You are here

Program Highlights

2015

Impact of Modified American Academy of Pediatrics Guideline Implementation on Osteopenia of Prematurity Markers

We are excited to announce that Sinai Health System recently won the 2015 ICHP (Illinois Council of Health System Pharmacists) Best Practice Award.  This annual award recognizes the most innovative program or innovative approach to an existing pharmacy practice challenge within the state of Illinois. A multi-disciplinary, team-based approach was utilized to improve the nutrition of premature infants, with the objective of improving overall health of their bones and to ultimately reduce the risk of fractures.  Bone rounds monitoring lab values and risk factors lead by a clinical pharmacist and clinical dietician in collaboration with the neonatologists contributed to positive results, improving the health and outcomes for our smallest (tiniest) patients at Sinai Children’s Hospital for years to come.

Congrats to:

  • Kuntal Patel, PharmD
  • Pavel Prusakov, PharmD
  • Heather Vaule, MS, RD
  • Victoria Geraldo, MD
  • Departments: Pharmacy, Neonatology, Nutritional Services

In addition to the residency project, which was awarded Best Practice, our resident’s projects are vital and compelling.

Current Projects:

Major Project Title

Baseline retrospective evaluation

Next Steps

Opioid stewardship in post-surgical patients 

 

·         The objective is to evaluate MSH’s baseline opioid discharge prescribing patterns for post-surgical patients.

·         Analysis  includes categorization by  type  of surgery, review of multimodal therapy use,  analyses of analgesics administered 24 hours prior to discharge and each the impact of each endpoint on opioid prescribing at discharge.

·   Baseline results will be compared to current Centers for Disease Control and Prevention (CDC) recommendations, which are that opioid prescriptions for acute pain should be written for 3, but no more than 7 days.

·   Opportunities for improvement will be identified and interventions will be discussed at appropriate committees and implemented.

Appropriateness of Intravenous Vancomycin Utilization

·  This  baseline study retrospectively examines use of vancomycin at MSH; reports in the literature cite inappropriate use ranging between 20-70%

· Results will be reported to the Antibiotic Stewardship and P&T Committees

·   If improvement is warranted, various possible strategies will be discussed at and agreed upon by the Antibiotic Stewardship Committee.

·   Improvements will be implemented and the resultant changes to practice reviewed.

Evaluation of Regadenoson Utilization

·     This study evaluates use of regadenoson as a stress test agent, including any adverse events with  regadenoson administration

·     Also, the current stress testing protocol will be reviewed

 

·      If baseline results determine improvement is warranted, collaboratively work with cardiology to develop new stress testing protocol and order set  

·      Decrease the use of regadenoson , encouraging use of exercise testing, when appropriate

·      Reduce overall cost for MSH 

 

Evaluation of vasopressor discontinuation sequence on hemodynamic stability in septic shock

•       The objective of the baseline evaluation is to determine the effect of the sequence of norepinephrine and vasopressin discontinuation on hemodynamic stability in septic shock.

•       Existing sepsis Order Set & Guideline have been reviewed; preliminary updates  have been approved by the P&T Committee and will be implemented.

•       If baseline results determine improvement is warranted, collaboratively work with ICU practitioners to further edit the Order Set & Guideline. 

•       Evaluate the impact of the changes to the Order Set and Guideline by conducting a follow-up evaluation  and comparing results with baseline.


 

PGY-1 residency projects leading to positive practice change:

 

Project name  

Resident

Preceptor

Brief Project Description

Impact or Practice Change

2017-18

Implementation of Reduced Dose Alteplase for Central Venous Catheter Clearance

Esther Chung

Tejal Patel, Zahra Khudeira

-   This study targeted implementation of reduced dose alteplase for  CVC  clearance.  Esther completed a comprehensive literature review, baseline MUE and a small  post-implementation evaluation.

-    Her efforts included:  

o Pharmacy education (including technicians)

o Physician education  (& CPOE change & Practice change alert); and

o Nursing efforts (Enhancement of EMar documentation, Development of mandatory Nursing Net Learning Module, Issuance of a Nursing Practice Alert).    

- This project optimized med use and ↓’d expenditure

Based on her small post-implementation study (which, importantly, demonstrated no difference in rate of catheter clearance), a minimum cost-savings of $13 K annually is anticipated for MSH alone    

- Now, as detailed in the plan, all catheter clearance doses are prepared in the Pharmacy Clean Room.

 

2017-18

Second-Line Vasopressors in Septic Shock Patients

Krista Policchio

Basi Sanuth

-   Initially,  Krista conducted a  retrospective analysis comparing  use of epinephrine vs. vasopressin as second-line vasopressor in septic shock patients. Both epinephrine and vasopressin achieved similar shock outcomes– however, epinephrine resulted in increased incidence of arrhythmias, with a significantly lower cost than vasopressin.  - Based on the baseline evaluation , Krista provided physician/resident education and changed the sepsis Order Set & Guideline (in late 2017) by delineating second-line vasopressor selection :  epinephrine in patients without tachyarrhythmias and vasopressin those with tachyarrhythmias.

-   Lastly, a follow-up evaluation was completed

-   Krista’s follow-up evaluation demonstrated ↓’d  use of epinephrine in patients with tachyarrhythmias; however, vasopressin use increased overall – even in those patients without tachyarrhythmias. 

-   Further education, reinforcing the data, is warranted.  

-   Sidebar note – use of third-line agent, phenylephrine decreased --- a drug with virtually no evidence-basis for use and thus quality of care was positively impacted.

2017-18

Impact of Incorporating a Pharmacy Resident into a Rapid Diagnosis Protocol for Bloodstream Infections

Daniel Carlsen

Jason Alegro,

Karen Trenkler

-   First Dan conducted a usage evaluation on appropriateness of hospital use of the Rapid Diagnostic Test.

-   Next, for a three month period, benchmarked against the baseline period, he acted in on RDT results, in  the capacity of an Antimicrobial Stewardship pharmacist.

-Dan’s results demonstrated that incorporating an antimicrobial stewardship pharmacist into RDT protocols for blood cultures results can improve patient outcomes – time to optimal therapy ↓’d (trending to significance) as did length of stay.  

- Trends demonstrated, but not statistical significance was not achieved because of prolonged ‘down times’ of evenings & weekends

2017-18

Chronic Care Management Pays Off

Lisa Do

Brooke Griffin, Julio Rebolledo

-Chronic Care Management (CCM)  is a topic at the ‘cutting edge’ of Ambulatory Care.  CCM is defined as non-face-to-face services provided to Medicare beneficiaries (> 65 years) who have multiple (>2) chronic conditions. Medicare may pay for a healthcare professional's help to manage those conditions in non-face-to-face interactions.   Centers for Medicare and Medicaid Services (CMS) estimates 2/3 of Medicare beneficiaries, ≈ 35 million individuals, are eligible for CCM services . 

-CCM is overall cost sparing:  in 2016 CMS paid out $52 million in CCM fees, but, realized a net savings $36 million.  CCM is substantially underutilized in the entire Midwest

-        

-Lisa studied the patient population at two Sinai clinics, evaluating patient profiles for CCM opportunities. 

She provided estimates for the range of reimbursement potential – possible revenues ranged from $530,000/year for 980 standard care patients to $556,000 for 472 complex care e.g., Type 2 DM) patients.  Further, she estimated that it would be a reasonable workload for an ambulatory care pharmacist to conduct 10 x 20 minute phone calls per day, working 260 days per year for a total 0f 2600 standard interventions. 

- Currently there is an ongoing pilot at Sinai clinics

2016-17

Efficacy and safety of inhaled nitric oxide compared to inhaled epoprostenol in patients with acute respiratory distress syndrome

MinHa Kim

Basi Sanuth

-   Baseline Evaluation, with follow-up  

-   P&T Formulary review

-   ICU Order Set & Guidelines

-   Comprehensive clinical staff education

o   MD, RNs, Respiratory Therapists, Pharmacists, Pharmacy Techs

-   Enactment of major critical care practice change, then ensuring integration into actual practice : follow-up, ongoing assessment

Critical Care Practice Change:  Change from Nitric Oxide to Epoprostenol in management of adult ARDS, with comprehensive clinician education.

-       Spared hospital > $ 250K in first year

2016-17

Impact of ambulatory care pharmacy services on human immunodeficiency virus (HIV) patients with concomitant diabetes, hypertension, or both in a safety-net clinic

Diebh Faraj

Sharon Sam , Thomas Yu

-   Baseline Evaluation, with evaluation post  

Incorporation of a pharmacist in HIV clinic

-   Outcomes

o   A1c and BP in HIV patients with DM and/or Hypertension

Demonstration of benefit of clinical pharmacist in an ambulatory care HIV ID clinic  .

2016-17

Medication administration through enteral feeding tubes: a quality improvement project

Katherine Wang

Karen Trenkler, Dallas Schepers

-   Evaluation of  baseline vs. subsequent to resident’s multi-disciplinary efforts

-   P&P and Guideline development

-   Meditech (EMR) enhancement

-   Comprehensive clinical staff ed

o   Nurses, pharmacists

Development of updated P&P, Guideline on Medication Administration through Feeding Tubes.   Meditech messages and alerts.

2016-17

Gentamicin Utilization as Infection Prophylaxis in Open Fractures

Tanya Abi-Mansour

Kuntal Patel,

 Marc McDowell

-   Evaluation of Open Fracture Anti-infective Prophylaxis

-   Development of MSH Guideline on Prophylaxis in Open Fracture Anti-infective

A study of aminoglycoside use in  fracture prophylaxis identified potential for quality improvement in documentation of bone fracture scores

2015-16

Implementation of a behavioral pain score in a community teaching hospital

Darah Preston

Basi Sanuth

-   Baseline Evaluation, with follow-up  

-   Comprehensive clinical staff education

- MD, RNs, Resp Therapist, Pharmacists, Pharm Techs

-   Enactment of major crit care practice change, then ensuring integration into actual practice : follow-up, ongoing assessment

-   Meditech Enhancement

Critical Care Practice Change:   Change in pain assessment from FLACC to BPS, with demonstration of improved criteria and outcomes

2015 - 16

Evaluation of transition from patient controlled analgesia to oral analgesia in post surgical patients

Alok Salgia

  Dallas Schepers, Tejal Patel

-   Baseline MUE, with follow-up MUE

-   Development / Implementation of Order Set to Transition Patients off PCA

-   Comprehensive Clinical Education

- Surgeons, Nurses, Pharmacists

-   Study of opportunities for improvement in the “post-PCA” period post-op

-   Development of an Order Set to facilitate the transition

2015-16

Patient characteristics impacting understanding, retention, and demonstration of inhaler technique in an underserved population

Alika Moitra

Karen Trenkler

-   Baseline evaluation, with follow-up  

-   Study of patient literacy, inhaler knowledge and skill

-   Optimization of patient education materials

-   Development of enhanced educational  material for pharmacy students:  “train the trainer” method

 

- Enhancement of inhaler patient instructional materials, improvement in patient skills and process for ‘training the trainers’  

- Train the Trainer: education of pharm students (w skill competency) to educate our patients.    

2014-15

Evaluation of opportunities for pharmacist integration into the discharge process 

Diane Cluxton

Karen Trenkler

-   Project:  resident functioned as TOC  pharmacist  x 2 months

o   Adm & Dischg Med Hx, Pt Counseling

-   Comparison of readmission rates prior to resident project to those patients with admissions during resident project (those patients benefiting from resident service)

-   Readmission rates tracked

Demonstration of an expanded role for pharmacists at discharge – based on resident effort.  Highlighted significance of accurate ADM Med History. Also, resulted in eventual hire of 2 TOC pharmacists

***One of TOP 4 RESIDENCY PROJECTs of 2015, ICHP ***

2014-15

Clinical and economic outcomes of diabetes management at an outpatient clinic within an urban community hospital system 

Irvin Lau

Anupa Patel

-   Baseline evaluation vs.   FOLLOWING addition of pharmacist to Chronic Disease Amb Care Clinic, focus on DM

-   Outcome:  A1c

Study of the impact of clinical pharmacist to DM outcomes (A1c) in the Ambulatory Care setting

-   resulted in doubling of FTE allocation to Ambulatory Care, from 0.5 to 1.0

2014-15

Impact of modified American Academy of Pediatrics guideline implementation on osteopenia of prematurity markers

Kuntal Patel

Pavel Prusakov

-   Baseline evaluation   vs. subsequent to Bone Round Implementation  

Improvement in Bone Care & Outcomes for NICU preemies

***AWARDED ICHP Best Practice for 2015***.

2013-14

Management of alcohol withdrawal syndromes (AWS) at an urban teaching hospital

Jacqui Aroworade

Adrienne Perotti, Jillian Szseziul

-   Baseline MUE, follow-up MUE

-   Revision of AWS Order Set

Optimization of AWS Order Set

2013-14

A retrospective analysis of vancomycin dosing and monitoring in patients on hemodialysis 

Tyler A Bickel

Karen Trenkler, Basi Sanuth

-   Baseline MUE demonstrating opportunities for improvement

-   Development / Implementation of Guideline, then Protocol, for Vancomycin Dosing in HD

Development of Guidelines for dosing & monitoring of Vancomycin in hemodialysis patients

2013-14

Utilization of  a patient monitoring program to improve patient safety  

Maureen Ebo

Zahra Khudeira

-   Customization of MedMined (surveillance software) for MSH

-   Implementation of MedMined

-   Comprehensive Pharmacist Educatioon

Implementation of surveillance software system (Medmined)

2013-14

Management of sickle cell crisis in an urban teaching hospital 

Uzoma Okeagu

Karen Trenkler

-   MUE

-   Education of Pharmacists

 

Analysis of Efficacy of Analgesia – Design of Guidelines for Sickle

   Cell patients

2012-13

Pharmacist initiative to optimize medication therapy at transitions of care: a focus on human immunodeficiency virus (HIV) patients in an underserved population 

Andrea Bidlencik

Karen Trenkler

-   Baseline MUE, Follow-up MUE

-   Development and Implementation of MSH’s initial inpatient HIV  medication guidelines

-   Meditech EMR automated alerts enhancements

- Pharmacist Education and

- Development of automated alerts to facilitate safe/ effective order review by pharmacists.

- Initial start of MSH’s HIV Stewardship Program

2012-13

Evaluation of the potential use of Hydroxyethyl starch 130/0.4 

Andrew Volk

Karen Trenkler

-   Formulary evaluation & analysis for P&T

-   MUE

Cost – Efficacy review of Plasma Volume Expanders

2011-12

Optimization of Empiric Treatment of Obstetrics and Gynecologic (Ob-Gyn) Infections

Jonathan Murray

Karen Trenkler

-   Baseline MUE

-   Development/Implementation of OB-Gyne Anti-infective Guidelines (new)

-   Comprehensive clinical staff education

o Physicians, pharmacists

Implementation of Empiric Antibiotic Treatment Guidelines for Obstetrics and Gynecologic (Ob-Gyn) Infections

2011-12

Adherence of Patient-Controlled Analgesia Order Form on an Oncology Unit 

Tejal Patel

Zahra Khudeira

-   Baseline MUE

-   Development/Implementation of PCA Orderset

-   EMR (Meditech) Enhancements

-   Comprehensive clinical staff education

o Physicians, pharmacists

-   PCA Order Set, PCA Dosing Card, Automated Nursing Assessments

-   EMR (Meditech) Enhancements