of prescribing physicians and inpatient clinical staff on insulin at discharge. These results also highlight the importance of pharmacist review in the transitions of care space for management of diabetes upon discharge and for the facilitation of close outpatient follow-up.

Moderators

Erin Murdock

Clinical Oncology Pharmacist / PGY2 Oncology RPC, Northside Hospital

Presenters

Darci Conklin

PGY-1 Ambulatory Care Resident, AdventHealth Celebration

Evaluators

Kishan Patel

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena B

Ambulatory Care (AMB), AdventHealth Celebration

global Y

2:10pm EDT

Quality Assessment of Implementation of a VA Population Management Tool for SGLT2 Inhibitor Use in the Primary Care Setting

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena C

Purpose:
Type 2 diabetes mellitus (T2DM) is a global health issue with substantial costs. To improve care, Ralph H. Johnson VA Health Care System (RHJ VAHCS) adopted the “Potential SGLT2 Candidate by Appointment Dashboard”, a population management tool (PMT). This tool helps providers identify scheduled T2DM patients who are ideal candidates for SGLT2 inhibitors, specifically those with additional risks like kidney or heart disease. The PMT aims to increase prescriptions of SGLT2 inhibitors by proactively alerting providers to upcoming patient appointments. The purpose of this project is to increase appropriate prescribing of SGLT2 inhibitors in the primary care setting.
Methods:
The pre-PMT implementation period is 10/1/2023 - 12/31/2024 followed by the PMT implementation period of 1/1/2025 - 3/31/2026. All primary care providers (PCPs) at RHJ VAHCS were formally introduced to the PMT in August of 2025. Through the months of August-November, hands-on experience was gained through pulling patients with upcoming appointments from a community-based outpatient clinic (CBOC). 51 patients that populated on the PMT were reviewed and those that were determined to be candidates were contacted to initiate SGLT2 inhibitors. Once hands-on experience was complete, smaller meetings were conducted individually at 5 outpatient clinics through November and January to further educate about the PMT. Survey questions were provided to assess providers’ overall comfortability with utilizing the PMT and to determine how many providers planned to implement this PMT in practice. During February and March, weekly meetings were held individually with 8 providers. The Plan-Do-Study-Act model was implemented through the meetings to establish overall facilitators and barriers to utilization of the PMT with the overarching goal to increase utilization for all providers. The primary endpoint of the study is to evaluate the impact of implementation of a PMT on the number of new SGLT2 inhibitor prescriptions initiated by PCPs. Subgroup analysis were included to assess how providers’ subscription to PMT, patients physically viewed on the PMT, and PharmD education on the PMT impacted the rate of new SGLT2 inhibitor prescriptions. The secondary endpoint is to determine the facilitators and barriers to implementation of the PMT.
Results
During the pre-PMT implementation period, there was a total of 2,950 new start SGLT2 inhibitor prescriptions at the RHJ facility compared to the PMT implementation period with a total of 2,881 new starts. Of the 2,881 prescriptions, 448 new starts are specific to an associated visit on the PMT which was defined as prescriptions issued within three days of an appointment flagged on the tool. A total of 43,399 total candidates populated on the tool with 448 resulting in new start prescriptions making the overall rate of new starts with PMT utilization 1.03%. The rate of new starts increases up to 2.47% when compared to providers subscriptions to the PMT and increases to 4.51% when compared to patients reviewed on the PMT. When comparing any type PMT interaction including both subscriptions and views, that rate of new starts with subscriptions and views is 3.88%, subscription with no views is 1.89%, and no subscription with views 7.02%. When looking at pre/post PharmD education on the PMT, the rate of new starts decreased from 3.53% to 2.44% with a p-value of 0.0194 (significance ≤ 0.01). For the secondary endpoint, common facilitators to use include sustainability (6%, n=1), ease of use (17%, n=3), data accuracy (18%, n=3), timeliness (18%, n=3), and clinical relevance (41%, n=7). The common barriers to use include change fatigue (13%, n=5), information overload (15%, n=6), perceived lack of value (13%, n=5), usability (8%, n=3), lack of training or technical support (2%, n=1), workflow disruption (23%, n=9), data quality concerns (8%, n=3), and time constraints (18%, n=7).
Conclusion:
In conclusion, most providers feel that it is a priority to initiate SGLT2 inhibitor prescriptions for the cardiorenal protective properties. While the overall number of new start SGLT2 inhibitors remains relatively the same after the PMT was implemented, the PMT demonstrated having a positive impact on the rate of new start SGLT2 inhibitor prescriptions through subscribing and viewing patients with the tool. Time constraints, workflow disruption, and alert fatigue were common barriers to utilization of the PMT. While the “Potential SGLT2 Candidate by Appointment Dashboard” is a population management tool that aims to increase appropriate prescribing of SGLT2 inhibitors, updates that incorporate changes recommended by providers may lead to an uptake of utilization in the future.

Moderators

Alexis Pruitt

Presenters

Brooke Jordan-Brown

PGY-2 Ambulatory Care Pharmacy Resident, Ralph H. Johnson VA Healthcare system

Brooke Jordan-Brown is a South Carolina native and grew up in Greenville, SC. She played basketball at UNC Asheville where she received a bachelor’s degree in Biology in 2020 and she graduated from the UNC Eshelman School of Pharmacy in 2024. Her current interests in pharmacy... Read More →

Evaluators

Kayla Brown

PGY-1 Residency Program Director, East Alabama Medical Center

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena C

Ambulatory Care (AMB), VA - Charleston, SC - Ralph H. Johnson Veterans Affairs Medical Center

global Y

2:10pm EDT

Pharmacist-Led Lipid Optimization: Bridging Post-ACS Care with Early Injectable Therapy Initiation

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Parthenon 1

Background: Cardiovascular (CV) disease is the leading cause of death worldwide, accounting for nearly eighteen million deaths annually. Among patients with acute coronary syndrome (ACS), up to twenty percent experience a recurrent major adverse cardiovascular event (MACE) within two years. Optimizing lipid lowering therapies to achieve a goal low-density lipoprotein (LDL) is a cornerstone of secondary prevention and reduces the residual risk of MACE. Injectable-lipid lowering therapies have a prominent role in LDL goal achievement for patients deemed statin-intolerant or those who need additional lipid-lowering in addition to their maximally tolerated statin therapy. Despite the proven efficacy of injectable lipid-lowering therapies, their usage remains suboptimal due to access, cost, and workflow barriers. Pharmacist-led lipid clinics have shown to bridge the gap to initiation of injectable lipid-lowering therapy by increasing the use of guideline-directed therapy, identifying and managing statin-intolerance, and improved calculated low-density lipoprotein (LDL-C) goal achievement. This project evaluates the impact of an inpatient pharmacist-led referral process to a pharmacist-managed lipid clinic on the timely initiation of injectable lipid-lowering therapies in post-ACS patients.
Methods: This single-center, retrospective cohort with pre-post analysis included adults who survived hospitalization for ACS, including non-ST-elevated myocardial infarction (NSTEMI) or ST-elevated myocardial infarction (STEMI), with an LDL greater than or equal to 55 mg/dL or statin-intolerant. Patients were excluded if they were already on injectable lipid-lowering therapy or pregnant or breastfeeding. Patients who met the inclusion criteria were eligible to be referred by the inpatient pharmacy team to a pharmacist-led lipid clinic for ambulatory lipid management post-ACS. A collaborative practice agreement (CPA) allowed clinical pharmacists practitioners (CPPs) to independently conduct lipid management visits, initiate, titrate, or discontinue antihyperlipidemic medications, order and evaluate laboratory tests, provide adherence and lifestyle counseling, and document all care in the electronic health record for physician review. The primary outcome assessed was the proportion of patients that were started on injectable lipid lowering therapy within four weeks of discharge post-ACS event. Secondary outcomes were proportion of patients started on injectable lipid lowering therapy within 12 weeks of discharge post-ACS event, proportion of patients seen in lipid clinic within four and 12 weeks of discharge post-ACS event, median time to seen in lipid clinic, median time to started on injectable lipid-lowering therapy post-discharge, and percent reduction of LDL from baseline to eight or more weeks post-initiation of injectable lipid-lowering therapy.
Results: A total of 196 patients were screened with 45 patients being included in the pre-PharmD referral group and 151 patients in the post-PharmD referral group. A higher proportion of patients in the post-referral to pharmacist-managed lipid clinic group were initiated on injectable lipid-lowering therapies within four weeks of ACS discharge compared to the pre-referral group [15 (23.8%) vs 0 (0%); p=0.002]. Patients in the post-referral group were also more likely to be seen in lipid clinic within four weeks (OR 0.13; p=0.003) and 12 weeks (OR 0.32; p=0.04) of discharge.
Conclusion: Implementation of a standardized referral process to an outpatient pharmacist managed lipid clinic post-ACS discharge enhance transitions of care and implementation of guideline-directed lipid-lowering therapy to reduce residual risk of MACE for patients post-ACS. This standardized process increased the number of patients seen by a pharmacist and initiated on injectable lipid-lowering therapies within four and 12 weeks of ACS discharge. These findings suggest that pharmacist-managed lipid clinics can bridge the gap in post-ACS care by ensuring lipid therapy optimization to reduce the risk of recurrent MACE.
Presentation Objective: Describe the impact of an inpatient pharmacist-led referral process to an outpatient pharmacist-managed lipid clinic on the initiation of injectable lipid-lowering therapies in post-ACS patients.
Self-Assessment: What are some advantages of referring post-ACS patients to an outpatient pharmacist-led lipid clinic?

Moderators

Kimm Freeman

Presenters

Maegan Herring

PGY-1 Pharmacy Resident, Cone Health - Moses Cone Hospital

Evaluators

Khushbu Patel

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Parthenon 1

Cardiology (CAR), Cone Health

global Y

2:10pm EDT

Unmasking the Neurologic Exam: Sugammadex for Neuromuscular Blockade Reversal in Neurocritical Care

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena D

Unmasking the Neurologic Exam: Sugammadex for Neuromuscular Blockade Reversal in Neurocritical Care

Authors: Autumn Locke McClung1; Gianna Marie Antinone2; Michael L. Behal1; Mary W. Massaro; Thomas J. Christianson1,4; Paige Ledlow1; Bryn E. Ferguson3; Sarah J. Kugler,3; Robert E. Heidel4; Leslie A. Hamilton1,3

1University of Tennessee Medical Center, Knoxville, TN
2Inova Fairfax Hospital, Falls Church, VA
3University of Tennessee Health Science Center College of Pharmacy, Knoxville, TN
4University of Tennessee Health Science Center College of Medicine, Knoxville, TN

Background
Evidence supporting sugammadex for neuromuscular blockade reversal is largely derived from perioperative and traumatic populations, with limited data in nontraumatic neurocritical care patients. Residual blockade following emergent intubation may delay neurologic assessment and impact time-sensitive decisions. This study evaluated the safety and effectiveness of sugammadex in facilitating neurologic assessment and informing clinical decision-making in this population.

Methods
This retrospective, observational cohort study was conducted at a large academic medical center in Knoxville, Tennessee. Adult patients with nontraumatic neurologic injury who received sugammadex for NMB reversal between April 2016 through December 2024 were included. Patients were excluded if they were pediatric, pregnant, had traumatic neurologic injury, or received sugammadex for routine postoperative anesthesia reversal. The primary outcome was the impact of sugammadex on neurologic decision-making, defined as escalation or de-escalation of care following reversal. Secondary outcomes included adverse events, train-of-four monitoring when available, and successful NMB reversal defined as improvement in neurologic examination using Glasgow Coma Scale scores. Four a priori subgroup analyses were conducted, including comparisons of sugammadex dosing strategies relative to neurologic injury severity, neurologic injury type and the incidence of escalation or de-escalation of care, and patients intubated at an outside hospital or by Emergency Medical Services (EMS) versus the study institution. Statistical analyses were performed using SPSS (Version 31). Descriptive statistics summarized variables, and subgroup comparisons were conducted using chi-square tests, with significance defined as p<0.05.

Results
A total of 153 patients were included. Patients had severe neurologic injury, with a median presenting Glasgow Coma Scale (GCS) of 5 (IQR 3–8) and pre-intubation GCS of 4 (IQR 3–8). Intracranial hemorrhage syndromes were most common (57.5%), followed by ischemic stroke (22.9%) and status epilepticus (22.9%). Intubation occurred prior to arrival in 39.9% of patients and at the study institution in 60.1%. Rocuronium was the predominant paralytic (92.2%) at a median dose of 1.2 mg/kg (IQR 1.04–1.33). Most patients received sugammadex 2–4 mg/kg (64.1%), with fewer receiving <2 mg/kg (7.8%) or >4 mg/kg (15%). Following sugammadex administration, 23.5% of patients underwent escalation of care, most commonly neurosurgical intervention, while 24.8% experienced de-escalation, including 19% of patients who transitioned to comfort-based management. No neurologic deterioration was attributed to sugammadex. Adverse events were infrequent, including hypotension (13.7%) and bradycardia (11.1%). Subgroup analyses demonstrated no significant differences in outcomes across dosing strategies or neurologic injury subtypes.

Conclusions
Sugammadex demonstrated a favorable safety profile in nontraumatic neurocritical care patients and was not associated with neurologic deterioration. Nearly half of patients underwent escalation or de-escalation of care following sugammadex administration, supporting its role in expediting neurologic assessment and facilitating timely, clinically meaningful management decisions.

Moderators

Molly Thompson

PGY1 Residency Program Director, HCA Healthcare Trident Hospital

Presenters

Autumn McClung

PGY2 Critical Care Resident, The University of Tennessee Medical Center

Evaluators

Naomi Yates

Manager, Clinical Pharmacy Services, KFHP - Kaiser Foundation Health Plan of Georgia (Ambulatory)PGY2

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena D

Critical Care/Emergency Medicine (CCM), University of Tennessee Medical Center

global Y

2:10pm EDT

Cracking The CRAB: Evaluating Clinical Outcomes of Eravacycline Therapy in Carbapenem-resistant Acinetobacter baumanni - Madeline Lemmon

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena I

Purpose: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a high-priority antibiotic-resistant pathogen of public health concern and is associated with substantial morbidity and mortality. In 2024, the Infectious Disease Society of America (IDSA) recommended sulbactam-durlobactam in combination with a carbapenem as the preferred regimen for the treatment of CRAB. Despite IDSA recommendations, there isn’t a standard of care regimen for CRAB. Eravacycline, a synthetic fluorocycline, demonstrates structural resilience against common resistance mechanisms and shows in vitro activity against CRAB. This study aims to evaluate the clinical effectiveness of eravacycline-based therapy compared with best available therapy (BAT) in hospitalized patients with CRAB.
Methods: A retrospective chart review was performed on patients admitted to FMOL Health- Our Lady of the Lake with CRAB infections between January 2020 to December 2025. Patients aged 18 years and older with a documented infection of CRAB who receive one or more doses of eravacycline-based therapy or BAT were included. Patients were excluded if they were pregnant, did not receive antimicrobial treatment, discharged within 48 hours of admission, transferred to another hospital, or died prior to initiating antimicrobials. The primary outcome is a desirability of outcome ranking (DOOR) comparing eravacycline to BAT for treatment of infections caused by CRAB. The rankings are defined as the following: (1) clinical success without infectious complications or adverse events, (2) clinical success with infectious complications or adverse events, (3) absence of clinical success without infectious complications or adverse events, (4) absence of clinical success with infectious complications or adverse effects, and (5) death. Secondary outcomes include length of stay, duration of therapy, and relapse infection.
Results: A total of 271 patients were screened for eligibility. Of those evaluated, 96 patients were included in this study: 42 patients in the eravacycline group and 54 patients in the BAT group. The majority of patients were male (66.7%), black or African American race (51.04%), and had a median age of 60 years old. Most patients had at least one hospitalization in the 90 days prior to index hospitalization (65.6%) and had received IV antibiotics at least 90 days prior (60.4%). There was no significant difference between groups between any DOOR scale. The median length of hospital stay was 29.94 days, and the average length of therapy was 13.18 days. Repeat CRAB cultures were seen in 35.71% and 27.78% of patients in the eravacycline group and BAT group, respectively.
Conclusion: Among patients with CRAB, eravacycline did not appear to improve clinical outcomes or affect DOOR distribution.

Moderators

Lindsey Arthur

Clinical Pharmacy Manager, Self Regional Healthcare

Presenters

Madeline Lemmon

PGY1 Pharmacy Resident, FMOL Health - Our Lady of the Lake

Madeline Lemmon, Pharm.D., is a PGY-1 pharmacy resident at FMOL Health -- Our Lady of the Lake in Baton Rouge, Louisiana. She earned both her Bachelor of Science in Pharmaceutical Sciences and Doctor of Pharmacy degrees from University of South Carolina College of Pharmacy. Madeline... Read More →

Evaluators

Lyndsay Gormley

RPD, PRIS10Prisma Health-Upstate (Critical Care)PGY2

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena I

Infectious Disease (ID), Our Lady of the Lake Regional Medical Center

global Y

2:10pm EDT

Effect of Antibiotic Selection on Clinical Outcomes in Patients with Bloodstream Infections Caused by AmpC β-lactamase–producing Enterobacterales

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena J

Effect of Antibiotic Selection on Clinical Outcomes in Patients with Bloodstream Infections Caused by AmpC β-lactamase–producing Enterobacterales
Phuong Giao Nguyen Tran, Christopher M. Bland, Susan E. Smith, Caroline Turpin, Rachel Musgrove
St. Joseph's/Candler Health System

Background: Antibiotic resistance remains a major global health threat. Bacterial production of β-lactamases is a key resistance mechanism, with AmpC β-lactamases commonly identified in some Enterobacterales isolates. Mortality from bacteremia caused by AmpC-producing organisms has been reported to be significant. The 2024 Infectious Diseases Society of America (IDSA) guidance recommends cefepime or carbapenems for the treatment of infections caused by organisms at moderate risk of significant AmpC production and advises against ceftriaxone and piperacillin/tazobactam due to concerns about inducible resistance. However, clinical studies have not yet demonstrated superior outcomes with cefepime or carbapenems compared with ceftriaxone or piperacillin/tazobactam in this setting.

Methods: A multicenter, retrospective chart review was conducted during the period of January 2015 to December 2025. Eligible patients were adults 18 years of age or older and admitted to either St. Joseph’s Hospital or Candler Hospital with at least one blood culture isolating Hafnia alvei, Enterobacter cloacae, Citrobacter freundii, Klebsiella aerogenes, Yersinia enterocolitica, or Serratia marcescens. Patients were excluded if the initial antibiotic regimen was started at an outside hospital, if empiric therapy included a fluoroquinolone, or if blood cultures were polymicrobial. The primary objective was to determine if the use of IDSA-nonpreferred antibiotics (ceftriaxone, piperacillin/tazobactam) as empiric therapy in patients with bloodstream infections caused by AmpC β-lactamase–producing Enterobacterales results in increased incidents of suboptimal patient outcomes, as measured by greater rates of mortality, compared with IDSA-preferred agents (cefepime, meropenem). Secondary outcome measures include requirement of change of antibiotic therapy, total duration of antibiotic therapy, incidence of relapsed bacteremia, and incidence of Clostridium difficile infection while inpatient. All qualitative data points were evaluated using Chi-square analysis. All quantitative data points were evaluated using t-test analysis. A p-value of less than 0.05 was considered statistically significant.

Results: A total of 184 patients were screened and 146 of those patients were included in the analysis. The remaining 38 patients were excluded based on the criteria mentioned above, with the most common being polymicrobial blood cultures. The breakdown of the organisms isolated is as follows – 59 Enterobacter cloacae isolates (40%), 48 Serratia marcescens isolates (33%), 29 Klebsiella aerogenes isolates (20%), 9 Citrobacter freundii isolates (6%), and 1 Hafnia alvei isolate (1%). There was no statistically significant difference with regards to in-hospital mortality between the IDSA-nonpreferred antibiotics (ceftriaxone, piperacillin/tazobactam) and the IDSA-preferred agents (cefepime, meropenem) (p > 0.05). Secondary objectives were comparable between the two groups as well.

Conclusions: Use of IDSA-preferred agents, such as cefepime or meropenem, did not lead to improved clinical outcomes in patients with bacteremia caused by AmpC-producing organisms. However, this study has several important limitations. Notably, the study period spanned the COVID-19 pandemic, which may have introduced confounding factors affecting patient outcomes, including mortality. The true clinical significance must be assessed in larger, prospective, randomized control trials.

Moderators

Kelley Norris

Presenters

Phuong Giao Tran

PGY-1 Pharmacy Resident, St. Joseph's/Candler Health System

Evaluators

Ketrin Mount

PGY1 Pharmacy Residency Program Director, James H. Quillen VA Medical Center

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena J

Infectious Disease (ID), St. Joseph's/Candler Health System

global Y

2:10pm EDT

Evaluating the Efficacy of Rifaximin Monotherapy versus Rifaximin Plus Lactulose for the Treatment of Recurrent Hepatic Encephalopathy in Hospitalized Patients with Cirrhosis across the Wellstar Health System

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena G

Background/Purpose:
Hepatic encephalopathy (HE) is a common and burdensome complication of cirrhosis, associated with significant morbidity, mortality, and frequent hospitalizations. Lactulose remains the cornerstone of therapy; however, its use is often limited by poor tolerability and adherence. Rifaximin is recommended as add-on therapy for prevention of recurrence, but in clinical practice, it is increasingly used as monotherapy, particularly in patients who are unable to tolerate lactulose.

Despite this shift, there is limited real-world data evaluating the effectiveness of rifaximin monotherapy in the inpatient setting. The purpose of this study was to compare clinical outcomes between patients treated with rifaximin monotherapy and those treated with rifaximin in combination with lactulose for the treatment of overt HE across the Wellstar Health System.

Methodology:
Adult patients (≥18 years) with cirrhosis who had been hospitalized for an episode of overt hepatic encephalopathy (HE; ICD-10 K76.82) between January 1, 2015, and July 31, 2025, were enrolled into this retrospective cohort study. These patients were categorized according to the treatment they received while hospitalized: those treated with rifaximin as monotherapy, and those treated with rifaximin + lactulose. Patients with acute liver failure, active infection, intensive care unit admissions, or hospitalizations of < 24 hours were excluded. The primary outcome was improvement in hepatic encephalopathy, defined as a reduction of one or more points in the West Haven Score grade during hospitalization. Secondary outcome measures include changes in serum ammonia levels, length of stay (LOS), acute kidney injury (AKI) events, in-hospital mortality, 30-day mortality, and 30-day readmissions due to HE. The continuous data collected were compared using two-sample t-tests. Categorical data collected were compared using chi-squared analyses. A p-value of ≤ .05 was used to determine if observed differences are statistically significant.

Results:
A total of 104 patients were included, with 52 patients in each group. Baseline characteristics were well balanced between groups, including age (57.3 vs 56.8 years, p=0.84), Charlson Comorbidity Index (4.94 vs 4.79, p=0.48), and MELD score (~20 in both groups, p=0.91).

Both treatment groups demonstrated meaningful reduction in WHS grade during hospitalization. The mean WHS decreased from 2.94 to 0.96 in the lactulose + rifaximin group and from 2.87 to 0.88 in the rifaximin monotherapy group. The degree of improvement was similar between groups (mean change: 1.98 vs 1.99, p=0.96).

Ammonia levels decreased in both groups as well, from 75.7 to 53.9 µmol/L in the lactulose + rifaximin group and from 71.3 to 52.3 µmol/L in the rifaximin group, with no significant difference observed (p=0.61).

Hospital length of stay was numerically shorter in the rifaximin monotherapy group (5.38 vs 6.85 days), though this did not reach statistical significance (p=0.17).

Rates of AKI, 30-day readmission, and mortality were low and comparable between groups. AKI occurred in 3.8% vs 5.8% of patients (p=0.65), and 30-day readmission occurred in 0% vs 3.8% (p=0.15) in the lactulose + rifaximin and rifaximin groups, respectively. In-hospital mortality occurred in 0% of patients in the lactulose + rifaximin group and 5.8% in the rifaximin group; however, this difference was not statistically significant (p=0.08).

Conclusions:
Rifaximin monotherapy demonstrated similar effectiveness to combination therapy with lactulose in reducing WHS grade and reducing ammonia levels during hospitalization.

No meaningful differences were observed in readmissions, AKI, or overall safety outcomes. While not statistically significant, the shorter LOS observed in the monotherapy group may suggest a potential advantage that warrants further investigation.

These findings support the idea that rifaximin monotherapy may be a reasonable alternative in select patients, particularly those who are unable to tolerate lactulose. Given the limitations of retrospective data and potential confounding factors, larger prospective studies are needed to better define the role of rifaximin monotherapy in the management of hepatic encephalopathy.

Moderators

Leigh Joyner

Clinical Pharmacist, Tandem Health

Presenters

Manderrious Glenn

PGY2 HSPAL Resident, Wellstar Cobb Medical Center

Hello, my name is Manderrious Glenn — Glenn for short. I am currently a PGY2 Health-System Pharmacy Administration and Leadership (HSPAL) resident at Wellstar Cobb Medical Center. My professional interests center on health-system strategy, formulary management, operational optimization... Read More →

Evaluators

Kristina Evans

PGY2 Internal Medicine Residency Program Coordinator, Grady Health System

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena G

Infectious Disease (ID), Wellstar Cobb Medical Center / Wellstar Health System PGY1/PGY2 HSPAL

2:10pm EDT

Impact of a Pharmacist Driven Penicillin Allergy Re-labeling Process in the Emergency Department Setting

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Parthenon 2

IMPACT OF A PHARMACIST-DRIVEN PENICILLIN ALLERGY RE-LABELING PROCESS IN THE EMERGENCY DEPARTMENT SETTING
Erin Schuld PharmD, Aayush Patel PharmD, Mckenzie Hodges PharmD
Piedmont Columbus Regional Midtown-Columbus GA

Background/Purpose: Approximately 10% of U.S. patients report a penicillin allergy, yet fewer than 1% are truly allergic. Mislabeling often leads to use of broad-spectrum antibiotics, increasing antimicrobial resistance and risk of adverse effects. Pharmacist-driven allergy clarification protocols may improve antibiotic stewardship by enabling safe re-labeling of inaccurate allergy records. This study evaluates the impact of a pharmacist-driven penicillin allergy re-labeling protocol in the emergency department (ED) using the institution’s hypersensitivity pathway and the Pen-FAST risk stratification tool.

Methods: We conducted a single-center, retrospective chart review of adult patients (≥18 years) presenting to the ED between February 2, 2026 and March 31, 2026 with a documented penicillin allergy. Patients were excluded if they could not meaningfully participate in the allergy assessment for any reason. The primary outcome was the proportion of patients safely and successfully re-labeled using the pharmacist-driven protocol. Secondary outcomes included changes in antibiotic therapy following re-labeling and incidence of adverse reactions during oral or test-dose challenges. Data were abstracted from electronic health records and analyzed using descriptive statistics.

Results: A total of 559 patients were included in this study. 441 patients were not able to have their allergies assessed by a pharmacist. 70 unassessed patients were on antibiotics and, of these, 29 patients potentially could have undergone a change to their antibiotic regimen. 118 patients were able to have their allergy assessed and re-labeled by a pharmacist. 46 assessed patients were receiving antibiotics. Of these 46, 18 patients underwent changes to their antibiotic regimen secondary to the pharmacist assessment. The most frequent change was from a fluoroquinolone, namely levofloxacin, to a cephalosporin with cefepime and ceftriaxone being the most common agents. The second most common change was from aztreonam to a cephalosporin with cefepime and ceftriaxone being the most common agent. 3 challenges (2 amoxicillin and 1 cephalosporin) were performed with no adverse reactions reported.

Conclusion: Implementation of a standardized Pen-FAST-based workflow enabled allergy clarification in a high-acuity setting by a clinical pharmacist. Some patients were able to be successfully transitioned to a first line recommended agent secondary to their allergy assessment, supporting the safety of a pharmacist-driven allergy assessment. While a majority of patients assessed by a pharmacist were not receiving antibiotics, full documentation of the allergy assessment in the electronic medical record may have downstream benefits should antibiotics be required during their next encounter. Overall, a pharmacist-driven penicillin allergy re-labeling process in the ED is feasible, safe, and clinically impactful.

Contact: [email protected]

Moderators

Lucy Crosby

Medication Policy and Compliance Pharmacist, AUMC2Augusta University Medical Center/University of Georgia College of Pharmacy PGY1

Presenters

Erin Schuld

PGY-1 Pharmacy Resident, Piedmont Healthcare

Hi, my name is Erin Schuld and I am currently a PGY-1 resident at Piedmont Columbus Regional Midtown! I graduated from Auburn University Harrison College of Pharmacy in 2023 and subsequently started as a staff pharmacist with CVS. After two years, I decided to pursue a PGY-1 residency... Read More →

Evaluators

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Parthenon 2

Infectious Disease (ID), Piedmont Columbus Regional Midtown

global Y

2:10pm EDT

Impact of Time to Positive Blood Culture and Time to Definitive Antimicrobial Therapy on Mortality in Intensive Care Unit Patients with Bacteremia

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena H

Impact of Time to Positive Blood Culture and Time to Definitive Antimicrobial Therapy on Mortality in Intensive Care Unit Patients with Bacteremia
Nicole Rios Serrano, Lena K. Tran, Christopher Lloyd
AdventHealth Kissimmee – Kissimmee, FL

Background: Bacteremia in critically ill patients is associated with a high risk of morbidity and mortality. Delays between blood culture collection, result availability, and adjustment to proper antimicrobial therapy can lead to worse clinical outcomes. Previous studies have linked delayed appropriate therapy to increased mortality, but the relationship between time to positive blood culture and treatment timing remains less defined. This study aims to evaluate the association between time to positive blood culture (TTP) and time to definitive antimicrobial therapy, and their effect on in-hospital mortality among critically ill patients with bacteremia.

Methods: This study was reviewed by the local investigational review board and deemed a quality improvement project. A retrospective analysis was performed on adult patients admitted to the intensive care unit (ICU) with positive blood cultures at AdventHealth Central Florida Division hospitals from July 1, 2023, through June 30, 2025. Data collected from the electronic health record included baseline characteristics, co-morbidities, baseline sepsis markers, pathogen identification, and timing of empiric therapy initiation. The primary outcome was in-hospital mortality. Secondary outcomes include time to definitive antimicrobial therapy, time to positive blood culture, appropriate empiric antibiotic coverage, length of definitive treatment, and hospital length of stay. Descriptive statistics, student t-tests, Mann–Whitney U, or chi-squared test were conducted, as appropriate. This study will identify gaps in diagnostic and treatment workflows and provide actionable data to enhance hospital protocols, strengthen antimicrobial stewardship programs, and improve outcomes for critically ill patients with bacteremia.

Results: After screening 669 patients for exclusion, 166 patients were included in the final analysis. Patients were divided into two separate groups, rapid time to initial positive blood culture (<360 minutes, n=81) and prolonged time to initial positive blood culture (>360 minutes, n=85). Demographics included an average patient age of 66 years for rapid TTP and 64 years for prolonged TTP. The rapid TTP group had 83% of patients meeting sepsis criteria, compared to 79% in the prolonged TTP group (p = 0.525). The predominant organism in the rapid TTP group was Klebsiella pneumoniae (25%) compared to Escherichia coli (24%) in the prolonged TTP group. Piperacillin-tazobactam and vancomycin were the most common antibiotics ordered empirically in both groups. 91% of patients in the rapid TTP group were started on appropriate empiric therapy compared to 84% in the prolonged TTP group (p = 0.129). Patients with rapid TTP suffered higher all-cause in-hospital mortality (47%) compared to the prolonged TTP group (39%; p = 0.292). The median TTP in the rapid group was 272 minutes compared to 567 minutes in the prolonged group (p = 0.001). The median time to definitive antimicrobial therapy was 22 hours for rapid TTP and 21 hours for prolonged TTP (p = 0.691). The hospital length of stay was 14 days for rapid TTP and 14 days for prolonged TTP (p = 0.676). Average time to empiric treatment initiation was 99 minutes for rapid TTP and 156 minutes for prolonged TTP (p = 0.290). Time between antibiotic administration and blood culture collection was on average 172 minutes for rapid TTP and 313 minutes for prolonged TTP (p = 0.0053).

Conclusions: These findings highlight that TTP may serve as an early indicator of illness severity. Although rapid TTP did not shorten time to definitive antimicrobial therapy, it may be associated with higher in-hospital mortality, suggesting that rapid microbial growth may reflect higher burden of infection. This underscores the importance of using rapid TTP as an early warning tool to recognize high-risk patients and guide timely clinical intervention.

Moderators

Kellie Ball

PGY2 Ambulatory Care Coordinator, University of Tennessee Medical Center

Presenters

Nicole Rios Serrano

PGY-1 Pharmacy Resident, AdventHealth

Evaluators

Kelvin Gandhi

Infectious Diseases Clinical Pharmacist, AdventHealth Daytona Beach

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena H

Internal Medicine (IM), AdventHealth Kissimmee

2:10pm EDT

Impact of Pharmacist Education on Opioid Stewardship Interventions in a Community Hospital - Malena Pontrich

Thursday April 30, 2026 2:10pm - 2:30pm EDT

Athena A

Impact of Pharmacist Education on Opioid Stewardship Interventions in a Community Hospital
Authors: Malena Pontrich; Will Stewart
Background:
Opioid stewardship is an important component of patient safety and therapy augmentation. The 2022 CDC Clinical Practice Guidelines for Prescribing Opioids for Pain endorse the use of collaborative efforts among a variety of clinicians, including pharmacists, for integrated pain management. This study is designed to evaluate the impact of pharmacist education on the average number of opioid stewardship clinical interventions per month. Secondary outcomes will include monthly averages of patients discharged with naloxone prescriptions after an opioid stewardship intervention occurred, and average morphine milligram equivalents (MMEs) received per day while inpatient.
Methods:
This retrospective study was approved by the local Institutional Review Board. Patients admitted to Baptist Health Lexington were included if they were over the age of 18 and had a pharmacist-led opioid stewardship intervention documented during their admission. Subjects were excluded if they were incarcerated patients, pregnant patients, hospice patients, enhanced recovery after surgery (ERAS) patients, or patients with patient-controlled analgesia (PCA). Clinical pharmacists received education on internal opioid stewardship workflow guidelines including possible opioid stewardship intervention types, appropriate use of opioid stewardship interventions, and documentation in the electronic health record. Baseline data on the number of opioid stewardship interventions, naloxone prescriptions at discharge, and average inpatient MMEs was collected from the electronic health record for the six months preceding the intervention, March 2025 through August 2025. The same data was collected for the six months after the education occurred, September 2025 through February 2026. The findings from the pre- and post-intervention stages will then be evaluated.
Results:
Among the 142 interventions included in the final study, 74 were in the pre-intervention group and 68 were in the post-intervention group. Among both groups the breakdown of intervention subtypes in the pre-intervention and post-intervention cohorts, respectively, is as follows: alternative therapy 9 (12.16%) vs 16 (23.53%, discontinuation of opioid 38 (51.35%) vs 31 (45.59%), dose change 13 (17.57%) vs 6 (8.82%), drug information/consultation 7 (9.09%) vs 3 (4.41%), initiation of naloxone 2 (2.70%) vs 6 (8.82%), none selected 5 (6.76%) vs 6 (8.82%). For the primary objective, the pre- and post-intervention average monthly number of opioid stewardship interventions was 12.33 and 11.33 (p = 0.50), respectively. For secondary objectives, the average number of naloxone prescriptions written at discharge per month was 0.7 before pharmacist education and 2.0 after pharmacist education (p = 0.03). The average number of MMEs administered per patient per day while admitted was 57.82 and 51.86 (p = 0.50) pre- and post-intervention, respectively.
Conclusions:
There was no statistically significant difference in the average number of opioid stewardship interventions documented per month in the pre- and post-intervention groups (p = 0.50). There was a statistically significant increase in the average number of naloxone prescriptions written at discharge (p = 0.03). There was no statistically significant difference in the monthly average of inpatient MMEs administered per patient per day (p = 0.50). Pharmacist education did not significantly impact the average number of opioid stewardship interventions or the average number of MMEs administered per patient per day. The average number of naloxone prescriptions written at discharge was significantly increased after pharmacist education on opioid stewardship workflow. Limitations include a small sample size, the exclusion of a large portion of the initial sample population after applying exclusion criteria, staff turnover, and variation in hospital census. Outpatient opioid doses and length of stay were also not accounted for when quantifying administered MMEs for patients which may have impacted results.

Moderators

John Puryear

Presenters

Malena Pontrich

Malena Pontrich, PharmD is a PGY1 resident at Baptist Health Lexington. She received her undergraduate degree in biology from the University of Kentucky in May 2021. She completed her Doctor of Pharmacy at UK in May 2025. After residency, she has accepted a position as a staff pharmacist... Read More →

Evaluators

Katherine Fuller

Clinical Pharmacy Specialist --Hepatology

Thursday April 30, 2026 2:10pm - 2:30pm EDT
Athena A

Pain Management (PM), Baptist Health Lexington

global Y

2:30pm EDT

UNFILLED SLOT

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena G

Moderators

Leigh Joyner

Clinical Pharmacist, Tandem Health

Evaluators

Kristina Evans

PGY2 Internal Medicine Residency Program Coordinator, Grady Health System

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena G

global Y

2:30pm EDT

The Financial Impact of Implementing an Intravenous Syringe Filler Robot

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Olympia 2

Background/Purpose: Intravenous (IV) therapy is administered to over 90% of hospitalized patients, and medication errors with IV push drugs remain a significant safety concern. Best practice recommendations from the Institute for Safe Medication Practices encourage health institutions to employ ready-to-administer (RTA) formulations to minimize bedside preparation and compounding errors. Hospital pharmacies typically utilize manual preparation, 503B outsourcing, and/or robotic automation for bulk syringe production. Manual compounding can be labor-intensive and prone to human error, while outsourcing introduces variable costs and supply chain risks. Robotic syringe filling technology offers potential improvements in efficiency, compliance, and financial sustainability. This study aims to evaluate the financial and operational implications of implementing robotic syringe filling technology, by comparing cost, efficiency, and quality metrics with those of manual compounding and 503B outsourcing methods for select medications.
Goal: To evaluate the financial and operational impact of implementing an IV syringe filler robot at a large academic medical center.
Purpose Statement: This study aims to evaluate the financial and operational implications of implementing robotic syringe filling technology by comparing cost, efficiency, and quality metrics with those of manual compounding and 503B outsourcing methods for select medications.
Primary objective:
Compare cost per syringe before and after the implementation of an IV syringe filler robot
Secondary objectives:

Evaluate changes in operational efficiency
Describe return on investment (ROI) and sterility pass rates following implementation

Methods: A quasi-experimental, pre-test/post-test study will be conducted at a large academic medical center over a ten-month period. The study timeframe incorporates a washout period following robot implementation to accommodate staff training and ensure the technology operates at full capacity. Data sources include inventory management software, purchasing history, syringe filler robot logs, manually completed technician logs, and electronic health record (EHR) systems. Comparator groups consist of pre-implementation (manual compounding and 503B outsourcing) and post-implementation (robotic syringe compounding) periods. The primary endpoint is cost per syringe pre- and post-robot implementation, including supplies, drugs, and IV fluid components. Secondary endpoints include ROI, compounding times during full capacity and downtime events, and sterility pass rates. Continuous data will be analyzed using t-tests, and sterility outcomes and ROI will be summarized with descriptive statistics.
Results: Data collection is currently underway, with preliminary findings expected by June 2026.

Moderators

Karen Babb

Residency Program Director, CHIM1CHI MemorialPGY1

Presenters

Justin Haywood

Evaluators

Karen Barlow

PGY1 Residency Program Director, Wellstar Kennestone Regional Medical Center

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Olympia 2

Administration (ADM), Wake Forest Baptist

global Y

2:30pm EDT

Evaluation of lipid profiles in patients taking tumor necrosis factor-alpha inhibitors for inflammatory bowel disease

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Olympia 1

Background:
Inflammatory bowel disease (IBD) is a group of chronic inflammatory gastrointestinal conditions characterized by symptoms of diarrhea, abdominal pain, and fatigue. Tumor necrosis factor (TNF)-alpha inhibitors are commonly used to treat these conditions by blocking activation of the pro-inflammatory cytokine TNF-alpha, which mediates inflammation in the gastrointestinal system. TNF-alpha inhibitors have a potential class-wide effect of causing hyperlipidemia; however, there is a paucity of data to show the extent to which hyperlipidemia can occur. To evaluate the prevalence and severity of changes in lipid profiles for patients prescribed TNF-α inhibitors for IBD.
Methods:
This single-center retrospective cohort study examined lipid panels of patients with IBD before and after initiation of TNF-alpha inhibitors. Included patients were age 18 or older, had a documented diagnosis of IBD, were taking a maintenance dose of a TNF-alpha inhibitor, and had lipid panels available within the 2 years before the TNF-alpha inhibitor was started and 2 to 5 years after the TNF-alpha inhibitor was started. Patients were excluded if they were taking TNF-alpha inhibitors for a condition other than IBD. The study period was individualized per patient, spanning from 2 years prior to up to 5 years after the TNF-alpha inhibitor start date. The primary objective of this study was to determine the volume of patients with an increase in either total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), or triglycerides after starting TNF-alpha inhibitor treatment. The secondary objective was to measure the change in lipid panel values after initiation of TNF-alpha inhibitor treatment. Data was collected by both electronic medical record reporting software and manual chart review by the investigator. Descriptive statistics were used for the primary objective, and the Wald Test was used for the secondary objective, controlling for variation within individuals and adjusting for lipid medications, cardiovascular diagnosis, and high or low dose medication status.
Results:
Overall, 195 patients were included in this analysis. The most used TNF-alpha inhibitors were infliximab and biosimilar (56.4%), and adalimumab and biosimilar (40.6%). Among patients included, 29.2% were taking high-dose maintenance therapy, and 59.5% of patients had a concomitant cardiovascular disease state diagnosis (including hypertension, atherosclerotic vascular disease, hyperlipidemia, history of stroke/cerebrovascular accident or venous thromboembolism). During the study period, 30.7% of patients were taking anti-hyperlipidemic medications. After TNF-alpha inhibitor initiation, 52.3% of patients had an increase in total cholesterol, 20% had an increase in triglycerides, 49.2% had an increase in LDL, and 64.6% had an increase in HDL. The mean increase in total cholesterol was 5.25 mg/dL (95% CI [0.53, 9.97]; p=0.029). The mean increase in HDL from baseline to follow-up was 4.3 mg/dL (95% CI [2.69, 5.91]; p<0.001). The mean changes in LDL and triglycerides from baseline to follow-up were not statistically significant.
Conclusions:
In this study, a statistically significant increase in total cholesterol and HDL was observed in patients taking maintenance doses of TNF-alpha inhibitors for inflammatory bowel disease. No statistically significant difference in triglyceride or LDL levels was observed. It is possible that the change in total cholesterol was driven by the increase in HDL levels, however, increases in HDL levels are typically advantageous from a cardiovascular disease prevention standpoint. More research is needed to determine if the change in cholesterol levels is clinically significant to cardiovascular risk in patients with inflammatory bowel disease. Limitations of the study include variations in lipid panel lab ordering by providers and an assumption that patients who received maintenance dosing of TNF-alpha inhibitors continued treatment throughout the study period. Additionally, while it was recorded if patients were taking antihyperlipidemic medications, we did not stratify these medications based on degree of lipid-lowering ability.

Moderators

Nathan Wayne

Cardiology Clinical Pharmacist, PGY1 RPC, Wellstar MCG Health

Presenters

Molly Duckett Hogan

PGY2 Ambulatory Care Resident, Kaiser Permanente Georgia

Evaluators

Nieka Jackson

Pain Clinical Pharmacist Practitioner (Facility PMOP Coordinator)

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Olympia 1

Ambulatory Care (AMB), Kaiser Foundation Health Plan of Georgia, Inc.

global Y

2:30pm EDT

Impact of Health-System Community Pharmacists on Adherence for Medicare Advantage Plan Members - Heather Vance

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena I

Title: Impact of Health-System Community Pharmacists on Adherence for Medicare Advantage Plan Members
Primary Author: Heather Vance
Co-Authors: Catie Harper
Practice Site: Cone Health Community Pharmacies and Triad HealthCare Network
Background:
The Centers for Medicare and Medicaid Services (CMS) indicates quality of Medicare plans using a star-rating system, with one being the lowest and five being the highest. Three of the measures included in the star-rating system relate to patient medication adherence, including medication adherence to statins. CMS defines adherence as a proportion of days covered (PDC) of 80% or more.
Cone Health participates in value-based care agreements with payers to improve the quality of care provided to patients. Additionally, Cone Health sponsors a Medicare Advantage plan with Part D prescription drug coverage.
Through continuous evaluation, our organization identified that patients using integrated health-system pharmacies had improved medication adherence compared to outside pharmacies. Proactively, Cone Health began targeting patients failing or at risk of failing the statin adherence measure using health-system pharmacies to characterize the impact of targeted community-pharmacist intervention on plan member adherence.
Methods:
This is an IRB reviewed, determined exempt, retrospective pre-post study evaluating medication adherence among members of a Medicare Advantage plan. Included patients were active plan members in 2025, with one or more statin fills at an integrated pharmacy, with Medication Adherence for Cholesterol measure PDC of 85% or less through the end of July 2025, identified through reports provided by the plan. Excluded patients were deceased, filling at non-health-system pharmacies, transitioned to hospice, or had therapy discontinued by their provider. The percentage of patients with PDC > 80% pre-intervention compared to post-intervention was the primary outcome, evaluated with McNemar’s Test. The number/type of pharmacist intervention was the secondary outcome, evaluated with descriptive statistics.
Patients received telephonic and electronic communication from the primary investigator regarding their prescribed statin therapy. After 3 unsuccessful attempts, patients were considered lost to follow-up. An adherence interview was conducted to assess understanding, tolerability, need for referral, and barriers to adherence. Patients were enrolled in appropriate adherence services. After enrollment, patients were contacted before their next refill to ensure sustained adherence.
Results:
Of the 53 eligible patients, 19 patients were excluded. At baseline, the average age was 73.7 years, 50% of patients had clinical ASCVD, 55.9% had an LDL < 70 mg/dL, 50% had a PDC score of 65-79.9%, and 26.5% with PDC < 65%.
At baseline, 23.5% (n = 8) patients were considered passing the MAC measure with a PDC score > 80% compared to 41.2% (n = 14) after study completion. Of these patients, 7 were initially failing the MAC measure at baseline and were converted to passing. The final percentage of patients failing the MAC measure after study completion was 58.8% (n = 20), 19 of which were initially failing at baseline.
A total of 73 interventions were completed over the course of this study, with 53 conducted in the PDC < 80% group. The most common intervention was refilling other medications (n = 24), refilling targeted medication (n = 13), and leaving a voicemail with returned call (n = 13). The most common adherence service provided was automatic-refill enrollment (n = 5).
Conclusions:
There was not a statistically significant difference between PDC scores among patients during pre- and post-intervention. This study encouraged the development of an adherence monitoring platform to ease monitoring and intervention for population health pharmacists. In the future, a single investigator driven intervention may not be sufficient to improve patient adherence, especially among larger cohorts.

Moderators

Lindsey Arthur

Clinical Pharmacy Manager, Self Regional Healthcare

Presenters

Heather Vance

Evaluators

Lyndsay Gormley

RPD, PRIS10Prisma Health-Upstate (Critical Care)PGY2

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena I

Community Pharmacy (CP), Cone Health

global Y

2:30pm EDT

Association of Acetaminophen/Butalbital/Caffeine Doses and Incidence of Cerebral Vasospasm

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Parthenon 2

Authors: Emma Cloud, Eric Shaw, Mallory Stringer

Contact: [email protected]

Practice Site: Memorial Health University Medical Center

Background:
Aneurysmal subarachnoid hemorrhage (aSAH) is a subtype of hemorrhagic stroke where the bleed occurs between the brain tissue and the arachnoid mater surrounding the brain. The characteristic symptom is a severe headache which patients often describe as “the worst headache of my life.” These headaches often continue to affect patients beyond the acute period and have a multifactorial etiology requiring a multimodal pain management approach. Guidelines do not have specific recommendations for headache management. Opioids, while a mainstay of treatment, have sedating effects that may confound the frequent neurological monitoring necessary for these patients. Nonsteroidal anti-inflammatory drugs carry an increased risk of bleeding and neuropathic pain medications such as gabapentin and pregabalin warrant further investigation. Butalbital has been shown to decrease pain scores secondary to aSAH and is often utilized as the combination agent acetaminophen/butalbital/caffeine (A/B/C) at our institution. Prior literature has found inconclusive results regarding the safety of A/B/C and its association with cerebral vasospasm. This study aimed to identify a potential relationship between use of A/B/C and occurrence of cerebral vasospasm in this patient population.

Methods:
This was a retrospective chart review conducted at a 711-bed academic medical center between July 2018 and September 2025. Adults admitted to the neurovascular intensive care unit with a diagnosis of non-traumatic aSAH, confirmed by diagnostic angiography, who underwent surgical fixation via clipping or coiling and received A/B/C were included. The following were exclusion criteria: pregnant, incarcerated, Hunt and Hess Score of 4 or 5, and intubated >48 hours. Patients were divided into those who had a vasospasm versus those that did not. Baseline data was analyzed using Chi-Square and Fisher’s Exact tests for categorical data and T-Test for continuous data. Primary and secondary outcomes were analyzed using Mann-Whitney U tests.

Results:
Thirty-seven patients were included in the analysis. The patient population was predominantly female (70.3%), black (48.6%), underwent coiling for surgical fixation (97%), and had an average Hunt and Hess score of 2. Baseline demographics were not significantly different between the two groups with the exception of the vasospasm group being younger (55.9 ± 10.7 vs 42.81 ± 8.6, p<0.001). There was no significant difference in A/B/C usage between patients who had a vasospasm versus those who did not have a vasospasm (2.2 ± 1.7 vs 2.3 ± 1.5; p=0.751). When looking only patients who had a vasospasm, there was no significant difference in A/B/C usage on days they had a vasospasm versus days they did not (2.4 ± 1.8 vs 2.2 ± 1.9; p = 0.955).

Conclusions:
Based off our study population, A/B/C was not associated with occurrence of cerebral vasospasm. This study was limited by variable frequency of pain score measurements across patients, small sample size, and reliance on infrequent transcranial dopplers that could lead to underreporting of vasospasm.

Moderators

Lucy Crosby

Medication Policy and Compliance Pharmacist, AUMC2Augusta University Medical Center/University of Georgia College of Pharmacy PGY1

Presenters

Emma Cloud

I am a current PGY1 pharmacy resident at Memorial Health University Medical Center in Savannah, GA. After completion of PGY1, I will be staying at MHUMC to complete a PGY2 in critical care. My primary practice interests are surgical/trauma critical care and code response.

Evaluators

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Parthenon 2

Critical Care/Emergency Medicine (CCM), Memorial Health University Medical Center

2:30pm EDT

Evaluation of Oxycodone Errors Associated with Auto‑Verification in the Emergency Department

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena J

Background:
Auto‑verification enables medication orders to bypass pharmacist review and verify automatically upon entry. Its use is limited to settings, such as the emergency department (ED), where a licensed practitioner oversees ordering, preparation, and administration. While this workflow improves efficiency in emergency departments (EDs), there are concerns regarding the safety of auto‑verifying high‑alert medications, which when used incorrectly can cause significant patient harm. At Cone Health, certain high‑alert agents, including opioids such as oxycodone, are permitted to be auto‑verified. Opioids carry risks for respiratory depression, overdose, and dizziness/lightheadedness leading to instability. A quality improvement evaluation was performed to assess whether auto‑verification of oxycodone-containing medications results in clinically meaningful errors or overlooked interventions.
Methods:
This IRB reviewed, determined exempt retrospective chart review included auto‑verified oxycodone immediate‑release 5 mg tablets and oxycodone/acetaminophen 5/325 mg tablets ordered in Cone Health EDs between January 1 and July 31, 2025. There were no exclusion criteria. A random sample of 140 orders (70 from each product) was selected using random date and order number generation. Outcomes measured in this study were incidence of order modification, prevalence of adverse effects, and quantity of documented pharmacist interventions. Adverse effects evaluated included overdose (naloxone use as a proxy) and allergic reaction.
Results:
A total of 9,456 auto‑verified orders were identified during the study period. Among the 140 orders analyzed, 82% (n = 140) had at least one modification during initial order entry. Frequency was the most modified order parameter (79%, n= 140). Dispense location changes occurred in a further 12% (n = 140) of all orders. No dose, route, start time, or stop time adjustments were observed. Oxycodone/acetaminophen orders had a higher rate of modification compared with oxycodone IR (91% vs. 73%). None of the order modifications were made by a pharmacist. Rather, order modifications were made by providers and mid-level providers. Additionally, there were no documented pharmacist interventions and no adverse effects in the sample.
Conclusion:
Auto‑verification of oxycodone products in the Cone Health ED was not associated with patient harm. Although modifications at initial order entry were common, these changes did not lead to errors. Expansion of this quality improvement process to additional opioids and other high‑alert medications is warranted.

Moderators

Kelley Norris

Presenters

Andrew Dodson

Evaluators

Ketrin Mount

PGY1 Pharmacy Residency Program Director, James H. Quillen VA Medical Center

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena J

Critical Care/Emergency Medicine (CCM), Cone Health

global Y

2:30pm EDT

Resident Presentation - Natalee Chornak

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Parthenon 1

Moderators

Kimm Freeman

Presenters

Natalee Chornak

PGY-1 Pharmacy Resident, Ballad Health - Johnson City Medical Center

PGY-1 Pharmacy Resident

Evaluators

Khushbu Patel

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Parthenon 1

Critical Care/Emergency Medicine (CCM), Johnson City Medical Center

global Y

2:30pm EDT

Comparison of Linezolid to Usual Therapy in Enterococcus Urinary Tract Infections

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena H

Authors: Chase Arrington; Kelsey Bouwman; Dorothy Williams

Background: Urinary tract infections (UTIs) account for 30-32% of all healthcare-acquired infections, with Enterococcus species found in 15.9% of all catheter-associated UTIs. Standard treatment options include aminopenicillins, fosfomycin, nitrofurantoin, daptomycin, or vancomycin; however, resistance rates to these continue to climb. Linezolid offers an appealing alternative, but its ability to concentrate within the bladder could limit its clinical utility for UTIs. The manufacturer reports that approximately only 30% of the dose is excreted within the urine. Few retrospective studies exist looking at linezolid's effectiveness in UTIs, but the available data shows similar outcomes regarding clinical success. This study was conducted to assess linezolid’s effectiveness within lower UTIs caused by Enterococcus species in comparison to standard therapies.

Methods: This is a single system, retrospective cohort study assessing linezolid's effectiveness in UTIs caused by Enterococcus species. The study included patients admitted between August 15, 2022, and August 15, 2025. Patients were included if they were 18 years or older, had a positive urine culture reporting an Enterococcus species, and it was their first encounter within the timeframe of this study. Patients were excluded if they had polymicrobial infections, negative urinalysis (<10 white blood cells per high-power field or leukocyte esterase negative), positive blood cultures, received fewer than three days of effective therapy, were pregnant or incarcerated, received both linezolid and another active antibiotic, or had been diagnosed with pyelonephritis. The primary outcome was a composite of bacterial persistence or antibiotic reinitiation within 14 days. Secondary outcomes included length of stay, 30-day recurrence or readmission related to UTI, development of resistance to linezolid, and mortality.

Results: A total of 128 patients were included, with 37 receiving linezolid and 91 receiving conventional therapy. For the primary outcome of bacterial persistence or antibiotic reinitiation, no significant difference was found between linezolid and conventional therapy (13.51% vs. 9.89%, p=0.545). No differences were observed between groups in the secondary outcomes of 30-day UTI readmission rate (24.32% vs. 15.38%, p=0.309), median length of stay (5.83 vs 6.76 days, p=0.592), or 30-day mortality (2.70% vs 8.79%, p=0.446). No patients developed resistance to linezolid within 30 days. Rates of thrombocytopenia during treatment were also comparable between groups (2.70% vs. 3.30%, p=1).

Conclusion: In this retrospective cohort study, linezolid demonstrated comparable outcomes and safety to conventional therapies for the treatment of Enterococcus UTIs. This supports the potential utility of linezolid in UTIs despite concerns regarding urinary drug concentrations, particularly in cases involving resistant Enterococcus species. Larger randomized controlled studies are needed to confirm the findings seen within this study.

Email: [email protected]

Moderators

Kellie Ball

PGY2 Ambulatory Care Coordinator, University of Tennessee Medical Center

Presenters

Mckinzie Arrington

PGY1 Pharmacy Resident, Spartanburg Medical Center

Hi, my name is Chase Arrington. I am a PGY1 Pharmacy Resident at Spartanburg Medical Center. I graduated from Presbyterian College with my Bachelor of Science and PharmD degrees. I plan to complete a PGY2 in Infectious Diseases at Penn Presbyterian Medical Center in Philadelphia... Read More →

Evaluators

Kelvin Gandhi

Infectious Diseases Clinical Pharmacist, AdventHealth Daytona Beach

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena H

Infectious Disease (ID), Spartanburg Medical Center

global Y

2:30pm EDT

Evaluation of Atrial Fibrillation Post-Left Ventricular Assist Device - Glennessa Hodge

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena A

Evaluation of Atrial Fibrillation Post-Left Ventricular Assist Device Authors: Glennessa Hodge, Anna Crider, Brian Tran, Kiara Patino, Eleanor Schoen, Mahmoud H. Abdou Background
Atrial fibrillation is a common postoperative complication following ventricular assist device (VAD) placement contributing to significant morbidity. Beta-blockers are considered first-line agents for the prevention of postoperative atrial fibrillation (POAF); however, many VAD patients are not on beta-blockers preoperatively due to relying on inotropes. Amiodarone is commonly used to reduce the incidence of POAF; however, its role and optimal duration in VAD recipients remains unclear. Current guidelines offer varying recommendations on dosing and therapy duration, ranging from 4 to 12 weeks. This study aims to identify the incidence of POAF, assess the use of amiodarone in management, and explore the impact on patient outcomes.
Methods
This study was a retrospective chart review of patients who received a left ventricular assist device (LVAD) at Emory University Hospital (EUH) or Emory Saint Joseph’s Hospital (ESJH) from October 1st, 2022, to March 31st, 2025.
The primary outcome of this study was to identify the incidence of atrial fibrillation from LVAD implant to post-operative day 90. Secondary objectives included 90-day rehospitalization, postoperative total length of stay, thromboembolic or stroke incidence, and death. Amiodarone dosing was up to provider discretion as there were no protocols in place during this study time frame. Descriptive statistics include mean, median, or mode as appropriate to assess the primary and secondary outcomes. A multivariate regression analysis was conducted to compare POAF and non-POAF patients to identify associated risk factors.
Results
POAF was seen in 71 out of 119 (37.5%) participants. 90-day all cause and arrhythmia related rehospitalization were 69 (36%) and 12 (6%) out of 190 respectively. The median postoperative length of stay was 22 in the total population, 24 (IQR 19-38.5) amongst POAF patients, and 20 (IQR 16-25.5) for non-POAF patients. 90-Day mortality was 18 (9%) out of 190, 6 from the POAF group and 12 from the non-POAF group. Antiarrhythmics used to treat POAF were amiodarone (35.3%), digoxin (4.2%), and dofetilide (0.5%). Majority of POAF patients were treated with intravenous amiodarone and then transitioned to oral amiodarone 200 mg daily at discharge. 43% of patients discharged on amiodarone did not have their amiodarone plan readdressed within 90 days post discharge. Of the 73 out of patients who received amiodarone prophylaxis for a median of 14 days, 44 (60.2%) did not experience POAF (OR = 1.77, 95% CI = 0.64 - 2.14).
Conclusion
The POAF incidence is consistent with the 15-50% reported from previous studies. The patient population had common risk factors for POAF, including older age (≥ 60, 42.8%), male sex (77%), hypertension (76%), diabetes (46%), and non-ischemic cardiomyopathy (75%). Amongst patients that experienced POAF, approximately 89.5% were managed with amiodarone at a variety of doses. 56% of patients were on amiodarone prior to admission and 7% were intentionally placed or continued amiodarone for prophylaxis per documentation.
Analysis of all patients that received amiodarone within the 72 hours immediately prior to LVAD implantation, revealed a greater percentage of patients who got prophylaxis did not experience POAF, however this study was not adequately powered to detect significant difference in outcomes. 90-day outcomes between patients that did and did not experience POAF were similar, however, the POAF group had a longer length of stay at 24 days and a higher percentage of cardiac related readmission compared to the non-POAF group.
This study suggests a possible benefit in amiodarone prophylaxis in patients with high risk features or history of atrial fibrillation prior to LVAD. The exact dosing regimen and duration is still to be explored, but our study found that higher cumulative amounts of amiodarone did not show better outcomes.

Moderators

John Puryear

Presenters

Glennessa Hodge

PGY1 Acute Care Resident, Emory Healthcare

Hello, I am Glen a current PGY1 pharmacy resident at Emory University Hospital. I received my PharmD from Mercer University College of Pharmacy and will be continuing my training next year as a PGY2 in internal medicine at East Tennessee State University Bill Gatton College of Pharmacy... Read More →

Evaluators

Katherine Fuller

Clinical Pharmacy Specialist --Hepatology

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena A

Internal Medicine (IM), Emory University Hospital

global Y

2:30pm EDT

Evaluation of Initial Dose of Nitroglycerin for Acute Heart Failure Exacerbation

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena C

Evaluation of Initial Dose of Nitroglycerin for Acute Heart Failure Exacerbation
Authors: Amaury Santiago Malave, Christopher Lloyd, Lena Tran
Background Nitroglycerin, a vasodilator, administered as an intravenous (IV) bolus at doses between 400 to 800 mcg and infusions of 100-200 mcg/min have shown to rapidly decrease preload, afterload, and improve myocardial oxygen supply in patients with pulmonary edema and acute decompensated heart failure. Literature suggests these higher IV doses of nitroglycerin have led to reduced intensive care unit (ICU) admissions and intubations; however, there is currently limited guidance for an initial nitroglycerin bolus dose or infusion rate, leading to frequent underdosing. The objective of this study is to evaluate the use of nitroglycerin for acute heart failure exacerbations and to assess the significance of nitroglycerin doses on ICU admission and need for mechanical ventilation.

Methods This study was reviewed by the local investigational review board and deemed a quality improvement project. A retrospective data analysis was conducted on adult patients presenting to AdventHealth Central Florida hospitals between August 6, 2023 and August 29, 2025 with acute heart failure exacerbation requiring intravenous nitroglycerin and non-invasive positive airway pressure (NIPAP).
Patients were stratified according to nitroglycerin initiation strategy: 1) higher-intensity nitroglycerin (HIN) which included receiving an IV nitroglycerin bolus and/or initiation of continuous infusion at ≥ 100 mcg/min. 2) lower-intensity nitroglycerin (LIN) which consisted of starting a continuous infusion at < 100 mcg/min with no bolus.
Data was collected from the electronic health record and included baseline demographics, nitroglycerin bolus dose (if administered), initial infusion rate, and maximum infusion rate. Safety data included baseline and repeated measurements of systolic blood pressure, heart rate, respiratory rate, and oxygen saturation. The primary outcome was ICU admission. Secondary outcomes included hospital length of stay, endotracheal intubation, incidence of hypotension, infusion duration, time to NIPAP discontinuation, and change in vital signs two hours after infusion initiation. Continuous variables were analyzed using means with standard deviations and medians with interquartile ranges, as appropriate, and compared using Student’s t-test or the Mann-Whitney U test.

Results A total of 181 patients met inclusion criteria, with 99 managed using HIN and 82 managed using a LIN. ICU admission occurred in 59.6% of patients in the higher-intensity group compared to 68.2% in the lower-intensity group, though this difference did not reach statistical significance (p = 0.226). Rates of endotracheal intubation (2.02% vs 4.88%, p = 0.285) and hypotension (4.04% vs 3.66%, p = 0.894) were similar between groups. Hospital length of stay and time to NIPAP discontinuation were not significantly different. The HIN group received significantly greater initial and maximum infusion rates (p < 0.001 for both comparisons). Median infusion duration was significantly shorter in the higher-intensity group (3 vs 4 hours, p=0.033). Changes in systolic blood pressure, respiratory rate, heart rate, and oxygen saturation were comparable between groups.

Conclusion In this retrospective analysis of patients with acute heart failure exacerbations requiring NIPAP, a higher-intensity nitroglycerin initiation strategy was associated with lower ICU admission and intubation rates compared to a lower-intensity approach, although these differences did not reach statistical significance. Of note, this higher-intensity strategy was not associated with increased hypotension or adverse effects and resulted in a shorter median infusion duration.
While the study was not powered to detect small differences in clinical outcomes, the observed trends suggest that more aggressive upfront nitroglycerin dosing may be both feasible and well tolerated in appropriately selected patients. These findings support the need for prospective, adequately powered studies to further evaluate dose thresholds for nitroglycerin strategies that can meaningfully reduce ICU admission and respiratory deterioration in acute heart failure exacerbations.

Moderators

Alexis Pruitt

Presenters

Amaury Santiago Malave

Evaluators

Kayla Brown

PGY-1 Residency Program Director, East Alabama Medical Center

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena C

Internal Medicine (IM), AdventHealth Kissimmee

global Y

2:30pm EDT

Inpatient Pharmacist-led Penicillin Allergy Delabeling (iPPADL)

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena D

Inpatient Pharmacist-led Penicillin Allergy Delabeling (iPPADL)
Authors: Caleb Gosnell, Benjamin Britt, Vince Buttrick, Erik Turgeon at Lexington Medical Center
Background/Purpose: Reports of penicillin allergies are common, as many as 25% of patients have a penicillin allergy in their medical record. Most of these patients have mild reactions, such as urticaria. Patients with a remote history of allergy from childhood are <5% likely to have a retained allergy to penicillins. Recent studies have identified pharmacist-led allergy de-labeling approaches with a focus on antimicrobial stewardship have positive outcomes on alternative antibiotic utilization, Clostridioides difficile infection rates, inpatient length of stay, and patient costs. Barriers to traditional approaches include the need for either skin testing supplies with appropriate training or additional stock of oral amoxicillin. In a cost-saving approach, it may be efficacious to use patient medical history and interviewing to assess the possibility of de-labeling.
Methodology: This was a pre- and post-intervention review of inpatient encounters at a single-center 607-bed community teaching hospital. The intervention for this study was the implementation of a pharmacist-led penicillin allergy delabeling protocol. Pharmacists determine eligibility by reviewing PEN-FAST assessment results, reported allergy reactions, and previous inpatient penicillin/aminopenicillin administrations. Patients with a PEN-FAST score of 0 with a non-immune mediated reaction, such as nausea, qualified for de-labeling. Patients with a PEN-FAST score of 0 or 1, with a minor immune-mediated reaction, such as urticaria, were further evaluated for prior inpatient administrations of a penicillin or aminopenicillin. If tolerated, the patient qualified for delabeling. All patients received bedside education of the process of qualifying for delabeling and required verbal consent to remove the allergy from the medical chart. The pre-intervention group consisted of inpatients with a penicillin allergy and PEN-FAST assessment between July 1, 2025 – October 31, 2025. The post-intervention group consisted of inpatients with a penicillin allergy and PEN-FAST assessment between November 1, 2025 – February 28, 2026. Outcomes were then assessed manually by the investigator through electronic health record (EHR )-generated data and manual chart review.
Results: During the pre-intervention phase, a total of 1,912 admissions had a labeled penicillin allergy and 215 had a PEN-FAST score reported with 75 patients eligible for delabeling. In the post-intervention phase, a total of 1,527 admissions had a penicillin allergy. Of those admissions, 232 had a PEN-FAST score reported. Seventy-nine patients were eligible for delabeling with 25 qualifying by a non-immune reaction and 54 with a penicillin class administration. Piperacillin/tazobactam was the major contributor with 38 eligibilities. A total of 18 patients were delabeled with most (14) qualifying via penicillin class administrations. Three patients refused the intervention, and two patients were relabeled at a subsequent outpatient encounter.
Conclusions: A pharmacist-led allergy delabeling protocol based upon chart review and patient interview is a low-cost alternative to skin testing, though its success is highly limited by workflow time constraints, altered patient mentation, EHR reporting logistics, and patients located on floors without decentralized pharmacists. Another potential limiting factor is that this study did not account for patients with short length of stays that could further decrease the time available for assessment and intervention. Future considerations are a more direct identification process through pharmacist notification rather than a passive report that must be actively reviewed. Additionally, expanding the protocol to include conversations with medical decision-makers for patients with chronic altered mental status. In the future, the protocol will shift to a stewardship initiative to capture more patients, improve decentralized communication of opportunities, and potential expansion to oral challenge in patients who are low risk for a true allergy without qualifying administrations.

Moderators

Molly Thompson

PGY1 Residency Program Director, HCA Healthcare Trident Hospital

Presenters

Caleb Gosnell

PGY1 Pharmacy Resident, Lexington Medical Center

Evaluators

Naomi Yates

Manager, Clinical Pharmacy Services, KFHP - Kaiser Foundation Health Plan of Georgia (Ambulatory)PGY2

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena D

Internal Medicine (IM), Lexington Medical Center

global Y

2:30pm EDT

Evaluating Emergency Department Order Set in Sickle Cell Pain Management

Thursday April 30, 2026 2:30pm - 2:50pm EDT

Athena B

Evaluating Emergency Department Order Set in Sickle Cell Pain Management
Katherine Weller PharmD, Kanaan Shah PharmD, Christele Francois PharmD, BCPS, Tonya Hershman PharmD, BCPS, Karen Clarke, MD, Alexandra Arges MD, Mohamad Moussa MD, Yoo Mee Shin MD, Nicholas Kurtzman MD, Krista Dumkow PharmD, BCEMP, BCPS; Emory University Hospital, Atlanta, GA

Background:

Vaso-occlusive crises (VOC) in patients with sickle cell disease (SCD) occur because of adhesion of red blood cells to small vessel walls, leading to obstruction of blood flow, pain, and ischemia1. VOC is the most common complication of SCD. Patients often present to the emergency department (ED) for acute pain management when their home pain regimens fail to adequately control the crisis2. To manage acute crises, the American Society of Hematology Clinical Practice Guidelines on SCD recommend administering opioids within 60 minutes of arrival to the ED3. The guidelines further recommend a tailored opioid regimen that is reassessed every 30 to 60 minutes and multi-modal pain regimens with non-opioid therapies such as non-steroidal anti-inflammatory drugs (NSAIDs), skeletal muscle relaxants, or acetaminophen. This study aimed to assess the utilization of a guideline-based order set for acute pain management of patients with SCD presenting to the ED in a VOC.

Methods:

This was an Institutional Review Board-approved, single center, retrospective observational study of patients presenting to the ED with a diagnosis of VOC between January 1, 2024, and January 31, 2025. A total of 289 patients were identified and 181 met inclusion criteria of age >18, presentation during the study period, and a final diagnosis of VOC. Exclusion criteria included active infection, chronic or acute pain due to alternative diagnosis or other causes, history of substance abuse, left against medical advice, and pregnancy. The primary outcome was the incidence of analgesia administered within 60 minutes of ED arrival. Secondary outcomes included incidence of inpatient admission, time to initial dose of analgesia from arrival to the ED, time spent in the waiting room, pain re-assessment within 15-30 minutes of pain medication administration, dose escalation by 25% every 15-30 minutes until pain is adequately controlled, reduction in pain intensity measured by a pain scale, adverse events associated with opioid use, use of adjunctive NSAIDs, and ED length of stay.

Results:

Of the 181 patients that were included in this study, 37 patients had medications ordered utilizing the SCD order set in the ED. The primary outcome of incidence of analgesia administered within 60 minutes of ED arrival was not statistically significant (order set group, 10.8%; non-order set group, 11.8%; p-value=0.56). The use of NSAIDs was significantly higher in the orderset group (order set group, 43.2%; non-order set group, 16%; p-value=0.0003). Inpatient admission rates, pain assessment, dose escalation, and reduction in pain intensity were similar between groups, with no statistically significant differences. Operational metrics such as average time to analgesia, time spent in the waiting room, or average ED length of stay were not statistically significant. For adverse events associated with opioid use, there was no difference between groups (order set group, 8.11%; non-order set group, 1.39%; p-value=0.99). Of patients that had the order set used upon ED arrival, 70% had analgesics ordered through the order set panel.

Conclusions:

Implementation of the order set did not significantly improve the or timeliness of analgesia within 60 minutes of ED arrival. The greatest barrier to receiving analgesia within 60 minutes of ED arrival was delays in appropriate room placement and IV placement. Strategies to address this barrier include prioritizing triage for patients presenting with VOC and implementing bed prioritization protocols to expedite rooming. The order set promotes guideline driven, multimodal VOC management while further optimization is needed to enhance timely analgesia, pain reassessment, and operational metrics. Future efforts should educate providers about the order set and refine the order set to improve its effectiveness, such as ensuring that analgesics are ordered through the order set and enhance timely nursing communications for pain scores and dose escalation.

Moderators

Erin Murdock

Clinical Oncology Pharmacist / PGY2 Oncology RPC, Northside Hospital

Presenters

Katherine Weller

PGY-1 Pharmacy Resident, Emory University Hospital

I am a PGY-1 Pharmacy Resident at Emory University Hospital and will continue my training there as a PGY-2 in Internal Medicine. I earned my Doctor of Pharmacy from the University of Georgia and am an active member of GSHP, ACCP, APhA, and ASHP.

Evaluators

Kishan Patel

Thursday April 30, 2026 2:30pm - 2:50pm EDT
Athena B

Pain Management (PM), Emory University Hospital

global Y

2:50pm EDT

Driving Accuracy and Accountability: A Systemwide Inventory Integrity Program

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Olympia 2

Title: Driving Accuracy and Accountability: A Systemwide Inventory Integrity Program

Authors: Veronica Bekheit, PharmD, MSMEd & Heath Jennings, PharmD, MBA, BCPS, FASHP, FACHE

Background:
The Central Florida Division historically relied on a third-party vendor to conduct biannual full inventory audits across pharmacy locations. While these audits provided external validation, they required significant internal labor to verify results and did not support continuous inventory oversight. A prior internal pilot demonstrated that full physical inventory counts could be completed across all campuses within one week using internal resources, supporting the feasibility of an internally managed model. Based on these findings, a Pharmacy Inventory Integrity Analyst Team was established to assume ownership of inventory processes and support a transition to an internal audit model. The goal of this initiative was to improve inventory accuracy to enable adoption of a perpetual inventory system. In June 2025, the team conducted a division-wide internal full inventory count, followed by a comparative validation against a subsequent external audit. These efforts informed the development of a standardized, system-wide inventory integrity program focused on ongoing accuracy, discrepancy reduction, and operational sustainability.

Methods:
A dynamic, risk-based audit framework was developed to prioritize medications with the highest operational and financial impact. To establish the initial audit baseline for January 2026, high-discrepancy medications were identified by averaging variance data from October through December 2025, generating a list of the top 30 discrepancy items per campus. For ongoing audits, this list is updated monthly using a rolling two-month lookback period to ensure prioritization reflects the most recent inventory performance and that previously identified discrepancies are resolved. High-cost medications were identified by estimating average on-hand inventory using PAR level midpoints ((minimum + maximum)/2) and multiplying by blended unit cost to approximate financial exposure. This analysis is also refreshed monthly to account for changes in utilization, pricing, and inventory levels, producing a current list of the top 50 high-cost medications per campus. The Pharmacy Inventory Integrity Analyst Team conducts standardized physical audits during the second week of each month. Physical counts are compared against PLX system inventory, and results are calculated as accuracy percentages and trended month-over-month. Audit findings are reported to campus leadership, and discrepancies undergo further review to identify root causes and support corrective actions.

Results:
A total of 1,248-line items were evaluated during the October 2025 audit. Internal team alignment with the inventory management system (IMS) was higher compared to the external vendor (73.7% vs. 67.0%). Full agreement between the internal team, vendor, and IMS occurred in 63.8% of line items, while complete disagreement was observed in 19.5%. Internal counting accuracy reached 92.0% (1,149/1,248), corresponding to an error rate of 8.0%, with variability observed across campuses. During the February–April 2026 audit period, 2,505 medications were evaluated. Internal team error rates demonstrated progressive improvement from 1.28% in February to 1.02% in March and 0.11% in April, representing a 91% reduction in error rate over the study period.

Conclusion:
Implementation of a structured internal inventory integrity team and a data-driven audit process was associated with improved inventory accuracy and team performance across campuses. This approach supports scalable, standardized inventory management and progression toward a perpetual inventory system.

Moderators

Karen Babb

Residency Program Director, CHIM1CHI MemorialPGY1

Presenters

Veronica Bekheit

PGY2 Health-Systems Pharmacy Administration & Leadership Resident, AdventHealth Orlando

Evaluators

Karen Barlow

PGY1 Residency Program Director, Wellstar Kennestone Regional Medical Center

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Olympia 2

Administration (ADM), AdventHealth Orlando

2:50pm EDT

Evaluating Symptom Documentation of Uncomplicated Urinary Tract Infection and Bacterial Vaginosis in Women’s Health Clinics at the Fayetteville NC VA

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena B

Background/Purpose: Asymptomatic bacteriuria (ASB) is defined as the isolation of quantifiable bacteria in the urine in the absence of urinary symptoms. Per 2019 IDSA guidelines for the management of asymptomatic bacteriuria, healthy nonpregnant women, patients with diabetes, and older adult women should not be screened or treated for asymptomatic bacteriuria. Despite most recent guideline recommendations, estimated incidence of inappropriate asymptomatic bacteriuria treatment range from 40-83% in the United States. Similarly, 2021 CDC guidelines recommend treating bacterial vaginosis in symptomatic women. Currently there is no data supporting the routine screening of bacterial vaginosis in healthy, nonpregnant women. This quality improvement initiative aims to evaluate the impact of provider education and order set optimization on the quality of symptom documentation for uncomplicated urinary tract infections and bacterial vaginosis in women's health clinics at the Fayetteville NC VA Coastal Health Care System (FNCVACHCS).
Methodology: This project will identify Veterans treated for uUTI and/or BV at FNCVACHCS during two periods: September 1–November 28, 2025 (pre-intervention) and a subsequent 2.5-month post-intervention period. Data collection will utilize Computerized Patient Record System (CPRS) and Microsoft Excel software to review women’s health providers’ notes, cultures, and labs. The primary objective assessed the difference in symptom documentation rates after intervention. The secondary outcome evaluated treatment of uUTI and BV 28 days before and after intervention implementation. Primary and secondary endpoint changes will be compared to assess the impact of provider education and order set adjustments.
Results: In progress
Conclusion: In progress

Moderators

Erin Murdock

Clinical Oncology Pharmacist / PGY2 Oncology RPC, Northside Hospital

Presenters

Jordan Powe

PGY-1 Resident, Fayetteville NC VA Coastal Health Care System

Jordan Powe, Pharm.D. is a PGY-1 Pharmacy Practice resident with the Fayetteville NC VA Coastal Health Care System. She earned her Doctor of Pharmacy from Campbell University College of Pharmacy & Health Sciences. Her practice interests include ambulatory care, women’s health, and... Read More →

Evaluators

Kishan Patel

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena B

Ambulatory Care (AMB), VA - Fayetteville, NC â€“ Fayetteville VA Coastal Health Care System

2:50pm EDT

Impact of Amlodipine to Nifedipine Conversions by a Remote Pharmacy Hypertensive Service

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Parthenon 2

Authors: Rayna Wallace, Jamie Coates, Kristina Hazard

Background: Blood pressure guidelines involve a stepwise approach with lifestyle modifications and medication(s) to achieve target blood pressure. Calcium channel blockers, amlodipine and nifedipine, are recommended as first-line antihypertensive agents due to their efficacy in lowering blood pressure. While amlodipine and nifedipine’s effects on blood pressure compared to other antihypertensive classes have been well studied, there is limited data regarding nifedipine’s role as a direct substitute for amlodipine. This project aims to evaluate the impact of amlodipine to nifedipine conversions by a remote pharmacy hypertension service to explore the conversion as a potential alternative to intensifying antihypertensive regimens with additional agents.

Methods: This IRB-exempt retrospective cohort project includes Kaiser Permanente Georgia members 18 years or older with a hypertension diagnosis who were enrolled in a remote pharmacy hypertension service and prescribed amlodipine 10 mg or switched from amlodipine 10 mg to nifedipine SR 90 mg between May 4, 2021, and May 3, 2025. The primary objective was to determine if the conversion of amlodipine to nifedipine would improve blood pressure in patients with uncontrolled hypertension as compared to patients remaining on amlodipine. The secondary objective was to assess the average change in blood pressure after the conversion of amlodipine to nifedipine in patients with uncontrolled hypertension. The tertiary objective was to evaluate if the conversion of amlodipine to nifedipine in patients with uncontrolled hypertension could result in ambulatory blood pressure goals being met at the next pharmacy hypertension service visit and within 3 months post conversion. Patients who remained on amlodipine 10 mg were matched up to a 1:2 ratio to patients who were converted to nifedipine SR 90 mg. Conditional logistic regression and generalized estimating equation (GEE) models were applied to report outcomes data.

Results: A total of 664 patients met inclusion criteria, of whom 596 remained on amlodipine 10 mg and 68 were converted to nifedipine SR 90 mg. 63 of the nifedipine SR 90 mg patients were matched to 120 patients remaining on amlodipine 10 mg. Conversion from amlodipine 10 mg to nifedipine SR 90 mg was not associated with statistically significant improvement in blood pressure outcomes. There was no significant difference in systolic blood pressure improvement (OR = 1.23; 95% CI = 0.61, 2.47) or diastolic improvement (OR = 1.54; 95% CI = 0.81, 2.92) between groups. At follow-up, the average systolic blood pressure in the nifedipine group was lower by -2.12; 95% CI = -5.65, 1.42 (p = 0.24) and average diastolic blood pressure was lower by -1.66; 95% CI = -4.36, 1.05 (p = 0.23); neither difference was statistically significant. Similarly, there were no significant differences in change from baseline systolic blood pressure (Estimate: -0.80; 95% CI = -2.72, 1.13) or change from baseline diastolic blood pressure (Estimate: -2.04; 95% CI = -4.59, 0.51) between groups. Achievement of blood pressure goals at follow-up (OR 0.95; 95% CI = 0.43, 2.11) and at 3 months (OR = 0.69; 95% CI = 0.33, 1.45) did not differ significantly between patients converted to nifedipine SR 90 mg and those maintained on amlodipine 10 mg.

Conclusions: Conversion from amlodipine 10 mg to nifedipine SR 90 mg was not associated with significant improvements in blood pressure reduction or goal attainment as compared to those remaining on amlodipine 10 mg after an adjusted analysis. These findings suggest that routine conversion to nifedipine SR 90 mg may not provide additional benefit over continued amlodipine 10 mg therapy. Further assessment of these findings may be warranted in a larger nifedipine cohort.

Contact Rayna Wallace at [email protected] with any questions regarding this project.

Moderators

Lucy Crosby

Medication Policy and Compliance Pharmacist, AUMC2Augusta University Medical Center/University of Georgia College of Pharmacy PGY1

Presenters

Rayna Wallace

Evaluators

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Parthenon 2

Ambulatory Care (AMB), Kaiser Foundation Health Plan of Georgia, Inc.

2:50pm EDT

Resident Presentation- Sherique Shaw

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Parthenon 1

AUTHORS: Sherique S. Shaw, Jeremy Bennett, Brianna Rhodes, Kalyn D. Pounders

BACKGROUND: Approximately 6.7 million American adults over the age of 20 were diagnosed with heart failure (HF) in 2024. This number is expected to rise to 8.7 million by 2030. Heart failure hospitalizations accounted for the highest healthcare costs among cardiovascular related hospitalization at $18.5 billion. The first 30 days following hospital discharge, patients with HF are highly vulnerable to readmission due to residual symptoms, medication changes, and gaps in care transitions. During the 2024-2025 fiscal year [FY25] at the Atlanta VA only 35-42% of HF admission patients received any follow up by a provider (primary care, cardiologist, or Clinical Pharmacist practitioner (CPP)) within 14 days of discharge. Previous studies have highlighted the role that clinical pharmacists can play in improving hospital readmission rates for patients with heart failure. In FY25, no standardized process existed to enable CPPs to systematically follow up with and intervene for discharged heart failure patients. The Atlanta VA Health Care System implemented a protocol in FY26 Q1 [October 1, 2025 – December 31, 2025] enabling clinical pharmacists to assess and optimize medication regimens for patients discharged following heart failure diagnosis or exacerbation. This project aims to assess the impact of follow-up intervention or optimization via pharmacist involvement on heart failure discharges on 30-day cardiac readmission rates in veterans with heart failure at the Atlanta VA Health Care System.

METHODOLOGY: This project is a retrospective quality improvement project comparing 30-day readmission rates among patients who were assessed by a CPP within 30 days of hospital discharge versus those who did not receive CPP intervention or follow-up. Inclusion criteria for the study are adults 18 years or older who were hospitalized at the Atlanta VA hospital for FYQ1 2025 and FYQ1 2026 and received a diagnosis of heart failure with reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF). Exclusion criteria included veterans who are pregnant, complex heart failure, terminally ill or hospice enrolled and if the veterans were discharged to a non-home environment. Eligible Veterans will be identified using the following methods: heart failure diagnosis ICD-10 codes, heart failure population-management dashboard, the 2-day post-discharge dashboard (monitored by primary care nurses who notify CPPs of actionable patients), referrals from the inpatient team via Pharmacotherapy Heart Failure Discharge Consults, and referrals from any primary care team member or specialist. Once identified, CPPs will provide an intervention and document the interaction under the note titled "Pharmacotherapy Heart Failure Post-discharge Note". Intervention for this research is defined as initiating, titrating, or maintaining GDMT at target or maximally tolerated doses. For this project, a readmission is defined as a hospitalization within 30 days of initial discharge for a HF exacerbation. Readmissions will be identified through discharge summaries tab in computerized patient record system [CPRS] or notes filtered by ICD-10 codes under the post-discharge category. We also will be collecting demographic and clinical characteristics including, age, gender, time of hospitalization, active GDMT prescription before hospitalization, active GDMT prescriptions after CPP assessment, patient readmission, primary care provider or clinic, EF classification prior to admission, type of intervention/optimization provided if any. After capturing the data, we will calculate the percentage of HF readmissions with and without CPP intervention for each fiscal year. Upon review of the data, the impact of the pharmacotherapy task force post discharge follow up will be assessed in order to identify areas for quality improvement.

RESULTS:
In FYQ1 2025, there was a total of 106 HF patients, and 16%(17/106) were readmitted within thirty days. In FYQ1 2026, there was a total of 63 HF patients and 24% (15/63) of HF patient readmitted within 30 days. Only 13% (8/63) of the HF patients in FYQ1 2026 received CPP follow up from the intervention team. Of the HF patients that received a CPP follow up, 13% (1/8) were readmitted in 30 days compared to 26% (14/53) of the HF patients that did not receive CPP follow up.
Veterans were identified for intervention after discharge using the multiple methods such as ICD-10 codes, the 2-day post-discharge dashboard, and the pharmacotherapy heart failure discharge consults. Of the 8 patients that received a CPP intervention, 63%(5/8) were identified through pharmacotherapy heart failure discharge consults. All patients identified through this consult (5/5) remained readmission-free at 30 days.

CONCLUSIONS: It is recommended to provide additional education to staff of available options to notify CPPs to heart failure discharge patients to make a greater impact. CPP intervention had lower percentage of 30 day readmission rate.

Moderators

Kimm Freeman

Presenters

Sherique Shaw

PGY 1 Pharmacy residents, Atlanta VA Medical Center

Hi! My name is Sherique Shaw. I am one of the current PGY1 Pharmacy Residents at the Atlanta VA Medical Center. I earned my Doctor of Pharmacy degree from Mercer University College of Pharmacy in Atlanta, GA. I have a strong interest in ambulatory care, with a focus on chronic disease... Read More →

Evaluators

Khushbu Patel

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Parthenon 1

Cardiology (CAR), VA-Atlanta, GA- Atlanta VA Health Care System

global Y

2:50pm EDT

Analgesic Dose Ketamine Infusion for Pain Control of Trauma Patients in the Critical Care Setting

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Olympia 1

Title: Analgesic Dose Ketamine Infusion for Pain Control of Trauma Patients in the Critical Care Setting

Authors: Alyssa Sangalang, Brooke Gallman, & Jamie McCarthy

Practice Site: Piedmont Athens Regional Medical Center

Introduction: Adequate pain control is essential in the management of traumatic injuries. Per the 2018 Society of Critical Care Medicine Pain, Agitation/Sedation, Delirium, Immobility, Sleep Guidelines and the 2024 American College of Surgeons Trauma Quality Improvement Programs Best Practice Guidelines, opioids remain as the standard treatment approach with trauma induced pain. However, because of the deleterious effects of opioids, such as hypotension, hypoxia, decreased gastrointestinal motility, and tolerance, these guidelines recommend a multimodal analgesic approach for sparing opioids and therefore, avoiding unwanted side effects. Ketamine is a N-methyl-D-aspartate receptor antagonist that has analgesic properties at low doses (<0.5 mg/kg/hr) and is a component of the multimodal approach. Ketamine usage at Piedmont Athens Regional (PAR) has previously been utilized for pain as single dose, push orders. Additionally, ketamine use has been ordered at higher, titratable doses for indications such as sedation and agitation. At higher doses, ketamine requires patient monitoring due to the potential risk of cardiovascular, respiratory, and psychiatric events. The analgesic dose ketamine infusion could be a favorable option because it provides analgesia while reducing these potential risks. The primary objective of this study was to determine if the intervention of analgesic dose ketamine infusion would be a safe and effective adjunct therapy to opioids for pain control in trauma patients.

Methods: This single-center, IRB-exempt, pre-post interventional study was completed via a chart review. The intervention investigated was a low, analgesic dose ketamine infusion for pain control in patients admitted due to trauma. The pre-intervention group included patients from October 1st, 2024, to February 28th, 2025, who would have met criteria to receive an adjunct analgesic dose ketamine infusion for pain control if the guidance had been readily available. Patients admitted during this pre-specified period were randomized and data collected on the number of patients necessary to match the post-intervention group. The inclusion criteria included age greater than 18 years and admission to ICU for a trauma event. The exclusion criteria included pregnancy and contraindications to ketamine. The post-intervention group included patients admitted from October 1st, 2025, to February 28th, 2026. The primary outcome was oral morphine milligram equivalents (MME) per day between the pre- and post-intervention groups. Secondary outcomes were numeric rating pain scores, other multimodal pain modalities received, lengths of stay, oral MME at discharge, and adverse events related to ketamine. Data between the two groups was analyzed with Microsoft Excel. Chi-square tests were utilized for categorical data and reported as number and percentage. Paired and unpaired t-Test and two-way ANOVA were used for continuous parametric data and reported as mean and standard deviation as appropriate. Outcomes were considered statistically significant if the p-value is ≤ 0.05.

Results: Seven patients were included in the pre- and post-intervention groups. For the primary outcome, the pre-intervention group had an average of 54 oral MME per day compared to 44 oral MME in the post-intervention group (p = 0.26). There was no difference in pain scores between groups over time (p = 0.61) or MME at discharge (p = 0.087). There was a reduction in pain scores prior to and 24 hours after ketamine initiation (p = 0.006). No difference in heart rate or mean arterial pressure was detected between groups (p = 0.22 and p = 0.08). No adverse events were reported in the post-intervention group due to ketamine.

Discussion: A low, analgesic dose ketamine infusion did not detect a difference in oral MME in this small cohort. However, ketamine reduced pain at 24 hours and appeared to be a safe adjunct to opioids.

Moderators

Nathan Wayne

Cardiology Clinical Pharmacist, PGY1 RPC, Wellstar MCG Health

Presenters

Alyssa Sangalang

Alyssa Sangalang, PharmD, is a PGY1 Pharmacy Resident at Piedmont Athens Regional in Athens, GA. She completed her Doctor of Pharmacy degree at the University of Georgia College of Pharmacy. Upon completion of her PGY1 residency, she plans on continuing her pharmacy career with Piedmont... Read More →

Evaluators

Nieka Jackson

Pain Clinical Pharmacist Practitioner (Facility PMOP Coordinator)

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Olympia 1

Critical Care/Emergency Medicine (CCM), Piedmont Athens Regional

global Y

2:50pm EDT

Efficacy and Safety of Sugammadex Versus Neostigmine for Neuromuscular Blocker Reversal Following Minimally Invasive Direct Coronary Artery Bypass

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena A

Title: Efficacy and Safety of Sugammadex Versus Neostigmine for Neuromuscular Blocker Reversal Following Minimally Invasive Direct Coronary Artery Bypass
Authors: Micah Wilson and Jeannie Watson

Introduction: Neuromuscular blocking agents given for anesthesia are reversed with neostigmine or sugammadex to facilitate extubation. Due to neostigmine's shorter half-life and indirect mechanism of action1, patients may require additional doses in order to achieve extubation, leading to longer recovery times, increased risk of complications and costs2. Sugammadex however, has a longer half life, less adverse effects, and has a direct mechanism of action3. The purpose of this study was to evaluate the safety, effectiveness, and cost associated with each agent.
Methods: This is a single-center, retrospective, cohort study utilizing electronic medical records of adult patients undergoing minimally invasive direct coronary artery bypass (MIDCAB) procedure and receiving either sugammadex or neostigmine/glycopyrrolate at Ascension Saint Thomas Hospital West from January 2021 to September 2025. Patients were included if they were 18 years of age or older and received either sugammadex or neostigmine/glycopyrrolate post-MIDCAB. Patients were excluded if they originally failed reversal with neostigmine, returned to the operating room for complications, were on mechanical circulatory support, pregnant or incarcerated. The primary outcome was to determine whether there was a difference in the time to extubation between both cohorts. Secondary outcomes included total hospital length of stay, total time spent in the ICU (Intensive Care Unit) post-op, reintubation rates, occurrence rate of safety objectives, and cost per dose.
Results: A total of 156 patients were included in the study, with 78 patients receiving sugammadex and 78 patients receiving neostigmine. The primary outcome was found to be statistically significant, with patients receiving sugammadex spending significantly shorter time intubated when compared to neostigmine. (3.9 hours vs.7.9 hours ; p = <0.0001). There was also a statistically significant difference between the groups in total hospital length of stay as well as ICU length of stay. Additionally, both groups were similar in adverse events and reintubation rates.
Conclusion: In this study, we observed that patients reversed with sugammadex had shorter time to extubation when compared to neostigmine. These patients were also more likely to be extubated in the OR (operating room) rather than the ICU and had shorter lengths of stay in the ICU and hospital overall. Despite positive outcomes, the limiting factor to increasing the use of sugammadex for all patients, is the cost compared to neostigmine. Therefore, further studies that include more patients are warranted to fully determine the benefit of sugammadex and to justify the additional cost associated with it.

Moderators

John Puryear

Presenters

Micah Wilson

Evaluators

Katherine Fuller

Clinical Pharmacy Specialist --Hepatology

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), Saint Thomas West Hospital

global Y

2:50pm EDT

Evaluation of Antibiotic Duration Between Concordant vs Discordant Multiplex Pneumonia PCR and Respiratory Culture Results

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena G

Title: Evaluation of Antibiotic Duration Between Concordant vs Discordant Multiplex Pneumonia PCR and Respiratory Culture Results
Authors: Kala Eliacin, Rachel Tendler, Haodi Ruan
Background/Purpose: Multiplex pneumonia PCR panels provide rapid identification of respiratory pathogens; however, discrepancies between PCR results and conventional respiratory cultures can introduce uncertainty in antimicrobial decision-making. The purpose of this study is to evaluate PCR-culture concordance vs discordance and their implications on antibiotic duration in critically ill patients with suspected pneumonia.
Methodology: This was a single-center, retrospective chart review of adult patients admitted to the intensive care units at Emory Saint Joseph’s Hospital between January 1, 2023 and December 31, 2025 . Patients were included if they had suspected pneumonia and underwent both a multiplex pneumonia pathogen panel (PPP) and respiratory culture during the same hospitalization. Patients were excluded if they had a concurrent infection, died within 5 days of specimen collection, or had concordant negative PCR and culture results. The primary outcome was total duration of antibiotic therapy within 14 days of PPP and culture collection. Secondary outcomes included antibiotic regimens eligible for change, antibiotic regimens changed, ICU length of stay (LOS), hospital LOS, and pathogen identification. Continuous variables were reported using descriptive statistics and compared between groups using an unpaired t-test.
Results: A total of 70 patients were included, with 36 (51.4%) concordant results and 34 (48.6%) discordant results. Average age was around 62.3 years in the concordant group and 61.3 years in the discordant group and average weight was about 75 kg in both groups. Overall, the majority type of pneumonia identified in patients for both groups was community acquired pneumonia (CAP) with 41.7% in the concordant group and 47.1% in the discordant group. The mean total days of antimicrobial therapy within 14 days of index testing were 7.8 days in the concordant group compared with 8.0 days in the discordant group (p = 0.8303). ICU LOS was 13.8 days in the concordant group versus 13.2 days in the discordant group. Hospital LOS for the concordant and discordant group was 26.4 days versus 18.5 days, respectively. Antibiotic regimens were eligible for modification in 48 patients (68.6%), including 23 (63.9%) in the concordant group and 25 (73.5%) in the discordant group. Antibiotic regimens were changed in 37 patients (52.9%) overall following PPP results. Multiplex PCR detected more pathogens than respiratory culture, with common organisms including Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Overall, resistance genes were detected in 9.7% of cases with mecA/C being the most common in both the concordant group (13.5%) and discordant group (25.7%).
Conclusions: There was no difference in antibiotic duration of treatment or ICU LOS between concordant and discordant PPP and respiratory culture results. Hospital LOS, however, was shorter in the discordant group but may have been due to confounding factors. PPP results frequently identified opportunities for antimicrobial optimization, and antibiotic regimens were modified in over half of patients. These findings show that concordance vs discordance between multiplex PCR and culture results were not associated with a difference in antibiotic duration in critically ill patients with suspected pneumonia.

Moderators

Leigh Joyner

Clinical Pharmacist, Tandem Health

Presenters

Kala Eliacin

PGY1 Pharmacy Resident, Emory Saint Joseph Hospital

Kala Eliacin is from Buford, Georgia and attended Georgia State University where she majored in chemistry.  She received her Doctor of Pharmacy from the University of Georgia College of Pharmacy.  Her professional interests include critical care and cardiology.  After completion... Read More →

Evaluators

Kristina Evans

PGY2 Internal Medicine Residency Program Coordinator, Grady Health System

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena G

Infectious Disease (ID), Emory Saint Josephâ€™s Hospital

global Y

2:50pm EDT

Tracking the Trends: Staphylococcus aureus Bacteremia Rates in a Rural, Not-for-Profit Hospital

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena I

Title: Tracking the Trends: Staphylococcus aureus Bacteremia Rates in a Rural, Not-for-Profit Hospital
Authors: Natalie Ly, Heather Gibson, Allison Cid, Gretchen Arnoczy
FirstHealth Moore Regional Hospital – Pinehurst, NC

Background: Infectious Diseases (ID) consultation is associated with improved outcomes in Staphylococcus aureus bacteremia (SAB), yet access may be limited in community settings. This study evaluated SAB outcomes following interventions to increase ID consultation at a community health system. Interventions included increased ID availability for telemedicine consults, as well as a recommendation for ID consultation for all appropriate SAB cases.

Methods: This retrospective chart review study utilized electronic medical records from FirstHealth patients with data collected from January 1, 2024 through January 31, 2025. All patients within the 4-hospital FirstHealth of the Carolinas system who had blood cultures positive for Staphylococcus aureus were evaluated. Patients were excluded if they met the following criteria: died or transitioned to comfort care within 3 days of positive blood culture, transferred to another institution, or were lost to follow-up. Patient characteristics and demographics were collected including age, sex, methicillin-resistant Staphylococcus aureus (MRSA), persistent bacteremia, persons who inject drugs (PWID), confirmed endocarditis, transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), and ID consult status, as these are predictors of 6-month mortality for patients with SAB. The primary outcome studied was difference in 6-month mortality and recurrence rates, compared to rates observed within the hospital system during the COVID-19 pandemic. Secondary outcomes include differences in mortality or frequency of ID consults, particularly related to the implementation of ID telemedicine consults, as well as use of dalbavancin or oritavancin.

Results: A total of 147 patients were included in this study. The 6-month mortality rate was 40/147 (27.2%), which was 5.9% lower than during the previous studied time frame; however, this was not statistically significant with a p-value of 0.25 (Relative Risk 0.82 [95% Confidence Interval 0.58-1.15]). Recurrence was defined as a return of SAB at least 2 weeks after resolution of the initial episode, as evidenced by documented negative blood cultures and improvement of clinical symptoms. The 6-month recurrence rate was 10/147 (6.8%), which was 2.5% lower than during the previous studied time frame. This was also a nonsignificant finding (Relative Risk 0.73 [95% Confidence Interval 0.34-1.56], p-value 0.42). The majority of patients 140/147 (95.2%) had an ID consult, as compared to 116/172 (67.4%) in the previous study. This 27.8% increase was statistically significant at a p-value of <0.001, with the rise in consult rates primary driven by telemedicine visits. There was also a higher incidence of cardiac imaging obtained and a trend toward shorter time to ID consult placed after positive blood culture. Utilization of long-acting lipoglycopeptides was low, as only 3 patients received dalbavancin and none received oritavancin.
There are a number of factors that may have impacted the results of this study. Firstly, there were a small number of patients evaluated, which could make it more difficult to detect statistical significance when the study is not adequately powered. Furthermore, the population in this study included non-COVID patients, in contrast to the previous studied time period where patients had COVID-19 complicating their SAB. These patients may have differed in baseline illness severity, potentially biasing outcome comparisons.

Conclusions: In this study, the expansion of ID access was associated with significantly higher ID consultation rates and favorable trends in 6-month mortality and recurrence rates among patients with SAB. These findings support the role of expanded ID access in improving SAB management within community health systems.

Moderators

Lindsey Arthur

Clinical Pharmacy Manager, Self Regional Healthcare

Presenters

Natalie Ly

Evaluators

Lyndsay Gormley

RPD, PRIS10Prisma Health-Upstate (Critical Care)PGY2

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena I

Infectious Disease (ID), FirstHealth Moore Regional Hospital

global Y

2:50pm EDT

Evaluating Methotrexate Effectiveness for Ectopic Pregnancy Management in Obese Patients

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena C

Background: Ectopic pregnancy is a potentially life-threatening condition commonly managed with methotrexate in hemodynamically stable patients without absolute contraindications. Although methotrexate dosing is calculated using body surface area, the optimal weight-based strategy in obese patients remains uncertain. Historically, Northside Hospital Atlanta, Cherokee, and Forsyth utilized adjusted body weight for dosing due to concerns about toxicity. However, questions regarding potential underdosing and reduced efficacy prompted a transition to total body weight–based dosing on May 6, 2025. This study compares treatment success and adverse drug reactions between adjusted body weight and total body weight methotrexate dosing strategies in hemodynamically stable obese patients with tubal ectopic pregnancy.

Methods: This retrospective cohort study evaluated the safety and efficacy of single-dose intramuscular methotrexate dosed at 50 mg/m2 in obese patients diagnosed with tubal ectopic pregnancy before and after implementation of total body weight–based dosing. Obesity was defined as a total body weight greater than 130% of ideal body weight. The primary outcome was treatment success, defined as resolution of ectopic pregnancy without additional methotrexate doses or surgical intervention. Secondary outcomes included adverse drug reactions. Eligible patients were ≥18 years old and received methotrexate for tubal ectopic pregnancy. Patients with relative contraindications to methotrexate such as, β-hCG >5,000 mIU/mL, ectopic mass >4 cm, or fetal cardiac activity, were included. Data collected from electronic medical records included demographics, baseline labs, initial β-hCG levels, ultrasound findings, need for additional methotrexate dosing, surgical intervention, and documented adverse events. Comparative analyses were performed within and between adjusted and total body weight dosing groups.

Results: A total of 120 women were included in the study, with 60 patients in both the pre-implementation and post-implementation cohorts. In the pre-implementation cohort, 32 patients were obese and 28 were non-obese. Treatment resolution occurred in 81.3% (26/32) of obese patients and 64.3% (18/28) of non-obese patients. Among non-obese patients, 17.9% (5/28) had pre-methotrexate β-hCG levels >5,000 mIU/mL, 7.1% (2/28) had ectopic masses >4 cm, and 0% had cardiac embryonic activity. In contrast, 0% of obese patients had β-hCG levels >5,000 mIU/mL, and none had ectopic masses >4 cm or embryonic cardiac activity. The post-implementation cohort included 37 obese and 23 non-obese patients. Treatment resolution occurred in 59.5% (22/37) of obese patients and 56.5% (13/23) of non-obese patients. Among non-obese patients, 4.3% (1/23) had pre-methotrexate β-hCG levels >5,000 mIU/mL, 0% had an ectopic mass >4 cm, and 4.3% (1/23) had cardiac embryonic activity. Among obese patients, 13.5% (5/37) had pre-methotrexate β-hCG levels >5,000 mIU/mL, 5.4% (2/37) had ectopic masses >4 cm, and 0% had cardiac embryonic activity. After accounting for relative contraindications to methotrexate administration in obese and non-obese patients within each group, there was a lower difference in resolution rates within the pre-implementation arm (obese, 81.3% vs non-obese, 76.2%) vs the post-implementation arm (obese, 66.7% vs non-obese, 57.1%)

Conclusions: In this retrospective study, adjusted resolution rates for relative contraindications showed a greater difference in success rates, favoring obese patients, in the post-implementation group compared to the pre-implementation group. Although total body weight dosing was associated with a higher frequency of adverse events, no serious adverse events were observed. These findings confirm that relative contraindications to methotrexate reduce efficacy, and further prospective studies with larger sample sizes are needed to define the optimal methotrexate dosing strategy in obese patients. Considerations for future studies include utilizing a 2-dose methotrexate regimen for patients with an initial elevated hCG, evaluating differences in success rates across obese subgroups stratified by differences in BMI, and excluding patients with relative contraindications to methotrexate.

Moderators

Alexis Pruitt

Presenters

David Matatov

David Matatov is from Atlanta, GA. He did his undergraduate studies at Georgia State University and received his Doctor of Pharmacy degree from Mercer University College of Pharmacy. David is a current PGY1 Pharmacy Resident at Northside Hospital Atlanta. Next year, David will be... Read More →

Evaluators

Kayla Brown

PGY-1 Residency Program Director, East Alabama Medical Center

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena C

Internal Medicine (IM), Northside Hospital

global Y

2:50pm EDT

Implementation of Prescriber Antibiotic Scorecards in a Rural Community Hospital

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena D

Title: Implementation of Prescriber Antibiotic Scorecards in a Rural Community Hospital

Authors: Valeriy Shipilov PharmD, Joshua Pruitt PharmD, BCIDP

Purpose: Antimicrobial stewardship is an essential practice component in acute care settings as about 30% of all antibiotics prescribed in U.S. acute care hospitals are unnecessary or suboptimal. Tracking and reporting of antimicrobial utilization are two core elements of stewardship programs and aid benchmarking, transparency, and accountability. Previous studies on implementation of antimicrobial utilization reports have limited data on efficacy of these interventions on prescribing trends. The purpose of this study is to implement and track the impact on provider prescribing habits in a rural community hospital.

Methods: This report was developed and implemented at a rural community hospital with an average daily census of 125. Prescriber antibiotic utilization will be tracked by determining the number of shifts worked by a prescriber and the number of broad-spectrum antibiotics prescribed in a month. Data will be tracked and analyzed with a reporting software available through the hospital's electronic health record. Broad spectrum antibiotics will be defined as cefepime, meropenem, levofloxacin, and piperacillin-tazobactam. Broad spectrum antibiotic utilization will be reported to providers monthly as a rolling average of the number of targeted antibiotics prescribed per shift worked. Prescribers will be privately provided with their randomized identification number in an effort to blind data of their peers.

Results: We saw a statistically significant reduction in antibiotics prescribed per shift over time after the intervention (p = 0.019). There was no trend observed that was independent of the intervention (p=0.951) and there was no statistically significant immediate effect based on the intervention (p=0.076). We did not see a statistically significant reduction in days of therapy for targeted antibiotics (p=0.191) after the implementation of the scorecard.

Conclusions: Overall, we saw a statistically significant reduction in antibiotics prescribed per shift after the implementation of our prescribing scorecard. Although there was no effect on days of therapy, the results support the use of antibiotic scorecards as a means of tracking and reporting prescribing habits to physicians. Additionally, the reduction in use of broad-spectrum antibiotics has allowed us to meet quality goals for antibiotic prescribing, and we hope to expand the scope of the report to target reduction in days of therapy and possibly intravenous to oral switching.

Contact Information: [email protected]

Moderators

Molly Thompson

PGY1 Residency Program Director, HCA Healthcare Trident Hospital

Presenters

Valeriy Shipilov

PGY1 Pharmacy Resident, Baptist Health Deaconess Madisonville

Hello! My name is Valeriy Shipilov and I am a PGY1 Pharmacy Resident at Baptist Health Deaconess Madisonville. I completed my PharmD at Keck Graduate Institute in Southern California and have previously worked as a pharmacy Intern while I was in school. For the future, I plan on working... Read More →

Evaluators

Naomi Yates

Manager, Clinical Pharmacy Services, KFHP - Kaiser Foundation Health Plan of Georgia (Ambulatory)PGY2

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena D

Internal Medicine (IM), Baptist Health Deaconess Madisonville

2:50pm EDT

Assessment of Antiresorptive Therapy Utilization in Prostate Cancer Patients Receiving Abiraterone with Prednisone + Androgen Deprivation Therapy

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena H

Title: Assessment of Antiresorptive Therapy Utilization in Prostate Cancer Patients Receiving Abiraterone with Prednisone + Androgen Deprivation Therapy

Authors: Makenzie Boyd & Barbie Gleaton

Background: Abiraterone is an oral anticancer agent widely used for the treatment of metastatic prostate cancer in combination with prednisone and androgen deprivation therapy (ADT). One of the adverse effects associated with this regimen is bone density loss, leading to an increased risk of fractures and skeletal-related events. Bone health is critically important in these patients to maintain quality of life and reduce morbidity. The veteran population may be at greater risk of bone density loss due to multiple factors, including advanced age, higher comorbidity burden, and potential exposure to hazardous substances during military service, which could contribute to decreased bone health. Rapid bone loss without preventive measures can lead to severe complications, including pathological fractures, spinal cord compression, and reduced mobility. Assessing the current practices regarding the use of antiresorptive therapies in this high-risk population is essential to improving care and outcomes.

Methods: This study is a retrospective chart review of veterans with metastatic prostate cancer treated at the Birmingham VA Medical Center between January 1, 2024, and July 31, 2025. Patients were identified via fill history for active prescriptions of abiraterone. Included patients were at least 18 years old with a documented diagnosis of metastatic castrate-resistant prostate cancer who received at least 3 months of treatment and had at least 30 days of follow-up in the VA electronic medical record. Patients were excluded if they were followed by non-VA providers, had secondary malignancies, used steroids chronically for other comorbidities, had less than 180 days of life expectancy at the initiation of treatment, or had unspecified metastatic disease. The primary data point of this study was the appropriate utilization of antiresorptive treatment. Other data points included analysis of adjunctive supportive therapy for bone health and examination of pharmacist intervention in initiating supportive care. Baseline demographics and comorbidities were also collected to describe the study population and identify risk factors for bone mineral density loss.

Results: There were 131 patients reviewed, of which 38 met inclusion criteria. Of these, 12 patients had metastatic castration-resistant prostate cancer (mCRPC) and 26 had metastatic castration-sensitive prostate cancer (mCSPC). All patients with mCRPC were receiving appropriate antiresorptive therapy, including zoledronic acid or denosumab. In contrast, three patients in the mCSPC group received inappropriate bone-modifying therapy based on current guideline recommendations. At baseline, 86.8% of patients had a vitamin D level <30 ng/mL, indicating a high prevalence of vitamin D deficiency. Despite this, 65.3% of patients did not undergo bone mineral density screening with DEXA. Additionally, clinical pharmacists initiated 65.8% of vitamin D monitoring and prescribed 55.3% of supportive care supplementation.

Conclusions: Overall, it was determined that antiresorptive therapies were used appropriately for patients with mCRPC. However, inappropriate use of these therapies for patients with mCSPC, highlighting the need for review of current guideline recommendations. Gaps in supportive care were also identified, particularly in the underutilization of bone mineral density screening. Limited use of DEXA scanning restricted the ability to fully assess fracture risk and identify patients who may benefit from additional bone-modifying therapy while on this treatment regimen. Pharmacists played a significant role in driving laboratory monitoring and supportive care interventions. Future efforts should focus on implementing standardized bone health screening for all patients receiving androgen deprivation therapy to improve early identification and prevention of skeletal-related events in this high-risk population.

Moderators

Kellie Ball

PGY2 Ambulatory Care Coordinator, University of Tennessee Medical Center

Presenters

Makenzie Boyd

Evaluators

Kelvin Gandhi

Infectious Diseases Clinical Pharmacist, AdventHealth Daytona Beach

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena H

Oncology (ONC), VA-Birmingham, Al-Birmingham VA Health Care System

global Y

2:50pm EDT

Impact of Ciprofloxacin/Dexamethasone Utilization in Pediatric Tracheostomy Patients

Thursday April 30, 2026 2:50pm - 3:10pm EDT

Athena J

Title: Impact of Ciprofloxacin/Dexamethasone Utilization in Pediatric Tracheostomy Patients
Authors: Rachel Dickey, Andrea Gerwin, Stephanie Conrad
Background/Purpose: Ciprofloxacin/dexamethasone (cip/dex) is a combination antibiotic and corticosteroid that is available in a topical otic formulation. Current approved indications include the treatment of acute otitis externa and post-tympanostomy tube otorrhea. Cip/dex has been used off-label for reducing granulation tissue formation in pediatric tracheostomy patients by pediatric otolaryngologists for many years despite limited supporting data, mostly anecdotal. With long term use of cip/dex, there is theoretical concern for development of resistance to fluoroquinolone (FQ) antibiotics, such as ciprofloxacin and levofloxacin, the only enteral antibiotic formulations with effective broad-spectrum gram-negative coverage. The purpose of this review is to examine the influence of FQ exposure on antimicrobial resistance in our pediatric tracheostomy patients.
Methods: This study is a single center, retrospective review conducted using electronic health records of patients followed by Children’s Hospital at Erlanger between January 1, 2018 and December 31, 2025. Included patients had a tracheostomy and microbiological data available in the EHR. Patients were excluded if they received cip/dex drops via alternative route, were lost to follow up, or had care transferred to another institution. Patients were divided into groups based on history of FQ resistant or sensitive organisms. The primary outcome will evaluate total topical and systemic FQ exposure in patients who received cip/dex drops. Secondary outcomes will include number of respiratory cultures and rate of hospitalizations. Standardization of reported outcomes was achieved by normalizing cip/dex exposure, FQ exposure days, and days of hospitalization to patient tracheostomy days.
Results: Preliminary results include 16 patients in the FQ-sensitive cohort and 15 patients in the FQ-resistant cohort. Mean days of cip/dex per tracheostomy day were 0.06 (0-0.34) in FQ-sensitive group as compared to 0.05 (0-0.27) in the FQ-resistant group. The mean days of hospitalization per tracheostomy day were 0.76 (0.06-2.96) in the FQ-sensitive group as compared to 0.75 (0.01-8.42) in the FQ-resistant group. Approximately 56 % of the FQ sensitive group were male as compared to 60% of the FQ resistant group. Mean age (months) at tracheostomy was 8.73 (0.9-23.37) and 8.18 (1.70-29.70) in sensitive group and resistant group, respectively. The average number of cultures in the sensitive group and resistant group were 9.9 (2-34) and 10.9 (6-20).
Conclusions: There is a paucity of data on the impact of cip/dex drops on bacterial resistance patterns. The FQ-resistant cohort had more cultures than the FQ-sensitive patients. Patients with FQ-resistance had similar hospitalization days per tracheostomy days and tracheostomy duration when compared to the FQ-sensitive cohort. Both cohorts had similar ratios of systemic FQs and topical cip/dex exposure.

Moderators

Kelley Norris

Presenters

Rachel Dickey

Evaluators

Ketrin Mount

PGY1 Pharmacy Residency Program Director, James H. Quillen VA Medical Center

Thursday April 30, 2026 2:50pm - 3:10pm EDT
Athena J

Pediatric (PED), Erlanger Health System

global Y

3:10pm EDT

Prescription for Productivity: Assessment of Pharmacy Workload as a Productivity Metric

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Olympia 2

Authors: Derek Rhodes, Tim Walker, Doug Furmanek, Laura Holden, Harry Jozefczyk, Deborah Hurley, Ally Nielson, Natalia Valenti
Background: Productivity is measured as a ratio of an input of work hours to an output of a unit of service. Many health systems rely on traditional metrics such as number of billed doses, order processed or patient days to evaluate staffing needs and operational efficiency. Currently, there is no established gold standard for measuring pharmacy productivity that captures all the activities pharmacists perform. This study aimed to evaluate the accuracy of the current productivity metric of 1000 billed doses and determine whether novel pharmacy workload dashboard metrics provide a more accurate representation of pharmacy workload.
Methods: A study was conducted across Prisma Health hospitals including a retrospective review comparing historical workload data derived from the external productivity report (1000 billed doses) with pharmacy workload dashboard data through the electronic health record (EHR), which captures both operational and clinical actions. In addition, a prospective survey and time study were performed to estimate time spent on routine operational and clinical pharmacy tasks across multiple facilities.The primary endpoint compares the correlation coefficients between these two units of service: 1000 billed doses versus pharmacy dashboard workload actions. Secondary objectives include evaluating workload trends between hospitals of varying bed size and clinical service scope using time study data and assessing correlations among different workload categories to identify variations in workload patterns across facilities. Data will be analyzed using correlation analysis and simple linear regression, with multivariable regression modeling as appropriate to identify metrics most predictive hours worked.
Results: In progress
Conclusions: This study will contribute evidence toward improving pharmacy productivity measurement by assessing whether EHR-based workload metrics better reflect real pharmacist workload and support appropriate staffing allocation.

Moderators

Karen Babb

Residency Program Director, CHIM1CHI MemorialPGY1

Presenters

Joy Dahlen

Pharmacy Resident, Prisma Health

Current PGY2 Health System Administration and Leadership Resident at Prisma Health Richland, originally from North Dakota with interests in pharmacy benefits, medication safety, and supply chain management.

Evaluators

Karen Barlow

PGY1 Residency Program Director, Wellstar Kennestone Regional Medical Center

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Olympia 2

Administration (ADM), Prisma Health Richland - University of South Carolina

global Y

3:10pm EDT

An Observational Study of Patients Using U-200 Insulin in Insulin Pumps

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Parthenon 1

Title:
An Observational Study of Patients Using U-200 Insulin in Insulin Pumps

Authors:
Gabrielle E. Hall, Lauren Blumenfeld, Tavajay Campbell, Haley Pressley, Jonathan Hughes, Blake R. Johnson

Practice Site:
Ascension Saint Thomas

Background:
The use of concentrated insulin in insulin pumps has been described in a few small studies. These studies describe the use of human regular U-500 insulin via continuous subcutaneous insulin infusion versus multiple daily injections in adults with type 2 diabetes,1 the switch from rapid-acting U-100 insulin to U-500 regular insulin in patients with type 2 diabetes on insulin pump therapy,2 and the use of U-200 insulin in insulin pumps in adolescents and young adults with type 1 diabetes.3 The identified literature gap includes a lack of randomized controlled trials regarding the use of U-200 insulin in insulin pumps, a practice that has not been approved by the FDA.

Methods:
This is a retrospective, observational chart review of patients who used U-200 insulin via Omnipod® insulin pump. Patients were included if an order for Omnipod® and U-200 insulin were active at the same time from January 1, 2022 to November 30, 2025. To be included patients were further required to use the U-200 insulin in their insulin pump, wear a continuous glucose monitor, and complete at least two consecutive visits with their provider while using this regimen. Patients were excluded if they were pregnant or under age 18 at the start of the study period. Outcomes of interest include ambulatory glucose profile results, including time in range, time below range, and time above range, as well as A1c results and instances of stage 2 or 3 hypoglycemia.

Results:
There were 315 patients using Omnipod® insulin pumps during the study period who were screened for inclusion. Fifteen patients met initial inclusion criteria. Of those fifteen, seven were excluded for not using U-200 insulin via insulin pump, one was excluded for not wearing a continuous glucose monitor, and three were excluded for not completing at least two consecutive visits with the managing provider while using this regimen. The four remaining patients were included in this retrospective chart review and described in a narrative which includes their care plan and associated outcomes. No patients experienced greater than 2% time below range or stage 2 or 3 hypoglycemia. One patient met the time in range goal of >70% after transitioning to using U-200 insulin via Omnipod® insulin pump. Though the other three patients did not meet time in range goals, they experienced improved time in range, time above range, and A1c after transitioning to using U-200 insulin via Omnipod® insulin pump.

Conclusion:
In this case series of four patients using U-200 insulin via Omnipod® insulin pump, all patients made improvements towards reaching time in range goal >70%, time above range goal <25%, and A1c goal <7%. These findings add to the currently available evidence for this practice and reinforce the need for further study in this area.

Moderators

Kimm Freeman

Presenters

Gabrielle Hall

PGY2 Ambulatory Care Pharmacy Resident, Ascension Saint Thomas

Gabrielle Hall, PharmD is the PGY2 Ambulatory Care Pharmacy Resident at Ascension Saint Thomas Medical Partners where she has been exposed to a variety of disease states within a collaborative practice agreement. Prior to PGY2 residency, she completed her PGY1 Pharmacy Practice Residency... Read More →

Evaluators

Khushbu Patel

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Parthenon 1

Ambulatory Care (AMB), Ascension Saint Thomas Health

global Y

3:10pm EDT

Impact of Clinical Pharmacist Collaborative Management on A1C Reduction in a Rural Family Medicine Clinic

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena D

Objective: To evaluate whether collaborative management with a clinical pharmacist in a family medicine setting leads to more adult patients with type 2 diabetes mellitus (T2DM) achieving hemoglobin A1c (A1C) reduction within 3–6 months compared to matched patients receiving usual care.

Background: T2DM remains a major contributor to morbidity and mortality, particularly in rural populations where access to care and provider shortages can make disease management difficult. Clinical pharmacists integrated into primary care teams may improve glycemic outcomes through medication optimization. While prior studies have demonstrated improved A1C outcomes in pharmacist-managed diabetes clinics, many evaluate outcomes over 6–12 months. Limited data exist assessing short-term (3–6 month) glycemic response under collaborative models embedded within rural family medicine practices.

Methods: This retrospective, single-system, 1:1 matched cohort study included 34 adult patients with T2DM seen at a family medicine clinic between July 31, 2024, and July 31, 2025. Seventeen patients with ≥1 documented visit and management by a clinical pharmacist were matched to 17 patients without pharmacist involvement based on provider, age (±5 years), sex, and baseline A1C category (<8%, 8–10%, >10%).
The primary outcome was any A1C reduction (yes/no) from baseline to 3–6 months. Secondary outcomes included A1C reduction ≥1% and achievement of A1C goal (<7% or individualized target) within 3–6 months.

Results: Within 3–6 months, 9 of 17 (52.9%) pharmacist-managed patients demonstrated A1C reduction compared to 5 of 17 (29.4%) patients receiving usual care. When evaluating clinically meaningful reductions (≥1%), 7 of 17 (41.2%) pharmacist-managed patients and 4 of 17 (23.5%) usual care patients met this reduction. For goal attainment, 3 pharmacist-managed patients and 6 usual care patients met A1C target, however, most were already at goal at baseline (2 and 4 patients, respectively). Among patients not at goal at baseline, new goal attainment occurred in 1 of 15 (6.7%) pharmacist-managed patients and 2 of 13 (15.4%) usual care patients.

Conclusion: Collaborative management in a rural family medicine setting was associated with a higher proportion of patients achieving short-term A1C reduction, including clinically meaningful reductions ≥1%, compared to usual care. While goal attainment rates were similar and limited by small sample size, these findings support integration of pharmacists into rural primary care teams to promote early glycemic improvement.

Moderators

Molly Thompson

PGY1 Residency Program Director, HCA Healthcare Trident Hospital

Presenters

Jessica James

PGY1 Pharmacy Resident, Phoebe Putney Memorial Hospital

My name is Jessica James, and I am a PGY1 Pharmacy Resident at Phoebe Putney Memorial Hospital in Albany, Georgia. I earned my PharmD from St. John's University in New York. Following completion of my residency, I plan to begin working as a clinical pharmacist.

Evaluators

Naomi Yates

Manager, Clinical Pharmacy Services, KFHP - Kaiser Foundation Health Plan of Georgia (Ambulatory)PGY2

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena D

Ambulatory Care (AMB), Phoebe Putney Memorial Hospital/The University of Georgia

global Y

3:10pm EDT

Pharmacist-Led Intervention to Reduce Anticholinergic Burden in Older Adults

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena B

Name: Caroline McKenna
[email protected]

Background/Purpose:
Anticholinergic medications block the effects of the neurotransmitter acetylcholine. These medications treat a variety of conditions, including seasonal allergies, Parkinson’s disease, chronic obstructive pulmonary disease, urinary incontinence, and more. Side effects of anticholinergic medications include urinary retention, blurred vision, confusion, altered mental status, dry eyes and mouth, flushing of skin, and tachycardia.1 Persistent use of anticholinergic medications are associated with cognitive dysfunction in older adults, including Alzheimer’s, Lewy body dementia, and delirium.2 Various scoring scales are able to quantify the risk of anticholinergic burden in a quick and reproducible way. The Anticholinergic Cognitive Burden (ACB) Scale compares a medication’s ability to bind to muscarinic receptors and the degree of serum anticholinergic activity, and is the most common scoring system used in clinical research.2 Medications are scaled from 0-3, with zero implying no anticholinergic activity and 3 implying high anticholinergic cognitive effect. Summative burden can be categorized into low (0), medium (1,2), or high (3+) risk. The purpose of this study was to reduce anticholinergic burden in older adults and lower the risk of cognitive impairment, by implementing pharmacist-led ACB scoring and medication review during Medicare Annual Wellness Visits (AWVs).

Methodology:
This prospective, quality improvement study included patients with Medicare Part B coverage scheduled with a clinical pharmacist for their AWV across two outpatient family medicine clinics. Scheduling was handled by office support staff and based on primary care provider availability and pharmacist schedule openings. Patients were excluded if younger than 65. Guidance from the American Academy of Family Physicians in combination with clinical judgement by pharmacists were incorporated to determine appropriate intervention. During the AWV, medication reconciliations were completed. Patients received paper handouts for applicable anticholinergic medications, including but not limited to medications for pain, sleep, anxiety, allergies, and reflux. Handouts reviewed both risk and benefit of the offending agent, which were discussed with the pharmacist. Additional appointments were scheduled for deprescribing on a case-by-case basis. Data of age, ACB score, risk category, offending agents, and intervention offered was collected and analyzed by hand on a spreadsheet.

Results:
A total of 76 patients were evaluated, with 6 patients excluded given age <65. Of those included, 28 (40%) had a low ACB score, 28 (40%) had a medium ACB score, and 14 (20%) had a high ACB score. The most common offending agents were omeprazole/pantoprazole/lansoprazole (n=14), metformin (n=11), cetirizine/loratadine (n=6), and chlorthalidone (n=4). In terms of interventions, 28 patients (40%) had no intervention given low ACB score, 3 (4%) patients were no longer taking an anticholinergic medication, 14 (20%) patients declined pharmacist intervention, 18 (26%) patients medication benefit outweighed anticholinergic risk, and 7 (10%) patients were open to pharmacist intervention and scheduled follow-up for deprescribing. For patients open to pharmacist follow-up, 4 patients were on omeprazole/pantoprazole, 2 patients were on cetirizine, and 1 patient was on both omeprazole and cetirizine. For patients on proton-pump inhibitors, 2 patients were successful in stopping the agent with minimal reflux symptoms, 1 patient found that famotidine alone relieved symptoms, 1 patient agreed to esomeprazole switch (ACB score = 0), and 1 patient continued on omeprazole after trial off. For patients on anticholinergic allergy medications, 1 patient self-stopped use prior to AWV, one agreed to as needed use, and one agreed to switch to fexofenadine (ACB score = 0).

Conclusions:
Incorporating anticholinergic burden discussions during Medicare Annual Wellness Visits by pharmacists provided a seamless and meaningful impact. Of those reviewed, 60% had a medium or high ACB score. Through patient education and deprescribing efforts, a pharmacist was able to identify inappropriate anticholinergic use and support individualized deprescribing plans, promoting medication safety for older adults. Although only a subset of patients elected to pursue pharmacist follow-up, the majority saw success in either discontinuing the anticholinergic medication or switching to a safer medication alternative. Continued focus on anticholinergic deprescribing by pharmacists during AWVs may further enhance medication optimization, promote shared decision-making, and reduce long‑term risks associated with anticholinergic medications.

Moderators

Erin Murdock

Clinical Oncology Pharmacist / PGY2 Oncology RPC, Northside Hospital

Presenters

Caroline McKenna

PGY-2 in Ambulatory Care and Academia, Mountain Area Health Education Center (MAHEC)

Caroline is originally from Saratoga Springs, NY and completed her doctorate of pharmacy degree from the University of Pittsburgh School of Pharmacy in 2024. She completed her PGY-1 in Ambulatory Care and is completing her PGY-2 in Ambulatory Care and Academia at the Mountain Area... Read More →

Evaluators

Kishan Patel

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena B

Ambulatory Care (AMB), Mountain Area Health Education Center /UNC Eshelman School of Pharmacy

global Y

3:10pm EDT

Evaluation of Safety Outcomes in Patients with Diabetes Receiving Perioperative Dexamethasone

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena I

Title: Evaluation of Safety Outcomes in Patients with Diabetes Receiving Perioperative Dexamethasone

Investigators: Christian Garner, Devon Johnson, Spencer Livengood
Practice Site: ECU Health Medical Center
Contact: [email protected]

Background: Postoperative nausea and vomiting (PONV) occurs in ~30% of surgical patients and is more common in high-risk procedures. Intravenous dexamethasone is often utilized for PONV prophylaxis but may increase the risk of hyperglycemia in patients with diabetes. At ECU Health Medical Center (ECUHMC), cases of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) have been observed following perioperative dexamethasone use. However, the incidence of these complications remains poorly described in current literature. This research project aimed to evaluate the incidence of DKA and HHS in patients with diabetes receiving perioperative dexamethasone and identify associated risk factors for postoperative insulin drip initiation.

Methods: This single-center, retrospective observational review evaluated adult patients with diabetes who underwent surgery and received perioperative dexamethasone at ECUHMC from July 2024 to July 2025. Patients were excluded for conditions likely to confound glycemic outcomes, including chronic steroid use, perioperative insulin infusion, or administration of additional steroids. The primary outcome was the incidence of postoperative DKA or HHS as defined by the 2026 American Diabetes Association. Secondary outcomes included hospital length of stay and mean 72-hour postoperative blood glucose levels. Descriptive statistics were used to summarize primary and secondary outcomes. A multivariate analysis was used to identify an association between independent variables and insulin infusion initiation.

Results: Of 1,450 patients screened, 381 met inclusion criteria. Two patients (0.5%) developed confirmed DKA, and no cases of HHS were identified. Median postoperative length of stay was 92.2 hours and mean 72-hour postoperative blood glucose was 172 mg/dL, with 65.9% having a 24-hour postoperative blood glucose >200 mg/dL. Seventeen patients (4.5%) required initiation of an insulin infusion within 72 hours of dexamethasone administration but were missing necessary information to confirm DKA or HHS diagnosis. Results from the multivariate analysis confirmed higher admission blood glucose was independently associated with insulin infusion initiation (p=0.0435).

Conclusion: Although perioperative dexamethasone use was associated with a low incidence of confirmed DKA and HHS, a notable proportion of patients required insulin infusion, indicating a higher burden of postoperative hyperglycemia and potential under-recognition of hyperglycemic crises. Elevated preoperative blood glucose levels were associated with increased risk of insulin infusion initiation, supporting closer perioperative glucose monitoring in patients with diabetes.

Moderators

Lindsey Arthur

Clinical Pharmacy Manager, Self Regional Healthcare

Presenters

Christian Garner

PGY-1 Pharmacy Resident, ECU Health Medical Center

My name is Christian Garner, PharmD, and I am a PGY1 pharmacy resident at ECU Health Medical Center. I received my PharmD degree from Campbell University College of Pharmacy & Health Sciences in May 2025. I am currently pursuing a job as an internal medicine pharmacist post-residency... Read More →

Evaluators

Lyndsay Gormley

RPD, PRIS10Prisma Health-Upstate (Critical Care)PGY2

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena I

Community Pharmacy (CP), ECU Health Medical Center

global Y

3:10pm EDT

Evaluation of Hydrocortisone vs Hydrocortisone Plus Fludrocortisone in Septic Shock Among Critically Ill Patients

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Olympia 1

Authors: Matthew Huebner, Julie Willmon, Kevin Pacheco

Background
Septic shock is a life-threatening condition characterized by a dysregulated host response to an infection. Hydrocortisone and fludrocortisone are corticosteroids that are proposed to modulate the host response and may improve outcomes in septic shock. In the ADRENAL trial, hydrocortisone did not lower mortality versus placebo1, whereas the APROCCHSS trial demonstrated a mortality benefit with the combination of hydrocortisone plus fludrocortisone2. Evidence from clinical trials is conflicting, and there is a gap in trial data comparing the combination to hydrocortisone monotherapy. However, guidelines suggest the use of both hydrocortisone and fludrocortisone for critically ill patients with septic shock3. The objective of this study is to assess clinical outcomes associated with the current prescribing practices of corticosteroids in septic shock at AdventHealth Central Florida Division hospitals.

Methods
A retrospective analysis was conducted in critically ill patients with septic shock to evaluate the effect of hydrocortisone versus hydrocortisone plus fludrocortisone. The primary outcome was the number of vasopressor free days (VFD) out of 28. Secondary outcomes included dose of norepinephrine upon initiation of corticosteroids, number of vasopressors, days of vasopressors, hours of vasopressors, need for mechanical ventilation, duration of mechanical ventilation, recurrence of shock, in hospital mortality, and time to discharge from ICU and hospital. Safety outcomes included new onset infections, number of days with blood glucose >180 g/dL, and number of days with serum sodium out of normal range.

Results
From the 140 patients included in this analysis, the median vasopressor free days out of 28 was 0 days (IQR 0-24) in the hydrocortisone group versus 0 days (IQR 0-24) in the hydrocortisone plus fludrocortisone group (P=0.59). When vasopressor free days are adjusted for hospice related deaths, the median VFD was 21.5 days (IQR 0-25) in the hydrocortisone group versus 19 days (IQR 0-24) in the hydrocortisone plus fludrocortisone group (P=0.32). The days of vasopressors were significantly higher in the hydrocortisone plus fludrocortisone group (5 vs 3 days, P=0.005) and hours of norepinephrine (83.0 vs 52.4 hours, P=0.008), vasopressin (51.2 vs 35.6 hours, P=0.04), phenylephrine (83.2 vs 18.3 hours, P=0.03) but not epinephrine (43.8 vs 27.2 hours, P=0.21) compared to the hydrocortisone group. Secondary outcomes for each group were similar, which included the dose of norepinephrine when corticosteroids were initiated in the hydrocortisone plus fludrocortisone group compared to hydrocortisone alone (0.2 vs 0.3 mcg/kg/min, P=0.34), number of vasopressors (2 vs 2 vasopressors, P=0.38), mechanical ventilation (63.9% vs 78.6%, P=0.09), duration of mechanical ventilation (4 vs 3 days, P=0.76), recurrence of shock (15.7% vs 15.7%, P=1.0), in hospital mortality (34.3 vs 37.1%, P=0.72), time to ICU discharge (6 vs 6 days, P=0.19), and time to hospital discharge (11 vs 10 days, P=0.55). The safety outcomes were also similar among both groups, which included new onset infections in the hydrocortisone plus fludrocortisone group compared to hydrocortisone alone (5.7% vs 5.7%, P=1.0), median number of days with BG>180 g/dL (1.5 vs 2 days, P=0.14), and median number of days with sodium out of normal range (1 vs 1 day, P=0.65).

Conclusion
Among critically ill patients with septic shock, the number of vasopressor free days did not significantly differ between the hydrocortisone plus fludrocortisone and hydrocortisone monotherapy groups. However, the days of vasopressor use was higher in the group containing fludrocortisone.

Moderators

Nathan Wayne

Cardiology Clinical Pharmacist, PGY1 RPC, Wellstar MCG Health

Presenters

MATTHEW Huebner

PGY1 Pharmacy Resident, AdventHealth

I am Matt Huebner, a PGY1 Pharmacy Resident at AdventHealth Winter Park in Winter Park, Florida. I received my bachelors and PharmD degree from Philadelphia College of Pharmacy in Pennsylvania. Currently, I am planning to become a clinical pharmacist in the Orlando area with an interest... Read More →

Evaluators

Nieka Jackson

Pain Clinical Pharmacist Practitioner (Facility PMOP Coordinator)

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Olympia 1

Critical Care/Emergency Medicine (CCM), AdventHealth Winter Park

global Y

3:10pm EDT

Antimicrobial Prescribing Practices for Community-Acquired Pneumonia in a Community, Teaching Health System

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena G

Title: Antimicrobial Prescribing Practices for Community-Acquired Pneumonia (CAP) in a Community, Teaching Health System
Authors: Anna Collins, Chris Whitman, Rachel L. Foster, Jeff Bruni, Cherie Abernathy
Background: Community-acquired pneumonia (CAP) is a major U.S. health concern, particularly in adults aged 65 years and older. Many antibiotic prescriptions may deviate from guidelines, with frequent overuse of broad-spectrum antibiotics, failure to de-escalate therapy, and prolonged durations of therapy. This project aims to evaluate prescribing patterns for the treatment of community-acquired pneumonia (CAP) within Infirmary Health (IH). Antibiotic selection and treatment durations were compared to current national guideline recommendations to determine guideline concordance and appropriateness of current inpatient CAP treatment within IH. These findings will support data-driven antimicrobial stewardship efforts by identifying specific areas for improvement in prescribing practices to enhance patient care and reduce antimicrobial resistance within the community.
Methods: This study is a retrospective chart review of adult inpatients who were diagnosed with and treated for CAP within IH in 2024. International Classification of Diseases (ICD-10) codes and Diagnosis Related Groups for CAP were used to obtain patients. Patients were then randomized and 270 patients were reviewed. The first admission in 2024 was included per patient. The primary outcome was to determine the prevalence of Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) guideline-concordant CAP treatment according to disease severity and risk factors. The primary outcome was assessed at three different timepoints: day one of CAP therapy, day two of CAP therapy, and the last day of inpatient CAP therapy. Secondary outcomes included comparing baseline characteristics, length of stay, 30-day readmission, and 30-day all-cause mortality between patients treated according to IDSA/ATS guidelines and those that were not. Patients were excluded if they received less than 72 hours of antibiotics for CAP treatment, had a concurrent infection requiring a longer length of therapy or alternative drug selection, any hospital-acquired or ventilator-associated pneumonia, had a diagnosis of cystic fibrosis or other advanced structural lung disease, had conditions predisposing to noncommunity-acquired pathogens, patients who left against medical advice, expired, or transitioned to hospice during the CAP treatment course, history of lung transplant, pregnant or breastfeeding, incarcerated, those transferring from an outside hospital, and patients with a pneumonia-related complication.
Results: There were 2,576 unique patients identified. Of these, 270 charts were reviewed and 130 patients were included in the final analysis. The median age was 71 and 68 years in the guideline concordant and discordant groups, respectively, and baseline characteristics were similar between the two groups. Recent healthcare exposure in the prior 90 days was more common among patients receiving guideline-discordant therapy: 19% had received intravenous (IV) antibiotics compared with 2% in the guideline-concordant group, and 29% had a hospital admission compared with 9%, respectively. Overall, 64% of patients received guideline discordant therapy. Rates of guideline discordance were similar across the three timepoints assessed. Notably, 36% of patients received empiric MRSA or Pseudomonas therapy when it was not indicated. The antibiotic lengths of therapy were 8 and 9 days in the guideline concordant and discordant groups, respectively. There were no significant differences in length of stay, 30-day readmission, or 30-day mortality between the two groups.
Conclusions: The majority of patients in this population received guideline discordant therapy for the treatment of CAP, with trends toward overly broad antibiotic selection and longer than recommended durations of therapy. Patients receiving guideline discordant therapy were more likely to have an admission and receipt of IV antibiotics in the prior 90 days. These findings highlight an opportunity to optimize antibiotic selection and duration of therapy for CAP treatment within Infirmary Health.

Moderators

Leigh Joyner

Clinical Pharmacist, Tandem Health

Presenters

Anna Collins

PGY1 Resident, Mobile Infirmary

Anna is a PGY1 resident at Mobile Infirmary in Mobile, Alabama. She is originally from Hurley, Mississippi and received her Doctor of Pharmacy from the University of Mississippi.

Evaluators

Kristina Evans

PGY2 Internal Medicine Residency Program Coordinator, Grady Health System

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena G

Infectious Disease (ID), Mobile Infirmary Medical Center

global Y

3:10pm EDT

Treatment of Staphylococcus Aureus Bacteremia and the Impact of Infectious Disease Consultation

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena H

Title:
Treatment of Staphylococcus Aureus Bacteremia and the Impact of Infectious Disease Consultation

Authors:
Westley Eccles, Stephen Eure, Doug Carroll

Practice Site:
DCH Regional Medical Center-Tuscloosa, AL

Background: Staphylococcus aureus (S. aureus) remains a highly virulent pathogen causing infections worldwide. The pathogen frequently invades into the bloodstream to cause S. aureus bacteremia, which currently has an in-hospital mortality range of 10% to 30%. The Infectious Diseases Society of America (IDSA) guidelines on methicillin-resistant S. aureus (MRSA) remain an important backbone on proper management of S. aureus bacteremia. The IDSA guidelines outline antibiotic selection, classification, and duration of therapy, as well as recommended additional tests to manage the infection. These guidelines are still commonly followed to this date, with some notable differences in current best practice. It is highly important that patients receive optimal antibiotics and proper duration of antibiotic treatment to improve outcomes and reduce mortality. Other research projects have been conducted to compare patient outcomes when an infectious diseases (ID) specialist is directly involved in the management of S. aureus bacteremia. These studies suggest an improvement in both guideline-adherent management of the infection and a reduction in patient mortality. This project aims to assess the overall performance in managing S. aureus bacteremia in our facility, with a comparison between two groups (ID consultation versus no ID consultation).

Methodology: This study was a retrospective chart review of patients ≥18 years of age with positive blood cultures for either methicillin-sensitive S. aureus (MSSA) or MRSA between January 2024 to June 2025. A total of 140 patients were identified within our time period and screened for inclusion. After a chart review to confirm eligibility, 99 patients were included in the project. These patients were divided based on presence of ID consultation, where 42 patients received an ID consult and 57 patients did not receive an ID consult. Individual elements of performance (i.e., antibiotic selection, repeat blood cultures, echocardiography, and duration of therapy) were created to assess patient care based on the standard set by current practice and guidelines. Outcomes were compared between patients who had ID specialist consultation to those without ID specialist consultation. The primary outcome was a composite of all elements of performance, where compliance with all elements of performance was required to meet the primary outcome. Additional secondary outcomes included each individual element of performance, inpatient mortality, average duration of therapy, and hospital readmissions within 30 days, due to infectious process.

Results: Thirty-two (76%) patients with ID consult met the primary outcome compared to twenty-two (39%) patients without ID consult. Secondary outcomes included each individual element of performance alone. For ID consult, each individual element of performance was met as follows: thirty-five (83%) patients for antibiotic selection; Forty-one (98%) for repeat blood cultures; Forty-one (98%) for echocardiography; thirty-eight (91%) for guideline-compliant therapy. For no ID consultation, each individual element of performance was met as follows: forty-two (74%) patients for antibiotic selection; forty-nine (86%) for repeat blood cultures; Forty-four (77%) for echocardiography; thirty-four (60%) for guideline-compliant therapy. Ultimately, there was greater adherence to all elements of performance in the group of patients that had an ID specialist onboard in their care.

Conclusions: Adherence to current guidelines and best practice was more commonly seen in patients with an ID specialist onboard. Overall, ID specialist involvement improved the appropriate management of patients diagnosed with S. aureus bacteremia.

Moderators

Kellie Ball

PGY2 Ambulatory Care Coordinator, University of Tennessee Medical Center

Presenters

Westley Eccles

PGY1 Pharmacy Resident, DCH Regional Medical Center

Hello, my name is Westley Eccles, Pharm.D. I am currently a PGY1 pharmacy resident at DCH Regional Medical Center. I attended the Harrison College of Pharmacy located at Auburn University for my academic pharmacy studies. Following completion of my residency training, I'm planning... Read More →

Evaluators

Kelvin Gandhi

Infectious Diseases Clinical Pharmacist, AdventHealth Daytona Beach

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena H

Infectious Disease (ID), DCH Regional Medical Center

3:10pm EDT

Characterization of Extravasation Events in Brain and Spinal Cord Injury Rehabilitation Patients

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena J

Title: Characterization of Extravasation Events in Brain and Spinal Cord Injury Rehabilitation Patients

Authors: Muhan Wang, Lauren Wilcox, Virginia Montgomery

Background: Extravasation injuries are a significant source of treatment-related harm in hospitalized patients, with reported incidences of non-vesicant extravasation ranging from 0.1% to 6% in adult patients. Extravasation events can result in tissue injury, necrosis, and increased healthcare costs if not promptly recognized and managed. In the acute rehabilitation setting, caring for patients with acquired brain injury (ABI) and spinal cord injuries (SCI), identification of extravasation is particularly challenging. Impaired sensation, altered cognition and communication barriers can limit patients’ ability to perceive or report symptoms associated with infiltration and extravasation, leading to delayed recognition and more severe injury. Additionally, variability in documentation and management, including the use of non-pharmacologic interventions such as warm or cold compresses, can contribute to inconsistent care. This study evaluates current practices in the management and documentation of extravasation and infiltration events and to identify opportunities for standardization and process improvement to enhance patient safety.

Methods: This retrospective, single-center cohort study included ABI and SCI rehabilitation inpatients admitted between July 1st, 2019, and July 31st, 2025. Adult patients (≥18 years) with peripheral intravenous lines (IV) who had documented extravasation or infiltration events within the institution or received phentolamine injection, terbutaline injection, or topical nitroglycerin 2% for extravasation or infiltration were included. Patients with central lines only or no IV access were excluded. Baseline characteristics were collected via EPIC electronic medical records. The primary outcome was to describe cases of extravasation. Secondary outcomes included identification of patient and treatment-related factors potentially contributing to extravasation risk.

Results: A total of 43 documented events were identified among 33 patients. After excluding two patients due to one central line associated event and one event occurring outside the institution, 31 patients with 40 documented events were included in the final analysis. Among these patients, 16 had ABI, nine had SCI, and six had dual ABI and SCI. The study population was majority male (n=27, 87%) with a mean age of 49 years (SD 17). Of the 40 events, 12 (30%) could be attributed to IV medication administration. Medications administered within 24 hours of documented infiltration or extravasation events included anti-infectives (n=4), multiple medications administered during the same period (n=3), IV fluids (n=2), dopamine (n=2), or dexamethasone (n=1). No pharmacologic antidotes were administered in any documented extravasation cases. The majority of events (n=28, 70%) were not associated with medication administration reflecting line occlusion rather than extravasation or infiltration. Documentation review identified one instance of warm compress recorded as an intervention for line occlusion.

Conclusion/Discussion: The results demonstrate most documented events were likely not true extravasations associated with medications, and no cases required pharmacologic antidote use. One of the limitations of the study is inconsistency in documentation. Discussions with nursing staff suggested documentation of infiltration or extravasation may represent an occluded IV line rather than medication leakage, contributing to misclassification. The development of a standardized order set presents an opportunity to further align documentation and management efforts. These findings highlight the important role of physical assessments, informed staff, and accurate and detailed documentation with appropriate details in identifying infiltration and extravasation events in a high-risk neurorehabilitation population. The findings offer a strong foundation for quality improvement focused on improving documentation accuracy, streamlining management approaches, and strengthening education. Collaborative education and the use of standardized tools may promote consistency and support patient safety within the rehabilitation setting.

Moderators

Kelley Norris

Presenters

Muhan Wang

Evaluators

Ketrin Mount

PGY1 Pharmacy Residency Program Director, James H. Quillen VA Medical Center

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena J

Internal Medicine (IM), Shepherd Center

3:10pm EDT

Evaluating the Impact of Empiric Anti-MRSA Therapy on Length of Stay in Patients Hospitalized with Community-Acquired Pneumonia - Jessica Giraldo

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena C

Title: Evaluating the Impact of Empiric Anti-MRSA Therapy on Length of Stay in Patients Hospitalized with Community-Acquired Pneumonia
Authors: Jessica Giraldo, Dina Kheir, Timmy Do
Institution: AdventHealth Central Florida Division (AH-CFD)

Background
Community-acquired pneumonia (CAP) remains one of the leading causes of hospitalization in the United States, contributing to morbidity, mortality, and healthcare costs. The 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines recommend reserving empiric anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy for patients with validated risk factors. Despite these recommendations, anti-MRSA agents are frequently initiated empirically in patients without validated risk factors. Prior studies evaluating empiric anti-MRSA therapy in CAP have primarily focused on clinical outcomes such as 30-day mortality. These studies also reported increased rates of acute kidney injury (AKI), Clostridioides difficile infection (CDI), and prolonged hospitalization with anti-MRSA therapy. This study evaluated whether empiric anti-MRSA therapy impacts hospital length of stay (LOS) among adults hospitalized with CAP in a large, multi-hospital health system.

Methods
This retrospective observational cohort study included adults ≥18 years admitted with a diagnosis of CAP across AdventHealth Central Florida Division (AH-CFD) hospitals between January 1, 2023 and December 31, 2024. Exclusion criteria included documented MRSA risk factors, severe immunocompromise (absolute neutrophil count <500 cells/mm³, CD4 <200 cells/mm³, or recent transplant), or ICU admission at presentation. The primary outcome was hospital LOS and secondary outcomes included 30-day all-cause mortality, 30-day hospital readmission, antibiotic-associated adverse events (e.g. AKI and CDI), and time to clinical stability.

Results
A total of 178 patients met inclusion criteria, including 92 patients who received empiric anti-MRSA therapy and 86 who received standard CAP therapy. Median hospital LOS was 3.15 days (IQR 2.16–4.81) in the anti-MRSA group compared with 2.79 days (IQR 1.79–4.20) in the standard-therapy group, with no statistically significant difference (p = 0.091).

Thirty-day all-cause mortality occurred more frequently in patients receiving empiric anti-MRSA therapy compared with standard therapy (4.35% vs 2.33%; RR 1.87, 95% CI 0.35–9.95; p = 0.68). Thirty-day readmission occurred significantly more frequently among patients receiving empiric anti-MRSA therapy (15.22% vs 3.49%; RR 4.36, 95% CI 1.30–14.66; p < 0.001). Antibiotic-associated adverse events were also more common in the anti-MRSA group (5.43% vs 0%; RR 10.29, 95% CI 0.58–183.37; p = 0.06). CDI occurred in more patients of the anti-MRSA group when compared to standard-therapy patients (1.09% vs 0%; RR 2.81, 95% CI 0.12–67.98; p = 1.00). Time to clinical stability was assessable in 40 patients in each treatment group. Median time to clinical stability was 2 days (IQR 2–3; p = 0.67) in both the anti-MRSA and standard therapy groups.

Conclusions
Empiric anti-MRSA therapy in adults hospitalized with CAP was not associated with shorter LOS, faster clinical stability, or improved mortality. While 30-day readmission occurred significantly more frequently among patients receiving empiric anti-MRSA therapy, antibiotic-associated adverse events, AKI, and CDI were numerically higher but did not reach statistical significance. These findings support guideline recommendations to reserve anti-MRSA therapy for patients with validated risk factors and highlight opportunities for antimicrobial stewardship interventions to reduce unnecessary antibiotic exposure and improve patient safety.

Contact Information: [email protected]

Moderators

Alexis Pruitt

Presenters

Jessica Giraldo

PGY1 Pharmacy Resident, AdventHealth East Orlando

Jessica Giraldo, PharmD, is a PGY-1 Pharmacy Resident at AdventHealth East Orlando. She earned her Doctor of Pharmacy degree from Lake Erie College of Osteopathic Medicine (LECOM) and plans to work as a clinical pharmacist after completing her residency.

Evaluators

Kayla Brown

PGY-1 Residency Program Director, East Alabama Medical Center

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena C

Internal Medicine (IM), AdventHealth East Orlando

global Y

3:10pm EDT

Evaluation of Discharge Medication Prescribing for Patients with Heart Failure Before and After Pharmacist Involvement 

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Parthenon 2

TITLE: Evaluation of Discharge Medication Prescribing for Patients with Heart Failure Before and After Pharmacist Involvement 
AUTHORS: Uyen Nguyen, Amanda Herndon, and Christine Wong
BACKGROUND: Heart failure (HF) is a leading cause of hospital admissions and readmissions in the United States. The 2022 ACC/AHA/HFSA guidelines recommend that eligible patients with heart failure be discharged on compare guideline-directed medical therapy (GDMT) to reduce morbidity, mortality, and rehospitalization. Despite strong evidence supporting GDMT, many patients are not discharged on all recommended therapies due to system-level gaps, and unaddressed patient-specific barriers. Meta-analysis and observational studies have shown that patients who have medications reviewed by pharmacists prior to discharge are more likely to be discharged on appropriate GDMT. This study aims to assess the effect of pharmacist involvement on adherence to heart failure GDMT prescribing at discharge in a community teaching hospital.

METHODOLOGY: This single-center, comparative study received Institutional Review Board exemption. Retrospective chart review was conducted to compare GDMT prescribing at discharge for all patients with HF before and after pharmacist involvement. During the intervention period, pharmacists received education on assessing HF GDMT eligibility, identifying opportunities for initiation, and ensuring appropriate documentation of contraindications. Providers also received education on potential GDMT initiation, appropriate documentation, medication contraindications, and cost considerations.
Pharmacists reviewed medications and provided recommendations to optimize GDMT for all HF patients prior to discharge. All pharmacist interventions and documentation of contraindications were recorded. Patients who were at least 18 years of age and had a diagnosis of HF were included in the results. Patients who expired or enrolled in hospice or comfort care at any time during the study were excluded. Enrollment of 80 patients in both pre-intervention and post-intervention groups would provide 80% power to detect a 20% difference in the composite GDMT prescribing, with a significant p-value of 0.05.
The primary outcome was the percentage of patients with HF discharged on appropriate composite GDMT. Composite GDMT was defined as adherence to angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNi), mineralocorticoid receptor antagonists (MRA), and evidence-based beta-blockers (BB) for patients with heart failure with reduced ejection fraction (HFrEF) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) for all patients with heart failure. Secondary outcomes included the percentage of patients prescribed each individual component of GDMT at discharge, including ACEi/ARB/ARNi, BB, MRA, and SGLT2i, when indicated. Adherence was defined as recommended therapy prescribed at discharge or documented contraindications to any component of GDMT.

RESULTS: The primary outcome of composite GDMT before and after pharmacist involvement increased from 40% in the pre-intervention group to 77.5% in the post-intervention group, n= 80 in each group, p-value <0.001. Secondary outcomes showed an increase in each individual component of GDMT. Among patients with HFrEF, n = 31 in each group, prescribing rates in the post-intervention group compared to the pre-intervention group group increased as follow: ACEi/ARB ARNi from 35% to 74%, p 0.002, BB increased from 74% to 100%, p=0.003, MRA increased from 47.5% to 87%, p=0.002. Prescribing of SGLT2i for all HF patients increased from 47.5% to 78%, p<0.001.

CONCLUSIONS: Baseline findings showed significant gaps in the prescribing of GDMT or appropriate documentation of contraindications for patients with heart failure at hospital discharge, particularly with ACEi/ARB/ARNi, MRA, and SGLT2i. Improvements following pharmacist involvement suggest that targeted education, medication review, and real-time recommendations at discharge can increase adherence to evidence-based therapies. The findings highlight the benefit of pharmacist involvement to optimize GDMT, address barriers to prescribing, and improve documentation of contraindications.

Moderators

Lucy Crosby

Medication Policy and Compliance Pharmacist, AUMC2Augusta University Medical Center/University of Georgia College of Pharmacy PGY1

Presenters

Uyen Nguyen

Evaluators

Sarah Frye

PGY2 Critical Care Residency Program Director, Spartanburg Medical Center (Critical Care)PGY2

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Parthenon 2

Internal Medicine (IM), AdventHealth Redmond

3:10pm EDT

Evaluation of Antibiotic Use in Culture-Negative Early-Onset Sepsis in Neonates within a Community Health System

Thursday April 30, 2026 3:10pm - 3:30pm EDT

Athena A

Background/Purpose: Early-onset sepsis (EOS) is a systemic infection occurring within the first week of life and remains a major contributor to neonatal morbidity and mortality. Clinical manifestations of EOS are often nonspecific. Empiric broad‑spectrum antibiotics are frequently initiated in suspected infection based on maternal or neonatal risk factors. Literature supports discontinuation of empiric antibiotic therapy if blood cultures remain negative at 36 – 48 hours. Despite support for discontinuation, providers often continue antibiotics due to concerns of missed infection or presumed clinical improvement due to initiation of therapy. Prolonged antibiotic exposure in neonates is associated with adverse outcomes including disruption of gut microbiome, necrotizing enterocolitis, and development of antimicrobial resistance. This study aimed to evaluate the prevalence of prolonged empiric antibiotic therapy for culture‑negative EOS.

Methodology: This was a multi-centered, retrospective chart review which evaluate neonates delivered within the Northeast Georgia Health System and admitted to the NICU between January 1, 2023, and December 31, 2024. Patients were included if blood cultures were obtained within the first 72 hours of life, and at least one dose of ampicillin plus gentamicin was administered. Patients with positive blood cultures within the first 72 hours were excluded, as well as any patient that was discharged and readmitted within the first 72 hours of life. The primary objective was to evaluate the prevalence of prolonged empiric antibiotic therapy (> 48 hours) despite negative cultures. The secondary objective was to evaluate the prevalence of treatment failure, defined as discontinuation and reinitiation of any antibiotic within the first 14 days of life.

Results: A total of 125 neonates met inclusion criteria. Of these, 94 neonates (75%) received standard empiric therapy, and 31 neonates (25%) received prolonged empiric therapy despite negative blood cultures. Baseline characteristics were similar between groups, with no statistically significant differences observed for gestational age, birth weight, gender, or mode of delivery. The mean total days antibiotic exposure was 3 days in the standard group compared to 7 days in the prolonged group (P < 0.001). Treatment failure occurred in 9 of 94 neonates (10%) in the standard group and 3 of 31 neonates (10%) in the prolonged group, with no significant difference between groups (P = 0.613).

Conclusions: Of the 125 neonates included in this retrospective chart review, (25%) received empiric antibiotics beyond the consensus recommended 36 to 48 hour rule‑out period despite negative cultures. Prolonged empiric therapy did not reduce treatment failure when compared to the standard group. There was a clinically significant increase in antibiotic exposure in the prolonged group. Further studies are needed to evaluate the long-term effects of empiric treatment for early onset sepsis. These findings also highlight opportunities for antimicrobial stewardship initiatives aimed at reinforcing evidence-based, consensus recommended use of empiric antibiotics.

Moderators

John Puryear

Presenters

Bayley George

PGY1 Pharmacy Resident, Northeast Georgia Medical Center

Bayley George is a PGY1 Pharmacy Resident at Northeast Georgia Medical Center - in Gainesville. He received his PharmD from South College School of Pharmacy - in Knoxville, Tennessee.

Evaluators

Katherine Fuller

Clinical Pharmacy Specialist --Hepatology

Thursday April 30, 2026 3:10pm - 3:30pm EDT
Athena A

Pediatric (PED), Northeast Georgia Medical Center

global Y

3:40pm EDT

Assessing the Implementation of a Community Health Worker Program at a Community Clinic

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena B

Title: Assessing the Implementation of a Community Health Worker Program at a Community Clinic

Authors: Ryan Grady, Pharm.D., Courtney E. Gamston, Pharm.D., Linda Gibson-Young, Ph.D., FNP-C, RHN-C, MBA, FAANP, Amy Pridemore BSN, MA, MSN, DNP, FNP-C, David Redden, Ph.D., Kimberly Braxton Lloyd, Pharm.D.

Background:
Community Health Workers (CHWs) serve as bridges between healthcare systems and underserved populations, helping connect individuals to preventive services, chronic disease management, and social resources. Underserved communities face barriers to healthcare access, continuity of care, and clinic-based services. To address this, a newly initiated (2022) primary care and women’s health clinic with dispensing pharmacy implemented a CHW program designed to extend the reach of clinical services through interacting with the community and providing education and referrals. Evaluating the implementation of this initiative is important for determining its potential to enhance community engagement and inform future expansion.

Methods:
This project uses the RE-AIM framework to evaluate Reach, the extent to which the program engaged the community, and Effectiveness, evaluating how well the CHW were able to engage the local community. Data was collected from CHW field notes and clinic documentation. Community-based activity data included date, time, location, nature of touchpoint, number of interactions, types of interactions, educational or referral interventions, and challenges encountered. Clinic-level activities included the number of CHW-generated referral appointments, total clinic visits before and after CHWs implementation, and the number and proportion of clinic events scheduled and/or staffed by the CHWs. Descriptive analyses were used to summarize program activities and assess feasibility and effectiveness.

Results:
In Progress

Conclusions:
In Progress

Moderators

Lauren Lyons

Clinical Pharmacist - Advanced Heart Health Center, Prisma Health

Presenters

Ryan Grady

Ryan Grady, Pharm.D., is currently a PGY1 Pharmacy Resident at Auburn University Clinical Health Services. He earned his Bachelor of Science in Biology in 2020 from the University of Georgia, followed by his Doctor of Pharmacy degree in 2025 from the University of Georgia College of Pharmacy. During pharmacy... Read More →

Evaluators

Laurie Leith

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena B

Ambulatory Care (AMB), Auburn University Clinical Health Services

global Y

3:40pm EDT

Utilization of Pharmacogenomic Testing Among Veterans Receiving Fluoropyrimidine- or Irinotecan-Based Chemotherapy within the Salisbury VA Health Care System

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Parthenon 1

Background:
Fluoropyrimidines (5-fluorouracil and capecitabine) and irinotecan are chemotherapy agents commonly used to treat upper and lower gastrointestinal malignancies, and various other solid tumors. These medications have important pharmacogenomic (PGx) considerations involving the dihydropyrimidine dehydrogenase (DPYD) and uridine diphosphate-glucuronosyltransferase 1A1 (UGT1A1) genes. Variants in these genes can impair drug metabolism and increase the risk of severe hematologic and gastrointestinal toxicity. Between 2024 and 2025, revisions to medication labeling and National Comprehensive Cancer Network (NCCN) guidelines-initiated support for preemptive DPYD testing. While PGx testing is available within the Salisbury VA Health Care System (SVAHCS), the extent to which it is utilized in oncology practice remains unclear. This quality improvement project evaluated the utilization of multi-gene PGx testing among Veterans receiving fluoropyrimidine- or irinotecan-based chemotherapy within the SVAHCS.

Methods:
This IRB-exempt, retrospective, quality improvement project evaluated Veterans initiating fluoropyrimidine (5-fluorouracil or capecitabine) or irinotecan-based chemotherapy across three oncology sites within the SVAHCS between November 1, 2024, and November 30, 2025. Eligible patients were identified using Computerized Patient Record System (CPRS) chemotherapy orders. Patients receiving oncology care exclusively outside the VA system or receiving topical fluorouracil were excluded. A retrospective chart review was performed. REDCap database software was utilized to collect patient demographics, cancer type, chemotherapy regimen, and relevant PGx testing information. For patients who underwent testing, PGx phenotypes, PGx-guided therapy modifications, and testing turnaround times were evaluated. Reasons for omission of PGx testing were also recorded when available.

Results:
A total of 70 Veterans receiving fluoropyrimidine- or irinotecan-based chemotherapy were identified. 40 Veterans were included in the analysis. The mean patient age was 66.35 years, and the cohort was predominantly male (95%). The most common malignancies were colon cancer (52.5%) and pancreatic cancer (22.5%). PGx testing was ordered in 25 patients (62.5%). Documented rationale for not obtaining PGx testing included: prior tolerance of therapy, prior PGx results on file, needing to rapidly initiate chemotherapy, and awaiting eligibility for an investigational treatment. Of the 15 patients for whom PGx testing was not obtained there was no documented reason for the lack of testing in 7 patients (46.7%). Among patients with PGx results, DPYD phenotypes were normal in 96% (n=24), and intermediate in 4% (n=1). UGT1A1 phenotypes were normal in 72% (n=18), intermediate in 16% (n=4), and poor in 12% (n=3). PGx-guided irinotecan dose reductions were documented in all patients that were poor UGT1A1 metabolizers and receiving irinotecan (n=2). Median turnaround time from PGx order to vendor report was 12 days (IQR: 9-13), and the median time from vendor report to CPRS result posting was 6 days (IQR: 3-9).

Conclusions:
Multi-gene (PGx) testing for DPYD and UGT1A1 genes increased following updated guidance in October 2025, however, it was not consistently utilized during the review period. Over one-third of the review population did not undergo testing, with most lacking documented rationale for omission. The lack of definitive guidance before updates to the VA clinical oncology pathways may have contributed to the limited use of PGx testing among these Veterans. Among those tested, actionable UGT1A1 results led to irinotecan starting dose reductions, demonstrating potential clinical impact. Standardized, preemptive testing workflows represent an opportunity to improve uptake and optimize the safety of chemotherapy within the Veteran population.

Moderators

Rion Poland

Presenters

Ryan Osteen

PGY1 Pharmacy Resident, Salisbury Veterans Affairs Health Care System

I am a PGY1 Pharmacy Resident at the Salisbury Veterans Affairs Healthcare System. I earned my Doctor of Pharmacy degree from Wingate University's School of Pharmacy Hendersonville campus in Hendersonville, North Carolina. My current practice interests include primary care, and geriatrics... Read More →

Evaluators

Sophea Chan

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Parthenon 1

Ambulatory Care (AMB), VA â€“ Salisbury, NC â€“ Salisbury VA Health Care System

3:40pm EDT

 Impact of Preconception GLP-1RA and Dual GIP/GLP-1RA Use on Insulin Requirements During Pregnancy in Patients with Type 2 Diabetes 

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena I

Impact of Preconception GLP-1RA and Dual GIP/GLP-1RA Use on Insulin Requirements During Pregnancy in Patients with Type 2 Diabetes
Authors: Kiera Rountree, Jessica Odom, Autumn Clemins, and Megan Schellinger
Practice Site: Prisma Health-Upstate

Background
Pregestational diabetes affect approximately 1–2% of pregnancies and is associated with increased maternal and neonatal morbidity. Achieving tight glycemic goals before and throughout pregnancy is essential to reduce the risk of congenital anomalies, abnormal fetal growth, hypertensive disorders, and delivery complications. Insulin requirements fluctuate during pregnancy due to physiologic changes in insulin sensitivity, with progressive insulin resistance typically emerging in the second and third trimesters. Insulin is the preferred treatment for diabetes in pregnancy; however, glucagon-like peptide-1 receptor agonists (GLP-1RA) and dual glucose-dependent insulinotropic polypeptide/GLP-1RA (GIP/GLP-1RA) are increasingly used in women of reproductive age for type 2 diabetes and obesity. Current guidelines recommend discontinuation of these agents prior to conception due to limited safety data, yet optimal timing of discontinuation remains unclear. Discontinuation may precipitate hyperglycemia requiring insulin initiation or escalation, and many pregnancies are unplanned, resulting in inadvertent early exposure. Data evaluating the impact of preconception GLP-1–based therapy on insulin requirements during pregnancy are lacking. This study aims to evaluate whether preconception exposure to GLP-1RA or dual GIP/GLP-1RA affects insulin requirements during pregnancy in patients with preexisting type 2 diabetes.

Methods
This single-center, observational, retrospective cohort study included pregnant patients with preexisting type 2 diabetes enrolled in the Management of Maternal Diabetes (MOMs) program at Prisma Health Upstate between June 2023 and March 2025. Eligible patients were ≥18 years old with singleton pregnancies and documented GLP-1RA or dual GIP/GLP-1RA use within 60 days prior to conception, discontinued before or during early pregnancy. A comparator group without GLP-1–based therapy exposure was identified. Patients with gestational or type 1 diabetes, multiple gestations, insulin pump use, or incomplete insulin data were excluded. The primary outcome was the change in total daily insulin dose (units/kg/day) from baseline intake visit to the third trimester visit closest to delivery. Secondary outcomes included change in hemoglobin A1c, weight change, initiation and use of continuous glucose monitor (CGM), and maternal and neonatal outcomes. Data was collected through manual chart review, existing REDCap registry of MOMS participants, and pharmacy dispensing records. Statistical analyses were conducted with support from a statistician.

Results
64 pregnant patients with type 2 diabetes were included; 13 (20.3%) had preconception GLP-1 receptor agonist exposure. Mean age (31.6 ± 6.2 years) and baseline BMI (37.4 ± 8.3 kg/m²) were similar between groups. Patients with preconception GLP-1 use were more likely to have hypertension (69.2% vs 31.4%, p=0.02) and obesity (76.9% vs 35.3%, p=0.01). Median total daily insulin dose increased from baseline to the third trimester from 0.3 (0.3–0.7) to 1.1 (0.8–1.5) units/kg/day. Patients with preconception GLP-1 exposure had higher insulin requirements at baseline (0.7 vs 0.3 units/kg/day, p=0.04) and in the third trimester (1.35 vs 1.0 units/kg/day, p=0.05). Hemoglobin A1c improved during pregnancy from 8.6 ± 2.0% to 6.4 ± 0.8%, with no differences between groups. A trend toward greater weight gain was observed in the preconception GLP-1 group (median 10 vs. 6 kg, p = 0.07), though not statistically significant. CGM use increased during pregnancy, with 43.8% of patients initiating CGM, and did not differ by exposure group. Maternal and neonatal outcomes were similar between groups; however, postpartum hemorrhage (15.4% vs 0%, p=0.04) and other major maternal complications (15.4% vs 0%, p=0.04) occurred more frequently in the preconception GLP-1 group. Neonatal complications were not significantly different.

Conclusion
Preconception GLP-1-RA or dual GIP/GLP-1RA use was associated with higher insulin requirements throughout pregnancy, suggesting greater baseline insulin resistance. Glycemic targets and maternal and neonatal outcomes were similar, though greater weight gain was observed. These findings support early anticipation of increased insulin requirements, with proactive monitoring and timely dose titration to maintain glycemic targets.

Contact: [email protected]

Moderators

Kendall Huntt

PGY1 Residency Program Coordinator, Emory University Hospital

Presenters

Kiera Rountree

PGY1 Ambulatory Care Pharmacy Resident, Prisma Health - Upstate

Kiera Rountree, a native of Portsmouth, Virginia, who earned her Bachelor of Science in Biology with a pre-medical concentration from Hampton University. She went on to obtain a dual degree from High Point University, receiving both her Doctor of Pharmacy (Pharm.D.) and a Master of... Read More →

Evaluators

Kendra Brookshire

Associate Chief, Outpatient Clinical Pharmacy Services, Birmingham VA Healthcare System

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena I

Ambulatory Care (AMB), Prisma Health-Upstate

global Y

3:40pm EDT

Comparison of Dexamethasone versus Methylprednisolone in Acute Respiratory Distress Syndrome (ARDS) - Kayla Phillips

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena D

Comparison of Dexamethasone versus Methylprednisolone in Acute Respiratory Distress Syndrome (ARDS)
Authors: Kayla Phillips, PharmD, Lindsey Mclendon PharmD Candidate, Lauren Floris, PharmD, BCPS, BCCCP
Background:
Acute respiratory distress syndrome (ARDS) represents about ten percent of all intensive care unit (ICU) admissions with nearly a fourth of these requiring intubation.1 Early phase ARDS is characterized by alveolar inflammation leading to hypoxemia.3 Steroids can inhibit the progression of this inflammation by decreasing cytokine release and promoting clearance of alveolar edema.2 The Society of Critical Care Medicine (SCCM) consensus update in 2024 suggests using corticosteroids in all patients with ARDS, regardless of the severity but no drug or dosing regimen was advised over another.4 The purpose of this study is to determine if there is a difference in duration of mechanical ventilation when either dexamethasone or methylprednisolone is used in the management of ARDS.
Methods:
We conducted a single center, retrospective, chart review to evaluate the effects of dexamethasone compared to methylprednisolone in adults ICU patients diagnosed with ARDS. This study included adult patients admitted from January 1, 2021, to August 31, 2025, who were intubated with a diagnosis of ARDS and received either intravenous (IV) dexamethasone or IV methylprednisolone within 72 hours of intubation. Patients who received both dexamethasone and methylprednisolone, diagnosed with COVID-19, history of adrenal insufficiency, prescribed steroids at baseline, or those who only received one dose of IV steroids were excluded from this study. The primary outcome was days alive and ventilator free at 28 days compared between the two steroid groups. Secondary outcomes included duration of mechanical ventilation, duration of steroid use, ICU and hospital length of stay, rate of ICU readmission within 90 days, ARDS severity defined by PaO2/FiO2 ratio, and mortality rate. Safety outcomes recorded are hypernatremia, fluid overload, uncontrolled hyperglycemia requiring insulin, gastrointestinal bleeding, and new infection acquired during admission post-steroid use.
Results:
A total of 45 patients were included (22 dexamethasone, 23 methylprednisolone). Baseline characteristics were similar between groups. There was no significant difference in the primary outcome of days alive and ventilator-free at 28 days between dexamethasone and methylprednisolone, 16 days vs 15.2 days respectively (p= 0.82). Secondary outcomes including ICU readmission within 90 days, did not differ between groups (2/22 vs 0/23, p=0.14). Safety outcomes were comparable with no significant differences in rates of hyponatremia (6/22 vs 7/23, p=0.82) or hyperglycemia requiring insulin (13/22 vs 18/23, p=0.17).
Conclusion:
In this single center retrospective study of patients with ARDS, dexamethasone and methylprednisolone were associated with similar ventilator free days and comparable secondary and safety outcomes. This study was not powered to detect small differences between treatment groups, and larger prospective studies are needed to further evaluate optimal corticosteroid selection.

Moderators

Alison Martin

Presenters

Kayla Phillips

PGY1 Pharmacy Resident, Atrium Health Navicent the Medical Center

Evaluators

Martin Gordon

Clinical Pharmacy Specialist - Critical Care, Spartanburg Medical Center

Martin Gordon, PharmD, BCCCP is the Clinical Pharmacy Specialist for the Medical ICU and Residency Director for the PGY1 Residency Program at Spartanburg Medical Center in Spartanburg, South Carolina.

Martin completed his Doctor of Pharmacy degree from Presbyterian College School of Pharmacy and completed a PGY1 Pharmacy Practice and PGY2 in Critical Care Residency at Spartanburg Medical Center in Spartanburg, SC... Read More →

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena D

Critical Care/Emergency Medicine (CCM), Atrium Health Navicent The Medical Center

global Y

3:40pm EDT

Full-Dose versus Low-Dose Diltiazem Bolus for Management of Atrial Fibrillation with Rapid Ventricular Rate

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena A

Purpose/Background: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Sixty to seventy percent of patients with AF who present to the emergency department (ED) have rapid ventricular response (RVR), a heart rate (HR) greater than 120 beats per minute (bpm) in response to inappropriate ventricular rate control. The 2023 Guideline for the Diagnosis and Management of Atrial Fibrillation recommends that patients with acute AF with RVR without decompensated heart failure receive an intravenous (IV) bolus dose of diltiazem 0.25 mg/kg actual body weight. However, this is not always applied in practice with some prescribers utilizing lower, non-weight-based doses.

Methodology: A retrospective chart review and analysis was conducted to evaluate the efficacy of utilizing the full, guideline and package insert recommended bolus of diltiazem as compared to a low dose bolus for AF with RVR. All patients included in this study were adults admitted to any CaroMont Health ED. Patients were identified by generating a report of those who have been admitted for AF with RVR and received an IV bolus of diltiazem between January 1, 2022 and January 1, 2025. The primary endpoint was the incidence of achieving a HR of less than 100 bpm within 30 minutes of diltiazem bolus administration. Secondary endpoints included incidence of bradycardia, incidence of hypotension, administration of additional rate-controlling medications, length of stay, mortality and readmission after 30 days. Additional information collected included past medical history of AF, heart failure, hypertension, and hyperthyroidism; home antiarrhythmic prescription(s); and primary diagnosis of admission. All categorical endpoints and demographics were evaluated using a chi-square test. Parametric continuous variables utilized t-tests, while nonparametric continuous variables were analyzed using Mann-Whitney U tests. The reliability of data abstracted was validated through a 10 percent medical record review by a co-investigator. An interrater agreement coefficient was reported using a kappa statistic.

Results: In progress

Conclusions: In progress

Moderators

Kristina Nakhla

PGY1 Residency Program Director, Northside Hospital

Presenters

Katherine Pierce

Evaluators

Michael Behal

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), CaroMont Regional Medical Center

global Y

3:40pm EDT

Impact of Variable Rocuronium Dosing for Intubation in the Emergency Department - Dani Anastasovites

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Parthenon 2

Study Objective: To pragmatically assess rocuronium dosing practices for emergency department intubation procedural outcomes and post-intubation sedation practices.
Methods: We conducted a retrospective, single-center, observational study of adult patients who received rocuronium for intubation in the emergency department at an academic medical center between January 1st, 2022, and December 31st, 2024. Rocuronium doses were categorized as less than 0.6 mg/kg (low-dose), 0.6 to 1.2 mg/kg (intermediate-dose), or greater than 1.2 mg/kg (high-dose). Secondary outcomes included reversal agent use, first-pass intubation failure, intubation indication, intubating service, dosing year, and induction agent selection. Subgroup analysis evaluated post-intubation sedation timing and practices among patients who received either intermediate-dose or high-dose. Categorical variables are reported as counts and percentages, and continuous variables are summarized using descriptive statistics.
Results: A total of 237 patients met inclusion criteria. Most patients received doses within 0.6 to 1.2 mg/kg (189 (79.7%)), whereas 18 patients (7.6%) received low-dose and 30 patients (12.7%) received high-dose. First-pass intubation failure was greatest in the intermediate-dose group, occurring in 45 patients (23.8%) versus 3 patients (10%) in the high-dose group. Emergency medicine clinicians performed the majority of intubations (82.3%). The median time to sedation initiation was 5 minutes for the low-dose group, 6 minutes for the intermediate-dose group, and 3 minutes for the high dose group. Fentanyl was administered in 100% of patients in the higher-dose group compared with 83.3%% of patients in the low-dose group and 79.6% in the intermediate-dose group. While propofol was administered in 31% of patients who received higher-doses compared to 33.3 % and 57.5% respectively. Overall, a majority of patients received an infusion (124 (52%)) as the post-intubation sedation method with bolus plus infusion (94 (40%)) being the next most common method.
Conclusion: The majority of patients received doses of rocuronium within the 0.6 to 1.2 mg/kg range, consistent with recommendations in available literature. Lower observed first-pass failure rates among patients receiving lower rocuronium doses, however, the smaller sample sizes in the low and high-dose groups limit the significance of differences in observed event rates. Post-intubation sedation practices varied across dosing groups, particularly with respect to fentanyl and propofol utilization.

Moderators

Sheema Hallaji

PGY1 Residency Director, Cone Health- Alamance Regional Medical Center

Presenters

Dani Anastasovites

Grady Memorial Hospital

Evaluators

Savannah Owen

Assistant Professor of Pharmacy Practice, South College School of Pharmacy

Savannah Owen earned her PharmD from Auburn University Harrison College of Pharmacy. Since graduating, she has completed the PGY-1 community pharmacy residency at South College School of Pharmacy in Knoxville, TN. She also completed an ambulatory care PGY-2 residency with St. Peter... Read More →

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Parthenon 2

Critical Care/Emergency Medicine (CCM), Grady Memorial Hospital

global Y

3:40pm EDT

Steroid Stewardship: Corticosteroids in the Emergency Department for Treatment of Musculoskeletal Pain

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Olympia 2

Abstract:
Background
Musculoskeletal (MSK) pain is a frequent complaint in patients who present to the emergency department (ED) and these patients are often treated with corticosteroids. However, there is mixed and low-level evidence for use of steroids in treatment of MSK pain. The College of Urgent Care Medicine has emphasized steroid stewardship in response to the increasing use of short course steroids in the ED. Steroid stewardship is the systemic effort to prescribe corticosteroids in a rational, evidence-based manner and evaluate the risks associated with short-term use. Steroids with enhanced glucocorticoid selectivity are preferred due to their anti-inflammatory effects but the risks are not benign. Adverse effects such as hyperglycemia, insomnia, dyspepsia, and changes in mood and appetite can occur even with short-term use. Patients at the Ralph H. Johnson V.A. Medical Center (RHJVAMC) may be at higher risk of these adverse reactions based on age, comorbidities and drug-drug interactions with concomitant medications. Little evidence exists to guide use of steroids; therefore careful evaluation of risks and benefits is necessary. This project aims to evaluate the opportunity for steroid stewardship regarding the treatment of MSK pain.
Methods
This retrospective analysis evaluated Veterans at the RHJVAMC that presented to the ED with a chief complaint of MSK pain based on selected ICD-10 codes from May 1st, 2024 to April 30th, 2025. The population was separated into two groups: patients prescribed steroids and patients that did not receive steroids. The electronic medical record (EMR) was utilized to collect data and determine eligibility for chart review. Patients were excluded if they received steroids for an indication other than MSK pain or were prescribed chronic steroids. The primary outcome was return visit rate within 30 days of index visit for the same MSK chief complaint. Steroid prescribing practices and ED interventions were also observed. The secondary outcome was the rate of steroid-related adverse drug reactions (ADRs) within 30 days of index visit in patients who received steroids in the ED or at ED discharge. A generalized estimating equations (GEE) analysis was performed to investigate associated factors that may impact return visit rates and is reported as adjusted odds ratios (aOR) and 95% confidence intervals (95% CI).
Results
Five hundred eighty-eight patients were included in the analysis; 283 patients received steroids and 305 patients did not receive steroids at the initial ED visit for MSK pain. The primary outcome of return visit for the same MSK pain complaint was significantly higher in patients that received steroids compared to the no steroid group (aOR 1.96, 95% CI 1.05-2.63; p = 0.003) within 30 days of initial ED visit. The GEE model confirmed the administration of steroids was independently associated with rate of return. The majority of patients received intramuscular (IM) dexamethasone in the ED (76.2%) and were discharged on prednisone with a mean 6.4 day (SD ± 3.8) duration of therapy. Pain consultations differed between groups (2.7% vs 0.7%, p=0.022), but were overall seldomly utilized in this patient population. Secondary outcomes data identified 8 patients that experienced steroid-related ADRs. Most of these patients received dexamethasone 10mg (IM) (75%) and all were discharged with multimodal pain control including steroid, NSAID, muscle relaxer, and/or topical pain relief.
Conclusion
Patients who received steroids in the emergency department for MSK pain were more likely to return for the same chief complaint within 30 days compared to patients who did not. ED interventions for MSK pain, like specialty pain or physical therapy consultations, were found to be under-utilized and warrant further investigation for impact on return rates. Few steroid-related ADRs were observed in this retrospective analysis.

Moderators

Krista Dumkow

Presenters

Lana Callaghan

Evaluators

Marci Swanson

Clinical Pharmacist Practitioner, Carl Vinson VA Medical Center

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Olympia 2

Critical Care/Emergency Medicine (CCM), VA - Charleston, SC - Ralph H. Johnson Veterans Affairs Medical Center

global Y

3:40pm EDT

A RETROSPECTIVE EVALUATION OF THE IMPACT OF VANCOMYCIN AUC DOSING ON ACUTE KIDNEY INJURY AND DRUG EXPOSURE IN HOSPITALIZED PATIENTS.

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena H

A RETROSPECTIVE EVALUATION OF THE IMPACT OF VANCOMYCIN AUC DOSING ON ACUTE KIDNEY INJURY AND DRUG EXPOSURE IN HOSPITALIZED PATIENTS.
Shemaiah Caine, Deanne Tabb, Tushar Patel, Aayush Patel Piedmont Columbus Regional Midtown Columbus, GA

Background/Purpose: Vancomycin trough-based monitoring is associated with excessive exposure and increased acute kidney injury (AKI). however, trough-based monitoring is associated with excessive drug exposure and increased risk of acute kidney injury (AKI). ASHP/IDSA consensus guidelines recommend AUC guided dosing with a target AUC of 400 - 600 mg·hr/L to improve safety and efficacy. In January 2025, Piedmont Columbus Regional Midtown implemented InsightRX®, a Bayesian dosing platform designed to support individualized AUC guided vancomycin dosing. The purpose of this study is to assess the impact of this transition on AKI incidence and drug exposure.

Methodology: This retrospective single center pre/post cohort study will include adult patients who received ≥ 72 hours of intravenous vancomycin, comparing a trough-based cohort (Oct-Dec 2024) with an AUC guided cohort after InsightRX® implementation (Jun-Aug 2025). Data from Epic and InsightRX® will capture demographics, baseline renal function, vancomycin dosing characteristics, and nephrotoxin exposure. The primary outcome is AKI during therapy or within 48 hours after the last dose, defined per KDIGO criteria. Secondary outcomes include time to target AUC, number of levels drawn, trough distributions, and total vancomycin exposure. Continuous variables will be analysed using a two-sample t-test, and categorical variables using Fisher’s exact test.

Results: For the primary outcome, AKI occurred in approximately 9% of patients in the trough-based group compared with 7% in the AUC-guided group. The p-value of 1.00 suggests there was no statistically significant difference between groups. However, given the small sample size and descriptive design, this analysis was likely underpowered to detect meaningful differences in AKI risk. For secondary outcomes, average vancomycin exposure within the first 72 hours was similar between groups, at approximately 2,300 mg/day in the trough-based cohort and 2,208 mg/day in the AUC-guided cohort, with no statistically significant difference observed, p=0.64. However, a greater proportion of patients in the AUC-guided group achieved target therapeutic exposure within 48 hours compared with the trough-based group, 56% versus 18%, respectively, which was statistically significant with a p-value of 0.005. Within the trough-based cohort, most patients, 68%, had trough concentrations between 11 and 14.9 mcg/mL, while 27% were between 15 and 20 mcg/mL. Only one patient had a trough concentration greater than 20 mcg/mL.

Conclusions: AUC guided vancomycin dosing was associated with a significantly higher rate of early target attainment within 48 hours compared to trough-based dosing. Despite this difference, overall vancomycin exposure within the first 72 hours of therapy was similar between groups, suggesting comparable initial dosing intensity. There was no statistically significant difference in the incidence of acute kidney injury between the two strategies; however, this study was likely underpowered to detect meaningful differences in safety outcomes. Overall, these findings suggest that AUC guided dosing may improve early pharmacokinetic target achievement without increasing nephrotoxicity, though larger studies are needed to further evaluate its impact on renal outcomes.

[email protected]

Moderators

Jenna Jewett

Presenters

Shemaiah Caine

Evaluators

Sarah McDaniel

Antimicrobial Stewardship Coordinator, Baptist Medical Center South

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena H

Infectious Disease (ID), Piedmont Columbus Regional Midtown

global Y

3:40pm EDT

Resident Presentation - Natalie Harris

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Olympia 1

Comparison of cefazolin plus ertapenem to alternative approaches in patients with persistent MSSA bacteremia while on cefazolin
Natalie Harris, PharmD1; Caroline Jozefczyk, PharmD, BCIDP2; Jake Crocker, PharmD, BCIDP2; Sarah Al Mansi, MD1; Brandon Bookstaver, PharmD, BCIDP1,3

Prisma Health Richland Hospital, Columbia, SC
Prisma Health Greenville Memorial Hospital, Greenville, SC
University of South Carolina College of Pharmacy, Columbia, SC

Background: Persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia despite standard cefazolin therapy poses a significant clinical challenge. Historically, salvage approaches have involved anti-staphylococcal penicillins (ASPs), given the growing concern for cefazolin inoculum effect. With ASPs less favorable pharmacokinetic and safety profile, various combination regimens have emerged as potential alternatives. Data directly comparing salvage strategies remains limited. This study compared outcomes of cefazolin plus ertapenem versus alternative salvage therapies in persistent MSSA bacteremia.
Methods: This retrospective cohort study included adults who failed cefazolin and received salvage therapy for persistent MSSA bacteremia from March 1, 2021 to August 31, 2025. Patients were excluded if they transferred from another hospital, had polymicrobial bacteremia, died within 24 hours, or received empiric therapy for > 24 hours after positive blood cultures. The primary objective was to compare the duration of MSSA bacteremia after salvage therapy in patients receiving cefazolin plus ertapenem versus alternative salvage strategies. Secondary objectives included all-cause mortality, infection related re-admission, and adverse effects (ADEs) in both groups.
Results: Fifty-seven patients were included, with 30 in the cefazolin plus ertapenem cohort and 27 in the alternative cohort. The most common source was skin and soft tissue (n=19, 33.3%), and endocarditis was the most common complication (n=17, 29.8%). Most patients in the alternative salvage cohort received nafcillin (n/N=19/30, 70.4%). The average duration of bacteremia after salvage was 1.6 and 2.8 days in the cefazolin plus ertapenem and alternative cohorts, respectively. Patients receiving cefazolin plus ertapenem experienced higher rates of 90-day mortality (23.3% vs 22.2%) and infection-related re-admission (26.7% vs 11.1%), however, patients receiving alternative salvage therapy experienced more ADEs (51.9% vs 36.7%).
Conclusion: Cefazolin plus ertapenem shortened bacteremia duration and led to less ADEs compared with alternative regimens, supporting the use of this combination as a salvage therapy option in persistent MSSA bacteremia.

Moderators

Ryan Tilton

Presenters

Natalie Harris

Natalie Harris, PharmD, BCIDP
I am a PGY-3 Clinical Infectious Diseases Pharmacy Fellow at Prisma Health Richland. I completed pharmacy school at the University of South Carolina, and both a PGY-1 pharmacy residency and a PGY-2 Infectious Diseases pharmacy residency at Duke University Hospital... Read More →

Evaluators

Katie Coffee

PGY1 Residency Program Director, Kaiser Permanente Georgia

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Olympia 1

Infectious Disease (ID), Prisma Health Richland - University of South Carolina

global Y

3:40pm EDT

Safety Outcomes of Empiric Linezolid versus Vancomycin in Patients with Pneumonia and Risk Factors for Methicillin-Resistant Staphylococcus aureus Infection

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena G

Title:
Safety Outcomes of Empiric Linezolid versus Vancomycin in Patients with Pneumonia and Risk Factors for Methicillin-Resistant Staphylococcus aureus Infection

Purpose:
Vancomycin and linezolid are primary agents recommended for treating methicillin resistant Staphylococcus aureus pneumonia¹. However, linezolid tends to become the secondary agent during therapy selection due to lack of familiarity, cost, or concern for adverse effects of myelosuppression or serotonin syndrome. The purpose of this study is to investigate key safety outcomes in use of intravenous linezolid and vancomycin for the purpose of inpatient treatment of pneumonia.

Methods:
The study was conducted as a single-center, Institutional Review Board (IRB)-approved, retrospective observational cohort study. Patients were identified from clinical data already available in the Ascension central data repository (across 11 practice sites) and screened based on inclusion and exclusion criteria. Encounters were then categorized by receipt of either “vancomycin” or “linezolid,” with further stratification for the various primary and secondary outcomes. The primary outcome is defined as composite safety outcomes, defined as incidences of acute kidney injury, cytopenias, serotonin syndrome, infusion reactions, and suspected or confirmed Clostridioides difficile infection. This data was collected from the facilities’ respective electronic health records for patients admitted between January 1, 2020 to September 30, 2025. Data was analyzed using Student’s t-test or Wilcoxon rank sum test or Chi-square or Fisher’s exact test, as appropriate for the data type. Alpha was set as 0.05 with 80% power.

Results:
14 patients were included in the study from a single site of the 11 sites. The remaining sites are assessed in a separate analysis. 7 patients were in each of the two groups, vancomycin and linezolid. Baseline characteristics were similar between groups. There was no significant difference found between the composite safety outcomes in either treatment group. Within the secondary outcomes, vancomycin patients had a statistically significant increased rate of 30-day all-cause mortality when compared to those of the linezolid group.

Discussion:
In this study, we found no significant difference in composite safety outcomes between patients with pneumonia being treated with vancomycin or linezolid. This may represent comparable safety profiles between the agents. It is important to consider the increase in 30-day all-cause mortality rate and apply it to a patient’s full clinical picture. More research is warranted with a larger sample size.

Moderators

Madison Schwartz

Presenters

Hailey Selders

PGY-1 Pharmacy Resident, Ascension Saint Thomas West

Evaluators

Michelle Turner

PGY1 RPD and Clinical Coordinator, MCNC1Moses Cone Hospital - Cone HealthPGY1

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena G

Infectious Disease (ID), Ascension Saint Thomas Health

global Y

3:40pm EDT

Factors Associated With Nocturnal Hypoglycemia In A Small Community Hospital

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena C

Factors Associated With Nocturnal Hypoglycemia In A Small Community Hospital
Nhien Nguyen, Maggie Braxton Green, Geren ThomasArchbold Memorial Hospital - Thomasville, GA

Background/Purpose: The American Diabetes Association guideline categorizes hypoglycemia in three levels. Level one hypoglycemia is a glucose concentration of 54–69 mg/dL. Level two hypoglycemia is a glucose concentration of <54 mg/dL. Level three hypoglycemia is a severe event characterized by altered mental and/or physical functioning that requires assistance from another person for recovery, irrespective of glucose level. Nocturnal hypoglycemia is defined as glucose falling below 70 mg/dL and lasting at least 15 minutes anytime from midnight to 6-am. It is important to avoid hypoglycemia in hospitalized patients as there are complications associated with increased cost, length of stay, morbidity, and mortality. The purpose of this study is to analyze and identify risk factors associated with nocturnal hypoglycemia occurring in hospitalized patients in a rural single site hospital.

Methodology: This was a single site, retrospective, cross-sectional study of adult hospitalized patients at a 264-bed community hospital. Data was extracted from electronic the health record and included patient’s gender, race, weight, past medical history, length of stay, renal function, A1C, glucose levels, time of episode, diet orders, medication orders, and signs and symptoms which may have occurred during nocturnal episode. Patient’s blood glucose levels were collected on admission, 24 hours prior to nocturnal hypoglycemic episode and during hypoglycemic episode. Patient’s chart was reviewed 24 hours prior from the time of the episode to identify potential causes. Primary endpoint is identifying factors potentially associated with nocturnal hypoglycemia episodes in hospitalized patients.

Results: From January to December 2025, a total of 451 patients were identified to have a hypoglycemic episode. Exclusion criteria included patient on insulin drip during hospital stay, history of DKA and/or HHS, sleep apnea, history of cirrhosis, hepatitis B and C, adrenal insufficiency, pancreatic diseases. The most common exclusion criteria met were factors related to past medical history, insulin drip or hypoglycemic episodes did not take place during 0000-0600. These patients were then reviewed for potential risk factors that were associated with the hypoglycemic episode. Among review, the blood glucose level ranged from 10 to 69 mg/dL with average of 59 mg/dL. Level one hypoglycemia occurred 691 times while level two occurred 210 times. Of the patients who experienced nocturnal hypoglycemia, 47% had diet order for “nothing by mouth,” 33% of patients were on at least one or more beta-blocker agents, 9% were on a quinolone agent, and 34% were on at least one or more nonsteroidal anti-inflammatory drugs during their hospitalization.

Conclusions: Nocturnal hypoglycemia can be a dangerous medical complication that can be influenced by types of diet, the use of beta-blockers, quinolones, and nonsteroidal anti-inflammatory drugs. Due to the multiple confounders associated with increased risk, a larger population with closer real time monitoring may be needed to directly correlate associated risk factors.

Presentation Objective: Identify potential risk factors associated with nocturnal hypoglycemia occurring in hospitalized patients in a single site community hospital.
Self-Assessment:
Which of the following is the definition of nocturnal hypoglycemic per the ADA guideline?
A.Glucose level < 69 mg/dL and lasting at least 5 minutes from midnight to 0600
B.Glucose level ≤ 70 mg/dL and lasting at least 15 minutes from midnight to 0300
C.Glucose level < 70 mg/dL and lasting at least 15 minutes from midnight to 0600
D.Glucose level < 54 mg/dL and lasting at least 10 minutes from 0300 to 0600

Moderators

Natalie Hurst

Presenters

Nhien Nguyen

Pharmacy Resident (PGY1), Archbold Memorial Hospital

Evaluators

Nathaniel Swanson

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena C

Internal Medicine (IM), John D. Archbold Memorial Hospital

global Y

3:40pm EDT

Utility of β-hydroxybutyrate as a defining criterion for diabetic ketoacidosis resolution in adults

Thursday April 30, 2026 3:40pm - 4:00pm EDT

Athena J

Utility of β-hydroxybutyrate as a defining criterion for diabetic ketoacidosis resolution in adults
Kevin Fenter, Tyler Bui, Alvin Tomika

Background: The criteria for determining resolution of diabetic ketoacidosis (DKA) have varied over the years. The most recent position statement published in 2024 by the American Diabetes Association (ADA) significantly modified the criteria for DKA resolution to include the use of beta-hydroxybutyrate (BHB). With the development of point-of-care ketone measurement devices it is more feasible to measure serum ketones to define DKA resolution; however, limited data exists on the benefit of serum ketones compared to traditional criteria historically used to define DKA resolution. The objective of this study is to evaluate the utility of BHB as a criterion for DKA resolution to successful transition from intravenous (IV) to subcutaneous (SUBQ) insulin.

Methods: This study was a single center retrospective chart review of electronic health records between November 1, 2023, and October 31, 2025 of patients with DKA treated with intravenous regular insulin as well as additional standard of care therapy. The study included adult patients 18 years of age or older admitted to the hospital with a primary diagnosis of DKA. Patients must have been treated with IV regular insulin and transitioned to SUBQ insulin prior to discharge. Patients were excluded if received insulin infusions related to conditions other than DKA, if treated outside the institutional DKA order set/protocol, received concomitant treatment with IV regular insulin and SUBQ insulin, died, were discharged or enrolled in comfort care prior to insulin transition, pregnant or lactating, or if were missing key clinical data.

Patients were stratified into two groups dependent on if BHB was collected and normalized (Group 1) or not BHB not normalized/collected prior to transition to subcutaneous insulin (Group 2). The primary outcome was post transition treatment failure within 48hrs defined as resumption of IV insulin or meeting two out of the three criteria for DKA diagnosis. Secondary outcomes include duration of ICU stay, duration of hospitalization, time from regular insulin initiation to initiation of SUBQ insulin, duration of IV insulin, hypoglycemia events during admission, IV insulin requirements prior to transition, and post transition insulin requirements. Outcomes were evaluated using statistical methods such as Fisher’s exact test and Mann-Whitney U test as appropriate. Demographics and baseline characteristics were evaluated using descriptive statistics.

Results: A total of 105 patients met criteria for inclusion with 31 patients included within Group 1. The mean age was 44 years with 66% on home insulin prior to admission; of which 61% reported not compliant. Baseline characteristics were similar, however; Group 1 saw 90.3% of patients admitted to the ICU while Group 2 saw 46% admitted to the ICU. For the primary outcome of transition failure there was no statistically significant difference between the two groups (16.1% vs 13.5%, p=0.16). For the secondary outcomes there was no statistically significant difference for hospital length of stay, ICU length of stay, insulin requirements before and after transition as well as hypoglycemic events. In Group 1 there was a non-statistically significant trend toward longer duration of IV insulin therapy and time to transition to subcutaneous insulin.

Conclusion: Among adults admitted for treatment of DKA and transitioned from intravenous insulin to subcutaneous insulin, resolution criteria utilizing normalization of beta-hydroxybutyrate to <0.6 mmol/L were not associated with decreased rates of transition failure.

Contact Information: [email protected]

Moderators

Rachel Friend

Presenters

Kevin Fenter

PGY1 Pharmacy Resident, AdventHealth

Kevin Fenter, PharmD is currently a PGY1 pharmacy resident at AdventHealth Celebration. He completed his pharmacy education at the University of Florida. Following completion of his PGY1 residency year Kevin plans to pursue a clinical role ideally within the critical care realm.

Evaluators

Rachel Langenderfer

Clinical Pharmacy Specialist - Residency Program Coordinator, Bon Secours St. Francis Downtown

I am a clinical pharmacy specialist at Bon Secours St. Francis Downtown Hospital, and I serve as the PGY-1 Residency Program Coordinator and the PGY-2 Internal Medicine Residency Program Director. I went to Campbell University College of Pharmacy and Health Sciences and completed... Read More →

Thursday April 30, 2026 3:40pm - 4:00pm EDT
Athena J

Internal Medicine (IM), AdventHealth Celebration

global Y

4:00pm EDT

Association Between Outpatient Glucagon-like Peptide-1 Receptor Agonist (GLP-1 RA) use and the Incidence and Severity of Sepsis

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena B

Title: Association between outpatient glucagon-like peptide-1 receptor agonist use and the incidence or severity of sepsis
Authors:

Primary: Mary Sizer
Secondary: Hanna Kim, Jinae Lee, Daniel B. Hall, John Carr, PharmD, Akshaya Arunkumar, Abigail Case. PharmD, Chelsea Keedy

Objective: To determine if outpatient GLP-1 RA is associated with a decreased risk of sepsis occurrence or severity.

Background:
Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs) mimic the endogenous hormone involved in regulating blood glucose concentrations and appetite. These agents are approved in management of type 2 diabetes and have grown popular for weight management. Pre-clinical and clinical data found anti-inflammatory, antioxidant, and multiorgan protective effects from use, suggesting a potential protective effect in acutely ill patients. Inversely, preliminary data has also suggested an increase in mortality for critically ill patients on such agents. There is limited data that investigates this association. The purpose of this study is to evaluate the association between GLP-1 RA use and incidence and severity of sepsis.

Methods:
This retrospective cohort study investigated the association between outpatient GLP-1 RA therapy and both the incidence and severity of sepsis using Merative MarketScan Commercial Database insurance claims recorded between January 1, 2022 and December 31, 2024. The cohort included adults with BMI >30, hospitalization or emergency room visit, and diagnosis of pneumonia, urinary tract infection, diabetic foot infection or intraabdominal infection identified by ICD10 codes. Patients that were pregnant, had cancer, were on hospice, or diagnosed with diabetes or diabetic foot infection were excluded. Inclusion and exclusion criteria were examined for the 6-month period prior to the data of hospitalization/ER visit (the index date) and eligible patients were divided into a GLP-1 RA use group and a control group. Chronic therapy was defined as ≥ 90-day total supply filled within 6 months of the index date and identified using NDC codes. Those that did not meet this definition were placed in the control. For both sepsis incidence and severe sepsis incidence, propensity score weighted logistic regression was used with inverse probability of treatment weighting to estimate odds ratios quantifying the average treatment effects among the treated while controlling for baseline confounders including age, sex, BMI (30-39.9 vs. >=40), and all baseline comorbidities including chronic heart failure, chronic kidney disease, liver cirrhosis, AFib, dementia, chronic ischemic heart disease. Propensity scores were estimated using logistic regression and covariate balance was assessed using both the standardize mean difference (acceptable range of +/- 0.1) and Kolmogorov-Smirnov (<0.05) criteria. Statistical inference was based on the nonparametric bootstrap implemented using 500 resampled datasets.

Results:
Of the 634,718 patients identified with a hospitalization/emergency room visit and concurrent infection, 22,267 patients fit eligibility criteria for the study. GLP-1 RA use accounted for 640 of those enrolled (2.87%) and 21,627 (97.1%) were enrolled into the comparator group. Baseline characteristics were similar, with the exception of gender, for which there was a significantly higher proportion of males in the comparator group (26.7% vs 15.2%; p=<0.001). The proportion of enrollees with pneumonia also differed significantly between groups, favoring the comparator group (25% vs 18.4%; p=<0.001). Urinary tract infection proportion favored the GLP-1 RA use cohort (52.7% vs 42.4%; p=<0.01). Additionally, enrolled comorbidities varied only in heart failure between the two cohorts (3.2% comparator group vs 1.3% use of GLP-1 RA; p=0.0085). The odds ratio (OR) for sepsis was 1.17 [95% CI: 0.85-1.46] (p=0.789) and the OR for severe sepsis was 0.92 [95% CI: 0.37-1.63] (p=0.934), indicating that the occurrence of sepsis and severe sepsis did not differ significantly between the two groups after controlling for baseline confounders.

Conclusions:
GLP-1 RA use was not associated with any significant difference in the odds of sepsis, nor of severe sepsis, in acutely ill enrollees with concurrent infection. GLP-1 RA combination products with dual mechanisms were examined alongside sole GLP-1 RA use. Differences in therapy were not examined. Overall, the evidence is not sufficient to conclude that there is a difference in sepsis risk with GLP-1 RA use.

Moderators

Lauren Lyons

Clinical Pharmacist - Advanced Heart Health Center, Prisma Health

Presenters

Mary Sizer

Pharmacy Resident, Candler Hospital

Mary Sizer is a current PGY2 ambulatory care pharmacy resident at St. Joseph's/Candler in Savannah, GA. Mary is from Cincinnati, OH and received her PharmD degree from West Virginia University in Morgantown, WV.

Evaluators

Laurie Leith

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena B

Ambulatory Care (AMB), St. Joseph's/Candler Health System

global Y

4:00pm EDT

Clinical Outcomes with Full Versus Reduced Dose of Rivaroxaban and Apixaban After Initial VTE Treatment

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Olympia 2

Authors: Tahir Razzaq, Sweta M. Patel, Irene Robb, Naomi Yates

Background:
Direct oral anticoagulants such as rivaroxaban and apixaban are recommended first-line options for the initial treatment of venous thromboembolism (VTE). In patients with unprovoked or recurrent VTEs, extended treatment beyond the initial 3-6 months is recommended. The API-CAT and RENOVE trials evaluated whether dose reduction is appropriate or beneficial in certain patient populations in the extended phase treatment. Both trials concluded that dose reduction had similar VTE recurrence rates with lower bleeding risk compared to full dose treatment. The purpose of this study was to determine if reduced doses of rivaroxaban (10 mg daily) or apixaban (2.5 mg twice daily) offer a safe and effective alternative to the full dose (rivaroxaban 20 mg daily or apixaban 5 mg twice daily) treatment.

Methods:
This is a retrospective, IRB-exempt cohort study that included adult patients of Kaiser Permanente Georgia treated with rivaroxaban or apixaban for VTE after completion of the initial 6-month duration. The study population consisted of patients treated with full dose treatment between January 1, 2023 to June 30, 2024, with clinical outcomes assessed through June 30, 2025. Patients with mechanical heart valves, atrial fibrillation/flutter, and/or concurrent antiplatelet therapy were excluded. The primary outcome of this study was to evaluate the incidence of VTE recurrence and major bleeding events in patients who took reduced or full doses of rivaroxaban or apixaban after the initial VTE treatment period. The secondary outcome was to analyze patient characteristics among those who received either reduced or full doses of rivaroxaban or apixaban to identify factors associated with dose selection. Descriptive statistics were used to assess differences in clinical outcomes and patient characteristics. Chi-squared tests were used to determine statistical significance with a P-value of < 0.05.

Results:
A total of 165 patients received either reduced or full dose rivaroxaban or apixaban after the initial VTE treatment period. Of these, 152 patients were included in this analysis. Among this cohort, 14 (9%) patients received dose reduction, including 1 who was on rivaroxaban and 13 on apixaban. A total of 5 patients (3%) experienced a recurrent VTE (2 with rivaroxaban 20 mg daily and 3 with apixaban 5 mg twice daily). Overall, 18 patients (11.8%) experienced either a major or minor bleeding event (10 with rivaroxaban 20 mg daily and 8 with apixaban 5 mg twice daily). Patients who experienced a bleeding event were younger compared to those without bleeding events (mean age 53y vs. 60y; p=0.049). Of the patients who were not dose reduced (n=138), 50 of them (36%) could have benefited from dose reduction. Patients who qualified for dose reduction were significantly older than those who did not (mean age 62y vs 56y; p=0.022). Additionally, the Internal Medicine and Oncology departments were among the prescribing departments that had the highest rates of prescribing both full-dose and reduced-dose regimens.

Conclusion:
Dose reduction of rivaroxaban and apixaban after the first 6 months of initial VTE treatment demonstrated a lower risk of bleeding. However, full doses of both DOACs were associated with a trend toward higher rates of bleeding and VTE risk. While dose reduction may offer a safer side effect profile, further research may help identify which patient populations would benefit most from dose reduction and its impact on long-term VTE recurrence and bleeding events among those requiring extended VTE treatment. Additionally, pharmacy-led education sessions could help to ensure that dose reductions are performed safely and effectively in clinical practice.

Moderators

Krista Dumkow

Presenters

Tahir Razzaq

Dr. Tahir Razzaq was born and raised in Chicago and moved to Atlanta in 2021 to attend pharmacy school at PCOM. His professional interests include ambulatory care and managed care, with a focus on expanding the role of pharmacists beyond traditional settings. Outside of pharmacy... Read More →

Evaluators

Marci Swanson

Clinical Pharmacist Practitioner, Carl Vinson VA Medical Center

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Olympia 2

Ambulatory Care (AMB), Kaiser Foundation Health Plan of Georgia, Inc.

global Y

4:00pm EDT

Evaluating Pharmacist-Led Post-Discharge Medication Management in Cardiothoracic Surgery Patients - William Freeman

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Parthenon 2

Background
Patients discharged after coronary artery bypass graft (CABG) or aortic valve replacement (AVR) surgery are at high risk for hospital readmissions, medication discrepancies, and adverse drug events during care transitions. Readmission rates following cardiac surgery range from 11-25%, carrying significant clinical and economic consequences with an estimated annual national cost exceeding $250 million for CABG alone.1-3 The transition from hospital to home represents a particularly vulnerable period, as approximately 50% of patients experience medication errors or unintentional discrepancies following discharge. While pharmacist-led medication reconciliation has been shown to reduce medication discrepancies and hospital readmissions in general populations, limited data exist evaluating the clinical impact of these interventions specifically in the cardiac surgery population.

Objective
To evaluate the impact of a pharmacist-led medication reconciliation intervention on clinical outcomes in patients following cardiac surgery, and to identify opportunities to standardize and improve discharge workflows.

Methods
A retrospective chart review was completed to evaluate patients' post discharge with scheduled Transition of Care Management (TCM) appointments between June 2024 to June 2025. Patients were included if they were at least 18 years of age, discharged from AdventHealth Celebration following CABG or valve replacement surgery, and had a scheduled TCM visit. Patients were excluded if they had no scheduled TCM appointment at discharge or death occurred prior to visit. Upon discharge, patients who are referred to TCM are contacted by an ambulatory care pharmacist within the AdventHealth Celebration Clinical Pharmacy Services Teams. At this time, pharmacists perform a medication reconciliation and correct any discrepancies found prior to TCM visit. The primary outcome of the study was 30-day all cause readmission rate. Secondary outcomes included TCM show rate, pharmacist interventions, and medication discrepancies identified.

Results
The study included 297 patients who underwent cardiac surgery. Of these, 212 patients (71%) received pharmacist intervention prior to their transitional care management (TCM) visit, while 85 patients (29%) did not receive intervention. Patients who received pharmacist intervention had a 30-day readmission rate of 18% versus 22% in those who did not receive intervention. TCM visit attendance was 94% in the intervention group versus 92% in the comparison group. The most prevalent medication discrepancy identified during pharmacist contact was commission errors, followed by frequency errors and dosing errors.
Among patients who underwent CABG, the 30-day readmission rate was 20% in those who received pharmacist intervention versus 22% in those who did not. The average time to readmission was 10 days in the intervention group versus 3 days in the comparison group. TCM visit attendance was 94% for the intervention group versus 93% in the comparison group.
Among patients undergoing aortic valve replacement (AVR), the 30-day readmission rate was 11% in those who received pharmacist intervention versus 25% in those who did not. The average time to readmission was 3 days in the intervention group versus 2 days in the comparison group. TCM visit attendance was 93% in the intervention group versus 75% in the no-intervention group.

Conclusion
The delayed time to readmission in the intervention group (particularly CABG) may indicate that pharmacist involvement helps patients manage early post-discharge issues that would otherwise result in rapid readmission. The later readmissions might represent disease progression or complications less amenable to medication management and education.

References
1. Pharmacist and Student Pharmacist Perspectives on Providing Preconception Care in the United States. Journal of the American Pharmacists Association : JAPhA. 2018. Ng C, Najjar R, DiPietro Mager N, Rafie S.
2. Readmissions After Cardiac Surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network. The Annals of Thoracic Surgery. 2014. Iribarne A, Chang H, Alexander JH, et al.
3. Readmissions Following Isolated Coronary Artery Bypass Graft Surgery in the United States (From the Nationwide Readmissions Database 2010 to 2014). The American Journal of Cardiology. 2019. Khoury H, Sanaiha Y, Rudasill SE, et al.
4. Jošt M, Kerec Kos M, Kos M, Knez L. Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial. Front Pharmacol. 2024;15:1377781. Published 2024 Mar 28. doi:10.3389/fphar.2024.1377781
5. Incidence, Cost, and Risk Factors for Readmission After Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery. 2019. Shah RM, Zhang Q, Chatterjee S, et al.
6. A Multi-Center Analysis of Readmission After Cardiac Surgery: Experience of the Northern New England Cardiovascular Disease Study Group. Journal of Cardiac Surgery. 2019. Trooboff SW, Magnus PC, Ross CS, et al.
7. Prevention of Complications in the Cardiac Intensive Care Unit: A Scientific Statement From the American Heart Association. Circulation. 2020. Fordyce CB, Katz JN, Alviar CL, et al.Guideline
8. Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge From Hospital to Community Settings: A Systematic Review. Drug Safety. 2020. Alqenae FA, Steinke D, Keers RN

Moderators

Sheema Hallaji

PGY1 Residency Director, Cone Health- Alamance Regional Medical Center

Presenters

William Freeman

Evaluators

Savannah Owen

Assistant Professor of Pharmacy Practice, South College School of Pharmacy

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Parthenon 2

Ambulatory Care (AMB), AdventHealth Celebration

global Y

4:00pm EDT

Impact of Pharmacist-led Discharge Interventions in the Multi-Visit Patient Population

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena H

Impact of Pharmacist-Led Discharge Interventions in the Multi-Visit Patient Population

Background: Multi-visit patients (MVPs), defined as individuals with three or more hospital admissions within a 12-month period, represent a high-risk population with significant chronic disease burden and increased risk of early readmission. Frequent hospitalizations, particularly similar conditions, are associated with worse clinical outcomes and increased healthcare utilization. Pharmacist involvement during care transitions has been shown to improve medication management and patient outcomes; however, data evaluating the impact of pharmacist-led interventions in MVP populations remain limited. This study aimed to assess the impact of pharmacist-led post-discharge medication review in this high-risk population.

Methodology: This retrospective chart review included Medicare enrolled MVPs who were discharged from AdventHealth Celebration between September 15, 2025, and January 16, 2026. Patients were excluded if they were discharged to an inpatient rehabilitation unit (IPR), skilled nursing facility (SNF), hospice, left against medical advice, transferred to an outside hospital, expired during hospitalization, or patients with current malignancy treated with systemic therapy. Eligible patients were identified by a nurse educator and referred for a post-discharge medication review call conducted by a clinical pharmacist. All eligible patients received an attempted telephone outreach. The primary outcome was 30-day hospital readmission rate. Outcomes were compared between patients who successfully completed the post-discharge pharmacist call and those who were unable to be reached or declined participation. Secondary outcomes included the rate of identical (potentially preventable) 30-day readmissions, defined as readmissions for the same or clinically similar condition as the index admission. Secondary outcomes also included the number of medication discrepancies identified and resolved. Additional process measures included the incidence and type of patient counseling and education provided (e.g., medication-related, disease state, lifestyle, self-monitoring, and adherence counseling), as well as the number and type of pharmacist recommendations, including medication initiation, discontinuation, dose adjustment, and laboratory or immunization recommendations.

Results: A total of 40 MVPs were identified during the study period. Of these, 22 patients met inclusion criteria, leaving 18 patients eligible for inclusion who received an attempted post-discharge medication review call from a clinical pharmacist. Among the 18 eligible patients 12 (66.7%) successfully completed the pharmacist-led telephone encounter, while 6 (33.3%) were either unable to be reached or declined participation. The 30-day readmission rate was 50% (n=6) among patients who completed the call, compared to 33% (n=2) among those who did not complete the call. Among patients who completed the intervention, a total of 33 medication discrepancies were identified and resolved (mean 2.8 per patient). Additionally, over 50 patient counseling interventions were performed, with the majority categorized as medication-related or disease state-related education. A total of 33 pharmacist recommendations were made, most commonly involving medication dose adjustments. Other recommendations included medication initiation, discontinuation, and laboratory or immunizations.

Conclusion: Pharmacist-led post-discharge medication review in a high-risk multi-visit patient population identified a substantial number of medication discrepancies and generated clinically meaningful interventions, including medication optimization and patient education. Although no reduction in 30-day readmissions was observed, these findings highlight the potential role of pharmacists in improving care transitions and addressing medication-related problems in medically complex patients. Larger studies are needed to further evaluate the impact of these interventions on clinical outcomes in this population.

Moderators

Jenna Jewett

Presenters

Sheila-Marie Payne

Evaluators

Sarah McDaniel

Antimicrobial Stewardship Coordinator, Baptist Medical Center South

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena H

Ambulatory Care (AMB), AdventHealth Celebration

global Y

4:00pm EDT

Evaluation of Glucocorticoid Dosing Strategies in Acute Chronic Obstructive Pulmonary Disease Exacerbation: A Retrospective Review

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena D

Authors: Logan Wildman, Vanessa Velazco, Tracey Bastian

Background: The use of systemic corticosteroids for acute chronic obstructive pulmonary disease (COPD) exacerbation has been associated with shortened recovery time, improvement in FEV1, decreased patient length of stay, and the prevention of treatment failure; however, differences in patient outcomes using varying corticosteroid dosing strategies has yet to be demonstrated in large scale randomized controlled trials. The purpose of this study is to compare the effects of corticosteroid dosing strategies on outcomes in acute COPD exacerbation.

Methods: This was a single-center, IRB exempt, retrospective chart review study. All patients selected for data extrapolation were hospitalized at Williamson Medical Center within the dates of September 1st, 2024 and September 1st, 2025. Patients were extrapolated for data collection utilizing the ICD diagnosis code for acute COPD exacerbation (J44.1). Patients were evaluated in a 1:1 ratio based upon the amount of cumulative prednisone equivalents they received within 48 hours of admission (>1.5 mg/kg of prednisone equivalents versus ≤1.5 mg/kg prednisone equivalents). Weight based grouping was utilized to account for the varying nature of physician preference in terms of systemic corticosteroid selection. Primary endpoints included total hospital length of stay and readmission rate within 30 days for recurrent COPD exacerbation. Secondary endpoints included need for mechanical intubation and change in oxygen requirements at discharge. Lastly, safety endpoints included: incidence of hyperglycemia, severe hyperglycemia, and nosocomial infection. In total, 208 patients were identified for data collection. After exclusion, 128 patients were included for data extrapolation. Fisher’s t-test calculations were utilized to determine statistical significance for nominal and ordinal data. Mann-Whitney- U calculations were utilized when evaluating the statistical significance of continuous variables.

Results: In total 128 patients were included for analysis. 71 patients were assigned to the >1.5 mg/kg prednisone equivalents group and 57 patients were assigned to the ≤1.5 mg/kg prednisone equivalents group. Baseline characteristics were similar between the two groups, with the exception of weight (>1.5 mg/kg: 89.4kg vs ≤1.5 mg/kg: 68.6kg), BMI (>1.5 mg/kg: 29.9 kg/m2 vs ≤1.5 mg/kg: 24.2 kg/m2), and cumulative prednisone equivalents distribution (>1.5mg/kg: 318mg vs ≤1.5 mg/kg: 600mg). These baseline characteristics were determined to be statistically significantly different between groups. For primary outcomes, the utilization of >1.5 mg/kg prednisone equivalents within 48 hours of patient admission resulted in an average patient length of stay of 4.62 days and 6 instances of readmission for subsequent COPD exacerbation. In comparison, patients who received ≤1.5 mg/kg within 48 hours of admission were found to have an average length of stay of 5.58 days and 4 instances of readmission for subsequent COPD exacerbation. Differences between groups for both length of stay (U = 1781.5, p =0.123) and repeat admission for exacerbation (p = 1.00) were found to be statistically insignificant. For secondary endpoints, need for mechanical intubation (p = 1.00) and change in oxygen requirement at discharge (p = 0.562) were found to be similar between groups. Lastly, safety endpoints of hyperglycemia incidence (p = 1.00), severe hyperglycemia incidence (p = 0.196), and nosocomial infection incidence (p = 0.323) were determined to be similar among groups.

Conclusions: There were no statistically significant differences in hospital length of stay or 30 day readmission rates in patients receiving >1.5 mg/kg prednisone equivalents when compared to ≤1.5 mg/kg prednisone equivalents within 48 hours of admission for acute COPD exacerbation. Secondary endpoints, including need for mechanical intubation and change in oxygen requirements at discharge, as well as safety endpoints, were similar between groups. Additional evidence from larger cohorts would be valuable in evaluating outcomes associated with varying corticosteroid dosing strategies in this patient population.

Moderators

Alison Martin

Presenters

Logan Wildman

PGY-1 Clinical Pharmacist Resident, Williamson Medical Center

Evaluators

Martin Gordon

Clinical Pharmacy Specialist - Critical Care, Spartanburg Medical Center

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena D

Critical Care/Emergency Medicine (CCM), Williamson Medical Center

global Y

4:00pm EDT

Ketamine versus Dexmedetomidine for ICU Sedation

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Olympia 1

Title: Ketamine versus Dexmedetomidine for ICU Sedation
Authors: Rebecca Olisa, Anh Nguyen, Jana Mills, Nikulkumar Chaudhari, MD
Background/Purpose:
Critically ill, mechanically ventilated patients often require sedation to manage pain and agitation. Traditional agents like benzodiazepines and propofol can prolong ventilation and increase intensive care unit (ICU) delirium. Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, offers potent analgesia and hemodynamic support but carries a risk of psychomimetic effects. Conversely, dexmedetomidine, an alpha-2 agonist, provides cooperative sedation and reduced delirium without respiratory depression, though its use is often limited by bradycardia and hypotension. Evidence suggests that using these agents, individually or combined, can improve sedation quality, stabilize hemodynamics, and reduce time to extubation when compared to traditional sedatives.
This retrospective chart review evaluated the impact of ketamine or dexmedetomidine on clinical outcomes in mechanically ventilated patients with the primary endpoint being time from initiation of continuous sedation, with ketamine or dexmedetomidine, to successful extubation.
Methods:
This single-center retrospective cohort study was conducted between October 31, 2022, and July 31, 2025. Adult patients were eligible for inclusion if they required mechanical ventilation and received continuous infusions of either ketamine or dexmedetomidine, whether administered alone or were begun as adjuncts to wean traditional sedatives.
Patients were excluded from the analysis if they failed to receive either dexmedetomidine or ketamine, or if they received both agents concurrently or sequentially during a single ICU stay. Further clinical exclusions included patients receiving ketamine at a fixed rate or a dose exceeding 2 mg/kg/hour, those with an overlap of more than 24 hours between primary and adjunctive sedatives, individuals with an ICU stay of less than 24 hours or mortality prior to extubation, and patients who were transitioned to comfort measures, diagnosed with anoxic brain injury, or pregnant.
The primary endpoint was the time from initiation of continuous sedation with ketamine or dexmedetomidine to successful extubation. Secondary assessments included ICU length of stay, total ventilator duration, and the incidences of ICU mortality, hemodynamic instability, and delirium.
Results:
A total of 20 patients met inclusion criteria, 7 in the ketamine group, and 13 in the dexmedetomidine group. The two groups were similar in age (mean 55.6 ± 14.7 vs. 60.8 ± 14.6 years, p = 0.751) and sex distribution (57.1% vs. 53.8% female). Median pre-initiation ventilation times for ketamine and dexmedetomidine were 7.82 vs. 12.30 hours (p=0.699). These comparable durations, alongside similar Richmond Agitation-Sedation Scale scores (RASS), indicate equivalent sedation depth and suggest that pre-sedation ventilation did not confound the primary outcome. For the primary endpoint, ketamine was associated with a shorter median time from sedation initiation to extubation compared to dexmedetomidine (15.5 vs. 23.2 hours), though this difference did not reach statistical significance (p = 0.157). Among secondary endpoints, ketamine patients had numerically shorter total ventilator duration (median 24.3 vs. 39.9 hours, p = 0.097) and ICU length of stay (median 2.0 vs. 3.0 days, p = 0.057). Rates of ICU delirium were lower in the ketamine group (28.6% vs. 46.2%, p = 0.642), as were rates of hemodynamic instability (0% vs. 15.4%, p = 0.521). No deaths occurred in either group during the ICU stay.
Conclusion:
This retrospective pilot study compared ketamine and dexmedetomidine as primary weaning agents for mechanically ventilated patients at two sites within a single healthcare system. Although underpowered for statistical significance, ketamine was associated with shorter times to extubation, reduced ventilator duration, and shorter ICU stays. Furthermore, the ketamine group experienced lower rates of delirium and hemodynamic instability, with no deaths in either cohort. These findings suggest a consistent trend favoring ketamine and support the rationale for a larger, randomized study to definitively evaluate its utility as a weaning sedative in this population. Future research should incorporate illness severity scoring and standardized weaning protocols to build on these promising preliminary trends.

Moderators

Ryan Tilton

Presenters

Rebecca Olisa

PGY1 Pharmacy Resident, Emory Decatur Hospital

Dr. Rebecca Olisa is from Lancaster, California. She completed her undergraduate coursework at the University of California, San Diego and received her Doctor of Pharmacy degree from Mercer University College of Pharmacy. Her professional interests include critical care, infectious... Read More →

Evaluators

Katie Coffee

PGY1 Residency Program Director, Kaiser Permanente Georgia

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Olympia 1

Critical Care/Emergency Medicine (CCM), Emory Decatur Hospital

global Y

4:00pm EDT

The Impact of Systemic Corticosteroids on Antibiotics Days of Therapy in Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena A

Impact of Systemic Corticosteroids on Antibiotic Days of Therapy in Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia
Samantha Saraceno, Zoanne Harlas, Joseph Crosby, Ryan Sarvestani, John Carr
St. Joseph/Candler Health System
Background/Purpose: Clinical outcomes related to the use of systemic corticosteroids are not well defined in hospital-acquired pneumonia and ventilator-associated pneumonia (HAP/VAP) patients. Much of the available evidence is extrapolated from research and guidelines on community-acquired pneumonia (CAP). However, HAP and VAP are fundamentally different from CAP and are associated with significantly higher morbidity and mortality. Studies have suggested long-term use of corticosteroids prior to developing HAP/VAP can increase mortality, antibiotic days of therapy and days of mechanical ventilation. The purpose of this study was to determine whether the use of corticosteroids is associated with prolonged need for antimicrobial therapy in patients with HAP/VAP.

Methodology: This was a retrospective, cohort study. We looked at two groups, those who received systemic corticosteroids during treatment and those who did not. Adult patients diagnosed with HAP/VAP based on ICD10 codes were included. Exclusion criteria included pregnancy, multiple sources of infection, viral or fungal pneumonia, those who were immunocompromised, neutropenia and long-term steroid use at baseline. The primary outcome was the number of days free from antibiotics. Secondary outcomes included number of days free from mechanical ventilation, incidence of multi-drug resistant infection, hospital length of stay and in-hospital mortality. Continuous measures were analyzed by mean and standard deviation, and a t-test was used to determine p-value. For intermittent measures, percentages were calculated, and chi-square tests were used to analyze data. Statistical significance was determined as a p-value < 0.05.

Results: 116 patients were screened, with 81 being excluded and 35 meeting inclusion criteria. There were 15 patients included in the corticosteroid group and 20 patients included in the no corticosteroid group. The primary outcome was not statistically significant with number of days free from antibiotics being 15.98 days in the steroid group and 11.2 days in the without steroids group, resulting in a p-value of 0.087. The secondary outcome of number of days free from mechanical ventilation showed statistical significance with the steroid treatment group having a mean of 7.65 days on mechanical ventilation compared to the without steroids group having a mean of 15.92 days, resulting in a p-value of 0.035. All other outcomes showed no statistical significance with no p-values > 0.05.

Conclusion: For patients diagnosed with HAP/VAP, treatment involving corticosteroids had no impact on duration of antibiotic therapy compared to those who did not receive corticosteroids. Thus, systemic corticosteroids may have little to no impact on duration of antibiotic therapy in this patient population. Patients diagnosed with HAP/VAP who are mechanically ventilation may have a shorter duration of ventilation if systemic corticosteroids are used as part of therapy. Further research is needed to confirm these preliminary findings.

Moderators

Kristina Nakhla

PGY1 Residency Program Director, Northside Hospital

Presenters

Samantha Saraceno

PGY1 Pharmacy Resident, St. Josephs/Candler Health System

Evaluators

Michael Behal

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), St. Joseph's/Candler Health System

global Y

4:00pm EDT

Less is More: Safety and Efficacy of De-escalating Antipseudomonal Therapy to Pathogen-Directed Therapy in Patients with Neutropenic Fever

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena J

Authors’ Names: Madison Moncus, Ashton Dickinson, Mary Massaro, Brandon Hawkins, Alexandra McBrayer, Clark Cutrer, Samantha Walker

Background: Febrile neutropenia is a life-threatening complication in patients with malignancy and hematopoietic stem cell transplant (HSCT) recipients. Empiric anti-pseudomonal beta-lactam therapy is recommended; however, the optimal strategy for narrowing therapy based on culture data remains uncertain. While de‑escalation to pathogen‑directed regimens is widely endorsed when microbiologic data is available, the evidence supporting this practice remains limited. Emerging data suggests de-escalation may safely reduce broad-spectrum antibiotic exposure; though evidence in high-risk populations, such as those with hematologic malignancy and HSCT recipients, is limited. This study evaluates the safety and efficacy of narrowing empiric therapy to pathogen-directed therapy in adults with malignancy and HSCT recipients.

Methods: This retrospective cohort evaluates adult hospitalized patients with cancer-associated febrile neutropenia between January 2020 and January 2025. Eligible patients received initial empiric antipseudomonal beta-lactam therapy and had a positive bacterial culture obtained within 72 hours of fever onset. Patients with pseudomonal infections, organisms resistant to definitive therapy, ANC recovery (ANC > 500 cells/mm³) within 72 hours of initiating antibiotic therapy, or death within 72 hours were excluded. Patients were stratified into two groups: those who remained on empiric anti-pseudomonal therapy for more than 72 hours after susceptibility results became available, and those who were narrowed to pathogen-directed therapy within 72 hours. Data was collected securely via RedCap. The primary composite outcome included escalation of antibiotic therapy or infection recurrence within 30 days. Secondary outcomes included incidence of new onset Clostridioides difficile infection (CDI), hospital length of stay, all-cause mortality at 30 days, new positive culture with resistance demonstrated to initial treatment agents within 30 days, and time to de-escalation. Data collected included baseline demographics, cancer type, culture results, antibiotic regimens, fluoroquinolone prophylaxis, resistance patterns, and readmissions. Categorical variables were analyzed using chi-square or Fisher’s exact test, and continuous variables were analyzed using the Mann-Whitney U test. Data was analyzed utilizing SPSS.

Results: A total of 44 patients met inclusion criteria, with 32 patients in the empiric therapy group and 12 patients in the pathogen‑directed therapy group. Baseline demographics, malignancies, and microbiologic characteristics were similar between groups, with most patients having hematologic malignancies and comparable distributions of gram‑positive and gram‑negative organisms. Patients de‑escalated to pathogen‑directed therapy received significantly shorter durations of antipseudomonal therapy (median 3 vs. 18 days, p < 0.001). De‑escalation typically occurred within 24 hours of susceptibility reporting (58%). The composite primary endpoint occurred in 72% of the empiric group and 42% of the pathogen‑directed group (p = 0.085). Antibiotic escalation was more frequent among patients who remained on empiric therapy (50% vs. 8%, p = 0.015), with meropenem accounting for most escalations (94%, p = 0.003). Rates of recurrent fever, repeat positive cultures, readmission due to infection, CDI, and 30‑day mortality were low and did not differ significantly between groups. Hospital length of stay was shorter in the pathogen‑directed group (7 vs. 20 days, p = 0.005).

Conclusions: De‑escalation of empiric antipseudomonal therapy to pathogen‑directed therapy was associated with substantially reduced broad‑spectrum antibiotic exposure and shorter hospital length of stay without increased treatment failure, recurrent infection, or mortality. These findings support the safety of culture‑guided de‑escalation in adults with malignancy‑associated febrile neutropenia, including HSCT recipients, and highlight the need for larger multicenter studies to confirm generalizability across diverse oncology populations.

Moderators

Rachel Friend

Presenters

Madison Moncus

Evaluators

Rachel Langenderfer

Clinical Pharmacy Specialist - Residency Program Coordinator, Bon Secours St. Francis Downtown

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena J

Infectious Disease (ID), University of Tennessee Medical Center

global Y

4:00pm EDT

Resident Presentation - Shannon Mayberry

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena G

Authors: Shannon R. Mayberry, Cristina Martinez, Benjamin Albrecht, Sujit Suchindran, Sarah B. Green

Resident e-mail for contact: [email protected]

Standard of Care compared to alternative beta-lactam agents in high-inoculum AmpC infections

Purpose/Background:
Treatment of low-risk AmpC-inducible organisms should rely on antimicrobial susceptibility testing (AST) to guide treatment of infection. Current Infectious Diseases Society of America (IDSA) guidelines identify Serratia marcesens, Morganella morganii, and Providencia spp. as low-risk species. Per this guidance, when susceptibility to agents such as ceftriaxone and piperacillin-tazobactam is demonstrated, treatment with that antibiotic is considered appropriate. However, infections with high bacterial burden, including endocarditis and central nervous system (CNS) infections, pose an additional challenge for optimal treatment selection. The IDSA guidelines state cefepime may be reasonable to utilize for high-inoculum infections despite susceptibility to ceftriaxone, due to less risk of AmpC hydrolysis. However, efficacy to cefepime in this setting is uncertain given potential for an inoculum effect, while carbapenems appear less affected. Clinical evidence remains limited, and treatment guidance for high-inoculum AmpC infections is unclear. In this retrospective case series, we describe the clinical outcomes of patients treated with a carbapenem, cefepime, or an alternative beta-lactam agent for deep-seated endovascular and CNS infections due to low-risk AmpC-inducible organisms.

Methods:

This IRB approved, retrospective case series included adults (≥18 years) admitted to Emory Healthcare acute care hospitals between January 1, 2023, and January 31, 2025, with endocarditis, endovascular, or CNS infection due to a low-risk AmpC-inducible organism (Serratia marcescens, Morganella morganii, or Providencia spp.). Patients were identified through diagnosis codes (e.g. endocarditis, endovascular infection, CNS infection) and a positive blood or CNS culture for a low-risk AmpC organism. A total of 28 patients were identified for review. Further exclusion criteria were polymicrobial cultures, switch of therapy after 72 hours, or definitive non–β-lactam or combination therapy. Of this, 10 patients were included for final evaluation. Case data collected included patient demographics, comorbidities, infection characteristics, microbiology, antimicrobial therapy, 30-day all-cause mortality, 90-day infection recurrence, 90-day readmission, and adverse events.

Results:

Ten patients with high-inoculum infections due to low-risk, high inoculum AmpC-inducible organisms were included. Nine infections were caused by Serratia marcescens and one by Morganella morganii. Infection types included endovascular infections (n=6), central nervous system infections (n=3), and infective endocarditis (n=1). Initial antimicrobial regimens varied and included ceftriaxone, cefepime, ceftazidime, and piperacillin/tazobactam, with several patients undergoing antibiotic escalation after organism identification. All but one patient had infectious diseases consultation. Antibiotic modifications were common, ranging from zero to eight changes during admission. One patient experienced inpatient mortality. A single patient had a 90-day infection-related readmission. No consistent signal of clinical failure was observed among patients treated with ceftriaxone compared with cefepime or carbapenems. Despite frequent antimicrobial adjustments, most patients achieved clinical stability without recurrent infection or excess mortality within 90 days.

Conclusions:

In this small retrospective case series, clinical outcomes were similar among patients receiving ceftriaxone, cefepime, or carbapenems for high-inoculum infections caused by low-risk AmpC-inducible organisms. Rates of inpatient mortality and 90-day readmission were low, and no clear outcome advantage was observed with broader-spectrum therapy. These findings suggest that carefully selected non-carbapenem β-lactams may be a reasonable option in certain deep-seated infections when supported by susceptibility data and close clinical monitoring. However, frequent antibiotic escalation highlights ongoing clinician concern regarding inducible resistance and the inoculum effect. Given the limited sample size and descriptive design, definitive comparative conclusions cannot be drawn. Larger, multicenter studies are needed to better define optimal therapy in this high-risk population. Until additional data are available, antimicrobial stewardship decisions should balance theoretical resistance risks with the goal of preserving carbapenem activity.

Moderators

Madison Schwartz

Presenters

Shannon Mayberry

PGY1 Pharmacy Resident, Emory University Hospital

Evaluators

Michelle Turner

PGY1 RPD and Clinical Coordinator, MCNC1Moses Cone Hospital - Cone HealthPGY1

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena G

Infectious Disease (ID), Emory University Hospital

global Y

4:00pm EDT

COMPARATIVE EFFECTIVENESS OF MEROPENEM VS NOVEL β-LACTAMS FOR ESBL BLOOD STREAM INFECTIONS: A RETROSPECTIVE COHORT EVALUATION Valerie Alonso, Anel Couzo, Dana Roth, Pamela Andrews, Jessica Snawerdt, Monica Cozad, Timmy Do AdventHealth Altamonte Springs- A

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena C

Background/Purpose:
Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales bacteremia is associated with increased morbidity and mortality. Although carbapenems are considered standard therapy, their use is not always feasible in clinical practice, emphasizing the need for evidence supporting effective alternative strategies. Newer β-lactam/β-lactamase inhibitor combinations, including ceftolozane/tazobactam and ceftazidime/avibactam, demonstrate activity against ESBL-producing organisms, but comparative effectiveness remains limited.

The purpose of this study was to evaluate clinical outcomes of patients with ESBL bacteremia treated with meropenem compared with ceftolozane/tazobactam, or ceftazidime/avibactam.

Methodology:
This multicenter retrospective cohort study included adult patients (≥18 years) with at least one positive blood culture for ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis who received ≥48 hours of definitive monotherapy with meropenem, ceftolozane/tazobactam, or ceftazidime/avibactam. Patients were identified through electronic medical records reports across AdventHealth hospital campuses. A retrospective chart review was conducted for encounter occurring between August 1, 2022, and December 31, 2025.

The primary outcome was clinical efficacy, defined as a composite of: resolution of fever by day 5, improvement in leukocytosis (white blood cell count ≤10,000/µL) by day 5, no vasopressor requirement at day 5, survival at hospital discharge or 30 days from admission, and absence of recurrent primary infection due to ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis at day 5.

Secondary outcomes included 14-day all-cause mortality, hospital length of stay, need for transfer to a higher level of care ≥48 hours after treatment onset, escalation or change in antimicrobial therapy, and serious adverse events such as Clostridioides difficile infection and seizures. A Desirability of Outcome Ranking (DOOR) analysis was performed to evaluate overall clinical outcomes incorporating treatment response, safety events, and mortality.

Results:
A total of 68 patients met inclusion criteria and were included across three treatment groups: meropenem (MEM, n=44), ceftolozane/tazobactam (C/T, n=10), and ceftazidime/avibactam (CZA, n=14). Baseline characteristics were generally comparable between groups, with similar illness severity based on Pitt bacteremia scores. Clinical success rates did not significantly differ between treatment groups (MEM 68.2% vs C/T 70% vs CZA 78.6%; p>0.05). No statistically significant differences were observed in recurrence of infection, 14-day all-cause mortality, hospital length of stay, transfer to higher level of care, or adverse events such as seizures. However, antibiotic change occurred significantly more often in the BL/BLI groups compared with meropenem (C/T 30%, p<0.001; CZA 21.4%, p=0.002), with most changes involving transition to meropenem therapy. DOOR analysis demonstrated similar overall patient outcomes across treatment groups without statistically significant differences.

Conclusions:
In this multicenter retrospective cohort study, meropenem and novel β-lactam/β-lactamase inhibitor agents demonstrated comparable clinical efficacy and mortality outcomes for treatment of ESBL bloodstream infections. While overall outcomes were similar, meropenem showed greater therapeutic stability, reflected by the absence of antibiotic change. Interpretation is limited by the retrospective design and small sample size, highlighting the need for larger prospective studies to better define the role of these agents in ESBL bacteremia management.

Moderators

Natalie Hurst

Presenters

Valerie Alonso

Evaluators

Nathaniel Swanson

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena C

Internal Medicine (IM), AdventHealth Altamonte Springs

global Y

4:00pm EDT

Evaluating the Duration of Mupirocin’s Effect on Methicillin-Resistant Staphylococcus aureus Nares Polymerase Chain Reaction Validity

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Parthenon 1

Background:
Mupirocin, an RNA synthetase inhibitor produced by Pseudomonas fluorescens, is widely used for empiric methicillin-resistant Staphylococcus aureus (MRSA) decolonization in hospitalized patients. MRSA nares polymerase chain reaction (PCR) testing is frequently performed on admission to guide antimicrobial therapy; however, the effect of prior mupirocin exposure on PCR detectability is not well described.
Methods:
This retrospective cohort study was conducted across Ballad Health facilities from August 2022 to July 2025. Adults aged ≥18 years with documented MRSA colonization within one year who completed a five-day mupirocin decolonization course during a prior admission and underwent MRSA nares PCR testing on readmission were included.
The primary endpoint was median time in days from mupirocin completion to repeat PCR testing, compared between PCR-positive and PCR-negative groups. Secondary endpoints included MRSA culture positivity on readmission and concordance between PCR and culture results, assessed using McNemar’s test and Cohen’s kappa.
Results:
Among 124 readmissions, 84 (68%) patients had positive and 40 (32%) had negative MRSA nares PCR results. Median time to PCR testing did not significantly differ between PCR-positive (77 days; IQR 38.3–120.8) and PCR-negative groups (52 days; IQR 26–118.5; p = 0.18).
When stratified by time since mupirocin completion, PCR positivity was 59.5% (25/42) within ≤60 days, 78.6% (22/28) at 61–90 days, 66.7% (12/18) at 91–120 days, and 69.4% (25/36) at >120 days. Differences across these intervals were not statistically significant (χ² p = 0.15).
MRSA was isolated in 11 cultures during the index admission and in 23 cultures on readmission, most commonly from wound, respiratory, and blood specimens. During the index admission, 18% (22/124) of patients with a positive PCR had a corresponding positive MRSA culture. On readmission, overall observed agreement between PCR and culture results was 52.4%, with a Cohen’s kappa coefficient of 0.20. McNemar’s test indicated statistically significant discordance between PCR and culture findings (p < 0.05), predominantly attributable to PCR-positive, culture-negative pairs.
Conclusions:
In this study, timing of prior mupirocin exposure was not associated with reduced MRSA nares PCR detectability on readmission. Although culture positivity increased on readmission, concordance between PCR and culture remained limited. Evaluation within a larger cohort is warranted.

Moderators

Rion Poland

Presenters

Robert Berger

Evaluators

Sophea Chan

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Parthenon 1

Internal Medicine (IM), Johnson City Medical Center

global Y

4:00pm EDT

Impact of a pilot standardized, multi-preceptor approach to acute care medicine APPEs on student outcomes & preceptor satisfaction

Thursday April 30, 2026 4:00pm - 4:20pm EDT

Athena I

Background and Purpose: Increasing complexity in healthcare has led to the growth of pharmacists' clinical responsibilities, requiring a high level of adaptability and critical thinking. Therefore, pharmacy graduates need strong critical thinking and problem-solving skills to navigate complex patient care. Because of this, pharmacy school curriculum promotes critical thinking development through as case-based learning in the classroom setting, culminating with experiential learning that further emphasizes analysis and application. Previous studies have explored multi-preceptor approaches to advanced pharmacy practice experiences (APPE) to enhance student learning; however, these studies were not focused on critical thinking and had no direct evaluation of preceptor satisfaction. The purpose of this pilot study was to evaluate the impact of a standardized, multi-preceptor approach to acute care medicine APPEs on student critical thinking skills and preceptor satisfaction.
Methods: This was an IRB-exempt, single center pilot study conducted from September 1st, 2025 to April 30th, 2026. During September 2025, a team of Acute Care Medicine APPE preceptors developed and implemented a standardized, multi-preceptor approach consisting of eight scheduled case-based active learning sessions focused on core internal medicine topics. The sessions were designed to enhance students’ critical thinking and clinical problem-solving skills. As part of their rotation, students were given a pre- and post-rotation competency assessment consisting of sixteen multiple-choice, case-based questions aligned with content from the eight sessions (maximum score: 16). The pre- and post-rotation assessments varied slightly but tested the same core concepts. Improvement in student critical thinking was measured by the change in pre- and post-rotation assessment scores. Preceptor satisfaction was assessed using an anonymous online survey at the end of the study period, consisting of ten Likert scale and three free response questions. All student assessment data were collected as part of routine educational activities within the rotation and analyzed in aggregate. Scores of all 4th year pharmacy students completing an Acute Care Medicine rotation in either Internal Medicine or Family Medicine at Wellstar MCG Health during the study period were included. Preceptors were included in the study if they served as the primary preceptor for at least one pharmacy student within the same timeframe. Change in assessment scores was analyzed using a paired t-test. All other results were analyzed using descriptive statistics.
Results: Assessment data from 12 APPE students and survey responses from 6 preceptors were included in the analysis. Prior to acute care medicine rotation, the students included in the analysis had a median of 3 direct patient care APPE rotations [IQR: 2-3] and a median of 1 acute care APPE rotation [IQR: 1-2]. Average assessment scores increased significantly from pre- to post-rotation (8.08 vs 10.17, p = 0.0036). Across the 10 Likert-scale items, the majority of responses indicated agreement or strong agreement. Preceptors most strongly endorsed statements regarding team precepting effectiveness (16.7% agree, 83.3% strongly agree), student experience consistency (16.7% agree, 83.3% strongly agree), and critical thinking development (50% agree, 50% strongly agree). In free response questions, preceptors highlighted prespecified case-based discussions and collaborative scheduling as key strengths of the model.
Conclusions: In this pilot study, 4th year pharmacy students demonstrated improved case-based assessment scores following an acute care medicine with a standardized, multi-preceptor model. This suggests that a multi-preceptor, case-based approach may support development of student critical thinking skills. Preceptors reported high satisfaction with the standardized model, with all preceptors in agreement that the acute care medicine team worked together effectively to precept students.

Moderators

Kendall Huntt

PGY1 Residency Program Coordinator, Emory University Hospital

Presenters

Andrew Bennett

Evaluators

Kendra Brookshire

Associate Chief, Outpatient Clinical Pharmacy Services, Birmingham VA Healthcare System

Thursday April 30, 2026 4:00pm - 4:20pm EDT
Athena I

Internal Medicine (IM), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

4:20pm EDT

Clearing the Air: Impact of a Pharmacist-led Pulmonary Medication Management Clinic

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena D

Clearing the Air: Impact of a Pharmacist-led Pulmonary Medication Management Clinic

Chloe Warren, Christopher Rogers, Lauren Young, Danielle Dennis, Sabrina Fineberg, Dana Walters, Kellie Ball
University of Tennessee Medical – Knoxville, TN

Purpose: To evaluate the impact of a pharmacist-led medication management clinic, providing patient education and specialty medication access support in the setting of high costs, insurance and PBM restrictions, and limited pharmacy networks that contribute to treatment delays

Methods: This retrospective chart review consists of 172 patients who are active patients with the pharmacist-led medication management clinic services between December 2023 and June 2025. Eligible patients were 18 years or older, had at least one documented visit with a clinical pharmacist, carried a diagnosis of asthma, chronic obstructive pulmonary disease, or interstitial lung disease, and were referred by a pulmonologist for medication education and access assistance. The primary outcome looked at the percentage of days covered for medications filled at a health-system specialty pharmacy. Secondary outcomes included the total time to treatment measured in days. Additional data collection included the pulmonary disease state of the patient and initial visit billing code utilized.

Results: Overall, 90.6% of patients achieved greater than 90% of days covered (PDC), which is above the standard metric of 80% for specialty medication adherence. As for the secondary outcome, the average time to treatment was 2.17 days.

Conclusion: Overall, this study reinforces the expanding role of clinical pharmacists in specialty care delivery models. By addressing both clinical and administrative barriers, pharmacists are uniquely positioned to improve access, adherence, and overall quality of care for patients receiving specialty medications. Their involvement not only supports patients but also alleviates workload burdens for providers and enhances coordination across the healthcare system.

Link: https://docs.google.com/document/d/e/2PACX-1vS6hc93X09DzHIrP9LAM05FIvxd6iYh9am_wF7kl1NMMFZyVzSKUCQQS2gGv_oCROiAuk2Ht5MxuwF-/pub

Moderators

Alison Martin

Presenters

Chloe Warren

PGY2 Ambulatory Care Pharmacy Resident, University of Tennessee Medical

Evaluators

Martin Gordon

Clinical Pharmacy Specialist - Critical Care, Spartanburg Medical Center

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena D

Ambulatory Care (AMB), University of Tennessee Medical Center

global Y

4:20pm EDT

Evaluation of Antibiotic Prescribing Practices in Adult Female Patients with Asymptomatic Bacteriuria or Uncomplicated Cystitis

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena B

Authors
Liz Lively, Amanda Stankowitz, Alexander Tunnell, Mallorie Vaughn

Background
A multitude of organizations have released guidelines to aid providers in the treatment of urinary tract infections in women based on pregnancy status. The Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: 2010 Update by the IDSA provide specific recommendations for drug therapy and treatment options for non-pregnant women. According to the 2019 IDSA guidelines for asymptomatic bacteriuria (ASB), antibiotics should not be prescribed to treat women who have ASB but are not pregnant. Conversely, according to the 2023 ACOG Clinical Consensus for urinary tract infection, pregnant women with bacteria in the urine should be prescribed antibiotics, regardless of symptoms. The goal of this study was to assess the current state of antibiotic prescribing practices for female patients diagnosed with ASB or uncomplicated cystitis at two outpatient primary care offices, WT Anderson Community Health Center (WTACHC) and Primary Care West Macon (PCWM).

Methods
Researchers utilized a database generated report to conduct a chart review of all women who had a primary diagnosis of ASB, UTI, or cystitis as documented by ICD-10 code. Females ages 18 and older were included if they were seen at WTACHC or PCWM from January 1, 2024 to December 31, 2024. The primary outcome of this study was the percent of women seen at WTACHC or PCWM who were diagnosed with ASB and treated appropriately per IDSA or ACOG guidelines. Secondary outcomes evaluated the percent of women who were diagnosed with ASB and treated appropriately based on pregnancy status and location. Additional secondary outcomes included the incidence of misdiagnosis of uncomplicated cystitis without documented symptoms of a UTI and a descriptive analysis of the antibiotics prescribed, duration of therapy, and whether they align with recommended practices for empiric treatment of ASB or uncomplicated cystitis per IDSA or ACOG guidelines.

Results
Of the 93 subjects included in the study, six were from WTACHC and 87 from PCWM. Regarding the primary outcome, 28.6% (4/14) of adult women seen at WTACHC or PCWM met criteria for ASB and were treated appropriately. For secondary outcomes, overall, 33.3% (4/12) of non-pregnant women and none (0/2) of the pregnant women who were diagnosed with ASB were treated appropriately. There were no patients seen at WTACHC diagnosed with ASB, all six at this location had uncomplicated cystitis. Therefore, it was not possible to assess this secondary outcome at WTACHC. At PCWM, 28.6% (4/14) met criteria for ASB and were treated appropriately. Of all patients diagnosed with uncomplicated cystitis, 22.9% (19/83) were misdiagnosed due to lack of documented UTI symptoms. A total of 83 patients were prescribed antibiotics, most commonly with nitrofurantoin at 62.7% (52/83) or SMX/TMP at 16.9% (14/83). Of the patients who were prescribed antibiotics, 90.4% (75/83) were prescribed an appropriate antibiotic per the IDSA or ACOG guidelines. However, only 55.4% (46/83) were treated with the appropriate duration, which varies from 5-10 days based on agent and pregnancy status. The overall average duration of prescribed therapy was 6.29 days. Among the entire sample, 44.1% (41/93) of patients were treated appropriately for uncomplicated cystitis or ASB.

Conclusion
A majority of patients seen at WTACHC and PCWM diagnosed with ASB in 2024 were not treated per guidelines. Most of the patients diagnosed with uncomplicated cystitis were prescribed an appropriate antibiotic, but many had treatment durations beyond IDSA and ACOG guidance. Lack of documentation of symptoms may have falsely elevated the number of patients with ASB. Additionally, a significant limitation was identified in using ICD-10 coding to identify ASB, which limited the study population. Future initiatives should instead utilize urine culture to fully capture patients with ASB.

Moderators

Lauren Lyons

Clinical Pharmacist - Advanced Heart Health Center, Prisma Health

Presenters

Liz Lively

Evaluators

Laurie Leith

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena B

Ambulatory Care (AMB), Atrium Health Navicent The Medical Center

global Y

4:20pm EDT

Review of urine drug screens of patients on buprenorphine-naloxone products at a family medicine office based opioid treatment (OBOT) program

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Olympia 1

Authors: Maria Onusko, Olivia Caron, Marcia Thacher, Carriedelle Fusco, and Nabarun Dasgupta

Background: Buprenorphine is a life-saving treatment for opioid use disorders (OUD) often co-formulated in a sublingual product with the opioid antagonist naloxone as a diversion prevention measure. While pharmacokinetic studies suggest the amount of naloxone absorbed with proper sublingual administration is negligible, some studies have observed more interpatient variability.1,2,3 Patients can report adverse effects of the combination, buprenorphine-naloxone product, such as headache, nausea, vomiting, dyspepsia, diaphoresis, and fatigue.4 This study sought to assess the levels of naloxone detected in confirmatory urine drug screens (UDS), interpatient variability of naloxone absorption, and any patient specific characteristics (labs, comorbidities, concurrent medications) that may impact absorption of naloxone sublingually. Chart reviews were also conducted to identify any withdrawal symptoms reported at the time of the drug screen. This study was conducted at the Mountain Area Health Education Center (MAHEC), a federally qualified health center in Asheville, NC. The OBOT clinic is a part of one of MAHEC’s outpatient family medicine clinics.

Methods: As a qualitative improvement project, the research team requested a registry for all patients on buprenorphine-naloxone products between 5/1/2023 and 9/1/2024. Data points extracted from EHR include patient name, patient identification number, date of birth, age, height in inches, weight in kilograms, primary insurance carrier, concomitant benzodiazepine prescribed, type of buprenorphine-naloxone product, strength of product, duration of medication for OUD treatment at Mountain Area Health Education Center’s OBOT program, serum creatinine, LFTs, and date of last BMP. Two PharmD students manually extracted the following data points between 7/1/24 and 9/30/24: dosing instructions, total daily buprenorphine dose, total daily naloxone dose, quantities of buprenorphine, norbuprenorphine, and naloxone present on UDS, any other positive results on UDS, date of last confirmatory urine drug screen, any withdrawal symptoms reported at time of UDS, and other pertinent comorbidities (Hepatitis C, NASH, cirrhosis). Due to the high number of patients with reported naloxone, this project was expanded to a research analysis. IRB #2402187 submitted in March 2025 and granted exemption. Data will be analyzed by a research scientist. Results will be reviewed and themes identified by the research team.

Results
In progress

Conclusions:
In progress

References:

Heidbreder C, Fudala PJ, Greenwald MK. History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder. Drug and Alcohol Dependence Reports. 2023;6:100133. doi:10.1016/j.dadr.2023.100133

Strickl DM, Burson JK. Sublingual Absorption of Naloxone in a Large Clinical Population. Journal of Drug Metabolism & Toxicology. 2018;9(4):1-4. Accessed March 31, 2026. https://www.longdom.org/open-access/sublingual-absorption-of-naloxone-in-a-large-clinical-population-25281.html

Michel I, Ochal D, Paharia A, Jannetto P, Breitinger S, Oesterle T. Absorption of naloxone in patients prescribed buprenorphine‐naloxone. The American Journal on Addictions. Published online February 2, 2025. doi:https://doi.org/10.1111/ajad.13674

Providers Clinical Support System Medications for Opioid Use Disorders Buprenorphine Prescribing Flexibility: Buprenorphine Prescribing Flexibility: Buprenorphine Monoproduct for Adverse Effects Buprenorphine Monoproduct for Adverse Effects from Buprenorphine/Naloxone from Buprenorphine/Naloxone. https://pcssnow.org/wp-content/uploads/2024/03/Buprenorphine-Prescribing-Flexibility.pdf

Moderators

Ryan Tilton

Presenters

Maria Onusko

Evaluators

Katie Coffee

PGY1 Residency Program Director, Kaiser Permanente Georgia

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Olympia 1

Ambulatory Care (AMB), Mountain Area Health Education Center /UNC Eshelman School of Pharmacy

global Y

4:20pm EDT

Impact of Vasopressin Initiation Timing on Outcomes of Septic Shock Patients Receiving Norepinephrine

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena J

TITLE: Impact of Vasopressin Initiation Timing on Outcomes of Septic Shock Patients Receiving Norepinephrine

AUTHORS: Somer Pye, Steven Robinette, Jacquelyn Bryant, Logan Doriety

OBJECTIVE: Assess the timing of vasopressin addition to norepinephrine in intensive care unit patients experiencing septic shock and the potential impact it has on patient outcomes.

SELF-ASSESSMENT QUESTION: According to the 2026 Surviving Sepsis Guidelines, which vasopressor is recommended second line to norepinephrine in septic shock?

BACKGROUND: According to the 2021 Surviving Sepsis Guidelines, norepinephrine is recommended as the first-line vasopressor, with the addition of vasopressin as a second-line agent when mean arterial pressure cannot be maintained above 65 mmHg. However, the optimal timing for vasopressin initiation remains undefined.

METHODS: This is a retrospective, single-center cohort study of adult patients in the ICU at McLeod Regional Medical Center that received norepinephrine and vasopressin for at least 8 hours with an electronic diagnosis grouper (EDG) coded diagnosis of severe sepsis with septic shock between August 1, 2023 and July 31, 2025. The primary outcome of this evaluation includes length of time to achieving and maintaining a MAP of 65 mmHg for at least 4 hours without the need for additional vasoactive agents. Secondary outcomes included norepinephrine dose at 3 hours after vasopressin was initiated, incidence of in-hospital mortality, and ICU length of stay.

RESULTS: A total of 170 patients were screened with 120 patients meeting the inclusion criteria. Of these, 33 were included in the vasopressin <3 hours group, and 87 belonged to the vasopressin ≥3 hours group. All baseline characteristics were similar across the two groups including age, sex, comorbidities, and initial resuscitation strategies with borderline differences in SOFA scores. The primary outcome was achieved in 4.5 hours ([IQR] 4-5) in the vasopressin <3 hours group and 4.3 hours ([IQR] 4-5) in the vasopressin ≥3 hours group (p= 0.55). Secondary outcomes in both groups are as follows: norepinephrine dose at 3 hours (mcg/kg/min) (0.45 [IQR] 0.24-0.5 vs. 0.3 [IQR] ) 0.2-0.5, p=0.33), in-hospital mortality (63.6% vs. 66.6%, p= 0.75), ICU length of stay (days) (5 [IQR] 3-7 vs. 7 [2-13], p=0.12). A subgroup analysis was performed to analyze patients that survived through vasopressor discontinuation. The primary outcome was achieved in 4.5 hours ([IQR] 4-4.7) in the early vasopressin group and 4.2 hours ([IQR] 4-4.7) in the late vasopressin group (p= 0.65).Secondary outcomes for both groups were as follows: norepinephrine dose at 3 hours (mcg/kg/min) (0.3 [IQR] 0.21-0.5 vs. 0.3 [IQR] 0.18-0.4, p=0.40), in-hospital mortality (42.1% vs. 34%, p= 0.26), ICU length of stay (days) (6 [IQR] 4.5-8.5 vs. 11.5 [IQR] 7-16, p=<0.001). Exploratory outcomes of renal dysfunction were as follows: improvement in Scr over 72 hours (57.9% vs. 41.7% p= 0.22), total UOP over 72 hours (mL/kg/hr) (1.80 [IQR] 1.30-2.50 vs. 1.35 [IQR] 0.37-2.5, p=0.59), and new requirement of renal replacement (25.9% vs 34.7%, p= 0.41). Additionally, average time to vasopressin initiation once norepinephrine dose reached 0.15 mcg/kg/min was analyzed between the two groups and was 1.5 hours ([IQR] 0.73-2) and 8 hours ([IQR] 4.46-25.32), respectively.

CONCLUSION: In this retrospective cohort study, early vasopressin initiation (< 3 hours) was not associated with a statistically significant difference in time to achieving goal MAP or in-hospital mortality compared to later initiation (≥ 3 hours). A shorter ICU length of stay was observed in the subgroup analysis but should be interpreted cautiously. These findings contribute to the existing body of evidence suggesting that vasopressin timing alone may not significantly impact clinical outcomes. Future studies with larger sample sizes should further evaluate optimal timing of vasopressin initiation while accounting for patient severity and dynamic clinical factors.

Moderators

Rachel Friend

Presenters

Somer Pye

PGY-1 Pharmacy Resident, McLeod Regional Medical Center

Hi! My name is Somer Pye and I am a PGY-1 Pharmacy Resident at McLeod Regional Medical Center in Florence, South Carolina. I earned my Doctor of Pharmacy degree from Presbyterian College School of Pharmacy in Clinton, South Carolina.

Evaluators

Rachel Langenderfer

Clinical Pharmacy Specialist - Residency Program Coordinator, Bon Secours St. Francis Downtown

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena J

Critical Care/Emergency Medicine (CCM), McLeod Regional Medical Center

global Y

4:20pm EDT

Prophylactic Tocilizumab to Reduce Vasoplegic Syndrome During Left Ventricular Assist Device Implantation

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena A

Objective: Determine if prophylactic tocilizumab reduces the incidence of vasoplegic syndrome (VS) in patients undergoing left ventricular assist device (LVAD) implantation.
Background: Vasoplegic syndrome is a life-threatening complication that occurs in 5% to 25% of patients undergoing cardiothoracic surgery with a mortality rate as high as 25%. Vasoplegic syndrome is characterized by profound systemic hypotension with normal to high cardiac output, requiring treatments such as vasopressors, nitric oxide modulators, (e.g. methylene blue and hydroxocobalamin) and other rescue medications such as angiotensin II. Recent case studies have suggested that tocilizumab may prevent vasodilatory syndromes, including VS. Tocilizumab’s antagonism of interleukin-6 may prevent the vasodilatory response by reducing the body’s cytokine production and inflammatory response. This mechanism may be able to reduce the sterile inflammatory response that is thought to cause VS.
Methodology: This was a retrospective chart review study of adult patients who underwent LVAD implantation at Piedmont Atlanta Hospital between January 2020 and December 2025. Patients were excluded from the study if they had received tocilizumab for alternative indications or had a SARS-CoV-2 infection within 10 days of surgery. The primary outcome of the study was to compare the incidence of VS between those who did and did not receive tocilizumab. Secondary outcomes included adverse drug events attributed to tocilizumab, vasoactive-inotropic score (VIS) at 6 and 24 hours, mortality at 48 hours and 28 days, the need for rescue medications use, infection within 28 days of surgery, the duration of mechanical ventilation, intensive care unit (ICU) length of stay, and mechanical circulatory support post-surgery. Statistical analysis was completed using chi-squared test or Fischer’s exact test. A p-value of < 0.05 was considered statistically significant.
Results: The assessed cohort included 82 patients in the control group and 41 patients in the experimental group. All patients were included in the statistical analysis. When comparing prophylactic tocilizumab to the control group, there was found to be no difference in incidence of VS (26.8% vs 15.9%; p=0.1476. No statistical significance was found between rate of infection (26.8% vs 21.9%; p=0.548), mortality at 48 hours (0% vs 0%; p=0), mortality at 28 days (10% vs 9.8%; p=0.2509), and the use of rescue medications (14.6% vs 9.8%; p=0.1661). There was a significant difference when comparing VIS scores at 6 hours (15; 95% CI 11-21.48 vs 11.96; CI 8.5-17.12, p=0.0098) and at 24 hours (12.33; CI 9.5-15.29 vs 9.25; CI 7.5-15.75).
Conclusions: There was no statistically significant difference seen in the primary outcome of incidence of VS when using prophylactic tocilizumab. There were no statistically significant differences noted in any secondary endpoints, except that tocilizumab may worsen the VIS score at 6 and 24-hours post-surgery and prolong times on the ventilator. Study limitations included the retrospective and small patient population. Prospective trials with a larger sample size are warranted in this population.

Moderators

Kristina Nakhla

PGY1 Residency Program Director, Northside Hospital

Presenters

Nick McConnell

PGY-1 Resident, Piedmont Atlanta Hospital

Evaluators

Michael Behal

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), Piedmont Atlanta Hospital

global Y

4:20pm EDT

Clinical and Microbiological Outcomes of Ertapenem Mono-Resistant Enterobacteriaceae

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena G

Multidrug resistant organisms can be difficult to treat due to limited options and are a public health threat. Increasing rates of antimicrobial resistance have led to high rates of mortality and greater costs for the healthcare system. Isolates are labeled as carbapenem-resistant Enterobacteriaceae (CRE) if noted to have resistance to at least one carbapenem agent or produce a carbapenemase. There are multiple mechanisms of carbapenem resistance including carbapenemase production, porin channel mutations, and overexpression of efflux pumps. The literature suggests that the risk of carbapenemase production is less than 3% in isolates that are resistant to ertapenem but susceptible to meropenem and imipenem-cilastatin. A study by Wang et al showed that ertapenem-mono-resistant isolates were more likely to be susceptible or intermediate to beta-lactams and beta-lactam/beta-lactamase inhibitor combination agents when compared to meropenem and imipenem-cilastatin resistant isolates. However, current Infectious Diseases Society of America (IDSA) guidelines recommend that they be treated with extended infusion of meropenem or imipenem-cilastatin.
The Clinical and Laboratory Standards Institute (CLSI) recently lowered the susceptibility breakpoint of ertapenem from a mean inhibitory concentration (MIC) of <2 to <0.5 µg/mL, increasing the number of isolates that would be labeled as CRE. The purpose of this study was to describe the outcomes in patients with ertapenem mono-resistant Enterobacteriaceae infections, and to compare the use of carbapenem and non-carbapenem antibiotics in ertapenem mono-resistant isolates.
This study was a single-center, retrospective chart review of mono-resistant Enterobacterales isolates from January 1st, 2023 to December 31st, 2024. Mono-resistance is defined as having an ertapenem MIC of > 1 mg/L and meropenem MIC of < 1 mg/L. Patients were included if they were > 18 years old at time of culture collection, were inpatient, and completed an antibiotic course for an infection with a positive culture. At our institution, genotyping data was only available for some blood cultures. Patients were excluded from analysis if cultures were collected at an outside facility, belonged to protected population, and did not receive antibiotic treatment. The comparative groups were patients treated with carbapenems, non-carbapenem beta-lactams, and non-beta-lactam antibiotics. The primary outcome was clinical cure of infection. To strengthen our analysis of the primary outcome, an infectious diseases physician validated the primary outcome. Secondary outcomes included microbiological cure, in-house mortality, and inpatient length of stay. For statistical analysis, chi-square tests and student t-tests were conducted when appropriate.
Ninety-eight isolates were reviewed: 25 (26%) were treated with a carbapenem, 51 (52%) were treated with a non-carbapenem beta-lactam, and 22 (22%) were treated with a non-beta-lactam. Most isolates came from a respiratory (34%) or urinary (20%) sample. Clinical cure rates were similar across three groups, 76% vs 80% vs 77%, respectively (p=0.8955). A multivariable regression analysis adjusted for sex, age, bed-type, polymicrobial culture status, and specimen type revealed no difference in clinical cure between antibiotic groups. When comparing carbapenem and non-carbapenem treated patients, the portion of patients who died was significantly smaller in the non-carbapenem group, (7 patients [28%] vs 4 patients [6%], p=0.006). Length of stay was longer in the carbapenem group when compared to the non-carbapenem group, but this difference was not statistically significant (76 days vs 32 days, p=0.184).
Similar rates of clinical cure were observed in the three different groups (carbapenem, non-carbapenem beta-lactam, and non-beta lactam antibiotics), despite the current IDSA recommendation to use extended-infusion carbapenems for these mono-resistant isolates. Longer rates of length of stay in the carbapenem-treated group may cause a significant burden on our healthcare system. This suggests that most mono-resistant isolates are not carbapenemase producing and could be treated with beta-lactam therapy, if reported as susceptible.

Moderators

Madison Schwartz

Presenters

Liana Ha

PGY-2 Infectious Diseases Pharmacy Resident, Grady Health System

Evaluators

Michelle Turner

PGY1 RPD and Clinical Coordinator, MCNC1Moses Cone Hospital - Cone HealthPGY1

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena G

Infectious Disease (ID), Grady Memorial Hospital

global Y

4:20pm EDT

Evaluation of periprocedural antibiotic practices in high-risk patients undergoing cardiac implantable electronic device placement

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Parthenon 1

Nguyen Minh Anh Ngo, Amanda Sowder
AdventHealth Orlando
Background: Cardiac implantable electronic devices (CIED) are essential for managing arrythmias and preventing sudden cardiac death thereby improving survival. However, transvenous CIED-related infections are a serious complication, occurring in 2% to 4% of high-risk patients yearly. Device-related infections are associated with increased healthcare costs, morbidity, and mortality. The 2023 American Heart Association Update on CIED Infections recommends cefazolin as a standard preprocedural systemic antibiotic, with vancomycin reserved for select patients, and suggest consideration of an antimicrobial envelope in high-risk patients. The use of a novel absorbable antibiotic envelope, coated with rifampin and minocycline eluted to local tissues over nine weeks, has been shown to reduce infection rates in CIED patients compared to standard care; however, data in high-risk populations remain limited. While the BLISTER study validated the use of a risk stratification tool to identify patients most likely to benefit from the antibiotic envelope with a qualifying score threshold over five, the comparison group used in this study received antibiotics that do not align with current recommendations. Currently, practical use of prophylactic antibiotic regimens varies at physicians’ discretion despite existing guidance. This study aims to describe outcomes of antibiotic envelope use compared to real-world antibiotic prophylaxis regimens in high-risk patients undergoing CIED placement.

Methods: Adult patients undergoing transvenous CIED placement, including first placement, generator exchange, or upgrade, at AdventHealth Orlando between October 1, 2024 and September 30, 2025 were identified using electronic health records report generation. Key exclusion criteria included epicardial pacing lead placement, leadless pacemaker, subcutaneous implantable cardioverter-defibrillators, or temporary pacing systems. High-risk patients were identified using the BLISTER score. The primary outcome was incidence of CIED-related infections at 12 months. Secondary outcomes included incidence of pocket hematoma, infection-related hospitalization, and all-cause mortality at 12 months.

Results: During the interim timeframe (October 1, 2024 – December 26, 2024), 265 patients were screened; 50 high-risk patients were identified based on BLISTER score of 6 or greater. Of these, 24 received the antibiotic envelope and 26 received other antibiotic prophylaxis. Baseline characteristics were well-balanced between groups, with a mean age of 70 years, 70% male, and 60% with history of severe left ventricle dysfunction. The majority of patients underwent cardiac resynchronization therapy-related procedure (86% new implant or generator exchange), followed by pacemakers (8%) and implantable cardioverter-defibrillators (6%). Regarding procedure type, 44% had generator exchanges and median procedure duration was 74 minutes (IQR 42 – 112 minutes). Antibiotic appropriateness, based on institutional standards, was 92% in the envelope group and 85% in the other antibiotics group. CIED-related infection at 12 months for the antibiotic envelope versus other antibiotics group was comparable between groups (4.1% vs 3.8%). Secondary outcomes resulted as follows: pocket hematoma (8.3% vs 3.8%), infection-related hospitalization (8.3% vs 15.3%), and all-cause mortality (20.8% vs 15.3%).

Conclusion: In this interim analysis, CIED-related infection rates were similar between patients receiving antibiotic envelope and those receiving other antibiotic prophylaxis regimens. While infection-related hospitalization showed higher rates in the other antibiotics group, these cases were driven by infectious sources outside of CIED. Additionally, the high all-cause mortality across both groups reflects the baseline risk of this patient population. These preliminary findings highlight the potential for cost savings supporting a default strategy of prophylactic antibiotics over antibiotic envelope. Moreover, standardized use of pre-procedural risk stratification tool prior to CIED procedures may allow for individualized approaches. Larger prospective studies are warranted to further define the role of antibiotic envelope use compared to real-world antibiotic strategies in high-risk patients.

Moderators

Rion Poland

Presenters

Nguyen Minh Anh Ngo

PGY1 Pharmacy Resident, AdventHealth Orlando

Evaluators

Sophea Chan

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Parthenon 1

Infectious Disease (ID), AdventHealth Orlando

global Y

4:20pm EDT

Identification of risk factors for beta-lactam resistant Pseudomonas aeruginosa bacteremia

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena I

Title: Identification of risk factors for beta-lactam resistant Pseudomonas aeruginosa bacteremia

Background: Pseudomonas aeruginosa bloodstream infections (BSI) are associated with significant morbidity and mortality. Increasing resistance to antipseudomonal beta-lactams, including piperacillin-tazobactam, cefepime, and carbapenems, has complicated empiric treatment strategies. Currently, institutional risk factors for beta-lactam resistant P. aeruginosa are largely derived from studies of respiratory isolates, which may not accurately reflect resistance patterns or risk factors in bloodstream infections. The goal of this study is to evaluate risk factors for beta-lactam resistant Pseudomonas aeruginosa bacteremia.

Methods: This retrospective cohort study included patients 18 years and older within the Prisma Health system with a positive blood culture for P. aeruginosa from March 1, 2021 to August 31, 2025. The first positive blood culture within a 12-month period was included. Patients were excluded if they had cystic fibrosis. The primary objective of this study was to identify patient-specific risk factors for beta-lactam resistant P. aeruginosa BSIs (defined as resistance to cefepime or piperacillin-tazobactam). The secondary objectives were to identify risk factors for carbapenem-resistant P. aeruginosa bacteremia, determine predictors for isolates with elevated minimum inhibitory concentrations (MICs), and evaluate susceptibility patterns to novel antibiotics. Multivariate logistic regression was performed to determine independent predictors of beta-lactam and carbapenem resistance, as well as factors associated with isolates exhibiting elevated MICs.

Research & Conclusion: In progress

Moderators

Kendall Huntt

PGY1 Residency Program Coordinator, Emory University Hospital

Presenters

Madison Nordin

PGY2 Infectious Diseases Pharmacy Resident, Prisma Health Richland Hospital

Evaluators

Kendra Brookshire

Associate Chief, Outpatient Clinical Pharmacy Services, Birmingham VA Healthcare System

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena I

Infectious Disease (ID), Prisma Health Richland - University of South Carolina

global Y

4:20pm EDT

Evaluation of apixaban dosing strategies for venous thromboembolism in patients receiving hemodialysis

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena C

Title: Evaluation of apixaban dosing strategies for venous thromboembolism in patients receiving hemodialysis

Authors: Hayden Caldwell, Blake Sloan, Ryan Tilton, Ryan Imel, Grace Barr, Caitlin Hastings, & Brittney Bright

Background: Venous thromboembolism (VTE) is categorized as deep venous thromboembolism (DVT) or pulmonary embolism (PE) caused by the formation of a thrombus in the veins of the lower extremities or pulmonary arteries. Apixaban is a factor Xa inhibitor approved for the indication of VTE treatment. Apixaban is mainly metabolized by CYP3A4 with other CYP enzymes contributing to minor metabolism. Apixaban is 87% protein bound and approximately 27% renally eliminated. However, patients with end stage renal disease (ESRD) receiving hemodialysis were not included in initial trials which established dosing. Existing literature is limited regarding whether to omit or include the loading dose of apixaban (10mg twice daily for 7 days) in this patient population. Given that a percentage of apixaban is renally cleared, there is concern regarding an increased bleed risk in patients with ESRD on HD receiving the standard loading dose. Current clinical practice varies and may be influenced by provider preference.

Methods: This study evaluated the safety and efficacy of the apixaban loading dose versus no loading dose in patients with ESRD on hemodialysis receiving treatment for VTE. We conducted a multi-center, retrospective cohort study at North Carolina Baptist Hospital and Atrium Health High Point Medical Center. Eligible patients included adults who have ESRD receiving hemodialysis and developed a VTE treated with apixaban from April 2024 to October 2025. Patients were excluded if they had antiphospholipid syndrome, received concurrent CYP3A4 inducers/inhibitors, received continuous renal replacement therapy, received apixaban 2.5mg, or received greater than or equal to seven days of parenteral anticoagulation prior to starting apixaban. The primary outcome was the incidence of recurrent VTE or progression of DVT to PE within 90 days after apixaban initiation. Secondary outcomes were the occurrence of major bleeding and clinically relevant non-major bleeding within 14 days of apixaban initiation defined by the International Society on Thrombosis and Haemostasis . Statistical analyses included descriptive statistics using t-test for continuous variables, Fischer’s exact test for categorical variables, and mean and interquartile range for various characteristics.

Results: There were 30 patients included in this study, 18 patients in the apixaban load group, and 12 patients in the apixaban no-load group. The most common reason for not being included in this study was receipt of parenteral agents for greater than seven days and chronic VTE. There were more patients in the apixaban load group with liver disease with seven in the load group and one in the no load group. Overall, comorbidities were similar between the two groups except there were more patients in the load group that had liver disease with seven patients in the load group and one patient in the no load group. The primary outcome was incidence of recurrent VTE or progression of DVT to PE, which occurred in one (5.6%) patient in the apixaban load group and zero (0.0%) in the apixaban no-load group. The secondary outcome of occurrence of major bleeding within 14 days occurred in two (11.1%) patients in the apixaban load group and zero (0.0%) in the apixaban no load group. The other secondary outcome of clinically relevant non-major bleeding within 14 days occurred in one (5.6%) patient in the apixaban load group and one (8.3%) patient in the no load group.

Conclusion: The results of this study were inconclusive due to the small sample size and low incidence of outcomes. The overall low sample size limited the ability to perform appropriate statistical analysis. The observed data showed a possible increased incidence of major bleeding events, but statistical significance is indeterminant. Further studies with larger sample sizes are needed to determine any changes needed in clinical practice.

Moderators

Natalie Hurst

Presenters

Hayden Caldwell

Evaluators

Nathaniel Swanson

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena C

Internal Medicine (IM), High Point Medical Center, Atrium Health Wake Forest Baptist

global Y

4:20pm EDT

Evaluation of Phosphorus Replacement Protocol Implementation during CRRT

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Athena H

Evaluation of Phosphorus Replacement Protocol Implementation during Continuous Renal Replacement Therapy (CRRT)
Emma Smits, Morgan Vincent, Mike Maccia
Cone Health at Moses Cone Hospital - Greensboro, NC

Background:
Continuous renal replacement therapy (CRRT) is a common modality of renal replacement therapy among critically ill patients. However, hypophosphatemia is a frequent complication of CRRT, with several studies reporting incidence of at least 60%. This risk increases with CRRT duration, especially when a phosphorus-free dialysate is utilized. The pre-filter, post-filter, and dialysate fluids for CRRT at Cone Health do not contain phosphorus. Hypophosphatemia in critically ill adults has been associated with increased duration of ventilatory and vasopressor support, prolonged hospital and intensive care unit (ICU) stay, and increased 28-day mortality. In June 2025, Cone Health introduced a protocol for pharmacist-driven replacement of phosphorus among patients receiving CRRT. This study aimed to evaluate the effectiveness of this protocol in reducing the incidence of hypophosphatemia and related clinical outcomes.
Methods:
This was a retrospective, pre-post comparator study of adults hospitalized within Cone Health ICUs who received CRRT. Data was collected from February to May 2025 for the pre-intervention group and July to November 2025 for the post-intervention group. Patients were excluded for receipt of total parenteral nutrition (TPN), death within 72 hours of CRRT initiation, or receipt of CRRT for less than 72 hours in duration. The primary endpoint was the incidence of hypophosphatemia within the first 72 hours. Secondary endpoints included percentage of phosphorus levels in goal range, change in phosphorus level following replacement, number of phosphorus replacements, ordering user type, time to development of hypophosphatemia, time to phosphorus replacement from low phosphorus level, mechanical ventilation duration, and in-hospital mortality. Endpoints were compared using Chi square, t-test, Fischer’s exact test, or Mann-Whitney U test as appropriate.
Results:
Ninety patients were included in the evaluation (n=45 in each group). The rate of hypophosphatemia was 60% in the pre-protocol group and 68% in the post-protocol group (p=0.51). In the post-protocol group, pharmacists served as the ordering provider more frequently than either physicians or advanced practice providers (75% vs 45%, p=0.028). Most secondary outcomes were similar between groups.
Conclusions:
Implementation of a pharmacist-driven phosphorus replacement protocol during CRRT did not reduce incidence of hypophosphatemia but did increase the proportion of phosphorus replacements completed by pharmacists. Potential limitations include limited sample-size, single-institution study, and possible variation in workflow or practice between individual ICUs. Future directions include assessment of barriers to utilization of the phosphorus replacement protocol and identification of strategies to increase utilization.

Moderators

Jenna Jewett

Presenters

Emma Smits

PGY1 Pharmacy Resident, Cone Health

My name is Emma Smits, PharmD, and I am a PGY1 Pharmacy Resident at Cone Health at Moses Cone Hospital. I attended pharmacy school at the University of North Carolina at Chapel Hill. I am continuing my postgraduate training next year in the PGY2 Pediatric Pharmacy Residency Program... Read More →

Evaluators

Sarah McDaniel

Antimicrobial Stewardship Coordinator, Baptist Medical Center South

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Athena H

Internal Medicine (IM), Cone Health

global Y

4:20pm EDT

Impact of 2025 Acute Coronary Syndromes Guidelines on Prescribing Practices at a Tertiary Medical Center - Taylor Butler

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Parthenon 2

Background: In February 2025, the American College of Cardiology (ACC) and American Heart Association (AHA) released updated guidelines for acute coronary syndrome (ACS) management. Key medication-related updates include a preference for ticagrelor or prasugrel over clopidogrel in patients undergoing percutaneous coronary intervention (PCI), as well as more aggressive lipid management strategies recommending the addition of non-statin therapies in patients who do not achieve recommended low-density lipoprotein cholesterol (LDL-C) targets of < 55-70 mg/dL despite maximally tolerated statin therapy. This study aims to evaluate changes in prescribing patterns following guideline release at a tertiary medical center and to identify potential barriers to adoption.
Methods: This single-center, retrospective cohort study will evaluate adult patients diagnosed with Non–ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI) who underwent PCI between October 1, 2024 and January 31, 2025 (pre-guideline cohort), and June 1, 2025 and September 30, 2025 (post-guideline cohort). Patients requiring coronary artery bypass graft (CABG) surgery will be excluded. A three-month washout period following publication of the updated guidelines until June 1, 2025 was incorporated to allow for integration into clinical practice. Data will be abstracted from the electronic medical record (EMR) and will include patient demographics, ACS presentation, baseline laboratory values, and medication prescribing patterns, including discharge antiplatelet therapy and lipid-lowering therapy. All data will be de-identified prior to analysis. Descriptive statistics will be used to summarize baseline characteristics and prescribing patterns. Categorical variables will be compared between cohorts using chi-square analysis to evaluate differences in guideline adoption before and after publication. Statistical significance will be defined as a p-value <0.05.
Results: A total of 442 patients with STEMI or NSTEMI were screened, of whom 97 met inclusion criteria (pre-guideline cohort n=46; post-guideline cohort n=51). Baseline characteristics were generally similar between groups, although statin intolerance was more common in the post-guideline cohort (13.7% vs 2.2%, p=0.037) and oral anticoagulant use at discharge was lower (9.8% vs 26.1%, p=0.035). Appropriate P2Y12 inhibitor prescribing at discharge increased numerically following guideline publication (50% vs 56.9%), though this difference was not statistically significant (p=0.499); however, the distribution of discharge P2Y12 inhibitor selection differed significantly between cohorts (p=0.001), with increased use of prasugrel and ticagrelor and reduced use of clopidogrel post-guideline. Nonstatin lipid-lowering therapy prescribing increased from 15.2% to 23.5% (p=0.303), while appropriate statin prescribing remained high in both groups (91.3% vs 98%, p=0.129).
Conclusion: Following the 2025 ACS guideline update, prescribing patterns shifted modestly toward guideline-preferred P2Y12 inhibitors and increased use of nonstatin lipid-lowering therapies after PCI, though adoption remained incomplete and may have been influenced by factors such as baseline oral anticoagulant use and cost limitations. These findings highlight the need for continued education and targeted strategies to improve implementation of updated guideline-directed discharge therapy after PCI.

Moderators

Sheema Hallaji

PGY1 Residency Director, Cone Health- Alamance Regional Medical Center

Presenters

Taylor Butler

Evaluators

Savannah Owen

Assistant Professor of Pharmacy Practice, South College School of Pharmacy

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Parthenon 2

Internal Medicine (IM), Piedmont Atlanta Hospital

global Y

4:20pm EDT

OPIOID UTILIZATION WITH ENHANCED RECOVERY AFTER CESAREAN DELIVERY PROTOCOL VERSUS STANDARD OF CARE

Thursday April 30, 2026 4:20pm - 4:40pm EDT

Olympia 2

OPIOID UTILIZATION WITH ENHANCED RECOVERY AFTER CESAREAN DELIVERY PROTOCOL VERSUS STANDARD OF CARE
Authors: Trace Easterling, Amanda Williams, Allison Daneault, Catherine Childre, Anna Bulman, Brianna Wheeler, Megan Missanelli, Brittney Bicksler, Francie Ruzic.

Objective: Compare opioid utilization in patients undergoing cesarean delivery with and without use of the enhanced recovery after cesarean delivery protocol.

Background/Purpose –
Cesarean delivery is the most common surgical procedure in the United States and accounts for many women’s first exposure to opioids. The Enhanced Recovery After Surgery (ERAS) Society has published guidelines for many surgical procedures, including cesarean delivery, with the goal of expediting post-surgical recovery, minimizing exposure to opioids, and improving maternal and neonatal outcomes. Until recently, only one facility within Infirmary Health System utilized a standardized Enhanced Recovery and Cesarean (ERAC) protocol. The primary aim of this study is to compare opioid utilization in patients undergoing cesarean delivery with and without use of the ERAC protocol.

Methods –
A retrospective chart review of patients at least 18 years of age undergoing cesarean delivery with ERAC protocol and without ERAC protocol across the three labor and delivery units encompassed in Infirmary Health System was conducted starting July 31, 2025 and working back in time until 150 patients in each category had been reviewed. Data collected through the electronic health record (EHR) included patient demographics, primary or repeat cesarean, scheduled or unscheduled cesarean, intraoperative and post-operative pain management modality, total morphine milligram equivalents (MMEs) post-operatively, length of hospitalization, average daily pain scores for post-operative days 1-3, and post-operative duration epidural and urinary catheterization. Discharge prescriptions were also reviewed and total MMEs of all outpatient prescriptions were recorded. Patient were excluded if they were less then 18 years old, had a complication that may have resulted in increased opioid requirements or length of stay, or had grossly incomplete chart data.

Results –
A total of 303 patients were included in the results of the study. 145 patients received the non-ERAC protocol and 158 received the ERAC protocol. The median total postoperative MMEs were lower in the ERAC arm compared to the non-ERAC study arm (22.5 vs. 86.3 p < 0.01). Median length of stay and time to first as needed analgesic was also lower in the ERAC group compared to the non-ERAC group (Length of stay (h): 63 vs 75 p < 0.01; Time to first as needed analgesic (h): 15.8 vs. 24.6 p < 0.01). Median postoperative pain scores at day one, two, and three were also decreased in the ERAC arm (Day 1: 1 vs. 2 p < 0.01; Day 2: 2 vs. 3 p < 0.01; Day 3: 2 vs. 3 p < 0.01). For the median MMEs prescribed at discharge, patients in the ERAC group had a lower MME prescribed at discharge compared to those in the non-ERAC group. (MMEs at discharge: 112.5 vs 225 p < 0.01)

Conclusions –
Patient receiving cesarean sections in the ERAC protocol had reduced inpatient opioid requirements, a shorter length of stay, improved pain control and accelerated recovery timelines compared to those in the non-ERAC group. Mothers in the ERAC group also went longer without requesting additional analgesics and received less opioids at discharge on average. These results continue to prove positive outcomes for ERAC protocols mothers receiving cesarean sections.

Moderators

Krista Dumkow

Presenters

Trace Easterling

PGY1 Resident, Mobile Infirmary

Evaluators

Marci Swanson

Clinical Pharmacist Practitioner, Carl Vinson VA Medical Center

Thursday April 30, 2026 4:20pm - 4:40pm EDT
Olympia 2

Internal Medicine (IM), Mobile Infirmary Medical Center

global Y

4:40pm EDT

Evaluating The Risk of Hypertension Exacerbations in Women Taking Combined Oral Contraceptives with a Pre-Existing Diagnosis of Hypertension

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena J

Title: Evaluating The Risk of Hypertension Exacerbations in Women Taking Combined Oral Contraceptives with a Pre-Existing Diagnosis of Hypertension
Authors: Taylor Paris, Lisa Ambrose
Background: The purpose of this research is to evaluate the risk of women who are diagnosed with hypertension and are prescribed a combined oral contraceptive (COC) experiencing an exacerbation of their hypertension. COCs have been shown to cause a modest increase in blood pressure, and their use is generally not recommended in patients with uncontrolled or significant hypertension. However, COCs still continue to be routinely prescribed for women with an existing hypertension diagnosis.
Methods: This single-center, retrospective study aimed to assess the association between combined oral contraceptive (COC) use and hypertensive exacerbations in women with preexisting hypertension. Eligible patients were identified through the electronic health record (EHR) by having an active COC prescription with a concurrent hypertension diagnosis at the time of COC initiation. Chart review was conducted using a standardized abstraction tool that evaluated five criteria: an increase in average blood pressure, an increase in the dose of existing antihypertensive medication(s), initiation of an antihypertensive agent, addition of another antihypertensive to current regimen, and the occurrence of a hypertensive event (i.e. stroke, MI). Binary yes/no responses were for each criterion to determine the presence or absence of hypertensive exacerbation. The goal of this analysis was to quantify the risk of hypertensive exacerbation associated with COC use and inform contraceptive decision‑making in this population.
Results: 14 patients were identified and reviewed within the EHR. 85% of patients met at least one defined criterion, and 64% met two or more criteria. Only 14% of patients did not meet any of the defined criteria. There was a 26% occurrence of 3 of the defined criteria (initiation of BP lowering therapy, dose titration of existing therapy, and increase in average BP reading) and a 22% occurrence of patients requiring addition of another medication. No patients experienced a hypertensive event.
Conclusion: These results suggest that contraceptive options other than COCs may be more appropriate for individuals with established hypertension. The findings highlight the importance of active blood pressure monitoring and medication management to reduce the risk of hypertensive exacerbations within this patient population. Ongoing provider education remains essential to ensure both clinicians and patients can make informed decisions for contraception that account for existing comorbidities.

Moderators

Rachel Friend

Presenters

Taylor Paris

PGY-1 Pharmacy Resident, Birmingham VA Health Care System

Evaluators

Rachel Langenderfer

Clinical Pharmacy Specialist - Residency Program Coordinator, Bon Secours St. Francis Downtown

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena J

Ambulatory Care (AMB), VA-Birmingham, Al-Birmingham VA Health Care System

global Y

4:40pm EDT

Evaluation of Ambulatory Pharmacist Transitions of Care Outreach for Patients with Uncontrolled Diabetes

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena B

Background: An estimated 12% of the United States population is living with diabetes. This specific patient population is at an increased risk of hospital admission with longer lengths of stay and higher rates of readmission. Patients with diabetes are often lost to follow-up due to lack of disease education, access to medication, or access to care. At Cone Health, ambulatory pharmacists are embedded within primacy care clinics and provide disease state management and have been able to contribute to improve disease state related quality metrics. Inpatient diabetes coordinators identified embedded pharmacists to assist in transitions of care outreach to high-risk patients with diabetes upon hospital discharge. The purpose of this study was to evaluate the impact of ambulatory pharmacist transitions of care outreach on diabetes control in patients recently admitted to the hospital.

Methods: This was a single-center, multi-site, IRB-reviewed and determined exempt, retrospective cohort, pre-post matched analysis that included patients with uncontrolled type 2 diabetes who were referred to an ambulatory care pharmacist during hospital admission between February 2025 and December 2025 for transitions of care outreach. Ambulatory care pharmacists were encouraged to outreach patients upon discharge to address immediate medication access concerns in an effort to prevent readmissions and ensure adequate follow-up. Patients were included in the final analysis if there was documented pharmacist engagement and were affiliated with a Cone Health primary care clinic. The primary outcome was percent of patients meeting A1c <8% from baseline to follow-up which was assessed utilizing a McNemar’s Chi-square test. Secondary outcomes include 30-day all-cause unplanned readmissions, frequency of pharmacist engagement, and pharmacist-documented medication therapy problems and interventions.

Results: There were 139 patients referred to ambulatory pharmacy services for transitions of care outreach. A total of 103 patients were excluded due to study criteria. Of the patients referred, a total of 36 patients were included in primary statistical analysis. The mean age was 49.7 years, 13 (36.1%) patients were female, and 16 (44.4%) patients identified as Black or African American. A total of 32 (88.8%) of patients had type 2 diabetes with an average A1C of 11.7%. At baseline, 1 patient (2.7%) had an A1C <8%. After pharmacist outreach and PCP follow‑up, 17 patients (44.4%) achieved an A1C <8% (difference 41.6%, 95% CI 25.6 – 57.8, p < 0.0001). The average time between baseline and follow-up A1C measurements was four months. During initial pharmacist outreach, medication therapy problems were identified with adherence (33.3%) being a top concern for patients, frequently driven by medication affordability and medication access barriers. Pharmacists were able to assist patients proactively through enrollment in patient assistance programs, switching to cost effective medications, completing prior authorizations, or referring patients to health system free pharmacies when appropriate. Patients continued to engage with ambulatory pharmacists on average of three times throughout the study duration. Continuous engagement further improved disease state management, medication access, and glycemic control.

Conclusions: Embedded pharmacist transitions of care outreach were associated with improvements on uncontrolled diabetes outcomes upon hospital discharge. More importantly, pharmacists were able to fill in the gap in the transitions of care process for patients with uncontrolled diabetes through providing access of care, medication accessibility, and reinforcing chronic disease state education. In addition to glycemic improvement, 30-day all cause unplanned readmissions rates were low. Patients were able to achieve A1C <8% from baseline to follow-up and a low 30-day all cause unplanned readmission rate was seen.

Presentation objective: Recognize key interventions an ambulatory care pharmacist can provide to support patients with uncontrolled diabetes during transitions of care.

Self-assessment question: Which of the following interventions was most commonly identified and addressed by pharmacists during transitions of care outreach?

Moderators

Lauren Lyons

Clinical Pharmacist - Advanced Heart Health Center, Prisma Health

Presenters

Halie Au

PGY1 Pharmacy Resident, Cone Health - Moses H. Cone Memorial Hospital

Hi! My name is Halie Au. I am currently a PGY1 Pharmacy Resident at Cone Health in the ambulatory care setting. My clinical and professional interests include primary care and cardiometabolic diseases. I enjoy managing diabetes and heart failure. Upon completing my PGY1, I will be... Read More →

Evaluators

Laurie Leith

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena B

Ambulatory Care (AMB), Cone Health

global Y

4:40pm EDT

Antimicrobial Stewardship in the Emergency Department: Evaluation of Discharge Antibiotic Prescribing for UTI and CAP

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Parthenon 1

Antimicrobial Stewardship in the Emergency Department: Evaluation of Discharge Antibiotic Prescribing for UTI and CAP

Delaney Peterson, Mckenzie Hodges, Courtney McDonald, Emma Hornsby, Aayush Patel, Lauren Simmons
Piedmont Columbus Regional Midtown (PCRM) - Columbus, Georgia

Background: Antibiotics are among the most frequently prescribed medications at emergency department (ED) discharge. Community-acquired pneumonia (CAP) and urinary tract infections (UTIs), including cystitis and pyelonephritis, account for a substantial proportion of ED infectious diagnoses and represent key opportunities for antimicrobial stewardship. This study aimed to evaluate adherence to institutional guidelines for ED discharge antibiotic prescribing for UTIs and CAP and to identify actionable targets for improvement.

Methodology: A retrospective, pre–post intervention chart review was conducted at a single hospital-based emergency department. Adult patients (≥18 years) discharged from the ED with a diagnosis of urinary tract infections (cystitis or pyelonephritis) or community-acquired pneumonia and prescribed oral antibiotics at discharge were included. Patients who left against medical advice, left before evaluation, or had end-of-life or palliative status were excluded. Encounters were reviewed during a pre-intervention period (October 1st–December 31st, 2025) and a post‑intervention period (February 1st–March 24th, 2026) following implementation of an updated institutional treatment guideline with accompanying antimicrobial stewardship education. The primary outcome was guideline compliance of discharge antibiotic prescriptions, defined by appropriate drug selection, dose, and duration. Secondary outcomes included the frequency and types of guideline non-compliance. To ensure feasibility and minimize bias, we used stratified random sampling to select equal numbers of eligible encounters per phase and per diagnosis, with UTIs further stratified as cystitis or pyelonephritis.

Results: In Progress
Conclusion: In Progress
Contact: [email protected]

Moderators

Rion Poland

Presenters

Delaney Peterson

Evaluators

Sophea Chan

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Parthenon 1

Critical Care/Emergency Medicine (CCM), Piedmont Columbus Regional Midtown

global Y

4:40pm EDT

Complications Associated with Prolonged High-Rate Propofol Infusion in ICU Patients

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Parthenon 2

Title: Complications Associated with Prolonged High-Rate Propofol Infusion in ICU Patients

Authors: Phuongloan Hoang, Brook Jacobs, Rupal Sheth

Background/Purpose:
Propofol is a highly lipophilic sedative hypnotic that exerts its effects by stimulating γ-aminobutyric acid (GABA) receptors. It is widely used in the intensive care unit (ICU) for sedation, ventilator synchrony, oxygen optimization, and management of status epilepticus. Advantages include its fast onset and short duration of action. Propofol administration may lead to propofol-related infusion syndrome (PRIS), a rare but potentially fatal complication characterized by metabolic acidosis, cardiac abnormalities, hypotension, acute kidney injury, hepatic dysfunction, and electrolyte disturbances. Diagnosis is challenging because these features overlap with propofol’s expected pharmacologic effects and manifestations of critical illness. PRIS most often occurs with higher infusion rates, prolonged exposure, and concomitant vasopressor therapy.

Within our health system, the standard continuous infusion range for propofol is between 5 to 80 mcg/kg/min using the ALARIS pump. A soft stop at 50 mcg/kg/min was previously implemented as a safeguard to reduce the risk of PRIS and other potential complications. While this threshold provides an additional layer of safety, concerns arose regarding whether this 50 mcg/kg/min soft stop may have been overly conservative, particularly since PRIS has been reported at lower infusion rates which suggests that risk is not strictly dose-dependent. Maintaining this limit could potentially restrict treatment options unnecessarily, especially for patients who have high sedation requirements and might benefit from higher infusion rates. Additionally, if adverse safety events are not being observed, reevaluating the threshold could help to reduce alert fatigue for nursing staff, supporting both patient care and workflow efficiency. Recently, a decision was made to raise the soft stop to 60 mcg/kg/min. This study aims to evaluate the incidence of presumed PRIS and to assess whether it is safe to raise the upper dosing threshold for propofol infusions.

Methods:
This study was a multicenter, retrospective cohort study that included patients aged ≥18 who received continuous propofol infusions for ≥24 hours at our institution from April through September 2025. Patients were eligible if they received continuous propofol infusions for ≥24 hours and were grouped based on average propofol infusion rates (<50 mcg/kg/min and ≥50 mcg/kg/min). The primary outcome is the incidence of presumed PRIS defined as the development of 3 or more criteria after the initiation of propofol therapy, one of which must be hypertriglyceridemia or rhabdomyolysis, or a diagnosis of PRIS found in patient’s chart. Secondary outcomes included presumed PRIS incidence in patients receiving propofol at 50-60 mcg/kg/min, ICU length of stay, and initiation of vasopressors or renal replacement therapy.

Results:
Of 54 patients, the incidence of overall presumed PRIS was 1.9% (n=1). This patient belonged to the propofol <50 mcg/kg/min group. Of the four cases that would have met criteria for presumed PRIS (7.4%), three of these cases were excluded due to timing of clinical findings. In those who received continuous propofol infusion for ≥24 hours, secondary outcomes were not statistically significant between the <50 mcg/kg/min and ≥50 mcg/kg/min groups.

Conclusion:
Consistent with previous studies, the incidence of presumed PRIS incidence was low in our patient population. Secondary outcomes were not statistically significant. Further studies are needed to determine a clinically meaningful difference in PRIS rates between dosage groups.

Moderators

Sheema Hallaji

PGY1 Residency Director, Cone Health- Alamance Regional Medical Center

Presenters

Phuongloan Hoang

PGY-1 Pharmacy Resident, Emory Decatur Hospital

Dr. Phuongloan Hoang is from Riverdale, Georgia. She completed her undergraduate coursework at Clayton State University, followed by her Doctor of Pharmacy degree from Philadelphia College of Osteopathic Medicine. Her professional interests include critical care, psychiatry, infectious... Read More →

Evaluators

Savannah Owen

Assistant Professor of Pharmacy Practice, South College School of Pharmacy

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Parthenon 2

Critical Care/Emergency Medicine (CCM), Emory Decatur Hospital

global Y

4:40pm EDT

Decreasing hypoglycemic events after administration of anti-diabetic agents

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena A

Title: Decreasing hypoglycemic events after administration of anti-diabetic agents
Presenter: Lillian James
Authors: Lillian James, Amanda Guffey, Jean Goette, Erik Turgeon at Lexington Medical Center
Background: Inpatient hypoglycemia remains a significant and preventable complication in hospitalized patients, particularly those receiving insulin or other anti-diabetic medications. Numerous studies have shown that inpatient hypoglycemia is associated with increased morbidity, mortality, length of hospital stay, and healthcare costs. Importantly, many episodes of inpatient hypoglycemia are preventable. The ADA Standards of Care in Diabetes 2025 guidelines emphasize that preventing hypoglycemia is just as important as avoiding hyperglycemia and call for hospital wide protocols to guide insulin dosing and glucose monitoring. The purpose of this study was to implement targeted strategies aimed at reducing the incidence of severe hypoglycemic events, defined as a blood glucose level less than or equal to 40 mg/dL, in hospitalized patients.
Methodology: This study was a pre- and post-intervention chart review of severe inpatient hypoglycemic events conducted at a single-center, 607-bed community teaching hospital. The interventions involved implementation of modified insulin orders, which included adjustments to the frequencies and thresholds for sliding scale insulin, instructions to contact the provider regarding basal insulin administration when the patient is NPO, and the introduction of a sliding scale insulin calculator. The purpose of this review was to evaluate the impact of these interventions on the incidence of severe hypoglycemic events in hospitalized patients. A severe hypoglycemic event is defined as a blood glucose level less than or equal to 40 mg/dL occurring within 24 hours of receiving an anti-diabetic medication. The pre-intervention group consisted of patients who experienced a severe hypoglycemic event between January 1, 2025, and June 30, 2025. The post-intervention group included patients who experienced a severe hypoglycemic event between October 15, 2025, and March 31, 2026. Outcomes were manually analyzed by the investigator through EHR- generated data and manual chart review.
Results: A total of 4,294 patients were included in the pre-intervention group, and 4,188 patients were included in the post-intervention group. Severe hypoglycemic events occurred in 83 patients in the pre-intervention group and 69 patients in the post-intervention group. The incidence of severe hypoglycemia decreased from 1.9% to 1.6%; however, this reduction was not statistically significant (p = 0.33).
Conclusions: Implementation of an insulin calculator and revised insulin order sets resulted in a numerical, but not statistically significant reduction in severe hypoglycemic events. Continued data collection will be essential to better assess the impact of these interventions and determine alignment with national performance standards.

Moderators

Kristina Nakhla

PGY1 Residency Program Director, Northside Hospital

Presenters

Lillian James

PGY1 Pharmacy Resident, Lexington Medical Center

Evaluators

Michael Behal

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), Lexington Medical Center

global Y

4:40pm EDT

Evaluation of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome in ICU

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena I

Evaluation of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome in ICU
Gun Moon, Christen Freeman, Alston Poellnitz
DCH Regional Medical Center, Tuscaloosa, AL

Learning Objective: Identify the oxygenation response and appropriate utilization of inhaled epoprostenol in ICU patients with acute respiratory distress syndrome.

Self-Assessment Question:
Abrupt discontinuation of inhaled epoprostenol may lead to rebound pulmonary hypertension and worsening hypoxemia. True or False?

Background: Acute respiratory distress syndrome (ARDS) is associated with significant morbidity and mortality. Inhaled epoprostenol is used as salvage therapy. The study evaluated its impact on oxygenation, utilization, protocol adherence, and hospital outcomes.

Methods:
This IRB-exempt, single-center retrospective chart review study included adult ICU patients who received inhaled epoprostenol for ARDS at a 583-bed community hospital from January 2024 to August 2025. Patients required documented SpO₂ and FiO₂ values within 120 minutes before and 4 hours after initiation. The primary outcome was oxygenation response, defined as >15% improvement in SpO₂:FiO₂ at 4 hours. Secondary outcomes included appropriate use as salvage therapy, adherence to institutional titration/discontinuation protocol implemented in January 2025, ICU length of stay, ventilator-free days, and mortality.

Results:
Fifty patients were included with mean age of 60.4 years, with 70% of patients meeting severe ARDS criteria defined by PaO2:FiO2 <100. Seventeen patients (34%) met criteria for oxygenation response. Overall, 68% demonstrated increased SpO₂:FiO₂ from baseline, while 22% decreased and 10% showed no change. Appropriate use as salvage therapy was observed in 86% of patients. Appropriate titration/discontinuation occurred in 44.4% of patients prior to protocol implementation and 47.8% after implementation. Mean ICU length of stay was 9.1 ± 5.7 days, ventilator-free days were 20.7 ± 4.8 days, and mortality was 60%.

Conclusion:
Despite appropriate use as salvage therapy, inhaled epoprostenol demonstrated limited clinically meaningful improvement in oxygenation. Protocol adherence for titration and discontinuation remained inconsistent. Findings suggest the need for provider education, improved documentation, and evaluation of non-responders, including delays in discontinuations. Standardized discontinuation criteria may optimize use and reduce unnecessary resource utilization.

Resident e-mail: [email protected]

Moderators

Kendall Huntt

PGY1 Residency Program Coordinator, Emory University Hospital

Presenters

Gun Moon

Evaluators

Kendra Brookshire

Associate Chief, Outpatient Clinical Pharmacy Services, Birmingham VA Healthcare System

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena I

Critical Care/Emergency Medicine (CCM), DCH Regional Medical Center

global Y

4:40pm EDT

Evaluation of Pediatric Pharmacy Driven Methicillin Resistant  Staphylococcus Aureus (MRSA) Nasal Polymerase Chain Reaction (PCR) protocol - Rachel Samples

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena G

Title: Evaluation of Pediatric Pharmacy Driven Methicillin Resistant 
Staphylococcus Aureus (MRSA) Nasal Polymerase Chain Reaction (PCR) protocol 
Authors: Beth Addington, PharmD, BCPPS, Sarah Withers, PharmD, MS, BCIDP, Rachel Samples, PharmD, MBA 
Objective: To evaluate the impact of a pediatric pharmacy-driven MRSA nasal PCR protocol on the duration of anti-MRSA antibiotic therapy in pediatric patients before and after protocol implementation.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of pediatric infections. Current Infectious Diseases Society of America guidelines recommend MRSA nasal polymerase chain reaction (PCR) screening as a de-escalation tool for anti-MRSA therapy, given its high negative predictive value. While pharmacist involvement in antimicrobial stewardship has demonstrated benefits, limited data exist on pediatric pharmacy-driven MRSA nasal PCR protocols.
Methods: A single-center, pre- and post-interventional, retrospective cohort study included pediatric patients who received MRSA nasal PCR testing during two study periods: March 1–July 31, 2024 (pre-implementation) and March 1–July 31, 2025 (post-implementation). The primary outcome was the median duration of anti-MRSA antibiotic therapy before versus after protocol implementation. Secondary outcomes included pharmacist-ordered or documented MRSA PCRs, duration of intravenous antibiotic therapy, hospital length of stay, escalation of care, suspected or confirmed infection types, empiric and oral antibiotic selection, culture acquisition and results, and diagnostic performance of MRSA nasal PCRs, including sensitivity, specificity, positive predictive value, and negative predictive value.
Results: A total of 283 patients were included (pre-intervention n=134; post-intervention n=149). Median duration of intravenous anti-MRSA therapy was unchanged (1 [IQR 1–2] vs 1 [1–1] days; p=0.90). However, total MRSA antibiotic duration decreased (2 [1–6] vs 1 [1–5] days; p=0.01), as did total antibiotic duration (9 [7–14] vs 8 [6–12] days; p=0.02). Hospital length of stay was also reduced (median 3 vs 2 days; p<0.01). No significant differences were observed in culture acquisition, MRSA isolation rates, surgical interventions, or rates of therapy de-escalation. The MRSA PCR demonstrated high NPV (93.2% overall; 96.7% for pneumonia) but lower positive predictive value (PPV) (66.6% for SSTI; 20.0% for pneumonia).
Conclusion: Implementation of a pediatric pharmacy-driven MRSA nasal PCR protocol was associated with reductions in total MRSA and overall antibiotic duration, as well as shorter hospital length of stay, without adversely affecting clinical outcomes. These findings support the role of pharmacists in antimicrobial stewardship initiatives and highlight the clinical utility of MRSA PCR testing in pediatric populations.

Moderators

Madison Schwartz

Presenters

Rachel Samples

PGY1 HSPAL, Prisma Health Upstate

Evaluators

Michelle Turner

PGY1 RPD and Clinical Coordinator, MCNC1Moses Cone Hospital - Cone HealthPGY1

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena G

Infectious Disease (ID), Prisma Health-Upstate

global Y

4:40pm EDT

Impact of Antibiotic Allergies on Susceptibilities Among Isolates Responsible for Gram Negative Bacteremia

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Olympia 2

Background: Penicillin and sulfonamide allergies are reported by many patients, yet most are not clinically significant. Documented allergies lead to the use of alternative agents such as fluoroquinolones, and this inappropriate use has been linked to increased rates of antimicrobial resistance. While studies have demonstrated the impact antibiotic allergies can have on patient outcomes and healthcare costs, there is minimal literature evaluating the influence documented allergies, whether true or not, may have on antimicrobial susceptibilities. The purpose of this study is to evaluate the relationship between documented antibiotic allergies and antimicrobial susceptibilities for gram-negative bloodstream isolates.

Methods: This is a multicenter, retrospective, cohort study of adult patients admitted to the Prisma Health System with confirmed gram-negative bacteremia from March 1, 2021, to August 1, 2025. The primary outcome is the difference in antibiotic susceptibilities (% susceptible vs % non-susceptible) of isolates between patients with and without documented beta-lactam allergies. Secondary outcomes include the difference in antibiotic susceptibilities among patients with and without fluoroquinolone and sulfonamide allergies and assessing variation in antimicrobial susceptibilities by severity of beta-lactam allergies. Baseline characteristics and outcomes were assessed using descriptive and inferential statistics.

Results: This retrospective cohort study included 500 patients, of which 92 had a beta-lactam allergy present on their chart. The most common bacteria isolated were E. coli (46%), K. pneumoniae (20%), P. mirabilis (10%), and P. aeruginosa (9%). For the primary outcome of rates of non-susceptible isolates in patients with and without a documented beta-lactam allergy, there was no statistically significant difference between the two groups for Enterobacterales or Pseudomonas species for any antimicrobials evaluated. However, patients with a beta-lactam allergy did have numerically higher rates of non-susceptible Enterobacterales isolates for cefazolin, ciprofloxacin, and sulfamethoxazole-trimethoprim, with a difference of 5%, 5% and 9%, respectively. The secondary outcomes evaluating rates of non-susceptible isolates in patients with and without a fluoroquinolone allergy and with and without a sulfonamide allergy showed no statistically significant difference between groups. Lastly, when stratified by severity of beta-lactam allergy, it was found that patients with a high severity beta-lactam had the highest proportion of non-susceptible Enterobacterales isolates for ampicillin (67%). The medium severity beta-lactam allergy group had the highest proportion of non-susceptible isolates for ceftriaxone (29%), ciprofloxacin (43%), levofloxacin (100%), and sulfamethoxazole-trimethoprim (43%).

Conclusions: Overall, the presence of beta-lactam, fluoroquinolone, or sulfonamide allergies did not impact antibiotic susceptibilities. Almost half of beta-lactam allergies were documented as an “unknown” reaction which emphasizes the improvements that can be made in allergy documentation and reconciliation. This study was limited by the small population of patients with fluoroquinolone or sulfonamide allergies, the subjective manner of allergy assessment, and the process of manual chart review.

Moderators

Krista Dumkow

Presenters

Tara Kennell

PGY1 Acute Care Pharmacy Resident

I am currently a PGY1 acute care pharmacy resident at Prisma Health Richland in Columbia, SC. I completed my B.S. in biology at the University of Florida, then earned my PharmD from the University of Georgia in 2025. I will be staying with Prisma Health Richland to complete PGY2 training... Read More →

Evaluators

Marci Swanson

Clinical Pharmacist Practitioner, Carl Vinson VA Medical Center

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Olympia 2

Infectious Disease (ID), Prisma Health Richland - University of South Carolina

global Y

4:40pm EDT

Impact of Antibiotic Therapy on Weight in Adult Patients

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena H

Title: Impact of Antibiotic Therapy on Weight in Adult Patients

Authors: Nghi Nguyen, Kate O’Connor, Joshua Eudy, Elizabeth Spitzer, Bintaben Patel, Emmie Wu, Daniel Anderson

Objective: To evaluate short‑ and long‑term weight changes and metabolic effects associated with antibiotic use in adults.

Background: Approximately 80–90% of antibiotic prescriptions occur in the outpatient setting, and an estimated 30% are considered inappropriate. This unnecessary overuse of antibiotics is often cited as a risk factor for increased rates of antimicrobial resistance and adverse drug events. Another often-overlooked consequence of antibiotic use is gut dysbiosis, a disruption of the microbial composition involved in host energy metabolism, such as modulation of Glucagon-like peptide-1 (GLP-1). As such, gut dysbiosis associated with antibiotic exposure may contribute to unintended weight gain. While pediatric studies have linked early and broad-spectrum antibiotic exposure to increased rates of obesity by age five, data on weight and metabolic changes following antibiotic exposure in adults are limited. Understanding these long‑term physiological effects is necessary to support personalized antimicrobial stewardship and improve shared decision-making with patients in the ambulatory care setting.

Method: This was a single-center retrospective cohort study evaluating adult patients at the Wellstar MCG Health Internal Medicine Clinic between December 1, 2024, and February 28, 2025. Cohorts included patients who received at least three days of antibiotics and those who received no antibiotics. Patients were excluded if they were prescribed a GLP-1 receptor agonist, if they were pregnant or postpartum during the inclusion window, had a recent major surgery, had prolonged hospitalization (intensive care unit stay > 72 hours and/or medical‑surgical unit admission > seven days), active cancer treatment, or uncontrolled HIV. The primary outcome was the change in weight from baseline at 12-months. Secondary outcomes included weight changes at three and six months and changes in A1C at six and twelve months. Statistical analysis was completed using an independent t-test for continuous data and a chi-squared test for categorical data.

Results: A total of 158 patients were included (66 antibiotic‑exposed and 92 controls). Baseline characteristics were balanced, although a higher proportion of patients in the antibiotic arm were receiving medications with potential for weight gain than in the control arm (54.5% and 27.2%, respectively). Antibiotic‑exposed patients also had a higher median number of clinic visits per year than controls: 8.5 and 6.5 visits. Patients received a mean of 2.8 antibiotic courses and a median of 15 days per course. Amoxicillin/clavulanate, azithromycin, and doxycycline were the most frequently prescribed antibiotics. There was no difference in weight change at 12 months between the antibiotic and no-antibiotic groups (0.84 kg vs -0.2 kg, p=0.16). No differences were observed in weight at three or six months, nor in A1C at six and twelve months.

Conclusion: There was no difference in 12‑month weight change between antibiotic-exposed and unexposed adults. However, this data indicates a need for further investigations that include a prolonged follow-up period, targeted evaluation of high-dysbiosis-risk antibiotics, and cumulative antibiotic consumption, while accounting for exposure to other weight-impacting factors such as medications and comorbid conditions.

Moderators

Jenna Jewett

Presenters

Nghi Nguyen

Evaluators

Sarah McDaniel

Antimicrobial Stewardship Coordinator, Baptist Medical Center South

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena H

Infectious Disease (ID), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

4:40pm EDT

Association of degree of pyuria and symptomatic urinary tract infections at a community hospital

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena C

Background/Purpose: Asymptomatic bacteriuria (ASB) is common in the general population. The Infectious Diseases Society of America (IDSA) guidelines have recommended only screening for and treating ASB in pregnant women or before an invasive urological procedure. ASB is the presence of 1 or more species of bacteria growing in the urine between (≥105 colony-forming units [CFU]/mL or ≥108 CFU/L) in the absence of signs or symptoms of a urinary tract infection (UTI). The lack of pyuria or white blood cells (WBCs) in the urine makes the diagnosis of a UTI highly unlikely. However, the presence of pyuria alone is not an indicator of a UTI.

At CHI Memorial Hospital, when a UTI is suspected, a culture can only be ordered through a urinalysis (UA) reflex process. The urinalysis must show ≥ 20 WBCs for a culture to be performed. Anecdotally, the antimicrobial stewardship team sees a large number of urine cultures performed despite patients clinically meeting criteria for ASB. This analysis was designed to evaluate our current urinalysis WBC count threshold for reflex to urine culture with the hope of determining an optimal cutoff to decrease the overculturing of urines without significantly missing true infections.

Methods: This will be a single-center, IRB-approved, retrospective chart review evaluating hospitalized adult patients with a urinalysis with reflex to culture order during the month of July 2025. Patients who were treated as outpatients or those presenting with long term urinary catheters (> 4 weeks) were excluded. The primary objective of this study is to determine how the degree of pyuria relates to a symptomatic UTI: sensitivity, specificity, and positive and negative predictive values will be assessed at various urinary WBC count ranges.

Results: Most patients in the study were elderly females and over 90% of the orders were from the emergency department. About one-third of the patients grew a uropathogen in culture out of the total sampled patients. Uropathogens were generally more likely to grow at increasing urine WBC count; <1% at 0-10 WBC/hpf and 11% at > 100 WBC/hpf. Sensitivity, specificity, positive and negative predictive value were calculated at different urine white blood cell cutoffs which showed that as urine white blood cell count increases, sensitivity decreases significantly from 100% to about 20%. The specificity increases as white blood cell count in the urine increases from 20% to up to 95%. The positive predictive value remains low at less than 50% for all urine white blood cell counts and the negative predictive value remains high at greater than 85% for all urine white blood cell counts. About one-third of patients each grew a uropathogen, a non-uropathogen or had no growth. Among the uropathogens, The most prevalent organism was E. coli at 47%, followed by Klebsiella species at about 24%.

Conclusion: Despite growing more uropathogens at urine WBCs > 100, only 6% of the patients had a clinically significant UTI. The low prevalence of UTIs in our study of 377 patients is reflective of inappropriate testing and maintaining our urine culture reflex criteria at > 20 WBCs/hpf keeps sensitivity high at above 95% However, specificity is low at 35%. There may be a future role in increasing the threshold for urine reflex to culture to sacrifice some sensitivity for improved specificity and a decrease in unnecessary labor for microbiology labs.

Email: [email protected]

Moderators

Natalie Hurst

Presenters

Jason Tuttle

PGY1 Pharmacy Resident, CHI Memorial Hospital

My name is Jason Tuttle, PharmD, and I am a PGY1 resident at CHI Memorial Hospital. I attended pharmacy school at the University of Tennessee Health Science Center College of Pharmacy and was also a pharmacy intern at Blount Memorial Hospital in Maryville, TN. My plans for the future... Read More →

Evaluators

Nathaniel Swanson

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena C

Internal Medicine (IM), CHI Memorial

global Y

4:40pm EDT

Evaluation of Vitamin K Antagonist versus Direct Oral Anticoagulants in the Management of Left Ventricular Thrombus 

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Athena D

Authors: Seana-Pierre Williams, Jaleesa Myers
Wellstar Cobb Medical Center, Austell, GA

Purpose: Left ventricular thrombus (LV thrombus) is a complication arising from left ventricular dysfunction, secondary to acute myocardial infarction or nonischemic cardiomyopathies. The current standard of care for the management of LV thrombus involves anticoagulation with warfarin, a vitamin K antagonist (VKA). While large-scale randomized controlled trials comparing the efficacy of direct oral anticoagulants (DOACs) to VKAs in this context are lacking, several retrospective analyses have demonstrated that DOACs may be non-inferior to VKAs with respect to mortality, incidence of stroke, and thrombus resolution. However, controversy remains regarding the off-label use of DOACs for this indication. The primary objective of this study is to evaluate the safety and efficacy of DOACs in comparison to warfarin in patients diagnosed with LV thrombus, and to assess anticoagulant prescribing patterns in the management of LV thrombus within Wellstar Health System.

Methods: This study was a multicenter, retrospective chart review. Patients admitted to Wellstar Health System with a diagnosis of intracardiac thrombus (ICD-10 codes: I51.3 or I23.6), aged 18 years and older, and received either a DOAC (apixaban, rivaroxaban) or VKA (warfarin) for the management of LV thrombus were eligible for inclusion in this study. Data was collected from electronic medical records between January 1, 2023, and January 1, 2025. The target sample size was 100 patients, with 50 patients in each treatment cohort. Data was collected on the first 100 patients to meet the inclusion criteria within the specified time frame. The primary outcome of this study is the incidence of thromboembolic events, defined as recurrent left ventricular thrombus, stroke, or systemic embolism occurring within 90 days of treatment initiation. Secondary outcomes include left ventricular thrombus resolution within 90 days, hospital length of stay, incidence of bleeding events requiring blood transfusion within 90 days, and 30-day hospital readmission rates.

Results: A total of 100 patients diagnosed with LV thrombus were included in this study. Fifty patients received warfarin and 50 received a DOAC. Of the patients prescribed a DOAC, 5 received rivaroxaban and 45 received apixaban. There was no statistically significant difference in the composite outcome of the incidence of thromboembolic events within 90 days between the warfarin and DOAC groups. There were no statistically significant differences between the warfarin and DOAC groups when comparing the rate of stroke (0% vs. 0%) and systemic embolism (2% vs. 4%). No recurrent LV thrombus within 90 days of treatment initiation were noted in either treatment groups. There were no bleeding events requiring blood transfusions within 90 days. The median length of hospital stay was 10 days (IQR 7–17) in the warfarin group versus 9 days (IQR 4–13) in the DOAC group with no statistically significant difference between groups. Thirty-day hospital readmission rates did not differ significantly between the groups.

Conclusion: Based on the results of this study, DOACs may be as safe and efficacious as warfarin for the management of LV thrombus. This data underscores the importance of further large-scale, randomized controlled clinical trials to inform treatment decisions. Currently, the choice between warfarin and DOACs is informed by limited comparative data. However, both pharmacologic treatment options are used in clinical practice.

Moderators

Alison Martin

Presenters

Seana-Pierre Williams

PGY1 Pharmacy Resident, Wellstar Cobb Medical Center

Hello, my name is Seana-Pierre Williams, and I am currently a PGY1 Pharmacy Resident at Wellstar Cobb Medical Center. My professional interests include critical care, internal medicine, and ambulatory care. I am passionate about addressing healthcare disparities and improving patient... Read More →

Evaluators

Martin Gordon

Clinical Pharmacy Specialist - Critical Care, Spartanburg Medical Center

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Athena D

Internal Medicine (IM), Wellstar Cobb Medical Center PGY1

global Y

4:40pm EDT

Standardizing Biologics Management: A Community Health System Approach to Formulary Development and Implementation

Thursday April 30, 2026 4:40pm - 5:00pm EDT

Olympia 1

Healthcare is undergoing a transformative shift, largely driven by the growing utilization of biologic therapies. While biologics have significantly advanced the treatment of complex and chronic diseases, their high costs have introduced considerable financial strain on both healthcare systems and patients. The creation of biosimilars, agents that are highly similar to their branded reference biologics, have emerged as a promising solution. They offer substantial cost savings and increased patient access without compromising therapeutic efficacy. However, the widespread adoption of biosimilars has been hindered by several challenges, including complex regulatory pathways, evolving reimbursement models, inventory management issues, and payer-imposed restrictions.

Developing and implementing a biosimilar formulary presents unique challenges that Pharmacy and Therapeutics (P&T) Committees have not traditionally encountered. This project was initiated with two primary objectives. The first objective is to establish a systematic process for evaluating both current and future biologic agents in order to develop and maintain a comprehensive formulary for the health system. To achieve this, a structured evaluation framework was created, encompassing key considerations such as drug availability, acquisition cost, site of care, reimbursement pathways, payer policies, and patient access. The data collected through this framework is then analyzed and synthesized into a biologics formulary. Unlike traditional formularies, which often designate a single preferred agent, this biologics formulary ranks the reference product and its biosimilars by site of care, enabling more nuanced and context specific decision making.

The second objective is to implement a standardized workflow that integrates formulary based decision making into clinical practice seamlessly, with no disruption to patient care. To accomplish this, a multidisciplinary team of clinical providers, prior authorization coordinators, and reimbursement specialists collaborates to operationalize the formulary. This integrated approach ensures that the most clinically and economically appropriate agent is selected, balancing the needs of both the health system and the patient.

Looking at biologic invoices for the cancer center with actionable products from September 1, 2025 to March 30, 2026, a total of 963 units were purchased equaling a total of $890,795.56. Reference products accounted for $261,456.22 of the total with only 109 units purchased. Even though the quantity of biosimilars purchased was initially greater than expected, there was a lack of consistency in ordering prior to initiating the formulary, creating missed opportunity for selecting the preferred product with the most reimbursement. Based on the same purchasing data, if all products were switched to the most preferred biologic, it is estimated to have saved a total of $496,625.04. The totals excluded biologics that did not have available biosimilars.

Implementing a biologic formulary has the potential to generate considerable savings and reimbursement. The creation and maintenance of the formulary was without significant challenge. However, the implementation into patient care did have a few setbacks. Most notably there were multiple instances where the most preferred product could not be selected due to insufficient quantities available for purchase, forcing the decision to choose the next best product with reliable stock to not delay patient treatment. There are also instances where patient preference for convenience outweighs the transition to the preferred biosimilar. The majority of implementation of the biosimilar formulary remains at initiation of a new start to therapy, with a few patients transitioning to the preferred biosimilar at the time of insurance authorization renewal. Despite the few setbacks, the initial data are reassuring to confirm the potential of cost savings and maximizing reimbursement to lower financial burden on both the health system and patients.

Moderators

Ryan Tilton

Presenters

Julia Williamson

Evaluators

Katie Coffee

PGY1 Residency Program Director, Kaiser Permanente Georgia

Thursday April 30, 2026 4:40pm - 5:00pm EDT
Olympia 1

Internal Medicine (IM), Cookeville Regional Medical Center

global Y

5:00pm EDT

Evaluating Patient and Caregiver Perceptions of Pharmacist Involvement in Diabetes Management Within A Pediatric Endocrinology Clinic

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Parthenon 1

Authors: Chloe McGee, Aubrey Slaughter

Background:
Diabetes mellitus is an endocrine disorder caused by insulin resistance, insulin deficiency, or both leading to hyperglycemia along with an increased risk of microvascular and macrovascular complications if untreated. Children diagnosed with diabetes have a six to nine times higher risk of hospitalization in comparison to their peers without diabetes. At Wellstar MCG Health, pharmacists have not previously been involved with outpatient pediatric endocrinology management. During the 2025 – 2026 residency year, the PGY2 ambulatory care pharmacy resident has developed a new service in which the resident works collaboratively with the pediatric endocrinologist and nurse practitioner to manage medications and provide education for pediatric patients with diabetes mellitus. This implementation of a new pharmacy service is part of clinical care optimization and is not a research intervention.
Multiple studies have demonstrated patient satisfaction with pharmacist management of diabetes within the adult primary care setting; however, data is lacking in the pediatric population. Regarding clinical outcomes, a previous study of pediatric patients with type 1 diabetes managed by a pharmacist found a mean decrease in hemoglobin A1c of 0.54 percentage points at six months in comparison to an increase of 0.32 in the control group. The study did not assess satisfaction with the services provided.6 The purpose of this study is to assess patient and caregiver satisfaction with the services provided by the PGY2 ambulatory care pharmacy resident for patients with diabetes in the pediatric endocrinology clinic.

Methods:
This was an IRB exempt, observational, single center study of patients diagnosed with diabetes who were seen by the PGY2 ambulatory care pharmacy resident at the pediatric endocrinology clinic at Wellstar MCG Health. The primary outcome was patient/caregiver satisfaction with pharmacist engagement. The secondary outcome was change in hemoglobin A1c from baseline to 3 months. Data was collected via two methods. First, an anonymous survey assessing patient/caregiver satisfaction with pharmacist involvement in diabetes management was distributed in the pediatric endocrinology clinic. If agreeable, the patient/caregiver completed a paper survey consisting of 21 questions prior to leaving clinic. Second, a retrospective chart review of the pediatric endocrinology patients seen by the pharmacist was completed. Data analysis included descriptive statistics and Wilcoxon signed rank tests as appropriate.

Results:
A total of 41 surveys were completed. As self-reported on the survey, participants were a median 15 years old with a median 5 years since diagnosis of diabetes. 85.4% of participants had type 1 diabetes mellitus and 58.6% were female. Over 90% of survey respondents gave a positive response of “agree” or “strongly agree” regarding their satisfaction with pharmacist interaction. On a scale of 0 to 10, all respondents rated the pharmacist interaction as an 8, 9, or 10 with nearly 82% choosing 10/10. A total of 16 patients met criteria to be included for the chart review; the median A1c decreased from 11.0% at baseline to 9.3% at follow-up (p-value < 0.001).

Conclusions:
Based on these results, patients and caregivers were satisfied overall with their interactions with the pharmacist. While the study was limited by a small sample size and short-term follow-up, there was a trend towards improvement in A1c after pharmacist involvement. This real-world study, using a dual survey and chart review design, provides new data on patient/caregiver satisfaction and further supports clinical outcomes with pharmacist involvement in pediatric diabetes management. Future research should be conducted after a longer duration of pharmacist diabetes management in pediatric patients.

Moderators

Rion Poland

Presenters

Chloe McGee

PGY2 Ambulatory Care Pharmacy Resident, Wellstar MCG Health - UGA College of Pharmacy

Evaluators

Sophea Chan

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Parthenon 1

Ambulatory Care (AMB), Wellstar MCG Health/University of Georgia College of Pharmacy

global Y

5:00pm EDT

Evaluation of a Pharmacist-Led Levothyroxine Monitoring and Management Program at the Salisbury VA Health Care System

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena B

Evaluation of a Pharmacist-Led Levothyroxine Monitoring and Management Program at the Salisbury VA Health Care System

Authors: Kendra G. Hofler, Camille P. Robinette, Meghan Mark, and Aashish A. Shah

Background:
Hypothyroidism is an endocrine disorder and can contribute to fatigue, weight gain, cognitive impairment, and cardiovascular complications if inadequately managed.1 Veterans are at increased risk for this disease due to certain environmental exposures, frequency of iodine exposure, and having post-traumatic stress disorder. 2-4 Appropriate levothyroxine dosing and regular thyroid function test (TFT) monitoring are essential for optimizing therapy, yet patients may experience delayed dose adjustments or overdue labs due to limited follow-up and provider workload. Pharmacist involvement in chronic disease management has demonstrated benefits in improving medication adherence, lab monitoring, and patient outcomes in various therapeutic areas.5 However, a structured, pharmacist-led hypothyroidism management process has not been formally implemented or evaluated at the Salisbury VA Health Care System (SVAHCS). The purpose of this quality improvement project is to assess the impact of pharmacist-led levothyroxine monitoring on treatment optimization, laboratory follow-up rates, and patient education within the SVAHCS.

Methods:
This project will be conducted as a quality improvement initiative involving Veterans with a diagnosis of hypothyroidism and active levothyroxine prescription at the SVAHCS. Pharmacists will identify patients who are overdue for TFTs (>6 months) using population management tools within the Computerized Patient Record System (CPRS). Interventions will include recommending and/or ordering TFTs, evaluating laboratory results, making evidence-based dose adjustment recommendations, and providing patient education on proper levothyroxine administration (e.g., timing, drug–food interactions, and adherence). Pharmacists will also recommend endocrinology referral for complex or refractory cases. Primary outcomes will include the proportion of patients achieving euthyroid status (TSH within target range) and improvement in TFT follow-up compliance. Secondary outcomes will assess number of Veterans educated on proper levothyroxine administration, dosing, and side effects, number educated on signs and symptoms of hypothyroidism, and number of patients referred to endocrinology clinic. Data will be analyzed to determine the effectiveness and feasibility of pharmacist-led hypothyroidism management at the SVAHCS and to identify opportunities for broader implementation across the VA system.

Results:
A total of 35 patients were included in the analysis, all of which received counseling on appropriate levothyroxine administration. Prior to intervention, 32 patients (91.4%) were identified as taking levothyroxine incorrectly. Pharmacist-led interventions were made in 9 cases (25.7%), including 3 dose decreases, 5 dose increases, and 1 discontinuation of levothyroxine therapy. Only 1 patient required referral to endocrinology for further management.

Discussion:
The high proportion of patients taking levothyroxine incorrectly highlights a significant gap in patient understanding of proper administration, which may impact therapeutic outcomes. Pharmacist-led counseling appears to play an important role in identifying and addressing these issues. The relatively low number of medication interventions suggests that improper administration, rather than inappropriate dosing, may be a primary contributor to suboptimal therapy in this population. Additionally, the minimal need for endocrinology referral indicates that most patients can be effectively managed within a primary care or pharmacy setting.

Conclusion:
This study demonstrates that incorrect levothyroxine administration is common among patients but can be effectively addressed through targeted counseling. Pharmacist involvement can improve medication use and optimize therapy, potentially reducing the need for specialist referral. Further studies are warranted to evaluate the long-term impact of counseling on clinical outcomes.

References
1. Chaker L, Papaleontiou M. Hypothyroidism: A Review. JAMA. Published online September 03, 2025. doi:10.1001/jama.2025.13559
2. O'Donovan A, Cohen BE, Seal KH, Bertenthal D, Margaretten M, Nishimi K, Neylan TC. Elevated risk for autoimmune disorders in iraq and afghanistan veterans with posttraumatic stress disorder. Biol Psychiatry. 2015 Feb 15;77(4):365-74. doi: 10.1016/j.biopsych.2014.06.015. Epub 2014 Jun 28. PMID: 25104173; PMCID: PMC4277929.
3. Inoue K, Guo R, Lee ML, Ebrahimi R, Neverova NV, Currier JW, Bashir MT, Leung AM. Iodinated Contrast Administration and Risks of Thyroid Dysfunction: A Retrospective Cohort Analysis of the U.S. Veterans Health Administration System. Thyroid. 2023 Feb;33(2):230-238. doi: 10.1089/thy.2022.0393. Epub 2023 Jan 25. PMID: 36173108.
4. Spaulding SW. The possible roles of environmental factors and the aryl hydrocarbon receptor in the prevalence of thyroid diseases in Vietnam era veterans. Curr Opin Endocrinol Diabetes Obes. 2011 Oct;18(5):315-20. doi: 10.1097/MED.0b013e32834a8764. PMID: 21825977.
5. Wang L, Zhang Y, Wei Q, Liang X, Zhou J, Ma A, Wang L. The effect of pharmacist intervention on medication adherence measured with proportion of days covered: a systematic review and meta-analysis. Int J Clin Pharm. 2025 Aug 7. doi: 10.1007/s11096-025-01974-4. Epub ahead of print. PMID: 40775483.

Contact for Follow-up:
Kendra G. Hofler
[email protected]

Moderators

Lauren Lyons

Clinical Pharmacist - Advanced Heart Health Center, Prisma Health

Presenters

Kendra Hofler

PGY1 Resident, Salisbury VA Medical Center

Kendra is a PGY1 Pharmacy Resident at the Salisbury Veterans Affairs Healthcare System. She earned her Doctor of Pharmacy and Masters in Business Administration degrees from Wingate University School of Pharmacy in Wingate, North Carolina. Her current practice interests include primary... Read More →

Evaluators

Laurie Leith

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Athena B

Ambulatory Care (AMB), VA â€“ Salisbury, NC â€“ Salisbury VA Health Care System

global Y

5:00pm EDT

Weight Loss Medication Tapering and Its Effect on Sustainability of Decreased Body Weight - Mary Buehner

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena I

Title: Weight Loss Medication Tapering and Its Effect on Sustainability of Decreased Body Weight
Authors: Mary Christine Buehner, Paul Strange

Background:

Obesity affects the lives of more than 1 billion people worldwide. For this population, long-term maintenance of weight loss proves difficult as lifestyle modifications alone are often unsustainable due to components such as adherence and alterations in metabolism. Although management of weight loss with medications has proven to be effective for upwards of three years in previously completed randomized controlled trials, outcomes beyond the use of medications have not been consistently measured. Additionally, there is limited information available concerning the process of tapering individuals off of medication management and the corresponding long-term results associated with this method. The Ralph H. Johnson VA Healthcare System (RHJ VAHS) has previously utilized both the abrupt discontinuation and tapering off of weight loss medications, but it has yet to be determined which method allows patients increased maintenance of weight loss.

Methods:

This retrospective cohort analysis utilized Electronic Health Record (EHR) data available through the VA Computerized Patient Record System (CPRS) and the VISTA pharmacy database for all patients treated in a Ralph H Johnson VA Primary Care Clinic setting and prescribed an FDA-approved weight loss medication for the indication of obesity for at least 6-months between January 1, 2020, and February 1, 2025. Once evaluated, patients were allocated to two cohorts in a 3:1 fashion – those whose medications had been abruptly discontinued and those who had been tapered prior to discontinuation (or decreased to a maintenance dose appropriate for treatment of comorbid conditions). The primary endpoint was to determine if patients who were tapered off medications were able to maintain more than the abruptly discontinued cohort’s anticipated maintenance amount of 50% of total weight lost after treatment completion. The secondary endpoints analyzed weight loss between the cohorts over 10% at year two and 5% at year 3, as well as mean percentage of weight loss maintained at year 1, year 2, and year 3 (or end of study period). Other secondary outcomes considered in analysis were those patients lost to follow-up and those who were able to lose additional weight following year 1 therapy completion.

Results:

The primary outcome did not demonstrate statistical significance between the abruptly tapered cohort and the tapered cohort (53.8% maintained >50% total body weight loss at year 1 vs. 46.2%; OR 1.36 (0.97-1.91); p=0.0759). Secondary outcomes showed a significantly higher percentage of weight loss at year 1 in the abrupt cohort (-2.6±7.7% (median -0.7%) vs. -0.8±7.2% (median +0.5%); p=0.0082). However, data extraction determining efficacy became limited when a statistically significant increase in loss to follow-up impacted the tapered cohort from year 2 forward (69.8% vs. 57.4%; p=0.0034; OR=0.58).

Conclusion:

No significant difference was found in ability to maintain >50% of total weight loss at year 1 between patients abruptly discontinued and those tapered off of weight loss medications. Weight loss in subsequent years was difficult to analyze due to increased loss to follow-up in the tapered cohort demonstrating a need for consistent and efficient patient monitoring.

Moderators

Kendall Huntt

PGY1 Residency Program Coordinator, Emory University Hospital

Presenters

Mary Christine Buehner

PGY1 Pharmacy Resident, Ralph H Johnson VA Health Care System

Mary "Christine" Buehner is a PGY1 Pharmacy Resident at the Ralph H. Johnson VAMC in Charleston, SC. She received her PharmD from the Medical University of South Carolina. Dr. Buehner shifted her career to pharmacy from education in 2019. Prior to pharmacy school, she received her... Read More →

Evaluators

Kendra Brookshire

Associate Chief, Outpatient Clinical Pharmacy Services, Birmingham VA Healthcare System

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Athena I

Ambulatory Care (AMB), VA - Charleston, SC - Ralph H. Johnson Veterans Affairs Medical Center

5:00pm EDT

Lacosamide versus Levetiracetam for Seizure Prophylaxis in Patients with Traumatic Brain Injury

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena A

Background: Traumatic brain injury (TBI) is associated with increased risk of post-traumatic seizures (PTS), and seizure prophylaxis may reduce seizure prevalence, brain injury, and mortality.1,2 Currently, guidelines from the American College of Surgeons Trauma Quality Programs (ACS-TQIP), Brain Trauma Foundation (BTF), and Neurocritical Care Society (NCS) recommend the use of levetiracetam or phenytoin for early PTS prevention in patients with TBIs.1,3,4 However, adverse effects associated with levetiracetam, including somnolence and behavioral disturbances (i.e. agitation, hallucinations, emotional lability), have prompted interest in lacosamide as a potential alternative. 5 Levetiracetam is the standard antiepileptic medication prescribed for PTS prophylaxis at Prisma Health Richland. This study will evaluate the efficacy and safety of lacosamide compared with levetiracetam for seizure prophylaxis in patients with TBI.
Methods: Adults diagnosed with TBI and, within 24 hours of admission, received seizure prophylaxis with either lacosamide or levetiracetam between February 27th, 2021, and August 31st, 2025, were included in the study. Patients were excluded if they had a history of seizures or epilepsy prior to admission or if they had a seizure prior to initiating antiepileptic medication. The primary objective, seizure incidence within the first 7 days following TBI, will be analyzed using multivariable logistic regression adjusting for clinically relevant covariates and incorporating propensity score methods as appropriate. Secondary objectives include time to seizure following prophylaxis initiation, analyzed using Cox proportional hazards regression, and adverse effects occurring within 7 days of prophylaxis initiation, which will be summarized descriptively and compared using appropriate statistical tests.
Results: In Progress
Conclusions: In Progress

Moderators

Tracey Bastian

Pharmacy Clinical Manager and RPD PGY1, Williamson Medical Center

Presenters

Bailey Nero

PGY2 Critical Care Pharmacy Resident, Prisma Health Richland

Graduated pharmacy school from the University of North Carolina at Chapel Hill in May 2024. Currently a PGY2 critical care pharmacy resident at Prisma Health Richland hospital in Columbia, SC. Complete PGY1 acute care residency at Prisma Health Richland as well.

Evaluators

Tabitha Carney

PGY1 Residency Program Director, Emory University Hospital MidtownPGY1

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Athena A

Critical Care/Emergency Medicine (CCM), Spartanburg Medical Center

global Y

5:00pm EDT

Propofol, Midazolam, and Dexmedetomidine: Impact on Fluid Balance Derangements and Diuretic Resistance in Critically Ill Intensive Care Unit Patients

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena D

Author's Names: Morgan Keller, PharmD; Susan Smith, PharmD, BCCCP, FCCM, FCCP; Madison Wiklund, PharmD Candidate 2027; Marlie Windgate, PharmD Candidate 2027; John Carr, PharmD, BCPS, BCCCP

Background:
Anesthetics such as propofol and midazolam can contribute to fluid retention and reduce diuretic responsiveness in the perioperative setting. It is unclear whether this same effect occurs in critically ill patients, and if alternative sedatives could mitigate such a risk. The goal of this study is to determine whether the use of dexmedetomidine, propofol, or midazolam is correlated with a difference in the incidence of fluid overload and diuretic resistance in critically ill patients who are mechanically ventilated in the intensive care unit.

Methods:
This investigation is a single center, retrospective, observational cohort study evaluating mechanically ventilated patients for differences in fluid balance and diuretic use while receiving propofol, midazolam, or dexmedetomidine during mechanical ventilation. Patients were grouped by primary sedative agent and data pertaining to baseline demographics, illness severity, and comorbidities were collected. Patients were excluded for pregnancy, acute/severe neurologic disorder, simultaneous use of multiple sedatives, Child-Pugh class C liver failure, dialysis or continuous renal replacement therapy at the time of initiating sedative, and/or patients who underwent surgery or procedure with sedation during the study period or within 72 hours prior. The primary outcome of fluid balance is measured as net fluid balance 72 hours after sedation initiation. Daily fluid input and output, diuretic dosing, hemodynamic parameters (mean arterial pressure, blood pressure, and heart rate), and electrolyte laboratory values were collected from patient electronic medical records. Statistical analysis was performed by multivariable regression to adjust for potential confounders, including chronic kidney disease and home diuretic use.

Results:
Twenty patients were enrolled in this study, including 8 receiving midazolam, 11 receiving propofol, and 1 receiving dexmedetomidine. Baseline characteristics were similar across age, baseline creatinine, peak creatinine, creatinine clearance, and Glasgow coma score. The primary outcome of this study is net fluid balance at 72 hours, and showed no statistically significant difference between groups (midazolam 2212.3 mL [1084.7-7601], propofol 3286 mL [1266-11032], and dexmedetomidine 8915 mL; p=0.475). Secondary outcomes including furosemide diuresis equivalents, urine output, ventilator free days at day 14, ICU length of stay, and vasopressor requirements at day 14 showed no difference across sedative groups. Additionally in multivariable analyses, no significant differences were observed between midazolam, propofol, and dexmedetomidine in SOFA scores, CrCl, and total furosemide diuresis equivalents.

Conclusions:
In this study of mechanically ventilated intensive care unit patients, there were no significant differences in fluid balance at 72 hours in patients receiving midazolam, propofol, or dexmedetomidine. Secondary outcomes including ventilator free days, ICU length of stay, and vasopressor requirements were also similar across the three sedation groups. Potential limitation factors include feasibility and exclusion criteria of multiple simultaneous sedatives and dialysis, considering the acuity of the patient population studied. Future directions should target a larger study group with less stringent exclusion factors to confirm this finding.

Moderators

Alison Martin

Presenters

Morgan Keller

PGY2 Critical Care Resident, St. Joseph's/Candler Health System

Dr. Morgan Keller is originally from Longwood, Florida. She completed her Bachelor’s Degree in Interdisciplinary Medical Sciences at Florida State University before completing her Doctor of Pharmacy Degree from Auburn University’s Harrison College of Pharmacy. Dr. Keller completed... Read More →

Evaluators

Martin Gordon

Clinical Pharmacy Specialist - Critical Care, Spartanburg Medical Center

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Athena D

Critical Care/Emergency Medicine (CCM), St. Joseph's/Candler Health System

global Y

5:00pm EDT

Resident Presentation - Yurim Lee

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Olympia 2

Title: Impact of Sedation Protocol Changes on Restraint Use:   A Pre-Post Analysis of Weight-Based Dosing Adjustment in the Emergency Department
Authors: Yurim Lee, Carrie Baker
Practice Site: Wellstar Kennestone Regional Medical Center, Marietta, GA

Background: Wellstar Kennestone Regional Medical Center (WKRMC) recently implemented a sedation protocol in which initial fentanyl and propofol infusion doses for mechanically ventilated patients are calculated using ideal body weight (IBW), replacing the previous strategy of non-weight-based fentanyl and total body weight-based propofol dosing. Anecdotally, emergency department (ED) staff have observed an increase in the use of physical restraints among mechanically ventilated patients following this change. This study was conducted to assess the impact of protocol change on sedation adequacy by examining physical restraint use in mechanical ventilated (MV) patients. Physical restraint use was selected as a pragmatic surrogate measure for inadequate sedation in the ED.
Methods: A single-center retrospective chart review was conducted at WKRMC. Adults ≥18 years who were MV in the ED and received continuous fentanyl or propofol as initial sedation were identified through Epic SlicerDicer and stratified into pre-implementation and post-implementation groups. Protocol adherence was defined as initiation and titration of sedation infusions according to the institutional sedation protocol, including appropriate weight selection and protocol-guided titration intervals. Patients were excluded if they were intubated prior to ED arrival, had restraints applied before intubation, had a Glasgow Coma Scale score of 3 throughout the ED stay, had an ED length of stay ≤1 hour, were pregnant, or arrived in cardiac arrest and expired in the ED. The primary outcome was the frequency of restraint use within 12 hours after intubation or until ICU transfer, whichever occurred first. The secondary outcome was the total dose of adjunctive sedatives administered within the first 12 hours after intubation or until ICU transfer, whichever occurred first, to evaluate the adequacy of initial continuous infusion sedation. Data was collected and analyzed using Microsoft Excel.
Results: A total of 247 patients were screened, and 50 patients per group were included in the analysis. Baseline demographics, comorbidities, and indications for intubation were similar between the two groups. Restraint use within the first 12 hours after intubation or until ICU transfer occurred in 32% of patients in the pre-implementation group compared with 26% in the post-implementation group. All restraints applied were soft restraints. Protocol adherence occurred in only 54% of pre-implementation patients and 42% of post-implementation patients. When sedation was protocol-adherent, restraint utilization was similar between groups (25.9% vs 23.8%). Among non-protocol-adherent cases, restraint use was higher in the pre-implementation group than in the post-implementation group (39.1% vs 27.6%). Adjunctive sedatives were used in 64% of pre-implementation patients and 58% of post-implementation patients. Benzodiazepines were the most common adjunctive agents used. The mean benzodiazepine-equivalent dose was substantially higher in the pre-implementation group (22.72 mg vs 7.78 mg). Dexmedetomidine and ketamine were also used more frequently in the pre-implementation group. Overall, sedative exposure was higher in the pre-implementation cohort.
Conclusions: Implementation of an IBW–based sedation protocol in MV ED patients was not associated with increased restraint use or greater adjunctive sedative requirements. Despite lower calculated infusion doses, the new weight-based protocol appeared to provide adequate early sedation and may reduce the need for additional sedative escalation. However, several limitations should be considered. Protocol deviations and inconsistent titration practices were frequently observed and likely contributed to variability in sedation management and restraint utilization. These findings suggest that adherence to standardized sedation protocols, including appropriate weight selection and protocol-guided titration, may play a more important role in achieving adequate sedation than the dosing strategy alone. The results highlight opportunities to improve sedation practices and documentation workflows in the ED, particularly during emergent intubation when medication administration may be documented after the fact. Routine auditing and feedback may help improve protocol adherence and support sustained practice improvement.

List e-mail of the resident (or best contact) for follow-up: [email protected]

Moderators

Krista Dumkow

Presenters

Yurim Lee

PGY1 Pharmacy Resident, Wellstar Kennestone Regional Medical Center

Kristy (Yurim) Lee, PharmD, was born in South Korea and raised in College Station, Texas. She earned her Bachelor of Science in Biology from the University of Texas at Austin and her Doctor of Pharmacy degree from the Texas A&M University Irma Lerma Rangel College of Pharmacy. Dr... Read More →

Evaluators

Marci Swanson

Clinical Pharmacist Practitioner, Carl Vinson VA Medical Center

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Olympia 2

Critical Care/Emergency Medicine (CCM), Wellstar Kennestone Regional Medical Center

global Y

5:00pm EDT

Effectiveness of Amoxicillin-Clavulanate for the Treatment of Extended-Spectrum β-Lactamase-Producing Enterobacterales (ESBL-E) Urinary Tract Infection

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena H

Background: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, with Enterobacterales being the predominant pathogens. The rise in prevalence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) has led to increased antimicrobial resistance and recurrence rates. This prompts evaluation of alternative treatments such as amoxicillin-clavulanate, in which clavulanate may restore amoxicillin activity against common ESBL enzymes. The IDSA 2024 Antimicrobial-Resistant Gram-Negative guidelines recommend against its use but fail to cite high-quality evidence studying its efficacy in UTIs caused by ESBL-E. Other studies, limited by small sample size, suggest clinical efficacy of amoxicillin-clavulanate in the treatment of UTI caused by ESBL-E. This study attempts to bolster the body of data showing amoxicillin-clavulanate can be as effective as standard of care (SOC) antibiotics for the treatment of UTI caused by ESBL-E.

Methods: This multi-site, retrospective cohort study is approved by the Institutional Review Board. Adult patients (≥18 years) with either uncomplicated or complicated UTI with a urine culture positive for ESBL-E (confirmed via susceptibility testing) treated between April 1, 2024, and July 1, 2025, at Atrium Health Wake Forest Baptist facilities were included. Patients must have received at least 72 hours of amoxicillin-clavulanate or SOC therapy. Patients were excluded if they had concurrent bacterial infections, polymicrobial urine cultures, a previous UTI within 90 days already captured in the dataset, anatomic urinary tract abnormalities or instrumentation, renal abscesses, prostatitis, received in-vitro active antibiotic lead-in therapy for >50% of treatment duration, were immunosuppressed, or used methenamine or antibiotics for prophylaxis. The primary endpoint is clinical failure within 90 days, defined as retreatment with antibiotics and either recurrence of UTI symptoms or a repeat urine culture positive for the same organism as the index infection. Secondary endpoints include recurrence of resistant organisms (carbapenem-resistant Enterobacterales, SOC-resistant, or amoxicillin-clavulanate-resistant strains) within 90 days and time to clinical failure. Chi-square or Fisher’s exact tests tested categorical variables, and t-tests or Mann-Whitney U tests will test continuous variables. Kaplan-Meier survival analysis and Cox regression will assess time-to-event outcomes, and multivariable analysis will be used to identify patient factors associated with clinical failure.

Results: A total of 688 patients were screened; 274 patients met the inclusion criteria and were analyzed. Fifty-four patients were included in the amoxicillin-clavulanate group, and 220 in the SOC group. No statistically significant difference was observed in the primary outcome of treatment failure between the SOC and amoxicillin-clavulanate groups (p = 0.11). Patients with a prior history of ESBL infection had more than twice the odds of treatment failure (OR 2.09; p = 0.04), a finding that remained significant after adjustment for antibiotic selection and UTI type (OR 2.11, p = 0.047). Additionally, the use of sulfamethoxazole-trimethoprim for treatment of the index infection was associated with an 80% reduction in clinical failure compared to amoxicillin-clavulanate (p = 0.008).

Conclusions: Among patients treated with antibiotics for urinary tract infections caused by ESBL-producing Enterobacterales species, there was no statistical difference in effectiveness between amoxicillin-clavulanate and SOC within the limits of this study design.

Moderators

Jenna Jewett

Presenters

Nicholas Rosen

PGY-1 Pharmacy Resident, Atrium Health Wake Forest Baptist Medical Center

Nicholas Rosen, PharmD is a PGY-1 pharmacy resident at Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina. Nicholas recently matched to the PGY-2 Critical Care Pharmacy Residency Program at the Hospital of the University of Pennsylvania in Philadelphia... Read More →

Evaluators

Sarah McDaniel

Antimicrobial Stewardship Coordinator, Baptist Medical Center South

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Athena H

Infectious Disease (ID), Wake Forest Baptist

global Y

5:00pm EDT

Outcomes Associated with Implementation of an Electronic Health Record Based Automatic Infectious Disease Consultation for Positive Blood Cultures with Staphylococcus Aureus

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Olympia 1

Outcomes Associated with Implementation of an Electronic Health Record Based Automatic Infectious Disease Consultation for Positive Blood Cultures with Staphylococcus aureus

Authors: Taylor Bird, Elise Richoux, Brandon Hawkins, Samantha Walker, Miller Hadley, Amber Wolfe

Background:
Staphylococcus aureus bacteremia is often associated with high rates of morbidity and mortality if not managed appropriately. Infectious Diseases (ID) involvement in the clinical care of these patients has demonstrated reduced mortality, with early ID consultation also associated with decreased hospital length of stay. This study aims to evaluate the impact of an automatic electronic-health record (EHR) based ID consultation for patients with S. aureus bacteremia. This study will assess whether the automatic ID consultation protocol improves hospital length of stay, time to ID consultation, and time to targeted therapy.

Methods:
This single-center, retrospective, observational cohort study evaluated the impact of an EHR based automatic infectious disease consultation order for patients with S. aureus bacteremia. This protocol was implemented July 1, 2024. The pre-intervention group was composed of hospital encounters from June 1, 2022 through May 31, 2024, while the post-intervention group contained hospital encounters from July 1, 2024 through April 30, 2025. The primary outcome evaluated overall hospital length of stay. Secondary outcomes included time to ID consultation, time to targeted therapy, and pharmacist interventions recommending ID consultation. Potential subjects were identified via a list generated from clinical surveillance software (TheraDoc). List composition components included patients with at least one positive blood culture for S. aureus. Patients were included in the study, if they were 18 years of age or older and received an ID consultation during the related hospitalization. Exclusion criteria included death or transition to hospice within 48 hours of a positive culture result, patient directed discharge prior to clinical stability, or consult communication to the ID service greater than 24 hours after the EHR automatically ordered an ID consult. Statistical analysis will be performed using SPSS (IBM). Categorical data will be analyzed using Chi-Square or Fisher’s Exact tests. Continuous data will be analyzed using Student’s t-test or Mann-Whitney U test, as appropriate.

Results:
Hospital length of stay was significantly shorter in the post-intervention groups as compared to the pre-intervention group (15.3 vs 19.1 days p = 0.01). Time to ID consultation was not significantly different, with a mean of 0.38 ± 1.35 days in the pre-intervention group compared to 0.52 ± 0.48 days in the post-intervention groups (p = 0.226). Time to targeted antibiotic therapy was significantly shorter in the post-intervention group with a mean of 2.40 days compared to 2.90 days in the pre-intervention group (p = 0.039). Pharmacy interventions recommending ID consultation were significantly lower in the post-intervention group (5.7% vs 0%; p = 0.001).

Conclusions:
The implementation of an electronic health record based automatic infectious disease consultation protocol for Staphylococcus aureus bacteremia resulted in significant reductions in overall hospital length of stay and decreased the time to targeted antibiotic therapy.

Moderators

Ryan Tilton

Presenters

Taylor Bird

Evaluators

Katie Coffee

PGY1 Residency Program Director, Kaiser Permanente Georgia

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Olympia 1

Infectious Disease (ID), University of Tennessee Medical Center

global Y

5:00pm EDT

Tolerability of Extended-Duration Linezolid Therapy at a Large Academic Medical Center

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena G

BACKGROUND
Linezolid is an oxazolidinone antibiotic with activity against drug-resistant gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus. The typical duration of linezolid therapy is approximately two weeks, with a maximum recommended duration of 28 days per the package insert. Bone and joint infections often require prolonged courses of antimicrobial therapy of 4 to 6 weeks. Linezolid is an ideal agent for treatment of bone and joint infections due to its reliable oral bioavailability and activity against resistant organisms. However, concerns regarding hematologic and neurologic toxicity often limit extended use beyond recommended durations. Real-world data describing tolerability during prolonged outpatient therapy remains limited. This study evaluated treatment completion and adverse effects associated with extended-duration linezolid therapy in an outpatient cohort.
METHODS
We conducted a retrospective cohort study at a large academic medical center evaluating adults prescribed oral linezolid 600 mg every 12 hours for more than 14 days for bone and joint infections between January 2022 and December 2024. Laboratory data were evaluated at two-week intervals. Patients lacking follow up laboratory data after the first 14 days of therapy or who were lost to follow up were excluded. Baseline demographics, laboratory values, duration of therapy, and adverse effects were collected from electronic health records. The primary outcome was the completion of prescribed therapy. Secondary outcomes included incidence of hematologic toxicity, defined as thrombocytopenia (platelet count < 150 x 103/ mcL or 50% decrease from baseline) or anemia (hemoglobin ≤ 10 g/dL or 2 g/dL decrease from baseline), and neurologic toxicity defined by documented new-onset neuropathic or visual symptoms. Time to adverse events was also assessed.

Moderators

Madison Schwartz

Presenters

Kendall Cooper

PGY1 Pharmacy Resident, Grady Memorial Hospital

Evaluators

Michelle Turner

PGY1 RPD and Clinical Coordinator, MCNC1Moses Cone Hospital - Cone HealthPGY1

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Athena G

Infectious Disease (ID), Grady Memorial Hospital

global Y

5:00pm EDT

Evaluation of Inpatient Opioid Use in Opioid-Naive Patients without an Acute Pain Indication

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena J

Background: Opioids are analgesic medications that are commonly used for the management of moderate to severe pain. In hospitalized patients, opioid administration carries risks including respiratory depression, delirium, constipation, and potential long-term dependence, with opioid-naïve individuals being particularly at risk for adverse outcomes when exposed. While opioids are appropriate for moderate to severe acute pain, inpatient prescribing frequently occurs without documented acute pain indications. Characterizing opioid use in this population represents an important opportunity for opioid stewardship and quality improvement.
Methods: This single-center, retrospective observational study evaluated opioid-naïve adult patients admitted to medical floors at a community teaching hospital between September 2024 and October 2025. Patients were included if they were ≥18 years of age, admitted to selected medical floors for at least 24 hours, had the “Admit to Med Surg” orderset added within 24 hours of admission, and opioid-naïve based on medication history and insurance claims data. Patients were excluded if they had operative procedures requiring anesthesia, chronic pain, acute pain indications, active cancer, opioid use disorder, pregnancy, incarceration, or enrollment in hospice or palliative care. Eligible patients were grouped based on patients with the as-needed (PRN) pain orders and patients without the PRN pain orders within the “Admit to Med Surg” orderset. The primary outcome was inpatient opioid exposure, measured in morphine milligram equivalents (MME), during the first seven days of hospitalization. Secondary outcomes included the rate of patients who received over the first seven days of admission, opioid prescription at discharge (MME and duration) and opioid-related adverse events requiring naloxone administration or intubation.
Results: A total of 198 patients were included (65 with PRN pain orders, 133 without PRN pain orders). Mean opioid exposure over the first seven days of admission was significantly higher in patients with an PRN pain orders compared to those without (p<0.001, 95% CI 1.66(1.4997 - 1.8203)). For secondary outcomes, 61.5% of patients with the opioid orders received at least one dose of opioid medication, and only 17.2% of patients without the opioid orders received an opioid medication during admission. There was no difference between groups in opioid-related adverse events requiring naloxone. Discharge opioid prescribing rates showed 4.6% of patients received a prescription in the group with the PRN pain orders compared to only 0.6% of patients without the PRN pain orders received an prescription for an opioid at discharge. Of patients who received a prescription at discharge, the average days supply of 3.67 days in the group with the PRN pain orders with an average MME of 80, whereas the group without the PRN pain orders had an average days supply of 2 with average MME of 75.
Conclusion: Opioid-naïve patients without acute pain indications who had an PRN pain orders within 24 hours of admission experienced significantly higher inpatient opioid exposure at 7 days than those without. These findings highlight an opportunity for standardizing pain management strategies to help minimize unintended opioid exposure in this population.

Moderators

Rachel Friend

Presenters

Taylor Romine

PGY1 Pharmacy Resident, Baptist Health Princeton Hospital

Taylor Romine is a PGY-1 pharmacy resident at Baptist Health Princeton Hospital. She earned her Doctor of Pharmacy and Master's in Healthcare Administration from Samford University in Birmingham, AL. She is planning to complete a PGY-2 in internal medicine at Baptist Health Princeton... Read More →

Evaluators

Rachel Langenderfer

Clinical Pharmacy Specialist - Residency Program Coordinator, Bon Secours St. Francis Downtown

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Athena J

Internal Medicine (IM), Baptist Health Princeton Hospital

global Y

5:00pm EDT

Improving VTE Prophylaxis in Multiple Myeloma: An EHR-Based Approach Using IMPEDE and SAVED Risk Stratification Score in an Outpatient Setting

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Parthenon 2

Improving VTE Prophylaxis in Multiple Myeloma: An EHR-Based Approach Using IMPEDE and SAVED Risk Stratification
Score in an Outpatient Setting
Purpose:
Multiple myeloma patients are at an increased risk of venous thromboembolism due to drug usage, decreased mobility,
and hypercoagulability. Use of IMPEDE/SAVED score to determine prescribing of VTE prophylaxis has resulted in
significantly lower risk of venous thromboembolism. Real world data are needed to determine whether implementation
of a new electronic health record (EHR) system incorporating these scoring tools improves the effectiveness of guiding
thromboembolism prophylactic treatment in multiple myeloma patients, as clinical trial results may not fully reflect their
impact across diverse patient populations, practice settings, and workflow environments.
Methods:
This retrospective, single-center, quality improvement evaluated newly diagnosed patients with multiple myeloma (MM)
before and after implementation of IMPEDE and SAVED risk stratification score that was integrated in an EHR treatment
order set to guide prophylaxis selection. The pre-intervention group was managed using Varian EHR system, whereas the
post-intervention group used Cerner EHR platform, where the order set was implemented. Although the risk scores were
calculated by the treating physicians, integration of the order set serves as a structured reminder to promote consistent
risk assessment and documentation. The primary outcome was guideline adherence to VTE prophylaxis, with secondary
outcomes including incidence of VTE within six months of prophylaxis and assessing risk reclassification.
Results
A total of 19 patients with MM were included with 8 in the pre-intervention group using Varian EHR, and 11 patients in the
post-intervention group following Cerner EHR implementation with VTE prophylaxis order sets. Guideline adherence to
NCCN recommended VTE prophylaxis based on SAVED and IMPEDE scores were 87.5% and 25% pre-intervention versus
63.6% and 36.4% post-intervention, respectively. No patients receiving prophylactic anticoagulation developed VTE
within six months, and one pre-intervention patient (12.5%) had a prophylaxis change after crossover to the post
intervention period.
Conclusion
Implementation of IMPEDED and SAVED VTE risk stratification score being added to treatment order sets demonstrated
variable adherence to guideline recommended prophylaxis but was associated with no observed VTE events among
patients receiving prophylaxis. Larger studies are needed to further evaluate clinical impact and prescribing consistency

Moderators

Sheema Hallaji

PGY1 Residency Director, Cone Health- Alamance Regional Medical Center

Presenters

Sydney Lampkin

Evaluators

Savannah Owen

Assistant Professor of Pharmacy Practice, South College School of Pharmacy

Thursday April 30, 2026 5:00pm - 5:20pm EDT
Parthenon 2

Internal Medicine (IM), John D. Archbold Memorial Hospital

global Y

5:00pm EDT

Lipoglycopeptides Unleashed: The Power of Dalbavancin and Oritavancin

Thursday April 30, 2026 5:00pm - 5:20pm EDT

Athena C

Title: Lipoglycopeptides Unleashed: The Power of Dalbavancin and Oritavancin

Authors: Michael Wallace, Heather Gibson, Gretchen Arnoczy, Allison Cid

Background: Lipoglycopeptides are newer antimicrobial agents used to treat gram positive bacterial infections that would otherwise require long term therapy. Advantages include less frequent dosing, no need for pharmacokinetic monitoring, and long half-lives. The long-acting effects of dalbavancin or oritavancin are useful to help prevent patients from needing long-term intravenous access for IV antibiotics and hospital admission. The purpose of this study was to compare the costs between dalbavancin and oritavancin use compared to traditional therapy for gram-positive infections.
Methods: This was a retrospective, multicenter cohort study at a rural, community health system that included patients who received either dalbavancin or oritavancin at an outpatient infusion center. Patients were included if they received dalbavancin or oritavancin from September 2022 to September 2025. Excluded patients were those that are incarcerated, pregnant women, those younger than 18 years old, or received dalbavancin or oritavancin inpatient. The primary outcome of the study was cost minimization with comparisons between oritavancin and dalbavancin and the standard treatment for gram-positive infections. Secondary outcomes included adverse events, clinical failure, and mortality. Clinical characteristics such as organism, type of infection, and rationale for dalbavancin or oritavancin use were recorded.

Results: A total of 110 patients were included in this study, 103 in the dalbavancin group and 7 in the oritavancin group. The total cost savings were stratified based upon indication for both medications. Overall total cost savings for dalbavancin was $308,788.83 and total cost savings for oritavancin was $54,327.54. Total hospital days saved for dalbavancin were 298 and 26 days for oritavancin. The 90-day hospital readmission rate was 20/103 (19%) in the dalbavancin group and 1/7 (14%) in the oritavancin group. The most common organisms in the dalbavancin group were Methicillin-resistant Staphylococcus aureus (MRSA) with 30/104 (29%) and polymicrobial with 31/103 (30%) and in the oritavancin group was unknown organism with 3/7 (43%). Clinical failure rates for dalbavancin were 14/103 (13%) of patients and oritavancin was 2/7 (28%). 90-day mortality rates for the dalbavancin group were 3/103 (3%) and none in the oritavancin group.

Conclusions: In this study, the clinical utility, cost saving, and decreased length of hospital stays was shown with implementation of dalbavancin and oritavancin. Total cost avoided for both medications during the period was $363,114.37. These results show that the medications will cut costs and facilitate quicker discharge. Further research to showcase the use of long acting lipoglycopeptides at other institutions could reinforce the cost savings potential on a larger scale.

Moderators

global Y