Final Program - Canadian Society of Hospital Pharmacists
Final Program - Canadian Society of Hospital Pharmacists
Final Program - Canadian Society of Hospital Pharmacists
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ANNUAL PROFESSIONAL PRACTICE CONFERENCE<br />
THE LARGEST PHARMACY CONFERENCE IN CANADA<br />
FEBRUARY 4-8, 2012<br />
CONFÉRENCE ANNUELLE SUR LA PRATIQUE PROFESSIONNELLE<br />
LE PLUS GRAND CONGRÈS EN PHARMACIE AU CANADA<br />
4-8 FÉVRIER 2012<br />
<strong>Final</strong> <strong>Program</strong><br />
<strong>Program</strong>me final<br />
The Sheraton Centre Toronto Hotel<br />
123 Queen Street West<br />
Toronto, ON
What is CSHP 2015?<br />
● Vision <strong>of</strong> pharmacy practice excellence in the year 2015<br />
● Strategic objective <strong>of</strong> CSHP’s Vision 2014 which aims to improve<br />
patient medication outcomes and safety by advancing practice<br />
excellence<br />
● A quality care initiative<br />
● A project aiming to answer the questions… “What would make the<br />
most difference to our patients?” and “What will convey the positive<br />
contributions <strong>of</strong> the pharmacist?”<br />
● Six specific goals that will guide practitioners towards the CSHP vision<br />
● Sub-objectives that include measurable targets with established<br />
baselines used to monitor progress, which can be reviewed and<br />
revised as practice goals change<br />
Qu’est-ce que le projet SCPH 2015?<br />
● Une vision de l’excellence en pratique pharmaceutique en l’an 2015<br />
● Un objectif stratégique de la Vision 2014 de la SCPH, lequel s’applique<br />
à améliorer les résultats et la sécurité de la pharmacothérapie des<br />
patients en faisant avancer l’excellence en pratique.<br />
● Un projet axé sur la qualité des soins<br />
● Un projet qui vise à répondre aux questions suivantes : « Qu’est-ce qui<br />
serait le plus pr<strong>of</strong>itable pour nos patients? Qu'est ce qui permettrait de<br />
communiquer les contributions positives du pharmacien? »<br />
● Six buts précis qui aideront les pharmaciens à concrétiser la vision de la<br />
SCPH<br />
● Des objectifs sous-jacents qui sont assortis de cibles mesurables nous<br />
permettant d'établir un point de référence et de suivre les progrès, et<br />
qui pourront être réexaminés et modifiés à mesure que les objectifs et<br />
les lignes directrices de la pratique changent<br />
CSHP<br />
Targeting Excellence in Pharmacy Practice<br />
Goals<br />
1Increase 2Increase 3Increase 4<br />
Increase<br />
5Increase 6Increase the extent to which pharmacists help individual hospital<br />
inpatients achieve the best use <strong>of</strong> medications<br />
the extent to which pharmacists help individual<br />
non-hospitalized patients achieve the best use <strong>of</strong> medications<br />
the extent to which hospital and related healthcare setting<br />
pharmacists actively apply evidence-based methods to the<br />
improvement <strong>of</strong> medication therapy<br />
the extent to which pharmacy departments in hospitals and<br />
related healthcare settings have a significant role in improving the<br />
safety <strong>of</strong> medication use<br />
the extent to which hospitals and related healthcare settings<br />
apply technology effectively to improve the safety <strong>of</strong> medication use<br />
the extent to which pharmacy departments in hospitals and<br />
related healthcare settings engage in public health initiatives on<br />
behalf <strong>of</strong> their communities<br />
To get started on CSHP 2015 now, go to CSHP’s website at www.cshp.ca.<br />
There you will find the complete list <strong>of</strong> goals and objectives, a<br />
self-assessment tool, PowerPoint presentations and more.<br />
*CSHP 2015 was adapted with permission from the ASHP 2015 Initiative.<br />
SCPH<br />
Point de mire sur l’excellence en pratique pharmaceutique<br />
Buts<br />
1<br />
Accroître<br />
le degré d'intervention des pharmaciens auprès de<br />
chaque patient hospitalisé afin d'assurer l'utilisation optimale des<br />
médicaments.<br />
2Accroître le degré d'intervention des pharmaciens auprès de la<br />
clientèle non hospitalisée afin d'assurer une utilisation optimale des<br />
médicaments.<br />
3Étendre l'application du principe des décisions fondées sur les<br />
preuves à la pratique clinique quotidienne des pharmaciens des<br />
établissements de santé dans le but d'améliorer la pharmacothérapie<br />
4Accroître le rôle joué par les départements de pharmacie des<br />
établissements de santé dans l'amélioration de l'utilisation sécuritaire<br />
des médicaments.<br />
5Étendre l'application efficace des technologies dans les<br />
départements de pharmacie des établissements de santé pour<br />
améliorer l'utilisation sécuritaire des médicaments.<br />
6Accroître le degré d'intervention des départements de pharmacie<br />
des établissements de santé dans la mise en oeuvre d'initiatives de<br />
santé publique.<br />
Pour vous engager dès maintenant dans le projet SCPH 2015, visitez le<br />
site Web de la SCPH au www.cshp.ca. Vous y trouverez une liste<br />
complète des buts et des objectifs du projet, un outil d’autoévaluation,<br />
des présentations PowerPoint et d'autres renseignements.<br />
*Le projet SCPH 2015 est une adaptation approuvée de l’ASHP 2015 Initiative.<br />
www.cshp.ca
4<br />
Dear Colleague,<br />
On behalf <strong>of</strong> the Officers, Council and staff <strong>of</strong> the <strong>Canadian</strong> <strong>Society</strong> <strong>of</strong><br />
<strong>Hospital</strong> <strong>Pharmacists</strong> (CSHP), it is our pleasure to welcome you to CSHP’s<br />
43rd Annual Pr<strong>of</strong>essional Practice Conference.<br />
Over the last 10 months, CSHP’s Educational Services Committee has worked<br />
hard to assemble an impressive faculty <strong>of</strong> pharmacy specialists and develop a<br />
program <strong>of</strong> exceptional educational value with topics covering a wide range<br />
<strong>of</strong> specialties, management issues and pharmacy practice-related challenges.<br />
This conference is designed to maximize your opportunities for pr<strong>of</strong>essional<br />
development, networking and socializing with practitioners from across the<br />
country. It is our hope that you are able to take full advantage <strong>of</strong> the 2012<br />
<strong>of</strong>ferings – and enjoy yourself in the process.<br />
At anytime throughout the conference, the Officers and staff <strong>of</strong> CSHP are<br />
available to you. Please let us know if we can answer any <strong>of</strong> your questions,<br />
address any <strong>of</strong> your concerns or be <strong>of</strong> assistance in any way. Be sure to take<br />
a few minutes and stop by the CSHP booth during the exhibits program and<br />
say hello.<br />
We look forward to welcoming each <strong>of</strong> you to another spectacular<br />
conference.<br />
Thank you for your ongoing support <strong>of</strong> CSHP!<br />
Janice Munroe<br />
BScPhm<br />
CSHP President<br />
Myrella Roy<br />
BScPhm, PharmD, FCCP<br />
Executive Director
5<br />
Chères (Chers) collègues,<br />
Au nom de la Direction, du Conseil et du personnel de la Société canadienne<br />
des pharmaciens d’hôpitaux (SCPH), nous avons le plaisir de vous souhaiter la<br />
bienvenue à la 43e Conférence annuelle sur la pratique pr<strong>of</strong>essionnelle de la<br />
SCPH.<br />
Au cours des dix derniers mois, le Comité des services éducatifs de la SCPH<br />
s’est affairé à rassembler un groupe impressionnant de conférenciers<br />
spécialisés en pharmacie et à vous préparer un programme d’une valeur<br />
éducative exceptionnelle avec des sujets touchant un large éventail de<br />
spécialités, de questions relatives à la gestion et de défis posés à la pratique<br />
pharmaceutique. Ce congrès est destiné à maximiser les possibilités de<br />
perfectionnement pr<strong>of</strong>essionnel, de réseautage et de rencontre avec d’autres<br />
praticiens de toutes les régions du pays. Nous espérons que vous pourrez tirer<br />
pleinement pr<strong>of</strong>it de ce que nous vous <strong>of</strong>frons en 2012 – tout en vous<br />
divertissant.<br />
Nous vous rappelons qu’au cours du congrès, la Direction et le personnel de<br />
la SCPH seront à votre entière disposition. Nous ferons tout en notre pouvoir<br />
pour répondre à vos questions, discuter des sujets qui vous préoccupent et<br />
vous aider au besoin de quelques manières que ce soit. Pendant le salon des<br />
exposants, assurez-vous d’effectuer un arrêt au stand de la SCPH afin de<br />
nous saluer!<br />
Nous sommes impatients de vous accueillir à cet autre congrès exceptionnel<br />
et vous remercions de votre appui soutenu à la SCPH.<br />
Janice Munroe<br />
Myrella Roy<br />
B. Sc. Phm. B. Sc. Phm., Pharm. D., FCCP<br />
Présidente de la SCPH<br />
Directrice générale
6<br />
Table <strong>of</strong> Contents<br />
Table des matières<br />
Executive, Council and Staff<br />
Bureau de direction, Conseil et Personnel<br />
Executive Committee Bureau de direction 7<br />
Council Conseil 7<br />
CSHP Staff Personnel de la SCPH 7<br />
With Thanks<br />
Remerciements<br />
CSHP Industry Corporate Members Entreprises membres du secteur de l’industrie 8<br />
CSHP <strong>Hospital</strong> Corporate Members Entreprises membres du secteur hospitalier 8<br />
CSHP Sponsors 2011 Commanditaires de la SCPH en 2011 9<br />
Awards <strong>Program</strong><br />
<strong>Program</strong>me des prix<br />
Distinguished Service Award Prix pour service distingué 10<br />
Isabel E. Stauffer Meritorious Service Award Prix Isabel E. Stauffer pour service méritoire 10<br />
New <strong>Hospital</strong> Pharmacy Practitioner Award Prix du nouveau praticien en pharmacie hospitalière 10<br />
<strong>Hospital</strong> Pharmacy Student Award Prix de l’étudiant en pharmacie hospitalière 10<br />
2011/2012 Awards Committee Comité des prix 2011-2012 11<br />
2011/2012 Awards <strong>Program</strong> <strong>Program</strong>me des prix 2011-2012 11<br />
Tribute to Appraisers Hommage aux évaluateurs 11<br />
Conference Information<br />
Information sur la conférence<br />
Upcoming Events Événements à venir 12<br />
Satellite Symposiums Symposiums satellites 12<br />
CSHP Educational Services Committee Comité des services éducatifs 13<br />
<strong>Program</strong><br />
<strong>Program</strong>me<br />
<strong>Program</strong> <strong>of</strong> Events <strong>Program</strong>me des événements 14<br />
Speakers Abstracts Résumés des conférenciers 22<br />
SES 2012 Call for Abstracts Demande de résumés pour les SÉÉ 2012 41<br />
Oral Presentations Présentations orales 44<br />
Poster Abstracts Résumés des affiches 46<br />
Poster Abstract Reviewers Réviseurs des présentations par affiches 68<br />
CSHP Fellows Associés de la SCPH 69<br />
Faculty Conférenciers 72<br />
Exhibitor List Liste des exposants 73
7<br />
Executive Committee • Bureau de direction<br />
President<br />
Présidente<br />
Janice Munroe<br />
Fraser Health<br />
Langley, BC<br />
President Elect<br />
Président designé<br />
Doug Sellinger<br />
Regina Qu’Appelle Health Region<br />
Pasqua <strong>Hospital</strong> Site<br />
Regina, SK<br />
Past President<br />
Président sortant<br />
Neil MacKinnon<br />
University <strong>of</strong> Arizona<br />
Tucson, AZ<br />
Director <strong>of</strong> Finance<br />
Directeur des finances<br />
Patrick Fitch<br />
Victoria General <strong>Hospital</strong><br />
Winnipeg, MB<br />
Executive Director<br />
Directrice générale<br />
Myrella Roy<br />
<strong>Canadian</strong> <strong>Society</strong> <strong>of</strong> <strong>Hospital</strong><br />
<strong>Pharmacists</strong><br />
Société canadienne des<br />
pharmaciens d’hôpitaux<br />
Ottawa, ON<br />
Council • Conseil<br />
British Columbia<br />
Colombie-Britannique<br />
Bruce Millin<br />
Fraser Health Authority<br />
Langley, BC<br />
Manitoba<br />
Albert Eros<br />
Winnipeg Regional Health<br />
Authority<br />
Winnipeg, MB<br />
Quebec<br />
Québec<br />
Diem Vo<br />
Hôpital Pierre-Boucher<br />
Longueuil, QC<br />
Prince Edward Island<br />
Île-du-Prince-Édouard<br />
Amy Cheverie<br />
Kings County Memorial <strong>Hospital</strong><br />
Montague, PE<br />
Alberta<br />
Sheri Koshman<br />
University <strong>of</strong> Alberta<br />
Calgary, AB<br />
Saskatchewan<br />
Donald Kuntz<br />
Regina Qu’Appelle Health Region<br />
Regina, SK<br />
Ontario – Senior/Principale<br />
Rita Dhami<br />
London Health Sciences Centre<br />
London, ON<br />
Ontario – Junior/Débutant<br />
Olavo Fernandes<br />
University Health Network<br />
Toronto, ON<br />
New Brunswick<br />
Nouveau-Brunswick<br />
Faith Louis<br />
Horizon Health Network<br />
Fredericton, NB<br />
Nova Scotia<br />
Nouvelle-Écosse<br />
Theresa Hurley<br />
QEII Health Sciences Centre<br />
Halifax, NS<br />
Newfoundland and Labrador<br />
Terre-Neuve-et-Labrador<br />
Tiffany Lee<br />
General <strong>Hospital</strong>,<br />
Health Sciences Centre<br />
St. John’s, NL<br />
Student Delegate<br />
Déléguée des étudiants<br />
Megan Riordon<br />
Dalhousie University<br />
Halifax, NS<br />
CSHP Staff • Personnel de la SCPH<br />
Executive Director<br />
Directrice générale<br />
Myrella Roy<br />
Operations Manager<br />
Gérante des opérations<br />
Laurie Frid<br />
Coordinator, Pr<strong>of</strong>essional &<br />
Membership Affairs<br />
Coordonnatrice, Affaires<br />
pr<strong>of</strong>essionnelles et service<br />
aux membres<br />
Cathy Lyder<br />
Executive Assistant<br />
Adjointe de direction<br />
Rosemary Pantalone<br />
Conference & PSN<br />
Administrator<br />
Agente des congrès et des RSP<br />
Desarae Davidson<br />
Membership & Awards<br />
Administrator (on leave)<br />
Agente du service aux<br />
membres et des prix<br />
(en congé)<br />
Robyn Rockwell<br />
Interim Membership & Awards<br />
Administrator<br />
Agente par intérim du service<br />
aux membres et des prix<br />
Amanda Cuirrier<br />
CHPRB & Advocacy<br />
Administrator<br />
Agente du CCRPH et de la<br />
valorisation<br />
Gloria Day<br />
Finance Administrator<br />
Agente des finances<br />
Anna Dudek<br />
Publications Administrator<br />
Agente des publications<br />
Colleen Drake<br />
Web Administrator<br />
Agente du Web<br />
Olga Chrzanowska<br />
Ontario Branch & Board <strong>of</strong><br />
Fellows Administrator<br />
Agente de la section de<br />
l’Ontario et du Conseil des<br />
associés<br />
Susan Korporal<br />
CSHP 2015 Project Coordinator<br />
Coordonnatrice du projet<br />
SCPH 2015<br />
Carolyn Bornstein<br />
CSHP Research and Education<br />
Foundation Administrator<br />
Agente de la Fondation pour<br />
la recherche et l’éducation de<br />
la SCPH<br />
Janet Lett
8<br />
2011-2012 CSHP<br />
Industry Corporate Members<br />
(At time <strong>of</strong> printing)<br />
2011-2012 Entreprises membres du<br />
secteur de l’industrie<br />
(au moment de l’impression)<br />
2010-2011 CSHP<br />
<strong>Hospital</strong> Corporate Members<br />
(At time <strong>of</strong> printing)<br />
2010-2011 Entreprises membres du<br />
secteur hospitalier<br />
(au moment de l’impression)<br />
Amgen Canada Inc.<br />
AstraZeneca Canada Inc.<br />
Bayer Inc.<br />
<strong>Canadian</strong> Pharmaceutical Distribution Network<br />
Eli Lilly Canada Inc.<br />
Fresenius Kabi Canada<br />
Galenova Inc.<br />
Healthmark Ltd.<br />
Hospira Healthcare Corporation<br />
LIfeScan Canada<br />
Alberta Health Services<br />
Horizon Health Network<br />
Lakeridge Health Network<br />
London Health Sciences Centre<br />
Medbuy Corporation<br />
Northern Health<br />
St. Michael’s <strong>Hospital</strong><br />
The Royal Victoria <strong>Hospital</strong> <strong>of</strong> Barrie<br />
University Health Network<br />
McKesson Canada Corporation<br />
Merck Canada Inc.<br />
Omega Laboratories Ltd.<br />
Pendopharm, a Division <strong>of</strong> Pharmascience Inc.<br />
Pfizer Canada Inc.<br />
Pharmaceutical Partners <strong>of</strong> Canada<br />
A Company <strong>of</strong> the Fresenius Kabi Group<br />
San<strong>of</strong>i-aventis Canada Inc.<br />
Teva Canada
9<br />
CSHP Sponsors 2011<br />
The following list reflects all CSHP<br />
Sponsorship received from January 1 to<br />
December 31, 2011.<br />
Commanditaires de la<br />
SCPH en 2011<br />
La liste suivante reflète toutes les<br />
commandites reçues du premier janvier au<br />
31 décembre 2011.<br />
Diamond Sponsor<br />
Commanditaires diamant<br />
$80,000 or greater<br />
80 000 $ et plus<br />
CSHP<br />
Targeting Excellence in Pharmacy Practice<br />
Platinum Sponsor<br />
Commanditaires platine<br />
$60,000 - $79,999<br />
• Hospira Healthcare Corporation<br />
Gold Sponsor<br />
Commanditaires or<br />
$40,000 - $59,999<br />
• Boehringer-Ingelheim Canada Ltd.<br />
• Eli Lilly Canada Inc.<br />
• TEVA Canada<br />
Silver Sponsor<br />
Commanditaires argent<br />
$20,000 - $39,999<br />
• Apotex Inc.<br />
• AstraZeneca<br />
• Bayer Inc.<br />
• Johnson & Johnson Family <strong>of</strong> Companies<br />
• Merck Canada Inc.<br />
Bronze Sponsor<br />
Commanditaires bronze<br />
$10,000 - $19,999<br />
• Abbott Laboratories Inc.<br />
• Mylan Pharmaceuticals<br />
• Pendopharm,<br />
a division <strong>of</strong> Pharmascience Inc.<br />
• San<strong>of</strong>i-aventis Canada Inc.<br />
CSHP would like to acknowledge and thank the following CSHP Sponsors for their<br />
contributions to CSHP 2015 initiatives:<br />
• Pfizer Canada Inc.<br />
• Sandoz Canada Inc.<br />
• Pharmaceutical Partners <strong>of</strong> Canada<br />
A Company <strong>of</strong> the Fresenius Kabi Group<br />
SCPH<br />
Point de mire sur l’excellence en pratique pharmaceutique<br />
Donor Sponsor<br />
Commanditaires donateurs<br />
$1000 - $9,999<br />
• Alveda Pharma<br />
• AmeriscourceBergen Canada<br />
• Amgen Canada Inc.<br />
• Astellas Canada<br />
• ATP a TCP Company<br />
• B Braun Medical Inc.<br />
• Baxa Corporation<br />
• Baxter Corporation<br />
• British Columbia Ministry <strong>of</strong> Health<br />
• Bristol-Meyers Squibb Canada<br />
• <strong>Canadian</strong> Agency for Drugs and<br />
Technologies in Health (CADTH)<br />
• Caverly Consulting Group<br />
• <strong>Canadian</strong> Pharmaceutical Distribution<br />
Network (CPDN)<br />
• <strong>Canadian</strong> Patient Safety Institute (CPSI)<br />
• Fraser Health Authority<br />
• Galenova Inc.<br />
• Healthmark Ltd.<br />
• HealthPRO<br />
• H<strong>of</strong>fman La Roche Limited<br />
• HSBC<br />
• LEO Pharma Inc.<br />
• Lexi-comp Inc.<br />
• Lundbeck Canada Inc.<br />
• Manrex Ltd.<br />
• McKesson Canada<br />
• Medbuy<br />
• Department <strong>of</strong> National Defence (DND)<br />
• Northwest Telepharmacy<br />
• Novartis Pharma Canada<br />
• Omega Laboratories Limited<br />
• Omnicell<br />
• Ontario College <strong>of</strong> <strong>Pharmacists</strong> (OCP)<br />
• PCCA Canada<br />
• Pharmacy Examining Board <strong>of</strong> Canada<br />
(PEBC)<br />
• RxFiles - Academic Detailing <strong>Program</strong><br />
• Servier Canada Inc.<br />
• Shoppers Drug Mart Specialty Health<br />
• St. Paul’s <strong>Hospital</strong><br />
• SteriMax Inc.<br />
• Swisslog Healthcare Solutions
10<br />
Distinguished Service<br />
Award<br />
Prix pour service<br />
distingué<br />
Sponsored by Johnson & Johnson Family<br />
<strong>of</strong> Companies • $10,000<br />
This award recognizes outstanding<br />
achievement in hospital pharmacy<br />
practice.<br />
Individuals are nominated by their peers.<br />
2012 Winner<br />
Carolyn Bornstein<br />
Past Winners<br />
2011 Myrella Roy<br />
2010 Emily Musing<br />
2009 Robin Ensom<br />
2008 Nancy Roberts<br />
2007 Thomas W. Paton<br />
2006 Linda Poloway<br />
2005 Bill Bartle<br />
2004 Garry King<br />
2003 Bob Nakagawa<br />
2002 Glen R. Brown<br />
2001 Charlie Bayliff<br />
2000 James Blackburn<br />
1999 Bonnie Salsman<br />
1998 Scott Walker<br />
1997 Rosemary Bacovsky<br />
1996 Kevin Hall<br />
1995 James L. Mann<br />
1994 William McLean<br />
1993 Pauline Beaulac<br />
1992 William Wilson<br />
1991 C. Brian Tuttle<br />
1990 Reta Fowler<br />
1989 Alan Samuelson<br />
1988 Bruce R. Schnell<br />
1987 Jack Dancey<br />
1986 William R. Foltas*<br />
1985 Donna M. Shaw*<br />
1984 Sister Grace Sauvé<br />
1983 Mary T. Gannon*<br />
1982 J. Glen Moir*<br />
1981 Brian A. Dinel<br />
1980 Betty C. Riddell<br />
1979 Jack L. Summers*<br />
1978 Douglas J. Stewart*<br />
1977 Phyllis Yagi*<br />
1976 Orest Buchko<br />
1975 Muriel Hale<br />
1974 Anne O’Toole<br />
1973 Leonard Gibson*<br />
1972 J. Edwin Smith*<br />
1971 Paule Benfante<br />
1970 Gordon Brown*<br />
1969 Isabel E. Stauffer*<br />
1968 Jacqueline McCarthy<br />
1967 Michael J.V. Naylor<br />
*Deceased<br />
Isabel E. Stauffer<br />
Meritorious Service<br />
Award<br />
Prix Isabel E. Stauffer<br />
pour service méritoire<br />
Sponsored by Pharmaceutical Partners <strong>of</strong><br />
Canada A Company <strong>of</strong> the Fresenius Kabi<br />
Group • $3,750<br />
This award recognizes prolonged service<br />
and involvement in CSHP, primarily at the<br />
branch or chapter level.<br />
Individuals are nominated by their peers.<br />
2012 Winner<br />
Judy Chong<br />
Past Winners<br />
2011 John McBride<br />
2010 Victoria Sills<br />
2009 Lynda Chilibeck<br />
2008 Catherine Doherty<br />
2007 Harry S. Hopkins<br />
2006 Susan Poulin<br />
2005 Donna Wheeler-Usher<br />
2004 Nancy Roberts<br />
2003 Margaret Gray<br />
2002 Margaret Colquhoun<br />
2001 No candidates this year<br />
2000 Kelly Babcock<br />
1999 Linda Poloway<br />
1999 Kenneth McGregor<br />
1998 Larry Legare<br />
1998 Emily Somers<br />
1997 No candidates this year<br />
1996 Dennis Leith<br />
1996 Robert S. Nakagawa<br />
1995 Donna Pipa<br />
1995 Kristina Wichman<br />
1994 Rosemary Bacovsky<br />
1994 Roy A. Steeves<br />
1993 No candidate this year<br />
1992 John Iazzetta<br />
1992 Cecilia Laskoski<br />
1991 Louanne Twaites<br />
1991 David Windross<br />
1990 Doris A. Thompson<br />
1989 Fred Rumpel<br />
1988 D. Bryce Thompson<br />
1987 Alan Samuelson<br />
1986 Herbert A. Dixon<br />
1986 A.W. Stanley Garvin<br />
New <strong>Hospital</strong> Pharmacy<br />
Practitioner Award<br />
Prix du nouveau<br />
praticien en pharmacie<br />
hospitalière<br />
Sponsored by<br />
Sandoz Canada Inc. • $3,750 x 2<br />
This award acknowledges new hospital<br />
pharmacy practitioners, who through their<br />
service to patient care, to education or<br />
research, to the pr<strong>of</strong>ession and to the<br />
society, are worthy <strong>of</strong> recognition. The<br />
individuals exhibit promising leadership,<br />
dedication and commitment to practice<br />
excellence and pr<strong>of</strong>essional growth.<br />
2012 Winners<br />
Christina Adams & Erin Marie Yakiwchuk<br />
Past Winners<br />
2011 Zack Dumont & Shanna Trenaman<br />
2010 Erin Cashin & Rochelle Gellatly<br />
2009 Eva Cho & Lynette Kolodziejak<br />
2008 Yvonne Kwan & Adrienne Lindblad<br />
2007 Tracy Cheung & Jennifer Dyck<br />
2006 Dawn Dalen & Gloria Tsang<br />
2005 Stephanie Ong & Kerry Wilbur<br />
<strong>Hospital</strong> Pharmacy<br />
Student Award<br />
Prix de l’étudiant en<br />
pharmacie hospitalière<br />
Sponsored by CSHP and the <strong>Canadian</strong><br />
Association <strong>of</strong> Pharmacy Students and<br />
Interns (CAPSI) • $500<br />
This award recognizes pharmacy students<br />
who show promise as future hospital<br />
pharmacy practitioners through their<br />
student activities or their experiential<br />
training in direct patient care, research or<br />
education. The winners exhibit eagerness,<br />
dedication and a positive attitude toward<br />
the academic learning, the practice, and<br />
the pr<strong>of</strong>ession <strong>of</strong> hospital pharmacy.<br />
2012 Winner<br />
Sarah Hasenbank<br />
Past Winners<br />
2011 Jessica Gagatek & Timothy Leung<br />
2010 Christine Leong<br />
2009 Amy Grossberndt<br />
2008 Omolayo O. Famuyide<br />
2007 Cathryn Sibbald<br />
2006 Justin Lee
11<br />
2011-2012 Awards Committee<br />
Comité des prix 2011-2012<br />
Sincere appreciation is extended to the CSHP National Awards<br />
Committee.<br />
Chairperson<br />
Présidente<br />
Kathryn Hollis<br />
Management and Leadership<br />
Best Practices Award<br />
Sponsored by:<br />
Apotex Inc. ...................$3,750<br />
Hospira Healthcare<br />
Corporation ..................$3,750<br />
Patient Care Enhancement<br />
Award<br />
Sponsored by:<br />
AstraZeneca<br />
Canada Inc. ..................$3,750<br />
TEVA Canada................$3,750<br />
Pharmacotherapy Best<br />
Practices Award<br />
Sponsored by:<br />
Merck Canada Inc.........$3,750<br />
Pfizer Canada Inc. .........$3,750<br />
Members<br />
Membres<br />
Candra Cotton<br />
Janice Ma<br />
My-Linh Nguyen<br />
Pooja Patel<br />
Rosemary Zvonar<br />
2011-2012 Awards <strong>Program</strong><br />
<strong>Program</strong>me des prix 2011-2012<br />
The CSHP general awards program will be presented in six<br />
categories with nine sponsors, as listed below. The redesign was<br />
implemented several years ago. This was a recommendation by the<br />
Members Rewards and Recognition Task Force in order to update<br />
the program, increase accessibility and foster innovative pharmacy<br />
practice.<br />
Safe Medication Practices<br />
Award<br />
Sponsored by:<br />
Baxter Corporation .......$3,750<br />
Hospira Healthcare<br />
Corporation ..................$3,750<br />
Specialties in Pharmacy<br />
Practice Award<br />
Sponsored by:<br />
Pharmascience Inc. .......$3,750<br />
Hospira Healthcare<br />
Corporation ..................$3,750<br />
Teaching, Learning and<br />
Education Award<br />
Sponsored by:<br />
Eli Lilly Canada Inc. ......$3,750<br />
2011-2012 Tribute to CSHP National<br />
Award Appraisers<br />
Hommage aux évaluateurs<br />
Award appraisers are an integral part <strong>of</strong> the CSHP National Awards<br />
program. We would like to extend our sincere thanks to the<br />
individuals listed below who volunteered their time to review this<br />
year’s award submissions. We are very grateful to you for sharing<br />
your time and expertise in support <strong>of</strong> the CSHP Awards <strong>Program</strong>.<br />
Without your dedicated efforts on the <strong>Society</strong>’s behalf, the program<br />
would not exist.<br />
Shirin Abadi<br />
Alison Alleyne<br />
Mayce Al-Sukhni<br />
Trudy Arbo<br />
Tejinder Bains<br />
Swasti Bhajan-Mathur<br />
Judy Chong<br />
Celine Corman<br />
Anne Dar Santos<br />
Mario De Lemos<br />
Anar Dossa<br />
Douglas Doucette<br />
Liz Edwards<br />
Dinie Engels<br />
Barb Evans<br />
Olavo Fernandes<br />
Michelle Foisy<br />
Susan Halasi<br />
Nicholas Honcharik<br />
Sherilyn Houle<br />
Christine Hughes<br />
Cynthia Jackevicius<br />
Derek Jorgenson<br />
Christopher Judd<br />
Jean-Yves Julien<br />
Zahra Kanji<br />
Heather Kertland<br />
Jaclyn LeBlanc<br />
Larry Legare<br />
Adrienne Lindblad<br />
Anita Lo<br />
Peter Loewen<br />
Barry Lyons<br />
Janice Ma<br />
Greta Mah<br />
Mark Makowsky<br />
Anne Massicotte<br />
Karen McDermaid<br />
Tania Mysak<br />
Carmine Nieuwstraten<br />
Glen Pearson<br />
Patricia Pracsovics<br />
Irina Rajakumar<br />
Cheryl Sadowski<br />
Brenda Schuster<br />
Roy Steeves<br />
Daniel Thirion<br />
Joyce Totton<br />
Régis Vaillancourt<br />
Lori Wazny<br />
Bertha (Mary) Whyte<br />
Sharon Yamashita<br />
Peter Zed<br />
If you are interested in acting as an appraiser for the 2012-2013<br />
Awards <strong>Program</strong>, please contact Amanda Cuirrier:<br />
Tel.: 613-736-9733, ext. 222<br />
Fax: (613) 736-5660or<br />
Email at acuirrier@cshp.ca.
12<br />
Upcoming Events<br />
Événements à venir<br />
Pr<strong>of</strong>essional Practice<br />
Conference (PPC):<br />
February 2-6, 2013<br />
Sheraton Centre Toronto Hotel<br />
February 1-5, 2014<br />
Sheraton Centre Toronto Hotel<br />
January 31-February 4, 2015<br />
Sheraton Centre Toronto Hotel<br />
January 30-February 3, 2016<br />
Sheraton Centre Toronto Hotel<br />
Summer Educational<br />
Sessions (SES):<br />
August 11-14, 2012<br />
Delta Prince Edward Hotel<br />
Charlottetown, Prince Edward Island<br />
August 10-13, 2013<br />
Hyatt Regency Calgary<br />
Calgary, Alberta<br />
August 9-12, 2014<br />
Delta Newfoundland Hotel<br />
St. John’s, Newfoundland & Labrador<br />
August 8-11, 2015<br />
Hilton London Ontario<br />
London, Ontario<br />
Attendance at CSHP conferences, PPC and<br />
SES, are approximately 550 and 250<br />
respectively, excluding exhibitors. Please<br />
note we <strong>of</strong>fer an exhibit program at both<br />
events.<br />
For further information, please contact<br />
Desarae Davidson, Conference & PSN<br />
Administrator.<br />
Tel.: (613) 736-9733, ext. 229<br />
Fax: (613) 736-5660<br />
Email: ddavidson@cshp.ca<br />
Satellite Symposiums<br />
Symposiums satellites<br />
CSHP would like to thank the following<br />
sponsors <strong>of</strong> Satellite Symposiums for their<br />
participation in conjunction with the<br />
PPC 2012.<br />
Sunday, February 5<br />
12:15-13:45 • AstraZeneca Canada<br />
• Boehringer-Ingelheim<br />
Canada Inc.<br />
• Eli Lilly Canada Inc.<br />
Monday, February 6<br />
17:30-19:30 • Janssen Inc. Canada<br />
• Hospira Healthcare<br />
Corporation<br />
Tuesday, February 7<br />
17:30-19:30 • Hospira Healthcare<br />
Corporation<br />
• Otsuka Pharmaceutical Inc.<br />
Wednesday, February 8<br />
12:40-14:10 • Bayer Inc.<br />
• Purdue Pharma<br />
See the program section for more details.<br />
Satellite<br />
Symposium<br />
SPONSORSHIP<br />
OPPORTUNITY<br />
65th Summer Educational Sessions<br />
Delta Prince Edward Hotel<br />
Charlottetown, PEI<br />
August 11 to 14, 2012<br />
Breakfast and<br />
Luncheon Availability<br />
For more information please contact<br />
Desarae Davidson<br />
Conference & PSN Administrator<br />
(613) 736-9733, ext. 229 or<br />
ddavidson@cshp.ca
13<br />
The Educational Services Committee<br />
Le Comité des services éducatifs<br />
EP C.C.E.P.<br />
<strong>Canadian</strong> Council on<br />
Continuing Education in Pharmacy<br />
Chairperson • Présidente<br />
Margaret Ackman, PharmD, FCSHP<br />
Alberta Health Services<br />
Edmonton, AB<br />
Members • Membres<br />
Toni Bailie, BScPhm<br />
Mount Sinai <strong>Hospital</strong><br />
Toronto, ON<br />
Claudia Bucci, PharmD<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
Allison Callaghan, BScPhm<br />
QEII Health Sciences Centre<br />
Halifax, NS<br />
Roxane Carr, PharmD, BCPS, FCSHP<br />
BC Children’s and Women’s Health Centre<br />
Vancouver, BC<br />
Clarence Chant, PharmD, FCSHP<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Elaine Chong, PharmD, BCPS<br />
BC Ministry <strong>of</strong> Health Services<br />
New Westminster, BC<br />
Judy Chong, BScPhm<br />
Royal Victoria <strong>Hospital</strong> <strong>of</strong> Barrie<br />
Barrie, ON<br />
Olavo Fernandes, PharmD, FCSHP<br />
University Health Network<br />
Toronto, ON<br />
Alfred Gin, PharmD, FCSHP<br />
Health Sciences Centre<br />
Winnipeg, MB<br />
Colette Raymond, PharmD<br />
Winnipeg Regional Health Authority<br />
Winnipeg, MB<br />
Kat Timberlake, PharmD<br />
The <strong>Hospital</strong> for Sick Children<br />
Toronto, ON<br />
Erica Wang, BScPhm<br />
PharmD Candidate<br />
University <strong>of</strong> British Columbia<br />
Vancouver, BC<br />
The Educational Services Committee (ESC) <strong>of</strong><br />
CSHP has been working for approximately<br />
10 months on the content and format <strong>of</strong><br />
PPC 2012. The committee also works on the<br />
Summer Educational Sessions, in<br />
conjunction with the local host task force<br />
and the national <strong>of</strong>fice. The ESC is<br />
comprised <strong>of</strong> a core committee <strong>of</strong> 15 CSHP<br />
members as well as corresponding members<br />
from the CSHP branches.<br />
Goal and Objectives for the<br />
2012 PPC <strong>Program</strong><br />
Goal:<br />
• To provide registrants with quality<br />
educational sessions.<br />
Objectives:<br />
• To provide educational sessions which<br />
inform, educate and motivate clinical<br />
practitioners and managers.<br />
• To provide leadership in hospital<br />
pharmacy practice by presenting sessions<br />
on innovative pharmacists’ roles,<br />
pharmacy practice and pharmacy<br />
programs.<br />
• To promote life-long learning skills<br />
through active participation in<br />
problem-based workshops.<br />
• To provide registrants with networking<br />
and sharing opportunities through the<br />
exhibits program and poster sessions.<br />
• To promote excellence in pharmacy<br />
practice through oral and poster<br />
presentations <strong>of</strong> original work and<br />
award winning projects.<br />
• To provide an opportunity for Pharmacy<br />
Specialty Networks to share their<br />
expertise with others and meet as<br />
Networks.<br />
Le Comité des services éducatifs travaille<br />
depuis près de 10 mois à l’élaboration du<br />
contenu et de la forme de la CPP 2012.<br />
Le Comité prépare aussi les Séances<br />
éducatives d’été de la SCPH en<br />
collaboration avec le Groupe de travail<br />
hôte local et le personnel de la SCPH. Le<br />
Comité comprend 15 membres principaux<br />
et membres correspondants des sections<br />
de la SCPH.<br />
But et objectifs du<br />
programme de la CPP 2012<br />
But :<br />
• Présenter des conférences éducatives de<br />
qualité aux participants.<br />
Objectifs :<br />
• Présenter aux personnes inscrites des<br />
conférences éducatives susceptibles<br />
d’informer, d’instruire et de motiver les<br />
cliniciens et les gestionnaires.<br />
• Orienter la pratique de la pharmacie<br />
hospitalière en présentant des<br />
conférences sur les nouveautés touchant<br />
le rôle du pharmacien, la pratique de la<br />
pharmacie et les programmes de<br />
pharmacie.<br />
• Développer des habiletés pour un<br />
apprentissage continu par une<br />
participation active à des ateliers de<br />
formation axés sur la résolution de<br />
problèmes.<br />
• Donner aux participants des occasions<br />
de réseautage et d’échanges grâce au<br />
salon des exposants, aux séances<br />
d’affichage et aux discussions<br />
interactives structurées.<br />
• Promouvoir l’excellence dans la pratique<br />
de la pharmacie par des présentations<br />
orales et des séances d’affichage sur des<br />
travaux originaux et des projets primés.<br />
• Donner l’occasion aux réseaux de<br />
spécialistes en pharmacie de se réunir et<br />
de partager leur savoir-faire.
14<br />
<strong>Program</strong><br />
<strong>Program</strong>me<br />
Saturday, February 4 • Samedi 4 février<br />
15:00-17:00 Registration<br />
Inscription<br />
CONCOURSE COAT CHECK<br />
17:30-19:30 CHPRB 50th Anniversary Reception<br />
Everyone welcome<br />
Réception pour le 50 e anniversaire du CCRPH<br />
Bienvenue à tous<br />
CHURCHILL ROOM<br />
Sponsored by Pendopharm,<br />
a division <strong>of</strong> Pharmascience Inc.<br />
Sunday, February 5 • Dimanche 5 février<br />
Research Focus Day<br />
Journée consacrée à la recherche<br />
07:30-17:00 Registration<br />
Inscription<br />
CONCOURSE COAT CHECK<br />
08:00-08:15 Opening Remarks<br />
Remarques préliminaires<br />
DOMINION BALLROOM<br />
08:15-09:15 Motivational Plenary<br />
Assemblée plénière de motivation<br />
DOMINION BALLROOM<br />
Dr. Roberta Bondar, OCO Ont, MD, PhD, FRCP, FRSC<br />
Consultant, Physician, Scientist, Author,<br />
Photographer, Educator<br />
Canada’s first female astronaut. Dr. Roberta Bondar<br />
is an advocate for our unique planet after the rare<br />
opportunity to view Earth from space. As science<br />
and photography have always been linked in Dr.<br />
Bondar’s life, it was natural that one <strong>of</strong> Bondar’s<br />
assignments aboard the space shuttle Discovery in<br />
January 1992 was to take photographs <strong>of</strong> Earth.<br />
Sponsored by Sandoz Canada Inc. through an<br />
unrestricted educational grant<br />
9:30-11:00 Facilitated Poster Session<br />
Discussions <strong>of</strong> original research, award-winning<br />
projects and pharmacy practice projects<br />
Séance animée de présentations par<br />
affiches<br />
Discussions sur des projets de recherche originale,<br />
des projets primés et des projets dans le domaine<br />
de la pratique pharmaceutique<br />
ESSEX BALLROOM<br />
11:15-12:00 Concurrent Sessions<br />
Séances concomitantes<br />
1. Managing Acute Stroke: What You Need<br />
To Know<br />
WINDSOR<br />
Tania Mysak, BSP, PharmD<br />
Alberta Health Services<br />
Edmonton, AB<br />
2. Extended Infusion <strong>of</strong> Beta Lactams: A<br />
Primer on Why, When, and Mainly How<br />
SIMCOE/DUFFERIN<br />
Sandra Walker, BSc, BScPhm, ACPR, PharmD,<br />
FCSHP<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
3. Smartphones: A Novel “App”roach to<br />
Patient Care<br />
CONFERENCE B/C<br />
Sean Spina, BScPhm, ACPR, PharmD<br />
Vancouver Island Health Authority<br />
Victoria, BC<br />
4. Understanding Observational Studies and<br />
Implications for Patient Care<br />
CONFERENCE D/E<br />
David Juurlink, BScPhm, MD, PhD, FRCPC<br />
Sunnybrook Health Sciences Centre<br />
Institute for Clinical Evaluative Sciences<br />
Toronto, ON<br />
12:15-13:45 Satellite Symposiums<br />
Luncheon included<br />
Symposiums satellites<br />
Dîner inclus<br />
1. Pharmacy C.A.R.E. in ACS (Clinical<br />
Advances for the Reduction <strong>of</strong> Events)<br />
CITY HALL<br />
Patrick Robertson, PharmD – Moderator<br />
Saskatoon Health Region<br />
Saskatoon, SK<br />
Jennifer Pickering, BScPhm, ACPR<br />
Hamilton Health Sciences<br />
Hamilton, ON<br />
Hosted by AstraZeneca Canada<br />
2. From Sliding Scale to Basal Bolus:<br />
Optimizing the Management <strong>of</strong><br />
Hyperglycemia in Non-Critically Ill<br />
<strong>Hospital</strong>ized Patients<br />
DOMINION BALLROOM NORTH<br />
Anar Dossa, BScPhm, PharmD, CDE<br />
Vancouver General <strong>Hospital</strong><br />
Vancouver, BC<br />
Maureen Clement, MD, CCFP<br />
University <strong>of</strong> British Columbia<br />
Vancouver, BC<br />
Hosted by Eli Lilly Canada Inc.
15<br />
3. Preventing Stroke in Atrial Fibrillation:<br />
From Clinical Trials to the Bedside<br />
DOMINION BALLROOM SOUTH<br />
William Semchuk, MSc, PharmD, FCSHP (Chair)<br />
Regina Qu’Appelle Health Region<br />
Regina, SK<br />
Claudia Bucci, PharmD<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
Hosted by Boehringer-Ingelheim Canada Inc.<br />
14:00-16:00 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. Research Design for Dummies:<br />
Chart Review Studies<br />
SIMCOE/DUFFERIN<br />
Ross Tsuyuki, BScPhm, PharmD, MSc, FCSHP,<br />
FACC<br />
Faculty <strong>of</strong> Medicine and Dentistry<br />
University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
2. Geriatrics PSN<br />
RSP en gériatrie<br />
CONFERENCE B/C<br />
Antipsychotic Use Circa 2012: What Have<br />
We Learned Regarding Their Efficacy and<br />
Safety for Behavioural Psychological<br />
Symptoms <strong>of</strong> Dementia (BSPD)?<br />
Carlos Rojas-Fernandez, BScPhm, PharmD<br />
Schlegel-UW Research Institute on Aging &<br />
School <strong>of</strong> Pharmacy, University <strong>of</strong> Waterloo<br />
Kitchener, ON<br />
Blood Pressure and Diabetes in the<br />
Elderly: Moving Targets<br />
Naomi Dore, BScH, MSc, BScPhm<br />
Hamilton Health Sciences Centre<br />
Hamilton, ON<br />
3. Global Health PSN<br />
RSP en santé mondiale<br />
WINDSOR<br />
Is an Ounce <strong>of</strong> Palivizumab Worth a<br />
Pound <strong>of</strong> Cure? The Intersection <strong>of</strong><br />
Research Advocacy and Politics in the<br />
Arctic<br />
Anna Banerji, MD, MPH, FRCPC, DTM&H<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Student Insights from Bottom-Up and<br />
Top-Down: Approaches in Global Health<br />
Matt Koehler, BScPhm, RPh<br />
Shoppers Drug Mart<br />
Thunder Bay, ON<br />
Ryan McGuire, BScPhm<br />
Toronto General <strong>Hospital</strong><br />
Toronto, ON<br />
4. Anticoagulation PSN<br />
RSP en anticoagulation<br />
CONFERENCE D/E<br />
Anticoagulation Risk Assessment:<br />
Practical Implications for <strong>Pharmacists</strong><br />
Cynthia Brocklebank, BScPhm, PharmD, ACPR<br />
Alberta Health Services<br />
Calgary, AB<br />
New Anticoagulants for Stroke<br />
Prevention in Atrial Fibrillation<br />
Jennifer Pickering, BScPhm, ACPR<br />
Hamilton Health Sciences Centre<br />
Hamilton, ON<br />
16:10-17:50 Awards Ceremony<br />
Everyone welcome<br />
Cérémonie de remise des prix<br />
Bienvenue à tous<br />
ESSEX BALLROOM<br />
18:00-19:30 Career Opportunities Evening<br />
Soirée de perspectives d’emploi<br />
Research and Education Silent Auction<br />
Vente aux enchères par écrit de la Fondation<br />
pour la recherche et l’éducation de la SCPH<br />
OSGOODE HALL<br />
Monday, February 6 • Lundi 6 février<br />
Primary Care Day<br />
Journée des soins primaires<br />
07:30-17:00 Registration<br />
Inscription<br />
CONCOURSE COAT CHECK<br />
08:00-08:15 Announcements<br />
Annonces<br />
DOMINION BALLROOM<br />
08:15-09:45 Immigrant Health Issues: Implications for<br />
<strong>Hospital</strong> <strong>Pharmacists</strong><br />
DOMINION BALLROOM<br />
Kevin Pottie, MD, MCIS<br />
Department <strong>of</strong> Family Medicine and Clinical<br />
Epidemiology and Community Medicine<br />
University <strong>of</strong> Ottawa<br />
Ottawa, ON
16<br />
New Fellows Presentation<br />
Présentation des nouveaux membres associés<br />
Acknowledgement <strong>of</strong> the recipient <strong>of</strong> the<br />
Distinguished Service Award<br />
Reconnaissance de la lauréate du prix pour<br />
service distingué<br />
Acknowledgement <strong>of</strong> the Research and<br />
Education Foundation Grant Recipients<br />
Reconnaissance des boursiers de la Fondation<br />
pour la recherche et l’éducation<br />
DOMINION BALLROOM<br />
09:45-10:15 Break, Exhibits<br />
Pause, Kiosques<br />
SHERATON/OSGOODE HALLS<br />
10:30-11:15 Concurrent Sessions<br />
Séances concomitantes<br />
1. Total Parenteral Nutrition for Pediatrics:<br />
A Pharmacy Perspective<br />
SIMCOE/DUFFERIN<br />
Vijay Rasaiah, RPh, BScPhm, MSc, BSc(Hon)<br />
The <strong>Hospital</strong> for Sick Chidlren<br />
Toronto, ON<br />
2. Highlights in Pharmacy Excellence:<br />
Oral Abstract Session<br />
Intriguing Papers from Original Research,<br />
Award Winners and Research and<br />
Education Grants<br />
For details on the specific projects, please see<br />
page 44.<br />
Plein feu sur l'excellence en pharmacie :<br />
Séance d’exposés oraux<br />
Communications fascinantes tirées de<br />
travaux de recherche inédits.<br />
Récipiendaires de prix, de bourses de<br />
recherche et de perfectionnement<br />
Pour plus de détails, s'il vous plaît voir la page 44.<br />
CONFERENCE D/E<br />
3. Controversies in Diabetes Management:<br />
Are we ADVANCE-ing our Knowledge<br />
and Treatment ACCORD-ingly?<br />
CITY HALL<br />
Anar Dossa, BScPhm, PharmD, CDE<br />
Vancouver General <strong>Hospital</strong><br />
Vancouver, BC<br />
4. Transition with Success! Increasing the<br />
Awareness <strong>of</strong> Medication Misadventures<br />
after Discharge from <strong>Hospital</strong><br />
CONFERENCE B/C<br />
Lisa Sever, BScPhm, ACPR, CGP<br />
York Central <strong>Hospital</strong><br />
Richmond Hill, ON<br />
11:25-12:10 Concurrent Sessions<br />
Séances concomitantes<br />
1. To TREAT or not to TREAT: Making Sense<br />
<strong>of</strong> ESAs and Targets in CKD<br />
SIMCOE/DUFFERIN<br />
Amy Sood, BScPhm, PharmD<br />
Manitoba Renal <strong>Program</strong>, St. Boniface <strong>Hospital</strong><br />
Winnipeg, MB<br />
2. Beyond Statins: Treating Dyslipidemia<br />
and Residual Cardiovascular Risk with<br />
Other Lipid-Lowering Agents<br />
CITY HALL<br />
Glen Pearson, BSc, BScPhm, PharmD, FCSHP<br />
Division <strong>of</strong> Cardiology, University <strong>of</strong> Alberta<br />
Manzankowski Alberta Institute<br />
Edmonton, AB<br />
3. Highlights in Pharmacy Excellence:<br />
Oral Abstract Session<br />
Intriguing Papers from Original Research,<br />
Award Winners and Research and<br />
Education Grants<br />
For details on the specific projects, please see<br />
page 44.<br />
Plein feu sur l’excellence en pharmacie :<br />
Séance d'exposés oraux<br />
Documents fascinants tirés de travaux de<br />
recherche inédits. Récipiendaires de prix,<br />
de bourses de recherche et d’étude<br />
Pour plus de détails, s'il vous plais voir la page 44.<br />
CONFERENCE D/E<br />
4. Smartphones: A Novel “App”roach to<br />
Patient Care (encore)<br />
CONFERENCE B/C<br />
Sean Spina, BScPhm, ACPR, PharmD<br />
Vancouver Island Health Authority<br />
Royal Jubilee <strong>Hospital</strong><br />
Victoria, BC<br />
12:15-13:50 Lunch, Exhibits, Posters, Silent Auction<br />
Dîner, Kiosques, Affiches, Vente aux<br />
enchères par écrit<br />
SHERATON/OSGOODE HALLS<br />
13:55-14:55 A Practical Approach to Drug Interactions<br />
DOMINION BALLROOM<br />
David Juurlink, BScPhm, MD, PhD, FRCPC<br />
Sunnybrook Health Sciences Centre<br />
Institute for Clinical Evaluative Sciences<br />
Toronto, ON<br />
15:00-17:00 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. What are the Appropriate National<br />
Clinical Pharmacy Key Performance<br />
Indicators (KPI) for <strong>Canadian</strong> <strong>Hospital</strong><br />
<strong>Pharmacists</strong>?<br />
SIMCOE/DUFFERIN
17<br />
Olavo Fernandes, PharmD, FCSHP<br />
University Health Network<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<br />
Richard Slavik, PharmD, FCSHP<br />
Pr<strong>of</strong>essional Practice Interior Health<br />
University <strong>of</strong> British Columbia<br />
Kelowna, BC<br />
2. Paediatric PSN<br />
RSP en pédiatrie<br />
CONFERENCE D/E<br />
Chemotherapy-Induced Nausea and<br />
Vomiting in Children: An Evidence-Based<br />
Approach<br />
Lee Dupuis, RPh, ACPR, MScPhm, FCSHP<br />
The <strong>Hospital</strong> for Sick Children<br />
Toronto, ON<br />
Pain, Pain, Go Away. Don’t Come Back<br />
Another Day! Exploring Treatment<br />
Options and Strategies for the<br />
Management <strong>of</strong> Pediatric Chronic Pain<br />
Régis Vaillancourt, OMM, OD, CD, BPhm,<br />
PharmD, FCSHP<br />
Children’s <strong>Hospital</strong> <strong>of</strong> Eastern Ontario<br />
Ottawa, ON<br />
3. Primary Care PSN<br />
RSP en soins de santé primaires<br />
CONFERENCE B/C<br />
Practical Approaches to Reducing<br />
Polypharmacy in the Elderly: An<br />
Interactive Workshop<br />
Debbie Kwan, BScPhm, MSc, FCSHP<br />
Toronto Western <strong>Hospital</strong><br />
Family Health Team<br />
Toronto, ON<br />
Barbara Farrell, BScPhm, PharmD, FCSHP<br />
Bruyère Continuing Care<br />
Ottawa, ON<br />
4. Infectious Disease PSN<br />
RSP en infectiologie<br />
CITY HALL<br />
MRSA Guidelines and Clinical<br />
Controversies: A Practical Overview<br />
Tim Lau, PharmD, FCSHP<br />
Vancouver General <strong>Hospital</strong><br />
Vancouver Coastal Health<br />
Vancouver, BC<br />
Update on Urinary Tract Infections<br />
Monique Pitre, BScPhm, FCSHP<br />
University Health Network<br />
Toronto, ON<br />
17:30-19:30 Satellite Symposiums<br />
Dinner included<br />
Symposiums satellites<br />
Souper inclus<br />
1. The Value <strong>of</strong> Biologics and Follow-On<br />
Biologics: What the Future Holds for<br />
Personalized Medicine, Co-Diagnostics<br />
and Subsequent Entry Biologics<br />
DOMINION BALLROOM NORTH<br />
George Dranitsaris, MPharm, FCSHP, DPH<br />
<strong>Canadian</strong> Association <strong>of</strong> <strong>Pharmacists</strong> in Oncology<br />
Toronto, ON<br />
Vandana Ahluwalia, MD, FRCPC<br />
Ontario Rheumatology Association<br />
Toronto, ON<br />
Hosted by Janssen Inc. Canada<br />
2. Implementation <strong>of</strong> Smart Pump<br />
Technology: How We Did It<br />
ESSEX BALLROOM<br />
Karen Smith, RN, MHSPCM<br />
Ross Tilley Burn Centre<br />
Sunnybrook Health Sciences<br />
Toronto, ON<br />
Hosted by Hospira Healthcare Corporation<br />
Tuesday, February 7 • Mardi 7 février<br />
07:30-17:00 Registration<br />
Inscription<br />
CONCOURSE COAT CHECK<br />
08:00-08:15 Announcements<br />
Annonces<br />
DOMINION BALLROOM<br />
08:15-9:30 Pharmacy Issues and Controversies Forum –<br />
Panel Discussion<br />
Forum sur des questions et controverses en<br />
pharmacie – Panel<br />
Issues and Controversies: Pr<strong>of</strong>essional<br />
Integrity and Conflict <strong>of</strong> Interest<br />
DOMINION BALLROOM<br />
Judy Chong, BScPhm, RPh - Moderator<br />
Royal Victoria <strong>Hospital</strong> <strong>of</strong> Barrie<br />
Barrie, ON<br />
Peter Loewen, BScPhm, ACPR, PharmD, RPh, FCSHP<br />
Provincial Health Services Authority<br />
University <strong>of</strong> British Columbia<br />
Vancouver, BC<br />
James E. Tisdale, BScPhm, PharmD, BCPS, FCCP,<br />
FAPhA, FAHA<br />
College <strong>of</strong> Pharmacy, Purdue University<br />
Indianapolis IN
18<br />
Anne Hiltz, BScPhm, ACPR, RPh<br />
Capital District Health Authority<br />
Halifax, NS<br />
09:45-10:15 Break, Exhibits<br />
Pause, Kiosques<br />
SHERATON/OSGOODE HALLS<br />
10:25-11:10 Concurrent Sessions<br />
Séances concomitantes<br />
1. Top Clinical Papers in General Medicine<br />
CITY HALL<br />
Derek Jorgenson, BSP, PharmD, FCSHP<br />
University <strong>of</strong> Saskatchewan<br />
Saskatoon, SK<br />
2. Probiotics for C. difficile Infections, Yes...<br />
No... Maybe? A Review <strong>of</strong> Evidence<br />
SIMCOE/DUFFERIN<br />
Miranda So, BScPhm, PharmD<br />
University Health Network<br />
Toronto, ON<br />
3. COPE Implementation: Prescription for<br />
Success<br />
CONFERENCE B/C<br />
Janice Wells, PharmD<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Pegi Rappaport, BSc, MSc<br />
Toronto East General <strong>Hospital</strong><br />
Toronto, ON<br />
11:20-12:05 Concurrent Sessions<br />
Séances concomitantes<br />
1. Management <strong>of</strong> Street Drug Toxicities<br />
SIMCOE/DUFFERIN<br />
Debra Kent, PharmD, DABAT, CSPI<br />
BC Drug and Poison Information Centre,<br />
BC Centre for Disease Control, Provincial Health<br />
Services Authority<br />
Vancouver, BC<br />
2. Controversies in Diabetes Management:<br />
Are we ADVANCE-ing our Knowledge<br />
and Treatment ACCORD-ingly? (encore)<br />
CITY HALL<br />
Anar Dossa, BScPhm, PharmD, CDE<br />
Vancouver General <strong>Hospital</strong><br />
Vancouver, BC<br />
3. Best Papers in Pharmacy Practice<br />
CONFERENCE B/C<br />
Jean-François Bussières, BPharm, MSc, MBA, FCSHP<br />
CHU Sainte-Justine<br />
Montréal, QC<br />
12:15-13:50 Lunch, Exhibits, Posters, Silent Auction<br />
Dîner, Kiosques, Affiches, Vente aux<br />
enchères par écrit<br />
SHERATON/OSGOODE HALLS<br />
14:00-15:00 What is the Optimal Prioritization <strong>of</strong><br />
Pr<strong>of</strong>essional Activities in a<br />
Collaboratively-Developed <strong>Hospital</strong><br />
<strong>Pharmacists</strong> Best Practice Model?<br />
DOMINION BALLROOM<br />
Olavo Fernandes, PharmD, FCSHP<br />
University Health Network<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<br />
15:10-17:10 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. Simulation Game: Building Pharmacy<br />
Services from Scratch<br />
SIMCOE/DUFFERIN<br />
Jean-François Bussières, BPharm, MSc, MBA,<br />
FCSHP<br />
CHU Sainte-Justine<br />
Montréal, QC<br />
2. Cardiology PSN<br />
RSP en cardiologie<br />
CONFERENCE B/C<br />
Antiplatelet in 2012 and Beyond<br />
Heather Kertland, BScPhm, PharmD<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Antiarrhythmic Drug Safety: Illusion,<br />
Fantasy, and Wishful Thinking?<br />
Dronedarone and Other Disappointments<br />
James E. Tisdale, BScPhm, PharmD, BCPS, FCCP,<br />
FAPhA, FAHA<br />
College <strong>of</strong> Pharmacy, Purdue University<br />
Indianapolis, IN<br />
3. Medication Safety PSN<br />
RSP en sécurité des médicaments<br />
CITY HALL<br />
Current Accreditation Challenges:<br />
Panel Discussion with Representatives <strong>of</strong><br />
Key National Organizations<br />
Janice Munroe, BScPhm - Moderator<br />
Fraser Health Pharmacy Services<br />
Regional Pharmacy Administration<br />
Lanlgey, BC<br />
Joanne Garrah<br />
Health Canada<br />
Ottawa, ON
19<br />
Julie Greenall, RPh, BScPhm, MHSc<br />
ISMP Canada<br />
Toronto, ON<br />
Diana Sarakbi<br />
Accreditation Canada<br />
Ottawa, ON<br />
17:30-19:30 Satellite Symposiums<br />
Dinner included<br />
Symposiums satellites<br />
Dîner inclus<br />
1. Addressing Drug Supply Issues in Canada<br />
and from a Global Perspective<br />
ESSEX BALLROOM<br />
Grace Breen<br />
Hospira Healthcare Corporation<br />
Lake Forest, IL<br />
Beryl Chan<br />
Tina Dematos<br />
Hospira Healthcare Corporation<br />
Montréal, QC<br />
Hosted by Hospira Healthcare Corporation<br />
2. Recognition and Treatment <strong>of</strong><br />
Hyponatremia in the <strong>Hospital</strong> Setting<br />
DOMINION BALLROOM NORTH<br />
Hosted by Otsuka Pharmaceutical Inc.<br />
Wednesday, February 8 • Mercredi 8 février<br />
07:30-15:00 Registration<br />
Inscription<br />
CONCOURSE COAT CHECK<br />
08:00-08:15 Announcements<br />
Annonces<br />
DOMINION BALLROOM<br />
08:15-09:15 CPSI-ISMP Canada Patient Safety Lecture<br />
Conférence sur la sécurité des patients de<br />
l’ICSP et de l’IUSM du Canada<br />
DOMINION BALLROOM<br />
Improving Medication Safety at Transitions<br />
in Care<br />
Chaim Bell, MD, PhD, FRCPC<br />
Li Ka Shing Knowledge Institute<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Sponsored by the <strong>Canadian</strong> Patient Safety Institute<br />
and the Institute for Safe Medication Practices<br />
Canada through an unrestricted grant<br />
Commandité par l’Institut canadien sur la sécurité<br />
des patients et l’Institut pour l’utilisation sécuritaire<br />
des médicaments du Canada grâce à une<br />
subvention sans restriction<br />
09:15-10:15 Learning from High Reliability<br />
Organizations to Improve Reliability and<br />
Safety in Health Care<br />
DOMINION BALLROOM<br />
Marlys Christianson, MD, PhD<br />
Rotman School <strong>of</strong> Management<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<br />
10:15-10:45 Break, Posters<br />
Pause, Affiches<br />
DOMINION FOYER<br />
10:55-11:40 Concurrent Sessions<br />
Séances concomitantes<br />
1. New Advances in the Management <strong>of</strong><br />
Metastatic Renal Cell Carcinoma<br />
SIMCOE/DUFFERIN<br />
Shirin Abadi, BScPhm, ACPR, PharmD<br />
BC Cancer Agency<br />
Vancouver, BC<br />
2. Combination Therapy for Problem Gram<br />
Negative Pathogens<br />
CITY HALL<br />
Linda Dresser, PharmD, FCSHP<br />
University Health Network<br />
Toronto, ON<br />
3. The State <strong>of</strong> <strong>Hospital</strong> Pharmacy Practice<br />
in Canada: The Good, The Bad, and the<br />
Perhaps a Bit Ugly (Courtesy <strong>of</strong> the<br />
<strong>Hospital</strong> Pharmacy in Canada 2009/10<br />
Report)<br />
CONFERENCE B/C<br />
Kevin Hall, BScPhm, PharmD, FCSHP<br />
Faculty <strong>of</strong> Pharmacy and Pharmaceutical<br />
Sciences, University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
11:50-12:35 Concurrent Sessions<br />
Séances concomitantes<br />
1. VTE in the ICU<br />
SIMCOE/DUFFERIN<br />
David Williamson, MSc, BCPS<br />
Hôpital du Sacré-Cœur de Montréal<br />
Montréal, QC<br />
2. How will Pharmacogenomics Practically<br />
Impact Patient Care & Practicing<br />
<strong>Pharmacists</strong>: Now and In the Future?<br />
CITY HALL<br />
Anke-Hilse Maitland-van der Zee, PharmD, PhD<br />
Utrecht Institute for Pharmaceutical Services,<br />
Utrecht University<br />
Utrecht, The Netherlands
20<br />
3. What Should a System for the<br />
Recognition <strong>of</strong> Special Areas <strong>of</strong> Practice<br />
Look Like?<br />
CONFERENCE B/C<br />
Arthur Whetstone, EdD, MA, BEd, BA(Hon), RPN<br />
<strong>Canadian</strong> Council on Continuing Education in<br />
Pharmacy<br />
Saskatoon, SK<br />
12:40-14:10 Satellite Symposiums<br />
Luncheon included<br />
Symposiums satellites<br />
Dînr inclus<br />
1. Management <strong>of</strong> New Oral Anticoagulant<br />
Therapy for Stroke Prevention in Atrial<br />
Fibrillation<br />
ESSEX BALLROOM<br />
Kori Leblanc, BScPhm, ACPR, PharmD<br />
Peter Munk Cardiac Centre<br />
Toronto, ON<br />
Claudia Bucci, BScPhm, PharmD, ACPR<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
Shaun Goodman, MD, MSc, FRCPC<br />
St. Michael's <strong>Hospital</strong><br />
Toronto, ON<br />
Hosted by Bayer Inc.<br />
2. Prescription Opioid Misuse: What<br />
<strong>Pharmacists</strong> Really Need to Know<br />
CIVIC BALLROOM<br />
Donnie Edwards, RPh, BScPhm<br />
Boggio Pharmacy Ltd.<br />
Port Colborne, ON<br />
Hosted by Purdue Pharma<br />
14:15-15:15 CSHP 2015 Town Hall: Are We on Target for<br />
Pharmacy Practice Excellence?<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
DOMINION BALLROOM<br />
Carolyn Bornstein, BScPhm, ACPR, FCSHP -<br />
Moderator/Speaker<br />
CSHP 2015 Project Coordinator<br />
Newmarket,ON<br />
Stephen Shalansky, BScPhm, PharmD, ACPR, FCSHP<br />
Providence Healthcare<br />
Vancouver, BC<br />
Emily Muir, BScPhm, ACPR<br />
Horizon Health Network<br />
Saint John, NB<br />
15:25-17:30 Workshops & PSN Sessions<br />
Ateliers et séances des RSP<br />
1. Critical Care PSN<br />
RSP en soins intensifs<br />
SIMCOE/DUFFERIN<br />
Dexmedetomidine: A New Sedative in<br />
the ICU: Balancing Responsibility and<br />
Real Life<br />
Salmaan Kanji, BScPhm, PharmD, ACPR<br />
The Ottawa <strong>Hospital</strong><br />
Ottawa <strong>Hospital</strong> Research Institute<br />
Ottawa, ON<br />
What's New, What's Next? 1 Year<br />
Experience for an Antimicrobial<br />
Stewardship <strong>Program</strong> in a Community<br />
<strong>Hospital</strong> Intensive Care Unit (ICU)<br />
Kelly Walker, BSP<br />
Toronto East General <strong>Hospital</strong><br />
Toronto, ON<br />
Jaclyn Litynsky, BCPS, PharmD<br />
Toronto East General <strong>Hospital</strong><br />
Toronto, ON<br />
2. Pharmacist-in-Training PSN<br />
RSP des pharmaciens en apprentissage<br />
CONFERENCE B/C<br />
Antibiotic Pharmacokinetics and<br />
Pharmacodynamics: Putting the Practical<br />
into Practice<br />
Rosemary Zvonar, BScPhm, ACPR, FCSHP<br />
The Ottawa <strong>Hospital</strong><br />
Ottawa, ON<br />
Miranda So, BSc, BScPhm, PharmD<br />
University Health Network<br />
Toronto, ON<br />
3. What are the Appropriate National<br />
Clinical Pharmacy Key Performance<br />
Indicators (KPI) For <strong>Canadian</strong><br />
<strong>Pharmacists</strong>? (encore)<br />
CONFERENCE D/E<br />
Olavo Fernandes, PharmD, FCSHP<br />
University Health Network<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<br />
Richard Slavik, PharmD, FCSHP<br />
Pr<strong>of</strong>essional Practice Interior Health<br />
University <strong>of</strong> British Columbia<br />
Kelowna, BC<br />
17:30 Close <strong>of</strong> the 43rd Annual Pr<strong>of</strong>essional<br />
Practice Conference<br />
Clôture de la 43 e Conférence annuelle sur la<br />
pratique pr<strong>of</strong>essionnelle
R&E Foundation<br />
Silent Auction<br />
This year’s Research & Education Foundation<br />
Fundraiser at the PPC 2012 will once again be<br />
the popular silent auction. Items will be on<br />
display Sunday, February 5, 2012 inside the Career<br />
Opportunities Evening (Osgoode Hall, Lower<br />
Concourse) and on Monday and Tuesday during the<br />
exhibitor lunches (12:15-13:50) in the Exhibit Hall.<br />
<strong>Final</strong> bids will be tallied at 13:00 on Tuesday. Winners<br />
will be announced at the end <strong>of</strong> the exhibits program.<br />
We request your presence in order to pick up your<br />
item(s). All payments must be made on-site.<br />
Money raised on behalf <strong>of</strong> the R&E Foundation means<br />
you are helping to support the development <strong>of</strong><br />
research skills among practicing hospital pharmacists<br />
as well as research projects and targeted pharmacy<br />
education programs undertaken by CSHP members.<br />
Awards Ceremony<br />
Please join us for our CSHP’s National Awards<br />
Ceremony and Cocktail Reception! It is an<br />
opportunity to congratulate your colleagues,<br />
network, and socialize with members.<br />
This event is open to the public (you do not have to be<br />
registered for the PPC to attend).<br />
Sunday, February 5, 2012 • 16:10-17:50<br />
Essex Ballroom<br />
Cocktails to follow<br />
Career Opportunities<br />
Evening<br />
This annual networking and recruitment event will<br />
take place after the Awards Ceremony on Sunday,<br />
February 5, 2012. Join us in the Osgoode Hall<br />
(new location!) from 18:00-19:30 and chat with hospitals<br />
and other organizations from across the country.<br />
This event is open to the public (you do not have to be<br />
registered for the PPC to attend). Refreshments will be<br />
provided.
22<br />
Speaker Abstracts<br />
Résumés des conférenciers<br />
Sunday, February 5<br />
Dimanche 5 février<br />
Managing Acute Stroke: What You Need To Know<br />
Tania Mysak, BSP, PharmD, Alberta Health Services, Edmonton, AB<br />
The goal <strong>of</strong> this session is to provide pharmacists with a strategy to<br />
manage the top clinical issues patients face in the first days<br />
following an acute stroke.<br />
Stroke is the fourth leading cause <strong>of</strong> death and the leading cause<br />
<strong>of</strong> long term adult disability in Canada. It burdens our health care<br />
system with annual costs <strong>of</strong> at least $6 billion due to<br />
hospitalization, long term care, rehabilitation, drug use and lost<br />
productivity. Over half <strong>of</strong> those costs occur within the first 6<br />
months <strong>of</strong> care and 80% <strong>of</strong> those early costs can be attributed to<br />
the acute hospitalization period. To help manage those costs and<br />
optimize patient care, clinical efforts are focussed on reducing<br />
stroke size, prevention <strong>of</strong> acute complications as well as prevention<br />
<strong>of</strong> early recurrent stroke.<br />
In the hyperacute stage, the goal is to minimize infarct size and<br />
prevent mortality and morbidity. In the acute stage (i.e. the first<br />
days to weeks following acute stroke) patients are exposed to risks<br />
such as venous thromboembolism, infection, depression and<br />
recurrent stroke. While clinical guidelines exist to aid clinicians<br />
navigate these early stages <strong>of</strong> a patient’s recovery, gaps in evidence<br />
require care providers to exercise clinical judgement in areas such<br />
as hypertension management. <strong>Final</strong>ly, clinicians must consider<br />
optimal timing <strong>of</strong> initiation <strong>of</strong> pharmacotherapy for secondary<br />
stroke prevention.<br />
Goals and Objectives<br />
1. To provide pharmacists with an overview <strong>of</strong> management <strong>of</strong><br />
hyperacute and acute stroke, including optimal timing for<br />
initiation <strong>of</strong> secondary stroke prevention strategies.<br />
2. To provide pharmacists context in which guideline<br />
recommendations are made, to enable them to make<br />
patient-specific choices in their practice.<br />
Self-Assessment Questions<br />
1. How would you approach management <strong>of</strong> hypertension in<br />
patients with acute stroke?<br />
2. What is the optimal strategy for prevention <strong>of</strong> venous<br />
thromboembolism in a patient with intracerebral hemorrhage?<br />
Extended Infusion Beta Lactams: A Primer on<br />
Why, When, and Mainly How<br />
Sandra A.N. Walker, BSc, BScPhm, ACPR, PharmD, FCSHP,<br />
Sunnybrook Health Sciences Centre, Toronto, ON<br />
The purpose <strong>of</strong> this concurrent session is to provide a brief<br />
overview about the use <strong>of</strong> extended infusion (EI) β-lactams.<br />
There is accumulating interest and support for the use <strong>of</strong> EI<br />
β-lactams. β-lactams have time dependent bacterial killing, where<br />
the rate and extent <strong>of</strong> killing is independent <strong>of</strong> increases in<br />
concentration <strong>of</strong> the antibiotic; but rather, is determined by the<br />
length <strong>of</strong> time that unbound drug remains above the minimum<br />
inhibitory concentration <strong>of</strong> the bacteria. The bactericidal activity is<br />
optimal when the time that the β-lactam concentration remains<br />
above the MIC (T>MIC) for at least 40-70% <strong>of</strong> the dosing interval.<br />
However, the short half-life <strong>of</strong> most β-lactams necessitates frequent<br />
intermittent dosing to achieve this pharmacokinetic /<br />
pharmacodynamic target. The use <strong>of</strong> EI β-lactams provides a<br />
feasible method <strong>of</strong> optimizing T>MIC compared to intermittent<br />
infusion.<br />
Goals and Objectives<br />
1. To review the rationale for EI β-lactams, with a summary <strong>of</strong><br />
existing evidence (The Why).<br />
2. To identify when EI β-lactams may be beneficial.<br />
3. To provide practical information on how to use EI β-lactams in<br />
patient care.<br />
Self-Assessment Questions<br />
1. Why is there an interest in using EI β-lactams?<br />
2. Under what circumstances may EI β-lactams be most beneficial<br />
for patients?<br />
3. How would you determine appropriate dosing for a specific<br />
β-lactam using published pharmacokinetic data, in the absence<br />
<strong>of</strong> published recommendations for EI?<br />
Smartphones: A Novel ‘App’roach to Patient Care<br />
Sean P. Spina, BScPhm, ACPR, PharmD, Vancouver Island Health<br />
Authority, Victoria, BC<br />
The goal <strong>of</strong> this session is to provide the pharmacist with an<br />
overview <strong>of</strong> how smartphone technology can be incorporated into<br />
patient care.<br />
Over the past decade, the use <strong>of</strong> technology in healthcare has<br />
grown exponentially. The days <strong>of</strong> pharmacists having a desktop<br />
computer in an <strong>of</strong>fice and then carrying a drug information<br />
reference in their labcoat pocket have been transformed into<br />
pharmacists carrying powerful multifunctional mobile devices in<br />
their pockets to the bedside. The smartphone has become the 21st
23<br />
century workhorse for timely communication, obtaining efficient<br />
drug information, organizing schedules and providing bedside<br />
decision support tools to the pharmacist. The smartphone has<br />
become an integral part <strong>of</strong> many pharmacist’s personal and<br />
pr<strong>of</strong>essional life.<br />
Incorporating technology into clinical practice can be<br />
overwhelming at times. This session will outline how smartphones<br />
can be effectively incorporated into clinical practice including a<br />
review <strong>of</strong> common clinically useful applications.<br />
Goals and Objectives<br />
1. To provide pharmacists with an overview <strong>of</strong> how smartphone<br />
technology can be incorporated into patient care.<br />
2. To provide pharmacists with practical suggestions <strong>of</strong> ways that<br />
smartphones can improve their daily workflow.<br />
3. To provide pharmacists with a glimpse <strong>of</strong> the technology which<br />
will be available in the near future.<br />
Self-Assessment Questions<br />
1. List 5 smartphone applications which will improve your worklife.<br />
2. Describe how smartphone technology can keep pharmacists up<br />
to date with the literature.<br />
3. Outline how smartphone technology can allow pharmacists to<br />
work more efficiently.<br />
Research Design for Dummies: Chart Review<br />
Studies<br />
Ross T. Tsuyuki, BScPhm, PharmD, MSc, FCSHP, FACC. Faculty <strong>of</strong><br />
Medicine and Dentistry, University <strong>of</strong> Alberta, Edmonton, AB<br />
Retrospective chart review studies are popular in pharmacy<br />
research and are an excellent choice for many (but not all) research<br />
questions.<br />
The purpose <strong>of</strong> this presentation is to discuss the methodologic<br />
principles necessary to conduct high quality chart review studies,<br />
including sampling, case definition, sample size, blinding,<br />
abstractor training, standardized data collection forms, abstractor<br />
monitoring, and testing for agreement.<br />
This workshop is for residents, those who supervise residents, and<br />
pharmacists who see clinical problems and would like to be able to<br />
address them by conducting their own studies.<br />
I also hope you will bring along your ideas for chart review studies<br />
or studies you are working on or have completed yourself. Or,<br />
bring along a published chart review study and we can review and<br />
critique it together.<br />
Goals and Objectives<br />
1. To understand the strength and weaknesses <strong>of</strong> chart review<br />
studies<br />
2. To review the methodologic features necessary to design and<br />
conduct high quality chart review studies.<br />
Self-Assessment Questions<br />
1. What kind <strong>of</strong> research questions are best addressed using a<br />
chart review study design?<br />
2. What are the limitations <strong>of</strong> using convenience sampling <strong>of</strong> cases<br />
for chart review studies?<br />
Antipsychotic Use Circa 2012: What have we<br />
Learned Regarding their Efficacy and Safety for<br />
Behavioural and Psychological Symptoms <strong>of</strong><br />
Dementia (BSPD)?<br />
Carlos Rojas-Fernandez, PharmD, University <strong>of</strong> Waterloo School <strong>of</strong><br />
Pharmacy, RBJ-UW Schlegel Research Institute for Ageing,<br />
McMaster University School <strong>of</strong> Medicine and The Centre for Family<br />
Medicine, Kitchener, ON<br />
The purpose <strong>of</strong> this presentation is to provide a historical<br />
perspective on the safety and efficacy <strong>of</strong> antipsychotic drugs for<br />
management <strong>of</strong> BPSD, and put these findings into an appropriate<br />
contemporary clinical context.<br />
Antipsychotic medications have been used for over 25 years for<br />
treatment <strong>of</strong> behavioural and psychological symptoms <strong>of</strong> dementia<br />
(BSPD). In the 1990s, atypical antipsychotic drugs (AAPs) largely<br />
supplanted older antipsychotics due to their perceived safety<br />
advantage. In the early 21st century it became evident that AAPs<br />
were associated with a different set <strong>of</strong> adverse outcomes, namely<br />
metabolic side effects. Additionally, it was revealed that they were<br />
associated with a higher risk <strong>of</strong> cerebrovascular adverse events<br />
(CVAEs) and mortality in patients with BPSD (compared to<br />
placebo). These findings led regulatory agencies to issue safety<br />
warnings regarding their use in this population in 2005.<br />
Subsequently, a plethora <strong>of</strong> pharmacoepidemiologic studies were<br />
published which continued to clarify these risks, as well as identify<br />
additional risks associated with use <strong>of</strong> these drugs in patients with<br />
BPSD. These risks include increased risk <strong>of</strong> pneumonia, diabetes,<br />
venous thromboembolic events, and cognitive impairment.<br />
Nevertheless, evidence to support use <strong>of</strong> other pharmacological<br />
strategies for moderate to severe psychosis or aggression in this<br />
population are lacking. Of equal, if not greater interest, are studies<br />
that have documented successful withdrawal <strong>of</strong> antipsychotic<br />
drugs in patients with BPSD after an adequate treatment duration,<br />
which is consistent with the natural course <strong>of</strong> dementia. While a<br />
matter <strong>of</strong> debate, the manner in which antipsychotics are used in<br />
contemporary (and judicious) practice in essence, has not changed,<br />
and, until improved alternatives are brought forth, likely should not<br />
change. Thus, appropriate use <strong>of</strong> antipsychotics, in safe and<br />
effective doses, and for time-limited periods should not be viewed<br />
upon in a pejorative manner.<br />
Goals and Objectives<br />
1. To provide pharmacists a historical perspective regarding the<br />
associations between antipsychotics, mortality and<br />
cerebrovascular events in patients with dementia.<br />
2. To discuss, in summary form, evidence for the efficacy <strong>of</strong><br />
antipsychotics for BPSD.
24<br />
3. To put recent safety data regarding antipsychotics in context <strong>of</strong><br />
contemporary practice.<br />
Self-Assessment Questions<br />
1. What are two potential key safety concerns for using<br />
antipsychotics in patients with BPSD?<br />
2. Which atypical antipsychotics have the most evidence for<br />
efficacy for BPSD?<br />
3. Describe data that support discontinuation <strong>of</strong> psychotropic drugs<br />
in stable patients with BPSD.<br />
Blood Pressure and Diabetes in the Elderly: Moving<br />
Targets<br />
Naomi Dore, BScH, MSc, BScPhm, Hamilton Health Sciences,<br />
Hamilton ON<br />
The purpose <strong>of</strong> this session is to discuss blood pressure and<br />
diabetes targets in very elderly patients. Though the very elderly are<br />
<strong>of</strong>ten treated to the same targets as identified for younger<br />
patients, no trials have been designed to examine treatment<br />
targets in this population.<br />
In younger patients (aged 60-79), treating hypertension to a SBP<br />
80 years treated to achieve a target <strong>of</strong> 150/80 mmHg<br />
showed benefit in stroke reduction, but this evidence cannot be<br />
applied to the sick or frail elderly population. In the general<br />
>80-year population the same degree <strong>of</strong> anti-hypertensive<br />
treatment may be associated with an increase in mortality, and<br />
lower SBP (
25<br />
Student Insights from Bottom-up and Top-down<br />
Approaches in Global Health<br />
Matt Koehler, BScPhm, RPh, Shoppers Drug Mart, Thunder Bay, ON<br />
The purpose <strong>of</strong> this session is to explore the experience <strong>of</strong> a<br />
pharmacy student in global health initiatives. The initiatives <strong>of</strong><br />
focus include projects with a “bottom-up” approach working at a<br />
hospital in Gambia, West Africa, and a “top-down” approach<br />
working at the WHO headquarters in Geneva, Switzerland.<br />
In The Gambia, the speaker participated in a project under the<br />
direction <strong>of</strong> <strong>Canadian</strong> hospital pharmacist Jennifer Dyck, focused<br />
on inventory management and education. There, they worked with<br />
staff and students <strong>of</strong> the regional hospital, and the national drug<br />
and medical supply procurement and distribution center.<br />
Following this experience, the speaker completed an internship<br />
with the Good Governance for Medicines program in the WHO’s<br />
department <strong>of</strong> Essential Medicines and Pharmaceutical Policy. The<br />
goal <strong>of</strong> the program is to contribute to health system<br />
strengthening and prevent corruption by promoting good<br />
governance in the pharmaceutical sector. This is achieved largely<br />
through partnering with state ministries <strong>of</strong> health in improving<br />
transparency and accountability in medicine regulatory and supply<br />
management systems.<br />
Student initiatives, specifically related to global health will also be<br />
discussed in broad terms, paying particular interest in aspects <strong>of</strong><br />
meaningful and lasting impact.<br />
Goals and Objectives<br />
1. To teach pharmacists and students about various types <strong>of</strong><br />
student initiatives in global health, including successes and<br />
challenges.<br />
2. To demonstrate the impact a student can have on a project, as<br />
well as the impact such projects can have on the student and<br />
mentor themselves.<br />
3. To describe ways pharmacists and students can get involved in<br />
global health initiatives.<br />
Self-Assessment Questions<br />
1. Name an important initial consideration in developing a<br />
successful global health initiative.<br />
2. Describe what is mean by a top-down and bottom-up approach<br />
in global health initiatives.<br />
Anticoagulation Risk Management: Practical<br />
Implications for <strong>Pharmacists</strong><br />
Cynthia Brocklebank, BScPhm, PharmD, ACPR, Alberta Health<br />
Services, Calgary, AB<br />
Optimizing pharmacist management <strong>of</strong> high-risk medication<br />
regimens, which include anticoagulants, in ambulatory and<br />
specialty clinics is a goal <strong>of</strong> CSHP 2015. Patient assessment for risk<br />
<strong>of</strong> thrombosis and bleeding is a cornerstone <strong>of</strong> good<br />
anticoagulation practice regardless <strong>of</strong> the indication. Patient<br />
assessment for bleeding risk in an ambulatory setting can be<br />
challenging, particularly as risk factors change, and depending on<br />
the clinic service delivery model.<br />
Factors contributing to increased bleeding in anticoagulated<br />
patients have been well documented. Variations <strong>of</strong> the Outpatient<br />
Bleeding Risk Score have been used by ambulatory programs for<br />
years to categorize bleeding risk. More recently, the<br />
HEMORR2HAGES and HASBLED scoring tools have been used in<br />
atrial fibrillation populations. Recent published <strong>Canadian</strong> guidelines<br />
in atrial fibrillation have also incorporated thrombosis risk<br />
assessment tools for clinicians to assist with anticoagulation<br />
decision making. CHADS2 and CHADS2VaSc scores have been<br />
validated for estimating the annual stroke risk, <strong>of</strong>f anticoagulants,<br />
for patients with non-valvular atrial fibrillation. Estimating<br />
thrombosis risk for other anticoagulation indications is much less<br />
formalized but equally important.<br />
The purpose <strong>of</strong> this presentation is to provide an overview <strong>of</strong><br />
thrombosis and bleeding risks using a case based approach, and<br />
outline strategies for integrating risk assessment into ambulatory<br />
care pharmacist anticoagulation practice.<br />
Goals and Objectives<br />
1. Define factors that increase bleeding risk in an anticoagulated<br />
patient.<br />
2. Apply thrombosis and bleeding risk scores to an atrial fibrillation<br />
case example.<br />
3. Consider strategies for incorporating bleeding and thrombosis<br />
risk assessment and reassessment into an ambulatory care<br />
pharmacy practice.<br />
Self-Assessment Questions<br />
1. Patient C.D. is a 90 year old female with a past medical history<br />
that includes: hypertension, CHF, and atrial fibrillation. She has<br />
fallen twice at home, and with one <strong>of</strong> those events her physician<br />
queried whether or not she also had a TIA. What<br />
anticoagulation strategy is best for this patient?<br />
2. What other risk factors, that are not included in the HASBLED<br />
scoring system, should be considered when assessing a patient’s<br />
bleeding risk with anticoagulation.<br />
New Anticoagulants for Stroke Prevention in Atrial<br />
Fibrillation<br />
Jennifer Pickering, BScPhm, ACPR, Hamilton Health Sciences<br />
Centre, Hamilton, ON<br />
Atrial fibrillation (AF) affects approximately 200,000 to 250,000<br />
<strong>Canadian</strong>s and is responsible for approximately 1 in 5 <strong>of</strong> all strokes.<br />
Of these 20% will result in death and 60% will result in disability.<br />
Registries show us that only 50-60% <strong>of</strong> eligible patients receive<br />
warfarin therapy. Those patients who are receiving warfarin<br />
therapy it is important that the time in therapeutic range is greater<br />
than 60% which can be difficult to obtain given the variability in<br />
response to warfarin. In the past few years, new antithrombotic<br />
agents (dabigatran, rivaroxaban and apixaban) have published data<br />
<strong>of</strong>fering AF patients improved options for care. The purpose <strong>of</strong> this<br />
talk is to discuss the clinical evidence for, and pharmacological
26<br />
differences <strong>of</strong>, these new agents and also the challenges they bring<br />
to practice.<br />
Goals and Objectives<br />
1. Be familiar with current knowledge regarding new anticoagulant<br />
treatment options for patients with AF<br />
2 Discuss some <strong>of</strong> the challenges and opportunities these agents<br />
(dabigatran, rivaroxaban, apixaban) bring in management <strong>of</strong> AF<br />
patients.<br />
Self-Assessment Questions<br />
1. List at least 3 pharmacological differences between dabigatran,<br />
rivaroxaban and apixaban<br />
2. Mr. A.S. is currently taking dabigatran 150mg po bid. His<br />
CHADS2 is 2. He is booked for cardiac bypass surgery this<br />
admission. He has normal renal function. What is the<br />
recommendation for stopping dabigatran prior to surgery?<br />
Monday, February 6<br />
Lundi 6 février<br />
New recommendations from <strong>Canadian</strong> Task Force<br />
and <strong>Canadian</strong> Collaboration for Immigrant and<br />
Refugee Health<br />
Kevin Pottie, MD, MClSc, Departments <strong>of</strong> Family Medicine and<br />
Clinical Epidemiology and Community Medicine, University <strong>of</strong><br />
Ottawa, Ottawa, ON<br />
Immigrant and refugee health needs may differ significantly from<br />
those <strong>of</strong> native-born populations. Proactive interventions for<br />
preventable and treatable disease <strong>of</strong>fer an opportunity to reduce<br />
emerging health inequities that are <strong>of</strong>ten aggravated by limited<br />
local access to health care. But which migrants are most at risk for<br />
decline in health and which require special attention? Which<br />
conditions require tailored clinical recommendations?<br />
The <strong>Canadian</strong> Collaboration for Immigrant and Refugee Health<br />
(CCIRH) combined the AGREE best practice framework for<br />
guidelines, Cochrane Evidence Review Methods and the GRADE<br />
approach to devise evidence based clinical guidelines for<br />
immigrants and refugees. CCIRH guidelines differ from other<br />
guidelines because <strong>of</strong> their insistence on finding evidence for clear<br />
benefits before recommending routine interventions and in their<br />
explicit detailing <strong>of</strong> values and preference that influence<br />
recommendation statements.<br />
For example, in the context <strong>of</strong> possible asymptomatic intestinal<br />
parasites, the CCIRH guidelines recommend serology testing for<br />
parasites with associated morbidity and mortality (for example,<br />
strongyloides and schistosoma) rather than the traditional series <strong>of</strong><br />
stool tests given the finding that most tropical worms and parasites<br />
will resolve once the person has left the endemic region and this<br />
marks a significant shift in current clinical practice. Content focuses<br />
on four areas: infectious diseases; mental health and maltreatment;<br />
chronic and noncommunicable diseases; and women’s health.<br />
Detailed evidence reviews on specific illnesses and conditions<br />
including diabetes, PTSD, malaria, hepatitis, vision and dental<br />
disorders, provide an opportunity to advocate for effective<br />
interventions for all migrants and the evidence-base toward<br />
international migrant health guidelines.<br />
Goals and Objectives<br />
1. To provide pharmacists with an introduction to the “GRADE”<br />
approach for developing clinical guidelines<br />
2. To introduce pharmacists to new evidence based<br />
recommendations for immigrants and refugees<br />
Self-Assessment Questions<br />
1. What are the factors that increase the risk for poor health<br />
outcomes for migrants?<br />
2. Which conditions require interventions for which pharmacists<br />
should be aware?<br />
Total Parenteral Nutrition for Pediatrics: A<br />
Pharmacy Perspective<br />
Vijay P.A. Rasaiah, RPh, BScPhm, MSc, BSc (Hon), Staff Pharmacist,<br />
Department <strong>of</strong> Pharmacy, The <strong>Hospital</strong> for Sick Children, Toronto,<br />
ON<br />
This session will review some <strong>of</strong> the challenges facing pharmacists<br />
who compound Total Parenteral Nutrition (TPN) for pediatric<br />
patients.<br />
Pediatric patients have high nutritional requirements for growth<br />
and development. TPN is a life-saving therapy for many patients<br />
who are unable to meet these requirements through traditional<br />
enteral routes. TPN is compounded using macronutrients (protein,<br />
carbohydrate, fat, and water) and micronutrients (calcium,<br />
phosphorus, magnesium, etc). <strong>Pharmacists</strong> can play an important<br />
role in prescribing, compounding, and administering TPN by<br />
working collaboratively with nurses, dieticians, and physicians.<br />
Many pediatric patients also have complex therapeutic needs<br />
requiring long-term treatment with TPN. Although TPN is an<br />
essential part <strong>of</strong> the therapeutic plan <strong>of</strong> care for these patients, it<br />
may contribute to various adverse complications (such as infection<br />
and parenteral nutrition-associated cholestasis). <strong>Pharmacists</strong> may<br />
play an important role in customizing TPN compounds for these<br />
patients in order to optimize nutritional support and minimize the<br />
risk <strong>of</strong> adverse complications.<br />
Goals and Objectives<br />
1. To describe the pharmacist’s role in compounding TPN in a large<br />
pediatric hospital.
27<br />
2. To explain some <strong>of</strong> the complications <strong>of</strong> TPN in pediatric<br />
patients.<br />
Self-Assessment Questions<br />
1. What is the importance <strong>of</strong> typical components <strong>of</strong> TPN for<br />
pediatric patients?<br />
2. What are some <strong>of</strong> the ingredients in TPN that are associated<br />
with adverse complications?<br />
Controversies in Diabetes Management: Are we<br />
ADVANCE-ing our Knowledge and Treatment<br />
ACCORD-ingly?<br />
Anar Dossa, BScPhm, PharmD, CDE, Vancouver General <strong>Hospital</strong>,<br />
Vancouver, BC<br />
The purpose <strong>of</strong> this session is to address current clinical<br />
controversies in diabetes management.<br />
In the last 2-3 years several landmark trials have been published<br />
increasing our knowledge base in the area <strong>of</strong> diabetes<br />
management. The United Kingdom Prospective Diabetes Study<br />
(UKPDS) and the Diabetes Control and Complications (DCCT) trials<br />
demonstrated that microvascular, not macrovascular complications<br />
can be reduced with intensive control. The A1c targets achieved in<br />
these trials was 7% in the UKPDS study and 7.4% in the DCCT<br />
study.<br />
Most diabetes patients, however, die <strong>of</strong> macrovascular causes. The<br />
Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial<br />
was designed to investigate if ‘normalizing’ the A1c, that is, aiming<br />
for an A1c <strong>of</strong> under 6%, would reduce macrovascular<br />
complications. This trial was stopped early due to the increased<br />
mortality risk.<br />
The Action in Diabetes and Vascular Disease:Preterax and<br />
Diamicron MR Controlled Evaluation (ADVANCE) trial was also<br />
looking to see if achieving a lower A1c (< 6.5%) would reduce<br />
microvascular and/or macrovascular complications. Aiming for the<br />
lower A1c did reduce nephropathy but not macrovascular<br />
outcomes. Mortality was not increased in this trial.<br />
The ACCORD blood pressure trial demonstrated that a systolic<br />
target <strong>of</strong>
28<br />
To TREAT or not to TREAT: Making Sense <strong>of</strong> ESAs<br />
and Targets in CKD<br />
Amy Sood, BScPhm, PharmD, Manitoba Renal <strong>Program</strong>, St.<br />
Boniface <strong>Hospital</strong>, Winnipeg, MB<br />
Erythropoiesis-stimulating agents (ESAs) have been essential for the<br />
treatment <strong>of</strong> anemia <strong>of</strong> chronic kidney disease (CKD). Treating to<br />
maintain a hemoglobin target <strong>of</strong> 110 to 120 g/L has been widely<br />
practiced and supported by guidelines. The results <strong>of</strong> previous<br />
studies have shown either no benefit or increased risk <strong>of</strong><br />
cardiovascular events with higher hemoglobin targets. With the<br />
recent publication <strong>of</strong> the TREAT study, the debate on hemoglobin<br />
targets has been stirred up again.<br />
On June 24, 2011, the U.S. Food and Drug Administration (FDA)<br />
released a Safety Communication with modified recommendations<br />
for more conservative dosing <strong>of</strong> ESAs in CKD. Among their<br />
recommendations, they state that the lowest dose <strong>of</strong> ESA to avoid<br />
red blood cell transfusions should be used. In addition, they<br />
recommend reducing or interrupting the ESA dose when the<br />
hemoglobin level exceeds 100 g/L in CKD patients not on dialysis<br />
or 110 g/L in CKD patients on dialysis. In the U.S., the<br />
manufacturers have also changed their labeling <strong>of</strong> ESAs to reflect<br />
the FDA’s recommendations. The previous target range for<br />
hemoglobin levels in CKD patients has been removed.<br />
The purpose <strong>of</strong> this session is to critically analyze the evidence to<br />
determine whether these FDA recommendations make sense and<br />
to help you determine whether these recommendations should be<br />
adopted in your practice.<br />
Goals and Objectives<br />
1. To re-examine the evidence for ESAs in CKD in light <strong>of</strong> the new<br />
FDA recommendations.<br />
2. To assist pharmacists in determining whether they should adopt<br />
these new FDA recommendations in their practice.<br />
Self-Assessment Questions<br />
1. Does the evidence support the FDA’s new recommendations on<br />
dosing <strong>of</strong> ESAs in CKD?<br />
2. What risks and benefits should I discuss with patients with CKD<br />
before initiating ESA therapy?<br />
Beyond Statins: Treating Dyslipidemia and Residual<br />
Cardiovascular Risk with Other Lipid-Lowering<br />
Agents<br />
Glen J. Pearson, BSc, BScPhm, PharmD, FCSHP; Division <strong>of</strong><br />
Cardiology, University <strong>of</strong> Alberta, Manzankowski Alberta Heart<br />
Institute, Edmonton, AB<br />
Cholesterol treatment targets levels recommended in current<br />
guidelines have been defined from randomized control trials. The<br />
2009 CCS Dyslipidemia Guidelines suggest as a primary target,<br />
lowering the low-density lipoprotein (LDL) cholesterol to
29<br />
may guide the selection process <strong>of</strong> appropriate clinical KPI not<br />
possible before. A national working group has recently been<br />
formed with representatives from across Canada with the aim to<br />
develop national clinical pharmacy KPI for hospital pharmacists via<br />
a systematic evidence-informed consensus process. It is envisioned<br />
that these consensus KPI will be generalizable and adoptable in all<br />
hospital settings (small, large, urban, rural, community and<br />
academic centres). In this workshop, feedback will be pro-actively<br />
gathered on: the process and criteria to select KPI, candidate KPI as<br />
well as practical advantages and limitations for each.<br />
One health region’s experience with the development and<br />
implementation <strong>of</strong> a clinical KPI monitoring system will be<br />
presented to generate ideas and discussion. Embedding quality<br />
improvement (balancing, process, or outcome) measures to<br />
prioritize clinical services and track clinical performance has<br />
important rationale but also challenging barriers. Resolution <strong>of</strong><br />
DTPs (process measure) with pharmaceutical care is essential to a<br />
pharmacist’s role, and is a standardized, accepted surrogate <strong>of</strong><br />
clinical outcomes proven to affect important dimensions <strong>of</strong> quality.<br />
These can serve as the foundation for development <strong>of</strong> clinical KPIs<br />
that are collected using handheld personal data assistant (PDA)<br />
device. Standardized analyses can benchmark the value and<br />
productivity <strong>of</strong> clinical services.<br />
Goals and Objectives<br />
1. To provide pharmacists with an overview <strong>of</strong> the rationale,<br />
development, and implementation <strong>of</strong> a clinical KPI monitoring<br />
system from one health region along with the PDA tool used to<br />
collect the information.<br />
2. To facilitate an interactive discussion to gather feedback on the<br />
national process and criteria to select KPI, potential candidate<br />
KPI and practical definitions, advantages and limitations for each<br />
measure.<br />
Self-Assessment Questions<br />
1. Outline the background and rationale for why it is important to<br />
implement clinical pharmacy KPI measures<br />
2. List 3 potential clinical pharmacy KPI metrics and practical<br />
advantages and limitations for each.<br />
3. List some ideal attributes and anticipated barriers to the<br />
implementation <strong>of</strong> a KPI system.<br />
Chemotherapy-Induced Nausea and Vomiting in<br />
Children: An Evidence-Based Approach<br />
L.L. Dupuis, RPh, ACPR, MScPhm, FCSHP, The <strong>Hospital</strong> for Sick<br />
Children, Toronto, ON<br />
Chemotherapy-induced nausea and vomiting (CINV) continue to be<br />
negative influences on the lives <strong>of</strong> children with cancer. Although<br />
acute antineoplastic-induced vomiting may improve over the<br />
course <strong>of</strong> treatment, antineoplastic-induced nausea may actually<br />
become more problematic. The use <strong>of</strong> evidence-based or<br />
consensus-based guidelines for antiemetic selection has been<br />
shown to improve control <strong>of</strong> acute CINV in adults. Evidence-based<br />
guidelines for the classification <strong>of</strong> antineoplastic emetogenicity and<br />
the selection <strong>of</strong> antiemetic agents for children have now been<br />
developed under the auspices <strong>of</strong> the Pediatric Oncology Group <strong>of</strong><br />
Ontario (POGO).<br />
The methods used to develop the POGO CINV guidelines will be<br />
presented. Recommendations regarding the emetic risk <strong>of</strong><br />
antineoplastic regimens in children will be reviewed as will<br />
recommendations regarding antiemetic selection to optimize CINV<br />
control in children. The use <strong>of</strong> aprepitant in children and antiemetic<br />
options for children who cannot receive corticosteroids will be<br />
discussed. Research gaps in the available evidence base informing<br />
the POGO CINV guidelines will be highlighted.<br />
Goals and Objectives<br />
1. To inform pharmacists regarding the importance <strong>of</strong> CINV control<br />
in children<br />
2. To provide pharmacists with an evidence-based approach to the<br />
prevention <strong>of</strong> acute CINV in children<br />
Self-Assessment Questions<br />
1. How does the classification <strong>of</strong> the emetogenicity <strong>of</strong><br />
antineoplastic agents differ between adults and children?<br />
2. What antiemetic strategies are recommended to children who<br />
are receiving antineoplastic agents <strong>of</strong> high, moderate, low and<br />
minimal emetogenic risk?<br />
3. What is the role <strong>of</strong> aprepitant in controlling CINV in children?<br />
Pain, Pain, Go Away. Don’t Come Back Another<br />
Day! Exploring Treatment Options and Strategies<br />
for the Management <strong>of</strong> Pediatric Chronic Pain<br />
Regis Vaillancourt, OMM, OD, CD, BPhm, PharmD, FCSHP,<br />
Children’s <strong>Hospital</strong> <strong>of</strong> Eastern Ontario, Ottawa, ON<br />
The goal <strong>of</strong> this session is to provide pharmacists with an<br />
understanding <strong>of</strong> current practices and treatment strategies when<br />
managing chronic pediatric pain conditions.<br />
During this module the emerging and increasing practice <strong>of</strong><br />
multidisciplinary care will be discussed. Specifically, the topic <strong>of</strong>:<br />
The Three P’s <strong>of</strong> Pediatric Pain Management: Pharmacology,<br />
Physical therapy and Psychotherapy will be explored and how<br />
integrating these three elements have affected our practice, patient<br />
outcomes and relationships with other care providers.<br />
This presentation will also provide pharmacists with an overview <strong>of</strong><br />
pharmacological approaches to pain management with a focus on<br />
Chronic Regional Pain Syndrome (CRPS). Additionally, the role <strong>of</strong><br />
natural health products used to manage pain and its secondary<br />
symptoms such as insomnia will also be addressed. Evidence for<br />
each <strong>of</strong> these therapies will be presented for review and discussion.<br />
Goals and Objectives<br />
1. To provide pharmacists with an overview <strong>of</strong> the three P approach<br />
to pediatric chronic pain management<br />
2. To describe the role <strong>of</strong> natural health products in the treatment<br />
<strong>of</strong> pediatric chronic pain
30<br />
3. To outline the pharmacological approaches to managing chronic<br />
pain in children<br />
Self-Assessment Questions<br />
1. What is the role <strong>of</strong> magnesium in the management <strong>of</strong> chronic<br />
pain?<br />
2. What is the benefit <strong>of</strong> using pregabaline in chronic pain?<br />
3. What is the relationship between vitamin D anc chronic pain?<br />
Practical Approaches to Reducing Polypharmacy in<br />
the Elderly: An Interactive Workshop<br />
Debbie Kwan, BScPhm, MSc, FCSHP, Toronto Western <strong>Hospital</strong>,<br />
Family Health Team, Toronto, ON; Barbara Farrell, BScPhm,<br />
PharmD, FCSHP, Bruyère Continuing Care, Ottawa, ON<br />
The <strong>Canadian</strong> National Population Health Survey showed that ≥ 5<br />
medications are used by 53% <strong>of</strong> seniors residing in health care<br />
institutions and 13% <strong>of</strong> community dwelling seniors.(1) Multiple<br />
medication use is associated with increased non-adherence,<br />
adverse reactions, fall risk, medication errors, and inappropriate<br />
prescribing.(2,3,4) Several approaches to screening for and<br />
managing polypharmacy have been studied but are not routinely<br />
implemented in practice.(5)<br />
Polypharmacy in the elderly is a major public health issue.<br />
<strong>Pharmacists</strong> must take responsibility for identifying prescribing<br />
cascades, reducing un-necessary medications, managing<br />
medication adverse effects and reducing pill burden. We are best<br />
suited to work with prescribers and their elderly patients to<br />
minimize polypharmacy.<br />
This interactive workshop will discuss practical approaches to<br />
addressing polypharmacy in the frail elderly.<br />
Participants will work through several cases designed to highlight<br />
common prescribing cascades and opportunities for interventions<br />
to minimize medication use. Steps to avoid or detect prescribing<br />
cascades, and the use <strong>of</strong> explicit and implicit criteria to ensure<br />
appropriate medication use will be discussed. Adapting guidelines<br />
and targets for the frail elderly population will be highlighted.<br />
Non-pharmacological and interpr<strong>of</strong>essional approaches to<br />
managing symptoms will be presented as alternatives to<br />
medication use. Strategies to safely manage the withdrawal <strong>of</strong><br />
medication will be described. The importance <strong>of</strong> communicating<br />
reasons for medication reduction or simplification, and practical<br />
mechanisms for doing so, will be covered. Participants will leave<br />
the workshop with a toolkit <strong>of</strong> practical tips and suggestions that<br />
will enable them to help their patients prevent or reduce the risks<br />
associated with polypharmacy.<br />
Goals and Objectives<br />
Participants will be able to:<br />
1. Describe the impact <strong>of</strong> polypharmacy on patient health, quality<br />
<strong>of</strong> life and health services utilization<br />
3. Structure an approach to manage patient symptoms and risk,<br />
while minimizing medication use<br />
4. Consider the impact <strong>of</strong> psychosocial issues on managing<br />
polypharmacy<br />
Self Assessment Questions<br />
1. Review a patient’s history to determine whether a prescribing<br />
cascade may have occurred.<br />
2. Summarize the advantages and disadvantages <strong>of</strong> various<br />
screening and prescribing guidelines for the elderly<br />
MRSA Guidelines and Clinical Controversies: A<br />
Practical Overview<br />
Tim T.Y. Lau, PharmD, FCSHP, Vancouver General <strong>Hospital</strong>,<br />
Vancouver Coastal Health, Vancouver, BC<br />
Methicillin-resistant Staphylococcus aureus (MRSA) is a significant<br />
pathogen that causes a range <strong>of</strong> infections in the hospital and the<br />
community setting worldwide. MRSA resistance is encoded by the<br />
mecA gene that changes the conformation <strong>of</strong> the penicillin-binding<br />
protein 2a, conferring resistance to beta-lactam anti-infectives. Two<br />
general types <strong>of</strong> MRSA exist: hospital-associated MRSA (HA-MRSA)<br />
and community-associated MRSA (CA-MRSA). HA-MRSA is<br />
associated with multi-drug resistance, while CA-MRSA appears to<br />
be more susceptible to anti-infectives such as co-trimoxazole,<br />
tetracyclines, and clindamycin. The newer anti-MRSA agents will be<br />
reviewed and other anti-infectives will be highlighted. Common<br />
infections caused by MRSA include skin and s<strong>of</strong>t tissue infections,<br />
bactermia and endocarditis, pneumonia, bone and joint infections,<br />
and central nervous system infections. In 2011, the Infectious<br />
Diseases <strong>Society</strong> <strong>of</strong> America published clinical practice guidelines<br />
for the treatment <strong>of</strong> MRSA. Recommendations on the<br />
management <strong>of</strong> common infections associated with MRSA in<br />
adults will be summarized. Clinical controversies exist with the<br />
treatment <strong>of</strong> MRSA. These include the effectiveness <strong>of</strong> incision and<br />
drainage alone for s<strong>of</strong>t tissue abscesses, the addition <strong>of</strong> rifampin in<br />
skin and s<strong>of</strong>t tissue infections, the use <strong>of</strong> combination therapy for<br />
endocarditis, the superiority <strong>of</strong> linezolid over vancomycin for<br />
pneumonia, and the general effectiveness <strong>of</strong> vancomycin for MRSA<br />
infections.<br />
Goals and Objectives<br />
1. To describe the epidemiology <strong>of</strong> MRSA<br />
2. To understand the differences between HA-MRSA and CA-MRSA<br />
3. To become familiar with the antibiotics used in MRSA treatment<br />
4. To recognize the common infections associated with MRSA<br />
infections<br />
5. To be acquainted with the guidelines on the treatment <strong>of</strong> MRSA<br />
infections<br />
6. To review the clinical controversies with MRSA treatment<br />
2. Identify common prescribing cascades
31<br />
Self-Assessment Questions<br />
1. What is the difference between the treatment <strong>of</strong> HA-MRSA and<br />
CA-MRSA?<br />
2. Is vancomycin still a good drug for treating MRSA infections?<br />
Update on Urinary Tract Infections<br />
Monique Pitre, BScPhm, FCSHP, University Health Network,<br />
Toronto, ON<br />
The purpose <strong>of</strong> this session is to review the diagnostic criteria and<br />
the treatment options for complicated health-care associated<br />
urinary tract infections and highlight the challenges.<br />
The diagnosis and treatment <strong>of</strong> uncomplicated cystitis and<br />
pyelonephritis is well defined and does not pose many challenges.<br />
However, the increasing resistance <strong>of</strong> urinary pathogens to<br />
commonly prescribed antimicrobials does pose treatment<br />
challenges.<br />
The diagnosis and treatment <strong>of</strong> hospitalized patients with<br />
complicated urinary tract infections is less well defined.<br />
Catheter-associated bacteriuria is one <strong>of</strong> the most common<br />
health-care associated infections and results in considerable<br />
antimicrobial use. Urinary tract infections causing bacteremia have<br />
also been associated with increased mortality. Antimicrobial<br />
Stewardship <strong>Program</strong>s can play a major role in determining<br />
appropriateness <strong>of</strong> diagnostic criteria and treatment options. This is<br />
very important for the appropriate treatment <strong>of</strong> the patient and the<br />
ecological impact to the health-care facility. Inappropriate<br />
antimicrobial use in the treatment <strong>of</strong> urinary tract infections can<br />
lead to increased resistance and can become a reservoir for<br />
multi-drug resistant organisms.<br />
Goals and Objectives<br />
1. To review the challenges in diagnosis and treatment <strong>of</strong><br />
complicated urinary tract infections.<br />
2. To identify the role <strong>of</strong> antimicrobial stewardship programs in<br />
developing guidelines for the diagnosis and treatment <strong>of</strong><br />
health-care associated urinary tract infections.<br />
3. To provide data on current resistance patterns in urinary tract<br />
pathogens in Canada and Ontario.<br />
4. To discuss treatment options for multidrug-resistant pathogens.<br />
Self-Assessment Questions<br />
1. Do all positive urine cultures in hospitalized patients require<br />
treatment?<br />
2. How can antimicrobial stewardship programs play a role in<br />
appropriate treatment <strong>of</strong> health-care associated urinary tract<br />
infections?<br />
3. What are the current treatment options for resistant urinary<br />
pathogens?<br />
Top Clinical Papers in General Medicine<br />
Derek Jorgenson, BSP, PharmD, FCSHP, University <strong>of</strong> Saskatchewan,<br />
Saskatoon, SK<br />
Every year dozens <strong>of</strong> new clinical trials are published that have<br />
significant relevance to pharmacists who practice in generalist acute<br />
or ambulatory care settings. To be effective clinicians it is important<br />
be aware <strong>of</strong> these new papers and the impact that they should have<br />
on patient care. This session will provide a detailed critical appraisal<br />
and summary <strong>of</strong> 3-4 <strong>of</strong> the most influential clinical papers published<br />
in the general medicine literature within the last year.<br />
Goals and Objectives<br />
1. Summarize and critically appraise 3-4 <strong>of</strong> the most influential<br />
papers published in the general medicine literature within the<br />
last year.<br />
2. Make specific recommendations regarding how these 3-4 new<br />
papers should change practice.<br />
Self-Assessment Questions<br />
1. Describe one key take-home message from each <strong>of</strong> the papers<br />
summarized during this session?<br />
2. Describe two aspects <strong>of</strong> your practice that you will change<br />
starting tomorrow as a result <strong>of</strong> attending this session?<br />
Tuesday, February 7<br />
Mardi 7 février<br />
Issues and Controversies: Pr<strong>of</strong>essional Integrity &<br />
Conflicts <strong>of</strong> Interest<br />
Judy Chong, BScPhm, The Royal Victoria <strong>Hospital</strong> <strong>of</strong> Barrie, Barrie,<br />
ON – Moderator. Panelists: Peter Loewen, PharmD, Lower<br />
Mainland Pharmacy Services, Vancouver General <strong>Hospital</strong>,<br />
University <strong>of</strong> British Columbia, Vancouver, BC; James E. Tisdale,<br />
PharmD, College <strong>of</strong> Pharmacy, Purdue University School <strong>of</strong><br />
Medicine, Indiana University, Indianapolis, IN; Anne Hiltz, BScPhm,<br />
ACPR, Capital District Health Authority, QEII Health Sciences<br />
Centre, Halifax, NS<br />
By virtue <strong>of</strong> their specialized knowledge and skills, pharmacists are<br />
in a privileged position to make decisions which affect the health<br />
<strong>of</strong> other people. Patients, therefore, expect that pharmacists’<br />
decisions are based primarily on what is in their best interests. In<br />
our complex healthcare environment, pharmacists have the<br />
opportunity to form many different kinds <strong>of</strong> pr<strong>of</strong>essional and<br />
personal relationships with a wide variety <strong>of</strong> people. Each <strong>of</strong> these<br />
relationships has the potential to positively or negatively affect the<br />
pr<strong>of</strong>essional integrity <strong>of</strong> the pharmacist involved. As such,<br />
pharmacists who are interested in maintaining a high degree <strong>of</strong><br />
pr<strong>of</strong>essional integrity are well served by a appreciating the<br />
implications <strong>of</strong> each relationship from this viewpoint.<br />
In this interactive case-based panel discussion, several case<br />
vignettes involving different kinds <strong>of</strong> relationships which may have<br />
positive, neutral, or detrimental effects on the pr<strong>of</strong>essional integrity
32<br />
<strong>of</strong> the pharmacists involved will be explored. These scenarios will<br />
involve inter-pr<strong>of</strong>essional relationships, relationships with industry,<br />
patients, and others. Participants’ views and perspectives will be<br />
invited and debated.<br />
Goals and Objectives<br />
After the session and upon personal reflection, participants should<br />
be able to:<br />
1. Articulate a personal vision for what pr<strong>of</strong>essional integrity means<br />
to them<br />
2. Weigh the benefits and risks <strong>of</strong> entering relationships which may<br />
have implications for their pr<strong>of</strong>essional integrity.<br />
Probiotics for C. difficile Infection: Yes… No…<br />
Maybe? A Review <strong>of</strong> Evidence<br />
Miranda So, BScPhm, PharmD, University Health Network, Toronto,<br />
ON<br />
Clostridium difficile infection (CDI) is a distinct and severe form <strong>of</strong><br />
antibiotic-associated diarrhea (AAD), implicated in 20-30% <strong>of</strong><br />
cases. The association between C. difficile and<br />
pseudomembraneous colitis was first described decades ago,<br />
though CDI remains a major cause <strong>of</strong> nosocomial infections today.<br />
Risk factors include antibiotic use, hospitalization or residence in<br />
long-term care facilities; advanced age and proton pump inhibitor<br />
therapy. Since CDI carries significant mortality, morbidity and<br />
economic burden to society, outbreaks in Canada in recent years<br />
have prompted the calls for multi-modal strategies to tackle this<br />
problem. These include diligent infection control practices; new<br />
antibiotics against C. difficile; antimicrobial stewardship programs<br />
to guide the appropriate use <strong>of</strong> antibiotics; and probiotics, the<br />
“good bugs”, in an attempt to affect the gut flora composition in<br />
the host.<br />
Several probiotics <strong>of</strong> interests include Saccharomyces boulardii;<br />
Lactobacillus spp.; Bifidobacterium bifidum, and their combination.<br />
Although probiotics have long been studied for AAD, their roles in<br />
the prevention and/or treatment <strong>of</strong> CDI remain controversial for<br />
several reasons. First, regimens and formulations have not been<br />
standardized. Second, evidence from clinical trials has been<br />
conflicting, and is <strong>of</strong>ten limited by small sample size, highly<br />
selective study patients, or methodology flaws. Third, the safety <strong>of</strong><br />
probiotics, especially in those with severe comorbidities, has been<br />
called into question following reports <strong>of</strong> fungemia or bacteremia<br />
from probiotic therapy.<br />
This session will provide the clinical context regarding probiotics in<br />
CDI by critically reviewing existing evidence on this subject, as well<br />
as new information from ongoing trial(s).<br />
Goals and Objectives<br />
1. Explain the possible mechanisms <strong>of</strong> action <strong>of</strong> probiotics in CDI.<br />
2. Interpret the evidence supporting and refuting the use <strong>of</strong><br />
probiotics in preventing and treating CDI.<br />
Self-Assessment Questions<br />
1. What are the risk factors <strong>of</strong> developing CDI, its recurrence and<br />
complications?<br />
2. What are probiotics?<br />
CPOE Implementation: Prescription for Success<br />
Pegi Rappaport, BSc, MSc, Toronto East General <strong>Hospital</strong>, Janice<br />
Wells, PharmD, Pharmacy, St. Michael’s <strong>Hospital</strong>, Toronto, ON<br />
Your organization has committed to implementing Computer<br />
Provider Order Entry (CPOE), including medications. This session<br />
will outline important roles that pharmacists should lead, areas<br />
requiring collaboration, and suggestions for measuring impact and<br />
benefits from medication system and patient care perspectives.<br />
<strong>Pharmacists</strong> should contribute actively or lead development <strong>of</strong><br />
evidenced based order sets, and ensure a robust Pharmacy and<br />
Therapeutics process is in place to expedite their review and<br />
approval. <strong>Pharmacists</strong> must collaborate to redesign<br />
inter-pr<strong>of</strong>essional accountabilities and workflows in the new<br />
environment for issues such as medication administration times,<br />
re-assessment <strong>of</strong> medications approaching expiry, integration <strong>of</strong><br />
pharmacy information systems and databases with the hospital<br />
information system, as well as new workflows for validation <strong>of</strong><br />
orders, therapeutic interchange and managing new types or more<br />
complex orders. <strong>Pharmacists</strong> can also contribute to measuring<br />
CPOE impact through metrics such as turn around time, near<br />
misses, proportion <strong>of</strong> telephone orders and compliance with<br />
initiatives such as VTE prophylaxis.<br />
Goals and Objectives<br />
1. To describe leadership and collaborative roles for pharmacists to<br />
support the development, implementation and evaluation <strong>of</strong><br />
CPOE in healthcare organizations.<br />
2. To facilitate sharing and comparing approaches to CPOE in<br />
academic, community and paediatric hospitals.<br />
Self-Assessment Questions<br />
1. The recommended approach to implementing CPOE for<br />
medications is to transition all paper based orders, policies and<br />
processes to electronic. True/ False<br />
2. The practice <strong>of</strong> physicians, nurses and pharmacists is largely<br />
unchanged after CPOE is introduced. True/ False<br />
Management <strong>of</strong> Street Drug Toxicities<br />
Debra A. Kent, PharmD, DABAT, CSPI, B.C. Drug and Poison<br />
Information Centre, B.C. Centre for Disease Control, Provincial<br />
Health Services Authority, Vancouver, BC<br />
The purpose this session is to discuss current street drug use in<br />
Canada, their acute clinical effects and approach to treatment.<br />
Clinical pharmacists should be knowledgeable about current street<br />
drug use and understand the toxicology <strong>of</strong> these substances in<br />
order to enhance patient care in the emergency and critical care
33<br />
setting. Street drug patterns vary by region, and information<br />
volunteered by patients may be unreliable, incomplete or<br />
unobtainable. Literature and media reports from other countries<br />
may not reflect local street drug use patterns in Canada.<br />
The most commonly abused substances in many <strong>Canadian</strong> regions<br />
include ethanol, benzodiazepines, prescription opioids, and<br />
marijuana. These will not be the primary focus <strong>of</strong> this talk.<br />
Discussion in this session will highlight toxicity and management <strong>of</strong><br />
exposures to ecstasy, methamphetamine, cocaine, GHB and<br />
ketamine. While use varies across Canada, toxicity and<br />
management required are similar. Newer synthetic designer drugs<br />
will also be discussed including the piperazines (e.g., BZP), the<br />
tryptamines (e.g., 5-MeO-DiPT, “foxy methoxy”), the<br />
phenethylamines (e.g., cathinone, mephedrone, “bath salts”), and<br />
the synthetic cannabinoids (“spice”).<br />
Life-threatening toxicities <strong>of</strong> these agents range from extreme<br />
hyperthermia, acute kidney injury, coagulopathy, metabolic<br />
acidosis, hypertension and dysrhythmias to CNS and respiratory<br />
depression, hyponatremia and cerebral edema. Mechanisms <strong>of</strong><br />
acute toxicity and approach to management will be discussed.<br />
Goals and Objectives<br />
1. To discuss current and emerging street drugs and their toxicity.<br />
2. To discuss the current approach to managing toxicity <strong>of</strong> street<br />
drug overdose.<br />
Self-Assessment Questions<br />
1. What are the primary acute toxicities associated with street<br />
drugs in Canada?<br />
2. What treatment strategies should be considered in the<br />
management <strong>of</strong> these patients?<br />
3. What information sources can clinical pharmacists use to find<br />
local trends/patterns <strong>of</strong> street drug use in their region?<br />
Best Papers in Pharmacy Practice<br />
Jean-François Bussières, BPharm, MSc, MBA, FCSHP, CHU<br />
Saint-Justine, Montréal, QC<br />
In this age <strong>of</strong> constantly changing information and new<br />
developments in healthcare and the medical literature, the<br />
publication <strong>of</strong> influential papers and investigations can have an<br />
immediate impact on contemporary pharmacy practice. Keeping<br />
pace with the rapid pace <strong>of</strong> change can be a challenge for<br />
pharmacy practitioners, administrators and educators. The goal <strong>of</strong><br />
this session is to provide a practical overview and summary <strong>of</strong> key<br />
findings <strong>of</strong> the significant publications in pharmacy practice over<br />
the last 18 months (2010-2012). Selected key papers (3-5) will be<br />
highlighted and selected from a broad range <strong>of</strong> pharmacy practice<br />
settings and topics including clinical pharmacy practice,<br />
pharmaceutical care, medication safety and pharmacy education.<br />
For published papers that are controlled investigations, trial<br />
objectives, patient populations, study endpoints will be reviewed<br />
with an emphasis on practical practice implications, strengths and<br />
limitations. This session is aimed to broaden awareness <strong>of</strong><br />
developments in pharmacy practice.<br />
Goals and Objectives<br />
1. To highlight and summarize key findings <strong>of</strong> influential pharmacy<br />
practice publications in 2010-2012<br />
2. To provide an overview <strong>of</strong> selected controlled trial evidence in<br />
pharmacy practice in terms <strong>of</strong> highlighting major objectives,<br />
results and conclusions as well as strengths, limitations and<br />
practical implications.<br />
3. To provide participants with an open forum for sharing<br />
interactive discussion and questions on current published<br />
developments in pharmacy practice.<br />
Self-Assessment Questions<br />
1. What two practical strategies based on recent findings can I<br />
consider to incorporate into my everyday pharmacy practice or<br />
into my departmental initiatives for the next year?<br />
2. What three novel developments in pharmacy practice can I<br />
summarize for my pharmacy team?<br />
What is the Optimal Prioritization <strong>of</strong> Pr<strong>of</strong>essional<br />
Activities in a Collaboratively Developed <strong>Hospital</strong><br />
Pharmacist Best Practice Model?<br />
Olavo Fernandes, PharmD, FCSHP, University Health Network, Leslie<br />
Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, On<br />
This session focuses on addressing the fundamental need for clarity<br />
and direction for pharmacists amidst a time <strong>of</strong> unprecedented<br />
challenges and opportunities within our pr<strong>of</strong>ession. <strong>Hospital</strong><br />
pharmacists today are challenged with many competing and<br />
overlapping pr<strong>of</strong>essional priorities for the scope <strong>of</strong> pharmacy<br />
practice including: pharmaceutical care, patient safety, expanded<br />
experiential teaching responsibilities, competency –based residency<br />
training, enhanced expectations for scholarly activity,<br />
evidence-informed medicine, computerized prescriber order entry,<br />
medication reconciliation, hospital accreditation requirements, as<br />
well as expanded scope <strong>of</strong> practice legislation. Consequently, there<br />
is an authentic need for pharmacists to objectively assess, reflect<br />
and realign our current practice patterns to effectively address<br />
these priorities with the resource challenges <strong>of</strong> our current<br />
healthcare environment. This session will outline a multi-faceted<br />
generalizable framework for collaboratively discerning a practical,<br />
relevant and robust hospital pharmacist best practice model with a<br />
focus on an optimal prioritization <strong>of</strong> pr<strong>of</strong>essional activities (clinical<br />
and operational). This evolving model takes into practical<br />
consideration feedback from front-line pharmacists, pharmacy<br />
leaders, pharmacy practice published evidence, peer hospitals,<br />
CSHP 2012/ ASHP PPMI and local hospital priorities. This adaptable<br />
process is intended to position hospital pharmacists to best meet<br />
the needs <strong>of</strong> patients, healthcare pr<strong>of</strong>essionals, students, staff,<br />
government funders, and academia. It is envisioned that this<br />
hospital pharmacist practice model can be personalized for<br />
individual hospitals, as it should appropriately account for local<br />
priorities, influences, resources and perspectives.
34<br />
Goals and Objectives<br />
1. Outline a multi-faceted generalizable framework for discerning<br />
an optimal prioritization <strong>of</strong> pr<strong>of</strong>essional activities in a<br />
collaboratively developed hospital pharmacist best practice<br />
model.<br />
2. Highlight key bottom-lines <strong>of</strong> published evidence to inform this<br />
prioritization process: What specific pharmacist interventions/<br />
clinical services have demonstrated impact on meaningful<br />
patient outcomes?<br />
3. Illustrate various stakeholder perspectives with imagery for<br />
prioritized activities and practice models<br />
Self-Assessment Questions<br />
1. What specific clinical pharmacy activities have linked to<br />
improved patient outcomes?<br />
2. What specific meaningful patient outcomes have been improved<br />
by specific hospital pharmacy interventions?<br />
3. List and define four generalized hospital pharmacist practice<br />
models.<br />
4. Outline specific practical pr<strong>of</strong>essional responsibility domains that<br />
can be used to categorize and prioritize pr<strong>of</strong>essional<br />
responsibilities for hospital pharmacists.<br />
Simulation Game: Building Pharmacy Services from<br />
Scratch<br />
Jean-François Bussières, BPharm, MSc, MBA, FCSHP, CHU<br />
Sint-Justine, Montréal, QC<br />
<strong>Hospital</strong> pharmacy practice has undergone many changes over the<br />
course <strong>of</strong> the last three decades. New technologies such as<br />
automated repackaging technologies, robotic unit dose cart-fill<br />
systems, and automated dispensing cabinets have improved the<br />
efficiency, effectiveness and quality <strong>of</strong> drug distribution systems.<br />
New pharmacy practice models have been introduced in which<br />
pharmacists accept responsibility and accountability for drug<br />
therapy management. While there is an abundance <strong>of</strong> evidence<br />
related to the positive impact that many pharmacy services can<br />
have on the quality and effectiveness <strong>of</strong> health care, the uptake <strong>of</strong><br />
many evidence-based services has been slow and incomplete.<br />
There is a relative paucity <strong>of</strong> literature regarding the<br />
decision-making processes that are used by pharmacy managers<br />
and practitioners to prioritize the pharmaceutical services that they<br />
provide. Given the limited human and financial resources that are<br />
available, it is important for pharmacy managers and others in the<br />
pr<strong>of</strong>ession to identify and understand the basis on which their<br />
prioritization decisions are being made. We need to understand if<br />
the portfolio <strong>of</strong> services provided by pharmacy departments is<br />
evidence-based, preference-based, or a result <strong>of</strong> random<br />
opportunities that have arisen in a given hospital. We developed a<br />
simulation game to examine how prioritization decisions are made<br />
by hospital pharmacy managers<br />
Goals and Objectives<br />
1. To examine the consistency <strong>of</strong> prioritization decisions made by<br />
pharmacists in a simulated environment where the available<br />
resources are constrained.<br />
2. To rank the factors that influenced prioritization decisions and to<br />
compare individual and teams’ rankings <strong>of</strong> these factors.<br />
Self-Assessment Questions<br />
1. Do pharmacists agree on a core set <strong>of</strong> pharmaceutical activities<br />
that should be prioritized ?<br />
2. What are the factors that influence prioritization decisions in<br />
pharmacy practice ?<br />
3. What should the pharmacy pr<strong>of</strong>ession do to better prioritize<br />
pharmaceutical activities ?<br />
Antiplatelets in 2012 and Beyond<br />
Heather Kertland, BScPhm, PharmD, St. Michael’s <strong>Hospital</strong>,<br />
Toronto, ON<br />
Antiplatelet therapy is recommended in the guidelines for a variety<br />
<strong>of</strong> cardiac conditions ranging from acute coronary syndrome,<br />
post-PCI, primary prevention, and post-CABG. In the last year, the<br />
choice <strong>of</strong> agents has increased to include ticagrelor. The question is<br />
which agent or what combination <strong>of</strong> agents, at which dose and for<br />
how long. The goal <strong>of</strong> this session is to provide pharmacists with<br />
the knowledge to be able to determine what agent(s) are the<br />
optimal agents for their patients.<br />
Goals and Objectives<br />
1. Compare and contrast the risks and benefits <strong>of</strong> the various<br />
antiplatelet agents available on the <strong>Canadian</strong> market<br />
2. Identify which patient groups will benefit from which agent<br />
3. Defend your recommendation for antiplatelet agents for a given<br />
clinical scenario with reference to primary literature.<br />
Self-Assessment Questions<br />
1. On average, what is the rate <strong>of</strong> non-CABG major bleeding for a<br />
patient receiving dual antiplatelet therapy?<br />
2. What if any, is the benefit <strong>of</strong> using ticagrelor and ASA compared<br />
to clopidogrel and ASA in a patient with non-ST segment ACS?<br />
3. What is the optimal dose <strong>of</strong> ASA in a patient receiving<br />
prasugrel?<br />
Antiarrhythmic Drug Safety: Illusion, Fantasy and<br />
Wishful Thinking? Dronedarone and Other<br />
Disappointments<br />
James E. Tisdale, BScPhm, PharmD, BCPS, FCCP, FAPhA, FAHA,<br />
College <strong>of</strong> Pharmacy, Purdue University, Indianapolis, IN<br />
Antiarrhythmic drug safety has been an issue for many years.<br />
Quinidine-induced syncope was reported in the 1950s, and has<br />
been known to be due to the ventricular arrhythmia torsades de
35<br />
pointes (TdP) since the 1970s. TdP is associated with many<br />
antiarrhythmic drugs, including procainamide, sotalol, d<strong>of</strong>etilide,<br />
ibutilide, and, to a lesser extent, amiodarone and dronedarone. In<br />
the late 1980s and early 1990s, flecainide, encainide and<br />
moricizine were found to be associated with increased mortality in<br />
patients with a history <strong>of</strong> myocardial infarction, likely by inducing<br />
ventricular tachycardia in the presence <strong>of</strong> structural heart disease.<br />
Similar findings were subsequently reported associated with other<br />
antiarrhythmic agents including quinidine and procainamide.<br />
Perhaps the most effective antiarrhythmic agent available,<br />
amiodarone, is associated with many adverse effects, including<br />
life-threatening pulmonary fibrosis, hypothyroidism or<br />
hyperthyroidism, neurologic issues, bradycardia, hepatic toxicity,<br />
and dermatologic effects including blue-grey skin discoloration and<br />
photosensitivity. The newest available antiarrhythmic drug,<br />
dronedarone, was developed in an effort to create a drug with<br />
similar efficacy to amiodarone, but with a more favorable adverse<br />
effect pr<strong>of</strong>ile. However, dronedarone has been shown to be less<br />
effective for atrial fibrillation management than amiodarone. In<br />
addition, while dronedarone is free <strong>of</strong> adverse thyroid adverse<br />
effects and, possibly, pulmonary fibrosis, the drug is associated<br />
with increased mortality in patients with heart failure and in<br />
patients with permanent atrial fibrillation, severely limiting the use<br />
<strong>of</strong> this agent. Despite continued efforts to develop antiarrhythmic<br />
drugs with favorable adverse effect pr<strong>of</strong>iles, antiarrhythmic drug<br />
safety may simply be illusion, fantasy, and wishful thinking.<br />
Goals and Objectives<br />
1. Describe adverse effects associated with commonly used<br />
antiarrhythmic drugs<br />
2. Describe the advantages and disadvantages <strong>of</strong> the<br />
antiarrhythmic drug dronedarone, particularly its safety pr<strong>of</strong>ile in<br />
patients with heart failure or permanent atrial fibrillation<br />
Self-Assessment Questions<br />
1. Which <strong>of</strong> the following antiarrhythmic agents is safe to use<br />
(does not increase mortality) in patients with a history <strong>of</strong><br />
myocardial infarction?<br />
a. Amiodarone<br />
b. Flecainide<br />
c. Procainamide<br />
d. Quinidine<br />
2. Which <strong>of</strong> the following antiarrhythmic agents is safe to use<br />
(does not increase mortality or worsen the disease) in patients<br />
with heart failure?<br />
a. D<strong>of</strong>etilide<br />
b. Dronedarone<br />
c. Flecainide<br />
d. Propafenone<br />
3. Which <strong>of</strong> the following adverse effects or drug interactions<br />
associated with amiodarone is not associated with dronedarone?<br />
a. Bradycardia<br />
b. Hypothyroidism<br />
c. QT interval prolongation<br />
d. Interaction with digoxin<br />
Wednesday, February 8<br />
Mercredi 8 février<br />
Learning from High Reliability Organizations to<br />
Improve Reliability and Safety in Health Care<br />
Marlys Christianson, MD, PhD, Rotman School <strong>of</strong> Management,<br />
University <strong>of</strong> Toronto, Toronto, ON<br />
The purpose <strong>of</strong> this session is to introduce the concept <strong>of</strong> high<br />
reliability organizing as a way <strong>of</strong> thinking about consistent and<br />
excellent performance and to provide some examples <strong>of</strong> how high<br />
reliability organizing is being used in health care.<br />
Aircraft carriers, electrical power grids, and wildland firefighting,<br />
although seemingly different, are exemplars <strong>of</strong> high reliability<br />
organizations (HROs) – organizations that have the potential for<br />
catastrophic failure, yet engage in nearly error-free performance.<br />
HROs commit to safety at the highest level and adopt a special<br />
approach to its pursuit. High reliability organizing has been studied<br />
and discussed for some time in other industries and is receiving<br />
increasing attention in healthcare. The essence <strong>of</strong> high reliability<br />
organizing is a set <strong>of</strong> practices that enable organizations to focus<br />
attention on emergent problems and to deploy the right set <strong>of</strong><br />
resources to address those problems. HROs behave in ways that<br />
sometimes seem counterintuitive – they don’t try and hide failures<br />
but rather celebrate them as windows into the health <strong>of</strong> the<br />
system, they seek out problems, they avoid focusing on just one<br />
aspect <strong>of</strong> work and are able to see how all the parts <strong>of</strong> work fit<br />
together, they expect unexpected events and develop the capability<br />
to manage them, and they defer decision making down to local<br />
front-line experts who are empowered to solve problems. Given<br />
that health care is also a setting where error has potentially<br />
catastrophic consequences, high reliability organizing practices<br />
hold promise for improving reliability and safety in health care.<br />
Goals and Objectives<br />
1. To introduce the concept <strong>of</strong> high reliability organizing as a way<br />
<strong>of</strong> thinking about consistent and excellent performance.<br />
2. To provide some examples <strong>of</strong> how high reliability organizing is<br />
being used in health care<br />
Self-Assessment Questions<br />
1. What practices enable high reliability organizing?<br />
2. What are some ways to build the capability for high reliability<br />
organizing in health care?
36<br />
New Advances in the Management <strong>of</strong> Metastatic<br />
Renal Cell Carcinoma<br />
Shirin Abadi, BScPhm, ACPR, PharmD, BC Cancer Agency,<br />
Vancouver, BC<br />
In 2011, kidney cancer was the 6th most common cancer diagnosis<br />
affecting <strong>Canadian</strong> men and the 11th most common cancer<br />
diagnosis affecting <strong>Canadian</strong> women. Based on the 2004-2006<br />
<strong>Canadian</strong> Cancer Statistics, the estimated 5-year relative survival<br />
rate for kidney cancer is about 67%, and is significantly worse in<br />
cases <strong>of</strong> advanced disease. Drug therapy options are currently<br />
restricted to patients with advanced disease and have historically<br />
included cytokine-based therapies with high dose interleukin 2, or<br />
interferon-alpha. In recent years, a number <strong>of</strong> new treatment<br />
options have been introduced into the market for the management<br />
<strong>of</strong> metastatic renal cell carcinoma, including tyrosine kinase<br />
inhibitors such as sunitinib, sorafenib, and pazopanib, monoclonal<br />
antibodies such as bevacizumab, and mTOR inhibitors such as<br />
temsirolimus and everolimus. This presentation will provide an<br />
overview <strong>of</strong> the efficacy and safety <strong>of</strong> the new treatment options<br />
for the management <strong>of</strong> metastatic renal cell carcinoma.<br />
Goals and Objectives<br />
1. To review the clinical evidence behind the use <strong>of</strong> the new<br />
pharmacotherapeutic options for the management <strong>of</strong> metastatic<br />
renal cell carcinoma.<br />
2. To discuss the toxicity parameters and potential drug interactions<br />
associated with the use <strong>of</strong> the new pharmacotherapeutic<br />
options for the management <strong>of</strong> metastatic renal cell carcinoma.<br />
Self-Assessment Questions<br />
1. What are the roles <strong>of</strong> tyrosine kinase inhibitors, monoclonal<br />
antibodies, and mTOR inhibitors in the management <strong>of</strong><br />
metastatic renal cell carcinoma?<br />
2. What are the most common side effects and drug interactions<br />
associated with the use <strong>of</strong> sunitinib, sorafenib, pazopanib,<br />
bevacizumab, temsirolimus, and everolimus?<br />
Combination Therapy for Problem Gram Negative<br />
Pathogens<br />
Linda Dresser PharmD, FCSHP, University Health Network, Toronto,<br />
ON<br />
The goal <strong>of</strong> this presentation is to provide pharmacists involved in<br />
the care <strong>of</strong> patients with infectious diseases a familiarity with the<br />
literature and evidence concerning the use <strong>of</strong> combination<br />
antimicrobial therapy to manage problem gram negative infections.<br />
The role <strong>of</strong> combination therapy for the treatment <strong>of</strong> infections<br />
due to gram negative organisms, particularly those associated with<br />
resistance issues, is an ongoing topic <strong>of</strong> debate. The rationale for<br />
initiating combination therapy is usually justified by one fo the<br />
following: the potential for synergistic activity between two or<br />
more classes <strong>of</strong> antimicrobials; initial provision <strong>of</strong> broad spectrum<br />
activity from antimicrobial agents with differing spectra <strong>of</strong> activity<br />
and resistance patterns; or the prevention <strong>of</strong> resistance<br />
development while on therapy. The disadvantages <strong>of</strong> ongoing<br />
combination therapy include increased risk <strong>of</strong> toxicity, increased<br />
costs, increased risk <strong>of</strong> superinfection with more-resistant<br />
organisms. This common practice <strong>of</strong> prescribing double coverage<br />
for the treatment <strong>of</strong> gram negative pathogens is not congruent<br />
with current evidence.<br />
In this presentation the literature comparing monotherapy and<br />
combination therapy for gram negative infections will be reviewed<br />
and guidance for the pharmacotherapy practitioner provided.<br />
Goals and Objectives<br />
1. To review the evidence for monotherapy versus combination<br />
therapy for infections due to gram negative pathogens.<br />
2. To discuss the pharmacists role in translating the evidence into<br />
practice.<br />
Self-Assessment Questions<br />
1. For what indications is the empiric use <strong>of</strong> combination therapy<br />
to manage gram negative infections supported by the literature?<br />
2. For what patient populations is the empiric use <strong>of</strong> combination<br />
therapy to manage gram negative infections supported by the<br />
literature?<br />
The State <strong>of</strong> <strong>Hospital</strong> Pharmacy Practice in Canada:<br />
The Good, The Bad, and Perhaps a Bit <strong>of</strong> Ugly<br />
(Courtesy <strong>of</strong> the <strong>Hospital</strong> Pharmacy in Canada<br />
2009/10 Report)<br />
Kevin W. Hall, BScPhm, PharmD, Faculty <strong>of</strong> Pharmacy and<br />
Pharmacutical Sciences, University <strong>of</strong> Alberta; <strong>Hospital</strong> Pharmacy in<br />
Canada Report, Edmonton, AB<br />
The goals <strong>of</strong> this presentation are to review the 2009/10 results <strong>of</strong><br />
the biannual, national survey <strong>of</strong> hospital pharmacy departments in<br />
Canada, and to highlight a few areas that warrant discussion and<br />
action by hospital pharmacy practitioners.<br />
All <strong>Canadian</strong> hospitals with a minimum <strong>of</strong> 50 acute care beds are<br />
invited to participate in the biannual survey. The response rate in<br />
2009/10 was 72% (160/222), which was similar to the 2007/08<br />
response rate <strong>of</strong> 74% (166/223). Seventy-three percent <strong>of</strong><br />
respondents were from non-teaching organizations and 27% were<br />
from teaching facilities, compared to 76% and 24% respectively in<br />
the 2007/08 report. The data provided by respondents was<br />
reviewed and analyzed by members <strong>of</strong> the editorial board, who<br />
subsequently wrote the 12 chapters that appear in the <strong>Hospital</strong><br />
Pharmacy in Canada 2009/10 Report.<br />
Goals and Objectives<br />
1. To provide conference participants with a summary <strong>of</strong> the<br />
national survey data that appears in the <strong>Hospital</strong> Pharmacy in<br />
Canada 2009/10 Report.<br />
2. To highlight certain findings in the Report which warrant<br />
discussion and action by hospital pharmacy practitioners.
37<br />
Self-Assessment Questions<br />
1. What type <strong>of</strong> pharmacy practice model should we be aiming for<br />
as the future standard for hospital pharmacy practice in<br />
Canada? Is the integrated drug distribution/clinical practice<br />
model where we want to be in the future?<br />
3. Will the health care system/the public demand consistency and<br />
accountability for the clinical services provided by pharmacists?<br />
Is hospital pharmacy practice evidence-based or<br />
preference-based?<br />
3. Are hospital pharmacists providers <strong>of</strong> care or providers <strong>of</strong><br />
information?<br />
4. Are today’s competency requirements for pharmacists different<br />
than in the past? Do existing pharmacists and/or new pharmacy<br />
graduates possess these competencies?<br />
VTE in the ICU<br />
David Williamson, BPharm, MSc, BCPS, Hôpital du Sacré-Cœur de<br />
Montréal and Faculté de pharmacie, Université de Montréal,<br />
Montréal, QC<br />
The purpose <strong>of</strong> this session is to review the causes, prophylaxis and<br />
treatment <strong>of</strong> venous thromboembolism in the setting <strong>of</strong> the<br />
intensive care unit.<br />
The practice <strong>of</strong> venous thromboembolism (VTE) prevention critically<br />
ill patients is in constant evolution as new clinical trials are being<br />
published. In addition, intensive care unit (ICU) patients <strong>of</strong>ten have<br />
comorbidities or complications that increase the risk <strong>of</strong> bleeding or<br />
alter the pharmacokinetics <strong>of</strong> anticoagulants. Thromboprophylaxis<br />
regimens may require different dosing and monitoring strategies.<br />
The use <strong>of</strong> heparins in the ICU is not without risks and<br />
heparin-induced thrombocytopenia (HIT) is <strong>of</strong>ten suspected in<br />
patients with thrombocytopenia. However, this complication<br />
remains relatively rare and strategies enabling proper identification<br />
are key. Advances in laboratory diagnostic and new scoring systems<br />
may help clinicians tackle this conundrum. Unfortunately, deep vein<br />
thrombosis and pulmonary embolism still occur in the critically ill<br />
and prompt treatment <strong>of</strong> these complications is key. Massive and<br />
selected cases <strong>of</strong> submassive pulmonary embolism can potentially<br />
be treated with intravenous thrombolytics.<br />
Goals and Objectives<br />
1. Evaluate interventions for VTE prevention with respect to<br />
efficacy, safety, and cost in critically ill patients.<br />
2. Design optimal dosing strategies for low molecular weight<br />
heparin in renal failure and obesity.<br />
3. Design interventions for preventing, identifying and optimally<br />
treating patients with heparin induced thrombocytopenia<br />
4. Evaluate the role <strong>of</strong> thrombolysis in the treatment <strong>of</strong> submassive<br />
and massive pulmonary embolism<br />
Self-Assessment Questions<br />
1. What is the role for low molecular weight heparins in VTE<br />
prevention <strong>of</strong> medical-surgical ICU patients?<br />
2. What is the optimal dosing strategy for anticoagulants in the<br />
VTE prevention <strong>of</strong> renally impaired ICU patients?<br />
3. How can HIT be optimally identified in ICU patients?<br />
4. What is the role for thrombolytics in submassive pulmonary<br />
embolism?<br />
How will Pharmacogenomics Practically Impact<br />
Patient Care & Practicing <strong>Pharmacists</strong>: Now and In<br />
the Future?<br />
Anke-Hilse Maitland-van der Zee, PharmD, PhD, Utrecht Institute<br />
for Pharmaceutical Sciences, Utrecht University, Utrecht,<br />
The Netherlands<br />
Pharmacogenomics uses genetic information to individualize drug<br />
therapy. Even though it did not fulfill the expectations that we had<br />
10-15 years ago, there are gene-drug interactions known that can<br />
and should be used in clinical practice. However implementing<br />
these interactions in challenging. How much evidence is needed?<br />
Who should perform and who should pay for genotyping. Is It<br />
cost-effective? <strong>Pharmacists</strong> might be able to play an important role<br />
in bringing this into practice.<br />
Goals and Objectives<br />
1. Give an introduction in pharmacogenetics/genomics<br />
2. Give an overview <strong>of</strong> clinical relevant gene-drug interactions<br />
3. Discuss challenges in implementation<br />
4. Talk about future opportunities in research and implementation<br />
Self-Assessment Questions<br />
1. Which gene-drug interactions are ready for practice?<br />
2. How can pharmacists play a role in implementation <strong>of</strong><br />
pharmacogenomics in everyday practice?<br />
What Should a System for the Recognition <strong>of</strong><br />
Special Areas <strong>of</strong> Practice in Pharmacy Look Like?<br />
Arthur Whetstone, EdD, MA, Bed, BA(Hon), RPN, <strong>Canadian</strong> Council<br />
on Continuing Education in Pharmacy, Saskatoon, SK<br />
The CPD/CE Policy Summit, which brought together pharmacy<br />
pr<strong>of</strong>essionals from all sectors <strong>of</strong> the pharmacy community,<br />
advocated that action needed to be taken now on the<br />
establishment <strong>of</strong> a system <strong>of</strong> recognition <strong>of</strong> specialization and<br />
special areas <strong>of</strong> practice in pharmacy. While a number <strong>of</strong> models<br />
were discussed, there was agreement the system needed to be a<br />
Condominium <strong>of</strong> specialities in which a core administrative system<br />
and framework enabled a number <strong>of</strong> individual specialities.<br />
Specialization in pharmacy has been discussed for over two<br />
decades. It has never gotten beyond the discussion stage. The<br />
Summit participants stated that there has been enough talk, it is<br />
now time to walk the talk.<br />
In the session we will discuss: (i) What do we mean by<br />
specialization, special areas <strong>of</strong> practice, and are they the same
38<br />
thing? (ii) What are different models for the recognition or<br />
certification <strong>of</strong> specialities and special areas <strong>of</strong> practice in<br />
pharmacy? (iii) What are the issues that need to be addressed to<br />
develop a system <strong>of</strong> recognition? (iv) Is there really a need and<br />
interest in becoming a specialist among <strong>Canadian</strong> pharmacists? (v)<br />
And, what is the preferred approach to a system <strong>of</strong> recognition <strong>of</strong><br />
specialization in pharmacy practice?<br />
Goals and Objectives<br />
At the end <strong>of</strong> the session, the participant will be able to:<br />
1. State the differences between area <strong>of</strong> specialization and special<br />
area <strong>of</strong> practice.<br />
2. Describe four basic models <strong>of</strong> certification <strong>of</strong> pr<strong>of</strong>essional<br />
practice.<br />
3. Describe the issues with recognition <strong>of</strong> special areas <strong>of</strong> practice<br />
and specialization in Canada.<br />
4. Identify a preferred approach to a system <strong>of</strong> recognition <strong>of</strong><br />
specialization and special areas <strong>of</strong> practice.<br />
Self-Assessment Questions<br />
1. What are the options for the development <strong>of</strong> a system <strong>of</strong><br />
recognition for special areas <strong>of</strong> practice in pharmacy in Canada?<br />
2. What are the issues that must be addressed to establish a system<br />
<strong>of</strong> recognition <strong>of</strong> special areas <strong>of</strong> practice in pharmacy in<br />
Canada?<br />
3. What is a feasible option for a system <strong>of</strong> recognition <strong>of</strong> special<br />
areas <strong>of</strong> practice in pharmacy?<br />
CSHP 2015 Town Hall: Are we on Target for<br />
Pharmacy Practice Excellence?<br />
Carolyn Bornstein, BScPhm, ACPR, FCSHP, CSHP 2015 Project<br />
Coordinator, Newmarket, ON, Stephen Shalansky, BScPhm, PharmD,<br />
ACPR, FCSHP, Providence Healthcare, Vancouver, BC, Emily Muir,<br />
BScPhm, ACPR, Horizon Health Network, Saint John, NB<br />
CSHP 2015 is a vision <strong>of</strong> Pharmacy Practice Excellence. Its 6 goals<br />
aim to ensure that the use <strong>of</strong> medications is effective,<br />
evidence-based and safer, and to contribute meaningfully to public<br />
health. Thirty-six pharmacy practice-related objectives support the<br />
goals. Highlights <strong>of</strong> the progress <strong>of</strong> hospital pharmacy departments<br />
in Canada towards the CSHP 2015 objective targets will be<br />
presented. Although some targets have been reached, progress in<br />
many areas falls short <strong>of</strong> the targets. Some say they are “too busy”<br />
for the CSHP 2015 initiative, without realizing that as they strive to<br />
comply with Accreditation Canada’s Medication Management<br />
Standards and the Safer Healthcare Now! initiatives they are<br />
already “committed” to CSHP 2015. The supports and resources<br />
provided for CSHP 2015 will be highlighted.<br />
CSHP 2015’s success depends on the commitment <strong>of</strong> pharmacy<br />
departments and their implementation <strong>of</strong> the CSHP 2015<br />
objectives. Incorporating CSHP 2015 into your pharmacy<br />
departments’ strategic plan is critical. Strategies for strategic<br />
planning will be presented, including the experience <strong>of</strong> a CSHP<br />
2015 branch champion and interim pharmacy director.<br />
In one organization the pharmacists identified evidence-based<br />
medicine and critical appraisal skills as a learning need. The third<br />
speaker will share her experience <strong>of</strong> using the CSHP toolkit, FROM<br />
PAPER TO PRACTICE: Incorporating Evidence into Pharmacy<br />
Practice in the development <strong>of</strong> an evidence based medicine<br />
curriculum for her organization. Their goal was to increase the<br />
pharmacist’s confidence and ability to seek the best possible clinical<br />
evidence and apply it to patient care.<br />
The town hall will conclude by welcoming CSHP member feedback<br />
on the value <strong>of</strong> the information, supports, resources and tools that<br />
CSHP has provided to help incorporate CSHP 2015 into their<br />
practice.<br />
Goals and Objectives<br />
1. To provide highlights <strong>of</strong> the CSHP 2015 progress to date and<br />
some <strong>of</strong> the many supports, resources and tools that CSHP has<br />
provided for its members.<br />
2. To provide an example <strong>of</strong> a strategic planning process that<br />
considers and aligns as much as possible: a) previous pharmacy<br />
department strategic goals, b) institutional strategic goals, and c)<br />
CSHP 2015 goals and objectives.<br />
3. To provide insight and an opportunity for discussion regarding<br />
how CSHP 2015 objectives can be implemented in a manner<br />
that maximizes the chance <strong>of</strong> success and sustainment.<br />
Self-Assessment Questions<br />
1. When planning a pharmacy department strategic planning<br />
session, why is it important to consider previous departmental<br />
objectives, as well as the institutions strategic priorities?<br />
2. Name two documents available on the CSHP National website<br />
that you will use during your next departmental strategic<br />
planning session.<br />
3. What CSHP 2015 toolkits are available on the CSHP website and<br />
how can you use them in your pharmacy department to reach<br />
CSHP 2015 goals and objectives?<br />
Dexmedetomidine: A New Sedative in the ICU:<br />
Balancing Responsibility and Real Life<br />
Salmaan Kanji, BScPhm, PharmD, ACPR, The Ottawa <strong>Hospital</strong> and<br />
Ottawa <strong>Hospital</strong> Research Institute, Ottawa, ON<br />
The purpose <strong>of</strong> this session is to discuss the role <strong>of</strong> a new sedative<br />
agent, dexmedetomidine, in the context <strong>of</strong> ICU sedation and<br />
analgesia during a time where current strategies are being<br />
re-evaluated in light <strong>of</strong> new information and new tools.<br />
Sedation practices in the ICU are in a current state <strong>of</strong> flux. The<br />
consequences <strong>of</strong> over-sedation <strong>of</strong> ICU patients are increasingly<br />
being recognized and associated with negative outcomes such as<br />
increased length <strong>of</strong> stay, increased duration <strong>of</strong> mechanical<br />
ventilation, complications associated with critical illness and even<br />
mortality. Furthermore, long term evaluations have established a
39<br />
correlation between ICU sedation and complications during the<br />
rehabilitative phase <strong>of</strong> survivors <strong>of</strong> critical illness including mood<br />
disturbances, post traumatic stress disorders and prolonged<br />
myopathic rehabilitation.<br />
In the last 10 years many strategies to minimize the consequences<br />
<strong>of</strong> oversedation have been investigated and challenge our<br />
traditional paradigms as they relate to sedation in the critically ill<br />
patient. These consist <strong>of</strong> new procedural strategies and<br />
interventions (i.e., nurse driven sedation protocols, spontaneous<br />
breathing trials, goal directed sedation, daily sedation interruption)<br />
and new drugs (i.e., dexmedetomidine, ketamine, clonidine).<br />
Dexmedetomidine has entered the <strong>Canadian</strong> market amidst much<br />
anticipation and controversy. It is expensive relative to alternative<br />
drug therapy and approved for only niche indications. It is also a<br />
new novel therapy that has attractive qualities particularly from a<br />
pharmacokinetic/pharmacodynamic point <strong>of</strong> view and from a<br />
pharmacologic perspective. This combination <strong>of</strong> attributes lends<br />
new therapies to the potential for misuse.<br />
Goals and Objectives<br />
1. To review the evidence for dexmedetomidine in the ICU with<br />
respect to comparative efficacy and safety.<br />
2. To propose the “place in therapy” for dexmedetomidine as it<br />
pertains to clinicians caring for patients in <strong>Canadian</strong> ICUs.<br />
3. To propose strategies to use dexmedetomidine responsibly while<br />
maximizing its niche potential for benefit within the scope <strong>of</strong><br />
approval.<br />
Self-Assessment Questions<br />
1. For what indication is dexmedetomidine approved in Canada?<br />
2. What type <strong>of</strong> ICU patient is most likely to benefit from<br />
dexmedetomidine within the approved <strong>Canadian</strong> indication?<br />
3. What strategies can be employed to minimize cost and adverse<br />
events related to dexmedetomidine while maximizing the<br />
potential benefits in ICU patients.<br />
What’s New, What’s Next… 1 Year Experience for<br />
an Antimicrobial Stewardship <strong>Program</strong> in a<br />
Community <strong>Hospital</strong> Intensive Care Unit (ICU)<br />
Kelly Walker, BSP, Toronto East General <strong>Hospital</strong>, Toronto, ON,<br />
Jaclyn Litynsky, PharmD, BCPS, Toronto East General <strong>Hospital</strong>,<br />
Toronto, ON<br />
Antimicrobial stewardship promotes appropriate antimicrobial use<br />
with the overall goal <strong>of</strong> optimizing patient outcomes while<br />
minimizing negative consequences <strong>of</strong> antimicrobial use such as<br />
nosocomial Clostridium difficile infection. In 2007, the Infectious<br />
Disease <strong>Society</strong> <strong>of</strong> America (IDSA) and the <strong>Society</strong> for Healthcare<br />
Epidemiology <strong>of</strong> America (SHEA) published evidence-based<br />
guidelines on how to develop an institutional program to enhance<br />
antimicrobial stewardship.<br />
Our antimicrobial stewardship program (ASP) goal is to reduce the<br />
use and expenditure <strong>of</strong> antimicrobials using a prospective audit and<br />
feedback approach (a core strategy in the IDSA/SHEA guidelines).<br />
This is carried out by an Infectious Disease (ID)<br />
physician-pharmacist team. The critical care/stewardship<br />
pharmacist independently reviews all ICU patients on antimicrobials<br />
and meets with the ID physician to discuss the cases. Afterwards,<br />
the ASP team meet with the ICU team and provides feedback on<br />
antimicrobial optimization.<br />
1 year following implementation <strong>of</strong> an ASP, a substantial reduction<br />
in both antimicrobial use and overall cost savings has been<br />
achieved. No adverse impact on patient outcomes, such as length<br />
<strong>of</strong> stay or mortality has been observed.<br />
Community hospitals can successfully implement ASP. We<br />
identified knowledge exchange, peer-to-peer communication and<br />
decision support as key to the ongoing success factors in our<br />
community-hospital based program.<br />
Goals and Objectives<br />
1. To describe the day to day activities <strong>of</strong> an antimicrobial<br />
stewardship program in a community hospital ICU.<br />
2. To review the key successes <strong>of</strong> the TEGH antimicrobial<br />
stewardship program.<br />
3. To explore innovative ways to improve upon and ensure<br />
sustainability <strong>of</strong> the antimicrobial stewardship program at TEGH.<br />
Self-Assessment Questions<br />
1. What is my institution’s readiness to implement a formal<br />
antimicrobial stewardship program?<br />
2. What is my own readiness and/or ability as a clinician to be part<br />
<strong>of</strong> an ASP?<br />
3. Are there any other antimicrobial stewardship strategies that are<br />
already in place at my institution? If so, how can these be<br />
optimized?<br />
Antibiotic Pharmacokinetics and<br />
Pharmacodynamics: Putting the Practical into<br />
Practice<br />
Rosemary Zvonar, BScPhm, ACPR, FCSHP, The Ottawa <strong>Hospital</strong>,<br />
Ottawa, ON, Miranda So, BScPhm, PharmD, University Health<br />
Network, Toronto, ON<br />
As part <strong>of</strong> the healthcare team, pharmacists are <strong>of</strong>ten relied upon<br />
to choose and adjust drug doses. Selecting an appropriate<br />
antibiotic dosing regimen improves the chances <strong>of</strong> a positive<br />
outcome in patients with infection, and is an essential component<br />
<strong>of</strong> antimicrobial stewardship.<br />
Several factors should be considered in order to optimize a<br />
patient’s antibiotic dose. These include characteristics <strong>of</strong> the host<br />
such as organ function and immune status, the pharmacokinetics<br />
<strong>of</strong> the drug, the pharmacodynamic action <strong>of</strong> the antibiotic, the<br />
severity <strong>of</strong> infection, and infecting organism.<br />
Pharmacodynamic considerations include whether the antibiotic is<br />
concentration dependant or time dependant and the associated<br />
pharmacodynamic target. Patient specific pharmacokinetic<br />
variables are <strong>of</strong>ten calculated using serum drug levels for the
40<br />
aminoglycoside antibiotics and vancomycin. This allows for<br />
individualized dosing regimens to maximize therapeutic efficacy<br />
while minimizing toxicity.<br />
Critical illness, obesity, and organ dysfunction may alter volume <strong>of</strong><br />
distribution and/or elimination. These pharmacokinetic parameters<br />
should also be taken into account when selecting drug doses.<br />
This session will review important aspects <strong>of</strong> pharmacokinetics and<br />
pharmacodynamics which influence the dosing <strong>of</strong> antibacterial<br />
agents. It will also include a review <strong>of</strong> aminoglycoside<br />
pharmacokinetic calculations. Participants will be given the<br />
opportunity to apply the information to sample cases. The target<br />
audience <strong>of</strong> this session is pharmacists-in-training; however, any<br />
pharmacist wishing a review <strong>of</strong> these concepts will benefit from<br />
this session. A scientific calculator will facilitate aminoglycoside<br />
sample calculations.<br />
Goals and Objectives<br />
1. Interpret a set (peak, trough) <strong>of</strong> aminoglycoside levels, and<br />
calculate patient specific pharmacokinetic parameters.<br />
2. Understand the difference between pharmacokinetics and<br />
pharmacodynamics and how these may influence antibiotic<br />
dosing.<br />
Self-Assessment Questions<br />
1. What factors should be considered when selecting an empiric<br />
aminoglycoside dosing regimen?<br />
2. What is the role <strong>of</strong> ‘Monte Carlo Simulation’ in the assessment<br />
<strong>of</strong> the adequacy <strong>of</strong> antibiotic dosages?
41<br />
Call for Abstracts<br />
2012 Summer Educational Sessions (SES)<br />
Delta Prince Edward, Charlottetown, Prince Edward Island<br />
August 11 to 14, 2012<br />
Demande de résumés<br />
Séances éducatives d’été (SÉÉ) 2012<br />
Delta Prince Edward, Charlottetown, Île-du-Prince-Édouard<br />
11 au 14 août 2012<br />
GENERAL INFORMATION<br />
Category<br />
Author must specify the category that best suits the particular<br />
abstract.<br />
1. Original Research (includes Pharmaceutical/Basic Science, Clinical<br />
Research, Drug Use Evaluations, Systematic Reviews and<br />
Meta-Analysis, Pharmacoeconomics Analysis, etc.)<br />
2. Case Reports<br />
3. Pharmacy Practice (includes Administration Projects, Health<br />
Pr<strong>of</strong>essional Education, Medication Safety Initiatives, etc.)<br />
CSHP 2015<br />
CSHP 2015 related abstracts will be designated as such at SES. If<br />
your abstract is linked to CSHP 2015 initiatives, please clearly<br />
indicate this on the online abstract submission form.<br />
Abstract Submissions<br />
All abstract submissions must be submitted no later than 18:00<br />
(Eastern Daylight Time) on May 6, 2012.<br />
Abstracts MUST be submitted electronically. Please complete the<br />
abstract submission form online at CSHP’s Web site<br />
(http://www.cshp.ca) prior to submitting the abstract. If you are<br />
submitting more than one abstract, an abstract submission form<br />
must be completed for each abstract. Abstracts are then submitted<br />
by e-mail to ddavidson@cshp.ca. Please provide 2 copies <strong>of</strong> your<br />
abstract. One copy must be blinded (remove authors’ affiliations<br />
and identifying features in body <strong>of</strong> abstract). Please indicate in the<br />
filename which copy is blinded. Please submit your file in MS Word<br />
Format.<br />
Abstract review and grading is conducted by 2 randomly assigned,<br />
blinded, and independent reviewers. Abstracts are selected on the<br />
basis <strong>of</strong> scientific merit, originality, level <strong>of</strong> interest to pharmacists,<br />
and compliance with style rules. Guidance for authors and sample<br />
abstracts will be available on the CSHP website shortly at<br />
www.cshp.ca/event/SES2012.<br />
Failure to comply with requirements for submission, including<br />
submission <strong>of</strong> blinded abstract or any other style rules, will result in<br />
automatic rejection <strong>of</strong> the submission.<br />
Research in progress will not be accepted.<br />
Abstracts previously presented at non-CSHP meetings or at local or<br />
provincial CSHP meetings will be reviewed for potential inclusion as<br />
INFORMATION GÉNÉRALE<br />
Catégorie<br />
L’auteur doit indiquer la catégorie qui sied le mieux au résumé<br />
soumis.<br />
1. Recherche originale (inclut la recherche pharmaceutique ou<br />
fondamentale, scientifique ou clinique, les évaluations de<br />
l’utilisation des médicaments, les examens systématiques et les<br />
méta-analyses, les analyses pharmacoéconomiques, etc.)<br />
2. Observations cliniques<br />
3. Pratique pharmaceutique (inclut les projets administratifs, la<br />
formation des pr<strong>of</strong>essionnels de la santé, les projets liés à la<br />
sécurité des médicaments, etc.)<br />
SCPH 2015<br />
Les résumés liés au projet SCPH 2015 seront désignés comme tels<br />
sur les lieux des SÉÉ. Si votre résumé est relié au projet SCPH 2015,<br />
assurez-vous de le mentionner clairement sur le formulaire de<br />
soumission en ligne des résumés.<br />
Soumission des résumés<br />
Tous les résumés doivent être soumis au plus tard à 18 h (heure<br />
avancée de l’est) le 6 mai 2012.<br />
Les résumés DOIVENT être présentés électroniquement. Veuillez<br />
remplir le formulaire de soumission en ligne des résumés affiché<br />
sur le site Web de la SCPH à http://www.cshp.ca avant de<br />
soumettre votre résumé. Si vous présentez plus d’un résumé, vous<br />
devez remplir un formulaire pour chaque résumé soumis. Les<br />
résumés sont ensuite expédiés par courriel à ddavidson@cshp.ca.<br />
Veuillez fournir deux exemplaires de votre résumé. Un de ces<br />
exemplaires doit être anonyme. (Il faut supprimer du corps du texte<br />
l’affiliation des auteurs et les éléments qui révèlent leur identité.) Le<br />
nom du fichier doit préciser quel exemplaire est anonyme. Le<br />
fichier doit être présenté en format MS Word.<br />
Les résumés sont examinés et évalués par deux réviseurs<br />
indépendants assignés au hasard et en aveugle. Les résumés seront<br />
choisis en tenant compte de leur valeur scientifique, leur<br />
originalité, leur intérêt pour les pharmaciens et le respect des règles<br />
de présentation. Des directives à l’intention des auteurs et des<br />
exemples de résumés seront affichés d’ici peu sur le site Web de la<br />
SCPH à www.cshp.ca/event/SES2012.<br />
Si la demande ne respecte pas les exigences pour la soumission de<br />
résumés, y compris la soumission d’un résumé anonyme ou toute<br />
autre règle de présentation, cette soumission sera<br />
automatiquement rejetée.
42<br />
encore presentations. These encore presentations will be marked as<br />
such. These submissions must include the original conference/date<br />
citation on the abstract submission form. Abstracts presented<br />
previously at national CSHP events (PPC or SES) will not be eligible<br />
to be presented again as an encore.<br />
Accepted abstracts will be published in the final SES 2012 program<br />
and also in the <strong>Canadian</strong> Journal <strong>of</strong> <strong>Hospital</strong> Pharmacy.<br />
Authors <strong>of</strong> accepted abstracts will be notified within 3 to 4 weeks.<br />
Authors are responsible for their own transportation and<br />
accommodations at SES. Early registration fees will apply to all<br />
accepted poster applications. Guidelines for posters will be<br />
provided to authors <strong>of</strong> accepted abstracts.<br />
Abstract Style Rules<br />
Title should be brief and should clearly indicate the nature <strong>of</strong> the<br />
presentation. Capitalize only the first letter <strong>of</strong> each word <strong>of</strong> the<br />
title. Do not use abbreviations in the title. List the authors,<br />
institutional affiliation, city, and province. Omit degrees, titles, and<br />
appointments. The recommended font is Times New Roman, 12<br />
point.<br />
Organize the body <strong>of</strong> the abstract according to the selected<br />
category as follows:<br />
Original Research:<br />
a. rationale,<br />
b. objectives,<br />
c. study design and methods,<br />
d. results <strong>of</strong> study including statistical analysis used,<br />
e. conclusion <strong>of</strong> study (which should be supported by results<br />
presented).<br />
Case Reports:<br />
a. rationale for case report,<br />
b. description <strong>of</strong> case,<br />
c. assessment <strong>of</strong> causality if appropriate,<br />
d. evaluation <strong>of</strong> the literature,<br />
e. importance <strong>of</strong> case to pharmacy practitioners.<br />
Pharmacy Practice:<br />
a. rationale for report;<br />
b. description <strong>of</strong> concept, service, role, or situation;<br />
c. steps taken to identify and resolve problem, implement change,<br />
or develop and implement new program;<br />
d. evaluation <strong>of</strong> project,<br />
e. the concept’s importance and usefulness to current and/or<br />
future practice.<br />
Abstract Text<br />
• Abstract body (not including title and authors) is limited to 300<br />
words.<br />
• A table is equivalent to 30 words.<br />
• A graphic is equivalent to 60 words.<br />
Les recherches en cours ne seront pas acceptées.<br />
Les résumés qui ont déjà fait l’objet d’une présentation lors de<br />
réunions autres que celles de la SCPH ou dans des assemblées<br />
locales ou provinciales de la SCPH seront évalués et possiblement<br />
acceptés comme des reprises. Ces présentations seront clairement<br />
identifiées comme des reprises. Le formulaire de soumission doit<br />
faire mention de la date et du nom du congrès où le résumé a été<br />
présenté précédemment. Les résumés qui ont déjà été présentés à<br />
un événement national de la SCPH (CPP ou SÉÉ) ne sont pas<br />
admissibles.<br />
Les résumés qui auront été acceptés seront publiés dans le<br />
programme final des SÉÉ 2012 et dans le Journal canadien de la<br />
pharmacie hospitalière.<br />
Les auteurs des résumés acceptés seront avisés dans un délai de<br />
trois à quatre semaines. Les auteurs doivent assumer leurs propres<br />
frais de transport et de logement pour les SÉÉ. Tous les auteurs des<br />
résumés acceptés auront droit aux frais d’inscription anticipée. Des<br />
directives concernant l’affichage seront fournies aux auteurs dont<br />
les résumés auront été acceptés.<br />
Règles de présentation<br />
Le titre devrait être bref et indiquer clairement la nature de la<br />
présentation. Seule la première lettre du premier mot du titre doit<br />
être en majuscule. Le titre ne doit pas contenir d’abréviations. Le<br />
nom des auteurs, l’établissement auquel ceux-ci sont affiliés ainsi<br />
que la ville et la province où est situé l’établissement doivent être<br />
précisés, tandis que les diplômes, les titres et les affectations ne<br />
doivent pas être mentionnés. Il est recommandé d’utiliser la police<br />
Times New Roman 12.<br />
Le texte du résumé doit être organisé conformément aux règles<br />
propres à la catégorie à laquelle il appartient, de la manière<br />
suivante :<br />
Recherche originale :<br />
a. justification,<br />
b. objectifs,<br />
c. méthodologie et démarche de l’étude,<br />
d. résultats de l’étude, y compris les analyses statistiques utilisées,<br />
e. conclusion de l’étude (la conclusion devrait être appuyée par les<br />
résultats présentés).<br />
Observations cliniques:<br />
a. justification de l’observation clinique,<br />
b. description du cas,<br />
c. analyse de la causalité s’il y a lieu,<br />
d. évaluation de la documentation,<br />
e. importance du cas pour les praticiens en pharmacie.<br />
Pratique pharmaceutique:<br />
a. justification du rapport;<br />
b. description du concept, du service, du rôle ou de la situation;<br />
c. mesures prises en vue de cerner et de résoudre le problème,<br />
d’apporter des changements, ou de créer et de mettre en œuvre<br />
un nouveau programme;<br />
d. évaluation du projet;<br />
e. importance et utilité du concept par rapport à la pratique<br />
actuelle et future.
43<br />
• Results or evaluation must be included in the abstract. It is not<br />
acceptable to state that results will be discussed.<br />
• Do not indent the start <strong>of</strong> a paragraph.<br />
• Place abbreviations in parentheses after the full word the first<br />
time it appears. Please keep abbreviated terms to a minimum.<br />
• Use numerals to indicate numbers, except to begin sentences.<br />
• Use only generic names <strong>of</strong> drugs, material, devices, and<br />
equipment.<br />
Abstracts should not include citations or reference numbers.<br />
For original research or pharmacy practice projects, ensure that the<br />
objectives, methods, analysis, results, and conclusions are internally<br />
consistent<br />
Email Confirmation <strong>of</strong> Abstract Submissions<br />
You should receive an email confirmation <strong>of</strong> your abstract<br />
submission. If you have not received an email confirmation by the<br />
deadline, please contact Desarae Davidson:<br />
Tel.: (613) 736-9733, ext. 229<br />
Fax: (613) 736-5660<br />
Email: ddavidson@cshp.ca<br />
Texte du résumé<br />
• Le corps du résumé (excluant le titre et les auteurs) ne doit pas<br />
dépasser 300 mots.<br />
• Un tableau compte pour 30 mots.<br />
• Un graphique compte pour 60 mots.<br />
• Les résultats ou l’évaluation doivent être inclus dans le résumé. Il<br />
est inacceptable de mentionner que les résultats seront discutés.<br />
• Le début des paragraphes ne doit pas être précédé d’un alinéa.<br />
• Placer les abréviations entre parenthèses après le terme qu’elles<br />
remplaceront, la première fois que le terme est utilisé. Veuillez<br />
limiter au minimum l’utilisation d’abréviations.<br />
• Les nombres doivent être écrits en chiffres, sauf lorsqu’ils<br />
représentent le premier mot d’une phrase.<br />
• Seuls les noms génériques des médicaments, du matériel, des<br />
instruments et de l’équipement doivent être employés.<br />
• Les résumés ne devraient pas comprendre de citations ni de<br />
numéros de référence.<br />
Dans le cas d’une recherche originale ou de projets liés à la<br />
pratique pharmaceutique, il faut s’assurer que les objectifs, la<br />
méthodologie, les analyses, les résultats et les conclusions sont<br />
intrinsèquement logiques.<br />
Confirmation par courriel de la réception<br />
du résumé<br />
La réception de votre résumé devrait être confirmée par courriel.<br />
Si vous n’avez pas reçu de confirmation par courriel avant la date<br />
limite, veuillez téléphoner à madame Desarae Davidson:<br />
Téléphone : (613) 736-9733, ext. 229<br />
Fax : (613) 736-5660<br />
Courriel : ddavidson@cshp.ca
44<br />
Oral Presentations <strong>of</strong> Award-Winning<br />
Projects and Original Research<br />
Présentations orales de projets primés<br />
et de recherche originale<br />
Monday February 6, 2011<br />
10:35-11:15<br />
Simcoe/Dufferin<br />
1. National Survey <strong>of</strong> Critical Care <strong>Pharmacists</strong>’ Views and Involvement in<br />
Clinical Research<br />
2. <strong>Hospital</strong> Wide Roll-Out <strong>of</strong> Antimicrobial Stewardship: A Stepped Wedge<br />
Randomized Controlled Trial<br />
3. Evaluation <strong>of</strong> Concordance to Ventilator-Associated Pneumonia<br />
Guidelines in the Intensive Care Unit Before and During Antimicrobial<br />
Stewardship<br />
11:25-12:10<br />
1. Identifying Barriers to Pharmacist Medication Discharge Counselling<br />
2. Lack <strong>of</strong> Effectiveness <strong>of</strong> a Pharmacist Intervention Towards Improving<br />
Medication Adherence in Patients Attending Cardiac Rehabilitation: A<br />
Randomized Controlled Trial<br />
3. Prioritizing Pharmaceutical Activities – A Simulation<br />
National Survey <strong>of</strong> Critical Care <strong>Pharmacists</strong>’ Views and<br />
Involvement in Clinical Research<br />
Marc Perreault, Zoé Thiboutot, Lisa Burry, Louise Rose, Salmaan Kanji,<br />
Jaclyn LeBlanc, Roxane Carr, David Williamson<br />
Rationale: <strong>Canadian</strong> critical care pharmacists are increasingly involved in<br />
clinical research. Over the last four years, two multicenter studies evaluating<br />
use <strong>of</strong> pharmacotherapy in <strong>Canadian</strong> intensive care units were successfully<br />
performed by pharmacists. However, the current state <strong>of</strong> clinical research<br />
conducted by these clinicians is not known.<br />
Objectives: The objectives were to describe the clinical research experience<br />
as well as beliefs and views about clinical research <strong>of</strong> <strong>Canadian</strong> critical care<br />
pharmacists.<br />
Study Design and Methods: A nation-wide survey <strong>of</strong> critical care<br />
pharmacists was conducted. The questionnaire was pre-tested and then<br />
submitted to a validation process that included pilot-testing and clinical<br />
sensibility testing. Once completed, the survey was distributed to an<br />
identified sample <strong>of</strong> critical care pharmacists. Pharmacy associations and<br />
individual hospital pharmacy departments across Canada were contacted to<br />
establish a list <strong>of</strong> Critical Care <strong>Pharmacists</strong>. The survey was self-administered<br />
and a mixed-mode format was used. Only surveys completed >70% were<br />
analysed.<br />
Results: 325 Critical Care pharmacists were identified and invited to<br />
participate. A total <strong>of</strong> 215 from all regions <strong>of</strong> Canada completed the survey.<br />
In regards to research experience in the last 5 years, 32,7% <strong>of</strong> respondents<br />
had participated at least once in the development <strong>of</strong> a research protocol,<br />
24,3% more than 3 times and 43,7% had presented results at least one or<br />
twice. In regards to publications, 15,9% <strong>of</strong> respondents had published as<br />
first authors and 23,8% as coauthors. When asked about their interest and<br />
opportunities, 64,5% had a strong interest in research and 61,9%<br />
responded they had opportunities to be involved in research. However,<br />
80,8% felt they did not have enough time to carry out research and only<br />
50,2% felt pharmacy administration support.<br />
Conclusion: Critical care pharmacists across Canada are interested and<br />
involved in clinical research. Opportunities are present but adequate time<br />
and support seem to be barriers.<br />
<strong>Hospital</strong> Wide Roll-Out <strong>of</strong> Antimicrobial Stewardship:<br />
A Stepped Wedge Randomized Controlled Trial<br />
Nick Daneman, Marion Elligsen, Sandra Walker, Lesley Palmay, Andrew<br />
Simor, Samira Mubareka, Anita Rachlis, Vanessa Allen, Ruxandra Pinto<br />
Sunnybrook Health Sciences Centre, Toronto, ON<br />
Rationale: Inappropriate antimicrobial use, increasing antibiotic resistance,<br />
and lack <strong>of</strong> development <strong>of</strong> new antimicrobial agents, has provided the<br />
impetus for worldwide initiatives in antimicrobial stewardship. However,<br />
there is paucity <strong>of</strong> good quality evidence to evaluate the impact <strong>of</strong> such<br />
initiatives. As a result <strong>of</strong> the positive impact our institution’s Antimicrobial<br />
Stewardship <strong>Program</strong> (ASP) had in the critical care unit, we rolled out our<br />
stewardship intervention to seven patient care services across the hospital<br />
using a stepped-wedge design to provide a more rigorous evaluation <strong>of</strong> the<br />
efficacy <strong>of</strong> our interventions.<br />
Objective: To determine the impact <strong>of</strong> antimicrobial stewardship on<br />
antimicrobial use and C. difficile infection rates in seven non-intensive care<br />
medical and surgical services.<br />
Study Design and Methods: A formal review <strong>of</strong> all patients on their 3rd<br />
or 10th day <strong>of</strong> broad-spectrum antibiotic therapy in seven patient care<br />
services was conducted at Sunnybrook Health Sciences Centre using a<br />
stepped–wedge randomized design. The primary outcome for the<br />
preliminary 11 month analysis was a comparison <strong>of</strong> days <strong>of</strong> therapy (DOTs)<br />
<strong>of</strong> targeted antibiotics/1000 patient bed days/month during the<br />
intervention period compared to the control period. Secondary outcomes<br />
included overall and non-targeted antibiotic use and rates <strong>of</strong> nosocomial<br />
C.difficile infections.<br />
Results: From November, 1, 2010 to July 31, 2011, the ASP reviewed a<br />
total <strong>of</strong> 1,042 orders with an overall suggestion and acceptance rate <strong>of</strong><br />
48% and 84%, respectively. Across all services, our program reduced<br />
broad-spectrum antimicrobial use by 12% (256 to 225 DOT/1000 patient<br />
days) and the number C. difficile infection by 59% (44 to 18 cases).<br />
Conclusion: Sunnybrook’s ASP hospital-wide roll-out <strong>of</strong> its case-by-case<br />
audit-and-feedback intervention was successful in reducing broad-spectrum<br />
antimicrobial use and C. difficile infection rates.<br />
Evaluation <strong>of</strong> Concordance to Ventilator-Associated<br />
Pneumonia Guidelines in the Intensive Care Unit Before and<br />
During Antimicrobial Stewardship<br />
Eileen Hill 1 , Matthew Muller 1,2 , Clarence Chant 1 , Reem Haj 1<br />
1 St Michael’s, Toronto, ON<br />
2 University <strong>of</strong> Toronto, Toronto, ON<br />
Rationale: Ventilator-associated pneumonia (VAP) guideline concordance<br />
may improve patient outcomes. Concordance measures the appropriate<br />
physician application <strong>of</strong> guidelines at a patient-specific level. When<br />
guideline concordance is suboptimal, an antimicrobial stewardship program<br />
(ASP) has the potential to improve it.<br />
Objectives: To measure guideline concordance and outcomes for patients<br />
in the intensive care unit (ICU) with VAP before and during implementation<br />
<strong>of</strong> an ASP-pilot.<br />
Methods: This was a retrospective review <strong>of</strong> patients in the<br />
Medical/Surgical and Trauma/Neurosurgery (MS/TN) ICUs with suspected<br />
VAP on ≥3 days <strong>of</strong> targeted antimicrobials. Data was collected<br />
pre-implementation (January to June 2010), and during implementation <strong>of</strong><br />
the ASP-pilot (October 2010 to February 2011). The primary outcome was<br />
overall guideline concordance, which consisted <strong>of</strong> concordance with<br />
empiric drug choice, duration, de-escalation, and route. Concordance was<br />
assessed, using standard case-report forms, by an investigator and a<br />
blinded 3rd party observer. Secondary outcomes were ICU mortality, ICU<br />
length <strong>of</strong> stay (LOS) and duration <strong>of</strong> therapy. Data was summarized using
45<br />
descriptive statistics and compared using Student’s t-test, Mann-Whitney<br />
test and Fischer’s-exact test where appropriate.<br />
Results: Nineteen patients with VAP were enrolled into each group, with<br />
similar baseline demographics and clinical parameters. There were no<br />
differences between the pre-ASP group and the ASP-pilot group in overall<br />
concordance and in concordance to the individual components (overall:<br />
5.3% vs. 10.5%, p=1.0; empiric drug choice: 33.3% vs. 50%, p=0.68;<br />
de-escalation: 76.5% vs. 93.8%, p=0.34; duration: 27.8% vs. 29.4%,<br />
p=1.0; route: 47.4% vs. 47.4%, p=1.0). There were also no differences<br />
between the groups for ICU mortality (2 vs. 6, p=0.2), mean ICU LOS (21<br />
vs. 26 days, p=0.99), or mean duration <strong>of</strong> therapy (10 vs. 9.4 days, p=0.3).<br />
Conclusion: VAP guideline concordance is poor overall, but concordance to<br />
individual components is highly variable. The ASP-pilot did not significantly<br />
improve concordance or change patient outcomes.<br />
2 CSHP<br />
Targeting Excellence<br />
Identifying Barriers to Pharmacist Medication<br />
Discharge Counselling<br />
in Pharmacy Practice<br />
Sandra AN Walker, Jennifer Lo, General Medicine <strong>Pharmacists</strong>,<br />
Sunnybrook Health Sciences Centre, Toronto, ON<br />
Rationale: Medication errors may occur more frequently at discharge,<br />
making discharge counselling a vital facet <strong>of</strong> medication reconciliation.<br />
Data identifying barriers to discharge counselling by pharmacists in adult<br />
hospitalized patients is lacking.<br />
Objective: The objective was to identify barriers to pharmacists performing<br />
medication discharge counselling and to determine their relative frequency<br />
<strong>of</strong> occurrence and time expenditure.<br />
Study Design and Methods: A prospective study <strong>of</strong> all general medicine,<br />
nephrology or medical oncology acute care hospital pharmacists (N=8) was<br />
conducted. <strong>Pharmacists</strong> completed a survey on each <strong>of</strong> the first 50 patients<br />
eligible for discharge counselling on their wards (n = 400). Patients were<br />
considered ineligible for counselling if they were to be discharged to<br />
another facility, had
46<br />
Poster Sessions<br />
There are two different types <strong>of</strong> poster presentations at PPC 2012. A<br />
Facilitated Poster session on Sunday and traditional Poster sessions on<br />
Monday, Tuesday and Wednesday.<br />
Facilitated Poster Session<br />
Posters in the facilitated poster session consist <strong>of</strong> a mixture <strong>of</strong> award<br />
winners and those abstracts submitted in the categories <strong>of</strong> original research<br />
and pharmacy practice. They are grouped as 5 or 6 posters with similar<br />
themes outlined below. The author <strong>of</strong> each poster will do a 6 minute<br />
presentation in front <strong>of</strong> their poster highlighting the key points <strong>of</strong> their<br />
work. This will be followed by questions and group discussion. The<br />
presentations within each group will occur in sequence as the participants<br />
move from one poster to the next. The session is scheduled from 09:30 to<br />
11:30, but posters will be displayed throughout the day.<br />
Traditional Poster Session<br />
Posters in the traditional sessions were selected from those submitted in the<br />
categories <strong>of</strong> original research and pharmacy practice. Although no formal<br />
presentations will occur, the author <strong>of</strong> each poster will be available during<br />
the presentation timeslot for discussion and questions. Posters will be<br />
available for viewing throughout the day.<br />
CSHP 2015<br />
CSHP 2015 is a quality program that sets out a vision <strong>of</strong> pharmacy practice<br />
excellence in the year 2015. Through this project, CSHP challenges hospital<br />
pharmacists to reach measurable targets for 36 objectives grouped under 6<br />
goals, all aimed toward the effective, scientific, and safe use <strong>of</strong> medications<br />
and meaningful contributions to public health. CSHP 2015 applies to<br />
inpatients and outpatients, community and hospital pharmacists, and all<br />
practice settings. Posters identified with a “CSHP 2015” logo are those<br />
judged by the CSHP 2015 Steering Committee to be particularly relevant to<br />
one or more <strong>of</strong> the 36 objectives.<br />
Séances d’affichage<br />
Deux types de présentation par affiches seront <strong>of</strong>ferts dans le cadre de la<br />
CPP 2012. Une séance animée de présentations par affiches qui se tiendra<br />
le dimanche et des séances traditionnelles d’affichage qui auront lieu lundi,<br />
mardi et mercredi.<br />
Séance animée d’affichage<br />
Les affiches de la séance animée d’affichage sont formées d’un mélange de<br />
résumés primés et de résumés soumis dans les catégories recherche<br />
originale et pratique de la pharmacie. Elles sont combinées en groupes de<br />
cinq ou six affiches ayant des thèmes similaires comme il est fait mention<br />
ci-dessous. L’auteur de chaque affiche fera une présentation de six minutes<br />
devant son affiche, faisant ressortir les principaux points de son travail.<br />
Cette présentation sera suivie d’une période de questions et d’une<br />
discussion de groupe. Les présentations à l’intérieur de chaque groupe<br />
auront lieu les unes à la suite des autres au fur et à mesure que les<br />
participants se déplaceront d’une affiche à la suivante. Cette séance se<br />
déroulera de 9 h 30 à 11 h 30.<br />
Séance traditionnelle d’affichage<br />
Les affiches pour les séances traditionnelles ont été choisies parmi celles<br />
soumises dans les catégories recherche originale et pratique de la<br />
pharmacie. Bien qu’aucune présentation <strong>of</strong>ficielle n’ait été prévue, les<br />
auteurs de chaque affiche seront sur place pendant les heures d’affichage<br />
et pourront répondre aux questions et s’entretenir avec vous. Les affiches<br />
pourront être examinées tout au long de la journée.<br />
SCPH 2015<br />
Le projet SCPH 2015 est un programme axé sur la qualité qui propose une<br />
vision de l’excellence en pratique pharmaceutique en l’an 2015. Au moyen<br />
de ce projet, la SCPH met les pharmaciens d’établissements au défi<br />
d’atteindre les cibles mesurables de 36 objectifs répartis entre 6 buts, visant<br />
tous l’utilisation efficace, scientifique et sûre des médicaments ainsi que des<br />
contributions significatives à la santé publique. Le projet SCPH 2015<br />
s’applique aux patients hospitalisés et externes, aux pharmaciens<br />
d’hôpitaux et communautaires, et à tous les milieux de pratique. Les<br />
affiches marquées du logo « SCPH 2015 » sont celles que le comité<br />
directeur du projet SCPH 2015 a jugé particulièrement appropriées à l’un<br />
ou l’autre des 36 objectifs.<br />
Sunday February 5, 2012<br />
09:30-11:30 (presentations)<br />
Essex Ballroom<br />
Facilitated Poster Session: Discussion <strong>of</strong> Original Research, Award<br />
Winning Projects and Pharmacy Practice Projects<br />
Séance animée de présentations par affiches: Discussions sur des projets<br />
de recherche originale, des projets primés et des projets dans le domaine de<br />
la pratique pharmaceutique<br />
Antimicrobials and Pediatrics<br />
1. An Outpatient Parenteral Antimicrobial Therapy <strong>Program</strong> Experience at<br />
the University Health Network<br />
2. Evaluation <strong>of</strong> a Prospective Audit and Feedback <strong>Program</strong> in Critical Care:<br />
A Controlled Interrupted Time Series Analysis (Award)<br />
3. Antimicrobial Prescribing Practices for Catheter Urine Cultures<br />
4. Oseltamivir Pharmacocinketics in Morbid Obesity (OPTIMO Trial) (Award)<br />
5. Description <strong>of</strong> Prop<strong>of</strong>ol Use in a Pediatric Intensive Care Unit<br />
6. Development and Implementation <strong>of</strong> a Pediatric Emergency Department<br />
Asthma Action Plan and Prescription (AAPP) (Award)<br />
Clinical Pharmacy<br />
1. Providing Comprehensive Assessment and Pharmaceutical Care at the<br />
Geriatric Clinic for Parkinson’s<br />
2. Performance <strong>of</strong> Clinical Prediction Tools Used to Predict Major Bleeding<br />
in Patients Receiving Anticoagulation Therapy<br />
3. Development <strong>of</strong> a Clinical Institute Withdawl Assessment (CIWA) Scale<br />
and Treatment Regimen for the Management <strong>of</strong> Alcohol Withdrawl<br />
4. Implementation <strong>of</strong> an Insulin Pen Piolet in an In-Patient <strong>Hospital</strong> Setting<br />
5. Organizational Restructuring <strong>of</strong> Regional Pharmacy Services and<br />
Pharmacy Practice Model (Award)<br />
6. Drug Evaluation <strong>of</strong> Intravenous Tranexamic Acid: Adherence to <strong>Hospital</strong><br />
Guidelines and Adverse Events in an Off-Label Use in Orthopedic<br />
Patients<br />
Patient Safety<br />
1. Extending <strong>Hospital</strong>-Based Medication Incident Reporting to Enhance<br />
Medication Safety and Continuous Quality Assurance in Pharmacy<br />
Practice (Award)<br />
2. Implementation and Evaluation <strong>of</strong> Medication Reconciliation Tool on<br />
Internal <strong>Hospital</strong> Transfer (Award)<br />
3. Improving Continuity <strong>of</strong> Care Post-<strong>Hospital</strong> Discharge: A Needs<br />
Assessment <strong>of</strong> Community <strong>Pharmacists</strong><br />
4. Patient Recall <strong>of</strong> Interaction with a Pharmacist During <strong>Hospital</strong><br />
Admission<br />
5. How Well Do Pharmacy Clinicians Perform in a Patient<br />
Simpultion-Based Admission Medication Reconciliation Validation<br />
<strong>Program</strong>?
47<br />
6. Who's Looking at the BPMH? Prescription and Utilization <strong>of</strong> the Best<br />
Possible Medication History in a Tertiary Care <strong>Hospital</strong><br />
Education and Research<br />
1. The Evaluation <strong>of</strong> a New Hierarchical Teaching Model for Pharmacy<br />
Students in Experiential Education<br />
2. Evaluation <strong>of</strong> Effectiveness <strong>of</strong> Online versus Face to Face Interactions in<br />
Interpr<strong>of</strong>essional Education<br />
3. An Online E-Learning Patient Education Tool for SOT Recipients (Award)<br />
4. Diabetes Education in Pharmacy Residencies Across Canada<br />
5. Evaluating the Role <strong>of</strong> Pharmacist Teachers in <strong>Canadian</strong> Family<br />
Medicine Residency <strong>Program</strong>s: A Qualitative Analysis (Award)<br />
6. A Survey <strong>of</strong> Institutional <strong>Pharmacists</strong> Involvement in and Attitudes<br />
Towards Research (Award)<br />
Oncology<br />
1. Interactions Between Antiretroviral Agents and Chemotherapy<br />
Regimens for the Treatment <strong>of</strong> Lymphoma: A Quick Reference Guide<br />
(Award)<br />
2. Impact <strong>of</strong> Drug Access Facilitator in an Outpatient Chemotherapy Clinic<br />
3. High Dose Methotrexate in Adult Oncology Patients: A Case-Control<br />
Study Assessing the Risk Association Between Drug Interactions and<br />
Methotrexate Toxicity<br />
4. Stability <strong>of</strong> Azacitidine Solutions in Sterile Water for Injection<br />
5. Pharmacist-Directed Toxicity Management <strong>Program</strong> for Patients<br />
Receiving Capecitabine: Implementation and Evaluation (Award)<br />
Monday February 6, 2012<br />
09:45-10:15 (viewing)<br />
13:15-13:50 (presentations)<br />
Sheraton/Osgoode Halls<br />
1. In For a Penny, in for a Pound: Evaluation <strong>of</strong> Factors Affecting Learner<br />
Participation in the Pilot ADAPT E-Learning Primary Health Care<br />
<strong>Program</strong><br />
2. Moving Practice Forward with Early Exposure Students<br />
3. Provincial Implementation <strong>of</strong> Accreditation Canada Required<br />
Organizational Practices: The Alberta Experience<br />
4. Drugs Obtained by Quebec University Health Centers through Health<br />
Canada’s Special AccessPprogramme – Descriptive Analysis by the<br />
programme de gestion therapeutique des Medicament<br />
5. Safety and Efficacy <strong>of</strong> CHOP or R-chop for Treatment <strong>of</strong> Diffuse Large<br />
B-cell Lymphoma with Protease Inhibitor or Non-Protease Inhibitor<br />
Based Antiretroviral Regimens in HIV–infected patients: SCULPT Study<br />
6. Drug Access Navigator Database: Improving the Management <strong>of</strong> Drug<br />
Access Cases through the Development and Implementation <strong>of</strong> a<br />
Computerized Database<br />
7. Residents as Preceptors: Development, Implementation and Evaluation<br />
<strong>of</strong> a Pharmacy Summer Student Clinical Experience<br />
8. Imatinib Plasma Through Concentrations and the Ability to Assess<br />
Patient Adherence<br />
9. Evolution de la thromboprophylaxie chez les usagers medicaux dans un<br />
institute universitaire<br />
10. 2010-2011 Perspectives on Drug Shortages in <strong>Hospital</strong>s in Quebec<br />
11. Multicenter Study on Environmental Contamination by Hazardous<br />
Drugs in Quebec Healthcare Centres<br />
12. Temps associe a la purge des tublures lors de la preparation d’une dose<br />
de medicament dangereux et contamination visuelle<br />
13. Is Vasopressin (>0.03 units/minute) Associated with the Adverse Events<br />
in Cardiac Surgery Patients?<br />
14. Assessing the Extent <strong>of</strong> Fluoroquinolone-Cation Interactions at a<br />
Teaching <strong>Hospital</strong><br />
Tuesday February 7, 2012<br />
09:45-10:15 (viewing)<br />
13:15-13:50 (presentation)<br />
Sheraton/Osgoode Halls<br />
1. A Systematic Analysis <strong>of</strong> Pharmacist Referrals Originating from the<br />
Order Desk<br />
2. Audit <strong>of</strong> Antibiotic Duration <strong>of</strong> Therapy, Appropriateness and Outcome<br />
in Patients with Nosocomial Pneumonia Following the Removal <strong>of</strong> an<br />
Automatic Stop-date Policy<br />
3. Identification <strong>of</strong> Predictors <strong>of</strong> Infection in Acute Burn Injury<br />
4. Impact <strong>of</strong> a Multi-Layered Initiative to Improve Venous<br />
Thromboembolism Prophylaxis Rates in Medicine Patients in a<br />
Community <strong>Hospital</strong> Setting<br />
5. A Pilot Study to Evaluate Methodology for Assessing the Treatment <strong>of</strong><br />
Low Back Pain<br />
6. Classifications <strong>of</strong> Drug Related Problems Discovered During Senior<br />
Brown Bag Medication Reviews<br />
7. Evaluation <strong>of</strong> Education on Preventative Care and Poison Control<br />
Center Awareness During Brown Bag Medication Reviews for Older<br />
Adults<br />
8. Self-Perceived Knowledge Gained and Satisfaction from Brown Bag<br />
Medication Reviews for Older Adults<br />
9. Cost Analysis <strong>of</strong> an Insulin Pen Pilot Project in an In-Patient <strong>Hospital</strong><br />
Setting<br />
10. Venous Thromboembolism Prophylaxis Electronic Physician Risk<br />
Assessment Tool<br />
11. Fingertip Sampling is a More Sensitive Evaluation <strong>of</strong> Aseptic Technique<br />
Competency<br />
12. Potential Cross-Reactivity between Prasugrel and Clopidogrel<br />
13. Total Parenteral Nutrition: Supporting Practice Through Standardizing<br />
Solutions<br />
14. Determination <strong>of</strong> Tobramycin Pharmacokinetics in Burn Patients to<br />
Evaluate the Potential Utility <strong>of</strong> Once Daily Dosing in this Population<br />
Wednesday February 8, 2012<br />
10:15-10:45 (presentations)<br />
Churchill Room<br />
1. Diagnostic Reasoning by <strong>Hospital</strong> <strong>Pharmacists</strong>: An Assessment <strong>of</strong><br />
Attitudes, Knowledge, Skills, and Learning Needs<br />
2. A Pilot Study on the Use <strong>of</strong> Warfarin Sliding Scales in Hemodialysis<br />
Patients<br />
3. Potentially Inappropriate Medication Use in Elderly Patients Presenting<br />
to the Emergency Department<br />
4. Intentional Overdose <strong>of</strong> Enoxaparin<br />
5. Implementation <strong>of</strong> a Pharmacy Residency <strong>Program</strong> in Primary Care<br />
6. Differences in Nova Scotian <strong>Pharmacists</strong>’ Experiences and Barriers to<br />
Providing the Emergency Contraceptive Pill Based on Primary Practice<br />
Site<br />
7. Chemotherapy-Induced Nausea and Vomiting in Children Receiving<br />
Ifosfamide Plus Etoposide: Preliminary Results<br />
8. Improving a Complex Pharmacist Scheduling Model at a Tertiary Care<br />
<strong>Hospital</strong><br />
9. Statin Treatment Use in Diabetics with Breast Cancer: A Potential<br />
C-Reactive Protein Mediated Benefit
48<br />
Sunday, February 5<br />
Dimanche 5 février<br />
An Outpatient Parenteral Antimicrobial Therapy <strong>Program</strong><br />
Experience at the University Health Network<br />
Anjie Yang 1 , Ron Fung 1 , James Brunton 2 , Linda Dresser 1,3<br />
1 Department <strong>of</strong> Pharmacy, University Health Network, Toronto, ON<br />
2 Department <strong>of</strong> Medicine - Division <strong>of</strong> Infectious Diseases, University Health<br />
Network, Toronto, ON<br />
3 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
Rationale for Report: Current literature shows that Outpatient Parenteral<br />
Antimicrobial Therapy (OPAT) programs improve treatment efficacy and<br />
safety for patients discharged on intravenous (IV) antimicrobials. However,<br />
such programs are still relatively new in Ontario. In response to cases <strong>of</strong><br />
treatment related adverse events with the present standard <strong>of</strong> care, an<br />
OPAT program was developed, implemented and evaluated.<br />
Description <strong>of</strong> Situation: Adverse events involving nephrotoxicity among<br />
outpatients receiving IV vancomycin identified a gap in antimicrobial<br />
management. The OPAT program was developed to address this gap.<br />
Development <strong>of</strong> Service: This interpr<strong>of</strong>essional antimicrobial stewardship<br />
effort was fully implemented in February 2010 and included all eligible<br />
patients discharged on IV antimicrobials. The OPAT pharmacist role is<br />
integral in selecting the choice <strong>of</strong> therapy and vascular access device, as<br />
well as providing patient education and monitoring throughout the<br />
treatment course.<br />
Evaluation: A retrospective matched cohort study was conducted involving<br />
108 surgery patients enrolled in the OPAT program between Feb 1 and Nov<br />
30, 2010, with cure rates, 30-day rehospitalization within our hospital and<br />
length <strong>of</strong> stay as primary endpoints. The OPAT patients were matched 1:1<br />
to historical controls discharged between Jan 1, 2001 and Jan 1, 2010<br />
based on age, gender, type <strong>of</strong> surgery, infection, and co-morbidities<br />
(Charlson Co-morbidity Index). Due to the rigor <strong>of</strong> the matching criteria,<br />
twenty-one OPAT patients were matched. For this cohort, the OPAT<br />
program was trending towards improved cure rates (61.9% vs 57.1%),<br />
reductions in rehospitalization (14.3% vs 28.6%) and mean length <strong>of</strong> stay<br />
(10.7 vs 13.9 days) compared to the control group.<br />
Importance to Practice: The OPAT program is an innovative expansion <strong>of</strong> the<br />
antimicrobial stewardship program, with the pharmacist role being crucial<br />
in optimizing antimicrobial therapy in the outpatient setting. A further<br />
evaluation <strong>of</strong> the impact <strong>of</strong> this project on rehospitalizations province-wide<br />
is in progress.<br />
Evaluation <strong>of</strong> a Prospective Audit and Feedback <strong>Program</strong> in<br />
Critical Care: A Controlled Interrupted Time Series Analysis<br />
Marion Elligsen 1 , Sandra A.N. Walker 1,2,4 , Ruxandra Pinto 3 , Andrew Simor 4,5 ,<br />
Samira Mubareka 3,4,5 , Anita Rachlis 4,5 , Vanessa Allen 4,5,6 , Nick Daneman 3,4,5,7<br />
1 Sunnybrook Health Sciences Centre, Department <strong>of</strong> Pharmacy; Toronto, ON<br />
2 University <strong>of</strong> Toronto, Leslie L. Dan Faculty <strong>of</strong> Pharmacy; Toronto, ON<br />
3 Sunnybrook Research Institute; Toronto, ON<br />
4 Sunnybrook Health Sciences Centre, Department <strong>of</strong> Microbiology and<br />
Division <strong>of</strong> Infectious Diseases; Toronto, ON<br />
5 University <strong>of</strong> Toronto, Faculty <strong>of</strong> Medicine; Toronto, ON<br />
6 Public Health Ontario; Toronto, ON<br />
7 Institute for Clinical Evaluative Sciences, Toronto, ON<br />
Rationale: While there is support for antibiotic stewardship programs in<br />
critical care, most data comes from uncontrolled before-and-after studies<br />
that are prone to bias and temporal confounding.<br />
Objective: We aimed to rigorously evaluate the impact <strong>of</strong> a prospective<br />
audit-and-feedback program in critical care patients, using a controlled,<br />
interrupted time series analysis.<br />
Methods: The antimicrobial stewardship team provided prospective<br />
audit-and-feedback for all patients in level III ICUs on their 3rd or 10th day<br />
<strong>of</strong> targeted broad-spectrum antibiotic therapy. Antibiotic use during the<br />
one year pilot was compared to the year prior using a controlled<br />
interrupted time series analysis. Secondary outcomes included overall<br />
antibiotic use, gram negative bacterial susceptibility, rates <strong>of</strong> nosocomial<br />
C.difficile infection, length <strong>of</strong> stay and mortality.<br />
Results: Broad-spectrum antibiotic use significantly decreased (119<br />
DOTs/1000 PDs; SE=37.9; p=0.0054) with the implementation <strong>of</strong> the<br />
program, with no change in either control wards or use <strong>of</strong> control<br />
medications (stress ulcer prophylaxis). The incidence <strong>of</strong> C. difficile infections<br />
decreased from 11 to 6 cases, while increasing in the control wards from 87<br />
to 116 cases (p=0.04). Overall gram negative susceptibility to meropenem<br />
increased. Length <strong>of</strong> stay and mortality did not change.<br />
Conclusions: Through collaboration with critical care, a successful<br />
prospective audit-and-feedback program was implemented in the level III<br />
ICUs.<br />
Key Words: Antimicrobial Stewardship, Critical Care, Intensive Care<br />
Antimicrobial Prescribing Practices for Catheter Urine<br />
Cultures<br />
Jonathan Chiu, William G. Thompson, Thomas W. Austin, Michael John,<br />
Zafar Hussain, Anne Marie Bombassaro, Sarah Connelly, Sameer Elsayed,<br />
London Health Sciences Centre, London, ON<br />
Rationale: To investigate the literature suggestion that positive catheter<br />
urine cultures frequently result in unnecessary antimicrobial prescribing.<br />
Objectives: The study objective was to determine the need for<br />
antimicrobial stewardship directed to catheter urine cultures by evaluating<br />
concordance <strong>of</strong> treatment decisions between an expert panel and<br />
prescribers.<br />
Methods: This was a retrospective case-control study <strong>of</strong> adults at a tertiary<br />
care centre. Cases and controls were defined as having positive and<br />
negative catheter urine cultures, respectively, and were identified through a<br />
microbiology laboratory report. Medical records were consecutively<br />
screened to select a convenience sample <strong>of</strong> 80 inpatients (40 per group).<br />
Abstracted patient histories were independently evaluated by an expert<br />
panel (3 Infectious Diseases consultants) blinded to decisions <strong>of</strong> prescribers<br />
and fellow panelists. The primary endpoint <strong>of</strong> concordance was defined as<br />
agreement between experts and prescribers (majority response) with<br />
respect to the indication for therapy. Secondary endpoints including<br />
unnecessary days <strong>of</strong> therapy and predefined patient outcomes were<br />
assessed over a 7-day period.<br />
Results: Target enrolment required screening 591 charts. Intensive care<br />
stay, immunosuppression and emergency/outpatient status were the main<br />
reasons for exclusion. Baseline demographics between groups were<br />
comparable. Concordance was 40% (16/40) and 85% (34/40) in cases and<br />
controls, respectively (OR 0.118, 95% CI 0.04-0.344; p
49<br />
4 Department <strong>of</strong> Medicine, Dalhousie University, Halifax, NS<br />
5 Capital District Health Authority Halifax Infirmary, Pharmacy Department,<br />
Halifax, NS<br />
6 WK Health Centre, Halifax, NS<br />
7<br />
<strong>Canadian</strong> Centre for Vaccinology, Halifax, NS<br />
Synopsis<br />
Background: Detailed pharmacokinetics to guide oseltamivir (Tamiflu ®)<br />
dosing in morbidly obese patients is lacking.<br />
Objectives: Characterize the single dose and steady state<br />
pharmacokinetics <strong>of</strong> oseltamivir and its active carboxylate metabolite in this<br />
population.<br />
Methods: The OPTIMO trial was a single center non-randomized open<br />
label pharmacokinetic study <strong>of</strong> single dose and steady state oral oseltamivir<br />
phosphate and active metabolite in healthy morbidly obese and healthy,<br />
non-obese subjects.<br />
Results: In the morbidly obese v.s. control subjects, respectively, the<br />
single-dose median oseltamivir: oral clearance, CL/F [840 v.s. 580 L h-1] was<br />
higher; the area under the curve (AUC0-¥) [89 v.s. 132 ng mL-1 h] was<br />
lower and, the volume <strong>of</strong> distribution Vd/F [2320 v.s. 1670 L] was<br />
unchanged. In the morbidly obese v.s. control subjects, respectively, the<br />
single-dose median oseltamivir carboxylate CL/F, AUC0-12h and Vd/F did<br />
not differ significantly. Similar results for oseltamivir and oseltamivir<br />
carboxylate CL/F, AUC0-12h and Vd/F values were observed in the multiple<br />
dose study.<br />
Conclusions: Systemic exposure to oseltamivir is decreased but that <strong>of</strong><br />
oseltamivir carboxylate is largely unchanged. Based on these<br />
pharmacokinetic data, an oseltamivir dose adjustment for body weight<br />
would not be needed in morbid obese individuals.<br />
Key Words: Oseltamivir, obesity, body mass index, obese,<br />
pharmacokinetics<br />
Description <strong>of</strong> Prop<strong>of</strong>ol Use in a Pediatric Intensive Care Unit<br />
Hiromi Koriyama 1 , Margaret L. Ackman 2 , Jonathan P. Duff 3 , Alice W. Chan 2<br />
1 Pharmacy Services, Covenant Health, Edmonton, AB<br />
2 Pharmacy Services, Alberta Health Services, Edmonton, AB<br />
3 Department <strong>of</strong> Pediatrics, University <strong>of</strong> Alberta, Edmonton, AB<br />
Rationale: Prop<strong>of</strong>ol infusions continue to be used in pediatric intensive<br />
care units (PICUs), despite being contraindicated in this population due to<br />
concerns <strong>of</strong> prop<strong>of</strong>ol related infusion syndrome (PRIS). However, some<br />
studies have not identified harm with prop<strong>of</strong>ol use in PICUs. The <strong>Canadian</strong><br />
Pediatric Critical Care Network (CPCCN) prepared a consensus statement<br />
on prop<strong>of</strong>ol use in PICUs, suggesting a 4 mg/kg/h maximum mean rate and<br />
24 hour maximum duration. Since this statement was developed, no<br />
studies have evaluated prop<strong>of</strong>ol use in the Stollery Children’s <strong>Hospital</strong> PICU.<br />
Objectives: To describe the practice patterns <strong>of</strong> prop<strong>of</strong>ol use in a<br />
single-center PICU, the rate <strong>of</strong> concordance <strong>of</strong> prop<strong>of</strong>ol use with CPCCN<br />
guidelines, and assess for the presence <strong>of</strong> signs and symptoms <strong>of</strong> PRIS.<br />
Methods: A retrospective chart review <strong>of</strong> initial prop<strong>of</strong>ol infusions used in<br />
PICU patients admitted during January 1 – December 31, 2009 was<br />
conducted. Charts were reviewed for prop<strong>of</strong>ol infusion characteristics, and<br />
presence <strong>of</strong> signs and symptoms <strong>of</strong> PRIS.<br />
Results: Data were collected from 223 patients. The mean <strong>of</strong> the average<br />
hourly prop<strong>of</strong>ol dose (including boluses) was 2.8±1.2 mg/kg/h and the<br />
average infusion duration was 10.3±6.7 hours. 86.5% and 97.8% <strong>of</strong><br />
infusions were concordant with CPCCN guideline maximum mean rate and<br />
duration, respectively. No cases <strong>of</strong> PRIS or deaths associated with prop<strong>of</strong>ol<br />
infusions were identified.<br />
Conclusions: Initial prop<strong>of</strong>ol infusions are being used in the Stollery<br />
Children’s <strong>Hospital</strong> PICU with a mean average hourly dose <strong>of</strong> 2.8 mg/kg/h<br />
and average duration <strong>of</strong> 10.3 hours. The majority <strong>of</strong> use was in<br />
concordance with CPCCN guidelines, but the need for consideration <strong>of</strong> the<br />
use and contribution <strong>of</strong> bolus doses to hourly prop<strong>of</strong>ol dose was identified.<br />
The use <strong>of</strong> initial prop<strong>of</strong>ol infusions in PICU patients appears to be safe, as<br />
an association with presence <strong>of</strong> signs and symptoms <strong>of</strong> PRIS, cases <strong>of</strong> PRIS,<br />
or death were not found.<br />
Development and Implementation <strong>of</strong> a Pediatric Emergency<br />
Department (ED) Asthma Action Plan And Prescription<br />
(AAPP)<br />
Danica Irwin, Régis Vaillancourt, Roger Zemek, Elena Pascuet, Children’s<br />
<strong>Hospital</strong> <strong>of</strong> Eastern Ontario (CHEO), Ottawa, ON<br />
Background: National and international asthma guidelines endorse asthma<br />
action plan (AP) use. Preprinted prescription incorporation into the AP<br />
should enhance physician use. Provision <strong>of</strong> information in visual and text<br />
format addresses varied health literacy levels.<br />
Objectives: To develop and implement a pediatric AP combined with a<br />
prescription based on validated pictograms accessible to the patient,<br />
pharmacist and physician.<br />
Methods: The Asthma Action Plan and Prescription (AAPP) was developed<br />
by a working group from ED, Respirology and Pharmacy, with additional<br />
input from the Ontario College <strong>of</strong> <strong>Pharmacists</strong> and the Institute for Safe<br />
Medication Practices. Evidence-based content was enhanced with<br />
pictograms <strong>of</strong> asthma control/triggers, with prescriptions embedded.<br />
Education was sent to ED staff via emails, posters and educational sessions.<br />
The ED pharmacist, via the region’s pharmacy email system/website and<br />
telephone, instructed retail pharmacies how to incorporate the AAPP into<br />
practice.<br />
Results: Since implementation in March 2011, more than 750 AAPPs have<br />
been used. Response is positive based on physician, pharmacist and patient<br />
feedback. An analysis <strong>of</strong> effectiveness is planned.<br />
Conclusions: An AAPP has been developed and implemented to enhance<br />
patient, pharmacist and physician asthma management. The AAPP<br />
facilitates physician use <strong>of</strong> the document and subsequent enhanced rational<br />
medication prescribing.<br />
Key Words: asthma action plan, emergency department, health literacy<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Providing Comprehensive Assessment and<br />
Pharmaceutical Care at the Geriatric Clinic for<br />
Parkinson’s<br />
Greta Mah, Joyce Lee, North York General <strong>Hospital</strong>, Toronto, ON<br />
Rationale: Parkinson’s disease (PD) is a common neurodegenerative disease<br />
with majority <strong>of</strong> patients being over the age <strong>of</strong> 60. Traditionally, PD<br />
management focuses on only motor features which are more apparent.<br />
However, recent studies showed up to 60% <strong>of</strong> patients also suffer from<br />
non-motor symptoms (NMS) leading to cognitive, autonomic and<br />
neuropsychiatric dysfunction which result in greater disability and hospital<br />
admission. Unfortunately, NMS are <strong>of</strong>ten under-diagnosed. In addition,<br />
elderly patients with PD are at high risk <strong>of</strong> experiencing drug therapeutic<br />
problems (DTPs) from their complex medication regimen. Therefore, a<br />
Geriatric Clinic with a physician-pharmacist team was established to provide<br />
comprehensive assessment and pharmaceutical care.<br />
Objectives & Descriptions: A prospective observational study was<br />
designed to determine whether comprehensive assessment could identify<br />
previously unrecognized NMS and to describe the nature <strong>of</strong> DTPs. Patients<br />
were seen by pharmacist followed by physician during each clinic<br />
appointment. Patients also have easy access to the pharmacist for<br />
telephone consultation or urgent assistance. All patients seen from Jan<br />
2008 to Nov 2009 were included in the study which was approved by the<br />
ethic review board.<br />
Results: One hundred and forty patients with an average age <strong>of</strong> 76 were<br />
assessed. About 4 DTPs per patient were identified. Most common DTP was<br />
NMS required treatment such as dementia, depression, anxiety,<br />
constipation, psychosis, orthostatic hypotension and sleep disorders. Other<br />
common DTPs were adverse drug reactions (ADRs), sub-therapeutic dosing<br />
and medication non-adherence. Over 120 ADRs were identified. Most<br />
common presentations were hallucination, confusion, dizziness, sedation
50<br />
and impulsive behaviours (i.e. gambling, hyper-sexuality) which <strong>of</strong>ten lead<br />
to caregiver stress and E.R. visits if not identified early.<br />
Conclusion: Patients and families appreciated the comprehensive<br />
assessment and pharmaceutical care provided by the clinic. Many NMS and<br />
DTPs were managed to maintain patient’s function, quality <strong>of</strong> life and to<br />
prevent unnecessary hospital admission.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Performance <strong>of</strong> Clinical Prediction Tools Used to<br />
Predict Major Bleeding in Patients Receiving<br />
Anticoagulation Therapy<br />
Sarah Burgess, Alejandro Lazo-Langner, George Dresser, Richard Kim,<br />
Natalie Crown, London Health Sciences Centre, London, ON<br />
Rationale: Fear <strong>of</strong> bleeding is a major determinant <strong>of</strong> the underuse <strong>of</strong><br />
anticoagulation therapy. Studies suggest clinical tools developed to predict<br />
major bleeding have poor agreement and predictive ability; however,<br />
guidelines recommend the HAS-BLED score to assess bleeding risk in<br />
patients with atrial fibrillation. The purpose <strong>of</strong> this study is to evaluate the<br />
performance and utility <strong>of</strong> these tools in a real-world clinical setting.<br />
Methods: A retrospective cohort study was performed at the<br />
anticoagulation clinic at University <strong>Hospital</strong>, London Health Sciences Centre.<br />
Clinic charts <strong>of</strong> patients receiving warfarin therapy between September<br />
2008 and February 2011, were reviewed. Bleeding risk factors identified at<br />
first clinic visit were used to apply bleeding risk tools (Outpatient Bleeding<br />
Risk Index, Contemporary Bleeding Risk Model, HEMORR2HAGES,<br />
HAS-BLED) which stratified major bleeding risk as low, moderate or high.<br />
The primary endpoint <strong>of</strong> agreement in risk stratification between the tools<br />
was assessed using Kendall’s tau-b coefficient. All predefined major and<br />
clinically relevant non-major bleeding events were identified from hospital<br />
charts and emergency department encounters. The predictive ability <strong>of</strong> each<br />
tool was evaluated using the C-statistic as a secondary endpoint.<br />
Results: The study included chart-abstracted data for 321 patients on<br />
warfarin therapy with a follow-up <strong>of</strong> 319 patient-years to assess for<br />
bleeding events. The stratification <strong>of</strong> bleeding risk was inconsistent<br />
between the tools, evidenced by Kendall’s tau-b coefficients for agreement<br />
(0.30 to 0.54). There were 3.8 major bleeds and 8.1 clinically relevant<br />
non-major bleeds per 100 patient-years <strong>of</strong> observation. C-statistics for<br />
predicting major bleeding were 0.61, 0.67, 0.71, 0.74 for Outpatient<br />
Bleeding Risk Index, HAS-BLED, Contemporary Bleeding Risk Model, and<br />
HEMORR2HAGES, respectively, demonstrating limited predictive ability.<br />
Conclusion: Bleeding risk prediction tools demonstrated poor agreement<br />
and limited predictive ability for major bleeding events. Further study should<br />
focus on how to incorporate such tools into clinical decision making.<br />
Development <strong>of</strong> a Clinical Institute Withdrawal Assessment<br />
(CIWA) Scale and Treatment Regimen for the Management <strong>of</strong><br />
Alcohol Withdrawal<br />
Rajini Retnasothie, Jason Volling. University Health Network, Toronto, ON,<br />
University <strong>of</strong> Toronto, Toronto, ON<br />
Rationale: The Clinical Institute Withdrawal Assessment Scale – Alcohol<br />
revised (CIWA-Ar) with symptom-triggered benzodiazepine therapy is the<br />
management <strong>of</strong> choice for alcohol withdrawal. Preliminary exploration<br />
revealed that practice at the University Health Network (UHN) was not<br />
completely aligned with these recommendations.<br />
Description: The objective <strong>of</strong> this project was to determine which factors<br />
UHN clinicians felt impeded the current alcohol withdrawal management<br />
process. The goal was to use this information to modify the CIWA-Ar tool<br />
and develop management regimens which integrate the best evidence and<br />
promote consistent, standardized use across our sites.<br />
Implementation: A focus group and survey were conducted to gather<br />
clinicians’ opinions on barriers they faced when managing patients<br />
experiencing acute alcohol withdrawal. A working group was then formed<br />
to review survey results and current evidence, revise the CIWA scoring tool<br />
and develop management regimens.<br />
Evaluation: Survey respondents identified inconsistencies in the prescribing<br />
process as well as variation in benzodiazepine choice, dose, route, and<br />
frequency as major impediments to optimal workflow.<br />
The previous CIWA scoring tool was deemed user-unfriendly, leading many<br />
assessors to use tools from other centers. Respondents also indicated that<br />
most benzodiazepine orders were not linked to CIWA scores. Based on<br />
this information and the evidence, the CIWA scoring tool was revised<br />
and standard orders were developed in paper and electronic form, for<br />
outpatients and inpatients, respectively. These orders feature<br />
three unique benzodiazepine regimens, selected based on patient<br />
factors, which correlate directly to CIWA scores.<br />
Importance: By creating a more user-friendly CIWA-Ar tool with correlating<br />
benzodiazepine orders, we are promoting symptom-triggered therapy,<br />
which is proven to reduce the risk <strong>of</strong> mortality associated with alcohol<br />
withdrawal (when compared to fixed dosing therapy). The modified scoring<br />
tool and order sets can be used by other centers that are also facing<br />
challenges with their alcohol withdrawal management process.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Implementation <strong>of</strong> an Insulin Pen Pilot Project in an<br />
In-Patient <strong>Hospital</strong> Setting<br />
Sara Kynicos 1 , Jin Hyeun Huh 1,2<br />
1 University Health Network, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, ON<br />
Rationale: Insulin is considered a high-risk medication due to its potential<br />
to cause severe patient harm when implicated in adverse drug events.<br />
Following insulin medication incidents in our institution, the Safe<br />
Medication Practice committee recommended trialling a novel approach;<br />
in-patient administration by nurses using insulin pens.<br />
Objective: To implement an insulin pen pilot in general internal medicine<br />
(98 beds across 3 floors) at one hospital site over 3 months, then measure<br />
safety outcomes related to medication incidents and satisfaction outcomes<br />
using nurse and patient feedback.<br />
Method: In order to ensure that nursing staff would be able to use the pen<br />
devices and that new types <strong>of</strong> errors would not be introduced, a human<br />
factors usability study was conducted. This simulated various scenarios to<br />
test all steps in the process; including loading cartridges, labelling, priming,<br />
using safety needles and administration <strong>of</strong> dose. The results <strong>of</strong> this testing<br />
were used to design the pilot workflow processes and education for staff.<br />
All existing formulary insulins were made available in pen devices as<br />
floor-stock and each patient was allocated their own pen for each insulin<br />
type.<br />
Results: A review <strong>of</strong> all reported incidents showed that no medication<br />
incidents involving insulin were reported on the pilot floors.<br />
A survey <strong>of</strong> nursing staff showed they preferred to use the insulin pens with<br />
75% wanting to continue. The staff felt that the pens decreased the risk <strong>of</strong><br />
administration <strong>of</strong> incorrect doses, were easy and efficient to use and<br />
allowed for increased patient teaching opportunities. A patient survey<br />
showed that the majority <strong>of</strong> insulin users (87%) preferred for nurses to<br />
administer their insulin with pen devices.<br />
Conclusion: This project demonstrates that insulin pen devices can be<br />
successfully implemented in an in-patient hospital setting, and should be<br />
considered as an option to potentially reduce errors with this high-risk<br />
medication.<br />
Organizational Restructuring <strong>of</strong> Regional Pharmacy Services<br />
to Facilitate Pharmacy Practice Model Change<br />
Kevin W Hall 1 , Colette B Raymond 2 , Donna MM Woloschuk 2 , and Nicholas<br />
Honcharik 2<br />
1 Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Alberta<br />
2 Winnipeg Regional Health Authority<br />
Background: Prior to restructuring, the Winnipeg Regional Health<br />
Authority’s Pharmacy <strong>Program</strong> (WRHAPP) coordinated the delivery <strong>of</strong><br />
pharmacy services at eight facilities with different drug distribution systems
51<br />
and pharmacy practice models. Pharmacy Managers had matrix<br />
accountability to their site and the WRHAPP.<br />
Objectives: A three year pharmacy change initiative was approved, with<br />
the objectives <strong>of</strong>: i) creating a single line <strong>of</strong> staff accountability to the<br />
WRHAPP, ii) expanding, and standardizing the use <strong>of</strong><br />
information/automation technologies, iii) focusing pharmacists on direct<br />
patient care activities, iv) expanding the role <strong>of</strong> pharmacy technicians to<br />
encompass responsibility for most drug distribution activities, v) creating<br />
management positions for pharmacy technicians, and vi) developing<br />
regional teams <strong>of</strong> specialized pharmacists, aligned with the WRHA’s clinical<br />
program model.<br />
Methods: Changes in the roles <strong>of</strong> pharmacists, technicians, and<br />
automation technology were facilitated by: i) the use <strong>of</strong> a structured project<br />
management approach, ii) the development and delivery <strong>of</strong> targeted<br />
educational/training programs, and iii) a consistent, repetitive<br />
communication strategy<br />
Conclusions: The new model optimizes the use <strong>of</strong> pharmacy staff and<br />
automation technologies and positions the WRHAPP to efficiently deliver<br />
high quality, patient-focused pharmacy services.<br />
Keywords: Pharmacy Practice Model, Automation, Project Management<br />
Drug Use Evaluation <strong>of</strong> Intravenous Tranexamic Acid:<br />
Adherence to <strong>Hospital</strong> Guidelines and Adverse Events in an<br />
Off-Label Use in Orthopedic Patients<br />
C. Dara, North York General <strong>Hospital</strong>, Toronto, ON<br />
Rationale: Routine administration <strong>of</strong> intravenous tranexamic acid (IVTA) for<br />
<strong>of</strong>f-label use during total knee replacement in patients without history <strong>of</strong><br />
thromboembolic disease is associated with a 67% reduction in red blood<br />
cell (RBC) transfusions and, in those transfused, with a reduction in the<br />
number <strong>of</strong> units administered. In the literature, IVTA treatment was not<br />
associated with an increase in thromboembolic complications.<br />
Objectives: The primary objective was to evaluate utilization <strong>of</strong> IVTA based<br />
on Pharmacy and Therapeutics (P&T) approved criteria in both knee and hip<br />
orthopedic patients. The secondary objective was to describe safety<br />
outcomes in patients treated with IVTA, after 6 months <strong>of</strong> usage<br />
Study Design and Methods: The agent was approved for addition to<br />
North York General <strong>Hospital</strong> (NYGH) formulary in January 2011 at a dose <strong>of</strong><br />
10-15mg/kg/dose given intra-operatively and repeated 3 hours<br />
post-operative. A retrospective drug use evaluation was completed on all<br />
patients identified through the pharmacy electronic database receiving IVTA<br />
between January - June 2011. Electronic charts were reviewed by a<br />
pharmacist using an audit tool. Criteria evaluated included compliance with<br />
prescribing criteria in orthopedic patients, incidence <strong>of</strong> hemoarthrosis,<br />
venous thromboembolism (VTE) and transfusion rates, and any hospital<br />
readmission.<br />
Results <strong>of</strong> Study: From January 2011 to June 2011, 31 orthopedic<br />
patients received IVTA<br />
NYGH approved<br />
indications for<br />
IVTA<br />
RBC<br />
n Transfused Hemoarthrosis VTE<br />
Hip/Knee revision 1 1 unit 0 0 0<br />
1 1 unit 0 0 0<br />
Major long bone<br />
fractures<br />
Bilateral total knee 26 No 0 0 0<br />
replacement<br />
Single knee<br />
replacement in an<br />
anemic patient Hgb<br />
< 125 g/L<br />
3 No 0 0 0<br />
Readmit/<br />
ER visits<br />
Conclusion: Use <strong>of</strong> tranexamic acid for the <strong>of</strong>f-label indication to decrease<br />
need for blood transfusions in orthopedic surgery has been within the<br />
NYGH approved indications with no adverse events (hemoarthosis or VTE)<br />
complicating hospital stay, discharge or follow-up.<br />
Extending <strong>Hospital</strong>-Based Medication Incident Reporting to<br />
Enhance Medication Safety and Continuous Quality<br />
Assurance in Pharmacy Practice<br />
Certina Ho 1,2 , Roger Cheng 1 , Calvin Poon 1,2 , Patricia Hung 1,2 , Gary Lee 1 , Joe<br />
O’Leary 1 , Kristian Duwyn 1 , Medina Kadija 1 , Carol Lee 1 , Sanaz Riahi 1,2<br />
1 Institute for Safe Medication Practices Canada, Toronto, ON<br />
2 School <strong>of</strong> Pharmacy, University <strong>of</strong> Waterloo, Waterloo, ON<br />
Background: Medication safety / risk management is a relatively foreign<br />
terminology in community pharmacy practice when compared to other<br />
health care settings in Canada. This stems from the lack <strong>of</strong> a medication<br />
incident reporting tool tailored for community pharmacies, thereby<br />
discouraging community pharmacies from learning past mistakes.<br />
Objective: Based on learning and experience acquired from hospital-based<br />
incident reporting, the ISMP Canada Community Pharmacy Incident<br />
Reporting (CPhIR) program was created specifically for community /<br />
ambulatory pharmacies.<br />
Methods: After multiple iterations <strong>of</strong> feedback, pilot-testing, and<br />
consultation with community pharmacy practitioners, CPhIR is now<br />
available to community / ambulatory pharmacies. Reported incidents are<br />
analyzed anonymously using a qualitative aggregate analysis approach with<br />
key findings disseminated back to frontline users by ISMP Canada.<br />
Results: As <strong>of</strong> August 2011, there are over 300 registered CPhIR users. An<br />
accumulative total <strong>of</strong> 17,000 incidents have been anonymously reported.<br />
CPhIR provides users with a secure online interface to document medication<br />
incidents, export data for analysis, and view comparisons <strong>of</strong> individual<br />
pharmacy and aggregate data.<br />
Conclusions: The innovative CPhIR program provides the necessary tools to<br />
empower community pharmacies to enhance safe medication practices.<br />
Through anonymous reporting, community pharmacies can analyze<br />
medication incidents, identify root causes, and consequently implement<br />
system-based strategies for continuous quality assurance.<br />
Key Words: Community Pharmacy, Ambulatory Pharmacy, Incident<br />
Reporting, Medication Incidents, Near Miss, Continuous Quality Assurance<br />
2 CSHP<br />
Targeting Excellence<br />
Implementation and Evaluation <strong>of</strong> a Medication<br />
Reconciliation Tool on Internal <strong>Hospital</strong> Transfer<br />
in Pharmacy Practice<br />
Natalie LeBlanc, Timothy MacLaggan, Leslie Manuel, Julie<br />
Levesque, Rochelle Johnston, Julie Weir, Horizon Health Network, Zone 1,<br />
Moncton, NB<br />
Background: Patients are susceptible to medication errors at the point <strong>of</strong><br />
transfer, particularly in transfer from an intensive care unit to a general<br />
ward. Data to assess the optimal strategy in performing medication<br />
reconciliation at the time <strong>of</strong> transfer is currently limited.<br />
Objectives: To determine if implementation <strong>of</strong> a medication reconciliation<br />
tool comprised <strong>of</strong> a patient-specific computer generated physician order<br />
form would result in a decrease in the number, type and severity <strong>of</strong><br />
medication discrepancies that occur on internal hospital transfer.<br />
Methods: Two groups <strong>of</strong> patients transferred from the intensive care unit<br />
to the surgery step-down unit were compared. Current practices with<br />
regard to transfer orders were provided to the control group and a<br />
patient-specific medication reconciliation tool (completed by the<br />
transferring physician) was utilized for the intervention group. Medication<br />
discrepancies at the time <strong>of</strong> transfer were identified by two independent<br />
reviewers.<br />
Results: Fifty-two patients were included in the analysis. Mean number <strong>of</strong><br />
discrepancies per-patient were significantly decreased in the intervention<br />
group compared to the control group (0.96 ± 1.5 vs. 2.37 ± 1.8; p =<br />
0.003). There was a significant reduction in the number <strong>of</strong> policy violation<br />
discrepancies (0% vs. 45%; p
52<br />
Key Words: medication reconciliation, internal hospital transfer,<br />
medication discrepancy, intensive care unit, patient safety<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Improving Continuity <strong>of</strong> Care Post-<strong>Hospital</strong><br />
Discharge: A Needs Assessment <strong>of</strong> Community<br />
<strong>Pharmacists</strong><br />
Minh-Hien Le, Vincent Teo , Sunnybrook Health Sciences Centre, Toronto, ON<br />
Rationale: Increasing information exchange between community and<br />
hospital pharmacists has been shown to increase the number <strong>of</strong><br />
interventions by both. Sunnybrook Health Sciences Centre (SHSC) currently<br />
provides patients with a discharge summary (DS), generated by SHSC’s<br />
e-discharge program, which outlines details <strong>of</strong> their hospital admission.<br />
Such information may be useful to community pharmacists to ensure<br />
continuity <strong>of</strong> care.<br />
Description: To determine the importance <strong>of</strong> various hospital admission<br />
details to community pharmacists and to identify common barriers that are<br />
encountered when ensuring continuity <strong>of</strong> care.<br />
Steps: A feedback survey was developed from findings <strong>of</strong> previous studies<br />
and information currently provided in the DS. Surveys were distributed to<br />
over 600 community pharmacists working within a 10 km radius <strong>of</strong> SHSC.<br />
The survey asked pharmacists to rank the importance <strong>of</strong> patient hospital<br />
admission details using a five-point scale. It also asked a series <strong>of</strong><br />
open-ended questions relating to barriers in providing continuity <strong>of</strong> care,<br />
feedback on other discharge tools seen in practice, and other information<br />
that would be helpful in improving post-discharge care.<br />
Evaluation: Sixty pharmacists responded and 90% or more ranked the<br />
following as being “very important”: current medication list on discharge;<br />
list <strong>of</strong> discontinued medications; list <strong>of</strong> medications which have been<br />
adjusted. Details such as procedures performed while in hospital, results <strong>of</strong><br />
procedures and tests performed in hospital, list <strong>of</strong> complications occuring<br />
while in hospital and course in hospital were ranked from “neutral” to “not<br />
important” by the majority <strong>of</strong> pharmacists. Common barriers included<br />
prescription processing issues, lack <strong>of</strong> contact information and medication<br />
reconciliation issues. <strong>Pharmacists</strong> commented that lab results might be<br />
helpful to facilitate patient monitoring, particularly if the scope <strong>of</strong> practice<br />
<strong>of</strong> pharmacists was to expand.<br />
Relevance: Having identified the needs <strong>of</strong> community pharmacists, we can<br />
improve communication tools that will enhance the continuity <strong>of</strong> care for<br />
patients.<br />
2 CSHP<br />
Targeting Excellence<br />
Patient Recall <strong>of</strong> Interaction with a Pharmacist<br />
During <strong>Hospital</strong> Admission<br />
in Pharmacy Practice<br />
Douglas Doucette, Regional Pharmacy Services; Carole<br />
Goodine, Zone 3 Fredericton; Jodi Symes, Zone 2 Saint John; Erin Clarke,<br />
Zone 1 Moncton; Scott Simpson, Zone 7 Miramichi. All authors affiliated<br />
with Pharmacy Services, Horizon Health Network, NB<br />
Purpose: CSHP 2015 Objective 1.5 proposes that at least 50% <strong>of</strong> recently<br />
hospitalized patients or their caregivers will recall speaking with a<br />
pharmacist while in the hospital. Following a major reorganization <strong>of</strong> health<br />
authorities in New Brunswick, we sought to determine the baseline<br />
prevalence <strong>of</strong> patients who recall interacting with the pharmacist during<br />
their hospital admission, and their level <strong>of</strong> satisfaction with these<br />
encounters.<br />
Methods: Former inpatients from 27 units in 9 hospitals in Horizon Health<br />
Network were randomly selected to complete a telephone questionnaire<br />
within 5 to 7 months <strong>of</strong> discharge from hospital. Patient responses were<br />
validated against pharmacist documentation in the patient health record.<br />
Approval was granted by Horizon’s Research Ethics Board. Funding was<br />
provided by Medbuy Incorporated.<br />
Results: From August 2010 to July 2011, 1055 former inpatients were<br />
screened and 399 completed the telephone survey. Respondents were<br />
mainly female (56%) with mean age 67 years. During their recent<br />
admission 46% (n=184) <strong>of</strong> patients recalled speaking with a pharmacist.<br />
Eighty-nine percent responded they were “satisfied” or “very satisfied” in<br />
their interaction with the pharmacist. If the hospital <strong>of</strong>fered the opportunity<br />
to talk with a pharmacist who could help answer their questions about<br />
medications, 83% <strong>of</strong> respondents indicated they would want this service.<br />
For patients who recalled speaking with a pharmacist, a sample <strong>of</strong> 181<br />
patients was explored for evidence <strong>of</strong> pharmacist intervention or encounter<br />
with subject (medication history, consultation, etc.). Pharmacist<br />
documentation was found in health records <strong>of</strong> 65% <strong>of</strong> patients who<br />
recalled an interaction and in 88% <strong>of</strong> all patients.<br />
Conclusions: During a recent hospital admission, 46% <strong>of</strong> former inpatients<br />
recalled speaking with a pharmacist. The vast majority <strong>of</strong> patients were<br />
satisfied with this interaction and would welcome future services from<br />
hospital pharmacists.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
How Well Do Pharmacy Clinicians Perform in a<br />
Patient Simulation-Based Admission Medication<br />
Reconciliation Validation <strong>Program</strong>?<br />
Karen Cameron 1,2 , Natalia Persad 1,2 , Cindy Natsheh 1,2 , Kristie Small 1,2 , Sara<br />
Ingram 1,2 , Shiwani Chhibbar 1,3 , Olavo Fernandes 1,2<br />
1 University Health Network, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
3 University <strong>of</strong> Waterloo School <strong>of</strong> Pharmacy, Kitchener, ON<br />
Rationale: <strong>Hospital</strong>s are looking for effective strategies to implement<br />
medication reconciliation, train clinicians, and meet accreditation standards.<br />
The purpose <strong>of</strong> this study was to assess performance <strong>of</strong> pharmacy clinicians<br />
participating in a standardized formal medication reconciliation training<br />
program and compare the results among participant groups.<br />
Description: Pharmacy clinicians participated in an educational program<br />
designed to teach and evaluate key competencies linked to medication<br />
reconciliation. In the education phase, participants completed a pre-reading<br />
package and attended a group learning session that introduced medication<br />
reconciliation, best possible medication history (BPMH) taking, and<br />
identification and coding <strong>of</strong> discrepancies. In the validation phase,<br />
participants interviewed a standardized patient and were evaluated on: 1)<br />
time to complete BPMH; 2) BPMH process accuracy; 3) identification and<br />
coding <strong>of</strong> discrepancies. Data was grouped by participant type and<br />
analyzed.<br />
Evaluation: During a 5 year period, 135 pharmacy clinicians including<br />
pharmacists (n=87), pharmacy students (n=36) and pharmacy<br />
residents/interns (n=12) participated in the program. In the validation<br />
phase, the overall mean BPMH score was 88.9% [range 64.0-100.0%]. The<br />
mean BPMH scores for pharmacists, students and new graduates were<br />
88.4% [56.0-100.0%], 88.8% [64.0-100.0%] and 93.0% [88.0-100.0%]<br />
respectively. The overall mean BPMH completion time was 17 minutes<br />
[5-60] The average BPMH time (in minutes) by group was: pharmacists 20<br />
[5-60], students15 [10-30] and residents/interns 17 [12-23]. The overall<br />
discrepancy identification and coding accuracy scores were 94.4%<br />
[50.0-100.0%] and 99.5% [90.0-100.0%] respectively. The participants<br />
who used the BPMH interview guide (102/135) had a higher average score<br />
than those that did not (91.3% vs. 81.6%).<br />
Importance: A standardized medication reconciliation validation process<br />
enables consistent teaching and promotes competence in BPMH taking and<br />
medication reconciliation. This process can be widely applied to other<br />
institutions and clinician groups. Notably, the evaluation scores are high and<br />
similar across pharmacy clinician groups.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Who’s Looking at the BPMH? Perception and<br />
Utilization <strong>of</strong> the Best Possible Medication History<br />
in a Tertiary Care <strong>Hospital</strong><br />
Sara Ingram 1,2 , Julia Streminsky 1,2 , Rosalyn Fleites 1,3 , Olavo Fernandes 1,2<br />
1 University Health Network, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
3 University <strong>of</strong> Waterloo School <strong>of</strong> Pharmacy, Waterloo, ON<br />
Rationale: The Best Possible Medication History (BPMH) is a comprehensive<br />
medication history completed by clinicians, using several sources <strong>of</strong>
53<br />
information. The BPMH is used in medication reconciliation, where a<br />
systematic comparison with current orders helps ensure safe, accurate<br />
medication information transfer. The study hospitals had admission<br />
medication reconciliation completed for >75% <strong>of</strong> inpatients, but it was<br />
unclear to what extent the BPMH was being used by healthcare providers.<br />
The primary objective <strong>of</strong> this study was to assess the utilization and<br />
integration into practice <strong>of</strong> the BPMH across healthcare pr<strong>of</strong>essionals<br />
providing direct patient care at a tertiary hospital in order to better direct<br />
education and quality improvement measures.<br />
Description: The study was conducted via a survey over a 10-week period.<br />
Specific groups targeted included: Medicine, Nursing, Pharmacy and Allied<br />
Health. Participants were contacted by email via hospital mailing lists, or<br />
were provided a paper copy <strong>of</strong> the survey by study coordinators.<br />
Evaluation: This study (N=330) revealed the majority <strong>of</strong> respondents used<br />
the BPMH (64%), <strong>of</strong> which 40% reported regular use (>10 times/week). An<br />
analysis <strong>of</strong> BPMH utilization by listed pr<strong>of</strong>ession revealed that 50% <strong>of</strong><br />
physicians, 63% <strong>of</strong> nurses, 70% <strong>of</strong> nursing leadership/nurse practitioners,<br />
71% <strong>of</strong> dieticians and 93% <strong>of</strong> pharmacists use the BPMH. Participants who<br />
did not use the BPMH (36%) cited being unaware <strong>of</strong> the resource as the<br />
most frequent reason for not using it. Further education on the BPMH,<br />
including its content and location is warranted to increase its clinical impact<br />
in patient care.<br />
Importance: Findings suggest that the majority <strong>of</strong> clinicians were familiar<br />
with the BPMH and actively used it as part <strong>of</strong> routine patient care. However,<br />
results also highlight that more education about the purpose and<br />
availability <strong>of</strong> the BPMH is still required, in order for all clinicians to<br />
integrate it more commonly into their practice.<br />
The Evaluation <strong>of</strong> a New Hierarchical Teaching Model for<br />
Pharmacy Students in Experiential Education<br />
Laura Tsang, Minh-Hien Le, Vincent Teo, Sunnybrook Health Sciences<br />
Centre, Toronto, ON<br />
Rationale: Pharmacy students undergoing experiential education are<br />
traditionally mentored by pharmacist preceptors. The changing curriculum<br />
at the University <strong>of</strong> Toronto (UT) and increased number <strong>of</strong> pharmacy<br />
students have created stress on this system and other teaching models<br />
should be explored.<br />
Description: To evaluate a new teaching model involving UT fourth-year<br />
pharmacy Structured Practical Experience <strong>Program</strong> (SPEP) students and<br />
residents mentoring junior pharmacy students under pharmacist<br />
supervision. The impact on learning, overall experience and pharmacist<br />
workload were examined.<br />
Steps: Surveys were distributed to 13 second year UT pharmacy students<br />
completing their Early <strong>Hospital</strong> Experience (EHE) rotation and their mentors.<br />
Seven EHE students were matched with SPEP students, two with residents<br />
and four with pharmacists concurrently preceptoring SPEP students.<br />
Evaluation: Of the nine EHE students with an SPEP/resident mentor, 89%<br />
found the experience worthwhile and 100% agreed this hierarchical<br />
teaching model should be repeated. All students agreed that a SPEP<br />
student/resident mentor enriched learning and those EHE students with<br />
pharmacist mentors wished they had this opportunity. For mentors, none<br />
“strongly agreed” to a significantly increased workload or impaired learning<br />
experience and described improved teaching skills and a worthwhile<br />
experience. <strong>Pharmacists</strong> agreed the program did not significantly increase<br />
workload, space constraints or disrupt SPEP learning and would coordinate<br />
this model again.<br />
Relevance: This new hierarchical teaching model was well received. EHE<br />
students preferred SPEP/resident mentors as they were more accessible,<br />
familiar with the curriculum and could advise on course selection and career<br />
options. Traditionally, preceptoring students requires a large time<br />
commitment and many pharmacists feel they cannot grant the increasing<br />
requests for rotations. However, this study shows the successful<br />
implementation and feasibility <strong>of</strong> a student structured teaching model with<br />
supervision by pharmacists with both clinical and dispensing responsibilities.<br />
Furthermore, this model helps to maximize the number <strong>of</strong> students exposed<br />
to hospital pharmacy practice.<br />
Evaluation <strong>of</strong> the Effectiveness <strong>of</strong> Online versus Face to Face<br />
Interactions in Interpr<strong>of</strong>essional Education<br />
Vincent Ho, Joan Lee, Justin Lee. Hamilton Health Sciences, Hamilton, ON<br />
Rationale for Report: The focus <strong>of</strong> interpr<strong>of</strong>essional education (IPE) is the<br />
development <strong>of</strong> skills to facilitate collaboration but achieving this goal can<br />
be difficult due to logistical challenges. Utilizing online services may provide<br />
an effective and familiar way for students to interact.<br />
Description <strong>of</strong> Concept: Undergraduate students from nursing,<br />
occupational therapy, pharmacy, physiotherapy and social work completed<br />
2 clinical scenarios, one as an online interaction utilizing Google Docs,<br />
Gmail and Skype, then was compared to a face to face (F2F) interaction.<br />
Development and Implement <strong>of</strong> Project: Seven students were recruited<br />
and took part in the study. Two observers assessed the students on the<br />
number <strong>of</strong> pre-defined learning objectives achieved and the demonstration<br />
<strong>of</strong> interpr<strong>of</strong>essional competencies in each interaction. Participants’<br />
experiences and attitudes toward IPE were assessed using pre- and<br />
post-interaction surveys and the Readiness for Interpr<strong>of</strong>essional Learning<br />
Survey (RIPLS).<br />
Evaluation <strong>of</strong> Project: The online and F2F interactions achieved 71% and<br />
86% <strong>of</strong> the learning objectives respectively. The F2F interaction resulted in a<br />
higher team score in the demonstration <strong>of</strong> interpr<strong>of</strong>essional competencies<br />
and 57% <strong>of</strong> students also received higher individual scores. The F2F<br />
interaction was preferred overall by 71% <strong>of</strong> students and both observers.<br />
The F2F interaction was preferred by 71% <strong>of</strong> students in terms <strong>of</strong> logistics<br />
and 100% <strong>of</strong> students in terms <strong>of</strong> IPE experience and learning experience.<br />
RIPLS scores improved after completing the interactions. Participants<br />
highlighted components <strong>of</strong> each interaction that could be combined to<br />
improve future interactions.<br />
Concept’s Importance and Usefulness to Current and or Future<br />
Practice: The online interaction may not be as effective as the F2F<br />
interaction in IPE. Students felt that the online interaction was less effective<br />
for discussion but may help address some logistical challenges. Educators<br />
should implement a combination <strong>of</strong> components highlighted by<br />
participants to help improve the online collaborative experience.<br />
An Online e-Learning Patient Education Tool for Solid Organ<br />
Transplant Recipients<br />
Jennifer Harrison 1,2 , Julia Cervenko 1 , Penny Demas-Clarke 1 , Bassem<br />
Hamandi 1,2 , Dipika Munyal 1 , June Wang 1 , Teresa Yi 1<br />
1 Department <strong>of</strong> Pharmacy, Toronto General <strong>Hospital</strong>, University Health<br />
Network, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
Background: Medication regimens for solid organ transplant recipients<br />
(SOTR) are complex and non-adherence can lead to rejection and graft loss.<br />
Educational tools are needed to reinforce patient knowledge <strong>of</strong> transplant<br />
medications.<br />
Objective: To develop a tool to support ongoing medication education<br />
needs <strong>of</strong> SOTR.<br />
Methods: <strong>Program</strong> content was developed by pharmacists and reviewed by<br />
an interpr<strong>of</strong>essional clinician group. Micros<strong>of</strong>t Power Point®, Adobe®<br />
Captivate® and Dreamweaver® were used to create an e-learning<br />
internet-based format. A Virtual Patient Focus Group (VPFG) assessed<br />
usability and utility <strong>of</strong> the tool.<br />
Results: The Transplant Medication Information Teaching Tool (TMITTã,<br />
www.TMITT.ca) launched in September 2010. Content is structured as<br />
medication courses and lessons, and includes interactive quizzes and<br />
medication summaries. ‘Learning Prescriptions’ direct patients to<br />
appropriate content to meet their learning objectives. The majority <strong>of</strong> VPFG<br />
members (n=27) agreed or strongly agreed that the program was an<br />
effective way to learn, language and difficulty level were appropriate, and<br />
that they had the necessary computer skills to use the tool.
54<br />
Conclusions: While further study is needed, use <strong>of</strong> an internet-based<br />
e-learning program to control content, sequence, pace and timing <strong>of</strong><br />
education to achieve personal learning objectives appears to be an<br />
attractive and effective teaching modality in SOTR.<br />
Keywords: patient education, e-learning, internet, solid organ<br />
transplantation<br />
Diabetes Education in Pharmacy Residencies Across Canada<br />
Henry Halapy, St. Michael’s <strong>Hospital</strong>, Toronto, ON, Gary Wong, University<br />
Health Network, Toronto, ON<br />
Rationale: Diabetes is a growing chronic health problem in Canada,<br />
requiring complex management. As a result teaching, pharmacy students<br />
about diabetes has become increasingly important. However, little is known<br />
about the amount and type <strong>of</strong> education regarding diabetes given to<br />
post-graduate pharmacy residents in Canada.<br />
Objective: To evaluate the extent and type <strong>of</strong> training currently conducted<br />
around diabetes management in <strong>Canadian</strong> pharmacy residencies.<br />
Study design and methods: A web-based survey tool asking about<br />
exposure to diabetes topics (such as diabetes medication pharmacology,<br />
insulin dosing) in pharmacy residency training was distributed to pharmacy<br />
residency coordinators/ directors and residents across Canada via email.<br />
Most answers were recorded using a 5 point Likhert scale (no exposure, a<br />
little, some, a lot, resident becomes pr<strong>of</strong>icient). The survey was reviewed for<br />
face and content validity prior to distribution. Congestive heart failure, a<br />
frequently occurring chronic health problem in Canada, was used as a<br />
comparator therapeutic topic.<br />
Results: A total <strong>of</strong> 41 responses were received (19 coordinators, 5<br />
directors, 17 residents). Diabetes rotations were uncommon in <strong>Canadian</strong><br />
pharmacy residencies (2.4% <strong>of</strong> responses), while cardiology rotations were<br />
common (81% <strong>of</strong> responses). Residents were exposed predominantly to no<br />
(4/15 topics, e.g., carbohydrate counting), a little (5/15 topics, e.g., blood<br />
glucose meters), or some (6/15 topics, e.g., sliding scales) with regard to<br />
diabetes topics while residents were exposed predominantly to some (8/15<br />
topics, e.g., amiodarone use) or a lot (4/15 topics, e.g., blood pressure<br />
monitoring) to heart failure topics. Between 4-9% <strong>of</strong> residents became<br />
pr<strong>of</strong>icient in some heart failure topics (warfarin counseling) while very few<br />
residents became pr<strong>of</strong>icient in diabetes topics.<br />
Conclusions: This survey would suggest that pharmacy residents are<br />
exposed to diabetes topics relatively less than congestive heart failure.<br />
Greater exposure to diabetes topics may be beneficial in pharmacy<br />
residency training.<br />
Evaluating the Role <strong>of</strong> Pharmacist Teachers in <strong>Canadian</strong><br />
Family Medicine Residency <strong>Program</strong>s: A Qualitative Analysis<br />
Derek Jorgenson 1 , Andries Muller 1 , Anne Marie Whelan 2<br />
1 University <strong>of</strong> Saskatchewan<br />
2 Dalhousie University<br />
Background: A 2009 survey found >25% <strong>of</strong> <strong>Canadian</strong> family medicine<br />
residency programs have a pharmacist teaching residents; however, little is<br />
known about the impact <strong>of</strong> these pharmacists.<br />
Objective: Evaluate the role <strong>of</strong> pharmacist teachers within <strong>Canadian</strong> family<br />
medicine residency programs.<br />
Methods: One-on-one interviews with residents, physicians and<br />
pharmacists from the 40 <strong>Canadian</strong> family medicine residency programs that<br />
employ a pharmacist teacher. Interviews continued until data saturation<br />
was observed. Transcripts were analyzed using grounded theory analysis<br />
(inductive and deductive) to identify themes. Codes were entered into<br />
NVivo s<strong>of</strong>tware. Themes were sent to participants to confirm validity.<br />
Results: 11 residents, 6 physicians and 17 pharmacists participated. Four<br />
themes emerged from deductive analyses regarding the impact <strong>of</strong><br />
pharmacists on residents: (1) Improved drug knowledge (2) Improved<br />
confidence (3) Improved patient care (4) Appreciation for pharmacist<br />
expertise. Five additional themes emerged from inductive analyses: (1)<br />
Desire to expand pharmacist teaching (2) Impact on collaboration (3) Impact<br />
on faculty (4) Lack <strong>of</strong> criticism <strong>of</strong> the role (5) No formal curriculum utilized.<br />
Conclusions: The role <strong>of</strong> pharmacist teachers is valued in <strong>Canadian</strong> family<br />
medicine residency programs and consideration could be made to expand<br />
the role. Developing a formal curriculum is recommended.<br />
Key words: family medicine residency, pharmacist teacher, qualitative<br />
A Survey <strong>of</strong> Institutional <strong>Pharmacists</strong>’ Involvement In and<br />
Attitudes Towards Research<br />
Joseph E. Blais 1 , Sheila L. Walter 1 , Dean T. Eurich 2 , Ross T. Tsuyuki 3 , Sheri L.<br />
Koshman 3<br />
1 Pharmacy Services, Alberta Health Services, Edmonton, AB<br />
2 School <strong>of</strong> Public Health, University <strong>of</strong> Alberta, Edmonton, AB<br />
3 Division <strong>of</strong> Cardiology, University <strong>of</strong> Alberta, Edmonton, AB<br />
Background: Research is critical for the future <strong>of</strong> pharmacy yet institutional<br />
pharmacists’ current research activities and perceptions towards research<br />
are largely unknown.<br />
Objectives: To describe institutional pharmacists’ involvement in research<br />
activities and to assess the attitudes <strong>of</strong> pharmacists towards research.<br />
Methods: We conducted a cross-sectional survey <strong>of</strong> all institutional<br />
pharmacists within Alberta Health Services, Alberta, Canada, in March<br />
2011. The survey explored involvement in research, current research<br />
activities, and attitudes towards research.<br />
Results: Overall response rate was 45% (286/636). Respondents were<br />
predominantly female (80%), practiced in urban institutions (76%) and<br />
reported a primary clinical role (61%). Over half <strong>of</strong> pharmacists indicated<br />
having involvement in research (168/286 [60%]) with 43% <strong>of</strong> pharmacists<br />
(119/280) currently participating in research activities but only 26%<br />
(72/280) leading research projects. <strong>Pharmacists</strong> tended to agree (94%) that<br />
research was important to the pr<strong>of</strong>ession <strong>of</strong> pharmacy. Almost all<br />
respondents (99%) felt that pharmacists should be involved in research, but<br />
indicated additional time and training were barriers to their personal<br />
involvement.<br />
Conclusion: While the majority <strong>of</strong> institutional pharmacists in Alberta have<br />
had involvement in research projects, few were involved in leading research.<br />
There is strong support from pharmacists to be involved in research.<br />
Key Words: research, institutional pharmacist, attitudes, involvement,<br />
activities<br />
Interactions between Antiretroviral Agents and<br />
Chemotherapy Regimens for the Treatment <strong>of</strong> Lymphoma: A<br />
Quick Reference Guide<br />
Alison YJ Wong 1,2,3 , Alice Tseng 1,2 , Jack Seki 1,2 , Pam Ng 1 , Vishal Kukreti 1<br />
1 University Health Network, Toronto, ON<br />
2 University <strong>of</strong> Toronto, Toronto, ON<br />
3 McGill University Health Centre, Montréal, QC<br />
Background: Despite the success <strong>of</strong> antiretroviral therapy, HIV-infected<br />
individuals remain at higher risk <strong>of</strong> developing malignancies. Clinically<br />
important interactions between cART and chemotherapy agents have been<br />
described in the literature, but practical, comprehensive guidelines for<br />
clinical practice do not exist.<br />
Objective: To provide a comprehensive summary <strong>of</strong> documented and<br />
potential interactions between antiretroviral agents (ARVs), common<br />
chemotherapy regimens used in the treatment <strong>of</strong> lymphoma, and<br />
supportive therapy.<br />
Methods: A literature review was conducted through Ovid Medline 1948 –<br />
March 2011 using MeSH terms for individual antineoplastics, keywords for<br />
chemotherapy regimens, and available and emerging ARVs. Pertinent<br />
conference abstracts were identified through the International AIDS <strong>Society</strong>
55<br />
USA abstract search engine. Quality <strong>of</strong> evidence was evaluated according to<br />
an adapted GRADE system.<br />
Results: Thirteen documents were developed, summarizing potential<br />
interactions between ARVs and the following chemotherapy regimens:<br />
ABVD, BEACOPP, CHOP, CNS LYMPHOMA, CODOX-M, CVP, DHAP, ESHAP,<br />
GDP, ICE, IVAC, MINIBEAM, and supportive therapy. A summary <strong>of</strong> current<br />
principles <strong>of</strong> HIV treatment was also developed for non-HIV specialists.<br />
Conclusion: This guide provides clinicians with a user-friendly tool which<br />
allows quick identification <strong>of</strong> possible ARV-chemotherapy interactions;<br />
clinical implications and practical management guidelines are included to<br />
facilitate optimal treatment <strong>of</strong> both disease states with minimal toxicity.<br />
Key words: HIV infection, lymphoma, antiretrovirals, chemotherapy,<br />
interactions<br />
Impact <strong>of</strong> a Drug Access Facilitator in an Outpatient<br />
Chemotherapy Clinic<br />
Mei Shi, Daniela Gallo-Hershberg, Nicole Harvey, North York General<br />
<strong>Hospital</strong>, Toronto, ON<br />
Rationale: Obtaining reimbursement and access for treatment and<br />
supportive therapies for outpatient chemotherapy clinics has been<br />
fragmented where multiple stakeholders, including patients, are involved in<br />
the process. The role <strong>of</strong> a drug access facilitator (DAF) was investigated to<br />
reduce wait time to treatments, clinician administrative workload, and<br />
clinician and patient frustration.<br />
Description and Steps Taken: Through interviewing key stakeholders, a<br />
needs assessment <strong>of</strong> the existing reimbursement process was conducted.<br />
This resulted in the development <strong>of</strong> a new streamlined workflow as well as<br />
drug specific access protocols, and led to the creation <strong>of</strong> the centralized<br />
DAF role. Because the DAF would require extensive knowledge in<br />
medications and experience in dealing with third-party payers, a pharmacy<br />
technician was selected to fulfill this role. A pharmacist was available for<br />
consultation for clinically challenging cases.<br />
Evaluation: Over a 6-month period, the DAF managed a total <strong>of</strong> 140<br />
reimbursement cases. The average time to approval for Exceptional Access<br />
<strong>Program</strong> applications was decreased from 35 days to less than 10 days with<br />
the DAF intervention. A similar pattern was observed with applications for<br />
the Special Access <strong>Program</strong> and Trillium <strong>Program</strong>. Also, centralization <strong>of</strong> the<br />
drug access workflow to a single individual reduced administrative<br />
workload for members <strong>of</strong> the interpr<strong>of</strong>essional team. A follow-up written<br />
survey <strong>of</strong> clinic staff and patients reported high levels <strong>of</strong> satisfaction with<br />
the DAF with average scores <strong>of</strong> 90.8% and 88.3%, respectively.<br />
Importance: The DAF has demonstrated a positive impact for the<br />
chemotherapy clinic. This role can be applied to various medical specialities<br />
outside <strong>of</strong> oncology for any medication with outpatient reimbursement and<br />
access barriers. This concept also aligns with the future <strong>of</strong> pharmacy<br />
practice as it empowers pharmacy technicians to expand their scope <strong>of</strong><br />
practice to promote seamless care.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
High Dose Methotrexate in Adult Oncology<br />
Patients: A Case-Control Study Assessing the Risk<br />
Association Between Drug Interactions and<br />
Methotrexate Toxicity<br />
April Chan, Irina Rajakumar, London Health Sciences Centre, London, ON<br />
Background: High-dose methotrexate, defined as dose ≥ 1g/m2, is<br />
commonly used in chemotherapy protocols. Certain drugs such as acyclovir,<br />
allopurinol, proton pump inhibitors (PPIs) and some antibiotics have been<br />
associated with delayed renal clearance <strong>of</strong> methotrexate and may<br />
predispose patients to toxicities. Currently, no specific recommendations<br />
exist on adjusting high-dose methotrexate regimen in the presence <strong>of</strong><br />
potential interacting drugs. This study aims to determine whether presence<br />
<strong>of</strong> interacting drugs is associated with delayed methotrexate clearance.<br />
Methods: This was a case-control study <strong>of</strong> adult oncology patients who<br />
received their first cycle <strong>of</strong> high-dose methotrexate. Cases were defined as<br />
patients who experienced delayed methotrexate clearance, as indicated by<br />
serum methotrexate level ≥ 0.1 umol/L at 72 hours. The primary endpoint<br />
was the frequency <strong>of</strong> interacting drugs between cases and controls. These<br />
were compared using Fisher’s exact test. Where possible, adjustment for<br />
significant baseline differences was made using logistic regression. The<br />
secondary endpoint was frequency <strong>of</strong> methotrexate-related clinical toxicities<br />
between groups and included myelosuppression, nephrotoxicity,<br />
hepatotoxicity and mucositis.<br />
Results: From January 2004 to March 2011, 73 patients met study criteria,<br />
<strong>of</strong> which 23 were defined as cases. Significant baseline differences were<br />
high-dose methotrexate dose received and renal impairment. The presence<br />
<strong>of</strong> interacting drugs was not associated with delayed methotrexate<br />
clearance (OR 0.91, 95% CI 0.24-3.38, p>0.999). After adjusting for<br />
high-dose methotrexate dose, drugs observed with the most frequency<br />
(allopurinol, PPIs and sulfamethoxazole/ trimethoprim) were not associated<br />
with delayed methotrexate clearance (p-values <strong>of</strong> 0.948, 0.592 and 0.204<br />
respectively). Cases experienced more severe anemia (grade 2.52 versus<br />
1.68, p=0.007) and higher rates <strong>of</strong> mucositis (65.2% versus 20.0%,<br />
p
56<br />
Background: Capecitabine is an oral pro-drug <strong>of</strong> the cytotoxic agent<br />
5-fluorouracil used in the treatment <strong>of</strong> several types <strong>of</strong> cancer. As more oral<br />
chemotherapy agents come to market, there is interest in how pharmacists<br />
in oncology can adapt their practices to best provide patient care.<br />
Objective: To establish and evaluate the impact <strong>of</strong> a pharmacist-led toxicity<br />
management program for patients being treated with capecitabine.<br />
Methods: Implementation and prospective evaluation <strong>of</strong> the program was<br />
conducted using a matched historical cohort. <strong>Pharmacists</strong> performed<br />
weekly toxicity assessments. Interventions were made using developed<br />
algorithms and evidence-informed guidelines. Patient quality <strong>of</strong> life and<br />
satisfaction with the program were also evaluated.<br />
Results: Seventeen patients were enrolled with 17 retrospective matches<br />
subsequently identified. There was a trend towards a decreased<br />
requirement for dose modifications and a significant decrease in the<br />
number <strong>of</strong> days <strong>of</strong> treatment delay in the intervention group (94 vs. 14<br />
days, p=0.03). The mean number <strong>of</strong> toxicities identified per patient was 5.3<br />
in the prospective group compared to 1.6 in the retrospective group<br />
(p15hrs over three<br />
weeks.<br />
Conclusion: While average weekly time spent on the ADAPT program was<br />
consistent with outlined requirements, participants struggled with technical<br />
aspects <strong>of</strong> online learning, as well as, committing time learning and<br />
practicing skills. Feedback will assist revisions to program marketing,<br />
‘readiness to participate’ self-assessment and learner orientation.<br />
Moving Practice Forward with Early Exposure Students<br />
Thomas ER Brown 1,2 , Farida Meghji 1 , Jane Mosley 1 , Lisa McCarthy 1,2<br />
1 Women’s College <strong>Hospital</strong>, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
Acknowledgements: Michaela Hogan, Adam Lam, Mitsumi Louis-Foster,<br />
Lauren Sule<br />
Rationale: Early practice experience rotations help students apply and build<br />
confidence with skills they are learning in the classroom while enhancing<br />
their appreciation for the aims <strong>of</strong> their education. Preceptors may feel<br />
challenged to identify project activities for these students given the limited<br />
amount <strong>of</strong> formal therapeutics education they have received.<br />
Description: Our aim was to demonstrate that early learners can make<br />
vital contributions to pharmacy department initiatives. Second-year<br />
undergraduate pharmacy students were assigned projects around optimal<br />
medication use and safety during 4-week rotations. Topics were<br />
strategically selected to lay the foundation for important safety initiatives at<br />
our institution, including: an audit <strong>of</strong> medication sampling practices; review<br />
<strong>of</strong> institutional practices around dangerous abbreviations; an audit <strong>of</strong><br />
non-formulary medication requests; and a review <strong>of</strong> medication<br />
reconciliation initiatives in ambulatory care settings.<br />
Evaluation: Four students participated in the program between May and<br />
August 2011. The audit <strong>of</strong> medication sampling found that 80% <strong>of</strong><br />
samples in the audited areas were expired and has led to creation <strong>of</strong> a safer<br />
medication sampling pilot program in partnership with the Department <strong>of</strong><br />
Psychiatry. Dangerous abbreviations have been removed from all<br />
pre-printed order sets and an online learning module has been created for<br />
staff. An assessment <strong>of</strong> non-formulary items in floor stock found that 20%<br />
<strong>of</strong> products in the hospital are non-formulary and raised questions about<br />
the concept <strong>of</strong> a formulary in an ambulatory institution. Lastly, the<br />
medication reconciliation review led to striking <strong>of</strong> a working group to<br />
develop a strategy for identifying patient populations to target in<br />
ambulatory care thereby satisfying a test <strong>of</strong> compliance for a required<br />
organizational practice for Accreditation Canada.<br />
Importance: This program demonstrates that learners early in their<br />
pharmacy careers can lay the groundwork for pharmacy initiatives around<br />
optimal medication use and safety.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Provincial Implementation <strong>of</strong> Accreditation Canada<br />
Required Organizational Practices: The Alberta<br />
Experience<br />
Dawn McDonald 1 , Gwen Erdmann 2 , Kefah Hayek 2 , Nancy Louis 1 , Jim<br />
Manley 1 , Shaheen Nenshi Nathoo 1 , Laurine Sanderson 2 , Medication Quality<br />
and Safety Team, Pharmacy Services, Alberta Health Services
57<br />
1 Alberta Children’s <strong>Hospital</strong>, Calgary, AB<br />
2 Seventh Street Plaza, Edmonton, AB<br />
Rationale: Alberta Health Services (AHS) was created in 2008 through the<br />
amalgamation <strong>of</strong> nine former health regions and oversees 107 hospitals.<br />
The first AHS Accreditation Canada (AC) on-site survey was conducted in<br />
October 2010. Within the AC Managing Medications standards, seven<br />
Required Organizational Practices (ROPs) were identified as essential<br />
practices to be implemented. Four <strong>of</strong> these ROPs were within the purview<br />
<strong>of</strong> AHS Provincial Pharmacy Services: concentrated electrolytes, heparin<br />
safety, narcotics safety, and standardized concentrations. The challenge for<br />
the Provincial Pharmacy Services Medication Quality and Safety Team<br />
(MQST) was how to assess the current level <strong>of</strong> compliance at each site and<br />
fully implement the 4 ROPs across the province.<br />
Description: Online assessments were created and used to quantify<br />
compliance with each ROP. The results <strong>of</strong> the assessments were used to<br />
develop a provincial implementation plan for each <strong>of</strong> the ROPs.<br />
Steps Taken: The first online assessment, ROP Compliance Assessment –<br />
Current State, was completed in January 2011 by all 107 AHS acute care<br />
sites. This provided a provincial baseline. Alternatives were suggested to<br />
assist with product removal where required. When product removal was<br />
not possible, rationale was requested. A repeat assessment, Verification <strong>of</strong><br />
Compliance, was completed in February 2011 to assess each site’s progress<br />
in the actual implementation <strong>of</strong> the ROPs.<br />
Evaluation: As <strong>of</strong> April 2011, the 4 ROPs within the Managing Medication<br />
standard were fully implemented throughout all 107 AHS sites. In<br />
September 2011, two pharmacy policies (High Potency Narcotics and<br />
Concentrated Electrolytes) were implemented provincially. A<br />
post-implementation audit will be conducted to evaluate safety<br />
mechanisms and processes in place, and determine the effectiveness <strong>of</strong> the<br />
Policies and Procedures.<br />
Importance: Similar efforts to address AC ROP requirements provincially<br />
across 107 sites are unprecedented in Canada. Local engagement with<br />
provincial oversight was key to the success <strong>of</strong> this work.<br />
Drugs Obtained by Quebec University Health Centers<br />
through Health Canada’s Special Access <strong>Program</strong>me –<br />
Descriptive Analysis by the programme de gestion<br />
thérapeutique des Medicaments<br />
Élaine Pelletier 1 , Benoît Cossette 2 , Céline Dupont 3 , Nathalie Marcotte 4 ,<br />
Marie-Claude Michel 4 , France Varin 5 , Louise Deschênes 4 , Paul Farand 2 ,<br />
Daniel Froment 5 , Pierre Gaudreault 1 , Raghu Rajan 3<br />
1 Centre hospitalier universitaire Sainte-Justine (CHU Sainte-Justine), Québec<br />
2 Centre hospitalier universitaire de Sherbrooke (CHUS), Québec<br />
3 Centre hospitalier universitaire de Santé McGill (CUSM), Québec<br />
4 Centre hospitalier universitaire de Québec (CHUQ), Québec<br />
5 Centre hospitalier universitaire de Montréal (CHUM), Québec, 1 à 5 :<br />
<strong>Program</strong>me de gestion thérapeutique des médicaments (PGTM), Québec<br />
Rationale: University health centres (CHU) in the Province <strong>of</strong> Quebec<br />
commonly have to use medications authorized by Health Canada’s Special<br />
Access <strong>Program</strong>me (“SAP-drugs”). Indeed many <strong>of</strong> their patients have<br />
diseases that are rare, complex or refractory to conventional drugs available<br />
on the <strong>Canadian</strong> market. In January 2008, Health Canada issued a new<br />
version <strong>of</strong> its guidance document defining principles and practices<br />
pertaining to SAP-drugs.<br />
Objectives: To describe the overall utilization pr<strong>of</strong>ile <strong>of</strong> SAP-drugs and the<br />
CHU’s compliance with the administrative and therapeutic management<br />
guidelines proposed by Health Canada.<br />
Design and methods: Retrospective identification <strong>of</strong> SAP-drugs used<br />
between 1 April 2008 and 31 March 2009. Sampling procedure allowing to<br />
describe the main usage characteristics, including prescription frequency<br />
and costs, and measure compliance with five criteria for management and<br />
monitoring <strong>of</strong> use <strong>of</strong> SAP-drugs.<br />
Results: The utilization pr<strong>of</strong>ile brings to light the diversity, distribution, and<br />
impact <strong>of</strong> SAP-drugs use. For the reference one-year period, approximately<br />
12,000 prescriptions were written, corresponding to more than 140<br />
nonproprietary names. This represents 10.4 M CAN$ or 7.5% <strong>of</strong> the CHU’s<br />
overall annual budget. Compliance with the criteria was very variable.<br />
Interesting qualitative observations and gaps have been identified at several<br />
stages <strong>of</strong> the drug distribution circuit.<br />
Conclusion: Quebec’s university health centres must improve their<br />
management <strong>of</strong> SAP-drugs, namely documentation and archiving, clinical<br />
monitoring, and funding.<br />
Safety and Efficacy <strong>of</strong> Chop or R-chop for Treatment <strong>of</strong><br />
Diffuse Large b-cell Lymphoma with Protease Inhibitor or<br />
Non-Protease Inhibitor Based Antiretroviral Regimens in<br />
HIV-Infected Patients: SCULPT Study<br />
Alison Y.J. Wong 1,2,3 , Suzanne Marcotte 4 , Mathieu Laroche 4 , Nancy L.<br />
Sheehan 3 , Vishal Kukreti 1 , Jean-Pierre Routy 3 , Bernard Lemieux 4 , Jack Seki 1 ,<br />
Danielle Rouleau 4,5 , Alice Tseng 1,2<br />
1 University Health Network, Toronto, ON<br />
2 University <strong>of</strong> Toronto, Toronto, ON<br />
3 McGill University Health Centre, Montréal, QC<br />
4 Centre hospitalier de l’Université de Montréal, Montréal, QC<br />
5 Université de Montréal, Montréal, QC<br />
Rationale: Use <strong>of</strong> combination antiretroviral therapy (cART) and<br />
cyclophosphamide, doxorubicin, vincristine, prednisone with or without<br />
rituximab (CHOP+/-R) for treatment <strong>of</strong> diffuse large B-cell lymphoma<br />
(DLBCL) substantially increases response rates but may also increase toxicity,<br />
possibly due to antiretroviral-antineoplastic drug interactions.<br />
Objectives: We evaluated the frequency <strong>of</strong> confirmed or unconfirmed<br />
complete remission (CR/CRu) <strong>of</strong> DLBCL in HIV-positive patients treated with<br />
CHOP+/-R while receiving protease inhibitor (PI) versus non-PI based cART.<br />
Design and Methods: A retrospective multi-centered observational pilot<br />
study was conducted in patients on cART, treated for DLBCL with CHOP+/-R<br />
between 2002-2010. Percentage <strong>of</strong> CR/CRu, 2-year overall survival (OS)<br />
and frequency <strong>of</strong> severe adverse events were evaluated. Possible predictors<br />
<strong>of</strong> CR/CRu between groups were evaluated by univariate logistic<br />
regressions.<br />
Results: Thirty-four patients were included, 65% and 35% <strong>of</strong> patients<br />
received a PI and non-PI based cART, respectively. Baseline characteristics<br />
were similar between both groups; 85% <strong>of</strong> patients were male, median age<br />
43 years, 50% with International Prognostic Index (IPI) score 2-3, median 7<br />
years since HIV diagnosis and CD4+ <strong>of</strong> 225 cells/mm3. CR/CRu was<br />
achieved in 77% and 58% <strong>of</strong> patients in the PI and non-PI group,<br />
respectively (p=0.21), with 65% and 63% <strong>of</strong> patients achieving 2-year<br />
overall survival (p=1.00). Univariate analyses showed that a lower IPI score<br />
and a higher total number <strong>of</strong> received chemotherapy cycles were<br />
significantly associated with higher CR/CRu rates (p=0.02 and 0.03,<br />
respectively). Tolerability was similar between both groups except decreased<br />
frequency <strong>of</strong> anemia in the PI group (23% versus 37%, p=0.04).<br />
Conclusion: Similar efficacy and tolerability <strong>of</strong> CHOP+/-R was observed<br />
with PI based and non-PI based cART, though less anemia was observed in<br />
the PI group. Response rates appear to be higher in patients receiving a PI<br />
based cART but requires confirmation with larger studies.<br />
Drug Access Navigator Database: Improving the<br />
Management <strong>of</strong> Drug Access Cases through the<br />
Development and Implementation <strong>of</strong> a Computerized<br />
Database<br />
Allison Jocko, Janet Lui, The Scarborough <strong>Hospital</strong>, Toronto, ON<br />
Most oral chemotherapy and related support medications prescribed for<br />
oncology patients in Ontario are not routinely funded by the provincial drug<br />
programs. Navigating patient access is challenging and requires special<br />
request letters, private insurance investigations, or enrolment in assistance<br />
programs. Tracking case status and associated workload is equally difficult.<br />
As referrals and complexities increase, the need for a tool to facilitate
58<br />
processes was identified. Consequently, a Drug Access Navigator Database<br />
(DAND) was created using Micros<strong>of</strong>t Access s<strong>of</strong>tware to support the<br />
process <strong>of</strong> tracking cases and generating reports on workload and<br />
outcomes.<br />
The DAND links to forms, websites, costs, and contact information. Reports<br />
capture number <strong>of</strong> referrals, time spent, time for case resolution by drug,<br />
monthly or per cycle patient cost savings for new cases, approval expiry list,<br />
and pending case list. In the month <strong>of</strong> August 2011, there were 49<br />
referrals, and 33 hours spent with an estimated patient cost diverted <strong>of</strong><br />
$130,000.<br />
After implementing DAND, tracking and managing drug access cases was<br />
found to be simpler and faster. It was also found to be an easy tool for<br />
workload tracking and solidifying the need for the role <strong>of</strong> a drug access<br />
navigator for Oncology drugs in Ontario.<br />
Residents as Preceptors: Development, Implementation and<br />
Evaluation <strong>of</strong> a Pharmacy Summer Student Clinical<br />
Experience<br />
Natalie Crown, Sarah Burgess, April Chan, Jonathan Chiu, Janice Lee, Kelly<br />
MacLean, Anne Marie Bombassaro, London Health Sciences Centre,<br />
London, ON<br />
Rationale: <strong>Hospital</strong> pharmacy residency programs seek to ensure graduates<br />
exhibit competencies in patient care and teaching. Opportunities for<br />
residents to precept students may be limited in the current program<br />
structure. Conversely, undergraduate pharmacy students are frequently<br />
employed in technical roles with limited opportunities to participate in<br />
patient care.<br />
Description: A 1 week rotation was developed to provide residents with an<br />
opportunity to provide practice based teaching to pharmacy students in a<br />
patient care setting, and practice direct instruction, modeling and coaching<br />
skills. The rotation provided students the opportunity to practice curriculum<br />
based skills, enhance understanding <strong>of</strong> patient care roles for hospital<br />
pharmacists and the benefits <strong>of</strong> a residency.<br />
Steps: The rotation took place during the clinical practice rotation in the<br />
final month <strong>of</strong> the residency program. Students were matched to clinical<br />
rotations based on interest, complexity and academic year completed.<br />
Resident and student specific objectives were developed. Participants<br />
completed a daily self-reflection guide and submitted an end <strong>of</strong> rotation<br />
evaluation in a blinded format.<br />
Evaluation: Five residents and 5 students participated in rotations<br />
including critical care, cardiac care, general surgery, internal medicine and<br />
nephrology. All residents strongly agreed that the experience increased<br />
“readiness” to function as a preceptor in the future, with 4 <strong>of</strong> 5 strongly<br />
feeling that the experience provided the opportunity to develop teaching<br />
and precepting skills. All pharmacy students strongly agreed that the<br />
rotation enhanced understanding <strong>of</strong> clinical practice in a hospital setting<br />
and were influenced positively about a career in hospital pharmacy, with 4<br />
<strong>of</strong> 5 being motivated to pursue a post-graduate residency.<br />
Importance: There was unanimous agreement amongst participants that a<br />
clinical rotation conducted by pharmacy residents for undergraduate<br />
pharmacy students should be incorporated into the residency program. The<br />
opportunity was subjectively evaluated as benefiting both residents and<br />
students from teaching and learning perspectives, respectively.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Imatinib Plasma Through Concentrations and the<br />
Ability to Assess Patient Adherence<br />
Narducci 1 , S.E. Walker 1,2 , C. DeAngelis 1,2<br />
1 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto<br />
2 Sunnybrook Health Sciences Centre, Toronto, ON<br />
Rationale: Imatinib mesylate is an oral tyrosine kinase inhibitor used for the<br />
treatment <strong>of</strong> chronic myeloid leukemia (CML) and gastrointestinal stromal<br />
tumours (GIST). Therapeutic drug monitoring has been recommended due<br />
to recent studies demonstrating improved clinical outcomes.<br />
Objectives: To determine the proportion <strong>of</strong> patients with imatinib plasma<br />
trough concentrations (Cmin) below the therapeutic range and the<br />
probability that a sub-therapeutic Cmin level is due to patient<br />
non-adherence.<br />
Methods: A literature search was conducted to identify adult<br />
pharmacokinetic (PK) studies that determined any <strong>of</strong> the following: imatinib<br />
clearance, volume <strong>of</strong> distribution or half-life. Data was pooled to calculate a<br />
weighted mean ± SD for each PK parameter and these values were used to<br />
create a concentration-time pr<strong>of</strong>ile based on a 1 compartment model. A<br />
Monte Carlo Simulation (MCS; Crystal Ball v.11.1.1.3) was then completed<br />
to generate a distribution <strong>of</strong> steady state Cmin values for 1 million patients.<br />
This distribution was based solely on kinetic data; however, patient<br />
adherence would also affect Cmin. The MCS was used to demonstrate the<br />
probability <strong>of</strong> patient nonadherence (NA) according to the equation: NA =<br />
100% - [The probability <strong>of</strong> a specific Cmin according to the distribution].<br />
Results: The MCS demonstrated that at a standard dose <strong>of</strong> 400mg once<br />
daily, 63% <strong>of</strong> patients do not achieve the Cmin threshold (> 1000 ng/mL)<br />
recommended for CML patients, and 68% <strong>of</strong> patients are below 1100<br />
ng/mL, the target suggested for GIST patients. At Cmin levels between 0<br />
and 300 ng/ml, the probability <strong>of</strong> nonadherence is 90-100%; whereas at<br />
Cmin levels greater than 800 ng/ml, the probability <strong>of</strong> nonadherence is less<br />
than 50%.<br />
Conclusions: The majority <strong>of</strong> patients do not achieve the imatinib trough<br />
levels proposed for clinical efficacy with the standard dose <strong>of</strong> 400mg daily.<br />
Also, it is difficult to determine patient adherence based solely on Cmin<br />
levels.<br />
2 CSHP<br />
Targeting Excellence<br />
Évolution de la thromboprophylaxie chez les<br />
usagers médicaux dans un institut universitaire<br />
in Pharmacy Practice<br />
Julie Méthot, Marie-Noëlle Bartholoméi, Karine Lejeune, Institut<br />
universitaire de cardiologie et de pneumologie de Québec, QC<br />
La thromboprophylaxie s’inscrit dans une politique de sécurisation et<br />
d’amélioration de la prise en charge des patients. Cette dernière se place au<br />
cœur même de la prévention du risque thromboembolique chez les patients<br />
nécessitant des soins médicaux entraînant une immobilisation prolongée ou<br />
subissant une chirurgie. Des actions stratégiques ont été mises en œuvre au<br />
sein de l’Institut universitaire de cardiologie et de pneumologie du Québec<br />
afin de promouvoir et évaluer la thromboprophylaxie chez les patients<br />
médicaux admis. En 2008 la création et la mise en place d’un aide-mémoire<br />
sur la thromboprophylaxie fut placé avec les documents d’admission à<br />
l’urgence. L’aide-mémoire comprenait les indications, les contre–indications<br />
et les posologies des médicaments utilisés en thromboprophylaxie. L’impact<br />
de la création de cet outil a été évalué suite à la révision de 263 dossiers. Le<br />
taux de thromboprophylaxie est demeuré stable (36,5% avant la mise en<br />
place de l’aide-mémoire à 38,7% après l’implantation de l’aide-mémoire).<br />
Cette première étude nous a amené à reconsidérer et remanier notre<br />
approche de la prévention des complications thromboemboliques chez les<br />
patients médicaux admis. L’étape suivante consista en la réalisation d’une<br />
ordonnance pré-imprimée de thromboprophylaxie. Elle fut annexée aux<br />
feuilles d’admission de l’urgence de l’établissement pour favoriser son<br />
utilisation et fut implantée en février 2010. Une révision de 241 dossiers a<br />
été faite. Nos données suggèrent un taux de thromboprophylaxie d’environ<br />
72% chez les patients médicaux admis après l’implantation de cette<br />
prescription. Les actions posées et les évaluations effectuées ont permis de<br />
promouvoir et améliorer la prescription adéquate de thromboprophylaxie.<br />
2010-2011 Perspectives on Drug Shortages in <strong>Hospital</strong>s in<br />
Quebec<br />
Ottino G. 1 , Lebel D. 1 , Bussières J.F. 1,2<br />
1 Pharmacy practice research unit, Pharmacy department, CHU<br />
Sainte-Justine, Montréal, QC<br />
2 Faculty <strong>of</strong> Pharmacy, Université de Montréal, Montréal, QC<br />
Rationale: Many stakeholders underscore the importance <strong>of</strong> the drug<br />
shortage problem and its risks, but few quantitative data have been<br />
published on the subject.
59<br />
Objectives: To report all the drug shortages experienced in Quebec<br />
hospitals.<br />
Study design and methods: This is a retrospective study based on all drug<br />
shortages reported by the wholesaler and individuals members <strong>of</strong> the<br />
Group Purchasing Organization (SigmaSanté) for Montreal, Laval and<br />
Eastern township regions for 12 months (e.g. August 30, 2010 to August<br />
23, 2011).<br />
Results: A total <strong>of</strong> 429 drug shortages were reported in 2010-2011 vs.<br />
similar 12-month period; 493 in 2006, 400 in 2007, 442 in 2008, 680 in<br />
2009 and 385 in 2010 (only the 8 first months). The average duration <strong>of</strong><br />
the drug shortages remained similar, with 103 ± 85 days [8-363] in 2010 vs<br />
108 ± 130 days [5-1623] in 2006-2010. A smaller number <strong>of</strong><br />
manufacturers involved in drug shortages was also noted (41 in 2010-2011<br />
vs. 70 in 2006-2010), a decrease that was undoubtedly related to mergers<br />
and the integration or closing <strong>of</strong> certain drug manufacturers. Most <strong>of</strong> the<br />
reported shortages in 2010-2011 came from generic drug manufacturers<br />
and their relative ranking remained similar (i.e., in decreasing order, in<br />
2006-2010, Apotex (19% <strong>of</strong> total drug shortages), Pharmascience (14%),<br />
Novopharm (now TEVA) (12%), Sandoz (10%), Hospira (6%), TEVA (4%),<br />
Baxter (3%), Ratiopharm (taken over by Teva) (3%), Omega (2%), Taro<br />
(2%) vs. in 2010-2011, TEVA (23%), Apotex (16%), Pharmascience (12%),<br />
Hospira (7%), Sandoz (7%), Baxter (5%), AA Pharma (created from the<br />
resale <strong>of</strong> certain licenses held by Apotex) (3%), Schering (3%), Abbott<br />
(3%), Merck Canada (2%). Most therapeutic classes were involved in drug<br />
shortages in 2006-2010 as in 2010-2011,<br />
Conclusion: There are an important amount <strong>of</strong> drug shortages in Quebec<br />
hospital since 2006 and there are no sign <strong>of</strong> reduction <strong>of</strong> their occurrence.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Multicenter Study on Environmental<br />
Contamination by Hazardous Drugs in Quebec<br />
Healthcare Centers<br />
Bussières J.F. 1,2 , Touzin K. 1 , Tanguay C. 1 , Langlois E. 3 , Métra A. 4 , Lefebvre M. 3<br />
1 Pharmacy department and Pharmacy practice research unit<br />
2 Faculty <strong>of</strong> pharmacy, University <strong>of</strong> Montreal<br />
3 Centre de toxicologie du Québec, Institut national de santé publique du<br />
Québec<br />
4 Association paritaire de santé et sécuritaire au travail – secteur affaires<br />
sociales<br />
Rationale: Many occupational exposure studies have revealed the presence<br />
<strong>of</strong> hazardous drugs contamination on work surfaces used for the<br />
preparation, storing and administration <strong>of</strong> hazardous drugs in healthcare<br />
centers. Most studies were conducted in the United States, Europe and<br />
Japan. This multicenter study is the first to be conducted in Quebec<br />
healthcare centers.<br />
Objectives: To describe environmental contamination by hazardous drugs<br />
in Quebec healthcare centers.<br />
Study design and methods: Descriptive, prospective, comparative study.<br />
Six standardized sites in the pharmacy and six sites on wards were sampled<br />
in each participating center. Samples were analysed for the presence <strong>of</strong><br />
cyclophosphamide, ifosfamide and methotrexate by UPLC-MS-MS. A<br />
sample was considered positive if these drugs were detected and a sample<br />
was considered contaminated if the detected concentration was above<br />
1ng/cm 2 .<br />
Results: Twenty-five <strong>of</strong> 68 (37%) Quebec healthcare centers were included<br />
in the study. A total <strong>of</strong> 259 samples were collected between April 2008 and<br />
January 2010. Each center had at least one positive sample for one <strong>of</strong> the<br />
three drugs tested (median [min-max] 5[1-12] positive samples per center<br />
and 0[0-3] contaminated samples per center). Overall, 135 (52%) samples<br />
were positive for cyclophosphamide, 45 (17%) were positive for ifosfamide<br />
and 3 (1%) were positive for methotrexate. The pharmacy hood front grille<br />
was the sample site with the higher proportion <strong>of</strong> positive samples, with 23<br />
out <strong>of</strong> 25 (92%) samples positive for cyclophosphamide. The median<br />
[min-max] concentration <strong>of</strong> hazardous drug was <strong>of</strong> 0.004[0-28.0] ng/cm 2<br />
for cyclophosphamide, ND[0-8.6] ng/cm2 for ifosfamide and ND[0-0.58]<br />
ng/cm2 for methotrexate.<br />
Conclusion: Although hazardous drug traces are frequently found, a<br />
median <strong>of</strong> less than one sampling site per center was actually<br />
contaminated. Periodic surface contamination measurements are necessary<br />
to ensure that current practices limit occupational exposure to hazardous<br />
drugs.<br />
Temps associé à la purge des tubulures lors de la préparation<br />
d’une dose de médicament dangereux et contamination<br />
visuelle<br />
Voisine M.1, Touzin K. 1 , Therrien R., Bussières J.F. 1,2<br />
1 Unité de recherche en pratique pharmaceutique, Département de<br />
pharmacie, CHU Sainte-Justine, Montréal, QC<br />
2 Faculté de pharmacie, Université de Montréal, Montréal, QC<br />
Justification : L’amorçage des sacs de médicaments dangereux ainsi que la<br />
purge centralisée à la pharmacie de la tubulure peuvent contribuer à<br />
minimiser l’exposition pr<strong>of</strong>essionnelle aux médicaments dangereux.<br />
L’impact de cette centralisation sur la charge de travail est méconnu.<br />
Objectifs : Évaluer l’impact de la purge centralisée des tubulures sur le<br />
temps associé à la préparation d’une dose de médicament dangereux et sur<br />
la présence de contamination visuelle à la pharmacie et à l’unité de soins<br />
d’hématologie-oncologie.<br />
Méthodologie : Il s’agit d’une étude observationnelle comparative en deux<br />
phases. La première consistait à comparer le temps médian pour la<br />
préparation d’une dose de médicament dangereux par un<br />
assistant-technique en pharmacie sans purge et avec purge des tubulures à<br />
la pharmacie. La seconde visait à évaluer le temps médian nécessaire à la<br />
préparation d’une dose de médicament dangereux par le personnel<br />
infirmier à l’étage, suite à la purge des tubulures par le personnel de la<br />
pharmacie. Pour l’étude, le médicament dangereux était remplacé par une<br />
solution d’eau stérile colorée (essence de cerise). La contamination visuelle<br />
était évaluée dans les deux phases.<br />
Résultats : Dans la première phase, le temps médian [intervalle] de<br />
préparation d’un sac de médicament non purgé (n=30) était de 98[80-167]<br />
secondes et le temps médian de préparation d’un sac purgé par la<br />
pharmacie (n=30) s’élevait à 295[207-520] secondes (Kruskal-Wallis<br />
p 0.03 units/minute) Associated with Adverse<br />
Events in Cardiac Surgery Patients?<br />
Hina Ahmed, Marcin Wasowicz, Lior Flor, Vivek Rao, Toronto General<br />
<strong>Hospital</strong>, Toronto, ON<br />
Rationale: Vasopressin is used in the setting <strong>of</strong> vasopressor resistant<br />
vasodilatory shock. The Surviving Sepsis guidelines recommend maximum<br />
vasopressin infusion <strong>of</strong> 0.03units/minute as an adjunct to norepinephrine.<br />
Vasopressin has been used to help reduce norepinephrine dose and to<br />
prevent adverse events related to high dose norepinephrine. In higher doses<br />
vasopressin has been associated with adverse events including reduced<br />
cardiac output, decreased oxygen delivery, decrease in mixed-venous<br />
oxygen saturation leading to impaired tissue perfusion, reduction in platelet<br />
count, hyponatremia, and injury to splanchnic organs. The safety <strong>of</strong><br />
vasopressin use in cardiac surgery patients has not been studied as a<br />
primary endpoint.<br />
Objectives: Use <strong>of</strong> high dose vasopressin (> 0.03 units/minute) is<br />
associated with adverse events in cardiac surgery patients.<br />
Study Design and Methods: Upon REB approval, retrospective chart<br />
review was conduced to identify patients scheduled for cardiac surgery
60<br />
receiving vasopressin (> 0.03units/minute). Data was collected through<br />
retrospective chart review. Primary outcome: adverse events potentially<br />
related to high dose vasopressin. Secondary objective: review vasopressin<br />
infusion use in relation to other vaopressor support.<br />
Results: Over a 60-day period, 280 patients underwent cardiac surgery and<br />
34 (12.5%) received vasopressin. Major perioperative bleeding was seen in<br />
8 patients (26%) receiving vasopressin. Vasopressin was infused at doses<br />
higher than recommended, ranging from 0.03 units/min – 0.13 units/min<br />
with an average duration <strong>of</strong> 34 hours. Ischemic complications were seen in<br />
less than 10% <strong>of</strong> patients and only one patient developed bowel ischemia.<br />
Among all patients, 85% received norepinephrine concurrently.<br />
Norepinephrine was used first line in over 50% <strong>of</strong> cases. In majority (87%)<br />
vasopressin was used an adjunct to other vasopressors. Average hospital<br />
LOS was 16 days as opposed to 6 days.<br />
Conclusion: Adverse events were seen infrequently with high dose<br />
vasopressin. Due to limitations <strong>of</strong> this study, a prospective study will help<br />
capture the true incidence <strong>of</strong> adverse events.<br />
Assessing the Extent <strong>of</strong> Fluoroquinolone-Cation Interactions<br />
at a Teaching <strong>Hospital</strong><br />
Wenya Miao, Pharmacy Student, University <strong>of</strong> Toronto, Toronto ON,<br />
Rosemary Zvonar, The Ottawa <strong>Hospital</strong>, Ottawa, ON<br />
Rationale: Both fluoroquinolone antibiotics (FQ) and divalent or trivalent<br />
cationic drugs (DTC), such as aluminum, magnesium, iron, calcium and<br />
zinc, are frequently prescribed in hospitalized patients. The interaction<br />
between oral FQs and DTCs is well recognized, and therapeutic failures due<br />
to impaired FQ absorption have been reported when these agents are taken<br />
concomitantly.<br />
Objective: To determine the prevalence <strong>of</strong> the interaction between FQs<br />
and DTCs at our institution.<br />
Methods: On a single day in July 2010, patients prescribed formulary oral<br />
FQs (lev<strong>of</strong>loxacin and cipr<strong>of</strong>loxacin) and DTCs were identified by the<br />
Pharmacy computer system. The Medication Administration Records <strong>of</strong><br />
these patients were examined and scheduled drug administration times<br />
recorded. An interaction was defined as follows: for lev<strong>of</strong>loxacin, an<br />
administration time for the DTC within 2 hours before or after that <strong>of</strong><br />
lev<strong>of</strong>loxacin; for cipr<strong>of</strong>loxacin, an administration time for the DTC within 4<br />
hours before or 2 hours after any cipr<strong>of</strong>loxacin dose. Based on the results <strong>of</strong><br />
the initial review, additional interventions to those already in place to<br />
minimize the chance <strong>of</strong> interaction were implemented. A similar assessment<br />
was repeated in June 2011.<br />
Review performed<br />
Results:<br />
July 26, 2010<br />
Number <strong>of</strong> patients on oral 61 68<br />
FQ<br />
Number <strong>of</strong> patients on an oral 27 38<br />
FQ and DTC<br />
Number <strong>of</strong> interactions 16 18<br />
59.2% 47.4%<br />
Percentage <strong>of</strong> patients on<br />
both oral FQ and DTC with<br />
interaction<br />
Review performed<br />
June 15, 2011<br />
Conclusion: We identified a significant proportion <strong>of</strong> patients receiving oral<br />
FQs and DTCs either concomitantly or with inappropriate spacing, despite<br />
education and additional computer warnings following the initial review.<br />
Healthcare workers must remain vigilant for this frequent interaction.<br />
Continual review and intervention may be required to limit its occurrence.<br />
Tuesday, February 7<br />
Mardi 7 février<br />
2 CSHP<br />
Targeting Excellence<br />
A Systematic Analysis <strong>of</strong> Pharmacist Referrals<br />
Originating from the Order Desk<br />
in Pharmacy Practice<br />
Danette Beechinor, Credit valley <strong>Hospital</strong>, Mississauga, ON and<br />
University <strong>of</strong> Waterloo, Kitchener, ON<br />
Rationale for Report: Significant clinical pharmacist time is spent resolving<br />
problems which originate on the order desk, which is typical for many<br />
hospitals. There is no published or local data which describes the problems<br />
returned to the clinical pharmacist.<br />
Description <strong>of</strong> Concept, Service, Role or Situation: A study <strong>of</strong> the types<br />
<strong>of</strong> problems which are returned to the floor pharmacist was undertaken to<br />
determine potential time saving policies and procedures which could be<br />
developed while ensuring patient safety and minimizing distribution related<br />
delays.<br />
Steps Taken to Identify and Resolve Problem: Two hundred forty<br />
documents (convenience sample) which were identified by the order desk<br />
pharmacist as needing follow up by the floor pharmacist were analyzed<br />
using content analysis methodology. The documents were categorized<br />
according to problem type and analyzed to determine if improved policies<br />
or programs could facilitate problem resolution by the order desk and serve<br />
patients more efficiently and safely. All categories were considered for<br />
potential time savings and safety enhancement. Examples <strong>of</strong> categories<br />
which emerged included: identifying patients’ own non-formulary<br />
medication, inappropriate dosage form ordered crushed, confirm date <strong>of</strong><br />
weekly and monthly medications and dosage adjustment for renal<br />
dysfunction.<br />
Evaluation <strong>of</strong> Project: <strong>Hospital</strong> and departmental policies are under<br />
development as a result <strong>of</strong> this study to save time and enhance patient<br />
safety. Examples <strong>of</strong> policies include: pharmacist adjustment <strong>of</strong> antibiotics for<br />
poor renal function, non-formulary medication identification and<br />
documentation by technician during Best Possible Medication History, and<br />
standardized administration dates for weekly or monthly medications such<br />
as bisphosphonates.<br />
Importance and Usefulness: A systematic exploration <strong>of</strong> the<br />
departmental needs and typical problems which arise on order entry was<br />
used to propose policy changes to improve efficiency in order entry.<br />
Systematic problem review by hospital pharmacies can identify time- and<br />
cost-saving measures which enhance patient safety and delivery <strong>of</strong> care.<br />
Audit <strong>of</strong> Antibiotic Duration <strong>of</strong> Therapy, Appropriateness<br />
and Outcome in Patients with Nosocomial Pneumonia<br />
Following the Removal <strong>of</strong> an Automatic Stop-date Policy<br />
Jennifer Do, Sandra A. N. Walker, Scott E. Walker, William Cornish, Andrew<br />
E. Simor, Sunnybrook Health Sciences Centre. Toronto, ON<br />
Rationale: Although automatic stop-orders (ASOs) may discourage<br />
inappropriately prolonged antibiotic therapy, risks to patient safety<br />
associated with premature antibiotic discontinuation resulting from ASO<br />
policies have been reported. An ASO policy necessitating reordering <strong>of</strong><br />
antibiotics after day seven <strong>of</strong> therapy had been in place at our institution<br />
prior to 2002; but was revoked after instances <strong>of</strong> compromised patient care<br />
associated with inadvertent and inappropriate interruption <strong>of</strong> antimicrobial<br />
treatment. Comparative data <strong>of</strong> patient outcomes with and without<br />
institutional ASO policies is lacking.<br />
Objectives: The study objective was to evaluate the impact <strong>of</strong> revoking the<br />
ASO policy on duration <strong>of</strong> antibiotic therapy, infection-related outcome,<br />
relapsing infection, occurrence <strong>of</strong> resistant bacteria and superinfection in<br />
patients with nosocomial pneumonia.<br />
Study Design and Methods: A retrospective chart review <strong>of</strong> hospitalized<br />
adults (> 18 years) who developed nosocomial pneumonia requiring<br />
antibiotic therapy was conducted. Duration <strong>of</strong> antibiotic therapy,
61<br />
infection-related outcome (cure vs. failure), rate <strong>of</strong> relapsing infection,<br />
resistance and superinfection were compared for the pre and post-ASO<br />
policy revocation cohorts. An unpaired t-test or Fisher’s exact test was used<br />
for interval and nominal data comparisons, respectively. Multiple regression<br />
analysis and propensity score adjustment were completed to adjust for<br />
imbalances between groups. A p-value 0.5).<br />
Conclusion: Revocation <strong>of</strong> the ASO policy for antibiotics at our institution<br />
was not associated with a longer duration <strong>of</strong> antibiotic therapy, or an<br />
increased incidence <strong>of</strong> infection-related mortality, relapsing infection,<br />
resistant bacteria or superinfection for patients with nosocomial<br />
pneumonia.<br />
Identification <strong>of</strong> Predictors <strong>of</strong> Infection in Acute Burn Injury<br />
Patients<br />
Laura Schultz, Sandra A.N. Walker, Marion Elligsen, Scott E. Walker,<br />
Andrew Simor, Samira Mubareka, Nick Daneman, Toronto, ON<br />
Rationale: Burn patients are at high risk for infections; however, common<br />
indicators <strong>of</strong> infection are unreliable in this population and can lead to<br />
unnecessary use <strong>of</strong> antibiotics.<br />
Objectives: The objective <strong>of</strong> this study was to determine if predictors <strong>of</strong><br />
infection in adult acute burn injury patients could be identified in order to<br />
provide clinicians with a practical tool to aid in the diagnosis <strong>of</strong> infection in<br />
acute burn injury, thereby minimizing unnecessary antimicrobial exposure.<br />
Study Design and Methods: A retrospective chart review was conducted on<br />
all adult acute burn injury patients admitted to the burn centre at SHSC<br />
over a 1 year period. If a patient was started on the antibiotics during the<br />
first 10 days <strong>of</strong> admission, they were assessed for infection using the<br />
American Burn Association guidelines. Patient demographic data and<br />
clinical parameters were collected from admission to day 10 <strong>of</strong><br />
hospitalization. If the patient was started on antibiotics, information was<br />
gathered inclusively from 3 days before to 7 days after antibiotic initiation.<br />
Patients without infection were compared to patients with sepsis and those<br />
with infection using unpaired t-test, Fisher’s exact, regression analysis and<br />
CART analysis.<br />
Results: Of the 111 patients studied, 50% had infection and 16% had<br />
sepsis within the first 10 days <strong>of</strong> admission. Using regression analysis and<br />
CART identified breakpoints, it was determined that heart rate ≥110 bpm,<br />
systolic blood pressure ≤100 mmHg and intubation were the best predictors<br />
<strong>of</strong> sepsis; and fraction <strong>of</strong> inhaled oxygen >25% and maximum temperature<br />
≥39˚C were the best predictors <strong>of</strong> infection (p
62<br />
A Pilot Study to Evaluate Methodology for Assessing the<br />
Treatment <strong>of</strong> Low Back Pain<br />
Jerrold Petr<strong>of</strong>sky 1 , Lee Berk 1,2 , Gurinder Bains 1 , Geraldine Doyle 3 , Shijie<br />
Chen 3 , Lisa Baird 3 , Paul Desjardins 3 , and Jill Stark 3<br />
1 Department <strong>of</strong> Physical Therapy<br />
2 Department <strong>of</strong> Pathology & Human Anatomy, Loma Linda University,<br />
Loma Linda, CA<br />
3 Pfizer Consumer Healthcare, Madison, NJ<br />
Rationale: Low back pain (LBP) is a common and costly medical problem.<br />
Using a stopwatch to measure the time <strong>of</strong> the onset <strong>of</strong> the analgesic effect<br />
has not been evaluated in a LBP model.<br />
Objective: This pilot study was to evaluate the sensitivity <strong>of</strong> using the<br />
methodology for assessing LBP relief with ThermaCare LowBack/Hip<br />
Heatwraps.<br />
Study Design and Methods: Subjects with baseline primary muscle acute<br />
LBP were randomized to ThermaCare, oral placebo, unheated “sham”<br />
wrap, or oral ibupr<strong>of</strong>en. The last 2 treatments were included for blinding<br />
purposes only.<br />
Subjects stopped the first stopwatch upon feeling the “first perceptible”<br />
pain relief, and the second stopwatch upon feeling “meaningful” pain<br />
relief. Subjects also assessed pain relief hourly.<br />
Results: Sixty-one subjects participated in this single-center, single-dose<br />
(single wrap wear occasion), randomized, single-blind, placebo-controlled<br />
trial.<br />
The TOTPAR 0-8 was significantly higher for ThermaCare Heatwrap than<br />
placebo group (22.0 vs. 11.5; p240 and 215.7 vs. >240,<br />
respectively; p
63<br />
Self-Perceived Knowledge Gained and Satisfaction from<br />
Brown Bag Medication Reviews for Older Adults<br />
Nishi S. Gupta 1 , Feng Chang 1 , Megan E. Kleinow 2 , Jamie M. Hwang 3 ,<br />
Candice L. Garwood 4 , Hanan S. Khreizat 2 , Mary Beth O’Connell 4<br />
1 University <strong>of</strong> Waterloo, School <strong>of</strong> Pharmacy, Waterloo, ON<br />
2 Henry Ford Health System, Detroit, MI<br />
3 Henry Ford Piersen Clinic, Grosse Pointe Farms, MI<br />
4 Wayne State University, Eugene Applebaum College <strong>of</strong> Pharmacy and<br />
Health Sciences, Detroit, MI<br />
Rationale: Community based brown bag medication reviews are used in<br />
settings without access to primary care providers or the medical chart.<br />
Objectives: To examine self-perceived knowledge gained and participant<br />
satisfaction during community based brown bag medication reviews.<br />
Methods: Reviews were conducted in 9 senior centers for adults over the<br />
age <strong>of</strong> 60 and on 5 or more medications. Each appointment was scheduled<br />
for 45-60 minutes. A medication calendar and a list <strong>of</strong> recommendations<br />
were given. Seniors were asked to complete a 13-items satisfaction<br />
questionnaire following the session and rate the program’s helpfulness in a<br />
follow-up survey at 3 months. Each item was ranked 1-5 (strongly disagree<br />
– strongly agree). Self-perceived learning was reported using an 8-items<br />
survey. Each item was ranked 1-5 (very little – lots). Unreturned surveys<br />
were followed-up over the phone. Descriptive statistics were used.<br />
Results: Sixty-four participants completed follow-up. All items on the<br />
satisfaction questionnaire were ranked between 4.44– 4.90. The highest<br />
ranked items were: having enough time to ask questions (4.90); time and<br />
place <strong>of</strong> the review were convenient (4.83); trust in the pharmacist’s<br />
answers (4.83); and better understanding <strong>of</strong> their medications (4.83). The<br />
lowest ranked item was perceived resolution <strong>of</strong> their health problems<br />
(4.44). At 3-months, 98% ranked the brown bag program as helpful.<br />
Self-perceived knowledge gained was rated between 4.40-4.71. The<br />
highest ranked items were: learning how to use their medications (4.71);<br />
when to correctly take the medications (4.66); and learning the purpose <strong>of</strong><br />
their medications (4.64). Perceived knowledge gained in understanding<br />
medication side effects was rated the lowest (4.40). Over 95% would like<br />
to attend the program again.<br />
Conclusion: Seniors were highly satisfied with the brown bag medication<br />
reviews. They felt a high degree <strong>of</strong> learning and found the program<br />
convenient. Individual items ranked demonstrated unique advantages and<br />
limitations <strong>of</strong> such programs.<br />
Cost Analysis <strong>of</strong> an Insulin Pen Pilot Project in an In-Patient<br />
<strong>Hospital</strong> Setting<br />
Sara Kynicos 1 , Jin Hyeun Huh 1,2<br />
1 University Health Network, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, ON<br />
Rationale: Following medication incidents involving insulin, a known<br />
high-risk medication, a 3 month pilot project using insulin pens for<br />
in-patients was implemented in general internal medicine (98 beds across 3<br />
floors) at one hospital site.<br />
Objective: To review costs and wastage associated with implementing<br />
insulin pens, together with nursing and safety benefits using staff surveys<br />
and a review <strong>of</strong> medication incidents.<br />
Method: All existing formulary insulins were made available in pen devices<br />
as floor-stock and each patient was allocated their own pen for each insulin<br />
to be administered by nurses. A review <strong>of</strong> data compared the usage and<br />
costs <strong>of</strong> insulin dispensed during the 3-month pilot period to the 3 previous<br />
months <strong>of</strong> traditional 10mL insulin vial dispensing.<br />
Results: The results showed that there was a 12% decrease in total volume<br />
(mLs) <strong>of</strong> insulin dispensed during the pen pilot, however less favourable<br />
contract prices resulted in increased total cost for pre-filled pens /<br />
cartridges, equivalent to a 24% increase ($115 per month per floor). During<br />
the pilot 20% more safety needles were used compared to traditional<br />
safety syringes.<br />
A review <strong>of</strong> insulin pen wastage over one month showed that 64% <strong>of</strong><br />
insulin not used in the pen devices was short or rapid insulin types.<br />
No medication incidents involving insulin were identified during the pilot<br />
and nursing staff surveys indicated that they felt nursing time was saved<br />
due to pens being readily available for individual patient-use. Staff also<br />
suggested that less time was spent on discharge patient education,<br />
resulting in an improved patient discharge process.<br />
Conclusion: This project demonstrates that insulin pen devices can be<br />
successfully implemented in an in-patient hospital setting, with medication<br />
safety, nursing time and patient discharge benefits, despite increased<br />
medication costs.<br />
2 CSHP<br />
Targeting Excellence<br />
in Pharmacy Practice<br />
Venous Thromboembolism Prophylaxis Electronic<br />
Physician Risk Assessment Tool<br />
Pauline Santora and Cristina Scherf, Baycrest, Toronto, ON<br />
Rationale: VTE prophylaxis is the number 1 strategy to improve patient<br />
safety in hospitals and is recognized by Accreditation Canada as an<br />
‘organizational required practice’. Universally starting prophylaxis on<br />
admission did not seem justifiable at Baycrest, a geriatric acute, complex<br />
continuing care and long-term care facility where the situation is <strong>of</strong>ten<br />
more long term and risks <strong>of</strong> harm from the prophylaxis elevated.<br />
Description <strong>of</strong> Concept: To develop an electronic tool that would provide<br />
a physician assessment <strong>of</strong> VTE prophylaxis for each geriatric hospitalized<br />
patient and that could electronically generate preselected quality indicators.<br />
Steps Taken: Based on a literature review and manual chart audits, a<br />
multi-disciplinary group developed an algorithm with input from experts.<br />
Background information specific to geriatrics is available for each question<br />
at the click <strong>of</strong> a button. Information Technology built the algorithm into<br />
Meditech for easy access by the admitting physician who completes it<br />
within 24 hours <strong>of</strong> admission, transfer or new acute medical illness in the<br />
hospitalized patient. The policies, procedures, and algorithm were approved<br />
prior to training and implementation.<br />
Evaluation: Physician’s evaluation indicated that this electronic point and<br />
click tool is straight forward and can be completed in 15-60 seconds.<br />
The tool provides the electronic means to audit VTE prophylaxis assessment<br />
rates, the timeline <strong>of</strong> assessment completion, which VTE protection was<br />
ordered and if not, the reason(s), for any period, on any day, within<br />
minutes.<br />
Previously documented VTE Risk Assessments were hard to find. The<br />
electronic tool has increased this to 68 % <strong>of</strong> admissions in May, 80 % in<br />
June and 92 % in July.<br />
Importance to Practice: The use <strong>of</strong> technology to provide a practical<br />
standardized approach for VTE prophylaxis, supported by educational<br />
information and up-to-date audit results is extremely useful in our efforts to<br />
improve the safety <strong>of</strong> hospitalized elderly patients.<br />
2 CSHP<br />
Targeting Excellence<br />
Fingertip Sampling is a More Sensitive Evaluation<br />
<strong>of</strong> Aseptic Technique Competency<br />
in Pharmacy Practice<br />
Mari Culotta-Mascioli, John Iazzetta, Scott Walker, Fausto Noce,<br />
Sunnybrook Health Sciences Centre, Odette Cancer Centre, Department <strong>of</strong><br />
Pharmacy, Toronto, ON<br />
Rationale: A system <strong>of</strong> random gloved finger tip testing in tandem with a<br />
media fill test allows auditors to visually inspect aseptic technique in<br />
addition to producing evidence <strong>of</strong> positive or negative growth <strong>of</strong> microbes<br />
through finger tip imprinting on agar plates filled with test media.<br />
Objectives: To determine microbial contamination rate during sterile<br />
preparation with the best <strong>of</strong> controls being in place. Compare these results<br />
with those from planned media fill tests done as part <strong>of</strong> an annual<br />
recertification.
64<br />
Study design: We conducted gloved finger tip sampling in 32 sterile<br />
compounders. Raised test plates containing trypticase soy agar with<br />
polysorbate and lecithin were used as the test media. Samples <strong>of</strong> gloved<br />
finger tips were taken under three scenarios. A group <strong>of</strong> 18 volunteers gave<br />
finger tip samples without having performed a scrub or hand hygiene. A<br />
second group <strong>of</strong> 16 after thorough hand scrubbing and a third group <strong>of</strong> 16<br />
under random conditions while performing regular aseptic compounding<br />
duties. The samples collected were incubated for 48 hours at 33-37°C.<br />
After 48 hours the plates were visually inspected for colony forming units.<br />
The Media fill testing was conducted during annual recertification.<br />
Results: After the incubation period it was noted that while some plates<br />
resulted in no growth, 62% <strong>of</strong> plates from all three groups were positive<br />
with CFU’s. However, all the volunteers were able to produce test media<br />
bags with no growth at time <strong>of</strong> planned testing in previous tests.<br />
Conclusion: Our results indicate a need for an additional evaluation to<br />
ensure a high standard <strong>of</strong> aseptic technique is maintained. Perhaps an<br />
evaluating system that allows for more frequent random auditing.<br />
Potential Cross-Reactivity between Prasugrel and Clopidogrel<br />
Joyce Chan 1 , Yvonne Kwan 1 , Sonia Mota 1 and Kori Leblanc 1,2<br />
1 University Health Network, Toronto, ON<br />
2 Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
Rationale: Prasugrel is a third-generation thienopyridine antiplatelet agent<br />
effective for the management <strong>of</strong> acute coronary syndrome in planned<br />
percutaneous coronary intervention (PCI). It became available to <strong>Canadian</strong><br />
patients in June 2010 and is attractive as an alternative in patients who<br />
have experienced adverse reactions to clopidogrel. Cross-reactivity between<br />
clopidogrel and other thienopyridine antiplatelet agents has been reported.<br />
Although cross-reactivity with prasugrel on allergy testing has been seen,<br />
reports <strong>of</strong> patient experience are extremely limited.<br />
Objective: To document the experience <strong>of</strong> patients with a history <strong>of</strong><br />
adverse skin reactions to clopidogrel who received prasugrel.<br />
Methods: Patients with a documented skin reaction to clopidogrel who<br />
were prescribed prasugrel were followed at 24h and post-discharge. Data<br />
was collected regarding tolerance as well as adherence to therapy.<br />
Results: Eight patients received prasugrel. All reported good medication<br />
adherence. One patient developed an itchy macular rash over the body and<br />
upper thighs within 24 hours <strong>of</strong> prasugrel exposure, requiring<br />
discontinuation and replacement with ticlopidine. A Naranjo Adverse Drug<br />
Reaction (ADR) probability score <strong>of</strong> 4 defined this as a “possible” ADR<br />
association. No other patients experienced skin reactions. Seven out <strong>of</strong> 8<br />
patients required financial assistance to afford prasugrel which was<br />
facilitated by the pharmacist pre-discharge. In all cases, the patients’<br />
community pharmacy did not have prasugrel readily available.<br />
See table on page 65.<br />
Conclusion: Our experience with 8 patients with previous skin reactions to<br />
clopidogrel suggests that there is at least a small risk <strong>of</strong> cross-reactivity with<br />
prasugrel. Further experience is needed to clearly define that risk.<br />
Determining patients’ financial coverage for prasugrel and facilitating its<br />
availability in community pharmacies post-discharge is essential to ensure<br />
that doses are not unintentionally missed.<br />
2 CSHP<br />
Targeting Excellence<br />
Total Parenteral Nutrition: Supporting Practice<br />
Through Standardized Solutions<br />
in Pharmacy Practice<br />
Rosemary Tanzini and Jill Garland, St. Michael’s <strong>Hospital</strong>,<br />
Toronto, ON<br />
Rationale: Commercial options for TPN base solutions no longer met<br />
evolving practice. Over the years, in order to meet protein requirements, the<br />
administration <strong>of</strong> TPN had become more complex, due to the additional<br />
administration <strong>of</strong> amino acids (Y-connected in a separate bag to the 2-in-1<br />
(dextrose/amino acid) bsolutions. This “modular” approach to supplying<br />
TPN complicates the prescribing process and increases the risk <strong>of</strong> pump<br />
programming errors and workload for the RN. Lack <strong>of</strong> standardization and<br />
a manual system <strong>of</strong> generating patient specific worksheets and labels for<br />
compounding purposes was also labor intensive for Pharmacy and<br />
increased the risk <strong>of</strong> errors. It also became apparent that to enable<br />
electronic compounding worksheets automated for calculations, it was<br />
necessary to provide the daily dextrose/amino acid requirement into 1 bag.<br />
Developing a “menu” <strong>of</strong> TPN base solutions which would meet the needs<br />
<strong>of</strong> the majority <strong>of</strong> patients and a comprehensive TPN order form has the<br />
potential to facilitate prescribing, production and administration.<br />
Description/Implementation: Project began with audit <strong>of</strong> current state to<br />
determine different permutations <strong>of</strong> amino acids/dextrose/lipids being<br />
prescribed, as well as wastage. Empiric calculations, for the purpose <strong>of</strong> dose<br />
banding, was done for patients ranging in weight, taking into account<br />
target calories and step-wise approach to advancing caloric intake in<br />
patients at risk <strong>of</strong> refeeding syndrome. Next, there was a review <strong>of</strong><br />
commercial and compounding options (with stability data), including a<br />
time-motion study. Input from Nutrition team was critical to coming up<br />
with a final list <strong>of</strong> solutions. Accordingly, an order set was developed which<br />
clearly outlined options and provide decision support. Electronic<br />
compounding worksheets and computer-generated labels were to follow.<br />
Evaluation: Over first 5 months post implementation, <strong>of</strong> 53 patients,<br />
standard solutions met the needs <strong>of</strong> all but 2 patients.<br />
Importance to Practice: Improved safety, quality, transparency, efficiency<br />
and communication.<br />
Determination <strong>of</strong> Tobramycin Pharmacokinetics in Burn<br />
Patients to Evaluate the Potential Utility <strong>of</strong> Once Daily<br />
Dosing in this Population<br />
Diane Vella, Sandra A.N. Walker, Scott E. Walker, Andrew Simor,<br />
Sunnybrook Health Sciences Centre, Toronto, ON<br />
Rationale: Once-daily aminoglycosides (ODAs) have been avoided in burn<br />
injury patients, due to their complicated pharmacokinetics. Theoretically,<br />
ODAs may have the same advantages in burn patients as in other<br />
populations.<br />
Objectives: The objectives were to determine the pharmacokinetics <strong>of</strong><br />
tobramycin in adult critically ill burn patients and evaluate a variety <strong>of</strong><br />
mg/kg dosing regimens to determine if ODA therapy was feasible.<br />
Methods: A retrospective study <strong>of</strong> 58 adult critically ill burn injury patients<br />
who received tobramycin and had at least one set <strong>of</strong> tobramycin<br />
steady-state levels was conducted. Pharmacokinetic parameters were<br />
calculated using first-order pharmacokinetic equations. CART analysis to<br />
identify whether a breakpoint for days post burn injury existed for<br />
tobramycin clearance (Cl) and Monte Carlo Simulations (MCS) <strong>of</strong> a range <strong>of</strong><br />
mg/kg dosing regimens, using mean pharmacokinetic parameters with<br />
respective standard deviations targeting a peak <strong>of</strong> ≥ 20mg/L and trough <<br />
2mg/L with at least 70% probability were run.<br />
Results: A CART identified breakpoint <strong>of</strong> days post burn for Cl <strong>of</strong> ≤45 days<br />
versus >45 days was determined. The geometric mean (95% CI)<br />
pharmacokinetic parameters in patients receiving tobramycin: ≤45 days<br />
post-burn were: ke 0.167h-1 (0.15-0.18), t1/2 4.1h (3.8-4.6), Vd 0.40L/kg<br />
(0.37-0.43), Cl 5.3L/h (4.9-5.8); and >45 days post-burn were: ke 0.13h-1<br />
(0.11-0.14), t1/2 5.4h (4.8-6.1), Vd 0.37L/kg (0.32-0.41), Cl 3.7L/h<br />
(3.2-4.1). MCS identified ODA regimens that attained the desired targets<br />
using higher mg/kg dosing known to be safe in other populations (≤45<br />
days post-burn: 10 to 13mg/kg; >45 days post burn: 8 to 10mg/kg).<br />
Conclusion: This study identified initial ODA tobramycin dosing<br />
recommendations that could attain desired targets in burn patients.
65<br />
Patient Age<br />
Gender<br />
Antiplatelet<br />
Therapy Indication ADR To Other Antiplatelets Follow up Tolerability<br />
1 60 Male PCI- DES Clopidogrel (urticaria) At 24 hours Prasugrel discontinued due<br />
to pruritic macular rash<br />
2 58 Female PCI- DES and BMS Clopidogrel (total body rash)<br />
Ticlopidine (rash and diarrhea)<br />
At 24 hours, then at 6 months and 7<br />
months post discharge<br />
3 63 Male PCI- DES Clopidogrel (localized rash)<br />
Ticlopidine (severe diarrhea<br />
resulting in weight loss)<br />
At 24 hours, then at 5 months post<br />
discharge<br />
4 63 Male PCI- BMS Clopidogrel (pruritic rash) At 24 hours, then at 1 week, 6 weeks<br />
and 4 months post discharge<br />
5 52 Female PCI- DES Acetylsalicylic acid (urticaria)<br />
Clopidogrel (pruritic maculopapular<br />
rash with positive rechallenge)<br />
6 59 Male PCI- DES Clopidogrel (pruritic rash - first to<br />
arms then to entire body)<br />
At 24 hours, then at 3 weeks and 4<br />
months post discharge<br />
At 24 hours, then at 3 weeks and 3<br />
months post discharge<br />
7 42 Male PCI- BMS Clopidogrel (total body rash) At 24 hours, then at 24 days post<br />
discharge<br />
8 73 Male PCI- DES Clopidogrel (non-itchy rash to arms,<br />
chest, abdomen, and upper back)<br />
DES: Drug Eluting Stent<br />
BMS: Bare Metal Stent<br />
At 1 week, 6 weeks, and 4 months<br />
post discharge (prasugrel was started<br />
the day after discharge)<br />
Well tolerated<br />
Well tolerated<br />
Well tolerated<br />
Well tolerated<br />
Well tolerated<br />
Well tolerated<br />
Wednesday, February 8<br />
Mercredi 8 février<br />
Diagnostic Reasoning by <strong>Hospital</strong> <strong>Pharmacists</strong>: An<br />
Assessment <strong>of</strong> Attitudes, Knowledge, Skills, and Learning<br />
Needs<br />
Kseniya Chernushkin, Peter Loewen, Joanne Jung, Amneet Aulakh, Jane de<br />
Lemos, Karen Dahri<br />
Background: Currently, hospital pharmacists participate in activities that<br />
can be seen as diagnostic in nature. Two reasoning approaches to making<br />
diagnoses have been previously described: non-analytic and analytic. Of the<br />
six analytic traditions “probabilistic” has been shown to improve diagnostic<br />
accuracy and reduce unnecessary testing. <strong>Pharmacists</strong>’ attitudes toward<br />
having a diagnostic role and their diagnostic knowledge and skills have<br />
never been studied.<br />
Objectives: To describe pharmacists’ attitudes toward the role <strong>of</strong> diagnosis<br />
in pharmacotherapeutic problem-solving; to characterize the extent <strong>of</strong><br />
pharmacists’ knowledge and skills related to diagnostic literacy; to identify<br />
knowledge/skill gaps and propose means <strong>of</strong> closing them.<br />
Method: <strong>Pharmacists</strong> <strong>of</strong> Lower Mainland Pharmacy Services with at least<br />
33% in direct patient care were studies in a prospective observational<br />
survey.<br />
Results: A sample <strong>of</strong> 260 pharmacists was identified. Results showed that<br />
89% <strong>of</strong> participants agreed with the proposed definition <strong>of</strong> diagnosis and<br />
92% agreed that it is important for pharmacists to have skills related to<br />
diagnosis. Respondents preferred analytic to non-analytic approach to<br />
diagnostic decision-making. Probabilistic tradition was not the preferred<br />
method in any <strong>of</strong> the three cases. In the evaluation <strong>of</strong> clinical scenarios that<br />
may require diagnostic skills 84% <strong>of</strong> respondents agreed that they should<br />
be involved in assessing such problems and 84% agreed that the case<br />
problems were diagnostic in nature. Participants’ knowledge <strong>of</strong> and ability<br />
to apply probabilistic diagnostic tools were highest with test sensitivity<br />
(61% <strong>of</strong> correct answers) and lower with test specificity (48% <strong>of</strong> correct<br />
answers) and likelihood ratios (39% <strong>of</strong> correct answers).<br />
Conclusions: The pharmacists studied strongly believe that diagnostic skills<br />
are important for them to solve drug-related problems, but demonstrated<br />
low levels <strong>of</strong> knowledge and ability to apply concepts <strong>of</strong> probabilistic<br />
diagnostic reasoning. Opportunities to expand pharmacists’ knowledge <strong>of</strong><br />
diagnostic reasoning exist, and our findings indicate that they would<br />
consider such development valuable.<br />
2 CSHP<br />
Targeting Excellence<br />
A Pilot Study on the Use <strong>of</strong> Warfarin Sliding Scales<br />
in Hemodialysis Patients<br />
in Pharmacy Practice<br />
Grace Leung, Emmelia Lau, and Henry Chen, York Region<br />
Chronic Kidney Disease <strong>Program</strong>, York Central <strong>Hospital</strong>, Richmond Hill, ON<br />
Background: Inter-prescriber variation is one <strong>of</strong> the causes <strong>of</strong> INR<br />
fluctuations in patients on warfarin. The use <strong>of</strong> a pharmacist-driven<br />
warfarin sliding scale (WSS) has the potential to decrease inter-prescriber<br />
variation to achieve more stable INRs within the therapeutic range. This<br />
pilot study investigates the use <strong>of</strong> WSS in hemodialysis patients at a<br />
multi-site dialysis program with weekly nephrologist rotations.<br />
Methods: In this self-controlled study, 27 hemodialysis patients stable on<br />
warfarin with a target INR <strong>of</strong> 2-3 were selected to have warfarin dosed by<br />
WSS. <strong>Pharmacists</strong> designed and adjusted the WSS based on previous INR<br />
results and warfarin doses with nephrologist approval. INR results 6 weeks<br />
before and 6 weeks after the implementation <strong>of</strong> WSS were compared. The<br />
primary outcome was percentage <strong>of</strong> time with a therapeutic, sub- (INR<br />
4) INR. Secondary outcomes include<br />
bleeding or clotting events. Statistical analysis was performed with<br />
Wilcoxon Paired Signed Rank Test. A p-value <strong>of</strong>
66<br />
The use <strong>of</strong> WSS resulted in significantly more therapeutic INRs versus<br />
traditional dosing. Supra-therapeutic INRs were also reduced significantly<br />
and sub-therapeutic INRs were trending lower.<br />
Discussion: <strong>Pharmacists</strong> provided consistency in warfarin dosing via WSS<br />
by avoiding drastic changes in warfarin doses as a result <strong>of</strong> over-reaction to<br />
sub- or supra-therapeutic INRs. Nursing and physician time was saved as<br />
nurses no longer need to call physicians about patients’ INRs.<br />
Conclusions: More therapeutic INRs are achieved by pharmacists’<br />
involvement in warfarin dosing via the WSS, which has positive impact for<br />
patients, nurses and nephrologists. WSS use can be considered for other<br />
hemodialysis patients stable on warfarin.<br />
Potentially Inappropriate Medication Use In Elderly Patients<br />
Presenting to the Emergency Department<br />
Vincent Teo 1 , Patrick Edwards 2 , Minh-Hien Le 1<br />
1 Sunnybrook Health Sciences Centre, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, ON<br />
Rationale: The Beers criteria is a list <strong>of</strong> medications considered<br />
inappropriate in elderly patients and it has been widely used to assess the<br />
safety <strong>of</strong> medications in ambulatory and nursing facilities. Currently, few<br />
studies have examined the prevalence <strong>of</strong> potential inappropriate medication<br />
use in elderly patients presenting to the emergency department (ED).<br />
Objective: To determine the incidence <strong>of</strong> potentially inappropriate<br />
medication use in elderly patients presenting to the ED at Sunnybrook<br />
Health Sciences Centre.<br />
Methods: Patients 65 years <strong>of</strong> age or older who were eligible for coverage<br />
by Ontario Drug Benefit (ODB) were included in the study. Patients were<br />
excluded if they had removed consent from the ODB drug pr<strong>of</strong>ile viewer<br />
(DPV). A current medication list for each patient was obtained from the<br />
DPV and demographic information for each patient was collected from the<br />
ED chart. Using the Beers criteria, medication lists were assessed for<br />
potentially inappropriate medications independent <strong>of</strong> a diagnosis or<br />
condition.<br />
Results: Data were collected for 60 consecutive days resulting in a total <strong>of</strong><br />
2940 patients who met the inclusion criteria. A total <strong>of</strong> 252 patients (8.6%<br />
<strong>of</strong> eligible ED visits) were found to be taking at least one potentially<br />
inappropriate medication when they presented to the ED. Nineteen patients<br />
were taking two potentially inappropriate medications and one patient was<br />
taking three. The three most frequently occurring potentially inappropriate<br />
medications were amiodarone (50 instances), followed by amitriptyline and<br />
nitr<strong>of</strong>urantoin (44 and 39 instances, respectively).<br />
Conclusion: Although this study did not determine whether the potentially<br />
inappropriate medications were the cause for a patient’s presentation to the<br />
ED, it highlights the need for increased awareness concerning safe<br />
medication prescribing practices in the elderly.<br />
Intentional Overdose <strong>of</strong> Enoxaparin<br />
Koren Lui 1,2 , Vincent Teo 3<br />
1 <strong>Canadian</strong> Forces Health Services Group<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
3 Sunnybrook Health Sciences Centre, Toronto, ON<br />
Rationale: Minimum toxic doses <strong>of</strong> low molecular weight heparins<br />
(LMWH) are not well established. Published cases <strong>of</strong> LMWH overdose have<br />
reported consumption <strong>of</strong> up to 30-times the therapeutic dose. Overdoses <strong>of</strong><br />
LMWH are rarely fatal and there are no clear guidelines pertaining to the<br />
management <strong>of</strong> acute LMWH overdoses. A case <strong>of</strong> acute intentional<br />
enoxaparin overdose is reported.<br />
Description <strong>of</strong> case: A 42 year-old male presented to the emergency room<br />
claiming he had injected himself with a 10-day supply <strong>of</strong> enoxaparin. He<br />
exhibited signs <strong>of</strong> intoxication and also complained <strong>of</strong> leg pain. The<br />
patient’s medical history included bilateral deep vein thrombosis, pulmonary<br />
embolism, hepatitis B, cholecystitis, ethanol abuse, and suspected<br />
tetrahydrocannabinol (THC) use. His medications prior to admission<br />
consisted <strong>of</strong> enoxaparin 100mg subcutaneous injection daily. On<br />
examination, it was noted that the patient lacked motor coordination.<br />
There were no signs <strong>of</strong> bleeding. His INR (1.23) and aPTT (97.1 s) were<br />
elevated. Poison control was contacted and suggested hourly monitoring <strong>of</strong><br />
aPTT, INR, and vital signs until the patient’s INR and aPTT normalized.<br />
Assessment <strong>of</strong> Causality: Temporal relationship suggests that the<br />
elevated INR and aPTT were the result <strong>of</strong> acute LMWH overdose.<br />
Evaluation <strong>of</strong> Literature: At time <strong>of</strong> writing, three published case reports<br />
<strong>of</strong> acute intentional LMWH overdose were found. In all cases, the patients<br />
did not experience bleeding. The aPTT’s were monitored until normalized. A<br />
published analysis <strong>of</strong> available case reports suggested that management by<br />
observation is appropriate.<br />
Importance <strong>of</strong> Case to Pharmacy Practitioners: There are available<br />
antidotes for the anticoagulant activity <strong>of</strong> LMWH. However, a more<br />
appropriate course <strong>of</strong> action may be to observe and monitor for signs <strong>of</strong><br />
bleeding until the aPTT is normalized. It is not necessary to treat with<br />
protamine or factor VIIa unless there is an active bleed in the setting <strong>of</strong><br />
LMWH overdose.<br />
2 CSHP<br />
Targeting Excellence<br />
Implementation <strong>of</strong> a Pharmacy Residency <strong>Program</strong><br />
in Primary Care<br />
in Pharmacy Practice<br />
Kwan, Debbie 1,2 ; Cameron, Karen 1,2 ; Marr, Patricia 1,2 ;<br />
Papoushek, Christine 1,2 ; Siu, Victoria 1,2<br />
1 University Health Network, Department <strong>of</strong> Pharmacy, Toronto, ON<br />
2 Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, ON<br />
Rationale: Integration <strong>of</strong> pharmacists into primary care has been identified<br />
as a priority for primary health care reform in Canada. However, little exists<br />
by way <strong>of</strong> formal training to prepare pharmacists for this role.<br />
Description: The Toronto Western <strong>Hospital</strong> Academic Family Health Team<br />
(FHT) serves approximately 14,000 patients in downtown west Toronto. In<br />
2008, the FHT launched Canada’s first Pharmacy Residency <strong>Program</strong> in<br />
Primary Care. The goal <strong>of</strong> the program is to provide practice-based,<br />
experiential learning to prepare residents to develop expertise and<br />
successful careers as pharmacists in primary care. The resident works with<br />
patients and in collaboration with members <strong>of</strong> the inter-pr<strong>of</strong>essional team.<br />
Required and ambulatory-based elective rotations are completed<br />
longitudinally. The resident is also required to complete a primary care<br />
focused research project, teach health pr<strong>of</strong>essional students and give<br />
academic presentations.<br />
Implementation: The application process for this residency program was<br />
linked to the same application process for hospital pharmacy residency<br />
programs in Ontario and was open to graduates <strong>of</strong> post-baccalaureate<br />
pharmacy programs. As such, the application and interview process<br />
commenced in the fall <strong>of</strong> 2007 and the first resident was accepted into the<br />
program starting July 2008.<br />
Evaluation: Two candidates have successfully completed the program. One<br />
graduate continues to work in the Toronto Western FHT. The number <strong>of</strong><br />
applications to the program has risen yearly indicating an ongoing demand<br />
for such a program.<br />
Importance: As the pharmacist’s role in primary care continues to grow,<br />
training for practitioners in this unique practice area will continue to be<br />
required. In addition, the implementation <strong>of</strong> new residency programs helps<br />
to fill the increasing demand for pharmacy residency training in Canada.<br />
Differences in Nova Scotian <strong>Pharmacists</strong>’ Experiences and<br />
Barriers to Providing the Emergency Contraceptive Pill Based<br />
on Primary Practice Site<br />
Anne Marie Whelan 1 , Donald Langille 2 , Eileen Hurst 1,2<br />
1 College <strong>of</strong> Pharmacy Dalhousie University, Halifax, Nova Scotia<br />
2 Department <strong>of</strong> Community Health & Epidemiology, Dalhousie University,<br />
Halifax, NS
67<br />
Rationale: There is little in the literature about differences between<br />
pharmacists whose primary place <strong>of</strong> practice is hospital versus community,<br />
pertaining to their experiences and barriers to providing the emergency<br />
contraceptive pill (ECP).<br />
Objectives: In 2005 ECP became more accessible to women in Canada<br />
when the regulatory status <strong>of</strong> levonorgestrel changed from Schedule I to<br />
Schedule II (available without a prescription in pharmacies following a<br />
consultation with a pharmacist). The objective <strong>of</strong> this study was to examine<br />
if there is a difference between primarily hospital based versus community<br />
based pharmacists’ experiences providing ECPs.<br />
Study Design and Methods: All pharmacists licensed to practice in Nova<br />
Scotia were invited to anonymously complete a 25 item paper<br />
questionnaire sent in the mail. The research was approved by Dalhousie<br />
University Health Sciences Ethics Board. Descriptive statistics were<br />
generated using SPSS.<br />
Results: The response rate was 53% (595/1123) with 415 pharmacists<br />
indicating that they had previously provided nonprescription ECP in<br />
community pharmacy and their primary place <strong>of</strong> practice was either<br />
hospital or community (13 hospital, 402 community). In comparing their<br />
experiences providing ECP, 38.7% <strong>of</strong> hospital pharmacists indicated they<br />
spent 11minutes or longer providing consults while only17.4% <strong>of</strong><br />
community pharmacists spent this much time. With regard to barriers to<br />
ECP provision, more hospital pharmacists than community pharmacists<br />
reported the following as barriers: 1) lack <strong>of</strong> privacy (61.6% vs. 46.0%), 2)<br />
lack <strong>of</strong> staffing (76.9% vs. 49.6%), and 3) length <strong>of</strong> consultation (46.2%<br />
vs. 28.0%).<br />
Conclusion: Results from this survey suggest that there may be some<br />
differences in the experiences between hospital and community based<br />
pharmacists providing ECP which should be explored further. Regardless <strong>of</strong><br />
primary practice site, results indicate that there are some barriers to ECP<br />
provision that should be addressed when considering providing this type <strong>of</strong><br />
consultation in a community pharmacy.<br />
Chemotherapy-Induced Nausea and Vomiting in Children<br />
Receiving Ifosfamide Plus Etoposide: Preliminary Results<br />
S.R. Lavoratore, C. Lui, M. Linseman, A.M. Maloney, P.C. Nathan, T. Taylor,<br />
E. Zelunka, L.L. Dupuis, The <strong>Hospital</strong> for Sick Children, Toronto, Ontario;<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy, University <strong>of</strong> Toronto, Toronto, ON<br />
Rationale: Adult evidence is commonly used to determine the<br />
emetogenicity <strong>of</strong> chemotherapeutic agents in children and informs the<br />
selection <strong>of</strong> nausea and vomiting prophylaxis. This approach may be<br />
inaccurate in children. Pediatric information regarding the emetogenic<br />
potential <strong>of</strong> ifosfamide plus etoposide, a combination which in adults is<br />
deemed to be moderately emetogenic, is lacking.<br />
Objective: To describe chemotherapy-induced nausea and vomiting (CINV)<br />
in the acute and delayed phases in children receiving ifosfamide<br />
1800mg/m2/day plus etoposide 100mg/m2/day for 5 days.<br />
Study Design and Methods: A diary was used by children to record<br />
episodes <strong>of</strong> vomiting and retching, nausea severity and antiemetic agents<br />
administered during acute and delayed phases. Patients themselves<br />
reported nausea severity a minimum <strong>of</strong> twice daily using a validated<br />
pediatric nausea assessment instrument. During the phase <strong>of</strong> interest,<br />
complete CINV control was defined as no emetic episodes (no vomiting or<br />
retching) and a maximum nausea score <strong>of</strong> 1 (none) out <strong>of</strong> 4. Patients<br />
received antiemetic agents as prescribed by the clinical team.<br />
Results: 10 patients (median age: 10.1yrs; range: 5-17yrs) participated. No<br />
patient was chemotherapy-naïve. Three had a history <strong>of</strong> motion sickness<br />
and 2 experienced anticipatory CINV. All patients received ondansetron<br />
during the acute phase; 9 also received dexamethasone. Four patients<br />
experienced complete acute phase CINV control. Six patients received<br />
ondansetron during the delayed phase while 2 also received<br />
dexamethasone. Six patients experienced complete CINV control during the<br />
delayed phase.<br />
Conclusions: Preliminary findings suggest that ifosfamide plus etoposide is<br />
highly emetogenic in children. Interventions aimed at improving CINV<br />
control in both the acute and delayed phases should be investigated. Study<br />
findings are limited by small sample size.<br />
Improving a Complex Pharmacist Scheduling Model at a<br />
Tertiary Care <strong>Hospital</strong><br />
Daniel Cortes, Kevin Curley, Jodie Leung, Jenny Lieu, St. Michael’s <strong>Hospital</strong>,<br />
Toronto, ON<br />
Rationale: Pharmacist scheduling has undergone increased strain and<br />
demand amidst recent medication system changes such as a computerized<br />
physician order entry system and expansion to 24-hour pharmacy<br />
operations. In this new environment, the complexities <strong>of</strong> scheduling for 25<br />
pharmacists necessitated the development <strong>of</strong> a new scheduling model that<br />
would decrease workload for schedulers, while meeting the needs <strong>of</strong><br />
individual pharmacists.<br />
Description: A literature review on MEDLINE and CINHAL provided<br />
guidance based on nursing scheduling models. A hybrid model <strong>of</strong><br />
self-scheduling and set-scheduling was identified, that allows for autonomy,<br />
flexibility, fairness and transparency for pharmacists and decreased<br />
workload for schedulers.<br />
An Excel-based scheduling tool was developed that allows pharmacists’<br />
availability based on cross-coverage responsibilities, vacations, teaching and<br />
pr<strong>of</strong>essional development responsibilities to be entered. This data can then<br />
be used to ensure all assigned shifts are covered, shifts are equally<br />
distributed and that each pharmacist meets their quota <strong>of</strong> required shifts.<br />
Evaluation: Post-implementation, pharmacists were surveyed to assess if<br />
the new model met their needs based on customizability, flexibility, fairness,<br />
transparency and effort required. A total <strong>of</strong> 23 pharmacists responded and<br />
the ratings for the new model met or exceeded ratings for the prior model<br />
in all categories. Overall, 21 <strong>of</strong> the pharmacists (92% <strong>of</strong> respondents)<br />
reported being somewhat or very satisfied with the new model. In contrast,<br />
70% <strong>of</strong> eligible respondents were dissatisfied with the previous scheduling<br />
model. Schedulers found a reduced administrative burden for filling vacant<br />
shifts and decreased time needed to create the schedule.<br />
Importance: The new scheduling model provides decreased workload for<br />
schedulers while meeting individual clinical pharmacists’ needs.<br />
Statin Treatment use in Diabetics with Breast Cancer: A<br />
Potential C-Reactive Protein Mediated Benefit<br />
A.C. Ceacareanu, C. C. Hong, J.J. Brennan III, M. Epstein, E. Koss<strong>of</strong>f, G.K.<br />
Nimako, K. Patel, A. Forrest; School <strong>of</strong> Pharmacy and Pharmaceutical<br />
Sciences, State University <strong>of</strong> New York, Buffalo, NY, NYS Center <strong>of</strong><br />
Excellence, Buffalo, NY, Roswell Park Cancer Institute, Buffalo, NY<br />
Background: Statin treatment has not yet been evaluated in relation to<br />
breast cancer (BC) prognosis in diabetes mellitus (DM) patients. Reported<br />
decreased survival following BC in women with metabolic syndrome, led us<br />
to investigate whether specific statin therapy may lead to improved BC<br />
survival. Reported associations between elevated C-reactive protein (CRP)<br />
levels at the time <strong>of</strong> diagnosis with worse cancer prognosis, and<br />
CRP-lowering properties <strong>of</strong> statin treatment in non-cancer patients, led us<br />
to investigate whether statin use is associated with lower CRP levels at the<br />
time <strong>of</strong> BC diagnosis and with improved BC outcomes.<br />
Methods: All DM patients newly diagnosed with BC between 2003 and<br />
2007 (Roswell Park Cancer Institute) were retrospectively reviewed (n =<br />
225). BC pathology, outcomes, existing comorbidities and drug therapy<br />
were documented. Follow up began at BC diagnosis and ended with first<br />
confirmed recurrence and/or death, or last date <strong>of</strong> follow-up. Hazard ratios<br />
(HR) and 95% confidence intervals (CI)s representing the association<br />
between statins, BC and a defined event were computed with Cox<br />
proportional hazards model. CRP plasma levels were determined by<br />
enzyme-linked immunosorbent assay in specimens donated at the time <strong>of</strong><br />
BC diagnosis. A total <strong>of</strong> 98 study patients, DM+BC, and their matched<br />
controls, BC only (n = 196) were analyzed.
68<br />
Results: After a median follow up <strong>of</strong> 30 months, patients receiving statins<br />
for cholesterol management were found to have better disease-free survival<br />
(HR 0.27, 95% CI: 0.10, 0.71, X2 = 7.31, p = 0.06), and lower overall<br />
mortality (HR 0.23, 95% CI: 0.08, 0.66, X2 = 7.80, p = 0.05) compared to<br />
patients not receiving any cholesterol management medication. CRP levels<br />
have ranged between 0.2 and 21 mg/L and clinically relevant levels (><br />
3mg/L) were noted in the study group.<br />
Conclusions: This study explored for the first time the association between<br />
statin therapy and BC prognosis in DM. We observed improved outcomes in<br />
statin-treated patients. While we currently analyze statin therapy in<br />
relationship with baseline CRP levels and BC prognosis, our existing findings<br />
suggest that statins have the potential to improve BC outcomes potentially<br />
through lowering overall inflammation.<br />
Poster Abstract Reviewers<br />
Réviseurs des présentations par affiches<br />
Sincere appreciation is extended to the abstract reviewers for PPC 2012.<br />
Educational Services Committee<br />
Roxane Carr<br />
Allison Callaghan<br />
Olavo Fernandes<br />
Alfred Gin<br />
Colette Raymond<br />
Kat Timberlake<br />
Erica Wang<br />
Research Committee<br />
David Blackburn<br />
Roxane Carr<br />
Dawn Dalen<br />
Scott Edwards<br />
Janice Irvine-Meek<br />
Salmaan Kanji<br />
Sheri Koshman<br />
Marc Perreault<br />
Kerry Wilbur<br />
Adjudicators<br />
Margaret Ackman<br />
Clarence Chant<br />
Peter Zed
69<br />
CSHP New Fellows<br />
Nouveaux associés de la SCPH<br />
CSHP Fellow status is conferred by the Board <strong>of</strong> Fellows upon CSHP<br />
members who have demonstrated noteworthy, sustained service<br />
and excellence in the practice <strong>of</strong> pharmacy in an organized<br />
healthcare setting.<br />
Board <strong>of</strong> Fellows 2011-2012<br />
Conseil des associés 2011-2012<br />
Chairperson<br />
Président:<br />
Jim Mann, FCSHP<br />
Chair-Elect:<br />
Président désigné<br />
Peter Loewen, FCSHP<br />
Past Chair<br />
Président sortant:<br />
Peter Zed, FCSHP<br />
Board Members<br />
Membres du Conseil:<br />
Shallen Letwin, FCSHP<br />
Glen Pearson, FCSHP<br />
Kris Wickman, FCSHP<br />
Rita Dhami (ex-<strong>of</strong>ficio<br />
member)<br />
Carole Chambers, BScPhm, MBA, FCSHP<br />
Carole Chambers holds both a Bachelor <strong>of</strong><br />
Science in Pharmacy and a Masters in Business<br />
Administration, and is the Director <strong>of</strong><br />
Pharmacy, Cancer Services with the Alberta<br />
Health Services in Alberta Canada.<br />
Carole has cross appointments in the two<br />
Universities in Alberta. Practicing for over 30<br />
years she has many peer reviewed<br />
publications. She is the immediate Past President <strong>of</strong> the<br />
International <strong>Society</strong> <strong>of</strong> Oncology Pharmacy and has recently<br />
served on an international advisory panel for the creation <strong>of</strong> a<br />
Medication Safety Self-Assessment tool in Oncology.<br />
Kevin W. Hall, BScPhm, PharmD, FCSHP<br />
Kevin obtained his B. Sc. Pharm. From<br />
Dalhousie University in 1976 and his Pharm.<br />
D. from the State University <strong>of</strong> New York at<br />
Buffalo in 1978. He subsequently joined the<br />
staff <strong>of</strong> the Winnipeg Health Sciences Centre<br />
as a critical care clinical pharmacist<br />
(1978-1986), and later held positions as<br />
Coordinator <strong>of</strong> Critical Care Pharmacy Services<br />
(1981 to 1986), Assistant Director <strong>of</strong> Pharmacy (1986-1991) and<br />
Director <strong>of</strong> Pharmacy (1991 to 1998). In 1998 he became the<br />
Director <strong>of</strong> Pharmacy for the Winnipeg Regional Health Authority<br />
(WRHA), with responsibility for managing pharmacy services at 8<br />
Winnipeg hospitals. In 2010, Kevin accepted a position as a Clinical<br />
Associate Pr<strong>of</strong>essor in the Faculty <strong>of</strong> Pharmacy and Pharmaceutical<br />
Sciences at the University <strong>of</strong> Alberta, where he teaches courses on<br />
pharmacy management and the <strong>Canadian</strong> health care system. He is<br />
currently involved in a research initiative that is studying the impact<br />
that the “mindset” <strong>of</strong> pharmacy practitioners and the “culture” <strong>of</strong><br />
the pharmacy pr<strong>of</strong>ession has on the adoption <strong>of</strong> new pharmacy<br />
practice models, such as those being pursued through the<br />
Blueprint for Pharmacy initiative.<br />
Kevin has been active in a number <strong>of</strong> pharmacy organizations and<br />
has served as President <strong>of</strong> both the <strong>Canadian</strong> <strong>Society</strong> <strong>of</strong> <strong>Hospital</strong><br />
<strong>Pharmacists</strong> and the <strong>Canadian</strong> <strong>Pharmacists</strong> Association. Other<br />
appointments that he has held include serving as Co-chair <strong>of</strong> the<br />
Steering Committee for “Moving Forward: Pharmacy Human<br />
Resources for the Future”, a $1.5 million national study <strong>of</strong><br />
pharmacy manpower issues; serving as a member <strong>of</strong> the Human<br />
Resources Sub-group for the development <strong>of</strong> the Blueprint for<br />
Pharmacy’s implementation plan; serving as a member <strong>of</strong> the<br />
National Advisory Committee for the development <strong>of</strong> the <strong>Canadian</strong><br />
Medication Incident Reporting System (CMIRPS); and serving two<br />
terms as Chair <strong>of</strong> the CSHP Research and Education Foundation.<br />
Since the early 1990s Kevin has been an Editor, and currently<br />
serves as one <strong>of</strong> the two Managing Editors, for the <strong>Hospital</strong><br />
Pharmacy in Canada Survey and Report, which biannually collects<br />
and publishes comprehensive data on the state <strong>of</strong> hospital<br />
pharmacy practice in Canada. He also currently serves as an<br />
Associate Editor for the <strong>Canadian</strong> Journal <strong>of</strong> <strong>Hospital</strong> Pharmacy.<br />
During his career to date Kevin has authored or co-authored 34<br />
peer-reviewed papers and has given over 60 invited presentations<br />
at national, regional and provincial conferences across Canada.<br />
Derek Jorgenson, BSP, PharmD, FCSHP<br />
Derek Jorgenson received his Bachelor <strong>of</strong><br />
Pharmacy Degree from the University <strong>of</strong><br />
Saskatchewan and his Doctor <strong>of</strong> Pharmacy<br />
Degree from the University <strong>of</strong> Toronto.<br />
His practice experience includes positions in<br />
Manitoba, Ontario and Saskatchewan where<br />
he has worked as a community pharmacist, a<br />
researcher for the Saskatchewan Health<br />
Quality Council and as a clinical pharmacist / practice leader in a<br />
large variety <strong>of</strong> hospital based ambulatory clinics.<br />
Derek was recently honoured for his service to the pr<strong>of</strong>ession by<br />
being awarded the <strong>Canadian</strong> Pharmacist <strong>of</strong> the Year in 2010 by the<br />
<strong>Canadian</strong> <strong>Pharmacists</strong> Association.<br />
Derek is currently an Assistant Pr<strong>of</strong>essor <strong>of</strong> Pharmacy at the<br />
University <strong>of</strong> Saskatchewan and a clinical pharmacist in an<br />
interpr<strong>of</strong>essional primary care clinic in Saskatoon.<br />
Zahra Kanji, BScPhm, ACPR, PharmD, FCSHP<br />
Zahra Kanji received her Bachelor <strong>of</strong> Science in<br />
Pharmacy degree at the University <strong>of</strong> British<br />
Columbia (UBC) in 1995, completed a hospital<br />
pharmacy residency at the Children’s and<br />
Women’s Health Centre <strong>of</strong> British Columbia in<br />
1996 and graduated with a Doctor <strong>of</strong><br />
Pharmacy (PharmD) degree from UBC in 1998.
70<br />
Since completing her PharmD, Zahra has been working as a Clinical<br />
Pharmacy Specialist in Critical Care at Lions Gate <strong>Hospital</strong> and has<br />
held the positions <strong>of</strong> Residency Coordinator and Education<br />
Coordinator. Zahra is also a Clinical Pr<strong>of</strong>essor with the Faculty <strong>of</strong><br />
Pharmaceutical Sciences at UBC.<br />
She has led and participated in numerous initiatives within the<br />
Intensive Care Unit (ICU) to improve patient care and patient safety<br />
<strong>of</strong> the critically ill population and has been involved in similar<br />
initiatives hospital wide. Zahra has also served on a number <strong>of</strong><br />
institutional and regional committees, most recently including the<br />
Antimicrobial Stewardship Working Group for Lower Mainland<br />
Pharmacy Services.<br />
Zahra has been actively involved in teaching, precepting, and<br />
mentoring undergraduate pharmacy students, pharmacy residents,<br />
PharmD students and clinical pharmacists. She has precepted over<br />
30 Pharmacy residents and PharmD students for clinical critical care<br />
rotations. Zahra has also been serving as a member the Regional<br />
Residency Advisory Council for a number <strong>of</strong> years.<br />
Zahra has been extensively involved in clinical research and<br />
published numerous articles in a variety <strong>of</strong> different areas. She<br />
received the National CSHP/Glaxo Smith Kline Award in<br />
Pharmaceutical Care in 2004. She has served on research review<br />
committees both institutionally and within the community.<br />
Zahra has been involved with CSHP in a number <strong>of</strong> roles, including<br />
leadership positions. She has just completed her term as President<br />
<strong>of</strong> CSHP BC Branch and is now serving as Past President. She held<br />
the position <strong>of</strong> Communications Officer with CSHP BC Branch for<br />
two years prior to this and was instrumental in making the Branch’s<br />
website an effective communication tool for members. She served<br />
on the <strong>Canadian</strong> <strong>Hospital</strong> Pharmacy Residency Board (CHPRB) for<br />
six years from 2005-2010 during which a major revision <strong>of</strong> the<br />
Accreditation Standards, by which pharmacy practice residency<br />
programs are accredited, were developed and implemented. In<br />
addition, Zahra has served as an appraiser <strong>of</strong> the CSHP awards<br />
programs both nationally and provincially for many years and is<br />
also a reviewer with <strong>Canadian</strong> Journal <strong>of</strong> <strong>Hospital</strong> Pharmacy.<br />
Zahra is honored to receive Fellow status and would like to thank<br />
her family, friends, and colleagues for their continued support. She<br />
would like to especially acknowledge her husband, Anil, for his<br />
support and their children, Noah and Jenna, for the immense joy<br />
that they bring to her life.<br />
Brenda G. Schuster, BSP, ACPR, PharmD, FCSHP<br />
Brenda Schuster received her Bachelor <strong>of</strong><br />
Science in Pharmacy degree at the University<br />
<strong>of</strong> Saskatchewan in 1986 and completed a<br />
hospital pharmacy residency at the Regina<br />
General <strong>Hospital</strong> in 1987. Following her<br />
residency she worked at St. Paul’s <strong>Hospital</strong> in<br />
Vancouver as a Clinical Pharmacist on the<br />
internal medicine ward until 1993. From<br />
1994-1996 she had a leadership position as Pharmaceutical Care<br />
Coordinator with the Saskatchewan College <strong>of</strong> <strong>Pharmacists</strong><br />
assisting pharmacists to implement pharmaceutical care into their<br />
practice. This included assisting with the several implementation <strong>of</strong><br />
several pilot projects, and the development and implementation <strong>of</strong><br />
the Trial Prescription <strong>Program</strong>.<br />
In 1996-98 she attended the University <strong>of</strong> Toronto where she<br />
completed her Doctor <strong>of</strong> Pharmacy Degree. From1998-2010 she<br />
provided pharmacy services on internal medicine and family<br />
practice with the Regina Qu’Appelle Health Region Pharmacy<br />
Department. During this time she worked as the Pharmacy<br />
Educator/Pharmacist Development Specialist mentoring many<br />
pharmacists, residents and students. She developed the Pharmacist<br />
Orientation <strong>Program</strong>, Pharmacist Educational Development<br />
<strong>Program</strong> and the Preceptor Development <strong>Program</strong>. She was also<br />
involved in the development <strong>of</strong> the Anemia Management<br />
Certification program and with updates/reviews <strong>of</strong> the residency<br />
program.<br />
Over the last 12 years her passion for promoting excellence in drug<br />
therapy is demonstrated with her with the RxFiles Academic<br />
Detailing <strong>Program</strong>. This work complements her most recent clinical<br />
practice in the Academic Family Medicine Unit which includes<br />
patient care responsibilities, teaching medical residents and<br />
students in the College <strong>of</strong> Medicine. Brenda has demonstrated<br />
leadership in her commitment to evidence based educational<br />
programming through her numerous provincial and national<br />
presentations to both pharmacists and physicians. She teaches with<br />
the College <strong>of</strong> Pharmacy and Nutrition, University <strong>of</strong> Saskatchewan<br />
in her specialty interest <strong>of</strong> gastroenterology.<br />
Throughout her career, Brenda has demonstrated significant<br />
involvement and leadership in CSHP and many other organizations.<br />
She has held presidential roles with both Saskatchewan College <strong>of</strong><br />
<strong>Pharmacists</strong> and the Saskatchewan branch <strong>of</strong> CSHP. Other activities<br />
include work for the CSHP National Educational Services<br />
Committee, Pharmacy Examining Board <strong>of</strong> Canada, advisory<br />
committees <strong>of</strong> NAPRA, CADTH, <strong>Canadian</strong> Patient Safety and the<br />
Pharmacy Human Resources Study. Local involvement included the<br />
RQHR Antimicrobial Utilization Committee and Saskatchewan<br />
Continuing Medication Education conference planning<br />
committees.<br />
Brenda strives for innovation in teaching and clinical practice. This<br />
has been recognized by the Saskatchewan Branch CSHP<br />
<strong>Pharmacists</strong> <strong>of</strong> the Year Award, & JL Summers Achievement Award.<br />
Her contribution as a teacher was acknowledged through the work<br />
<strong>of</strong> the RxFiles Academic Detailing <strong>Program</strong> being awarded the<br />
2010 Dr. Michael Krochak Award in recognition <strong>of</strong> significant<br />
contributions to Family Medicine in Saskatchewan and the program<br />
receiving Teacher <strong>of</strong> the Year Award from the College <strong>of</strong> Medicine<br />
Continuing Pr<strong>of</strong>essional Learning. She has received presentation<br />
awards from CCCP and the University <strong>of</strong> Toronto Doctor <strong>of</strong><br />
Pharmacy program. She has published on several topics, and was<br />
awarded a CSHP national award for her coauthoring <strong>of</strong> a “Critical<br />
Analysis <strong>of</strong> the Pharmaceutical Care Research Literature”.<br />
Brenda and her husband Rob enjoy travelling, biking, cooking and<br />
time at their cabin.
71<br />
Rosemary Zvonar, BScPhm, FCSHP<br />
Rosemary obtained her Bachelor <strong>of</strong> Science in<br />
Pharmacy degree from the University <strong>of</strong><br />
Toronto, and the following year completed the<br />
<strong>Hospital</strong> Pharmacy Residency <strong>Program</strong> at the<br />
Ottawa Civic <strong>Hospital</strong>. Rosemary remained on<br />
staff at The Ottawa <strong>Hospital</strong>, working in a<br />
number <strong>of</strong> different areas including Drug<br />
Information, and Internal Medicine. Prior to<br />
her current position, Rosemary was a clinical pharmacist in the<br />
Intensive Care Unit at the Civic Campus.<br />
In 2002, Rosemary was the successful candidate for the new<br />
corporate position <strong>of</strong> Antimicrobial Pharmacy Specialist at The<br />
Ottawa <strong>Hospital</strong>.<br />
She developed this new role, and was responsible for creating<br />
institutional guidelines, protocols, and tools in conjunction with the<br />
Division <strong>of</strong> Infectious Diseases to improve anti-infective use within<br />
the hospital. Rosemary implemented antibiotic use monitoring<br />
strategies, established two new institutional policies and<br />
procedures, and has been involved in various research projects. She<br />
also played a key role in launching a formal Antimicrobial<br />
Stewardship program at the hospital in 2011.<br />
Rosemary has devoted substantial effort in providing education in<br />
antimicrobial use and infectious disease. Within the hospital,<br />
Rosemary precepts all five pharmacy residents each year for their<br />
Infectious Diseases rotation and is a frequent preceptor for<br />
residents’ research projects. She regularly presents to the<br />
pharmacists and teaches medical and surgical housestaff. In<br />
addition, Rosemary lectures for the School <strong>of</strong> Nursing and Faculty<br />
<strong>of</strong> Medicine at the University <strong>of</strong> Ottawa. Over the years, Rosemary<br />
has been invited to speak at various conferences and courses, with<br />
over 30 oral presentations given locally and nationally.<br />
Rosemary has been actively involved in CSHP, including as a<br />
longstanding member <strong>of</strong> the National Awards Committee, and<br />
previous Education Coordinator for the ID-PSN. Additional activities<br />
include being a regular reviewer in the area <strong>of</strong> Infectious Disease<br />
for a number <strong>of</strong> pharmacy journals, and participating in various<br />
hospital committees.
72<br />
Faculty<br />
Conférenciers<br />
CSHP would like to recognize the<br />
generous contributions <strong>of</strong> the<br />
following speakers:<br />
La SCPH désire souligner les<br />
généreuses contributions des<br />
conférenciers suivants:<br />
Shirin Abadi<br />
BScPhm, ACPR, PharmD<br />
BC Cancer Agency<br />
Vancouver, BC<br />
Anna Banerji<br />
MD, MPH, FRCPC, DTM&H<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Chaim Bell<br />
MD, PhD, FRCPC<br />
Li Ka Shing Knowledge Institute<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Roberta Bondar<br />
OCO Ont, MD, PhD, FRCP, FRSC<br />
Consultant, Physician, Scientist,<br />
Author, Photographer, Educator<br />
Carolyn Bornstein<br />
BScPhm, FCSHP<br />
CSHP 2015<br />
Newmarket, ON<br />
Cynthia Brocklebank<br />
BScPhm, PharmD, ACPR<br />
Alberta Health Services<br />
Calgary, AB<br />
Jean-François Bussières<br />
BPharm, MSc, MBA, FCSHP<br />
CHU Sainte-Justine<br />
Montréal, QC<br />
Judy Chong - Moderator<br />
BScPhm, RPh<br />
Royal Victoria <strong>Hospital</strong> <strong>of</strong> Barrie<br />
Barrie, ON<br />
Marlys Christianson<br />
MD, PhD<br />
Rotman School <strong>of</strong> Management<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<br />
Naomi Dore<br />
BScH, MSc, BScPhm<br />
Hamilton Health Sciences Centre<br />
Hamilton, ON<br />
Anar Dossa<br />
BScPhm, PharmD, CDE<br />
Vancouver General <strong>Hospital</strong><br />
Vancouver, BC<br />
Linda Dresser<br />
BScPhm, PharmD, FCSHP<br />
University Health Network<br />
Toronto General <strong>Hospital</strong><br />
Toronto, ON<br />
Lee Dupuis<br />
RPh, ACPR, MScPhm, FCSHP<br />
The <strong>Hospital</strong> for Sick Children<br />
Toronto, ON<br />
Barbara Farrell<br />
BScPhm, PharmD, FCSHP<br />
Bruyère Continuing Care<br />
Ottawa, ON<br />
Olavo Fernandes<br />
BScPhm, PharmD, FCSHP<br />
Leslie Dan Faculty <strong>of</strong> Pharmacy<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<br />
Joanne Garrah<br />
Health Canada<br />
Ottawa, ON<br />
Julie Greenall<br />
RPh, BScPhm, MHSc<br />
ISMP Canada<br />
Toronto, ON<br />
Kevin Hall<br />
BScPhm, PharmD, FCSHP<br />
Faculty <strong>of</strong> Pharmacy Pharmaceutical<br />
Sciences, University <strong>of</strong> Alberta<br />
Edmonton, AB<br />
Anne Hiltz<br />
BScPhm, ACPR, RPh<br />
Capital District Health Authority<br />
Halifax, NS<br />
Derek Jorgenson<br />
BSP, PharmD<br />
University <strong>of</strong> Saskatchewan<br />
Saskatoon, SK<br />
David Juurlink<br />
BScPhm, MD, PhD, FRCPC<br />
Sunnybrook Health Sciences Centre<br />
Institute for Clinical Evaluative<br />
Sciences<br />
Toronto, ON<br />
Salmaan Kanji<br />
BScPhm, PharmD<br />
The Ottawa <strong>Hospital</strong><br />
General Campus<br />
Ottawa, ON<br />
Debra Kent<br />
PharmD, DABAT<br />
CSPI andBC Centre for Disease<br />
Control, Provincial Health Services<br />
Authority<br />
BC Drug & Poison Information<br />
Centre<br />
Vancouver, BC<br />
Heather Kertland<br />
BScPhm, PharmD<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Matt Koehler<br />
BScPhm<br />
Shoppers Drug Mart<br />
Thunder Bay, ON<br />
Debbie Kwan<br />
BScPhm, MSc, FCSHP<br />
Toronto Western <strong>Hospital</strong><br />
Family Health Team<br />
Toronto, ON<br />
Tim Lau<br />
PharmD, FCSHP<br />
Vancouver General <strong>Hospital</strong><br />
Vancouver Coastal Health<br />
Vancouver, BC<br />
Jaclyn Litynsky<br />
BCPS, PharmD<br />
Toronto East General <strong>Hospital</strong><br />
Toronto, ON<br />
Peter Loewen<br />
BScPhm, ACPR, PharmD, RPh,<br />
FCSHP<br />
Provincial Health Services Authority<br />
University <strong>of</strong> British Columbia<br />
Vancouver, BC<br />
Anke-Hilse Maitland-van der Zee<br />
PharmD, PhD<br />
Utrecht University<br />
Utrecht, The Netherlands<br />
Ryan McGuire<br />
BScPhm<br />
University <strong>of</strong> Toronto<br />
Toronto, ON<br />
Emily Muir<br />
BScPhm, ACPR<br />
Horizon Health Network<br />
Saint John, NB<br />
Janice Munroe - Moderator<br />
BScPhm<br />
Fraser Health Pharmacy Services<br />
Regional Pharmacy Administration<br />
Langley, BC<br />
Tania Mysak<br />
BSP, PharmD<br />
Alberta Health Services<br />
Edmonton, AB<br />
Glen Pearson<br />
BScPhm, PharmD, FCSHP<br />
Division <strong>of</strong> Cardiology, University <strong>of</strong><br />
Alberta<br />
Manzankowski Alberta Heart<br />
Institute<br />
Edmonton, AB<br />
Jennifer Pickering<br />
BScPhm, ACPR<br />
Hamilton Health Sciences Centre<br />
Hamilton, ON<br />
Monique Pitre<br />
BScPhm, FCSHP<br />
University Health Network<br />
Toronto, ON<br />
Kevin Pottie<br />
MD, CCFP, MCISc, FCFP<br />
University <strong>of</strong> Ottawa<br />
Elisabeth Bruyère Research Institute<br />
Pegi Rappaport<br />
BSc, MSc<br />
Toronto East General <strong>Hospital</strong><br />
Toronto, ON<br />
Vijay Rasaiah<br />
RPh, BScPhm, MSc, BSc (Hon)<br />
The <strong>Hospital</strong> for Sick Children<br />
Toronto, ON<br />
Carlos Rojas-Fernandez<br />
BScPhm, PharmD<br />
Schlegel-UW Research Institute on<br />
Ageing & School <strong>of</strong> Pharmacy,<br />
University <strong>of</strong> Waterloo<br />
Kitchener, ON<br />
Diana Sarakbi<br />
Accreditation Canada<br />
Ottawa, ON<br />
Lisa Sever<br />
BScPhm<br />
York Central <strong>Hospital</strong><br />
Richmond Hill, ON<br />
Stephen Shalansky<br />
BScPhm, PharmD, ACPR, FCSHP<br />
Providence Healthcare<br />
Vancouver, BC<br />
Richard Slavik<br />
PharmD, FCSHP<br />
Pr<strong>of</strong>essional Practice Interior<br />
Health, University <strong>of</strong> British<br />
Columbia<br />
Kelowna, BC<br />
Miranda So<br />
BSc, BScPhm, PharmD<br />
University Health Network<br />
Toronto, ON<br />
Amy Sood<br />
BScPhm, PharmD<br />
Manitoba Renal <strong>Program</strong>/St.<br />
Boniface <strong>Hospital</strong><br />
Winnipeg, MB<br />
Sean Spina<br />
BScPhm, ACPR, PharmD<br />
Vancouver Island Health Authority<br />
Victoria, BC<br />
James E. Tisdale<br />
BScPhm, PharmD, BCPS, FCCP,<br />
FAPhA, FAHA<br />
College <strong>of</strong> Pharmacy, Purdue<br />
University<br />
Indiana University<br />
Indianapolis, IN<br />
Ross Tsuyuki<br />
PharmD, MSc, FCSHP, FACC<br />
University <strong>of</strong> Alberta<br />
Faculty <strong>of</strong> Medicine and Dentistry<br />
Edmonton, AB<br />
Régis Vaillancourt<br />
OMM, OD, CD, BPharm, PharmD,<br />
FCSHP<br />
Children’s <strong>Hospital</strong> <strong>of</strong> Eastern<br />
Ontario<br />
Ottawa, ON<br />
Kelly Walker<br />
BSP, ACPR<br />
Toronto East General <strong>Hospital</strong><br />
Toronto, ON<br />
Sandra Walker<br />
BSc, BScPhm, PharmD, ACPR, FCSHP<br />
Sunnybrook Health Sciences Centre<br />
Toronto, ON<br />
Janice Wells<br />
PharmD<br />
St. Michael’s <strong>Hospital</strong><br />
Toronto, ON<br />
Arthur Whetstone<br />
EdD, MA, BEd, BA (Hon), RPN<br />
<strong>Canadian</strong> Council on Continuing<br />
Education in Pharmacy<br />
Saskatoon, SK<br />
David Williamson<br />
MSc, BCPS<br />
Hôpital du Sacré-Coeur du<br />
Montréal<br />
Montréal, QC<br />
Rosemary Zvonar<br />
BScPhm, FCSHP, ACPR<br />
The Ottawa <strong>Hospital</strong><br />
Ottawa, ON
73<br />
The Sheraton Centre Toronto Hotel<br />
All booths are 8’ x 10’, except where noted.<br />
Floor plan subject to facility approval.<br />
79 equivalent 8’ x 10’ booths.<br />
■ RESERVED<br />
Exhibitor List (at time <strong>of</strong> printing)<br />
Liste des exposants (au moment de l’impression)<br />
Company Booth #<br />
Compagnie Kiosque #<br />
Abbott Labs ..............................................................................200<br />
Alveda Pharma..........................................................................411<br />
Apotex Inc. ...............................................................................209<br />
Amerisourcebergen Canada ......................................................402<br />
AstraZeneca Canada Inc. ..........................................................406<br />
B Braun Medical........................................................................107<br />
Baxa Corporation ......................................................................409<br />
Bayer Inc. ..........................................................................103/105<br />
Bio-K International ...................................................................500<br />
Blueprint for Pharmacy..............................................................708<br />
Boehringer-Ingelheim Canada Ltd. ....................................106/108<br />
<strong>Canadian</strong> Institute for Health Information .................................505<br />
<strong>Canadian</strong> Patient Safety Institute...............................................700<br />
<strong>Canadian</strong> Pharmaceutical Distribution Network .........................207<br />
<strong>Canadian</strong> <strong>Pharmacists</strong> Association......................................508/510<br />
Cardinal Health Canada .....................................................501/503<br />
Caverly Consulting Group .........................................................206<br />
Department <strong>of</strong> National Defence...............................................400<br />
Eli Lilly Canada Inc. ...................................................................102<br />
Fresenius Kabi ....................................................................208/210<br />
Galenova...................................................................................311<br />
Health Canada - Canada Vigilance ............................................506<br />
Healthmark Ltd. .................................................................308/310<br />
Company Booth #<br />
Compagnie Kiosque #<br />
Hospira Healthcare ......................................................305/307/309<br />
Lexicomp...................................................................................202<br />
McKesson Canada ....................................................................407<br />
Merck Canada Inc. ...................................................................203<br />
Mylan Pharmaceuticals Inc. .......................................................100<br />
North West Telepharmacy..........................................................104<br />
Northern Health ........................................................................504<br />
Omega Laboratories Limited......................................................306<br />
PCCA Canada Corp. .................................................................410<br />
Pendopharm a Division <strong>of</strong> Pharmascience Inc. ...........................111<br />
PEPID LLC..................................................................................511<br />
Pharmacy Examining Board .......................................................408<br />
Pfizer Canada Inc. ........................................112/114/213/215/509<br />
Pharmascience ..........................................................................109<br />
Pharmaceutical Partners <strong>of</strong> Canada<br />
A Company <strong>of</strong> the Fresenius Kabi Group ............................301/303<br />
Purdue Pharma..........................................................................502<br />
RxFiles .......................................................................................101<br />
Sandoz Canada Inc. ............................................300/302/401/403<br />
San<strong>of</strong>i-Aventis Canada ..............................................................204<br />
SDM Specialty Health Network..................................................205<br />
SteriMax Inc. .............................................................................404<br />
Teva Canada..............................................................................201
SES 2012<br />
A U G U S T 11 - 1 4<br />
on the<br />
la<br />
SES Sbeach<br />
SÉÉ plage<br />
à<br />
o<br />
August ust 11-14 Charlottetown 11-14 août<br />
ÉÉ<br />
h 2012
Connecting pharmacists across Canada<br />
PHARMACY SPECIALTY NETWORKS<br />
NETWORK<br />
communicate<br />
CSHP has more<br />
than 20 PSNs to<br />
join! Check out<br />
www.cshp.ca for<br />
a complete list.<br />
Join the Pharmacy Specialty Network! CSHP membership will connect<br />
you with what’s important – people and information.<br />
PSNs:<br />
• connect members with others who share a passion for a particular facet<br />
<strong>of</strong> pharmacy practice<br />
• facilitate the quick exchange <strong>of</strong> ideas, developments, methods,<br />
experiences, knowledge to improve practice<br />
• support collaboration on projects, research, and educational programs to<br />
address the needs <strong>of</strong> the members <strong>of</strong> a PSN<br />
• provide additional opportunities for members to serve as both opinion<br />
leaders and key resources for CSHP Council on pr<strong>of</strong>essional specialty<br />
issues, including development <strong>of</strong> relevant position statements, guidelines,<br />
and information papers<br />
Participation in PSNs is free <strong>of</strong> charge to CSHP members<br />
Visit MY.CSHP.ca and sign up today!
Join Us!<br />
CSHP M EMBERSHIP HAS M ANY ADVANTAGES<br />
MEMBER BENEFITS<br />
As a member <strong>of</strong> CSHP, you connect<br />
not only to a strong pr<strong>of</strong>essional<br />
organization, but also to a dynamic<br />
network <strong>of</strong> over 3,100 hospital<br />
pharmacy colleagues. When you join CSHP,<br />
you instill fresh energy into a 65-year-strong<br />
association for expanding and improving<br />
programs and services.<br />
● Advocacy<br />
● Awards <strong>Program</strong><br />
● <strong>Canadian</strong> <strong>Hospital</strong> Pharmacy Residency Board<br />
● Continuing Education<br />
● CSHP 2015<br />
● Partner Discount <strong>Program</strong>s<br />
● Fellows <strong>Program</strong><br />
● Pharmacy Specialty Networks (PSNs)<br />
● Products and Services<br />
● Pr<strong>of</strong>essional Liability/Malpractice Insurance<br />
● CSHP Research and Education Foundation<br />
For more information about CSHP member benefits, please contact:<br />
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T: 613-736-9733, ext. 222 | F: 613-736-5660 | E: membershipservices@cshp.ca | www.cshp.ca
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