Final Program Programme final - English Homepage · Final Program Programme final The Sheraton Centre Toronto Hotel 123 Queen Street West Toronto, ON CSHP ... Poster Abstracts Résumés

ANNUALPROFESSIONALPRACTICECONFERENCEThe Largest PharmacyConference in CanadaFEbRUARy 1-5, 2014

CONFÉRENCEANNUELLE SUR LA PRATIQUEPROFESSIONNELLELe plus grand congrès enpharmacie au Canada1-5 FÉvRIER 2014

Final ProgramProgramme final

The Sheraton CentreToronto Hotel123 Queen Street WestToronto, ON

CSHPTargeting Excellence in Pharmacy Practice

SCPHPoint de mire sur l’excellence en pratique pharmaceutique

What is CSHP 2015?� Vision of pharmacy practice excellence in the year 2015� Strategic objective of CSHP’s Vision 2014 which aims to improve

patient medication outcomes and safety by advancing practiceexcellence

� A quality care initiative

� A project aiming to answer the questions… “What would make themost difference to our patients?” and “What will convey the positivecontributions of the pharmacist?”

� Six specific goals that will guide practitioners towards the CSHP vision

� Sub-objectives that include measurable targets with establishedbaselines used to monitor progress, which can be reviewed andrevised as practice goals change

Goals

1 Increase the extent to which pharmacists help individual hospitalinpatients achieve the best use of medications

2 Increase the extent to which pharmacists help individualnon-hospitalized patients achieve the best use of medications

3 Increase the extent to which hospital and related healthcare settingpharmacists actively apply evidence-based methods to theimprovement of medication therapy

4 Increase the extent to which pharmacy departments in hospitals andrelated healthcare settings have a significant role in improving thesafety of medication use

5 Increase the extent to which hospitals and related healthcare settingsapply technology effectively to improve the safety of medication use

6 Increase the extent to which pharmacy departments in hospitals andrelated healthcare settings engage in public health initiatives onbehalf of their communities

To get started on CSHP 2015 now, go to CSHP’s website at www.cshp.ca.There you will find the complete list of goals and objectives, aself-assessment tool, presentations and more.

*CSHP 2015 was adapted with permission from the ASHP 2015 Initiative.

Qu’est-ce que le projet SCPH 2015?� Une vision de l’excellence en pratique pharmaceutique en l’an 2015� Un objectif stratégique de la Vision 2014 de la SCPH, lequel s’applique

à améliorer les résultats et la sécurité de la pharmacothérapie despatients en faisant avancer l’excellence en pratique.

� Un projet axé sur la qualité des soins

� Un projet qui vise à répondre aux questions suivantes : « Qu’est-ce quiserait le plus profitable pour nos patients? Qu'est ce qui permettrait decommuniquer les contributions positives du pharmacien? »

� Six buts précis qui aideront les pharmaciens à concrétiser la vision de laSCPH

� Des objectifs sous-jacents qui sont assortis de cibles mesurables nouspermettant d'établir un point de référence et de suivre les progrès, etqui pourront être réexaminés et modifiés à mesure que les objectifs etles lignes directrices de la pratique changent

Buts

1 Accroître le degré d'intervention des pharmaciens auprès dechaque patient hospitalisé afin d'assurer l'utilisation optimale desmédicaments.

2 Accroître le degré d'intervention des pharmaciens auprès de laclientèle non hospitalisée afin d'assurer une utilisation optimale desmédicaments.

3 Étendre l'application du principe des décisions fondées sur lespreuves à la pratique clinique quotidienne des pharmaciens desétablissements de santé dans le but d'améliorer la pharmacothérapie

4 Accroître le rôle joué par les départements de pharmacie desétablissements de santé dans l'amélioration de l'utilisation sécuritairedes médicaments.

5 Étendre l'application efficace des technologies dans lesdépartements de pharmacie des établissements de santé pouraméliorer l'utilisation sécuritaire des médicaments.

6 Accroître le degré d'intervention des départements de pharmaciedes établissements de santé dans la mise en oeuvre d'initiatives desanté publique.

Pour vous engager dès maintenant dans le projet SCPH 2015, visitez lesite Web de la SCPH au www.cshp.ca. Vous y trouverez une listecomplète des buts et des objectifs du projet, un outil d’autoévaluation,des présentations et d'autres renseignements.

*Le projet SCPH 2015 est une adaptation approuvée de l’ASHP 2015 Initiative.

www.cshp.ca

Dear Colleague,

On behalf of the Officers, Council and staff of the Canadian Society ofHospital Pharmacists (CSHP), it is our pleasure to welcome you to CSHP’s45th Annual Professional Practice Conference.

Over the last 10 months, CSHP’s Educational Services Committee hasworked hard to assemble an impressive faculty of pharmacy specialists anddevelop a program of exceptional educational value with topics covering awide range of specialties, management issues and pharmacypractice-related challenges. This conference is designed to maximize youropportunities for professional development, networking and socializingwith practitioners from across the country. It is our hope that you are ableto take full advantage of the 2014 offerings – and enjoy yourself in theprocess.

At any time throughout the conference, the Officers and staff of CSHP areavailable to you. Please let us know if we can answer any of your questions,address any of your concerns or be of assistance in any way.

We look forward to welcoming each of you to another spectacularconference.

Thank you for your ongoing support of CSHP!

Patricia Macgregor Myrella RoybSc, RPh, MRPharmS, MHSc, CHE bScPhm, PharmD, FCCPCSHP President Executive Director

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Chères (Chers) collègues,

Au nom de la Direction, du Conseil et du personnel de la Sociétécanadienne des pharmaciens d’hôpitaux (SCPH), nous avons le plaisir devous souhaiter la bienvenue à la 45e Conférence annuelle sur la pratiqueprofessionnelle de la SCPH.

Au cours des dix derniers mois, le comité des services éducatifs de laSCPH s’est affairé à rassembler un groupe impressionnant deconférenciers spécialisés en pharmacie et à vous préparer un programmed’une valeur éducative exceptionnelle avec des sujets touchant un largeéventail de spécialités, de questions relatives à la gestion et de défisposés à la pratique pharmaceutique. Ce congrès est destiné à maximiserles possibilités de perfectionnement professionnel, de réseautage et derencontre avec d’autres praticiens de toutes les régions du pays. Nousespérons que vous pourrez tirer pleinement profit de ce que nous vousoffrons en 2014 – tout en vous divertissant.

Nous vous rappelons qu’au cours du congrès, la Direction et le personnelde la SCPH seront à votre entière disposition. Nous ferons tout en notrepouvoir pour répondre à vos questions, discuter des sujets qui vouspréoccupent et vous aider au besoin de quelques manières que ce soit.

Nous sommes impatients de vous accueillir à cet autre congrèsexceptionnel et vous remercions de votre appui soutenu à la SCPH.

Patricia Macgregor Myrella Royb. Sc., R. Ph., M. R. Pharm. S., b. Sc. Phm., Pharm. D., FCCPM. H. Sc., C.H.E. Directrice généralePrésidente de la SCPH

Table of Contents Table des matièresExecutive, Council and Staff Bureau de direction, Conseil et PersonnelExecutive Committee bureau de direction 7

Council Conseil 7

CSHP Staff Personnel de la SCPH 7

With Thanks RemerciementsCSHP Industry Corporate Members Entreprises membres du secteur de l’industrie 8

CSHP Hospital Corporate Members Entreprises membres du secteur hospitalier 8

CSHP Sponsors 2013 Commanditaires de la SCPH en 2013 9

Conference Information Information sur la conférenceUpcoming Events Événements à venir 11

Satellite Symposiums Symposiums satellites 11

CSHP Educational Services Committee Comité des services éducatifs 12

Program ProgrammeProgram of Events Programme des événements 13

Speakers Abstracts Résumés des conférenciers 19

SES 2014 Call for Abstracts Demande de résumés pour les SÉÉ 2014 39

Oral Presentations Présentations orales 42

Poster Abstracts Résumés des affiches 44

Poster Abstract Reviewers Réviseurs des présentations par affiches 68

CSHP Fellows Associés de la SCPH 69

Faculty Conférenciers 72

Exhibitor List Liste des exposants 73

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PresidentPrésidentePatricia MacgregorThe Hospital for Sick ChildrenToronto, ON

President ElectPrésident désignébruce Millin Fraser Health AuthorityLangley, bC

Past PresidentPrésident sortantDoug SellingerRegina Qu’Appelle HealthRegionRegina, SK

Director of FinanceDirectrice des financesDeborah EmeryThunder bay Regional HealthSciences CentreThunder bay, ON

Executive DirectorDirectrice généraleMyrella RoyCanadian Society of HospitalPharmacistsSociété canadienne despharmaciens d’hôpitauxOttawa, ON

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Executive Committee • Bureau de direction

British ColumbiaColombie-BritanniqueShirin AbadibC Cancer Agencyvancouver, bC

AlbertaSherilyn HouleUniversity of AlbertaEdmonton, Ab

SaskatchewanZack DumontRegina Qu’Appelle HealthRegionRegina, SK

ManitobaPat TrozzoCancerCare ManitobaWinnipeg, Mb

Ontario – Senior/PrincipalMario bédardThe Ottawa HospitalOttawa, ON

Ontario – Junior/DébutanteChristina AdamsNorthwest TelepharmacySolutionsPembroke, ON

QuebecQuébecDiem voHôpital Pierre-boucherLongueuil, QC

New BrunswickNouveau-BrunswickFaith LouisHorizon Health NetworkFredericton, Nb

Nova ScotiaNouvelle-ÉcosseTheresa HurleyQEII Health Sciences CentreHalifax, NS

Prince Edward IslandÎle-du-Prince-ÉdouardAmy CheverieKings County Memorial HospitalMontague, PE

Newfoundland and LabradorTerre-Neuve-et-LabradorJustin PeddleMemorial UniversitySt. John’s, NL

Student DelegateDéléguée des étudiantsJaskiran OtalUniversity of WaterlooWaterloo, ON

Council • Conseil

Executive DirectorDirectrice généraleMyrella Roy

Operations Manager (on leave)Gérante des opérations (en congé)Laurie Frid

Interim Operations ManagerGérante des opérations parintérimDesarae Davidson

Coordinator, Professional &Membership AffairsCoordonnatrice, Affairesprofessionnelles et service aux membresCathy Lyder

Executive AssistantAdjointe de directionRosemary Pantalone

Interim Conference & PSNAdministratorAgente par intérim descongrès et des RSPSusan Maslin

Membership & AwardsAdministratorAgente du service auxmembres et des prix Robyn Rockwell

CHPRB AdministratorAgente du CCRPH Gloria Day

Finance AdministratorAgente des financesAnna Dudek

Publications AdministratorAgente des publicationsColleen Drake

Web AdministratorAgente du WebOlga Chrzanowska

Ontario Branch & AdvocacyAdministratorAgente de la section del’Ontario et de lavalorisationvacant

Office Administrator (CSHP2015 & Board of Fellows)Agente de bureau (SCPH2015 et Conseil desassociés)Pamela Saunders

CSHP 2015 ProjectCoordinatorCoordonnatrice du projetSCPH 2015Carolyn bornstein

CSHP FoundationAdministratorAgente de la Fondation dela SCPHJanet Lett

CSHP Staff • Personnel de la SCPH

2013-2014 CSHP Industry Corporate Members(At time of printing)

2013-2014 Entreprises membres du secteur de l’industrie(au moment de l’impression)

• Alveda Pharmaceuticals Inc.

• AstraZeneca Canada Inc.

• baxter Corporation (Canada)

• bayer Inc.

• bCE Pharma

• bioSyent Pharma Inc.

• Eli Lilly Canada Inc.

• Galenova Inc.

• Healthmark Services Ltd.

• Hospira Healthcare Corporation

• LEO Pharma Inc.

• McKesson Canada Corporation

• Mylan Canada

• Omega Laboratories Ltd.

• Pendopharm, a Division of Pharmascience Inc.

• Pfizer Canada Inc.

• Pharmaceutical Partners of Canada A Company of the Fresenius Kabi Group

• Sandoz Canada Inc.

• Servier Canada Inc.

• SteriMax Inc.

• TEvA Canada Ltd.

2013-2014 CSHP Hospital Corporate Members(At time of printing)

2013-2014 Entreprises membres du secteur hospitalier(au moment de l’impression)

• Alberta Health Services

• Horizon Health Network

• Interior Health Authority

• London Health Sciences Centre

• Lower Mainland Pharmacy Services

• Northern Health Authority

• Northwest Telepharmacy Solutions

• University Health Network

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CSHP Sponsors 2013The following list reflects all sponsorshipreceived from January 1 to December 31,2013.

Commanditaires de laSCPH en 2013La liste suivante reflète toutes lescommandites reçues du premier janvierau 31 décembre 2013.

Diamond SponsorCommanditaires diamant$80,000 or greater80 000 $ et plus

Platinum SponsorCommanditaires platine$60,000 - $79,999

• Sandoz Canada Inc.

Gold SponsorCommanditaires or$40,000 - $59,999

• AstraZeneca Canada Ltd.• Hospira Healthcare Corporation• Teva Canada Ltd.

Silver SponsorCommanditaires argent$20,000 - $39,999

• Apotex Inc.• Astellas Pharma Canada• bayer Inc.• Eli Lilly Canada Inc.• Pendopharm/Pharmascience• Sanofi Canada

Bronze SponsorCommanditaires bronze$10,000 - $19,999

• boehringer-Ingelheim Canada Ltd.• LEO Pharma Inc.• Merck Canada Inc.• Mylan Canada• Omega Laboratories Limited• Sunovion Pharmaceuticals Inc.

Donor SponsorCommanditaires donateurs $1000 - $9,999

• Abbott Laboratories Inc. / AbbvIE• Allied Pharmacy Products Inc.• Alveda Pharmaceuticals Inc.• Amgen Canada Inc.• b.braun Medical Inc.• baxter• bCE Pharma Inc.• bioSyent Pharma Inc.• bristol-Meyers Squibb Canada• Calea• Canadian Council on Continuing

Education in Pharmacy• Canadian Forces• Canadian Institute for Health Information • Canadian Patient Safety Institute• Canadian Pharmaceutical Distribution

Network• Canadian Pharmacists Association• Cardinal Health Canada• College of Pharmacists of british

Columbia • ESbE Scientific• Galenova Inc.• Healthmark Services Ltd.• Health Match bC• HealthPRO• Hoffman La Roche Limited• Johnson & Johnson Family of

Companies• Lexicomp Inc.• Lundbeck Canada Inc.• Manrex Ltd.• McKesson Canada Corporation• Medtronic of Canada• Meta Healthcare IT Solutions• Northern Health Authority• Northwest Telepharmacy Solutions• Novartis Pharma Canada• Novo Nordisk Canada Inc.• Omnicell• Ontario College of Pharmacists• Optimer Pharmaceuticals• Otsuka Pharmaceutical Inc.• PCCA Canada• PharmaSystems Inc.• RxFiles Academic Detailing Program• Shoppers Drug Mart Specialty Health• Servier Canada Inc.• SteriMax Inc.• Swisslog Healthcare Solutions• Truven Health Analytics• valeo Pharma• WIS International

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CSHP would like to acknowledge and thank the following CSHP Sponsors for theircontributions to CSHP 2015 initiatives:

CSHPTargeting Excellence in Pharmacy Practice

SCPHPoint de mire sur l’excellence en pratique pharmaceutique

About the CSHP Foundation

The CSHP Foundation is an independent, charitableorganization created by the Canadian Society ofHospital Pharmacists to support research and

educational programs that advance patient-centredpharmacy practice in hospitals and related healthcaresettings for the betterment of public health.

The Foundation raises funds that are used to:

• promote research within organized healthcare settingsrelated to the practice of pharmacy;

• the advancement of pharmaceutical science; and • programs of pharmaceutical education so that the public interest may be well

served and protected.

The nine trustees of the Foundation are appointed by Council annually. CSHPCouncil also appoints one of the trustees as chairperson, who reports to Council.

The Foundation operates independently from CSHP in accordance with its Trust Deed.

• See the CSHP Foundation video on youTube• Read the CSHP Foundation Fact Sheet

• view the CSHP Foundation 25th Anniversary Presentation,1988-2013

Fundraising

In order to accomplish its goals, the Foundation seeksfunding from a variety of sources. An annual fundraising

campaign is initiated each summer to solicit funds from individual members of the Society,

pharmaceutical companies and othercompanies/trade associations that are

associated with hospital pharmacy.

The trustees are proud that theFoundation’s administrative costs arenegligible. A number of CSHP membersprovide their services on a voluntary basisso that the funds raised can be directedalmost entirely to the research andeducation objectives of the Foundation.

ChairpersonCarolyn bornstein

TrusteesFred CuvelierAidan GriffinHeather NevilleMarlo PalkoGlen PearsonMyrella RoyTerri Schindel

www.cshpfoundation.ca

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Professional PracticeConference (PPC):January 31-February 4, 2015Sheraton Centre Toronto Hotel

January 30-February 3, 2016Sheraton Centre Toronto Hotel

Summer Educational Sessions (SES):August 9-12, 2014Delta St. John’s Hotel and Conference CentreSt. John’s, Newfoundland & Labrador

August 15-18, 2015Westin HotelOttawa, Ontario

Attendance at CSHP conferences, PPCand SES, are approximately 500 and 150respectively, excluding exhibitors. Pleasenote we offer an exhibit program at bothevents.

For further information, please contactSusan Maslin, Interim Conference & PSNAdministrator.Tel.: (613) 736-9733, ext. 229Fax: (613) 736-5660Email: [email protected]

Upcoming EventsÉvénements à venir

SatelliteSymposiumSPONSORSHIPOPPORTUNITY

Delta St. John’s Hotel and Conference CentreSt. John’s, NLAugust 9-12, 2014

Breakfast and Luncheon Availability

For more information please contactSusan MaslinInterim Conference & PSN Administrator(613) 736-9733, ext. 229 [email protected]

67th Summer Educational Sessions

Satellite SymposiumsSymposiums satellitesCSHP would like to thank the followingsponsors of Satellite Symposiums for their participation in conjunction with the PPC 2014.

Sunday, February 2 12:15-13:45 • Healthmark Services Ltd.

Monday, February 3 17:30-19:30 • bayer Inc.17:30-19:30 • Hospira Healthcare

Corporation

Wednesday, February 512:40-14:10 • Janssen Inc.

See the program section for more details.

The Educational Services Committee(ESC) of CSHP has been working forapproximately 10 months on the contentand format of PPC 2014. The committeealso plans the Summer EducationalSessions, in conjunction with the localhost task force and the national office.The ESC is comprised of a corecommittee of 15 CSHP members as wellas corresponding members from theCSHP branches.

Goal and Objectives for the2014 PPC ProgramGoal:

• To provide registrants with qualityeducational sessions.

Objectives:

• To provide educational sessions whichinform, educate and motivate clinicalpractitioners and managers.

• To provide leadership in hospitalpharmacy practice by presentingsessions on innovative pharmacists’roles, pharmacy practice and pharmacyprograms.

• To promote life-long learning skillsthrough active participation inproblem-based workshops.

• To provide registrants with networkingand sharing opportunities through theexhibits program and poster sessions.

• To promote excellence in pharmacypractice research through oral andposter presentations of original workand award winning projects.

• To provide an opportunity forPharmacy Specialty Networks to meetand share their expertise with others.

Le comité des services éducatifs travailledepuis près de 10 mois à l’élaboration ducontenu et de la forme de la CPP 2014. Lecomité prépare aussi les Séanceséducatives d’été de la SCPH encollaboration avec le Groupe de travailhôte local et le personnel de la SCPH. Lecomité comprend 15 membres principauxet membres correspondants des sectionsde la SCPH.

But et objectifs du programmede la CPP 2014But :

• Présenter des conférences éducatives dequalité aux participants.

Objectifs :

• Présenter aux personnes inscrites desconférences éducatives susceptiblesd’informer, d’instruire et de motiver lescliniciens et les gestionnaires.

• Orienter la pratique de la pharmaciehospitalière en présentant desconférences sur les nouveautés touchantle rôle du pharmacien, la pratique de lapharmacie et les programmes depharmacie.

• Développer des habiletés pour unapprentissage continu par uneparticipation active à des ateliers deformation axés sur la résolution deproblèmes.

• Donner aux participants des occasionsde réseautage et d’échanges grâce ausalon des exposants, aux séancesd’affichage et aux discussionsinteractives structurées.

• Promouvoir l’excellence dans larecherche en pratique pharmaceutiquepar des présentations orales et desséances d’affichage sur des travauxoriginaux et des projets primés.

• Donner l’occasion aux réseaux despécialistes en pharmacie de se réunir etde partager leur savoir-faire.

ChairpersonPrésidentClarence Chant, PharmD, FCSHP, FCCPSt. Michael’s Hospital Toronto, ON

Staff LiaisonEmployée de liaisonSusan Maslin

MembersMembresMargaret Ackman, PharmD, FCSHP Alberta Health Services Edmonton, Ab bernadette Almeida, RPh, bScPhm, ACPR Trillium Health PartnersToronto, ONClaudia bucci, PharmDSunnybrook Health Sciences CentreToronto, ONRoxane Carr, PharmD, bCPS, FCSHPbC Children’s and Women’s HealthCentrevancouver, bCLorie Carter, bScPhmEastern HealthMarystown, NLElaine Chong, PharmD, bCPSbC Ministry of Health ServicesNew Westminster, bCJudy Chong, bScPhm Ontario College of PharmacistsToronto, ONLeah Edmonds, bScPhmQEII Health Sciences CentreHalifax, NSAlfred Gin, PharmD, FCSHPHealth Sciences CentreWinnipeg, MbDerek Jorgenson, bSP, PharmD, FCSHPUniversity of SaskatchewanSaskatoon, SKErnest Law, bScPhm, ACPRPharmD StudentUniversity of british Columbiavancouver, bCKat Timberlake, PharmD (on leave)The Hospital for Sick ChildrenToronto, ONErica Wang, bScPhm, PharmDKelowna General HospitalKelowna, bC

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The Educational Services CommitteeLe comité des services éducatifs

EPCanadian Council on

Continuing Education in Pharmacy

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Program ProgrammeSaturday, February 1Samedi 1er février15:00-17:00 Registration

Inscription CONCOURSE COAT CHECK

17:30-19:00 CHPRB Students & Residents NetworkingEventRéception de réseautage du CCRPH pour lesétudiants et les résidents

PROvINCIAL bALLROOM

Sunday, February 2Dimanche 2 février07:30-17:00 Registration


08:00-08:15 Opening RemarksRemarques préliminaires

DOMINION bALLROOM

08:15-09:15 Motivational PlenarySéance plénière de motivation

DOMINION bALLROOM

Change Your Thoughts. Change Your Life!With Stuart Ellis, a.k.a. “Twitchy”

Sponsored by Sandoz Canada Inc.

9:30-11:00 Facilitated Poster Session Discussions of Original Research, AwardWinning Projects and Pharmacy PracticeProjects

Séance animée de présentations par affiches Discussions sur des projets de rechercheoriginale, des projets primés et des projetsdans le domaine de la pratiquepharmaceutique

PROvINCIAL bALLROOM

11:15-12:00 Concurrent SessionsSéances concomitantes

1. Update on Hepatitis C Management CIvIC bALLROOM NORTH

Alice Tseng, bScPhm, PharmD, FCSHP, AAHIPToronto General HopsitalToronto, ON

2. The Role of Iron in the Management ofAnemia

CIvIC bALLROOM SOUTH

Marisa battistella, bScPhm, PharmD, ACPRUniversity Health NetworkToronto, ON

3. Which Methods to Answer Your ResearchQuestion? Qualitative? Quantitative orBoth?

SIMCOE DUFFERIN

Lisa Dolovich, bScPhm, PharmD, MScMcMaster UniversityHamilton, ON

4. CSHP 2015 Winning Success Stories –Hospital Residency Award Winner andMore…

CITy HALL

Facilitator: Carolyn bornstein, bScPhm, ACPR, FCSHP,CGPSouthlake Regional Health CentreNewmarket, ON

Jessica Power, bScPhmvictoria General Hospitalvictoria, bC

12:15-13:45 Satellite Symposium Luncheon includedSymposium satelliteDîner inclus

DOMINION bALLROOM NORTH

Cleanrooms/Sterile Preparation: Complianceand Cost Optimizing towards USP <797>Sterile Preparation within Canadian Budgetand Regulatory Frameworkbruce C. PeatH.E.P.A. Filter Services Inc. and Design Filtration

Lisa CampbellHealthmark Services Ltd.

Hosted by Healthmark Services Ltd.

14:00-16:00 Workshops & PSN SessionsAteliers et séances des RSP

1. How to Write a Research Paper and Get itPublished

CITy HALL

Peter Zed, bSc, bScPhm, ACPR, PharmD,FCSHP University of british Columbiavancouver, bC

2. Infectious Diseases PSNRSP en infectiologie


Infections in Solid Organ TransplantsShahid Husain, MD, MSUniversity Health NetworkToronto, ON

Antibiotic Prophylaxis in Surgery: Issues &ControversiesSumit Raybardhan, bScPhm, ACPR, MPHNorth york General HospitalToronto, ON

3. Global Health PSN RSP en santé mondiale

SIMCOE DUFFERIN

Ethical Issues in Global HealthJessica Sleeth, MPH, CHE, bPHE, bAQueen’s UniversityKingston, ON

Working as a Pharmacist with MédecinsSans FrontièresAlexandra Marcil, bSc, bScPhmMédecins Sans FrontièresWinnipeg, Mb

4. Psychiatry PSNRSP en psychiatrie

CIvIC bALLROOM NORTH

Lithium….Is It Still Useful?Wende Wood, bA, bSP, RPh, bCPPOntario Pharmacists AssociationToronto, ON

Anxious? Don’t Panic: A Review of AnxietyDisordersbarbara Thomas, PharmDEastern HealthSt. John’s, NL

16:10-17:50 Awards CeremonyEveryone welcomeCérémonie de remise des prixbienvenue à tous

PROvINCIAL bALLROOM

18:00-19:30 Career Opportunities EveningSoirée de perspectives d’emploi

LOWER CONCOURSE vIDE

Monday, February 3Lundi 3 février07:30-17:00 Registration


08:00-08:15 AnnouncementsAnnonces

DOMINION bALLROOM

08:15-09:15 Plenary SessionSéance plénière

DOMINION bALLROOM

Developing an Advanced Pharmacy PracticeFramework: Key Learnings and StrategicOutcomesLisa Nissen, bPharm, PhD, FPS, FHKAPh, FSHPQueensland University of Technologybrisbane, Australia

Sponsored by Pharmaceutical Partners of Canada

09:15-09:45 New Fellows PresentationPrésentation des nouveaux membresassociés

Acknowledgement of the Recipient of theDistinguished Service AwardReconnaissance du lauréat du prix pourservice distingué

Acknowledgement of the CSHP FoundationGrant RecipientsReconnaissance des boursiers de laFondation de la SCPH

DOMINION bALLROOM

09:45-10:15 Break, ExhibitsPause, Kiosques

SHERATON/OSGOODE HALLS

10:20-11:30 Panel DiscussionPanel

DOMINION bALLROOM

Managing Expensive Oncology DrugsElaine Chong, PharmD, bCPS – ModeratorbC Ministry of Healthvancouver, bC

Jin – Hyeun Huh, bScPhm, ACPR, bCPSUniversity Health NetworkToronto, ON

Lyndee yeung, bScPhm, MbACancer Care OntarioToronto, ON

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Hazel Markwell, bA(Hon), MA, PhD, ThDCentre for Clinical EthicsToronto, ON


1. Clinical Trials in Internal Medicine that willChange Your Practice


Peter Thomson, bScPhm, PharmDWinnipeg Regional Health AuthorityWinnipeg, Mb

2. Using Physical Assessment in YourPractice!

CITy HALL

Glen Pearson, bScPhm, PharmD, FCSHPUniversity of AlbertaEdmonton, Ab

3. Oral Abstract Session Selected Papers from Original Research,Award Winners and Research andEducation GrantsPlease see page 42 for abstracts

Séance d'exposés orauxCommunications choisies parmi les travauxde recherche originale et les projets desrécipiendaires de prix, de bourses derecherche et de perfectionnementveuillez consulter les résumés à la page 42

SIMCOE DUFFERIN

4. A Pharmacist’s Tale: The Journey fromClinician to Director

PROvINCIAL bALLROOM NORTH

Allan Mills, bScPhm, ACPR, PharmDTrillium Health PartnersMississauga, ON

12:30-13:50 Lunch, Exhibits, PostersDîner, Kiosques, Affiches


14:00-15:00 Landmarks in Pharmacy Practice Research:More and More Evidence for the BeneficialImpact of Pharmacist Care

DOMINION bALLROOM

Ross Tsuyuki, bScPhm, PharmD, MSc, FCSHP,FACCUniversity of AlbertaEdmonton, Ab


1. Primary Care PSNRSP en soins de santé primaires


Challenges and Opportunities inIntraprofessional Pharmacist Collaborationin Primary CareSuzanne Singh, bScPhm, PharmDMount Sinai Academic Family Health TeamToronto, ON

Taking Responsibility for Patient Care: A Toolkit for Pharmacists on Primary CareTeamsDerek Jorgenson, bSP, PharmD, FCSHPUniversity of SaskatchewanSaskatoon, SK

2. Emergency Medicine PSNRSP en urgentologie


Acute Analgesia in EmergencyDepartments: Is Our Performance Painful?Richard Wanbon, bSc, bScPhm, ACPR, PharmDIsland Healthvictoria, bC

Adverse Drug-Related Events andEmergency Department Visits:Opportunities and Challenges forPharmacistsPeter Zed, bSc, bScPhm, ACPR, PharmD,FCSHPUniversity of british Columbiavancouver, bC

3. Paediatric PSNRSP en pédiatrie

SIMCOE DUFFERIN

Update on Management of Urinary TractInfection in Children: What Does theEvidence Say?Jennifer Poh, bScPhm, ACPR, PharmDThe Hospital for Sick ChildrenToronto, ON

Tools to Improve the Health Literacy ofSick Children and their FamiliesRégis vailliancourt, OMM, CS, bPharm,PharmD, FCSHPThe Children’s Hospital of Eastern OntarioOttawa, ON

4. WorkshopAtelier

CITy HALL

Which National Clinical Pharmacy KeyPerformance Indicators (cpKPI) are YouMeasuring? A Practical and InteractivecpKPI Guide to What, When, Why and How Olavo Fernandes, bScPhm, ACPR, PharmD,FCSHPUniversity Health NetworkToronto, ON

Kent Toombs, bScPhm, ACPRCapital HealthHalifax, NS

17:30-19:30 Satellite Symposiums Dinner includedSymposiums satellitesSouper inclus

1. Evolution in Thrombosis Management:Clinical Challenges in the Treatment ofVenous Thromboembolism


Menaka Pai, bSc, MSc, MD, FRCPC, AbIMMcMaster University

Hosted by bayer Inc.

2. Outstanding Issues in MedicationReconciliation

PROvINCIAL bALLROOM SOUTH

Margaret ColquounISMP Canada

Hosted by Hospira Healthcare Corporation

Tuesday, February 4Mardi 4 février07:30-17:00 Registration



DOMINION bALLROOM

08:15-9:30 Comprehensive Patient Care: A Team-BasedSport

DOMINION bALLROOM

barbara Farrell, bScPhm, PharmD, FCSHPveronique French-Merkley, MD, CCFP, CoEbruyère Continuing CareOttawa, ON

09:45-10:15 Break, ExhibitsPause, Kiosques



1. The Double-Edged Sword: How Can aDrug Be a Life Saver and Potentially Fatalat the Same Time? Drug Interactions inOncology


Scott Edwards, bScNeuro, bScPhm, PharmDEastern HealthSt. John’s, NL

2. CSHP 2015: What Pharmacy DirectorsWant!

SIMCOE DUFFERIN

Carolyn bornstein, bScPhm, ACPR, FCSHP,CGPSouthlake Regional Health CentreNewmarket, ON

3. Scrutinizing Statins in the Prevention ofCardiovascular Disease: New SafetyConcerns


Glen Pearson, bScPhm, PharmD, FCSHPUniversity of AlbertaEdmonton, Ab


1. Inspiring the Leader Within: PowerfulPearls & Potent Principles

SIMCOE DUFFERIN

Shirin Abadi, bScPhm, ACPR, PharmDbC Cancer Agencyvancouver, bC

2. Antibiotic Locks for Catheter-RelatedBloodstream Infections: There’s a Lock forThat!!!


Alfred Gin, bScPhm, PharmD, FCSHPHealth Sciences CentreWinnipeg, Mb

3. Outpatient Clinic Scheduling ofPharmacist Call Back for OralChemotherapy


Sean Hopkins, bScPhmThe Ottawa Hospital Cancer CentreOttawa, ON

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12:15-13:50 Lunch, Exhibits, Posters Dîner, Kiosques, Affiches


14:00-15:00 Use of Insulin in Hospital DOMINION bALLROOM

Alice y.y. Cheng, MD, FRCPCTrillium Health PartnersMississauga, ON


1. Internal Medicine PSNRSP en médecine interne


Role of Suboxone for Opioid Dependencebeth Sproule, RPh, bScPhm, PharmDJuno Kim, RPh, bScPhmCentre for Addiction and Mental HealthToronto, ON

ConstipationPeter Thomson, bScPhm, PharmDWinnipeg Regional Health AuthorityWinnipeg, Mb

2. Surgery PSNRSP en chirurgie


Tranexamic Acid as a Blood ConservationStrategyMelanie MacInnis, bScPhm, PharmDIWK Health CentreHalifax, NS

Optimizing Surgical Antibiotic Prophylaxis:What’s New? What You Can DoRosemary Zvonar, bScPhmThe Ottawa HospitalOttawa, ON

3. Small Hospital PSNRSP des petits hôpitaux

SIMCOE DUFFERIN

Roads to the Information SuperhighwayJeff barnett, bScPhm, ACPR, PharmDbC Cancer Agencyvictoria, bC

Kurt Schroeder, bScPhmInterlake – Eastern Regional Health AuthoritySelkirk, Mb

4. Workshop (encore) CITy HALL

Which National Clinical Pharmacy KeyPerformance Indicators (cpKPI) are YouMeasuring? A Practical and InteractivecpKPI Guide to What, When, Why andHow Olavo Fernandes, bScPhm, ACPR, PharmD,FCSHPUniversity Health NetworkToronto, ON

Kent Toombs, bScPhm, ACPRCapital HealthHalifax, NS

Wednesday, February 5Mercredi 5 février07:30-15:00 Registration



DOMINION bALLROOM

08:15-09:15 CPSI Patient Safety LectureConférence de l’ICSP sur la sécurité despatients

DOMINION bALLROOM

The Oncology Under-Dosing Incident:Lessons Learned Elaine Chong, PharmD, bCPS – ModeratorbC Ministry of Healthvancouver, bC

Marshall Moleschi, RegistrarOntario College of PharmacistsToronto, ON

Sandy Jansen, bScPhm, MHSLondon Health Sciences CentreLondon, ON

Jake Thiessen, bScPhm, MSc, PhDUniversity of WaterlooWaterloo, ON

Sponsored by the Canadian Patient SafetyInstituteCommanditée par l’Institut canadien sur lasécurité des patients

09:15-10:15 Biologicals: What Pharmacists Need to KnowAbout Monoclonal Antibodies

DOMINION bALLROOM

Tom McFarlane, bScPhm, PharmDCambridge Memorial HospitalCambridge, ON

10:15-10:45 BreakPause

DOMINION FOyER


1. Deprescribing Benzodiazepines: Do WeNeed a New Approach?


barbara Farrell, bScPhm, PharmD, FCSHPbruyère Continuing CareOttawa, ON

2. The Hierarchical Teaching Model:Redefining the Structure in ExperientialPharmacy Training

CITy HALL

Tim T. y. Lau, bScPhm, ACPR, PharmD, FCSHPvancouver Coastal Healthvancouver, bC

3. Overdoses That Should Send a Chill UpYour Spine

PROvINCIAL bALLROOM SOUTH

Debra Kent, bA, PharmD, DAbAT, FAACT, RPhbC Drug and Poison Information Centrevancouver, bC


1. Neuromuscular Blocking Agents in theIntensive Care Unit

CITy HALL

Norman Dewhurst, bScPhm, ACPR, PharmD,RPhSt. Michael’s HospitalToronto, ON

2. Treatment Decisions in Osteoporosis PROvINCIAL bALLROOM SOUTH

Elaine beltijar, bScPhmWomen’s College HospitalToronto, ON

3. Updates in Management ofGastrointestinal Bleeding


Jennifer Teng, bScPhm, ACPR, PharmDSt. Michael’s HospitalToronto, ON

12:40-14:10 Satellite Symposium Luncheon includedSymposium satelliteDîner inclus

DOMINION bALLROOM NORTH

Subsequent Entry Biologics: What aPharmacist Needs to KnowDr. John Marshall, MD MSc FRCPCMcMaster UniversityHamilton, Ontario

Carolyn Whiskin, bScPhmCharlton CentreHamilton, Ontario

Hosted by Janssen Inc.

14:15-16:00 Workshops & PSN Sessions Ateliers et séances des RSP

1. Medication Safety PSNRSP en sécurité des médicaments


Implementing Insulin Pens in InstitutionsSara Kynicos, MPharm, RPhToronto Western HospitalToronto, ON

Jeremy Johnson, RN, bScN, MN Student, CDESt. Joseph’s Healthcare Hamilton, ON

2. Cardiology PSNRSP en cardiologie


Novel Anticoagulants in Atrial Fibrillation:Practical Tips from the TrenchesNatalie Crown, bScPhm, ACPR, PharmDWomen’s College HospitalToronto, ON

Kori Leblanc, bScPhm, ACPR, PharmDToronto General HospitalToronto ON

Heart Failure with Preserved EjectionFraction: The Younger MisunderstoodSibling of Heart Failure with ReducedEjection FractionArden barry, bScPhm, PharmD, ACPRMazankowski Alberta Heart InstituteEdmonton, Ab

16:15 Close of the 45th Annual ProfessionalPractice ConferenceClôture de la 45e Conférence annuelle sur lapratique professionnelle

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Speaker AbstractsRésumés des conférenciersSUNDAY, FEBRUARY 2DIMANCHE 2 FÉVRIER

Update on Hepatitis C ManagementAlice Tseng, BScPhm, PharmD, FCSHP, AAHIVP, Toronto GeneralHospital, Toronto, ON

The advent of the directly acting antivirals (DAAs) boceprevir andtelaprevir revolutionized the field of hepatitis C therapy.Combining a DAA with pegylated-interferon and ribavirin astriple therapy has led to significantly higher rates of sustainedvirological response (SvR) in patients infected with HCvgenotype 1. The recent approval of two new agents, simeprevirand sofosbuvir have further altered the treatment landscape,offering simpler and more efficacious regimens to a widerpopulation. Additionally, several new drugs are in late phase 3development, and are anticipated to come to market in theupcoming months.

boceprevir, telaprevir and simeprevir are substrates and inhibitorsof CyP3A4. These agents also inhibit p-glycoprotein andtelaprevir may inhibit renal transporters. Therefore, the potentialfor interactions between DAAs and concomitant medications ishigh, particularly if treatment for comorbid conditions includingHIv is required. Preliminary data indicate that up to 83% of HCvinfected patients initiating triple therapy with a DAA have at leastone drug-drug interaction. Potential consequences of druginteractions include viral breakthrough and development ofresistance, sub-optimal disease/symptom management, or drugtoxicities and possible non-adherence. Pharmacists can play acritical role in identifying, preventing and managing druginteractions in this population.

Goals and Objectives

1. To update pharmacists on the current standard of care forpatients with hepatitis C genotype 1 infection.

2. To provide a review of current and new directly actingantivirals (DAAs).

3. To outline a strategy for identifying and managing drug-druginteractions involving DAAs.

Self-Assessment Questions

1. What is the rationale for DAA-based combination therapy forhepatitis C infection?

2. How are HCv protease inhibitors metabolized and how candrug interactions be identified and managed in thispopulation?

The Role of Iron in the Management of AnemiaMarisa Battistella, BScPhm, PharmD, ACPR, University HealthNetwork, Toronto, ON

Anemia is a frequent complication reported in pregnancy andconditions such as chronic kidney disease, cancer, chronic heartfailure, inflammatory bowel disease and heavy uterine bleedingand is associated with increased morbidity and mortality. Optimalmanagement strategies for anemia are not clearly defined,leading to highly variable approaches to patient care andsuboptimal clinical outcomes. A chief cause of anemia isdysregulation of iron homeostasis and erythropoiesis due toongoing inflammatory processes. A critical balance exists inproviding sufficient iron to maintain adequate iron stores,ensuring erythropoiesis but also minimizing the potential for longterm toxicity associated with iron overload. In this 45 minutesession, we will review molecular metabolism of iron metabolismand the role of iron replacement. Using different patient cases,we will compare and contrast the different iron productsavailable in Canada and determine ways to best choose therapyfor these patients.


1. To review molecular metabolism of iron

2. To compare and contrast different iron products available onthe Canadian market with respect to efficacy, safety anddosing


1. What are possible immediate and delayed adverse effectsseen with iv iron

2. What are conditions that cause underutilization of iron?

Which Methods to Answer Your ResearchQuestion? Qualitative? Quantitative? Or Both?Lisa Dolovich, BScPhm, PharmD, MSc, McMaster University,Hamilton, ON

The purpose of this session is to discuss the broad nature ofqualitative, quantitative and mixed methods research designs.

The basis for choosing a research design starts with the researchquestion. Questions focused on how and why can be addressedwell using qualitative research designs. Questions focused onwhat, whether and who can be addressed well using quantitativeresearch designs. Mixed methods research designs incorporateboth qualitative and quantitative research designs into astructured approach that combines the learnings from eachresearch approach. Pharmacy has typically focused onquantitative research designs that are best for comparisonsbetween medications. Health services research includingpharmacy practice research including program evaluation oftenbenefits from findings generated from qualitative and mixedmethods studies along with quantitative studies. Examples fromrecently planned or completed pharmacy program evaluation

research will be used to highlight how to make decisions amongresearch designs.


1. To describe the qualitative, quantitative and mixed methodsresearch designs.

2. To describe a mixed methods study that uses both qualitativeand quantitative research approaches.


1. What are the benefits of using a qualitative research design?

2. What are the main considerations to take into account whenchoosing a research design?

Integration of Smartphones into Clinical PharmacyPractice: An Evaluation of the Impact onPharmacists’ EfficiencyJessica Power, BScPhm, ACPR, Victoria General Hospital,Vancouver Island Health Authority, Victoria, BC; Sean Spina,BScPhm, ACPR, PharmD, Royal Jubilee Hospital, VancouverIsland Health Authority, Victoria, BC; David Forbes, BScPhm,ACPR, MPA, BCPS, Nanaimo Regional General Hospital,Nanaimo, BC; Curtis K. Harder, BScPhm, ACPR, PharmD, RoyalJubilee Hospital, Victoria, BC; Sherry Lalli, BScPhm, ACPR, RoyalJubilee Hospital, Victoria, BC; Peter Loewen, BScPhm, ACPR,PharmD, FCSHP, Vancouver General Hospital, University of BritishColumbia, Vancouver, BC; Peter Zed, BSc, BScPhm, ACPR,PharmD, FCSHP, University of British Columbia, Vancouver, BC

Personal smartphones are used frequently by healthcarepractitioners in hospitals to assist in the provision of care. Thevancouver Island Health Authority (vIHA) is one of the first healthauthorities in Canada to endorse the iPhone® smartphone as apotentially valuable tool for clinical practice. We collaboratedwith the University of british Columbia (UbC) Faculty ofPharmaceutical Sciences to design and conduct our research.

Our objective was to measure smartphones effect onpharmacists’ efficiency, to assess pharmacist acceptance ofcorporate smartphones, and to investigate how these devices arebeing utilized.

We conducted a multi-center time-trial, survey, and observationalprospective study which enrolled 90 pharmacists across 8hospitals on vancouver Island. Participants performed a time-trialof 22 situational drug information questions before and afterreceiving an iPhone. They also completed both demographic andsatisfaction surveys. A subset of 14 of the 90 pharmacistsparticipated in a pre and post iPhone® implementation 8 hourdirect observation study. Lastly, communication data from thephone service provider was collected and analyzed. To the bestof our knowledge this is the first study of its kind in NorthAmerica.


1. To understand the impact of mobile technology in pharmacypractice.

2. To describe the positive and negative aspects of smartphoneuse.

3. To discuss methods for evaluating the integration ofsmartphones into pharmacy practice.

4. To appreciate the importance of integrating a research projectinto the pharmacy residency program in promotingevidence-based practices.


1. What types of technology support can be used to facilitatesmartphone implementation across a multi-center pharmacydepartment?

2. What further research is needed to aid other healthdepartments and organizations in deciding how to endorsesmartphone technology in their own departments?

How to Write a Research Paper and Get ItPublishedPeter J. Zed, BSc, BScPhm, ACPR, PharmD, FCSHP, Faculty ofPharmaceutical Sciences (Department of Emergency Medicine),Faculty of Medicine, University of British Columbia, Vancouver, BC

Following the completion of any research project the researchteam often then starts to think about the preparation of amanuscript and submission for publication consideration.However, many factors must be considered in the preparation ofa research paper before, during and following the completion ofthe project, which will both reduce some of the challenges in theknowledge translation of research findings but also increased thelikelihood of acceptance of the submitted manuscript. Thisworkshop will review the many factors a research team shouldconsider at all stages of the research project development andconduct and provide several tips to optimize publication success.The workshop will allow participants to work together in smallgroups to navigate several key steps in this process and whenpossible an interactive discussion will be encouraged allowingparticipates to share successes and failures from their ownexperiences.


1. To review several factors at all stages of a research project thatmust be considered to increase the success of a researchpaper being published.

2. To discuss the core components of a research paper.

3. To discuss strategies to manage an unsuccessful journalsubmission.


1. What factors must be considered before, during and followingthe completion of a research project to increase the chanceyour project will be published?

2. What strategies should be considered to improve thelikelihood of a manuscript being accepted following arejection from a journal on the first (or second!) submission?

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Antibiotic Prophylaxis in Surgery: Issuesand Controversies

Sumit Raybardhan, BScPhm, ACPR, MPH, North York General,Toronto, ON

The goal of this session is to provide a critical appraisal of thenew clinical practice guidelines for surgical antimicrobialprophylaxis led by the American-Society of Health-SystemPharmacists (ASHP). This review will focus on the evaluative basisof the guidelines by drawing on examples from therecommendations in antimicrobial dosing, antimicrobial choice,and the timing and duration of antimicrobial prophylaxis.

Several important changes have occurred since the previousiteration of the ASHP surgical prophylaxis guidelines. Theseinclude, but are not limited to: approval of a new antimicrobialfor surgical prophylaxis, changes in epidemiology and resistancepatterns of causative pathogens in surgical site infections, as wellas a greater incorporation of pharmacokinetic andpharmacodynamic parameters into appropriate antimicrobialdosing. Furthermore, given the growing public health crisisaround antimicrobial resistance, evaluation of these guidelines inthe context of existing antimicrobial stewardship principles is anessential consideration.

With over 80 pages of text and 1000 references, this guidelineprovides a robust overview of the evidence in this field.Identifying gaps and areas of controversies in therecommendations are an important aspect of implementing anyguidelines. Participants in this session will benefit from a broaderunderstanding of the evidence underpinning, as well as the,limitations and gaps within key recommendations, and will beable to create a framework for applying these guidelines to theirpractice setting.


1. To provide an overview of the evidence frameworkunderpinning the ASHP antimicrobial surgical prophylaxisguidelines.

2. To describe controversies in key recommendations aroundantimicrobial dosing, choice, and duration in surgicalprocedures.

3. To highlight gaps in recommendations within the guidelines.


1. What is the key difference between the evidence frameworkused in the ASHP clinical practice guideline for surgicalantimicrobial prophylaxis versus other standardized evidenceframeworks?

2. What is the ideal dosing strategy for cefazolin in surgicalprophylaxis settings?

3. Describe one area of surgical antimicrobial prophylaxis thatthe guidelines do not address.

PHARMACYSPECIALTYNETWORKSPSNN E T W O R K • C O M M U N I C AT E

R SKROWWOTENYTLLTACIEPSCYAPHARM P

O R K • C O M M U N I CWN E TNSP

T EAO R K • C O M M U N I C

Ethical Issues in Global Health

Jessica Sleeth, MPH, CHE, BPHE, BA, Office of Global Health,Faculty of Health Sciences, Queen’s University, Kingston, ON

The purpose of this session is to review current literature andpractices regarding the ethics of global health work. Severalperspectives will be examined, including: the academicinstitution, host institution or non-governmental organization,and the learner/preceptor/pharmacist perspective. An importantperspective to consider is that of the host institution/organizationand the interaction with the pharmacist (and/orlearner/preceptor).

The Office of Global Health (OGH) at Queen’s University hasdeveloped comprehensive pre-departure training andpost-arrival debrief sessions to decrease the potential risk andimprove the experience for the learner and hostinstitution/preceptor. Development of long-term sustainablepartnerships is also an important goal. Our programming can beapplied to various situations, including that of pharmacistsworking in both short and long-term roles in internationalsettings. A very important aspect to examine is that of bilateralexchanges between North and South institutions andorganizations.

Advocacy, both at home and abroad, is another importantcomponent of global health ethics. Throughout the session wewill examine how the OGH integrates advocacy into theeducation curriculum and global health placement program. Thegoal of this session is to transfer the knowledge the OGH hasacquired over the last 4 years to the audience in a manner thatensures the programming and discussion points are relevant toyour specific clinical responsibility whether it is as a learner,preceptor, or pharmacist working in a global health setting inCanada or abroad.


1. Discuss ethical issues surrounding global health work forlearners and professionals and potential solutions to mitigatepersonal risk and volunteer tourism.

2. Examine the potential for bilateral exchanges and long-termpartnerships with non-government organizations andacademic institutions abroad.


1. Is the global health work I am involved in taking course in anethical manner that I am comfortable with?

2. What key messages can I take away from this session to myorganization/academic institution to potentially improve thesafety and ethics of our global health work?


RKSKROWWOTENYTLLTACIEPSCYAPHARM P



Working as a Pharmacist with MédecinsSans Frontières

Alexandra Marcil, BScPhm, Médecins Sans Frontières, Winnipeg, MB

The purpose of this session is to describe the work of apharmacist working with Médecins Sans Frontières (MSF) aroundthe world, using examples from field experiences in DemocraticRepublic of the Congo, Pakistan, and Jordan.

MSF is an international, independent, medical humanitarianorganisation that delivers emergency aid to people affected byarmed conflict, epidemics, natural disasters and exclusion fromhealthcare. MSF offers assistance to people based on need,irrespective of race, religion, gender or political affiliation. Some30,000 MSF staff from all over the world provide assistance topeople in crisis. MSF staff are professionals who choose to workfor MSF because of a commitment to and concern for people’shealth and survival. They are doctors, nurses, midwives, surgeons,anaesthetists, epidemiologists, psychiatrists, psychologists,pharmacists, laboratory technicians, logistics experts, water andsanitation engineers, administrators and other support staff.

Pharmacists manage drugs and medical equipment in MSFprojects. They work closely with international and nationalmembers of the team to ensure good pharmaceutical practicesand adherence to national rules. Pharmacists work with thelogistics and medical teams and ensure a positive collaborationbetween them. They are responsible for the quality,appropriateness and smooth coordination of the medical supplylines, including the storage, distribution and ordering process ofdrugs and medical supplies. Pharmacists working with MSFimplement improvements and monitor medical consumptionsystems in end-user units. They analyze actual consumptionfigures and medical data. They assist and advise on localpurchase, drug destruction and medical donations.


1. To provide pharmacists with examples of the tasks performedby pharmacists working with MSF.

2. To draw parallels between MSF fieldwork and that ofpharmacists currently practicing in Canada


1. What activities do MSF pharmacists perform in their fieldworkthat are similar to tasks performed by pharmacists in Canada?

2. What skills are needed to be able to perform the tasks of anMSF pharmacist?

Lithium… Is It Still Useful?Wende Wood, BA, BSP, RPh, BCPP, Ontario

Pharmacists Association, Toronto, ON

A naturally-occurring element, lithium has been used as medicinefor centuries. Its use in psychopharmacology stretches backdecades. Long considered the gold-standard for the treatment ofbipolar disorder, the aggressive marketing of second-generation









antipsychotics seemed to push lithium out of the spotlight. Along list of potential short-term and long-term side effects, alongwith the need for therapeutic drug monitoring, made lithium aless than appealing option. but limitations of alternative agentshave come to light, and newer data on possible anti-suicidalityand neuroprotective effects have brought lithium back to theforefront. So what is the role of lithium in thepsychopharmacology world of today? This presentation will lookat the evidence base for the use of lithium in the treatment ofbipolar disorder and treatment refractory depression and discusstherapeutic monitoring and the management of side effects. Usein special populations such as the elderly and pregnant andlactating women will also be reviewed.


1. To describe the place of lithium in the treatment of psychiatricdisorders yesterday, today and moving forward

2. To examine management strategies for the short and longterm side effects of lithium


1. Which do you see used in the treatment of bipolar disorder inyour practice more frequently – lithium or atypicalantipsychotics?

2. What are the key monitoring parameters for long-term lithiumtherapy?

3. What is the role of lithium now and moving forward?

Anxious? Don’t Panic: A Review ofAnxiety Disorders

Barbara Thomas, PharmD, Eastern Health and Faculty ofPharmacy and Medicine (Department of Psychiatry), MemorialUniversity of Newfoundland, St. John’s, NL

This session is intended to provide an update on thepharmacological treatment of anxiety disorders to aidpharmacists in their understanding of the optimal use ofmedications utilized in the management of these disorders.

Anxiety disorders as a group are characterized by variouscombinations of key features such as excessive anxiety, worry,avoidance, and compulsive rituals which are associated withimpaired functioning or significant stress. They are among themost common psychiatric disorders with a lifetime prevalence ofapproximately 17%. between 1 in 5 – 10 patient visits to aprimary care physician are by those presenting with symptoms ofan anxiety disorder. These disorders typically present when anindividual is in his or her early twenties but can develop inadolescence or later in life. The chronic and disabling nature ofthese conditions is often underestimated leading tounder-diagnosis and under-treatment and considerable disabilityincluding functional impairment, increased use of psychiatric andnon-psychiatric medical services, reduced work productivity andsuicidal behaviour. Rates of suicide attempts and completions isten times that of the general population.





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MONDAY, FEBRUARY 3LUNDI 3 FÉVRIER

Developing an Advanced Pharmacy PracticeFramework: Key Learnings and Strategic OutcomesLisa Nissen, BPharm, PhD, FPS, FHKAPh, FSHP, School of ClinicalSciences, Queensland University of Technology, Australia

We often feel like the pharmacy profession has been at a"crossroad" for decades. The traditional roles for our professionin the supply and dispensing of medicines have slowly beenevolving, moving towards cognitive service provision, leveragingoff our growing recognition within the health sector as societiesmedicines experts. yet, the mechanisms needed to best facilitatethese changes have not always been clear. While professionalpractice for pharmacists has expanded in many countries toinclude areas like prescribing and vaccination, and the conceptsof “Advanced Practice” have also been embedded withinpolitical and health system frameworks, within Australia the valueof these to the wider health sector have only just grownmomentum. Recently, a number of key health policy changes andprofession wide practice initiatives have pointed a way forwardfor pharmacy practice in Australia, including the introduction ofthe profession wide Australian Advanced Pharmacy PracticeFramework. built on the core competencies for pharmacists, thisdocument seeks to provide a practice progression pathway forthe whole profession, and to provide a training and developmentpathway that transcends individual practice scopes and locations.This presentation will discuss the development of the frameworkand the key outcomes and strategic learnings for the professionin Australia.


1. To provide an overview of the Australian Advanced PharmacyPractice Framework (APPF) development process

2. To discuss the key principles and objectives of the APPF in thecontext of practitioner development

3. To discuss strategic outcomes for the profession and futuredirections now the APPF is in place


1. How does the APPF relate to the development of Advancedpractitioner training in Canada?

2. Can the key learnings and messages from the Australianexperience be used in reviewing the training needs in Canada?

Managing Expensive Oncology DrugsJin-Hyeun Huh, BScPhm, ACPR, BCPS, University HealthNetwork, Toronto, ON; Lyndee Yeung, BScPhm, MBA, CancerCare Ontario, Toronto, ON; Hazel Markwell, BA(Hon), MA, PhD,ThD, Centre for Clinical Ethics, Toronto, ON

Societal values on timely and equitable access to new cancertherapies needs to be balanced with evidence-based coverageand the sustainability of a public funding system. As the cost ofnew cancer drugs continues to rise, public payers and healthcareadministrators are faced with making difficult choices when itcomes to managing access to new and expensive cancertherapies that may not offer significant benefit, or whereevidence gaps may exist. In Canada, a pan-Canadian Oncology

While the etiology of anxiety disorders remains largely unknown,dysregulation of several neurotransmitter systems has beenpostulated. Several classes of psychiatric medications are usedclinically in the management of these disorders with varyinglevels of evidence to support their use. This presentation willreview these medications in context of treatment guidelines andcurrent evidence. Antidepressants are widely regarded asfirst-line treatment for many anxiety disorders. However, there isincreasing use of other agents such as pregabalin andpharmacological classes including

the second-generation antipsychotics. The optimal use of thesetherapies will be discussed in terms of defining treatment goalsand expectations, initiating and monitoring therapy.Pharmacological treatment perils will be discussed including therole of medication in the management of anxiety disorders inyouth.


1. Review the epidemiology, etiology, symptomatology, clinicalcourse and prognosis of various anxiety disorders

2. For select anxiety disorders identify different pharmacologicaltherapies and approaches that can be employed in treatment

3. List the goals of pharmacological treatment, identifymonitoring parameters for efficacy and tolerability as well asreview the evidence that may help guide decisions aroundduration of therapy

4. Identify the role and discuss the appropriate use ofbenzodiazepines in the management of anxiety disorders

5. Discuss the differences that exist in the diagnosis and clinicalpresentation of anxiety disorders in children and adolescentsand be able to identify with the specific treatment challengesand differing treatment approaches in this patient population


1. The most recent guidelines for the treatment of anxietydisorders in Canada were published in 2006. Is there morerecent data that would support a shift in our approach totreating these disorders?

2. As a pharmacist do I know how to help an individualundergoing pharmacological treatment for an anxiety disorderget the best out of that treatment?

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Drug Review Process has been established to promote theconsistency in the review of new cancer therapies. Apan-Canadian brand Drug Pricing Alliance has also been createdto help jurisdictions make listing decisions after each drug review.In Ontario, other public drug funding programs have also beenestablished to help improve access to new cancer therapies.Regardless of all these initiatives, there continues to bechallenges in the provision of new and expensive cancertherapies at all levels of the health care system. Questions ariserelated to the ethics of resource allocation and the process bywhich such decisions are made. From an ethical perspective,some would suggest that the best that we can do is to provide

“good enough care”, given that limiting treatment options isunavoidable. Others however raise questions as to equity andfairness and whether or not clinicians should ever be

“gatekeepers”.


1. To provide an overview of the drug review and approvalprocess in Ontario, as well as the strategies that have beenimplemented to improve access to cancer therapies

2. To understand the current structure and management withinand outside the hospital setting to provide intravenous andoral chemotherapies

3. To look at the ethics of resource allocation and to propose aframework which might inform the review and approvalprocess in Ontario.

Clinical Trials in Internal Medicine that will ChangeYour PracticePeter Thomson, BScPhm, PharmD, Winnipeg Regional HealthAuthority and University of Manitoba Faculty of Pharmacy,Winnipeg, MB

This session is intended to take a less mainstream approach.Rather than review a few large landmark trials, it will exploresome common misconceptions in clinical practice for acute caremedicine.

Much has been discussed about the newer oral anticoagulantsand their associated risks and benefits compare to warfarin. Wewill explore the relevance of one of the many sub analysis nowavailable – management and outcomes of major bleeding withdabigatran and warfarin.

Diabetic ketoacidosis is often thought of as an Emergency andIntensive Care Issue. In practice, In Winnipeg, after earlyassessment in ER, many patients are managed by InternalMedicine. We will discuss a relatively obscure article from Spainon the Management of DKA in a teaching hospital and comparesome of the findings from an audit of practice in two of theteaching hospitals in Winnipeg. We will also discuss thechallenges for all pharmacists in preventing unintentionalmisadventures in the medical emergency.

There is no question workloads on medicine wards are increasing- on a straight line upwards. We will briefly explore clinical

activities of pharmacist and discuss how we need to take focusaway from the drugs and move it to the patient.


1. Understand what impacts the outcome of patients with majorbleeding on oral anticoagulants

2. Describe why normalizing blood glucose values are of littleimportance in diabetic ketoacidosis

3. Want to return to the practice and develop ways to reducecreating their own workload


1. Why do antidotes make little difference to the outcome ofpatients with major bleeding on oral anticoagulants?

2. What is one major error internal medicine house staff makes inmanaging diabetic ketoacidosis

3. Why do you want to order a drug level?

Using Physical Assessment in Your Practice!Glen J. Pearson, BSc, BScPhm, PharmD, FCSHP; University ofAlberta, Mazankowski Alberta Heart Institute, Edmonton, AB

The purpose of this session is to provide a review of howpharmacists may use physical assessment skills in their dailypractice, for purpose of evaluating the need for and outcomesassociated with pharmacotherapy interventions.

In recent years, pharmacists in some regions of Canada have beengranted a new, expanded scope-of-practice through legislation.This has allowed pharmacists to embrace new responsibilities,such as adapting prescriptions, administering injectablemedications, accessing and ordering laboratory values andprescribing independently. Along with this expanded scope ofpractice, pharmacists have sought to broaden and advance theirknowledge base and skills to include other patient care activitiestraditionally performed by other members of the health care team,such as physical assessment (PA). PA is the systematic process ofevaluating the body and its function. It is divided into 4 separateprocesses: inspection, palpation, percussion and auscultation.Typically, pharmacists develop inspection skills, but are lessfamiliar with the other processes. Development of PA skillsbeyond inspection has the potential to allow pharmacists toaugment their assessment and monitoring of drug therapy, and toincrease their effectiveness in a collaborative health care teamenvironment.

This presentation will focus on provides examples of opportunitieswhere pharmacists who have developed PA skills may apply them,within their scope of practice, to assess and monitor drug therapyin their patients.


1. To review various opportunities for pharmacists to use acquiredphysical assessment skills to assume a broader role in toassessing and monitoring a patient’s drug therapy.

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2. To provide pharmacists with a rationale for and a motivation toacquire physical assessment skills.


1. What are the barriers preventing pharmacists from performingphysical assessment in practice?

2. What physical assessment skills are required to assess apatient’s response to �-blocker therapy?

A Pharmacist’s Tale: The Journey from Clinician toDirectorAllan Mills, BScPhm, PharmD, FCSHP, Trillium Health Partners,Mississauga, ON

This session will provide those individuals consideringadministrative roles with an overview of a transition from bedsideclinician, to clinical manager and director. The session will look atthe personal learning associated with such a transition andprovide advice for those considering such an evolution.

In this presentation the knowledge and skills sets that arerequired to fulfill a formal leadership role will be reviewed. Wewill review the core functions of a pharmacist and how the clinicalskills, knowledge and systems thinking that pharmacistsdemonstrate align with tasks associated with pharmacyadministrative roles. The session will also include a review of theperspective changes required to function at a senioradministrative level and will review the value of a personal visionstatement as a tool to guide actions and skill development.Formal and informal leadership will be reviewed and we willdiscuss how to identify opportunities as they arise that can allowfor clinicians to develop and demonstrate leadership. Otheropportunities to expand skills and demonstrate capabilities willalso be discussed.

Lastly, the session will look at the satisfying aspects of a formalleadership role and the need for more pharmacy leaders in thefuture.


1. To provide an overview of the skills and knowledge required tofunction at a director level.

2. To inform clinicians of opportunities that can be utilized toprepare for an administrative role.

3. To review the importance of informal and formal leadershipopportunities in the development of career goals.


1. How can a personal vision statement facilitate one’sprofessional development?

2. What tangible steps can be taken to create leadershipopportunities to facilitate personal development?

Landmarks in Pharmacy Practice Research: Moreand More Evidence for the Beneficial Impact ofPharmacist CareRoss T. Tsuyuki, BScPhm, PharmD, MSc, FCSHP, FACC, Faculty ofMedicine and Dentistry, University of Alberta, Edmonton, AB

Pharmacy practice is changing, at least that’s what they aresaying… but it’s a tough world out there and you need to haveevidence to “get” anything. It’s important that we all becomefamiliar with the evidence for the benefit of pharmacist care. Inthis presentation I will review some of the most importantdevelopments in pharmacy practice research.

In the face of this mountain of evidence, why is it not changingpractice very much? Is it us? I will talk about some preliminarywork which suggests that pharmacists are the biggest barrier topractice change.


1. Discuss some of the recent evidence for the impact ofpharmacist care on patient outcomes.

2. Understand the role of leadership, personality traits andorganizational culture in advancing (or not advancing)pharmacy practice.


1. List 2 recent major pharmacy practice trials give a “thumbnailsketch” of their results.

2. Describe some of the barriers to the implementation ofpharmacy practice research evidence.

Challenges and Opportunities inIntraprofessional Pharmacist

Collaboration in Primary CareSuzanne Singh, BScPhm, ACPR, PharmD, Mount Sinai AcademicFamily Health Team, Toronto, ON

Pharmacists in primary care have a responsibility to collaboratewith pharmacists working at other practices sites when neededto consult, refer and coordinate care to ensure the right care isprovided to the right patient at the right time. While this mayseem obvious to many practitioners, differences related tohistorical and evolving roles within discrete practiceenvironments, organizational cultures, biases and beliefs,geographic separation and economic drivers, at times coupledwith perceived intraprofessional rivalry, may in fact complicatethe establishment of productive intraprofessional care, to thedetriment of our patients and our profession. This session willhighlight strategies to cultivate effective partnerships betweenpharmacists working across the spectrum of health careinterfaces encountered by patients and their families, with afocus on optimizing medication management for patients inprimary care. Examples of practice scenarios includingintersections of care where intraprofessional collaboration would





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be beneficial will be provided. Shared-care intraprofessionalmodels for patient-care initiatives at the primary care level willalso be discussed.


1. To discuss barriers to and enablers of effective collaborativerelationships between pharmacists caring for patients inprimary care

2. To provide specific examples of patient-centered primary careinitiatives that feature shared-care between pharmacistsworking across various health care settings


1. What strategies may be implemented to foster effectivecollaborative practice between pharmacists in differentsettings to optimize medication management for patients inprimary care?

2. Which patient-centered primary-care initiatives may warrant aconcerted intraprofessional approach to care planning?

Taking Responsibility for Patient Care: A Toolkit for Pharmacists on Primary

Care TeamsDerek Jorgenson, BSP, PharmD, FCSHP, University ofSaskatchewan, Saskatoon, SK

It is becoming increasingly common for interprofessional primarycare teams to recruit non-dispensing pharmacists to practicealongside the other health professionals as direct patient careproviders. However, since this is a relatively new role, manypharmacists are unsure of the services that they should offer tooptimally impact patient outcomes. The aim of this study is todevelop recommendations that will assist pharmacists practicingon interprofessional primary care teams to select services thatthey should provide that will optimally impact patient outcomes.

A comprehensive literature search was performed to identifypeer-reviewed and non peer-reviewed papers that describe theoptimal services that pharmacists should provide in this setting.In addition, practicing pharmacist experts from across Canadawere invited to take part in one-on-one telephone interviews toprovide advice based on their personal experiences.

Sixty-five relevant papers were identified and reviewed duringthe literature search and 15 pharmacist experts were interviewed.The overall theme that emerged was that pharmacists in thissetting need to proactively identify high-risk patients andintervene to optimally impact patient care. They cannot just waitfor physicians to refer patients. To achieve this goal pharmacistson interprofessional primary care teams can: (1) build arelationship of trust and respect with the team; (2) Generate theirown patient referrals; (3) be an educator; (4) Screen the overallpatient population for drug therapy problems; (5) Offer sharedmedical appointments.






1. To provide recommendations that will assist pharmacistspracticing on interprofessional primary care teams to selectservices that they should provide that will optimally impactpatient outcomes.

2. To convince pharmacists practicing on interprofessionalprimary care teams to be proactive and take responsibility forpatient care on their teams.


1. List four services that primary care team pharmacists canprovide to take responsibility for patient care and improvepatient outcomes.

2. Explain why it is important for pharmacists practicing oninterprofessional primary care teams to be proactive and takeresponsibility for patient care on their teams.

Acute Analgesia in EmergencyDepartments: Is Our Performance Painful?

Richard Wanbon, BSc, BScPhm, ACPR, PharmD, Royal JubileeHospital – Island Health, Victoria, BC

The purpose of this session is to review analgesic strategies andperformance assessments for the treatment of EmergencyDepartment (ED) patients presenting with acute pain.

Acute pain is a common presentation with ED patients and acutepain is also induced by numerous procedures performed in EDs.There are a number of common and less common strategies toprevent and treat pain, yet our ability to utilize these options in asafe, effective and timely manner requires improvement. Muchattention has rightfully been focused on medication safety issueswith opiates, however identifying processes to improve thedelivery of analgesia is also important.

We performed a local chart audit of patients presenting to ourED with acute pain. based on this audit, we implemented severalregional processes including the introduction of an EmergencyDepartment analgesia protocol. Implementation strategies andbarriers will be discussed in addition to an assessment of our pre-and post-protocol audit data. A quick review of both commonand less traditional analgesic options for a variety of patientgroups will also be provided.


1. To provide both published and local data identifyingsub-standard provisions of analgesia to ED patients.

2. To share our local experience with several initiatives weimplemented to improve the quality of analgesia-related careprovided to ED patients with acute pain.

3. To review analgesic options to consider for ED patients withacute pain.





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1. Is there an opportunity to improve the quality ofanalgesia-related care to ED patients elsewhere?

2. How can other health regions in Canada utilize Island Health’sED experience to improve the quality of analgesia-related careto ED patients with acute pain?

Adverse Drug-Related Events andEmergency Department Visits:

Opportunities and Challenges for PharmacistsPeter J. Zed, BSc, BScPhm, ACPR, PharmD, FCSHP, AssociateProfessor and Associate Dean, Practice Innovation, Faculty ofPharmaceutical Sciences, Associate Member, Department ofEmergency Medicine, Faculty of Medicine, University of BritishColumbia, Vancouver, BC

In the era of increased attention to overall patient safety, severalinterventions have been implemented to attempt to reducemedication misadventure in both the community and hospitalsetting. However, patients continue to experience adversedrug-related events (ADREs) which are associated with significantmorbidity and mortality and result in many emergencydepartment visits. Only recently has the magnitude andcharacterization of ADREs been evaluated in Canada butunfortunately very little has been done to address this growingproblem placing significant burden on our health-care system.

As pharmacists we must identify, treat and prevent drug-relatedproblems. This session will outline the impact of ADREs inCanada and discuss the overall burden on our health-care system.Patient populations at risk and the drugs/drug classes mostcommonly associated with ADREs will also be discussed. Thesession will include numerous case studies illustrating the issuesand discuss how many of these events could have beenprevented. Finally, strategies and future directions will beoutlined to describe how pharmacists can identify and preventADREs.


1. To discuss the overall health care impact of adversedrug-related events.

2. To discuss factors associated with identifying patients at riskand drug classes commonly associated with adversedrug-related events.

3. To discuss strategies pharmacists can utilize in their practice toidentify, manage and prevent adverse drug-related events.


1. What are the patient, drug and system factors that increasethe risk of adverse-drug-related events that result inemergency department visits?

2. What strategies can pharmacists utilize in their practice tomanage and prevent adverse drug-related events?





Update on the Management of UrinaryTract Infections in Children: What Does

the Evidence Say?Jennifer Poh, BScPhm, ACPR, PharmD, Hospital for Sick Children,Toronto, ON

Urinary tract infections (UTIs) are among the most commonlydiagnosed bacterial infections in childhood. Although frequentlyencountered, the management of UTIs remain among one of themore controversial issues in pediatric care. This has been evenmore so with the emergence of resistance to commonly usedantibiotics, and recent evidence regarding the use of antibioticUTI prophylaxis. The goal of this session is to provide anup-to-date summary of the literature surrounding the diagnosis,treatment and prophylaxis of UTIs in the pediatric populationwith particular attention to practical questions about itsmanagement for the pediatric pharmacist.


1. Apply evidence-based recommendations and guidelines to thetreatment of children suspected of having a UTI

2. Use evidence-based recommendations to guide the choice ofantibiotic prophylaxis for UTIs in children.


1. What are the indications for hospitalization and/or parentalantibiotic therapy in children with UTIs?

2. When should we consider UTI prophylaxis in a pediatricpatient?

Tools to Improve the Health Literacy ofSick Children and their Families

Régis Vaillancourt, OMM, CS, BPharm, PharmD, FCSHP,Children’s Hospital of Eastern Ontario, Ottawa, ON

Four out of 10 adult Canadians aged 16 to 65 - representing 9million Canadians - struggle with low literacy. Of these, fifteenpercent have great difficulty to understand any printed materials;and an additional 27 per cent can only handle simple readingtasks (Adult Literacy and Life Skills Survey, 2005).

Health literacy is defined as "The degree to which individualshave the capacity to obtain, process, and understand basichealth information and services needed to make appropriatehealth decisions". Families with poor literacy or health literacyskills have the poorest health outcomes. Low levels of healthliteracy, language differences and cultural variations are barriersto effective communication between healthcare providers andtheir patients.

Pictograms are clever tools that help overcome communicationbarriers between healthcare providers and their patients. The useof pictograms together with written instructions, improvespatient comprehension, understanding and recall of healthinformation. In fact, it has been demonstrated that the less









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education someone has; the more combining written instructionswith pictures improves their understanding of health information.

We have been creating and validating pictograms for the past 14years, and collaborate in pictogram design and validation inAfrica, India, Central America, the Caribbean and Europe. Withthis experience, our team has developed a process to create andvalidate pictograms to support patient counselling. The processinvolves the following steps: semiotic analysis, design,guessability, translucency and recall.


1. Understand the difference between literacy and health literacy

2. Understand the link between literacy and health outcome

3. Describe the method to create and to validate pictogrambased counseling tools


1. Pictogram comprehension is similar amongst differentcultures?

2. Semiotic analysis is the capacity of patients to guess themeaning of a pictogram?

Which National Clinical Pharmacy Key PerformanceIndicators (cpKPI) are You Measuring? A Practicaland Interactive cpKPI Guide to What, When, Whyand HowOlavo Fernandes, BScPhm, ACPR, PharmD, FCSHP, UHN,Toronto, ON, Leslie Dan Faculty of Pharmacy, University ofToronto; Kent Toombs, BScPharm, ACPR, Capital Health, Halifax, NS

Key Performance Indicators (KPIs) are quantifiable measures ofquality that reflect the critical success factors of an organization.A set of eight Canadian hospital clinical pharmacy keyperformance indicators (cpKPI) was recently established using asystematic, pan-Canadian, consensus-building (modified-Delphi)process. A cpKPI is defined by 5 characteristics: it reflects adesired quality practice; it is a metric which links to direct patient

care; it is associated with evidence of impact on meaningfulpatient outcomes; it is pharmacist sensitive; and it is feasible tomeasure. cpKPIs may allow pharmacists to re-focus and prioritizetheir patient-care efforts on interventions “that matter” andinfluence important outcomes such as hospital re-admissions.cpKPI were collaboratively developed, with representatives fromall 10 provinces, with the goal to advance pharmacy practice toimprove patient outcomes.

In this session, we will review 1) the key elements of the nationalconsensus process, 2) the final overall national Delphi results (thefinal 8 consensus cpKPI) and the3) post-Delphi cpKPI “next step”phases. A focus of the interactive session will be to obtainworkshop participant feedback on: outstanding cpKPI-specificcontroversial questions, practical implementation issues and adraft national cpKPI knowledge mobilization kit.


1. To outline the key elements of the national consensus processin developing clinical pharmacy key performance indicators(cpKPI) for hospital pharmacists

2. To report the final pan-Canadian results of the recent Delphiconsensus process to establish a final suite of cpKPI

3. To summarize the post-Delphi phases in the national cpKPIprocess (interprofessional and patient stakeholder feedback,national measurement systems, knowledge mobilization kit)

4. To review and gather workshop participant feedback on keycomponents of the draft national knowledge mobilization kit,cpKPI controversial outstanding questions and practicalimplementation issues.


1. State 3 reasons why implementing cpKPI in your hospital/department is valuable to advancing pharmacy practice andpatient outcomes..

2. List the final 8 national consensus clinical pharmacy KPI.

3. List 3 anticipated practical barriers and proposed solutions tothe implementation of cpKPI at your hospital.

TUESDAY, FEBRUARY 4MARDI 4 FÉVRIER

Comprehensive Patient Care: A Team-Based SportBarbara Farrell, BScPhm, PharmD, FCSHP and Veronique FrenchMD, CCFP, CoE, Bruyère Continuing Care, Ottawa, ON

Interprofessional teams enhance comprehensive patient care,improve patient safety and reduce workload issues that causeburnout among health care professionals. Successful teams sharea common purpose and goal (e.g., patient centred care),understand each member’s expertise, define roles and

responsibilities, communicate clearly and regularly, and havestrategies for conflict management in place. Other importantelements include cooperation, assertiveness, autonomy,coordination, growth of mutual trust andresponsibility/accountability. Strong leadership, effectiveadministrative support and organizational commitment tocollaboration and teamwork are key.

At an undergraduate level, health care professionals are taughtto complete comprehensive, profession-specific assessments andmay or may not be exposed to the roles and responsibilities ofothers. In practice, with multiple professionals contributing topatient care, providers need to understand the potential

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contributions of each, and learn to coordinate assessments andinterventions in a comprehensive plan that efficiently maximizestheir contributions and minimizes duplication.

Clinical scenarios from inpatient geriatric rehabilitation andoutpatient geriatric day hospital will be used to illustratesuccesses and challenges with team-based care. These willemphasize the importance and efficiency of developingpatient-centred goals as a team, rather than as individualprofessionals. The importance of defining expectations forcontributions and determining what the group is trying toaccomplish will be discussed. Mechanisms to ensure teammembers ask precise and relevant questions of each other, andto avoid repetition of workload will be described. Flexibleapproaches to team management when team members change,as well as approaches to managing conflict and dysfunction willbe discussed.


1. Consider the elements of successful collaboration in assessingthe strengths and weaknesses of their own interprofessionalteams.

2. Utilize learning as a springboard to improve their own teamfunctioning.


1. List the elements of successful interprofessional collaboration.

2. Is my patient care team functioning as a group of individualprofessionals or as an integrated unit?

The Double-Edged Sword: How Can a Drug Be aLife Saver and Potentially Fatal at the Same Time?Drug Interactions in OncologyScott Edwards, Cancer Care Program, Eastern Health, St. John’s, NL

The purpose of this session is to provide the hospital pharmacistwith an overview and review of drug-drug interactions (DDIs) inoncology.

Cancer patients are at a high risk for drug-drug interactions dueto potentially impaired pharmacokinetics. Oncology patients arealso commonly prescribed many medications which furtherincreases the risk. It has been determined that one-third ofambulatory cancer patients are at risk for DDIs.

Oral oncology agents represent a major breakthrough in thetreatment of cancer but most of these oral agents have a highpotential for DDIs. A recent study found 23-74 percent ofpatients taking an oral kinase inhibitor were also on a drug thathad the potential to reduce the effectiveness of the cancertreatment or increase its toxicity.

This session will use a cased based approach to identify andresolve clinically significant DDI’s, highlighting the role andimpact of the hospital pharmacist in improving patient care.


1. To better understand the mechanisms by which DDIs occur.

2. Discuss how a hospital pharmacist can systematically assess anoncology patient for clinically significant DDIs.


1. How can a hospital pharmacist identify clinically significantDDIs in a cancer patient?

2. What is the impact of DDIs in oncology?

CSHP 2015: What Pharmacy Directors Want!Carolyn Bornstein, BScPhm, ACPR, CGP, FCSHP, The ArthritisProgram, Southlake Regional Health Centre, Newmarket, ON

The CSHP 2015 initiative, launched in 2008, provides a vision ofwhat pharmacy practice excellence will look like in the year 2015.The 6 goals promote safe, effective, and evidence-basedmedication use, and a meaningfully contribution to public health.Canadian hospital pharmacy department progress with thethirty-six pharmacy practice-related objectives have beenreported in the Hospital Pharmacy in Canada Reports1.

A CSHP online survey in 2012 identified the respondents’ top 10high priority CSHP 2015 objectives, as well as their stage ofimplementation for each objective2. Pharmacy directors andmanagers who responded to the 2012 survey indicated that theywould like CSHP to provide more assistance with the CSHP 2015initiative. Another CSHP online survey in June 2013 (in Englishand French) was used to identify the objectives for which supportwas highly desirable, and how the respondents preferred thesupport be provided3. The survey also identified the mostcommon competing priorities with CSHP 2015, and therespondents’ key factors for their success with new pharmacyprograms or services. Some respondents who had achieved the2015 objective volunteered to offer support or advice to others.

This presentation will highlight the results of the 2013 survey. Itwill also compare the high priority objectives of 2012 with theobjectives identified as needing support in 2013. In addition tohighlighting the many resources and tools currently available toassist pharmacy directors and managers working to achieve the2015 objectives, other requested tools/methods of sharing willbe revealed, along with CSHP’s plans as to what they can provide.


1. To compare and contrast the CSHP 2015 Top 10 High PriorityObjectives from a 2012 survey with the results of a 2013 onlinesurvey to identify which CSHP 2015 objectives pharmacydirectors and managers would like support for.

2. To identify current competing priorities for the CSHP 2015initiative.

3. To review the currently available resources and tools tosupport achieving the CSHP 2015 objectives, and to futureplans for additional methods of sharing and supportingpharmacy directors and managers with this initiative.

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1. Name the top 3 CSHP 2015 objectives that pharmacy leaderswould like more support to achieve.

2. List at least 3 competing priorities for the CSHP 2015 initiativethat pharmacy leaders in Canada are currently facing.

3. What methods of resource sharing did the survey respondentsprefer/request from CSHP?

Scrutinizing Statins in the Prevention ofCardiovascular Disease: New Safety ConcernsGlen J. Pearson, BSc, BScPhm, PharmD, FCSHP; University ofAlberta, Mazankowski Alberta Heart Institute, Edmonton, AB

The purpose of this session is to provide a review of recentidentified statin-associated adverse effects/intolerances andappropriate management suggestions.

Recently, clinical studies have identified or provided insight intothe effects of statin therapy on muscles, cognition, cataracts,diabetes, kidney disease, and cancer. Among adverse drugeffects, the greatest controversy pertains to purported effects oncognition and the emergence of diabetes during long-term statintherapy. Some of this evidence has prompted regulatoryauthorities to require drug labeling changes or safety warningsfor drugs in this class. In addition, clinicians a faced with thechallenges of managing statin intolerance among patientsprescribed this therapy.

The clinical and academic observations in aggregate indicate thatoverall risk/benefit ratio favors therapy in patients meetingcriteria for lipid lowering therapy and Cv risk reduction.Furthermore, the CCS guidelines recommends that all purportedstatin-associated symptoms should be evaluated systematically,incorporating observation during cessation, re-initiation toidentify a tolerated, statin-based therapy for chronic use.


1. To review the evidence for recently identified statin-associatedadverse effects, such as new-onset diabetes, memoryimpairment, etc.

2. To provide a clear definition for the clinical syndrome of “statinintolerance” and outline a recommended statin intolerancemanagement approach.


1. What is the incidence of new-onset diabetes mellitusassociated with long-term statin therapy?

2. Is a creatine kinase (CK) elevation required for a patient to beintolerant to a statin?

3. In patients with statin-induced myopathy, does the use ofCo-enzyme Q10 (ubiquinone) reduce or prevent thesesymptoms?

Inspiring the Leader Within: Powerful Pearls &Potent PrinciplesShirin Abadi, BScPhm, ACPR, PharmD, BC Cancer Agency,Vancouver, BC

Effective pharmacy leadership can have a tremendous influenceon one’s ability to positively impact patient care and improvepatient health outcomes. Regardless of one’s position within thehealthcare system, there are multiple opportunities forpharmacists to lead and to make a positive difference. by gaininga better understanding of the key leadership strategies, it ispossible to take one’s practice to the next level.

This presentation will provide an overview of a few keyleadership principles that would enable pharmacists to increasetheir leadership effectiveness, while highlighting importantstrategies for continued success. by reflecting on differentperspectives and broadening one’s point of view, additionalinsights will be gained about one’s leadership potential.


1. To describe the key leadership principles, which apply to one’spharmacy practice.

2. To identify opportunities for improving one’s leadershipeffectiveness.


1. What are some strategies that you could incorporate in yourdaily work that would improve your leadership effectiveness?

2. How would you take your current practice to the next level?

Antibiotic Locks for Catheter-Related BloodstreamInfections: There's a Lock for That!!!Alfred Gin, BScPhm, PharmD, FCSHP, Health Science Centre,Winnipeg, MB

Nosocomial bloodstream infections (bSIs) are a commoncomplication associated with the use of intravascular devices forvenous access. Although bSIs may emanate from different organsites, a majority of bSIs are associated with intravascular orcentral venous catheters. Catheter-related bSIs (CRbSIs) areassociated with significant morbidity and mortality. Of theestimated 250,000 cases of bSIs in the United States, 80,000cases of central line associated bSI occur in the intensive careunit. Among affected patients, CRbSIs increase the cost andlength of hospitalization.

Significant efforts have been directed towards the prevention ofbSIs through catheter selection and placement; aseptictechniques; and the development of catheterinsertion/maintenance bundles. Treatment of primary CRbSIsusually involves systemic antibiotic therapy with/without theremoval of the infected catheter. Several guidelines and reviewsfor the prevention and management of CRbSIs have been

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published. Lost among the myriad of recommendations are thoserecommending the use of antibiotic lock therapy (ALT). ALT hasbeen used to treat and/or prevent CRbSI in patients especiallythose with long term indwelling devices. ALT involves theintra-luminal instillation of an antimicrobial solution (usually withan anticoagulant) or ethanol for a specified period of time.Despite recent recommendations, questions and the lack offamiliarity with ALT remain.

This talk will review the pathogenesis and epidemiology ofCRbSIs and the application of ALT for treatment. Studies,considerations and limitations of ALT will also be provided.


1. To provide the pharmacist an understanding of catheterrelated blood stream infections.

2. To identify indications and considerations for the use ofantibiotic lock therapy.


1. What is an antibiotic lock?

2. What are the recommendations for antibiotic lock therapy?

Use of Insulin in HospitalAlice Y.Y. Cheng, MD, FRCPC, Trillium Health Partners,Mississauga, ON

The purpose of this session is to review the types of insulin andinsulin regimens available for use in the hospital setting.

There are 3 types of insulin: basal, bolus and premixed. There arealso 3 fundamental regimens in type 2 diabetes – basal alone,basal bolus and premixed. In the hospital setting, achieving andmaintaining glycemic control is a challenge due to system andpatient-related factors. Insulin is the usual mainstay of therapy inhospital. but what regimen should be used?

• Continuation of pre-existing insulin regimen and the originaldoses is a good starting point for patients admitted previouslyon insulin

• A regimen consisting of routine basal + routine bolus insulin ormealtimes + correction dose bolus insulin regimen is ideal inhospital

• Sliding scale bolus insulin alone as the treatment in hospital isinappropriate

• Frequent reassessment of the routine insulin regimen isrequired to ensure good results


1. To review the 3 types of insulin and the pros and cons of the 3fundamental insulin regimens in type 2 diabetes

2. To describe practical strategies to dose insulin in the hospitalsetting


1. What are the 3 types of insulin and the pros and cons of the 3insulin regimens?

2. What are the ideal insulin strategies to deal with specialpopulations such as variable feeding and glucocorticoidtherapy?

Role of Suboxone in Opioid Dependence

Beth Sproule, BScPhm, PharmD, Centre for Addiction andMental Health and University of Toronto, Toronto, ON; Juno Kim,BScPhm, Centre for Addiction and Mental Health, Toronto, ON

The purpose of this session is to review the role ofbuprenorphine, marketed as Suboxone®, in the treatment ofopioid dependence. Compared to methadone, its partialmu-opioid agonist properties confer desirable features such asincreased safety in overdose, reduced potential for abuse, andthe ability to titrate to a stable dose quickly. However, the partialagonism also means that even when prescribed at maximal dosesit may not be sufficient for all patients, and special considerationsare needed during induction to avoid precipitating withdrawal.The addition of naloxone to the Suboxone® product formulationis intended to further reduce the risk of abuse by injection, butdoes not eliminate the risk. At the Centre for Addiction andMental Health, a flexible short-term buprenorphine dosingprotocol has been developed for inpatients undergoingmedically-assisted withdrawal from opioids (primarily prescriptionopioids), largely replacing the previous protocol using clonidine.Importantly, opioid substitution therapy with buprenorphine ormethadone, has been shown to be far more effective thandetoxification in improving health and drug outcomes in thetreatment of opioid dependence. When patients takingbuprenorphine or methadone are hospitalized, pharmacists playa key role in ensuring the safe maintenance of this treatmentduring transitions in care.


1. To describe the role of buprenorphine in the treatment ofopioid dependence compared to methadone, based on itsunique pharmacology.

2. To explain the use of buprenorphine and its effectiveness insubstitution therapy and medically-assisted withdrawal.


1. What are the clinical significant differences in thepharmacokinetics and pharmacodynamics of buprenorphineand methadone?

2. When would buprenorphine be chosen over methadone inopioid substitution therapy?





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ConstipationPeter Thomson, BScPhm, PharmD; Winnipeg Regional HealthAuthority and University of Manitoba Faculty of Pharmacy,Winnipeg, MB

This session will use a case based format to discuss constipation.The focus will be on the difficult to manage patient from a fewdifferent perspectives: refractoriness to laxatives, adverse effectsor intolerance to laxatives and constipation associated with pain.In addition to discussing laxatives an introduction to non-drugrelated concepts will be provided.


1. Describe some common adverse effects with specific laxatives

2. Describe the difference between functional and organic bowelsyndromes

2. Discuss the building blocks of cognitive behavioral therapy


1. What is a normal bowel routine?

2. What is cognitive behavioral therapy?

Tranexamic Acid as a Blood ConservationStrategy

Melanie MacInnis; BScPhm, PharmD; IWK Health Centre, Halifax,NS

With the evolution of the concepts of bloodless medicine andblood conservation; pharmacologic strategies are gaining moreclout as one of options to minimize blood loss and the need forblood transfusions. Tranexamic acid (TXA), a lysine analogue; hasbeen used intravenously for many years to manage perioperativeblood loss. In the past ten years; the literature has exploded withinformation on the efficacy of TXA in reducing the need forblood transfusions.

While the efficacy of systemic TXA is established; the studies arenot powered sufficiently to inform reliably on risk of adverseevents such as thromboemolic complications. Wide ranges ofdosing strategies are reported in the literature. Topicaladministration of TXA is one way to attempt to maximize thecoagulation afforded by TXA while minimizing the theoreticalsystemic adverse events. The topical administration of TXA is juststarting to be reported in the literature; but again not in anystudies with enough power to reliably determinethromboembolic risk.

This session will review the rationale for blood conservationstrategies, the pharmacologic profile of TXA, and its place intherapy as a blood conservation strategy. Evidence for use ofTXA, both topical and systemic, will be reviewed with a focus inorthopedic surgeries. Cardiovascular, vascular, spine, andemergency/trauma will also be reviewed.








T EAO R K • C O M M U N I CGoals and Objectives

1. Describe the impact of TXA on reducing blood loss whenadministered in the peri-operative setting by either topical orintravenous route.

2. Understand the risk of thromboembolic events and rate ofoccurrence in the peri-operative setting in the face of TXAadministration.


1. What impact does study design have on being able to makestatements on the safety and efficacy profile of using TXA toreduce the need for peri-operative transfusions?

2. In which patients would TXA be contra-indicated and anotherblood conservation strategy be utilized?

Optimizing Surgical Antibiotic Prophylaxis:What’s New? What You Can Do

Rosemary Zvonar, BScPhm, ACPR, FCSHP, The Ottawa Hospital,Ottawa, ON

Surgical site infections are associated with patient morbidity,mortality and increased health care costs. It has been wellestablished that timely administration of appropriate antibioticsperi-operatively can reduce the incidence of surgical siteinfections and is recommended for high-risk procedures. Thus,optimizing delivery of surgical antibiotic prophylaxis is animportant patient safety goal and an obvious qualityimprovement target. Pharmacists can play an important role inevaluating and optimizing practice at their institution.

Antibiotics administered for surgical prophylaxis should benarrow spectrum, active against organisms of concern at thesurgical site, well tolerated, and administered such that adequateserum and tissue concentrations are achieved from the time ofincision until closure. Although studies are available to informpractice for a variety of surgical procedures, a number ofuncertainties remain. Guidelines for the use of antimicrobialsurgical prophylaxis, developed jointly by a number of keySocieties, have recently been published. These guidelinessummarize the current literature and provide a basis on which tostandardize practice. Recommendations pertaining to dosing,choice, timing and duration of prophylaxis within the guidelineswill be reviewed.


1. To review the general principles of antibiotic prophylaxis insurgery

2. To highlight key recommendations in the recent clinicalpractice guidelines for antibiotic surgical prophylaxis

3. To identify ways in which pharmacists can work with otherhealthcare practitioners to improve the delivery of antibioticprophylaxis at their institution





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1. List 5 quality indicators which should be assessed whenevaluating surgical prophylaxis practice

2. What are the antibiotic regimens recommended forprophylaxis for General and Orthopaedic surgeries?

Roads to the Information SuperhighwayKurt Schroeder, BScPhm, ACPR, Director of Pharmacy,Interlake-Eastern Regional Health Authority, Selkirk, MB; JeffBarnett, BScPhm, MSc, FCSHP, Director of Clinical Informatics,BC Cancer Agency, Victoria, BC

The purpose of this session is to provide an overview of currente-Health activities across Canada and highlight some of thechallenges and opportunities facing pharmacists practising inrural communities.

There are 2 main national committees looking at the interests ofpharmacists in regard to health information technology. CSHP isrepresented at the National e-Pharmacy Task Force whichinvolves several national groups such as CPHA, CADS, andNAPRA. This committee evolved from the activities outlined inthe bluePrint for Pharmacy. It looks at information technologyissues such as e-prescribing, drug information systems andelectronic health records and makes recommendations to theappropriate organizations and legislative bodies.

The other committee is the Canada Health Infoway, PharmacistReference Group. This group is actively involved with the work





done by Canada Health Infoway – a federal body thatcollaborates with all of the provinces that promotes thetransformation of health care through the use of healthinformation technology. The Pharmacists Reference Group iscomposed of pharmacists from several practice areas and isinvolved in advising CHI and assisting in the adoption ofinformation technology by pharmacists. both these groups haverepresentation from CSHP and have been working on activitiesintended to promote the use health information technology bypharmacists.

There are many challenges in pharmacy practice for projectimplementation and sustainability. Informatics projects in rural orregionalized organizations provide a unique logistics thatrequires a strategic approach


1. To provide pharmacists with an understanding of e-Healthactivities across Canada

2. To describe CSHP involvement at the national level in e-Health

3. To identify key barriers for informatics project implementationin rural practice and strategies that address these barriers.


1. How will the national e-Health strategies impact hospitalpharmacy programming?

2. How can local pharmacy informatics projects be designed tobetter support the national Infoway strategy?

WEDNESDAY FEBRUARY 5MERCREDI 5 FÉVRIER

The Oncology Under-Dosing Incident: LessonsLearnedSandy Jansen, BScPhm, MHS, London Health Services, London,ON; Jake J. Thiessen BScPhm, MSc, PhD, University of Waterloo,Waterloo, ON; Marshall Moleschi, Ontario College ofPharmacists, Toronto, ON

On March 22, 2013, with one single phone call received fromLakeridge Hospital, the landscape for hospital pharmacychanged dramatically. being at the centre of a critical incidentinvolving one patient is something every pharmacist andtechnician dreads, but being at the centre of an event thatimpacted 691 patients locally and over 1200 patients across twoprovinces is something most of us cannot comprehend and iscertainly not something we train for or plan for. This presentationwill focus on leadership lessons learned from the front line.

Through the oncology review, pharmacy’s identifiable footprintswere evident in affected hospitals, outsourcing vendors(Marchese Hospital Solutions), the group purchasing organization(Medbuy), and oversight regulatory agencies. NotwithstandingPharmacy’s expanding professional role, a critical responsibility

remains: safeguarding the quality of the drug supply. Goodintentions are not enough to mitigate risks. Greater vigilancethrough a series of recommendations, along with checks andbalances, will close gaps in: group purchasing organizations,vendors, hospitals, the Ontario College of Pharmacists, OntarioHospital Association and Health Canada.

The challenges of navigating the grey are not reserved forpractitioners but also apply to the Ontario College ofPharmacists. Although current legislation excludes the Collegefrom regulatory oversight of hospital pharmacies and HealthCanada holds jurisdiction for drug manufacturers, how clear arethese divisions of authority? When standing at these borders wemust consider the risks of assuming that others have stepped in,where we have stopped. The delivery of safe and effectivehealthcare is complex and dependent on all stakeholderscommitted to working collaboratively.


1. To understand leadership lessons learned from the hospitalpharmacy front line during the oncology under-dosing incident.

2. To understand how the recommendations and their potentialimpact to stakeholders.

3. To understand the roles of regulatory authorities.

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Biologicals: What Pharmacists Need to KnowAbout Monoclonal AntibodiesTom McFarlane, BScPhm, PharmD, Cambridge MemorialHospital, Cambridge, ON

Since the advent of a process to produce monoclonal antibodieswon its discoverers the Nobel Prize in 1984, these agents havebecome widespread in medicine in a number of applications,particularly as therapeutic drugs. Furthermore, the number ofmonoclonal antibodies receiving approval for therapy isskyrocketing, with dozens of potential candidates for futureapproval in the pharmaceutical pipeline. As the use of theseagents becomes more prevalent, it will be incumbent uponpharmacists to have some familiarity with the therapeutic actionand potential adverse effects which relate to them.

This presentation will give an overview of the monoclonalantibodies which are currently in use in therapeutic treatment inthe settings of cancer treatment, autoimmune disease, and otheruses. Topics covered will include classification of monoclonals,differences between murine, chimeric, humanized, and fullyhuman antibodies, mechanisms of action, potential side effectssuch as infusion-related reactions, and the place ofantibody-directed treatment in the oncology and autoimmunesettings.

Also covered will be future directions in monoclonal antibodytreatment, including discussion of various agents in thepharmaceutical pipeline which are imminently awaiting approval,drug-antibody conjugates, and the potential impact of so-called

“follow-on” or “biosimilar” monoclonal antibodies on thehealthcare system given the large number of expiring patents onmonoclonals in the next few years.


1. To familiarize pharmacists with the concept, namingconventions, and basic properties of monoclonal antibodes

2. To give an overview of the therapeutic uses of variousmonoclonal antibodies

3. To outline the patient management issues seen with variousmonoclonals

4. To delineate the impact of monoclonal antibodies on thehealth care system from both treatment and cost perspectives


1. What therapeutic areas are monoclonal antibodies typicallyused in, and what is their impact within these areas?

2. What is the role of the pharmacist in the management ofpatients receiving these agents?

3. What potential impact might future directions in biologicdrugs have on the Canadian healthcare system?

Deprescribing Benzodiazepines: Do We Need aNew Approach?Barbara Farrell, BScPhm, PharmD, FCSHP, Bruyère ContinuingCare and Bruyère Research Institute, Ottawa, ON

benzodiazepines are associated with sedation, dizziness,cognitive impairment, falls, hip fractures, and motor vehicleaccidents. yet, between 22% -27% of adults 65+, and over 30%of those 85+, use them regularly. Up to 50% of people takingbenzodiazepines do so long-term despite only short-termevidence (up to 6 weeks) for insomnia and Health Canadarecommendations for anxiety limited to 2 months.

Stopping benzodiazepines is difficult due to patient resistance,withdrawal symptoms, and physician prescribing practices.Reports of withdrawal symptoms, some severe (e.g. seizures,psychosis) are frightening. Rebound insomnia is common andpatients may believe they need medication indefinitely for sleep.Health care providers often have difficulty helping patients taperbenzodiazepines. Physicians sometimes prescribe for short-terminsomnia treatment but hesitate to deprescribe for many reasons.

The most consistently effective methods to stop benzodiazepinesinclude slow tapering and support through cognitive behaviouraltherapy, psychological counseling, and self-help. Theseapproaches are not commonly used, however, perhaps due tolack of expertise or perceived expense. With interprofessionalhealth care teams and focus on supports for self-management,there is potential for team approaches to assist patients withbenzodiazepine tapering.

In September 2013, the Canadian Institute of Health Researchfunded a 1.5 day meeting at the bruyère Research Institute,Ottawa. Over 50 health care professionals, researchers andstakeholders discussed and identified components of aninterprofessional model to benzodiazepine deprescribing. Agrant writing team was established and has begun workdeveloping a related research grant framework which will bediscussed during the session.


1. Explain the reasons why attempts should be made todeprescribe benzodiazepines

2. Describe a framework for an interprofessional team approachto benzodiazepine tapering


1. What are the risks of continuing benzodiazepine use in theelderly?

2. How can I work with other health care professionals tofacilitate reduction of benzodiazepine use in the elderly?

The Hierarchal Teaching Model: Redefining theStructure in Experiential Pharmacy TrainingTim T.Y. Lau, PharmD, ACPR, FCSHP, Vancouver Coastal Health,Vancouver, BC

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The demand for high-quality experiential training for pharmacystudents, pharmacy residents, and PharmD students has beenincreasing in Canada. However, the limited number of preceptorsand clinical placements in hospitals make it difficult toaccommodate these trainees and ensure their learning objectivesare fulfilled. Traditionally, the one-to-one preceptor to studentmodel has been the main teaching strategy at most institutions,but this approach is time intensive and is suboptimal in cateringto the need of this large population. Consequently, moreeffective models of experiential education are needed.

The hierarchical teaching model with senior students mentoringjunior students is traditionally used in medical training. Under thisapproach, pharmacy students at various levels of training wouldbe overseen by an attending pharmacy preceptor. Theadvantages and disadvantages of this teaching model will bereviewed.


1. To provide an overview of different experiential trainingmodels for pharmacy internships.

2. To highlight the advantages and disadvantages of ahierarchical teaching model.


1. What are some considerations when setting up a hierarchicalteaching model for a pharmacy internship?

2. What should be considered when evaluating trainees underthe hierarchical teaching model?

Overdoses That Should Send a Chill Up Your SpineDebra A. Kent, BA(Biol), PharmD, DABAT, FAACT, B.C. Drug andPoison Information Centre, Provincial Health Services Authority,Vancouver, BC

The purpose of this session is to familiarize clinical pharmacistswith some uncommon but potentially fatal overdoses. Thiscase-based discussion highlights overdoses resulting in rapiddeterioration of clinical status such as hydroxychloroquine,bupropion, colchicine, dapsone, ecstasy and massive amounts ofacetaminophen. by anticipating potential toxicity andunderstanding aggressive approach to management, clinicalpharmacists can improve outcomes in patients who haveoverdosed on these agents.

Hydroxychloroquine overdose can result in rapid onset ofhypotension, hypokalemia, conduction delays and cardiac arrest.Aggressive resuscitation includes fluids, vasopressors, sodiumbicarbonate, and electrolytes.

bupropion overdose commonly results in seizures but followinglarge ingestions, patients can develop multiple seizures andcardiac dysrhythmias. Management requires sedation andanticonvulsants; Iv lipid emulsion has been used successfully forasystole.

Colchicine overdose results in multi-system toxicity and potentialfor poor outcome must be recognized early. There is no specificantidote; various agents have been used with limited success.

Dapsone overdose causes methemoglobinemia and delayedhemolysis. Patients with chronic disease tend to have worseoutcomes. Pulse oximetry cannot be used to diagnose ormonitor these patients. Methylene blue can be life-saving andrepeated doses may be required.

Ecstasy overdose can result in severe hyperthermia. Thesepatients require rapid cooling, sedation, paralysis and possibleuse of dantrolene.

Acetaminophen in massive amounts can result in metabolicacidosis, coma and hypotension within several hours of ingestion.This clinical presentation is not secondary to hepatic failure andearly aggressive treatment with consideration of hemodialysis isessential.


1. To discuss drug overdoses associated with rapid deteriorationin clinical status or where aggressive management may berequired.

2. To discuss current approach to managing toxicity of theseoverdoses.


1. What potential toxicity and treatment can a clinical pharmacistanticipate when managing a patient who has overdosed onhydroxychloroquine?

2. What antidote may a clinical pharmacist require in managing amassive bupropion overdose?

3. With regard to lactic acidosis secondary to acetaminophenoverdose, compare pathophysiology and approach tomanagement following early acidosis seen with massiveingestion vs late acidosis following development of fulminanthepatic failure.

Neuromuscular Blocking Agents in the IntensiveCare UnitNorman Dewhurst, BScPhm, ACPR, PharmD, St. Michael’sHospital & University of Toronto, Toronto, ON

The goal of this session is to provide pharmacists with anoverview of the use of neuromuscular blocking agents (NMbAs)in the critical care setting.

NMbAs paralyze skeletal muscle by blocking the transmission ofnerve impulses at the myoneural junction. A number of NMbAsare available, differing in their pharmacologic andpharmacokinetic properties. Patient-specific factors should betaken into consideration when selecting the most appropriateagent to maximize efficacy and minimize toxicity.

NMbAs have many clinical applications, including immobilizingpatients for emergency intubation or procedural interventions,facilitating mechanical ventilation for acute respiratory distress

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syndrome (ARDS) and status asthmaticus, decreasing elevatedintracranial or intra-abdominal pressures, and facilitatingtherapeutic hypothermia after ventricular fibrillation-associatedcardiac arrest. The available evidence suggests that theshort-term administration of neuromuscular blockade in selectpatients may be safe and potentially beneficial.

However, the continuous administration of NMbAs is associatedwith a number of adverse effects and complications, includingpost-paralytic syndrome, prolonged neuromuscular weaknessand inability to wean from the ventilator. Medical errors withNMbAs also cause profound morbidity and mortality. Seriousadverse events occur when NMbAs are used without adequateknowledge, experience or safeguards. Pharmacists are the idealhealthcare providers to manage the complexities associated withNMbA use in critically ill patients.


1. Compare and contrast the pharmacologic andpharmacokinetic properties of available NMbAs.

2. Describe the rationale and current therapeutic indications forNMbA use.

3. Summarize recent literature on the use of NMbAs toprevent/treat ARDS.

4. Discuss practical considerations for the use of NMbAs.


1. Which NMbAs are preferred in patients with renal and/or liverdysfunction?

2. List 5 drugs or conditions that affect the activity of NMbAs.

3. List the goals of therapy and monitoring parameters forpatients on NMbAs.

4. Which supplemental medications should be initiated oravoided in patients on NMbAs?

Treatment Decisions in OsteoporosisElaine Beltijar, BScPhm, Women’s College Hospital:Multidisciplinary Osteoporosis Program, Toronto, ON

The purpose of this presentation is to provide an overview of thepharmacological options in the management of postmenopausalosteoporosis and to address common questions encountered indaily practice relating to the initiation of treatment, the choice ofagent, long-term safety concerns, and the duration of therapy.

Over the past two decades, the number of treatment options,available in Canada, has expanded to include severalanti-resorptive agents (oral and intravenous bisphosphonates,raloxifene, hormone therapy, denosumab) and a bone-formingagent (teriparatide). Treatment initiation should be based on areview of patients’ clinical risk factors and the evaluation of theirabsolute 10-year fracture risk, either using the CAROC or FRAXfracture risk assessment tools. Selection of the appropriatetherapeutic agent involves the consideration of its anti-fractureefficacy, administration, side effect profile, drug-interactions,

safety, convenience, and cost, but may also rely on overallpatient preference.

Treatment duration has recently been a hot topic of contention inthe wake of media reports describing long-term risks associatedwith bisphosphonate use, i.e. osteonecrosis of the jaw [ONJ] andatypical femoral fractures [AFF], which have also been linked todenosumab. bisphosphonates and denosumab haveundoubtedly been proven as effective therapies for reducingfracture rates in clinical trials for up to 3 years. Long-term efficacydata has been less robust, although treatment extension trialshave provided some insight over 6 to 10 years of continued use,which will be reviewed in this session. Information about ONJand AFF (re: incidence rates, clinical presentation, and riskfactors) will also be discussed.


1. To provide an overview of the medication options available forthe treatment of osteoporosis.

2. To discuss the use of fracture risk assessment tools (CAROC /FRAX) to help identify patients in need of treatment.

3. To describe the rare risks associated with long-term treatmentand to review important patient counselling points.

4. To examine the efficacy data from treatment extension trialsand to provide guidance for either continuing or stoppingtherapy.


1. When should treatment be initiated and which medicationshould be selected?

2. What do I know about ONJ and AFF risks related to long-termtreatment with bisphosphonates / denosumab?

3. How long should treatment be continued?

Updates in Management of GastrointestinalBleedingJennifer Teng, BScPhm, ACPR, PharmD, St. Michael’s Hospital,Toronto, ON

The purpose of this session is to provide a brief overview ofpharmacologic management of upper-gastrointestinal bleeding(UGIb), variceal and non-variceal.

Many hospital pharmacists encounter patients withgastrointestinal bleeding regularly in their practice. Pharmacistsare essential in identifying drug and disease related causes ofupper gastrointestinal bleeding and recommending treatmentfor prevention of recurrent bleeding.

Topics of discussion will include acute management of varicealand non-variceal bleeding, when to restart antiplatelets oranticoagulants after a bleeding event, post-GI bleedinggastroprotection, treatment of H. pylori, and antibioticprophylaxis for variceal bleeding.

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1. To provide pharmacists with an overview of the epidemiology,risk factors, and diagnostic procedures for patients withvariceal and non-variceal bleeding.

2. To describe evidence based treatment and preventionstrategies for variceal and non-variceal gastrointestinalbleeding.


1. What are the clinical benefits ( e.g. risk of rebleeding, mortalitybenefits) of using pantoprazole infusion or octreotide infusionfor GI bleeding?

2. When should antiplatelets or anticoagulants be re-started afteran episode of GI bleeding?

3. What type of gastroprotection should be used after anepisode of GI bleeding?

4. What antibiotic treatments or treatment regimens arerecommended in patients with variceal or non-varicealgastrointestinal bleeding?

Implementing Insulin Pens in Institutions

Sara Kynicos, MPharm, RPh, University Health Network, TorontoON; Jeremy Johnson, RN, BScN, MN student, CDE, St. Joseph’sHealthCare Hamilton, Hamilton, ON

In recent years, there has been growing interest in using insulinpen devices for subcutaneous insulin administration in hospitalsettings; primarily related to how to introduce insulin pens safely.Although risks exist, transitioning to insulin pens correctly canreduce medication error potential, improve staff safety, reduceinsulin costs and wastage, enhance nurse and patient satisfaction,promote educational best practice and support transitions ofcare.

The purpose of this session is to describe experiences from penimplementation projects at a number of institutions, includingthe benefits and risks identified from both a pharmacy andnursing perspective.

When planning to implement insulin pens, a number of factorsshould be considered including which stakeholders to involve,how to roll-out to multiple areas, patient flow considerations andplans for specific patient populations, in addition to fundamentaldecisions surrounding the choice of insulin pen devices andneedles to use.

In order to ensure a successful implementation, staff educationrelating to insulin administration using insulin pen devices andthe processes involved are crucial aspects in circumventing risk.Focus should also be given to the design of the dispensing andlabeling process during pharmacy hours and after hours.

In this session, we will share our experiences, discuss challengesand opportunities that we have faced and share tools that have





been created in hopes that these will facilitate discussion withinyour own institution.


1. To provide an understanding of the benefits and risks ofimplementing insulin pens in your institution.

2. To describe insulin pen implementation processes and factorsto consider.


1. What are the benefits and risks associated with implementinginsulin pens within my own institution?

2. What are the considerations in implementing insulin penswithin my own institution?

Novel Anticoagulants in Atrial Fibrillation: Practical Tips from the Trenches

Natalie Crown, BScPhm, ACPR, PharmD, Women’s CollegeHospital, Toronto, ON; Kori Leblanc, BScPhm, ACPR, PharmD,Toronto General Hospital, Toronto, ON

The purpose of this session is to discuss common issuesencountered by pharmacists surrounding the initiation,monitoring, and management of new oral anticoagulants inclinical practice. The focus will be on the management of novelanticoagulants for stroke prevention in atrial fibrillation.

In recent years, the availability of new oral anticoagulants haschanged the landscape of anticoagulation therapy. The use ofthese new agents is growing rapidly, in part due to severaladvantages over warfarin. However, distinctions amongst newagents exist, and clinicians struggle with optimal management ofthese drugs in some scenarios. This presentation will aim topresent common clinical situations and formulate practicalmanagement approaches based on current available evidence.Topics addressed will include: an approach to initiation &monitoring, choice of agent and in select patients populations,peri-procedural management for planned or urgent surgicalinterventions, and laboratory monitoring of the new agents.


1. Assess the appropriateness and tailor anticoagulation therapyto specific clinical situations.

2. Identify risk factors for bleeding complications withanticoagulants

3. Develop a peri-procedural anticoagulation plan

4. Describe an approach to monitoring ongoing therapy


1. What factors are important to consider when choosing ananticoagulant for stroke prevention in a patient with atrialfibrillation?





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2. Describe your approach to making a recommendationsurrounding the peri-procedural management of new oralanticoagulant?

3. What parameters will include in a follow-up plan for a patientreceiving long term therapy with a new oral anticoagulant?

Heart Failure with Preserved EjectionFraction: The Younger Misunderstood

Sibling of Heart Failure with Reduced EjectionFractionArden Barry, BSc, BScPhm, PharmD, ACPR, Mazankowski AlbertaHeart Institute, Edmonton, AB

This session will provide pharmacists with a general overview ofheart failure with preserved ejection fraction (HFpEF), which isalso known as diastolic heart failure. HFpEF is a commonlymisunderstood clinical presentation of heart failure, though theprevalence of HFpEF is increasing. This session will cover theterminology, definition and classification of HFpEF, and will alsobriefly review the pathophysiology and diagnosis. The limited





published evidence (including the recently completed TOPCATstudy) and corresponding guideline recommendations for thetreatment of HFpEF will be discussed, as the management ofHFpEF (specifically how it differs from heart failure with reducedejection fraction) is not well appreciated and understood by mostclinicians. As well, a brief summary of some of the emergingtherapies for the treatment of HFpEF will also be included. Finally,pharmacists will be provided with a practical case-basedapproach as to how to treat HFpEF in practice.


1. To summarize the current definition, classification anddiagnosis of HFpEF.

2. To summarize the primary literature and guidelinerecommendations for the treatment of HFpEF.

3. To outline a practical approach for the treatment of HFpEF.


1. What is HFpEF?

2. What are the prime0w do they differ from heart failure withreduced ejection fraction?

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SES 2014 Call for Abstracts 2014 Summer Educational Sessions (SES)Delta St. John’s Hotel and Conference CentreSt. John’s, Newfoundland and LabradorAugust 9 to 12, 2014

GENERAL INFORMATIONCategoryAuthor must specify the category that best suits the particularabstract. Abstracts will be judged according to the categorysubmitted to by authors.

1. Original Research (includes Pharmaceutical/basic Science,Clinical Research, Drug Use Evaluations, Systematic Reviewsand Meta-Analysis, Pharmacoeconomics Analysis, etc.)

2. Case Reports3. Pharmacy Practice (includes Administration Projects, Health

Professional Education, Medication Safety Initiatives, etc.)

CSHP 2015CSHP 2015 related abstracts will be designated as such. If yourabstract is linked to CSHP 2015 initiatives, please clearly indicatethis on the online abstract submission form.

Abstract SubmissionsAbstracts MUST be submitted electronically as a file in MS WordFormat. Please complete the abstract submission form online atCSHP’s Web site (http://www.cshp.ca) prior to submitting theabstract. If you are submitting more than one abstract, anabstract submission form must be completed for each abstract.

Abstract review and grading is conducted by 2 randomlyassigned, blinded, and independent reviewers. Abstracts areselected on the basis of scientific merit, originality, level ofinterest to pharmacists, and compliance with style rules using astandardized scoring system. Disagreement between the 2reviewers will be adjudicated by a third, blinded independentreviewer. The decision of the adjudicator will be the final decision.

Failure to comply with style requirements for submission (seebelow), including submission of an unblinded abstract or anyother style rules, will result in automatic rejection of thesubmission.

Encore Presentations: Abstracts of papers published or in-pressare not eligible. Abstracts previously presented at other National(other than another CSHP meeting) or International meetingsmay be considered for inclusion as encore presentations. Detailsincluding the citation of a published abstract and/or name,location and dates of the conference presented at must beincluded. These encore presentations will be marked as such.Encore abstracts must still follow all style and blinding rules andwill be assessed as per standard evaluation criteria.

Demande de résumés pour les SÉÉ 2014Séances éducatives d'été (SÉÉ) 2014Delta St. John’s Hotel & Conference CentreSt. John’s, Terre-Neuve et Labrador9 au 12 août 2014

INFORMATION GÉNÉRALECatégorieL’auteur doit indiquer la catégorie qui sied le mieux au résumé qu’ilsoumet. Les résumés seront évalués en tenant compte de la catégoriementionnée par les auteurs.

1. Recherche originale (y compris la recherche pharmaceutique,fondamentale ou clinique, les évaluations de l’utilisation desmédicaments, les examens systématiques et les méta-analyses, lesanalyses pharmacoéconomiques, etc.)

2. Études de cas3. Pratique pharmaceutique (y compris les projets administratifs, la

formation des professionnels de la santé, les projets liés à lasécurité des médicaments, etc.)

SCPH 2015Les résumés qui sont en lien avec le projet SCPH 2015 seront désignéscomme tels sur les lieux. Si votre résumé est lié au projet SCPH 2015,assurez-vous de le mentionner clairement sur le formulaire desoumission en ligne de résumés.

Soumission de résumésLes résumés DOIvENT être présentés électroniquement et le fichierdoit être en format MS Word. veuillez remplir le formulaire desoumission de résumés en ligne affiché sur le site Web de la SCPH àhttp://www.cshp.ca avant de soumettre votre résumé. Si vousprésentez plus d’un résumé, vous devez remplir un formulaire pourchaque résumé soumis.

Les résumés sont examinés et évalués par deux réviseursindépendants assignés au hasard et en aveugle. Les résumés sontchoisis en tenant compte de leur originalité, de leur intérêt pour lespharmaciens et du respect des règles de style, ceci à l'aide d'unsystème normalisé de notation. S’il y a divergence d’opinions entre lesdeux réviseurs, une troisième personne indépendante examinera lerésumé à l’aveugle et prendra une décision finale.

Le non-respect des exigences de présentation des résumés (voirci-dessous), y compris la soumission d’un résumé dont l’anonymat n’apas été préservé ou l’utilisation de toute autre règle de présentation,entraînera le rejet automatique de cette soumission.

Présentations en rappel : Les résumés d’articles publiés ou sur le pointde l’être ne sont pas admissibles. Les résumés ayant déjà étéprésentés au cours d’un autre congrès national (autre qu’un congrèsde la SCPH) ou international peuvent être évalués en tant queprésentations en rappel. Il est nécessaire de préciser le nom, le lieu etles dates de la conférence où la présentations a été faite ou laréférence du résumé publié. Ces présentations seront identifiéescomme des rappels. Les résumés de présentations en rappel doiventaussi respecter l’ensemble des règles de style et d’anonymat, et ilsseront évalués selon les mêmes critères que les autres résumés.

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Accepted abstracts will be published in the final program and inthe Canadian Journal of Hospital Pharmacy (CJHP). Abstracts willbe published as submitted. Only the abstract title, authors, andoriginal citation will be published in CJHP for encorepresentations, unless space permits.

Authors of accepted abstracts will be notified within 4 weeks ofthe deadline submission. Authors are responsible for their owntransportation and accommodations. Early registration fees willapply to all accepted poster applications. Guidelines for posterswill be provided to authors of accepted abstracts. Date andmethod of presentation will be determined by the EducationServices Committee. It is the responsibility of the presentingauthor to be at their designated poster boards during the posterviewing hours. If the presenting author cannot be there for theassigned date, it is the presenting author’s responsibility to findan alternate author as presenter.

Abstract Style RulesAbstracts that do not adhere to the rules will be rejected. Titleshould be brief and should clearly indicate the nature of thepresentation. Capitalize only the first letter of each word of thetitle. Do not use abbreviations in the title. List the authors (lastname, first initial) under the title. Institutional affiliation, city, andprovince should be listed under the list of authors withcorresponding footnotes identifying author affiliation(s). Pleaseunderline the name of the author who will present the poster ifaccepted. Omit degrees, titles, and appointments. The requiredfont is Times New Roman, 12 point.

Organize the body of the abstract, using the exact headingsbelow, according to the selected category as follows. Theabstract (including the title and body) should be blinded and notinclude any identifying information including the geographiclocation, authors, programs or institutions of origin. Authornames will be removed after submission for blinded review.

Original Research:Headings are: Background, Objective(s), Methods, Results,Conclusion(s)

The background section should briefly describe the rationale forthe study. The objective section should include the main studyobjective(s). The method section should include study design,methods, intervention, and statistical analysis. The results sectionshould provide main results. The conclusion section shouldinclude the main conclusion and interpretation of the resultswhich are supported by the data provided.

Case Reports:Headings are: Background, Case description, Assessmentof causality, Literature review, Importance to practitioners

The background section should briefly describe the rationale forthe case report. The case description should provide details ofthe case. Enough details should be provided to clearly outlinethe case and support the assessment of causality. The

Les résumés qui auront été acceptés seront publiés dans leprogramme final et le Journal canadien de la pharmacie hospitalière(JCPH). Ils y seront publiés tels quels. Pour ce qui est desprésentations en rappel, seuls les noms des auteurs, la référenced’origine et le titre du résumé seront publiés dans le JCPH à moinsqu’il y ait suffisamment d’espace pour les publier.

Les auteurs des résumés choisis seront avisés dans un délai dequatre semaines après la date butoir de soumission. Les auteursdoivent assumer leurs propres frais de transport et d’hébergement.Tous les auteurs des résumés acceptés auront droit aux fraisd’inscription anticipée. Des directives concernant l’affichage serontfournies aux auteurs dont les résumés auront été acceptés. Ilincombe au comité des services éducatifs de décider des dates etdes modalités de présentation. L’auteur qui présente le résumé sedoit d’être présent à son tableau d’affichage pendant les heures deprésentation des affiches. Si l’auteur ne peut être présent à la dateassignée, il a la responsabilité de désigner un remplaçant qui pourraen faire la présentation.

Règles de style pour les résumésLes résumés qui ne se conforment pas aux règles de présentationseront rejetés. Le titre devrait être bref et indiquer clairement lanature de la présentation. Seule la première lettre du premier motdu titre doit être en majuscule. Le titre ne doit pas contenird’abréviations. Le nom des auteurs (nom de famille et initiale) doitapparaître sous le titre. Les noms des établissements auxquels sontaffiliés les auteurs, la ville et la province où sont situés lesétablissements devraient être précisés sous la liste des auteurs avecdes appels de notes servant à indiquer les affiliations du ou desauteurs. veuillez souligner le nom de l’auteur qui présentera l’affichesi le résumé est accepté. Les diplômes, les titres et les affectationsne doivent pas être mentionnés. Il faut utiliser la police Times NewRoman 12.

Le texte du résumé doit être organisé conformément aux règlespropres à la catégorie à laquelle il appartient, en utilisant lesen-têtes exacts mentionnés ci-dessous. Le résumé (dont le titre et letexte) doit préserver l’anonymat et ne contenir aucune informationsusceptible de révéler l’emplacement géographique, les auteurs, lesprogrammes et les établissements d’origine. Les noms des auteursseront retirés après la soumission pour que l’examen soit effectué àl'insu.

Recherche originale : Les en-têtes sont : Contexte, Objectif(s), Méthodologie,Résultats, Conclusion(s)Le Contexte devrait décrire brièvement la raison d’être de l’étude.L’Objectif devrait inclure les principaux objectifs de l’étude. LaMéthodologie devrait inclure le plan de l’étude, la méthodologie, lesinterventions et l’analyse statistique. La rubrique Résultats devraitfournir les principaux résultats obtenus. La Conclusion devraitcomprendre la conclusion principale et l’interprétation des résultatsqui sont supportés par les données fournies.

Études de cas : Les en-têtes sont : Contexte, Description du cas, Analyse decausalité, Évaluation de la documentation, Importance pour lepraticienLe Contexte devrait décrire brièvement la raison d’être de l’étudede cas. La Description devrait fournir des détails sur le cas étudié.

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assessment of causality section should describe assessment ofcausality. Strong consideration should be given to using anobjective tool such as the Naranjo scale. The literature reviewsection should briefly examine current literature relating to orsurrounding the case report. The importance to practitionerssection should briefly describe implications/importance of thecase report to pharmacy practitioners.

Pharmacy Practice:Headings are: Background, Description, Action, Evaluation,Implications

The background section should briefly describe background andrationale for service, program, problem, need, etc. Thedescription section should describe the concept, service, role, orsituation. The action section should describe the steps taken toidentify and resolve a problem(s), implement change, or developand implement the new program. The evaluation should describethe evaluation process of the project and results of evaluation.The implications section should describe the concept’simportance and usefulness to current and/or future practice.

Abstract Text• Abstract body (not including title and authors) is limited to 300

words. This includes the required section headings as outlinedabove. Any abstract that exceed the word count will berejected.

• Each table is equivalent to 30 words.• Each graphic is equivalent to 60 words.• Results or evaluation must be included in the abstract. It is not

acceptable to state that results will be discussed. Abstractsdoing so will be rejected.

• Do not indent the start of a paragraph.• Place abbreviations in parentheses after the full word the first

time it appears. Please keep abbreviated terms to a minimum.• Use numerals to indicate numbers, except to begin sentences.• Use only generic names of drugs, material, devices, and

equipment.• Do not include citations or reference numbers.

Email Confirmation of Abstract SubmissionsSubmission Deadline:

CSHP 67th Summer Educational Sessions (SES) May 9, 2014

you should receive an email confirmation of your abstractsubmission. If you have not received an email confirmation by thedeadline, please contact:

Susan Maslin:Tel.: (613) 736-9733, ext. 229Fax: (613) 736-5660Email: [email protected]

Les détails devraient être suffisamment nombreux pour définirclairement le cas à l’étude et soutenir l’analyse de causalité.L’Analyse de causalité devrait donner une description de l’analyse decausalité. Il est fortement recommandé d’utiliser un outil objectifcomme l’échelle de Naranjo. L’Évaluation de la documentationdevrait examiner brièvement la documentation existante en lien ouapparentée à l'étude de cas. La rubrique Importance pour lepraticien devrait décrire brièvement les répercussions de l'étude decas sur la pratique de la pharmacie et son importance pour lespharmaciens.

Pratique pharmaceutique : Les en-têtes sont : Contexte, Description, Action, Évaluation,RépercussionsLe Contexte devrait décrire brièvement la toile de fond et la raisond’être du service, du programme, du problème, du besoin, etc. LaDescription devrait fournir des détails sur le concept, le service, lerôle ou la situation. La rubrique Action devrait décrire les étapesprises pour identifier et résoudre les problèmes, effectuer lechangement, ou développer et entreprendre le nouveau programme.L’Évaluation devrait décrire le processus utilisé pour l'évaluation duprojet et les résultats de l’évaluation. La rubrique Répercussionsdevrait énoncer l’importance du concept et l’utilité pour la pratiqueactuelle et future.

Texte du résumé• Le corps du résumé (excluant le titre et les auteurs) ne doit pas

dépasser 300 mots. Ceci comprend les en-têtes requis commementionné précédemment. Tout résumé qui dépasse le nombrede mots permis sera rejeté.

• Un tableau compte pour 30 mots.• Un graphique compte pour 60 mots.• Les résultats ou l’évaluation doivent être inclus dans le résumé. Il

est inacceptable de mentionner que les résultats seront discutés.Les résumés qui procèdent de cette manière seront rejetés.

• Le début des paragraphes ne doit pas être précédé d’un alinéa.• Placer les abréviations entre parenthèses après le terme qu’elles

remplaceront, la première fois que le terme est utilisé. veuillezlimiter au minimum l’utilisation d’abréviations.

• Les nombres doivent être écrits en chiffres, sauf lorsqu’il s’agit dupremier mot d’une phrase.

• Seuls les noms génériques des médicaments, du matériel, desinstruments et de l’équipement doivent être employés.

• Les résumés ne doivent pas contenir de citations ni de numéros deréférence.

Confirmation par courriel de la réception durésuméDate limite de soumission :67e Séances éducatives d’été (SÉÉ)9 mai 2014vous devriez recevoir une confirmation par courriel de la réceptionde votre résumé. Si vous n’avez pas reçu de confirmation parcourriel avant la date limite, veuillez communiquer avec madameSusan Maslin:Téléphone : (613) 736-9733, poste 229Télécopieur : (613) 736-5660Courriel : [email protected]

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Oral Abstract Session: IntriguingPapers from Original Research, AwardWinners and Research and EducationGrants

Séance d’exposés oraux :Communications fascinantes choisiesparmi les travaux de rechercheoriginale et les projets desrécipiendaires de prix, de bourses derecherche et de perfectionnementMonday, Febuary 3Lundi 3 février11:40 – 12:25Simcoe / Dufferin1. Risk Factors Associated with venous Thromboembolic Disease in

Orthopaedic Surgery Patients: A Retrospective Case Control Study forQuality Analysis

2. Implementation and Evaluation of an “Avoid Heparin” Program on theIncidence, Clinical Consequences and Resource Use Associated withHeparin-Induced Thrombocytopenia

3. Does Interprofessional Medication Reconciliation from Admission toDischarge Reduce Post-Discharge Patient Emergency Departmentvisits and Hospital Readmissions?

Results: vTE was significantly and independently predicted by the timeto initiation of vTE prophylaxis postoperatively (R= 0.240, p = 0.010).The R2 value for this model was 0.057, showing 5.7% of the variability indiagnosis of vTE was due to this variable. The R value shows a weak butsignificant correlation between time to the first dose of prophylaxis andthe diagnosis of vTE. Patients diagnosed with symptomatic vTEreceived the first dose of prophylaxis an average of 24.6 (SD 11.1) hourspost-operatively, and controls 18.6 (SD 10.4) hours post-operatively.Conclusion: The time to the first dose of prophylaxis is an importantand modifiable predictor for symptomatic vTE post orthopedic surgery.Time to first dose should be considered when developing systems toimprove patient care.

Implementation and Evaluation of an “Avoid Heparin”Program on the Incidence, Clinical Consequences andResource Use Associated with Heparin-InducedThrombocytopeniaClaudia Bucci1,2, Artemis Diamantouros1,2, Joy Makari1,2, Kelly McGowan1,William Geerts1,3

1 Sunnybrook Health Sciences Centre, Toronto, ON2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON3 Faculty of Medicine, University of Toronto, Toronto, ON

Rationale: Heparin-induced thrombocytopenia (HIT) is a transient,immune-mediated syndrome occurring in a sensitized individual withprevious heparin exposure. Unfractionated heparin (UFH) is one of themost common drugs used in hospitals but up to 5% of patients exposedto heparin develop HIT. HIT leads to thrombosis, amputations, death,and is associated with a massive disease and resource burden.Objectives: The “Avoid Heparin” program was implemented as ahospital-wide patient safety intervention to reduce the risk ofdeveloping HIT by replacing UFH with low molecular weight heparin(LMWH). The evaluation of the program aimed to examine the impact ofthis quality improvement strategy on the incidence of HIT and itsconsequences.Methods: A multi-disciplinary task force reviewed the literature for eachtype of heparin exposure and prepared recommendations for practicemodifications. In March 2006, the “Avoid Heparin” program wasimplemented replacing Iv and SC UFH with SC LMWH for all therapeuticand prophylactic indications and removing UFH from arterial and centralvenous lines.A retrospective chart review of all suspected HIT cases from 2003 to2011 was conducted to evaluate incidence of HIT and relatedthrombosis. All cases of suspected HIT were adjudicated using explicitcriteria for Negative (NEG), HIT and HIT with thrombosis (HITT).Outcomes in the Pre-Intervention Phase (2003-05) were compared tothose in the Avoid-Heparin Phase (2007-11). There were no changes tothe investigation of HIT over the study period.Results: The annual number of suspected HIT cases decreased 34%from the Pre-Intervention Phase to the Avoid-Heparin Phase (p<0.001).Adjudicated HIT decreased 73% from 11 to 3/10,000 admissions(p<0.001) and HITT decreased 80% from 5 to 1/10,000 admissions(p<0.001). Although the use of LMWH increased more than 6-fold from2003-2011, the annual rate of LMWH-associated HIT remained constantat 1/10,000 admissions per year, p=1.000. The total inpatient care daysassociated with HIT cases decreased 82% in the Avoid-Heparin phase.Patients with HIT in the Pre-Intervention and Avoid-Heparin Phases hadsimilar age, sex, admitting service, duration of heparin exposure, andlength of stay. We did not identify any other factors that could accountfor the observed reduction in HIT and HITT.Conclusion: A dramatic reduction in the incidence of HIT was observedafter the implementation of a hospital-wide “Avoid Heparin” program.To our knowledge, this is the first quality improvement studydemonstrating the success of a hospital-wide HIT prevention strategy.The findings strongly support our local “avoid-heparin” policy andshould be considered by every hospital. Implementation of a simple

Risk Factors Associated with Venous ThromboembolicDisease in Orthopaedic Surgery Patients: A RetrospectiveCase Control Study for Quality AnalysisManal Rostrom2, Danette Beechinor1,2, Blair Ernst1, Allan Mills1,3

1 Credit Valley Hospital and Trillium Health Centre, Mississauga, ON2 University of Waterloo School of Pharmacy, Kitchener, ON3 University of Toronto, Toronto, ON

Rationale: The rate of symptomatic venous thromboembolism (vTE) atour institution in the 2011 and 2012 calendar years was 1.75% followingtotal knee arthroplasty (TKA), 1.73% following total hip arthroplasty(THA), and 2.07% following hip fracture surgery (HFS), higher thanreported rates despite appropriate thromboprophylaxis, which are0.80% and 0.35%, respectively, in the first 14 days. This was anopportunity to systematically explore all modifiable and process relatedrisk factors for vTE to determine if there were any potential qualityrelated improvements. Objectives: To determine the impact of modifiable perioperativeclinical practices on the development of vTE and to demonstrate theimportance of systematic analysis of outcome data for qualityimprovement.Methods: This retrospective case control study included patients 18years of age or older, undergoing a TKA, THA, or HFS at our institutionin 2011 and 2012. For each case, 3 controls without vTE were matchedfor sex, age (± 5 years), surgery, and year of surgery. Data analysis wasconducted using stepwise multiple regression analysis.

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heparin avoidance intervention can lead to a dramatic decrease in theburden of HIT and in the costs of HIT care as well as to improved patientsafety and quality of care.

Does Interprofessional Medication Reconciliation fromAdmission to Discharge Reduce Post-Discharge PatientEmergency Department Visits and Hospital Readmissions?Michelle Baker1, Chaim M. Bell2,3,6, Wei Xiong1, Edward Etchells4,6, PeterRossos1,6, Kaveh Shojania4, Kelly Lane1, Tim Tripp1, Mary Lam1, KimindraTiwana5, Nita Dhir1, Derek Leong1, Gary Wong1,6, Jin Huh1,6, EmilyMusing1,6, and Olavo Fernandes1,6

1 University Health Network, Toronto, ON2 Mount Sinai Hospital, Toronto, ON3 St. Michael’s Hospital, Toronto, ON4 Sunnybrook Health Sciences Centre, Toronto, ON5 Institute for Safe Medication Practices Canada, Toronto, ON6 University of Toronto, Toronto, ON

Rationale: Medication reconciliation has been shown to reducepotential adverse drug events, but its specific impact on post-dischargehospital readmission is still not known.Objective: To evaluate the impact of integrated interprofessional(pharmacist-prescriber) medication reconciliation on patient emergencydepartment visits and hospital readmissions.Study Design and Methods: In this observational cohort study at atertiary-care hospital, patients discharged by General Internal Medicine

(GIM) were identified through administrative databases. The interventiongroup (patients receiving interprofessional admission to dischargereconciliation supported by an electronic platform) was compared to acontrol group. The outcome was defined as a composite of emergencydepartment or hospital readmissions within 30 days of the indexdischarge. A multivariate logistic regression model was used to adjustfor age, gender, number of medications, and LACE index.Results: From 2007-2011, a total of 9,931 unique GIM patient visits(n=8678 patients) met the criteria of the study. The main analysis did notdetect a difference in outcomes between the intervention group(540/2541) and control (1423/7390) for the primary endpoint. Theadjusted odd’s ratio was 1.058 (21.25% vs. 19.26%, 95% CI 0.945-1.19,p= 0.326). After propensity score adjustment, the relative risk ofreadmission was 0.88 (16.7% intervention vs.18.9% control, 95% CI0.59-1.32, p=0.535). Increasing number of medications, LACE indexscore, as well as male gender were independently correlated with ahigher risk of hospital visits. Also, subgroup analyses of high-risk groups:patients ≥65 years, LACE index ≥10, those on high-alert medications,and ≥10 medications did not detect a statistically significant outcomedifference between groups.Conclusion: A 5 year observational evaluation of interprofessionalmedication reconciliation did not detect a difference in 30 daypost-discharge patient hospital visits. Future prospective studies couldfocus on an enhanced reconciliation intervention bundle on avoidable

“medication-related” hospital admissions and post-discharge adversedrug events.

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Poster SessionsThere are two different types of poster presentations at PPC 2014. AFacilitated Poster session on Sunday and traditional Poster sessions onMonday and Tuesday.

Facilitated Poster SessionPosters in the facilitated poster session consist of a mixture of awardwinners and those abstracts submitted in the categories of originalresearch and pharmacy practice. They are grouped as 5 or 6 posterswith similar themes outlined below. The author of each poster will do a 6 minute presentation in front of their poster highlighting the key pointsof their work. This will be followed by questions and group discussion.The presentations within each group will occur in sequence as theparticipants move from one poster to the next. The session is scheduledfrom 09:30 to 11:30.

Traditional Poster SessionsPosters in the traditional sessions were selected from those submitted inthe categories of original research and pharmacy practice. Although noformal presentations will occur, the author of each poster will beavailable during the presentation timeslot for discussion and questions.Posters will be available for viewing throughout the day.

CSHP 2015CSHP 2015 is a quality program that sets out a vision of pharmacypractice excellence in the year 2015. Through this project, CSHPchallenges hospital pharmacists to reach measurable targets for 36objectives grouped under 6 goals, all aimed toward the effective,scientific, and safe use of medications and meaningful contributions topublic health. CSHP 2015 applies to inpatients and outpatients,community and hospital pharmacists, and all practice settings. Postersidentified with a “CSHP 2015” logo are those judged by the CSHP 2015Steering Committee to be particularly relevant to one or more of the 36objectives.

Séances d’affichageDeux types de présentation par affiches seront offerts dans le cadre dela CPP 2014. Une séance animée de présentations par affiches qui setiendra le dimanche et des séances traditionnelles d’affichage qui aurontlieu lundi et mardi.

Séance animée d’affichageLes affiches de la séance animée d’affichage sont formées d’un mélangede résumés primés et de résumés soumis dans les catégories rechercheoriginale et pratique de la pharmacie. Elles sont combinées en groupesde cinq ou six affiches ayant des thèmes similaires comme il est faitmention ci-dessous. L’auteur de chaque affiche fera une présentation desix minutes devant son affiche, faisant ressortir les principaux points deson travail. Cette présentation sera suivie d’une période de questions etd’une discussion de groupe. Les présentations à l’intérieur de chaquegroupe auront lieu les unes à la suite des autres au fur et à mesure queles participants se déplaceront d’une affiche à la suivante. Cette séancese déroulera de 9 h 30 à 11 h 30.

Séances traditionnelles d’affichageLes affiches pour les séances traditionnelles ont été choisies parmi cellessoumises dans les catégories recherche originale et pratique de lapharmacie. bien qu’aucune présentation officielle n’ait été prévue, lesauteurs de chaque affiche seront sur place pendant les heuresd’affichage et pourront répondre aux questions et s’entretenir avec vous.Les affiches pourront être examinées tout au long de la journée.

SCPH 2015Le projet SCPH 2015 est un programme axé sur la qualité qui proposeune vision de l’excellence en pratique pharmaceutique en l’an 2015. Aumoyen de ce projet, la SCPH met les pharmaciens d’établissements audéfi d’atteindre les cibles mesurables de 36 objectifs répartis entre 6buts, visant tous l’utilisation efficace, scientifique et sûre desmédicaments ainsi que des contributions significatives à la santépublique. Le projet SCPH 2015 s’applique aux patients hospitalisés etexternes, aux pharmaciens d’hôpitaux et communautaires, et à tous lesmilieux de pratique. Les affiches marquées du logo « SCPH 2015 » sontcelles que le comité directeur du projet SCPH 2015 a jugéparticulièrement appropriées à l’un ou l’autre des 36 objectifs.

Sunday, February 2, 2014Dimanche 2 février09:30-11:00 (presentations)Provincial BallroomFacilitated Poster Sessions: Discussion of Original Research, AwardWinning Projects and Pharmacy Practice ProjectsSéance animée de presentations par affiches: Discussions sur des projetsde rechereche originale, des projets, primes et des projets dans ledomaine de la pratique pharmaceutique

Education1. Do Learning Styles of Pharmacy Practice Residents Change When

They Enter Practice?2. Implementation and Assessment of a Continuous Pharmacy Student

Clinical Roles in a Hemodialysis Unit3. Institutional Pharmacists’ Perspectives on Precepting: A

Comprehensive Province-Wide Study4. Assessment of the Effect of behavioural Change Strategies on

Knowledge Translation and Interventions from Disease StateEducation Modules: DSEM-KT Study

5. Accuracy of Medication Histories Documented by PharmacyStudents versus Health Care Professionals

Clinical 11. Retrospective Analysis of the Implementation Success of an

Antimicrobal Stewardship Program in a Community HospitalWithout an Infectious Disease Physician

2. Risk Factors of Adverse Drug Reaction: Related HospitalizationsAmong Seniors, 2006 – 2011

3. Chemotherapy-Induced Nausea and vomiting in Children ReceivingHigh Dose Methotrexate With or Without vincristine: PreliminaryResults

4. Safe Swallowing of Oral Liquid Medications in Patients withDysphagia: A Patient Quality and Safety Initiative

5. Systematic Approach to Evaluate Hazardous Antineoplastic Drugsby a Provincial Healthcare Organizations

Clinical 21. Evaluation of a Secondary Stroke Prevention Checklist Implemented

on a Stroke-Medicine Unit in a Community Teaching Hospital2. Losartan-Induced Autoimmune Hepatoxicity: A Case Report3. venous Thromboembolism Prophylaxis in Long Term Care: A

Prevalence Chart Review4. Patterns and Predictors of Use of Oral Anticoagulants for Atrial

Fibrillation5. Aluminum Exposure from Calcium Gluconate 10% Injection in

Neonates Receiving Parenteral Nutrition

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Professional Practice1. Comparison of the Levels of Conformity between the Medication

Management Standards of Accreditations Canada and the Resultsof the Hospital Pharmacy in Canada Report

2. The Role of Clinical Informatics in Improving the Assessment ofvenous Thromboembolism Risk and Prophylaxis

3. How Do Local, Provincial and National Perspectives on Clinical KeyPerformance Indicator Critical Activity Areas Compare?

4. The Role of Online/Smartphone Applications in Type II DiabetesManagement: A Qualitative Study

5. Laboratory Test Ordering by Pharmacists in Canada: A NationwideStudy of Policies and Practices

Monday, February 3, 2014Lundi 3 février09:45-10:15 (viewing)13:15-13:50 (presentations) Sheraton/Osgoode Halls

1. National Canadian venous Thromoembolism (vTE) Prevent AuditDay: Design and Results

2. Improving Influenza vaccinations Uptake in the Progressive CareUnit of a Community Teaching Hospital

3. Appropriateness of Using Alternate Oral Anticoagulants in PoorlyControlled Warfarin Patients

4. Personalized Medicine: Teaching Strategies for a Novel ClinicalPharmacy Residency Rotation

5. Stroke Prediction in Atrial Fibrillation: Meta-Analysis of thePredictive Performance of the CHADS2 and CHA2DS2-vASc ClinicalPrediction Rules

6. Development of Guidelines for Safe Management of AntithromboticMedications Prior to Elective Surgical and Diagnostic Procedures ina Community Hospital Setting

7. Opportunities to Enhance Institutional Experiential Education inbritish Columbia: Learner Perspectives

8. Exploring Innovative Institutional Learner-Preceptor Models AcrossHealth Disciplines: A Systemic Review

9. Patient Medication Education at Discharge: A MultidisciplinaryTeam based Approach (TEACH)

10. How Do National Clinical Pharmacy Key Performance IndicatorsAlign With Top-Ranked Consensus Selection Criteria?

11. Handbook for a Pilot Study to Reduce Potential HospitalizationsDue to Preventable Drug-Drug Interactions

12. What are the Appropriate Clinical Pharmacy Key PerformanceIndicators for Hospital Pharmacists

13. Démarche pour la mise à niveau d’un secteur de soinspharmaceutiques le cas de la chiurgie pediatrique

14. Stability of Clobazam 1mg/mL in Extemporaneously CompoundedSuspensions Using Oral Mix vehicle in PET, PvC, Glass bottles andPlastic Oral Unit-Dose Syringes

15. Stability of Domperidone 5mg/mL in ExtemporaneouslyCompounded Suspensions Using Oral Mix vehicle in PET, PvC,Glass bottles, and Plastic Oral Unit-Dose Syringes

16. Iv to PO Stepdown Interventions in a Community Hospital Withoutan Infectious Disease Physician

17. Update of the Canadian Labels for Antipsychotic Drugs Following aReview of the Evidence on the Risk of venous ThromboembolismAssociated with the Use of These Medications

18. Pharmacists Joining a Multi-Disciplinary Specialty Private Practice19. Impact and Role of Pharmacists in Cystic Fibrosis20. Evaluation of Change in a Clinical Pharmacist Practice Model in a

Community Hospital

21. Médias sociaux, comportements en linge et pharmaciens: lingesdirectrices et réflexions

22. Experience with Dexmedetomidine in a Medical Intensive Care UnitAs a Community Teaching Hospital

23. Adherence to Hospital Sepsis Treatment Guidelines

Tuesday, February 4, 2014Mardi 4 février09:45-10:15 (viewing)13:15-13:50 (presentations) Sheraton/Osgoode Halls

1. Drug Shortages in Health Care Institutions: Perspectives in Early 20142. Adverse Drug Reaction-Related Hospitalizations Among Seniors,

2006 - 20113. Development of a Process to Ensure Timeline Home Medication

Access for Patients Awaiting Admission In the EmergencyDepartment

4. Reduction of Polypharmacy in a Rehabilitation and Progressive CareUnit

5. What Doses Should Our Chemotherapy Robot Prepare?6. The Effect of Residual Renal Function and Other Patient Factors on

Gram Positive Peritonitis Outcomes7. Can a Collective Community Mental Health Smoking Cessation

Program Reduce Cigarette Consumption?8. Comparison Among Atovastatin, Rosuvastatin and Pravastatin with

Focus on Efficacy and Safety Profiles9. The Path Forward: Solutions from a Province-Wide University Health

Authority Engagement Initiative10. Successful Medication Reconciliation Implementation in a Multi-Site

Acute Care Facility11. Facilitation of Medication Reconciliation by a Clinical Registered

Pharmacy Technician in an Orthopedic Unit of a CommunityHospital: A Pilot Project

12. Impact of a Multidisciplinary Program on Smoking CessationMedication Use Patterns

13. Impact des données probantes sur l’implantation des codes-barreen milieu hospitalier

14. Impact des données probantes sur l’implantation des pompesinteligentes en milieu hospitalier

15. Impact des données probantes sur l’implantation de lareconciliation medicamenteuse en milieu hospitalier

16. Prescribing Patterns and Safety of Intramuscular Olanzapine inHospitalized Elderly Patients

17. Optimizing Pharmacotherapy in a Geriatric Day Hospital: AMedication Use and Cost Analysis

18. Home Care Pharmacy Services: A Demonstration Project19. Impact des données probantes sur l’implantation des prescripteurs

électroniques en milieu hospitalier20. Impact des données probantes sur l’implementation d’aides à la

décision Clinique pour les prescripteurs électroniques en milieuhospitalier

21. Impact of an “Avoid-Heparin” Quality Improsvement Program onthe Incidence, Clinical Consequences and Resource Use Associatedwith Heparin-Induced Thrombocytopenia (HIT)

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SUNDAY, FEBRUARY 2DIMANCHE 2 FÉVRIER

Do Learning Styles of Pharmacy Practice Residents ChangeWhen They Enter Practice?Peter Loewen1,2; Janice Yeung1,2; Anca Jelescu-Bodos2; Torey Lau1

1 Faculty of Pharmaceutical Sciences, The University of British Columbia,Vancouver, BC

2 Lower Mainland Pharmacy Services, Vancouver, BC

Rationale: Learning styles (LS) of medical residents change over timefrom the more passive Assimilator toward more active preferences likeAccommodator or Converger. We have shown pharmacy residents to bepredominantly Assimilators at the start of their residency program.Whether learning styles of pharmacy residents change after they enterpractice has never been studied. Objective: To describe the evolution of learning styles of pharmacyresidents as they transition from residency into practice.Study Design & Methods: Prospective observational survey andsemi-structured interviews. A complete provincial cohort of formerpharmacy residents (n=28) who had their LS characterized during theirresidency and were now 1 year post-residency were invited to repeat thePharmacists’ Inventory of Learning Styles (PILS). Interviews wereadministered to consenting participants to gain additional insights.Results: 27 residents (96%) completed the PILS survey and 16 (59%)completed the interview. 13 (48%) changed their dominant LS and 20(74%) changed their secondary LS. Six (22%) participants did not changeeither LS. The overall proportion of dominant Assimilators (59%) andConvergers (26%) remained similar to baseline (52% and 26%,respectively), meaning participants had adopted and abandoneddifferent learning styles in similar numbers. Change in LS was associatedwith receiving preceptor training (p<0.05). Of the 12 preceptorsinterviewed, 58% stated that they had adjusted their teaching practicesbased on knowledge of their LS.Conclusions: Change in dominant and/or secondary learning style iscommon after 1 year in practice compared to during pharmacy practiceresidency. There is no overall direction to the shifts, however, withresidents transitioning in and out of more active learning styles withsimilar frequency. Overall after a year in practice, the cohort of formerresidents we studied remained mostly Assimilators, who prefer passivelearning approaches. These results contrast with medical students, whoadopt more active preferences like Accommodator.

Implementation and Assessment of a Continuous PharmacyStudent Clinical Role in a Hemodialysis UnitKaren Cameron1,2, Marisa Battistella1,2, Colette Raymond1,2

1 University Health Network, Toronto, ON2 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON

Rationale: In 2011, the hemodialysis (HD) pharmacist role at a 300patient tertiary care HD unit changed to clinician scientist, necessitatingrestructuring the way clinical pharmacy services were delivered. Thischange corresponded with availability of four month co-op studentsfrom University of Waterloo (UW) and summer students from Universityof Toronto (UT).Description: Many core clinical pharmacist activities are ideally suitedto be performed by pharmacy students in a supervisor-teacher model.Experiences in hospital settings/direct patient care areas are soughtafter as opportunities to practice core skills. A pharmacy student jobdescription was created.Implementation: Since January 2012, four UW and one UT pharmacystudent have carried out the role. One summer term the role was splitwith two volunteer UT students. One term (winter 2013) did not have astudent. Student activities include: medication reconciliation,

anticoagulation monitoring, antibiotic assessment and review, resolutionof drug coverage issues, responding to drug information questions andmonthly blood work review. Students also perform pharmacotherapywork ups (select patients) and assist with research projects and medicalwriting. The outgoing student trains the subsequent student andparticipates in near-peer teaching with students on experiential rotations. Evaluation: Four jobs were posted for UW co-op students and one forUT students. Twenty seven to forty five students applied for each oneposition, indicating high interest in this role. An anonymous evaluationsurvey was administered to all participating students (survey monkey) aswell as HD unit medical and nursing staff. Students highly valued theexperience. HD team members appreciate increased accessibility ofpharmacy staff.Importance: This model may be transferable to other HD units orsimilar practice sites with increasing patient numbers, changingpharmacist responsibilities or increased number of advanced pharmacypractice experiential learners.

Institutional Pharmacists’ Perspectives on Precepting: A Comprehensive Province-Wide StudyMichael Legal; Donna Rahmatian; Kyle Collins; Patricia Gerber; AngelaKim-Sing; Peter J. Zed; Peter S. Loewen, Faculty of PharmaceuticalSciences, The University of British Columbia, Vancouver, BC

Rationale: It is a challenge to provide sufficient quantities of highquality institutional experiential placements for learners. In recent years,this issue has become increasingly acute in pharmacy due to curricularand program changes in Canada. In british Columbia a comprehensivemulti-stakeholder engagement project was undertaken to identifysolutions. This report describes the pharmacist engagement portion ofthe project.Objectives: To characterize the perspectives of institutional pharmacists,identify potential solutions to capacity challenges and to find ways tobetter support preceptors and learners. Methods: Pharmacist perspectives were gathered using a mixedmethods approach. An online survey was deployed to all hospitalpharmacists in bC. In addition, focus groups and structured interviewswere conducted across the province. The survey utilized a combinationof likert, ranking, multiple-answer, and open field responses. Focusgroups and interviews were recorded and the resulting transcripts wereanalyzed using qualitative methods and iterative coding to identifymajor themes.Results: A total of 233 pharmacists responded to the survey and over200 participated in the focus groups and interviews. Pharmacistsindicated that teaching is an important professional role and theyappear to be intrinsically motivated to precept. Workload, lack of timeto teach, inadequate staffing, lack of faculty support and unpreparedlearners were major barriers. Participants identified a need to strengthenthe curriculum to increase learner exposure to institutional practice andto enhance their practice-readiness. Human resource support was themost desirable solution for workload issues. Multi-learner models wereviewed favourably as a capacity solution but increased teachingworkload and limited physical space were concerns. A more robustrelationship with the faculty was also desired.Conclusions: This project highlighted some key challenges faced bypreceptors and suggests some possible solutions. These solutions willrequire collaboration and commitment by all parties to ensure success.

Assessment of the Effect of Behavioral Change Strategieson Knowledge Translation and Interventions from DiseaseState Education Modules: DSEM-KT StudyRichard Slavik, Sarah Murray, Sean Gorman, Nicole Bruchet, Dawn Dalen,Brett Hamilton, Interior Health Authority, Kelowna, BC

Rationale: Pharmacists require continuous professional development(CPD) to resolve drug related problems (DRPs) for patients with priority

47

disease states. To promote pharmacist CPD, eight 4-week disease stateeducation modules (DSEMs) were delivered from January 2009 toDecember 2011. After each DSEM, lists of disease-specific keypharmacist interventions (DSEM KPI) - evidence-based interventionsproven to reduce mortality, morbidity, or health care utilization, weredeveloped to guide pharmacists’ interventions. A recent study showedthat DSEMs improved process of care measures by pharmacists, but notfor the subgroup of patients with heart failure (HF). Objective: To determine if the application of multifaceted professionalbehavioral change strategies improves knowledge translation of HFtherapeutics for clinical pharmacists and improves processes of caremeasures for HF patients. Methods: Prospective quasi-experimental, one group, pre/post studyevaluating proven multifaceted behavioral change strategies on clinicalpharmacists from July 1, 2012 to July 31, 2013. The primary outcomewas the change in proportion of pharmacist-resolved HF DRP/DSEMDRP. Secondary outcomes included the change in proportion ofpharmacist-resolved HF KPI/DSEM KPI, the change in quiz scoresevaluating clinical pharmacists’ knowledge of HF therapeutics, and theprimary outcome analyzed by site. Results: The proportion of pharmacist-resolved HF DRP/DSEM DRPincreased from 9.6% to 15.3%; (relative risk increase [RRI] 59.7%, 95%confidence interval [CI] 43.4-78.0%). The proportion ofpharmacist-resolved HF KPI/DSEM KPI increased from 4.4% to 9.7% (RRI119.1%, 95% CI 82.3-163.6%). Knowledge translation quiz scoresincreased from 16.8/20 (84%) to 18.9/20 (95%), p<0.05. Conclusions: There was a statistically significant increase in knowledgetranslation of HF therapeutics for clinical pharmacists and a statisticallysignificant increase in the proportion of resolved HF DRP/DSEM DRPand HF KPI/DSEM KPI for HF patients. bundled behavioral changestrategies should be provided after future DSEMs to improve knowledgetranslation for pharmacists and care of patients with priority diseases.

Accuracy of Medication Histories Documented byPharmacy Students versus Health Care ProfessionalsFacca N.M.1, Ahrari S.1,2, Stovel J.1,3, Seabrook J.A.3,4, Jansen S.1

1 London Health Sciences Centre, London, ON2 University of Waterloo, Waterloo, ON3 Western University, London, ON4 Children’s Health Research Institute, London, ON

Rationale: A multi-site teaching hospital has successfully implemented amixed model of medication reconciliation across all in-patient units.Accurate medication histories reduce medication errors and preventadverse drug events. Pharmacists have been shown to obtain moreaccurate medication histories than other health care professionals. Dueto lack of pharmacist resources, pharmacy students were trained tocomplete medication histories in the pre-admission clinic at this facilityto support medication reconciliation workflow.Objective: To compare the number and types of medicationdiscrepancies in the best possible medication history captured by apharmacy student compared to other health care professionals. Methods: This quasi-experimental retrospective study took place fromMarch to April 2013. Patients included in the study were admitted fororthopedic surgery and were required to have had the medicationhistory reviewed by at least one other health care professional. A trainedpharmacy student documented the medication history in thepre-admission clinic, whereas the first health care professionaldocumented medication histories upon patient presentation to theemergency department. An independent investigator reviewed charts todetect discrepancies between the initial and reviewed medicationhistories. Unintentional discrepancies were reviewed with a clinicalpharmacist. Results: There were 38 medication discrepancies found in the 50medication histories done by the pharmacy student (with 37/38classified as unintentional discrepancies) versus 151 found in the 50

medication histories done by the health care professional (with 133/151unintentional discrepancies). The difference in unintentionaldiscrepancies between the groups was statistically significant (p <0.001). Conclusion: Pharmacy students in the pre-admission clinic documentedmedication histories containing fewer discrepancies than staff in theemergency department and are, therefore, a viable hospital resource tohelp improve patient safety and continuity of patient care.

Retrospective Analysis of the Implementation Success ofan Antimicrobial Stewardship Program in a CommunityHospital Without an Infectious Disease PhysicianMark Taylor, Andrea Wist, Gayathri Radhakrishnan, Rebecca Strutchbury,Joel Varsava, Alicia Oesch; Bluewater Health, Sarnia, ON

Rationale: There is a paucity of data on the impact of theimplementation of an Antimicrobial Stewardship Program in communityhospitals without an Infectious Disease physician. This report of thebluewater Health (bWH) Stewardship Program, with emphasis on thepharmacist, serves as a sustainable template for community hospitals tosatisfy the Accreditation Standards.Description: bWH is a 326-bed community hospital without anInfectious Disease Physician. Our Stewardship program is designedbased on the Infectious Disease Society of America (IDSA) guidelines.We used the 2 IDSA proactive models: Prospective audit withintervention and Formulary Restriction.Implementation Steps: Our process included the following steps:1. Creation of a bWH antimicrobial guideline and antibiogram in 2011.2. Implementation of a “restricted” antimicrobial selection process

based on cost, adverse events, negative patient outcome risks. 3. Monitoring of antimicrobials’ Defined Daily Dosing (DDD) 4. Monitoring of Clostridium Difficile infection rates.Evaluation: The Stewardship program was evaluated using qualitativeand quantitative parameters. Quantitative parameter(s) include: Numberof antimicrobial orders which necessitated Clinical Interventions initiatedby pharmacists (Table 1), trends in Defined Daily Dose (DDD) of 2 broadspectrum antimicrobials, trends in Clostridium Difficile rates. Qualitative Parameter(s) Include: Pharmacists’ self perceived level ofcomfort and competency regarding antimicrobials. On a Likert Scale of 1to 4, pharmacists rated their competency and comfort as 1.42 (preimplementation) and 1.89 (post implementation) Table 1: Summary of Quantitative Parameters for ClinicalInterventions (see page 48)Relevance to Practice: by highlighting our strategies, we will beadding to the current paucity of literature that surrounds antimicrobialstewardships in community hospitals without Infectious DiseasePhysicians.

Risk Factors of Adverse Drug Reaction–RelatedHospitalizations Among Seniors, 2006 to 2011Michele Arthur and Michael Gaucher, Canadian Institute for HealthInformation, Ottawa, ON

Rationale: Adverse drug reactions (ADRs) are defined by the WorldHealth Organization as adverse effects of a drug that was properlyadministered in the correct dose, for therapeutic or prophylactic use.Seniors are at greater risk for ADRs, as well as other types ofdrug-related adverse events, due to the number of drugs they take,their higher prevalence of certain chronic conditions and age-relatedchanges in the body.Objectives: This analysis examined potential risk factors for ADRhospitalizations and compared seniors’ drug therapy pre-admission andpost-discharge to see if ADR-related hospitalizations led to changes indrug therapy.

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Study Design and Methods: This analysis used hospital dischargedata from the Discharge Abstract Database and drug claims data fromthe National Prescription Drug Utilization Information System Databaseto assess potential risk factors for ADR hospitalizations among seniorson public drug programs in Alberta, Manitoba and P.E.I.Results: The number of drugs was the most significant risk factor, withseniors taking 15 or more drugs being 6.4 times more likely than seniorstaking fewer than 5 drugs to have been hospitalized for an ADR. Otherfactors associated with hospitalizations for ADRs were age andhospitalizations in the previous year. The relationship between new drugstarts and ADR-related hospitalizations varied by drug class. Of seniorshospitalized for an opioid-related ADR, 33.2% started taking an opioidwithin 30 days of hospitalization, while only 28.2% of seniorshospitalized for an anticoagulant-related ADR started an anticoagulantwithin a year of hospitalization.Conclusion: Although it is often necessary for seniors to take multipledrugs to manage their chronic conditions, regular medication reviewscan help reduce the risk of adverse events including drug interactions. Ahigh proportion of the hospitalizations related to anticoagulant ADRsoccurred more than a year after starting therapy, which underscores theimportance of ongoing monitoring.

Chemotherapy-Induced Nausea and Vomiting in ChildrenReceiving High Dose Methotrexate With or WithoutVincristine: Preliminary Results Jacqueline Flank1,4; Sara Lavoratore1; Helen Vol1; Tracey Taylor1; ElyseZelunka1; Paul Nathan2; Anne Marie Maloney3; L. Lee Dupuis1,4

1 Department of Pharmacy, The Hospital for Sick Children, Toronto, ON2 Department of Paediatrics, Division of Haematology/Oncology, TheHospital for Sick Children, Toronto, ON

3 Department of Nursing, The Hospital for Sick Children, Toronto, ON4 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON

Rationale: Chemotherapy-induced nausea and vomiting (CINv)negatively influences the quality of life of children receivingchemotherapy. Little is known about the severity of CINv experiencedby children receiving Iv methotrexate ≥ 1g/m2/dose (HD-MTX).

Objective: To describe the prevalence of acute and delayed phaseCINv in children aged 4-18 years receiving HD-MTX ± vincristine. Study Design and Methods: Children about to receive HD-MTX wereeligible to participate in this prospective, observational study. Patientsreceived antiemetics as ordered by their primary care team. Nauseaseverity (assessed using the Pediatric Nausea Assessment Tool; PeNAT),time of emetic episodes, and administration of antiemetics wererecorded in a diary beginning immediately prior to HD-MTXadministration, for 24 hours after the patient achieved a MTXconcentration of < 0.1µM (acute phase), and for up to an additional 7days (delayed phase). Complete CINv control was defined as: novomiting, no retching and a maximum PeNAT score of 1 (out of 4).Results: Data are available for 23 patients (mean age: 12±3.9 years; 14boys). Fourteen patients received HD-MTX plus vincristine while 9received HD-MTX alone. The average MTX dose was 9g/m2 (range:3-12g/m2). Antiemetic prophylaxis consisted of either ondansetron (16)or granisetron (7) with (10) or without (13) dexamethasone. Six patientsalso received nabilone. Ten patients received breakthrough antiemetics(lorazepam ± dimenhydrinate). Mean duration of the acute and delayedphases were 81.7 and 144.8 hours, respectively.One (4%) and 7 (30%) patients experienced complete CINv controlduring the acute and delayed phases, respectively. More patientsexperienced complete vomiting control during the acute (52%) anddelayed (61%) phases than experienced complete nausea control (4 and30%, respectively). Conclusion: Acute and delayed phase CINv control, most especiallynausea control, following HD-MTX administration is sub-optimal.Subsequent analyses will evaluate the influence of guideline-consistentantiemetic prophylaxis on CINv control.

Safe Swallowing of Oral Liquid Medications in Patientswith Dysphagia: A Patient Quality and Safety InitiativeAarthi Iyer and Darien Heathcote, Trillium Health Partners, MississaugaHospital, Mississauga, ON

Table 1: Summary of Quantitative Parameters for Clinical Interventions

( ( ( # # # # # # # # # # # # # # ## # # # # # # # # ##

( ( ( ( ( ( ( ( ( ( ( (!

! ! ! ! ! ! ! ! ! ! ! !(

( # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # # # # # # # #

# # # # # # # # # # # #(

( # # # # # # # # # # # # ## # # # # # # # # # # # # # #

(( ( ( ( # # # # # # # # # # # ## # # # # # # # # # # # # # ## # # # # # # # # # # # # # # #

(( # # # # # # # # # # # # # # # # # # #

# # # # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # #

# # # # # # # # # # # # # # # ## # # # # # # # # # # # # # # # #

# # # # # # # # # # # # #(

( # # # # # # # # # # # # # # # ## # # # # # # # # # # # # # # #

# # # # # # # # # # # # # # # ## # # # # # #

Antibiotic Stewardship Clinical Interventions

24 SEP- 21 NOV 2012

22 NOV - 22 JAN 2013

23 JAN - 27 FEB 2013

28 FEB - MAR 18 2013

19 MAR - APR 30 2013

01 MAY - MAY 31 01 JUNE - JUNE 30 01 JULY - JULY 31

(58 DAYS) (61 DAYS) (35 DAYS) (13 DAYS) (42 DAYS) (31 DAYS) (30 DAYS) (31 DAYS)

Total number of anti infective orders reviewed

124 253 167 83 230 162 163 182

# of orders dispensed as ordered (includes no pharmacist intervention or physician unwilling to accept recommendations)

88 (71%) 157 (62%) 111(66%) 66 (80%) 154 (67%) 93 (57%) 90 (55%) 103 (57%)

# of orders that pharmacists intervened to make dose/frequency/duration/lab order changes (includes discontinuation of non-restricted antimicrobials)

16 (13%) 55 (22%) 39 (23%) 9 (11%) 55 (24%) 43 (27%) 44 (27%) 40 (22%)

# of orders that pharmacists intervened to change drug (broad spectrum to narrow spectrum abx change or change based on C&S or change based on indication)

9 (7.2%) 26 (10%) 10 (6%) 6 (7%) 9 (8%) 17 (11%) 13 (8%) 19 (10.4%)

# of orders where IV antibiotics changed from IV to PO (involving physician with/without pharmacist intervention)

5 (4%) 11 (4%) 6 (4%) 2 (2%) 1 (0.4%) 3 (2%) 9 (5.5%) 9 (4.9%)

# of orders where restricted IV antibiotic was discontinued after intervention from pharmacist

5 (4%) 3 (1%) 0 (0%) 0 (0%) 1 (0.4%) 5 (3.1%) 7 (4.3%) 11 (6.0%)

# of orders where restricted IV antibiotic was continued after intervention from pharmacist

1 (0.8%) 1 (0.004%) 1(0.6%) 0 (0%) 0 (0%) 1 (0.6%) 0 (0%) 0 (0%)

% of pharmacist time in doing Stewardship

22% ( 22% OF 322 HRS)

21% (21% OF 585 HRS)

33% (33% OF 193 HRS)

35% ( 35% OF 274 HRS)

35% (34% OF 715 HRS)

38% (38% OF 414 HRS)

43% (43% OF 351 HRS)

41% (41% OF 453 HRS)

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Rationale: Patients with oropharyngeal dysphagia are at aspiration risk,making the administration of oral medications challenging. Liquidmedications may be too thin and the use of xantham gum basedthickeners for liquid medications has not been evaluated.Objectives: This project sought to: • classify the viscosity of commonly prescribed liquid medications • standardize thickening of liquid medications • establish an institution specific collaborative process for thickening

liquid medicationsStudy Design & Methods: viscosity of commonly prescribed liquidmedications was visually determined. Next, serial quantities of water(thinnest consistency) were added to applesauce to determine thethreshold at which its puree consistency is altered. Finally, medicationsprescribed in volumes above 10 mls were tested with thickening agent.viscosity of the prepared product was determined using The LineSpread Test.Results: It was determined that up to 2.5 ml of thin liquid added to16 ml of applesauce does not alter the consistency of applesauce. Formedications prescribed in volumes greater than 10mls, for whichcrushable alternatives are not available, recipes with thickener wereestablished. The final consistency attained was pudding thickening (withthe exception of Lactulose).

Conclusion: Administering liquid medications to patients withoropharyngeal dysphagia is a significant challenge. We developed astandardized approach to the safe and effective administration of liquidmedications.

Systematic Approach to Evaluate Hazardous AntineoplasticDrugs by a Provincial Healthcare OrganizationNadine Badry, Joan Fabbro, Mário de Lemos, Provincial Pharmacy, BCCancer Agency, Vancouver, BC

Rationale: The US National Institute for Occupational Safety and Health(NIOSH) list of hazardous drugs and evaluation criteria provide afoundation to help identify hazardous formulary drugs. However, weneeded to develop further guiding principles to adopt the NIOSHguidelines.Objective: To identify hazardous oncology drugs used by the bCCancer Agency (bCCA).Study Design/Methods: Three guiding principles were developed. • Inherent toxicity vs. occupational exposure: NIOSH defines hazard

based on inherent drug toxicity. Safe handling policies are driven byworkers’ protection from this toxicity before considering theresource-dependent operations to minimize occupational exposure.We found no strong evidence to support differentiating hazard levels(high, low).

• NIOSH reviews: We assumed drugs marketed pre-2004 were reviewedsince NIOSH List 2004 was compiled from major US organizations.Drugs marketed post-2004 were ascertained with NIOSH lists (2010,2012) and proposed lists (2004-12).

• Drug evaluation: NIOSH decisions are based on its evaluation criteriaand external consultations. based on the NIOSH proposed changes(2006, 2011), fulfilling the criteria would not necessarily make a drughazardous.

Results: We identified hazardous drugs by assessing their inherenttoxicity and developed safe handling policies based on occupationalexposure related to dosage form. Our list consists of drugs in thecurrent NIOSH list and assessed by bCCA because NIOSH review wasnot confirmed. A drug is hazardous if designated by NIOSH. Otherdrugs are hazardous if they fulfill the NIOSH criteria or used primarily asantineoplastic but insufficient information to evaluate with NIOSHcriteria. Conclusion: bCCA has adopted an approach within the NIOSHframework and it follows the precautionary principle when there is risk ofharm affecting individuals not directly benefiting from these hazardousdrugs.

Evaluation of a Secondary Stroke Prevention ChecklistImplemented on a Stroke-Medicine Unit in a CommunityTeaching HospitalMonica Lee, Vickie Chang, Parisa Parnian, Rochelle Liem, Tiffany Kan,North York General Hospital, Toronto, ON

Rationale: The use of antithrombotic therapies and management ofcardiovascular risk factors are vital to preventing recurrent strokes.Hospital pharmacists can play an important role in ensuring patientsadmitted with a stroke or transient ischemic attack (TIA) be dischargedon evidence-based secondary prevention medications. Description and Steps Taken: based on current evidence and bestpractice recommendations, a secondary stroke prevention checklist wasdeveloped and implemented on the stroke-medicine unit. The checklistassists pharmacists in the systematic assessment of patients’ stroke riskfactors as well as their secondary prevention therapies. It also serves as acommunication tool for follow-up issues when patients are reassessed atthe stroke prevention clinic. A retrospective chart review was conductedto evaluate the adherence to checklist completion by pharmacists. Inaddition, the proportion of patients discharged on secondary preventiondrug therapies was examined.Evaluation: During a 2-month period, 37 patients with a mean age of73.4 years were discharged with a diagnosis of stroke or TIA. Thesecondary stroke prevention checklist was completed in 31 (84%)patients, with follow-up issues documented in 29 (94%) of them. Amongthe 35 (95%) patients who suffered from an ischemic event, 33 (94%)were discharged on antithrombotic therapies, 26 (74%) onantihypertensive drugs, and 29 (83%) on lipid-lowering agents. A higherproportion of these patients with a completed checklist were dischargedon secondary prevention therapies than those without a checklist(antithrombotics, 100% vs. 67%; antihypertensives, 79% vs. 50%;lipid-lowering drugs, 93% vs. 33%). Importance: The implementation of a checklist by pharmacists helpsensure consistent evaluation of stroke survivor’s risk factors andapplication of appropriate secondary prevention therapies. It may alsoimprove follow-up management of stroke patients across the continuumof care. Such a tool may be adopted by other hospital units to ensureoptimal care in stroke patients.

Losartan-Induced Autoimmune Hepatotoxicity: A Case ReportRochelle Liem, Monica Lee, Nitin Sarin, North York General Hospital,Toronto, ON

Rationale: Drug-induced autoimmune hepatitis (DIAIH) iswell-characterized and makes up a significant portion of autoimmunehepatitis. The angiotensin receptor blockers (ARbs), have been linked tohepatotoxicity. We describe a probable case of losartan-inducedautoimmune hepatotoxicity, which represents the first such casereported in the literature.

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Description: A 74-year-old female presented to hospital with a 6-weekhistory of malaise, low-grade fever, anorexia, weight loss and jaundice.Her past medical history consisted of hypertension,non-insulin-dependent diabetes mellitus, gastrointestinal reflux,osteoporosis, and depression. Medications at the time of admissionincluded metformin, lansoprazole, escitalopram, aspirin, vitamin D,calcium carbonate, and losartan 100mg daily. Losartan was started 4months prior to her initial symptoms. The patient denied alcohol or illicitdrug use. Laboratory results showed ALT 560 U/L, AST 827 U/L, ALP 135U/L, total bilirubin 359 umol/L, GGT 396 U/L, and INR 2.15. viralserologies were negative. IgG was grossly elevated at 30.91 g/L andANA was positive at 1.6. A liver biopsy was consistent with autoimmuneliver injury. Corticosteroids were started and the patient’s liver enzymesgradually decreased. Losartan was never resumed. Her follow-upinvestigations 21 months later revealed normal liver enzymes. She has acomplete resolution of clinical symptoms. Causality Assessment: Drug molecules can trigger an immuneresponse when they are bound to self-proteins. The patientdemonstrated clinical characteristics of autoimmune hepatitis, whichresolved after losartan was discontinued. The Naranjo score of 7indicates a probable adverse drug reaction.Literature Evaluation: Hepatotoxicity associated with ARb’s has beenreported in the literature. There has been one case report describingprobable autoimmune hepatitis with irbesartan. Importance: Practitioners should be aware of this potentially fataladverse drug reaction with losartan and other ARbs. In patients whopresent with autoimmune hepatotoxicity, a thorough medication reviewshould be performed to rule out this adverse drug reaction.

Venous Thromboembolism Prophylaxis in Long Term Care:A Prevalence Chart ReviewTiffany Kan1, Danette Beechinor2, Anjana Sengar3, Ramola Bhojwani3,Christina Lee2, Barbara Clive2, Allan Mills2,3

1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON 2 Trillium Health Partners Credit Valley Hospital, Mississauga, ON3 Trillium Health Partners Mississauga Hospital, Mississauga, ON

Rationale: Despite recommendations to provide venousthromboembolism (vTE) prophylaxis in acutely ill medical and surgicalpatients, there are currently no recommendations that suggest the useof thromboprophylaxis in long term care (LTC) patients. There is also alack of evidence demonstrating the safety and efficacy ofthromboprophylaxis in this population.Objectives: To assess current practices of thromboprophylaxis and todetermine if there is an excess of patients receiving thromboprophylaxisin the LTC setting.Study Design and Methods: A retrospective chart review wasconducted at a large community teaching hospital. Patients admitted tocomplex continuing care, alternate level of care, or LTC beds wereeligible for inclusion during a two-week evaluation period. The PaduaPrediction Score was used to assess risk factors for vTE, and to stratifypatients into high or low risk of vTE. The rate of pharmacologicthromboprophylaxis and the cost of providing thromboprophylaxis tolow risk patients were determined. Results: A total of 124 patients with a mean age of 76.3 years wereincluded in the study. Advanced age, acute infection, and reducedmobility were the most prevalent risk factors for vTE. Seventy-three(59%) patients were receiving thromboprophylaxis. Among thesepatients receiving thromboprophylaxis, 55 (75%) patients wereconsidered to be at low risk of vTE. The annual cost of providingthromboprophylaxis to low risk patients was approximately $165,600. Conclusion: These findings suggest that there may be an excess of LTCpatients receiving thromboprophylaxis despite being at low risk of vTE.This prompts the need for education and validated risk assessmentmodels to better identify LTC patients who may benefit from

thromboprophylaxis. This would help minimize exposure in low riskpatients and potentially provide cost-savings.

Patterns and Predictors of Use of Oral Anticoagulants forAtrial FibrillationCaroline Brais1,2; Marie-Hélène Turgeon1,2; Josiane Larochelle1,2; LucieBlais2,3; Marie-Pierre Garant4; Anne-Sophie Tousignant5; Diane Rochon5;Paul Farand5; Geneviève Letemplier5; Sylvie Perreault2; Marie-FranceBeauchesne1,2,4

1 Pharmacy Services, Centre hospitalier universitaire de Sherbrooke,Sherbrooke, Québec

2 Faculty of Pharmacy, Université de Montréal, Montréal, Québec3 Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal,Québec

4 Centre de recherche Clinique Étienne-Le Bel, Centre hospitalieruniversitaire de Sherbrooke, Sherbrooke, Québec

5 Department of Medicine, Centre hospitalier universitaire deSherbrooke, Université de Sherbrooke, Sherbrooke, Québec

Rationale: In the era of new oral anticoagulants (NOAC) for atrialfibrillation (AF), few studies have identified patterns of NOAC use overwarfarin.Objectives: To describe oral anticoagulants (OAC) use and to identifypatterns associated with the choice of NOAC over warfarin.Methods: A cohort of patients on OAC for AF was built from inpatientrecords of hospitalisations between October 2011 and March 2013. Anested case-control study was conducted to identify predictors ofNOAC use among new users of OAC.Results: In the 6-month period following dabigatran availability in thehospital, 447 patients met our inclusion criteria: 59 (13%) were on NOAC(dabigatran) and 388 (87%) on warfarin. About 71%, 25% and 3% ofpatients on NOAC were prevalent users, incident users, and patientswho switched OAC, respectively. The NOAC group had a lower meanCHADS2 score (2.34 versus 2.76, p = 0.018), a higher mean creatinineclearance (72 versus 53 mL/min, p < 0.001), a lower proportion ofcoronary artery disease (34% versus 55%, p = 0.002) and a lowerproportion of dementia (9% versus 20%, p = 0.039) than the warfaringroup. In the nested case-control study (n = 245 incident users), 40 (16%)patients on NOAC (dabigatran and rivaroxaban) were compared to 205(84%) patients on warfarin, using a multiple logistic regression analysis.Renal insufficiency independently decreased the probability of NOACuse versus no renal insufficiency (OR 0.363; 95% confidence interval0.133 – 0.990). NOAC use probability independently decreased whilstthe number of chronic medications increased (OR 0.844; 95%confidence interval 0.748 – 0.952). Prior stroke independently predictedNOAC use compared to no stroke history (OR 2.480; 95% confidenceinterval 1.108 – 5.549).Conclusion: The percentage of NOAC use is low. Patients with a normalrenal function, a stroke history and fewer chronic medications are morelikely to receive a new oral anticoagulant.

Aluminum Exposure from Calcium Gluconate 10% Injectionin Neonates Receiving Parenteral NutritionRenee Woo1, Amelia Rodrigues1, Vera Riss1, Marialena Mouzaki2, JoanBrennan-Donnan3, Glenda Courtney-Martin3, Elaine Lau1

1 Department of Pharmacy, The Hospital for Sick Children, Toronto, ON2 Department of Gastroenterology, Hepatology and Nutrition, TheHospital for Sick Children, Toronto, ON

3 Department of Clinical Dietetics, The Hospital for Sick Children,Toronto, ON

Rationale: Aluminum exposure from parenteral nutrition (PN)exceeding 4-5 mcg/kg/day can be associated with central nervoussystem toxicity, bone and liver damage, and anemia in preterm infantsand those receiving prolonged PN. In 2011, Health Canada issued analert regarding aluminum leaching from glass vials of calcium gluconate

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10% injection manufactured by Pharmaceutical Partners of Canada (PPC),the sole Canadian supplier. SickKids® uses this product to prepare PN. Description of Concept: To identify alternative calcium gluconate 10%injectable products that can be safety added to PN. To predict aluminumexposure in Neonatal Intensive Care Unit (NICU) patients receiving PNcontaining calcium gluconate from PPC and compare to predictedaluminum exposure from alternative products.Problem Resolution: Alternative calcium gluconate products wereinvestigated by the SickKids® Drug Information Service. The predictedamount of aluminum neonates received from PPC calcium gluconate inPN during July 2011 was calculated, and compared to predictedamounts from alternative sources. Actual aluminum content in SickKids®PN (with PPC product) was measured using inductively coupled plasmamass spectrometry.Evaluation: Calcium gluconate 10% injections by b. braun (10mL plasticampoule, Germany) and Phebra (10mL glass vial, Australia) wereidentified. The predicted average aluminum content neonates wouldreceive from calcium gluconate products in PN by PPC, b. braun, andPhebra was 62 mcg/kg/day, 1.25 mcg/kg/day, and 24 mcg/kg/day,respectively. The predicted aluminum content from PPC and Phebraproducts exceeded the recommended safe aluminum limit, unlike theb. braun product. Measured aluminum content in our PN samples (withPPC product) was 29.2 mcg/kg/day, six times the recommended safelimit. International pediatric advisory groups have recommended usingcalcium gluconate packaged in plastic to avoid aluminum leaching. Importance to Practice: SickKids® pharmacy has switched to usingcalcium gluconate manufactured by b. braun and is following PPC’sinvestigation for alternate packaging of calcium gluconate.

Comparison of the Level of Conformity Between theMedication Management Standards of AccreditationCanada and the Results of the Hospital Pharmacy inCanada ReportIsabelle Barthélémy1, Denis Lebel1, Cynthia Tanguay1, Régis Vaillancourt2,Chris Niro3, Jean-François Bussières1,4

1 Pharmacy Department and Pharmacy Practice Research Unit, CHUSainte-Justine, Montréal, QC

2 Pharmacy Department, Children’s Hospital of Eastern Ontario, Ottawa,ON

3 Accreditation Canada, Ottawa, ON4 Faculty of Pharmacy, Université de Montréal, Montréal, QC

Rationale: We proposed to Accreditation Canada to explore thediscrepancy about the conformity of the drug use process between theaccreditation process compliance rating and the Canadian pharmacysurvey. Objectives: The main objective was to compare the level of conformitybetween the Medication Management Standards (MMS) ofAccreditation Canada and the results of the Hospital Pharmacy inCanada (HPC) Report. The secondary objective was to discuss anyimportant discrepancies between both sources. Study Design and Methods: This is a retrospective cross-sectionalstudy. Whenever possible, each MMS criterion was paired by apharmacy resident with specific results from the 2009-2010 HPC report.Pairing was validated by a five-person panel. A discrepancy ratio wascalculated between the results of the 2009-2010 HPC and the 2010MMS by dividing both levels of conformity per criterion. Results: A total of 60% (81/135 criteria) of the MMS criteria have beenpaired with some 2009-2010 HPC results by the panel members. Theaverage calculated discrepancy ratio between MMS and HPC results is0.62±0.28 [min: 0.05 - max: 1.19]. The average discrepancy ratiobetween MMS and HPC results per domain was respectively thefollowing: 0.49 (safely administering medications), 0.58 (accuratelypreparing and dispensing medications), 0.61 (working together topromote medication safety), 0.62 (carefully selecting and procuring

medications), 0.64 (monitoring quality and achieving positive results),0.71 (appropriately ordering and transcribing medications) and 0.76(properly labelling and storing medications). We noted an importantdiscrepancy between the 2010 MMS on-site surveys and 2009/2010 HPCresults for a total of 62 criteria. Conclusion: A total of 60% of the MMS criteria have been paired withsome 2009-2010 HPC results. The average calculated discrepancy ratiobetween both sources is 0.62±0.28. Further studies are required toexplore the reasons for such discrepancy.

The Role of Clinical Informatics in Improving theAssessment of Venous Thromboembolism Risk andProphylaxisVaishali Sengar, Brenda Cardiff, Vera Dounaevskaia, Heather Kertland,Karen Ng, Rosemary Tanzini, Chris Hayes, St. Michael’s Hospital, Toronto,ON

Rationale: Due to the morbidity and mortality associated with hospitalacquired venous thromboembolism (vTE), Accreditation Canada hasmade the documentation of vTE risk assessment a requiredorganizational practice. We wanted to determine how a recentlyimplemented Computerized Provider Order Entry (CPOE) system couldsupport this requirement.Description of concept: A hospital specific vTE prophylaxis guidelinehad informed the development of a paper-based physician’s order setwhich included risk assessment documentation. This order set was usedto build the service specific admission order sets during CPOEimplementation. Following implementation of CPOE, data from thephysician ordering system was extracted to identify the percentage ofpatients with documented vTE prophylaxis assessment and/or treatmentwithin 24 hours of admission. Data was compiled quarterly on acorporate and admitting service basis and shared unblinded withphysician and care team leadership. Methods and Evaluation: Initial assessment/treatment rates wereestablished. Following the initial roll-out, optimizing strategies wereimplemented using Plan Do Study Act methodology to assess for impacton the overall and individual service rates. Changes implementedincluded; incorporating the vTE order set into the admission order setsthat had been missed on initial build, opening the vTE order set sectionwithin the admission order set to prompt for assessment, modifyingorder set content to address surgical services pre-operativeconsiderations and adding an electronic reminder when patients wereadmitted not using an admission order set. Each of these contributed toincreasing rates of vTE prophylaxis assessment/treatment.Conclusions: The use of clinical informatics order set standardizationand design principles and the sharing of service level data wassuccessful in improving the rates of vTE prophylaxisassessment/treatment.

How Do Local, Provincial and National Perspectives onClinical Pharmacy Key Performance Indicator CriticalActivity Areas Compare?Bannerman, H.1, Gorman, S.2, Toombs, K.3, Lo, J.1, Shukla, S.1, Doucette,D.4, Slavik, R.2, Semchuk, B.5, Chan, W.1, Benninger, N.1, MacKinnon, N.6,Bell, C.7, Slobodan, J.8, Lyder, C.9 , Pereira, T.8, Bjelajac-Mejia, A.10, Spina,S.11, Fernandes, O.1,12

1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON2 Interior Health Authority, Kelowna, BC3 Capital Health, Halifax, NS4 Horizon Health Network, Moncton, NB5 Regina Qu’Appelle Health Region, Regina, SK6 University of Cincinnati, Cincinnati, OH7 Mount Sinai Hospital, Toronto, ON8 Alberta Health Services, Red Deer, AB9 Canadian Society of Hospital Pharmacists, Edmonton, AB/Ottawa, ON10 The Hospital for Sick Children, Toronto, ON

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11 Vancouver Island Health Authority, Victoria, BC12 University Health Network, Toronto, ON

Rationale: A set of hospital clinical pharmacy key performanceindicators (cpKPI) was recently developed using a systematic, national,consensus-building process. The cpKPI were grouped into 8evidence-informed critical activity areas (i.e. pharmaceutical care,discharge medication reconciliation, patient medication education)representing hospital pharmacist best practices which demonstratedimprovements in meaningful patient outcomes. The relative importanceof the critical activities is not known. Description: Our objective was to determine local, provincial, andnational perspectives of pharmacists on the relative importance of cpKPIcritical activities and how these perspectives compare with each other.Participant pharmacist subgroups included the: national cpKPI workinggroup (n=11), national Delphi panel (n=25), provincial subgroup (Ontariobranch) (n=14), local clinical pharmacy leaders (n=10), and local front linepharmacists (Kelowna/ Toronto n=23). Each participant was asked toidentify the relative importance of 8 critical activities based on thequestion, “Will a cpKPI in this critical activity area advance clinicalpharmacy practice to improve the quality of patient care?” Eachparticipant was given 20 “dot” votes to assess (assign dots for relativeimportance) the critical activities. Evaluation: A total of 83 hospital pharmacists from all 10 provincesparticipated. Pooled results indicated that the three most importantcritical activity areas were; (1) Pharmaceutical Care - Integrated (24%); (2)Interprofessional Patient Care Rounds (15%); and (3) DischargeMedication Reconciliation (13%). between subgroups, the mostimportant critical activity was the same (Pharmaceutical Care), but therewas some variation on second and third rankings. The national Delphipanel ranked Interprofessional Patient Care Rounds and AdmissionMedication Reconciliation second and third most important respectively.Importance: Pharmacists’ perspectives at the local, provincial, andnational levels appear to align on the most important cpKPI criticalactivities. Pan-Canadian collaboration to standardly implement cpKPI inthese domains may serve to advance pharmacy practice to improvepatient outcomes.

The Role of Online/Smartphone Applications in Type IIDiabetes Management: A Qualitative StudyAlina R. Rashid, Certina Ho, School of Pharmacy, University of Waterloo,Waterloo, ON

Rationale: Diabetes is a chronic medical condition that affects the livesof over 9 million Canadians. Multiple interventions, includingsmartphone applications (or apps), have been developed for patients toself-manage this condition. Description of Concept: This study intends to identify a list ofsmartphone applications that can be recommended to patients forself-management of diabetes with respect to medication adherence,physical activity, diet, and weight management.Steps Taken: An environmental scan was performed to identify andevaluate the top 7 diabetes management apps for iPhone, iPad, iPodTouch, Android, and Windows Phones. These apps were assessed basedon features, usability, and their authority, accuracy, currency, objectivity,and quality. We interviewed 4 Certified Diabetes Educators (CDEs) andobtained their feedback and experience on the use of these apps indiabetes patient education.

Evaluation: The assessment of the 7 apps revealed some key featuresthat were available in some but not others – medication reminders;tracking of blood glucose readings, insulin dosing, physical activity,weight, blood pressure readings, and carbohydrate intake; electronicsynchronization with healthcare providers, and glucometer compatibility.We identified that simplicity of the app, ease of use, and cost were thekey factors in determining the best app for self-management of diabetes.ibG Star and Glucose buddy both fulfilled these criteria, and TactioHealth was a close second.Importance to Practice: Smartphones are now an integral part of thedaily life of many Canadians. As a result, there is an increase in appsavailable for self-management of diabetes. Patients play a critical role inchronic disease management. Pharmacists can expect to receivequestions about the role of smartphone apps in the management ofdiabetes. When recommending phone apps to diabetic patients, it isimportant to individualize app selection to ensure optimal benefits topatient care.

Laboratory Test Ordering by Pharmacists in Canada: A Nationwide Study of Policies and PracticesPeter Loewen, Julia Higgins, Faculty of Pharmaceutical Sciences, TheUniversity of British Columbia, Vancouver, BC

Rationale: Clinical laboratory tests provide information that is essentialfor pharmacotherapeutic decision-making. Having the authority to ordertests also streamlines care provision. There is limited data available onthe prevalence and nature of policies and regulation to supportlaboratory test ordering by pharmacists. Objective: To characterize pharmacist laboratory test ordering policiesacross Canadian health delivery units (HDU: health authorities, regions,hospitals).Study Design & Methods: Pan-Canadian cross-sectional policyanalysis including legislative, regulatory, professional association, HDU,and individual pharmacist key informant perspectives. Data sources wereweb searches and key informants (pharmacy directors and practiceleaders) in all Canadian HDUs. Key informants were approached bye-mail to request relevant policy documentation. Policies were stratifiedgeographically and categorized by scope, nature, and context using aniterative approach.Results: Six provinces have legislation permitting pharmacists to orderlab tests and in 2 of these the pharmacy regulator has implementedpolicies accordingly (QC, Ab). 108 key informants responded,representing 90% of identified HDUs. Of the 53 policies identified, 11authorize pharmacists to order a broad scope of laboratory tests, 18restrict pharmacists to a limited set of tests or restrict this authority tospecific settings. Policy development is underway in 9 of the 24 HDUswhere none currently exists. In 4 HDUs an existing policy is beingexpanded in scope. broadly permissive policies were found in provinceswhere legislation is permissive or pending with the exception of britishColumbia where 50% of HDUs have broadly permissive policies despitethe lack of supportive legislation. besides a lack of regulatory support,the major barriers identified by key informants were laboratoryaccreditation standards and sources of funding for laboratory tests. Conclusions: Laboratory test ordering by Canadian HDU pharmacists iscommon and moving toward ubiquity along with legislation andregulatory changes.

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MONDAY, FEBRUARY 3LUNDI 3 FÉVRIER

National Canadian Venous Thromboembolism (VTE)Prevention Audit Day: Design and ResultsArtemis Diamantouros, Sunnybrook HSC, Safer Healthcare Now andUniversity of Toronto, Toronto, ON; Anne MacLaurin, Canadian PatientSafety Institute, Edmonton, AB; Virginia Flintoft, Safer Healthcare Nowand University of Toronto, Toronto, ON; William Geerts, SunnybrookHSC, Safer Healthcare Now and University of Toronto, Toronto, ON

Rationale: venous Thromboembolism (vTE) is one of the most common,and costly complications of hospitalization. Most hospitalized patientsare at risk for vTE and studies prove vTE is preventable. Objectives: To establish a national estimate of vTE prophylaxis rates,raise awareness, and promote use of a new vTE data collection toolcreated for the audit. Methods: A National Call to Action and information call was held topromote participation. National and provincial agencies were involvedto endorse the audit and hospitals and health authorities were invited toregister. The audit was to be conducted on a sample of at least 20general medicine or surgery patients or both. A detailed workbookproviding instructions on how to participate and an optical markrecognition data collection form was made available to all participants.Data were submitted by fax or direct entry to the CPSI Patient SafetyMetrics System. Results: The Audit Day was a success in attracting interest andestablishing a Canadian vTE prophylaxis estimate. Data on 4667patients was reported by 118 hospitals, up from 14 in 2012. . Overall81% of patients received appropriate vTE prophylaxis. The use of ordersets contributed to higher vTE prophylaxis rates. Results showedvariability in vTE prophylaxis by patient group, province and provincialregions. Audit Day survey feedback indicated all respondents wouldparticipate in a 2014 Audit Day.Conclusions: Providing detailed instructions, an audit tool and auditsupport reduced reporting burden and improved participation. Limitingthe patient sample to medical/surgical patients made it difficult for smallsites to achieve the desired sample size. Participant education wasrequired to assist with determinations of ‘appropriate vTE prophylaxis’and reasons prophylaxis was not used. Improved planning andparticipation strategies will be required to expand the audit to evenmore centers in 2014.

Improving Influenza Vaccination Uptake In TheProgressive Care Unit of a Community TeachingHospital

Sonia Wang, Sumit Raybardhan, North York General Hospital, Toronto,ON

Rationale: The development of a coordinated influenza vaccinationprogram among a vulnerable institutional population is important toreduce the risk of influenza infection and complications.Description: The Rehabilitation and Progressive Care Unit (RPCU) atNorth york General Hospital is a short stay unit for patients awaitingplacement to alternate level of care facilities. The patients on this unithave an average age of eighty-five years with multiple comorbidities,representing a high risk group for influenza infection and complications.Recurrent influenza outbreaks have been noted particularly in this unit. Apharmacist-led initiative of systematically screening and educatingpatients was developed to facilitate a collaborative approach forinfluenza vaccination in this vulnerable population. Method: An evidence-based screening tool with expert input wascreated to determine eligibility for the influenza vaccine. An in-servicewas given to RPCU staff, educating them on the safety and effectivenessof the influenza vaccine and familiarizing them with the screening tool

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workflow. Collaboratively, patient’s consent was obtained. The clinicalpharmacist ensured all patients who consented, received the vaccineprior to discharge from the unit. A standardized letter indicating vaccineadministration date was included upon discharge. Evaluations: During a three and a half month period, ninety patientsout of the one hundred and twenty-five admitted to RPCU werescreened. Of the ninety patients, fifty-four were eligible for influenzavaccinations. A total of forty-four patients consented and received thevaccine. This initiative resulted in a more than five time increase inordered and administered influenza vaccine compared to the same priorperiod on the unit. Impact: The implementation of an interprofessional vaccinationprogram led to increased influenza vaccine uptake among a vulnerablepopulation. Implementing the pharmacist driven influenza screening toolin the whole hospital along with screening for other vaccines will be thenext goal for our institution.

Appropriateness of Using Alternate OralAnticoagulants in Poorly Controlled WarfarinPatients

Debbie Kwan, Patricia Marr, Kori Leblanc, Chandani Upadhyay, ManalRostom, Jessica Jakob, Victoria Siu, and Toni Basinski, University HealthNetwork and University of Toronto, ON

Rationale: Patient outcomes with warfarin therapy are best when INRtime in therapeutic range (TTR) is optimized. A TTR of ≥ 60% has beensuggested for achieving high quality anticoagulation. At the TorontoWestern Family Health Team, warfarin continues to be the mostcommonly used oral anticoagulant and is managed by the pharmacists.Description: We conducted a quality improvement evaluation to 1)Assess the quality of warfarin therapy management using TTR, 2)Compare the characteristics of patients who achieved an accepted TTRvs. those who did not, 3) Assess the appropriateness of switchingpatients with poor TTRs to a novel oral anticoagulant (NOAC).Steps Taken to Identify and Resolve Problem: A retrospective chartreview was conducted for patients on warfarin therapy for a 12 monthperiod. TTR was calculated using the Rosendaal method. Demographicand clinical characteristics were compared between patients with poor(i.e. TTR < 60%) vs. good (i.e.TTR ≥ 60%) control. Charts of poorlycontrolled patients were further reviewed to determine whether theycould have been safely switched to a NOAC. Specific criteria usedincluded: appropriate indication for anticoagulation, patientcomorbidities, renal function and potential for drug interactions.Evaluation: A total of 168 charts were reviewed; 30% (51) had anaverage TTR < 60%. There were no statistically significant differences indemographic and clinical characteristics between poor vs. acceptablecontrol groups. Of the poor control group, 65% (33) had an indicationthat allowed use of a NOAC. Five (9.8%) patients had an absolutecontraindication to using a NOAC. Relative contraindications andprecautions were not assessed since appropriateness of NOAC therapywould depend on subsequent interventions to manage these.Implications for Future Practice: TTRs should be routinely assessedproactively to identify poorly controlled warfarin patients. Those withsuboptimal TTRs should be considered for NOAC therapy unless acontraindication exists.

Personalized Medicine: Teaching Strategies for a NovelClinical Pharmacy Residency RotationFacca N.M.1, Jansen S.1, Kim R.B.1,2

1 London Health Sciences Centre, London ON2 Schulich School of Medicine and Dentistry, Western University, LondonON

Rationale: Pharmacists are well positioned within the health care teamto provide patient care based on pharmacogenomics, an emerging field

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of clinical relevance for individualized drug therapy. Current curricula ofthe pharmacy schools and residency programs across Canada lacksubstantial education in this field.Description: The ultimate goal of the rotation is to familiarize theresident with the new field of medicine known as personalized medicineor pharmacogenomics. Implementation: To better develop the skills of pharmacists to be ableto provide pharmacogenomics-based pharmaceutical care, a mandatorypharmacy residency rotation in personalized medicine was established.Learning objectives for the rotation were defined and specific, validatedteaching strategies were deployed by the preceptor.Evaluation: The residents were given a survey at the end of the rotationto assess the mandatory personalized medicine rotation and assess theteaching strategies used during the rotation (response rate of 80%).Answers to the survey questions used the following assessment scale:does not apply, strongly disagree, disagree, agree, and strongly agree.

See table below.

Relevance: Personalized medicine is a new and exciting field ofmedicine. To be able to use pharmacogenomics information to providepersonalized therapeutic recommendations to patients, pharmacistsneed adequate training and education. The introduction of a mandatorypharmacy residency rotation achieves this learning need for futurepharmacists. Teaching strategies that can be used by a pharmacistpreceptor for a pharmacy residency rotation in personalized medicinehave been described.

Stroke Prediction in Atrial Fibrillation: Meta-Analysis of thePredictive Performance of the CHADS2 andCHA2DS2-VASc Clinical Prediction RulesPeter Loewen, Christopher Yearwood, Faculty of PharmaceuticalSciences, The University of British Columbia, Vancouver, BC

Rationale: Guidelines recommend using the CHADS2 orCHA2DS2-vASc stroke clinical prediction rules (CPRs) in patients withatrial fibrillation (AF). Their clinical usefulness is dependent on theirpredictive performance, which can be measured using stratum-specific

likelihood ratios (SSLR). SSLR magnitudes indicate weak, moderate, orstrong predictive performance. No prior research has studied theCHADS2 or CHA2DS2-vASc CPRs from this perspective.Objectives: To measure the clinical usefulness of the CHADS2 andCHA2DS2-vASc CPRs for stroke prediction using SSLRs.Study Design & Methods: Meta-analysis using PRISMA guidelines.Prospective and retrospective studies reporting stroke rates inCHADS2/CHA2DS2-vASc strata were included. Data was pooled withand without adjustment to account for the effects of antithrombotictherapy use in cohorts where this was reported. SSLRs were computedusing Peirce & Cornell’s method and predictive strength of the SSLRswere classified using Jaeschke’s scheme.Results: 2249 citations were screened and 43 articles were included inthe analysis. Pooled adjusted CHADS2 data (n=30 studies, N=319,992patients) showed that a score of 0 weakly predicts low stroke risk (SSLR-0.225; 95% CI 0.219 to 0.232) while a score ≥ 3 weakly predictsincreased stroke risk (SSLR+ 3.70; 95% CI 3.66 to 3.75). Pooled adjustedCHA2DS2-vASc data (n=16 studies, N=256,672 patients) showed that ascore of 0 predicts decreased stroke risk with moderate strength (SSLR-0.104; 95% CI 0.096 to 0.112) while a score ≥5 weakly predicts increasedstroke risk (SSLR+ 2.80; 95% CI 2.76 to 2.84). CHADS2 andCHA2DS2-vASc scores ≥3 and ≥5, respectively do not have sufficientlydistinct SSLRs to warrant use of individual scores for clinicaldecision-making. Conclusions: A CHA2DS2-vASc score of 0 is a clinically useful negativepredictor of stroke. No other stratum or group of strata for CHADS2 orCHA2DS2-vASc, including extreme scores, demonstrated better thanweak stroke predictive performance in this comprehensive meta-analysis.

Development of Guidelines for Safe Managementof Antithrombotic Medications Prior to ElectiveSurgical and Diagnostic Procedures in a

Community Hospital SettingShelita Dattani, Queensway Carleton Hospital, Ottawa, ON

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Survey Question to Residents (80% response rate)

Survey Responses (%)

Does NotApply

StronglyDisagree Disagree Agree

StronglyAgree

The personalized medicine rotation increased my skills, knowledge and competency in theprovision of pharmacogenomics-based pharmaceutical care.

0 0 0 75 25

The assigned readings were useful at developing a baseline of knowledge required for thisrotation.

0 0 0 25 75

The online tools demonstrated were effective at allowing me to apply my knowledge ofpharmacogenomics.

0 0 0 75 25

The teaching strategy of case-based learning was effective. 0 0 0 50 50The teaching strategy of modeling (done by the preceptor) was effective. 0 0 0 50 50The teaching strategy of coaching (done by the preceptor) when I was actively engaged inpatient care was effective.

0 0 0 50 50

Overall, the teaching strategies used during the rotation were effective to accomplishlearning goals and objectives.

0 0 0 75 25

The time allotted for each learning objective/activity was sufficient. 0 0 0 75 25The total time allotted in the pharmacy residency program (i.e two weeks) is sufficient toachieve the learning goals and objectives of this rotation.

0 0 0 75 25

I agree that personalized medicine should be a mandatory rotation for pharmacy residents. 0 0 0 100 0What I learned in this rotation about pharmacogenomics is useful for my career as apharmacist.

0 0 0 50 50

5555

Rationale: Annually, 10% of patients taking antithrombotic agentsundergo procedures that require temporary discontinuation of therapy.The ultimate goal is to minimize thromboembolic events while balancingrisk of bleeding in the peri-procedural period. In recent years, we haveseen increased use of new oral anticoagulants and anti platelets at ourinstitution. Review of multiple patient cases has demonstratedinconsistencies in peri-procedural management of these agents.Description: Our multidisciplinary task group developed a guideline,initially focusing on an approach to interruption of therapy for allcommonly used antithrombotic agents. The primary goal was tofacilitate decision making and to support safe and consistent practice. Asecondary goal was to promote clear communication between allstakeholders regarding interruption of therapy prior to surgical ordiagnostic procedures. Steps Taken To Develop the Guideline: Due to the paucity ofpublished evidence in this area, feedback was solicited from severalexternal and internal stakeholders and a conservative, consensus basedapproach was used to develop recommendations.Evaluation: The guideline was presented to key stakeholder groupsincluding surgery, anesthesia, medicine, radiology, nursing and pharmacy.Stakeholder representatives then tested “real world” application of theguidelines to patients in our preoperative assessment clinic. based onthis initial evaluation, further suggestions were implemented. Theevaluation validated that development of guidelines facilitated safe andconsistent practice and education of patients prior to procedures. It alsohighlighted the importance of clear communication among all providers,the proceduralist and the patient.Relevance to Current and Future Practice: This initiative provides astarting point to enable our providers to safely and consistently manageinterruption of antithrombotic therapy prior to procedures.Another evaluation is ongoing, using a question-based audit tool toassess compliance with the guidelines in the preoperative settingfollowed by a patient interview on the day of surgery.

Opportunities to Enhance Institutional ExperientialEducation in British Columbia: Learner PerspectivesMichael Legal; Donna Rahmatian; Kyle Collins; Marguerite Billingsley;France Carriere; Patricia Gerber; Angela Kim-Sing; Peter J. Zed; Peter S.Loewen; Faculty of Pharmaceutical Sciences, The University of BritishColumbia, Vancouver, BC

Background: It is a challenge to provide sufficient quantities of highquality institutional experiential placements for learners. In recent years,this issue has become increasingly acute in pharmacy due to curricularand program changes in Canada. In british Columbia a comprehensivemulti-stakeholder engagement project was undertaken to identifysolutions. This report describes the learner engagement portion of theproject.Objectives: To characterize the perspectives of pharmacy learners inrelation to experiential education in the institutional environment.Research Methods: The perspectives of undergraduate students,pharmacy practice residents and post graduate doctor of pharmacystudents were gathered through focus groups and one on onestructured interviews. Focus groups and interviews were recorded andthe resulting transcripts were analyzed using qualitative methods anditerative coding to identify major themes.Results: A total of 50 learners participated. Learners felt that theundergraduate program emphasizes community practice and that thereis a lack of exposure to hospital practice. Undergraduate studentsreported being anxious prior to their hospital placements and spentmuch of their time on rotation learning to adapt to the practiceenvironment. They felt that an early hospital experiential placementtowards the end of second year would be beneficial. They alsosuggested updating course and practice lab content to include: hospitalterminology, abbreviations, interpretation of labs, systematic approachand chart note writing. Learners viewed precepting as added work for

pharmacists and expressed a desire for preceptors to be afforded moretime “just to teach”. Precepting models which incorporate peer, tieredor group learning were viewed positively. Learners expressed frustrationat a mismatch in expectations between preceptors, learners, and theExperiential Office.Conclusions: This project highlighted some key challenges faced bylearners and suggests some possible solutions. These solutions will needto be part of a comprehensive institutional experiential educationstrategy.

Exploring Innovative Institutional Learner-PreceptorModels Across Health Disciplines: A Systematic ReviewAllison Gamble; Kieran Shah; Stacey Tkachuk; Michael Legal; Peter S.Loewen; Peter J. Zed, Faculty of Pharmaceutical Sciences, The Universityof British Columbia, Vancouver, BC

Background: It is a challenge to provide sufficient quantities of highquality experiential placements for learners in hospital settings. In recentyears, this issue has become increasingly acute due to curricular andprogram changes in Canada. Most placements in institutional pharmacyemploy the traditional 1:1 (learner-to-preceptor model). Drawbacks ofthis model are an inability to adapt to increasing numbers of learners inthe system and lack of opportunities for peer-learning. Novel (>1:1)models may offer a solution.Objectives: To conduct a systematic review of the literatureencompassing multiple health disciplines’ experience with novellearner-preceptor models and to compare the advantages anddisadvantages of these models. This systematic review will be valuableboth to Canadian pharmacy programs, and to other health disciplinefaculties facing institutional experiential placement shortages. Methods: Eight health and education literature databases weresearched. Search terms related to the type of learner, health discipline(pharmacy, medicine, nursing, occupational therapy (OT), physiotherapy(PT), dietetics, dentistry, speech therapy or audiology),institutional/hospital experience, and preceptor model. Data fromincluded studies were synthesised descriptively, and theadvantages/disadvantages of different models of were summarized in anarrative format.Results: Seventy-three articles were included in the final review.Sixty-four articles related to nursing, OT or PT education, while 4 articlesrelated to pharmacy, 2 to dietetics, 2 to speech therapy while 1 wasinterprofessional. Eight learner-preceptor models were identified: 1:1,2:1, 3:1, greater than 3:1 (up to 10:1), 2+:2+ (collaborative learninggroups), 1:2 (shared precepting), 1:‘0’ (interprofessional precepting), andtiered (or ‘learner-as-preceptor’). Conclusion: Each model offers unique advantages and disadvantages.While no model was superior to the others, the 2:1 model may facilitatepeer learning and increase institutional placement capacity, withoutsubstantially increasing preceptor workload. To our knowledge this is thefirst review of its kind to include pharmacy models.

Patient Medication Education at Discharge: A Multidisciplinary Team Based Approach(TEACH)

Cheyanne Boehm1, Lynette Kosar1, Lisa Ruda1, Lori Zulyniak1

1 Regina Qu’Appelle Health Region, Regina, SK

Rationale: Healthcare models lack effective means of communicatingpatients’ drug therapies upon hospital discharge. Up to 45% ofdischarge medications are first prescribed in hospital, which increasesthe risk of patient adverse events if adequate medication education isnot received. Objectives: The purpose of the study was to propose a feasible andsustainable patient-centered medication discharge education processfor atrial fibrillation (AF) patients within the Cardiac Surveillance Unit(CSU) at the Regina General Hospital. The objectives were:

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1. To identify the current medication discharge education process. 2. To elicit the enablers for the provision of patient medication

discharge education. 3. To elicit the barriers for the provision of patient medication discharge

education. 4. To determine what medication discharge education is essential for

patients to receive to promote adherence and safety. 5. To provide suggestions for further consideration of a multidisciplinary

medication discharge education process.Study Design and Methods: A single multidisciplinary focus groupincluding pharmacists, nurses, and a social worker, was conducted. Results: Thematic coding was used to identify the current process,enablers, barriers, and essential information, and to propose thefollowing suggestions: (1) All CSU providers should be responsible forproviding patient education; (2) Use pharmacy technology to identifypatients for education; (3) Provide consistent written and verbalinformation to increase patient understanding; (4) Facilitate patientaccess to discharge medications; (5) Improve inpatient and outpatientprovider communication; (6) Expand use of the Cardiac TeachingDocument to all CSU members; (7) Create an AF pathway; (8) Developadditional education tools and house materials online. Conclusion: The ideas proposed build upon the current process andintegrate aspects of discharge medication education that have beensuccessful for CSU or other teams. Implementation of these suggestionsmay improve both patient understanding and adherence to AFmedications.

How Do National Clinical Pharmacy Key PerformanceIndicators Align With Top-Ranked Consensus SelectionCriteria?Lo, J.1, Gorman, S.2, Toombs, K.3, Bannerman, H.1, Shukla, S.1, Slavik, R.2,Semchuk, B.4, Doucette, D.5, Chan, W.1, Benninger, N.1, MacKinnon, N.6,Bell, C.7, Slobodan, J.8, Lyder, C.9, Pereira, T.8, Bjelajac-Mejia, A.10, Spina,S.11, Fernandes, O.1, 12

1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON2 Interior Health Authority, Kelowna, BC3 Capital Health, Halifax, NS4 Regina Qu’Appelle Health Region, Regina, SK5 Horizon Health Network, Moncton, NB6 University of Cincinnati, Cincinnati, OH7 Mount Sinai Hospital, Toronto, ON8 Alberta Health Services, Red Deer, AB9 Canadian Society of Hospital Pharmacists, Edmonton, AB/Ottawa, ON10 The Hospital for Sick Children, Toronto, ON11 Vancouver Island Health Authority, Victoria, BC12 University Health Network, Toronto, ON

Rationale: National consensus candidate clinical pharmacy keyperformance indicators (cpKPIs) and selection criteria (Slavik-11)representing pan-Canadian cpKPI ideal attributes have been established.A Slavik-11 scoring scale was designed to facilitate a balancedassessment of competing perspectives for individual cpKPIs. Description: Objectives: 1) To report national Delphi panelist priorityranking of consensus cpKPI selection criteria and the top-five cpKPIs foreach of the top-five selection criteria, 2) to determine how panelistratings of candidate cpKPIs based on individual top-ranked Slavik-11criteria align with the overall ratings and consensus cpKPIs. An electronicsurvey instrument using a 9-point Likert scale was used by the panel (n =26) to rate each candidate cpKPI on individual Slavik-11 criteria andassign an overall score. The pre-defined consensus threshold wasreached when ≥75% of panelists assigned the candidate cpKPI anoverall rating of ≥7. Panelists also ranked the importance of eachSlavik-11 criterion in advancing clinical pharmacy practice to improve thequality of patient care. The five candidate cpKPIs with the highest meanratings for each Slavik-11 criterion were compared to the consensuscpKPIs. Overall scores were compared to Slavik-11 composite means.

Evaluation: The top-five Slavik-11 criteria were: 1) high quality evidence,2) clinically important outcomes, 3) best suited to pharmacist role, 4)attributable to direct patient care, and 5) specific to a pharmaceuticalcare process. The top-five candidate cpKPIs for these categories variedfrom the consensus cpKPIs. However, average overall ratings ofcandidate cpKPIs correlated well with the composite mean Slavik-11ratings for each of the candidate cpKPI (R = 0.973, P < 0.0001).Importance: The Slavik-11 consensus criteria appear to align well withthe final-eight consensus cpKPI. Utilization of the Slavik-11 scoring scalein selecting national cpKPIs provides a systematic approach to ensurethat the entire spectrum of predefined ideal attributes is considered.

Handbook for a Pilot Study to Reduce PotentialHospitalizations Due to Preventable Drug-DrugInteractions

Atsushi Kawano, Certina Ho, Institute for Safe Medication PracticesCanada (ISMP Canada), Toronto, ON

Rationale: Hospital reports on medication incidents suggest 37-51% ofreported adverse drug events, including drug-drug interactions (DDIs),may have been prevented with appropriate interventions. The Instituteof Clinical Evaluative Sciences conducted population-based studiesexamining the association between specific DDIs and hospitalizations.Description of Concept: This study intends to compile a list ofevidence-based DDIs with association to an increased risk ofhospitalizations and develop a treatment algorithm handbook tofacilitate pharmacists or clinicians in ambulatory care in identifying andoffering recommendations to prescribers to prevent these DDIs.Steps Taken: A comprehensive literature search was conducted andarticles were selected based on relevant DDIs that were associated withan increased risk of hospitalization. Evidence-based treatmentalgorithms were created to suggest alternative therapeutic options forthree common community infections – Group A �-hemolyticStreptococcus pharyngitis, outpatient community-acquired pneumonia,and uncomplicated lower urinary tract infections.Evaluation: Evidence-based DDIs identified in this study involved eithera macrolide or trimethoprim-sulfamethoxazole. In all cases, the evidencesupported an alternative to either antibiotic for selected communityinfections. Older persons were underrepresented in trials evaluatingantibiotic therapy for community infections. Selecting an appropriateantibiotic required using data derived primarily from children and adults.A treatment algorithm handbook was created for clinicians inambulatory care.Importance to Practice: The list of evidence-based DDIs withassociation to an increased risk of hospitalizations identified in this studywas made available to all pharmacists via the Ontario College ofPharmacists quarterly publication, Pharmacy Connection, in Spring 2013.Pharmacists/clinicians have the option of using the treatment algorithmhandbook developed in this project to help resolve and prevent theseDDIs.

What are the Appropriate Clinical Pharmacy Key Performance Indicators for HospitalPharmacists?

Olavo Fernandes1, Sean K. Gorman2, Richard S. Slavik2, William M.Semchuk3, Douglas Doucette4, Heather Bannerman5, Jennifer Lo5,Simone Shukla5, Winnie Chan5, Natalie Benninger5, Neil J. MacKinnon6,Chaim M. Bell7, Jeremy Slobodan8, Catherine Lyder9, Peter J. Zed10, KentToombs11

1 University Health Network, Toronto, ON2 Interior Health Authority, Kelowna, BC3 Regina Qu'Appelle Health Region, Regina, SK4 Horizon Health Network, Moncton, NB5 University of Toronto, Toronto, ON6 University of Arizona, Tucson, AZ7 Mount Sinai Hospital, Toronto, ON

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8 Alberta Health Services, Red Deer, AB9 Canadian Society of Hospital Pharmacists, Edmonton, AB/Ottawa, ON10 University of British Columbia, Vancouver, BC11 Capital District Health Authority, Halifax, NS

Rationale: Key performance indicators are quantifiable measures ofquality. Clinical pharmacy key performance indicators (cpKPI) aim toadvance clinical pharmacy practice and improve patient care. There arecurrently no published, systematically-derived cpKPI. Objectives: To systematically develop a core set of national cpKPI.Study Design and Methods: A cpKPI working group systematicallyand sequentially established a cpKPI consensus definition, 8evidence-derived cpKPI critical activity areas, 26 candidate cpKPI, and11 cpKPI ideal attributes in addition to 1 overall consensus criterion.Over a 3-month period, 26 clinical pharmacists and hospital pharmacyleaders participated in a 3-round modified Delphi survey. Using anInternet-based, pre-tested survey instrument, panelists independentlyrated the 26 candidate cpKPI using the 11 cpKPI ideal attributes and 1overall consensus criterion on a 9-point Likert scale. A meeting wasfacilitated between rounds 2 and 3 to debate the merits of eachcandidate cpKPI and clarify wording. Consensus was reached if 75% ormore of the panelists assigned a score of 7-9 on the consensus criterionduring the third Delphi round. Results: All panelists completed the 3 Delphi rounds and 25/26 (96%)attended the meeting. Eight candidate cpKPI of activities performed bypharmacists met the consensus definition after the third Delphi round: 1)performing admission medication reconciliation (including best possiblemedication history); 2) participating in inter-professional patient carerounds; 3) completing pharmaceutical care plans; 4) resolving drugtherapy problems; 5) providing in-person disease and medicationeducation to patients 6) providing discharge patient medicationeducation; 7) performing discharge medication reconciliation; and 8)providing bundled, proactive direct patient care activities. Conclusions: A Delphi panel of hospital pharmacists was successful indetermining 8 consensus cpKPI. Measurement and assessment of thesecpKPI, which are believed to be generalizable to other health systems,will serve to advance clinical pharmacy practice and improve patient care.

Démarche pour la mise à niveau d’un secteur desoins pharmaceutiques : le cas de la chirurgiepédiatrique

Aurélie Guérin1, Maxime Thibault1, Christina Nguyen1, Denis Lebel1,Jean-François Bussières1,2

1 Département de pharmacie et Unité de recherche en pratiquepharmaceutique, Centre Hospitalier Universitaire Sainte-Justine,Montréal, QC

2 Faculté de pharmacie, Université de Montréal, Montréal, QC

Justification : Depuis deux décennies, les pharmaciens hospitaliersexercent majoritairement de façon décentralisée dans les programmesde soins. On reconnait les difficultés inhérentes à la hiérarchisation deces programmes et des activités pharmaceutiques lorsque les ressourcesdisponibles sont insuffisantes.Objectif : Mettre à jour le niveau de pratique utilisé en soinspharmaceutiques en chirurgie pédiatrique.Méthodologie et démarche : Il s’agit d’une étude descriptive avecrevue documentaire menée dans un centre hospitalier universitairemère-enfant canadien. La démarche de mise à niveau proposéecomporte trois étapes soit une revue de la documentation, unedescription du profil du secteur et une description de la mise à jour duniveau de pratique. Résultats : Des 137 articles recensés, 15 ont été retenus. Nous nerecensons aucune activité pharmaceutique spécifique reposant sur desdonnées de très bonne qualité (A). Nous recensons cinq activitéspharmaceutiques reposant sur des données de bonne qualité (b) et septcomportant un niveau de preuve insuffisant (C, D). Toutefois, plusieurs

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auteurs ont décrit l’évolution du rôle clinique du pharmacien enchirurgie. Une revue de l’activité pharmaceutique en 2012-2013, apermis de recenser 2,89 interventions/heure de soins décentralisé (40%modification de la thérapie, 26% continuité des soins, 13%conseils/histoires) pour un total de 17867 admissions. La mise à jourenvisagée du secteur de pratique inclut l’implantation de bilancomparatif médicamenteux avec profil web sur l’intranet pourl’ambulatoire, la consultation systématique via tablette numérique àl’étage de tous les dossiers pharmacologiques informatisés, la révisiondes protocoles et des pratiques afin de standardiser lapharmacothérapie, la production de plans de soins pharmaceutiquespour transmission au pharmacien communautaire pour lespharmacothérapies complexes, etc. Conclusion : Il existe peu de données sur la hiérarchisation desprogrammes de soins et des activités pharmaceutiques. Cette étudedécrit une démarche de mise à jour en chirurgie pédiatrique.

Stability of Clobazam 1mg/mL in ExtemporaneouslyCompounded Oral Suspensions Using Oral Mix Vehicle inPET, PVC, Glass Bottles and Plastic Unit-Dose SyringesBlake E. Ziegler, Andrea Walsh, Scott E. Walker, Shirley Law, KarenLingertat-Walsh, Pacita Sales, Departments of Pharmacy at SunnybrookHealth Sciences Centre and The Hospital For Sick Children, Toronto, ON

Background and Rationale: An oral liquid formulation of clobazam isnot commercially available in Canada and has not been previouslystudied. An extemporaneous oral liquid formulation is required foradministration to patients who cannot swallow intact tablets.Objective: To evaluate the stability of clobazam 1mg/mL prepared inOral Mix vehicle and stored in 3 types of containers (amber glass, amberpolyethylene terephthalate [PET] and amber polyvinylchloride [PvC])over 91 days at 4ºC and 23º and polypropylene oral plastic syringes at23ºC only.Methods: A reverse-phase stability-indicating liquid chromatographicmethod was validated before the study. Three separate batches ofclobazam suspension 1mg/mL were prepared with Oral Mix. Fifty mLaliquots of the suspension were stored in 100mL bottles (amber glass,amber PET, or amber PvC). Half of the bottles from each container typewere stored at 23ºC and the other half at 4ºC. On study days0,2,7,14,21,28,42,56,72 and 91, clobazam concentration wasdetermined in samples drawn from bottles stored at each temperaturein each type of container. Oral syringes, filled with 2mL suspension, werestored at 23ºC and tested on days 0,2,7,21,42 and 91. Results: The concentration of clobazam 1mg/mL in Oral Mix in all studysamples from bottles and oral syringes remained within 4% of the initialconcentration. based on the fastest degradation rate with 95%confidence, on day 91 suspensions stored in bottles at 23ºC and 4ºChad between 91-94 % and 95-96% remaining respectively. Oral syringesat 23ºC had 89% remaining on day 91.Conclusions: Using the fastest degradation rate, clobazam 1mg/mL oralsuspension in Oral Mix in all bottle types retained more than 95% of theinitial clobazam concentration at 4C, more than 91% at 23C and only89% when stored in oral syringes on day 91.

Stability of Domperidone 5mg/mL in ExtemporaneouslyCompounded Suspensions Using Oral Mix Vehicle in PET,PVC, Glass Bottles and Plastic Oral Unit-Dose SyringesKaren Lingertat-Walsh, Shirley Law, Scott Walker, and Pacita Sales,Departments of Pharmacy at Sunnybrook Health Sciences Centre andThe Hospital For Sick Children, Toronto, ON

Background and Rationale: Domperidone 1mg/mL and 10 mg/mL inORA-blend was studied previously in PvC bottles only. Oral Mix is a newvehicle manufactured in Canada, similar in composition to ORA-blend.Stability of domperidone 5mg/mL using Oral Mix was determined using

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different bottle types and plastic oral syringes which has not beenpreviously done. Objective: To evaluate the stability of domperidone 5mg/mLsuspension prepared in Oral Mix and stored in 3 types of containers(amber glass, amber polyethylene terephthalate [PET] and amberpolyvinylchloride [PvC]) over 91 days at 4ºC and 23ºC andpolypropylene oral syringes at 23ºC only.Methods: A validated reverse-phase stability-indicating liquidchromatographic method was used. Three separate batches ofdomperidone 5mg/mL suspension were prepared in Oral Mix.Seventy-five mL aliquots of the suspension were stored either in amberPvC and amber glass (250mL bottles), amber PET (100mL bottles) or1.5mL in polypropylene oral syringes . Half the bottles of each containertype were stored at 23ºC and the other half at 4ºC. On study days0,1,2,4,7,10,14,21,28,35,42,49,63,77,91 domperidone concentration wasdetermined in samples from bottles stored at each temperature in eachcontainer type and from polypropylene oral syringes.Results: The concentration of domperidone 5mg/mL in Oral Mix in allstudy samples from bottles and oral syringes remained within 6% and7% of the initial concentration. based on the fastest degradation ratewith 95% confidence, on day 91 suspensions stored in bottles at 23Cand 4C had between 88-92% and 92-93% remaining respectively. Oralsyringes at 23C had only 87% remaining.Conclusion: Using the fastest degradation rate, domperidone 5mg/mLoral suspension in Oral Mix in all bottle types retained more than 92% ofthe initial domperidone concentration at 4ºC, more than 88% at 23ºCand only 87% when stored in polypropylene syringes on day 91.

IV to PO Stepdown Interventions in a Community Hospital Without an InfectiousDisease Physician

Andrea Wist, Gayathri Radhakrishnan, Kayleigh Curts, Bluewater Health,Sarnia, ON

Rationale: This project demonstrates the successes(Pharmacoeconomics and Time) of implementing Iv to PO antibioticstepdown involving a multidisciplinary approach, as part of astewardship program in line with Accreditation Standards.Description: bluewater Health (bWH) is a 326 bed community hospitalwithout an Infectious Disease Physician. bWH had an automatic Iv to POstepdown policy only for 5 antibiotics since 2007. In this project, all Ivantibiotics on formulary were included for review.Implementation: All patients initiated on Iv antibiotics in MedTelemetry unit (MEDT) were reviewed on Day 3 of antibiotic therapy.Patients were excluded if they transferred in or out of MEDT during theirIv antibiotic therapy. The project period covered 4 weeks in May-June2012. The pharmacist reviewed the patient’s clinical status to determineeligibility for stepdown. If patient met eligibility, the pharmacist notifiedthe clinician of an appropriate PO alternative. Follow up was done thenext day to determine if the suggestion was accepted, partiallyaccepted or rejected. Iv to PO stepdown data was also captured whenthere was no pharmacist involvement. The amount of time spent inreviewing patients and follow up was also collected.Upon completion, the cost of total PO antibiotic therapy was subtractedfrom the cost of the anticipated full duration of Iv therapy (if POconversion was not completed) to calculate cost savings. Evaluation: 18 patients (who had a total of 20 antibiotic orders) wereincluded.

See Table 1.

Relevance to Practice: This project adds to current literature on Iv toPO antibiotic conversions, creating a template on how it can beaccomplished without an Infectious Disease Physician.

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Update of the Canadian Labels for Antipsychotic DrugsFollowing a Review of the Evidence on the Risk of VenousThromboembolism Associated With the Use of TheseMedicationsDavid Duguay, Co Pham, Marc Berthiaume, Marketed Pharmaceuticalsand Medical Devices Bureau, Marketed Health Products Directorate,Health Canada, Ottawa, ON

Rationale: venous thromboembolism (vTE) has been reported withantipsychotics use in numerous published case reports and in severalstudies since the introduction of phenothiazines in Canada in the 1950’s. Objectives: The purpose of the review conducted by Health Canadawas to evaluate the association between the risk of vTE and theutilization of antipsychotics as a class, and to recommend strategies tomitigate risk as needed.Study Design and Methods: Health Canada conducted a review ofcases of vTE with antipsychotic drugs reported in the Canadavigilancedatabase between January 1st, 1965 and May 31, 2011, and a review ofpublished studies and case reports related to vTE and antipsychotics.Results: As of May 31, 2011, the Canadavigilance database contained atotal of 140 unique reports of vTE associated with antipsychotic drugs(most cases were reported with clozapine [69%]* and some witholanzapine, risperidone, quetiapine, haloperidol, flupenthixol, andloxapine). A literature search from 1948 to September 9, 2011 identifiedover 80 published case reports of vTE suggestive of an association withantipsychotic drugs, in addition to 14 pharmacoepidemiology studies onthis specific issue. The review demonstrated a consistent trend in studiessuggesting an increased risk of vTE with exposure to antipsychoticdrugs.Conclusion: The evaluation of the risk of vTE gathered fromepidemiological studies, published case reports, and reports of adversedrug reactions in pharmacovigilance databases has resulted in arecommendation to update the Canadian Product Monographs of allantipsychotic drugs. *Clozapine is available in Canada only through a restrictive distributionsystem. This drug is under an increased level of scrutiny compared toother antipsychotics.

Table 1: Summary of IV to PO Outcomes

# of orders ineligible for Iv � PO (15%) 3# of orders discontinued (20%) 4# of orders discontinued with pharmacist and physicianinvolvement

(3)

# of orders discontinued with physician involvement only (1)# of orders eligible for Iv � PO (50%) 10# of orders changed to PO with pharmacist and physicianinvolvement

(6)

# of orders changed to PO with physician involvement only (3)# of orders continued as Iv (1)# of orders lost to follow up (15 %) 3Antibiotics reviewed: Ceftriaxone, Ceftazidime ,Moxifloxacin, Cefazolin, Azithromycin, Ciprofloxacin,Metronidazole.

–

Average amount of time required to review patients whowere eligible for Iv to PO:

50minutes

Cost savings by switching to PO $2128.96

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Pharmacists Joining a Multi-Disciplinary SpecialtyPrivate PracticeKerry Wilbur, College of Pharmacy, Qatar University, Doha,

Qatar; Jason Kur, Artus Health Centre & University of British Columbia,Vancouver, BC

Rationale: Pharmacists have assumed medication management roles inboth inpatient hospital and outpatient primary health care settings;however, proliferation of pharmacists in private practices is not yetpervasive. (CSHP 2015 Objective 2.1). Established multidisciplinaryteams may not recognize the potential contributions of pharmacistsjoining these settings, which may contribute to barriers to integrationand patient care. Objective: Explore the attitudes and perceptions amongmultidisciplinary members of a private rheumatology clinic towards theskills and responsibilities of a pharmacist joining their practice.Methods: The physicians, nurse, physiotherapist and officeadministrators of a private rheumatology clinic were invited toparticipate in focus group and semi-structured interviews to discuss theirunderstanding of pharmacist skills and knowledge and how they wouldforesee a pharmacist assuming patient care responsibilities in theircurrent setting. Sessions were audio recorded and transcribed verbatim.Thematic content analysis of the data was supported with nvivo10software.Results: Discussions with two physicians, the nurse, the physiotherapistand one office administrator were conducted. Concepts related to twokey themes emerged from the seeding questions and included positivelyviewed pharmacist roles broadly related to activities that encompassprovision of drug information and management of medications. Lessenthusiasm was found for pharmacist documentation of their patientassessments and care plans in the shared medical record. Disparateviews arose regarding anticipated volume of pharmacist responsibilitiesand independent follow up with patients. Most members were notcomfortable with pharmacists conducting physical assessments andimpressed the need for a team member who could adapt to variations inworkflow preferences across rheumatologists in the practice.Conclusions: Overall, existing multidisciplinary staff exhibitedfavourable attitudes towards a pharmacist joining their practice setting,but expressed conflicting concerns regarding sufficient workload tosupport a full-time position.

Impact and Role of Pharmacists in Cystic Fibrosis Aurélie Guérin, Denis Lebel1, Jean-François Bussières1,2

1 Pharmacy Department and Pharmacy Practice Research Unit, CHUSainte-Justine, Montréal, QC

2 Faculty of pharmacy, Université de Montréal, Montréal, QC

Rationale: Cystic fibrosis is an autosomal recessive genetic disorder thataffects the lungs, the pancreas, the liver and the intestine. Thepharmacotherapy contributes to a better quality of life, reducedhospitalizations and prolonged survival. Objective: The aim of this study was to review the literature on theimpact and the role of pharmacists in cystic fibrosis.Study Design and Methods: A Web portal about the evidences of theimpact and the role of pharmacists in specific diseases, programs of careor pharmaceutical activities was developed. A literature search onPubmed® was conducted: pharmacist OR clinical pharmacy ORpharmaceutical care AND cystic fibrosis. Articles about the role and theimpact of pharmacists in cystic fibrosis in French and English from1990-2013 were included. For each article included in the analysis, keyindicators that document the impact of pharmacist with statisticalanalysis and the role of pharmacists with only quantitative or qualitativemetrics were identified. All relevant pharmaceutical activities in thatcontext were also identified.

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Results: A total of 217 articles were initially identified. Only fourrelevant articles were included in our analysis Nine key indicators of theimpact were identified: drug level costs, dosing adjustment costs,costs/admission, total costs, length of stay, quality of life, levels/patient,days to goal of therapy and courses with pharmacokinetics goals. Eightof the nine indicators showed a positive impact of the pharmacist incystic fibrosis. Twenty-four key indicators about the role of pharmacistswere identified. Amongst the pharmaceutical activities, pharmacistswere providing medication reconciliation, patient counseling, drugtherapy evaluation, pharmacokinetics consultation, drug information andmedical rounds.Conclusion: There are limited data published about the role ofpharmacists in cystic fibrosis. While it seems relevant to support suchclinical implication, pharmacists involved in that program of care shouldbetter document and evaluate their impact.

Evaluation of a Change in Clinical Pharmacist Practice Model in a CommunityHospital

Monica Lee, Jenny Chiu, Saadia Fazil, Edith Rolko, North York GeneralHospital, Toronto, ON

Rationale: North york General is a 420-bed community hospital staffedwith 23 full-time equivalent (FTE) clinical pharmacists. Historically, clinicalpharmacists rotated through different areas and were not assigned tospecific units. It was determined that a change from this rotation-basedmodel to a designated unit-based model would enable pharmacists todevelop clinical expertise and improve service to patients and staff.Description and Steps Taken: Clinical pharmacists were asked toprovide the units they preferred to service. The pharmacy leadershipgroup then discussed and finalized assignments. The designatedunit-based model was implemented in early 2012. A one-yearpost-implementation survey was developed to evaluate pharmacists’view of how this change has affected job satisfaction, workload andcontribution to patient care. Clinical pharmacists who worked 30 hoursper week or more, and have practised in both models for at least oneyear were invited to participate. Evaluation: An on-line survey consisting of nine questions was sent to15 pharmacists, of which 14 (93%) responded. Eleven (79%) pharmacistsindicated that their job satisfaction has improved with the new model.All respondents agreed that they would better cultivate clinical expertisewith the designated unit-based model. However, most considered therotation-based model to be associated with the development of abroader scope of skills and knowledge. Interestingly, 9 (64%)respondents felt less comfortable covering units that were not theirdesignated units. With respect to workload, 6 (43%) felt that workloadhas increased with the new model, while 7 (50%) perceived no change.Thirteen (93%) pharmacists believed the quality of care provided withthe designated unit-based model to be superior to the rotation-basedmodel.Importance: Overall, clinical pharmacists considered the change inpractice model to be positive. Further studies should be conducted toexamine how patients and staff perceive this

Médias sociaux, comportements en ligne et pharmaciens :lignes directrices et réflexionsAurélie Guérin, Denis Lebel, Jean-François Bussières, CHUSainte-Justine, Département de pharmacie et unité de recherche enpratique pharmaceutique, Montréal, QC

Justification : Avec l’émergence de nombreux outils decommunications, la place des médias sociaux comportent denombreuses opportunités et défis pour les pharmaciens et sescollaborateurs.

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Objectifs : Recenser et comparer les lignes directrices et normespouvant contribuer à l’encadrement des comportements en ligneprofessionnels.Méthodologie et démarche de l’étude : Étude descriptive. À partird’une revue documentaire, nous avons identifié les principales lignesdirectrices de société savantes médicales et pharmaceutiques publiéessur les médias sociaux. Nous avons ensuite comparé le contenu et laportée des lignes directrices proposées. Résultats : Nous avons recensé 11 lignes directrices de 11 sociétéssavantes dont quatre canadiennes, trois américaines, deux britanniqueset une australienne. Dix sociétés savantes sont médicales et unepharmaceutique. Treize paramètres ont été extraits des lignes directrices.Quatre paramètres font davantage consensus à savoir la protection desrenseignements personnels des patients, le respect de la frontièreprofessionnel-patient, l’évitement de la communication desrenseignements personnels sur soi et la saisie des enjeux descommunications en ligne. Il existe peu de balises en pharmacie et lespharmaciens doivent être sensibilisés aux opportunités et enjeux reliésaux comportements en ligne.

Conclusion : Avec l’émergence de nombreux outils de communicationset le développement des médias sociaux, 11 sociétés savantes ontpublié des lignes directrices pour encadrer le comportement en lignedes professionnels dans le domaine de la santé. Voir tableau ci-dessous.

Experience with Dexmedetomidine in a MedicalIntensive Care Unit at a Community TeachingHospital

Bonnie Thieu, North York General Hospital, Toronto, ON

Rationale: Sedative agents are commonly used in mechanicallyventilated patients to control agitation. These include opioid analgesics,benzodiazepines, and propofol, all of which can cause delirium andrespiratory depression. Dexmedetomidine is an alpha-2 adrenergicagonist that does not cause respiratory depression and may beassociated with a lower risk of delirium. As a result of its favourableprofile, our institution has recently added dexmedetomidine to the drug

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Paramètres bMA A/NZ GMC ACP AMA ASHP AMC ACPM CMPNb CPSbC CMQ

1. Assurer la protection des renseignementspersonnels des patients

X X X X X X X X X X X

2. Exercer une prudence quant au partagede données relatives aux cas cliniques, auxanecdotes et expériences pratiques

X X X X X

3. Échanger des renseignements etdocumenter ces échanges aprèsconsentement éclairé des patients etsoignants

X X

4. Comprendre et utiliser adéquatement lesparamètres de gestion de la protectiondes renseignements

X X X X X

5. Respecter la frontièreprofessionnel-patient

X X X X X X X X X

6. Éviter de communiquer desrenseignements personnels sur soi

X X X X X X X

7. Être conscient de son image en ligne etde son influence sur la profession

X X X X

8. Surveiller sa présence sur le web X X X

9. Identifier clairement son identité etdéclarer ses conflits d’intérêts

X X X X X

10. Obtenir les consentements appropriés etmentionner l’origine des renseignementsdivulgués

X X

11. Fournir des conseils conformes auxmeilleures données disponibles et auxdonnées probantes

X X X

12. Comprendre les technologies utilisées etles publics rejoints

X X

13. Saisir les enjeux des communications enligne et l’ensemble du cadre juridiqueapplicable

X X X X X X

Légende: bMA : british Medical Association, A/NZ-MACDT: Australian Medical Association Council of Doctors- in-Training, New Zealand MedicalAssociation Doctors-in-Training Council, New Zealand Medical Students’ Association, Australian Medical Students’ Association, Australian MedicalAssociation, GMC: General medical council, ACP-FSMb: American College of Physicians and the Federation of State Medical board, AMA: AmericanMedical Association, ASHP: American Society of Health-System Pharmacist, AMC: Association médicale canadienne, ACPM : Association canadiennede protection médicale, CPSbC: College of Physicians and Surgeons of british Columbia, CMPNb : Collège des médecins et pharmaciens du Nouveaubrunswick et CMQ: Collège des médecins du Québec.

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formulary. However, due to the high cost of this drug, strict guidelineshave been established for its use, which outline specific indications,contraindications, and maximum duration of therapy.Objective: To evaluate adherence to hospital guidelines for the use ofdexmedetomidine by clinicians.Methods: We conducted a retrospective chart review of all patientsinitiated on dexmedetomidine in the medical intensive care unit (ICU)from January 1, 2012 to December 31, 2012. The primary endpoint wasoverall concordance with hospital guidelines, including the indicationsfor which dexmedetomidine was prescribed; the presence of anycontraindications; and the total duration of therapy. Descriptive statisticswas used to analyze the data. Results: Over the 1-year period, 13 patients were prescribeddexmedetomidine. All patients had one or more of the approvedindications. However, 9 patients (69%) also had 1 or morecontraindications to the use of dexmedetomidine. In addition, 7 patients(46%) remained on the drug for longer than the recommended durationof 72 hours. Overall, none of the dexmedetomidine use was in completeconcordance with hospital guidelines.Conclusions: The use of dexmedetomidine was discordant withguidelines established by our institution with respect to indications,contraindications, and duration of therapy. It is necessary to identifybarriers to adherence, revise the guidelines, and re-educate the ICUteam.

Adherence to Hospital Sepsis TreatmentGuidelinesI. Wong1, S. Elsayed2,3, G.W. Thompson3,

A.M. Bombassaro3,4, J. Newman4

1 School of Pharmacy, University of Waterloo, Waterloo, ON2 Departments of Microbiology & Immunology and Pathology &Laboratory Medicine, Western University, London, ON

3 Department of Medicine, Western University, London, ON4 Pharmacy Services, London Health Sciences Centre, London, ON

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Rationale: A quality improvement initiative was undertaken to examineand characterize aspects of antimicrobial therapy in patients with sepsisor severe sepsis/septic shock. Objectives: The primary objective was to evaluate empiric antimicrobialprescribing for sepsis and severe sepsis/septic shock as a surrogate ofadherence to hospital treatment guidelines. The secondary objectiveswere to determine the timing of administration, adequacy of thespectrum of initial therapy and frequency of modifications. Study Design and Methods: Retrospective chart review wasperformed using a convenience sample of sequentially selected recordswith a diagnosis of sepsis or septic shock. Adherence (full and partial)was evaluated by comparing the empiric regimen (antibiotic, dose, route,timing) to the hospital treatment guidelines. Adequacy of the initialregimen was determined using microbiology results andguideline/expert consensus when the former was inconclusive.Opportunity for spectrum modification was assessed by expertconsensus. Results: Seventy charts were reviewed, of which 66 met the inclusioncriteria (34 sepsis, 32 severe sepsis/septic shock). Regimens prescribedfor 35 patients were evaluable for adherence. The most common reasonfor exclusion from the adherence analysis was a suspected site ofinfection not addressed in the guidelines (22/31). Adherence of theprescribed regimen to the guidelines was found in 15/35 (43%) with only3 of these being fully adherent. Antibiotics were administered within 1hour of the diagnosis of severe sepsis/septic shock in 15/32 (47%)patients. The initial spectrum was deemed adequate in 49/66 (74%)patients. The opportunity for spectrum modification existed in 20/29cases in which no change was made.Conclusions: Several areas for improvement in the sepsis initiative atthis institution were identified. A minority of evaluable patients receivedempiric antimicrobial therapy adherent to the treatment guidelines.Gaps were noted in the scope of the guidelines, timely antimicrobialadministration, adequacy and modification of the initial spectrum.

TUESDAY, FEBRUARY 4MARDI 4 FÉVRIER

Drug Shortages in Health Care Institutions: Perspectives inEarly 2014Isabelle Barthélémy, Denis Lebel, Jean-François Bussières, CHUSainte-Justine, Montreal, QC

Rationale: The drug shortage crisis represented a total opportunity costof more than half a million dollars for five Quebec University HospitalCenters and contributed to the postponement of pharmaceuticalactivities. Objectives: To describe drug shortages for the period of 2006-2013. Study Design and Methods: Retrospective study. Drug shortagesdata have been collected from the Fridaypm.com Website since 2006.The number of drug shortages, average duration, number ofmanufacturers involved and therapeutic classes involved were collectedfor each year. Results: From 2006-2013, the annual number of drug shortages was of,respectively, 493, 400, 441, 679, 429, 1081 and 497. A 46% decreasewas observed in 2012-2013 compared with 2011–2012. An increase inthe average duration of drug shortages was observed, from 108±130days in 2006-2010, to 103±85 in 2011-2012 and to 168±153 in

2012-2013. The number of manufacturers involved in drug shortagesdecreased from 58 in 2011–2012 to 38 in 2012–2013. Most of the drugshortages in 2012–2013 involved generic drug manufacturers, whichrepresented 85% of the total number of drug shortages and 87% of thetotal number of drug-shortage days. Most therapeutic classes wereaffected by shortages in 2012–2013. The main drug classes affectedwere central nervous system agents (23%), cardiovascular drugs (13%)and anti-infective agents. The percentage of parenteral formulationsamong the total number of drug shortages increased from 33% in2011-2012 to 36% in 2012-2013. In terms of duration, parenteralformulations drug shortages accounted for and increased from 37% ofdays in 2011-2012 to 47% in 2012-2013. Conclusion: A decrease in the number of drug shortages was observedfor 2012-2013, but there was an increase in the percentage of parenteralformulations drug shortages and duration. There was also an increase inthe number of drug shortages involving generic manufacturers.

Adverse Drug Reaction–Related Hospitalizations AmongSeniors, 2006 to 2011Michele Arthur, Michael Gaucher, Canadian Institute for HealthInformation, Ottawa, ON

Rationale: Adverse drug reactions (ADRs) are defined by the WorldHealth Organization as adverse effects of a drug that was properlyadministered in the correct dose, for therapeutic or prophylactic use.

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Seniors are at greater risk for ADRs, as well as other types ofdrug-related adverse events, due to the number of drugs they take,their higher prevalence of certain chronic conditions and age-relatedchanges in the body.Objectives: This analysis examines the prevalence of ADR-relatedhospitalizations among seniors. It also examines the drugs and the typesof reactions most commonly associated with these hospitalizations.Study Design and Methods: This analysis used data from theDischarge Abstract Database and Hospital Morbidity Database from allCanadian provinces. Hospitalizations due to ADRs were identified usingICD-10 diagnosis and external cause codes. Results: In 2010–2011, 1 in 200 Canadian seniors was identified ashaving an ADR-related hospitalization (five times more than non-seniors).Anticoagulants were the drug class most commonly associated withADR-related hospitalizations. The most common diagnosis associatedwith anticoagulants was bleeding. Other drugs commonly associatedwith ADR-related hospitalizations were antineoplastic drugs and opioidsand related analgesics. The most common diagnosis associated withADR-related hospitalizations due to antineoplastic drugs wasneutropenia, while the most common diagnosis associated withopioid-related hospitalizations was constipation.Conclusion: Many of the commonly observed ADRs were well knownreactions. Although it is not always possible to prevent an ADR fromoccurring, patient monitoring and education are important to ensurethat ADRs can be identified quickly so that harm to the patient, and inturn the likelihood of hospitalization, can be minimized.

Development of a Process to Ensure TimelyHome Medication Access for Patients AwaitingAdmission in the Emergency Department

Shelita Dattani, Queensway Carleton Hospital, Ottawa ON

Rationale: In our Emergency Department (ED), patients frequently waitseveral hours before a final decision is made for admission to hospital.These patients do not consistently receive their home medicationsduring this time as a complete Medication Reconciliation is usually notperformed until the point of admission. This has great potential tocompromise patient safety and efficiency of care. Description: Our multidisciplinary task group developed a consistentand streamlined process in order to:A. Ensure timely access to patient’s home medications during longer ED

staysb. Enhance interdisciplinary communication of home medication

initiation prior to admission.Steps Taken to Implement Change: In order to minimize duplicationof successful processes, our pharmacist-led multidisciplinary teamevaluated a modification of our current best Possible Medication History(bPMH) form. This tool was designed to:A. Trigger completion of a bPMH on patients remaining in the ED

greater than four hours.b. Provide an opportunity for the ED physician to continue home

medications as needed for patients with longer ED stays. Evaluation: A pharmacist conducted education and brainstormingsessions with ED and pharmacy staff prior to modification andimplementation of the revised form. After implementation, focus group surveys revealed that modification toour bPMH form has motivated staff to complete medicationreconciliation for those patients with longer ED stays and has improvedpatient’s early access to home medications. Relevance to Current and Future Practice: Thismultidisciplinary–driven process change has improved efficiency of carein the ED and through admission. It contributes to a safer and enhancedpatient experience in the hospital.

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A formal evaluation is planned to assess the contribution of this processto improving access and communication around home medicationsinitiated in the ED.

Reduction of Polypharmacy in a Rehabilitationand Progressive Care UnitSonia Wang, Monica Lee, North York General Hospital,

Toronto, ON

Rationale: The Rehabilitation and Progressive Care Unit (RPCU) atNorth york General Hospital has the third highest number ofmedications dispensed among all medicine units. Patients in this unit areon average 85 years or older with multiple comorbidities, thus puttingthem at high risk of polypharmacy. The pharmacist can play an importantrole in minimizing inappropriate drug therapies while these patientsawait discharge to the next level of care. Description and Steps Taken: A literature review was performed toestablish the approach to reducing polypharmacy. Six criteria were usedwhen considering whether a medication was unnecessary, or dose orduration of therapy was excessive. A documentation form wasdeveloped to guide the process of assessment and to document theintervention plan and outcomes. Medication reviews were systematicallyperformed by the unit pharmacist within 72 hours of a patient’s transferto the RPCU. The process was piloted between January and March 2013. Evaluation: During the 3-month period, 106 (81%) of the 131 patientsin the RPCU had their medications reviewed by the unit pharmacist.Forty-eight drug therapy problems related to unnecessary medicationsor excessive dose or duration were identified in 29 (27%) patients. Ofthe recommendations made by the pharmacist, 44 (92%) were acceptedby the physicians. The average time between identification andresolution of a drug therapy problem was 2.4 days. Common classes ofdrugs identified to be unnecessary include anticoagulants, laxatives,anti-infectives, and vitamins.Implications: Minimizing polypharmacy in the elderly patients canreduce the risk of adverse effects, and improve compliance and qualityof life. The RPCU unit is a perfect setting for conducting thoroughmedication reviews and discontinuing any inappropriate drug therapies,since patients are closely monitored by a collaborative healthcare team.The interventions may ultimately improve patient safety and reduce costto the healthcare system.

What Doses Should Our Chemotherapy RobotPrepare?Rita Kwong, Roy Lee, Jeanne Chu, Tamara Rumsey, Princess

Margaret Cancer Centre, Toronto, ON

Objective: Manual preparation of parenteral chemotherapy dosesposes inherent patient and occupational safety risks. In 2012, an Iv robotwas installed in our chemotherapy pharmacy that serves over 120patients daily in our outpatient systemic chemotherapy unit and also 130oncology inpatients. The pharmacy implementation team developed alist of criteria to identify the cancer treatment drugs to be prepared bythe robot. The drug list was used to guide the ramp up duringimplementation. Method: The pharmacy team analyzed the robot’s efficiency factors andtechnological limitations to identify those drugs and doses that aretechnically compatible with the robot. Past chemotherapy order recordswere used to assess frequency of prescribing for each drug. Drugcharacteristics and drug distribution workflow for both just-in-time andnext day model of care were also reviewed. The team then developedspecific selection criteria for chemotherapy drugs that would benefitfrom robotic production and their priority in the implementation. Results: All chemotherapy drugs used at the cancer centre wereidentified and categorized based on the selection criteria that includedfrequency of use, supply format, presence of barcodes, drug stability,usual dose volume, applicable dispensing format, and cost. The drugswere then grouped in priority for production ramp up.

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Conclusion: Thirty-three drugs used in our centre were identified aspotentially compatible with the robot based on known enhancements tobe released by the vendor. As of September 2013, we had implementedthe drugs in our first phase with over 9 frequently dispensed hazardousdrugs being prepared by the robot. Additional drugs will be added aswe modify our workflow and as the known product enhancements arereleased.

The Effect of Residual Renal Function and Other PatientFactors on Gram Positive Peritonitis OutcomesRachel Whitty1, Philip Lui1,2, Alex Kiss3, Linda Dresser1,2 and Joanne M.Bargman1

1 University Health Network, Toronto, ON2 Faculty of Pharmacy, University of Toronto, Toronto, ON3 Sunnybrook Research Institute, Toronto, ON

Rationale: Gram positive organisms are the most common cause ofperitonitis in patients treated with peritoneal dialysis (PD).Pharmacokinetic studies have indicated that clearance of antibiotics ishigher with Continuous Cyclic Peritoneal Dialysis (CCPD) thanContinuous Ambulatory Peritoneal Dialysis (CAPD), and that patientswho are non-anuric have lower cefazolin concentrations compared topatients who are anuric. Few studies have examined how these andother factors affect peritonitis treatment outcomes.Objective: The objective of this study was to determine the effect ofPD modality, renal creatinine clearance, and other patient factors ongram positive peritonitis treatment outcomes in patients treated with PD. Methods: between 2003 and 2010, all gram positive peritonitisepisodes treated with cefazolin at a large tertiary care hospital wereincluded. A Cox proportional hazards model was used to examine therelationship between the primary outcome, time to resolution of theintraperitoneal (IP) white blood cell (WbC) count, and the followingfactors: PD modality, renal creatinine clearance (CrCL), PD vintage,hospitalization during peritonitis treatment, age, change in antibioticduring peritonitis treatment, and cefazolin dose per kilogram of bodyweight. Polymicrobial infections were excluded.Results: There were 119 patients with 177 peritonitis episodes in thisstudy. Lower CrCL was associated with a greater likelihood of resolutionof the IP WbC count (p=0.0002). Shorter duration of PD was associatedwith a greater likelihood of resolution (p=0.005). Interestingly, age wasalso statistically significant (p=0.03) with older age associated withgreater resolution.Conclusions: Longer PD vintage may be associated with changes to theperitoneal membrane that leads to decreased resolution. Theassociation between greater renal function and non-resolution suggestsrenal cefazolin clearance contributing to lower cefazolin concentrationsand treatment failure. The unexpected association of younger age withnon-resolution warrants further investigation.

Can a Collaborative Community Mental HealthSmoking Cessation Program Reduce CigaretteConsumption?

Kayla Cameron & Andrew Brillant, Saint John Regional Hospital, SaintJohn, NB

Rationale: To contribute to the growing body of evidence supportingcommunity based smoking cessation interventions in the mental healthpopulation. Hopes include that those living with mental illness will gainfurther access to alike programs where they feel accepted, satisfied, andcan obtain benefits while paving their way to a healthier lifestyle. Objectives: Determine if a smoking cessation group based programwould result in a reduced number of cigarettes smoked per day.Secondary aims included changes in nicotine dependence, medicationchanges reflective of smoking reduction, and participant satisfaction.

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Design/Methods: Using a naturalistic design, data was collected byconvenient sampling from a single community mental health recoverycenter at baseline, pre implementation of the smoking cessationprogram, and then compared at six to eight weeks into the program.Sessions involved education, information, activities, games, copingmethods, support, and encouragement weekly for one hour. Results: Number of cigarettes smoked per day was reduced from amean of 24.13 (SD 9.471) to 1.5710 (SD 4.72) for those who remainedenrolled in the program at weeks six to eight, p=0.005. A minimum of13 cigarettes daily decreased to a new minimum of zero. A maximum of50 cigarettes daily dropped to a maximum of 15. Nicotine dependencecould not be assessed given number of non-smokers at data collection,there were no reflective changes to medications, and overall satisfactionof the program appeared positive. Conclusions: The smoking cessation group intervention providedbenefit to those who remained enrolled; further investigation should beexplored using larger scale trials.

Comparison Among Atovastatin, Rosuvastatin andPravastatin with Focus on Efficacy and Safety ProfilesLolwa Barakat1, Amin Jayyousi2, Abdulbari Bener3,4,5, Bilal Zuby6, andMahmoud Zirie2

1 Departments of Pharmacy and Clinical Pharmacy, Hamad GeneralHospital, Hamad Medical Corporation, Doha, Qatar

2 Departments of Medicine and Endocrinology, Hamad MedicalCorporation, Doha, Qatar

3 Department of Medical Statistics and Epidemiology, Hamad MedicalCorporation, Doha, Qatar

4 Departments of Public Health and Medical Education, Weill CornellMedical College in Qatar, Doha, Qatar

5 Department of Evidence for Population Health Unit, School ofEpidemiology and Health Sciences, The University of Manchester,Manchester, UK

6 Pediatric Intensive Care Unit, Department of Pediatrics, HamadMedical Corporation, Doha, Qatar

Rationale: Qatar has a high prevalence of diabetes and heart disease.Statins are commonly prescribed in diabetic patients with dyslipidemia.Data is lacking to show head to head comparison of the 3 mostcommonly prescribed statins in Qatar with regards to effect on serumlipid levels and safety profiles on muscular, hepatic and renal functions indiabetic patients in this country.Objectives: To compare the effects of atorvastatin, rosuvastatin andpravastatin on lipid profile and possible impact on muscular, hepatic andrenal functions.Study Design and Methods: A retrospective observational study on350 consecutive diabetic patients with dyslipidemia who wereprescribed any of the 3 statins, during the period September 2005 –September 2009. Data on lipid (serum triglycerides (TG), totalcholesterol (Chol), high-density lipoprotein (HDL-C) and low-densitylipoprotein (LDL-C) levels), muscular (creatinine phosphokinase), hepaticenzymes (Alanine transaminase (ALT), aspartate transaminase (AST) andalkaline phosphatase (ALP)) and renal (serum creatinine,microalbuminuria & glomerular filtration rate) profiles were collected atbaseline and after 2 years of treatment, using Electronic and paperpatient records.Results: At the end of 2 years of treatment, rosuvastatin 10 mg reducedLDL-C by 29.03%, followed by atorvastatin 40 mg (22.8%) andpravastatin 20 mg (20.3%). Serum triglyceride level showed greatestreduction by 25.1% with rosuvastatin 10mg. Triglyceride levels werereduced with atorvastatin 40 mg and pravastatin 40 mg by 21.6% and13.5%, respectively. No effects on the muscular or hepatic profiles wereobserved with any of these statins. Atorvastatin resulted in the leastnumber of patients with new onset of microalbuminuria (10.9%),followed by rosuvastatin (14.3%) and then pravastatin (26.6%).

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Conclusion: In Qatari diabetic dyslipidemic population, the mosteffective statin in reducing serum LDL-C and triglyceride levels wasrosuvastatin 10 mg. The safest statin in relation to renal function wasatorvastin.

The Path Forward: Solutions from a Province-WideUniversity-Health Authority Engagement Initiative Michael Legal; Donna Rahmatian; Kyle Collins; Patricia Gerber; AngelaKim-Sing; Peter S. Loewen; Peter J. Zed, Faculty of PharmaceuticalSciences, The University of British Columbia, Vancouver, BC

Rationale: It is a challenge to provide sufficient quantities of highquality experiential placements for learners in institutional settings. Inrecent years, this issue has become increasingly acute due to curricularand program changes in Canada. There is a critical need to developapproaches that address these challenges and ensure healthy andadaptable experiential programs in the future. Approach: A comprehensive and rigorous methodology was employedto engage preceptors, learners and health authority leaders in britishColumbia. Root causes for capacity challenges were identified andpotential solutions articulated. Local feedback was combined withrecommendations from the literature and best practices from acrossNorth America.Solutions: Several broad areas of solutions were identified: healthauthority- faculty partnership, novel learner-preceptor models, directfaculty support for preceptors and learners, learner preparation, andenhanced experiential office. Formal, mutually beneficial partnershipsbetween the faculty and health authorities will ensure preceptors andsites are equipped to provide optimal experiences for learners, while thefaculty will benefit from a reliable supply of placements. The faculty willpromote the use of pairs, small tiers and facilitated multi-placements forjunior learners. Dedicated clinical faculty or protected teaching time forpreceptors will address workload concerns and teaching support needs.A comprehensive preceptor development program that leveragestechnology and preceptor networks will ensure preceptors have theskills to teach. The addition of an early hospital practice experience andinclusion of acute care content in the curriculum will improve thepreparedness of learners. Creation of a user friendly “preceptor portal”on the Faculty’s website will provide an enhanced customer orientedapproach.Implications: While these solutions will require substantial investmentand the commitment of all parties involved, the result will be a modern,collaborative, and adaptable institutional experiential program. Thesesolutions could have broad applicability to other jurisdictions in Canada.

Successful Medication ReconciliationImplementation in a Multi-site Acute Care Facility

Facca N.M.1, Ahrari S.1,2, Jansen S.1, Sellery C.1, Laman D.1, Bogorad I.1,Andress P.1, Runnels R.1,2, Barbour G.1, Buschell P.1, Caldwell K.1,Channon C.1, Creasor L.1, Davies M.1, Delamere K.1, Dhaliwal S.1,2,

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Douglas M.1, Goldszmidt M.1,3, Johnson N.1, Glover C.1, Lawson S.1, LeeS.1,2, Lemaire D.1, Loblaw C.1, Macpherson M.1, Martin M.1, Neumann L.1,Sumpton J.1, Vandervecht A.1, Yoon J.1 and Walker R.1,3

1 London Health Sciences Centre, London, ON2 University of Waterloo, Waterloo, ON3 Western University, London, ON

Background: Medication reconciliation is a required organizationalpractice by Accreditation Canada, and has been shown to reduce bothmedication errors at interfaces of care and prevent adverse drug events.Description: Previous strategies to implement medication reconciliationin one of Canada’s largest acute care teaching hospitals focused onadmission and were limited in spread across all inpatient units. The goalof this project was to establish a medication reconciliation process at allinterfaces of care.Action: A strategy was devised to implement a new process and forms.The medication reconciliation project team engaged with variousstakeholders to ensure successful adoption and implementation. broadstakeholder communication strategies were used to inform and sustainchange. The educational process included: • Early general information sessions with frontline staff and leadership; • Creation and distribution of tools and resources including workflows,

web-based training modules, posters, and presentations;• Unit specific planning, workflow reviews, and follow-up sessions led by

the project team with clinical and clerical staff; and• Unit specific educational sessions led by clinical educators for all

frontline staff and by the project team for prescriber and pharmacystaff.

Evaluation: The project team and Health Records set up a process toabstract information from the medication reconciliation forms andgenerate reports that would assess staff and prescriber compliance.See table below.Implication: Medication reconciliation was successfully implemented atadmission, transfer, and discharge across all inpatient units of thisinstitution as of June 2012. The process continues to be successful andsustainable. Institutions that are in the process of fully adoptingmedication reconciliation would benefit from using similar strategies tobe successful in implementing this vital patient safety initiative.

Facilitation of Medication Reconciliation by aClinical Registered Pharmacy Technician in anOrthopedic Unit of a Community Hospital:

A Pilot Project Lindsay Yoo, Jenny Chiu, Jocelyn Jackson, Mary Salgado-Corpuz, YuenChan-Lau, Joyce Choy, Edith Rolko, North York General Hospital,Toronto, ON

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Compliance (%) with Medication Reconciliation

Preadmission Admission

verification of bestPossible Medication

History Transfer DischargeSite 1 Site 2 Site 1 Site 2 Site 1 Site 2 Site 1 Site 2 Site 1 Site 2

F2013 Q1 70 89.6 85.7 19.9 73.1

F2013 Q2 88.2 56.1 92.9 73.1 93.1 69.5 66.6 35.5 81.5 55.5

F2013 Q3 90.5 51.7 94.9 72.3 94.9 68.1 65.6 39.6 82.0 53.9

F2013 Q4 93.3 64.5 96 70.6 95.7 66.9 65.8 46.6 81.1 53.9

F2014 Q1 96.5 87.5 96.7 73.7 96.3 70.1 73.2 74.9 82.9 57.1

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Rationale: A previous study at North york General Hospital identifieddelays in completion of a best Possible Medication History (bPMH) to beassociated with low rates of admission Medication Reconciliation(MedRec) performed in surgical in-patients. In order to improve theadmission MedRec rates, means to enhance the timeliness of bPMHcompletion were explored.Description and Steps Taken: With the expanded scope of registeredpharmacy technicians (RPhTs), our goal was to develop a bPMH RPhTrole to facilitate the process of conducting a bPMH. We first performeda literature review and reviewed the experience of bPMH RPhTs at otherinstitutions. Then, we examined the current bPMH and admissionMedRec workflow in our hospital. Finally, we defined the role of thebPMH RPhT and developed a bPMH training and certification programfor RPhTs. One RPhT was certified, and the bPMH RPhT role was pilotedin the orthopedic unit for approximately 1 month.Evaluation: During the 20 days on the unit, the bPMH RPhTinterviewed 78 of 140 (55.7%) patients, who were taking an average of 7medications. The RPhT verified the availability of patient’s own supply in31 (67.4%) of the 46 patients who were on non-formulary medications.based on workload data, it was determined the RPhT saved thepharmacist 80 minutes per day in bPMH interviews and documentation.The RPhT prioritized and referred 67% of patients for further evaluationby the pharmacist (e.g. NF alternatives, need for influenza vaccine, etc).Comparing this period to the same a year ago, an increase from 57.3%to 87.9% in admission MedRec was observed.Importance: The bPMH RPhT role helped facilitate admission MedRecand potentially saved pharmacists’ time, thus allowing them to focus onother clinical activities. This initiative should be further evaluated andpossibly expanded to other areas.

Impact of a Multidisciplinary Program on SmokingCessation Medication Use Patterns Koren Lui, Livia Vodenicar, Janice Ma, Canadian Armed Forces HealthServices Group, Ottawa, ON

Background: In May 2012, a multidisciplinary smoking cessationprogram was implemented at a Canadian Armed Forces medical clinic.The program aimed to enhance patient access and convenience tomultidisciplinary support. Weekly clinics were conducted for self-referredand medically referred patients. A pharmacist educated patientsregarding available medication therapies (nicotine replacement therapy(NRT), varenicline, and bupropion) to aid the patients in makinginformed choices. A health promotions team member followed with an

interactive teaching session on behaviour modification. After thesegroup sessions, patients were individually assessed by a physician. Theselected medication was dispensed in two-week allocations at theclinic’s pharmacy. Objective: To describe a multidisciplinary approach and its impact onsmoking cessation medication use patterns.Methods: A retrospective analysis was performed comparingdispensing records of patients who expressed interest in smokingcessation to a health care team member from June to December 2011(pre-program implementation) and June to December 2012 (first 6months after program implementation). Specifically: the selectedtherapy, completion of the 12 week therapy, and first to last fill intervals(as estimations of time spent in therapy). See table below.Conclusion: Our new multidisciplinary approach was able to encouragemore patients to initiate smoking cessation medication therapy, with anabsolute increase in the number of people completing the 12 weektherapy. Unexpectedly, there was a reduction in the proportion ofpeople completing therapy and a marked decrease in the estimatedtime spent in therapy for those who did not complete it. Furtherfollow-up and analysis are required to determine the clinical significance,and possible next steps to improve adherence.

Impact des données probantes sur l’implantationdes codes-barres en milieu hospitalier Aurélie Guérin1, Denis Lebel1, Jean-François Bussières1,2

1 CHU Sainte-Justine, Département de pharmacie et unité de rechercheen pratique pharmaceutique, Montréal, QC


Justification : On reconnaît les difficultés inhérentes à l’implantation denouvelles technologies dans le circuit du médicament en hôpital.Certains auteurs considèrent qu’il faut en moyenne plus de 15 ans auréseau de la santé pour qu’un changement soit implanté à plus de 50%en présence de données probantes. Objectifs : Évaluer les délais entre la publication des meilleures preuvesdisponibles et l’implantation de lecteurs codes-barres pourl’identification du patient durant le processus d’administration dumédicament au Canada. Méthodologie et démarche de l’étude : Étude descriptive etrétrospective. À partir d’une revue documentaire sur Pubmed et Google,les meilleures preuves disponibles ont été identifiées à partir de revues(méta-analyses, revues systématiques, revues de littérature), les étudesdescriptives issues de ces revues et les recommandations. Le tauxd’implantation a été calculé à partir des données des rapports canadienssur la pharmacie hospitalière de 1985-1986 à 2011-2012. Résultats : Nous avons recensé une revue systématique (2010), troisrevues de littérature (2003-2011), 16 études descriptives différentesissues de ces revues (2002-2008) et quatre recommandations(2004-2011). La première mention d’implantation de lecteurscodes-barres pour l’identification du patient durant le processusd’administration du médicament apparaît en 2001-2002. Sonimplantation demeure limitée au Canada, soit 3% (2003-2004), 8%(2005-2006), 3% (2007-2008), 6% (2009-2010) et 4% (2011-2012).Compte tenu du faible taux d’implantation, on ne peut calculer le délaientre la publication des meilleures preuves et l’implantation à largeéchelle de lecteurs codes-barres pour l’identification du patient durantle processus d’administration du médicament au Canada. Conclusion: Il existe peu de données sur les délais observés entre lapublication des meilleures preuves disponibles et l’implantation detechnologies. S’il existe des preuves de l’utilité des lecteurscodes-barres pour l’identification du patient durant le processusd’administration du médicament au Canada, il est raisonnable de penserqu’il faudra quelques années avant que cette technologie ne soitlargement implantée au Canada.

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Results

Pre-ProgramImplementation(June-Dec 2011)

Post-ProgramImplementation(June-Dec 2012)

Self or medicallyreferred for smokingcessation

201 322

Subsequently initiatedmedication therapy

187 317

Champix 125 (67.2%) 222 (70.0%)

Zyban 21 (11.2%) 45 (14.2%)

NRT 40 (21.5%) 50 (15.8%)

Completed 12-wk Tx 36 (19.6%) 48 (15.4%)

Did not complete12-wk Tx

147 (80.3%) 263 (84.6%)

Loss to Follow-up 4 6

First to last fill interval 72.1 days 25.6 days

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Impact des données probantes sur l’implantation despompes intelligentes en milieu hospitalier Aurélie Guérin1, Denis Lebel1, Jean-François Bussières1,2



Justification : On reconnaît les difficultés inhérentes à l’implantation denouvelles technologies dans le circuit du médicament en hôpital.Certains auteurs considèrent qu’il faut en moyenne plus de 15 ans auréseau de la santé pour qu’un changement soit implanté à plus de 50%en présence de données probantes.Objectifs : Évaluer les délais entre la publication des meilleures preuvesdisponibles et l’implantation de pompes intelligentes au Canada. Méthodologie et démarche de l’étude : Étude descriptive etrétrospective. À partir d’une revue documentaire sur Pubmed et Google,les meilleures preuves disponibles ont été identifiées, soit les les revues(méta-analyses, revues systématiques, revues de littérature), les étudesdescriptives issues de ces revues et les recommandations. Le tauxd’implantation a été documenté à partir des données des rapportscanadiens sur la pharmacie hospitalière de 1985-1986 à 2011-2012. Résultats : Nous avons recensé une revue systématique (2007), troisrevues de littérature (2008-2011), 13 études descriptives différentesissues de ces revues et trois recommandations (2009-2012). Ons’intéresse à l’implantation des pompes intelligentes au Canada pour lapremière fois en 2007-2008. Son implantation demeure importantedepuis, soit 61 % (2007-2008), 68% (2009-2010) et 75% (2011-2012).Compte tenu du faible nombre de données probantes soutenantl’efficience des pompes intelligentes, on ne peut calculer, le délai entrela publication des meilleures preuves disponibles et l’implantation àlarge échelle des pompes intelligentes au Canada. Conclusion: Il existe peu de données sur les délais observés entre lapublication des meilleures preuves disponibles et l’implantation detechnologies. La majorité des hôpitaux au Canada ont implanté despompes intelligentes malgré l’absence de recommandations de sociétéssavantes et d’études de bonne qualité. Cette implantation n’est pasétrangère au renouvellement des équipements.

Impact des données probantes sur l’implantationde la réconciliation médicamenteuse en milieuhospitalier

Aurélie Guérin1, Denis Lebel1, Jean-François Bussières1,2



Justification : Les différentes étapes de transition de soins du patient àl’hôpital sont à risque majeur d’erreurs médicamenteuses. On reconnaîtpar ailleurs les difficultés inhérentes à l’implantation de nouveauxprocessus. Certains auteurs considèrent qu’il faut en moyenne plus de15 ans au réseau de la santé pour qu’un changement soit implanté àplus de 50% en présence de données probantes.Objectifs : Évaluer les délais entre la publication des meilleures preuvesdisponibles et l’implantation de la réconciliation médicamenteuse auCanada. Méthodologie et démarche de l’étude : Étude descriptive etrétrospective. À partir d’une revue documentaire sur Pubmed et Google,nous avons identifié les meilleures preuves disponibles, soit les revues(méta-analyses, revues systématiques, revues de littérature), les étudesdescriptives issues de ces revues et les recommandations. Le tauxd’implantation a été documenté à partir des données des rapportscanadiens sur la pharmacie hospitalière de 1985-1986 à 2011-2012. Résultats : Nous avons recensé 10 revues systématiques (2009-2013),une revue de littérature (2005), 70 études descriptives issues de ces

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revues (1993-2012) et cinq recommandations (2006-2013). Ons’intéresse au préalable à l’implantation de l’histoire médicamenteusedès 1985-1986 au Canada. L’implantation était alors de 6%. Le terme deréconciliation médicamenteuse apparaît en 2005-2006. En 2011-2012,son implantation était, respectivement, de 85 % à l’admission, 47% autransfert et de 44% au départ. En tenant compte du processus completde réconciliation médicamenteuse, le délai entre la publication desmeilleures preuves disponibles et l’implantation à large de laréconciliation médicamenteuse au Canada n’est que d’une année.Conclusion : Il existe peu de données sur les délais observés entre lapublication des meilleures preuves disponibles et l’implantation denouveaux processus. L’ajout de la réconciliation médicamenteuse auxpratiques organisationnelles requises d’Agrément Canada n’est sansdoute pas étranger au court délai d’implantation de cette pratique.

Prescribing Patterns and Safety of IntramuscularOlanzapine in Hospitalized Elderly PatientsAmy Wong1, Kam-Tong Yeung2, Fran Wolfe2, Monica Lee2

1 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON2 North York General Hospital, Toronto, ON

Background: Intramuscular (IM) olanzapine is sometimes used tomanage acute behavioural and psychological symptoms in hospitalizedelderly patients with dementia or delirium. However, its use for thisindication is off-label and safety concerns remain. Objectives: To identify prescribing patterns of IM olanzapine andassociated adverse effects, and to compare the results to those from acase series of elderly patients who received the drug when it firstbecame available for these patients in 2008. Methods: We conducted a retrospective chart review of all in-patientsaged 65 years or older who received at least one dose of IM olanzapinebetween November 2010 and December 2012. Patient demographics,comorbidities, IM olanzapine treatment details, concurrent medications,and documented adverse effects were analyzed. Results: Seventy-six patients were identified to have received at leastone dose of IM olanzapine. Of the 100 orders, 52 (52%) were written bypsychiatrists and 32 (32%) by geriatricians. The most commonindications included agitation (64 individuals, 84%) and refusal orinability to take oral medications (23 individuals, 30%). The mean dosegiven at one time was 4.2 mg (±2.6 mg). Eighteen (24%) individualsexperienced constipation, 15 (20%) experienced lethargy and 11 (15%)experienced drowsiness. Serious adverse effects observed included 9cases (12%) of hypotension, 3 (4%) falls within 24 hours post dose, and 1(1%) case of aspiration pneumonia. Compared to the previous caseseries, prescribing patterns remained the same with respect topredominant prescribers and indications. Lethargy and drowsinesscontinued to be commonly experienced adverse effects while theincidence of falls, infections and extra-pyramidal symptoms was lower inthe current cohort. Conclusions: In the acute setting, psychiatrists and geriatricians mayprescribe IM olanzapine for behavioural symptoms in elderly patients.Commonly experienced adverse effects include lethargy, drowsiness andconstipation. Close monitoring is the key to ensuring safe use.

Optimizing Pharmacotherapy in a Geriatric DayHospital: A Medication Use and Cost Analysis Barbara Farrell1,2,3, Evan Steed1,2,3, Danielle Paes1,2,3, Salima

Shamji1,2, Veronique French Merkley1,2, Anne Monahan1,2

1 Bruyère Continuing Care, Ottawa, ON2 University of Ottawa, Ottawa, ON3 University of Waterloo, Waterloo, ON

Rationale: Polypharmacy in the elderly is associated with adverse drugreactions, emergency room visits, hospitalization and cost.Deprescribing and interprofessional team interventions are importantapproaches to reducing polypharmacy, pill burden and cost.

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Objective: To determine impact—on medication use and cost to aprovincial drug program—of interprofessional medication review andinterventions aimed at optimizing pharmacotherapy for patientsadmitted to a 12-week Geriatric Day Hospital program. Study Design and Methods: Pre- and post-intervention medicationnumbers (prescription & non-prescription), pill burden (number of oraldoses per day) and Ontario Drug benefit (ODb) acquisition drug costs(using lowest priced generic drug - excluding ‘as needed’ medicationsand those not covered by ODb) for 8 patient cases accepted forpublication. Calculations independently verified by a second researcher.Daily and yearly ODb program cost-savings estimates and projectionsmade using annual GDH admission rates. Results: Average daily per patient medication use was reduced by 4.4medications (from 17.5 to 13.1) and average daily pill burden wasreduced by 5.2 doses (from 21.8 to 16.6). Estimated per patientmedication cost savings were $2.55 per day, with annual cost savingsprojected at $930 per patient. If extrapolated to the 350 patientsadmitted to the GDH each year, medication review and interventionsaimed at optimizing pharmacotherapy could result in savings ofapproximately $325,000 in medication costs to ODb annually.Limitations include highly selected patient cases, and inclusion of onlysome costs related to medication use.Conclusion: Inter-professional medication review and interventionsduring GDH admissions reduced medication use and pill burden withimportant projected savings. Future economic modeling should includecosts relating to medications not covered by ODb, mark-up anddispensing fees, pharmacist time spent and benefits ofpharmacotherapy optimization (e.g. reduced hospitalization, falls etc.).

Home Care Pharmacy Services: A Demonstration ProjectDouglas Doucette1, Terry Morrissey2, Ann Nickerson2

1 Regional Pharmacy Services, Horizon Health Network, Moncton, NB2 Extra-Mural Program, Moncton Area, Horizon Health Network,Moncton, NB

Rationale: In 2008 clinical pharmacy services were introduced to homecare clients in the Extra-Mural Program (EMP) in collaboration with amultidisciplinary team. A second phase of the demonstration projectevaluated the pharmacist’s role in providing a feasible and sustainableservice to EMP clients. The project was intended to align pharmacyservices with EMP needs for a designated geographical area, avoidduplication of existing services and obtain meaningful outcomemeasures. Description of Project: This project evaluated the effectiveness of thepharmacy services provided to EMP clients over a 12-month period in2012-2013. Clients referred to the pharmacist had at least 2 previousattempts by health care professionals to resolve the high-risk symptomsor medication-related problems, and were classified by the clients’likelihood for adverse outcome or admission to hospital. Once acceptedon the pharmacy caseload the pharmacist conducted a home visit toestablish a care plan and provided additional follow-up visits or phonecalls as required. Clinical and quality measures of the medication-relatedissues identified were used to assess the impact of the interventions. Project Evaluation: Working with clients and healthcare team membersto establish goals of therapy, the pharmacist was able to fully or partiallyresolve 305 of 330 (92.4 percent) of clients’ medication-related issues.This result is even more compelling considering many clients weredeemed high/urgent priority based on their symptoms, quality of life, orrisk of hospital admission. Although often requested to investigate 1unresolved symptom or issue, clients seen by the pharmacist had amedian of 5 medication-related issues. The percent of clients on thepharmacy caseload admitted to hospital (per quarter) ranged from 21 to50 and often involved consultation between pharmacist and attendingphysician.

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Summary: A home care pharmacist was effectively able to resolveclients’ high-risk medication-related issues that were unable to beresolved by other healthcare team members.

Impact des données probantes sur l’implantationdes prescripteurs électroniques en milieuhospitalier




Justification : On reconnaît les difficultés inhérentes à l’implantation denouvelles technologies dans le circuit du médicament en hôpital.Certains auteurs considèrent qu’il faut en moyenne plus de 15 ans auréseau de la santé pour qu’un changement soit implanté à plus de 50%en présence de données probantes.Objectifs : Évaluer les délais entre la publication des meilleures preuvesdisponibles et l’implantation de prescripteurs électroniques au Canada. Méthodologie et démarche de l’étude : Étude descriptive etrétrospective. À partir d’une revue documentaire sur Pubmed et Google,les meilleures preuves disponibles ont été identifiées, les revues(méta-analyses, revues systématiques, revues de littérature), les étudesdescriptives issues de ces revues et les recommandations. Le tauxd’implantation a été documenté à partir des données des rapportscanadiens sur la pharmacie hospitalière de 1985-1986 à 2011-2012.Résultats : Nous avons recensé trois méta-analyses (2008-2013), 13revues systématiques (2003-2013), quatre revues de littérature(2003-2010), 198 études descriptives issues de ces revues (1984-2011) etquatre recommandations (2010-2011). On s’intéresse à l’implantation deprescripteurs électroniques au Canada pour la première fois en2001-2002. Son implantation demeure limitée, soit 7% (2001-2002), 5%(2003-2004), 6% (2005-2006), 5% (2007-2008), 8% (2009-2010) et 8%(2011-2012). Compte tenu du faible taux d’implantation, on ne peutcalculer le délai entre la publication des meilleures preuves disponibleset l’implantation à large échelle de prescripteurs électroniques auCanada. Conclusion : Il existe peu de données sur les délais observés entre lapublication des meilleures preuves disponibles et l’implantation detechnologies. Le délai d’implantation des prescripteurs électroniquesn’est peut-être pas étranger aux coûts, à la complexité de l’implantationet aux preuves limitées dans la littérature.

Impact des données probantes sur l’implantationd’aides à la décision clinique pour lesprescripteurs électroniques en milieu hospitalier




Justification: On reconnaît les difficultés inhérentes à l’implantation denouvelles technologies dans le circuit du médicament en hôpital.Certains auteurs considèrent qu’il faut en moyenne plus de 15 ans auréseau de la santé pour qu’un changement soit implanté à plus de 50%en présence de données probantes.Objectifs : Évaluer les délais entre la publication des meilleures preuvesdisponibles et l’implantation d’aides à la décision clinique pour lesprescripteurs électroniques au Canada. Méthodologie et démarche de l’étude : Étude descriptive etrétrospective. À partir d’une revue documentaire sur Pubmed et Google,les meilleures preuves disponibles ont été identifiées, les revues(méta-analyses, revues systématiques, revues de littérature), les étudesdescriptives issues de ces revues et les recommandations. Le taux

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d’implantation a été documenté à partir des données des rapportscanadiens sur la pharmacie hospitalière de 1985-1986 à 2011-2012.Résultats : Nous avons recensé 3 méta-analyses et revuessystématiques (1999-2013), 17 revues systématiques (1998-2013), septrevues de littérature (1994-2012) et deux rapports (2011,2012), 341études descriptives différentes issues des revues (1957-2012) et unerecommandation (2006). On s’intéresse à l’implantation d’aides à ladécision clinique pour les prescripteurs électroniques au Canada pour lapremière fois en 2001-2002. Son implantation évolue progressivement,soit 33% (2001-2002), 14% (2003-2004), 75% (2005-2006), 58%(2009-2010) et 75% (2011-2012). Le délai calculé entre la publication desmeilleures preuves et l’implantation à large échelle de prescripteursélectroniques au Canada était de 5 ans, soit entre 2000 et 2005. Conclusion : Il existe peu de données sur les délais observés entre lapublication des meilleures preuves disponibles et l’implantation detechnologies. On reconnaît que le changement est difficile et sa gestioncomplexe, particulièrement au sein de grandes organisations. Il a fallu 5années pour implanter à large échelle des aides à la décision cliniquepour les prescripteurs électroniques au Canada; le nombre deprescripteurs électroniques implanté demeure toutefois extrêmementlimité.

Impact of an “Avoid-Heparin” QualityImprovement Program on the Incidence, ClinicalConsequences and Resource Use Associated with

Heparin-Induced Thrombocytopenia (HIT)Kelly McGowan1,2, Joy Makari2,3, Peter Rempel2, Claudia Bucci1,2,3,Artemis Diamantouros1,2,3, William Geerts1,2

1 Faculty of Medicine, University of Toronto, Toronto, ON2 Sunnybrook Health Sciences Centre, Toronto, ON3 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON

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Rationale: Unfractionated heparin (UFH) is one of the most commondrugs used in hospitals but produces heparin-inducedthrombocytopenia (HIT) in up to 5% of exposed patients. HIT leads tothrombosis, amputations, death, and massive use of resources. Can HITbe prevented? Objective: To examine the impact of a formal hospital-wide strategy tolimit exposure to UFH on the incidence of HIT and its consequences. Study Design and Methods: A multi-disciplinary task force reviewedthe literature for each type of heparin exposure and preparedrecommendations for practice modifications. A comprehensive

“Avoid-Heparin Program” was implemented at a Canadian teachinghospital in 2006 as a specific attempt to reduce HIT and improve patientsafety. This involved replacing intravenous(Iv) and subcutaneous (S/C)UFH with LMWH for prophylactic and therapeutic indications andremoving UFH from arterial and central venous lines. The program wasevaluated by retrospective chart review.Measures: All cases of suspected HIT 2003-2011 were adjudicatedusing explicit criteria into Negative, HIT and HIT with thrombosis (HITT).Outcomes in the Pre-Intervention Phase (2003-05) were compared tothose in the Avoid-Heparin Phase (2007-11). Results: The annual number of suspected HIT cases decreased 34%from the Pre-Intervention Phase to the Avoid-Heparin Phase (p<0.001).Adjudicated HIT decreased 73% from 11 to 3/10,000 admissions(p<0.001) and HITT decreased 80% from 5 to 1/10,000 admissions(p<0.001). The hospital expenditure on HIT-safe anticoagulants alsodecreased 41% in the Avoid-Heparin Phase; this led to mean cost savingof $257,910/year. Conclusion: To our knowledge, this is the first quality improvementstudy demonstrating the success of a hospital-wide HIT preventionstrategy. Implementation of a simple heparin avoidance intervention canlead to a dramatic decrease in the burden of HIT, the costs of HIT care,and ultimately to improved patient outcomes.

Poster Abstract ReviewersRéviseurs des présentations par affichesSincere appreciation is extended to the Research Committee members for reviewing theabstract submissions for PPC 2014.

David blackburnRoxane CarrDawn DalenScott EdwardsSean GormanJanice Irvine-MeekNatalie KennieMarc Perreault

Ajudicators:

Céline Corman Sheri Koshman

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publications, posters and oral presentations to her credit. She hasreceived the Award for Teaching Excellence from Memorial’sSchool of Pharmacy on two occasions and has been recognizedwith several awards for her commitment to the pharmacyprofession. Notable among these include being named as thePreceptor of the year for the University of Colorado in 2010 andreceiving the Alfred G. Dawe Distinguished Service Award in 2006for her contributions to CSHP at the branch level.

She has held a variety of leadership positions with a number ofprofessional organizations including CSHP, where she is currentlyserving as Senior Advisor and Membership Committee chair forthe NL branch. She has previously held positions with the NLbranch executive including: President, Secretary, and Treasurer,and has served as co-chair of the national AGM in 2003. Dr.bishop is also a member of the Canadian Pharmacy PracticeResearch Group, the Association of Faculties of Pharmacy ofCanada (AFPC), Pharmacists Association of NL and the NLPharmacy board. She is also a member of the Canada HealthInfoway/AFPC’s Informatics project working group and serves asan expert advisor for the NL Peer-to-Peer Project, an initiative ofthe NL Centre for Health Information.

David Blackburn, BSP, PharmD, FCSHPDavid blackburn is an Associate Professorand Chair in Patient Adherence in theCollege of Pharmacy and Nutrition, at theUniversity of Saskatchewan. He is also theDirector of the Saskatchewan Drug Utilizationand Outcomes Research Team (SDUORT).After graduating with a bachelor of Sciencein Pharmacy in 1995 from the U of S, Davidworked briefly as a community pharmacist

before completing a hospital residency program in Saskatoon andthen moved to Toronto to complete a Doctor of Pharmacydegree from the University of Toronto in 2001. His researchprogram is focused on patient adherence, drug utilization, healthoutcomes, and chronic disease management in primary caresettings. He has extensive experience in the use of theSaskatchewan’s health-administrative databases for studying theuse of prescriptions and their influence on health outcomes. Hecontinues to teach undergraduate pharmacy students and trainsMaster’s and PhD level candidates in the College of Pharmacy &Nutrition. His ultimate goal is to discover the true determinants ofmedication non-adherence in order to design effective andpractical solutions for this public health epidemic.

Margaret Gray, BSP, FCSHPMargaret graduated from University ofSaskatchewan with her bachelor’s degree inpharmacy (bSP) with distinction 1987. After avery brief stint as a community pharmacist(weeks!), she moved to Edmonton where sheworked as a hospital staff pharmacist atMisericordia Hospital (1987-95). Her clinicalpractice areas included internal medicine,pharmacokinetics and ICU/CCU. She initiated

CSHP New FellowsNouveaux associés de la SCPHCSHP Fellow status is conferred by the board of Fellows uponCSHP members who have demonstrated noteworthy, sustainedservice and excellence in the practice of pharmacy in anorganized healthcare setting.

Board of Fellows 2013-2014Conseil des associés 2013-2014ChairpersonPrésidente:Kris Wickman, FCSHP

Chair-Elect:Président désignéShallen Letwin, FCSHP

Past ChairPrésident sortant:Peter Loewen, FCSHP

Board MembersMembres du Conseil:Janice Irvine-Meek, FCSHPJames Mann, FCSHPRégis vaillancourt, FCSHPPat Trozzo (ex-officiomember)

Lisa Bishop, PharmD, FCSHPDr. Lisa bishop is an assistant professor with the School of Pharmacy at Memorial University with a crossappointment to Memorial’s Faculty ofMedicine. She is a family practice pharmacistin an inter disciplinary teaching clinic whereshe provides pharmaceutical care to thepatients at the clinic. Dr. bishop is also aformer critical care pharmacist from

Eastern Health in St. John’s.

Dr. bishop began her pharmacy career as a student in Memorial’sbachelor of science in pharmacy program. Upon graduation shebegan working as a staff hospital pharmacist and a communityrelief pharmacist in St. John’s, eventually going on to complete ahospital pharmacy residency at St. Joseph’s Hospital in Hamilton,Ontario. Dr. bishop returned to Newfoundland and Labrador (NL)in 1998 and began working as a critical care pharmacist, aposition she held until 2006. She then joined Memorial Universityas a clinical faculty member. She completed a Non-TraditionalPharm.D from the University of Colorado in 2007.

Dr. bishop has made a significant contribution to hospital andcommunity pharmacy practice in NL at a number of levels in thelast 18 years. Her work with the critical care program with EasternHealth and her time as a family medicine pharmacist haveadvanced the provision of quality patient care in this province.Her current role is one that she established in a family practiceclinic that also serves as an academic teaching site for familymedicine residents. Dr. bishop has developed a new position inthis clinic, successfully integrating the role with a family medicineteam from a variety of disciplines.

Dr. bishop is also an accomplished scholar and educator withcontributions to a number of peer-reviewed journals and other

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a multi-disciplinary antimicrobial utilization program for theMisericordia and then Caritas in 1991-95. When healthcareservices were regionalized in Alberta in 1995, the ICU at theMisericordia was closed and Margaret moved into a regionalposition with Capital Health as a DUE pharmacist where her focuswas on medications used in anaesthesia and critical care (1995-97).In this role, she served as co-chair of the Anaesthesia AdvisorySubcommittee to P&T, as well as a member of regional P&T (thenDTC) from 1995-2005. In 1997 she moved from her DUE role toan expanded antimicrobial DUE role (1997-2005), returning to herlove of infectious diseases. In 2006, Margaret took on thechallenge of joining the Clinical Practice Leader team at CapitalHealth (which became Alberta Health Pharmacy Services in 2008)where she continues to work. In this role she maintains an activeclinical practice with the adult ID consult team at University ofAlberta Hospital as well as working on clinical pharmacist practiceissues at several sites in and around Edmonton and as far away asthe Cold Lake Hospital.

Through her career Margaret has been dedicated to theadvancement and promotion of the pharmacist role in healthcare.She has precepted innumerable students, and residents studentsthroughout her career (recently adding PharmD students to thislist), as well as being a Clinical Academic Colleague at theUniversity of Alberta Faculty of Pharmacy where she teaches inthe Advanced Therapeutics and Infectious Diseases courses. Sheis also a regular presenter to the U of A Medicine’s Division of IDacademic half days for the ID and medical microbiologist fellows,as well as at the Edmonton zone divisional ID rounds. Margarethas worked to attain her additional prescribing authority andinjection certification with the Alberta College of Pharmacists;ensuring she is willing to walk the talk of full scope of practice.She is currently serving as the chair of the Alberta College ofPharmacists Competence Committee. Margaret has presentedtalks at meetings including CSHP AGMs and SES, banff Seminar,Alberta Pharmacists Association meetings, posters at AMMICanada (Association of Medical Microbiologists and ID), and haspublished in the Annals of Pharmacotherapy as well as theInternational Journal of Infectious Diseases. Margaret has servedas a contributing editor for bugs & Drugs as well as for theUniversity of Alberta Medicine’s publication of Drugs & Drugs.

Margaret’s contribution to the profession is also evident in herwork with CSHP. She joined the society when she was still astudent at U of S. After moving to Edmonton, she served on theAlberta branch council as chapter chair, president and thenmoved to being the Alberta branch delegate from 1997-2000.From 2000-2003 Margaret served CSHP as the vision Liaison andpresident from 2001-02. She has served CSHP on severalcommittees, and task forces, including being the current chair ofthe CSHP Advocacy Committee.

Margaret has been recognized for her contributions to theprofession and CSHP with the Practitioner and MeritoriousService Awards from the branch, the Isobel Stauffer MeritoriousService Award from CSHP national, and the Pharmacy CentennialAward of Distinction from the Alberta College of Pharmacists andAlberta Pharmacists Association.

Margaret is also active at home, managing a busy family life withher husband, brian and two children, Ian and Lindsay.

Mits Miyata, BScPhm, ACPR, FCSHPMits is a Pharmacy Director with the LowerMainland Pharmacy Services (LMPS), which isa consolidation of regional hospital pharmacydepartments spanning four health authoritiesin the Greater vancouver area. Aftergraduating from the University of britishColumbia (UbC), Mits subsequentlycompleted a Hospital Pharmacy Residency atSt. Paul’s Hospital (vancouver), and a Health

Care Management Program at the british Columbia Institute ofTechnology (bCIT).

Mits has held numerous leadership positions during his career,including President of the Pharmacy Examining board of Canada(PEbC), and Chair of the board of Examiners of the College ofPharmacists of british Columbia (CPbC). Over the years, he hascontributed to the scientific literature, and has presented his workto his colleagues, most recently at the CSHP Summer EducationalSessions 2013.

Mits has actively served CSHP as the current PEbC Representative,a past Executive Mentee, past Chair of the SES Sustainability taskForce, and a past Senior Chair of the Advocacy Committee. He isan active Council member on the local CSHP bC-branch Counciland is the most recent bC branch Distinguished Service Awardrecipient. He also currently sits on the bC Provincial Pharmacy andTherapeutics Committee and well as the Drug benefits Councilfor the Ministry of Health.

Outside of the work setting, Mits holds a national certification as apower tumbling judge, is an avid distance runner and swimmer,and is currently training for the 2014 Tough Mudder in Whistler, bC.

Jennifer Ryan, BScPhm, PharmD, ACPR, FCSHPJennifer Ryan is currently the RegionalEducation and Research Coordinator for theHorizon Health Network in New brunswickand an adjunct clinical faculty member atDalhousie University, College of Pharmacy.

Jennifer received her bachelor of Pharmacyin 1999 from Dalhousie University, Halifax,Nova Scotia and completed the Canadian

Hospital Pharmacy Residency Program at the Hospital for SickChildren in Toronto, Ontario in 2000. She received her Doctor ofPharmacy in 2006 from the University of Florida. From2001-present she has held several positions within the HorizonHealth Network including: Clinical Manager, Pharmacy ResidencyCoordinator and Pharmacy Practice Leader in Nephrology.Jennifer’s research interests have included areas of preventionand medication adherence in patients with chronic kidney diseaseand diabetes and pharmacy education. Jennifer has presentednationally and internationally.

Jennifer has served CSHP in many capacities both at the branchand National Level including a term as president of the Nb branch,Chair of the National Advocacy Committee, and co-chair of theCSHP AGM planning committee in Saint John, Nb in 2009. Shecontinues to contribute as a reviewer for CJHP

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In addition to her ongoing role in hospital pharmacy, Jennifer hasrecently started a “new adventure” with her pharmacist husbandand opened a Medicine Shoppe Pharmacy in their communitytown of Grand bay-Westfield, Nb.

Kerry Wilbur, BScPhm, PharmD, ACPR, FCSHPKerry Wilbur graduated from DalhousieUniversity in Halifax with her bachelor ofScience in Pharmacy in 1997. Followingcompletion of the hospital pharmacyresidency program at the QEII HealthSciences Centre, she traveled to vancouverwhere she earned her Doctor of Pharmacydegree from the University of britishColumbia in 2000. Kerry accepted a position

as a Pharmacotherapeutic Specialist at vancouver GeneralHospital where she was responsible for providing pharmaceuticalcare to patients admitted to internal medicine and acute care forelders units. In 2002, she assumed the co-coordinator role ofvancouver General’s hospital pharmacy residency program andserved as chair of the bC hospital pharmacy residency committee.

During this time, she also held a Clinical Associate Professorposition in the Faculty of Pharmaceutical Sciences at UbC where

she instructed and also precepted residents and PharmD studentson rotation in the internal medicine practice setting andsupervised several pharmacy residency and undergraduateprojects. She also participated in UbC’s Continuing PharmacyProfessional Development Canadian Practice Program designedfor foreign-trained pharmacists to achieve competencies forpractice in Canada and Canadian-trained pharmacists re-enteringpractice following prolonged absence.

In 2007, Kerry relocated to Doha, Qatar to be part of thefounding faculty of the country’s first College of Pharmacy whichwas the first international program accredited by the CanadianCouncil of Accreditation of Pharmacy Programs (CCAPP). She iscurrently an Associate Professor and Director of the PharmDprogram. In 2011, she completed a Masters of Science in PublicHealth through the University of London School of TropicalMedicine and Hygiene.

Since joining as a pharmacy student, Kerry has had the privilegeto serve CSHP in various capacities including bC branch treasurer,National Research and Education Committee member, Nationalawards and CJHP reviewer, and national Membership Committeechair. She continues to promote advanced pharmacy practicemodels and link Qatar pharmacists to a wider professionalcommunity through QU-supported CSHP-membership for all QUPharmD students and preceptors.

CSHP Fellows ProgramThe CSHP Fellows program was initiated over 40 years ago todistinguish members who, through their practice activities andcontributions to CSHP and the profession, were worthy of arecognition that signified outstanding leadership, dedication andcommitment to practice excellence and professional growth.

To date, 167 members of CSHP have achieved the distinction ofbeing recognized as a Fellow of the Canadian Society of HospitalPharmacists (FCSHP).

The Goals of the Fellows Program are:• To challenge CSHP members to achieve peer recognition for

practice excellence.

• To promote worthwhile contributions to the pharmacy literature.

• To promote research in pharmacy.

• To promote the role of pharmacists as primary health careprofessionals through active involvement in hospital,professional, educational, and community activities.

• To recognize members who serve as models for others throughexemplary practice.

• To apply for Fellow status, candidates are required to completean application which documents the member’s achievements inseveral key criteria areas, and includes letters of support fromtwo recommenders. Each application is evaluated by membersof the board of Fellows using the following criteria.

CSHP Fellowship Criteria Please visit the CSHP website for more detailed information oneach criterion.

1. Candidate must have practiced pharmacy for at least ten years,of which a minimum of five must have been in an organizedhealth care setting.

2. Candidate must demonstrate support and leadership for theprofession through active, current membership and voluntaryparticipation in CSHP for a minimum of five consecutive years.Candidate must show consistent involvement, includingleadership, in professional pharmacy association activities.Participation in APES is considered equivalent to participationin CSHP activities. The candidate must be a current active orhonorary life member of CSHP.

3. Candidate must have demonstrated sustained practice focusand excellence.

4. Candidate must have contributed to pharmacy knowledgethrough publication, presentation, and research.

5. Candidate must have demonstrated ongoing commitment toeducating health care practitioners and the public.

6. Candidate must provide the names of at least two (2)recommenders of whom he or she has requested to submitconfidential recommendations attesting to the contributions ofthe candidate, and who support the application for Fellowstatus.

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Shirin AdabibScPhm, ACPR, PharmD

Jeff BarnettbScPhm, ACPR, PharmD

Arden BarrybSc, bScPhm, PharmD, ACPR

Marisa BattistellabScPhm, PharmD, ACPR

Elaine BeltijarbScPhm

Carolyn BornsteinbScPhm, ACPR, FSCHP, CGP

Alice Y.Y. ChengMC, FRCPC

Natalie CrownbScPhm, ACPR, PharmD

Elaine ChongModeratorPharmD, bCPS

Norman DewhurstbScPhm, ACPR, PharmD, RPh

Lisa DolovichbScPhm, PharmD, MSc

Scott EdwardsbScNeuro, bScPhm, PharmD

Barbara FarrellbScPhm, PharmD, FCSHP

Olavo FernandesbScPhm, ACPR, PharmD, FCSHP

Veronique French-MerkleyMD, CCFP, CoE

Alfred Gin bScPhm, PharmD, FCSHP

Sean HopkinsbScPhm

Jin-Hyeun HuhbScPhm, ACPR, bCPS

Shahid HusainMD, MS

Sandy JansenbScPhm, MHS

Jeremy JohnsonRN, bScN, MN Student, CDE

Derek JorgensonbSP, PharmD, FCSHP

Debra KentbA, PharmD, DAbAT, FAACT, RPh

Juno KimRPh, bScPhm

Sara KynicosMPharm, RPh

Tim T.Y. LaubScPhm, ACPR, PharmD, FCSHP

Kori Leblanc,bScPhm, ACPR, PharmD

Melanie MacInnisbScPhm, PharmD

Alexandra MarcilbSc, bScPhm

Hazel MarkwellbA(Hon), MA, PhD, ThD

Tom McFarlanebScPhm, PharmD

Alan MillsbScPhm, ACPR, PharmD

Marshall MoleschiRegistrar

Lisa NissenbPharm, PhD, FPR, FHKPh, FSHP

Glen PearsonbScPhm, PharmD, FCSHP

Jennifer PohbScPhm, ACPR, PharmD

Sumit RaybardhanbScPhm, ACPR, MPH

Kurt SchroederbScPhm

Suzanne SinghbScPhm, PharmD

Jessica SleethMPH, CHE, bPHE, bA

Beth SprouleRPh, bScPhm, PharmD

Jennifer TengbScPhm, ACPR, PharmD

Jake ThiessenbScPhm, MSc, PhD

Barbara ThomasPharmD

Peter ThomsonbScPhm, PharmD

Kent ToombsbScPhm, ACPR

Alice TsengbScPhm, PharmD, FCSHP, AAHIP

Ross TsuyukibScPhm, PharmD, MSc, FCSHP, FACC

Régis VaillancourtOMM, CD, bPharm, PharmD, FCSHP

Richard WanbonbSc, bScPhm, ACPR, PharmD

Wende WoodbA, bSP, bCPP

Lyndee YeungbScPhm, MbA

Peter ZedbSc, bScPhm, ACPR, PharmD, FCSHP

Rosemary ZvonarbScPhm

FacultyCSHP would like to recognize the generous contributions of the following speakers:

ConférenciersLa SCPH désire souligner les généreuses contributions des conférenciers suivants :

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AbbvIE........................................................................................115Allied Pharmacy Products Inc.....................................................408Alveda Pharmaceuticals .............................................................409Apotex Inc. ................................................................................306AutoMed Technologies Canada.................................................406bayer Inc. ...................................................................................224bCE Pharma................................................................................402bioSyent Pharma ........................................................................100Canadian Forces Recruiting Centre ...........................................117Canadian Institute for Health Information .................................500Canadian Patient Safety Institute...............................................236Canadian Pharmaceutical Distribution Network........................222Canadian Pharmacists Association.............................................501Cardinal Health Canada......................................................103/105Eli Lilly Canada Inc. ....................................................................107ESbE Scientific ............................................................................228Galenova.....................................................................................209Health Match bC ........................................................................106Healthmark Services ...................................................................108Hospira Healthcare Corporation.........................................213/215Lexicomp ....................................................................................404Manrex........................................................................................125McKesson Canada Corp.............................................................407Medisca.......................................................................................234

Mylan Pharmaceuticals Inc. .......................................................101Northwest Telepharmacy Solutions ...........................................102Northern Health Authority .........................................................104Novartis Pharmaceuticals Canada Inc........................................507Omega Laboratories Limited .....................................................205PCCA Canada Corp. ..................................................................123Pendopharm, Division of Pharmascience ..................................111Pfizer Canada..............................................................................502Pharmascience............................................................................109PharmaSystems Inc.....................................................................410Pharmaceutical Partners of Canada

A Company of the Fresenius Kabi Group...............................300Qlean Air Scandinavia ................................................................230RxFiles Academic Detailing Program.........................................119Sandoz Canada Inc. ............................................................201/203Sanofi Canada.............................................................................308Servier Canada ...........................................................................207SteriMax Inc.........................................................................112/114Sunovion Pharmaceuticals Inc. ...................................................129Swisslog Healthcare Solutions....................................................411Teva Canada ...............................................................................310Truven Health Analytics ..............................................................113valeo Pharma..............................................................................400

Exhibitor List (at time of printing)

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All booths are 8’ x 10’, except where noted.Floor plan subject to facility approval.

79 equivalent 8’ x 10’ booths.

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NETWORKWORKWcommunicate

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CSHP has morethan 20 PSNs tojoin! Check outwww.cshp.ca fora complete list. PSNs:

• connect members with others who share a passion for a particular facetof pharmacy practice

• facilitate the quick exchange of ideas, developments, methods,experiences, knowledge to improve practice

• support collaboration on projects, research, and educational programs toaddress the needs of the members of a PSN

• provide additional opportunities for members to serve as both opinionleaders and key resources for CSHP Council on professional specialtyissues, including development of relevant position statements, guidelines,and information papers

Participation in PSNs is free of charge to CSHP members

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Join the Pharmacy Specialty Network! CSHP membership will connectyou with what’s important – people and information.

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For more information about CSHP member benefits, please contact:Membership servicesT: 613-736-9733, ext. 222 | F: 613-736-5660 | E: [email protected] | www.cshp.ca

CSHP M EM BERSHIP HA S M ANY ADVANTAGES

A s a member of CSHP, you connect not only to a strong professionalorganization, but also to a dynamicnetwork of over 3,500 hospital

pharmacy colleagues. When you join CSHP, you instill fresh energy into a 67-year-strongassociation for expanding and improvingprograms and services.

� Advocacy� Awards Program� Canadian Hospital Pharmacy Residency Board� Continuing Education� CSHP 2015� Partner Discount Programs� Fellows Program� Pharmacy Specialty Networks (PSNs)� Products and Services� Professional Liability/Malpractice Insurance� CSHP Research and Education Foundation

MEMBER BENEFITS

Final Program Programme final - English Homepage · Final Program Programme final The Sheraton Centre Toronto Hotel 123 Queen Street West Toronto, ON CSHP ... Poster Abstracts Résumés

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