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poster presentations

Angela Baalmann, P4
University of Kansas School of Pharmacy
Encore Presentation


Title
An Interprofessional Simulation: Improving Transitions of Care & Reducing Medical Errors

Objective
This research project was designed, implemented, and facilitated by both University of Kansas Pharmacy Practice and University of Kansas Medical Center healthcare professionals. The objectives of this study were to create and implement a simulation-based learning opportunity for pharmacy and medical students in order to foster greater understanding of transitions of care, the role of pharmacists in contributing to patient care, and to build the skills of medical error recognition, error communication and interprofessional collaboration. This simulation took place over the 2018-2019 academic year and utilized both in-person and telehealth communication methods in order to expose students to some of the multiple modalities used in interprofessional collaboration when caring for patients.

Abstract
Background:
Transitions of care are fraught with medical errors. The importance of healthcare professionals developing the skills to identify and communicate errors cannot be overstated. Interprofessional (IP) collaboration is an essential component in skill development as patient care becomes more complex and integrated across the healthcare continuum. Discharge planning simulated experiences may allow medical and pharmacy students to understand the role of the community pharmacist in contributing to patient care through medication therapy management (MTM), and effectively identify, communicate, and disclose errors to another professional.

Methods:
A simulation was developed for pharmacy and medical students which emphasized IP collaboration in error disclosure. Pre-learning tasks were required for pharmacy students to identify errors using medication reconciliation and MTM tools. Students communicated via a video telehealth conference encounter to identify and correct errors surrounding a transition of care. A 13-item rubric guided the faculty evaluation of pharmacy students’ achievement level of medication error disclosure and IP communication. Data was evaluated using descriptive statistics. A 5-point Likert scale survey assessing students’ experience was conducted both pre and post simulation, data from surveys were evaluated using Wilcoxon Rank Sum statistical analysis.

Results:
Pharmacy student rubric data (N=148) from the academic year 2018-19 revealed a median score of 7/13 for error disclosure and IP communication items, signifying sufficient competency in both areas. The pre-simulation survey (N=254) was compared to the post-simulation survey (N=139) for all medical and pharmacy students. Significant improvements were seen for all students in understanding MTM as performed by community pharmacists (p<0.001), identifying medication errors (p<0.001), and in confidence with disclosing and reporting medical errors (p<0.001).

Conclusion:
This simulation allowed for pharmacy students to identify errors and communicate them to medical students. The simulation increased all students’ ability to practice effective IP communication and students’ confidence in identifying and disclosing medical errors.


Genee Figuieras, P4
University of Kansas School of Pharmacy
Original Research - Complete


Title
P4 Student Resource and Collaboration Platform Utilizing Microsoft Teams

Objective
The Advanced Pharmacy Practice Experience (APPE) rotational year for fourth year pharmacy (P4) students is challenging and demanding. Students must apply clinical knowledge in various practice settings, understand residency application processes, navigate the job market, and student loan repayment. Additionally, P4 students often feel disconnected from each other and from their pharmacy school. The president and vice president of the University of Kansas School of Pharmacy Class of 2021 worked with university faculty and staff in order to facilitate a university-sponsored web-based platform which would to contain resources for P4 utilization during their final year. The Microsoft Teams platform was chosen to provide a unified center with aims to facilitate communication and collaboration between students and to maintain connection to their pharmacy school and classmates.

Abstract
Background:
The Advanced Pharmacy Practice Experience (APPE) rotational year for fourth year pharmacy (P4) students is challenging and demanding. Students must apply clinical knowledge in various practice settings, understand residency application processes, navigate the job market, and student loan repayment. Additionally, P4 students often feel disconnected from each other and from their pharmacy school. We proposed the creation of a platform designed to contain resources for P4 utilization during their final year with aims to facilitate communication and collaboration between students and to maintain connection to their pharmacy school and classmates.

Methods:
Utilizing the Microsoft Teams unified platform, which allows members to form teams and organize topics in channels, a team was created by P4 leadership for the University of Kansas School of Pharmacy Class of 2021 during their P4 year. In coordination with university faculty and staff, a layout was established with multiple channels to provide valuable resources to P4 students. Multiple email and video conference communications with faculty and staff were conducted to create the team while communication with the class of 2021 was performed via email, newsletter and video conference modalities. A video conference informational meeting was conducted within Microsoft Teams to orient students and provide pertinent information on using Microsoft Teams.

Results:
Eleven channels were created based on the following topics; clinical practice guidelines, quick reference guides, drug information resources, medical calculators, patient education resources, APPE rotation resources, residency preparation, NAPLEX and MPJE preparation, student loan management, and P4 achievement highlights.150 users were added to the team.

Conclusion:
A platform which would aid P4 students during their final year in pharmacy school was created. Multiple resources were made available for use and students were oriented to the Microsoft Teams platform. Assessment and adjustment of the team's utility for P4 students is an area of future research.


Natalie Hartung, P4
University of Kansas School of Pharmacy
Original Research - Complete


Title
Evaluation of Granulocyte Colony Stimulating Factor Utilization in Oncology Patients

Objective
The purpose of this quality improvement project was to evaluate the use of granulocyte colony stimulating factors in cancer patients and assess whether induction was in accordance with the updated practice guidelines. Guideline compliance was assessed by reviewing the frequency of inappropriately used growth factor agents among oncology patients across a multi-hospital health system. The aim was to identify whether a problem exists with the current implementation of this medication class for the prevention of neutropenia in oncology patients within Saint Luke's Health System. Appropriate prophylactic use of these agents in patients at an increased risk for neutropenic complications can enhance cost-effectiveness and substantially reduce the costs of treatment care. Additionally, the guideline criteria emphasizing appropriate use of these drugs represents a new opportunity for cost control within in the health system.

Abstract
Background:
Granulocyte colony stimulating factors (G-CSFs) are responsible for regulating the growth and differentiation of cells within the myeloid lineage. The pharmacologic agents of this class, filgrastim and pegfilgrastim, are used in patients receiving myelosuppressive chemotherapy to prevent neutropenic complications that coincide with subsequent use, specifically febrile neutropenia. Identification of chemotherapy regimens with increased risk for neutropenia is key in determining prophylactic use of G-CSF agents. When the risk for febrile neutropenia is >20% or 10-20% along with patient specific risk factors, then primary prophylaxis is warranted. Appropriate use of these agents can reduce the occurrence of neutropenia, therefore limiting dose delays, infections, and hospitalizations.

Methods:
A retrospective chart review was conducted utilizing Saint Luke's Health System EMR program, Epic, from December 2019 through May 2020. Cancer patients who were actively receiving growth factor along with chemotherapy were included. Appropriate use of growth factor was determined based on the risk factors for the development of febrile neutropenia, which were assessed based on chemotherapy regimen risk (high >20%, intermediate 10-20%, low < 10%), patient specific factors, and timing of growth factor administration.

Results:
A total of 254 patients were analyzed for guideline compliance. Inappropriate use of growth factor was identified in 34 (13.4%) of the patients assessed. From these patients, 154 doses of growth factor were administered despite not meeting guideline criteria. Low risk chemotherapy regimens accounted for 32 (94.1%) of the identified misuse; specifically with the GYN paclitaxel/carboplatin regimen (18, 52.9%).

Conclusion:
Among cancer patients receiving chemotherapy, growth factor misuse was most commonly seen in low risk regimens. This ultimately lead to overtreatment and increased health system costs. There is significant need for modification of growth factor use among providers and a possible de-escalation plan for patients no longer on higher risk regimens.


Aletha Loeb, P4
University of Kansas School of Pharmacy
Original Research - Complete


Title
Patient Perceptions of Interprofessional Teams in an Interprofessional Teaching Clinic

Poster Co-Authors
Aletha Loeb, PharmD Candidate 2021; Tumi Osunsanmi, PharmD Candidate 2021; Ashley Crowl, PharmD, BCACP; Brittany Melton, PhD, PharmD

Objective
Examine patient perceptions surrounding interprofessional team-based care.

Abstract
Introduction:
Interprofessional collaborative practice is becoming a prominent focus in healthcare. However, there is minimal literature available evaluating patients' perceptions of team-based care. With the standardization of patient-centered care, determining patients' perceptions of team-based care is important.

Methods:
This study was a single-center, prospective, observational study. Patients completed a voluntary survey focused on the perception of interprofessional teams after visiting with an interprofessional student team. The survey included four questions, utilizing a 5-point Likert-scale from strongly disagree to strongly agree. Additionally, the survey included one open-ended question regarding team-based care. The data was analyzed using descriptive statistics. Some questions were positively and negatively worded to allow for comparison and were analyzed using the Wilcoxon Signed-Rank Test via SPSS®.

Results:
Fifty patients completed the survey in its entirety: 51% were African American, they had a mean age of 51 years old (28% were 65 years or older) and were taking a mean of 8.7 medications (68% met criteria for polypharmacy defined as patients taking five or more medications). Majority of patients (72%) agreed/strongly agreed that meeting with a team improved their care and 72% agreed/strongly agreed meeting with a team allowed for more of their concerns to be addressed. When comparing if patients felt like a team improved their care or if they preferred being seen by only one doctor, patients significantly preferred team-based care (p=0.00).

Conclusions:
When comparing patient preference for care provided by a single physician or a team, patients significantly preferred team-based care. Overall, patients felt that having team-based care improved their care and more concerns were addressed. Evaluating patients' perceptions of team-based care may improve patient care and facilitate shared decision making.


Mackenzy Meinhardt, P4
University of Kansas School of Pharmacy
Original Research - Complete


Title
Excessive Sedation and Cardiorespiratory Depression with Concomitant Use of Parenteral Olanzapine and Benzodiazepines Compared to Olanzapine Alone

Objective
The objective of this study was to investigate further the warning in Zyprexa's package insert that concomitant use of olanzapine and benzodiazepines has a potential increased risk for cardiorespiratory depression and excessive sedation.

Abstract
Background:
The package insert for Zyprexa states it is not recommended to use both olanzapine and benzodiazepines concomitantly due to the potential for excessive sedation and cardiorespiratory depression. The co-administration of these two drugs is common practice for sedation and agitation especially in emergency medicine and critical care. This retrospective study looked to see if there was an increase in cardiorespiratory depression or increased sedation in patients that received co-administration compared to those who only received olanzapine.

Methods:
This one-center retrospective study focused on two patient groups; those that received parenteral olanzapine and a parenteral benzodiazepine concomitantly and patients that only received parenteral olanzapine. Patients must have received olanzapine and a benzodiazepine within 12 hours of each other to be included in the coadministration group. Decreased oxygen saturation, occurrence of a code blue, occurrence of an MRT or mortality within 24 hours of drug administration were assessed to determine an increase in cardiorespiratory depression or increased sedation.

Results:
As of now, there appears to be no significant difference in cardiorespiratory depression or sedation in the co-administration group compared to the olanzapine only group. Further statistic analysis still needs to be completed to see the statistical difference in the two groups.

Conclusion:
Final data collection and statistical analysis still need to be completed. As for now, it appears that the co-administration of the two drugs does not increase the risk for cardiorespiratory depression or sedation.


Tumi Osunsanmi, P4
University of Kansas School of Pharmacy
Original Research - Complete


Title
Patient Perceptions of Medication-Use an Interprofessional Teaching Clinic

Objective
Medications are a large focus in disease-state management. However, minimal literature exists evaluating patients' perceptions of medication-use. With an increasing emphasis on shared decision making and patient-centered care in healthcare, it is important to evaluate patients' perceptions on medication-use. This study was conducted to evaluate patients' perceptions surrounding medication management.

Abstract
Methods:
Patients completed a voluntary survey focused on the perception of medication-use after visiting with an interprofessional student team. The survey included eight questions, utilizing a 5-point Likert-scale from strongly disagree to strongly agree. Additionally, the survey included one open-ended question regarding medications. The data was analyzed using descriptive statistics and differences in responses based on age over 65 and polypharmacy were analyzed using the Wilcoxon Signed-Rank Test via SPSS®.

Results:
Fifty patients completed the survey in its entirety: 51% were African American, they had a mean age of 51 years old (28% were 65 years or older) and were taking a mean of 8.7 medications (68% met criteria for polypharmacy defined as patients taking five or more medications). Sixty-six percent of patients agreed/strongly agreed that medications help them to live a healthier life and 50% agreed/strongly agreed that life would be impossible without their medications. Age over 65 and polypharmacy both significantly impacted patients' perceptions that life would be impossible without their medications, with those over 65 and those with polypharmacy more strongly agreeing with the statement (p=0.28 and p=0.20 respectively).

Conclusion:
People over 65 and those who experience polypharmacy more strongly believe their lives would be impossible without their medications. The majority of patients believed that their medication helped them live a healthier life. Evaluating patients' perceptions about medication will facilitate patient-centered care and hopefully improve medication management.


Matthew Rockhold, P4
University of Kansas School of Pharmacy
Original - Research Complete


Title
Catecholamines Effect on Bacteria

Objective
The purpose of this comprehensive literature review was to observe the effects of catecholamines on bacterial virulence.

Abstract
Background:
Vasopressors and inotropes are frequently used in critically ill and post-surgery patients, and we are increasingly learning about the effects of hormones on both the host immune system and pathogen virulence.

Methods:
A PubMed search conducted 08/18/2020 through 08/20/2020 using the following phrases: “((norepinephrine) OR (vasopressin) OR (dobutamine) OR (milrinone) OR (phenylephrine) OR (isoproterenol) OR (catecholamine) OR (epinephrine) OR (dopamine))” combined with #1 “AND ((bacterial infection) OR (bacterial growth))” #2 AND ((staphylococcus aureus) OR (pseudomonas) OR (Escherichia coli) OR (streptococcus pneumoniae) OR (staphylococcus epidermidis)).” In addition, the references of retrieved articles were reviewed.

Results:
Multiple in vitro and in vivo studies were found evaluating the effects of catecholamines on bacteria. In vitro studies demonstrated that catecholamines can bind iron and deliver it to bacteria. In vitro and in vivo animal studies show many types of bacteria can take up these hormones and use iron for metabolic processes that increase bacterial virulence including bacterial growth, tissue adhesion, colonization, and biofilm formation. In addition, norepinephrine has been shown in vitro and in animal studies to have immunosuppressive effects through its anti-inflammatory effect. This effect is due to increased IL-10, an anti-inflammatory cytokine, synthesis through cAMP and protein kinase A dependent pathways triggered by norepinephrine release.

Conclusion:
The combined effect of catecholamines on bacterial virulence promotion and immunosuppressive action could theoretically lead to increased or more severe primary or secondary infections leading to increased hospital length of stay and mortality. A comparison of clinical infection rates between vasopressors and inotropes is needed to evaluate the potential clinical impact.

Hunter Rondeau, P2
University of Kansas School of Pharmacy
Encore Presentation


Title
Exposing pharmacy students to public health concepts through volunteering in the Medical Reserve Corps

Poster Co-Authors
Hunter Rondeau; Natalie R. Gadbois, PharmD, MPA; Robert L. Emerson Jr., PharmD, RPh

Objective
The purpose of this study was to determine the relationship between pharmacy student involvement in the Medical Reserve Corps and the application of public health concepts in relation to the profession of pharmacy. It was hypothesized that students who volunteer in the Medical Reserve Corps possess a sense of awareness of their profession's role in public health.

Abstract
Method:
A survey was administered to students exposed to a partnership between a Medical Reserve Corps Unit and their School of Pharmacy. Development of the survey was guided by the Center for Advancement of Pharmacy Education (CAPE) 2013 Educational Outcomes, Center for Disease Control and Prevention's Ten Essential Public Health Services, and the Medical Reserve Corps's Mission Statement. The survey included select-all-that apply and a short response question, as well as twenty items that utilized a 5-point Likert scale. Descriptive statistics were performed for all items.

Objectives:
The purpose of this study was to determine the relationship between pharmacy student involvement in the Medical Reserve Corps and the application of public health concepts in relation to the profession of pharmacy. It was hypothesized that students who volunteer in the Medical Reserve Corps possess a sense of awareness of their profession's role in public health.

Results:
Pharmacy students agreed that past and future volunteering in the Medical Reserve Corps helps them to understand their role in public health. On average, pharmacy students agreed (means ranging from 4.43 to 4.71) that they were able to fulfill CAPE Outcomes through volunteering in the Medical Reserve Corps. Additionally, pharmacy students agreed (means ranging from 4.29 to 4.62) that the CDC's Ten Essential Public Health Services fall within the scope of a pharmacist.

Conclusions:
Volunteering in the Medical Reserve Corps has the potential to serve as an application-based learning environment, as pharmacy students had positive viewpoints on their ability to meet educational outcomes and their profession's role in public health.


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