BEGIN:VCALENDAR VERSION:2.0 X-WR-CALNAME:2026serc X-WR-CALDESC:Event Calendar METHOD:PUBLISH CALSCALE:GREGORIAN PRODID:-//Sched.com 2026 Southeastern Residency Conference//EN X-WR-TIMEZONE:UTC BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260429T220000Z DTEND:20260430T000000Z SUMMARY:Early Check-In DESCRIPTION:\n CATEGORIES: LOCATION:Creature Comforts Brewery\, 271 W Hancock Ave\, Athens\, GA 30601 SEQUENCE:0 UID:84129df1786f7437e5a07ee929c4e489 URL:http://2026serc.sched.com/event/84129df1786f7437e5a07ee929c4e489 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T120000Z DTEND:20260430T121000Z SUMMARY:Welcome DESCRIPTION:\n CATEGORIES: LOCATION:Ballroom EF\, Athens\, GA\, USA SEQUENCE:0 UID:6e6671181de6e7feb91655c5170cdc10 URL:http://2026serc.sched.com/event/6e6671181de6e7feb91655c5170cdc10 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T121000Z DTEND:20260430T130000Z SUMMARY:Keynote: Navigating Your Leadership Journey: Career insights and practical advice for new practitioners DESCRIPTION:\n CATEGORIES: LOCATION:Ballroom EF\, Athens\, GA\, USA SEQUENCE:0 UID:a935ae3441e8b4859b45ccfd7da3468d URL:http://2026serc.sched.com/event/a935ae3441e8b4859b45ccfd7da3468d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Class of Trade: An Exploratory Review Through the Lens of a National Group Purchasing Organization DESCRIPTION:CLASS OF TRADE: AN EXPLORATORY REVIEW THROUGH THE LENS OF A NATIONAL GROUP PURCHASING ORGANIZATION\nBenton Zielinski\, Laura Crow\, Samantha Randlett\, Alyssa Huff\, Jason Braithwaite\nHealthTrust Performance Group/University of Tennessee Health Science Center – Nashville\, TN\nBackground/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.\n\nMethodology: 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.\n\nResults: 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.\n\nConclusions: 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.\n\n CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:add609430c8165e597a306ec9128567c URL:http://2026serc.sched.com/event/add609430c8165e597a306ec9128567c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Impact of a Pharmacist-Led Practice Change in Anti-Xa Monitoring on Bleeding Rates in Burn Injury Patients Receiving Enoxaparin for Venous Thromboembolism Prophylaxis DESCRIPTION: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\nAuthors: Jacob King\, Nirali Naik\nBackground: \;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.\nMethods: \;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.\nResults: 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).  \; \;\nAdditional 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. \;\nConclusion: \;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.\nContact: jacob.king4@wellstar.org\n\n \n CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:f9f3c33261f2690a646c45fe610ae4cc URL:http://2026serc.sched.com/event/f9f3c33261f2690a646c45fe610ae4cc END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Impact of a Pharmacist-led Weight Management Clinic in a Medically Underserved Population within a Federally Qualified Health Center DESCRIPTION:Impact of a Pharmacist-led Weight Management Clinic in a Medically Underserved Population within a Federally Qualified Health Center\n\nRebecca Axson-Wells1\, L. Tate Owens1\, N. Leigh Joyner1\, Carrington Huneycutt1\, Joseph Magagnoli2\, P. Brandon Bookstaver2\, Robert Etheridge1\, Reagan K. Barfield2\n\n1Tandem Health\, 2University of South Carolina College of Pharmacy \;\n\nBackground/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. \;\n\nMethodology: 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.\n\nThe 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. \;\n\nResults: 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).\n\nThere 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.\n\nConclusion: 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. \; CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:abc97b1d2f352d06ab7d99116d620371 URL:http://2026serc.sched.com/event/abc97b1d2f352d06ab7d99116d620371 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:The Change in Blood Pressure and other CGRP-related Adverse Events when used Long-Term for Migraine Prevention - Allison Eppenauer - Allison Eppenauer DESCRIPTION:Background  \;-\nSince 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.\n\nMethods -\nThis 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.\nThe 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.\n\nResults –\nA 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.\nAfter 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.\nSecondary 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.\n\nConclusion:\nLong-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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:85dc64733c71a5142f14cebe1e808f18 URL:http://2026serc.sched.com/event/85dc64733c71a5142f14cebe1e808f18 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Retrospective Data Review of Adherence Rates\, Drug Interactions\, and Perceived Outcomes in Patients Prescribed Resmetirom in a Community-Based Specialty Pharmacy DESCRIPTION:Authors: Tsuraya Iswanto\, Mariam Saba\, Victoria Phan\n\nBackground: 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. \n\nMethods: 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). \n\nResults (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. \n\nConclusions (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. \n\nE-mail of resident: tsuraya.iswanto@walgreens.com CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:9279953225d88f8717ecc03f71a8457d URL:http://2026serc.sched.com/event/9279953225d88f8717ecc03f71a8457d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Impact of Pharmacist-Led Blood Glucose Management on Patients in the Medical Intensive Care Unit DESCRIPTION:Impact of Pharmacist-Led Blood Glucose Management on Patients in the Medical Intensive Care Unit  \;\nAbigail Reeves\, Ann Maxwell\, Megan Lail\, Marwan Elya \;\n \;\nBackground\nHyperglycemia 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. \;\n \;\nMethods \nThis 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. \;\n \;\nResults \nThe 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.  \;\n \;\nConclusions \nPharmacist 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:72b0b2cd354f23442d413fb047137b4f URL:http://2026serc.sched.com/event/72b0b2cd354f23442d413fb047137b4f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Standardizing Local Inhaled Epoprostenol Use in Acute Respiratory Distress Syndrome: A Quality Improvement Project DESCRIPTION:Title: Standardizing Local Inhaled Epoprostenol Use in Acute Respiratory Distress Syndrome: A Quality Improvement Project\n\nAuthors: Adelaine Hogan\, Ryan Lally\, Rachel Langenderfer\, Brittany NeSmith\n\nBackground: 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.\n\nMethods/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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:2b5a9320d5c6e5bf13e0db3f1b614e1e URL:http://2026serc.sched.com/event/2b5a9320d5c6e5bf13e0db3f1b614e1e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Impact of Provider Education on Adherence to a Urine Culture Guidance Algorithm in a Community Hospital DESCRIPTION:Authors: Cameron Howell\, PharmD\; Layla Marefat\, PharmD \;\n\nBackground: 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. \n \;\nMethods: 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. \n \nResults: 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). \n \nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:70dbf6c3169e9e3409958944adf1e1e0 URL:http://2026serc.sched.com/event/70dbf6c3169e9e3409958944adf1e1e0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Characterizing the Microbial Landscape of Febrile Neutropenia at an Academic Medical Center DESCRIPTION:Title: Characterizing the Microbial Landscape of Febrile Neutropenia at an Academic Medical Center\nAuthors:\nAlexander Durant\, PharmD1\,2\nAmber Clemmons\, PharmD\, BCOP\, FHOPA1\,2\nAffiliations:\nWellstar MCG Health\, Augusta\, Georgia\nUniversity of Georgia College of Pharmacy\, Athens\, Georgia\nBackground:\nFebrile 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.\nObjectives:\nThis 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.\nMethods:\nThis 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.\nResults:\nMost 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.\nConclusion/Discussion:\nThis 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. CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:3f956607ffb9208988f9f0fe051c0874 URL:http://2026serc.sched.com/event/3f956607ffb9208988f9f0fe051c0874 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Evaluation of Early Onset Severe Treatment-related Adverse Events for Fluoropyrimidine-based Chemotherapy DESCRIPTION:Title: Evaluation of Early Onset Severe Treatment-related Adverse Events for Fluoropyrimidine-based Chemotherapy\nAuthors: Alexandria Rakestraw\, Alex Balkcom\, Rodna Larson\nBackground:\nFluoropyrimidines 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.\nThe 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.\nThis 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.\nMethods:\nThis 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.\nThe 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.\nResults:\nAmong 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).\nConclusions: \;\nThese 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.\n \; \; CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:bc0c192b23c0c38a393d9be5736be574 URL:http://2026serc.sched.com/event/bc0c192b23c0c38a393d9be5736be574 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Evaluation of Postoperative Outcomes and the Impact of an Enhanced Recovery Pathway in Patients Who Have Undergone a Laparotomy Procedure DESCRIPTION:Evaluation of Postoperative Outcomes and the Impact of an Enhanced Recovery Pathway in Patients Who Have Undergone a Laparotomy Procedure\n\nMackenzie Winter Waters\, Melissa Bagwell\, Leborah Cole Lee\, Courtney Reliford\, Kayla Brown\n\nAbstract\nPurpose: 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.\n\nMethods: 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).\n\nResults: 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.\n\nConclusion: 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. CATEGORIES:PAIN MANAGEMENT (PM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:f83318dffae76cff5f64c2cb430479f2 URL:http://2026serc.sched.com/event/f83318dffae76cff5f64c2cb430479f2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T131000Z DTEND:20260430T133000Z SUMMARY:Chemical Restraint Utilization and Standardization in Adult Hospitalized Patients DESCRIPTION: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.\n\nMethods: 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.\n\nResults: 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.\n\nMost 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%).\n\nConclusions: 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. CATEGORIES:PSYCHIATRIC PHARMACY (PSY) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:63b28e715aa85c9db232d48a61bfed4b URL:http://2026serc.sched.com/event/63b28e715aa85c9db232d48a61bfed4b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Assessing Adherence to ADA-Recommended Annual Vitamin B12 Monitoring in Veterans on Long-Term Metformin Therapy at the Salisbury VA Health Care System DESCRIPTION:Authors: Abigail Murray\, Brittany Melville\, Micah Corriher\, Camille P. Robinette \;\n \;\nBackground: 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. \;\n \;\nMethodology: 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. \;\nResults: 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. \;\nConclusions: 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. \;\n\nResults: 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. \;\nConclusions: 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. \;\n\nConclusion: 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:526957ef45882ed007fc85ccb60795cf URL:http://2026serc.sched.com/event/526957ef45882ed007fc85ccb60795cf END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Evaluation of Documented Medication Access Barriers at Hospital Discharge DESCRIPTION: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.  \;\n \;\nMethods: 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. \;\n \;\nResults: In Progress \;\n \;\nConclusions: In Progress \;\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:d5fb067e0995c91c76a40533389187e3 URL:http://2026serc.sched.com/event/d5fb067e0995c91c76a40533389187e3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Optimization of Guideline-Directed Medical Therapy in Veterans Hospitalized with an Acute Heart Failure Exacerbation DESCRIPTION:Optimization of Guideline-Directed Medical Therapy in Veterans Hospitalized with an Acute Heart Failure Exacerbation\nBenjamin Brewer\, Mary Martin McGill\nBirmingham VA Health Care System-Birmingham\, AL\nBackground/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.\nMethodology: \;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.\nResults: \;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.\nConclusions: \;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.\nPresentation Objective: Evaluate 30-day readmission rates of HFrEF admissions who have GDMT titrated at discharge in the Birmingham VA Health Care System (BVAHCS).\nSelf-Assessment: Which of the following is not a first line option for optimizing GDMT? CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:ffc160f909d194bd82a95b86369d86de URL:http://2026serc.sched.com/event/ffc160f909d194bd82a95b86369d86de END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Impact of IV Fluid Components on Clinical Outcomes in Type 1 Diabetics Admitted to the PICU in DKA  DESCRIPTION:Authors: Alexa Ruzicka\, Magen Check\, Austin Weiss\, Tamara Downing\, Ashlee Baucom \;\n\nBackground:  \;\nDiabetic 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.  \;\n\nMethods: \;\nThis 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.  \;\n\nResults: \;\n109 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.  \;\nRates 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). \n\nConclusion: \;\nThe 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.  \;\n\nContact email: alexa.ruzicka@ecuhealth.org\n\n CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:5dbc05124f61d5a985dadb168538bc9e URL:http://2026serc.sched.com/event/5dbc05124f61d5a985dadb168538bc9e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Patient-Reported Outcomes with Semaglutide Sublingual Suspension for Wellness: A Prospective Observational Study DESCRIPTION:Title: Patient-Reported Outcomes with Semaglutide Sublingual Suspension for Wellness: A Prospective Observational Study.  \;\n\nAuthors: Jonathan Reynolds\; Brandon Sucher  \;\n\nBackground:  \;\nGlucagon-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.  \;\n\nMethods:  \;\nThis 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. \;\n\nResults: \nA 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.  \;\n\nConclusion: \;\nCompounded 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. CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:29f83d3402954065319dee17b2d41234 URL:http://2026serc.sched.com/event/29f83d3402954065319dee17b2d41234 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Evaluating Antibiotic Overuse DESCRIPTION:Evaluating Antibiotic Overuse at Hospital Discharge for Uncomplicated Community Acquired Pneumonia and Urinary Tract Infections: A Retrospective Review\n \;\nBlake McClellan\, Sarah Grace Gunter\, Noah Sanford\, Braxton Clines\, Elizabeth Covington\n\nAbstract\nPurpose: \;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.\n\nMethods: \;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).\n\nResults: \;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).\n\nConclusions: \;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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:8ae114670908c4b7ef60f37bf3f6e173 URL:http://2026serc.sched.com/event/8ae114670908c4b7ef60f37bf3f6e173 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Resident Presentation - Alexis Titus DESCRIPTION:\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:be3ce2b0a4aae4cbb5914c011e3bded8 URL:http://2026serc.sched.com/event/be3ce2b0a4aae4cbb5914c011e3bded8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Evaluation of Carbapenem and Valproic Acid Interaction Warnings DESCRIPTION: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.\nMethods: 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.\nResults: \;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.\nConclusions: \;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. CATEGORIES:MEDICATION SAFETY (MES) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:72d1a20bbde9fe0024d3bc0d514b664c URL:http://2026serc.sched.com/event/72d1a20bbde9fe0024d3bc0d514b664c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Impact of Autoverification Strategies on Time to Antimicrobial Administration in the Emergency Department DESCRIPTION:Impact of Autoverification Strategies on Time to Antimicrobial Administration in the Emergency Department \; \;\nJessie Vo\, Christopher Campbell\, Taylor Gregory\, Kelley Norris\, Alicia Sanchez \;\nBackground\nAutoverification 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. \;\n\nMethods\nA 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.  \; \;\n\nResults\nA 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). \;\n\nConclusion\nThis 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. \;\n\n\n\nContact: jessie.vo3@wellstar.org CATEGORIES:MEDICATION SAFETY (MES) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:40a42a97341bdbda9faa7efff429d4a0 URL:http://2026serc.sched.com/event/40a42a97341bdbda9faa7efff429d4a0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Impact of IV Electrolyte Autoverification Compared to Pharmacist Verification in the Emergency Department DESCRIPTION:Title: Impact of IV Electrolyte Autoverification Compared to Pharmacist Verification in the Emergency Department  \; \;\n\nAuthors: Raven Gadson\, Brittany Onyeji\, Kirsten DiPiro\, Ambra Hannah \;\n\nBackground/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).  \;\n\nMethods: 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. \;\n\nResults: 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%. \;\n\nConclusion: 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. \;\n\nList e-mail of resident (or best contact) for follow-up: Raven.gadson@wellstar.org CATEGORIES:MEDICATION SAFETY (MES) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:c6eb0e213c7a37d6a32995cd002a2ccb URL:http://2026serc.sched.com/event/c6eb0e213c7a37d6a32995cd002a2ccb END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Acute Pain Management in Patients with Opioid Use Disorder: Evaluating Practice and Outcomes Within a Tertiary Care Facility DESCRIPTION:Title: Acute Pain Management in Patients with Opioid Use Disorder: Evaluating Practice and Outcomes Within a Tertiary Care Facility\n\nAuthors: Breanna Wright\, Mary Beth Brinkman\, Justin Gruca\nTriStar Centennial Medical Center – Nashville\, TN\n\nBackground: 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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusion: 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.\nThis 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. CATEGORIES:PAIN MANAGEMENT (PM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:2dd783fa0ee49f937db5a8682bc71aa1 URL:http://2026serc.sched.com/event/2dd783fa0ee49f937db5a8682bc71aa1 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T133000Z DTEND:20260430T135000Z SUMMARY:Systematic Use of the MORE Tool to Reduce Opioid-Related Adverse Events at a Community Teaching Hospital DESCRIPTION:Title: Systematic Use of the MORE Tool to Reduce Opioid-Related Adverse Events at a Community Teaching Hospital \;\nAuthors: Mariam Diaby\, Kimm Freeman  \;\n\nBackground: 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. \;\n\nIn 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. \;\n\nThe 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. \;\n\nMethods: 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. \;\n\nThe 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. \;\n\nInterventions 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. \;\n\nResults: 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). \;\n\nThe 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. \;\n\nConclusion: 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.\n\n Contact: Mariam-sere.diaby2@wellstar.org CATEGORIES:PAIN MANAGEMENT (PM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:0739b85468529def8fa82d1c1744b9af URL:http://2026serc.sched.com/event/0739b85468529def8fa82d1c1744b9af END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:5cad8a49c31f2f550081d1ae599e1287 URL:http://2026serc.sched.com/event/5cad8a49c31f2f550081d1ae599e1287 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Comparative Effectiveness of Acetazolamide Versus Thiazide-like Diuretics for Sequential Nephron Blockade in Acute Decompensated Heart Failure: A Retrospective Cohort Study DESCRIPTION:TITLE: \;Comparative Effectiveness of Acetazolamide Versus Thiazide-like Diuretics for Sequential Nephron Blockade in Acute Decompensated Heart Failure: A Retrospective Cohort Study\n\nAUTHORS: Angel D. Posadas\, Otsanya Ochogbu\n\nBACKGROUND: 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.\n\nMETHODS: \;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.\n\nRESULTS: 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).\n\nCONCLUSION: 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:3a07e22706abc3ee76b73dbd798b6b8f URL:http://2026serc.sched.com/event/3a07e22706abc3ee76b73dbd798b6b8f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Levetiracetam Dosing Strategies for Seizure Prophylaxis in the Neurosurgical Intensive Care Unit DESCRIPTION:Authors: \;Alexander Leaman\, Mary Tremaine\, Sandrine Nelson\n\nBackground: \;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.\n\nMethods: \;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.\n\nResults: 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.\n\nConclusions: \;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.\n\nContact information: \;Alexander.Leaman@AdventHealth.com CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:f7fe14c41110592f8090833520bd426a URL:http://2026serc.sched.com/event/f7fe14c41110592f8090833520bd426a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Comparing the efficacy and safety of sotalol and dofetilide for maintenance of normal sinus rhythm at a community health system DESCRIPTION: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 \;\nBackground: \;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.  \;\n\nSotalol 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. \;\n\nThere 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. \;\n\nPurpose: 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. \;\n\nMethods: 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. \;\n\nResults: 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). \;\n\nConclusion: 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. \;\n\n\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:9442cd022c24e13c95978bae3cdf2f7f URL:http://2026serc.sched.com/event/9442cd022c24e13c95978bae3cdf2f7f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Pharmacist-Led Calcium Replacement in Trauma Patients - Aileen Jimenez DESCRIPTION:Poster Abstract Title: Pharmacist-Led Calcium Replacement in Trauma Patients\nPrimary Author: Aileen Jimenez\nContact: aileen.jimenez2@conehealth.com\nCo Authors: Heather Wilson and Madeline Mitchell\nBackground: \;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.\nMethods: \;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.\nResults: \;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).\nConclusion: 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:6eeb3e639cd5a7161b9935ba490e2365 URL:http://2026serc.sched.com/event/6eeb3e639cd5a7161b9935ba490e2365 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Enhancing Surveillance of Unlinked Overrides from Automated Dispensing Cabinets with a Company-Wide Dashboard DESCRIPTION:Background: \;\nAutomated 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.\n\nOverrides 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.\n\nOverride 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.\n\nObjective: \;\nTo evaluate data integrity within a company-wide ADC override dashboard to enhance identification and review of unlinked overrides.\n\nMethods: \;\nThis 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.\n\nResults: \;\nDashboard 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.\n\nMedications 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.\n\nConclusions:\nRefinement 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.\n \; \; CATEGORIES:MEDICATION SAFETY (MES) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:82b81402a52e0154c01b383cc7aaa531 URL:http://2026serc.sched.com/event/82b81402a52e0154c01b383cc7aaa531 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Evaluation of the Medication Discrepancy Rate at Discharge DESCRIPTION:Title: Evaluation of the Medication Discrepancy Rate at Discharge\nPurpose: 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.\nMethods: 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.\nResults: 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.\nConclusion: 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. CATEGORIES:MEDICATION SAFETY (MES) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:bdbb81944057b7f727711c49fd308664 URL:http://2026serc.sched.com/event/bdbb81944057b7f727711c49fd308664 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Outcomes of Intracranial Stenting During Tirofiban Infusion in Obese Patients: A Retrospective Analysis DESCRIPTION: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. \;\nMethods: 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. \;\nResults: 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). \;\nConclusions: 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. CATEGORIES:NEUROLOGY (NEU) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:4c022f219de736134de553d437d3ae37 URL:http://2026serc.sched.com/event/4c022f219de736134de553d437d3ae37 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Evaluation of Outcomes for HiDAC-135 Versus HiDAC-123 DESCRIPTION:Title: Evaluation of Outcomes for HiDAC-135 Versus HiDAC-123\nInvestigators: \;Chelsea Hylton\nRachel Matthews\nDarby Siler\nLaura Beth Parsons\nPractice site: Sarah Cannon Cancer Center at TriStar Centennial Medical Center\nBackground (464/600 words): \; \;\nIntermediate 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].\nThis study compares HiDAC-135 and HiDAC-123 in a real-world setting.\nMethods:\nThis 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.\nResults: \;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.\nConclusions/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.\nReferences:\n1.  \;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\n2.  \;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\n3. 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\nContact information: Chelsea Hylton\, PharmD\nChelsea.hylton@hcahealthcare.com CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:491b11a037e54fad78ea255665cbe47b URL:http://2026serc.sched.com/event/491b11a037e54fad78ea255665cbe47b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Comparison of Ketamine Monotherapy versus Ketamine and Propofol for Procedural Sedation in the Pediatric Emergency Department and the Impact on Time to Discharge DESCRIPTION:Title: Comparison of Ketamine Monotherapy versus Ketamine and Propofol for Procedural Sedation in the Pediatric Emergency Department and the Impact on Time to Discharge \;\n \;\nAuthors: Francesco Mottola\; Andrea Gerwin\; Maggie Raker\; Sarah Sterner\; Morgan Padron \;\nBackground/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. \;\n \;\nMethods: 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. \;\n \;\nResults: 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. \;\nConclusions: 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. \;\n\n CATEGORIES:PEDIATRIC (PED) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:d1149d37c78330cb397222b15c2e5095 URL:http://2026serc.sched.com/event/d1149d37c78330cb397222b15c2e5095 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Evaluation of Staphylococcal Scalded Skin Syndrome Treatment DESCRIPTION: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.\n\n CATEGORIES:PEDIATRIC (PED) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:0ab4b72c7e8a2abc069a5230150a678d URL:http://2026serc.sched.com/event/0ab4b72c7e8a2abc069a5230150a678d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T135000Z DTEND:20260430T141000Z SUMMARY:Evaluation of Discharge Process from a High Intensity Psychiatric Unit at a Veteran’s Health Care System DESCRIPTION:Title: \;Evaluation of Discharge Process from a High Intensity Psychiatric Unit at a Veteran’s Health Care System\n\nAuthor’s names: \;Dalton V. Scott\, Lynsey Neighbors\, Anisa Britt\, Perry Thompson\n\nBackground: 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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusions: 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. CATEGORIES:PSYCHIATRIC PHARMACY (PSY) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:e7ff162c6345b85d2e9c44ae5d7c29e7 URL:http://2026serc.sched.com/event/e7ff162c6345b85d2e9c44ae5d7c29e7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Development of a Pharmacist Credentialing and Privileging Framework - Ellis Simerly DESCRIPTION: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. \;\n\nMethods: 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. \;\n\nResults: 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.\nThe 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. \;\n\nConclusions: 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.\n\n CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:3c3d5f09e02ae7550c6b3b5c074eabdd URL:http://2026serc.sched.com/event/3c3d5f09e02ae7550c6b3b5c074eabdd END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Economic Impact of Sodium Bicarbonate Infusion Order Set Standardization DESCRIPTION:Background: \;\nSodium 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. \;\n \;\nMethods: \;\nThis 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. \n \;\nResults: \;\nBaseline 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. \n \;\nConclusions: \;\nThis 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. \n \;\nContact: \;\nCaitlin.brown@piedmont.org \;\n\n CATEGORIES:ADMINISTRATION (ADM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:ec50ff800d75f8ac6bdf6d8895d4135e URL:http://2026serc.sched.com/event/ec50ff800d75f8ac6bdf6d8895d4135e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Comparison of Heart Rate and Blood Pressure Control Agents in Acute Aortic Dissection DESCRIPTION:Title: \;Comparison of Heart Rate and Blood Pressure Control Agents in Acute Aortic Dissection\nAuthors: Brianna Lu\, Kathryn Harvell\, Ginger Gamble\nBackground: \;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.\nMethods: \;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.\nResults: \;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).\nConclusion: 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.\nContact Information: \;brianna.lu@ecuhealth.org CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:97372d13051d276f8165fe607036001e URL:http://2026serc.sched.com/event/97372d13051d276f8165fe607036001e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Evaluation of Antipsychotic Administration Strategies in Critically Ill Adults: Comparing Scheduled Quetiapine and PRN Ziprasidone in the ICU DESCRIPTION:Background \;\nIntensive 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. \;\nMethods \;\nA 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. \;\nResults \;\nAfter 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. \;\nConclusion \;\nIn 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. \;\n \;\nReferences:  \;\nEly 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.  \; \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:317e12ac9f01e2ad2f8671610a02bfda URL:http://2026serc.sched.com/event/317e12ac9f01e2ad2f8671610a02bfda END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Clinical Management and Outcomes in Patients with Coagulase-negative Staphylococcus spp. in Lone Blood Culture Sets DESCRIPTION:Clinical Management and Outcomes in Patients with Coagulase-negative Staphylococcus spp. in Lone Blood Culture Sets\nBenjamin K Battle\, Andrew B. Watkins\nFMOL Health | St. Dominic\nBackground/Purpose:\nBlood 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.\nMethodology:\nThis 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.\nResults:\nA 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.\nConclusions:\nOf 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:4c881322a0efe0ada79d11972a4c89b3 URL:http://2026serc.sched.com/event/4c881322a0efe0ada79d11972a4c89b3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Impact of a System-wide Pharmacy Clinical Decision Support Council on Pharmacist-Facing Medication Warning Alerts DESCRIPTION:Title: Impact of a System-wide Pharmacy Clinical Decision Support Council on Pharmacist-Facing Medication Warning Alerts\nAuthors: Benny Zhang\, PharmD\; Craig MacDonald\, PharmD\n\nBackground: 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.\n\nMethods: 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.\n\nResults: \;In Progress\n\nConclusion: In Progress CATEGORIES:INFORMATICS (INF) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:d6ea70140e576c79ff5b38f1c35a983c URL:http://2026serc.sched.com/event/d6ea70140e576c79ff5b38f1c35a983c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Comparing Tenecteplase and Alteplase for Acute Ischemic Stroke: A Real-World Evaluation of Efficacy and Safety DESCRIPTION:Comparing Tenecteplase and Alteplase for Acute Ischemic Stroke: A Real-World Evaluation of Efficacy and Safety  \;\nCatherine Wise\, Katleen Chester\, Olivia Morgan\, Morgan Daniel\; Grady Memorial Hospital\, Atlanta\, Georgia \;\nBackground: \;\nAcute 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. \;\nMethods: \;\nThis 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). \;\nResults:  \;\nA 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). \;\nConclusion:  \;\nTenecteplase 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. \;\n \;\nFor additional questions: Contact cwise@gmh.edu \; CATEGORIES:NEUROLOGY (NEU) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:1e1f6ac73093d34f7055a1c6d1756bb9 URL:http://2026serc.sched.com/event/1e1f6ac73093d34f7055a1c6d1756bb9 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Head-to-Head: Atorvastatin vs. Rosuvastatin for Secondary Stroke Prevention in Patients with Acute Ischemic Stroke DESCRIPTION: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.  \;\n\nMethods: 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. \;\n\nResults: 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. \;\n\nConclusions: 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.  \;\n\n CATEGORIES:NEUROLOGY (NEU) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:354054ef4f42719f656c23629b97d406 URL:http://2026serc.sched.com/event/354054ef4f42719f656c23629b97d406 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:The Impact of Inhaled Antibiotic Use in Critically Ill Neonatal and Pediatric Populations DESCRIPTION:Title: The Impact of Inhaled Antibiotic Use in Critically Ill Neonatal and Pediatric Populations\nAuthors: Madeline DiCenso\, Andrea Gerwin\, Renee Hughes\, Paige Klingborg\nBackground/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.\nMethods: 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.\nResults: 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.\nConclusions: \;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. CATEGORIES:PEDIATRIC (PED) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:aab5af6e256eb95ffdc29dc96248d559 URL:http://2026serc.sched.com/event/aab5af6e256eb95ffdc29dc96248d559 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Identifying Opportunities to Improve Discharge Prescribing of Newly Initiated Quetiapine During Transitions of Care DESCRIPTION:Title: \;Identifying Opportunities to Improve Discharge Prescribing of Newly Initiated Quetiapine During Transitions of Care: A Medication Use Evaluation \nAuthors: \;Audra Butler\, Bobby Azevedo\, Abigayle Campbell\n \nBackground: \;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. \;\n\nMethods: \;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. \;\n\nResults: \;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.\n\nConclusions: \;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. CATEGORIES:PSYCHIATRIC PHARMACY (PSY) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:5db02b7930acb3eff4615fedd5cdbfbf URL:http://2026serc.sched.com/event/5db02b7930acb3eff4615fedd5cdbfbf END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Improving naloxone prescribing rates for Veterans with stimulant use disorder (StUD) through AudioCARE technology at the Atlanta VA Healthcare System DESCRIPTION:Title: Improving naloxone prescribing rates for Veterans with stimulant use disorder (StUD) through AudioCARE technology at the Atlanta VA Healthcare System\nPresenters: Kathryne Spratlin\, PharmD\nAuthors: \;Lauren Ramshur\, MD\; Stephanie Oh\, PharmD\; Kathryne Spratlin\, PharmD\; Melanie Pafford\, NP\; Natalie Haslem\, NP\; Mary K. Pounders\, PharmD\, BCACP\nBackground:\nStUD 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.\nMethodology: \;\nThis 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.  \;\nResults: \;\nAudioCARE 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%.\nConclusions: \;\nThe 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. \;\n \; \;\n CATEGORIES:PSYCHIATRIC PHARMACY (PSY) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:e619a5bd6b6105a25d7f3ba5f522b725 URL:http://2026serc.sched.com/event/e619a5bd6b6105a25d7f3ba5f522b725 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T141000Z DTEND:20260430T143000Z SUMMARY:Early post-transplant conversion from tacrolimus to belatacept in kidney transplant patients DESCRIPTION:Early post-transplant conversion from tacrolimus to belatacept in kidney transplant patients\nAuthors: Mikayla Morrow\, Kwame Asare\, Victoria Burnette\, Nicole Melby\n\n1)Background\nAscension 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.\n \n 2)Methods\nThis 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).\n\n3)Results\nOverall\, 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).\n \n4)Conclusions\nIn 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.\n\n CATEGORIES:TRANSPLANT (TRP) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:f9280d9e10985c6a2826f8663ffad924 URL:http://2026serc.sched.com/event/f9280d9e10985c6a2826f8663ffad924 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Evaluation of Inhaled Corticosteroid Prescribing for Patients with COPD DESCRIPTION: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).\n\nMethods: 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. \;\n\nResults: 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.\n\nConclusions: 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:afc12ba6c348a2c0a2152564918c6429 URL:http://2026serc.sched.com/event/afc12ba6c348a2c0a2152564918c6429 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Optimization of Sodium-glucose Cotransporter-2 Inhibitors in Veterans with Heart Failure DESCRIPTION:Authors: \nAustin Seawright\, Natalie Giddens\, Marci Swanson\, Alexis Pruitt\n\nPurpose:\nSodium-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.\n\nMethods:\nThis 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.\n\nResults:\nOf 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.\n\nConclusions: \nThis 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. CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:e78be546fe5ea7ce002dc639807e0b43 URL:http://2026serc.sched.com/event/e78be546fe5ea7ce002dc639807e0b43 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Sotalol Dose Adjustments in Obese versus Non-Obese Patients DESCRIPTION:Brady Ratliff\, Jessica Brumit\n\nBackground/Purpose:\nSotalol 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.\nMethods:\nThis 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.\nResults:\nA 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.\nConclusions:\nObesity 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. CATEGORIES:CARDIOLOGY (CAR) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:9f9cc1687a817c6837ce3de42f990285 URL:http://2026serc.sched.com/event/9f9cc1687a817c6837ce3de42f990285 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Impact of Early Methylene Blue on Vasopressor-Free Days in Medical ICU Patients with Septic Shock DESCRIPTION:Impact of Early Methylene Blue on Vasopressor-Free Days in Medical ICU Patients with Septic Shock\n\nPurpose: 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.\n\nMethods: 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.\n\nResults: In progress CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:87f5bca8e1e582a2c2279908513c0eed URL:http://2026serc.sched.com/event/87f5bca8e1e582a2c2279908513c0eed END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Utilization of Medication Reconciliation Technicians in the Identification of Adverse Drug Events in the Emergency Department DESCRIPTION:Aidan Bush\, Patrick Blankenship\, Crystal Laudermilk\, Susan Roberts\, Rob Lucas \;\nPrisma Health Blount Memorial Hospital – Maryville\, TN \;\n\nBackground: 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. \;\n\nMethods: 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.  \;\n\nResults: 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. \;\n\nConclusions: 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:8c0b36bdfd9c49815ca1cfae3ad170ad URL:http://2026serc.sched.com/event/8c0b36bdfd9c49815ca1cfae3ad170ad END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Beyond Pneumonia - Evaluating the Predictive Utility of MRSA Nasal Screening for Infections Outside of the Lungs DESCRIPTION: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.  \; \;\n\nMethods: 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).  \;\n \;\nResults: 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%. \;\n \;\nConclusion: \;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. \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:a6d12767ad2f4e70a37877a4949db8e4 URL:http://2026serc.sched.com/event/a6d12767ad2f4e70a37877a4949db8e4 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Optimal Duration of Daptomycin plus Ceftaroline Combination Therapy in Persistent MRSA Bacteremia - Aliese Dashiell DESCRIPTION:Optimal Duration of Daptomycin plus Ceftaroline Combination Therapy in Persistent MRSA Bacteremia\nAliese Dashiell\, Brandon Bookstaver\, Ryan McCormick\, Alex Ewing\, Lauren McAbee\, Jake Crocker\n\nBackground: 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.\n\n\nMethods: 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. \n\n\nResults: 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.\n\n\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:93dd04bb8afea585f89cf7d39f2500ce URL:http://2026serc.sched.com/event/93dd04bb8afea585f89cf7d39f2500ce END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Evaluation of an Institutional Inpatient Warfarin Policy Within an Academic Health System DESCRIPTION:Title: Evaluation of an Institutional Inpatient Warfarin Policy Within an Academic Health System \n\nAuthors: Conner Correll Cain\; Hannah Young\; Gabrielle Iliff\; Laura Holden\n\nBackground: 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. \n \nMethods: 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.\n\n 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%).\n\n 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.\n\nResident Contact: conner.correll@prismahealth.org CATEGORIES:MEDICATION SAFETY (MES) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:7419655e6f22d3a2a65a5455f13173d0 URL:http://2026serc.sched.com/event/7419655e6f22d3a2a65a5455f13173d0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Inpatient Medication Use Evaluation of Chemotherapy-Induced Febrile Neutropenia DESCRIPTION:Inpatient Medication Use Evaluation of Chemotherapy-Induced Febrile Neutropenia\n \n 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.\n\nMethods: 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. \n\n 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. \n\n 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. \n\n CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:4af9f96c56a66a02c8306ada748a7f5a URL:http://2026serc.sched.com/event/4af9f96c56a66a02c8306ada748a7f5a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Impact of Opioid-Sparing Multimodal Pain Management Order Set on Opioid Use and Clinical Outcomes in Thoracic Surgery Patients DESCRIPTION:Impact of Opioid-Sparing Multimodal Pain Management Order Set on Opioid Use and Clinical Outcomes in Thoracic Surgery Patients\n\nAuthors: Kylie Michot\, Michael Ezebuenyi\, Monica Campbell\, Jennifer Jones\, Greggory Davis\n\nBackground: 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.\nMethods: 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.\nThe 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.\nResults: 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).\nConclusion: 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.\nContact Information: kylie.michot@fmolhs.org CATEGORIES:PAIN MANAGEMENT (PM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:630b2fdbfebffd1edf5a1d30564461e0 URL:http://2026serc.sched.com/event/630b2fdbfebffd1edf5a1d30564461e0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Evaluation Of Sickle Cell Fever Protocols in the Pediatric Emergency Department DESCRIPTION: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. \;\n\nMethods: 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.  \;\n\nResults: 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). \;\n\nConclusions: 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. \;\n\nContact: anne.abrams@wellstar.org CATEGORIES:PEDIATRIC (PED) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:2645d07d60e8b84488e0ff4c26e86157 URL:http://2026serc.sched.com/event/2645d07d60e8b84488e0ff4c26e86157 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T143000Z DTEND:20260430T145000Z SUMMARY:Impact of pre-transplant midodrine use on simultaneous liver-kidney transplant outcomes DESCRIPTION:Title: \;Impact of pre-transplant midodrine use on simultaneous liver-kidney transplant outcomes\n\nAuthors: \;Matthew Molk1\, Mojibola Awe2\, Teresa Gennaro1\, Heather Snyder1\, Farjad Siddiqui1\; \;Emory University Hospital\, Atlanta\, GA1\; The Johns Hopkins Hospital\; Baltimore\, MD2\n\nObjective: Determine the impact of pre-transplant midodrine use on outcomes after SLK transplant related to delayed graft function.\n\nSelf Assessment Question: Does midodrine use prior to \;simultaneous liver-kidney transplant increase the incidence of specific kidney delayed graft function. \;\n\nBackground: \;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.\n\nMethods: \;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.\n\nResults: \;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.\n\nConclusion: \;Pre-transplant midodrine use in SLK recipients does not appear to affect short term outcomes after transplant\; however larger studies need to be conducted. CATEGORIES:TRANSPLANT (TRP) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:865c0184135cdc81ae950985c6525b21 URL:http://2026serc.sched.com/event/865c0184135cdc81ae950985c6525b21 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Resident Presentation - Josh Kota DESCRIPTION:\n CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:23de16b4030e797a047d608ca3a193a7 URL:http://2026serc.sched.com/event/23de16b4030e797a047d608ca3a193a7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Pharmacogenomics-Guided Statin Reinitiation in Veterans with History of Statin-Associated Muscle Symptoms DESCRIPTION:Pharmacogenomics-Guided Statin Reinitiation in Veterans with History of Statin-Associated Muscle Symptoms\nDe’Vaughn Vaughn\, Jennifer Clark\nFayetteville VA Health Care Center – Fayetteville\, NC\n \;\nBackground/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.\nMethodology: 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. \;\nResults: 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. \nConclusions: \;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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:3eba442bb234897a8293c1c3cd72cce8 URL:http://2026serc.sched.com/event/3eba442bb234897a8293c1c3cd72cce8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Evaluation of Prealbumin Levels on Clinical Outcomes in Transthyretin Cardiac Amyloidosis Treated with Transthyretin Stabilizers DESCRIPTION:Authors: Jalyn Martin\, Justin Joy\, Brian Tran\, Matthew Brown\, Susie Sennhauser\, Matthew Gold\, Daniel Gold\, Kunal Bhatt\n\nBackground: 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.\n\nMethods: 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.\n\nResults: \;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.\n\nConclusions: 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.\n \; \; CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:30d3b7ee2298d042f67bc6736976617a URL:http://2026serc.sched.com/event/30d3b7ee2298d042f67bc6736976617a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Evaluation of the PRECISE-DAPT Score in Predicting CABG Related Bleeding Readmissions - Laura Adler DESCRIPTION:Evaluation of the PRECISE-DAPT Score in Predicting CABG Related Bleeding Readmissions\nInyeong Choi\, Danielle McPherson\, Davide Ventura\nAdventHealth Orlando\, FL\n\nBackground/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.\n\nMethodology: 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.\n \nResults: 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.\n\nConclusion: 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.\n\n CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:3c6f40eab995a699f826a9a571ab9176 URL:http://2026serc.sched.com/event/3c6f40eab995a699f826a9a571ab9176 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Iron Supplementation in Patients with Heart Failure with Reduced Ejection Fraction Following Pharmacist-Led Review DESCRIPTION:Iron Supplementation in Patients with Heart Failure with Reduced Ejection Fraction Following Pharmacist-Led Review\nLauren Finn\, Rachel Kile \;\nCHI Memorial Hospital\, Chattanooga\, TN \;\n\nBackground/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.\n \;\nMethods: 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.\n\nResults: 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. \;\n\nConclusions: 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. \;\n\n\n\nContact: lauren.finn@commonspirit.org CATEGORIES:CARDIOLOGY (CAR) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:5215dd9ea4cb59e322cc7dee3cdf0900 URL:http://2026serc.sched.com/event/5215dd9ea4cb59e322cc7dee3cdf0900 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Impact of Daptomycin Weight-Based Dosing Strategies in Obese Patients with Staphylococcal and Enterococcal Infections DESCRIPTION:Impact of Daptomycin Weight-Based Dosing Strategies in Obese Patients with Staphylococcal and Enterococcal Infections \nColeton Waggoner\, Emily Perez\, David Laurent \nBackground: 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).\n\nMethods: 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.\n\nThe 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.\n\nResults: 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. \n\nConclusions: 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. \n\nEmail: Coleton.Waggoner@ecuhealth.org CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:1eee5fcaf56b3d60d99d9ffed756375e URL:http://2026serc.sched.com/event/1eee5fcaf56b3d60d99d9ffed756375e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Evaluation of compliance to post bariatric surgery enoxaparin protocol for venous thromboembolism in high-risk patients DESCRIPTION:Title: \;Adherence to Venous Thromboembolism Prophylaxis Protocol in High-Risk Bariatric Surgery Patients\nAuthors: \;Ashley Bennett\, Adele Robbins\, Angelita Incer\n Emory Saint Joseph's Hospital - PGY1 - Atlanta\, Georgia \;\n 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. \;\n 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. \;\n 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.\n 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:f7d8b6891f651bad1d0c825640d142d4 URL:http://2026serc.sched.com/event/f7d8b6891f651bad1d0c825640d142d4 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Cefazolin vs. Clindamycin for Surgical Prophylaxis in Patients with a Beta-Lactam Allergy DESCRIPTION:Abstract \;\nTitle: Cefazolin vs. Clindamycin for Surgical Prophylaxis in Patients with a Beta-Lactam Allergy \;\nAuthors: John Otasowie\, Plamen Mangarov\, Daniel Rogers\, and Mydien Tran \;\nBackground \;\nAbout 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.  \; \;\nHowever\, 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. \;\nMethods \;\nThis 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. \;\nResults \;\nA 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. \;\nConclusion \;\nCefazolin 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. \;\n \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:2e56fe0f2f68190ee72e0ca6becb4394 URL:http://2026serc.sched.com/event/2e56fe0f2f68190ee72e0ca6becb4394 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Evaluating the Impact of Perioperative Antibiotic Timing on Surgical Site Infections in Hysterectomy and Colorectal Surgeries DESCRIPTION:AUTHORS: Brittany Shellhouse\, Eric Shaw\, Amy Taylor\n\nBACKGROUND: 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.\n\nMETHODS: 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.\n\nThe 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.\n\nRESULTS: 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.\nWhile 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.\n\nAppropriate 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%).\nFor 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.\n\nCONCLUSION: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:b1fb1274f0d5164e30a9ce1ac6b4df07 URL:http://2026serc.sched.com/event/b1fb1274f0d5164e30a9ce1ac6b4df07 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Micafungin Treatment Failure in Obese Patients: Standard versus Body Mass Index-Adjusted Dosing Regimens DESCRIPTION:Title: \;Micafungin Treatment Failure in Obese Patients: Standard versus Body Mass Index-Adjusted Dosing Regimens\n\nAuthors: \;Helene Gao\, Zachary Halbig\, Caroline Gresham\, Qian Zhong\nPiedmont Athens Regional Medical Center - Athens\, GA\n\nBackground: 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. \n\nMethods: 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.\n\nResults: 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).\n\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:0eef6eb9d574d85afe9f920e9711eca6 URL:http://2026serc.sched.com/event/0eef6eb9d574d85afe9f920e9711eca6 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Evaluation of Pharmacist Impact on Inpatient Glycemic Management DESCRIPTION: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.\n\nMethods: 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.\n\nResults: 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).\n\nConclusions: \;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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:251598562064baf362c827fc06671d56 URL:http://2026serc.sched.com/event/251598562064baf362c827fc06671d56 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T150000Z DTEND:20260430T152000Z SUMMARY:Incidence of Bleeding in Patients Receiving Parenteral Anticoagulation and Apixaban Therapy for VTE Treatment DESCRIPTION:Title: \;Incidence of Bleeding in Patients Receiving Parenteral Anticoagulation and Apixaban Therapy for VTE Treatment\n\nPrimary: Ashley Hannah\, hannahas@sjchs.org\nSecondary: Sara Anne Meyer\, Lilia Macias\, Evaline Inigo\, Sarah Lopez\n\nBackground: \;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.\n\nMethods: \;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.\nThe 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.\n\nConclusion: \;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.\n \; \; CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:9af6fdef60431331230e82464ca4d53d URL:http://2026serc.sched.com/event/9af6fdef60431331230e82464ca4d53d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Burnout Among Pharmacy Residents DESCRIPTION:Background:\nBurnout 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.\n\nMethods:\nSurveys 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.\n\nResults: \; \;\nA 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).\n\nConclusion: 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:b597bd86dda7c50be948e4f0e1adde02 URL:http://2026serc.sched.com/event/b597bd86dda7c50be948e4f0e1adde02 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Taking a Bite Out of Learning: Teaching Pharmacy Students Counseling Points Using Mobile Micro-Learning DESCRIPTION:Authors’ Names: Victoria Creo\, Rebecca Stone\, Jordan Khail\n\nBackground\nMicro-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.\n\nMethods\nDoctor 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.\n\nKnowledge 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.\n\nResults\nTo 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.\n\nConclusion\nIn progress\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:4a0fbdb7f1c22b246f6225b1d95cd045 URL:http://2026serc.sched.com/event/4a0fbdb7f1c22b246f6225b1d95cd045 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Impact of Anticoagulation Strategies on Thrombotic Events in Patients with Durable Left Ventricular Assist Devices (IMPACT-LVAD) DESCRIPTION:Title: \;Impact of Anticoagulation Strategies on Thrombotic Events in Patients with Durable Left Ventricular Assist Devices (IMPACT-LVAD) \nAuthors: \;Asya Bookal\, Danielle McPherson\, Michelle Dillon\n \nBackground/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. \;\n\nMethods: 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.  \;\n\nResults: 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).\n\nConclusions: Patients who underwent HM3 implantation experienced low rates of thrombotic events despite changes in anticoagulation strategies and did not experience fatal bleeding.\n\n CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:128c09021fb1786a718d54174cf688c4 URL:http://2026serc.sched.com/event/128c09021fb1786a718d54174cf688c4 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Pharmacogenomic- and Drug-Drug Interaction-Guided Antiplatelet Therapy in Veterans Taking Clopidogrel and Omeprazole DESCRIPTION:Title: Pharmacogenomic- and Drug-Drug Interaction-Guided Antiplatelet Therapy in Veterans Taking Clopidogrel and Omeprazole\nAuthors: Sydney Magrath\, Julianne Isaac\, David Deen\nBackground:\nAtherosclerotic 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).\nMethods:\nThis 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.\nResults: \;\nOf 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.\nNo 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.\nConclusion:\nThis 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.\n \; CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:6a130b8610c2a61abbd08f97529c943d URL:http://2026serc.sched.com/event/6a130b8610c2a61abbd08f97529c943d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Association between cephalexin dosing frequency in uncomplicated urinary tract infections and treatment failure in discharged Emergency Department patients DESCRIPTION:Association between cephalexin dosing frequency in uncomplicated urinary tract infections and treatment failure in discharged Emergency Department patients\nKameron Francis\, Rachel Musgrove\, Analise Williams\, Fataba Gailor\, Meghan Hammond\, Devon Burhoe\nBackground/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.\nMethodology: 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.\nResults: 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.\nConclusions: \;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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:0e252efdcc1a4a63dd638684d6b820f3 URL:http://2026serc.sched.com/event/0e252efdcc1a4a63dd638684d6b820f3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Correlation of Methicillin-Resistant Staphylococcus Aureus Polymerase Chain Reaction Nasal Swab in Empyema DESCRIPTION:Correlation of Methicillin-Resistant Staphylococcus Aureus Polymerase Chain Reaction Nasal Swab in Empyema\nElliott Wilch\; Sarah Frye\; Martin Gordon\; Cragin Currence\n\nBackground: \;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.\nMethods: \;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.\nResults: \;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.\nConclusion: 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.\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:22e7471236419b7f5007a67b225e872c URL:http://2026serc.sched.com/event/22e7471236419b7f5007a67b225e872c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Blood Culture Clearance with Different Vancomycin AUC Thresholds in Gram-Positive Bacteremia DESCRIPTION: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  \;\n\nBackground: 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. \nMethods: 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. \nResults: 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. \nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:f1375fde67280d6a39ac8027cca8e53e URL:http://2026serc.sched.com/event/f1375fde67280d6a39ac8027cca8e53e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Comparative Outcomes of Oral Beta-Lactams Versus Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Step-Down Therapy in Enterobacterales Bacteremia Secondary to Urinary Tract Infections DESCRIPTION:Title: \;Comparative Outcomes of Oral Beta-Lactams Versus Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Step-Down Therapy in Enterobacterales Bacteremia Secondary to Urinary Tract Infections\n\nPrimary: Taylor Hewitt\nSecondary: Jordyn Meredith\, Joseph Crosby\, Courtney Zeigler\n\nBackground: \;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.\n\nResults: \;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.\n\nConclusion: \;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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:474fb511e76455e9740da5ed7e066984 URL:http://2026serc.sched.com/event/474fb511e76455e9740da5ed7e066984 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Effectiveness of Amoxicillin-Clavulanate for the Treatment of Extended-Spectrum β-Lactamase-producing Enterobacterales (ESBL-E) Urinary Tract Infection DESCRIPTION:Title: Effectiveness of Amoxicillin-Clavulanate for the Treatment of Extended-Spectrum β-Lactamase-producing Enterobacterales (ESBL-E) Urinary Tract Infection \n\nAuthor: Haseeb Ahmed\, Nicholas Rosen\, Ryan Tilton\, Olivia Randazza\, John Williamson\, Charles Hartis\, Michael E DeWitt\, Alexandria Taylor\, Jennifer J Wenner\, \;Mary Banoub \n\nBackground: 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.\n\nMethods: 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. \n\nResults: 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). \n\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:775680ce4471d60863254c20b75bcbc4 URL:http://2026serc.sched.com/event/775680ce4471d60863254c20b75bcbc4 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Optimizing Anti-Pseudomonal Therapy Through Risk Stratification: Outcomes of Empiric Cefepime and Piperacillin/Tazobactam De-Escalation DESCRIPTION:OPTIMIZING ANTIPSEUDOMONAL THERAPY THROUGH RISK STRATIFICATION:EFFICACY AND SAFETY OUTCOMES OF EMPIRIC CEFEPIME AND PIPERACILLIN/TAZOBACTAM DE-ESCALATION THROUGH ANTIMICROBIAL STEWARDSHIP INTERVENTIONSJacob Krissinger\, Michael Shaw\, Rachel Langenderfer\, Brittany NeSmithBon Secours St. Francis Downtown Hospital\, Greenville\, South Carolina\nBackground/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.  \;\n\nMethodology: 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. \;\n\nResults: 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.  \;\n\nConclusion: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:1e24fa9bd72f45aa069e6d307ed62196 URL:http://2026serc.sched.com/event/1e24fa9bd72f45aa069e6d307ed62196 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Management of Lipid-Lowering Therapy for Hospitalized Patients with Acute Coronary Syndrome (ACS) DESCRIPTION:Abstract\nPurpose/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.\n\nMethodology: 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.\n\nResults: 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.\n\nConclusion: 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:b5189417914a75051a0f16bf8e4d627c URL:http://2026serc.sched.com/event/b5189417914a75051a0f16bf8e4d627c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T152000Z DTEND:20260430T154000Z SUMMARY:Real World Comparison of CAR T-Cell and Bispecific Antibody Therapy in Relapsed/Refractory Multiple Myeloma DESCRIPTION: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.\nMethods: 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.\nResults: 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).\nConclusions: 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.\n \; \;  \;[KN1]included CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:b6c4cd83e6ae83c282a3879a7a48f2a1 URL:http://2026serc.sched.com/event/b6c4cd83e6ae83c282a3879a7a48f2a1 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Characterization of Auto-Verification Gaps in a Post-Merger Health-System - Benjamin Emery DESCRIPTION: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.\n\nObjectives: 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.\n\nMethods: 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.\n\nResults:  \;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).\nA 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.\nHigh 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.\nAnalysis by provider type could not be completed due to limitations in data availability and will be addressed in the study’s limitations.\nSites 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.\n\nConclusions: 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:ab9c79c36ccc80d0349231d887e0c3fa URL:http://2026serc.sched.com/event/ab9c79c36ccc80d0349231d887e0c3fa END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Evaluation of the Impact of a Pharmacy Technician Practice Counc DESCRIPTION:Background\nPharmacy 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.\n\nMethods\nThis 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.\n\nResults \;\nA 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). \n\nConclusion \nImplementation 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.\n\nObjective \;\nTo 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. \;\n\nAssessment Question\nWhich of the following statements best reflects the current understanding of inpatient pharmacy technician roles within a hospital setting?\nA) Pharmacy technicians are primarily limited to distributive tasks\, with minimal involvement in advanced responsibilities or workflow improvement initiatives\nB) Decreased pharmacy technician job satisfaction is associated with opportunities for role expansion\, professional development\, and advanced responsibilities\nC) Pharmacy technician involvement in structured governance models such as technician practice councils is well-established with literature demonstrating improvements across healthcare systems\n 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 CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:1cf58cae522eef4cfb723c6c77a8c797 URL:http://2026serc.sched.com/event/1cf58cae522eef4cfb723c6c77a8c797 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:SGLT2 Inhibitors for Glycemic coNtrol in hospitAL patients with CKD and HF (SIGNAL-CKD-HF) DESCRIPTION:Background\nSodium-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.\nMethodology\nThis 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.\nDescriptive 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.\nResults\nA 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.\nWith 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\nThe 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).\nConclusions\nAlbeit 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:f052ba318e86203e44607472e315e85a URL:http://2026serc.sched.com/event/f052ba318e86203e44607472e315e85a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Evaluation of Semaglutide and Tirzepatide on Clinical Improvement in HFpEF and HFmrEF at the Salisbury Veterans Affairs Health Care System DESCRIPTION:Authors: Julie A. Gordon\, Jon E. Folstad\, Charley A. Hepfinger\, Camille P. Robinette\, Allison E. Strain\, Anita A. Kelkar\n\nBackground: 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.\n\nMethods: 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.\n\nResults: \;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.\n\nConclusion: \;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.\n\nContact: julie.gordon@va.gov CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:81aebfce16b70e045c8eaf5621b0e777 URL:http://2026serc.sched.com/event/81aebfce16b70e045c8eaf5621b0e777 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Real World Conversion from NPH to Insulin Glargine-yfgn in an Outpatient Clinic Setting DESCRIPTION:Authors: Faith White\, Ah Lim Yoo\, Erin Pace\nBackground:\nInsulin 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.\nMethods:\nThis 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.\nResults:\nOf 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.\nConclusion:\nThe 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:69d1f971648562c18267fb37c783d2dd URL:http://2026serc.sched.com/event/69d1f971648562c18267fb37c783d2dd END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Evaluating the Impact of a Cardiology-Focused Unit on Guideline-Directed Medical Therapy for Heart Failure with Reduced Ejection Fraction at Hospital Discharge DESCRIPTION:Authors: \;Joan M. Jakab\, William W. Feese\, Mitchell S. Hutson\, A. Shaun Rowe\, & Kaylee W. Behal \;\nBackground: 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). \;\nMethods: 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.  \;\nResults: 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). \;\nConclusions: 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. \; CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:d4d8129c0ba49e3d6de4b32cdb4ce098 URL:http://2026serc.sched.com/event/d4d8129c0ba49e3d6de4b32cdb4ce098 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Evaluating Provider Behavior Around Alternative Fluid Orders During the 2024 IV Fluid Shortage DESCRIPTION:Evaluating Provider Behavior Around Alternative Fluid Orders During the 2024 IV Fluid Shortage\nAuthors: Cady Thomas\, Jennifer Peltz\, \;Christopher Dennis\nPractice site: ECU Health \;\nContact: cady.thomas@ecuhealth.org\n\n\nBackground: 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. \n\nMethods: 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. \n\nResults: 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.  \;\n\nConclusion: 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.  \;\n\n\n1. \;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.\n\n\n\n\n CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:abcd3260bde777014107ac7eeaa590d9 URL:http://2026serc.sched.com/event/abcd3260bde777014107ac7eeaa590d9 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Implementation of Standardized Electrolyte Replacement Practices at a Veteran’s Affairs Hospital DESCRIPTION:Emily Robert\, Michelle Alonso\, and Hunter Perrin\nJames H. Quillen Veteran Affairs Medical Center – Mountain Home\, TN\nContact Information: emily.robert@va.gov\nBackground/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.\nMethodology: 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.\nResults: In progress\nConclusions: In progress CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:17bf2a2530e922ca8616dc20fd851c7a URL:http://2026serc.sched.com/event/17bf2a2530e922ca8616dc20fd851c7a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Impact of Antimicrobial Stewardship Education on Antibiotic Prescribing Practices for Asymptomatic Bacteriuria and Urinary Tract Infections in the Emergency Department DESCRIPTION:Authors: Emily Gunselman\; Linda Johnson\; Rachel Anderson\; Bradley Proctor\n\n\nBackground/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. \;\n\n\nMethods: 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.\n\nResults: \nPrimary 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.\nSecondary 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.\nNo values were found to be statistically significant.\n\nConclusion: \;\nThe educational intervention was not effective at guiding provider empiric antibiotic choice in the ED\nASB was often treated in the pre- and post-intervention periods\nThe expected practice document was not an effective tool in altering clinical behavior in the ED\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:c5b4421c1ca76d886d757662e4146b96 URL:http://2026serc.sched.com/event/c5b4421c1ca76d886d757662e4146b96 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Comparative Safety of Inpatient versus Outpatient Step‑Up Dosing for Bispecific T‑Cell Engagers in Multiple Myeloma DESCRIPTION:Comparative Safety of Inpatient versus Outpatient Step‑Up Dosing for Bispecific T‑Cell Engagers in Multiple Myeloma\nSaumyaa Patel\; Chynna Bambico\; Jon Shaffer\nAdventHealth Orlando\, Orlando\, FL\, USA\nBACKGROUND\nBispecific 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.\nMETHODS\nThis 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.\nRESULTS 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%).\n 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%).\nCONCLUSIONS 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. CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:60542e600af4e1896fef8e6187bb065d URL:http://2026serc.sched.com/event/60542e600af4e1896fef8e6187bb065d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:IV Methadone in Cardiothoracic Surgery DESCRIPTION:Title: \;Evaluation of intraoperative intravenous methadone administration for cardiothoracic surgery analgesia \;\nAuthor(s): Anna Carlson\, Nevena Mihalovich\, Ethan Gerrald\, Zachary Klick\, Paige Behr\, Madison Fielding\, Akshara Patel\; Atrium Health Wake Forest Baptist\, Winston Salem\, NC \;\n\nObjective: To evaluate the efficacy and safety of intravenous (IV) methadone as adjunctive analgesia in cardiothoracic surgery (CTS)\n  \; \;\nBackground:  \;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. \;\n\nMethods: \;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.  \;\nBaseline 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.  \;\n \;\nResults: 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).  \;\n \;\nConclusions: Administration of intraoperative IV methadone significantly reduces postoperative MME requirements when compared to standard of care. \;\n\n\n CATEGORIES:PAIN MANAGEMENT (PM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:2fd4edd3df884cb0504b02723f09356f URL:http://2026serc.sched.com/event/2fd4edd3df884cb0504b02723f09356f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T154000Z DTEND:20260430T160000Z SUMMARY:Evaluating the Impact of Penicillin Allergy Assessment in Obstetrics and Gynecology Clinics DESCRIPTION:Background: \nApproximately 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.  \;\n \;\nAntimicrobial 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.  \;\n\nMethods:\nThis 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.  \; \n\nResults: \nA 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. \n\nConclusion: \nPatients 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.  \; \n\nMartine.Abouchabki@wellstar.org CATEGORIES:PEDIATRIC (PED) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:2ede005e9c238ca758eb1e856fc713dd URL:http://2026serc.sched.com/event/2ede005e9c238ca758eb1e856fc713dd END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Systemwide Implementation of a Centralized Remote Order Verification Pilot DESCRIPTION: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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusions: \;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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:2997d75673e717bc4fe9e47895e1950c URL:http://2026serc.sched.com/event/2997d75673e717bc4fe9e47895e1950c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Closing the Immunization Gap: Using the RE-AIM Framework to Assess a Pharmacy-Led Initiative- Lauren Mikell DESCRIPTION:Closing the Immunization Gap: Using the RE-AIM Framework to Assess a Pharmacy-Led Initiative  \; \nLauren Mikell\, Courtney E. Gamston\, Greg Peden\, Kimberly Braxton Lloyd \;Auburn University Clinical Health Services -Auburn\, AL \;\n\nBackground/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. \;\n\nMethodology: 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.  \;\n\nResults: 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. \;\n\nConclusions: 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.  \;\n\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:702c7fe0c72d4739fbb1d729f0e4c378 URL:http://2026serc.sched.com/event/702c7fe0c72d4739fbb1d729f0e4c378 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Characterization of P2Y12 Platelet Function Test Assessment on Antiplatelet Utilization DESCRIPTION: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.\nMethods: 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.  \;\nResults: In progress\nConclusion: In progress CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:b915301ba5ae8a35c6dacf21b0125930 URL:http://2026serc.sched.com/event/b915301ba5ae8a35c6dacf21b0125930 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Impact of an Inpatient Heart Failure Consult Service on Readmission Rates and Guideline-Directed Medical Therapy Prescribing: A Single-Center Pre-Post Intervention Study DESCRIPTION: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\nAuthors: Margaret Matthews\, Jessica Yarbrough\, Rachel Robinson\nPurpose: \;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.\nMethods: \;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.\nResults: \;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.\nConclusion: \;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. CATEGORIES:CARDIOLOGY (CAR) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:268a5d6e4eb305df648b12303fb321fb URL:http://2026serc.sched.com/event/268a5d6e4eb305df648b12303fb321fb END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Clinical Outcomes with Cefazolin Compared to Broad-Spectrum β-lactams as Targeted Therapy for MSSA Bacteremia DESCRIPTION: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.\n \nMethods: 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.\n\nResults: 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.\n \nConclusion: 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.\n\n CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:382005414b3106dd735a566c6216452c URL:http://2026serc.sched.com/event/382005414b3106dd735a566c6216452c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Post-Thrombectomy Tirofiban in High-Risk LVO Stroke: Evaluating Early Neurological Deterioration DESCRIPTION: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.  \; \nMethods: 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. \nResults: 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.\nConclusion: There were no statistically significant differences in assessed safety or functional outcomes between groups.\nContact: brooke.landry@piedmont.org\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:c23ce09018e099fa3aac436f6f942f8f URL:http://2026serc.sched.com/event/c23ce09018e099fa3aac436f6f942f8f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:The Incidence and Timing of Venous Thromboembolism After 4-Factor Prothrombin Complex Concentrate Administration in Trauma Patients DESCRIPTION:Title: \;The Incidence and Timing of Venous Thromboembolism After 4-Factor Prothrombin Complex Concentrate Administration in Trauma Patients \;\n\nAuthors: Gregory Gurin\, Sharon Jordan\, Aysu Erdemir \;\n\nGrand Strand Medical Center – Myrtle Beach\, SC \;\n\n\nBackground/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. \;\n\nMethodology: 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. \;\n\nResults: \;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. \n\nConclusions: \;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. \n\nContact email: Gregory.Gurin@hcahealthcare.com\n\n“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.” \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:56d36068c6d7b7436c568797f6b7813a URL:http://2026serc.sched.com/event/56d36068c6d7b7436c568797f6b7813a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Daptomycin Combination Therapy with Ceftaroline versus Anti-Staphylococcal Beta-Lactams for the Treatment of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia DESCRIPTION:Title:\nDaptomycin Combination Therapy with Ceftaroline versus Anti-Staphylococcal Beta-Lactams for the Treatment of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia\n\nAuthors:\nChristopher Staten\, PharmD\nKelvin Gandhi\, PharmD\, BCIDP\nLindsey Moeller\, PharmD\, BCPS\n\nBackground:\nPersistent 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).\n\nMethods: \;\nThis 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.\n\nResults: \;\nA 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.\n\nDiscussion:\nThis 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.\n\nConclusion: \;\n 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:16125e305d620571ffa84f4173c24e52 URL:http://2026serc.sched.com/event/16125e305d620571ffa84f4173c24e52 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY: Fall Occurrences in Relation to Psychotropic Medications: Association with Polypharmacy and Anticholinergic Burden - Brie Levy DESCRIPTION:\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:7d3b67f3a2bbb982958c4a1eb8606e0b URL:http://2026serc.sched.com/event/7d3b67f3a2bbb982958c4a1eb8606e0b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Assessing Appropriate Use of Trastuzumab and Pertuzumab-Containing Product Reloading Doses After Treatment Delays and Their Effect on Outcomes DESCRIPTION: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.\n\nMethods: \;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.\n\nResults: \;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).\n\nConclusion: \;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.\n \; \; CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:1f189430f785a8f076d5b733593ea508 URL:http://2026serc.sched.com/event/1f189430f785a8f076d5b733593ea508 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Evaluating Appropriate Treatment of Neonatal Late Onset Sepsis in a Level III Neonatal Intensive Care Unit DESCRIPTION: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. \n \;\nMethodology: \;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.  \;\n \;\nResults: 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.\n \;\nConclusions: \;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. CATEGORIES:PEDIATRIC (PED) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:0d7065564de9855e8a569be7c88b77ac URL:http://2026serc.sched.com/event/0d7065564de9855e8a569be7c88b77ac END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T160000Z DTEND:20260430T162000Z SUMMARY:Beyond First-Line: A Retrospective Evaluation of Vilazodone and Vortioxetine in Veterans with Treatment-Resistant Depression DESCRIPTION:Madison Brotze and \;Mark LaBossiere\nJames H. Quillen VA Medical Center – Mountain Home\, TN\nContact Information: madison.brotze@va.gov\nBackground/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.\nMethodology: \;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.\nResults: \;In progress\nConclusion: In progress \; CATEGORIES:PSYCHIATRIC PHARMACY (PSY) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:192a4053bd00e420b6f0ef025b1182b4 URL:http://2026serc.sched.com/event/192a4053bd00e420b6f0ef025b1182b4 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Factors Associated with Successful Publication of Pharmacy Resident Research Projects (Description: Victoria Michel-Milian) DESCRIPTION:Factors Associated with Successful Publication of Pharmacy Resident Research Projects\nTitle: Factors Associated with Successful Publication of Pharmacy Resident Research Projects\nPresenters: \;Victoria Michel-Milian\nAuthor: \;Victoria Michel-Milian\, Eric K. Shaw\, Amy Taylor\nContact information: Victoria.michelmilian@hcahealthcare.com\nBackground:\nAmerican 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.\nMethodology: \;\nThis 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.\nResults: \;\nThis 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.\nConclusions: \;\nThis 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:1858979ff085f4f975a0dd5ea89acd14 URL:http://2026serc.sched.com/event/1858979ff085f4f975a0dd5ea89acd14 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Falling into Z-drugs: An Analysis of Z-drug Use and Fall Risk in Older Adults DESCRIPTION:Title: Falling into Z-drugs: An Analysis of Z-drug Use and Fall Risk in Older Adults \;\nAuthors: Madelyn Singleton\, Laura Schalliol\, Kelsee Tignor\, Taylor Dabney \;\n \;\nPurpose: \;\nThis 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. \;\n \;\nMethods: \;\nThis 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. \;\n\nFrom 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. \;\n \;\nResults: \;\nOf 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.  \;\n \;\nConclusion: \;\nIn 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:97065df7debbda1ef01ca6d9cdcaa939 URL:http://2026serc.sched.com/event/97065df7debbda1ef01ca6d9cdcaa939 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Pharmacist Impact on Quality of Anticoagulation Management: A Before and After Study DESCRIPTION:Pharmacist Impact on Quality of Anticoagulation Management: A Before and After Study\n\nEdward McPartland\, Victoria Burnette\, Kelley Baxter\, Chris Larkin\nAscension Saint Thomas Hospital West\n\nBackground/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. \;\nMethodology: 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.\nResults: 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 (2 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 (6 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.\nConclusions: 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:71dabfd356f819ec2473369f5b28d26d URL:http://2026serc.sched.com/event/71dabfd356f819ec2473369f5b28d26d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Assessment of Adherence to an Institutional aPTT Level Monitoring Protocol for Unfractionated Heparin Infusions DESCRIPTION:ASSESSMENT OF ADHERENCE TO AN INSTITUTIONAL aPTT LEVEL MONITORING PROTOCOL FOR UNFRACTIONATED HEPARIN INFUSIONS\nGeorge Saied\, Rachel Hemberger\, Mary Beth Brinkman\nTriStar Centennial Medical Center – Nashville\, TN\nBackground: 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.\n\nMethods: 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.\n\nResults: \;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.\n\nConclusions: 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.\n\n \;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. CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:936cfd6bc5d2da982578409576464ecf URL:http://2026serc.sched.com/event/936cfd6bc5d2da982578409576464ecf END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:The Heart of Monitoring: A Retrospective Evaluation of an Antiarrhythmic Monitoring Program DESCRIPTION:Title: \;Retrospective Evaluation of an Antiarrhythmic Monitoring Program\nAuthors: Kaitlin A Roberts\, Rebecca Holt\, Cynthia Pohland\nObjective: \;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).\nSelf-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\nBackground: \;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.\nMethods: 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.\nResult: 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.\nConclusions: \;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. CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:b5e754a3b22c8115f145798c96b67ec7 URL:http://2026serc.sched.com/event/b5e754a3b22c8115f145798c96b67ec7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Impact of GLP-1/GIP Receptor Agonists on HF-Related Hospitalizations  DESCRIPTION:Impact of GLP-1/GIP Receptor Agonists on HF-Related Hospitalizations \;\n\nInvestigators: Haley Jones\, PharmD\; Erika Schoenborn\, PharmD\, BCCP\, CPP\; Kacy Whyte\, PharmD\, BCPS\, BCCP\nPractice Site: ECU Health Medical Center\, Greenville\, NC\nEmail: haley.jones2@ecuhealth.org\n\nPurpose: 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.  \;\nMethods: 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.  \;\nResults: 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). \;\nIn 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). \;\nConclusions: 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.  \;\n\n CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:ea9f0a0415d589c8d62bbd78d21c87a0 URL:http://2026serc.sched.com/event/ea9f0a0415d589c8d62bbd78d21c87a0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Does Probiotic Use Protect Against Clostridioides difficile Infections in Patients Taking Antibiotics? DESCRIPTION:Does Probiotic Use Protect Against \;Clostridioides difficile \;Infections in Patients Taking Antibiotics?\n\nInvestigators: \;Brittany Baskett\, Kaitlyn Ledet\, Melanie Rae Schrack\n\nPractice Site: \;FMOL Health - Our Lady of the Lake\n\nEmail: \;brittany.baskett@fmolhs.org\n\nPurpose: \;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.\nMethods: 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.\nThe 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.\nResults: \;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.\nConclusion: \;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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:12d255c5a4dd9e7021fffc96a79c3276 URL:http://2026serc.sched.com/event/12d255c5a4dd9e7021fffc96a79c3276 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Impact of Early Resumption of Neuropsychiatric Medications on Sedation Outcomes in Critically Ill Patients DESCRIPTION:Title: Impact of Early Resumption of Neuropsychiatric Medications on Sedation Outcomes in Critically Ill Patients \;\nAuthors: Jade Gallahair\, Victoria Biaggi\, Morgan Turney\, Joseph Trang  \;\n\nBackground: 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. \;\n\nMethods: 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.  \;\n \;\nResults: 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).  \;\n\nConclusion: \;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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:83e5eb53205d0ac78742670873bc9b65 URL:http://2026serc.sched.com/event/83e5eb53205d0ac78742670873bc9b65 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY: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 DESCRIPTION: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 \n\n 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. \n\n 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. \n\n 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:8a543e4b9f31277d1d0e9b09cbcb7f0c URL:http://2026serc.sched.com/event/8a543e4b9f31277d1d0e9b09cbcb7f0c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Evaluation of Chromium Picolinate for Blood Glucose Control in Critically Ill Patients DESCRIPTION:Evaluation of Chromium Picolinate for Blood Glucose Control in Critically Ill Patients\nChristopher Stone\, Richard Lane\, Jared Briones \;\nAdventHealth Apopka\n\nBackground: 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. \n\nMethods: 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.\n\nResults: 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).\n \nConclusion: 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. \n \;\nEmail Christopher.stone1@adventhealth.com\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:9a2b28e81dea9369f5b4bf2790d1d32c URL:http://2026serc.sched.com/event/9a2b28e81dea9369f5b4bf2790d1d32c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Impact on AKIs and Duration of Response in First-Line Treatment for Non-Small Cell Lung Cancer - Tabitha Massengill DESCRIPTION:Background\nNon-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\n\nMethods:\nThis 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.\n\nResults\n169 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.\n\nConclusion\nAn 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. CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:16a41dd24ba59f2a9a36be885fedf57e URL:http://2026serc.sched.com/event/16a41dd24ba59f2a9a36be885fedf57e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T162000Z DTEND:20260430T164000Z SUMMARY:Evaluation of RSV hospitalizations in high-risk infants who received nirsevimab vs. palivizumab DESCRIPTION:Evaluation of RSV hospitalizations in high-risk infants who received nirsevimab vs. palivizumab \;\nAuthors: Allison Lopez\, Courtney Campbell\, Erica Gray\, Katelyn Gibson \;\n\nBackground \;\nRespiratory 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. \;\n\nMethods \;\nThis 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. \;\n\nResults \;\nA 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). \;\n\nConclusions \;\nThis 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. \;\n\nContact: allison.lopez2@wellstar.org \;\n\n CATEGORIES:PEDIATRIC (PED) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:66dabe7a0a08df0551dd7bdb2f172503 URL:http://2026serc.sched.com/event/66dabe7a0a08df0551dd7bdb2f172503 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Impact of Intravenous Fluid Shortage Mitigation Strategies on Crystalloid Utilization and Clinical Outcomes in Critically Ill Adults DESCRIPTION:Title: Impact of Intravenous Fluid Shortage Mitigation Strategies on Crystalloid Utilization and Clinical Outcomes in Critically Ill Adults \;\n\nAuthors: CC Gooden\, Stuart Pope\, Amanda Hammond\, Neha Naik \;\n\nObjective: To evaluate the impact of IV fluid shortage mitigation strategies on continuous crystalloid utilization and clinical outcomes among adult ICU patients. \;\n\nBackground: 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. \;\n\nMethods: 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. \;\n\nResults: 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). \;\n\nConclusions: 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. \;\n\nSelf-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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:fc791ac3a3e3c7ebfb558a4505db079d URL:http://2026serc.sched.com/event/fc791ac3a3e3c7ebfb558a4505db079d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Assessment of Pharmacist Led Medication Reconciliation in the Emergency Department at a VA Medical Center  DESCRIPTION: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. \n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:8a0ab77897e6fd36f67a8887b285e0e0 URL:http://2026serc.sched.com/event/8a0ab77897e6fd36f67a8887b285e0e0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Impact of Midodrine on 30-Day Readmission Rates in Heart Failure Patients with Hypotension​ - Kaelen Glaze DESCRIPTION:Abstract \;\nBackground and Purpose \;\nHypotension 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. \;\n \;\nMethods \;\nThis 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. \;\n \;\nResults \;\nA 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). \;\nHypertensive 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. \;\n \;\nConclusions \;\nIn 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.  \; CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:98efeca72225a162435d6ea9a0f77b9d URL:http://2026serc.sched.com/event/98efeca72225a162435d6ea9a0f77b9d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Evaluation of Second-Dose Antibiotics in the Emergency Department DESCRIPTION: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.\nMethods: 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.  \; \;\nResults: \;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.\nConclusion: 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:99ff5de063dcfc497af484548aeef696 URL:http://2026serc.sched.com/event/99ff5de063dcfc497af484548aeef696 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Insulin Treatment Strategies for Emergent Hyperkalemia DESCRIPTION:Title: Insulin Treatment Strategies for Emergent Hyperkalemia  \;\nAuthors: Margaret Brown\, Matthew Bamber\, William Markle \nFirstHealth Moore Regional Hospital Emergency Department – Pinehurst\, NC\n\nBackground: \;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. \n\n\nMethods: \;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. \n\n\nResults: \;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). \n\n\nConclusions: \;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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:01329668a4ab096b7ccfedae840993c6 URL:http://2026serc.sched.com/event/01329668a4ab096b7ccfedae840993c6 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Comparative Outcomes and ESBL-Emergence After Beta-Lactam vs First-Line Therapy for Pyelonephritis in the Emergency Department - Halie Anderson DESCRIPTION: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. \;\nAdditionally\, 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.  \;\nThis 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. \;\n \;\nMethodology: 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.  \;\nData 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. \;\nResults: 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. \;\nPatient 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%). \;\nThe 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). \;\nConclusions: 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. \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:fd9d499e05c0196b43b67f1fec84f8a2 URL:http://2026serc.sched.com/event/fd9d499e05c0196b43b67f1fec84f8a2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Evaluating the Nephrotoxicity of Extended Infusion Piperacillicin/Tazobactam given concomitantly with Vancomycin DESCRIPTION:Background\n\nA 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.\n\nMethods\n\nThis 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.\n\nResults - Vancomycin + Piperacillin/Tazobactam 3.375g ( n=105): 13 (12.4%) experienced AKI.\n \;  \;  \;  \;  \;  \;  \;  \; Vancomycin +Piperacillin/Tazobactam 4.5g ( n=105) : 16 (15.2%) experienced AKI. \;\n \;  \;  \;  \;  \;  \;  \;  \;  \;p-value = 0.55\n\n\nConclusion - 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.\n \n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:f603c9555190be09dfad4fd1784e8b0f URL:http://2026serc.sched.com/event/f603c9555190be09dfad4fd1784e8b0f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Outcomes Associated with Early Versus Late Infectious Disease Consult for Staphylococcus aureus Bacteremia DESCRIPTION:Outcomes Associated with Early Versus Late Infectious Disease Consult for Staphylococcus aureus Bacteremia\n\nAuthors: Peyton Johnson\, Alanna H. Rufe\, Adam Harnden\, Nancy Bailey\, Sarah Vines\, W. Creed Carleton\n\nPurpose: \;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.\n\nMethods: \;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).\nThe 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.\n\nResults: 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%).\nMean 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.\n\nConclusion: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:1aabb6ea3663a1139a31f88a06866988 URL:http://2026serc.sched.com/event/1aabb6ea3663a1139a31f88a06866988 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Resident Presentation - Felipe Gomez DESCRIPTION:Title: Association between Enterococcal Infective Endocarditis following a Transcatheter Aortic Valve Replacement\nAuthors: Felipe Gómez\; Caren Azurin\; Stefanie Pappas\nAffiliation: Ascension Saint Thomas Hospital West\, Nashville\, TN\nIntroduction 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.\nMethods 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.\nResults 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.\nDiscussion & 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.\n\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:a2db565d7c2ecdc8d9c2c97e1d6db4b8 URL:http://2026serc.sched.com/event/a2db565d7c2ecdc8d9c2c97e1d6db4b8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Assessing Adherence and Outcomes of Tafamidis and Vutrisiran in Patients with Cardiac Amyloidosis in a Rural Setting DESCRIPTION:Authors: Amanda Dunlap\, Dillion Frazier\, and Cy Sims\n\nBackground: 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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusion: 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:3928e3c0bb0e0c3b91d5066bcef868c4 URL:http://2026serc.sched.com/event/3928e3c0bb0e0c3b91d5066bcef868c4 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Impact of a Clinical Pharmacist Workflow Change on Heart Failure Readmissions DESCRIPTION:Title: Impact of a Clinical Pharmacist Workflow Change on Heart Failure Readmissions  \;\n \;\nAuthors: Sean Ramoso\, Kathrina Gonzales Raymundo\, Natalie Ortiz-Gratacos\, Richard Lane\, Nicholas Mastromarino\, Tracey Dobbs \;\nContact: Sean.Ramoso@AdventHealth.com\n \;\nBackground:  \;\nHeart 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. \;\n \;\nMethods:  \;\nA 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. \;\n \;\nResults: \;\nAt 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). \;\n \;\nConclusion: \;\nA 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. \;\n \;\nReferences \;\nHeidenreich\, 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). Ph... CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:42a65e6273222dd60637ef3c234ec17b URL:http://2026serc.sched.com/event/42a65e6273222dd60637ef3c234ec17b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T175000Z DTEND:20260430T181000Z SUMMARY:Impact of Antimicrobial Stewardship Provider Education on Patients with Community-Acquired and Aspiration Pneumonia DESCRIPTION:Authors: \;Dalia Chamma\, Colin Busbee\, Holly Mclean\, Desmond Durham \;\n\nPurpose/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.  \;\n \;\nMethodology: 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. \;\n\nResults: In progress. \;\n\nConclusions: In progress. \; CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:3ca3e8d726769fb5b98a0cca1e069dc2 URL:http://2026serc.sched.com/event/3ca3e8d726769fb5b98a0cca1e069dc2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Development of a Hospital-based Comprehensive Pharmacy Intern Program DESCRIPTION: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.  \;\n \nMethods: \;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.\n \nResults: 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. \;\n\nConclusion: 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. \;\n\n CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:db41276acbb5d8af189b2308e091e187 URL:http://2026serc.sched.com/event/db41276acbb5d8af189b2308e091e187 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Transforming Care: Assessing the Role and Impact of Clinical Pharmacist Practitioners through Electronic Consult Services DESCRIPTION:Title:\nTransforming Care: Assessing the Role and Impact of Clinical Pharmacist Practitioners through Electronic Consult Services\n\nAuthors:\nMcKinley Corley\, Deborah Hobbs\, Marci Swanson\, Nieka Jackson\n\nBackground/Purpose:\nThe 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.\n\nElectronic 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.\n\nMethodology:\nThis 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.\n\nResults: \nA 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.\n\nConclusions: \nThe 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:1f5ec3b0b706b7421b0ba4b219155ef8 URL:http://2026serc.sched.com/event/1f5ec3b0b706b7421b0ba4b219155ef8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Assessing the Prevalence of Inappropriate Insulin Prescribing at Hospital Discharge DESCRIPTION:Assessing the Prevalence of Inappropriate Insulin Prescribing at Hospital Discharge\nDarci Conklin\, Jack Handshaw\nAdventHealth Celebration – Celebration\, FL\n\nBackground/Purpose: To review current prescribing trends to assess whether patients with diabetes are receiving appropriate insulin therapy at hospital discharge.\n\nMethodology: 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.\n\nResults: 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.\n\nConclusions: 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:3c9742048dd15076a6cb9cdc008d9e11 URL:http://2026serc.sched.com/event/3c9742048dd15076a6cb9cdc008d9e11 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Quality Assessment of Implementation of a VA Population Management Tool for SGLT2 Inhibitor Use in the Primary Care Setting DESCRIPTION:Purpose: \;\nType 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.  \;\nMethods:\nThe 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.\nResults \;\nDuring 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).\nConclusion:\nIn 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.  \; CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:f13c21d2772a7c56aaa30a5baa1d1aed URL:http://2026serc.sched.com/event/f13c21d2772a7c56aaa30a5baa1d1aed END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Pharmacist-Led Lipid Optimization: Bridging Post-ACS Care with Early Injectable Therapy Initiation DESCRIPTION: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.  \;\nMethods: 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. \;\nResults: 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. \;\nConclusion: 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. \;\nPresentation 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. \;\nSelf-Assessment: What are some advantages of referring post-ACS patients to an outpatient pharmacist-led lipid clinic? \;\n\n CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:d0ba59c392dd170a1125463904cfcdba URL:http://2026serc.sched.com/event/d0ba59c392dd170a1125463904cfcdba END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Unmasking the Neurologic Exam: Sugammadex for Neuromuscular Blockade Reversal in Neurocritical Care DESCRIPTION:Unmasking the Neurologic Exam: Sugammadex for Neuromuscular Blockade Reversal in Neurocritical Care \;\n \;\nAuthors: 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 \;\n \;\n1University of Tennessee Medical Center\, Knoxville\, TN  \;\n2Inova Fairfax Hospital\, Falls Church\, VA  \;\n3University of Tennessee Health Science Center College of Pharmacy\, Knoxville\, TN  \;\n4University of Tennessee Health Science Center College of Medicine\, Knoxville\, TN \;\n \; \;\nBackground \;\nEvidence 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. \;\n\nMethods \;\nThis 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. \;\n\nResults \;\nA 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. \;\n\nConclusions \;\nSugammadex 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:927aa47331824dc12ed57becd5db86fa URL:http://2026serc.sched.com/event/927aa47331824dc12ed57becd5db86fa END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Cracking The CRAB: Evaluating Clinical Outcomes of Eravacycline Therapy in Carbapenem-resistant Acinetobacter baumanni - Madeline Lemmon DESCRIPTION: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.\nMethods: 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.\nResults: 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.\nConclusion: Among patients with CRAB\, eravacycline did not appear to improve clinical outcomes or affect DOOR distribution. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:60ebb6ebc59b5eafe31dd899b0fe1b11 URL:http://2026serc.sched.com/event/60ebb6ebc59b5eafe31dd899b0fe1b11 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Effect of Antibiotic Selection on Clinical Outcomes in Patients with Bloodstream Infections Caused by AmpC β-lactamase–producing Enterobacterales DESCRIPTION:Effect of Antibiotic Selection on Clinical Outcomes in Patients with Bloodstream Infections Caused by AmpC β-lactamase–producing Enterobacterales\nPhuong Giao Nguyen Tran\, Christopher M. Bland\, Susan E. Smith\, Caroline Turpin\, Rachel Musgrove\nSt. Joseph's/Candler Health System\n\nBackground: \;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.\n\nMethods: \;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.\n\nResults: \;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.\n\nConclusions: \;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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:6e23e5d3d038122170ccfac3cc257cde URL:http://2026serc.sched.com/event/6e23e5d3d038122170ccfac3cc257cde END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY: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 DESCRIPTION:Background/Purpose: \;\nHepatic 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. \;\n\nDespite 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. \;\n \;\nMethodology: \;\nAdult 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. \;\n \;\nResults: \;\nA 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). \;\n\nBoth 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).  \;\n\nAmmonia 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). \;\n\nHospital 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). \;\n\nRates 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). \;\n\nConclusions: \;\nRifaximin monotherapy demonstrated similar effectiveness to combination therapy with lactulose in reducing WHS grade and reducing ammonia levels during hospitalization. \;\n\nNo 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. \;\n\nThese 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. \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:86717598181d1dc22eab666cd3807169 URL:http://2026serc.sched.com/event/86717598181d1dc22eab666cd3807169 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Impact of a Pharmacist Driven Penicillin Allergy Re-labeling Process in the Emergency Department Setting DESCRIPTION:IMPACT OF A PHARMACIST-DRIVEN PENICILLIN ALLERGY RE-LABELING PROCESS IN THE EMERGENCY DEPARTMENT SETTING\nErin Schuld PharmD\, Aayush Patel PharmD\, Mckenzie Hodges PharmD\nPiedmont Columbus Regional Midtown-Columbus GA\n\nBackground/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.\n\nMethods: 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.\n\nResults: \;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.\n \;\nConclusion: \;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.\n\nContact: \;Erin.Schuld@piedmont.org CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:c12f5c06d034fabbeffe65be0b6481fa URL:http://2026serc.sched.com/event/c12f5c06d034fabbeffe65be0b6481fa END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Impact of Time to Positive Blood Culture and Time to Definitive Antimicrobial Therapy on Mortality in Intensive Care Unit Patients with Bacteremia DESCRIPTION:Impact of Time to Positive Blood Culture and Time to Definitive Antimicrobial Therapy on Mortality in Intensive Care Unit Patients with Bacteremia\nNicole Rios Serrano\, Lena K. Tran\, Christopher Lloyd\nAdventHealth Kissimmee – Kissimmee\, FL\n\nBackground: 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.\n\nMethods: 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.\n\nResults: 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).\n\nConclusions: 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:903ab117381cd74fd77f2b44127f23f1 URL:http://2026serc.sched.com/event/903ab117381cd74fd77f2b44127f23f1 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T181000Z DTEND:20260430T183000Z SUMMARY:Impact of Pharmacist Education on Opioid Stewardship Interventions in a Community Hospital - Malena Pontrich DESCRIPTION:Impact of Pharmacist Education on Opioid Stewardship Interventions in a Community Hospital \;\nAuthors: \;Malena Pontrich\; Will Stewart \nBackground: \nOpioid 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. \nMethods:  \;\nThis 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. \nResults:\nAmong 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. \nConclusions:\nThere 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. \; CATEGORIES:PAIN MANAGEMENT (PM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:a246c1863836a1141c37725a617851c5 URL:http://2026serc.sched.com/event/a246c1863836a1141c37725a617851c5 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:d57e65add67a35b4168a3051338b1f74 URL:http://2026serc.sched.com/event/d57e65add67a35b4168a3051338b1f74 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:The Financial Impact of Implementing an Intravenous Syringe Filler Robot DESCRIPTION: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.\nGoal: To evaluate the financial and operational impact of implementing an IV syringe filler robot at a large academic medical center.\nPurpose 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. \;\nPrimary objective: \;\nCompare cost per syringe before and after the implementation of an IV syringe filler robot\nSecondary objectives: \;\nEvaluate changes in operational efficiencyDescribe return on investment (ROI) and sterility pass rates following implementationMethods: 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.\nResults: \;Data collection is currently underway\, with preliminary findings expected by June 2026. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:8a7cc2a2c22337adb57d8a7c7e163e2c URL:http://2026serc.sched.com/event/8a7cc2a2c22337adb57d8a7c7e163e2c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Evaluation of lipid profiles in patients taking tumor necrosis factor-alpha inhibitors for inflammatory bowel disease DESCRIPTION:Background:\nInflammatory 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.\nMethods:\nThis 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. \;\nResults:\nOverall\, 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.\nConclusions:\nIn 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:cffa4a02e6253a4f97cf8495452d5295 URL:http://2026serc.sched.com/event/cffa4a02e6253a4f97cf8495452d5295 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Impact of Health-System Community Pharmacists on Adherence for Medicare Advantage Plan Members - Heather Vance DESCRIPTION:Title: \;Impact of Health-System Community Pharmacists on Adherence for Medicare Advantage Plan Members \;\nPrimary Author: \;Heather Vance \;\nCo-Authors: \;Catie Harper \;\nPractice Site: \;Cone Health Community Pharmacies and Triad HealthCare Network\nBackground: \;\nThe 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.\nCone 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.\nThrough 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.\nMethods: \;\nThis 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.\nPatients 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.\nResults: \;\nOf 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%.\nAt 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.\nA 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).\nConclusions: \;\nThere 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. CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:34efd6cbecec2f8614367ba93cef141f URL:http://2026serc.sched.com/event/34efd6cbecec2f8614367ba93cef141f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Association of Acetaminophen/Butalbital/Caffeine Doses and Incidence of Cerebral Vasospasm DESCRIPTION:Authors: Emma Cloud\, Eric Shaw\, Mallory Stringer\n\nContact: emma.cloud2@hcahealthcare.com\n\nPractice Site: Memorial Health University Medical Center\n\nBackground:\nAneurysmal 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.\n\nMethods:\nThis 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.\n\nResults:\nThirty-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).\n\nConclusions:\nBased 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:074f82f20e9a7cdb98edcc7a032a95de URL:http://2026serc.sched.com/event/074f82f20e9a7cdb98edcc7a032a95de END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Evaluation of Oxycodone Errors Associated with Auto‑Verification in the Emergency Department DESCRIPTION:Background:\nAuto‑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.\nMethods:\nThis 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.\nResults:\nA 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.\n \;Conclusion:\nAuto‑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.  \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:3f644fe88bd17f8f16ae6c69385974c3 URL:http://2026serc.sched.com/event/3f644fe88bd17f8f16ae6c69385974c3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Resident Presentation - Natalee Chornak DESCRIPTION: CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:e60db502edb388a6f4ff3921569477da URL:http://2026serc.sched.com/event/e60db502edb388a6f4ff3921569477da END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Comparison of Linezolid to Usual Therapy in Enterococcus Urinary Tract Infections DESCRIPTION:Authors: Chase Arrington\; Kelsey Bouwman\; Dorothy Williams\n \nBackground: 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.  \;\n\nMethods: 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.  \;\n\nResults: 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).  \;\n\nConclusion: 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.  \;\n\nEmail: Marrington2@srhs.com\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:b60919f525abc75512c60d68f5ba5443 URL:http://2026serc.sched.com/event/b60919f525abc75512c60d68f5ba5443 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Evaluation of Atrial Fibrillation Post-Left Ventricular Assist Device - Glennessa Hodge DESCRIPTION:Evaluation of Atrial Fibrillation Post-Left Ventricular Assist Device \;Authors: Glennessa Hodge\, Anna Crider\, Brian Tran\, Kiara Patino\, Eleanor Schoen\, Mahmoud H. Abdou \;Background  \;\nAtrial 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.  \;  \;\nMethods  \;\nThis 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. \;\nThe 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.  \; \;\nResults\nPOAF 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).  \;\nConclusion\nThe 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. \;\nAnalysis 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.  \;\nThis 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:2f556175b2fa710f613421c08e2c08ab URL:http://2026serc.sched.com/event/2f556175b2fa710f613421c08e2c08ab END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Evaluation of Initial Dose of Nitroglycerin for Acute Heart Failure Exacerbation DESCRIPTION:Evaluation of Initial Dose of Nitroglycerin for Acute Heart Failure Exacerbation\nAuthors: Amaury Santiago Malave\, Christopher Lloyd\, Lena Tran \;\nBackground 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. \n\nMethods 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).  \;\nPatients 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.  \;\nData 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.  \;\n\nResults 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. \;\n\nConclusion 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. \;\nWhile 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:43b63fbb37564d0f8ca13ae2c49291bb URL:http://2026serc.sched.com/event/43b63fbb37564d0f8ca13ae2c49291bb END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Inpatient Pharmacist-led Penicillin Allergy Delabeling (iPPADL) DESCRIPTION:Inpatient Pharmacist-led Penicillin Allergy Delabeling (iPPADL)\nAuthors: Caleb Gosnell\, Benjamin Britt\, Vince Buttrick\, Erik Turgeon at Lexington Medical Center\nBackground/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.\nMethodology: 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.\nResults: 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.\nConclusions: 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.\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:869efd4d9ad35ba767522c0cf9c301f1 URL:http://2026serc.sched.com/event/869efd4d9ad35ba767522c0cf9c301f1 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T183000Z DTEND:20260430T185000Z SUMMARY:Evaluating Emergency Department Order Set in Sickle Cell Pain Management DESCRIPTION:Evaluating Emergency Department Order Set in Sickle Cell Pain Management\nKatherine 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 \;\n\nBackground: \;\n\nVaso-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.  \; \;\n\n\nMethods: \;\n\nThis 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. \;\n\n\n\nResults: \;\n\nOf 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.  \;\n\n\n\nConclusions: \;\n\nImplementation 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. CATEGORIES:PAIN MANAGEMENT (PM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:b061fb8b4e481d1233a099515150d4ed URL:http://2026serc.sched.com/event/b061fb8b4e481d1233a099515150d4ed END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Driving Accuracy and Accountability: A Systemwide Inventory Integrity Program DESCRIPTION:Title: Driving Accuracy and Accountability: A Systemwide Inventory Integrity Program\n\nAuthors: Veronica Bekheit\, PharmD\, MSMEd & Heath Jennings\, PharmD\, MBA\, BCPS\, FASHP\, FACHE\n\nBackground:\nThe 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.\n\nMethods:\nA 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.\n\nResults: \nA 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.\n\nConclusion: \;\nImplementation 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:4de1344ff3a240a4bf490c2c50c3065d URL:http://2026serc.sched.com/event/4de1344ff3a240a4bf490c2c50c3065d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Evaluating Symptom Documentation of Uncomplicated Urinary Tract Infection and Bacterial Vaginosis in Women’s Health Clinics at the Fayetteville NC VA DESCRIPTION: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).\nMethodology: 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.\nResults: In progress\nConclusion: In progress CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:63f8427ac8df1728fce8e640e73b21d9 URL:http://2026serc.sched.com/event/63f8427ac8df1728fce8e640e73b21d9 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Impact of Amlodipine to Nifedipine Conversions by a Remote Pharmacy Hypertensive Service DESCRIPTION:Authors: Rayna Wallace\, Jamie Coates\, Kristina Hazard\n\nBackground: \;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.\n\nMethods: 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.\n\nResults: \;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.\n\nConclusions: \;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.\n\nContact Rayna Wallace at rayna.d.wallace@kp.org with any questions regarding this project. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:10f258707cafe3cdf1ba66906144e105 URL:http://2026serc.sched.com/event/10f258707cafe3cdf1ba66906144e105 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Resident Presentation- Sherique Shaw DESCRIPTION:AUTHORS: Sherique S. Shaw\, Jeremy Bennett\, Brianna Rhodes\, Kalyn D. Pounders\n\nBACKGROUND: 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.\n\nMETHODOLOGY: \;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.\n\nRESULTS:\nIn 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.\nVeterans 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.\n\nCONCLUSIONS: It is recommended to provide additional education to staff of available options to notify CPPs to heart failure dis... CATEGORIES:CARDIOLOGY (CAR) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:09a6a5dca910c3174c5c4e9dcc1c5521 URL:http://2026serc.sched.com/event/09a6a5dca910c3174c5c4e9dcc1c5521 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Analgesic Dose Ketamine Infusion for Pain Control of Trauma Patients in the Critical Care Setting DESCRIPTION:Title: \;Analgesic Dose Ketamine Infusion for Pain Control of Trauma Patients in the Critical Care Setting\n\nAuthors: Alyssa Sangalang\, Brooke Gallman\, & Jamie McCarthy\n\nPractice Site: Piedmont Athens Regional Medical Center\n\nIntroduction: 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.\n\nMethods: \;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. \n\nResults: 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.\n\nDiscussion: \;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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:6bea545d876584024bedc307da7b48a9 URL:http://2026serc.sched.com/event/6bea545d876584024bedc307da7b48a9 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Efficacy and Safety of Sugammadex Versus Neostigmine for Neuromuscular Blocker Reversal Following Minimally Invasive Direct Coronary Artery Bypass DESCRIPTION:Title: Efficacy and Safety of Sugammadex Versus Neostigmine for Neuromuscular Blocker Reversal Following Minimally Invasive Direct Coronary Artery Bypass \;\nAuthors: Micah Wilson and Jeannie Watson\n\nIntroduction: 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.  \;\nMethods: 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.\nResults: 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.\nConclusion: 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:0994f79f6a5c741bdde7334fa1bd67f0 URL:http://2026serc.sched.com/event/0994f79f6a5c741bdde7334fa1bd67f0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Evaluation of Antibiotic Duration Between Concordant vs Discordant Multiplex Pneumonia PCR and Respiratory Culture Results DESCRIPTION:Title: Evaluation of Antibiotic Duration Between Concordant vs Discordant Multiplex Pneumonia PCR and Respiratory Culture Results \;\nAuthors: Kala Eliacin\, Rachel Tendler\, Haodi Ruan  \;\nBackground/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.\nMethodology: 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.\nResults: 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%).\nConclusions: 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.\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:91d39f6fe63cd9a5e07e3307967485d6 URL:http://2026serc.sched.com/event/91d39f6fe63cd9a5e07e3307967485d6 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Tracking the Trends: Staphylococcus aureus Bacteremia Rates in a Rural\, Not-for-Profit Hospital DESCRIPTION:Title: Tracking the Trends: Staphylococcus aureus Bacteremia Rates in a Rural\, Not-for-Profit Hospital \;\nAuthors: Natalie Ly\, Heather Gibson\, Allison Cid\, Gretchen Arnoczy \;\nFirstHealth Moore Regional Hospital – Pinehurst\, NC \;\n \;\nBackground: 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. \;\n\nMethods: 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. \;\n\nResults: 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.  \;\nThere 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.  \;\n\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:390270da4fb5e6271330efc35b13ff0e URL:http://2026serc.sched.com/event/390270da4fb5e6271330efc35b13ff0e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Evaluating Methotrexate Effectiveness for Ectopic Pregnancy Management in Obese Patients DESCRIPTION: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.\n\nMethods: 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.\n\nResults: 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%)\n\nConclusions: 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.  \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:1034d0eb47e808e62ff4e232968a6e1d URL:http://2026serc.sched.com/event/1034d0eb47e808e62ff4e232968a6e1d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Implementation of Prescriber Antibiotic Scorecards in a Rural Community Hospital DESCRIPTION:Title: Implementation of Prescriber Antibiotic Scorecards in a Rural Community Hospital\n\nAuthors: Valeriy Shipilov PharmD\, Joshua Pruitt PharmD\, BCIDP\n\nPurpose: 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.\n\nMethods: 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. \;\n\nResults: \;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. \;\n\nConclusions: \;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. \;\n\nContact Information: Valeriy.Shipilov@baptistdeaconess.com CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:ae0c15b81d5be237c8eea0ffbbd78e83 URL:http://2026serc.sched.com/event/ae0c15b81d5be237c8eea0ffbbd78e83 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Assessment of Antiresorptive Therapy Utilization in Prostate Cancer Patients Receiving Abiraterone with Prednisone + Androgen Deprivation Therapy DESCRIPTION:Title: \;Assessment of Antiresorptive Therapy Utilization in Prostate Cancer Patients Receiving Abiraterone with Prednisone + Androgen Deprivation Therapy\n\nAuthors: \;Makenzie Boyd & Barbie Gleaton\n\nBackground: \;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.\n\nMethods: \;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.\n\nResults: \;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. \n\nConclusions: \;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. CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:3898f8d5e7a8be9c442bf01a74e9208f URL:http://2026serc.sched.com/event/3898f8d5e7a8be9c442bf01a74e9208f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T185000Z DTEND:20260430T191000Z SUMMARY:Impact of Ciprofloxacin/Dexamethasone Utilization in Pediatric Tracheostomy Patients DESCRIPTION:Title: Impact of Ciprofloxacin/Dexamethasone Utilization in Pediatric Tracheostomy Patients\nAuthors: Rachel Dickey\, Andrea Gerwin\, Stephanie Conrad\nBackground/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.\nMethods: \;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.\nResults: \;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).\nConclusions: \;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. CATEGORIES:PEDIATRIC (PED) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:fa26af9eb7e56f8bd57380bbe2f198e7 URL:http://2026serc.sched.com/event/fa26af9eb7e56f8bd57380bbe2f198e7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Prescription for Productivity: Assessment of Pharmacy Workload as a Productivity Metric DESCRIPTION:Authors: \;Derek Rhodes\, \;Tim Walker\, Doug Furmanek\, Laura Holden\, Harry Jozefczyk\, Deborah Hurley\, Ally Nielson\, Natalia Valenti\nBackground: 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. \;\nMethods: 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.  \;\nResults: In progress\nConclusions: 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. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:a9c312a20d15b3a57087cc3f85fa7e07 URL:http://2026serc.sched.com/event/a9c312a20d15b3a57087cc3f85fa7e07 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:An Observational Study of Patients Using U-200 Insulin in Insulin Pumps DESCRIPTION:Title:\nAn Observational Study of Patients Using U-200 Insulin in Insulin Pumps \;\n\nAuthors:\nGabrielle E. Hall\, Lauren Blumenfeld\, Tavajay Campbell\, Haley Pressley\, Jonathan Hughes\, Blake R. Johnson\n\nPractice Site: \;\nAscension Saint Thomas\n\nBackground: \;\nThe 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.\n\nMethods:\nThis 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. \;\n\nResults:\nThere 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. \;\n\nConclusion:\nIn 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. \; CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:001a160026ee667c9354652838538837 URL:http://2026serc.sched.com/event/001a160026ee667c9354652838538837 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Impact of Clinical Pharmacist Collaborative Management on A1C Reduction in a Rural Family Medicine Clinic DESCRIPTION: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.\n\nBackground: 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.\n\nMethods: 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%).\nThe 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.\n\nResults: 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.\n\nConclusion: 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:669cbeeb5f035de11d5770f7afeca77d URL:http://2026serc.sched.com/event/669cbeeb5f035de11d5770f7afeca77d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Pharmacist-Led Intervention to Reduce Anticholinergic Burden in Older Adults DESCRIPTION:Name: Caroline McKenna\ncaroline.mckenna@mahec.net \;\n\nBackground/Purpose:\nAnticholinergic 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).\n\nMethodology:\nThis 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. \;\n\nResults:\nA 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).\n\nConclusions:\nIncorporating 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:9897e7659b1d83f81f128ce88134745d URL:http://2026serc.sched.com/event/9897e7659b1d83f81f128ce88134745d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Evaluation of Safety Outcomes in Patients with Diabetes Receiving Perioperative Dexamethasone DESCRIPTION:Title: Evaluation of Safety Outcomes in Patients with Diabetes Receiving Perioperative Dexamethasone  \;\n\nInvestigators: Christian Garner\, Devon Johnson\, Spencer Livengood\nPractice Site: ECU Health Medical Center \;\nContact: Christian.Garner@ecuhealth.org\n\nBackground: 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. \;\n\nMethods: 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. \;\n\nResults: 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).  \;\n\nConclusion: 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. \; CATEGORIES:COMMUNITY PHARMACY (CP) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:0b30015fad205d471fb343a3b55d335b URL:http://2026serc.sched.com/event/0b30015fad205d471fb343a3b55d335b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Evaluation of Hydrocortisone vs Hydrocortisone Plus Fludrocortisone in Septic Shock Among Critically Ill Patients DESCRIPTION:Authors: Matthew Huebner\, Julie Willmon\, Kevin Pacheco\n\nBackground \;\nSeptic 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. \;\n\nMethods \;\nA 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. \;\n\nResults \;\nFrom 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). \;\n\nConclusion \;\nAmong 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. \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:3b408cb4252d0bcadd63c97a3c1df49f URL:http://2026serc.sched.com/event/3b408cb4252d0bcadd63c97a3c1df49f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Antimicrobial Prescribing Practices for Community-Acquired Pneumonia in a Community\, Teaching Health System DESCRIPTION:Title: Antimicrobial Prescribing Practices for Community-Acquired Pneumonia (CAP) in a Community\, Teaching Health System\nAuthors: Anna Collins\, Chris Whitman\, Rachel L. Foster\, Jeff Bruni\, Cherie Abernathy\nBackground: 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.\nMethods: 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.\nResults: 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.\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:dcb5c0d4eed889f86156a2e4c9b39652 URL:http://2026serc.sched.com/event/dcb5c0d4eed889f86156a2e4c9b39652 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Treatment of Staphylococcus Aureus Bacteremia and the Impact of Infectious Disease Consultation DESCRIPTION:Title:\nTreatment of Staphylococcus Aureus Bacteremia and the Impact of Infectious Disease Consultation\n\nAuthors:\nWestley Eccles\, Stephen Eure\, Doug Carroll\n\nPractice Site:\nDCH Regional Medical Center-Tuscloosa\, AL\n\nBackground: 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).\n\nMethodology: 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.\n\nResults: 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.\n\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:da7f8b348a6d5e30591e527e2c7a8ed7 URL:http://2026serc.sched.com/event/da7f8b348a6d5e30591e527e2c7a8ed7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Characterization of Extravasation Events in Brain and Spinal Cord Injury Rehabilitation Patients DESCRIPTION:Title: Characterization of Extravasation Events in Brain and Spinal Cord Injury Rehabilitation Patients \;\n\nAuthors: Muhan Wang\, Lauren Wilcox\, Virginia Montgomery \;\n\nBackground: 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. \;\n \;\nMethods: 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. \;\n \;\nResults: 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.  \;\n\nConclusion/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. \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:399403ae1da06640ec90e954d9c58c26 URL:http://2026serc.sched.com/event/399403ae1da06640ec90e954d9c58c26 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Evaluating the Impact of Empiric Anti-MRSA Therapy on Length of Stay in Patients Hospitalized with Community-Acquired Pneumonia - Jessica Giraldo DESCRIPTION:Title: Evaluating the Impact of Empiric Anti-MRSA Therapy on Length of Stay in Patients Hospitalized with Community-Acquired Pneumonia \;\nAuthors: Jessica Giraldo\, Dina Kheir\, Timmy Do \nInstitution: AdventHealth Central Florida Division (AH-CFD)\n \nBackground \;\nCommunity-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.  \;\n\nMethods \;\nThis 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.  \;\n\nResults \;\nA 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).  \;\n\nThirty-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. \;\n\nConclusions \;\nEmpiric 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. \;\n\nContact Information: jessica.giraldo@adventhealth.com \;\n \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:60e15c66a73d6f32681012f1d66f1152 URL:http://2026serc.sched.com/event/60e15c66a73d6f32681012f1d66f1152 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Evaluation of Discharge Medication Prescribing for Patients with Heart Failure Before and After Pharmacist Involvement  DESCRIPTION:TITLE: Evaluation of Discharge Medication Prescribing for Patients with Heart Failure Before and After Pharmacist Involvement  \nAUTHORS: Uyen Nguyen\, Amanda Herndon\, and Christine Wong \nBACKGROUND: 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. \n\nMETHODOLOGY: 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. \nPharmacists 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. \nThe 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. \n\nRESULTS: 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. \n\nCONCLUSIONS: 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:541b21be66775b6d5cfbd09d85d10a38 URL:http://2026serc.sched.com/event/541b21be66775b6d5cfbd09d85d10a38 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T191000Z DTEND:20260430T193000Z SUMMARY:Evaluation of Antibiotic Use in Culture-Negative Early-Onset Sepsis in Neonates within a Community Health System DESCRIPTION: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.\n\nMethodology: \;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. \n\nResults: \;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).\n\nConclusions: \;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. CATEGORIES:PEDIATRIC (PED) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:ce7b0da37cd9fa34c722b69da1b5fb29 URL:http://2026serc.sched.com/event/ce7b0da37cd9fa34c722b69da1b5fb29 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Assessing the Implementation of a Community Health Worker Program at a Community Clinic DESCRIPTION:Title: Assessing the Implementation of a Community Health Worker Program at a Community Clinic\n  \;\nAuthors: 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. \;\n\nBackground: \; \;\nCommunity 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.\n \;\nMethods: \; \;\nThis 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. \;\n\nResults:\nIn Progress\n\nConclusions:\nIn Progress CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:0b2557ef34a21f753197c6046b1872f9 URL:http://2026serc.sched.com/event/0b2557ef34a21f753197c6046b1872f9 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Utilization of Pharmacogenomic Testing Among Veterans Receiving Fluoropyrimidine- or Irinotecan-Based Chemotherapy within the Salisbury VA Health Care System DESCRIPTION:Background: \;\nFluoropyrimidines (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. \;\n\nMethods: \;\nThis 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. \;\n \;\nResults: \;\nA 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).  \;\n \;\nConclusions: \;\nMulti-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.  \;\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:f70ab12a6202bf37f1d3dcbf8923c4b5 URL:http://2026serc.sched.com/event/f70ab12a6202bf37f1d3dcbf8923c4b5 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY: Impact of Preconception GLP-1RA and Dual GIP/GLP-1RA Use on Insulin Requirements During Pregnancy in Patients with Type 2 Diabetes  DESCRIPTION:Impact of Preconception GLP-1RA and Dual GIP/GLP-1RA Use on Insulin Requirements During Pregnancy in Patients with Type 2 Diabetes \;\nAuthors: Kiera Rountree\, Jessica Odom\, Autumn Clemins\, and Megan Schellinger\nPractice Site: Prisma Health-Upstate \;\n \;\nBackground \;\nPregestational 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.\n\nMethods \;\nThis 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.\n\nResults \;\n64 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.\n\nConclusion \;\nPreconception 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.\n\nContact: kiera.rountree@prismahealth.org\n \; CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:10b7bccbac04c8726a27bc8dd074d27a URL:http://2026serc.sched.com/event/10b7bccbac04c8726a27bc8dd074d27a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Comparison of Dexamethasone versus Methylprednisolone in Acute Respiratory Distress Syndrome (ARDS) - Kayla Phillips DESCRIPTION:Comparison of Dexamethasone versus Methylprednisolone in Acute Respiratory Distress Syndrome (ARDS)\nAuthors: Kayla Phillips\, PharmD\, Lindsey Mclendon PharmD Candidate\, Lauren Floris\, PharmD\, BCPS\, BCCCP\nBackground:\nAcute 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.\nMethods:\nWe 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.\nResults:\nA 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).\nConclusion:\nIn 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:6699e1f8e38782ae195e3e7ebd090063 URL:http://2026serc.sched.com/event/6699e1f8e38782ae195e3e7ebd090063 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Full-Dose versus Low-Dose Diltiazem Bolus for Management of Atrial Fibrillation with Rapid Ventricular Rate DESCRIPTION: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. \;\n\nMethodology: 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. \;\n\nResults: In progress \;\n\nConclusions: In progress \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:9ae0b17e11ba1a1a28dd7afe92ed8198 URL:http://2026serc.sched.com/event/9ae0b17e11ba1a1a28dd7afe92ed8198 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Impact of Variable Rocuronium Dosing for Intubation in the ​ Emergency Department - Dani Anastasovites DESCRIPTION:Study Objective: To pragmatically assess rocuronium dosing practices for emergency department intubation procedural outcomes and post-intubation sedation practices. \;\nMethods: 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. \;\nResults: 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. \;\nConclusion: 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. \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:6df5b0df16e95299517e829e4b7ccea0 URL:http://2026serc.sched.com/event/6df5b0df16e95299517e829e4b7ccea0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Steroid Stewardship: Corticosteroids in the Emergency Department for Treatment of Musculoskeletal Pain DESCRIPTION:Abstract: \;\nBackground\nMusculoskeletal (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.\nMethods\nThis 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).\n Results\nFive 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. \;\nConclusion \nPatients 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:1ec6c6b836389f62408aea7158577e38 URL:http://2026serc.sched.com/event/1ec6c6b836389f62408aea7158577e38 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:A RETROSPECTIVE EVALUATION OF THE IMPACT OF VANCOMYCIN AUC DOSING ON ACUTE KIDNEY INJURY AND DRUG EXPOSURE IN HOSPITALIZED PATIENTS. DESCRIPTION:A RETROSPECTIVE EVALUATION OF THE IMPACT OF VANCOMYCIN AUC DOSING ON ACUTE KIDNEY INJURY AND DRUG EXPOSURE IN HOSPITALIZED PATIENTS. \nShemaiah Caine\, Deanne Tabb\, Tushar Patel\, Aayush Patel Piedmont Columbus Regional Midtown Columbus\, GA\n\n\nBackground/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.\n\n\n\n\nMethodology: 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.\n\n\n\n\nResults: \; 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.\n\n\nConclusions: 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.\n\n\n\n\nShemaiah.Caine@piedmont.org CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:39ebb0780244c177c17b4172619d0c54 URL:http://2026serc.sched.com/event/39ebb0780244c177c17b4172619d0c54 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Resident Presentation - Natalie Harris DESCRIPTION:Comparison of cefazolin plus ertapenem to alternative approaches in patients with persistent MSSA bacteremia while on cefazolin\nNatalie Harris\, PharmD1\; Caroline Jozefczyk\, PharmD\, BCIDP2\; Jake Crocker\, PharmD\, BCIDP2\; Sarah Al Mansi\, MD1\; Brandon Bookstaver\, PharmD\, BCIDP1\,3\nPrisma Health Richland Hospital\, Columbia\, SCPrisma Health Greenville Memorial Hospital\, Greenville\, SCUniversity of South Carolina College of Pharmacy\, Columbia\, SC\n\nBackground: 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.\nMethods: 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.\nResults: 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%).\nConclusion: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:3cd56f35a68f02937e530862b6efcf0d URL:http://2026serc.sched.com/event/3cd56f35a68f02937e530862b6efcf0d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Safety Outcomes of Empiric Linezolid versus Vancomycin in Patients with Pneumonia and Risk Factors for Methicillin-Resistant Staphylococcus aureus Infection DESCRIPTION:Title: \;\nSafety Outcomes of Empiric Linezolid versus Vancomycin in Patients with Pneumonia and Risk Factors for Methicillin-Resistant Staphylococcus aureus Infection\n\nPurpose:\nVancomycin 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. \n\nMethods:\nThe 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.\n\nResults:\n14 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.\n\nDiscussion:\nIn 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:6e400b07c54f0a3295ccbbdc31417957 URL:http://2026serc.sched.com/event/6e400b07c54f0a3295ccbbdc31417957 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Factors Associated With Nocturnal Hypoglycemia In A Small Community Hospital DESCRIPTION:Factors Associated With Nocturnal Hypoglycemia In A Small Community Hospital \nNhien Nguyen\, Maggie Braxton Green\, Geren ThomasArchbold Memorial Hospital - Thomasville\, GA\n\nBackground/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.  \;\n\nMethodology: \;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. \;\n\nResults: \;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.  \;\n\nConclusions: \;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. \;\n\nPresentation Objective: Identify potential risk factors associated with nocturnal hypoglycemia occurring in hospitalized patients in a single site community hospital. \nSelf-Assessment: \nWhich of the following is the definition of nocturnal hypoglycemic per the ADA guideline?\nA.Glucose level <\; 69 mg/dL and lasting at least 5 minutes from midnight to 0600 \nB.Glucose level ≤ 70 mg/dL and lasting at least 15 minutes from midnight to 0300 \nC.Glucose level <\; 70 mg/dL and lasting at least 15 minutes from midnight to 0600 \nD.Glucose level <\; 54 mg/dL and lasting at least 10 minutes from 0300 to 0600\n\n\n\n\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:aeea17a7fb5f013a0de61d37147a8c02 URL:http://2026serc.sched.com/event/aeea17a7fb5f013a0de61d37147a8c02 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T194000Z DTEND:20260430T200000Z SUMMARY:Utility of β-hydroxybutyrate as a defining criterion for diabetic ketoacidosis resolution in adults DESCRIPTION:Utility of β-hydroxybutyrate as a defining criterion for diabetic ketoacidosis resolution in adults \;\nKevin Fenter\, Tyler Bui\, Alvin Tomika \;\n \;\nBackground: 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. \;\n \;\nMethods: 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. \;\n \;\nPatients 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.  \;\n \;\nResults: 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.  \;\n \;\nConclusion: 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.  \;\n \;\nContact Information: kevin.fenter@adventhealth.com \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:19c472a4e8a879e3dcea3cd12ffbea63 URL:http://2026serc.sched.com/event/19c472a4e8a879e3dcea3cd12ffbea63 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Association Between Outpatient Glucagon-like Peptide-1 Receptor Agonist (GLP-1 RA) use and the Incidence and Severity of Sepsis DESCRIPTION:Title: Association between outpatient glucagon-like peptide-1 receptor agonist use and the incidence or severity of sepsis\nAuthors:\n\nPrimary: Mary Sizer\nSecondary: Hanna Kim\, Jinae Lee\, Daniel B. Hall\, John Carr\, PharmD\, Akshaya Arunkumar\, Abigail Case. PharmD\, Chelsea Keedy\n\nObjective: To determine if outpatient GLP-1 RA is associated with a decreased risk of sepsis occurrence or severity.\n\nBackground:\nGlucagon-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.\n\nMethods:\nThis 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.\n\nResults:\nOf 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.\n\nConclusions:\nGLP-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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:22a08ab6dc2b58b55d168449c8347ccd URL:http://2026serc.sched.com/event/22a08ab6dc2b58b55d168449c8347ccd END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Clinical Outcomes with Full Versus Reduced Dose of Rivaroxaban and Apixaban After Initial VTE Treatment DESCRIPTION:Authors: \;Tahir Razzaq\, Sweta M. Patel\, Irene Robb\, Naomi Yates\n\nBackground:\nDirect 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.\n\nMethods: \;\nThis 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.\n\nResults: \;\nA 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.\n\nConclusion: \;\nDose 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. \; \; CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:f7f6cb4ca1adde2cf12af84814154972 URL:http://2026serc.sched.com/event/f7f6cb4ca1adde2cf12af84814154972 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Evaluating Pharmacist-Led Post-Discharge Medication Management in Cardiothoracic Surgery Patients - William Freeman DESCRIPTION:Background \n 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. \n\nObjective \n 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. \n\n Methods \n 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. \n\n Results \n 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.\n 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. \nAmong 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. \n\n Conclusion \n 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. \n\nReferences \n 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. \n 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. \n 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. \n 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 \n 5. Incidence\, Cost\, and Risk Factors for Readmission After Coronary Artery Bypass Grafting. The Annals of Thoracic Surgery. 2019. Shah RM\, Zhang Q\, Chatterjee... CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:d56d46926d7369f614c4b521f01b546b URL:http://2026serc.sched.com/event/d56d46926d7369f614c4b521f01b546b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Impact of Pharmacist-led Discharge Interventions in the Multi-Visit Patient Population DESCRIPTION:Impact of Pharmacist-Led Discharge Interventions in the Multi-Visit Patient Population\n\n 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.\n\n 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.\n\n 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. \n \;\n 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.\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:955270f825f3909a0cca3accfd1aec47 URL:http://2026serc.sched.com/event/955270f825f3909a0cca3accfd1aec47 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Evaluation of Glucocorticoid Dosing Strategies in Acute Chronic Obstructive Pulmonary Disease Exacerbation: A Retrospective Review DESCRIPTION:Authors: Logan Wildman\, Vanessa Velazco\, Tracey Bastian\n\nBackground: 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.\n\nMethods: 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.\n\nResults: 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.\n \;\nConclusions:  \;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.  \; \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:a190468a4b482fcb111b21d6ada9fb16 URL:http://2026serc.sched.com/event/a190468a4b482fcb111b21d6ada9fb16 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Ketamine versus Dexmedetomidine for ICU Sedation DESCRIPTION:Title: Ketamine versus Dexmedetomidine for ICU Sedation\nAuthors: Rebecca Olisa\, Anh Nguyen\, Jana Mills\, Nikulkumar Chaudhari\, MD\nBackground/Purpose:\nCritically 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.\nThis 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.\nMethods:\nThis 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.\nPatients 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.\nThe 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.\nResults:\nA 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.\nConclusion:\nThis 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:f963c140de319662c9796b795ea9a9ce URL:http://2026serc.sched.com/event/f963c140de319662c9796b795ea9a9ce END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:The Impact of Systemic Corticosteroids on Antibiotics Days of Therapy in Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia DESCRIPTION:Impact of Systemic Corticosteroids on Antibiotic Days of Therapy in Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia \;\nSamantha Saraceno\, Zoanne Harlas\, Joseph Crosby\, Ryan Sarvestani\, John Carr \;\nSt. Joseph/Candler Health System\nBackground/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.\n\nMethodology: 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.\n\nResults: 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.\n\nConclusion: 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:9b6c038a757157bd0b69ddc604483ea7 URL:http://2026serc.sched.com/event/9b6c038a757157bd0b69ddc604483ea7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Less is More: Safety and Efficacy of De-escalating Antipseudomonal Therapy to Pathogen-Directed Therapy in Patients with Neutropenic Fever DESCRIPTION:Authors’ Names: Madison Moncus\, Ashton Dickinson\, Mary Massaro\, Brandon Hawkins\, Alexandra McBrayer\, Clark Cutrer\, Samantha Walker \;\n\nBackground: 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. \;\n\nMethods: 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. \;\n\nResults: 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). \;\n\nConclusions: 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. \; CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:98c507c1fc4171c7a0805bfb5dd9e991 URL:http://2026serc.sched.com/event/98c507c1fc4171c7a0805bfb5dd9e991 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Resident Presentation - Shannon Mayberry DESCRIPTION:Authors: Shannon R. Mayberry\, Cristina Martinez\, Benjamin Albrecht\, Sujit Suchindran\, Sarah B. Green  \;\n\nResident e-mail for contact: shannon.mayberry@emoryhealthcare.org \;\n\nStandard of Care compared to alternative beta-lactam agents in high-inoculum AmpC infections  \;\n\nPurpose/Background: \;\nTreatment 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.  \;\n\nMethods: \;\n\nThis 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. \;\n\nResults: \;\n\nTen 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. \;\n\nConclusions:  \;\n\nIn 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. \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:66536a30415c2057ced6045bc27537c6 URL:http://2026serc.sched.com/event/66536a30415c2057ced6045bc27537c6 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY: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 DESCRIPTION:Background/Purpose: \;\nExtended-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.  \;\n \;\nThe purpose of this study was to evaluate clinical outcomes of patients with ESBL bacteremia treated with meropenem compared with ceftolozane/tazobactam\, or ceftazidime/avibactam.  \;\n \;\nMethodology:  \;\nThis 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.  \;\n \;\nThe 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. \;\n \;\nSecondary 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. \;\n \;\nResults:  \;\nA 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. \;  \;\n \;\nConclusions:  \;\nIn 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. \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:90cf0c062dbde39eba7d2e67b62a8e35 URL:http://2026serc.sched.com/event/90cf0c062dbde39eba7d2e67b62a8e35 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Evaluating the Duration of Mupirocin’s Effect on Methicillin-Resistant Staphylococcus aureus Nares Polymerase Chain Reaction Validity DESCRIPTION:Background:\nMupirocin\, 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.\nMethods:\nThis 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.\nThe 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.\nResults:\nAmong 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).\nWhen 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).\nMRSA 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.\nConclusions:\nIn 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:201594c6f26de36a163585129153e9cd URL:http://2026serc.sched.com/event/201594c6f26de36a163585129153e9cd END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T200000Z DTEND:20260430T202000Z SUMMARY:Impact of a pilot standardized\, multi-preceptor approach to acute care medicine APPEs on student outcomes & preceptor satisfaction DESCRIPTION: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. \;\nMethods: 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. \;\nResults: 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. \;\nConclusions: 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.  \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:08cd8c6ce3069bb4dadd7dd82e2dc0d6 URL:http://2026serc.sched.com/event/08cd8c6ce3069bb4dadd7dd82e2dc0d6 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Clearing the Air: Impact of a Pharmacist-led Pulmonary Medication Management Clinic DESCRIPTION:Clearing the Air: Impact of a Pharmacist-led Pulmonary Medication Management Clinic \;\n \;\nChloe Warren\, Christopher Rogers\, Lauren Young\, Danielle Dennis\, Sabrina Fineberg\, Dana Walters\, Kellie Ball \;\nUniversity of Tennessee Medical – Knoxville\, TN \;\n \;\nPurpose: 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 \;\n\nMethods: 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. \;\n\nResults: 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.  \;\n\nConclusion: 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. \n\nLink: https://docs.google.com/document/d/e/2PACX-1vS6hc93X09DzHIrP9LAM05FIvxd6iYh9am_wF7kl1NMMFZyVzSKUCQQS2gGv_oCROiAuk2Ht5MxuwF-/pub CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:5bf74b021c656baad5533b5ae5bbf67e URL:http://2026serc.sched.com/event/5bf74b021c656baad5533b5ae5bbf67e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Evaluation of Antibiotic Prescribing Practices in Adult Female Patients with Asymptomatic Bacteriuria or Uncomplicated Cystitis DESCRIPTION:Authors\nLiz Lively\, Amanda Stankowitz\, Alexander Tunnell\, Mallorie Vaughn\n\nBackground\nA 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).\n \;\nMethods\nResearchers 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.\n \;\nResults\nOf 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.\n \;\nConclusion\nA 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:55bf1443934c9cf8742af471e4695514 URL:http://2026serc.sched.com/event/55bf1443934c9cf8742af471e4695514 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Review of urine drug screens of patients on buprenorphine-naloxone products at a family medicine office based opioid treatment (OBOT) program DESCRIPTION: \;\nAuthors: Maria Onusko\, Olivia Caron\, Marcia Thacher\, Carriedelle Fusco\, and Nabarun Dasgupta  \;\n\nBackground: 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.  \;\n\nMethods: 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.  \;\n\nResults \;\nIn progress \;\n\nConclusions: \;\nIn progress \;\n \;\nReferences:  \;\nHeidbreder 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  \; \;\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:13459e9cb3a3f325b7d605dfeee83c51 URL:http://2026serc.sched.com/event/13459e9cb3a3f325b7d605dfeee83c51 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Impact of Vasopressin Initiation Timing on Outcomes of Septic Shock Patients Receiving Norepinephrine DESCRIPTION:TITLE: Impact of Vasopressin Initiation Timing on Outcomes of Septic Shock Patients Receiving Norepinephrine \;\n\nAUTHORS: \;Somer Pye\, Steven Robinette\, Jacquelyn Bryant\, Logan Doriety \;\n\nOBJECTIVE: 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. \;\n\nSELF-ASSESSMENT QUESTION: \;According to the 2026 Surviving Sepsis Guidelines\, which vasopressor is recommended second line to norepinephrine in septic shock?\n\nBACKGROUND: 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.\n \nMETHODS: 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.  \;\n\nRESULTS: 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.  \; \;\n\nCONCLUSION: 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:5d979d229247902ed85cb1a52f5682e2 URL:http://2026serc.sched.com/event/5d979d229247902ed85cb1a52f5682e2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Prophylactic Tocilizumab to Reduce Vasoplegic Syndrome During Left Ventricular Assist Device Implantation DESCRIPTION:Objective: \;Determine if prophylactic tocilizumab reduces the incidence of vasoplegic syndrome (VS) in patients undergoing left ventricular assist device (LVAD) implantation.\nBackground: \;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.  \; \;\nMethodology: \;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.\nResults: \;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). \;\nConclusions: \;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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:f09ceb86ec1344d8830e0c6fe6fb4f1c URL:http://2026serc.sched.com/event/f09ceb86ec1344d8830e0c6fe6fb4f1c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Clinical and Microbiological Outcomes of Ertapenem Mono-Resistant Enterobacteriaceae DESCRIPTION: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.  \;\nThe 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.  \;\nThis 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.  \; \nNinety-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).  \; \nSimilar 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.  \; CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:431852900f639b79cbc672e303a58c97 URL:http://2026serc.sched.com/event/431852900f639b79cbc672e303a58c97 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Evaluation of periprocedural antibiotic practices in high-risk patients undergoing cardiac implantable electronic device placement DESCRIPTION:Nguyen Minh Anh Ngo\, Amanda Sowder\nAdventHealth Orlando\nBackground: 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.\n\n\nMethods: \;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.\n\n\nResults: \;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%).\n\n\nConclusion: \;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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:3a9d768f7b412ad0e52702cee6cb803c URL:http://2026serc.sched.com/event/3a9d768f7b412ad0e52702cee6cb803c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Identification of risk factors for ​beta-lactam resistant Pseudomonas aeruginosa bacteremia​ DESCRIPTION:Title: Identification of risk factors for beta-lactam resistant Pseudomonas aeruginosa bacteremia  \; \;\n\nBackground: 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. \;\n\nMethods: 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. \;\n\nResearch & Conclusion: In progress \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:e6b5201fb66879742337c9eb428e9afb URL:http://2026serc.sched.com/event/e6b5201fb66879742337c9eb428e9afb END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Evaluation of apixaban dosing strategies for venous thromboembolism in patients receiving hemodialysis DESCRIPTION:Title: Evaluation of apixaban dosing strategies for venous thromboembolism in patients receiving hemodialysis \;\n\nAuthors: Hayden Caldwell\, Blake Sloan\, Ryan Tilton\, Ryan Imel\, Grace Barr\, Caitlin Hastings\, &\; Brittney Bright\n\nBackground: \;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.  \; \n\nMethods: \;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.  \;\n\nResults: \;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.  \; \n\nConclusion: \;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. \n\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:28a23b1f6b7fb7851c8580da89266ff2 URL:http://2026serc.sched.com/event/28a23b1f6b7fb7851c8580da89266ff2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Evaluation of Phosphorus Replacement Protocol Implementation during CRRT DESCRIPTION:Evaluation of Phosphorus Replacement Protocol Implementation during Continuous Renal Replacement Therapy (CRRT)\nEmma Smits\, Morgan Vincent\, Mike Maccia\nCone Health at Moses Cone Hospital - Greensboro\, NC\n\nBackground:\nContinuous 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.\nMethods:\nThis 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.\nResults:\nNinety 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.\nConclusions:\nImplementation 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:169326caa5ac6c83b8224cce2ed3ad4d URL:http://2026serc.sched.com/event/169326caa5ac6c83b8224cce2ed3ad4d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:Impact of 2025 Acute Coronary Syndromes Guidelines on Prescribing Practices at a Tertiary Medical Center - Taylor Butler DESCRIPTION: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.\nMethods: \;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.\nResults: \;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). \nConclusion: \;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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:322aa2251f6765ebc06343fa9174a3c0 URL:http://2026serc.sched.com/event/322aa2251f6765ebc06343fa9174a3c0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T202000Z DTEND:20260430T204000Z SUMMARY:OPIOID UTILIZATION WITH ENHANCED RECOVERY AFTER CESAREAN DELIVERY PROTOCOL VERSUS STANDARD OF CARE DESCRIPTION:OPIOID UTILIZATION WITH ENHANCED RECOVERY AFTER CESAREAN DELIVERY PROTOCOL VERSUS STANDARD OF CARE\nAuthors: Trace Easterling\, Amanda Williams\, Allison Daneault\, Catherine Childre\, Anna Bulman\, Brianna Wheeler\, Megan Missanelli\, Brittney Bicksler\, Francie Ruzic.\n\nObjective: Compare opioid utilization in patients undergoing cesarean delivery with and without use of the enhanced recovery after cesarean delivery protocol.\n\nBackground/Purpose –\nCesarean 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.\n\nMethods –\nA 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.\n\nResults –\nA 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)\n\nConclusions –\nPatient 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. \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:104d5d9f90c3e1f8d9b24aa16148c0bb URL:http://2026serc.sched.com/event/104d5d9f90c3e1f8d9b24aa16148c0bb END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Evaluating The Risk of Hypertension Exacerbations in Women Taking Combined Oral Contraceptives with a Pre-Existing Diagnosis of Hypertension DESCRIPTION:Title: \;Evaluating The Risk of Hypertension Exacerbations in Women Taking Combined Oral Contraceptives with a Pre-Existing Diagnosis of Hypertension\nAuthors: Taylor Paris\, Lisa Ambrose\nBackground: \;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.\nMethods: \;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.\nResults: \;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.\nConclusion: \;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.\n\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:ee9689604970114f4387f849a62c1e23 URL:http://2026serc.sched.com/event/ee9689604970114f4387f849a62c1e23 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Evaluation of Ambulatory Pharmacist Transitions of Care Outreach for Patients with Uncontrolled Diabetes DESCRIPTION: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.\n\nMethods: 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.\n\nResults: 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.\n\nConclusions: 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.\n\nPresentation objective: Recognize key interventions an ambulatory care pharmacist can provide to support patients with uncontrolled diabetes during transitions of care.\n\nSelf-assessment question: Which of the following interventions was most commonly identified and addressed by pharmacists during transitions of care outreach? CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:f254038d45d742cf20b6b1670c782202 URL:http://2026serc.sched.com/event/f254038d45d742cf20b6b1670c782202 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Antimicrobial Stewardship in the Emergency Department: Evaluation of Discharge Antibiotic Prescribing for UTI and CAP DESCRIPTION:Antimicrobial Stewardship in the Emergency Department: Evaluation of Discharge Antibiotic Prescribing for UTI and CAP\n\nDelaney Peterson\, Mckenzie Hodges\, Courtney McDonald\, Emma Hornsby\, Aayush Patel\, Lauren Simmons\nPiedmont Columbus Regional Midtown (PCRM) - Columbus\, Georgia\n\nBackground: 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.\n\nMethodology: 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.\n\nResults: In Progress\nConclusion: In Progress\nContact: Delaney.peterson@piedmont.org CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:85cb1358b8697c5b12d764363ab7114e URL:http://2026serc.sched.com/event/85cb1358b8697c5b12d764363ab7114e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Complications Associated with Prolonged High-Rate Propofol Infusion in ICU Patients DESCRIPTION:Title: Complications Associated with Prolonged High-Rate Propofol Infusion in ICU Patients \;\n\nAuthors: Phuongloan Hoang\, Brook Jacobs\, Rupal Sheth \;\n\nBackground/Purpose: \;\nPropofol 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. \;\n\nWithin 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.  \; \;\n\nMethods: \;\nThis 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.  \;\n\nResults: \;\nOf 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. \;\n\nConclusion: \;\nConsistent 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:6ff91e644a3638fef603c64ef1d69b8b URL:http://2026serc.sched.com/event/6ff91e644a3638fef603c64ef1d69b8b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Decreasing hypoglycemic events after administration of anti-diabetic agents DESCRIPTION:Title: Decreasing hypoglycemic events after administration of anti-diabetic agents\nPresenter: Lillian James\nAuthors: Lillian James\, Amanda Guffey\, Jean Goette\, Erik Turgeon at Lexington Medical Center\nBackground: 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.\nMethodology: 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.\nResults: 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).\nConclusions: 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:c767b3a4e3cf10997e2efdacecf7ac33 URL:http://2026serc.sched.com/event/c767b3a4e3cf10997e2efdacecf7ac33 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Evaluation of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome in ICU DESCRIPTION:Evaluation of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome in ICU\nGun Moon\, Christen Freeman\, Alston Poellnitz\nDCH Regional Medical Center\, Tuscaloosa\, AL\n\nLearning Objective: \;Identify the oxygenation response and appropriate utilization of inhaled epoprostenol in ICU patients with acute respiratory distress syndrome.\n\nSelf-Assessment Question:\nAbrupt discontinuation of inhaled epoprostenol may lead to rebound pulmonary hypertension and worsening hypoxemia. True or False?\n\nBackground: 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.\n\nMethods:\nThis 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.\n\nResults:\nFifty 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%.\n\nConclusion:\nDespite 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.\n\nResident e-mail: Gun.Moon@dchsystem.com CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:9ba0eb2dfd3e559915826bc8b8c9a498 URL:http://2026serc.sched.com/event/9ba0eb2dfd3e559915826bc8b8c9a498 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Evaluation of Pediatric Pharmacy Driven Methicillin Resistant  Staphylococcus Aureus (MRSA) Nasal Polymerase Chain Reaction (PCR) protocol - Rachel Samples DESCRIPTION:Title: Evaluation of Pediatric Pharmacy Driven Methicillin Resistant  \nStaphylococcus Aureus (MRSA) Nasal Polymerase Chain Reaction (PCR) protocol  \nAuthors: Beth Addington\, PharmD\, BCPPS\, Sarah Withers\, PharmD\, MS\, BCIDP\, Rachel Samples\, PharmD\, MBA  \nObjective: 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. \nBackground: 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. \nMethods: 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. \nResults: 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).\nConclusion: 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.\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:6d5ac335065ab60ac5a86a9eb12ddbc7 URL:http://2026serc.sched.com/event/6d5ac335065ab60ac5a86a9eb12ddbc7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Impact of Antibiotic Allergies on Susceptibilities Among Isolates Responsible for Gram Negative Bacteremia DESCRIPTION: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.\n\nMethods: 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.\n\nResults: 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%).\n\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:379275e33f881c40430dbb5563612aaf URL:http://2026serc.sched.com/event/379275e33f881c40430dbb5563612aaf END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Impact of Antibiotic Therapy on Weight in Adult Patients DESCRIPTION:Title: Impact of Antibiotic Therapy on Weight in Adult Patients\n\nAuthors: Nghi Nguyen\, Kate O’Connor\, Joshua Eudy\, Elizabeth Spitzer\, Bintaben Patel\, Emmie Wu\, Daniel Anderson\n\nObjective: To evaluate short‑ and long‑term weight changes and metabolic effects associated with antibiotic use in adults.\n\nBackground: 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.\n \nMethod: \;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.\n\nResults: 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.\n\nConclusion: 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.  \;  \; CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:86722fa55778791c6756c1af2003ade2 URL:http://2026serc.sched.com/event/86722fa55778791c6756c1af2003ade2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Association of degree of pyuria and symptomatic urinary tract infections at a community hospital DESCRIPTION: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. \;\n\nAt 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. \;\n\n\nMethods: 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.\n\nResults: 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%. \;\n\nConclusion: 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. \;\n\n\n\nEmail: jasontuttle57@gmail.com CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:106cacd3c99c032c1bf89fe7bc2c1e26 URL:http://2026serc.sched.com/event/106cacd3c99c032c1bf89fe7bc2c1e26 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Evaluation of Vitamin K Antagonist versus Direct Oral Anticoagulants in the Management of Left Ventricular Thrombus  DESCRIPTION: \;\nAuthors: Seana-Pierre Williams\, Jaleesa Myers \;\nWellstar Cobb Medical Center\, Austell\, GA \;\n \;\nPurpose: 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.  \;\n \;\nMethods: 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. \;\n \;\nResults: 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.  \;\n \;\nConclusion: 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. \;\n \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:a4d49c7d2af274750e6aaed060f65693 URL:http://2026serc.sched.com/event/a4d49c7d2af274750e6aaed060f65693 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T204000Z DTEND:20260430T210000Z SUMMARY:Standardizing Biologics Management: A Community Health System Approach to Formulary Development and Implementation DESCRIPTION: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.\n\nDeveloping 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.\n\nThe 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.\n\nLooking 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.\n\nImplementing 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. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:f027b972ad943c7ae296e331a7651ab2 URL:http://2026serc.sched.com/event/f027b972ad943c7ae296e331a7651ab2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Evaluating Patient and Caregiver Perceptions of Pharmacist Involvement in Diabetes Management Within A Pediatric Endocrinology Clinic DESCRIPTION:Authors: Chloe McGee\, Aubrey Slaughter\n\nBackground:\nDiabetes 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.\nMultiple 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.\n\nMethods:\nThis 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.\n\nResults:\nA 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).\n\nConclusions:\nBased 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:56161ee64a9a3af6a5afe2355225ad54 URL:http://2026serc.sched.com/event/56161ee64a9a3af6a5afe2355225ad54 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Evaluation of a Pharmacist-Led Levothyroxine Monitoring and Management Program at the Salisbury VA Health Care System DESCRIPTION:Evaluation of a Pharmacist-Led Levothyroxine Monitoring and Management Program at the Salisbury VA Health Care System\n\nAuthors: Kendra G. Hofler\, Camille P. Robinette\, Meghan Mark\, and Aashish A. Shah\n\nBackground:\nHypothyroidism 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.\n\nMethods:\nThis 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.\n \;\nResults:\nA 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.\n\nDiscussion:\nThe 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.\n\nConclusion:\nThis 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.\n\nReferences\n1. Chaker L\, Papaleontiou M. Hypothyroidism: A Review. JAMA. Published online September 03\, 2025. doi:10.1001/jama.2025.13559\n2. 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.\n3. 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: 361731... CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:171defc0a3a4d37de814fb513d0a1e9b URL:http://2026serc.sched.com/event/171defc0a3a4d37de814fb513d0a1e9b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Weight Loss Medication Tapering and Its Effect on Sustainability of Decreased Body Weight - Mary Buehner DESCRIPTION:Title: Weight Loss Medication Tapering and Its Effect on Sustainability of Decreased Body Weight\nAuthors: Mary Christine Buehner\, Paul Strange\n\nBackground:\n\nObesity 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.\n\nMethods:\n\nThis 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.\n\nResults:\n\nThe 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).\n\nConclusion:\n\nNo 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. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:4f8baaef60e8630ed9194798a7150bae URL:http://2026serc.sched.com/event/4f8baaef60e8630ed9194798a7150bae END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Lacosamide versus Levetiracetam for Seizure Prophylaxis in Patients with Traumatic Brain Injury DESCRIPTION: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.\nMethods: 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.\nResults: In Progress\nConclusions: In Progress CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:70c9db8caf038ac46735c00fe2ee7077 URL:http://2026serc.sched.com/event/70c9db8caf038ac46735c00fe2ee7077 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Propofol\, Midazolam\, and Dexmedetomidine: Impact on Fluid Balance Derangements and Diuretic Resistance in Critically Ill Intensive Care Unit Patients DESCRIPTION: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\n\nBackground:\nAnesthetics 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.\n\nMethods:\nThis 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.\n\nResults:\nTwenty 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.\n\nConclusions:\nIn 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:f155785620643937f8a044d50f0b209e URL:http://2026serc.sched.com/event/f155785620643937f8a044d50f0b209e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Resident Presentation - Yurim Lee DESCRIPTION:Title: \;Impact of Sedation Protocol Changes on Restraint Use:   A Pre-Post Analysis of Weight-Based Dosing Adjustment in the Emergency DepartmentAuthors: \;Yurim Lee\, Carrie BakerPractice Site: Wellstar Kennestone Regional Medical Center\, Marietta\, GABackground: \;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: Kristy.Lee2@wellstar.org\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:d398ce29e03bdc7ccf39abdd4fb69fb8 URL:http://2026serc.sched.com/event/d398ce29e03bdc7ccf39abdd4fb69fb8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Effectiveness of Amoxicillin-Clavulanate for the Treatment of Extended-Spectrum β-Lactamase-Producing Enterobacterales (ESBL-E) Urinary Tract Infection DESCRIPTION: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. \;\n\nMethods: 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. \;\n\nResults: 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). \;\n\nConclusions: 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. CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:de5da8779a8180d4ca38ee2b88176e01 URL:http://2026serc.sched.com/event/de5da8779a8180d4ca38ee2b88176e01 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Outcomes Associated with Implementation of an Electronic Health Record Based Automatic Infectious Disease Consultation for Positive Blood Cultures with Staphylococcus Aureus DESCRIPTION:Outcomes Associated with Implementation of an Electronic Health Record Based Automatic Infectious Disease Consultation for Positive Blood Cultures with Staphylococcus aureus \;\n\nAuthors: Taylor Bird\, Elise Richoux\, Brandon Hawkins\, Samantha Walker\, Miller Hadley\, Amber Wolfe \;\n\nBackground: \;\nStaphylococcus 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.  \;\n\nMethods:\nThis 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.  \;\n\nResults:\nHospital 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).\n\nConclusions: \;\nThe 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. \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:e57322f78ca83fe2df9655f72a62ae54 URL:http://2026serc.sched.com/event/e57322f78ca83fe2df9655f72a62ae54 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Tolerability of Extended-Duration Linezolid Therapy at a Large Academic Medical Center DESCRIPTION:BACKGROUND \;\nLinezolid 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. \;\nMETHODS \;\nWe 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. \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:7eeb5c77c270f3b1c9f572d4e7a810bd URL:http://2026serc.sched.com/event/7eeb5c77c270f3b1c9f572d4e7a810bd END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Evaluation of Inpatient Opioid Use in Opioid-Naive Patients without an Acute Pain Indication DESCRIPTION: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. \;\nMethods: 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.  \;\nResults: 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.  \;\nConclusion: 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. \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:bd83ffeb1f8453ce5b43e2cb4bfefb87 URL:http://2026serc.sched.com/event/bd83ffeb1f8453ce5b43e2cb4bfefb87 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Improving VTE Prophylaxis in Multiple Myeloma: An EHR-Based Approach Using IMPEDE and SAVED Risk Stratification Score in an Outpatient Setting DESCRIPTION: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 CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:8d49c2b360946502718a1b2ef9375429 URL:http://2026serc.sched.com/event/8d49c2b360946502718a1b2ef9375429 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260430T210000Z DTEND:20260430T212000Z SUMMARY:Lipoglycopeptides Unleashed: The Power of Dalbavancin and Oritavancin DESCRIPTION:Title: Lipoglycopeptides Unleashed: The Power of Dalbavancin and Oritavancin \;\n\nAuthors: Michael Wallace\, Heather Gibson\, Gretchen Arnoczy\, Allison Cid  \;\n\nBackground: 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.  \; \;\nMethods: 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.  \;\n\n \;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. \;\n\nConclusions: 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.  \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:3c4cdcee5407ad1b3490fd95d074f345 URL:http://2026serc.sched.com/event/3c4cdcee5407ad1b3490fd95d074f345 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:A Guide to Becoming A Sports Medicine Pharmacist in the Ambulatory Care Setting DESCRIPTION:Authors: Deena Alsabbah\, Alexis Shook\, Brian Atkinson\, and Graham Grush\n\nBackground: Pharmacists have proven valuable across various clinical areas and interprofessional teams\, especially in ambulatory care settings\, improving health outcomes and quality of care. Within the past few decades\, sports medicine pharmacy has emerged as a unique specialty\, ranging from counseling individuals in local club sports and fitness to advising elite Olympic athletes. Despite this\, sports or sports medicine pharmacy remains underrepresented in pharmacy education and practice. The aim of this project was to design a guide for becoming a sports medicine pharmacist in the ambulatory care setting that addresses roles and responsibilities\, areas for interprofessional collaboration\, and resources to expand knowledge and networking opportunities.\n\nMethods: A literature review was conducted to gather information on sports pharmacy organizations and resources\, education and training opportunities\, and roles and responsibilities. A 13-question qualitative survey was also distributed to practicing sports pharmacists within 3 sports pharmacy organizations (Sports Pharmacy Network\, International Sports Pharmacist Network\, and/or U.S. Sports Pharmacy Group) to obtain perspectives on current practice. Responses were summarized to highlight most common themes. \;\n\nResults: This abstract describes results from the qualitative survey and how it translates to ambulatory care practice.\nSurvey respondents (n = 14) reported diverse practice backgrounds across multiple settings\, including ambulatory care\, independent community pharmacy\, student health\, athletics\, acute care\, and scientific writing. The majority of respondents had been practicing for 2-5 years (42.9%)\, followed by 10-20+ years (35.7%)\, and 0-1 years (21.4%). 78.6% of respondents reported working with nutritionists\, as well as physicians\, nurse practitioners\, nurses\, athletic trainers\, physical therapists\, sports psychologists\, and sports dentists. The most common roles and responsibilities included medication and therapeutic management (50%)\, clinical assessment and screening (28.6%)\, personalized care and performance planning (28.6%)\, consultation and education (71.4%)\, and scientific and educational content development (21.4%). Respondents frequently managed conditions such as pain and injury\, Relative Energy Deficiency in Sport (RED-S)\, mental health disorders\, infectious diseases\, and many more.\nPrimary barriers to sports pharmacy practice included lack of buy-in and awareness from other parties and sustainable reimbursement. Funding sources varied considerably\, with 42.8% of respondents receiving private or cash payments\, while others relied on educational sites and programs or additional employment.\n\nConclusions: There are a variety of ways pharmacists can make an impact in sports medicine\, particularly in ambulatory care settings. Resources and organizations\, like the International Sports Pharmacists Network\, Global DRO\, WADA\, and Sports Pharmacy Network\, are just a few of many that provide the necessary education\, skills\, and networking opportunities for pharmacists and student pharmacists to enter a career path caring for a unique patient population. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:825329cecd93c6ee56bd4f3498924efa URL:http://2026serc.sched.com/event/825329cecd93c6ee56bd4f3498924efa END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Adherence to Recommended Vaccinations in a Veteran Rheumatology Population: A Quality Improvement Initiative DESCRIPTION:ADHERENCE TO RECOMMENDED VACCINATIONS IN A VETERAN RHEUMATOLOGY POPULATION: A QUALITY IMPROVEMENT INITIATIVE  \;\nAvery Zapp\, Lilian Culp\, Whitney White\n\nBirmingham VA Healthcare System – Birmingham\, AL\n\n\nBackground/Purpose: \;This project aimed to systematically evaluate the vaccination status of patients managed by the rheumatology clinic at a Veterans Affairs Medical Center\, with a focus on adherence to current immunization guidelines. The interventions also aimed to promote provider engagement and patient awareness. The effectiveness of a multifaceted pharmacist–provider intervention on vaccination rates among veterans was evaluated.\nMethodology: \;Eligible participants include those who are followed in the Birmingham VA rheumatology clinic\, currently taking a JAK inhibitor and due for the herpes zoster vaccination. Intervention included pharmacist dashboard monitoring to evaluate patients due for vaccination\, with those patients subsequently sent to providers as reminder for their upcoming appointment. Reminder notifications were also sent to eligible patients. Intervention with nursing staff was also performed to address triage and patient education. Vaccination rates in the rheumatology clinic were assessed before and after the interventions were implemented.  \;\nResults: \;Twenty-nine patients with upcoming appointments were reviewed\, all prescribed tofacitinib or upadacitinib. At baseline\, 46 percent had at least one documented dose of recombinant zoster vaccine\, while 54 percent had no documentation. Most patients (25 of 29) were established in primary care. Overall clinic vaccination rates increased by approximately 1 percent during the study period\, with completion of the two‑dose series rising from 41 percent to 42 percent. The primary barriers were patient preference and hesitancy\, often related to safety concerns or misperceptions about risk. Documentation gaps\, particularly for vaccines administered outside the VA\, likely contributed to underestimation of true vaccination status.\nConclusions: \;Pharmacist‑driven provider reminders and patient outreach efforts improved awareness of vaccination needs but did not produce a substantial increase in herpes zoster vaccination rates during the short study interval. Persistent patient hesitancy and documentation inconsistencies remained barriers to adherence. These findings highlight the need for ongoing\, multifaceted strategies - particularly targeted patient education\, streamlined documentation processes\, and incorporation of additional staff support - to enhance vaccine acceptance in Veterans receiving JAK inhibitors. Future expansion of this initiative will address additional immunization gaps in the rheumatology population.\nPresentation Objective: By the end of this presentation\, participants will be able to identify key factors affecting herpes zoster vaccination adherence in Veteran rheumatology patients on JAK inhibitors and develop strategies to improve these rates. \;Self-Assessment: What intervention is most likely to improve recombinant herpes zoster vaccination rates in veterans receiving JAK inhibitors?\n\n\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:e6b76685419cb7139b46414f1959ba46 URL:http://2026serc.sched.com/event/e6b76685419cb7139b46414f1959ba46 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:VOICES OF WOMEN’S HEALTH: A SURVEY TO SHAPE ACCESSIBLE\, PHARMACIST-LED CARE DESCRIPTION:Title: \;VOICES OF WOMEN’S HEALTH: A SURVEY TO SHAPE ACCESSIBLE\, PHARMACIST-LED CARE \;\n\nAuthors: \;MK Schwaemmle\, Fallon Hartsell\, Courtney E. Gamston\, Kimberly B. Lloyd \;\n\nBackground/Purpose: Women’s health has been a topic that has been historically neglected by the medical community at large\, and limited research regarding specific conditions that primarily affect women\, make it difficult for practitioners and patients to navigate and manage disease states such as endometriosis\, menopause\, migraines\, pelvic floor disorders\, and others. According to the Center for Disease Control and Prevention (CDC) in 2023\, 15.6% of women 18 years old and older in the United States reported to be in fair or poor health. In addition\, 3 out of 4 people diagnosed with an autoimmune disease are women. Many women lack consistent support for their health needs\, providing pharmacists an opportunity for addressing health care needs in this underserved patient population. This survey seeks to identify which women's health services are needed and desired within a self-insured adult female population and the acceptability of having pharmacists provide these services. \;\n\nMethodology: An incentivized\, anonymous online survey was distributed via email\, social media\, and flyers. Eligible participants were females covered by the employee insurance plan at a large\, self-insured employer and were 18 years old and older. Survey domains included demographics\, assessment of general health\, gynecologic history\, sexual health\, current health concerns\, facilitators and barriers to care\, brief health history\, and desire for pharmacist-led services.  \;The survey took participants between 20 and 30 minutes to complete. Data was reported as descriptive statistics. The results of this study will identify the status of women’s health needs in the community\, characterize this patient population\, and inform the development of pharmacy-provided services.  \;\n\nResults: In progress \;\n\nConclusions: In progress \;\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:25571e7839fe4ba09b479335abdde3d7 URL:http://2026serc.sched.com/event/25571e7839fe4ba09b479335abdde3d7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Effects of Ketamine Infusion Rate and Dosing on Delirium in Medical ICU Patients DESCRIPTION:Introduction: \nKetamine\, an N-methyl-D-aspartate (NMDA) receptor antagonist\, is increasingly utilized for analgosedation in mechanically ventilated intensive care unit (ICU) patients due to its analgesic and sedative properties. Its effects are dose dependent\, with lower infusion rates (0.1–0.4 mg/kg/hr) providing analgesia and higher rates (0.4–1.0 mg/kg/hr) producing sedation. At higher doses\, ketamine may cause dissociative or psychiatric effects that can resemble ICU delirium. However\, existing data on the relationship between ketamine and delirium are limited and conflicting\, often without adequate adjustment for confounders or consideration of dosing variability. This study aimed to evaluate the association between maximum daily ketamine infusion rate and ICU delirium. A secondary objective assessed the relationship between cumulative ketamine dose and delirium. \nMethods: \nThis multicenter retrospective cohort study included adult medical ICU patients requiring mechanical ventilation and received ketamine infusions for sedation between January 1\, 2013 and June 30\, 2025 at two tertiary care hospitals. Patients were excluded if ketamine was used for non-sedation indications\, administered for less than 24 hours\, or if continuous neuromuscular blockade was used. Demographic and clinical data were collected\, including age\, race\, sex\, Sequential Organ Failure Assessment (SOFA) score\, comorbidities\, history of substance use or psychiatric illness\, and sedation-related variables. Additional data included ketamine infusion rates\, cumulative ketamine dose\, duration of ketamine therapy\, timing of ketamine initiation\, concomitant sedative or analgesic use\, Richmond Agitation-Sedation Scale (RASS) scores\, and Confusion Assessment Method for the ICU (CAM-ICU) scores.  \; \nThe primary outcome was ICU delirium\, defined by a positive CAM-ICU at any point during ICU stay. A modified Poisson regression evaluated linear associations of delirium with the primary exposure variable\, highest daily ketamine rate\, and secondary exposure variable\, cumulative ketamine dose. Covariates included SOFA score\, cumulative morphine milligram equivalents (MME)\, cumulative benzodiazepines\, and ICU length of stay (LOS). Logistic spline models and multivariate logistic regression were also conducted for both exposure variables. Other secondary outcomes\, including mortality and LOS were analyzed using descriptive statistics\, Mann Whitney U\, or Chi Square as appropriate. \;\nResults: \nOf 837 screened patients\, 114 met inclusion criteria and 42 (36.8%) developed delirium. Baseline characteristics were similar between groups\, with a median age of 57–58 years. There was no difference between those who developed delirium and those who did not with regard to the maximum daily ketamine infusion rate (0.6 vs 0.43 mg/kg/hr\, p=0.08) and cumulative doses (3440.6 vs 2461.4 mg\, p=0.10). Patients with delirium had longer mechanical ventilation duration (210.7 vs 140.9 hours\, p<\;0.01)\, longer ICU length of stay (364.7 vs 268.6 hours\, p=0.04)\, and higher opioid exposure (5126.8 vs 2911.8 morphine milligram equivalents\, p=0.85). Benzodiazepine use and mortality were not significantly different. \nIn the modified Poisson regression\, there was no association between maximum daily ketamine infusion rate and delirium (Relative risk ratio (RR) 1.15\, p=0.21) or cumulative ketamine dose and delirium (RR 1.0\, p=0.97). Duration of mechanical ventilation was independently associated with delirium in both regression models (RR 1.0\, p<\;0.01). No association between maximum daily ketamine infusion rate or cumulative ketamine dose with delirium was seen in logistic spline or multivariate regression models.  \; \;\nConclusion: \nNeither maximum daily ketamine infusion rate nor cumulative dose was associated with ICU delirium after adjustment for confounders. As seen in previous literature\, duration of mechanical ventilation was associated with delirium. These findings suggest ketamine infusion rate and dosing may not significantly influence delirium risk\, though prospective studies are needed to confirm these results. \n \n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:155aca577afe9a3a6c795261d49a7475 URL:http://2026serc.sched.com/event/155aca577afe9a3a6c795261d49a7475 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Evaluation of Guideline-Recommended Duration of Levetiracetam Prophylaxis Prescribed in Patients After Traumatic Brain Injury DESCRIPTION:Title: Evaluation of Guideline-Recommended Duration of Levetiracetam Prophylaxis Prescribed in Patients After Traumatic Brain Injury\nAuthors: Michael Kim\, Kameron Hicks\, Rachel Friend\, Donley Galloway\nBackground: \;Traumatic brain injuries (TBI) may lead to early post-traumatic seizures (PTS)\, especially in instances of severe TBI and to a lesser extent in mild to moderate TBI. Early PTS are mechanistically distinct from late PTS and most often occur within seven to fourteen days of the inciting TBI. They are associated with poor morbidity and mortality outcomes. Recent guidelines by the Neurocritical Care Society suggest that there is no statistical difference in the reduction of early seizures with or without the use of antiseizure medications. However\, levetiracetam is commonly used as seizure prophylaxis due to its favorable adverse drug effect profile. The use of antiseizure medications for a shorter duration of time of ≤ 7 days is recommended because the studies have identified no statistical difference with longer duration of antiseizure medication therapy and worse adverse effect incidence. As the use of prophylactic levetiracetam provides limited benefits in preventing early seizures\, the purpose of this study is to evaluate its current prescribing practices to potentially provide evidence to support standardized as lengthy duration and high dose is not well supported by current evidence.\nMethods: \;This was an IRB approved single-centered\, retrospective evaluation of adult patients diagnosed with traumatic brain injury and given levetiracetam as seizure prophylaxis who were admitted to one of four inpatient neurologic or trauma units between June 1\, 2025\, to May 31\, 2025. Patients were excluded if they had any prior history of seizures\, on any maintenance antiepileptic medications\, used any other antiepileptic medications for seizure prophylaxis\, or were prisoners. The primary outcome of this study was the rate of guideline recommended duration of levetiracetam prophylaxis. Secondary outcomes included documented seizure activity within the encounter\, dose and frequency of levetiracetam used as prophylaxis\, number of patients discharged home with levetiracetam\, and any documented CNS or hypersensitivity reactions from levetiracetam. The collected data was analyzed using descriptive statistics and chi-square test.\nResults: A total of 111 patients were included. The rate of guideline recommended duration of levetiracetam for seizure prophylaxis after TBI was 43.2% (n=48/111. The rate of guideline directed duration of therapy in just the inpatient days of prophylactic therapy yielded 82% (n=91/111). Within the subgroups\, the rate of guideline directed duration of therapy was 47.4% (n=27/57) in the STICU\, 48.6% (n=17/35) in the NICU\, 18.2% (n=2/11) in E5\, and 25% (n=2/8) in E4. The frequency of the maintenance prophylaxis was twice daily dosing. The doses administered inpatient were varied\, but was most commonly 500 mg twice daily (63.1%\, n=71/111). The number of those discharged on levetiracetam was 51.4% (n=57/111) with durations ranging from 1-90 days and doses ranging from 500mg-1000mg. Possible CNS effects from levetiracetam was seen in 21 patients (18.9%). One patient (0.9%) had evidence of seizure activity.\nConclusions: \;Guideline recommended duration of levetiracetam as early post-traumatic seizure prophylaxis was seen in less than half of the patients within this institution’s main trauma and neurologic units when accounting for both initial inpatient and outpatient continuation of prophylactic therapy. Most patients in the inpatient setting received the recommended duration of therapy of seven days or fewer\, but prescription orders at discharge for prophylaxis up to 90 days were observed. With the only seizure having been seen in the severe TBI patient\, potential adverse drug effects seen\, and long duration of prophylaxis that the majority of these patients received\, more conservative management with seizure prophylaxis may be warranted. Future studies that evaluate the seizure incidence between evidence supported shorter duration of therapy and extended duration of therapy may contribute to the potential de-prescribing efforts of pharmacists.\n\nContact Information: Min.Kim1@advocatehealth.org CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:71a3087db09ec643c29b1c0bc7566a99 URL:http://2026serc.sched.com/event/71a3087db09ec643c29b1c0bc7566a99 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Evaluation of Post-Intubation Sedation Practices Following Rapid Sequence Intubation in a Community Hospital Emergency Department DESCRIPTION:Background: \;Rapid-sequence intubation (RSI) involves administration of an induction agent and neuromuscular blocking agent to facilitate patient comfort and endotracheal intubation. Following RSI\, initiation of post-intubation sedation is essential to maintain patient comfort\, reduce agitation\, and prevent awareness with paralysis (AWP)\, which has been associated with psychological distress and other adverse outcomes. Several factors may contribute to AWP\, including the use of long-acting neuromuscular blocking agents such as rocuronium\, underdosing of induction agents\, and delays in initiation of post-intubation sedation. In many emergency department (ED) settings\, post-intubation sedation may be delayed\, inconsistently initiated\, or omitted\, potentially increasing the risk of “awake paralysis.” At our community hospital\, pharmacists are not routinely involved in the RSI process\, as medication orders are auto-verified and pharmacy staff are not alerted when intubations occur. Additionally\, the existing RSI order set does not include guidance for post-intubation sedation. Pharmacists may play an important role in supporting medication selection\, preparation\, and timely initiation of sedation following RSI. The purpose of this study was to evaluate to evaluate post-intubation sedation practices following RSI in the ED at a community hospital.\n\nMethodology: \;This single-center\, IRB-reviewed\, determined exempt retrospective evaluation assessed adult patients undergoing RSI in the ED between January 2025 and March 2025. Adult patients aged ≥ 18 years who underwent RSI with an induction agent and neuromuscular blocking agent in the ED were included. Patients were excluded if intubation or post-intubation management was performed by a non-ED provider\, RSI occurred outside the ED\, the patient died in the ED\, or ED length of care was less than one hour. Outcomes evaluated included receipt of a sedative within one hour following RSI and time to first sedative administration. Continuous variables were summarized using descriptive statistics\, and categorical variables were reported as frequencies and percentages.\n\nResults: \;A total of 186 patients were screened\, of which 52 patients met inclusion criteria for evaluation. The mean age was 65 years (SD 13.3)\, and 54% were female. The most common indication for RSI was respiratory distress (58%)\, followed by altered mental status (21%) and unresponsiveness (13%). Etomidate was the most commonly used induction agent (79%)\, and rocuronium was the most frequently used neuromuscular blocking agent (77%). Overall\, 81% of patients received at least one sedative agent within one hour following RSI. Fentanyl was the most commonly used agent (88%)\, while propofol was the second most frequently used sedative (63%)\, followed by midazolam (21%). The mean time to first sedative dose was 29.4 minutes.\n\nConclusion: \;In this evaluation of post-intubation sedation practices following RSI in the ED\, most patients received a sedative within one hour\; however\, variability in the timing and initiation of therapy was observed. Delays or absence of sedation following RSI may increase the risk of complications such as inadequate sedation and awareness with paralysis. These findings highlight an opportunity to improve the consistency and timeliness of post-intubation sedation practices. Greater pharmacist involvement during RSI events may help optimize medication selection and promote more timely initiation of sedation. Future efforts should focus on establishing a consistent pharmacy presence in the ED and developing a standardized workflow to facilitate pharmacist involvement during RSI events. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:1abf4756aa05e7f98c980fda55928834 URL:http://2026serc.sched.com/event/1abf4756aa05e7f98c980fda55928834 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Standardized Calcium Replacement During Massive Transfusion Protocol in Trauma DESCRIPTION:Purpose: Historically\, trauma resuscitation has focused on three main complicating factors known as the “lethal triad”: hypothermia\, acidosis\, and coagulopathy. However\, recent literature has begun to recognize hypocalcemia as a fourth pillar in mortality rates. Data has shown up to 97% of patients can experience an exacerbation of hypocalcemia during massive transfusion protocol (MTP)\, of which 71% may experience severe hypocalcemia (ionized calcium <\; 0.9 mmol/L). The purpose of this study is to evaluate the effect of a standardized protocol for calcium repletion in trauma patients requiring MTP. \;\nMethods: This was a single center\, retrospective\, descriptive\, observational study among trauma patients who presented to Wellstar Kennestone Regional Medical Center Emergency Department (WKRMCED). Data was collected prior to implementation of a calcium repletion protocol from July 1\, 2023 to May 31\, 2024\, and post-protocol implementation from August 1\, 2024 to June 30\, 2025. Patients were included if they presented to WKRMCED during the specified treatment dates as a tier 1 trauma requiring activation of MTP for administration of blood products. Patients were excluded if they were pregnant\, ≤ 15 years old\, had activation of MTP for a non-trauma related reason\, did not have documentation of calcium levels after transfusion\, or if the calcium replacement protocol was not followed after transfusion of blood products. The primary outcome was calcium levels up to 24h following the last documented blood product given post-transfusion. Secondary outcomes included total amount of blood products transfused within 24h of MTP initiation\, hospital length of stay\, intensive care unit length of stay\, and in-hospital mortality.  \;\nResults: Of the 6217 patients screened for inclusion in this study\, 122 met inclusion criteria. Patients were screened further based on the predefined exclusion criteria and a total of 98 patients were included in the study (pre-protocol n=62\; post protocol n=36).  \;Although this study was observational\, and descriptive statistics were used\, there did not appear to be any vast differences\, numerically in demographic information. The primary outcome increased nearly 25% from pre-protocol (51.5%) to post-protocol (75%). Regarding the secondary outcomes\, more elemental calcium was given in the post-protocol group\, and there was a decrease from pre- to post-protocol in the time difference between the first unit of blood being given and the first dose of calcium being administered (pre-protocol: median 1.17 hours\, IQR 3.21 hours\; post-protocol: median 0.45 hours\, IQR 0.65 hours). In the pre-protocol group\, the baseline to follow up iCAL was 1.07 to 1.1. Comparatively\, the difference in baseline to follow up iCAL in the post-protocol group was 0.195 mmol/L\, which is a 6.5 times greater increase than the pre-protocol of 0.03 mmol/L. \;\nConclusions: The implementation of a calcium repletion protocol during MTP in trauma suggests maintenance of higher serum calcium levels and thus may decrease the risk of complications during trauma resuscitation. Future studies should focus on the inclusion of larger populations for better generalizability and defining a dose of calcium (gluconate\, chloride\, or both) that is most efficacious among any trauma patient requiring massive transfusion protocol. \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:45533becbc3cab032b9ce1b900074936 URL:http://2026serc.sched.com/event/45533becbc3cab032b9ce1b900074936 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Streamlining Phenobarbital Usage in Alcohol Withdrawal Patients at a Large Community Hospital DESCRIPTION:Authors: Leah Franks\, Jeremy Ray\, and Mickala Thompson\n \;\nBackground: Alcohol withdrawal syndrome (AWS) is a serious condition that progresses in severity. The most severe symptoms include withdrawal seizures and delirium tremens. Phenobarbital is a barbiturate currently classified as an alternative agent for severe AWS in the 2020 American Society of Addiction Medicine’s “Clinical Practice Guideline on Alcohol Withdrawal Management.” A 2023 meta-analysis conducted by Umar\, et al. concluded that phenobarbital can be used safely and effectively for AWS within the ICU setting. Phenobarbital prescribing practices have not been analyzed thus far at our institution. Therefore\, the purpose of this research is to assess the current utilization and dosing schemes of phenobarbital for AWS at our large community hospital.\n \;\nMethods: A single-center\, institutional review committee-approved pre-post analysis was conducted at Huntsville Hospital to assess the safety\, efficacy\, and outcomes of patients receiving phenobarbital after the implementation of a streamlined-dosing order set. Information from an initial chart review was utilized to develop an order set based on current guideline recommendations/literature while also aligning with current prescribing practices at our institution. After implementation of streamlined dosing\, a post-hoc analysis will be conducted. Adult patients\, greater than 18 years of age\, who received phenobarbital for management of AWS were included in the study. Exclusion criteria included vulnerable patients and those who received phenobarbital for underlying seizure disorders. The primary endpoints are the utilization of a pre-determined\, guideline-directed dosing scheme and benzodiazepine usage post-phenobarbital loading dose administration. Secondary endpoints include ICU admission\, need for intubation\, withdrawal seizure or delirium tremens occurrence\, and adverse events.\n \;\nResults: A total of 54 patients in the pre-implementation group and 29 patients in the post-implementation group were included in this study. Baseline characteristics were similar between pre-post data regarding age (mean ~ 50 years)\, sex (majority male)\, baseline liver dysfunction (~50% for both groups)\, and receipt of CNS depressants (26% vs 21%) prior to phenobarbital. In terms of the primary endpoints\, 38% of the providers utilized the phenobarbital order set. Benzodiazepine usage (in lorazepam equivalents - mg\, median [IQR]) post-phenobarbital was comparable (4 [7.8] vs 4 [7.25]). Lastly\, variability amongst secondary outcomes occurred with the need for ICU admission and the need for intubation post-phenobarbital between the pre-implementation group (56% and 13%) and the post-implementation group (31% and 21%).\n \;\nConclusion: Overall\, order set utilization was minimal\, which hindered appropriate comparison between pre-post implementation data. Limitations included the \;variety of ordering providers\, a single center study\, as well as the order set not initially being in all alcohol withdrawal order sets. Future directions include implementing further education across all provider types and improving visibility of the order set to providers by adding it to the overall alcohol withdrawal admission and add-on order sets. \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:09c93398f61e5ddeab5cd1e2a75bfae5 URL:http://2026serc.sched.com/event/09c93398f61e5ddeab5cd1e2a75bfae5 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Tirofiban use following mechanical thrombectomy with emergent stent placement in acute ischemic stroke DESCRIPTION:Title: Tirofiban use following mechanical thrombectomy with emergent stent placement in acute ischemic stroke\nAuthor Names: Taylor Dodd\, Mallory Stringer\, Eric Shaw\nResident E-mail: taylor.dodd2@hcahealthcare.com\n\nBackground\nTandem lesions are present in 15-25% of all acute ischemic strokes (AIS) presenting with a large vessel occlusion (LVO) and are associated with increased morbidity and mortality. Treatment of tandem lesions is not standardized\, but may include intra-arterial thrombolysis\, balloon angioplasty\, and/or emergent stent placement during mechanical thrombectomy. Emergent stent placement requires antiplatelet therapy which may include glycoprotein (GP) IIb/IIIa inhibitors (e.g. tirofiban)\, aspirin\, and/or P2Y12 inhibitors. Currently\, there is inconsistent data regarding the dosing and duration of tirofiban infusion following mechanical thrombectomy with emergent stent placement in AIS. Retrospective data suggests similar rates of symptomatic intracranial hemorrhage (ICH)\, mortality\, and reperfusion rates with tirofiban use compared to without tirofiban. The study objective is to evaluate the safety and efficacy of tirofiban followed by dual antiplatelet therapy (DAPT) compared to antiplatelet therapy alone in AIS patients post mechanical thrombectomy with emergent stent placement.\n\nMethods\nThis was a single-center retrospective study conducted at a 711-bed DNV certified comprehensive stroke academic medical center. Adults admitted to the neurovascular intensive care unit (ICU) for AIS following mechanical thrombectomy and emergent stent placement that received tirofiban and/or antiplatelet therapy were included. Protected populations were excluded. The primary outcome was symptomatic ICH\, defined as ICH on imaging with any of the following: need for neurosurgical intervention\, intubation\, decrease in Glasgow Coma Scale score ≥ 2 within 24 hours of tirofiban or DAPT. Secondary outcomes included any ICH\, hospital and ICU length of stay (LOS)\, successful reperfusion (defined as a thrombolysis in cerebral infarction (TICI) score ≥ 2b)\, neurologic improvement (change in modified Rankin scale (mRS) from admission to discharge)\, and all-cause mortality.\n\nResults\nIn this study\, 56 patients were included with 27 patients in the tirofiban group and 29 patients in the group without tirofiban. Four patients (14.8%) in the tirofiban group compared to none in the without tirofiban group experienced symptomatic ICH within 24 hours of receiving tirofiban or DAPT (p<\;0.001). Any ICH was more prevalent in the tirofiban group compared to without tirofiban (51.9% vs. 6.9%\, p<\;0.001). Hospital LOS (6.9 days vs. 6.1 days\, p=0.386) and ICU LOS (3.8 vs. 3.7 p=0.444) were similar between groups. Successful reperfusion was achieved in 92% of patients in the tirofiban group compared to 84.6% in the without tirofiban group (p=0.668). Changes in mRS were not statistically different between groups (p=0.733). All-cause mortality was similar between groups (22.2% vs. 20.7%\, p=0.837).\n\nConclusions\nIn our study population\, the use of tirofiban had more ICH compared to patients not receiving tirofiban in AIS patients following mechanical thrombectomy and emergent stent placement. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:19799a9f3476757cf81788544015a7dc URL:http://2026serc.sched.com/event/19799a9f3476757cf81788544015a7dc END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Hospital acquired anemia in non-surgical patients receiving therapeutic anticoagulation versus venous thromboembolism prophylactic anticoagulation DESCRIPTION:Purpose: \n \;  \; Hospital-acquired anemia (HAA) is a common complication of hospitalization and is associated with increased length of stay\, healthcare costs\, readmissions\, and mortality. Although anticoagulation therapy carries a known bleeding risk\, its role as an independent contributor to HAA has not been well defined. This study evaluated compared the incidence of HAA in non-surgical hospitalized patients receiving prophylactic versus therapeutic anticoagulation. \nMethods: \n \;  \; This retrospective cohort study included adults (≥18 years) hospitalized for more than 4 days who received prophylactic or therapeutic anticoagulation for over 75% of their admission. Prophylactic regimens included subcutaneous heparin\, prophylactic-dose enoxaparin\, or fondaparinux 2.5 mg daily. Therapeutic anticoagulation included direct oral anticoagulants\, intravenous heparin\, therapeutic-dose enoxaparin\, argatroban\, or fondaparinux ≥ 5 mg daily. Patients were required to have hemoglobin measured on admission and within 72 hours of discharge. Exclusion criteria included anemia on admission\, surgical procedures (excluding minor/low-risk procedures)\, therapies affecting hemoglobin\, or documented physiologic bleeding. \nResults: \n \;  \; Hospital-acquired anemia occurred in 44.8% of patients receiving prophylactic anticoagulation and 51.3% receiving therapeutic anticoagulation\, with no significant difference between groups (p = 0.28). No differences were observed in anemia severity\, absolute hemoglobin change (p = 0.93)\, or rate of hemoglobin decline (p = 0.74). \nConclusion: \n \;  \; Hospital-acquired anemia was common in non-surgical hospitalized patients\, with no significant differences between prophylactic and therapeutic anticoagulation. Anticoagulation intensity alone may not be a primary contributor to HAA. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:126b3da67c98c0213b2e4690047ae9c1 URL:http://2026serc.sched.com/event/126b3da67c98c0213b2e4690047ae9c1 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Hydrocortisone vs. Methylprednisolone for the Treatment of Refractory Septic Shock DESCRIPTION:Title: Hydrocortisone vs. Methylprednisolone for the Treatment of Refractory Septic Shock \;\nAuthors: Erin Weippert\, Sydney Kisala\, Van Bui\, Sarah Jung\, Marina Rabinovich  \;\nBackground: The 2024 Society of Critical Care Medicine Guidelines on the Use of Corticosteroids in Sepsis recommend the use of corticosteroids in patients with septic shock. The recommended regimen is hydrocortisone 200 – 300 mg intravenously (IV) per day in divided doses or as a continuous infusion. Due to an ongoing IV hydrocortisone shortage\, IV methylprednisolone is increasingly used as an alternative\, though evidence for its safety and efficacy in septic shock is limited. The purpose of this study was to compare the effectiveness and safety of methylprednisolone to hydrocortisone in the management of refractory septic shock. \;\nMethods: This was a single-center\, retrospective\, cohort study conducted at a safety net hospital in Atlanta\, GA. Patients with septic shock who received methylprednisolone during the primary and secondary IV hydrocortisone shortage periods (February 2023 - February 2024 and May - August 2025) were compared with patients who received hydrocortisone (February 2024 - February 2025). Eligible patients were at least 18 years old\, admitted to an intensive care unit (ICU)\, diagnosed with septic shock requiring at least two vasopressors\, and received at least 48 hours of either IV methylprednisolone or IV hydrocortisone. Patients were excluded if they were pregnant\, received corticosteroids for an alternative indication\, or received both hydrocortisone and methylprednisolone. Variables collected include patient demographics\, highest serum lactate level\, initial Sequential Organ Failure Assessment (SOFA) score\, type and number of vasopressors received\, source of infection\, steroid duration\, and time from shock onset to steroid initiation. The primary outcome was time to shock resolution\, defined as the attainment of a goal mean arterial pressure (MAP) ≥ 65 mmHg without vasopressor support for at least 24 hours. Secondary outcomes included the incidence of shock recurrence\, time to achieving lactate of <\; 2 mmol/L\, receipt of vasopressors and corticosteroids beyond 7 days\, hospital mortality at 28 days\, ICU length of stay\, and duration of corticosteroid therapy. Safety outcomes included the incidence of hyperglycemia\, hypernatremia\, and gastrointestinal bleeding. Descriptive statistics were used for analysis and categorical variables were compared using a chi-square or Fisher’s exact test while continuous variables were compared using the Mann-Whitney U test. A p-value of 0.05 was considered statistically significant. \;\nResults: A total of 191 patients were included for analysis with 116 included in the hydrocortisone group and 75 in the methylprednisolone group. Baseline characteristics were similar between groups with the majority of patients being male\, of Black or African American race\, median age of 60 years\, and admitted to the medical ICU. However\, patients in the methylprednisolone group had a greater need for renal replacement therapy (50.6% vs. 35.3%\, p=0.036). 85 patients (73.3%) in the hydrocortisone group and 50 patients (67%) in the methylprednisolone group achieved shock resolution (p=0.327). The primary outcome of time to shock resolution was similar in the two groups (4 days vs. 3.9 days\, p=0.479). For secondary outcomes\, there were no significant differences between the groups for recurrence of shock\, time to achieving lactate of <\; 2 mmol/L\, or ICU length of stay. More patients in the hydrocortisone group received vasopressors and corticosteroids beyond seven days (25.9% vs. 9.3%\, p=0.005)\, while the methylprednisolone group exhibited a higher 28-day hospital mortality (56% vs. 38.8%\, p=0.02). There were no significant differences in safety outcomes between the groups. \;\nConclusions: The results of this study demonstrated no difference in time to shock resolution between hydrocortisone and methylprednisolone in critically ill patients with septic shock. These results suggest that methylprednisolone may be a reasonable alternative to hydrocortisone in this patient population\, although larger prospective studies are needed to confirm these findings and evaluate long-term outcomes.  \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:2127fcd2f9b6e04e89669a7847474d6d URL:http://2026serc.sched.com/event/2127fcd2f9b6e04e89669a7847474d6d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T123000Z DTEND:20260501T125000Z SUMMARY:Incidence of Ribociclib-Induced Serum Creatinine Elevation in Hormone Receptor-Positive Breast Cancer DESCRIPTION:Background: Ribociclib is a cyclin-dependent kinase 4 and 6 inhibitor approved for treatment of  \; advanced or metastatic hormone receptor (HR) positive\, human epidermal growth factor receptor 2 (HER2) negative breast cancer at a dose of 600 mg and adjuvantly for high-risk\, early-stage HR+\, HER2- breast cancer at a dose of 400 mg . While ribociclib has resulted in improved cancer-related outcomes\, the incidence of ribociclib-induced serum creatinine (SCr) elevations has been reported in 8-65% of patients in phase 3 trials although up to 73% of those cases are attributed to a phenomenon known as pseudo-acute kidney injury (AKI). The proposed mechanism is thought to be due to ribociclib’s competitive inhibition of renal tubular secretion transporters\, OCT2\, MATE1\, MATE2-K\, blocking creatinine secretion into urine without affecting actual glomerular filtration rate. Cystatin C is an alternative surrogate marker of renal function that is not affected by ribociclib’s inhibition of renal tubular transporters and thus may be utilized to distinguish pseudo-AKI from true kidney injury. This study aimed to further describe the nature and clinical significance of ribociclib-induced SCr elevation in patients with HR+\, HER2- breast cancer in a real-world setting.  \; \n\nMethods: \;This IRB approved\, single-center\, retrospective chart review included all adult patients prescribed ribociclib for HR+\, HER2- breast cancer at Emory Winship Cancer Institute between October 2022 and August 2025. Patients were excluded if ribociclib was prescribed by an external provider\, used for investigational purposes\, or if baseline SCr documentation at least 6 months prior to ribociclib initiation was missing. The primary outcome was incidence of ribociclib-induced SCr elevation\, defined as ≥ grade 1 per CTCAE v5.0. Cystatin C\, defined as >\; 0.95 mg/dL\, was utilized to assess reduced renal function. Use of concomitant nephrotoxic medications including CT contrast\, zoledronic acid\, diuretics\, NSAIDs\, metformin\, antihypertensives\, and antibiotics was assessed.  \;\n\n Results: \;168 females and 2 males were reviewed\, median age 58 years old. The majority (139 patients\, 81.7%)\, were prescribed ribociclib for metastatic disease\; 31 (18.2%) adjuvantly. Ribociclib-induced SCr elevation occurred in 49 patients (28.8%). Of those patients\, 40 (81.6%) had metastatic disease\, the initial dose was 600 mg for 36 (73.5%)\, and 47 (95.9%) were prescribed concomitant nephrotoxic medications though not statistically significant (p-value\, 0.515). Median absolute change in SCr from baseline was 0.45 mg/dL (range\, 0.34-0.54 mg/dL)\; median time to SCr elevation was 33 days (range\, 15-83 days). Most events were grade 2 (35\, 71.4%)\; 14 (28.6%) were grade 1. Of those with elevated SCr\, 5 patients (10.2%) had true kidney injury as indicated by an elevated cystatin C warranting consideration of dose interruption or reduction. Median time to SCr recovery was 155 days (range\, 27-316 days). \n\nConclusion: \;Ribociclib-induced SCr elevation often occurred within the first or second cycle and remained elevated yet stable through the first six cycles. The majority were grade 1 or 2 events and did not require dose reductions or interruptions. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:bb40737edbd202b71796a22bec437f15 URL:http://2026serc.sched.com/event/bb40737edbd202b71796a22bec437f15 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:EVALUATION OF A PHARMACY RESIDENT-LED VIRTUAL POPULATION HEALTH CLINIC DESCRIPTION:EVALUATION OF A PHARMACY RESIDENT-LED VIRTUAL POPULATION HEALTH CLINIC \;\nKatrina Bitcon\, Katie Sfirlea\, Catie Harper\, Madison Yates \;\n\nBackground/Purpose: A value-based care delivery model aims to enhance patient care by reimbursing providers based on patient outcomes and the quality of care instead of the quantity of services delivered. In 2024\, our health system established a new objective to expand value-based care throughout all areas of our system. Pharmacists in the health system's primary care clinics deliver chronic disease management services using a value-based care model\; however\, access to pharmacists working within these clinics has historically been limited to traditional business hours. To expand access to pharmacy services for patients experiencing barriers to this model\, staffing for ambulatory care interested PGY1 pharmacy residents was structured to include virtual care outside of traditional business hours. During these visits\, chronic disease states were assessed and documented\, as well as any recommendations that the resident made for therapeutic management. The purpose of this study was to characterize this pharmacy resident-led virtual population health clinic and assess its impact on patient care. \;\n\n\nMethodology: Fifty patients were included in this single health system\, retrospective\, cohort study. Patients were eligible for inclusion if they completed at least one pharmacy resident-led virtual visit between October 1\, 2024\, and May 31\, 2025.  \;The primary objective of this study was to determine the percentage of pharmacy resident recommendations approved by the primary care provider (PCP)\, which was defined as corresponding orders in the electronic medical record within 10 days of the visit. Secondary objectives included the percentage of patients achieving an A1C <\;8%\, blood pressure (BP) <\;140/90 mm Hg\, and LDL-C <\;70 mg/dL pre- and post-intervention\, as well as the types of recommendations made by the pharmacy resident. \;\n\n\nResults: A total of 204 resident visits among 50 patients were conducted with the pharmacy residents. \;Of the 77 recommendations provided by the pharmacy residents\, 97.3% were accepted by the referring PCP\, with the most common recommendations being an increase in dose or addition of medication. There was an increase in patients achieving the goal A1C by 22% (P <\; 0.01)\, blood pressure by 24.2% (P <\; 0.05)\, and LDL-C by 20.6% (P >\; 0.05). The most common disease state managed by the pharmacy residents was diabetes. After the intervention\, 32% were helped with medication access\, 16% gained access to CGM\, and 4% of patients gained access to home blood pressure monitors. \;\n\n\nConclusions: The results of this study show that the majority of pharmacy resident recommendations were approved and implemented by the PCP. Additionally\, there was a significant reduction in A1C and blood pressure after pharmacy resident intervention. Alongside improvements in disease state management\, patients were able to gain access to home monitoring devices and assisted with medication access. Based on the findings of this study\, providing after-hours virtual visits with a pharmacy resident is an effective method for reaching patients who face barriers to traditional healthcare hours. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:300b570f7d32a1eabdb2c93b28b31f08 URL:http://2026serc.sched.com/event/300b570f7d32a1eabdb2c93b28b31f08 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Remote Continuous Glucose Monitoring Service Pilot in an Ambulatory Care Setting DESCRIPTION:Background: Traditional markers of glycemic control – such as quarterly A1C measurements and patient-reported self-monitored blood glucose – offer only brief\, intermittent views of glucose trends. These limited snapshots can delay necessary therapy adjustment and often contribute to inadequate glycemic control. Continuous glucose monitoring (CGM)\, by contrast\, provides real-time\, detailed glucose information that supports more timely clinical decisions and a more proactive approach to diabetes management. Current guidelines now recommend CGM not only for individuals using insulin but also for those on any form of glucose-lowering therapy. Despite the expansion\, pharmacist-led remote monitoring of CGM data remains limited. At the Piedmont Columbus Family Medicine Center\, patients referred for diabetes management share CGM data with clinical pharmacists for ongoing remote assessment and intervention. Pharmacists conduct weekly remote monitoring outside of standard clinic appointments\, including scheduled phone visit with patients to meet study criteria. This study will assess changes in A1C\,hypoglycemia events utilizing time below range (TBR) <\;70 mg/dL from CGM initiation through study completion\, and will characterize the pharmacist-driven interventions employed to optimize glycemic control. \;\n\nMethods: This single-center\, retrospective\, and IRB-approved study included adult patients with Type 1 or Type 2 diabetes\, a baseline A1c >\;7%\, and active use of a continuous glucose monitor capable of remote data sharing. Patients with available CGM data between July 1\, 2025\, and December 31\, 2025\, were included. Baseline demographics\, A1C\, and CGM summary metrics were extracted from the electronic medical record. Primary outcomes were changes in A1C and time below range (TBR) from baseline to study completion. Pharmacist interventions were recorded and categorized. Only CGM reports with adequate sensor wear time were included. Pre-post comparisons will be analyzed using paired statistical methods.\n\nResults: \;A total of 19 patients were included in this study. Mean baseline A1c was 9.4%\, which was decreased to 8% following pharmacy intervention\, reflecting a mean reduction of 1.4% (p=0001). Nearly all participants (94.7%) experienced an A1c reduction\, and 21.1% achieved glycemic control with A1c <\;7%. Hypoglycemia events (TBR <\;70 mg/dL) occurred in 42% of patients at baseline and 37% at follow-up. Pharmacists delivered a total of 473 interventions with the most being diabetes education (n=211).\n\nConclusions: \;Implementation of a pharmacist-CGM collaboration was associated with clinically meaningful improvements in glycemic control among adults with uncontrolled diabetes. These findings suggest that pharmacy-CGM collaboration can enhance diabetes management in ambulatory care settings. Future work should explore barriers to completing phone visits and evaluate scalability in larger populations.\n\nContact: neta.burford@piedmont.org\n\n\n\n\n\n\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:c7440ee5e1376a0da23621fd3040a84c URL:http://2026serc.sched.com/event/c7440ee5e1376a0da23621fd3040a84c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Efficacy of Intravenous Lidocaine Infusion vs. Liposomal Bupivacaine for Analgesia following MIDCAB DESCRIPTION:\nGraham Anglin\, Adam L. Wiss \;\nAscension Saint Thomas Hospital West - Nashville\, TN \;\n\nIntroduction: Multimodal analgesia has become a cornerstone of perioperative pain management\, reducing opioid exposure and associated adverse effects. At Ascension Saint Thomas Hospital West (ASTHW)\, continuous intravenous lidocaine infusions have been utilized to improve postoperative pain control in minimally invasive direct coronary artery bypass (MIDCAB) procedures. However\, safety concerns and intensive care unit (ICU) monitoring requirements limit their broader use. In June 2022\, liposomal bupivacaine\, a long-acting local anesthetic\, was added to the formulary as an alternative strategy for prolonged analgesia. While studies have shown mixed outcomes depending on surgical type and administration technique\, data specific to cardiothoracic surgery remain limited. The objective of this study was to compare intravenous lidocaine and liposomal bupivacaine for postoperative pain management in patients undergoing MIDCAB. \;\n\nMethods: This single-center retrospective chart review included adults who underwent MIDCAB at ASTHW between June 2022 and July 2025. Patients received either a single dose of liposomal bupivacaine or a continuous intravenous lidocaine infusion for postoperative analgesia. Exclusion criteria included substance use disorder\, concurrent buprenorphine\, methadone\, or naltrexone therapy\; pregnancy\, incarceration\, surgical re-exploration for bleeding within 24 hours of MIDCAB\, or use of mechanical circulatory support. The primary outcome was postoperative opioid use\, reported as morphine milligram equivalents (MME) within 72 hours. Secondary outcomes included postoperative pain scores\, ICU and total hospital length of stay (LOS)\, and incidence of adverse effects such as hypotension\, bradycardia\, arrhythmia\, and nausea. \;\n\nResults: One-hundred fifty patients were included in the study (intravenous lidocaine = 75\; liposomal bupivacaine = 75). Baseline characteristics were comparable\, with both groups consisting predominantly of Caucasian males (median age 66 years). All patients received multimodal analgesia\; however\, the intravenous lidocaine group had higher use of methocarbamol (17% vs 3%\, p = 0.007) and erector spinae plane blocks (77% vs 1%\, p <\; 0.001).  \;There was no statistically significant difference in postoperative MME usage between the intravenous lidocaine group and liposomal bupivacaine group on postoperative day 0/1 (61 vs. 72\; p = 0.659)\, postoperative day 2 (23 vs. 23\; p = 0.467) or postoperative day 3 (8 vs. 8 \; p = 0.92). The groups were also similar in postoperative pain scores\, hospital and ICU LOS\, and incidence of adverse effects.\n\nConclusion: In this study evaluating postoperative analgesia following MIDCAB surgery\, patients who received continuous infusion of intravenous lidocaine had comparable postoperative opioid consumption to those who received a single administration of liposomal bupivacaine with no difference in adverse events between groups. While either of these analgesia strategies may be effective in patients undergoing MIDCAB\, further investigation is warranted to determine the role other treatments (i.e.\, local anesthetic blocks and muscle relaxers) may have had on outcomes in our population.\n\n\n\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:0c5565092dcc4497ee7b651c935b46c7 URL:http://2026serc.sched.com/event/0c5565092dcc4497ee7b651c935b46c7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Evaluating Different Bromocriptine Doses for Central Fever in the Intensive Care Unit DESCRIPTION:Evaluating Different Bromocriptine Doses for Central Fever in the Intensive Care Unit \;\nMaggie Nobles\, Zackery Moreo\, Sam Pournezhad\, Chelsea Wamsley \;\nmlnobles@gmh.edu  \;\nGrady Health System Department of Pharmacy \;\nBackground: \;Central fever is a diagnosis of exclusion characterized by persistent\, noninfectious hyperthermia that is unresponsive to antipyretics and antimicrobial therapy. It is commonly observed in patients with acute neurologic injury and is thought to result from disruption of hypothalamic thermoregulatory pathways. Central fever has been associated with increased metabolic demand\, prolonged ICU length of stay\, and worse neurologic outcomes. Bromocriptine\, a dopamine-2 receptor agonist\, has been used off-label for central fever due to its ability to reduce hypothalamic set point and sympathetic activity. While prior studies support its antipyretic efficacy\, there is limited evidence guiding optimal dosing strategies. This study aimed to evaluate the effectiveness of different bromocriptine doses for central fever in critically ill patients with neurologic injury to inform dosing decisions and institutional practice.  \;\nMethods: This single-center\, retrospective chart review was conducted at an academic safety-net hospital and included adult patients (≥18 years) admitted to the neurocritical care unit or surgical-trauma ICU between January 2023 and June 2025. Eligible patients received at least one dose of bromocriptine 2.5 mg\, 5 mg\, or 10 mg for suspected central fever. Patients were excluded if they had evidence of active infection\, prior bromocriptine use before admission\, death within 48 hours of bromocriptine initiation\, or belonged to a protected population. Baseline demographic and clinical characteristics\, neurologic diagnoses\, and use of potential confounding therapies were collected. The primary outcome was fever resolution\, defined as a temperature of ≤ 38.3°C within 2 hours of the initial bromocriptine dose\, compared across initial dose groups. Secondary outcomes included sustained fever resolution at 8\, 24\, and 48 hours\, assessed according to total daily bromocriptine dose. \;\nResults: A total of 274 patients were screened\; 47 met inclusion criteria for the primary outcome analysis. Baseline characteristics were largely similar across groups\, though differences in neurologic diagnosis and ICU admission location were observed. Fever resolution within 2 hours occurred in 78.6% of patients receiving an initial dose of 2.5 mg\, compared with 37.5% in the 5 mg group and 47.1% in the 10 mg group. Fever resolution within 2 hours was significantly more frequent with 2.5 mg compared with 5 mg (p=0.024)\, while no statistically significant differences were observed between the 2.5 mg and 10 mg groups (p=0.073) or between the 5 mg and 10 mg groups (p=0.579). Secondary outcomes were similar across total daily dose groups\, with no significant differences observed in sustained fever resolution at 8\, 24\, or 48 hours. Duration of therapy tended to increase with higher daily doses\, though this did not reach statistical significance. No differences were observed in ICU length of stay or in-hospital mortality. \;\nConclusion: More patients achieved fever resolution within 2 hours with the 2.5 mg dose\, while no differences were observed between dose groups in sustained fever control. These findings suggest that bromocriptine’s antipyretic effect may not be dose dependent\, and that lower initial dosing strategies may be reasonable for the management of central fever. Prospective studies are needed to further define optimal dosing strategies and evaluate safety outcomes. \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:1ac394fd2338bea05f9483789b29f735 URL:http://2026serc.sched.com/event/1ac394fd2338bea05f9483789b29f735 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Evaluation of Antibiotic De-escalation from Intravenous to Oral Antimicrobial Therapy in Critically Ill Patients with Gram-Negative Bacteremia DESCRIPTION:Background \;\nGram-negative bloodstream infections (GN-BSI) are associated with significant morbidity and mortality and traditionally managed with intravenous (IV) antibiotics. However\, emerging evidence supports the use of oral (PO) antibiotics as step-down therapy in uncomplicated GN-BSI.1-7 Oral agents such as fluoroquinolones\, sulfamethoxazole-trimethoprim\, and β-lactams have demonstrated efficacy in this setting.1-2 Transitioning to a PO agent offers several benefits such as reduced cost\, easier administration\, and less risk of IV-associated complications\, which include venous thrombosis\, extravasation\, and phlebitis.8-9 Despite these potential benefits\, data on this practice in critically ill patients remain limited. This study aims to evaluate the safety and efficacy of IV therapy alone versus IV to PO step-down therapy in the treatment of critically ill patients with a GN-BSI. \;\n \;\nMethods \;\nThis is a multicenter retrospective cohort analysis that evaluated adult patients with an uncomplicated GN-BSI who were initiated on appropriate empiric IV antibiotic treatment within 24 hours of their initial blood culture collection. The study included patients who were admitted to an intensive care unit (ICU) within Emory Healthcare (EHC) between May 1\, 2023 and May 1\, 2025. Patients were excluded if the duration of PO therapy was less than 48 hours\, there was polymicrobial growth or presence of an organism other than Enterobacterales or Pseudomonas spp.\, hospice or comfort care was initiated within 72 hours of initial blood culture\, or the organism(s) isolated was not susceptible to an available PO agent. The primary outcome was treatment failure\, defined as a composite of 90-day mortality or recurrence of the same causative GN-BSI within 30 days of treatment completion. Secondary efficacy outcomes include ICU and inpatient length of stay\, recurrence of GN-BSI within 90 days of treatment completion\, emergence of resistance to study antibiotics\, antibiotic duration\, and IV to PO transition time. Secondary safety outcomes include adverse drug events leading to discontinuation or change in antibiotic therapy. Baseline demographics and outcomes were summarized with descriptive statistics while continuous data was summarized with means and standard deviations. \;\n \;\nResults \;\nPatients were separated into two cohorts based on antibiotic regimen: IV only (n=108) versus IV to PO (n=33). Baseline characteristics differed between groups\, with patients in the IV only group demonstrating higher illness severity\, depicted by higher median APACHE II (18 vs 14) and Pitt bacteremia scores (3 vs 2). The most common pathogens were Escherichia coli\, Klebsiella pneumoniae\, Serratia marcescens\, Enterobacter cloacae\, and Pseudomonas aeruginosa. Pulmonary sources were more prevalent in the IV only group\, while genitourinary sources were more common in the IV to PO group. Treatment failure occurred more frequently in the IV only group compared to the IV to PO group (41.7% vs 15.1%). Recurrence of the same causative bacteria within 90 days was similar between groups (4.6% vs 6.1%)\, as was the emergence of resistance to study antibiotics (7.4% vs 9.1%). ICU and hospital length of stay were longer in the IV only group (13 vs 4 days and 21 vs 11 days). However\, total antibiotic duration was longer in the IV to PO group (13 vs 9 days). Adverse drug events were uncommon in both groups. \;\n \;\nConclusions \;\nWhile IV to PO step-down therapy was associated with lower rates of treatment failure\, further research is needed to optimize treatment by determining appropriate drug selection and timing of transition. For critically ill patients with uncomplicated GN-BSI and adequate source control\, this approach appears to be appropriate and may reduce length of stay without compromising effectiveness. These findings align with existing literature supporting PO step-down therapy as a method with comparable efficacy to continued IV therapy. \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:9d950b123dc43c49a0be69e5c7f903bc URL:http://2026serc.sched.com/event/9d950b123dc43c49a0be69e5c7f903bc END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Evaluation of Antiepileptic Therapy and Outcomes in Status Epilepticus Patients Presenting to the Emergency Department - Michelle Tubolino DESCRIPTION:Evaluation of Antiepileptic Therapy and Outcomes in Status Epilepticus Patients Presenting to the Emergency Department\nMichelle Tubolino\, Megan Heath\nDCH Regional Medical Center-Tuscaloosa\, Alabama\nBackground/Purpose: Assess guideline-based selection and dosing of the initial antiepileptic drug (AED) administered in the emergency department (ED) in patients presenting with status epilepticus (SE) at a large community hospital.  \;\n\nMethodology: Retrospective chart review where patients were screened from July 15\, 2023 to July 14\, 2025. Eligible patients were those who received greater than or equal to one AED in the emergency department and had a status epilepticus diagnosis documented by a provider during that encounter. AED selection and dose were assessed for appropriateness in accordance with the American Epilepsy Society (AES) 2016 guidelines.\n\nResults: 63 patients were included in this study. Thirty-six patients had a documented history of seizure disorder and thirty were on antiepileptic medications at home. Thirty-nine patients received a benzodiazepine prior to ED arrival\, with midazolam being the most frequently used. Average time to first AED administration from seizure onset was nine minutes. 18 (28.6%) patients received an appropriate agent and weight-based dose in the ED. Out of the 13 patients who receive guideline adherent weight-based dosing of a second-line agent\, 12 had pharmacists involved in their care.\n\nConclusions: Majority of patients received lower than recommended weight-based doses of benzodiazepines and second-line AEDs in the ED. Most patients who received the appropriate initial agent and dose for status epilepticus had pharmacist involvement in their care\, suggesting the impact of pharmacist intervention on treatment optimization.\n\nPresentation Objective: the application of the American Epilepsy Society (AES) treatment guidelines for pharmacologic management of status epilepticus in the emergency department. Self-Assessment: What is one of the most common reasons for benzodiazepine underdosing in status epilepticus?\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:11e2f53ee77b6350cc152c482f08e515 URL:http://2026serc.sched.com/event/11e2f53ee77b6350cc152c482f08e515 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Evaluation of Periprocedural Anticoagulant Management in Patients Undergoing Cardiac Catheterization at a Large Community Hospital DESCRIPTION:Authors: Madison Farkas and Gregg Knowles\n\nBackground: Periprocedural management of chronic anticoagulation is an important consideration for patients undergoing invasive cardiovascular procedures such as cardiac catheterization. Anticoagulant therapy is often temporarily held to reduce procedural bleeding risk\; however\, delayed or missed resumption after the procedure may increase the risk of thromboembolic complications. Current evidence\, including the 2022 CHEST Guideline and Expert Panel Report: Perioperative Management of Antithrombotic Therapy and findings from the PAUSE trial\, supports standardized\, time-based strategies for interruption and resumption of anticoagulants to balance bleeding and thrombotic risks. Despite these recommendations\, variability in real-world practice and inconsistent documentation of post-procedure anticoagulant management may result in unnecessary therapy interruptions and increased patient safety risks. The purpose of this research is to determine the frequency of delayed resumption of anticoagulation in post cardiac catheterization patients and evaluate the impact of a pharmacy-driven intervention on addressing gaps in care\n\nMethods: This single-center\, pre-post implementation study evaluated periprocedural anticoagulation management in patients undergoing cardiac catheterization at a large community hospital. An electronic daily report was developed to identify patients who may require resumption of chronic anticoagulation following cardiac catheterization. The report populates based on the following criteria: (1) presence of post–cardiac catheterization orders\, (2) documentation of an anticoagulant on the patient’s home medication list\, and (3) absence of an active inpatient anticoagulant medication order. The report is reviewed daily by the investigator to identify patients whose chronic anticoagulation may have been held for the procedure but not yet resumed. For patients meeting these criteria\, the medical record is reviewed to assess procedural details\, bleeding risk\, and clinical appropriateness for anticoagulation resumption. If anticoagulation appears appropriate and has not been restarted within 48 hours of the cardiac catheterization\, the investigator communicates with the responsible clinical team to recommend therapy resumption when clinically indicated. The primary endpoint of this study is Proportion of patients without appropriate resumption of anticoagulation post cardiac catheterization. The secondary endpoint is the Proportion of patients with anticoagulation resumed following pharmacist intervention.\n\nResults: Delayed resumption of home anticoagulation within 48 hours of cardiac catheterization occurred in 38% (25/66) of patients in the pre-implementation group and 45% (22/49) of patients in the post-implementation group. Among patients in whom anticoagulation was not resumed\, inappropriate holds were identified in 9% (6/66) pre-implementation and 12% (6/49) post-implementation. In the post-implementation group\, pharmacy intervened in 5 of 6 cases of inappropriately held anticoagulation (1 patient was lost to follow-up). Of these\, 4 interventions were accepted\, resulting in resumption of therapy. Common reasons for inappropriate holds included omission from the home medication list and delayed recognition prior to pharmacist intervention. Overall\, pharmacy intervened to request anticoagulation resumption in 10% (5/49) of patients. The mean number of patients identified on the daily anticoagulation surveillance report was 0.84 (SD 0.87).\n\nConclusion: Delayed anticoagulation resumption occurred more frequently than originally reported which emphasized the need for process improvement. Pharmacy involvement via the daily surveillance report played a key role in ensuring appropriate and timely resumption when clinically indicated. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:b1757f33b8cd68d6a609f2324153e327 URL:http://2026serc.sched.com/event/b1757f33b8cd68d6a609f2324153e327 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Impact of Oral Naloxone on Analgesia in Critically Ill Patients with Opioid-Induced Constipation DESCRIPTION:Background: \;Opioid-induced constipation (OIC) is a frequent and challenging side effect of pain management in critically ill patients. While it is standard of care to initiate conventional laxatives concurrently with opioid therapy\, they do not directly address the underlying mechanism of OIC. Oral naloxone offers a targeted approach by acting as a mu-opioid receptor antagonist. Due to its low oral absorption\, it is thought to primarily exert peripheral effects\, helping relieve constipation with minimal impact on central analgesia. Despite its theoretical safety profile\, evidence regarding its effects on pain control is not well defined in the available literature. This study aimed to evaluate the effect of oral naloxone on pain scores and opioid requirements in a large\, real-world cohort of critically ill patients.\n\nMethods: \;This multicenter\, retrospective pre–post cohort study was conducted across eight community teaching hospitals within AdventHealth Central Florida Division South. Adult patients admitted to an intensive care unit (ICU) who received at least one dose of oral naloxone for OIC and received opioid treatment for at least 24 hours prior to the first dose of oral naloxone were eligible. Patients with chronic opioid use\, concurrent peripherally acting mu-opioid receptor antagonists\, or chronic naloxone use were excluded. The primary outcome was within-patient change in pain scores 24 hours before and after naloxone initiation\, stratified by assessment tool. Secondary outcomes included changes in scheduled and rescue opioid use (morphine milligram equivalents [MME]) and bowel movement occurrence. Continuous outcomes were analyzed using the Wilcoxon signed-rank test and categorical outcomes using the exact McNemar test.\n\nResults: \;Among 105 patients\, fentanyl was the predominant opioid (81%). Pain was most commonly assessed using the Critical Care Pain Observation Tool (CPOT) (77%)\, followed by the Numeric Rating Scale (NRS) (20%)\, and Visual Analogue Scale (VAS) (3%). No significant change in pain scores was observed in the CPOT group (median 0.10 vs 0\; p = 0.073). NRS scores showed a small but statistically significant decrease (median 2.9 vs 2.5\; p = 0.031)\, while VAS scores did not change significantly (median 2.6 vs 1.8\; p = 0.593). Scheduled opioid use decreased significantly (median 555 vs 357.5 MME\; p = 0.004)\, with no change in rescue opioid use (median 5 vs 0 MME\; p = 0.831). Bowel movement occurrence increased from 13% to 44% (p <\;0.001).\n\nConclusion: \;In critically ill patients predominantly receiving fentanyl infusions\, oral naloxone was not associated with increased pain scores and was associated with increased bowel movement occurrence. These findings suggest that oral naloxone may be a safe adjunct for the management of OIC in ICU patients without compromising analgesia. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:85ab0a608aeb97c715a03bfdd7840656 URL:http://2026serc.sched.com/event/85ab0a608aeb97c715a03bfdd7840656 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Incidence of Mechanical Ventilation in the Emergency Department among Patients with Acute Pulmonary Edema Utilizing High versus Low Dose Intravenous Nitroglycerin DESCRIPTION:TITLE: Incidence of Mechanical Ventilation in the Emergency Department among Patients with Acute Pulmonary Edema Utilizing High versus Low Dose Intravenous Nitroglycerin\n\nAUTHORS: \;Saralyn Hardin\, Kira Council\, Erica Merritt\, Megan Cavagnini\n\nBACKGROUND: \;Heart failure affects approximately 2% of adults in the United States\, with an estimated 33% at risk of developing the condition. It is classified into progressive stages\, with Stage C characterized by symptomatic disease and Stage D representing advanced heart failure. Patients with Stage D heart failure frequently experience debilitating symptoms that significantly impact daily life and often result in recurrent hospitalizations. According to the American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines\, nitroglycerin may be considered for the management of pulmonary edema in acute heart failure presentations\, provided hypotension is not present. Nitroglycerin is a targeted vasodilator that primarily reduces preload\; at higher doses\, it also induces arterial vasodilation\, thereby decreasing afterload. While typically initiated at low infusion rates\, higher rates (≥100 mcg/min) have demonstrated improved clinical outcomes in the treatment of pulmonary edema.\n\nMETHODS: \;This retrospective\, observational chart review evaluated the incidence of mechanical ventilation in patients in the emergency department at St. Joseph’s or Candler Hospitals diagnosed with acute pulmonary edema based on the nitroglycerin dose in the first hour of treatment.  \;The health system’s software and a computer-generated list using MedMined services was used to identify patients with acute pulmonary edema then filtered based on the inclusion and exclusion criteria between January l\, 2023\, and January 1\, 2024.\nPatients were identified\, and data was gathered to include demographic information\, nitroglycerin infusion rate within the first hour\, blood pressure\, baseline serum creatinine and admission location. The primary objective was to determine the rate of mechanical ventilation in patients who received high dose nitroglycerin in comparison to those who received low dose nitroglycerin. The secondary endpoints of the study were the average nitroglycerin dose within the first hour of initiation\, admitted level of care\, percent of patients that develop acute kidney injury or hypotension after infusion initiation\, average length of time in minutes the infusion was active\, and all-cause mortality.\n\nRESULTS: \;Three patients were screened for eligibility with 36 meeting inclusion criteria. Ten (27%) received high dose nitroglycerin (rate ≥100mcg/min) and 26 (72%) received low dose nitroglycerin (rate <\;100mcg/min). The mean number of patients requiring mechanical intubation was found to be 0.2 in the high dose nitroglycerin compared to 0.04 in the low dose group. Of the thirty-six patients three required mechanical ventilation and one of the three had a prior medical history revealing asthma and chronic obstructive pulmonary disease. Overall\, there was found to be no statically significant correlations between the nitroglycerin dosing group and adverse events including admittance into the intensive care unit\, incidence of hypotension\, incidence of acute kidney injury\, and all-cause mortality.\n\nCONCLUSION: \;The overall \;nitroglycerin dosage administered to patients during the first hour following a pulmonary edema diagnosis was not comparable to the incidence of mechanical intubation in prior studies. Considering the study’s limitations of small sample size\, further research with larger\, multicenter data should explore potential relationship between nitroglycerin dosing within the first hour of diagnosis to adverse events. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:e84893ba74eb970533ce6e2dd2024a74 URL:http://2026serc.sched.com/event/e84893ba74eb970533ce6e2dd2024a74 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Impact of a Pharmacist-Led COPD Transitions of Care Program on 30-Day Readmission Rates DESCRIPTION:Title: \;Impact of a Pharmacist-Led COPD Transitions of Care Program on 30-Day Readmission Rates\n\nAuthors: Allison Edmondson\, Quyen Nguyen\, Jeremy Walley\n\nBackground: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in the United States. The total annual medical costs for COPD near 24 billion dollars\, with the cost of inpatient care accounting for 6.3 billion of those dollars. Additionally\, COPD is a target condition under the Centers for Medicare and Medicaid Services under the Hospital Readmissions Reduction Program. COPD readmissions pose a significant economic burden to the healthcare system and may result from gaps in care during transitions from the hospital back to home. Transitions of care interventions by pharmacists can assist in bridging gaps in care for these patients.\n\nMethods: \;This study will implement a pharmacist-led transitions of care program for patients admitted to the hospital with a COPD exacerbation. Pharmacists will assist in optimizing COPD regimens\, medication and inhaler technique counseling\, medication access\, education on symptom self-management\, and post-discharge follow-up phone calls. The primary objective is to evaluate the impact of the transitions of care service on 30-day readmission rates for COPD exacerbation within the facility. Secondary objectives will include pharmacist interventions performed.\n\nResults: \;A total of 102 patients were included in the study. Readmission rates among COPD patients prior to the transition of care service in December 2024 to March 2025 were 27%\, compared with 17% following the implementation of the service between December 2025 to March 2026. The primary pharmacist interventions performed included recommendations to change inhaler therapy\, phone call follow up\, and patient education. Among patient home medications\, there was a 20.7% increase of patients on guideline-directed COPD therapy from admission to discharge.\n\nConclusions: \;The implementation of a pharmacist-led COPD transitions of care service appeared to decrease 30-day readmission rates. Pharmacists can play a role in helping to optimize therapy\, medication access\, patient education\, and enhancing follow-up care. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:4562ed588474d5068a4eb28efb2ebdc9 URL:http://2026serc.sched.com/event/4562ed588474d5068a4eb28efb2ebdc9 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Impact of a Practice Advisory Alert on the Duration of Antibiotics Prescribed at Discharge DESCRIPTION:Authors: Savannah Odom\, Lauren Freeman\, Hannah Harpe\nObjective: This study evaluates the effectiveness of a practice advisory alert in improving antibiotic prescribing at hospital discharge. \nBackground: \;Antimicrobial resistance is a major and growing global public health threat\, driven largely by antimicrobial misuse and overuse. Inappropriate antibiotic prescribing at hospital discharge is a key contributor\, with studies demonstrating that durations frequently exceed guideline recommendations. Prior research has shown that antibiotic overuse occurs in up to 75% of patients\, primarily due to excessive treatment duration and failure to account for inpatient therapy. This highlights a critical opportunity for antimicrobial stewardship interventions targeting transitions of care to optimize antibiotic use and improve patient outcomes. \;Building on a prior institutional initiative in which a fluoroquinolone-specific alert significantly reduced treatment duration\, this study assesses whether expanding the alert to additional antibiotic agents results in similar improvements in prescribing practices. The alert prompts providers to account for inpatient antibiotic days when determining discharge durations\, supporting appropriate therapy length and antimicrobial stewardship efforts. \nSelf Assessment Question: \;What was the main finding after implementation of the practice advisory? \nMethods: This retrospective\, multi-center\, quasi-experimental study evaluates adults discharged on oral antibiotics before (January 2025-February 2025) and after (January 2026-February 2026) implementation of a practice advisory. A random sample from the pre-intervention group is matched 1:1 to the post-intervention group by antibiotic and indication. Patients receiving antibiotics for prophylaxis or suppression\, those immunocompromised\, or those with severe or complicated infections were excluded. \;Data collected include demographics\, antibiotic regimen and indication\, infectious diseases consultation\, and prescriber credentials. The primary outcome is the proportion of patients discharged with antibiotic durations consistent with guidelines or infectious diseases recommendations\, adjusted for inpatient days of therapy. Secondary outcomes include 30-day treatment for Clostridioides difficile and 30-day all-cause readmission. \;\nResults: A total of 300 patients were included\, with 150 patients in both the pre- and post-intervention groups. Baseline characteristics\, including age\, sex\, infection type\, and antibiotic selection\, were well balanced between groups. Implementation of the practice advisory alert was associated with a significant improvement in guideline-concordant antibiotic prescribing at discharge\, increasing from 53.3% in the pre-intervention group to 81.3% in the post-intervention group (p <\; 0.001). Thirty-day all-cause readmission rates were 13.3% in the pre-intervention group versus 12% in the post-intervention group (p = 0.73). Additionally\, no patients in either group required treatment for Clostridioides difficile infection within 30 days of discharge. \nConclusion: Implementation of an electronic practice advisory alert that incorporates inpatient antibiotic days resulted in a clinically meaningful and statistically significant improvement in appropriate antibiotic duration at discharge. Expansion of this alert beyond fluoroquinolones to a broader range of antimicrobial agents successfully optimized prescribing practices. Importantly\, these improvements were achieved without negatively impacting patient safety outcomes\, as evidenced by unchanged readmission rates and absence of Clostridioides \;difficile infection \;events. Overall\, this study demonstrates that targeted electronic clinical decision support tools are an effective and scalable antimicrobial stewardship strategy CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:5d1f880bef3a233649b1569bc7e0bbab URL:http://2026serc.sched.com/event/5d1f880bef3a233649b1569bc7e0bbab END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T125000Z DTEND:20260501T131000Z SUMMARY:Resident Presentation Abstract - Jessica Arnold DESCRIPTION:The purpose of this study was to evaluate the effect of a pharmacist-led transitions of care (TOC) consult service\, specifically designed to address medication access barriers\, on patients undergoing inpatient percutaneous coronary interventions. The study sought to assess the program’s impact on medication adherence and hospital readmission rates at 30- and 90-days post-discharge\, while also contextualizing these outcomes within the existing body of literature. This retrospective study evaluated the impact of pharmacist-led interventions during TOC consults on medication adherence and hospital readmission. The study period extended from April 1\, 2023\, through April 1\, 2025\, providing a two-year window to ensure adequate patient capture. Data were extracted from the electronic health record and entered into REDCap\, with all protected health information excluded to maintain confidentiality and compliance with institutional review standards. The primary outcome was the first-fill rate of antiplatelet medications among patients admitted under the post–coronary artery stent pathway who underwent percutaneous coronary intervention during their inpatient stay at this academic medical center\, assessing whether pharmacist engagement improved timely medication initiation in a population at elevated cardiovascular risk. Secondary outcomes included 30-day and 90-day readmission rates\, documentation of pharmacist clinical interventions across inpatient and outpatient settings\, and the type of medication access support provided to patients who filled their antiplatelet prescriptions at the hospital’s affiliated outpatient pharmacy at discharge\, providing additional insight into the broader impact of pharmacist involvement during care transitions. The primary endpoint was analyzed using a chi-square test\, and descriptive and inferential statistics were applied to secondary outcomes as appropriate. Collectively\, this study aimed to characterize the role of pharmacists in optimizing medication use\, reducing readmissions\, and improving outcomes for patients undergoing percutaneous coronary intervention. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:1d99c394484788b1c5ae7c4a8052c024 URL:http://2026serc.sched.com/event/1d99c394484788b1c5ae7c4a8052c024 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Evaluating the Impact of Clinical Pharmacist Interventions on the New Anticholinergic Measure in a Private Primary Care Setting DESCRIPTION:Title: Evaluating the Impact of Clinical Pharmacist Interventions on the New Anticholinergic Measure in a Private Primary Care SettingAuthors: Sarah Emily Strickland\, Leah A. Surbaugh\, Whitney AultmanBackground: Ambulatory care clinical pharmacists have historically been involved in interventions to improve quality metrics set forth by the Centers for Medicare and Medicaid Services Star Ratings. The Centers for Medicare and Medicaid Services recently established a new star rating which includes patient’s 65 years or older\, prescribed and filling 2 or more anticholinergic medications concurrently for 30 days or more on a Medicare Part D plan. The purpose of this study is to evaluate the impact on metric improvement following clinical pharmacists' interventions on the Polypharmacy: Use of Anticholinergic Medications (POLY-ACH) quality metric.Methods: Patients evaluated for inclusion in the study were identified from data provided by BlueCross BlueShield and Humana Medicare Advantage Plans. Selection of these Medicare Advantage plans was based on those currently monitoring or tracking the anticholinergic metric as well as insurance plans holding a gain share contract with the private care practice site. Patients were included if they were 65 years or older\, followed by a primary care provider within State of Franklin Healthcare Associates\, which is a physician-led and employee-owned private medical group with over 30 practices across Northeast Tennessee and Southwest Virginia with the majority being internal medicine or family medicine practices. Patients must be prescribed 1 or more anticholinergic medication and there must have been communication of medication recommendations made to the provider from the clinical pharmacist related to the anticholinergic medication prescribed. All patients included needed an appointment scheduled on or before December 31\, 2025. Data collection points included patient demographics\, baseline and follow up anticholinergic burden score\, anticholinergic medication use and duration\, prescribing physician\, and intervention response. The primary outcome was a composite endpoint of the impact of interventions made by the clinical pharmacist. This included medication changed based on pharmacist recommendations\, patient declined alternative therapy despite provider encouragement\, or the provider contacted an outside prescriber with alternative recommendation provided by clinical pharmacist. Data analysis included a one-sample proportion test for the primary outcome and descriptive statistics for the secondary outcomes\, along with a paired t-test for anticholinergic burden score comparison.Results: A total of 459 patients were screened for inclusion\, and 99 patients were included in final analysis. The average patient was 76 years of age\, and a majority of patients were female. The average number of baseline anticholinergic agents for each patient was 1.1. The result for the primary outcome was 73.7%. Most patients had been prescribed the anticholinergic agent for more than a year. The most common anticholinergic class prescribed was antihistamine followed by antidepressant and skeletal muscle relaxant. The average baseline anticholinergic burden score for patients enrolled was 4.6\, with the follow up anticholinergic burden score showing a decrease to 3.1.Conclusions: The results of this study highlight that clinical pharmacist interventions on anticholinergic medications led to an improvement in the Polypharmacy: Use of Anticholinergic Medications (POLY-ACH) quality metric and potentially increased reimbursement rates from Medicare Advantage Plans. The impact from the clinical pharmacist intervention also led to a reduction in patient’s anticholinergic burden score\, showing a positive impact on patient outcomes. Future directions include developing educational materials based on prescribing trends identified to influence future prescribing practices. \n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:d35436a5f96bd4ef1e7d575f3d53004b URL:http://2026serc.sched.com/event/d35436a5f96bd4ef1e7d575f3d53004b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Impact of the Implementation of Vitamin D Screening and Supplementation on COPD Exacerbations DESCRIPTION:Background: Vitamin D deficiency is common among patients with chronic obstructive pulmonary disorder (COPD) and has been associated with increased frequency of exacerbations and higher mortality. Recent Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend assessing the vitamin D status of all patients hospitalized for COPD exacerbations\, specifically to identify those with severe vitamin D deficiency\, defined as <\;10 ng/mL\, as this population has been shown to benefit the most from receiving supplementation. As of January 1\, 2024\, Piedmont Columbus Midtown Medical Clinic (MMC) orders vitamin D levels for COPD patients\, if not previously obtained while inpatient\, and prescribes supplementation for patients with below normal vitamin D levels\, defined as <\;30 ng/mL. This study assesses the impact of this intervention on COPD exacerbation rates and time to repeat exacerbation.\n\nMethods: A single-center\, retrospective\, observational\, pre-post chart review compared clinical outcomes of COPD patients who completed a post-discharge visit at Piedmont Columbus MMC during January 1 to December 31\, 2023\, (pre-implementation) and January 1 to December 31\, 2024\, (post-implementation) following a COPD-related hospitalization at either Piedmont Columbus Regional (PCR) Midtown or PCR Northside. Patients were excluded if they received vitamin D supplementation prior to hospitalization or had a past medical history of lung cancer or parathyroid disorder. The primary objective was mean number of COPD exacerbations per person year. The secondary objective was time to repeat COPD exacerbation. Post-implementation results for each objective were stratified by baseline vitamin D levels into three pre-defined categories: sufficiency (≥30 ng/mL)\, deficiency (10-29 ng/mL)\, and severe deficiency (<\;10 ng/mL). A student t-test was used to evaluate the primary outcome\, while the secondary outcome and stratification of post-implementation results were evaluated using descriptive statistics.\n\nResults: A total of 30 patients were included in the study\, with 17 being in the pre-implementation cohort and 13 being in the post-implementation cohort. Age was similar between groups\, but a large difference was seen with sex and race. The post-implementation cohort had an average baseline vitamin D level of 18.7 ng/mL\, which correlated with deficiency. The post-implementation cohort had fewer COPD exacerbations per person year on average (1.46 vs 1.71\, p=0.76) but had a shorter time to repeat exacerbation compared to the pre-implementation cohort (98.6 days vs 142 days). Within the post-implementation cohort\, patients with deficient baseline vitamin D levels experienced fewer exacerbations per person year and had a longer time to repeat exacerbation compared to those with sufficient or severely deficient baseline vitamin D levels.\n\nConclusion: Routine screening and supplementation of vitamin D in COPD patients may be associated with fewer exacerbations\, though no statistically significant difference was observed in this small sample. Trends toward reduced exacerbation frequency following implementation suggest potential benefit\, particularly among patients with baseline vitamin D deficiency. Larger studies are warranted to further evaluate the clinical impact of vitamin D optimization in this population.\n\nContact: Shelby.Barron@piedmont.org CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:0fc0d3d033ab31856b5032a49fda5865 URL:http://2026serc.sched.com/event/0fc0d3d033ab31856b5032a49fda5865 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Evaluation of the Safety and Tolerability of Intravenous Push Dose Valproic Acid DESCRIPTION:​​​​Title: \;Evaluation of the Safety and Tolerability of Intravenous Push Dose Valproic Acid  \; \;\nAuthors’ names: Maryam Hashem\, Kaitlyn Wallace\, Olivia Morgan\, Katleen Chester \;\nEmail: mhashem@gmh.edu \;\n\nBackground: Valproic acid (VPA) is an antiseizure medication that inhibits voltage-gated sodium channels and gamma-aminobutyric acid (GABA) transaminase and enhances GABA synthesis. Multiple VPA formulations are commercially available\, but intravenous (IV) administration is preferred when patients lack oral access or require emergent treatment. Grady Memorial Hospital (GMH) transitioned from IV VPA maintenance doses administered via IV piggyback (IVPB) at a rate of 6 mg/kg/minute to slow IV push (IVP) over 2 to 5 minutes\, due to the fluid shortages following Hurricane Helene. The transition to IVP VPA was based on limited available evidence evaluating the safety and operational efficiency of this administration strategy. The objective of this study was to investigate the safety\, tolerability\, and operational efficiency of IVP VPA compared to IVPB VPA.  \; \;\n\nMethods: This was a single center\, retrospective\, observational study evaluating the safety\, tolerability\, and operational efficiency of IVP VPA maintenance doses (≤1500 mg) compared to IVPB from July 2024 to January 2025. Included patients were aged 18 years or older who received at least one dose of IV VPA. The primary outcome was the incidence of injection site reactions including injection site pain\, discomfort\, phlebitis\, burning\, infiltration\, extravasation\, or erythema. Secondary outcomes included number of doses received prior to a reaction\, type of reaction\, type of line medication was administered through\, dispense location (central pharmacy or floor pyxis)\, and time from order verification to administration. Baseline characteristics such as age\, gender\, weight\, location at the time of initial administration\, and type of line were collected. Descriptive statistics were used to summarize baseline characteristics and outcoming using medians and interquartile ranges\, or means and standard deviation\, as appropriate. Continuous variables were compared using the Mann-Whitney U test\, and categorical variables were compared using chi-square test.  \;\n\nResults: A total of 200 patients met inclusion criteria and were included in the analysis. Baseline characteristics were similar between groups\, with no significant differences in age between the IVPB and IVP groups or weight. In the IVPB VPA cohort\, there were a total of 1\,338 administrations\; only 2 administrations resulted in a reaction. In the IVP VPA cohort\, there were a total of 1\,068 administrations\; 8 administrations resulted in a reaction. Infiltration was the most common reaction\, occurring in 2 patients in the IVPB group and 5 patients in the IVP group (p-value=0.07).  \;Burning occurred in two patients and erythema in one patient in the IVP group\; neither finding was statistically significant (p-value=0.14 and 0.30\, respectively). All patients continued to receive IV VPA after the initial reaction without a reported reoccurrence. Dispense location differed significantly between groups. All IVPB doses were prepared by the central pharmacy\, whereas only 39% of IVP doses came from the pharmacy and 61% were dispensed from automated dispensing cabinets (p-value <\;0.001). The median time from pharmacist verification to administration of the first maintenance dose was 85 minutes in the IVPB group and 78 minutes in the IVP group\; however\, this finding was not statistically significant (p-value = 0.168).  \;\n\nConclusion: Injection site reactions were low overall. Implementation of IVP VPA did not result in a significant increase in injection site reactions when compared to IVPB VPA for maintenance doses\, indicating that the switch to IVP for maintenance dosing is a safe and efficient practice. \;\n \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:6075dbd24a464311564c5ce857f0ce70 URL:http://2026serc.sched.com/event/6075dbd24a464311564c5ce857f0ce70 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Impact of Docusate De-Implementation on Invasive Laxative Use in Intensive Care Unit Patients with Thoracic Trauma DESCRIPTION:Title: \;Impact of docusate de-implementation on invasive laxative use in intensive care unit patients with thoracic traumaAuthors: \;Isaiah Hicks\, Blake Henderson\, Spencer Roper\, Amanda McKinneyObjective: \;Explain the impact of docusate de-implementation and consider benefits to patients and institutions.Self-Assessment Question: \;Which of the following are reasons that contribute to the use of docusate in many institutions? Select all that apply.Background: \;The purpose of this study is to establish if the de-implementation of docusate from opioid pathways reduced the use of invasive laxatives in trauma surgical intensive care unit patients with thoracic trauma.Methods: \;The primary outcome of this retrospective chart \;review was the use of invasive laxatives such as rectal suppositories (i.e. glycerin\, bisacodyl) and enemas (i.e. sodium phosphate\; lactulose\; admixture of saline\, mineral oil\, glycerin). Mean number of non-invasive laxatives (e.g. polyethylene glycol\, senna\, magnesium citrate)\, intensive care unit length of stay (ICU LOS)\, hospital length of stay (HLOS)\, and morphine milligram equivalents (MMEs) were secondary outcomes. Patients were divided into pre-removal and post-removal groups. Results: \;In this study\, 378 patients were screened\, and 160 patients were included in statistical analysis. There was no statistically significant difference in invasive laxative use between pre- and post-removal groups (30.9% vs 27.3%\, p = 0.62). There was no statistically significant difference in mean number of non-invasive laxatives used (1.45±0.6 vs 1.48±0.5\, p = 0.52)\, mean HLOS (8.1±5.2 days vs 8.2±5.5 days\, p = 0.73)\, or mean MMEs (31.3±54.3 vs 39.4±42.7\, p = 0.07). Mean ICU LOS was statistically significant between the pre- and post-removal groups (3.3±2.1 days vs 2.8±2.2 days\, p = 0.04). Conclusion: \;A reduction in invasive laxative use after the removal of docusate from opioid order pathways was not established\, likely due to limited sample size. Notably\, removal was associated with shorter ICU LOS. Further analysis focusing on financial impact would provide insight into potential cost savings and decreasing pill burden.(Link to Abstract Document) CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:436db526c23732ead3b2c630bf34adfa URL:http://2026serc.sched.com/event/436db526c23732ead3b2c630bf34adfa END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Sedation Practices in Patients Undergoing Targeted Temperature Management at 36° C DESCRIPTION:Sedation Practices in Patients Undergoing Targeted Temperature Management at 36° C\nGrace Clark\, Anais Solomon\, Joanna Brennan\, Bibidh Subedi\nAdventHealth Orlando\, FL\n\nBackground: Targeted temperature management (TTM) is the practice of cooling patients’ core body temperature for comatose patients after cardiac arrest to prevent brain damage. Historically\, patients undergoing TTM to a goal of 33° C have been deeply sedated with Richmon Agitation and Sedation Scale (RASS) goals of -4 to -5 to avoid shivering\, which increases the cerebral metabolic demand. In 2013\, the TTM trial was published\, prompting the 2015 ACLS guidelines to include 36° C for TTM. TTM to 36° C reduces shivering and possibly sedation needs. The objective of this study was to characterize sedation practices during TTM at 36° C\, focusing on RASS goals and the sedation level achieved.\n\n\nMethods: \;This was a multicenter\, retrospective cohort study with 75 patients from AdventHealth Central Florida campuses who were enrolled between 4/1/2025 and 9/30/2025. Adult patients 18 years of age or older were included if they received TTM at 36° C after out-of-hospital or in-hospital cardiac arrest. Patients were excluded if they were pregnant\, had multiple cardiac arrests\, or if they were placed on extracorporeal membrane oxygenation (ECMO). The primary outcome was sedation level achieved measured by the RASS score for five days post cardiac arrest. Secondary outcomes included prescribed RASS goal\, if the RASS goal was changed during TTM\, sedation medications utilized\, cumulative doses of sedative medications\, Glascow Coma Scale (GCS) at baseline and on day five\, time to extubation\, incidence of seizure\, incidence of tracheostomy\, ICU and in-hospital mortality\, and ICU and hospital length of stay.\n\n\nResults: All 75 patients were included in analysis. The average age of our patients was 62 years old with 68% being male. Witnessed arrests occurred in 77.3% of patients with 25.3% having a shockable rhythm initially. The median time to ROSC in witnessed arrests was 12 minutes. Around 61.3% of patients received vasoactive agents within 1 hour of hospital admission. The median RASS achieved was -2.5 on day 1 and 0 on days 2-5. The most common RASS goals were -1 to -2 (73.3%) and 0 to -1 (14.7%)\, with 29.3% of patients having their RASS goals changed during TTM. The most common continuous sedation medications were fentanyl (78.67%)\, propofol (76%)\, midazolam (58.67%)\, and dexmedetomidine (30.67%). The cumulative daily dose for dexmedetomidine increased over the first 72 hours\, while fentanyl\, midazolam\, and propofol doses decreased. Patients were on sedative continuous infusions for a median of 36 hours with a TTM median duration of 72 hours. The number of patients on continuous sedation was 67 (89.3%)\, 48 (64%)\, 38 (50.7%)\, 25 (33.3%)\, and 16 (21.3%) respectively for days 1-5. The number of patients on as needed sedation was 8 (10.7%)\, 11 (14.7%)\, 11 (14.7%)\, 8 (10.7%)\, and 7 (9.3%) respectively for days 1-5. Around 37% of patients had TTM discontinued early with 5.3% of them due to the patient following commands. Median GCS was 15 at baseline and 10 on day 5. Seizures occurred in 19 people (25.3%) for a median of 2.63 days. Shivering occurred in 11 people (14.7%) and 8 people (10.7%) received tracheostomy. The median time to extubation was 2.7 days. The median lengths of stay were 4 days for the ICU and 7 days for the whole hospitalization. Mortality occurred in 46 cases (61.3%) with all the patients dying during their ICU stay.\n\n\nConclusions: Our study found that most patients undergoing TTM at 36° C had lower sedation targets prescribed and achieved than have been historically attained. Most patients were able to complete the full 72 hours of TTM. Further prospective studies are warranted to evaluate optimal sedation target in this demographic.\n\nPresentation Objective: \;Analyze current targeted temperature management (TTM) sedation practices within AdventHealth Central Florida division. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:2d1a586c54bff9f0661fdb66aa63190e URL:http://2026serc.sched.com/event/2d1a586c54bff9f0661fdb66aa63190e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Appropriate Diagnosis of Sepsis via SIRS Criteria and Opportunities for Reduction in Broad-Spectrum Antibiotic Use in the Emergency Department DESCRIPTION:Purpose: Time-sensitive completion of bundled interventions is the focus of the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Centers for Medicaid and Medicare Services (CMS) quality measure\, which aims to reduce sepsis-related morbidity and mortality. To avoid missed cases of sepsis\, clinicians often rely on the Systemic Inflammatory Response Syndrome (SIRS) criteria as the major identifier of sepsis\, which has \;inadvertently raised concerns for potential overdiagnoses. This study evaluated the incidence of patients diagnosed with sepsis in the emergency department (ED) who did not meet SIRS criteria and/or lacked a documented source of infection. Recognizing such cases may highlight opportunities to reduce unnecessary use of broad-spectrum antibiotics and ultimately support more targeted antimicrobial stewardship in sepsis care.\nMethods: This study design was submitted to the Ballad Health System Institutional Review Board for approval. This was a retrospective electronic chart review that included adult patients aged 18 years and older who presented to the ED of Bristol Regional Medical Center\, Holston Valley Medical Center\, or Johnson City Medical Center between December 2025 and March 2026 with a sepsis ICD-10 diagnosis. Using the electronic health record\, we identified patients who were reported to have met the SIRS criteria. Among these qualifying candidates\, patients were then assessed whether there was a documented source of infection and whether broad-spectrum antibiotics were administered. Data collected included patient age\, gender\, ethnicity\, respiratory rate\, heart rate\, temperature\, white blood cell count\, and antibiotics received. Provider documentation was reviewed to verify whether there was a documented source of infection. All data was reviewed and recorded in a manner that ensured complete patient anonymity. Statistical analysis was conducted to compare groups meeting sepsis criteria\, antibiotic use\, and documented infection source. \nResults: Among evaluated patients\, 11% of those diagnosed with sepsis in the ED did not meet greater than two SIRS criteria at initial presentation\, while 89% met SIRS criteria. Additionally\, 3% of the study population lacked a documented or suspected source of infection. Clinician compliance with SIRS-based sepsis diagnosis across facilities ranged from 81% to 97%\, exceeding the pre-study hypothesis of 70%. Cefepime and vancomycin were the most commonly utilized antimicrobials\, with broad-spectrum antibiotic use occurring in approximately 90% of patients. \nConclusions: Majority of patients diagnosed with sepsis in the ED met SIRS criteria\, with compliance rates higher than initially anticipated. However\, a subset of patients did not meet diagnostic criteria or lacked an identifiable infectious source\, suggesting potential opportunities for improvement with diagnostic accuracy and reducing unnecessary broad-spectrum antibiotic use. Further studies with larger sample sizes and less exclusion criteria are warranted to better assess antimicrobial appropriateness based on patient-specific risk factors and presumed sources of infection. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:9176bfd1e299f3724409574eaaa0c3e0 URL:http://2026serc.sched.com/event/9176bfd1e299f3724409574eaaa0c3e0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Comparing Safety and Efficacy of Subcutaneous Unfractionated Heparin Dosing Frequencies for Venous Thromboembolism Prophylaxis in a Community Hospital DESCRIPTION:Comparing Safety and Efficacy of Subcutaneous Unfractionated Heparin Dosing Frequencies for Venous Thromboembolism Prophylaxis in a Community Hospital\nAuthors: \;Jonathan Johnson\, Adam Harnden\, Madison Sanders\, M. Trey Dailey\, Nancy Bailey\, Matthew Hadley\nBackground: \;Venous thromboembolism (VTE) is a major cause of in-hospital morbidity and mortality with an estimated 375\,000 new cases and approximately 100\,000 deaths annually in the United States. Patients in the hospital are at a higher risk of developing VTE due to underlying conditions and acute illness. Using unfractionated heparin (UFH) to prevent VTE is an appropriate choice of therapy to decrease the risk of VTE events and death\; however\, there is not a consensus on administration frequencies. This study aimed to assess the safety and efficacy between dosing strategies in patients that were admitted to a community hospital. \nMethods: \;This retrospective\, institutional review board approved study\, was conducted at a 344-bed community hospital in Montgomery\, Alabama. A clinical decision support tool was utilized to identify patients receiving UFH 5\,000 units subcutaneously twice daily (BID) or three times daily (TID) between January 1\, 2024 to December 31\, 2024. Patients included in the study were at least 19 years old\, non-surgical\, and received prophylactic UFH 5\,000 units for at least 48 hours dosed either BID or TID. Patient populations excluded were pregnant patients\, trauma patients\, those on continuous renal replacement therapy\, those who had a major bleed upon admission\, therapeutic anticoagulation doses for more than 12 hours\, received low molecular weight heparin or fondaparinux\, or if patients received both UFH dosing schedules for at least 48 hours. Patients were separated into two cohorts of UFH dosing: BID or TID. The primary endpoint of this study was the incidence of VTE events. Secondary endpoints included incidence of the individual components of VTE: deep vein thrombosis and pulmonary embolism. Other secondary endpoints included major and minor bleeding\, heparin-induced thrombocytopenia\, hospital length of stay (LOS)\, hospital re-admission\, and in-hospital mortality. Data for the study were collected from an on-site secure electronic medical record where patient information was reviewed. Power was calculated through an open-access statistical analysis software such that 120 patients were required to reach 90% power. Appropriate statistical tests were applied to analyze data as well as appropriate use of descriptive statistics. \nResults: \;A total of 140 patients were included in this study with 70 patients in each arm\, meeting protocol. A total of 156 patients were excluded with the majority due to not receiving doses for at least 48 hours.  \;The primary outcome\, incidence of VTE\, occurred in 1/70 (1%) patients in the TID dosing group compared to no incidence of VTE in the BID group (P=1). The incidence of VTE that occurred in the TID group was due to a deep vein thrombosis. Major bleeding occurred in 1/70 (1%) patients in the TID group and minor bleeding occurred in 1/70 patients (1%) of both the BID and TID groups. Re-admission rates occurred in 35 patients in the BID group compared to 23 patients in the TID group (P=0.06). Incidence of in-hospital mortality occurred in 3 patients in the BID group compared to 10 patients in the TID group (P=0.08). Mean number of days for LOS was 7.94 for the BID group and 10.57 for the TID group (P=0.13). \nConclusion: \;In this study\, patients receiving UFH 5\,000 units for VTE prophylaxis had similar safety and efficacy endpoints when comparing BID and TID dosing. Limitations of this study include being a single center study that relied on medical record documentation and having difficulty in extrapolating the results due to the prevalence of hospital acquired VTE. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:d1a316c3149cbb5d2d6fb002ddebad5d URL:http://2026serc.sched.com/event/d1a316c3149cbb5d2d6fb002ddebad5d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Evaluating the implementation of prolonged beta-lactam infusions for sepsis patients in the ICU DESCRIPTION:Title: \;Evaluating the implementation of prolonged beta-lactam infusions for sepsis patients in the ICU\nAuthors: \;Nathaniel Park\, Jeremy Frens\, Alex Chappell\, and Dustin Zeigler\nBackground/Purpose:\nBeta-lactams are generally the preferred and most frequently prescribed antibiotics to treat patients with sepsis due to their broad spectrum of activity and favorable safety profile. Their efficacy is dependent on time above minimum inhibitory concentration (MIC) with requirements depending on beta-lactam class. Therefore\, patients are at risk of treatment failure if beta-lactam concentrations at the site(s) of infection fall below the MIC for extended periods of time. Recently\, data from the BLING-III trial and subsequent meta-analyses have suggested that there may be benefits in terms of clinical cure and reduced 90-day mortality with prolonged beta-lactam infusions in comparison with conventional\, intermittent infusions. As a result\, Cone Health adopted prolonged or continuous infusion protocols for piperacillin/tazobactam\, penicillin G\, and nafcillin. More recently\, additional prolonged infusion protocols were implemented for cefepime\, ceftazidime\, and meropenem in critically ill patients with sepsis or septic shock. The aim of this study was to evaluate the efficacy and safety associated with the implementation of a prolonged infusion regimen protocol for cefepime\, ceftazidime\, and meropenem in ICU patients with sepsis or septic shock.\nMethodology:\nThis Institutional Review Board (IRB) reviewed\, determined exempt\, retrospective\, multicenter\, single-health system\, pre-post study was conducted from October 2024 to December 2025. Patients were included if they were >\; 18 years old\; ICU admission for sepsis or septic shock\; had documented site of infection or strong suspicion for bacterial infection\; initiated on meropenem\, cefepime\, or ceftazidime <\; 24 hours from sepsis or septic shock diagnosis\; and >\; 1 sign of organ dysfunction [mean arterial pressure (MAP) <\; 60 mm Hg for >\; 1 hour\, vasopressor required >\; 4 hours\, respiratory support required for >\; 1 hour\, or serum creatinine >\; 2.49 mg/dL]. Exclusion criteria included renal replacement requirement at the time of antibiotic initiation\, received antibiotics <\; 48 hours\, and antibiotics not initiated within 24 hours of sepsis diagnosis. Baseline demographic data\, safety data\, and data relevant to the primary and secondary endpoints were collected among eligible patients. The primary endpoint was ICU length-of-stay (LOS) defined as days on ICU unit. Secondary endpoints were clinical cure (defined as completion of antibiotics within 14 days without resumption within 48 hours of cessation)\, vasopressor-free days\, and 30-day all-cause mortality. Continuous data was analyzed with Student’s t-test or Mann-Whitney U test\, and categorical data was analyzed with chi-square test or Fisher’s exact test. Two-sided alpha was set at 0.05.\nResults:\nIn total\, 200 patients were screened for inclusion (100 in pre- and 100 in post-intervention cohort). Ultimately\, 38 patients were analyzed – 18 in the pre-intervention cohort\, and 20 in the post-intervention cohort. Less than half of the patients were female (n=17\, 44.7%) with an average age of 71 years old. Most patients were started on cefepime (n=29\, 76.3%)\, with pulmonary and urinary sources accounting for most of the suspected sepsis sources (n=28\, 73.7%). Of the 20 patients in the post-intervention cohort\, 14 patients met criteria for prolonged beta-lactam infusion. Among patients meeting criteria (n=14)\, 1 patient (7.1%) received prolonged beta-lactam infusion. For the primary endpoint\, the post-intervention group had a shorter median ICU LOS (2.7 vs 5.0 days\, p=0.285). For secondary endpoints\, the post-intervention group had less vasopressor-free days (0.7 vs 1.1 days\, p=0.055)\, reduced 30-day mortality (15.0% vs 33.3%)\, and increased clinical cure (90.0% vs 77.8%). One occurrence of a new C. difficile \;infection occurred\, which was in the pre-intervention cohort\, and beta-lactams were appropriately renally adjusted in the 27 patients meeting criteria for renal dosing. \nConclusions:\nAlthough numeric differences were observed in favor of the prolonged beta-lactam infusion protocol cohort with decreased ICU LOS\, increased vasopressor-free days\, 30-day mortality\, and clinical cure\, there were no statistical differences among any of the primary or secondary endpoints. Additionally\, the observed low implementation rate of prolonged beta-lactam infusion among eligible patients further complicates interpretation. Most likely\, the cohort identification methods did not have the sensitivity to identify more patients administered prolonged beta-lactam infusions. The results of this study should not dissuade use of the prolonged beta-lactam infusion protocol. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:cdabde8befcb0377fe8e5d54e18f7c58 URL:http://2026serc.sched.com/event/cdabde8befcb0377fe8e5d54e18f7c58 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Evaluation of Febrile Neutropenia Prophylaxis Use in Inpatient Oncology DESCRIPTION:Evaluation of Febrile Neutropenia Prophylaxis Use in Inpatient Oncology\nOlivia Jones\, PharmD\; Sarah Bowman\, PharmD\, BCOP\; Samantha Lightle\, PharmD\nHuntsville Hospital – Huntsville\, AL\n\n\nBackground: Febrile neutropenia is a common and potentially serious complication among patients with hematologic malignancies. The National Comprehensive Cancer Network (NCCN) provides evidence-based guidance to identify oncology patients who qualify for prophylactic antimicrobial therapy to prevent febrile neutropenia. Consistent application of these recommendations is critical for reducing infection-related morbidity and mortality. Prior evaluation at our institution has highlighted gaps in guideline adherence\, particularly among high-risk populations such as patients with acute myeloid leukemia (AML)\, acute lymphoblastic leukemia (ALL)\, myelodysplastic syndromes (MDS)\, and multiple myeloma (MM). The purpose of this retrospective chart review is to evaluate current antimicrobial prescribing patterns and associated outcomes in these populations. \n\n\nMethodology: This single-center\, IRB-approved\, pre–post implementation study was conducted at Huntsville Hospital to evaluate prescribing patterns of prophylactic antimicrobials and associated outcomes in patients at high risk for febrile neutropenia. The pre-intervention group included hospitalized patients with the aforementioned hematologic malignancies between January 1\, 2025 and August 31\, 2025. Data extracted from the electronic medical record included demographics\, chemotherapy regimens\, risk factors\, use of prophylactic antimicrobial agents\, and incidence of febrile neutropenia. Following analysis of baseline data\, a disease specific decision support tool and educational initiative were developed and delivered to oncology nurse practitioners and pharmacists in early March 2026. Post-intervention data was collected from the same patient population following March 10\, 2026.  \;The primary outcome was percentage of eligible patients who received appropriate prophylactic antimicrobials.\n\n\nResults: A total of 87 patients were included in the pre-implementation group and 15 patients in the post-implementation group. Appropriate prophylactic antimicrobial use among eligible patients increased from 42.8% (3/7) to 100% (3/3) for antibacterial prophylaxis and from 50% (10/20) to 100% (3/3) for antifungal prophylaxis. Antiviral prophylaxis increased from 50.9% (26/51) to 57.1% (8/14). Median time to prophylaxis initiation decreased from 80.7 to 4.7 hours for antibacterial agents and from 17.9 to 4.7 hours for antifungal agents. Antiviral prophylaxis showed minimal change in time to initiation (19.6 vs 18.6 hours). Febrile neutropenia incidence did not differ consistently between groups. In the pre-implementation cohort\, patients who received prophylaxis had lower absolute neutrophil counts and longer hospital lengths of stay compared to those who did not receive prophylaxis.\n\n\nConclusions: A pharmacist-driven educational initiative was associated with improved adherence to guideline-recommended prophylactic antimicrobial use\, particularly for antibacterial and antifungal agents\, and significantly reduced time to initiation. Variability in antiviral prescribing practices may explain the more modest changes observed in this group. These findings highlight the impact of pharmacist involvement and support further efforts to standardize prophylaxis use earlier in hospitalization. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:2c92de8ffd4d6541c21183e78a3dc3d0 URL:http://2026serc.sched.com/event/2c92de8ffd4d6541c21183e78a3dc3d0 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Evaluation of Glucagon-like Peptide-1 Receptor Agonist Use and the Risk of Pancreatitis DESCRIPTION:Authors: Isaac Sauvageau\, Kerri Smith\, Brittney Bright\, Ryan Imel\, Blake Sloan \;\n\nBackground: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a therapeutic class that mimics the naturally occurring incretin hormone GLP-1. Through this mechanism\, they enhance glucose-dependent insulin secretion\, suppress glucagon release\, delay gastric emptying\, and promote satiety. These effects make GLP-1 RAs effective agents for the management of type 2 diabetes mellitus (T2DM) and chronic weight management. They have also demonstrated cardiovascular and renal protective benefits\, leading to increased use in patients with cardio-renal comorbidities. Despite their broad acceptance in clinical practice\, early clinical trials and observational studies suggest a potential increase in the risk of pancreatitis (0.4% versus 0.03% in the general population). Multiple studies identify an increased risk of pancreatitis across the class\, though results remain inconsistent\, and the underlying mechanisms are not fully established. \;\n\nMethods: This was a multi-center\, matched case-control design that included adult patients with active GLP-1 RAs on their home medication lists from May 1\, 2024 – October 1\, 2025. The primary objective was to determine the incidence of pancreatitis in patients using GLP-1 RAs at North Carolina Baptist Hospital\, Highpoint Medical Center\, and Davie Medical Center. The secondary objective was to identify patient-specific factors associated with pancreatitis risk among GLP-1 RA users. Patients were excluded from the study if they initiated GLP-1 RA therapy within 30 days of data collection. The incidence of pancreatitis was calculated from the unadjusted population prior to case matching. Cases were defined as GLP-1 RA users admitted to the hospital with a primary diagnosis of pancreatitis. Controls consist of GLP-1 RA users without hospitalization for pancreatitis and were matched to cases in a 1:1 ratio by age category\, sex\, and residential zip code to minimize confounding variables.  \;\n\nResults: A total of 6\,109 GLP-1 RA users were identified\, of which 34 were admitted to the hospital with a primary problem of pancreatitis. This corelates with an 0.56% incidence of pancreatitis. After matching\, 50 patients were included\; 25 pancreatitis cases and 25 matched controls. The median age was 54 years\, and 60% of the cohort was male. The median BMI was 35 kg/m2. The majority of patients were obese (82%) and had type 2 diabetes (78%). Semaglutide (56%) and tirzepatide (32%) were the most common GLP‑1 RAs used. Significant differences between cases and controls were observed for GLP‑1 RA agent distribution (p = 0.004)\, presence of chronic kidney disease (CKD) (36% vs. 8%\; p = 0.017)\, cholelithiasis/cholecystitis (32% vs. 0%\; p = 0.004)\, and serum creatinine levels (0.99 vs. 0.81 mg/dL\; p = 0.038). \;\n\nUnivariable logistic regression indicated increased odds of pancreatitis associated with CKD (OR 6.47\; 95% CI 1.43–46.3\; p = 0.027) and higher serum creatinine (OR 5.32\; 95% CI 1.32–42.7\; p = 0.059). Tirzepatide use was associated with significantly lower odds of pancreatitis (OR 0.11\; 95% CI 0.02–0.44\; p = 0.003) compared with semaglutide. GLP‑1 RA dose category\, HbA1c\, triglycerides\, alcohol use\, smoking status\, and baseline metabolic parameters were not significantly associated with pancreatitis. In multivariable regression adjusting for CKD and agent\, CKD remained an independent predictor (OR 8.95\; p = 0.028)\, while tirzepatide maintained a protective association (OR 0.10\; p = 0.005). \;\n\nConclusions: \;The incidence of pancreatitis in GLP-1 RA users was \;0.56%\, \;which \;correlates with a higher risk of \;pancreatitis \;when compared to \;0.03% in the general population. \;CKD and elevated serum creatinine were significantly associated with increased odds of pancreatitis \;in GLP-1 RA \;users\, \;whereas \;tirzepatide was associated with reduced risk compared with semaglutide.\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:2a1d791dda099aeb7698b4c9ace743ab URL:http://2026serc.sched.com/event/2a1d791dda099aeb7698b4c9ace743ab END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:Evaluation of Thromboprophylaxis Strategies for Orthopedic Surgery Patients DESCRIPTION:Title: Evaluation of Thromboprophylaxis Strategies for Orthopedic Surgery Patients\n\nBackground: Orthopedic surgery patients are high-risk for post-operative venous thromboembolism (VTE) and often require prolonged prophylaxis. Several studies demonstrated that aspirin (ASA) is non-inferior to traditional prophylactic regimens\, such as enoxaparin (LMWH)\, in orthopedic surgery\, however these studies are limited regarding therapeutic durations\, transitions of care\, and inpatient versus outpatient practices. This has led to significant heterogeneity in practice regarding VTE prophylactic agents. This study aims to compare local rates of post-operative VTE and bleeding for patients receiving ASA vs LMWH prophylaxis.\n\nMethods: This retrospective\, observational cohort study included adults with surgical femur fractures or femur fractures with prosthetic replacement at Prisma Health Midlands sites between May 2024 and May 2025 receiving either ASA or LMWH for inpatient post-operative VTE prophylaxis. Therapeutic anticoagulation and those with contraindications to either therapy were excluded. The primary outcome was a composite of VTE events or bleeding during post-operative admission. Secondary outcomes included outpatient VTE or bleeding within 60 days\, and evaluation of factors that may affect choice of agent. Tertiary outcomes evaluated therapeutic durations\, duplications\, and transition opportunities.\n\nResults: Rates of the primary outcome of VTE and bleeding during post-operative admissions were not significantly different between groups (adjusted OR 1.05\, 95% CI 0.39-2.28)\, nor were rates of VTE and bleeding from discharge to 60 days post-op (adjusted OR 0.78\, 95% CI 0.26-2.40). Provider factors had the largest influence on choice of agent. Half of patients who received LMWH inpatient were switched to ASA on discharge and only 62% of patients had an appropriate stop date on their prophylactic agent.\n\nConclusion: No significant differences in VTE and bleeding were found between ASA and LMWH groups\, both inpatient and post-discharge. Opportunities for improvement exist for several aspects of prophylactic therapy related to transitions of care. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:cbdf7868447c2a5c242006373a734a7b URL:http://2026serc.sched.com/event/cbdf7868447c2a5c242006373a734a7b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T131000Z DTEND:20260501T133000Z SUMMARY:EVALUATION OF MEDICATION ACCESS INTERVENTIONS BY TRANSITIONS OF CARE PHARMACIST FOR PATIENTS REQUIRING HIGH-COST CARDIAC MEDICATIONS DESCRIPTION:EVALUATION OF MEDICATION ACCESS INTERVENTIONS BY TRANSITIONS OF CARE PHARMACIST FOR PATIENTS REQUIRING HIGH-COST CARDIAC MEDICATIONS \; \;\nEsther Cho\, Alexandra Cooper\, Laura Provost\, Nathan Wayne\, Maegan Whitworth Wellstar MCG Health – Augusta\, GA \;\nBackground/Purpose: Centers for Medicare and Medicaid Services (CMS) monitors 30-day readmission rates per the CMS Hospital Readmission Reduction Program based on relative conditions or procedures including acute myocardial infarction (AMI)\, heart failure (HF)\, and coronary artery bypass graft (CABG). These three conditions have a high readmission rate per the CDC 2021 national data\, with HF having the highest readmission rate at 22% (AMI 16% and CABG 13%). Current studies show TOC interventions\, by a multidisciplinary team\, lower 30-day readmission\, but there is no literature focusing on an exclusive pharmacist-led intervention\, with a specific focus to medication access such as medication affordability. n these studies\, since most hospitals do not have a dedicated Transitions of Care (TOC) pharmacists\, “standard of care” is considered to be general patient care\, whereas TOC interventions are established to ensure continuity and coordinate care to patients. Therefore\, further evaluation is required to evaluate the effectiveness and impact of pharmacist-led TOC intervention. \n\nMethodology: This is a retrospective chart review of adult patients who were discharged from a cardiac floor with high-cost cardiac medications (e.g. Eliquis\, Entresto\, Jardiance) between November 4\, 2024 – May 31\, 2025. Interventions made by a non-TOC pharmacist\, pregnant patients\, and prisoners were excluded in this study. The primary outcome is overall 30-day readmission rate. Secondary outcomes include quantification and classification of TOC pharmacy interventions\, patient assistance applications initiated and/or approved\, percentage of prescriptions filled at discharge\, and 30-day readmission cause. \n\nResults: Overall\, 186 patients were included in the pharmacist-led TOC intervention group and 79 patients were included in the non-TOC intervention group. No significant difference was observed in rate of readmission within 30 days of discharge between TOC intervention and non-intervention groups (24% vs 20%\, p=0.62). However\, higher percentage of patients in the intervention group filled new high cost medication prescriptions at discharge (60% vs 47%\, p=0.30)\, more medications were prescribed to meds-to-beds pharmacy (47% vs 32%\, p=0.22)\, and patients in the TOC intervention group were less likely to be readmitted for medication related events (2% vs 12%\, p=0.11). \n\nConclusions: No difference was observed in overall 30-day readmission rate between pharmacy-led TOC intervention group vs non-TOC intervention group. More providers prescribed new high-cost medications to Wellstar MCG Meds-to-Beds pharmacy\, and a higher percentage of new prescriptions were dispensed at discharge with TOC pharmacist intervention. Additionally\, patients were less likely to be readmitted for medication-related events in the TOC intervention group. CATEGORIES:TRANSITIONAL CARE (TC) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:8b0934a5aa9c89f05ef5da01ae120cdf URL:http://2026serc.sched.com/event/8b0934a5aa9c89f05ef5da01ae120cdf END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Burnout Amongst Pharmacy Preceptors Across the United States DESCRIPTION:Authors: Rachel Denison\; Danielle Lott\; Eric K. Shaw\; Audrey Johnson\nContact Information: rachel.denison@hcahealthcare.com\nBackground\nBurnout is a growing epidemic affecting healthcare professionals worldwide. A 2023 study found that 45% of pharmacists reported burnout. As a profession that relies heavily on hands-on learning\, the need for assessment of burnout amongst pharmacy preceptors is critical. A 2022 survey-based study of pharmacy preceptors in northern California found that 57% of participants were experiencing burnout. Other studies have examined burnout amongst pharmacists and pharmacy leadership\, but there remains limited information regarding burnout amongst pharmacy preceptors across the United States.\nMethods\nThis survey-based study aimed to assess burnout amongst pharmacy preceptors across the United States. Preceptors were contacted by email through health system and professional society registries. Participants were included if they self-identified as a pharmacist preceptor for pharmacy students and/or residents. The primary outcome was the percentage of burnout amongst participating pharmacy preceptors using the Copenhagen Burnout Inventory. Burnout was defined as a Copenhagen Burnout Inventory score ≥ 50. Secondary outcomes included subcategories of burnout: personal\, work-related\, and learner-related. Secondary outcomes were analyzed by additional contributing factors related to pharmacy preceptors. Statistical analyses utilized were Pearson’s chi-square test and Fischer’s exact test.\nResults\nFrom the invitations sent\, 638 participants across the United States completed the survey. A total of 311/638 (48.7%) pharmacy preceptors had scores that indicated burnout. Of the participants experiencing burnout\, the following also indicated burnout in learner-related\, personal\, and work-related subcategories: 230/311 (74%) learner-related burnout\, 283/311 (91%) personal burnout\, and 281/311 (90.4 %) work-related burnout. Factors related to participants who scored above threshold for burnout include: highest level of postgraduate training\, precepting at university-affiliated teaching hospitals\, greater percentage of students/residents that were difficult to teach and/or unmotivated\, greater average number of hours worked per week\, preceptors who participate in daily rounding\, and greater amount of free time spent on work-related responsibilities. Factors related to participants who scored below threshold for burnout were: precepting at non-teaching hospitals\, compensation or rewards for precepting\, having adequate time for administrative or precepting duties\, and having children/dependents.\nConclusion\nThis study examined current burnout trends facing pharmacy preceptors across the United States. Our survey recognized that 48.7% of participating preceptors are experiencing burnout. These results provide information about contributing factors to burnout\, specifically learner-related\, personal\, and work-related burnout factors. Due to different cultures amongst employers\, this study could be replicated at individual sites to determine levels of burnout and site-specific risk factors. Limitations of this study include possible biases created by a survey-based study\, underrepresentation in several regions of the U.S.\, inability to rule out duplicate responses\, and inability to verify survey responses. Our survey illustrates the need to further develop processes and initiatives that could be incorporated to improve reduce preceptor burnout. CATEGORIES:ADMINISTRATION (ADM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:b21241808d851c726771087f9992e003 URL:http://2026serc.sched.com/event/b21241808d851c726771087f9992e003 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Agitation and Delirium in the ICU: Management with Valproic Acid DESCRIPTION:Agitation and Delirium in the ICU: Management with Valproic Acid\nMaddie Treadway\; Sarah Wyatt\; Robert Steed\; Steve Lindley\nBackground: \;Agitation and delirium are common complications in critically ill patients\, with delirium occurring in up to 80% of mechanically ventilated patients in the intensive care unit (ICU) setting. These conditions are associated with an increased cost to healthcare systems due to prolonged hospital and ICU length of stay\, long-term cognitive impairment\, and increased morbidity and mortality. Pharmacological management of delirium and agitation in the ICU often involves antipsychotics or sedatives\, which are limited by their arrhythmogenic and deliriogenic side effects. Due to the lack of improvement in clinically meaningful patient-centered outcomes\, the Society of Critical Care Medicine’s focused guideline update could not make a recommendation for or against the use of antipsychotics over usual care. More recently\, valproic acid (VPA)\, has emerged as a potential alternative for the management of delirium and agitation in the ICU. Despite promising preliminary data for VPA\, evidence remains limited\, and institutional practices vary widely. The purpose of this study was to evaluate the efficacy and safety of VPA for the management of agitation and delirium in ICU patients.\n\nMethods: \;This single-center\, retrospective descriptive analysis evaluated 60 adult patients admitted to a medical\, surgical-trauma\, or cardiovascular ICU from 1/1/2022-7/1/2025. Patients were included if they were ≥ 18 years old\, admitted to an ICU for ≥ 24 hours\, and received scheduled VPA for the management of delirium or agitation for ≥ 3 days. Patients were excluded if they received VPA for any other indication (i.e.\, seizures)\, were pregnant\, had a critical care pain observation tool score ≥ 3 immediately before VPA initiation\, or were prescribed VPA prior to admission. The primary outcome was the overall change in the Intensive Care Delirium Screening Checklist (ICDSC) and Riker Sedation-Agitation Scale (SAS) scores. The secondary outcomes were the incidence of agitation (SAS >\; 4) and delirium (ICDSC ≥ 4) for up to 7 days and the change in concurrent psychoactive medications over 7 days. The safety outcome was the incidence of adverse events.\n\nResults: A total of 988 VPA orders were identified\, corresponding to 182 patients after removal of duplicate orders. Ninety patients met initial screening criteria\, with 60 patients included in the outcomes analysis based on availability of ICDSC and SAS scores. Following initiation of VPA\, the incidence of agitation decreased from 80% on days 0–1 to 18.3% on days 3–7 (z = - 5.8\, P <\; 0.001). The incidence of delirium decreased from 46.7% on days 0–1 to 25% during days 3–7 (z = - 2.9\, P = 0.003). The median concurrent psychoactive medication use was 3 (IQR 1-5) vs. 3 (IQR 1.75-4.25) on day 1 vs. day 7\, respectively. Thrombocytopenia (platelets <\; 100 10*3/µL) occurred in 4 (6.7%) patients\, elevated AST (>\; 80 IU/L) in 12 (20%) patients\, elevated ALT (>\; 80 IU/L) in 8 (13.3%) patients\, and hyperammonemia (>\; 60 µmol/L) in 7 (11.7%) patients.\n\nConclusion: In this retrospective analysis\, initiation of VPA was associated with statistically significant reductions in agitation and delirium scores among critically ill patients. However\, interpretation of these results should be made cautiously given the retrospective design\, documentation variability\, and the complex nature of critically ill patient populations. Further prospective studies are needed to compare VPA to the standard of care for agitation and delirium treatment in the ICU and establish optimal dosing strategies.\n\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:462ee861275c7ffe1ae5b58d7e22b317 URL:http://2026serc.sched.com/event/462ee861275c7ffe1ae5b58d7e22b317 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Comparison of Nicardipine and Labetalol for Peri-Thrombolysis Blood Pressure Management in Acute Ischemic Stroke - Olivia Klassa DESCRIPTION:Title: \;Comparison of Nicardipine and Labetalol for Peri-Thrombolysis Blood Pressure Management in Acute Ischemic Stroke \nAuthors: Olivia Klassa\, Braiden Sorgenfrei\, Michael Wagner\, Alex Ewing\, Lauren McAbee \;\nBackground:  \;\nAcute ischemic stroke requires rapid thrombolytic therapy to restore cerebral blood flow and optimize outcomes\; however\, safe administration depends on effective blood pressure control. Current AHA/ASA guidelines recommend reducing blood pressure to less than 185/110 mmHg prior to tenecteplase and maintaining less than 180/105 mmHg for 24 hours after administration. Elevated blood pressure may delay thrombolytic administration and increase hemorrhagic risk. Labetalol and nicardipine are commonly used first-line agents\, though limited evidence supports a preferred option. This study aims to compare labetalol and nicardipine for their impact on door-to-needle time and 24-hour blood pressure control in patients receiving tenecteplase for acute ischemic stroke. \;\nMethods:  \;\nA retrospective chart review was conducted at an 864-bed academic medical center in Greenville\, South Carolina\, between January 1\, 2021\, and October 31\, 2025. Adults with acute ischemic stroke who received tenecteplase and required pre-thrombolysis blood pressure management with nicardipine or labetalol were included. Eligible patients were identified using a report from the Get With The Guidelines–Stroke database. Patients with hemorrhagic stroke\, pregnancy\, or receipt of alternative antihypertensives were excluded. The primary outcome was door-to-needle time. Secondary outcomes included time to blood pressure control\, 24-hour blood pressure variability\, antihypertensive utilization\, and clinical outcomes including bleeding\, mortality\, and functional and neurologic status. \;\nResults:  \;\nA total of 100 patients met inclusion criteria and were included in the final analysis. Of these\, 38 received labetalol alone\, 25 received nicardipine alone\, 31 required escalation from labetalol to nicardipine\, and 6 required escalation from nicardipine to labetalol prior to TNK administration. Baseline characteristics were similar between groups\, though the nicardipine group had a higher prevalence of hypertension and greater outpatient antihypertensive use. Median door-to-needle time was similar between groups (28 vs. 33 minutes\, p=0.09)\, and a similar proportion of patients achieved a door-to-needle time less than or equal to 30 minutes. However\, a greater proportion of patients receiving labetalol achieved door-to-needle times less than or equal to 15 minutes (15.8% vs. 0%\, p=0.02). Door-to-CT times were also similar across groups. Time to blood pressure control differed significantly between strategies\, with labetalol achieving faster control compared to nicardipine (4 minutes vs. 8 minutes\, p=0.001). Patients requiring escalation between agents experienced longer times to blood pressure control. Blood pressure parameters during the first 24 hours\, as well as safety and functional outcomes\, were similar across treatment strategies. \;\nConclusions:  \;\nThe findings of this study demonstrate that antihypertensive strategy prior to TNK administration did not significantly impact door-to-needle time in patients presenting with acute ischemic stroke. While labetalol achieved faster time to blood pressure control compared with nicardipine\, this difference did not translate into meaningful differences in treatment timing or clinical outcomes. Safety and functional outcomes were also similar between treatment strategies. These findings should be interpreted in the context of the retrospective single-center design and small sample sizes. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:1e7fcc3e8d8d9120425d54137aec0df8 URL:http://2026serc.sched.com/event/1e7fcc3e8d8d9120425d54137aec0df8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Evaluation Of Intra-Procedural Blood Pressure In Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy DESCRIPTION:Sarah Layne\, Chelsea Mitchell\, Sterling Torian\, Austin Roberts\nTriStar Centennial Medical Center – Nashville\, Tennessee\n\nBackground: Blood pressure (BP) control is an essential component in management of patients with acute ischemic stroke (AIS). Significant reductions in BP can lead to hypoperfusion and worsened cerebral injury\, whereas uncontrolled hypertension can increase the risk of hemorrhage and cerebral edema. In patients undergoing mechanical thrombectomy (MT)\, current guidelines recommend a pre-procedure BP less than 185/110 mmHg\, but intra-procedural goals have yet to be established. Literature evaluating intra-procedural BP goals in patients undergoing mechanical thrombectomy is lacking. Current randomized controlled trials have evaluated the use of anesthesia\, which may impact hemodynamics. Further studies are needed to determine if there is an ideal blood pressure target to prevent neurologic deterioration and worse functional outcomes. The purpose of this study was to evaluate the effect of intra-procedural blood pressure on clinical and safety outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy.\n\nMethods: This was a single-center retrospective cohort study conducted through chart review from October 1\, 2022\, to June 30\, 2025. Patients who underwent MT within the study timeframe were included. Exclusion criteria consisted of any intra-procedural hemorrhagic complication\, lack of successful reperfusion (TICI score 0-2a)\, missing baseline Glasgow Coma Scale (GCS)\, or patients aged less than 18 years old. Patients were divided into two groups\, those who had an intra-procedural systolic blood pressure (SBP) less than 140 mmHg or a drop in SBP by at least 40 mmHg (group 1) and those who did not meet the criteria (group 2). The primary outcome was incidence of neurologic deterioration at 24 hours post-mechanical thrombectomy\, defined as a decrease in GCS score of at least 2 from the baseline score. The secondary outcome was incidence of intracranial hemorrhage at 48 hours. Subgroup analyses were performed for patients who received intravenous (IV) fibrinolytics and those who did not\, and separately for patients with any intra-procedural SBP less than 120 mmHg compared with those who had SBP greater than 120 mmHg.\n\nResults: Fifty-four patients were screened. Five patients did not meet inclusion criteria\, and thirteen patients were excluded (n=5 lack of successful reperfusion\, n=1 intra-procedural hemorrhagic complication\, n=7 missing baseline GCS). This resulted in a final sample size of thirty-six. All patients met criteria for group 1 (n=36). Six patients (16.7%) developed neurologic deterioration at 24 hours. Eighteen patients (50%) had some degree of intracranial hemorrhage\, as determined by any mention of hemorrhage on brain imaging. In the subgroup analysis comparing patients who received IV fibrinolytics with those who did not\, 1 of 9 patients (11%) in the fibrinolytic group had neurologic deterioration\, compared with 5 of 27 patients (18.5%) in the non-fibrinolytic group. Neurologic deterioration occurred in all six (100%) patients in the SBP less than 120 mmHg subgroup.\n \;\nConclusions: Our study found that 16.7% of patients had neurologic deterioration 24 hours post-procedure. All patients who received MT had an intra-procedural SBP less than 140 mmHg or a drop by 40 mmHg\; therefore\, we were unable to detect differences between groups for our original analysis. While not powered for significance\, patients who did not receive fibrinolytic therapy as well as those with intra-procedural SBP less than 120 mmHg had numerically higher percentages of neurologic deterioration at 24 hours. Further research is warranted to determine the optimal intra-procedural SBP goal for patients undergoing MT.\n \;\nThis 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. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:6ab32bcb40cec02b4e829a14af87860d URL:http://2026serc.sched.com/event/6ab32bcb40cec02b4e829a14af87860d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Evaluation of Phenobarbital Dosing for the Management of Alcohol Withdrawal Syndrome DESCRIPTION:Background: Alcohol withdrawal syndrome (AWS) results from the sudden cessation of heavy alcohol use\, causing symptoms such as tremors\, anxiety\, and agitation. Benzodiazepines remain first-line for alcohol withdrawal management according to American Society of Addition Medicine (ASAM) guidelines. Phenobarbital has a half-life of about 80 to 120 hours which allows for adequate control of withdrawal symptoms\, and its self-tapering effect reduces the risk of medication abuse seen with benzodiazepines. The initial dosing of phenobarbital varies across institutions\, typically starting at 130 mg or 260 mg\, based on recommendations derived from clinical practice and studies such as Hendey et al. However\, weight-based dosing strategies (ex. 10 mg/kg) have emerged with aims of achieving therapeutic serum concentrations and optimizing symptom control\, as opposed to repeated smaller doses. The purpose of this study was to compare outcomes between patients that received an initial phenobarbital dose higher than 260 mg versus those that got a lower dose of 260 mg or less.\n\nMethods: This IRB approved\, retrospective chart review was conducted at a 711-bed academic medical center from 1/1/2020 to 9/26/2025. Adult patients who received phenobarbital were identified through a report from the electronic medical record. Patients were included if they had alcohol withdrawal documented within the chart. Patients were excluded if they were pregnant\, incarcerated\, had phenobarbital listed as a home medication\, had a urine drug screen positive for barbiturates\, any history of seizures not related to alcohol withdrawal\, or were mechanically ventilated prior to phenobarbital administration. The primary outcome was stable or improved CIWA and/or RASS scores from baseline within the first 24 hours\, defined as two consecutive CIWA and/or RASS scores equal to or below baseline. The secondary outcomes were the change in CIWA and/or RASS score after the first dose\, improved or stable CIWA and/or RASS scores from 24-48 hours and 48-72 hours\, cumulative benzodiazepine requirements\, adjunctive medication requirements\, hospital and ICU length of stay\, and escalation of care. Comparative analyses of the primary and secondary outcomes were conducted using t-tests. Other appropriate statistical tests were utilized as needed.\n\nResults: Of the 395 patients screened\, 187 met inclusion criteria and were enrolled in the final analysis. Patients were grouped by initial phenobarbital dose\; 118 received low-dose phenobarbital (≤260 mg) and 69 received high-dose phenobarbital (>\;260 mg). The primary outcome was achieved in 81 (80%) patients in the low-dose group compared with 59 (90%) in the high-dose group (p=0.111). No significant differences were found between the low-dose group and high-dose group for stable or improved CIWA and/or RASS scores at 24-48 hours (87% vs 90%\; p=0.53) or 48-72 hours (94% vs 97%\; p=0.71). Cumulative benzodiazepine requirements\, adjunctive medication requirements\, hospital length of stay\, ICU length of stay\, and escalation of care were similar between groups. Patients in the high-dose group demonstrated statistically significant greater reductions in CIWA scores following the initial dose compared to the low-dose group at 6 hours (mean change: 6.24 vs 0\; p=0.005) and 24 hours (mean change: 8.05 vs 2.25\; p=0.002).\n\nConclusions: \;Based on the results of this study\, both low-dose and high-dose phenobarbital appear to have similar outcomes in the management of alcohol withdrawal. This study also found that higher initial phenobarbital doses were associated with more rapid symptom control in the first 24 hours without resulting in any additional complications or safety concerns. Establishing evidence-based protocols could improve standardization of care and optimize outcomes for patients with alcohol withdrawal.\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:00a1ec06658ed94c0d8512bafe5aabd5 URL:http://2026serc.sched.com/event/00a1ec06658ed94c0d8512bafe5aabd5 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Evaluation of Updates to the Rabies Post-Exposure Prophylaxis Order Set DESCRIPTION:Evaluation of Updates to the Rabies Post-Exposure Prophylaxis Order Set\nR. Tye Fobbs\, Rachael Weingarten\, Rachel Rumbarger\nCone Health at Moses Cone Hospital – Greensboro\, NC\nBackground:\nRabies is a vaccine-preventable zoonotic viral disease affecting the central nervous system. The World Health Organization (WHO) recommends giving human rabies immune globulin (HRIG) to patients exposed to rabies if they have broken or punctured skin\, or if their mucous membranes were contaminated with saliva from a mammal confirmed to have rabies or if the animal is not up to date on rabies vaccinations or the animal is unavailable for quarantine and observation. In \;the last 10 years\, the utilization of rabies immunoglobulin and vaccinations has more than doubled in Cone Health emergency departments. There is no attributable cause to this increase in vaccination across our health systems. Inappropriate use of rabies post-exposure prophylaxis results in unnecessary costs and medical risks. A recent medication use evaluation explored the use of HRIG and rabies vaccines at Cone Health. Results showed that rabies post-exposure prophylaxis use in the emergency departments was not in accordance with WHO guidelines approximately 31% of the time.  \;In May 2025\, Cone Health introduced a rabies post-exposure prophylaxis order set to help guide providers in assessing the need for post-exposure prophylaxis for individual patients who meet criteria as well as providing a dose rounding protocol to decrease waste. This study aims to evaluate the implementation of the new rabies post-exposure prophylaxis order set in relation to the recommended WHO guidelines.\nMethods:\nThis was an IRB-reviewed\, determined exempt retrospective\, pre-post comparator study of patients who received human rabies immune globulin (HRIG) in Cone Health emergency departments. Data was collected between January to June 2024 for the pre-intervention group and June to December 2025 for the post-intervention group. Patients were excluded if they received immune globulin at an urgent care center\, did not meet inclusion criteria for dose rounding or weighed less than 37.5 kg. The primary outcome was appropriate use of HRIG. Secondary outcomes included amount of HRIG given\, amount that would have been given based on weight-based dosing\, amount of waste saved\, cost savings incurred\, number of patients that received <\; 90% or >\; 110% of their weight-based dose\, and re-presentation within 30 days for a suspected adverse reaction to HRIG.\nResults: \;A total of 170 patients were screened with 70 patients in the pre-protocol group and 100 patients in the post-protocol group. The post protocol group was associated with a higher proportion of appropriate administration of HRIG when compared to the pre-protocol group [90 (90%) vs. 48 (68.5%)\; p = 0.0005]. There were no patients who represented within 30 days for a suspected adverse reaction to HRIG.\nConclusions: \;Implementation of a rabies post-exposure prophylaxis order set resulted in increased compliance with administration of HRIG per WHO guidelines. Dose rounding did not result in representation within 30 days for a suspected adverse reaction to HRIG and decreased overall waste. These findings suggest that having an established order set and dose rounding protocol increases compliance with WHO guidelines while decreasing waste.\n \;\n \; \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:206e2c84668ade320aa5f7dc3dd6d093 URL:http://2026serc.sched.com/event/206e2c84668ade320aa5f7dc3dd6d093 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Resident Presentation - Terence Natt DESCRIPTION:Evaluation of Alternative Dosing of Tranexamic Acid in Adults with Traumatic Injuries \;\nTerence Natt\, Madison Schwartz\, Kevin Lynch\, Dana Thorvilson \;\n\nCaroMont Regional Medical Center - Gastonia\, NC \;\n\nBackground/Purpose: Timely and proper dosing of tranexamic acid (TXA) in traumatic bleeding is imperative to reduce patient mortality. There is limited literature evaluating alternative dosing strategies to ensure TXA is consistently administered to patients that meet criteria. The purpose of this study is to determine if alternative dosing of TXA 2-grams administered intravenously over 10 minutes improves survival outcomes compared to standard dosing of a 1-gram intravenous (IV) bolus over 10 minutes followed by a 1-gram infusion over 8 hours.  \; \;\n\nMethodology: Eligible patients were those >\;18 years old who met traumatic hemorrhage protocol criteria and were provided TXA by Gastonia Emergency Medical Services (GEMS) or in CaroMont Regional Medical Center’s emergency department (ED). The retrospective phase included patients who received standard dosing of TXA. Following protocol changes enacted in January 2026\, the prospective phase included patients who received a 1-gram IV bolus of TXA in the ED following a 1-gram TXA administration by GEMS or received 2- grams of TXA as an IV bolus administered over 10 minutes in the ED. A chart review was completed to determine the primary endpoint of patient survival at 28 days\, and secondary endpoints including change in heart rate and systolic blood pressure from initial presentation to 1 hour after TXA administration\, blood product administration\, ICU and hospital length of stay\, and adverse drug events related to TXA administration). \;\n\nResults: In progress \;\n\nConclusion: In progress \;\n\n\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:3c53dd776fd6567be0170abace7fe53e URL:http://2026serc.sched.com/event/3c53dd776fd6567be0170abace7fe53e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Antibiotic escalation strategies after ceftriaxone failure in culture-negative spontaneous bacterial peritonitis (SBP): a single-center retrospective cohort study DESCRIPTION:Background: \;Spontaneous bacterial peritonitis (SBP) is the most common bacterial infection among patients with decompensated cirrhosis. Ceftriaxone remains a widely used first line empiric therapy\; however\, shifts in epidemiology and rising antimicrobial resistance have raised concerns regarding treatment failure in this population. A key challenge in SBP management is that up to 60% of cases are culture negative\, necessitating reliance on peritoneal fluid cytology for diagnosis and assessment of therapeutic response. In patients with culture negative SBP who fail to respond to ceftriaxone\, evidence-based guidance for antibiotic escalation is lacking\, resulting in substantial variability in clinical practice. Evaluation of outcomes in patients with culture negative SBP empirically treated with ceftriaxone may help identify risk factors for treatment failure and inform the effectiveness of commonly employed escalation strategies.\nObjective: \;This \;study aims to determine the success rates of the following antibiotic escalation strategies used after ceftriaxone failure: carbapenem-sparing regimens (cefepime\, or piperacillin-tazobactam)\, carbapenem regimens\, carbapenem-sparing + broad gram-positive coverage (vancomycin\, linezolid\, or daptomycin)\, or carbapenem + broad gram-positive coverage. A secondary aim is to identify risk factors associated with ceftriaxone treatment failure in the patient population.\nMethods: \;This is a retrospective cohort study conducted at a tertiary referral hospital from June 2022 to December 2025. Adult patients were included if they had culture negative SBP\, defined as an ascitic polymorphonuclear (PMN) count ≥250 cells/µL\, were primarily treated with ceftriaxone\, and underwent a repeat paracentesis ≥48 hours later to assess treatment response (or had resolution of ascites). Patients were excluded if they had secondary peritonitis\, non-cirrhotic peritonitis\, or received ≥ 24 hours of alternative antibiotics prior to ceftriaxone. For the primary outcome\, we evaluated response rates across the 4 antibiotic escalation groups. Treatment success was defined as a ≥25% reduction in PMN count on repeat paracentesis. For the secondary endpoint\, we planned to evaluate risk factors associated with treatment failure and compare patient outcomes.\nResults: A total of 69 patients with culture-negative SBP were included. The median age was 55 years (IQR 47–66)\, 67% were male\, and the most common etiology of cirrhosis was alcohol-related (41%). Median MELD-Na score was 22 (IQR 17–28). The median time from admission to SBP diagnosis was 20 hours (IQR 1–69)\, and 86% of patients received ceftriaxone 2g. Ceftriaxone failure occurred in 5 patients (7.2%). All five received antibiotic escalation: four were treated with a carbapenem-based regimen\, and one received cefepime with metronidazole. Among patients with documented PMN response data\, reductions ranged from 31% to 89%. Two patients in the ceftriaxone failure group died in-hospital (40%) compared to 4 patients (6%) in the success group. Median hospital length of stay was longer in the failure group (14 days [IQR 10–16] vs. 8 days [IQR 6–18])\, as was duration of antibiotic therapy (9 days [IQR 7–13] vs. 5 days [IQR 4–6]). In an exploratory analysis of potential risk factors\, nosocomial SBP was identified in 20% of failures and 27% of successes. Prior anti-pseudomonal antibiotic exposure within 90 days was more prevalent among ceftriaxone failures compared to successes (40% vs. 23%). The small sample size precluded formal statistical comparison for all outcomes.\nConclusion: Ceftriaxone failure was uncommon in our cohort of culture-negative SBP\, occurring in approximately 7% of patients. Ceftriaxone failure was associated with prolonged hospitalization\, extended antibiotic exposure\, and higher in-hospital mortality. Prior broad-spectrum antibiotic use emerged as a potential risk factor warranting further investigation in larger cohorts. These findings underscore the need for larger prospective studies to establish evidence-based escalation strategies. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:6ac3800bfffda62ccab058a99bde362a URL:http://2026serc.sched.com/event/6ac3800bfffda62ccab058a99bde362a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Evaluation of the Implementation of a Cardiothoracic Surgery Pre-Operative Anemia Treatment Protocol  DESCRIPTION:Evaluation of the Implementation of a Cardiothoracic Surgery Pre-Operative Anemia Treatment Protocol  \;\n\nAlyan Saeed\, Brendon Banes\, Rebecka Hazelwood \n \;\nBackground/Purpose: Patients undergoing cardiothoracic surgery (CTS) frequently present with baseline anemia\, which has been associated with increased transfusion requirements\, acute kidney injury (AKI)\, and higher postoperative morbidity and mortality. Prior studies suggest that pre-operative anemia optimization using intravenous iron\, erythropoiesis-stimulating agents\, and vitamin supplementation may reduce transfusion needs and improve surgical outcomes. In November 2023\, Wellstar Kennestone Regional Medical Center (WKRMC) implemented a pre-operative anemia protocol for CTS patients with hemoglobin <\;12 g/dL\; however\, its clinical impact has not been formally evaluated. This study aimed to assess the efficacy and safety of the CTS pre-operative anemia protocol.  \;\n\nMethods: This was an observational\, retrospective chart review conducted at WKRMC evaluating adult patients (≥18 years) who underwent CTS between December 1\, 2023 and September 1\, 2025. Patients with a baseline hemoglobin <\;12 g/dL were grouped based on whether they received the pre-operative anemia treatment protocol prior to surgery. Patients were followed from three days prior to surgery through seven days post-operatively\, hospital discharge\, or death\, whichever occurred first.   \;\nThe primary endpoint was the difference in post-operative hemoglobin levels between patients managed under the protocol and those in the non-protocol group. Secondary endpoints included number of post-operative red blood cell (RBC) units transfused and incidence of AKI within seven days. Safety outcomes included venous thromboembolism\, stroke\, post-operative infection\, and hypersensitivity reactions to IV iron.  \;\nStatistical analyses included paired and independent t-tests\, along with Fisher’s exact test for categorical variables.  \;\n\nResults: A total of 100 patients were included (protocol n=50\, non-protocol n=50). Post-operative hemoglobin was similar between patients managed under the protocol and those receiving usual care (8.80 g/dL vs 9.07 g/dL\, p=0.25). The mean number of RBC units transfused did not differ significantly between patients managed under the protocol and those receiving usual care (2.28 units vs 2.26 units\, p=0.98). Post-operative AKI occurred less frequently in the protocol group compared to the non-protocol group (20% vs 36%\, p=0.037). No significant differences were observed regarding the safety end points. There were no cases of IV iron hypersensitivity reactions in the protocol group.  \;\n\nConclusion: The pre-operative anemia protocol was associated with a lower incidence of post-operative acute kidney injury in CTS patients\, while post-operative hemoglobin levels were similar between groups. These findings suggest that pre-operative anemia management may contribute to improved renal outcomes\, despite comparable perioperative hematologic values.  \;\n \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:036e344b5be061559c97f503d50b665a URL:http://2026serc.sched.com/event/036e344b5be061559c97f503d50b665a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Impact of GLP-1 and GLP-1/GIP Receptor Agonists on Perioperative Glycemic Control in Arthroplasty DESCRIPTION:Impact of GLP-1 and GLP-1/GIP Receptor Agonists on Perioperative Glycemic Control in Arthroplasty\n\nAuthors: Julia Sitek\, Charles Hartis\, Zachary Klick\, Minal Patel\, Amit Saha\, Ashley Talbott\, Sarah Kittner\, Emily Schaefer \;\n\nObjective: Describe the effect of GLP-1 and GLP-1/GIP receptor agonists on perioperative blood glucose levels. \;\n\nBackground:  \;\nObesity and type 2 diabetes (T2DM) are well-established risk factors for osteoarthritis\, a leading cause of joint degeneration requiring arthroplasty. Both conditions\, along with perioperative hyperglycemia\, have been associated with worse postprocedural outcomes and increased risk of mortality.  \;Glucose-like peptide-1 (GLP-1) and GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RA) are becoming increasingly popular due to their indications for T2DM and weight management. Perioperative management of GLP-1 and GLP-1/GIP RAs\, specifically the optimal holding duration in surgery\, remains controversial. Case reports describing intraoperative aspiration events have prompted recommendations to hold these agents before surgery. Conversely\, emerging evidence suggests potential benefits of continuing these medications preoperatively\, including improved metabolic outcomes. Given their long-half-lives\, these agents may continue to confer glycemic benefits even when held\; however\, withholding them may increase the risk of perioperative hyperglycemia. Therefore\, the purpose of this study is to determine the effect of GLP-1 and GLP-1/GIP RAs on perioperative glycemic control in patients undergoing arthroplasty.  \;\n\nMethods: \;\nThis multicenter\, retrospective\, cohort study compared the incidence of perioperative hyperglycemia in patients with T2DM with or without a GLP-1 or GLP-1/GIP RA. Patients 18 years and older with T2DM who underwent primary elective total knee or hip arthroplasty and had available preoperative and postoperative blood glucose data were included in this study. Those with type 1 diabetes\, an operative diagnosis of periarticular knee or lower extremity fracture\, an American Society of Anesthesiologists classification of 4 or higher\, or a need for general anesthesia were excluded. The primary outcome was the percentage of patients with preoperative and postoperative blood glucose levels of 180 mg/dL or greater. Secondary outcomes include any incidence of a hyperglycemic event during admission\, 30-day incidence of prosthetics joint infections (PJI) and surgical site infections\, incidence of aspiration or regurgitation during procedure\, postoperative nausea and vomiting\, and 30-day all-cause mortality. \;Data collection includes baseline demographics\, hospitalization characteristics\, and drug characteristics\, specifically the agent\, dose\, and time withheld before surgery. Descriptive statistics were used to summarize the incidence of the primary outcome. Inferential statistics were analyzed using Student-t tests for continuous endpoints and Chi-square tests for categorical endpoints. \;\n\nPreliminary Results: Among patients undergoing total knee or hip arthroplasty across five hospitals between March 2\, 2024 and September 1\, 2025\, 104 patients were included in the analysis. The cohort was 53.8% female with a mean age of 69 years\, mean A1c of 6.5%\, and mean BMI of 32.65 kg/m². Preoperatively\, 42.3% were on a GLP‑1 or GLP‑1/GIP RA preoperatively. \;The primary outcome occurred in one (2.3%) patient on a GLP‑1 RA and one (1.7%) patient not receiving a GLP‑1 or GLP‑1/GIP RA preoperatively [OR of 1.37 (95% CI : 0.08 – 22.55\, P-Value 0.82)]. The secondary outcome of any event of hyperglycemia during admission occurred in 19 (43.2%) patients receiving a GLP‑1 or GLP-1/GIP RA and 24 (40%) patients not receiving a GLP‑1 or GLP‑1/GIP RA [OR 1.14 ( 95% CI : 0.51 – 2.51\, P- Value 0.74)]. Among GLP‑1 or GLP‑1/GIP RA users\, the mean duration of medication hold prior to surgery was 10 days. No patients experienced a surgical site infection\, PJI\, or aspiration/regurgitation event during the study period.  \;\n\nConclusion: Holding GLP-1 or GLP-1/GIP RAs for elective total knee or hip arthroplasties does not affect perioperative glycemic control. The benefit of holding GLP-1 or GLP-1/GIP RAs for primary elective arthroplasty may outweigh the risk as no statistically significant increase in incidence of hyperglycemia was observed. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:c2bffa737973ff3edebb782dc464de3e URL:http://2026serc.sched.com/event/c2bffa737973ff3edebb782dc464de3e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Safety of Intravenous Push Lacosamide Compared with Intravenous Piggyback at a Community Hospital DESCRIPTION:Authors: Lauren Baugh\, Karen Babb \;\n\nBackground: \nLacosamide is an FDA approved medication for the treatment of focal onset seizures and primary generalized tonic-clonic seizures and is also used off-label for status epilepticus.1 The Neurocritical Critical Care Guidelines for the Evaluation and Management of Status Epilepticus propose 200 mg lacosamide given over 15 minutes as an alternative for rapid administration\, while acknowledging the risk for possible adverse effects\, such as hypotension or QT prolongation.2 Recent studies suggest an increased incidence of cardiovascular\, neurological\, and infusion site related adverse events with intravenous push as compared to intravenous piggyback administration.4\n\nThis study will assess the incidence of adverse events associated with intravenous push compared to intravenous piggyback lacosamide within our institution.\n\nMethodology: \nThis was a single-center retrospective cohort analysis. Chart review was utilized to compare patients that received lacosamide via intravenous piggyback or push administration. Included in the study were adult patients 18 years old or older that received at least one dose of IV push or IV piggyback lacosamide from May 1\, 2024 - October 31\, 2024 and December 1\, 2024 - May 31\, 2025. Exclusion criteria was doses greater than 400 milligrams. The primary outcome was incidence of adverse drug events (hypotension\, bradycardia\, infusion site reactions\, sedation) in patients receiving intravenous push lacosamide compared to those that receive intravenous piggyback lacosamide. Secondary outcomes reviewed time to administration of intravenous push lacosamide compared to that of intravenous piggyback lacosamide.\n\nResults: \nA total of 110 patients were included in the study\, with 50 in the intravenous piggyback group and 60 in the intravenous push group. Baseline characteristics\, such as age\, sex\, weight\, race\, home lacosamide use\, and pre-existing comorbidities\, were comparable between the two cohorts. Of the 110 patients\, a total of 747 doses were observed\, with 379 doses given intravenous push and 368 given intravenous piggyback. Of the primary outcomes\, incidence of bradycardia\, hypotension\, medication related sedation\, and administration site reaction\, there were no statistically significant differences. The median time to first dose administration was 50 minutes in the intravenous push group and 62 minutes in the intravenous piggyback group.\n\nConclusion:\nThis study highlights the advantages of administering intravenous push lacosamide without increased risk of adverse events. The findings indicate that the incidence of adverse events was not higher than that seen in the intravenous piggyback administration\, while providing shorter time to first dose administration. However\, limitations of the study should be considered in the interpretation of the results. The primary limitation of this study was the missing documentation of heart rate\, blood pressure\, and sedation scores with each dose of lacosamide given. Furthermore\, findings should be interpreted in light of the fact that patients requiring hospitalization are often critically ill and exposed to a multitude of factors which could independently contribute to adverse outcomes rather than solely lacosamide administration. In the future\, the findings should be presented to the pharmacy and therapeutics committee to further support the current implemented practice. The results of this study should also encourage education on the importance of standardized nursing documentation.\n\nLauren.baugh@commonspirit.org CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:4ebe6459928c669a9171a9d17625c9b6 URL:http://2026serc.sched.com/event/4ebe6459928c669a9171a9d17625c9b6 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T133000Z DTEND:20260501T135000Z SUMMARY:Pharmacist Led COPD Medication Recommendations During Discharge Medication Review DESCRIPTION:Title: Pharmacist Led COPD Medication Recommendations During Discharge Medication Review \n\nAuthors: Bridget Arellano\, Ali Diaz\, Dahlia Kaiser \nAdventHealth Orlando\, Orlando\, FL \n\nBackground/Purpose: Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity\, with national 30-day readmission rates near 30%. To reduce rates of readmission\, the Center for Medicare and Medicaid Services (CMS) implemented a Hospital Readmission Reduction Program\, incentivizing improved communication and coordination for patients at discharge. Currently our COPD readmission rate is approximately 20%. To address this\, our hospital initiated a pharmacist-led discharge medication reconciliation (DMR) workflow to optimize COPD therapy with a goal to maintain readmission rates below 16%. However\, the clinical reach of this program and the rate of provider acceptance of these recommendations is not well established. This study aimed to evaluate physician acceptance of pharmacist-driven COPD therapy recommendations and its association with 30-day readmission rates.\n \nMethods: This retrospective chart review included patients ≥65 years of age with COPD\, discharged home from AdventHealth Orlando between January and September of 2025. Data collected included demographics\, pharmacist interventions\, recommendation types\, provider response\, and 30-day readmission outcomes. Descriptive statistics were used to evaluate intervention frequency\, acceptance rates\, and readmission outcomes. \n\nResults: A total of 168 patient encounters and 119 unique patients were analyzed. Pharmacist interventions were made in 14 (8.3%) patient encounters\, and the majority (n=10\; 71.4%) were to recommend adding an additional agent to the patient’s current regimen. Of the 14 pharmacist interventions\, 9 (64.3%) were accepted by the provider. Overall\, 30-day readmissions occurred in 22 (18.5%) patients and 59 (35.1%) encounters. Out of the nine encounters with accepted interventions\, 4 (44.4%) had a 30-day readmission. Due to the low intervention rate\, comparative analysis between accepted and non-accepted recommendations was limited. \n\nConclusions: Pharmacist interventions during discharge medication reconciliation were very limited in this dataset of elderly patients with COPD. Although readmission rates in this specific population remained above goal\, the low number of interventions restricts conclusions regarding the impact of recommendation acceptance on patient readmission rates. Future efforts should focus on the DMR workflow and evaluate various barriers surrounding pharmacist interventions on optimizing COPD therapy. \n\n CATEGORIES:TRANSITIONAL CARE (TC) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:2f4b7b4f8dbcaf3a1a64e31f816fcf5c URL:http://2026serc.sched.com/event/2f4b7b4f8dbcaf3a1a64e31f816fcf5c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Impact of Embedded Clinical Pharmacy Services on Glycemic Control in an Internal Medicine Clinic DESCRIPTION:Title: Impact of Embedded Clinical Pharmacy Services on Glycemic Control in an Internal Medicine Clinic \;\n\nAuthors: Kisara Thompson\, Tacorya Adewodu\, Andrew Bundeff\, Molly Hinely\, Danielle Baker\, Michael DeWitt \;\n\nObjective: Evaluate the effect of clinical pharmacy services on A1c reduction in patients with type 2 diabetes and a baseline A1c of ≥ 8%\, compared with patients who were managed by usual care\, defined as a primary care provider acting as the sole responsible diabetes managing provider. \;\n\nBackground: Uncontrolled type 2 diabetes results in serious health complications. Hemoglobin A1c is used to measure average blood glucose over the past three months and is used to guide optimal treatment plans. Studies have demonstrated an improvement in microvascular and macrovascular complications in patients with improved glycemic control in those with type 2 diabetes. \;\n\nThe Winston-Salem East Clinic\, a part of Atrium Health Wake Forest Baptist\, is the primary study site. It is a medical resident-run internal medicine clinic that serves a large population of underserved and uninsured patients. Since March of 2023\, a clinical pharmacist practitioner (CPP)\, has been integrated into the clinic two days of the week working under collaborate practice agreements with supervising physicians. Patients with uncontrolled type 2 diabetes are referred to the CPP to provide medication management.  \;\n\nMethods: This single-center\, retrospective\, cohort study compared mean percent change of A1c managed by a primary care provider (PCP) versus A1c managed by a CPP. Patient data was collected between July 1st\, 2023 and October 31st\, 2025. Patients included were ≥ 18 years of age\, diagnosed with type 2 diabetes\, and those who had completed at least two follow-up visits with their PCP or clinical pharmacist. Patients excluded were the following: type 1 diabetes\, managed by endocrinology\, seen by non-network PCPs\, pregnant\, lost to follow-up – defined as no additional follow-up appointments or A1c labs drawn within the study time frame. Demographic information such as sex assigned at birth\, age at encounter\, race and ethnicity and primary payor were collected. The primary outcome assessed was mean percent change in A1c at 90- and 180- days with and without established clinical pharmacy management. Secondary outcomes included clinical interventions made\, number of continuous glucose monitors (CGMs) prescribed\, and incidence of diabetes related emergency department visits and/or hospitalizations during the study time frame. Patients were identified through a data sorting platform within the electronic health record.  \;\n\nResults: A total of 144 patients were enrolled in the study\, with 72 patients per study group. The primary endpoints were statistically analyzed by linear regression. Adjusting for baseline A1c\, there is an average reduction of 1.2 percentage points in A1c measured at 90-days in patients managed by a pharmacist\, compared to patients managed by usual care (95% CI: -2.0 – (-0.36)\, p-value: 0.005). Adjusting for baseline A1c\, there is an average reduction of 1.3 percentage points in A1c measured at 180-days in patients managed by a pharmacist\, compared to patients managed by usual care (95% CI: -2.1 – (-0.46)\, p-value: 0.003). Pharmacist managed patients were approximately eight times more likely to have their insulin therapy changed compared to patients who were managed by usual care (95% CI: 1.3 – 2.9\, p-value: 0.001). There were no differences associated with rates of change in other medication therapy changes. During the study period\, pharmacy managed patients had approximately a 53-point higher prescription rate for a CGM than those managed by usual care. There were no differences detected in the incidence rates between pharmacy managed and usual care patients in regard to ED and/or hospitalizations related to type 2 diabetes within the study period. \n\nConclusions: Among patients with type 2 diabetes and a baseline A1c ≥ 8%\, clinical pharmacy management was associated with a statistically significant greater reduction in A1c compared with usual care management with mean reduction of 1.2 and 1.3 percentage points at 90-days and 180-days\, respectively. \; CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:e4b3decc4d5e48e2e82bcafa810e0bcd URL:http://2026serc.sched.com/event/e4b3decc4d5e48e2e82bcafa810e0bcd END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Utility of ZOLL Heart Failure Management System (HFMS) in the management of chronic heart failure DESCRIPTION:Title: Utility of ZOLL Heart Failure Management System (HFMS) in the management of chronic heart failure \;\n\nAuthors: Emily Rudisell\, Laura Jane Straw\, James Ampadu\, Melissa Redmond\, Joseph Bates\, Lauren Lyons  \; \;\n\nBackground: Heart failure with reduced ejection fraction (HFrEF) remains a burdensome disease in which patients experience progressive neurohormonal activation leading to worsening symptoms\, fluid retention\, and recurrent exacerbations. Guideline-directed medical therapy (GDMT)\, as recommended by the 2022 AHA/ACC/HFSA Heart Failure Guidelines\, has been shown to significantly reduce morbidity and mortality in these patients\; however\, timely medication titration remains challenging. Non-invasive remote monitoring offers the opportunity to detect changes in fluid status earlier\, allowing expedited interventions and potentially supporting optimization of GDMT. The ZOLL Heart Failure Monitoring System (HFMS) is a first-in-class non-invasive wearable patch-based device that utilizes a transdermal radiofrequency sensor to monitor pulmonary fluid levels. This system generates alerts when predefined fluid thresholds are exceeded\, prompting clinical evaluation and treatment. Despite increasing clinical use\, real-world data describing HFMS and its role in supporting GDMT optimization remain limited. This study aims to characterize the impact of outpatient HFMS utilization and to evaluate its potential to decrease time to GDMT optimization and reduce HF-related morbidity and readmissions. \;\n\nMethods: This single-center\, retrospective cohort study included adult patients with HFrEF who were prescribed HFMS by an advanced heart failure provider. The primary endpoint was time to GDMT optimization following HFMS initiation\, defined as the number of days to achieve maximally tolerated dose of GDMT\, compared with patients who were prescribed HFMS but were unable to receive it due to insurance denial. Secondary endpoints included HF related readmission rates at 30 and 90 days after HFMS use discontinuation\, comparison of HF readmission rates 6 months before and after HFMS utilization\, frequency of thoracic fluid index alerts\, and the presence of clinical interventions in response to alerts. Data was collected from the electronic health record and HFMS monitoring system. Primary outcomes were analyzed using generalized estimating equations and descriptive analyses. Secondary outcomes were interpreted using a McNemar test\, Wilcoxon signed ranked test with Hodges-Lehmann estimator\, and descriptive analyses.  \;\n\nResults: In progress.  \;\n\nConclusions: In progress. \;\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:4f4d5ae3402939213ab1921f8954595e URL:http://2026serc.sched.com/event/4f4d5ae3402939213ab1921f8954595e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Evaluating the Accuracy of Medication Histories of Behavioral Health Patients in the Emergency Department DESCRIPTION:Background: Accurate medication histories reduce the likelihood of medication errors in patients being admitted to the hospital. Medication histories can inform inpatient providers of what medications the patient is taking prior to the emergency department encounter. Existing literature corroborates that pharmacist involvement in the medication history process leads to less discrepancies. Regarding patients in the emergency department with behavioral health problems\, pharmacists are ideally qualified to collect accurate medication histories in this patient population. At our institution\, medication histories for behavioral health patients are nursing-led. The purpose of this study is to determine the accuracy of medication histories collected for behavioral health patients in the emergency department.  \; \;\n \;\nMethodology: Over a specified 4-month period\, patients admitted to the behavioral health units of CaroMont Regional Medical Center’s emergency department (ED) had their medication histories performed by a member of the pharmacy team following completion by nursing staff. Patients aged 18 years or older roomed in behavioral health areas of the ED with a medication history completed by nursing staff were eligible for inclusion. Pregnant and incarcerated patients were excluded. For each patient\, investigators utilized interviews with the patient or patient’s caregiver(s)\, prior to encounter medication lists\, medication dispense histories\, facility medication administration records\, and telephone consultations with primary care providers\, pharmacies\, or facilities to collect information regarding a patient’s prior to encounter medications. Investigators then compared findings from the pharmacist-completed medication histories to the medication history completed by nursing staff. Any discrepancies between medication histories were collected as data and corrected in the electronic medical record. Additional data collected included patient demographics\, reason for emergency department visit\, and time taken to complete each medication history. Primary endpoint data were reported descriptively for the number of discrepancies across the cohort. Secondary endpoint data were reported descriptively for number of prior to encounter medications per patient\, number of discrepancies per patient\, and types of discrepancies (including omissions/erroneous exclusions\, commissions/erroneous inclusions\, drug name errors\, drug formulation errors\, drug dose errors\, and drug regimen errors). \n \;\nResults: During the specified data collection period\, 92 patients were screened. Thirty patients had prior to encounter medications reviewed. Female sex accounted for 53.3% of patients and median age was 34 years. Reasons for exclusion are described below.  \;\n\nExclusion Reason \;n (%) \;\nChief Complaint not Psychiatric \;51 (82.1) \;\nPatient Admitted 5 (8.3) \nPatient Discharged 2 (3.2) \nPatient Condition 2 (3.2) \nPrior to Encounter Medications Reviewed by PTA Technician \;1 (1.6) \;\nPrior to Encounter Medications Not Reviewed by Nursing During Encounter 1 (1.6)\n \nAcross the 30 patients whose prior to encounter medications were reviewed\, 71 discrepancies were identified- an average of 2.33 discrepancies per patient. Patients had an average of 6.23 prior to encounter medications\, and the average time for medication history completion was 6.13 minutes. The specific type of discrepancies among the 71 identified are broken down in the table below. \;\n\nDiscrepancy Type \;n (%) \;\nCommission 31 (43.1) \nOmission 21 (29.9) \nRegimen 9 (12.8) \nDose 8 (11.4) \nFormulation 2 (2.8) \nName 0 (0) \n \;\nConclusion: Based on our findings\, pharmacy personnel are in a position to optimize the detection and correction of discrepancies following an initial nursing driven review of behavioral health patients’ prior to encounter medications. Due to the nature of how the study was conducted\, limitations of this study include that it cannot be determined how many discrepancies were already corrected by nursing personnel\, or how many discrepancies were not identified by investigators. Additional limitations are that the mental state of patients may have contributed to inadequate histories\, as well as previous medication changes having gone undetected during transfers to other care areas. \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:2f698f733d58afa1398e96730b7b680f URL:http://2026serc.sched.com/event/2f698f733d58afa1398e96730b7b680f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Evaluation of the use of 3% sodium chloride in traumatic brain injury DESCRIPTION:Authors: \;Yasmeen A. Ettrick\, Kelly M. Bodine\, John Patka\, Shauntrell Johnson\nBackground: \;Traumatic brain injury (TBI) is a major cause of morbidity and mortality and is frequently complicated by cerebral edema and elevated intracranial pressure. Osmotic therapy with hypertonic saline is a key intervention to mitigate secondary brain injury\; clinical guidelines\, however\, recommend its use for symptomatic neurologic deterioration rather than prophylactic administration. At Grady Memorial Hospital\, 3% sodium chloride is commonly used in the emergency department (ED)\, often prior to neuroimaging due to clinical urgency.\nMethods: \;This single-center\, retrospective cohort study was conducted at Grady Memorial Hospital\, a Level I trauma center in Atlanta\, Georgia. Adult patients (≥18 years) presenting to the emergency department with traumatic brain injury who received at least one dose of 3% sodium chloride between January 1 and June 30\, 2024\, were included. Patients were excluded for pregnancy\, incarceration\, non-traumatic indications\, transfer from outside facilities\, or initial administration after hospital admission. The primary outcome was appropriateness of 3% sodium chloride use\, defined by the presence of clinical findings and radiographic evidence of herniation or midline shift. Secondary outcomes included total volume administered and changes in serum sodium and osmolarity.\nResults: \;A total of 65 patients met inclusion criteria\, of whom 57 received 3% hypertonic saline prior to CT imaging and 8 received it after imaging. Patients treated prior to CT were younger (median age 40 vs 62 years\, p = 0.056) and had lower Glasgow Coma Scale scores (median 4 vs 11\, p = 0.013)\, while hemodynamic parameters were similar between groups. Appropriateness of 3% sodium chloride use was observed in 54.4% of pre-CT administrations compared with 25% post-CT\, though this difference was not statistically significant (p = 0.149). Median total volume administered was 500 mL prior to CT and 250 mL after CT\, with no significant difference. Median serum sodium increased by 5 mEq/L in the pre-CT group and 4 mEq/L in the post-CT group (p = 0.635)\, while median serum osmolarity increased by 8 mOsm/L and 3 mOsm/L\, respectively (p = 0.45).\nConclusion: \;In this cohort\, 3% hypertonic saline was most often administered before CT imaging\, typically in patients with more severe neurologic impairment. Pre-CT administrations were more frequent and more likely to meet guideline criteria than post-CT hypertonic administration\, though some still lacked clinical or radiographic indications. Neither pre-CT nor post-CT administration was associated with harmful changes in serum sodium or osmolarity\, suggesting that early use may be safe when clinically justified.\nObjective: To evaluate the timing\, utilization patterns\, and physiologic effects of 3% sodium chloride administration in adult ED patients with TBI.\nSelf-Assessment Question: Identify the recommended indication for hypertonic saline use in adult patients with traumatic brain injury. \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:a07453b32bac40d572200a0bfd614674 URL:http://2026serc.sched.com/event/a07453b32bac40d572200a0bfd614674 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Evaluation of Two Four-Factor Prothrombin Concentrates for Anticoagulant Reversal DESCRIPTION:Title: Evaluation of Two Four-Factor Prothrombin Concentrates for Anticoagulant Reversal  \; \;\nAuthors: Mary G. Johnson\, Jessica Hernandez\, Annmarie Vallomthail\, Kristina Larizadeh\, Nina Casanova\, Feras Akbik\nBackground: Vitamin K antagonists (VKAs) and factor Xa inhibitors are oral anticoagulants used for the treatment and prevention of thromboembolic events. Bleeding is the most common adverse effect of oral anticoagulants\, and rapid reversal may be required in cases of severe hemorrhage or when urgent surgery is indicated. Four-factor prothrombin complex concentrates (4F-PCCs)\, including Kcentra® and Balfaxar®\, are standard treatments for reversal of VKAs and factor Xa inhibitors. Emory University Hospital recently changed formulary agents from Kcentra® to Balfaxar®. In one clinical trial\, Balfaxar® was found to be non-inferior to Kcentra® for the reversal of warfarin for urgent surgery\; however\, there is a paucity of data directly comparing these agents for VKA and factor Xa inhibitor-related bleeding. Limited data and lack of guideline recommendations for a preferred 4F-PCC contribute to clinical uncertainty in selecting an optimal reversal agent. The objective of this study is to evaluate the safety and efficacy of Balfaxar® vs. Kcentra® for reversal of VKAs and factor Xa inhibitors.  \; \;\nMethods: This study is an Institutional Review Board-approved\, single-center\, retrospective chart review of patients who received 4F-PCC from December 4\, 2024 to August 1\, 2025. Patients were included if they were at least 18 years of age\, presented to Emory University Hospital\, and received at least one dose of 4F-PCC for reversal of a VKA or factor Xa inhibitor. Patients were excluded if they received 4F-PCC at an outside hospital or for procedural use\, were concomitantly taking a P2Y12 inhibitor\, had a history of a congenital bleeding disorder\, or were pregnant\, nursing\, or incarcerated. The primary outcome was hemostatic efficacy. Hemostatic efficacy in intracerebral hemorrhage (ICH) patients was defined as change in hematoma volume ≤ 20% or 21-35% within 24 hours of baseline without a repeat 4F-PCC dose or surgical intervention within 24 hours. In non-ICH patients\, hemostatic efficacy was defined as a hemoglobin drop ≤ 2g/dL within 24 hours\, or transfusion of <\; 2 units of packed red blood cells without a repeat 4F-PCC dose or surgical intervention within 24 hours. Secondary outcomes include in-hospital mortality\, thrombotic events\, ICU length of stay\, hospital length of stay\, and number of repeat doses within 48 hours. Descriptive statistics will be used to summarize the continuous and categorical variables. Chi-squared tests will assess differences in outcomes between treatment groups.  \;\nResults: Out of 71 patients\, 37 patients were included in the Kentra® group and 34 in the Balfaxar® group. Baseline characteristics were similar between the groups except BMI of 25-29.9 kg/m2 was notably different (45.9% vs. 14.7%\, p=0.004). A total of 20 patients in the Kcentra® group and 19 in the Balfaxar® group met the primary outcome of hemostatic efficacy (54.1% vs. 50.0%\, p=0.877). There were notable differences between in-hospital mortality (13.5% vs. 32.4%\, p=0.058) and number of repeat doses (0.0% vs. 8.8%\, p=0.065)\, but these findings\, along with the other secondary outcomes\, were not statistically significant. However\, there was a significant increase in thrombotic events (ischemic stroke) in the Balfaxar® group (0.0% vs. 14.7%\, p=0.016).  \;\nConclusion: \;There was no significant difference in hemostatic efficacy between \;Kcentra® \;and \;Balfaxar®. \;While no difference in efficacy was \;observed\, ischemic stroke\, in-hospital \;mortality\, and repeat doses within \;48 hours \;were more notable in the \;Balfaxar® \;group. \;Larger \;studies \;are needed to \;validate \;these results and further guide the selection of the \;optimal \;reversal agent.\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:9ff2ab7e7509227c15a1691ead6dfb77 URL:http://2026serc.sched.com/event/9ff2ab7e7509227c15a1691ead6dfb77 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Optimizing Rabies Post-Exposure Management: Assessing Immunoglobulin Use and Vaccination Follow Up DESCRIPTION:Optimizing Rabies Post-Exposure Management: Assessing Immunoglobulin Use and Vaccination Follow Up  \; \;\n\nQuartney Gilliam\, Mckenzie Hodges\, Bianca Rivera-Ramirez\, Aayush Patel \;\n\nPiedmont Columbus Regional Midtown\, Columbus\, GA \;\n\nBackground: Rabies is a viral infection that is fatal without timely and proper intervention. Transmission most commonly occurs through the bite of an infected animal\, with dogs representing the predominant source of human exposure. Current guidelines emphasize rapid and comprehensive post-exposure prophylaxis (PEP)\, which includes immediate wound cleansing\, prompt administration of human rabies immunoglobulin (HRIG)\, and initiation of the vaccine series. Although PEP is highly effective when given appropriately and on time\, its real-world implementation is often challenged by system level and institutional barriers. These include delays in starting treatment\, late or missed doses of HRIG or vaccines\, variability in provider adherence to protocols\, poor patient follow-up\, as well as significant strain on both patients and the healthcare system when navigating multiple visits across different facilities\, possibly leading to confusion and fragmented care. To help reduce unnecessary repeat emergency department visits and improve continuity of care\, patients presenting to Piedmont Columbus Regional Midtown (PCRM) or Piedmont Columbus Northside (PCN) emergency departments may be referred to Midtown Medical Clinic (MMC)\, a transitional care clinic\, for follow-up rabies vaccinations. This study aims to evaluate the effectiveness of the current institutional rabies PEP protocols implemented at both PCRM as well as PCN\, identify gaps in its application\, and explore strategies to improve adherence\, timeliness\, and patient outcomes after a potential rabies exposure. \;\n\nMethodology: We conducted an IRB‑approved retrospective chart review of patients presenting to the emergency departments of PCRM or PCN from January 1\, 2025\, to December 31\, 2025. This review included all patients who presented with a chief complaint of an animal-related bite or scratch. Patients were excluded if they transferred to another facility after evaluation or PEP initiation\, left against medical advice\, refused vaccination\, or had insufficient documentation to determine exposure type\, treatment\, or follow‑up. The primary outcome measured adherence to CDC rabies PEP guidelines by determining whether eligible patients received indicated HRIG and/or vaccine and identifying both missed treatment and treatment given to patients who did not meet criteria. The secondary outcomes evaluated instances where clinical criteria for initiating rabies PEP were not met\, follow-up compliance\, and the rate and factors associated with referral to MMC for follow-up care. The outcomes were assessed using descriptive statistics. \n\nResults: \;Among 200 screened patients (157 adults and 43 pediatric patients)\, eligibility for rabies post‑exposure prophylaxis (PEP) was identified in 42% of adults and 56% of pediatric patients. Among eligible patients\, 77% of adults and 50% of pediatric patients were initiated on PEP\, while 9% of ineligible adults and 10% of ineligible pediatric patients received PEP. Follow‑up after PEP initiation varied\, with 25% of adults and 43% of pediatric patients completing the full vaccination series\, and differences in follow‑up location observed based on the site of initial presentation. \n\nConclusions: \;In this evaluation adult rabies PEP initiation largely aligned with CDC guidance with most eligible adults receiving therapy and minimal use among those without indications. In contrast\, initiation among pediatric patients meeting eligibility criteria was inconsistent. Across both age groups completion of the rabies vaccination series remained challenging\, highlighting persistent barriers to follow‑up after initial PEP initiation.\n\nContact: quartney.gilliam@piedmont.org CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:2967a7fe173347beb43da2a8cd8dfecf URL:http://2026serc.sched.com/event/2967a7fe173347beb43da2a8cd8dfecf END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Valproic Acid for Seizure Prophylaxis and Reduction of Headache Burden Following Subarachnoid Hemorrhage - Kristin Lanier DESCRIPTION:Valproic Acid for Seizure Prophylaxis and Reduction of Headache Burden Following Subarachnoid Hemorrhage \nMichael Wagner\, Kristin Lanier\, Jenna Sorgenfrei\n\nBackground:  \;\nAneurysmal subarachnoid hemorrhage (aSAH) management includes possible surgical intervention\, blood pressure control\, management of hydrocephalus\, vasospasm prevention\, and seizure prophylaxis. Guidelines do not currently recommend a specific seizure prophylaxis agent for aSAH. Levetiracetam is commonly selected in favor of the benign side effect profile and overall patient tolerability\, yet it does not address any additional symptoms of aSAH. Valproic acid not only provides seizure prophylaxis but has demonstrated benefits in both migraine prophylaxis and headache treatment. The objective of this study is to determine if switching from levetiracetam to valproic acid reduces headache burden in patients based on utilization of pain medication for breakthrough symptoms  \;\n\n Methods: \;\nA single-center\, retrospective\, cohort study identified adult patients admitted to the neurological intensive care unit of Prisma Health-Upstate between September 1\, 2023 to September 1\, 2025 with a diagnosis of aneurysmal subarachnoid hemorrhage. Seizure prophylaxis with levetiracetam was compared to valproic acid to determine the difference in overall headache burden based on breakthrough pain medication administration. Secondary outcomes include seizure incidence\, intensive care unit length of stay\, transcranial doppler changes\, and incidence of adverse effects \;\n\nResults: \;\nA total of 115 patients were included with 66 in the levetiracetam group and 49 in the valproic acid group. Patients were prescribed similar pain regimens including scheduled gabapentin\, lidocaine patches\, and acetaminophen as needed in both the valproic acid group and levetiracetam (39.4% vs. 67.3%). For the primary outcome of daily headache incidence\, there was a statically significant difference in favor of the levetiracetam group (3.0 vs. 2.4\, P = 0.02). Additionally\, patients in the valproic acid group demonstrated more frequent use of both as needed and breakthrough pain medication utilization. No differences were found in adverse effects.  \; \n\nConclusions:\nSeizure prophylaxis with valproic acid did not reduce headache incidence or pain medication utilization following nontraumatic subarachnoid hemorrhage. These findings support the use of either valproic acid or levetiracetam as seizure prophylaxis\, with no added benefit seen in the valproic acid group.  \; \n\n\nResident Contact: Kristin.lanier@prismahealth.org CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:1b6c6c4a0ea262c2fbf2f11990a0a594 URL:http://2026serc.sched.com/event/1b6c6c4a0ea262c2fbf2f11990a0a594 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Improving Timeliness and Sequencing of Empiric Antibiotics in Sepsis Through a Standardized Order-Set DESCRIPTION:BACKGROUND: Sepsis is a leading cause of hospital morbidity and mortality. While current Surviving Sepsis Guidelines emphasize early broad-spectrum antibiotic administration\, they do not address sequencing. Evidence suggests that delays in gram negative coverage\, against Escherichia coli\, Klebsiella pneumoniae\, and Pseudomonas aeruginosa\, are associated with increased mortality\, and administration of broad-spectrum beta lactams prior to vancomycin may improve survival. In practice\, initiation of antibiotic therapy is delayed due to lack of IV access\, blood culture collection\, medication verification\, and absence of standardized order sets. These limitations are greater among spinal cord (SCI) and traumatic brain injury (TBI) patients who have atypical presentations complicating early sepsis recognition. The aim of this study is to assess the order of appropriate antibiotic administration\, delays in administration from lack of intravenous (IV) access\, and timing of blood culture collection to support creation of a sepsis order set.\n \nMETHODS: \;This is a single-center\, retrospective\, quality improvement project performed at a rehabilitation center. Patients (≥18 years) admitted between July 1\, 2023\, and July 31\, 2025\, who met systemic inflammatory response (SIRS) criteria and received IV vancomycin and one gram-negative agent for sepsis or neutropenic indications were included. Patients were excluded if antibiotic timing was inadequately documented. \nData collected included patient demographics\, injury type (SCI or TBI)\, sepsis indicators\, timing of sepsis recognition\, antibiotic timing and sequencing\, blood culture collection\, lactate measurement\, IV fluid resuscitation\, and IV access placement.  \;\n\nThe primary outcome was sequencing\, including gram-negative coverage first followed by gram-positive coverage antibiotics. Secondary outcomes included time between gram-negative and gram-positive therapy\, percentage of patients with cultures drawn before antibiotic administration\, frequency of IV-related delays\, and type of IV line. Data was analyzed using descriptive statistics. \;\n\nRESULTS: A total of 65 patients meeting SIRS inclusion criteria were evaluated. The median age was 34 years old (SD 18.8)\, with males comprising 81.5% of the cohort (n=53). Injury classifications included SCI (n=24\, 37%)\, TBI (n=26\, 41.5%)\, and dual (n=14\, 21.5%) diagnoses. \nWhen vancomycin was administered prior to gram-negative therapy\, the mean delay to gram-negative coverage was 141 minutes. Upon further analysis\, vancomycin was administered first in 15.4% of encounters\, while gram negative agents were more frequently administered first\, including piperacillin-tazobactam (57%)\, cefepime (20%)\, and meropenem (7.6%).  \;\n\nIn 20% of encounters\, blood cultures were either obtained after the first antibiotic dose or not obtained. IV access was not established prior to antibiotic ordering in 46.2% of patients. Antibiotics were administered via peripheral IV (75%)\, midline (11%)\, or peripherally inserted central catheter (14%). \; \n\nCONCLUSIONS: Administering vancomycin first resulted in an expected delay of more than two hours before effective gram-negative coverage. This delay was likely due to the standard vancomycin infusion time at this facility. Because delays in antibiotic administration increase mortality in sepsis\, education on Y-site compatibility is essential to allow compatible agents to be administered simultaneously and facilitate faster\, more efficient antibiotic delivery. Moreover\, 20% of blood cultures were collected inappropriately\, compromising diagnostic accuracy and limiting targeted antibiotic therapy\, highlighting the need for reinforcement of proper culture collection. \n\nAdditionally\, nearly half of patients meeting sepsis criteria at the time of antibiotic ordering did not have IV access\, reflecting a challenge unique to rehabilitation settings\, where the goal is early discontinuation of IV lines to enhance mobility\, minimize line associated complications\, and support functional recovery. However\, for sepsis\, a delay in IV access inadvertently leads to a delay in antibiotic administration. \;\nThese findings show inconsistent sepsis workflows and clinically relevant delays which can impact patient outcomes\, highlighting the need for a standardized sepsis order set in rehabilitation hospitals to streamline IV access\, culture collection\, and appropriate antibiotic prioritization. \;\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:caa9b2f7d4971af1e97720f3d527b84e URL:http://2026serc.sched.com/event/caa9b2f7d4971af1e97720f3d527b84e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Improving Pharmacy Inventory Management with Real-Time Barcode Scanning DESCRIPTION:Background:\nAccurate inventory management is essential for operational efficiency\, yet traditional models relying on periodic third-party counts limit real-time visibility and delay error correction. Over the previous years\, several audit processes have been trialed\, each with varying trade-offs related to ease of use\, time requirements\, utility\, and interruption of standard workflows. A significant amount of time was spent after the counts were completed\, reconciling discrepancies in the third party data including medications that could not be accurately identified based on barcode scans. Our institution recently transitioned from a biannual\, vendor-supported inventory process to an internally managed model\, revealing workflow inefficiencies and gaps in issue identification due to reliance on delayed data systems and fragmented scanning processes. To improve workflow and data integrity\, a real-time barcode scanning tool was developed and iteratively refined to facilitate live inventory validation.\n\nMethods:\nThe tool enables immediate feedback during both full inventory counts and targeted audits. Key development considerations included optimizing data refresh processes\, accommodating large and variable datasets\, and enhancing usability through simplified visual indicators to reduce user fatigue.  \;Over time\, improvements focused on minimizing error rates and improving workflow integration.\n\nResults:\nImplementation of the tool improved operational efficiency by reducing the need for dual auditors and minimizing workflow interruptions. The system enhanced auditor autonomy by removing the need for individual assignments and enabling users to validate counts independently in real time. It also decreased duplication of counts and enabled immediate identification and correction of discrepancies\, reducing the number of recounts required.\n\nConclusions:\nA real-time barcode scanning approach to inventory management enhances efficiency\, accuracy\, and staff autonomy. This solution addresses key limitations of traditional inventory processes and supports proactive discrepancy resolution. Ongoing evaluation during a full live-count inventory will further quantify its impact on time savings and error reduction.\n\n CATEGORIES:INFORMATICS (INF) LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:7b57aef87a6002f3d3d21f2d9f64e6a3 URL:http://2026serc.sched.com/event/7b57aef87a6002f3d3d21f2d9f64e6a3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Impact of Integrating the BioFire® Meningitis/ Encephalitis Panel (MEP) with Antimicrobial Stewardship in a Non-Teaching Community Hospital DESCRIPTION:Title: \;Title: Impact of Integrating the BioFire® Meningitis/ Encephalitis (ME) Panel with Antimicrobial Stewardship in a Non-Teaching Community Hospital \n\nInvestigators: Ashtyn Keller\; Brad Crane\; Emily Duncan\; Stephanie Grimes\; Joy (Abby) Bussey \;\n\nStudy Location: Prisma Health Blount Memorial Hospital\, Maryville\, TN – Department of Pharmacy \;\n\nBackground: Limited data exists on the clinical and financial impact of rapid cerebrospinal fluid (CSF) diagnostic testing in non-academic community hospitals. This study evaluated the effect of implementing the BioFire® MEP on patient outcomes and hospital resource utilization.  \;\n\nMethods: This IRB-approved\, single-center\, retrospective cohort study included adults hospitalized from July 2020 through June 2025 with an identified CSF culture ordered. Exclusion criteria were if less than 18 years old\, test cancellation or non-completion\, transfer to another facility\, repeat CSF specimens from the same patient or infection\, or treated outpatient only. The primary outcome was time to optimal antimicrobial therapy in patients without the BioFire® MEP or with the BioFire® MEP. Secondary outcomes compared duration of antimicrobial therapy\, hospital length of stay\, and hospital costs per visit. Student’s t-tests were used with significance defined as p <\; 0.05. \;\n\nResults: A total of one hundred and twenty-one patients were included: eighty-seven patients (72%) did not utilize the BioFire® MEP\, and thirty-four patients (28%) utilized the BioFire® MEP. Median time to optimal antimicrobial therapy without the BioFire® MEP was 3.0 days compared to 2.0 days with the BioFire® MEP (absolute difference 1 day\; 95% CI 0.004 to 1.96\; p=0.04). Mean duration of antimicrobial therapy without the BioFire® MEP was 4.0 days compared to 2.9 days with the BioFire® MEP (absolute difference 1.1\; 95% CI -2.72 to 0.56\; p=0.19). Median hospital length of stay without the BioFire® MEP was 6.0 days compared to 4.5 days with the BioFire® MEP (absolute difference 1.5\; 95% CI -1.74 to 4.74\; p=0.36). Median hospital costs per visit without the BioFire® MEP were $8\,456 compared to $9\,854 with the BioFire® MEP (absolute difference $1\,398). \;\n\nConclusion: In conclusion\, this retrospective cohort study in a non-academic\, community hospital\, demonstrated that the implementation of the BioFire® MEP was associated with a significantly significant reduction in time to optimal antimicrobial therapy and potentially shorter antimicrobial duration and hospital length of stay. Additional large-scale studies are recommended to confirm these findings.\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:9275749dc43f1a7f3d312876c4fbb054 URL:http://2026serc.sched.com/event/9275749dc43f1a7f3d312876c4fbb054 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Impact of the Intravenous Lorazepam Shortage on Alcohol Withdrawal Treatment in the ICU DESCRIPTION:Background: The American Society of Addiction Medicine guidelines recommend benzodiazepines as first-line treatment for moderate-severe alcohol withdrawal syndrome (AWS). Intravenous (IV) lorazepam is a first-line therapy for AWS at Emory Healthcare (EHC) to prevent complications such as seizures and delirium tremens. The quick onset\, half-life\, and lack of metabolites make IV lorazepam a desirable agent for AWS. There have been intermittent shortages of IV lorazepam\, with the most recent shortage beginning in May 2025. In response\, EHC built an electronic alert as a soft stop for all IV lorazepam orders to notify providers of the shortage and recommend alternatives. In addition\, the AWS order set was modified to replace IV lorazepam with IV midazolam. The goal of this study was to understand medication utilization patterns during this shortage and provide guidance for future shortages.  \;\n\nMethods: This study was a multi-center\, retrospective chart review of adult patients receiving treatment for moderate-severe AWS from 1/30/2025 to 9/7/2025 in the ICU. Pre-shortage and post-shortage groups were determined based on IV lorazepam shortage alerts\, which began in EPIC on 5/20/2025. The primary objective was to examine medication utilization patterns of AWS before and after the alert was implemented. Evaluation of this endpoint was determined by medication name\, strength\, route\, frequency\, and duration for 48 hours after the alcohol withdrawal order set was active. Secondary objectives measured safety and clinical outcomes and included respiratory rates\, hypotension\, and changes in scores of Clinical Institute Withdrawal Assessment Alcohol Scale (CIWA)\, length of stay\, mortality\, 30-day readmissions\, respectively. Data was analyzed using descriptive statistics\, t-test\, and Mann-Whitney U test.\n \nResults: There were 127 patients in the pre-shortage group and 152 patients in the post-shortage group. Baseline characteristics were similar between groups. The average baseline CIWA scores were similar with first CIWA ≥8 13.44 pre-shortage versus 12.86 post-shortage. IV lorazepam doses were higher in the first 12 hours of the AWS order set ordering time. In the post-shortage group\, there was a greater decrease in IV lorazepam dose 12-24 hours post-alert (63.14% versus 43.72%). IV lorazepam orders trended down (57% versus 47%\, p-value 0.097)\, and patients prescribed oral lorazepam trended up (23% versus 32%\, p-value 0.081). More patients in the post-shortage group were prescribed chlordiazepoxide (5 versus 16 patients\, p-value 0.038) and midazolam (20 versus 45 patients\, p-value 0.006). Phenobarbital use did not change significantly (86 versus 89 patients\, p-value 0.115). First CIWA <\;8\, was similar at 4.37 pre-shortage versus 3.84 post-shortage. The average time to CIWA score <\;8 from the first score ≥8 was greater in the pre-shortage group 9 hours and 13 minutes compared to 8 hours and 37 minutes (p-value 0.205). Average hospital length of stay (12.39 versus 11.07 days\, p-value 0.290)\, average ICU length of stay (5.28 versus 5.44 days\, p-value 0.725)\, and mortality (5 versus 7 patients\, p-value 0.784) were similar between the two groups. Readmission within 30 days and respiratory depression were higher in the post-shortage group (12% versus 18%\, p-value 0.166 and 67% versus 73%\, p-value 0.267\, respectively).\n \nConclusion: Following IV lorazepam alerts\, medication utilization shifted towards chlordiazepoxide and midazolam. The average cumulative dose of IV lorazepam decreased more in the post-shortage group after the first 12 hours. Phenobarbital use may not have changed due to provider practice styles and the recommended alternatives. This was a retrospective study\, alerts for alternative agents could be bypassed\, and medications listed may have been used for other indications. Future direction includes evaluating alternative medication usage patterns with a developed phenobarbital order set. A comparative analysis focused on adverse drug events and efficacy may further shape treatment. \n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:aafba309058b4c83dc664ffd69aa88bf URL:http://2026serc.sched.com/event/aafba309058b4c83dc664ffd69aa88bf END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T135000Z DTEND:20260501T141000Z SUMMARY:Resident Presentation - Katherine Albus DESCRIPTION:Linezolid as Empiric Therapy for Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia: A Retrospective Cohort Analysis of Clinical Outcomes  \;\nKatherine Albus\, Kellee Geren\, Samantha Walker\, Brandon Hawkins \;\nThe University of Tennessee Medical Center\, Knoxville\, TN \;\n \;\nBackground/Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult-to-treat Staphylococcus species worldwide\, with mortality exceeding 20%. Vancomycin (VAN) or daptomycin (DAP) are considered first-line empiric therapies for MRSA bacteremia.  \;Small subgroup analyses have suggested improved survival and faster bacteremia clearance with linezolid (LZD) versus glycopeptides\, yet its role is largely unclear. This study aimed to compare the effectiveness of LZD versus VAN or DAP in patients with MRSA bacteremia.  \; \;\n \;\nMethodology: This single-center\, retrospective\, observational cohort study included hospitalized between December 2017 and June 2024. The primary outcome was a composite of 60-day all-cause mortality and bacteremia persisting greater than 7 days. Secondary outcomes included the individual components of the composite outcome\, duration of antimicrobial therapy\, duration of bacteremia\, and ICU admission. Eligible patients were 18 years of age or older\, had at least one MRSA-positive blood culture\, and received empiric LZD\, VAN\, or DAP for at least 48 hours from culture collection. VAN and DAP were assessed as composite groups. Exclusion criteria included death or transition to hospice within 48 hours of culture collection\, failure to receive a study antibiotic within 3 hours of culture\, receipt of a comparator antimicrobial for more than 24 hours\, or lack of susceptibility to the empiric agent. \;\n \;\nResults: There was no difference in patients receiving LZD or VAN/DAP in the primary composite outcome (0% LZD vs. 43.8% VAN/DAP\; P = 0.074) or the individual components of 60-day all-cause mortality (0%  \;LZD vs. 19.8%  \;VAN/DAP\; P = 0.580) and persistent bacteremia greater than 7 days (0% LZD vs. 32.6% VAN/DAP\; P = 0.319). The median duration of antimicrobial therapy was numerically shorter in the LZD group compared with the VAN/DAP group (19.5 days vs. 43 days\, respectively)\, though this was not significant (P = 0.143). ICU admission rates during treatment were comparable between groups (20% LZD vs. 38% VAN/DAP\; P = 0.646). The duration of bacteremia was significantly shorter among patients treated with LZD compared to VAN/DAP\, with median durations of 2.4 days and 5.5 days\, respectively (P = 0.036). \;\n \;\nConclusions: In a small sample\, empiric LZD for MRSA bacteremia demonstrated comparable rates of 60-day mortality and persistent bacteremia compared with VAN or DAP. LZD demonstrated a significantly shorter duration of bacteremia than VAN/DAP\, although these findings may be due to LZD use in less complicated infections. These results\, when considered alongside existing clinical and pharmacologic evidence\, support further investigation of LZD as a potential first-line option for MRSA bacteremia. Larger\, prospective studies are needed to better define the role of LZD in uncomplicated\, Gram positive infections with Gram negative coverage where appropriate.  \; \n\nLink: https://docs.google.com/document/d/e/2PACX-1vQzRhZffUvSQUgtz-e88XOkxVPWlCJON2KHAtHhLXttKCpq05YARaPn9673tC8gAzP64x3Ss3WU3wYN/pub CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:e08035391fa8cbc6c090920e34e077a5 URL:http://2026serc.sched.com/event/e08035391fa8cbc6c090920e34e077a5 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:4143637d9ed846d7b49c085f476b95c2 URL:http://2026serc.sched.com/event/4143637d9ed846d7b49c085f476b95c2 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:599f56de1c51655764c8b8dc699b990c URL:http://2026serc.sched.com/event/599f56de1c51655764c8b8dc699b990c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:720476192d7ccdc1ef9fedd65076539e URL:http://2026serc.sched.com/event/720476192d7ccdc1ef9fedd65076539e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:75f89f1fc0cb0bd80704857fda32aad4 URL:http://2026serc.sched.com/event/75f89f1fc0cb0bd80704857fda32aad4 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Evaluation of Pharmacist-Led Intervention to Improve Statin Utilization Metrics in a Value-Based Care Model - A. Garrett Allegra DESCRIPTION:Background: \;Value-based care models are growing in popularity. These models follow the logic that healthcare organizations should receive a higher level of reimbursement for providing more effective care. Reimbursement rates are determined by the health systems’ performance on pre-determined patient care metrics. Health organizations can achieve better outcomes while lowering costs through a value-based care model.1 Examples of commonly measured outcomes include A1c\, blood pressure\, and statin-utilization. Value-based care starts with understanding the shared health needs of your patients and then implementing an interdisciplinary team approach to meet those needs.1 AdventHealth Hendersonville (AHH) is a non-profit health system in Western North Carolina comprising 13 primary care clinics and one main hospital campus. AHH participates in value-based care for patients insured by Medicare through an organization called CHESS\, which deploys clinical pharmacists to aid in monitoring their metrics. One metric AHH focused on for 2025 is statin utilization for people with diabetes or atherosclerotic cardiovascular disease (ASCVD) history. Prior studies have demonstrated that cardiovascular disease is the number one cause of death in the world and that statins are largely underutilized by populations that would benefit from them.2 The most common barrier to initiation is patient refusal.2 Pharmacist-led interventions can improve statin utilization metrics.2 The objective of this quality improvement project was to improve statin utilization metrics via pharmacist-led clinic visits at AHH. \;Methods: \;A pre-existing registry of 161 Medicare Advantage patients not meeting statin utilization metrics was analyzed for intervention opportunity. The patients included had either a diagnosis of diabetes or history of ASCVD and were not currently taking a statin. Exclusion criteria included prior refusal of service by patient or provider\, statin already on medication list\, appropriate chart documentation of statin intolerance\, and not being a patient of the clinic site anymore. Prior refusal of service was documented in the pre-existing patient registry by CHESS pharmacists. A pharmacy resident reached out via phone to each patient a maximum of three times to attempt to schedule an in person or virtual visit focused on statin initiation or appropriate documentation of statin intolerance. At these pharmacy visits\, the pharmacy resident discussed hyperlipidemia\, statin use history\, and potential adverse effects and use clinical decision making to either initiate a statin or appropriately document true statin intolerance in the record. \;Results: \;After removing patients that met exclusion criteria\, 30 patients with diabetes and 4 patients with ASCVD history were included (n=34). Of the 30 patients in the diabetes group\, 19 were able to be reached by phone (63.3%). After an appointment with pharmacy clinic\, 15 of these (78.9%) were able to meet the quality metric\, with 2 patients initiated on statin therapy and 13 having statin intolerance appropriately documented in their chart. Of the other 4 patients reached\, 1 patient declined statin therapy despite counseling\, 1 patient’s primary care provider declined statin initiation\, and 2 patients were not indicated for statin therapy. In the ASCVD group\, all 4 patients were able to be reached (100%). After an appointment with pharmacy clinic\, 2 of these patients (50%) were able to meet the quality metric\, with both patients having statin intolerance appropriately documented in their chart. The other 2 patients reached both declined meeting with a pharmacist to discuss cholesterol management. Combining the datasets gives 17 patients updated to meeting the quality metric of 23 patients reached (73.9%) and 34 patients overall (50%). \;Conclusion: \;Pharmacist intervention can improve statin utilization metrics for patients with diabetes or ASCVD. Integrating clinical pharmacy into a value-based care model can be beneficial to organizational reimbursement rates due to this improvement in metrics. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:b99b3f24158b4d2eb311b15c5628dc98 URL:http://2026serc.sched.com/event/b99b3f24158b4d2eb311b15c5628dc98 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Clinical Outcomes Associated with Aspirin Dose in Traumatic Blunt Cerebrovascular Injury DESCRIPTION:Background: \;Stroke complicates up to 20% of traumatic blunt cerebrovascular injuries (BCVI)\, with the highest risk occurring within 72 hours of injury\, underscoring the importance of prompt antithrombotic therapy. Current guidelines from the Eastern Association for the Surgery of Trauma and the Western Trauma Association recommend antithrombotic therapy but differ in preferred agents and dosing strategies. Prisma Health Richland’s (PHR) institutional guideline recommends aspirin monotherapy for BCVI grades I–III without specifying dose. Data comparing aspirin dosing in BCVI are limited. One retrospective study reported a 3.5% stroke rate with aspirin 81 mg\, compared with previously reported rates of 2–8% using aspirin 325 mg. We sought to compare the incidence of ischemic stroke among patients with traumatic BCVI treated with aspirin 81 mg versus 325 mg. \;\n \; \;\nMethods: \;We conducted a retrospective cohort study of adult patients with traumatic BCVI treated with aspirin monotherapy at PHR from February 27\, 2021 to September 30\, 2025. Patients with stroke prior to aspirin initiation during index admission\, inconsistent aspirin dosing within the first 7 days\, or grade V BCVI were excluded. The primary outcome was ischemic stroke within 90 days of injury. Secondary outcomes included time to aspirin initiation\, adherence to repeat imaging guidelines\, worsening intracerebral hemorrhage (ICH)\, worsening solid organ injury\, gastrointestinal (GI) bleeding\, and in-hospital mortality. Baseline characteristics were compared using appropriate univariate analyses. Multivariable logistic regression was performed to evaluate the association between aspirin dose and ischemic stroke\, adjusting for BCVI grade and time to aspirin initiation. \;\n \; \;\nResults: This study included 130 patients with a traumatic BCVI who were treated with aspirin therapy for stroke prevention. Of those included\, 106 patients (81.5%) received aspirin 325 mg and 24 patients (18.5%) received aspirin 81 mg. Baseline characteristics were similar between the two treatment groups\, with the majority being African American males. The most common mechanism of injury was motor vehicle collision (73.8%)\, followed by injury due to a fall (16.2%) and assault (1.5%). Concomitant traumatic brain injury was present in 46.2% of patients\, while 13.8% of patients also had a solid organ injury. During the study period\, 12 patients (9.2%) experienced an ischemic stroke. Ten of these patients received aspirin 325 mg\, while 2 patients received aspirin 81 mg (p=1). Multivariate logistic regression with covariates BCVI grade and time to aspirin initiation demonstrated no different in the incidence of ischemic stroke with aspirin 325 mg (aOR 0.831\, 95% CI 0.951-1.003). \;The majority of patients (94.6%) had repeat imaging completed within the 7-day timeframe indicated in our local BCVI guidelines. A new or worsening ICH occurred in 22 patients\, the majority being in the aspirin 325 mg group (n=19\; p=0.764)\, and a GI bleed occurred in 5 patients\, all of whom received aspirin 325 mg (p=0.584). The overall mortality rate was 9.2% with 8 patients in the aspirin 325 mg group and 4 patients in the aspirin 81 mg group dying during the study period (p=0.225) \;\n \;\nConclusion: This retrospective cohort study found that patients with a traumatic BCVI were more frequently treated with aspirin 325 mg compared to 81 mg\, however\, there was no significant difference in the primary outcome comparing the incidence of ischemic stroke between these two treatment groups. There was a non-significantly higher incidence of new or worsening ICH and GI bleed in the aspirin 325 mg group. These findings suggest that a larger study with more variance in aspirin treatment may be beneficial to validate a correlation between aspirin dose and incidence of ischemic stroke. \;\n\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:0a419853ad97797869db0053f712b751 URL:http://2026serc.sched.com/event/0a419853ad97797869db0053f712b751 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Comparison of Tenecteplase versus Alteplase for Pulmonary Embolism During In-Hospital Cardiac Arrest  DESCRIPTION:Comparison of Tenecteplase versus Alteplase for Pulmonary Embolism During In-Hospital Cardiac Arrest  \;\nAuthors: Paola Reyes-Serrano\, Jason Vilar\, Emily To \;\nBackground: Pulmonary embolism (PE) accounts for approximately 2–5% of in-hospital cardiac arrests (IHCA) and is associated with high mortality despite advanced resuscitative efforts. Current guidelines recommend systemic thrombolysis when PE is suspected or confirmed during cardiac arrest\; however\, evidence supporting thrombolytic use in this setting remains limited. Alteplase has historically been the most commonly used thrombolytic agent for PE\, while tenecteplase offers potential advantages\, including greater fibrin specificity\, longer half-life\, and administration as a single intravenous bolus. This study aimed to compare clinical outcomes and safety of tenecteplase versus alteplase for suspected or confirmed PE during IHCA following a system-wide formulary change. \;\n\nMethods: A retrospective cohort study was conducted across AdventHealth facilities. Adult patients who experienced IHCA and received systemic thrombolysis with alteplase or tenecteplase for suspected or confirmed PE between January 2024 and January 2026 were included. Suspected PE was defined by provider clinical assessment at the time of arrest. Baseline demographic characteristics\, arrest characteristics\, laboratory values\, and PE risk factors were collected from the electronic health record. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes included time from arrest to thrombolytic administration\, time from thrombolytic administration to ROSC\, cardiopulmonary resuscitation (CPR) duration\, ICU and hospital length of stay\, in-hospital mortality\, and neurologic outcomes at discharge. Sustained ROSC was defined as ROSC maintained for at least 20 minutes. Safety outcomes included major bleeding events and blood transfusion requirements. Continuous variables were compared using Mann–Whitney U tests\, and categorical variables using chi-square or Fisher’s exact tests. \;\n\nResults: A total of 48 patients met inclusion criteria\, 26 received alteplase and 22 received tenecteplase. ROSC occurred in 16 patients (33%)\, 10 patients (38.5%) in the alteplase group and 6 patients (27.3%) in the tenecteplase group. Sustained ROSC occurred in 7 patients (15.4%)\, 4 patients (15.4%) in alteplase group and 3 patients (13.6%) in tenecteplase group. Median time from thrombolytic administration to ROSC was 9.5 minutes (IQR 1.75–12.75) with alteplase and 13.5 minutes (IQR 5.75–16.25) with tenecteplase. Median total CPR duration was 41.0 minutes (IQR 22.5–54.0) with alteplase and 33.5 minutes (IQR 22.0–48.8) with tenecteplase. CPR duration following thrombolytic administration was similar between groups (16.5 minutes in both groups). Median time from arrest to thrombolytic administration was 18.5 minutes (IQR 11–31.3) with alteplase and 14.5 minutes (IQR 6.75–27.3) with tenecteplase. In-hospital mortality occurred in 24 patients (92.3%) who received alteplase and 22 patients (100%) who received tenecteplase. Neurologic outcomes were similar\, with a median modified Rankin Scale (mRS) score of 6 (IQR 6–6) in both groups. Major bleeding occurred in 2 patients (7.7%) in the alteplase group and 2 patients (9.1%) in the tenecteplase group. Blood transfusion requirements were low\, occurring in 1 patient (3.8%) in the alteplase group and 2 patients (9.1%) in the tenecteplase group. Baseline characteristics differed between groups in several variables. Patients who received tenecteplase were older (66.5 vs 58.5 years) and had lower median weight (73.9 vs 99.5 kg). Tenecteplase dosing was appropriate based on weight in 19 of 22 patients (86%)\, while 3 patients (14%) received doses outside of recommended weight-based ranges.  \;\n\nConclusion: In this multicenter retrospective cohort of patients receiving systemic thrombolysis for suspected pulmonary embolism during in-hospital cardiac arrest\, tenecteplase demonstrated clinical and safety outcomes comparable to alteplase. Rates of ROSC\, bleeding events\, and mortality were similar between treatment groups despite baseline differences in patient characteristics. Given its single intravenous bolus administration and comparable outcomes observed in this cohort\, tenecteplase may represent a practical alternative to alteplase for thrombolytic therapy during cardiac arrest when pulmonary embolism is suspected. Larger prospective studies are needed to better define optimal thrombolytic selection in this high-risk population. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:381b7af75b2a88088ef6c995293a6f56 URL:http://2026serc.sched.com/event/381b7af75b2a88088ef6c995293a6f56 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Development of an Ongoing Quality Metric for Vancomycin Dosing DESCRIPTION:Elena Galagan\, Joy Peterson\, Karen Barlow\nWellstar Kennestone Regional Medical Center\, Marietta\, GA\n\nBackground\n\nVancomycin has a narrow therapeutic index\, requiring individualized pharmacokinetic dosing to maintain trough levels between 10–20 mcg/mL while minimizing the risk of acute kidney injury (AKI). Despite its common use\, many institutions lack formal metrics to assess vancomycin dosing appropriateness. This quality assurance project at Wellstar Kennestone Regional Medical Center (WKRMC) aimed to create a sustainable\, ongoing quality metric and real-time monitoring system for vancomycin dosing practices.\n\nObjectives/Methods\n\nThe project was conducted in two parts. The primary objective was to develop an ongoing quality metric that evaluates vancomycin dosing quality by monitoring therapeutic trough levels and AKI in adult patients. The secondary objective was to use this metric and Microsoft® Power BI dashboard to enhance decision-making and increase the proportion of patients achieving therapeutic targets.\nPart 1 (establishing a baseline) was a retrospective quality assurance project including data from three fiscal years (July 1\, 2021\, through June 30\, 2024). Adult patients who received intravenous vancomycin during an inpatient admission at WKRMC\, had vancomycin dosed by a clinical pharmacist\, and had at least one vancomycin trough level were included\; pediatric patients under 18 years were excluded. The baseline percentage of patients with therapeutic vancomycin levels (10–20 mcg/mL) was calculated to establish the goal for the metric.\nBaseline AKI incidence was determined by collecting up to three serum creatinine values around the time of trough collection and measuring the frequency of AKI as defined by Kidney Disease: Improving Global Outcome (KDIGO) criteria. A random sample of 123 patients was selected by choosing every 100th patient from each fiscal year for detailed review to validate the dashboard\, estimate data capture performance\, identify opportunities for improvement\, and refine variables.\nPart 2 (implementation) focused on developing a sustainable\, ongoing quality metric and monitoring dashboard. Core metric components included the percentage of patients achieving therapeutic trough levels and the incidence of AKI\, with stratification by key risk factors. Data elements were mapped to automated reports from Epic®\, aggregated in a secure environment\, and visualized in Microsoft® Power BI to create an interactive dashboard for clinical pharmacists. The dashboard was designed to support ongoing monitoring\, early detection of trends\, and continuous optimization of vancomycin dosing practices.\n \;\nResults\n\nThe 123-patient review validated data accuracy\, assessed variable performance\, and guided refinement of the quality metric. This process led to adjustments in data capture\, including the addition\, modification\, and removal of specific variables to enhance clinical relevance and reliability. Variables related to trough timing\, serum creatinine trends\, and AKI risk factors were refined to improve clarity and support clinical decision-making.\nFindings from the review were used to validate automated Epic® data feeds\, ensuring accurate representation of therapeutic trough attainment and AKI indicators. Based on these insights\, targeted education was provided to clinical pharmacists on interpreting dashboard metrics and using the tool for ongoing dosing evaluation. The finalized dashboard enables monitoring of vancomycin dosing\, supports trend and outlier identification\, and provides a foundation for continuous quality improvement.\n\nConclusion\n\nThis project developed and validated a sustainable\, ongoing quality metric for vancomycin dosing\, supported by an interactive Power BI dashboard. Although this project was conducted around vancomycin troughs\, the concept is also applicable to Area Under the Curve (AUC) targets. The goal of this initiative is to provide actionable information to clinical pharmacists to assess and improve vancomycin dosing accuracy\, with the intent of increasing the proportion of trough levels within the therapeutic range while supporting ongoing renal safety surveillance.\n\nContact: elena.galagan@wellstar.org CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:d6d127e1277605085988df76741b4a44 URL:http://2026serc.sched.com/event/d6d127e1277605085988df76741b4a44 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Evaluating the Impact of ACEi or ARB Reinitiation versus Discontinuation Post Hospitalization with Acute Kidney Injury on Patient Outcomes DESCRIPTION:Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) provide cardiovascular and renal protections across hypertension\, chronic kidney disease\, and heart failure populations\, yet are often held during episodes of acute kidney injury (AKI). Optimal timing of post-AKI reinitiation remains uncertain. We aimed to compare outcomes among patients whose ACEi or ARB therapy was restarted at different times.  \; \;\n \;\nWe conducted a single center\, retrospective cohort study of adult inpatients with AKI whose ACEi\, ARB\, or ARNI therapy was held ≥24 hours during hospitalization. Patients were categorized into 3 groups depending on whether therapy was restarted during hospitalization\, restarted upon discharge\, or not continued at discharge. The primary endpoint was complete renal recovery at 90 days. Secondary endpoints were AKI readmission rates within 90 days of discharge\, cardiovascular events and all-cause mortality at 12 months\, and time to treatment reinitiation in group 3. \;\n \;\nAmong 148 patients (Group 1\, n=41\; Group 2\, n=52\; Group 3\, n=55)\, there was no significant difference across groups in renal recovery at 90 days (73.2%\, 59.6%\, 67.3%\, respectively\; p=0.13). AKI readmission rates within 90 days (9.8%\, 19.2%\, 9.1%\, respectively\; p=0.25)\, cardiovascular events within 12 months (17.1%\, 7.7%\, 18.2%\, respectively\; p=0.22)\, and all-cause mortality within 12 months (12.2%\, 5.8%\, 7.3%\, respectively\; p=0.53) were similar across groups. Median (SD) time to reinitiation in group 3 was 60 ±94 days (p=0.049). \;\n \;\nEarly reinitiation of ACEi or ARB after AKI did not worsen renal recovery at 90 days or increase adverse events. These findings support timely reinitiation with appropriate monitoring.  \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:2e3f6d11d1c47b3960eabf586a14d285 URL:http://2026serc.sched.com/event/2e3f6d11d1c47b3960eabf586a14d285 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Evaluating the Outcomes of Pharmacist Driven Interventions in a Geographic Rounding Pilot at a Large Community Hospital DESCRIPTION:Oksana Buksa\, PharmD\, April Williams\, PharmD\, BCPS\, Michele Moseley\, PharmD\, BCPS\, Anna Cross\, PharmD\, Erik Roberts\, CPhT\nHuntsville Hospital – Huntsville\, Alabama\n\nPurpose/Background:\nHuntsville Hospital has announced the implementation of a hospitalist-led geographic rounding pilot that began on October 1st\, 2025\, which was designed to allow providers to care for patients within the same inpatient unit\, thereby maximizing efficiency and improving continuity of care\, with the goal of decreasing hospital length of stay. The service currently spans three inpatient floors and encourages hospitalists to prioritize rounding on patients who are discharging home first\, followed by those discharging to post-acute care facilities\, and subsequently\, all other patients remaining.  \;In addition\, Huntsville Hospital has a robust Transitions of Care team that includes pharmacists who play an integral role in facilitating patient discharges by reviewing discharge medication reconciliation and communicating with providers to clarify medication orders as needed\, as well as providing essential medication education to patients. The purpose of this research is to evaluate the outcomes of pharmacist-driven interventions within a hospitalist-led geographic rounding model focused on improving patient outcomes and coordination of care. If the results from this pilot demonstrate positive outcomes and are well received by participating rounding physicians\, then the program may be expanded to additional inpatient units within the hospital.\n\nMethodology:\nThis single center\, Institutional Review Committee (IRC)–approved pre and post analysis was designed to evaluate the primary outcome\, defined as the time from discharge order placement to patient discharge from the hospital. Secondary outcomes include hospital length of stay\, total number of discharge reconciliations reviewed by the Transitions of Care pharmacy team per month\, average time required to complete individual discharge interventions\, and the total number of discharges classified as having significant clinical impact. Pre-implementation data was collected from the following dates: July 1st-September 30th\, 2025. Post implementation data was collected from patients discharged by physicians participating in the rounding pilot between November 1st\, 2025 and January 31st\, 2026. Outcomes were compared between the three month pre and post implementation periods. Baseline characteristics include age\, race\, sex\, and discharge disposition. Statistical analysis was conducted to evaluate categorical and continuous data using descriptive statistics. These analyses aim to evaluate the potential impact of the rounding pilot and pharmacist-driven discharge processes on the timeliness of hospital discharge and overall patient care outcomes.\n\nResults: \nA total of 1\,201 discharges occurred during the post-implementation period\, of which 418 patients (75.3%) were included in the rounding pilot with documented Transitions of Care (TOC) discharge notes. The primary outcome\, the time from discharge order placement to patient discharge from facility\, decreased overall in the post-implementation period. However\, when stratified by discharge disposition\, this time increased for home/self-care patients but not for facility discharges\, which may be attributable to the higher proportion of facility discharges in the post period\, requiring more complex coordination of care. Additionally\, duplicate discharge orders were identified\, which may have prolonged discharge timing\, as these patients were not ready for discharge at the time of initial order placement. For secondary outcomes\, patient length of stay did not decrease in the post-implementation period\, which could be impacted by seasonal variability and differences in patient acuity between the pre- and post-implementation groups. The average time to complete TOC discharge notes and the number of interventions with significant clinical impact remained similar between groups.  \;\n\nConclusion: \nAlthough the results from this study did not demonstrate a consistent improvement in the primary outcome across all discharge dispositions\, geographic rounding can still enhance patient care through improved coordination and interdisciplinary communication. The integration of Transitions of Care pharmacists into geographic rounding supports earlier involvement in the discharge process and facilitates optimized medication reconciliation\, discharge planning\, and patient education. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:e1968e5f199535425f62b9e05a634bb3 URL:http://2026serc.sched.com/event/e1968e5f199535425f62b9e05a634bb3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Impact of Education on Subcutaneous Electronic Glucose Management System Usage in a Community Hospital - Makenzie Foster DESCRIPTION:Impact of Education on Subcutaneous Electronic Glucose Management System Usage in a Community Hospital\nMakenzie Foster & Taylor Riedel-Rogers\n\nBackground:\nThe American Diabetes Association recommends using basal/bolus insulin for the management of hyperglycemia in non-critically ill hospitalized patients.1 \;The incidence of hypoglycemia while on a basal/bolus insulin regimen in the hospital setting can be as high as 33%.2 \;A hypoglycemic event during admission has been shown to increase mortality rates\, complications\, and hospital length of stay.1 The use of electronic glucose management systems (eGMS) in hospitalized patients has been shown to decrease incidence of hypoglycemia compared to those managed solely by providers.3 Additionally\, patients managed by eGMS were found to have a higher percentage of blood glucose levels within target range compared to traditional provider management.4 Baptist Health Lexington implemented a subcutaneous glucose management system in 2022. This study aims to assess the duration of subcutaneous eGMS use prior to and following a single session of subcutaneous eGMS education to pharmacists and nurses at Baptist Health Lexington.\n\nMethods:\nThis study is an IRB-approved study where a pre-post analysis of subcutaneous eGMS duration is conducted following a single session of eGMS education. A retrospective review of patient charts will be conducted on patients who received blood glucose management through eGMS at Baptist Health Lexington prior to implementing a single session of pharmacist and nurse education from 03/01/2025 to 08/31/2025. Additionally\, a retrospective review of patient charts will be conducted following the implementation of eGMS education from 10/01/2025 to 03/31/2026 for those managed by subcutaneous eGMS. The primary endpoint of this study is the duration of subcutaneous eGMS use following a single session of pharmacist and nurse eGMS education. The secondary endpoints are the number of patients transitioning from intravenous to subcutaneous eGMS\, the incidence of hypoglycemic events and the total number of patients managed by subcutaneous eGMS.\n\nResults: \;\nThe retrospective analysis identified 101 patients in the pre-intervention group and 66 patients in the post-intervention group. Following a single session of pharmacist and nurse subcutaneous eGMS education\, the duration of subcutaneous eGMS \;was found to be statistically significant (p-value 0.025). The incidence of hypoglycemic events was 7 out of 101 patients in the pre-intervention group and 3 out of 66 patients in the post-intervention group (p-value 0.73). The number of patients transitioning from intravenous to subcutaneous therapy was 33 out of 101 in the pre-intervention group and 19 out of 66 in the post-intervention group. \;\n\nConclusion: \;\nPharmacist and nurse subcutaneous eGMS education resulted in a statistically significant increase in the duration of subcutaneous eGMS therapy. However\, a statistically significant difference was not found for the incidence of hypoglycemic events or number of patients transitioning from intravenous to subcutaneous therapy following a single session of pharmacist and nurse education. There are still opportunities for improvement in the utilization of subcutaneous eGMS at Baptist Health Lexington and further education on eGMS is currently being pursued at a system level. \n\nReferences:\n1. El Sayed\, Nuha A.\, et al. “16. diabetes care in the hospital: standards of care indiabetes—2024.” Diabetes Care\, vol. 47\, no. Supplement_1\, 11 Dec. 2023\, https://doi.org/10.2337/dc24-s016.\n2. Aloi\, Joseph\, et al. “Comparison of an electronic glycemic management system versus provider-managed subcutaneous basal bolus insulin therapy in the hospital setting.” Journal of Diabetes Science and Technology\, vol. 11\, no. 1\, 25 Sept. 2016\, pp.12–16\, https://doi.org/10.1177/1932296816664746. \n3. Bouldin\, Mary Grace\, et al. “Evaluation of the efficacy and safety of an EGLYCEMIC management system in a community hospital setting.” Journal of Diabetes Science and Technology\, vol. 15\, no. 2\, 16 Dec. 2020\, pp. 236–241\, https://doi.org/10.1177/1932296820980026.\n\nResident Contact Information:\nMakenzie Foster\, PGY1 Pharmacy Resident\nEmail: makenzie.foster@bhsi.com CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:57f6cbe8a7046e6a796cb54950d0f4c9 URL:http://2026serc.sched.com/event/57f6cbe8a7046e6a796cb54950d0f4c9 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T142000Z DTEND:20260501T144000Z SUMMARY:Optimizing Postoperative Pain Management in Total Hip Arthroplasty with Liposomal Bupivacaine DESCRIPTION:Primary Author: Jessica Kennedy\n\nCo-Authors: Taylor Burich\; Michael Brandon Hardison\; Jeremy Walley\n\nTitle: Optimizing Postoperative Pain Management in Total Hip Arthroplasty with Liposomal Bupivacaine\n\nBackground: Total hip arthroplasty (THA) is associated with significant postoperative pain\, prolonged hospitalizations\, early mobilization\, and increased opioid utilization.  \;In the United States\, over 500\,000 THA occur every year and can often lead to opioid over prescribing. Effective postoperative pain control is critical in THA to facilitate early mobilization\, reduce opioid consumption\, and support recovery. Liposomal bupivacaine is Food and Drug Administration (FDA) approved as a long-acting local and regional anesthetic. The purpose of this study is to assess liposomal bupivacaine utilization as a part of a multimodal analgesia approach to improve pain control and reduce opioid consumption following THA. \n\nMethods: This study aims to evaluate the efficacy of liposomal bupivacaine as a part of a multimodal analgesic approach in patients undergoing THA. Data will be collected through patient interviews via a standardized questionnaire to determine opioid utilization\, pain score\, and time to regain mobility and sensation. Patients included in this study are those 18 years or older who underwent THA with liposomal bupivacaine utilization. Exclusion criteria will be patients receiving liposomal bupivacaine for any other indication and those with a documented hypersensitivity or allergic reaction to liposomal bupivacaine or any of its analogs. The primary objective of this study is to examine opioid requirements after surgery as well as pain scores in patients who received liposomal bupivacaine. Secondary objectives will include the time to regain mobility and sensation post-operatively\, as well as cost savings from a reduction in length of stay.  \;\n\nResults: The primary endpoint saw the pain scores of those who received liposomal bupivacaine 17 individuals fell within mild pain scores (0-3)\, and 5 within the moderate pain scores (4-6). Compared to the standard of care group who had 13\,16\,13 in their mild\, moderate\, and severe pain scores. As for opioid requirements there was change of an increase in usage within both groups\, however\, those who received liposomal bupivacaine required19 mg compared to standard of care which required on average 27.1 mg. As for secondary endpoints \; there was no difference within the mobility and sensation as both groups were moving about every hour at a minimum. Analysis for cost is still in progress. \;\n\nConclusion: Utilization of liposomal bupivacaine provides a multimodal approach for postoperative pain management in THA. Those individuals who received liposomal bupivacaine had a reduction in pain scores and opioid usage when compared to the standard of care. \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:19c3c4625d4c1be58b9a830d6acd7e02 URL:http://2026serc.sched.com/event/19c3c4625d4c1be58b9a830d6acd7e02 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:046a7057f9d21e4ca66a67fa61178fd3 URL:http://2026serc.sched.com/event/046a7057f9d21e4ca66a67fa61178fd3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:2e20283152c66f9b170af43769da844b URL:http://2026serc.sched.com/event/2e20283152c66f9b170af43769da844b END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:a84bca3aaddbfdf979e4b9cef0d6ac11 URL:http://2026serc.sched.com/event/a84bca3aaddbfdf979e4b9cef0d6ac11 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:c6491bddc969b899cfc5e8a31296767f URL:http://2026serc.sched.com/event/c6491bddc969b899cfc5e8a31296767f END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Resident Presentation - McKenzie Lane - Assessing the Real-World Impact of Inclisiran in an Outpatient Cardiology Clinic DESCRIPTION:McKenzie Lane\, Savannah Owen\, Elizabeth Egawa\, Erika McDonald\, Amy Moore\, Danielle Yates \n\nPurpose: Inclisiran has demonstrated effective lipid-lowering effects when combined with statins\; however\, the effects of inclisiran monotherapy on low-density lipoprotein (LDL) in patients with a history of atherosclerotic cardiovascular disease have not been thoroughly evaluated in a real-world setting. Additionally\, data to support that inclisiran reduces the risk of major adverse cardiac events (MACE) does not yet exist. \;\n\nMethods: In an East Tennessee cardiology clinic\, 68 patients were included for evaluation of inclisiran’s lipid-lowering effects. A retrospective chart review was completed for each patient to identify several key factors\, including LDL levels\, documentation of MACE\, and documentation of adverse effects. REDCap™ and Microsoft Excel™ were utilized as the data collection software. Statistical analysis for the primary outcome included chi square\; unpaired t-test was utilized for the secondary outcome. \;\n\nResults: Forty-eight percent of patients had an LDL reduction of greater than or equal to fifty percent. The primary outcome was also evaluated in patients who were using inclisiran as monotherapy for LDL lowering\, patients on high intensity statins in addition to inclisiran\, and non-adherent patients\, defined as at least 3 months past due for an inclisiran dose. Thirty-four patients were on inclisiran monotherapy\, and fifteen of those patients achieved an LDL lowering of at least fifty percent. Nine patients were on inclisiran in addition to a high intensity statin\, and five of those patients achieved an LDL lowering of at least fifty percent. Nineteen patients were non-adherent\, and ten of those patients achieved an LDL lowering of at least fifty percent. Additionally\, fourteen patients reached an LDL of twenty-five or less. There were three patients with documented occurrences of major adverse cardiac events and seven documented adverse events. The average reduction in LDL was forty-one percent.  \; \;\n\nConclusions: Approximately half of the patients evaluated met an LDL reduction of at least fifty percent. There was no statistically significant difference in the primary outcome based on the subgroups evaluated. However\, patients who were on high intensity statins in addition to inclisiran were more likely to achieve very low LDL levels. Results for patients who were non-adherent were similar to the total population. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:37c4ee9726e02704c073e7735dd587b7 URL:http://2026serc.sched.com/event/37c4ee9726e02704c073e7735dd587b7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Sustained Virologic Response Rates in Hepatitis C Treatment with Concomitant Acid Suppressive Therapy DESCRIPTION:Introduction:  \; \;\nHepatitis C (HCV) remains a significant public health concern in the United States\, with an estimated 2.4 million people living with chronic infection. Untreated HCV is a leading cause of chronic liver disease\, and a major contributor to the development of cirrhosis\, hepatic carcinoma and death. HCV management has been revolutionized by direct-acting antivirals (DAAs). Regimens such as sofosbuvir/velpatasvir (Epclusa™)\, glecaprevir/pibrentasvir (Mavyret™)\, ledipasvir/sofosbuvir (Harvoni™)\, and sofosbuvir/velpatasvir/voxilaprevir (Vosevi™) achieve cure rates exceeding 95%  \;with short\, well-tolerated treatment courses.1Treatment success is assessed by sustained virologic response (SVR)\, assessed 4–12 weeks after therapy completion and indicated by an undetectable HCV RNA level. Treatment failure was a detectable HCV RNA during the same post-treatment assessment window. \;\n \;\nA key consideration in DAA therapy\, Mavyret excluded\, is their requirement for an acidic gastric pH\, raising concerns for patients prescribed acid-suppressive agents such as proton-pump inhibitors (PPI) and histamine-2-receptor antagonists (H2RA). Guidelines recommend modifying PPI dose when they exceed 20 mg of omeprazole or an equivalent\, as pharmacokinetic studies demonstrate reduced DAA exposure at higher doses.  \;H₂RAs have a less pronounced interaction\, with coadministration permitted up to 40 mg twice daily of famotidine or an equivalent. Although the clinical impact is not fully established\, reduced exposure may affect efficacy. PPIs remain among the most commonly prescribed medication classes in the United States\, with many available over the counter\, increasing the risk of unreported use and overlooked interactions. This study evaluates virologic response rates in patients treated for HCV with and without concurrent acid-suppressive therapy at Grady Memorial Hospital. \;\n \;\n \;\nStudy Design and Methods:  \;\nA retrospective analysis was conducted to compare SVR achievement in patients who did and did not receive acid suppressive therapy during HCV treatment. Patients were included if they are ≥18 years of age\, diagnosed with HCV\, completed treatment and had a documented post-treatment HCV RNA level. Patients were excluded if they had an incomplete treatment course for HCV\, were lost to follow up or had no documented viral load 4-12 weeks after completion of therapy. Patients were stratified by use of acid suppressive therapy. The primary outcome was the rate of SVR achievement after treatment of HCV between groups. Secondary outcomes include differences in SVR between PPI’s including the drug and dose\, differences in SVR between PPI and H2RA and differences in SVR based on cirrhosis state. Descriptive statistics were utilized for baseline characteristics\, and demographic information. Chi Square test was used to analyze the rates of SVR between groups. \;\nResults:  \;\nAmong 736 adults who completed HCV treatment and had follow-up viral load testing\, 359 (48.8%) received concomitant acid-suppressant therapy and 377 (51.2%) did not. Baseline characteristics were similar between groups. SVR rates were high overall and did not differ significantly between the two groups (96% vs 95%\; p = 0.578). SVR differed by specific acid-suppressant agent (p <\; 0.001). Among patients receiving acid suppression\, SVR was highest in those receiving omeprazole (98%) and ranitidine (98%)\, followed by famotidine (97%) and pantoprazole (94%). Patients receiving esomeprazole had the lowest SVR rate at 87%\, corresponding to a higher proportion of treatment failures (13%) compared with other agents (2–6%). Overall\, cure rates remained above 90% for all agents except esomeprazole. Patients receiving guideline-recommended acid-suppressant dosing achieved higher SVR compared with those receiving non-recommended dosing (97% vs 74%\; p <\; 0.001). \;\n \;\nConclusion:  \;\nConcomitant acid-suppressant use was not associated with reduced SVR achievement\, supporting current guideline recommendations that PPIs and H2RAs\, when used at guideline recommended doses\, can be safely continued during HCV therapy. \;\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:90c0cfc35b285ecffd503c3a37b42535 URL:http://2026serc.sched.com/event/90c0cfc35b285ecffd503c3a37b42535 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Evaluating Predictive Value and Stewardship of Methicillin-Resistant Staphylococcus aureus Nasal Swab in Mechanically Ventilated Trauma Patients DESCRIPTION:Background: \;\nMethicillin-resistant Staphylococcus aureus (MRSA) nasal swabs are commonly used to safely discontinue empiric MRSA coverage in patients due to their high negative predictive value (NPV) of greater than 98% for MRSA infections. While MRSA nasal swabs have a high NPV\, they are not well studied to guide de-escalation in mechanically ventilated patients. Limited guidance exists on de-escalation in mechanically ventilated patients prior to respiratory culture results leading to continuation of empiric antibiotics for an extended duration. This study aims to evaluate the predictive value and stewardship of MRSA nasal swabs in mechanically ventilated trauma patients with ventilator associated pneumonia (VAP). \;\n\nMethods:  \;\nThis is a single-center\, retrospective prevalence study of adults admitted to the Surgical Critical Care (SCC) service with a traumatic injury who were mechanically ventilated for greater than or equal to 48 hours from January 2020 through January 2025. Patients who received a MRSA nasal swab\, bronchoalveolar lavage (BAL)\, and empiric antibiotics for MRSA pneumonia were included in the study. The primary outcome is to establish positive predictive value (PPV)\, negative predictive value (NPV)\, sensitivity\, and specificity of MRSA nasal swab results. \;\n\nResults: MRSA nasal swabs demonstrated a PPV of 58.3% (95% CI 30.4%-86.2%) while the NPV was 97.1% (95% CI 91.4%-100%)\, a sensitivity of 87.5% (95% CI 64.6%-100%)\, and a specificity of 86.8% (95% CI 76.1%-97.6%). The median turnaround time for MRSA nasal swab results was 26.4 hours (IQR 25.5\,27.6)\, compared to 48.7 hours (IQR 44.6\,64.3) for BAL culture results. \;\n\nConclusions: This study demonstrates that MRSA nasal swabs possess a high NPV in mechanically ventilated trauma patients with VAP and the rapid turnaround time for MRSA nasal swab results compared to BAL cultures provides a clinical advantage for timely antibiotic de-escalation. \;\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:b6adc89b21ed976737ebea184e05fb4d URL:http://2026serc.sched.com/event/b6adc89b21ed976737ebea184e05fb4d END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Evaluation of an Institutional Multimodal Analgesia Protocol- Kira Mike DESCRIPTION:Purpose/Background: Previously\, Huntsville Hospital implemented several multimodal analgesia order sets intended to enhance postoperative outcomes by reducing opioid utilization\, leading to reduced hospital length of stay\, early ambulation\, and improved overall outcomes. Although initial findings were favorable\, the emergence of new evidence necessitates re-evaluation of the protocol to ensure continued alignment with current best practices. This project will compare the utilization and effectiveness of the previous order sets with the development and implementation of updated order sets incorporating current literature.\nMethodology: This was a single-center\, Institutional Review Committee (IRC)–approved\, pre–post analysis conducted at Huntsville Hospital to evaluate existing multimodal analgesia protocols. The primary objective was to reduce opioid usage by optimizing multimodal regimen. The secondary objective was to characterize utilization patterns of the order sets by order set and prescriber type. Data was reviewed for patients receiving select order sets following surgery between February 1\, 2025\, and August 31\, 2025.\nBaseline demographic variables\, including sex\, age\, gender\, and related allergies\, were obtained from the electronic health record. Literature review was conducted\, and associated findings was utilized to update the respective order sets.  \;Opioid use in morphine equivalents and length of stay will be compared between the two groups. Descriptive analyses were performed to assess adherence to the existing multimodal order set and to identify discrepancies between current practice and recommendations described in the literature.\nResults: Pre-intervention data analysis demonstrated that multimodal analgesia utilization varied across specialties\, with acetaminophen being the most consistently used agent. Additionally\, existing order sets were not aligned with current primary literature recommendations. \nConclusion: Guided by pre-intervention data analysis and literature review\, recommendations for order set modifications were developed. Post-intervention data assessing primary and secondary outcomes are currently pending. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:becd00d30f815b2a9a3db7b77c568e98 URL:http://2026serc.sched.com/event/becd00d30f815b2a9a3db7b77c568e98 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Evaluation of Serum Phosphate Levels in ICU Patients Undergoing Continuous Renal Replacement Therapy DESCRIPTION:\nEvaluation of Serum Phosphate Levels in ICU Patients Undergoing Continuous Renal Replacement Therapy\nKatherine Fonfara\, Eric Pyles\, Rebecca Falter\nAdventHealth Orlando\, Orlando\, FL\nBackground: \;Severe hypophosphatemia is associated with serious adverse effects such as skeletal muscle weakness\, respiratory insufficiency\, cardiac rhythm disturbances\, and delirium. These complications have been linked to worsening clinical outcomes including failed extubations\, increased time on mechanical ventilation\, and increased intensive care unit (ICU) and hospital length of stay. Patients on continuous renal replacement therapy (CRRT) are at increased risk of experiencing hypophosphatemia and the corresponding complications.\n\nIatrogenic hypophosphatemia represents a modifiable risk factor that may potentially improve patient outcomes. This study aims to evaluate phosphate replacement strategies in critically ill patients on CRRT and characterize incidence and severity of hypophosphatemia. \;\n\nMethods: \;This evaluation was a single-center\, retrospective study comparing rates of hypophosphatemia in adult patients requiring CRRT and those not on CRRT admitted to the ICU at a large community hospital. Patients who were admitted to an ICU and receiving CRRT for 24 hours or more were included in the treatment group. The control group included patients admitted to an ICU and not requiring CRRT. Patients with end-stage renal disease on chronic dialysis\, nocturnal CRRT/sustained low-efficiency dialysis (SLED)\, or with confounding metabolic conditions were excluded from either group. The primary outcome was the percentage of hypophosphatemic levels\, defined as serum phosphate level less than 1.9 mg/dL. Secondary outcomes included percentage of severe hypophosphatemic levels\, defined as serum phosphate level less than 1.0 mg/dL\, in-hospital mortality\, hospital length of stay\, ICU length of stay\, and time requiring mechanical ventilation. A post-hoc subgroup analysis was conducted to compare the primary outcome based on average CRRT flow rates. \;\n\nResults: \;A total of 100 patients were included in the study\, with 50 patients included in each group. The baseline demographics were similar between both groups except home diuretic use\, and baseline phosphorus and serum creatinine levels. In the control group\, the median baseline phosphorus level was 3.1 mmol/L (IQR 2.6-3.8)\, and the median baseline serum creatinine was 1.0 mg/dL (IQR 0.8-1.2). In the CRRT group\, the median baseline phosphorus level was 5.4 mmol/dL (IQR 4.2-6.4)\, and the median baseline serum creatinine was 2.9 mg/dL (IQR 2.2-4.1). \;\n\nRegarding the primary outcome\, the CRRT group had a significantly higher median percentage of hypophosphatemic levels compared with the control group (10.8% [0-29.3] vs 0% [0]\, p <\; 0.001). For the secondary outcomes\, there was no difference in the median percentage of severely hypophosphatemic levels between groups (0% [0] in both groups\, p = 0.317). The median hospital length of stay was longer in the CRRT group compared with the control group (14 days [7-24.8] vs 4.5 days [3-9.5]\, p <\; 0.001). Similarly\, the median ICU length of stay was longer in the CRRT group (8 days [5-14] vs 3 days [2-7]\, p <\; 0.001). The median ventilator duration was also significantly longer in the CRRT group (4 days [3-8] vs 1 day [1-2]\, p <\; 0.001). In-hospital mortality was significantly higher in the CRRT group with 62% of patients dying during admission compared with 18% in the control group (p <\; 0.001). In the subgroup analysis of the CRRT group\, there was no difference in percentage of hypophosphatemic levels across flow rate groups (<\; 20 ml/kg/h\, 20-25 ml/kg/h\, and >\; 25 ml/kg/h). \;\n\nConclusions: Patients receiving CRRT were associated with a significantly greater percentage of hypophosphatemic phosphate measurements compared with control group. The CRRT group had higher phosphate levels at baseline and was associated with increased phosphate depletion. No association was observed between CRRT dialysate flow rate and the percentage of hypophosphatemic levels. These findings support the need for close phosphorus monitoring as well as early phosphorus supplementation.\n\n\n\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:0759870cb72fde0f2e2de4717bd40b4e URL:http://2026serc.sched.com/event/0759870cb72fde0f2e2de4717bd40b4e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Evaluating Pharmacist Monitoring in Patients with Euglycemic Diabetic Ketoacidosis Prescribed Sodium-Glucose Cotransporter-2 inhibitors Prior to Admission DESCRIPTION:Purpose/Background: Euglycemic diabetic ketoacidosis (EDKA) falls under the umbrella of diabetic ketoacidosis (DKA) and can occur in patients with type 1 or type 2 diabetes mellitus. EDKA is thought to be caused by a renal threshold for glucosuria that is lower due to increased gluconeogenesis and free fatty acid metabolism. A common medication class prescribed to patients with diabetes mellitus\, sodium-glucose cotransporter-2 (SGLT2) inhibitors\, are thought to inhibit both glucose and sodium resorption at the renal proximal tubule which leads ultimately to glucosuria and negative fluid balances. These mechanisms lead to a loss of bicarbonate and cause ketogenesis\, which ultimately leads to EDKA. The purpose of this study is to evaluate the effect of pharmacy monitoring on the appropriate clinical courses in patients on sodium-glucose cotransporter-2 inhibitors who are admitted for euglycemic diabetic ketoacidosis in a regional medical center. \nMethodology: Data will be collected based on a pre- and post-evaluation of the electronic medical record. Prospective data collection will be done through a daily report of patients that are greater than or equal to 18 years old\, admitted to CaroMont Regional Medical center\, have an SGLT2 inhibitor on their prior to admission medication list\, and have a diagnosis of diabetes on their hospital problem list. Patients will be excluded if they are less than 18 years old\, have no diagnosis of diabetes mellitus\, have a glucose on admission that is >\; 250 mg/dL\, are pregnant or incarcerated. Once the daily report is run\, the clinical pharmacist will ensure the correct lab values and medications are ordered. If a patient meets EDKA criteria\, a clinical pharmacist will evaluate the need for additional evaluation\, including β-hydroxybutyrate\, to strengthen diagnostic criteria and guide potential treatment. Retrospective data collection will be done through the collection of pre-specified criteria and analysis of the treatment course in patients that presented with EDKA. Both data sets will be taken from the same months\, one year apart. The data sets will be compared to assess the effectiveness of pharmacy interventions. The primary endpoint of the study will be the time to resolution of euglycemic diabetic ketoacidosis. Time to insulin infusion\, length of stay\, number of admissions\, and number of clinical pharmacist interventions will also be assessed.  \;\nResults: Pending \;\nConclusions: Pending \nPresentation Objective: To describe the benefit of pharmacy interventions in the treatment course of patients that present with euglycemic diabetic ketoacidosis secondary to receiving sodium-glucose cotransporter-2 inhibitors for management of their diabetes prior to admission.  \;\nSelf-Assessment: What are the criteria for a diagnosis of euglycemic diabetic ketoacidosis?\nAuthors: Rylee Williams\, Joe Norton\, Joanna Nixon CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:04068790037607bb73f0189762026966 URL:http://2026serc.sched.com/event/04068790037607bb73f0189762026966 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Evaluation of Prophylactic Anticoagulation usage within the Central Alabama Veterans Health Care System Inpatient Setting DESCRIPTION:Primary Author: Charles Pitts\nCo-Authors: Hope Allen\, Brittany Till\, Morgan Moulton\, Perry Thompson\, Walter Minger\, Tiffany Lyght\n\nBackground: Venous thromboembolism (VTE) is a common cardiovascular diagnosis\, with many cases linked to recent hospitalizations. Prophylactic anticoagulation is used to prevent VTE\, guided by patient risk factors. Risk Assessment Models (RAMs)\, such as the Padua VTE RAM\, help determine when VTE prophylaxis is appropriate or should be avoided due to bleed risk\, as recommended by the American Society of Hematology. This project was designed to evaluate the current utilization of prophylactic anticoagulation using the Padua VTE RAM to determine its appropriateness in patients admitted to the inpatient setting. According to the Padua RAM\, scores of 4 or more are indicative of high VTE risk and should receive anticoagulation.\n\nMethods: This project was a retrospective\, observational review of Veterans' charts who received prophylactic anticoagulation in the inpatient setting within the Central Alabama Veterans Health Care System (CAVHCS). Data collected included Veteran demographics\, active prescriptions\, ICD codes\, recent surgeries\, age\, body mass index (BMI)\, birth sex\, kidney function\, presence of a central venous catheter\, critical care admissions\, liver function tests\, platelet counts\, and recent bleeding events. The data was compiled in a de-identified Microsoft Excel spreadsheet for analysis. The primary outcome assessed was the percentage of Veterans appropriately placed on prophylactic anticoagulation based on inclusion/exclusion criteria. Secondary outcomes included the number of admitted Veterans receiving prophylactic anticoagulation who experienced bleeding-related events and thrombosis-related events.\n\nResults: One hundred Veteran charts were evaluated for this project. Of the evaluated charts\, prophylactic anticoagulation was appropriately administered or withheld in 53 Veterans and prophylactic anticoagulation was inappropriately administered or withheld in 47 Veterans based on their individual Padua RAM scores. Of the 47 Veterans\, 45 received inappropriate prophylactic anticoagulation and two Veterans had prophylactic anticoagulation withheld inappropriately. None of the Veterans evaluated experienced bleed or thrombosis-related events.\n\nConclusions: Nearly 50% of Veterans reviewed had anticoagulation inappropriately administered or withheld while admitted. While this evaluation did not find any bleed or thrombosis-related events\, the current anticoagulation prescribing trends leave room for improvement. The creation of a policy to standardize the criteria for VTE prophylaxis could increase appropriate anticoagulation prescribing patterns within the CAVHCS inpatient setting. This project also exposes an area of Veteran healthcare that Clinical Pharmacy Practitioners could assist in optimizing and monitoring. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:c425f8e3efb6632ad6353e662a5c2427 URL:http://2026serc.sched.com/event/c425f8e3efb6632ad6353e662a5c2427 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T144000Z DTEND:20260501T150000Z SUMMARY:Evaluation of the Impact of Lower Extremity Wound Order Set Revision DESCRIPTION:Title: \;Evaluation of the impact of lower extremity wound order set revision\n\nAuthors: \;Katie Hindman\, Adesuwa Utomwen\, Dustin Zeigler\, Jeremy Frens\n\nObjective: Discuss the utilization of an updated lower extremity wound order set\n\nSelf-Assessment Question: \;True or False: The updated lower extremity wound order set had numerically increased adherence compared to the prior order set.\nBackground: Diabetic foot infections (DFIs) pose a significant threat to quality of life\, being a leading cause of non-traumatic lower extremity amputations. Therefore\, it is essential to utilize effective antibiotics to treat these infections. The International Working Group on the Diabetic Foot (IWGDF) and Infectious Diseases Society of America (IDSA) published updated guidelines in 2023\, advising that empiric coverage for Pseudomonas aeruginosa \;is not necessary in Western countries and temperate climates. A prior systematic review on the epidemiology of P. aeruginosa in DFIs found a global prevalence of 16.6%\, with the lowest prevalence of 11.1% being in Western countries. A review of patients at our institution\, Cone Health\, with toe and/or foot amputation(s)\, supported these findings with only 1.7% of cultures identifying P. aeruginosa. The most isolated pathogens were Staphylococcus aureus and coagulase-negative Staphylococcus species. The lower extremity wound order set at Cone Health was modified\, removing empiric P. aeruginosa coverage due to its low incidence. The purpose of this study is to evaluate prescriber compliance with the updated order set and assess microbiological concordance between prescribed empiric therapy and cultured pathogens following the modifications.\n\nMethods: This was an IRB approved\, determined exempt\, retrospective cohort analysis of individuals with diabetic foot infections at a single health system encompassing four community hospitals. The revised order set went live in February 2025. The review spanned a pre-intervention cohort from June to December 2024 and a post-intervention cohort from June to November 2025. Adults aged 18 years or older with confirmed DFI with or without osteomyelitis were included in this study. Those individuals admitted to the intensive care unit or with the presence of chronic foot ulceration were excluded. Infection-related information collected included wound classification\, utilization of order set\, inpatient antibiotics utilized\, duration of antibiotics\, type of amputation\, culture results\, pathology results and discharge antibiotics. The primary outcome of this study is adherence to order set recommendations\, defined as aligning with the antibiotic recommendations per infection severity. Secondary outcomes include proportion of patients with microbiological match to empiric antibiotics\, 30-day mortality rate and 30-day readmission rate.\n\nResults: The post-intervention cohort demonstrated a modest increase in adherence to lower extremity wound order set recommendations compared to the pre-intervention cohort (34% vs 30%\, p=0.55). Among patients with available culture data\, all 17 individuals in the pre-intervention cohort received empiric antibiotics concordant with culture results compared to 26 of 30 patients (87%) in the post-cohort (p=0.075). Streptococcus species were the most commonly isolated gram-positive organisms in both cohorts (10 cases in the pre-cohort and 11 in the post-cohort). There was a higher prevalence of Proteus mirabilis and Enterobacter cloacae in the post-cohort\, but these organisms demonstrated minimal resistance to penicillins and cephalosporins. The use of vancomycin and cefepime decreased from the pre- to post-intervention period\, while utilization of linezolid and ampicillin/sulbactam increased.\n\nConclusion: The revised lower extremity wound order set was associated with a numerically higher rate of adherence compared to the prior version\, with approximately half of providers in each cohort utilizing the order set. Empiric antibiotics demonstrated microbiological match in most cases. The organisms cultured in this study align with those typically observed in DFIs in the United States. The updated order set represents an advancement in antimicrobial stewardship in DFIs through the inclusion of preferred alternatives. Limitations of this study include variability in obtainment of pathology and cultures between providers as well as a small sample size. Future directions include reinforcing appropriate utilization of the DFI order set and evaluating discharge antibiotic therapy to assess the potential benefit of creating standardized recommendations. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:fcd74146f087b76e611ab9cc738adfae URL:http://2026serc.sched.com/event/fcd74146f087b76e611ab9cc738adfae END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:7a759c9db9e472c05bb83bb3f9c76682 URL:http://2026serc.sched.com/event/7a759c9db9e472c05bb83bb3f9c76682 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:df783b29d7fc3982ff69b5cd111551b8 URL:http://2026serc.sched.com/event/df783b29d7fc3982ff69b5cd111551b8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:e138402cb28f3d38919a3ec9d55b3b22 URL:http://2026serc.sched.com/event/e138402cb28f3d38919a3ec9d55b3b22 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:ff6bee1816e59fda8fd371d847e218f8 URL:http://2026serc.sched.com/event/ff6bee1816e59fda8fd371d847e218f8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Optimizing Shingrix Immunization in Veterans on Immunosuppressive Therapy DESCRIPTION:Background & Purpose:\nHerpes zoster\, commonly known as shingles\, results from reactivation of latent varicella zoster virus and is associated with substantial morbidity\, particularly among older adults and immunocompromised populations. Veterans receiving immunosuppressive therapy are at increased risk for severe disease\, including postherpetic neuralgia and hospitalization. The recombinant herpes zoster vaccine (Shingrix) is a non-live\, adjuvanted vaccine with efficacy exceeding 90% and is recommended for adults aged ≥50 years and immunocompromised adults aged ≥19 years. Despite these recommendations\, vaccination rates among immunocompromised Veterans remain suboptimal. Within the Veterans Health Administration\, Shingrix administration requires provider ordering and coordination of nurse clinic visits\, which may introduce logistical barriers and contribute to delayed vaccination or incomplete series. Pharmacist-led interventions that incorporate patient education and care coordination may improve vaccine uptake by addressing hesitancy and streamlining the vaccination process.\n\nMethods:\nA pharmacist-led telephone intervention was conducted at the Ralph H. Johnson Veterans Affairs Health Care System in Charleston\, South Carolina. Veterans prescribed immunosuppressive therapy who lacked one or both doses of the recombinant zoster vaccine were identified using a National VA Rheumatology Immunization Population Management Tool. Eligible patients were those enrolled in specialty clinics and prescribed a biologic\, conventional synthetic\, or targeted synthetic disease-modifying antirheumatic drug or systemic glucocorticoid. A random sample of 100 patients was selected. A PGY1 pharmacy resident conducted structured telephone outreach using motivational interviewing techniques to assess vaccine acceptance\, explore concerns\, and provide tailored education regarding shingles risk and vaccine safety. For patients who agreed to vaccination\, orders for Shingrix and nurse clinic appointment were placed for one or both doses\, if applicable. Vaccination outcomes and documented reasons for acceptance or refusal were tracked through the electronic medical record.\n\nResults: \nSixty-six of 100 patients contacted agreed to receive Shingrix following pharmacist intervention\, 30 declined\, and 4 were previously vaccinated without documentation. Thirty-nine patients (59.1%) completed the vaccination series during the project period. Completion rates were higher among patients requiring one dose compared to two doses (72.2% vs 54.2%\, p = 0.18). No significant differences in completion were observed by sex or ethnicity. Among patients who did not complete vaccination\, over half were due to appointment-related barriers\, including cancelled visits or failure to schedule.\nVaccine acceptance was most commonly associated with improved awareness\, perceived benefit and risk reduction\, and provider engagement that addressed questions\, misinformation\, and resolved logistical barriers. Patients frequently cited increased understanding of the need to complete the two-dose series and elevated herpes zoster risk in the setting of immunosuppressive therapy as key drivers of acceptance. Reasons for vaccine decline included vaccine hesitancy\, low perceived risk\, desire for additional time\, information\, or provider input\, and scheduling barriers.\n\nConclusion: \nPharmacist-led outreach improved willingness to receive Shingrix among immunocompromised Veterans\; however\, series completion remained variable and was frequently impacted by logistical barriers. These findings highlight the importance of coordinated workflows and multidisciplinary collaboration to support vaccination beyond initial patient agreement. Addressing patient-specific concerns and streamlining scheduling processes can improve vaccine uptake and series completion while reinforcing the pharmacist’s role in vaccine stewardship. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:444189cb363e5ff2a1731ec53f336e8c URL:http://2026serc.sched.com/event/444189cb363e5ff2a1731ec53f336e8c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Similar but not the Same: Patient Reported Outcomes when Switching to Biosimilar Adalimumab - Hayleigh Hallam DESCRIPTION:Background: Adalimumab was one of the first monoclonal antibodies to have biosimilar agents commercially available. With its extensive list of indications\, the market for adalimumab biosimilars has grown rapidly\, and ten products have approved interchangeability in the United States. While the definition for biologic interchangeability includes demonstrated efficacy\, safety\, and immunogenicity comparable to the reference product\, biosimilars can contain different inactive ingredients\, preservatives\, and administration types. These characteristics led to the development of studies exploring potential discrepancies in the efficacy and safety of adalimumab biosimilars as measured via validated tools by disease-state. Most concluded that there are no significant differences between clinical outcomes with the use of an adalimumab biosimilar compared to the reference product. Despite these findings\, there are incidences of patients reporting differences in practice. This study will aim to identify patient-reported differences in efficacy and adverse effects related to switching from the adalimumab reference product (Humira®) to a biosimilar agent.\n\nMethods: This study used a unique retrospective-prospective design of patients followed by Prisma Health Specialty Pharmacy on adalimumab for an FDA approved use. First\, a retrospective chart review was conducted of patients from January 2024 through September 2025 who received at least 3 months of Humira® and at least one month of a biosimilar. Patients who discontinued adalimumab for any reason before adequate trials were completed or filled with another pharmacy were excluded. Patients meeting these criteria had their upcoming refill phone calls flagged for survey participation. At the end of this workflow completion\, patients were asked if they would like to participate in a survey related to their experience with switching to an adalimumab biosimilar. This featured 10 multiple-choice questions using Likert-scale responses to achieve validity\, and patients could decline any response at any time. Primary endpoints of this study included perceived efficacy and safety of Humira® and biosimilar as documented in the patient chart and obtained via patient survey. Secondary endpoints were differences between the former\, including between biosimilar agents.\n\nResults: A total of 324 patient charts were screened\, and 46 patients met inclusion criteria. Patients with rheumatoid or psoriatic arthritis made up 58.7% of the study population. A majority of patients (95.7%) were transitioned to an adalimumab biosimilar due to a non-medical\, insurance-mandated switch. Most patients were changed to adalimumab-adaz (Hyrimoz®\; 60.9%) or adalimumab-adbm (Cyltezo®\; 28.3%).\n\nA majority of patients completed the survey (71.7%)\, and most were still on an adalimumab product (75.8%). At baseline\, many patients thought that Humira® worked above average (27.3%) or excellent (54.6%)\, and almost two-thirds of patients claimed it worked better than the biosimilar. Of these patients\, those who completely agreed (30.3%) were generally on Hyrimoz® (90%)\, and those who mostly agreed (30.3%) were generally on Cyltezo® (70%). After switching to the biosimilar\, around half (48.5%) of patients experienced a delay in symptom management\, which included active disease flares.\n\nPer patient chart review\, there were minimal differences in side effects reported with both Humira® and the biosimilar products (9.9% and 6.5%\, respectively). This was similar in the patient survey\; however\, side effects were reported more frequently\, occurring in 27.4% of patients in each group. The most common side effect experienced was injection site reactions. If given the chance\, 61% of patients said they would switch back to Humira® from their biosimilar.\n\nConclusions: There are considerable patient-perceived differences in efficacy but minimal differences in safety experienced when switching from Humira® to a biosimilar. While most patients prefer Humira®\, their switch is typically mandated by insurance. Support from pharmacists and other healthcare team members is imperative to try and keep patients on an efficacious biologic regimen. CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:0faad588db0693dcff6dcf90956362c3 URL:http://2026serc.sched.com/event/0faad588db0693dcff6dcf90956362c3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Impact of hydrocortisone weaning on the duration of septic shock DESCRIPTION:Background:\nSepsis is a life-threatening condition caused by a dysregulated host response to infection\, and septic shock represents its most severe form\, carrying a high mortality risk. Intravenous (IV) hydrocortisone is recommended by the Surviving Sepsis Guidelines for patients requiring ongoing vasopressor support despite adequate fluid resuscitation. However\, the optimal discontinuation strategy remains unclear as current guidelines do not specify whether hydrocortisone should be tapered or abruptly discontinued. Existing literature is limited and conflicting\, and practice variability persists. This study evaluates the impact of hydrocortisone tapering versus abrupt discontinuation on recurrence of septic shock.\nMethods:\nThis single-center\, retrospective cohort study was conducted at Atrium Health Wake Forest Baptist Medical Center. Adult patients admitted to the Medical Intensive Care Unit (ICU) between September 2024 and August 2025 who received ≥ 8 doses or ≥48 hours of IV hydrocortisone for septic shock \;were included. Patients were categorized into two groups: taper (any dose reduction prior to discontinuation) or no taper (abrupt discontinuation). Resolution of shock was defined as maintaining a mean arterial pressure ≥65 mmHg without vasopressor support for ≥12 hours.\nThe primary outcome was recurrence of septic shock\, defined as vasopressor reinitiation within 72 hours or escalation in vasopressor or hydrocortisone therapy. Secondary outcomes included duration of vasopressor therapy\, ICU length of stay\, hospital length of stay\, and incidence of hyperglycemia (≥180 mg/dL). Continuous variables were analyzed using Wilcoxon rank-sum tests\, and categorical variables using chi-square or Fisher’s exact tests\, as appropriate.\nResults:\nA total of 43 patients were included (no taper n=30\; taper n=13). Baseline characteristics were similar between groups\, with no statistically significant differences in age\, sex\, vasopressor requirements\, or severity markers.\nRecurrence of septic shock occurred in 30% of the no-taper group and 38% of the taper group (p=0.7)\, demonstrating no statistically significant difference between strategies. Median duration of vasopressor therapy was similar (136 hours vs 123 hours\; p=0.6).\nThere were no significant differences in secondary outcomes\, including ICU length of stay (8 vs 7 days\; p>\;0.9)\, hospital length of stay (18 vs 16 days\; p=0.8)\, or incidence of hyperglycemia (70% vs 69%\; p>\;0.9).\nConclusions:\nIn this retrospective cohort study\, tapering of hydrocortisone did not reduce the recurrence of septic shock compared to abrupt discontinuation. No differences were observed in vasopressor duration\, length of stay\, or hyperglycemia. These findings suggest that routine tapering of hydrocortisone may not provide clinical benefit in this population. Prospective studies are warranted to confirm these findings and inform guideline recommendations. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:d291fc4c1f5de9653c9a212adee61941 URL:http://2026serc.sched.com/event/d291fc4c1f5de9653c9a212adee61941 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Incidence of Chronic Opioid Use Post-Surgical Exposure in Opiate Naïve Patients DESCRIPTION:Title: \;Incidence of Chronic Opioid Use Post-Surgical Exposure in Opiate Naïve Patients \;Authors: \;Rachel Peña\, PharmD\, Caitlin Thomas\, PharmD\, BCCCP\, James Neilen\, PharmDObjective: \;The purpose of this study was to evaluate the association between discharge opioid supply ( ≤3 days vs ≥7 days) and the development of chronic opioid use in opioid naive post-surgical patients. \;Background: \;Opioids are used as an effective treatment for post-operative management\, trauma\, or chronic pain\, but can be limited by their side effects and undesirable dependence if dosed improperly or lead to recreational misuse. Current literature states that by limiting opioid supply to 3 or fewer days post-operatively after discharge\, there are fewer conversions to long term opioid users among opioid naïve patients.  \;Evaluating similar opioid prescribing practices as in the literature may help to inform safer prescribing practices at our institution. \; \;Methods: \;A single center retrospective study was performed in a large acute care community teaching hospital from January 1\, 2024 through December 31\, 2025. Patients were identified between January 1\, 2024 to December 31\, 2024\, with follow up Prescription Drug Monitoring Program (PDMP) data collected for up to one year post discharge through December 31\, 2025 to track prescription opioid fills.  \;Adults admitted to the hospital who underwent surgery and were opiate naïve (defined  \;as patients who have not filled an opioid prescription in the previous 6 months prior to surgery) were included in the study. Patients were excluded if they had a history of substance abuse\, had cancer or chronic pain\, had a cardiac\, spinal\, or oncological related surgery\, and if they underwent another surgery within the 1-year study period after the initial surgery. Patients who were discharged with an opioid supply of 3 days or less were compared to patients discharged with an opioid supply of 7 days or more. Chronic opioid use was defined as having filled 10 or more prescriptions or 90 days of continuous use within a 1-year period after surgery. The primary endpoint was the incidence of new\, persistent opioid use defined as more than 10 opioid prescription fills or more than 90 days of continuous use. Secondary endpoints included the types of opioids prescribed\, inpatient and outpatient MME (daily and total)\, type of surgery\, 3-month\, 6-month\, and 1 year prescription fill quantities post discharge. \; \;Results: \;Of the 676 patients screened\, a total of 332 patients (281 in comparator group\, 51 in study group) met inclusion criteria. Of this population\, 229 (69%) were male\, the average hospital length of stay was 3.31 days\, the average opioid supply in days on discharge was 7.02\, average morphine milligram equivalent (MME) for discharge opioid supply was 35.56. The most prescribed opioid on discharge was oxycodone 5 mg immediate release tablet (42.2%) and most common surgery type among the population was cesarean section (26.5%). Of the 332 patients\, 4 (1.2%) filled more than 10 opioid prescriptions within 1 year after discharge\, and 4 (1.2%) had more than 90 days of continuous use of opioids within 1 year after discharge. Of the patients who filled more than 10 opioid prescriptions and had more than 90 days of continuous use of opioids\, all 4 of the patients were from the comparator group that had been discharged with 3 days or less supply of opioid upon discharge (P=1.000) . None of the patients in the study group filled more than 10 opioid prescriptions or had more than 90 days of continuous opioid use after discharge. The average number of fills at 3 months after discharge was 1.09\, at 6 months was 1.18\, and after 1 year was 1.36. \;Conclusion: \;Patients who were prescribed ≥ 3 days of opioids post-operatively at discharge did not have an increase in long term usage of opioids after 1 year. \; \;\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:90f41ea0ad866d4ab004771b34426175 URL:http://2026serc.sched.com/event/90f41ea0ad866d4ab004771b34426175 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Evaluating the Impact of Provider Education on Empiric Antibiotic Use for Low-Risk Intra-abdominal Infections at a Community Hospital​ DESCRIPTION:Background: \;\nIntra-abdominal infections (IAIs) are a frequent cause of hospitalization which occasionally require empiric broad-spectrum antibiotic use. Despite current guidelines indicating that P. aeruginosa is uncommon in low-risk\, community-acquired IAI\, antipseudomonal agents remain frequently prescribed. This unnecessary use increases risks of nephrotoxicity\, resistance\, and higher healthcare costs.2 For low-risk patients without significant comorbidities\, healthcare exposure\, or septic shock\, narrower regimens are recommended.1 Persistent inappropriate prescribing highlights an opportunity for targeted antimicrobial stewardship interventions to optimize empiric therapy\, improve patient outcomes\, and reduce unnecessary broad-spectrum exposure. \;Objectives: \;\nEvaluate the impact of pharmacy-led provider education on reducing inappropriate antipseudomonal antibiotic use in patients with low-risk intra-abdominal infections \;Primary outcome: Percentage difference of patients receiving antipseudomonal antibiotics before and after the intervention \;Secondary outcomes: Days of therapy (DOT) per 1\,000 patient days\, hospital length of stay\, incidence of C. difficile infection\, and identification of P. aeruginosa on culture during hospitalization\, impact of infectious disease (ID consult) on de-escalation \;Methods: \;\nRetrospective chart review approved by the local Institutional Review Board (IRB) \;Chart review to evaluate empiric antibiotic use in adult patients with low-risk intra-abdominal infections (IAIs)\, as defined by the 2024 Surgical Infection Society guidelines. \;During the pre-intervention period between May 1st\, 2025 and September 30th\, 2025\, patients are assessed for documented infection diagnosis and empiric antibiotic selection to determine the frequency of antipseudomonal antibiotic use. Data gathered from this review is used to develop an educational presentation for hospitalist providers to highlight recommended therapy for low-risk IAI. \;A post-intervention chart review between November 1st\, 2025 and March 30th\,  \;2026 will be performed to reassess prescribing practices \;Inclusion criteria \;Age ≥18 \;Admitted to Baptist Health Lexington with primary diagnosis of diverticulitis\, peritonitis\, cholecystitis\, cholangitis\, pancreatitis\, or appendicitis \;Received antimicrobial therapy \;Exclusion criteria \;Pregnant or incarceration. Met criteria for high-risk infection (admitted to ICU during hospital stay\, required surgical intervention\, received IV antibiotics in previous 90 days\, recent Pseudomonas culture\, immunocompromised\, post-operative infection or inadequate source control\, age ≥ 80) \;Results: \;\nBaseline characteristics were similar between pre- and post-intervention groups\, with diverticulitis most common. The educational intervention did not significantly reduce inappropriate antipseudomonal use\, which remained high. A numerical decrease in overall antimicrobial exposure was observed but was not statistically significant. No C. difficile testing or P. aeruginosa cultures were identified. Antimicrobial use shifted overall\, driven by reduced ertapenem use\, while other broad-spectrum agents remained common. Infectious disease consultation was associated with higher rates of de-escalation. \;Conclusions: \;\nProvider education alone did not significantly reduce inappropriate antipseudomonal use in low-risk IAI. Persistent broad-spectrum prescribing suggests the need for more active stewardship strategies. The absence of P. aeruginosa supports guideline recommendations\, and the impact of ID consultation highlights the value of multidisciplinary involvement. \;References \;\nThe Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update Jared M. Huston\, Philip S. Barie\, E. Patchen Dellinger\, Joseph D. Forrester\, Therese M. Duane\, Jeffrey M. Tessier\, Robert G. Sawyer\, Miguel A. Cainzos\, Kemal Rasa\, Jeffrey G. Chipman\, Lillian S. Kao\, Frederic M. Pieracci\, Kristin P. Colling\, Daithi S. Heffernan\, Janice Lester\, and Therapeutics and Guidelines Committee  \;Lodise TP\, Izmailyan S\, Olesky M\, Lawrence K. An Evaluation of Treatment Patterns and Associated Outcomes Among Adult Hospitalized Patients With Lower-Risk Community-Acquired Complicated Intra-abdominal Infections: How Often Are Expert Guidelines Followed? Open Forum Infect Dis. 2020 Jun 19\;7(7):ofaa237. doi: 10.1093/ofid/ofaa237. PMID: 32676511\; PMCID: PMC7353956. \;\n\n\n CATEGORIES:INFECTIOUS DISEASE (ID) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:edc583f76dedc29b68b108e94ac77588 URL:http://2026serc.sched.com/event/edc583f76dedc29b68b108e94ac77588 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Evaluating Vancomycin AUC Monitoring in Adult Cystic Fibrosis Patients DESCRIPTION:Title \;\nEvaluating Vancomycin AUC Monitoring in Adult Cystic Fibrosis Patients \;\n \;\nAuthors \;\nTaylor J. Merritt\, Carrie Tilton Callahan\, Kelly Soyeong Ko\, Cynthia Shin-Yee Tsai\, Heidi King Berman\, Nicole L. Metzger  \;\n \;\nPractice Site \;\nEmory University Hospital \;\n \;\nObjective  \;\nAudience members will be able to evaluate the impact of AUC-based vancomycin monitoring on therapeutic target attainment and safety outcomes compared with traditional trough-based monitoring in adult patients with cystic fibrosis (CF)  \;\n \;\nBackground  \;\nArea under the curve (AUC)–based vancomycin monitoring is recommended to improve efficacy and reduce nephrotoxicity. However\, evidence supporting its use in adult people with cystic fibrosis (PwCF) remains limited.  \;\n \;\nMethods  \;\nThis single-center\, retrospective observational study included hospitalized adults with CF who received intravenous vancomycin and at least one appropriately drawn vancomycin level. Patients were excluded if they were pediatric\, pregnant\, incarcerated\, had unstable renal function\, or did not have vancomycin for >\; 48 hours. Encounters were grouped based on strategy: AUC or trough-based monitoring. Therapeutic targets were defined as: AUC of 400–600 mg·hr/L or trough of 15–20 mg/dL. Primary outcome was the proportion of encounters achieving therapeutic targets at first appropriate level. Secondary outcomes included time to therapeutic target attainment\, number of regimen adjustments\, length of hospital stay\, and incidence of acute kidney injury. An exploratory analysis was conducted by reclassifying patients in the trough-based group who met institutional AUC-dosing criteria and assessing whether therapeutic targets would have been achieved when using an institutional AUC calculator.  \; \;\n \;\nResults  \;\nA total of 43 encounters representing 27 patients met inclusion criteria\, with 16 encounters in the AUC-based group and 27 in the trough-based group. Therapeutic exposure targets at first level draw were achieved in 37.5% of AUC-monitored encounters compared to 14.8% of trough-monitored (p-value 0.14). Mean time to therapeutic target attainment was similar between groups\, and no cases of acute kidney injury occurred in the AUC group compared to 7.4% in the trough-based group. Length of hospital stay and number of vancomycin levels collected were comparable between strategies. In the exploratory analysis\, patients regrouped from trough to AUC demonstrated 48.3% therapeutic targets at initial draw compared to 0% in the trough-based group. \;\n \;\nConclusions  \;\nAUC-based vancomycin monitoring did not demonstrate a statistically significant improvement over trough-based monitoring in adults with cystic fibrosis\; however\, a trend toward improved therapeutic target attainment and no increase in nephrotoxicity was observed. These findings support consideration of AUC-based monitoring in this population and add to the limited data available for adult patients with cystic fibrosis. \;\n \;\nSelf-Assessment Question \;\nWhich statement best reflects the findings from this study?  \;\nA) AUC-based monitoring significantly reduced AKI in PwCF  \; \;\nB) AUC-based monitoring significantly improved target attainment  \; \;\nC) Trough-based monitoring resulted in fewer regimen changes  \; \;\nD) AUC-based monitoring demonstrated a trend toward improved target attainment without increasing AKI \;\n \;\n \;\nContact Email \;\ntaylor.justice.merritt@emoryhealthcare.org \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:8e3bf18dde297c02f745f1b664c3db9c URL:http://2026serc.sched.com/event/8e3bf18dde297c02f745f1b664c3db9c END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Impact of a Pharmacist-Led IV Iron Referral Pathway on Outpatient Referrals and IV Iron Administration - Vanna Labi DESCRIPTION:Background: Intravenous (IV) iron is an effective therapy for iron deficiency anemia\, and growing evidence supports outpatient administration when clinically appropriate. Despite this\, hospitalized patients frequently receive IV iron without a standardized process to ensure therapy completion after discharge. To address this gap\, the adult iron replacement order set was updated to better facilitate ambulatory infusion referrals and incorporate a pharmacist consult. The consult prompts inpatient clinical pharmacists to review indication for IV iron with the ordering provider and determine whether remaining doses can be safely administered in the outpatient setting or if additional inpatient doses are medically necessary. The purpose of this study was to evaluate the impact of these order set changes on outpatient IV iron referral rates. \;\n\nMethods: This multi-center\, IRB-reviewed determined exempt\, retrospective cohort study evaluated adult patients receiving IV iron across four Cone Health hospitals and affiliated outpatient infusion centers. Patients with IV iron orders placed through the inpatient infusion order set during the study period were included. The primary outcome was the proportion of hospitalized patients receiving IV iron who were referred for outpatient infusion. Chi-square test was utilized to compare pre-intervention (September 17\, 2024–May 12\, 2025) and post-intervention (May 13\, 2025–October 31\, 2025) cohorts for the primary outcome. Secondary outcomes included the proportion of referred patients who received at least one outpatient IV iron dose\, the proportion who completed their planned outpatient IV iron treatment course\, median time from discharge to first outpatient IV iron administration\, median time from discharge to first outreach for infusion scheduling\, and reasons for incomplete outpatient IV iron treatment among referred patients. Descriptive statistics were used to summarize baseline characteristics. \;\n\nResults: Data on 201 patients were collected from both the pre- and postimplementation phases. During the pre-intervention period\, 1\,430 hospitalized patients received inpatient IV iron\, with 36 patients (2.5%) referred for outpatient infusion. In the post-intervention period\, 1\,131 hospitalized patients received inpatient IV iron\, and 168 patients (14.6%) were referred for outpatient infusion (p <\; 0.001).  \;Among referred patients\, 31 of 36 patients (86.1%) in the pre-intervention group and 99 of 165 patients (60.0%) in the post-intervention group received at least one outpatient IV iron dose (p = 0.0029). Overall\, 24 of 36 patients (66.7%) in the pre-intervention group and 88 of 165 patients (53.3%) in the post-intervention group completed their planned IV iron treatment course (p = 0.1445). Median time from hospital discharge to first outreach for infusion scheduling was 4 days (range 0–81) in the pre-intervention group and 3 days (range 0–30) in the post-intervention group. Median time from discharge to first outpatient IV iron administration was 13 days (range 5–91) in the pre-intervention group and 11 days (range 8–18) in the post-intervention group. The most frequently identified barriers to treatment completion were no-shows\, inability to contact patients\, rehospitalization\, patient-directed delays\, and documentation gaps. \;\n\nConclusions: Implementation of an updated IV iron order set incorporating pharmacist review significantly increased referrals for outpatient IV iron therapy. Standardizing referral workflows at hospital discharge may improve continuity of care\, support timely outpatient iron repletion\, and optimize utilization of inpatient and ambulatory infusion resources. \n\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:00f18ee08224e965b9e0ab6d2fc82dac URL:http://2026serc.sched.com/event/00f18ee08224e965b9e0ab6d2fc82dac END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T150000Z DTEND:20260501T152000Z SUMMARY:Impact of Midodrine on Optimization of Guideline-Directed Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction DESCRIPTION:Title: Impact of Midodrine on Optimization of Guideline-Directed Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction\nAuthors: Isabelle Perling\, Jessica Starr\, Nathan Pinner\, Alyssa Osmonson\, Kenda Germain\nObjective: Discuss whether the addition of midodrine in patients with heart failure with reduced ejection fraction (HFrEF) facilitates optimization of Step 1 guideline-directed medical therapy (GDMT)\nSelf-Assessment Question: True or false\, the addition of midodrine for HFrEF patients led to optimization of GDMT compared to those not started on midodrine.\nBackground: Heart failure is a complex syndrome that results from impairment of ventricular filling or blood ejection from the heart. It is classified by ejection fraction with the most common types being heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction.\nGuideline-directed medical therapy (GDMT) for HFrEF includes four step 1 agents: renin-angiotensin system inhibition with an angiotensin-converting enzyme inhibitors\, angiotensin receptor blockers\, or angiotensin receptor-neprilysin inhibitors\, beta blockers\, mineralocorticoid receptor antagonists\, and sodium-glucose cotransporter 2 inhibitors. These treatments prolong patient life\, improve symptoms\, and reduce hospitalizations for HFrEF patients. Due to the notable blood pressure lowering effects of many of these agents\, some patients cannot tolerate full GDMT.\n Midodrine is a peripheral alpha-1 agonist that increases arterial and venous tone resulting in increased BP. It is FDA approved for symptomatic orthostatic hypotension but has been used off-label for vasopressor weaning in the intensive care unit and hemodialysis associated hypotension. Because combining multiple agents of GDMT can lower BP\, some clinicians are beginning to use midodrine to counteract hypotension and ensure full optimization of GDMT.\nMethods: This is a single center\, IRB approved\, retrospective chart review in patients with HFrEF and at least one Step 1 GDMT agent(s) on their home medication list. Patients with ≥3 normotensive blood pressure readings\, contraindications to GDMT\, mixed heart failure\, end stage kidney disease\, liver failure\, and addition of midodrine for vasopressor de-escalation or no prescription fill data post-discharge were excluded. The primary endpoint was optimization of Step 1 GDMT\, including addition of further agents or dose increases in current. Secondary outcomes include addition of GDMT\, dose increase in current GDMT\, reduction of GDMT\, dose decreases in current GDMT\, 30-day re-admission\, mortality within a year\, ability to come off midodrine\, and improvement in ejection fraction.\nResults: 28 patients were analyzed\, 14 on midodrine and 14 without midodrine. There was no difference in optimization of Step 1 GDMT between the midodrine and matched control group. 3/14 patients in the midodrine group were optimized on step 1 GDMT compared to 6/14 in the control group (p=0.225). There was a meaningful difference in mortality within a year between the midodrine and control groups\, 5/14 and 1/14\, respectively (p=0.065).\nConclusion: Midodrine did not result in a difference in optimization of GDMT. Mortality was higher in the midodrine group\, emphasizing the need for further studies evaluating the safety of the medication in HFrEF patients. CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:bc4a805f373152274c2d8ddc8bb653ca URL:http://2026serc.sched.com/event/bc4a805f373152274c2d8ddc8bb653ca END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:56ad44fe1d2f5306be60525e2cb070cc URL:http://2026serc.sched.com/event/56ad44fe1d2f5306be60525e2cb070cc END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:7543a8b77a32ae1f8508434fdb45bb2e URL:http://2026serc.sched.com/event/7543a8b77a32ae1f8508434fdb45bb2e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:e02dba90aba34998e34caa19fc413cf1 URL:http://2026serc.sched.com/event/e02dba90aba34998e34caa19fc413cf1 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:f60dca2500a3d891a9526435073018ff URL:http://2026serc.sched.com/event/f60dca2500a3d891a9526435073018ff END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Evaluating the Risk Factors for Acute Kidney Injury Associated with Mannitol Therapy for Increased Intracranial Pressure DESCRIPTION:Background:  \;\nA common complication of traumatic and non-traumatic neurological injuries is elevated intracranial pressure (ICP). Preventing elevated ICP is critical for minimizing secondary neurologic injuries. First line pharmacologic therapies include hyperosmolar agents\, such as hypertonic saline and mannitol. In the 2020 Neurocritical Care Society (NCS) Guidelines for Acute Treatment of Cerebral Edema\, hypertonic saline and mannitol are both considered viable options\, and there is little data to support one therapy over another\, with many patients receiving both in clinical practice. Hypertonic saline is a plasma volume expander and may lead to hypernatremia\; while mannitol is an osmotic diuretic and may not be preferred in patients due to risk of acute kidney injury (AKI). \;\nIncreased serum concentrations of mannitol may be associated with AKI due to renal vasoconstriction. While most hospitals do not directly measure mannitol serum concentrations\, osmolar gap monitoring has emerged as a surrogate marker for serum levels of mannitol. The NCS Guidelines recommend monitoring osmolar gap over serum osmolarity to assess the risk of AKI\; however\, the osmolar gap value at which to withhold mannitol remains unclear. The aim of this study is to determine risk factors for AKI among patients who receive mannitol for elevated ICP.  \;\n \;\nMethods:  \;\nThis was a multi-center\, retrospective\, observational cohort study to identify the risk factors for AKI in patients who receive mannitol to manage elevated ICP. Patients were included if admitted to the Neurocritical Care or Trauma ICU between March 1st\, 2024\, and November 1st\, 2025\, received at least 1 g/kg of mannitol\, and at least 2 doses of mannitol during admission. Patients were excluded if they had end-stage renal disease or have a baseline dependence on renal replacement therapy.  \;The primary outcome was identification of risk factors associated with AKI. Univariate logistic regression analysis was used to determine which variables are associated with AKI. We included variables such as peak osmolar gap\, total mannitol dose administered\, age\, comorbid conditions\, and number of nephrotoxic medications.  \;The secondary outcome was to compare characteristics of patients with AKI to those without AKI. Other statistical analyses were descriptive and inferential in nature.  \;\n \;\nResults:  \; \;\nA total of 230 patients who received mannitol between March 1st\, 2024\, and November 1st\, 2025\, were screened for inclusion. Of these\, 102 patients met inclusion criteria and were included in the study cohort. The most common reason patients were not included was receiving less than 1 g/kg of mannitol and/or fewer than two doses of mannitol during admission. \;\nBaseline characteristics included patients that were predominantly male (56%) and White (53%)\, with a median age of 58 years. Most patients were admitted with a nontraumatic neurologic injury (94%) and were managed in the Neurocritical ICU (95%). Baseline serum creatinine was higher in patients who developed AKI compared to those who did not (1.02 mg/dL vs 0.79 mg/dL (p = 0.001). \;\nAmong the 102 included patients\, 28 developed AKI as defined by the Stage 1 AKI KDIGO Criteria. A univariate logistic regression analysis was conducted to evaluate differences between patients with and without AKI. Baseline serum creatinine (p = 0.010) and APACHE-II score (p = 0.032) were significantly associated with AKI. The median [IQR] peak serum creatinine among patients with AKI was 1.66 [1.41 - 2.46] mg/dL. \;\n\nConclusions: \;\nIn a univariate logistic regression analysis\, higher baseline serum creatinine and APACHE II scores were associated with an increased risk of AKI. Factors associated with administration of mannitol\, such as peak osmolar gap and total mannitol dose administered\, were not associated with an increased risk of AKI.  \; CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:bd93ab5da350200919df0ee1071e54ae URL:http://2026serc.sched.com/event/bd93ab5da350200919df0ee1071e54ae END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Evaluation of Neurostimulants on Functional-Cognitive Capacity in Traumatic Brain Injury DESCRIPTION:Introduction: Traumatic brain injury (TBI) is a major cause of long-term disability\, with persistent cognitive and functional deficits affecting millions of survivors. Neurostimulants such as amantadine are recommended for disorders of consciousness after TBI\; however\, limited evidence exists evaluating the impact of combination neurostimulant therapy with methylphenidate on functional recovery. This study evaluated the effect of single versus dual neurostimulant therapy on functional-cognitive outcomes in patients with moderate to severe TBI.\nMethods: A single-center retrospective observational study was conducted at a Level I trauma center from January 1 to December 31\, 2024. Adult patients (age >\;16 years) with moderate to severe TBI\, defined as a Glasgow Coma Score (GCS) <\; 12 within 72 hours of arrival\, who received amantadine alone or amantadine plus methylphenidate for ≥3 days during intensive care unit (ICU) admission were included. The primary outcome was discharge functional-cognitive capacity measured by the Rancho Los Amigos Scale-Revised (RLAS-R). Secondary outcomes included change in GCS\, ICU and hospital length of stay (LOS)\, and discharge disposition. Propensity matching (1:4) and multivariable analyses were performed.\nResults: Seventy-six patients were included (amantadine n=57\; dual therapy n=19). Baseline demographics and injury characteristics were similar between groups. Median discharge RLAS-R scores did not significantly differ between dual therapy and monotherapy groups (4 vs 5\, p=0.12). ICU and hospital LOS were comparable between groups\, and discharge disposition distributions were similar. Multivariable regression adjusting for initial GCS demonstrated no significant association between treatment strategy and discharge functional-cognitive outcomes (OR 0.73\, 95% CI 0.30–1.81). ICU (21 vs 19 days\, p = 0.20) and hospital LOS (29 vs 33 days\, p = 0.10) were comparable between groups\, and discharge disposition distributions were similar\, with more than 50% of patients being discharged to an acute rehab facility.\nConclusions: Early initiation of dual neurostimulant therapy (amantadine plus methylphenidate) produced functional-cognitive outcomes comparable to amantadine monotherapy without decreasing resource utilization. These findings suggest no clear additive benefit of combination therapy in moderate to severe TBI and highlight the need for CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:ca7e0036d60bda7e85479a998e9a18da URL:http://2026serc.sched.com/event/ca7e0036d60bda7e85479a998e9a18da END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Evaluation of Prophylactic Antibiotic Usage in Patients with Open Fracture DESCRIPTION:\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:9c5f0ab933cda088453b74ec5e9b7e76 URL:http://2026serc.sched.com/event/9c5f0ab933cda088453b74ec5e9b7e76 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Evaluation of Revisions to Pharmacist-Directed Heparin Infusion Protocol DESCRIPTION:Evaluation of Revisions to Pharmacist-Directed Heparin Infusion Protocol \;\nCaylen Wouters\, Samantha Sims\, Kristy Williams\, Andrew Revels\, Jordana Champion \;\nEast Alabama Medical Center\n\nABSTRACT \n\nPurpose \nAt our institution\, patients requiring heparin infusions are managed by the pharmacy staff based on activated partial thromboplastin time (aPTTs) levels. In July 2024\, revisions to our institution’s heparin protocol changed the way pharmacists modified heparin drips based on aPTT levels. These changes included updating the nomogram for heparin infusion rate adjustments and reducing the number of required boluses per protocol. The purpose of this study is to assess the effects of these revisions on the institution’s current heparin protocol.  \n\nMethods \nThis study was a single-center\, retrospective chart review evaluating the electronic health records (EHR) of adult patients admitted to our institution who received heparin for at least 48 hours according to the institution’s revised pharmacist-driven heparin protocol. The primary outcome was the frequency of achieving two consecutive therapeutic aPTTs within 48 hours of heparin infusion initiation. Secondary outcomes included: bleeding occurrences\, number of aPTT levels drawn within 48 hours\, total number aPTT levels drawn during infusion\, number of patients who received initial heparin boluses\, number of patients who received additional heparin boluses\, number of times heparin drips held for elevated aPTTs\, sub-\, supra- and therapeutic aPTTs\, time to achieving two consecutive therapeutic aPTTs\, and duration of heparin drip. Patients were identified using admission dates between January-June 2024 for the pre-revision group and January-June 2025 for the post-revision group and then randomized and evaluated for inclusion. The statistical analysis was done using IBM SPSS Statistics version 30.0.0.0 (IBM Corp.\, 2024). The chi-square method was used for the nominal data within the primary and secondary outcomes\, and the student t-test was used for the continuous data in the secondary outcomes. P-value <\; 0.05 was considered statistically significant. \n\nResults\nOne hundred patients were included in the final analysis of this study with 50 patients in the pre-revision group and 50 patients in the post-revision group. Baseline characteristics included men and women averaging about 65 years old\, mostly of White/European descent\, and a BMI of about 29 kg/m2. For the primary outcome\, there was no statistically significant difference in the achievement of two consecutive therapeutic aPTTs within 48 hours between the pre-revision group and the post-revision group (50% and 56% respectively\, P= 0.689). Overall\, the secondary outcomes were similar between groups and were not statistically significant. The one secondary outcome that demonstrated a statistically significant difference was the amount of additional heparin boluses administered during heparin treatment\, with 48% in the pre-revision group and 14% in the post-revision group. \n\nConclusions\nThe updated pharmacist-driven heparin protocol demonstrated comparable efficacy to the prior protocol revealing no significant decrease in time to therapeutic range. The significant decrease in the number of supplemental boluses between groups indicated improvement in the initial dosing accuracy and enhanced dose adjustments within the new protocol. A reduction in heparin boluses may ultimately lead to a decrease in the risk of supratherapeutic anticoagulation\, nurse workload\, and interruptions in therapy\; therefore\, these reductions could help improve overall patient safety and operational efficiency. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:ba4503409a1bf97d3f8d238a8b0d2d75 URL:http://2026serc.sched.com/event/ba4503409a1bf97d3f8d238a8b0d2d75 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Outcomes of anticoagulation alone vs anticoagulation plus intervention in patients who present to the ED with massive pulmonary embolism. DESCRIPTION:Purpose: The literature surrounding optimal treatment of massive pulmonary embolisms (PE) is unclear. Numerous studies have been published regarding treatment options including anticoagulation\, fibrinolytic therapy\, thrombectomies\, catheter-directed fibrinolytic therapy\, and surgical embolectomy with limited direct or combination therapy comparisons. This study aims to evaluate anticoagulation alone to anticoagulation plus intervention (fibrinolytics\, thrombectomy\, catheter-directed fibrinolytic therapy) in the treatment of massive PE in emergency department patients across Prisma Health. \;\n\nMethods: This study is a retrospective cohort study\, evaluating patients diagnosed with massive PE presenting to a Prisma Health emergency department from May 1\, 2021\, to August 31\, 2025. The primary outcomes will be time to first improvement in hemodynamic instability markers of either systolic blood pressure (≥ 120 mmHg without vasopressors)\, O2 saturation (≥ 94% on room air or 2 liters nasal cannula) or heart rate (≤ 100 beats per minute or patient’s baseline) as well as average time to composite improvement for those meeting at least 2 or more markers of hemodynamic instability. Additional variables collected and evaluated will include anticoagulant used\, intervention if any\, available imaging\, in-hospital mortality\, and readmission for PE. Outcomes will be evaluated using logistic regression for primary outcomes and other descriptive analyses. \;\n\nResults: Out of 860 patients screened\, 41 patients were included in the anticoagulation + intervention and 22 were included in the anticoagulation only group. The median age was 62 years in the intervention group compared with 70.5 in the anticoagulation only group. 78% of patients vs 95.5% of patients presented with comorbid conditions such as heart failure\, COPD\, and cancer. All of the first documented vital signs in the emergency department were outside of our set thresholds. Of the 41 patients in the intervention group\, 23 received fibrinolytics only\, 4 received a thrombectomy only\, 14 received a fibrinolytic plus a thrombectomy\, and none received catheter-directed fibrinolytic therapy. Of the patients who received a fibrinolytic only\, 19 received alteplase compared to 4 who received tenecteplase (p=0.002). There was no difference seen in which vital sign improved first between the intervention group and the anticoagulation only group\, as well as our subgroup population: alteplase vs tenecteplase patients. The median time to vital sign improvement (in hours) was significantly lower at 5 hours vs 8.5 hours between our two major groups (p=0.024). The logistic regression showed that there was no vital sign that stood out as the main driving factor for the improvement seen. 34.1% of patients in the intervention group had a bleed compared to 9.1% in the anticoagulation group. There was no difference seen in terms of major bleeds\, mortality\, or readmission rates. \;\n\nConclusion: Patients given anticoagulation plus an intervention had quicker time to vital sign improvement compared to patients given anticoagulation only. There was no difference in terms of mortality or readmission rates between the two primary groups and the two fibrinolytic subgroups. Future studies are needed to explore what kinds of interventions bring the best outcomes for massive pulmonary embolism patients. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:4d055559cffd99b9f290fab95069715a URL:http://2026serc.sched.com/event/4d055559cffd99b9f290fab95069715a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Protocol Guided VTE Prophylaxis in Trauma Patients: A Retrospective Cohort Study DESCRIPTION:Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality following traumatic injury. Trauma patients are at an increased risk for VTE secondary to dysregulation of the coagulation system\, reduced mobility\, and the type of traumatic injury. Low molecular weight heparin (LMWH) is the drug of choice for VTE prophylaxis in this population because of its increased bioavailability\, longer half-life\, and predictable pharmacokinetics. Subcutaneous heparin is alternatively recommended for patients with a creatinine clearance less than 30 mL/min or with end stage renal disease on hemodialysis. Timely initiation of appropriate VTE prophylaxis is crucial to preventing fatal complications in trauma patients. VTE prophylaxis must be initiated early and continue throughout the admission without missing doses for orthopedic and most other surgical procedures. Limited guidance has been established and VTE prophylaxis strategies generally rely on institutional protocol and surgeon’s discretion. Given the challenges of balancing bleed risk and VTE prevention\, there is a need for a standardized protocol guided VTE prophylaxis in trauma patients. The purpose of this study was to determine the impact of implementing a VTE prophylaxis protocol in trauma patients admitted to the intensive care unit.\n\nMethods: This was an observational\, pre-post study completed at Piedmont Columbus Regional Midtown in Columbus\, GA during two independent time periods. The primary objective of this study was to determine rate of compliance with evidence based VTE prophylaxis in the pre-implementation group compared to the post-implementation group\, including appropriate dose of VTE prophylaxis\, time to administration of VTE prophylaxis\, and time to perioperative re-initiation of VTE prophylaxis. The secondary objectives were incidence of VTE\, incidence of major bleeding\, number of initial anti-Xa levels in goal for patients who received LMWH\, and days needed to achieve goal anti-Xa level for patients who received LMWH. The primary outcome was analyzed using Chi-square test and the secondary outcomes were analyzed using either Chi-square test or Fisher's exact test. Patients were excluded if their length of stay was less than 24 hours\, they were pregnant\, had coagulopathy on admission\, clinical signs of ongoing hemorrhage\, had an indication for therapeutic anticoagulation on admission\, or traumatic brain injury meeting high-risk Modified Berne-Norwood Criteria.\n\nResults: For the primary objective of protocol compliance for VTE prophylaxis\, 25% of patients in the pre-group met compliance with the protocol versus 41% in the post-group. \;For secondary objectives\, three patients in the pre-group had a VTE occurrence whereas none did in the post-group. Six patients in the pre-group had an incidence of major bleeding\, compared to none in the post-group. \;Only 10 patients in the pre-group had anti-Xa level monitoring obtained and 13 patients in the post group. Of which\, 40% had an initial anti-Xa at goal in the pre-group versus 54% in the post-group. The days needed to achieve anti-Xa goal was also not significantly different after implementation of the protocol.\n\nConclusion: Implementation of a standardized VTE prophylaxis protocol improved appropriate selection of dose and time to initiation without increasing frequency of bleeding. \n\nContact: emily.davis2@piedmont.org CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:485c9ec722b212888605be5457d7ce62 URL:http://2026serc.sched.com/event/485c9ec722b212888605be5457d7ce62 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Medication-induced falls in hospitalized patients: assessing the impact of anticholinergic drugs and the predictability of fall risk scores - William W. Feese DESCRIPTION:Introduction:  \;  \;\nSome of the most prescribed medications in the elderly population have potent anticholinergic properties\, which are associated with potentially harmful side effects\, such as an increased risk of falls. In addition\, many elderly patients are on potentially inappropriate medications as defined by the Beers criteria\, many of which can also increase fall risk. Pharmacists can play a pivotal role in preventing inpatient falls by proactively identifying patients taking potentially inappropriate medications and making recommendations related to de-prescribing or medication optimization. The objective of this study is to investigate if a causal relationship exists between inpatient falls and medication usage. \;\nMethods:  \;\nThis is a retrospective case-controlled study of adult patients aged 65 years or older admitted to The University of Tennessee Medical Center from January 2023 to May 2025. Patients were separated into two groups: the fall group\, which included patients aged 65 years or older who had experienced an inpatient fall (as identified by ICD-10 codes for inpatient falls)\, and the control group\, which included patients aged 65 years or older who had not experienced an inpatient fall. Patients were excluded if they were under 65 years old. The Anticholinergic Burden Score and the Beers Criteria scoring systems were utilized to assess the total number of potentially inappropriate medications the patients were taking at admission\, during their hospital stay\, and at discharge. The primary outcome is the median score on each scoring system at each time point: admission\, during their hospital stay\, and on discharge. Secondary outcomes are length of stay and discharge location. \;\nResults: \;\nA total of 310 participants met the inclusion criteria. Baseline characteristics were similar between groups except for a higher prevalence of atrial fibrillation in the no-fall group (P = 0.004). Both measures of potentially inappropriate medication exposure were significantly higher in patients who experienced a fall. Median Anticholinergic Burden scores were 4 vs 2 (P <\; 0.0001)\, and median Beers Criteria scores were 7 vs 5 (P <\; 0.0001) in the fall and no-fall groups\, respectively. Despite no difference in admissions scores\, the change in both metrics from admission to maximum inpatient values were significantly greater in the fall group (P <\; 0.0001). Patients who fell had a longer median length of stay (8 vs 4 days\, P <\; 0.0001) and were more frequently discharged to skilled nursing facilities (P <\; 0.0001). A post-hoc analysis was conducted regarding past medical history for atrial fibrillation and Parkinson's disease\, as they were significant or marginally non-significant\, respectively. Each 1-point increase in Anticholinergic Burden Score increased fall risk by 26.9%\, and each 1-point increase in Beers Criteria Score increased fall risk by 14.3% among patients with atrial fibrillation or Parkinson's disease. \;\nConclusion: \;\nPatients who experienced an inpatient fall had significantly higher maximum Anticholinergic Burden and Beers Criteria scores than those who did not fall. Falls were also associated with longer hospital stays and a greater likelihood of discharge to a skilled nursing facility. Medication risk scores increased from admission through the time of the fall\, suggesting an opportunity to improve inpatient medication optimization to prevent falls. Future research should evaluate high-risk medication combinations and dose-related effects within the Anticholinergic Burden and Beers Criteria to better guide prescribing for high-risk hospitalized patients. \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:bb6e085082c117744ad87ed599aad541 URL:http://2026serc.sched.com/event/bb6e085082c117744ad87ed599aad541 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T152000Z DTEND:20260501T154000Z SUMMARY:Evaluation of Empiric Vancomycin Utilization in Febrile Neutropenia DESCRIPTION:Lauryn Malone\, Ben Casey\, Darby Siler \;\nTriStar Centennial Medical Center – Nashville\, TN \;\n\nBackground: Febrile neutropenia (FN) is a common complication of cancer treatment and is considered to be an oncologic emergency. Vancomycin is primarily used to treat infections caused by methicillin-resistant Staphylococcus aureus. FN guidelines do not recommend routine use of MRSA coverage as empiric therapy for FN unless pre-specified criteria are fulfilled. Despite these recommendations\, previous studies suggest vancomycin is often prematurely added to empiric antibiotic therapy regimens in patients with febrile neutropenia. Utilization of vancomycin empirically in FN has been increasing\, though its clinical utility remains uncertain due to the lower incidence of resistant gram-positive organisms causing FN. The purpose of this study was to evaluate the utilization and prescribing patterns of empiric vancomycin for febrile neutropenia at our facility. \;\n \;\nMethods: Patients were identified based on having vancomycin ordered for the indication of febrile neutropenia. Patients were included if they had a fever and were neutropenic. Exclusion criteria consisted of patients ages 18 years of age or younger\, patients receiving care under the pediatric oncology service\, patients without a diagnosis of cancer\, and patients with vancomycin ordered for less than 24 hours. The primary outcome was to evaluate the incidence of guideline-directed utilization of empiric vancomycin for febrile neutropenia. Secondary outcomes included the duration of fever\, appropriateness of gram-positive and gram-negative coverage\, incidence of positive blood cultures\, and prescribing patterns among various specialties. Descriptive statistics were used to report outcomes. \;\n \;\nResults: A total of 153 patients were screened\; 38 patients met inclusion criteria\, and 115 patients were excluded due to receiving vancomycin for less than 24 hours. Of the 38 patients included\, 89% (n =34) had hematologic malignancies\, with a cohort age range of 28–80 years. Among the 38 patients evaluated\, 26 (68%) received empiric MRSA coverage consistent with established FN guidelines. The most common indication for empiric vancomycin was concerns for pneumonia on imaging (13/38 patients\; 34%). The average duration of MRSA coverage was 93.8 hours (SD: 63.7 hours). Emergency medicine providers initiated empiric vancomycin for 17/38 patients (45%). No adverse reactions were noted for included patients. \n \;\nConclusions: This study found that in patients presenting with FN who were empirically started on vancomycin\, therapy was routinely discontinued within 24 hours. This study also found that in patients who received vancomycin for greater than 24 hours\, vancomycin utilization was discordant with guideline recommendations for MRSA directed therapy in FN\, highlighting the potential need for antimicrobial stewardship intervention for this patient population. \;\n \;\nThis 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. CATEGORIES:ONCOLOGY (ONC) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:9d6256aace06f6cb4820d667e6bad6e8 URL:http://2026serc.sched.com/event/9d6256aace06f6cb4820d667e6bad6e8 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Olympia 1\, Athens\, GA\, USA SEQUENCE:0 UID:7577c98077bb7ca6277f9eff20d831c3 URL:http://2026serc.sched.com/event/7577c98077bb7ca6277f9eff20d831c3 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Olympia 2\, Athens\, GA\, USA SEQUENCE:0 UID:81ae3ecc4f5841ad9a44d3534dd24632 URL:http://2026serc.sched.com/event/81ae3ecc4f5841ad9a44d3534dd24632 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:UNFILLED SLOT DESCRIPTION:\n CATEGORIES: LOCATION:Parthenon 1\, Athens\, GA\, USA SEQUENCE:0 UID:c08da924c2209688d0a7d325a84e5aff URL:http://2026serc.sched.com/event/c08da924c2209688d0a7d325a84e5aff END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:UNFILLED SLOT DESCRIPTION: CATEGORIES: LOCATION:Parthenon 2\, Athens\, GA\, USA SEQUENCE:0 UID:d2f5d09f949f621e835f8b87e8ebc6d7 URL:http://2026serc.sched.com/event/d2f5d09f949f621e835f8b87e8ebc6d7 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Optimizing Migraine Management in Veterans: A Pharmacist-Led Review of Triptan Use in Primary Care Clinics DESCRIPTION:Optimizing Migraine Management in Veterans: A Pharmacist-Led Review of Triptan Use in Primary Care Clinics\nJustin Barnett\, Jessica Parks\, Stephanie Hopkins\, Karyn Fabo\nFayetteville NC VA Coastal Health Care System – Fayetteville\, NC\n\nBackground: \;Acute migraine headaches affect approximately 16% of the United States population. Triptans (e.g.\, sumatriptan\, rizatriptan\, etc.) are often the first-line option for acute migraine management. Triptans provide symptom relief by promoting vasoconstriction of intracranial blood vessels\, and while this mechanism is the primary source of therapeutic benefit\, it also increases cardiovascular risks\, especially coronary vasospasm. As a result\, the triptan class is contraindicated in patients with a history of cardiovascular disease\, and use should be limited in patients with risk factors for cardiovascular disease. Nationwide prescribing patterns suggest that nearly 14% of patients using triptans meet at least one contraindication.\n\n\nMethods: \;This quality improvement initiative identified adult Veterans at a Veterans Affairs (VA) Health Care Center who had an active prescription for a triptan medication. Patients qualified for review if they were managed by one of six designated primary care clinics and were disqualified if their migraine disorder was actively managed by a VA or private-sector neurologist.\n\nContraindications (including ischemic heart disease\, arrhythmias\, uncontrolled hypertension\, history of gastrointestinal ischemia\, history of stroke\, peripheral vascular disease\, and structural heart disease) and cardiovascular risk factors (including hypertension\, hyperlipidemia\, diabetes mellitus\, hepatic or renal failure\, obesity\, age >\;65 years\, and current tobacco use) were identified via electronic health record (EHR) review. The primary author attempted telephone contact with each identified Veteran to reconcile any potential discrepancies in EHR documentation.\n\nAt the conclusion of the patient encounter\, the primary investigator recommended the following: no intervention\, referral by primary care provider (PCP) to neurology service\, referral by PCP to cardiology service\, discontinuation of triptan prescription\, or referral directly to clinical pharmacist practitioner (CPP) for chronic disease state management. Recommendations were assessed as “accepted” or “not accepted”\, and the results were analyzed using descriptive statistics. Findings will be communicated to the designated primary care clinics in order to improve future prescribing practices.\n\n\nResults: Of the 86 patients identified\, 13 patients (15.1%) had at least one contraindication to triptan use\, and the most frequent contraindication was uncontrolled hypertension (n=9\, 10.4%). Interventions were recommended for 33 Veterans but were accepted for only 17. The most frequently recommended intervention was for a neurology consult (n=20). The most frequently accepted intervention (n=10) was for referral to a CPP for management of chronic disease states that can increase cardiovascular risk.\n\n\nConclusions: Data from this quality improvement initiative demonstrate that pharmacists should be actively engaged in monitoring triptans and counseling patients to ensure those with contraindications do not use this class of medications.\n\n CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena C\, Athens\, GA\, USA SEQUENCE:0 UID:02a7cba40732a70c81298db0dfa46e3a URL:http://2026serc.sched.com/event/02a7cba40732a70c81298db0dfa46e3a END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Use and Safety of Direct Oral Anticoagulants Immediately Following Bioprosthetic Valve Replacement in Patients with Atrial Fibrillation DESCRIPTION:Use and Safety of Direct Oral Anticoagulants Immediately Following Bioprosthetic Valve Replacement in Patients with Atrial Fibrillation\nBoma Legg-Jack\, William Kendrick\, Kellie Ball\, Jeff Lewis\n \;\nBackground: Direct oral anticoagulants (DOACs) are preferred for stroke prevention in atrial fibrillation (A-fib) patients. However\, current American Heart Association guidelines suggest warfarin indefinitely for mechanical valves\, at least 3 months after surgical bioprosthetic valve replacement\, and possibly after transcatheter valve replacement with indication for anticoagulation. After 3 months\, DOACs may be considered\, though data during the initial 90 days after implantation is limited. This study assesses the efficacy of DOACs in patients who underwent surgical or transcatheter bioprosthetic valve replacement within the first 90 days after implantation.\n\nMethods: This is an Institutional Review Board-approved retrospective chart review conducted within the University of Tennessee Medical Center Knoxville (UTMCK). Patients were included if they were ≥ 18 years old\, had a surgical or transcatheter bioprosthetic valve replacement at UTMCK between January 2020 and February 2025\, a-fib indication\, and evidence of follow-up. The primary outcome was the composite of stroke\, transient ischemic attack (TIA)\, systemic embolism (deep vein thrombosis or pulmonary embolism)\, valve thrombosis\, intracardiac thrombus\, or death from any cause during the first 90 days after initiating oral anticoagulation following bioprosthetic valve replacement. Secondary outcomes included major bleeding during the first 90 days after initiating oral anticoagulation\, clinically relevant non-major bleeding\, death from any cause\, and 30-day and 90-day readmission rate.\n\nResults: \;Among 191 patients\, 5.8% of those receiving a DOAC experienced a thrombotic event[BK1] within 90 days of valve replacement. Nonmajor and major bleeding occurred in six and two patients\, respectively. Readmissions occurred in 19 patients within 30 days of discharge\, and 18 patients within 90 days of discharge.\n\nConclusion: \;Although thromboembolic and mortality events were observed\, the overall event rate was 5.8% among 191 patients\, lower than rates reported in existing literature. Given the limited sample size\, further studies are needed to more fully evaluate the safety and efficacy of DOACs during the first 90 days after valve replacement.\n \; \; CATEGORIES:AMBULATORY CARE (AMB) LOCATION:Athena B\, Athens\, GA\, USA SEQUENCE:0 UID:8aef70e50bb3692012855132a70d8275 URL:http://2026serc.sched.com/event/8aef70e50bb3692012855132a70d8275 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Comparing Time-to-target Mean Arterial Pressure with Weight-based vs. Non-weight-based Norepinephrine ​ DESCRIPTION:COMPARING TIME-TO-TARGET MEAN ARTERIAL PRESSURE WITH WEIGHT BASED VS. NON-WEIGHT-BASED NOREPINEPHRINE\n Logan Turner\, PharmD\; Brian Hairston\, PharmD\, MBA\; Allison Jolley\, PharmD\, BCCCP\; Andrew B. Watkins\, PharmD\, BCIDP\n\n FMOL Health | St. Dominic- Jackson\, MS\n\n Background/Purpose: Septic shock is a life-threatening manifestation of sepsis characterized by persistent hypotension requiring vasopressor therapy to maintain a mean arterial pressure (MAP) ≥ 65 mmHg. Norepinephrine is the first-line vasopressor recommended in current guidelines\; however\, there is no standardized dosing strategy\, and institutions utilize either weight-based (mcg/kg/min) or fixed (mcg/min) dosing protocols. At FMOL Health | St. Dominic\, practice transitioned from fixed dosing to weight-based dosing in 2022. The purpose of this study is to compare time to goal MAP between weight-based and fixed norepinephrine dosing strategies in critically ill adults with septic shock.\n\n\n Methodology: This quasi-experimental\, retrospective cohort study will evaluate adult ICU patients treated for septic shock during two time periods: January 1\, 2019 to December 31\, 2019 (fixed dosing cohort) and January 1\, 2023 to December 31\, 2023 (weight-based dosing cohort). Patients will be identified using electronic health record data. Eligible patients will include adults ≥ 18 years of age admitted to the ICU during the study periods with a diagnosis of septic shock requiring initiation of norepinephrine infusion to maintain a goal MAP ≥ 65 mmHg. Septic shock will be defined using clinical documentation and qSOFA criteria. Patients will be excluded if norepinephrine was initiated for indications other than septic shock\, if vasopressors were started prior to ICU admission\, if they are pregnant or incarcerated\, or if key norepinephrine infusion data are incomplete or missing.\n\n\n Results: A total of 100 patients were included\, with 50 patients in each group. There was no significant difference in median time to target MAP between the weight-based and non-weight-based groups (41 vs 46 minutes\; p = 0.73). Weight-based dosing was associated with significantly higher initial and maximum norepinephrine infusion rates. No statistically significant differences were observed in secondary outcomes\, including AKI\, mortality\, or ICU length of stay.\n\n\n Conclusions: \;Weight-based norepinephrine dosing did not improve time to target MAP and resulted in higher infusion rates without clear clinical benefit\, suggesting no advantage over non-weight-based dosing in patients with septic shock. Although the overall incidence of acute kidney injury did not differ between groups\, patients who developed AKI in the weight-based group received higher maximum norepinephrine doses\, highlighting a potential safety concern.\n\n\n CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena A\, Athens\, GA\, USA SEQUENCE:0 UID:1c4100ddcc35c876982b70ac244f9bbb URL:http://2026serc.sched.com/event/1c4100ddcc35c876982b70ac244f9bbb END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Intravenous Versus Subcutaneous Insulin Administration: Evaluation of Blood Glucose Control in the Critical Care Setting DESCRIPTION:Authors: \;Mikayla Texido\, Jill Dunning\, Caitlin Thomas\nPurpose/Background: \;Hyperglycemia is commonly seen and associated with adverse outcomes among hospitalized patients\, especially in the intensive care unit (ICU) because these patients are more vulnerable to poor outcomes. Previous trials demonstrate that improved glycemic management can reduce hospital complications\, infections\, and costs. In the critical care setting\, guidelines recommend continuous intravenous (IV) insulin infusion as the preferred method for achieving specific glycemic goals while avoiding hypoglycemia. Despite these recommendations\, there are limited studies that directly compare the safety and efficacy of IV insulin to subcutaneous (SubQ) insulin for glycemic management in the critical care setting. This study aims to evaluate patients who were eligible for IV insulin administration through an electronic glucose management system (eGMS) and compare those who were managed with IV insulin via eGMS versus those managed with SubQ insulin.\nMethodology: \;This was a single center\, retrospective chart review conducted at AdventHealth Orlando that evaluated patients in the ICU who received glycemic management with either IV or SubQ insulin from June 18\, 2025\, to August 18\, 2025. Adult patients with either two consecutive blood glucose values ≥180 mg/dL or one blood glucose ≥300 while admitted to the cardiac\, neuro\, medical\, surgical\, or multi-system ICU were included. Patients were excluded if they were managed on IV insulin utilizing eGMS for less than 6 hours\, were managed with IV insulin without eGMS\, had cardiovascular surgery within 30 days prior to inclusion\, or were being treated with insulin for diabetic ketoacidosis\, hyperosmolar hyperglycemic state\, or hyperkalemia. Patients managed with IV insulin through eGMS utilization were compared to those managed with SubQ insulin. The primary outcome was the percentage of blood glucose values within a goal range of 70-180 mg/dL. A total of 774 blood glucose values would provide 80% power to detect a 10% difference. Secondary efficacy endpoints included the time until blood glucose was in range\, median blood glucose\, and ICU length of stay in both groups\, with time on eGMS and percent of successful transitions from IV to SubQ additionally evaluated in the IV group. Safety endpoints included the incidence of hypoglycemia (BG <\;70 mg/dL) and severe hypoglycemia (BG <\;40 mg/dL). \nResults: \;Of the 431 patients screened\, 149 patients met inclusion criteria and no exclusion criteria with 74 in the IV group and 75 in the SubQ group. The IV group had a total of 3\,997 individual blood glucose values while the SubQ group had 1\,599. Of the patients included\, 82 (55.0%) were male\, the median A1c was 6.7%\, and the median blood glucose on ICU admission was 198 mg/dL. Blood glucose was within the goal range of 70-180 mg/dL in 79.9% of the measurements in the IV group versus 61.2% in the SubQ group (p<\;0.001). The median blood glucose in the IV group was 146 mg/dL versus 173 mg/dL in the SubQ group (p<\;0.001). Of patients who were able to maintain their blood glucose within goal range for at least 6 consecutive hours\, the median time to blood glucose within goal range was 6.3 hours in the IV group (n=72) versus 14.0 hours in the SubQ group (n=60\; U=1011\; p<\;0.001). The patients in the IV group had a longer median ICU length of stay (7.5 days vs. 4.0 days\; U=1877.5\; p<\;0.001) and there were no incidences of severe hypoglycemia in either group.\nConclusion: \;Hyperglycemic patients admitted to the ICU had a higher percentage of blood glucose values within the goal range of 70-180 mg/dL with intravenous insulin administered via eGMS compared to patients managed with subcutaneous insulin. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena I\, Athens\, GA\, USA SEQUENCE:0 UID:00572b4fd8a7d1318fcea74dd502fe86 URL:http://2026serc.sched.com/event/00572b4fd8a7d1318fcea74dd502fe86 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Outpatient Medical (OPM) Drug Formulary Expansion to Optimize Margin DESCRIPTION:Title: Outpatient Medical (OPM) Drug Formulary Expansion to Optimize Margin\n Authors: William \;Siders\, David Collette\n Background:\n Drug formularies for the Centers of Medicare & Medicaid Services and commercial insurers are updated regularly\, which can create reimbursement challenges related to misalignment between prescribed therapies and payer-specific formulary preferences. Administering non-preferred agents can result in claim denials and increased administrative burden for providers and pharmacy staff. At Huntsville Hospital Outpatient Medical Services\, variability in insurance coverage across commercial and government payers highlighted the need for a standardized approach to formulary management. The purpose of this pharmacoeconomics project was to expand and standardize the outpatient medical drug formulary to align with current insurance preferences and maximize reimbursement.\n Methodology:\n A comprehensive review of our current formulary workhorse agents along with formulary requirements and coverage criteria across major commercial and government insurers was conducted. Based on this review\, the Outpatient Medical Services drug formulary was updated to reflect payer-preferred agents by insurance type. Standardized\, provider-facing communications were developed\, including formal educational letters distributed to providers outlining formulary changes and payer-specific drug preferences. Educational efforts emphasized appropriate product selection at the time of prescribing and appropriate documentation to ensure alignment with each patient’s insurance coverage. Additionally\, education was also provided to administrative staff to reduce the number of denial claims through changes in the prior authorization process. The project team also worked in conjunction with the Finance and Information Technology teams at Huntsville Hospital to ensure appropriate billing codes were being used for each product. Pharmacy services were designated as a centralized resource to support therapeutic interchange\, prior authorization confirmation\, and transition planning during implementation.\nResults:\n In 2025\, a total of 499 denial claims were identified\, representing a potential loss of $402\,832. The most common reasons for denial included submission or billing errors (n=157)\, lack of medical necessity (n=103)\, and duplication of payments (n=32). In 2026\, only one denial claim had occurred as of March 1\, 2026. Formulary optimization identified certain brands of ustekinumab\, infliximab\, and tocilizumab as the largest negative margin products. Transitioning to payer-preferred agents and biosimilars (Yesintek/Wezlana\, Avsola/Inflectra\, and Tofidence) resulted in a projected margin improvement of approximately $350\,000 for 2026. The most profitable products included IVIG\, bevacizumab\, and rituximab. Overall\, the total projected margin increase for outpatient medical services in 2026 is estimated at 7-10%.\n\n Conclusion:\n Implementation of an insurance-aligned outpatient formulary was associated with improved projected reimbursement margins and a marked reduction in claim denials. Alignment with payer-preferred agents and improved documentation contributed to decreased denial rates and an increase in overall margin. This pharmacist-supported\, multidisciplinary approach may enhance financial stability and operational efficiency in outpatient infusion practices. CATEGORIES:CRITICAL CARE/EMERGENCY MEDICINE (CCM) LOCATION:Athena H\, Athens\, GA\, USA SEQUENCE:0 UID:836185339504b1d1ba1a31befa310c1e URL:http://2026serc.sched.com/event/836185339504b1d1ba1a31befa310c1e END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Comparative Evaluation of IV Push Versus IV Infusion Administration of Levetiracetam DESCRIPTION:Comparative Evaluation of IV Push Versus IV Infusion Administration of Levetiracetam \;\nTavin Cook\, Ashley Crisler\, T.J. Henderson\, Aayush Patel \;\nPiedmont Columbus Regional Midtown\, Columbus GA\n\nBackground: \nLevetiracetam is commonly administered as an IV infusion\; however\, IV push (IVP) administration has the potential to improve medication turnaround times\, reduce nursing workload\, and lower medication preparation costs without compromising safety. In January 2026\, Piedmont Columbus Regional implemented IVP levetiracetam hospital wide. The objective of this study is to compare the timeliness of administration and cost difference associated with IVP levetiracetam versus IV infusion levetiracetam. \;\n\nMethods: \nThis study was a single-center\, Institutional Review Board (IRB)–approved\, retrospective chart review. The overall study timeframe spanned from October 13\, 2025\, to March 13\, 2026. The pre-implementation period was October 13\, 2025\, to January 12\, 2026\, and the post-implementation period was January 14\, 2026\, to March 13\, 2026. The study included adult patients aged 18 years or older who received intravenous levetiracetam at doses of less than 2 grams.  \;An EHR Slicer/Dicer data collection tool was used to collect points of time of order entry\, order verification\, and administration of medication. Cost analyses were conducted by integrating direct drug cost. The primary objective is to assess the difference in time from order verification to administration of once dose levetiracetam pre and post implementation. Secondary objectives include direct drug cost\, time-critical medication compliance\, and adverse drug reactions. Statistical analysis for the primary outcome used Mann-Whitney-U\, secondary outcome descriptive analysis and chi-square testing. \;\n\nResults:\nIV push levetiracetam demonstrated a numerically faster time to administration compared to IV infusion (19.7 vs 23.9 minutes)\, though this difference was not statistically significant (p=0.41). Time-critical medication compliance was significantly higher with IV push (85.7% vs 81.8%\, p<\;0.001)\, and no adverse drug reactions were reported in either group. Additionally\, IV push was associated with substantially lower direct drug costs\, translating to significant projected annual savings.\n\nConclusions: \nIV push levetiracetam is a cost-effective alternative to IV infusion that improves time-critical medication compliance while maintaining a comparable safety profile. Although a faster administration trend was observed\, it did not reach statistical significance. Overall\, IV push represents a practical and efficient strategy for levetiracetam administration within institutional practice.\n\nContact: \nTavin.cook@piedmont.org \;  \;\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena G\, Athens\, GA\, USA SEQUENCE:0 UID:3caf3cdca6a5018b6d904c901fa73834 URL:http://2026serc.sched.com/event/3caf3cdca6a5018b6d904c901fa73834 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Dalbavancin versus oral antibiotics for Staphylococcus aureus bone and joint infections DESCRIPTION:Authors: Mackenzie G. Pearsall\, John Williamson\, Mary Banoub\, Charles Hartis\, Elizabeth Palavecino\, Vera Luther\, Erin Barnes\, Erika Swintosky\, Michael DeWitt\, Jennifer J. Wenner\, Olivia Randazza \n\nBackground/Purpose: Staphylococcus aureus is a common organism associated with bone and joint infections (BJI).  \;Historically\, the standard of care (SOC) treatment for BJIs is prolonged intravenous (IV) antibiotic therapy. Studies have compared alternative BJI treatments\, including oral antibiotics and long acting lipoglycopeptides like dalbavancin\, to SOC with no significant differences in clinical outcomes. This study aims to compare the clinical success of dalbavancin with or without an oral antibiotic versus oral antibiotics alone for the treatment of S. aureus BJI after IV lead-in.  \; \;\n \;\nMethods: This is a multisite\, retrospective\, cohort study including adult patients with a documented S. aureus BJI. Patients were randomly identified using microbiologic culture data until there were 52 matched pairs on initial or recurrent infection. Eligible patients were those treated with dalbavancin with or without an oral antibiotic or an oral antibiotic alone who received 50% or less of the planned total treatment duration as IV lead-in. Patients were excluded if they had a polymicrobial BJI\, concomitant endocarditis\, valvular abscess\, or infectious central nervous system involvement\, if the S. aureus isolate was resistant to the antibiotic received\, or if they had persistent bacteremia.  \;The primary outcome was clinical success at 90 days from the end of therapy. Secondary outcomes included identification of factors associated with clinical failure\, incidence of adverse events\, therapy discontinuation\, incomplete therapy\, and hospital readmission at 30 and 90 days. The results were analyzed using descriptive statistics. Categorical data was analyzed using Pearson’s chi-squared or Fisher’s exact test\, and continuous data was analyzed using the Wilcoxon rank sum test. A univariate logistic regression was completed to identify factors associated with clinical failure. \;\n \;\nResults: In total\, 1287 patients were screened\, and 104 patients were included in the study with 52 patients in each cohort. The sample size was limited by the number of patients who received dalbavancin within the study period. \;\n \; \;\nThe median age of the overall cohort was 50 years. There was a significant difference in the incidence of current or history of illicit intravenous drug use (IVDU) between the two cohorts\, representing 19.2% of the oral cohort compared to 55.8% of the dalbavancin cohort (p<\;0.001).  \;Types of BJI were similar between the groups (dalbavancin vs. orals)\, including native osteomyelitis (37% vs. 50%\, p=0.2)\, native joint septic arthritis (21% vs.17%\, p=0.6)\, and prosthetic joint or hardware-associated infection (35% vs. 25%\, p=0.3). However\, the dalbavancin cohort contained significantly more cases of vertebral osteomyelitis (15% vs.1.9%\, p=0.031) and MRSA isolates (77% vs. 52%\, p=0.008). There was no difference in presence of source control (81% vs. 92%\, p=0.085)\, however the dalbavancin group had significantly longer duration of IV lead-in (median 160 vs. 96 hours\, p<\;0.001). \;\n \;\nThe incidence of clinical success was 71% in the dalbavancin cohort compared to 69% in the oral cohort (p=0.8). There was a non-significant trend towards a higher rate of incomplete therapy in the dalbavancin cohort compared to the oral cohort (21% vs 9.6%\, p=0.10). There were no significant differences in the rates of other secondary outcomes. The estimated cost savings were not significantly different between cohorts\, with a median savings of $79006 in the dalbavancin cohort compared to $65580 in the oral cohort (p=0.5). \;\n \;\nNone of the factors assessed in the univariate logistic regression (bacteremia\, retained prosthetic material\, IVDU\, source control\, incomplete therapy\, isolate resistance to methicillin\, and vertebral osteomyelitis) were significantly associated with clinical failure. Patients who obtained source control had a numerically lower rate of clinical failure (OR 0.36\, p=0.084). \;\n \;\nConclusions: In this cohort\, there was no difference in clinical success between the oral antibiotic and dalbavancin treatment strategies after IV lead-in in S. aureus bone and joint infections. \;\n\n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena J\, Athens\, GA\, USA SEQUENCE:0 UID:cbb1b48e77277ce1dfa64a17bfc05913 URL:http://2026serc.sched.com/event/cbb1b48e77277ce1dfa64a17bfc05913 END:VEVENT BEGIN:VEVENT DTSTAMP:20260507T221016Z DTSTART:20260501T154000Z DTEND:20260501T160000Z SUMMARY:Evaluation of Electronic Health Record Alerts for Heparin Use After Direct Oral Anticoagulant Exposure DESCRIPTION:Background: Anticoagulation therapy in hospitalized patients is inherently high-risk with complex dosing requirements and significant potential for drug interactions. Heparin is an anticoagulant that utilizes laboratory monitoring to target therapeutic concentrations\, but accuracy of anti-Xa levels can be falsely elevated due to recent direct oral anticoagulant (DOAC) exposure. Our practice advisories (OPAs) are utilized within the electronic health record (EHR) to improve clinical decision-making and advance patient safety. The study site employs OPA alerts to identify elevated anti-Xa levels in patients who may have had recent exposure to a DOAC with the goal of helping practitioners decide if a reagent that removes DOAC effect on anti-Xa (DOAC-StopTM) should be utilized.  \;The objective of this study was to analyze the impact of an OPA for elevated anti-Xa levels in patients receiving heparin infusions with recent potential or known DOAC exposure\, focusing on clinical appropriateness of DOAC-StopTM utilization and safety outcomes. \;\nMethods: This single center\, retrospective cohort study analyzed patients with an elevated anti-Xa OPA alert(s) between January 1st and April 3rd\, 2024 focusing on clinical appropriateness and safety outcomes. OPAs alerted for patients who were on a heparin infusion\, had an elevated anti-Xa ≥ 1\, and were within three days of admission or had documented receipt of a DOAC within the previous five days. Exclusion criteria included pregnancy\, incarceration\, switching between heparin protocols during the admission\, and administration of enoxaparin within 24 hours of the elevated anti-Xa. The primary outcome assessed the appropriateness of subsequent actions in response to the OPA. Appropriateness was defined based on a treatment flowchart developed for study. Secondary outcomes included incidence of bleeding within 24 and 48 hours of the alert(s) per the International Society on Thrombosis and Haemostasias (ISTH) bleeding criteria and a subgroup analysis of DOAC-StopTM utilization by level of care and nursing shift. \;\nResults: A total of 100 patients were included in the final analysis. At baseline\, 46% of patients were receiving apixaban\, 6% rivaroxaban\, and 48% were not receiving any anticoagulant within the 72 hours prior to heparin initiation. Clinical use of DOAC-StopTM following the first OPA was deemed appropriate for 92% of initial advisories and inappropriate for 8%. Inappropriate use\, according to the study-developed flowchart\, included administering DOAC-Stop™ to patients without prior DOAC exposure and omitting it in high-risk patients with prior exposure. There was no statistically significant difference between appropriate clinical use based on time of shift (p = 0.426) or by level of care (p = 0.119). Bleeding events were mostly attributable to clinically relevant non-major bleeding or major bleeding defined as a hemoglobin decrease of 2 mg/dL or more that required no clinical intervention. These events occurred within 0-24 hours in 11% of patients and within 0-48 hours in 18% of patients.  \;\nConclusions: While the true effect of this OPA is difficult to discern given lack of a control group\, the high level of appropriate advisory response indicates that it was successful in identifying potential candidates for DOAC-StopTM and ensuring that high-risk patients received adequate anticoagulation evaluation. Practice advisories and protocols do not account for every scenario\, and clinical judgement must be utilized to determine candidacy for DOAC-StopTM. \;\n \n\n CATEGORIES:INTERNAL MEDICINE (IM) LOCATION:Athena D\, Athens\, GA\, USA SEQUENCE:0 UID:f59c74f8c2b7f5b0d1fe855e24c1ded6 URL:http://2026serc.sched.com/event/f59c74f8c2b7f5b0d1fe855e24c1ded6 END:VEVENT END:VCALENDAR