NYSCHP Annual Assembly 2015 Poster Abstracts

Maimonides Medical Center, Department of Pharmacy, Brooklyn, NY 11219

Insulin pump therapy, also known as continuous subcutaneous insulin infusion therapy, has been proven to be an effective modality for the management of hyperglycemia in insulin-dependent patients. At the study institution, a 700 bed academic medical center, there is an order set available, as well as nursing standards, to guide inpatient clinicians in management of insulin pump therapy. However, both are underutilized. In an initiative to improve continuity of care, the objective of this study is to assess clinicians’ knowledge and experience in managing patients on insulin pump therapy, as well as gaining their recommendations towards optimizing the use of insulin pumps in the hospital setting.

The hypotheses of the study are, as following: 1) Hospital clinicians are not familiar with insulin pump therapy, 2) Clinicians do not believe that insulin pump therapy is an appropriate therapy for diabetes in the in-patient setting, and 3) Clinicians are not aware that there guides and resources are available to help them manage insulin pump patients.

Through a focused questionnaire, the study seeks to identify patterns in clinician judgment in the treatment and management of patients on insulin pump therapy. The survey consisting of approximately 20 questions utilizing a Likert scale will be administered to clinicians (e.g., pharmacists, nurses, physicians). The following data will be collected and assessed: baseline demographics (e.g., years of practice, discipline, area of practice), familiarity with insulin pump therapy (e.g., components of an insulin pump, rate of infusion, type of insulin utilized), perceptions on the role of insulin pumps, knowledge of current institution-specific insulin pump policy, and clinician opinion of the management of insulin pump therapy in the inpatient setting. The results of the survey will assist in understanding clinician knowledge and practices with insulin pumps, and provide possible reasons for the current underutilization of available ordersets.

St. Peter’s Hospital, 315 South Manning Boulevard, Albany, NY 12208

Purpose: To examine whether a pharmacist-driven review of medications could reduce hospital acquired falls on one medical surgical unit at a community hospital. Background: Hospital acquired falls can cause significant morbidity and mortality and pose a significant liability issue. Medications have been noted as one of the contributing causes to falls in elderly patients. Medications, especially particular therapeutic classes, have been associated with an increased risk of falls through various mechanisms. Using a medication scoring system patients can be identified to be at risk for falls. Methods: The pilot utilized real time clinical surveillance to find patients at risk to fall using a previously studied Medication Fall Risk Score (MFRS) to identify patients potentially at greater risk for falling. Patients with a MFRS ≥ 6 were included for pharmacist review. The pharmacist provided medication review and medication recommendations (if warranted), and educated patient to why they were at risk to fall (if appropriate). The pharmacist evaluated the current fall precaution measures in place and communicated with nursing newly identified at risk patients for fall precautions implementation. Lastly, the pharmacist recommended a falls video for the patient at risk to watch and if modification to the current interventions were needed. Results and Conclusions: During the pilot period the pharmacist reviewed 144 patients’ medication profiles. The mean age of the pilot population was 66 years; of which 55% of the patients reviewed were greater than or equal to 65 years of age. The pilot population was 66% female. The pharmacist made a total of 304 interventions; of these 68 included interventions related to medications. Of the 146 patients seen by pharmacy 119 or 81.5% were identified as Risk to Fall by nursing upon admission. Pharmacy review identified an additional 18, or 12% of patients to be at Risk for Fall. During the pilot period there were 12 falls on the unit. Of those falls only 3 patients fell after being seen by the Pharmacist. Ninety-eight percent of the patients seen by pharmacy did not fall during their admission.

Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210

Introduction/Background: Vancomycin is used for gram-positive infections with antimicrobial resistance and is frequently used for patients with sepsis in the emergency department (ED). It is recommended by the American Society of Health-System Pharmacists (ASHP), the Society of Infectious Diseases Pharmacists (SIDP) and the Infectious Diseases Society of America (IDSA) that vancomycin be given at a dose of 15-20 mg/kg according to actual body weight (ABW). We sought to describe vancomycin-dosing pattern within our ED. It is our hypothesis that a majority of patients in our ED receive vancomycin doses outside the recommended dosing range. Methods: All adult patients receiving IV vancomycin between March and May 2014 were reviewed in this retrospective cohort study. Patients were identified via query of all ED automated dispensing cabinets (ADC). Patients that did not receive vancomycin in the ED and who did not have a documented weight were excluded. Data collected included demographics, vancomycin dose, and indication for vancomycin therapy. Data were analyzed using SPSS Statistics version 22.0.0. Mean values and standard deviations were calculated to illustrate vancomycin-dosing patterns in our ED. Due to the retrospective nature of this study, exempt-status was granted by the IRB. Results: During the study period, 327 vancomycin doses were removed from ED ADCs. A total of 31 patients were excluded. A majority of patients (89.2%) received vancomycin 1000 mg. When weight was taken into account, 77.8% of patients received vancomycin at a dose outside the recommended range of 15-20 mg/kg; 68.4% of patients received < 15 mg/kg and 9.4% received > 20 mg/kg. Further analysis revealed an inverse trend between dose received and ABW, as well as creatinine clearance (CrCl). Conclusion: Our study sought to describe vancomycin-dosing patterns in the ED. A large majority of our patients received vancomycin 1000 mg. Additionally, most patients received lower than recommended weight-based doses. There was a negative association between ABW and weight-based vancomycin dose received. More investigation is required to assess the impact this vancomycin dosing strategy in the ED has on daily drug exposure and attainment of therapeutic targets.

The Brooklyn Hospital Center, Department of Pharmacy, Brooklyn, NY 11201

Introduction: The transition from the hospital to an outpatient setting remains a vulnerable time for patients. Safe care transitions are essential in order to provide high-quality patient care, minimize medication errors and reduce avoidable readmissions. Prompt follow-up with an outpatient provider for post-discharge medication reconciliation is a key element in effective programs focusing on transitions from hospital to home. Current literature states ideal post-discharge follow-up can range anywhere between 48 hours and two weeks of hospital discharge. Although there has been much research in transitions of care, there is a lack of evidence regarding optimal timing of a follow-up visit to prevent readmissions. The purpose of this study is to evaluate the impact of early versus late post-discharge medication reconciliation on readmission rates and emergency department use. Hypothesis: It is expected that there will be no difference in outcomes whether a patient has early (≤48 hours) or late (between 48 hours and two weeks) post-discharge medication reconciliation. Methods: In this retrospective data analysis study, electronic data for all patients who had a clinic visit with a pharmacist or primary care physician in either Family Medicine or Internal Medicine at The Brooklyn Hospital Center from August 2013 to August 2014 for post-discharge medication reconciliation will be reviewed. The following data will be collected: baseline demographics (including length of stay, acuity of admission, Charlson Comorbidity Index, emergency department visits within the past 6 months), number of days from discharge to post-discharge clinic visit, and time to readmission or emergency department visit within 90 days post-discharge clinic visit. The primary efficacy endpoint is the readmission rate at 30 days (including hospital admission or emergency department visits). The secondary endpoint is the readmission rate at 90 days (including hospital admission or emergency department visits).The study will utilize purposeful non-random sampling. Descriptive statistics will be used to assess baseline demographics and bivariate and multivariate statistics will be used to determine association with primary and secondary outcomes. Results: Results will be presented pending further data analysis. Conclusions: With this study, there will be additional data evaluating the impact of timing of post-discharge medication reconciliation and the effect on readmission rates and emergency department use.

Lenox Hill Hospital, Department of Pharmacy, 100 East 77th St, New York, NY 10075

Introduction: Based on antimicrobial stewardship intervention data analysis, vancomycin is the most common antimicrobial agent that is dosed and monitored incorrectly at Lenox Hill Hospital. The Infectious Disease Society of America (IDSA) recommends a weight-based vancomycin dosing of 15-20 mg/kg/dose based on actual body weight (ABW). However, the most common dosing typically utilized is the conventional dosing of vancomycin 1 gram q12h. In order to reach target trough levels, improve therapeutic effectiveness, and practice proper antimicrobial stewardship, appropriate dosing and monitoring is crucial when prescribing vancomycin. Methods: A retrospective chart review of 100 randomly selected patients was conducted from June and July of 2014. Patients who were less than 18 years old, on hemodialysis or who were receiving therapy for less than 5 days were excluded. Data collected and analyzed included the most common dosing seen, the most common indication seen, whether a true trough was measured, and whether the trough was suboptimal (<10 mg/L). Post analysis, pharmacist and physician education regarding general information, proper dosing, and monitoring of vancomycin was implemented. In addition, a proposed weight-based dosing order set was created to potentially be built into a computerized prescriber-order-entry (CPOE) system to prospectively affect initial dosing of vancomycin in hopes of improving prescribing. Results: Physicians commonly dosed vancomycin 1 gram q12h in 85 of 100 patients (85%) regardless of the patient’s weight. The most common indication seen in these patients was to treat clinically proven or suspected MRSA (72%). True trough levels were only taken in 48 out of 100 patients (48%) and out of those 48 patients, 17 patients (35%) had suboptimal serum vancomycin levels (< 10 mg/L). Conclusions: To be determined.

Long Island Jewish Medical Center, Department of Pharmacy, New Hyde Park, NY 11040

Introduction/Background: Improving patient safety remains the key driver in hospital-wide quality improvement initiatives, and the Long Island Jewish (LIJ) Pharmacy Department has been exploring a variety of strategies to help achieve this goal. Automated dispensing machines (i.e., Pyxis^®) have been recommended as one potential mechanism to improve efficiency and patient safety. While the override function in Pyxis^® is necessary to ensure timely administration of medications in emergent cases, inappropriate or excessive use of overrides to bypass pharmacy screening of medication orders prior to administration may increase the risk of allergic reactions, drug interactions, suboptimal regimens and other adverse events for our patients. In December of 2013, the LIJ Pyxis^® override rate was at 8.74% and with initial intervention the rate was decreased to 6.35% in June. In an effort to identify additional areas for improvement the following quality improvement project was initiated. Hypothesis: Pharmacy-driven auditing of Pyxis^® override data and subsequent targeted intervention leads to a reduction in non-critical overrides thereby improving patient safety. Methods: An IRB-exempt, quality improvement, override audit took place from July through the end of November 2014 to assess the overrides that occurred during a specified shift; initially looking at orders from 7 am to 2 pm and then those from 7 pm to 7 am. A sample of overrides from random units was selected on a day-to-day basis and included the critical care areas. We evaluated the appropriateness of each override with the goal of identifying areas for improvement and re-education, such as awaiting pharmacist verification rather than removal of medication from Pyxis^® utilizing the override function. We also assessed alternative causes for override of medications, even after pharmacist verification had occurred. This included overrides due to product mismatch and a lack of synchronization between our computerized prescriber order entry system (Sunrise^®) and Pyxis^®. Results: In June, prior to our audit and intervention, the hospital-wide override rate was 6.35%. With pharmacist intervention, re-education, and changes to policy and/or product availability, we were able to reduce our override rate over a four month period to 4.86%. Additionally, we saw a reduction in override rates individually for the critical care, medical/surgical, and labor and delivery areas. Conclusion: By conducting an audit we were able to identify the causes for inappropriate use of the override function and take the necessary steps to resolve those issues and minimize the need to override medications.

Bassett Medical Center, 1 Atwell Road, Cooperstown, NY 13326

Background: With future reimbursement dollars tied to patient satisfaction with inpatient pain control, major initiatives aimed at improving pain management hospital wide have become an increasingly important part of many strategic plans. At Bassett Medical Center, the inpatient pharmacy has developed a multi-faceted Pain Stewardship Program in collaboration with the physician-based multidisciplinary Pain Consult Service. The objective of this program is to identify and act on patients at high risk for pain exacerbation, opioid related adverse effects, or catch sooner those who are already experiencing uncontrolled pain. Patients fitting this criteria are clinically worked up via intensive pharmacotherapeutics for opportunities to safely dose escalate opioids, rotate opioids, maximize non-opioid adjunctive therapy, mitigate risk for constipation, respiratory depression, oversedation, and triage for appropriateness of consultation with the Pain Consult Service. Methods: A custom electronic health record (Epic) report was built to capture patients with three or more pain assessments scoring 8/10 or higher in the previous 24 hours who concurrently have at least one of the following problems listed in their chart: COPD, obesity, or sleep apnea. A third party quality and safety system, Drug Informatics, was concurrently utilized to custom build a set of alerts that tag potentially unsafe drug–drug or drug–lab combinations by cross-referencing the patient specific medication administration record with laboratory parameters in Epic. Both the Epic report and Drug Informatics alert list are generated daily and reviewed by a hospital pharmacist for intensive pharmacotherapeutic workup and subsequent clinical interventions. Results: A total of 42 clinical interventions over 30.6 service hours were made with the following breakdown: 40% (n = 7) opioid optimization, 43% (n = 18) non-opioid adjunct optimization, 17% (n = 7) mitigation of opioid related adverse effects. The average pain reduction 24-48 hours post intervention is 4.6 on the 10 point pain scale. The average daily time to perform this service is 90 minutes. Conclusion: Pain Stewardship is an efficient and effective use of a hospital pharmacist’s time as it targets only patients most at risk for pain exacerbation or opioid related adverse events. Given discrete and limited staffing resources, this high-yield program design is ideal. While the primary benefit is clearly a substantial reduction in 24-48 hour post intervention pain scores, ancillary benefit includes broadening access of pain management education to providers, as the pharmacist consistently reinforces differentiation of pain source-specific pharmacotherapy, safe and effective opioid prescribing, non-opioid adjunctive therapies, and mitigation of opioid related side effects.

Buffalo General Medical Center, 100 High Street, Buffalo, NY 14203

Background: Tikosyn is an antiarrhythmic indicated for the maintenance of normal sinus rhythm in atrial fibrillation or flutter. A Risk Evaluation and Mitigation Strategy (REMS) Program was instituted to decrease the risk of Tikosyn-induced arrhythmias and requires pharmacies and prescribers undergo certification before using Tikosyn. Patients must be admitted for creatinine clearance (CrCl) and electrocardiographic (EKG) monitoring for the first six doses. Methods: A Computerized Physician Order Entry (CPOE) order set was implemented for Tikosyn to ensure appropriate patient monitoring and adherence with the REMS program. An assessment of the order set was conducted between August 2014 and January 2015. Data collection included: certification of the prescriber; placement of individual orders for the first six doses; EKG timing; initial dose modification based on CrCl and baseline QTc; potential drug interactions identified; dose modification after administration of first dose based on change in QTc or renal function; timing of dose administration; documentation of patient counseling. Results: Forty three patients were included. Nine prescribers utilized the order set, with one initial dose and two subsequent doses ordered by uncertified prescribers. Individual orders were placed for the first six doses; two (4.7%) patients did not have baseline EKGs. Eleven (25.6%) patients had an EKG completed more than three hours post-dose and nineteen (44.2%) patients did not receive an EKG between subsequent doses. Seven (16.3%) patients did not have documented baseline labs. Three (7%) patients had potential drug interactions identified and addressed before initiating Tikosyn. Initial doses were adjusted based on CrCl for nine (20.9%) patients with eleven subsequent dose adjustments based on EKG or CrCl. Incorrect timing of dose administration occurred in eighteen (8.6%) patients. All patients received pharmacist counseling before discharge. Results will be presented to the P&T committee with follow-up prescriber and pharmacist education to ensure order set adherence.

Buffalo General Medical Center, 100 High Street, Buffalo, NY 14203

Background: Tikosyn is an antiarrhythmic medication indicated for the maintenance of normal sinus rhythm in atrial fibrillation and atrial flutter. A Risk Evaluation and Mitigation Strategy (REMS) Program has been instituted in order to decrease the risk of Tikosyn-induced arrhythmias and requires that hospital pharmacies and prescribers undergo certification prior to using Tikosyn. Patients must be admitted to provide creatinine clearance (CrCl) and electrocardiographic (EKG) monitoring for the first six doses and also to provide cardiac resuscitation if necessary. Methods: A Computerized Physician Order Entry (CPOE) order set was implemented for Tikosyn in July 2014 to ensure appropriate patient monitoring and adherence with the REMS program. An assessment of the order set was conducted between August 2014 and January 2015 to evaluate prescribing and monitoring practices based on compliance with and utilization of the Tikosyn order set. Data collection included: certification of the prescriber to order Tikosyn; placement of an individual order for the first six doses; timing of EKGs; initial dose modification based on CrCl; baseline QTc and renal function; potential drug-drug interactions identified and addressed prior to initiating therapy; dose modification after administration of first dose based on change in QTc or renal function; timing of dose administration; documentation of patient counseling. Results: Thirty-nine patients were evaluated that had Tikosyn orders placed using the new order set. Nine prescribers utilized the order set, with one initial dose and two subsequent doses being ordered by prescribers that were not certified. These providers were informed of their requirement to complete the REMS training before being authorized to order Tikosyn. Individual orders were placed for the first six doses, but two (5%) patients did not have a baseline EKG noted prior to initiation. Eleven (28%) patients had at least one EKG that was completed more than three hours post dose and nineteen (48.7%) patients did not receive an EKG between one of the subsequent doses. Five (12.8%) patients did not have documented baseline laboratory values prior to initiation. Three (7.7%) patients had a potential drug interaction identified and addressed prior to initiation of Tikosyn. Initial doses were adjusted based on CrCl for eight (20.5%) patients with eleven subsequent dose adjustments based on EKG or CrCl. Incorrect timing of dose administration occurred in seventeen (43.6%) patients. All patients received pharmacist counseling prior to discharge. Results will be presented to the P&T committee with follow-up prescriber and pharmacist education to ensure adherence with the order set.

Data collected included: provider certified to order medication, medication individually ordered for the first six doses; timing of EKGs [baseline EKG, monitored on telemetry for the first 72 hours, EKG two to three hours post dose for the first six doses]; initial dose modification based on renal function; baseline QTc, and blood work; medications identified as possible drug-drug interactions and discontinued prior to initiating Tikosyn; dose modification after administration of first dose based on QTc or change in renal function; correct timing of doses; documented patient counseling. The review was approved by the Pharmacy and Therapeutics (P&T) Committee.

Thirty-nine patients received Tikosyn since institution of the CPOE order set, with a total of nine providers initiating the order set. One prescriber was identified as not being certified to prescribe Tikosyn and was then not allowed to continue to order it until the REMS was completed. Two additional prescribers had ordered one of the subsequent doses (not initial) who were determined to not be certified. All doses were individually ordered after an EKG was obtained. Two (5%) patients did not have a baseline EKG noted prior to initiation. Eleven (28%) patients had at least one EKG that was completed more than three hours post dose. A total of nineteen (48.7%) patients did not receive an EKG before on of the subsequent doses. Five (12.8%) patients did not have baseline laboratory values noted prior to initiation. Three patients had an interacting drug discontinued prior to initiation of Tikosyn. The initial dose was adjusted based on CrCl for 20.5% (8/39) patients. Eleven subsequent doses were adjusted based on EKG or CrCl. Incorrect timing of subsequent doses occurred in 43.6% (17/39) of patients. All patients were counseled by a pharmacist.

It is essential to determine and document the required baseline information before the institution of Tikosyn. An institution specific database was created during this assessment to assist the pharmacists in identifying prescribers who are certified to order Tikosyn. The results of this review will be presented to the P&T committee, prescribers ordering Tikosyn and reviewed with the pharmacists to ensure proper understanding and compliance of the order set.

Bassett Medical Center, 1 Atwell Road, Cooperstown, NY 13326

Background: The Agency for Healthcare Research and Quality (AHRQ) publication Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices, concluded that the evidence for the clinical impact of ED medication reconciliation (med rec) exclusively involves interventions in which pharmacists play a key role. This conclusion was sharply contrasted with the observation that ED med rec interventions actually implemented in routine practice and required by US hospital accreditation bodies are not, in fact, implemented with pharmacist involvement. Problematic to many institutions is this call to action in the setting of financial constriction. We developed an innovative pharmacist-centered cost effective med rec program utilizing medication reconciliation technicians (MRTs) to carry out the patient interview, confirm medications with outside resources, and report back findings to the pharmacist for final review. Methods: A hospital pharmacist was appointed as the MRT Lead to provide training, ongoing supervision, and periodic competency and quality checks. MRTs undergo initial training with the lead pharmacist via a med rec internship during their first month. During the internship, MRTs observe gold standard med rec technique from the lead pharmacist, then progressively work towards demonstrating gold standard competency while the lead pharmacist observes until deemed proficient. After successful completion of internship, the lead pharmacist periodically observes MRTs for continued competency and quality with a standardized pre-specified competency requirement checklist. MRTs are responsible for carrying out the patient interview, confirming medications with external resources, and reporting back discrepancies to the lead pharmacist. The lead pharmacist clinically evaluates these discrepancies via intensive pharmacotherapeutic workup and communicates pertinent findings with a pharmacotherapy note and verbal discussion with the provider. Results: Initial time investment by the lead pharmacist to train MRTs during internship is approximately 4 hours per MRT the first week, 2 hours per MRT the second week, 30 minutes per MRT the third week, and as needed to ensure proficiency the fourth week and thereafter. Three MRTs rotate 12 hours shifts to cover the highest med rec demand hours in the emergency department. Minimum requirements for MRT eligibility are either a certified pharmacy technician license or a practical nurse license with at least 2 years of experience in that licensed role. Conclusion: The MRT position is an innovative and sustainable solution to cost effectively provide a pharmacist-centered medication reconciliation program with limited resources.

North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030

Background: Over 25 million Americans experience some form of acute pain due to injury or surgery and many are not treated appropriately despite new advances in medicine. Inadequate pain control can result in decreased quality of life, longer recover time, and higher health care costs. Hospital consumer assessment of healthcare providers and systems (HCAHPS) and Press Ganey surveys are often used to measure patient satisfaction which also encompasses pain management. Low scores on the pain section of these surveys have been highly associated with overall low scores on these surveys as a whole. A comprehensive systemic review and meta-analysis evaluated 583 unique articles including 5 randomized controlled trials in chronic pain management with pharmacist involvement. Data shows that pharmacist led medication review in chronic pain management resulted in reduced pain intensity, improved physical functioning and patient satisfaction. Hypothesis: Pharmacists intervention in the orthopedic surgery unit on patients who had severe pain will improve both pain scores during the admission as well as Press Ganey scores. Methods: This study will be submitted for Institutional Review Board approval. This study will include approximately 100 patients on opioid therapy, aged 18 and over with significant pain scores. Pain scores are assessed on a scale of 1 to 10, with 10 being the most severe pain. Significant severe pain scores are defined as pain scores above 7. Patients with two consecutive significant pain scores are identified by the electronic medical record system. Patient will be assessed before and after the interventions. Pharmacists are assigned to the hospital’s orthopedic surgery unit to assess patient’s pain management. Data to be collected include age, gender, pain scores, all relevant medication information, pharmacist interventions, and Press Ganey survey scores. All data will be recorded without patient identifiers and maintained confidentially. Pharmacists will make recommendations based on patients’ drug regimens to improve pain control. The primary outcome measure will be the difference of pain scores 6 hours before and 12 hours after intervention, while the secondary outcome will be measured by difference in Press Ganey scores. Results: Pending.

Lenox Hill Hospital, New York, NY 10075, Arnold & Marie Schwartz College of Pharmacy & Health Sciences, Long Island University, Brooklyn, NY, 11201

Background: Aminoglycosides (AG’s) have been widely used and are indicated for a variety of serious infections (e.g., meningitis, endocarditis, bacteremia). Due to the effectiveness of AG’s and high risk of adverse events (e.g., nephrotoxicity, ototoxicity), appropriate dosing and monitoring of serum drug levels are vital. At Lenox Hill Hospital (LHH), pharmacists have observed a trend of errors with AG orders, and therefore education is warranted to ensure optimal therapy for these drugs. The purpose of this study is to compare the appropriateness in dosing of pre-education AG orders with dosing of post-education orders to determine if there was an improvement in the quality of AG orders. Hypothesis: It is predicted that there will be a decrease in the amount of AG errors after education is given. Methods: This is a retrospective review of adult patients who were prescribed routine orders of AG’s between January 1st and March 31st 2014. Each patient’s AG order was assessed for its appropriateness in dosing and monitoring based on the patient’s documented weight, time of trough/peak acquisition, renal function and if traditional dosing or once-daily dosing was used correctly. An educational presentation will be created and provided to pharmacists and ordering prescribers pending the approval of clinical pharmacists and Infectious Diseases Attendings. Data was collected and reviewed via LHH’s computerized physician order entry system and patient medication profiles. Results: Prior to the implementation of education, among 100 AG orders reviewed, dosing and monitoring errors had occurred due to incorrect weight (35%), incorrect renal dose adjustments (12%), and incorrect timing of peak/trough acquisition (10%). Post education results are still pending. Conclusion: Pending.

The Brooklyn Hospital Center, Department of Pharmacy, 121 Dekalb Avenue, Brooklyn, NY 11201

Background: Asthma is one of the most common disease states among American children. The state of New York exceeds the national prevalence rate reporting 9.1% of the population currently living with asthma. Incorrect inhalation technique can impair drug disposition into the lungs leading to poor asthma control and morbidity. Previous studies have reported that a high rate of pediatric patients and their caregivers have poor inhaler technique when assessed in an ambulatory care setting. There is a lack of studies conducted in the emergency department, which may allow access to a larger, more diverse patient population.

This study will assess metered-dose inhaler technique and medication knowledge in pediatric patients and their caregivers presenting to the emergency department for an asthma exacerbation. The objective of this study is to evaluate the correlations among metered-dose inhaler technique, medication knowledge, disease severity, and the frequency of emergency department visits and asthma-related hospital admissions. The primary outcome will be the correlation between metered-dose inhaler technique and frequency of emergency department visits. Primary endpoints include the metered-dose inhaler checklist score, Vitalograph^® AIM result, and number of emergency department visits for an asthma exacerbation in the past 12 months. Secondary outcomes include the correlation between metered-dose inhaler technique and hospital admissions, medication knowledge and emergency department visits, medication knowledge and asthma-related hospital admissions as well as the correlation between both metered-dose inhaler technique and medication knowledge with asthma severity. Hypothesis: Metered-dose inhaler technique and medication knowledge will correlate with disease severity and both frequency of emergency department visits and asthma-related hospital admissions. Methods: We will evaluate pediatric patients and their caregivers’ metered-dose inhaler technique and medication knowledge. A convenience sample will be collected from January through June 2015 with a goal sample size of up to one hundred patients. Participants will be asked to complete the study survey and have their inhaler technique observed using a checklist assessment. Following the checklist assessment of inhaler technique, participants will then be asked to demonstrate how they use their inhaler using the Vitalograph^® AIM device. The investigator will record the results on the inhaler technique assessment form. Results: Data for all patients will be collected and results will be presented. Conclusions: With the results of this study, we hope to focus on this at risk patient population for further education reinforcement and to ensure proper follow-up.

¹The Brooklyn Hospital Center, Department of Pharmacy, 121 Dekalb Avenue, Brooklyn NY

²Mount Sinai School of Medicine, New York City, NY

³Mount Sinai Hospital, New York City, NY

⁴Mount Sinai Beth Israel, New York City, NY

⁵Mount Sinai St. Luke’s Roosevelt, New York City, NY

Background: Combination treatment with sofosbuvir and simeprevir with or without ribavirin has resulted in >90% sustained virologic response (SVR) rates in HCV mono-infected patients. Although the combination of these two new direct acting antivirals (DAAs) are recommended for treatment in both mono-infection and co-infection, SVR rates with this regimen in co-infection have not yet been reported. Hypothesis: We hypothesize that using this combination regimen in HCV/HIV co-infection will result in overall SVR rates 12 weeks post treatment (SVR12) similar to those achieved in mono-infected HCV GT 1 infected populations treated with the same regimen (SVR12 >90%). Methods: Multi-centered, retrospective chart review of HCV/HIV co-infected patients from April 2014 to December 2014. The SVR rates achieved in this study will be compared to the historical data of SVR rates in the COSMOS study. The objective of the study is to investigate the efficacy and safety of sofosbuvir and simeprevir combination in a real-world urban HCV/HIV co-infected patient population. The primary endpoint is HCV RNA 12 weeks post treatment and secondary endpoints include HCV RNA at 4 weeks of treatment, end of treatment response, adverse effects, and HIV RNA levels. Results: Preliminary data will be collected and results will be presented. Conclusions: Currently a research gap exists in the treatment of HCV in HCV/HIV co-infected populations. The preliminary data presented will allow for further insight into the efficacy of combination sofosbuvir and simeprevir in co-infected populations by comparing SVR rates to mono-infected populations.