2026 Southeastern Residency Conference

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.

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]

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.

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.

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] 

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.

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.

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

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.

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.

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.

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.

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. 

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.

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.

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.

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.